Paramedic Pharmacology

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Adenosine (Adenocard)

Class:
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Adenosine (Adenocard)

Class:
Endogenous nucleoside
Antidysrhythmic.
Image: Adenosine (Adenocard) Class:
Adenosine (Adenocard)

Dosage:
Initial 6mg; Repeat 12mg
Image: Adenosine (Adenocard) Dosage:
Adenosine (Adenocard)

Actions:
Slows the conduction time through the A-V node, can interrupt the reentry pathways through the A-V node and can restore normal sinus rhythm in patients with PSVT, including PSVT associated with WPW.
Image: Adenosine (Adenocard) Actions:
Adenosine (Adenocard)

Indications:
First drug for narrow-complex PSVT. May be used diagnostically in wide-compex tachycardias of unknown type. PSVT associated with WPW.

Does NOT convert A-Fib, A-Flutter, or VT.
Image: Adenosine (Adenocard) Indications:
Adenosine (Adenocard)

Contraindications:
2nd or 3rd degree A-V block, except in a pt with functioning a atrial pacemaker. Sick Sinus Syndrome, except in pts with funtioning atrial pacemaker. Known hypersensitivity.
Image: Adenosine (Adenocard) Contraindications:
Adenosine (Adenocard)

Adverse Effects:
Flushing, Chest Pain, brief periods of Asystole, Bradycardia, Ventricular Ectopy.
Image: Adenosine (Adenocard) Adverse Effects:
Adenosine (Adenocard)

Pharmacokinetics/dynamics:
Onset: <20 secs
Duration: 3-7 mins
Toxicity: Prolonged action with Ca Channel Blockers
Absorption:<20sec
Distribution: Cardiovascular, Endothelium
Metabolism: Liver
Excretion: Renal
Image: Adenosine (Adenocard) Pharmacokinetics/dynamics:
Albuterol (Proventil)

Class:
Beta2-Adrenergic bronchodilator. Beta agonist.
Image: Albuterol (Proventil) Class:
Albuterol (Proventil)

Dosage:
2.5mg in 3mL Normal Saline nebulized
Image: Albuterol (Proventil) Dosage:
Albuterol (Proventil)

Actions:
Binds to Beta2 receptors, resulting relaxation of bronchial smooth muscles. Increased c-AMP levels are associated with relaxation of bronchial smooth muscles and inhibition of release of mediators of immediate hypersensitivity from cells, especially from mast cells.
Image: Albuterol (Proventil) Actions:
Albuterol (Proventil) Indications:Relief of bronchospasm in pts with reversible obstructive airway disease and acute attacks of bronchospasm.Albuterol (Proventil) Contraindications:Known hypersensitivity.Albuterol (Proventil) Adverse Effects:Flushing, Tachycardias, Bronchospasms, Palpitations, dry mouth, Nausea, Irritability.Albuterol (Proventil) Pharmocokinetics/dynamics:Onset: 15mis-2hrs Duration: 3-7min Toxicity: Try to avoid caffeine and ephedra. Beta blockers could interfere with Albuterol's mechanism of action.Amiodorone (Cordarone) Class:AntidysrhythmicAmiodarone (Cordarone) Dosage:300mg IVP- VF, Pulsless VT 150mg IVP- Stable VT, SVT.Amiodarone (Cordarone) Actions:Used in a wide variety of atrial and ventricular tachyarrhythmias and control in arrhythmias in pts with impaired LV function when Digoxin is not effective.Amiodarone (Cordarone) Indications:Shock-refractory VF/Pulseless VT. Polymorphic VT and wide complex tachycardia of uncertain types. COntrolled hemodynamically Stable VT when cardioversion is unsuccessful. SVT, PSVT and Atrial tachycardia wih preserved LV function. A-Fib or Flutter.Amiodarone (Cordarone) Contraindications:None.Amiodarone (Cordarone) Adverse Effects:Hypotension, negative inotropic effects and prolonged QT internal. Any use with other anti-arrhythmics can be pro-arrhythmic. Long half-life, approx 40 days.Amiodarone (Cordarone) Pharmacokinetics/dynamics:Onset: Immediate IV Duration: Unk. Absorption: Slow, variable Distribution: Blood tissues, crosses placenta. Metabolism: Liver extensively Excretion: Renal Half Life: 15-100 daysAspirin (ASA) Class:Salicylate, non-narcotic analgesic, anti-inflammatory, and antipyretic.Aspirin (ASA) Dosage:Baby 81mg each. Total 324mg. Adult 325mg enteric coated/chewedAspirin (ASA) Actions:Produces analgesia by affecting hypothalamus and by blocking generation of pain impulses. Exerts anti-inflammatory effect by inhibiting prostaglandin synthesis. Relieves fever. Decreases platelet aggregation (impedes clotting).Aspirin (ASA) Indications:Thromboembolic disorders, TIA, MI.Aspirin (ASA) Contraindications:GI ulcers, GI bleeding and bleeding disorders. Hypersensitivity. Use cautiously in hypoprothrombinemia, Renal Failure, Vitamin K deficiency.Aspirin (ASA) Adverse Effects:Prolonged bleeding time. EENT; Tinnitus, hearing loss. GI; nausea, vomiting, GI distress, occult bleeding. Hepatic: abnormal LFT, hepatitis, rash and bruising.Aspirin (ASA) Pharmacokinetics/dynamics:Onset: 15-30mins Duration: 4-6hrs Absorption: Well Absorbed Distribution: Rapidly distributed, crosses placeenta. Metbolism: Liver extensively Excretion: Renal, Breast Milk Half Life: 15-20minsAtropine Sulfate Class:Anticholinergic or antiparasympathetic (parasympatholytic) drug.Atropine Sulfate Dosage:0.5-1mg IVP.Atropine Sulfate Actions:Atropine inhibits the muscarinic actions of acetylcholine on structures innervated by postganglionic cholinergic nerves, and on smooth muscles which respond to endogenous acetylcholine.Atropine Sulfate Indications:First drug for symptomatic bradycardia (Class 1a). Lessen the degree of A-V heart block due to increased vagal tone. Poisoning from organophosphates.Atropine Sulfate Contraindications:Glaucoma, Pyloric stenosis, Prostatic hypertrophy (leads to complete urinary retention).Atropine Sulfate Adverse Effects:Caution in the presence of myocardial ischemia and hypoxia. Increases myocardial oxygen demand. Use with caution in Infranodal AV block (type II) and new 3rd degree block with wide QRS complexes (Class IIb). Be prepared to pace or give catecholamines. Dry mouth, blurred vision, photophobia, and tachycardia.Atropine Sulfate Pharmacokinetics/dynamics:Onset: 2mins Duration: 4-6hrs Absorption: Well absorbed IV, IO, IM Distribution: Crosses BBB, placenta Metabolism: Liver Excretion: Renal, breast milk Half Life: 13-40hrsCalcium Chloride (CaCl) Class:Mineral.Calcium Chloride (CaCl) Dosage:10mg/kg of 2-10% solution.Calcium Chloride (CaCl) Actions:Essential for the functional integrity of the nervous and muscular systems. It is necessary for cardiac function, blood coagulation, maintains cell membrane and capillary permeability. Stabilizes myocardial membrane associated with hyperkalemia.enteral administrationPO (oral)parenteral routedeposited directly into tissues when barriers are penetratedbioavailabilitythe rate at and the extent to which a nutrient is absorbed and usedhalf-lifelength of time required for half of the radioactive atoms in a sample to decayduration of actionthe length of time the drug has a pharmacologic effectBiotransformationOne or more biochemical reactions involving a parent drug; occurs mainly in the liver and produces a metabolite that is either inactive or active. Also known as metabolism.Pharmokineticsthe study of drugs within the body, absorption , distribution, metabolism, excretionactive transportEnergy-requiring process that moves material across a cell membrane against a concentration differencepassive transportthe movement of substances across a cell membrane without the use of energy by the cellendocytosisA process in which a cell engulfs extracellular material through an inward folding of its plasma membrane.passive diffusionthe movement of drugs from an area of higher concentration to lower concentrationvolume of distributionMeasure of apparent space in the body available to contain the drugonset of actionThe time required for a drug to elicit a therapeutic response after dosing.mechanism of actionhow a drug produces its physiological effect in the bodypotencythe strength of something such as a drug or alcoholic beverage.efficacythe ability to produce a desired or intended resultaffinityan attraction tosummationincreased force of contraction by a skeletal muscle fiber when a twitch occurs before the previous twitch relaxespotentiationincreased potency created by two drugs acting togethersubstrateA specific reactant acted upon by an enzymeadrenergic receptorsreceptor sites for the sympathetic neurotransmitters norepinephrine and epinephrineadrenergic agonistsDrugs that stimulate and mimic the actions of the sympathetic nervous system. Also called sympathomimetics.cholinergic agonistsdrugs that stimulate the parasympathetic nervous systemAlpha 1 receptorsvasoCONSTRICTION -> increase BPAlpha 2 receptorssmooth muscle contraction and neurotransmitter inhibitionBeta 1 receptorsincrease heart rateBeta 2 receptorsbronchodilationBeta Agonists• Positive inotropic agents, used to improve cardiac performance, facilitate diuresis, and promote clinical stability in pts with deteriorated refractory HF • Short-term use only!Beta Blockersdecrease heart rate and dilate arteries by blocking beta receptorsDopamine- Adrenergic Agonist - Inotropic - Vasopressor - 2-20 mcg/kg/min - Cardiac: 5-10 mcg/kg/min - Vasopressor: 10-20 mcg/kg/minNorepinephrine- Adrenergic Agonist - Inotropic - Vasopressor - Alpha 1/2 & Beta 1 Agonist - 4mg (250ml D5W or D5NS)Dobutamine- Adrenergic Agent - Inotropic - CHF, Cardiogenic Shock - 0.5 - 1 mcg/kg/min IV/IOEpinephrine1 mg 1:10,000 (Cardiac) 1:1,000 (Anaphylaxis - IM)Propanolol (Inderal)beta blocker Tx: Hypertension Beta Adrenergic Antagonistcholinergic receptorsreceptors of the parasympathetic nervous systemAcetylcholineA neurotransmitter that enables learning and memory and also triggers muscle contractionnicotinic receptorsopen chemically-gated sodium ion channelsmuscarinic receptorsstimulate smooth muscle and slow the heart rateAtropine SulfateAnticholinergic Agent 0.5 - 1 mg IV (Q3-5 min Max: 3mg) Nerve Agent Poisoning: 1-6 mg IVSchedule 1 drugsHighest potential for abuse, no therapeutic use, (Heroine marijuana LSD)Schedule 2 Drugs• High abuse potential • Accepted medical use • Severe physical and/or psychological dependenceSchedule 3 Drugs• Less abuse potential than schedule 1&2 drugs • Accepted medical uses • Moderate or low physical dependence • High psychological dependenceSchedule 4 Drugs• Lower abuse potential than schedule 3 drugs • Accepted medical uses • Limited physical or psychological dependenceSchedule 5 DrugsLimited potential for abuse, Ex: cough syrup w/codeine.Controlled Substance Actenforced by the DEA, regulates the manufacturer and sale of narcotics and dangerous drugsshelf lifeHow long a product may be stored before use.USDAenforces parameters in which medications are effective, storage temperaturesA3E3P3 Refusal Guidelines- Assess - Advise - Avoid - Ensure - Explain - Exploit - Persist - Protocols - ProtectBuccalpertaining to the cheekProAir HFAalbuterol sulfateDorsoglutealupper outer quadrant of the buttocksDeltoidcurve of shoulder formed by large deltoid muscleVentroglutealMuscle located on the side of the hip, just below the iliac crestZ-track injection methodSeals medication into the muscle tissues, used to decrease discomfort and pain, used in ventrogluteal & dorsogluteal sitessubcutaneous injectionbeneath the skinHeparinAnticoagulant 5,000 units STEMI protocolNitroglycerinnitrate drug used in the treatment of angina 0.4 mg SL VasodilatorCardizem (diltiazem)calcium channel blocker Tx: Atrial Flutter, Atrial Fib RVRGlucagonA protein hormone secreted by pancreatic endocrine cells that raises blood glucose levels; an antagonistic hormone to insulin.Lactated Ringerssodium chloride, sodium lactate, potassium chloride, and calcium chloride in water Isotonic Crystalloid Solution Commonly used for Dehydration, Malnourishment and/or Burn victims.Magnesium SulfateMgSO4 Eclamptic Seizure Preterm labor Reactive Airway DiseaseSolumedrol (methylprednisolone)CorticosteroidParasympathomimeticagent causing stimulation of the parasympathetic nervous systemSympathomimetic agentsmimics the sympathetic systemHarrison Drug Act (1914)restricted the use of addictive drugs such as: opium, cocaine, and their derivatives, as well as several other non-narcotic drugsantisepsis/antisepticcleaning technique used by disinfecting the skin using an alcohol or chloraprep prior administration of an injectionCalcium Channel Blockersagents that inhibit the entry of calcium ions into heart muscle cells, causing a slowing of the heart rate, a lessening of the demand for oxygen and nutrients, and a relaxing of the smooth muscle cells of the blood vessels to cause dilation; used to prevent or treat angina pectoris, some arrhythmias, and hypertensionTricyclic Antidepressants (TCAs)Drugs that inhibit the reuptake of norepinephrine and serotonin by the presynaptic neurons in the central nervous system, increasing the amount of time they are available to the postsynaptic receptors. Muscarinic blockage leads to anticholinergic effects such as blurred vision, dry mouth, tachycardia, urinary retention, and constipation.Potencythe strength of something such as a drug or alcoholic beverage.IV Bolusan IV method in which a concentrated dose of medication is introduced directly into the systemic circulationPostsynaptic Cell Stimulationrelease of acetylcholineBeta antagonists- generally used to effect the Beta 1 receptors - cause a decrease in cardiac contractile force and rate = decreased C.O. - these are used to normalize heart rate in arrhythmias or to reduce cardiac damage after MIBeta agonistsAlbuterol; bronchodilatorAlpha antagonists- used primarily to peripheral vascular tone by blocking the alpha 1 receptors. Remember endogenous catecholamines cause vasoconstriction of peripheral blood vessels so blocking these would cause vasodilation - so these are RX'd for HTNalpha-adrenergic receptorsPortions of the nervous system that, when stimulated, can cause constriction of blood vessels.alpha agonists-inhibit release of norepinephrine in the brain -Decrease BP -Suppress insulin secretion -Rx HTN: -Catapres (clonidine) -Aldomet (methyldopa)Activated Charcoala substance that absorbs many poisons and prevents them from being absorbed by the body 1gm/kgAdenosine/AdenocardAntidysrhythmic agent. Slows conduction time through the AV node, interrupts AV node pathways to restore NSR. Converts supraventricular tachycardia (SVT) to sinus rhythm. Rapid IV (1-2 seconds) push, flush immediately with normal saline. 6mg/6mg/12mg Dosed: 12mg/4mlAmiodarone (Cordarone)Antidysrhythmic agent. Prolongs repolarization, relaxes smooth muscles, decreases vascular resistance. For ventricular fibrillation and unstable ventricular tachycardia. Incompatible with heparin, may be given in PO maintenance dose, monitor for respiratory complications. 150mg/3mlCalcium Chloride-CaCl2 -Electrolyte -functional integrity of the nervous and muscular systems for normal cardiac contractility -Hypertonic Solution -10% solution in 10ml (100mg/ml) -Ampules, vials, prefilled -500-1000mgDiazepam (Valium)Benzodiazepine Category D (Pregnancy) 5mg/ml vialsDigoxin (Lanoxin)Digitalis cardiac stimulant and diuretic antidysrhythmic 0.25mg/mlDiltiazem (Cardizem)calcium channel blocker 25mg/5ml vials 0.25mg/kg Rate Control over 2 min IV push Maintenance Infusion: 125mg/100l Infuse 5-15mg/hrDiphenhydramine (Benadryl)1st generation antihistamineRacemic Epinephrine (MicroNEFRIN)Class: Sympathomimetic Action: Stimulates both alpha and beta receptors causing vasoconstriction, reduced mucosal edema, and bronchodilation. Indication: Croup Contraindications: Glaucoma, elderly, cardiac disease, hypertension, thyroid disease, diabetes Side effects: Anxiety, dizziness, headache, tremors, palpitations, tachycardia, cardiac arrhythmias, hypertension, nausea, vomiting Special considerations: Monitor blood pressure, heart rate, EKG for changes Adult dose: 0.5 ml UDN Packaged: 11.25 mg/0.5 ml fishEtomidate (Amidate)Adult Dose: 0.2-0.6 mg/kg IV/IO over 30-60 seconds (typical dose 20mg) Class: nonbarbituate hypnotic, sedative MOA: short acting hypnotic Indications: medication for RSI Cardioversion Contraindications: allergic, labor delivery Side effects: respiratory depression, hypotensionFentanylOpioid Analgesicanalgesic drugsdrugs that produce relief from pain while the patient remains consciousRomazicon (flumazenil)-Reverses benodiazepines -can cause seizures if reversal is too rapidFurosemide (Lasix)loop diureticHaloperidolHaldol Antipsychotic NeurolepticDystoniaa condition of abnormal muscle tone that causes the impairment of voluntary muscle movementExtrapyrimidal symptomsSide effects of psychotropic drugs. 3 reversible exta-pyramidal side effects are acute dystonia, Akathisia, and pseudoparkinsonism. Tardive dyskinesia, is the most serious and is not reversible.Akathisiainability to sit stilltardive dyskinesiainvoluntary movements of the facial muscles, tongue, and limbs; a possible neurotoxic side effect of long-term use of antipsychotic drugs that target certain dopamine receptorsPseudoparkinsonismA medication-induced temporary constellation of symptoms associated with Parkinson's disease, including tremor, reduced accessory movements, impaired gait, and stiffening of muscles.Hydromorphone (Dilaudid)Opioid Analgesic semisynthetic analog of morphine works at opioid receptor level to produce analgesia and euphoriaIpratropiuminhibits interaction of acetylcholine at the receptor site on bronchial smooth muscle, resulting in bronchodilationKetamine (Ketalar)Classification: General anesthetic Action: Produces a state of anesthesia while maintaining airway reflexes, heart rate, and blood pressure. Indications: Pain and as anesthesia for procedures of short duration. Adverse Effect: hypotension and sinus bradycardia, other cardiac arrhythmias {rare), respiratory depression, Contraindications: Patients in whom a significant elevation in blood pressure would be hazardous {hypertension, stroke, head trauma, increased intracranial mass or bleeding, Ml). Use with caution in patients with increased ICP or increased intraocular pressure {glaucoma) and patients with hypovolemia, dehydration, or cardiac disease {especially angina and CHF). Dosage: Administer slowly over a period of 60 seconds. IV, 10: • Adult: 1 to 4.5 mg/kg IV/10. 1 to 2 mg/kg produces anesthesia typically within 30 seconds that typically lasts 5 to 10 minutes. Special Considerations: Pregnancy class CKetorlac (Toradol)Class: NSAID Anti-inflammatory Use: For short term use ONLY. Post-op acute pain Dose range: 10 mg - 60 mg Never give more than 5 days Nsg considerations: Tx usually begins with IM or IV admin; but may be given PO. Give deep IM may cause pain at injection site Apply pressure at injection site to ↓ pain Has less antiplatelet effects than ASA If taking oral dose take with food. Use with caution in the elderly Do not use if Patient has renal impairment Do not take w/ ASA, DO NOT take for longer than 5 days Do NOT give if patient has history of Peptic Ulcer/GI Bleeding Less GI distress than ASALevalbuterol (Xopenex)beta 2 agonist; bronchodilatorLidocaine (Xylocaine)Antidysrhythmic. for PVBs VT VF SE-rare unless high dose.might occur with rapid injection in elderly, hepatic failure. Drowsy, weakness, bradycardia, hypotn, tinnitus NI- baseline VS. WF hypoTN, bradycardia. Continuous ECG monitor. watch for prolong PRI and QRSLorazepam (Ativan)Antianxiety (Benzodiazepine)Ketorolac (Toradol)*class*: nonsteroidal anti-inflammatory agents, nonopioid analgesics *Indication* pain *Action*: Pain relief due to prostaglandin inhibition *Nursing Considerations*: -may cause GI bleeding, Stevens-Johnson Syndrome, anaphylaxis, drowsiness - should not exceed 5 days of therapy - bleeding risk increased with garlic, ginger, and ginkgo - may decrease effectiveness of hypertensive medications and diureticsDobutamine (Dobutrex)*class*: beta-adrenergic agonist, inotropic *Indication*: short term management of heart failure *Action*: Dobutamine has a positive inotropic effect (increases cardiac output) with very little effect on heart rate. Stimulates Beta1 receptors in the heart. *Nursing Considerations*: - Monitor hemodynamics: hypertension, ↑HR, PVCs - Skin reactions may occur with hypersensitivity - Beta blockers may negate therapeutic effects of dobutamine - Monitor cardiac output - Monitor peripheral pulses before, during, and after therapy - DO NOT confuse dobutamine with dopamineSuccinylcholineDepolarizing neuromuscular blockerVecuronium (Norcuron)Classification: Neuromuscular blocker, nondepolarizing Action: Antagonizes acetylcholine at the motor end plate, producing skeletal muscle paralysis. Indications: To induce neuromuscular blockade for the facilitation of ET intubation. Adverse Effects: Muscle paralysis, apnea, dyspnea, respiratory depression, sinus tachycardia, urticaria. Contraindications: Known sensitivity to bromides. Use with caution in heart disease, liver disease. Dosage: • Adult: 0.08-0.1 mg/kg IV, 10. • Pediatric: Dosage is individualized. Special Considerations: Pregnancy class C