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