List the drugs usually used in anaphylactic shock mentioning their doses & routes.
Describe
pharmacological basis of how the drugs correct the anaphylactic shock.
Drugs used in Anaphylactic Shock
A. I. Specific treatment
(a) Adrenaline injection (0.5 ml of 1:1000 solution IM)
(b) Chlopheniramine (Injection, 10 mg IV)
(c) Hydrocortisone Sodium succinate {200 – 500 mg IV stat. and 6 hrly (if required)}
II. Non specific treatment only when there is no adequate response with specific treatment
Alternatives: Dopamine IV infusion (100-300 mg in 500 ml normal saline) (Cardiac dose)
B. Supportive Treatment: Bronchodilators – if necessary (salbutamol inhalation, adrenaline SC)
Pharmacological basis of anaphylactic shock
Cause Shock is a state of inadequate capillary perfusion of vital tissues (hypoperfusion).
Anaphylactic shock is caused by any hypersensitivity (it may be drugs such as penicillin , or food
etc.) and release of histamine from the mast cell.
Therapeutic objectives
I. Specific treatment: Treatment of underlying cause
II. Non specific therapy: To modify haemodynamic (maintenance of the diastolic blood
pressure and perfusion of vital oragan)
III. Supportive treatment
I. Specific treatment
(a) Adrenaline injection (0.5 ml of 1:1000 solution IM)
- Adrenaline is direct acting sympathomimetic drug which stimulates α1, α2, β1 and β2.
- It is drug of choice in the treatment of anaphylactic shock.
- The main effect of anaphylactic shock is gross swelling of the mucous membrane which
can obstruct breathing (BC) and cardiovascular collapse due to VD of Histamine on H1 receptor.
Immediate Action: It acts as a physiological antagonist of histamine by reversing the action of
histamine acting on different receptors.
- Adrenaline raises the BP due to action on α1 receptor which causes vasoconstriction and
stimulating the heart (β1) which causes increase heart rate and FOC. β2 stimulation
causes vasodilation and reduce PR resulting in increase in tissue perfusion.
- It also dilates the bronchi due to stimulating β2 receptor on bronchial smooth muscle.
Delayed Action (anti-allergic effect): It decreases the release of histamine from mast cell
(b)Chlopheniramine (Injection, 10 mg IV)
- It is anti-histamine which competitively inhibits the actions of histamine at the H1
receptors.
- It acts as a Pharmacological antagonist of histamine.
- It may shorten duration of anaphylactic reaction. Oedema formation and itchiness are well
controlled but less effect on hypotension & bronchoconstriction.
- It do not have immediate effect because most receptors are already occupied by released
autacoids
(c) Hydrocortisone Sodium succinate {200 – 500 mg IV stat. and 6 hrly (if required)}
Hydrocortisone is glucocorticoid.
Immediate Action (Permissive action to adrenaline)
- It can increase the sensitivity of adrenergic receptors to catecholamines.
Delayed Action (anti-allergic action)
- It decreases further release of histamine from the mast cells and so prevents recurrence.
- It inhibits the phospholipase A2 and reduces formation of Prostagladins and leukotrienes.
II. Non specific treatment only when there is no adequate response with specific treatment
Alternatives: Dopamine IV infusion (100-300 mg in 500 ml normal saline) (Cardiac dose)
B. Supportive Treatment
1. Monitor vital signs: Airway, Breathing and Circulation (ABC)
2. Keep IV catheter to administer the required drugs through IV line
3. Monitor urine output
4. Management of airway
- Bronchodilators – if necessary (salbutamol inhalation, adrenaline SC injection)
- Endotracheal tube – if needed – for airway patency
- Surgical airway management if needed (due to laryngeal oedema, laryngospasm) - tracheostomy
- Ventilate with 100% O2 – if necessary
