epinephrine Flashcards
Classification
epinephrine
- catecholamine
- sympathomimetic
Indications
epinephrine
PCP
- anaphylaxis
- severe bronchospasm
- stridor (2nd to croup or other infectious cause)
ACP
- cardiac arrest: ventricular fibrillation, pulseless ventricular tachycardia, asystole, PEA
- peri-arrest hypotension
- significant bradycardia
PEA - pulseless electrical activity
Contraindications
epinephrine
- no absolute in life threatening event
- See ACLS guidelines re: drug therapy in setting of hypothermia (< 30 degrees C)
Dosage - Adult
anaphylaxis
epinephrine
PCP
0.5mg IM - q 5mins
repeat x 3
Dosage - Adult
severe bronchospasm // impending respiratory arrest
epinephrine
PCP
0.5mg IM - q 5-20mins
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Dosage - Pediatric
anaphylaxis
epinephrine
EMR
0.01mg/kg IM - MAX 0.5mg
repeat x 3
Dosage - Pediatric
severe bronchospasm // impending respiratory arrest
epinephrine
PCP
0.01mg/kg
MAX - 0.5mg x1
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Dosage - Pediatric
stridor 2nd to croup
(tracheitis) or other infectious process
epinephrine
PCP
5mg NEB
< 1/yo - 0.5mg/kg
< 1y/o = total volume - 5mL
consider Westley Croup Score
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Pharmacodynamics
epinephrine
- α1 (alpha 1) effects: vasoconstriction
-
β1 (beta 1) effects: increased HR, increased force of cardiac contraction
+ve chronotropic // +ve dromotropic // +ve inotropic effects - β2 **(beta 2) effects [moderate]: bronchodilation
- inhibits histamine release
Pharmacokinetics
epinephrine
IV
onset - 30s
peak - 3-5mins
duration - 5-10mins
IM
onset - 30-90s
peak - 4-10mins
duration - 5-10mins
Inhalation
onset - 1-5 mins
peak - u/k
duration - 1-3 hrs
Warnings // Precautions
epinephrine
@RISK pts w/
- CAD - can cause S&S of ACS
- significant tachydysrhythmias
- hypothermia
ADVERSE EFFECTs
epinephrine
- anxiety
- tremor
- dizziness
- sweating
- palpitations
- headache
- nausea
- rapid increase in HR and BP
- accidental injection to digit/hand/feet - loss of blood flow to area
Drug Interations
epinephrine
- antiarrhythmics - can cause arrhythmias
- beta-blockers - limits bronchodilator & inotropic effects
- sodium bicarbonate - neutralizes/precipitates epinephrine
- DO NOT administer in the same IV line with bicarb unless the line has been flushed
OVERDOSE
epinephrine
- may produce significantly elevated BP + HR - can lead to cerebral hemorrhage
Special Notes
epinephrine
- Rarely give an IV bolus of epinephrine to an adult with a pulse - it may be LETHAL. It may be indicated in rare pre-arrest anaphylaxis in adults
- IM epinephrine in ideally given in the lateral thigh for most rapid absorption
