Transcript Pharmacology

Gimme ‘da DRUGS, man!
 During the transport of an ACS patient, you notice
that after giving nitroglycerin, their blood pressure
drops to s*&#! (S*&#! = 50/palp). As you wonder “how
did nitroglycerin drop it that low” you give a fluid
bolus but also grab the Dopamine. “How does
Dopamine work? How do I give it? What are the side
effects?” You ponder, noticing a bit late that your
patient has been unconscious for the past 10 seconds,
in V-fib. Things just went from S*&#! to F*&#!...
 Generic Name/Trade Name: different names depending on
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who is making it. Examples: acetaminophen/Tylenol,
fentanyl/Sublimaze, hydromorphone/Dilaudid.
Mechanism of Action: how it works in the body
Pharmacokinetics – how it is absorbed, distributed, and
eliminated from the body
Dosage/Route – how much and where (oral, rectal, nasal,
IV, IM, subcutaneous)
Indications/Contraindications – what its used for, what will
prevent you from giving it.
Adverse effects – things that might go wrong if you give it
 Therapeutic levels – range of serum levels in which
drug will have its predicted value
 LD50 – level at which drug will kill 50% of the patients
given the drug
 Metabolism – how the body transforms the drug to
make it inert and ready for removal
 Excretion – how the drug exits the body
 Liver/fecal
 Kidney/urine
 Combination
 Right Drug
 Right Patient
 Think Mass Casualty situations
 Right Dose
 Have a reference handy
 Right Time
 Right Route
 Right Documentation
 Time, who gave it, what happened!!
 Receptor
 A protein made by the cell, nestled in the cell wall that
acts as a signal sentinel.
 Acts in response to this signal in a certain way
 Usually by a second messenger system
 The structure of the receptor is such that it can be
stimulated, overstimulated, or blocked from acting.
 The second messengers cause the production of
enzymes
 Stimulate a receptor
 epinephrine, dopamine, Narcotics, Benzos, succinylcholine,
albuterol
 Block a receptor
 lidocaine, aspirin, Narcan, Vecuronium, atropine, adenosine,
amiodarone, diphenhydramine
 Directly effect body chemistry/osmolarity
 electrolytes, bicarb, NaCl, mannitol
 Act as an enzyme or catalyst
 tPA, thiamine, cyanocobalamin
 Block an enzyme
 Act as substrate for a chemical reaction
 Mucomyst, nitroglycerin, oxygen, glucose
 Kill Bugs - antibiotics
 Sympathetic
 Alpha (1, 2)
 Constricts blood vessels, dilates pupils
 Beta
 1 – increases heart rate
 2 – dilates bronchioles, arterioles
 Parasympathetic
 Muscarinic
 Relaxes smooth muscle (except bronchioles)
 Decreases heart rate, electrical conduction
 Constricts pupils
 GABA
 Causes a decrease in neuronal activity
 Opioid
 Block pain reception in the spinal cord
 Causes euphoria (mu receptor)
 Acetylcholine
 Allows for transmission of nerve impulse to a muscle
group – contracts muscle
 Dopamine
 Poorly understood, neuronal signaling and cognition
 Aspirin (Ecotrin, Bayer)
 Action: Thromboxane A2 inhibitor, causes platelet
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function inhibition
Dosage: 324mg oral chewed
Indications: Cardiac chest pain
Contraindications: Allergy, GI bleeding
Side Effects – bleeding, GI upset
 Nitroglycerin (EMT can assist patient with his/her
own, AEMT and medic can give without prior Rx)
 Effect: vasodilator, chest pain reliever
 Dosage: 0.4mg sublingual Q 15 min x3
 Indications: chest pain
 Contraindications: hypotension, allergy
 Side Effects: Headache, hypotension, syncope, cardiac
arrest
 Albuterol (Proventil)
 Effect: Dilates smooth muscle in bronchioles (B2)
 Dosage: 1-2 puffs per MDI PRN (max three doses);
AEMTs and Medics – 1 ampule neb prn, max 3
 Indications: Asthma or COPD exacerbations
 Contraindications: none
 Side Effects: jitteriness, tachycardia, arrhythmia,
sweating, anxiety
 Epinephrine (EpiPen, EpiPen Jr)
 Effect: A1, A2, B1, B2 receptor agonist – vasocontricts,
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relaxes bronchiole smooth muscle, increases heart rate
Dosage: EMTs: EpiPen (0.3ml) or EpiPen Jr (0.15ml)
Dosage: AEMTs: 0.3ml 1:1000 IM, or 0.15ml for 15-30kg
Dosage: Medics: as above, or 0.1-0.5mg iv 1:10,000 for
anaphylaxis, 0.1mg/kg, max 1mg IV Q5 min for arrest
Indications: Anaphylaxis, severe asthma (medical
control), cardiac arrest
Contraindications – none
Side Effects: arrhythmia, hypertension, MI, jitteriness
 Oxygen
 Effects: acts as a metabolic substrate for respiration,
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energy production
Dosage: 2-15lpm via NC (max 6lpm), or oxymask
Indications: hypoxia, respiratory distress, stroke like
syndromes
Contraindications: open flame
Side Effects: hyperoxia indicated in free radical
formation and increased cell damage.
 Dextrose/Glucagon
 Reviewed in Diabetic Emergencies Lecture
 Diphenhydramine (Benadryl)
 Reviewed in Anaphylaxis Lecture
 Naltrexone (Narcan)
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Effects: opioid receptor antagonist
Dosage: 0.4mg IV Q5 min until desired effect, max 2mg
Indications: altered mental status, narcotic OD
Contraindications: alert patient
Side Effects: pain, agitation, vomiting, injury to EMT if
patient not restrained.
 Benzodiazepines (diazepam/Valium; medazolam/Versed)
 Effects: GABA receptor agonist – increase seizure threshold,
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sedating effects
Dosage: Valium (long acting) .1-.2mg/kg IV, IM or PR
(gel) max 5-10mg x1 dose
Versed (medium acting) .02-.05mg/kg max 4mg x1
Indications :Seizures, acute severe agitation, bath salts
Contraindications: respiratory depression, sedation, high risk
airway, allergy
Side Effects: miosis, respiratory depression, need for
intubation
 Narcotics (morphine; fentanyl)
 Effects: opioid agonist – provides pain relief
 Dosage: Morphine 0.1mg/kg IV/IM max 10mg for pain
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Fentanyl – 0.5-1 mcg/kg iV max 50mcg x1 SLOW
Medical control for any further dosing
Indications: acute traumatic pain, cardiac pain
(morphine only)
Contraindications: abdominal pain, allergy, respiratory
depression or altered mental status
Side Effects: Chest Wall Rigidity syndrome, respiratory
depression, hypotension
 Zofran
 Effect: Reduction of nausea through inhibition of
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serotonin 5-HT3 receptor
Dosage: 4mg IV/ODT for Adults and Children 6 and
older
2mg IV/ODT children 2-6
1mg IV children 6 months-2 years
Indications: nausea and vomiting
Contraindications: allergies
Side effects: may prolong QT, headache
 Phenergan
 Effects: reduces nausea and vomiting via dopamine
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receptor antagonism
Dosage: 25mg IM for adults only. Pediatric use not
permitted
Indication: nausea and vomiting
Contraindication: sedation, allergy
Side Effects: respiratory depression, extrapyramidal
symptoms (dystonic reaction), anxiety, hypotension
 Haldol
 Effects: sedation and reduction of psychotic symptoms
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via dopamine receptor antagonism
Dosage: 2.5mg-5mg IM/2mg IV
Indication: acute psychosis, severe agitation, second line
to maxing out your benzos for bath salts.
Contraindications: allergies, prolonged QT syndrome
Side Effects: sedation, Torades de Pointe, ventricular
tachycardia, dystonia.
 Ketamine
 Effect: produces dissociative state through limbic system
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interaction
Dosage: 1-2mg/kg IV or 3-4mg/kg IM
Indications: induction agent
Contraindications: Theoretical – increased ICP,
increased IOP, allergy
Side effects: laryngospasm, emergence reactions,
excessive drooling
 Paralytics (Rocuronium/Vecuronium)
 Effect: inhibits release of acetylcholine at the
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neuromuscular junction causing paralysis
Dosage: Vecuronium: 0.1mg/kg IV
Rocuronium: 1mg/kg IV
Indications: paralytic agent for RSI
Contraindications: difficult airway, insuffient expertise
in airway management
Adverse Reactions: death
 Solu-Medrol
 Effects: corticosteroid - reduces inflammation and
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immunity through multiple messengers and
interactions
Dosage: 1mg/kg IV, max 125mg IV
Indications: asthma, COPD, anaphylaxis
Contraindications: allergy
Side Effect: hyperglycemia, jitteriness,
immunosuppression, renal impairment, GI bleeding
 Vasopressin
 Effect: hormone – constricts blood vessels and improves
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cardiac contractility
Dosage; 40 units x1 dose in lieu of first epi for cardiac
arrest.
Indications: cardiac arrest
Contraindications: none
Side effects: none in prehospital setting
 Lidocaine
 Effects: Sodium Channel Blockade, inhibiting nerve
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conduction for pain, and delaying ventricular
automaticity
Dosage: V-tach/V-fib – 1mg/kg IV x1
IO needle pain – flush IO tubing with lidocaine
and push through with first normal saline
flush
Indications – v-tach/v-fib, IO injection site pain
Contraindications: allergy
Side effects: complete heart block, ventricular arrest,
seizures
 MARK I Kit
 Effects: Reverses the effects of organophosphate poisons
 Dosage : 1 kit, repeat in 5 min as needed
 Contains: Atropine 1mg
2-PAM Chloride 600mg
 Indications: organophosphate poisoning, WMD event
 Contraindications: none in this setting
 Side Effects: blurred vision, headache, dizziness, nausea,
tachycardia
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 Magnesium Sulfate
 Effect: relaxes smooth muscles in bronchioles, uterus,
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stabilizes cardiac membranes
Dosage: 1-2 gm IV in adults over 20 minutes for asthma
(medical control required), 1-2gm IV push for Torsades
Indications: severe asthma, Torsades, preterm labor
Contraindications: hypermagnesemia
Side Effects: paralysis, respiratory depression
 Amiodarone
 Effect: Antiarrhythmic – multiple mechanisms
 Dosage: 150mg IV for V-tach, 300mg IV for V-fib arrest
 Indications: V-tach, V-fib
 Contraindications: allergy, AV block, pregnancy,
breastfeeding
 Side Effects: lung fibrosis, AV block, Torsades with other
QT prolonging medications
 Atropine
 Effect: antagonizes muscarinic receptors in
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parasympathetic nervous system
Dosage: 0.5mg-1mg IV
Indication: Symptomatic Bradycardia
Contraindications: none
Side Effects: dry mouth, tachycardia, jitteryness
 Hydroxocobalamin
 Effect: reverses cyanide toxicity by combining with
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cyanide to make Vitamin B12
Dosage:5gm IV
Indications: cyanide Toxicity
Contraindications: caution for hemodialysis patients
Side Effects: none
 Tetracaine
 Effect: anaesthetizes eye nerve ending through sodium
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channel blockade
Dosage: 1-2 gtts per eye, repeat PRN
Indications: eye trauma
Contraindications: allergy to agent, open globe
Side Effects: increasing tearing. Burning
 Adenosine
 Effects: AV nodal blocking agent
 Dosage: 0.05-0.1mg/kg up to 6mg IV RAPID push, max
12mg
 Indications: SVT
 Contraindications: wide complex tachycardia with
abberancy, WPW
 Side Effect: asystole (short lived), increased HR with
WPW.