Before administering ephedrine, Nurse Tony assesses the patient’s history. Because of ephedrine’s central nervous system (CNS) effects, it is not recommended for:
A. Patients with an acute asthma attack.
B. Patients with narcolepsy.
C. Patients under age
D. Elderly patients.
Correct Answer: D. Elderly patients
Ephedrine is not recommended for elderly patients, who are particularly susceptible to CNS reactions (such as confusion and anxiety) and to cardiovascular reactions (such as increased systolic blood pressure, coldness in the extremities, and anginal pain). Ephedrine is also arrhythmogenic, and caution should be used during administration to patients who are predisposed to arrhythmias or taking other arrhythmogenic medications, particularly digitalis.
Option A: Ephedrine is used for its bronchodilator effects with acute and chronic asthma. Oral formulations of ephedrine have been used historically to treat asthma via pulmonary vasoconstriction and reduction in airway edema along with beta-induced bronchodilation, but it is rarely used for this purpose in modern medicine due to unwanted cardiac effects and availability of more selective beta-agonists such as albuterol.
Option B: Ephedrine is used occasionally for its CNS stimulant actions for narcolepsy. Ephedrine acts as both a direct and indirect sympathomimetic. It binds directly to both alpha and beta receptors; however, its primary mode of action is achieved indirectly, by inhibiting neuronal norepinephrine reuptake and by displacing more norepinephrine from storage vesicles. This action allows norepinephrine to be present in the synapse longer to bind postsynaptic alpha and beta receptors.
Option C: It can be administered to children age 2 and older. The FDA has not formally established safety and effectiveness in pediatric populations. Additionally, ephedrine is distributed by the manufacturer in 50mg/mL vials and requires dilution before intravenous use.
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