Emergency Pharmacology: Corticosteroids and Magnesium Sulfate

Vocabulary practice flashcards covering the indications, mechanisms, dosages, contraindications, and clinical considerations for Decadron, Solu-Medrol, and Magnesium Sulfate based on the lecture.

Decadron

A corticosteroid and highly potent synthetic glucocorticoid that suppresses acute and chronic inflammation, primarily used in respiratory and allergic reactions.

Decadron Contraindications

Known hypersensitivity, premature infants, and serious untreated infections.

Decadron Adverse Reactions

Restlessness, fluid retention, and headache.

Decadron Adult Dosing

$0.6\,\text{mg/kg}$ up to a maximum dose of $60\,\text{mg}$, with most agencies pushing a standard dose of approximately $12\,\text{mg}$.

Methylprednisone (Solu-Medrol)

A synthetic glucocorticoid corticosteroid that suppresses acute and chronic inflammation, used in allergic reactions, anaphylaxis, COPD, and adrenal insufficiency.

Methylprednisone Dosing

$2\,\text{mg/kg}$ up to a maximum of $125\,\text{mg}$ for both adults and pediatrics (with some adult agencies opting to push $250\,\text{mg}$).

Solu-Medrol 1990s Asthma Study

A study that created the widespread belief that Solu-Medrol distributed into lung tissue more than any other steroid, leading many to switch from Decadron despite no foundational evidence supporting it.

Decadron Pharmacokinetics

Acts extremely fast to produce visible improvement in the field, but remains in the body much longer than Solu-Medrol, posing a risk of accumulation with repeated doses.

Tertiary Adrenal Insufficiency

Adrenal insufficiency caused when prolonged or high doses of exogenous steroids cause the body to shut down its own steroid production, leaving it unable to quickly ramp up production if stopped cold turkey.

Addison's Disease

A primary endocrine disorder classified as a primary adrenal insufficiency.

Magnesium Sulfate Classification

An electrolyte categorized alongside adenosine in the miscellaneous antidysrhythmic group, though commonly misreferred to by students as a class V antidysrhythmic.

Magnesium Sulfate Mechanism of Action

Depresses the CNS, blocks peripheral neuromuscular transmission, produces anticonvulsant effects, causes bronchodilation, slows the SA node impulse formation rate, and prolongs conduction time.

Physiological Relationship Between Magnesium and Calcium

Magnesium acts as the opposite of calcium; administering magnesium blocks calcium from facilitating muscle contraction in the bronchioles, heart, and skeletal muscles.

Magnesium Toxicity Hallmark Sign

The loss or absence of deep tendon reflexes, typically presenting alongside sedation, obtundation, and hypotension.

Antidote for Magnesium Toxicity

Calcium administration, accompanied by stopping the magnesium infusion.

Magnesium Sulfate Packaging Concentration Risk

Packaged at a $50\%$ concentration, which carries a high risk of inducing torsades arrest, V-Fib, or polymorphic V-Tach if not diluted before administration.

Magnesium Sulfate Dose for Bronchospasm and COPD

$2\,\text{g}$ diluted in a $100\,\text{mL}$ bag administered IV over $10\,\text{minutes}$.

Magnesium Sulfate Dose for Torsades with a Pulse

$2\,\text{g}$ in a $100\,\text{mL}$ bag administered over $10\,\text{minutes}$, followed by a maintenance drip.

Magnesium Sulfate Dose for Cardiac Arrest

$2\,\text{g}$ administered in a solution concentration of $20\%$ or less.

Magnesium Sulfate Dose for Obstetric Emergencies (Preterm Labor, Preeclampsia, Eclampsia)

$4\,\text{g}$ mixed in an IV bag and infused over $20\,\text{minutes}$.

Magnesium Sulfate IM Dose for Eclampsia

$10\,\text{g}$ total administered intramuscularly, split as $5\,\text{g}$ into each buttock and divided into $2.5\,\text{mL}$ boluses across separate injection sites.

Drug of Choice for Seizures in Pregnancy

Magnesium sulfate.

Percet Protocol for Seizing Pregnant Patients

A benzodiazepine administered at a dose of $10\,\text{mg}$ prior to administering $10\,\text{g}$ of magnesium sulfate according to select emergency protocols.