Hymenoptera Stings Medication
- Author: Hemant H Vankawala, MD; Chief Editor: Scott H Plantz, MD, FAAEM more...
Medications used to treat Hymenoptera stings include antihistamines (H1, H2), steroids, alpha- and beta-receptor agonists, and bronchodilators.
These drugs directly block effects of some venom and effects of endogenously released histamine.
Diphenhydramine is the drug of choice for all stings. It is an H1 and partial H2 receptor blocker used for symptomatic relief of allergic symptoms caused by histamine released in response to allergens.
Cimetidine is indicated for systemic reactions that do not respond completely to diphenhydramine, or when severity indicates a need for maximal treatment.
Epinephrine causes vasoconstriction, bronchodilation, and increased cardiac output. The effects of albuterol and theophylline are more focused on bronchodilation.
Epinephrine is the drug of choice for systemic reactions. It has alpha-agonist effects that increase peripheral vascular resistance and reverse peripheral vasodilation, systemic hypotension, and vascular permeability. Conversely, the beta-agonist activity of epinephrine produces bronchodilation, chronotropic cardiac activity, and positive inotropic effects. Epinephrine may be self-administered through auto-injectors.
Albuterol is an adjunctive treatment for bronchospasm given by nebulization, and it is a beta-agonist useful to treat bronchospasm refractory to epinephrine. It relaxes bronchial smooth muscle by action on beta2-receptors and has little effect on cardiac muscle contractility.
Theophylline is used to relieve bronchospasm in resistant cases. It acts to decrease muscle tone in both small and large airways in the lungs, thus increasing ventilation. Efficacy in managing bronchodilation may be due to its potentiation of exogenous catecholamines, stimulation of endogenous catecholamine release, and diaphragmatic muscular relaxation. Its effects as a bronchodilator usually are seen at levels considered to be toxic (>20 mg/dL).
These drugs act to stabilize lymphocytes and to reduce release of endogenous vasoactive compounds.
Methylprednisolone is indicated in all cases of generalized reaction unless contraindications exist. It is useful to treat inflammatory and allergic reactions. It may decrease inflammation by reversing increased capillary permeability and suppressing PMN activity.
Glucagon acts in the adipose tissue and liver to quickly stimulate gluconeogenesis, and thereby elevate blood glucose levels.
Glucagon is the drug of choice for severe anaphylaxis in patients taking beta-blockers (should be used in addition to epinephrine, not as a substitute).
Pancreatic alpha cells of the islets of Langerhans produce glucagon, a polypeptide hormone. It exerts the opposite effects of insulin on blood glucose. Glucagon elevates blood glucose levels by inhibiting glycogen synthesis and enhancing the formation of glucose from noncarbohydrate sources, such as proteins and fats (gluconeogenesis). It increases hydrolysis of glycogen to glucose (glycogenolysis) in the liver in addition to accelerating hepatic glycogenolysis and lipolysis in adipose tissue. Glucagon also increases the force of contractions in the heart and has a relaxant effect on the GI tract.
Dose used for anaphylaxis is higher than usual dose of 1 mg (1 U) IV/IM/SC used to treat hypoglycemia.
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