Week 13

Question 1

Bumetanide

Answer 1

Bumetanide Diuretic

Brand: Bumex

MOA: Potent loop diuretic w/ rapid onset & short duration. Inhibits reabsorption of sodium & chloride, enhances secretion of potassium

IND: Pulmonary edema induced hypervolemia, CHF

CON: hypersensitivity, anuria, electrolyte depletion, hypotension, Pnemonia

Adverse: dehydration, dizziness, nausea, hypokalemia, hypotension, hypochloremia, hyperuricemia, muscle cramping

Dose/Route: 0.5-1mg PO/IM/IV.IO
Pedi: NOPE

Special Notes: Preggo C, can cause profound diuresis, use caution w/ sulfa allergies, can be used in cases of Lasik allergies

Question 2

Acetylcysteine

Answer 2

Acetylcysteine Mucolytic

Brand: Mucomyst

MOA: protects liver against acetaminophen OD & loosens mucus viscosity

IND: Acetaminophen OD, asthmatic bronchitis, atelectasis, chronic bronchopulmonary disease (w/ abnormal mucus secretions [cystic fibrosis, etc.])

CON: hypersensitivity

Adverse: bronchospasm, nausea, vomiting, chest tightness, fever, runny nose

Dose/Route: 1-20mL of 10% solution every 1-6hr NEB
1-10mL of 20% solution every 1-6hr NEB
Pedi: SAME

Special Notes: Preggo B

Question 3

Activated Charcoal

Answer 3

Activated Charcoal Antidote/Absorbent

Brand: Actidose

MOA: Chemicals bind to surface & become trapped

IND: Oral poisoning

CON: ingestion of acid, alkaloid, ethanol, iron salts, lithium poisonings, AMS, GI obstruction

Adverse: nausea, vomiting, GI obstruction, hypotension, contripation, diarrhea, aspiration pneumonia

Dose/Route: 50-100g PO
Pedi: 1-2g/kg PO

Special Notes: Preggo C, if it burns on the way down it burns on the way down
Milk decreases ability to work

Question 4

Tricyclic Anti-Depressants

Answer 4

Tricyclic Anti-Depressants
MOA: Inhibits reuptake of norepi & serotonin in the CNS. Effect’s sodium flow in myocardium
Example: Amitriptoline

OD Signs & Symptoms (Adverse): AMS, seizure, coma, death, profound hypotension (caused by vasodilation), wide QRS, resting tachycardia, V-Tach, Torsades, and eventually V-fib arrest

Treatment: Consider RSI (in signs of severe toxicity)
Sodium Bicarb: 1meq/kg up to 50meq IV/IO
Versed(seizure) 1-2.5mg IV/IO
Pedi: 0.03-0.05mg/kg up to 0.4mg IV/IO
Magnesium(torsades): 5-10g at 1g/min IV/IO
Pedi: 25-50mg/kg over 2-5min IV/IO
Infusion: 2g/30-60minutes MAX

Special Notes: difficult to detect in field, PT decompensate RAPIDLY, O2/IV/MONITOR/ECG
TREAT EACH PRESENTATION