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54 Cards in this Set

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Epinephrine
(Class)
Sympathomimetic; Catecholamine
Epinephrine
(Action)
-Stimulates both alpha & beta (1 & 2) adrenergic receptors
-Produces bronchodilation
-Increases H.R. and force of contraction
-Lowers defibrillation threshold
-Larger mycardial workload because of alpha and beta
-Onset < 2 min IVP, 3-10 min SQ, < 1 min ET
Epinephrine
(Use)
-Bronchospasm associated w/ asthma refractory to Beta inhalation agents
-Severe anaphylactic shock
-Cardiac arrest
-Symptomatic bradycardia
a)1st line for peds.
b)secondary vasopressor for adult (w/ dopamine)
Epinephrine
(Side Effects)
CNS: Headache; Nervousness; Tremor

Cardiovascular: Angina; Ectopics, HypoT (low dose), hyperT (high does); palpitations, tachycardias

GI: Nausea; Vomiting
Epinephrine
(contraindicated)
Absolute: Hypersensitivity; Uncorrected tachycardia

Relative: over age 40
Epinephrine
(Precautions)
-Protect drug from light
-Administer w/ caution to elderly
-Must ventilate 100% O2
Epinephrine
(Drug interactions)
-MAOI and antidepressants intensify and prolong epi's effects
-NaHCO3 and Ca may inactivate epi
-May increase ectopics in patients who have digitalis toxicity
-beta blockers may inhibit the effects of epi
Epinephrine
(prep)
-1:10,000 1mg/10ml preload (0.1mg/ml)
-1:1000 1mg/ml ampule and preload
-30mg/30ml
Epinephrine
(Adult Bronchospasm)
0.3 to 0.5mg 1:1000 SQ. May repeat q 5 to 20 min p.r.n up to three times (4 doses)
Epinephrine
(Adult Anaphylaxis)
0.1 to 0.5mg 1:10,000 IV. Titrate to effect. May be repeated q 5 min p.r.n. May also be admin. rate of 1 to 4ug/min
Epinephrine
(Adult Cardiac Arrest)
1mg 1:10,000 IV or 2 to 2.5mg 1:1000 ET diluted to 10 ml repeated q 3-5 min
Epinephrine
(Adult Infusion)
Mix: 1mg in 250 ml to yield a 4ug/ml solution
Admin: 2 to 10 ug/min. Titrate to effect
Epinephrine
(Peds Bronchospasm)
0.01 mg/kg 1:1000 SQ. May repeat q 5 to 20 min p.r.n. up to 3 times (4 doses). 0.5 mg is the max single dose
Epinephrine
(Peds Anaphylaxis)
0.01 mg/kg 1:10,000 IV. May be repeated q 5 min. p.r.n.
Epinephrine
(Peds Cardiac Arrest)
1st dose: 0.01 mg/kg 1:10,000 IV or 0.1 mg/kg 1:1000 ET diluted to 5 ml. Move to subsequent dose in 3 to 5 min p.r.n.

Subsequent doses: 0.1mg/kg 1:1000 via all routes repeated q 3 to 5 min p.r.n.
Epinephrine
(Peds Bradycardia)
0.01 mg/kg 1:10,000 IV
Epinephrine
(Peds Infusion)
Mix: 0.5 mg in 250 ml to yield a 2ug/ml solution

Admin: 0.1 to 1ug/kg/min. Titrate to effect
Epinephrine
(Route)
SQ,ET,IV, and IVPB
Atropine Sulfate
(class)
Parasympatholytic; Anitcholinergic
Atropine Sulfate
(Action)
-Blocks acetylcholine receptor site, thereby decreasing the action of PS nerve fibers
-Enhances HR and atrioventricular conduction
-Decreases peristalsis
-Increases CNS stimulation
-Onset of action is immediate
Atropine Sulfate
(side effects)
Dilated pupils, drowsiness, chest pain, hypotension, palpitations, tachycardia, dry mouth, flushed hot dry skin
Atropine Sulfate
(Use)
-bradycardias or high degree heart blocks which are heodynamically unstable
-Asystole
-Pulseless elec. act. <60BPM
-Organophosphate poisoning
Atropine Sulfate
(contra indicated)
Absolute: Hypersensitivity
Relative: Glaucoma;Suspected or evolving AMI
Note: There are no con. ind. in the settings of op, asystole, PEA
Atropine Sulfate
(Drug Interactions)
-Anticholinergics may increase vagal blockade
-Antacids slow the absorption of antocholinergics
-Can be used in conjunction w/ Succinycholine to reduce salivation & potential for bradycardia during intubation
Atropine Sulfate
(Preperations)
-1mg/10ml preload is the most common
-2mg Auto-injector
-400 mcg/ml Multi dose Vial
Atropine Sulfate
(Adult bradycardia)
-0.5 to 1 mg IV, or 1-2 mg ET. Repeat q 3-5 m to a max of 0.04 mg/kg
Atropine Sulfate
(Adult Asystole/PEA)
1mg IV or 2mg ET. Repeat every 3-5 to a max of 0.04 mg/kg
Atropine Sulfate
(Adult OGP)
2mg IV or IM initially, if no improvement within 5 min, then 2-6mg IV. Call base hosp. for further orders if no protocol.
Atropine Sulfate
(Peds cardiac)
0.02 mg/kg IV or IO. Repeat q 3-5 min to a max dose of 0.04 mg/kg

Min Single Dose: 0.1mg
Max Single Dose: 1mg
Atropine Sulfate
(Peds OGP)
0.02 mg/kg IV or IO. Repeat in 3-5 min with 0.5 mg/kg. Contact medical control for further orders p.r.n
Atropine Sulfate
(Route)
IV;ET
Atropine Sulfate
(Precautions/Info)
-Dries up mucous plugs
-Paradoxical bradycardia may occur if dose is <0.5 mg in the adult, dose is <.1mg in child, or if given slowly.
-Excessive doses can cause delirium, coma, v-fib, or v-tach
-Use w/ caution in patients w/ known or suspected MI cuz it may increase the size of the infarct or promote arrhythmias
-May worsen 2nd degree type II and 3rd degree blocks. Go straight to transcutaneous pacing. If TCP is not available, use atropine w/ caution
-For ET admin, dilute with NS to a vol. of 10ml for adult, and 5ml for peds.
Glucagon
(Class)
Anti-hypoglycemic
Glucagon
(Action)
-A pancreatic hormone that stimulates the breakdown of glycogen in the liver
-Inhibits the conversion of circulating glucose to glycogen
-Indirectly raises blood glucose levels
-Relaxes GI smooth muscle
-Stimulates the release of catecholamines
-Onset is within 5-20 min.
Glucagon
(Use)
-Hypoglycemia/Insulin OD when an IV cannot be est.
-To relax the esophogus in cases of food obstruction
-Beta Blocker OD (requires high dose)
Glucagon
(Side effects)
CNS: Dizziness; lightheadedness
Cardiovascular:HyperT; HypoT; Tach
GI: Nausea, Vomiting
Other: Allergic RXN
Glucagon
(Contra indicated)
Absolute: Hypersensitivity to proteins

Relative: Alcoholics or malnourished patients
Glucagon
(Precautions)
-Use w/ caution in patients w/ pheochromocytoma
-Use w/ caution w/ cardiovascular disease
-Blood glucose levels should be taken if possible before admin.
Glucagon
(drug interaction)
-A precipitate will form if glucagon is mixed w/ chloride solutions
-Hyperglycemic effects can be increased and prolonged if it is used along w/ epi.
Glucagon
(Prep)
-1mg of white powder in vial #2, and 1ml of fluid diluent in vial #1
-Note: Reconstitute only w/ diluent provided
Glucagon
(Adult)
-Hypoglycemia: .05-1mg. May repeat q 20 min for a total of 3 doses
-Beta Blocker: 1mg. May repeat q 20 min p.r.n
Glucagon
(peds)
-Hypoglycemia: 0.03 mg/kg
-Beta Blocker: 0.25u/kg to max of 1 unit
Note: Rarely used in out of hospital setting
Glucagon
(route)
IM
Dextrose 50% in Water
(class)
hyperglycemic; carb
Dextrose 50% in Water
(action)
-a sugar that is rapidly used by the body for E and metabolism
-Quickly elevates blood glucose levels
-Provides short term osmotic diuresis
-Onset of Action is immediate
-Hyperkalemia
Dextrose 50% in Water
(use)
Known hypoglycemia. Altered level of consciousness of unknown etiology. Seizures of unknown etiology.
Dextrose 50% in Water
(side effects)
CNS: May cause neurologic symp. in the alcoholic patient

Cardiovascular: May aggravate hyperT and congestive heart failure

Other: Tissue necrosis if site infiltrates
Dextrose 50% in Water
(contraindications)
Absolute: Intracranial hemorrhage
Relative: None
Dextrose 50% in Water
(Precautions)
-Use the largest vein possible
-Aspirate the syringe at least 3x during the push to ensure patency of the route
-Thiamine should be admin. to the alcoholic patient before drug to prevent Wernicke's encephalopathy
-Blood glucose levels should be taken whenever possible
-Never withold if sever hypogylcemia is suspected.
Dextrose 50% in Water
(Interactions)
None in the emergency setting
Dextrose 50% in Water
(prep)
25g/50ml preload (D50)
12.5g/50ml preload (D25)
Dextrose 50% in Water
(adult)
25g May be repeated q 5 min. p.r.n as indicated by blood glucose levels.
Dextrose 50% in Water
(peds)
0.5g/kg D25 (D10 for neonates) May be repeated q 5 min. p.r.n as indicated by blood glucose levels
Dextrose 50% in Water
(route)
IV