Week 10 Drugs (Etomidate, Glucagon, Glucose, Ipratropium, Ketamine, Lorazepam)

Question 1

Etomidate
Pharmacology & Actions

Answer 1

• Sedative and Hypnotic
• Depresses activity of brain stem reticular activating system
• No analgesic properties

Question 2

Etomidate
Indications

Answer 2

• Induction of anesthesia for Rapid Sequence Intubation (RSI)

Question 3

Etomidate
Absolute Contraindications

Answer 3

• Known Hypersensitivity
• Etomidate Allergy

Question 4

Etomidate
Precautions & Side Effects

Answer 4

• Not intended for prolonged infusion due to suppression of cortisol and aldosterone production

Question 5

Etomidate
Aministration

Answer 5

Route: IV

Onset: 10-20 seconds

Peak Effect: < 1 min

Duration: 3-5 mins

Question 6

Etomidate
Dosage

Answer 6

(For ages greater than or equal to 15 yo)

0.3mg/kg given as single push dose

Question 7

Glucagon

Pharmacology & Actions

Answer 7

• Increase serum glucose by releases glycogen from liver
• Glucagon will only work if there are glycogen stores in liver, will not work with malnourished pt
• Counteracts effects of beta blocker or calcium channel blocker overdose

Question 8

Glucagon

Indications

Answer 8

• Hypoglycemia
• Symptomatic bradycardia from beta blocker or calcium channel blocker overdose

Question 9

Glucagon

Absolute Contraindications

Answer 9

• Glucagon in not first line for treatment of hypoglycemia and should ONLY be used if unable to obtain IV access
• Glucagon Allergy

Question 10

Glucagon

Precautions & Side Effects

Answer 10

• May cause nausea and vomiting
• Slower onset than IV dextrose

Question 11

Glucagon

Administration

Answer 11

Route: IM

Onset: 5-20 mins

Peak Effect: 30 mins

Duration: 1-2 hours

Question 12

Glucagon

Dose

Answer 12

Adult:

• 1 mg IM/IN

Pediatric:

• 0.5 mg IM/IN if < 20 kg or < 5 YO
• 1 mg IM/IN if > 20 kg or > 5 YO

Question 13

Glucose

Pharmacology and Actions

Answer 13

• Monosaccharide carbohydrate
• After absorption in GI tract, glucose is distributed in the tissues and promptly increases circulating blood sugar

Question 14

Glucose

Indications

Answer 14

• Hypoglycemia

Question 15

Glucose

Absolute Contraindications

Answer 15

• Glucose Allergy

Question 16

Glucose

Precautions & Side Effects

Answer 16

• Altered LOC
• Ascertain the pt’s ability to swallow oral glucose w/out airway compromise
• Must be swallowed, not absorbed sublingually or buccally

Question 17

Glucose

Administration

Answer 17

Route: PO

Onset: 10 mins

Peak Effect: variable

Duration: variable

Question 18

Glucose

Dose

Answer 18

For Adults with glucose < 60 mg/dL:

• 15-25g PO

For Pediatrics with glucose < 60 mg/dL (0-1 month < 40):

• 0.5-1g/kg PO, max dose 25g

Question 19

Ipratropium Bromide (Atrovent)

Pharmacology & Actions

Answer 19

• Antagonizes action of acetylcholine on bronchial smooth muscle in the lungs
• Causes bronchodilation

Question 20

Ipratropium Bromide (Atrovent)

Indications

Answer 20

• Bronchoconstriction
• May be given with albuterol

Question 21

Ipratropium Bromide (Atrovent)

Absolute Contraindications

Answer 21

• Allergy

Question 22

Ipratropium Bromide (Atrovent)

Precautions & Side Effects

Answer 22

• Use with caution in pts w/ narrow angle glaucoma
  
  • Side effects may include palpitations, dizziness, anxiety, headache, eye pain, urinary retention

Question 23

Ipratropium Bromide (Atrovent)

Administration

Answer 23

Route: SVN

Onset: 5 - 15 mins

Peak Effect: 1.5 - 2 hours

Duration: 4 - 6 hours

Question 24

Ipratropium Bromide (Atrovent)

Dose

Answer 24

Adults & Pediatrics > 2 YO:

• 0.5 mg nebulized with albuterol (may repeat 2x)

Question 25

Ketamine Pharmacology & Actions

Answer 25

* Non-competitive NMDA receptor antagonist * Functions as dissociative, amnestic, analgesic and anesthetic agent

Question 26

Ketamine Indications

Answer 26

* Excited Delirium * Induction agent for intubation * Pain control

Question 27

Ketamine Absolute Contraindications

Answer 27

* Angina * CHF * Pregnancy * Allergy

Question 28

Ketamine Precautions & Side Effects

Answer 28

* Transient periods of apnea occur with rapid IV infusion * May cause laryngospasm, hypersalivation, increased airway secretions, emergence reactions and nystagmus * Use w/ caution in pts w/ schizophrenia

Question 29

Ketamine Administration

Answer 29

Route: IV / IM Onset: \< 1 min / 3-4 min Peak Effect: 30 secs - 5 min / 3-12 min Duration: 10-45 min / 25-60 min

Question 30

Ketamine Dose

Answer 30

RSI * 1.5 mg/kg push, max 150mg Agitated or Violent Patient: * 4 mg/kg IM/IN max 250mg per admin (may repeat x1) Pain Management: * 0.25 mg/kg max 25mg per push (max total 100mg)

Question 31

Lorazepam (Ativan) Pharmacology & Actions

Answer 31

* Benzodiazepine that functions as a CNS depressant, anticonvulsant and sedative

Question 32

Lorazepam (Ativan) Indications

Answer 32

* Seizures * Sedation * Agitation/excited delerium * Uncontrolled shivering in hypothermia

Question 33

Lorazepam (Ativan) Absolute Contraindications

Answer 33

* Neurologic or respiratory depression * Acute angle glaucoma * Allergy

Question 34

Lorazepam (Ativan) Precautions & Side Effects

Answer 34

* Respiratory depression and/or hypotension can occur, pt should be monitored closely * Most likely to produce respiratory depression in pt who took other depressants (alcohol and barbiturates) or when given rapidly * Elderly pt may have more profound respiratory and/or CNS depression, half dose should be administered

Question 35

Lorazepam (Ativan) Administration

Answer 35

Route: IV / IM Onset: 1-2 min / 15-30 min Peak Effect: \<15 min / 2-3 hr Duration: 6-8 hr / 6-8 hr

Question 36

Lorazepam (Ativan) Dose

Answer 36

Seizure: * A + P: 0.1 mg/kg IV/IO, admin slowly over 2 mins (max single dose 4mg) Agitation: * A: 2-4 mg IM (may repeat once after 15 min) 2 mg IV/IO (max 4mg). Max total dose 4mg * P: 0.05 mg/kg IV/IO, max 2mg IV and 4mg IM Bradycardia: * A: 1 mg IV/IO every 5-10 min, max 4mg * P: 0.1 mg/kg IV/IO every 10 min, max 4mg Hyperthermia: * A: 1 mg IV/IO or 2 mg IM * P: 0.1 mg/kg IV/IO/IM max dose 1 mg RSI: A \> 15: 1-2 mg IV/IO, repeat every 5-10 min