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Pharmacology

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

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Pharmacology

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  1. Pharmacology 7 2a

  2. Electrolytes

  3. Calcium Chloride • Class: • Electrolyte • MOA: • Essential component for functional integrity of nervous and muscular systems • Enhances automaticity • Positive inotrope

  4. 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

  5. Calcium Chloride • Adverse Reactions: • Bradycardia • Hypotension • Metallic taste • Severe local necrosis (infiltration)

  6. 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

  7. 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

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

  9. Magnesium Sulphate • Adverse Reaction: • Diaphoresis • Facial flushing • Hypotension • Depressed reflexes • Hypothermia • Bradycardias • Circulatory collapse • Respiratory depression • Diarrhea

  10. 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)

  11. Potassium Chloride • Class: • Electrolyte • MOA: • Principle intracellular ion affecting muscular contraction and nervous system transmission

  12. 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

  13. Potassium Chloride • Adverse Effects: • N/V • Diarrhea with ABD pain • K+ toxicity/hyperkalemia • Hypotension • Cardiac arrhythmias • Heart block

  14. 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

  15. 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)

  16. 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

  17. Sodium Bicarbonate • Class: • Buffer • Alkalinizing agent • Electrolyte • MOA: • Reacts with H+ ions to form water and carbon dioxide

  18. 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

  19. Sodium Bicarbonate • Adverse Effects: • Metabolic alkalosis • Hypoxia • Increased intracellular PCO2 and increased tissue acidosis • Electrolyte imbalance (hypernatremia) • Seizures

  20. Sodium Bicarbonate • Supplied: • 50 mEq/50cc • Dosage: • First dose: 1 mEq/kg • Subsequent dose: 0.5 mEq/kg q 10 minutes PRN

  21. Volume Expanders

  22. Pentaspan • Other Names: • Pentastarch • Hydroxyethyl Starch • Class • Plasma Volume Expander

  23. 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

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

  25. 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.

  26. Pentaspan • Adverse Reactions: • Coagulation disorders or hemorrhage • Hypersensitivity • Chills • Anxiety

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

  28. 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.

  29. Albumin • Other Names: • Plasbumin- 5 % • Plasbumin- 25 % • Class: • Plasma Volume Expander

  30. 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)

  31. 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.

  32. Albumin • Contraindications: • Hyperhydration • Pulmonary edema • Severe anemia • Heart failure • Hypersensitivity

  33. Albumin • Adverse Effects: • Shaking • Chills • Uticaria • Severe anemia • Heart failure • Hypersensitivity

  34. Albumin • Supplied: • Vial of Albumin 5% USP • Vial of Albumin 25%

  35. 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

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