1. Pharmacology 7 2a

2. Electrolytes

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

4. 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

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

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

7. 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

8. 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

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

10. 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)

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

12. 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

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

18. 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

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

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

21. Volume Expanders

22. Pentaspan Other Names: Class Pentastarch Hydroxyethyl Starch
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 hours and is expected to improve hemodynamic status for 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 ml
Max: 28 ml/kg/day
In acute hemorrhagic shock, an administration of 20 ml/kg/hour may be used.

29. Albumin Other Names: Class: Plasbumin- 5 % Plasbumin- 25 %
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