Epinephrine (Adrenalin, EpiPen, EpiPen Jr)

Question 1

Drug classification

Answer 1

Sympathomimetic/Sympathetic agonist/Catecholamine

Question 2

Mechanism of Action

Answer 2

a1 agonist->second messenger release of calcium in VSMC-> peripheral vasocontriction->increased SVR->increased BP

B1 agonist->increased intracellular Ca2+ in cardiac cells ->positive iontropy, chronotropy, dromotropy

B2 agonist->bronchial smooth muscle relaxation -> bronchodilation
Blocks release of calcium ions and subsequent destruction of MAST cells

Question 3

Pharmacokinetics

• Onset of Action
• Peak Effects
• Duration of Effect
• Half-Life

Answer 3

• Onset of Action- <2 minutes IV, 3-10 minutes IM
• Peak Effects- Peak Effects<5 minutes IV, 20 minutes IM
• Duration of Effect- 5-10 minutes IV, 20-30 IM
• Half-Life- 5 minutes IV

Question 4

Indications/Field Use

Answer 4

• Cardiac Arrest
• Anaphalaxis/Severe reactive airway disease/asthma
• Symptomatic bradycardia/hypotension

Question 5

Contraindications

Answer 5

Tachydysrhythmias (HR>150)

Question 6

Side Effects/Adverse Reactions

Answer 6

Anxiety, HA, dysrhythmias, tremulousness, dizziness, N&V

Question 7

Dose

Answer 7

Adult:
Cardiac Arrest: 0.5-1mg rapid IV, IO [1:10,000] q 3-5 minutes
Anaphylaxis/Asthma: 0.3-0.5mg [1:1000] IM, then 0.1mg [1:10,000]
slow IV, IO over 3 minutes
Bradycardia/Hypotension: 2-10micrograms/min

Pedi:
Cardiac Arrest: 0.01mg/kg rapid IV/IO [1:10,000] q 3-5minutes
Anaphylaxis/Asthma: 0.01mg/kg [1:1000] IM (max 0.3mg), then
0.01mg/kg [1:10,000] slow IV/IO

Question 8

Precautions

Answer 8

• Should be protected from light
• Caution with CAD and pregnancy
• Leads to increased myocardial oxygen demand*

Question 9

Drug-Drug interactions

Answer 9

pH dependent, deactivated by alkaline solutions; effect intensified with pt’s taking antidepressants, reacts with CaCl2 and NaHCO3 to form PPT(in IV tubing)

Question 10

Any 2 symptoms require Epinephrine

Answer 10

• Hypotension
• Angioedema
• Wheezing
• Uticaria
• Vomiting & Diarrhea