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.
References in periodicals archive ?
There was also a delay of around half an hour between him falling ill and receiving his Epi-Pen because teachers "didn't connect the dots" and realise he was seriously ill.
The introduction of the generic for Adrena-click followed months of intense media scrutiny and even a congressional hearing on the pricing of the Epi-Pen, which had skyrocketed in price by more than 500% between 2009 and 2015 despite having been on the market for decades.
An innovations-in-pharmacy study designed to determine which prescription drugs pharmacists feel have safety profiles that warrant a switch to OTC status revealed that among the pharmacists surveyed, oral contraceptives were the most frequently cited category, followed by the asthma drug albuterol and Mylan's epinephrine autoinjector epi-pen for the treatment of anaphylaxis.
Before my mom dropped us off, she pulled out an Epi-pen and proceeded to give him a demonstration on how to use it.
(ANDAs) in each company's pipeline; and the company's combined growth outlook given the potential for generic competition on Teva's largest drug (Copaxone) and Mylan's largest drug (Epi-Pen).
Check if patient is carrying epi-pen for self administration; help to use it, if so required.
Her gym teacher had to jam an epinephrine auto-injector (or epi-pen) into her thigh, right through her clothing, to stop her face from swelling, her tongue from tingling, her skin from itching, and her throat from eventually closing.
Same with allergies, the app might even tell me that they have an epi-pen in their purse or pocket.”
"I now carry an epi-pen to give me a shot of adrenalin in case I get stung again and go into an anaphylactic shock," Lynn said.
Dylan has to take daily medication and inject himself with an epi-pen to assist with his growth.
"The standard management is to write a prescription for an Epi-Pen and make sure they know how to use it," Dr.
Once stable Chris was taken by land ambulance to University Hospital in Coventry and he now carries an Epi-pen in case he is stung again.