Miscellaneous

  • Dexamethasone
  • Dextrose
  • Furosemide
  • Insulin (Regular)
  • Tranexamic Acid

Dexamethasone

  • 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
Video Credit: Concept Clear

*Deep Dive: Let’s Talk About Dex (EP Monthly)



Dextrose

  • 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)
Video Credit: Handtevy

*Deep Dive: D50 vs D10 for Severe Hypoglycemia in the Emergency Department (ALiEM)



Furosemide

  • 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.
Video Credit: Ninja Nerd

*Deep Dive: Myths in Emergency Medicine: Rethinking Furosemide in Acute Pulmonary Edema (Emergency Medicine News)



Insulin (Regular)

  • 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.
Video Credit: NURSINGcom

*Deep Dive: Pharmacology of Insulins (CORE EM)



Tranexamic Acid

  • 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
Video Credit: Medicosis

*Deep Dive: The Evidence for TXA – Should Tranexamic Acid Be Routine Therapy in the Bleeding Patient (EM Cases)


Brandon Simpson, PA-C
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