Epinephrine (adrenaline, Epipen, Asthmanephrine)

Question 1

epinephrine (Adrenalin, EpiPen, AsthmaNefrin)
class

Answer 1

sympathomimetic, nonselective alpha/beta agonist, catecholamine

Question 2

epinephrine (Adrenalin, EpiPen, AsthmaNefrin)
Pharmacology and action

Answer 2

Catecholamine with strong alpha-1 effects, strong beta-1 effects, and
moderate beta-2 effects. Increases heart rate (chronotrope), myocardial contractility (inotrope), and
electrical conduction speed (dromotrope). Secondary relaxation effect on the smooth muscle of stomach,
intestine, uterus and bladder.

Question 3

epinephrine (Adrenalin, EpiPen, AsthmaNefrin)
onset, duration, peak effect

Answer 3

Onset: less than 2 minutes IV. 3-10 minutes IM. Duration: 5-10 minutes IV. 20-30 minutes IM. Peak
Effect: less than 5 minutes IV. 20 minutes IM.

Question 4

epinephrine (Adrenalin, EpiPen, AsthmaNefrin)
indications and contraindications

Answer 4

Indications
● Cardiac arrest
● Bradycardia
● Shock
● Anaphylaxis
● Severe allergic reactions
● Severe refractory wheezing
● Croup/bronchiolitis
IV. Contraindications
● Coronary insufficiency
● Cardiac dilation
● Active labor
● Hyperthyroidism (relative)
● Uncontrolled hypertension (relative)
● Hypothermia (relative)
● Pulmonary edema (relative)
● Myocardial ischemia (relative)
● Hypovolemic shock (relative)

Question 5

epinephrine (Adrenalin, EpiPen, AsthmaNefrin)
adverse reactions and side effects

Answer 5

Cardiovascular: dysrhythmias, chest pain, increased myocardial oxygen demand, palpitations,
hypertension
Neurological: Nervousness, restlessness, headache, tremor

Question 6

epinephrine (Adrenalin, EpiPen, AsthmaNefrin)
dosage

Answer 6

A. 1mg/ml = 1:1000
B. 0.1mg/ml = 1:10,000 (preloads are 1mg/10ml)
C. 0.01mg/ml = 1:100,000 ( To make 1:100,000 aka “push-dose epinephrine” mix 1ml of 1:10,000 in 9ml of
normal saline)
D. To make epinephrine drip for IV infusion, mix 1mg of 1:1000 in 250ml NS to get 4mcg/ml.
Adult
Anaphylaxis: 0.3mg 1:1000 IM. Repeat every 5-15 minutes as needed.
Respiratory distress with wheezing, stridor (from anaphylaxis): 5mg (5ml) of 1:1000 nebulized.
Cardiovascular collapse (from anaphylaxis): 0.5mcg/kg/min of 1:1000 IV infusion despite
repeated IM anaphylaxis doses (0.3mg IM) AND 60ml/kg isotonic fluid boluses.
Severe bronchoconstriction with impending respiratory failure: 0.01mg/kg of 1:1000 IM. Max
dose: 0.3mg

Profound bradycardia with hemodynamic instability: 0.02-0.2mcg/kg/min IV/IO infusion, titrated
to MAP >65mmHg, or 10-20mcg of 1:100,000 IV/IO push every 2 minutes titrated to MAP
>65mmHg.
Shock unresponsive to IV fluids, or cardiogenic shock: 0.05-0.3 mcg/kg/min IV/IO infusion.
Cardiac Arrest: 1mg 1:10,000 IV/IO every 3-5 minutes. If administered via ETT: 2-2.5mg diluted
in 10ml NS.
Pediatric
Anaphylaxis: Weight less than 25kg: 0.15mg 1:1000 IM. Weight 25kg or greater: 0.3mg 1:1000
IM. Repeat dose every 5-15 minutes as needed.
Respiratory distress with wheezing, stridor (from anaphylaxis): 5mg (5ml) of 1:1000 nebulized.
Cardiovascular collapse (from anaphylaxis): 0.5mcg/kg/min of 1:1000 IV infusion despite
repeated IM anaphylaxis doses (0.3mg IM) AND 60ml/kg isotonic fluid boluses.
Profound bradycardia with hemodynamic instability: 0.1mcg/kg IV/IO push of 1:100,000 every
3-5 minutes. Max single dose: 10mcg titrated to MAP >65mmHg.
Cardiac Arrest: 0.01mg/kg of 1:10,000 IV/IO push. Maximum dose: 1mg. If administered via
ETT: 0.1mg/kg every 3-5 minutes until IV/IO access is established.
Neonates
Bradycardia: 0.01-0.03 mg/kg of 1:10,000 IV/IO, followed by 0.5-1ml NS flush. If administered
via ETT: 0.05-0.1mg/kg 1:10,000 and repeate every 3-5 minutes as long as heart rate remains
under 60bpm