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Drug Name Dosages Therapeutic Actions Indications Adverse effects Contraindications Nursing considerations
Generic Name : ADULTS Epinephrine, an active  IV: In ventricular CNS effects; GI Preexisting Assessment
epinephrine principle of the standstill after all other disturbances; epigastric hypertension;  History: Allergy or
(adrenaline), Epinephrine injection adrenal medulla, is a measures have failed to pain; CV disorders; occlusive vascular hypersensitivity to
epinephrine  Cardiac arrest: 0.5–1 mg direct-acting restore circulation, given difficulty in micturition disease; angle-closure epinephrine or components
bitartrate, (5–10 mL of 1:10,000 sympathomimetic. It by trained personnel by with urinary retention; glaucoma (eye drops); of drug preparation;
epinephrine borate, solution) IV or by stimulates α- and β- intracardiac puncture dyspnoea; hypersensitivity; narrow-angle glaucoma;
epinephrine intracardiac injection into adrenergic receptors and intramyocardial hyperglycaemia; cardiac arrhythmias or shock other than
hydrochloride left ventricular chamber; resulting in relaxation injection; treatment and sweating; tachycardia. When anaphylactic shock;
during resuscitation, 0.5 of smooth muscle of prophylaxis of cardiac hypersalivation; used in addition to hypovolemia; general
Brand Name: mg q 5 min. the bronchial tree, arrest and attacks of weakness, tremors; local anaesthetics: anesthesia with
 Aerosol:  Primaten cardiac stimulation transitory AV heart block coldness of extremities; Procedures involving halogenated hydrocarbons
e Mist and dilation of skeletal with syncopal seizures hypokalaemia. digits, ears, nose, or cyclopropane; organic
Intraspinal muscle vasculature. It Gangrene, tissue penis or scrotum.
 Ophthalmic (Stokes-Adams brain damage, cerebral
is frequently added to syndrome); syncope due necrosis and sloughing arteriosclerosis; cardiac
solution: Epinal 0.2–0.4 mL of a 1:1,000 local anaesthetics to (extravasation) when
to carotid sinus dilation and coronary
solution added to anesthetic retard diffusion and used in addition to local
syndrome; acute insufficiency;
 Injection, OTC spinal fluid mixture. limit absorption, to hypersensitivity anaesthetics. Eye tachyarrhythmias; ischemic
nasal  Other use with local prolong the duration of (anaphylactoid) drops: Severe heart disease;
solution: Adrenalin anesthetic: effect and to lessen reactions, serum smarting, blurred hypertension; renal
Chloride Concentrations of the danger of toxicity. sickness, urticaria, vision, photophobia; impairment; COPD;
1:100,000–1:20,000 are angioneurotic edema; in naso-lachrymal ducts diabetes mellitus;
usually used. obstruction. Oedema,
 Insect-sting acute asthmatic attacks hyperthyroidism; prostatic
to relieve bronchospasm hyperaemia and hypertrophy; history of
emergencies: Epi
not controlled by inflammation of the seizure disorders;
Pen Auto-Injector 1:1,000 solution
inhalation or eyes with repeated psychoneuroses; labor and
(delivers 0.3 mg
IM adult dose),
 Respiratory distress: 0.3– subcutaneous injection; administration. delivery; lactation; contact
0.5 mL of 1:1,000 solution relaxation of uterine lens use, aphakic patients
EpiPen Jr. Auto-
(0.3–0.5 mg), musculature; additive to (ophthalmic preparations)
Injector (delivers
subcutaneously or IM, q local anesthetic solutions
0.15 mg IM for
20 min for 4 hr.  Physical: Weight; skin
children) for injection to prolong color, T, turgor; orientation,
their duration of action reflexes, IOP; P, BP; R,
1:200 suspension (for and limit systemic
 OTC solutions for
absorption
adventitious sounds;
nebulization: subcutaneous administration prostate palpation, normal
AsthmaNefrin, only)  Injection: Relief from urine output; urinalysis,
microNefrin,  Respiratory distress: 0.1– respiratory distress of renal function tests, blood
Nephron, S2 0.3 mL (0.5–1.5 mg) bronchial asthma, and urine glucose, serum
subcutaneously. chronic bronchitis, electrolytes, thyroid
emphysema, other function tests, ECG
Classification: COPDs
Sympathomimetic, Inhalation (aerosol)
Alpha-adrenergic
 Aerosols and solutions Interventions
 Begin treatment at for nebulization:
agonist, Beta1- and first symptoms of Temporary relief from
 WARNING: Use extreme
beta2-adrenergic bronchospasm. caution when calculating
acute attacks of
agonist, Cardiac Individualize dosage. Wait and preparing doses;
bronchial asthma, COPD
stimulant, 1–5 min between epinephrine is a very potent
Vasopressor, inhalations to avoid
 Topical nasal solution: drug; small errors in
Bronchodilator, overdose. Temporary relief from dosage can cause serious
Antasthmatic, Nasal nasal and adverse effects. Double-
decongestant, nasopharyngeal mucosal check pediatric dosage.
Mydriatic Inhalation (nebulization) congestion due to a cold,
sinusitis, hay fever, or
 Use minimal doses for
 Place 8–15 drops into the minimal periods of time;
Pregnancy Category nebulizer reservoir. Place other upper respiratory
"epinephrine-fastness" (a
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C nebulizer nozzle into
partially opened mouth.
Patient inhales deeply
while bulb is squeezed
one to three times. If no
relief in 5 min, give 2–3
additional inhalations. Use
four to six times per day
usually maintains comfort.
Topical nasal solution
 Apply locally as drops or
spray or with a sterile
swab, as required.
Ophthalmic solution
 Vasoconstriction,
mydriasis: Instill 1–2
drops into the eye or
eyes; repeat once if
necessary.
PEDIATRIC PATIENTS
Epinephrine injection
 1:1,000 solution, children
and infants except
premature infants and full-
term newborns: 0.01
mg/kg or 0.3 mL/m2 (0.01
mg/kg or 0.3 mg/m2)
subcutaneously q 20 min
(or more often if needed)
for 4 hr. Do not exceed
0.5 mL (0.5 mg) in a
single dose.
 1:200 suspension, infants
and children (1 mo–1 yr):
0.005 mL/kg (0.025
mg/kg) subcutaneously.
 Children < 30 kg:
Maximum single dose is
0.15 mL (0.75 mg).
Administer subsequent
doses only when
necessary and not more
often than q 6 hr.
Topical nasal solution
allergies; adjunctive form of drug tolerance) can
therapy in middle ear occur with prolonged use.
infections by decreasing
congestion around  Protect drug solutions from
eustachian ostia light, extreme heat, and
o 0.1% ophthalmic freezing; do not use pink or
solution: brown solutions. Drug
Conjunctivitis, during solutions should be clear
eye surgery to control and colorless (does not
bleeding, to produce apply to suspension for
mydriasis injection).
 Shake the suspension for
injection well before
withdrawing the dose.
 Rotate subcutaneous
injection sites to prevent
necrosis; monitor injection
sites frequently.
 WARNING: Keep a rapidly
acting alpha-adrenergic
blocker (phentolamine) or a
vasodilator (a nitrate)
readily available in case of
excessive hypertensive
reaction.
 WARNING: Have an alpha-
adrenergic blocker or
facilities for intermittent
positive pressure breathing
readily available in case
pulmonary edema occurs.
 WARNING: Keep a beta-
adrenergic blocker
(propranolol; a
cardioselective beta-
adrenergic blocker, such as
atenolol, should be used in
patients with respiratory
distress) readily available in
case cardiac arrhythmias
occur.
 Do not exceed
recommended dosage of
inhalation products;
administer pressurized
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 > 6 yr: Apply locally as
drops or spray or with a
sterile swab, as required.
Ophthalmic solutions
 Safety and efficacy for
use in children not
established.
GERIATRIC PATIENTS OR
PATIENTS WITH RENAL
FAILURE
 Use with caution; patients
> 60 yr are more likely to
develop adverse effects.
Teaching points
inhalation drug forms
during second half of
inspiration, because the
airways are open wider and
the aerosol distribution is
more extensive. If a second
inhalation is needed,
administer at peak effect of
previous dose, 3–5 min.
 Use topical nasal solutions
only for acute states; do not
use for longer than 3–5
days, and do not exceed
recommended dosage.
Rebound nasal congestion
can occur after
vasoconstriction subsides.
 Do not exceed
recommended dosage;
adverse effects or loss of
effectiveness may result.
Read the instructions that
come with respiratory
inhalant products, and
consult your health care
provider or pharmacist if
you have any questions.
 To give eye drops: Lie
down or tilt head backward,
and look up. Hold dropper
above eye; drop medicine
inside lower lid while
looking up. Do not touch
dropper to eye, fingers, or
any surface. Release lower
lid; keep eye open, and do
not blink for at least 30
seconds. Apply gentle
pressure with fingers to
inside corner of the eye for
about 1 minute; wait at
least 5 minutes before
using other eye drops.
 You may experience these
side effects: Dizziness,
drowsiness, fatigue,
apprehension (use caution
if driving or performing
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tasks that require

alertness); anxiety,
emotional changes;
nausea, vomiting, change
in taste (eat frequent small
meals); fast heart rate.
Nasal solution may cause
burning or stinging when
first used (transient).
Ophthalmic solution may
cause slight stinging when
first used (transient);
headache or brow ache
(only during the first few
days).

 Report chest pain,

dizziness, insomnia,
weakness, tremor or
irregular heart beat
(respiratory inhalant, nasal
solution), difficulty
breathing, productive
cough, failure to respond to
usual dosage (respiratory
inhalant), decrease in
visual acuity (ophthalmic) .

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