Epinephrine

Question 1

Epinephrine Generic Name

Answer 1

Epinephrine HCl

Question 2

Epinephrine Class

Answer 2

Sympathomimetic

Question 3

Epinephrine MOA

Answer 3

Pharmacological Effects: Direct acting a and ß agonist; a-bronchial, cutaneous, renal, and visceral arterial constriction (increased systemic vascular resistance); ß1-positive inotropic and chronotropic actions (increases myocardial workload and oxygen requirements), increases automaticity and irritability; ß2 bronchial smooth muscle relaxation and dilation of skeletal vasculature. Other: blocks histamine release

Clinical Effects: Cardiac Arrest-increases cerebral and myocardial perfusion pressure; increases systolic and diastolic blood pressures; increases electrical activity in the myocardium; can stimulate spontaneous contractions in asystole. Bradycardia-increases heart rate, increases BP; Bronchospasm/Anaphylaxis-reverse signs/symptoms

Question 4

Epinephrine Indications and Field Use

Answer 4

• Cardiac arrest - VF/Pulseless VT; asystole; PEA (First line pharmacologic agent for any pulseless dysrhythmia in cardiopulmonary arrest).
• Severe bronchospasm, i.e., bronchiolitis, asthma.
• Anaphylaxis.
• Bradycardia, refractory with profound hypotension, monitored patient only.
• Hypotension unresponsive to other therapy, monitored patient only.
• Croup

Question 5

Epinephrine Contraindications

Answer 5

None known for cardiac arrest

Hypothermia (relative contraindication)

Question 6

Epinephrine Adverse Reactions

Answer 6

CV: Hypertension, ventricular dysrhythmias; tachycardia; angina CNS: Anxiety, agitation
GI: Nausea/vomiting

Question 7

Epinephrine Incompatibilities/Drug Interactions

Answer 7

Potentiates other sympathomimetics.

Reacts with alkaline solutions, such as sodium bicarbonate, should not be mixed with alkaline agents.

Question 8

Epinephrine Adult Dosage

Answer 8

Pulseless Arrest: IV/IO: 1 mg of 1:10,000 solution repeat every 3 - 5 minutes

Continuous Infusion for Hypotension or Symptomatic Bradycardia: 1 mg added to 500 mL of NS administered at 1 mcg/min titrated to desired hemodynamic response (range 2-10 mcg/min); not first-line therapy.

Anaphylaxis and asthma: Give 0.3 - 0.5 mg of 1:1,000 solution IM (preferred)

Question 9

Epinephrine Pediatric Dosage

Answer 9

Pulseless Arrest or Refractory Bradycardia:
IV/IO: 0.01 mg/kg of 1:10,000 repeat every 3 - 5 minutes, maximum single dose 1 mg.

Asthma/anaphylaxis: Use 1:1,000 solution; give 0.01 mg/kg IM (preferred), SC (maximum single dose of 0.5 mg/dose).
IV Infusion: 0.1 – 1 mcg/kg/min; to prepare for small children 0. 6 x body wt. in kg = mg added to NS to make 100 mL. With this mixture, 1 mL/hr delivers 0.1 mcg/kg/min. Croup: 3 mg 1:1,000 mixed in 3 mL NS via SVN.

Question 10

Epinephrine Routes of Administration

Answer 10

IM, IO, IV, Nebulizer

Question 11

Epinephrine Onset

Answer 11

Seconds

Question 12

Epinephrine Peak Effects

Answer 12

Minutes

Question 13

Epinephrine Duration of Action

Answer 13

Several minutes

Question 14

Epinephrine Drug Box Minimum

Answer 14

1:10,000 prefilled syringes – 5 mg, 1:1,000 - 2 mg

Optional: 1:1,000 multidose vial- 30 mg