Pharm Exam Flashcards
Adenosine
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.
(***Transient bradycardia or asystole causing sense of doom, CP, dyspnea, lightheaded to be expected with momentary asystole)
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.
Amiodarone
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.
(***Hypotension, Bradycardia, AV blocks, Torsades)
DOSAGE:
- V-Fib/Pulseless Ventricular Tachycardia - 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.
**PEDIATRIC is 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 - 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
PEDIATRIC is OLMC only! - Tachycardia (stable or unstable) - Adult
150 mg over 10 minutes (15 mg/minute or 0.3 mL/minute very slow IVP/IOP/IVPB)
HOW SUPPLIED:
150 mg/3 mL in vial, ampule, or pre-filled syringe.
150 mg/100 mL pre-mixed infusion.
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.
(***extravasation necrosis, hypotension, brady, arrhythmias/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
Diltiazem
BRAND NAME: Cardizem
CLASS: Calcium Channel Blocker
PHARMACODYNAMICS: Diltiazem is a slow calcium channel blocker with pharmacologic actions similar to those of verapamil. It inhibits calcium ion influx through slow channels into cells of myocardial and arterial smooth muscle (both coronary and peripheral blood vessels). As a result, intracellular calcium remains at sub-threshold levels insufficient to stimulate cell excitation and contraction. Diltiazem slows SA and AV node conduction (antidysrhythmic effect) without affecting normal atrial action potential or intraventricular conduction.
INDICATIONS: Tachycardia - Stable
(Sustained narrow-complex tachycardia > 150 bpm in
adults with systolic BP ≥ 100 mmHg)
**OLMC Order Only
CONTRAINDICATIONS:
- Hypersensitivity
- 2nd/3rd degree AV Blocks (may induce asystole)
- Known Wolff-Parkinson-White Syndrome (may increase
heart rate)
- Known Sick Sinus Syndrome (may induce asystole)
- Hypotension
- Bradycardia
**Safe use in pregnancy and in children has not been established. Use with caution in CHF (especially if patient is also receiving a beta-blocker), conduction abnormalities, renal or hepatic impairment and the elderly due to exaggerated degree of effect.
PHARMACOKENETICS: Onset is 3 minutes; peak effect in 7 minutes; duration is 1-3 hours; half-life is 2 hours.
SIDE EFFECTS: Headache, fatigue, dizziness, dysrhythmias, 2nd/3rd degree AV block, bradycardia, CHF, hypotension, syncope, palpitations.
(***dysrhythmias, 2/3 degree HB, brady, CHF, hypotension)
DOSAGE: Tachycardia - Stable - Adult
(Sustained narrow-complex tachycardia > 150 bpm in adults with systolic BP ≥ 100mmHg)*OLMC Order Only
Usual adult dose is 0.25 mg/kg slow IVP over 2 minutes
(NOTHING ABOUT PEDS)
HOW SUPPLIED: 25 mg in 5 mL vial (5 mg/mL)
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.
5 – 20 mcg/kg/minute - see dosage chart - titrate to a sys B/P ≥ 100 mmHg
PEDIATRIC 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 & 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:
ADULT Anaphylaxis 1:1000 0.5 mg IM
If anaphylaxis refractory to above IM dose:
1:10,000 1 mg slow IVP/IOP over 3 minutes
PEDIATRIC Anaphylaxis 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
ADULT Dyspnea/Asthma (if severe and refractory to nebulization) 1:1000 0.3 mg IM
**OLMC Order Required if pt ≥ 50 years old, heart illness history, or blood pressure > 140/90 mmHg.
PEDIATRIC Dyspnea/Asthma (if severe and refractory to nebulization)1:1000 0.01 mg/kg (0.01 mL/kg) not to exceed 0.3 mg (0.3 mL) IM
**OLMC Order Required if pt ≥ 50 years old, heart illness history, or blood pressure > 140/90 mmHg.
ADULT Asystole/V-Fib/Pulseless V-Tach/Pulseless Electrical Activity - 1:10,000 1 mg IVP/IOP
Repeat every 3 - 5 minutes while resuscitating cardiac arrest
PEDIATRIC Asystole/V-Fib/Pulseless V-Tach/Pulseless Electrical Activity - 1:10,000 0.01 mg/kg (0.1 mL/kg) IVP/IOP Repeat every 3 - 5 minutes while resuscitating cardiac arrest
PEDIATRIC Bradycardia - Symptomatic & Systolic BP < 70 + (2 x age in years) mmHg (Sinus, First Degree, 2nd Degree Type I) 1:10,000 0.01 mg/kg (0.1 mL/kg) IVP/IOP
May repeat once (NO ADULT)
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
Etomidate
BRAND NAME: Amidate
CLASS: Sedative/hypnotic (Non-barbiturate, non-benzodiazepine, non-narcotic)
PHARMACODYNAMICS: Appears to modulate GABA receptors ; Etomidate is an intravenous hypnotic drug without analgesia. Etomidate is safe to use in patients with cardiac illness and patients with traumatic injuries. Etomidate has little to no effect upon myocardial metabolism, cardiac output, or peripheral circulation. Etomidate has been shown to reduce cerebral blood flow, cerebral oxygen consumption, and intracranial pressure – helpful in head injury situations.
INDICATIONS: Sedation for RSI
CONTRAINDICATIONS: History of Hypersensitivity
PHARMACOKENETICS: Rapid onset of action, seen as desired sedation within as little as 10-15 seconds, but nearly always within less than 1 minute. Duration of action, based upon a standard dose of 0.3 mg/kg (70 kg adult dose of 20 mg) is 5-15 minutes.
SIDE EFFECTS: Transient skeletal muscle movements, called (Myoclonic jerks), Transient venous pain at injection site, Nausea and/or vomiting, hypoventilation and apnea (very rare), hypotension on rapid push (rare)
DOSE: 0.3 mg/kg IVP/IOP over 15-30 seconds, given just prior to intubation
(NO PEDS GIVEN)
HOW SUPPLIED: 40 mg/20 mL (2 mg/mL) vial or pre-filled syringe
OTHER: Repeated doses of etomidate should be avoided to minimize its effect upon adrenal function. Repeated doses and continuous infusions of etomidate have been linked to adrenal suppression.
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
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
SIDE EFFECTS: Hypotension, respiratory depression, euphoria, dizziness. Nausea and/or vomiting if rapid IV push
DOSE:
(ADULT) For acute pain - 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
For unknown chest pain or acute coronary syndrome - 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
(PEDIATRIC) for all times is OLMC ONLY but the typical dose is s 1 mcg/kg up to 50 mcg per dose
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
Midazolam
BRAND NAME: Versed
CLASS: Sedative; Anticonvulsant; Amnestic; Muscle Relaxant, Anxiolytic, Benzodiazepine (Class IV)
PHARMACODYNAMICS: Short - acting benzodiazepine with central nervous system depressant, anticonvulsant, anterograde amnestic, muscle relaxant, and anxiolytic effects. Like the other benzodiazepines, it has no effect on pain.
INDICATIONS: - Pre & Post RSI - Post Cardiac Arrest Treatment (Hypothermia Induced Shivering Control) - Transcutaneous Pacing (Sedation) - Synchronized Cardioversion (Sedation) - Seizure - Dystonic Reactions - Chemical Restraint - Poisonings (Suspected stimulant toxicity) - Head/Neck/Spine Injury - Heat Illness
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.
PHARMACOKENETICS: Onset is 3-5 minutes, IVP/IOP; 6-14 minutes IN; up to 15 minutes IM (though clinically evident much faster); peak effects in 20-60 minutes. Duration is 2 hours IVP/IOP/IN; 1-6 hours IM; half – life is 1-4 hours
SIDE EFFECTS: Retrograde amnesia, headache, euphoria, drowsiness, weakness, excessive sedation, confusion, dizziness, blurred vision, diplopia, nystagmus, respiratory arrest, tachypnea, hypotension, nausea, vomiting
DOSE:
- Pre & Post RSI Sedation (ADULT)
0.1 mg/kg to max 5 mg IVP/IOP, may repeat once if
systolic BP > 100 mmHg
- Post Cardiac Arrest Treatment (Hypothermia Induced
Shivering Control) (ADULT & PEIDATRIC)
0.1 mg/kg to max 5 mg IVP/IOP - Transcutaneous Pacing (Sedation) (ADULT)
2 - 5 mg IVP based upon weight and hemodynamics
(0.1 mg/kg to max 5 mg) - Synchronized Cardioversion (Sedation) (ADULT)
- 1 mg/kg to max 5 mg IVP/IOP/INP
- Seizure/Heat Illness (ADULT)
0.1 mg/kg to max 5 mg IM/IVP/IN/IOP for active seizure
May repeat once in 5 minutes if still seizing - Dystonic Reactions (ADULT)
- 5 mg IVP/IM/IN
- Chemical Restraint (ADULT)
0.1 mg/kg to max 5 mg IM/IVP/IN/IOP.
May repeat once. - Poisoning (Suspected Stimulant Toxic) (ADULT)
0.1 mg/kg to max 5 mg IVP/IN/IM
(PEDIATRIC is OLMC ONLY) - Head/Neck/Spine Injury (ADULT)
5 mg IM/IVP/IN/IOP for active seizure.
May repeat once in 5 minutes if still seizing - Seizure, (Head/Neck/Spine) injury, Heat Illness (PEDIATRIC) 0.1 mg/kg to max 5 mg IM/IVP/IN/IOP for active seizure. May repeat once in 5 minutes if still seizing
- Dystonic Reactions (PEDIATRIC)
0. 1 mg/kg to max 2.5 mg IM/IVP/IN - Chemical Restraint (PEDIARIC)
0. 1 mg/kg to max 5 mg IM/IVP/IN/IOP
HOW SUPPLIED: 5 mg/1 mL in vials, ampules, or pre-filled syringes.
OTHER: Flumazenil is an antagonist
Morphine Sulfate
BRAND NAME: Morphine Sulfate
CLASS: Narcotic Analgesic
PHARMACODYNAMICS: Stimulates central nervous system opiate receptors, producing systemic analgesia. Modest vasodilation effects increase peripheral venous capacitance, and reduce venous return, myocardial workload, and myocardial oxygen demand
INDICATIONS: Acute pain control in alert, hemodynamically stable patient
CONTRAINDICATIONS: Hypotension, Respiratory Depression, Minor Degrees of Pain, Pain Assessed as Factitious
PHARMACOKENETICS: Onset of action within 3-5 minutes after IV administration. Duration of effect can reach 4 hours depending upon end-organ function.
SIDE EFFECTS: Hypotension, respiratory depression, euphoria, dizziness. Nausea and/or vomiting are rarely seen if administration is slow IVP. Rapid IVP will lead to an accompanying histamine release, producing the nausea and/or vomiting often erroneously attributed to morphine itself.
DOSE:
- For unknown chest pain or acute coronary syndrome
2 mg slow IVP ; May repeat every 5 minutes to a
maximum cumulative dose of 10 mg
- For acute pain control
2 – 4 mg slow IVP
May repeat every 5 minutes to a maximum cumulative
dose of 10 mg - FOR ALL PEDIATRIC DOSES
- OLMC Order ONLY – Typical dose is 0.1 mg/kg up to 2 mg per dose
HOW SUPPLIED: 2 mg/1 mL pre-filled syringe 4 mg/1 mL vial, ampule, or pre-filled syringe 8 mg/1 mL pre-filled syringe 10 mg/1 mL vial 10 mg/10 mL vial
Norepinephrine
BRAND NAME: Levophed
CLASS: Vasoconstrictor
PHARMACODYNAMICS: Stimulates alpha receptors in the peripheral vasculature, producing vasoconstriction-related increase in systemic blood pressure. Concurrent beta receptor stimulation may produce increases in heart rate and mild bronchodilation, though norepinephrine is a weaker beta stimulator than dopamine.
INDICATIONS: For all listed situations, indication is hypotension (adult = systolic < 100mmHg) due to cardiogenic, septic, or neurogenic shock either refractory to intravascular fluid boluses or in which intravascular fluid boluses is contraindicated (eg. pulmonary edema).
CONTRAINDICATIONS: 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: Few, though at higher doses, symptoms may include headache, palpitations, tachycardia, chest pain, and eventual hypertension. Bradycardia can result reflexively from an increase in blood pressure
DOSE: ADULT - Start at 2-4 mcg/minute - see dosage chart - titrated to a systolic B/P ≥ 100 mmHg. Maximum infusion rate is 12 mcg/minute
PEDIATRIC IS OLMC ONLY
HOW SUPPLIED: 4 mg/4 mL ampule or vial.
USE ONLY* 2 mL in a 250 mL bag of D5W.
(8 mcg/mL concentration)
OTHER:
Norepinephrine should be given into a large, patent vein. The vein of choice for EMS use is the antecubital vein, as this will decrease the risk of overlying skin necrosis. Do not administer norepinephrine through an IV in the hand or leg. These veins are more likely to be affected by vasoocclusive diseases and more prone to ischemic complications.
Administration through IO in the proximal tibia or humeral head is permitted.
Safety in pregnancy not firmly established, though when clinically indicated the benefits outweigh risks. Safety in pediatrics not firmly established and OLMC is to be consulted prior to pediatric usage.
Sodium Bicarbonate
BRAND NAME: Sodium Bicarbonate
CLASS: Alkalinizing agent
PHARMACODYNAMICS Raises the pH of blood by buffering excess hydrogen ions that are present in acidotic states. The role of sodium bicarbonate is limited in cardiac arrest. Because ventilation is an effective tool in managing respiratory acidosis, sodium bicarbonate should rarely be administered for cardiac arrest, unless the arrest is suspected to be secondary to hyperkalemia, a preexisting metabolic acidosis, or a tricyclic antidepressant over ingestion.
INDICATIONS:
- Specific Causes of Cardiac Arrest (Hyperkalemia)
- Poisonings – General Management (Tricyclic
Antidepressant)
- Dialysis-Related Issues (Hyperkalemia)
- Crush Injury Syndrome (Hyperkalemia Prophylaxis)
CONTRAINDICATIONS: Known metabolic alkalosis.
PHARMACOKENETICS: Onset of effect is observed within 3-5 minutes after IVP/IOP administration.
SIDE EFFECTS: Sodium bicarbonate may inhibit oxygen release secondary to a shift in oxyhemoglobin saturation. It also may produce a paradoxical acidosis that can depress cerebral and cardiac function. Severe soft tissue damage can occur in extravasated administrations.
DOSE:
For all indications above ADULT & PEDIATRIC
1 mEq/kg IVP/IOP with maximum dose of 50mEq
HOW SUPPLIED: 50 mEq/50 mL (1 mEq/mL) prefilled syringe.
OTHER: Do not administer with calcium chloride. A precipitate will form and obstruct the vascular access being utilized
