Silly first year drug question. Help?

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    Hi everyone! I'm new here, have been lurking and reading for a while, but I have only just gathered up the courage to post! I have a question, and I'd be very much obliged if you could help me out!!

    Iíve got a list of medications I might be tested on in the upcoming exams, and under Ďnebulisedí is adrenaline. Iím not sure if itís because Iím an idiot, or if itís not there, but I canít find it in MIMs as anything other than Ďinjectioní or Ďsolution for injectioní. Under dosage/administration, it only mentions IM/SC injections and IV. Iíve found some that say that the indications for use are ďIt may also be used for the symptomatic relief of respiratory distress due to bronchospasm.Ē, which is the case that Iím assuming it would be most useful to be delivered directly to the lungs.

    Iíve found a book that says there is a 1% solution for nebuliser, but I canít find any information about this one at all. It also says the 1:1000 IV form can be diluted and used, but again canít find any more info and nothing on MIMs in regards to using it in a nebuliser. Help! Is this a silly first-year-that-canít-see-the-answer-in-front-of-their-face kinda question?
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    See if the term racemic adrenaline (or racemic epinephrine) leads you anywhere.
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    Quote from Mangomonkey56
    Hi everyone! I'm new here, have been lurking and reading for a while, but I have only just gathered up the courage to post! I have a question, and I'd be very much obliged if you could help me out!!

    I’ve got a list of medications I might be tested on in the upcoming exams, and under ‘nebulised’ is adrenaline. I’m not sure if it’s because I’m an idiot, or if it’s not there, but I can’t find it in MIMs as anything other than ‘injection’ or ‘solution for injection’. Under dosage/administration, it only mentions IM/SC injections and IV. I’ve found some that say that the indications for use are “It may also be used for the symptomatic relief of respiratory distress due to bronchospasm.”, which is the case that I’m assuming it would be most useful to be delivered directly to the lungs.

    I’ve found a book that says there is a 1% solution for nebuliser, but I can’t find any information about this one at all. It also says the 1:1000 IV form can be diluted and used, but again can’t find any more info and nothing on MIMs in regards to using it in a nebuliser. Help! Is this a silly first-year-that-can’t-see-the-answer-in-front-of-their-face kinda question?
    I do not think you will need to know about adrenaline nebulised as it is an emergency medicine.
    I have just googled this "......adrenaline nebulised dose......lots to read and gives doses of adrenaline to nebulise for Monash medical students.

    I have never heard of racemic adrenaline...I have only seen adrenaline used from ampules and mixed with saline as a nebuliser for a child in respiratory distress, when a student in ED...I'm not an emergency nurse. Never seen this on wards.

    I think this racemic adrenaline is American and therefore not in the Australian MIMs, you might also like to look up Australian Medicine handbook which I find much more useful than MIMs.

    Be aware that American meds are given different names generically and chemically. Stick to Australian medical sites with Šu'' and medical handbooks....all lab values are of different values etc etc. over there and so are some lab tests.

    Good luck in your research...any other probs ...welcome.
    Anyone lurking, works with kids or in ED....comment please...
    Last edit by ceridwyn on Oct 26, '12
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    Thanks for the replies so far I did come across the term racemic epinephrine, but assumed it was an american thing, I'm trying to be extra careful not to get confused, so I made sure to post here in the Australian section.
    This is for a practical test, so we'll get allocated a random drug and have to demonstrate the administration of it, find out the common dosage, the correct dose for the patient, as well as filling out a questionaire prior, and knowing any assessments that need to be done before/after.
    Hopefully it's just a mistake, and it won't be one they use, if it's not common (and especially not for us brand-newbies!).
    Thanks again!!
  7. 1
    We use Adrenaline 1:1000 with a bit of normal saline as a nebuliser for kids with stridor in emergency situations
    ceridwyn likes this.
  8. 1
    Sorry... I was initially going to include a disclaimer that there could be differences from country to country, but then I quickly found a study from Brisbane on nebulised racemic epinephrine. I then assumed that it was a standard drug, as it is in the US. I appreciate the clarifications.

    I don't normally browse the international forums, but sometimes I end up there accidentally via the Last 24 Hours function.
    ceridwyn likes this.
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    No problem, thanks for taking time to answer the post. Got us all racing for more information about Adrenaline or as you guys call it epinephrine.
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    In ED, we will generally give adrenaline, the 1:1000 1ml vial injectable solution, in 1-5ml doses as nebuliser for anaphylaxis, severe allergic reactions with respiratory symptoms and respiratory distress occasionally- also for stridor and airway obstructions. In most emergency departments I have worked in this is standard practise. The IV adrenaline as neb. Incidentally, I was talking with one of our senior ED physicians about the optimal dose to give and after discussion about lack of recent clinical evidence, the general consensus at the moment is "whatever works" and is entirely at physician discretion. Hope this helps.
    Last edit by NO50FRANNY on Oct 28, '12


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