에페드린

교감신경 흥분성 기관지 확장제 / 승압제

에페드린은 비카테콜아민계 교감신경 흥분성 아민입니다. 수의학에서는 주로 개와 고양이의 **요도 괄약근 기능 부전(USMI)** 관리에 사용되지만, 중추신경계 부작용 발생률이 낮은 페닐프로판올아민(PPA)이 더 선호되는 경우가 많습니다. 또한 마취로 인한 저혈압을 치료하기 위한 주사용 **승압제** 및 호흡기 질환을 위한 **기관지 확장제**로도 사용됩니다. > **임상 요점:** 에페드린은 다른 많은 교감신경 흥분제보다 혈액-뇌 장벽을 더 쉽게 통과하기 때문에 경도에서 중등도의 중추신경계 자극을 유발할 수 있으며, 일부 환자에서는 안절부절못하거나 흥분하는 증상으로 나타납니다.

작용 기전: Ephedrine is a **mixed-acting sympathomimetic**. - **Indirect Action (Primary):** It enters the sympathetic nerve terminal and promotes the release of stored **norepinephrine** into the synaptic cleft. - **Direct Action (Secondary):** It directly stimulates **α- and β-adrenergic receptors**. **Key Pathways:** - **α1-receptors** → Smooth muscle contraction → Increased internal urethral sphincter tone (improving continence) and peripheral vasoconstriction (increasing blood pressure). - **β1-receptors** → Positive inotropic and chronotropic effects on the heart → Increased cardiac output. - **β2-receptors** → Smooth muscle relaxation → Bronchodilation. > **Note:** Because it relies heavily on endogenous norepinephrine stores, repeated frequent dosing can deplete these stores, leading to **tachyphylaxis** (diminished response over time).

동물 종별 용량

Cats

Treatment of bronchospasm (emergency treatment) · 2-5 mg PO · PO · Once
Treatment of urinary incontinence · 2-4 mg (total dose) PO q8h · PO · q8h
Treatment of urinary incontinence · 2-4 mg/kg PO q6-12h or 2-4 mg (total dose) PO q8h · PO · q6-12h or q8h
Treatment of urinary incontinence · 2-4 mg per cat PO q8-12h · PO · q8-12h
Treatment of hypotension associated with anesthesia · 0.15-0.25 mg/kg IV boluses OR CRI at 5-10 micrograms/kg/minute · IV · To effect or CRI · Dilute into 5 mL of a balanced electrolyte solution or saline and give small increment IV boluses until desirable blood pressure achieved.
Hypotension during anaesthesia · Dose not specified in monograph · IV/IM · As needed · Perioperative · Use with caution.
Nasal congestion (cat 'flu') · Dose not specified in monograph · topical · Not specified · Short-term · Proposed for treatment of nasal congestion; may be of some benefit.

Dogs

Treatment of bronchospasm (maintenance therapy) · 1-2 mg/kg PO q8-12h · PO · q8-12h
Treatment of bronchospasm · 2 mg/kg PO q8-12h · PO · q8-12h
Treatment of urinary incontinence · 5-15 mg (total dose) PO q8h · PO · q8h

투여 경로

POIVIMSCIntranasal

금기

Severe cardiovascular disease
Cardiac arrhythmias
Pregnancy
Lactation
Glaucoma

이상반응

Restlessness
Irritability
Tachycardia
Hypertension
Anorexia
Tachyphylaxis (decreased response to subsequent doses)
Panting
Mydriasis (dilated pupils)
CNS stimulation (restlessness, agitation)
Atrial fibrillation
Vasoconstriction
Reduction of intestinal wall motility and tone

약물 상호작용

Acepromazine (and other phenothiazines) · Phenothiazines block alpha-adrenergic receptors; concomitant use can lead to unopposed beta-activity causing vasodilation and increased cardiac rate.
Alpha-blockers (e.g., phentolamine, prazosin) · May negate the therapeutic effects of ephedrine.
General Anesthetics (cyclopropane, halogenated hydrocarbons) · Increased risk of arrhythmias. Propranolol may be administered should these occur.
Beta-blockers · Concomitant use may diminish the effects of both drugs.
Digoxin · Increased risk of arrhythmias if used concurrently. · major
Monoamine Oxidase Inhibitors (including amitraz) · Should not be given within two weeks of receiving MAOIs; severe hypertension and hyperpyrexia are possible.
Other Sympathomimetic Agents (e.g., phenylpropanolamine) · Should not be administered together as increased toxicity may result.
Reserpine · May reverse the pressor effects of ephedrine.
Theophylline · May increase the risk for theophylline toxicity. · moderate
Tricyclic Antidepressants · May decrease the pressor effects of ephedrine.
Urinary Alkalinizers (e.g., sodium bicarbonate, citrates, carbonic anhydrase inhibitors) · May reduce urinary excretion of ephedrine and prolong its duration of activity, potentially requiring dosage adjustments.

모니터링

Clinical effectiveness (resolution of incontinence, improved blood pressure, or bronchodilation)
Heart rate and rhythm
Blood pressure
Behavioral changes (restlessness, irritability)
Heart rate and rhythm (ECG during anaesthesia)
Resolution of urinary incontinence
Signs of CNS stimulation or excessive panting

과용량

Clinical signs of overdosage may consist of an exacerbation of adverse effects (restlessness, tachycardia). In a **very large overdose**, severe cardiovascular signs (hypertension leading to rebound hypotension, bradycardias to tachycardias, and cardiovascular collapse) or CNS effects (ranging from severe stimulation to coma) can be seen. **Treatment:** - If the overdose was recent, empty the stomach using usual precautions. - Administer activated charcoal and a cathartic. - Treat clinical signs supportively as they occur.

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