Pharmocology Week 1

Front 1

Dopamine

Back 1

CLASS: Adrenergic agonist, inotropid, vasopressor.
ACTION:Stimulates alpha & beta adrenergic receptor. At moderate doses (2 - 10mcg/kg/min), dopamine stimulate beta1 receptors, resulting in inotropy and increased cardiac output while maintaining dopaminergic-inducing vasodilatory effects. At high doses (>10mcg/kg/min), alpha adrenergic agonism predominates, & increased peripheral vascular resistance & vasoconstriction result.
INDICATION: Hypotension & decreased cardiac output associated with careodgenic shock & septic shock, hypotension after return of spontaneous circulation following cardiac arrest, symptomatic bradycardia, unresponsive to atropine.
ADVERSE: Tachycardia, arrythmias, skin & soft tissue necrosis, severe HTN from excessive vasoconstriction, angina, dyspnea, headache, N/V.
CONTRA: Pheochromocytoma, VF, VT, or other ventricular arrythmias, known sensitivity (including sulfites). Correct any hypovolemia with vol. fluid replacement beforeadministration.
DOSE:
Adult: 2 - 20mcg/kg/min IV,IO infusion. Starting slow dose 5mcg/kg/min; may gradually increase the infusion by 5 - 10mcg/kg/min to desired effect. Cardiac dose is usally 5 - 10 mcg/kg/min; vasopressor dose is usually 10 - 20mcg/kg/min.
Pediatric: Same as adult.

Front 2

Norepinepherine (Levophed)

Back 2

CLASS: Adrenergic agonist, inotropic, vasopressor.
ACTION: Norepinepherine is an alpha1, alpha2, and beta1, agonist. Alpha mediated peripheral vasoconstriction is the predominant clinical result of administration, resulting in increasing blood pressure and coronary blood flow. Beta adrenergic action produces inotropic stimulation of the heart and dilates the coronary arteries.
INDICATION: Cardeogenic shock, septic shock, severe hypotension
ADVERSE: Dizziness, anxiety, cardiac arrhythmia, dyspnea, exaceration of asthma
CONTRA: Pts taking MAOI, known sensitivity, Caution in hypovolemia
DOSE:
Adult: Add 4mg to 250 mL of D5W or D5Ns, but not to NS alone. 0.5 - 1 mcg/min as IV, IO, titrated to maintain BP of >80mmHg. refractory Shock may require doses as high as 30 mcg/min
Ped: 0.05 0 2 mcg/kg/min IV, IO infusion to a max dose of 2 mcg/kg/min
** DO NOT admin in same IV line as alkaline sol.

Front 3

Dobutamine (Dobutrex)

Back 3

CLASS: Adrenergic agent
ACTION: Acts primarily as an agonist beta1 adrenergic receptors with minor beta2 & alpha1 effects. Consequently, dobutamine increases myocardial contractility & stroke vol with minor chronotropic effects, resulting in > cardiac output.
INDICATIONS: CHF, cardiogenic shock.
ADVERSE: Tachycardia, PVCs, hypertension, hypotension, palpitations, arrhythmia.
CONTRA: suspected or known poisoning/drug-induced shock, systolic BP <100mm Hg with signs of shock, idiopathic hypertrophy subaortic stenosis, known sensitivity (including sulfites). Use with caution in hypertension, recent MI, arrhythmia, hypovolemia.
DOSE:
Adult & Ped: 2 - 20 mcg/kg/min IV, IO. @ doses of > 20 mcg/kg/min, > HR of >10% may induce or exacerbate MI
*Half-life 2 min

Front 4

Phenylephrine (Neo-Synephrine)

Back 4

CLASS: Adrenergic agonist
ACTION: Stimulates the alpha receptors, causing vasoconstriction, which results in increased BP.
INDICATION: Neurogenic shock, spinal shock, cases of shock in which the pt's NR does not need to be increased, drug-induced hypotension.
ADVERSE: Hypertension, VT, headache, excitability, tremor, MI, exacerbation of asthma, cardiac arrythmias,reflex bradycardia, soft tissue necrosis.
CONTRA: Acute MI, angina, cardiac arrythmias, severe HTN, CAD, pheochromocytoma, narrow-angle glaucoma, cardiomyopathy, MAOI therapy, known sensitivity, to phenylphrine of sulfites.
DOSE:
Adult: 100 - 180mcg/min IV, IO. Once BP has been stabilized, the dose can be reduced to 40 - 60mcg/min.
Pediatric: 5 - 20mcg/kg IV, IO followed by 0.1 - 0.5mcg/kg/min IV, IO (max dose: 3mcg/kg/min IV, IO)

Front 5

Epinepherine

Back 5

CLASS: Adrenergic agent, inotropic
ACTION: Binds strongly with both alpha and beta receptors, producing increased BP, increased HR, bronchodilation.
INDICATION: Bronchospams, allergic, and anaphylactic reactions, restoration of cardiac activity in cardiac arrest.
ADVERSE: Anxiety, headache, cardiac arrythmias, HTN, nervousness, tremors, chest pain, N/V.
CONTRA: Arrythmias other than VF, asystole, PEA; cardiovascular disease; HTN; cerebrovascular disease; shock secondary to causes other than anaphylactic shock; closed-angle glaucoma; diabetes, pregnant women in active labor; known sensitivity to epi or sulfites.
DOSE:
CARDIAC ARREST:
Adult: 1mg (1:10,000 sol.) IV, IO; may repeat q 3-5 min.
Pediatric: 0.01mg/kg (1:10,000 sol.) IV, IO, repear q 3- 5 min as needed (max dose 1mg)
SYMPTOMATIC BRADYCARDIA:
Adult: 1mcg/min (1:10.000 sol) as a cont. IV infusion; usual dose rand 2 - 10mcg/min IV; titrate to effect.
Pediatric: 0.01mg/kg (1:10,000 sol) IV, IO may repeat q 3 - 5 min (max dose 1mg). IF given ET Tube; admin 0.1mg/kg.
ASTHMA ATTACK & CERTAIN ALLERGIC REACTIONS
Adult: 0.3 - 0.5mg ( 1:1000 sol) IM or SQ; may repeat q 10 - 15 min. (max dose 1mg)
Pediatric: 0.01mg/kg (1;1000 sol) IM or SQ (max dose 0.5mg)
ANAPHYLACTIC SHOCK:
Adult: 0.1mg (1:10,000 sol) IV slowly over 5 min, or IV infusion of 1 - 4 mcg/min titrated to effect
Pediatric: continuous IV infusion rate of 0.1 - 1mcg/kg/min (1:10,000 sol. titrate to response.

Front 6

Propranolol (Inderal)

Back 6

CLASS: Beta adrenergic antagonist, antianginal, antihypertensive, antiarrythmic class II
ACTION: Nonselective beta antagonist that binds with both the beta1 and beta2 receptors. Propranolol inhibits the strength of the heart's contractions, as well as HR. This results in a decrease in cardiac O2 consumption.
INDICATION: Aninga; narrow-complex tachycardia that originate from either a reentry mechanism (reentry SVT) or an automatic focus (junctional, ectopic, or multifocal tachycardia) uncontrolled by vagal maneuvers and Adenosine in pts with preserved ventricular function; AF and atrial flutter in pts with preserved ventricular function; HTN; migraine headaches.
ADVERSE: Bradycardia, AV block, bronchospasm, hypotension
CONTRA: Cardeogenic shock, heart failure, AV block, Bradycardia, PE, sick sinus syndrome, known sensitivity. Use with caution in chronic lung disease ( asthma and COPD)
DOSE:
Adult: 1 - 3mg IV, IO at a rate of 1mg/min; may repeat the dose 2 min later.
Pediatric: 0.01 - 0.1mg/kg slow IV IO over a 10 min period.
** Monitor BP and HR closely during admin**

Front 7

Labetalol (Normodyne, Trandate)

Back 7

CLASS: Beta adrenergic antagonist, antianginal, antihypertensive
ACTION: Binds with both the beta1 and 2 recptors in vascualer smooth muscle. Inhibits the strength of the hearts contractions as well as the HR. This results in a decrease in cardiac O2 consumption.
INDICATIONS: ACS. SVT, severe HTN
ADVERSE: Usually mild and transient, hypotensive symptoms, N/V, pronchospams, arrythmia, bradycardia, AV block.
CONTRA: Hypotension, cardiogenic shock, acute pulmonary edema, heart failure, severe bradycardia, sick sinus syndrome, 2nd or 3rd degree heart block, asthma or acute cerebrovascular disease or stroke, poorly controlled diabeties, with hepatic disease. Use with caution at lowest effective dose in chronic lung disease.
DOSE:
CARDIAC INDICATIONS: (NOTE: monitor HR & BP closely during admin)
Adult: 10mg IV, IO over a 1 - 2 min period. May repeat q 10 min to a max dose of 150mg or give initial bolus & then follow with infusion @ 2 - 8mg/min.
Pediatric: 0.4 -

Front 8

Metoprolol (Lopressor, Toprol XL)

Back 8

CLASS: Beta adrenergic antagonist, antianginal, antihypertensive, class II antiarrhythmic.
ACTION: Inhibits strength of heart's contractions / HR. This results in a < in cardiac O2 consumption. Saturates the beta receptors & inhibits dilation of bronchial smooth muscle (beta2 receptor)
INDICATION: ACS, HTN, SVT, atrial flutter, AF, thyrotoxicosis.
ADVERSE: Tiredness, dizziness, diarrhea, heart block, bradycardia, bronchospams, < BP
CONTRA: Cardeogenic shock, AV block, bradycardia, known sensitivity. Caution in hypotension, chronic lung disease (asthma, COPD)
DOSE:
CARDIAC INDICATION:
Adult: 5mg slow IV, IO over a 5 minute pd; repeat @ 5 min intervals to total of 3 infusions totaling 15mg IV, IO.
Ped: Not recommended
** BR, HR, ECG monitored closely
** Caution in pt with asthma.

Front 9

Atenolol (Tenormin)

Back 9

CLASS: Beta adrenergic antagonist, antianginal, antihypertensive, class II antiarrhytmic.
ACTION: Inhibits strength of heart's contractions / HR. This results in a < in cardiac O2 consumption. Saturates the beta receptors & inhibits dilation of bronchial smooth muscle (beta2 receptor)
INDICATION: ACS, HTN, SVT, atrial flutter, AF
ADVERSE: Bradycardia, bronchospasm, hypotension
CONTRA: Cardeogenic Shock, AV block, bradycardia, known sensitivity, Caution in hypotension, chronic lung disease (asthma, COPD)
DOSE: ACS
Adult: 5mg IV, IO over a 5 minutes or; repeat in 5 minutes
Not recommended for Peds

Front 10

Atropine Sulfate

Back 10

CLASS Anticholinergic (antimuscarinic)
ACTION: competes reversibly with acetycholine @ the site of muscarinic receptor. (receptors effected from most sensitive to least - salivary, bronchial, sweat glands, eye, heart, GI Tract)
INDICATION: Symptomatic bradycardia, asystole or PEA, nerve agent exposure, organophosphate poisoning.
ADVERSE: < secretions resulting in dry mouth & hot skin temps, intense facial flushing, blurred vision or dilation of pupils with subsequent photophobia, tachycardia, restlessness. May cause paradoxical bradycardia if dose is admin too low or drug is admin too slowly.
CONTRA: Acute MI, myasthenia gravis, GI obstruction, closed0angle glaucoma, known sensitivity to atropine, belladona alkoloids, or sulfites. Will not be effective for infranodal (type II) AV block & new 3rd degree block with wide QRS complex.
DOSE:
SYMPTOMATIC BRADYCARDIA:
Adult: 0.5 mg IV, IO q 3 - 5 min to a max dose of 3mg
Adolescent: 0.02mg/kg (minimum of 0.1 mg/dose, max of 1 mg/dose) IV, IO to total dose of 2mg
Ped: 0.02mg/kg (min 0.1mg/dose; max 0.5 mg/dose) IV, IO total dose of 1mg.
AYSTOLE / PEA:
1mg IO, IV q 3 - 5 min, max dose 3mg. ET tube @ 2 - 2.5mg diluted in 5 - 10mL of H20 or NS.
NERVE AGENT / ORGANOPHOSPHATE POISONING:
Adult: 2 - 4mg IV, IM; repeat PRN q 20 - 30 min until symptoms dissipate. Initial dose can be as large as 2 - 6mg admin IV. Repeat doses of 2 - 6 mg can be admin IV, IM q 5 - 60 min
Ped: 0.05mg/kg IV, IM q 10 - 40 min PRN till symptoms dissipate.
Infant < 15lbs: 0.05mg/kg IV, IM q 5 - 20 min PRN until symptoms dissipate

Front 11

Scopolamine (Transderm Scop)

Back 11

CLASS: Neurologic antivertigo, antimuscarinic
ACTION: Antagonizes acetylcholine @ muscarinic receptors
INDICATION: Motion Sickness
ADVERSE: Dry mouth, drowsiness, dilated pupils & blurred vision, hallucinations, confusion.
CONTRA: Glaucoma, cardiac arrhythmia, CAD, known sensitivity
DOSE:
Adults and children >12 years: 1 disc applied to skin behind ear.
* Half-life 8 hours

Front 12

Insuline, Regular (Humulin R, Novolin R)

Back 12

CLASS: Hormone
ACTION: Binds to a receptor on the membrane of cells & facilitates transport of glucose into cells.
INDICATION: Hyperglycemia, insulin-dependent DM, hyperkalemia
AVERSE: Hypoglycemia, tachycardia, palpitations, diaphoresis, anxiety, confusion, blurred vision, weakness, depression, seizures, coma, insulin shock, hypokalemia
CONTRA: Hypoglycemia, known sensitivity
DOSE:
DKA:
Adult: 0.1 U/kg IV, IO, SQ. Because of poor tissue perfusion of the peripheral tissues, SQ admin is < effective than IV, IO route. IV, IO short half-life, making ineffective without subsequent infusion. Infusion rate is 0.05 - 1.0 U/kg.hr IV, IO. When dosing insulin use U-100 insulin syringe to measure & deliver. Time from admin to action as well as duration of effect varies greatly.
HYPERKALEMIA:
Adult: 10 U IV, IO of Insulin R, coadmin with 50 mL of D50W over 5 min
Ped: 0.1 U/kg Insulin R IV, IO
* Only Insulin R can be given IV, IO