EPINEPHrine Flashcards
What classification is EPINEPHrine under?
Sympathomimetic
Explain the pharmacodynamics of EPINEPHrine
- 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
What are the indications for EPINEPHrine?
(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
What are the contraindications for EPINEPHrine
- Significant tachyarrhythmias
- See ACLS guidelines re: drug therapy in the setting of hypothermia (< 30 degrees C)
List the precautions for EPINEPHrine
- 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
List the adverse effects for EPINEPHrine
- Tachycardia, palpitations, angina, PVC’s
- Hypertension
What is the peak timing for IM EPINEPHrine?
Unknown
What is the duration for IM EPINEPHrine?
1-4 hours
What is the half-life for IM EPINEPHrine?
Unknown
What is the onset timing for inhaled EPINEPHrine?
1-5 minutes (has a mostly local effect)
What is the peak timing for inhaled EPINEPHrine?
Unknown
What is the duration for inhaled EPINEPHrine?
1-3 hours
What is the half-life for inhaled EPINEPHrine?
Unknown
What is the PCP ADULT dosing for EPINEPHrine?
- 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
What is the ACP ADULT dosing for EPINEPHrine?
- 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
- Take a pre-load of Epinephrine (1:10’000 - 1 mg in 10
What is the PCP PEDIATRIC dosing for EPINEPHrine?
- .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
What is the ACP PEDIATRIC dosing for EPINEPHrine?
- .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
What is the PCP ADULT dosing for EPINEPHrine?
- 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
What is the ACP ADULT dosing for EPINEPHrine?
- 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
- Take a pre-load of Epinephrine (1:10,000 - 1 mg in 10
What is the PCP PEDIATRIC dosing for EPINEPHrine?
- .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
What is the ACP PEDIATRIC dosing for EPINEPHrine?
- .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
What is the most rapid route of absorption for IM EPINEPHrine?
Lateral thigh
Can PCPs nebulize epinephrine for croup?
If trained, yes.
MANDATORY consult with CliniCall to discuss differential diagnoses and treatment plans (PCP)
1-833-829-4099 or 604 829-4099
What should be taken into consideration when administering IM EPINEPHrine for moderate to severe asthma related bronchospasm?
- SpO2 <90%
- Increasing bronchospasm or silent chest
- Accessory muscle use
- Increasing SOB after treatments with MDI
- Decreasing LOC
What is the ADULT IM EPINEPHrine dosing for moderate to severe asthma related bronchospasm?
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
