Group 3A Drug Profiles

Question 1

EPI Class

Answer 1

Sympathomimetic (alpha/beta adrenergic agonist)

Question 2

MOA for EPI

Answer 2

1. Catecholamine with strong alpha and beta 1 and moderate beta 2.
2. Vasoconstrictors, increases peripheral vascular resistance and afterload.
3. Bronchial, intestinal, and urinary smooth muscle relaxer.

Question 3

Epinephrine Indications

Answer 3

1. Cardiac arrest (V-fib, PVT, asystole, PEA)
2. Severe Bronhospasm (asthma, bronchiolitis)
3. Hypotension/shock (refractory to any other therapy)
4. Bradycardia
5. Anaphylaxis
6. Croup

Question 4

EPI Adult Dose and Route for Pulseless Arrest

Answer 4

1. Pulseless Arrest: 1mg (10mL of 1:10,000) IV/IO, repeat every 3-5 min. (No max dose); Flush IV 10 mL after each dose.

Question 5

EPI Adult Dose and Route for Hypo-perfusion, symptomatic bradycardia, or ROSC (to maintain SBP> 90 or MAP >65 mmHg)

Answer 5

1. 10-20 mcg (1-2mL) IV/IO push every 2 min. (1mL Epi 1: 10,000) in 9mL NS= 10mcg/mL
2. 2-10 mcg/min/kg IV/IO (2mL of 1:1,000 added to 250 mL D5W /NS give 8mcg/mL)

Question 6

EPI Adult Dose and Route for Anaphylaxis/ asthma with impending respiratory failure

Answer 6

1. 0.3 mg (0.3 mL 1:1,000) IM via lateral thigh or deltoid, may repeat every 5-15 min.
2. 2-4 mcg/min IV/IO continuous infusion (2mL of 1:1,000 added to 250 mL D5W/ NS gives 8mcg/mL)

Question 7

EPI Adult Dose and Route for Stridor

Answer 7

1. 5mg (5mg of 1: 1,000) in 3mL of NS via SVN, may repeat every 5 min.

Question 8

EPI Onset of Action

Answer 8

IV/IO: <2 minutes
IM: 3-10 minutes

Question 9

EPI Peak Affect

Answer 9

IV/IO: <5 minutes
IM: 20 minutes

Question 10

EPI Duration of Action

Answer 10

IV/IO: 5-10 minutes
IM: 2O-30 minutes

Question 11

AMIODARONE Class

Answer 11

Antiarrythmic Agent (Class lll)

Question 12

AMIODARONE MOA

Answer 12

1. Potassium channel blocker slows ventricular automaticity.
2. Sodium channel blocker slows membrane depolarization and impulse conduction.
3. Calcium channel blocker and B-blockerL negative chronotropic activity in nodal tissue; rate reduction
4. Prolongs action potential and delays repolarization.
5. Decreases AV conduction and sinoatrial SA node function.

Question 13

AMIODARONE Indications

Answer 13

1. VF after CPR, defibrillation, and epinephrine.
2. Stable, regular, narrow-complex tachycardia refractory to vagal maneuvers and adenosine.
3. Control of ventricular rate in: AF with RVR with pre-excitation; stable wide-complex tachycardia; stable monomorphic VT; polymorphic VT with a normal QT interval.

Question 14

AMIODARONE Adult dose and route for VF/PVT

Answer 14

1. 300 mg IV/IO push over a minute, may repeat in 3-5 minutes. With 150mg IV/IO slow push (if needed)

Question 15

AMIDARONE Adult dose and route for wide-complex tachycardia, A-fib or flutter or SVT refractory to vagal maneuvers and adenosine

Answer 15

1. 150mg in 100 mL NS IV/IO over 10 min. May repeat in 10 min. (If needed)

Question 16

AMIDARONE Adult dose and route for Infusion (if needed for reperfusion arrhythmias) after ROSC

Answer 16

1. 1.5mg/min. IV/IO infusion over 24 hrs. (Max dose 2.2 G/24 hrs.)

Question 17

AMIDARONE Onset of Action

Answer 17

2 hrs.

Question 18

AMIDARONE Peak Affect

Answer 18

3-7 hrs.

Question 19

AMIDARONE Duration of Action

Answer 19

Varies

Question 20

Lidocaine Class

Answer 20

1. Antiarrythmic (class Ib)
2. Anesthetic

Question 21

Lidocaine MOA

Answer 21

1. Cardiac: Combines with fast sodium channels, inhibiting repolarization recovery, decreasing myocardial excitability and conduction velocity.
2. Local Anesthetic: Inhibits ion transport across neural membrane, blocking conduction of sensory nerve impulses.
3. RSI: may decrease ICP response during largyngoscopic placement of ET tube.

Question 22

Lidocaine Indications

Answer 22

1. Suppression of VF, PVT, stable monomorphic VT, poly VT with normal QT interval; after treatment of ischemia and electrolyte imbalances has been achieved.
2. May be used to treat stable Torasades de Pointes (poly VT with prolonged QT); consult medical control.
3. Local Anesthetic post-IO insertion before marrow displacement with saline push.
4. Pre-intubation for head trauma or suspected intracranial hemmorhage with saline push.

Question 23

Lidocaine Adult Dose and Route for VF/PVT

Answer 23

1. 1-1.5 mg/kg IV/IO push, may repeat with 0.5-0.75 mg/kg IV/IO push in 5-10 min. (Max dose 3mg/kg)

Question 24

Lidocaine Adult dose and route for Wide-complex tachycardia, more than 5 PVCs in a minutes, refractory A-fib or flutter; SVT

Answer 24

1. 1-1.5mg/kg IV/IO push may repeat in 5-10 min. With 0.5-0.75 mg/kg IV/IO push PRN. (Max dose 3mg/kg)

Question 25

Lidocaine Adult dose and route for Infusion after ROSC

Answer 25

1. 1-4 mg/min, (1G in 250 mL NS gives 4mg/mL).

Question 26

lidocaine Adult Dose and route Post-IO insertion pain management:

Answer 26

2ml of 2% lidocaine and wait 2 min., to be given after IO confirmation but before marrow displacement.

Question 27

Lidocaine Onset of Action

Answer 27

1-5 min.

Question 28

Lidocaine Peak Affect

Answer 28

5-10 min.

Question 29

Lidocaine Duration of Action

Answer 29

10-20 min.