Week 10 Drugs (Etomidate, Glucagon, Glucose, Ipratropium, Ketamine, Lorazepam) Flashcards
Etomidate
Pharmacology & Actions
- Sedative and Hypnotic
- Depresses activity of brain stem reticular activating system
- No analgesic properties
Etomidate
Indications
- Induction of anesthesia for Rapid Sequence Intubation (RSI)
Etomidate
Absolute Contraindications
- Known Hypersensitivity
- Etomidate Allergy
Etomidate
Precautions & Side Effects
- Not intended for prolonged infusion due to suppression of cortisol and aldosterone production
Etomidate
Aministration
Route: IV
Onset: 10-20 seconds
Peak Effect: < 1 min
Duration: 3-5 mins
Etomidate
Dosage
(For ages greater than or equal to 15 yo)
0.3mg/kg given as single push dose
Glucagon
Pharmacology & Actions
- Increase serum glucose by releases glycogen from liver
- Glucagon will only work if there are glycogen stores in liver, will not work with malnourished pt
- Counteracts effects of beta blocker or calcium channel blocker overdose
Glucagon
Indications
- Hypoglycemia
- Symptomatic bradycardia from beta blocker or calcium channel blocker overdose
Glucagon
Absolute Contraindications
- Glucagon in not first line for treatment of hypoglycemia and should ONLY be used if unable to obtain IV access
- Glucagon Allergy
Glucagon
Precautions & Side Effects
- May cause nausea and vomiting
- Slower onset than IV dextrose
Glucagon
Administration
Route: IM
Onset: 5-20 mins
Peak Effect: 30 mins
Duration: 1-2 hours
Glucagon
Dose
Adult:
- 1 mg IM/IN
Pediatric:
- 0.5 mg IM/IN if < 20 kg or < 5 YO
- 1 mg IM/IN if > 20 kg or > 5 YO
Glucose
Pharmacology and Actions
- Monosaccharide carbohydrate
- After absorption in GI tract, glucose is distributed in the tissues and promptly increases circulating blood sugar
Glucose
Indications
- Hypoglycemia
Glucose
Absolute Contraindications
- Glucose Allergy
Glucose
Precautions & Side Effects
- Altered LOC
- Ascertain the pt’s ability to swallow oral glucose w/out airway compromise
- Must be swallowed, not absorbed sublingually or buccally
Glucose
Administration
Route: PO
Onset: 10 mins
Peak Effect: variable
Duration: variable
Glucose
Dose
For Adults with glucose < 60 mg/dL:
- 15-25g PO
For Pediatrics with glucose < 60 mg/dL (0-1 month < 40):
- 0.5-1g/kg PO, max dose 25g
Ipratropium Bromide (Atrovent)
Pharmacology & Actions
- Antagonizes action of acetylcholine on bronchial smooth muscle in the lungs
- Causes bronchodilation
Ipratropium Bromide (Atrovent)
Indications
- Bronchoconstriction
- May be given with albuterol
Ipratropium Bromide (Atrovent)
Absolute Contraindications
- Allergy
Ipratropium Bromide (Atrovent)
Precautions & Side Effects
- Use with caution in pts w/ narrow angle glaucoma
- Side effects may include palpitations, dizziness, anxiety, headache, eye pain, urinary retention
Ipratropium Bromide (Atrovent)
Administration
Route: SVN
Onset: 5 - 15 mins
Peak Effect: 1.5 - 2 hours
Duration: 4 - 6 hours
Ipratropium Bromide (Atrovent)
Dose
Adults & Pediatrics > 2 YO:
- 0.5 mg nebulized with albuterol (may repeat 2x)
Ketamine
Pharmacology & Actions
- Non-competitive NMDA receptor antagonist
- Functions as dissociative, amnestic, analgesic and anesthetic agent
Ketamine
Indications
- Excited Delirium
- Induction agent for intubation
- Pain control
Ketamine
Absolute Contraindications
- Angina
- CHF
- Pregnancy
- Allergy
Ketamine
Precautions & Side Effects
- Transient periods of apnea occur with rapid IV infusion
- May cause laryngospasm, hypersalivation, increased airway secretions, emergence reactions and nystagmus
- Use w/ caution in pts w/ schizophrenia
Ketamine
Administration
Route: IV / IM
Onset: < 1 min / 3-4 min
Peak Effect: 30 secs - 5 min / 3-12 min
Duration: 10-45 min / 25-60 min
Ketamine
Dose
RSI
- 1.5 mg/kg push, max 150mg
Agitated or Violent Patient:
- 4 mg/kg IM/IN max 250mg per admin (may repeat x1)
Pain Management:
- 0.25 mg/kg max 25mg per push (max total 100mg)
Lorazepam (Ativan)
Pharmacology & Actions
- Benzodiazepine that functions as a CNS depressant, anticonvulsant and sedative
Lorazepam (Ativan)
Indications
- Seizures
- Sedation
- Agitation/excited delerium
- Uncontrolled shivering in hypothermia
Lorazepam (Ativan)
Absolute Contraindications
- Neurologic or respiratory depression
- Acute angle glaucoma
- Allergy
Lorazepam (Ativan)
Precautions & Side Effects
- Respiratory depression and/or hypotension can occur, pt should be monitored closely
- Most likely to produce respiratory depression in pt who took other depressants (alcohol and barbiturates) or when given rapidly
- Elderly pt may have more profound respiratory and/or CNS depression, half dose should be administered
Lorazepam (Ativan)
Administration
Route: IV / IM
Onset: 1-2 min / 15-30 min
Peak Effect: <15 min / 2-3 hr
Duration: 6-8 hr / 6-8 hr
Lorazepam (Ativan)
Dose
Seizure:
- A + P: 0.1 mg/kg IV/IO, admin slowly over 2 mins (max single dose 4mg)
Agitation:
- A: 2-4 mg IM (may repeat once after 15 min) 2 mg IV/IO (max 4mg). Max total dose 4mg
- P: 0.05 mg/kg IV/IO, max 2mg IV and 4mg IM
Bradycardia:
- A: 1 mg IV/IO every 5-10 min, max 4mg
- P: 0.1 mg/kg IV/IO every 10 min, max 4mg
Hyperthermia:
- A: 1 mg IV/IO or 2 mg IM
- P: 0.1 mg/kg IV/IO/IM max dose 1 mg
RSI:
A > 15: 1-2 mg IV/IO, repeat every 5-10 min