💉 Introduction:
Epinephrine, also known as Adrenaline, is a life-saving emergency drug commonly used in the treatment of cardiac arrest, anaphylaxis, and severe asthma attacks. As a potent adrenergic agonist, it stimulates multiple receptors in the body, producing widespread and immediate effects on the cardiovascular and respiratory systems.
Whether you're a nursing student, practicing nurse, or medical professional, understanding epinephrine's pharmacology and clinical application is vital for emergency care.
💊 Generic Name:
Epinephrine
💼 Trade Names:
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Adrenalin
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EpiPen
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Auvi-Q
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Symjepi
🧪 Class / Action:
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Pharmacologic Class: Adrenergic agonist (non-selective)
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Therapeutic Class: Vasopressor, bronchodilator, cardiac stimulant
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Action: Mimics the sympathetic nervous system (fight-or-flight response) by stimulating alpha and beta adrenergic receptors.
💉 Route / Dosage:
Routes of Administration:
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Intramuscular (IM)
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Intravenous (IV)
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Subcutaneous (SC)
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Inhalation
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Endotracheal (ET)
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Intracardiac (rare/emergency)
Dosage (Adults):
Anaphylaxis (IM):
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0.3–0.5 mg IM every 5–15 minutes as needed
Cardiac Arrest (IV/IO):
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1 mg every 3–5 minutes during CPR
Asthma (SC/IM):
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0.3–0.5 mg every 20 minutes up to 3 doses
Pediatric Dosage:
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Based on weight (0.01 mg/kg)
⚠️ High Alert Medication:
YES ✅
Due to its potent cardiovascular effects, epinephrine is considered a high-alert medication. Improper dosing or administration may result in fatal arrhythmias, hypertension, or cardiac arrest.
💡 Indications:
- Anaphylaxis (severe allergic reaction)
- Cardiac arrest (asystole, PEA, VF, pulseless VT)
- Severe bronchospasm/asthma
- Hypotension and shock unresponsive to fluids
- Local anesthetic adjunct to prolong duration and reduce bleeding
- Stridor/croup (nebulized form in pediatrics)
🔬 Mechanism of Action:
Epinephrine stimulates alpha-1, beta-1, and beta-2 adrenergic receptors:
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Alpha-1: Vasoconstriction → increases blood pressure
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Beta-1: Increases heart rate and contractility
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Beta-2: Bronchodilation → opens airways
These combined actions restore perfusion, reverse airway obstruction, and support cardiovascular function, especially in life-threatening emergencies.
🚫 Contraindications:
- Hypersensitivity to epinephrine (rare, ironic since it treats allergies)
- Narrow-angle glaucoma
- Patients on non-selective beta-blockers (may cause paradoxical hypertension)
- Labor and delivery (can delay labor via uterine relaxation)
- Use caution in elderly, hypertensive, and cardiac patients
⚠️ Adverse Reactions / Side Effects:
Common:
- Anxiety
- Palpitations
- Tremors
- Headache
- Dizziness
- Sweating
- Nausea
Serious:
- Arrhythmias (ventricular fibrillation, tachycardia)
- Hypertensive crisis
- Stroke
- Myocardial infarction
- Pulmonary edema
- Tissue necrosis if extravasated (IV)
🩺 Nursing Implications:
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Monitor vital signs (BP, HR, ECG) continuously during administration.
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Use correct concentration:
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1:1,000 for IM/subcut
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1:10,000 for IV (cardiac arrest)
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Administer IM in anterolateral thigh (vastus lateralis) for fastest absorption.
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Monitor for chest pain, arrhythmias, and hypertension.
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Have resuscitation equipment ready if given IV.
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Watch for signs of rebound bronchospasm or allergic response.
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Rotate injection sites if repeated dosing is needed.
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Use caution in patients taking MAO inhibitors, tricyclic antidepressants, or beta-blockers.
🧑⚕️ Patient Education:
- Teach patients (especially with allergies) how to use auto-injectors (EpiPen) properly.
- Instruct to seek emergency care immediately after use of EpiPen—effects are temporary.
- Do not inject into hands, feet, or buttocks (risk of ischemia).
- Store auto-injectors at room temperature, away from light and heat.
- Inform that shakiness and fast heartbeat are common but temporary effects.
- Carry medical identification if prescribed for anaphylaxis or asthma.
📋 Notes for Nurses:
- Always double-check concentration (1:1,000 vs 1:10,000) to prevent fatal dosing errors.
- IM route is preferred in anaphylaxis for safety and rapid absorption.
- In cardiac arrest, administer via IV push followed by flush.
- Document time, route, and patient response clearly.
- Be alert for extravasation with IV administration—can cause tissue necrosis; use central line when possible.
- Consider phentolamine (alpha-blocker) if extravasation occurs.
- Educate caregivers and patients on emergency use and replacement schedule for expired auto-injectors.
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