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Generic Name Epinephrine (Adrenaline)

Brand Name Primatene Mist

Mechanism of Action Relaxes bronchial smooth muscle by stimulating beta2 receptors and alpha and beta receptors in the sympathetic nervous system. Dosage and Indication Bronchospasm, hypersensitivity reactions, anaphylaxis Adults: 0.1 to 0.5 ml of 1:1,000 solution IM or SQ. Repeat q 10 to 15 minutes, prn or 0.1 to 0.25 ml of 1:1,000 solution IV slowly over 5 to 10 minutes. Children: 0.01 ml/kg (10 mcg) of 1:1,000 solution SQ; repeat q 20 minutes to 4 hours, prn. Maximum dose 0.5 mg. Hemostasis Adults: 1:50,000 to 1:1,000, sprayed or applied topically Acute asthma attacks Adults and children age 4 and older: one inhalation, repeated once if needed after at least 1 minute To prolong local anesthetic effect Adults and children: With local anesthetics, may be used in concentrations of 1:500,000 to 1:50,000; most commonly, 1:200,000 To control cardiac rhythm in cardiac arrest Adults: 0.5 to 1 mg IV, repeated q 3 to 5 minutes, if needed. Children: 0.01 mg/kg IV Contraindication Patient with angleclosure glaucoma, shock, organic brain damage, cardiac dilation, arrhythmias, coronary insufficiency, or cerebral arteriosclerosis. Patients receiving general anesthesia with halogenated hydrocarbons or cyclopropane and in patients in labor (may delay second stage). Patients with sulfite allergies

Contraindicated for use in fingers, toes, ears, nose, or genitalia when used with local anesthetic Side Effects/ Adverse Reactions CNS: drowsiness, headache, nervousness, tremor, cerebral hemorrhage, stroke, vertigo, pain, disorientation, agitation, fear, dizziness, weakness CV: palpitations, ventricular fibrillation, shock, widened pulse pressure, hypertension, tachycardia, angina pain, altered ECG (including a decreased T-wave amplitude) GI: nausea, vomiting Respiratory: dyspnea Skin: urticaria, hemorrhage at injection site, pallor Other: tissue necrosis Nursing Responsiblities 1. 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. 2. Keep physician informed of any changes in intake-output ratio. 3. Use cardiac monitor with patients receiving epinephrine IV. Have full crash cart immediately available. 4. Check BP repeatedly when epinephrine is administered IV during first 5 min, then q3 5min until stabilized. 5. Advise patient to report to physician if symptoms are not relieved in 20 min or if they become worse following inhalation. 6. Advise patient to report bronchial irritation, nervousness, or sleeplessness. Dosage should be reduced. 7. Monitor blood glucose & HbA1c for loss of glycemic control if diabetic.