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Epinephrine Drug StudyEpinephrine   (ep-i-ne´frin)
Bronkaid Mist, Epi-E-Zpen, Epinephrine Pediatric, EpiPen Auto-Injector, Primatene Mist Suspension

Epinephrine Bitartrate
AsthmaHaler, Bronkaid Mist Suspension, Bronitin Mist Suspension, Epitrate, Medihaler-Epi,Primatene Mist Suspension

Epinephrine Hydrochloride
Adrenalin Chloride, Bronkaid Mistometer, Dysne-Inhal, Epifrin, Glaucon, SusPhrine

Epinephrine ,Racemic
AsthmaNefrin, Dey-Dose Epinephrine, microNefrin, Vaponefrin

Epinephryl borate  (ep-i-ne´frill bor´ate)
Epinal, Eppy/N

Classifications: autonomic nervous system agent; alpha- and beta-adrenergic agonist; bronchodilator
Pregnancy Category: C
Availability
1:100, 1:1000, 2.25% solution for inhalation;  0.35 mg, 0.2 mg spray;  1:1000, 1:2000, 1:10,000, 1:100,000 injection;  1:200 suspension;  0.1%, 0.5%, 1%, 2% ophthalmic solution;  0.1% nasal solution

 

Actions
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.

Therapeutic effects
Constricts bronchial arterioles and inhibits histamine release, thus reducing congestion and edema and increasing tidal volume and vital capacity. Relaxes uterine smooth musculature and inhibits uterine contractions. Imitates all actions of sympathetic nervous system except those on arteries of the face and sweat glands.

Uses  
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 (open-angle) 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

Cautious Use
Older adult or debilitated patients; prostatic hypertrophy; hypertension; diabetes mellitus; hyperthyroidism; Parkinson’s disease; tuberculosis; psychoneurosis; in patients with long-standing bronchial asthma and emphysema with degenerative heart disease; in children <6 y of age.

 

Route & Dosage  

Anaphylaxis
adult:   SC  0.1–0.5 mL of 1:1000 q10–15min prn
IV  0.1–0.25 mL of 1:1000 q10–15min
child:   SC  0.01 mL/kg of, 1:1000 q10–15min prn
IV  0.01 mL/kg of 1:1000 q10–15min
neonate:   IV Intratracheal  0.01–0.03 mg/kg (0.1–0.3 mL/kg of 1:10,000) q3–5min prn

Cardiac Arrest
adult:   IV  0.1–1 mg (1–10 mL of 1:10,000) q5min as needed
Intracardiac  0.1–1 mg
child:   IV  0.01 mg/kg (0.1 mL/kg of 1:10,000) q5min as needed
Intracardiac  0.05–0.1 mg/kg

Asthma
adult:   SC  0.1–0.5 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

Glaucoma
adultchild:   Instillation  1–2 drops 0.25%–2% solution 1/d or b.i.d.

Nasal Hemostasis
adultchild:   Instillation  1–2 drops 0.1% ophthalmic or 0.1% nasal solution

Topical Hemostatic
adultchild:   Topical  1:50,000–1:1000 applied topically or 1:500,000–1:50,000 mixed with a local anesthetic

 

Administration

Inhalation

  • Have patient in an upright position when aerosol preparation is used. The reclining position can result in overdosage by producing large droplets instead of fine spray.
  • Instruct patient to rinse mouth and throat with water immediately after inhalation to avoid swallowing residual drug (may cause epigastric pain and systemic effects from the propellant in the aerosol preparation) and to prevent dryness of oropharyngeal membranes.
  • Do not give isoproterenol concurrently with epinephrine. Allow 4-h interval to elapse before a change is made from one drug to the other.

 

Instillation

  • Instill nose drops with head in lateral, head-low position to prevent entry of drug into throat.
  • Instruct patient to rinse nose dropper or spray tip with hot water after each use to prevent contamination of solution with nasal secretions.

Ophthalmic

  • Remove soft contact lenses before instilling eye drops.
  • Instruct patient to apply gentle finger pressure against nasolacrimal duct immediately after drug is instilled for at least 1 or 2 min following instillation to prevent excessive systemic absorption.
  •  When separate solutions of epinephrine and a topical miotic are used, the miotic should be instilled 2–10 min prior to epinephrine because of the conjunctival sac’s limited capacity.

Subcutaneous

  •  Use tuberculin syringe to ensure greater accuracy in measurement of parenteral doses.
  •  Protect, epinephrine, injection, from exposure to light at all times. Do not remove ampul or vial from carton until ready to use.
  •  Shake vial or ampul thoroughly to disperse particles before withdrawing epinephrine suspension into syringe; then inject promptly.
  •  Aspirate carefully before injecting epinephrine. Inadvertent IV injection of usual SC doses can result in sudden hypertension and possibly cerebral hemorrhage.
  •  Rotate injection sites and observe for signs of blanching. Vascular constriction from repeated injections may cause tissue necrosis.

Intravenous      

  • Note: Verify correct rate of IV injection to neonates, infants, children with physician.
  • Note: 1:1000 solution contains 1 mg/1 mL. 1:10,000 solution contains 0.1 mg/1 mL.

PREPARE  direct: Dilute each 1 mg of 1:1000 solution with 10 mL of NS to yield 1:10,000 solution. IV Infusion: Further dilute in 250–500 mL of D5W.

ADMINISTER  direct: Give each 1 mg over 1 min or longer; may give more rapidly in cardiac arrest. IV Infusion: 1–10 mcg/min titrated according to patient’s condition.

Incompatibilities  Solution / Additive:  Aminophylline, cephapirin, hyaluronidase, mephentermine, sodium bicarbonate, warfarin.   Y-site:  Ampicillin, thiopental, sodium bicarbonate.


Adverse effects

SpecSenses: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).
BodyWhole:Nervousness, restlessness, sleeplessness, fear, anxiety, tremors, severe headache, cerebrovascular accident, weakness, dizziness, syncope, pallor, sweating, dyspnea.
other:Nausea, vomiting.
other: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.
other:Altered state of perception and thought, psychosis.

 

Nursing implications 

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 q3–5min 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.

Patient & Family Education

  • Be aware intranasal application may sting slightly.
  • Administer ophthalmic drug at bedtime or following prescribed miotic to minimize mydriasis, with blurred vision and sensitivity to light (possible in some patients being treated for glaucoma).
  • Transitory stinging may follow initial ophthalmic administration and that headache and browache occur frequently at first but usually subside with continued use. Notify physician if symptoms persist.
  • Discontinue epinephrine eye drops and consult a physician if signs of hypersensitivity develop (edema of lids, itching, discharge, crusting eyelids).
  • Learn how to administer epinephrine subcutaneously. Keep medication and equipment available for home emergency. Confer with physician.
  • Note: Inhalation epinephrine reduces bronchial secretions and thus may make mucous plugs more difficult to dislodge.
  • Report tolerance to physician; may occur with repeated or prolonged use. Continued use of epinephrine in the presence of tolerance can be dangerous.
  • Take medication only as prescribed and immediately notify physician of onset of systemic effects of epinephrine.
  • Discard discolored or precipitated solutions.
  • Do not breast feed while taking this drug without consulting physician.
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