Prehospital Pharmacology

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Agonist Medications
initiate or alter a cellular activity by attaching to receptor sites, prompting a cell response

Antagonist Medications
prevent endogenous or exogenous agonist chemicals from reaching cell receptor sites and initiating or altering a particular cellular activity

Alpha (a)-1
Vasoconstriction of arteries and veins

Alpha (a)-2
Insulin restriction
glucagon secretion
inhibition of norepinephrine release

Beta (B)-1
Increased heart rate (chronotropic effect)
Increased myocardial contractility (inotropic effect)
Increased myocardial conduction (dromotropic effect)
Renin secretion for urinary retention

Beta (B)-2
Bronchus and brochiole relaxation
Insulin secretion
Uterine relaxation
Arterial dilation in certain key organs

Dopaminergic
Vasodilation of renal and mesenteric arteries (Numerous receptor subtypes exist)

Nicotinic
Present at neuromuscular junction, allowing acetylcholine (ACh) to simulate muscle contraction

Muscarinic-2
Present in the heart; activated by ACh to offset sympathetic stimulation, decreasing heart rate, contractility, and electrical conduction velocity

Acetaminophen
Class: Analgesic/Antipyretic
Mechanism of Action: Reduces fever and pain by decreasing the prostaglandin syntheses in the CNS
Indications: Fever symptoms, or to prevent febrile seizures in pediatric patients.
Contraindications: Hepatic impairment, use caution if hypothermia related to the toxic events of medications or environmental exposure, if malnutrition, alcohol use.
Adverse Effects: Overdose can cause severe liver injury.
Doseage and Administration: Adults and children over 12 years is 325 to 650mg every 4 to 6 hrs, up to 4000mg/day. 3 mo 40mg/4hrs. 4-11mo 80mg/4hrs. 12-23mo 120mg/4hrs. 2-3yr 160mg/4hrs. 4-5yr 240mg/4hrs. 6-8yr 320mg/4-6hr. 9-10yr 400mg/4-6hr. 11yr 480mg/4-6hr. 12yr 640mg/4-6hr
Duration: Rapidly absorbed from GI tract, Peak: 30-120 mins. Absorption slows when combined with diphenhydramine

Activated Charcoal
Class: Absorbent
Mechanism of Action: Absorbs toxic substances from the gastrointestinal tract
Indications: Most oral poisonings and medication overdoses; can be used after evacuation of poisons
Contraindications: Oral administration to comatose patients; after ingestion of corrosives, caustics, petroleum distillates (ineffective and may induce vomiting); simultaneous administration with other oral drugs. Use caution in patients experiencing abdominal pain of unknown origin or known GI obstruction
Adverse reactions/side effects: If aspirated, can induce fatal form of pneumonitis; constipation, black stools, diarrhea, vomiting, bowel obstruction
Drug Interactions: Bonds with and generally inativates whatever it is mixed with (eg, syrup of ipecac)
How supplied: 25g (black powder)/125-mL bottle (200mg/mL); 50g (black powder)/250-mL bottle (200mg/mL)
Duration of Action: Onset: Immediate. Peak effect: Depends on gastrointestinal function. Duration: Will act until excreted
Special Considerations: Pregnancy safety: Category C. Often used in conjunction with magnesium citrate. Must be stored in a closed container. Be sure to mix contents well before administration due to separation while being stored. Does not absorb cyanide, lithium, iron, lead, or arsenic.

Adenosine (Adenocard)
Class: Antidysrhythmic
Mechanism of Action: Slows conduction through the AV node; can interrupt re-entrant pathways; slows heart rate by acting directly on the sinus pacemaker cells by slowing impulse formation. The drug of choice for re-entry SVT. Can be used diagnostically for stable, wide-complex tachycardia of unknown origin after two doses of lidocaine.
Indications: Conversion of PSVT to sinus rhythm. May convert re-entry SVT due to Wolff-Parkinson-White syndrome. Not effective in converting atrial fibrillation/flutter or V-Tach. Most forms of stable narrow-complex SVT.
Contraindications: Second- or third-degree. AV block (if no pacemaker is present), sick sinus syndrome (If no pacemaker present), bronchoconstrictive or bronchospastic lung disease (asthma, COPD), poison- or drug-induced tachycardia
Adverse reactions/side effects: Generally short duration and mild; headache, dizziness, dyspnea, bronchospasm dysrhythmias, palpations, hypotension, chest pain, facial flushing, cardiac arrest, nausea, metallic taste, pain in the head or neck, paresthesia, diaphoresis
Drug interactions: Methylzanthines (theophylline-like drugs) antagonize the effects of adenosine. Dipyridamole (Persantine) potentiates the effect of adenosine. Carbamazepine (tegretol) may potentiate the AV node blocking effect of adenosine.
How supplied: 3mg/mL in 2-mL and 5-mL flip-top vials
Dosage and administration: Adult: 6mg rapid IV push, followed by 20mL saline flush and elevate extremity. If no response after 1-2 mins administer second dose of 12mg rapid IV push. Pediatric: Initial dose 0.1mg/kg rapid IV/IO push (maximum first dose 6mg), followed by 5-10mL saline flush. Second dose 0.2mg/kg rapid IV/IO push (maximum second dose 12mg/kg) followed by a 5-10 mL saline flush
Duration of action: Onset: Seconds. Peak effect: Seconds. Duration: 12 seconds
Special Considerations: Pregnancy safety: Category C. May cause brochoconstriction
in asthma patients. Evaluate elderly for signs of dehydration requiring fluid replacement prior to administering adenosine. Short half-life limits side effects in most patients

Albuterol (Proventil, Ventolin)
Class: Sympathomimetic, brochodilator
Mechanism of Action: Selective beta-2 agonist that stimulates adrenergic receptors of the sympathomimetic nervous system. Results in smooth-muscle relaxation in the brochial tree and preipheral vasculature
Indications: Treatment of broncospasm in patients with reversible obstructive airway disease (COPD/asthma). Prevention of exercise-induced bronchospasm
Contraindications: Known prior hypersensitivity reactions to albuterol, Tachycardia, dysrhythmias, especially those caused by digitalis. Synergistic with other sympathomimetics.
Adverse reactions/side effects: Often dose-related and include headache, fatigue, lightheadedness, irritability, restlessness, aggressive behavior, pulmonary edema, hoarseness, nasal congestion, increased sputum, hypertension, tachycardia, dysrhythmias, chest pain, palpations, nausea/vomiting, dry mouth, epigastric pain, and tremors.
Drug interactions: Tricyclic antidepressants may potentiate vasculature effects. Beta blockers are antagonistic and may block pulmonary effects. May potentiate hypokalemia caused by diuretics.
How supplied: metered-dose inhaler: 90mcg/metered spray. Solution for aerosolization: 0.5% (5mg/mL), 0.083% (2.5mg) in 3mL unit dose nebulizer
Dosage and administration: Adult: Administer 2.5mg. Dilute in 0.5mL of 0.5% solution for inhalation with 2.5mL normal saline in nebulizer and administer over 10-15 mins. Metered-dose inhaler: 1-2 inhalations (90-180mcg) wait 5 mins between inhalations. Pediatric: <20kg: 1.25mg/dose via hand-held nebulizer or mask over 20 mins. >20kg: 2.5 mg/dose via hand-held nebulizer or mask over 20 mins. Repeat once in 20 mins.
Duration of Action: Onset: 5-15 mins. Peak effect: 30 mins to 2 hrs. Duration: 3-4 hrs
Special Considerations: Pregnancy safety: Category C. May precipitate angina pectoris and dysrhythmias. In prehospital emergency care, albuterol should be administered only via inhalation

Amiodarone (Cordarone, Pacerone)
Class: Antidysrhythmic
Mechanism of Action: Blocks sodium channels and myocardial potassium channels, delaying repolarization and increasing the duration of action potential
Indications: Ventricular fibrillation, pulseless ventricular tachycardia, unstable ventricular tachycardia in patients refractory to other therapy
Contraindications: Known hypersensitivity to amiodarone or iodine, cardiogenic shock, sinus bradycardia, second or third degree AV block (if no pacemaker is present), severe sinus node dysfunction
Adverse reactions/side effects: Dizziness, fatigue, malaise, tremor, ataxia, lack of coordination, adult respiratory distress syndrome, pulmonary edema, cough, progressive dyspnea, congestive heart failure, bradycardia, hypotension, worsening of dysrhythmias, prolonged QT interval, nausea, vomiting, burning at IV site, Stevens-Johnson syndrome
Drug Interactions: Use with digoxin may cause digitalis toxicity. Antidysrhythmias may cause increased serum levels. Beta blocker and calcium channel blockers may potentiate bradycardia, sinus arrest, and AV heart blocks
How supplied: 50mg/mL vials and prefilled syringes. For rapid infusion, add 150mg/3mL to a 10mL D5W (1.5mg/mL) run at 600 mL/hr on infusion pump
Dosage and administration: Adult: Ventricular fibrillation/pulseless ventricular tachycardia unresponsive to CPR, defibrillation, and vasopressors: 300mg IV/IO push. Initial dose can be followed one time in 3-5 mins at 150mg IV/IO push. Recurrent life-threatening ventricular dysrhythmias. Maximum cumulative dose: 2.2g IV/24hr administered as follows: Rapid infusion: 150mg IV/IO over 10 mins (15mg/min) May repeat rapid infusion (150mg IV/IO) every 10 mins as needed. Pediatric: Refractory ventricular fibrillation pulseless ventricular tachycardia: 5mg/kg IV/IO bolus can repeat the 5mg/kg IV/IO bolus up to a total dose of 15 mg/kg/24hr. Maximum single dose: 300mg. Perfusing supraventricular and ventricular tachycardias: Loading dose 5mg/kg Iv/IO over 20-60 mins (maximum single dose of 300 mg). Can repeat to maximum dose of 15 mg/kg/day (2.2g in adolescents). Maximum single dose: 300 mg
Duration of Action: Onset: Immediate. Peak effect: 10-15 mins. Duration 30-45 mins
Special Considerations: Pregnancy safety: Category D. Monitor patient hypotension. May worsen or precipitate new dysrhythmias

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