Epinephrine

Question 1

Generic Name:

Answer 1

Epinephrine HCL

Question 2

Trade Name:

Answer 2

Adrenalin

Question 3

Class:

Answer 3

Sympathomimetic

Question 4

Supplied:

Answer 4

• 1mg/10mL pre-filled syringe (1:10 000)

- 30mg/30mL vial (1:1000

Question 5

Mechanism of Action: Pharmacological Effects:

Answer 5

Direct acting a and ß agonist; a-bronchial, cutaneous, renal, and visceral arterial constriction (increased systemic vascular resistance); ß1-positive inotropic and chronotropic actions (increases myocardial workload and oxygen requirements), increases automaticity and irritability; ß2 bronchial smooth muscle relaxation and dilation of skeletal vasculature. Other: blocks histamine release.

Question 6

Mechanism of Action: Clinical Effects:

Answer 6

Cardiac Arrest-increases cerebral and myocardial perfusion pressure; increases systolic and diastolic blood pressures; increases electrical activity in the myocardium; can stimulate spontaneous contractions in asystole. Bradycardia-increases heart rate, increases BP; Bronchospasm/Anaphylaxis-reverse signs/symptoms

Question 7

Indications and Field Use:

Answer 7

• Cardiac arrest - VF/Pulseless VT; asystole; PEA (First line pharmacologic agent for any pulseless dysrhythmia in cardiopulmonary arrest).
•  Severe bronchospasm, i.e., bronchiolitis, asthma.
  - Anaphylaxis.
  - Bradycardia, refractory with profound hypotension, monitored patient only.
  - Hypotension unresponsive to other therapy, monitored patient only.
  - Croup

Question 8

Contraindications:

Answer 8

• None known for cardiac arrest

- Hypothermia, relative contraindication

Question 9

Adverse Reactions:

Answer 9

CV: Hypertension, ventricular dysrhytmias; tachycardia; angina

CNS: Anxiety, agititation

GI: Nausea/vomiting

Question 10

Incompatibilities/Drug Interactions:

Answer 10

• Potentiates other sympathomimetics.

- Reacts with alkaline solutions, such as sodium bicarbonate, should not be mixed with alkaline agents.

Question 11

Adult Dosage: Pulseless Arrest:

Answer 11

• IV/IO: 1 mg of 1:10,000 solution repeat every 3 - 5 minutes or,
• ET: Give 2 - 2.5 mg via the ET tube.
• May use 1:10,000 or dilute 1:1000 to equal 10 mL via ET tube for adult. (i.e., 2 mg of 1:1,000 epinephrine diluted with 8 mL NS in a 10 mL syringe)

Question 12

Adult Dosage: Continuous Infusion for Hypotension or Symptomatic Bradycardia:

Answer 12

1mg added to 500mL of NS administered at 1 mcg/min titrated to desired hemodynamic response (range 2-10mcg/min); not first-line therapy.

Question 13

Adult Dosage: Anaphylaxis and Asthma:

Answer 13

• Give 0.3 - 0.5 mg of 1:1000 solution IM (preferred), SC or inject SL, may repeat every 15 to 20 minutes;
• or in extreme cases only, may be asked to use 1:10 000 solution and give 0.1mg every 5 minutes IV/IO
• or continuous IV/IO infusion of 1 - 4 mcg/min to prevent need for multiple injections

Question 14

Pediatric Dosage: Pulseless Arrest or Refractory Bradycardia:

Answer 14

IV/IO: 0.01 mg/kg of 1:10 000 repeat every 3 - 5 minutes, maximum single dose 1mg.

ET: 0.1 mg/kg of 1:1000, diluted with NS to a volume of 3 - 5 mL prior to instillation or followed with flush of 3 - 5 mL of NS after installation repeat every 3 to 5 minutes, maximum single dose 10mg.

Question 15

Pediatric Dosage: Asthma/Anaphylaxis:

Answer 15

Use 1:1000 solution; give 0.01 mg/kg IM (preferred), SC (maximum single dose of 0.5 mg/dose).

Question 16

Pediatric Dosage: IV Infusion:

Answer 16

0.1 - 1 mcg/kg/min; to prepare for small children 0.

6 x Body weight in kg = mg added to NS to make 100mL. With this mixture, 1 mL/hr delivers 0.1 mcg/kg/min.

Question 17

Pediatric Dosage: Croup:

Answer 17

3 mg 1:1000 mixed in 3mL NS with SVN

Question 18

Neonatal Dose (first 12 hours of life): IV/IO Initial and Repeat Dose for Cardiac Arrest or Refractory Bradycardia:

Answer 18

0.01 - 0.03 mg/kg of 1:10 000 every 3 to 5 minutes

Question 19

Neonatal Dose (first 12 hours of life): ET:

Answer 19

0.1 mg/kg of 1:10 000 every 3 to 5 minutes if neonate has no vascular access, fails to respond to positive pressure ventilation with 100% O2.

Question 20

Routes of Administration:

Answer 20

Cardiac: IV push, IV infusion, ET, or IO

Asthma/Anaphylaxis/Bronchitis: IM, SC, SL injection, IV, ET, IO

Question 21

Onset of Action:

Answer 21

Seconds

Question 22

Peak Effects:

Answer 22

Minutes

Question 23

Duration of Action:

Answer 23

Several minutes

Question 24

Arizona Drug Box Minimum Supply:

Answer 24

1:10 000 pre-filled syringes - 5 mg, 1:1000 - 2mg

Optional: 1:1000 multi-dose vial - 30 mg

Question 25

Special Notes:

Answer 25

- Total dose for an adult ET (drug plus diluting solution) should equal at least 10 ml to ensure that the drug reaches lung tissue rather than remaining in the tube. Pediatric patient should equal 3 - 5 ml.
- Multi-dose Vial: 1 mg/ml (1:1,000) in 30 ml bottle. May be used for administering the ACLS doses of epinephrine down the endotracheal tube (2-2.5 times the peripheral route dose, diluted with 8 ml NS to make a 1:10,000 solution) or for mixing an epinephrine infusions such as 1 mg in 500 mL NS
- Infusions: An infusion pump is required for interfacility transports. A minimum of microdrip tubing is required for field use.