Prehospital Emergency Pharmacology

Front 1

Oxygen class

Back 1

Gas

Front 2

Oxygen MOA

Back 2

Enters through respiratory system and transported by hemoglobin. Used to breakdown glucose into usable energy.

Front 3

Oxygen pharmacokinetics

Back 3

Onset: immediate

Peak effects: <1 min

Duration: <2 mins

Half-life: N/A

Front 4

Oxygen indications

Back 4

Hypoxia (as determined by physical exam and SPO2)

Front 5

Oxygen contraindications

Back 5

Non-hypoxic patients

Front 6

Oxygen precautions

Back 6

Titrate to avoid hyperoxia. Prolonged high concentration O2 to neonates can damage their eyes. >6L/min should be humidified. Monitor O2 with pulse oximetry.

Front 7

Oxygen side effects

Back 7

Hyperoxia can cause free-radical induction and oxidative stress.

Mucous membrane irritation. Nosebleeds.

Front 8

Oxygen dosage

Back 8

The least concentration that will correct the patient's hypoxia.

Front 9

Epinephrine class

Back 9

Sympathetic agonist, catecholamine

Front 10

Epinephrine MOA

Back 10

Acts on alpha and beta receptors. More profound effect on beta. Causes increase in HR, contractile force, electrical activity (in the myocardium), SVR, B/P and automaticity.

Front 11

Epinephrine pharmacokinetics

Back 11

(IV/ET)

Onset: <2 mins

Peak effects: <5 mins

Duration: 5-10 mins

Half-life: 5 mins

Front 12

Epinephrine indications

Back 12

Cardiac arrest

Severe anaphylaxis

Severe reactive airway disease

Calcium channel blocker or beta blocker overdose.

Front 13

Epinephrine contraindications

Back 13

Patients who do not require extensive cardiopulmonary resuscitation.

Front 14

Epinephrine precautions

Back 14

Protect from light.

Can be deactivated by alkaline solutions so flush line well between Epi and sodium bicarbonate.

Front 15

Epinephrine side effects

Back 15

Palpitations.

Anxiety.

Tremulousness.

Headache.

Dizziness

N/V

Increases myocardial O2 demand so can cause myocardial ischaemia.

Front 16

Epinephrine interactions

Back 16

Can be deactivated by sodium bicarbonate. Effects of Epi can be intensified by antidepressants.

Front 17

Epinephrine cardiac arrest dosage

Back 17

1.0 mg Epinephrine 1:10,000 IV or IO q 3-5 min prn

Front 18

Epinephrine anaphylaxis dosage

Back 18

0.3 mg Epinephrine 1:1,000 IM q 5 min prn to total max 0.9 mg

0.1 mg Epinephrine 1:10,000 SIVP/IO q 2 min to total max 1 mg

Infusion: (Anaphylaxis refractory to normal saline 500 mL administered and transport time greater than 30 minutes)IV/IO start at 1 mcg/min, increase by 1 mcg/min prn, titrate to systolic BP 90 mmHg or greater, to a maximum of 8 mcg/min

Front 19

Epinephrine bronchospasm dosage

Back 19

0.3 mg Epinephrine 1:1,000 IM q 20 min to total max of 0.9 mg

Front 20

Epinephrine CCB or BB OD

Back 20

Mandatory OLMC – Hypotensive beta blocker or calcium channel blocker overdose refractory to fluid boluses, glucagon and calcium chlorideInfusionIV/IO start at 2 mcg/min, increase by 1 mcg/min prn, titrate to systolic BP 90 mmHg or greater, to a maximum of 10 mcg/min

Front 21

Norepinephrine class

Back 21

Sympathetic agonist

Catecholamine

Front 22

Norepinephrine MOA

Back 22

Acts on alpha and beta receptors but more profound action on alpha. Potent peripheral vasoconstriction.

Front 23

Norepinephrine pharmacokinetics

Back 23

Onset: immediate

Peak effects: <1 min

Duration: 1-2 mins

Half-life: 3 mins

Front 24

Norepinephrine precautions

Back 24

Measure B/P q 5-10 mins to prevent dangerously high B/P.

Initiate fluid replacement prior to norepi.

Give through large vein as can caused necrosis if extravasates. Increases myocardial O2 demand. Typically induces renal and mesenteric vasoconstriction.

In septic pt, improves renal blood flow and urine output.

Front 25

Norepinephrine side effects

Back 25

Anxiety

Tremulousness

Headache

Dizziness

N/V

Bradycardia (reflex response to peripheral vasoconstriction)

Myocardial ischaemia

Front 26

Norepinephrine interactions

Back 26

Deactivated by alkaline solutions (sodium bicarb)

Administration with beta blockers can result in markedly elevated B/P

Front 27

Norepinephrine indications

Back 27

Hypotension (<70) not related to hypovolemia (i.e. septic shock)

Front 28

Norepinephrine contraindications

Back 28

Pts who are hypotensive from hypovolemia

Front 29

Norepinephrine dosage

Back 29

(Not AHS)

0.1-0.5 mcg/min to a max of 30 mcg/min

Front 30

Dopamine trade name

Back 30

Intropin

Front 31

Dopamine class

Back 31

Sympathetic agonist

Catecholamine

Front 32

Dopamine MOA

Back 32

Acts on alpha, beta and dopaminergic receptors. Effects are dose dependent. Increases B/P by acting an alpha and beta. Beta effect is positive inotropic. It does not increase myocardial O2 demand as much as other catecholamines and does not have same positive chronotropic effects. Acts on alpha receptors to cause peripheral vasoconstriction.

Front 33

Dopamine pharmacokinetics

Back 33

Onset: <5 mins

Peak effects: 5-8 mins

Duration: <10 mins

Half-life 2 mins

Front 34

Dopamine precautions

Back 34

Can induce or worsen supraventricular or ventricular arrhythmias. When dose is >20 mcg/kg/min, alpha effects dominate and acts like norepi. Do not administer if tachyarrhythmias or Vfib.

Front 35

Dopamine side effects

Back 35

Nervousness

Headache

Arrhythmias

Palpitations

CP

Dyspnea

N/V

Front 36

Dopamine interactions

Back 36

Deactivated by alkaline solutions.

Reduce dose if pt is taking MAOIs.

May cause hypotension if given cocomitantly with phenytoin (Dilantin)

Front 37

Dopamine indications

Back 37

Beta blocker/CCB OD

Heart block/bradycardia

Pulmonary edema

Sepsis

Shock

Front 38

Dopamine contraindications

Back 38

Hypovolemic shock where complete fluid resuscitation has not occurred

Pheochromocytoma (adrenal gland tumour)

Uncorrected tachyarrhythmias

V-fib

Monoamine oxidase inhibitor therapy within last 14 days

Hypersensitivity to sulphites

Front 39

Dopamine BB/CCB OD dose

Back 39

OLMC!

IV/IO start at 5 mcg/kg/min increase by 5 mcg/kg/min prn, titrate to systolic BP 90 mmHg or greater, to a maximum of 20 mcg/kg/min

Front 40

Dopamine bradycardia/heart block dose

Back 40

(Refractory to atropine and TCP)

IV/IO start at 5 mcg/kg/min, increase by 5 mcg/kg/min prn to a maximum of 10 mcg/kg/min

Front 41

Dopamine pulmonary edema dose

Back 41

(B/P <90)

IV/IO start at 5 mcg/kg/min, increase by 5 mcg/kg/min to a maximum of 20 mcg/kg/min; titrate to systolic BP 90 mmHg or greater

Front 42

Dopamine sepsis dose

Back 42

(Septic shock refractory to 2 fluid boluses)

IV/IO start at 5 mcg/kg/min, increase by 5 mcg/kg/min to a maximum of 20 mcg/kg/min; titrate to systolic BP 90 mmHg or greater

Front 43

Dopamine shock dose

Back 43

(Refractory to 2 fluid boluses)

IV/IO start at 5 mcg/kg/min, increase by 5 mcg/kg/min to a maximum of 20 mcg/kg/min; titrate to systolic BP 90 mmHg or greater

Front 44

Vasopressin MOA

Back 44

acts as a non-alpha-adrenergic vasoconstrictor through direct stimulation of smooth muscle receptors

Front 45

Vasopressin pharmacokinetics

Back 45

Onset: variable

peak effects: variable

Duration: 30-60 mins

Half-life: 10-20 mins

Front 46

Vasopressin indications

Back 46

used to replace 1st or 2nd dose of Epi in cardiac arrest. Used to increase peripheral vascular resistance during CPR

Front 47

Vasopressin contraindications

Back 47

pts with chronic nephritis, ischemic heart disease, PVCs, or advanced arteriosclerosis. When used in CPR, no contraindications.

Front 48

Vasopressin precautions

Back 48

Use with caution in pts with epilepsy, migraine, asthma, heart failure and angina.

Front 49

Vasopressin side effects

Back 49

blanching of the skin

abd cramps

nausea

hypertension

bradycardia

minor arrythmias

Front 50

Vasopressin interactions

Back 50

none in ACLS setting

Front 51

Vasopressin dosage

Back 51

40 units IV/IO. Single dose only. Replaces 1st or 2nd Epi in cardiac arrest.

Front 52

Sotalol class

Back 52

Beta-blocker

Class 2 and Class 3 antiarryhthmic properties

Front 53

Sotalol MOA

Back 53

blocks stimulation of B1 and B2

Front 54

Sotalol pharmacokinetics

Back 54

Onset: variable

Peak Effects: 2-3 hours

Duration: 24 hours

Half-Life: 7-18 hours

Front 55

Sotalol indications

Back 55

hemodynamically stable monomorphic V-tach

Front 56

Sotalol contraindications

Back 56

Pts with:

bronchial asthma

allergic rhinitis

severe sinus-node dysfunction

sinus brad

2nd and 3rd degree AV blocks (unless functioning pacemaker is present)

cardiogenic shock

severe or uncontrolled heart failure

hypersensitivity

prolonged QT interval

Front 57

Sotalol precautions

Back 57

may cause new or worsen existing arrhythmias. Such effects range from more frequent PVCs to development of more severe V-tach, V-fib and Torsades de pointes.

Front 58

Sotalol side effects

Back 58

CNS: fatigue, weakness, anxiety, dizziness, drowsiness, insomnia, memory loss, mental status changes, nervousness, nightmares

Resp: bronchospasm, wheezing

Cardiovascular: arrhythmias, bradycardia, CHF, pulmonary edema, orthostatic hypotension, peripheral vasoconstriction

Front 59

Sotalol interactions

Back 59

+general anesthesia, IV phenytoin or verapamil = additional myocardial depression

+digitalis glycosides = additional bradycardia

+ antihypertensives, ETOH, nitrates or MAOIs within 14 days = additional hypotension

May interact with class 1A antiarrhythmics (procainamide) and class 3 medications (amiodarone).

Front 60

Sotalol dosage

Back 60

1-1.5 mg/kg may be given at a rate of 10 mg/minute

Front 61

Metoprolol class

Back 61

Selective beta-blocker

Class 2 antiarrhythmic

Front 62

Metoprolol MOA

Back 62

Blocks both B1 and B2 receptors but is selective for B1 receptors. Has minimal (if any) effects on B2 at doses less than 100 mg.

Reduces HR, systolic B/P and cardiac output.

Inhibits tachycardia especially after AMI. Reduces the incidence of V-fib and chest pain in AMI pts.

Front 63

Metoprolol pharmacokinetics

Back 63

Onset: Immediate (IV)

Peak Effects: 20 mins

Duration: 5-8 hours

Half-Life: 3-4 hours

Front 64

Metoprolol indications

Back 64

AHS: Mandatory OLMC - stable (BP > 80 mmHg) and symptomatic (ALOC, CP, SOB and/or CHF) atrial fibrillation or atrial flutter

Other: AMI pts who are hypertensive and don't have contraindications, certain forms of polymorphic V-tach (associated with acute ischemia, familial long QT syndrome, catecholaminergic)

Front 65

Metoprolol contraindications

Back 65

AHS:

Hypersensitivity

Second and third degree AV blocks

Bradycardia less than 50 bpm

Systolic BP less than 100 mmHg

Severe acute heart failure

Bronchospastic COPD,

reactive airway disease

Recent (less than 24 hrs) cocaine use

Front 66

Metoprolol precautions

Back 66

Monitor B/P, pulse, ECG and resp status.

Watch for signs of CHF, bradycardia, shock, heart block or bronchospasm. If seen, discontinue.

Front 67

Metoprolol side effects

Back 67

bradycardia

hypotension

lethargy

CHF

dyspnea

wheezing

weakness

Front 68

Metoprolol interactions

Back 68

Do not administer to pts who have received IV CCBs.

Administer with caution to pts taking anti-hypertensives.

Front 69

Metoprolol dosage

Back 69

Mandatory OLMC

5 mg SIVP q 5 minutes prn to a total maximum of 15 mg or HR < 110 bpm or BP < 100 mmHg

Front 70

Salbutamol trade name

Back 70

Ventolin

Front 71

Salbutamol class

Back 71

sympathetic agonist

Front 72

Salbutamol MOA

Back 72

a selective B2 agonist. Causes prompt bronchodilation with minimal side effects.

Front 73

Salbutamol pharmacokinetics

Back 73

Onset: 5-15 mins

Peak effects: 1-1.5 hrs

Duration: 3-6 hrs

Half life: <3 hrs

Front 74

Salbutamol indications

Back 74

Bronchospasm

Anaphylaxis-induced bronchospasm

Front 75

Salbutamol contraindications

Back 75

Hypersensitivity

Tachydysrhythmias

Front 76

Salbutamol precautions

Back 76

Monitor pt's V/S.

Auscultate lung sounds before and after each dose.

Front 77

Salbutamol side effects

Back 77

Palpitations

Anxiety

Dizziness

Headache

Nervousness

Tremor

HTN

Arrhythmias

CP

N/V

Front 78

Salbutamol interactions

Back 78

Unpleasant side effects are more likely if given with other sympathetic agonists. B-blockers may blunt it's effects.

Front 79

Salbutamol dosage

Back 79

5 mg nebulized. Repeat PRN.

10 puffs via MDI spacer. Repeat q 5min PRN.

Front 80

Ipratropium bromide trade name

Back 80

Atrovent

Front 81

Ipratropium class

Back 81

Anticholinergic

Front 82

Ipratropium MOA

Back 82

A parasympatholytic used in Tx of resp emergencies. Causes bronchodilation and dries respiratory tract secretions. Works by blocking acetylcholine receptors thus inhibiting parasympathetic stimulation.

Front 83

Ipratropium pharmacokinetics

Back 83

Onset: varies

Peak effects: 1.5-2 hours

Duration: 4-6 hrs

Half-life: 1.5-2 hrs

Front 84

Ipratropium indications

Back 84

Anaphylaxis

Bronchospasm

Front 85

Ipratropium contraindications

Back 85

hypersensitivity

Front 86

Ipratropium precautions

Back 86

Monitor V/S.

Auscultate lung sounds before and after each dose.

Administer during rapid transport for pts in severe distress.

Prevent it from reaching pt's eyes.

Front 87

Ipratropium side effects

Back 87

Palpitations, anxiety, dizziness, HA, nervousness, rash, N/V

Front 88

Ipratropium interactions

Back 88

none in the emergency setting

Front 89

Ipratropium dosage

Back 89

500 mcg nebulized. Repeat prn in anaphylaxis. Repeat x2 in bronchospasm.

Front 90

Methylprednisolone trade name

Back 90

Solu-medrol

Front 91

Methylprednisolone class

Back 91

Corticosteroid and anti-inflammatory

Front 92

Methylprednisolone MOA

Back 92

Potent anti-inflammatory properties. Inhibits the release of substances which cause inflammation (cytokines, interleukin, interferon). Inhibits the synthesis of pro-inflammatory enzymes.

Front 93

Methylprednisolone pharmacokinetics

Back 93

Onset: varies

Peak effects: 4-8 days

Duration: 1-5 weeks

Half-life: 3.5 hours

Front 94

Methylprednisolone indications

Back 94

NOT AHS

severe anaphylaxis, asthma or COPD, and urticaria.

Front 95

Methylprednisolone contraindications

Back 95

none in emergency setting

Front 96

Diphenhydramine trade name

Back 96

Benadryl

Front 97

Diphenhydramine class

Back 97

antihistamine

Front 98

Diphenhydramine MOA

Back 98

a H1 (histamine 1) receptor antagonist blocking histamine release. It also has anticholinergic activity.

Front 99

Diphenhydramine pharmacokinetics

Back 99

Onset: 10-15 mins (IV)

Peak effects: 1 hr

Duration: 6-8 hrs

Half-life: 1-4 hrs

Front 100

Diphenhydramine indications

Back 100

Allergic reaction, anaphylaxis, headache (prevention or relief of extrapyramidal reaction or agitation due to metoclopramide), nausea and vomiting (prevention or relief of extrapyramidal reaction or agitation due to metoclopramide).

Front 101

Diphenhydramine contraindications

Back 101

hypersensitivity to diphenhydramine or dimenhydrinate.

Front 102

Diphenhydramine precautions

Back 102

Use with caution in pts with asthma, narrow-angle glaucoma, benign prostatic hypertrophy and in nursing mothers or neonates.

Front 103

Diphenhydramine side effects

Back 103

Drowsiness, dizziness, headache, fatigue, palpitations, euphoria, urinary frequency

Front 104

Diphenhydramine interactions

Back 104

Furosemide (hypotension)

Front 105

Diphenhydramine dosage

Back 105

Allergic reaction: 50 mg PO or 1mg/kg IM/SIVP to a single max dose of 50mg. NO repeat.

Anaphylaxis: 1 mg/kg IM/SIVP/IO to a single max of 50 mg. NO repeat.

Headache: 25 mg SIVP or deep IM. NO repeat.

N/V: 25 mg SIVP/IM. NO repeat

Front 106

Dexamethasone trade name

Back 106

Decadron

Front 107

Dexamethasone class

Back 107

Corticosteroid and anti-inflammatory

Front 108

Dexamethasone MOA

Back 108

Potent anti-inflammatory properties. Inhibits the substances that cause inflammation (cyotkines, interleukin, interferon) and also inhibits the synthesis of pro-inflammatory enzymes.

Front 109

Dexamethasone pharmacokinetics

Back 109

Onset: Immediate.

Peak effects: 1-2 hrs

Duration: 2.75 days

Half-life: 3-4.5 hrs

Front 110

Dexamethasone indications

Back 110

anaphylaxis, bronchospasm

Front 111

Dexamethasone contraindications

Back 111

Systemic fungal infections

Hypersensitivity to dexamethasone or other steroids.

Hypersensitivity to benzyl alcohol or sodium sulfite.

Patients with penumonia and any symptoms of SIRS

Front 112

Dexamethasone precautions

Back 112

Only give single dose. Effects will appear 2-4 hrs after dose.

Front 113

Dexamethasone interactions

Back 113

none in the emergency setting

Front 114

Dexamethasone side effects

Back 114

fluid retention, CHF, HTN, abdominal distension, vertigo, HA, N/V, malaise and hiccups

Front 115

Dexamethasone dosage

Back 115

8 mg IM/SIVP/IO. NO repeat