Verapamil & Epinephrine

  1. What is the generic name for Epinephrine?
  2. What is the brand name for Epinephrine?
  3. What is the class for Epinephrine?
    • Sympathomimetic
    • Adrenergic
  4. What is the mechanism of action for Epinephrine?
    • Alpha and Beta agonist
    •      Alpha -1 agonist
    •           Peripheral vasoconstriction increasing systemic vascular resistance
    •      Beta-1 agonist
    •           Positive inotrope         
    •           Positive chronotrope
    •           Postivive dromotrope
    •           Reduces defribrillation threshhold
    •           Renin release from kidneys
    •      Beta -2 agonist
    •           Bronchial smooth muscle relaxation
    •           Skeletal vasculature dilation
    •           Block histamine release

  5. Indications and field use for Epinephrine?
    • Cardiac arrest, all rythms (1st drug for dead people)
    •      Increases SVR increasing cerebral & myocardial perfusion pressure during CPR
    •      Positive dromotrope can increase success rate of defibrillation
    •      Positive dromotrope can increase electrical activity in heart in asytole

    • Refractory bronchospasm not relieved with other medication
    •      Bronchial smooth muscle relaxation increases bronchial airway diameter

    • Anaphylaxis
    •      Increased SVR increases blood pressure
    •      Peripheral vasoconstriction reduces edema
    •      Bronchial smooth muscle relaxation increases bronchial airway diameter
    •      Histamine release from mast cells inhibited

    • Hypotension not relieved by other therapy
    •      Increased SVR increases blood pressure
    •      Positive chronotropic and inotropic effects increases cardiac output

    • Croup
    •      Peripheral vasoconstrition reduces edema
  6. Dosage for Epinephrine?
    Dosage via IV/IO, IM, Sub-Q, SVN, or ETT

    • Cardiac arrest, all rhythms (for dead people)
    •      Epi 1mg of 1:10,000 IV push with 20cc NS flush q 3-5 minutes, no limit
    •           ETT route Epi 2mg of 1:1,000 diluted in syringe with 8cc

    • Anaphylaxis
    • Refractory bronchospasm
    •      Epi 0.3mg of 1:1,000 IM

    • Infusion for hypotension
    •      Epi 1, 2, or 4mg 1:1,000 added to 250cc NS at 2-10mcg/min
    •      Use after other treatment
  7. Contraindications for Epinephrine?
    • None for normal cardiac arrest
    •      Hyperthermia arrest (relative)
    • Adult with pulse, age <35 (relative, patch)
  8. Drug interactions for Epinephrine?
    • Potentiates with other sypathomimetics
    • Reacts with alkaline solution such as sodium bicarbonate
    • Beta blockers reduce effects
    • MAOI's increase effects
  9. Side effects for Epinephrine?
    • AMI/CHP
    • Dysrhthmias
    • Hypertension
    • Anxiety
    • Tremors
    • N/V
  10. Onset of action for Epinephrine?
  11. AZ drug box supply for Epinephrine?
    • 8 x Epi 1mg in 10cc (1:10,000) prefilled syringes
    • 2 x Epi 1mg in 1cc (1:1,000) ampule
    • 1 x Epi 30mg in 30cc (1:1,000) multidose vial
  12. What is the generic name for Verapamil?
    Verapamil HCL
  13. What is the brand name for Verapamil?
    • Calan
    • Isoptin
  14. What is the class for Verapamil?
    Calcium channel blocker
  15. Mechanism of action for Verapamil?
    • Blocks calcium channels in myocardial cell slowing influx of calcium ions
    •      Reduces force of contraction
    •      Slows heart rate
    •      Slows AV node conduction
    •      Slows ventricular response from atrial fibrillation/atrial flutter
    •      Interrupts reentry in SVT
  16. Indications and field use for Verapamil?
    • Rapid ventricular response from A-Fib/A-Flutter
    •      Slows influx of calcium ions reducing ventricular response
    • SVT refractory to Adenosine (no WPW)
    •      Slows influx of calcium ions reducing heart rate and interrupts reentry pathways
  17. Dosage for Verapamil?
    All doses are VERY slow IV push over 2-5 minutes with the patient supine

    Verapamil 2.5-5.0mg VERY slow IV push over 2-5 minutes.  May repeat in 15-30 minutes with 5-10mg
  18. What are the contraindications for Verapamil?
    • Wolf-Parkinson-White (WPW)
    • Any wide QRS tachycardia
    • Hypotension
    • Cardiogenic shock
    • Concurrent IV beta-blocker use
  19. Drug interactions for Verapamil?
    • Hypotension potentiated by other calcium channel blockers or beta blockers
    • Hypotension might be reversed by Calcium Chloride & IV fluids
    • Calcium Chloride recommended as pretreatment if BP marginal
  20. What are the side effects for Verapamil?
    • Hyoptension
    • Bradycardia
    • Heart block
    • Cardiac arrest
    • Cardiogenic shock/CHF
    • Nausea / Vomiting
    • Headache
  21. Onset of action for Verapamil?
    1-3 minutes
  22. AZ drug box supply for Verapamil?
    2 x Verapamil 5mg in 2cc vial
Card Set
Verapamil & Epinephrine
Phoenix College Paramedic 2012 2013 Drug Profiles - Verapamil & Epinephrine