Drug Info: Atropine Epi Ami Dextrose Sodium Bicarb Narcan Lido Dopamine

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Drug Info: Atropine Epi Ami Dextrose Sodium Bicarb Narcan Lido Dopamine
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2014-01-08 13:07:26
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MEDIC 2013
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  1. EPINEPHRINE: Indications
    • Cardiac arrest
    • Anaphylaxis
    • Severe bronchospasm
    • Hypotension
    • Bradycardia (60>BPM)
    • Croup
  2. EPINEPHRINE: Adverse Reactions
    (CV, CNS, GI)
    • CV: Hypertension 
    • Angina
    • Ventricular dysrhythmias 
    • Tachycardia 
    • CNS: Anxiety, agitation
    • GI: Nausea/vomiting
  3. Epinephrine: Adult dosage - Pulseless Arrest 
    IV/IO: 1 mg of 1:10,000 solution repeat every 3 - 5 minutes
  4. EPINEPHRINE: Adult dosage - Continuous Infusion for Hypotension or Symptomatic Bradycardia
    • 2mg added to 250mL of NS
    • administered at 2-10 mcg/min titrated to desired hemodynamic response
    • (15-75 gtts/min)
  5. EPINEPHRINE: Routes of Administration
    Cardiac
    Asthma/anaphylaxis/bronchiolitis
    • Cardiac: IV/IO push, IV infusion, ET
    • Asthma/anaphylaxis/bronchiolitis: IM, SC, SL injection, IV, IO, ET
  6. EPINEPHRINE: 
    Onset of Action
    Peak Effects
    Duration of Action
    • Onset of Action:
    • Seconds
    • Peak Effects:
    • Minutes
    • Duration of Action:
    • Several minutes
  7. EPINEPHRINE: Dosage Forms/Packaging
    1:10,000 solution 1 mg/10 ml pre-filled syringes

    1:1,000 solution 1 mg/1 ml ampule or pre-filled syringes

    • 30 mg/30 ml vial
  8. DOPAMINE Indications
    • Symptomatic Bradycardia (2nd line after Atropine)
    • Hypotension when fluid replacement isn't indicated (not resulting from hypovolemia)
    • Hemodynamically significant hypotension (systolic blood pressure 70-100 mmHg)
  9. DOPAMINE Contraindications
    • Hypovolemic shock (relative)
    • Pheochromocytoma (tumor)
    • MAO inhibitors (depression meds)
  10. DOPAMINE Adverse Reactions:
    (CV, GI, GU)
    • CV: Cardiac arrhythmias, tachydysrhythmias, hypertension, hypotension at low doses.(hyp-cat)
    • GI: Nausea and vomiting
    • GU: Renal shutdown (at higher doses)
  11. DOPAMINE Adult dosage
    BRADYCARDIA
    SHOCK
    • Dosage range 2-20 μg/kg/min
    • Bradycardia: Start at 5 μg/kg/min
    • Shock: (non hypovolemic)
    • BP < 70 systolic:Start drip at 6 μg/kg/min
    • BP > 70 systolic:Start drip at 3 μg/kg/min
  12. DOPAMINE Routes of Administration:
    IV infusion
  13. DOPAMINE
    Onset of Action:
    Peak Effects:
    Duration of Action:
    • Onset of Action:
    • Almost immediate, upon presentation to central circulation
    • Peak Effects:
    • 5-10 minutes
    • Duration of Action:
    • Effects cease almost immediately when infusion is shut off
  14. DOPAMINE Dosage Forms/Packaging:
    • 400 mg/5 ml vials
    • 400 mg in 250 ml D5W premixed IV solution
  15. DOPAMINE Mechanism of Action: (mcg/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
    1-2 μg/kg/min
  16. DOPAMINE  Mechanism of Action:(mcg/kg/min)
    ß1 (heart) stimulant action is primary effect (increases cardiac output and partially antagonizes the a-adrenergic-mediated vasoconstriction.Overall effect is increased cardiac output and only modest increase in systemic vascular resistance (SVR) 
    2-10 μg/kg/min
  17. DOPAMINE Mechanism of Action:(mcg/kg/min)
    a (blood vessels)-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 


    10-20 μg/kg/min
  18. DOPAMINE Mechanism of Action:(mcg/kg/min)

    Produces hemodynamic effects similar to norepinephrine; may increase HR and O2 demand to undesirable limits
    > 20 μg/kg/min
  19. ATROPINE SULFATE indications
    • Symptomatic bradycardia (under 60 BPM)
    • Organophosphate poisoning
  20. ATROPINE SULFATE Contraindications
    3rd degree heart block
  21. These are what type of reactions to what drug?
    Tachydysrhythmias
    Flushing 
    Ventricular irritability
    Exacerbation/initiation of angina
    Blurred vision
    Agitation to delirium
    Decreased gastric emptying
    Major Adverse Reactions: ATROPINE SULFATE
  22. These are what type of reactions to what drug?
    Dry mouth/mucous membranes 
    Loss of taste 
    Nausea 
    Vomiting 
    Urinary retention
    Neuromuscular weakness 
    Decreased sweating/increased body temperature
    Minor Adverse Reactions: ATROPINE SULFATE
  23. Dopamine Clock
    • 15 seconds: 400mcg
    • 30 seconds: 800mcg
    • 45 seconds: 1200mcg
    • 60 seconds: 1600mcg
  24. DOPAMINE Mechanism of Action:1-2 μg/kg/min
    • Dopaminergic receptors
    • Stimulates:
    • Cerebral
    • Renal
    • HR & BP unchanged
    • Increased urine
  25. ATROPINE SULFATE MOA:CV
    • CV: Increased heart rate
    • Increased conduction velocity
    • Increased force of contraction
    • Increase cardiac output.
  26. ATROPINE SULFATE MOA:Resp
    • Resp: Decreased mucus production
    • Increased bronchial smooth muscle relaxation (bronchodilation)
    • Blocks parasympathetic system
  27. ATROPINE SULFATE MOA: 
    GI
    GU
    MISC
    • GI: Decreased GI secretion and motility.
    • GU: Decreased urinary bladder tone.
    • Misc: Mydriasis (pupillary dilation); decreased sweat production.
  28. ATROPINE SULFATE 
    Onset of Action:
    Peak Effects:
    Duration of Action:
    • Onset of Action:
    • Rapid, 1 minute
    • Peak Effects:
    • IV – 2-5 minutes
    • IM – 30 minutes
    • Duration of Action:
    • Half life – 2 to 3 hours
    • Terminal half life – 12.5 hours
  29. ATROPINE SULFATE Adult Dosage:
    • Symptomatic Bradycardia: 0.5mg – 1mg IV/IO (max. of 3mg)
    • Organophosphate poisoning: 4mg every 5 mins IV push (no max. dose)
  30. ATROPINE SULFATE DosageForms/Packaging:
    • 1mg/10mL (0.1mg/mL) pre-filled syringes
    • 0.4mg/mL (8mg) 20mL vial
    • (2.5mL=1mg) x5 = (12.5mL =5mg)
  31. EPINEPHRINE MOA:
    • Increases:
    • Cerebral and myocardial perfusion
    • Blood pressure
    • Heart rate
    • Bronchospasm/Anaphylaxis: reverse signs/symptoms
  32. EPINEPHRINE: Adult dosage
    Anaphylaxis and asthma:
    0.3 - 0.5 mg of 1:1,000 solution IM, SC

    • Extreme cases: 
    • 1:10,000 solution 0.3 -.5mg every 5 minutes IV/IO
    • Continuous IV/IO infusion of 1 - 4 mcg/min
    • (8gtts/min to 30gtts/min) titrate to effect
  33. How do you determine gtts/min for Dopamine
    • 10% of pt's weight in Ibs. = Drops per min
    • (6mcg/kg/min)
  34. AMIODARONE indications
    • VF/VT pulseless
    • SVT
    • Rate control in artrial fibrillation or flutter
  35. AMIODARONE contraindications
    • Bradycardia
    • 2nd or 3rd degree heart block
    • Hypotension (90>systolic)
    • Pulmonary congestion (wet lungs; heart failure)
  36. AMIODARONE MOA:
    • Ventricular automaticity (potassium channel blockade)
    • Slows membrane depolarization & impulse conduction (sodium channel blockade)
    • Blocks electrolytes (brake pedal)
    • Slows heart rate
    • Dilates coronary arteries (more O2 to heart)
  37. AMIODARONE adult dosage
    VF/VT pulseless
    • 300mg IV/IO push over 30-60 sec.
    • (repeat in 3-5 min. w/ 150 mg)
    • W/ pulse: 150mg IV/IO
  38. AMIODARONE routes of administration
    IV/IO push, or infusion
  39. AMIODARONE 
    Onset of action
    Peak effects
    Duration of action
    • Onset of action: variable
    • Peak effects: variable
    • Duration of action: half-life may exceed 40 days
  40. AMIODARONE adverse reactions
    • Bradycardia
    • Hypotension
    • Asystole/cardiac arrest
    • Atrio-ventricular block
    • Liver abnormalities
  41. AMIODARONE dosage forms/ packaging
    • 150mg/3mL
    • 450mg/9mL
    • 900mg/18mL vials/ampules/syringes
  42. NARCAN indications
    narcotic (opioid) antagonist
    Antidote for opioid overdoses
  43. NARCAN contraindications
    Hypersensitivity
  44. NARCAN MOA
    • Reverses respiratory depression secondary to narcotics
    • Reverses ALOC due to narcotics
  45. NARCAN adult dosage
    IV/IO, IM, SL, SC, ET: 2mg IV push (repeat every 2 mins. as necessary;titrate to effect)

    • Intra-nasal: 1mg each nostril (2mg) 
    • (repeat every 2 mins. as necessary;titrate to effect)
  46. NARCAN routes of administration
    • IV/IO
    • ET
    • SC
    • SL
    • IV infusion
    • Intra-nasal
  47. NARCAN 
    Onset of action
    Peak effects
    Duration of action
    • Onset of action: (IV) within 2 mins
    • Peak effects: Variable
    • Duration of action: approximately 45 mins
  48. NARCAN adverse reactions
    • Withdrawal symptoms (especially newborns)
    • Nausea/vomiting
    • Diaphoresis (sweating)
    • Increased HR
    • Deceased BP
    • Tremors
    •      **Be prepared for combative patients
  49. NARCAN dosage forms/packaging
    • 0.4mg/mL: 1mL ampule, 10mL vials
    • 1mg/mL: 1mL, 2mL ampules, 5mL, 10mL vials
  50. DEXTROSE 50% indications
    carbohydrate, Hyperglycemic
    Hypoglycemia
  51. DEXTROSE 50% Contraindications
    • Thiamine deficiency (relative)
    • Delirium tremens (alcohol withdrawal) 
    •    **caution in patients with acute alcoholism
    •    **ineffective without thiamine
  52. DEXTROSE 50% MOA
    • Aerobic metabolic substrate (ATP production)
    • Reverses CNS effects of hypoglycemia
    •    *increases glucose levels
    • Provides short-term osmotic diuresis
    •    * causes urination
  53. DEXTROSE 50% adult dosage
    • 12.5 - 25g 
    •    *repeat in 10 mins if sugar isn't increased
  54. DEXTROSE 50% routes of administration
    IV/IO push
  55. DEXTROSE 50% 
    Onset of action
    Peak effects
    Duration of action
    • Onset of action: seconds
    • Peak effects: variable
    • Duration of action: variable
  56. DEXTROSE 50% Adverse reactions
    Cerebral edema in children when given IV 

    Worsening elevated ICP or cerebral edema from trauma or cerebral vascular accident.

    Extravasation leads to severe tissue necrosis.

    Sclerosing effect on peripheral veins
  57. DEXTROSE 50% dosage forms/packaging
    • 25g / 50mL pre-filled syringes
  58. SODIUM BICARBONATE 8.4%
    dosage forms/packaging
    • 50 mEq/50 ml prefilled syringes
  59. SODIUM BICARBONATE 8.4%
    indications
    • Pre-existing metabolic acidosis
    • Overdose of aspirin, cyclic antidepressants (alkalinization of blood)
    • Cardiac arrest after other interventions and ventilation is adequate
  60. SODIUM BICARBONATE 8.4%
    contraindications
    Alkalosis
  61. SODIUM BICARBONATE 8.4% MOA
    Buffers H+ and increases pH
  62. SODIUM BICARBONATE 8.4% adult dosages
    • Pre-existing Metabolic Acidosis or Alkalinization of Blood: 50-100 mEq IV per
    • medical control authority.
  63. SODIUM BICARBONATE 8.4%
    Routes of Administration:
    IV bolus; IV infusion
  64. SODIUM BICARBONATE 8.4%
    Onset of Action: 
    Peak Effects: 
    Duration of Action:
    • Onset of Action: Seconds
    • Peak Effects: 1-2 minutes
    • Duration of Action: 10 minutes
  65. SODIUM BICARBONATE 8.4% 
    Adverse Reactions:
    • CV: Congestive heart failure, edema secondary to sodium overload.
    • Metabolic: Hyperosmolarity, metabolic alkalosis, hypernatremia, in cardiac arrest may cause extracellular alkalosis and intracellular acidosis.
  66. LIDOCAINE indications
    Suppression of ventricular arrhythmias 

    Prophylaxis against recurrence after conversion from ventricular tachycardia or ventricular fibrillation 

    Frequent PVC's
  67. LIDOCAINE contraindications
    Hypersensitivity/allergy

    • **Do not treat ectopic beats if heart rate is <    60. They are probably compensating for the
    •    bradycardia; treat the bradycardia! 
  68. LIDOCAINE MOA
    Decreases automaticity 

    Increases ventricular fibrillation threshold.
  69. LIDOCAINE adult dosage
    • Pulseless VF/VT: Initial bolus of 1.0-1.5 mg/kg IV PUSH every 3-5 min
    • (total of 3 mg/kg) 

    Antidysrhythmic or rhythms with a pulse: Initial boluses can be given as 1.0-1.5mg/kg IV PUSH; additional boluses can be given as 0.5-0.75mg/kg every 5-10 mins to a total dose of 3 mg/kg

  70. LIDOCAINE Maintenance Infusion:
    Started after return of spontaneous rhythm for either indication above.

    • Add 1 gm - 2 gms to a 250 ml NS or 5 % dextrose solution or use premixed solution
    • (2 gm in 500 ml)

    Initiate a drip at 2-4 mg/min according to concentration.

    • Patients > 70 years or with hepatic, renal disease or poor perfusion state, reduce
    • maintenance infusion by half
  71. LIDOCAINE Routes of Administration:
    • IV bolus/push
    • followed by IV infusion
  72. LIDOCAINE 
    Onset of Action:
    Peak Effects:
    Duration of Action:
    • Onset of Action: 1-5 minutes
    • Peak Effects: 5-10 minutes
    • Duration of Action: Bolus only - 20 minutes
  73. LIDOCAINE adverse reactions
    • CV: May also cause SA nodal depression or conduction problems and hypotension in
    • large doses, or if given too rapidly 

    CNS: In large doses drowsiness, disorientation, paresthesias, decreased hearing acuity, muscle twitching, agitation, focal or generalized seizures.
  74. LIDOCAINE Dosage Forms/Packaging:
    • 100 mg/5 ml prefilled syringes (for bolus)
    • 1 Gm in 25 ml vials and prefilled syringes
    • (for infusion)
    • 2 Gm in 500 ml D5W premixed bags (optional)
  75. Lidocaine Clock
    • 15 seconds: 1mg
    • 30 seconds: 2mg
    • 45 seconds: 3mg
    • 60 seconds: 4mg

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