1. Introduction to Seattle Fire’s Medications
Pharmacology
Introduction to Seattle Fire’s Medications

2. Route of Administration
How do you give the medication?
Where does it go?
What are the affector organs?

3. Routes of Administration
Oral
Sublingual
Inhalation
Transdermal / Topical
Rectal
Parenteral

4. Oral
ASA
Most drugs enter Portal circulation- “First Pass” metabolism

5. Sublingual Nitroglycerine
Oral admin: 90% of nitroglycerine is cleared with a single pass through the liver
Sublingual goes to systemic circulation directly
Rapid onset, low risk of infection, bypasses liver and harsh stomach acids

6. Inhalation MDI- Albuterol Administration to the site of action
Less systemic absorption
Rapid onset
Requires ventilation by the patient or us…

7. Topical / Transdermal ?? What meds ?? Slow onset of absorption
Affected by location and type of skin
What about heating pads?

8. Rectal ?? What Meds ?? Does not require an IV Rapid onset
50% of blood returns bypasses portal circulation
What does that mean?

9. Parenteral Intravenous (IV) Usually drugs that can’t be given IV
Can’t be absorbed or first pass destroys too much
Rapid onset and maximizes control over circulating levels
May cause-
Infection, hemolysis, too high of a serum level with too high of administration, too fast

10. Parenteral Intramuscular (IM) Drug absorption is slower
Allows for a sustained dose over an extended period of time
May cause
Pain with injection, tissue necrosis at site, infection, scar tissue deposition

11. Parenteral Subcutaneous (SC) Even slower drug absorption
Works when minute amounts of medication are needed to be delivered over a long period of time
Examples?

12. Adenosine- Antiarrhythimic
Mechanism of Action
Naturally occurring nucleoside
In the AV node it:
Decrease conduction velocity
Prolongs refractory period
Decreases automaticity
Dose
6mg then 12 mg
Adv Side Effects
Transient or possibly prolonged heart block
Onset / Duration
Immediate onset- duration 30 seconds

13. Adenosine- Antiarrhythmic
Concentration
6mg/2cc
Route
Rapid IVP, near central circulation
Indication
SVT
Contraindications
2nd, 3rd degree heart block
Persantine (dipyridamole USP) requires you to decrease the dose

14. Albuterol- Class Mechanism of Action
B2 agonist- stimulates bronchodilation of smooth muscle
Dose
1 puff every 30 seconds to affect
Adv Side Effects
Tachycardia, anxiety, HTN, convulsions
Onset / Duration
Onset min
Duration- 3-6 hrs

15. Albuterol- Class Concentration 17g / 200 puffs- 90mcg / puff Route
Metered dose inhalor
Indication
Acute bronchospasm (rescue inhaler)
Contraindications
Prior reactions or sensitivity to albuterol, tachycardias

16. Aminophylline- Methylxanthine Bronchodilator
Mechanism of Action
Increases intracellular cAMP (which increase catecholimine release and affect) and is a adenosine receptor antagonist (which then inhibits bronchospasm)
Dose
5-7mg/kg- at 25mg a minute
Adv Side Effects
Headache, nausea, chest pain, convulsions
Onset / Duration
Varies- 15 min

17. Aminophylline- Class Concentration 250mg / 10 mls Route IV infusion
Indication
Bronchospam, Asthma, COPD
Contraindications
HTN, Tachycardia,

18. Anectine- Class Mechanism of Action
Succinylcholine attaches to somatic muscle fiber receptor site depolarizing the junction. Unlike acetlycholine it is not broken down quickly so it remains antagonizing the receptor.
Dose
1.5mg / kg
Adv Side Effects
Paralysis but no sedation, hyperkalemia, malignant hyperthermia
Onset / Duration
Onset 30 sec to 1 min
Duration 3-5 min

19. Anectine- Class Concentration Route Indication RSI Contraindications
Patients at risk for hyperkalemia- Renal Failure/Dialysis, prolonged crush injuries, patients with history of milignant hyperthermia

20. ASA- Class History In 1980 alone 36,000 tons were consumed
Mechanism of Action
Platelet aggregate inhibitor by blocking Thromboxane A2
ACS:
New England Journal- “51% reduction in mortality” when used for patients with angina (N Engl J Med 1983; 309:396–403.)
Dose
324mg PO
Adv Side Effects
Onset / Duration

21. ASA- Class Concentration 81mg tablet Route Oral Indication ACS
Contraindications
Ulcers, bleeding, chickenpox- Reye’s syndrome

22. Atropine- Antimuscarinic Agent

23. Atropine- Antimuscarinic Agent
Mechanism of Action
Blocks the muscarinic receptor site preventing acetylcholine from stimulating it
Dose
Varies- 0.5 to 1mg with max dose 2mg in adults? Peds: 0.02mg/kg with minimum dose .1mg. Why?
Adv Side Effects
Drying of secretions, tachycardia, blurred vision
Onset / Duration
Onset 2-4 minutes
Duration 4 hours

24. Atropine- Antimuscarinic Agent
Concentration
1mg in 10mls
Route
IV/IO/ET
Indication
Bradycardia, organophosphate poisonings,
Contraindications
3rd degree heart blocks, glaucoma

25. Benadryl- Antihistamine
Mechanism of Action
Blocks H1 histamine receptor sites
Dose
25-50mg
Adv Side Effects
Drowsiness, hypotension, palpitations, headache
Onset / Duration
Onset- varies with administration, but rapidly
Duration- 3-4 hours

26. Benadryl- Class
Concentration
Route
Indication
Contraindications

27. Calcium Chloride Mechanism of Action Critical mineral and electolyte
Dose 1g
Adv Side Effects
Syncope, cardiac arrest,
Onset / Duration
Onset- rapid
Duration- unk

28. Calcium Chloride- Class
Concentration
1g in 10 mls
Route IV
Indication
???
Contraindications
Hypercalcemia, dig toxicity

29. Dextrose- Class Mechanism of Action Dose Adv Side Effects
Onset / Duration

30. Dextrose- Class
Concentration
Route
Indication
Contraindications

31. Diazepam/Diastat- Benzodiazapine

32. Diazepam/Diastat- Benzodiazapine
Mechanism of Action
In conjunction with GABA increases intracellular chloride levels hyperpolarzing the nerve cell
Dose
Adv Side Effects
Onset / Duration

33. Diazepam/Diastat- Class
Concentration
Route IV
PR… any concerns here?
Indication
Contraindications

34. Diltiazem- Class Mechanism of Action
Decrease automaticity and depolarization of AV nodal tissue, with some smooth muscle relaxation.
Dose
Adv Side Effects
Hypotension, bradycardia
Onset / Duration

35. Diltiazem- Class
Concentration
Route
Indication
Contraindications

36. Epinephrine- Review Alpha Receptors- A for arms B1 Receptors- 1 heart
B2 Receptors- 2 lungs

37. Epinephrine- Class Mechanism of Action
A mixed Alpha and Beta receptor site agonist
Dose
Varies…
Adv Side Effects
Onset / Duration

38. Epinephrine- Class
Concentration
Route
Indication
Contraindications

39. Etomidate- Class Mechanism of Action
A potent hypnotic agent that induces general anesthesia without analgesic properties and little hemodynamic compromise
Dose
20 mg in pts weighing lbs
0.2mg to 0.6mg / kg 100kg patient gets 20mg
Adv Side Effects
Adrenal crisis
Onset / Duration

40. Etomidate- Class
Concentration
Route
Indication
Contraindications

41. Furosemide- Class Mechanism of Action Loop diuretic Dose 20mg-40mg or…
Adv Side Effects
Hypotension, dehydration
Onset / Duration

42. Furosemide- Class Concentration 40mg/4mls Route Indication
Contraindications

43. Levophed- Class Mechanism of Action Potent catecholamine Dose
Titrate to affect: 8mg in 250mls
Adv Side Effects
Tissue necrosis,
Onset / Duration

44. Levophed- Class Concentration 4mg in 4mls Route IV Indication
Acute hypotension, cardiogenic shock
Contraindications

45. Lidocaine- Class Mechanism of Action
Inhibits intracellular sodium rush
Dose
100mg IV or a drip rate of what?
Adv Side Effects
Decreased LOC, convulsions, bradycardia
Onset / Duration ??

46. Lidocaine- Class Concentration 100mg in 5mls 2g in 250mls Route IV
Indication
Contraindications

47. Midazolam- Benzodiazepine
Mechanism of Action
Works in conjunction with GABA receptor site to increase influx of chloride to hyperpolarize the nerve cell.
Dose
Adv Side Effects
Onset / Duration

48. Midazolam- Benzodiazepine
Concentration
Route
Indication
Contraindications

49. Mag Sulphate- Class Mechanism of Action
Relaxes smooth muscle and stabilizes cell membranes.
Dose
Depends 4gm over 20 minutes for eclampsia, 1-2gm IV for cardiac arrest
Adv Side Effects
Onset / Duration

50. Mag Sulphate- - Class Concentration Route Indication
Eclampsia, refractory V-Fib, polymorphic V-tach, bronchospasm
Contraindications
Heart blocks..

51. Morphine- Narcotic Mechanism of Action Narctotic analgesic Dose
Adv Side Effects
Onset / Duration

52. Morphine- Narcotic
Concentration
Route
Indication
Contraindications

53. Narcan- Narcotic antagonist
Mechanism of Action
Dose
Adv Side Effects
Onset / Duration

54. Narcan- Narcotic antagonist
Concentration
Route
Indication
Contraindications

55. Nitroglycerine- Nitrate
Mechanism of Action
Causes peripheral vascular vasodilation
Dose
0.4mg SL
Adv Side Effects
Hypotension, headache
Onset / Duration

56. Nitroglycerine- Nitrate
Concentration
Route
Indication
Contraindications
Inferior wall MIs that have right ventricular involvement

57. Oxytocin- Hormone Mechanism of Action Dose 10u in 10mls of LR
40u in 250mls of D5W
Adv Side Effects
Onset / Duration

58. Oxytocin- Hormone
Concentration
Route
Indication
Contraindications

59. Phenobarbital- Barbiturate
History
The barbiturates were formerly the mainstay of treatment to sedate the patient or to induce and maintain sleep.
Today, they have been largely replaced by the benzodiazepines, primarily because barbiturates induce tolerance, drug-metabolizing enzymes, physical dependence, and are associated with very severe withdrawal symptoms.
May cause coma in toxic doses.

60. Phenobarbital- Barbiturate
Mechanism of action
The sedative-hypnotic action of the barbiturates is due to their interaction with GABAa receptors, which enhances GABAergic transmission. The binding site is distinct from that of the benzodiazepines.
Barbiturates potentiate GABA action on chloride entry into the neuron by prolonging the duration of the chloride channel openings.
Dose
260 mg Peds- May see very high doses
Adv Side Effects
Sedation – Coma, bradypnea
Onset / Duration
Duration- 4-6 hours to days

61. Phenobarbital- Barbiturate
Concentration
Route
Indication
Contraindications

62. Phenylephrine- Sympathomimetic
Mechanism of Action
Potent Alpha agonist
Dose
Titrate to affect
Adv Side Effects
Slow HR, necrosis with tissue infiltration
Onset / Duration

63. Phenylephrine- Sympathomimetic
Concentration
10mg in 250mls
Route IV
Indication
PSVT, neurogenic shock
Contraindications
Left ventricular dysfunction

64. Procainamide- Antiarrhythmic
Mechanism of Action
Potent Na channel blocker
Dose
100mg IVP for Plan A, 2mg a minute post arrest
20-30mg a minute for non-arrest antiarrhythmic dose up to 17mg/kg or QRS widens greater than .08
Adv Side Effects
Hypotension, nausea, widening of QT
Onset / Duration

65. Procainaminde- Class Concentration Route Indication Contraindications
Torsades, heart blocks

66. Rocuronium- Non-depolarizing Paralytic

67. Rocuronium- Non-depolarizing Paralytic
Mechanism of Action
This drug block cholinergic transmission between motor nerve endings and the nicotinic receptors on the neuromuscular end plate of skeletal muscle
Dose
Induction-1.2mg/kg
Control- 0.2mg/kg
Adv Side Effects
Increased PVR, HTN
Onset / Duration
Onset 1 min
Duration 40 min

68. Rocuronium- Class
Concentration
Route
Indication
Contraindications

69. Sodium Bicarb- Electrolyte / Base
Mechanism of Action
Acts as a base to correct acidosis
Dose
Adv Side Effects
Tissue necrosis with inflitration
Onset / Duration

70. Sodium Bicarb- Class Concentration 8.4% 50meq/50mls Route IV
Indication
Contraindications
Precipitates with Calcium
Alkalosis