Epinephrine (Adrenalin®, EpiPen®, EpiPen Jr.®)

Question 1

Epi Drug Classification

Answer 1

Sympathomimetic / Sympathetic agonist / Catecholamine

Question 2

Epi Mechanism α1 agonist (1/4)

Answer 2

α1 agonist –> second messenger release of calcium in VSMC –> peripheral vasoconstriction –> increased SVR –> increased BP

Question 3

Epi Mechanism β1 agonist (2/4)

Answer 3

β1 agonist –> increased intracellular Ca2+ in cardiac cells –> positive inotropy, chronotropy, dromotropy

Question 4

Epi Mechanism β2 agonist (3/4)

Answer 4

β2 agonist –> bronchial smooth muscle relaxation –> bronchodilation.

Question 5

Epi Mechanism Misc (4/4)

Answer 5

Blocks release of calcium in and subsequent destruction of MAST cells

Question 6

Epi Onset of Action

Answer 6

<2 minutes IV, 3 - 10 minutes IM

Question 7

Epi Peak Effects

Answer 7

<5 minutes IV, 20 minutes IM

Question 8

Epi Duration of Effect

Answer 8

5 - 10 minutes IV, 20-30 minutes IM

Question 9

Epi Half-Life

Answer 9

5 minutes IV

Question 10

Epi Indications / Field Use

Answer 10

Cardiac arrest, anaphylaxis / severe reactive airway disease / asthma, symptomatic bradycardia / hypotension.

Question 11

Epi Contraindications

Answer 11

Tachydysrhythmias

Question 12

Epi Side Effects / Adverse reactions

Answer 12

Anxiety, headache, dysrhythmias, tremulousness, dizziness, N+V

Question 13

Epi Dose: Cardiac Arrest (ADULT)

Answer 13

0.5 - 1 mg rapid IV/IO [1:10,000] q 3-5 minutes

Question 14

Epi Dose: Anaphylaxis / Asthma (ADULT)

Answer 14

0.3 - 0.5 mg [1:1000] IM, then 0.1 mg [1:10,000] slow IV/IO over 3 minutes

Question 15

Epi Dose: Bradycardia / Hypotension (ADULT)

Answer 15

2 - 10 mcg/min

Question 16

Epi Dose: Cardiac Arrest (PEDI)

Answer 16

0.01 mg/kg rapid IV/IO [1:10,000] q 3 - 5 min

Question 17

Epi Dose: Anaphylaxis / Asthma (PEDI)

Answer 17

0.01 mg/kg IM [1:1000] (max 0.3 mg), then 0.01 mg/kg slow IV/IO [1:10,000]

Question 18

Epi Precautions

Answer 18

Should be protected from light; caution with CAD and pregnancy; Leads to increased myocardial oxygen demand

Question 19

Epi Drug-Drug Interactions

Answer 19

pH dependent, deactivated by alkaline solutions; effect intensified with patients taking antidepressants; reacts with CaCl2 and NaHCO3 to form PPT in IV tubing.