In this episode I’ll:
1. Discuss an article about subcutaneously administered dexmedetomidine.
2. Answer the drug information question “Why is IV dextrose given to patients with DKA?”
3. Share a tip for responding to inpatient medical emergencies.
Article
Lead author: Panu Uusalo
Published in European Journal of Clinical Pharmacology April 2018
Background
There is no prior information on the subcutaneous (SC) administration of dexmedetomidine. The authors undertook this study with the idea that subcutaneous dexmedetomidine would be useful in palliative care settings. However, this route also has the potential to be useful for the sedation of agitated patients without IV access.
Methods
The authors compared the pharmacokinetics and cardiovascular, sympatholytic, and sedative effects of SC and intravenously (IV) administered dexmedetomidine in healthy volunteers. The study design was an open two-period, cross-over design with balanced randomization. Ten male subjects were randomized to receive 1 μg/kg dexmedetomidine both IV and SC. Concentrations of dexmedetomidine and catecholamines in plasma were measured and cardiovascular and sedative drug effects were recorded.
Results
Peak concentrations of dexmedetomidine were observed 15 min after SC administration. The mean bioavailability of SC dexmedetomidine was 81%. Plasma concentrations associated with sedative effects were maintained for 4 hours after SC dosing. The onset of all therapeutic and side effects including cardiovascular, sympatholytic, and sedative effects of dexmedetomidine were slower after SC compared with IV administration.
Conclusion
The authors concluded:
Dexmedetomidine is relatively rapidly and efficiently absorbed after SC administration. Subcutaneous dexmedetomidine may be a feasible alternative in palliative sedation, and causes attenuated cardiovascular effects compared to IV administration.
Discussion
This study opens up considerable possibilities for future study. A peak onset of 15 minutes is not that far off from other sedatives such as IM haloperidol, olanzapine, or lorazepam. Dexmedetomidine may have a more favorable side effect profile than other sedatives given for acute agitation as it does not lower the seizure threshold, cause torsades, or cause respiratory depression. A study with 10 healthy volunteers is not robust enough to support routine use of SC dexmedetomidine for sedation. However, there may be a unique patient scenario that presents where SC dexmedetomidine would be a reasonable choice.
Drug information question
Q: Why is IV dextrose given to patients with DKA?
A: When the serum glucose reaches 200 mg/dL in a patient with DKA, IV dextrose is added to avoid the development of cerebral edema. In addition, the rate of insulin infusion may need to be slowed down to between 0.02 and 0.05 units/kg/hr. The goal is to slow the rate of glucose decline and avoid promoting the development of cerebral edema.
Tip for responding to inpatient medical emergencies
Prepare Labels for medications ahead of time, so that providing labeled medications does not delay the delivery of critical medications.
Properly labeled syringes and IV lines will help prevent medication errors in the fast-paced scenarios of code blues and rapid responses. Keeping preprinted labels in your drug boxes is very helpful. I also keep a roll of medical tape in my lab coat so that I can use that to label syringes and IV lines. In a pinch, I can always tape the syringe and medication vial together.
If you are interested in how pharmacists can respond to inpatient medical emergencies, I have an in-depth Code Blue and Rapid Response Training Program inside my Hospital Pharmacy Academy. Through this 6-module training program, you will develop the confidence and skills necessary to respond to code blue and rapid response calls. You will also be completely prepared to pass the healthcare provider BLS and ACLS classes. To learn more go to pharmacyjoe.com/academy.
If you like this post, check out my book – A Pharmacist’s Guide to Inpatient Medical Emergencies: How to respond to code blue, rapid response calls, and other medical emergencies.
Leave a Reply