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Pharmacology Final Exam Additional Drug Profiles

Terms in this set (103)

Amyl Nitrite (classification)
Nitrate, vasodilator
Amyl Nitrate site of action
Smooth muscle of vasculature
Amyl Nitrate Peak, Half Life
Peak immediate half life 5 minutes with duration up to 20 minutes
Amyl Nitrate Metabolization
metabolized by pulmonary alveoli, excreted in urine
Amyl Nitrate Actions
Converts to Nitric Oxide promoting extensive vasodilation, converts some hemoglobin from ferrous to ferric, converting hemoglobin to methemoglobin (cyanide has affinity for methemoglobin)
Amyl Nitrate Indications
Anginal CP (should just use nitro); cyanide toxicity (off label but primary EMS use)
Amyl Nitrate Contraindications
Hypotension, Sensitivity to nitrates, [Closed Angle Glaucoma, Head Injury, Pregnancy] [relative]
Amyl Nitrate Prep
0.3ml capsule for nasal inhalation
Amyl Nitrate Dose
Place crushed capsule into gauze and have patient hold under nose and inhale deeply 30s/min (alternate O2 admin for other 30s). New ampule every 3 minutes. continuous during transport
Amyl Nitrate Drug Interactions + Notes
EtOH and ED meds may increase hypotensive effects. Patient should be supine during administration. If unresponsive, capsule may be broken and placed under NRB
Amyl Nitrate Side Effects
Hypotension, HA, loss of bladder/bowel control
Amyl Nitrate Toxicity
Hypotension
Calcium Chloride Classification
Electrolyte
Calcium Chloride Site of Action
Sarcoplasmic reticulum in muscular contraction; allows release of neurotransmitters. For HyperK: tightly couples the excitation-contraction mech and prolongs plateau phase of AP. increases heart irritability leading to spastic heart. For Hypernatremia: inhibits transport of ionic Ca++ into cardiac cells?
Calcium Chloride Actions
Inotrope, supports muscle cell contraction, supports blood coagulation, supports cardiac function, relieves severe muscle cramps
CaCl2 Indications
Ca++ channel blocker OD, Chronic renal failure, Hyperkalemia, Black Widow spider bites (Ca Gluconate preferred), Magnesium poisoning, Hypocalcemia (CaGluconate preferred)
CaCl2 Contraindications
Never give IM, never administer to any patient taking digitalis
CaCl2 Prep
1g/10ml (100mg/1ml) 10% soln (270mg elemental Ca++)
CaCl2 dose
500-1000mg slowww IVP
CaCl2 Drug interactions
Digitalis will worsen any hyperkalemic states and result in VFib. Do not give with NaHCO3 (Sodium Bicarb) without flushing line.
CaCl2 Note
In the myocardium contractile cells primarily use Na+ channels, electrical cells use Ca++ channels
CaCl2 Side Effects
Vasodilation, irritation to veins and SQ tissue, irritation to GI tract
CaCl2 Tox
Bradycardia, severe tissue necrosis
Diphenhydramine (Benadryl) Classification
Antihistamine
Benadryl site of action
antagonizes central and peripheral histamine H1 receptors
Benadryl Onset, Peak, Duration
Onset 0-20min; peak 1 hr; duration 3-6 hours
Benadryl Actions
Block H1 histamine results in relieves bronchospasm, mild sedative, some anticholinergic action, antiemetic
Benadryl Indications
Allergic rxn, anaphylaxis, relief of extrapyramidal reactions EPR (anti-dyskinestic, possibly due to antimuscarinic effects)
Benadryl contraindications
Lower respiratory diseases (ie asthma), MAOI use, newborns/nursing mothers, closed angle glaucoma, hypersensitivity
Benadryl Prep
IV: 50mg/ml vial, ampule, PFS; tablets/capsules 25-50mg; syrup: 12.5mg/5ml
Benadryl Adult Dose
Allergic rxn/EPR: 25-50mg slow IVP; anaphylaxis: 50mg slow IVP
Benadryl pedi dose
1-2mg/kg slow IVP
Benadryl Drug Interactions
CNS depressants potentiated
Benadryl precautions
Pregnancy B
Benadryl Side Effects
CNS depressant, hypotension, drying of secretions (bad for lower airway disease), tremors, respiratory depression, hyperactivity (in children)
Benadryl Toxicity
Hypersensitivity rxns, cardiovascular collapse, seizures, hallucinations
Famotidine (Pepcid, Act, Fluxid) Classification
Antihistamine, H2 antagonist
Famotidine (Pepcid) site of action
Decrease production of stomach acid by blocking H2 receptors found on gastric lining.
Famotidine (Pepcid) Peak Duration
5-10 minutes (IV), 1-2 hrs (PO); duration 8-10 hours
Famotidine (Pepcid) Actions
Blocks H2 receptors in the stomach
Famotidine (Pepcid) Indications
adjunct to allergic rxns and anaphylaxis, urticaria
Famotidine (Pepcid) contraindications
Hypersensitivity, acute asthma attack, lower resp tract disease / PNA, newborns and nursing mothers
Famotidine (Pepcid) Prep
IV soln 20mg/2ml 40mg/4ml; or tablets
Famotidine (Pepcid) Dose
20mg IV; 20-40mg PO
Famotidine (Pepcid) Drug interactions
CNS depressants, MAOI - prolongs anticholinergic effects; potentiates effects of other antihistamines
Famotidine (Pepcid) Precautions
HTN, cardiac disease, renal disease, bronchial asthma, seizures, pregnancy (C), closed angle glaucoma, concurrent use of other H2 inhibitors. Do not administer IM
Famotidine (Pepcid) Side Effects
Fatigue, Insomnia, Muscle Pain, Headache, Chest Pain
Methylpredisolone (Solu-Medrol) Classification
Corticosteroid
Methylpredisolone (Solu-Medrol) Site of Action
stabilizes cell membrane
Methylpredisolone (Solu-Medrol) Peak, half life
1-2 hours PO; 4-8 days IM. Half life 3.5hrs
Methylpredisolone (Solu-Medrol) Action
reduces inflammation by suppressing leukocyte activity and preventing some inflammatory mediators (prostaglandins, leukotrienes) from acting
Methylpredisolone (Solu-Medrol) Indications
Bronchial asthma, severe allergic reactions (some EMS), cerebral edema, adrenal insufficiency, spinal cord injury, inflammatory bowel syndrome, crohn's disease
Methylpredisolone (Solu-Medrol) Contraindications
Administration of live virus vaccines, fungal infections, TB, cushing's disease
Methylpredisolone (Solu-Medrol) Prep
Vial 40mg/ml; 50mg/ml; 80mg/ml; 125mg/2ml
Methylpredisolone (Solu-Medrol) Dose
125mg IV or IM
Methylpredisolone (Solu-Medrol) Interactions
may cause Dig toxicity
Methylpredisolone (Solu-Medrol) Side effects
Facial flushing, GI distress, multiple others with maintenance/chronic dose
Methylpredisolone (Solu-Medrol) toxicity
hypokalemia, spontaneous bone fractures, CHF
Naloxone (Narcan) Classification
Narcotic antagonist
Narcan Site of Action
competitively blocks opioid receptor sites in CNS
Narcan Onset, Half Life
Onset: IV/IN 1min; IM 2-3min; SQ 5-10min
Narcan Action
Reverses CNS depressant actions of opioids/narcotics
Narcan Indications
Narcotic or Opioid OD
Narcan Contraindications
Known hypersensitivity, advanced airway placement prior to naloxone administration
Narcan Prep
0.4mg/ml; 1mg/1ml
Narcan Dose
0.4mg (up to 2mg single dose) IN/IV/IM titrated to effect up to 10mg
Narcan Precautions/Notes
Narcan has shorter half life than most opioid products, so repeat doses may be necessary. synthetic narcotics (Darvon) may require up to 10x dose to reach desired effects. New street drug acrylfentanyl (egyptenyl) is a tentanyl analog 50-100x more potent than MS but still responsive to normal doses of naloxone
Narcan Side Effects
Acute withdrawal syndrome, violent or aggressive behavior, projectile vomiting, CP, HA, agitation, anxiety, confusion, SOB
Narcan Toxicity
flash pulmonary edema, HTN crisis, seizures, Vtach/Vfib
Ranitidine (Zantac) classification
Antihistamine, H2 antagonist
Ranitidine (Zantac) site of action
blocks H2 receptors in gastric lining, reducing production of stomach acid
Ranitidine (Zantac) Onset/Peak, duration
Onset IM 20min IV 5-10min; duration 2-6 hours
Ranitidine (Zantac) Actions
Blocks H2 receptors
Ranitidine (Zantac) Indications
adjunct to allergic rxns
Ranitidine (Zantac) contraindications
hypersensitivity, acute asthma attack, lower respiratory tract disease/pna, newborns and nursing mothers
Ranitidine (Zantac) Prep
50mg/2ml
Ranitidine (Zantac) Dose
IV/IM 50mg adult. peds 1mg/kg
Ranitidine (Zantac) drug interactions
potentiates CNS depressants, MAOI prolongs anticholinergic effects
Ranitidine (Zantac) precautions
HTN, cardiac disease, renal, bronchial asthma, seizures, pregnancy (C), closed angle glaucoma, concurrent use of other H2 inhibitors
Ranitidine (Zantac) side effects
Fatigue, insomnia, muscle pain
Ranitidine (Zantac) Tox
Abnormal heart beat, difficulty breathing
Sodium Bicarbonate (NaHCO3) classification
alkalizing agent (buffer)
Bicarb Site of Action
Carbonic acid buffer system throughout body. dissociates into Na+ and HCO3- ions. combines with H+ to form carbonic acid, which dissociates to water and CO2
Bicarb Peak, duration
Peak immediate, duration 30-60 min
Bicarb actions
binds free H+ to form carbonic acid, neutralizes hydrogen ion concentration, raises blood and urine pH, tends to reduce serum K+ by driving K+ into the cell
Bicarb indications
cardiac arrest, metabolic acidosis, hyperkalemia, TCA OD with metabolic acidosis, baking
Bicarb Contraindications
metabolic or respiratory alkalosis, hypocalcemia, HF, hypokalemia
Bicarb Prep
Adult: 8.4% 50mEq/50ml PFS (1mEq/ml) Infant: 4.2% 5mEq/10ml PFS
Bicarb Dose
Cardiac arrest/hyperK+: 1mEq/kg slow IVP. repeat at 0.5-1mEq/kg in 10 minutes
Bicarb drug interactions and precautions
inactivates MgSO4, NE, Epi, and dopamine; precipitates with CaCl. flush IV tubing after administration
Bicarb Side Effects
May worsen pulmonary edema, metabolic alkalosis -- may alter o2:hemoglobin affinity, hypokalemia, tetany, hyperirritability, seizures
Bicarb toxicity
metabolic alkalosis
Vitamin B1 (Thiamine) Classification
Vitamin
Thiamine Site of action
Liver, kidneys, leukocytes
Thiamine peak
rapid
Thiamine actions
required for conversion of pyruvic acid to acetyl Coenzyme A (needed for aerobic metabolism); essential for conversion of glucose to energy; reverses thiamine deficiency
Thiamine Indications
coma of unknown origin, especially if EtOH may be involved (not used much anymore in EMS); delirium tremens; severe liver dysfunction (ie liver CA or cirrhosis)
Thiamine contraindications
none in prehospital setting
Thiamine Prep
100mg/1ml ampule, vial, PFS
Thiamine Dose
50-100mg slow
Thiamine precautions
Pregnancy (Class A), hypersensitivity
Thiamine Side effects
Rare: warmth/flushing/tingling, hives/itching, urinary retention
Thiamine toxicity
ventricular dysrhythmias possible if pushed too fast IV
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