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Drug Name Dosages Therapeutic Actions Indications Adverse effects Contraindications Nursing considerations
Generic Name :
epinephrine
(adrenaline),
epinephrine
bitartrate,
epinephrine borate,
epinephrine
hydrochloride
Brand Name:
Aerosol: Primaten
e Mist
Ophthalmic
solution: Epinal
Injection, OTC
nasal
solution: Adrenalin
Chloride
Insect-sting
emergencies: Epi
Pen Auto-n!ector
(deli"ers #$% mg
M adult dose),
EpiPen &r$ Auto-
n!ector (deli"ers
#$'( mg M )or
children)
OTC solutions for
nebulization:
AsthmaNe)rin,
microNe)rin,
Nephron, *+
Classification:
*ympathomimetic,
Alpha-adrenergic
agonist, ,eta'- and
beta+-adrenergic
agonist, Cardiac
stimulant,
-asopressor,
,ronchodilator,
Antasthmatic, Nasal
decongestant,
Mydriatic
Pregnancy Category
C
ADULTS
Epinephrine injection
Cardiac arrest. #$(/' mg
((/'# m0 o) '.'#,###
solution) - or by
intracardiac in!ection into
le)t "entricular chamber1
during resuscitation, #$(
mg 2 ( min$
Intraspinal
0!"0# m$ of a %:%,000
solution a&&e& to anesthetic
spinal flui& mi'ture
3ther use 4ith local
anesthetic.
Concentrations o)
'.'##,###/'.+#,### are
usually used$
%:%,000 solution
5espiratory distress. #$%/
#$( m0 o) '.',### solution
(#$%/#$( mg),
subcutaneously or M, 2
+# min )or 6 hr$
%:!00 suspension (for
subcutaneous a&ministration
only)
5espiratory distress. #$'/
#$% m0 (#$(/'$( mg)
subcutaneously$
Inhalation (aerosol)
,egin treatment at
)irst symptoms o)
bronchospasm$
ndi"iduali7e dosage$ 8ait
'/( min bet4een
inhalations to a"oid
o"erdose$
Inhalation (nebulization)
Place 9/'( drops into the
nebuli7er reser"oir$ Place
nebuli7er no77le into
Epinephrine, an acti"e
principle o) the
adrenal medulla, is a
direct-acting
sympathomimetic$ t
stimulates :- and ;-
adrenergic receptors
resulting in rela<ation
o) smooth muscle o)
the bronchial tree,
cardiac stimulation
and dilation o) s=eletal
muscle "asculature$ t
is )re2uently added to
local anaesthetics to
retard di))usion and
limit absorption, to
prolong the duration o)
e))ect and to lessen
the danger o) to<icity$
-. n "entricular
standstill a)ter all other
measures ha"e )ailed to
restore circulation, gi"en
by trained personnel by
intracardiac puncture
and intramyocardial
in!ection1 treatment and
prophyla<is o) cardiac
arrest and attac=s o)
transitory A- heart bloc=
4ith syncopal sei7ures
(*to=es-Adams
syndrome)1 syncope due
to carotid sinus
syndrome1 acute
hypersensiti"ity
(anaphylactoid)
reactions, serum
sic=ness, urticaria,
angioneurotic edema1 in
acute asthmatic attac=s
to relie"e bronchospasm
not controlled by
inhalation or
subcutaneous in!ection1
rela<ation o) uterine
musculature1 additi"e to
local anesthetic solutions
)or in!ection to prolong
their duration o) action
and limit systemic
absorption
n!ection. 5elie) )rom
respiratory distress o)
bronchial asthma,
chronic bronchitis,
emphysema, other
C3P>s
Aerosols and solutions
)or nebuli7ation.
?emporary relie) )rom
acute attac=s o)
bronchial asthma, C3P>
?opical nasal solution.
?emporary relie) )rom
nasal and
nasopharyngeal mucosal
congestion due to a cold,
sinusitis, hay )e"er, or
other upper respiratory
allergies1 ad!uncti"e
CN* e))ects1 @
disturbances1 epigastric
pain1 C- disorders1
di))iculty in micturition
4ith urinary retention1
dyspnoea1
hyperglycaemia1
s4eating1
hypersali"ation1
4ea=ness, tremors1
coldness o) e<tremities1
hypo=alaemia$
@angrene, tissue
necrosis and sloughing
(e<tra"asation) 4hen
used in addition to local
anaesthetics$ Eye
drops. *e"ere
smarting, blurred
"ision, photophobia1
naso-lachrymal ducts
obstruction$ 3edema,
hyperaemia and
in)lammation o) the
eyes 4ith repeated
administration$
Pree<isting
hypertension1
occlusi"e "ascular
disease1 angle-closure
glaucoma (eye drops)1
hypersensiti"ity1
cardiac arrhythmias or
tachycardia$ 8hen
used in addition to
local anaesthetics.
Procedures in"ol"ing
digits, ears, nose,
penis or scrotum$
Assessment
istor!: Allergy or
hypersensiti"ity to
epinephrine or components
o) drug preparation1 narro4-
angle glaucoma1 shoc=
other than anaphylactic
shoc=1 hypo"olemia1
general anesthesia 4ith
halogenated hydrocarbons
or cyclopropane1 organic
brain damage, cerebral
arteriosclerosis1 cardiac
dilation and coronary
insu))iciency1
tachyarrhythmias1 ischemic
heart disease1
hypertension1 renal
impairment1 C3P>1
diabetes mellitus1
hyperthyroidism1 prostatic
hypertrophy1 history o)
sei7ure disorders1
psychoneuroses1 labor and
deli"ery1 lactation1 contact
lens use, apha=ic patients
(ophthalmic preparations)
"h!sical: 8eight1 s=in
color, ?, turgor1 orientation,
re)le<es, 3P1 P, ,P1 5,
ad"entitious sounds1
prostate palpation, normal
urine output1 urinalysis,
renal )unction tests, blood
and urine glucose, serum
electrolytes, thyroid )unction
tests, EC@
Interventions
8A5NN@. Ase e<treme
caution 4hen calculating
and preparing doses1
epinephrine is a "ery potent
drug1 small errors in dosage
can cause serious ad"erse
e))ects$ >ouble-chec=
pediatric dosage$
Ase minimal doses )or
minimal periods o) time1
Bepinephrine-)astnessB (a
)orm o) drug tolerance) can
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partially opened mouth$
Patient inhales deeply
4hile bulb is s2uee7ed
one to three times$ ) no
relie) in ( min, gi"e +/%
additional inhalations$ Ase
)our to si< times per day
usually maintains com)ort$
Topical nasal solution
Apply locally as drops or
spray or 4ith a sterile
s4ab, as re2uired$
Ophthalmic solution
-asoconstriction,
mydriasis. nstill '/+
drops into the eye or
eyes1 repeat once i)
necessary$
"#DIAT$IC "ATI#NTS
Epinephrine injection
'.',### solution, children
and in)ants e<cept
premature in)ants and )ull-
term ne4borns. #$#'
mgC=g or #$% m0Cm+ (#$#'
mgC=g or #$% mgCm+)
subcutaneously 2 +# min
(or more o)ten i) needed)
)or 6 hr$ >o not e<ceed
#$( m0 (#$( mg) in a
single dose$
'.+## suspension, in)ants
and children (' mo/' yr).
#$##( m0C=g (#$#+(
mgC=g) subcutaneously$
Children D %# =g.
Ma<imum single dose is
#$'( m0 (#$E( mg)$
Administer subse2uent
doses only 4hen
necessary and not more
o)ten than 2 F hr$
Topical nasal solution
G F yr. Apply locally as
drops or spray or 4ith a
therapy in middle ear
in)ections by decreasing
congestion around
eustachian ostia
o #$'H ophthalmic
solution.
Con!uncti"itis, during
eye surgery to control
bleeding, to produce
mydriasis
occur 4ith prolonged use$
Protect drug solutions )rom
light, e<treme heat, and
)ree7ing1 do not use pin= or
bro4n solutions$ >rug
solutions should be clear
and colorless (does not
apply to suspension )or
in!ection)$
*ha=e the suspension )or
in!ection 4ell be)ore
4ithdra4ing the dose$
5otate subcutaneous
in!ection sites to pre"ent
necrosis1 monitor in!ection
sites )re2uently$
8A5NN@. Ieep a rapidly
acting alpha-adrenergic
bloc=er (phentolamine) or a
"asodilator (a nitrate)
readily a"ailable in case o)
e<cessi"e hypertensi"e
reaction$
8A5NN@. Ja"e an alpha-
adrenergic bloc=er or
)acilities )or intermittent
positi"e pressure breathing
readily a"ailable in case
pulmonary edema occurs$
8A5NN@. Ieep a beta-
adrenergic bloc=er
(propranolol1 a
cardioselecti"e beta-
adrenergic bloc=er, such as
atenolol, should be used in
patients 4ith respiratory
distress) readily a"ailable in
case cardiac arrhythmias
occur$
>o not e<ceed
recommended dosage o)
inhalation products1
administer pressuri7ed
inhalation drug )orms during
second hal) o) inspiration,
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sterile s4ab, as re2uired$
Ophthalmic solutions
*a)ety and e))icacy )or
use in children not
established$
G#$IAT$IC "ATI#NTS %$
"ATI#NTS &IT $#NAL
'AILU$#
Ase 4ith caution1 patients
G F# yr are more li=ely to
de"elop ad"erse e))ects$
because the air4ays are
open 4ider and the aerosol
distribution is more
e<tensi"e$ ) a second
inhalation is needed,
administer at pea= e))ect o)
pre"ious dose, %/( min$
Ase topical nasal solutions
only )or acute states1 do not
use )or longer than %/(
days, and do not e<ceed
recommended dosage$
5ebound nasal congestion
can occur a)ter
"asoconstriction subsides$
Teaching points
>o not e<ceed
recommended dosage1
ad"erse e))ects or loss o)
e))ecti"eness may result$
5ead the instructions that
come 4ith respiratory
inhalant products, and
consult your health care
pro"ider or pharmacist i)
you ha"e any 2uestions$
?o gi"e eye drops. 0ie do4n
or tilt head bac=4ard, and
loo= up$ Jold dropper
abo"e eye1 drop medicine
inside lo4er lid 4hile
loo=ing up$ >o not touch
dropper to eye, )ingers, or
any sur)ace$ 5elease lo4er
lid1 =eep eye open, and do
not blin= )or at least %#
seconds$ Apply gentle
pressure 4ith )ingers to
inside corner o) the eye )or
about ' minute1 4ait at least
( minutes be)ore using
other eye drops$
Kou may e<perience these
side e))ects. >i77iness,
dro4siness, )atigue,
apprehension (use caution
i) dri"ing or per)orming
tas=s that re2uire
alertness)1 an<iety,
emotional changes1
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nausea, "omiting, change in
taste (eat )re2uent small
meals)1 )ast heart rate$
Nasal solution may cause
burning or stinging 4hen
)irst used (transient)$
3phthalmic solution may
cause slight stinging 4hen
)irst used (transient)1
headache or bro4 ache
(only during the )irst )e4
days)$
5eport chest pain,
di77iness, insomnia,
4ea=ness, tremor or
irregular heart beat
(respiratory inhalant, nasal
solution), di))iculty
breathing, producti"e
cough, )ailure to respond to
usual dosage (respiratory
inhalant), decrease in "isual
acuity (ophthalmic) $
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