Quiz 6 Flashcards
Glucagon
Class: Pancreatic Hormone
Action: Stimulates breakdown of glycogen to glucose, resulting in BGL increase
Indications: Hypoglycemia (when IV access is not available), beta blocker overdose, calcium channel blocker overdose, esophageal obstruction
Contraindications: Hypersensitivity (usually to proteins)
Onset/Duration: Onset=10-20 mins IM (1 min IV); Duration=60-90 mins
Side Effects: Tachycardia, hypotension, nausea/vomiting, urticaria
Doses:
Adult=
(Hypoglycemia)0.5-1mg IM, may repeat in 10 mins if protocol allows
(Beta Blocker/Calcium Channel Blocker Overdose)3-10mg IV over 3-5 mins, followed by an infusion at 3-5mg/hr
Peds=
Used for peds>20kg at 0.5-1mg IM
Special Notes: If pt is malnourished, glucagon may not work
Ketamine
Class: Nonbarbituate Anesthetic
Action: Acts on limbic system and cortex to block afferent transmission of impulses associated w/ pain perception. Produces short-acting amnesia w/o muscular relaxation.
Indications: Pain control and sometimes as an adjunct to nitrous oxide
Contraindications: Stroke, increased ICP, severe hypertension, cardiac instability
Onset/Duration: Onset= 30 secs; Duration= 5-10 mins
Side Effects: Hypertension, increased heart rate, hallucinations, delusions, explicit dreams, respiratory depression
Doses:
Adult= 1-2mg/kg IV over 1 min or 4-5mg/kg IM
Pedi (>2y/o)= 1-2mg/kg IV over 1 min or 3-5mg/kg IM
Lidocaine (Xylocaine)
Class: Class 1B Antidysrhythmic
Action: Sodium channel blocker acts primarily on the ventricles of the heart during phase 4 diastolic depolarization (which decreases automaticity), suppresses premature ventricular complexes, and raises the V-Fib threshold
Indications: Significant ventricular ectopy w/ ischemia/MI, pulseless V-tach or V-Fib, cardiac arrest, stable V-Tach w/ a pulse
Contraindications: Hypersensitivity, prophylactic use in an acute MI, 2nd or 3rd degree heart block in the absence of a pacemaker, Stokes-Adams syndrome
Onset/Duration: Onset= 30-90 secs; Duration= 10-20 mins
Side Effects: Blurred vision, dizziness, hypotension, bradycardia, seizures, altered LOC
Doses:
Adult=
(Cardiac Arrest)- 1-1.5mg/kg IV/IO bolus, may be repeated 5-10 mins w/ a total of 3mg/kg. Bolus is followed by a maintenance infusion drip of 1-4mg/min post-cardiac arrest.
(PVC’s or V-Tach w/ a Pulse)- 0.5-0.75mg/kg IV/IO up to 1-1.5mg/kg IV/IO, and may be repeated w/ total max does of 3mg/kg.
Pedi=
(Cardiac Arrest)- 1mg/kg IV/IO bolus followed by maintenance infusion drip of 20-50mcg/kg/min IV/IO post-cardiac arrest
(PVC’s or V-Tach w/ a Pulse)- 1mg/kg IV/IO
Special Notes: Use caution in pt’s w/ impaired renal/liver function and elderly. Potentially half dose initially for pt’s over 70 y/o.
Magnesium Sulfate
Class: Electrolyte, Anticonvulsant
Action: Reduces striated muscle contractions and blocks peripheral neuromuscular transmission by reducing Acetylcholine release at the myoneural junction
Indications: Seizures due to eclampsia (after seizure activity has stopped), tornadoes de pointes, unstable V-Tach (attributed to digitalis toxicity), hypomagnesemia, status asthmaticus (not responsive to beta-adrenergic drugs)
Contraindications: Any heart block or myocardial damage, hypotension
Onset/Duration: Onset= Immediate; Duration= 30 mins (IV)
Side Effects: Hypotension, facial flushing, hyporeflexia (decreased reflexes), bradycardia, respiratory depression, diaphoresis
Doses:
Adult=
Pulseless arrest (hypomagnesemia and torsades de pointes) and status asthmaticus- 1-2g IV/IO diluted in 10ml D5W
Torsades de pointes or hypomagnesemia WITH A PULSE- 1-2g in 100ml D5W over 5-60mins IV
Eclampsia- 1-4g IV w/ a max dose of 30-40g/day
Special Notes: If overdose is suspected you may give calcium chloride or calcium gluconate to reverse effects
Versed (Midazolam)
Class: Benzodiazepine
Action: Increases the activity of GABA which produces a sedative effect, relaxes skeletal muscles, and induces sleep. Includes amnesic properties.
Indications: Seizures, anxiety, premedication for intubation, cardioversion, or conscious sedation procedures
Contraindications: Hypersensitivity, hypotension, respiratory depression, alcohol intoxication, depressed vital signs, use of any CNS depressants (including barbiturates, alcohol, narcotics)
Onset/Duration: Onset= 1-3 mins IV; Duration= 2-6 hrs IV
Side Effects: Hypotension, respiratory depression or arrest, CNS depression, hiccups, over sedation, blurred vision
Doses:
Adult= 2-5mg IV over 1-2mins or 0.07mg/kg IM w/ a max of 7mg
Pedi= 0.1-0.2mg/kg IV over 1-2mins (or IM if needed) w/ a max of 5mg
Special Notes: May be given IM since it’s water-based
