Pharmacology
Advanced Care Paramedicine
Module: 7
Session: 2a
Electrolytes
Calcium Chloride
 Class:
 Electrolyte
 MOA:
 Essential component for functional integrity of
nervous and muscular systems
 Enhances automaticity
 Positive inotrope
Calcium Chloride
 Indications:






Hyperkalemia
Hypocalcemia
CCB Toxicity
Hypermagnesemia
Respiratory depression after MgSO4 administration
To prevent Hypotension from CCB
 Contraindications:




Vfib
Digitalis toxicity
Hypercalcemia
Renal or Cardiac disease
Calcium Chloride
 Adverse Reactions:




Bradycardia
Hypotension
Metallic taste
Severe local necrosis (infiltration)
Calcium Chloride
 Supplied:
 10% solution in 10 ml
 Dosage:
 Adult:
5 - 10 cc over 3 minutes
 (8 – 16 mg/kg)
 Pediatric: 5 mg/kg over 3 minutes
Magnesium Sulphate
 Class:




Electrolyte
Anticonvulsant (toxemias)
Antiarrhythmic (torsades, TCA OD)
Uterine Relaxant
 MOA:
 Reduces striated muscle contractions and
blocks peripheral neuromuscular transmission
by reducing Ach release
Magnesium Sulphate
 Indications:





Seizure due to Eclampsia
Torsades de Pointes
Hypomagnesemia
Refractory Vfib (not NS)
Status Asthmaticus (not NS)
 Contraindications:
 Heart block
 Myocardial damage
Magnesium Sulphate
 Adverse Reaction:









Diaphoresis
Facial flushing
Hypotension
Depressed reflexes
Hypothermia
Bradycardias
Circulatory collapse
Respiratory depression
Diarrhea
Magnesium Sulphate
 Supplied:
 20% solution
 Dosage:
 Bolus:
 Torsades:
 Toxemia:
1 gm IV at 1 g/min
4 gm IV at 1 g/min
 Infusion:
 2 g in 100 cc NaCL (0.9%) at 50 ml/hr (1 g/hour)
Potassium Chloride
 Class:
 Electrolyte
 MOA:
 Principle intracellular ion affecting
muscular contraction and nervous system
transmission
Potassium Chloride
 Indications:




Transport medication only in doses of < 40 mEq/ml
Hypokalemia
Digitalis toxicity
May see it Post MI (in conjunction with Dextrose and
Insulin)
 Contraindications:




Renal impairment
Acute dehydration
Heat cramps
Elevated serum potassium causing diseases
Potassium Chloride
 Adverse Effects:






N/V
Diarrhea with ABD pain
K+ toxicity/hyperkalemia
Hypotension
Cardiac arrhythmias
Heart block
Potassium Chloride
 What to look for in
Hyperkalemia:
 Paresthesis of
extremities
 Flaccid paralysis
 Mental confusion
 Weakness and
heaviness of legs
 Cardiac changes




P waves flatten and
may disappear
Widening and slurring
of QRS
ST changes
Peaked T waves
Potassium Chloride
 What to do:
 Discontinue IV
 Treat hypotension as required (position and fluid
resuscitation)
 Arrhythmias
 Consider Calcium Chloride (if CV toxicity)
 Consider Sodium Bicarbonate (renal failure)
Potassium Chloride
 What to look for in
Hypokalemia:
 Polyuria
 Muscle weakness
 ECG Changes



Widen QRS
T waves may flatten
U wave may appear
and increase in size
and may pass T wave
size and eventually
fuse together at low
levels
Sodium Bicarbonate
 Class:
 Buffer
 Alkalinizing agent
 Electrolyte
 MOA:
 Reacts with H+ ions to form water and
carbon dioxide
Sodium Bicarbonate
 Indications:
 Wide complex tachycardia or arrest from TCA OD
 Acidosis
 Cardiac arrest with pre-existing hyperkalemia (renal
failure)
 Cardiac arrest patients with suspected ASA OD
 Contraindications:






Alkalosis
Severe pulmonary edema
Abdominal pain of unknown origin
Hypocalcemia
Hypokalemia
Hypernatremia
Sodium Bicarbonate
 Adverse Effects:





Metabolic alkalosis
Hypoxia
Increased intracellular PCO2 and increased tissue acidosis
Electrolyte imbalance (hypernatremia)
Seizures
Sodium Bicarbonate
 Supplied:
 50 mEq/50cc
 Dosage:


First dose:
1 mEq/kg
Subsequent dose:0.5 mEq/kg q 10 minutes PRN
Volume Expanders
Pentaspan
 Other Names:
 Pentastarch
 Hydroxyethyl Starch
 Class
 Plasma Volume Expander
Pentaspan
 MOA:
 Polysaccharides with water-retaining properties
and intravascular retention
 The colloidal properties make it a useful volume
expander.
 Intravascular infusion of pentaspan results in
expansion of plasma in excess of the volume of
pentaspan infused.
 Expansion exists for approx. 18-24 hours and is
expected to improve hemodynamic status for
12-18 hours.
 70% of drug eliminated in 24 hrs
Pentaspan
 Indications:
 Plasma volume expansion in the
management of:





Shock due to hemorrhage
Surgery
Sepsis
Burns
Other trauma
Pentaspan
 Contraindications:
 Hypersensitivity to hydroxyethyl starch
 Bleeding disorders
 CHF, where volume overload is a
potential problem
 Should not be used in renal disease with
oliguria or anuria not related to
hypovolemia.
Pentaspan
 Adverse Reactions:




Coagulation disorders or hemorrhage
Hypersensitivity
Chills
Anxiety
Pentaspan
 Supplied:
 IV infusion bags of 250 and 500 ml. (10%
solution) – which gives what
concentration?
 May appears translucent pale yellow to
amber colored
Pentaspan
 Dosage:
 Total dose and infusion depends on the
amount of blood or plasma lost.
 Typical is 500 - 2000 ml
 Max: 28 ml/kg/day
 In acute hemorrhagic shock, an
administration of 20 ml/kg/hour may be
used.
Albumin
 Other Names:
 Plasbumin- 5 %
 Plasbumin- 25 %
 Class:
 Plasma Volume Expander
Albumin
 MOA:
 Albumin is the main protein in human blood and the key to
the regulation of the osmotic pressure of blood.
Chemically, albumin is soluble in water, precipitated by
acid, and coagulated by heat.
 Albumin 5%

is oncotically equivalent volume for volume to normal human
plasma and will allow expansion of the blood volume equal
to the volume infused (if patient is hydrated)
 Albumin 25%

has an oncotic effect in which an additional fluid is drawn
from the extra cellular tissues into circulation within 15
minutes. Blood viscosity and hemoconcentration is reduced,
while total blood volume increases making Albumin 25% a
key plasma volume expander (3-4 times)
Albumin
 Indications:
 Emergency treatment of:




Hypovolemic shock,
burn therapy
cardiopulmonary bypass (CABG)
acute liver failure
 Volume deficit consider Albumin 5%
 Oncotic deficit consider Albumin 25% along with
appropriate crystalloid solution.
Albumin
 Contraindications:





Hyperhydration
Pulmonary edema
Severe anemia
Heart failure
Hypersensitivity
Albumin
 Adverse Effects:






Shaking
Chills
Uticaria
Severe anemia
Heart failure
Hypersensitivity
Albumin
 Supplied:
 Vial of Albumin
5% USP
 Vial of Albumin
25%
Albumin
 Dosage:
 500 ml of Albumin 5% q 30 min IV, PRN
 Needs to be administered IV slowly to
prevent fluid overload
 No specific duration