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33 Cards in this Set
- Front
- Back
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Epinephrine (Adrenalin)
Class |
Class: Beta-adrenergic Agonist
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Epinephrine (Adrenalin)
Pharmacology and Actions |
A. Sympathomimetic/catecholamine with alpha and beta effects
B. In general the following cardiovascular responses can be expected a. Increased heart rate (+chronotope) b. Increased myocardial contractile force ( + intrope) c. Increased vascular resistance d. Increased arterial blood pressure e. Increased myocardial oxygen consumption f. Increased automaticity (+ dromotope) and irritability of the heart C. Potent bronchodilator D. Pupilary dilation E. Onset of action: 90 sec IVP, 3-10 min SQ |
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Epinephrine (Adrenalin)
Indications |
A. Ventricular fib/Pulseless ventricular tachycardia (V-tach) – to increase electrical activity and to improve central flow by peripheral vasoconstriction
B. Asystole C. Pulseless electrical activity (PEA) D. Anaphylaxis and severe or systemic allergic reactions E. Bradycardia – 1 first line for pediatrics, 2. After atropine, pacing, and dopamine for adults F. Asthma G. Second vasopresseor agent for adult patients ( used in conjunction with dopamine – sepsis, nuergenic shock) |
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Epinephrine (Adrenalin)
Contraindications |
A. Hypertension, hyperthyroidism, ischemic heart disease, or cerebrovascular insufficiency (relative)
B. Hypersensitivity |
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Epinephrine (Adrenalin)
Precautions and Side Effects |
A. Tachycardia, ectopic beats, nausea, vomiting, angina, palpitations, headache, and anxiety
B. Should not be added directly to bicarbonate infusion, since catecholamines may be inactivated by alkaline solution C. When used for allergic reactions, increased cardiac work can precipitate angina or MI in susceptible individuals D. Due to peripheral vasoconstriction, should be used with caution in patients with poor peripheral circulation E. Wheezing in the elderly is MORE often due to pulmonary edema F. Because epinephrine is a non-selective beta drug, it exerts considerable stimulant effect on the heart. In asthma, particularly in older patients with heart disease, this may be detrimental and a more selective bronchodilator is used. |
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Epinephrine (Adrenalin)
Adult Dosages |
A. Arrest situation: v-fib, PEA, asystole, pulseless v-tach
a. 1 mg IVP/IO, 1:10,000 repeat every 3-5 mins B. Anaphylaxis/Allergic Reaction a. Allergic reaction (moderate to severe respiratory distress): i. 0.3 to 0.5 mg of 1:1000 SQ, may be repeated in 20 minutes b. Anaphylaxis i. Stridor and systolic blood pressure < 100 mmHg after fluid challenge. 0.1 mg increments SLOW IVP of 1:10,000 until BP > 100 mmHg or a total of 0.5 mg is given C. Asthma/Bronchospasm: (severe distress) 0.3 mg of 1:1000 SQ. May be repeated in 20 min D. Bradycardia: 2-10 mcg/min DRIP. Make by placing 1 mg in 250 CC of NS – yielding 4 mcg/mL E. ET tube administration is 2-2.5 times the IV dose, using 1:1000, diluting with 10 cc of NS |
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Epinephrine (Adrenalin)
Pediatric Dosages |
A. Asthma (severe distress): 0.1 mg/kg of 1:1000 SQ to a max of 0.3 mg
B. Allergic Reaction: 0.01 mg/kg of 1:1000SQ to a max of 0.3 mg. C. Anaphylaxis: 0.05 mg increments of 1:10,000 IV/IO to a max of 0.01 mg/kg D. Pulseless Arrest (PEA, v-fib, v-tach, asystole, or Heart rate <60 in neonates) and Bradycardia a. 0.01 mg/kg of 1:10,000 IV/IO b. 0.1 mg/kg of 1:1000 ET diluted in 1-2 cc’s NS E. IV infusion for bradycardia: 0.2 mcg/kg/min to 1 mcg/kg/min |
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Epinephrine (Adrenalin)
How Supplied |
A. 1 mg/10 mL – 1:10,000 prefilled syringe
B. 1mg/1mL – 1:1000 ampule of vial C. 30 mg/30mL – 1:1000 multidose vial |
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Atropine
Class |
Parasympatholytic/Anticholinergic
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Atropine
Pharmacology and Actions |
A. Blocks acetylcholine receptor sites, thereby decreasing the action of parasympathetic or cholinergic nerve fibers (parasympatholytic)
B. Increased myocardial oxygen demand C. Increases heart rate by blocking vagal influences at the SA node D. Increases conduction through the AV node E. Reduces motility and tone of GI tract (decreases peristalsis) F. Reduces action and tone of urinary bladder (may cause urinary retention) G. Dilates pupils H. Stops SLUDGE I. Onset of action: Immediate |
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Atropine
Indications |
A. Asystole
B. Hemodynamically significant bradycardias (ALOC, hypotension, chest pain, pulmonary edema) or heart blocks C. Antidote for some insecticide exposures (organophosphates) and nerve gases with symptoms of excessive cholinergic stimulation: salvation, constricted pupils, bradycardia, tearing, diaphoresis, vomiting, and diarrhea (SLUDGE) D. PEA is heart rate < 60 BPM E. Pre-intubation for pediatrics under the age of 8 |
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Atropine
Contraindications |
A. Evolving MI, glaucoma (relative)
B. Hypersensitivity |
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Atropine
Precautions and side effects |
A. Remember that in cardiac arrest situations, atropine dilates pupils
B. Pediatric bradycardias are most commonly due to hypoxia C. Many people do well with chronic second and third degree blocks. Use atropine based on hemodynamic parameters only D. Paradoxical bradycardias may occur in children with doses less than 0.1 mg E. Antacids slow the absorption of anticholinergics F. Headache, dizziness, palpitations, blurred vision, flushed dry skin, dry mouth |
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Atropine
Dosages |
A. Asystole/PEA w/ HR < 60
a. Adult: 1 mg IV/IO or 2 mg ET repeated every 3-5min to a total of 0.04 mg/kg (max 0.8 mg/kg ET) b. Ped: 0.02 mg/kg IV/IO or ET (minimum single does 0.1 mg. Max single dose 0.5 mg for child or 2.0 mg for an adolescent) B. Symptomatic Bradycardia a. Adult: 0.5 mg IV/IO or ET repeated if needed at 5 min intervals to a total does of 0.04 mg/kg. Stop at ventricular rate of 60 b. Ped: 0.02 mg/kg IV/IO or ET (min single does 0.1 mg. Max single does of 0.5 mg) C. Exposures a. Adult: symptomatic insecticide exposure (OGP): usually begin w/ 2-5 mg IV/IO/IM; if no improvement w/in 5-10min, repeat 2-5 mg IV/IO/IM, total required dose may be massive. Nerve agents 2-20 mg IV/IM/IO; titrate to response (drying of mucous membranes and ease of ventilation) b. Pediatric: symptomatic insecticide exposure (OGP): usually begin w/ 0.05 mg/kg IV/IM/IO. Repeat in 5-10 min w/ 0.05 mg/kg |
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Atropine
How Supplied |
A. Pre-filled syringes containing 1 mg of atropine in 10 ml
B. Multi-dose vial 0.4 mg/ml (8mg in 20 ml total) C. Auto-injector 2 mg |
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Dextrose
Class |
Carbohydrate
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Dextrose
Pharmacology and actions |
A. Glucose is the body’s basic sugar fuel for energy and metabolism
B. Quickly elevates blood glucose levels – very important to prevent brain injury from prolonged hypoglycemia C. Onset of action: immediate |
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Dextrose
Indications |
A. blood sugar less than 80 mg/dL and decreased sensorium
B. Any illness or ALOC in a known diabetic which might be caused by hypoglycemia C. Patient w/ active seizure and blood sugar <80 mg/dL D. Coma of unknown etiology if blood sugar determination is not available E. Pre-treatment of crush injuries F. Hyperkalemia |
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Dextrose
Contraindications |
A. Evolving CVA (relative – still administer if blood sugar < 60 mg/dL)
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Dextrose
Precautions and Side effects |
A. Use the largest vein possible, separate the syringe AT LEAST 3 times during administration to ensure patency of the line
B. Extravasation of dextrose will cause necrosis of tissue due to hyperosmolarity of the dextrose solution C. Do not draw blood for glucose determination from site proximal to an IV containing dextrose D. Thiamine should be administered to the alcoholic patient before dextrose to prevent Wernicke’s encephalopathy (thiamine is required for carbohydrate metabolism) |
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Dextrose
Dosage |
A. Adult: 24 g of D50 IVP – for hyperkalemia, blood sugar < 80 mg/dL and pre-treat crush injuries – may repeat every 5 min as indicated by blood glucose levels
B. Pediatric: 0.5 g/kg of D25 is blood sugar < 70 mg/dL, may be repeated every 5 min as indicated by blood sugar C. Neonates (0-30 days old): 0.5 g/kg of D10 if blood sugar < 45 mg/dL |
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Dextrose
How supplied |
A. Adult: 25 g min 50 mL (50% solution) preloaded syringe
B. Ped: 2.5 g in 10 mL (25% solution) preloaded syringe Note: D25 can be made by emptying 25cc’s of D50 and refilling with 25 cc’s of NS D10 can be made by emptying 40 cc’s of D50 and refilling w/ 40 CC of NS |
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Oxygen
Actions |
A. Increases concentration of oxygen in the alveoli
B. increases tissue oxygen saturation brain |
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Oxygen
Indications |
A. Mild, moderate, or severe dyspnea
B. Trauma C. Neurological conditions D. Medical Conditions E. Placebo/Psychological effects F. Shock |
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Oxygen
Contraindications |
A. None
B. Use cautions with hyperventilation |
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Oxygen
Adverse effects |
A. Apnea in COPD patients
B. Exacerbate hyperventilation |
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Oxygen
Dosage and Routes |
Dosage
A. Low flow 1-6 LPM B. High flow 10-15 LPM Route A. Nasal cannula B. NRB C. BVM |
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Procainamide (Pronestyl)
Pharmacology and actions |
A. Antidysrhythmic, regarded as cardiac depressant
B. Suppresses phase 4 depolarization in the ventricles and Purkinje fibers, decreasing the automaticity of the ectopic pacemakers C. Suppresses reentry dysrthymias by slowing conduction velocity |
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Procainamide (Pronestyl)
Indications |
A. PSVT (after adenosine and vagal maneuvers, if stable)
B. Stable wide complex tachycardia of unknown origin C. Atrial fibrillation with rapid rate D. WPW syndrome E. Pulsing or pulse less ventricular tachycardia or ventricular fibrillation |
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Procainamide (Pronestyl)
Contraindications |
A. Second and third – degree AV block
B. Digitalis Toxicity C. Tosades de pointes D. TCA overdose |
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Procainamide (Pronestyl)
Precautions and Side effects |
A. Use with caution in MI, CHF, hepatic or renal dysfunction
B. Hypotension in patients with impaired left ventricular function C. It may cause aarrhythmias in presence of AMI, Hypokalemia, or Hypomagnesemia D. Use with caution with other drugs that prolong the QT interval (Amiodarone) E. Bradycardia, heart blocks F. Widened QRS, prolonged PR or QT interval and ventricular ectopy |
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Procainamide (Pronestyl)
Dosage |
A. WPW, pulsing, V-tach, PSVT – 20 mg/min
B. Pulseless v-tach or v-fib – 20 mg/min or 100 mg IV at 5 min intervals C. Maintenance infusion – 1-4 mg/min D. Pedi: not recommended E. Max dose: 17 mg/kg OR until one of the following a. Arrhythmia suppression b. Hypotension c. QRS widens by more than 50% F. Reduce dose to 12 mg/min if cardiac or renal dysfunction NOTE: SHOULD NOT BE EXPOSED TO LIGHT |
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Procainamide (Pronestyl)
Supplied |
How Supplied:
A. 1 g/2cc’s or 1 g/10cc’s |
