Drug Box 2-1b

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jjsdad1
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116842
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Drug Box 2-1b
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2011-11-14 21:19:53
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Drug Box 2-1b
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  1. Dopamin

    Generic Name
    dopamine
  2. Dopamine

    Brand Name
    Intropin
  3. Dopamine

    Class
    Sympathomometic
  4. Dopamine

    Mechanism of Action
    • * 1-2 μg/kg/min: Acts on dopaminergic receptors to stimulate cerebral, renal and mesenteric vasculature to dilate; HR and B/P are usually unchanged; may increase urine output
    • * 2-10 μg/kg/min: ß1 stimulant action is primary effect (increases cardiac output and partially antagonizes the α-adrenergic-mediated vasoconstriction. Overall effect is increased cardiac output and only modest increase in systemic vascular resistance (SVR)
    • * 10-20 μg/kg/min: α-adrenergic effects predominate resulting in renal, mesenteric and peripheral arterial and venous vasoconstriction with marked increase in SVR, pulmonary vascular resistance and further increased preload
    • * > 20 μg/kg/min: Produces hemodynamic effects similar to norepinephrine; may increase HR and O2 demand to undesirable limits
  5. Dopamine

    Indications and Field Use
    • * Symptomatic bradycardias.
    • * Hemodynamically significant hypotension in the absence of hypovolemia (Cardiogenic or septic shock only after fluid admin.; assess breath sounds first).
  6. Dopamine

    Contraindications
    • * Hypovolemic shock (relative)
    • * Pheochromocytoma
    • * MAO inhibitors, such as Marplan, Nardil, or Parnate
  7. Dopamine

    Adverse Actions
    • * CV: Cardiac arrhythmias may occur due to increased myocardial oxygen demand (usually tachydysrhythmias), hypertension, hypotension at low doses.
    • * GI: Nausea and vomiting
    • * GU: Renal shutdown (at higher doses)
    • * Other: Extravasation may cause tissue necrosis
  8. Dopamine

    Adult Dosage
    • * (dosage range 2-10 μg/kg/min)
    • * Preparation: (If premixed not carried) Add 400 mg/ 250 ml NS or Dextrose = 1600 μg/ml.
    • * Bradycardia: Start at 5 μg/kg/min
    • * Shock: cardiogenic or septic (non-hypovolemic)
    • BP < 70 systolic: Start drip at 5 μg/kg/min
    • BP > 70 systolic: Start drip at 2.5 μg/kg/min
  9. Dopamine

    Pediatric Dosage
    • * 2-10 μg/kg/min for circulatory shock or shock unresponsive to fluid administration.
    • * To prepare infusion for small children: 6 x body wt. in kg = mg added to NS to make 100 ml. With this mixture 1 ml/hr delivers 1 μ/kg/min; titrate to effect.
  10. Dopamine

    Bonus Points
    Special Notes
    • * Always monitor drip rate, never run "wide open".
    • * An infusion pump is required for interfacility transports; a minimum of microdrip tubing is required for field use.
    • * It is important to remember that even in low dose ranges dopamine elevates pulmonary artery occlusive pressure and may induce or exacerbate pulmonary congestion despite a rise in cardiac output.
  11. Epinephrine HCl

    Generic Name
    epinephrine HCl
  12. Epinephrine HCl

    Brand Name
    Adrenalin
  13. Epinephrine HCl

    Class
    Sympathomimetic
  14. Epinephrine HCl

    Mechanism of Action
    • * Pharmacological Effects: Direct acting α and ß agonist; α-bronchial, cutaneous, renal, and visceral arterial constriction (increased systemic vascular resistance)
    • * ß1 = positive inotropic and chronotropic actions (increases myocardial workload and oxygen requirements), increases automaticity and irritability
    • * ß2 = bronchial smooth muscle relaxation and dilation of skeletal vasculature. Other: blocks histamine release
    • * Clinical Effects: Cardiac Arrest - increases cerebral and myocardial perfusion pressure; increases systolic and diastolic blood pressures; increases electrical activity in the myocardium; can stimulate spontaneous contractions in asystole.
    • * Bradycardia -increases heart rate, increases BP; Bronchospasm/Anaphylaxis-reverse signs/symptoms
  15. Epinephrine HCl

    Indications and Field Use
    • * Cardiac arrest - VF/Pulseless VT; asystole; PEA (First line pharmacologic agent for any pulseless dysrhythmia in cardiopulmonary arrest).
    • * Severe bronchospasm, i.e., bronchiolitis, asthma, croup or anaphylaxis.
    • * Bradycardia, refractory with profound hypotension, monitored patient only.
    • * Hypotension unresponsive to other therapy, monitored patient only.
  16. Epinephrine HCl

    Contraindications
    None known for cardiac arrest. Hypothermia is a relative contraindication
  17. Epinephrine HCl

    Advers Actions
    • * Cardiovascular: Hypertension, ventricular dysrhythmias; tachycardia; angina
    • * Central Nervous System: Anxiety, agitation
    • * GI: Nausea/vomiting
  18. Epinephrine HCl

    Adult Dosage
    • * Pulseless Arrest – 1 mg of 1:10,000 solution IV/IO; repeat every 3 - 5 minutes or;
    • * ET: Give 2-2.5 mg via the ET. May use 1:10,000 or dilute 1:1000 to equal 10 mL via ET tube for adult. 2 mg 1:1,000 epi. with 8 mL NS in a 10 mL syringe
    • * Infusion for Hypotension or Symptomatic Bradycardia: 1 mg added to 500 mL of NS administered at 1 mcg/min titrated to desired hemodynamic response (range 2-10 mcg/min); not first-line therapy.
    • * Anaphylaxis and asthma: Give 0.3 - 0.5 mg of 1:1,000 solution IM (preferred), SC, or inject SL, may repeat every 15 to 20 minutes; in extreme cases only, may be asked to use 1:10,000 solution and give 0.1 mg every 5 minutes IV/IO or continuous IV/IO infusion of 1-4 mcg/min to prevent multiple injections.
  19. Epinephrine HCl

    Pediatric Dosage
    • * Pulseless Arrest or Refractory Bradycardia: 0.01 mg/kg of 1:10,000 IV/IO repeat every 3 - 5 minutes, maximum single dose 1 mg.
    • * ET: 0.1 mg/kg of 1:1,000; mix with NS to a total of 3-5 mL in syringe; repeat every 3 - 5 minutes, maximum single dose 1 mg.
    • * Asthma/anaphylaxis: Use 1:1,000 solution; give 0.01 mg/kg IM (preferred), SC (maximum single dose of 0.5 mg/dose).
    • * IV Infusion: 0.1-1 mcg/kg/min; prepare for children 0.6 x body wt. in kg = mg added to NS to make 100 mL. Delivery of 1 mL/hr delivers 0.1 mcg/kg/min.
    • * Croup: 3 mg 1:1,000 mixed in 3 mL NS via SVN.
  20. Epinephrine HCl

    Neonatal Dosage for First 12 hours of life
    • * Initial and Repeat Dose for Cardiac Arrest/ Refractory Bradycardia: 0.01-0.03 mg/kg IV/IO of 1:10,000 every 3-5 minutes
    • * ET: 0.1 mg/kg of 1:10,000 every 3 – 5 minutes if neonate has no vascular access
  21. Nitroglycerin

    Generic Name
    nitroglycerin
  22. Nitroglycerin

    Brand Name
    • * Nitrostat
    • * Tridil
  23. Nitroglycerin

    Class
    • * Vasodilator
    • * Organic Nitrate
    • * Antianginal
  24. Nitroglycerin

    Mechanism of Action
    • * Smooth muscle relaxant acting on vascular, uterine, bronchial, and intestinal smooth muscle
    • * Reduces workload on the heart by causing blood pooling (decreased preload)
    • * Arteriolar vasodilation (decreased afterload)
    • * Coronary artery vasodilation
    • * Increases blood flow to myocardium
    • * Decreases myocardial O2 demand
  25. Nitroglycerin

    Indications and Field Use
    • * Angina
    • * Myocardial Infarction
    • * Congestive heart failure with pulmonary edema
  26. Nitroglycerin

    Contraindications
    • * Hypovolemia
    • * Increased Intra cranial pressure
  27. Nitroglycerin

    Adverse Actions
    * CV: Hypotension, reflex tachycardia, bradycardia, decreased coronary perfusion at high doses (secondary to hypotension), headache secondary to dilation of meningeal vessels.
  28. Nitroglycerin

    Adult Dosage
    • * SL for Chest pain: 0.4 mg sublingual tablets or spray. May be repeated x2, every 5 minutes as long as BP remains >90
    • * SL for Pulmonary edema: 0.4 mg sublingual tablets or spray. May be repeated x2 every 5 minutes as long as BP remains >90
  29. Nitroglycerin

    Pediatric Dosage
    * Not USED
  30. Nitroglycerin

    Bonus Points
    Incompatibilities / Drug Interactions
    • * Other vasodilators
    • * Viagra, Cialis, and Levitra
  31. Nitroglycerin

    Bonus Points
    Special Notes
    • * NTG is heat and light sensitive; stock rotation assures fresh supply.
    • * SL: Cautiously administer NTG to a patient who has never received it, consider establishing an IV prior to administration.
    • * Closely monitor vital signs, cardiac rhythm.
    • * Bradydysrhythmias and hypotension usually respond to Trendelenburg position; atropine and vasopressors may be administered if needed.

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