Emergency Drug Review

1
Emergency Drug Review

• UHHS BMH Paramedic Training Program
• Ronald Pristera EMT-P

2
Objectives

• This will be a quick overview
• You should have been studying your drug cards.
• We are not going to talk about pediatric doses
• Assume that a CI for any drug is known
  sensitivity. (its not listed here as a CI)

3
Adenosine

• CLASS Anti-dysrhythmic
• IND. SVT, including bypass tract disease.
• CI. 2nd or 3rd degree AV block
• SSS, sensitivity, Afib or
• flutter.

4
Adenosine

• Dose 6mg rapid IVP followed by 20ml saline
  flush.
• May repeat in 1-2 min if no response. 12
  mg IVP, then again in 1-2 min.
• Max single dose is 12 mg

5
Adenosine

• Practice points
• Brief periods of asystole are common
• Pts on theo may require larger doses
• Transplant recip. May require smaller dose
• May produce bronchoconstriction is asthma pts.

6
Amiodarone

• Class III Antidysrhythmic
• Indicated for
• Initial rx and prophylaxis of VF unstable VT
  refractory to other therapy
• Contraindicated
• Pulmonary congestion
• Cardiogenic shock
• hypotension

7
Amiodarone

• Dose
• 300 mg loading dose (cardiac arrest) flush with
  10 ml of D5 or saline
• 150 mg supplemental bolus dose (cardiac arrest)
  flush with 10 ml of D5 or saline
• 360 mg loading infusion-following ROSC over 6 hrs
• 540 mg maintenance infusion over 18 hr

8
Amiodarone

• Practice Points
• May potentiate hemodynamic status when given with
  beta blocker and CaCl channel blockers
• May increase risk of AV block when given with
  CaCl blockers
• May increase effects of wafarin
• Incompatible with lasix, heparin bicar (y site)

9
Amiodarone

• May effect serum levels of
• phenytoin,
• Procainamide
• Quinindine
• theo

10
Aspirin

• Analgesic, anti-inflammatory, antiplatelet
• Indications
• AMI
• CI
• Only systemic sensitivity in the context of MI
• Dose
• 160-325 mg PO (preferably chewed)

11
Aspirin

• Give it rapidly (ISIS trials)
• Go ahead if already on 1 pill per day

12
Atropine Sulfate

• Anticholinergic
• Indications
• Symptomatic bradycardia
• Asystole
• PEA
• ACE inhibitor OD
• Exercise induced bronchospastic disorders

13
Atropine Sulfate

• CI
• Tachycardia
• Obstructive disease of GI tract
• Unstable cardiovascular status in the context of
  cardiac ischemia hemorrhage
• Narrow angle glaucoma

14
Atropine Sulfate

• Dose
• Bradydysrhymias
• 0.5-1.0mg q 5 min to a max of 0.03-0.04 mg/kg
• Asystole
• 1.0 mg IV or ETT(dilute to 10 ml)
• ACE inhibitors
• 2mg IVP q 5-15 minutes (no max)

15
Atropine Sulfate

• Practice Pearls
• Dilates the pupils
• Follow ETT with several PPV s
• Effects are enhanced by
• Thiazides, antidepressants, ant psychotics
• Antihistamines, Procainamide, quinidine
• Adverse reactions with concurrent admin.
• Dig, cholinergics, neostigmine

16
Calcium Chloride

• Electrolyte
• Indications
• Hyperkalemia (except dig toxic)
• Hypocalcaemia
• CaCl blocker toxicity
• Hypermagnesmia
• To prevent hypotensive effects of CaCl blockers

17
Calcium Chloride

• Contraindications
• VF during cardiac resuscitation
• Dig toxic
• Hyperkalemia
• Renal or cardiac disease

18
Calcium Chloride

• Dose
• 2-4 mg/kg (1-2G) of 10 slow IV q 10 min PRN
• Practice Pearls
• May produce vasospasm in coronary/cerebral
  arteries
• Hypotension/bradycardia may result from rapid
  administration

19
Calcium Chloride

• Practice Pearls
• May antagonize the perp. Dilatory effects Ca
  channel blockers
• Severe tissue necrosis following IM use or
  extravasculation
• Must flush IV line if Bicarb was given-
  precipitation will occur

20
Diltiazem (Cardizem)

• Slow ca channel blocker or Ca channel antagonist.
• Indications
• A Fib/flutter
• Multifocal atrial tachycardias
• PSVT

21
Diltiazem (Cardizem)

• Contraindications
• SSS
• 2nd or 3rd degree HB (unless pacer present)
• Hypotension (SBP 90)
• Cardiogenic shock
• AF/flutter associated with WPW or short PR
  syndrome

22
Diltiazem (Cardizem)

• Contraindications
• Concomitant use of IV beta blockers
• VT
• Wide complex tachy of unknown origin
• AMI

23
Diltiazem (Cardizem)

• Dose
• 0.25mg/kg (20mg for average pt) over 2 min.
• Repeat dose of 0.35/mg/kg after 15 min
• Maintenance infusion is 125mg in 100 ml infused _at_
  5-15mg/hr (titrate to HR)

24
Diltiazem (Cardizem)

• Practice Pearls
• Caution in pts who take agents that affect
  contractility or conduction
• Incompatible with simultaneous lasix
• Use with caution in renal/hepatic failure
• Hypotension may occur
• PVCs may be present on conversion of PSVT

25
Dobutamine (Dobutrex)

• Sympathomimetic
• Indications
• Inotropic support for patients with LV
  dysfunction
• Contraindications
• AF/flutter
• Severe hypotension
• IHSS

26
Diltiazem (Cardizem)

• Dose
• 2.5-10 mcg/kg/min IV based on inotropic effect.
  MAX RATE is 40mcg/kg/min
• Practice Peals
• Need accurate admin method (pump)
• Closely monitor BP
• Increase of HR of 10 may increase cardiac
  ischemia

27
Diltiazem (Cardizem)

• Practice Pearls
• Lidocaine should be readily available
• Correct hypovolemia prior to use
• Incompatible with lasix bicarb in the same line

28
Dopamine (Intropin)

• Sympathomimetic
• Indications
• Hemodynamically significant hypotension in the
  absence of hypovolemia
• Contraindications
• Tachydysrhythmias
• VF
• pheochromocytoma

29
Dopamine (Intropin)

• Dose
• renaldose 1-5mcg/kg/min
• cardiac dose 5-15 mgc/kg/min
• vasopressor dose 15mcg/kg/min

30
Dopamine (Intropin)

• Practice Pearls
• Avoid extravasculation
• Use infusion pump
• Monitor closely for signs of compromised
  circulation
• Correct hypovolemia prior to use
• Dont give concomitantly with lasix or bicarb

31
Dopamine (Intropin)

• Practice pearls
• MAO inhibitors may deactivate
• Seizures may result if given with phenytoin,
  hypotension, bradycardia

32
Flumazenil (Romazicon)

• Benzodiazepine antagonist
• Indications
• Reversal of BZD
• Contraindications
• TCA OD
• Cocaine or other stimulant intoxication

33
Flumazenil (Romazicon)

• Dose
• 0.2mg IV over 30 seconds
• Additional dose of 0.3mg after 30 seconds
• Additional dose of 0.5mg at 1 min intervals
• Max of dose of 3 mg

34
Flumazenil (Romazicon)

• Practice Pearls
• To avoid pain at site give through large vein IV
• Be prepared to manage seizures in BZD addicted
  pts
• Monitor for resedation effects
• Be prepared to manage resp efforts

35
Furosemide (Lasix)

• Loop Diuretic
• Indications
• PE associated with CHF, hepatic or renal disease
• Contraindications
• Anuria
• Hypovolemia/dehydration

36
Furosemide (Lasix)

• Contraindications
• Electrolyte depletion
• Dose
• 20-40 mg slow IV (1-2min)
• Double the daily dose

37
Furosemide (Lasix)

• Practice Pearls
• Known to cause fetal abnormalities
• Protect from light
• May potentiate dig toxicity (K depletion)
• May potentiate lithium toxicity (Na deple)
• May potentiate therapeutic effects of other
  antihypertensives

38
Isoproterenol (Isuprel)

• Sympathomimetic
• Indications
• Hemodynamically significant bradycardia
  refractive to other therapy
• TDP

39
Isoproterenol (Isuprel)

• Contraindications
• VF/VT
• Hypotension (relative)
• Pulse less idioventricular rhythm
• Ischemia heart disease (relative)
• Cardiac arrest

40
Isoproterenol (Isuprel)

• Dose
• 1mg in 250 ml (4mcg/ml) infuse at 2-20 mcg/min
• Titrate to effect
• Practice Pearls
• Increases myocardial oxygen demand
• Infusion pump
• Last ditch- pace first

41
Isoproterenol (Isuprel)

• Practice Pearls
• Beta adrenergic antagonists my blunt the
  inotropic response

42
Labetol (Normodyne)

• Alpha-beta adrenergic blocker
• Indications
• Hypertensive emergencies
• Contraindications
• Bronchial asthma (relative)
• Uncompensated CHF
• 2nd 3rd AV block

43
Isoproterenol (Isuprel)

• Contraindications
• Bradycardia
• Cardiogenic shock
• Pulmonary edema
• Dose
• 10-20 mg IV over 1-2 min
• May repeat or double q 20 to a max of 150 mg

44
Isoproterenol (Isuprel)

• Dose
• Infusion mix 200 in 250 (0.8 mg/ml) infuse at
  2mg/min. Titrate to supine SBP,
• Practice Pearls
• VS should be constantly monitored
• Observe for signs of CHF, bradycardia,
  bronchospasm

45
Isoproterenol (Isuprel)

• Practice Pearls
• Keep the patient in the supine position
• NTG may augment hypotensive effects

46
Lidocaine (Xylocaine)

• Antidysrhythmic (Class 1-B)
• Indications
• VT/VF
• Wide complex tachycardia of uncertain origin
• Significant ventricular ectopy in the setting of
  MI

47
Lidocaine (Xylocaine)

• Contraindications
• Adams-Stokes Syndrome
• 2nd or 3rd degree HB in the absence of a
  pacemaker
• Dose
• 1.0-1.5 mg/kg consider repeat in 3 min
• Total IV dose is 3 mg/kg

48
Lidocaine (Xylocaine)

• Dose
• ETT is 2.5 times IV dose
• Main infusion is 2G in 500 (4mg/ml)
• Run _at_ 2-4 mg/min
• Practice Pearls
• 75-100 mg bolus will maintain level for 20 mins
• If bradycardia is present treat PVCs with
  Atropine

49
Lidocaine (Xylocaine)

• Practice Pearls
• Avoid for use in reperfusion dysrhythmia
• Use with caution in
• Hepatic disease/heart failure
• Marked hypoxia
• Respiratory depression
• Hypovolemia/shock
• Complete HB, AF

50
Norepinephrine (Levophed)

• Sympathomimetic
• Indications
• Cardiogenic shock
• Neurogenic shock
• Inotropic support
• Hemodynamically significant hypotension
  refractory to other sympaths

51
Norepinephrine (Levophed)

• Contraindications
• Hypotensive pts with hypovolemia
• Dose
• Dilute

52
Norepinephrine (Levophed)

• Practice Pearls
• May cause fetal anoxia
• Infuse through a large stable vein to avoid
  necrosis
• MAO inhibitors potentiate the effects
• Can be deactivated by alkaline sols
• May exacerbate dysrhythmia response

53
Propranolol (Inderal)

• Beta adrenergic blocker
• Indications
• Hypertension
• Angina
• VF/VT and SVT refractory to other therapy

54
Propranolol (Inderal)

• Contraindications
• Sinus bradycardia
• 2nd or 3rd degree AV block
• Asthma
• Cardiogenic shock
• Pulmonary edema
• Uncompensated CHF
• COPD (relative)

55
Propranolol (Inderal)

• Dose
• 1-3 mg IV over 2-5 min
• Can be repeated after 2 min
• Total dose not to exceed 0.1mg/kg
• Practice Pearls
• Catacholamine depleting drugs my potentiate
  hypotension

56
Propranolol (Inderal)

• Practice Pearls
• Verapamil may worsen AV conduction abnormalities
• Sux effects may be enhanced
• Effects are reversed by
• Isuprel, norepi, dopamine, dobutamine
• Epi may cause a rise in BP decrease in HR and
  severe vasoconstriction

57
Propranolol (Inderal)

• Practice Pearls
• May produce life-threatening side effects-closely
  monitor patients
• Use with caution in elderly
• Use with caution in patients with impaired
  hepatic or renal function.
• Atropine should be readily available

58
Sodium Bicarbonate

• Buffer, alkalinizing agent, electrolyte
• Indications
• Known bicarbonate responsive acidosis
• On return of ROSC following long arrest
• Intubated pt with long arrest interval
• PEA/DKA
• TCA OD
• Metabolic acidosis

59
Sodium Bicarbonate

• Contraindications
• Chloride loss from vomiting GI
• Met or resp alkalosis
• Severe pulmonary edema
• Abdominal pain of unknown origin
• Hypo
• Calcemia, kalemia, natremia

60
Sodium Bicarbonate

• Dose
• 1 mEq/kg IV with 0.5 mEq/kg repeat q 10 min
• Practice Pearl
• When possible ABGs should be the guide
• Produces CO2 which may worsen cellular acidosis
• May worsen CHF

61
Sodium Bicarbonate

• Practice Pearls
• Must maintain adequate ventilation
• Cant be administered concomitantly with
• Calcium
• May deactivate vasopressors

62
Verapamil (Calan)

• Calcium channel blocker
• Indications
• PSVT
• A flutter with rapid response
• A fib with rapid response
• Vasospastic and unstable angina
• Chronic stable angina

63
Verapamil (Calan)

• Contraindications
• SSS (without pacemaker)
• 2nd 3rd degree AV block
• Hypotension/Cardiogenic shock
• Wide complex tachycardia
• Severe CHF
• WPW with A Fib/flutter
• IV beta blockers

64
Verapamil (Calan)

• Dose
• 2.5-5 mg IVP over 1-2 minutes
• Repeat 5-10 mg 15-30 mins after initial dose
• Or 5 mg q 15 min until effect
• Max dose 30mg

65
Verapamil (Calan)

• Practice Pearls
• Closely monitor VS
• Give smaller doses over longer time when treating
  elderly
• AV block or Asystole may occur due to slowed
  conduction
• Increases serum dig
• Antihypertensives may potentiate hypotensive
  effects.

66
Albuterol (Proventil)

• Sympathomimetic that is selective for beta 2 it
  also relaxes the smooth muscle of the brachial
  tree and peripheral vasculature
• Indications
• Relief of bronchospasm
• Prevention of exercise induced bronchospasm

67
Albuterol (Proventil)

• Contraindications
• dysrhythmia's associated with tachycardia
• Dose
• Unit dose 0.083
• 2.5 mg diluted to 3 ml

68
Albuterol (Proventil)

• Practice Pearls
• Other sympathomimetics may exacerbate adverse
  cardiovascular effects.
• Beta Blockers may antagonize albuterol.
• May potentiate diuretic-induced hypokalemia.
• May precipitate angina and dysrhymias
• Should be used with caution in diabetes,
  hyperthyroidism, seizure or cardiac disorder.

69
Dextrose 50

• Dextrose is the 6 carbon sugar that is the
  principal carbohydrate used by the body.
• Indications
• Hypoglycemia
• ALOC
• Coma/seizure of unknown etiology

70
Dextrose 50

• Contraindications
• Intracranial hemorrhage
• Known or suspected CVA in absence of hypogly.
• Increased intracranial pressure
• Dose
• 12.5-25 G IV slowly

71
Dextrose 50

• Practice Pearls
• Draw a blood sample prior to infusion if
  possible.
• Extravasculation may cause necrosis. Aspirate
  often.
• May precipitate Wernickes encephalopathy

72
Dextrose 50

• Practice Pearls
• Wernickes encephalopathy (severe neurological
  symptoms) may result in thiamine deficiency
  (alcoholics).
• Administer Thiamine prior to D50 in
• Alcoholics
• Frail
• Elderly
• malnourished

73
Diazepam (Valium)

• Benzodiazepine
• Indications
• Acute anxiety states/alcohol withdrawal
• Skeletal muscle relaxation
• Seizure activity
• Premedication prior to cardioversion

74
Diazepam (Valium)

• Contraindications
• in coma (unless there is seizure activity)
• CNS depression as a result of head injury
• respiratory depression
• Shock
• Dose
• 5mg over 2 min IV q 10-15 min
• Max dose is 30mg

75
Diazepam (Valium)

• Practice Pearls
• Its use as an anti-convulsant may be short lived
  due to rapid redistribution by the CNS.
• Reduce dose by 50 in elderly patients.
• May cause local venous irritation
• May precipitate CNS depression psychomotor
  impairment
• Precipitates with almost everything

76
Epinephrine (Adrenalin)

• Sympathomimetic
• Indications
• Bronchial asthma
• Acute allergic reaction
• Cardiac arrest
• Profound symptomatic bradycardia

77
Epinephrine (Adrenalin)

• Contraindications
• Hypovolemia shock- correct volume deficit
• Use with caution in coronary insufficiency
• Dose
• Cardiac arrest
• 1 mg IVP q 3-5 min
• 2.5 times the normal dose if via ETT

78
Epinephrine (Adrenalin)

• Dose
• Drips
• Mix 1 mg ampule in 500 ml (2 mcg/ml) and infuse
  at 1-2 mcg/min titrate to desired response
• Anaphylactic reaction
• Mild- 0.3-0.5 mg (11000) SQ
• Severe- 1-2 ml (110000) slow IV

79
Epinephrine (Adrenalin)

• Practice Pearls
• Dont use prefilled units to mix drips
• Increases oxygen demand
• MAO inhibitors potentiate the effect
• Exacerbate the dysrhythmia's response
• May be deactivated by alkaline sols.

80
Epinephrine (Adrenalin)

• Practice Pearls
• Complications of IV epic are significant
• Uncontrolled hypertension
• Vomiting seizures dysrhythmia's
• IV Epi should only be used in severe cases

81
Glucagon

• Pancreatic Hormone, insulin antagonist
• Indications
• Persistent hypoglycemia despite glucose
• Contraindications
• Only hypersensitivity
• Dose
• 0.5-1 mg IM with one repeat in 7-10 min

82
Glucagon

• Practice Pearls
• Not a first choice for hypoglycemia
• Do not use dilutent to mix drips
• IV glucose must be given if there is not
  response to second dose
• May potentiate anticoagulants
• Glycogen must be available in the liver

83
Thiamine (Betaxin)

• Vitamin B1
• Indications
• Coma of unknown origin (with D50)
• DTs
• Beriberi
• Wernickes encephalopathy

84
Thiamine (Betaxin)

• Contraindications
• None
• Dose
• 100mg slow IV or IM
• Practice Pearls
• Used to metabolize glucose
• Certain conditions predispose for defic.

85
Thiamine (Betaxin)

• Practice Pearls
• Alcoholism/malnourishment
• Give before D50

86
Procainamide (Pronestyl)

• Antidysrhythmic
• Indications
• PVCs refractory to Lidocaine
• VT (pulse) refractory to Lidocaine
• VF refractory to Lidocaine
• PSVT (wide complex of unknown origin)

87
Procainamide (Pronestyl)

• Contraindications
• 2nd 3rd degree AV block (without pacer)
• Dig toxicity
• TDP
• Complete heartblock
• TCA toxicity

88
Procainamide (Pronestyl)

• Dose
• 20 mg/min (30 mg/min in refractory VF) slow IV
  infusion
• Maintenance infusion- 1G in 250 and run at 1-4
  mg/min
• Max dose 17 mg/kg
• 50 widening of QRS
• Hypotension

89
Procainamide (Pronestyl)

• Practice Pearls
• Potent vasodilating and inotropic effects
• Rapid injection may cause hypotension
• Use caution
• Asthma, dig induced dysrhymiass,, AMI
• Hepatic or renal insufficiency
• Increases effects of skeletal muscle relaxants

90
Nitroglycerin (Nitrostat)

• Vasodilator
• Indications
• Ischemia chest pain
• Pulmonary hypertension
• CHF
• Hypertensive emergencies

91
Nitroglycerin (Nitrostat)

• Contraindications
• Hypotension
• Head injury
• Cerebral hemorrhage
• Dose
• 0.15-0.6 mg SL q 5 minutes (3 max)
• Infusion- 200-400 mcg/ml _at_ 10-20 mcg/min increase
  by 5-10 prn.

92
Nitroglycerin (Nitrostat)

• Practice Pearls
• Caution with Viagra (intractable hypotension)
• Elderly are susceptible to hypotension
• very volatile
• PVC tubing will absorb
• Other dilators may have additive effects

93
Naloxone (Narcan)

• Opiod antagonist
• Indications
• Narcotic OD
• Morphine, heroin, hydromophone
• Methadone, meperidine, paregoric
• Fentanyl, oxycodone, codeine
• Propoxyphene
• Coma unknown origin

94
Naloxone (Narcan)

• Contraindications
• Use with caution in addicted pts may precipitate
  violent withdrawal issues.
• Dose
• 0.4-2mg IV, IM, SQ or ETT (dilute)
• Practice Pearls
• May not reverse hypotension

95
Naloxone (Narcan)

• Practice Pearls
• Seizures are possible
• Incompatible with bisulfate alkaline sols
• May cause hypertension, tachycardia and violent
  reactions

96
Morphine Sulfate

• Opiod analgesic
• Indications
• Chest pain associated with MI
• Pulmonary edema (with or without CP)
• Moderate to severe acute or chronic pain
• Contraindications
• Hypovolemia/hypotension

97
Morphine Sulfate

• Contraindications
• Head injury or undiagnosed abdom. Pain
• Increased ICP
• Severe resp depression
• MAO inhibitors within the last 14 days

98
Morphine Sulfate

• Practice Pearls
• CNS depressants may potentiate the effects
• May worsen bradycardia or heart block in inferior
  MI
• Should be used with caution in chronic pain
  syndromes
• Phenothiazides may potentiate analgesia

99
Magnesium Sulfate

• Electrolyte, Anticonvulsant
• Indications
• Seizures of eclampsia
• TDP
• Hypomagnesaemia
• Refractory VF

100
Magnesium Sulfate

• Contraindications
• Heart block or myocardial damage
• Dose
• Eclampsic seizures
• 1-4G (8-32 mEq) IV max dose of 30-40G/day
• TDP
• 1-2G (2-4ml of a 50 solution) in 10ml over 1-2
  min IV Give it IVP in VF

101
Magnesium Sulfate

• Practice Pearls
• Dont administer 2 hrs prior to delivery
• IV calcium gluconate or CaCl should be available
  as an antagonist
• Convulsions may occur up to 48 hrs post delivery.
• The cure for toxemia is delivery of the baby.

102
Magnesium Sulfate

• Practice Pearls
• Use with caution in renal failure
• CNS depressant effects may be enhanced in the
  presence of other CNS depressants

103
Vasopressin

• Naturally occuring hormone (ADH)
• Indications
• May be used as an alternate vasopressor in
  cardiac arrest
• May be useful in hemodynamic support of dilatory
  shock

104
Vasopressin

• Contraindications
• Not recommended for responsive pts with CAD
• Dose
• 40 U IV push- one dose only (buys you about 10
  min)

105
Vasopressin

• Practice Pearls
• Potent vasoconstrictor- may promote cardiac
  ischemia

106
Midazolam (Versed)

• Short acting BZD
• Indications
• Premed for ETT or CV
• Seizures
• Contraindications
• Glaucoma (relative)
• Shock, Coma, depressed VS

107
Midazolam (Versed)

• Contraindications
• Alcohol intox (relative)
• Concomitant use of barbs, etoh, narc or other CNS
  depressants
• Dose
• 1-2.5 mg IV slowly (1-2 min)
• Total max dose not to exceed 0.1 mg/kg

108
Midazolam (Versed)

• Practice Pearls
• Monitor continously
• Never admin as IV bolus
• Sedative effect may be enhanced by other CNS
  depressants

109
Digoxin (Lanoxin)

• Cardiac Glycoside
• Indications
• SVT esp A fib/flut
• CHF
• Cardiogenic shock

110
Digoxin (Lanoxin)

• Contraindications
• VF/FT
• AV Block
• Dig toxicity
• 2nd or 3rd AV (without pacer)

111
Digoxin (Lanoxin)

• Practice Pearls
• Amiodarone, verapamil, quinidine may increase
  serum levels 50
• Concurrent admin with calan may lead to severe
  heart block
• Antibiotics may increase serum levels by slowing
  hepatic breakdown
• Diuretics may potentiate cardiac toxicity because
  of potassium loss

112
Digoxin (Lanoxin)

• Sympathomimetics may augment the inotropic
  cardiotoxic effects.
• Pts with MI and or renal failure are prone to
  developing toxicity
• Avoid use in WPW
• Toxcity is potentiated in pts with hypokalemia,
  hypomagnesemia hypercalcemia

113
heparin

• Anti coagulent
• Two preparations
• Unfractionated (UFH)
• Low molecular weight (LWH)

114
heparin

• UFH
• Indications
• AMI
• Begin with fibrin specific lytics (alteplase)
• Contraindications
• Active bleeding
• Recent intracranial, spinal or eye surgery

115
heparin

• Contraindications
• Severe hypertension
• Bleeding disorders
• GI bleeding
• Dose
• Initial bolus- 60IU/kg (max bolus 4000IU)
• Continue _at_ 12IU/hr
• Therapuetic levels checked by labs

116
heparin

• Practice Pearls
• Can be reversed with Protamine (25mg IV)
• Dont use with low platelet count
• Use LMW in ACS pts (especially non Qwave MI
  unstable angina) It will inhibit thrombin
  generation.