respiratory emergencies, allergic reactions and anaphylaxis

Question 1

oxygen o2

Answer 1

Class: medicinal gas

MOA: enables cells to break down glucose into useable form. Carried from the lungs to the body tissues by hemoglobin in red blood cells. O2 administration increased arterial oxygen (PaO2) and hemoglobin saturation.

Pharmacokinetics: Duration: 2 minutes

Indications: cardiac ischemia, hypoxemia, cardiac arrest

AR/SE: none in emergencies; vasoconstriction;high concentration may cause decreased LOC and respiratory depression in pts with chronic carbon dioxide retention.

Contraindications: None

Dosage: 1-6 via NC, 10-15 via NRB

Special Considerations: (P class A)

Question 2

epinephrine ; adrenaline / racemic epinephrine

Answer 2

Class: adrenergic; sympathomimetic

MOA: affects both beta (1 & 2) and alpha adrenergic receptors, producing bronchodilation and vasoconstriction.

Pharmacokinetics: well absorbed; onset- SQ/IM=3-10 min,IV rapid; duration- SQ/IM 20-30

Indications: management of reversible airway disease due to asthma or COPD; used for severe allergic to anaphylactic reactions/ management of upper airway obstruction and croup (racemic epinephrine)

AR/SE: angina, arrhythmias, hypertension, tachycardia, nervousness, restlessness, tremors

Contraindications: known allergy

Dosage: anaphylaxis/asthma= 0.1-0.5mg (0.1 mg/kg for peds)1:1000 SQ,IM rep. q 10-15 min; severe anaphylaxis= 0.1mg IV q 5-15 min (1:10,000 for IV); croup= 0.25-0.5 ml of 2.25% in 3 ml of NS

Question 3

albuterol ; proventil / ventolin

Answer 3

Class: Beta 2 Adrenergic, bronchdilator

MOA: Binds to beta 2 adrenergic receptors in airway smooth muscle causing bronchdilation

Pharmacokinetics: absorbes rapidly; Onset 5-15 min; Duration 3-6 hrs

Indications: bronchoconstriction; control prevent reversible airway obstruction caused by asthma or COPD

AR/SE: paradoxical bronchospasm from excessive use of inhaler, chest pain, palpitations, agitation, N/V

Contraindications: known hypersensitivity

Dosage: 2.5mg in 3ml nebulized, may repeat as needed. 2 inhalations with MDI every 4-6 hours

Question 4

levalbuterol ; xopenex

Answer 4

Class: Beta 2 adrenergic

MOA: Binds to beta 2 adrenergic receptors in airway smooth muscle causing bronchodilation

Pharmacokinetics: onset 10-17 min; duration 5-6 hours

Indications: short-term control drug to treat bronchoconstriction due to reversible airway disease

AR/SE: paradoxical bronchospasm from excessive use of inhaler, chest pain, palpitations, agitation, N/V

Contraindications: known allergy including to albuterol

Dosage: 0.63 mg nebulized in 3 ml

Special Considerations: (P class C)

Question 5

terbutaline

Answer 5

Class: Sympathetic agonist (Beta 2 Selective)

MOA: causes bronchodilation due to its effects on Beta 2, also used to suppress preterm labor.

Pharmacokinetics: Onset 5 min; Duration; 1.5-4 hrs

Indications: bronchial asthma and reversibe bronchospasm associated with COPD

AR/SE: palpitations, anxiety, hypertension, N/V, Chest pain

Contraindications: known allergy

Dosage: 0.25 mg SC, can be repeated in 15-30 min if needed

Question 6

aminophylline

Answer 6

Class: Xanthine

MOA: relaxes bronchial smooth muscle, but not with adrenergic receptors. Also stimulates the respiratory center in the brain. Good for infants with apnea. Also has diuretic and inotropic effects.

Pharmacokinetics: Onset 51 min; Duration; Varies
Indications: bronchial asthma and reversibe bronchospasm associated with COPD, CHF, pulmonary edema

AR/SE: palpitations, anxiety, hypertension, N/V, Chest pain, tachycardia, seizures

Contraindications: known allergy , uncontrolled cardiac arrhythmias

Dosage: per protocol

Question 7

ipratropium ; atrovent

Answer 7

Class: anticholinergic; bronchodilator

MOA: blocks the muscarinic receptors of acetylcholine

Pharmacokinetics:

Indications: treatment of bronchospasm associated withasthma and COPD in patients requiring more than one bronchodilator.

AR/SE: cough, hypotension, palpitations

Contraindications: known allergy including to atropine or bromide

Dosage: 0.5mg in 2.5 ml neb

Special Considerations: Do not use with alupent.

Question 8

methylprednisolone ; solu-medrol

Answer 8

Class: corticosteroid

MOA: suppresses inflammation and the normal immune response.

Pharmacokinetics: rapid absorption; rapid onset; duration unknown

Indications: allergic reaction, asthma, COPD, anaphylaxis

AR/SE: peptic ulceration, thromboembolism, hypertension

Contraindications: known allergy, pts with active untreated infection.

Dosage: Adult:125 mg IV

Question 9

hydrocortisone ; solu-cortef

Answer 9

Class: corticosteroid

MOA: suppresses inflammation and the normal immune response.

Pharmacokinetics: rapid absorption; rapid onset; duration 1-1.5 days; HL: 90 minutes

Indications: allergic reaction, asthma, COPD, anaphylaxis

AR/SE: peptic ulceration, thromboembolism, hypertension

Contraindications: known allergy, pts with active untreated infection.

Dosage: Adult:40-250 mg IV

Question 10

dexamethasone ; decadron

Answer 10

Class: Antiasthmatic; corticosteroid

MOA: Supresses inflammation and the immune response

Pharmacokinetics: well absorbed; rapid onset; duration 2.75 days

Indications: allergic reaction, asthma, COPD, anaphylaxis

AR/SE: peptic ulceration, thromboembolism, anorexia, N/V, depression, euphoria, acne, slowed wound healing, osteoporosis

Contraindications: known allergy; pts with untreated infections

Dosage: 4-10 mg

Question 11

diphenhydramine ; benadryl

Answer 11

Class: antihistamine

MOA: antagonizes the effects of histamine at the H1 receptor site, does not bind to or inactivate histamine; has CNS and anticholinergic properties

Pharmacokinetics: well absorbed; onset: IV-rapid IM- 20-30 min; duration: 4-8 hours

Indications: relief of allergic symptoms cause by histamine

AR/SE: drowsiness, anorexia, dry mouth

Contraindications: known allergy; pts with acute asthma attacks

Dosage: Adult: 25-50 mg IV, IM Peds: 1.25 mg/kg IV, IM

Special Considerations: (P class B)