Drug Name

Dosage & Route

Action

Indication

Adverse Effects

Contraindication

Nursing Responsibility

EPINEPHRINE (ep-i-ne'frin) Bronkaid Mist, Epi-EZpen, Epinephrine Pediatric, EpiPen AutoInjector, Primatene Mist Suspension Classifications: AUTONOMIC NERVOUS SYSTEM AGENT; ALPHA- AND BETAADRENERGIC AGONIST; BRONCHODILATOR

Anaphylaxis Adult: SC 0.10.5 mL of 1:1000 q1015min prn IV 0.10.25 mL of 1:1000 q1015min Child: SC 0.01 mL/kg of, 1:1000 q1015min prn IV 0.01 mL/kg of 1:1000 q1015min Neonate: IV Intratracheal 0.01 0.03 mg/kg (0.10.3 mL/kg of 1:10,000) q3 5min prn Cardiac Arrest Adult: IV 0.11 mg (1 10 mL of 1:10,000) q5min as needed Intracardiac 0.11 mg Child: IV 0.01 mg/kg (0.1 mL/kg of 1:10,000) q5min as needed Intracardiac 0.050.1 mg/kg Asthma Adult: SC 0.10.5 mL of 1:1000 q20min 4h Inhalation 1 inhalation q4h prn Child: SC 0.01 mL/kg of 1:1000 q20min 4h Inhalation 1 inhalation q4h prn

Naturally occurring catecholamine obtained from animal adrenal glands; also prepared synthetically. Acts directly on both alpha and beta receptors; the most potent activator of alpha receptors. Strengthens myocardial contraction; increases systolic but may decrease diastolic blood pressure; increases cardiac rate and cardiac output.

Temporary relief of bronchospasm, acute asthmatic attack, mucosal congestion, hypersensitivity and anaphylactic reactions, syncope due to heart block or carotid sinus hypersensitivity, and to restore cardiac rhythm in cardiac arrest. Ophthalmic preparation is used in management of simple (openangle) glaucoma, generally as an adjunct to topical miotics and oral carbonic anhydrase inhibitors; also used as ophthalmic decongestant. Relaxes myometrium and inhibits uterine contractions; prolongs action and delays systemic absorption of local and intraspinal anesthetics. Used topically to control superficial bleeding.

Special Senses: Nasal burning or stinging, dryness of nasal mucosa, sneezing, rebound congestion. Transient stinging or burning of eyes, lacrimation, browache, headache, rebound conjunctival hyperemia, allergy, iritis; with prolonged use: melanin-like deposits on lids, conjunctiva, and cornea; corneal edema; loss of lashes (reversible); maculopathy with central scotoma in aphakic patients (reversible). Body as a Whole: Nervousness, restlessness, sleeplessness, fear, anxiety, tremors, severe headache, cerebrovascular accident, weakness, dizziness, syncope, pallor, sweating, dyspnea. Digestive: Nausea, vomiting. Cardiovascular: Precordial pain, palpitations, hypertension, MI, tachyarrhythmias including ventricular fibrillation. Respiratory: Bronchial and pulmonary edema. Urogenital: Urinary retention. Skin: Tissue necrosis with repeated injections. Metabolic: Metabolic acidoses, elevated serum lactic acid, transient elevations of blood glucose. Nervous System: Altered state of perception and thought, psychosis.

Hypersensitivity to sympathomimetic amines; narrow-angle glaucoma; hemorrhagic, traumatic, or cardiogenic shock; cardiac dilatation, cerebral arteriosclerosis, coronary insufficiency, arrhythmias, organic heart or brain disease; during second stage of labor; for local anesthesia of fingers, toes, ears, nose, genitalia. Safety during pregnancy (category C) or lactation is not established.

Assessment & Drug Effects

Monitor BP, pulse, respirations, and urinary output and observe patient closely following IV administration. Epinephrine may widen pulse pressure. If disturbances in cardiac rhythm occur, withhold epinephrine and notify physician immediately. Keep physician informed of any changes in intake-output ratio. Use cardiac monitor with patients receiving epinephrine IV. Have full crash cart immediately available. Check BP repeatedly when epinephrine is administered IV during first 5 min, then q35min until stabilized. Advise patient to report to physician if symptoms are not relieved in 20 min or if they become worse following inhalation. Advise patient to report bronchial irritation, nervousness, or sleeplessness. Dosage should be reduced. Monitor blood glucose & HbA1c for loss of glycemic control if diabetic.