Davis's Drug Guide
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EPINEPHrine

Implementation

  • Do not confuse epinephrine with ephedrine.
  • High Alert: Patient harm or fatalities have occurred from medication errors with epinephrine. Epinephrine is available in various concentrations, strengths, and percentages and used for different purposes. Packaging labels may be easily confused or products incorrectly diluted. Dilutions should be prepared by a pharmacist. IV doses should be expressed in milligrams not ampules, concentration or volume. Prior to administration, have second practitioner independently check original order, dose calculations, concentration, route of administration, and infusion pump settings.
  • Medication should be administered promptly at the onset of bronchospasm.
    • Use a tuberculin syringe with a 26-gauge ½-in. needle for subcut injection to ensure that correct amount of medication is administered.
    • Tolerance may develop with prolonged or excessive use. Effectiveness may be restored by discontinuing for a few days and then readministering.
    • Do not use solutions that are pinkish or brownish or that contain a precipitate.
    • For anaphylactic shock, volume replacement should be administered concurrently with epinephrine. Antihistamines and corticosteroids may be used in conjunction with epinephrine.
  • IM: SC: Medication can cause irritation of tissue. Rotate injection sites to prevent tissue necrosis. Massage injection sites well after administration to enhance absorption and to decrease local vasoconstriction. Avoid IM administration in gluteal muscle.
  • Endotracheal: Epinephrine can be injected directly into the bronchial tree via the endotracheal tube if the patient has been intubated. Perform 5 rapid insufflations; forcefully administer 10 mL containing 2–2.5 mg epinephrine (1 mg/mL) directly into tube; follow with 5 quick insufflations.

IV Administration

  • Direct IV: Diluent: The 1:10,000 solution can be administered undiluted. Dilute 1 mg (1 mL) of a 1:1000 solution in 9 mL of 0.9% NaCl to prepare a 1:10,000 solution. Concentration: 0.1 mg/mL (1:10,000).
  • Rate: Administer each 1 mg (10 mL) of a 1:10,000 solution over at least 1 min; more rapid administration may be used during cardiac resuscitation. Follow each dose with 20 mL IV saline flush.
  • Continuous Infusion: Diluent: Dilute 1 mg (1 mL) of a 1:1000 solution in 250 mL of D5W or 0.9% NaCl. Protect from light. Infusion stable for 24 hr. Concentration: 4 mcg/mL.
  • Rate: See Route/Dosage section. Titrate to response (BP, heart rate, respiratory rate).
  • Y-Site Compatibility
    • alfentanil
    • amikacin
    • aminocaproic acid
    • amiodarone
    • amphotericin B lipid complex
    • amphotericin B liposome
    • anidulafungin
    • argatroban
    • ascorbic acid
    • atracurium
    • atropine
    • aztreonam
    • benztropine
    • bivalirudin
    • bleomycin
    • bumetanide
    • buprenorphine
    • butorphanol
    • calcium chloride
    • calcium gluconate
    • carboplatin
    • caspofungin
    • cefazolin
    • cefoperazone
    • cefotaxime
    • cefotetan
    • cefoxitin
    • ceftazidime
    • ceftriaxone
    • cefuroxime
    • chloramphenicol
    • chlorpromazine
    • cisatracurium
    • cisplatin
    • clindamycin
    • cyanocobalamin
    • cyclophosphamide
    • cyclosporine
    • cytarabine
    • dactinomycin
    • daptomycin
    • dexamethasone sodium phosphate
    • dexmedetomidine
    • dexrazoxane
    • digoxin
    • diltiazem
    • diphenhydramine
    • dobutamine
    • docetaxel
    • dopamine
    • doxorubicin
    • doxycycline
    • enalaprilat
    • ephedrine
    • epirubicin
    • epoetin alfa
    • eptifibatide
    • ertapenem
    • erythromycin
    • esmolol
    • etoposide
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    • famotidine
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    • magnesium sulfate
    • mannitol
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    • metaraminol
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    • metoclopramide
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    • multiple vitamins
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    • norepinephrine
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    • oxacillin
    • oxaliplatin
    • oxytocin
    • paclitaxel
    • palonosetron
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    • pancuronium
    • pantoprazole
    • pemetrexed
    • penicillin G potassium
    • pentamidine
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    • phentolamine
    • phenylephrine
    • phytonadione
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    • potassium acetate
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    • ranitidine
    • remifentanil
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    • sodium acetate
    • streptokinase
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    • tacrolimus
    • teniposide
    • theophylline
    • thiamine
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    • ticarcillin/clavulanate
    • tigecycline
    • tirofiban
    • tobramycin
    • tolazoline
    • trimetaphan
    • vancomycin
    • vasopressin
    • vecuronium
    • verapamil
    • vinblastine
    • vincristine
    • vinorelbine
    • vitamin B complex with C
    • voriconazole
    • warfarin
    • zoledronic acid
  • Y-Site Incompatibility
    • acyclovir
    • alemtuzumab
    • aminophylline
    • azathioprine
    • carmustine
    • dantrolene
    • diazepam
    • diazoxide
    • fluorouracil
    • ganciclovir
    • indomethacin
    • micafungin
    • pentobarbital
    • phenobarbital
    • phenytoin
    • sodium bicarbonate
    • thiopental
    • trimethoprim/sulfamethoxazole

  • Inhaln: When using epinephrine inhalation solution, 10 drops of 1% base solution should be placed in the reservoir of the nebulizer.
    • The 2.25% inhalation solution of racepinephrine must be diluted for use in the combination nebulizer/respirator.
    • Allow 1–2 min to elapse between inhalations of epinephrine inhalation solution to make certain the second inhalation is necessary.
    • When epinephrine is used concurrently with corticosteroid or ipratropium inhalations, administer bronchodilator first and other medications 5 min apart to prevent toxicity from inhaled fluorocarbon propellants.
  • Endotracheal:
    Epinephrine can be injected directly into the bronchial tree via the endotracheal tube if the patient has been intubated. Perform 5 rapid insufflations; forcefully administer 10 mL containing 2–2.5 mg epinephrine (1 mg/mL) directly into tube; follow with 5 quick insufflations.

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