Week 5

Question 1

Calcium Gluconate

Answer 1

CLASS: Electrolyte

MOA:

-Mineral component of bones/teeth

-Cofactor in enzymatic reactions

-Essential for neurotransmission, blood clotting & contraction of cardiac,smooth & skeletal muscles

INDICATIONS:

-Beta blocker & calcium channel blocker toxicity

-Topical use in hydrofluoric acid burn management

-Hypocalcemia

-Hyperkalemia

CONTRAINDICATIONS:

-Digoxin toxicity
-Hypercalcemia
-Suspected severe hypokalemia

DOSAGE:

Adult= 1.5-3g (15-30mL 10% solution) slow IV/IO push over 5min

Peds= 60mg/kg slow IV over 10min

Question 2

Dopamine (intropin)

Answer 2

CLASS: (AEIV)
Adrenergic, Endogenous catecholamine, inotropic agent, vasopressor

MOA:

-Immediate metabolic precursor to norepinephrine

-Doses of 1-2mcg/kg/min stimulate dopamine receptors

-Doses of 2-10mcg/kg/min stimulate beta-1 receptors

-Doses of 10-20mcg/kg/min stimulate alpha receptors

-Doses greater then 20mcg/kg/min, alpha stimulations predominate

INDICATIONS:

-Cardiogenic or distributive shock
-Hypotension w/ low cardiac output
-2nd line for symptomatic bradycardia

CONTRAINDICATIONS:

-Hypovolemia
-Pheochromocytoma
-Uncorrected tachydysrhythmias
-VF

DOSAGE:

-Adult only

IV/IO infusion @ 5-20mcg/kg/min, slowly titrated

Question 3

Phenylephrine (Neo-Synephrine)

Answer 3

CLASS: Adrenergic, alpha agonist, vasoconstrictor

MOA:

-Stimulates alpha adrenergic receptors in the arterioles of the nasal mucosa to cause vasoconstriction

INDICATIONS:

-Epistaxis
-Reduce bleeding from nasotracheal intubation

CONTRAINDICATIONS:

-Use extreme caution in geriatric pt w/ preexisting cardiovascular disease

DOSAGE:

Adult=
2 sprays in nose before nasotracheal tube insertion

Question 4

Labetalol (Normodyne, Trandate)

Answer 4

CLASS:
-Selective alpha & nonselective beta-adrenergic blocker, antihypertensive

MOA:
-BP reduction w/out reflex tachycardia; total peripheral resistance reduced w/out significant change in cardiac output

INDICATIONS:
-Moderate to severe hypertension

CONTRAINDICATIONS: (BBCHS)
-Bronchial asthma
-Bradycardia
-Cardiogenic shock
-Heart failure
-2nd & 3rd degree heart block

DOSAGE:
-Adult

-10mg IV push over 1-2min; May repeat or 2x every 10min to a max dose of 150mg

-Infusion=
2-8mg/min, titrated to supine BP

Peds= NOT RECOMMENDED

Question 5

Sodium Bicarb

Answer 5

CLASS:
-Systemic hydrogen ion buffer, alkalizing agent

MOA:

-Reacts w/ hydrogen ions to form H20 & CO2, correcting metabolic acidosis

-Increases blood & urinary pH by releasing a bicarbonate ion, which neutralizes hydrogen ion concentrations

INDICATIONS:

-Cardiac arrest which hyperkalemia or TCA overdose is suspected

-50%+ QRS prolongation in known or suspected TCA overdose

-Crush syndrome

CONTRAINDICATIONS: (HHHKU)

-Hypernatremia
-Hypocalcemia
-Hypokalemia
-Known metabolic or resp. alkalosis
-Use w/ caution for heart/ renal failure

DOSAGE:

-Adult/Peds= 1 mEq/kg slow IV/IO push

-Call med control for repeat dosing