Epinephrine

Question 1

Trade Name

Answer 1

Adrenalin, Epi

Question 2

Class

Answer 2

1. Adrenergic Catecholamine

2. Sympathomimetic

Question 3

Action

Answer 3

1. β1—increases contractility (positive inotrope), AV
   conduction(positive dromotrope), and aut omaticity
2. β2–bronchodilation, skeletal muscle vasodilation
3. α–peripheral vasoconstriction, fight or flight
   response
4. Small doses, bet a effects dominate–vasodilation
5. Large doses, alpha effects dominate–vasoconstriction,
   increases systemic vascular resistance and blood
   pressure

Question 4

Indications

Answer 4

1. Hypersensitivity reactions (anaphylaxis)
2. Acute bronchospasm associated with asthma or COPD
   (refractory to first-line agents)
3. Asystole, VF, pulseless VT, PEA
4. Croup & epiglottitis

Question 5

Contraindications

Answer 5

1. None in cardiac arrest or severe anaphylaxis

2. Hypersensitivity

Question 6

Precautions

Answer 6

1. HTN
2. Ischemic heart disease
3. Cerebrovascular insufficiency
4. Pulmonary edema
5. Pregnancy (C)
6. Geriatrics
7. Protect from light
8. Deactivated/precipitates with alkaline solutions (NaHCO3) 9. Increases myocardial oxygen demand

Question 7

Dosage
ADULTS
Pulseless Rhythms

Answer 7

IV/IO: 1 mg (1:10,000) every 3-5 minutes

Question 8

Dosage
ADULTS
Anaphylaxis

Answer 8

M/SQ: 0.3-0.5 mg (1:1,000), repeat once at 10 minutes if s/s
do not improve
•IV Infusion: IV/IO: 0.05-1 mcg/kg/min titrate for effectoFor
refractory Cases oTo Mix: 1 mg epinephrine in 250 cc NS
bag
•Neb:For laryngeal edema only, 3 mg epinephrine 1:1,000
(3 ml) mixed with 3 ml NS for 6ml solution total

Question 9

Dosage
ADULTS
Acute Bronchospasm (associated w/ asthma or COPD)

Answer 9

IM/SQ: 0.3-0.5 mg (1:1,000)

Question 10

Dosage
ADULTS
Persistent/Refractory

Answer 10

•IV Infusion: IV/IO: 0.05-1 mcg/kg/min, titrate for effect
-For refractory Cases
-To Mix: 1 mg epinephrine in 250
cc NS bag

Question 11

Dosage
ADULTS
Symptomatic Ca Channel Blockers/Beta Blocker OD (refractory to other interventions)

Answer 11

•IV Infusion: IV/IO: 0.05-1 mcg/kg/min titrate for effect

- For refractory Cases 
- To Mix:   1 mg epinephrine in 250 cc NS bag

Question 12

Dosage
PEDI
Pulseless Rhythms

Answer 12

•IV/IO: 0.01 mg/kg (1:10,000) every 3-5 minutes
•NEONATES: 0.01-0.03 mg/kg (1:10,000) IV/IO every 3-5
minutes

Question 13

Dosage
PEDI
Anaphylaxis

Answer 13

•IM/SQ: 0.01 mg/kg (1:1,000), MAX: 0.3 mg
•Neb:For laryngeal edema only, 3 mg epinephrine 1:1,000
(3 ml) mixed with 3 ml NS for 6ml solution total

Question 14

Dosage
PEDI
Persistant/Refractory Hypotension

Answer 14

•IV Infusion: 0.05-1 mcg/kg/min,titrate for effect

-To Mix: 1 mg epinephrine in 250 cc NS bag

Question 15

Dosage
PEDI
Croup and Epiglottitis

Answer 15

•Neb:For laryngeal edema only, 3 mg epinephrine 1:1,000

(3 ml) mixed with 3 ml NS for 6ml solution total

Question 16

Dosage
PEDI
Refactory Bronchospasm (severe)

Answer 16

•IM/SQ: 0.01 mg/kg (1:1000, 0.1 ml/kg)

Question 17

Onset

Answer 17

IV/IO 1-2 min

IM/SQ 5-10 min

Question 18

Duration

Answer 18

IV/IM/SQ 5/10min

Question 19

Side Effects

Answer 19

1. Anxiety
2. Tachycardia
3. HTN
4. Angina
5. Arrhythmias
6. V-Fib
7. N/V
8. Fear
9. Headache
10. Pallor
11. Dizziness
12. Tremors

Question 20

Interactions

Answer 20

1. Potentiated by MAOIs and TCAs
2. Antagonized by beta blockers
3. Precipitates in alkaline solutions

Question 21

Special Notes

Answer 21

CAUTION: All patients receiving inhaled beta agonists and/or anticholinergic medications should be observed for a least one hour following treatment for return of symptoms.
ALS evaluation is indicated if Epi administered either PTA or by EMS, and transport strongly encouraged. Refusals require medical control contact.
•I.M. Epi may be more effective than SQ Epi in shock
situations.
•Sodium bicarbonat e or Furosemide will inactivate
epinephrine; flush line well between administration.
•Use an IV Infusion pump when administering Epi
Infusions.
-To Mix: 1 mg epinephrine in 250 cc NS bag