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Drugs Week 4
Epinephrine, D50, Glucagon, Diphenhydramine
58
Medical
Not Applicable
10/11/2017

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Term
D50W
Alternate Name
Definition
Dextrose 50% in Water
Term
D50W Classification
Definition
Hyperglycemic Agent
Carbohydrate
Term
D50W Therapeutic Effects
Definition
Increases Blood Glucose Level
Term
D50W Indications
Definition
-Known BGL of >60 mg/dL when oral glucose cannot be administered
-Suspected hypoglycemia when BGL is unknown
Term
Suspected hypoglycemic pts D50W is indicated for...
Definition
-Altered LOC
-Coma
-seizure of unknown etiology
-Acute or chronic alcohol intoxication with AMS
Term
D50W Contraindications (suspected hypoglycemia)
Definition
-Suspected intracranial hemorrhage AND new onset CVA signs/symptoms with unknown BGL in a non-diabetic pt.
Term
D50W Contraindications (known hypoglycemia)
Definition
None
Term
D50W Side Effects
Definition
-A feeling of warmth or pain at the injection site
-Phlebitis
Term
D50W Adult Dosing
Definition
-25 g (50mL) IVP over several minutes.
-250 mL D10W infusion over several minutes.
*In some systems, 12.5 g is the dosage and will usually achieve a normal BGL*
Term
D50W Notes
Definition
-Very irritating to veins. Use largest, most proximal vein for IV access.
-Constantly reassess IV patency and remove if patency cannot be confirmed due to the risk of necrosis from a leaking IV
-Dilute drug when giving IO
Term
How to make D25W
Definition
Discard 25 mL of original solution and replace with 25 mL of NSS. To mix medication, gently invert, DO NOT SHAKE.
Term
How to make D10W
Definition
Discard 40 mL of original solution and replace with 40 mL of NSS. To mix medication, gently invert, DO NOT SHAKE.
Term
Benadryl Alternate Name
Definition
Diphenhydramine
Term
Benadryl Classification
Definition
Antihistamine
Term
Benadryl Therapeutic Effects
Definition
-Competes with histamine for H1 receptor sites
-Relaxes non-vascular smooth muscle
Term
What does Benadryl reverse?
Definition
Histamine induced bronchospasm, broncho-secretions, vasodilation, and increased capillary permiability
Term
Benadryl Indications
Definition
-Anaphylaxis
-Dystonic Reactions (often from the use of phenothiazine or phenothiazine-like medications)
Term
Benadryl Absolute Contraindications
Definition
-Hypersensitivity
-Acute asthma exacerbation
Term
Benadryl Relative Contraindications
Definition
-Pregnant or nursing women
-Narrow-angle glaucoma
Term
Benadryl Cardiac Side Effects
Definition
-Hypotension
-Palpitations
-Tachycardia
Term
Benadryl Neuro Side Effects
Definition
-Drowsiness
-Confusion
-Decreased Coordination
-Blurred Vision
Term
Benadryl Respiratory Side Effects
Definition
Dry mucus plugs in lower airway
Term
Benadryl Other Side Effects
Definition
-Urinary Retention
-Dry mouth
Term
Benadryl Adult Dosing
Definition
50 mg IVP over 2 minutes.
-May be administered IM
-May be repeated in some system
Term
Benadryl Notes
Definition
-Has an atropine-like (anticholergenic) effect on the body, causing dry mucus plugs to form in asthma exacerbation pts
-May potentiate other antihistamines, alcohol, narcotics, and sedatives due to drug being a CNS depressant.
Term
Dystonic Reactions
Definition
-Buccolingual Crisis
-Akathisia
-Oculogyric Crisis
-Torticollis and muscle spasms involving other body parts
Term
Buccolingual Crisis
Definition
Facial Spams that may include tongue protrusion, difficulty swallowing, and a "thick tongue" sensation
Term
Akathisea
Definition
An ability to remain still or the inability to sit in general.
-Pts may stand, stare, and shuffle without any apparent purpose
Term
Oculogyric Crisis
Definition
Involuntary gyration of the eyes
Term
Phenothiazine/Phenothyazine-like medications
Definition
-compazine
-phenagren
-haldol
-throazine
-triavil
-stelazine
-novane
-mellaril
Term
Epinephrine Alternate Name
Definition
Adrenaline
Term
Epinephrine Classification
Definition
-Adrenergic Agonist
-Sympathomimetic
-Catecholamine
Term
Epinephrine (Therapeutic Effects; Beta 1 Receptor Effect)
Definition
Which drug acts on beta 1 receptors to increase chronotropy, inotropy, dromotropy, and automacity?
Term
Epinephrine (Therapeutic Effects; Beta 2 Receptor Effect)
Definition
Which drug relaxes bronchial smooth muscle by acting on beta 2 receptors?
Term
Epinephrine (Therapeutic Effects; Alpha 1 receptor Effect)
Definition
Which drug increases blood pressure by acting on alpha 1 receptors to promote vasoconstriction?
Term
Epinephrine Therapeutic Effect
Definition
May increase coronary and cerebral perfusion during CPR
Term
Epinephrine Indications
Definition
-Cardiac Arrest
-Hypotension post ROSC
-Allergic Reaction/Anaphylaxis
-Unstable Bradycardia
-Asthma/COPD/Bronchospasm
-Distributive Shock
-Croup/Stridor/Upper airway edema
Term
Epinephrine Contraindications
Definition
None when used for the appropriate indications.
Term
Epinephrine Cardiac Side Effects
Definition
-Palpitations
-tachycardia
-chest discomfort
-hypertension
-ectopy
-increased myocardial O2 demand
-V Fib
Term
Epinephrine GI Side Effects
Definition
-Nausea
-Vomiting
Term
Epinephrine Neuro Side Effects
Definition
-Restlessness
-Anxiety
-Headache
-Tremors
-Seizures
-Dizziness
Term
Epinephrine Doses - Cardiac Arrest
Definition
1 mg (1:10,000) IVP every 3-5 minutes
Term
Epinephrine Doses - Unstable Bradycardia/Hypotension Post-ROSC/Distributive Shock
Definition
-10-20 mcg IVP every 2 minutes
-Infusion starting at 5-10 mcg/min
Term
Epinephrine Doses - Anphylaxis/COPD/Broncospasm/Asthma
Definition
0.3 mg (1:1,000) IM
-May be repeated for some indications in 5-15 mins
Term
Epinephrine Notes - Other Concentrations
Definition
Push Dose Epi - 10 mcg/mL
-mix 1 mL of 1:10,000 with 9 mL NSS
Epi Infusion - PUMP ONLY
-mix 1 mg of 1:1,000 in 250-500 D5W/NSS bag.
Term
Epinephrine Notes - Special Patient Types
Definition
-Use caution with pregnant women, people over 40, and hypotension or cardiovascular disease patients
-Significant unstable bradycardia and Anaphylaxis pts sometimes require higher doses of medication in some systems
Term
Epinephrine Notes - Medication Interactions
Definition
Bicarb will decease the effectiveness of the drug. Give copious flushes and wait 1 minute after each medication administration
Term
Epinephrine Notes - Alternate Uses
Definition
Physicians and dentists use medication in combination with local
anesthetics (such as lidocaine) to anesthetize tissue. Due to its side effect of localized vasoconstriction, resulting in less bleeding and prolonged
anesthesia.
Term
Glucagon Classification
Definition
-Hyperglycemic agent
-Hormone
Term
Glucagon Therapeutic Effects
Definition
Increases BGL by Glycogenolysis and Glucogenesis
Term
Glucagon Indications
Definition
Known or suspected hypoglycemia when IV dextrose or oral glucose cannot be administered
Term
Glucagon Contraindications
Definition
Hypersensitivity
Term
Glucagon Side Effects
Definition
-Tachycardia
-Hypotension
-Nausea
-Vomiting
Term
Glucagon Dosing
Definition
1mg IM/IN
-Supplied in 2 vials with the glucagon as a powder to increase drugs' shelf life. To administer, draw up dilutent and insert into powder medication vial to mix. Administer immediately
Term
Glucagon Notes - Dilutent
Definition
-Some dilutant is glyceren, which is rarely associated with adverse reactions
-If dilutent is not provided, use NSS. Concentration should not be >1 mg/mL.
--Glucagon may precipitate with NSS, so it should be a last resort mix. IM/IN only. do not administer Glucagon/NSS mix through IV.
Term
Glucagon Notes
Definition
If dose does not provide desired effects, IV/IO dextrose should be administered over giving a second dose of medication
Term
Glucagon - Alternate Uses
Definition
-Can be used to treat unstable bradycardia secondary to beta blocker or calcium channel blocker OD. It increases heart rate and cardiac contractility independent of the beta adrenergic receptors.
--The initial dose is generally 0.05 mg/kg (up to 5 mg) IVP over 3-5 min.
-Can also be used to treat esophageal and lower airway obstructions because it relaxes smooth muscle.
Term
Glucagon Notes - Unlikely Treatable issues
Definition
Because it requires sufficient hepatic glycogen stores to function, drug is unlikely to treat hypoglycemia due to the following:
-Starvation
-Prolonged fasting
-Adrenal insufficiency
-Prolonged physical exertion without adequate carbohydrate intake
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