EPINEPHRINE Definition:

Epinephrine, widely called adrenaline, is a hormone and neurotransmitter. When produced in the body it increases heart rate, contracts blood vessels and dilates air passages and participates in the fight-or-flight response of the sympathetic nervous system.

Mechanism of Action: Adrenaline is a sympathomimetic amine that activates both alpha and Beta adrenoccptors.. y Contraction of vascular smooth muscle (alpha-mediated). An increased blood pressure helps maintain cerebral and coronary perfusion. y Increased force and rate of cardiac contraction (Beta1-mediated). This action increases cardiac output, which helps to maintain the blood pressure. However, this may be damaging as it increases myocardial oxygen requirements and may precipitate ischemia. y Relaxation of bronchial smooth muscle (Beta2-mediated). Increasing the caliber of the airway in acute anaphylaxis helps to re-establish airflow restricted by bronchospasm and oedema. y Inhibition of histamine release by mast cells (Beta2-effecf). Histamine is an important early mediator, responsible for some of the haemodynamic changes encountered in anaphylactic reactions. Therapeutic Uses: Adrenaline may be administered in the following situations: y Anaphylactic Shock - An allergic (type 1 hypersensitivity) reaction may be precipitated by any material or drug to which the patient has been sensitized. Lifethreatening events include: - cardiovascular collapse - bronchospasm - angio-oedema - pulmonary oedema y Cardiac Arrest - Adrenaline is used hi advanced cardiac life support protocols. Side Effects: y anxiety y headache y Fear y palpitations y vascular constriction

ATROPINE Definition:
A poisonous alkaloid obtained from belladonna or related plants, used medically to dilate the pupils of the eyes and to stop spasms.

Mechanism of Action: y Atropine is a competitive inhibitor of acetylcholine @ muscarinic receptor sites. y The increase of sympathetic activity seen with atropine administration is due to the drugs parasympatholytic effects. y In the setting of symptomatic bradycardias, atropine decreases vagal effects on the heart resulting in increased chronotropy & dromotropy (with little or no inotropic effects). y It is postulated that in some cases, asystole may be a result of a sudden & massive increase in vagal tone. Despite clear scientific evidence of atropines effectiveness in this instance, we still administer atropine because there is little evidence that it is harmful in this setting. y It is used in cholinergic exposures as a direct antidote for the poison. Therapeutic Uses: y Treatment of painful syndromes with spasmodic component, i.e. involving an exaggerated contraction of smooth muscles, such as biliary and renal colic pain. y In anesthesiology: prevention of respiratory tract secretion, bronchospasm, laryngospasm and reflexe reactions such as bradycardia, before surgical operations. y Treatment of poisonings: - by cardiac glycosides, to increase lowered cardiac rate - by anticholinesterase agents and mushrooms of Amanita muscarina type, to reduce muscarinic symptoms. In poisonings by anticholinesterase agents such as organophosphorus compounds, atropine is administered in large doses in combination with pralidoxime. y Atropine is a powerful mydriatic with a very long duration of action, now generally replaced by tropicamide Side Effects: y Anticholinergic Effects: - Dry mucous membranes, urinary retention, constipation - Restlessness, tachycardia, palpitations, dizziness - Flushed, hot, & dry skin - Pupillary dilation (mydriasis), blurred vision (cycloplegia), photophobia y Tachydysrhythmias, Ventricular Tachycardia/Fibrillation

DOPAMINE Definition: A drug that causes narrowing of the blood vessels, dopamine is used to treat patients who have abnormally low blood pressure (eg, those in shock). In low doses, dopamine is used to open vessels leading to the kidneys and thus increase urine output. Mechanism of Action: Dopamine stimulates dopaminergic receptors at lower doses producing renal and mesenteric vasodilation while at higher doses stimulate both dopaminergic and -adrenergic receptors producing cardiac stimulation and renal vasodilation. It increases heart rate and force of contraction. Therapeutic Uses: Levodopa is a dopamine precursor used in various forms to treat Parkinson's disease and doparesponsive dystonia. Side Effects: The following adverse reactions have been observed, but there are not enough data to support an estimate of their frequency. Cardiovascular System y ventricular arrhythmia (at very high doses) y ectopic beats y tachycardia y anginal pain y palpitation y cardiac conduction abnormalities y widened QRS complex y bradycardia y hypotension y hypertension y vasoconstriction Respiratory System y dyspnea Gastrointestinal System y nausea y vomiting Metabolic/Nutritional System y azotemia Central Nervous System y headache y anxiety Dermatological System y piloerection Other y Gangrene of the extremities y peripheral cyanosis

NITROGLYCERIN Definition:
Medication used during angina attacks or to prevent angina that opens the arteries to the heart. The opened arteries increase blood flow, relieving angina, and reducing the heart's workload.

Mechanism of Action: Antianginal or cardiac loadreducing agentNot specifically known but thought to cause a reduction of myocardial oxygen demand. This is attributed to a reduction in left ventricular preload and afterload because of venous (predominantly) and arterial dilation with a more efficient redistribution of blood flow within the myocardium. AntihypertensivePeripheral vasodilation. Therapeutic Uses: Nitroglycerin is used in the treatment of chest pain (angina) due to heart disease. Side Effects: Dizziness, lightheadedness, or fainting when sitting up or standing; flushing of face and neck; headache; irritation at the injection site; nausea; vomiting. Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); blurred vision; dry mouth; fainting; flushing; heavy sweating; irregular heartbeat; new or worsening chest pain; pale skin; pounding in the chest; rapid heartbeat; severe dizziness or headache; severe or persistent nausea or vomiting; shortness of breath; slow heartbeat; swelling of the hands, ankles, or feet; unusual weakness.

DOBUTAMINE Definition:
Dobutamine is a sympathomimetic drug used in the treatment of heart failure and cardiogenic shock. Its primary mechanism is direct stimulation of 1receptors of the sympathetic nervous system.

Mechanism of Action: Epinephrine is an endogenous compound formed from norepinephrine. It is principally produced with stress and produces widespread metabolic and hemodynamic effects via effects on b1 , b2 , and a-adrenergic receptors. The effects of epinephrine depend on the dosage selected and the range of plasma concentration achieved in the individual patient. b1 receptors are most sensitive to epinephrine, and are affected by very low plasma concentrations resulting in inotropic and chronotropic effects (that increase myocardial oxygen consumption). Stimulation of b2 receptors leads to vasodilation of splanchnic and skeletal muscle beds. Vasoconstriction from a- receptor stimulation in skin and renal vascular beds occurs at all concentrations, while at higher concentrations, vasoconstriction effects in the pulmonary, splanchnic, skeletal muscle, cerebral, and coronary vascular beds predominate. As the concentration of epinephrine increases, myocardial irritability occurs, manifested by atrial and ventricular dysrhythmias. Metabolic effects occur at higher plasma concentrations, including hyperglycemia from a-adrenergic-mediated suppression of insulin release that leads to ketogenesis, gluconeogenesis, and accelerated glycogenolysis with resulting lactic acidemia. Hypokalemia is attributable to b2 - adrenergic receptors linked to Na+-K+ ATPase in skeletal muscle. Other effects include hypophosphatemia, and activation of lipase. Therapeutic Uses: y Short-term management of pump failure following surgery, during acute congestive heart failure, or post-myocardial infarction. y Uncertain long-term efficacy. Side Effects: Headache; nausea. Severe allergic reactions (rash; hives; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); chest pain; fainting, dizziness, or lightheadedness; fast or irregular heartbeat; pounding in the chest; shortness of breath.

NORADRENALINE Definition: A vasoconstrictor whose release triggers action within the sympathetic nervous system, the part of the nervous system that regulates certain involuntary responses during times of stress. Noradrenaline serves as a neurotransmitter that stimulates receptors (alphaand beta-adrenergic receptors) at effector organs supplied or innervated by certain sympathetic nerve fibers (postganglionic adrenergic fibers). In addition to its production by neurons, noradrenaline is also secreted by the inner region of the adrenal glands (adrenal medulla). The release of noradrenaline serves to deepen breathing, raise blood pressure, and increase the heart rate. It also plays a role in regulating mood. Mechanism of Action:
Functions as a peripheral vasoconstrictor (alpha-adrenergic action) and as an inotropic stimulator of the heart and dilator of coronary arteries (beta-adrenergic action).

Therapeutic Uses: Restore blood pressure in acute hypertensive cases. Side Effects: y Headache y Slow heart rate (bradycardia) y High blood pressure (hypertension) y Inadequate blood flow leading to low levels of oxygen in the tissues of the extremities (peripheral ischaemia), which may lead to gangrene