Epinephrine

Question 1

Epinephrine

Class

Answer 1

• Sympathomimetic

Question 2

Epinephrine

Mechanism

Answer 2

• Direct-acting alpha and beta agonist
  
  • alpha 1
  • beta 1
  • beta 2

Question 3

Epinephrine

Indications

Answer 3

• Allergic reactions, anaphylaxis, asthma
• Cardiac arrest;
  
  • VF/pulseless VT
  • Asystole/PEA
• Alternative to dopamine in symptomatic bradycardia
• Severe hypotension secondary to bradycardia after atropine and pacing have failed

Question 4

Epinephrine

Contraindications

Answer 4

• HTN
• Hypothermia
• Pulmonary edema
• Myocardial ischemia
• Hypovolemic shock

Question 5

Epinephrine

Adverse reactions

Answer 5

• HTN
• Tachycardia
• Arrhythmias
• Agitation
• Nausea
• H/A
• Angina
• Pulmonary edema

Question 6

Epinephrine

Drug interactions

Answer 6

• Potentiates other sympathomimetics
• MAOI’s potentiate effects
  
  • (monamine oxidase inhibitors)
• Beta blockers decrease effects
• Deactivated by alkaline solutions (sodium bicarb)

Question 7

Epinephrine

Adult dose allergy/asthma/anaphylaxis

Answer 7

• Mild allergic reactions & Asthma
  
  • 0.3-0.5mg of **1:1 **SC (which is 0.3-0.5 mL)
• Anaphylaxis:
  
  • 0.1 mg of 1:10 IV over 5 min (which is 1 mL)
  • IV drip 1-4 µg/min (1mL of **1:1 **to 500 mL IV bag)

Question 8

Epinephrine

Adult dose cardiac

Answer 8

• Cardiac arrest:
  
  • 1mg 1:10 (10mL) IV q 3-5 min, then flush
  • Higher doses of 0.2 mg/kg may be used in calcium/beta blocker OD
• Continuous infusion:
  
  • 1mg of 1:1 (1mL) into 500 mL bag, start at 1 µg/min and titrate to effect (typical dose 2-10 µg/min)
• Profound bradycardia:
  
  • 2-20 µg/min, titrate to effect

Follow each does with flush and elevate are for 10-20 seconds

Question 9

Epinephrine

Ped dosage allergy/asthma

Answer 9

• Mild allergic reactions & Asthma
  
  • 0.01 mg/kg of **1:1 **SC (which is 0.01 mL/kg)
    
    • Max 0.3 mL

Question 10

Epinephrine

Ped dosage cardiac arrest

Answer 10

• Cardiac arrest:
  
  • 0.01 mg/kg (0.1 mL/kg) of 1:10 IV q 3-5 min
• Symptomatic bradycardia:
  
  • 0.01mg/kg (0.1 mL/kg) of 1:10
• Continuous infusion:
  
  • ​begin with rapid infusion then titrate to response
  • typical initial rate is 0.1 - 1 µg/min

Question 11

Epinephrine

Duration of action

Answer 11

• Onset: Immediate
• **Peak Effect: **Minutes
• Duration: Several minutes

Question 12

Epinephrine

Special Considerations

Answer 12

• Pregnancy: Cat C
• May cause syncope in asthmatic peds
• May increase myocardial oxygen demand