Week 1 Drugs

Question 0

Epinephrine pharmacology and action

Answer 0

Epinephrine is a naturally occurring catecholamine that increases heart rate, cardiac contractile force, myocardial electrical activity, systemic vascular resistance and systolic blood pressure. Epi decreases overall airway resistance and automaticity. It also, through bronchial artery construction may reduce pulmonary congestion and increase tidal volume and vital capacity.

Question 1

Epinephrine class

Answer 1

Sympathomimetic

Question 2

Epinephrine indications

Answer 2

To restore cardiac rhythms In a cardiac arrest event.
Allergic reaction/anaphylaxis
Bradycardia refractory to dopamine

Question 3

Epinephrine contraindications

Answer 3

None in the emergency setting
Hemorrhagic shock
Cardiogenic shock
Hypertension

Question 4

Epinephrine precautions and side effects

Answer 4

Weakness, headache/dizziness, syncope, hypertension, MI/CVA, tachycardia

Question 5

Epinephrine dosage

Answer 5

Cardiac arrest
1mg iv/io 1:10,000 (repeat every 3-5 min)
2-2.5mg ETT 1:10,000 (repeat every 3-5 min until vascular access is achieved
Allergic reactions/anaphylaxis
0.3-0.5mg 1:10,000 sc/im (repeat every 5-15 min PRN)
0.5-1.0mg 1:10,000 iv/io if sc/im dose ineffective
Bradycardia 2-10 mcg/min
Pediatric dosing
Cardiac arrest
0.01mg/kg iv/io repeat q3-5 minPRN
0.1mg/kg ETT repeat q 3-5 min until vascular access is achieved
Allergic reactions/anaphylaxis
0.01mg/kg 1:1000 sc/im repeat q 5-15 min PRN
0.01mg/kg 1:10,000 iv/io if sc/im ineffective repeat q3-5 min PRN

Question 6

Dextrose class

Answer 6

Carbohydrate

Question 7

Dextrose pharmacology and actions

Answer 7

Principal form of glucose used by the body to create energy.

Question 8

Dextrose indications

Answer 8

To increase the blood sugar in documented hypoglycemia

Question 9

Dextrose contraindications

Answer 9

None in documented hypoglycemia

Question 10

Dextrose precautions and side effects

Answer 10

Pain at the injection site
Necrosis
Hyperglycemia

Question 11

Dextrose dosage

Answer 11

Adult 
25g D50 iv/io/po
28 days to 8 years old 
0.5g/kg D25 iv/io/po
Neonate 
0.2g/kg D10 iv/io/po

Question 12

Atropine class

Answer 12

Parasympatholytic/anticholinergic

Question 13

Atropine pharmacology/actions

Answer 13

Atropine blocks the parasympathetic nervous system, specifically the vagal effects on the heart. It does not increase contractility but may increase myocardial oxygen demand. Decrease airway secretions.

Question 14

Atropine indications

Answer 14

(symptomatic) significant bradycardia

Organophosphate poisoning

Question 15

Atropine contraindications

Answer 15

None in the emergency setting

Question 16

Atropine precautions/side effects

Answer 16

Headache/dizziness
Aloc
Weakness
Hypertension/hypotension
A-fib/v-fib 
Increase the size of an MI

Question 17

Atropine dosage

Answer 17

Bradycardia
0.5 mg ivp/io (May repeat as needed every3-5 min to a max of 3.0mg
Pedi- 0.02 mg/kg (minimum single dose of 0.1 mg) iv/io
Organophosphate poisoning
2-5 mg iv/io/im (repeat as needed every 10-15 min)
Pedi- 0.05 mg/kg iv/io/im

Question 18

Oxygen class

Answer 18

Gas

Question 19

Oxygen pharmacology/actions

Answer 19

Enters the body via the respiratory system. Transported by gas to maintain aerobic cellular respiration.

Question 20

Oxygen indications

Answer 20

Management of any situation where hypoxia may be present.

Question 21

Oxygen contraindications

Answer 21

None in the emergency setting

Question 22

Oxygen precautions/side effects

Answer 22

Dry mucous membranes
Irritation of the upper respiratory tract
Decreased stimulus to breath in some co2 retaining copd patients

Question 23

Oxygen dosage

Answer 23

Hypoxia 100% by inhalation 
Nasal cannula 1-6 lpm
Simple mask 8-10 lpm
Non-rebreather mask 10-15 lpm
BVM 15+ lpm
CPAP 20+ lpm

Question 24

Lidocaine hydrochloride class

Answer 24

Antiarrhythmic, sodium channel blocker

Question 25

Lidocaine hydrochloride pharmacology/actions

Answer 25

• Depresses the automaticity of the purkinje fibers.
• Little antiarrhymic effects on atrial muscle at sub-toxic levels
• Cardiovascular effects- 1. decreased conduction rate and force of contraction, mainly at toxic levels. 2. Prolongs phase 4 depolarization and shortness action potential
• CNS stimulation- 1. Tremors, restlessness, convulsions followed by respiratory depression and respiratory failure at higher doses.
• Onset of action: less than 3 min

Question 26

Lidocaine hydrochloride indications

Answer 26

Ventricular tachycardia or wide-complex tachycardia with pulse
Recurrent or refractory ventricular fibrillation/pulse less v-tach
Following successful defibrillation
Pre- intubation in head injures (May minimize the rise in ICP associated with intubation)
Pre-treatment of localized pain caused by fluid boluses through an IO.

Question 27

Lidocaine hydrochloride contraindications

Answer 27

Not used for supraventricular rhythms or Bradycardia

Hypersensitivity to any of the “caines”

Question 28

Lidocaine hydrochloride precautions/side effects

Answer 28

CNS disturbances
Sleepiness, dizziness, disorientation, confusion, convulsions
Cardiovascular
Hypotension, bradycardia, decreased myocardial contractility and increased AV blocks at toxic levels only.

Question 29

Lidocaine hydrochloride dosage

Answer 29

Adult
1-1.5 mg/kg bolus; may repeat every 3-5 min at 0.5-0.75 mg/kg to a total dose of 3mg/kg. May the start continuos infusion of 1-4 mg/min use 4 mg/ml concentration for infusion
For endotracheal administration use 2-2.5 the loading dose followed by a 10ml ns flush
Pedi
1mg/kg bolus (not to exceed 100mg) May repeat at 0.5-1.0 mg/kg every 3-5 minutes as needed to total dose of 3 mg/kg. May then start continuous administration of 20-50 mcg/kg/min
For ETT use, increases loading dose by 2-3 times