Medications for Allergic Reactions

Question 1

diphenhydramine hydrochloride (Benadryl)

Answer 1

An ANTIHISTAMINE that binds and blocks H1 histamine receptors, treating histamine-mediated symptoms of an allergic reaction.

Question 2

diphenhydramine hydrochloride (Benadryl) Indications

Answer 2

Allergic reactions.
Dystonic medication reactions or akathisia (agitation or restlessness).

Question 3

diphenhydramine hydrochloride (Benadryl) Adverse Effects

Answer 3

Drowsiness
Dizziness
Headache
Excitable State
Dry Mouth
Flushing

Question 4

diphenhydramine hydrocholoride (Benadryl) Precautions

Answer 4

Acute asthma or COPD due to thickened secretions
Narrow-angle glaucoma.

Question 5

diphenhydramine hydrochloride (Benadryl) Dosage and Administration

Answer 5

Adult: 50 mg IV/IM

Pediatric: 1 mg/kg slow IV/IM not to exceed 50 mg.

Question 6

diphenhydramine hydrochloride (Benadryl) Special Considerations

Answer 6

CNS depressants and alcohol may have additive effects.
Anticholinergic and antiparkinsonian effects are used for treating dystonic reactions caused by antipsychotic and antiemetic medications (haloperidol, droperidol, reglan, compazine, etc.)
MAO inhibitors may prolong and intensify the anticholinergic effects of antihistamines.

Pregnancy class B.

Question 7

epinephrine (Adrenalin)

Answer 7

An INOTROPIC ADRENERGIC endogenous catecholamine alpha and beta adrenergic receptor agonist.

Question 8

epinephrine (Adrenalin) Indications

Answer 8

Pulseless Arrest
Anaphylaxis
Asthma
Bradycardia with poor perfusion

Question 9

epinephrine (Adrenalin) Adverse Reactions

Answer 9

Tachycardia and tachydysrhythmia
Hypertension
Anxiety
Angina Pectoris

Question 10

epinephrine (Adrenalin) Dosage and Administration

Answer 10

Adult: 0.3 (0.3 mL of 1:1000) IM. May repeat one time.

Pediatric: 0.01 mg/kg (0.01 mL/kg of 1:1000) IM. May repeat dose one time after 5 minutes.

Question 11

epinephrine (Adrenalin) Vasopressor Infusion

Answer 11

Indications: Severe allergic reaction/Anaphylaxis.
Hypotension with poor perfusion refractory to adequate fluid resuscitation
Bradycardia with signs or poor perfusion.

Dosage and Administration: Inject 1 mg epinephrine into a 1000 mL normal saline bag to achieve 1 mcg/mL concentration.
(1 mL 1:1000 or 10 mL of 1:10,000 - either way, 1 mg of drug).

Titrate to desired hemodynamic effect with the goal blood pressure of greater than 90 systolic, improved respiratory status (bronchodilation), and improved perfusion/mentation.

Pregnancy Class C.

Question 12

epinephrine (Adrenalin) Pediatric Severe Systemic Allergic Reaction refractory to IM epi

Answer 12

Dosage: 0.01 mg/kg (1 mL/kg of 1:100,000) IV.

1:100,000 = 1:10,000 - 9 mL + 9 mL normal saline.

Question 13

methylprednisolone (Solu-Medrol)

Answer 13

A synthetic CORTICOSTEROID that suppresses acute and chronic inflammation and may alter the immune response. It potentiates vascular smooth muscle relaxation by beta-adrenergic agonists and may alter airway hyperactivity.

Question 14

methylprednisolone (Solu-Medrol) Indications

Answer 14

Anaphylaxis
Severe Asthma
COPD
Suspected Addisonian Crisis (Cardiovascular collapse in patient at risk for adrenal insufficiency).

Question 15

methylprednisolone (Solu-Medrol) Adverse Reactions

Answer 15

Gastrointestinal bleeding
Hypertension
Hyperglycemia
usually as a result of long-term therapy

Question 16

methylprednisolone (Solu-Medrol) Dosage and Administration

Answer 16

Adult: 125 mg slow IV bolus over 2 minutes.

Pediatric: 2 mg/kg slow IV over 2 minutes. Max dose 125 mg.

Question 17

methylprednisolone (Solu-Medrol) Special Considerations

Answer 17

Must be reconstituted and used immediately.
The effect is usually delayed for several hours.
Is not considered a first-line drug. Always attend to the patient’s primary treatment needs first.
Do not delay transport to administer this drug.

Question 18

albuterol sulfate (Proventil)

Answer 18

A BETA AGONIST BRONCHODILATOR that binds and stimulates beta 2 receptors, resulting in relaxation of bronchial smooth muscle.

Question 19

albuterol sulfate (Proventil) Indications

Answer 19

Asthma, bronchitis with bronchospasm, and COPD.
Known or suspected hyperkalemia with EKG changes (peaked T waves or QRS widening).

Question 20

albuterol sulfate (Proventil) Contraindications

Answer 20

Sensitivity to albuterol or levalbuterol.
Severe tachycardia is a relative contraindication.

Question 21

albuterol sulfate (Proventil) Adverse Effects

Answer 21

Tachycardia
Palpitations
Dysrhythmias

Question 22

albuterol sulfate (Proventil) Drug Interactions

Answer 22

Sympathomimetics may exacerbate adverse cardiovascular effects. Beta-blockers may antagonize albuterol.

Question 23

albuterol sulfate (Proventil) Dosage and Administration

Answer 23

Adult: 2.5 mg/3 mL at 6-8 liters per minute over 5 to 15 minutes. May be repeated one time.
Continuous Neb: 7.5 mg/9 mL (3 premixed bullets) at 6-8 liters per minute.

Question 24

albuterol sulfate (Proventil) Special Considerations

Answer 24

Use with caution in lactating patients, those with cardiac dysrhythmias, suspected or known coronary disease, diabetes, hyperthyroidism, prostatic hypertrophy, or seizure disorder.
Angina Pectoris.
Wheezing associated with anaphylaxis should first be treated with epinephrine IM.
Consider inline nebs for patients requiring endotracheal intubation or CPAP.

Pregnancy Class C.