Epinephrine and Nitroglycerin

Generic/Trade Name (EPI)

Epinephrine, Adrenaline

Classification (EPI)

Natural catecholamine, Sympathomietic

Packaged (EPI)

1mg/1mL (1:1000 solution), ampule Epi-Pen auto injector (.3mg)

Pharmacological Action (EPI)

Stimulates alpha and beta adrenergic receptors. Its alpha receptors activity is most potent. Beta2 agonist: causes bronchodilation and dilation of vessels in skeletal muscles. \

Clinical Action (EPI)

Beta2 Effects: bronchodilation

Onset, Peak, Duration (EPI)

IM 3-10min, 20min, 20-30min

Indications (EPI)

Anaphylactic shock; severe bronchopspasm in status asthmaticus after Albuterol/Atrovent

Contraindications (EPI)

Tachydysrhythmias, hypotension, ventricular irritability, CVD, pulmonary edema.

Side Effects (EPI)

Cardiovascular: tachydysrhythmias, precipitation of agina or MI, palpitations, hypertension. CNS: anxiety, tremor, nervousness, headache. Other: pupil dilation, nausea, and vomiting

Interactions (EPI) 

Use with tricyclic antidepressants (TACs) and antihistamines may cause cardiac effects 

Adult Dosage (EPI)

Anaphylaxis: .3mg IMPed

Pediatric Dosage (EPI)

Anaphylaxis: .01mg/kg (1:1000) SQ or IM to a max dose of .3mg

Respiratory Distress/Failure: .1mg/kg SQ maximum single dosage .3mg.

May repeat every 20 minutes

Special Considerations (EPI)

Massage area after subcutaneous injection to counteract possible vasoconstriction. Monitor vitals signs and cardiac monitor frequently and watch for developing arrhythmias if given for anaphylaxis.

Special Considerations if patient is over 40yo, irregular heart rate, or over 150bpm, history of heart disease or hypertension

Generic/Trade Name (Nitro)

Nitroglycerine, Nitrostat/Nitrospray/Nitro-Bid

Classification (Nitro)

Vasodilator, anti-anginal

Packaged (Nitro)

.4mg SL tablet, .4mg metered dose spray, ointment 2: in 1g foil packet

Pharmacological Action (Nitro)

Dilates arterial and venous vasculature (primarily venous). Smooth muscle relaxant on vascular, uterine, bronchial, and intenstinal smooth muscle. 

Clinical Action (Nitro)

Decreasing blood flow to heart (preload), decreases amount of pressure the heart has to pump against (after load), and increases the blood flow to myocardium.

Onset, Peak, Duration (Nitro)

1-3min (SL) up to 60min for paste, unknown, 10-30min

Indications (Nitro)

Ischemic chest pain (angina/MI); cardiogenic pulmonary edema with systolic BP over 100mmHg 

Contraindications (Nitro)

ED drug use within 24-48hrs as it may result in irreversible hypotension, hypotension, severe Brady/tachycardia, hypovolemia, head trauma, cerebral hemorrhage (may increase ICP)

Side Effects (Nitro)

cardiovascular: orthostatic hypotension, reflex tachycardia, palpitations

CNS: headache, dizziness, blurred vision, weakness.

Sublingual burning and dry mouth

Interactions (Nitro)

Alcohol and anti-hypertestives may increase hypotension

Adult Dosage (Nitro)

For chest pain associated with MI: 1 metered dose (.4mg) SL spray or tablets at 3-5 intervals. May repeat a total of 3 doses if pain is unresolved and systolic BP remains above 100mmHg (90-100 if IV is established) 

Special Considerations (Nitro)

Establishing IV access prior to NTG is strongly recommended as hypotension causes by administration responds well to fluids and lifting lower extremities. In cases of acute inferior MI, NTG may cause and bradycardia (Bezold- Jarisch Reflex). A vagal reflex is triggered. Atropine may be necessary to manage the bradycardia and hypotension usually responds to IV fluids. Monitor vitals frequently.