Quiz 7

Question 1

Morphine

Answer 1

Class: Opioid analgesic

Action: Causes venous dilation and decreased venous return to the heart thus reducing myocardial oxygen demand. Also causes euphoria, CNS depression and sedation

Indications: Acute pain, chest pain associated with ACS, pulmonary edema

Contraindications: Hypersensitivity to narcotics, CNS depression, respiratory depression, hypotension, hypovolemia, AMS, head injury, respiratory depression, pt’s that took MAO inhibitors in last 14 days, and caution with pt’s with RV infarction/MI

Onset/Duration: Onset- 1-2 mins; Duration- 2-7 hrs

Dose/Route:
Adult- 2-5 mg IV repeat every 5-10 min as needed

Pedi- 0.1-0.2 mg/kg IV max total dose of 15mg

Side Effects: Hypotension, CNS depression, tachycardia, respiratory depression

Question 2

Promethazine

Answer 2

Class: Phenothiazine, antihistamine, antiemetic

Action: Promethazine is an H1 receptor antagonist that blocks the actions of histamine by competitive antagonism at the H1 receptor. Also acts as an antiemetic and sedative agent with some anticholinergic properties.

Indications: Nausea and vomiting, motion sickness, to potentiate the effects of analgesics, pre/post op obstetrical sedative, allergic reactions

Contraindications: Hypersensitivity, CNS depression or coma, CNS depression from alcohol, barbiturates, narcotics, signs associated with Reye’s syndrome. Use w/ caution in pt’s w/ asthma, peptic ulcer disease, and bone marrow depression.

Onset/Duration: Onset- Rapid by IV; Duration- 4-6 hrs

Dose/Route:
Adult- 12.5-25mg IV diluted in 10cc NS w/ doses of 25mg or less given over 10-15min. IM doses can be given undiluted.

Pedi- Not recommended in prehospital setting

Side Effects: Sedation, dizziness, hypotension, dystonias/EPS reaction, hallucinations, dysrhythmias, phlebitis, hyperexcitability

Question 3

Levophed

Answer 3

Class: Sympathomimetic Amine

Action: Norepinephrine is a peripheral vasoconstrictor (alpha-adrenergic action) and an inotropic stimulator of the heart and dilator of coronary arteries (beta-adrenergic action)

Indications: To raise BP in adult patients with severe, acute hypertension

Contraindications: None

Onset/Duration: Onset- Steady state plasma concentration achieved in 5 mins

Dose/Route: 4mcg/ml; 2-4 mcg/ml/min IV piggyback drip

Side Effects: Tissue ischemia, hypotension, cardiac arrhythmias, hypertension, bradycardia, anxiety, pulmonary edema, respiratory difficulty

Question 4

Procainamide

Answer 4

Class: Antidysrhythmic (Class 1a)

Action: Suppresses phase 4 depolarization in normal ventricular muscle and Purkinje fibers, reducing automaticity of ectopic pacemakers. Suppress reentry dysrhythmias by slowing intraventricular conduction.

Indications: Stable V-Tach, reentry SVT not controlled by adenosine/vagal maneuvers, A-Fib w/ a rapid rate w/ WPW syndrome

Contraindications: 2nd or 3rd degree heart blocks w/o a functioning artificial pacemaker in place, digitalis toxicity, tornadoes de pointes, tricyclic antidepressant overdose

Onset/Duration: Onset- 10-30 mins; Duration- 3-6 hrs

Dose/Route:
Adult- 20 mg/min slow IV infusion drip w/ a total dose of 17 mg/kg. Maintenance drip post cardiac arrest of 1 gm in 250 mL D5W or NS and infuse at 1-4mg/min

Pedi- Loading dose 15 mg/kg IV/IO and infuse over 30-60 mins

Side Effects: Hypotension, bradycardia, reflex tachycardia, AV block, widening QRS complex, prolonged P-R or QT interval, PVC’s, V-Tach/V-Fib/Asystole, seizures, CNS depression