Respiratory Drugs 03/26 Flashcards Preview

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Flashcards in Respiratory Drugs 03/26 Deck (36):
1

Epinephrine: drug classification

Sympathomimetric / sympathetic agonist / catecholamine

2

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

3

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

4

Epinephrine: indications/field use

Cardiac arrest
Anaphylaxis
Severe reactive airway disease/Asthma
Symptomatic bradycardia
Hypotension
Refractory anaphylaxis

5

Epinephrine: Contraindications

Tachydysrhythmias

6

Epinephrine: side effects/ adverse reactions

Anxiety
HA
Dysrhythmias
Tremulousness
Dizziness
N+V

7

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

8

Epinephrine: Precautions

Should be protected from light, caution with CAD
**LEADS TO INCREASED MYOCARDIAL O2 DEMAND**

9

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).

10

Nitroglycerin (Nitrostat): Classification

Vasodilator / Nitrate

11

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.

12

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

13

Nitroglycerin (Nitrostat): Indications/Field Use

Chest Pain associated with angina or MI
Acute pulmonary edema/CHF

14

Nitroglycerin (Nitrostat): Contraindications

- shock, hypotension
- Increased ICP
- Children under 12
- ED drugs w/in 48 hours

15

Nitroglycerin (Nitrostat): Side effects/Adverse Reactions

HA
Dizziness
Weakness
Tachycardia
Hypotension
Rash
Dry mouth
N + V

16

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

17

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

18

Nitroglycerin: (Nitrostat) Drug-Drug interactions

Orthostatic hypotension with Beta-blockers, severe hypotension with alcohol.

19

Oxygen: Drug classification

Gas

20

Oxygen: MOA

Enters body via respiratory system, transported to cells by hemoglobin, required for efficient breakdown of glucose into useable energy.

21

Oxygen: Pharmacokinetics

Onset: Immediate
Peak Effects: < 1 min inhaled
Duration: < 2 min inhaled
Half-life: N/A

22

Oxygen: Indications/Field Use

- Hypoxia
- Difficulty breathing
- SpO2 <94%

23

Oxygen: Contraindications

- ROSC post cardiac arrest with SPO2 >94%
- Chest pain, acute MI, suspected cellular injury and death with SPO2 > 94%

24

Oxygen: Side effects/ Adverse RXNs

Free radical formation in the presence of injured tissues, causing secondary cell death.

25

Oxygen: Dose

(ADULT) 2-6L NC, 12-15 NRB, 15L BVM
CPAP/VENT (ADULT) Varies by O2 demand to meet cmH2O requirement

(PED): 2-6L NC, 10-15 NRB, 15 LPM NRB, BVM

26

Oxygen: Precautions

Avoid hyperoxia, high concentration to neonates can cause eye damage

27

Oxygen: Drug-Drug interactions

None EMS

28

Furosemide (Lasix): Drug Classification

Loop Diuretic

29

Furosemide (Lasix): MOA

*Enhances vascular prostaglandin synthesis —> decreased intracellular calcium and vascular SMC relaxation —> venous dilation and reduced preload

*Binds to chloride binding site onNa+/2Cl-/K+ cotransporter found on the luminal surface of the thick ascending limb of the loop of Henle —> inhibits sodium and chloride reabsorption in the kidneys, thus impacting the osmotic gradient and reducing water reabsorption in the descending limb.

30

Furosemide (Lasix): Pharmacokinetics

Onset: 5-10 mins vasodilation, 5-30 mins, diuresis
Peak: 30 mins vasodilation, 20-60 mins diuresis
Duration: 2 hours vasodilation, 6 hours diuresis
Half-life: 30 mins

31

Furosemide (Lasix): Indications/ Field use

Acute pulmonary edema secondary to CHF

32

Furosemide (Lasix): Contraindications

Pregnancy

33

Furosemide (Lasix): Side effects/ Adverse RXNs

HA
Dizziness
Hypotension
Volume depletion
Potassium depletion
Dysrhythmias
Dehydration
Diarrhea
N + V

34

Furosemide (Lasix): Dose

(ADULT): 40 mg slow IV, IO; if PT takes lasix give 1.5x home dose.

(PEDI): 0.5-1mg/kg slow IVP (Not for kids under 12)

35

Furosemide (Lasix): Precautions

Protect from light
Caution with renal failure and sulfa allergies

36

Furosemide (Lasix): Drug-Drug interactions

-May cause additive effects and/or electrolyte imbalance if given with other diuretics
-NSAIDs may antagonize effects of Lasix