EpiPen

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epinephrine

Twinject

epinephrine hydrochloride

Adrenalin Chloride (CA), Anapen (UK), Epi-E-Z Pen (CA), EpiPen, EpiPen Jr.

Pharmacologic class: Sympathomimetic (direct acting)

Therapeutic class: Bronchodilator, mydriatic

Pregnancy risk category C

Action

Stimulates alpha- and beta-adrenergic receptors, causing relaxation of cardiac and bronchial smooth muscle and dilation of skeletal muscles. Also decreases aqueous humor production, increases aqueous outflow, and dilates pupils by contracting dilator muscle.

Availability

Auto-injector for I.M. injection: 1:2,000 (0.5 mg/ml)

Injection: 0.1 mg/ml, 0.5 mg/ml, 1 mg/ml

Ophthalmic drops: 0.5%, 1%, 2% Solution for inhalation (as racepinephrine): 2.5% (equivalent to 1% epinephrine)

Indications and dosages

Bronchodilation; anaphylaxis; hypersensitivity reaction

Adults: 0.1 to 0.5 ml of 1:1,000 solution subcutaneously or I.M., repeated q 10 to 15 minutes p.r.n. Or 0.1 to 0.25 ml of 1:10,000 solution I.V. slowly over 5 to 10 minutes; may repeat q 5 to 15 minutes p.r.n. or follow with a continuous infusion of 1 mcg/minute, increased to 4 mcg/minute p.r.n. For emergency treatment, EpiPen delivers 0.3 mg I.M. of 1:1,000 epinephrine.

Children: For emergency treatment, EpiPen Jr. delivers 0.15 mg I.M. of 1:2,000 epinephrine.

Acute asthma attack

Adults and children ages 4 and older: One to three deep inhalations of inhalation solution with hand-held nebulizer, repeated q 3 hours p.r.n.

To restore cardiac rhythm in cardiac arrest

Adults: 0.5 to 1 mg I.V., repeated q 3 to 5 minutes, if needed. If no response, may give 3 to 5 mg I.V. q 3 to 5 minutes.

Chronic simple glaucoma

Adults: One drop in affected eye once or twice daily. Adjust dosage to meet patient's needs.

To prolong local anesthetic effects

Adults and children: 1:200,000 concentration with local anesthetic

Contraindications

• Hypersensitivity to drug, its components, or sulfites

• Angle-closure glaucoma

• Cardiac dilatation, cardiac insufficiency

• Cerebral arteriosclerosis, organic brain syndrome

• Shock with use of general anesthetics and halogenated hydrocarbons or cyclosporine

• MAO inhibitor use within past 14 days

• Labor

• Breastfeeding

Precautions

Use cautiously in:

• hypertension, hyperthyroidism, diabetes, prostatic hypertrophy

• elderly patients

• pregnant patients

• children.

Administration

• In anaphylaxis, use I.M. route, not subcutaneous route, if possible.

Inject EpiPen and EpiPen Jr. only into anterolateral aspect of thigh. Don't inject into buttocks or give I.V.

Be aware that not all epinephrine solutions can be given I.V. Check manufacturer's label.

• For I.V. injection, give each 1-mg dose over at least 1 minute. For continuous infusion, use rate of 1 to 10 mcg/minute, adjusting to desired response.

• Use Epi-Pen Jr. for patients weighing less than 30 kg (66 lb).

Don't give within 14 days of MAO inhibitors.

Adverse reactions

CNS: nervousness, anxiety, tremor, vertigo, headache, disorientation, agitation, drowsiness, fear, dizziness, asthenia,cerebral hemorrhage, cerebrovascular accident (CVA)

CV: palpitations, widened pulse pressure, hypertension, tachycardia, angina, ECG changes,ventricular fibrillation, shock

GI: nausea, vomiting

GU: decreased urinary output, urinary retention, dysuria

Respiratory: dyspnea, pulmonary edema

Skin: urticaria, pallor, diaphoresis, necrosis

Other: hemorrhage at injection site

Interactions

Drug-drug. Alpha-adrenergic blockers: hypotension from unopposed beta-adrenergic effects

Antihistamines, thyroid hormone, tricyclic antidepressants: severe sympathomimetic effects

Beta-adrenergic blockers (such as propranolol): vasodilation and reflex tachycardia

Cardiac glycosides, general anesthetics: increased risk of ventricular arrhythmias

Diuretics: decreased vascular response Doxapram, mazindol, methylphenidate: enhanced CNS stimulation or pressor effects

Ergot alkaloids: decreased vasoconstriction

Guanadrel, guanethidine: enhanced pressor effects of epinephrine

Levodopa: increased risk of arrhythmias

Levothyroxine: potentiation of epinephrine effects

MAO inhibitors: increased risk of hypertensive crisis

Drug-diagnostic tests. Glucose: transient elevation

Lactic acid: elevated level (with prolonged use)

Patient monitoring

Monitor vital signs, ECG, and cardiovascular and respiratory status. Watch for ventricular fibrillation, tachycardia, arrhythmias, and signs and symptoms of shock. Ask patient about anginal pain.

• Assess drug's effect on underlying problem (such as anaphylaxis or asthma attack), and repeat dose as needed.

Monitor neurologic status, particularly for decreased level of consciousness and other signs and symptoms of cerebral hemorrhage or CVA.

• Monitor fluid intake and output, watching for urinary retention or decreased urinary output.

• Inspect injection site for hemorrhage or skin necrosis.

Patient teaching

• Teach patient who uses auto-injector how to use syringe correctly, when to inject drug, and when to repeat doses.

• Teach patient who uses hand-held nebulizer correct use of equipment and drug. Explain indications for both initial dose and repeat doses.

Inform patient that drug may cause serious adverse effects. Tell him which symptoms to report.

• If patient will self-administer drug outside of health care setting, explain need for prompt evaluation by a health care provider to ensure that underlying disorder has been corrected.

• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.

McGraw-Hill Nurse's Drug Handbook, 7th Ed. Copyright © 2013 by The McGraw-Hill Companies, Inc. All rights reserved

EpiPen

(ĕp′ĭ-pĕn′)
A trademark for a device that injects epinephrine intramuscularly in the treatment of anaphylactic shock.
The American Heritage® Medical Dictionary Copyright © 2007, 2004 by Houghton Mifflin Company. Published by Houghton Mifflin Company. All rights reserved.

EpiPen®

Allergy medicine A proprietary EM Pharmaceuticals device used to autoinject–IM epinephrine in Pts with potentially fatal anaphylactic reactions. See Anaphylactic reaction.
McGraw-Hill Concise Dictionary of Modern Medicine. © 2002 by The McGraw-Hill Companies, Inc.
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It's an excellent idea to give the patient an epi pen and instructions to carry it at all times while waiting for the specialist appointment, said Dr.
Father-of-four Denis Hollingworth, 60, told paramedics and doctors he had given himself a small shot of adrenaline from an Epi Pen after being stung while working in a garden in Holmfirth in September 2003.
Twelve of those children were provided with anti-histamine medication while two cases required Epi Pen jabs which are required for severe allergic reactions.
Medical staff had given her an epi pen, which meant she could inject adrenaline into her thigh and stop the reaction herself.
We administered 2 epi pens while she was conscious and waited on paramedics for what felt like an eternity," Kellie said.
Nonetheless, coprescription of epi pens "has never been the standard in Europe or other parts of the globe.
Drugs called epinephrine or adrenaline epi pens treat the allergy and sufferers should carry this with them at all times and teach friends andfamilyhowtouseit.Exposure therapy advances have reversed the condition in some sufferers in the US but it's still at the experimental stage.
The Epi pens were not all the same brand and feedback of usability based upon the clarity and conciseness of instructions led to a potential delay in a rapid delivery in some models of the pen.
Inside were two epi pens containing a hypodermic needle and three inhalers.
Two Epi Pens (self-administered Epinephrine adrenaline injectors) were also present in the pockets of guests just in case my wife, Helene, and I had erred in the application of certain dietary ingredient instructions in the preparation of our holiday recipes.