1. Pharmacology – Pot-pourri Peggy Andrews, Instructor Chemeketa CC

2. Analgesics

3. Opiates & Opiate Blockers

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

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

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

7. Contraindications –Hypersensitivity Precautions –Increased ICP Adverse reactions, SE –Confusion –Dysphoria –Hallucinations –Sedation –sweating

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

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

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

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

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

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

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

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

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

17. Meperidine HCl (Demerol) Class –Opioid analgesic –Schedule II Indications –Moderate or severe pain Action –Binds to opiate receptors in CNS

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

19. 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

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

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

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

23. Dosage & Route –2-10 mg slow IVP q 3 - 5 min. in 2 mg increments, titrated to relief How supplied –10 mg/ml in 1 ml tubex

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

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

26. Adverse reactions, SE –Apnea –Laryngospasm Route & dosage –50-100 mcg (0.05 – 1.0 mg) How supplied –0.05 mg/ml in one ml preload or tubex

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

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

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

30. 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

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

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

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

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

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

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

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

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

39. 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

40. Benzodiazepines And a Benzodiazepine Antagonist

41. We’ll talk about Valium Versed Lorazepam & Flumazanil

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

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

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

45. Adverse reactions, SE –Dizziness –Drowsiness –Lethargy

46. 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

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

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

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

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

51. 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

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

53. Action –Depresses CNS –Decreases seizures

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

55. Route & dosage –Amnesia 2-4 mg slow IV –Seizures 50 mcg IV May repeat in 10-15 min. –Sedation 2-4 mg slow IV or IM –How supplied 2 mg/ml in 1 or 2 ml tubex syringe

56. flumazanil (Romazicon) 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

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

58. 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

59. Barbiturates

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

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

62. 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

63. A different Anxiolytic

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

65. 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

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

67. Paralytics

68. We’ll talk about Succinylcholine Vecuronium Tracrium

69. succinylcholine (Anectine) Class –Anticholinergic drug –Currare –Neuromuscular blockade Indications –Facilitate ET intubation

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

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

72. 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.

73. 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

74. 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

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

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

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

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

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

80. Route & dosage –0.5 mg/kg IV –Duration 20-30 min. How supplied 50 mg/2 ml tubex or vial

81. Miscellaneous drugs

82. 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

83. Aspirin (salicylate) Class –Antiplatelet agent First synthesized in mid-195h century Indication –Inflammatory disorders –Fever –TIA –MI

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

85. 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

86. 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

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

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

89. 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 325 - 500 mg tablets

90. acetaminophen (Tylenol, 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

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

92. 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

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

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

95. Route & dosage –Adults, PO – 25 – 100 g –Children 1-12 y/o, PO – 25-50 g –Children < 1 y/o, PO 1 g/kg How supplied –Oral suspension with sorbitol, 15-50 g in 120-140 ml

96. dexamethasone sodium phosphate ( Decadron) Class: Short acting gluco-corticoid Indications: –Cerebral edema Action: suppresses inflammation

97. Contraindications: –Active untreated infections –Lactation Precautions –Chronic treatment –Children

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

99. 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

100. Dextrose 50% (D50) Class: –Caloric agent (carbohydrate) Indication: –Hypoglycemia –Altered mentation when history unobtainable

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

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

103. How Supplied: –25 gm in 50 ml (50% dextrose) –12.5 gm in 50 ml (25% dextrose) Route & Dosage –IV: Adults 20-50 ml of 50% solution slow infusion –IV: Infants and neonates: 250-500 mg//kg/dose (as 25% dextrose):

104. Important note: Assess IV site frequently for extravasation; will cause tissue necrosis; if occurs, immed. Stop administ. Of drug Check for free blood return into syringe several times during administration

105. diphenhydramine (Benadryl) Class –Antidyskinetic, antihistamine, antitussive, anti-anxiety, sedative Indication –Relief of allergic symptoms –Anaphylaxis –Parkinsons disease –Dystonic reactions

106. Action –Antagonizes histamine effect –Does not bind to or inactivate histamine –Significant CNS depressant properties

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

108. 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

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

110. 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.

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

112. Adverse reactions, SE: Seizures Extrapyramidal reactions Hypotension tachycardia

113. Route & Dosage –Chemical restraint: 0.625 – 10 mg IV slowly 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

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

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

116. Contraindications –Hypersensitivity Precautions –Cardiac disease –hypertension

117. Adverse reactions, SE –Nervousness –Restlessness –Tremor –Angina –Arrhythmias –hypertension

118. Route & dosage –Anaphylactic/ Acute Asthma: – SQ 0.1 – 0.5 mg q 10-15 min. How supplied –1 mg/ml in 1 mg tubex or preload

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

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

121. Contraindications: –Hypersensitivity to beef or pork protein Precautions: –pheochromocytoma

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

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

124. Glucose, oral Class –Glycemic agent Indications –Hypoglycemia Action –Increases blood glucose

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

126. Haloperidol (Haldol) Class –Antipsychotic agent Indications –Acute and chronic psychosis –Tourette’s syndrome –N/V from surgery or chemotherapy

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

128. Contraindications –Hypersensitivity Precautions –Geriatrics –Cardiac disease

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

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

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

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

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

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

135. Adverse reactions, SE –Myocarditis –Arrhythmias Route & dosage –PO (adults) 15-30 ml may repeat at 15 ml in 20-30 min –PO (children) 15 ml may repeat in 20-30 min How supplied –Syrup; 15 ml or 30 ml containers

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

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

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

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

140. 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

141. Contraindications –Active untreated infections –Systemic fungal infections –Don’t give live virus vaccines if pt. On methylprednisolone Precautions; –GI ulcerations –Renal disease –Hypertension

142. Adverse reactions and side effects: –Depression, euphoria –Hypertension –Nausea, anorexia –Decreased wound healing –Muscle wasting –osteoporosis

143. 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

144. Oxytocin (Pitocin) Class –Agent used during pregnancy Indication –Induction of labor at term –Postpartum control of bleeding

145. Action –Stimulates smooth muscle –Has vasopressor and antidiuretic effects

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

147. Route & dosage –Induction of labor: 0.5 – 2 milliunits/min; increase by 1-2 milliunits/min q 15-60 min to result –Postpartum hemorrhage 10 units infused at 20-40 milliunits/min. How supplied –10 units/ml in 0.5 and 1 ml ampules –1 ml preloads

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

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

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

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

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

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

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

155. Route & dosage –1 – 2 g SLOW IV bolus –or IV infusion over 30-60 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

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

157. 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

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

159. 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

160. 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 45-500 ml –(45 ml for MI –90 ml for DVT Administer through filter.

161. 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

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

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

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

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

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

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

168. 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