Drugs used in CPR and Emergency.ppsx

1. Drugs used in CPR and Emergency Nursing Lectures Incredibly Easy Dr. Binu Babu Ph. D (N), MSN, MBA Mrs. Jincy Ealias MSN, RN

2. Drugs used in CPR • Cardiopulmonary resuscitation is an emergency procedure consisting of chest compressions often combined with artificial ventilation in an effort to manually preserve intact brain function until further measures are taken to restore spontaneous blood circulation and breathing in a person who is in cardiac arrest. • The drugs which supports CPR are follows. Nursing Lectures Incredibly Easy

3. Drug IV Dosage Indications Epinephrine Low dosage (0.01 mg/kg); High dosage (0.1 mg/kg) after prolonged CPR; 10 times the dosage may be required when given IT Administered every 3–5 minutes early in CPR (every other cycle) for asystole, ventricular fibrillation, PEAb Vasopressin 0.4–0.9 U/kg As an alternative to epinephrine every 3–5 minutes (every second BLS cycle) for asystole, bradycardia, PEA Atropine 0.04 mg/kg; 0.1 mL/5 lb (0.5 mg/mL solution) Sinus bradycardia, asystole, or PEA associated with high vagal tone Lidocaine 2–4 mg/kg Pulseless ventricular tachycardia, ventricular fibrillation resistant to defibrillation Nursing Lectures Incredibly Easy

4. Drug IV Dosage Indications Sodium bicarbonate 1 mEq/kg (1 mEq/mL solution) Severe metabolic acidemia (pH < 7.0) associated with prolonged (>10–15 minutes) CPR efforts (must be adequately ventilated to be effective), hyperkalemia Calcium gluconate 1 mL/5–10 kg (2% solution without epinephrine) Routine use not recommended; treat cases with documented hypocalcemia or severe hyperkalemia Amiodarone 5 mg/kg Refractory ventricular fibrillation or pulseless ventricular tachycardia Magnesium sulfate 30 mg/kg Hypomagnesemia, torsades des pointes Defibrillation 4–6 J/kg external monophasic; 2–4 J/kg external biphasic; 0.5–1 J/kg internal monophasic; 0.2–0.4 J/kg internal biphasic Single shock for ventricular fibrillation or pulseless ventricular tachycardia; resume CPR efforts immediately after for one cycle (2 minutes) and reassess ECG, after which dosage escalation by 50% may occur (maximum dosage of 10 joules/kg) Nursing Lectures Incredibly Easy

5. Drug IV Dosage Indications Naloxone 0.02–0.04 mg/kg To reverse opioids Flumazenil 0.01–0.02 mg/kg To reverse benzodiazepines Atipamezole 0.05 mg/kg (or same volume as dexmedetomidine) To reverse dexmedetomidine Reversal Agents Nursing Lectures Incredibly Easy

6. Drugs used in Emergency • A patient may unexpectedly experience a medical emergency needs to have the equipment to deal with that emergency efficiently. • A crash cart contains all emergency equipment and medications that would be required to treat a patient in the golden hours or so of a medical emergency. Nursing Lectures Incredibly Easy

7. Activated Charcoal • Mechanism of action – Absorbs toxic substances from the gastrointestinal tract • Indications – Most oral poisonings/ medication overdoses • Contraindications – Oral administration to comatose patients • Adverse reactions – If aspirated, can induce fatal form of pneumonitis – Bowel obstruction • Considerations – Mix contents well before administration. – Does not absorb cyanide, lithium, iron, lead, or arsenic Nursing Lectures Incredibly Easy

8. Adenosine • Mechanism of action – Slows conduction through the AV node – Can interrupt reentrant pathways – The drug of choice for reentry SVT • Indications – Most forms of stable narrow-complex SVT • Contraindications – Bronchoconstrictive or bronchospastic lung disease • Adverse reactions – Generally short duration and mild • Considerations – Evaluate elderly for signs of dehydration Nursing Lectures Incredibly Easy

9. Albuterol • Mechanism of action – Results in smooth-muscle relaxation in the bronchial tree • Indications – Treatment of bronchospasm in patients with COPD/asthma) • Contraindications – Hypersensitivity reactions to albuterol • Adverse reactions – Often dose-related and include headache, fatigue, lightheadedness, irritability, restlessness • Considerations – Pregnancy safety: Category C – May precipitate angina pectoris and dysrhythmias Nursing Lectures Incredibly Easy

10. Alteplase • Mechanism of action – Restores perfusion • Indications – Acute myocardial infarction, STEMI, massive pulmonary emboli, acute ischemic cerebrovascular accident • Contraindications – Active internal bleeding – Recent surgery • Adverse reactions – Intracranial bleeding, reperfusion dysrhythmias, chest pain, hypotension, GI bleeding, nausea, abdominal pain • Considerations – Monitor vital signs closely. – Observe for bleeding. Nursing Lectures Incredibly Easy

11. Amiodarone • Mechanism of action – Delays repolarization and increases the duration of action potential • Indications – Ventricular fibrillation • Contraindications – Known hypersensitivity to amiodarone or iodine – Cardiogenic shock • Adverse reactions – Dizziness, fatigue, malaise – Congestive heart failure • Considerations – Pregnancy safety: Category D – Monitor patient for hypotension. Nursing Lectures Incredibly Easy

12. Amyl Nitrite • Mechanism of action – Converts hemoglobin to methemoglobin to prevent toxic effects • Indications – Cyanide poisoning • Contraindications – None in emergency settings • Adverse reactions – Headache, dizziness, weakness • Considerations – Pregnancy safety: Category X – Highly flammable Nursing Lectures Incredibly Easy

13. Aspirin • Mechanism of action – Prevents platelets from clumping together and forming emboli • Indications – New onset chest pain suggestive of acute myocardial infarction • Contraindications – Relatively contraindicated in patients with active ulcer disease or asthma • Adverse reactions – Bronchospasm, anaphylaxis, wheezing in allergic patients, prolonged bleeding • Considerations – Pregnancy safety: Category D – Not recommended in pediatric population Nursing Lectures Incredibly Easy

14. Atenolol • Mechanism of action – Decreases heart rate, myocardial contractility, and cardiac output • Indications – To reduce myocardial ischemia and damage in acute myocardial infarction patients • Contraindications – Heart failure, cardiogenic shock, bradycardia • Adverse reactions – Dizziness, bronchospasm, bradycardia • Considerations – Pregnancy safety: Category D – Atenolol must be given slowly IV over 5 minutes – Should be used with caution in patients with liver or renal dysfunction and COPD Nursing Lectures Incredibly Easy

15. Atropine Sulfate • Mechanism of action – Increases heart rate in life-threatening bradydysrhythmias • Indications – Hemodynamically unstable bradycardia • Contraindications – Tachycardia, hypersensitivity • Adverse reactions – Drowsiness, confusion, headache, tachycardia, palpitations • Considerations – Pregnancy safety: Category C – Moderate doses may cause pupillary dilation. Nursing Lectures Incredibly Easy

16. Calcium Chloride • Mechanism of action – Increases cardiac contractile state • Indications – Hypocalcemia, hyperkalemia, hypermagnesemia • Contraindications – Hypercalcemia, ventricular fibrillation, digitalis toxicity • Adverse reactions – Syncope, cardiac arrest, dysrhythmia, bradycardia • Considerations – Pregnancy safety: Category C – Do not use routinely in cardiac arrest. Nursing Lectures Incredibly Easy

17. Calcium Gluconate • Mechanism of action – Counteracts the toxicity of hyperkalemia • Indications – Hyperkalemia, hypocalcemia • Contraindications – Ventricular fibrillation, digitalis toxicity, hypercalcemia • Adverse reactions – Syncope, cardiac arrest, dysrhythmia, bradycardia • Considerations – Pregnancy safety: Category C – Do not administer by IM or SQ Nursing Lectures Incredibly Easy

18. Clopidogrel • Mechanism of action – Inhibits platelet aggregation • Indications – Acute coronary syndrome – Substitute for aspirin in patients unable to take aspirin • Contraindications – Active GI bleeding, intracranial hemorrhage • Adverse reactions – Severe neutropenia – Hemorrhaging • Considerations – Pregnancy safety: Category B – Often given with other anticoagulants Nursing Lectures Incredibly Easy

19. Dexamethasone Sodium Phosphate • Mechanism of action – Suppresses acute and chronic inflammation • Indications – Anaphylaxis, asthma, spinal cord injury • Contraindications – Hypersensitivity, use caution in suspected systemic sepsis • Adverse reactions – Headache, restlessness, euphoria, psychoses • Considerations – Pregnancy safety: Category C – Protect medication from heat. Toxicity and side effects occur with long- term use. Nursing Lectures Incredibly Easy

20. Dextrose • Mechanism of action – Rapidly increases serum glucose levels • Indications – Hypoglycemia, altered level of consciousness • Contraindications – Intracranial hemorrhage • Adverse reactions – Cerebral hemorrhage – Cerebral ischemia – Pulmonary edema • Considerations – Pregnancy safety: Category C Nursing Lectures Incredibly Easy

21. Diazepam • Mechanism of action – Raises the seizure threshold; induces amnesia and sedation • Indications – Acute anxiety states and agitation, acute alcohol withdrawal • Contraindications – Hypersensitivity, narrow- angle glaucoma • Adverse reactions – Dizziness, drowsiness, confusion, headache • Considerations – Pregnancy safety: Category D – Short duration for anticonvulsant effect – Reduce dose by 50% in elderly patients. Nursing Lectures Incredibly Easy

22. Digoxin • Mechanism of action – Increases force of myocardial contraction • Indications – Congestive heart failure, reentry SVTs, ventricular rate control in atrial flutter and atrial fibrillation • Contraindications – Ventricular fibrillation, ventricular tachycardia, digitalis toxicity • Adverse reactions – Fatigue, headache, blurred yellow or green vision, seizures • Considerations – Pregnancy safety: Category C – Patient receiving IV digoxin must be on a monitor Nursing Lectures Incredibly Easy

23. Dopamine Hydrochloride • Mechanism of action – Increases myocardial contractility and stroke volume • Indications – Cardiogenic and septic shock, hypotension with low cardiac output states • Contraindications – Hypovolemic shock, pheochromocytoma, tachydysrhythmias • Adverse reactions – Headache, anxiety, dyspnea, dysrhythmias • Considerations – Pregnancy safety: Category C – Effects are dose- dependent Nursing Lectures Incredibly Easy

24. Epinephrine (Adrenalin) • Mechanism of action – Blocks histamine receptors • Indications – Cardiac arrest, symptomatic bradycardia • Contraindications – Hypertension, hypothermia, pulmonary edema • Adverse reactions – Nervousness, restlessness, headache, tremor • Considerations – Pregnancy safety: Category C – May cause syncope in asthmatic children Nursing Lectures Incredibly Easy

25. Furosemide (Lasix) • Mechanism of action – Causes increased urine output • Indications – CHF, pulmonary edema, hypertensive crisis • Contraindications – Hypovolemia, anuria, hypotension • Adverse reactions – Dizziness, headache, ECG changes, weakness • Considerations – Pregnancy safety: Category C – Ototoxicity, deafness, and projectile vomiting can occur with rapid administration. Nursing Lectures Incredibly Easy

26. Hydrocortisone Sodium Succinate • Mechanism of action – Anti-inflammatory; immunosuppressive with salt-retaining actions • Indications – Shock due to acute adrenocortical insufficiency, anaphylaxis, asthma, and COPD • Contraindications – Systemic fungal infections, premature infants • Adverse reactions – Headache, vertigo, pulmonary tuberculosis • Considerations – Pregnancy safety: Category C – May be used in status asthmaticus as a second-line drug Nursing Lectures Incredibly Easy

27. Insulin • Mechanism of action – Allows glucose transport into cells of all tissues • Indications – Not used in emergency prehospital setting • Contraindications – Hypoglycemia, hypokalemia • Adverse reactions – Weakness, fatigue, confusion, headache • Considerations – Pregnancy safety: Category B – Insulin is the drug of choice for control of diabetes in pregnancy. Nursing Lectures Incredibly Easy

28. Magnesium Sulfate • Mechanism of action – Reduces striated muscle contractions • Indications – Seizures of eclampsia, torsades de pointes, hypomagnesemia • Contraindications – Heart block, myocardial damage • Adverse reactions – Drowsiness, CNS depression, respiratory depression • Considerations – Pregnancy safety: Category A – Recommended that the drug not be administered in the 2 hours before delivery, if possible Nursing Lectures Incredibly Easy

29. Mannitol • Mechanism of action – Decreases cerebral edema and intracranial pressure • Indications – Cerebral edema • Contraindications – Hypotension, pulmonary edema, severe dehydration, intracranial bleeding, CHF • Adverse reactions – Headache, confusion, seizures, pulmonary edema • Considerations – Pregnancy safety: Category C – May crystallize at low temperatures; store at room temperature – Have ventilatory support available. Nursing Lectures Incredibly Easy

30. Naloxone Hydrochloride • Mechanism of action – Reverses respiratory depression secondary to opiate drugs • Indications – Opiate overdose, complete or partial reversal of central nervous system and respiratory depression induced by opioids • Contraindications – Use with caution in narcotic-dependent patients • Adverse reactions – Restlessness, seizures, dyspnea, pulmonary • Considerations – Pregnancy safety: Category C Nursing Lectures Incredibly Easy

31. Nifedipine • Mechanism of action – Inhibits movement of calcium ions across cell membranes • Indications – Hypertensive crisis, angina pectoris • Contraindications – Compensatory hypertension, hypotension • Adverse reactions – Headache, dizziness, nervousness, weakness, mood changes • Considerations – Pregnancy safety: Category C – Have beta blocker available for control of reflex tachycardia Nursing Lectures Incredibly Easy

32. Nitroglycerin • Mechanism of action – Smooth muscle relaxant acting on vasculature, bronchial, uterine, intestinal smooth muscle • Indications – Acute angina pectoris, ischemic chest pain • Contraindications – Hypotension, hypovolemia, intracranial bleeding or head injury • Adverse reactions – Headache, dizziness, weakness, reflex tachycardia • Considerations – Pregnancy safety: Category C – Hypotension more common in the elderly Nursing Lectures Incredibly Easy

33. Norepinephrine • Mechanism of action – Potent alpha-agonist resulting in intense peripheral vasoconstriction • Indications – Cardiogenic shock, unresponsive to fluid resuscitation • Contraindications – Hypotensive patients with hypovolemia • Adverse reactions – Headache, anxiety, dizziness • Considerations – Pregnancy safety: Category C. – May cause fetal anoxia when used in pregnancy Nursing Lectures Incredibly Easy

34. Ondansetron Hydrochloride • Mechanism of action – Blocks action of serotonin • Indications – Prevention and control of nausea or vomiting • Contraindications – Known allergy to ondansetron • Adverse reactions – Headache, malaise, wheezing • Considerations – Pregnancy safety: Category B Nursing Lectures Incredibly Easy

35. Phenytoin • Mechanism of action – Promotes sodium efflux from neurons • Indications – Prophylaxis and treatment of major motor seizures • Contraindications – Hypersensitivity, bradycardia • Adverse reactions – Ataxia, agitation, dizziness, headache, drowsiness • Considerations – Pregnancy safety: Category D – Carefully monitor vital signs. Nursing Lectures Incredibly Easy

36. Sodium Bicarbonate • Mechanism of action – Buffers metabolic acidosis and lactic acid buildup • Indications – Metabolic acidosis during cardiac arrest, tricyclic antidepressant, aspirin • Contraindications – Metabolic/respiratory alkalosis, hypokalemia, electrolyte imbalance • Adverse reactions – Hypernatremia, metabolic alkalosis, tissue sloughing, cellulitis • Considerations – Pregnancy safety: Category C – Repeat as needed in tricyclic antidepressant overdose until QRS narrows Nursing Lectures Incredibly Easy

37. Streptokinase • Mechanism of action – Combines with plasminogen to convert free plasminogen to the proteolytic enzyme, plasmin • Indications – Acute myocardial infarction, massive pulmonary emboli, arterial thrombosis/ embolism, to clear intraventricular cannula • Contraindications – Hypersensitivity, active bleeding, recent cerebral vascular accident • Adverse reactions – Intracranial hemorrhage, bronchospastic hemoptysis, ARDS • Considerations – Pregnancy safety: Category C Nursing Lectures Incredibly Easy

38. Vasopressin • Mechanism of action – Stimulation of smooth muscle receptors • Indications – Alternative vasopressor to the first or second dose of epinephrine in cardiac arrest • Contraindications – Use with caution in patients with coronary artery disease, epilepsy, or heart failure. • Adverse reactions – Dizziness, headache, bronchial constriction, MI, chest pain, angina • Considerations – Pregnancy safety: Category C – May increase peripheral vascular resistance and provoke cardiac ischemia and angina Nursing Lectures Incredibly Easy

39. IV Solutions (Colloids and Crystalloids) • Colloids – Expand plasma volume – Most often used in hypovolemic shock states • Crystalloid solutions are used for: – Electrolyte replacement – A route for medication – Short-term intravascular volume expansion Nursing Lectures Incredibly Easy

40. Dextran • Mechanism of action – Sugar-containing colloid used as an intravascular volume expander • Indications – Hypovolemic shock • Contraindications – Patients with congestive heart failure, renal failure, or known bleeding disorders • Adverse reactions – Rash, itching, dyspnea, chest tightness, and mild hypotension • Considerations – In the management of burn shock, it is especially important to follow standard fluid resuscitation regimens to prevent possible circulatory overload. Nursing Lectures Incredibly Easy

41. Lactated Ringer’s (Hartmann’s Solution) • Mechanism of action – Replaces water and electrolytes • Indications – Hypovolemic shock; keep open IV • Contraindications – Should not be used in patients with congestive heart failure or renal failure • Adverse reactions – Rare in therapeutic dosages • Considerations – None Nursing Lectures Incredibly Easy

42. 5% Dextrose in Water (D5W) • Mechanism of action – Provides nutrients in the form of dextrose as well as free water • Indications – For dilution of concentrated drugs for intravenous infusion • Contraindications – Should not be used as a fluid replacement for hypovolemic states • Adverse reactions – Rare in therapeutic dosages • Considerations – Should not be used with phenytoin or amrinone Nursing Lectures Incredibly Easy

43. 10% Dextrose in Water (D10W) • Mechanism of action – Provides nutrients in the form of dextrose as well as free water • Indications – Neonatal resuscitation, hypoglycemia • Contraindications – Should not be used as a fluid replacement for hypovolemic states • Adverse reactions – Rare in therapeutic dosages • Considerations – None Nursing Lectures Incredibly Easy

44. 0.9% Sodium Chloride (Normal Saline) • Mechanism of action – Replaces water and electrolytes • Indications – Heat-related problems (heat exhaustion, heat stroke), freshwater drowning, hypovolemia • Contraindications – Should not be used in patients with congestive heart failure • Adverse reactions – Rare in therapeutic dosages • Considerations – None Nursing Lectures Incredibly Easy

45. 0.45% Sodium Chloride (½ Normal Saline) • Mechanism of action – Replaces free water and electrolytes • Indications – Patients with diminished renal or cardiovascular function for which rapid rehydration is not indicated • Contraindications – Cases in which rapid rehydration is indicated • Adverse reactions – Rare in therapeutic dosages • Considerations – None Nursing Lectures Incredibly Easy

46. 5% Dextrose in 0.45% Sodium Chloride (D5½NS) • Mechanism of action – Replaces free water and electrolytes and provides nutrients in the form of dextrose • Indications – Heat exhaustion, diabetic disorders • Contraindications – Should not be used when rapid fluid resuscitation is indicated • Adverse reactions – Rare in therapeutic dosages • Considerations – None Nursing Lectures Incredibly Easy

47. 5% Dextrose in 0.9% Sodium Chloride (D5NS) • Mechanism of action – Replaces free water and electrolytes and provides nutrients in the form of dextrose • Indications – Heat-related disorders, freshwater drowning • Contraindications – Should not be given to patients with impaired cardiac or renal function • Adverse reactions – Rare in therapeutic dosages • Considerations – None Nursing Lectures Incredibly Easy

48. 5% Dextrose in Lactated Ringer’s (D5LR) • Mechanism of action – Replaces water and electrolytes and provides nutrients in the form of dextrose • Indications – Hypovolemic shock, hemorrhagic shock • Contraindications – Should not be administered to patients with decreased renal or cardiovascular function • Adverse reactions – Rare in therapeutic dosages • Considerations – None Nursing Lectures Incredibly Easy

49. References • American Heart Association, Highlights of the 2020 AHA Guidelines Update for CPR and ECC. • Bernard SA, Gray TW, Buist MD, et al: Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J Med 346:557–563, 2002. doi: 10.1056/NEJMoa003289 • Nielsen N, Wetterslev J, Cronberg T, et al: Targeted temperature management at 33°C versus 36°C after cardiac arrest. N Engl J Med 369:2197–2206, 2013. doi: 10.1056/NEJMoa1310519. • Berman, A. J., Snyder, S., Kozier, B. J., & Erb, G. (2012). Kozier & Erb’s Fundamentals of nursing (9th ed.). Upper Saddle River, NJ: Pearson/Prentice Hall. • Brunton, L. L., Lazo, J. S., & Parker, K. L. (Eds.). (2006). Goodman & Gilman’s The pharmacological basis of therapeutics (11th ed.), New York, NY: McGraw-Hill. Nursing Lectures Incredibly Easy

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