NCTI- Pharmacology- Drug List J

  1. Terbutaline
    trade name
  2. Terbutaline
    • Sympathomimetic Bronchodilator
    • Tocolytic (in preterm labor)
  3. Terbutaline
    mechanism of action
    • 1. Relaxes bronchial smooth muscle causing bronchodilation
    • 2. Relaxes uterine smooth muscle inhibiting contractions
  4. Terbutaline
    • 1. Moderate to severe asthma
    • 2. Bronchospasms associated with COPD
    • 3. Secondary to Magnesium Sulfate in preterm labor to inhibit contractions
  5. Terbutaline
    Uncontrolled tachydysrythmias
  6. Terbutaline
    side effects
    • Cardiovascular: palpitations, tachycardia, dysrhythmias, hypertension, PVCs
    • Respiratory: paradoxical bronchospasm
  7. Terbutaline
    Use with cautions in patients with cardiac disease
  8. Terbutaline
    • 1. Beta Blockers will decrease the actions
    • 2. MAO inhibitors may cause hypertensive crisis
  9. Terbutaline
    SQ, IV, IO, IVPB
  10. Terbutaline
    onset and duration
    Onset is immediate and may last 15 minutes
  11. Terbutaline
    • 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.
  12. Terbutaline
  13. Fentanyl
    trade name
  14. Fentanyl
    narcotic analgesic
  15. Fentanyl
    mechanism of action
    Provides analgesia and sedation by acting on the opiate receptors in the brain, blocking sensation of pain.
  16. Fentanyl
    • 1. sedation during rapid sequence intubation
    • 2. control severe pain
  17. Fentanyl
    • 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
  18. Fentanyl
    side effects
    • 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
  19. Fentanyl
    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.
  20. Fentanyl
    Alcohol and other CNS depressants potentiate effects of fentanyl; MAO inhibitors may precipitate hypertensive crisis.
  21. Fentanyl
    IV, IO, IM (also found in home medication form in the transdermal patch)
  22. Fentanyl
    onset and duration
    Onset is immediate; peak effect in 3-5 min IV, 5-15 IM; duration is 30-60 minutes (or hours with transdermal patch).
  23. Fentanyl
    • Adult: 25-100 mcg SLOW IV push (over 2-3 minutes)
    • Pediatric (child > 2 years): 2.0 mcg/kg SLOW IV push or IM
  24. Fentanyl
    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).
  25. Lorazepam
    trade name
  26. Lorazepam
    • Benzodiazepine
    • Sedative
    • Anti-anxiety (anxiolytic)
  27. Lorazepam
    mechanism of action
    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.
  28. Lorazepam
    • 1. status epilepticus
    • 2. sedation prior to cardioversion/pacing
    • 3. anxiety
  29. Lorazepam
    • 1. pregnancy or nursing mothers
    • 2. Use with caution in shock, coma, acute alcohol intoxication, suicidal patients and those with depressed respirations.
  30. Lorazepam
    side effects
    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
  31. Lorazepam
    Use further care when administering Ativan to patients with renal or hepatic impairment; the elderly or debilitated; and those with psychosis
  32. Lorazepam
    Alcohol, CNS depressants, and anticonvulsants may potentiate CNS depression; may also increase Dilantin levels; and smoking decreases sedative and anti-anxiety effects.
  33. Lorazepam
    IV, IO, IM, PR
  34. Lorazepam
    onset and duration
    Onset is 1-5 min IV, 15-30 min IM; peak effects in 15-20 mins IV, 2 hrs IM; duration 6-8 hours.
  35. Lorazepam
    • 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
  36. Lorazepam
    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
  37. Haloperidol
  38. Haloperidol
    trade name
    • antipsychotic
    • tranquilizer
  39. Haloperidol
    mechanism of action
    • 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
  40. Haloperidol
    • 1. acute psychotic disorders/episodes
    • 2. delirium
  41. Haloperidol
    • 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
  42. Haloperidol
    side effects
    • 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
  43. Haloperidol
  44. Haloperidol
    Use with caution in elderly or debilitated patients or those with severe Cardiovascular disorders.
  45. Haloperidol
    CNS depressants, opiates and alcohol may increase CNS depression, may also antagonize oral anti-coagulants
  46. Haloperidol
    IM, PO (in inpatient care settings)
  47. Haloperidol
    onset and duration
    Onset in 10-45 minutes; peak effect in 10-20 min, can last up to 36 hours.
  48. Haloperidol
    • Adult: 2-5 mg IM
    • Pediatric: 0.05-0.15 mg/kg/day PO typically divided into 2 or 3 doses
  49. Hydromorphone Hydrochloride
    trade name
  50. Hydromorphone Hydrochloride
    Narcotic Analgesic
  51. Hydromorphone Hydrochloride
    mechanism of action
    • 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.
  52. Hydromorphone Hydrochloride
    • 1. moderate to severe pain
    • 2. persistent cough
  53. Hydromorphone Hydrochloride
    • 1. increased intracranial pressure
    • 2. respiratory depression / inadequacy – such as in COPD, status asthmaticus
    • 3. circulatory compromise
  54. Hydromorphone Hydrochloride
    side effects
    • CNS: sedation, dizziness, lightheadedness, somnolence, blurred vision, nystagmus
    • Cardiovascular: hypotension, bradycardia
    • Respiratory: respiratory depression or arrest, bronchospasm
    • GI: nausea / vomiting, constipation
  55. Hydromorphone Hydrochloride
    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.
  56. Hydromorphone Hydrochloride
    Other CNS depressants, general anesthetics, MAO inhibitors, other opioid analgesics, sedatives, tranquilizers, and tricyclic antidepressants may potentiate the effects of Dilaudid.
  57. Hydromorphone Hydrochloride
    IV, IO, IM, SQ, PR and PO
  58. Hydromorphone Hydrochloride
    onset and duration
    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.
  59. Hydromorphone Hydrochloride
    • 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
  60. Hydromorphone Hydrochloride
    Often used in the clinical internship setting.
Card Set
NCTI- Pharmacology- Drug List J
NCTI- Pharmacology- Drug List J