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Pipecuronium (Arduan) Potassium Chloride 1049
comments
No cardiovascular effects
Drug interactions: Neuromuscular blockade potentiated by
amino-
glycoside antibiotics, local anesthetics, loop diuretics,
magnesium,
lithium, hypothermia, hypokalemia, acidosis Has little role in
current clinical practice because of long duration
POTASSIUM CHLORIDE
JESSICA SAMPAT, MD
indication
Hypokalemia
dose
IV
1020 mEq/h
If critical condition, w/ close ECG monitoring, higher rates
(20
40 mEq/h) & concentrations (6080 mEq/L) may be admini-
stered.
Dilute with NS before use. Give by SLOW IV infusion.
Monitoring w/ ECG & plasma K concentrations is essential.
PO
20200 mEq/day in divided doses
onset
IV: immediate
kinetics
Peak effect IV is variable.
Renal excretion
Interactions: severe hyperkalemia may occur w/
concomitantadministration of potassium-sparing diuretics, salt
substitutes, ACE
inhibitors.
preparation
Dilution for infusion
IV (piggyback, peripheral line): 1020 mEq in 100 mL D5W, NS
or
LR (0.10.2 mEq/mL)
IV (piggyback, central line, cardiac monitor): 1020 mEq in
50 mL D5W, NS or LR (0.20.4 mEq/mL)
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1050 Potassium Chloride
IV (maintenance infusion): 1040 mEq in 1 L D5W, NS or LR
(0.010.04 mEq/mL)
IV (cardiac monitor, maintenance): 6080 mEq in 1 L D5W, NS
or
LR (0.060.08 mEq/mL)
Injection: 20 mEq/10 mL, 30 mEq/15 mL, 40 mEq/20 mL, 60
mEq/30mL, 400 mEq/200 mL
Tablets
8, 10 mEq capsules
Extended-release preparations: 8, 10, 20 mEq
mechanism
Following absorption, potassium enters the extracellular fluid
&
is actively transported intracellularly, where its concentration
is
40 times that of the extracellular compartment. 98% of total
body potassium is intracellular.
Total extracellular potassium content in adult is about 50
mEq.
Extracellular (plasma) potassium concentration is only a
general
guide to total body potassium stores.
comments
Do not use undiluted: direct injection may be instantly
fatal.
Infuse slowly, monitoring pt continuously w/ ECG & serial
serum
potassium determinations.
Watch for ECG changes of hyperkalemia: Peaked T waves
Loss of P wave
QT prolongation
Widening & slurring of QRS (sine wave)
Cardiac arrest
Watch for other signs & symptoms of hyperkalemia, which
include
Paresthesia of extremities
Weakness
Mental confusion Hypotension
Use cautiously in
Pts w/ cardiac disease
Pts on digitalis
Pts w/ renal disease
Pts w/ metabolic acidosis
Pts w/ Addisons disease
Pts w/ hyponatremia
Pts w/ hypoadrenalism
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Potassium Chloride Prilocaine (EMLA Cream) 1051
In dehydration & shock, start hydration & diuresis
before replacing
potassium.
Insulin & dextrose facilitate movement of potassium into
cells.
PRILOCAINE (EMLA CREAM)
GRETE H. PORTEOUS, MD
indication
Local anesthetic sold in U.S. only as topical anesthetic
No current commercial preparation available in the U.S. for
IV
use
dose
2.5 g on 2025 cm2. Max 2 g/10 cm2.
onset
60 min after application under occlusive dressing
kinetics
Max effect 23 h after application
Hepatic metabolism
Renal excretion
Elimination half-life: 10150 min
preparation
EMLA (eutectic mixture of local anesthetics) cream, film or
patch
Contains lidocaine 2.5%, prilocaine 2.5%
Eutectic mixture has melting point below room temperature
(ie,
both compounds exist as liquids).
mechanism
Binds to open sodium channels in sensory & motor neurons
& blocks
propagation of nerve impulses
comments
Causes local skin blanching & erythema
Greatly increased absorption (& toxicity) if applied over
broken or
inflamed skin
Major toxicity, like all local anesthetics, is neurologic
(confusion, agi-
tation, tremors, seizures) & cardiovascular (dysrhythmias,
hypoten-
sion, cardiovascular collapse).
Can cause methemoglobinemia
