Adrenaline
Class
- a catecholamine
Mechanism of Action
- direct acting sympatheomimetic -> alpha & beta agonist
- low doses -> beta-effects -> increase HR and Q
- higher doses -> alpha-effects
- maintains coronary & cerebral blood flow
Pharmaceutics
- opaque ampoule (1:1000), mini jets
Dose
- bolus -> 0.01 -> 0.5mcg/kg/min IV (give through CVL for safety)
Indications
- Anaphylactic/oid shock
- Asystole
- Low cardiac output states
- Glaucoma
- Local vasoconstictor
- Added to LA to increase duration of action
Adverse Effects
- hypokalaemia
- hypophosphataemia
- hyperglycaemia
- lactataemia
- caution with MAO-I
PK
- Absorption – IV, IM, nebulised, topical
- Distribution –
- Metabolism – hepatic + adrenergic nerve endings (COMT and MAO)
- Elimination – inactive products appear in urine
Evidence
CAT Study Investigators (2009 – Int Care Med)
- Australasian Trial
- RCT looking at Noradrenaline vs Adrenaline to treat hypotension (sepsis or cvs failure)
- n = 208
- -> no significant difference in mortality, LOS, ventilation, shock duration
- -> adrenaline – transient lactic acidosis, hyperglycaemia, tachycardia
Annane (2007, Lancet)
- MRCT
- noradrenaline vs adrenaline in septic shock
- n = 330
- -> no significant difference in mortality, BP, time to haemodynamic stability, duration of vasopressor therapy, time to organ dysfunction resolution, adverse effects
SUMMARY
Myburg (2008) – “The case for Adrenaline” Critical Care and Resuscitation, Volume 10 (3) page 178
- poor quality evidence
-> no difference in outcomes
References and Links
CCC Pharmacology Series
Respiratory: Bosentan, Delivery of B2 Agonists in Intubated Patients, Nitric Oxide, Oxygen, Prostacyclin, Sildenafil
Cardiovascular: Adenosine, Adrenaline (Epinephrine), Amiodarone, Classification of Vasoactive drugs, Clevidipine, Digoxin, Dobutamine, Dopamine, Levosimendan, Levosimendan vs Dobutamine, Milrinone, Noradrenaline, Phenylephrine, Sodium Nitroprusside (SNiP), Sotalol, Vasopressin
Neurological: Dexmedetomidine, Ketamine, Levetiracetam, Lignocaine, Lithium, Midazolam, Physostigmine, Propofol, Sodium Valproate, Sugammadex, Thiopentone
Endocrine: Desmopressin, Glucagon Therapy, Medications and Thyroid Function
Gastrointestinal: Octreotide, Omeprazole, Ranitidine, Sucralfate, Terlipressin
Genitourinary: Furosemide, Mannitol, Spironolactone
Haematological: Activated Protein C, Alteplase, Aprotinin, Aspirin, Clopidogrel, Dipyridamole, DOACs, Factor VIIa, Heparin, LMW Heparin, Protamine, Prothrombinex, Tenecteplase, Tirofiban, Tranexamic Acid (TXA), Warfarin
Antimicrobial: Antimicrobial Dosing and Kill Characteristics, Benzylpenicillin, Ceftriaxone, Ciprofloxacin, Co-trimoxazole / Bactrim, Fluconazole, Gentamicin, Imipenem, Linezolid, Meropenem, Piperacillin-Tazobactam, Rifampicin, Vancomycin
Analgesic: Alfentanil, Celecoxib, COX II Inhibitors, Ketamine, Lignocaine, Morphine, NSAIDs, Opioids, Paracetamol (Acetaminophen), Paracetamol in Critical Illness, Tramadol
Miscellaneous: Activated Charcoal, Adverse Drug Reactions, Alkali Therapies, Drug Absorption in Critical Illness, Drug Infusion Doses, Epidural Complications, Epidural vs Opioids in Rib Fractures, Magnesium, Methylene Blue, Pharmacology and Critical Illness, PK and Obesity, PK and ECMO, Sodium Bicarbonate Use, Statins in Critical Illness, Therapeutic Drug Monitoring, Weights in Pharmacology
Toxicology: Digibind, Flumazenil, Glucagon Therapy, Intralipid, N-Acetylcysteine, Naloxone, Propofol Infusion Syndrome
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
His one great achievement is being the father of three amazing children.
On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.
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