Pharmacology

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Pharmacology
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2a
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Electrolytes
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Calcium Chloride

• Class
• Electrolyte
• MOA
• Essential component for functional integrity of
  nervous and muscular systems
• Enhances automaticity
• Positive inotrope

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Calcium Chloride

• Indications
• Hyperkalemia
• Hypocalcemia
• CCB Toxicity
• Hypermagnesemia
• Respiratory depression after MgSO4 administration
• To prevent Hypotension from CCB
• Contraindications
• Vfib
• Digitalis toxicity
• Hypercalcemia
• Renal or Cardiac disease

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Calcium Chloride

• Adverse Reactions
• Bradycardia
• Hypotension
• Metallic taste
• Severe local necrosis (infiltration)

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Calcium Chloride

• Supplied
• 10 solution in 10 ml
• Dosage
• Adult 5 - 10 cc over 3 minutes
• (8 16 mg/kg)
• Pediatric 5 mg/kg over 3 minutes

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Magnesium Sulphate

• Class
• Electrolyte
• Anticonvulsant (toxemias)
• Antiarrhythmic (torsades, TCA OD)
• Uterine Relaxant
• MOA
• Reduces striated muscle contractions and blocks
  peripheral neuromuscular transmission by reducing
  Ach release

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Magnesium Sulphate

• Indications
• Seizure due to Eclampsia
• Torsades de Pointes
• Hypomagnesemia
• Refractory Vfib (not NS)
• Status Asthmaticus (not NS)
• Contraindications
• Heart block
• Myocardial damage

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Magnesium Sulphate

• Adverse Reaction
• Diaphoresis
• Facial flushing
• Hypotension
• Depressed reflexes
• Hypothermia
• Bradycardias
• Circulatory collapse
• Respiratory depression
• Diarrhea

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Magnesium Sulphate

• Supplied
• 20 solution
• Dosage
• Bolus
• Torsades 1 gm IV at 1 g/min
• Toxemia 4 gm IV at 1 g/min
• Infusion
• 2 g in 100 cc NaCL (0.9) at 50 ml/hr (1 g/hour)

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Potassium Chloride

• Class
• Electrolyte
• MOA
• Principle intracellular ion affecting muscular
  contraction and nervous system transmission

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Potassium Chloride

• Indications
• Transport medication only in doses of lt 40 mEq/ml
• Hypokalemia
• Digitalis toxicity
• May see it Post MI (in conjunction with Dextrose
  and Insulin)
• Contraindications
• Renal impairment
• Acute dehydration
• Heat cramps
• Elevated serum potassium causing diseases

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Potassium Chloride

• Adverse Effects
• N/V
• Diarrhea with ABD pain
• K toxicity/hyperkalemia
• Hypotension
• Cardiac arrhythmias
• Heart block

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Potassium Chloride

• What to look for in Hyperkalemia
• Paresthesis of extremities
• Flaccid paralysis
• Mental confusion
• Weakness and heaviness of legs
• Cardiac changes
• P waves flatten and may disappear
• Widening and slurring of QRS
• ST changes
• Peaked T waves

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Potassium Chloride

• What to do
• Discontinue IV
• Treat hypotension as required (position and fluid
  resuscitation)
• Arrhythmias
• Consider Calcium Chloride (if CV toxicity)
• Consider Sodium Bicarbonate (renal failure)

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Potassium Chloride

• What to look for in Hypokalemia
• Polyuria
• Muscle weakness
• ECG Changes
• Widen QRS
• T waves may flatten
• U wave may appear and increase in size and may
  pass T wave size and eventually fuse together at
  low levels

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Sodium Bicarbonate

• Class
• Buffer
• Alkalinizing agent
• Electrolyte
• MOA
• Reacts with H ions to form water and carbon
  dioxide

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Sodium Bicarbonate

• Indications
• Wide complex tachycardia or arrest from TCA OD
• Acidosis
• Cardiac arrest with pre-existing hyperkalemia
  (renal failure)
• Cardiac arrest patients with suspected ASA OD
• Contraindications
• Alkalosis
• Severe pulmonary edema
• Abdominal pain of unknown origin
• Hypocalcemia
• Hypokalemia
• Hypernatremia

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Sodium Bicarbonate

• Adverse Effects
• Metabolic alkalosis
• Hypoxia
• Increased intracellular PCO2 and increased tissue
  acidosis
• Electrolyte imbalance (hypernatremia)
• Seizures

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Sodium Bicarbonate

• Supplied
• 50 mEq/50cc
• Dosage
• First dose 1 mEq/kg
• Subsequent dose 0.5 mEq/kg q 10 minutes PRN

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Volume Expanders
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Pentaspan

• Other Names
• Pentastarch
• Hydroxyethyl Starch
• Class
• Plasma Volume Expander

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Pentaspan

• MOA
• Polysaccharides with water-retaining properties
  and intravascular retention
• The colloidal properties make it a useful volume
  expander.
• Intravascular infusion of pentaspan results in
  expansion of plasma in excess of the volume of
  pentaspan infused.
• Expansion exists for approx. 18-24 hours and is
  expected to improve hemodynamic status for 12-18
  hours.
• 70 of drug eliminated in 24 hrs

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Pentaspan

• Indications
• Plasma volume expansion in the management of
• Shock due to hemorrhage
• Surgery
• Sepsis
• Burns
• Other trauma

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Pentaspan

• Contraindications
• Hypersensitivity to hydroxyethyl starch
• Bleeding disorders
• CHF, where volume overload is a potential problem
• Should not be used in renal disease with oliguria
  or anuria not related to hypovolemia.

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Pentaspan

• Adverse Reactions
• Coagulation disorders or hemorrhage
• Hypersensitivity
• Chills
• Anxiety

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Pentaspan

• Supplied
• IV infusion bags of 250 and 500 ml. (10
  solution) which gives what concentration?
• May appears translucent pale yellow to amber
  colored

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Pentaspan

• Dosage
• Total dose and infusion depends on the amount of
  blood or plasma lost.
• Typical is 500 - 2000 ml
• Max 28 ml/kg/day
• In acute hemorrhagic shock, an administration of
  20 ml/kg/hour may be used.

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Albumin

• Other Names
• Plasbumin- 5
• Plasbumin- 25
• Class
• Plasma Volume Expander

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Albumin

• MOA
• Albumin is the main protein in human blood and
  the key to the regulation of the osmotic pressure
  of blood. Chemically, albumin is soluble in
  water, precipitated by acid, and coagulated by
  heat.
• Albumin 5
• is oncotically equivalent volume for volume to
  normal human plasma and will allow expansion of
  the blood volume equal to the volume infused (if
  patient is hydrated)
• Albumin 25
• has an oncotic effect in which an additional
  fluid is drawn from the extra cellular tissues
  into circulation within 15 minutes. Blood
  viscosity and hemoconcentration is reduced, while
  total blood volume increases making Albumin 25 a
  key plasma volume expander (3-4 times)

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Albumin

• Indications
• Emergency treatment of
• Hypovolemic shock,
• burn therapy
• cardiopulmonary bypass (CABG)
• acute liver failure
• Volume deficit consider Albumin 5
• Oncotic deficit consider Albumin 25 along with
  appropriate crystalloid solution.

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Albumin

• Contraindications
• Hyperhydration
• Pulmonary edema
• Severe anemia
• Heart failure
• Hypersensitivity

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Albumin

• Adverse Effects
• Shaking
• Chills
• Uticaria
• Severe anemia
• Heart failure
• Hypersensitivity

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Albumin

• Supplied
• Vial of Albumin 5 USP
• Vial of Albumin 25

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Albumin

• Dosage
• 500 ml of Albumin 5 q 30 min IV, PRN
• Needs to be administered IV slowly to prevent
  fluid overload
• No specific duration