Adrenaline

Question 1

Adrenaline - Mechanism of action

Answer 1

Adrenaline stimulates alpha and beta receptors, predominantly alpha1, beta1 and beta 2.
Alpha 1 causes smooth muscle contraction, vasoconstriction & stimulation of glycogenolysis and gluconeogenesis.
Beta 1 causes increase in contractility (inotropy) heart rate (chronotopy) and electrical conduction (dromotopy).
Beta 2 causes smooth muscle relaxation, vasodilation and bronchodilation, reducing histamine release.
Metabolised by the liver and taken up by the sympathetic nerve endings

Question 2

Adrenaline - Indications

Answer 2

[BAREBACSSB]
Bradycardia (severe)
Anaphylaxis
Respiratory Arrest (COPD)
Epistaxis
Bleeding (uncontrolled)
Asthma (severe)
Cardiac Arrest
Stridor
Shock
Blood Pressure support (if unresponsive to metaraminol)

Question 3

Adrenaline - Contraindications

Answer 3

None.

Question 4

Adrenaline - Cautions

Answer 4

Myocardial Ischaemia. (adrenaline will increase myocardial oxygen consumption).
Tachydysrhythmias. (adrenaline will usually make it worse)

Question 5

Adrenaline - Side effects

Answer 5

[3T2VH+mans]
Tachycardia.
Tachydysrhythmia.
Tremors
Ventricular ectopy.
Vomiting
Hyperglycaemia.
Hypertension.
Myocardial Ischaemia. 
Anxiety
Nausea
Sweating

Question 6

Adrenaline - Onset of effect

Answer 6

IV : 5-10 seconds.
IM : 2-5 minutes.
Nebulised, intranasal, & topical on contact with target site.

Question 7

Adrenaline - Duration of effect

Answer 7

Cardiovascular effects last 5-15 minutes.

The mast cell membrane effects may last for several hours.

Question 8

Adrenaline - Preparation

Answer 8

Ampoule containing 1mg in 1ml

Question 9

Adrenaline - Dose

Answer 9

Topical: 1mg diluted to total of 10mg using 0.9% sodium chloride.
IN: 1mg diluted to a total of 10mg using 0.9% sodium chloride, Administer 2ml per nostril using MAD device.
Nebulised: undiluted.
IM: undiluted. Administer lateral thigh preferred.

Question 10

Adrenaline - Repeats

Answer 10

Anaphylaxis - IM - every 10 min if patient not improving. Every 5 min if patient is deteriorating.
Asthma - IM every 10 min if patient is deteriorating.