Epinephrine and norepinephrine (NE) are adrenergics (also referred to as catecholamines) that stimulate the beta- and alpha-receptors on the target cell. Dopamine has dose-dependent effects on targeted arteries in the kidneys, heart, and brain.

Mechanism of Action: Epinephrine acts on both alpha- and beta-adrenergic receptors and is used in several routes, including intravenously (IV), subcutaneously, intramuscularly, and via inhalation. Epinephrine decreases vasodilation and increases vascular permeability through its alpha-adrenergic receptor action, which can lead to loss of intravascular fluid volume and hypotension. Through its action on beta-adrenergic receptors, epinephrine causes bronchial smooth muscle relaxation and helps alleviate bronchospasm, wheezing, and dyspnea that may occur during anaphylaxis.

Indications: Epinephrine is used for severe allergic reactions, acute bronchospasm during asthma attacks, cardiac resuscitation, hypotension in severe shock, or for local injection to control superficial bleeding.

Nursing Considerations: Epinephrine is contraindicated for use in fingers, toes, ears, nose, or genitalia when used with local anesthetic due to the vasoconstrictive action. Contraindicated in patients with narrow angle glaucoma. Administer with caution to the elderly and those with preexisting cardiovascular disease. When administering IV, monitor vitals (blood pressure, heart rate and respiratory rate) and cardiovascular and respiratory systems closely; if blood pressure increases sharply, give rapid-acting vasodilators. Monitor IV site for extravasation. Discard IV solution if discolored.

Side Effects/Adverse Effects: Common side effects include hypertension and tachycardia.

Patient Teaching & Education: Epinephrine formulated in a pen for injection is known as an EpiPen. An EpiPen is used for severe allergic reactions after exposure to an allergen like a bee sting. Check expiration date, store at room temperature, and protect from light. Effects fade after 15-20 minutes, so seek medical care immediately.^[1]

Norepinephrine is another catecholamine and is used as a peripheral vasoconstrictor (due to alpha-adrenergic action) and as an inotropic stimulator of the heart and dilator of coronary arteries (due to beta-adrenergic action) in patients with critically low blood pressure.

Now let’s take a closer look at the medication grid on epinephrine and norepinephrine in Table 4.15a.^[2]

Table 4.15a Epinephrine and Norepinephrine Medication Grid

Dopamine is another type of catecholamine specifically used to improve perfusion of organs, improve cardiac output, and increase blood pressure.

Mechanism of Action: In low doses, dopamine mainly stimulates dopamine receptors and dilates the renal vasculature. Moderate doses of dopamine stimulate beta-receptors for a positive inotropic effect. Higher doses also stimulate alpha-receptors, constricting blood vessels and increasing blood pressure.

Indications: Dopamine is used to treat shock, improve perfusion to vital organs, increase cardiac output, and correct hypotension.

Nursing Considerations: During infusion, frequently monitor blood pressure, cardiac output, urine output, and color and temperature of limbs. If urine flow decreases without hypotension, notify provider because dosage may need to be reduced. Concurrent alpha- or beta-blockers can antagonize dopamine.

Side Effects/Adverse Effects: Common side effects include hypotension, tachycardia, palpitations, and dyspnea. Other adverse effects include decreased blood flow to the extremities and decreased urine output.

Patient Teaching & Education: Patients should contact their health care provider immediately if experiencing unusual sweating, dizziness, heart palpitations, or chest pain.

Now let’s take a closer look at the medication grid on dopamine in Table 4.15b.^[3]

Table 4.15b Dopamine Medication Grid