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1. ANTI-ALLERGY DRUGS USE IN ANAPHYLAXIS Definition These are drugs used in prevention and treatment of allergic reactions and or anaphylaxis.   Anaphylaxis is rare but it is life threatening adverse reaction comprising of shock [hypotension caused by vasodilatation], bronchospasms and sometimes laryngeal oedema . Agents that may precipitate anaphylaxis in sensitized persons include; Foods like ; meat, fish, peanuts etc Drugs like; penicillins , cephalosporins , iron injections, heparin etc. Other agents like snake venom, insect stings etc.

2. Management of anaphylaxis It Involves the following; Administration of epinephrine – to restore Bp by deep IM or SC. This produces peripheral vasoconstriction and brochodilatation . It can be repeated every 10 -15minutes till normal Bp and PR are restored Ensure open air way. Give oxygen therapy prn Further treatment includes; Corticosteroids like hydrocortisone and antihistamines like chlorphenamine 6hourly for 24-48 hours prn. IV fluids prn; start with normal saline 500-1000ml in the first 1 hour If the patient has Asthma like symptoms, Aminophylline 5mg/ kgbwt by slow IV injection. The patient on recovery should be maintained on antihistamine therapy.

3. Drugs used in the treatment of allergy and anaphylaxis include; Chlorphenamine Dexamethasone Epinephrine Hydrocortisone Prednisolone

4. CHLORPHENAMINE Pharmacological class: it is a propylamine derivative and antihistamine Therapeutic class: it is antihistamine [H1 receptor antagonist] Preparations It comes in 2mg and 4mg tabs Syrup of 2mg/5ml Injection form of 10mg/ml and 100mg/ml   Pharmacokinetics It is well absorbed in the GIT after oral administration It is distributed extensively in the body. It is metabolized in the GIT mucosal cells and the liver. It is excreted in the urine. Pharmacodynamics It competes with histamine for H 1 receptor sites on the effector cells. It prevents but does not reverse histamine mediated responses It relieves allergic symptoms.

5. Indications Rhinitis Allergy symptoms Dosage Adults 4mg PO 6-8 hourly, not exceeding 24mg/day or 5-20mg in S/C or IM single dose. Children of 6-12 years; 2mg PO 6-8 hourly Children of 2-6 years; 1mg PO 6-8 hourly Contraindications Asthmatic patients Breastfeeding mothers Adverse reactions CNS stimulation Sedation, drowsiness Excitability especially in children Hypotension Palpitations Epigastric irritaion Dryness of the mouth Urinary retention

6. DEXAMETHASONE SODIUM. Pharmacological class: it is a glucocorticoid Therapeutic class: it is anti-inflammatory and immunosuppressant drug .   Preparation It comes in 0.25mg, 0.5mg, 0.75mg, 1mg, 2mg, 4 mg, 6mg tablets. Oral solutions of 0.5mg/5ml, 1mg/5ml and Skin Cream of 30g tubes Pharmacokinetics It is readily absorbed after PO administration. It distributed to muscles, liver, skin, intestines & kidneys It is metabolized in the liver, to inactive glucoronide and sulphate metabolites It is excreted in the urine

7. Pharmacodynamics Decreases inflammation mainly suppressing immune response, Stimulates bone marrow. Relieves cerebral oedema , Reverses anaphylactic shock Indications Cerebral oedema Inflammatory conditions Allergic reactions Anaphylactic shock Dosage 4-6 mg single dose. This can be repeated after 6 hours prn. Children; 0.04mg/ kgbwt 6 hourly Contraindications Patients with known hypersensitivity to the drug Systemic fungal infections

8. Adverse reactions Euphoria Insomnia Hypertension Oedema GIT irritation, peptic ulceration Increased appetite Pancreatitis Delayed wound healing   EPINEPHRINE [ADRENALINE] Preparation It comes in Aerosol inhaler 160mcg, 200mcg, 220mcg, 250mcg metered spray Nebulised inhaler 1% [1:100] Injection 0.01mg/ml [1:100,000], 0.1mg/ml [1:10,000] and 1mg/ml [1:1000]

9. Pharmacokinetics It is well absorbed after s/c or IM injection It is rapidly absorbed after inhalation administration It is widely distributed throughout the body It is metabolized at sympathetic nerve endings, in the liver and other tissues to inactive metabolites It is excreted in urine   Pharmacodynamics It stimulates the alfa and beta adrenergic receptors within the sympathetic nervous system. It relaxes the bronchial smooth muscles It causes cardiac stimulation It relieves allergic symptoms and signs It stops local bleeding e.g. Epistaxis by causing peripheral vasoconstriction.

10. Indications Bronchospasms Hypersensitivity reactions Anaphylaxis Cardiopulmonary arrest Hypotension induced by spinal anaesthesia Dosage 0.1-0.5ml of 1:1000 S/C or IM, repeat after 10-15 minutes prn. Children 0.01ml/ kgbwt of 1:1000 S/C or IM, repeated after 20minutes prn. Side effects Nervousness, tremors & vertigo Euphoria, anxiety Coldness of the extremities Headache Agitation Palpitations, Hypertension & Tachycardia Pulmonary oedema Hyperglycaemia Glycosuria

11. HYDROCORTISONE Pharmacological class: it is glucocorticoid Therapeutic class: adrenocorticoid replacement drug, antinflammatory drug   Preparation It comes in 5mg, 10mg, 20mg, tabs Injection form of 25mg/ml, 50mg/ml in 100mg vials. 250mg vials and 500mg vials Pharmacokinetics It is rapidly absorbed when given orally. It however has variable absorption with IM injection. It is distributed to muscles, liver, skin and kidneys. It is metabolized in the liver It is mostly excreted in the kidneys and some in faeces

12. Pharmacodynamics It inhibits inflammation mainly by stabilizing leukocyte lysosomal membranes. It suppresses immune response. It reduces fat and carbohydrate metabolism It raises adrenocorticoid hormone levels Indications Severe inflammation Adreno insufficiency Anaphylactic shock Allergic reactions Severe asthmatic attacks

13. Dosage Child 0.16-1mg/ kgbwt OD or BD Child < 1 yr 25mg PO or IM Child 1-5 years 50mg PO or IM Child 6-12 years 100mg PO or IM Adults 100-500mg PO or IM NB. This dose may be repeated 6 hourly up to 3-4 times prn. Adverse effects Euphoria Insomnia Hypertension Oedema GIT irritation Peptic ulceration Increased appetite Delayed wound healing Fatigue Rebound inflammation on sudden withdrawal

14. PREDNISOLONE Pharmacological class; steroid Therapeutic class –anti-inflammatory and immunosuppressant drug Preparation It comes in 1mg, 2.5mg, 5mg, 10mg, 20mg, 25mg, and 50mg tabs Oral solution of 5mg/5ml and 5mg/ml Pharmacokinetics It is absorbed readily after oral administration It is well distributed to muscles, liver intestines kidneys and the skin It is metabolized in the liver and Is excreted mainly in urine and with some in the faeces .  

15. Pharmacodynamics It reduces inflammation mainly by stabilizing leucocytes and kidneys lysozomal membranes suppressing immune response, Stimulates the bone marrow. Reduces inflammation and immune response Indications Severe inflammation Suppression of immune response Dosage 5- 60mg/day in 2-4 divided doses Children 0.14-2mg/ kgbwt /day in 2-4 divided doses . Contraindications Hypersensitivity to dexamethasone

16. Adverse reactions Most reactions are dose and duration dependent and include; Euphoria Insomnia Hypertension Oedema Cataract Glaucoma Peptic ulceration Delayed wound healing Skin eruptions   PROMETHAZINE HYDROCHLORIDE Pharmacological class –it is a phenothiazide derivative Therapeutic class – it is an anti-emetic, anti-vertigo, anti-histamine [H1 receptors antagonist], sedative.

17. Preparation It comes in 12.5mg, 25mg and 50mg tabs Syrup of 5mg/5ml, 6.25mg/5ml, 10mg/5ml and 25mg/5ml Injection form of 25mg/ml and 50mg/ml Suppositories of 12.5mg, 25mg and 50mg Pharmacokinetics It is well absorbed in the GIT after oral administration. It has fairly rapid absorption after IM administration. It is widely distributed throughout the body. It is metabolized in the liver. It is excreted in the urine and faeces

18. Pharmacodynamics It competes with histamine for H1 receptor sites It prevents, but does not reverse histamine mediated responses Prevents motion sickness Relieves nausea, nasal congestion and allergic symptoms Promotes calmness Indications Motion sickness Nausea and vomiting Rhinitis Allergy symptoms Sedation Routine pre and post operative management Dosage 25-50mg PO/IM/IV 12 hourly Children 12.5-25mg PO/IM/IV12 hourly [0.5mg/ kgbwt /dose 12 hourly

19. Adverse effects Confusion Restlessness Tremors Drowsiness Transient myopia Anorexia Urine retention Photosensitivity  

20. The end. I wonder where the world is taking us to.