Medication Infusions (LO3) Flashcards
Anti-microbial
- what is it
- how much of it can be given over what period of time
is an agent used to kill microbes or prevent the replication of microbes in an infected host
most, if not all, can be given intravenously over 15–20 minutes
what is the procedure for PCP and anti microbial infusion
- Ask the attending MD or RN to complete the administration of the IV anti-microbial before setting out on the transfer
- A dosage sticker must be affixed to the IV mini-bag indicating:
- The name of the anti-microbial.
- The dose and the time of preparation. - The anti-microbial will be given by constant IV infusion using an infusion control device at a predetermined rate according to the local pharmacy protocol
what is the procedure for PCP and anti microbial infusion during transport
Vital signs every 15 minutes.
Discontinue if any unexplained symptoms or signs of hypersensitivity develop. (If there is any doubt concerning the etiology of any new signs or symptoms during the transport, contact the referring physician.)
Discontinue if any signs or symptoms of anaphylaxis develop.
Treat anaphylaxis as per protocol.
If the patient’s condition deteriorates, arrange for an ALS intercept.
Heparin
directed primarily towards preventing development of intravascular thrombosis and the treatment of thromboembolitic disorders such as acute myocardial infarction, pulmonary embolism, and deep venous thrombosis
2 classes of anticoagulant drugs
parenteral (administered via IV)
oral agents
The patient receiving IV Heparin must meet certain criteria before being infused
-what does not meet the criteria
Anyone who has a known hypersensitivity to Heparin,
is actively bleeding,
is in shock,
is suffering from some form of severe bleeding disorder (hemophilia)
If any adverse reactions are going to occur, such as anaphylaxis, they usually begin within
the first several minutes to 1 hour of the infusion
why does a pt on heparin need to be closely monitored
This drug classification is potentially dangerous, capable of causing severe, possibly fatal hemorrhaging
Possible Complications of heparin
Localized bleeding
Irritation at the IV site
Hemorrhaging
Hypersensitivity (chills, urticaria, fever, anaphylaxis, bronchospasm)
Elevated blood pressure
Chest pain
Impaired renal function
Management of heparin
Observe for bleeding (GI urinary, epistaxis, etc.) and discontinue the infusion if present and significant.
Vital signs are to be recorded every 15 minutes, watching for any signs and symptoms of shock.
Ensure that you have an accurate baseline of all vital signs before the transport begins.
A record of the patient’s vital signs over the last several hours or days will provide you with some criteria to gather your baseline data.
Stop Heparin if unexplained hypotension occurs.
If there is any doubt about the origin of any new signs or symptoms during transport, contact the medical control physician for further orders.
Drug Interactions with heparin
very stable medication when mixed in normal saline, D5W or Ringer’s Lactate for a period of up to 24 hours
has to be given in a separate IV site if other medications are also being infused
Heparin will interact with salicylates (ASA), nonsteroidal anti-inflammatory drugs, NSAIDs, and will interfere with platelet aggregation.
Heparin will also antagonize the action of insulin.
Potassium
Potassium is an electrolyte that is frequently administered intravenously to maintain a serum level
what should the serum level of potassium be between
what is considered a low serum level and symptoms
what serum level is too low and what can happen
between 3.5 and 5.3
mmol/L
below 3.0 mmol/L may be associated with symptoms such as weakness and malaise.
below 2.5 mmol/L, lethal arrhythmias may occur
what can potassium added to an iv bag be infused up to in a patient with normal renal function
up to 40 mEq/hr
Sudden boluses of potassium may cause lethal arrhythmias meaning…
the rate of infusion of a potassium drip cannot be increased rapidly if the patient develops hypotension
To prevent a rapid infusion of potassium, the following must be adhered to:
must be administered via an IV pump.
ensure that a medication sticker is affixed to the IV bag which identifies potassium as the medication being infused, as well as the dose of potassium.
The rate of administration must be in writing and is not to be exceeded under any circumstances.
If the patient has the potential to develop hypotension enroute, a second IV line is to be established.
The patient may complain of burning along the vein where potassium is infusing; however, this is a common symptom the pre-hospital care provider should ensure the infusion is not exceeding the specified rate, and should provide reassurance to the patient.
Under no circumstances is the flow rate of potassium-containing solution to be increased.
Oxytocin
a naturally occurring hormone that is secreted by the posterior pituitary gland.
When secreted, it causes contraction of the uterine smooth muscles and lactation.
When postpartum hemorrhage cannot be controlled with breastfeeding or fundal massage, an IV infusion containing
10 – 20 units of synthetic oxytocin (Syntocinon®) may be administered
Possible Complications of oxytocin
Hypotension
Dysrhythmias
Tachycardia
Seizures
Coma
Nausea
Vomiting
Uterine rupture from overstimulation of uterus
Management of oxytocin
Monitor vital signs.
Due to the fact that excessive oxytocin can cause overstimulation of the uterus, uterine tone must be monitored throughout transport.
If there is any doubt about the origin of any new signs or symptoms during transport, contact the medical control physician for further orders.
Drug Interactions with oxytocin
Syntocinon® can cause hypertension when administered with a vasoconstrictor such as norepinephrine.
Total Parenteral Nutrition (TPN)
the most common site for administration is via a central venous catheter due to the high concentration of the solution
TPN is given to patients that have a long-term need for intravenous feeding, cannot receive adequate nutrition to meet their physiologic needs, do not have a functioning gastrointestinal (GI) tract or have a condition that has them on total bowel rest
possible patients that may receive TPN:
Hypercatabolic states (burns, trauma, sepsis)
Gastrointestinal diseases
Renal failure
Congenital GI abnormalities
Short bowel syndrome due to surgery
Standard dosing for an adult of TPN
is 2 liters per day of standard solution
Adverse reactions related to TPN’s components:
Water:
-Fluid overload
Insulin and dextrose:
-Hypoglycemia or hyperglycemia
Heparin:
-Hemorrhage
Electrolytes:
-Abnormal levels of sodium
chloride, potassium, and magnesium
Vitamins:
- Deficiency in vitamin D
- excess of vitamin A
Dextrose:
- Respiratory distress
- liver dysfunction
Allergic reaction
TPN Administration
When administering TPN via the central line, maintain sterility to help prevent infection.
The line that is used for TPN administration should not be used for any other purpose.
The TPN infusion must be transported on an infusion pump, and the prescribed rate must never be exceeded.
Acetylcysteine (Mucomyst®)
is an antidote for acetaminophen poisoning.
Acetylcysteine (Mucomyst®) classification
Its classification is Antitode (Mucolytic).
Acetylcysteine (Mucomyst®) Dosage
Loading dose: Dilute 150 mg/kg in 250 mL D5W; infuse over one hour
Second infusion (repeat): Dilute 50 mg/kg in 500 mL D5W, infuse over four hours
Third infusion (repeat): Dilute 100 mg/kg in 1000 mL D5W; infuse over sixteen hours or as directed
EMS Contraindications for Acetylcysteine (Mucomyst®)
No contraindications when used to treat acetaminophen overdose
Hypersensitivity to acetylcysteine when used for indications other than treating acetaminophen overdose
Cautions for Acetylcysteine (Mucomyst®)
Encephalopathy, due to hepatic failure
Asthma, chronic pulmonary disease, or sensitivity to acetylcysteine; administer loading dose slowly and be prepared to treat anaphylactoid reactions
Pregnancy/Breast Feeding: Contact pharmacy for most recent information
what is an iatrogenic response
is an adverse condition that is inadvertently induced in a patient by a treatment given.
what is an iatrogenic overdose
an overdose of medication by a medical personnel
It can be a result of wrong dosing or wrong route of administration.
