Альфа- и бета-адреностимулирующее средство. На клеточном уро... Инструкция
Показания к применению
Аллергические реакции немедленного типа, в т.ч.: Крапивница. Ангионевротический отек. Анафилактический шок. Анафилактические реакции и астма физического усилия. Бронхиальная астма (купирование астматического статуса). Бронхоспазм во время наркоза. Асистолия (в т.ч. на фоне остро развившейся атриовентрикулярной блокады III ст.). Кровотечение из поверхностных ...
Альфа- и бета-адреностимулирующее средство. На клеточном уровне действие обусловлено активацией аденилатциклазы на внутренней поверхности клеточной мембраны, повышением внутриклеточной концентрации циклического аденозинмонофосфата (цАМФ) и ионов кальция. В очень низких дозах, при скорости введения меньше 0,01 мкг/кг/мин может снижать артериальное давление (АД) вследствие расширения сосудов скелетной мускулатуры. При скорости введения 0,04-0,1 мкг/кг/мин увеличивает частоту и силу сердечных сокращений, ударный объем крови и минутный объем крови, снижает общее периферическое сосудистое сопротивление; выше 0,02 мкг/кг/мин суживает сосуды, повышает АД-(главным образом, систолическое) и общее периферическое сосудистое сопротивление. Прессорный эффект может вызвать кратковременное рефлекторное замедление частоты сердечных сокращений. Расслабляет гладкие мышцы бронхов. Дозы выше 0,3 мкг/кг/мин, снижают почечный кровоток, кровоснабжение внутренних органов, тонус и моторику желудочно-кишечного тракта. Расширяет зрачки, способствует снижению продукции внутриглазной -жидкости и внутриглазного давления. Вызывает гипергликемию (усиливает гликогенолиз и глюконеогенез) и повышает содержание в плазме свободных жирных кислот. Повышает проводимость, возбудимость и автоматизм миокарда. Увеличивает потребность миокарда в кислороде. Ингибирует индуцированное антигенами высвобождение гистамина и лейкотриенов, устраняет спазм бронхиол, предотвращает развитие отека их слизистой. Действуя на альфа-адренергические рецепторы, расположенные в коже, слизистых оболочках и внутренних органах, вызывает сужение сосудов, снижение скорости всасывания местноанестезирующих средств, увеличивает продолжительность и снижает токсическое влияние местной анестезии. Стимуляция бета 2 -адренорецепторов сопровождается усилением выведения К + из клетки и может привести к гипокалиемии. При интракавернозном введении уменьшает кровенаполнение пещеристых тел. Терапевтический эффект развивается практически мгновенно при внутривенном введении (продолжительность действия - 1-2 мин), через 5-10 мин после подкожного введения (максимальный эффект - через 20 мин), при внутримышечном введении - время начала эффекта вариабельное.
Показания к применению
Аллергические реакции немедленного типа, в т.ч.: Крапивница. Ангионевротический отек. Анафилактический шок. Анафилактические реакции и астма физического усилия. Бронхиальная астма (купирование астматического статуса). Бронхоспазм во время наркоза. Асистолия (в т.ч. на фоне остро развившейся атриовентрикулярной блокады III ст.). Кровотечение из поверхностных сосудов кожи и слизистых оболочек (в т.ч. из десен). Необходимость удлинения действия местных анестетиков. Эпизоды полной атриовентрикулярной блокады с развитием синкопального состояния (синдром Морганьи-Адамса-Стокса). Гипогликемия (вследствие передозировки инсулина). Открытоугольная глаукома. Внутриглазная гипертензия. Остановка кровотечения. Приапизм.
Противопоказания
Гиперчувствительность. Артериальная гипертензия . Выраженный атеросклероз (включая церебральный атеросклероз). Гипертрофическая обструктивная кардиомиопатия. Тахиаритмия. Фибрилляция желудочков . Фибрилляция предсердий . Желудочковые аритмии . Хроническая сердечная недостаточность 3-4 ст. Инфаркт миокарда. Феохромоцитома. Тиреотоксикоз. Сахарный диабет. Острая и хроническая артериальная недостаточность (в т.ч. в анамнезе): Артериальная эмболия. Атеросклероз. Болезнь Бюргера. Диабетический эндартериит. Болезнь Рейно. Гиповолемия. Метаболический ацидоз. Гиперкапния. Гипоксия. Легочная гипертензия. Шок неаллергического генеза, в том числе: Кардиогенный. Травматический. Геморрагический. Холодовая травма. Болезнь Паркинсона. Органические повреждения головного мозга. Закрытоугольная глаукома. Судорожный синдром. Гипертрофия предстательной железы. Возраст до 18 лет (кроме состояний, непосредственно угрожающих жизни). Беременность. Период лактации. Одновременное применение ингаляционных средств для общей анестезии (фторотана, циклопропана, хлороформа . Эпинефрин в комбинации с местными анестетиками не применяют для местной анестезии пальцев рук и ног из-за риска ишемического повреждения тканей. С осторожностью: Применять с осторожностью при гиперфункции щитовидной железы. Ишемической болезни сердца. В пожилом возрасте. Для профилактики аритмий на фоне применения препарата назначают бета-адреноблокаторы. Случайное внутривенное введение эпинефрина может вызвать резкое повышение артериального давления
Применение при беременности и в период грудного вскармливания
Применение адреналина в периоды беременности и лактации возможно только в тех случаях, когда ожидаемая польза для матери превышает потенциальный риск для плода. При необходимости применения препарата в период лактации следует прекратить грудное вскармливание.
Способ применения и дозы
Подкожно, внутримышечно, внутривенно капельно. Анафилактический шокВнутривенно медленно 0,1-0,25 мг разведенных в 10 мл. 0,9% раствора NaCl, при необходимости продолжают внутривенное , капельное введение в концентрации 1: 10000. При отсутствии непосредственной угрозы жизни, предпочтительнее введение внутримышечное или подкожное 0,3-0,5 мг, при необходимости повторное введение через 10-20 мин до 3 раз. Бронхиальная астмаПодкожно 0,3-0,5 мг, при необходимости повторные дозы можно вводить через каждые 20 мин до 3 раз, или внутривенно по 0,1-0,25 мг с разведением в концентрации 1: 10000. Как сосудосуживающее средствоВнутривенная инфузия 1 мкг/мин, скорость введения можно увеличить до 2-10 мкг/мин. Для удлинения действия местных анестетиковВ концентрации 0,005 мг/мл (доза зависит от вида используемого анестетика), для спинномозговой анестезии - 0,2-0,4 мг. При асистолииВнутрисердечно 0,5 мг (разбавляют 10 мл 0.9% раствора NaCl или другим раствором); во время реанимационных мероприятий - по 0,5-1 мг (в разбавленном виде) внутривенно каждые 3-5 мин. Если пациент интубирован, возможна эндотрахеальная инстилляция - дозы должны в 2-2,5 раза превышать дозы для внутривенного введения. Детям, старше 1 месяца: внутривенно, 10 мкг/кг (в последующем при необходимости каждые 3-5 мин вводят по 100 мкг/кг (после введения, по крайней мере, 2 стандартных доз можно каждые 5 мин использовать более высокие дозы - 200 мкг/кг)). Можно использовать эндотрахеальное введение. Детям при анафилактическом шокеПодкожно или внутримышечно по 0,01 мг/кг (максимально - до 0,3 мг), при необходимости введение этих доз повторяют через каждые 15 мин (до З раз).
Побочное действие
Со стороны сердечно-сосудистой системыМенее часто - стенокардия, брадикардия или тахикардия, сердцебиение, повышение или снижение артериального давления, при высоких дозах - желудочковые аритмии (включая фибрилляцию желудочков ); редко - аритмия, боль в грудной клетке, отек легких. Со стороны нервной системыБолее часто - головная боль, тревожное состояние, тремор; тики, менее часто - головокружение, нервозность, тошнота, рвота , психоневротические расстройства (психомоторное возбуждение, дезориентация, нарушение памяти, психотические расстройства), нарушение сна. Со стороны пищеварительной системыБолее часто - тошнота, рвота. Со стороны мочевыводящей системыРедко - затрудненное и болезненное мочеиспускание (при гиперплазии предстательной железы). Местные реакцииБоль или жжение в месте внутримышечной инъекции. Аллергические реакцииАнгионевротический отек, бронхоспазм, кожная сыпь, многоформная эритема. ПрочиеГипокалиемия; повышенное потоотделение.
Передозировка
Симптомы: чрезмерное повышение артериального давления, тахикардия, сменяющаяся брадикардией, нарушения ритма (в т.ч. фибрилляция предсердий и желудочков ), похолодание конечностей и бледность кожных покровов, рвота , головная боль, метаболический ацидоз, инфаркт миокарда, черепно-мозговое кровоизлияние (особенно у пожилых пациентов), отек легких, смерть. Лечение: прекратить введение, симптоматическая терапия - для снижения артериального давления - альфа-адреноблокаторы ( фентоламин ), при аритмии - бета-адреноблокаторы ( пропранолол ).
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На клеточном уровне действие обусловлено активацией аденилатциклазы на внутренней поверхности клеточной мембраны, повышением внутриклеточной концентрации циклического аденозинмонофосфата (цАМФ) и ионов кальция. В очень низких дозах, при скорости введения меньше 0,01 мкг/кг/мин может снижать артериальное давление (АД) вследствие расширения сосудов скелетной мускулатуры. При скорости введения 0,04-0,1 мкг/кг/мин увеличивает частоту и силу сердечных сокращений, ударный объем крови и минутный объем крови, снижает общее периферическое сосудистое сопротивление; выше 0,02 мкг/кг/мин суживает сосуды, повышает АД-(главным образом, систолическое) и общее периферическое сосудистое сопротивление. Прессорный эффект может вызвать кратковременное рефлекторное замедление частоты сердечных сокращений. Расслабляет гладкие мышцы бронхов. Дозы выше 0,3 мкг/кг/мин, снижают почечный кровоток, кровоснабжение внутренних органов, тонус и моторику желудочно-кишечного тракта. Расширяет зрачки, способствует снижению продукции внутриглазной -жидкости и внутриглазного давления. Вызывает гипергликемию (усиливает гликогенолиз и глюконеогенез) и повышает содержание в плазме свободных жирных кислот. Повышает проводимость, возбудимость и автоматизм миокарда. Увеличивает потребность миокарда в кислороде. Ингибирует индуцированное антигенами высвобождение гистамина и лейкотриенов, устраняет спазм бронхиол, предотвращает развитие отека их слизистой. Действуя на альфа-адренергические рецепторы, расположенные в коже, слизистых оболочках и внутренних органах, вызывает сужение сосудов, снижение скорости всасывания местноанестезирующих средств, увеличивает продолжительность и снижает токсическое влияние местной анестезии. Стимуляция бета 2 -адренорецепторов сопровождается усилением выведения К + из клетки и может привести к гипокалиемии. При интракавернозном введении уменьшает кровенаполнение пещеристых тел. Терапевтический эффект развивается практически мгновенно при внутривенном введении (продолжительность действия - 1-2 мин), через 5-10 мин после подкожного введения (максимальный эффект - через 20 мин), при внутримышечном введении - время начала эффекта вариабельное."}}]},{"id":3,"name":"Показания к применению","slug":"indications","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Аллергические реакции немедленного типа, в т.ч.: Крапивница. Ангионевротический отек. Анафилактический шок. Анафилактические реакции и астма физического усилия. Бронхиальная астма (купирование астматического статуса). Бронхоспазм во время наркоза. Асистолия (в т.ч. на фоне остро развившейся атриовентрикулярной блокады III ст.). Кровотечение из поверхностных сосудов кожи и слизистых оболочек (в т.ч. из десен). Необходимость удлинения действия местных анестетиков. Эпизоды полной атриовентрикулярной блокады с развитием синкопального состояния (синдром Морганьи-Адамса-Стокса). Гипогликемия (вследствие передозировки инсулина). Открытоугольная глаукома. Внутриглазная гипертензия. Остановка кровотечения. Приапизм."}}]},{"id":4,"name":"Противопоказания","slug":"contraindications","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Гиперчувствительность. Артериальная гипертензия . Выраженный атеросклероз (включая церебральный атеросклероз). Гипертрофическая обструктивная кардиомиопатия. Тахиаритмия. Фибрилляция желудочков . Фибрилляция предсердий . Желудочковые аритмии . Хроническая сердечная недостаточность 3-4 ст. Инфаркт миокарда. Феохромоцитома. Тиреотоксикоз. Сахарный диабет. Острая и хроническая артериальная недостаточность (в т.ч. в анамнезе): Артериальная эмболия. Атеросклероз. Болезнь Бюргера. Диабетический эндартериит. Болезнь Рейно. Гиповолемия. Метаболический ацидоз. Гиперкапния. Гипоксия. Легочная гипертензия. Шок неаллергического генеза, в том числе: Кардиогенный. Травматический. Геморрагический. Холодовая травма. Болезнь Паркинсона. Органические повреждения головного мозга. Закрытоугольная глаукома. Судорожный синдром. Гипертрофия предстательной железы. Возраст до 18 лет (кроме состояний, непосредственно угрожающих жизни). Беременность. Период лактации. Одновременное применение ингаляционных средств для общей анестезии (фторотана, циклопропана, хлороформа . Эпинефрин в комбинации с местными анестетиками не применяют для местной анестезии пальцев рук и ног из-за риска ишемического повреждения тканей. С осторожностью: Применять с осторожностью при гиперфункции щитовидной железы. Ишемической болезни сердца. В пожилом возрасте. Для профилактики аритмий на фоне применения препарата назначают бета-адреноблокаторы. 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При отсутствии непосредственной угрозы жизни, предпочтительнее введение внутримышечное или подкожное 0,3-0,5 мг, при необходимости повторное введение через 10-20 мин до 3 раз. Бронхиальная астмаПодкожно 0,3-0,5 мг, при необходимости повторные дозы можно вводить через каждые 20 мин до 3 раз, или внутривенно по 0,1-0,25 мг с разведением в концентрации 1: 10000. Как сосудосуживающее средствоВнутривенная инфузия 1 мкг/мин, скорость введения можно увеличить до 2-10 мкг/мин. Для удлинения действия местных анестетиковВ концентрации 0,005 мг/мл (доза зависит от вида используемого анестетика), для спинномозговой анестезии - 0,2-0,4 мг. При асистолииВнутрисердечно 0,5 мг (разбавляют 10 мл 0.9% раствора NaCl или другим раствором); во время реанимационных мероприятий - по 0,5-1 мг (в разбавленном виде) внутривенно каждые 3-5 мин. Если пациент интубирован, возможна эндотрахеальная инстилляция - дозы должны в 2-2,5 раза превышать дозы для внутривенного введения. Детям, старше 1 месяца: внутривенно, 10 мкг/кг (в последующем при необходимости каждые 3-5 мин вводят по 100 мкг/кг (после введения, по крайней мере, 2 стандартных доз можно каждые 5 мин использовать более высокие дозы - 200 мкг/кг)). Можно использовать эндотрахеальное введение. Детям при анафилактическом шокеПодкожно или внутримышечно по 0,01 мг/кг (максимально - до 0,3 мг), при необходимости введение этих доз повторяют через каждые 15 мин (до З раз)."}}]},{"id":7,"name":"Побочное действие","slug":"side_effects","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Со стороны сердечно-сосудистой системыМенее часто - стенокардия, брадикардия или тахикардия, сердцебиение, повышение или снижение артериального давления, при высоких дозах - желудочковые аритмии (включая фибрилляцию желудочков ); редко - аритмия, боль в грудной клетке, отек легких. Со стороны нервной системыБолее часто - головная боль, тревожное состояние, тремор; тики, менее часто - головокружение, нервозность, тошнота, рвота , психоневротические расстройства (психомоторное возбуждение, дезориентация, нарушение памяти, психотические расстройства), нарушение сна. Со стороны пищеварительной системыБолее часто - тошнота, рвота. Со стороны мочевыводящей системыРедко - затрудненное и болезненное мочеиспускание (при гиперплазии предстательной железы). Местные реакцииБоль или жжение в месте внутримышечной инъекции. Аллергические реакцииАнгионевротический отек, бронхоспазм, кожная сыпь, многоформная эритема. 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