Epinephrine (also known as adrenaline) is a hormone A hormone is a chemical released by a cell in one part of the body, that sends out messages that affect cells in other parts of the organism. Only a small amount of hormone is required to alter cell metabolism. It is essentially a chemical messenger that transports a signal from one cell to another. All multicellular organisms produce hormones; and neurotransmitter Neurotransmitters are endogenous chemicals which transmit signals from a neuron to a target cell across the synapse. Neurotransmitters are packaged into synaptic vesicles that cluster beneath the membrane on the presynaptic side of a synapse, and are released into the synaptic cleft, where they bind to receptors in the membrane on the postsynaptic.^[1]. It increases heart rate, contracts blood vessels, dilates air passages and participates in the fight-or-flight response The "fight-or-flight response", also called the "fight-or-flight-or-freeze response", the "fright, fight or flight response", "hyperarousal" or the "acute stress response", was first described by Walter Cannon in 1929 of the sympathetic nervous system The sympathetic nervous system is one of the three parts of the autonomic nervous system, along with the enteric and parasympathetic systems. Its general action is to mobilize the body's resources under stress; to induce the flight-or-fight response. It is, however, constantly active at a basal level in order to maintain homeostasis.^[2] Chemically, epinephrine is a catecholamine Catecholamines are sympathomimetic "fight-or-flight" hormones released by the adrenal glands in response to stress. They are part of the sympathetic nervous system, a monoamine Monoamine neurotransmitters are neurotransmitters and neuromodulators that contain one amino group that is connected to an aromatic ring by a two-carbon chain . All monoamines are derived from aromatic amino acids like phenylalanine, tyrosine, tryptophan, and the thyroid hormones by the action of aromatic amino acid decarboxylase enzymes produced only by the adrenal glands In mammals, the adrenal glands are the triangular-shaped endocrine glands that sit on top of the kidneys. They are chiefly responsible for releasing hormones in conjunction with stress through the synthesis of corticosteroids and catecholamines, including cortisol and adrenaline (epinephrine), respectively from the amino acids Amino acids are molecules containing an amine group, a carboxylic acid group and a side chain that varies between different amino acids. These molecules contain the key elements of carbon, hydrogen, oxygen, and nitrogen. These molecules are particularly important in biochemistry, where this term refers to alpha-amino acids with the general formula phenylalanine Phenylalanine is an α-amino acid with the formula HO2CCH(NH2)CH2C6H5. This essential amino acid is classified as nonpolar because of the hydrophobic nature of the benzyl side chain. L-Phenylalanine (LPA) is an electrically-neutral amino acid, one of the twenty common amino acids used to biochemically form proteins, coded for by DNA. The codons and tyrosine Tyrosine or 4-hydroxyphenylalanine, is one of the 20 amino acids that are used by cells to synthesize proteins. Its codons are UAC and UAU. It is a non-essential amino acid with a polar side group. The word "tyrosine" is from the Greek tyri, meaning cheese, as it was first discovered in 1846 by German chemist Justus von Liebig in the.

The term adrenaline is derived from the Latin Latin is an Italic language originally spoken in Latium and Ancient Rome. With the Roman conquest, Latin was spread to countries around the Mediterranean, including a large part of Europe. Romance languages such as Aragonese, Corsican, Catalan, French, Italian, Portuguese, Romanian, Sardinian, Spanish and others, are descended from Latin, while roots ad- and renes and literally means on the kidney The kidneys are paired organs with several functions. They are seen in many types of animals, including vertebrates and some invertebrates. They are an essential part of the urinary system and also serve homeostatic functions such as the regulation of electrolytes, maintenance of acid-base balance, and regulation of blood pressure. They serve the, in reference to the adrenal gland's anatomic location on the kidney. The Greek Greek , an independent branch of the Indo-European family of languages, is the language of the Greeks. Native to the southern Balkans, it has the longest documented history of any Indo-European language, spanning 34 centuries of written records. In its ancient form, it is the language of classical ancient Greek literature and the New Testament of roots epi- and nephros have similar meanings, and give rise to epinephrine. The term epinephrine is often shortened to epi in medical jargon.^[3]

Adrenal extracts containing adrenaline were first obtained by Polish physiologist Napoleon Cybulski in 1895. These extracts, which he called "nadnerczyna", contained epinephrine and other catecholamines Catecholamines are sympathomimetic "fight-or-flight" hormones released by the adrenal glands in response to stress. They are part of the sympathetic nervous system.^[4] Japanese chemist Jokichi Takamine Jokichi Takamine was a Japanese chemist and samurai and his assistant Keizo Uenaka independently discovered adrenaline in 1900.^[5][6] In 1901, Takamine successfully isolated and purified the hormone from the adrenal glands of sheep and oxen.^[7] Adrenaline was first synthesized in the laboratory by Friedrich Stolz Friedrich Stolz was a German chemist and, in 1904, the first person to artificially synthesize epinephrine (adrenaline) and Henry Drysdale Dakin He was born in London as the youngest of 8 children to a family of steel merchants from Leeds. As a school boy he did water analysis with the Leeds City Analyst. He studied chemistry at the University of Leeds with Julius B. Cohen and after he worked with Albrecht Kossel on arginase at the University of Heidelberg he joined Columbia University in 1, independently, in 1904.^[6]

Actions in the body

As a hormone, epinephrine acts on nearly all body tissues. Its actions vary by tissue type and tissue expression of adrenergic receptors The adrenergic receptors are a class of G protein-coupled receptors that are targets of the catecholamines, especially noradrenaline (norepinephrine) and adrenaline (epinephrine). Although dopamine is a catecholamine, its receptors are in a different category. For example, epinephrine causes smooth muscle Smooth muscle is an involuntary non-striated muscle. It is divided into two sub-groups; the single-unit and multiunit smooth muscle. Within single-unit smooth muscle tissues, the autonomic nervous system innervates a single cell within a sheet or bundle and the action potential is propagated by gap junctions to neighboring cells such that the relaxation in the airways, but causes contraction of the smooth muscle that lines most arterioles An arteriole is a small diameter blood vessel in the microcirculation that extends and branches out from an artery and leads to capillaries.

Epinephrine acts by binding to a variety of adrenergic receptors The adrenergic receptors are a class of G protein-coupled receptors that are targets of the catecholamines, especially noradrenaline (norepinephrine) and adrenaline (epinephrine). Although dopamine is a catecholamine, its receptors are in a different category. Adrenaline is a nonselective agonist of all adrenergic receptors, including α₁, α₂ , β₁, β₂, and β₃ receptors.^[8] Epinephrine's binding to these receptors triggers a number of metabolic changes. Binding to α-adrenergic receptors inhibits insulin Insulin is a hormone that is central to regulate energy and glucose metabolism in the body. Insulin causes cells in the liver, muscle, and fat tissue to take up glucose from the blood, storing it as glycogen in the liver and muscle secretion by the pancreas The pancreas is a gland organ in the digestive and endocrine system of vertebrates. It is both an endocrine gland producing several important hormones, including insulin, glucagon, and somatostatin, as well as an exocrine gland, secreting pancreatic juice containing digestive enzymes that pass to the small intestine. These enzymes help to further, stimulates glycogenolysis Glycogenolysis is the conversion of glycogen polymers to glucose monomers. Glycogen is catabolized by removal of a glucose monomer through cleavage with inorganic phosphate to produce glucose-1-phosphate. This derivative of glucose is then converted to glucose-6-phosphate, an intermediate in glycolysis in the liver The liver is a vital organ present in vertebrates and some other animals. It has a wide range of functions, including detoxification, protein synthesis, and production of biochemicals necessary for digestion. The liver is necessary for survival; there is currently no way to compensate for the absence of liver function and muscle Muscle is the contractile tissue of animals and is derived from the mesodermal layer of embryonic germ cells. Muscle cells contain contractile filaments that move past each other and change the size of the cell. They are classified as skeletal, cardiac, or smooth muscles. Their function is to produce force and cause motion. Muscles can cause, and stimulates glycolysis Glycolysis is the metabolic pathway that converts glucose, C6H12O6, into pyruvate, CH3COCOO− + H+. The free energy released in this process is used to form the high energy compounds, ATP (adenosine triphosphate) and NADH (reduced nicotinamide adenine dinucleotide) in muscle.^[9] β-Adrenergic receptor binding triggers glucagon Glucagon is a hormone, secreted by the pancreas, that raises blood glucose levels. Its effect is opposite that of insulin, which lowers blood glucose levels. The pancreas releases glucagon when blood glucose levels fall too low. Glucagon causes the liver to convert stored glycogen into glucose, which is released into the bloodstream. Glucagon also secretion in the pancreas, increased adrenocorticotropic hormone Adrenocorticotropic hormone , also known as corticotropin, is a polypeptide tropic hormone produced and secreted by the anterior pituitary gland. It is an important component of the hypothalamic-pituitary-adrenal axis and is often produced in response to biological stress (along with corticotropin-releasing hormone from the hypothalamus). Its (ACTH) secretion by the pituitary gland The pituitary gland, or hypophysis, is an endocrine gland about the size of a pea and weighing 0.5 g . It is a protrusion off the bottom of the hypothalamus at the base of the brain, and rests in a small, bony cavity (sella turcica) covered by a dural fold (diaphragma sellae). The pituitary fossa, in which the pituitary gland sits, is situated in, and increased lipolysis Lipolysis is the hydrolysis of lipids. Metabolically it is the breakdown of triglycerides into free fatty acids within cells. When fats are broken down for energy the process is known as beta oxidation. Ketones are produced, and are found in large quantities in ketosis . Lipolysis testing strips such as Ketostix are used to recognize ketosis by adipose tissue In histology, adipose tissue or body fat or just fat is loose connective tissue composed of adipocytes. It is technically composed of roughly only 80% fat; fat in its solitary state exists in the liver and muscles. Adipose tissue is derived from lipoblasts. Its main role is to store energy in the form of fat, although it also cushions and. Together these effects lead to increased blood glucose The blood sugar concentration or blood glucose level is the amount of glucose present in the blood of a human or animal. Normally, in mammals the body maintains the blood glucose level at a reference range between about 3.6 and 5.8 mM (mmol/L, ie, millimoles/liter). It is tightly regulated as a part of metabolic homeostasis and fatty acids In chemistry, especially biochemistry, a fatty acid is a carboxylic acid with a long unbranched aliphatic tail , which is either saturated or unsaturated. The most occurring natural fatty acids have an even number of carbon atoms because their biosynthesis involves acetyl-CoA, a coenzyme carrying a two-carbon-atom group (see fatty acid synthesis), providing substrates for energy production within cells throughout the body.^[9]

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

Biosynthesis and regulation

Adrenaline is synthesized in the adrenal gland in an enzymatic pathway that converts the amino acid Amino acids are molecules containing an amine group, a carboxylic acid group and a side chain that varies between different amino acids. These molecules contain the key elements of carbon, hydrogen, oxygen, and nitrogen. These molecules are particularly important in biochemistry, where this term refers to alpha-amino acids with the general formula tyrosine Tyrosine or 4-hydroxyphenylalanine, is one of the 20 amino acids that are used by cells to synthesize proteins. Its codons are UAC and UAU. It is a non-essential amino acid with a polar side group. The word "tyrosine" is from the Greek tyri, meaning cheese, as it was first discovered in 1846 by German chemist Justus von Liebig in the into a series of intermediates and ultimately adrenaline. Tyrosine is first oxidized to L-DOPA L-DOPA is a naturally-occurring dietary supplement and psychoactive drug found in certain kinds of food and herbs (e.g., Mucuna pruriens, or velvet bean), and is synthesized from the essential amino acid L-tyrosine (TYR) in the mammalian body and brain. L-DOPA is the precursor to the neurotransmitters dopamine, norepinephrine (noradrenaline), and, which is subsequently decarboxylated to give dopamine Dopamine is a catecholamine neurotransmitter that occurs in a wide variety of animals, including both vertebrates and invertebrates. In the brain, this phenethylamine functions as a neurotransmitter, activating the five types of dopamine receptors—D1, D2, D3, D4, and D5—and their variants. Dopamine is produced in several areas of the brain,. Oxidation gives norepinephrine Norepinephrine (abbreviated norepi or NE) or noradrenaline (BAN) (abbreviated NA or NAd) is a catecholamine with multiple roles including as a hormone and a neurotransmitter, which is methylated to give epinephrine.

Adrenaline is synthesized via methylation of the primary distal amine of noradrenaline Norepinephrine (abbreviated norepi or NE) or noradrenaline (BAN) (abbreviated NA or NAd) is a catecholamine with multiple roles including as a hormone and a neurotransmitter by phenylethanolamine N-methyltransferase (PNMT) in the cytosol of adrenergic neurons and cells of the adrenal medulla (so-called chromaffin cells). PNMT is only found in the cytosol of cells of adrenal medullary cells. PNMT uses S-adenosylmethionine (SAMe) as a cofactor to donate the methyl group to noradrenaline, creating adrenaline.^{[citation needed]}

For noradrenaline to be acted upon by PNMT in the cytosol, it must first be shipped out of granules of the chromaffin cells. This may occur via the catecholamine-H⁺ exchanger VMAT1. VMAT1 is also responsible for transporting newly synthesized adrenaline from the cytosol back into chromaffin granules in preparation for release.^{[citation needed]}

In liver cells, adrenaline binds to the β-Adrenergic receptor which changes conformation and helps Gs, a G protein, exchange GDP to GTP. This trimeric G protein dissociates to Gs alpha and Gs beta/gamma subunits. Gs alpha binds to adenyl cyclase thus converting ATP into Cyclic AMP. Cyclic AMP binds to the regulatory subunit of Protein Kinase A: Protein kinase A phosphorylates Phosphorylase Kinase. Meanwhile, Gs beta/gamma binds to the calcium channel and allows calcium ions to enter the cytoplasm. Calcium ions bind to calmodulin proteins, a protein present in all eukaryotic cells, which then binds to Phosphorylase Kinase and finishes its activation. Phosphorylase Kinase phosphorylates Glycogen phosphorylase which then phosphorylates glycogen and converts it to glucose-6-phosphate.^{[citation needed]}

Regulation

The major physiologic triggers of adrenaline release center upon stresses such as physical threat, excitement, noise, bright lights, and high ambient temperature. All of these stimuli are processed in the central nervous system^[10].

Adrenocorticotropic hormone (ACTH) and the sympathetic nervous system stimulate the synthesis of adrenaline precursors by enhancing the activity of tyrosine hydroxylase and dopamine-β-hydroxylase, two key enzymes involved in catecholamine synthesis.^{[citation needed]} ACTH also stimulates the adrenal cortex to release cortisol, which increases the expression of PNMT in chromaffin cells, enhancing adrenaline synthesis. This is most often done in response to stress.^{[citation needed]} The sympathetic nervous system, acting via splanchnic nerves to the adrenal medulla, stimulates the release of adrenaline. Acetylcholine released by preganglionic sympathetic fibers of these nerves acts on nicotinic acetylcholine receptors, causing cell depolarization and an influx of calcium through voltage-gated calcium channels. Calcium triggers the exocytosis of chromaffin granules and thus the release of adrenaline (and noradrenaline) into the bloodstream.^{[citation needed]}

Adrenaline (as with noradrenaline) does exert negative feedback to down-regulate its own synthesis at the presynaptic alpha-2 adrenergic receptor.^{[citation needed]} Abnormally elevated levels of adrenaline can occur in a variety of conditions, such as surreptitious epinephrine administration, pheochromocytoma, and other tumors of the sympathetic ganglia.

Chemical synthesis

Epinephrine may be synthesized by the reaction of catechol with chloroacetyl chloride, followed by the reaction with methylamine to give the ketone, which is reduced to the desired hydroxy compound. The racemic mixture may be separated using tartaric acid.

Therapeutic use

Epinephrine is available in a variety of preparations for the management of several medical conditions. Aqueous preparations of adrenaline are obtained by use of hydrochloric acid or tartaric acid, since it undergoes oxidation in the absence of acid medium.^{[citation needed]} Borate salt is used in ophthalmology.^{[citation needed]}

Cardiac arrest

Adrenaline is used as a drug to treat cardiac arrest and other cardiac dysrhythmias resulting in diminished or absent cardiac output. Its actions are to increase peripheral resistance via α₁ receptor-dependent vasoconstriction and to increase cardiac output via its binding to β₁ receptors.

Shock and anaphylaxis

Due to its vasoconstrictive effects, adrenaline is the drug of choice for treating anaphylaxis. It is also useful in treating sepsis. Allergy^[11] patients undergoing immunotherapy may receive an adrenaline rinse before the allergen extract is administered, thus reducing the immune response to the administered allergen. It is also used as a bronchodilator for asthma if specific β₂agonists are unavailable or ineffective.^[12]

Because of various expression of α₁or β₂receptors, depending on the patient, administration of adrenaline may raise or lower blood pressure, depending whether or not the net increase or decrease in peripheral resistance can balance the positive inotropic and chronotropic effects of adrenaline on the heart, effects which respectively increase the contractility and rate of the heart.^{[citation needed]}

Use in local anesthesics

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. Some of the adverse effects of local anesthetic use, such as apprehension, tachycardia and tremor, may be caused by epinephrine.^[13]

Autoinjectors

Epinephrine is available in an autoinjector delivery system. EpiPens, Anapens and Twinjects all use epinephrine as their active ingredient. Twinjects contain a second dose of epinephrine in a separate syringe and needle delivery system contained within the body of the autoinjector. The larger Twinject dose (0.3 mg) contains a third dose as well.

Though both EpiPen and Twinject are trademark names, common usage of the terms are drifting toward the generic context of any epinephrine autoinjector.^{[citation needed]}

Croup

Racemic epinephrine has historically been used for the treatment of croup.^[14][15] Racemic epinephrine is a 1:1 mixture of the dextrorotatory (D) and levorotatory (L) isomers of epinephrine.^[16] The L form is the active component.^[16] Racemic 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.^[15]

Side effects and drug interactions

Adverse reactions to epinephrine include palpitations, tachycardia, arrhythmia, anxiety, headache, tremor, hypertension, and acute pulmonary edema.^[17]

Use is contraindicated for patients on non-selective β-blockers because severe hypertension and even cerebral hemorrhage may result.^[8] While the use of epinephrine during life threatening anaphylaxis has no absolute contraindications, if it is not clear that the condition is indeed anaphylaxis and is instead an AMI, cardiac arrest will likely result, since epinephrine further constricts the already-occluded coronary arteries. Most of these side effects will be seen in the 2007 movie Crank (film) where, the main character, Chev, overdoses on epinephrine.

Measurement in biological fluids

Epinephrine may be quantitated in blood, plasma or serum as a diagnostic aid, to monitor therapeutic administration or to identify the causative agent in a potential poisoning victim. Endogenous plasma epinephrine concentrations in resting adults are normally less than 10 ng/L, but may increase by 10-fold during exercise and by 50-fold or more during times of stress. Pheochromocytoma patients often have plasma epinephrine levels of 1000-10,000 ng/L. Parenteral administration of epinephrine to acute-care cardiac patients can produce plasma concentrations of 10,000 to 100,000 ng/L.^[18][19]

Use in full contact sports

In sports such as boxing, adrenaline chloride, usually a 1:1000 epinephrine solution, is used to still bleeding during matches.^[20]

Adrenaline junkie

Adrenaline junkie is a term used to describe somebody who appears to be addicted to epinephrine (endogenous) and such a person is sometimes described as getting a "high" from life. The term adrenaline junkie was popularly used in the 1991 movie Point Break to describe individuals who enjoyed dangerous activities (such as extreme sports e.g. BASE jumping) for the adrenaline "rush". Adrenaline junkies appear to favour stressful activities for the release of epinephrine as a stress response. Doing this may result in physical harm because of the potential danger. Whether or not the positive response is caused specifically by epinephrine is difficult to determine, as endorphins are also released during the fight-or-flight response to such activities.^[21][22]

Terminology

This chemical is widely referred to as adrenaline outside of the United States; however, its United States Adopted Name and International Nonproprietary Name is epinephrine. Epinephrine was chosen because adrenaline bore too much similarity to the Parke, Davis & Co trademark Adrenalin (without the "e"), which was registered in the United States. The British Approved Name and European Pharmacopoeia term for this chemical is adrenaline, and is indeed now one of the few differences between the INN and BAN systems of names.^[23]

Amongst American health professionals and scientists, the term epinephrine is used over adrenaline. However, it should be noted that pharmaceuticals that mimic the effects of epinephrine are often called adrenergics, and receptors for epinephrine are called adrenergic receptors or adrenoceptors.

See also

• Anaphylaxis
• Adrenochrome
• Catechol-O-methyl transferase
• Adrenergic receptor

Notes

1. ^ Berecek KH, Brody MJ (1982). "Evidence for a neurotransmitter role for epinephrine derived from the adrenal medulla". Am J Physiol 242 (4): H593–601. PMID 6278965.
2. ^ Cannon, W. B. (1929). American Journal of Physiology 89: 84–107. ^{[Full citation needed]}
3. ^ Gail Askew and Marilyn Smith-Stoner. (2001). The Pharmacy Assistant (Clinical Allied Heathcare Series). Clifton Park, NY: Thomson Delmar Learning. pp. 4–6. ISBN 0-89262-438-8.
4. ^ "0406_s1_article_01". http://www.jpp.krakow.pl/journal/archive/0406_s1/articles/01_article.html. Retrieved 2010-03-02.
5. ^ Yamashima T (2003). "Jokichi Takamine (1854–1922), the samurai chemist, and his work on adrenalin". J Med Biogr 11 (2): 95–102. PMID 12717538.
6. ^ ^{a b} Bennett M (1999). "One hundred years of adrenaline: the discovery of autoreceptors". Clin Auton Res 9 (3): 145–59. doi:10.1007/BF02281628. PMID 10454061.
7. ^ Takamine J (1901). The isolation of the active principle of the suprarenal gland. Great Britain: Cambridge University Press. pp. xxix-xxx. http://books.google.com/books?id=xVEq06Ym6qcC&pg=RA1-PR29#PRA1-PR29,M1.
8. ^ ^{a b} Shen, Howard (2008). Illustrated Pharmacology Memory Cards: PharMnemonics. Minireview. pp. 4. ISBN 1-59541-101-1.
9. ^ ^{a b} Sabyasachi Sircar (2007). Medical Physiology. Thieme Publishing Group. pp. 536. ISBN 3-13-144061-9.
10. ^ L. Nelson, M. Cox, (2004) “Principles of Biochemstry 4th Ed Lehninger” Freeman pp. 908
11. ^ Sicherer, Scott H. M.D., Understanding and Managing Your Child's Food Allergy. Baltimore: The Johns Hopkins University Press, 2006.
12. ^ "Asthma Causes, Types, Symptoms, Treatment, Medication, Facts and the Link to Allergies by MedicineNet.com". http://www.medicinenet.com/asthma/page8.htm.
13. ^ R. Rahn and B. Ball. Local Anesthesia in Dentistry, 3M ESPE AG, ESPE Platz, Seefeld, Germany, 2001, 44 pp.
14. ^ Bjornson CL, Johnson DW (2008). "Croup". The Lancet 371 (9609): 329–339. doi:10.1016/S0140-6736(08)60170-1. PMID 18295000.
15. ^ ^{a b} Thomas LP, Friedland LR (1998). "The cost-effective use of nebulized racemic epinephrine in the treatment of croup". American Journal of Emergency Medicine 16 (1): 87–89. doi:10.1016/S0735-6757(98)90073-0. PMID 9451322.
16. ^ ^{a b} Malhotra A, Krilov LR (2001). "Viral Croup". Pediatrics in Review 22 (1): 5–12. doi:10.1542/pir.22-1-5. PMID 11139641.
17. ^ About.com - "The Definition of Epinephrine"
18. ^ Raymondos K, Panning B, Leuwer M, Brechelt G, Korte T, Niehaus M, Tebbenjohanns J, Piepenbrock S. Absorption and hemodynamic effects of airway administration of adrenaline in patients with severe cardiac disease. Ann. Intern. Med. 132: 800-803, 2000.
19. ^ R. Baselt, Disposition of Toxic Drugs and Chemicals in Man, 8th edition, Biomedical Publications, Foster City, CA, 2008, pp. 545-547.
20. ^ "Cut man". BoxRec Boxing Encyclopaedia. http://boxrec.com/media/index.php/Cut_man. Retrieved 2010-07-10.
21. ^ What Is An Adrenaline Junkie? What Can You Do If You Are One? by Elizabeth Scott, M.S. (updated: November 1, 2007) About.com Health's Disease and Condition content is reviewed by the Medical Review Board
22. ^ Fight-or-flight reaction - Explanations - Brain - ChangingMinds.org
23. ^ http://www.mhra.gov.uk/Howweregulate/Medicines/Namingofmedicines/ChangestomedicinesnamesBANstorINNs/index.htm

References

• Boron WF, Boulpaep EL (2005). Medical Physiology: A Cellular And Molecular Approach. Philadelphia, PA: Elsevier/Saunders. ISBN 1-4160-2328-3. OCLC 56191776.
• Voet D, Voet J (2004). Biochemistry (3rd ed.). USA: Wiley. ISBN 0-471-19350-x. OCLC 154657578.

External links

• U.S. National Library of Medicine: Drug Information Portal - Epinephrine

Categories: Hormones of the suprarenal medulla | Hormones of the hypothalamus-pituitary-adrenal axis | Catecholamines | Cardiac stimulants | Neurotransmitters | Bronchodilators | Stress | Anxiety | World Health Organization essential medicines

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