NCTI- Pharmacology- Drug List C

  1. Mannitol
    trade name
  2. Mannitol
    osmotic diuretic
  3. Mannitol
    mechanism of action
    • Inhibits sodium and water absorption in the kidneys
    • Promotes fluid movement from the intracellular into the extracellular space
    • Dehydrates brain tissue to decrease ICP
  4. Mannitol
    • Acute cerebral edema
    • Blood transfusion reactions
  5. Mannitol
    • Acute pulmonary edema
    • Severe pulmonary congestion
    • Hypovolemia
  6. Mannitol
    side effects
    • Cardiovascular: chest pain
    • Neurological: mental status change
  7. Mannitol
    • 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
  8. Mannitol
    Should not be administered during blood transfusions
  9. Mannitol
    IV, IO, IVPB
  10. Mannitol
    onset and duration
    Onset in 15 minutes to reduce ICP, 1-3 hours for diuresis; may last 3-8 hours
  11. Mannitol
    • Adult: 1.5 – 2 gm/kg slow IVPB/IV
    • Pediatric: 0.25 – 0.5 gm/kg over 60 minutes
  12. Mannitol
  13. Dopamine
    trade name
  14. Dopamine
    • Sympathomimetic
    • Catecholamine
    • Vasopressor
  15. Dopamine
    mechanism of action
    • 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
  16. Dopamine
    • Cardiogenic shock
    • Distributive shock after fluids
    • Hemodynamically significant hypotension
    • Symptomatic bradycardia (second line drug)
  17. Dopamine
    • Hypovolemia
    • Tachydysrhythmias
  18. Dopamine
    side effects
    • Cardiovascular: tachycardia, hypertension/hypotension, chest pain, ventricular irritability
    • Respiratory: dyspnea
  19. Dopamine
    • 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)
  20. Dopamine
    • 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)
  21. Dopamine
  22. Dopamine
    onset and duration
    Onset in 5 minutes and will last 3-5 minutes
  23. Dopamine
    • 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
  24. Dopamine
    • 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
  25. Sodium Bicarbonate
    trade name
  26. Sodium Bicarbonate
    Alkalinizing Agent
  27. Sodium Bicarbonate
    mechanism of action
    • Increases blood pH by neutralizing excess buildup of acids
    • Decreases precipitation of myoglobin in renal tubules
  28. Sodium Bicarbonate
    • 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
  29. Sodium Bicarbonate
  30. Sodium Bicarbonate
    side effects
    • Neurological: headache, confusion, tetany (intermittent tonic spasms), seizures
    • Respiratory: pulmonary edema
    • Other: metabolic alkalosis, hypokalemia, hypocalcemia, tissue acidosis
  31. Sodium Bicarbonate
    • Use with caution in patients with CHF
    • Administer for crush syndrome prior to removal of entrapped patient
  32. Sodium Bicarbonate
    Flush IV before and after administration as it will precipitate with calcium chloride and inactivates catecholamines
  33. Sodium Bicarbonate
    IV, IO
  34. Sodium Bicarbonate
    onset and duration
    Onset is immediate and may last 1-2 hours
  35. Sodium Bicarbonate
    • Adult: 1 mEq/kg IV/IO
    • Pediatric: 1 mEq/kg IV/IO
  36. Sodium Bicarbonate
    Verify IV patency before administration as it will cause tissue necrosis
  37. Calcium Chloride
    trade name
  38. Calcium Chloride
  39. Calcium Chloride
    mechanism of action
    • 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
  40. Calcium Chloride
    • Calcium Channel Blocker or Beta blocker overdose
    • Acute hyperkalemia or cardiac arrest when hyperkalemia is suspected
    • Hypocalcemia
    • Suspected hypermagnesemia
  41. Calcium Chloride
    • Digitalis toxicity
    • Hypercalcemia
    • Ventricular fibrillation
  42. Calcium Chloride
    side effects
    • Cardiovascular: hypotension, dysrhythmias, cardiac arrest
    • Neurological: syncope, tingling sensations
    • Gastrointestinal: metallic taste
    • Other: sense of heat waves, necrosis/cellulitis upon infiltration of IV
  43. Calcium Chloride
    • 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.
  44. Calcium Chloride
    • Do not mix with sodium bicarbonate (forms precipitate crystals in blood)
    • Potentiates the effects of digitalis
    • Antagonizes the effects of calcium channel blockers
  45. Calcium Chloride
    IV, IO push
  46. Calcium Chloride
    onset and duration
    Onset is immediate with an unknown duration
  47. Calcium Chloride
    • 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
  48. Calcium Chloride
    Always flush IV after administration of any drug, in particular those that could form a precipitate like sodium bicarbonate.
  49. Insulin
    trade name
    • NPH
    • Humulin
    • Novolin
  50. Insulin
  51. Insulin
    mechanism of action
    • Necessary for carrier mediated transport of glucose into body’s cells
    • Promotes conversion of glucose to glycogen to lower blood glucose levels
  52. Insulin
  53. Insulin
  54. Insulin
    side effects
    Neuological: hypoglycemia
  55. Insulin
  56. Insulin
    beta blockers amy mask certain signs of hypoglycemia
  57. Insulin
    IVPB, SQ
  58. Insulin
    onset and duration
    Onset in 30 minutes to 1 hour and may last 2-3 hours
  59. Insulin
    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
  60. Insulin
    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
  61. Lidocaine Hydrochloride
    trade name
    • Xylocaine
    • Xylocard
  62. Lidocaine Hydrochloride
    • Antidysrhythmic Agent
    • Local Anesthetic
  63. Lidocaine Hydrochloride
    mechanism of action
    • Suppresses ventricular ectopy
    • Increases ventricular fibrillation threshold
    • Decreases speed of electrical impulse through the conduction system
  64. Lidocaine Hydrochloride
    • 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
  65. Lidocaine Hydrochloride
    • Second degree heart block, Mobitz II
    • Third degree heart block
    • Junctional bradycardia
    • Ventricular ectopy associated with bradycardia
    • Idioventricular rhythm
  66. Lidocaine Hydrochloride
    side effects
    • Cardiovascular: bradycardia, hypotension, arrest
    • Neurological: paresthesia, disorientation, slurred speech, seizures, lightheadedness, muscle twitching, tinnitis, blurred vision
    • Respiratory: dyspnea, depression, apnea
  67. Lidocaine Hydrochloride
    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
  68. Lidocaine Hydrochloride
    • Increased effects in patients taking beta blockers, cimetidine (Tagamet), quinidine, and phenytoin (Dilantin)
    • Decreases effects when mixed with barbiturates
  69. Lidocaine Hydrochloride
  70. Lidocaine Hydrochloride
    onset and duration
    Onset in 1-3 minutes and may last 10-20 minutes
  71. Lidocaine Hydrochloride
    • 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
  72. Lidocaine Hydrochloride
    Signs of Lidocaine Toxicity: vision disturbances (blurred or double vision), tinnitus, trembling, dyspnea, dizziness/syncope, seizures, chest pain, palpitations and bradycardic dysrhythmias
Card Set
NCTI- Pharmacology- Drug List C
NCTI- Pharmacology- Drug List C