How Do I Use Epinephrine for Anaphylaxis?

Epinephrine hydrochloride is an anti-shock vasoactive drug. It is used for the rescue of cardiac arrest and anaphylactic shock. It can also be used for the treatment of other allergic diseases (such as bronchial asthma and urticaria). Combination with local anesthetics is beneficial for local hemostasis and prolonged efficacy. Alias: adrenaline, pararenin, paranephrine.

Chinese alias: (R) -4- [2- (methylamino) -1-hydroxyethyl] -1,2-benzenediol hydrochloride

English name: L-Epinephrine Hydrochloride

English alias: (-)-3,4-dihydroxy-alpha-((methylamino) methyl) benzyl alcohol hydrochloride; (r) -4- (1-hydroxy-2- (methylamino) ethyl) -1,2-benzenediol hydrochloride ; adrenalin chloride; Adrenaline Hydrochloride; Racepinephrine HCL; 4- [1-hydroxy-2- (methylamino) ethyl] benzene-1,2-diol hydrochloride (1: 1)

Molecular weight: 255.1189

[Chinese name]: adrenaline hydrochloride

[Simplified Pinyin]: YSSSXS

[English name]: Adrenaline Hydrochloride

[Category]: Cardiovascular System Drugs \ Anti-shock Vasoactive Drugs

[Alias]

excitement

When combined with -receptor blockers, such as phenothiazine, phentolamine, phenoxybenzamine and tolazoline, and various vasodilators, it can counteract the pressure effect of this product.

Equivalent to general anesthetics such as chloroform, cyclopropane, and halothane, which can make the myocardium more sensitive to sympathomimetic amines, and there is a risk of severe ventricular arrhythmia. The amount of this product must be reduced when used together When local anesthesia is applied to the fingertips, it is not advisable to add epinephrine to the medicinal solution to avoid necrosis due to insufficient blood supply to the extremities.

Combination with digitalis can cause arrhythmias, because digitalis can make the myocardium more sensitive to adrenaline.

Combined with ergotamine, ergometrine or oxytocin, it can exacerbate vasoconstriction and cause severe hypertension or peripheral tissue ischemia.

When combined with guanethidine, the antihypertensive effect of guanethidine is weakened, and the effect of adrenaline is enhanced, leading to hypertension and tachycardia.

Combination with hypoglycemic agents can reduce the hypoglycemic effect.

Combined with oral blockers such as propranolol, the effects of the two cancel each other out. After the -blocker, the effect of the -receptor is obvious. Hypertension and bradycardia may occur. Stagnation can also antagonize the bronchiectasis effect of this product, and enhance the effect of adrenaline to constrict blood vessels. It must be used with caution.

Combination with tricyclic antidepressants can be strengthened. Epinephrine's cardiovascular effects can produce arrhythmias, high blood pressure, or tachycardia.

Combined with other sympathomimetic drugs, the cardiovascular effects of both are exacerbated and side effects are prone to occur.

Combined with nitrate drugs, the product's boosting effect is offset, hypotension can occur, and the antianginal effect of nitrate drugs is also weakened ^[1]

Relax the bronchial smooth muscles to relieve bronchospasm and control asthma attacks;

Excite the heart, increase myocardial contractility and contraction speed for cardiac resuscitation;

For severe allergic reactions, such as anaphylactic shock, bronchospasm relief, urticaria, neurovascular edema, itching of the skin, etc .;

Adding local anesthetic solution can prolong spinal nerve block time;

Correction is mainly caused by low blood volume syndrome after extracorporeal circulation;

for treatment

Common amount for adults:

For anti-allergic, first inject 0.2 to 0.5 mg subcutaneously or intramuscularly, if necessary, repeat administration every 10 to 15 minutes, the dosage can be gradually increased to 1 mg once; in anaphylactic shock, the initial dose is 0.5 mg, injected subcutaneously or intramuscularly, followed by 0.025 to 0.05 mg intravenously, if necessary, repeated administration every 5 to 15 minutes.

For hypoglycemia, a single dose of 0.3mg, subcutaneous or intramuscular injection.

Treatment of bronchospasm, the initial amount of 0.2 ~ 0.5mg, subcutaneous injection, if necessary, can be repeated every 20 minutes to 4 hours, and gradually increased to 1 mg once.

For cardiac arrest, intracardial injection or intravenous injection after dilution, once 0.1 ~ lmg, if necessary, can be repeated every 5 minutes.

Used as a vasoconstrictor during anesthesia, the concentration of epinephrine in the local anesthetic solution, the subarachnoid space block should be high (1:10 000), the total amount is 0.3mg. Local anaesthesia should be low (1: 100 000 or 1: 200 000), and the total amount should not exceed 1 mg.

Pediatric commonly used amount:

Anti-bronchial spasm, subcutaneous injection is 0.01mg / kg body weight or 0.3mg / m2 body surface area, the maximum dose is 0.5mg y times, if necessary, repeated administration once every 15 minutes, a total of 2 times, every 4 hours thereafter Times

For hypoglycemia, subcutaneous or intramuscular injection by weight 0.01mg / kg or body surface area 0.3mg / m2;

For cardiac arrest, intracardiac or intravenous injection is 0.005 0.01mg / kg according to body weight or 0.15 0.3mg / m2 according to body surface area.

Long-term or excessive use can produce drug resistance, and the drug can be given for a few days before stopping, and the effect can be restored.

Adrenaline injection with a concentration of 1: 1 000 (1 mg / ml) must be diluted before intracardiac or intravenous injection; intra-arterial injection is not recommended, which can cause significant vasoconstriction and tissue necrosis.

Repeated injections at fixed sites can cause tissue necrosis, and the injection site must be rotated.

When used in anaphylactic shock, due to the increased permeability of its blood vessels, the effective blood volume is insufficient, and blood volume must be replenished at the same time.

Cross-allergic reactions: Those who are allergic to other sympathomimetic amines, such as ephedrine, isoprenaline, norepinephrine, phenylephrine, etc., may also be allergic to this product.

This product can pass through the placental barrier, causing fetal hypoxia. Animal studies have shown teratogenic effects when administered at doses 25 times higher than the maximum human dose. Because this product can relax the uterine smooth muscle, prolong the second stage of labor, and weaken the contractions at high doses, it is not recommended for delivery. This product is used to maintain blood pressure during cesarean anesthesia, which can accelerate the fetal heartbeat. It should not be used when the maternal blood pressure exceeds 17.3 / 10.7kPa (130 / 80mmHg).

Be careful in pediatric administration, syncope has been reported in children with asthma.

The elderly are sensitive to the effects of sympathomimetic drugs and should be used with caution.

Interference to diagnosis: blood sugar and serum lactate levels may be increased when using this product.

The following situations should be used with caution:

Organic brain damage

Cardiovascular diseases, including angina pectoris, arrhythmia, enlarged heart, cerebral vascular sclerosis, coronary artery disease, and various organic heart diseases;

diabetes;

Glaucoma;

hypertension

Hyperthyroidism;

Parkinson's disease can temporarily increase stiffness and tremor;

Circulation collapse or hypotension caused by phenothiazines, blood pressure is further reduced due to the use of this product;

Symptoms of mental and neurological disorders worsen;

It is not beneficial to use this product in cardiogenic, traumatic or hemorrhagic shock.

When applying this product, you must pay close attention to changes in blood pressure, heart rate, and heart rhythm, and you must measure blood glucose changes when you use it many times.

Signs of overdose are: anxiety, skin flushing, chest pain, chills, fever, convulsions, changes in blood pressure, arrhythmia, nausea, vomiting, pale and cold skin, etc.

1. Chest pain and arrhythmia are rare reactions, but they must be noticed when they occur, and they are more common when large doses are given.

2. The following reactions must be noted when they persist: headache, anxiety, irritability, insomnia, pale, fear, tremor, dizziness, sweating, abnormally fast heartbeat or heavy feeling ^[2] .