adult ii 2015 emergency medications. national ems education standard competencies emergency...

Adult II 2015Adult II 2015

Emergency Medications

National EMS Education Standard CompetenciesNational EMS Education Standard Competencies

Emergency Medications

• Names

• Effects

• Indications

• Routes of administration

• Dosages for the medications administered

National EMS Education Standard CompetenciesNational EMS Education Standard Competencies

Emergency Medications (cont’d)

• Actions

• Contraindications

• Complications

• Side Effects

• Interactions

AHA Classification of Recommendations and Level

of Evidence

AHA Classification of Recommendations and Level

of Evidence

• Class I− A treatment should be administered.

• Class IIa− It is reasonable to administer treatment.

• Class IIb− Treatment may be considered.

AHA Classification of Recommendations and Level

of Evidence

AHA Classification of Recommendations and Level

of Evidence

• Class III− Treatment should NOT be administered.

− It is harmful, not helpful.

• Class Indeterminate− Research is either beginning or continuing on

this treatment.

− Cannot be recommended for or against

Medication ListingsMedication Listings

• Name of medication− And other common names

• Class− How the medication is classified compared to

other medications

Medication ListingsMedication Listings

• Mechanism of action− The way a medication produces the intended

response

• Indications− Circumstance that shows cause or warning of

disease

• Contraindications− Any condition that renders some particular line

of treatment improper or undesirable

Medication ListingsMedication Listings

• Adverse reaction/side effects− An abnormal or harmful effect to an organism

caused by exposure to a chemical

• Drug interactions− Any potential effects a medication may have

when administered with or in the presence of something else in the patient’s system

Adenosine (Adenocard)Adenosine (Adenocard)

• Classification:

• anti arrhythmatic, diagnostic

agent

• Mechanism of action− Slows conduction through

the AV node

− Can interrupt reentrant pathways

− The drug of choice for reentry SVT

• Indications− Most forms of stable

narrow-complex SVT

• Contraindications− Bronchoconstrictive or

bronchospastic lung disease

• Adverse reactions− Generally short duration and

mild

• Considerations− Evaluate elderly for signs of

dehydration

− Dose:by rapid IV bolus only given over 1_2 seconds administered directly into a vein or as proximal as possible ; follow with a rapid saline flush .

Albuterol (Proventil, Ventolin)

Albuterol (Proventil, Ventolin)

• Mechanism of action− Results in smooth-

muscle relaxation in the bronchial tree

• Indications− Treatment of

bronchospasm in patients with COPD/asthma)

• Contraindications− Hypersensitivity

reactions to albuterol

• Adverse reactions− Often dose-related

and include headache, fatigue, lightheadedness, irritability, restlessness

• Considerations− Pregnancy safety:

Category C

− May precipitate angina pectoris and dysrhythmias

Alteplase, Recombinant (Tissue Plasminogen Activator

or rTPA, Activase)

Alteplase, Recombinant (Tissue Plasminogen Activator

or rTPA, Activase)

• Classification: Thrombolytic agent

• Mechanism of action− Restores perfusion

• Indications− Acute myocardial infarction,

STEMI, massive pulmonary emboli, acute ischemic cerebrovascular accident

• Contraindications− Active internal bleeding− Recent surgeryDose: 100mg IV over 2 hr,

followed immediately by heparin therapy .

• Adverse reactions− Intracranial bleeding,

reperfusion dysrhythmias, chest pain, hypotension, GI bleeding, nausea, abdominal pain

• Considerations− Monitor vital signs

closely.

− Observe for bleeding.

Amiodarone (Cordarone, Pacerone)

Amiodarone (Cordarone, Pacerone)

• Classification antiarrhythmatic

• Mechanism of action− Delays repolarization and

increases the duration of action potential

• Indications− Ventricular fibrillation

• Contraindications− Known hypersensitivity to

amiodarone or iodine− Cardiogenic shockDose:1000mg IV over 24hours,150

mg loading dose over 10min,followed

− Over 6 hr at rate 1mg/min− For maintenance infusion

540mg at 0.5 mg / min over 18 hr .

• Adverse reactions− Dizziness, fatigue,

malaise

− Congestive heart failure

• Considerations− Pregnancy safety:

Category D

− Monitor patient for hypotension.

Aspirin (ASA)Aspirin (ASA)

• Classification:

antiplatelet

• Mechanism of action− Prevents platelets from

clumping together and forming emboli

• Indications− New onset chest pain

suggestive of acute myocardial infarction

• Contraindications− Relatively contraindicated in

patients with active ulcer disease or asthma

• Adverse reactions− Bronchospasm,

anaphylaxis, wheezing in allergic patients, prolonged bleeding

• Considerations− Pregnancy safety:

Category D

− Use cautiously with impaired renal function .

Atropine SulfateAtropine Sulfate

• Classification:

• Parasympathetic,Anticholinergic

• Mechanism of action− Increases heart rate in life-

threatening bradydysrhythmias

• Indications− Hemodynamically unstable

bradycardia

• Contraindications− Tachycardia, hypersensitivity

Dose:

for bradycardia 0.4mg to1mg (up to 2 mg )IV every 1-2 hr as needed .

• Adverse reactions− Drowsiness, confusion,

headache, tachycardia, palpitations

• Considerations− Pregnancy safety: Category

C

− Moderate doses may cause pupillary dilation.

Calcium GluconateCalcium Gluconate

• Classification:

• Electrolytes

• Mechanism of action

− Helps maintain cardiac function

• Indications

− Hyperkalemia, hypocalcemia

• Contraindications

− Ventricular fibrillation, digitalis toxicity, hypercalcemia

− Dose :infusion slowly ,0.5ml-2ml/min, (500mg /kg/day IV given in divided

Doses.

• Adverse reactions− Syncope, cardiac

arrest, dysrhythmia, bradycardia

• Considerations− Pregnancy safety:

Category C

− Do not administer by IM or SQ,stop infusion if patient complains of discomfort; resume when symptoms disappear .

Clopidogrel (Plavix)

Clopidogrel (Plavix)

• Classification:Antiplatelet

• Mechanism of action− Inhibits platelet aggregation

by blocking Adenosine diphosphate receptors on platelets(ADP), preventing clumping of platelets.

• Indications

− Acute coronary syndrome

− Substitute for aspirin in patients unable to take aspirin

Dose: recent MI,stroke 75mg daily

ACS (Acute Coronary Syndrome )300mg PO loading dose , then 75mg/day with aspirin .

• Contraindications− Active GI bleeding,

intracranial hemorrhage

• Adverse reactions− Severe neutropenia

− Hemorrhaging

• Considerations− Pregnancy safety: Category

B

− Often given with other anticoagulants

Dexamethasone Sodium Phosphate (Decadron)

Dexamethasone Sodium Phosphate (Decadron)

• Classification: corticosteroid ,Hormone

• Mechanism of action− Suppresses acute and

chronic inflammation

• Indications− Anaphylaxis, asthma, spinal

cord injury,cerebral edema associated with brain tumor ,craniotomy, or head injury .

• Contraindications− Hypersensitivity, use

caution in suspected systemic sepsis

• Adverse reactions− Headache,

restlessness, euphoria, psychoses

• Considerations− Pregnancy safety:

Category C

− Protect medication from heat. Toxicity and side effects occur with long-term use.

Diazepam (Valium and Others)

Diazepam (Valium and Others)

• Classification :• Benzodiazepine, Anxiolytic,

Antiepileptic, Skeletal muscle relaxant (centrally acting ).

• Mechanism of action− Raises the seizure

threshold; induces amnesia and sedation

• Indications− Acute anxiety states and

agitation, acute alcohol withdrawal

• Dose :Status epilepticus5-10mg by slow IV. May repeat q 5-10 min to total dose 30mg .

• Contraindications− Hypersensitivity, narrow-

angle glaucoma

− Adverse reactions− Dizziness, drowsiness,

confusion, headache

• Considerations− Pregnancy safety: Category

D

− Short duration for anticonvulsant effect

− Reduce dose by 50%

in elderly patients.

Digoxin (Lanoxin)Digoxin (Lanoxin)

• Classification :

Cardiac glycoside ,Cardiotonic

• Mechanism of action− Increases force of

myocardial contraction

• Indications− Congestive heart failure,

reentry SVTs, ventricular rate control in atrial flutter and atrial fibrillation

• Dose:evaluate patient carefully to determine the appropriate dose

loading dose 0.125-0.25mg IV, maintenance dose0.125-0.25mg /day PO .

• Adverse reactions

− Fatigue, headache, blurred yellow or green vision, seizures

• Considerations

− Pregnancy safety: Category C

− Patient receiving IV digoxin must be on a monitor

− Assessment for renal function , serum K+, Mg++ level.

• Contraindications

− Ventricular fibrillation, ventricular tachycardia, digitalis toxicity

Diltiazem (Cardizem)Diltiazem (Cardizem)

• Classification :

• Calcium channel blocker, antianginal ,antihypertensive .

• Mechanism of action− Reduces myocardial oxygen

demand

• Indications− Controls rapid ventricular

rates(Paroxysmal supra ventriculartachycardia , atrial fibrillation , atrial flutter.

Dose :direct IV bolus :0.25mg/Kg (20mg for the average patient ) second bolus of 0.35mg /kg .

Continuous IV infusion 5-10 mg /hr

• Adverse reactions− Dizziness, weakness,

headache, dyspnea

• Considerations− Pregnancy safety: Category

C

− Use with caution in patients with renal or hepatic dysfunction.

• Contraindications− Hypotension

− Sick sinus syndrome

Dobutamine Hydrochloride (Dobutrex)

Dobutamine Hydrochloride (Dobutrex)

• Classification: Sympathomimetic ,Beta1 selective

adrenergic agonist.

• Mechanism of action− Increased myocardial

contractility, stroke volume, and increased cardiac output

• Indications− Cardiogenic shock, CHF

• Dose :Administer only by IV infusion using an infusion pump

• 2.5mg -10mg /kg/min IV is ususl rate to increase cardiac output .

• Adverse reactions

− Headache, dyspnea, tachycardia, hypertension, chest pain

• Considerations

− Pregnancy safety: Category B

− Monitor blood pressure

closely.

• Contraindications− Tachydysrhythmias, severe

hypotension

Dopamine Hydrochloride (Intropin)

Dopamine Hydrochloride (Intropin)

• Classification:

• Sympathomimetic

Alpha –adrenergic agonist , Beta1-selective adrenergic agonist, Dopaminergic drug .

• Mechanism of action− Increases myocardial

contractility and stroke volume

• Indications− Cardiogenic and septic

shock, hypotension with low cardiac output states

− Dose :Administer only by IV infusion using an infusion pump

− Initially 2-5mcg/kg/min IV patients who more seriously ill,5mcg/kg/min up to a rate of 20-50mcg/kg/min.

• Adverse reactions− Headache, anxiety,

dyspnea, dysrhythmias

• Considerations− Pregnancy safety: Category

C− Effects are dose-dependent

− Contraindications− Hypovolemic shock,

pheochromocytoma, tachydysrhythmias

Epinephrine (Adrenalin)

Epinephrine (Adrenalin)

• Classification: Sympathomimetic ,Alpha-adrenergic agonist,Beta1-and beta2- adrenegic agonist ,cardiac stimulant .

• Mechanism of action− Blocks histamine

receptors

• Indications− Cardiac arrest,

symptomatic bradycardia

• Dode:cardiac arrest ;0.5IV during resuscitation q 5 min.

• Adverse reactions− Nervousness, restlessness,

headache, tremor

• Considerations− Pregnancy safety: Category

C

− May cause syncope in asthmatic children

• Contraindications− Hypertension, hypothermia,

pulmonary edema

Furosemide (Lasix)

Furosemide (Lasix)

• Classification : loop diuretic

• Mechanism of action− Causes increased

urine output

• Indications− CHF, pulmonary edema,

hypertensive crisisDose: in pulmonary edema 40

mg IV over 1-2 min.may be increased to 80mg IV given over 1-2 min if response unsatisfactory after 1 hour .

in hypertension 40mg bid. if needed additional anti hypertensive may be needed .

• Adverse reactions− Dizziness, headache, ECG

changes, weakness

• Considerations− Pregnancy safety: Category

C

− Ototoxicity, deafness, and projectile vomiting can occur with rapid

administration.

• Contraindications− Hypovolemia, anuria,

hypotension

Haloperidol Lactate (Haldol)

Haloperidol Lactate (Haldol)

• Classification :

• Dopaminergic –blocking drug Antipsychotic.

• Mechanism of action

− Inhibits central nervous system catecholamine receptors

• Indications

− Acute psychotic episodes

Dose:IV unlabeled use for acute situations2-25mg IV q hr at arate of 5mg /min.

• Adverse reactions

− Seizures, sedation, confusion, restlessness

• Considerations

− Pregnancy safety: Category C

− Treat hypotension secondary to haloperidol with fluids and norepinephrine, not epinephrine

• Contraindications

− Parkinson's disease,

depressed mental status

Heparin SodiumHeparin Sodium

• Classification :Anticogulant

• Mechanism of action− Inhibiting thrombus and clot

formation by blocking the conversion of prothrombin to thrombin and fibronogen to fibrin plasmin; does not lyses existing clots

• Indications− Acute myocardial infarction,

prophylaxis and treatment of thromboembolic disorders

− Dose:Adjust dose according To cogulation tests. Dosage is

adequate when PTT=1.5-3 times control value .

• Adverse reactions− Pain, anaphylaxis, shock,

hematuria

• Considerations− Pregnancy safety: Category

C

− Heparin does not lyse

existing clots.

• Contraindications− Hypersensitivity, active

bleeding

Hydrocortisone Sodium Succinate (Solu-Cortef)Hydrocortisone Sodium Succinate (Solu-Cortef)

• Classification :• corticosteroid short

acting ,glucocorticoid ,Adrenal cortical steroid, hormone.

• Mechanism of action− Anti-inflammatory;

immunosuppressive with salt-retaining actions

• Indications− Shock due to acute

adrenocortical insufficiency, anaphylaxis, asthma, and COPD.

− Dose: 100mg- 500mg initially and q 2-10h based on condition and response .

• Adverse reactions− Headache, vertigo,

pulmonary tuberculosis

• Considerations− Pregnancy safety: Category

C

− May be used in status asthmaticus as a second-line drug

• Contraindications− Systemic fungal infections,

premature infants

Lidocaine Hydrochloride (Xylocaine)

Lidocaine Hydrochloride (Xylocaine)

• Classification: Antiarrhythmatic ,local anesthetic .

• Mechanism of action− Decreases automaticity of

ventricular cells , increase ventricular fibrillation threshold .

• Indications− Alternative to amiodarone in

cardiac arrest from ventricular tachycardia

− Dose :Arrhythmias, monitor ECG constantly ,give 50-100mg at rate of 25-50mg /min, 1/3 to 1/2the initial dose may be given after 5min if needed .do not exceed 200-300mgin 1 hr .

• Adverse reactions

− Anxiety, drowsiness, confusion, seizures

• Considerations

− Apnea induced with succinylcholine may be prolonged with high doses of lidocaine.

− Exceedingly high doses can result in coma or death.

• Contraindications

− Hypersensitivity, second- or third-degree AV block in the absence of an artificial pacemaker

Magnesium SulfateMagnesium Sulfate

• Classification:• Electrolyte Antiepileptic .

• Mechanism of action− Reduces striated muscle

contractions

• Indications− Seizures of eclampsia,

torsades de pointes, hypomagnesemia

• Dose:

• 1-4 gm of a 10%-20%solution .Do not exceed 1.5 ml/min of a10% solution. or 4-5 gm in 250ml of 5%dextrose. Do not exceed 3ml / min .

• Adverse reactions

− Drowsiness, CNS depression, respiratory depression

• Considerations

− Pregnancy safety: Category A

− Recommended that the drug not be administered in the 2 hours before delivery, if possible

• Contraindications

− Heart block, myocardial damage

Mannitol (Osmitrol)Mannitol (Osmitrol)

• Classification :

• osmotic diuretic, diagnostic agent,

• Mechanism of action− Decreases cerebral edema

and intracranial pressure

• Indications− Cerebral edema

• Dose:• In reduction of intracranial

pressure and cerebral edema:1.5-2 gm/kg as a 15%-25% solution over 30- 60min.Evidence of reduced pressure should be seen in 15 min.

• Adverse reactions− Headache, confusion,

seizures, pulmonary edema

• Considerations− Pregnancy safety:

Category C − May crystallize at low

temperatures; store at room temperature

− Have ventilatory support available.

• Contraindications− Hypotension,

pulmonary edema, severe dehydration, intracranial bleeding, CHF

Methylprednisolone Sodium Succinate (Solu-Medrol)

Methylprednisolone Sodium Succinate (Solu-Medrol)

• Classification:• corticosteroid,glucocorticoid ,

hormone.

• Mechanism of action− Suppresses acute and chronic

inflammation

• Indications− Acute spinal cord trauma,

anaphylaxis, bronchodilator for unresponsive asthma

• Dose:10-40mg IV administered over 1 min to several minutes .give subsequent dosesIVor IM.

• Warning :Rapid IV administration of large doses (more than0.5mg-1gm in less than 10-20min)has caused serious cardiac complications.

• Adverse reactions− Depression, euphoria,

headache, restlessness, seizure

• Considerations− Pregnancy safety:

Category C

− Not effective if time of spinal cord injury greater than 8 hours

• Contraindications− Premature infants, systemic

fungal infections

Midazolam Hydrochloride (Versed)

Midazolam Hydrochloride (Versed)

• Classification:• Benzodiazepine (short acting )

• CNS depressant

• Mechanism of action− Causes sedative, anxiolytic,

amnesic, and hypnotic effects

• Indications− Sedation for medical

procedures.− Continuous sedation of

intubated and mechanically ventilated patients during treatment in critical care setting .

• Adverse reactions− Headache, somnolence,

respiratory depression

• Considerations− Pregnancy safety: Category

D

− Administer immediately prior to intubation procedure.

• Contraindications− Acute narrow-angle

glaucoma, shock, coma, alcohol intoxication

Morphine Sulfate (Roxanol, MS Contin)

Morphine Sulfate (Roxanol, MS Contin)

• Classification: Opoid agonist analgesic .

• Mechanism of action

− Alleviates pain through CNS action

• Indications

− Severe CHF, acute cardiogenic pulmonary edema

Dose :2.5mg -15mg /70kg of body weight in 4-5ml water for injection administered over 4-5 min. Continuous IV infusion 0.1-1 mg /ml in 5% dextrose in water by controlled infusion device .

• Adverse reactions

− Confusion, sedation, headache, CNS depression

• Considerations

− Pregnancy safety: Category C

− Morphine rapidly crosses the placenta.

• Contraindications

− Head injury, exacerbated COPD, depressed respiratory drive

Naloxone Hydrochloride (Narcan)

Naloxone Hydrochloride (Narcan)

• Classification :

• Opoid antagonist , Diagnostic agent .

• Mechanism of action− Reverses respiratory

depression secondary to opiate drugs

• Indications

− Opiate overdose, complete or partial reversal of central nervous system and respiratory depression induced by opioids

• Dose: • Opoid overdose initial dose of

0.4 - 2 mg IV additional doses may be repeated at 2-3 min intervals. If no response after 10mg question the diagnosis .

• Contraindications− Use with caution in narcotic-

dependent patients

• Adverse reactions− Restlessness, seizures,

dyspnea, pulmonary

• Considerations− Pregnancy safety: Category

C

Nitroglycerin (Nitrostat, Nitro-Bid, Tridil)

Nitroglycerin (Nitrostat, Nitro-Bid, Tridil)

• Classification:

• Antianginal

• Mechanism of action− Smooth muscle relaxant

acting on vasculature, with a resultant decrease in venous return and decrease in arterial BP ,which reduces myocardial oxygen cosumption .

• Indications− Acute angina pectoris,

ischemic chest pain• Dose: Initial dose , 5mcg/min

delivered through an infusion pump .inceased by 5mcg/min .if no response

• 20mcg/min.Once BP response is obtained reduce dose and llengthen dosage intervals. continually monitor response and titrate carefully .

• Adverse reactions− Headache, dizziness,

weakness, reflex tachycardia

• Considerations− Pregnancy safety:

Category C − Hypotension more common

in the elderly

• Contraindications− Hypotension, hypovolemia,

intracranial bleeding or head injury

Norepinephrine Bitartrate (Levophed)

Norepinephrine Bitartrate (Levophed)

• Classification:• Sympathomimetic

• Alpha-adrenergic agonist ,Beta1adrenergic agonist , cardiac stimulant ,vasopresser.

• Mechanism of action− Potent alpha-agonist resulting

in intense peripheral vasoconstriction

• Indications− Cardiogenic shock,

unresponsive to fluid resuscitation

Dose :Add 4ml of the solution (1mg/ml)to 1000ml of 5% dextrose solution for a concentration of 4mcg base /ml

Initially give 8-12 mcg /min adjust dose gradually to maintain desired Bp .

• Adverse reactions− Headache, anxiety,

dizziness

• Considerations− Pregnancy safety: Category

C. − May cause fetal anoxia

when used in pregnancy

• Contraindications− Hypotensive patients with

hypovolemia

Ondansetron Hydrochloride (Zofran)

Ondansetron Hydrochloride (Zofran)

• Classification: Antiemetic

• Mechanism of action− Blocks action of serotonin

• Indications− Prevention and control of

nausea or vomiting

• Dose:• Prevention of chemotherapy -

induced nausea and vomiting three 0.15mg /kg doses IV first dose is given over 15 min, before 30min of starting the chemotherapy .

• Adverse reactions

− Headache, malaise, wheezing

• Considerations

− Pregnancy safety: Category B

• Contraindications− Known allergy to

ondansetron

OxygenOxygen

• Mechanism of action− Reverses hypoxemia

• Indications− Confirmed or

expected hypoxemia, ischemic chest pain

• Contraindications− Certain patients with

COPD will not tolerate oxygen concentrations over 35%.

• Adverse reactions− Decreased level of

consciousness (COPD patients), decreased respiratory drive in COPD patients

• Considerations− Be familiar with liter

flow and each type of delivery device used.

Phenytoin (Dilantin)

Phenytoin (Dilantin)

• Classification: • Antiepileptic , antiarrhythmic

group Ib.

• Mechanism of action− Promotes sodium

efflux from neurons− Effective in treating cardiac

arrhythmias, especially those induced by digitalis.

• Indications− Prophylaxis and treatment

of major motor seizures

Dose:status epilepticus 10-15 mg /kg

by slow IV .for maintenance 100mg 6-8 hr .

• Adverse reactions− Ataxia, agitation, dizziness,

headache, drowsiness

• Considerations− Pregnancy safety: Category

D

− Carefully monitor vital signs.

− Contraindications

− Hypersensitivity, bradycardia

Propofol (Diprivan)Propofol (Diprivan)

• Mechanism of action

− Produces rapid and brief state of general anesthesia

• Indications

− Anesthesia induction/ maintenance, sedation for mechanically ventilated patients

− Dose:Inducción anestésicaIV: 1 – 2,5 mg/kgMantenimiento anestésicoPerfusión IV: 50 – 150 mcg/kg/minSedaciónDosis de carga IV: 0,25 – 1 mg/kgMantenimiento IV: 10 – 50 µg/kg/min

• Adverse reactions

− Seizure, apnea, dysrhythmias, asystole, hypotension, hypertension

• Considerations

− Pregnancy safety: Category B

− Avoid rapid administration in elderly patients to avoid hypotension and airway obstruction.

• Contraindications

− Hypovolemia, known sensitivity

Propranolol Hydrochloride (Inderal)

Propranolol Hydrochloride (Inderal)

• Classification :• Beta-adrenergic blocker

(nonselective) antianginal,antiarrhythmic.

• Mechanism of action− Reduces chronotropic,

inotropic, and vasodilator response to beta-adrenergic stimulation

• Indications− Hypertension, angina

pectoris− Dose : life threatening

arrhythmias 1-3 mg IV with careful monitoring ,not to exceed 1mg /min .

• Adverse reactions− Weakness, depression,

fatigue, anxiety, dizziness, bronchospasm

• Considerations− Pregnancy safety:

Category C − Closely monitor patient

during administration.− Use with caution in elderly

patients.− Atropine should be readily

available.

• Contraindications− Sinus bradycardia, second-

or third-degree AV block

Sodium BicarbonateSodium Bicarbonate

• Classification :

• Electrolyte , systemic alkalinizer,

• Mechanism of action− Buffers metabolic acidosis

and lactic acid buildup

• Indications− Metabolic acidosis during

cardiac arrest.Dose:for severe metabolic

acidosis ,dose depends on blood CO2 content , PH, and patient clinical condition ,90-180mEq/L.IVduring first hour then adjust PRN.

• Adverse reactions

− Hypernatremia, metabolic alkalosis, tissue sloughing, cellulitis

• Considerations

− Pregnancy safety: Category C

− Repeat as needed in tricyclic antidepressant overdose until QRS narrows

• Contraindications

− Metabolic/respiratory alkalosis, hypokalemia, electrolyte imbalance

Tirofiban Hydrochloride (Aggrastat)

Tirofiban Hydrochloride (Aggrastat)

• Classification:

• Antiplatelet

• Mechanism of action− Inhibits aggregation of

platelets

• Indications− Acute coronary syndrome

• Dose:

• 0.4mcg/kg/min infusion over 30min .then continue at rate of 0.1 mcg/kg/min.

• Adverse reactions

− Dizziness, pain, sweating, intracranial bleeding, CVA

• Considerations

− Pregnancy safety: Category B

− Must be administered only with an infusion pump direct from bottle with a vented IV set

− Severe spontaneous bleeding risk

• Contraindications− Trauma or major surgery

within the past 30 days

IV Solutions (Colloids and Crystalloids)

IV Solutions (Colloids and Crystalloids)

• Colloids− Expand plasma volume

− Most often used in hypovolemic shock states

• Crystalloid solutions are used for:− Electrolyte replacement

− A route for medication

− Short-term intravascular volume expansion

DextranDextran

• Mechanism of action− Sugar-containing

colloid used as an intravascular volume expander

• Indications− Hypovolemic shock

• Contraindications− Patients with

congestive heart failure, renal failure, or known bleeding disorders

• Adverse reactions− Rash, itching,

dyspnea, chest tightness, and mild hypotension

• Considerations− In the management of

burn shock, it is especially important to follow standard fluid resuscitation regimens to prevent possible circulatory overload.