• KIGALI HEALTH INSTITUTE• ALLIED HEALTH SCIENCES• DENTAL DEPARTMENT

• GROUP FIVE PRESENTATION

• Index number:• AHSL2/06/0105• AHSL2/06/0488• AHSL2/06/0654• AHSL2/06/0277• AHSL2/06/0888

EPINEPHRINE

• Epinephrine is a hormone and a neurotransmitter known as adrenaline. It is a catecholamine, a sympathomimetic monoamine derived from the amino acids phenylalanine and tyrosine.

• Epinephrine is the fight or flight hormone which is released from the adrenal glands.

• Epinephrine plays a central role in the short-term stress reaction the physiological response to threatening, exciting or environmental stressor conditions (high noise levels )

• When released into the bloodstream, epinephrine binds to multiple receptors and has numerous effects throughout the body.

• Many actions take place after the adrenaline is released in the body. The supply of oxygen and glucose to muscles and the brain is increased.

• There is a rise in stroke volume and the heart rate increases. Stroke volume is the volume or quantity of blood pumped by a ventricle due to a single heart beat.

Role of epinephrine

• It increases heart rate• dilates the pupils, • Constricts blood vessels and dilates air passage. • It elevates blood sugar levels by increasing

catalysis of glycogen to glucose and at the same time begins the breakdown of lipids in fat cells.

• Like other stress hormones, epinephrine has a suppressive effect on the immune system.

Epinephrine stimulation

• It stimulates alpha and beta adrenergic receptors in dose-related fashion.

• It is the initial drug of choice for treating bronchoconstriction and hypotension resulting from anaphylaxis as well as all forms of cardiac arrest.

• It is useful in managing reactive airway disease.

• Rapid injection produces a rapid increase in systolic pressure, ventricular contractility, and heart rate.

• It antagonizes the effects of histamine.

Medical uses of epinephrineCardiac arrest

• Adrenaline is used as a drug to treat cardiac arrest and other cardiac dysrhythmias resulting in altering cardiac output leading to normal.

• Its actions are to increase peripheral resistance, and to increase cardiac output.

• Cardiac dysrhythmia AKA arrhythmia is a term for any of a large and heterogeneous group of conditions in which there is abnormal electrical activity in the heart. The heart beat may be too fast or too slow, and may be regular or irregular.

• Some arrhythmias are life-threatening medical emergencies that can result in cardiac arrest and sudden death

Anaphylaxis• Due to its vasoconstrictive effects, adrenaline is the

drug of choice for treating anaphylaxis. It is also useful in treating sepsis.

• Allergy patients undergoing immunotherapy may receive an adrenaline rinse before the allergen is administered, thus reducing the immune response to the administered allergen.

Croup (laryngotracheobronchitis)

• Epinephrine has historically been used for the treatment of croup. Epinephrine is a 1:1 mixture of the dextrorotatory (D) and levorotatory (L) isomers of epinephrine. The L form is the active component.

• Epinephrine works by stimulation of the α-adrenergic receptors in the airway with resultant mucosal vasoconstriction and decreased subglottic edema and by stimulation of the β-adrenergic receptors with resultant relaxation of the bronchial smooth muscle.

In local anesthetics

• Epinephrine is added to injectable forms of a number of local anesthetics, such as bupivacaine and lidocaine, as a vasoconstrictor to retard the absorption and therefore prolong the action of the anesthetic agent.

Mechanism of action• As a hormone, epinephrine acts on nearly all

body tissues. • Its actions vary by tissue type and tissue

expression of adrenergic receptors.

• For example, epinephrine causes smooth muscle relaxation in the airways but causes contraction of the smooth muscle that lines most arterioles.

Mechanism ctn…• Epinephrine acts by binding to a variety of adrenergic

receptors. Epinephrine's binding to these receptors triggers a number of metabolic changes.

• Binding to α-adrenergic receptors inhibits insulin secretion by the pancreas, stimulates glycogenolysis in the liver and muscle, and stimulates glycolysis in muscle.

• β-adrenergic receptor binding triggers glucagon secretion in the pancreas, increased adrenocorticotropic hormone (ACTH) secretion by the pituitary gland, and increased lipolysis by adipose tissue

Mechanism ctn…• Together, these effects lead to increased blood

glucose and fatty acids, providing substrates for energy production within cells throughout the body.

• In addition to these metabolic changes, epinephrine also leads to broad alterations throughout all organ systems.

Physiologic responses to epinephrine by organ

• Organ

• Heart• Lungs

• Nearly all tissues

• Liver

• systemic• systemic

• Effects

• Increases heart rate• Increases respiratory rate

• Vasoconstriction or vasodilation

• Stimulates glycogenolysis

• Triggers lipolysis• Muscle contraction

Adverse effects of epinephrine

Adverse reactions to epinephrine include :• palpitations• tachycardia • anxiety • headache • tremor • hypertension• pulmonary edema.

Insulin shock / Hypoglycemia

What is Insulin Shock?

• Insulin shock occurs when the level of your blood sugar drops quickly and leads to unconsciousness.

• It is a severe form of hypoglycemia (low blood sugar) and can be fatal if not treated in a timely manner. Insulin shock is considered a diabetes emergency.

Symptoms of Insulin shock

• The most common early warning symptoms are feeling: • confused • tired • hungry • shaky • sweaty • anxious • If these symptoms are left untreated, it could lead to

insulin shock and result in seizures, coma or even death.

Prevention

• To prevent insulin shock you must learn how your body shows symptoms of hypoglycemia

• When a person does go into insulin shock and loses consciousness the rapid intervention is:

• To administer an injection of glucagon to help the person regain consciousness and bring blood sugar levels back into a safe range.

• If a glucagon injection does not bring the person back to consciousness within a few minutes, emergency personnel should be called.

Hypoglycemia

• Hypoglycemia is the medical term for a state produced by a lower than normal level of blood glucose.

• The symptoms of hypoglycemia can vary from person to person, as can the severity.

• Classically, hypoglycemia is diagnosed by a low blood sugar with symptoms that resolve when the sugar level returns to the normal range.

• Blood sugar below 70 mg/dL is considered low. Blood sugars at this level can harm you.

Causes hypoglycemia

Hypoglycemia occurs when:

• Your body's sugar (glucose) is used up too quickly• Glucose is released into the bloodstream too slowly• Too much insulin is released into the bloodstream

• Insulin is a hormone that reduces blood sugar. It is produced by the pancreas in response to increased glucose levels in the blood.

Risk factors of hypoglycemia

• Hypoglycemia is relatively common in persons with diabetes.

If you have diabetes and you are taking any of the following diabetes medications, you have a risk for low blood sugar:

• Chlorpropamide (Diabinese)• tolazamide (Tolinase)

• acetohexamide (Dymelor)• glipizide (Glucotrol)• tolbutamide (Orinase)

• Glyburide (Micronase)• glimepiride (Amaryl)• repaglinide (Prandin)• Insulin

If you have diabetes, low blood sugars may occur when:

• You take too much insulin or diabetes medicine

• You don't eat enough food• You suddenly increase your exercise without

increasing the amount of food you eat

• Relative hypoglycemia is a fairly common condition in which a newborn's blood sugar is low.

• Babies born to mothers with diabetes may have severe hypoglycemia.

• Idiopathic hypoglycemia is hypoglycemia that occurs without a known cause. People with this type of hypoglycemia do not have diabetes.

Hypoglycemia may also be caused by:

• Ingestion of alcohol• Insulinoma a tumor in the pancreas that

produces too much insulin• Liver disease

Symptoms of hypoglycemia

• Cold sweats• Convulsions• Double vision or blurry vision• Fast or pounding heartbeat• General discomfort, uneasiness, or ill feeling

(malaise)• Headache• Hunger

• Irritability (possible aggression)• Nervousness • Shaking or trembling• Sleeping difficulty• Tingling or numbness of the skin• Tiredness or weakness• Unclear thinking

Sometimes your blood sugar may be too low, even if you do not have symptoms.

If your blood sugar gets too low, you may:

• Faint• Have a seizure• Go into a coma

Treatment of hypoglycemia

Treatment depends on the cause.

• If you have diabetes, check your blood sugar level whenever you have symptoms of low blood sugar. If your blood sugar is low (70 mg/dl), you need to treat yourself right away.

• Eat something that has about 15 grams of carbohydrates.

Some examples are

• 3 glucose tablets• A 1/2 cup (4 ounces) fruit juice or regular,

non-diet soda• 5 or 6 hard candies• 1 tablespoon sugar, plain or dissolved in water• 1 tablespoon honey or syrup

• Persons with severe hypoglycemia are treated with glucose injections or the hormone glucagon. Immediate treatment is needed to prevent serious complications or death.

• Hypoglycemia due to drug overdose or effect is supported with extra glucose until the drugs have been metabolized. The drug doses or combination often needs to be altered.

• If hypoglycemia is caused by an insulinoma (insulin-secreting tumor), surgery to remove the tumor is the best treatment.

Hyperinsulinism due to diffuse overactivity of beta cells, such as in many of the forms of congenital hyperinsulinism is treated by:

• diazoxide that is given by mouth and• Octreotide that is given by injection.

• In more severe cases of persistent congenital hyperinsulinism unresponsive to drugs, a near-total pancreatectomy may be needed to prevent continuing hypoglycemia