Anchorage Fire Drugs

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wspicer
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196998
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Anchorage Fire Drugs
Updated:
2013-02-01 01:00:37
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Anchorage drugs paramedic ems aaos nancy caroline
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Description:
Drugs from chapter 7 pharmacology from nancy caroline's emergency care in the streets
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  1. Adenosine
    (Adenocard)
    • Class: Endogenous Nucleotide

    • Mechanism of Action:
    • Slows conduction time through the AV node. Can interrupt re-entrant
    • pathways ; slow heart rate; acts directly on sinus pacemaker cells. Is drug of
    • choice for reentry SVT. Can be used diagnostically for stable  wide complex tachcardias of unknown type
    • after two doses of lidocaine.

    • Indications: 
    • Conversion of PSVT (Paroxysmal supraventricular tachycardia) to sinus
    • rhythm. May convert reentry SVT due to Wolff Parkinson White Syndrome. Not
    • effective in converting arterial fibrillation/flutter or V-tach.

    • Contraindications: 
    • Second or third degree block or sick sinus syndrome , atrial flutter /
    • atrial fibrillation, ventricular tachycardia , hypersensitivity to adenosine,
    • poison induced tachycardia.

    • Adverse reactions: 
    • Facial flushing, shortness of breath, chest pain, headache, paresthesia,
    • diaphoresis palpitations, hypotension, nausea, metallic taste.

    • How supplied: 
    • 3mg/mL in 2mL flip top vials for IV injections

    • Dosage and Administration: 
    • Adult 6mg over 1-3 seconds followed by a 20 mL saline flush
    • and elevate extremity if no response after 1-2 mins administer 12mg over 1-3
    • seconds maximum total dose 30 mg

    • Pediatric 0.1 – 0.2 mg/kg rapid IV maximum
    • single dose 12mg. 

    • Duration of action:  
    • Onset and peak effects in seconds duration 12 seconds

    • Special Considerations: 
    • Short half life limits side effects in most patients. Pregnancy safety
    • category C.
  2. Albuterol
    (Proventil, Ventolin)
    • Class: Sympathomimetic Bronchodilator

    • Mechanism of Action:
    • Selective beta2 agonist that stimulates adrenergic receptors of the
    • sympathomimetic nervous system resulting in smooth muscle relaxation in the
    • bronchial tree and peripheral vasculature.

    • Indications: 
    • Treatment of bronchospasm in patients with reversible obstructive airway
    • disease ( COPD/Asthma) . Prevention of exercise induced bronchospasm.

    • Contraindications: 
    • Known prior hypersensitivity reactions to albuterol. Tachycardia
    • arrhythmias, especially those caused by digitalis. Synergistic with other
    • sympathomimetics.

    • Adverse reactions: 
    • Often dose related and include restlessness, vasodilation, nausea,
    • vomiting, hyperglycemia, increased blood pressure, and paradoxical
    • bronchospasm.

    • How supplied: 
    • Solution for aerosolization 0.5% (5mg/mL) metered dose inhaler 90
    • ug/metered spray (17g canister with 200 inhalations) syrup 2mg/5mL

    • Dosage and Administration: 
    • Adult; Administer 2.5mg dilute 0.5 mL of 0.5% solution for
    • inhalation with 2.5 mL normal saline in nebulizer and administer over 10-15
    • mins three times. 

    • Duration of action:  
    • Onset in 5-15 mins with peak effect in 30 mins to 2 hours and duration
    • of 3-4 hours.

    • Special Considerations:
    • Pregnancy safety category C.
    • Antagonized by beta blockers (eg inderal, Lopressor) . May precipitate angina
    • pectoris and arrhythmias. Should only be administered by inhalation methodology
    • in pre hospital management.
  3. Atropine Sulfate
    • Class: Anticholinergic Agent

    • Mechanism of Action: 
    • Parasympatholytic inhibits action of acetylcholine at postganglionic
    • parasympathetic neureffector sites. Increases heart rate in life threatening
    • bradyarrhytmias.

    • Indications: 
    • Hemodynamically unstable bradycardia, asystole, bradycardic (<60
    • beats/min) pulseless electrical activity (PEA), organophosphate poisoning,
    • brochospastic pulmonary disorders.

    • Contraindications: 
    • Tachycardia, Hypersensitivity, unstable cardiovascular status in acute
    • hemorrhage and myocardial ischemia, narrow angle glaucoma.

    • Adverse reactions: 
    • Headache, dizzeness, palpitations, nausea and vomiting, tachycardia,
    • arrhythmias, anticholinergic effects ( blurred vision, dry mouth, urinary
    • retention) , paradoxical bradycardia when pushed slowly or at low doses flush
    • hot dry skin.


    • How supplied: 
    • Prefilled syringes 1mg in mL (0.1 mg/mL). Nebulizer 0.2% (1mg in 0.5ml)
    • and 0.5% (2.5mg in 0.5mL)

    • Dosage and Administration: 
    • Adult; Asystole or bradycardic PEA 1mg IV/IO push. May repeat every 3-5
    • mins (if asystole or PEA persists to a max of 3 doses (3mg). Endotracheal
    • administration 2-3 mg diluted in 10 mL of water or normal saline. Unstable
    • Bradycardia 0.5 mg IV/IO every 3-5 mins as needed, not to exceed total dose of
    • 3mg. use shorter dosing interval (3 mins) and higher doses in severe clinical
    • conditions. Organophosphate poisoning extremely large doses (2-4 mg or higher)
    • maybe needed. Pediatric; 0.02 mg/kg via IV/IO push may double this dose for
    • second dose. 0.5 mg, child dose 1mg adolescent single dose 1mg adolescent total
    • dose 2mg. Endotracheal administration 0.03 mg/kg absorption maybe unreliable.

    • Duration of action: 
    • Onset immediate peck effect rapid to 1-2 mins duration 2-6 hours.

    • Special Considerations: 
    • Pregnancy safety category c moderate doses may cause papillary dilation.
  4. CALCIUM CHLORIDE
    • CLASS:
    • Electrolyte

    • MECHANISM OF ACTION:
    • Increases cardiac contractile state (postitive inotropic effect). May enhance ventricular automaticity.

    • INDICATIONS:
    • Hypocalcemia, hyperkalemia, magnesium sulfate overdose, calcium channel blocker overdose, adjunctive therapy in treatment of insect bites and stings.

    • CONTRAINDICATIONS:
    • Hypercalcemia, V-fib, digitalis toxicity.

    • ADVERSE REACTIONS:
    • Bradycardia, asystole, hypotension, peripheral vasodilation, metallic taste, local necrosis, coronary and cerebral artery spasm, nausea and vomiting.

    • HOW SUPPLIED:
    • Prefilled syringes containing a 10% solution in a 10 mL. (100mg/mL).

    • DOSAGE AND ADMINISTRATION:
    • Adult: 500 mg to 1,000 mg (5-10 mL of a 10% solution) IV/IO push for hyperkalemia and calcium channel blocker overdose. May be repeated as needed.

    • Pediatric: 20 mg/kg (0.2 mL/kg) slow IV/IO push. Maximum 1 g dose;
    • may repeat in 10 minutes.

    • SPECIAL CONSIDERATIONS:
    • Pregnancy safety: Category C. Do not use routinely in cardiac arrest.
  5. DIGOXIN
    (LANOXIN)
    • CLASS: Inotropic agent.

    • MECHANISM OF ACTION:
    • Rapid-acting cardiac glycoside with direct and indirect effects that increase force of
    • myocardial contraction, increase refractory period of AV node, and increase
    • total peripheral resistance.

    • INDICATIONS:
    • Congestive heart failure, re-entry SVT, especially atrial flutter and atrial fibrillation.

    • CONTRAINDICATIONS:
    • Ventricular fibrillation, ventricular tachycardia, digitalis toxicity, hypersensitivity to
    • digoxin.

    • ADVERSE REACTIONS:
    • Headache, weakness, blurred yellow or green vision, confusion, seizures, arrhythmias,
    • nausea, vomiting, and skin rash.

    • HOW SUPPLIED:
    • 2-mL ampules of 0.5 mg digoxin; also as tablets, capsules, and elixirs.

    • DOSAGE AND ADMINISTRATION:
    • Adult: Loading dose of 10 to 15 ug/kg.

    Pediatric: Not recommended in the prehospital setting.

    • DURATION OF ACTION:
    • Onset: IV: 5-30 minutes; Peak effect: 30-120 minutes. Duration: Several days.

    • SPECIAL CONSIDERATIONS:
    • Pregnancy safety: Category A. Patients receiving IV digoxin must be on a monitor. Patients with known renal failure are prone to digoxin toxicity. Hypokalemia, hypomagnesemia, and hypercalcemia potentiate digitalis toxicity. Use carefully in patients with Wolff-Parkinson-White Syndrome (ventricular arrhythmias).
  6. DOPAMINE
    (INTROPIN)
    • CLASS:
    • Sympathomimetic, inotropic agent.

    • MECHANISM OF ACTION:
    • Immediate metabolic precursor to morepinephrine. Increases systemic vascular resistance, dilates renal and splanchnic vasculature. Increases myocardial contractility and stroke volume.

    • INDICATIONS:
    • Cardiogenic, septic or spinal shock, hypotension with low cardiac output states, distributive shock.

    • CONTRAINDICATIONS:
    • hypovolemic shock, pheochromocytoma, tachyarrhythmias, V-fib.

    • ADVERSE REACTIONS:
    • Cardiac arrhythmias, hypertension, increases myocardial oxygen demand; extravasation may cause tissue necrosis.

    • HOW SUPPLIED:
    • 200mg/5mL prefilled syringes, ampules for IV infusion; 400 mg in 250-mL D5W premixed solutions.

    • DOSAGE AND ADMINISTRATION:
    • Adult: 2-20ug/kg/min titrated to patient response;
    • Pediatric:
    • 2-20 ug/kg/min titrated to patient response.

    • DURATION OF ACTION:
    • Onset: 1-4 minutes. Peak effect: 5-10 minutes. Duration: Effects cease almost
    • immediately after infusion is shut off.

    • SPECIAL CONSIDERATION:
    • Pregnancy safety not established. Effects are close-dependent. Dopaminergic
    • response: 2-4 ug/kg/min: dilates vessels in kidneys; increased urine output.
    • Beta-adrenergic response: 10-20 ug/kg/min: primarily alpha
    • stimulant/vasoconstriction. Greater than 20 ug/kg/min: reversal of renal
    • effects/ override alpha effects. Always monitor drip rate. Avoid extravasation
    • injury.
  7. Activated Charcoal
    • ACTION:Adsorbs or binds toxin preventing it from being absorbed during its transit through the gastrointestinal tract.

    INDICATIONS:• Overdose• Poisonings

    CONTRAINDICATIONS:• Should not be given to unconscious patients

    ADVERSE REACTIONS:• May induce nausea and vomiting

    DOSE:• 15 to 30 grams (3 to 6 tablespoons)

    ROUTE:• Oral or via Nasogastric Tube

    HOW SUPPLIED:• Bottle containing 25 grams
  8. Amiodarone
    (Cordarone, Pacerone)
    ACTIONS:Antiarrhythmic drug with sodium channel blocking, and anti-sympathetic nervous system properties, resulting in negative dromotropic effect on the heart.Prolonged administration results in a lengthening of the cardiac action potential.Amiodarone possesses negative chronotropic effects slowing conduction and prolonging the refractory period. Amiodarone administration prolongs intranodal conduction and refractoriness of the atrioventricular node, but has no effect on the sinus node. Used in a wide variety of atrial and ventricular tachyarrhythmias and for rate control of rapid atrial arrhythmias in patients with impaired LV function.

    INDICATIONS: Ventricular Fibrillation and Pulseless Ventricular Tachycardia.• Treatment of Polymorphic Ventricular Tachycardia and Wide ComplexTachycardia of uncertain etiology• Control of hemodynamically stable Ventricular Tachycardia whencardioversion is unsuccessful• Used as adjunct to cardioversion of SVT and PSVT• May be used for rate control in atrial fib and flutter when other therapies areineffective or contraindicated• Acceptable for termination of ectopic or multifocal atrial tachycardia with LeftVentricular dysfunction

    CONTRAINDICATIONS:• Torsade de Pointes• Cardiogenic Shock• Hypotension

    PRECAUTIONS:• May produce vasodilatation and hypotension, and negative inotropic effects• May prolong QT interval, DO NOT USE WITH OTHER DRUGS THAT PROLONG THE QT INTERVAL• Use with caution in renal failure, half-life can last up to 40 days

    ADVERSE REACTIONS:• Hypotension• Headache• Bradycardia• AV conduction abnormalities• Flushing

    DOSAGE:• Cardiac Arrest: 300 mg IV push, repeated in 3-5 minutes at 150 mgs if required.• Wide Complex Tachycardia (stable): 150mg in 100 ml D5W over 10 minutes• Pediatric dose in VF/pulseless VT is 5 mg / kg• Pediatric dose in perfusing supraventricular and ventricular arrhythmias is 5mg/ kg over 20-60 minutes ( max of 15 mg /kg / day ).

    ROUTE:• IV

    HOW SUPPLIED: 150 mg in a 3 ml vial

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