Adrenaline

Question 1

Presentation

Answer 1

1mg in 1ml glass ampoule (1:1000)

1mg in 10ml glass ampoule (1:10,000)

Question 2

Pharmacology

Answer 2

Primarily used for its Alpha effects to enhance venous return and increase cardiac output (in an attempt to overcome increasing ITP)
Alpha effects: Causes peripheral vasoconstriction leading to:
• Increased Venous return
• Increased Myocardial perfusion
B1 effects: Causes an increase in myocardial contractility
B2 effects: Causes Bronchodilation
Can assist with the stabilisation of mast cells if there is an allergic element to the asthmatic episode

Question 3

Metabolism

Answer 3

By monoamine oxidase and other enzymes in the blood, liver and around nerve endings; excreted by the kidneys

Question 4

Primary emergency indications

Answer 4

1. cardiac arrest- VF/VT, asystole or PEA
2. inadequate perfusion (cardiogenic or non-cardiogenic/non-hypovolaemic)
3. bradycardia with poor perfusion
4. anaphylaxis
5. severe asthma- imminent life threat not responding to nebulised therapy, or unconscious with no BP
6. Croup

Question 5

Contraindications

Answer 5

Hypovolaemic shock without adequate fluid replacement

Question 6

Precautions

Answer 6

Consider reduced doses for:

1. elderly/frail patients
2. patients with cardiovascular disease
3. patients on monoamine oxidase inhibitors
4. higher doses may be required for patients on beta blockers

Question 7

Route of administration

Answer 7

IV
IM
Nebulised

Question 8

Side effects

Answer 8

• sinus tachycardia
• supraventricular arrythmias
• hypertension
• pupillary dilation
• may increase size of MI
• feeling of anxiety/palpitations in the conscious patient

Question 9

Special notes

Answer 9

IV adrenaline should be reserved for life threatening situations.
IV effects
Onset: 30 seconds
Peak: 3-5mins
Duration: 5-10mins
IM effects
Onset: 30-90 seconds
Peak: 4-10mins
Duration: 5-10mins