Epinephrine, Atropine, Dopamine and Vasopressin

EPINEPHRINE(Adrenalin)

100

Epinephrine (adrenalin) is a Class: Sympathomimetic. 1. name the mechanism of action for Epinephrine (5)

Mechanism of action: 1. Direct-acting alpha and beta agonist. 2. Alpha: vasoconstriction. 3. Beta-1: positive inotropic, chronotropic, and dromotropic effects. 4. Beta-2: bronchial smooth muscle relaxation and dilation of skeletal vasculature. 5. Blocks histamine receptors.

200

Name 1. 6 indications for the use of Epinephrine (Adrenalin) 2. 4(5) contrications for the use of Epinephrine

Indications: 1. Cardiac arrest (asystole, PEA, ventricular fi brillation and pulseless ventricular tachycardia), 2.symptomatic bradycardia as an alternative infusion to dopamine, 3.severe hypotension secondary to bradycardia when atropine and transcutaneous pacing are unsuccessful,4. allergic reaction, 5.anaphylaxis, 6.asthma. Contraindications: 1. Hypertension,2. hypothermia, 3.pulmonary edema, 4.myocardial ischemia, 5.hypovolemic shock.

300

For Epinephrine (Adrenalin) name: 1. 6(10) adverse reactions/ side effects 2. Name 3(5) drug interactions

Adverse reactions/side effects: 1. Nervousness, 2.restlessness, 3.headache, 4.tremor, 5.pulmonary edema, 6.dysrhythmias, 7.chest pain,8. hypertension, 9.tachycardia, 10.nausea, vomiting. Drug interactions: 1.Potentiates other sympathomimetics. 2. Deactivated by alkaline solutions. 3. MAOIs may potentiate effect. 5. Beta blockers may blunt effects.

400

Name the duration of action for the use of Epinephrine (adrenaline) 1. Onset 2. Peak effect 3. Duration

Duration of action: 1.Onset: Immediate. 2.Peak effect: Minutes. 3. Duration : Several minutes.

500

Name 4(5) special considerations for the use of Epinephrine (Adrenalin)

Special considerations1. Pregnancy safety: Category C. 2.May cause syncope in asthmatic children. 3.May increase myocardial oxygen demand. 4.To mix an infusion add 1 mg of epinephrine 1:1,000 to 500 mL D 5 W for a yield of 2 mcg/mL. 5. Many states and systems are pulling away from IV/IO/IM administration of 1:1,000 and replacing it with auto-injectors due to the vascular side effects of solo epinephrine 1:1,000 injection.

EPINEPHRINE(Adrenaline) Dosages

100

Give the proper dosage and Administration for the use of Epinephrine (Adenalin) for the following indications. 1. Adult allergic reaction/asthma dose route &concentration 2. Adult anaphlaxis dose, routhe and concentration 3. Adult Cardiac Arrest dose route and concentration

1. Adult: Mild allergic reactions and asthma: 0.3–0.5 mg (0.3–0.5 mL 1:1,000) SC. 2. Anaphylaxis: 1 mg (10 mL of 1:10,000) IV, IO over 5 minutes 3.Cardiac arrest: IV/IO dose: 1 mg (10 mL, 1:10,000 solution) 3–5 minutes during resuscitation. Follow each dose with a 20-mL flush and elevate arm for 10–20 seconds after dose

200

Give the following doses for the following in the use of Epinephrine (adrenalin) 1. Continuous infulsion 2. Endotracheal dose

1. Continuous infusion: Add 1 mg (1 mL of a 1:1,000 solution) to 250 mLnormal saline or D 5 W (4 μg/mL). Initial infusion rate of 1 μg/min titrated to effect (typical dose: 2–10 μg/min). 2. Endotracheal (ET) dose: 2–2.5 mg diluted in 10 mL normal saline.

300

Give the proper infusion dose for the following for use of Epinephrine (Adrenalin) 1. Profound bradycardia or hyotension

Profound bradycardia or hypotension: 2–10 μg/min; titrate topatient response. Higher dose: Higher doses (up to 0.2 mg/kg) may be used for specifi c indications: (beta blocker or calcium channel blocker overdose).

400

Give the proper dosing and concentration for Epinephrine (Adrenalin) for: 1. Pediatric Mild Allergic Reaction and asthma 2. Pediatric Anaphlaxis/ Sever Asthmaticus and Max Dose 3. Pediatric Cardiac Arrest

1. Pediatric: Mild allergic reactions and asthma: 0.01 mg/kg (0.01 mL/kg) of a 1:1,000 solution SC(maximum of 0.3 mL). 2. Anaphylaxis/severe status asthmaticus: 0.01 mg/kg (0.01 mL/kg) IM of a 1:1,000 solution (maximum single dose: 0.3 mg). 3. Cardiac arrest: IV/IO dose: 0.01 mg/kg (0.1 mL/kg) of a 1:10,000 solution every 3–5 minutes during arrest.

500

Name the Proper dosing for the use of Epinephrine (adrenalin) for: 1. Pediatric ET dose and Max Single Dose 2. Pediatric Symptomatic Bradycardia and Hypotension

1. All ET doses 0.1 mg/kg (0.1 mL/kg) of a 1:1,000 solution mixed in 3–5 mL of saline until IV/IO access is achieved. Maximum single dose 1 mg. 2. . Symptomatic bradycardia: IV/IO dose: 0.01 mg/kg (0.01 mL/kg) of a 1:10,000 solution. All ET doses 0.1 mg/kg (0.1 mL/kg) of a 1:1,000 solution. Continuous IV/IO infusion: Begin with rapid infusion, and then titrate to response. Typical initial infusion: 0.1–1 μg/min. Higher doses may be effectiv

ATROPINE(Atropine Sulfate)

100

Atropine is Class: Anticholinergic agent. What is the Mechanism of Action for Atropine (2)

Mechanism of action: 1. Inhibits the action of acetylcholine at postganglionic parasympathetic neuroeffector sites. 2.Increases heart rate in life-threatening bradydysrhythmias

200

Name proper information for the use of Atropine for the following: 1. Name 4(5) indications for use of Atropine 2. Name 4(5) contraindicationsin the use of Atropine

Indications: 1. Hemodynamically unstable bradycardia, 2.organophosphate poisoning, 3.nerve agent exposure, 4.rapid sequence intubation in pediatrics, 5.beta blocker or calcium channel blocker overdose. Contraindications: 1. Tachycardia,2 hypersensitivity, 3. unstable cardiovascular status in acute hemorrhage with myocardial ischemia, 4. narrow-angle glaucoma, 5.hypothermic bradycardia.

300

Give proper information for the use of Atropine Sulfate int he following situation. 1. Name 8 (12) adverse reactions/side effects 2. Name 3 (5) drug interactions in the use of Atropine

Adverse reactions/side effects: 1. Drowsiness, 2.confusion, 3.headache, 4.tachycardia, 5.palpitations, 6.dysrhythmias, nausea,7/ vomiting, 8.pupil dilation, 9.dry mouth/nose/skin, 10.blurred vision, 11.urinary retention, 12.constipation, 13.flushed, hot, dry skin;14. paradoxical bradycardia when pushed too slowly or when given at low doses. Drug interactions: 1. Potential adverse effects when administered with digitalis, 2.cholinergics, 3.physostigmine. 5.Effects enhanced by antihistamines, procainamide, quinidine, antipsychotics, benzodiazepines, and antidepressants.

400

For atropine sulfate give proper dosing and administration. 1. Adult unstable bradycardia and max dose 2. Adult Organophosphate poisoning 3. Pediatric Unstable Bradycardia 4. max single does and total dose for child, and adolescent.

Adult: 1. Unstable bradycardia: 0.5 mg IV/IO every 3–5 minutes as needed. (maximum 3 mg total). 2. Organophosphate poisoning: Extremely large doses (2– 4 mg or higher) may be needed. 3. Pediatric: Unstable bradycardia: 0.02 mg/kg IV/IO (minimum dose: 0.1 mg). May repeat once. 4. Maximum single dose: Child: 0.5 mg. Adolescent: 1 mg. Maximum total dose: Child: 1 mg. Adolescent: 3 mg

500

Name two special considerations in the use of Atropine Sulfate

Special considerations: 1. Pregnancy safety: Category C. 2.Moderate doses may cause pupillary dilation. 3. Paradoxical bradycardia can occur with doses lower than 0.1 mg.

Dopamine Hydrocholoride(Intropin)

100

Dopamine (intropin) is:Class: Sympathomimetic, vasopressor, inotropic agent. What is the mechanism of action for Dopamine (5)

Mechanism of action:1. Immediate metabolic precursor to norepinephrine. 2. Produces positive inotropic and chronotropic effects. 3. Dilates renal and splanchnic vasculature. 4. Constricts systemic vasculature, increasing blood pressure and preload. 5.Increases myocardial contractility and stroke volume.

200

For Dopamine (intropin) name the following: 1. Name 2 (3)indications for use of Dopamine 2. Name 3 (4) contraindications for the use of Dopamine

Indications: 1. Cardiogenic and septic shock,2 hypotension with low cardiac output states, 3.distributive shock, 3.second-line drug for symptomatic bradycardia. Contraindications: 1. Hypovolemic shock, 2.pheochromocytoma, 3.tachydysrhythmias, 4.ventricular fibrillation.

300

In the use of Dopamine (intropin) name the following. 1. Name 8(12) adverse reactions/side effects 2. Name 4(5) drug interactions

Adverse reactions/side effects: 1.Extravasation may cause tissue necrosis. 2.Headache, 3.anxiety, dyspnea, 4.dysrhythmias, 5.hypotension, 6.hypertension, 7.palpitations, 8.chest pain,9. increased myocardial oxygen demand, 10.PVCs, 11.nausea,12. vomiting. Drug interactions:1. Incompatible with alkaline solutions (sodium bicarbonate). 2.MAOIs will enhance the effect of dopamine. 3.Bretylium may potentiate effect of dopamine. 4.Beta blockers may antagonize effects of dopamine. 5.When administered with phenytoin, may cause hypotension, bradycardia, and seizures.

400

What is the Proper 1. Adult dose and administraion for the use of Dopamine (Intropin) 2. Pediatric dose and admiistration for use of Dopamine

Dosage and administration: 1. Adult: IV/IO infusion at 2–20 μg/kg/ min, slowly titrated to patient response. 2. Pediatric: IV/IO infusion at 2–20 μg/kg/min, slowly titrated to patient response.

500

For Dopamine name: 1. Duration of action: A. onset B. Peak effect C. Duration 2. Special Consideration: Dopaminergic response dose, Beta Adrenergic response dose, Adrenergic Respinse dose

1. Duration of action: Onset: 1–4 minutes. Peak effect: 5–10 minutes. Duration: Effects cease almost immediately after infusion is discontinued. Special considerations: 1.Pregnancy safety: Category C. Effects are dose-dependent. 2.Dopaminergic response: 2–4 μg/ kg/min: dilates vessels in kidneys; increased urine output. 3.Beta-adrenergic response: 4–10 μg/kg/min: positive chronotropic and inotropic effects. 4.Adrenergic response: 10–20 μg/kg/min: primary alpha stimulant/vasoconstriction. Greater than 20 μg/kg/min: reversal of renal effects/override of alpha effects, consider other agents such as epinephrine or norepinephrine infusions. Should be administered by infusion pump.

VASOPRESSIN(Pitressin)

100

Vasopressin is: Class: Vasopressor What is the Mechanism of action for VASOPRESSIN (intropin) (2)

Mechanism of action: 1. Stimulation of smooth muscle receptors. 2. Potent vasoconstrictor when given in high doses.

200

For the use of VASOPRESSIN (Pitressin) 1. Name 2 indications for the use of VASOPRESSIN 2. Use in caution for patient who have (3)

Indications: 1. Alternative vasopressor to the first or second dose of epinephrine in cardiac arrest, 2. alternative to epinephrine in asystole, PEA. Contraindications: Use with caution in patients with 1. coronary artery disease, 2. epilepsy, 3. or heart failure.

300

For VASOPRESSIN (Pitressin) 1. Name 8(14) Adverse reactions 2. are there any drug interactions for the use of Vasopressin?

Adverse reactions/side effects: 1. Dizziness,2. headache, 3.bronchial constriction, 4.MI, 5.chest pain,6. angina, 7.cardiac dysrhythmia, 8.decreased cardiac output, 9.abdominal cramps,10. diarrhea, 11.nausea, 12.vomiting, 13.paleness, 14.sweating. Drug interactions: None reported.

400

Give the Proper dosing for Vasopressin in the following: 1. Adult Dose and administration 2. Pedatric Dose and administration

1. Adult: 40 U one-time dose IV/ IO to replace the first or second dose of epinephrine in cardiac arrest. 2. Pediatric: 0.4–1 unit/kg IV/ IO to a maximum of 40 units to replace the first or second dose of epinephrine in cardiac arrest.

500

For Vasopressin (Pitressin) name 1. Duration of action 2. 2 special considerations

Duration of action: Onset: Immediate. Peak effect: Variable. Duration: Variable. Special considerations: 1. Pregnancy safety: Category C. 2.May increase peripheral vascular resistance and provoke cardiac ischemia and angina.