IR Pharmacology Flashcards
Fentanyl Citrate
-Brand: Sublimaze
-Opioid Analgesic
-Combined with benzodiazepines for conscious sedation
-Side Effects: nausea, vomiting, dry mouth, shortness of breath, weakness, and aphasia
-can be addictive and fatal even in small doses
-Reversed by: Naloxone (Narcan)
Naloxone
-Brand: Narcan
-Opioid antagonist(reverses effects)
-Naloxone effects last up to 45min.
-IV,IM,Subcutaneous,oral,inhalation
-Side effects: sweating, vomiting, headache, mood swings, fainting, seizures, chest pain
-Dose: 0.4-2mg injections
-Response should occur within 10min.
Meperidine
-Brand: Demerol
-Narcotic for pain control
-Not used as frequently as fentanyl due to increased neurotoxicity and serotonin syndrome
-Oral, IV,IM,Subcutaneous,
-Side Effects: Nausea, vomiting, dizziness, sedation, diaphoresis, hypotension
-Reversed by: Naloxone (Narcan)
-Dose: 25-100mg/4hrs
Midazolam
-Brand: Versed
-Benzodiazepine for sedation and amnesia
-often combined w/ fentanyl for conscious sedation
-Oral, IV, IM, intrathecal, intrarectal
-Contraindicated for: Renal insufficiency, liver impairment, benzo hypersensitivity, shock, head injury, geriatric, pediatric, and critically ill pts.
-Side Effects: amnesia, vomiting, nausea, hangover, dizziness
-Dose: 1-2.5mg over 2-3min.
-Reversed by: Flumazenil (Romazicon)
Flumazenil
-Brand: Romazicon
-Code Blue Cart Mandatory
-Antagonist to sedatives
-Reverses effects of benzodiazepines
-initial dose of 0.2mg/15sec.
-too much = seizures
Sedatives (Lorazepam and Diazepam)
-Lorazepam (Brand: Ativan)
-Diazepam (Brand: Valium)
- Given orally or IV to control anxiety before a procedure
-can also treat insomnia and seizures
-dose: 1mg tablet
-half life: 12 hours
-effects can last up to 72hours
-side effects: dizziness, weakness, confusion, amnesia, ataxia, hypotension, respiratory depression
-Reversed by: Flumazenil (Romazicon)
NSAIDs
-Nonsteroidal anti-inflammatory drug
-non-narcotic analgesic used to treat pain and fever
-Treats inflammation in large doses
-Overuse can cause intestinal bleeding
Antiemetics (4)
-Ondansetron: Zofran
-Metoclopramide: Reglan
-Promethazine: Phenergan
-Dexamethazone: Decadron
- Similar side effects to sedatives but also: dizziness, fainting, SOB, vision loss, bradycardia, and anxiety
-Dose depends on age ( more intense for pediatrics, older adults, and the elderly
Vasoconstrictors
-Vasopressin: Pitressin
-Epinephrine (adrenaline)
-Dopamine
-Elevate blood pressure by increasing peripheral vascular resistance
-used to correct hypovolemic shock
Vasodilators
- Nifedipine: Procardia
- Tolazoline hydrochloride: Priscoline
- Sodium Nitroprusside: Nitropress
- Papaverine
-Nitroglycerin
Nitroglycerin
-most common vasodilator
-treats: angina, congestive heart failure, and vasospasm
-Increases heart rate and blood pressure
-Vasodilator
Anticoagulants
-Warfarin: Coumadin
-Clopidogrel: Plavix
-Aspirin
-Prevent formation of thrombi
-Most often prescribed for patients at risk of MI, stroke, or respiratory depression
-Bleeding is main concern on anti-coagulation therapy
Heparin
-Generally injected as an anticoagulant
-Thins blood to prevent clot formation during procedures
-Treats coronary syndrome, atrial fibrillation, deep vein thrombosis, and pulmonary embolism.
-Side effects: heparin-induced thrombocytopenia, hyperkalemia, alopecia, and osteoporosis
-Reversed with: 1mg protamine sulfate as an antagonist to 100 units of heparin
Thrombolytic (alteplase,reteplase,tenecteplase)
-Tissue Plasminogen Activators (t-PAs)
-alteplase: Activase
-reteplase: Retivase
-tenecteplase: TNKase
-t-PA: concentrated protein referred to as a clot buster
-Thrombolysis: used to treat thrombotic stroke, myocardial infarction, and pulmonary embolism
-Contraindicated for hemorrhagic stroke
Streptokinase and Urokinase
-Enzymes that bind and activate plasminogen
-Activated plasminogen is converted to plasmin
-Plasmin helps break down thrombin and therefoe dissolves blood clots
-Useful for MI and PE
-Onset is slower than t-PA
Lidocaine Hydrochloride 1%
-Brand name: Xylocaine
-standard local anesthetic
-numbs tissues to prepare patient for initial needle punctures
-can also be used as an antiarrythmia medication
Sodium Bicarbonate
-indicated for treatment of metabolic acidosis
-often mixed with local anesthetic to prevent acidosis during interventions involving spinal injections, facet injections, nerve blocks, and medial branch blocks
Glucagon
-peptide hormone released by the pancreas to increase blood glucose
-administered before G, GJ, and J-tube placements
-relaxes the bowels and decreases motility
-allows for more accurate tube placement
Ketorolac
-analgesic NSAID
-side effects more pronounced than other NSAIDs
-associated with anaphylaxis
-useful following Uterine Artery Embolization
-administration should not be longer than 5 days
Triamcinolone Acetonide
-Brand name: Kenalog
-synthetic corticosteroid
-often injected during spinal interventions to treat arthritic intervertebral facet join pain
Albuterol
-used as an inhalant to treat severe cases of bronchospasm caused by medication
Albumin
-main protein of human blood plasma
-administered following paracentesis to restore normal blood protein levels
Respiratory Arrest
-Frequently occurs during the administration of analgesics and sedatives
-Oxygen can be increased to counter decreased respiratory activity
-if increasing oxygen cant remedy the situation, opioid and sedative antagonists should be used (Naloxone, Flumazenil)
Antiarrhythmic Medications
-Restore natural electrical impulses of the heart
-1. Supra-ventricular Arrhythmias (Adenosine, Verapamil, Cardiac Glycosides, beta blockers)
-2. Supra-ventricular and ventricular Arrhythmias (beta blockers, amiodarone
-3. Ventricular arrhythmias ( lidocaine hydrochloride 2%)
Bleeding
-Anticoagulants: should be discontinued for a minimum of 3 doses, 1-5days before the procedure
Air Embolism
-A significant complication of IV and IA drug administration.
-Can cause life-threatening problems
-air enters the vasculature and blocks a vessel
-Pulmonary Embolism: *blockage of pulmaonary artery
* affects ability to breathe
*can be fatal
- Can block arteries of the brain causing stroke
Symptoms of Air Emboli
- Difficulty breathing
- Chest pain
- Heart failure
- Low blood pressure
- Respiratory failure
- Cyanotic skin
- Changes in mental status
Basic Life Support Medications
- Oxygen: given for hypoxia
- Sodium Bicarbonate: treats acidosis
- Epinephrine: most important drug for treating MI
- Atropine: treats compromised hemodynamics and sinus bradycardia
- Lidocaine: administered for cardiac arrhythmias
Diphenhydramine
- an antihistamine that is effective in treating allergic reactions to medications and contrast
-has hypnotic, antiemetic, and sedative properties
-often administered with the corticosteroid methyprednisolone to counter allergic response to contrast media
Carbon Dioxide Gas
-generally used when patients suffers from renal insufficiency, renal failure, or has recently received a kidney transplant.
- dissociates into tissues almost immediately
-decrease in image quality
-contra-indicated for studies above the diaphragm due to potential for gas embolism
Vasovagal Response
-a sudden drop in heart rate and blood pressure leading to fainting, often in reaction to a stressful trigger.
Allergic Reactions to Contrast
-allergic reactions can be treated with Benadryl and Solu-Medrol(methyprednisolone) given via IV at the immediate onset of symptoms.
Types of Contrast Media
- Oil Based: ethiodol and lipiodol
- Water-Soluble: preffered
- Aqueous Suspension: Barium
Viscosity
-the resistance of contrast as it moves through the vascular system
-higher viscosity = thicker/stickier
Miscibility
-the ability of a contrast media to mix with bodily fluids
Osmolality
-the concentration of a solution, measured by the total number of solute particles per kilogram of solvent
-relevant to vasovagal response
Epinephrine
-possibly most important drug for treating MI
- causes hypertension, and vasoconstriction
- acts as a bronchodilator
-paired with lidocaine to reduce bleeding in certain procedures
Atropine
- used to treat pt. with compromised hemodynamics and sinus bradycardia
- can produce subsequent heart problems such as tachycardia and ventricular asystole
Sodium Bicarbonate
- used to treat acidosis
- for example pt.’s with respiratory acidosis from hypoventilatuon
