Adrenaline

Question 1

Presentation

Answer 1

1 mg in 1 mL glass ampoule

1 mg in 10 mL glass ampoule

Question 2

Pharmacology

Answer 2

A naturally occurring alpha and beta adrenergic stimulant.
Actions:
- increases HR by increasing SA node firing rate (Beta 1)
- increases conduction velocity through the A-V node (Beta 1)
- increases myocardial contractility (Beta 1)
- increases irritability of the ventricles (Beta 1)
- causes bronchodilatation (Beta 2)
- causes peripheral vasoconstriction (Alpha)

Question 3

Metabolism

Answer 3

By monoamine oxidase and other enzymes in the blood, liver and around nerve endings; excreted via the kidneys

Question 4

Primary emergency indictions

Answer 4

1. cardiac arrest- VT/VF, Asystole, or PEA.
2. inadequate perfusion (cardiogenic or non-cariogenic/non-hypovalaemic)
3. bradycardia with poor perfusion
4. anaphylaxis
5. severe asthma- imminent life threat not responding to nebuliser therapy or unconscious with no BP.
6. croup

Question 5

Contraindications

Answer 5

1. hypovalaemic shock without adequate fluid replacement.

Question 6

Precautions

Answer 6

consider reduced doses for:

1. elderly/frail
2. patients with CVD
3. patients on monamine oxidase inhibitors

Higher doses may be required for patients on beta blockers.

Question 7

Route of administration

Answer 7

IV
IM
Nebulised 
IV infusion
IO

Question 8

Side effects

Answer 8

Sinus tachycardia 
Supraventricular arrhythmias 
Ventricular arrhythmias 
Hypertension
Pupillary Dilation 
Anxiety/ heart palpitations 
May increase size of MI

Question 9

Special notes

Answer 9

IV adrenaline should be reserved for life threatening situations.

IV effects

onset: 30 seconds
peak: 3-5 minutes
duration: 5-10 minutes

IM effects

onset: 30-60 seconds
peak: 4-10 minutes
duration: 5-10 minutes

Question 10

Dose

Answer 10

Cardiac: 1mg unlimited every 4 minutes
Asthma: 500mcg. Repeat every 5minutes (max 1.5mg)
Paed: 10mcg/kg. (max dose 30mcg/kg)