Nurses Compass
Drug Guide
Epinephrine Bitartrate
Classification
Therapeutic: Vasopressor, Bronchodilator
Pharmacological: Adrenergic agonist (alpha and beta adrenergic receptors)
FDA Approved Indications
- Anaphylaxis
- Asthma exacerbation
- Cardiac arrest (as emergency treatment)
- Local vasoconstriction in procedures
Mechanism of Action
Epinephrine stimulates alpha-adrenergic receptors causing vasoconstriction and reduction of mucosal edema, and beta-adrenergic receptors leading to bronchodilation, increasing cardiac output, and improving airway patency.
Dosage and Administration
Adult: Dose varies by indication: for anaphylaxis, 0.3 mg IM every 5-15 minutes as needed; inhalation doses vary per formulation.
Pediatric: 0.01 mg/kg IM (max 0.3 mg per dose) for anaphylaxis; inhalation doses based on age and weight.
Geriatric: Adjust based on clinical response; caution due to cardiovascular risks.
Renal Impairment: Use with caution; no specific dose adjustment, but monitor closely.
Hepatic Impairment: No specific dose adjustment established.
Pharmacokinetics
Absorption: Rapid absorption via injection route; inhalation delivers localized effect.
Distribution: Widely distributed; crosses the placenta.
Metabolism: Primarily hepatic via COMT and MAO enzymes.
Excretion: Renal excretion of metabolites.
Half Life: Approximately 2-3 minutes intravenously; longer when administered via inhalation or intramuscularly.
Contraindications
- Hypersensitivity to epinephrine or adrenergic amines.
- Use with caution in patients with cardiac disease, hypertension, or hyperthyroidism.
Precautions
- Monitor cardiac status; use with caution in patients on certain antidepressants or MAO inhibitors.
- Pregnancy Category C; weigh benefits vs risks.
Adverse Reactions - Common
- Increase in blood pressure (Common)
- Tachycardia (Common)
- Palpitations (Common)
- Anxiety, tremor (Common)
Adverse Reactions - Serious
- Arrhythmias (Rare)
- Hypertension leading to cerebrovascular accidents (Rare)
- Pulmonary edema (Rare)
Drug-Drug Interactions
- Tricyclic antidepressants and MAO inhibitors can increase adrenergic effects.
- Beta-blockers can antagonize epinephrine effects.
Drug-Food Interactions
- Avoid other vasoconstrictive agents.
Drug-Herb Interactions
- Use caution with herbal supplements affecting blood pressure or cardiac function.
Nursing Implications
Assessment: Monitor vital signs closely, especially heart rate, blood pressure, and respiratory status.
Diagnoses:
- Ineffective tissue perfusion related to vasoconstriction or arrhythmias.
- Imbalanced nutrition: less than body requirements related to metabolic demands.
Implementation: Administer via appropriate route (IM, inhalation, IV) as prescribed; monitor for adverse effects.
Evaluation: Assess for improvement of respiratory symptoms, blood pressure regulation, and presence of adverse reactions.
Patient/Family Teaching
- Instruct on proper use of inhaler or injection device.
- Notify healthcare provider of chest pain, palpitations, or severe hypertension.
- Carry identification indicating allergy to epinephrine if applicable.
Special Considerations
Black Box Warnings:
- Potential for severe hypertension, myocardial ischemia, or arrhythmias.
Genetic Factors: No specific genetic considerations.
Lab Test Interference: None significant.
Overdose Management
Signs/Symptoms: Hypertension, tachycardia, palpitations, tremors, anxiety, chest pain.
Treatment: Discontinue epinephrine, provide supportive care, monitor cardiac status, treat hypertension with antihypertensives if necessary.
Storage and Handling
Storage: Store at controlled room temperature (68-77°F), protected from light and moisture.
Stability: Stable under recommended storage conditions; check expiration before use.