Module:

Session:

Advanced Care ParamedicineAdvanced Care Paramedicine

Pharmacology

7

2a

Electrolytes

Calcium Chloride

Class: Electrolyte

MOA: Essential component for functional integrity of

nervous and muscular systems Enhances automaticity Positive inotrope

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

Calcium Chloride

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

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

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

Magnesium Sulphate

Indications: Seizure due to Eclampsia Torsades de Pointes Hypomagnesemia Refractory Vfib (not NS) Status Asthmaticus (not NS)

Contraindications: Heart block Myocardial damage

Magnesium Sulphate

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

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)

Potassium Chloride

Class: Electrolyte

MOA: Principle intracellular ion affecting

muscular contraction and nervous system transmission

Potassium Chloride

Indications: Transport medication only in doses of < 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

Potassium Chloride

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

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

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)

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

Sodium Bicarbonate

Class: Buffer Alkalinizing agent Electrolyte

MOA: Reacts with H+ ions to form water and

carbon dioxide

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

Sodium Bicarbonate

Adverse Effects: Metabolic alkalosis Hypoxia Increased intracellular PCO2 and increased tissue

acidosis Electrolyte imbalance (hypernatremia) Seizures

Sodium Bicarbonate

Supplied: 50 mEq/50cc

Dosage: First dose: 1 mEq/kg Subsequent dose: 0.5 mEq/kg q 10 minutes PRN

Volume Expanders

Pentaspan

Other Names: Pentastarch Hydroxyethyl Starch

Class Plasma Volume Expander

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

Pentaspan

Indications: Plasma volume expansion in the

management of: Shock due to hemorrhage Surgery Sepsis Burns Other trauma

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.

Pentaspan

Adverse Reactions: Coagulation disorders or hemorrhage Hypersensitivity Chills Anxiety

Pentaspan

Supplied: IV infusion bags of 250 and 500 ml. (10%

solution) – which gives what concentration?

May appears translucent pale yellow to amber colored

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.

Albumin

Other Names: Plasbumin- 5 % Plasbumin- 25 %

Class: Plasma Volume Expander

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)

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.

Albumin

Contraindications: Hyperhydration Pulmonary edema Severe anemia Heart failure Hypersensitivity

Albumin

Adverse Effects: Shaking Chills Uticaria Severe anemia Heart failure Hypersensitivity

Albumin

Supplied: Vial of Albumin

5% USP Vial of Albumin

25%

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