에피네프린

알파 및 베타 아드레날린 수용체 작용제

**에피네프린**(일반적으로 아드레날린으로 알려짐)은 부신 수질에서 생성되는 강력한 내인성 카테콜아민입니다. 교감신경계의 주요 "투쟁-도피" 호르몬입니다. 수의학에서는 주로 다음과 같은 목적으로 사용되는 필수적인 응급 구명 약물입니다: * **심폐뇌소생술(CPCR):** 심정지(무수축) 시 자발순환을 회복시키기 위해 사용. * **중증 아나필락시스:** 기관지 확장 및 혈관 수축을 유도하여 생명을 위협하는 알레르기 반응을 신속하게 역전시키기 위해 사용. * **국소 마취 보조제:** 국소 마취제(예: 리도카인)에 첨가하여 국소 혈관 수축을 유도함으로써 전신 흡수를 지연시키고 마취 효과를 연장하며 시술 부위의 출혈을 줄임. > **임상 요점:** 에피네프린은 매우 강력하며 치료 지수가 매우 좁습니다. 올바른 농도를 사용하도록 각별한 주의를 기울여야 합니다. **1:1,000(1 mg/mL) 농도와 1:10,000(0.1 mg/mL) 농도를 절대 혼동하지 마십시오.**

작용 기전: Epinephrine is a direct-acting, non-selective adrenergic agonist that stimulates both alpha (α) and beta (β) receptors via G-protein coupled pathways (activating **adenylyl cyclase** → ↑ **cAMP**). * **α1-receptors:** → Induces profound smooth muscle contraction and vasoconstriction, increasing systemic vascular resistance and blood pressure. * **β1-receptors:** → Directly stimulates the heart, increasing both chronotropy (heart rate) and inotropy (contractility), which increases cardiac output and myocardial oxygen demand. * **β2-receptors:** → Relaxes smooth muscle, leading to profound bronchodilation (relieving bronchospasm in anaphylaxis), vasodilation in skeletal muscle, and increased glycogenolysis (raising blood sugar). * **Histamine Antagonism:** Physiologically antagonizes the effects of histamine released during anaphylaxis. *Hemodynamic effects depend on the route and rate of administration:* Rapid IV injection causes direct cardiac stimulation and increased systolic BP. Slow IV infusion produces a modest rise in systolic pressure, a decrease in diastolic pressure, and decreased total peripheral resistance due to dominant β2 effects.

동물 종별 용량

Goats

Anaphylaxis · 0.5-1 mL/100 lbs. body weight of 1:1,000 (dilute to 1:10,000 if using IV) · SC, IM, IV · may be repeated at 15 minute intervals · Often used in conjunction with corticosteroids and diphenhydramine.

Sheep

Anaphylaxis · 0.5-1 mL/100 lbs. body weight of 1:1,000 (dilute to 1:10,000 if using IV) · SC, IM, IV · may be repeated at 15 minute intervals · Often used in conjunction with corticosteroids and diphenhydramine.

Dogs

Cardiac resuscitation (asystole) · 0.01 mg/kg · IV · Repeat every 3-5 minutes if no return of spontaneous circulation (ROSC) · Part of CPCR protocol after ABCs. Vasopressin may be alternated.
Cardiac resuscitation · 0.1-0.2 mg/kg (high dose) or 0.01-0.02 mg/kg (low dose) · IV or IO · Repeat at 3-5 minute intervals if no response · Low dose generally attempted first.
Cardiac resuscitation · 0.01-0.02 mg/kg (IV) or 0.03-0.1 mg/kg (IT) · IV, IT · every 3-5 minutes · For IT, dilute in 5-10 mL of sterile water or normal saline.
Neonatal resuscitation (when respiratory support/compressions fail) · 0.1-0.3 mg/kg · IV or IO
Anaphylaxis · 0.01-0.02 mg/kg · IV, IT, IM, SC · Dosage may be doubled and given via endotracheal tube if IV line not established. Less severe cases may use IM or SC.
Anaphylaxis · 0.2-0.5 mg (total dose) · SC or IM

투여 경로

IVIMSCIOIntratracheal (IT)IntracardiacCRITopicalInhalation

금기

Narrow-angle glaucoma
Hypersensitivity to epinephrine
Shock due to non-anaphylactoid causes
During general anesthesia with halogenated hydrocarbons or cyclopropane
During labor (may delay the second stage)
Cardiac dilatation or coronary insufficiency
Conditions where vasopressors are contraindicated (e.g., thyrotoxicosis, diabetes, hypertension, toxemia of pregnancy)
Injection with local anesthetics into small appendages (toes, ears, etc.) due to risk of necrosis

이상반응

Anxiety and fear
Tremors and excitability
Vomiting
Hypertension (especially with overdosage)
Cardiac arrhythmias (especially with pre-existing heart disease)
Hyperuricemia
Lactic acidosis (with prolonged use or overdose)
Tissue necrosis and sloughing at the injection site (with repeated injections or injection into small appendages)

약물 상호작용

Alpha-blockers (phentolamine, phenoxybenzamine, prazosin) · May negate the therapeutic effects of epinephrine.
Alpha-2 agonists (detomidine, dexmedetomidine, xylazine) · Do NOT use epinephrine to treat cardiac effects caused by alpha-2 agonists; may worsen hemodynamics.
General Anesthetics (halogenated hydrocarbons, cyclopropane) · Increased risk of developing severe arrhythmias. Propranolol may be used to treat if they occur.
Antihistamines (diphenhydramine, chlorpheniramine) · May potentiate the effects of epinephrine.
Beta-blockers (propranolol) · May potentiate hypertension and antagonize epinephrine's cardiac and bronchodilating effects.
Digoxin · Increased risk of arrhythmias if used concurrently.
Nitrates · May reverse the pressor effects of epinephrine.
Levothyroxine · May potentiate the effects of epinephrine.
Oxytocic agents · Hypertension may result if used concurrently. · moderate
Other Sympathomimetic agents (isoproterenol) · Should not be administered together as increased toxicity may result.
Phenothiazines · May reverse the pressor effects of epinephrine.
Reserpine · May potentiate the pressor effects of epinephrine.

모니터링

Cardiac rate and rhythm (ECG)
Respiratory rate and auscultation (especially during anaphylaxis)
Urine flow (if possible)
Blood pressure
Blood gases (if indicated and possible)

과용량

Clinical signs of overdosage or inadvertent IV administration of SC/IM doses include: * Sharp rises in systolic, diastolic, and venous blood pressures * Cardiac arrhythmias * Pulmonary edema and dyspnea * Vomiting, headache, and chest pain * Cerebral hemorrhages (due to severe hypertension) * Renal failure, metabolic acidosis, and cold skin **Treatment:** Because epinephrine has a relatively short duration of effect, treatment is mainly supportive. If necessary, an alpha-adrenergic blocker (e.g., phentolamine) or a beta-adrenergic blocker (e.g., propranolol) can be used to treat severe hypertension and cardiac arrhythmias. Prolonged periods of hypotension may follow, requiring treatment with norepinephrine.

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