Adrenaline

Question 1

Adrenaline - Mechanism of action

Answer 1

Stimulates alpha and beta receptors with predominant effects occurring at alpha 1, beta 1 and beta 2 receptors.

Alpha 1 stimulation causes smooth muscle contraction, vasoconstriction of blood vessels and stimulation of glycogenolysis and gluconeogenises.

Beta 1 stimulation causes increase in inoptropy, chronoptropy and dromoptropy.

Beta 2 stimulation causes smooth muscle relaxation, skeletal muscle vasodilation, bronchodilation and stabilisation of mast cell membranes reducing histamine release from mast cells.

Question 2

Adrenaline - Indicated for (5 at EMT level)

Answer 2

Anaphylaxis 
Severe Asthma
Moderate to severe stridor 
significant bleeding nose
Topical for significant bleeding from wound

Cardiac Arrest
Imminent respiratory arrest from CORD
Severe Bradycardia 
Septic Shock
Cardiogenic shock
Neurogenic shock

Question 3

Adrenaline - Contraindications?

Answer 3

None

Question 4

Adrenaline - Cautions (2)

Answer 4

Myocardial Ischaemia

Tachydysrhythmias

Question 5

Adrenaline - Dosage

Answer 5

Topical - each mg to 10ml sodium chloride - This contains 0.1mg per ml.

Intranasal - each mg to 10ml sodium chloride. Administer 2ml of solution to each bleeding nostril using mucosal atomising device (MAD).

Nebulised - undiluted 5mg at 8 Ltrs per minute for Anaphylaxis, Stridor

IM - undiluted 0.5mg to lateral thigh or lateral upper arm if thigh not suitable.

Question 6

Adrenaline - Common adverse effects (5 cardio, 5 other)

Answer 6

Tachycardia 
Tachydysrhythmia
Moicardial ischaemia
Ventricular ectopy 
Hypertension 
Nausea and vomiting
Tremor, anxiety, sweating 
Hyperglycaemia

Question 7

Adrenaline - Onset of effect

Answer 7

IM - 2 - 5 minutes

Nebulised, intranasal and topical- on contact with target site

Question 8

Adrenaline - Usual preparation

Answer 8

Ampoules containing 1mg in 1ml

Metabolised by the liver