Hospital Management

Medical antishock trousers (MAST)

Continued therapy with above agents and management of complications

Table 20-7 Drugs that Can Worsen or Complicate Therapy in Anaphylaxis

Drug Class

Effect

Beta blockers

Can worsen hypotension or wheeze and simultaneously decrease the ^-adrenergic response to epinephrine as well as accentuate its a-adrenergic response.

ACE inhibitors

ACE metabolizes kinins that are activated during anaphylactic events; therefore an ACE inhibitor can worsen episodes.

ACE blockers

Although there is no clear-cut admonition regarding ACE blockers, theoretically they can have an effect similar to an ACE inhibitor.

Monoamine oxidase inhibitors

Interfere with catabolism of epinephrine and thus complicate calculation of correct dose of these drug inhibitors.

Tricyclic antidepressants

Prevent catecholamine reuptake and therefore can accentuate effect of a dose of epinephrine, thus complicating calculation of a proper dose.

ACE, Angiotensin-converting enzyme.

Box 20-9 Dosing Recommendations for Intramuscular Epinephrine in Anaphylaxis

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