Pharmacology 7 2a

Electrolytes

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

Calcium Chloride Indications: Contraindications: 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: Dosage: 10% solution in 10 ml Adult: 5 - 10 cc over 3 minutes (8 – 16 mg/kg) Pediatric: 5 mg/kg over 3 minutes

Magnesium Sulphate Class: MOA: 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: Contraindications: 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: Dosage: 20% solution Bolus: Infusion: 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: MOA: Electrolyte Principle intracellular ion affecting muscular contraction and nervous system transmission

Potassium Chloride Indications: Contraindications: 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: MOA: Buffer Alkalinizing agent Electrolyte Reacts with H+ ions to form water and carbon dioxide

Sodium Bicarbonate Indications: Contraindications: 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: Dosage: 50 mEq/50cc First dose: 1 mEq/kg Subsequent dose: 0.5 mEq/kg q 10 minutes PRN

Volume Expanders

Pentaspan Other Names: Class Pentastarch Hydroxyethyl Starch 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: Class: Plasbumin- 5 % Plasbumin- 25 % 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