Pharmacology Quiz #3 (D50, Glucagon, Cynokit, Duodote & Normal Saline)

What is Dextrose (D50)’s Chemical name?

50% Dextrose in water

What is Dextrose (D50) ‘s trade name?

D50, D50w

What Class is Dextrose (D50)?

Carbohydrate

What is the Mechanism of Action of Dextrose (D50)?
(How does Dextrose work inside the body?)

Increases Glucose concentration in the blood for the reversal of Acute Hypoglycemia.

What are the Indications of giving Dextrose (D50)?
(What would make you think a patient needs Dextrose (D50) ?)

Hypoglycemia in Adults with Altered mental status.

What are some Contraindications of Dextrose (D50)?
(Reasons to NOT give a patient Dextrose)

Hyperglycemia. Intracranial hemorrhage is still listed as a contraindication.

What are some Precautions of giving Dextrose (D50)?

Check BGL before and after administering. Extravasation (Leakage of drugs or fluid from the blood vessels or tube into the surrounding area.) will cause sever necrosis of the tissue. D50 will NOT last long, so patients refusing transport should be encouraged to eat. Call medical control for patients refusing transport.

What are the Side Effects of Dextrose (D50)?

Localized irritation can still occur with a patent line. Monitor site closely.

What are the Interactions of Dextrose (D50)?

None significant for this indication.

What is the Dosage of Dextrose (D50)?

25g slow IV push. May be repeated in 10-15 minutes if BGL remains below 70 mg/dl.

What are the delivery Routes of Dextrose (D50)?

IV Push, IO Administration is reserved for SEVERE Altered Mental Status or Hypoglycemic seizures ONLY IF IV Access can't be established.

What is Glucagon’s Chemical name?

Glucagon

What Class is Glucagon?

Hormone

What is the Mechanism of Action of Glucagon?
(How does Glucagon work inside the body?)

Glucagon in its natural form is a hormone secreted by the alpha cells in the pancreas. Glucagon will cause a release of stored glycogen and convert them to Glucose. It inhibits the storage of more glycogen.

What are the Indications of giving Glucagon?
(What would make you think a patient needs Glucagon?)

Significant hypoglycemia with altered mental status and no IV access.

What are some Contraindications of Glucagon?
(Reasons to NOT give a patient Glucagon)

Hypersensitivity

What are some Precautions of giving Glucagon?

If the patient has already depleted their storage of Glycogen, glucagon will be ineffective. There is no test in the field to know.

What are the Side Effects of Glucagon?

Hypotension, Dizziness, Headache, N/V. It is unclear if these effects are from the Admin of Glucagon or the Hypoglycemic episode.

What are the Interactions of Glucagon?

None in the emergency setting, in therapeutic doses.

What is the Dosage of Glucagon?

1 mg

What is the delivery Route of Glucagon?

IM Injection

How long does it take for Glucagon to take effect?

3-5 minutes.

Side Notes about Glucagon:

Glucagon typically comes in a kit which requires you to premix it. Familiarize yourself with how to mix and inject this medication.

What is Cyanokit’s Chemical name?

Hydroxocobalamin

What is Cyanokit’s trade name?

Cyanokit

What Class is Cyanokit?

Vitamin, Antidote

What is the Mechanism of Action of Cyanokit?
(How does Cyanokit work inside the body?)

Hydroxocobalamin is the precursor to vitamin B12(Cyanocobalamin). When exposed to Hydroxocobalamin, the cyanide attaches itself to form Vitamin B12. It is then safely excreted in the urine.

What are the Indications of giving Cyanokit?
(What would make you think a patient needs Cyanokit?)

Treatment of Known or suspected Cyanide poisoning. (Smoke inhalation is most common.)

What are some Contraindications of Cyanokit?
(Reasons to NOT give a patient Cyanokit)

Hypersensitivity to any component of the medication (including cobalt).

What are some Precautions of giving Cyanokit?

Transient severe hypertension secondary to infusion Administration of Hydroxocobalamin may interfere with some clinical laboratory evaluations.

What are the Side Effects of Cyanokit?

Hypertension, pruritis (itching), headache, Chromaturia (up to 5 weeks) ((Chromaturia means abnormal discoloration in the urine, in this case red urine)), Hematochezia (Fresh bright red blood in the stool).

What are the Interactions of Cyanokit?

Due to incompatibilities (particulate formation) the following medications need to be run through different tubing.
- Diazepam
- Dobutamine
- Dopamine
- Fentanyl
- Nitroglycerin.

What is the Dosage of Cyanokit?

1 Kit (5g) over 15 minutes. May repeat giving 1 additional kit (5g) over 15 minutes to 2 hours if needed based on symptoms. Kit must be given immediately if poisoning is suspected!

1. Reconstitute the 5g vial with 200ml NS using the transfer spike. Fill to line.
2. Repeatedly invert vial for 60 seconds to reconstitute; DO NOT SHAKE!
3. Administer contents of vial (5g) over 15 minutes, use vented tubing.
4. Prepare and administer second vial if necessary.

Cyanokit Onset (How long does until it takes effect)?

Will begin working immediately.

Side Notes about Cyanokit:

This medication needs to be reconstituted prior to admin.

What is Naloxone Chemical name?

Naloxone

What is Naloxone trade name?

Narcan

What Class is Naloxone?

Competitive narcotic antagonist

What is the Mechanism of Action of Naloxone?
(How does Naloxone work inside the body?)

Competitively binds with narcotic receptor sites, displacing narcotics and blocking their effects.

What are the Indications of giving Naloxone?
(What would make you think a patient needs Naloxone?)

To reverse respiratory depression associated with narcotic overdose.

What are some Contraindications of Naloxone?
(Reasons to NOT give a patient Naloxone)

Known Hypersensitivity.

What are some Precautions of giving Naloxone?

Rapid administrations of large doses may cause immediate withdrawals in narcotic dependent patients. Titrate dosages to reverse respiratory depression rather than complete reversal of narcotic effects.

What are the Side Effects of Naloxone?

N/V, Hyper/Hypotension, Dysrhythmia’s.

What are the Interactions of Naloxone?

No direct drug interactions. Only works with Opiate overdoses.

What is the Dosage of Naloxone?

IV: 0.4mg – 2mg to a max of 10mg.

May also follow protocols for EMT administration for intranasal. (1mg per nostril) or commercially prepared nasal sprays (4mg)

What are the delivery Routes of Naloxone?

IV/IM/IN/SQ/IO

Side Notes about Naloxone:

Naloxone has a shorter half-life than opiates. May need to re-administer to combat the effects of a large overdose.

What is Duodote’s Chemical name?

Pralixdoxime Chloride (2-pam) and atropine.

What is Duodote’s trade name?

Duodote

What Class is Duodote?

Acetylcholinesterase reactivator, parasympatholytic.

What is the Mechanism of Action of Duodote?
(How does Duodote work inside the body?)

The duodote kit contains two medications Pralixdoxime Chloride is an Acetylcholinesterase re-activator and Atropine is Parasympatholytic.

Atropine reverses SLUDGEM symptoms while Pralixdoxime Chloride attaches to the site where an Acetylcholinesterase inhibitor has attached, then attaches to the inhibitor, removing the organophosphates from the Acetylcholinesterase enzyme, allowing it to work normally again.

What are the Indications of giving Duodote?
(What would make you think a patient needs Duodote?)

Treatment of suspected Organophosphate poisonings. Asses for SLUDGEM Symptoms.
Also assess for “KILLER B’S”
- Bradycardia
- Bronchospasm
- Bronchorrhea (excessive production of watery mucus from the lungs)

What are some Contraindications of Duodote?
(Reasons to NOT give a patient Duodote)

No contraindications in an emergency setting.

What are some Precautions of giving Duodote?

Does NOT work prophylactically. Repeated doses may be necessary. When symptoms of poisoning are not severe, Duodote should be with extreme caution. In people with heart disease, Arrhythmia’s, recent Myocardial infarction’s, Severe narrow angle glaucoma, Pyloric stenosis, Prostatic Hypertrophy, significant renal insufficiency, Chronic Pulmonary Disease, or hypersensitivity to any component of the product.

What are the Side Effects of Duodote?

Transient hypertension, temporary decreased renal function.

What are the Interactions of Duodote?

None relevant at the EMT level.

What is the Dosage of Duodote?

Each DuoDote Auto-injector contains a sterile solution of atropine (2.1) mg/0.7 mL) and a sterile solution of pralidoxime chloride (600 mg/0.2ml) in two separate internal changers. When activated, the DuoDote Auto-injector sequentially administers both drugs intramuscularly through a single needle in one injection.

What are the delivery Routes of Duodote?

On-set of 3-5 minutes

Side Notes about Duodote:

If the medications are supplied separately, atropine MUST be given first.

What is Normal Saline’s Chemical name?

0.9% sodium chloride solution.

What Class is Normal Saline?

Crystalloid

What is the Mechanism of Action of Normal Saline?
(How does Normal Saline work inside the body?)

Used to temporarily expand the vascular volume by replacing water and electrolytes. (Sodium and Chloride only, 154 mEw of each, isotonic with normal intravascular concentrations).

What are the Indications of giving Normal Saline?
(What would make you think a patient needs Normal Saline?)

Hypovolemia, Heat exhaustion, heat stroke (Cautiously), and DKA.

What are some Contraindications of Normal Saline?
(Reasons to NOT give a patient Normal Saline)

Heart Failure (CHF), Extreme Hypertension.

What are some Precautions of giving Normal Saline?

Patients receiving large volumes of fluid should be carefully monitored for fluid overload. Monitor lung sounds. Administer VERY carefully in patients exhibiting signs and symptoms of cardiogenic shock.

What are the Side Effects of Normal Saline?

Large Volumes can result in hemodilution, electrolyte imbalnces, pulmonary eduma, peripheral edema and hydrocephaly. For extremely large volumes, hyperchloremic acidosis may develop.

What are the Interactions of Normal Saline?

None

What is the Dosage of Normal Saline?

Depend on patient’s needs. NS can be administered as a volume replacement, 10-20 ml/kg in 250 ml boluses. Reassess frequently.

What are the delivery Routes of Normal Saline?

IV infusion or Syringe bolus for pediatric patients.

Notes about Normal Saline:

For every liter of Ns given, approximately 25% actually remains in the intravascular and intracellular space. The rest moves into the interstitial tissues or is filtered by the kidneys. This occurs in the first 15-30 minutes.