Drug Name:

                        Epinephrine

Trade Name:

Adrenalin, Epi

Class:

·       Adrenergic Catecholamine

·       Sympathomimetic

Mechanism of Action:

·       b1--contractility, inotropic, increases AV conduction, automaticity

·       b2--bronchodilation, skeletal muscle vasodilation

·       a--peripheral vasoconstriction, fight or flight response

·       Small doses (slow administration), beta effects dominate--vasodilation

·       Large doses (rapid administration), alpha effects dominate--vasoconstriction, increases systemic vascular resistance, blood pressure

·       CNS stimulation

Indications:

·       Hypersensitivity reactions (anaphylaxis)

·       Acute bronchospasm associated with asthma or COPD (refractory to first-line agents)

·       Asystole, VF, pulseless VT, PEA

·       Symptomatic bradycardia

·       Refractory hypotension

·       Croup & Epiglottitis

Contraindications:

·       None in cardiac arrest or severe anaphylaxis

·       Hypersensitivity

Precautions:

·       Will increase myocardial oxygen demand

·       HTN

·       Ischemic heart disease

·       Cerebrovascular insufficiency

·       Pulmonary edema

·       Pregnancy (C)

·       Geriatrics

·       Protect from light

·       Deactivated by alkaline solutions (NaHCO3)

Available Forms:

·       1:1000 1 mg/ml (amps, vials, pre-filled syringes, 30 ml vials)

·       1:10000  0.1 mg/ml (10 ml pre-filled syringe)

Pediatrics

·       Cardiac arrest--

·       0.01 mg/kg (1:10,000) IV/IO every 3-5 min.

·       0.1 mg/kg (1:1000, diluted to a volume of 3-5 cc) ET every 3-5 min.

·       Symptomatic Bradycardia—

·       0.01 mg/kg (1:10,000) IV/IO every 3-5 min.

·       0.1 mg/kg (1:1000, diluted to a volume of 3-5 cc) ET every 3-5 min.

·       Infusion:  0.1-1 mcg/kg/min (1 mg (1:1000) / 250 NS = 4mcg/ml), for persistent

hypotension, titrate to response

·       Anaphylaxis--0.01 mg/kg (1:1000) SubQ/IM.  Max 0.3 mg.

·       Infusion:  0.1-1 mcg/kg/min (1 mg (1:1000) / 250 NS = 4mcg/ml), for persistent

hypotension, titrate to response

·       Croup & Epiglottitis:  5 mg (5 cc) of 1:1000 nebulized

·       Bronchospasm (Severe, refractory):  0.01 mg/kg (1:1000) SubQ/IM 

Onset:

·       IV--1-2 min

·       SC--5-10 min

Duration:

·       IV/SC--5-10 min

Side Effects:

·       Anxiety

·       Tachycardia

·       HTN

·       Angina

·       Dysrhythmias

·       N/V

·       Fear

·       Headache

·       Pallor

·       Dizziness

·       Tremors

Interactions:

·       Potentiated by--MAOIs, TCAs

·       Antagonized by--Beta blockers

·       Precipitates in alkaline solutions

PEARLS:

·       Sodium Bicarbonate & Furosemide will inactivate epinephrine, flush line well between administration.

·       Although epinephrine can be delivered ET, studies suggest that the ET route is less successful in arrest situations than IV.  ET administration should be utilized only until IV or IO access can be established.

·       Because of epinephrine’s effects on myocardial oxygen demand, patients should be adequately oxygenated when receiving epinephrine.

·      Epinephrine (1:1000) should not be administered IV without dilution.