pharmacology – pot-pourri peggy andrews, instructor chemeketa cc

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

Buprenex (Buprenorphine)

• 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– Confusion– Dysphoria– Hallucinations– Sedation– sweating

• Route & dosage– IV, 0.3 mg q 4-6 h prn

• How supplied– 0.3 mg/ml in 1 ml

preload

butorphanol tartrate (Stadol)

• 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

Meperidine HCl (Demerol)

• 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

Morphine Sulfate (MS contin)

• 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

Nubain (nalbuphine)

• 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

Trexan

• 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

Narcan (naloxone)

• 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

nitrous oxide (Nitronox)

• 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

Benzodiazepines

And a Benzodiazepine Antagonist

We’ll talk about

• Valium• Versed• Lorazepam

• & Flumazanil

diazepam (Valium)• 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

midazolam

Versed

• 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

lorazepam (Ativan)

• 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

flumazanil (Romazicon)• 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

BuSpar (buspirone)

• 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• Tracrium

succinylcholine (Anectine)

• 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

Tracrium

• 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 (salicylate)

• Class– Antiplatelet agent

• First synthesized in mid-195h century

• Indication– Inflammatory disorders– Fever– TIA– MI

• Action– Produces analgesia – Reduces inflammation and fever

by inhibiting the production 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

acetaminophen (Tylenol, 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

activated charcoal (Acti-Char, Actidose)

• 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

dexamethasone sodium phosphate (Decadron)

• 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

Dextrose 50% (D50)

• 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; if occurs, immed. Stop administ. Of drug

• Check for free blood return into syringe several times during administration

diphenhydramine (Benadryl)

• Class– Antidyskinetic, antihistamine,

antitussive, anti-anxiety, sedative

• Indication– Relief of allergic symptoms– Anaphylaxis– Parkinsons disease– Dystonic reactions

• Action– Antagonizes histamine effect – Does not bind to or inactivate

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

droperidol Inapsine

• 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 IV slowly 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 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– Antidote to Beta-blockers:

0.25 – 2 mg IV– Antidote to Calcium

channel blockers: 2 mg IV

• How supplied:– 1 mg glucagon in powder

for injection with diluent of glycerin & sm. Amount of hydrochloric acid

– Mix immediately before administration

Glucose, oral

• Class– Glycemic agent

• Indications– Hypoglycemia

• Action– Increases blood glucose

• Contraindications– Loss of gag reflex

• Precautions– Decreased mentation

• Route & dosage– 25 gm glucose, oral

Haloperidol (Haldol)

• 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

• 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 – 10,000 u q 4-6 h

– Continuous infusion: 20,000 – 40,000 u infused over 24 h

• How supplied– 5,000 u/ml in vial

Ipecac

• Class– Antidote

• Indications– Induce vomiting in early mgmt 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

methylprednisolone sodium succinate

Solu-Medrol• Class:

– An intermediate-acting glucocorticoid– Anti-inflammatory– Immunosuppressant

• Indications:– Management of acute spinal cord injury– Used systemically for wide variety of

chronic diseases, including:• 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 pt. 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

Oxytocin (Pitocin)

• Class– Agent used during pregnancy

• 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

Promethazine (Phenergan)

• 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.

Pralidoxime Cl (Protopam Chloride,

PAM)• 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 pt 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 DVTAdminister 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)

Terbutaline

• 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