:warning: DRUG THERAPY :warning:
First-Line Drug (Sympathomimetics)
-Epinephrine (Adrenalin): rapidly stimulates alpha- and beta-adrenergic receptors of autonomic nervous system (alpha: vasoconstricts; beta: bronchodilates)
SE: tachycardia, palpitations, nervousness, muscle twitching, sweating, anxiety, insomnia, hypertension, headache, hyperglycemia
-Isoproterenol (Isuprel): stimulates beta-adrenergic receptors, relaxing bronchial smooth muscles and dilating vessels
SE: same as epinephrine
-Ephedrine sulfate (Vatronol): similar to Isoproterenol but with longer duration of action
SE: same as epinephrine
Second-Line Drug (Antihistamines)
-Diphenhydramine HCL (Allerdryl; Benadryl): competes with histamine for H1 receptors on effector cells, thus blocking effects of histamine on bronchioles, gastrointestinal tract, and blood vessels
SE: drowsiness, confusion, insomnia, headache, vertigo, photo-sensitivity, diplopia, nausea, vomiting, dry mouth
Second-Line Drugs (Corticosteroids)
-Hydrocortisone sodium succinate (Solu-Cortef) (IV/IM)
-Dexamethasone (Decadron) (IV/IM)
-Methylprednisolone sodium succinate (Solu-Medrol) (IV/IM)
-Prednisone (PO)
Mechanism of Action
Anti-inflammatory; inhibits mast cell degranulation
SE: fluid and sodium retention, HTN, cushingoid state, gastric distress, adrenal suppression, psychois, osteoporosis, susceptibility to infection
Vasopressors (Support Drugs)
-Norepinephrine (Levophed): raises BP and CO in severly decompensated states
SE: headache, tachycardia, fibrillation, dec. urine output, HTN, metabolic acidosis
-Dopamine (Intropin): raises BP and CO in severly decompensated states
SE: dysrhythmias, tachycardia, HTN, dyspnea, N and V, azotemia, headache
:red_flag:WARNING :red_flag:
-Be prepared to administer epinephrine IV or IM
-Epinephrine 1:1000 concentration, 0.3 to 0.5 mL IV push and repeat as needed q5mins until patient responds
-Give oxygen using a high-flow, non-rebreather mask at 90% to 100%
-Elevate the bed to 45 degrees unless severe hypotension is also present
-If bronchospasms occur, give an inhaled beta-adrenergic agonist such as metaproterenol (Alupent) or albuterol (Proventil) via high-flow NEB q2-4h.
