5- Epinephrine(adrenaline)

Question 1

Class

Answer 1

Sympathomimetic

Question 2

Onset
Peak effect
Duration

Answer 2

Onset: immediate
Peak effect: minutes
Duration: several minutes

Question 3

MOA:

Answer 3

Alpha and beta agonists
Alpha-vasoconstriction
Beta 1- positive inotropic, chronotropic, and dromotropic effects
Beta 2- smooth muscle relaxation and dilation of skeletal vasculature
Blocks histamine receptors

Question 4

Indication

Answer 4

Cardiac arrest (PEA, asystole, v fib, pulseless v tach)
Symptomatic bradycardia as alternative to dopamine
Severe hypotension secondary to bradycardia when atropine and transcutaneous pacing are unsuccessful
Allergic reaction
Anaphylaxis
Asthma

Question 5

Contraindication

Answer 5

Hypertension
Hypothermia
Pulmonary edema
Myocardial ischemia
Hypovolemic shock

Question 6

Adult dose

Answer 6

Mild allergic reaction/asthma: 0.3-0.5 mg SC (0.3-0.5 ml 1:1,000)
Anaphylaxis: 1mg (10ml of 1:10,000) IV/IO over 5 minutes
Cardiac arrest: 1mg (10ml of 10,000) IV/IO over 3-5 minutes during resuscitation
*follow each dose with 20 ml flush, elevate arm 10-I 20 seconds
Continuous infusion: add 1 mg (1 ml of 1:1,000) to 250 ml saline or D5W (4mcg/ml)
Initial infusion rate: 1 mcg/min (tirate to effect)
Endotracheal: 2-2.5mg diluted in 10 ml normal saline
Profound bradycardia or hypotension: 2-10 mcg / minute (titrate to Response)
Higher dose: up to 0.2mg/kg for special considerations : beta blocker overdose or calcium channel blocker overdose