EMSP 2140/2310 Medications PDF

Fall B EMSP 2140/2310 Medications (page 1) Amiodarone Class: Class III antidysrhythmic Action: K+ channel blocker with Na+ and Ca++ channel blocking attributes. Prolongs the QRS duration and QT interval. Automaticity is also inhibited, prolonging action potential and repolarization Indications/dosa...

Fall B EMSP 2140/2310 Medications (page 1) Amiodarone Class: Class III antidysrhythmic Action: K+ channel blocker with Na+ and Ca++ channel blocking attributes. Prolongs the QRS duration and QT interval. Automaticity is also inhibited, prolonging action potential and repolarization Indications/dosage: - VF and pulseless VT: 300 mg repeated after 3-5 min with 150 mg IV/IO - Wide complex tachycardia in stable patients: 150 mg. over 10 min. (mixed in 100 mL of NS) Contraindications: Hypersensitivity, cardiogenic shock, long QT syndrome. Precaution: Avoid breastfeeding. Caution with Hepatic disease due to long half-life Possible Side Effects: Hypotension, Bradycardia Adenosine (Adenocard®) Class: Antidysrhythmic, non-specific class Action: A naturally occurring nucleoside that is a byproduct of the breakdown of ATP. Slows conduction through the AV node and interrupts AV reentry pathways to restore an NSR. Indications/dosage: - Stable SVT/monomorphic wide complex tachycardia: 6 mg. fast IV push with a flush - 2nd dose: 12 mg. fast IV push with a flush (can be repeated) Contraindication: Hypersensitivity, atrial flutter or fibrillation, WPW Possible Side Effects: Headache, CP Atropine (Atropen®) Class: Anticholinergic, toxicity antidotes Action: Parasympathetic blocker. Competitively inhibits the action of acetylcholinesterase on autonomic effectors innervated by postganglionic nerves Indications/dosage: - Symptomatic bradycardia: 1 mg every 3-5 min (max 3 doses) Contraindications: Hypersensitivity RELATIVE CONTRAINDICATIONS: Narrow-angle glaucoma, GI obstruction, severe ulcerative colitis, thyrotoxicosis Possible Side Effects: dilated pupils, tachycardia, dry mouth Aspirin (Bayer Aspirin®) Class: Antiplatelet agent, non-steroidal anti-inflammatory drug (NSAID) Action: Inhibits synthesis of prostaglandin by COX enzymes; inhibits platelet aggregation by preventing thromboxane A2 formation; has antipyretic and analgesic activity Indications/dosage: Acute coronary syndrome: 162-325 mg PO Contraindications: Hypersensitivity to NSAIDs, bleeding disorders, lactating mother, thrombocytopenia. Possible Side Effects: GI bleeding EMSP 2140/2310 Medications (page 2) Calcium Chloride Class: Antidotes, other; Electrolyte Action: Essential for neurotransmission, muscle contraction, and many signal transduction pathways Indications/dosage: Hyperkalemia/Calcium channel blocker and Beta blocker OD: 500-1000 mg (*Slow push) Contraindications: Hypercalcemia, Hypersensitivity, Hypokalemia Possible Side Effects: Tissue necrosis at injection site. Rapid injection can cause bradycardia, and hypotension Dopamine (Intropin®) Class: Inotropic agent; catecholamine; pressor Action: Endogenous catecholamine, acting on both dopaminergic and adrenergic neurons. Low dose stimulates mainly dopaminergic receptors, renal and mesenteric vasodilation Higher dose stimulates both beta-1-adrenergic and dopaminergic receptors Large dose stimulates alpha-adrenergic receptors Indications/dosages: Cardiogenic/distributive shock: 5 mcg/kg/min (titrated to effect) Contraindications: Hypersensitivity, ventricular fibrillation, Tachyarrhythmias WARNING: Dopamine is a vesicant and can cause severe tissue damage if extravasation occurs Possible Side Effects: Nervousness, headache, arrhythmias, CP, dyspnea, N/V Epinephrine Class: Alpha/beta adrenergic agonist Action: Strong alpha-adrenergic effects, resulting in systemic vasoconstriction and increased vascular permeability, a decrease in renal perfusion, and a variable effect on BP. Strong beta-1 which causes an increase in cardiac output and heart rate A moderate beta-2-adrenergic effect, resulting in bronchial dilation. Indications/dosages: - ROSC: 0.1-0.5 mcg/kg/min infusion IV/IO - Cardiac arrest: 1 mg every 3-5 min. IV/IO (1-10000) - Bradycardia/Hypotension: 2-10 mcg/min infusion Contraindications: Hypersensitivity Possible Side Effects: Palpations, tachycardia, hypertension, N/V, anxiety Ketamine (Ketalar®) Class: General anesthetics, systemic Action: Produces dissociative anesthesia. Blocks NMDA receptors interrupting the connection between the cortex and the limbic system. Stimulates the sympathetic NS and releases catecholamines, increasing MAP. Indications/dosage: Pain management: 0.5-1 mg/kg Slow push. Max total dosage is 100 mg. Contraindications: Hypersensitivity WARNING: Overdose may lead to panic attacks and aggressive behavior Possible Side Effects: Tachycardia, Laryngospasm, hallucinations, increased intraocular pressure, and vomiting. Labetalol (Trandate®) Class: Beta-blockers, alpha activity Action: Nonselective beta blocker with intrinsic sympathomimetic activity; also, alpha-blocker Indications/dosage: Severe hypertension/pre-eclampsia: 10-20 mg IV/IO over 2 min. Contraindications: Hypersensitivity, Bradycardia, Hypotension, myocardial damage, heart block, hypermagnesemia, hypercalcemia Possible Side Effects: Bradycardia, hypotension, CHF, bronchial asthma, AV blocks EMSP 2140/2310 Medications (page 3) Lidocaine (Xylocaine) Class: Ib antiarrhythmic and local anesthetic agent Action: Na+ channel blocker. Lidocaine depresses depolarization and automaticity in the ventricles. Indications/dosages: - Pulseless VT/VF: 1-1.5 mg/kg IV/IO (repeated every 5 min. at ½ dosage) - Dangerous PVC’s: 0.5-1 mg/kg IV (repeated after 5 min.) Contraindications: 2nd and 3rd degree AV blocks Possible side effects: Hypotension, bradycardia, >70 y/o, Hepatic disease Magnesium Sulfate Class: Electrolyte Action: Demonstrates antiarrhythmic effects by blockade of Na+ currents. A nonselective calcium antagonist. Natural Ca++ channel blocker. Indication/dosage: - Torsades de Point/refractory VF and pulseless VT: 2 gm over 10 min. (100 mL of D5W) Contraindications: Hypersensitivity Possible Side-effects: Hypotension, Bradycardia, Respiratory depression Metoprolol (Lopressor®, Toprol XL®) Class: Beta-blocker, beta-1 selective Action: Blocks response to beta-adrenergic stimulation; Selective for beta-1 receptors at low doses Indications/dosage: Narrow complex tachycardias: 2.5-5 mg IV/IO every 2 min (max 15 mg) Contraindications: Hypersensitivity. Bradycardia, Hypotension, AV blocks, cardiogenic shock, sick sinus syndrome severe peripheral vascular disease WARNING: May cause 1st, 2nd, or 3rd degree AV block Possible Side Effects: Hypotension, bradycardia, bronchospasm, CP, N/V, CHF Nitroglycerin Class: Nitrates, anti-anginal Action: Causes systemic vasodilation, decreasing preload, afterload, and myocardial O2 demand. Enters vascular smooth muscle and is converted to nitric oxide leading to smooth muscle (vascular) relaxation. Indications/dosage: Cardiac ischemia/MI/Acute pulmonary edema: 0.4 mg SL tablet or spray (max 3 doses) Contraindications: Hypersensitivity. Recent use of erectile dysfunction medications – sildenafil (Viagra® — within the last 24 hours). Other phosphodiesterase-5 inhibitors within 48 hours. Hypotension, bradycardia, and right ventricular infarction Possible Side Effects: Headache, Hypotension, syncope, tachycardia, flushing EMSP 2140/2310 Other Related Medications (page 4) Fentanyl (Sublimaze®) Class: Synthetic opioid, opioid analgesics (Schedule II) (Pregnancy category C) Action: Narcotic agonist-analgesic of opiate receptors; inhibits ascending pain pathways, thus altering response to pain, increasing pain threshold; produces analgesia, respiratory depression, and sedation. 30-60 min. duration. Indications/dosages: Acute pain: 50-100 mcg over 2-3 min. Contraindications: Hypersensitivity WARNING: Should be used with caution in the elderly and in patients with hypotension, suspected gastrointestinal obstruction, head injury, and concomitant CNS depressants Possible Side Effects: Altered mental status, bradycardia, N/V Ketamine (Ketalar®) Class: General anesthetics, systemic Action: Produces dissociative anesthesia. Blocks NMDA receptor interrupting the connection between the cortex and the limbic system. Stimulates the sympathetic NS and releases catecholamines, increasing MAP. Indications/dosage: Slow push. Max total dosage is 100 mg. - Pain management: 0.5-1 mg/kg Contraindications: Hypersensitivity WARNING: Overdose may lead to panic attacks and aggressive behavior Possible Side Effects: Tachycardia, Laryngospasm, hallucinations, increased intraocular pressure, vomiting. Morphine Sulfate (MS Contin®, Avinza®, Depodur®) Class: Opioid analgesic Action: Opioid agonist. Inhibits ascending pain pathways, thus altering response to pain; produces analgesia, respiratory depression, and sedation; suppresses cough by acting in medulla Indications/dosages: Acute pain/Cardiac Ischemia/MI/CHF: 2 mg. IV/IO/IM (May repeat 5 min. – max 10 mg.) Contraindications: Hypersensitivity, respiratory depression, acute bronchial asthma, upper air, GI obstruction, head injuries/ICP, brain tumors, deliriums tremens Possible Side Effects: Respiratory depression, Hypotension, altered mental status, N/V, bradycardia Ondansetron (Zofran®, Zofran ODT®, Zuplenz®) Class: Antiemetic, selective 5-HT3 antagonist Action: Selective 5-HT3 receptor antagonist; binds to 5-HT3 receptors both in periphery and in CNS, with primary effects in GI tract. May cause QT prolongation Indication/dosages: Nausea/vomiting: 4 mg. IV/IM (May be repeated) NOTE: EKG monitoring is recommended in patients who have electrolyte abnormalities, CHF, or bradyarrhythmia’s or who are also receiving other medications that cause QT prolongation Contraindications: — Hypersensitivity, coadministration with morphine, Long QT syndrome. Possible Side Effects: Headache, diarrhea, QT prolongation, fever EMSP 2140/2310 Other Related Medications (page 5) Promethazine (Phenergan®) Class: Antiemetic Action: Histamine H1, dopamine, muscarinic, and NMDA receptor antagonist. Indications/dosages: N/V: 12.5-25 mg IV/IO/IM Contraindications: Pt. on depressants, hypersensitivity Possible side-effects: Drowsiness, sedation, blurred vision, tachycardia, dizziness Sodium Bicarbonate (Bicarb) Class: Antidote, other Action: Increases blood and urinary pH by releasing a bicarbonate ion, which in turn neutralizes hydrogen ion concentrations Indications/dosage: Metabolic acidosis/Hyperkalemia/tricyclic antidepressant (TCA) overdose: 1 mEq/kg. This may be repeated at 0.5 mEq/kg Contraindications: Documented hypersensitivity, severe pulmonary edema, known alkalosis Possible Side Effects: Metabolic alkalosis, hypokalemia Patient Medications to be familiar with: Digoxin Action Has a positive inotropic and a negative chronotropic effect by inhibiting an enzyme (at the ATPace pump) that regulates the entry of electrolytes. Intracellular Na+ and Ca++ increases in the myocardial cells. Digoxin has a narrow therapeutic window. Indications For the treatment of mild to moderate heart failure in adult patients. To maintain control ventricular rate in adult patients diagnosed with chronic atrial fibrillation. Side effects Toxicity can lead to N/V, visual changes, arrhythmias, and decreased renal function (causing electrolyte abnormalities). Furosemide (Lasix) Action It is a loop diuretic and is used in situations where volume removal is indicated such as congestive heart failure, pulmonary edema, or systemic fluid overload. It can reduce body potassium levels Indications Fluid overload with symptoms (pulmonary edema, dyspnea, respiratory distress) Precautions Will only work if the patient can produce urine (anuria). This can lead to hypokalemia Side effects Profound rapid diuresis (enlarged prostate can prevent urination). Hypotension