Pharmacology - Emergency Medications

Phenylephrine (Neo-Synephrine)

  • Mechanism
    • α1 agonist
  • Indication
    • Hypotension
  • Dosing
    • 50-100 mcg
  • Considerations
    • Monitor for reflex bradycardia
    • Efficacy reduced in dehydrated patients
    • Provides coronary vasodilation

Ephedrine

  • Mechanism
    • Catecholamine release (α1 & β1 activation)
  • Indication
    • Hypotension
  • Dosing
    • 5-10 mg
  • Considerations
    • Slower peak onset relative to phenylephrine

Hydralazine

  • Mechanism
    • α1 antagonist
  • Indication
    • Hypertension
  • Dosing
    • 10-20 mg
  • Considerations
    • Monitor for reflex tachycardia

Labetalol

  • Mechanism
    • β1 & β2 > α1 inhibition
  • Indication
    • Hypertension
  • Dosing
    • 5-10 mg
  • Considerations
    • Infrequently required as high BP often resolves with improved analgesia or anesthetic depth
    • Minimal HR or CO change

Atropine

  • Mechanism
    • Anticholinergic
  • Indication
    • Bradycardia
  • Dosing
    • 20 mcg/kg or 0.3-1 mg

Ventolin

  • Mechanism
    • β2 agonist
  • Indication
    • Bronchospasm
  • Dosing
    • 2-4 puffs
  • Considerations
    • Tachycardia side effect

Succinylcholine (Anectine)

  • Mechanism
    • Overactivation of nicotinic (R)
  • Indication
    • Laryngospasm
  • Dosing
    • 0.1-0.5 mg/kg
  • Considerations
    • Most commonly used in paediatric patients
    • Should first attempt 1-2mg/kg propofol

Epinephrine (Adrenalin)

  • Mechanism
    • Agonist of all adrenergic receptors
  • Indication
    • Anaphylaxis
      • Dosing: 0.3-0.6 mg IM
    • Cardiac Arrest
      • Dosing: 1 mg q 3-5 min

Naloxone

  • Mechanism
    • Opioid antagonist
  • Indication
    • Opioid overdose
  • Dosing
    • 0.04 mg IV q3-5 min
  • Considerations
    • Given short acting, beware of rebound hemodynamic, respiratory, and CNS depression

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