Epinephrine: Difference between revisions
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*Metabolism: Hepatic | *Metabolism: Hepatic | ||
*Excretion: Renal | *Excretion: Renal | ||
*Mechanism of action: potent α and β agonist that increases cardiac output and peripheral vascular resistance | |||
==Mechanism of Action== | ==Mechanism of Action== | ||
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*Use with caution in patients with CAD | *Use with caution in patients with CAD | ||
**However clinical trials have not demonstrated worsened outcomes | **However clinical trials have not demonstrated worsened outcomes | ||
==Indications== | |||
*Epi versus norepi in patients with shock found that elevated levels of lactic acidosis or tachycardia in 13% of epi patients causes <ref> https://www.ncbi.nlm.nih.gov/pubmed/18654759 </ref> | |||
*second- line agent in sepsis that should be considered after shock is refractory to other pressors 2/2 increased number of adverse events that include tachydysrhythmias and lactate production | |||
==See Also== | ==See Also== | ||
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==References== | ==References== | ||
<references/> | <references/> | ||
http://www.atsjournals.org/doi/abs/10.1164/rccm.201006-0972CI?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed#readcube-epdf | |||
[[Category:Pharmacology]] | [[Category:Pharmacology]] | ||
Revision as of 23:54, 13 July 2017
See critical care quick reference for drug doses by weight.
General
- Type: Vasopressors
- Dosage Forms:
- Concentration
- Amount of solution in mL used to dilute 1,000mg of epinephrine
- eg 1:10,000 = 1,000mg/10,000mL = 0.1mg/mL
- Common Trade Names: Adrenaline, EpiPen (IM autoinjector)
Adult Dosing
Anaphylaxis
0.3-0.5mg of 1:1,000 IM
- Consider glucagon 1-5mg IV if patient on beta-blockers and not responding to epi
Anaphylactic shock
0.1mg of 1:10,000 slow IV during 5 min, can start infusion of 1-4 mcg/min
Cardiac Arrest
1mg of 1:10,000 IVP
Quick Epi Drip
- Take your code-cart epinephrine (it does not matter if It is 1:1,000 or 1:10,000) and inject 1mg into a liter bag of NS. Final concentration is 1mcg/ml. Run at 1cc/min and titrate to effect.
Pediatric Dosing
See critical care quick reference for drug doses by weight.
Pressors
Dosing
- Dose-dependent effects:
- 1-10 mcg/min - increase HR and SV
- 10-20 mcg/min - increase SVR
Rate of Titration
- Q2-5 min
Special Populations
- Pregnancy Rating: C
- Lactation risk: Infant risk cannot be ruled out
- Renal Dosing
- Adult
- Pediatric
- Hepatic Dosing
- Adult
- Pediatric
Contraindications
- Allergy to class/drug
Adverse Reactions
- Tachyarrhythmias
- Myocardial ischemia
- Increased serum lactate
- Splanchnic ischemia
- Digital EpiPen injection
Pharmacology
- Half-life:
- Metabolism: Hepatic
- Excretion: Renal
- Mechanism of action: potent α and β agonist that increases cardiac output and peripheral vascular resistance
Mechanism of Action
Primary Receptor
- β1
- α1
- β2
Relative Effects
- ↑↑↑HR
- ↑↑↑SV
- ↑↑↑SVR
- Bronchodilation (β2)
Notes
- ↑lactate occurs primarily from ↑glycolysis/glycogenolysis within skeletal muscles not tissue hypoperfusion
- Use with caution in patients with CAD
- However clinical trials have not demonstrated worsened outcomes
Indications
- Epi versus norepi in patients with shock found that elevated levels of lactic acidosis or tachycardia in 13% of epi patients causes [1]
- second- line agent in sepsis that should be considered after shock is refractory to other pressors 2/2 increased number of adverse events that include tachydysrhythmias and lactate production