Question

Discuss the following medications: potassium, magnesium, calcium, sodium, IV fluids- .9% NSS, D5W, D10, potassium infusions epinephrine, tensilon, levodopa, carbidopa, Sinemet, Aricept, rivastigmine (Exelon), interferon-beta, phenytoin, valprotic acid, ibuprofen, ASA, acetaminophen, morphine, hydromorphone, methadone, naloxone, fentanyl, propofol, secobarbital, eszopiclone (Lunesta), latanoprost, pilocarpine, atropine, phenobarbital, dantrolene, baclofen, methocarbamol (Robaxin), cyclobenzaprine (Flexeril)

Answer 1

1. what is potassium :

-most abundant electrolyte inside cells (95% intracellular)

-smallc hanges in levels can have unwanted effects on neuromuscular and cardiovascular system

-obtained from variety of foods including fruits, juices, vegetables, fish, meat

-excess dietary is excreted by kidneys in the urine

#. hypokalemia

-deficiency of potassium

-serum potassium level less than 3.5 mEq/L

-result from decreased intake, renal excretion, shifting potassium into cells, diarrhea, vomiting, tube drianage

meds that cause: diuretics, steroids, beta blockers, aminoglycoside antibiotics

-early symptoms: hypotension, letharthy, mental confusion, muscle weakness and nausea

-late symptoms: cardiac irregularities, neuropathies, paralytic ileus

-digoxin toxicity: serious ventricular dysrythmmias

#. hyperkalemia

-exceeding 5.5 mEq/L

-can result from: increased potassium intake, reduced renal excretion of potassium or redistribution of potassium

symptoms: fatigue, weakness, parasthesia, palpitations and payalysis

-severe (over 7) can precipitate ventricular fibrillation and cardiac arrest

#. mechanism

-muscle contraction, transmission of nerve impulses, pacemaker of the heart

-essential for maintenance of acid-base balance, isotonicity and electrodynamic characteristics of the cell

-essential componenet in gastric secretion, renal function, tissue synthesis and cho metabolism

#. indications

-treatment or depletion of potassium

-potassium salts commonly used: potassium chloride, potassium phosphate, potassiuma cetate

#. contraindications

-known allergy to specific drug

-hyperkalemia

-severe renal disease,a cute dehydration

-untreated addisons disease, severe hemolytic disease

-conditions involving extensive tissue breakdown

#. adverse effects

-oral: limited to GI tract which include diarrhea, nausea and vomitting or GI bleeding and ulceration

-excessive amdinitration parenteral can lead to hyperkalemia and roxic effects

-must not be given faster than 10 mEq/hr pt not on monitor and 20 mEq/hr ICU

#. reversal agents toxicity

-dextrose, insulin, sodium bicarbonate, calcium gluconate or chloride

#. interactions

-concurrent use with potassiums paring diurectic and ACE inhibitors

-non potassium sparing diurectics, amphotericin B and mineralocorticoids can produce hypokalemic state

#. dosages

-depends on: pt losses, adrenal, cardiovascular and kidney functions, durrent drug tehrapy, selection of route

oral: 10-20 mEq several times a day

parenteral:30-60 mEq every 24 hrs

2. Sodium Bicarbonate :

Systemic Hydrogen Ion Buffer, Alkalizing Agent.

#. Mechanism Of Action :

Sodium Bicarbonate Buffers Metabolic Acidosis and Lactic Acid buildup in the body caused by Anaerobic Metabolism Secondary to Severe Hypoxia by reacting with Hydrogen Ions to form Water and Carbon Dioxide.

#. Indications for Sodium Bicarbonate:

Use Sodium Bicarbonate for Metabolic Acidosis during Cardiac Arrest.

Tricyclic Antidepressant, Aspirin, and Phenobarbital Overdose.

Hyperkalmia and Crush Injuries.

#. Contraindications for Sodium Bicarbonate :

You don't use Sodium Bicarbonate Metabolic and Respiratory Alkalosis, Hypokalemia, and Electrolyte Imbalance due to Severe Vomiting or Diarrhea.

#. Adverse Reactions/Side Effects of Sodium Bicarbonate

Seizures, Fluid Retention, Hypokalemia, Electrolyte Imbalance, Tetany, Sodium Retention, Peripheral Edema, Hypernatremia, Metabolic Alkalosis, Tissue Sloughing, Cellulitis, or Necrosis at injection site.

#. Drug interactions for Sodium Bicarbonate

Sodium Bicarbonate Increases the effects of Amphetamines. It Decreases the effects of Benzodiazepines, and Tricyclic Antidepressants. Sodium Bicarbonate may Deactivate Sympathomimetics(Dopamine, Epinephrine, Norepinephrine).

#. How is Sodium Bicarbonate Supplied

Sodium Bicarbonate is Supplied 1 mEq/mL of an 8.4% solution in 10- and 50-mL vials and prefilled syringe.

Also 0.5 mEq/mL of a 4.2% solution in 2.5-, 5-, and 10-mL prefilled syringe.

#. Dosage and Administration of Sodium Bicarbonate for an Adult :

1 mEq/kg slow IV, IO push you may repeat at 0.5 mEq/kg every 10 minutes.