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

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

Routes of Administration Oral Sublingual Inhalation Transdermal / Topical Rectal Parenteral

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

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

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

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

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

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

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

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?

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

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

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- 5-15 min Duration- 3-6 hrs

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

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

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

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

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

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

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

Atropine- Antimuscarinic Agent

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

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

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

Benadryl- Class Concentration Route Indication Contraindications

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

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

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

Dextrose- Class Concentration Route Indication Contraindications

Diazepam/Diastat- Benzodiazapine

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

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

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

Diltiazem- Class Concentration Route Indication Contraindications

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

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

Epinephrine- Class Concentration Route Indication Contraindications

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 150-250lbs 0.2mg to 0.6mg / kg 100kg patient gets 20mg Adv Side Effects Adrenal crisis Onset / Duration

Etomidate- Class Concentration Route Indication Contraindications

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

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

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

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

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 ??

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

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

Midazolam- Benzodiazepine Concentration Route Indication Contraindications

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

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

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

Morphine- Narcotic Concentration Route Indication Contraindications

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

Narcan- Narcotic antagonist Concentration Route Indication Contraindications

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

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

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

Oxytocin- Hormone Concentration Route Indication Contraindications

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.

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

Phenobarbital- Barbiturate Concentration Route Indication Contraindications

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

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

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

Procainaminde- Class Concentration Route Indication Contraindications Torsades, heart blocks

Rocuronium- Non-depolarizing Paralytic

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

Rocuronium- Class Concentration Route Indication Contraindications

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

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