Subscribe Our YouTube Channel Nurses Note YouTube Thanks To All For Your Support


Wednesday, June 23, 2021

Adrenaline (Epinephrine): Action, Uses, Dosage, Administration and Side Effects | Nursing Students Pharmacology/Medication notes

Injection Adrenaline (Epinephrine)

Action: β1 and β2 agonist causing increased levels of cAMP, thereby producing bronchodilation, cardiac and CNS stimulation; high doses cause vasoconstriction via ∝- receptors; low dose can cause vasodilation via β2-vascular receptors.

Function class: Bronchodilator nonselective adrenergic agonist, vasopressor.

Chemical Class: Catecholamine.

Uses of Adrenaline (Epinephrine)

  • Acute asthmatic attacks
  • Hemostasis
  • Bronchospasm
  • Anaphylaxis
  • Allergic reactions
  • Cardiac arrest
  • Adjunct in anaesthesia
  • Shock
Unlabeled Uses

  • Bradycardia
  • Chloroquine overdose
Contraindications of adrenaline (Epinephrine)

  • Hypersensitivity to sympathomimetics
  • Closed-angle glaucoma
  • Nonanaphylactic shock during general anaesthesia.
Precautions During Administration of Adrenaline 

  • Pregnancy
  • Breastfeeding
  • Cardiac disorders
  • Hyperthyroidism
  • Diabetes Mellitus
  • Prostatic hypertrophy
  • Hypertension
  • Organic brain syndrome
  • Local anaesthesia of certain areas
  • Labor
  • Cardiac dilation
  • Coronary insufficiency

Dosage and Routes of Adrenaline (Epinephrine)

Anaphylaxis/severe asthma exacerbation

  • Adult: IM/Subcut 0.3-0.5mg, may repeat q10-15min (anaphylaxis ) or q20min-4hr (asthma
Severe Anaphylaxis

  • Adult: IV 0.1-0.25 mg q5-15 min, then 1-4 mcg/min continuous infusion if needed.
  • Child: IV ≤0.1 mcg/kg/min, then 0.1 mcg/kg/min continuous infusion needed.
Severe Allergic Reaction type 1

  • Adult/child ≥30 kg: IM 0.3 mg (Epipen 2-pak)
  • Child <30 Kg: IM 0.15 mg (Epipen Jr/ Epipen Jr 2-pack).

  • Adult: IV 1 mg q3-5 min
Bradycardia (ACLS)

  • Adult: IV 2-10 mcg/min
Bradycardia/Pulseless arrest (PALS)

  • Child: IV 0.01 mg/kg may repeat q3-5min, may increase to 0.1-0.2 mg/kg if needed.
Administration of Adrenaline (Epinephrine)

  • Increased dose of insulin for Diabetic patients if glucose is elevated.
  • Check for correct concentrations, route, dosage before administering.
  • Give subcut, IM, intraosseously, IV;
  • Visually inspect parenteral products for particulate matter and discolouration before use; do not use sols that are pinkish to brownish or that contain a precipitate.
  • Avoid extravasation during parenteral administration; if extravasation occurs, infiltrate the affected area with phentolamine diluted NS.
  • Death has occurred from drug errors; make sure the right concentration is used.
Inhalation Route

  • Place in nebulizer (10 drops of a 1% base sol)
  • Dilute racepinephrine 2.25% sol
IM Rout
  • Give in the deltoid or anterior thigh (vatus lateralis); do not administer into the gluteal muscle, may give through clothing in emergency.
Subcut Route
  • Inject, taking care not to inject intradermally; massage injection site well after use to enhance absorption and to decreased local vasoconstriction; injection cause tissue irritation.
Intracardiac Route
  • Intracardiac route should be reversed for extreme emergencies; Intracardiac injection should only be performed by properly trained medical personal.
Endotrachial Route
  • Per the ACLS or PALS guidelines, the Epinephrine parenteral product is administered via endotracheal (ET) route; ET administration should only be used if access to IV or intraosseous routes is not possible.
Intraosseous Route (unlabeled )
  • During CPR, the same Epinephrine dosage may be given via the intraosseous route when IV access is not available.
  • Dilute dose in 5-10 mL of NS or sterile distilled water; administer via ET tube; endotracheal absorption of Epinephrine may be improved by diluting with water instead of NS.
  • After dose administration, flush the ET tube with a minimum of 5 mL NS.
Direct IV Injection Route
  • 1:10,000 solution can be given directly without diluting: dilute 1:1000 ( 1mg/0.9 mL) 0.9% NaCL (1:1000 solution )
  • Inject Epinephrine directly into a vein over 5-10 min for adult or 1-3 min for children; maybe given IV push in cardiac arrest.
  • In neonates, may administer via the umbilical vein.
During adult cardiopulmonary resuscitation (CPR)
  • Resuscitation drugs may be given IV by bolus injection into a peripheral vein, followed by an injection of 20 mL IV fluid; elevate the extremity for 10-20 sec to facilitate drug delivery to the central circulation.
Continuous IV infusion route
  • Dilute 1 mg Epinephrine in 250 or 500 mL of a compatible IV infusion solution to provide a concentration of 4 or 2 mcg/mL, respectively; give into a large vein, if possible; more-concentrated sols (16-32 mcg/mL) may be used in fluid-restricted patients when administered through a central line.
Side Effects Adrenaline (Epinephrine)

  • Tremors, anxiety, insomnia, headache, dizziness, confusion, hallucinations, weakness, drowsiness.
  • Palpitations, tachycardia, hypertension, dysrhythmias.
  • Anorexia, nausea, vomiting.
  • Sweating, dry eyes
  • Dyspnea, paradoxical bronchospasm.
  • Hypoglycemia
  • Crosses placenta, metabolized in liver.
  • IM: 6-10 min, duration 1-4hr.
  • Subcut: Onset 5-10 min, duration 20 min-4hr.
  • IV: Onset immediate, peak 20 min, duration 1-4 hr.
  • INH: Onset 1-5 min, duration 1-3 hr.
  • Do not use with MAOIs or tricyclics; hypertensive crisis may occur.
  • Toxicity: other sympathomimetics.
  • Decrease: hypertensive effects -β adrenergic blockers, stop β-blockers 3 days before starting product.
  • Increase: hypotension ∝ blockers
  • Increase: cardiac effects--antihistamines, thyroid replacement hormones.
  • Increase: dysrhythmias--cardiac glycosides.
Nursing Considerations 
  • Asthma: auscultate lungs, pulse B/P, respiration, monitor pulmonary function studies before and during treatment.
  • Vasopressor: ECG during administration continuously; if B/P increases, decrease dose; B/P, pulse q5min after parenteral route; CVP, ISVR, PCWP during infusion if possible; inadvertent high arterial B/P can result in angina, aortic rupture, cerebral haemorrhage.
  • Inj site: tissue sloughing; administrator phentolamine with NS.
  • Sulfite sensitivity: may be life-threatening.
  • Cardiac status, I&O, blood glucose in diabetes.
  • Allergic reactions, bronchospasms (swelling of face/lips/eyelids, rash difficulty breathing): withhold dose, notify prescriber.
  • Therapeutic response: increased B/P with stabilization or ease of breathing, relief of bronchospasm.
Treatment of Overdose for Adrenaline (Epinephrine)
  • Administer ∝-blocker and β-blocker.
    Reference Mosby and Saunders medicine book

No comments:

Post a Comment

please do not enter any spam link in the comment box