Upload
kaida
View
29
Download
3
Embed Size (px)
DESCRIPTION
Pharmacology – Pot-pourri. Peggy Andrews, Instructor Chemeketa CC. Analgesics. Opiates & Opiate Blockers. Buprenex Stadol Vicodin Demerol Morphine sulfate Fentanyl. Nubain Trexan Narcan. We’ll talk about. Buprenex buprenorphine. Class Opioid analgesic (agonist – antagonist) - PowerPoint PPT Presentation
Citation preview
Pharmacology – Pot-pourri
Peggy Andrews, Instructor
Chemeketa CC
Analgesics
Opiates & Opiate Blockers
We’ll talk about• Buprenex• Stadol• Vicodin• Demerol• Morphine
sulfate• Fentanyl
• Nubain • Trexan• Narcan
Buprenexbuprenorphine
• Class– Opioid analgesic (agonist –
antagonist)– Schedule V
• Indications– Management of moderate to
severe pain
• Action– Binds to opiate receptors in
CNS (30x morphine and 3x narcan)
– Alters perception of and response to pain
– Produces generalized CNS depression
• Contraindications– Hypersensitivity
• Precautions– Increased ICP
• Adverse reactions, SE– Nausea/Vomiting– Dizzyness– Headache– Confusion– Dysphoria– Sedation– Sweating
•Route & dosage– IV, 0.3 mg q 4-6 h prn
•How supplied– 0.3 mg/ml in 1 ml
preload
Stadol butorphanol tartrate
• Class– Opioid analgesic
(agonist/antagonist)• Indications
– Management of moderate to severe pain
– Analgesic during labor
• Action– Binds to opiate
receptors in CNS– Alters perception of
response to painful stimuli
• Contraindications– Hypersensitivity– Opioid dependency
• Precautions– Head trauma– Increased ICP
• Adverse reactions, SE– Confusion– Dysphoria– Hallucinations– Sedation– Sweating– Use with extreme
precautions in patient on MAO Inhibitors
• Route & dosage– 1 mg q 3-4 h prn
• How supplied– 1 mg/ml or 2 mg/ml in 1
ml preloads
Vicodin (Anexia)hydrocodone bitartrate w/
acetaminophen• Class
– Analgesic– Contains 5 mg narcotic, 500 mg
acetaminophen– Schedule III
• Indications– Analgesic for moderate to severe
pain
• Action– Binds to opiate
receptors– Acetaminophen
produces peripheral and central mechanisms
• Contraindications– Hypersensitivity
• Precautions– Head injuries
• Adverse reactions, SE– Respiratory depression– Sedation– Dizziness– Mental clouding– Acetaminophen overdose may
result in potentially fatal hepatic necrosis
• Route & dosage– 1 – 2 tablets q 4-
6 h prn PO– Total 24-hour
dose should not exceed 8 tablets
Demerol meperidine hydrochloride • Class
– Opioid analgesic– Schedule II
• Indications– Moderate or severe pain
• Action– Binds to opiate receptors in CNS
• Contraindications– Hypersensitivity
• Precautions– Head injury– Increased ICP
• Adverse reactions, SE– Seizures– Confusion, sedation– Hypotension– Constipation– N/V
• Route & dose– 50 – 100 mg slow IV,
SQ, IM • How supplied
– 10 mg/ml in 5 ml preload,
– 20 mg/ml, or 50 mg/ml in 5 ml preload
MS ContinMorphine Sulfate
• Class: Opioid analgesic• Indications
– Pulmonary edema– Pain – MI
• Action– Acts on opiate receptors to block
sensation of pain. Also causes peripheral vasodilation
• Contraindications– Head injury– Depressed respiratory drive– Hypotension
• Precautions: have intubation equipment and naloxone ready
• Adverse reactions, SE– Respiratory
depression– hypotension– Confusion– Sedation– constipation
• Dosage & Route– 2-10 mg slow IVP q 3 - 5
min. in 2 mg increments, titrated to relief
• How supplied– 10 mg/ml in 1 ml tubex
fentanyl• Class
– Opioid analgesic– Schedule II
• Indications– Analgesia
• Action– Binds to opiate receptors in CNS,
altering response to and perception of pain
• Contraindications– Hypersensitivity
• Precautions– Geriatrics– Diabetes– CNS tumors– alcoholism
• Adverse reactions, SE– Apnea– Laryngospasm
• Route & dosage– 50-100 mcg (0.05 – 1.0
mg) • How supplied
– 0.05 mg/ml in one ml preload or tubex
Nubainnalbuphine
• Class– Opioid analgesic
(Agonist/antagonist)• Indication
– Moderate to severe pain• Action
– Binds to opiate receptors– Alters perception of and response
to pain
• Contraindications– Hypersensitivity – Opioid
dependency• Precautions
– Head trauma– Increased ICP
• Adverse reactions, SE– Dizziness– Headache– Sedation– Dry mouth– N/V– Clammy feeling, sweating
• Route & dosage– 10 mg g 3-6 h (not to
exceed 20 mg) IV• How supplied
– 10 mg/ml in 1 and 10 ml vials or
– 20 mg/ml in 1 and 10 ml vials
– 1 ml preloads
Trexannaltrexone
• Class– Opiate receptor agonist
• Indications– Alcoholics to decrease
compulsive consumption– Detoxified addicts to stay opiate-
free
• Action– Competes for opiate receptors
• Contraindications– None noted
• Precautions– None noted
• Adverse reactions, SE– Abdominal cramps, – H/A– Depression– irritability
• Route & dosage– 25 mg tablets, PO;
repeat if no withdrawal sx in one hour
– Alcohol dependence; 50 mg qd PO
Narcannaloxone
• Class– Opioid antagonist
• Indication– Reversal of CNS depression and
respiratory depression 2ndary to opiate overdose
• Contraindications– Hypersensitivity
• Precautions– Cardiovascular
disease– Pregnancy
• Adverse reactions, SE– None in emergent
setting
• Route & dosage– 2 mg IV, SQ, IM,
ET, SL injection– Repeat prn
Nitronoxnitrous oxide
• Class– Analgesic
• Indications– Moderate to severe pain
• Action– Alters perception of pain– Decreases hypoxia
• Contraindications– Do not administer for
abdominal pain– Severe head injury
• Precautions– Must be self-
administered– N/V
• Route & dosage– Inhaled, blended
mixture of 50% nitrous oxide and 50% oxygen
– Effects dissipate within 2-5 min. after cessation of administ.
– Unit consists of oxygen & nitrous oxide cylinders, fed into blender; delivered to modified demand valve
BenzodiazepinesAnd a Benzodiazepine
Antagonist
We’ll talk about• Valium• Versed• Lorazepam
• & Flumazanil
Valiumdiazepam
• Class– Anticonvulsant– Sedative hypnotic agent– Skeletal muscle relaxant– Schedule IV
• Indications– seizures– Anxiety– Pre-paralytic– Pre-cardioversion– Alcohol withdrawal
• Action– Depresses CNS– Produces anterograde amnesia– Has anticonvulsant properties
• Contraindications– Hypersensitivity– Comatose patients– Pre-existing CNS depression
• Precautions– Hepatic dysfunction
• Adverse reactions, SE– Dizziness– Drowsiness– Lethargy
• Dosage & route• Seizures
– 5 – 10 mg IV; may repeat q 10 – 15 min. to total dose of 30 mg
• Precardioversion– 5 – 15 mg IV; 5 min.
before• Sedation
– 5 – 15 mg IV slowly
Versedmidazolam
• Class– Sedative/hypnotic (benzodiazepine)– Schedule IV
• Indications– Used to produce sedation
preoperatively– Antegrade & retrograde amnesia– Provides conscious sedation
• Action– Acts at many
levels of the CNS to produce generalized CNS depression; produces short-term sedation
• Contraindications– Shock– Pre-existing CNS depression
• Precautions– Pulmonary disease– CHF– Renal impairment– Severe hepatic impairment– Geriatric or debilitated
patients– children
• Adverse reactions, SE– Cardiac arrest– Apnea– Laryngospasm– Bronchospasm– Respiratory depression– Phlebitis at IV site
• Route & dosage– 0.5 – 1 mg slow IV or IM
initially – May repeat in 2-3 minutes
up to max dose of 5 mg.
• How supplied– 1 mg/ml in 2, 5, and 10 ml
vials and preloaded syringes
Ativanlorazepam
• Class– Anti-anxiety, sedative hypnotic – Schedule IV
• Indications– Anxiety– Preoperative sedation– Seizures
• Action– Depresses CNS– Decreases seizures
• Contraindications– Hypersensitivity
• Precautions– Myasthenia gravis
• Adverse reactions, SE– Apnea– Cardiac arrest– Dizziness– Drowsiness– lethargy
• Route & dosage– Amnesia
•2-4 mg slow IV – Seizures
•50 mcg IV•May repeat in 10-15 min.
– Sedation•2-4 mg slow IV or IM
– How supplied•2 mg/ml in 1 or 2 ml tubex
syringe
Romaziconflumazanil
• Class– Antidote (benzodiazepine
antagonist)• Indications
– Reverses the effect of benzodiazepines
• Action– Antagonizes CNS depressant effects
of benzodiazepines. Has no effect on CNS depression from other causes
• Contraindications– Hypersensitivity
• Precautions– Mixed CNS depressant
overdose– History of seizures– Head injury
• Adverse reactions, SE– Seizures– Dizziness– N/V
• Route & dosage– 0.2 – 0.5 mg IV – Maximum dose 3 mg
in a one hour period• How supplied
– 0.1 mg/ml in 5- and 10-ml vials
Barbiturates
Brevital• Class
– Ultra-short acting barbiturate– Schedule IV
• Indications– Cardioversion – Induction of anesthesia
• Action– Affects CNS
• Contraindications– None noted
• Precautions– Cardiac arrest
• Adverse reactions, SE– Hypotension– Laryngospasm– Seizures– shivering
• Route & dosage– 1-2 mg/kg IV
• How supplied– Brevital is a freeze-dried nonpyrogenic
mixture of methohexital sodium with anhydrous sodium carbonate as a buffer. A white crystalline powder, freely soluble in water.
– Prepare and use promptly.– Dilute with sterile water, 0.9% sodium
chloride, or D5W– Do not use LR– Mix vial (500 mg) with 50 ml of diluent
A different Anxiolytic
BuSparbuspirone
• Class– Anti-anxiety, sedative hypnotic
agent• Indication
– Anxiety• Action
– Binds to seratonin and dopamine receptors
• Contraindications– Hypersensitivity
• Precautions– Pts receiving other antianxiety
agents• Adverse reactions, SE
– dizziness, drowsiness, excitement, fatigue, H/A, insomnia, nervousness, weakness
– Blurred vision, nasal congestion– Chest pain, palpitations,
tachycardia
• Route & dosage– 10 – 15 mg PO
tid• How supplied
– tablets
Paralytics
We’ll talk about• Succinylcholine• Vecuronium• Rocuronium • Tracrium
Anectinesuccinylcholine
• Class– Anticholinergic drug– Currare– Neuromuscular blockade
• Indications– Facilitate ET intubation
• Action– Blocks acetylcholine
receptors at neuromuscular junctions
• Contraindications– Hypersensitivity
• Precautions– Must be skilled in
intubation
• Adverse reactions, SE– Apnea– Arrhythmias– Malignant hyperthermia – Vomiting– Aspiration– Bradycardia– Hypertension– Concurrent
administration with physostigmine intensifies paralysis
• Route & dosage– 1.5 mg/kg IV– Onset ~ 1 min.– Recovery, 4-6 min.– OR– 3-4 mg/kg IM (max. dose 150 mg)– Onset 2 – 3 min.
• How supplied– 20 mg/ml in 10 ml vial
• Note:– Fasciculations start at eyelids, jaw –
progresses to limbs, abdomen, then diaphragm and intercostal muscles.
– Succs does NOT affect consciousness
• Procedure– Preoxygenate– Prepare equipment– Atropine, 0.01 – 0.02 mg.kg (Peds or
bradycardia)– Lidocaine 1 mg/kg (Head injury)– Valium or Versed – Succinylcholine, IV– Stop ventilations– Sellick’s maneuver until intubated– When fasciculations stop, check paralysis– Intubate!– If Succs starts to wear off, consider
Vecuronium 0.1 mg/kg IVP; may repeat 0.05 mg/kg
Vecuronium • Class
– Non-depolarizing neuromuscular blocking agent
• Indications– Intubation
• Action– Binds to acetylcholine at motor
receptors– Has little histamine release
• Contraindications– None in the emergency setting
• Precautions– Increased blockade with
bacitracin, lidocaine, verapamil• Adverse reactions, SE
– Malignant hyperthermia
• Route & dosage– 0.15 mg/kg IV– Onset: 2-3 minutes– Duration: 45 minutes
• How supplied
Zemuronrocuronium bromide
• Class– Non-depolarizing neuromuscular
blocking agent with a rapid to intermediate onset
• Indications– Intubation
• Action– Competes for cholinergic receptors at
the motor end-plate
• Contraindications– None in the emergency setting
• Precautions– Myasthenia Gravis
• Adverse reactions, SE– H/A– Hypertension or– Hypotension
• Route & dosage– 0.6-1.2 mg/kg IV (90mg)– Onset: 1-2 minutes– Duration: 30 minutes
• How supplied– 10 mL vials (10 mg/mL)
Tracriumatracurium besylate
• Class– Nuromuscular blocking agent
• Indications– Intubation
• Action– Competes with acetylcholine for
receptors at neuromuscular junction
• Contraindications– Myasthenia gravis
• Precautions– Increased neuromuscular
blockade with lidocaine, bacitracin, verapamil
• Adverse reactions, SE– Does NOT affect
consciousness– Arrhythmias
• Route & dosage– 0.5 mg/kg IV– Duration 20-30 min.
• How supplied• 50 mg/2 ml tubex or vial
Miscellaneous drugs
We’ll talk about• Aspirin (again)• Acetaminophen• Activated charcoal• Decadron• D50• Diphenhydramine• Epinephrine
1:1000• Inapsine• Glucagon• Glucose, Oral• Heparin
• Haloperidol• Ipecac• Mannitol• Solu-Medrol• Oxytocin• Phenergan• Pralidoxime• Streptokinas
e• Thiamine• Terbutaline
Aspirin (acetysalicylate acid,
ASA)• Class
– Salicylate• First synthesized in mid-19th century• Indication
– Inflammatory disorders– Fever– TIA– MI
• Action– Produces analgesia – Reduces inflammation and fever by
inhibiting the synthesis of prostoglandins
– Decreases platelet aggregation
New Info!New England Journal of Medicine,
3/05• Men 50 y/o or more
(no clinical evidence of coronary disease).
• ASA - Risk of MI 44% less
• No significant effect on risk of stroke and no effect on mortality from cardiovascular causes
• Women 65 y/o or more (no history of cardiovascular disease)
• ASA - No significant effect on risk of MI or risk of death from cardiovascular causes
• BUT 24% reduction in risk of ischemic stroke and 17% reduction in stroke risk overall
Conclusion of study• Women < 65 y/o• Reasonable to avoid prescribing
low-dose aspirin (75-100mg) as a preventative measure for coronary disease
• Rx for stroke – left to pt and Dr
• Contraindications– Hypersensitivity – Bleeding disorders or
thrombocytopenia• Precautions
– GI bleeds or ulcers– Chronic alcohol use/abuse– Severe renal disease– Viral infections – Pregnancy
• Adverse reactions, SE– GI bleeding– Anaphylaxis– Laryngeal edema– Dyspepsia, epigastric distress– Heartburn, nausea
• Dosage & route– Pain, Fever
•PO, Rectal– 325 – 500 mg q 3 h OR– 325 – 650 mg q 4 h– Not to exceed 4 g/day
– Cardiac chest pain•PO•81 mg x 3 chewable children's
aspirin (243 mg)– (UNLESS TAKING COUMADIN)
• How supplied– Children's aspirin, 81 mg tablets– Aspirin 325 - 500 mg tablets
Tylenolacetaminophen, APAP
• Class– Antipyretic agent
• Indications– Mild pain– Fever
• Action– Inhibits synthesis of prostaglandins
that serve as mediators of pain and fever
– Has no significant anti-inflammatory properties
• Contraindications– Hypersensitivity
• Precautions– Hepatic disease, renal
disease• Adverse reactions, SE
– Hepatic failure
• Route & dosage– PO (adults)
•325 – 650 mg q 4 h– Rectal (children & infants)
•80 mg q 4-6 h (infants 3 – 11 mo children 1 – 3 y/o)
– How supplied•500 mg tablets•80 mg suppositories
Acti-Char, Actidose activated charcoal
• Class– Antidote
• Indications– Acute management of many
poisonings following emesis/lavage
• Action– Binds drugs and chemicals in the
GI tract
• Contraindications– None known
• Precautions– Cyanide, corrosive, ethanol,
petroleum, organic solvent or iron poisoning
• Adverse reactions, SE– Black stool
• Route & dosage– Adults, PO – 25 – 100 g– Children 1-12 y/o, PO – 25-50 g– Children < 1 y/o, PO 1 g/kg
• How supplied– Oral suspension with sorbitol, 15-
50 g in 120-140 ml
Decadrondexamethasone sodium phosphate
• Class– Short acting gluco-corticoid
• Indications– Cerebral edema
• Action– Suppresses inflammation
• Contraindications– Active untreated
infections– Lactation
• Precautions– Chronic treatment – Children
• Adverse reactions, SE– Peptic ulcers– Thromboembolism – Depression – Euphoria– Muscle wasting– Cushingoid appearance– Osteoporosis
• Route & Dosages– 10 – 100 mg IVP
•10 mg initially, then 4 – 6 mg q 6 hr for 2-4 days then taper off over 5-7 days
• How supplied– 10 mg/ml in 10 ml vial
D50Dextrose 50%
• Class– Caloric agent (carbohydrate)
• Indication– Hypoglycemia– Altered mentation when history
unobtainable
• Contraindications– Allergies to corn or corn products
• Precautions– Chronic alcoholics– Severe malnutrition
• Adverse reactions, SE– None if blood glucose
is less than 80 mg/dcL– Venous irritation
• Interactions:– Will alter requirements
for insulin
• How Supplied:– 25 gm in 50 ml (50% dextrose)– 12.5 gm in 50 ml (25% dextrose)
• Route & Dosage– IV: Adults
•20-50 ml of 50% solution slow infusion
– IV: Infants and neonates•250-500 mg/kg/dose (as 25% dextrose)
• Important note– Assess IV site frequently for
extravasation; will cause tissue necrosis; immediately stop administration of drug
– Check for free blood return into syringe several times during administration
Benadryldiphenhydramine
• Class– Antihistamine
• Indication– Relief of allergic symptoms– Anaphylaxis– Parkinsons disease– Dystonic reactions
• Action– Competes for histamine receptor
sites
– Blocks histamine
– Significant CNS depressant properties
• Contraindications– Hypersensitivity– Acute asthmatic episode
• Precautions– Geriatrics– Severe liver disease
• Adverse reactions, SE– Drowsiness– Anorexia– Dry mouth
• Route & dosage– 10-50 mg IVP q 2-3 h
• How supplied– 5 mg/ml in 10 ml preload
or tubex
Inapsinedroperidol
• Class– Tranquilizer– Antiemetic
• Indications– Sedation of combative
patients to facilitate restraint
– N/V
• Action– Similar to haloperidol, alters
action of dopamine in CNS– Allays apprehension and
provides a state of mental detachment and indifference while maintaining a state of reflex alertness.
• Contraindications– Hypersensitivity– CNS depression– Severe liver disease or cardiac
disease• Precautions
– Hypotension may occur; have fluids available
– Elderly
•Adverse reactions, SE•Seizures •Extrapyramidal reactions
•Hypotension•tachycardia
• Route & Dosage– Chemical restraint
•0.625 – 10 mg slow IV or IM (Usual dose 2.5 – 5.0 mg)
•Onset 3 – 10 min.•Peak 30 min.•Duration 2-4 hr.
– Antiemetic•0.5 – 1 mg q 4 hr
How supplied– 2.5 mg/ml in 2 ml preload
Epinephrine 1:1,000• Class
– Adrenergic agonist– Vasopressor
• Indications– Management of reversible airway disease– Management of severe allergic reaction– Cardiac arrest
• Action– Affects both beta1 and beta2
receptor sites– Has alpha1 properties– Produces bronchodilation– Vasoconstriction– Inhibits release of mediators
from mast cells
• Contraindications– Hypersensitivity
• Precautions– Cardiac disease– Hypertension
• Adverse reactions, SE– Nervousness– Restlessness– Tremor– Angina– Arrhythmias– Hypertension
• Route & dosage– Anaphylactic/ Acute Asthma:– SQ or IM 0.1 – 0.5 mg q 10-15
min.• How supplied
– 1 mg/ml in 1 mg tubex or preload
Glucagon• Class
– Hormone• Indications
– Acute management of severe hypoglycemia
– Antidote to Beta-adrenergic blocking agent, calcium channel blockers
• Action– Stimulates hepatic production of
glucose from glycogen stores– Relaxes smooth muscle of GI
tract– Has positive inotropic and
chronotropic effects
Contraindications– Hypersensitivity to
beef or pork protein
• Precautions– Pheochromocytoma
• Adverse reactions & side effects– N/V
• Drug Interactions– Large doses may inhance
effects of Warfarin
• Route & dosage– Hypoglycemia: 1 mg IV or IM– Antidote to Beta-blockers: 0.25–
2mg IV– Antidote to Calcium channel
blockers: 2 mg IV• How supplied
– 1 mg glucagon in powder for injection with diluent of glycerin & small amount of hydrochloric acid
– Mix immediately before administration
Oral Glucose
• Class– Glycemic agent
• Indications– Hypoglycemia
• Action– Increases blood glucose
• Contraindications– Loss of gag reflex
• Precautions– Decreased mentation
• Route & dosage– 25 gm glucose, oral
Haldolhaloperidol
• Class – Antipsychotic agent
• Indications– Acute and chronic psychosis– Tourette’s syndrome– N/V from surgery or
chemotherapy
• Action– Alters effect of dopamine in CNS– Has anticholinergic, alpha-
adrenergic blocking activity
• Contraindications– Hypersensitivity
• Precautions– Geriatrics– Cardiac disease
• Adverse reactions, SE– Seizures– Blurred vision, dry eyes– Constipation, dry mouth
• Route & dosage– 0.5 – 5 mg IV or IM
• How supplied– 5 mg/ml in 1-ml tubex
Heparin• Class
– Anticoagulant• Indication
– Thromboembolic disorders• Action
– Potentiates the inhibitory effect of antithrombin
• Contraindications– Hypersensitivity– Uncontrolled bleeding
• Precautions– Spinal cord or brain
injury– Bleeding disorder– Women > 60– Severe uncontrolled
hypertension– Hemorrhagic stroke
• Adverse reactions, SE– Bleeding– Anemia– Thrombocytopenia
• Route & dosage– Anticoagulation
•10,000 u IV followed by 5,000 – 10,000u q 4-6 h
– Continuous infusion•20,000 – 40,000u infused over 24 h
• How supplied– 5,000 u/ml in vial
Ipecac• Class
– Antidote• Indications
– Induce vomiting in early managment of OD/poisoning
• Action– Stimulates chemoreceptor trigger
zone in CNS and irritates gastric mucosa
• Contraindications– Decreased mentation– Inebriated– Seizing patient
• Precautions– Pregnancy, lactation, children < 6
mo
• Adverse reactions, SE– Myocarditis– Arrhythmias
• Route & dosage– PO (adults) 15-30 ml
may repeat at 15 ml in 20-30 min
– PO (children) 15 ml may repeat in 20-30 min
• How supplied– Syrup
•15 ml or 30 ml containers
Mannitol 20%• Class
– Diuretic agent• Indications
– Increased ICP• Action
– Increases osmotic pressure of glomerular filtrate, inhibits reabsorption of water and electrolytes
• Contraindications– Dehydration– Active intracranial bleeding
• Precautions– Pregnancy, lactation
• Adverse reactions, SE– Transient volume expansion
• Route & dosage– IV, 1-2 g/kg slow IVP
(over 30 min.)
• How supplied– 2 g in 20 ml vial
Solu-Medrolmethylprednisolone sodium
succinate• Class:
– An intermediate-acting glucocorticoid– Anti-inflammatory– Immunosuppressant
• Indications:– Management of acute spinal cord injury– Used systemically for chronic diseases
• Inflammatory• Allergic• Autoimmune disorders
• Action– Stimulates the synthesis of enzymes
needed to decrease the inflammatory response. Suppresses the immune system by reducing activity and volume of lymphatic system, and possibly reduces reactivity of tissue to antigen-antibody interactions
• Contraindications– Active untreated infections – Systemic fungal infections– Don’t give live virus vaccines
if patient on methylprednisolone
• Precautions– GI ulcerations– Renal disease– Hypertension
• Adverse reactions and side effects– Depression, euphoria
– Hypertension
– Nausea, anorexia
– Decreased wound healing
– Muscle wasting
– Osteoporosis
• Route and dosage– Spinal cord injury
•30 mg/kg over 15 min. initially, then 45 min. later initiate continuous infusion of 5.4 mg/kg/hr for 23 hrs.
• How supplied– 4 mg/ml, 10 mg/ml, 20 mg/ml vial
PitocinOxytocin
• Class– Hormone
• Indication– Induction of labor at term– Postpartum control of bleeding
•Action
– Stimulates smooth muscle
– Has vasopressor and
antidiuretic effects
• Contraindications– Hypersensitivity
• Precautions– First and second stage of
labor• Adverse reactions, SE
– Coma– Seizure – Intracranial hemorrhage– Fetal asphyxia– Painful contractions
• Route & dosage– Induction of labor: 0.5 – 2
milliunits/min; increase by 1-2 milliunits/min q 15-60 min to result
– Postpartum hemorrhage•10 units infused at 20-40
milliunits/min.
• How supplied– 10 units/ml in 0.5 and 1 ml ampules– 1 ml preloads
PhenerganPromethazine
• Class– Antiemetic agent– Antihistamine – Sedative hypnotic
• Indications– Preoperative sedation – Allergic conditions– Motion sickness
• Action– Blocks histamine effects
– Inhibitory effect on chemoreceptor trigger zone in medulla
– Significant anticholinergic activity
• Contraindications– Hypersensitivity
• Precautions– Hypertension– Sleep apnea– Epilepsy
• Adverse reactions, SE– Neuroleptic malignant syndrome– Confusion, disorientation,
sedation
• Route & dosage– Antihistamine: IV, IM, PR,
25 mg; repeat in 2 hr– Sedation: IV, IM, PR, 25-
50 mg• How supplied
– 25 mg/ml in 1 ml ampules and 1 and 10 ml vials
– Suppositories: 12.5 mg, 25 mg, 50 mg.
Protopam Chloride, 2 PAM
Pralidoxime Cl• Class
– Antidote– Anticholinesterase poisoning
inhibitor• Indication
– After Atropine in severe cases of organophosphate poisoning•Muscle twitching, paralysis
• Action– Reactivates cholinesterase
• Contraindications– Inorganic phosphate
poisoning
• Precautions– Tachycardia, laryngospasm,
muscle rigidity with rapid infusion
– Reduce dosage for patient with impaired renal function
• Adverse reactions, SE– Dizziness, headache– Tachycardia– Nausea– Blurred vision
• Route & dosage– 1 – 2 g SLOW IV bolus or– IV infusion over 30-60 min. after
administration of Atropine– For infusion; mix 1 g in 250 ml NS
• How supplied– 1 g/20 ml vial– Must be reconstituted with 20 ml
sterile water
Streptokinase• Class
– Thrombolytic agent• Indications
– AMI < 12 h old– Pulmonary emboli– DVT
• Action– Convert plasminogen to plasmin;
degrades fibrin
• Contraindications– Active internal bleed– CVA– Recent CNS trauma or
surgery– Severe uncontrolled
hypertension• Precautions
– Surgery with in 10 days– Trauma– GI or GU bleeding– Recent arterial puncture
• Adverse reactions, SE– Intracranial hemorrhage– GI bleeding– Retroperitoneal bleeding– GU tract bleeding– Anaphylaxis– Reperfusion arrhythmias
• Route & dosage– MI
•1.5 million IU infused over 60 min.
– DVT, PE•250,000 IU loading dose over 30
min., followed by 100,000 IU/h for 24 – 72 h
• How supplied– Powder for injection; 250,000
IU/vial, or 1,500,000 IU/vial– Reconstitute with 5 ml NaCl or
D5W (direct to side of vial)– Swirl gently; do not shake– Dilute further with NaCl for total
volume of 45-500 ml – 45 ml for MI– 90 ml for DVT
• Administer through filter
Thiamine• Class
– Vitamin B-1• Indications
– Treatment of thiamine deficiency (Beriberi)
– Prevention of Wernicke’s encephalopathy
– Dietary supplement in pt with GI disease, alcoholism, or cirrhosis
• Actions– Required for carbohydrate metabolism
• Distribution– Widely distributed
• Metabolism & excretion– Metabolized by the liver.– Excess amounts excreted unchanged
by kidneys
• Half-life– Unknown
• Contraindications– None in prehospital setting
• Precautions– Wernicke’s encephalopathy
•Condition may be worsened unless thiamine is administered before glucose.
• Adverse reactions & side effects– None in prehospital setting
• Interactions– May inhance
neuromuscular blocking agents
• How supplied– 100 mg/ml in 1 ml ampules and
prefilled syringes
• Route and dosage– 100 mg IVP (may be given IM)
Brethineterbutaline
• Class– Bronchodilator
• Indication– Asthma– COPD– Preterm labor
• Action– Results in accumulation of cyclic adenosine
monophosphate at beta-adrenergic receptors
• Contraindications– Hypersensitivity
• Precautions– Near-term pregnancy
• Adverse reactions, SE– Paradoxical bronchospasm– Nervousness,
restlessness, tremor
• Route & dosage– Preterm labor: IV, 10
mcg/min., increase by 5 mcg/min until contractions stop.
• How supplied– 1 mg/ml in 1 ml tubex