PCV Pharm Test Study Guide Flashcards
Adenosine
GET PD DOSAGE OUT OF PAMPHLET
BRAND NAME: Adenocard
CLASS: Anti-Tachydysrhythmia (Purine Nucleoside)
PHARMACODYNAMICS: Slows electrical conduction through the cardiac atrioventricular (AV) node, with ability to interrupt reentry pathways through the AV and sinoatrial (SA) nodes. Adenosine is administered to convert paroxysmal supraventricular tachycardia (PSVT) to normal sinus rhythm.
INDICATIONS: Tachycardia - Stable PSVT (sustained regular, narrow-complex tachycardia >150 bpm in adults) & systolic BP ≥ 100mmHg (After failed valsalva maneuver)
CONTRAINDICATIONS:
- 2nd/3rd degree AV Blocks (may induce asystole)
- Known Wolff-Parkinson-White Syndrome (may increase
heart rate)
- Known Sick Sinus Syndrome (may induce asystole)
- Bradycardia (may induce symptomatic hypotension)
PHARMACOKENETICS: Onset of action within 10-20 seconds after IV administration. Very rapid metabolism (and duration of effect) within 10-20 seconds after IV administration.
SIDE EFFECTS: Common, though transient, symptoms include chest pain, palpitations of irregular bradycardia, dyspnea, lightheadedness, numbness, and sweating. A constellation of these side effects may produce significant patient apprehension and/or sense of impending doom. The patient should be advised of these possibilities prior to adenosine administration and given reassurance such symptoms will be short-lived in duration of seconds. Transient asystolic or profound, irregular bradycardic rhythms may be observed on ECG monitoring.
DOSAGE: Tachycardia - Stable - Adult (PSVT)
6 mg rapid IVP (1 – 2 seconds) followed rapidly by 10 mL saline flush. May repeat twice at 12 mg.
**OLMC Order Only for use in pediatric patients. OLMC may direct use of adenosine in evaluating etiology of regular, monomorphic wide complex tachycardia.
HOW SUPPLIED: 12 mg/4 mL in prefilled syringe.
Albuterol
BRAND NAME: Proventil, Ventolin
CLASS: Sympathomimetic Bronchodilator
PHARMACODYNAMICSS: Albuterol is a relatively selective beta2 adrenergic stimulant. Albuterol causes relaxation of the smooth muscles of the bronchial tree thus decreasing airway resistance, facilitating mucus drainage, and increasing vital capacity. It exerts mild effects on beta1 (heart) or alpha (peripheral vasculature) receptors. In therapeutic doses, albuterol, by inhibiting histamine release from mast cells, also reduces the mucus secretion, capillary leaking, and mucosal edema caused by an allergic response in the lungs.
INDICATIONS:
- Dyspnea - Asthma/COPD/Unknown Etiology
- Acute Allergic Reactions
- Smoke Inhalation
CONTRAINDICATIONS: Known hypersensitivity to albuterol. Albuterol should not be used if the sole etiology of dyspnea is strongly suspected to be CHF, as albuterol-induced tachycardia may worsen the compromised cardiac output in CHF.
PHARMACOKENETICS: Onset within 5 – 15 minutes; peak effect in 1 – 1.5 hours; duration of effect is up to 3 – 6 hours; half – life is less than 3 hours. Distribution: When inhaled, albuterol is distributed to muscle cells along the bronchial tree. Very little is systemically absorbed and distributed.
SIDE EFFECTS: Tremors, anxiety, dizziness, headache, cough, reflex bronchospasm, palpitations, tachycardia, and hypertension.
DOSAGE: Adult - 5 mg nebulized (with ipratropium bromide 0.5 mg for acute allergic reactions) may repeat twice
Ped - 2.5mg nebulized (w/ ipratropium bromide 0.25mg) may repeat twice
HOW SUPPLIED: 2.5 mg/3 mL (0.083%) in nebulizer vials.
Amiodarone
DOUBLE CHECK DOSAGES WITH AHA
BRAND NAME: Cordarone, Nexterone
CLASS: Class III Anti-Dysrhythmic (Vaughn William Classification)
PHARMACODYNAMICS: Prolongs the cardiac action potential’s refractory period, slowing conduction through the heart. Amiodarone also has secondary actions in the other three classifications of anti-dysrhythmics. Amiodarone blocks sodium channels (class I) which can prevent cardiac action potentials. It is a non-competitive anti-sympathetic (class II) which slows cardiac action potentials. Amiodarone also slows conduction through the cardiac atrioventricular (AV) node (class IV). In sum, all of these actions lead to slowing of conduction and prolongation of refractoriness in the cardiac conduction system.
INDICATIONS:
- V-Fib/Pulseless Ventricular Tachycardia
- Tachycardia - Stable
(Wide-Complex Tachycardia of Uncertain Type or
Monomorphic Ventricular Tachycardia (if heart rate ≥
150 beats) per minute with systolic BP ≥ 100 mmHg in
adults)
(Narrow-Complex Tachycardia (if heart rate ≥ 150 beats
per minute with systolic BP ≥ 100 mmHg in adults
**OLMC Order Only)
- Tachycardia - Unstable
(Post-Cardioversion of Ventricular Tachycardia)
- Premature Ventricular Contractions
(Symptomatic Premature Ventricular Contractions (with
BP < 100mmHg in adults due to frequent non
conducted ventricular impulses and in absence of
2nd/3rd degree AV blocks))
CONTRAINDICATIONS: 2nd/3rd degree AV blocks (may induce asystole) ; Bradycardia (may induce symptomatic hypotension)
PHARMACOKENETICS: Onset of action within 60 seconds after IV administration, with effects lasting up to 20-25 minutes.
SIDE EFFECTS: Hypotension is the most common side effect, requiring treatment in less than 20% of patients (transient effect). Bradycardia and AV Block may also result, requiring treatment in less than 10% of patients (transient effect). In a very rare circumstance, as with all
anti-dysrhythmics which can have pro-dysrhythmic effects, Torsades may result from excessive prolongation of the cardiac action potential. When indicated by protocol, the benefits of amiodarone administration exceed these risks of side effects.
DOSAGE:
- V-Fib/Pulseless Ventricular Tachycardia
a) Adult (refractory to initial defibrillation ATTEMPT)
300 mg IVP/IOP. Repeat at 150 mg IVP/IOP in 5 minutes to maximum cumulative dose of 450 mg. Epinephrine 1 mg (1:10,000) IVP/IOP is to be given with every amiodarone administration.
b) Pediatric (refractory to initial defibrillation attempt) 5 mg/kg IVP/IOP in single dose. Epinephrine 0.01 mg/kg (1:10,000,0.1 mL/kg) IVP/IOP is to be given with every amiodarone administration.
- V-Fib/Pulseless Ventricular Tachycardia
a) Adult
(post RETURN of sustained spontaneous circulation)
150 mg over 10 minutes (15 mg/minute or 0.3 mL/minute very slow IVP/IOP/IVPB) IF maximum cumulative dose of 450 mg has not been achieved
b) Pediatric
* *OLMC Consult & Order Only
- Tachycardia (stable or unstable)
a) Adult
150 mg over 10 minutes (15 mg/minute or 0.3 mL/minute very slow IVP/IOP/IVPB)
b) Pediatric - None
HOW SUPPLIED:
150 mg/3 mL in vial, ampule, or pre-filled syringe.
150 mg/100 mL pre-mixed infusion.
Activated Charcoal
Brand Name: Activated Charcoal
Classification: Absorbent
Action: A liquid suspension that adsorbs drugs and chemicals. It acts by binding / adsorbing toxic substances, thereby inhibiting their GI absorption, uptake into the liver, and thus, their presence in the bloodstream for action, also called “bioavailability”
Indications: Poisonings (including: acetaminophen, aspirin, atropine, barbiturates, digitalis, glycosides, phenytoin, propoxyphene, strychnine, and tricyclic antidepressants, among many others)
Contraindications: Poisoning via: (cyanide, mineral acids, caustic alkalis, organic solvents, iron, ethanol, and methanol) ; altered mental status, dysphagia, or vomiting
Dose: 1 gram/kg for Adult and PED (get OLMC consultation if transport is 30+ min long)
Routes: PO
Adverse Effects: Nausea, vomiting, aspiration, constipation, black stool
Other: not frequently used (requires authorization by OLMC or OK Poison Center if transport is more that 30min)
Pharmacokinetics: Nonabsorbed; onset immediate; peak, duration, and half – life: unknown.
How Supplied: 25 grams of activated charcoal in aqueous suspension in bottle.
Atropine Sulfate
CHECK NEW AHA
BRAND NAME: Atropine Sulfate
PHARMACODYNAMICS: Blocks parasympathetic impulses to the heart via the vagus nerve. Atropine increases the rate of cardiac sinoatrial (SA) node discharges, enhances conduction through the atrioventricular (AV) node, and by increasing heart rate, increases the cardiac output and blood pressure. Additionally, in the treatment of indicated poisonings (organophosphates) atropine reverses muscarinic effects of acetylcholine, including diaphoresis, diarrhea, urination, bronchorrhea (secretions from the lower respiratory tract), emesis, lacrimation (tearing), and salivation. Atropine produces dilation of pupils by blocking stimulation of the ciliary muscle surrounding the pupils.
INDICATIONS:
- Bradycardia
- Poisonings – General Management Organophosphate
CONTRAINDICATIONS: None absolute in indicated situations.
PHARMACOKENETICS: Typical onset within 60 seconds given IV. Effects can persist in excess of 1 hour.
SIDE EFFECTS: Tachycardia (either supraventricular or ventricular), hypertension, palpitations, blurred vision due to pupillary dilation, photophobia, dry mouth.
DOSAGE:
- Adult; Bradycardia – Symptomatic & Systolic BP < 100 mmHg (Sinus, First Degree, 2nd Degree Type I) - In Non-Acute Coronary Syndrome,
1 mg IVP/IOP. May repeat every 5 minutes to cumulative maximum dose of 3 mg
- Adult Organophosphate Poisoning
2 mg IVP/IOP/IM. Use IVP for severe presentations
(May repeat as often as every 3-5 minutes if symptoms
progressive or persistent.)
- PED; Bradycardia – Symptomatic & Systolic BP < 100 mmHg (Sinus, First Degree, 2nd Degree Type I) - PED - Unresponsive to Epinephrine, 0.02 mg/kg IVP/IOP; minimum dose 0.1 mg Max. single dose 0.5 mg. May repeat once.
- PED Organophosphate Poisoning - 0.05 mg/kg IVP/IOP/IM. Use IVP for more severe presentation.
Minimum dose 0.1 mg.
Consult with OLMCP for repeat dosing needs.
HOW SUPPLIED:
- 1 mg/10 mL prefilled syringe
- 1 mg/1 mL vial 0.25 mg/5 mL prefilled syringe for
pediatric use
Calcium Chloride
BRAND NAME: Calcium Chloride
CLASS: Electrolyte
PHARMACODYNAMICS: Calcium causes a significant increase in myocardial contractility and in ventricular automaticity. It is used as an antidote for some electrolyte imbalances (eg. stabilizing cardiac rhythm in the setting of hyperkalemia) and to minimize the side effects from calcium channel blocker overdose. The actions of calcium chloride are similar to those of calcium gluconate but, since it ionizes more readily, it is more potent than calcium gluconate.
INDICATIONS:
- Specific Causes of Cardiac Arrest (Hyperkalemia)
- Poisonings - General Management (Calcium Channel
Blocker Overdose)
- Dialysis-Related Issues (Hyperkalemia)
- Crush Injury Syndrome (Hyperkalemia Prophylaxis)
CONTRAINDICATIONS: Calcium chloride is contraindicated in ventricular fibrillation unless known hyperkalemia, in known hypercalcemia, and in suspected digitalis toxicity. It should be used with caution in patients taking digoxin as it may precipitate toxicity. Safe use in pregnancy and in children has not been established, though in indicated conditions, benefits outweigh risks.
PHARMACOKENETICS: Onset nearly immediate when given IVP/IOP. The peak effect time frame and duration of effect is not well established.
SIDE EFFECTS: Paresthesia (tingling), syncope, sensations of heat waves (peripheral vasodilation), pain and burning at IV site, skin necrosis and sloughing (with extravasation), hypotension, bradycardia, cardiac dysrhythmias, cardiac arrest.
DOSAGE:
For all indications adult & pediatrics its -
10 mg/kg (10% solution) IVP/IOP, max dose of 1 gram
HOW SUPPLIED: 1 gram in a 10 mL prefilled syringe (100 mg/mL)
SPECIAL COMMENTS: Calcium chloride will interact with sodium bicarbonate and form a precipitate. Do not give both medications via the same vascular access line unless giving a copious flush of NS - approximately 50+ mL - between medications. In general, use an 18-20 gauge angiocatheter in a proximal IV site or use an IO line and test line patency before administration. In non-cardiac arrest or non-impending cardiac arrest settings, administer at 0.5 -1.0 mL per minute to reduce chances of venous irritation and extravasation
Dextrose
KNOW HOW TO MAKE D5/1-/25/50 concentrations
Brand Name: Dextrose, 10% & 50%
Classification: Carbohydrate
Action: Dextrose is the principal form of glucose used by the body to create energy and support critical metabolic processes
Indications: Anything that may indicate Hypoglycemia (<50mg/dL) (Respiratory Arrest, Specific Cause of Cardiac Arrest, Altered Mental Status, Seizure, Syncope, Dystonic Reaction, Behavioral Disorder, Poisonings, Dialysis Related Issues, Complications of Pregnancy)
Contraindications: Hyper/Normoglycemia
Dose:
Adult (pt weight >25) (D50) 1 mL/kg IVP up to 50 mL
Ped (pt weight <25(D25) 2 mL/kg IVP up to 50 mL
Adverse Effects: : Warmth, pain, or burning at the injection site. D50 extravasation can cause tissue necrosis, phlebitis, sclerosis, or thrombosis at the injection site.
Other: D50/25 should be administered using an INFUSING IV, NOT a saline lock. NO DIRECT IV PUSH
Pharmacokinetics: Onset with 60 seconds after IVP with peak effect and duration of action dependent upon degree and cause of hypoglycemia. Usually effective duration in excess of 30 minutes.
How Supplied:
Prefilled syringes of D50 - 25 grams dextrose in 50 mL of water (0.5 gram/mL)
Prefilled syringes of D25 - 2.5 grams dextrose in 10 mL of water (0.25 gram/mL)
Diazepam
BRAND NAME: Valium
CLASS: Benzodiazepine (Schedule IV)
(Sedative; Anticonvulsant; Muscle Relaxant; Anxiolytic)
PHARMACODYNAMICS: Binds to Type A GABA receptors, causing sedation ; it has no effect on pain. (Diazepam has considerably more muscle relaxant properties than midazolam, though no substantial amnestic effects as with midazolam)
INDICATIONS:
- Post RSI Sedation (onset delay does not favor pre
intubation use)
- Seizure (Midazolam preferred due to faster onset)
- Dystonic Reactions
- Chemical Restraint (Midazolam preferred due to faster
onset)
- Poisonings (Suspected stimulant toxicity)
- Head/Neck/Spine Injury (Midazolam preferred due to
faster onset)
- Heat Illness (Midazolam preferred due to faster onset)
CONTRAINDICATIONS:
- Hypersensitivity
- Acute narrow - angle glaucoma, shock, or coma.
- Caution with use in patients with COPD, chronic
hepatic or renal failure, CHF, acute alcohol
intoxication, and the elderly due to increased risk of
respiratory depression.
DOSE:
ADULT
- Post RSI Sedation (Adult)
0.1 mg/kg to max 5 mg IVP/IOP,
may repeat once if systolic BP > 100 mmHg
- Seizure ; Head/Neck/Spine Injury ; Heat Illness (Adult)
5 mg IVP/IOP or 10 mg IM for active seizure
May repeat once in 5 minutes if still seizing
- Dystonic Reactions (Adult) 5mg IVP
- Chemical Restraint (Adult) 5mg IVP/IOP or 10 mg IM
- Poisoning (Susp Stimulant Toxic)(Adult) 2.5-5 mg IVP
PEDIATRIC
- Post RSI Sedation - None listed for ped
- Seizure ; Head/Neck/Spine Injury ; Heat Illness
0.1 mg/kg to max 5 mg IVP/IOP/IM for active seizure
May repeat once in 5 minutes if still seizing
- Dystonic Reactions 0.1 mg/kg to max 5 mg IVP/IM
- Chemical Restraint 0.1 mg/kg to max 5 mg IVP/IOP/IM
- Poisoning (Susp Stimulant Toxic) OLMC Order only!
SIDE EFFECTS: Headache, euphoria, drowsiness, excessive sedation, confusion, dizziness, blurred vision, diplopia, nystagmus, respiratory arrest, hypotension, nausea, vomiting.
PHARMACOKENETICS: Onset is 3-5 minutes, IVP/IOP;
15-30 minutes IM with erratic absorption, mandating IM dosing only utilized as a last option in adults; peak effects in 15-45 minutes. Duration is 2+ hours IVP/IOP/IM; half – life can reach 20 – 50 hours
HOW SUPPLIED: 10 mg/2 mL in vials, ampules, or pre-filled syringes.
OTHER: Incompatible with other medication because it is not water soluble. Can cause irritation with injection. Flumazenil is an antagonist
Diphenhydramine
BRAND NAME: Benadryl
CLASS: Antihistamine, Anticholinergic
PHARMACODYNAMICS: Competes for H1 - histamine receptor sites on
effector cells, thus blocking histamine release
INDICATIONS: Dystonic Reactions, Acute Allergic Reactions, Bee/Wasp Stings
CONTRAINDICATIONS: Hypersensitivity
DOSE:
Adult - 50mg IV/IM (25-50PO but that not in protocol)
Ped - 1 mg/kg IM/IVP to maximum of 50 mg
ADVERSE EFFECTS: Drowsiness, dizziness, disturbed coordination.
PHARMACOKENETICS: Onset within 15 – 30 minutes; duration is approximately 6 hours
HOW SUPPLIED: 50 mg/1 mL in vial, ampule, or pre-filled syringe.
Dopamine
BRAND NAME: Intropin
CLASS: Vasoconstrictor
PHARMACODYNAMICS: Dose dependent. Higher doses (5+ mcg/kg/min) increasingly stimulate alpha receptors in the peripheral vasculature, producing vasoconstriction-related increases in system blood pressure. Concurrent beta receptor stimulation may produce increases in heart rate and mild bronchodilation. Lower doses (<5 mcg/kg/min), as may be encountered infrequently in interhospital transfers, produce mesenteric (intestinal) and renal vascular dilation to ensure continued perfusion to these organ systems in complicated medical illness that would otherwise sacrifice such circulation.
INDICATIONS: For all listed situations, indication is hypotension (adult = systolic < 100 mmHg) due to cardiogenic, septic, or neurogenic shock either refractory to intravascular fluid boluses or in which intravascular fluid boluses is contraindicated (eg. pulmonary edema)
CONTRAINDICATION: Hypertension
PHARMACOKENETICS: Onset of action within 5 minutes after IV/IO infusion initiated. Rapid metabolism, requiring ongoing IV/IO infusion to maintain clinical effects.
SIDE EFFECTS: Palpitations, tachycardia, chest pain, and hypertension if not titrated
DOSE: For hypotension (shock) refractory to fluids or fluids contraindicated.
Adult: 5 – 20 mcg/kg/minute - see dosage chart - titrate to a sys B/P ≥ 100 mmHg
Ped: OLMC ONLY
HOW SUPPLIED: 400 mg/10 mL vial to be mixed into 250 mL D5W. (1600 mcg/mL concentration) OR pre-mixed dopamine infusion at 1600 mcg/mL concentration.
SPECIAL COMMENTS: Relative caution should be exercised prior to use in the setting of marked
tachydysrhythmias, due to the potential for further increase in heart rates. In the setting of tachydysrhythmia-induced cardiogenic shock, treat per
Protocol 5G - Tachycardia - Unstable. Ensure aggressive fluid resuscitation is accomplished (unless contraindicated) prior to dopamine use.
Epinephrine 1:1K and 1:10K
CLASS: Vasoconstrictor, Bronchodilator (Catecholamine)
PHARMACODYNAMICS: Stimulates alpha receptors in the peripheral vasculature, producing vasoconstriction-related increases in systemic blood pressure. Stimulates beta-1 receptors in the myocardium, producing increases in heart rate, myocardial contraction, and as a result, cardiac output. Stimulates beta-2 receptors in the lower respiratory tract smooth musculature, producing bronchodilation.
INDICATIONS: Dyspnea/Asthma (Severe & Refractory to Nebulization) , Asystole, V-Fib, Pulseless V-Tach, Pulseless Electrical Activity, Bradycardia (Pediatric), Anaphylaxis
CONTRAINDICATIONS: None
PHARMACOKENETICS: Onset within 2 minutes after IVP/IOP; within 5-10 minutes after IM.
Duration of effect ranges from 3-5 minutes after IVP/IOP to upwards of 30 minutes after IM.
SIDE EFFECTS: Restlessness, anxiety, generalized tremors, headache, dizziness, chest pain, palpitations,
hypertension, premature ventricular contractions, tachycardia.
DOSE:
Anaphylaxis
(Adult) 1:1000 0.5 mg IM
If anaphylaxis refractory to above IM dose:
1:10,000 1 mg slow IVP/IOP over 3 minutes
(Ped): 1:1000 0.01 mg/kg (0.01 mL/kg) not to exceed 0.3 mg (0.3 mL) IM
If anaphylaxis refractory to above IM dose:
1:10,000 0.01 mg/kg slow IVP/IOP over 3 minutes
Dyspnea/Asthma
(Adult) 1:1000 0.3 mg IM
**OLMC Order Required if pt ≥ 50 years old, heart illness history, or blood pressure > 140/90 mmHg.
(Ped): 1:1000 0.01 mg/kg (0.01 mL/kg) not to exceed 0.3 mg (0.3 mL) IM
**OLMC Order required if heart illness history or blood pressure > 140/90mmHg.
Asystole/V-Fib/Pulseless V-Tach/Pulseless Electrical Activity
(Adult): 1:10,000 1 mg IVP/IOP
Repeat every 3 - 5 minutes while resuscitating cardiac arrest
(Ped): 1:10,000 0.01 mg/kg (0.1 mL/kg) IVP/IOP
Repeat every 3 - 5 minutes while resuscitating cardiac arrest
HOW SUPPLIED:
Epinephrine 1:1000 in 1 mg/1mL ampules or 30 mg/30 mL vial
Epinephrine 1:10,000 in 1 mg/10 mL prefilled syringes
Fentanyl
BRAND NAME: Sublimaze
CLASS: Narcotic analgesic (opioid) (Schedule II)
PHARMACODYNAMICS: Stimulates central nervous system opiate receptors, producing systemic analgesia. Fentanyl is 50-100 times more potent than morphine but shorter lasting. An IV dose of 100 mcg of fentanyl is roughly equivalent to an IV dose of 10 mg of morphine. Fentanyl has less emetic effects than other narcotic analgesics.
INDICATIONS: acute pain in alert, hemodynamically stable patient
CONTRAINDICATIONS: Hypersensitivity, Hypotension
Respiratory Depression, Minor Degrees of Pain
DOSE:
Acute pain:
(Adult) - 1 mcg/kg slow IVP/IM/IN, maximum single dose of 100 mcg
*May repeat every 10 minutes to a maximum cumulative dose of 3 mcg/kg or 250 mcg, whichever is lesser
(Ped) - OLMC ONLY but typical dose is 1 mcg/kg up to 50 mcg per dose
For unknown chest pain or acute coronary syndrome - (Adult): 0.5 mcg/kg slow IVP/IM/IN, maximum single dose of 50 mcg
**May repeat every 10 minutes to a maximum cumulative dose of 1.5 mcg/kg or 125 mcg, whichever is lesser
(Ped): OLMC ONLY but typical dose is 1 mcg/kg up to 50 mcg per dose
PHARMACOKENETICS: Onset of action nearly immediate after IV administration. Peak effects occur within 3 – 5 minutes. Duration of effect is 30 - 60 minutes, with a half-life of 6 – 8 hours
ADVERSE EFFECTS: Hypotension, respiratory depression, euphoria, dizziness. Nausea and/or vomiting if rapid IV push
OTHER: Use Appropriate monitors. Naloxone is an antagonist
HOW SUPPLIED:
100 mcg/2 mL (50 mcg/mL) ampule, vial, or pre-filled syringe
250 mcg/5 mL (50 mcg/mL) ampule or vial
500 mcg/10 mL (50 mcg/mL) vial
Glucagon
CLASS: Hormone
PHARMACODYNAMICS: Glucagon is a hormone produced in the pancreas. When released in times of hypoglycemia, it causes a breakdown of glycogen (stored in the liver) to glucose and inhibits the subsequent synthesis of glycogen from circulating glucose. Both actions increase the blood levels of glucose. Given via the IM route, it is a useful drug in hypoglycemia when IV access is unsuccessful. Glucagon also increases heart rate, myocardial contractility and improves AV conduction in a manner similar to that produced by catecholamines. Its actions are independent of beta blockade and therefore may be useful via IV/IO administration by paramedics for reversing cardiovascular collapse effects of suspected beta blocker toxicity.
INDICATIONS: Respiratory Arrest, Specific Causes of Cardiac Arrest, Altered Mental Status, Seizure, Syncope, Dystonic Reactions, Behavioral Disorder, Poisonings – General Management, Complications of Pregnancy
For all listed situations, indication is hypoglycemia (blood glucose <50 mg/dL) without ability to safely administer oral glucose (due to aspiration concern) and without ability to establish IV access in EMT-I85, AEMT, and Paramedic Scopes of Practice. Additional indication for beta blocker toxicity with hypotension and bradycardia in Paramedic Scope of Practice.
CONTRAINDICATIONS: None
PHARMACOKENETICS: Onset 5 – 20 minutes; peak effects in 30 minutes; duration is 1 – 1.5 hours.
SIDE EFFECTS: Dizziness, headache, nausea/vomiting, hyperglycemia
DOSE:
- Hypoglycemia w/out safe PO access & w/out IV access
Adult and Ped 25kg or more: 1 mg IM
Ped Less then 25kg: 0.5mg IM
- Suspected beta blocker toxicity with arrest or hypotension/bradycardia (Paramedic only)
Adult: 1 mg IVP/IOP; May be given IM if no IV access obtainable - Ped: Suspected beta blocker toxicity with arrest or hypotension/bradycardia (Paramedic only)
0. 5 mg IVP/IOP; May be given IM if no IV access obtainable
Glucose
CLASS: Carbohydrate
PHARMACODYNAMICS: Increases blood sugar level
INDICATIONS: Hypoglycemia
CONTRAINDICATIONS: Unconscious or semi–conscious and unable to follow simple commands. Care should be taken to prevent choking or aspiration of medication in semi–conscious patient
PHARMACOKENETICS: Rapid oral absorption uptake to increase circulating blood sugar levels. Onset of effect within several minutes of oral dosing. Duration of effect up to 30+ minutes, but patient should be advised to consume complex carbohydrates within minutes of restoration of normal blood sugar, unless otherwise contraindicated
SIDE EFFECTS: None
DOSE:
Adult & Ped Wt ≥ 25 kg: 15 grams (1 tube) PO or SL for blood glucose < 50 mg/dL
Ped Wt <25kg: 7.5 grams (1/2 tube) PO or SL for blood glucose < 50 mg/dL
HOW SUPPLIED: 15 grams of glucose for oral administration in a squeeze tube container.
(Always check concentration and dose per container at time of patient medication administration)
SPECIAL COMMENT: Medical grade glucose should be utilized in place of sodas, candy, and other carbohydrate-heavy solid food. In many cases, the carbohydrate grams cannot be measured.
Hydroxocobalamin
BRAND NAME: Cyanokit
CLASS: Cyanide Antidote
PHARMACODYNAMICS: Hydroxocobalamin binds cyanide, forming cyanocobalamin for urinary excretion.
INDICATIONS: Cyanide (12E)
CONTRAINDICATIONS: None in the setting of suspected cyanide toxicity.
PHARMACOKENETICS: Near immediate onset of action following IVPB initiation. Effect is seen for hours, with duration of action seen predominantly in the first 24 hours following administration, but measurable for days.
SIDE EFFECTS: Redness of skin and mucous membranes may be prominently noted. Additional side effects include headache, dizziness, restlessness, eye irritation, throat irritation, dyspnea, pulmonary edema, chest tightness, hypertension, tachycardia, palpitations, nausea, vomiting, diarrhea, abdominal pain, dysphagia, red urine, and hives.
DOSAGE:
Adult -5 grams IVPB in 15 minutes
Pediatric -
Safe use in children has not been firmly established, though in indicated clinical situation, benefit out weights risk. Contact OLMC for consult and order. The pediatric dose used in most situations is 70 mg/kg IVPB in 15 minutes.
HOW SUPPLIED: CYANOKIT ® preparations include either one glass vial containing 5 grams of hydroxocobalamin as a dark red crystalline powder for reconstitution with 200 mL normal saline or a set of two glass vials, each containing 2.5 grams of hydroxocobalamin as a dark red crystalline powder for reconstitution with 100 mL normal saline per vial. Follow full instructions accompanying CYANOKIT® for preparation and administration, including use of transfer spike for normal saline addition to the vial(s), rocking, but not shaking the vial for 60 seconds prior to administration, and administering the infusion from the vial(s). (Always check concentration and dose per container at time of patient medication administration)
SPECIAL COMMENT: Multiple drug-drug incompatibilities exist with hydroxocobalamin. Use a
separate IV line for the administration of hydroxocobalamin
