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treatment_adrenaline [2025/04/16 02:36] – jkohtstreatment_adrenaline [2025/04/29 02:21] (current) – [7. References] jkohts
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 ===== - Overview ===== ===== - Overview =====
-Adrenaline is an endogenous catecholamine, and is used pharmacologically as a sympathomimetic agent. It acts on the β and α adrenoreceptors with dose-dependent selectivity. It is used to treat symptomatic bradycardia (e.g. in β-blocker toxicity), anaphylaxis, +Adrenaline is an endogenous catecholamine, and is used pharmacologically as a sympathomimetic agent. It acts on the β and α adrenoreceptors with dose-dependent selectivity. It is used to treat anaphylaxis, symptomatic bradycardia (e.g. in β-blocker toxicity), and cardiac arrest.
  
 ===== - Toxicologic Indications & Dosing ===== ===== - Toxicologic Indications & Dosing =====
  
-==== - Indication 1 ====+==== - Anaphylaxis ====
  
-  * Also see: [[relevant pages]].+  * Also see: [[anaphylaxis]].
   * **Adult:**   * **Adult:**
-    * 💊 **DrugName Dose Route**, Frequency.+    * 💊 **Adrenaline 0.5 mg IM** (0.5 mL of 1:1,000), q5min PRN.
   * **Child:**   * **Child:**
-    * 💊👶 **DrugName Dose Route**, Frequency. +    * 💊👶 **Adrenaline 10 micrograms/kg IM** (0.01 mL/kg of 1:1,000), q5min PRN. Min dose 0.1 mL, max dose 0.5 mL. 
-  * Other notes if applicable.+  * IV adrenaline may be given only by experienced specialists in an appropriate setting, as the dose requirements are different.
  
  
-==== - Indication 2 ==== +==== - Bradycardia ==== 
-  * Also see: [[relevant pages]].+  * Also see: [[:beta_blocker_toxicity|Beta Blocker Toxicity]].
   * **Adult:**   * **Adult:**
-    * 💊 **DrugName Dose Route**, Frequency. +    * 💊 **Adrenaline 5-20 microgram IV**, q3min PRN. 
-    * 💊 **DrugName Dose Route**, Frequency.+    * 💊 **Adrenaline 2-10 microgram/min IV infusion**, titrate to response.
   * **Child:**   * **Child:**
-    * 💊👶 **DrugName Dose Route**, Frequency. +    * 💊👶 **Adrenaline 10 microgram/kg IV** (0.1 mL/kg of 1:10,000), q3min PRN. 
-    * 💊👶 **DrugName Dose Route**, Frequency. +    * 💊👶 **Adrenaline 0.1-1.5 microgram/kg/min IV infusion**, titrate to response. 
-  * Other notes if applicable.+==== - Cardiac Arrest ====
  
- +  * Also see: [[cardiac arrest]]. 
-==== - Indication 3 ==== +  * **Adult:** 💊 **Adrenaline 1 mg IV**, every 2 cycles. 
- +  * **Child:** 💊👶 **Adrenaline 10 microgram/kg IV**, every 2 cycles.
-  * Also see: [[relevant pages]]. +
-  * **Adult:** 💊 **DrugName Dose Route**, Frequency. +
-  * **Child:** 💊👶 **DrugName Dose Route**, Frequency. +
-  * Other notes if applicable.+
  
  
 ===== - Cautions & Contraindications ===== ===== - Cautions & Contraindications =====
 +There are no absolute contraindications to the use of adrenaline in a life-threatening situation. 
 +  * Overtreatment may result in hypertension and tachyarrhythmias. 
 +  * ↑ serum lactate. 
 +  * Myocardial ischemia.
  
 ===== - Special Populations ===== ===== - Special Populations =====
-**Pregnancy rating:** +**Pregnancy rating:** A (AU/NZ)
- +
-**Lactation:** +
- +
-**Renal impairment:** +
- +
-**Hepatic impairment:**+
  
 +**Lactation:** Excreted in breast milk, but potential effects on breastfed infant is unknown.
  
 ===== - Adverse Effects ===== ===== - Adverse Effects =====
-  * Description of important/serious adverse effects, e.g. +  * **CVS:** hypertension, tachyarrhythmias, myocardial ischemia. 
-  * Serotonin syndrome:  +  * **CNS:** anxiety, tremor. 
-  * Systems e.g.  +  * **Skin:** tissue necrosis if extravasates. 
-  * **GI:** +  * **Metabolic:** hyperglycemia, hyperlactatemia.
-  * **Resp:** +
-  * **MSK:** local phlebitis +
-  * Frequency e.g. +
-  * **Common:** +
  
 ===== - Pharmacology ===== ===== - Pharmacology =====
  
 ==== - Pharmacodynamics ==== ==== - Pharmacodynamics ====
-**Mechanism of action:**+**Mechanism of action:** Dose-dependent adrenoceptor activity, with β-agonist effects predominate at low doses, and added α-agonist effects at higher doses.
  
 ==== - Pharmacokinetics ==== ==== - Pharmacokinetics ====
  
 **Absorption:** **Absorption:**
-  * Oral bioavailability: +  * Oral bioavailability: 0%.
-  * GI tract absorption: +
-  * First pass metabolism:+
  
 **Distribution:** **Distribution:**
-  * Vd:+  * Vd: 0.1-0.2 L/kg.
   * Lipid solubility:   * Lipid solubility:
-    * Crosses/Does not cross BBB +    * Does not cross BBB 
-    * Crosses/Does not cross placenta +    * Crosses placenta 
-    * Excreted/Not excreted in breast milk +    * Excreted in breast milk 
-  * Protein binding: +  * Protein binding: 50%
-  * Tmax:+
  
-**Metabolism:**+ 
 +**Metabolism:** Rapidly metabolized by COMT and MAO into metanephrine and 3,4-dihydroxymandelic acid, then ultimately into vanillylmandelic acid.
  
 **Excretion:** **Excretion:**
-  * Elimination t½: +  * Elimination t½: 2-3 mins. 
-  * Hepatic clearance: +  * Renal clearance: Renally excreted, mostly as inactive metabolites.
-  * Renal clearance:+
  
 ==== - Pharmaceutics ==== ==== - Pharmaceutics ====
 **Formulation:** **Formulation:**
- +  * Ampoules containing 1000 microgram/1 mL or 1000 microgram/10 mL. 
 +  * Autoinjector with varying doses (commonly 0.15 mg, 0.3 mg, 0.5 mg). Various brands exist, e.g. EpiPen, Emerade, Auvi-Q.
 ===== - References ===== ===== - References =====
-Useful general references:+Further Reading:
  
 ~~REFNOTES~~ ~~REFNOTES~~