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Medications > EPINEPHrine > Flashcards

EPINEPHrine Flashcards

1
Q

What classification is EPINEPHrine under?

A

Sympathomimetic

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2
Q

Explain the pharmacodynamics of EPINEPHrine

A
  • α1 (Alpha 1) Effects: Vasoconstriction
  • β1 (Beta 1) Effects: ­Increased Heartrate, Increased­ force of cardiac contraction
  • β2 (Beta 2) Effects (moderate): Bronchodilation
  • Inhibits histamine release
  • +ve chronotropic, +ve dromotropic and +ve inotropic effects
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3
Q

What are the indications for EPINEPHrine?

A

(PCP)

  • IM, IV, IO, nebulized: Anaphylaxis
  • IM dose: Bronchospasm (uncommon)

(ACP)

  • IV/IO dose - Cardiac arrest: ventricular fibrillation, pulseless ventricular tachycardia, asystole, pulseless electrical activity
  • Nebulized for severe croup
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4
Q

What are the contraindications for EPINEPHrine

A
  • Significant tachyarrhythmias

- See ACLS guidelines re: drug therapy in the setting of hypothermia (< 30 degrees C)

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5
Q

List the precautions for EPINEPHrine

A
  • May cause significant dysrhythmias in patients > 35 y/o and/or cardiovascular disease
  • Reduced dosage may be required for patient on MAO inhibitor as there is an increased sympathomimetic response
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6
Q

List the adverse effects for EPINEPHrine

A
  • Tachycardia, palpitations, angina, PVC’s

- Hypertension

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7
Q

What is the peak timing for IM EPINEPHrine?

A

Unknown

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8
Q

What is the duration for IM EPINEPHrine?

A

1-4 hours

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9
Q

What is the half-life for IM EPINEPHrine?

A

Unknown

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10
Q

What is the onset timing for inhaled EPINEPHrine?

A

1-5 minutes (has a mostly local effect)

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11
Q

What is the peak timing for inhaled EPINEPHrine?

A

Unknown

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12
Q

What is the duration for inhaled EPINEPHrine?

A

1-3 hours

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13
Q

What is the half-life for inhaled EPINEPHrine?

A

Unknown

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14
Q

What is the PCP ADULT dosing for EPINEPHrine?

A
  • 0.5 mg 1:1000 IM q 5 min x3 doses for anaphylaxis

- 0.5 mg IM for asthma with failing respirations - repeat q 5 – 20 min

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15
Q

What is the ACP ADULT dosing for EPINEPHrine?

A
  • 1 mg IV/IO for cardiac arrest. Repeat q 3-5 minutes (current literature suggests maximum dose of 3-4 mg)
  • 2-10 µg/min infusion - generally reserved for patients who are profoundly bradycardic and hemodynamically unstable
  • 0.5 mg 1:1000 IM q 5 min x3 doses for anaphylaxis
  • 0.5 mg IM for asthma with failing respirations - repeat q 5 – 20 min
  • 50-100 µg 1/10000 epinephrine IV or IO repeated as necessary for pre-arrest anaphylaxis or asthma

Peri-Cardiac Arrest Cardiogenic Shock or Bradycardia:

  • 10 µg Slow IV/IO Q2 to 3 mins PRN
  • Suggested Method
    • Take a pre-load of Epinephrine (1:10’000 - 1 mg in 10
      mL), and empty 9 mL. You will have 100 µg
      remaining
    • Withdraw 9 mL Normal Saline from the luer lock of
      an IV line to obtain 100 µg in 10 mL - 10 µg per 1 mL
    • Can now administer 10 µg/1 mL aliquots
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16
Q

What is the PCP PEDIATRIC dosing for EPINEPHrine?

A
  • .01 mg/kg IM for respiratory failure /anaphylaxis to a max of 0.5 mg
  • 5 mg (5 mL) 1:1000 for croup, by nebulizer mask with an oxygen flow sufficient to aerosolize the medication
    (PCP only if trained)
    • Patients under 1 year of age receive a weight based dose, 0.5 mg/kg in 5 mL N/S; max 5 mg
    • MANDATORY consult with CliniCall to discuss differential diagnoses and treatment plans (PCP)
      1-833-829-4099 or 604 829-4099
17
Q

What is the ACP PEDIATRIC dosing for EPINEPHrine?

A
  • .01 mg/kg IV/IO for cardiac arrest
  • .005 mg/kg IV/IO for pre-arrest anaphylaxis
  • .01 mg/kg IM for respiratory failure /anaphylaxis to a max of 0.5 mg
  • 5 mg (5 mL) 1:1000 for croup, by nebulizer mask with an oxygen flow sufficient to aerosolize the medication
    (PCP only if trained)
    • Patients under 1 year of age receive a weight based dose, 0.5 mg/kg in 5 mL N/S; max 5 mg
    • MANDATORY consult with CliniCall to discuss differential diagnoses and treatment plans (PCP)
      1-833-829-4099 or 604 829-4099
  • Peri-intubation resuscitation: 1 µg/kg Slow IV/IO Q2 to 3mins PRN
18
Q

What is the PCP ADULT dosing for EPINEPHrine?

A
  • 0.5 mg 1:1,000 IM q 5 min x3 doses for anaphylaxis

- 0.5 mg IM for asthma with failing respirations - repeat q 5 – 20 min

19
Q

What is the ACP ADULT dosing for EPINEPHrine?

A
  • 1 mg IV/IO for cardiac arrest. Repeat q 3-5 minutes (current literature suggests maximum dose of 3-4 mg)
  • 2-10 µg/min infusion - generally reserved for patients who are profoundly bradycardic and hemodynamically unstable
  • 0.5 mg 1:1,000 IM q 5 min x3 doses for anaphylaxis
  • 0.5 mg IM for asthma with failing respirations - repeat q 5 – 20 min
  • 50-100 µg 1/10,000 epinephrine IV or IO repeated as necessary for pre-arrest anaphylaxis or asthma

Peri-Cardiac Arrest Cardiogenic Shock or Bradycardia:

  • 10 µg Slow IV/IO Q2 to 3 mins PRN
  • Suggested Method
    • Take a pre-load of Epinephrine (1:10,000 - 1 mg in 10
      mL), and empty 9 mL. You will have 100 µg
      remaining
    • Withdraw 9 mL Normal Saline from the luer lock of
      an IV line to obtain 100 µg in 10 mL - 10 µg per 1 mL
    • Can now administer 10 µg/1 mL aliquots
20
Q

What is the PCP PEDIATRIC dosing for EPINEPHrine?

A
  • .01 mg/kg IM for respiratory failure /anaphylaxis to a max of 0.5 mg
  • 5 mg (5 mL) 1:1,000 for croup, by nebulizer mask with an oxygen flow sufficient to aerosolize the medication
    (PCP only if trained)
    • Patients under 1 year of age receive a weight based dose, 0.5 mg/kg in 5 mL N/S; max 5 mg
    • MANDATORY consult with CliniCall to discuss differential diagnoses and treatment plans (PCP)
      1-833-829-4099 or 604 829-4099
21
Q

What is the ACP PEDIATRIC dosing for EPINEPHrine?

A
  • .01 mg/kg IV/IO for cardiac arrest
  • .005 mg/kg IV/IO for pre-arrest anaphylaxis
  • .01 mg/kg IM for respiratory failure /anaphylaxis to a max of 0.5 mg
  • 5 mg (5 mL) 1:1,000 for croup, by nebulizer mask with an oxygen flow sufficient to aerosolize the medication
    (PCP only if trained)
    • Patients under 1 year of age receive a weight based dose, 0.5 mg/kg in 5 mL N/S; max 5 mg
    • MANDATORY consult with CliniCall to discuss differential diagnoses and treatment plans (PCP)
      1-833-829-4099 or 604 829-4099
  • Peri-intubation resuscitation: 1 µg/kg Slow IV/IO Q2 to 3mins PRN
22
Q

What is the most rapid route of absorption for IM EPINEPHrine?

A

Lateral thigh

23
Q

Can PCPs nebulize epinephrine for croup?

A

If trained, yes.

MANDATORY consult with CliniCall to discuss differential diagnoses and treatment plans (PCP)
1-833-829-4099 or 604 829-4099

24
Q

What should be taken into consideration when administering IM EPINEPHrine for moderate to severe asthma related bronchospasm?

A
  • SpO2 <90%
  • Increasing bronchospasm or silent chest
  • Accessory muscle use
  • Increasing SOB after treatments with MDI
  • Decreasing LOC
25
Q

What is the ADULT IM EPINEPHrine dosing for moderate to severe asthma related bronchospasm?

A

0.5 mg IM 1:1000 (max dose 0.5mg)
- Mandatory call to CliniCall for PCP - 1-833-829-4099
or 604 829-4099
- Must have completed face-to-face training during
2019 Continuing Professional Development course to
administer

Medications (19 decks)

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