Pharmacology Flashcards
1
Q
Adenosine Action
A
endongenous nucleotide: slows conduction through the AV node; blocks reentrant pathways in SVT
2
Q
Adenosine Indication
A
SVT
3
Q
Adenosine Contraindications
A
2nd or 3rd degree AV blocks; atrial flutter; atrial fibrillation, ventricular tachycardia, wolf-Parkinson-white syndrome, hypersensitivity; may cause bronchoconstriction.
4
Q
Adenosine side effects
A
facial flushing, pain palpitations, headache, dyspnea, vertigo, nausea, metallic taste
5
Q
Adenosine Dose and administration
Pediatric dose: use tape
A
6 mg rapid IVP, 20 mL saline flush/proximal IV;
If no conversion after 1-2 minutes repeat dose of 12 mg rapid IVP followed by 20 mL flush
6
Q
Albuterol action
A
sympathomimetic bronchodilator, acts selectively on beta-2 receptors to relax bronchial smooth muscle tissue
7
Q
Albuterol indications
A
bronchospasm secondary to asthma or exacerbation due to COPD
8
Q
Albuterol contraindications
A
hypertension, hypersensitivity, tachycardia secondary to digitalis toxicity
9
Q
Albuterol precautions
A
patients with cardiovascular disease or CHF
10
Q
Albuterol side effects
A
headache, hypertension, drowsiness, vertigo, dysrhythmias, nausea
11
Q
Albuterol dosage & administration
A
2.5 mg with 3-6 mL NS with O2 set to 6LPM; may repeat if no adverse effects or treatment not working
12
Q
DuoNeb substance
A
3 mg of albuterol sulfate equal to 2.5 albuterol base; 0.5 mg Ipratropium in isotonic sterile sodium chloride
13
Q
DuoNeb action
A
maximize response in treatment for patients with severe COPD symptoms; producing greater bronchodilation effects.
14
Q
DuoNeb indications
A
treatment of bronchospasm associated with asthma, COPD, respiratory distress, drowning, allergic reaction,
toxic inhalation
15
Q
DuoNeb side effects
A
headaches, tachycardia, palpitations, dizziness, nausea, dry mouth, *occasionally can make breathing worse immediately after treatment
16
Q
DuoNeb contraindications
A
hypersensitivity to any of its components including atropine
17
Q
DuoNeb precautions
A
cardiovascular disorders, especially coronary insufficiency, cardiac arrythmias, and hypertension, convulsive disorders, use in pregnancy only if benefit outweigh the risks.
18
Q
DuoNeb dosage and administration
A
3 mL vial, may repeat 2X if wheezing persists
19
Q
Amiodarone action
A
antiarrythmic medication; calcium, potassium and sodium channel blocker; negative chronotropic, negative dromotropic, and vasodilator.
20
Q
Amiodarone Indications
A
shock refractory V-fib; shock refractory pulseless V-tach;
hemodynamically unstable V-tach refractory to treatment; control of hemodynamically stable VT; use as adjunct to cardioversion of SVT and PSVT;
21
Q
Amiodarone Contraindications
A
hypersensitivity, cardiogenic shock, sinus bradycardia, high degree AV block.
22
Q
Amiodarone Incompatibilities
A
do not mix with sodium bicarbonate
23
Q
Amiodarone side effects
A
bradycardia, nausea, AV block, vasodilation and hypotension
24
Q
Amiodarone dosage and administration
A
cardiac arrest: 300 mg then 150 mg after 3-5 min; followed by a 20-30 mL flush. SLOW DRAW from vial with large bore needle.
25
Amiodarone dosage for ventricular ectopy:
VT with pulse and unstable PSVT administer 150 mg in 100 mL of D5W over 10 minutes: 40 mL per hour
26
Aspirin action
interferes with platelet aggregation and is known as an anti-platelet medication.
27
Aspirin Indication
MI patients, reduction of death chance with past MI hx., unstable angina, cardiac related chest pain.
28
Aspirin contraindications
hypersensitivity and hx of gastric or intestinal ulcers
29
Aspirin precautions
patients taking diabetic medications, or medications for anticoagulation or gout
30
Aspirin side effects
anaphylaxis, GI bleeding if preexisting conditions exist
31
Dosage and administration
324 mg chewable aspirin
32
Atropine Action
parasympatholytic drug inhibits actions of acetacholine: dilates pupils, relaxes bronchioles, increases heart rate, creates positive chronotropic and dromotropic effects
33
Atropine Indications
symptomatic bradycardia, organophosphate poisoning
34
Atropine contraindications
tachycardia, narrow angle glaucoma, myasthenia gravis
35
Atropine side effects
palpitations, paradoxical bradycardia from too slow of administration, headache, tachycardia, dry mouth, vertigo
36
Atropine dosage and administration
0.5 mg IV push rapid. repeat every 3-5 minutes. Max dose 3 mg
37
Atropine pediatric dose
0.02 mg/kg, minimum dose 0.1 mg - max 0.5 mg. May repeat for a second dose
38
Calcium chloride action
essential electrolyte for functional integrity of the nervous and muscular system, cardiac contractility and blood coagulation.
39
Calcium chloride indications
hypocalcemia, hyperkalemia, calcium channel blocker toxicity, magnesium sulfate OD, cardiac resuscitation.
40
Calcium chloride contraindications
VF during arrest, hypercalcemia, calcium chloride precipitates on contact with sodium bicarb.
41
calcium chloride side effects
bradycardia, hypotension
42
Calcium chloride dosage and administration
1 gram IV/IO slowly; Pediatric 20 mg/kg slowly
43
Dextrose Action
carbohydrate, Monosaccharide, is a hypertonic solution which increases blood glucose levels intravenously.
44
Dextrose indications
hypoglycemia, Altered level of consciousness, coma or seizure of unknown etiology
45
Dextrose precautions
patients with CVA and intra-cerebral hemorrhage
46
Dextrose side-effects
warm, painful burning sensation from administration of the medication; thrombophlebitis, sclerosis of the vein
47
Dextrose dosage and adminstration
25 grams slow IV push with 18 gauge (250 mL of 10% solution) - may discontinue without full infusion if patient awakens and can swallow oral glucose. Repeat in 10 minutes if BLGL less than 60
48
Dextrose pediatric dose and administration
0.5 grams/kg (5mL/kg of 10% solution) max 10 grams;
| if patient less than 20 kg use a syringe for accurate dosing
49
Diazepam (valium) Action
sedative-hypnotic benzodiazepine. Acts on the limbic, thalamic and hypothalamic regions of the CNS to potentiate the effects of inhibitory neurotransmitters. Raises the SEIZURE threshold and produces sedation and amnesia.
50
Diazepam Indications
Seizure control, acute anxiety, muscle relaxant, pre-medication prior to cardioversion.
51
Diazepam side effects
hypotension, respiratory depression, ataxia (impaired balance and coordination), confusion, nausea, CNS depression.
52
Diazepam contraindications
respiratory depression, substance abuse of CNS depressants, hypersensitivity.
53
Diazepam (valium) precautions
Patients with renal or hepatic insufficiency. smaller doses usually required for the elderly.
54
Diazepam dosage and adminstration
5 mg IV/IO or MAD; repeat as needed after 5 min - up to 10 mg.
55
Diazepam pediatric dosage and adminstration
0.2 mg/kg IV/IO or MAD (maximum 5 mg) repeat after 5 minutes if necessary up to MAX 10 mg.
56
Diltiazem (cardizem) action
Calcium channel blocker inhibits transport of calcium into myocardial and vascular smooth muscle cells. causes systemic vasodilation, decreasing BP and coronary vasodilation.
57
Diltiazem indications
management of SVT; rapid ventricular rates in atrial fibrillation or flutter.
58
Diltiazem contraindications
2nd or 3rd degree AV block; myocardial infarction, WPW syndrome, Sick sinus syndrome, hypotension <90 mmhg systolic, pulmonary congestion
59
Diltiazem precautions
patients with renal or hepatic insufficiency or CHF, geriatric, pregnant with lactation, children, hx of serious ventricular dysrhythmias
60
Diltiazem side effects
epitaxis, CHF, chest pain, syncope, dyspnea, bradycardia, palpations, tachycardia, diaphoresis, hyperglycemia
61
Diltiazem dosage and administration
0.25 mg IV over 2 minutes, max 20 mg - may repeat in 15 minutes if first does ineffective; consider vagal maneuvers as first line treatment for regular, narrow complex tachycardias suggestive of SVT.
62
Diphenhydramine action
antihistamine, blocks effects of allergic reactions inhibits motions sickness and causes mild sedation.
63
Diphenhydramine indications
anaphylaxis, extrapyramidal reaction to phenothiazine medications (anti-psychotics), mild to moderate allergic reactions
64
Diphenhydramine contraindications
asthma (relative), narrow angle glaucoma, patients taking MAO inhibitors.
65
Diphenhydramine precautions
pregnant patients, may have additive effects when used with CNS depressant medications.
66
Diphenhyramine side effects
drowsiness, palpitations, urinary retention, drying of bronchial secretions, dry mouth
67
Diphenhydramine dosage and administration
1 mg/kg max 50 mg IV or IM if no IV access. for Dystonic reactions give 25-50 mg IV/IM
68
Epinephrine action
endogenous catecholamine with beta 1 and beta 2 vasoconstriction and bronchodilation effects; Alpha 1 effects - peripheral vasocontriction. Increasing cerebral and coronary perfusion and increased automaticity with increase in myocardial O2 demand.
69
Epinephrine Indication
cardiac arrest, acute bronchospasm from asthma or COPD, Anaphylaxis.
70
Epinephrine contraindication
no known contras in cardiac arrest.
71
Epinephrine precautions
hyperthyroidism, diabetes mellitus, glaucoma, may exacerbate hypertension or angina, SVT, CHF, is unstable in alkaline solutions.
72
Epinephrine side effects
headache, palpitations, dizziness, tachycardia, N&V, anxiety
73
Epinephrine dosage and administration CODE
1 mg IV/IO 1:10,000 push for cardiac arrest every 3-5 minutes; can be given via ETT at 2-2.5 times the dose diluted in 10 mL of NS - Pediatric 0.01 mg/kg cardiac arrest
74
Epinephrine dosage and administration ANAPHYLAXIS
0.3 mg of 1:1,000 IM adult; 0.15 mg IM pedi: may repeat if signs and symptoms of shock persist
75
Epinephrine dosage and administration SEVERE SOB
ADULT: 0.3 mg 1:1,000 IM ; discuss prior to use with patient over 55 or using beta blockers
76
Etomidate Action
hypnotic drug without analgesic or muscle relaxing properties. Can cause myoclonus upon injection. Usually given with neuromuscular blocking agents and/or analgesics.
77
Etomidate indications
Induction PRIOR to neuromuscular blocking agents and/or analgesics. (RSI)
78
Etomidate contraindications
pregnancy or lactation, patients under 3 months of age
79
Etomidate precautions
patients with hepatic and/or renal insufficiency
80
Etomidate side effects/adverse effects
transient venous pain at injection site; transient muscle skeletal spasms/twitching
81
Etomidate complications
anticipate that the patient will awaken and will be left without residual analgesia; medicate with additional narcotics and neuromuscular blockers as needed.
82
Etomidate dosage and administration
Adult and Pedi: 0.3 mg/kg IV; Onset within 1 minute, duration 5 minutes. Patient will awaken fully within 7-14 minutes.
83
Fentanyl (sublimaze) action
opioid analgesic, binds to opiate receptors in the CNS altering its response and perception to pain. May produce CNS and/or respiratory depression in higher doses.
84
Fentanyl indications
pain control; sedation of the intubated patient
85
Fentanyl contraindications
patients currently taking MAO inhibitors; hypotension; inferior myocardial wall infarct on EKG
86
Fentanyl use with PRECAUTION
head injury, COPD injury, Respiratory difficulty
87
Fentanyl side effects
apnea, laryngospasm, hypotension, respiratory depression, N&V, bradycardia
88
Fentanyl dosage and administration
50-100 mcg, IV push slowly over 1-2 minutes or IM injection, may repeat every 5 minutes to a total of three doses or a maximum cumulative dose of 250 mcg.
89
Fentanyl dosage and administration PEDI
0.5 mcg/kg IV push slowly over 1-2 minutes; not to exceed 100 mcg. 1.5 mcg/kg MAD if IV inaccessible; may repeat every 5 minutes up to 3 times to a total dose of 250 mcg - recheck pain score and HR, RR, and BP
90
Fentanyl sedation in patient with advanced airway
100 to 250 mcg IV, may repeat to a cumulative dose of 250 mcg. Discuss with medical control if more needed.
91
Glucagon action
Increases blood glucose secondary to glycogenesis, which is the breakdown of glycogen to glucose in the liver. Action in hypoglycemia in hypoglycemia relies on the presence of adequate liver glycogen stores.
92
Glucagon Indications
Hypoglycemia with inability to obtain IV access
93
Glucagon contraindications
hypersensitivity; depleted glycogen stores in liver (starvation states)
94
Glucagon precautions
cardiac disease, malnutrition, children
95
Glucagon side effects
N&V, tachycardia, decreased gastric motility, sudden transient hypertension
96
Glucagon dosage and administration
adults and children >25 kg 1 mg IM; children <25 kg 0.5 mg IM, may repeat every 10 minutes for persistent hypoglycemia up to 1.5 mg.
97
Glucagon NOTE:
patient usually awakens from hypoglycemic state within 15 to 20 minutes after admin of glucagon. Give carbs PO ASAP after patient able to swallow.
98
Oral Glucose Action
after absorption in the GI tract, glucose is distributed in the tissues and provides a prompt increase in circulating blood sugar.
99
Oral glucose indications
hypoglycemia
100
Oral glucose side effects
nausea
101
Oral glucose precautions
AMS may impair ability to follow directions, make sure patient can swallow, must be swallowed.
102
Oral glucose dosage and administration
15 grams PO for patients who can swallow; pediatric 5 to 15 grams PO for patients who can swallow
103
Haloperidol (haldol) Action
Anti-psychotic; precise action has not been established ; has effects on dopamine and seritonin receptors. blocking dopamine D2 receptors in the brain. When 72% of dopamine receptors are blocked, this drug achieves its maximal effect.
104
Haldol inidications
prompt control of acute agitated delirium with moderate to severe symptoms; preferentially used in the setting of an acute psychiatric episode.
105
Haldol side effects
tachycardia, hypertension, diaphoresis, blurred vision, nausea and vomiting.
106
Haldol contraindications
severe, toxic CNS depression (DRUNK patients) or comatose states, hypersensitivity, known prolonged QT
107
haldol precautions
caution for patients with severe cardiovascular disorder; history of seizures: may lower convulsion threshold; use caution with patients over 50; will make the effects of alcohol and CNS depressants worse.
108
Haldol dosage and administration
5 mg IV/IM; may repeat once in 10 minutes
109
hydroxcobalamin (cyanokit) action
ability to detoxify cyanide
110
Cyanokit indications
known or suspected cyanide poisoning: can present after breathing smoke from a house or industrial fire, breathing or swallowing cyanide, skin exposure to cyanide.
111
cyanokit side/adverse effects
anaphylaxis, edema, skin and urine redness, eye swelling, irritation and redness. liver damage
112
cyanokit incompatibilities
do not administer through same IV line as sodium nitrate, propofol, diazepam, nitro blood products: GET TWO IV ACCESS LINES
113
cyanokit dosage and administration
5 grams in one vial ADD 200 mL of 0.9% NS to vial using the transfer spike, fill to line and keep upright. Rock and rotate vial for 60 seconds to mix. Infuse the vial using vented IV tubing. Infuse over 15 minutes.
114
Ketamine action
Rapid acting general anesthetic: producing a dissociate state characterized by profound analgesia with cardiovascular and respiratory stimulation with an occasional transient and minimal respiratory depression.
115
Ketamine indications
Induction or agitated delirium
116
ketamine side effects
hypertension, tachycardia, laryngospasm, respiratory depression, N&V
117
ketamine contraindications
patients in whom a significant rise in BP would cause serious problems. Hemorrhagic stroke; BP > 240/120, children less than 3 months old.
118
ketamine dosage and administration
2 mg/kg IV or IM. Use only in extreme cases of excited delirium and SAME dose for INDUCTION; 30 to 40% of patients treated with ketamine may require intubation in the ER for sedation and respiratory depression.
119
Labetalol Action (Normodyne)
Adrenergic blocking agent with selective alpha and non-selective beta adrenergic blocking actions: lowering blood pressure without reflexive tachycardia.
120
Labetalol Indications
acutely symptomatic hypertension 220/120; may be used in presence of CVA symptoms. May be used for sinus tachycardia in the setting of chest pain. Pregnant patient or recently delivered (fewer than 6 weeks) hypertensive patient: greater than 140 systolic or 100 diastolic. Especially if acutely symptomatic for preeclampsia or eclampsia.
121
Labetalol contraindications
high degree AV block, cardiogenic shock, bradycardia, hypotension.
122
Labeatlol precautions
heart failure, liver disease, diabetes, asthma
123
labetalol side effects/adverse effects
postural hypotension, diaphoresis, vertigo, N&V
124
Labetalol dosage and administration hypertension
10 mg IV over 1-2 minutes; may be repeated in 10 minutes if no change in blood pressure. The goal is to lower blood pressure but not more than 25%.
125
Labetalol pre-eclampsia/eclampsia
10 mg IV over 1-2 minutes; may repeat in 10 minutes if no change. Lower BP to less than 130 over 100
126
Labetalol sinus tachycardia dose
5 mg IV over 1-2 minutes wait for response; repeat in 5 minutes if no change. another 5 mg but no more than 20 mg. maximum effect usually occurs within 5 min.
127
Labetalol notes
patient BP should always be closely monitored; and in SUPINE position
128
Lorazepam action
Benzodiazepine with anti-anxiety, sedative and anti-convulsant effects.
129
Lorazepam indication
continuous or multiple seizures; shivering or seizure activity with rapid cooling of hypothermic patients.
130
Lorazepam contraindications
hypersensitivity to glycols or benzyl alcohol, acute narrow angle glaucoma or COPD
131
Lorazepam side effects
respiratory depression, drowsiness or confusion, headache, ekg changes or tachycardia
132
Lorazepam dosage and administration
>18 years of age: 2-4 mg IV, IO slow push; may repeat if needed after 5 minutes. <18 years of age: 0.1 mg/kg but not more than 4 mg. For cooling due to hyperthermia 2 mg
133
Magnesium sulfate action
Depresses cardiac muscle and nerve junctions, depresses the CNS,
134
Magnesium sulfate indications
cardiac arrest if torsade de pointes or hypomagnesemia is present; seizure for eclampsia, bronchospasm due to COPD or status asthmaticus
135
mag sulfate contraindications
symptomatic heart block, use with caution in patients with renal impairment.
136
Mag sulfate adverse effects
bradycardia, paralysis, severe diaphoresis, hypothermia
137
Mag sulfate dose and admin
respiratory distress: 2 grams mixed in 100 mL bag D5W over 10-20 minutes. Eclampsia: 4 grams mixed in 100 mL D5W over 15 minutes.
138
Methlyprednisolone action
potent anti-inflammatory glucocorticoid steroid. Can control severe inflammatory conditions such as anaphylaxis and allergic reactions; exacberations of COPD and asthma. Onset of about 1 hour and last up to 12 hours.
139
Methylprednisolone indication
Acute bronchospasm (asthma or COPD); allergic reactions including anaphylaxis.
140
Solumedrol contraindications
systemic fungal infections; use with caution if tuberculosis, or patients who have received steroids in last 24 hours.
141
Solumedrol side effects
nervousness, dizziness, headache, may raise glucose serum levels.
142
Solumedrol dosage and administration
125 mg IV preferred or IM PEDI: 2 mg/kg IV max 125 mg
143
Midazolam (versed) Action
short-acting benzodiazapine; Produces generalized CNS depression.
144
Midazolam indications
sedative for agitation or post intubation AND treatment of seizure
145
Midazolam contraindications
known hypersensitivity to benzos, hypotension/shock, respiratory distress
146
Midazolam precautions
pulmonary disease, CHF, renal or hepatic impairment, geriatric or debilitated patients
147
Midazolam side effects
agitation, excess sedation, bronchospasm, N&V, respiratory depression, cough
148
Midazolam dosage and admin
post-intubation or pre-treatment for cardioversion: 2-4 mg IV/IO; Agitated delirium 5-10 mg IV/IM or 10 mg IN with 5 mg for each nostril per MAD.
149
Midazolam dosage pediatric
<50kg use 5 mg Versed with MAD: 2.5 mg each nostril; sedation post-intubation or pre cardioversion use 0.1 mg/kg IV/IO max 2 mg; agitated delirium: 5-10 mg IV/IO or 10 mg MAD; SEIZURE preferred if no IV use 0.2 mg/kg with max of 10 mg total. ONSET 1.5 to 5 minutes
150
Naloxone (narcan) Action
synthetic opioid antagonist; competes at opiate receptor sites resulting in reversal of respiratory depression, sedation and pupil miosis.
151
Naloxone Indication
Acute CNS depression; decreased Level of consciousness due to opiate OD or unknown etiology
152
Naloxone contraindication
none known
153
Naloxone precautions
known opiate abusers, narcotic dependent - may cause severe withdrawal effects; pre-existing cardiac disease, patients who have received cardio-toxic drugs.
154
Naoloxone side effects
tachycardia, hypertension, hypotension, N&V
155
Naloxone dose and admin
0.5 mg IV, IM, IN, IO. May be given in one 2 mg dose or in increments of 0.5 up to four times. depending on clinical presentation. FOR SEVERE RESPIRATORY DEPRESSION ADMINISTER 2 mg. Use ENTIRE 4 mg of nasal MAD when administering narcan. PEDI: 0.1 mg/kg
156
Nitroglycerin Action
peripheral vasodilator: reduces preload, decreasing myocardial 02 demand.
157
Nitroglycerin indication
Ischemic chest pain, HTN, acute pulmonary edema possibly secondary to CHF
158
Nitro contraindications
Hypotension, head injury or possibility of intracranial hemorrhage, use of viagra or levitra in 24 hourse or cialis in 48 hours. Right ventricular infarct (preload)
159
Nitro precautions
patients with glaucoma as it may increase intraocular pressure.
160
Nitro side effects
headaches, hypotension, vomiting, diaphoresis, syncope, tachycardia
161
Nitro dose and admin
0.4 mg tablet SL or 0.4 mg metered dose SL spray every 3-5 minutes up to 3 times
162
Norepinephrine action
sympathomimetic drug acts as a peripheral vasoconstrictor (alpha adrenergic)/inotropic stimulator/dilator of the coronary arteries (beta adrenergic); has a rapid onset and lasts 1-2 minutes, should be given as a continuous infusion.
163
Norepinephrine indication
bradycardia with a pulse, hypotension in cardiogenic shock to maintain a SBP of 90 or greater; treatment of hypotension refractory to fluid challenge
164
Norepinephrine contraindication
Relative: patients with shock from hemorrhage, or other causes of hypovolemia (patient needs fluid replacement), do not use in patient who is severely tachycardic, or in any patient with good perfusion. MUST use 18G catheter and AC location with PATENT IV
165
Norepinephrine side effects
tachycardia, HTN
166
Norepinephrine dose and admin
4 mL from 250 bag of D5W and inject the 4mg/4mL of Norepi to make an infusion of 16mcg/mL. 60 gtts/min or 1 drop every second. To titrate give 1 drop every two seconds for 8 mcg a minute. RECHECK vitals every 2 minutes while setting drip and every 5 minutes thereafter. MONITOR for tachycardia and/or HTN.
167
Ondansetron (Zofran)
anti-emetic blocks effects of serotonin in the vagal nerve terminals and in the CNS
168
Zofran indications
prevention and treatment of N&V
169
Zofran contraindications
hypersensitivity
170
Zofran precautions
liver impairment not to exceed 8 mg; pregnant or lactating females and children less than 3 years old
171
Zofran side effects
headache, dizzy, drowsy, fatigue
172
Zofran dose and admin
4 mg IV or IM administer over at least 30 seconds preferably over 2 - 5 minutes. Peak effect in 15 to 30 minutes with a duration of 4 hours; 0.1 mg/kg for children fewer than 40 kg
173
Rocuronium (Zemuron) Action
non-depolarizing, neuromuscular blocker that competitively blocks acetylcholine receptors without stimulation
174
Rocuronium Indications
use for skeletal muscle paralysis following an induction agent such as etomidate and ketamine or fetanyl in rapid sequence intubation. paralysis may also facilitate chest wall for good bag compliance in mechanical ventilation.
175
Rocuronium side effects
transient HTN
176
Rocuronium contraindications
known hypersensitivity to bromides USE caution in patients with liver disease - the duration of action in these patients can be 1.5 times longer.
177
Rocuronium dose and admin
1 mg/kg IV ONSET of action about 45 to 60 seconds and lasts up to 25 to 70 minutes. Use plenty of hypnotic to endure the length of paralysis.
178
Sodium bicarbonate action
alkalizing agent which raises blood pH
179
Sodium bicarb indications
OD of antidepressants, aspirin, cocaine or benadryl; prolonged resuscitation with adequate ventilation, ROSC after long arrest interval. Severe acidosis, hyperkalemia, pretreatment prior to trapped extremity with a serious crush injury.
180
Sodium bicarb contraindications
metabolic and respiratory alkalosis, hypocalcemia, hypokalemia - Infiltration can cause necrosis
181
Sodium bicarb side effects
metabolic alkalosis, seizures, electrolyte imbalance
182
Sodium bicarb dose and admin
1 mEq/kg IV or IO bolus - may repeat after 10 minutes maximum of 2 doses. PRE-TREATMENT in a CRUSH INJURY - 25 mEq IV/IO prior to the release of the trapped extremity; these patients may require a 2nd dose of 25 mEq if symptomatic of hyperkalemia.
183
Succinylcholine (Anectine) Action
short acting, motor nerve depolarizing and skeletal muscle tissue relaxant. It binds to cholinergic receptors in the motor neuron end plate ultimately causing MUSCLE PARALYSIS.
184
Succinylcholine Indication
Used after induction of anesthesia to produce paralysis. Achieves temporary paralysis for intubation where muscle tone and/or seizure activity prevent it.
185
Succinylcholine contraindication
known hypersensitivity, penetrating eye injuries, hx of glaucoma, and malignant hyperthermia (use ROX)
186
Succinylcholine side effects
hypotension, hypertension, ventricular disrhythmias, tachycardia, cardiac arrest. Increases intraocular and intracranial pressure with a repeat dose and child uner 5 years old.
187
Succinylcholine dose and adminstration
1.5 mg/kg IV/IO push, in extreme necessity deep IM injection of 3-4 mg/kg; total dose NOT to exceed 150 mg, however paralytics are preferred IV push.
188
Succinylcholine NOTE
after IV, complete paralysis is obtained within 1 minute and persists for approximately 2-4 minutes; effects will fade within 4-10 minutes. IM EFFECTS take up to 3 minutes onset and the duration is 10 to 30 minutes.
