- Author: Elliot Stieglitz, MD; Chief Editor: Emmanuel C Besa, MD more...
The goals of pharmacotherapy are to reduce morbidity and prevent complications.
These agents are used for the treatment of thromboembolic disorders.
Heparin augments activity of antithrombin III and prevents conversion of fibrinogen to fibrin. It does not actively lyse but is able to inhibit further thrombogenesis. It prevents reaccumulation of clot after spontaneous fibrinolysis.
These agents act by competitive inhibition of histamine at the H1 receptor. This mediates the wheal and flare reactions, bronchial constriction, mucous secretion, smooth muscle contraction, edema, hypotension, CNS depression, and cardiac arrhythmias.
This is a first-generation antihistamine with anticholinergic effects that binds to H1 receptors in the CNS and the body. It competitively blocks histamine from binding to H1 receptors. It is used for symptomatic relief of symptoms caused by release of histamine in allergic reactions and may be used in patients that experience transfusion related reactions, in particular with FFP.
Corticosteroids have anti-inflammatory properties and cause profound and varied metabolic effects. In addition, these agents modify the body's immune response to diverse stimuli.
Hydrocortisone decreases inflammation by suppressing the migration of polymorphonuclear leukocytes (PMNs) and reversing increased capillary permeability.
Beta1/Beta2 Adrenergic Agonists
Adrenergic agonists cause vasoconstriction, reduce vascular permeability, and bronchodilation. They are vitally important in treating acute angioedema associated with allergic reactions affecting upper airways. Their benefit in other types of laryngeal edema (eg, acute hereditary angioedema [HAE]) is less certain.
Epinephrine is used in cases of laryngeal edema. It has alpha-agonist effects that include increased peripheral vascular resistance and reduced vascular permeability.
Pain control is essential to quality patient care. Analgesics ensure patient comfort, promote pulmonary toilet, and have sedating properties.
Acetaminophen reduces fever by acting directly on hypothalamic heat-regulating centers, thereby bringing about increased dissipation of body heat with vasodilation and sweating.
Calcium and vitamin D are essential to increase bone density. Vitamin D repletion is essential for calcium absorption. Calcium supplements are used to increase calcium levels. Adequate calcium intake is essential to attain peak bone mass and for continued maintenance of bone health.
Calcium is the primary component of skeletal tissue, providing structural integrity and support for individual growth. Bone undergoes constant remodeling and turnover. Combination of supplemental calcium and vitamin D can potentially lower the incidence of fractures. Calcium citrate is absorbed equally well when taken with or without food.
Calcium intake is essential in the prevention and treatment of osteoporosis. Calcium carbonate is generally more inexpensive and requires fewer tablets. Because of its dependence on stomach acid for absorption, calcium carbonate is absorbed most efficiently when taken with food.
Calcium chloride moderates nerve and muscle performance by regulating the action potential excitation threshold. This form of calcium is preferred for patients in cardiac arrest and in other serious cases.. The 10% IV solution provides 100 mg/mL of calcium chloride equaling 27.2 mg/mL (1.4 mEq/mL) of elemental calcium (ie, 10 mL of calcium chloride 10% solution contains 272 mg of elemental calcium).
Serum potassium levels can fall during therapy. Therefore, potassium supplements may be indicated.
Essential for transmission of nerve impulses, contraction of cardiac muscle, maintenance of intracellular tonicity, skeletal and smooth muscles, and maintenance of normal renal function.
Blood and Blood Products
Correction of acute anemia often requires blood and/or blood products. With significant ongoing hemorrhage or hemolysis, transfusion of blood alone is insufficient. Nonetheless, providing timely transfusion to restore hemoglobin to safe levels can prevent major complications of acute anemia.
Packed red blood cells
Packed red blood cells (PRBCs) are used preferentially to whole blood, since they limit volume, immune, and storage complications. PRBCs have 80% less plasma, are less immunogenic, and can be stored about 40 days (versus 35 d for whole blood). PRBCs are obtained after centrifugation of whole blood. Leukocyte-poor PRBCs are used in patients who are transplant candidates/recipients and in those with prior febrile transfusion reactions. Washed or frozen PRBCs are used in individuals with hypersensitivity transfusion reactions.
Fresh frozen plasma (FFP) contains coagulation factors, as well as protein C and protein S. Its uses include the treatment of coagulopathies and TTP and the reversal of Coumadin. FFP does not transmit infections.
Albumin is used for treatment of certain types of shock or impending shock. It is useful for plasma volume expansion and maintenance of cardiac output. A solution of NS and 5% albumin is available for volume resuscitation.
Isotonic sodium chloride (normal saline [NS]) is a standard crystalloid intravenous (IV) fluid used for initial volume resuscitation. It expands the intravascular and interstitial fluid spaces. Typically, about 30% of administered isotonic fluid stays intravascular; therefore, large quantities may be required to maintain adequate circulating volume.
Normal saline (NS, 0.9% NaCl)
NS restores interstitial and intravascular volume. It is used in initial volume resuscitation.
Magnesium can be administered either orally in an oxide or gluconate form or parenterally as a sulfate salt.
This agent is used for the treatment of magnesium deficiencies or magnesium depletion from malnutrition, restricted diet, alcoholism, or magnesium-depleting drugs.
Five hundred milligrams of magnesium gluconate contain 27 mg of elemental magnesium.
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