Epinephrine

35

Summary

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Key Points

  • Mechanism
    • Catecholamine
      • Stimulates alpha and beta adrenergic receptors
    • Bronchodilation
      • Stimulation of beta-2 receptors relaxes bronchial smooth muscle to cause airway dilation
    • Vasoconstriction
      • Stimulation of alpha-1 receptors increases blood pressure
    • Increased Heart Rate
      • Stimulation of beta-1 receptors increases heart rate
    • Clinical Use
      • Anaphylactic shock
        • Drug of choice; dilates airways and constricts systemic vasculature to restore normal blood pressure
        • Usually given IM
        • Can be repeated every 5-15 min if no response
        • Patients with a history of severe allergic reaction should always carry an EpiPen
      • Cardiac arrest
        • Used in ACLS algorithm, believed to improve return of circulation and perfusion
      • Bronchodilation also used to treat
        • Severe asthma attacks
        • Acute bronchospasm (COPD)
        • Croup (laryngotracheitis)
      • Bradycardia
        • Increases heart rate
      • May be combined with local anesthetics to reduce local bleeding by reducing blood flow and reduce anesthetic extravasation
    • Side Effects and Adverse Reactions
      • Cardiac distress
        • Dysrhythmias
        • Angina
        • Tachycardia
        • Hypertension
          • Concurrent use with MAOI may lead to hypertensive crisis
      • Excitability, anxiety, restlessness
      • Mydriasis (pupil dilation)
      • Hyperglycemia