EPINEPHrine

Question 1

What classification is EPINEPHrine under?

Answer 1

Sympathomimetic

Question 2

Explain the pharmacodynamics of EPINEPHrine

Answer 2

• α1 (Alpha 1) Effects: Vasoconstriction
• β1 (Beta 1) Effects: ­Increased Heartrate, Increased­ force of cardiac contraction
• β2 (Beta 2) Effects (moderate): Bronchodilation
• Inhibits histamine release
• +ve chronotropic, +ve dromotropic and +ve inotropic effects

Question 3

What are the indications for EPINEPHrine?

Answer 3

(PCP)

• IM, IV, IO, nebulized: Anaphylaxis
• IM dose: Bronchospasm (uncommon)

(ACP)

• IV/IO dose - Cardiac arrest: ventricular fibrillation, pulseless ventricular tachycardia, asystole, pulseless electrical activity
• Nebulized for severe croup

Question 4

What are the contraindications for EPINEPHrine

Answer 4

• Significant tachyarrhythmias

- See ACLS guidelines re: drug therapy in the setting of hypothermia (< 30 degrees C)

Question 5

List the precautions for EPINEPHrine

Answer 5

• May cause significant dysrhythmias in patients > 35 y/o and/or cardiovascular disease
• Reduced dosage may be required for patient on MAO inhibitor as there is an increased sympathomimetic response

Question 6

List the adverse effects for EPINEPHrine

Answer 6

• Tachycardia, palpitations, angina, PVC’s

- Hypertension

Question 7

What is the peak timing for IM EPINEPHrine?

Answer 7

Unknown

Question 8

What is the duration for IM EPINEPHrine?

Answer 8

1-4 hours

Question 9

What is the half-life for IM EPINEPHrine?

Answer 9

Unknown

Question 10

What is the onset timing for inhaled EPINEPHrine?

Answer 10

1-5 minutes (has a mostly local effect)

Question 11

What is the peak timing for inhaled EPINEPHrine?

Answer 11

Unknown

Question 12

What is the duration for inhaled EPINEPHrine?

Answer 12

1-3 hours

Question 13

What is the half-life for inhaled EPINEPHrine?

Answer 13

Unknown

Question 14

What is the PCP ADULT dosing for EPINEPHrine?

Answer 14

• 0.5 mg 1:1000 IM q 5 min x3 doses for anaphylaxis

- 0.5 mg IM for asthma with failing respirations - repeat q 5 – 20 min

Question 15

What is the ACP ADULT dosing for EPINEPHrine?

Answer 15

• 1 mg IV/IO for cardiac arrest. Repeat q 3-5 minutes (current literature suggests maximum dose of 3-4 mg)
• 2-10 µg/min infusion - generally reserved for patients who are profoundly bradycardic and hemodynamically unstable
• 0.5 mg 1:1000 IM q 5 min x3 doses for anaphylaxis
• 0.5 mg IM for asthma with failing respirations - repeat q 5 – 20 min
• 50-100 µg 1/10000 epinephrine IV or IO repeated as necessary for pre-arrest anaphylaxis or asthma

Peri-Cardiac Arrest Cardiogenic Shock or Bradycardia:

• 10 µg Slow IV/IO Q2 to 3 mins PRN
• Suggested Method
  
  • Take a pre-load of Epinephrine (1:10’000 - 1 mg in 10
    mL), and empty 9 mL. You will have 100 µg
    remaining
  • Withdraw 9 mL Normal Saline from the luer lock of
    an IV line to obtain 100 µg in 10 mL - 10 µg per 1 mL
  • Can now administer 10 µg/1 mL aliquots

Question 16

What is the PCP PEDIATRIC dosing for EPINEPHrine?

Answer 16

• .01 mg/kg IM for respiratory failure /anaphylaxis to a max of 0.5 mg
• 5 mg (5 mL) 1:1000 for croup, by nebulizer mask with an oxygen flow sufficient to aerosolize the medication
  (PCP only if trained)
  
  • Patients under 1 year of age receive a weight based dose, 0.5 mg/kg in 5 mL N/S; max 5 mg
  • MANDATORY consult with CliniCall to discuss differential diagnoses and treatment plans (PCP)
    1-833-829-4099 or 604 829-4099

Question 17

What is the ACP PEDIATRIC dosing for EPINEPHrine?

Answer 17

• .01 mg/kg IV/IO for cardiac arrest
• .005 mg/kg IV/IO for pre-arrest anaphylaxis
• .01 mg/kg IM for respiratory failure /anaphylaxis to a max of 0.5 mg
• 5 mg (5 mL) 1:1000 for croup, by nebulizer mask with an oxygen flow sufficient to aerosolize the medication
  (PCP only if trained)
  
  • Patients under 1 year of age receive a weight based dose, 0.5 mg/kg in 5 mL N/S; max 5 mg
  • MANDATORY consult with CliniCall to discuss differential diagnoses and treatment plans (PCP)
    1-833-829-4099 or 604 829-4099
• Peri-intubation resuscitation: 1 µg/kg Slow IV/IO Q2 to 3mins PRN

Question 18

What is the PCP ADULT dosing for EPINEPHrine?

Answer 18

• 0.5 mg 1:1,000 IM q 5 min x3 doses for anaphylaxis

- 0.5 mg IM for asthma with failing respirations - repeat q 5 – 20 min

Question 19

What is the ACP ADULT dosing for EPINEPHrine?

Answer 19

• 1 mg IV/IO for cardiac arrest. Repeat q 3-5 minutes (current literature suggests maximum dose of 3-4 mg)
• 2-10 µg/min infusion - generally reserved for patients who are profoundly bradycardic and hemodynamically unstable
• 0.5 mg 1:1,000 IM q 5 min x3 doses for anaphylaxis
• 0.5 mg IM for asthma with failing respirations - repeat q 5 – 20 min
• 50-100 µg 1/10,000 epinephrine IV or IO repeated as necessary for pre-arrest anaphylaxis or asthma

Peri-Cardiac Arrest Cardiogenic Shock or Bradycardia:

• 10 µg Slow IV/IO Q2 to 3 mins PRN
• Suggested Method
  
  • Take a pre-load of Epinephrine (1:10,000 - 1 mg in 10
    mL), and empty 9 mL. You will have 100 µg
    remaining
  • Withdraw 9 mL Normal Saline from the luer lock of
    an IV line to obtain 100 µg in 10 mL - 10 µg per 1 mL
  • Can now administer 10 µg/1 mL aliquots

Question 20

What is the PCP PEDIATRIC dosing for EPINEPHrine?

Answer 20

• .01 mg/kg IM for respiratory failure /anaphylaxis to a max of 0.5 mg
• 5 mg (5 mL) 1:1,000 for croup, by nebulizer mask with an oxygen flow sufficient to aerosolize the medication
  (PCP only if trained)
  
  • Patients under 1 year of age receive a weight based dose, 0.5 mg/kg in 5 mL N/S; max 5 mg
  • MANDATORY consult with CliniCall to discuss differential diagnoses and treatment plans (PCP)
    1-833-829-4099 or 604 829-4099

Question 21

What is the ACP PEDIATRIC dosing for EPINEPHrine?

Answer 21

• .01 mg/kg IV/IO for cardiac arrest
• .005 mg/kg IV/IO for pre-arrest anaphylaxis
• .01 mg/kg IM for respiratory failure /anaphylaxis to a max of 0.5 mg
• 5 mg (5 mL) 1:1,000 for croup, by nebulizer mask with an oxygen flow sufficient to aerosolize the medication
  (PCP only if trained)
  
  • Patients under 1 year of age receive a weight based dose, 0.5 mg/kg in 5 mL N/S; max 5 mg
  • MANDATORY consult with CliniCall to discuss differential diagnoses and treatment plans (PCP)
    1-833-829-4099 or 604 829-4099
• Peri-intubation resuscitation: 1 µg/kg Slow IV/IO Q2 to 3mins PRN

Question 22

What is the most rapid route of absorption for IM EPINEPHrine?

Answer 22

Lateral thigh

Question 23

Can PCPs nebulize epinephrine for croup?

Answer 23

If trained, yes.

MANDATORY consult with CliniCall to discuss differential diagnoses and treatment plans (PCP)
1-833-829-4099 or 604 829-4099

Question 24

What should be taken into consideration when administering IM EPINEPHrine for moderate to severe asthma related bronchospasm?

Answer 24

• SpO2 <90%
• Increasing bronchospasm or silent chest
• Accessory muscle use
• Increasing SOB after treatments with MDI
• Decreasing LOC

Question 25

What is the ADULT IM EPINEPHrine dosing for moderate to severe asthma related bronchospasm?

Answer 25

0.5 mg IM 1:1000 (max dose 0.5mg) - Mandatory call to CliniCall for PCP - 1-833-829-4099 or 604 829-4099 - Must have completed face-to-face training during 2019 Continuing Professional Development course to administer