Pharmocology List 3

Front 1

Oxygen

Back 1

CLASS: Elemental Gas
ACTION: Facilitates cellular energy metabolism.
INDICATIONS: Hypoxia, ischemic chest pain, respiratory distress, suspected Carbon Monoxide Poisoning, traumatic injuries, shock.
ADVERSE: High concentrations can cause < LOC and respiratory depression in Pts with chronic carbon dioxide retention of chronic lung disease.
CONTRA: Known paraquat poisoning.
DOSE:
LOW-CONCENTRATION:
1-4 L/min NC
HIGH-CONCENTRATION:
10-15 L/min NRB

Front 2

ASPIRIN, (ASA)

Back 2

CLASS: Antiplatelet, nonnarcotic analgesic, antipyretic
ACTION: Prevents the formation of thromboxane A2, which causes platelets to aggregate, and form plugs that cause obstructions / constriction of small coronary arteries.
INDICATIONS: Fever, inflammation, angina, acute MI, & pts C/O chest pain, pressure, squeezing, or crushing in the chest that may be cardiac in origin.
ADVERSE: Anaphylaxis, angioedema, bronchospasm, bleeding, stomach irritation, N/V
CONTRA: GI bleed, active ulcer disease, hemorrhagic stroke, bleeding disorders, children with chickenpox or flulike symptoms, known sensitivity.
DOSE: (NOTE: "Baby Aspirin" 81mg, standard adult dose 325mg.
MI:
ADULT: 160 - 325mg PO (alternatively 4 81mg baby ASA), 300mg rectal suppository
PED: 3 - 5mg/kg/day to 5 - 10 mg/kg/day given as a single dose.
PAIN / FEVER:
ADULT: 325 - 600 mg PO (1 - 2 adult tabs) q 4 - 6 hours
PED: 60 - 90mg/kg/day in divided doses q 4 - 6 hours

Front 3

NITROGLYCERIN (Nitrolingual, NitroQuick, Nitro-Dur)

Back 3

CLASS: Antianginal agent
ACTION: relaxes vascular smooth muscles, thereby dilating peripheral arteries & veins. Causing pooling of venous bleed and < venous return to the heart, <ing preload. < left ventricular systolic wall tension, < after load.
INDICATIONS: Angina, ongoing ischemic chest discomfort, HTN, MI associated with cocaine intox.
ADVERSE: HA, hypotension, bradycardia, lightheadedness, flushing, cardiovascular collapse, methemoglobinemia.
CONTRA: Hypotension, severe bradycardia or tachycardia, > ICP, intracranial bleeding, Rx for "ED" sildenafil [Viagra], tadalafil, [Cialis], or verdenafil [Levitral], known sensitivity to nitrates. Use with caution in anemia, closed-angle glaucoma, hypotension, postural hypotension, uncorrected hypovolemia
DOSE:
ADULT:
-SL Tab: 1 tab (0.3 - 0.4mg) @ 5 min intervals to max of 3 doses
-Translingual Spray: 1 (0.4mg) spray @ 5 min intervals max of 3 sprays.
-Ointment: 2% topical (Nitro-Bid): apply 1 - 2" of paste over the chest wall, cover with transparent wrap; secure with tape.
-IV:
(Bolus) 12.5 - 25mcg
(Infusion) 5 mcg/min; may > rate by 5 - 10 mcg/min q 5 - 10 min PRN. End points of dose titration for nitro should include a drop in the BP of 10%, releif of CP, and return of ST segment to normal on 12 ECG
PED INFUSION: Initial infusion is 0.25 - 0.5 mcg/kg/min IV, IO titrated by 0.5 - 1 mcg/kg/min. Usual required dose is 1 - 3 mcg/kg/min to a max dose of 5 mcg/kg/min.
**Admin of Nitro to a pt with a right ventricular MI can result in hypotension

Front 4

Morphine Sulfate

Back 4

CLASS: Opiate agonist, Schedule C-II
ACTION: Binds with opiod receptors. Capable of inducing hypotension by depression of the vasomotor centers of the brain, as well as release of histamine. Mngmt of angina- reduces stimulation of the sympathic nervous system caused by Pn & anxiety. Reduction of the sympathic stimulation < HR, cardiac work, and myocardial O2 consumption
INDICATIONS: Moderate to severe pain, including CP associated with ACS, CHF, Pulmonary edema.
ADVERSE: Respiratory depression, hypotension, N/V, dizziness, lightheadedness, sedation, diaphorises, euphoria, dysphoria, worsening of bradycardia and heart block in some pts with acute inferior wall MI, seizures, cardiac arrest, anaphylactoid reactions.
CONTRA: Respiratory depression, shock, known sensitivity. Use with caution in hypotension, acute bronchial asthma, respiratory insufficiency, head trauma.
DOSE:
PAIN:
Adult: 2.5 - 15mg IV, IO, IM, or SQ admin slowly over a period of several minutes. The dose is the same whether admin IV, IO, IM, or SQ.
Ped:
6 months - 12 years: 0.05 - 0.2 mg/kg IV, IO, IM, or SQ
< 6 months: 0.03 - 0.05 mg/kg IV, IO, IM, or SQ
CP ASSOCIATED WITH ACS, CHF, PE: (Administer small doses and reeval pt. Large doses may lead to respiratory depression & worsen pts hypoxia)
Adult: 2 - 4 mg slow IV, IO over a 1 0 5 min period with increments of 2 0 8 mg repeated q 5 - 15 min until pt relieved of CP.
Ped: 0.1 - 0.2 mg/kg/dose IV, IO
** Monitor VS & SaO2 closely
** OD should be treated with Naloxone

Front 5

Esmolol ( Brevibloc )

Back 5

CLASS: Beta adrenergic antagonist, class II antiarrythmic
ACTION: Inhibits the strength of the heart's contraction, as well as HR, resulting in < in cardiac O2 consumption.
INDICATIONS: ACS, MI, acute HTN, SVT, thyrotoxicosis.
ADVERSE: Hypotension, sinus bradycardia, AV block, cardiac arrest, N/V, hypoglycemia, injection site reaction.
CONTRA: Acute bronchospams, COPD, 2nd or 3rd degree heart block, bradycardia, cardiogenic shock, pulmonary edema, sick sinus syndrome, known sensitivity. Use with caution in pts with pheochromocytoma, Prinzmetals angina, cerebrovascular disease, stroke, poorly controlled DM, hyperthyroidism, thyrotoxicis, renal disease.
DOSE:
ADULT: 500 mcg/kg (0,5 mg/kg) IV, IO over a 1 min period, followed by 50 mcg/kg/min ( 0.5 mg/kg) infusion over 4 min period (max total: 200mcg/kg). If pt response is inadequate, admin 2nd bolus 500 mcg/kf )0.5 mg/kg) over a 1 minute period, and then > infusion to 100 mcg/kg/min. Max infusion rate of 300 mcg/kg/min
Ped: 500 mcg/kg (0.5 mg/kg) IV, IO over a 1 minutes period, followed by infusion @ 25 - 200 mcg/kg/min
** Half-life 5 - 9 min
** Any adverse effects caused by admin are brief.

Front 6

Clopidogrel (Plavix)

Back 6

CLASS: Antiplatelet
ACTION: Blocks platelet aggregation by antagonizing the GP IIb/IIa receptors.
INDICATIONS: ACS, chronic coronary & vascular disease, ischemic stroke
ADVERSE: Nausea, abd pn, hemorrhage
CONTRA: Hx of intracranial hemorrhage, GI bleed or trauma, known sensitivity
DOSE:
UNSTABLE ANGINA OR NON-Q-QWAVE ACUTE MI:
Adult: single loading dose of 300 mg PO followed by a daily dose of 75 mg PO
* No Pediatric recommendation

Front 7

Heparin (Unfractionated Heparin)

Back 7

CLASS: Anticoagulant
ACTION: Acts on the antithrombin III to reduce the ability of the blood to form clots, thus preventing clot deposition in the coronary arteries.
INDICATIONS: ACS, acute pulmonary embolism, DVT
ADVERSE: Bleeding, thrombocytopenia, allergic reactions.
CONTRA: Predisposition to bleeding, aortic aneurysm, peptic ulceration, known sensitivity or Hx of heparin-induced thrombocytopenia, devere thrombocytopenia, sulfite sensitivity
DOSE
CARDIAC INDICATION:
Adult: 60 U/kg IV (max 4000 Units), followed by 12 U/kg/hr (max 1000 units). Once in hospital, additional dosing is determined based on lab blood tests.
Pediatrics: 75 U/kg followed by 20 U/kg/hr
PULMONARY EMBOLISM & DVT:
Adult: 80 U/kg IV followed but 18 U/kg/hr
Ped: 75 U/kg IV followed by 20 U/kg/hr

Front 8

Abciximab (ReoPro)

Back 8

CLASS: GP IIb/IIa inhibitor
ACTION: Prevents the aggregation of platelets by inhibiting the integrin GP IIa/IIa receptor.
INDICATION: UA/NSTEMI pts undergoing planned or emergent percutaneous coronary intervention.
ADVERSE: Bleeding from the GI tract, internal bleeding, intracranial hemorrhage, hypotension, stroke, anaphylactic shock
CONTRA: Bleeding from any source, severe uncontrolled HTN, surgery or trauma within the previous 6 weeks, stroke within the previous 30 days, renal failure, Thrombocytopenia, intracranial mass
DOSE:
UA/NSTEMI WITH PLANNED PCI WITHIN 24 HOURS:
0.25 mg/kg IV, IO (10 - 60 minutes before procedure), then 0.125 mcg/kg/min IV, IO infusion for 12 - 24 hours.
PERCUTANEOUS CORONARY INTERVENTION ONLY:
0.25 mg/kg IV, IO, then 10 mcg/min IV, IO infusion

Front 9

Eptifibatide (Integrilin)

Back 9

CLASS: GP IIb/IIa inhibitor
ACTION: Prevents the aggregation of platelets by inhibiting the integrin GP IIa/IIa receptor
INDICATIONS: UA/NSTEMI - to manage medically & for those undergoing Percutaneous coronary intervention.
ADVERSE: Bleeding from the GI tract, internal bleeding, intracranial hemorrhage, hypotension, stroke, anaphylactic shock.
CONTRA: Bleeding from any source, severe uncontrolled HTN, surgery or trauma within the previous 6 weeks, stroke within the previous 30 days, renal failure, thrombocytopenia, intracranial mass
DOSE:
Adult: loading dose: 180 mcg/kg IV, IO (max dose 22.6 mg) over 1 - 2 minutes, then 2 mcg/kg/min IV, IO infusion (max dose: 15 mg/hr)
* No pediatric recommendation

Front 10

Tirofiban (Aggrastat)

Back 10

CLASS: GP IIb/IIa inhibitor
ACTION: Prevents the aggregation of platelets by inhibiting the integrin GP IIa/IIa receptor
INDICATIONS: UA/NSTEMI - to manage medically & for those undergoing Percutaneous coronary intervention.
ADVERSE: Bleeding from the GI tract, internal bleeding, intracranial hemorrhage, hypotension, stroke, anaphylactic shock.
CONTRA: Bleeding from any source, severe uncontrolled HTN, surgery or trauma within the previous 6 weeks, stroke within the previous 30 days, renal failure, thrombocytopenia, intracranial mass
DOSE:
0.4 mcg/kg/min IV, IO for 30 min, then 0.1 mcg/kg/min IV, IO infusion for 48 - 96 min
*Hlaf-life approximately 2 hours

Front 11

Angiotensin-Convertin Enzyme (ACE) Inhibitor: Captoprol (Capoten), Enalapril (Vasotec), Lisinopril (Prinvil, Zestril) Ramipril (Altace)

Back 11

CLASS: ACE inhibitors
ACTION: Blocks the enzyme responsible for production of angiotension II, resulting in a < in BP
INDICATIONS: CHF, HTN, post-MI
ADVERSE: HA, dizziness, fatigue, depression, CP, hypotension, palpitations, cough, dyspnea, upper respiratory infection, N/V, rash, Pruritus, angioedema, renal failure
CONTRA: Angioedema R/T the previous Tx with an ACE inhibitor, known sensitivity. Use with caution in aortic stenosis, bilateral renal artery stenosis, hypertrophic obstructive cardiomyopathy, pericarial tamponade, elevated serum K levels acute kidney failure
DOSE:
Rx is admin PO and individualized

Front 12

HMG Coenzyme A Statins: Atorvastatin (Lipitor), Fluvastatin (Lescol), Lovastatin (Mevacor), Prevastatin (Pravachol), Rosuvastatin (Crestor), Simvastatin (Zocor)

Back 12

CLASS: HMG coenzyme A statin
ACTION: Reduces the level of circulating total cholesterol, LDL, cholesterol, and serum triglycerides; reduces the incidence of reinfarction, recurrent angina, re-hospitalization, and stroke when initiated within a few days of onset of ACS
INDICATIONS: ACS / Acute MI prophylaxis, hypercholesterolemia, hyperlipoproteinemia, stroke prophylaxis.
ADVERSE: Constipation, flatulence, dyspepsia, abd pn, sinusitis, pharyngitis, rash, arthralgia, N/V, myopathy, myasthenia, renal failure, rhabdomyosis, CP, bronchitis, rhinitis, insomnia.
CONTRA: Active hepatic disease, pregnancy, breast-feeding, rhabdomyolysis.
DOSE:
Individualized PO Rx.
* No pediatric safe use
*Pregnancy class X