Classification Adrenergic agent directacting

See also Sympathomimetic Drugs and Nasal Decongestants. Action/Kinetics: Causes marked stimulation of alpha, beta-1, and beta-2 receptors, causing sympa-thomimetic stimulation, pressor effects, cardiac stimulation, bronchod-ilation, and decongestion. It crosses the placenta but not the blood-brain barrier. Extreme caution must be taken never to inject 1:100 solution intended for inhalation—injection of this concentration has caused death. SC: Onset, 6-15 min; duration: <1-4 hr. Inhalation: Onset, 1-5 min; duration: 1-3 hr. IM, Onset: variable; duration: <1-4 hr. Ineffective when given PO. Uses: Cardiac arrest, Stokes-Adams syndrome, low CO following ECB. To prolong the action of local anesthetics. As a hemostatic during ocular surgery; treatment of conjunctival congestion during surgery; to induce mydriasis during surgery; treat ocular hypertension during surgery. Topically to control bleeding. Acute bronchial asthma, bronchospasms due to emphysema, chronic bronchitis, or other pulmonary diseases. Treatment of anaphylaxis, angioede-ma, anaphylactic shock, drug-induced allergic reactions, transfusion reactions, insect bites or stings. As an adjunct in the treatment of open-angle glaucoma (may be used with miotics, beta blockers, hyperosmotic agents, or carbonic anhydrase inhibitors). To produce mydriasis; to treat conjunctivitis. NOTE: Autoinjectors are available for emergency self-administration of first aid for anaphylac-tic reactions due to insect stings or bites, foods, drugs, and other allergens as well as idiopathic or exercise-induced anaphylaxis. Additional Contraindications:

Narrow-angle glaucoma. Use when wearing soft contact lenses (may discolor lenses). Aphakia. Lactation. Special Concerns: May cause anoxia in the fetus. Safety and efficacy of ophthalmic products have not been determined in children; administer parenteral epinephrine to children with caution. Syncope may occur if epinephrine is given to asthmatic children. Administration of the SC injection by the IV route may cause severe or fatal hypertension or ce-rebrovascular hemorrhage. Epineph-rine may temporarily increase the rigidity and tremor of parkinsonism. Use with caution and in small quantities in the toes, fingers, nose, ears, and genitals or in the presence of peripheral vascular disease as vaso-constriction-induced tissue sloughing may occur.

Additional Side Effects: CV: Fatal ventricular fibrillation, cerebral or subarachnoid hemorrhage, obstruction of central retinal artery. A rapid and large increase in BP may cause aortic rupture, cerebral hemorrhage, or angina pectoris. GU: Decreased urine formation, urinary retention, painful urination. CNS: Anxiety, fear, pallor. Parenteral use may cause or aggravate disorientation, memory impairment, psychomotor agitation, panic, hallucinations, suicidal or homicidal tendencies, schizophrenic-type behavior. Miscellaneous: Prolonged use or overdose may cause elevated serum lactic acid with severe metabolic acidosis. At injection site: Bleeding, urticaria, wheal formation, pain. Repeated injections at the same site may cause necrosis from vascular constriction. Ophthalmic: Transient stinging or burning when administered, conjunctival hyper-emia, brow ache, headache, blurred vision, photophobia, allergic lid reaction, ocular hypersensitivity, poor night vision, eye ache, eye pain. Prolonged ophthalmic use may cause deposits of pigment in the cornea, lids, or conjunctiva. When used for glaucoma in aphakic clients, reversible cystoid macular edema.

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