Pharmocology Week 2

Front 1

Albumin

Back 1

CLASS: Volume expander, colloid
ACTION: > oncotic pressure in intravascular space.
INDICATION: Expand intravascular vol.
ADVERSE: Allergic reaction in some pt; an excess vol of fluids can result in CHF and PE in susceptible pts.
CONTRA: Severe anemia or cardiac failure in the presence of normal or > intravascular vol, sol appears turbid, or after 4 hrs since opening the container, known sensitivity.
DOSAGE: Two preparations; 500mL of a 5% sol & 100mL of a 25% sol.
Adult:
5%: 500 - 1000mL IV,IO
25%: 50 - 200mL IV, IO
Pediatric:
5%: 12 - 20mL/kg IV; initial dose may be repeated in 15 - 30 min if clinical response is inadequate.
25%: 2.5 - 5mL/kg IV,IO
Alternatively, may be admin based on G @ 0.5 - 1g/kg/dose IV, IO. May repeat PRN (max dose 6g/kg/day)

Front 2

Hetastarch (Hespan)

Back 2

CLASS: Vol expander colloid
ACTION: causes H2O to move from interstitial space, thereby > the oncotic pressure within the intravascular space.
INDICAITON: Hypovolemia when vol must be > only in the intravascular compartments.
ADVERSE: Anaphylactic reactions CHF, PE, Cardiac arrhythmia, Cardiac arrest, pruritus, edema, platelet dysfunction, bleeding complication, dilution of the serum proteins responsible for the formation of blood clots, N/V.
CONTRA: bleeding disorders, intracranial bleeding, CHF, PE, renal failure, thrombocytopenia or other coagulopathy (hemophilia), known sensititvity to hestastarch or corn.
DOSE: (NOTE: The dose of hetastarch required is determined by the clinical situation & the severity of the hypovolemia)
Adult: 500 - 1000mL IV, IO; more than 1500 mL of hetastarch is not admin d/t concerns that > doses can interfere with platelet function and promote bleeding.
Pediatric: 10 mL/kg dose IV; total daily dosage should not exceed 20 mL/kg.

Front 3

Hypertonic Saline (3% Saline)

Back 3

CLASS: Vol. expander, electrolyte sol.
ACTION: The hypertonic nature of this fluid pulls extravascular fluid into the vascular space. Hypertonic saline may therefore be used as a vol. expander in cases of hypovolemia or to reduce the edema of a swollen brain. 3% saline has an electrolyte concentration of 514mEq/L sodium.
INDICATION: Reduction of ICP resulting from traumatic brain injury, hypovolemic shock.
ADVERSE: > rate of bleeding, alterations of blood clotting ability, demyelination syndrome.
CONTRA: Pulmonary congestion, pulmonary edema, known sensitivity. Hypertonic saline should not be admin IO.
DOSE: (NOTE: available in several concentrations from 3% - 5%)
Adult: 250mL bag of Hypertonic saline infused slow IV over a 1 hr period.
Pediatric: 6.5 - 10mL/kg infused slow IV over a 2 hr period.

Front 4

Calcium Gluconate

Back 4

CLASS:Electrolyte Sol
ACTION: Counteracts the toxicity of hyperkalemia by stabilizing the membranes of cardiac cells, reducing the likelihood of fibrillation.
INDICATIONS: Hyperkalemia, hypocalcemia, hypermagnesemia.
ADVERSE: soft tissue necrosis, hypotension, bradycardia(c fast admin)
CONTRA: VF, digitalis toxicity, hypercalcemia.
DOSE: Supplied as 10% sol, therefore q Ml contains 100mg of calcium gluconate.
Adult: 500 - 1000mg IV, IO admin slowly @ rate of approximately 1 - 1.5mL/min; max dose 3G IV, IO.
Pediatric: 60 - 100 mg/kg IV, IO slowly over a 5 - 10 min period; max dose 3G IV, IO.

Front 5

Dextrose (Dextrose 50%, Dextrose 25%, Dextrose 10%)

Back 5

CLASS: antihypoglycemic
ACTION: > blood glucose concentration
INDICATION: Hypoglycemia
ADVERSE: Hypercalcemia, warmth, burning from IV infusion. concentrated sol may cause pain and thrombosis of the peripheral veins.
CONTRA: Intracranial & intraspinal hemorrhage, delerium tremens, sol is not clear, seals are not intact.
DOSE:
HYPERKALEMIA:
Adult: 25G of dextrose 50% IV, IO
Pediatric: 0.5 - 1G/kg IV, IO
HYPOGCLYCEMIA:
Adult: 1- - 25G of dextrose 50% IV (20 - 50mL of dextrose sol.)
Pediatric:
> 2 years: 2mL/kg of dextrose 50%
< 2 years: 2 - 4mL/kg of dextrose 10%

Front 6

Potassium Chloride

Back 6

CLASS: Electrolyte replacement
ACTION: replaces K Slight alterations in extracellular K levels can cause serious alterations in both cardiac and nervous function.
INDICATIONS: Hypokalemia.
ADVERSE: Hyperkalemia, AV block, cardiac arrest, GI bleeding, obstruction or perforation, tissue necrosis if the infusion infiltrates into the soft tissue.
CONTRA: Use with caution in pts with cardia arrythmias, renal failure, muscle cramps, severe tissue trauma.
DOSE:
Adult & Pediatric: Individualized according to pt serum K concentration.

Front 7

Sodium Bicarbonate

Back 7

CLASS: Electrolyte replacement
ACTION: Counteracts existing acidosis.
INDICATION: Acidosis, drug intoxication's ( barbiturates, salicylates, methyl alcohol)
ADVERSE: Metabolic alkolosis, hypernatremia, injection site reaction, Na and fluid retention, peripheral edema.
CONTRA: Metabolic alkolosis
DOSE:
METABOLIC ACIDOSIS DURING CARDIAC ARREST:
Adult: 1mEq/kg slow IV, IO, may repeat @ 0.5mEq/kg in 10 min
Pediatric: Same as adult
METABOLIC ACIDOSIS NOT ASSOCIATED WITH CARDIAC ARREST IS NOT RECOMMENDED.
** DO NOT ADMIN IN LINE WHERE ANOTHER Rx IS BEING GIVEN **