Cumulative Drug - Summary Form

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Author:
cjl410
ID:
175615
Filename:
Cumulative Drug - Summary Form
Updated:
2012-10-04 20:31:14
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Cumulative Drug Summary Form
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Description:
Cumulative Drug - Epinephrine Atropine Dopamine ASA Pitocin Glucagon Lidocaine Verapamil Adenosine
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  1. What is the generic name for Epinephrine?
    Epinephrine
  2. What is the brand name for Epinephrine?
    Adrenalin
  3. What is the class for Epinephrine?
    • Sympathomimetic
    • Adrenergic
  4. What is the mechanism of action for Epinephrine?
    Alpha and Beta agonist     

    • Alpha -1 agonist         
    • Peripheral vasoconstriction increasing systemic vascular resistance     

    • Beta-1 agonist         
    • Positive inotrope                   
    • Positive chronotrope         
    • Postivive dromotrope         
    • Reduces defribrillation threshhold         
    • Renin release from kidneys     

    • Beta -2 agonist         
    • Bronchial smooth muscle relaxation         
    • Skeletal vasculature dilation         
    • Block histamine release
  5. Indications and field use for Epinephrine?
    • Cardiac arrest, all rythms (1st drug for dead people)     
    • Increases SVR increasing cerebral & myocardial perfusion pressure during CPR     
    • Positive dromotrope can increase success rate of defibrillation     
    • Positive dromotrope can increase electrical activity in heart in asytole

    • Refractory bronchospasm not relieved with other medication
    • Bronchial smooth muscle relaxation increases bronchial airway diameter

    • Anaphylaxis     
    • Increased SVR increases blood pressure     
    • Peripheral vasoconstriction reduces edema     
    • Bronchial smooth muscle relaxation increases bronchial airway diameter     
    • Histamine release from mast cells inhibited
    • Hypotension not relieved by other therapy     
    • Increased SVR increases blood pressure     
    • Positive chronotropic and inotropic effects increases cardiac output

    • Croup     
    • Peripheral vasoconstrition reduces edema
  6. Dosage for Epinephrine?
    Dosage via IV/IO, IM, Sub-Q, SVN, or ETT

    • Cardiac arrest, all rhythms (for dead people)
    • Epi 1mg of 1:10,000 IV push with 20cc NS flush q 3-5 minutes, no limit         
    • ETT route Epi 2mg of 1:1,000 diluted in syringe with 8cc

    • Anaphylaxis, Refractory bronchospasm
    • Epi 0.3mg of 1:1,000 IM

    • Infusion for hypotension     
    • Epi 1, 2, or 4mg 1:1,000 added to 250cc NS at 2-10mcg/min     
    • Use after other treatment
  7. Contraindications for Epinephrine?
    • None for normal cardiac arrest     
    • Hyperthermia arrest (relative)
    • Adult with pulse, age <35 (relative, patch)
  8. What is the generic name for Verapamil?
    Verapamil HCL
  9. What is the brand name for Verapamil?
    • Calan
    • Isoptin
  10. What is the class for Verapamil?
    Calcium channel blocker
  11. Mechanism of action for Verapamil?
    • Blocks calcium channels in myocardial cell slowing influx of calcium ions     
    •   Reduces force of contraction     
    •   Slows heart rate     
    •   Slows AV node conduction     
    •   Slows ventricular response from atrial fibrillation/atrial flutter     
    •   Interrupts reentry in SVT
  12. Indications and field use for Verapamil?
    • Rapid ventricular response from A-Fib/A-Flutter     
    •    Slows influx of calcium ions reducing ventricular response

    • SVT refractory to Adenosine (no WPW)     
    •    Slows influx of calcium ions reducing heart rate and interrupts reentry pathways
  13. Dosage for Verapamil?
    All doses are VERY slow IV push over 2-5 minutes with the patient supine

    Verapamil 2.5-5.0mg VERY slow IV push over 2-5 minutes.  May repeat in 15-30 minutes with 5-10mg
  14. What are the contraindications for Verapamil?
    • Wolf-Parkinson-White (WPW)
    • Any wide QRS tachycardia
    • Hypotension
    • Cardiogenic shock
    • Concurrent IV beta-blocker use
  15. Generic name for Aspirin?
    Acetylsalicylic Acid, Aspirin
  16. Brand names for Aspirin:
    Aspirin, Bayer, Bufferin, Anacin, Children's flavored chewable aspirin
  17. Class for Aspirin:
    Analgesic
    Anti-Thrombotic
    Anti-Pyretic
    Anti-Inflamatory
  18. What is the mechanism of Action for Aspirin:
    Blocks Thromoxane 2
    Decreased platelet aggregation and thrombus formation
    Use in management of MI
  19. Indications and Field Use of Aspirin:
    Chest pain
    Signs/Symptoms or MI
    ECG suggestive of MI
    Unstable angina
  20. Contraindications of Aspirin:
    Bleeding ulcer
    Hemorrhagic state
    Hemophilia
    Known allergies to salicylates
    Childern or adolescents
  21. Adult Dosage with Aspirin:
    Cardiac: 325 (4 x 81mg pediatric chewable tabs), chew or swallow

    • Peds
    • Not indicated for prehospital
  22. Generic name for Adenosine?
    Adenosine
  23. Brand name for Adensoine?
    Adenocard
  24. Class of Adenosine?
    Antiarrhthmic
  25. Mechanism of Action of Adenosine?
    Slows Sinus rate
    Slows conduction through the AV node
         Interrupts reentrant pathways
  26. Indications and field use for Adenosine?
    SVT refractory to vagal maneuvers (including WPW syndrome)
    Why?
         Interrupts reentry pathways

    Wide QRS tachycardia of unknown origin refractory to lidocaine/amiodarone
    Why?
         Interrupts reentry pathways
  27. Dosage for Adenosine?
    All dosage VERY rapid IV push over 1-3 seconds followed by 20cc NS flush with patient supine.  
         16 or 18 guage in the AC
         Use injection port closest to hub
         Have ECG printing during administration

    Adult
    6mg rapid IV push with 20cc NS flush.  May repeat twice every two minutes wtih 12 mg
  28. Contraindications of Adenosine?
    Known allergy/hypersensitivity
    Sick sinus syndrom or 2nd/3rd degree block
    Asthma
    Carbamazepine (Tegretol) use
    Known A-Fib/A-Flutter
    Pregnancy (patch)
    Heart transplants (reduce dose)
  29. Generic name for Lidocaine?
    Lidocaine HCL
  30. Brand name for Lidocaine?
    Xylocaine
  31. Class of Lidocaine?
    Sodium channel blocker
    Antiarrythmic
  32. Mechanism of Action for Lidocaine?
    Blocks sodium channels decreasing automaticity
         Prolongs phase 4 depolarization 
         Terminates re-entry
         Increases v-fib threshhold
  33. Indications and Field Use for Lidocaine?
    Cardiac arrest
         Ventricular fibrillation/pulsless Ventricular Tachycardia only

         Why?
              Blocks sodium channels decreasing depolarization

    Supression of ventricular arrythmias
         Ventricular techycardia with pulse
         Wide QRS tachycardia of unknown origin
         Prevent recurrance of VFib/VTach
         Frequent PVCs
              >6/min
              R on T
              Couplets
              Multiform
              Why?
                   Blocks sodium channels decreasing depolarization
  34. Dosage for Lidocaine?
    IV push, ETT, or infusion
    Adult - 
    1.0 - 1.5mg/kg IV push
    Every 5-10 minutes at 1/2 original dose up to 3mg/kg max

    If successful - infusion at 2-4mg/min by adding 1gm to 250cc NS

    Cardiac arrest - 20cc NS flush after giving
    ETT dose - double IV dose
  35. Contraindications of Lidocaine?
    Known allergy / hypersensitivity
    3rd degree heart block
    Extreme caution in 2nd degree heart block
    Idoventricular rythym
    Ventricular arrythmias with pulse <60
  36. Generic name for Atropine?
    Atropine Sulfate
  37. Brand name for Atropine?
    Atropine
  38. Class for Atropine?
    Parasympatholytic
    Anticholinergic
  39. Mechanism of Action for Atropine?
    Competitive antagonist to ACh at muscarinic receptor site
         Blocks parasypathetic response & allows sysmpathetic response to take over
             Heart
                   Atrial effects
                        Positive chronotrope
                        Postive dromotrope                    
                        Positive inotrope
                             Slight effect
              Lungs
                   Decreased mucous production
                   Increased bronchial smooth muscle relaxation
              GI
                   Decreased secretions
                   Decreased motility
              Urinary
                   Decreased bladder tone
              Other  
                   Pupil dilation
                   Decreased sweat production
  40. Indications and field use for Atropine?
    Symptomatic Bradycardia
         Atrial mechanisms only
              Why?
                     Blocks parasympathetic response increasing heart rate
    Acetylcholinesterase inhibitor poisoning
         Organophosphate poisoning
         Nerve agent poisoning
    Cholinergic posoning
         Why?
              Blocks the muscarinic receptors reducing the effects of ACh
  41. Dosage for Atropine?
    All Dosages are IV Push or ETT - FAST

    Adult

    Symptomatic Bradycardia
         Atrial mechanisms only
              Atropine 0.5mg IV Push - q 5 min - max 0.04mg/kg

    Acetylcholinestrase inhibitor poisoning
    Cholinergic poisoning
         Atropine 2.0 - 5.0 mg IV Push - q 5 min - until symptoms resolved
  42. Contraindications for Atropine?
    Allergy
    Wide complex 2nd Degree type II heart block
    3rd degree heart block
    Acute narrow angle glaucoma
         Painful glaucoma probably narrow type
  43. Generic name for Dopamine?
    Dopamine
  44. Brand name for Dopamine?
    Intropin
  45. Class for Dopamine?
    Dopamine agonist
    Sympathomimetic
  46. Mechanism of Action for Dopamine?
    MOA depends upon dosage

    Dopamine dose 1-2mcg/kg/min
         Activates dopamine receptors causing cerebral, renal, mesenteric vasodilation
              May increase urine output
              May drop BP

    Beta-1 Dose 2-10mcg/kg/min
         Activates Beta-1 receptors stimulates heart increasing cardiac output & BP
              Postive inotrope
              Positive chronotrope
              Postivite dropmotrope

    Alpha-1 dose 10-20mcg/kg/min
         Activates Alpha-1 receptors causing renal, mesenteric, & peripheral vasoconstriction
              Increases PVR increases BP
              Increased Preload
              >20mcg/kg/min similar to norepi with massive vasoconstriction
  47. Indications and field use for Dopamine?
    Hypotension without fluid loss
         Symptomatic bradycardia with hypotension
         Cardiogenic shock
         Septic shock
         Neurogenic shock
  48. Dosage for Dopamine?
    All doses via IV infusion

    Add 400mcg to 250cc NS bag giving 1600mcg/cc
         Symptomatic bradycardia with hypostension &/or non-hypovolemic shock
              Dopamine 5mcg/kg/min initial infusion, increase if no repsonse
  49. Contraindication for Dopamine?
    Hypovolemic shock
    Pheochromocytoma (tumor of the adrenal gland)
    MAOI's
  50. What is the generic name for Glucagon?
    Glucagon
  51. What is the brand name for Glucagon?
    Glucagon
  52. What is the class for Glucagon?
    Pancreatic hormone
  53. What is the mecahnism of action for Glucagon?
    • Converts liver glycogen to glucose raising serum glucose levels
    •      Reverses effects of hypoglycemia
    • Smooth muscle relaxant
    • Cardiac inatrope
  54. What are the indications and field use for Glucagon?
    • Hypoglycemia if IV unattainable
    • Why?
    • Raises blood sugar levels by converting glycogen to glucose

    • Trapped food bolus in esophagus
    • Why?
    • Smooth muscle relaxant may allow food to pass to stomach

    • Beta-Blocker OD
    • Why?
    • Positive cardiac inotrope
  55. Doseage for Glucagon?
    All hytpoglycemic doses are IM.  Other indications may be given IV.  

    • Adult:
    • Hypoglycemia
    •      Glucagon 1mg IM
    • Smooth muscle relaxant/Beta-blocker OD
    •      Per agency or patch with medical control
  56. Contraindications for Glucagon?
    • Known hypersensitivity / allergy
    • Pheocromocytoma
    • Insulinoma
  57. Generic name for Pitocin?
    Oxytocin
  58. Brand name for Pitocin?
    • Pitocin
    • Syntocin
  59. Class for Pitocin?
    Pituitary hormone
  60. Mechanism of action for Pitocin?
    • Oxytocin receptor agonist
    •      Increases force & frequency of urinary contractions
  61. Indications and field use for Pitocin?
    • Postpartem hemorrhage AFTER delivery of placenta and twins/triplets if any
    • Why
    • Stimulates uterus to contract which slows bleeding
  62. Dosage for Pitocin?
    All dosages via IV infusion or IM

    • Adult
    • Infusion
    •      Pitocin 10 units added to 10000cc LR infused at rate necessary to control bleeding

    • IM
    •      10 units IM
  63. Contraindications for Pitocin?
    • Known hypersensitivity/allergy
    • Baby/Babies have not yet delivered
    • Placenta has not yet delivered

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