Epinephrine Hydrochloride Flashcards
Drug classification
Sympathomimetic agent (catecholamine)
Trade name
Adrenalin
Actions (5)
- Increases cardiac output due to increased inotropy, chronotropy, and AV conduction (Dromotrophy) (beta-1 effect)
- increases systolic blood pressure due to increased cardiac output and vasoconstriction (beta-1, Alpha effect)
- Increases coronary perfusion during CPR by increasing aortic diastolic pressure (Alpha effect)
- Prevents hypotension and loss of intravascular fluid in anaphylactic reactions by counteracting vasodilation and decreases vascular permeability (Alpha effect)
- Relaxes smooth muscles of the respiratory tract (beta-2 effect)
Indications (5)
1. Cardiopulmonary arrest Ventricular fibrillation asystole pulseless ventricular tachycardia pulseless electrical activity (PEA)
- Asthma/severe allergic reaction
- anaphylaxis with shock
- Pediatric bradycardia
- Severe respiratory distress with stridor and croup
Contraindications (2)
- Hypovolemia
2. Hypertension
Adverse effects - cardiovascular (5)
Tachycardia Hypertension Palpitations Chest pain Ventricular fibrillation
Adverse effects - gastrointestinal (2)
Nausea/vomiting
Adverse effects - neurological (5)
Anxiety/restlessness
Headache
Tremors/seizures
Dizziness
Administration- cardiac arrest
1mg (1:10,000) IVP or IO
May repeat dose for either route every 3-5 minutes.
Administration - asthma/allergic reaction
0.3 mg (1:1,000) SQ
May repeat every 20 minutes x 2
Administration - anaphylaxis with shock
0.1 mg (1:10,000) slowly (over 1 minute) IVP
May repeat every 3-5 minutes
Or
0.5 mg (1:1,000) IM if unable to obtain venous access
Pediatrics - cardiac arrest
0.01mg/kg (1:10,000) IVP or IO
May repeat every 3-5 minutes
Maximum single dose is 1mg
Pediatrics - asthma/allergic reaction
0.01mg/kg (1:1,000) SQ
Maximum single dose 0.3mg
May repeat every 20 minutes x 2
Pediatrics - anaphylaxis with shock
0.01mg/kg (1:10,000) slowly (over 1 minute) IVP
(Maximum single dose 0.1mg)
May repeat every 3-5 minutes
Administration - Bradydysrhythmia
0.01mg/kg (1:10,000) IVP
Maximum single dose is 0.1mg
May repeat 0.02 mg/kg IVP every 3-5 minutes
Pediatrics - stridor with croup
less than and equal to 1 year
2.5 mg (1:1,000) diluted with 5mL NS via HHN
Greater than and equal to 1 year
5mg (:1,000) diluted with 5mL NS via HHN
Onset
Immediate if given IVP or IO
5-10 min SQ
Duration
3-5 min if given IVP or IO
20 min if SQ
Precautions
Flush IV tubing before and after administration of sodium bicarbonate
rationale
Inactivated by sodium bicarbonate
Precautions
Give slow IVP
Rationale
Rapid IV administration may cause cardiac arrest
Precautions
Monitor blood pressure, pulse and ECG rhythm frequently after administration
Rationale
High incidence of cardiovascular side effects especially in patients over 40 years of age or with hypertension
Precautions
Follow cardiac does with 20 mL flush and elevate arm for 10-20 sec
Rationale
Ensures dose reaches central circulation
Precautions
Provide oxygen
Rationale
Myocardial oxygen requirements are increased
Precautions
Observe IV site
Rationale
tissue ischemia and necrosis my results if IV infiltration occurs
Note
2 mg may be given down ET, but preferred method of delivery is IVP or IO
croup is usually found in children 3 months to 5 years of age.
Maximum dose 5 mg
rebound stridor or croup may occur. Must transport for further care.
Hold epi if heart rate is greater than 200 bpm
806 – cardiopulmonary arrest adult
1 mg IV or IO
806 - cardiopulmonary arrest pediatrics
0.01 mg/kg IV or IO
806 - severe anaphylaxis adult
0.1 mg slow IVP (of 1:10,000)
806 - severe anaphylaxis pediatric
0.01 mg/kg slow IVP (of 1:10,000)
Maximum single dose 0.1mg
