| back 5
Special Considerations:
- For pediatrics: if calcium gluconate is unavailable, 1-2 ml of
10% calcium chloride solution, diluted with IV fluid, may be
substituted.
-
Pregnancy Safety: Category C.
|
| back 6
Special Considerations:
- Use in caution in patients with renal or hepatic
dysfunction.
-
Pregnancy Safety: Category C.
|
| back 7
Special Considerations: Effects are dose-dependent;
-
Dopaminergic response: 2 - 4mcg/kg/min: dilates
vessels in kidneys; increased urine output.
-
Beta-adrenergic response: 4 - 10mcg/kg/min:
Increased chronotropy and inotropy.
-
Adrenergic response: 10 - 20mcg/kg/min: Primarily
alpha stimulant/vasoconstriction.
-
>20mcg/kg/min: reversal of renal
effects/override alpha effects.
- Always monitor drip
rate.
- Avoid extravagation injury.
-
Pregnancy Safety: not established.
|
| back 8
Special Considerations:
-
Pregnancy Safety: Category C.
|
front 9 Fentanyl citrate (Sublimaze) | back 9
Special Considerations:
-
Pregnancy Safety: Category C.
|
| back 10
Special Considerations:
- Ototoxicity and deafness can occur.
-
Pregnancy Safety: Category C.
|
| back 11
Special Considerations:
- Reduce maintenance infusions by 50% if patient is over 70
years of age, has liver disease, or is in CHF or shock.
- A
75-100 mg bolus maintains levels for only 20 minutes.
- If
bradycardia occurs with PVCs, always treat the bradycardia with
atropine.
- Exceedingly high doses can result in coma or
death.
-
Pregnancy Safety: Category B.
|
| back 12
Special Considerations:
- IV calcium gluconate or calcium chloride should be available
as antagonist if needed.
- Use with caution in patients with
renal failure.
- Being used for acute MI patients in some
systems under Medical Direction.
-
Pregnancy Safety: Recommended that drug not be given in the
2 hours before delivery, if possible.
|
front 13 Metoprolol (Lopressor/Toprol XL) | back 13
Special Considerations:
- Not recommended in pediatric population. The safety and
effectiveness have not been established in children.
-
Pregnancy Safety: Category C (manufacturer); D (2nd and 3rd
trimesters - expert analysis).
|
| back 14
Special Considerations:
- Safety in neonate not established.
- Use with caution
in geriatric population and those with COPD, asthma.
- Naloxone should be readily available as antidote.
-
Pregnancy Safety: Category C.
**Rapidly crosses the placenta. |
front 15 Nitroglycerin (Nitrolingual/NitroQuick/Nitro-Dur) | back 15
Special Considerations:
- Hypotension more common in geriatric population.
- Decomposes if exposed to light or heat.
- Must be kept in
airtight containers.
- Active ingredient may have a stinging
effect when administered SL.
-
Pregnancy Safety: Category C.
|
| back 16
Special Considerations:
- Infuse through a large, stable vein to avoid extravasation and
tissue necrosis.
- Drug or poison induced hypotension may
require higher doses to achieve adequate perfusion.
-
Pregnancy Safety: Category C.
**Use cautiously
during pregnancy and while breastfeeding. May cause fetal anoxia
when used in pregnancy. |
| back 17
Special Considerations:
- Be familiar with liter flow and each type of delivery device
used.
- Supports possibility of combustion.
|
| back 18
Special Considerations:
- Must ventilate patient after
administration.
Intracellular acidosis may be worsened by
production of carbon dioxide. - May worsen CHF.
-
Pregnancy Safety: Category C.
|