Epinephrine

Question 1

Epinephrine Class?

Answer 1

Sympathomimetic, catecholamine, inotropic agent, vasopressor, antidysrhythmic bronchodilator (C)

Question 2

Epinephrine Indications?

Answer 2

1. Cardiac arrest (asystole, pulseless electrical activity, v-fib, pulseless v-tach)
2. Anaphylaxis or severe allergic reaction
3. Severe reactive airway disease (asthma, COPD)
4. Hypotension
5. Symptomatic bradycardia (only in pediatric patients)

Question 3

Epinephrine Mechanism?

Answer 3

Acts directly on alpha and beta receptors of the sympathetic nervous system to increase inotropy, chronotropy, dromotrope, automaticity, systemic vascular resistance, and bronchial smooth muscle dilation; decreases vascular permeability.

Question 4

Epinephrine Side effects?

Answer 4

1. Anxiety
2. Chest pain
3. Dizziness
4. Dysrhythmias
5. Headache
6. Hypertension
7. Nausea
8. Palpitations
9. Seizures
10. Tachycardia
11. Tremors
12. Ventricular fibrillation
13. Vomiting

Question 5

Epinephrine Precautions?

Answer 5

1. Will increase myocardial oxygen demand
2. may potentially increase myocardial ischemia
3. use caution in patients with underlying cardiovascular disease or who are pregnant
4. protect from light Interactions
5. epinephrine is pH dependent and can be inactivated by alkaline solutions such as sodium bicarbonate
6. effects are intensified in patients taking antidepressants

Question 6

Epinephrine Contraindications?

Answer 6

1. Hypertension
2. Tachydysrhythmias
3. Hypovolemia
4. No contraindications in cardiac arrest

Question 7

Epinephrine Routes of administration?

Answer 7

IV, IO, IVPB, ET*, SC, IM (vastus lateralis [anterolateral thigh] preferred) *If no IV/IO in cardiac arrest, may be administered 0.1 mg/kg (1:1,000) (1 mg/mL) via ETT every 3–5 minutes.

Question 8

Epinephrine Onset?

Answer 8

Immediate

Question 9

Epinephrine Duration?

Answer 9

3–5 minutes

Question 10

Epinephrine Adult Dose - Cardiac Arrest?

Answer 10

1 mg (1:10,000) (0.1 mg/mL) IV/IO; every 3–5 minutes, no max

Question 11

Epinephrine Adult Dose - Anaphylaxis/Asthma

Answer 11

0.3 mg IM adult autoinjector (preferred) or 0.3 mg IM (1:1,000) (1 mg/mL) every 5–15 minutes

Question 12

Epinephrine Adult Dose - Profound bradycardia or hypotension

Answer 12

2–10 mcg/min titrated to effect (mix 1 mg for every 100 mL NaCl)

Question 13

Epinephrine Adult Dose - Croup

Answer 13

3 mg (1:1,000) (1 mg/mL) in 3 mL NaCl via nebulizer every 5–15 min

Question 14

Epinephrine Pedi Dose - Cardiac Arrest

Answer 14

0.01 mg/kg (1:10,000) (0.1 mg/mL) IV/IO every 3–5 minutes

Question 15

Epinephrine Pedi Dose - Anaphylaxis/Asthma

Answer 15

0.01 mg/kg 1:1,000 SQ/IM max single dose 0.3mg

Question 16

Epinephrine Pedi Dose - Profound bradycardia or hypotension?

Answer 16

0.1–1 mcg/kg/min titrated to effect (mix 1 mg for every
100 mL NaCl)

Question 17

Epinephrine Pedi Dose - Croup

Answer 17

3 mg (1:1,000) (1 mg/mL) in 3 mL NaCl via nebulizer every 5–15 min