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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