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Epinephrine
Class
Sympathomimetic.
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Epinephrine
Mechanism of Action
Direct-acting alpha- and beta-agonist. Alpha: vasoconstriction. Beta-1: positive inotropic, chronotropic, and dromotropic effects. Beta-2: bronchial smooth muscle relaxation and dilation of skeletal vasculature.
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Epinephrine
Indications
Cardiac arrest (V-fib/pulseless V-tach, asystole, PEA), symptomatic bradycardia as an alternative infusion to dopamine, severe hypotension secondary to bradycardia when atropine and transcutaneous pacing are unsuccessful, allergic reactions, anaphylaxis, asthma.
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Epinephrine
Contraindications
Hypertension, hypothermia, pulmonary edema, myocardial ischemia, hypovolemic shock.
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Epinephrine
Adverse Reactions
Hypertension, tachycardia, arrythmias, pulmonary edema, anxiety, restlessness, psychomotor agitation, nausea, headache, angina.
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Epinephrine
Drug Interactions
Potentiates other sympathomimetics, deactivated by alkaline solutions (ie, sodium bicarbonate), monamine oxidase inhibitors (MAOIs) may potentiate effects, beta blockers may blunt effects.
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Epinephrine
how is it supplied
1;1,000 Solution: ampules and vials containing 1mg/ml. 1:10,000 solution: prefilled syringes containing 1mg in 10ml (0.1mg/ml). Auto-injector (EpiPen): 0.5mg/ml (1:2,000).
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Epinephrine
dosage and administration
Adult
Adult:mild allergic reactions and asthma:0.3-0.5mg (0.3-0.5 ml of 1;1,1000) SC. Anaphylaxis: 0.1mg (1ml of 1:10,000) IV/IO over 5 minutes. Cardiac arrest: IV/IO dose:1mg (10ml of 1:10,000 solution) every 3-5 minutes during resuscitation. Follow each dose with 20ml flush and elevate arm for 10 to 20 seconds after dose. Higher dose:higher doses (up to 0.2mg/kg) may be used for specific indications (beta blocker or calcium channel blocker overdose). Continuous infusion:add 1mg (1ml of 1:1,000 solution) to 500ml NS or D5W. Initial infusion rate of 1mcg/min titrated to effect (typical dose:2-10 mcg/min). endotracheal (ET) dose:2-2.5 mg diluted in 10ml NS. Profound Bradycardia or hypotension: 2-10mcg/min; titrate to pt. response.
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Epinephrine
Dosage and Administration
Pediatric
Pediatric:mild allergic reactions and asthma:0.01mg/kg (0.01ml/kg) of 1:1,000 solution SC (maximum of 0.3 ml). Cardiac arrest:IV/IO dose:0.01mg/kg (0.1 ml/kg) of 1:10,000 solution every 3-5 minutes during arrest. All endotracheal (ET) doses: 0.1 mg/kg (0.1 ml/kg) of 1:1,000 solution. Symptomatic bradycardia:IV/IO dose:0.01 mg/kg (0.1 ml/kg) of 1:10,000 solution. All ET doses:0.1 mg/kg (0.1ml/kg) of 1:1,000 solution. Continuous IV/IO infusion: begin with rapid infusion, then titrate to response. Typical initial infusion:0.1-1mcg/min. higher doses may be effective.
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Epinephrine
Duration of action
- onset: immediate.
- Peak effect: minutes
- Duration: several minutes
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Epinephrine
Special considerations
- Pregnancy safety: Catergory C.
- May cause syncope in asthmatic children.
- May increase myocardial oxygen demand.
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