Natrecor

[FL_Medic]

does anyone know if paramedics administer this drug anywhere? Natrecor

Is there a master list of drugs somwhere of drugs allowed by states to be given by paramedics with medical director approval?

[Ridryder 911]

I have used it in ER and CCU occasionally. I doubt we will see it pre-hospital. It is a potent vasodilator and as well one needs to know renal functions, as much as possible. What I have seen it works great, but, very one has to be very cautious that not too much damage from an AMI has occurred, or old infarcts, that will produce poor ejection fractions.

I believe the medication is still quite expensive and has to be closely monitored through IV drip (pump) and it is recommended some form of wedge pressure monitoring be done if possible.

Good medication to be aware although for those critical care transports...

R/r 911

[chbare]

FL_Medic, check with your state EMS board. The NREMT web site has a page with links to all of the state EMS boards. I would not expect paramedics to administer this medication with the exception of flight teams and critical care transport teams. However, I do not have allot of transport experience outside of my area. Here is a link for people who have never heard of this drug.

http://www.rxlist.com/cgi/generic/natrecor.htm

Take care,

chbare.

[FL_Medic]

Thanks guys, i was just wondering because I think it would be great in a CHF situation when you don't want to use an Inotrope or secondary to an inotrope.

how about milrinone, you guys use that?

by the way I am on shift today, I work 24 hours on/48 off. we have had one call and it was a fender bender refusal..

...you know that means my ass is gonna be up all night. If not it will be my best shift yet.

[chbare]

FL_Medic, again, I think Primacor like Natrecor, would be pretty limited to flight teams and critical care transport teams. It is a potent drug that requires close observation for hepatotoxicity & thrombocytopenia. I would want invasive monitoring with this drug as well.

Take care,

chbare.

[FL_Medic]

FL_Medic, again, I think Primacor like Natrecor, would be pretty limited to flight teams and critical care transport teams. It is a potent drug that requires close observation for hepatotoxicity & thrombocytopenia. I would want invasive monitoring with this drug as well.

Take care,

chbare.

Thanks for your input. All of our drugs have undesirable effects though especially if not monitored correctly. I think education would be key of coarse, but I think it could be bennificial for pt. outcomes.

I mean inotropes alone shorten a persons lifespan when used. If we had alternative drug therapies like Natrecor I think it would be great. I appreciate you sharing your knowledge of these drugs, and maybe I will look into our flight team and the possible implimentation into our system.

[AZCEP]

The nice thing about Primacor/Natrecor is the lack of beta activation to get a response. Beta blocker OD's? No problem, if the patient can tolerate the vasodilation that goes with it. These are great with hypertensive left heart failure. Increase the contractility, dilate the vessels, double-edged sword, but very effective.

You do not want these if you don't have pumps to control the rate. They act nothing like Dopamine/Dobutamine, and titrating to effect is a moment to moment situation. The dosing is a nightmare as well. Whoever came up with the initial dose range for these had to be a masochist.

Arterial lines, and Swan-Ganz make life easier, but even with them, this class of medication is a bit challenging when you aren't bouncing down the road.

Leave them for flight, or ICU.

[FL_Medic]

The nice thing about Primacor/Natrecor is the lack of beta activation to get a response. Beta blocker OD's? No problem, if the patient can tolerate the vasodilation that goes with it. These are great with hypertensive left heart failure. Increase the contractility, dilate the vessels, double-edged sword, but very effective.

You do not want these if you don't have pumps to control the rate. They act nothing like Dopamine/Dobutamine, and titrating to effect is a moment to moment situation. The dosing is a nightmare as well. Whoever came up with the initial dose range for these had to be a masochist.

Arterial lines, and Swan-Ganz make life easier, but even with them, this class of medication is a bit challenging when you aren't bouncing down the road.

Leave them for flight, or ICU.

Thanks for your knowledge on this