epinephrine

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Author:
Anonymous
ID:
1888
Filename:
epinephrine
Updated:
2009-11-29 22:47:13
Tags:
Pharmacology
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Description:
paramedic pharmacology
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  1. Epinephrine
    Class
    Sympathomimetic.
  2. 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.
  3. 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.
  4. Epinephrine
    Contraindications
    Hypertension, hypothermia, pulmonary edema, myocardial ischemia, hypovolemic shock.
  5. Epinephrine
    Adverse Reactions
    Hypertension, tachycardia, arrythmias, pulmonary edema, anxiety, restlessness, psychomotor agitation, nausea, headache, angina.
  6. 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.
  7. 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).
  8. 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.
  9. 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.
  10. Epinephrine
    Duration of action
    • onset: immediate.
    • Peak effect: minutes
    • Duration: several minutes
  11. Epinephrine
    Special considerations
    • Pregnancy safety: Catergory C.
    • May cause syncope in asthmatic children.
    • May increase myocardial oxygen demand.

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