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Paramedic Drugs

These are the drugs used in the NCTI riverside paramedic program

What is the mechanism of action for Calcium Chloride? 1. Necessary for proper function of the muscular, endocrine, respiratory, digestive, and nervous systems. 2. Positive inotropic avtivity increases the strength of myocardial contrqctions 3. Increases ventricular automaticity
What is the class of Calcium Chloride? Electrolyte.
What are the indications for Calcium Chloride? 1. Calcium channel blocker or Beta blocker overdose. 2. Acute hyperkalemia or cardiac arrest when hyperkalemia is suspected. 3. Hypocalcemia 4. Suspected hypermagnesemia with respiratory depression. 5. Crush syndrome.
What are the contraindications for Calcium Chloride? 1. Digitalis toxicity 2. Hypercalcemia 3. Ventricular fibrillation
What are the side effects of Calcium Chloride? ` Cardiovascular: Hypotension, dysrhythmias, cardiac arrest. Neurological: Syncope, tingling sensations. Gastrointestinal: Metallic taste. Other: Sense of heat waves, necrosis/cellulitis upon infiltration of IV
What are the Dosages/Routes for Calcium Chloride? (Adult) Adult: Known or suspected hyperkalemia or Blocker OD, cardiac arrests: 500 mg to 1 gm IVP/IO over 5-10 minutes (May repeat every 10 mins as necessary). Repeat as clinically indicated. Calcium Channel blocker (prophylaxis): 2-4 mg/kg
What are the Dosages/Routes for Calcium Chloride? (Pediatric) 20 mg/kg (0.2 ml/kg)) slow IVP/IO (no faster than 100mg/min). Repeat as clinically indicated.
What is the class of Magnesium Sulfate? 1. Electrolyte 2. Anticonvulsant 3. CNS depressant 4. Anti-dysrhythmic
Mechanism of action for Magnesium Sulfate 1. Decreases Acetylcholine in the motor nerve terminals 2. Produces neuromuscular blockade in the CNS 3. Physiologic calcium channel blocker
Indications for Magnesium sulfate 1. Refractory VFIB/pulseless VTAC (ACLS) 2. Treatment for Torsades De Pointes (polymorphic VTAC) 3. /seizures associated with alcohol withdrawal and eclampsia 4. Dysrhythmias associated with Digitalis toxicity 5.Bronchospasms refractory to trad med
Contraindications for magnesium sulfate 1. Cardiogenic shock 2. Heart blocks
Side effects for Magnesium sulfate Cardiovascular: dysrhythmias, bradycardia, hypotension, heart blocks Neurological: drowsiness Respiratory: decreased respiratory rate, respiratory paralysis Other: flushing, sweating
Dosages for Magnesium Sulfate Adult: 1-4 g in 50-100 ml Normal Saline IVPB/IVP over 5 minutes Pediatric: 20-50 mg/kg in 50-100 Normal Saline IVPB Maximum single dose is 2 g
Classification of Epinephrine Vasopressor, catecholamine, sympathomimetic
Mechanism of action for Epinephrine (1 & 2) 1.Increases cardiac output and BP increasing inotropy, chronotropy, and dromotropy (beta1 effect) 2. Vasoconstriction; increases systolic BP (alpha)
Mechanism of action for Epinephrine (3 &4) 3. Relaxes smooth muscles in the respiratory tract, dilating the bronchioles (beta2 effect) 4. Increases coronary perfusion during CPR by increasing aortic diastolic pressure (from vasoconstriction)
Indications for Epinephrine 1. Cardiac arrest 2. Asthma and allergic reaction 3. Anaphylaxis 4. Symptomatic bradycardia (PEDS) 5. Beta Blocker Overdose (PEDS)
Contraindications for Epinephrine 1. Hypovolemia 2. Hypertension
Side Effects for Epinephrine Cardiovascular: tachycardia, hypertension, palpitations, chest pain, ventricular fibrillation Neurological: tremors/seizures Respiratory: paradoxical bronchospasms (with excessive use in inhalers)
Dosages for Epinephrine (Adult) Cardiac arrest: 1 mg (1:10,000) IV/IO MR q 3-5 mins Asthma/allergic reaction: 0.3-0.5 mg SQ/IM MR q 20 mins x 2 Anaphylaxis: 0.1-0.5 mg(1:10,000)IV/IO (over 1-5 mins) MR q 3-5 mins Vasopressor: 1-4 mcg/min IVPB
Dosages for Epinephrine (Pediatric) (cardiac arrest, allergic reaction) Cardiac Arrest: 0.01 mg/kg (1:10,000) IV/IO MR 0.01 mg/kg IV/IO q 3-5 mins Asthma/Allergic Reaction:0.01mg/kg (1:1,000) SQ/IM to a max dose of 0.3 mg MR q 20 mins x2
Dosages for Epinephrine (Pediatric)bradydysrhythmia,vasopressor Bradydysrhythmia: Neonate/Infant:0.01 mg/kg (1:10,000) IV/IO/ET (dilute ET dose with 1-2ml of NS)may repeat every 3-5 mins Child:0.01 mg/kg (1:10,000)IV/IO may repeat every 3-5 mins Vasopressor:1-4 mcg/min IVPB
Dosages for Epinephrine (Pediatric) Anaphylaxis Anaphylaxis with Shock:0.01 mg/kg (1:10,000) slow IV/IO (over 1 minute) to a maximum single dose of 0.1 mg MR q 3-5 mins
Class for Dopamine Sympathomimetic, Catecholamine, Vasopressor
Mechanism of action for Dopamine (Low dose) Renal/Mesenteric Dose : 1.Dilates renal and mesenteric arteries by stimulating dopaminergic receptors 2.Increases urinary output
Mechanism of action for Dopamine (moderate dose) Inotropic Dose:1. Increases inotropy without increasing chronotropy2. Increases blood pressure by stimulating the beta1 receptors
Mechanism of action for Dopamine (high dose) Vasopressor Dose:1. Causes vasoconstriction (alpha); increasing blood pressure Increase inotropy and chronotropy (beta 1); increasing blood pressure
Indications for dopamine 1. Cardiogenic shock 2. Distributive shock after fluids 3. Hemodynamically significant hypotension 4. Symptomatic bradycardia (second line drug)
Contraindications for dopamine 1. Hyperthermia 2. Tachydysrhythmias 3. Hypovolvemia
Side effects for dopamine Cardiovascular: tachycardia, hypertension/hypotension, chest pain, ventricular irritability Respiratory: dyspnea
Dosages for dopamine Adult and pediatric: Low dose:1-5 mcg/kg/min Moderate dose: 5-10 mcg/kg/min High dose: 10-20 mcg/kg/min
Class for diphenhydramine Antihistamine, Antidyskinetic (anticholinergic), Sedative/Hypnotic
Mechanism of action for diphenhydramine 1.Competes with histamine receptor sites 2.CNS depressant and anticholinergic
Indications for diphenhydramine 1.Allergic symptoms 2.Dystonic reactions or extrapyramidal symptoms
Contraindications for diphenhydramine 1.Acute asthma (relative contraindication) 2.Nursing mothers 3.Glaucoma
Side effects for diphenhydramine Cardiovascular: tachycardia, hypotension, palpitations Neurological: drowsiness, seizures Respiratory: mucus plugs, wheezing
Dosages for DIPHENHYDRAMINE Adult: 25-100 mg slow IVP/IO (25 mg per minute) or deep IM Pediatric: 1 mg/kg slow IVP/IO (25 mg per minute) or deep IM
Classification of DILTIAZEM HYDROCHLORIDE Antidysrhythmic, Calcium channel blocker, Antihypertensive
MOA for DILTIAZEM HYDROCHLORIDE 1. Inhibits calcium influx across cellular membranes 2. Coronary artery dilation – increasing myocardial oxygen delivery 3. Smooth muscle relaxation – decreases peripheral vascular resistance 4. Slows SA/AV node conduction
Contraindications for DILTIAZEM HYDROCHLORIDE 1. BP < 90 mmHg systolic 2. 2nd and 3rd degree heart blocks 3. Sick Sinus Syndrome 4. AMI 5. Wolf-Parkinson-White Syndrome
Side effects for DILTIAZEM HYDROCHLORIDE Cardiovascular: bradycardia, hypotension, CHF, heart blocks CNS: dizziness, drowsiness, confusion
Dosages for DILTIAZEM HYDROCHLORIDE Adult: 15-20 mg IVP/IO Pediatric: 0.25 mg/kg IV push over 2-5 min; repeat at 0.35 mg/kg if no response/improvement in 15 minutes. Max dose of 3.5 mg/kg in a 24 hour period
Classification of Adenosine Antidysrhythmic, Endogenous nucleoside 1
Mechanism of action for Adenosine 1. Slows conduction of the SA and AV nodes 2.Can interrupt reentry pathways through the AV and SA nodes
Indications for Adenosine 1. SVT or PSVT unresponsive to Valsalva (vagal) maneuvers 2. Wide complex tachycardia as diagnostic drug (not used for torsades)
Contraindications for Adenosine 1.Sick Sinus Syndrome 2.2nd or 3rd degree heart block 3.Hypovolemia – do not give adenosine prior to fluid administration
Side Effects for Adenosine CV: CP/pressure, hypoT, transient PACs/PVCs, brady, asystole, 2&3 AVB Neuro: seizures, blurred vision, tingling/numbness, dizziness Resp: SOB/dyspnea, respiratory failure GI: nausea, metallic taste/ other: flushed skin
Dosages for Adenosine: Adult:6 mg rapid IVP/IO followed by 10-20 ml flush May repeat with 12 mg twice after 1-2 minutes each Pediatric: 0.1 mg/kg rapid IVP/IO followed by 10 ml flush May repeat with 0.2 mg/kg twice after 1-2 minutes
Classification for Amiodarone Antidysrhythmic
Mechanism of Action for Amiodarone 1. Prolongs duration of action potential and refractory period without significantly effecting the resting potential 2.Relaxes smooth muscles causing vasodilation (especially in the coronary arteries) 3. Raises the threshold for VFIB
Indications for Amiodarone 1. Monomorphic VTAC 2. Pulseless VTAC/VFIB refractory to defibrillation attempts 3. Symptomatic PVC’s
Contraindications for Amiodarone 1. Cardiogenic shock 2. Bradycardia 3. Sick Sinus Syndrome
Side Effects for Amiodarone Cardiovascular: cardiogenic shock, hypotension, bradycardia, CHF Neurological: muscle weakness, tingling/numbness, dizziness, headache Respiratory: pulmonary toxicity
Dosages for Amiodarone (Arrest) Adult: Arrest: 300 mg IVP/IO followed by 10-20 ml NS flush 150 mg IVP/IO followed by 10-20 ml NS flush in 3-5 minutes if no conversion
Dosages for Amiodarone (Wide-complex Tachycardia/symptomatic PVC’s and maintenance infusion) Wide-complex/ Tachycardia/ symptomatic PVC’s: 150 mg slow IVP/IO over 10 minutes (max dose 450 mg)Maintenance Infusion (IVPB): 0.5 mg per minute for post conversion (540 mg over 18 hours)
Dosages for Amiodarone (Pediatric) Pediatric: VTAC/ VFIB Arrest: 5 mg/kg IVP/IO followed by 10 ml NS flush,max dose is 15 mg/kg Tachydysrhythmias: 5 mg/kg IVP/IO over 20-60 minutes, max dose 15 mg/kg
Classification of Metaproterenol Sympathmomimetic Bronchodilator
Mechanism of Action for Metaproterenol 1.Selective Beta2 agonist 2.Relaxes bronchial smooth muscle 3.Inhibits histamine release from mast cells, reducing mucus production, capillary leaking and mucosal edema caused by allergic reaction in lungs
Indications for Metaproterenol 1.Asthma 2.Bronchospasms associated with COPD 3.Allergic reaction/anaphylaxis
Contraindications for Metaproterenol 1.Narrow angle glaucoma 2.cardiac dysrhythmias associated with tachycardia
Side effects of Metaproterenol Cardiovascular: palpitations, tachydysrhythmias, hypertension CNS: nervousness, weakness, drowsiness, tremors
Dosages for Metaproterenol (Adult) Adult: 10-15 mg (0.2-0.3 mL of a 5% solution), dilute in 2.5 mL of NS every 4 hours
Dosages for Metaproterenol (pediatric Pediatric: 0.5 to 1 mg/kg (0.01 to 0.02 mL/kg of 5% solution); dilute in 3 mL NS (age > 5 yrs) minimum dose: 5 mg (0.1 mL); maximum dose: 15 mg (0.3 mL); every 4 hours
Created by: gloobadafet