Drug Profiles: Winter quiz 1 Flashcards
(52 cards)
<p>Succinylcholine: Pharmacokinetics</p>
<p>Onset: 1-2 minutes.
| Duration: 6-10 minutes.</p>
<p>Rocuronium (Zemuron): Precautions</p>
<p>Not routinely used in EMS as the initial paralytic due to the long duration of action.</p>
<p>Diltiazem: Contraindications</p>
<p>Should not be administered to any patient with hypotension, cardiogenic shock, VT, or A flutter, and A fib with WPW (may percipitate ventricular fibrillation). </p>
<p>Vasopressin: Mechanism of Action</p>
<p>In high doses, vasopressin acts as a non-adrenergic peripheral vasoconstrictor. When given during CPR, vasopressin increases coronary perfusion pressure.</p>
<p>Vasopressin: Pharmacokinetics</p>
<p>Onset: 2 minutes
| Duration: 10-20 minutes </p>
<p>Etomidate: Note</p>
<p>Etomidate is able to lower ICP while maintaining CPP, making it a useful agent in patients with increased ICP. </p>
<p>Rocuronium (Zemuron): Interactions</p>
<p>Intensity and duration, or paralysis may be prolonged by pretreatment with succinylcholine, general anesthesia (inhalation), lidocaine, quinidine, procainamide, beta-adrenergenic-blocking agents, potassium-losing diuretics, or magnesium.</p>
<p>Rocuronium (Zemuron): Dosage</p>
<p>RSI: 0.6 mg/kg</p>
<p>Vasopressin: Precautions</p>
<p>Do not give to patients with perfusing rhythms.</p>
<p>Succinylcholine: Contraindications</p>
<p>Hyperkalemia, history of malignant hyperthermia, penetrating eye injury, neuromuscular disorder (MS), Paralysis >1 day, crush injury >3 days, sever burns >3 days.</p>
<p>Succinylcholine: Mechanism of Action</p>
<p>Combines with cholinergic receptors in motor nerves to cause depolarization. Neuromuscular transmission is inhibited, causing temporary skeletal paralysis, untill it is metabolized and the cells become repolarized.</p>
<p>Vasopressin: How Supplied</p>
<p>20 units/ml vial</p>
<p>Vasopressin: Dosage</p>
<p>Single bolus dose of 40 units IV. After 3 to 5 minutes, if no response, give 1 mg Epi doses </p>
<p>Succinylcholine: Class</p>
<p>Depolarizing neuromuscular blocking agent.</p>
<p>Rocuronium (Zemuron): Description</p>
<p>A non-depolarizing neuromuscular blocking agent with rapid to intermediate onset, depending on dose, and intermediate duration of action.</p>
<p>Diltiazem: Pharmacokinetics</p>
<p>Onset: Immediate
Peak: Immediate
Duration: 1-3 hours</p>
<p>Ketamine: Mechanism of action</p>
<p>Phencyclidine derivitive causes "dissociative anaesthesia" characterized by profound analgesia and amnesia with retention of protective airway reflexes, spontaneous respirations and cardiopulmonary stability. Dissociative anesthesia results in a patient who does not appear to be anesthetized and can swallow and open eyes but does not process information or pain. Other actions: keeps airway reflexes intact; releases endogenous catecholamines; maintaines BP and heart rate; relaxes bronchial muscles; stimulates beta receptors in the lungs. </p>
<p>Rocuronium (Zemuron): Contraindications</p>
<p>None in EMS.</p>
<p>Etomidate: Mechanism of Action</p>
<p>Decreases activity of the reticular formation in the brain with minimal cardiac and respiratory effects.</p>
Diltiazem: Dosage
0.25 mg/kg over 2 minutes
Repeat 0.35 mg/kg if no responce in 15 minutes.
Max single dose: 20-25 mg
Maintenance infusion of 5-15 mg/hr
<p>Ketamine: Pharmacokenetics</p>
<p>Onset: 30-60 seconds
| Duration: 5-15 minuets</p>
<p>Vasopressin: Class</p>
<p>Anti-diuretic hormone.</p>
<p>Succinylcholine: Indications</p>
<p>To achieve temporary paralysis when endotrachial intubation is indicated and muscletone impedes successful intubation.</p>
<p>Ketamine: Precautions </p>
<p>Administer with midazolam 2.5 mg IV/IO in adults to prevent/treat negitive emergnce reaction (not necessary in peds); monitor for laryngospasm (0.1%)</p>
Succinylcholine: Note
Store in refrigerator at 2-8 deg C (36-46 deg F). The multi dose vials are stable for upto 14 days at room temprature without significant loss of potency.
Etomidate: Indications
General anasthesia, EMS intuation.
Ketamine: Side effects
Emergence reaction (5-30%); may cause hypertension, increase cardiac output and myocardial oxygen consumption; may transiently increase intracranial pressure and cardiac perfusion pressure.
Ketamine: Contraindications
Coronary artery disease, pregnany, infants < 3 months; tracheal stenosis or tracheomalacia, acute globe injury or glaucoma; schizophrenia.
Rocuronium (Zemuron): pharmacokinetics
Onset: 60-90 seconds | Duration: 30 minutes
Diltiazem: Class
Calcium Channel Blocker
Etomidate: Pharmacokinetics
Onset: 10-20 seconds | Duration: 3-5 minutes
Etomidate: Class
General anasthetic.
Diltiazem: Precautions
Can cause systemic hypotension (blood pressure should be constantly monitored). Calcium can be used to prevent the hypotensive effecs of calcium hannel blockers and in the management of calcium channel blocker OD.
Etomidate: Contraindications
None in prehospital.
Vasopressin: Indications
Ventricular fibrillation, pulseless VT, PEA, and or asystole.
Rocuronium (Zemuron): Indications
Rapid sequence intubation, maintenance of desired paralysis.
Rocuronium (Zemuron): Side Effects
Bronchospasm; associated with a slight elevation of the heart rates and BP. Tachycardia may occur in pediatric patients.
Etomidate: Dosage
0.3 mg/kg IV. Max 20 mg.
Etomidate: Side effects
Involuntary muscle movements (myoclonus - rarely seen due to concurrent administration of paralytics)
Succinylcholine: Side Effects
Arhythmias, bradycardia, increased inraoccular pressure, increased intracrainial pressure, hyperkalemia.
Vasopressin: Contraindications
None in EMS.
Diltiazem: Interactions
Should not be administered to patiens recieving IV B-blockers because of an increased risk of CHF, bradycardia, and asystole
Vasopressin: Side Effects
None in cardiac arrest.
Ketamine: Indications
Analgesia and sedation for painful procedures or painful conditions; induction agent for RSI (instead of etomidate).
Succinylcholine: Precautions
Make sure all intubation equipment is ready prior to administration of succinylcholine. Be wary of a patient's potential to become bradycardicduring RSI, especially patients with CHF.
Succinylcholine: Dosage
Adult: 1-2 mg/kg IV (IM if in protocol) | Pediatric: 2 mg/kg IV
Diltiazem: Mechnism of Action
Diltiazem interferes with the entry influx of calcium into cardiac and vascular smooth muscle. In addition it slowes the rate of the SA node and the conduction velosity through the AV node. Diltiazem's ability to relax coronary arteries, as well as its negitive inotropic and negitive chronotropic qualities makes it a useful antianginal. It is also used as an antihypertensive. however in the EMS setting, we use it primarily as an antidysrhythmic so its ability to slow the conduction through the AV node is most pertinent.
Ketamine: Dosage
Induction agent: 2 mg/kg IV/IO Analgesia, sedation: 1 mg/kg IV/IO over 30 seconds; may repeat 0.5-1 mg/kg very 3-5 minutes. Or 4-5 mg/kg IM; may repeat with 2-5 mg IM after 5-10 minutes if needed.
Diltiazem: Indications
To control rapid ventricular rates associated with atrial fibillation and atrial flutter, and SVT refractory to adenosine.
Diltiazem: Side Effects
Dizziness, headache, bradycardia, heart block, hypotension, and asystole.
Rocuronium (Zemuron): Mechanism of Action
Competitively binds to cholinergic receptors. Reversible in the presence of acetylcholinesterase inhibitors, such as neostigmine.
Rocuronium (Zemuron): Class
Non-depolarizing neuromuscular blocker.
