NCTI- Pharmacology- Drug List J

Brethine

• Sympathomimetic Bronchodilator
• Tocolytic (in preterm labor)

• 1. Relaxes bronchial smooth muscle causing bronchodilation
• 2. Relaxes uterine smooth muscle inhibiting contractions

• 1. Moderate to severe asthma
• 2. Bronchospasms associated with COPD
• 3. Secondary to Magnesium Sulfate in preterm labor to inhibit contractions

Uncontrolled tachydysrythmias

• Cardiovascular: palpitations, tachycardia, dysrhythmias, hypertension, PVCs
• Respiratory: paradoxical bronchospasm

Use with cautions in patients with cardiac disease

• 1. Beta Blockers will decrease the actions
• 2. MAO inhibitors may cause hypertensive crisis

SQ, IV, IO, IVPB

Onset is immediate and may last 15 minutes

• Adult:
• Bronchodilation: 0.25 mg SQ. May repeat once in 15-30 minutes
• Tocolytic: 10 mcg/min IV/IVPB titrated to a max of 80 mcg/min

Pediatric: 0.01 mg/kg SQ. Maximum dosage is 0.25 mg.

none

Sublimaze

narcotic analgesic

Provides analgesia and sedation by acting on the opiate receptors in the brain, blocking sensation of pain.

• 1. sedation during rapid sequence intubation
• 2. control severe pain

• 1. patients who have received MAO inhibitors in the last 14 days
• 2. myasthenia gravis
• 3. safe use in pregnancy and in children < 2 years old not established

• CNS: sedation, euphoria, dizziness, diaphoresis, seizures with high doses, delirium
• Cardiovascular: hypotension, bradycardia, circulatory depression, cardiac arrest
• Respiratory: respiratory depression or arrest, bronchoconstriction, laryngospasm
• GI: nausea/vomiting, constipation

Use with caution in head injuries, suspected or known increased intracranial pressure; the elderly, debilitated or immuno-compromised patients; COPD or other respiratory problems and those with kidney or liver dysfunction.

Alcohol and other CNS depressants potentiate effects of fentanyl; MAO inhibitors may precipitate hypertensive crisis.

IV, IO, IM (also found in home medication form in the transdermal patch)

Onset is immediate; peak effect in 3-5 min IV, 5-15 IM; duration is 30-60 minutes (or hours with transdermal patch).

• Adult: 25-100 mcg SLOW IV push (over 2-3 minutes)
• Pediatric (child > 2 years): 2.0 mcg/kg SLOW IV push or IM

Fentanyl provides much faster acting, more prolonged pain relief. Duration of respiratory depressant effects may be significantly longer than analgesic effects – always have oxygen immediately available and be prepared with intubation equipment and a narcotic antagonist (i.e. naloxone).

Ativan

• Benzodiazepine
• Sedative
• Anti-anxiety (anxiolytic)

Most potent of all Benzodiazepines; its effects (anxiolytic, sedative, hypnotic, and skeletal muscle relaxant) are all mediated by increasing the levels of the inhibitory neurotransmitter GABA. GABA works mostly at the hypothalamus, limbic system and thalamus in the brain.

• 1. status epilepticus
• 2. sedation prior to cardioversion/pacing
• 3. anxiety

• 1. pregnancy or nursing mothers
• 2. Use with caution in shock, coma, acute alcohol intoxication, suicidal patients and those with depressed respirations.

CNS: Anterograde amnesia, drowsiness, sedation, dizziness/disorientation, confusion, Hallucinations (found frequently in elderly patients), restlessness

Cardiovascular: hypertension or hypotension

GI: nausea/vomiting, abdominal discomfort

Other: depressed hearing

Use further care when administering Ativan to patients with renal or hepatic impairment; the elderly or debilitated; and those with psychosis

Alcohol, CNS depressants, and anticonvulsants may potentiate CNS depression; may also increase Dilantin levels; and smoking decreases sedative and anti-anxiety effects.

IV, IO, IM, PR

Onset is 1-5 min IV, 15-30 min IM; peak effects in 15-20 mins IV, 2 hrs IM; duration 6-8 hours.

• Sedation for Cardioversion:
• Adult: 2-4 mg IM, or 0.5-2 mg IV
• Pediatric: 0.03 mg-0.05 mg/kg IV/IM/PR max dose of 4mg

• Seizure Management:
• Adult: 2 mg slow IV (1mg/min) – repeat half dose if needed in 2-5 mins
• Pediatric: 0.1 mg/kg slow IV (over 2-5 mins); repeat half dose if needed in 2-5 minutes (Can be given PR to children if no IV obtained)

Riverside County Protocol: Not in Riverside County Protocol

Keep benzodiazepine antagonist (i.e. Romazicon) nearby; patient over 50 years of age have frequent incidents of psychosis with Ativan administration do exceed 2 mg initial dose

Haldol

• antipsychotic
• tranquilizer

• 1. demonstrates anti-psychotic effects by blocking dopamine receptors in the brain (dopamine receptors are linked to mood and behavior)
• 2. exerts strong anti-emetic effects and impairs central thermoregulation

• 1. acute psychotic disorders/episodes
• 2. delirium

• 1. Parkinson’s Disease
• 2. seizure disorders
• 3. coma
• 4. alcoholism
• 5. ALOC
• 6. Safe use during pregnancy, in nursing mothers, and in children < 3 years has not been established

• CNS: Extrapyramidal reactions, dystonia, restlessness, reflexive anxiety, Combativeness (particularly in elderly patient administration)
• Cardiovascular: tachycardia, hypotension, ECG changes
• GI: dry mouth, constipation, diarrhea, N/V
• Respiratory: respiratory depression, bronchospasm

Use with caution in elderly or debilitated patients or those with severe Cardiovascular disorders.

CNS depressants, opiates and alcohol may increase CNS depression, may also antagonize oral anti-coagulants

IM, PO (in inpatient care settings)

Onset in 10-45 minutes; peak effect in 10-20 min, can last up to 36 hours.

• Adult: 2-5 mg IM
• Pediatric: 0.05-0.15 mg/kg/day PO typically divided into 2 or 3 doses

Dilaudid

Narcotic Analgesic

• 1. Binds with opiate receptors in brain, altering perception and emotional response to pain.
• 2. suppresses the cough reflex by direct action on the cough center in the medulla oblongata.

• 1. moderate to severe pain
• 2. persistent cough

• 1. increased intracranial pressure
• 2. respiratory depression / inadequacy – such as in COPD, status asthmaticus
• 3. circulatory compromise

• CNS: sedation, dizziness, lightheadedness, somnolence, blurred vision, nystagmus
• Cardiovascular: hypotension, bradycardia
• Respiratory: respiratory depression or arrest, bronchospasm
• GI: nausea / vomiting, constipation

Use with caution in head injuries; the elderly, debilitated or immuno-compromised patients; COPD or other respiratory problems and those with kidney or liver dysfunction.

Other CNS depressants, general anesthetics, MAO inhibitors, other opioid analgesics, sedatives, tranquilizers, and tricyclic antidepressants may potentiate the effects of Dilaudid.

IV, IO, IM, SQ, PR and PO

IV and IM administration most common in the hospital setting – IV: onset in 10-15 minutes, peaks in 15-30 minutes and lasts 2-3 hours. IM: onset in 15 minutes, peaks in 30-60 minutes, and lasts 4-5 hours.

• For Pain Control:
• Adults: 1-4 mg IM, SQ or SLOW IV push (over at least 2-5 minutes) every 4-6 hours
• Pediatrics: Rarely given for pain control – primarily for cough suppressant effects.

• For Cough:
• Adults and children > 12 years: 1 mg cough syrup PO every 3-4 hours
• Children ages 6-12 years: 0.5 mg of cough syrup every 3-4 hours

Often used in the clinical internship setting.