Epinephrine

1. Name/Classification

1.1. Therapeutic Class: Anti-asthmatics, Vasopressors, Bronchodialator

1.2. Pharmacological Class: Adrenergics

1.3. Drug Name: Epinephrine

1.4. Brand Names: Adrenalin, Allerject, Anapen, Epipen

2. Dose

2.1. Subcut/IM;Adults: 0.1-0.5 mg single dose (do not exceed 1mg) Repeat q 10-15 min for anaphyactic shock; q 20 min-4 hr for asthma

2.1.1. Inhalation; Adults: 1 inhalation of 1% solution repeat q 1-2 min up to 4-6 times daily

2.1.1.1. IV; Adults: 0.1-0.25 mg q 5-15 min for severe anaphylaxis; 1 mg q 3-5 min for cardiopulmonary resuscitation; 2-10 mg/min for bradycardia

2.1.1.1.1. Intracardiac; Adults; 0.3-0.5 mg

2.2. Subcut; Children >1 Month; 0.01 mg/kg (do not exceed 0.5 mg) q 15 min for 2 doses, then q 4 hr for anaphylactic reactions/asthma

2.2.1. Inhalation; Children: 0.25-0.5 ml of 2.25% racemic epinephrine solution diluted in 3 ml NS

2.2.1.1. IV; Children: 0.1 mg-01.5 mcg/kg/min for severe anaphlyaxis; 0.01 mg/kg q3-5 min up to 0.2 mg/kg for bradycardia/pulseless arrest

2.3. Endotracheal;Adults & Children: 2-2.5 mg

2.4. Intraspinal;Adults & Children; 0.2-0.4 ml of 1:1000 solution

3. Indications

3.1. Subcut, IV, Inhalation: Management of irreversible airway disease d/t asthma or COPD

3.2. Subcut, IM, IV: Management of severe allergic reactions

3.3. Intratracheal,Intraosseous, Pediatric Advanced Life Support: Management of cardiac arrest

3.4. Inhalation: management of upper airway obstruction and croup

3.5. Local/Spinal: anesthesia

4. Contraindications/Drug Interactions

4.1. Hypersensitivity to adrenergic amines; some inhalers may contain bisulfites or fluorocarbons, avoid in patients with known sensitivites or intolerance

4.2. Use cautiously with: angina, tachycardia, MI, HTN, hyperthyroidism, diabetes, cerebral ateriosclerosis, glaucoma

4.3. Excessive use may result in: tolerance and bronchospasm

4.4. OB: use only if potential maternal benefits outweighs fetal risks, may cause decrease milk production or let down

4.5. Geriatric: more susceptible to adverse reactions (may require lower dose)

4.6. Alcohol, Drugs, CNS depressants, smoking or other respiratory depressants

5. Lab Values

5.1. Normal Range: 1-4 mg

5.2. Toxic Dosage: 7-8 mg

6. Evaluation

6.1. Prevention/relief of bronchospasm, asthma, and increased ease of breathing

6.2. Reversed signs and symptoms of anaphylaxis

6.3. Increase cardiac rate, output, BP, and heart rate

7. Action

7.1. Accumulates cyclic adenosine mono-phosphate (cAMP) at the adrenergic receptors

7.2. This then affects the beta1 (cardiac) adrenergic and beta2 (pulmonary) adrenergic receptor sites

7.2.1. This then causes an increase in heart rate, muscle strength, blood pressure, and bronchodilation

8. Nursing Implications

8.1. High alert medication, adhere to policies and procedures of the facility before, after, and during administration

8.2. Asses BP, HR, O2 saturation, respiratory rate, CNS/Behavior; before after and during administration

8.3. Ensure Y site compatibility

8.4. Respiratory assesment; lung sounds, sputum, SOB

9. Patient Teaching

9.1. Teach patient importance of adhering to prescription instruction; taked missed dose immeditaly, no double dosing, do not exceed doses

9.2. Teach patient to seek medical attention if; experiencing; SOB that is not relieved by medication, or accompanied by diaphoresis,dizziness,palpitations or chest pain (teach how to identify each symptom)

9.3. Advise patient, with rationale (can increase/decrease effects or cause adverse effects), to avoid alcohol, smoking, CNS depressants, and respiratory irritants

9.4. Teach proper administration with inhalation; test medication, inhale with one press, wait recommended time between inhalations, rinse water afterwards and notify of normal side effects

9.5. Advise patients to use broncodilators first before other inhalers unless other wise prescribed (bronchodilators open airways, while others help to keep them open)

9.6. Teach patient signs of allergic reaction (itchiness, rash, swelling, difficulty breathing, flushing)

9.7. Teach patient on use of Epipens. If patient is too young or not able to administer to self safely, ensure parent, guardian or caregivers can safely administer and know the signs/symptoms to look for

10. Side Effects

10.1. Nervousness, restlessness, tremor, headache, insomnia, paradoxical bronchospasm, angina, arryhythmias, hypertension, tachycardia, nausea, vomiting, hyperglycemia

10.2. Adverse Effects: dizziness, chest pain, diaphoresis