EPINEPHRINE

Drug Name/Trade Name/Class

Drug Name: Epinephrine

Trade Name: Adrenaline, Epi

Class:

-Adrenergic Catecholamine

-Sympathomimetic

EPINEPHRINE

Mechanism of Action

Beta 1:--contractility, inotropic, increases AV conduction, automaticity

Beta 2:--bronchodilation, skeletal muscle vasodilation

Alpha:--peripheral vasoconstriciton, fight/flight response

Small doses (slow administration), beta effects dominate--vasodilation

Large doses (rapid administration), alpha effect dominate--vasoconstriction, increases systemic vascular resistance, blood pressure

- CNS Stimulation

EPINEPHRINE

Indications (6)

Indications:

- Hypersensitivity Reactions (anaphylaxis)

- Acute bronchospasm associated w/ asthma or COPD (refractory to first-line agents)

- Asystole, VF, pulseless VT, PEA

- Symptomatic Bradycardia

- Refractory hypotensions

- Croup & Epiglottitis

EPINEPHRINE

Contraindications (2) & Precautions (9)

Contraindications:

- None in cardiac arrest or severe anaphylaxis

- Hypersensitivity

Precautions:

- Will increases myocardial osygen demand

- HTN

- Ischemic Heart disease

- Cerebrovascular insufficiency

- Pulmonary Edema

- Pregnancy Class (c)

- Geriatrics

- Protect from light

- Deactivated by alkaline solutions (NaHCO3)

EPINEPHRINE

Available Forms

1) 1:1000 1 mg/mL (amps, vials, pre-filled syringes, 30 mL vials)

2) 1:10000 0.1 mg/mL (10 mL pre-filled syringe)

EPINEPHRINE

Adult Dosages

Anaphylaxis: 0.3-0.5 mg SubQ/IM (1:1000) every 5-15 mins. PRN

- Infusion: 1 mg (1:1000)/100 cc via Buretrol -OR-1 mg (1:1000)/ 250 cc

administered at a rate of 2-10 mcg/min.; titrated to response

Nebulizer (laryngeal edema): 5 mg (5cc) (1:1000) undiluted

Acute Broncospams0.3-0.5 mg (1:1000) SubQ/IM

Symptomatic Bradycardia & Refractory Hypotension:

Infusion-1 mg(1:1000)/100cc via Buretrol-OR-1 mg (1:10000)/ 250cc

administered at a rate of 2-10 mcg/min, titrated to response

Asystole, VF, pulseless VT, PEA:

Standard = 1 mg (1:10000) IV/IO every 3-5 mins.

ET: 2-2.5 X IV dose (diluted to a volume of 10 cc) every 3-5 mins.

EPINEPHRINE

Pediatric Dosages

CARDIAC ARREST: 0.01 mg/kg (1:10000) IV/IO every 3-5 min.

0.1 mg/kg (1:1000), diluted to a volume of 3-5 cc ET every 3-5 min.

SYMPTOMATIC BRADYCARDIA:

0.01 mg/kg (1:10000) IV/IO every 3-5 minutes

0.1 mg/kg (1:1000, diluted to a volume of 3-5 cc) ET every 3-5 min.

Infusion: 0.1-1 mcg/kg/min (1mg (1:1000)/250 NS=4 mcg/mL)-for persistent hypotension; titrate to response

ANAPHYLAXIS: 0.01 mg/kg (1:1000) SubQ/IM. Max 0.3 mg

Infusion - see symptomatic bradycardia

CROUP & EPIGLOTTITIS: 5 mg (5cc) of 1:1000 nebulized

BRONCHOSPAMS (severe refractory): 0.01 mg/kg (1:1000) SubQ/IM

EPINEPHRINE

Onset, Duration, Side Effects (11)

ONSET:IV: 1-2 minutes, SC: 5-10 minutes

DURATION: IV/SC: 5-10 minutes

SIDE EFFECTS:

-Anxiety                   - Fear

-Tachy                      - Headache

-HTN                        - Pallor

-Angina                    - Dizziness

-Dysrhythmias          - Tremors

-N/V

EPINEPHRINE

Interactions

Potentiated by: MAOI's, TCA's

Antagonized by: Beta blockers

Precipitates in Alkaline solutions

EPINEPHRINE

PEARLS of wisdom...

- Sodium Bicarbonate & Furosemide will inactivate epi, flush line well between administration

- Although epi can by delivered ET, studies suggest that the ET route is less successful in arrest situation than IV. ET administration should be utilized only until IV or IO access can be established

- Because of epi's effects on myocardial O2 demand, pt.'s should be adequately oxygenated when receiving epi

- Epi (1:1000) should not be administered IV without dilution

DOPAMINE HYDROCHLORIDE

Drug name, Trade name, Class

Drug name: Dopamine Hydrochloride

Trade name: Dopamine; Intropin

Class:

- Adrenergic Dopaminergic Catecholamine

- Sympathomimetic

DOPAMINE

Mechanism of Action

Naturally occuring catecholamine.

- 2-10 mcg/kg/min--beta receptors--inotropic,chronotropic

- 10-20 mcg/kg/min--alpha&beta--casoconstriction of renal, mesenteric, an dperipheral arteries and veins

- 20 mcg/kg/min +--alpha dominates, norepinephrine like effects

DOPAMINE

Indications (4), Contraindications (5), Precautions (4)

Indications:                    Contraindications:

 - Cardiogenic Shock                              - Women on oxytocin

- Neurogenic Shock                               - Tachydysrhythmias

- Septic Shock                                      - VF/VT

- Refractory Bradycardia                         - Uncorrected hypovolemia

                                                        - Pt.'s w/ known pheochromocytoma

Precautions:

- MAOI's, TCA's, other cardiac stimulants, vasopressors, will cause increased HR, SV dysrhythmias

- Will ppt in basic, alkaline solutions

- May cause necrosis, sloughing at infusion site

- Pregnancy (c)

DOPAMINE

Available Forms (4)

- 40 mg/mL -- 200 mg/5mL (amps vials)

- 80mg/100mL -- 0.8mg/mL (200mg in 250mL D5W)

- 160mg/100mL--1.6mg/mL (400mg in 250mL D5W)

- 320mg/100mL--3.2 mg/mL (800mg in 250mL D5W)

DOPAMINE

Adult Dosage

2-20 mcg/kg/min

titrate to effect, running through a lrg. vein.

adding 2 vials (400 mg) to 250mL of NS = 1600 mcg/mL

DOPAMINE

Pediatric dosage

2-20 mcg/kg/min - titrated to effect

-multiply by childs weight X6 & dilute to a total volume of 100 mL

- when the resulting mix is administered at 1mL/hr; it delivers a dose of 1 mcg/kg/min.

DOPAMINE

Onset, Duration, and Interactions (4)

Onset: 2-4 minutes

Duration: 10-15 minutes

Interactions:

-potentiated by MAOI's/TCA's, bretylium

-ppt in alkaline solutions

- discard if pink or brown

- may cause hypotension when used concomitantly with phenytoin (dilantin)

DOPAMINE

Side Affects (10)

1.) Dysrhythmias     7.) Angina/AMI

2.) HTN/HA             8.) Pain

3.) N/V                   9.) Tachycardia

4.) Dizziness           10.) Bradycardia

5.) Tremors

6.) Flushing

DOPAMINE

PEARLS...

- Can cause tissue necrosis and sloughing. take care to avoid infiltration, use control IV access or lrg. veins of the arm

-Titrate dosage to pt.'s hemodynamic response

VASOPRESSIN, ADH

Drug Name, Trade Name, Class

Drug Name:

Vasopressin, ADH

Trade Name:

Pitressin

Class:

Exogenous, parenteral form of ADH

VASOPRESSIN, ADH

Mechanism of Action (4)

1.) In unnaturally high doses, vasopressin acts as an non-adrenergic peripheral vasoconstrictor

2.) Vasopressin acts by direct stimulation of smooth muscle V1 receptors, causing intense peripheral vasoconstriction of skin, skeletal muscle, intestine, & fat with less constriction of coronary and renal vascular beds.

3.) Vasopressin produces no skeletal muscle vasodilation of incresed myocardial oxygen demand during CPR because it has no beta-adrenergic activity

4.) In one study, after a short duration of ventricular fibrillation & during CPR, vasopressin increased coronary perfusion pressure, vital organ blood flow, and cerebral oxygen deliver

VASOPRESSIN

Indications (1), Contraindications (1), Precautions (6)

Indications: Adult refractory pulseless arrest

Contraindications: None

Precautions: few if any in arrest settings

- Migraine

- Epilepsy

- CHF

- Asthma

- CAD

- Pregnancy (C)

VASOPRESSIN

Available Forms, Dosage (adults), Onset, Duration

Available Forms: 5 U/mL

Dosage (adults only): IV - single dose of 40 U

Onset: immediate

Duration: variable

VASOPRESSIN

Side Effects (6)

possible post-resuscitation
- Ischemic CP

- ABD distress

- N/V

- Sweating

- Tremors

- Bronchial constriction

VASOPRESSIN

Interactions & PEARLS..

Interactions: None

PEARLS: may be used to replace the 1st of 2nd dose of epi in pulselss arrest