hidden pixel

Epinephrine Information

Epinephrine (also known as adrenaline) is a hormone and a neurotransmitter.[1] It increases heart rate, constricts blood vessels, dilates air passages and participates in the fight-or-flight response of the sympathetic nervous system.[2] In chemical terms, adrenaline is one of a group of monoamines called the catecholamines. It is produced in some neurons of the central nervous system, and in the chromaffin cells of the adrenal medulla from the amino acids phenylalanine and tyrosine.[3]

Extracts of the adrenal gland were first obtained by Polish physiologist Napoleon Cybulski in 1895. These extracts, which he called nadnerczyna, contained adrenaline and other catecholamines.[4] Japanese chemist Jokichi Takamine and his assistant Keizo Uenaka independently discovered adrenaline in 1900.[5][6] In 1901, Takamine successfully isolated and purified the hormone from the adrenal glands of sheep and oxen.[7] Adrenaline was first synthesized in the laboratory by Friedrich Stolz and Henry Drysdale Dakin, independently, in 1904.[6]

Contents

Medical uses

Epinephrine ampoule, 1 mg (Suprarenin)

Adrenaline is used to treat a number of conditions including: cardiac arrest, anaphylaxis, and superficial bleeding.[8] It has been used historically for bronchospasm and hypoglycemia, but newer treatments for these, such as salbutamol, a synthetic epinephrine derivitive, and dextrose, respectively, are currently preferred.[8]

Cardiac arrest

Adrenaline is used as a drug to treat cardiac arrest and other cardiac dysrhythmias resulting in diminished or absent cardiac output. Its actions are to increase peripheral resistance via α1receptor-dependent vasoconstriction and to increase cardiac output via its binding to β1 receptors.

Anaphylaxis

Due to its vasoconstrictive effects, adrenaline is the drug of choice for treating anaphylaxis. Allergy[9] patients undergoing immunotherapy may receive an adrenaline rinse before the allergen extract is administered, thus reducing the immune response to the administered allergen. It is also used as a bronchodilator for asthma if specific β2 agonists are unavailable or ineffective.[10]

Because of various expressions of α1 or β2 receptors, depending on the patient, administration of adrenaline may raise or lower blood pressure, depending on whether or not the net increase or decrease in peripheral resistance can balance the positive inotropic and chronotropic effects of adrenaline on the heart, effects that increase the contractility and rate, respectively, of the heart.

The usual concentration for SQ or IM injection is 0.3 - 0.5 mg 1:1,000.

Croup

Racemic epinephrine has historically been used for the treatment of croup.[11][12] Racemic adrenaline is a 1:1 mixture of the dextrorotatory (d) and levorotatory (l) isomers of adrenaline.[13] The l- form is the active component.[13] Racemic adrenaline works by stimulation of the α-adrenergic receptors in the airway, with resultant mucosal vasoconstriction and decreased subglottic edema, and by stimulation of the β-adrenergic receptors, with resultant relaxation of the bronchial smooth muscle.[12]

In local anesthetics

Adrenaline is added to injectable forms of a number of local anesthetics, such as bupivacaine and lidocaine, as a vasoconstrictor to retard the absorption and, therefore, prolong the action of the anesthetic agent. Some of the adverse effects of local anesthetic use, such as apprehension, tachycardia, and tremor, may be caused by adrenaline.[14]

Autoinjectors

Adrenaline is available in an autoinjector delivery system. EpiPens, Anapens, and Twinjects all use adrenaline as their active ingredient. Twinjects contain a second dose of adrenaline in a separate syringe and needle delivery system contained within the body of the autoinjector.

Though both EpiPen and Twinject are trademark names, common usage of the terms is drifting toward the generic context of any adrenaline autoinjector.

Adverse effects

Adverse reactions to adrenaline include palpitations, tachycardia, arrhythmia, anxiety, headache, tremor, hypertension, and acute pulmonary edema.[15]

Use is contraindicated in people on nonselective β-blockers, because severe hypertension and even cerebral hemorrhage may result.[16] Although commonly believed that administration of adrenaline may cause heart failure by constricting coronary arteries, this is not the case. Coronary arteries have only β2 receptors, which cause vasodilation in the presence of adrenaline.[17] Even so, administering high-dose adrenaline has not been definitively proven to improve survival or neurologic outcomes in adult victims of cardiac arrest.[18]

Measurement in biological fluids

Adrenaline may be quantitated in blood, plasma, or serum as a diagnostic aid, to monitor therapeutic administration, or to identify the causative agent in a potential poisoning victim. Endogenous plasma adrenaline concentrations in resting adults are normally less than 10 ng/L, but may increase by 10-fold during exercise and by 50-fold or more during times of stress. Pheochromocytoma patients often have plasma adrenaline levels of 1000-10,000 ng/L. Parenteral administration of adrenaline to acute-care cardiac patients can produce plasma concentrations of 10,000 to 100,000 ng/L.[19][20]

Mechanism of action

See also: Adrenergic receptor

As a hormone, adrenaline acts on nearly all body tissues. Its actions vary by tissue type and tissue expression of adrenergic receptors. For example, adrenaline causes smooth muscle relaxation in the airways but causes contraction of the smooth muscle that lines most arterioles.

Adrenaline acts by binding to a variety of adrenergic receptors. Adrenaline is a nonselective agonist of all adrenergic receptors, including α1, α2, β1, β2, and β3 receptors.[16] Epinephrine's binding to these receptors triggers a number of metabolic changes. Binding to α-adrenergic receptors inhibits insulin secretion by the pancreas, stimulates glycogenolysis in the liver and muscle, and stimulates glycolysis in muscle.[21] β-Adrenergic receptor binding triggers glucagon secretion in the pancreas, increased adrenocorticotropic hormone (ACTH) secretion by the pituitary gland, and increased lipolysis by adipose tissue. Together, these effects lead to increased blood glucose and fatty acids, providing substrates for energy production within cells throughout the body.[21]

In addition to these metabolic changes, epinephrine also leads to broad alterations throughout all organ systems.

Physiologic responses to epinephrine by organ
Organ Effects
Heart Increases heart rate
Lungs Increases respiratory rate
Nearly all tissues Vasoconstriction or vasodilation
Liver Stimulates glycogenolysis
N/A, systemic Triggers lipolysis
N/A, systemic Muscle contraction

Biosynthesis and regulation

Adrenaline is synthesized in the medulla of the adrenal gland in an enzymatic pathway that converts the amino acid tyrosine into a series of intermediates and, ultimately, adrenaline. Tyrosine is first oxidized to L-DOPA, which is subsequently decarboxylated to give dopamine. Oxidation gives norepinephrine, which is methylated to give epinephrine.

Adrenaline is synthesized via methylation of the primary distal amine of noradrenaline by phenylethanolamine N-methyltransferase (PNMT) in the cytosol of adrenergic neurons and cells of the adrenal medulla (so-called chromaffin cells). PNMT is found in the cytosol of only cells of adrenal medullary cells. PNMT uses S-adenosylmethionine (SAMe) as a cofactor to donate the methyl group to noradrenaline, creating adrenaline.

The biosynthesis of adrenaline involves a series of enzymatic reactions.

For noradrenaline to be acted upon by PNMT in the cytosol, it must first be shipped out of granules of the chromaffin cells. This may occur via the catecholamine-H+ exchanger VMAT1. VMAT1 is also responsible for transporting newly synthesized adrenaline from the cytosol back into chromaffin granules in preparation for release.

In liver cells, adrenaline binds to the β-adrenergic receptor, which changes conformation and helps Gs, a G protein, exchange GDP to GTP. This trimeric G protein dissociates to Gs alpha and Gs beta/gamma subunits. Gs alpha binds to adenyl cyclase, thus converting ATP into cyclic AMP. Cyclic AMP binds to the regulatory subunit of protein kinase A: Protein kinase A phosphorylates phosphorylase kinase. Meanwhile, Gs beta/gamma binds to the calcium channel and allows calcium ions to enter the cytoplasm. Calcium ions bind to calmodulin proteins, a protein present in all eukaryotic cells, which then binds to phosphorylase kinase and finishes its activation. Phosphorylase kinase phosphorylates glycogen phosphorylase, which then phosphorylates glycogen and converts it to glucose-6-phosphate.

Regulation

The major physiologic triggers of adrenaline release center upon stresses, such as physical threat, excitement, noise, bright lights, and high ambient temperature. All of these stimuli are processed in the central nervous system.[22]

Adrenocorticotropic hormone (ACTH) and the sympathetic nervous system stimulate the synthesis of adrenaline precursors by enhancing the activity of tyrosine hydroxylase and dopamine-β-hydroxylase, two key enzymes involved in catecholamine synthesis.

Adrenaline (as with noradrenaline) does exert negative feedback to down-regulate its own synthesis at the presynaptic alpha-2 adrenergic receptor. Abnormally elevated levels of adrenaline can occur in a variety of conditions, such as surreptitious epinephrine administration, pheochromocytoma, and other tumors of the sympathetic ganglia.

Its action is terminated with reuptake into nerve terminal endings, some minute dilution, and metabolism by monoamine oxidase and catechol-O-methyl transferase.

Chemical synthesis

Epinephrine may be synthesized by the reaction of catechol with chloroacetyl chloride, followed by the reaction with methylamine to give the ketone, which is reduced to the desired hydroxy compound. The racemic mixture may be separated using tartaric acid.

Formula for the synthesis of adrenaline

For isolation from the adrenal glands tissue of livestock:

Synthetic production:

Adrenaline junkie

"Adrenaline junkie" redirects here. For the British reality TV series, see Jack Osbourne: Adrenaline Junkie.

Adrenaline junkie is a term used to describe somebody appearing to be addicted to epinephrine (endogenous), and such a person is sometimes described as getting a "high" from life. The term adrenaline junkie was popularly used in the 1991 movie Point Break to describe individuals enjoying dangerous activities (such as extreme sports, e.g. BASE jumping) for the adrenaline "rush". Adrenaline junkies appear to favor stressful activities for the release of epinephrine as a stress response. Whether or not the positive response is caused specifically by epinephrine is difficult to determine, as endorphins are also released during the fight-or-flight response to such activities.[23][24]

Adrenaline Addiction

Adrenaline addiction is not officially included in the DSM; however, that does not mean it is not a topic of intense debate or will not be included in the future. Psychology Today defines it as Always overwhelmed, adrenaline junkies seem to have a constant need for urgency, even panic, to get them through the day. They cannot grasp the race driver's motto: you have to slow down to go fast. Instead, they keep their foot on the pedal at full throttle, convinced that any deceleration is lost opportunity.[25] The same source describes the reason for the addiction is that someone has experienced a traumatic event past but has become "stuck."[25] The traumatic event is over but the body keeps seeking adrenaline. Endorphins are thus highly effective painkillers-numbing physical pain and emotional pain too.[25]

Symptoms include:

These individuals have developed the belief that they will be highly successful when they are speeding along in life. However, when this becomes a pattern of behavior, it can cause health and performance issues to surface.

Unlike other addicts whose behaviors are socially frowned-upon, adrenaline addicts are often praised for their frantic activity, even promoted for it during their careers. (which helps it to be such a pervasive disorder, adrenaline addiction can be very difficult to conquer)[25]

Terminology

This chemical is widely referred to as "adrenaline" outside of the United States; however, its United States Adopted Name and International Nonproprietary Name is epinephrine. Epinephrine was chosen because adrenaline bore too much similarity to the Parke, Davis & Co trademark Adrenalin (without the e), which was registered in the United States. The British Approved Name and European Pharmacopoeia term for this chemical is adrenaline and is indeed now one of the few differences between the INN and BAN systems of names.[27]

Among American health professionals and scientists, the term epinephrine is used over adrenaline. However, pharmaceuticals that mimic the effects of epinephrine are often called adrenergics, and receptors for epinephrine are called adrenergic receptors or adrenoceptors.

Notes

  1. ^ Berecek Kh, B. M.; Brody, M. J. (1982). "Evidence for a neurotransmitter role for epinephrine derived from the adrenal medulla". Am J Physiol 242 (4): H593–H601. PMID 6278965.
  2. ^ Cannon, W. B. (1929). American Journal of Physiology 89: 84–107.
  3. ^ von Bohlen und Halbach, O; Dermietzel, R (2006). Neurotransmitters and neuromodulators: handbook of receptors and biological effects. Wiley-VCH. p. 125. ISBN 978-3-527-31307-5. http://books.google.com/books?id=AfmA_KJMjJAC&pg=PA125.
  4. ^ "Polish Thread in the History of Circulatory Physiology". http://www.jpp.krakow.pl/journal/archive/04_06_s1/articles/01_article.html. Retrieved 2011-04-24.
  5. ^ Yamashima T (2003). "Jokichi Takamine (1854–1922), the samurai chemist, and his work on adrenalin". J Med Biogr 11 (2): 95–102. PMID 12717538.
  6. ^ a b Bennett M (1999). "One hundred years of adrenaline: the discovery of autoreceptors". Clin Auton Res 9 (3): 145–59. doi:10.1007/BF02281628. PMID 10454061.
  7. ^ Takamine J (1901). The isolation of the active principle of the suprarenal gland. Great Britain: Cambridge University Press. pp. xxix-xxx. http://books.google.com/?id=xVEq06Ym6qcC&pg=RA1-PR29#PRA1-PR29,M1.
  8. ^ a b "Epinephrine". The American Society of Health-System Pharmacists. http://www.drugs.com/monograph/epinephrine.html. Retrieved 3 April 2011.
  9. ^ Sicherer, Scott H. (2006). Understanding and Managing Your Child's Food Allergy. Baltimore: The Johns Hopkins University Press. ISBN 0801884918.
  10. ^ "Asthma Causes, Types, Symptoms, Treatment, Medication, Facts and the Link to Allergies by MedicineNet.com". http://www.medicinenet.com/asthma/page8.htm.
  11. ^ Bjornson CL, Johnson DW (2008). "Croup". The Lancet 371 (9609): 329–339. doi:10.1016/S0140-6736(08)60170-1. PMID 18295000.
  12. ^ a b Thomas LP, Friedland LR (1998). "The cost-effective use of nebulized racemic adrenaline in the treatment of croup". American Journal of Emergency Medicine 16 (1): 87–89. doi:10.1016/S0735-6757(98)90073-0. PMID 9451322.
  13. ^ a b Malhotra A, Krilov LR (2001). "Viral Croup". Pediatrics in Review 22 (1): 5–12. doi:10.1542/pir.22-1-5. PMID 11139641.
  14. ^ R. Rahn and B. Ball. Local Anesthesia in Dentistry, 3M ESPE AG, ESPE Platz, Seefeld, Germany, 2001, 44 pp.
  15. ^ About.com - "The Definition of Epinephrine"
  16. ^ a b Shen, Howard (2008). Illustrated Pharmacology Memory Cards: PharMnemonics. Minireview. pp. 4. ISBN 1-59541-101-1.
  17. ^ Sun, D; Huang, A; Mital, S; Kichuk, MR; Marboe, CC; Addonizio, LJ; Michler, RE; Koller, A et al. (2002). "Norepinephrine elicits beta2-receptor-mediated dilation of isolated human coronary arterioles". Circulation 106 (5): 550–5. doi:10.1161/01.CIR.0000023896.70583.9F. PMID 12147535.
  18. ^ Stiell, I. G.; Hebert, P. C.; Weitzman, B. N.; Wells, G. A.; Raman, S.; Stark, R. M.; Higginson, L. A. J.; Ahuja, J. et al. (1992). "High-Dose Epinephrine in Adult Cardiac Arrest". New England Journal of Medicine 327 (15): 1045. doi:10.1056/NEJM199210083271502. PMID 1522840.
  19. ^ Raymondos, K.; Panning, B.; Leuwer, M.; Brechelt, G.; Korte, T.; Niehaus, M.; Tebbenjohanns, J.; Piepenbrock, S. (2000). "Absorption and hemodynamic effects of airway administration of adrenaline in patients with severe cardiac disease". Ann. Intern. Med. 132 (10): 800–803. PMID 10819703.
  20. ^ Baselt, R. (2008). Disposition of Toxic Drugs and Chemicals in Man (8th ed.). Foster City, CA: Biomedical Publications. pp. 545–547. ISBN 0962652377.
  21. ^ a b Sabyasachi Sircar (2007). Medical Physiology. Thieme Publishing Group. pp. 536. ISBN 3-13-144061-9.
  22. ^ Nelson, L.; Cox, M. (2004). Lehninger Principles of Biochemstry (4th ed.). New York: Freeman. p. 908. ISBN 0716743396.
  23. ^ What Is An Adrenaline Junkie? What Can You Do If You Are One? by Elizabeth Scott, M.S. (updated: November 1, 2007) About.com Health's Disease and Condition content is reviewed by the Medical Review Board.
  24. ^ Fight-or-flight reaction - Explanations - Brain - ChangingMinds.org.
  25. ^ a b c d http://www.psychologytoday.com/blog/somatic-psychology/201101/addicted-success
  26. ^ a b c d e http://www.weinholds.org/youcanheal/adrenaline-addiction/
  27. ^ http://www.mhra.gov.uk/Howweregulate/Medicines/Namingofmedicines/ChangestomedicinesnamesBANstorINNs/index.htm

References

External links

Phenethylamines
Phenethylamines Psychedelics: 2C-B • 2C-B-FLY • 2C-C • 2C-D • 2C-E • 2C-F • 2C-G • 2C-I • 2C-N • 2C-P • 2C-SE • 2C-T • 2C-T-2 • 2C-T-4 • 2C-T-7 • 2C-T-8 • 2C-T-9 • 2C-T-13 • 2C-T-15 • 2C-T-17 • 2C-T-21 • 2C-TFM • 2C-YN • Allylescaline • DESOXY • Escaline • Isoproscaline • Jimscaline • Macromerine • MEPEA • Mescaline • Metaescaline • Methallylescaline • Proscaline • Psi-2C-T-4 • TCB-2 Stimulants: 2-OH-PEA • β-Me-PEA • Hordenine • N-Me-PEA • Phenethylamine (PEA) Entactogens: Lophophine • MDPEA • MDMPEA Others: BOH • DMPEA
Amphetamines Phenylisopropylamines Psychedelics: 3C-BZ • 3C-E • 3C-P • Aleph • Beatrice • Bromo-DragonFLY • D-Deprenyl • DMA • DMCPA • DMMDA • DOB • DOC • DOEF • DOET • DOI • DOM • DON • DOPR • DOTFM • Ganesha • MMDA • MMDA-2 • Psi-DOM • TMA • TeMA Stimulants: 4-MA • 4-MMA • 4-MTA • 5-IT • Alfetamine • Amfecloral • Amfepentorex • Amphetamine (Dextroamphetamine, Levoamphetamine) • Amphetaminil • Benfluorex • Benzphetamine • Cathine • Clobenzorex • Dimethylamphetamine • Ephedrine (EPH) • Ethylamphetamine • Fencamfamine • Fencamine • Fenethylline • Fenfluramine (Dexfenfluramine) • Fenproporex • Fludorex • Furfenorex • Isopropylamphetamine • Lefetamine • Mefenorex • Methamphetamine (Dextromethamphetamine, Levomethamphetamine) • Methoxyphenamine • MMA • Norfenfluramine • Oxilofrine • Ortetamine • PBA • PCA • Phenpromethamine • PFA • PFMA • PIA • PMA • PMEA • PMMA • Phenylpropanolamine (PPA) • Prenylamine • Propylamphetamine • Pseudoephedrine (PSE) • Sibutramine • Tiflorex (Flutiorex) • Tranylcypromine • Xylopropamine • Zylofuramine Entactogens: 5-APDB • 6-APB • 6-APDB • EDA • IAP • MDA • MDEA • MDHMA (FLEA) • MDMA ("Ecstasy") • MDOH • MMDMA • NAP • TAP Others: Amiflamine • DFMDA • D-Deprenyl • L-Deprenyl (Selegiline)
Phentermines Stimulants: Chlorphentermine • Cloforex • Clortermine • Etolorex • Mephentermine • Pentorex (Phenpentermine) • Phentermine Entactogens: MDPH • MDMPH
Cathinones Stimulants: Amfepramone • Brephedrone • Buphedrone • Bupropion (Amfebutamone) • Cathinone (Propion) • Dimethylcathinone (Dimethylpropion, Metamfepramone) • Ethcathinone (Ethylpropion) • Flephedrone • Methcathinone (Methylpropion) • Mephedrone • Methedrone Entactogens: Ethylone • Methylone
Phenylisobutylamines Entactogens: 4-CAB • 4-MAB • Ariadne (α-Et-DOM) • BDB (J) • Butylone (bk-MBDB) • EBDB (Ethyl-J) • Eutylone (bk-EBDB) • MBDB (Methyl-J) Stimulants: Phenylisobutylamine
Phenylalkylpyrrolidines Stimulants: α-PBP • α-PPP • α-PVP • MDPBP • MDPPP • MDPV • MOPPP • MPBP • MPHP • MPPP • Naphyrone • PEP • Prolintane • Pyrovalerone
Catecholamines (and relatives..) 6-FNE • 6-OHDA • α-Me-DA • α-Me-TRA • Adrenochrome • Ciladopa • D-DOPA (Dextrodopa) • Dopamine • Epinephrine (Adrenaline) • Epinine • Fenclonine • Ibopamine • L-DOPA (Levodopa) • L-DOPS (Droxidopa) • L-Phenylalanine • L-Tyrosine • meta-Octopamine • meta-Tyramine • Metanephrine • Metirosine • Methyldopa • Nordefrin (Levonordefrin) • Norepinephrine (Noradrenaline) • Normetanephrine • para-Octopamine • para-Tyramine
Miscellaneous Amidephrine • Arbutamine • Cafedrine • Denopamine • Dobutamine • Dopexamine • Etafedrine • Ethylnorepinephrine • Etilefrine • Famprofazone • Gepefrine • Isoprenaline (Isoproterenol) • Isoetarine • Metaraminol • Metaterol • Methoxamine • Norfenefrine • Orciprenaline • Phenylephrine (Neosynephrine) • Phenoxybenzamine • Prenalterol • Pronethalol • Propranolol • Salbutamol (Albuterol; Levosalbutamol) • Synephrine (Oxedrine) • Theodrenaline • Xamoterol
Endocrine system: hormones (Peptide hormones · Steroid hormones)
Endocrine glands
Hypothalamic- pituitary
Hypothalamus GnRH · TRH · Dopamine · CRH · GHRH/Somatostatin · Melanin concentrating hormone
Posterior pituitary Vasopressin · Oxytocin
Anterior pituitary α (FSH FSHB, LH LHB, TSH TSHB, CGA) · Prolactin · POMC (CLIP, ACTH, MSH, Endorphins, Lipotropin) · GH
Adrenal axis Adrenal cortex: aldosterone · cortisol · DHEA Adrenal medulla: epinephrine · norepinephrine
Thyroid axis Thyroid: thyroid hormone (T3 and T4) · calcitonin Parathyroid: PTH
Gonadal axis

Testis: testosterone · AMH · inhibin

Ovary: estradiol · progesterone · activin and inhibin · relaxin (pregnancy)

Placenta: hCG · HPL · estrogen · progesterone
Islet-Acinar Axis

Pancreas: glucagon · insulin · amylin · somatostatin · pancreatic polypeptide

Pineal gland: melatonin
Non-end. glands

Thymus: Thymosin (Thymosin α1, Thymosin beta) · Thymopoietin · Thymulin

Digestive system: Stomach: gastrin · ghrelin · Duodenum: CCK · GIP · secretin · motilin · VIP · Ileum: enteroglucagon · peptide YY · Liver/other: Insulin-like growth factor (IGF-1, IGF-2)

Adipose tissue: leptin · adiponectin · resistin

Skeleton: Osteocalcin

Kidney: JGA (renin) · peritubular cells (EPO) · calcitriol · prostaglandin

Heart: Natriuretic peptide (ANP, BNP)

: END

///

()//, /

, drug (////)
Cardiac stimulants excluding cardiac glycosides (C01C)
Adrenergic and dopaminergic agents
Adrenergic agonists
α Metaraminol • Phenylephrine • Methoxamine • Norfenefrine • Oxedrine • Midodrine • Mephentermine
β Dobutamine • Arbutamine • Isoprenaline • Prenalterol
mixed Amezinium metilsulfate • Epinephrine # • Norepinephrine • Etilefrine
Dopamine agonists Fenoldopam
Both Dopamine # • Dopexamine • Ibopamine • Octopamine
Unknown/ungrouped Dimetofrine • Gepefrine • Cafedrine • Theodrenaline
Phosphodiesterase inhibitors (PDE3I) Amrinone • Milrinone • Enoximone • Bucladesine
Other cardiac stimulants Angiotensinamide • Xamoterol • Levosimendan
#WHO-EM. ‡Withdrawn from market. Clinical trials: †Phase III. §Never to phase III

: HRT

//

//, /,

, drug (///),

Drugs for obstructive airway diseases: asthma/COPD (R03)
Adrenergics, inhalants
Short acting β2-agonists Salbutamol#/Levosalbutamol • Fenoterol • Terbutaline • Pirbuterol • Procaterol • Bitolterol • Rimiterol • Carbuterol • Tulobuterol • Reproterol
Long acting β2-agonists (LABA) Arformoterol • Bambuterol • Clenbuterol • Formoterol • Salmeterol Ultra LABA: Indacaterol
other Epinephrine# • Hexoprenaline • Isoprenaline (Isoproterenol) • Orciprenaline (Metaproterenol)
Glucocorticoids Beclometasone# • Budesonide • Ciclesonide • Fluticasone • Mometasone • Flunisolide • Betamethasone • Triamcinolone
Anticholinergics/ muscarinic antagonist Ipratropium bromide# • Oxitropium bromide • Tiotropium bromide
Mast cell stabilizers Cromoglicate • Nedocromil
Xanthines Doxofylline • Enprofylline • Theobromine • Theophylline/Aminophylline/Choline theophyllinate
Eicosanoid inhibition
Leukotriene antagonists Montelukast • Pranlukast • Zafirlukast
Lipoxygenase inhibitor Zileuton
Thromboxane receptor antagonists Ramatroban • Seratrodast
Combination products Budesonide/formoterol • Fluticasone/salmeterol • Ipratropium bromide/salbutamol • Mometasone/formoterol
#WHO-EM. ‡Withdrawn from market. Clinical trials: †Phase III. §Never to phase III

: RES

anat(, , , )//

(, )//, /,

, drug(/////)
Antihemorrhagics (B02)
Hemostatics (coagulation)
Systemic
Vitamin K Phytomenadione (K1) • Menadione (K3)
Coagulation factors

intrinsic: IX/Nonacog alfa • VIII

extrinsic: VII/Eptacog alfa

common: X • II/Thrombin • I/Fibrinogen
Other systemic Etamsylate • Carbazochrome • Batroxobin • thrombopoietin receptor agonist (Romiplostim, Eltrombopag)
Local Absorbable gelatin sponge • Oxidized cellulose • Tetragalacturonic acid hydroxymethylester • Thrombin • Collagen • Calcium alginate • Epinephrine/Adrenalone
Antifibrinolytics amino acids (Aminocaproic acid, Tranexamic acid, Aminomethylbenzoic acid) serpins (Aprotinin, Alfa1 antitrypsin, C1-inhibitor, Camostat)

: MYL

/ (, , , ),

///, /,

drug (//), ,

Health science > Medicine > Emergency medicine
Procedures Acute Care of at-Risk Newborns (ACoRN) · Advanced cardiac life support (ACLS) · Advanced Trauma Life Support (ATLS) · Cardiopulmonary resuscitation (CPR) · First aid · Neonatal Resuscitation Program (NRP) · Pediatric Advanced Life Support (PALS) · Basic Life Support
Equipment Bag valve mask (BVM) · Chest tube · Defibrillation (AED, ICD) · Electrocardiogram (ECG/EKG) · Intraosseous infusion (IO) · Intravenous therapy (IV) · Tracheal intubation · Nasopharyngeal airway (NPA) · Oropharyngeal airway (OPA) · Pocket mask
Drugs Atropine · Amiodarone · Epinephrine/Adrenaline · Magnesium Sulfate · Sodium Bicarbonate · Naloxone
Other Golden hour · Emergency department · Emergency medical services · Emergency nursing · Emergency physician · Emergency psychiatry · Medical emergency · Trauma center · Triage · NACA score
Book:Emergency medicine · Category:Emergency medicine · Portal:Medicine
Adrenergics
Receptor ligands
α1 Agonists: 5-FNE • 6-FNE • Amidephrine • Anisodamine • Anisodine • Cirazoline • Dipivefrine • Dopamine • Ephedrine • Epinephrine (Adrenaline) • Etilefrine • Ethylnorepinephrine • Indanidine • Levonordefrin • Metaraminol • Methoxamine • Methyldopa • Midodrine • Naphazoline • Norepinephrine (Noradrenaline) • Octopamine • Oxymetazoline • Phenylephrine • Phenylpropanolamine • Pseudoephedrine • Synephrine • Tetrahydrozoline Antagonists: Abanoquil • Adimolol • Ajmalicine • Alfuzosin • Amosulalol • Arotinolol • Atiprosin • Benoxathian • Buflomedil • Bunazosin • Carvedilol • CI-926 • Corynanthine • Dapiprazole • DL-017 • Domesticine • Doxazosin • Eugenodilol • Fenspiride • GYKI-12,743 • GYKI-16,084 • Indoramin • Ketanserin • L-765,314 • Labetalol • Mephendioxan • Metazosin • Monatepil • Moxisylyte (Thymoxamine) • Naftopidil • Nantenine • Neldazosin • Nicergoline • Niguldipine • Pelanserin • Phendioxan • Phenoxybenzamine • Phentolamine • Piperoxan • Prazosin • Quinazosin • Ritanserin • RS-97,078 • SGB-1,534 • Silodosin • SL-89.0591 • Spiperone • Talipexole • Tamsulosin • Terazosin • Tibalosin • Tiodazosin • Tipentosin • Tolazoline • Trimazosin • Upidosin • Urapidil • Zolertine * Note that many TCAs, TeCAs, antipsychotics, ergolines, and some piperazines like buspirone, trazodone, nefazodone, etoperidone, and mepiprazole all antagonize α1-adrenergic receptors as well, which contributes to their side effects such as orthostatic hypotension.
α2 Agonists: (R)-3-Nitrobiphenyline • 4-NEMD • 6-FNE • Amitraz • Apraclonidine • Brimonidine • Cannabivarin • Clonidine • Detomidine • Dexmedetomidine • Dihydroergotamine • Dipivefrine • Dopamine • Ephedrine • Ergotamine • Epinephrine (Adrenaline) • Esproquin • Etilefrine • Ethylnorepinephrine • Guanabenz • Guanfacine • Guanoxabenz • Levonordefrin • Lofexidine • Medetomidine • Methyldopa • Mivazerol • Naphazoline • Norepinephrine (Noradrenaline) • Phenylpropanolamine • Piperoxan • Pseudoephedrine • Rilmenidine • Romifidine • Talipexole • Tetrahydrozoline • Tizanidine • Tolonidine • Urapidil • Xylazine • Xylometazoline Antagonists: 1-PP • Adimolol • Aptazapine • Atipamezole • BRL-44408 • Buflomedil • Cirazoline • Efaroxan • Esmirtazapine • Fenmetozole • Fluparoxan • GYKI-12,743 • GYKI-16,084 • Idazoxan • Mianserin • Mirtazapine • MK-912 • NAN-190 • Olanzapine • Phentolamine • Phenoxybenzamine • Piperoxan • Piribedil • Rauwolscine • Rotigotine • SB-269,970 • Setiptiline • Spiroxatrine • Sunepitron • Tolazoline • Yohimbine * Note that many atypical antipsychotics and azapirones like buspirone and gepirone (via metabolite 1-PP) antagonize α2-adrenergic receptors as well.
β Agonists: 2-FNE • 5-FNE • Amibegron • Arbutamine • Arformoterol • Arotinolol • BAAM • Bambuterol • Befunolol • Bitolterol • Broxaterol • Buphenine • Carbuterol • Cimaterol • Clenbuterol • Denopamine • Deterenol • Dipivefrine • Dobutamine • Dopamine • Dopexamine • Ephedrine • Epinephrine (Adrenaline) • Etafedrine • Etilefrine • Ethylnorepinephrine • Fenoterol • Formoterol • Hexoprenaline • Higenamine • Indacaterol • Isoetarine • Isoprenaline (Isoproterenol) • Isoxsuprine • Labetalol • Levonordefrin • Levosalbutamol • Mabuterol • Methoxyphenamine • Methyldopa • N-Isopropyloctopamine • Norepinephrine (Noradrenaline) • Orciprenaline • Oxyfedrine • Phenylpropanolamine • Pirbuterol • Prenalterol • Ractopamine • Procaterol • Pseudoephedrine • Reproterol • Rimiterol • Ritodrine • Salbutamol (Albuterol) • Salmeterol • Solabegron • Terbutaline • Tretoquinol • Tulobuterol • Xamoterol • Zilpaterol • Zinterol Antagonists: Acebutolol • Adaprolol • Adimolol • Afurolol • Alprenolol • Alprenoxime • Amosulalol • Ancarolol • Arnolol • Arotinolol • Atenolol • Befunolol • Betaxolol • Bevantolol • Bisoprolol • Bopindolol • Bormetolol • Bornaprolol • Brefonalol • Bucindolol • Bucumolol • Bufetolol • Buftiralol • Bufuralol • Bunitrolol • Bunolol • Bupranolol • Burocrolol • Butaxamine • Butidrine • Butofilolol • Capsinolol • Carazolol • Carpindolol • Carteolol • Carvedilol • Celiprolol • Cetamolol • Cicloprolol • Cinamolol • Cloranolol • Cyanopindolol • Dalbraminol • Dexpropranolol • Diacetolol • Dichloroisoprenaline • Dihydroalprenolol • Dilevalol • Diprafenone • Draquinolol • Dropranolol • Ecastolol • Epanolol • Ericolol • Ersentilide • Esatenolol • Esmolol • Esprolol • Eugenodilol • Exaprolol • Falintolol • Flestolol • Flusoxolol • Hydroxycarteolol • Hydroxytertatolol • ICI-118,551 • Idropranolol • Indenolol • Indopanolol • Iodocyanopindolol • Iprocrolol • Isoxaprolol • Isamoltane • Labetalol • Landiolol • Levobetaxolol • Levobunolol • Levocicloprolol • Levomoprolol • Medroxalol • Mepindolol • Metalol • Metipranolol • Metoprolol • Moprolol • Nadolol • Nadoxolol • Nafetolol • Nebivolol • Neraminol • Nifenalol • Nipradilol • Oberadilol • Oxprenolol • Pacrinolol • Pafenolol • Pamatolol • Pargolol • Parodilol • Penbutolol • Penirolol • PhQA-33 • Pindolol • Pirepolol • Practolol • Primidolol • Procinolol • Pronethalol • Propafenone • Propranolol • Ridazolol • Ronactolol • Soquinolol • Sotalol • Spirendolol • SR 59230A • Sulfinalol • TA-2005 • Talinolol • Tazolol • Teoprolol • Tertatolol • Terthianolol • Tienoxolol • Tilisolol • Timolol • Tiprenolol • Tolamolol • Toliprolol • Tribendilol • Trigevolol • Xibenolol • Xipranolol
Reuptake inhibitors
NET Selective norepinephrine reuptake inhibitors: Amedalin • Atomoxetine (Tomoxetine) • Ciclazindol • Daledalin • Esreboxetine • Lortalamine • Mazindol • Nisoxetine • Reboxetine • Talopram • Talsupram • Tandamine • Viloxazine; Norepinephrine-dopamine reuptake inhibitors: Amineptine • Bupropion (Amfebutamone) • Fencamine • Fencamfamine • Lefetamine • Levophacetoperane • LR-5182 • Manifaxine • Methylphenidate • Nomifensine • O-2172 • Radafaxine; Serotonin-norepinephrine reuptake inhibitors: Bicifadine • Desvenlafaxine • Duloxetine • Eclanamine • Levomilnacipran • Milnacipran • Sibutramine • Venlafaxine; Serotonin-norepinephrine-dopamine reuptake inhibitors: Brasofensine • Diclofensine • DOV-102,677 • DOV-21,947 • DOV-216,303 • JNJ-7925476 • JZ-IV-10 • Methylnaphthidate • Naphyrone • NS-2359 • PRC200-SS • SEP-225,289 • SEP-227,162 • Tesofensine; Tricyclic antidepressants: Amitriptyline • Butriptyline • Cianopramine • Clomipramine • Desipramine • Dosulepin • Doxepin • Imipramine • Lofepramine • melitracen • Nortriptyline • Protriptyline • Trimipramine; Tetracyclic antidepressants: Amoxapine • Maprotiline • Mianserin • Oxaprotiline • Setiptiline; Others: Cocaine • CP-39,332 • EXP-561 • Fezolamine • Ginkgo biloba • Indeloxazine • Nefazodone • Nefopam • Pridefrine • Tapentadol • Tedatioxetine • Teniloxazine • Tramadol • Ziprasidone
VMAT Ibogaine • Reserpine • Tetrabenazine
Releasing agents
Morpholines: Fenbutrazate • Morazone • Phendimetrazine • Phenmetrazine; Oxazolines: 4-Methylaminorex • Aminorex • Clominorex • Cyclazodone • Fenozolone • Fluminorex • Pemoline • Thozalinone; Phenethylamines (also amphetamines, cathinones, phentermines, etc): 2-OH-PEA • 4-CAB • 4-FA • 4-FMA • 4-MA • 4-MMA • Alfetamine • Amfecloral • Amfepentorex • Amfepramone • Amphetamine (Dextroamphetamine, Levoamphetamine) • Amphetaminil • β-Me-PEA • BDB • Benzphetamine • BOH • Buphedrone • Butylone • Cathine • Cathinone • Clobenzorex • Clortermine • D-Deprenyl • Dimethylamphetamine • Dimethylcathinone (Dimethylpropion, metamfepramone) • DMA • DMMA • EBDB • Ephedrine • Ethcathinone • Ethylamphetamine • Ethylone • Famprofazone • Fenethylline • Fenproporex • Flephedrone • Fludorex • Furfenorex • Hordenine • IAP • IMP • L-Deprenyl (Selegiline) • Lisdexamfetamine • Lophophine • MBDB • MDA (Tenamfetamine) • MDEA • MDMA • MDMPEA • MDOH • MDPEA • Mefenorex • Mephedrone • Mephentermine • Methamphetamine (Dextromethamphetamine, Levomethamphetamine) • Methcathinone • Methedrone • Methylone • NAP • Ortetamine • Paredrine • pBA • pCA • Pentorex (Phenpentermine) • Phenethylamine • Pholedrine • Phenpromethamine • Phentermine • Phenylpropanolamine • pIA • Prenylamine • Propylamphetamine • Pseudoephedrine • Tiflorex • Tyramine • Xylopropamine • Zylofuramine; Piperazines: 2C-B-BZP • BZP • MBZP • mCPP • MDBZP • MeOPP • pFPP; Others: 2-Amino-1,2-dihydronaphthalene • 2-Aminoindane • 2-Aminotetralin • 2-Benzylpiperidine • 4-Benzylpiperidine • 5-IAI • Clofenciclan • Cyclopentamine • Cypenamine • Cyprodenate • Feprosidnine • Gilutensin • Heptaminol • Hexacyclonate • Indanorex • Isometheptene • Methylhexanamine • Octodrine • Phthalimidopropiophenone • Propylhexedrine (Levopropylhexedrine) • Tuaminoheptane
Enzyme inhibitors
Anabolism
PAH 3,4-Dihydroxystyrene
TH 3-Iodotyrosine • Aquayamycin • Bulbocapnine • Metirosine • Oudenone
AAAD Benserazide • Carbidopa • Genistein • Methyldopa
DBH Bupicomide • Disulfiram • Dopastin • Fusaric acid • Nepicastat • Phenopicolinic acid • Tropolone
PNMT CGS-19281A • SKF-64139 • SKF-7698
Catabolism
MAO Nonselective: Benmoxin • Caroxazone • Echinopsidine • Furazolidone • Hydralazine • Indantadol • Iproclozide • Iproniazid • Isocarboxazid • Isoniazid • Linezolid • Mebanazine • Metfendrazine • Nialamide • Octamoxin • Paraxazone • Phenelzine • Pheniprazine • Phenoxypropazine • Pivalylbenzhydrazine • Procarbazine • Safrazine • Tranylcypromine; MAO-A selective: Amiflamine • Bazinaprine • Befloxatone • Befol • Brofaromine • Cimoxatone • Clorgiline • Esuprone • Harmala alkaloids (Harmine, Harmaline, Tetrahydroharmine, Harman, Norharman, etc) • Methylene Blue • Metralindole • Minaprine • Moclobemide • Pirlindole • Sercloremine • Tetrindole • Toloxatone • Tyrima; MAO-B selective: D-Deprenyl • Selegiline (L-Deprenyl) • Ladostigil • Lazabemide • Milacemide • Mofegiline • Pargyline • Rasagiline • Safinamide * Note that MAO-B inhibitors also influence norepinephrine/epinephrine levels since they inhibit the breakdown of their precursor dopamine.
COMT Entacapone • Tolcapone
Others
Precursors L-Phenylalanine → L-Tyrosine → L-DOPA (Levodopa) → Dopamine • L-DOPS (Droxidopa)
Cofactors Ferrous Iron (Fe2+) • S-Adenosyl-L-Methionine • Vitamin B3 (Niacin, Nicotinamide → NADPH) • Vitamin B6 (Pyridoxine, Pyridoxamine, Pyridoxal → Pyridoxal Phosphate) • Vitamin B9 (Folic acid → Tetrahydrofolic acid) • Vitamin C (Ascorbic acid) • Zinc (Zn2+)
Others Activity enhancers: BPAP • PPAP; Release blockers: Bethanidine • Bretylium • Guanadrel • Guanazodine • Guanclofine • Guanethidine • Guanoxan; Toxins: Oxidopamine (6-Hydroxydopamine)
List of adrenergic drugs
Neurotransmitters
Amino acids

Alanine · Aspartate · Cycloserine · DMG · GABA · Glutamate · Glycine · Hypotaurine · Kynurenic acid (Transtorine) · NAAG (Spaglumic acid) · NMG (Sarcosine) · Serine · Taurine · TMG (Betaine)
Endocannabinoids

2-AG · 2-AGE (Noladin ether) · AEA (Anandamide) · NADA · OAE (Virodhamine) · Oleamide · PEA (Palmitoylethanolamide) · RVD-Hpα · Hp (Hemopressin)
Gasotransmitters

Carbon monoxide · Hydrogen sulfide · Nitric oxide · Nitrous oxide
Monoamines

Dopamine · Epinephrine (Adrenaline) · Melatonin · NAS (Normelatonin) · Norepinephrine (Noradrenaline) · Serotonin (5-HT)
Purines

Adenosine · ADP · AMP · ATP
Trace amines

3-ITA · 5-MeO-DMT · Bufotenin · DMT · NMT · Octopamine · Phenethylamine · Synephrine · Thyronamine · Tryptamine · Tyramine
Others

1,4-BD · Acetylcholine · GBL · GHB · Histamine
See also

: PNS

(///////)/()/////

///, /,

, drug()

Categories:

 

The above information uses material from Wikipedia and is licensed under the GNU Free Documentation License.
Some facts may not have been fully verified for accuracy. [Disclaimers]
This page was last archived by our server on Thu Jan 12 01:14:16 2012.
Displaying this page or its contents does not use any Wikimedia Foundation's resources.
The owners of this site proudly support the Wikimedia Foundation.

More Information Results for "Epinephrine"
[Hide]▼
'Epinephrine' Images
Epinephrine jpg
asnanaka.com
Epinephrine jpg
104px x 150px | 2.40kB

[source page]

Enuresis jpg 21 Mar 2006 12 59 4k Epilepsy jpg 21 Mar 2006 12 59 4k Epinephrine jpg 21 Mar 2006 12 59 2k Epithelium jpg 21 Mar 2006 12 59 6k

Google Images Search: epinephrine,
Sun Jan 22 22:29:23 2012
[Hide]▲