Ephedrine (efipres)-30mg/ml Inj.

Class: Vasopressor, Decongestant Actions Stimulates both alpha-and beta-receptors, causing increased heart rate, unchanged or augmented stroke volume, enhanced cardiac output, and increased BP. Causes relaxation of smooth muscle of bronchi and GI tract, stimulation of cerebral cortex, and pupil dilation. Indications IM/IV/SC: Treatment of acute hypotensive states; treatment of Adams-Stokes syndrome with complete heart block; stimulation of CNS to combat narcolepsy and depressive states; treatment of acute bronchospasm; treatment of enuresis; treatment of myasthenia gravis; allergic disorders, such as bronchial asthma. Nasal: Treatment of nasal congestion; promotion of nasal or sinus drainage; relief of eustachian tube congestion. Oral: Temporary relief of shortness of breath, tightness of chest, and wheezing caused by bronchial asthma. Eases breathing for asthma patients by reducing spasms of bronchial muscles. Contraindications Angle-closure glaucoma; patients anesthetized with cyclopropane or halothane; cases in which vasopressor drugs are contraindicated (eg, thyrotoxicosis, diabetes mellitus, hypertension of pregnancy); MAOI therapy; narrow-angle glaucoma; nonanaphylactic shock during general anesthesia with halogenated hydrocarbons or cyclopropane. Route/Dosage Asthma ADULTS AND CHILDREN ³ 12 yr: PO 12.5 to 25 mg q 4 hrs, not to exceed 150 mg in 24 hr. ADULTS: SC/IM/IV 25 to 50 mg SC or IM, or 5 to 25 mg administered slowly IV, repeated q 5 to 10 min, if necessary. CHILDREN: SC/IM 0.5 to 0.75 mg/kg or 16.7 to 25 mg/m2 q 4 to 6 hr. Hypotension ADULTS: SC 25 to 50 mg (IM/IV if rapid effect is needed) 10 to 25 mg may be given by IV push; may give additional doses at 5 to 10 min intervals (max 150 mg/24 hr). CHILDREN: IV/SC 3 mg/kg/day or 25 to 100 mg/m2 /day in 4 to 6 divided doses. Labor ADULTS: SC/IV/IM prn to maintain BP £ 130/80 mm Hg. Nasal Congestion ADULTS: Nasal Dose is product specific. See labeling. Interactions Alpha-Adrenergic Blockers (eg, Phentolamine): Vasoconstricting and hypertensive effects are antagonized. Diuretics: Vascular response may be decreased. General Anesthetics (eg, Halothane, Cyclopropane)/Cardiac Glycosides: The potential for the myocardium to be sensitized to the effects of sympathomimetic amines is increased. Arrhythmias may result with coadministration and may respond to beta blockers. Guanethidine: May negate antihypertensive effects. MAOIs: Increases pressor response from vasopressors significantly; hypertensive crisis and intracranial hemorrhage are possible. Rauwolfia Alkaloids, Methyldopa, Furazolidone: May result in hypertension. Tricyclic Antidepressants: May potentiate pressor response. Urinary Acidifiers: May increase elimination of ephedrine. Urinary Alkalinizers: May decrease elimination of ephedrine. INCOMPATIBILITIES: Ephedrine is chemically incompatible with sodium bicarbonate; avoid admixture. Lab Test Interferences Amphetamine Enzyme-Multiplied Immunoassay Test (EMIT) Assay: False-positive results may occur. Adverse Reactions CARDIOVASCULAR: Palpitation; tachycardia; precordial pain; cardiac arrhythmias; hypertension. CNS: Headache; insomnia; sweating; nervousness; vertigo; confusion; delirium; restlessness; anxiety; tension; tremor; weakness; dizziness; hallucinations. EENT: Nasal use: Local irritation; sneezing; rebound congestion. GI: Nausea; vomiting; anorexia; dry mouth. GU: Difficult and painful urination; urinary retention in men with prostatism; decreased urine formation (initial parenteral use). RESPIRATORY: Shortness of breath. OTHER: Pallor. Precautions Pregnancy: Category C. Parenteral administration of ephedrine to maintain BP during low or other spinal anesthesia for delivery can cause acceleration of fetal heart rate; do not use in obstetrics when maternal BP exceeds 130/80. Lactation: Undetermined. Asthma: Use drug with caution. Hypertension: Drug may cause severe hypertension, resulting in intracranial hemorrhage, angina, or potentially fatal arrhythmias, especially in patients with organic heart disease or those receiving drugs that sensitize myocardium. Labor: Do not use when maternal BP exceeds 130/80 mmHg; use during delivery may cause acceleration of fetal heart rate. Sulfite Sensitivity: Use nasal decongestant form of drug with caution. PATIENT CARE CONSIDERATIONS Administration/Storage For nasal spray, have patient keep head upright. Instruct patient to sniff hard for few min after administration. Protect from light. Do not give unless solution is clear. Discard any unused medication. Assessment/Interventions Obtain patient history, including drug history and any known allergies. Note any hypersensitivity to epinephrine or sulfites. Obtain baseline assessment of vital signs and monitor frequently. Determine baseline glucose for patients with diabetes mellitus. Monitor for nervousness and agitation. Monitor for nasal congestion. OVERDOSAGE: SIGNS & SYMPTOMS Convulsions, nausea, vomiting, chills, cyanosis, irritability, nervousness, fever, suicidal behavior, tachycardia, dilated pupils, blurred vision, opisthotonos, spasms, pulmonary edema, gasping respirations, coma, respiratory failure, personality changes, hypertension with anuria Patient/Family Education Caution patient to use topical decongestants only in acute states and not to use for > 3 to 5 days. Inform patient that nasal burning or stinging may occur with nasal drops or spray. Caution patient not to share nasal spray container with others. Advise patient to notify health care provider if symptoms do not improve after 7 days. With topical decongestant form of drug, instruct patient to report the following symptoms to health care provider: headache, palpitations, tremors, sweating, faintness, insomnia, weakness. With SC form of drug, advise patient to notify health care provider of syncope, palpitations, weakness, agitation, dizziness, or chest pain. Instruct patient to take sips of water frequently, suck on ice chips or sugarless hard candy, or chew gum if dry mouth occurs. Caution patient not to take otc medications without consulting health care provider.