Epinephrine/ Adrenalin

Question 1

Epinephrine Class

Answer 1

• Adrenergic Catecholamine

* Sympathomimetic

Question 2

Epinephrine Action

Answer 2

• β1—increases contractility (positive inotrope), AV conduction (positive dromotrope), and automaticity
• β2–bronchodilation, skeletal muscle vasodilation
• α–peripheral vasoconstriction, fight or flight response
• Small doses, beta effects dominate–vasodilation
• Large doses, alpha effects dominate–vasoconstriction, increases systemic vascular resistance and blood pressure

Question 3

Epinephrine Indications

Answer 3

• Hypersensitivity reactions (anaphylaxis)
• Acute bronchospasm associated with asthma or COPD (refractory to first-line agents)
• Asystole, VF, pulseless VT, PEA
• Croup and epiglottitis

Question 4

Epinephrine Contraindications

Answer 4

• None in cardiac arrest or severe anaphylaxis

* Hypersensitivity

Question 5

Epinephrine Precautions

Answer 5

• HTN
• Ischemic heart disease
• Cerebrovascular insufficiency
• Deactivated/precipitates with alkaline solutions (bicarb)
• Increases myocardial oxygen demand
• Pulmonary edema
• Pregnancy (C)
• Geriatrics
• Protect from light

Question 6

Epinephrine Dosage

Answer 6

Adults:
• Pulseless Rhythms= IV/IO: 1 mg (1:10,000) q 3-5 min.
• Anaphylaxis= SQ: 0.3-0.5 mg (1:1,000), repeat once at 10 minutes if s/s do not improve. IV Infusion: For refractory cases, 2-10 mcg/min titrated to BP response. Neb: For laryngeal edema only, 3 mg epinephrine 1:1,000 (3 ml) mixed with 3 ml NS for 6ml solution total
• Acute bronchospasm associated with asthma or COPD (refractory to first-line agents)= SQ: 0.3-0.5 mg (1:1,000)
• Persistent/Refractory Hypotension: Mix 1 mg epinephrine in a 100 cc buretrol or 250 cc NS bag. IV: 2-10 mcg/min, titrate for effect.
• Symptomatic CCB & BB OD refractory to other interventions: Mix 1 mg epinephrine in a 100 cc buretrol or 250 cc NS bag. IV: 2-10 mcg/min, titrate for effect (requires Medical Control contact)
Pediatrics:
• Pulseless Rhythms: IV/IO: 0.01 mg/kg (1:10,000) q 3-5 min. NEONATES: 0.01-0.03 mg/kg (1:10,000) IV/IO q 3-5 min.
•Anaphylaxis: 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.
• Persistent/Refractory Hypotension: IV: 0.1-1 mcg/kg/min, not to exceed 10 mcg/min
•Croup and Epiglottitis: Neb: For laryngeal edema only, 3 mg epinephrine 1:1,000 (3 ml) mixed with 3 ml NS for 6ml solution total.
• Refractory Bronchospasm (Severe): IM/SQ: 0.01 mg/kg (1:1000, 0.1 ml/kg)

Question 7

Epinephrine Onset/ Duration

Answer 7

• Onset: IV/IO: 1-2 min • IM/SQ: 5-10 min

* Duration: IV/IM/SQ: 5-10 min

Question 8

Epinephrine Side Effects

Answer 8

• Anxiety
• Tachycardia
• HTN
• Angina
• Arrhythmias
• V-Fib
• N/V
• Fear
• Headache
• Pallor
• Dizziness
• Tremors

Question 9

Epinephrine Interactions

Answer 9

• Potentiated by MAOIs and TCAs
• Antagonized by beta blockers
• Precipitates in alkaline solutions