epinephrine

Question 1

Classification

EPI

Answer 1

• catecholamine
• sympathomimetic

Question 2

Indications

EPI

Answer 2

[PCP]
- anaphylaxis
- severe bronchospasm
- severe croup

[ACP]
- cardiac arrest: ventricular fibrillation, pulseless ventricular tachycardia, asystole, PEA
- peri-arrest hypotension
- significant bradycardia

PEA - pulseless electrical activity

Question 3

Contraindications

EPI

Answer 3

• no absolute in life threatening event

- See ACLS guidelines re: drug therapy in setting of hypothermia (< 30 degrees C)

Question 4

Dosage - Adult
[anaphylaxis]

EPI

Answer 4

[PCP]
0.5mg IM - q 5mins

repeat x 3

Question 5

Dosage - Adult
[severe bronchospasm]

EPI

Answer 5

[PCP]
0.5mg IM - q 5-20mins

cliniCALL - RECCOMENDED

Question 6

Dosage - Pediatric
[anaphylaxis]

EPI

Answer 6

[PCP]
0.1mg/kg IM - MAX 0.5mg

repeat x 3

Question 7

Dosage - Pediatric
[severe bronchospasm]

EPI

impending respiratory arrest

Answer 7

[PCP] - cliniCALL - REQUIRED
0.01mg/kg
MAX - 0.5mg

< 1y/o = total volume - 5mL

cliniCALL REQUIRED

Question 8

Dosage - Pediatric
[croup]

EPI

Answer 8

[PCP]
5mg NEB
< 1/yo - 0.5mg/kg

< 1y/o = total volume - 5mL

cliniCALL RECCOMENDED

Question 9

Pharmacodynamics

EPI

Answer 9

• α1 (alpha 1) effects: vasoconstriction
• β1 (beta 1) effects: ­increased HR, increased­ force of cardiac contraction
  +ve chronotropic // +ve dromotropic // +ve inotropic effects
• • β2 (beta 2) effects [moderate]: bronchodilation
• inhibits histamine release

Question 10

Pharmacokinetics

EPI

Answer 10

IV
 onset - immediate
 peak - 3-5mins
 duration - 5-10mins

IM
 onset - 30-90s
 peak - 4-10mins
 duration - 5-10mins

Inhalation
onset - 1-5 mins
peak - u/k
duration - 1-3 hrs

Question 11

Warnings // Precautions

EPI

Answer 11

@RISK pts w/
- CAD - can cause S&S of ACS
- significant tachydysrhythmias
- hypothermia

Question 12

ADVERSE EFFECTs

EPI

Answer 12

• anxiety
• tremor
• dizziness
• sweating
• palpitations
• headache
• nausea
• rapid increase in HR and BP
• accidental injection to digit/hand/feet - loss of blood flow to area

Question 13

Drug Interations

EPI

Answer 13

• antiarrhythmics - can cause arrhythmias
• beta-blockers - limits bronchodilator & inotropic effects
• epinephrine is neutralized by and may precipitate with sodium bicarbonate. DO NOT administer in the same IV line with bicarb unless the line has been flushed

Question 14

OVERDOSE

EPI

Answer 14

• may produce significantly elevated BP + HR - can lead to cerebral hemorrhage

Question 15

Special Notes

EPI

Answer 15

• Rarely give an IV bolus of epinephrine to an adult with a pulse - it may be LETHAL. It may be indicated in rare pre-arrest anaphylaxis in adults
• IM epinephrine in ideally given in the lateral thigh for most rapid absorption

Question 16

Supplied

EPI

Answer 16

1mg/mL - ampoule

pre-filled syringe - 1:10,000 = 1mg/10mL