The Pharmacology Of Emergency Medicine, Paramedic

Front 1

ACTIDOSE AQUA

Back 1

CLASS-
Absorbent

PHARMACOLOGICAL EFFECTS-
Charcoal is inert and not absorbed.
Toxins are inactivated and excreted once bound by charcoal in gut.
Absorbs gas.

USES-
Ped TCA overdoses.
Ped poisionings, after vomiting.
Ped overdoses where ipecac is contraindicated.
When in doubt call poision control.

DURATION AND EXCRETION-
Charcoal absorbes toxins instantly.
Excreted through GI tract.

PREPERATIONS-
25g/120mL bottle
50g/240mL bottle

DOSE-
Peds (under 12yrs old- 1-2gm/kg P.O.
Shake bottle well, and rinse and administer rest.
Wait 30-60 min if ipecac was used.

SIDE EFFECTS-
Aspiration
GI obstruction, vomiting, constipation, diarrhea, black stools.

CONTRAINDICATIONS-
Ingested corrosive agents

PRECAUTIONS/INFO-
Have BLS in place.
Produces black stools.
Appropriate emptying container.

Front 2

ACTIDOSE WITH SORBITOL

Back 2

CLASS-
Absorbant with cathartic

PHARMACOLOGICAL EFFECTS-
Charcoal is inert and not absorbed.
Toxins are inactivated and excreted when bound by charcoal.
Sorbitol is sweet, easier to go down, and is an osmotic cathartic.

USES-
Adutlt TCA overdoses, ipecac is not given.
Adult posionings, after vomiting.
Overdoses where ipecac is contraindicated.
If in doubt, call poision control.

DURATION OF ACTION AND EXCRETION-
Charcoal absorbes toxins instantly.
Cathartic enhances excretion through GI tract.

PREPERATIONS-
25g/120mL bottle
50gm/240mL bottles

DOSE-
Adults (over 12)50-100gm P.O.
Shake well, rinse and administer rest.
If ipecac was used, wait 30-60 min after vomiting.

SIDE EFFECTS-
Excessive catharsis, fluid and electrolte problems, hypotension.
Aspiration.
GI obstruction, vomiting, constipation, black stools, diarrhea.

CONTRAINDICATIONS-
Rare intolderance to frutose.
Under 12 yrs old.
Dehydration.
Ingested corroseive agents.
Electrolyte problems.

PRECAUTIONS/INFO-
BLS in place and bowl for emptying.
Black diarretic stools for hrs.
Use cathartics intermittintly during multiple doses of charcoal therapy.
unknown if safe in pregnancy or breast feeding, risk vs benefit.
Use lavage tube if low LOC, with ET tube in place.
Use cautously if toxins interfere with peristalsis (opitates, anticholinergics).

Front 3

ADENOSINE (ADENOCARD)

Back 3

CLASS-
Antidysrhythmic

PHARM EFFECTS-
During myocardial hypoxia it casodilates coronary vascular beds and inhibits Ca+, protecting myocardium. Reduced inotrope, MVO2, automaticity in SA, AV, Purkinje.
Slows AV node.

USES-
Converts stable narrow SVT.
Can do for unstable narrow SVT till cardioverstion.
Wide tach.

DURATION OF ACTION AND EXCRETION-
Immediate onset, within 30 sec.
Half life less than 10 sec.
Taken up by RBCs.
Metabolized into inosine and AMP.

PREPERATIONS-
6mg/2mL vials
6mg/2mL or 12mg/4ml preload syringes.

ADULT DOSE AND ADMINISTRATION-
6mg IV slam followed by flush of 20mL NS.
2nd/3rd dose is 12mg, flush with 20mL NS.

Use large vein close to heart. Slam it in. Flush. Elevate extremity.

SIDE EFFECTS-
CNS- lightheadedness, dizziness, tingling in arms.
VC- facial flushing, palpitations, transient asystole, short lasting brady, tach, PVC, PACs.
GI- nausea, metallic taste.
RESP- chest pressure, hyperventilation, bronchospasm.

CONTRAINDICATIONS-
2nd or 3rd degree block and sick sinus synd.
A-fib or A-flutter or also with WPW.
Poison or drug induced tach.
Hypersensitivity.

PRECAUTIONS/INFO
Pts on Theophyline may need more.
It's not blocked by Atropine.
Monitor vitals and ECG.
Ok for preg, if really needed.
Can be given IO for peds.
Only give one treatment, then move on to next thing (cardioversion).

PED DOSE-
Don't do anything in pre hospital.
If established IV and see SVT, give 1st dose at 0.1 mg/kg (max 6mg). 2nd at 0.2mg/mL (max 12mg). Flush with 5mL or less.

Front 4

ALBUTEROL (PROVENTIL, VENTOLIN)

Back 4

CLASS-
Beta2 adrenergic bronchodilator

PHARM EFFECTS-
Relaxes smooth muscle of bronchi, uterus, vascular supply to skeletal muscle.
Pushes K+ into cells.

USES-
Asthma.
Allergic reations.
Bronchospasm from bronchitis and emphysema.
Croup.
Hyerperkalemia.

DURATION OF ACTION AND EXCRETION-
Onset 5-15 min.
Peak 30-60 min.
Lasts 3-6 hrs.
Metabolized by liver.
72% excreted in urine in 24 hrs.

PREPERATIONS-
Metered dose inhaler (MDI). Inhalation solutions, pre mixed (0.083%) or not (0.5%, must dilute with 2.5mL of NS).

ADULT DOSE AND ADMINISTRATION-
MDI: 4-8 puffs every 20 min, up to 4 hrs.
Nebulized: 3mL (2.5 mg) with 6-9 LPM over 5-15 min. Can repeat once. Use BVM in needed.
Severe: 2.5-5mg every 20 min for 3 doses, then 2.5-10mg every 1-4 hrs, or 10-15 mg by continuous neb.
For hyperkalemia: 10-20 mg nebulized over 15 min.

SIDE EFFECTS-
CNS- tremors, headache, dizziness, sweating, vertigo.
CV- tach, palpitations, peripherial vasodilation, angina.
EENT- dilated pupils, nasal congestion.
GI- nausea, vomiting, unusual taste.
METABOLIC- hypokalemia
RESP- bronchospasm, cough, wheezing.
OTHER- difficult urination, muscle cramps, allergic reaction.

CONTRAINDICATIONS-
Hypersensitivity

PRECAUTIONS/INFO-
Use with caution for pts with cardiovascular problems, convulsive problems, diabetes, hyperthryroid.
Caution with MAO inhibitors, or TCAs.
Beta receptor agents and Albuterol inhibit effects of both.
Preg, risk vs. benefit.
Repeated use may cause bronchospasm.
Measure flow before and after.

ANTIDOTE-
Lorpressor, but risk vs. benefit.

PED DOSE-
1.25-2.5 mg with 6-8 LPM over 5-15 min. May repeat once.Use BVM if needed.
Severe dose-0.15mg/kg every 20 min for 3 doses, then 0.15-0.3 mg/kg up to 10mg every 1-4 hrs, or 0.5mg/kg/hr by continuous nebulization.

NEONATAL DOSE-
using 0.083% solution
1.5mL and 1.5mL saline mixed with 6-8 LPM over 5-15 min. Can repeat once. Use BVM if needed.

Front 5

ALTEPLASE, tPA

Back 5

CLASS-
Fibrinolytic

PHARM EFFECTS-
Alteplase binds to fibrin in a thrombus and converts the plasminogen to plasmin. Plasmin then digests fibrin in clots. New clot selective.

USES-
Acute coronary syndrome.
1. Chest pain suggesting MI.
2. ST seg elevated, or new LBBB.
3. Time to therapy is less than 12 hrs.
Non hemorrhagic stroke (less than 3 hrs)
Pulmonary embolism.

CONTRAINDICATIONS-
For coronary pt.
Absolute: prior intercranial hemorrhage, active bleeding, suspected aortic dissection, closed head or facial trauma within 3 months, ischemic stroke with in 3 months, known malignamt intracranial tumor, known cerebral lesion.
Relative: HX of bad hyoertension or prior intracrainial problems, BP greater than 180 systolic or 110 diastolic, non compressible vascular punctures, pregnancy, recent bleeding, surgery, trauma, surrent use of anticoagulants, peptic ulcer.

Front 6

ATROPINE

Back 6

CLASS-
Parasympatholytic

PHARM EFFECTS-
Blocks actylcholine receptor sites. Increases HR, decreased salivary, GI, sweating.
Cardiac: Increases firing for SA node, increases automaticity of junctional and atrial tissue, increases conduction from SA to bundle of Hiss.
Systemic: Dilates pupils, dries mucus membranes or respiratory, decreases smooth muscle tone, contracts sphincters, inhibits insulin.

USES-
Symptomatic bradycardia.
Asystole.
PEA.
Organophosphate poisioning.
Ped RSI, prevents brady.

DURATION AND EXCRETION-
Rapid onset.
Peak in 2-4 min.
Cardiac lasts 30 min, systemic 4-6 hrs.
Metabolized by liver, excreted by kidney.

PREPERATIONS-
Prefilled syringe- 1mg/10mL (0.1mg/mL).
Multi dose vial 8mg/20mL (0.4mg/mL).

DOSE-ADULT
ET 2-3 mg diluted in 10mL of NS.
Bradycardia: 0.5 mg IV push. Repeat 3-5 min till desired effects.
Cardiac arrest: 1mg IV or IO. Every 3-5 min, up to three doses.
Organophosphate poisioning: 2mg IV every 3-5 till desired effects.

SIDE EFFECTS-
CNS: headeache, restlessness, excitements, confusion.
CV: tach, palpitations, angina.
EENT: "sandy eyes" blurred vision.
GI: dry mouth, thrist, nausea, vomiting.
GU: urinatry retention.
SKIN: hot, flushed

CONTRAINDICATIONS-
Glaucoma.
Tachycardica.
CHF.
2nd degree type II and 3rd degree HB with new wide complexes.

PRECAUTIONS/INFO-
Can increase MVO2.
Can cause short brady if too small a dose (less than 0.4mg)or too slow.
Monitor everything.

ANTIDOTE-
Physostigmine.

PED DOSE-
Bradycardia: 0.02mg/KG IV/IO. Can repeat once. ET route is 0.04-0.06mg/KG.
Min single dose 0.1mg.
Max single 0.5 child, 1mg for kid.
Max total dose-1mg child, 2mg for kid.
Organophosphate poisioning: 0.05mg/KG IV every 3-5 min till desired effects.
Cardiac arrest:UKN.
RSI: 0.01-0.02mg/KG IV.

Front 7

DOBUTAMINE (DOBUTREX)

Back 7

CLASS-
Beta 1 agonist

PHARM EFFECTS-
Increase CO and improved coronary artery perfusion with min increase in MVO2.

USES- Consider for pump problems. Low systolic BP with no s/s of shock (use Dopamine if shock is present).

DURATION AND EXCRETION-
Onset 2 min.
Peak within 10.
Half life is 2 min.
Metabolized by liver and excreted in urine.

PREP-
Vials with 250mg/mL.

DOSE ADULT-
2-20 mcg/kg/min, titrate to effect.

SIDE EFFECTS-
Chest pain, palpitations, hypertenstion, headache, nausea, vomiting, local tissue pain with infiltration.

CONTRAINDICATIONS-
Uncontrolled a-fib and flutter.
Hypersensitivity.
Known poision/drug induced shock.
Systolic BP lower than 100 with signs of shock.
Hypovolemia with out volume replacement.

PRECAUTIONS/INFO-
Try to avoid increasing HR by more than 10%.
Monitor everything.
Will not work with alkaline solutions.
May not work with Beta Blockers.

ANTIDOTE-none.

PED DOSE-
2-20mcg/KG/min.

Front 8

DOPAMINE (INTROPIN)

Back 8

CLASS-
Sympathomimetic

PHARM EFFECTS-
Increases CO by positive inotrope. Vasoconstrictor in skeletal muscles (in higher doses).

USES-
Hypotension with shock.
Bradycardia when Atropine and pacing doesn't work.

DURATION AND EXCRETION-
Onset 5 min.
Half life 2 min.
Duration less than 10, but if MAO inhibitors then it may be 1 hour.
Metabolized in liver and kidney.

PREPERATIONS-
Prefilled syringe 400mg in 5mL. Also comes premixed bag.

DOSE ADULT-
Hypotension: 2-10mcg/KG/min drip. Titrate to effect.

SIDE EFFECTS-
Anxiety, headache, nervousness, ectopic beats, tach, palpitations, angina, nausea, vomiting, dyspnea, pallor, necrosis and tissue sloughing around IV site.

CONTRAINDICATIONS-
Pheochromocytoma (tumor in medulla).
Hypovolemia without volume replacement.
Hypersensitivity.

PRECAUTIONS/INFO-
Tissue necrosis may happen, put Regitine with NS to limit it.
Monitor everything.
Doesn't work with alkaline things.
Don't use with v fib or uncorrected tachy dysrhythmias.

ANTIDOTE-
Reduce rate will it goes away.

PED DOSE-
Occasionally used. 5-20mcg/KG/min for decompensated shock. 2-20 for comensated.

Front 9

EPINEPHRINE

Back 9

CLASS-
Sympathomimetic and vasoconstrictor

PHARM EFFECTS-
Alpha: constricts bronchiols, peripheral, renal vessels.
Maybe coronary arteries.
Beta: Increased Inotrope, Chronotrope, Dromotrope= increased CO.
Decreased chemical release that bronchioconsrtict.
May go into v fib easier.

USES-
Cardiac arrest.
Asthma attacks.
Allergic reactions, and anaphylactic shock.
3rd line for brady.
Ped and neonatal brady.

DURATION AND EXCRETION-
Rapid onset via IV.
Duration 5-15 min.
Metabloized by COMT and MAO, excreted in urine.
Slow if given sub Q.

PREPERATIONS-
Prefilled 10mL at 0.1mg.mL =1 to 10.
Prefilled amL at mg.mL=1 to 1.
Vial 30mL at 1mg/mL=1 to 1.

DOSE ADULT-
Cardiac arrest: 1mg IV/IO (1to10) every 3-5 min. ET 2-2 1/2 times IV dose.
Asthma: 0.3-0.5 mg (1to1) SQ. may repeat in 20 min. Watch those older than 40.

Allergic reaction: 0.3-0.5 mg (1to1). If poor presentation use the 1 to 10 mix. May repeat in 20min.
Bradycardia: 2-10mcg per min IV infusion. Atropine, dopamine and TCA should be used first though.
Poision/drug shock: high dose up to 0.2 mg/KG.

SIDE EFFECTS-
Nervousness, headache, fear, panic, hallucinations, euphoria, palpitations, ECG changes, hypertension, tachycardia, syncope, nausea, vomiting, hyperglycemia, apnea, pulmonary edema, diaphoresis.

CONTRAINDICATIONS-
Hypertension.
Hypovolemic shock.
Glaucoma.

PRECAUTIONS/INFO-
Monitor everything.
May cause fetal distress.
May need more when given SQ to maintain effect.
May increase MVO2 demand.
Store out of direct sunlight.

ANTIDOTE- none

PED DOSE-
Cardiac arrest: 0.01 mg/KG of 1to10, IV or IO every 3-5 min. ET dose is 0.1 mg/KG of 1to1 with some NS.
Asthma: 0.01 mg/KG of 1to1.
Brady: 0.01 mgKG of 1to10 IV bolus, or ET 0.1 mg/KG of 1to1.

NEONATAL-
0.01-0.03 mg/KG of 1to10 IV, IO, ET. Repeat every 3-5min.

Front 10

VASOPRESSIN (PITRESSIN SYNTHETIC)

Back 10

CLASS-
Hormone-antiduretic (ADH)

PHARM EFFECTS-
Potent arterial and venous vasoconstrictor.
Fewer negative effects on heart than epi.
Decreases water loss by reducing urine output and sweating.

USES-
Cardiac arrest, may be a sub dose.
Esophageal varices.
Hemodynamic support in vasodilatory shock.

DURATION AND EXCRETION-
Rapid onset.
Lasts 1-20 min for cardiac arrest.
Metabolized in liver and kidneys, excreted in urine.

PREPERATIONS-
0.5 mL and 1 mL ampules and vials with contain 20 units/mL.

DOSE ADULT-
40 Units via IV, IO, or ET one time only.

SIDE EFFECTS-
Drowsiness, headache, flushing, increased BP, dysrythmias, myocardial ischemia, decreased CO, congestion, nausea, cramps, bronchiol constriction, gangrene from infiltraion, sweating, tremor.

CONTRAINDICATIONS-
Hypersensitivity.
Coronary heart disease.

PRECAUTIONS/INFO-
Use cautiously with seizure disorders, heart failure, fluid overload, childern,elderly, pregnant, pre/post op.
Could get water intoxication.

Front 11

OXYGEN

Back 11

CLASS-
a element

PHARM EFFECTS-
Decreases ventilatory and myocardial effort in ill and injured.
Increases alveolar oxygen tension.
Reduces extent of ST segment changes during MI.
Increased contractility.

USES-
Hypoxemia.
Decrease work of breathing and myocardial work.
O2 sat below 95% needs oxygen.
O2 sat below 85% needs oxygen and BVM.

PREPERATIONS-
Cylinders

DOSE AND ADMINISTRATION-
Cannula: 1-6
Simlpe mask: 6-10
Non rebreather: 10-15
BVM: 15

PRECAUTIONS/INFO-
Humidify for low flow.
Use adjunct.
Do not withhold O2 from COPD.
High flow for over 25 vent/min.
Peak flow should be measured before and after bronchiodilator.

Front 12

DEXTROSE 5% (D5W)

Back 12

CLASS-
Hypotonic water and carbs.

PHARM EFFECTS-
Glucose enters cells, turns into energy.
Hydrates.
Provides carbs for metabolization.
Quickly metabolized and turns into water.

USES-
Adult solution for TKO.
To mix for IV for all ages.
May be primary fluid in services.

DURATION AND EXCRETION-
Glucose stored in liver and muscle as glycogen.
Water excreted via skin, lungs, kidney.

PREPERATIONS-
50, 100, 250, 500, and 1,000 mL bags.

DOSE ADULT-
Depends on KG, condition, age.

SIDE EFFECTS-
Fluid overload.
Hyperglycemia.

CONTRAINDICATIONS-
Cardiac arrest.
High glucose levels.
Hypovolemia.
Burns.
Neurological dysfunction.
Risk for increased ICP.

PRECAUTIONS/INFO-
Avoid using in head injuries.
Do not admin excess.
Monitor everything.
Use sterile tech.

Front 13

LACTATED RINGERS

Back 13

CLASS-
Isotonic volume expander with electrolytes.

PHARM EFFECTS-
Expands blood volume.
Provides certain electrolytes.
Lactate in solution is converted to bicarb, helps mild acidosis.
pH is 6.0-7.5

USES-
Trauma, hypovolemia, burns, OB, medical emergencies, a lot of things.

DURATION AND EXCRETION-
Passes out rapidly, if normal renal function.

PREPERATIONS-
50, 100, 250, 500, 1,000 mL bags.

DOSE ADULT-
Depends, use formula.

SIDE EFFECTS-
Fluid overload.
CHF.

CONTRAIDICATIONS-
CHF.
Renal failure.

PRECAUTIONS/INFO-
Monitor everything.
Auscultate breath sounds for rales.
Use cautiously in kids.
Can be used for contra indications if only for TKO.
Burn formula may not be enough, look at urine output. 0.5-1mL/KG/hr.
When infused, 66% goes in interstital fluid in 1 hr.

PED DOSE-
TKO if needed.
20mL/KG IV of IO for fluid rescuscitation.

NEONATAL DOSE-
TKO if needed.
Hypovolemia: 10mL/KG IV syringe over 5-10 min.

Front 14

NORMAL SALINE

Back 14

CLASS-
Isotonic salt solution.

PHARM EFFECTS-
Expands volume

USES-
Trauma, burns, medical emergenices, dilution for meds, riirgation for wounds.

DURATION AND EXCRETION-
Passes out of blood stream rapidly, if renal is working right.

PREPERATIONS-
50,100,