Introduction

Adrenaline(also known asepinephrine,or,3,4trihydroxy-N-methylphenethylamine) is a hormone and

a neurotransmitter
Epinephrine and norepinephrine are two separate but
related hormones secreted by the medulla of the
adrenal glands. They are also produced at the ends of
sympathetic nerve fibres, where they serve as chemical

The investigation of thepharmacology of epinephrine made a

major contribution to the understanding of theautonomic
system and the function of thesympathetic system.
Epinephrine remains a useful medicine for several emergency

indications. The influence of adrenaline is mainly limited to

ametabolic effect and bronchodilation effect on organs devoid
of direct sympatheticinnervation
In chemical terms, adrenaline is one of a group
ofmonoaminescalled the catecholamines. It is produced in
someneuronsof the central nervous system, and in the
chromaffin cells of theadrenal medullafrom the amino
acidsphenylalanine andtyrosine

Adrenaline structure

Medical Uses

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
1receptor-dependent vasoconstriction and to increase cardiac
output via its binding to 1receptors. The goal of reducing
peripheral circulation is to increase coronary and cerebral
perfusion pressures and therefore increase oxygen exchange at
the cellular level While epinephrine does increase aortic,

Anaphylaxis
Adrenaline is the drug of choice for treating anaphylaxis. Allergy
patients undergoing immunotherapy may receive an adrenaline rinse
before the allergen extract is administered, thus reducing the immune
response to the administered allergen.
Different strengths, doses and routes of administration of epinephrine
are used for several medical emergencies. The commonly used Epipen
Auto-Injector delivers 0.3 mg epinephrine injection (0.3 mL, 1:1000) is
indicated in the emergency treatment of allergic reactions (Type I)
including anaphylaxis to stings, contrast agents, medicines or patients
with a history of anaphylactic reactions to known triggers

Asthma
Adrenaline is also used as a bronchodilator for asthma if specific
2 agonists are unavailable or ineffective When given by the
subcutaneous or intramuscular routes for asthma, an appropriate
dose is 300-500 mcg

Croup
1:1 mixture of the dextrorotatory (d) and levorotatory (l) isomers of
adrenaline the l- form is the active component Racemic adrenaline
works by stimulation of the -adrenergic receptors in the airway,
with resultant mucosal vasoconstriction and decreased subglottic
edema, and by stimulation of the -adrenergic receptors, with

Local anesthetics
Adrenaline is added to injectable forms of a number of local
anesthetics, such as bupivacaine and lidocaine, as a vasoconstrictor
to slow the absorption and, therefore, prolong the action of the
anesthetic agent. Due to epinephrine's vasoconstricting abilities, also
helps to diminish the total blood loss the patient sustains during minor
surgical procedures. Some of the adverse effects of local anesthetic
use, such as apprehension, tachycardia, and tremor, may be caused
by adrenaline.

Mechanism of action
As a hormone and neurotransmitter, adrenaline acts on nearly all body
tissues. Its actions vary by tissue type and tissue expression of adrenergic
receptors. For example, high levels of 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 the major subtypes 1, 2, 1, 2, and 3 adrenaline 's binding to
these receptors triggers a number of metabolic changes. Binding to adrenergic receptors inhibits insulin secretion by the pancreas, stimulates
glycogenolysis in the liver and muscle, and stimulates glycolysis in muscle
-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

Biosynthesis
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, epinephrine. Tyrosine is first oxidized
to L-DOPA, which is subsequently decarboxylated to give dopamine.
Oxidation gives norepinephrine. The final step in epinephrine
biosynthesis is the methylation of the primary amine of noradrenaline.
This reaction is catalyzed by the enzyme phenylethanolamine Nmethyltransferase (PNMT) which utilizes S-adenosylmethionine (SAMe)
as the methyl donor While PNMT is found primarily in the cytosol of the
endocrine cells of the adrenal medulla (also known as chromaffin cells),
it has been detected at low levels in both the heart and brain

Adrenaline Biosynthesis

Overdose
After overdosage or inadvertent intravenous administration of
usual intramuscular subcutaneous doses of Adrenaline systolic
and diastolic blood pressure rise sharply; venous pressure also
rises. Cerebrovascular or other haemorrhages and hemiplegia
may result, especially in elderly patients. Pulmonary oedema
may occur.
Adrenaline overdosage causes transient bradycardia followed
by tachycardia and may cause other potentially fatal cardiac
arrhythmias Kidney failure, metabolic acidosis and cold white
skin

Treatment
The pressor effects of Adrenaline may be counteracted by an
immediate intravenous injection of a quick-acting alphaadrenoreceptor blocking agent such as 5-10 mg of phentolamine
mesylate, followed by a beta-adrenoreceptor blocking agent, such as
2.5 - 5 mg of propranolol. Arrhythmias, if they occur, may be
counteracted by propranolol injection

ADRENALINE SIDE EFFECTS

Pounding in the chest (palpitations)
Fast heartbeat (tachycardia)
High blood pressure (hypertension)
Sweating
Nausea
Vomiting
Breathing difficulties
Paleness
Dizziness
Weakness
Tremor
Headache
Anxiety and restlessness
Irregular heartbeat rhythm (arrhythmias)

Chest pain
Low blood sugar (hypoglycaemia)
Cold extremities
Fluid on the lung (pulmonary
oedema)
Bleeding in the brain (cerebral
haemorrhage)