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Pharmacology

Pharmacology. Introduction to Seattle Fire’s Medications. Route of Administration. How do you give the medication? Where does it go? What are the affector organs?. Routes of Administration. Oral Sublingual Inhalation Transdermal / Topical Rectal Parenteral. Oral. ASA

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Pharmacology

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  1. Pharmacology Introduction to Seattle Fire’s Medications

  2. Route of Administration • How do you give the medication? • Where does it go? • What are the affector organs?

  3. Routes of Administration • Oral • Sublingual • Inhalation • Transdermal / Topical • Rectal • Parenteral

  4. Oral ASA • Most drugs enter Portal circulation- “First Pass” metabolism

  5. Sublingual Nitroglycerine • Oral admin: 90% of nitroglycerine is cleared with a single pass through the liver • Sublingual goes to systemic circulation directly • Rapid onset, low risk of infection, bypasses liver and harsh stomach acids

  6. Inhalation MDI- Albuterol • Administration to the site of action • Less systemic absorption • Rapid onset • Requires ventilation by the patient or us…

  7. Topical / Transdermal ?? What meds ?? • Slow onset of absorption • Affected by location and type of skin • What about heating pads?

  8. Rectal ?? What Meds ?? • Does not require an IV • Rapid onset • 50% of blood returns bypasses portal circulation • What does that mean?

  9. Parenteral • Intravenous (IV) • Usually drugs that can’t be given IV • Can’t be absorbed or first pass destroys too much • Rapid onset and maximizes control over circulating levels • May cause- • Infection, hemolysis, too high of a serum level with too high of administration, too fast

  10. Parenteral • Intramuscular (IM) • Drug absorption is slower • Allows for a sustained dose over an extended period of time • May cause • Pain with injection, tissue necrosis at site, infection, scar tissue deposition

  11. Parenteral • Subcutaneous (SC) • Even slower drug absorption • Works when minute amounts of medication are needed to be delivered over a long period of time • Examples?

  12. Adenosine- Antiarrhythimic Mechanism of Action • Naturally occurring nucleoside • In the AV node it: • Decrease conduction velocity • Prolongs refractory period • Decreases automaticity Dose • 6mg then 12 mg Adv Side Effects • Transient or possibly prolonged heart block Onset / Duration • Immediate onset- duration 30 seconds

  13. Adenosine- Antiarrhythmic Concentration • 6mg/2cc Route • Rapid IVP, near central circulation Indication • SVT Contraindications • 2nd, 3rd degree heart block • Persantine (dipyridamole USP) requires you to decrease the dose

  14. Albuterol- Class Mechanism of Action • B2 agonist- stimulates bronchodilation of smooth muscle Dose • 1 puff every 30 seconds to affect Adv Side Effects • Tachycardia, anxiety, HTN, convulsions Onset / Duration • Onset- 5-15 min • Duration- 3-6 hrs

  15. Albuterol- Class Concentration • 17g / 200 puffs- 90mcg / puff Route • Metered dose inhalor Indication • Acute bronchospasm (rescue inhaler) Contraindications • Prior reactions or sensitivity to albuterol, tachycardias

  16. Aminophylline- Methylxanthine Bronchodilator Mechanism of Action • Increases intracellular cAMP (which increase catecholimine release and affect) and is a adenosine receptor antagonist (which then inhibits bronchospasm) Dose • 5-7mg/kg- at 25mg a minute Adv Side Effects • Headache, nausea, chest pain, convulsions Onset / Duration • Varies- 15 min

  17. Aminophylline- Class Concentration • 250mg / 10 mls Route • IV infusion Indication • Bronchospam, Asthma, COPD Contraindications • HTN, Tachycardia,

  18. Anectine- Class Mechanism of Action • Succinylcholine attaches to somatic muscle fiber receptor site depolarizing the junction. Unlike acetlycholine it is not broken down quickly so it remains antagonizing the receptor. Dose • 1.5mg / kg Adv Side Effects • Paralysis but no sedation, hyperkalemia, malignant hyperthermia Onset / Duration • Onset 30 sec to 1 min • Duration 3-5 min

  19. Anectine- Class Concentration Route Indication • RSI Contraindications • Patients at risk for hyperkalemia- Renal Failure/Dialysis, prolonged crush injuries, patients with history of milignant hyperthermia

  20. ASA- Class History • In 1980 alone 36,000 tons were consumed Mechanism of Action • Platelet aggregate inhibitor by blocking Thromboxane A2 • ACS: • New England Journal- “51% reduction in mortality” when used for patients with angina (N Engl J Med 1983; 309:396–403.) Dose • 324mg PO Adv Side Effects Onset / Duration

  21. ASA- Class Concentration • 81mg tablet Route • Oral Indication • ACS Contraindications • Ulcers, bleeding, chickenpox- Reye’s syndrome

  22. Atropine- Antimuscarinic Agent

  23. Atropine- Antimuscarinic Agent Mechanism of Action • Blocks the muscarinic receptor site preventing acetylcholine from stimulating it Dose • Varies- 0.5 to 1mg with max dose 2mg in adults? Peds: 0.02mg/kg with minimum dose .1mg. Why? Adv Side Effects • Drying of secretions, tachycardia, blurred vision Onset / Duration • Onset 2-4 minutes • Duration 4 hours

  24. Atropine- Antimuscarinic Agent Concentration • 1mg in 10mls Route • IV/IO/ET Indication • Bradycardia, organophosphate poisonings, Contraindications • 3rd degree heart blocks, glaucoma

  25. Benadryl- Antihistamine Mechanism of Action • Blocks H1 histamine receptor sites Dose • 25-50mg Adv Side Effects • Drowsiness, hypotension, palpitations, headache Onset / Duration • Onset- varies with administration, but rapidly • Duration- 3-4 hours

  26. Benadryl- Class Concentration Route Indication Contraindications

  27. Calcium Chloride Mechanism of Action • Critical mineral and electolyte Dose • 1g Adv Side Effects • Syncope, cardiac arrest, Onset / Duration • Onset- rapid • Duration- unk

  28. Calcium Chloride- Class Concentration • 1g in 10 mls Route • IV Indication • ??? Contraindications • Hypercalcemia, dig toxicity

  29. Dextrose- Class Mechanism of Action Dose Adv Side Effects Onset / Duration

  30. Dextrose- Class Concentration Route Indication Contraindications

  31. Diazepam/Diastat- Benzodiazapine

  32. Diazepam/Diastat- Benzodiazapine Mechanism of Action • In conjunction with GABA increases intracellular chloride levels hyperpolarzing the nerve cell Dose Adv Side Effects Onset / Duration

  33. Diazepam/Diastat- Class Concentration Route • IV • PR… any concerns here? Indication Contraindications

  34. Diltiazem- Class Mechanism of Action • Decrease automaticity and depolarization of AV nodal tissue, with some smooth muscle relaxation. Dose Adv Side Effects • Hypotension, bradycardia Onset / Duration

  35. Diltiazem- Class Concentration Route Indication Contraindications

  36. Epinephrine- Review • Alpha Receptors- A for arms • B1 Receptors- 1 heart • B2 Receptors- 2 lungs

  37. Epinephrine- Class Mechanism of Action • A mixed Alpha and Beta receptor site agonist Dose • Varies… Adv Side Effects Onset / Duration

  38. Epinephrine- Class Concentration Route Indication Contraindications

  39. Etomidate- Class Mechanism of Action • A potent hypnotic agent that induces general anesthesia without analgesic properties and little hemodynamic compromise Dose • 20 mg in pts weighing 150-250lbs • 0.2mg to 0.6mg / kg 100kg patient gets 20mg Adv Side Effects • Adrenal crisis Onset / Duration

  40. Etomidate- Class Concentration Route Indication Contraindications

  41. Furosemide- Class Mechanism of Action • Loop diuretic Dose • 20mg-40mg or… Adv Side Effects • Hypotension, dehydration Onset / Duration

  42. Furosemide- Class Concentration • 40mg/4mls Route Indication Contraindications

  43. Levophed- Class Mechanism of Action • Potent catecholamine Dose • Titrate to affect: 8mg in 250mls Adv Side Effects • Tissue necrosis, Onset / Duration

  44. Levophed- Class Concentration • 4mg in 4mls Route • IV Indication • Acute hypotension, cardiogenic shock Contraindications

  45. Lidocaine- Class Mechanism of Action • Inhibits intracellular sodium rush Dose • 100mg IV or a drip rate of what? Adv Side Effects • Decreased LOC, convulsions, bradycardia Onset / Duration • ??

  46. Lidocaine- Class Concentration • 100mg in 5mls • 2g in 250mls Route • IV Indication Contraindications

  47. Midazolam- Benzodiazepine Mechanism of Action • Works in conjunction with GABA receptor site to increase influx of chloride to hyperpolarize the nerve cell. Dose Adv Side Effects Onset / Duration

  48. Midazolam- Benzodiazepine Concentration Route Indication Contraindications

  49. Mag Sulphate- Class Mechanism of Action • Relaxes smooth muscle and stabilizes cell membranes. Dose • Depends 4gm over 20 minutes for eclampsia, 1-2gm IV for cardiac arrest Adv Side Effects Onset / Duration

  50. Mag Sulphate-- Class Concentration Route Indication • Eclampsia, refractory V-Fib, polymorphic V-tach, bronchospasm Contraindications • Heart blocks..

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