Epinephrine administration route

Alternative Routes of Epinephrine Administration for First-Aid Treatment... 

If an i.v. line cannot be placed, the intraosseous drug administration route can be used for pediatric patients during, for example, cardiopulmonary resuscitation (CPR) because drug delivery by this route is similar to that for i.v. administration.If drug or fluid deliver by this route is sluggish, a saline flush can be used to clear the needle. Intraosseous administration is used to deliver medications such as epinephrine, atropine, sodium bicarbonate, dopamine, diazepam, isoproterenol, phenytoin, phenobarbital, dexametha-sone, and various antibiotics. ... 

In this review, we will describe the pharmacologic activity of epinephrine in anaphylaxis, the evidence base for its use, epinephrine dosing and routes of administration, epinephrine autoinjector use in first-aid treatment, reasons for failure to inject epinephrine promptly, reasons for occasional apparent lack of response, and future directions in epinephrine research. 

Given the unexpected occurrence of anaphylaxis, the rapidity with which symptoms evolve after exposure to the trigger, and the observation that delay in epinephrine injection is associated with fatality [15, 16], randomized controlled trials of epinephrine in anaphylaxis will not be easy to conduct however, it is time to consider the possibility of performing such trials. Future directions with regard to studies of the optimal dose and optimal route of administration of epinephrine in anaphylaxis that do not involve a placebo control will be outlined at the end of this review [17]. 

Drugs metabolized by COMT Administer drugs known to be metabolized by COMT (ie, isoproterenol, epinephrine, norepinephrine, dopamine, dobutamine, methyidopa, apomorphine, isoetherine, bitolterol) with caution in patients receiving entacapone regardless of the route of administration (including inhalation), as their interaction may result in increased heart rates, arrhythmias, and excessive changes in blood pressure. 

The effects of ephedrine are similar to those of epinephrine. However, ephedrine is much less potent, and with routes of administration other than intravenous, the glandular responses do not always occur. Ephedrine does produce hyperglycemia and eosinopenia. 

When used therapeutically, intravenous injection or infusion is the most common route of administration. Epinephrine is available in nebulized racemic dosage form for inhalation. 

Epinephrine is well absorbed after oral administration but is rapidly inactivated in the gut mucosa. When intravenously injected or infused, the onset of drug effect is rapid (within 5 min for dopamine and 3-10 min for epinephrine) and the duration of drug effect is short (10 min for dopamine, 1 or 2 min for norepinephrine, and 15 min to hours for epinephrine depending on route of administration). Exogenous catecholamine in the circulation is rapidly and efficiently taken up by adrenergic neurons. Catecholamine is metabolized by monoamine oxidase, which is localized largely in the outer membrane of neuronal mitochondria, and by catechol-0-methyl transferase, which is found in the cytoplasm of most animal tissues, particularly the kidneys and the liver. 

The endotracheal (ET) route has been used to administer medications during CPR when other routes, such as the i.v. route, are unavailable. It provides rapid access as well as rapid drug absorption and distribution.Some studies have shown that the time to reach peak absorption is similar to that for the i.v. route, but serum concentrations achieved were 10-33% of that achieved with i.v. administration, resulting in a weaker response. A depot effect has also been demonstrated for drugs such as epinephrine. Work needs to be done to determine the optimal dose by this route, drug-delivery vehicle, and the most effective delivery technique. 

Nor-epinephrine the same dose and the same route of administration as with adrenaline, were used. A marked hypertension with bradycardia and unchanged kininogen levels are noted. 

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