- Insulin (Regular)
- Tranexamic Acid
- Mechanism of Action: Corticosteroid; decreases production of inflammatory mediators, reverses capillary permeability, and suppresses normal immune response.
- Indications: Allergic reactions, asthma, and autoimmune conditions. May also be used to treat acute COVID-19 infections.
- Contraindications: allergy to drug or class
- Dosage: Usually 4 – 20mg in single or divided doses; depending on disease.
- Half-life: 4 hours for oral, 1-5 hours for IV
- Adverse Reactions: nausea, dizziness,
- Special Considerations: Use may have small increase in risk for sepsis, fractures, and venous thromboembolism
*Deep Dive: Let’s Talk About Dex (EP Monthly)
- Mechanism of Action: Simple carbohydrate that increases serum blood glucose concentrations
- Indications: Hypoglycemia. When used with insulin, can treat hyperkalemia by allowing for uptake of potassium into cells
- Contraindications: Intracranial/intraspinal hemorrhage, delirium tremens (if patient is already dehydrated)
- Dosage: 25 grams in several different formulations; D50 comes in 50mL sterile water amp, D10 comes in 250mL sterile water bag, D5W comes in 500mL sterile water bag)
- Onset: Less than 10 minutes
- Duration: Variable
- Adverse Reactions: Tissue necroses, hyperglycemia, cerebral ischemia/hemorrhage
- Special Considerations: Can only be given via IV route (due to tissue necrosis)
- Mechanism of Action: Loop diuretic; inhibits sodium and chloride reabsorption in the loop of henle and proximal/distal convoluted tubule. Promotes excretion of sodium, water, chloride, and potassium.
- Indications: Fluid overload, hypertension, hypercalcemia
- Contraindications: Allergy to class/drug, anuria
- Dosage: Usual dosage in ED is 20-40mg IV; titrate to effect.
- Onset: 5 min (IV); 20-30 min (PO)
- Duration: 2 hours (IV); 6-8 hours (PO)
- Adverse Reactions: Hypokalemia, hypovolemia, urinary frequency, dizziness, weakness
- Special Considerations:
- Furosemide (Lasix) inhibits sodium and chloride absorption in the kidneys and serves as a diuretic. It is used for edema from congestive heart failure, cirrhosis, or renal disease as well as for fluid on the lungs.
- Mechanism of Action: Hormone/Anti-diabetic agent; increases peripheral glucose uptake, increases inotropy, and shifts potassium intracellularly
- Indications: DKA/HHS, hyperkalemia, calcium-channel blocker overdose
- Contraindications: None
- Dosage: Hyperkalemia (5-10 units IV x 1); DKA/HHS (0.1 unit/kg bolus followed by 0.1 unit/kg/hour infusion)
- Onset: 30-60 minutes
- Duration: 3-6 hours
- Adverse Reactions: Hypoglycemia, hypersensitivity reactions
- Special Considerations: For hyperkalemia, insulin should be used in conjunction with dextrose.
*Deep Dive: Pharmacology of Insulins (CORE EM)
- Mechanism of Action: Antifibrinolytic agent; competitively inhibits the activation of plasminogen to plasmin, thus preventing clot breakdown during blood loss.
- Indications: Massive hemorrhage, postpartum bleeding, epistaxis,
- Contraindications: Greater than 3 hours from injury, previous DVT/PE, allergy to drug
- Dosage: 1 gram IV over 10 minutes (Initial bolus); followed by 1 gram IV over 8 hours.
- Onset: 5-15 min
- Duration: 3 hours
- Adverse Reactions: Thrombotic events, hypotension, nausea/vomiting
- Special Considerations: None
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