Pharmacology of Adrenaline and Glucagon
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Questions and Answers

What is the recommended administration route for adrenaline in severe acute anaphylactic reactions to achieve the fastest effect?

  • Intravenous (IV)
  • Sublingual (SL)
  • Subcutaneous (SC)
  • Intramuscular (IM) (correct)

    • What type of adrenergic receptors does adrenaline primarily stimulate to produce its effects?

  • Muscarinic and nicotinic receptors
  • Gamma and delta receptors
  • α and β adrenergic receptors (correct)
  • Only β adrenergic receptors

    • How often can adrenaline be administered if symptoms persist during an anaphylactic reaction?

  • Every 5 minutes (correct)
  • Once per hour
  • Every 15 minutes
  • Every 10 minutes

    • Which of the following statements about adrenaline's pharmacokinetics is accurate?

    <p>Adrenaline is readily excreted in urine. (D)</p> Signup and view all the answers

    What is the correct formulation and dosage for emergency self-injection using an EpiPen?

    <p>0.3 mg in 0.3 mL of 1:1,000 solution (C)</p> Signup and view all the answers

    What is the primary indication for administering glucagon?

    <p>For severe hypoglycemic reactions when oral glucose cannot be taken (D)</p> Signup and view all the answers

    What is the maximum duration of hyperglycemic action after an IV or IM injection of glucagon?

    <p>60-90 minutes (C)</p> Signup and view all the answers

    Which substance is recommended for administration when a patient is conscious and experiencing mild to moderate hypoglycemia?

    <p>10-20 g of rapid-acting glucose (B)</p> Signup and view all the answers

    What mechanism helps carbonation in a non-diet carbonated beverage benefit the treatment of hypoglycemia?

    <p>It dilates the esophageal and gastric sphincters (A)</p> Signup and view all the answers

    In the case of a blood glucose measurement below 70 mg/dL, what is the recommended immediate glucose administration?

    <p>15-20 g of glucose (C)</p> Signup and view all the answers

    What is a severe symptom of adrenaline/epinephrine overdose?

    <p>Rapid increase in blood pressure (B)</p> Signup and view all the answers

    Which of the following is a recommended treatment for adrenaline/epinephrine overdose?

    <p>Fast-acting vasodilators (B)</p> Signup and view all the answers

    In cases of suspected myocardial infarction, aspirin serves what primary purpose?

    <p>Antiplatelet action (A)</p> Signup and view all the answers

    Which demographic should NOT be administered aspirin due to its contraindications?

    <p>Patients with asthma (C)</p> Signup and view all the answers

    What is NOT a lesser side effect of adrenaline/epinephrine?

    <p>Insomnia (A)</p> Signup and view all the answers

    Glucagon has which of the following actions in the body?

    <p>Induces breakdown of liver glycogen (B)</p> Signup and view all the answers

    What is the correct storage recommendation for glucagon?

    <p>Refrigerated between 2 - 8°C (A)</p> Signup and view all the answers

    Which symptom is NOT associated with adrenaline/epinephrine side effects?

    <p>Frequent urination (D)</p> Signup and view all the answers

    What is the primary function of adrenaline in an emergency situation?

    <p>Stimulates both α and β adrenergic receptors (B)</p> Signup and view all the answers

    Which of the following is NOT classified as a common medical emergency?

    <p>Skin rash (B)</p> Signup and view all the answers

    Which drug is described as the most important injectable drug in an emergency kit?

    <p>Adrenaline (C)</p> Signup and view all the answers

    What action does α1 adrenergic receptor stimulation produce?

    <p>Vasoconstriction, increasing blood pressure (C)</p> Signup and view all the answers

    What is the mechanism of action (MOA) of adrenaline?

    <p>α and β adrenergic receptors agonist (B)</p> Signup and view all the answers

    Which emergency medication can be administered intramuscularly to treat hypoglycemia?

    <p>Glucagon (B)</p> Signup and view all the answers

    What is the role of β2 adrenergic receptors in the context of adrenaline's action?

    <p>Cause bronchodilation (A)</p> Signup and view all the answers

    Which form of aspirin is generally used in emergencies?

    <p>300 mg dispersible tablets (D)</p> Signup and view all the answers

    What is the maximum time to contact emergency medical services after administering the third dose for unresolved symptoms?

    <p>15 minutes (B)</p> Signup and view all the answers

    Which of the following medications must be avoided if a patient has taken a phosphodiesterase inhibitor recently?

    <p>Glyceryl trinitrate (GTN) (C)</p> Signup and view all the answers

    What is the recommended adult dosage of buccal midazolam for prolonged seizures?

    <p>10 mg (B)</p> Signup and view all the answers

    What potential adverse effect is most directly associated with the use of nitrates like Glyceryl trinitrate?

    <p>Hypotension (A)</p> Signup and view all the answers

    Which scenario presents a contraindication for administering Glyceryl trinitrate?

    <p>The patient took sildenafil 30 hours ago (A)</p> Signup and view all the answers

    What is the primary reason oxygen may not be indicated for hyperventilation?

    <p>It may worsen the patient's condition. (C)</p> Signup and view all the answers

    Which inhaler dosage is recommended for adults using Salbutamol for bronchospasm?

    <p>2-3 sprays every 1-2 minutes. (B)</p> Signup and view all the answers

    What percentage of Salbutamol administered through an inhaler actually reaches the airways?

    <p>10% (C)</p> Signup and view all the answers

    What type of patients may benefit from using a large volume inhalation device for Salbutamol?

    <p>Children and the elderly. (B)</p> Signup and view all the answers

    Which medication is indicated as the drug of choice for anaphylaxis and severe allergic reactions?

    <p>Epinephrine. (A)</p> Signup and view all the answers

    What is the mechanism of action of atropine as a muscarinic antagonist?

    <p>It inhibits the action of parasympathetic nervous system receptors. (D)</p> Signup and view all the answers

    What is a key pharmacokinetic characteristic of atropine?

    <p>It can be administered via SC, IM, or IV routes. (D)</p> Signup and view all the answers

    What is a known characteristic of Ephedrine compared to Epinephrine?

    <p>Similar efficacy but prolonged duration. (A)</p> Signup and view all the answers

    Flashcards

    Adrenaline (Epinephrine)

    A drug used to treat life-threatening conditions like severe allergic reactions and cardiac arrest. It stimulates both alpha and beta adrenergic receptors.

    Salbutamol (Albuterol)

    A drug that relaxes muscles in the airways, making it easier to breathe. It's commonly used for treating asthma attacks.

    Glucagon

    A drug used to treat low blood sugar (hypoglycemia). It helps the body release stored sugar into the bloodstream.

    Glycerin Trinitrate (Nitroglycerin) Spray

    A drug commonly used to treat chest pain (angina) and heart attacks. It relaxes blood vessels, reducing the workload on the heart.

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    Aspirin (ASA)

    A drug that helps prevent blood clots from forming and is used to treat heart attacks.

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    Midazolam (Versed)

    A drug that relieves anxiety and seizures. It's administered orally or as an injection.

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    Oxygen

    A crucial component in emergency kits, providing supplemental oxygen to patients in need.

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    Oral Glucose

    A simple sugar solution that helps raise blood sugar levels quickly. It's used to treat hypoglycemia.

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    What is Adrenaline?

    Adrenaline, also known as epinephrine, is a medication used to treat severe allergic reactions, particularly anaphylaxis, and to reverse the effects of certain types of cardiac arrest.

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    When is adrenaline used for anaphylaxis?

    Adrenaline is effective in treating anaphylaxis when there are signs of stridor, wheezing, respiratory distress, or clinical signs of shock.

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    How is adrenaline given and how long does it last?

    Adrenaline, administered by injection, rapidly enters the bloodstream and has a short-lived effect.

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    What are the common forms of adrenaline?

    Adrenaline can be found in various formulations, including self-injection syringes like EpiPens. These usually contain a dose of 0.3 mg in a 1:1,000 concentration.

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    How is adrenaline administered for anaphylaxis?

    For severe anaphylaxis, adrenaline is typically given intramuscularly (IM), subcutaneously (SC), or sublingually (SL). IM injection is preferred for faster absorption.

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    What is the purpose of adrenaline?

    A medication used to treat severe allergic reactions, which stimulates both alpha and beta adrenergic receptors.

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    How does nitroglycerin work?

    A medication used to treat chest pain or heart attacks by relaxing blood vessels, reducing the heart's workload.

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    What is the purpose of midazolam?

    A medication that reduces anxiety and seizures. It is used for both oral and injection administration.

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    What is the main function of salbutamol?

    A medication that relaxes muscles in the airways, making breathing easier. It's commonly used to treat asthma.

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    How does glucagon work?

    A medication used to treat low blood sugar by helping the body release stored sugar into the bloodstream.

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    Liver Glycogen Stores

    The amount of glucose stored in the liver as glycogen, which is readily available for release when blood sugar levels drop.

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    Pharyngeal Reflex

    The ability to swallow, which is essential for administering oral glucose to treat hypoglycemia.

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    Carbonated Beverages for Hypoglycemia

    The quickest way to raise blood sugar levels in hypoglycemic patients due to the rapid absorption of sugar from the small intestine.

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    What is adrenaline (epinephrine) and what does it do?

    A hormone naturally produced by the adrenal glands, also used as a medication to treat severe allergic reactions and heart conditions. It acts by stimulating both alpha and beta adrenergic receptors.

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    What is cerebrovascular hemorrhage in the context of adrenaline overdose?

    A dangerous side effect from excessive adrenaline that occurs when blood pressure rises sharply, causing bleeding in the brain.

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    What is Aspirin (ASA) and what is its primary function?

    A type of medication that acts as a powerful antiplatelet agent, meaning it prevents blood clotting. It is commonly used for treating and preventing heart attacks, particularly in the early stages.

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    What is a contraindication for Aspirin use?

    A common side effect associated with Aspirin, making it unsuitable for patients with certain conditions.

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    What is Glucagon and what is its primary function?

    A medication used for treating dangerously low blood sugar levels (hypoglycemia). It works by stimulating the release of stored glucose from the liver into the bloodstream.

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    What is the effect of Glucagon on gastrointestinal motility?

    A specific effect of Glucagon that involves relaxing the muscles in the digestive tract, impacting the movement of food.

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    What is Glycerin Trinitrate (Nitroglycerin) used for and how does it work?

    A medication used to treat chest pain (angina) and heart attacks. It works by dilating blood vessels, reducing the workload of the heart and improving blood flow.

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    What is Midazolam (Versed) and how is it typically administered?

    A medication used to relieve anxiety and seizures. It is administered orally or by injection.

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    Salbutamol (Ventolin®)

    A short-acting bronchodilator that relaxes airway muscles, making breathing easier. Used for treating bronchospasm, a sudden narrowing of the airways.

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    Atropine

    A drug that blocks the effects of acetylcholine, a neurotransmitter in the parasympathetic nervous system. This relaxation of the muscles in the airways helps to improve breathing.

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    Ephedrine

    A medication that mimics the effects of adrenaline, but with a longer duration of action, also relaxes smooth muscle in the airways.

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    Hydrocortisone

    A corticosteroid that reduces inflammation in the airways, helping to control asthma symptoms. It's commonly given intravenously (IV) for severe allergic reactions.

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    Anticholinergic Drugs

    A type of medication that blocks the action of acetylcholine in the parasympathetic nervous system, which can help relax the muscles in the airways

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    Short-acting β2-adrenergic stimulant

    A type of quick-acting bronchodilator medication, used in the form of an inhaler, to ease the narrowing of airways.

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    Hypoxemia

    A condition where there is not enough oxygen in the blood, which can lead to various health problems.

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    Anaerobic metabolism

    A state where the body's metabolism is taking place without oxygen. This can happen in cases of insufficient oxygen supply to tissues.

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    Study Notes

    Workshop 10: Essential Emergency Drugs

    • Workshop focused on essential emergency drugs for 3rd-year medicine students in the 2024/25 academic year.
    • Emergency medications used in life-threatening conditions.
    • Medications used to manage symptoms and save patients' lives.

    Introduction to Emergency Medications

    • Emergency medications used in life-threatening situations.
    • Common medical emergencies: postural/orthostatic hypotension, syncope, asthma attack, diabetic emergencies (hypoglycemia), allergies/hypersensitivity reactions, chest pain (myocardial infarction), seizures, acute adrenal insufficiency, and hyperventilation.
    • Emergency kits should only include drugs for which specialist personnel have knowledge and training.

    Basic Emergency Drugs

    • Adrenaline (epinephrine): 1 ml vials of 1:1000 IM solution.
    • Aspirin (ASA): 300 mg dispersible tablets.
    • Glycagon: 1 mg IM.
    • Glycerin trinitrate spray: 400 ug
    • Liquid buccal midazolam: 10mg/mL or 5 mg/mL injections (2 mL vials).
    • Oral glucose.
    • Oxygen.
    • Salbutamol (inhaler): 100 ug

    Adrenaline/Epinephrine

    • Endogenous catecholamine, drug of choice for CVD and respiratory manifestations of acute allergic reactions.
    • Clinical use: bronchodilator, restore proper cardiac output.
    • Mechanism of action: a and β adrenergic receptors agonist (SNS).
    • α1: vasoconstriction, increased BP
    • α2: inhibits the release of norepinephrine (NA)
    • β1: tachycardia, myocardial contractility
    • β2: vasodilation, bronchodilation
    • Most effective when administered after the onset of reaction in a reanimation dose.
    • Indications: anaphylaxis
    • Signs and symptoms of anaphylaxis: airway, brain, heart, and skin.
    • Pharmacokinetics: parenteral route (rapid onset and short duration of action), metabolism in the liver, urine excretion, crosses the placenta but not the BBB, distributed in breast milk.
    • Formulations: autoinjector (EpiPen®), preloaded syringes, ampoules.
    • Adrenaline 1:1,000 (IM), Adrenaline 1:10,000 (IV)
    • Dosage and route of administration (Adrenaline 1:1.000): IM, SC, SL, preferably IM (faster), repeat every 5 minutes if symptoms persist.
    • Needle length for administration depending on patient size.

    Aspirin (ASA)

    • Recommended in cases of suspected myocardial infarction (MI).
    • Administered to patients with chest pain suggestive of ischemia and evolving myocardial infarction.
    • Stops progression of MI, prevents further damage.
    • Mechanism of action: prevents clots from forming.
    • Dosage and route of administration: 325 mg (dispersible aspirin tablets).
    • Contraindications: asthma, peptic ulcer, hypersensitivity.

    Glucagon

    • Anti-hypoglycemic action; breaks down liver glycogen, promotes glucose release into the blood.
    • Inhibits gastrointestinal motility (relaxing the stomach, duodenum, small intestine, colon).
    • Storage: refrigerated (2-8°C) or outside refrigerator below 25°C for up to 18 months.
    • Dosage: Adults: 1 mg IM, Children: 0.5 mg IM.
    • Indications: severe hypoglycemic reactions (low blood sugar), when oral glucose can't be administered.
    • Can be effective in 10 minutes.
    • Duration of hyperglycemic action after IV or IM injection: 60-90 minutes.
    • Other aspects: Use with caution in patients with prolonged fasting, low adrenaline levels, chronic hypoglycemia, and alcohol-induced or tumor-related hypoglycemia.
    • ADRs (side effects): nausea and vomiting (doses greater than 1 mg or with rapid injection), tachycardia, and hypertension.
    • Interactions: Beta-blockers, Indomethacin, Warfarin, and Insulin.
    • Use in pregnancy: glucagon does not cross the placental barrier.

    Nitrates (Glyceryl Trinitrate/GTN/Nitroglycerin)

    • Mechanism of action: arterial and venous vasodilation, to increase the supply of oxygen to the heart, reduces tension of heart muscle, treats acute angina or MI.
    • Dosage forms: sublingual tablets, tongue spray (0.4 mg every 5 minutes).
    • Indications: acute angina or MI.
    • Route of administration: buccal and sublingual mucosa; peak plasma concentrations within 4 minutes.
    • Patients with known coronary heart disease: clear advice on self-medication with NTG for relieving angina symptoms; initial dose at symptom onset; take further doses every 5 minutes if needed; contact emergency services if symptoms persist.
    • Contraindications: systolic BP below 90 mmHg, hypotension, medications (sildenafil, tadalafil or vardenafil).
    • ADRs (side effects): hypotension, facial redness, dizziness, headache, and palpitations.

    Midazolam

    • Buccolam® Oromucosal midazolam solution → treatment of prolonged (>5 min) or repeated seizures.
    • Buccal administration → quickly absorbed into bloodstream.
    • Mechanism of action: Benzodiazepines (sedative action).
    • Dosage and route of administration:
      • Adults: 10 mg (2 mL) buccal
      • Children (1-5 years): 5 mg
      • Children (5-10 years): 7.5mg
      • Children (above 10 years): 10 mg
    • ADR (side effects): Drowsiness and respiratory depression

    Oxygen

    • Indications: for all emergencies EXCEPT for hyperventilation; oxygen may not improve the patient, but it will not worsen their condition.
    • Usage: As needed for the patient; can breathe spontaneously (face mask)or Apneic patient (Bag-valve mask).

    Salbutamol Inhaler (Ventolin)

    • Short-acting β2-adrenergic stimulant (bronchodilation).
    • First choice for the treatment of bronchospasm.
    • Only 10% of the drug reaches the airways; 50% is deposited in the mouth, and about 90% is finally ingested.
    • Adult dosage: 2-3 sprays/1-2 min; Children: 1 spray/1-2 min.
    • Use of large volume inhalation device is useful for children and the elderly.

    Additional Medications

    • List of additional medications included in the emergency kit

    Anticholinergic Drugs

    • Atropine, Glycopyrrolate, and Scopolamine

    Atropine

    • Muscarinic antagonist.
    • Mechanism of action: antagonizes M receptors of the parasympathetic nervous system.
    • Pharmacokinetics: SC, IM, IV, crosses the BBB

    Ephedrine

    • Sympathomimetic agent (α/β agonist).
    • Similar to epinephrine, but less powerful and longer duration of action.

    Hydrocortisone

    • Anti-inflammatory adrenocortical steroid.
    • Use: allergic reactions and adrenal crises (IV: slow onset of action).
    • Epinephrine remains the drug of choice for anaphylaxis and severe allergic reactions (acts immediately); hydrocortisone can be followed up by IV or IM administration.

    Antihistamines

    • Management of allergic reactions, mainly dermatological signs and symptoms (hives).
    • Mild reactions: oral administration (25 to 50 mg of diphenhydramine every 6 hours until symptoms disappear).
    • Life-threatening reactions: parenteral administration.

    Syncope

    • Aromatic ammonia: noxious odor that stimulates the respiratory and vasomotor centers of the spinal cord.
    • Treatment: Trendelenburg position, supplemental oxygen administration, and using aromatic ammonia.

    Severe Pain of Acute Myocardial Infarction (AMI)

    • Nitrous oxide: for AMI pain relief.
    • Morphine: 1-3 mg IV or 5 mg IM for pain relief.

    Reversal Agents

    • Naloxone: to reverse the effects of opioid overdose and respiratory depression. Opioid Receptor Antagonist.
    • Flumazenil: Benzodiazepine antagonist, reverses BDZ-induced respiratory depression.

    Emergency Clinical Cases

    • Clinical cases related to specific emergency scenarios including patient presentation, diagnosis suspected, and management.

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    Workshop 10 Essential Emergency Drugs - 2024/25 PDF

    Description

    This quiz covers critical topics related to the administration and pharmacokinetics of adrenaline and glucagon during medical emergencies. Learn about the appropriate routes for administration, dosage formulations like EpiPen, and management strategies for hypoglycemia. Test your knowledge about the actions of these vital medications.

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