NREMT Paramedic Drugs

Terms in this set (29)

TRADE NAME: Atropine, Atropa
CLASS: Anticholingeric
Description: Anticholingeric, antimuscarinic, parasympatholytic
ACTIONS: Decreases vagal tone resulting in positive chronotropic effect & increases AV conduction. Competitive antagonist for acetylcholine at muscarinic receptors. Atropine bronchodilates via parasympatholytic mechanism.
INDICATIONS: Hemodynamically significant bradycardia and asystole. Cholinergic poisoning by certain mushrooms (Amanita spp.), insecticides (carbamates, acetycholinesterase inhibitors), and nerve gas.
PHARMACOKINETICS:
Onset: < 2 minutes
Peak Effect: 2 - 4 min. IV (20 - 60 min. IM)
Duration: 4 hours
Half Life: 2 - 3 hours
CONTRAINDICATIONS: No significant contraindications, however, may worsen bradycardia associated with Mobitz-Type 2 and complete heart block. Use transcutaneous pacing if available. Use with extra caution in patients with symptoms of myocardial ischemia.
SIDE EFFECTS:
CNS: Pupillary dilation, confusion, restlessness, drowsiness, seizure
CV: Tachycardia, paradoxical bradycardia
Resp: Can cause mucus plugs due to drying of secretions
GI/GU: Dry Mouth
INTERACTIONS: Additive anticholinergic effects with antihistamines, phenothiazines, antipsychotics, tricyclic antidepressants, procainamide, other anticholinergics drugs. Caution with SSRIs.
DOSAGE:
ADULT: Symptomatic Bradycardias 0.5 - 1.0mg IV push; may be repeated q 3-5 minutes to a maximum of 0.04mg/kg; (2.5 - 3mg adults) results in full vagal blockage. Doses of less than 0.5mg may cause further slowing of the heart rate.
Asystole & PEA initially 1.0mg IV; may be repeated q 3-5 minutes for total of 3mg. ETT-2.0mg
Poisoning initially 1mg rapid IV, 2nd 1mg slow IV; larger doses may be required. Dosage exceeding 4mg by physician order only.
PEDIATRIC: 0.05mg/kg IV, IM, IO every 10-15 min.
ROUTE: IV, IO, ET (May be administered via *ABT in some cases of bronchospasm. Smaller doses of atropine are indicated for the elderly.)
NOTES: Monitor vital signs carefully.
TRADE NAME: Lasix
CLASS: Diuretic
DESCRIPTION: Potent diuretic. Causes venous dilation
ACTIONS: Causes venous dilation and therefore decreases preload and cardiac workload.
Blocks reabsorption of chloride and sodium primarily in the Loop of Henle thereby increasing urine volume/decreasing blood volume.
INDICATIONS: Congestive heart failure, acute pulmonary edema, hypertensive crisis
PHARMACOKINETICS:

Onset: 5 - 10 minutes, diuresis in 5 - 30 minutes
Peak Effect: 30 minutes. (IV) 1 - 2 hr (PO)
Duration: 2 hours, Diuresis duration approx. 6 hours
Half Life: 30 minutes
CONTRAINDICATIONS: Hypersensitivity to furosemide or other sulfonamides. Renal failure.
Use with caution in cases of known urinary retention. May cause birth defects, safety has not been established in pregnancy. Extreme caution in cases of pneumonia - creates mucus plugs.
SIDE EFFECTS:
CNS: Dizziness
CV: Hypotension, hypokalemia, dehydration, dysrhythmias, headache
GI/GU: Nausea, vomiting, diarrhea
INTERACTIONS: Possible additive or synergistic effects with antihypertensives,
nitrates, and other diuretics. Do not mix with amrinone (Inocor) - will precipitate.
DOSAGE:
ADULT: 40 - 80 mg slow IV push at 10-20mg/minute (4 mg/min. recommended).
Titrate to maintain uterine tone
PEDIATRIC: 1 mg/kg
ROUTES: IV preferred, slow - moderate push.
May be given IM if IV route is not available.
NOTES: Protect from light, heat.
Observe patient carefully during administration, especially elderly, during diuresis is essential. Currently, furosemide is rarely administered in the field,
unless the patient is already taking furosemide.
TRADE NAME: Magnesium
CLASS: Electrolyte, Anticonvulsant, Antidysrhythmic
DESCRIPTION: Electrolyte, cation, Physiologic calcium channel blocker, CNS depressant and anticonvulsant. Acts as neuromuscular blocker.
ACTIONS: Raising magnesium level inhibits calcium flux across cell membranes, corrects hypomagnesemia, depresses CNS and inhibits muscle cell activity.
INDICATIONS: Convulsive states associated with severe preeclampsia and eclampsia, Torsades de Pointes, refractory/recurrent VF or pulseless VT, refractory bronchospasm
PHARMACOKINETICS:

Onset: Immediate in IV , IM: 1 hour
Peak Effect: Varies
Duration: 1 hour
CONTRAINDICATIONS: Contraindicated in: High degree heart block, shock, patients on digitalis or who are on dialysis or who are hypocalcemic,
or persistent hypertension.
Use with caution in patients with other CNS depressants on board.
Patients with impaired renal function may not be able to eliminate excess Mg++
Use with caution in patients with asthma.
SIDE EFFECTS:
CNS: Sedation, confusion, muscle weakness, paralysis
CV: Hypotension, bradycardia, heart block
Resp: Depression, arrest
Other: Flushing, sweating, hypotension, hypocalcemia
INTERACTIONS: Incompatible with many drugs. Those present in the prehospital arena include:
digitalis, alcohol, salicylates, and sodium bicarbonate.
DOSAGE:
ADULT: VF/VT/Torsade: 1 - 2 grams. Maintenance infusion is indicated following initial IV dose at a rate of 0.5 - 1.0 g/hr. IV for control of Torsade.
PEDIATRIC: VFVT/Torsade: 25 - 50 mg/kg IV/IM
Eclampsia: 1 - 4 grams of 10% solution. Smallest effective dose should be used. Dose rate should not exceed 1.5 ml (150mg)/min.
Bronchospasm: Adults 1 - 2 grams, Pediatric: 25 - 50 mg/kg
ROUTES: IV over 1-20 minutes depending upon illness and seriousness.
It is preferred to use a more dilute solution (10%) when administering IV.
NOTES: Calcium is antidote if respiratory depression occurs. Continuous cardiac monitoring is essential.
General signs of toxicity include: sedation, thirst, diarrhea, muscle weakness.
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