Flight Drugs Flashcards
drip dose
concentration x rate/ = mcg/min
drip rate
concentration x rate/ 60/ wt(kg) = mg/kg/min
Esmolol
Adult: 500mcg/kg/min bolus, infusion 50mcg/kg/min
Alpha & Beta, rapid onset short duration
SVT & uncontrolled hypertension,
Hemaglobin
increase values: in smokers
decrease:anemia, blood loss, overhydration
Hematocrit
increase: dehydration, polycythemia
decrease: anemia, blood loss, overhydration
WBC
increase: infection, leukemia, steroids
decrease: viral infection
Vecuronium (Norcuron)
Class of Drug
Nondepolarizing muscle relaxant (paralytic).
Mechanism of Action
TBinds to cholinergic receptors at motor end plate; does not produce muscular depolarization, so risk of hyperkalemic complications minimized in comparison to depolarizing agent.
Indications
Defasciculation prior to administration of depolarizing agent; intermediate-duration paralysis (45 – 60min) in larger dose.
Contraindications
Unsecured airway (paralyzing dose).
Inadequate confirmation of tracheal tube placement.
Known hypersensitivity.
Adverse Effects
(5 years: 0.01 mg/kg IVP prior to administration of other RSI medications.
Sustained paralysis:
Adults/children: 0.1 mg/kg IVP.
Vasopressin
Class of Drug Posterior pituitary hormone. Mechanism of Action Directly stimulates smooth muscle V1 receptors, resulting in vasoconstriction. Acts similarly to endogenous antidiuretic hormone and has antidiuretic properties, causes GI peristalsis, and stimulates vasoconstriction of capillaries and small arterioles. Indications GI hemorrhage, cardiac arrest, vasodilatory shock. Contraindications Hypersensitivity to drug or components Adverse Effects MI, bradycardia, angina, dysrhythmias, HTN, anaphylaxis, bronchospasm, angioedema, venous thrombosis, GI distress, sweating, pallor, headache, vertigo, rash, fever, urticaria. Precautions Pregnancy Category B. Caution in patients with cardiovascular disease, seizure disorder, renal disease, asthma, migraines, liver disease. Dosing/Administration Available for SC, IM or IV injection. Adult: GI Hemorrhage: 0.2 – 0.4 units/min IV. Arrest: 40 units IV once. Shock: 0.01 – 0.04 units/min IV. Pediatric: GI Hemorrhage: 0.002 – 0.005 units/kg/min IV (Max 0.01 units/kg/min). Shock: 0.00002 – 0.002 units/kg/min IV.
Terbutaline
Class of Drug
Beta-2 agonist (bronchodilator/tocolytic).
Mechanism of Action
β-adrenergic receptor agonist which exerts a preferential effect on β-2 adrenergic receptors, such as those located in smooth muscle. The β-adrenergic agonists produce many of the pharmacologic effects by activation of adenyl cyclase, the enzyme which catalyzed the conversion of adenosine triphosphate to cyclic adenosine monophosphate.
The half-life is 3 – 4 hours and it is excreted in the urine.
Indications
Reversible bronchospasm in patients with obstructive airway diseases, such as asthma, bronchitis, and emphysema.
Premature labor.
Contraindications
History of hypersensitivity.
Adverse Effects
Use caution in patients with cardiovascular disorders, hyperthyroidism or diabetes mellitus, history of seizures, or in patients who are unusually responsive to sympathomimetic amines. Watch for hypokalemia.
Pregnancy Category B.
Precautions
Tremor, nervousness, increased heart rate, palpitations, dizziness, headache, drowsiness, vomiting, nausea, sweating and muscle cramps. These are all usually transient and do not require treatment.
Dosing/Administration
Bronchospasm:
Adult: 0.25 mg SC repeat in 15 min (max dose 0.5 mg in 4 hrs).
Pediatric (under age 12): 0.005 – 0.01 mg/kg SC every 15 min x 2.
Premature Labor:
0.25 mg SC every 20 min (max 1 mg in 4 hrs).
Succinylcholine (Anectine)
Class of Drug
Depolarizing neuromuscular blocking agent (paralytic) and a skeletal muscle relaxant used to facilitate intubation.
Mechanism of Action
Short acting skeletal muscle relaxant that exerts effects by binding with cholinergic receptor sites, producing depolarization and preventing the action of acetylcholine. This depolarization is observed as fasciculations of muscle groups. Flaccid paralysis occurs rapidly, within one min after IV administration. The duration of effect is approximately four to six min.
Indications
Indicated as an adjunct to general anesthesia, for facilitation of tracheal intubation, and to provide skeletal muscle relaxation during surgery or mechanical ventilation.
Contraindications
- Personal or family history of malignant hyperthermia.
- Personal or family history of skeletal muscle myopathies.
- Known hypersensitivity.
- Known or suspected hyperkalemia.
- Denervation of skeletal muscle or upper motor neuron injury may cause severe hyperkalemia which may result in cardiac arrest (prior spinal cord injury).
Adverse Effects
1. Malignant hyperthermia: Likelihood increases with administration of general anesthetics. Presents with spasm of the masseter (jaw) muscles, progressive to generalized rigidity, tachycardia, tachypnea and elevated temperature.
2. BRADYCARDIA is primarily noted in children. Pretreatment with atropine may reduce this instance.
Reports of cardiac arrest, dysrhythmias, tachycardia, hypertension, increased ICP and IOP, hyperkalemia, muscle fasciculations, and rhabdomyolysis with the potential for acute renal failure.
Precautions
Electrolyte abnormalities and those who may have digitalis toxicity – cardiac dysrhythmia may occur.
Patients must be maintained on a cardiac monitor during and after medication administration.
This solution should be kept refrigerated, or may be stored at room temperature for short periods only (up to 14 days).
Dosing/Administration
Anectine is available in a sterile solution for IV injection containing 20 mg/mL.
Adults/pediatrics: 2 mg/kg IV
Onset: approximately one min
Duration: 4 – 6 min
Rocuronium (Zemuron)
Class of Drug
Non-depolarizing neuromuscular blocker.
Mechanism of Action
Antagonizes motor endplate acetylcholine receptors. Time of onset is within 3 min. Duration of action is typically 30 min.
Indications
Need for prolonged neuromuscular blockade.
Contraindications
Hypersensitivity to drug or components.
Adverse Effects
Dysrhythmias, bronchospasm, anaphylaxis, injection site pain, HTN, hypotension.
Precautions
Pregnancy Category B.
Use with caution in patients with impaired liver function, severe obesity.
Use with extreme caution in patients who may have a difficult airway to manage definitively.
Dosing/Administration
Available for IV injection.
Adult and pediatric: 0.6 – 1.2 mg/kg IV.
Ranitidine (Zantac)
Class of Drug
Histamine-2 receptor antagonist.
Mechanism of Action
Competitively inhibits histamine’s action at the H2 receptors in gastric parietal cells reducing gastric acid secretion.
Indications
Duodenal or gastric ulcer.
Prophylaxis of stress ulcer.
GERD.
Contraindications
Hypersensitivity to drug or components.
Adverse Effects
Malaise, dizziness, vertigo, confusion, rash, GI distress, blood dyscrasias, injection site discomfort.
Precautions
Pregnancy Category B.
Use caution in patients with renal or hepatic disease.
Dosing/Administration
Available for oral use (150 or 300 mg tablets, 75 mg/5 mL soln) or for injection 25 mg/mL.
When using IV must dilute solution to total volume of 20 mL and inject over at least 5 min.
Adult: 150 mg PO twice a day or 50 mg IM/IV every 6 – 8 hours.
Pediatric: 2 – 4 mg/kg/day PO or 2 mg/kg/day IV divided every 6 – 8 hours.
Propofol (Diprivan)
Class of Drug
Anesthetic.
Mechanism of Action
Creates a dose-dependent CNS depression similar to benzodiazepines and barbiturates. Careful titration of infusion rate maintains anesthesia. Rapid onset of action and short duration of action make it ideal in many emergent situations.
Indications
Requirement for continuous sedation when a short duration of action is desired.
Contraindications
Hypersensitivity to drug or components (soybean oil, egg lecithin and glycerol).
Adverse Effects
Headache, dizziness, myoclonus, hypotension, bradycardia, hypertension, flushing, GI distress, apnea, hiccups, injection site pain, fever.
Precautions
Pregnancy Category B.
Use with caution in patients with pancreatitis, hyperlipidemia, elderly or those with circulatory disorders.
Patients receiving propofol must be on a cardiac monitor and pulse oximeter and be attended by a provider with the ability to manage respiratory depression and marked hypotension. In most cases, the patient receiving propofol infusions should be intubated.
Dosing/Administration
Available for IV use in 10 mg/mL 20 mL ampules.
Adult: 1 – 2 mg/kg slow IV for induction, lower ends of dose range for sedation. For maintenance of sedation or anesthesia in intubated patients, 5 mcg/kg/min IV with titration by 5 – 10 mcg/kg/min every 5 min until desired effect reached.
Potassium Chloride
Class of Drug
Electrolyte supplement.
Mechanism of Action
Potassium is the main cation in body tissue and is needed for physiological processes throughout the body.
Indications
Hypokalemia.
Contraindications
Hypersensitivity to drug or components.
Renal failure, hyperkalemia, anuria.
Adverse Effects
Hyperkalemia: paresthesias, confusion, flaccid paralysis, dysrhythmias, hypotension, cardiac arrest, GI distress, phlebitis.
Typical EKG findings of hyperkalemia: prolonged PR interval, wide QRS complex, ST segment depression, tall tented T waves.
Precautions
Pregnancy Category C.
In general potassium should be replaced orally unless the level is dangerously low or the patient cannot absorb enteral medications adequately.
IV potassium should only be given while a patient is on a cardiac monitor.
Dosing/Administration
Available in several oral forms, also in a solution for IV injection 2 mEq/mL in a 20 mL vial.
In children: Dilute to at least 10 mEq/250 mL NS or D5W and infuse at no faster than 10 – 15 mEq/hr.
Total single dose should not be greater than 40 mEq before a serum level is rechecked.
Phenytoin (Dilantin)
Class of Drug
Anticonvulsant.
Mechanism of Action
Modulates neuronal voltage-dependent sodium and calcium channels. This stabilizes neuronal membranes and limits seizure activity. Has an anti-dysrhythmic effect by normalizing sodium influx to cardiac fibers in patients with digitalis induced dysrhythmias.
Indications
Seizures.
Ventricular dysrhythmias unresponsive to other agents or those induced by cardiac glycosides
Contraindications
Hypersensitivity to drug or components.
Bradycardia.
Hypotension.
Adverse Effects
Hypotension, ventricular dysrhythmias, cardiovascular collapse, AV conduction abnormalities, blood dyscrasias, TEN, Stevens-Johnson syndrome, tissue necrosis (IV), hypersensitivity syndrome, toxic delirium, nausea, vomiting, rash, nystagmus, ataxia, slurred speech, dizziness, confusion, blurred vision, somnolence, constipation, headache, phlebitis (IV).
Precautions
Pregnancy Category D.
Hemodynamic adverse effects are accentuated by rapid infusion.
Dosing/Administration
Available as 125 mg/5 mL intravenous solution.
Adults/Children: 15 – 20 mg/kg IV (max 1500 mg).
Therapeutic level 10 – 20 mcg/mL.
Rate of administration not to exceed 50 mg/min.
Should not be given IM.
Phenylephrine (Neo-Synephrine)
Class of Drug
Alpha-adrenergic vasopressor.
Mechanism of Action
Directly stimulates alpha adrenergic receptors resulting in constriction of all vessels and an increase in peripheral vascular resistance, increase in systolic and diastolic blood pressure, decreased blood flow to vital organs, skin and muscle. No action on beta adrenergic receptors thus minimal increase in myocardial oxygen consumption.
Indications
Hypotension.
Cardiogenic shock.
Neurogenic and spinal shock.
Contraindications
Hypersensitivity to drug or components.
Patients with un-resuscitated hypovolemia.
Adverse Effects
Hypertension, bradycardia, headache, dizziness, severe peripheral and visceral vasoconstriction, dysrhythmias.
Precautions
Pregnancy Category C.
Caution in sulfite allergic patients.
Caution in patients with bradycardia, heart block, myocardial disease, atherosclerotic vascular disease, hyperthyroidism, or taking beta-blocker medication.
Dosing/Administration
Available as phenylephrine hydrochloride 1% (10 mg/mL)
1 mL ampules.
Mix 50 mg/250 mL or 100 mg/500 mL in D5W or NS for Central Line use ONLY
Mix 10 mg/250 mL of D5W or NS for peripheral access
Adult: Start 100 mcg/min and titrate between 40 mcg/min to 180 mcg/min.
Pediatric: 0.1 – 0.5 mcg/kg/min IV infusion.
Norepinephrine (Levophed)
Class of Drug
Adrenergic vasopressor.
Mechanism of Action
Directly stimulates alpha adrenergic receptors resulting in constriction of all vessels and an increase in peripheral vascular resistance, increase in systolic and diastolic blood pressure, decreased blood flow to vital organs, skin and muscle. Directly stimulates beta-1 receptors with a positive inotropic effect.
Indications
Hypotension.
Cardiac arrest.
Contraindications
Hypersensitivity to drug or components.
Patients with peripheral or mesenteric vascular thrombosis, profound hypoxia or hypercapnea, hypovolemia.
Adverse Effects
Headache, weakness, dizziness, hypertension, severe peripheral and visceral vasoconstriction, dysrhythmias, bradycardia, GI distress, decreased urine output, necrosis with extravasation, dyspnea, apnea, pallor, cerebral hemorrhage, seizures, metabolic acidosis, hyperglycemia, hyperthermia.
Precautions
Pregnancy Category D.
Caution in sulfite allergic patients.
Dosing/Administration
Mix 4 mg/250 mL in D5W or NS.
Available in 4 mg/mL ampules for IV infusion.
Adult: 2 – 20 mcg/min IV infusion titrated to goal BP.
Pediatric (< 2 years): 0.1 – 2 mcg/kg/min IV infusion titrated to goal BP.
Nitroprusside (Nipride)
Class of Drug
Vasodilator.
Mechanism of Action
Acts directly on vascular smooth muscle causing peripheral vasodilation. Sodium nitroprusside slowly breaks down to release cyanide ions. This process is accelerated when the medication is exposed to UV light.
Indications
Hypertension.
Contraindications
Hypersensitivity to drug or components.
Compensatory hypertension secondary to AV shunt or coarctation of the aorta.
Adverse Effects
Headache, dizziness, coma, dilated pupils, diaphoresis, tachycardia, hypotension, GI distress, acidosis (cyanogens toxicity).
Precautions
Pregnancy Category C.
Use with caution in patients with renal disease (toxic byproducts may accumulate).
Can cause cyanide toxicity over several days.
Must be wrapped in foil wrap to protect from light.
Dosing/Administration
Available in 50 mg/5 mL vials for dilution in D5W (NOT NS) for IV infusion. Fresh solution has slight brown tint.
Adult and Pediatric: 0.5 – 10 mcg/kg/min titrated every 5 min to goal BP.
Nitroglycerin (Tridil)
Class of Drug
Nitrate.
Mechanism of Action
Relaxes vascular smooth muscle both in venous and arterial beds causing a decrease in myocardial oxygen consumption, reduction in afterload and preload. Also dilates coronary vessels.
Indications
Congestive heart failure.
Angina.
Acute coronary syndrome.
Contraindications
Hypersensitivity to drug or components
Head trauma or cerebral hemorrhage, hypotension or uncorrected hypovolemia.
Adverse Effects
Hypotension, bradycardia, methemoglobinemia, headache, dizziness, flushing, postural hypotension, tachycardia, burning oral sensation (SL).
Precautions
Pregnancy Category C.
Use with caution in head injured patients, glaucoma, hypovolemia, hypotension, right ventricular infarction or any other preload dependent state.
Dosing/Administration
Available in tablets or metered dose spray canister at 0.4mg/dose, or as a solution for IV injection.
Adult: 0.4 mg SL every 5 min or continuous infusion 5 mcg/min IV increasing by 5 – 20 mcg/min every 3 – 5 min (usual dose 5 – 200 mcg/min).
Pediatric: 1 – 5 mcg/kg/min IV (start 0.5 mcg/kg/min and increase by 0.5 – 1 mcg/kg/min every 3 – 5 min to max dose 20 mcg/kg/min).
