Update on the usage and safety of epinephrine auto-injectors, 2017

Posner, L.S.; Camargo, Carlos A.

doi:10.2147/dhps.s121733

Cited by 37 publications

(31 citation statements)

References 67 publications

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“…Estudo sobre adequação de prescrição demonstrou que apenas 61% dos médicos indicaram a dose correta da adrenalina 11 . A dose incorreta aumenta os riscos do tratamento 17 . A superdosagem pode causar arritmias ventriculares, crises hipertensivas, edema pulmonar e morte 18 .…”

Section: Discussionunclassified

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Conhecimento de pediatras que atuam em urgências e emergências sobre tratamento da anafilaxia

Faria

Fernandes

2018

ABCS Health Sci.

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resumo introdução: Anafilaxia é uma reação sistêmica grave, aguda e potencialmente fatal. Apresenta vários desencadeantes e mecanismos diferentes, entretanto, o tratamento agudo é igual em todos os casos. objetivo: Avaliar o conhecimento sobre tratamento da anafilaxia e choque anafilático (CA) de pediatras que atuam em setor de emergência pediátrica. métodos: Estudo transversal através da aplicação de questionário de múltiplas escolhas com 10 perguntas sobre tratamento da anafilaxia e CA. Foram convidados todos os pediatras do Pronto Socorro de um Hospital Público Pediátrico. resultados: Cinquenta entre 51 pediatras concordaram em participar do estudo. A média de acertos foi 6,32 com mediana de 7 (mínimo 2 e máximo 10). Houve reconhecimento adequado dos pediatras sobre a droga de escolha para iniciar o tratamento da anafilaxia e CA em 96% e 92%, respectivamente. Sobre a via de administração da adrenalina, a adequação das respostas foi de 64%. Em relação à dose de adrenalina, 70% identificaram corretamente, porém, o conhecimento sobre a dose máxima foi de 44%. Ao perguntar o intervalo para repetir a adrenalina, 38% responderam corretamente. Perguntou-se sobre terapias adjuvantes no tratamento do CA com 74% de acerto. Sobre a droga que previne a reação anafilática bifásica, 60% responderam corretamente. Quanto ao tempo de observação, 54% responderam o período adequado. O acerto sobre apresentações disponíveis de adrenalina autoinjetável foi de 40%. Conclusão: Houve dificuldade principalmente em reconhecer dose máxima, dose de adrenalina autoinjetável e tempo necessário para ser repetida, o que aumenta o risco de superdosagem e seus efeitos adversos.Palavras-chave: anafilaxia; epinefrina; pediatria; tratamento de emergência. AbstrACt introduction:Anaphylaxis is a severe, acute and potentially fatal systemic reaction. It presents several triggers and different mechanisms, however, the acute treatment is the same in all the cases. objective: To evaluate the knowledge about treatment of anaphylaxis and anaphylactic shock (AS) of pediatricians who works in the pediatric emergency sector. methods: Cross-sectional study through the use of a multiplechoice questionnaire with 10 questions about the treatment of anaphylaxis and AS. All the emergency room pediatricians of a general pediatric hospital were invited. results: Fifty of fifty-one pediatricians agreed to take part of the study. The mean of right answers was 6.32 and median of 7 (minimum 2 and maximum 10). There was an appropriate recognition about the drug of choice to initiate the treatment of anaphylaxis and AS in 96% and 92%, respectively. On the route of adrenaline administration, the adequacy of the answers was 64%. Regarding to adrenaline dose 70% were right, however the recognition of the maximum dose was 44%. When asked about the interval to repeat the adrenaline, 38% responded correctly. About adjuvant therapies to treat AS the score was 74% and 60% when questioned about the drug that prevents biphasic anaphylactic reaction. In relation to the observation...

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Section: Discussionunclassified

“…A superdosagem pode causar arritmias ventriculares, crises hipertensivas, edema pulmonar e morte 18 . O menor ín-dice de acerto observado neste estudo, foi o intervalo para repetir a adrenalina (5 a 10 minutos) 9,14,17 . Em um estudo realizado com 582 pacientes com anafilaxia, 45 (8%) exigiram doses múltiplas de adrenalina 19 .…”

Section: Discussionunclassified

Conhecimento de pediatras que atuam em urgências e emergências sobre tratamento da anafilaxia

Faria

Fernandes

2018

ABCS Health Sci.

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“…Epinephrine is most commonly administered via intramuscular (IM) injection via an autoinjector 4‐6 . Autoinjectors are effective in reducing anaphylactic symptoms; however, they are associated with several patient concerns and are often underused 7‐9 .…”

Section: Introductionmentioning

confidence: 99%

“…Patients and caregivers may lack confidence with autoinjectors, which can contribute to anxiety and impede autoinjector use 10‐12 . In addition, there is potential for injuries associated with accidental injections and lacerations at the injection site, as well as the administration of expired autoinjector epinephrine 5,7,9,13,14 . Furthermore, there have been product recalls due to issues associated with autoinjector malfunction and inadequate drug delivery 15 .…”

Section: Introductionmentioning

confidence: 99%

Intranasal epinephrine in dogs: Pharmacokinetic and heart rate effects

Dretchen

Mesa

Robben³

et al. 2020

Pharmacology Res & Perspec

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Epinephrine is the standard of care for the treatment of severe allergy and anaphylaxis. Epinephrine is most often administered through the intramuscular (IM) route via autoinjector. The current study aimed to evaluate an alternative method of epinephrine treatment through intranasal (IN) delivery in dogs. The pharmacokinetic (PK) parameters of maximum plasma concentration (Cmax), time to reach maximum plasma concentration (Tmax), and area under the plasma concentration‐time curve from 0 to 90 minutes (AUC0–90) were observed after IN epinephrine (2, 3, 4, 5, 10, and 20 mg) and IM epinephrine via autoinjector (0.15 and 0.3 mg) for 90 minutes. Heart rate effects were measured after IN (2 and 5 mg) and IM (0.15 and 0.3 mg) epinephrine administration. IN epinephrine (5 mg) demonstrated significantly greater plasma epinephrine concentration at 1 minute as compared with IM epinephrine (0.3 mg) (1.68 ± 0.65 ng/mL vs 0.21 ± 0.08 ng/mL, P = .03). There were no significant differences in Cmax, Tmax, and AUC0–90 between 2‐mg IN and 0.15‐mg IM epinephrine or between 5‐mg IN and 0.3‐mg IM epinephrine. IN epinephrine reduced heart rate increases, as compared to IM epinephrine. IN and IM epinephrine were both well‐tolerated. Overall, IN epinephrine demonstrated advantages over IM epinephrine, including the rapid increase in plasma epinephrine and lack of increased heart rate over time.

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“…Despite the effectiveness of epinephrine delivery via autoinjector, issues or concerns associated with autoinjector use exist [8,9]. Use of an autoinjector is often avoided or delayed because of user anxiety surrounding stigma or fear of selfharm, especially in children and adolescents [8][9][10]. In children, there is an increased risk of intraosseous administration and muscle laceration with autoinjector use [8,11].…”

Section: Introductionmentioning

confidence: 99%

Intranasal epinephrine effects on epinephrine pharmacokinetics and heart rate in a nasal congestion canine model

et al. 2020

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Background: Histamine release and vasodilation during an allergic reaction can alter the pharmacokinetics of drugs administered via the intranasal (IN) route. The current study evaluated the effects of histamine-induced nasal congestion on epinephrine pharmacokinetics and heart rate changes after IN epinephrine. Methods: Dogs received 5% histamine or saline IN followed by 4 mg epinephrine IN. Nasal restriction pressure, epinephrine concentration, and heart rate were assessed. Maximum concentration (C max), area under plasma concentration-time curve from 1 to 90 min (AUC 1-90), and time to reach C max (T max) were measured. Clinical observations were documented. Results: In the 12 dogs in this study, nasal congestion occurred at 5-10 min after IN histamine administration versus no nasal congestion after IN saline. After administration of IN epinephrine, IN histamine-mediated nasal congestion was significantly reduced to baseline levels at 60, 80, and 100 min. There were no significant differences in C max and AUC 1-90 between histamine and saline groups after IN epinephrine delivery (3.5 vs 1.7 ng/mL, p = 0.06, and 117 vs 59 ng/ mL*minutes, p = 0.09, respectively). After receiving IN epinephrine, the histamine group had a significantly lower T max versus the saline group (6 vs 70 min, respectively; p = 0.02). Following IN epinephrine administration, the histamine group showed rapidly increased heart rate at 5 min, while there was a delayed increase in heart rate (occurring 30-60 min after administration) in the saline group. Clinical observations included salivation and emesis. Conclusion: IN histamine led to more rapid epinephrine absorption and immediately increased heart rate compared with IN saline. IN epinephrine decreased histamine-induced nasal congestion.

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Update on the usage and safety of epinephrine auto-injectors, 2017

Cited by 37 publications

References 67 publications

Conhecimento de pediatras que atuam em urgências e emergências sobre tratamento da anafilaxia

Conhecimento de pediatras que atuam em urgências e emergências sobre tratamento da anafilaxia

Intranasal epinephrine in dogs: Pharmacokinetic and heart rate effects

Intranasal epinephrine effects on epinephrine pharmacokinetics and heart rate in a nasal congestion canine model

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