Respiratory Drugs 03/26 Flashcards
(36 cards)
Epinephrine: drug classification
Sympathomimetric / sympathetic agonist / catecholamine
Epinephrine: MOA
Alpha 1 agonist —> second messenger release of calcium in VSMC —> peripheral vasoconstriction —> increased SVR —> increased BP
Beta 1 agonist —> increased intracellular Ca2+ in cardiac cells —> positive inotropy, chronotropy, dromotropy.
Beta 2 agonist —> bronchial smooth muscle relaxation —> bronchodilation.
Blocks release of calcium in and subsequent destruction of mast cells
Epinephrine: pharmacokinetics
Onset: < 2 mins IV, 3-10 mins IM
Peak: < 5 mins IV, 20mins IM
Duration: 5-10 mins IV, 20-30 mins IM
Half-life: 5 mins IV
Epinephrine: indications/field use
Cardiac arrest Anaphylaxis Severe reactive airway disease/Asthma Symptomatic bradycardia Hypotension Refractory anaphylaxis
Epinephrine: Contraindications
Tachydysrhythmias
Epinephrine: side effects/ adverse reactions
Anxiety HA Dysrhythmias Tremulousness Dizziness N+V
Epinephrine: Dosage
Cardiac arrest (ADULT): 1mg rapid IV, IO [1:10,000] q 3-5min Anaphylaxis/Asthma (ADULT): 0.3mg [1:1000] IM q 5 min x 3 doses Bradycardia/Hypotension/Refractory Anaphylaxis (ADULT): 2-10mcg/min IV, IO infusion
Cardiac Arrest (PEDI): 0.01 mg/kg rapid IV, IO [1:10,000] q 3-5 min
Anaphylaxis/Asthma (PEDI): 0.01mg/kg [1:1,000] IM (MAX 0.3mg), repeat epinephrine 0.01mg/kg IM every 5 min until symptoms resolve. For persistent hemodynamics compromise, bronchospasm, consider: Epinephrine infusion 0.1-0.2mcg/kg/min MAX 10mcg/min [1:1,000] slow IV, IO
Bradycardia (PEDI): 0.01mg/kg IV, IO [1:10,000] q 3-5 min
Epinephrine: Precautions
Should be protected from light, caution with CAD
LEADS TO INCREASED MYOCARDIAL O2 DEMAND
Epinephrine: Drug-Drug interactions
pH dependent
Deactivated by alkaline solutions; effect intensified w/ PT’s taking antidepressants
Reacts CaCl2 and NaHCO3 to form PPT (in IV tubing).
Nitroglycerin (Nitrostat): Classification
Vasodilator / Nitrate
Nitroglycerin (Nitrostat): MOA
Pro-drug which must be de-nitrated to form the active metabolite nitric oxide (NO). Then, NO activates the conversion of GTP —> cGMP + 2Pi in vascular smooth muscle cells (VSMC). CGMP activates a cascade of reactions that cause a reduction in intracellular Ca2+, VSMC relaxation (in arterioles) and decreased cardiac preload and afterload.
Nitroglycerin (Nitrostat): Pharmacokinetics
Onset: 1-2 mins IV, 1-3 mins SL, 30 mins topical
Peak: 5-10 mins SL, varies topical
Duration: 20-30 mins SL, 3-6 hours topical
Half-life: 1-4 mins
Nitroglycerin (Nitrostat): Indications/Field Use
Chest Pain associated with angina or MI
Acute pulmonary edema/CHF
Nitroglycerin (Nitrostat): Contraindications
- shock, hypotension
- Increased ICP
- Children under 12
- ED drugs w/in 48 hours
Nitroglycerin (Nitrostat): Side effects/Adverse Reactions
HA Dizziness Weakness Tachycardia Hypotension Rash Dry mouth N + V
Nitroglycerin (Nitrostat): Dose
Spray/Tablet (ADULT): 0.4mg SL q 3-5min until effect achieved or BP drops (max 3x25mins)
Paste (ADULT): 1-2 inches Topical
Nitroglycerin (Nitrostat): Precautions
- Expect HA from cerebral vasodilation
- Routine use may cause tolerance
- 12-lead ECG prior to administration
- Doesn’t improve morbidity or mortality, is only used to treat pain
- Use with EXTREME CAUTION in Inferior wall MI
Nitroglycerin: (Nitrostat) Drug-Drug interactions
Orthostatic hypotension with Beta-blockers, severe hypotension with alcohol.
Oxygen: Drug classification
Gas
Oxygen: MOA
Enters body via respiratory system, transported to cells by hemoglobin, required for efficient breakdown of glucose into useable energy.
Oxygen: Pharmacokinetics
Onset: Immediate
Peak Effects: < 1 min inhaled
Duration: < 2 min inhaled
Half-life: N/A
Oxygen: Indications/Field Use
- Hypoxia
- Difficulty breathing
- SpO2 <94%
Oxygen: Contraindications
- ROSC post cardiac arrest with SPO2 >94%
- Chest pain, acute MI, suspected cellular injury and death with SPO2 > 94%
Oxygen: Side effects/ Adverse RXNs
Free radical formation in the presence of injured tissues, causing secondary cell death.
