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Prehospital Emergency Pharmacology Cardiac Drugs Cards

Terms in this set (32)

Morphine sulfate
Classification: opiate agonist; schedule C-II
Action: binds with opiod receptors. Depression of vasomotor centers of brain as well as release of histamines. For angina: morphine reduces stimulation of the sympathic nervous system caused by pain/anxiety. Reduces heart rate, cardiac work, and myocardial oxygen consumption.
Indication: pain mgmt
Side effects: resp depression, hypotension, nausea/vomiting, dizziness, lightheadedness, sedation, deaphoresis, euphoria, hysphoria, worsening of bradycardia and heart block in some patients with acute inferior wall MI, seizures, cardiac arrest, anaphylactoid reactions.
Contraindicaiton: resp depression, shock
Dose
Pain Adult 2.5-5mg slow IVP
Ped 6mo-12 yrs: 0.05-02mg/kg <6mo: 0.03-0.05mg/kg
Chest pain:
Adult 2-4mg slow iv with increments of 2-8mg repeated every 5-15min until relief
Ped: 0.1-0.2 mg/kg
Aspirin
Classification: Antiplatelet, nonnarcotic analgesic, antipyretic
Action: Prevents formation of chemical "thromboxane A2" which causes platelets to clump and obstruct arteries
Indications: fever, inflammation, angina, MI, cardiac chest pain
Side Effects: Anaphylaxis, angioedema, bronchospasm, bleeding, stomach irritation, nausea/vomiting
Contraindication: GI bleed, ulcers, hemorrhagic stroke, bleeding disorders
Dose: Adult MI 160-325mg PO Pediatric MI 3-10mg/kg/day
Adult Pain/Fever 325-650mg q 4-6hours Peds: 60-90mg/kg/day divided doses q 4-6hrs
Nitrous oxide
Classification: inorganic gas, inhaled anesthetic
Action: exact mechanism in not known
Indications: mild to severe pain
Adverse effects: delirium, hypoxia, resp depression, nausea/vomiting
Contraindication: use with caution in head trauma, increased ICP, pneumothorax, bowel obstruction, pts with COPD who require a hypoxic respiratory drive.
Dose: inhaled 20-50% concentration mixed with oxygen
Atropine sulphate
Class: Anticholinergic
Action: Competes reversibly with acetylcholine at the site of muscarinic receptors.
Indications: Symptomatic brady, asystole, PEA,
Adverse Effects: Decreased secretions resulting in dry mouth and hot skin temperature.
Contraindications: Acute MI, GI obstruction, known sensitivity.
Dose: Adult .5 mg IV every 3 to 5 minutes. Peds: .02 mg/kg IV total dose of 1mg highest.
Monitoring Parameters: Medication half life of 2.5 hrs. Possibly unsafe in lactating mothers.
Furosemide (Lasix)
Classification: Loop diuretic
Action: inhibits the absorption of the sodium and chloride ions and water in the loop of Henle, as well as the convoluted tubule of the nephron. This results in decreased absorption of water and increased production of urine.
Indication: Pulmonary edema, CHF, hypertensive emergency.
Adverse Effects: Vertigo, dizziness, weakness, orthostatic hypotension, hypokalemia, thrombophlebitis. Patients with anuria, severe renal failure, untreated hepatic coma, increasing azotemia, and electrolyte depletion can develop life-threatening consequences.
Contraindications: known sensitivity to sulfonamides or furosemide.
Dose: CHF and Pulmonary Edema:
Adult: 40mg IV, IO administered slowly over a 1-2min period. If a satisfactory response is not achieved within 1 hour, an additional dose of 80mg can be given. Max single IV dose is 160-200mg.
Peds: 1mg/kg IV,IO or IM. If response is not satisfactory, an additional dose of 2 mg/kg may be administered no sooner than 2 hours after the first dose.
Hypertensive emergency:
Adult 40-80 mg IV,IO
Peds: 1mg/kg IV or IM
Special Consideration:
Onset of action for IV, IO administration occurs within 5 minutes and will peak within 30 minutes.
Nitroglycerin
Classification: antianginal agent
Action: relaxes vascular smooth muscle, therby dilating peripheral arteries and veins. Decreases preload and afterload of the heart.
Indication: angina, ischemic chest discomfort, hypertension, myocardial ischemia associated with cocaine intoxication
Side effects: headache, hypotension, bradycardia, lightheadedness, flushin, cardiovascular collapse, methemoglobinemia.
Contraindicaiton: hypotension, severe bradycardia, tachycardia, increased ICP, intracranial bleeding. Use of ED meds
Dose Adult sublingual: 0.4mg
IV: bolus 12.5-25mcg infusion: 5mcg/min
Ped infusion: 0.25-0.5mcg/kg/min to max of 5mcg/kg/min
Digoxin (Lanoxin)
Classification: cardiac glycoside
Action: inhibits sodium-potassium-adenosine triphosphatase membrane pump, resulting in a n increase in calcium inside the heart muscle cell, which causes an increase in the force of contraction of the heart.
Indication: CHF, to control the ventricular rate in chronic AF and atrial flutter, narrow-complex PSVT
Adverse Effects: Headache, weakness, GI disturbances, arrhythmias, nausea/vomiting, diarrhea, vision disturbances
Contraindications: Digitalis allergy, VT and VF, heart block, sick sinus syndrome, tachycardia without heart failure, pulse lower than 50-60beats/min, MI, ischemic heart disease, patients with preexcitation AF or atrial flutter (i.e., a delta wave, characteristic of Wolff-Parkinson-White syndrome, visible during normal sinus rhythm).
Dose: individualized
Special Considerations: low levels of serum potassium can lead to digoxin toxicity and bradycardia. Conditions of administration of steroids or diuretics or vomiting and diarrhea can produce low levels of potassium and subsequent digoxin toxicity. Pregnancy class C
Metoprolol
Classification Beta adrenergic antagonist, antianginal, antihypertensive, class II antiarrhythmic
Action: inhibits the strength of the hearts contractions, as well as heart rate. This results in a decrease in cardiac oxygen consumption. Also saturates the beta receptors and inhibits dilation of bronchial smooth muscle (beta2 receptor)
Indications: ACS, hypertension, SVT, atrial flutter, AF, thyrotoxicosis
Adverse Effects: tiredness, dizziness, diarrhea, heart block, bradycardia, bronchospasm, drop in blood pressure
Contraindications: cardiogenic shock, AV block, bradycardia, know sensitivity. Use with caution in hypotension, chronic lung disease (asthma and COPD)
Dose:
Cardiac Indication: Adult 5mg slow IV, IO over a 5 min period. Repeat at 5min intervals up to a total of three infusions totaling 15mg
Peds: not recommended
Sodium nitroprusside
Classification: antihypertensive agent
Action: causes direct relaxation of both arteries and veins
Indications: HTN emergencies
Adverse effects: cyanide or thiocyanate toxicity, nausea/vomiting, dizziness, headache, restlessness, abdominal pain, methemoglobinemia.
Contraindication: Hypotension, increased ICP, cerebrovascular disease, coronary artery disease, hepatic disease, renal disease, pulmonary disease.
Dose: Adult-0.3-10mcg/kg/min IV,IO. Titrate to desired blood pressure
Peds: same as adult dosing.
Special Consideration: nitroprusside will break down when exposed to ultraviolet light. Therefore the infusion should be shielded from light by wrapping the bag with aluminum foil.
Labetolol
Classification: beta adrenergic antagonist, antianginal, antihypertensive
Action: binds with both beta1 and beta2 receptors and alpha1 receptors in vascular smooth muscle. Inhibits the strength of the hearts contractions, as well as heart rate. This results in a decrease in cardiac oxygen consumption.
Indications: ACS, SVT, sever hypertension
Adverse Effects: usually mild and transient; hypotensive symptoms, nausea/vomiting, bronchospasm, arrhythmia, bradycardia, AV block
Contraindication: hypotension, cardiogenic shock, acute pulmonary edema, heart failure, severe bradycardia, sick sinus syndrome, second or third degree heart block, asthma or acute bronchospasm, cocaine induced ACS, known sensitivity. Caution in pheochromocytoma, cerebrovascular disease or stroke, poorly controlled diabetes, with hepatic desease. Use caution at lowest effective dose in chronic lung disease.
Dose:
Cardiac: Note monitor blood pressure and heart rate closely during administration.
Adult: 10mg IV, IO over a 1-2min period. May repeat q 10min to a max of 150mg or give initial bolus and then follow with infusion at 2-8mg/min
Peds: 0.4-1mg/kg/hr to a max dose of 3mg/kg/hr
Severe hypertension: Adult-initial dose is 20mg IV, IO slow infusion over a 2min period. After the initial dose, blood pressure should be checked q 5min. repeat doses can be given at 10min intervals. The second dose should be 40mg IV, IO and subsequent doses should be 80mg IV,IO to a max total dose of 300mg. effect on BP typically noted within 5min from time of admin. Alternatively, may be administered via IV infusion at 2mg/min to a total max dose of 300mg.
Peds: 0.4-1mg/kg/hr IV, IO infusion with a maximum dose of 3mg/kg/hr
Magnesium sulfate
Classification: electrolyte, tocolytic, mineral
Action: required for normal physiologic function.
Indication: torsades de pointes, cardiac arrhythmias associated with hypomagnesemia, eclampsia and seizure prophylaxis in preeclampsia, status asthmaticus
Side effects: magnesium toxicity (signs inc flushing, diaphoresis, hypotension, muscle paralysis, weakness, hypothermia, and cardiac, CNS or resp depression
Contraindicaiton: AV block, GI obstruction. Caution with renal impairment
Dose: VFIB, pulseless VT with torsades de pointes or hypomagnesemia:
Adult: 1-2g in 10ml D5W IV admin over 5-10 min
Ped: 25-50mg/kg IV over 10-20 min
Torsades de pointes with a pulse or cardiac arrhythmias with hypomagnesemia:
Adult: 1-2g in 50-100ml D5W admin over 5-60min. follow with 0.5-1g/hr titrate for effect
Ped: 25-50mg/kg over 10-20min. max single dose 2g
Eclampsia and seizure prophylaxis in preeclampsia
Adult: 4-6g IV over 20-30min followed by infusion of 1-2g/hr
Status Asthmaticus:
Adult: 1.2-2g slow IV (over 20 min)
Ped: 25-50mg/kg (diluted in D5W) slow IV over 10-20min
Hydralasine (Apresoline)
Classification: antihypertensive agent, vasodilator
Action: directly dilates the peripheral blood vessels
Indications: hypertension associated with preeclampsia and eclampsia, hypertensive crisis
Adverse effects: headache, angina, flushing, palpitations, reflex tachycardia, anorexia, nausea/vomiting, diarrhea, hypotension, syncope, peripheral vasodilation, peripheral edema, fluid retention, paresthesias.
Contraindications: patients taking diazoxide or MAOIs, coronary artery disease, stroke, angina, dissecting aortic aneurysm, mitral valve and rheumatic heart diseases.
Dose:
Preeclampsia and eclampsia
Adult 5-10mg IV,IO. Repeat every 20-30min until systolic bp of 90-105mmhg is attained
Acute hypertension not associated with preeclampsia:
Adult-10-20mg IV,IO,IM
Peds: 1mo-12years: 0.1-0.6mg/kg IV<IO or IM. Max 20mg/dose
Propranolol
Classification: beta adrenergic antagonist, antianginal, antihypertensive, antiarrhythmic class II
Action: nonselective beta antagonist that binds with both the beta1 and beta2 receptors. Propranolol inhibits the strength of the hearts contractions, as well as heart rate. This results in a decrease in cardiac oxygen consumption.
Indications: angina; narrow complex tachycardias that originate from either a reentry mechanism (reentry SVT) or an automatic focus (junctional, ectopic, or multifocal tachycardia) uncontrolled by vagal maneuvers and adenosine in pts with preserved ventricular function; AF and atrial flutter in pts with preserved ventricular function; hypertension; migraine headaches
Adverse effects: bradycardia, AV block, bronchospasm, hypotension
Contraindications: cardiogenic shock, heart failure, AV block, bradycardia, pulmonary edema, sick sinus syndrome. Caution with chronic lung disease
Dose: adult: 1-3mg IV, IO at a rate of 1mg/min; repeat dose 2 min later
Peds: 0.01-0.1mg/kg slow IV, IO over a 10 min period
Heparin
Classification: anticoagulant
Action: acts on antithrombin III to reduce the ability of the blood to form clots, thus preventing clot deposition in the coronary arteries
Indications: ACS, acute pulmonary embolism, deep vein thrombosis
Adverse effects: bleeding, thrombocytopenia, allergic reactions
Contraindication: predisposition to bleeding, aortic aneurysm, peptic ulceration; sensitivity or history of heparin induced thrombocytopenia, sever thrombocytopenia, sulfite sensitivity
Dose: Cardiac Indications
Adult: 60U/kg IV (max 4000 units), followed by 12U/kg/hr (max 1000 units). Once in hospital, additional dosing is determined based on lab blood tests
Peds: 75U/kg followed by 20U/kg/hr
Pulmonary Embolism and Deep Vein Thrombosis
Adult: 80U/kg IV, followed by 18U/kg/hr
Peds: 75U/kg IV followed by 20U/kg/hr
Streptokinase (Streptase)
Classification: thrombolytic agent
Action: dissolves thrombi plugs in the coronary arteries and reestablishes blood flow
Indications: ST-segment elevation (greater than or equal to 1mm in two or more contiguous leads), new or presumed new left bundle branch block
Adverse effects: bleeding, intracranial hemorrhage, stroke, cardiac arrhythmias, hypotension, bruising
Contraindications: ST-segment depression, cardiogenic shock, recent (within 10 days) major surgery, cerebrovascular disease, recent (within 10 days) GI bleeding, recent trauma, hypertension, (systolic BP >180mm HG or diastolic blood pressure <110 mmHG), high likelihood of left heart thrombus, acute pericarditis, subacute bacterial endocarditis, severe renal or liver failure with bleeding complications, significant liver dysfunction, diabetic hemorrhagic retinopathy, septic thrombophlebitis, advanced age (>75), pt taking Warfarin (coubadin) Dose: dosing per medical direction
Alteplase, tissue plasminogen activator (tPA) (Activase)
Classification: thrombolytic agent
Action: dissolves thrombi plugs in the coronary arteries and reestablishes blood flow
Indications: ST-segment elevation (greater than or equal to 1mm in two or more contiguous leads), new or presumed new left bundle branch block
Adverse effects: bleeding, intracranial hemorrhage, stroke, cardiac arrhythmias, hypotension, bruising
Contraindications: ST-segment depression, cardiogenic shock, recent (within 10 days) major surgery, cerebrovascular disease, recent (within 10 days) GI bleeding, recent trauma, hypertension, (systolic BP >180mm HG or diastolic blood pressure <110 mmHG), high likelihood of left heart thrombus, acute pericarditis, subacute bacterial endocarditis, severe renal or liver failure with bleeding complications, significant liver dysfunction, diabetic hemorrhagic retinopathy, septic thrombophlebitis, advanced age (>75), pt taking Warfarin (coubadin) Dose: dosing per medical direction
Retaplase, Recombinant (Retavase)
Classification: thrombolytic agent
Action: dissolves thrombi plugs in the coronary arteries and reestablishes blood flow
Indications: ST-segment elevation (greater than or equal to 1mm in two or more contiguous leads), new or presumed new left bundle branch block
Adverse effects: bleeding, intracranial hemorrhage, stroke, cardiac arrhythmias, hypotension, bruising
Contraindications: ST-segment depression, cardiogenic shock, recent (within 10 days) major surgery, cerebrovascular disease, recent (within 10 days) GI bleeding, recent trauma, hypertension, (systolic BP >180mm HG or diastolic blood pressure <110 mmHG), high likelihood of left heart thrombus, acute pericarditis, subacute bacterial endocarditis, severe renal or liver failure with bleeding complications, significant liver dysfunction, diabetic hemorrhagic retinopathy, septic thrombophlebitis, advanced age (>75), pt taking Warfarin (coubadin) Dose: dosing per medical direction
Epinephrine
Classification: Adrenergic agent, inotropic
Action: Binds strongly with both alpha and beta receptors, producing increased blood pressure, increased heart rate, bronchodilation.
Indication: Bronchospasm, allergic and anaphylactic reactions, restoration of cardiac activity in cardiac arrest.
Adverse Effects: anxiety, headache, cardiac arrhythmias, hypertension, nervousness, tremors, chest pain, nausea/vomiting
Contraindication: Arrhythmias other than VF, asystole, PEA; cardiovascular disease; hypertension, cerebrovascular disease, shock secondary to anything other than anaphylaxis, diabetes, pregnant women in active labor.
Dose: Cardiac arrest: Adult-1mg (1:10,000) q 3-5 min Peds-0.01mg/kg (1:10,000) q 3-5min
Bradycardia: Adult-2-10mcg/min (1:10,000) titrate for effect Peds-0.01mg/kg (1:10,000) q3-5
Asthma/Some allergic reatctions: Adult:0.3-0.5mg (1:1,000) IM or SubQ q10-15min
Peds: 0.01mg/kg (1:1,000) IM/SubQ max of 0.5mg
Anaphylaxis: Adult-0.1mg (1:10,000) IV slowly over 5 min
Peds-IV infusion 0.1-1mcg/kg/min (1:10,000) titrate to response
Dobutamine
Classification: Adrenergic Agent
Action: Acts primarily as an agonist at beta1 adrenergic receptors with minor beta 2 and alpha1 effects. Consequently, dobutamine increases myocardial contractility and stroke volume with minor chronotropic effects, resulting in increased cardiac output.
Indications: CHF, cardiogenic shock.
Adverse Effects: Tachycardia, PVCs, HTN, hypotension, palpitations, arrhythmias
Contraindications: Suspected or known poisoning/drug-induced shock, systolic blood pressure<100mmHg with signs of shock, idiopathic hypertrophic subaortic stenonis, sulfa sensitivity. Use in caution in hypertension, recent MI, arrhythmias, hypovolemia.
Dosage:
Adult 2-20mcg/kg/min IV,IO. Doses >20mch/kg/min, increases of heart rate of >10% may induce or exacerbate MI
Peds: Same as adult
Dopamine (Inotropin)
Classification: Adrenergic agonist, inotropic, vasopressor
Action: Simulates alpha and beta adrenergic receptors. At moderate doses (2-10mcg/kg/min), dopamine stimulates beta 1 receptors, resulting in inotropy and increased cardiac output while maintaining dopaminergic-induced vasodilatory effects. At high doses (>10mcg/kg/min), alpha adrenergic agonism predominates, and increased peripheral vascular resistance and vasoconstriction result.
Indication: Hypotension and decreased cardiac output associated with cardiogenic shock and septic shock, hypotension after ROSC following cardiac arrest, symptomatic bradycardia unresponsive to atropine.
Adverse Effects: Tachycardia, arrhythmias, skin and soft tissue necrosis, sever hypertension from excessive vasoconstriction, angina, dyspnea, headache, nausea/vomiting.
Contraindications: Pheochromocytoma, VF,VT, or other ventricul arrhythmias, known sulfites sensitivity. Correct any hypovolemia with volume fluid replacement before admin of dopamine.
Dose:
Adult-2-20mcg/kg/min IV,IO infusion. Starting dose 5mcg/kg/min; may gradually increase the infusion by 5-10 mch/kg/min to desired effect. Cardiac dose is usually 5-10mcg/kg/min, vasopressor dose is usually 10-20mcg/kg/min. Little benefit from doses beyond 20mcg/kg/min
Peds: Same as adult
Noepinephrine (Levophed)
Classification: Adrenergic agonist, inotropic, vasopressor
Action: Norepinephrine is an alpha1,alpha2,and beta1 agonist. Alpha-mediated peripheral vasoconstriction is the predominant clinical result of administration, resulting in increasing blood pressure and coronary blood flow. Beta adrenergic action produces inotropic stimulation of the heart and dilates the coronary arteries.
Indications: Cardiogenic shock, septic shock, severe hypotension.
Adverse Effects: Dizziness, anxiety, cardiac arrhythmias, dyspnea, exacerbation of asthma.
Contraindicaitons: Patients taking MAOIs, known sensitivity. Use with caution in hypovolemia.
Dosage: Adult: add 4mg to 250ml of D5W or D5NS, but not normal saline alone. 0.5-1mcg/min as IV,IO, titrated to maintain systolic blood pressure >80mmHg. Refractory shock may require doses as high as 30mcg/min
Peds: 0.05 to 2mcg/kg/min IV,IO infusion, to a maximum dose of 2 mcg/kg/min
Vasopressin
Class: Nonadrenergic vasoconstrictor
Action: Vasopressin
Class: Nonadrenergic vasoconstrictor
Action: Vasopressin can cause vasoconstriction independent of adrenergic receptors or neural innervations.
Indication: Adult shock refractory VF or pulse less VT, asystole, PEA, Vasodilatory shock
Adverse: Cardiac ischemia, Angina
Contraindication: responsive patients with cardiac disease
Dosage: 40 units IV IO. Replaces 1st 2nd or 3rd dose of epinephrine
Adenosine (Adenocard)
Class: Antiarrhythmic
Action: slows the conduction of electrical impulses at the AV node
Indication: Stable reentry SVT. Does not convert AF, atrial flutter, or VT
Adverse: commonly mild and short-lived. Include sense of impending doom, complications of flushing, chest pressure, throat tightness, numbness. Patients should have a short period of asystole after administration.
Contraindication: sick sinus syndrome, 2nd or 3rd degree heart block, poison/drug induced tachycardia.
Dosage: Initial dose of 6mg rapid IV IO (over 1-3 seconds) immediately followed by a 20ml rapid saline flush. If that does not work, in 1-2 mins, 12mg rapid. Repeat 2nd time if necessart\y
Amiodarone (Cordarone)
Class: Antiarrhythmic, class III
Action: acts directly to the myocardium to delay the repolarization and incase the duration of the action potential
Indication: ventricular arrhythmias, second-line agent for atrial arrhythmias
Adverse: Burning at the IV site, hypotension, bradycardia
Contraindication: sick sinus syndrome, 2nd and 3rd degree heart block, cardiogenic shock, when episode of bradycardia have caused syncope, sensitivity to benzyl alcohol and iodine
Dosage:
• V fib and PVT: 300 mg IV IO followed by one 150 mg dose in 3-5 min
• Stable patients with arrhythmias such as PVCs or wide complex tachs w/strong pulse: 150 mg in 100 ml d5w IV IO over a 10 minute period. May repeat in 10 mins up to 2.2 grams in 24 mins
Diltiazem (Cardizem)
Class: calcium channel blocker, class IV antiarrhythmic
Action: blocks calcium from moving into cardiac muscle cell which prolongs the conduction of electrical impulses through the AV node
Indication: Ventricular rate control in rapid AF
Adverse: flushing, headache, bradycardia, hypotension, heart block, mayocardial depression, severe AV block, and at high doses, cardiac arrest
Contraindication: hypotension, heart block, heart failure
Dosage: optimum dose is .25 mg/kg IV IO over a 2 minute period to control rapid AF. 20mg is a reasonable dose for average adult. A second higher dose of .35 mg/kg (25mg) can be administered over a 2 minute period if results from initial dose are not satisfactory. For continued reduction, a continuous infusion can be started at 5-15 mg/hr
Lidocaine (Xylocaine)
Class: antiarrhythmic, class IB
Action: blocks sodium channels, increasing the recovery period after repolarization, suppresses automaticity in the his-purkinje system and depolarizes in the ventricles
Indication: ventricular arrhythmias, when amiodarone is not available
Adverse: toxicity, seizures w/o warning, cardiac arrhythimas, hypotension, cardiac arrest, pain @ injection site
Contra: AV block, bleeding, thrombocytopenia, known sensitivity to lidocaine, sulfite, or paraben
Dosage: 1-1.5 mg/kg IV IO may repeat at half the original dose every 3-5 minutes max dose 3mg/kg
Procainamide (Pronestyl)
Class: antiarrhythmic, class IA
Action: blocks influx of sodium through membrane pores, consequently suppresses atrial and ventricular arrhythmias by slowing conduction in mayocardial tissue
Indication: alternative to amiodarone for stable monomorphic VT with normal QT interval and preserved ventricular function, reentry SVT if uncontrolled by adenosine and vagal maneuvers if blood pressure stable, AF with rapid rate in wolff-parkinson-white syndrome
Adverse: asystole, VF, flushing, hypotension, PR prolongation, QRS widening, QT prolongation
Contra: AV block, QT prolongation, torades de pointes
Dosage: 20 mg/min slow IV IO
Sodium Bicarbonate
Class: Electrolyte replacement

Action: Counter acts existing acidosis.

Indications: Acidosis, drug intoxications (e.g., barbiturates, salicylates, methyl alcohol).

Adverse effects: Metabolic alkalosis, hypernatremia, injection site reaction, sodium and fluid retention, peripheral edema.

Contraindications: Metabolic alkalosis.

Dosage: Metabolic Acidosis during cardiac arrest: Adult; 1mEq/kg slow IV, IO; may repeat at 0.5 mEq/kg in 10 minutes. Pediatric: Same as adult. Metabolic Acidosis Not associated with Cardiac Arrest: Adult; dosage should be individualized. Pediatric; Dosage should be individualized.

Monitoring Parameters: Do not administer this medication in the same IV/IO lines as other medications. Caution with administration of this medication with patients with history of CHF and renal disease.
Calcium chloride
Class:
-Electrolyte Modifier
Action:
-Essential for transmission of nerve impulses that initiate contraction of cardiac muscle
Indication:
-Hyperkalemia
-Hypocalcemia
-Calcium Channel Blocker OD
Contraindication:
-Hypercalcemia
-Digitalis Toxicity
Precaution:
-Patients using digoxin
-Cardiac, Pulmonary, or Cerebrovascular Disease
-Precipitate will for if mixed with NaHCO3
Side effects:
-Syncope -Cardiac Arrest -Arrhythmia
-Bradycardia -N/V -Tissue Necrosis at IV site
Supplied:
100mg/mL (10%)
Adult dose:
-20mg to 30mg/kg IV given over several minutes
Ped dose:
-20mg to 30mg/kg IV/IO given over several minutes
Nifedipine (Procardia, Adalat)
Class:
Calcium Channel Blocker
Indication:
exertional angina, unstable angina, coronary spasms, HTN, pre-eclampsia, Raynaud's phenomenon
Adverse effects:
increased angina, (rare) MI, palpitations, peripheral edema, flushing, constipation, heartburn, dizziness
MOA:
blocks L-type calcium channels in vasculature, causing vasodilation; affects arteries more than veins
Dose:
Sublingual 10mg capsule
Enoxaparin (Lovenox)
Drug: Generic: Enoxaparin (Trade: Lovenox)
Classification: Pharmacotherapeutic: Low molecular weight heparin. Clinical: anticoagulant.
Action: Potentiates action of antithrombin III, inactivates coagulation factor Xa. Therapeutic effect: Produces anticoagulation. Does not significantly influence bleeding time, PT, aPTT.
Uses: Prevention of post op DVT following hip or knees replacement surgery, abdominal surgery. Long term DVT prevention following hip replacement surgery, nonsurgical acute illness. Treatment of unstable angina, non q-wave MI, acute ST-segment elevation MI (STEMI), acute DVT (with warfarin). OFF Label: Prevention of DVT following general surgical procedures. Dose: Adult- 1mg/kg SQ for unstable angina/MI; 0.5 mg/kg for pulmonary embolism, ped - 1 mg/kg SQ
Neseritide (Natercor)
Class:
Natriuretic peptide
Indication:
used for treatment of acutely decompensated CHF in pt's who have dyspnea at rest or with minimal activity
Contraindication:
should not be administered to people with known hypersensitivity to the drug. should not be used in pt's with a BP of <90mmHg and cardiogenic shock
Dose:
adult - initial bolus of 2 mcg/kg over 60 seconds followed by continuous infusion of 0.01 mcg/kg/min, with monitored BP, ped - not indicated
MOA:
causes vasodilation through relaxation of vascular smooth muscle. it also causes diuresis and loss of sodium in the kidney
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