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Pharmacology Exam 3 Drug Profiles

Terms in this set (104)

Adenosine (Adenocard) Classification
Antiarrhythmic; endogenous nucleoside
Adenosine Site of Action
Purine-based nucleoside found in all cells of the body formed by breakdown of ATP. Adenosine receptors found in heart and lungs, and when stimulated decrease electrical conduction, especially through AV node
Adenosine Peak, Half life
Peak 2-5 s, half life 5-10s
Adenosine Action
Slow AV conduction, disrupt reentry pathways, coronary vasodilation (mild, if any)
Adenosine Indications
PSVT refractory to vagal maneuvers, WPW
Adenosine Contraindications
High degree heart blocks, sick sinus, hypersensitivity
Adenosine Prep
6mg/2ml vial/pfs
Adenosine Dose
6mg rapid IV push x1; 12 mg rapid IV push repeated x1 as necessary through a large vein. Follow immediately with rapid 20ml bolus of NS to facilitate rapid administration to myocardium
Adenosine Drug interactions
Methylxanthines (aminophylline) diminish effects
Adenosine side effects
Facial flushing (18%), SOB (may stimulate bronchospasm in reactive airway disease), brief period of asystole (1-3s), HA, chest pressure/papitations
Adenosine signs of toxicity
Prolonged heart block, asystole
Amiodarone (Cordarone) Classification
Class III antidysrhythmic
Amiodarone site of action
prolongs duration of myocardial cell action potential and refractory period by acting on all cardiac tissue. Primarily blocks K+ channels and inactivated Na+ channels
Amiodarone peak of action
Rapid, 1-3 min
Amiodarone action
Decreases av and sinus node function, K+ and Na+ channel blocker, inhibit abnormal automaticity, prolongs QT and QRS duration, Ca++ channel blocker (limited), increases atrial, av nodal, and ventricular refractory periods
Amiodarone Indications
Pulseless monomorphic VTach/Vfib, pulsing monomorphic VTach, polymorphic vtach (give MgSO4 first), narrow complex tachycardia (not first line)
Amiodarone contraindications
Bradycardia, high degree heart block, cardiogenic shock
Amiodarone prep
150mg/3ml vial or PFS, or 450mg/9ml
Amiodarone Dose
Pulseless VTach/Vfib: 300mg followed by 150mg in 3-5min if unsuccessfull; Pulsing VTach/ narrow tachycardia: 150mg in 100ml NS IV over 10min
Amiodarone Side Effects
Hypotension, bradycardia, twitching, pro-arrhythmia, blurred vision, N/V
Amiodarone signs of toxicity
hypotension, bradycardia, seizure, pulmonary fibrosis, tinnitis
Aspirin Classification
platelet inhibitor/NSAID
ASA site of action
impedes clotting by blocking prostaglandin synthesis, prevents platelet aggregating substance thromboxaneA2, acts on hypothalamus heat regulating center
ASA Peak and half life
10-60minutes peak, half life 15-20 minutes
ASA Action
decrease platelet adhesiveness for life of the platelet, diminish inflammation, fever, pain
ASA Indications
CP/ AMI, (CVA non hemmorhagic)
ASA Contraindications
RMH of ulcers/GI bleed, known bleeding disorders, sensitivity to ASA or NSAIDs, hemorrhagic stroke
ASA Prep
81mg (baby asa), 325mg, 500mg, 650mg
ASA dose
162-324mg chewed or swallowed
ASA Side effects
Occasional GI distress, tinnitis, tachycardia, fever, tachypnea
ASA Tox
urticaria, bronchospasm, pruritis
Atropine Sulfate Classification
antimuscarinic, anticholinergic/parasympatholytic
Atropine Sulfate Site of Action
Blocks ACh at muscarinic sites of the myocardium, lungs, GI/GU tract and glands
Atropine Sulfate Peak, onset, duration
Rapid peak, onset 1-2min, lasts 5 minutes
Atropine Sulfate Action
decreases vagal tone --> increase AV conduction (+dromotrope, +chronotrope); suppresses glandular activity (organophosphate poisoning)
Atropine Sulfate Indications
Symptomatic bradycardia; organophosphate poisoning; refractory bronchospasm (not a stand alone treatment)
Atropine Sulfate contraindications
Tachycardia, high degree AV blocks (relative -- wont really help)
Atropine Sulfate prep
IV, IO, ETT; nebulized for bronchospasm. 1mg/10ml PFS; 10mg/10ml mdv
Atropine Sulfate dose
Symptomatic bradycardia: 0.5-1.0mg slow IVP q3-5min to max 0.04mg/kg; Organophosphate poisoning: 2mg repeat as necessary. may need a lot.; Bronchospasm: 0.5mg mixed with albuterol and nebulized
Atropine sulfate side effects
Tachydysrhythmias, precipitation of MI, dry mouth
Diltiazem (cardizem) classification
Ca channel blocker, class IV antidysrhythmic
Diltiazem (cardizem) mechanism of action
inhibits influx of extracellular calcium across myocardial and vascular smooth muscle cell membranes --> results in dilation of coronary and systemic arteries; improved O2 delivery to myocardium, decreased peripheral resistance BP and afterload. Negative dromotrope, refractory period in AV node increased. Slowed ventricular rate. Works equally on SA and AV nodes and peripheral vasculature
Diltiazem (cardizem) indications
a fib and a flutter with RVR; multifocal atrial tachycardia, PSVT (secondary med)
Diltiazem (cardizem) contraindications
Hypotension (less than 90mmHg); 2nd or 3rd degree AV block, sick sinus syndrome, cardiogenic shock, hypersensitivity, Afib/flutter with WPW or short PR syndrome; v-tach or wide tach of unknown origin; AMI, advanced aortic stenosis
Diltiazem (cardizem) precautions
CHF, elderly, renal/hepatic impairment, pregnancy class C
Diltiazem (cardizem) prep
25mg/5ml or 50mg/10ml vial/pfs
Diltiazem (cardizem) dose
0.25mg/kg slow IVP over 2 minutes (typ 15-20mg). repeat in 15min 0.35mg/kg IV over 2 minutes; maintenance infusion 125mg in 100ml infused @5-15mg/hr titrate to HR
Diltiazem (cardizem) onset, duration
onset 2-5 min, duration 1-3hrs
Diltiazem (cardizem) side effects
First or second degree AV block, bradycardia, ventricular dysrhythmias, CHF/edema, vasodilation (hypotension,syncope); flushing, chest pain, dyspnea, sweating, N/V/dizziness, nervousness, dry mouth, headache
Diltiazem (cardizem) interactions
may prolong sedative effects of versed, may enhance ffects of ASA and prolong bleeding time, additive effect with anti-hypertensives, alpha-blockers, diuretics, incompatible with simultaneous lasix injection
Dopamine (Intropin) classification
sympathomimetic, catecholamine, inotrope
Dopamine (Intropin) site of action
Precursor of NE and stimulates its release. stimulates alpha, Beta1, and dopaminergic receptors (found in renal and mesenteric vessels, resulting in vasodilation)
Dopamine (Intropin) onset, peak, half life
Onset 1-2 min, peak 10min, half life 2 minutes
Dopamine (Intropin) Action
Vasoconstriction; +inotrope, maintains or improves renal and mesneteric blood flow, indirectly stimulates release of NE from nerve endings
Dopamine (Intropin) Indications
cardiogenic shock, low output HF, sepsis, refractory symptomatic bradycardia, hypotension after ROSC
Dopamine (Intropin) contraindications
pheochromocytoma, VF, VT, other ventricular tachydysrhythmias, known sensitivity including sulfites
Dopamine (Intropin) prep
400mg/5ml vial in 250ml (IV/IO infusion only)
Dopamine (Intropin) Dose
start 2-20mcg/kg/min IV, titrate to effect (5-10mcg/kg/min common starting doses)
Dopamine (Intropin) Drug interactions
can be deactivated by alkaline solutions (bicarb), decrease dose if pt on MAOIs. use only after fluid resuscitation performed
Dopamine (Intropin) side effects
tachycardia, hypertension, MI, PVCs, dysrhythmias
Dopamine (Intropin) effect range
1-2mcg/kg/min: renal; 2-10mcg/kg/min: renal, B1; 10-20mcg/kg/min: B1, a, decreased renal blood flow; 20 and up: a, possible chronotropy/ it's just norepi now
Epinephrine Classification
catecholamine, sympathomimetic
Epinephrine site of action
alpha and beta adrenergic receptor agonist
Epinephrine peak and half life
peak immediate half life 1 min
Epinephrine Actions
+chronotrope, +inotrope, peripheral vasoconstriction, bronchodilation
Epinephrine Indications
Cardiac arrest, bronchospasm, bradycardia (peds), allergic rxn/anaphylaxis/shock, angioedema (neb), croup (peds, nebulized -- racemic?)
Epinephrine Contraindications
None in cardiac arrest, shock; age over 40 w history of HTN or significant cardiovascular disease (relative for bronchospasm or allergic rxn)
Epinephrine preps
1:1000 (1ml amp or 10ml mdv 1mg/1ml); 1:10,000 (1mg/10ml PFS); 1:100000 (10mcg/ml); racemic epi (vaponephrine) 2.25% soln
Epinephrine dose for cardiac arrest
1mg IV/IO q 3-5 min
Epinephrine dose for allergic rxn/refractory asthma
0.3-0.5mg IM/SQ q 15min
Epinephrine dose for severe shock (anaphylaxis, cardiogenic, sepsis, etc
5-10mcg IV push dose epi 1:100,000
Epinephrine side effects
CP, HTN, ectopy, tachydysrhythmias, anxiety, palpitations, tachycardia
Epinephrine toxicity
AMI, VT/VF
Lidocaine (Xylocaine) classification
antidysrhythmic (Type I-B)
Lidocaine (Xylocaine) site of action
blocks (fast) sodium channels
Lidocaine (Xylocaine) half life
100min in normal situations; may increase to 4-10hrs in heart failure
Lidocaine (Xylocaine) actions
decreases phase 4 depolarization (depresses automaticity, decreases AP); increases threshold of excitability; increases refractory period of cells
Lidocaine (Xylocaine) indications
VTach/VFib; stable monomorphic VTach; prevent VT/Vfib reoccurrence
Lidocaine (Xylocaine) contraindications
high degree AV block, stokes-adams syndrome, IVR, allergies to local anesthetics, hypotension, WPW
Lidocaine (Xylocaine) prep
2% = 100mg/5ml PFS; 20% 1g/5ml vial; 1g/250ml vial
Lidocaine (Xylocaine) dose
Cardiac arrest: 1.5mg/kg q5-10 min repeat x1 max of 3.0mg/kg; stable VT: 0.5-0.75mg/kg q5-10min, max 3.0mg/kg; post conversion infusion 1-4mg/min
Lidocaine (Xylocaine) side effects
Reduces CO, hypotension
Lidocaine (Xylocaine) Toxicity
tinnitis, fasciculations, slurred speech, ALOC, seizures
Nitroglycerin (nitrostat, tridil, nitro-bid) classification
nitrate/antianginal
Nitro site of action
smooth muscle cell wall where nitro broken down into nitric oxide by glutathion S-transferase
Nitro peak and half life
peak 4-8 minutes (30 minutes for ointment); half life 1-4 minutes
Nitro actions
relaxes vascular smooth muscle (marked venodilation, mild-moderate arterial dilation), decreases pre and afterload, relaxes coronary arteries and collateral blood vessels
Nitro indications
anginal chest pain, ACS, pulmonary edema, HTN
Nitro contraindications
hypotension (officially 90mmHg but for Rod 100mmHg), marked bradycardia, recent ED med use, hypersensitivity to nitrates, inferior wall AMI (relative)
Nitro preps
0.4mg/1 tablets, metered dose spray, 2% (1g, 30g, 60g) ointment
Nitro dose
chest pain 0.4mg SL q 5min, Edema: 0.4-1.6mg SL q5min; HTN: controversial in EMS -- 0.4mg SL until diastolic below 100mmHg.
Nitro side effects
hypotension, reflex tachycardia, HA
Furosemide
Not yet put in here
Norepinephrine (levophed) classification
sympathomimetic
Norepinephrine (levophed) site of action
NMJ alpha receptors of resistance and capacitance blood vessels. 85%Alpha, 15% Beta1
Norepinephrine (levophed) peak of action and duration
1-2 min, then diminishes
Norepinephrine (levophed) actions
promotes widespread vasoconstriction, decreases renal blood flow, mild B-1 effects (no effect on CO)
Norepinephrine (levophed) indications
hypotension unresponsive to fluids, septic shock (first line), HF/cardiogenic shock (limited O2 demand increase)
Norepinephrine (levophed) contraindications
hypoxia, isolated AMI, hypovolemia
Norepinephrine (levophed) prep
4mg/4ml ampules
Norepinephrine (levophed) dose, route
IV infusion in D5W 8-12mcg/min; maintenance 2-4mcg/min titrated to effect
Norepinephrine (levophed) precautions/notes
not common prehospital med. assure adequate volume before pressors, administer through larger vein (AC, EJ), probably best not to mix in NS
Norepinephrine (levophed) side effects
bradycardia, palpitations/arrhythmias, HTN/pulmonary edema, extravasation may cause necrosis and sloughing
Norepinephrine (levophed) signs of toxicity
severe HTN and violent HA, CP, dysrhythmias, excessive sweating
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