Pharmacology Lecture Notes: Emergency and Clinical Medications

Vocabulary flashcards covering pharmacology classifications, mechanisms of action, clinical indications, contraindications, and emergency dosages.

Etomidate

A sedative-hypnotic administered as a single dose to facilitate airway placement, notable for having minimal effect on blood pressure and a short duration of action.

Ketamine

A sedative-hypnotic used for general anesthesia and airway placement that maintains blood pressure and heart rate, raises intracranial pressure (ICP), and provides some degree of bronchodilation.

Succinylcholine (Anectine)

A competitive depolarizing paralytic agent with a rapid onset and brief duration that binds to nicotinic receptors on muscles to prevent additional acetylcholine (Ach) activation.

Rocuronium

A nondepolarizing paralytic agent that competes with acetylcholine (Ach) at receptor sites, characterized by a longer duration of action and fewer adverse effects compared to depolarizing paralytics.

Ipratropium Bromide

An anti-muscarinic medication that antagonizes muscarinic receptors to cause bronchodilation and reduce mucus production during bronchospasms or reactive airway disease.

Class I Antidysrhythmics

Sodium-channel blockers used to treat atrial and ventricular dysrhythmias; subclass IA slows sodium movement through channels in cardiac cells, while subclass IB blocks sodium channels in Purkinje fibers and ventricles to suppress ectopic foci.

Class III Antidysrhythmics

Potassium channel blockers, such as Amiodarone and Sotalol, that treat atrial or ventricular tachycardias by extending the cellular action potential and increasing the duration of phases $1$, $2$, and $3$ of the cardiac cycle.

Class IV Antidysrhythmics

Calcium channel blockers, such as Vermapil and Diltiazem, that displace calcium at receptor sites to relax smooth muscle in the heart, blood vessels, GI tract, and uterus, while slowing AV node conduction.

Adenosine

A Class V antidysrhythmic purine nucleoside base ($\text{ATP}$) that binds to purinergic adenosine receptors to slow AV node conduction; indicated for stable, regular, narrow QRS tachycardias.

Angiotensin-Converting Enzyme (ACE) Inhibitors

Medications ending in '-pril' (such as Enalapril and Lisinopril) that alter the renin-angiotensin system by preventing the conversion of angiotensin I to angiotensin II, lowering blood pressure and afterload without significantly altering cardiac output.

Digitalis Preparations

Agents including Digoxin (Lanoxin) and Digitoxin (Crystodigin) that increase the force of myocardial contraction to improve cardiac output while slowing conduction through the AV node.

Direct Vasodilators

Agents such as Nitroglycerin, Sodium nitroprusside, and Hydralazine that dilate veins and coronary arteries to decrease cardiac preload, reduce myocardial oxygen demand, and improve coronary circulation.

Loop Diuretics

Diuretics such as Furosemide (Lasix) that disrupt sodium reabsorption in the thick ascending limb of the loop of Henle to promote electrolyte and fluid excretion.

Tranexamic Acid (Lysteda)

An antifibrinolytic lysine derivative that prevents the breakdown of fibrin clots, thereby promoting blood clotting and reducing mortality in trauma patients suffering from severe bleeding.

Warfarin (Coumadin)

A coumarin anticoagulant that prevents the liver from synthesizing four vitamin K-dependent clotting factors, requiring dosage titration based on INR laboratory values.

Activase

A fibrinolytic agent indicated for the emergency dissolution of existing blood clots within arteries and veins during acute myocardial infarction and stroke.

Glucagon

A carbohydrate-elevating agent that converts hepatic glycogen stores to circulating glucose and exerts positive inotropic and chronotropic effects on the heart without requiring $\beta_1$ receptor stimulation.

Magnesium Sulfate

An electrolyte indicated for the treatment of torsades de pointes, hypomagnesemia, and prevention of eclamptic seizures during pregnancy, functioning by relaxing smooth muscle tissues and facilitating ion transport.

Sodium Bicarbonate

An alkalinizing agent that neutralizes metabolic acids to elevate blood pH, stabilizes cardiac membranes in tricyclic antidepressant overdoses, promotes salicylate clearance, and manages hyperkalemia.

Monoamine Oxidase Inhibitors (MAOIs)

Antidepressants (such as Isocarboxazid, Phenelzine, Tranylcypromine, and Selegiline) that increase neurotransmitter levels by inhibiting the enzyme responsible for breaking down norepinephrine, serotonin, dopamine, and tyramine.

Selective Serotonin Reuptake Inhibitors (SSRIs)

Antidepressants (such as Citalopram, Escitalopram, Sertraline, and Fluoxetine) that block serotonin reabsorption into nerve cells without inhibiting the reuptake of dopamine or norepinephrine.

Tricyclic Antidepressants (TCAs)

Medications (including Amitriptyline, Doxepin, and Desipramine) that elevate synaptic concentrations of serotonin and norepinephrine while also blocking histamine and cholinergic receptors.

Acetylcysteine

The specific antidote for acetaminophen toxicity, dosed intravenously for adult and pediatric patients at $150\,\text{mg/kg}$ mixed in $200\,\text{mL}$ of $\text{D5W}$ over $4$ hours (or $140\,\text{mg/kg}$ orally).

Activated Charcoal

An adsorbent agent administered orally or via NG tube for ingested poisons in alert patients with intact protective airway reflexes, dosed at $20\text{--}100\,\text{g}$ ($1\,\text{g/kg}$ for infants under $1$ year of age).

Adenosine (Dosing)

Administered as an initial rapid IV/IO bolus of $6\,\text{mg}$ over $1\text{--}3$ seconds followed immediately by a $10\,\text{mL}$ flush, with a repeat dose of $12\,\text{mg}$ if necessary, up to a maximum cumulative dose of $30\,\text{mg}$.

Amiodarone (Dosing)

Administered in adult cardiac arrest (pulseless VT/VF) as an initial dose of $300\,\text{mg}$ IV/IO push followed by a second dose of $150\,\text{mg}$ IV/IO push (maximum $2.2\,\text{g}$ per $24$ hours); dosed in pediatrics at $5\,\text{mg/kg}$ IV/IO.

Atropine Sulfate

An anticholinergic agent that blocks M-2 acetylcholine receptors, administered for symptomatic bradycardia at $0.5\text{--}1\,\text{mg}$ IV/IO every $3\text{--}5$ minutes up to $3\,\text{mg}$, or in high doses ($2\text{--}4\,\text{mg}$ or higher) for organophosphate poisoning.

Aspirin (Acetylsalicylic Acid)

An antiplatelet agent administered at a dose of $162\text{--}325\,\text{mg}$ orally (chewed) for new-onset chest discomfort suggestive of acute coronary syndrome (ACS).

Plavix (Clopidogrel)

An antiplatelet medication indicated for STEMI or moderate to high risk NSTEMI, given at a standard oral maintenance dose of $75\,\text{mg}$ once daily.