Pharmacology – Pot-pourri Peggy Andrews, Instructor Chemeketa CC

Analgesics

Opiates & Opiate Blockers

We’ll talk about Buprenex Stadol Vicodin Demerol Morphine sulfate Fentanyl Nubain Trexan Narcan

Buprenex buprenorphine Class –Opioid analgesic (agonist – antagonist) –Schedule V Indications –Management of moderate to severe pain

Action –Binds to opiate receptors in CNS (30x morphine and 3x narcan) –Alters perception of and response to pain –Produces generalized CNS depression

Contraindications –Hypersensitivity Precautions –Increased ICP Adverse reactions, SE –Nausea/Vomiting –Dizzyness –Headache –Confusion –Dysphoria –Sedation –Sweating

Route & dosage –IV, 0.3 mg q 4-6 h prn How supplied –0.3 mg/ml in 1 ml preload

Stadol butorphanol tartrate Class –Opioid analgesic (agonist/antagonist) Indications –Management of moderate to severe pain –Analgesic during labor

Action –Binds to opiate receptors in CNS –Alters perception of response to painful stimuli Contraindications –Hypersensitivity –Opioid dependency

Precautions –Head trauma –Increased ICP Adverse reactions, SE –Confusion –Dysphoria –Hallucinations –Sedation –Sweating –Use with extreme precautions in patient on MAO Inhibitors

Route & dosage –1 mg q 3-4 h prn How supplied –1 mg/ml or 2 mg/ml in 1 ml preloads

Vicodin (Anexia) hydrocodone bitartrate w/ acetaminophen Class –Analgesic –Contains 5 mg narcotic, 500 mg acetaminophen –Schedule III Indications –Analgesic for moderate to severe pain

Action –Binds to opiate receptors –Acetaminophen produces peripheral and central mechanisms

Contraindications –Hypersensitivity Precautions –Head injuries Adverse reactions, SE –Respiratory depression –Sedation –Dizziness –Mental clouding –Acetaminophen overdose may result in potentially fatal hepatic necrosis

Route & dosage –1 – 2 tablets q 4-6 h prn PO –Total 24-hour dose should not exceed 8 tablets

Demerol meperidine hydrochloride Class –Opioid analgesic –Schedule II Indications –Moderate or severe pain Action –Binds to opiate receptors in CNS

Contraindications –Hypersensitivity Precautions –Head injury –Increased ICP Adverse reactions, SE –Seizures –Confusion, sedation –Hypotension –Constipation –N/V

Route & dose –50 – 100 mg slow IV, SQ, IM How supplied –10 mg/ml in 5 ml preload, –20 mg/ml, or 50 mg/ml in 5 ml preload

MS Contin Morphine Sulfate Class: Opioid analgesic Indications –Pulmonary edema –Pain –MI Action –Acts on opiate receptors to block sensation of pain. Also causes peripheral vasodilation

Contraindications –Head injury –Depressed respiratory drive –Hypotension Precautions: have intubation equipment and naloxone ready

Adverse reactions, SE –Respiratory depression –hypotension –Confusion –Sedation –constipation

Dosage & Route –2-10 mg slow IVP q min. in 2 mg increments, titrated to relief How supplied –10 mg/ml in 1 ml tubex

fentanyl Class –Opioid analgesic –Schedule II Indications –Analgesia Action –Binds to opiate receptors in CNS, altering response to and perception of pain

Contraindications –Hypersensitivity Precautions –Geriatrics –Diabetes –CNS tumors –alcoholism

Adverse reactions, SE –Apnea –Laryngospasm Route & dosage – mcg (0.05 – 1.0 mg) How supplied –0.05 mg/ml in one ml preload or tubex

Nubain nalbuphine Class –Opioid analgesic (Agonist/antagonist) Indication –Moderate to severe pain Action –Binds to opiate receptors –Alters perception of and response to pain

Contraindications –Hypersensitivity –Opioid dependency Precautions –Head trauma –Increased ICP

Adverse reactions, SE –Dizziness –Headache –Sedation –Dry mouth –N/V –Clammy feeling, sweating

Route & dosage –10 mg g 3-6 h (not to exceed 20 mg) IV How supplied –10 mg/ml in 1 and 10 ml vials or –20 mg/ml in 1 and 10 ml vials –1 ml preloads

Trexan naltrexone Class –Opiate receptor agonist Indications –Alcoholics to decrease compulsive consumption –Detoxified addicts to stay opiate-free

Action –Competes for opiate receptors Contraindications –None noted Precautions –None noted Adverse reactions, SE –Abdominal cramps, –H/A –Depression –irritability

Route & dosage –25 mg tablets, PO; repeat if no withdrawal sx in one hour –Alcohol dependence; 50 mg qd PO

Narcan naloxone Class –Opioid antagonist Indication –Reversal of CNS depression and respiratory depression 2ndary to opiate overdose

Contraindications –Hypersensitivity Precautions –Cardiovascular disease –Pregnancy Adverse reactions, SE –None in emergent setting

Route & dosage –2 mg IV, SQ, IM, ET, SL injection –Repeat prn

Nitronox nitrous oxide Class –Analgesic Indications –Moderate to severe pain Action –Alters perception of pain –Decreases hypoxia

Contraindications –Do not administer for abdominal pain –Severe head injury Precautions –Must be self- administered –N/V

Route & dosage –Inhaled, blended mixture of 50% nitrous oxide and 50% oxygen –Effects dissipate within 2-5 min. after cessation of administ. –Unit consists of oxygen & nitrous oxide cylinders, fed into blender; delivered to modified demand valve

Benzodiazepines And a Benzodiazepine Antagonist

We’ll talk about Valium Versed Lorazepam & Flumazanil

Valium diazepam Class –Anticonvulsant –Sedative hypnotic agent –Skeletal muscle relaxant –Schedule IV Indications –seizures –Anxiety –Pre-paralytic –Pre-cardioversion –Alcohol withdrawal

Action –Depresses CNS –Produces anterograde amnesia –Has anticonvulsant properties

Contraindications –Hypersensitivity –Comatose patients –Pre-existing CNS depression Precautions –Hepatic dysfunction

Adverse reactions, SE –Dizziness –Drowsiness –Lethargy

Dosage & route Seizures –5 – 10 mg IV; may repeat q 10 – 15 min. to total dose of 30 mg Precardioversion –5 – 15 mg IV; 5 min. before Sedation –5 – 15 mg IV slowly

Versed midazolam Class –Sedative/hypnotic (benzodiazepine) –Schedule IV Indications –Used to produce sedation preoperatively –Antegrade & retrograde amnesia –Provides conscious sedation

Action –Acts at many levels of the CNS to produce generalized CNS depression; produces short- term sedation

Contraindications –Shock –Pre-existing CNS depression Precautions –Pulmonary disease –CHF –Renal impairment –Severe hepatic impairment –Geriatric or debilitated patients –children

Adverse reactions, SE –Cardiac arrest –Apnea –Laryngospasm –Bronchospasm –Respiratory depression –Phlebitis at IV site

Route & dosage –0.5 – 1 mg slow IV or IM initially –May repeat in 2-3 minutes up to max dose of 5 mg. How supplied –1 mg/ml in 2, 5, and 10 ml vials and preloaded syringes

Ativan lorazepam Class –Anti-anxiety, sedative hypnotic –Schedule IV Indications –Anxiety –Preoperative sedation –Seizures

Action –Depresses CNS –Decreases seizures

Contraindications –Hypersensitivity Precautions –Myasthenia gravis Adverse reactions, SE –Apnea –Cardiac arrest –Dizziness –Drowsiness –lethargy

Route & dosage –Amnesia 2-4 mg slow IV –Seizures 50 mcg IV May repeat in min. –Sedation 2-4 mg slow IV or IM –How supplied 2 mg/ml in 1 or 2 ml tubex syringe

Romazicon flumazanil Class –Antidote (benzodiazepine antagonist) Indications –Reverses the effect of benzodiazepines Action –Antagonizes CNS depressant effects of benzodiazepines. Has no effect on CNS depression from other causes

Contraindications –Hypersensitivity Precautions –Mixed CNS depressant overdose –History of seizures –Head injury Adverse reactions, SE –Seizures –Dizziness –N/V

Route & dosage –0.2 – 0.5 mg IV –Maximum dose 3 mg in a one hour period How supplied –0.1 mg/ml in 5- and 10- ml vials

Barbiturates

Brevital Class –Ultra-short acting barbiturate –Schedule IV Indications –Cardioversion –Induction of anesthesia Action –Affects CNS

Contraindications –None noted Precautions –Cardiac arrest Adverse reactions, SE –Hypotension –Laryngospasm –Seizures –shivering

Route & dosage –1-2 mg/kg IV How supplied –Brevital is a freeze-dried nonpyrogenic mixture of methohexital sodium with anhydrous sodium carbonate as a buffer. A white crystalline powder, freely soluble in water. –Prepare and use promptly. –Dilute with sterile water, 0.9% sodium chloride, or D5W –Do not use LR –Mix vial (500 mg) with 50 ml of diluent

A different Anxiolytic

BuSpar buspirone Class –Anti-anxiety, sedative hypnotic agent Indication –Anxiety Action –Binds to seratonin and dopamine receptors

Contraindications –Hypersensitivity Precautions –Pts receiving other antianxiety agents Adverse reactions, SE –dizziness, drowsiness, excitement, fatigue, H/A, insomnia, nervousness, weakness –Blurred vision, nasal congestion –Chest pain, palpitations, tachycardia

Route & dosage –10 – 15 mg PO tid How supplied –tablets

Paralytics

We’ll talk about Succinylcholine Vecuronium Rocuronium Tracrium

Anectine succinylcholine Class –Anticholinergic drug –Currare –Neuromuscular blockade Indications –Facilitate ET intubation

Action –Blocks acetylcholine receptors at neuromuscular junctions Contraindications –Hypersensitivity Precautions –Must be skilled in intubation

Adverse reactions, SE –Apnea –Arrhythmias –Malignant hyperthermia –Vomiting –Aspiration –Bradycardia –Hypertension –Concurrent administration with physostigmine intensifies paralysis

Route & dosage –1.5 mg/kg IV –Onset ~ 1 min. –Recovery, 4-6 min. –OR –3-4 mg/kg IM (max. dose 150 mg) –Onset 2 – 3 min.

How supplied –20 mg/ml in 10 ml vial Note: –Fasciculations start at eyelids, jaw – progresses to limbs, abdomen, then diaphragm and intercostal muscles. –Succs does NOT affect consciousness

Procedure –Preoxygenate –Prepare equipment –Atropine, 0.01 – 0.02 mg.kg (Peds or bradycardia) –Lidocaine 1 mg/kg (Head injury) –Valium or Versed –Succinylcholine, IV –Stop ventilations –Sellick’s maneuver until intubated –When fasciculations stop, check paralysis –Intubate! –If Succs starts to wear off, consider Vecuronium 0.1 mg/kg IVP; may repeat 0.05 mg/kg

Vecuronium Class –Non-depolarizing neuromuscular blocking agent Indications –Intubation Action –Binds to acetylcholine at motor receptors –Has little histamine release

Contraindications –None in the emergency setting Precautions –Increased blockade with bacitracin, lidocaine, verapamil Adverse reactions, SE –Malignant hyperthermia

Route & dosage –0.15 mg/kg IV –Onset: 2-3 minutes –Duration: 45 minutes How supplied

Zemuron rocuronium bromide Class –Non-depolarizing neuromuscular blocking agent with a rapid to intermediate onset Indications –Intubation Action –Competes for cholinergic receptors at the motor end-plate

Contraindications –None in the emergency setting Precautions –Myasthenia Gravis Adverse reactions, SE –H/A –Hypertension or –Hypotension

Route & dosage – mg/kg IV (90mg) –Onset: 1-2 minutes –Duration: 30 minutes How supplied –10 mL vials (10 mg/mL)

Tracrium atracurium besylate Class –Nuromuscular blocking agent Indications –Intubation Action –Competes with acetylcholine for receptors at neuromuscular junction

Contraindications –Myasthenia gravis Precautions –Increased neuromuscular blockade with lidocaine, bacitracin, verapamil Adverse reactions, SE –Does NOT affect consciousness –Arrhythmias

Route & dosage –0.5 mg/kg IV –Duration min. How supplied 50 mg/2 ml tubex or vial

Miscellaneous drugs

We’ll talk about Aspirin (again) Acetaminophen Activated charcoal Decadron D50 Diphenhydramine Epinephrine 1:1000 Inapsine Glucagon Glucose, Oral Heparin Haloperidol Ipecac Mannitol Solu-Medrol Oxytocin Phenergan Pralidoxime Streptokinase Thiamine Terbutaline

Aspirin (acetysalicylate acid, ASA) Class –Salicylate First synthesized in mid-19 th century Indication –Inflammatory disorders –Fever –TIA –MI

Action –Produces analgesia –Reduces inflammation and fever by inhibiting the synthesis of prostoglandins –Decreases platelet aggregation

New Info! New England Journal of Medicine, 3/05 Men 50 y/o or more (no clinical evidence of coronary disease). ASA - Risk of MI 44% less No significant effect on risk of stroke and no effect on mortality from cardiovascular causes Women 65 y/o or more (no history of cardiovascular disease) ASA - No significant effect on risk of MI or risk of death from cardiovascular causes BUT 24% reduction in risk of ischemic stroke and 17% reduction in stroke risk overall

Conclusion of study Women < 65 y/o Reasonable to avoid prescribing low-dose aspirin (75-100mg) as a preventative measure for coronary disease Rx for stroke – left to pt and Dr

Contraindications –Hypersensitivity –Bleeding disorders or thrombocytopenia Precautions –GI bleeds or ulcers –Chronic alcohol use/abuse –Severe renal disease –Viral infections –Pregnancy

Adverse reactions, SE –GI bleeding –Anaphylaxis –Laryngeal edema –Dyspepsia, epigastric distress –Heartburn, nausea

Dosage & route –Pain, Fever PO, Rectal –325 – 500 mg q 3 h OR –325 – 650 mg q 4 h –Not to exceed 4 g/day –Cardiac chest pain PO 81 mg x 3 chewable children's aspirin (243 mg) –(UNLESS TAKING COUMADIN) How supplied –Children's aspirin, 81 mg tablets –Aspirin mg tablets

Tylenol acetaminophen, APAP Class –Antipyretic agent Indications –Mild pain –Fever Action –Inhibits synthesis of prostaglandins that serve as mediators of pain and fever –Has no significant anti-inflammatory properties

Contraindications –Hypersensitivity Precautions –Hepatic disease, renal disease Adverse reactions, SE –Hepatic failure

Route & dosage –PO (adults) 325 – 650 mg q 4 h –Rectal (children & infants) 80 mg q 4-6 h (infants 3 – 11 mo children 1 – 3 y/o) –How supplied 500 mg tablets 80 mg suppositories

Acti-Char, Actidose activated charcoal Class –Antidote Indications –Acute management of many poisonings following emesis/lavage Action –Binds drugs and chemicals in the GI tract

Contraindications –None known Precautions –Cyanide, corrosive, ethanol, petroleum, organic solvent or iron poisoning Adverse reactions, SE –Black stool

Route & dosage –Adults, PO – 25 – 100 g –Children 1-12 y/o, PO – g –Children < 1 y/o, PO 1 g/kg How supplied –Oral suspension with sorbitol, g in ml

Decadron dexamethasone sodium phosphate Class –Short acting gluco-corticoid Indications –Cerebral edema Action –Suppresses inflammation

Contraindications –Active untreated infections –Lactation Precautions –Chronic treatment –Children

Adverse reactions, SE –Peptic ulcers –Thromboembolism –Depression –Euphoria –Muscle wasting –Cushingoid appearance –Osteoporosis

Route & Dosages –10 – 100 mg IVP 10 mg initially, then 4 – 6 mg q 6 hr for 2-4 days then taper off over 5-7 days How supplied –10 mg/ml in 10 ml vial

D 50 Dextrose 50% Class –Caloric agent (carbohydrate) Indication –Hypoglycemia –Altered mentation when history unobtainable

Contraindications –Allergies to corn or corn products Precautions –Chronic alcoholics –Severe malnutrition

Adverse reactions, SE –None if blood glucose is less than 80 mg/dcL –Venous irritation Interactions: –Will alter requirements for insulin

How Supplied: –25 gm in 50 ml (50% dextrose) –12.5 gm in 50 ml (25% dextrose) Route & Dosage –IV: Adults ml of 50% solution slow infusion –IV: Infants and neonates mg/kg/dose (as 25% dextrose)

Important note –Assess IV site frequently for extravasation; will cause tissue necrosis; immediately stop administration of drug –Check for free blood return into syringe several times during administration

Benadryl diphenhydramine Class –Antihistamine Indication –Relief of allergic symptoms –Anaphylaxis –Parkinsons disease –Dystonic reactions

Action –Competes for histamine receptor sites –Blocks histamine –Significant CNS depressant properties

Contraindications –Hypersensitivity –Acute asthmatic episode Precautions –Geriatrics –Severe liver disease

Adverse reactions, SE –Drowsiness –Anorexia –Dry mouth Route & dosage –10-50 mg IVP q 2-3 h How supplied –5 mg/ml in 10 ml preload or tubex

Inapsine droperidol Class –Tranquilizer –Antiemetic Indications –Sedation of combative patients to facilitate restraint –N/V

Action –Similar to haloperidol, alters action of dopamine in CNS –Allays apprehension and provides a state of mental detachment and indifference while maintaining a state of reflex alertness.

Contraindications –Hypersensitivity –CNS depression –Severe liver disease or cardiac disease Precautions –Hypotension may occur; have fluids available –Elderly

Adverse reactions, SE Seizures Extrapyramidal reactions Hypotension tachycardia

Route & Dosage –Chemical restraint – 10 mg slow IV or IM (Usual dose 2.5 – 5.0 mg) Onset 3 – 10 min. Peak 30 min. Duration 2-4 hr. –Antiemetic 0.5 – 1 mg q 4 hr How supplied –2.5 mg/ml in 2 ml preload

Epinephrine 1:1,000 Class –Adrenergic agonist –Vasopressor Indications –Management of reversible airway disease –Management of severe allergic reaction –Cardiac arrest

Action –Affects both beta 1 and beta 2 receptor sites –Has alpha 1 properties –Produces bronchodilation –Vasoconstriction –Inhibits release of mediators from mast cells

Contraindications –Hypersensitivity Precautions –Cardiac disease –Hypertension

Adverse reactions, SE –Nervousness –Restlessness –Tremor –Angina –Arrhythmias –Hypertension

Route & dosage –Anaphylactic/ Acute Asthma: – SQ or IM 0.1 – 0.5 mg q min. How supplied –1 mg/ml in 1 mg tubex or preload

Glucagon Class –Hormone Indications –Acute management of severe hypoglycemia –Antidote to Beta-adrenergic blocking agent, calcium channel blockers

Action –Stimulates hepatic production of glucose from glycogen stores –Relaxes smooth muscle of GI tract –Has positive inotropic and chronotropic effects

Contraindications –Hypersensitivity to beef or pork protein Precautions –Pheochromocytoma

Adverse reactions & side effects –N/V Drug Interactions –Large doses may inhance effects of Warfarin

Route & dosage –Hypoglycemia: 1 mg IV or IM –Antidote to Beta-blockers: 0.25–2mg IV –Antidote to Calcium channel blockers: 2 mg IV How supplied –1 mg glucagon in powder for injection with diluent of glycerin & small amount of hydrochloric acid –Mix immediately before administration

Oral Glucose Class –Glycemic agent Indications –Hypoglycemia Action –Increases blood glucose

Contraindications –Loss of gag reflex Precautions –Decreased mentation Route & dosage –25 gm glucose, oral

Haldol haloperidol Class –Antipsychotic agent Indications –Acute and chronic psychosis –Tourette’s syndrome –N/V from surgery or chemotherapy

Action –Alters effect of dopamine in CNS –Has anticholinergic, alpha-adrenergic blocking activity

Contraindications –Hypersensitivity Precautions –Geriatrics –Cardiac disease

Adverse reactions, SE –Seizures –Blurred vision, dry eyes –Constipation, dry mouth Route & dosage –0.5 – 5 mg IV or IM How supplied –5 mg/ml in 1-ml tubex

Heparin Class –Anticoagulant Indication –Thromboembolic disorders Action –Potentiates the inhibitory effect of antithrombin

Contraindications –Hypersensitivity –Uncontrolled bleeding Precautions –Spinal cord or brain injury –Bleeding disorder –Women > 60 –Severe uncontrolled hypertension –Hemorrhagic stroke

Adverse reactions, SE –Bleeding –Anemia –Thrombocytopenia Route & dosage –Anticoagulation 10,000 u IV followed by 5,000 – 10,000u q 4-6 h –Continuous infusion 20,000 – 40,000u infused over 24 h How supplied –5,000 u/ml in vial

Ipecac Class –Antidote Indications –Induce vomiting in early managment of OD/poisoning Action –Stimulates chemoreceptor trigger zone in CNS and irritates gastric mucosa

Contraindications –Decreased mentation –Inebriated –Seizing patient Precautions –Pregnancy, lactation, children < 6 mo

Adverse reactions, SE –Myocarditis –Arrhythmias Route & dosage –PO (adults) ml may repeat at 15 ml in min –PO (children) 15 ml may repeat in min How supplied –Syrup 15 ml or 30 ml containers

Mannitol 20% Class –Diuretic agent Indications –Increased ICP Action –Increases osmotic pressure of glomerular filtrate, inhibits reabsorption of water and electrolytes

Contraindications –Dehydration –Active intracranial bleeding Precautions –Pregnancy, lactation Adverse reactions, SE –Transient volume expansion

Route & dosage –IV, 1-2 g/kg slow IVP (over 30 min.) How supplied –2 g in 20 ml vial

Solu-Medrol methylprednisolone sodium succinate Class: –An intermediate-acting glucocorticoid –Anti-inflammatory –Immunosuppressant Indications: –Management of acute spinal cord injury –Used systemically for chronic diseases Inflammatory Allergic Autoimmune disorders

Action –Stimulates the synthesis of enzymes needed to decrease the inflammatory response. Suppresses the immune system by reducing activity and volume of lymphatic system, and possibly reduces reactivity of tissue to antigen- antibody interactions

Contraindications –Active untreated infections –Systemic fungal infections –Don’t give live virus vaccines if patient on methylprednisolone Precautions –GI ulcerations –Renal disease –Hypertension

Adverse reactions and side effects –Depression, euphoria –Hypertension –Nausea, anorexia –Decreased wound healing –Muscle wasting –Osteoporosis

Route and dosage –Spinal cord injury 30 mg/kg over 15 min. initially, then 45 min. later initiate continuous infusion of 5.4 mg/kg/hr for 23 hrs. How supplied –4 mg/ml, 10 mg/ml, 20 mg/ml vial

Pitocin Oxytocin Class –Hormone Indication –Induction of labor at term –Postpartum control of bleeding

Action –Stimulates smooth muscle –Has vasopressor and antidiuretic effects

Contraindications –Hypersensitivity Precautions –First and second stage of labor Adverse reactions, SE –Coma –Seizure –Intracranial hemorrhage –Fetal asphyxia –Painful contractions

Route & dosage –Induction of labor: 0.5 – 2 milliunits/min; increase by 1-2 milliunits/min q min to result –Postpartum hemorrhage 10 units infused at milliunits/min. How supplied –10 units/ml in 0.5 and 1 ml ampules –1 ml preloads

Phenergan Promethazine Class –Antiemetic agent –Antihistamine –Sedative hypnotic Indications –Preoperative sedation –Allergic conditions –Motion sickness

Action –Blocks histamine effects –Inhibitory effect on chemoreceptor trigger zone in medulla –Significant anticholinergic activity

Contraindications –Hypersensitivity Precautions –Hypertension –Sleep apnea –Epilepsy Adverse reactions, SE –Neuroleptic malignant syndrome –Confusion, disorientation, sedation

Route & dosage –Antihistamine: IV, IM, PR, 25 mg; repeat in 2 hr –Sedation: IV, IM, PR, mg How supplied –25 mg/ml in 1 ml ampules and 1 and 10 ml vials –Suppositories: 12.5 mg, 25 mg, 50 mg.

Protopam Chloride, 2 PAM Pralidoxime Cl Class –Antidote –Anticholinesterase poisoning inhibitor Indication –After Atropine in severe cases of organophosphate poisoning Muscle twitching, paralysis Action –Reactivates cholinesterase

Contraindications –Inorganic phosphate poisoning Precautions –Tachycardia, laryngospasm, muscle rigidity with rapid infusion –Reduce dosage for patient with impaired renal function

Adverse reactions, SE –Dizziness, headache –Tachycardia –Nausea –Blurred vision

Route & dosage –1 – 2 g SLOW IV bolus or –IV infusion over min. after administration of Atropine –For infusion; mix 1 g in 250 ml NS How supplied –1 g/20 ml vial –Must be reconstituted with 20 ml sterile water

Streptokinase Class –Thrombolytic agent Indications –AMI < 12 h old –Pulmonary emboli –DVT Action –Convert plasminogen to plasmin; degrades fibrin

Contraindications –Active internal bleed –CVA –Recent CNS trauma or surgery –Severe uncontrolled hypertension Precautions –Surgery with in 10 days –Trauma –GI or GU bleeding –Recent arterial puncture

Adverse reactions, SE –Intracranial hemorrhage –GI bleeding –Retroperitoneal bleeding –GU tract bleeding –Anaphylaxis –Reperfusion arrhythmias

Route & dosage –MI 1.5 million IU infused over 60 min. –DVT, PE 250,000 IU loading dose over 30 min., followed by 100,000 IU/h for 24 – 72 h

How supplied –Powder for injection; 250,000 IU/vial, or 1,500,000 IU/vial –Reconstitute with 5 ml NaCl or D5W (direct to side of vial) –Swirl gently; do not shake –Dilute further with NaCl for total volume of ml –45 ml for MI –90 ml for DVT Administer through filter

Thiamine Class –Vitamin B-1 Indications –Treatment of thiamine deficiency (Beriberi) –Prevention of Wernicke’s encephalopathy –Dietary supplement in pt with GI disease, alcoholism, or cirrhosis

Actions –Required for carbohydrate metabolism Distribution –Widely distributed Metabolism & excretion –Metabolized by the liver. –Excess amounts excreted unchanged by kidneys

Half-life –Unknown Contraindications –None in prehospital setting Precautions –Wernicke’s encephalopathy Condition may be worsened unless thiamine is administered before glucose.

Adverse reactions & side effects –None in prehospital setting Interactions –May inhance neuromuscular blocking agents

How supplied –100 mg/ml in 1 ml ampules and prefilled syringes Route and dosage –100 mg IVP (may be given IM)

Brethine terbutaline Class –Bronchodilator Indication –Asthma –COPD –Preterm labor Action –Results in accumulation of cyclic adenosine monophosphate at beta-adrenergic receptors

Contraindications –Hypersensitivity Precautions –Near-term pregnancy Adverse reactions, SE –Paradoxical bronchospasm –Nervousness, restlessness, tremor

Route & dosage –Preterm labor: IV, 10 mcg/min., increase by 5 mcg/min until contractions stop. How supplied –1 mg/ml in 1 ml tubex