Adrenaline ' Epinephrine " : Sympathomimetics : Commonly used drugs in Emergency & ICU

Adrenaline ' Epinephrine " : Sympathomimetics

Trade name: Adrenaline

Class: Direct acting-adrenergic agent.

Pregnancy: (Category C) 

Action:

A natural hormone produced from adrenal medulla; induce marked stimulation of alpha, β1 + β2 receptors causing cardiac stimulation, bronchodilation & decongestion.

Uses:

1-                  Relief of respiratory distress due to bronchospasm.

2-                  Rapid relief of hypersensitivity reactions.

3-                  Cardiac arrest.

4-                  Open- angle glaucoma.

5-                  To prolong the action of anesthesia.

6-                  Topically to stop bleeding.

Dose:

Available in ampoules of 1ml containing 1 mg adrenaline Can be given by I.M injection. I.V. & S.C.

In CPR "A systole and PEA":

1 in 10 000 (100 micrograms/mL) is recommended in a dose of 10 mL by intravenous injection, preferably through a central line.

If injected through a peripheral line, the drug must be flushed with at      least 20 mL sodium chloride 0.9% injection (to aid entry into the central circulation).

 In Acute anaphylaxis:

 By intramuscular injection (preferably midpoint in anterolateral thigh) (or by subcutaneous injection " not generally recommended ') of 1 in 1000 (1 mg/mL) solution " when there is doubt as to the adequacy of the circulation, by slow intravenous injection of 1 in 10 000 (100 micrograms/mL) solution (extreme caution),   Dose:

IV: 10 micrograms/kg " 1 in 10 000 " as indicated: every 3-5 min"

    If endotracheal route:

             The used dose should be 3-10 times IV dose and diluted.

    IM injection

Adult 0.5 mg may be repeated several times if necessary at 5- minute intervals according to blood pressure, pulse and respiratory function Infusion: 2-10 mic/min titrated to response.

Contraindications:

§   Narrow angle glaucoma.

§   Shock

§   Lactation.

§   Tachycardia

§   During labor (it may delay the 2^nd 8 loge do labor).

Side effects:

§   Fatal ventricular fibrillation.

§   Cerebral hemorrhage

§   urinary retention,

§   headache,

§   necroses at injection side,

§   Blurring of vision, photophobia.

Nursing considerations:

§   Never administer 1: 100 solutions IV. Use 1: 1000 mg sol. For I.V. use.

§   Use tuberculin (1cc) syringe to measure adrenaline.

§   Administer adrenaline using piggyback set to adjust the rate of infusion.

§   Administer infusion by electronic infusion device for safety & accuracy.

§   Closely monitor patients receiving I.V. adrenaline infusion.

§   Note the client for signs of shock “loss of consciousness, clammy, cold skin, cyanosis…. etc.).

§   Briskly massage site of S.C. or I.M. injection to hasten the action of the drug.

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