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Flashcards in Epinephrine Deck (22):
1

What is the drug classification of Epi?

Endogenous catecholamine
-nonselective adrenergic agonist stimulating alpha (1&2) and beta (1&2) receptors
-receptor selectivity is dose dependent

2

What are the uses/indications of Epinephrine?

-bronchospasm/ bronchial asthma
-Hypersensitivity rxn (allergic rxn)
-open-angle glaucoma
-Cardiac arrest, asystole
-Electromechanical dissociation
-V.Fib unresponsive to initial defibrillation
-Infusion to increase myocardial contractility
-also added to LAs to decrease systemic absorption and prolong DOA of the anesthetic

3

What is the MOA of Epi (hint: tell me by the dosages used, which receptors are being activated)?

-Beta 2: 1-2mcg/min IV (redistribution of BF to skeletal muscle)
-Beta 1: 4-5mcg/min IV
-Alpha and Beta: 10-20mcg/min IV (vasoconstriction

4

What is Epi the most potent activator of?

Alpha receptors!!!!!!!!

5

What are the routes of Epi?

SQ or IV

6

What is the onset of SQ and IV Epi?

SQ: 5-10 minutes
IV: 1-2 minutes

7

What is the DOA of Epi?

5-10 minutes

8

What is the standard bolus dose of Epi for resuscitation?

10mcg/kg IV (can start with 2-8mcg/kg)
-with single bolus dose CV effects dissipate after 1-5min

9

What are the CV effects of Epi?

-major role is BP regulation
-a1: Vasoconstriction-> Increase BP, CVP, Cardiac work, SVR
-a2: negative feedback-> decrease BP
-B1: increased contractility, HR, CO
-B2: Peripheral vasodilation-> decrease BP
-skin, mucosa, hepatic, renal (a1)
-B2- skeletal muscle

10

With moderate epi doses SBP tends to __________(B1, A1), and DBP tends to _________ (B2) and MAP _______ _____ _______

-increase
-decrease
-stay the same

11

What are the cerebral effects of epi?

at clinically relevant doses, MINIMAL effects on vasoconstriction of arterioles in: Cerebral, Coronary, and Pulmonary vasculature

12

What are the ocular effects of Epi?

-accommodation for far vision (a1-mydriasis)
-regulation of IOP (a1, a2: increase humoral flow; B1: increase production of aqueous humor)

13

What are the respiratory effects of Epi?

BRONCHODILATION
-dilates smooth muscles of bronchial tree (B2)
-Decreased release of vasoactive mediators (histamine) in bronchial vasculature (B2)
-Reduce mucosal secretion (decongestion) (a1)

14

What are the GI effects of Epi?

A2: decreased digestive secretions
a, B2: decreased peristalsis, direct smooth muscle relaxation
a1: decreased splanchnic BF (drastically reduced even if BP relatively normal)

15

What are the GU effects of Epi?

a1-renal BF decreased; contraction of urethral sphincter
B1- increased renin release from kidney
B2- relaxation- decreases UO
a1-facilitates ejaculation
B2- relaxation: inhibits labor!

16

What are the metabolic effects of Epi?

-Glycogenolysis: B2
-Lipolysis (B3)
-Inhibit insulin release (a2)

17

What is the e 1/2t of Epi?

30 seconds

18

How is epi metabolized and eliminated?

-biotransformation by enzyme catechol-O-methyltransferase in the liver and kidneys; and monoamine oxidase
-inactive metabolites eliminated in the urine

19

What are the side effects of Epi?

-tachycardia
-hypertension
-life threatening arrhythmias
-HA, nervousness, tremor
-palpitations
-hyperglycemia
-hypokalemia
-increased IOP

20

What are the contraindications to Epi?

-shock
-cardiac arrhythmias
-severe HTN
-labor
-CHF
-CAD
-pheochromocytoma

21

What is the dose of EPI for hypotension?

2-8mcg/kg IV

22

What is the continuous infusion dose of Epi?

1-20mcg/min