Emergency medications 3 Dr. Maha Khalid EMS 353 Lectures 16,17 Adverse reactions Hypernatremia, metabolic alkalosis, cellulitis Considerations Pregnancy safety: Category C Repeat as needed in tricyclic antidepressant overdose until QRS narrows Mechanism of action Buffers metabolic acidosis and lactic acid buildup Indications Metabolic acidosis during cardiac arrest, tricyclic antidepressant, aspirin Contraindications Metabolic/respiratory alkalosis, hypokalemia, electrolyte imbalance Sodium Bicarbonate Adverse reactions Hypotension, tachycardia, fainting, nausea, vomiting Considerations Pregnancy safety: Category C Potent vasodilator causes significant hypotension if given too rapidly Mechanism of action Reacts with hemoglobin to form methemoglobin, which reacts with cyanide Indications Cyanide poisoning Contraindications None in the emergency setting Sodium Nitrate Adverse reactions Diarrhea Considerations Pregnancy safety: Category C If response to treatment is inadequate, repeat sodium nitrite and sodium thiosulfate Mechanism of action Converts cyanide to the less toxic thiocyanate, which is then excreted in the urine Indications Cyanide poisoning Contraindications None in the emergency setting Sodium Thiosulfate Contraindications Hypersensitivity, active bleeding, recent cerebral vascular accident Adverse reactions Intracranial hemorrhage, bronchospastic. Considerations Pregnancy safety: Category C Mechanism of action Thrombolytic Drugs act on Fibrinolytic Phase Indications Acute myocardial infarction, massive pulmonary emboli, arterial thrombosis/ embolism. Streptokinase (Streptase) Drug used for treatment of CAD Vascular Phase Platelet Phase Coagulation Phase Fibrinolytic Phase VASOCONSTRICATION Antiplatelet drugs Anticoagulant Thrombolytic Drugs Plasmin is produced in the blood to break down fibrin, the major constituent of blood thrombi, thereby dissolving clots once they have fulfilled their purpose of stopping bleeding. Extra production of plasmin caused by streptokinase breaks down unwanted blood clots, for example, in the lungs (pulmonary embolism).bloodfibrinthrombilungs Mechanism of action of Streptokinase Adverse reactions Apnea, respiratory depression, bradydysrhythmia, tachydysrhythmia Considerations Pregnancy safety: Category C If the patient is conscious, explain the effects of the drug before administration. Mechanism of action Ultra-short-acting depolarizing skeletal muscle relaxant Indications Rapid-sequence intubation Contraindications Acute narrow-angle glaucoma, penetrating eye injuries, malignant hyperthermia Succinylcholine Chloride (Anectine) Suxamethonium chloride (INN), also known as suxamethonium or succinylcholine, is a nicotinic acetylcholine receptor antagonist, used to induce muscle relaxation and short-term paralysis, usually to facilitate tracheal intubationINNnicotinic acetylcholine receptorantagonistparalysis tracheal intubation Succinylcholine Chloride (Anectine) mechanism of action Contraindications Hypersensitivity, tachydysrhythmias Adverse reactions CNS stimulation, headache, seizure, restlessness. Considerations Pregnancy safety: Category B Monitor vital signs. Mechanism of action B2 agonist cause Relaxation of bronchial tree Indications Bronchial asthma, bronchospasm associated with exercise Terbutaline Sulfate (Brethine) Adverse reactions Dizziness, pain, sweating, intracranial bleeding. Considerations Pregnancy safety: Category B Must be administered only with an infusion pump direct from bottle with a vented IV set Severe spontaneous bleeding risk Mechanism of action Inhibits aggregation of platelets Indications Acute coronary syndrome Contraindications Trauma or major surgery within the past 30 days Tirofiban Hydrochloride (Aggrastat) vented tubing is the tubing that has multiple ports along it. When a small air bubble get in the tubing, you manipulate the tubing so that the air nears a close port. You can then flick the port and the air escapes. Non-vented tubing must be backflowed or advanced/re-primed to rid tubing of air. Adverse reactions Dizziness, headache, bronchial constriction, MI, chest pain, angina Considerations Pregnancy safety: Category C May increase peripheral vascular resistance and provoke cardiac ischemia and angina Mechanism of action Stimulation of smooth muscle receptors Indications Alternative vasopressor to the first or second dose of epinephrine in cardiac arrest Contraindications Use with caution in patients with coronary artery disease, epilepsy, or heart failure. Vasopressin (Pitressin) Contraindications Wolff-Parkinson-White syndrome, Lown-Ganong-Levine syndrome Adverse reactions Dizziness, headache, pulmonary edema Considerations Pregnancy safety: Category C Closely monitor patients vital signs. Mechanism of action Calcium channals blockers. Causes vasodilation, decreases heart rate and contractility, slows SA and AV conduction. Indications supraventricular tachycardia, Controlling ventricular rate in atrial fibrillation or flutter Verapamil Hydrochloride (Isoptin, Calan) IV Solutions (Colloids and Crystalloids) Colloids Expand plasma volume Most often used in hypovolemic shock states Crystalloid solutions are used for: Electrolyte replacement A route for medication Short-term intravascular volume expansion Adverse reactions Chills, fever, urticaria (hives), nausea, and vomiting Considerations Do not use if the solution is cloudy or if you see sedimentation. Mechanism of action Increases intravascular volume Indications Hypovolemic shock, especially burn shock Contraindications No major contraindications Plasma Protein Fraction (Plasmanate) Adverse reactions Rash, itching, dyspnea, chest tightness, and mild hypotension Considerations In the management of burn shock, it is especially important to follow standard fluid resuscitation regimens to prevent possible circulatory overload. Mechanism of action Sugar-containing colloid used as an intravascular volume expander Indications Hypovolemic shock Contraindications Patients with congestive heart failure, renal failure, or known bleeding disorders Dextran Adverse reactions Nausea, vomiting, mild febrile reactions, chills, itching, and urticaria Considerations Pregnancy safety: Category C Patients allergic to corn may be allergic to hetastarch. Mechanism of action A starch-containing colloid used as an intravascular volume expander Indications Hypovolemic shock, especially burn shock; septic shock Contraindications No major contraindications Hetastarch (Hespan) Adverse reactions Rare in therapeutic dosages Considerations None Mechanism of action Replaces water and electrolytes Indications Hypovolemic shock; keep open IV Contraindications Should not be used in patients with congestive heart failure or renal failure Lactated Ringers (Hartmanns Solution) Adverse reactions Rare in therapeutic dosages Considerations Should not be used with phenytoin or amrinone Mechanism of action Provides nutrients in the form of dextrose as well as free water Indications For dilution of concentrated drugs for intravenous infusion Contraindications Should not be used as a fluid replacement for hypovolemic states 5% Dextrose in Water (D 5 W) Adverse reactions Rare in therapeutic dosages Considerations None Mechanism of action Provides nutrients in the form of dextrose as well as free water Indications Neonatal resuscitation, hypoglycemia Contraindications Should not be used as a fluid replacement for hypovolemic states 10% Dextrose in Water (D 10 W) Adverse reactions Rare in therapeutic dosages Considerations None Mechanism of action Replaces water and electrolytes Indications Heat-related problems (heat exhaustion, heat stroke), freshwater drowning, hypovolemia Contraindications Should not be used in patients with congestive heart failure 0.9% Sodium Chloride (Normal Saline) Adverse reactions Rare in therapeutic dosages Considerations None Mechanism of action Replaces free water and electrolytes Indications Patients with diminished renal or cardiovascular function for which rapid rehydration is not indicated Contraindications Cases in which rapid rehydration is indicated 0.45% Sodium Chloride ( Normal Saline) Adverse reactions Rare in therapeutic dosages Considerations None Mechanism of action Replaces free water and electrolytes and provides nutrients in the form of dextrose Indications Heat exhaustion, diabetic disorders Contraindications Should not be used when rapid fluid resuscitation is indicated 5% Dextrose in 0.45% Sodium Chloride (D 5 NS) Adverse reactions Rare in therapeutic dosages Considerations None Mechanism of action Replaces free water and electrolytes and provides nutrients in the form of dextrose Indications Heat-related disorders, freshwater drowning Contraindications Should not be given to patients with impaired cardiac or renal function 5% Dextrose in 0.9% Sodium Chloride (D 5 NS) Adverse reactions Rare in therapeutic dosages Considerations None Mechanism of action Replaces water and electrolytes and provides nutrients in the form of dextrose Indications Hypovolemic shock, hemorrhagic shock Contraindications Should not be administered to patients with decreased renal or cardiovascular function 5% Dextrose in Lactated Ringers (D 5 LR) End of the course