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).

CPR (ACLS)

• 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.

Adult

• 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.

Child

• 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)

CNS

• Tremors, anxiety, insomnia, headache, dizziness, confusion, hallucinations, weakness, drowsiness.

CV

• Palpitations, tachycardia, hypertension, dysrhythmias.

GI

• Anorexia, nausea, vomiting.

MISC

• Sweating, dry eyes

RESP

• Dyspnea, paradoxical bronchospasm.

META

• Hypoglycemia

Pharmacokinetics

• 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.

Interactions

• 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 

Assess

• 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.

Evaluate

• 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