Epinephrine (Adrenalin, EpiPen, EpiPen Jr.)

Question 1

Epinephrine Classification

Answer 1

Sympathomimetic/Sympathetic agonist/Catecholamine

Question 2

Epinephrine Mechanism

Answer 2

A1 agonist -> 2nd messenger release of Ca2+ in VMSC -> peripheral vasoconstriction -> increased SVR -> increased BP
B1 agonist -> Increased intracellular Ca2+ in cardiac cells -> positive inotropy, chronotropy, dromotropy
B2 agonist -> bronchial SM relaxation -> bronchodilation

Blocks release of Ca2+ ion and subsequent destruction of MAST cells

Question 3

Epinephrine Pharmacokinetics

Answer 3

Onset: <5min IV, 20 min IM
Duration: 5-10min IV, 20-30 min IM
Half Life: 5min IV

Question 4

Epinephrine Indications

Answer 4

• Cardiac Arrest
• Symptomatic bradycardia/hypotension
• Anaphylaxis/Severe Reactive Airway Disease/Asthma

Question 5

Epinephrine Contraindications

Answer 5

Tachydysrhythmias

Question 6

Epinephrine Side Effects/Adverse Reactions

Answer 6

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

Question 7

Epinephrine Dose

Answer 7

Adult:
Cardiac Arrest: 0.5-1mg [1:10000] rapid IV IO q3-5min
Anaphylaxis/Asthma: 0.3-0.5mg [1:1000] IM, then 0.1mg [1:10000] slow IV IO over 3min
Bradycardia: 2-10mcg/min

Pedi:
Cardiac Arrest: 0.01mg/kg [1:10000] rapid IV IO q3-5min
Anaphylaxis/Asthma: 0.01mg/kg [1:1000] IM (max 0.3mg), then 0.01mg/kg [1:10000] slow IV IO

Question 8

Epinephrine Precautions

Answer 8

• Should be protected from light
• Caution with CAD and pregnancy
• Leads to increase myocardial O2 demand

Question 9

Epinephrine Drug Interactions

Answer 9

• pH dependant, deactivated by alkaline solutions
• effect intensified in pts taking antidepressants
• reacts with CaCl2 and NaHCO3 to form PPT in IV tubing