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Antiasthma Agents during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Epinephrine has alpha and beta-adrenergic actions. It is used to relieve bronchospasm and other allergic reactions. Acute asthma attacks are treated with 0.3–0.5 mL of 1:1000 epinephrine subcutaneously every 30 min, up to three times (Table 5.2). Epinephrine use is contraindicated in those with severe hypertension, cardiac arrhythmias, and a heart rate of more than 140 beats per minute. Epinephrine is not associated with an increased frequency of congenital anomalies or adverse fetal effects. Congenital anomalies were increased in frequency among 189 women who used epinephrine during the first trimester, but not among 508 who used the drug only during the first and second trimesters (Heinonen et al., 1977). Birth defects (i.e., inguinal hernia) that were increased were not of clinical significance, and probably not causally related to the drug exposure but rather the disease being treated (i.e., inguinal hernia and preterm delivery). Maternal treatment with epinephrine readily crosses the placenta. Epinephrine is endogenous, and is released from the adrenal medulla as a stress response. Therefore, it seems reasonable to conclude that it is unlikely that epinephrine is associated with an increased risk of malformations in the fetus when used in usual therapeutic adult doses.
Food Allergy
Published in Praveen S. Goday, Cassandra L. S. Walia, Pediatric Nutrition for Dietitians, 2022
Alison Cassin, Ashley Devonshire, Stephanie Ward, Meghan McNeill
Oral allergy syndrome (OAS) or pollen food allergy syndrome (PFAS) is an adverse food reaction characterized by primarily localized oropharyngeal symptoms immediately following consumption of a food and is mediated by cross-reactivity between food and aeroallergens. Individuals with IgE to aeroallergens (e.g., birch tree, ragweed, oak tree, grass, mugwort) may have IgE that is cross-reactive with particular proteins found in fruits and vegetables. Individuals with this phenotype often develop oral and/or throat itching, difficulty swallowing, nasal and/or ear itching, and/or oropharyngeal angioedema immediately after consumption of the implicated food. In less than 5% of cases, patients develop systemic symptoms or anaphylaxis. Interestingly, a large number of patients with OAS can tolerate the implicated food without symptoms when it has been peeled and/or cooked. OAS is largely managed by avoidance of the fruits and/or vegetables implicated, in either raw and/or cooked form, depending on symptom severity. Patients who experience severe symptoms should carry an an epinephrine auto-injector.
Monographs of Topical Drugs that Have Caused Contact Allergy/Allergic Contact Dermatitis
Published in Anton C. de Groot, Monographs in Contact Allergy, 2021
Epinephrine (adrenaline) is the active sympathomimetic hormone from the adrenal medulla. It stimulates both the α- and β-adrenergic systems, causes systemic vasoconstriction and gastrointestinal relaxation, stimulates the heart, and dilates bronchi and cerebral vessels. Epinephrine injections are used in the emergency treatment of allergic reactions (Type I) including anaphylaxis to insects, allergen immunotherapy, foods, drugs, diagnostic testing substances (e.g. radiocontrast media) and other allergens, as well as idiopathic or exercise-induced anaphylaxis. This agent is also used in hay fever, rhinitis, acute sinusitis, bronchial asthmatic paroxysms, syncope due to complete heart block or carotid sinus hypersensitivity, serum sickness, urticaria, angioedema, for resuscitation in cardiac arrest following anesthetic accidents, in simple (open-angle) glaucoma, for relaxation of uterine musculature and to inhibit uterine contractions. Epinephrine can also be utilized to prolong the action of local anesthetics, for the maintenance of mydriasis during intraocular surgery and as a hemostatic agent. In addition, epinephrine is used as an over-the- counter agent for the intermittent symptoms of asthma, such as wheezing, tightness of the chest and shortness of breath.
History of asthma in Canada
Published in Canadian Journal of Respiratory, Critical Care, and Sleep Medicine, 2022
Acute asthma treatment throughout the first half of the 20th century was dominated by the use of parenteral epinephrine.39–43 Epinephrine, a nonselective α and ß adrenergic agonist and an important autonomic neurotransmitter, was identified in 1901 and synthesized in 1904.44 Toward the end of this half-decade, mention is made of the acute use of nebulized epinephrine.43 Atropine received occasional mention39,41 but was regarded as less reliable.41 Aminophylline, administered either intravenously or rectally, was added to the treatment of acute asthma in the 1940s.42–43 The remainder of treatments were nonspecific and included morphine,41 ether,41 chloroform,41 potassium iodide,39,40 amyl nitrate1,3 and others.
Clinical electrophysiology of the aging heart
Published in Expert Review of Cardiovascular Therapy, 2022
Kyle Murray, Muizz Wahid, Kannayiram Alagiakrishnan, Janek Senaratne
Epinephrine/dopamine can be used in patients where atropine/isoproterenol is insufficient to stabilize the patient and transvenous pacing is not feasible or not yet implemented. Both medications increased SAN rates and improved AVN conduction. Epinephrine has strong alpha- and beta-adrenergic effects increasing inotropy, chronotropy, BP, and myocardial oxygen demand. Epinephrine requires central access with a usual dose of 1–10 mcg/min. Dopamine has alpha-adrenergic, beta-adrenergic, and dopaminergic effects depending on infusion rates. Lower infusion rates (1–5 mcg/min) cause vasodilation, while higher rates (5–20 mcg/min) enhance alpha-adrenergic and beta-adrenergic effects increasing inotropy and chronotropy. Dopamine can be infused peripherally or centrally though [37].
Scoping review of complications associated with epinephrine use in arthroscopy fluid
Published in The Physician and Sportsmedicine, 2021
Taher Abdelrahman, Scott Tulloch, Kate Lebedeva, Ryan M. Degen
The incidence of epinephrine-related complications when used in irrigation during arthroscopic procedures is unknown. Cho et al however noted their experience which is 2 in 2000 cases or an incidence of 1:1000 [3]. To our knowledge, there are no guidelines in the literature with regards to this use of epinephrine. Epinephrine is an adrenergic alpha-agonist, and adrenergic beta-agonist. Stimulating vascular alpha-adrenergic receptors, it causes vasoconstriction, increasing the blood pressure. Beta-1 receptor-stimulating effect, increases the force and rate of myocardial contraction. Epinephrine-induced pulmonary edema has been reported in the literature and is thought to be dose-related [24]. Both endogenous and exogenous catecholamines can induce pulmonary edema. The proposed mechanism of action is through alpha-adrenergic stimulation with increased pulmonary arterial and capillary pressure, which can be maintained and aggravated by inflammation and disruption of the alveolar-capillary barrier. Beta-adrenergic stimulation increases cardiac output and leads to generalized vasodilation, with ensuing pulmonary overperfusion [25].