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Indication & Dosage Anaphylactic shock

Adult: 0.5 mg (5 mL of a 1:10,000 solution) given at a slow rate of 100 mcg/minute, stopping

when a response is achieved.

Child: 10 mcg/kg. If autoinjectors are used, doses are based on body wt: 15-30 kg: 150 mcg and

>30 kg: 300 mcg.

Intramuscular

Anaphylactic shockAdult: As 1:1,000 solution: 500 mcg (0.5 ml), repeat every 5 minutes as needed until

improvement occurs. For emergency self-admin (e.g. via autoinjector): A dose of 300 mcg (0.3 ml)

may be used.

Child: Dose depends on age and weight. Usual dose: 10 mcg/kg.

Overdosage Overdosage intravascular inj of epinephrine may cause cerebral haemorrhage due to a sharp rise

in BP. Fatalities may also result from pulmonary oedema because of peripheral vascular

constriction together with cardiac stimulation.

Contraindications Preexisting hypertension; occlusive vascular disease; angle-closure glaucoma (eye drops);

hypersensitivity; cardiac arrhythmias or tachycardia. When used in addition to local anaesthetics:

Procedures involving digits, ears, nose, penis or scrotum.

Special Precautions CV diseases; hyperthyroidism; DM; Parkinson's disease; elderly; pregnancy, lactation.

Adverse DrugReactions

CNS effects; GI disturbances; epigastric pain; CV disorders; difficulty in micturition with urinaryretention; dyspnoea; hyperglycaemia; sweating; hypersalivation; weakness, tremors; coldness of

extremities; hypokalaemia. Gangrene, tissue necrosis and sloughing (extravasation) when used in

addition to local anaesthetics. Eye drops: Severe smarting, blurred vision, photophobia; naso-

lachrymal ducts obstruction. Oedema, hyperaemia and inflammation of the eyes with repeated

administration.

Drug Interactions Halogenated inhalation anaesthetics; - or -blocking agents; methyldopa,guanethidine;drugs

with vasoconstrictor and pressor effects; antihypertensives; adrenergic neuron blockers;

potassium-depleting drugs; cardiac glycosides; ephedra, yohimbe. TCAs may induce hypertension

and arrhythmia.

Potentially Fatal: Halogenated inhalation anaesthetics; - or -blocking agents;

methyldopa,guanethidine;drugs with vasoconstrictor and pressor effects; antihypertensives;

adrenergic neuron blockers; potassium-depleting drugs; cardiac glycosides; ephedra, yohimbe.

TCAs may induce hypertension and arrhythmia.

Click to view more epinephrine Drug Interactions

Lab Interference Increase in bilirubin, catecholamines, glucose, uric acid.

Pregnancy Category

(US FDA)

Category C: Either studies in animals have revealed adverse effects on the foetus (teratogenic or

embryocidal or other) and there are no controlled studies in women or studies in women and

animals are not available. Drugs should be given only if the potential benefit justifies the potential

risk to the foetus.

Storage Inhalation: Store at 25C. Intramuscular: Store at 25C. Intravenous: Store at

25C. Ophthalmic: Store at 25C. Parenteral: Store at 25C.

Mechanism of Action Epinephrine, an active principle of the adrenal medulla, is a direct-acting sympathomimetic. It

stimulates - and -adrenergic receptors resulting in relaxation of smooth muscle of the bronchial

tree, cardiac stimulation and dilation of skeletal muscle vasculature. It is frequently added to local

anaesthetics to retard diffusion and limit absorption, to prolong the duration of effect and to

lessen the danger of toxicity.

Onset: SC: approx 5-10 min; inhalation: approx 1 min; conjunctival instillation: IOP declines

approx 1 hr.

Duration: Ocular effect: 12-24 hrs.

Pharmacokinetics Absorbtion : Well absorbed in IM or SC administration

Distribution : Does not cross the blood-brain barrier, but does cross the placenta and is

distributed into milk.

Metabolism : Mainly in liverExcretion : Via urine

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Indication & Dosage

Intravenous

Acute hypotensive states

Adult: Initially, 8-12 mcg/minute, up to 8-30 mcg/minute in refractoryshock.Infuse using a

solution of 4 mcg/ml in glucose 5%, or sodium chloride 0.9% and glucose 5% at a rate of 2-3

ml/minute. Adjust according to BP response. Average maintenance dose: 0.5-1 ml/minute (2-4

mcg/minute). Infuse via a central venous catheter or into a large vein.

Child: Administer at a rate of 2 mcg/minute. Alternatively, 2 mcg/m2/minute. Adjust rate

according to BP response and perfusion.

Elderly: Initial dose should be at low end of dose range.

Injection

Upper gastrointestinalhaemorrhage

Adult: Intraperitoneal admin: 8 mg in 250 ml of 0.9% sodium chloride inj. Alternatively, instill 8

mg in 100 ml of 0.9% sodium chloride solution through a nasogastric tube every hr for 68 hr,

then every 2 hr for 46 hr. Withdraw drug gradually.

Reconstitution: Dilute with 5% glucose inj, with or without sodium chloride; dilution with sodium

chloride inj alone is not recommended.

Incompatibility: Incompatible with alkali and oxidising agents, barbiturates, chlorphenamine,chlorothiazide, nitrofurantoin, novobiocin, phenytoin, sodium bicarbonate, sodium iodide,

streptomycin, insulin.

Overdosage Symptoms: Hypertension, sweating, cerebral haemorrhage, convulsions.

Contraindications Hypertension. Pregnancy. Patients with peripheral or mesenteric vascular thrombosis unless

necessary as a life-saving procedure.

Special Precautions Not a substitute for replacement of blood, plasma, fluids, and/or electrolytes; correct volume

depletion prior to admin. Identify and correct hypoxia, hypercapnia and acidosis prior to or during

admin. Avoid extravasation as tissue necrosis may occur. Avoid inj into leg veins, especially in

elderly or those with occlusive vascular diseases, arteriosclerosis, DM or Buerger's disease.

Hypertensive or hyperthyroid patients. In conjunction with local anaesthetics, do not use in

fingers, toes, ears, nose or genitalia. Lactation.

Adverse DrugReactions

Hypertension, headache, peripheral ischaemia, bradycardia, arrhythmias, anxiety, skin necrosis(with extravasation), dyspnoea, respiratory difficulty.

Drug Interactions Guanethidine,methyldopa,reserpine,TCAs may increase pressor response to norepinephrine.

Potentially Fatal:Guanethidine,methyldopa,reserpine,TCAs may increase pressor response to

norepinephrine.

Click to view more norepinephrine Drug Interactions

Pregnancy Category

(US FDA)

Storage Intravenous: Store at room temperature (25C) and protect from light. Store in tight, light-

resistant containers as norepinephrine is readily oxidised. Do not use if discoloured (e.g. pink,

dark yellow, brown) or if there is a precipitate.

Mechanism of Action Norepinephrine is a direct-acting sympathomimetic which stimulates 1- and -adrenergic

receptors. Its -agonist effects cause vasoconstriction, thereby raising systolic and diastolic BP

with reflex slowing of heart rate.

Onset: Rapid.

Duration: Short; stops within 1-2 min after discontinuing the infusion.

Pharmacokinetics Absorption: Oral: Destroyed in the GI tract; SC: Poorly absorbed.

Distribution: Mainly localises in sympathetic nervous tissue; crosses the placenta but not the

blood-brain barrier.

Metabolism: Metabolised in the liver and in other tissues by the enzymes catechol-O-

methyltransferase (COMT) and monoamine oxidase (MAO).

Excretion: Via urine (mainly as metabolites).

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Reseptor Cathecolamine (Adrenergic)

Terdiri dari reseptor : Alpha-adrenergic dan Beta-adrenergic Potensial epinephrine > norepinephrine dalam aktivasi reseptor beta-adrenergic Potensial norepinephrine > epinephrine dalam aktivasi reseptor alpha-adrenergic

Type of catecholamine receptor Tissue Location Action following Receptor ActivationAlpha 1 Vascular smooth muscle Increases vasoconstriction (increase BP)

Liver Increase glycogenolysis&gluconeogenesis

Eye Increase ciliary muscle contraction (pupil

dilatation)

Skin Increase pilomotor smooth muscle

contraction (erects hair)

Prostate Increase contraction

Uterus Increase contraction

Alpha2 Pancreatic islet cells Decrease release of insulin and glucagon

Blood platelets Increase platelet aggregation

Adipose cells Decrease lipolysis

Preganglionic and postganglionic nerves Decrease release of neurotransmitter

Beta1 Myocardium Increase foce and rate of contractionKidney Increase secretion of renin

Most tissues Increase calorigenesis

Nerves Increase conduction velocity

Beta2 Intestinal smooth muscle Decrease intestinal and increase sphincter

tone

Bronchiolar smooth muscle Decrease contraction (bronchial dilation)

Liver Increase glycogenolysis and gluconeogenesis

Pancreatic islet cells Increase release of insulin and glucagon

Adipose tissue Increase lipolysis

Muscle Increase potassium uptake

Liver and kidney Increase peripheral conversion T4 to T3

Uterus smooth muscle Decrease uterine contrction (uterine

relaxation)Beta3 Adipose cell Increase lipollysis

Pseudoephedrine

Asympathomimeticdrug of thephenethylamine andamphetaminechemical classes.It may be used as anasal/sinus

decongestant, as astimulant,[2]

or as awakefulness-promoting agent.[3]

MoA: Release of noradrenaline from storage vesicle in presynaptic neuronactivate adrenergic receptor (1) on the

muscle lining of blood vesselmuscle contractvasoconstrictionfluid leave the blood vessel and enter the nose and

sinus lining decrease inflammation and mucous formation in nasal membrane

Indication: nasal and sinus congestion,allergic rhinitis,croup,sinusitis,otitis media,andtracheobronchitis

Contraindication : diabetes mellitus,cardiovascular disease,severe or uncontrolledhypertension,severecoronary artery

disease,prostatic hypertrophy,hyperthyroidism,closed angle glaucoma,or by pregnant women

Adverse effect: insomnia, nervousness, excitability, dizziness,tachycardia orpalpitations

Dosing:

Children:6-12 years: 30 mg every 6 hours; maximum: 120 mg/24 hours

Adults: 30 to 60 mg every 4-6 hours. Sustained release: 120 mg every 12 hours. Maximum: 240 mg/24 hours

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