NCTI- Pharmacology- Drug List C

Osmitrol

osmotic diuretic

• Inhibits sodium and water absorption in the kidneys
• Promotes fluid movement from the intracellular into the extracellular space
• Dehydrates brain tissue to decrease ICP

• Acute cerebral edema
• Blood transfusion reactions

• Acute pulmonary edema
• Severe pulmonary congestion
• Hypovolemia

• Cardiovascular: chest pain
• Neurological: mental status change

• May cause transient increase in intravascular volume
• May cause CHF
• May cause sodium depletion (hyponatremia)
• Will crystallize in low temperatures
• Should be used with in-line filters

Should not be administered during blood transfusions

IV, IO, IVPB

Onset in 15 minutes to reduce ICP, 1-3 hours for diuresis; may last 3-8 hours

• Adult: 1.5 – 2 gm/kg slow IVPB/IV
• Pediatric: 0.25 – 0.5 gm/kg over 60 minutes

none

Intropin

• Sympathomimetic
• Catecholamine
• Vasopressor

• Low Dose or Renal/Mesenteric Dose (1-5 mcg/kg/min):
• Dilates renal and mesenteric arteries by stimulating dopaminergic receptors
• May decrease blood pressure due to vasodilation
• Increases urinary output

• Moderate Dose or Inotropic Dose (5-10 mcg/kg/min):
• Increases inotropy without increasing chronotropy
• Increases blood pressure by stimulating the beta1 receptors

• High Dose or Vasopressor Dose (10-20 mcg/kg/min):
• Causes vasoconstriction
• Increase inotropy and chronotropy
• Increases blood pressure by stimulating the alpha and beta1 receptors

• Cardiogenic shock
• Distributive shock after fluids
• Hemodynamically significant hypotension
• Symptomatic bradycardia (second line drug)

• Hypovolemia
• Tachydysrhythmias

• Cardiovascular: tachycardia, hypertension/hypotension, chest pain, ventricular irritability
• Respiratory: dyspnea

• Cannulate largest vein possible and ensure IV patency (necrotic)
• Start a second IV line if additional medications are needed (Dopamine infusion should not be interrupted to ensure adequate therapeutic blood levels)

• Flush tubing before and after administration of Sodium Bicarbonate as Dopamine will be inactivated by the change in pH
• Actions may be intensified if patient is also taking antidepressants
• May cause hypotension if patient taking phenytoin (Dilantin)

IVPB

Onset in 5 minutes and will last 3-5 minutes

• Adult: Add 400 mg into 250 ml Normal Saline solution (creating1600 mcg/ml solution)
• Low dose: 1-5 mcg/kg/min
• Moderate dose: 5-10 mcg/kg/min
• High dose: 10-20 mcg/kg/min

• Pediatric: Add 400 mg into 250 ml Normal Saline solution (creating1600 mcg/ml solution)
• Low dose: 1-5 mcg/kg/min
• Moderate dose: 5-10 mcg/kg/min
• High dose: 10-20 mcg/kg/min

• Flow rate determines which receptor sites are stimulated and results in a graded response
• Frequent vital signs are required for all patients with a Dopamine infusion
• Once appropriate blood pressure is achieved, infusion may need to be slowed but should not be stopped

NaHCO3

Alkalinizing Agent

• Increases blood pH by neutralizing excess buildup of acids
• Decreases precipitation of myoglobin in renal tubules

• Cardiopulmonary Arrest with:
• unsuccessful drug therapy and defibrillation
• suspected tricyclic overdose (acidosis)
• suspected hyperkalemia (elevated potassium in dialysis patients)

Crush syndrome or crush injury greater than 4 hours

none

• Neurological: headache, confusion, tetany (intermittent tonic spasms), seizures
• Respiratory: pulmonary edema
• Other: metabolic alkalosis, hypokalemia, hypocalcemia, tissue acidosis

• Use with caution in patients with CHF
• Administer for crush syndrome prior to removal of entrapped patient

Flush IV before and after administration as it will precipitate with calcium chloride and inactivates catecholamines

IV, IO

Onset is immediate and may last 1-2 hours

• Adult: 1 mEq/kg IV/IO
• Pediatric: 1 mEq/kg IV/IO

Verify IV patency before administration as it will cause tissue necrosis

none

electrolyte

• Necessary for the proper function of the nervous, muscular, skeletal, digestive and endocrine systems
• Positive inotropic activity increases the strength of the myocardial contractions
• increases ventricular automaticity

• Calcium Channel Blocker or Beta blocker overdose
• Acute hyperkalemia or cardiac arrest when hyperkalemia is suspected
• Hypocalcemia
• Suspected hypermagnesemia

• Digitalis toxicity
• Hypercalcemia
• Ventricular fibrillation

• Cardiovascular: hypotension, dysrhythmias, cardiac arrest
• Neurological: syncope, tingling sensations
• Gastrointestinal: metallic taste
• Other: sense of heat waves, necrosis/cellulitis upon infiltration of IV

• Use with caution in patients with renal insufficiency or history of cardiac disease
• May cause cerebral or coronary vasospasm
• Can cause bradycardia if administration is too rapid
• Safe use in children, pregnant mothers or nursing mothers has not been established.

• Do not mix with sodium bicarbonate (forms precipitate crystals in blood)
• Potentiates the effects of digitalis
• Antagonizes the effects of calcium channel blockers

IV, IO push

Onset is immediate with an unknown duration

• Adult:
• Known or suspected hyperkalemia or Beta Blocker OD: 500-1000 mg slow IV/IO (may repeat in10 minutes). Max single dose 1 gram
• Calcium channel blocker (prophylaxis):2-4 mg/kg

Pediatric: 20 mg/kg (0.2ml/kg) slow IV/IO

Riverside County: not included in the Riverside County protocol

Always flush IV after administration of any drug, in particular those that could form a precipitate like sodium bicarbonate.

• NPH
• Humulin
• Novolin

hormone

• Necessary for carrier mediated transport of glucose into body’s cells
• Promotes conversion of glucose to glycogen to lower blood glucose levels

hyperglycemia

none

Neuological: hypoglycemia

none

beta blockers amy mask certain signs of hypoglycemia

IVPB, SQ

Onset in 30 minutes to 1 hour and may last 2-3 hours

Adult: 10-25 units infused at a rate of 0.1 U/kg/hr

Pediatric: 10-25 units infused at a rate of 0.1 U/kg/hr

Riverside County: not included in the Riverside County protocol

Obtain blood glucose level prior to administering. Insulin must be refrigerated if kept for greater than one month so when checking for home medications, check in the refrigerator as well

• Xylocaine
• Xylocard

• Antidysrhythmic Agent
• Local Anesthetic

• Suppresses ventricular ectopy
• Increases ventricular fibrillation threshold
• Decreases speed of electrical impulse through the conduction system

• Ventricular dysrhythmias: symptomatic PVCs and VTach
• Cardiac arrest: VFib/pulseless VTach
• Post conversion from a ventricular dysrhythmia (with pulses or pulseless) into a perfusing rhythm

• Second degree heart block, Mobitz II
• Third degree heart block
• Junctional bradycardia
• Ventricular ectopy associated with bradycardia
• Idioventricular rhythm

• Cardiovascular: bradycardia, hypotension, arrest
• Neurological: paresthesia, disorientation, slurred speech, seizures, lightheadedness, muscle twitching, tinnitis, blurred vision
• Respiratory: dyspnea, depression, apnea

Due to reduced ability to excrete the drug and the resulting accumulation of the drug in the body, reduce dose in: suspected liver disease, suspected kidney disease, cardiogenic shock, pulmonary edema and the elderly

• Increased effects in patients taking beta blockers, cimetidine (Tagamet), quinidine, and phenytoin (Dilantin)
• Decreases effects when mixed with barbiturates

IVP, IO, IVPB, ET

Onset in 1-3 minutes and may last 10-20 minutes

• Adult:
• VFib/Pulseless VTach: 1.0-1.5 mg/kg slow IVP/IO (over 1 minute) or 3 mg/kg ET. May repeat 1.5 mg/kg IVP/IO once (no repeat for ET). Maximum dose of 3 mg/kg

Ventricular Ectopy/Post Conversion:1 mg/kg slow IVP/IO (50 mg/minute) or 2 mg/kg ET. May repeat 0.5 mg/kg slow IVP/IO (50 mg/minute) every 5-10 minutes to a maximum of 3 mg/kg. May repeat 1 mg/kg ET once

• Pediatric:
• VFib/Pulseless VTach:1 mg/kg slow IVP/IO (over 1 minute) or 2 mg/kg ET. May repeat 1 mg/kg IVP/IO every 3-5 minutes or 1 mg/kg ET. Maximum dose of 3 mg/kg

Ventricular Ectopy/Post Conversion:1 mg/kg slow IVP/IO (50 mg/minute) or 2 mg/kg ET. May repeat 1 mg/kg slow IVP/IO (50 mg/minute) or 1 mg/kg ET Maximum dose of 3 mg/kg

Signs of Lidocaine Toxicity: vision disturbances (blurred or double vision), tinnitus, trembling, dyspnea, dizziness/syncope, seizures, chest pain, palpitations and bradycardic dysrhythmias