Homework Answers
Medication: Epinephrine
Category class: Alpha and beta-adrenergic agonist: bronchodilator: Autonomic nervous system agent
Purpose of medication
Expected pharmacological action: Epinephrine acts by binding to the adrenergic receptors, the different types of adrenergic receptors are alpha-1, alpha-2, beta-1, beta-2. Adrenaline binds to these receptors and creates different metabolic reactions with each. By binding with the alpha-adrenergic receptors it inhibits insulin secretion from the pancreas, stimulates glycolysis, gluconeogenesis, increased lipolysis. All these effects increase the blood glucose levels and the fatty acids and thus provides energy throughout the body. By binding to alpha-1 receptors it increases the peripheral resistance and increases the cardiac output by binding to the beta-1 receptors. It increases the force of myocardial contraction, increases the systolic blood pressure but may decrease the diastolic blood pressure.
Therapeutic use: Epinephrine causes the constriction of the bronchial arterioles and also inhibits the secretion of histamines and reduces the edema and congestion( bronchodilator) and it increases the tidal volume and vital capacity of the lungs. Epinephrine mimics the action of the sympathetic nervous system except on the sweat glands and face. It also relaxes the uterine smooth muscles and inhibits the contraction of the uterus.
Complications:
Nervous system:
- cerebrovascular accident
- Restlessness
- Tremors
- Syncope
- Psychosis
Cardiovascular:
- Chest pain
- Hypertension
- MI
- Tachyarrhythmias
- Ventricular fibrillation
Reparatory:
- Dyspnea
- Pulmonary edema
Special senses:
- Maculopathy
- Headache
- corneal edema
Metabolic:
- Metabolic acidosis
- Hyperglycemia
Medication administration:
Inhalation: this medicine can be given through inhalation with the patient in an upright position, the patient should be asked to rinse the mouth after inhalation.
Installation: this medicine can also be instilled as nose drops with the patient's head in the lateral, head low position.
Ophthalmic: epinephrine can also be administered as eye drops. Gentle pressure by the fingers should be applied against the nasolacrimal duct after instilling the eye drops.
Subcutaneous: it can be given by using a tuberculin syringe. The injection should be protected from light. The injection sites should be rotated.
Contraindications
- Hypersensitivity to sympathomimetic drugs
- Hemorrhagic shock
- Traumatic shock
- Cardiogenic shock
- Narrow-angle glaucoma arrhythmias
- Coronary insufficiency
- Pregnancy
- Lactation
Precautions:
- Hypertension
- Diabetes mellitus tuberculosis
- Parkinson’s disease
- Bronchial asthma
Interaction:
Decreases the blood pressure
- Phenothiazines( hypotension)
- Oxytocin
- Entacapone
Additional toxicity
- Albuterol
- Dobutamine
- Dopamine
- Norepinephrine
- Salmeterol
Suppresses the action the drug(antagonize)
- Alpha and beta adrenergic blockers ( propranolol)
- MAO inhibitors
- Tricyclic antidepressants
Nursing interventions:
- Assess the pulse, BP, respiration, and urine output before anf after administration of the drug
- Epinephrine can increase pulse pressure. If there are any variations notify the physician
- Monitor the bP during the first five minutes and then every 3-5 minutes until the patient is stabilized.
- Monitor blood glucose levels if patient is diabetic.
Evaluation of medication effectiveness:
- Relief or prevention of bronchospasm
- Increase in BP
- Reversal sign and symptoms of anaphylaxis
- Increase cardiac rate and output
- Resolved dyspnea
Client education:
- Ophthalmic drugs should be taken at bedrime
- Instruct the client that intranasal drops can sting the nose
- If the patient develops itching, discharge, crusting eyelids because of eyedrops the patient should discontinue and inform the ohysician
- Teach the patient how to use the subcutaneous route for drug administration.
- Do not breatfeed when on this drug
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