MEDICATIONS - Medicine for Mountaineering and Other Wilderness Activities - page 527

The tablets should be kept in their original brown bottle and should not be kept longer
than six months after purchase as they begin to lose their potency. Cotton wads should not
be kept in the bottle, which must be kept tightly stoppered.
Epinephrine
Epinephrine(adrenaline)isahormonesecretedbythemedullaoftheadrenalgland.Itis
used to treat spasm of the bronchi due to anaphylactic shock or severe asthma or to relieve
the spasm and respiratory obstruction of laryngeal edema. Epinephrine is effective when
injected or when applied directly to the involved tissues. It is destroyed by the acid and di-
gestive enzymes in the stomach and is ineffective when administered orally.
Precautions: Epinephrine must be administered slowly and carefully to elderly indi-
viduals or to persons with heart disease of any kind, high blood pressure, thyroid disease,
or diabetes. It also should not be given to persons in shock from blood loss. Epinephrine is
a powerful cardiac stimulant; its effect on individuals with these disorders could be lethal.
The epinephrine preparation must be discarded without being used if it is outdated, has
turned brown, or contains a precipitate.
DECONGESTANTS
Decongestant Sprays
These agents cause the blood vessels in the nasal mucosa to contract, reducing their
volume but also reducing the amount of fluid collected in the tissue (edema) around the
vessels. Decongestants shrink the swollen mucosa of the nose for persons with colds, hay
fever,orsinusitis.Importantly,thesedrugsnotonlyrelieveobstructiontothepassageofair
but also promote drainage from the small canals opening into the sinuses.
Phenylephrine hydrochloride, a widely used decongestant and well known as Neo-
Synephrine®, has been found to increase the incidence of cerebrovascular accidents
(strokes). It has been replaced in most decongestants, including Neo-Synephrine®.
Oxymetazoline, a decongestant that is equally effective, is much longer acting and lasts
uptotwelvehoursafterasingleapplication.(Becausetheonsetofitsactionisslower,some
individualshavegainedtheimpressionthatoxymetazolineisnotaseffectiveasphenyleph-
rine.) A 0.05 percent solution is contained in a number of preparations such as Afrin® and
Dristan® long-acting nasal sprays, but many drugstore and grocery chains sell identical
preparations under their own label at a price 40 to 50 percent below that of the established
brands.
Precautions: Individuals with severe hypertension should not use nasal sprays.
Administration of the nasal spray should be repeated ten minutes after the first applica-
tion. Initially the spray only reaches the mucosa over the more prominent structures in the
nasal cavity. Not until this portion of the mucosa has been shrunken can a subsequent ap-
plication extend into the recesses where the small canals draining the sinuses open.