Session 02a (Pharmacology)
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Transcript Session 02a (Pharmacology)
Pharmacology
Advanced Care Paramedicine
Module: 7
Session: 2a
Electrolytes
Calcium Chloride
Class:
Electrolyte
MOA:
Essential component for functional integrity of
nervous and muscular systems
Enhances automaticity
Positive inotrope
Calcium Chloride
Indications:
Hyperkalemia
Hypocalcemia
CCB Toxicity
Hypermagnesemia
Respiratory depression after MgSO4 administration
To prevent Hypotension from CCB
Contraindications:
Vfib
Digitalis toxicity
Hypercalcemia
Renal or Cardiac disease
Calcium Chloride
Adverse Reactions:
Bradycardia
Hypotension
Metallic taste
Severe local necrosis (infiltration)
Calcium Chloride
Supplied:
10% solution in 10 ml
Dosage:
Adult:
5 - 10 cc over 3 minutes
(8 – 16 mg/kg)
Pediatric: 5 mg/kg over 3 minutes
Magnesium Sulphate
Class:
Electrolyte
Anticonvulsant (toxemias)
Antiarrhythmic (torsades, TCA OD)
Uterine Relaxant
MOA:
Reduces striated muscle contractions and
blocks peripheral neuromuscular transmission
by reducing Ach release
Magnesium Sulphate
Indications:
Seizure due to Eclampsia
Torsades de Pointes
Hypomagnesemia
Refractory Vfib (not NS)
Status Asthmaticus (not NS)
Contraindications:
Heart block
Myocardial damage
Magnesium Sulphate
Adverse Reaction:
Diaphoresis
Facial flushing
Hypotension
Depressed reflexes
Hypothermia
Bradycardias
Circulatory collapse
Respiratory depression
Diarrhea
Magnesium Sulphate
Supplied:
20% solution
Dosage:
Bolus:
Torsades:
Toxemia:
1 gm IV at 1 g/min
4 gm IV at 1 g/min
Infusion:
2 g in 100 cc NaCL (0.9%) at 50 ml/hr (1 g/hour)
Potassium Chloride
Class:
Electrolyte
MOA:
Principle intracellular ion affecting
muscular contraction and nervous system
transmission
Potassium Chloride
Indications:
Transport medication only in doses of < 40 mEq/ml
Hypokalemia
Digitalis toxicity
May see it Post MI (in conjunction with Dextrose and
Insulin)
Contraindications:
Renal impairment
Acute dehydration
Heat cramps
Elevated serum potassium causing diseases
Potassium Chloride
Adverse Effects:
N/V
Diarrhea with ABD pain
K+ toxicity/hyperkalemia
Hypotension
Cardiac arrhythmias
Heart block
Potassium Chloride
What to look for in
Hyperkalemia:
Paresthesis of
extremities
Flaccid paralysis
Mental confusion
Weakness and
heaviness of legs
Cardiac changes
P waves flatten and
may disappear
Widening and slurring
of QRS
ST changes
Peaked T waves
Potassium Chloride
What to do:
Discontinue IV
Treat hypotension as required (position and fluid
resuscitation)
Arrhythmias
Consider Calcium Chloride (if CV toxicity)
Consider Sodium Bicarbonate (renal failure)
Potassium Chloride
What to look for in
Hypokalemia:
Polyuria
Muscle weakness
ECG Changes
Widen QRS
T waves may flatten
U wave may appear
and increase in size
and may pass T wave
size and eventually
fuse together at low
levels
Sodium Bicarbonate
Class:
Buffer
Alkalinizing agent
Electrolyte
MOA:
Reacts with H+ ions to form water and
carbon dioxide
Sodium Bicarbonate
Indications:
Wide complex tachycardia or arrest from TCA OD
Acidosis
Cardiac arrest with pre-existing hyperkalemia (renal
failure)
Cardiac arrest patients with suspected ASA OD
Contraindications:
Alkalosis
Severe pulmonary edema
Abdominal pain of unknown origin
Hypocalcemia
Hypokalemia
Hypernatremia
Sodium Bicarbonate
Adverse Effects:
Metabolic alkalosis
Hypoxia
Increased intracellular PCO2 and increased tissue acidosis
Electrolyte imbalance (hypernatremia)
Seizures
Sodium Bicarbonate
Supplied:
50 mEq/50cc
Dosage:
First dose:
1 mEq/kg
Subsequent dose:0.5 mEq/kg q 10 minutes PRN
Volume Expanders
Pentaspan
Other Names:
Pentastarch
Hydroxyethyl Starch
Class
Plasma Volume Expander
Pentaspan
MOA:
Polysaccharides with water-retaining properties
and intravascular retention
The colloidal properties make it a useful volume
expander.
Intravascular infusion of pentaspan results in
expansion of plasma in excess of the volume of
pentaspan infused.
Expansion exists for approx. 18-24 hours and is
expected to improve hemodynamic status for
12-18 hours.
70% of drug eliminated in 24 hrs
Pentaspan
Indications:
Plasma volume expansion in the
management of:
Shock due to hemorrhage
Surgery
Sepsis
Burns
Other trauma
Pentaspan
Contraindications:
Hypersensitivity to hydroxyethyl starch
Bleeding disorders
CHF, where volume overload is a
potential problem
Should not be used in renal disease with
oliguria or anuria not related to
hypovolemia.
Pentaspan
Adverse Reactions:
Coagulation disorders or hemorrhage
Hypersensitivity
Chills
Anxiety
Pentaspan
Supplied:
IV infusion bags of 250 and 500 ml. (10%
solution) – which gives what
concentration?
May appears translucent pale yellow to
amber colored
Pentaspan
Dosage:
Total dose and infusion depends on the
amount of blood or plasma lost.
Typical is 500 - 2000 ml
Max: 28 ml/kg/day
In acute hemorrhagic shock, an
administration of 20 ml/kg/hour may be
used.
Albumin
Other Names:
Plasbumin- 5 %
Plasbumin- 25 %
Class:
Plasma Volume Expander
Albumin
MOA:
Albumin is the main protein in human blood and the key to
the regulation of the osmotic pressure of blood.
Chemically, albumin is soluble in water, precipitated by
acid, and coagulated by heat.
Albumin 5%
is oncotically equivalent volume for volume to normal human
plasma and will allow expansion of the blood volume equal
to the volume infused (if patient is hydrated)
Albumin 25%
has an oncotic effect in which an additional fluid is drawn
from the extra cellular tissues into circulation within 15
minutes. Blood viscosity and hemoconcentration is reduced,
while total blood volume increases making Albumin 25% a
key plasma volume expander (3-4 times)
Albumin
Indications:
Emergency treatment of:
Hypovolemic shock,
burn therapy
cardiopulmonary bypass (CABG)
acute liver failure
Volume deficit consider Albumin 5%
Oncotic deficit consider Albumin 25% along with
appropriate crystalloid solution.
Albumin
Contraindications:
Hyperhydration
Pulmonary edema
Severe anemia
Heart failure
Hypersensitivity
Albumin
Adverse Effects:
Shaking
Chills
Uticaria
Severe anemia
Heart failure
Hypersensitivity
Albumin
Supplied:
Vial of Albumin
5% USP
Vial of Albumin
25%
Albumin
Dosage:
500 ml of Albumin 5% q 30 min IV, PRN
Needs to be administered IV slowly to
prevent fluid overload
No specific duration