Gua Asistencial

URGENCIAS Y EMERGENCIAS
EXTRAHOSPITALARIAS
Segunda Edicin 2014

Comit Clnico Asistencial

Ral Canabal Berlanga
Gema Pastor Pons
Elena Garca Medina
Victor Fernndez Gallego
Joaqun Hernandez Corral
Andrs Pacheco Rodrguez
Juan Jos Lara Snchez
Mercedes Caamia Garca
Luis Alberto Ambrosio Carrasco
Samuel Gmez Caro Marn
Enrique Snchez Garca Pardo
Fernando Gonzalo Ruprez
Manuel Snchez Nieto
Nieves Sanroma Gmez
Jos Ignacio Garrote Moreno

 

 


 


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URGENCIAS Y EMERGENCIAS EXTRAHOSPITALARIAS

GUETS - SESCAM

PRESENTACIN DE LA DIRECCIN DE LA GUETS

Esta gua es fruto del trabajo, experiencia, dedicacin y entusiasmo de muchos de los
primeros profesionales que se incorporaron hace 15 aos a la Gerencia de Atencin
Primaria 061 de Castilla-La Mancha (nuestra actual GUETS), junto al de compaeros
que han ido sumando y enriqueciendo nuestro servicio desde entonces. Tambin
hemos querido compartir la visin de la emergencia de profesionales de Atencin
Primaria y Hospitales que han querido colaborar con nosotros.
En ella no encontraremos protocolos ni procedimientos cerrados para actuar en
emergencias, sino experiencias y evidencias que intentarn guiarnos para hacernos el
trabajo diario un poco ms fcil.
Juan Antonio Snchez Losada
Mdico de Urgencias y Emergencias
Gerente de Urgencias, Emergencias y Transporte Sanitario
Servicio de Salud de Castilla La Mancha

La implicacin es para un proyecto lo que la sal a la comida, sin ella el plato puede
tener una presencia estupenda pero al probarlo nos dice que algo falta y que se podra
mejorar, y esto de intentar mejorar algo, se traduce en retos personales, en
inquietudes individuales que en determinados desarrollos precisan de un aglutinador
que facilite la accin. En este proyecto, la 2 edicin de la Gua Asistencial de la GUETS,
el pegamento ha sido la implicacin de un gran nmero de profesionales por reescribir
el algo que faltaba en un trabajo previo, y no es que faltara mucha sal, pero no
podemos evitar que nuestra percepcin cambie con el tiempo y ms en temas
dinmicos como lo es la asistencia sanitaria de emergencias. Dicho esto, se podra
desear y deseo una larga andadura en futuras ediciones de esta gua, pero prefiero
quedarme con el presente y disfrutar de ver como la implicacin rebosa en cada
captulo y nos proporciona un texto de consulta exquisito. Disfrutad de su lectura tanto
como yo viendo como se desarrollaba.

Montserrat Marcos Rodrguez

Enfermera de Emergencias
Directora de Enfermera de la GUETS
Servicio de Salud de Castilla La Mancha

URGENCIAS Y EMERGENCIAS EXTRAHOSPITALARIAS

GUETS - SESCAM

Si ya es difcil aunar talentos, esfuerzos y voluntades para conseguir crear la primera edicin de
una obra cientfica, el objetivo de afrontar una segunda aparece en el horizonte de los autores
como un lejano, tortuoso y, hasta cierto punto, peligroso camino. La ilusin y frescura
aportada por los nuevos compaeros en el viaje, amortigua siquiera el sentimiento de prdida
por los autores que no nos acompaan en la nueva aventura, y provoca que la revisin sea
dolorosa en ocasiones ante la prdida de excelentes pasajes de la obra inicial. Por suerte, la
oportunidad de completar la obra con nuevos, y en ocasiones novedosos contenidos, tambin
ha facilitado mantener firme la decisin de avanzar y llegar al destino que, un ya lejano da de
2011, nada ms presentada la primera edicin, nos planteamos.
Os presentamos, pues, la segunda edicin de la Gua Asistencial de la GUETS del Servicio de
Salud de Castilla La Mancha. La obra ha sido revisada y ampliada, incorporando mdulos, a
nuestro entender, imprescindibles para completar un amplio marco de referencia en nuestra
especialidad; como pudiera ser la atencin urgente al paciente en cuidados paliativos el
helitransporte sanitario. Adems, otros captulos se han incorporado a los mdulos ya
existentes, pretendiendo completarlos y aportando temas de necesario abordaje por parte de
las instituciones y los profesionales: aspectos bioticos en la asistencia, seguridad del paciente,
entrenamiento avanzado y simulacin. Tambin se ha hecho un esfuerzo especial por
presentar nuevos captulos que, de un modo prctico, permitan al profesional de la
emergencia aproximarse de un modo ms efectivo al nio al anciano, cuyas peculiaridades
fisiolgicas de enfermedad convierten en ciudadanos especialmente vulnerables. De igual
manera, el grupo del Dr. Andrs Estudillo ha realizado un magnfico trabajo revisando y
completando la gua farmacutica del Servicio.
Esta Gua Asistencial pretende ser el reflejo de un ilusionado trabajo cientfico colectivo y, por
ello, una muestra de la implicacin de los profesionales sanitarios del Servicio de Emergencias
Sanitarias de Castilla La Mancha en la misin que les ha sido encomendada: intentar por
todos los medios posibles, acoger, detectar y atender precozmente las emergencias sanitarias
de los ciudadanos, all donde acontezcan, siempre desde la mejor capacidad tcnica y
cientfica posibles, pero tambin bajo imprescindibles principios ticos y humanistas. Todo
nuestro desvelo debe estar dirigido hacia ellos; que tambin somos nosotros, nuestros
familiares, amigos, vecinos conciudadanos en general.
Debo reconocer muy especialmente a los miembros del Comit Clnico Asistencial de la GUETS
(su fuerza y entusiasmo han sido imprescindibles para ver la obra terminada) y a todos y cada
uno de los 159 autores que han hecho posible esta obra: profesionales propios de Servicios
de Emergencias hermanos, compaeros urgencilogos y otros especialistas del hospital, de
atencin primaria profesionales de otras disciplinas del conocimiento.
Ral Canabal Berlanga
Mdico de Urgencias y Emergencias
Director Mdico de la GUETS
Servicio de Salud de Castilla La Mancha

 

 


 


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X

URGENCIAS Y EMERGENCIAS EXTRAHOSPITALARIAS

GUETS - SESCAM

sanitario, y si bien esta gua est basada en las caractersticas de Castilla La Mancha, a buen
seguro que puede ser de utilidad en otros Servicios de Emergencia.
El propsito de esta gua no es ser un tratado de medicina extrahospitalaria, para ello hay una
amplia bibliografa y gran cantidad de referencias en internet, desafortunadamente tampoco
es por su volumen una gua de bolsillo, pues no cabe en el del pantaln ni en el del chaleco,
aunque esta es una idea que estamos trabajando para un futuro, -algunos probablemente ya
consultis esta gua en una tablet, y por ah deben caminar nuestros pasos para futuras
ediciones- pero si esperamos que satisfaga las necesidades tanto del profesional consolidado
como del principiante, el cual tras una consulta rpida tenga un conocimiento de que hacer y
como actuar ante una emergencia.
No quiero finalizar esta presentacin y la oportunidad de presentarla por que la obra en si ya
es una justificacin en si, de la existencia de un cuerpo doctrinal propio como es la Medicina
de Urgencias y Emergencias, la cual esperamos que sea una realidad en breve.
Agradecer finalmente a D. Ral Canabal el ofrecimiento de prologar esta edicin, as como el
esfuerzo de todos y cada uno de los autores, cada uno con conocimientos especficos en cada
uno de los temas que aborda, que hacen que esta segunda edicin sea una realidad que
puedas disfrutar en tus manos, la cual espero que termine usada y sobada,. Pues ser el
mejor indicador de que la gua ha cumplido el objetivo de ser til y prctica.

Victor Fernndez Gallego

Comit Clnico Asistencial
Gerencia de Urgencias, Emergencias y Transporte Sanitario

Tened cuidado ah fuera

(Sargento Estherhaus a sus agentes, Cancin Triste de Hill Street)

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Captulo 20

URGENCIAS Y EMERGENCIAS HIPERTENSIVAS

Bernardo Touza Garma

La HTA es una de las enfermedades crnicas ms frecuentes. Su prevalencia en Espaa, en personas

mayores de 18 aos, es de aproximadamente un 35%; en edades medias aumenta al 40% y en mayores
de 60 sube al 68%. En nuestro pas afecta a 10 millones de personas1. En Estados Unidos tiene una
prevalencia del 30% en la poblacin mayor de 20 aos2.
Mientras que la hipertensin arterial (HTA) crnica es un factor de riesgo claro en afecciones cardacas,
cardiovasculares y renales; las elevaciones descontroladas de la Tensin Arterial (TA) pueden producir
daos orgnicos con significativa morbilidad.
Las crisis hipertensivas fueron descritas por primera vez en 1914 por Volhard y Fahr3. En 1939 se public
el primer gran estudio4 sobre su historia natural; en l se revelaba que, crisis hipertensivas sin
tratamiento, tenan una tasa de mortalidad al ao del 79%, con una media de supervivencia anual de
10,5 meses.

DEFINICIN
La Gua Espaola de Hipertensin Arterial 20055 define a la crisis hipertensiva como una elevacin aguda
de la TA capaz de producir alteraciones estructurales o funcionales en los rganos diana de la HTA
(aorta, cerebro, corazn, rin, placenta). Tambin determina como lmites una Tensin Arterial
Sistlica (TAS) 210 mmHg o una Tensin Arterial Diastlica (TAD) 120 mmHg para proceder al
diagnstico de una crisis hipertensiva. En la gran mayora de los artculos revisados sobre crisis HTA no
se da una cifra tensional concreta para su desarrollo; aunque se reconoce ampliamente que es rara la
disfuncin de un rgano diana con una TAD < 130 mmHg (excepto en nios y en el embarazo). El valor
absoluto de TA suele ser menos importante que su tasa de incremento6.
El Joint National Committee on Detection, Evaluation and Treatment on High Blood Pressure (JNC)
divide a las crisis hipertensivas en dos clases: urgencia y emergencia hipertensiva. Esta clasificacin, que
es ampliamente aceptada, data de 1993 y todava se mantiene en su ms reciente informe (JNC-7) 7.
Tabla 20.1 Definiciones de HTA (JNC-7)
Vocablo
Crisis Hipertensiva
A. Urgencia Hipertensiva
B. Emergencia Hipertensiva
Prehipertensin
Hipertensin

Definicin
Aumento abrupto de la TA sin signos de dao en rgano diana;
TAD habitualmente >120 mmHg.
Aumento abrupto de la TA con signos de dao en rgano diana;
TAD habitualmente >120 mmHg.
TAS 120-139 mmHg y/o TAD 80-89 mmHg.
TAS >140 mmHg y/o TAD >90 mmHg.

Las emergencias hipertensivas se caracterizan por abruptas elevaciones de la TA complicadas con

evidencia de inminente o progresiva disfuncin de un rgano diana. La Sociedad Europea de Cardiologa
(ESC) y la Sociedad Europea de Hipertensin (ESH), en sus protocolos de 20078, consideran emergencias
hipertensivas los siguientes cuadros:
- Encefalopata hipertensiva.
- Fallo ventricular izquierdo hipertensivo.
- HTA con infarto de miocardio.
- HTA con angina inestable.
- HTA y diseccin de aorta.
- HTA severa asociada a hemorragia subaracnoidea o accidente cerebrovascular.

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URGENCIAS Y EMERGENCIAS HIPERTENSIVAS

-

Captulo 20

Crisis asociada a feocromocitoma.

Uso de drogas recreativas tales como anfetaminas, LSD, cocana o xtasis.
HTA perioperatoria.
Preeclampsia severa o eclampsia.

Las urgencias hipertensivas son aquellas situaciones, asociadas a serias elevaciones de la TA, en las que
no se evidencia disfuncin progresiva de rgano diana. El JNC-7 considera ejemplos de urgencias
hipertensivas a la HTA estado II (TAS160mmHg o TAD100mmHg) asociada con cefalea severa, disnea,
epistaxis o ansiedad importante.
Las emergencias hipertensivas necesitan una reduccin (no hasta valores normales) inmediata de la TA,
habitualmente con medicacin intravenosa (iv) y en una Unidad de Cuidados Intensivos (UCI). Las
urgencias hipertensivas requieren una reduccin de la TA ms progresiva, en 24 a 48 horas6, con
medicacin oral y sin necesidad de vigilancia intensiva.
El trmino hipertensin maligna ha sido abandonado por las guas internacionales. En la Gua espaola
de hipertensin arterial 2005 se menciona la hipertensin acelerada-maligna referida a la retinopata
hipertensiva grados III-IV de Keith-Wegener. Este cuadro ha sido incluido clsicamente en las
emergencias hipertensivas; sin embargo, se diagnostica habitualmente en situacin paucisintomtica,
alteraciones visuales y ligera-moderada afectacin renal, sin objetivarse datos de riesgo en otros
rganos diana. Por ello, la mencionada Gua, considera a este tipo de hipertensin una urgencia
hipertensiva, aunque aconseja su manejo inicial en hospital5.
Las pseudocrisis hipertensivas o falsas crisis hipertensivas son elevaciones momentneas de la TA en
determinadas situaciones que condicionan una elevacin secundaria de la misma. Se observan en
situaciones de stress emocional, dolor, vrtigo perifrico, lesiones medulares, retencin aguda de orina,
hipoxemia, TCE, etc. El tratamiento se centra en controlar la causa primaria de la elevacin32.
Tabla 20.2 CAUSAS DE EMERGENCIAS HIPERTENSIVAS
Hipertensin esencial.
Enfermedades renales parenquimatosas:
Glomerulonefritis aguda.
Vasculitis. Lupus eritematoso sistmico. Esclerodermia.
Sndrome urmico-hemoltico.
Prpura trombtica trombocitopnica.
Enfermedad renovascular:
Estenosis de la arteria renal (ateromatosa o por displasia fibromuscular).
Poliarteritis nodosa.
Embarazo:
Preeclampsia.
Eclampsia.
Causas endocrinas:
Feocromocitoma.
Sndrome de Cushing.
Tumores secretores de renina.
Hipertensin por mineralocorticoides.
Drogas:
Cocana, simpaticomimticos, eritropoyetina, ciclosporina, deprivacin
antihipertensivos (clonidina).
Interacciones con IMAOs, anfetaminas, intoxicacin por plomo.
Hiperreactividad autonmica:
Sndrome de Guillain-Barr.
Porfiria aguda intermitente.
Alteraciones del SNC :
TCE, ictus isqumico/hemorrgico, tumores cerebrales.
Coartacin de aorta.
Quemaduras.
Dolor postoperatorio y/o complicaciones anestsicas.

de

Adaptada de Vaughan y Delanty14

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ETIOLOGA Y FISIOPATOLOGA
Una crisis hipertensiva puede aparecer de novo o complicar una hipertensin esencial o secundaria.
Cualquier desorden que cause HTA puede originar una crisis hipertensiva (Tabla 2).
Los factores que desencadenan una elevacin rpida y severa de la TA se conocen insuficientemente. La
rapidez del comienzo sugiere un factor desencadenante, conocido o no, superpuesto sobre una HTA
preexistente13.
Dicho factor se cree que es un abrupto incremento en la resistencia vascular sistmica, probablemente
relacionado con la liberacin de sustancias vasoconstrictoras de tipo humoral, tales como la
angiotensina II o la adrenalina o como resultado de una hipovolemia relativa. Durante la elevacin inicial
de la TA, el endotelio vascular trata de compensar el cambio en la resistencia vascular secretando
sustancias autocrinas/paracrinas vasodilatadoras, tales como el xido ntrico o la prostaciclina. Cuando
la HTA es mantenida o severa, se sobrepasan estos mecanismos compensadores, y se produce la
llamada descompensacin endotelial6.
La tensin mecnica en las paredes del vaso provoca la secreccin de ms sustancias vasoconstrictoras y
daa el endotelio, formndose un crculo vicioso con ms vasoconstriccin, aumento de la TA y dao
vascular.
El mecanismo concreto de la lesin celular es poco conocido, pero se cree que est mediado por la
secreccin de sustancias inflamatorias, a nivel local, y por el aumento en la expresin de molculas de
adhesin vascular; esto provoca una reaccin inflamatoria local que altera an ms la funcin del
endotelio vascular. Esto se traduce en un aumento de la permeabilidad endotelial, en la inhibicin de la
actividad fibrinoltica local y en la activacin de la cascada de la coagulacin. La agregacin plaquetaria y
su degranulacin produce ms inflamacin, trombosis y vasoconstriccin14. El resultado final es dao
vascular, isquemia tisular y ms liberacin de sustancias vasoconstrictoras.
La activacin del sistema renina-angiotensina-aldosterona se ha asociado a la patognesis y
perpetuacin de las crisis hipertensivas13. La angiotensina II no slo es un vasoconstrictor sino que tiene
efectos citotxicos directos14. Blumenfeld y Laragh15, dependiendo de si los niveles de renina plasmtica
estn por encima o por debajo de 65ng/ml/h, dividen a las crisis hipertensivas en Tipo R (reninaangiotensina dependiente) o en tipo V (volumen dependiente), respectivamente.
La deplecin de volumen resultante de la natriuresis por presin tambin estimula la produccin de
sustancias vasoconstrictoras6.

CLNICA
La mayora de los pacientes tienen una elevacin persistente de la TA antes de desarrollar una crisis
hipertensiva. Las manifestaciones clnicas de una emergencia hipertensiva estn directamente
relacionadas con la disfuncin del rgano diana afectado (Tabla 20.3). Lgicamente, los sntomas varan
mucho de un paciente a otro.
Tabla 20.3
-

MANIFESTACIONES CLNICAS DE LAS EMERGENCIAS HIPERTENSIVAS

Encefalopata hipertensiva.
Diseccin artica aguda.
Infarto agudo de miocardio.
Sndrome coronario agudo.
Edema agudo de pulmn.
Pre-eclampsia severa, sndrome HELLP*, eclampsia.
Insuficiencia renal aguda.
Anemia hemoltica microangioptica.
Hipertensin aguda postoperatoria.

* Hemolisis, Enzimas hepticas elevadas y Plaquetas bajas

Tomada de Marik y Varon6

Los s tLos sntomas de presenetaicn ms frecuentes en las urgencias hipertensivas son la cefalea (22%)
y la epistaxis (17%), mientras que en las emergencias hipertensivas son el dolor torcico (27%), la disnea
(22%) y dficits neurolgicos (21%). Ms an, los rganos diana ms frecuentemente involucrados en las
emergencias hipertensivas son el infarto cerebral (24%), el edema agudo de pulmn (23%) y la
encefalopata hipertensiva (16%), la hemorragia cerebral se presenta aproximadamente en el 4,5% de
los casos estudiados9 (Tabla 20.4).

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URGENCIAS Y EMERGENCIAS HIPERTENSIVAS

Captulo 20

Tabla 20. 4 FRECUENCIA DE SIGNOS Y SNTOMAS EN CRISIS HIPERTENSIVAS

SIGNOS Y SNTOMAS
CEFALEA
EPISTAXIS
DOLOR TORCICO
DISNEA
ASTENIA
AGITACIN PSICOMOTORA
DFICIT NEUROLGICO
VRTIGO
PARESTESIAS
VMITOS
ARRITMIAS
OTROS
Adaptada de Zampaglione et al9

URGENCIAS HTA (%)

22
17
9
9
10
10
3
7
6
2
6
2

EMERGENCIAS HTA (%)

3
0
27
22
10
0
21
3
8
3
0
3

No se ha asociado un lmite concreto de TA con el desarrollo de una emergencia hipertensiva. Sin

embargo la disfuncin orgnica es rara con una TAD menor a 130 mmHg (excepto en nios y embarazo).
El valor absoluto no parece ser tan importante como el valor relativo. Por ejemplo, en pacientes con
larga historia de HTA, una TAS de 200 mmHg o una TAD de hasta 150 mmHg puede ser bien tolerada sin
desarrollar una emergencia hipertensiva; mientras que una embarazada o un nio pueden padecer una
encefalopata con una TAD de slo 100 mmHg.
Encefalopata hipertensiva
Es un sndrome cerebral orgnico agudo (encefalopata aguda) que surge como resultado del fallo del
lmite superior de la autorregulacin vascular cerebral.
En individuos normotensos el flujo vascular cerebral se mantiene sin cambios con valores de TAM de
entre 60 y 120 mmHg. Al aumentar la TAM, el flujo vascular cerebral se limita mediante una
vasoconstriccin compensatoria. Pero al sobrepasar la TAM los 180 mmHg, la autorregulacin es
superada, aparece vasodilatacin y se desarrolla edema cerebral15.
Clnicamente se caracteriza por el comienzo agudo o subagudo de letargia, confusin, cefalea,
alteraciones visuales (incluyendo ceguera) y convulsiones. Las convulsiones pueden ser el sntoma de
comienzo y ser focales o generalizadas14. Los sntomas focales no son caractersticos, aunque aparecen
si se desarrolla un ictus isqumico o hemorrgico. Sin tratamiento adecuado, la encefalopata
hipertensiva puede progresar a hemorragia cerebral, coma y muerte. Su tasa de mortalidad sin
tratamiento en un ao es del 90%15.

EVALUACIN INICIAL6,13,14,15,16
El historial y el examen fsico son muy importantes a la hora de determinar la severidad de la crisis
hipertensiva y como gua para el posterior manejo. El objetivo es evitar dao en rganos diana.
La anamnesis debe incluir informacin sobre la duracin y la severidad de una HTA preexistente, los
valores habituales de TA y si se ha producido dao orgnico (especialmente cerebrovascular o renal).
Son importantes los detalles sobre el tratamiento antihipertensivo actual, su grado de cumplimiento y
cuando fue la ltima dosis. Tambin es til preguntar si se ha puesto fin abruptamente a cualquier
tratamiento antihipertensivo. Se debe consultar especficamente sobre el uso de frmacos sin receta,
tales como simpaticomimticos o antiinflamatorios no esteroideos, y descartar el uso de drogas
recreativas (cocana, anfetaminas) o de frmacos como los IMAO.
Adems, se debe indagar sobre sntomas sugestivos de dao orgnico, incluyendo dolor torcico
(isquemia miocrdica, diseccin artica), disnea (edema pulmonar, fallo ventricular izquierdo), dolor de
espalda (diseccin artica) y sntomas neurolgicos tales como cefalea, visin borrosa, convulsiones o
alteraciones del nivel de consciencia (encefalopata hipertensiva).
La exploracin fsica busca valorar si hay dao en rganos diana. La TA debe medirse en supino y, si es
posible, en bipedestacin, para valorar si hay deplecin de volumen intravascular por natriuresis por
presin. La medicin debe hacerse en ambos brazos, una discrepancia significativa (TAS > 20 mmHg)
entre ellos debe hacer considerar la diseccin artica.
La exploracin de cabeza y cuello debe incluir el examen del fondo de ojo, ya que puede ayudar a
distinguir una emergencia de una urgencia hipertensiva (la presencia de nuevas hemorragias, exudados

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URGENCIAS Y EMERGENCIAS EXTRAHOSPITALARIAS

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Captulo 10

o papiloedema apunta hacia la primera). El examen cardiovascular buscar la presencia de nuevos

soplos o de signos de fallo cardaco, sin olvidar la palpacin de los pulsos. La presencia de crepitantes en
la auscultacin pulmonar puede ratificar la sospecha de fallo cardaco. Un soplo abdominal sugiere un
origen renovascular de la HTA.
Una cuidadosa exploracin neurolgica debe siempre completar el examen. Valorando el nivel de
conocimiento, los campos visuales o signos de irritacin menngea. Los signos focales son ms
indicativos de ictus isqumico o hemorrgico. La encefalopata hipertensiva es un diagnstico de
exclusin; se deben descartar otras causas, tales como ictus, hemorragia subaracnoidea o masas
intracraneales16.

TRATAMIENTO
Principios generales
No se han realizado grandes ensayos clnicos en el campo del tratamiento de las crisis hipertensivas. Por
lo tanto, la terapia no est basada en la evidencia y, en general, ha sido dictada por consenso14.
El tratamiento de los pacientes con crisis hipertensivas debe ser individualizado y no basarse
nicamente en el valor absoluto de la TA, sino en la presencia o no de dao en rgano diana (o en la
amenaza de dao inminente) 14.
Johnson et al33 recomiendan unos principios generales:
- Verificar las lecturas de la TA antes de comenzar el tratamiento.
- Los pacientes con una emergencia hipertensiva deben ver reducida su TAM entre un 20% a un 25%
en la primera hora, con la excepcin del ictus isqumico y de la diseccin artica (Tabla 20.5).
- Las urgencias hipertensivas deben ser tratados con frmacos orales y no parenterales.
- Se deben realizar las pruebas adecuadas para diferencias las urgencias de las emergencias
hipertensivas.
- Una vez estabilizada la TA con medicacin parenteral, la transicin a tratamiento oral puede
comenzar en 6 a 12 horas.
Tabla 20. 5. Descenso de cifras tensionales
Tipo de emergencia hipertensiva
Encefalopata hipertensiva

Ictus isqumico

Ictus isqumico en trombolisis

Hemorragia intracerebral
Retinopata hipertensiva
Fallo ventricular izquierdo
Diseccin artica
Fallo renal agudo
HTA inducida por embarazo
HTA post operatoria
Isquemia/ Infarto miocardio
Estados hiperadrenrgicos
Fuente: Johnson et al33

TA diana
Reduccin de TAM 20% mximo o TAD 100-110 mmHg en la
primera hora (despus alcanzar cifras normales en 24-48
horas).
Reduccin de TAM no ms del 15-20%, TAD no menor a 100110 mmHg en las primeras 24 horas. (Los protocolos de
trombolisis pueden permitir un tratamiento algo ms
agresivo).
TAS < 185 mmHg, TAD <110 mmHg.
Reduccin TAM 20-25%.
Reduccin TAM 20-25%.
TAM 60-100 mmHg.
TAS 100-120 mmHg.
Reduccin TAM 20-25%.
TAS 130-150 mmHg y TAD 80-100 mmHg.
Reduccin TAM 20-25%.
TAM 60-100 mmHg.
Reduccin TAM 20-25%.

Las urgencias hipertensivas se pueden tratar, por lo general, con antihipertensivos orales y, tras un
periodo de seguimiento adecuado, ser dadas de alta con cita para control y ajuste de terapia 1-2 das
despus de la presentacin inicial. El tratamiento se debe iniciar con dosis bajas e ir incrementndo
paulatinamente, se desaconseja comenzar con dosis altas que pueden causar una reduccin excesiva de
la TA6. Una rpida reduccin de la TA se asocia a un aumento de la morbilidad debido a un
desplazamiento hacia la izquierda de la curva flujo/presin en territorios arteriales crticos (cerebro,
corazn, rin). En consecuencia, la reduccin del flujo resultante, por debajo de rango de
autorregulacin de estos territorios, puede causar isquemia e infarto15.

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URGENCIAS Y EMERGENCIAS HIPERTENSIVAS

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Las emergencias hipertensivas, al causar dao tisular, necesitan una correccin de la TA precisa, rpida
y personalizada. Por lo tanto, estos pacientes se tratan mejor con antihipertensivos intravenosos,
fcilmente titulables y de accin corta. Debido a su impredecible farmacocintica, no se aconsejan las
vas intramuscular o sublingual. El tratamiento debe hacerse en una UCI con una monitorizacin
exhaustiva y toma frecuente de la TA (cada 15 a 30 minutos)10. El frmaco de eleccin depende de cual
es el rgano diana afectado y de las posibilidades de monitorizacin. La velocidad de reduccin de la TA
es relevante dependiendo de la clnica del paciente; pacientes con clnica de diseccin artica necesitan
un descenso ms rpido que los que tienen sntomas neurolgicos, a quienes una brusca reduccin
puede perjudicar ms que beneficiar10.
La natriuresis por presin, en emergencias hipertensivas, puede causar deplecin de volumen y la
administracin en estos pacientes de medicacin antihipertensiva puede ocasionar una bajada
pronunciada de la TA. Si se sospecha reduccin del volumen intravascular, se debe administrar suero
salino para restaurar dicho volumen y apagar el sistema renina-angiotensina-aldosterona14.

Tratamiento de las urgencias hipertensivas

Desafortunadamente, el tratamiento de las urgencias hipertensivas no se menciona en las guas sobre la
HTA europeas8,18 de 2007 o canadienses19 de 2008. Sin embargo, tanto el JNC-77 como la ltima
revisin17 publicada por el Sistema Nacional de Salud recomiendan para el tratamiento de las urgencias
hipertensivas, el captopril, el labetalol y la clonidina (todos por va oral).
En lo que hay, prcticamente, unanimidad de todos los autores consultados, es en desaconsejar el uso
del nifedipino para el tratamiento de las crisis hipertensivas; esto es debido a las bruscas bajadas de la
TA que causa y por ser asociado a un aumento en el riesgo de ictus20. De hecho, su uso en este contexto
no est aconsejado por la US Food and Drug Administration (FDA) en EEUU. La nica discrepancia
encontrada al revisar la bibliografa es la recomendacin, en la Gua Espaola de la Hipertensin 2005,
del uso del nifedinino oral, mientras que, al mismo tiempo, desaconseja su uso sublingual. En el resto de
la bibliografa desaconsejan su uso sin especificar si es por va oral o sublingual.
Los protocolos holandeses de manejo de la crisis hipertensiva (en su revisin de 2010)34 prefieren el
nifedipino retard, en lugar del captopril, como agente de primera eleccin para el tratamiento de las
urgencias hipertensivas. Alegan que tiene un efecto hipotensor ms gradual y predecible, ya que el
efecto de los IECAs depende del estado del volumen intravascular y de la actividad del sistema reninaangiotensina; los antagonistas del calcio derivados de la dihidropiridina son relativamente
independientes de la volemia.
El captopril es un inhibidor de la enzima convertidora de la angiotensina (IECA) con un inicio de accin
de 15 a 30 minutos y una mxima cada de la TA entre los 30 y 90 minutos. Habitualmente se
administran 25 mg inicialmente, seguido por dosis de 50 a 100 mg de 90 a 120 minutos despus.
El labetalol es un bloqueante adrenrgico 1 y con comienzo de accin en 1 a 2 horas y mxima a los
60 minutos. En general, la dosis inicial es de 200 mg, pudiendo repetirse cada 3 a 4 horas.
La clonidina es un simpaticoltico de accin central (agonista del receptor 2-adrenrgico) que comienza
a actuar en 15-30 minutos y llega al mximo en 2 a 4 horas. Un rgimen teraputico habitual es
administrar 0,1 a 1,2 mg como dosis de carga seguido por 0,05 a 0,1 mg cada hora hasta llegar a la TA
deseada o a un mximo de 0,7 mg.
Otro frmaco sugerido5 es el atenolol va oral a dosis de 50 a 100mg. Los holandeses34 no lo consideran
una opcin de tratamiento por tener un lento comienzo de accin y efectos adversos relativamente
frecuentes.

Tratamiento de las emergencias hipertensivas.

El tratamiento de las emergencias hipertensivas debe ser individualizado dependiendo del rgano diana
afectado y del historial mdico del paciente. En la tabla 6 se resume el uso de los diferentes frmacos
antihipertensivos en los cuadros clnicos ms habituales de acuerdo con la Gua Espaola de HTA de
20055.
En estas circunstancias es necesario el uso de frmacos parenterales ya que el control de la TA debe ser
rpido y preciso. Se recomienda tratar a estos enfermos en UCIs o en instalaciones que faciliten una
monitorizacin continua de la TA.
Tampoco para las emergencias hipertensivas se han llevado a cabo ensayos clnicos de suficiente
entidad como para definir objetivos concretos en su tratamiento21. Segn el JNC-77, el objetivo inicial del
tratamiento es reducir la TAM en no ms del 25% en la primera hora (otros autores21 amplan el margen

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Captulo 10

a 2 horas); entonces, si el paciente est estable, rebajar a 160/110-100 mmHg en las siguientes 2 a 6
horas. Si este nivel de TA se tolera bien y el paciente contina estable, se pueden intentar reducciones
posteriores hacia una TA normal en las siguientes 24 a 48 horas.
Frmacos
Los frmacos ms habituales en el tratamiento de las emergencias hipertensivas se clasifican, de
acuerdo a su mecanismo de accin, en vasodilatadores e inhibidores adrenrgicos7 (Tabla 6).
- El nitroprusiato sdico (Nitroprussiat Fides 50 mg vial) es un vasodilatador arterial y venoso, que
reduce tanto la precarga como la postcarga. Rebaja la perfusin cerebral al tiempo que aumenta la
Presin Intracraneal (PIC), lo que le hace poco apropiado para pacientes con encefalopata
hipertensiva o un ictus. En pacientes con enfermedad coronaria puede inducir una reduccin del
flujo sanguneo regional (robo coronario). El nitroprusiato es un frmaco muy potente, comienza su
accin en segundos, tiene una duracin de accin de 1 a 2 minutos y una vida media plasmtica de
3 a 4 minutos. Uno de sus efectos adversos ms importantes, no relacionado con una bajada
abrupta de la TA, es la intoxicacin por cianuro. Los datos existentes sugieren que infusiones
>4mcg/Kg/min durante 2 o 3 horas pueden elevar los niveles de cianuro a un rango txico. En su
revisin de 2007, Marik6 opina que, teniendo en cuenta la potencial toxicidad del nitroprusiato, ste
slo debera usarse cuando no estn disponibles otros agentes antihipertensivos intravenosos y,
entonces, solamente en circunstancias clnicas especficas y en pacientes con funciones renal y
heptica normales. En dosis por encima de 4mcg/Kg/min se recomienda comenzar el tratamiento
con su antdoto el tiosulfato.
- La hidralazina23 (Hydrapres 20mg/1ml ampolla) es un vasodilatador arteriolar directo con poco
efecto en territorio venoso. Su comienzo de accin es a los 10-20 minutos. La dosis recomendada (iv
o im) es de 5 a 10 mg diluidos en 10 ml de salino, en bolo repetidos cada 20 minutos hasta un
mximo de 30 mgs. Si el paciente no experimenta ningn cambio en su TA tras 20 minutos, se
debera considerar el uso de otro antihipertensivo. Su efecto adverso ms frecuente es una
hipotensin impredecible, relacionada con la metabolizacin individual del frmaco.
- El enalaprilato (Renitec 1 mg/ml ampolla) es un inhibidor de la enzima convertidora de la
angiotensina (IECA). La dosis inicial es 1 mg en bolo iv administrado en 5 minutos; si al cabo de 1
hora la respuesta es insuficiente, se puede administrar otra dosis de 1-2 mg; dosis posteriores se
administrarn cada 6 horas; dosis mxima 5mg/dosis. Es necesario reducir la dosis a la mitad en
insuficiencia renal.
- El labetalol (Trandate 100mg/20ml ampolla) es un bloqueante combinado de los receptores
adrenrgicos, selectivo para los 1 y no selectivo para los ; con una proporcin de bloqueo a de
1:7. Su efecto hipotensor comienza a los 2 a 5 minutos de administracin, alcanza el mximo a los 5
a 15 minutos y su efecto dura de 2 a 4 horas. Por su efecto betabloqueante, la frecuencia cardaca
se mantiene o reduce ligeramente. A diferencia de otros bloqueantes beta, el labetalol no reduce el
gasto cardaco. Tambin rebaja la resistencia vascular sistmica sin disminuir el flujo total de sangre
perifrica. Adems, mantiene el flujo sanguneo cerebral, coronario y renal. El labetalol es muy poco
liposoluble, razn por la que, prcticamente, no traspasa la barrera placentaria. El labetalol se
puede administrar con una dosis de carga de 20 mg, seguido por dosis crecientes de 20 a 80 mgs a
intervalos de 10 minutos hasta que se consigue el nivel deseado. Por otro lado, despus de la dosis
de carga, se puede comenzar con una infusin de 1 a 2 mg/min, regulando la perfusin hasta llegar
a las tensiones deseadas. Dosis de 1 a 2 mg/Kg administradas en bolo deben ser evitadas ya que se
han documentado cadas abruptas de la TA6.
- El esmolol (Brevibloc 100mg/10ml vial) es un agente betabloqueante cardioselectivo de accin
ultracorta. El comienzo de accin es a los 60 segundos, con una duracin de 10 a 20 minutos. Su
administracin no depende de las funciones renal o heptica. Su administracin iv puede ser tanto
en bolo como en perfusin. El esmolol es particularmente til en la HTA severa postoperatoria.
Tambin es un frmaco adecuado en situaciones en las que estn aumentados el gasto cardaco, la
FC o la TA. Habitualmente, se administra 0,5 a 1mg/Kg como dosis de carga en 1 minuto, seguido de
una perfusin que comienza con 50 g/Kg/min aumentando la dosis hasta 300 g/Kg/min.
- El urapidilo (Elgadil 50mg/10ml ampolla) es un antagonista selectivo de los receptores
adrenrgicos, que produce vasodilatacin perifrica sin taquicardia reactiva debido a su accin
antagonista sobre los receptores centrales serotoninrgicos (5-HT-1A). La dosis ms habitual es de
25 mg administrados en 20 sg, seguido (si es preciso) de la misma dosis a los 5 min y, en caso
necesario, de 50 mg en 20 sg si tras otros 5 minutos no se hubiera obtenido la respuesta esperada.

187

URGENCIAS Y EMERGENCIAS HIPERTENSIVAS

Captulo 20

En un estudio24 espaol sobre el uso prehospitalario del urapidilo, se concluy que el urapidilo era
efectivo y seguro para tratar las crisis hipertensivas en un marco prehospitalario; en dicho artculo
observaron una reduccin de la TAS, la TAD y de la TAM en los primeros 10 minutos, con una
duracin de un mnimo de 20 minutos, con dosis de urapidilo de 25 a 50 mg. Otros autores25
observaron que el 57% de los pacientes respondan con dosis de 12,5-25 mg, cifra que les parece
ms adecuada como dosis de inicio. En el mismo estudio, al comparar el urapidilo con el
nitroprusiato, concluyeron que ambos son igual de eficaces, aunque el urapidilo produce menos
efectos adversos. Por ello, creen que ste es ms adecuado para pacientes con enfermedad cardio
o cerebrovascular preexistente, ya que el riesgo de hipoperfusin es ms bajo con el urapidilo.
El nicardipino (Vasonase 5mg/5ml ampolla) es un antagonista de los canales del calcio de
segunda generacin con alta selectividad vascular y fuerte actividad vasodilatadora cerebral y
coronaria35. El comienzo de accin es a los 5 a 15 minutos, con una duracin de 4 a 6 horas. Se ha
demostrado que reduce la isquemia cardaca y cerebral. Los protocolos holandeses34 lo
recomiendan como primera opcin de tratamiento para la HTA peri y post operatoria tras un bypass o tras una craniotoma.
Un futuro agente farmacolgico35 es la clevidipina (Cleviprex), un antagonista del calcio de cuarta
generacin. Es un vasodilatador selectivo arteriolar de accin ultracorta (VM 2 minutos), con poca o
ninguna accin sobre la contractibilidad miocrdica o la capacitancia venosa, reduce la postcarga sin
afectar la presin de llenado ventricular o causar taquicardia refleja. Se metaboliza rpidamente por
las esterasas de los hemates sin afectar la funcin heptica o renal. Una revisin bibliogrfica de
2010 sobre los ensayos en fase III de este frmaco concluye que fue efectivo en el control de la TA
en el marco de la ciruga cardaca y de la HTA severa36,37. Aunque no est incluido an en ninguna
gua, su perfil lo hace una droga ideal para estas situaciones.

Tabla 20.6. FARMACOS PARENTERALES PARA EL TRATAMIENTO DE EMERGENCIAS HIPERTENSIVAS

Frmaco
Dosis
Comienzo
Duracin
Efectos adversos
VASODILATADORES
Nitroprusiato sdico

Inmediato

2-5 min

1-2 min tras

finalizar la
infusin
5-10 min

5-30 min

3-9 h

15 min
5-15 min

4-12 hr
30-40 min

5-10 min

3-6 h

0,25-10 mcg/Kg/min perfusin IV

Nitroglicerina
Hidralacina

Enalaprilato
Nicardipino

5-500 mcg/Kg/min perfusin IV

10-20 mg bolus IV
10-50 mg IM
0,625-1,25 mg bolus IV
5-15 mg/h perfusin IV; comienzo 5
mg/h, incrementar dosis en 2,5
mg/h cada 15-30 min.

Nauseas, hipotensin, toxicidad por

tiocianato y cianuro, metahemoglobinemia
Cefalea, nauseas, taquicardia, vmitos,
tolerancia con uso prolongado
Aumento del gasto cardaco y de la
frecuencia cardaca, cefaleas, angina de
pecho.
Hipotensin, fallo renal.
Mareo, cefalea, edema, rubefaccin,
vrtigo.

INHIBIDORES ADRENERGICOS
Labetalol

20-80 mg bolus IV cada 10-15 min

2-4 mg/min perfusin IV

Esmolol

250-500 mcg/Kg/min bolo IV + 501-2 min

10-30 min
100 mcg/Kg/min perfusin IV;
Urapidilo
12.5-25 mg bolo IV + 5-40 mg/h
3-5 min
4-6 h
perfusin IV
Fentolamina
2-5 mg bolo IV, repetido tras 5-15
1-2 min
3-5 min
min hasta conseguir objetivo.

IV = Intravenoso; IM = Intramuscular. Todos estos frmacos pueden provocar hipotensin.

Todos estos frmacos pueden provocar hipotensin.

Modificada de JAMA. 2003;289:2560-2572

Nauseas, parestesias, broncoespasmo,

taquicardia, mareo, bloqueo cardaco,
hipotensin ortosttica
Hipotensin, nausea, asma, bloqueo AV de
primer grado, fallo cardaco.
Hipotensin, cefaleas, vrtigo.
Taquiarritmias, angina de pecho.

Cuadros clnicos
Diseccin artica
Es la complicacin ms dramtica y ms rpidamente fatal de las crisis hipertensivas14. Sin tratamiento,
tres cuartas partes de los pacientes con diseccin tipo A (aorta ascendente) morirn dentro de las
siguientes 2 semanas a un episodio agudo, pero con una terapia exitosa la supervivencia a los 5 aos es

188

URGENCIAS Y EMERGENCIAS EXTRAHOSPITALARIAS

GUETS - SESCAM

Captulo 10

del 75%26. La propagacin de la diseccin se relaciona con del incremento de la onda de pulso artica
(dP/dp), que, a su vez, depende de la contractilidad miocrdica, de la TA y de la frecuencia cardaca15.
En este caso, de forma excepcional, es necesario bajar lo ms rpidamente posible, en alrededor de 20
minutos16, la TAS a valores iguales o inferiores a 100-120 mmHg14, 16. La combinacin de tratamiento
clsica es un bloqueante beta y un vasodilatador. Un vasodilatador solo puede causar taquicardia
refleja, aumento de la velocidad de eyeccin artica y promover la propagacin de la diseccin. Por ello,
se debe asociar un betabloqueante para disminuir la contractilidad miocrdica, y dicho frmaco debe
ser administrado antes que el vasodilatador27. Clsicamente, se recomienda la asociacin de esmolol o
labetalol con nitroprusiato o el labetalol solo14,16.
Encefalopata hipertensiva
El objetivo es reducir la TAM en un 20% o llegar a una TAD de 100 mmHg en la primera hora, se aconseja
cautela al disminuir la TA en ancianos e hipertensos14. En este escenario el rpido incremento de la TA
se relaciona con una masiva produccin de renina y angiotensina II en respuesta a isquemia renal. Por
ello, frmacos como los IECAs o los betabloqueantes, que interrumpen el sistema renina-angiotensinaaldosterona (R-A-A) a diferentes niveles, desplazan de forma favorable la curva de autorregulacin
cerebral y mantienen un flujo sanguneo cerebral adecuado a pesar de haber niveles tensionales ms
bajos. Por el contrario, el uso de diurticos o vasodilatadores directos puede ser menos efectiva porque
estimulan la secrecin de renina15. No se aconseja el uso de la clonidina por ser un depresor del SNC.
Ictus. En el caso de los ictus isqumicos, la elevacin de la TA que habitualmente los acompaa, es ms
una respuesta fisiolgica de proteccin de la perfusin cerebral que la manifestacin de una crisis
hipertensiva6. Por ello, intentar normalizar la TA en estas circunstancias es peligroso. Los protocolos
americanos y europeos28,29 recomiendan no iniciar el tratamiento antihipertensivo en esta
circunstancia, a menos que est planeada una trombolisis, exista evidencia de dao orgnico no
cerebral o la TA sea excesivamente alta; eligindose arbitrariamente una TAS >220 mmHg o una TAD
>120 mmHg. En estos pacientes el objetivo es reducir la TA no ms de un 10 a 15% en las primeras 24
horas. En pacientes que van a recibir tratamiento tromboltico, se requiere tratamiento si la TAS >185
mmHg o la TAD es >110 mmHg. En ictus hemorrgicos solo se recomienda tratar cuando la TAS es >200
mmHg, la TAD es >110mmHg o la TAM es >130 mmHg. Al contrario que los frmacos bloqueantes de los
canales del calcio, no modifican la presin de perfusin cerebral los IECAs y los bloqueantes simpticos
(1 y )15.
Insuficiencia cardaca
Una insuficiencia cardaca descompensada puede ser tanto la causa como la consecuencia de una crisis
hipertensiva, y refleja una excesiva activacin del sistema R-A-A junto con un incremento del contenido
de sodio total del cuerpo15. Las estrategias de tratamiento incluyen diurticos, nitroglicerina e IECAs. Se
puede usar el nitroprusiato si los frmacos anteriores no controlan el episodio16.
Infarto agudo de miocardio (IAM)
Al igual que el fallo cardaco, el IAM puede aparecer en el cuadro de una crisis hipertensiva a travs del
aumento del trabajo de la pared miocrdica y del consumo de oxgeno. Los nitritos intravenosos pueden
ser beneficiosos al mejorar el riego coronario, reducir la precarga del ventrculo izquierdo y ser
moderadamente hipotensores. Tambin son tiles los betabloqueantes por reducir simultneamente la
TA y la FC; Tanto ellos como los IECAs aumentan la supervivencia en casos de isquemia miocrdica. A
diferencia de la nitroglicerina, el nitroprusiato (y los bloqueantes de los canales del calcio) provoca
taquicardia simptica refleja, por lo que no se recomienda su uso14,16.
Insuficiencia renal
El dao renal agudo puede ser tambin causa o consecuencia de una crisis hipertensiva. Los pacientes
en hemodilisis, particularmente si estn recibiendo eritropoyetina, presentan frecuentemente severas
subidas de TA. Tambin se pueden observar en trasplantados renales, sobre todo si estn en
tratamiento con ciclosporina y corticoides. Son apropiados antihipertensivos que conservan la perfusin
renal, tales como los bloqueantes del calcio y los alfabloqueantes. Si falla el tratamiento se pueden usar
el nitroprusiato o la hidralazina. Los diurticos en estas circunstancias pueden ser beneficiosos o
perjudiciales dependiendo del estado volumtrico del paciente14,15.

189

URGENCIAS Y EMERGENCIAS HIPERTENSIVAS

Captulo 20

Preeclampsia-eclampsia
La preeclampsia es una enfermedad multisistmica caracterizada por la presencia de HTA y proteinuria
despus de la semana 20 de gestacin. Es ms frecuente en gestantes multparas, hipertensas,
diabticas o con insuficiencia renal. Los valores tensionales que definen a la preeclampsia son: TAS >140
mmHg o TAD >90 mmHg. La excreccin urinaria de protenas debe ser >300 mg al da para completar el
diagnstico (corresponde a una reaccin positiva, +1, de una tira de orina). La preeclampsia severa se
define con una TAS >160 mmHg o una TAD >110 mmHg y ms de 5 gramos de protenas en la orina de
24 horas. Cuando la preclampsia se complica con la aparicin de novo de convulsiones se habla de
eclampsia. sta aparece slo en el 1% de las pacientes con preeclampsia y puede aparecer en ausencia
de preeclampsia. La mayor parte de los casos de eclampsia aparece en el tercer trimestre de embarazo
o en las primeras 48 horas postparto; hay raros casos de aparicin de eclampsia antes de las 20 semanas
de gestacin o hasta 23 das postparto.
La clnica neurolgica de la preclampsia incluye a: edema cerebral, hemorragia, ceguera temporal y
convulsiones. Una eclampsia inminente puede ser anunciada por cefalea persistente o hiperreflexia. Las
convulsiones suelen ser autolimitadas y duran tpicamente menos de 3 minutos.
La encefalopata hipertensiva en la embarazada aparece con valores tensionales ms bajos que en la no
gestante y se manifiesta con convulsiones, coma o con ambos. Por ello debe ser includa en el
diagnstico diferencial, adems, tanto la preeclampsia como la encefalopata hipertensiva se pueden
asociar al sndrome de la leucoencefalopata posterior, que causa una destruccin, a veces irreversible,
de la vaina de mielina. El sntoma inicial comn en ambos trastornos es la cefalea.
El frmaco de eleccin para la prevencin y el control de convulsiones maternas en pacientes con
preeclampsia severa o eclampsia durante el periodo del periparto es el sulfato de magnesio30,31
(Magnesium 1,5g/10mls = 0,6088mmol/ml). Habitualmente se administra6 una dosis de carga de 4-6 gr
diluidos en 100 a 250 mls de cristaloide en unos 20 minutos, seguido por una perfusin de 1 a 2gr/hr
dependiendo de la diuresis y de los reflejos tendinosos que se deben controlar cada hora.
El Colegio Americano de Gineclogos y Obstetras31 recomienda mantener la TAS entre 140 y 160 mmHg
y la TAD entre 99 y 105 mmHg. Pacientes con eclampsia o preclampsia severa con cifras tensionales por
encima de 160 mmHg tienen grandes probabilidades de sufrir un ACV.
Finalmente, no hay una medicacin antihipertensiva especficamente aprobada por la FDA para uso en
gestantes. Se ha recomendado clsicamente la hidralazina, pero sus efectos secundarios (cefalea,
nauseas y vmitos) son frecuentes y pueden simular una preclampsia deteriorndose. Adems, tiene un
comienzo de accin tardo, un efecto hipotensor impredecible y una prolongada duracin. Por ello, no
se recomienda su uso como frmaco de primera lnea (al igual que el nifedipino oral o sublingual).
Habitualmente, se prefiere el labetalol iv, que es ms fcil de titular, tiene efectos ms predecibles y es
seguro en pacientes embarazadas hipertensas6.
Tabla 20. 7 Indicaciones y contraindicaciones de los frmacos antihipertensivos de uso habitual por va
parenteral en las emergencias hipertensivas ms frecuentes
CUADRO CLNICO
Accidente Cerebrovascular (ACV)

Encefalopata hipertensiva
Edema Agudo de Pulmn (EAP)

Patologa coronaria aguda

190

INDICACIONES ESPECIALES
Labetalol
Nitroprusiato*
Urapidil
Enalapril
Labetalol
Nitroprusiato*
Nitroglicerina + Diurtico
Nitroprusiato + Diurtico
Enalapril
Nitroglicerina + betabloqueante
Nitroprusiato + betabloqueante
Labetalol

CONTRAINDICACIONES
Clonidina
Alfametildopa

Clonidina
Alfametildopa
Hidralacina
Labetalol
Alfabloqueantes
Verapamilo
Hidralacina

URGENCIAS Y EMERGENCIAS EXTRAHOSPITALARIAS

GUETS - SESCAM
Perioperatorio

Embarazo
Patologa renal aguda
Diseccin artica

Labetalol
Nitroglicerina
Nitroprusiato
Urapidil
Labetalol
Hidralacina
Labetalol
Nitroprusiato
Nitroprusiato + betabloqueante
Labetalol
Verapamilo

Captulo 10

Enalapril
Nitroprusiato
Enalapril
Hidralacina

* En casos de hipertensin intracraneal significativa ser necesario monitorizar la Presin Intracraneal.

No deben utilizarse frmacos que pueden alterar el nivel de consciencia dada la necesaria monitorizacin de este parmetro.

Es txico fetal aunque puede utilizarse como tratamiento de rescate por cortos periodos de tiempo.

Precaucin en uremia grave.

El uso de frmacos con actividad cronotrpica negativa tiene como objeto minimizar las fuerzas de cizallamiento o shear stress sobre la
pared arterial.
Hipertensin. 2005;22 Supl 2:58-69

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192

 

 






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URGENCIAS Y EMERGENCIAS EXTRAHOSPITALARIAS

GUETS - SESCAM

Captulo 58

Captulo 58

CDIGO TRAUMA DE CASTILLA LA MANCHA

Ral Canabal Berlanga Antonio Marcos Garca Luis Marina Martnez
Jose Mara Jimnez Vizuete

Pese a la importante y esperanzadora disminucin de los ltimos aos en la incidencia, mortalidad y

morbilidad asociada a los accidentes de trfico, cabe resaltar que los accidentes siguen siendo una
causa muy importante de morbilidad y mortalidad en nuestro pas. De hecho, sigue siendo la primera
causa de mortalidad y discapacidad en menores de 45 aos, as como la segunda causa de mortalidad
infantil (entre 1 y 14 aos). La repercusin familiar y social sigue siendo especialmente importante. Una
vez que se ha producido el trauma grave, las mximas posibilidades de supervivencia dependen de la
eficacia de los sistemas de emergencias. Por ello, la asistencia precoz, capacitada y coordinada de los
sistemas de emergencia, al menos en su aspecto sanitario, se constituye en un objetivo primordial de los
Servicios de Salud, con el objetivo de conseguir una reduccin aadida a las previas, en las cifras
asociadas a los accidentes.

OBJETIVOS DEL CDIGO TRAUMA

La asistencia inicial al paciente politraumatizado, all donde se produzca la circunstancia que
desencadene las lesiones y sea sta de la naturaleza que sea (accidente de trfico, domstico, de ocio o
deportivo, agresin, etc) es una de las funciones fundamentales de los Sistemas Extrahospitalarios de
Emergencias Sanitarias. Por ello, y con una carga ponderal importante, el sistema de control de calidad
dependiente del registro de tal actividad marca la calidad global de dicho Servicio y del Sistema de Salud
que lo sostiene.
El objetivo primario es la reduccin de la mortalidad y secuelas derivadas de los accidentados que
sufren trauma grave. La consecucin de dicho objetivo incluye distintos objetivos secundarios:
- La formacin de equipos de trabajo multidisciplinares capaces de elaborar procedimientos de
actuacin.
- La optimizacin de los tiempos de asistencia y traslado de los pacientes con trauma grave.
- La disminucin de los tiempos de asistencia hospitalarios, a travs de una prealerta de traslado.
- La obtencin de datos que permitan conocer reas de mejora en la asistencial al trauma grave.
Estos objetivos secundarios requieren de unos objetivos operativos, que contemplaran:
La regulacin sanitaria eficaz en los Centros Coordinadores de Urgencias, as como la
imprescindible comunicacin y coordinacin con el nivel asistencial hospitalario.
La asistencia sanitaria precoz al paciente politraumatizado, con criterios de calidad asistencial y
seguridad del paciente, utilizando pautas estandarizadas de asistencia basadas en la evidencia
cientfica, consensuadas con el inmediato nivel asistencial hospitalario.
El Traslado Sanitario, seguro y precoz, hasta el Centro Hospitalario til para las lesiones
detectadas en el paciente. Se considerar como centro hospitalario til , de una manera
secuencial:
Aquel que est capacitado para proporcionar resolucin diagnstica y teraputica
orientada a salvaguardar la supervivencia del accidentado.
Aquel que est capacitado para proporcionar resolucin diagnstica y teraputica
orientada a salvaguardar la funcin de un rgano del accidentado.
Ello implica que el destino hospitalario inicial del paciente depender de la sospecha diagnstica
derivada de la atencin extrahospitalaria, as como de su situacin clnica inicial y evolutiva, primando la
vida frente a la funcin.
485

CDIGO TRAUMA DE CASTILLA LA MANCHA

Captulo 58

DEFINICIONES
Accidentado Politraumatizado: aquel en el que coexisten lesiones que afectan a ms de un rgano
sistema, producido por un evento traumtico, y que repercuten en la estabilidad del paciente,
comportando, aunque slo sea una de ellas, un riesgo vital un riesgo de prdida funcional grave para
el paciente.
Accidentado con Trauma Grave: aquel afecto de un traumatismo que condiciona una lesin que
puede poner en peligro su vida.

RECURSOS DISPONIBLES
1. Centro Coordinador de Urgencias
Integrado como Sector Sanitario en el Servicio de Atencin de Urgencias 1-1-2 de Castilla La Mancha.
Su misin genrica es la de gestin gil y la coordinacin eficaz de los incidentes comunicados a dicho
Centro. Todo ello Incluye:
- Consideracin inicial de los mecanismos causales y biomecnicos de los accidentes.
- Priorizacin de recursos de alto nivel, tanto genricamente, como ante regulacin dependiente de
escasez de datos iniciales.
- Tiempo mximo de gestin de recursos: son objetivos iniciales de regulacin unos tiempos
mximos de asignacin de 1 minuto, y de activacin de 30 segundos.
- Sugerencia de activacin del cdigo a los recursos asistenciales.
- Coordinacin multisectorial: Mesa Multisectorial, Sector de Extincin, Rescate y Salvamiento y
Sector de Seguridad (Guardia Civil, Polica Nacional y Polica Municipal) del SAU 1-1-2.
- Coordinacin con el nivel hospitalario, decisin de hospital til y Coordinacin con hospitales
pertenecientes a otras Comunidades Autnomas.
- Seguimiento del cumplimiento efectivo del cdigo, tanto en sus aspectos de coordinacin, como en
los objetivos temporales.
2. Unidades Asistenciales Extrahospitalarias
Quedan incluidas las Unidades Mviles de Emergencias (en adelante, UMEs) y los helicpteros de
emergencias sanitarias (en adelante, HEMS), dependientes de la GUETS, as como los equipos sanitarios
dependientes de las Gerencias de Primaria y de rea Integrada de los Centros de Salud Puntos de
Atencin Continuada (en adelante, PAC). Tambin quedan incluidas las Ambulancias No Asistenciales de
Urgencias y las ambulancias de Soporte Vital Bsico (en adelante, SVB) de la GUETS. Las
responsabilidades, al menos en los recursos de gestin directa de la GUETS son:
- Optimizacin del tiempo de movilizacin, con el objetivo primario de agilizar al mximo el tiempo
de asistencia. Dichos recursos de urgencias y emergencias, deben perseguir un objetivo inicial de
movilizacin en un tiempo mximo de 1 minuto y 30 segundos.
- Clasificacin in situ, valoracin del Trauma e inicio de cuidados.
- Activacin del Cdigo.
- Continuacin de cuidados y priorizacin del traslado en pacientes de riesgo. Se aplicar,
inicialmente, una recomendacin de tiempo de traslado (mediado entre el inicio efectivo de
asistencia plena tras la extricacin, si hubiera lugar, hasta el inicio de traslado) mxima de 30
minutos.
- Garantizar la continuidad de Coordinacin con el Centro Coordinador de Urgencias y el nivel
hospitalario.
- Registro de la asistencia, tanto en el informe asistencial, como en el registro especfico del cdigo
trauma.
3. Recursos Hospitalarios
Incluyen los 14 centros hospitalarios de Castilla La Mancha y todos aquellos centros hospitalarios
ajenos al SESCAM considerados como tiles por razones de tiempo de traslado por funcin de rgano
(reimplante, quemados). En el Centro Coordinador de Urgencias se valorar la informacin transmitida
por los recursos asistenciales y, en funcin de ella, se decidir colegiadamente con ellos el destino del
paciente, considerando lo referido en relacin al concepto de hospital til. El Centro Coordinador de

486

URGENCIAS Y EMERGENCIAS EXTRAHOSPITALARIAS

GUETS - SESCAM

Captulo 58

Urgencias dispondr de un esquema de recursos hospitalarios que le permita valorar la idoneidad de un

hospital ante cada caso especfico planteado. Es responsabilidad del mbito hospitalario:
- La coordinacin con el Centro Coordinador de Urgencias ubicado en el SAU 1-1-2.
- El asesoramiento clnico al recurso asistencial si ste es solicitado.
- Activacin precoz del procedimiento intrahospitalario. Para la consecucin de los objetivos
generales del procedimiento, es imprescindible que, de la alerta precoz efectuada desde el mbito
prehospitalario, se derive una preparacin efectiva de todos aquellos servicios intrahospitalarios
que estn implicados en la asistencia eficaz del trauma grave: activacin del procedimiento de
transfusin masiva preparacin de derivados hemticos, reserva de recursos de pruebas
complementarias, activacin efectiva de especialistas localizados, preparacin y reserva de
quirfanos, gestin de camas, etc)
- El aseguramiento de la Transferencia Hospitalaria. De la correcta previsin de llegada al hospital,
dependiente de la coordinacin extrahospitalaria, debe derivarse una gil y coordinada
transferencia del paciente a su llegada al hospital. Como norma general, se establece como espacio
de transferencia del paciente, el rea de asistencia a pacientes crticos del Servicio de Urgencias del
Hospital correspondiente. Cualquier variacin a esta norma general, deber ser acordada entre las
partes en la fase de coordinacin extrahospitalaria.
- La clasificacin Valoracin hospitalaria.
- La continuidad del registro, si hubiera lugar.

CRITERIOS DE ACTIVACIN
Se considera que una combinacin de parmetros (fisiolgicos y anatmicos, as como el mecanismo de
trauma, comorbilidades y demografa) nos proveen de un mejor triage frente a cualquier otra
combinacin alguno solo. Con el objetivo ltimo de evitar el infratriage se asume que, pese a que
ciertos criterios son mejores indicadores que otros y que, por ello, se aplicarn de manera secuencial,
todos tendrn la misma influencia a la hora de activar el cdigo. Los criterios de activacin, en orden
secuencial de consideracin, son:
1.- Criterios Fisiolgicos. (el cdigo se activar ante la presencia de uno de ellos).
1.- Constantes Vitales y GCS (marcar) Activar cdigo si aparece una
? GCS <
? TAS < 90 mmHg (adulto)
? FR < 10 > 29 (> 6 aos)
? FC > 160 (< 1 ao) > 150 (1 a 2aos)
13
> 35 (3-5 a); > 40 (1-2 a) > 60 (< 1 a)
? PCR recup. < 70 + edad x 2 (nios)
> 140 (3 - 5 aos) > 120 (6 - 12 aos)
2.- Criterios Anatmicos. (El cdigo se activar ante la presencia de uno de ellos).
2.- Lesiones Anatmicas (marcar) Activar cdigo si aparece una
Cabeza y Cuello
? TCE con focalidad neurolgica
? Lesiones penetrantes
Afectacin sistmica
? Fx abierta deprimida de crneo
? Quemaduras > 15 % con / sin inhalacin.
? Signos de Fx de la base del crneo
? Traumatismo cerrado masivo / atrapamiento /
Trax
aplastamiento.
? Sospecha trax inestable, volet costal
? Sospecha hemorragia masiva
? Lesiones penetrantes
? Sospecha hemotrax masivo
? Herida soplante de trax
Extremidades
? Amputacin proximal
? Lesiones penetrantes proximales
? Fx 2 ms huesos largos
? Fx con afectacin vascular
? Extremidad catastrfica
? Aplastamiento / atrapamiento

Abdomen
? Sospecha de lesin abdominal con distensin
y/o peritonismo
? Lesiones penetrantes
? Ecofast +
Columna y Pelvis
? Sospecha Fx plvica.
? Sospecha lesin raquimedular

487

CDIGO TRAUMA DE CASTILLA LA MANCHA

Captulo 58

3.- Criterios causales y/o biomecnicos. (El cdigo se activar ante la presencia de uno de ellos).
3.- Biomecnica (marcar) Activar Cdigo si aparece uno
? Extricacin > 20
? Atropello peatn
? Atropello ciclista
? Proyectado
minutos
? Deformidad importante del vehculo
? Accidente de Trfico a ms de 60 70 Km/h
? Muerte de ocupante en el mismo vehculo
? Precipitado de ms de 3 metros de altura
4.- Factores asociados y/o morbilidad asociada. (El cdigo se activar ante la presencia de uno de ellos).
4.- Factores asociados (marcar) Activar Cdigo si aparece uno
? Antecedentes conocidos de coagulopata /
? Embarazo
anticoagulacin

ALGORITMO DE ACTIVACIN
ALGORITMO CDIGO TRAUMA DE CASTILLA - LA MANC HA
ACTIVAR

1 Criterio Fisiolgico

CDIGO
1 Criterio Anatmico

1 Criterio Causal

1 Factor Asociado

VALORAR ACTIVACIN DIRECTA

A UNIDAD DE CRITICOS
(segn hospitales)

TRAUMA
PERSONAL

PERSONAL

GUETS
LINEA INTERNA

NO GUETS
1-1-2

ENFERMERO

ENFERMERO

COORD.

COORD.

TAS < 90 mmHg (Adulto)

TAS < 70 + edad x 2 (nio)
Lesiones penetrantes
Sospecha Fx Pelvis
Trax inestable
Sospecha Neumotrax

Sexo y Edad
N victimas pendientes de traslado
Criterios de activacin y lesiones de inters
Constantes vitales significativas
Estabilidad / inestabilidad
Tiempo estimado de llegada (real)

ACTIVACIN
SERVICIO DE URGENCIAS
HOSPITALARIO

El equipo asistencial aplicar secuencialmente los criterios de activacin del cdigo trauma,
sucesivamente: fisiolgicos, anatmicos, causales biomecnicos y factores asociados. La existencia de
uno de ellos condicionar la activacin definitiva del cdigo.

488

URGENCIAS Y EMERGENCIAS EXTRAHOSPITALARIAS

GUETS - SESCAM

Captulo 58

Dicha activacin se realizar a travs de su comunicacin al Centro Coordinador de Urgencias, mediante

una distinta va de acceso, en funcin de que el recurso sea de coordinacin directa (UMEs, HEMs,
ambulancias no asistenciales de urgencias y ambulancias de SVB) indirecta (recursos de los Centros de
Salud de los PAC):
- Coordinacin directa: a travs de la lnea interna de seguimiento del enfermero coordinador. En el
caso de, por motivo que fuere, no poder contactar con el enfermero coordinador a travs de la
referida lnea telefnica, se intentar, sucesivamente, a travs de la lnea del mdico 3 (responsable
del turno) a travs de radiofona TETRA.
- Coordinacin indirecta: a travs del acceso general al SAU, nmero de telfono 1-1-2. Al acceder al
operador de demanda, indicar que desea activar el cdigo trauma, aportando la informacin
requerida por los operadores, siendo posteriormente transferida la llamada siguiendo el
procedimiento de flujo de llamadas del SAU 1-1-2.
Los datos mnimos a proporcionar al Centro Coordinador de Urgencias, a los efectos de su
transmisin posterior al hospital son:
- Sexo y edad (si es desconocida, se aportar de una manera aproximada).
- Criterios de activacin y lesiones de inters significativo para la coordinacin intrahospitalaria.
- Constantes vitales significativas: entendiendo stas como las que, sin llevar a activar el cdigo por
s mismas, tengan un inters significativo para la posterior coordinacin intrahospitalaria.
- Situacin de estabilidad inestabilidad del paciente: entendindolo como la tendencia evolutiva
del paciente a mantener la estabilizacin que haya sido posible en el lugar de los hechos con los
cuidados iniciales. Especial significacin a la estabilidad hemodinmica y la aplicacin de
hipotensin permisiva.
- Tiempo estimado de llegada al hospital. Este tiempo debe ser calculado en base a criterios reales
y no ideales. Cualquier motivo que lleve a variacin del tiempo estimado de llegada comunicado
al hospital, ya condicione adelanto retraso, deber ser actualizado al hospital.
- Nmero total de vctimas afectadas en el accidente: aquellas que permanezcan en el lugar de los
hechos y sean subsidiarias de traslado al mismo hospital en otros recursos de urgencias aquellas
que hubieran podido ser trasladadas por medios no controlados.

ACTIVACIN A HOSPITAL ACTIVACIN HOSPITALARIA

El enfermero coordinador comunicar la activacin del cdigo trauma extrahospitalario al hospital que
sea considerado, por razones de regulacin sanitaria, como til para el accidentado en esas
determinadas circunstancias. Para ello se aplicarn las recomendaciones referidas en apartados
anteriores, que condicionan una priorizacin de la viabilidad vital, frente a la de rgano funcin;
fundamentalmente en lo que respecta a mantenimiento de va rea, respiracin y ventilacin, as como
sospecha evidencia de trauma exanguinante. Como ayuda a la toma de decisiones, los profesionales
de regulacin dispondrn de un listado de la cartera de servicios de cada hospital, en lo que respecta a
la atencin al trauma grave.
El Centro Coordinador de Urgencias dispondr de los medios de contacto directo con las reas y
profesionales de cada uno de los hospitales que vayan a recibir la comunicacin de la activacin del
cdigo. En funcin de los datos comunicados al enfermero y segn la decisin de cada uno de los
hospitales, la comunicacin puede ser:
1. rea Servicio de Urgencias (rea de triage, cirujano de guardia en el Servicio de Urgencias,
etc).
2. rea o Servicio de Crticos, ya sea de adultos de pediatra, segn los casos (intensivista,
anestesista, pediatra, segn corresponda).
La activacin del cdigo ser efectuada a travs del contacto entre profesionales sanitarios. El Centro
Coordinador de Urgencias comunicar la activacin del cdigo al Hospital efectuando una nica llamada
telefnica, siendo el hospital el responsable de la activacin del cdigo intrahospitalario que estuviera
establecido en cada uno de ellos.

489

CDIGO TRAUMA DE CASTILLA LA MANCHA

Captulo 58

TRANSFERENCIA DEL PACIENTE

Cuando la UME llegue al Servicio de Urgencias del Hospital se realizar la transferencia del paciente.
Dicha transferencia, por norma, se realizar, segn la nomenclatura aplicada, en el box vital o de
reanimacin del Servicio de Urgencias. En casos de especial gravedad por su inestabilidad, en los que
se requiera minimizar la movilizacin del accidentado, la transferencia podr ser efectuada
directamente en otros espacios del hospital, transfiriendo el paciente directamente a la camilla de la
TAC del quirfano, segn los casos; aunque, en todo caso, sin demorar esta transferencia para
valoraciones de especialistas quirrgicos de cuidados crticos. Durante la transferencia se garantizar
la transmisin oral de la informacin sanitaria y la entrega de documentacin clnica del paciente;
siendo obligatorio que sta sea efectuada entre profesionales de idntica categora profesional (mdico
con mdico y enfermera con enfermera). Dentro del material entregado al personal del hospital cobran
especial inters las muestras sanguneas que sern entregadas, adecuadamente identificadas, a la
enfermera responsable del paciente en la urgencia hospitalaria. A nivel local, se podrn establecer
procedimientos especficos de identificacin de las muestras sanguneas, de acuerdo a la metodologa
propia de cada centro hospitalario. Tras la transferencia del paciente, la activacin del Cdigo
Intrahospitalario ser responsabilidad del mdico hospitalario que haya adquirido la responsabilidad
inicial de ste.

BIBLIOGRAFA
-

490

Gerencia de Urgencias, Emergencias y Transporte Sanitario del SESCAM. Gua Asistencial: Urgencias
y Emergencias Extrahospitalarias. Toledo: GUETS-SESCAM; 2011. p 469-588.
Butcher N, Balogh ZJ. The definition of polytrauma: the need for international consensus. Injury.
2009;40 Suppl 4:S12-22.
The Eastern Practice Management Guidelines Work Group. Practice Management Guidelines for
appropiate Triage of the victims of trauma. Eastern Association for the Surgery of Trauma 2010.
[Acceso
30
de
Julio
de
2013].
Disponible
en:
http://www.east.org/search?q=The%20Eastern%20Practice%20Management%20Guidelines%20Wor
k%20Group%20triage&offset=2
Guideline Committee of the German Registered Society for Trauma Surgery, in collaboration with
The Polytrauma Association of the German Registered Society for Trauma Surgery. Recommended
Guidelines for Diagnostics and Therapy in Trauma Surgery: Recommended Guidelines for
Polytrauma. Eur J Trauma. 2001;27:137-50.
Direccin General de Trfico. Anuario estadstico de accidentes 2009. [Acceso 30 de julio de 2013].
Disponible
en:
http://www.dgt.es/was6/portal/contenidos/es/seguridad_vial/estadistica/publicaciones/anuario_e
stadistico/anuario_estadistico013.pdf
Protocolo de actuacin y buenas prcticas en la atencin sanitaria inicial al accidentado de trfico.
Grupo de Trabajo de la Sociedad Espaola de Urgencias y Emergencias (SEMES). Edita. Ministerio de
Sanidad y Poltica Social. 2010.
Jimnez Vizuete JM et al. Reanimacin de Control de Daos en el paciente adulto con Trauma
Grave. Rev Esp Anestesiol Reanim 2012; 59(1): 31-42.
Esposito TJ, Offner PJ, Jurkovich GJ, et al. Do prehospital trauma center triage criteria identify major
trauma victims? Arch Surg. 1995;130:171-176.
Knopp R, Yanagi A, Kallsen G, et al. Mechanism of injury and anatomic injury as criteria for
prehospital trauma triage. Ann Emerg Med. 1988;17:895-902.
Henry MC, Hollander JE, Alicandro M, et al. Incremental benefit of individual American College of
Surgeons trauma triage criteria. Acad Emerg Med. 1996;3:992-1000.

 

 






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TRIAJE Y EVACUACIN EN INCIDENTES CON MLTIPLES

LESIONADOS Y CATSTROFES

Apertura
Ocular

Respuesta
Verbal

Respuesta
Motora

Respuesta

Puntos

Espontnea

Al habla

Al dolor

Nula

Orientado
Confuso
Palabras inapropiadas
Gruidos
(ininteligibles)
Nula
Obedece rdenes
Localiza dolor
Retirada al dolor
Reflejo Flexor
Reflejo Extensor

5
4
3

Nula

Tabla 121.1 ESCALA DE COMA DE GLASGOW

2
1
6
5
4
3
2

Captulo 123

Variable
Frecuencia
Respiratoria

Tensin Arterial
Sistlica

Escala del Coma

De Glasgow

Valor
10-29
> 29
6-9
1-5
0
89 mmHg
76-89
50-75
1-49
0
13-15
9-12
6-8
4-5
3

Puntos
4
3
2
1
0
4
3
2
1
0
4
3
2
1
0

Tabla 121.2 TRAUMA SCORE REVISADO

Triage-RTS:
puntuacin
12
11
10
9
8
7
6
5
4
3
2
1
0

Probabilidad
Supervivencia (%)
99,5
96,9
87,9
76,6
66,7
63,6
63,0
45,5
33,3
33,3
28,6
25
3,7

Tabla 121.3 PROB. SUPERVIVENCIA RTS

Triaje Mixto
Existe un sistema de triaje mixto, en el que utilizando un sistema de triaje bsico, con ecografa porttil
in situ, podra considerarse un triaje secundario (avanzado), utilizndolo en lesionados clasificados
Amarillo (Demorado-Prioridad 2). Se han realizado estudios con ultrasonografa abdominal con el
sistema STAR Mass Casualty Triage System, con resultados prometedores. El uso de eco-FAST
obviamente puede realizarse con cualquier otro sistema de triaje bsico. Probablemente su mayor
eficiencia se alcanzara al realizarlo profesionales con experiencia en ecografa FAST (Focused
Assessment with Sonography in Trauma), que habitualmente utilizan en su prctica diaria, en el medio
prehospitalario.
Grupos de lesionados en Triaje Avanzado: Clasificacin
Esta clasificacin es variable, porque depende de la desproporcin entre necesidades y recursos
asistenciales disponible en cada momento.
El juicio clnico y pronstico del personal de triaje debe tener en cuenta la magnitud actual del incidente,
para adaptar la clasificacin, de forma dinmica, a la situacin futura.
El acto de clasificar supone el disponer de conocimientos, capacitacin, aptitud y actitudes, adems de
un gran coraje, porque su papel es clave en la supervivencia del mayor nmero de lesionados.

894

 

 






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PKBQTIRSC

URGENCIAS Y EMERGENCIAS EXTRAHOSPITALARIAS GUETS - SESCAM

GUA FARMACOLGICA

GUIA FARMACOLGICA
Andrs Estudillo Mustafa (Coordinador)
Jos Miguel Edo Cebollada - Remedios Belmonte Gmez - Javier de Buen Torralba
M Carmen Martn Fernndez - Jos Ignacio Lpez Gonzlez - M Almudena Benito Fernndez
M Pilar Izquierdo Garca - M Jos Arce Ruiz - Nelly Habed Lobos - Andrs Pacheco Rodrguez

INDICE DEL MDULO

x
x
x
x
x
x
x

Introduccin y uso de la Gua Resumida Farmacolgica

Tabla con Indice de siglas
Tabla con Indice Alfabtico de Principios activos
Texto Resumido de cada Medicamento por orden alfabtico del principio activo asociado a un nmero de
referencia
Tabla con Indice Alfabtico de Nombres Comerciales asocindolos con los principios activos
Tabla con Indice Alfabtico de Procesos y Patologas asocindolos con los principios activos
Categoria de riesgo de los medicamentos en el embarazo segn la FDA

INTRODUCCIN Y USO DE LA GUA RESUMIDA FARMACOLGICA

En esta revisin, se ha intentado incluir todos los productos-qumicos sanitarios que se usan en Urgencias y Emergencias.
Los medicamentos estn ordenados alfabticamente, y lo hemos ligado a un nmero de referencia, ya que un mismo
principio activo puede tener varios sinnimos o denominado con varias palabras.
El nmero de referencia nos servir para buscar el medicamento a texto completo. En el texto completo, por motivos
prcticos y de economa de espacio, slo hemos desarrollado 5 apartados: 1 Nombres Comerciales y presentaciones, 2
Indicaciones, 3 Posologa, 4 Contraindicaciones y 5 Observaciones. En Nombres comerciales exponemos los ms
importantes o los que hemos encontrado. En las presentaciones resaltamos sobre todo las ampollas (amp.) en lo posible
en mg./ml. En Posologa en su mayora lo expresamos en mg. o mcg. por Kg. de peso, e incluso en lo posible en ml. por
kg. Cuando no podemos expresarlo as, ponemos la dosis estandar en mg. o ml. por dosis. En la misma, expresamos
cmo preparar tanto la Dosis Inicial (DI.) como la Dosis de Mantenimiento (DM) que solemos exponer en ml./kg./h. Por
tanto en la mayora de las veces tendris que multiplicar las dosis por el peso aproximado del paciente, y ante la duda de
peso la dosis estandar ser hallada, multiplicndola por 70 kg. Seguidamente mencionamos las contraindicaciones y a
veces precauciones. En la mayora de los casos no ponemos la hipersensibilidad o alergia al medicamento, por darlo por
supuesto. Como ltimo apartado exponemos las observaciones, en la que expresamos, en su mayoria, la categora en el
uso durante el embarazo y la Lactancia, as como algunos datos de inters a tener en cuenta, de cada uno de los 243
productos qumico-sanitarios incluidos en esta gua.
Posteriormente hemos realizado un ndice alfabtico por marcas comerciales que se relacionan con principios activos y
por tanto con su nmero de referencia. Tambin realizamos un indice por orden alfabtico de las patologas mas
importantes, relacionandolas con los principios activos que se usan para su tratamiento. As como un esquema de las
clasificacin de las categoras de riesgo del uso de frmacos en la Embarazada.
Es nuestro deseo que este pequeo resumen os pueda servir para usar esta gua y tambin tenemos la esperanza de que
el esfuerzo que han realizado estos autores os pueda servir un poco para mejorar la prctica diaria en el Tratamientos de
los pacientes, as como todas las observaciones que tengis sobre la misma la remitis para mejorar en otras revisiones.

911

URGENCIAS Y EMERGENCIAS EXTRAHOSPITALARIAS GUETS - SESCAM

GUA FARMACOLGICA

ABREVIATURAS USADAS MS FRECUENTEMENTE

Siglas

Contenido

Siglas

Contenido

ACVA

Accidente Cerebro Vascular Agudo

min.

minutos

ADT

Anti Depresivos Tricclicos

ml.

mililitros

AESP

Actividad Electrica Sin Pulso

mmHg

Milimetros de Mercurio

AIT

Accidente Isqumico Transitorio (Cerebral)

milisegundos
MiliUnidades Internacionales
Nebulizado
Oxgeno

Amp.

Ampolla

A-V

Auriculo Ventricular

B.A-V

Bloqueo A-V

msg
mUI
Nebu.
O2

Caps

Capsula

Grados Centgrados

cc

Centmetros Cubicos o Mililitros

OtrAut

Otros Autores

Comp.

Comprimidos,

PC.

Perfusin Contnua

DI.

Dosis Inicial

PCR

Parada Cardiaco Respiratoria

DM.

Dosis Mantenimiento

PIC

Presin Intracraneal

Dmx

Dosis Mxima

RN.

Recin Nacido

EAP

Edema Agudo de Pulmn

S.

Suero

Ej.

Ejemplo

sc.

Va Subcutnea

Enf.
EV

Enfermedad
Extrasstoles Ventriculares

SCA

Sindrome Coronario Agudo

SDR

Sindrome Distress Respiratorio

FA

Fibrilacin Auricular

FV

Fibrilacin Ventricular

seg.
sem.

Segundos
Semanas

g.

gramos

SG.

Suero Glucosado al 5%

gr.

gramos

h.

Horas

Sindr.
sl.

Sndrome
Sublingual

HITC

Hipertensin Intracraneal

SNG

Sonda Nasogstrica

IAM

Infarto Agdudo Miocardio

Solucin

ICC
ICP

Insuficiencia Cardiaca Congestiva

Intervencin Coronaria Percutanea

ICTUS

Isquemia Cerebral

Sol.
SSF o
SFF
Supo.
Susp.

im.

Va Intramuscular

Infus.

Infusin

inh

Va Inhalatoria

inj

Inyectable

Insuf.

Suero Salino Fisiolgico al 0,9%

Supositorio
Suspensin

T.A

Tensin Arterial

TCE

Traumatismo CraneoEnceflico

Temp.

Temperatura

Insuficiencia

TEP
TET

Tromboembolismo Pulmonar
Tubo Endo Traqueal

Intox.
IOT

Intoxicacin
Intubacin Orotraqueal

Trat.

Tratamiento

TSV

Taquicardia Supreventricular

iv.

Va Intravenosa

Kg.

Kilos de peso

TSVP
TV

Taquicardia Supraventricular Paroxistica

Taquicardia Ventricular

L.

Litros

lpm.

Latidos por minuto

UI
viO.

Unidades Internacionales
Va Intrasea

Vit.

Vitaminas

M2

Metros Cuadrados

vo.

Va Oral

mcg.

microgramos

mg.

912

Miligramos

WPW
g.

Wolf-Parkinson-White
microgramo

URGENCIAS Y EMERGENCIAS EXTRAHOSPITALARIAS GUETS - SESCAM

GUA FARMACOLGICA

NDICE ALFABTICO POR PRINCIPIOS ACTIVOS

Principio Activo

Ver en:
(Sinnimo de:)
Metoxamina

2,5-Dimetoxinorefedrina
4-Aminopiridina
4-Metil-Pirazol
Fomepizal
AAS
Acido Acetil Saliclico
Acenocumarol
Acetil Salicilato de Lisina
Acetilcisteina
cido 2,3 Dimercaptopropanilsulfnico
cido 2,3
Dimercaptosuccinico
cido Acetil Saliclico
cido Aminocaprico
cido Ascrbico
cido Clavulnico
Amoxicilina
Acido EpsiloAcido Aminocaprico
Aminocaproico
Acido Folnico
cido Mefenmico
Mefenmico, cido
cido Tranexmico
Tranexminco, cido
cido Valproico
Valproico, Acido
Adenosina Difosfato
Adenosina Trifosfato
Adrenalina
Agua Albuminosa
Agua Destilada o Estril
Suero Agua Destilada
Agua Gel
Agua Oxigenada
Peroxido Hidrgeno
Albmina Seca
Agua Albuminosa
Alcohol Etlico
Almidn
Alprazolam
Alteplasa
Aminocaprico, Acido
Acido Aminocaprico
Aminofilina
Amiodarona
Amoxicilina
Ampicilina
Amrinona
Anticuerpos AntiDigoxina
Apomorfina
Ascrbico, cido
cido Ascrbico
Atenolol
Atosibn
Atracurio, Besilato
Atropina
Besilato Atracurio
Atracurio, Besilato
Biperideno
Bivalirudina
Bretilio
Bromuro Ipratropio
Ipratropio, Bromuro
Budesonida
ButilBromuro
Butil-Escopolamina
Butil-Escopolamina
Calcio Edetato Sdico (EDTA)
Calcio, Cloruro
Calcio, Gluconato

Principio Activo

Refer.
141
1
99
7
2
4
3
5
6
7
8
9
22
8
10
131
234
237
11
12
13
14
197
15
170
14
16
17
18
19
8
20
21
22
23
24
25
26
9
27
28
29
30
29
31
32
33
117
34
35
35
37
36
38

Captopril
Carbn Activado
Carboprost
Carvelidol
Ceftrixona
Chitoxan
Cilastatina
Cimetidina
Ciprohetadina
Cisatracurio
Citicolina
Claculnico, cido
Clindamicina
Clometiazol
Clonazepam
Clonidina
Clopidogrel
Cloracepato Dipotsico
Clorhexidina
Clorhidrato Mepivacana
Clorhidrato Morfina
Clorpromazina
Cloruro Clcico
Cloruro Etilo
Cloruro Potsico
Colirio Anestsico Doble
Colirio Fluorescena
Colirio Midritico
Colirio Mitico
Cotrimoxazol
Dantroleno
Dehidrobenzilperidol
Deltaparina Sdica
Desferroxamina, Mesilato
Dexametaxona
Dexclorfeniramina,
Maleato
Dexketoprofeno
Diazepam
Diazxido
Diclofenaco
Dicobltico, EDTA
DifenilHidantona
Digoxina
Diltiazem
Dimentindeno
Dimepirindeno
Dimercaprol
Dinoprostona
Diphoterine
Dipirona Magnsica
Dipotsico,
Cloracepato
DMPS

Ver en:
(Sinnimo de:)

Imipenem

Amoxicilina

Mepivacana, Clorh.
Morfina
Calcio, Cloruro
Potasio, Cloruro

EDTA Dicobltico
Fenitona

Dimentindeno

Metamizol
Cloracepato
Dipotsico
Ac. 2,3
Dimercaptopropanils
ulf.

Refer.
39
40
41
42
43
44
114
45
46
47
48
22
49
50
51
52
53
54
55
133
145
56
36
57
175
58
59
60
61
62
64
66
63
65
67
68
69
70
71
72
82
91
73
74
75
75
76
77
78
135
54
5

913

URGENCIAS Y EMERGENCIAS EXTRAHOSPITALARIAS GUETS - SESCAM

Principio Activo
DMSA
Droperidol
Dobutamina
Dopamina
D-Penicilamina
Edetato Clcico Disdico
Edrofonio
EDTA
EDTA Calcio Disdico
EDTA Dicobltico
Efedrina
Enalapril
Enalprilato
Enoxaparina Sdica
Epsilo-Aminocaproico,
Acido
Escopolamina
Esmolol
Esomeprazol
Estreptoquinasa
Etanol
Etilo, Cloruro
Etomidato
Eufilina
Fenilefrina
Fenitona
Fenobarbital
Fentanilo Citrato
Fentolamina
Ferrocianuro Frrico
Fisostigmina, Salicilato
Fitomenadiona
Fitonadiona
Flecainida, Acetato
Flumazenilo
Fluorescena
Folinato Clcico
Folnico, cido
Fomepizal
Formoterol
Furosemida
Glicopirrolato
Glucagn
Glucitol
Gluconato Ccico
Glucosa
Haloperidol
Heliox
Heparina Sdica
HesCianoFerrato Frrico
Potasio
Hexadimetrina
Hexoprenalina, Sulfato
Hidralazina
Hidrocortisona

914

Ver en:
(Sinnimo de:)
Ac. 2.3.
DimerCaptoSuc.
Dehidrobenzilperidol

Penicilamina
Calcio Edetato
Sdico (EDTA)
Calcio Edetato
Sdico

Enalapril
Acido Aminocaprico
Butil-Escopolamina

Alcohol Etlico
Cloruro Etilo
Aminofilina

HesCianoFerrato
Frrico Potasio

Fitomenadiona

Colirio Fluorescena
Acido Folnico
Acido Folnico

Sorbitol
Calcio, Gluconato

Refer.

Principio Activo
6

66
79
80
168
37
81
37
37
82
83
84
83
85
8
35
86
87
88
16
57
89
20
90
91
92
93
94
108
95
96
96
97
98
59
10
10
99
100
101
102
103
195
38
104
105
106
107
108
109
110
111
112

HidroxietilCelulosa
Hidroxicobalamina
Hioscina
Imipenem
Insulina
Ipecacuana
Ipratropio, Bromuro
Isoprenalina
Ketamina
Ketorolaco
Labetalol
Levetiracetam
Levofloxacino
Levomepromazina
Levosimendan
Lidocana
Lorazepam
Lubricante Anestsico
Lubricante Hidrosoluble
Magnesio, Sulfato
Maleato Dexcloreniramina
Mefenmico, cido
Meperidina
Mepivacana, Clohidrato
Meropenen
Mesilato Desferroxamina
Metamizol
Metilergometrina,
Maleato
Metilprednisolona
Metiltionina, Cloruro
Metoclopramida,
Clorhidrato
Metoprolol
Metoxamina
Midazolam
Milrinona
Mivacurio
Morfina, Clorhidrato
N-Acetilcisteina
Nadroparina
Nafazolina
Naloxona
N-ButilBromuro
Neostigmina
Nifedipino
Nimodipino
Nitrato Plata
Nitrito Amilo
Nitrito Sdico
Nitroglicerina
Nitroprusiato Sdico
Noradrenalina
Norepinefrina
Obidoxima
Obiodoxina
Octreotida

GUA FARMACOLGICA
Ver en:
(Sinnimo de:)
Lubricante
Hidrosoluble
Butil-Escopolamina

Isoproterenol

Dexclorfeniramina

Desferroxamina

Refer.
128
113
35
114
115
116
117
118
119
120
121
122
123
124
125
126
127
129
128
130
68
131
132
133
134
65
135
136
137
138
139

Acetilcisteina
Colirio Anestsico
Doble
Butil-Escopolamina

Noradrenalina
Obidoxima
Sandostatina

140
141
142
143
144
145
3
146
58
147
35
148
149
150
151
152
153
154
155
156
156
157
157
192

URGENCIAS Y EMERGENCIAS EXTRAHOSPITALARIAS GUETS - SESCAM

Principio Activo
Olanzapina
Omeprazol
Ondansetrom
Oxibuprocaina
Oxido Nitroso
Oxgeno
Oxiomas
Oxitocina
Pancuronio
Pantoprazol
Paracetamol
Paraldehido
Penicilamina
Penicilina G Sdica
Peroxido Hidrgeno
Petidina
Piperacilina
Piridostigmina
Piridoxina
Plasugrel
Polibreno
Polietilenglicol
Poractan Alfa
Potasio, Cloruro
Povidona Iodada
Pralidoxima
Procainamida
Propafenona
Propofol
Propranolol
Prostaglandina E1
Prostaglandina E2
Protamina
Ranitidina
Remifentanil
Reteplasa
Ribavirina
Ritodrina
Ritoquinona
Rocuronio
RTPA
Salbutamol
Sandostatina
Silibinina
Silimarina
Somatostatina
Sorbitol
Succinil Colina
Suero Agua Destilada o Estril

Suero Amnico
Suero Antibotulnico
Suero Antiofdico
Suero Bicarbonatado
Suero Coloide Albmina
Suero Coloide Almidn
Suero Coloide de Gelatina
Succinilada

Ver en:
(Sinnimo de:)

Colirio Anestsico
Doble

Obidoxima

Meperidina

Hexadimetrina
Surfactante
Pulmonar Porcino

Dinoprostona

Fitomenadiona
Alteplasa

Silibinina

Refer.
158
159
160
58
161
162
157
163
164
165
166
167
168
169
170
132
171
172
173
178
109
174
218
175
176
177
179
180
182
181
183
77
184
185
186
187
188
189
96
190
19
191
192
193
193
194
195
196
197
198
199
200
201
202
203
205

Principio Activo
Suero Coloide Dextrano
Suero Coloide HidroxietilAlmidn
Suero Glucosado 5%
Suero Glucosado
Hipertnico > 10%
Suero Glucosalino
Suero Manitol
Suero Ringer Lactato
Suero Salino Fisiolgico
Suero Salino Fisiolgico
Irrigacin
Suero Salino Hipertnico
Suero Salino Hiposdico
Sugammadex
Sulfadiazina Argntica
Sulfametoxazol
Sulfato Magnesio
Sulpirida
Sulfato Hexoprenalina
Surfactante Pulmonar
Porcino
Suxametonio
Tapentadol
Tazobactn
Tenecteplasa
Teofilina Monohidrato
Terbutalina
Terlipresina
Tiamina
Tiaprida
Ticagrelor
Ticlopidina
Tierra de Fuller
Tiopental Sdico
Tiosulfato Sdico
Tirofibn
Torasemida
Tramadol
Tranexmico, Acido
Trecaina
Trimetafan
Trimetoprima
Urapidil
Valproico, Acido
Vancomicina
Vaselina (Petrolato)
Vasopresina
Vecuronio
Verapamilo
Vernakalant
Vitamina B1
Vitamina B12
Vitamina B6
Vitamina C
Vitamina K
Yodo, Povidona

GUA FARMACOLGICA
Ver en:
(Sinnimo de:)
Suero Coloide
Almidn

Refer.
204
203
206
207
208
209
210
211
212

Cotrimoxazol
Magnesio, Sulfato
Hexoprenalina

Succinil Colina

Aminofilina

Colirio Anestsico
Doble
Cotrimoxazol

Tiamina
Hidroxicobalamina
Piridoxina
cido Ascrbico
Fitomenadiona
Povidona Iodada

123
124
215
216
62
130
217
110
218
196
219
220
221
20
222
223
224
225
226
227
228
229
230
231
232
233
234
58
235
62
236
237
238
239
240
241
242
243
224
113
173
9
96
176

915

URGENCIAS Y EMERGENCIAS EXTRAHOSPITALARIAS GUETS - SESCAM

1-4-AMINOPIRIDINA
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Dalfampridina, Ampyra, Fampyra. Fampridina (Comp. 10 mg.) (Amp. 3
mg./ml.)
2.- INDICACIONES:
-Intoxicaciones agudas por: -Antagonistas del Calcio (Verapamil,
Diltiazem, Nifedipina, Nicardipina, Papaverina, Amilodipino,
Nimodipino, Felodipino, Cinarizina, Flunarizina, etc.) -Botulismo
(Como Trat. Coadyuvante, pocos estudios) y -Toxina del Pez Globo
(en experimentacin). -Patologas crnicas de: -Lesin crnica de
mdula espinal. -Esclerosis mltiple, -Miastenia Gravis, Enf. Alzheimer.
Sndr. Eaton-Lambert.
3.- POSOLOGA:
-Adultos: -Patologa Aguda: DI: Iv. 0,12 mg./kg. (0,04 ml./kg.)
(Paciente 70 kg. = 8,4 mg. = 2,8 ml.) -Patologa Crnica: DI: iv. (45-60
mg./d.) (0,51,0 mg./kg./d.), o vo. 10 mg./12h. (durante 9-14
semanas)
-Peditrica: -Neonatos: DI: iv. 5 mg./8 h.
4.- CONTRAINDICACIONES:
-Antecedentes de crisis epilpticas. Insuficiencia Renal leve,
moderada o severa (aclaramiento de la creatinina < 80 ml./min.)
5.- OBSERVACIONES:
-Efectos adversos puede apartecer a partir de los 10 mg. -Efectos
txicos a partir de 60 mg. -Se usa tambin como pesticida, en grandes
dosis, como repelente de las aves. -En Embarazo: Categora C (en vo.) En Lactancia: Evitar. -Es un bloqueante de los canales de potasio.

2-ACENOCUMAROL
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Sintrom (Comp. 1 y 4 mg.)
2.- INDICACIONES:
-Trat. y profilaxis de las afecciones tromboemblicas. -Trombosis
venosa profunda y Tromboembolismo pulmonar. -Profilaxis de
reinfarto de miocardio. TVP y TEP asociado a FA crnica, -IAM, Cardioversin de RA crnica, -Prtesis valvulares cardiacas, Recurrencia de Tromboembolismo cerebral (en ausencia de
hemorragia cerebral).
3.- POSOLOGA:
-Adultos: -Individualizado y ajustado al Tiempo de Protombina o INR
(Internacional Normalizad Ratio.)
DI: vo. 1 da de 8 a 12
mg., 2 da de 4 a 8 mg. y finalmente de 1 a 8 mg./d. segn el INR.
-Peditrica: Neonatos DI: vo. 0,2 mg./kg. ; Nios <1 ao. DI: vo. 0,1
mg./kg. ; Nios >1 a <5 aos. DI: vo. 0,06 mg./kg.; Nios >5 a <10
aos. DI: vo. 0,05 mg./kg.; Nios >10 a <18 aos. DI: vo. 0,04 mg./kg.
4.- CONTRAINDICACIONES:
-Endocarditis bacteriana. -HTA grave, -Aneurisma, -Ciruga de menos
de 3 das. Precaucin en: -Alteracin renal o heptica. -Discrasias
Sanguneas, -Hemofilia, -lcera gastroduodenal, -Hemorragia
gastrointestinal, genitourinaria o respiratoria, -Amenaza de Aborto, Alteraciones tiroideas, -Insuf. Cardiaca grave, -Infecciones o -Tumores.
-Embarazo.
5.- OBSERVACIONES:
-Antdoto: Vit. K1: -En hemorragias moderadas 2-5 mg. (va oral). Hemorragia significativa: 5-10 mg. (va iv. lenta) -En Embarazada:
Categora X. -En Lactancia: Compatible

3-ACETILCISTEINA
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Fluimucil antdoto 20 %, (Vial 2 gr./10 ml.(1 ml.= 200 mg.))
2.- INDICACIONES:
Intoxicaciones Agudas por Paracetamol (dosis txica ingerida por
encima de 7,5 gr. o 140 mg./kg.).
3.- POSOLOGA:
-Adultos: DI: iv. 150 mg./Kg. (0,75 ml. = 150 mg.) (Preparacin: DI. en
SG. hasta 100 ml. a pasar en 15-20 min. (a 400-300 ml./h.) DM: Infu.
iv. 50 mg./Kg.,(0,25 ml./kg.) (Preparacin: DM. en SG. hasta 500 ml. a
pasar en 4 h. (a 125 ml./h.)
DI: vo. en SNG..:1 dosis de 140 mg./Kg. diluidos en agua o zumo,
seguidas de 17 dosis de 70 mg./kg.

916

GUA FARMACOLGICA

-Peditrica: DI: iv. misma dosis/kg. que en adultos. (Pero en < 25 kg.
dar la mitad de la dosis/kg. que en adultos)
4.- CONTRAINDICACIONES:
Precaucin en: -Asma, Insuf. Respiratoria,
-Predisposicin a
Hemorragias Digestivas e Insuf. Renal.
5.- OBSERVACIONES:
-La sobredosificacin puede entraar riesgo de encefalopata heptica.
-En Embarazo: Categora B. -En Lactacia se desconoce si pasa a la
leche. -Administrar precozmente antes de las 8-10 h. postingesta de la
sobredosis de Paracetamol, puesto que pasadas 24 h. no es til.

4-ACETIL-SALICILATO DE LISINA
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Inyesprn vial de 900 mg. (equivalen a 500 mg. de AAS).
2.- INDICACIONES:
-Dolores reumticos, neurlgicos, post-traumticos, postoperatorios,
post-parto y neoplsicos. -Profilaxis y trat. de la enfer.
tromboemblica. -Hipertermia. -SCA (alternativa a la AAS vo.). Pericarditis
3.- POSOLOGA:
-Adultos: En SCA. DI: iv. 450-900 mg. en SSF hasta 100 ml. durante 10
min. a 600 ml./h. 30 min. a 200 ml./h. -En otras Indicaciones. DI: iv.
6,43-12,86 mg./kg. (0,07-0,14 ml./kg.) (Preparacin: 900 mg. en 10 ml
SSF. (1 ml.=90 mg.) Dosis/kg. en SFF. hasta 100 ml. a pasar en 10 min.
a 600 ml./h. Desde 1 a 4 veces al da. (Puede ser administrada por va
im. pero sin disolver en 100 ml. de SSF.).
-Peditrica: Misma dosis/kg. que en adultos. en <15 kg. 5,00-16,67
mg./kg. (0,055-0,185 ml./kg.) (Preparacin: 1 vial en 10 ml. SSF. (1
ml.=90 mg.) (Dosis en SFF. hasta 10 ml. a pasar en 10 min. a 60 ml./h.
cada 6 h.
4.- CONTRAINDICACIONES:
-Antecedentes de broncoespasmo. -Rinitis o Urticaria debido a la
administracin de antiinflamatorios inhibidores de la sntesis de
Prostaglandinas o a la Tartrazina. (Reaccin cruzada). -lcera pptica o
hemorragia gstrica, -Alteraciones de la coagulacin. -Insuficiencia
renal o heptica grave. -Terapia conjunta con anticoagulantes orales. Pacientes con plipos nasales asociados a asma que sean inducidos o
exacerbados por el AAS. -Nios menores de 16 aos con procesos
febriles, gripe o varicela por riesgo de aparicin del sndrome de Reye.
-Asma crnico- -Diabetes. Gota. HTA. (Niveles de Albmina baja).
5.- OBSERVACIONES:
-Embarazo: Categora D. -Lactancia: Se desaconseja. -No conservar a
Temp. superior a 25C. -Evitar mezclar con otros frmacos.

5-CIDO 2,3 DIMERCAPTOPROPANILSULFNICO

(DMPS)
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Unithiol (DMPS) (Compr. 100 mg.). Dimaval (Amp. 250 mg./5 ml.) (100
mg./20 ml.)
2.- INDICACIONES:
Intoxicaciones por cobre, nquel, plomo, cadmio, cobalto y oro.
3.- POSOLOGA:
-Adultos: DI: iv. 30 mg./kg./da 250 mg. 5 ml. en 3 a 5 min. y cada
3 a 4 h. si es posible usar DI: vo. 200 mg./m2./da dividido en 3 dosis,
durante 10 das. (OtrAut: DI: im. sc. 5 mg./kg./3-4 h.)
-Peditrica: DI: iv. 30 mg./kg./da
4.- CONTRAINDICACIONES:
-IR. -Insuf. Heptica. Precaucin en pacientes asmticos
5.- OBSERVACIONES:
La desintoxicacin con el Dimaval es la nica manera de eliminar los
metales pesados dentro de un tiempo apreciable. Pero an no est
reconocido por la FDA. En Embarazo y Lactancia, sin evidencia de su
utilidad.

6-cido 2,3 DIMERCAPTOSUCCINICO (DMSA)

1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Succimer (Caps. 100 mg.)

URGENCIAS Y EMERGENCIAS EXTRAHOSPITALARIAS GUETS - SESCAM

2.- INDICACIONES:
Intoxicaciones por Mercurio, Arsnico o Plomo (En nios con plomo en
sangre de >45 mg./dl.) (Con menos intensidad en Oro, Zinc y Cobre).
3.- POSOLOGA:
-Adultos: DI: vo. 30 mg./kg./da o 10 mg./kg./8 h. se puede
administrar con alimentos pero sin masticar.
-Peditrica: En nios de 8-15 Kg. DI: vo. 100 mg./8 h., En nios de 1623 Kg. DI: vo. 200 mg./8 h. En nios 24-34 Kg. DI: vo. 300 mg./8 h. En
nios de 35-44 kg. DI: vo. 400 mg./8 h. En nios de >45 kg. DI: vo. 500
mg./8 h.
4.- CONTRAINDICACIONES:
Intoxicacin Cadmio, Arsina, Uranio, Selenio e Hierro
5.- OBSERVACIONES:
Si sobredosificacin a 2300-2400 mg./kg. se dar Carbn Activado. Es
dializable. En Embarazo y Lactanci. Sin encontrar datos que avalen
su uso.

GUA FARMACOLGICA

idioptica: DI: vo. 300-600 mg. (Coadyuvante con Azul de Metileno) En Intoxicacin por hierro: DI: vo. 100-200 mg. tras 1 2 h. de
Desferoxamina. -En Forunculosis Crnica con Neutrofilia: DI: vo.
1gr./da (4 a 6 semanas).
Peditrica: -En Escorbuto: Nios DI: (vo., sc., im., iv.) 100-300 mg.
Lactantes. DI: (vo. sc. im. iv.) 50-100 mg.
4.- CONTRAINDICACIONES:
-Anemias tipo falciforme, -Hemocromatosis, -Deficiencia en G6PD
(Glucosa-6-Fostato-Deshidrogenasa).
5.- OBSERVACIONES:
-No dar la Desferoxamina a la vez que el Ac. Ascrbico, puede
aumentar la intoxicacin del hierro y provocar descompensacin
cardiaca, slo en el caso y la forma indicada. En Embarazada:
Categora C. En Lactancia: Precaucin.

10-CIDO FOLNICO (Folinato-Clcico)

7-CIDO ACETIL SALICLICO (AAS)
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
A.A.S, cido acetilsaliclico Mundogn Farma, Adiro, Asasantin,
Aspirina, Bioplak, Desenfriol, Dolmen, Fiorinal, Solusprin, Tromalyt.
(Comp. Sobres o Caps. 100, 125, 200, 250, 300, 500 y 1000 mg.)
2.- INDICACIONES:
-Dolor Somtico, -Inflamaciones, -Hipertermia-Fiebre, -Profilaxis y
Trat de trombosis venosas y arteriales, -Artritis Reumatoide Juvenil, Profilaxis del IAM en pacientes con Angina de Pecho Inestable.
3.- POSOLOGA:
-Adultos: En SCA. DI: vo. 160-325 mg. si es posible, masticado. En
otras Indicaciones DI: vo. 500 mg./4-6 h.
-Peditrica: DI: vo. 20-50 mg./Kg./da.
4.- CONTRAINDICACIONES:
No usar en lo posible en: Nios con varicela o gripe. -Una semana
antes de cualquier intervencin quirrgica. -En pacientes con
problema de coagulacin, -Asma. -En pacientes con cualquier tipo de
disfuncin medular y -En pacientes inmunodeprimidos.
5.- OBSERVACIONES:
-En Embarazada: Categora D. -En Lactancia: Evitar

8-CIDO AMINOCAPROICO
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Caproamin Fides (amp. 4 g./10 ml.)
2.- INDICACIONES:
Hemorragias en General y Hemorragias por Fibrinolisis, o sobredosis
de trombolticos.
3.- POSOLOGA:
-Adultos: DI: Infu. iv. 4-5 g. en SG. o SSF. hasta 250 ml. a pasar en 1 h.
repetir segn evolucin cada 4-6 h.
-Peditrica: DI: Infu. iv. 50-100 mg./Kg. en 1 h. repetir segn evolucin
cada 4-6 h.
4.- CONTRAINDICACIONES:
-Coagulacin
intravascular
diseminada
y
enfermedad
tromboemblica.
5.- OBSERVACIONES:
La administracin iv. rpida o con una dilucin insuficiente puede
producir hipotensin, bradicardia y arritmias. No se conoce antdoto,
en caso de sobredosis, puede ser eliminado por hemodilisis. Embarazo, categora C evitar. -Lactancia: Precaucin

9-CIDO ASCRBICO o VITAMINA C

1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Redoxn, Citrovit, Cebin, Vitamina C Roche (amp. 5 ml./1 gr.)
2.- INDICACIONES:
-Intoxicacin por Cromo, -Escorbuto, -Metahemo- globinemia, Intoxicacin por Hierro, -Acidificacin de orina, -Abstinencia
Alcohlica.
3.- POSOLOGA:
Adultos: -En Intoxicacin por Cromo: DI: iv. 1 gr./h. durante 10 h. -En
Escorbuto: DI: (vo. sc, im. iv.) 100-250 mg. -En Metahemoglobinemia

1.- NOMBRES COMERCIALES Y PRESENTACIONES:

Folidan, Folinato Clcico. (Tableta=15 mg.) (Amp. 3 mg./1 ml, 10 mg./1
ml.) (Vial 350 mg./35 ml.; 800 mg./80 ml.).
2.- INDICACIONES:
-Intoxicacin por: (Metanol, Metotrexate, Trimetropn Pirimetemina,
Triamterene). -Anemia Megaloblstica.
-(Contrarrestar los efectos secundarios en los Trat. con Metotrexate).
3.- POSOLOGA:
-Adultos: DI: iv. 120 mg. o 34,3 ml. y despus a las 12 h. DM: iv. 75
mg. o 21,4 ml. cada 12 h. hasta 350 mg. (no dar ms de 160 mg./min.).
(Preparacin: 350 mg. en SFF. o SG. hasta 100 ml. (1 ml.=3,5 mg.)).
4.- CONTRAINDICACIONES:
-Precaucin en Anemia Megaloblstica por falta de Vitamina B12. -En
epilepsia.
5.- OBSERVACIONES:
Una sobredosis puede anular el efecto de la quimioterapia. -En
Embarazada: Categora A. -En Lactancia: Compatible.

11-ADENOSINA DIFOSFATO
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Adenocor, Adenoscan. (Amp. 6 mg./ 2ml.; 30 mg./10 ml.) (1ml.=3mg.).
2.- INDICACIONES:
-TPSV. -Taquicardias supraventriculares asociadas a vas de conduccin
anmalas (Sindr. WPW.). -Diagnstico de cualquier taquicardia. Taquicardia Ventricular inducida por el ejercicio. -Taquicardia
reentrante del ndulo sinusal. -Provoca bloqueo A-V transitorio en FA.
o Flutter Auricular y en Taquicardia Auricular. (-No tiene efecto en la
TV y en la FA y Flutter Auricular con Preexcitacin. -No tiene efecto en
la TPSV Antidrmica con 2 vas accesorias.)
3.- POSOLOGA
-Adultos: DI: iv. 2 ml.=6 mg. rpido seguido de 20 ml. de SSF. (Todo si
es posible en menos de 5 seg.), si no remite en 1 2 min., administrar
otros 4 ml.=12 mg. rpido seguido de 20 ml. de SSF, (Tambin rpido),
si no remite antes de 2 min. repetir la misma dosis anterior y a la
misma velocidad.
-Peditrica: DI. iv. 0,05 a 0,1 mg./Kg.=0,016 a 0,033 ml./kg. seguida
de 5 ml. de SSF. (En nios hasta 5 kg.: 0,25 a 0,5mg.=0,08 a 0,16ml.)
(En nios hasta 10 kg.: 0,5 a 1mg=0,16 a 0,32 ml.) (En nios hasta 20
kg.: 1 a 2 mg.=0,32 a 0,64 ml.). Si no responde a los 2 min. administrar
0,1 mg./Kg.=0,033 ml./Kg.; si no responde a los 2 min. dar 0,15
mg./Kg.=0,05 ml./Kg.; si continua sin responder a los 2 min. poner
0,25 mg./Kg. = 0,08 ml./Kg.
4.- CONTRAINDICACIONES:
-Absolutas: -Bloqueo AV de 2 y 3. -Enf. del Seno (excepto los
portadores de marcapasos). -Asma Bronquial. Sindr. del QT Largo. Hipotensin grave. FV. TV. -Hipertensin pulmonar. -Fase aguda del
IAM. -Angina Inestable no
estabilizada. -Insuf. Cardiaca
Descompensada. RN.
-Relativas: -Embarazo. -Fallo renal. -Fallo heptico. Pacientes en Trat.
con Dipiridamol.
5.- OBSERVACIONES:
-En Embarazo: Categora C. En Lactancia: Evitar

917

URGENCIAS Y EMERGENCIAS EXTRAHOSPITALARIAS GUETS - SESCAM

12-ADENOSINA TRIFOSFATO
1.- NOMBRES COMERCIALES Y PRESENTACIONES
Atepodn (Amp. 100 mg./10ml.)
2.- INDICACIONES:
TPSV que no cede a maniobras vagales, -Diagnstico de Arritmias
Supraventriculares.
3.- POSOLOGA:
-Adultos: DI: iv. 10 mg. en una jeringa seguidos de 20 ml. de SSF, en
otra, en menos de 5 seg. si es posible. Si no responte antes de 2 min.,
repetir 2 dosis pero de 15 mg. y otros 20 ml. de SSF. en menos de 5
seg. Si fuera necesario una 3 dosis administrandto 20 mg. seguidos
de 20 ml. de SSF. Tambin en menos de 5 seg.
-Pediatra: DI. iv. 0,05-0,1 mg./kg. en bolo. Si no responde a los 2
minutos doblar dosis y si fuese preciso una 3 dosis de 0,2-0,4 mg./kg.
Dmx.=12 mg. (No usar en RN. o neonatos.)
4.- CONTRAINDICACIONES:
-Absolutas: -Asma, -Insuficiencia Renal, -Trat. con Digoxina, -Bloqueo
AV de 2 o 3 grado. Enf. del Seno (excepto portadores de
Marcapasos.) -Relativas: -EPOC, -Insuficiencia coronaria, -Aumento de
la PIC.
5.- OBSERVACIONES:
En caso de sobredosis administrar Aminofilina iv., 1 amp. directa (en
adultos). -En Embarazo: en ausencia de pruebas de inocuidad, no
administar a no ser que sea indispensable. -En Lactancia: Evitaqr.

GUA FARMACOLGICA

DI: vo. 100 ml./h. (La duracin depende del estado clnico y la
tolerancia) (Preparacin: 10 gr. en 1000 ml. de agua.)
4.- CONTRAINDICACIONES:
No administrar si hay riesgo de aspiracin
5.- OBSERVACIONES:
El Agua albuminosa tambin se puede obtener batiendo 4 a 6 claras
de huevo en 1 litro de agua. En Embarazo y Lactancia: sin datos
encontrados que lo contraindiquen.

15-AGUA GEL
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Water-jel, Burnaid Gel, BurnFree, BurnShield (Gasas impregnadas de
Agua gel desde gasas a mantas)
2.- INDICACIONES
Quemaduras
3.- POSOLOGA
Colocar sobre toda la superficie quemada
4.- CONTRAINDICACIONES
Hipotermia
5.- OBSERVACIONES
Para fijarlas al cuerpo se puede envolver en vendas y manta
metlizada. Se puede utilizar en Embarazo y Lactancia sin estudios
que lo contradigan.

13-ADRENALINA O EPINEFRINA

16-ALCOHOL ETLICO O ETANOL

1.- NOMBRES COMERCIALES Y PRESENTACIONES:

Adrenalina Braun, Adrenalina Level amp. de 1 m./1 ml. (1/1000) o
jeringa precargada de 1 mg./1 ml. al 1/1000.
2.- INDICACIONES:
-Primer frmaco en PCR (FV, TVSP, AESP y asistolia) y Shock
Anafilctico. -Bloqueo cardiaco, -Broncoespasmo, -Hipotensin grave,
-Shock cardiognico, -Espasmo larngeo, -Hemorragias
3.- POSOLOGA:
-Adultos: en PCR: DI. iv. 1 mg. o 1 m. cada 3-5 min. seguido de 20 ml
de SSF. con elevacin del brazo cuando se administre por va perifrica
(si falla iv., usar viO, .Si falla esta ltima se administra por TET, 3 mg.
disueltos en 10 ml. de SSF. En Anafilaxia y Broncoespasmo: DI. iv. 0,51 mg. en bolo. o sc.(Preparacin: diluir la amp. en 9 ml. de SSF. e ir
administrando dosis segn respuesta). En Broncoespasmo: Adultos y
nios >4 aos: (Preparacin: mezclar 0,5 ml adrenalina con 3 ml. de
SSF. o Agua Destilada) y administrarla en 15 min./3-4 h. En
Bradicardia: DI. iv. 2-10 mcg./min. (Preparacin: 2 mg. en 250 ml.
SG5% a 15-75 ml./h.)
-Peditrica: En RCP. DI. Iv. 0,01 mg./kg. (Preparacin: 1 mg. en en SSF.
hasta 10 ml. (1 ml.=0,1 mg). De esta preparacin coger 1 mi. y volverlo
a diluir en SSF. hasta 10 ml. (1 m.=0,01 mg.) dando 1 ml./kg.) En dosis
sucesivas dar 0,1 mg./kg. cada 3 min. sin diluir (0,1 ml./Kg.= 0,1
mg./Kg.). Dmx. 5 mg. En Anafilaxia y Broncoespasmo: DI: im. o sc.
0,01 mg./Kg. sin diluir. Se puede repetir hasta 3 veces cada 15 min.
Dmx. 0,35mg. En Crup Severo: DI: Nebulizado: 0,5 mg./Kg. en 10 ml.
de SSF. en nebulizacin. Se puede repetir cada 30 min. hasta un
mximo de 3 dosis.
4.- CONTRAINDICACIONES:
-En situaciones de emergencia no hay contraindicaciones absolutas. Hipersensibilidad a los simpaticomimticos, -HTA, -Hipertiroidismo, Diabetes, -Taquicardia y -Neurosis.
5.- OBSERVACIONES:
-Fotosensible. -No mezclar con soluciones alcalinas porque se
inactiva. -Precipita con el Calcio. -Evitar extravasacin (provoca
isquemia y necrosis tisular). -Embarazo: Categora C. -En Lactancia: se
excreta por la leche, usar con precaucin.

1.- NOMBRES COMERCIALES Y PRESENTACIONES:

Alcohol Etlico 70 y 96 (Envases de 100, 250, 500 y 1000 ml.)
2.- INDICACIONES:
-Antisepsia de piel sana para la administracin de inyecciones.
Antisepsia general (pero no destruye esporas ). Intoxicaciones de:
Metanol, Etilenglicol, Dietilenglicol. -Antagonista del efecto
antidiurtico de los opiceos y derivados.
3.- POSOLOGA:
Antisepsia: (Alcohol 70): Va Tpica: Aplicar sobre la zona a limpiar o
desinfectar, dejando secar.
Intoxicaciones: (Alcohol 96) (Preparacin para vo. diluir 50 ml de
Alcohol 96 en 50 ml. de SG. o Zumo de frutas. DI: vo. 0,75 ml./kg.
(Otros Aut. 0,8-1,0 ml./kg. de etanol al 96%) seguido de 0,50 ml./kg./4
h. el 1 da (Preparacin: Si es vo. diluir con dextrosa o jugo de frutas
en la misma cantidad de etanol)) Preparacin para va iv. diluir 25 ml.
de alcohol 96 en SG. hasta 250 ml. DI: iv. 7,6 - 10 ml./kg. de etanol
10% administrar en 15-30 minutos. DM.: iv. 5 ml./kg./4 h. con etanol
al 10%.
4.- CONTRAINDICACIONES:
-En heridas abiertas, desinfeccin de material quirrgico.
-En iv., cuidado en hipoglucemia, Deshidratacin y Acidosis Metablica
5.- OBSERVACIONES:
-Se inactiva en presencia de materia orgnica. -En Trat. iv. tras 1 da
se seuele cambiar a la va oral. -El paciente es emborrachado y puede
entrar en delirios, siendo necesario trat. sintomtico. En Embarazo
y Lactancia: no se encuentran datos que contradigan su uso.

14-AGUA ALBUMINOSA o ALBMINA SECA

1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Agua Albuminosa. Sobres 10 gr. Albmina desecada
2.- INDICACIONES:
Intoxicacin o ingesta de productos custicos
3.- POSOLOGA:

918

17-ALMIDN
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Almidn (sobres de 10 gr.)
2.- INDICACIONES:
Intoxicacin por Yodo o derivados ingeridos
3.- POSOLOGA:
Preparacin: 80 gr. de Almidn en 1 litro de agua. DI: vo. dar 1 litro.
Lavado gstrico. (Otra Preparacin: 15 gr. de Almidn de Maz o
harina en 500 ml. de agua )
4.- CONTRAINDICACIONES:
Paciente Inconsciente
5.- OBSERVACIONES:
-En Embarazo: sin datos. En Lactancia sin datos.

URGENCIAS Y EMERGENCIAS EXTRAHOSPITALARIAS GUETS - SESCAM

18-ALPRAZOLAM
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Trankimazn (Compr. 0,50, 0,75, 1,00 y 2,00 mg.)(Sol. Gotas 0,75
mg./ml.)
2.- INDICACIONES:
-Ansiedad generalizada. -Ansiedad por Depresin, -Trastornos de
Angustia con o sin Agorofobia, -Neurosis de Ansiedad, -Crisis de
Pnico.
3.- POSOLOGA:
Adultos: -Ansiedad asociada o no a sntomas de depresin: DI: vo.
0,25-0,50 mg./8 h.; -Trastornos de Angustia. DI: vo. 0,50-1,00 mg./24
h. al acostarse. (Dmx.=10 mg./da) (0,2 mg./kg./da)
Ancianos: En Trastorno de Angustia: DI. vo. 0,25 mg. /8 h.
4.- CONTRAINDICACIONES
-Miastenia Grave. -Insuficiencia Respiratoria Grave. -Sndrome de
Apnea de Sueo. -Insuficiencia Heptica grave.
5.- OBSERVACIONES
-Puede crear dependencia fsica y psquica. -En Trat. a largo plazo,
deben suspender el Trat. lentamente. -Si hay sobredosis en la ingesta:
(Lavado gstrico, Carbn Activo y Flumazenilo). -En Embarazo:
Categora D. En Lactancia: Evitar.

19-ALTEPLASA (RTPA)
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Actilyse, (Vial: 10 mg.; 20 mg.; 50 mg.)(1 mg. = 580.000 UI.)
2.- INDICACIONES
-IAM, -Especialmente indicado en IAM extenso y/o anterior, en <75
aos, con 4-6 horas de evolucin y cuando est contraindicada la
estreptoquinasa. -En ACV isqumico (Trat. Si los sntomas empezaron
hace menos de 3 horas). Embolia Pulmonar o TEP.
3.- POSOLOGA
-Preparacin: Disolver los viales en Agua para inyectable hasta
obtener 1 ml.=1 mg. (10 mg./10 ml.)(20 mg./20 ml.)(50 mg./50 ml.) Se
puede despus para infus. disolver en SSF. hasta obtener 1 ml. = 0,2
mg. (10 mg./50 ml.) (20 mg./100 ml.) o (50 mg./250 ml.).
-IAM antes de 6h. inicio sntomas.: DI. iv. 15 mg. iv. en bolo (en 2
min.) seguido de 50 mg. ( 0,75 mg./kg.) en infus. en 30 min. y
despus 35 mg. ( 0,50 mg./kg.) en infus. iv. en 60 min. (hasta una
Dmx. de 100 mg.). (Dmx en <65 kg. = 1,5 mg./kg.)
-IAM entre 6 h. a 12 h. inicio sntomas.: DI. iv. 10 mg. iv. en bolo (en 2
min.) seguido de 50 mg. ( 0,75 mg./kg.) en infus. en 60 min. y
despus 10 mg. ( 0,16 mg./kg.) en infus. iv. cada 30 min. (hasta una
Dmx. de 100 mg.) o hasta 3 h.. (Dmx en <65 kg.=1,5 mg./kg.) Embolia pulmonar o TEP.: DI: iv. 10 mg. en bolo (en 1-2 min.) seguidos
de 90 mg. en infus. iv. durante 2 h. -ACVA isqumico: DI: iv. 0,09
mg./kg. en bolo. Seguido de Infus. 0,81 mg./kg. en 60 min. No Trat.
con AAS. ni Heparina.
4.- CONTRAINDICACIONES:
-Alergia a la Tecneteplasa, -Trastorno hemorrgico significativo actual
o durante los ltimos 6 meses. -Ditesis hemorrgica conocida. Pacientes que reciben anticoagulantes orales, p.ej. warfarina de sodio.
-Hemorragia grave o peligrosa manifiesta o reciente. -Sospecha o
historia conocida de hemorragia intracraneal. -Sospecha de
hemorragia subaracnoidea o trastorno despus de una hemorragia
subaracnoidea por aneurisma. -Cualquier historia de lesin del
sistema nervioso central (es decir, neoplasia, aneurisma, ciruga
intracraneal o espinal). -Masaje cardaco externo traumtico reciente
(menos de 10 das), parto obsttrico reciente, -Puncin reciente de un
vaso sanguneo no comprimible (p.ej. puncin de la vena yugular o
subclavia). -HTA grave no controlada. -Endocarditis bacteriana,
pericarditis. -Pancreatitis aguda. -Enf. Gastrointestinal Ulcerativa
documentada durante los ltimos 3 meses. -Varices Esofgicas, Aneurismas arteriales. -Malformaciones venosas/arteriales. -Neoplasia
con riesgo de hemorragia aumentado. Enf. Heptica grave
(incluyendo: Insuficiencia heptica, Cirrosis, Hipertensin portal y
Hepatitis activas.). -Ciruga mayor o traumatismo importante en los
ltimos 3 meses
5.- OBSERVACIONES:
-No mezclar con SG. -En el Embarazo: Categora C, no usar a no ser
que no existan alternativas teraputicas ms seguras. -Peditrica: No
ha sido establecida la seguridad y eficacia -En caso de intoxicacin o

GUA FARMACOLGICA

Sobredosis Trat. con Plasma Fresco Congelado o sangre. -En

Lactancia: Usar cpn prudencia

20-AMINOFILINA O TEOFILINA
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Eufilina venosa, Amp. 240 mg./10 ml. (equivalente a 196,3 mg. de
Teofilina).(1 ml.= 24 mg. Eufilina) o (1 ml.=19,63 mg. Teofilina)
2.- INDICACIONES
-Broncoespasmo (Asma Bronquial, Bronquitis crnica o Enfisema),
Apnea neonatal, -EAP. ICC. -EPOC.
3.- POSOLOGA
-Adultos: Si el paciente no ha tomado teofilinas en las ltimas 24 h.,
DI.: iv. 5-6 mg. (Eufilina) o 4-5 mg. (Teofilina) /Kg. o 0,21 a 0,25
ml./kg. en 20 o 30 min. (Preparacin: DI. en SFF. hasta 100 ml. a pasar
entre 300 a 200 ml./h.) DM.: Iv. 0,5-0,7 mg./Kg./h. (Preparacin: DM.
en SFF hasta 100 ml. (0,21 a 0,29 ml./kg./h.) durante 2 h. (Total dosis
para 2 h. = 0,42 a 0,58 ml./kg. o 1,0-1,4 mg./kg.)) -Si el paciente
tomaba Teofilina, o es >60 aos o tiene ICC o Insuf. Heptica. DI. iv. y
DM. iv. La mitad de la dosis que el caso anterior.
-Peditrica: Nios <5 kg. DI.: iv. de 25 mg. en 30 min. y DM: iv. 2,53,5 mg./h.; 5-10 kg. DI.: iv. 50 mg. 30 min. y DM: iv. 5-7 mg./h.; 10-15
kg. DI: iv. 75 mg 30 min y DM: iv. 7,5-10,5 mg/h. Neonatos: DM: iv.
0,13 mg./Kg./h. >2 <6 mes: DM: iv. 0,4 mg./Kg./h. >6 <11 mes: DM.
iv. 0,7 mg./Kg./h.
4.- CONTRAINDICACIONES:
Absolutas: -Hipersensibilidad a la Teofilina, -Insuf. Heptica o renal
avanzada. -Taquiarritmia Aguda. -IAM Reciente.
Relativas: -Glaucoma, -lcera gstrica, -Hipertensin, -Hipertiroidismo,
-Hipoxemia severa.
5.- OBSERVACIONES:
-No dar a una velocidad mayor de 16,5 mg./min.(Teofilina) o 20,17
mg./min. (Eufilina). -En Embarazo categora D, No dar en el 1
trimestre. -Lactancia: Pasa a leche materna, si es posible no dar. -No
tiene antdoto. -Proteger de la Luz. -Administrar siempre diluida.

21-AMIODARONA
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Trangorex . (Amp. 150 mg./3 ml.) (Comp. 200 mg.)
2.- INDICACIONES:
-WPW, -Taquiarritmias Supraventriculares y Ventriculares. - en RCP
cuando no ha revertido con otros medicamentos.
3.- POSOLOGA:
-Adultos: DI: iv. 5 mg./kg. 0,1 ml./kg. diluido en 20 ml. de SG. en 3-5
min. o Infus. iv. en 100 ml. de SG. en 20 min. (si no revierte con el 1
bolo se puede repetir despus de 15 min.). y (si no revierte con la
infus. iv. se puede repetir 2-3 veces en 24 h.) (No diluir a <0,6
mg./ml.). Si revierte DM: iv. 10-20 mg./kg. cada 24 h.
-Pediatra: DI: iv. 10-15 mg./Kg./da hasta control de la arritmia,
despus reducir a 5 mg,/Kg.,/da. DM: iv. 2,5 mg./Kg./da.
4.- CONTRAINDICACIONES:
-Hipersensibilidad al Yodo o Amiodarona., -Disfuncin sinusal. Bloqueo Sinoauricular, -Enf. del seno, -Bloqueo AV de 2 y 3 grado. Alteraciones Tiroideas.
5.- OBSERVACIONES:
-No conservar a Temp. >25C. -Preservar de la luz. -Evitar la
extravasacin. -No mezclar con otros frmacos. -No diluir con SSF. -No
usar recipientes de suero de PVC. En Embarazo, categora C utilizar
solo en caso de arritmias graves refractarias. -No dar en Lactancia.

22-AMOXICILINA (con Ac. Clavulnico)

1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Augmentine,, Amoxiclav, Amoxiplus (Amoxicilina / Clavulnico = 500
mg./50 mg.; 1 g./200 mg.; 2 g./200 mg.)
2.- INDICACIONES:
Infecciones del tracto respiratorio superior: Sinusitis, Otitis media,
Amigdalitis recurrente. Infecciones del tracto respiratorio inferior,
exacerbaciones agudas de bronquitis crnicas, bronconeumona.
Infecciones del tracto genito-urinario e infecciones abdominales,

919

URGENCIAS Y EMERGENCIAS EXTRAHOSPITALARIAS GUETS - SESCAM

Cistitis, Aborto sptico, Sepsis plvica o puerperal, Sepsis intraabdominal y Peritonitis. Infecciones de la piel y tejidos blandos,
Celulitis, Mordeduras de animales y Abscesos Dentales con celulitis
diseminada. Septicemia. Infecciones postquirrgicas. Profilaxis frente
a infecciones asociadas a ciruga mayor, como gastro-intestinal,
plvica, de cabeza y cuello, cardiaca, renal, prtesis articulares y
ciruga del tracto biliar.
3.- POSOLOGA:
-Adultos: DI. iv. bolo lento 1g./200 mg. (Preparacin Vial en 20 ml. de
SFF.). En Septicemia e Infecciones graves Dmx./da = 6 g. a 12
g./1200 mg.
-Peditricas: Prematuros. DI: iv. 50 mg./Kg./12 h.;
RN. y Lactantes <3 mes (>2,5 <5 kg.): DI. iv. 50 mg./Kg./8-12 h. Nios y
Lactantes >3 mes (>5 <40 Kg.): DI. iv. 25-50 mg./Kg./6 h.
4.- CONTRAINDICACIONES:
-Alrgicos a Penicilina o Cefalosporina. -Leucemia Linfoide. Precaucin en Mononucleosis Infecciosa, -Insuficiencia Heptica
5.- OBSERVACIONES:
-Proteger de la Luz. -Puede Administrarse en la lactancia. -Evitar en el
1 trimestre de Embarazo.

23-AMPICILINA:
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Ampicilina; Britapen; Gobemicina, Nuvapen, (Vial. 250, 500, 1000 mg.)
2.- INDICACIONES:
Antibitico B-Lactmico Bactericida. Grmenes ms sensibles:
Haemophilus, Escherichia Coli, Proteus, Salmonella, Shigella. Sepsis
del Sistema Nervioso Central
3.- POSOLOGA:
-Adultos: Infecciones Graves: DI: iv. 2-4 gr./4-6 h. (En infecciones no
graves: DI: iv. 500 mg./6 h.). Meningitis (H. Influenzae, S. Neumoniae,
N. Meningitidis): DI: iv. 150-200 mg./Kg./da (Repartidas cada 4-6 h.).
(Preparacin: DI. en 50-100 ml. de SSF. (peor con SG) administrar en
15 a 20 min.) a 200-300 ml./h.
-Peditrcas: DI: iv. <7 das y <2 kg.= 75-200 mg./kg./da cada 12 h.; <7
das y >2 kg.= 75-200 mg./kg./da cada 8h.; >7 das y <2 kg.= 100-300
mg./kg./da cada 8 h.; >7 das y <2 kg.= 100-300 mg./kg./da cada 6 h.;
Lactantes y nios= 100-400 mg./kg./da cada 4-6 h. (o bien nios 1-3
aos= 125 mg. cada 6 h.; nios de 3-6 aos= 250 mg. cada 6 h.)
4.- CONTRAINDICACIONES:
-Hipersensibilidad a las penicilinas. -Mononucleosis infecciosa.
5.- OBSERVACIONES:
-No asociar con Alopurinol, -No administrar conjuntamente con
Antibiticos Basteriostticos. En Embarazo: Categora B, -En
Lactancia: Usar con precaucin.

24-AMRINONA:
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Wincoram, Inocor (Amp.: 5 mg./ml.; 100 mg./20 ml.)
2.- INDICACIONES:
-Intoxicacin grave por bloqueadores de los canales de calcio. Insuf. Cardiaca Aguda o Crnica Refractaria. -Hipertensin pulmonar.
3.- POSOLOGA:
-Adultos: DI: iv. 0,75 mg./Kg. o 0,15 ml./kg. en 2-3 min.
DM: infus. iv. 5-10 mcg./Kg./min. o 0,3-0,6 ml./kg./h. (Preparacin:
100 mg. en SSF. hasta 100 ml. (1 m.=1 mg.))
(Se puede repetir la DI. a los 30 min. de iniciada la perfusin.)
Dmx./da: 10 mg./kg./24 h.
-Peditrcas: DI.: iv. 1-4,5 mg./kg. o 0,2-0,9 ml./kg. en 30 min.
(Preparacin DI. en SSF. hasta 100 ml. a 200 ml./h.
DM: infus. iv. 3-5 mcg./Kg./min o 0,18-0,3 ml./kg./h. (Preparacin: 50
mg. en SSF hasta 50 ml. (1 mg.= 1 ml.)).
4.- CONTRAINDICACIONES:
-Hipersensibilidad a Bisul tos. No mezclar con Disopiramida,
Furosemida o Bicarbonato.
5.- OBSERVACIONES:
-No diluir en SG. En Embarazo: Categora C: -En Lactancia usar con
cautela, no hay estudios que evidencien su excresin en la leche.

920

GUA FARMACOLGICA

25-ANTICUERPOS ANTIDIGOXINA
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Digibind, FAB-Antidigoxina, Digoxin Immune Fab, (Vial 38 mg. se unen
a 0,5 mg. de Digoxina) Digitalis Antidot Roche (Vial 80 mg.).
2.- INDICACIONES:
-Intoxicacin por Digoxina, (>0,1 mg./kg. en nios (o >4 mg.), >10 mg.
en Adulto); Digitoxina, Hojas de Adelfas y otras plantas con D. Lanata
(Tambin en Hiperpotasemia por Intox. Digoxina).
3.- POSOLOGA:
Adultos: DI. iv. dosis calculada a pasar en 20 a 30 min.
Cmo calcular la dosis?.: Dosis de Digoxina ingerida en mg. x 0,8; el
resultado se x 2, y este a su vez x 38. Si no se sabe la dosis ingerida se
administra 380 mg. Preparacin: Diluir cada vial en 4 ml. de agua
estril y apirgena (la estabilidad del vial reconstituido es de 4 h. entre
2-8C). Seguidamente diluir en SSF. hasta 100 ml. la pasar a 300-200
ml./h. en 30 min. El efecto del trat. se observar en unos 60 min. La
inyeccin iv. directa sin disolver en 100 ml. de SSF. solo se recomienda
en caso de parada cardiaca. En Ancianos: Dmx: 80-120 mg.
4.- CONTRAINDICACIONES:
Alergias a las protenas de oveja
5.- OBSERVACIONES:
Debe conservarse en nevera (Sin datos con respecto al Embarazo y
Lactancia.)

26-APOMORFINA
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Apo go pen, Apokinon, Apomorfina Archmedes (Amp. 10 mg./ml.).
2.- INDICACIONES:
-En Intoxicaciones generales como emtico, (Provoca vmitos en
pocos min.). (En Emergencias). Enf. de Parkinson, -Disfuncin Erctil,
3.- POSOLOGA:
En Intoxicaciones: -Adultos DI: im. o sc. 100 mcg./kg.=0,01 ml./kg. Peditrica: DI: im. o sc. 70 mcg./kg.=0,007 ml./kg.
4.- CONTRAINDICACIONES:
-Angina severa inestable, -IAM reciente- -Insuficiencia Cardiaca
Severa, -Hipotensin. -Depresin Respiratoria
5.- OBSERVACIONES:
Antdoto: La Emesis producida por la apomorfina, pueden revertirse
con un antagonista opiceo como la naloxona (a dosis 0,01 mg./kg. va
sc. o 1/3 de la dosis administrada de Apomorfina). En Embarazo:
Categora C. En Lactancia: Evitar

27-ATENOLOL
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Tenormn, Atenolol, Blokium, Kalten, Naetenol, tenoretic, Tanser
(Amp. 5 mg./10 ml.) (Comp. 50 mg y 100mg.)
2.- INDICACIONES:
-Arritmias cardiacas, -IAM, -HTA.
3.- POSOLOGA:
-Adultos: Arritmias: DI: iv. 35,71 mcg./kg. o 0,071 ml./kg. en 2-3 min.
-Repetir la misma dosis cada 5 min. hasta respuesta adecuada o hasta
un mximo total de 10 mg. o en infus. iv. 0,15 mg./kg. o 0,3 ml./kg. en
20 min. (Preparacin: DI en SSF. hasta 100 ml. a 300 ml./h.)
IAM: Dentro de las 12 horas siguientes al inicio del dolor torcico. DI:
iv. 0,071-0,142 mg./kg. o 0,24-0,48 ml./kg. en 2 a 3 min. -Seguidos a
los 15 -60 min. de 50 mg vo.
-Peditrica: No se recomienda su empleo. (Apenas experiencia.).
(OtrAut: DI: iv. 0,7-1,4 mg./kg./da. repartidos en 1 2 dosis. Dmx: 2
mg/kg./da.)
4.- CONTRAINDICACIONES:
-Bradicardia. -Shock cardiognico,. Hipotensin. -Acidosis metablica.
-Hipersensibilidad conocida al frmaco. Trastornos graves de la
circulacin arterial perifrica. B.AV. 2 o 3. Sndr. del Seno. Feocromocitoma no tratado. -Insuficiencia cardiaca no controlada.
5.- OBSERVACIONES:
No utilizar va im. o sc. Embarazo Categora D. Lactancia se acumula
en la leche, precaucin.

URGENCIAS Y EMERGENCIAS EXTRAHOSPITALARIAS GUETS - SESCAM

28-ATOSIBAN
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Tractocile (Amp. 37,5 mg./5 ml. (7,5 mg./ml.))
2.- INDICACIONES:
Amenaza Parto Prematuro. (Tocoltico).
3.- POSOLOGA:
DI: iv. 6,75 mg.=0,9 ml. en 1 min. Seguir con una infus. iv. 18 mg./h.
durante 3 h. a 24 ml./h. y finalmente 6 mg./h. durante 45 h. a 8 ml./h.
(Preparacin: 2 amp. o 75 mg. en SFF. SG. o S.Ringer en 100 ml. (75
mg./100 ml.=0,75 mg./ml.)
4.- CONTRAINDICACIONES:
-Hipersensibilidad, -Edad gestacional <24 >33 sem. - Rotura
prematura de membranas despus de 30 semanas de gestacin. Frecuencia cardiaca fetal anormal; -Hemorragia uterina preparto. Eclampsia y preeclampsia grave. -Muerte intrauterina del feto. Sospecha de infeccin intrauterina. -Placenta previa; Abruptio
Placenta. -Cualquier otra condicin de la madre o feto por lo que el
embarazo sea peligroso.
5.- OBSERVACIONES:
Puede provocar Hiperglucemias, e irritacin en el lugar de la
inyeccin. Conservar en nevera 2 a 8C

29-ATRACURIO (Besilato de)

1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Tracrium, Besilato de atracurio Inibsa, Laurak (Amp. 25 mg./2,5 ml. y
50 mg./5 ml. (10 mg./ml.))
2.- INDICACIONES:
-Relajacin msculos esquelticos en Anestesia General, -Intubacin
endotraqueal, -Ventilacin Mecnica, -Ciruga. til si la funcin
heptica y renal est alterada.
3.- POSOLOGA:
-Adultos: DI: iv. 0,3-0,6 mg./Kg. o 0,03-0,06 ml./kg. en bolo. Se puede
repetir cada 30 min. Despus de 30-40 min. de la induccin, DM.
Infus. iv. 0,4 mg./Kg./h. (Preparacin: 100 mg. o 2 amp. en SFF. hasta
100 ml. (1 mg./1 ml.) a 0,4 ml./kg./h.)
-Peditrica: La dosis para nios mayores de 1 mes es igual que la de
adultos, en base al peso corporal.
4.- CONTRAINDICACIONES:
Hipersensibilidad al frmaco, precaucin en EPOC y en pacientes con
disfunciones neuromusculares: (Miastenia Gravis, Sndrome de EatonLambert). -En quemados pueden desarrollar resistencias a este
frmaco.
5.- OBSERVACIONES:
-Almacenar entre 2-8C. no congelar. -Proteger de la luz.
-No mezclar en la misma jeringa con otros agentes alcalinos. Categora C en el embarazo. Antcodo: En caso de intoxicacin:
Revertir con Neostigmina o Edrofonio + Atropina

GUA FARMACOLGICA

Bradicardia sintomtica y en arritmia post-infarto. DI: iv. 0,5-1 mg.

cada 3-5 min. (0,01-0,03 mg./Kg., sin superar los 0,04 mg./kg.) (Posible
repetir cada 4-6 horas.). -Intoxicacin por organofosforados. DI: iv. o
im. 1-2 mg. como dosis de prueba, si la intoxicacin es leve o aparecen
signos de atropinacin, no dar mas. Si prosigue la intoxicacin y no
hay atropinacin, seguir con 2-4 mg iv. cada 10-15 min. -Hasta la
desaparicin de sntomas muscarnicos. -Si no cesa la sintomatologa.
DM: Infus. iv. 0,02-0,08 mg./kg./h. Preparacin: Dosis en SFF. hasta
100 ml. a 50 ml./h. -Antdoto de inhibidores de la colinesterasa. DI:
iv. 2-4 mg. y continuar con 2 mg. iv. cada 5-10 min. -Antdoto en
intoxicaciones muscarnicas. DI: iv. o im. o sc. 0,3-1,2 mg./4-6 h.
Preanestesia. DI: iv. 0,5 mg.
-Pediatrico: Preanestesia. DI: iv. o im. o sc. 0,01-0,02 mg/Kg.
(Preparacin diluir 1 mg. 1 ml. en SFF, hasta 10 ml.). -RCP. DI: iv. bolo
0,02-0,05 mg./kg. repetir cada 5 min.
(Preparacin: Diluir 1 mg. o 1 ml. en SFF. hasta 10 ml. (0,1 mg. = 1 ml.)
administrar 0,1 ml./kg. de esta dilucin. (Dosis mnima: 0,1 mg.)
(Dmx. en nios 0,5 mg. en Adolescentes 1 mg.). -Bloqueo vagal y
Antimuscarnico: DI. iv. 0,01 mg./kg. (Dmx. 0,4 mg./4-6h.). Intoxicacin por organofosforados: En <12 aos. DI: iv. 0,02-0,05
mg./Kg. cada 10-20 min. durante 1 hora hasta que aparezcan signos de
atropinizacin
4.- CONTRAINDICACIONES:
-Bloqueo AV infranodal (Movitz II), -Bloqueo AV 3er grado, Glaucoma
de ngulo estrecho, -Taquicardia, -IAM, Cardiopatia isqumica.
Precaucin en: (-Bradicardia hipotrmica y otras causas no vagales de
bradicardia, -Asma bronquial, -Miastenia gravis.)
5.- OBSERVACIONES:
Embarazo: Categora C. Lactacia: Se excreta por leche materna.
Precaucin en Insuficiencia cardiaca, heptica y renal.

31-BIPERIDENO
1.- NOMBRE COMERCIAL Y PRESENTACION:
Akinetn. (Amp. 5 mg./ml.) (Comp. 2 mg. y 4 mg.)
2.- INDICACIONES:
-Sntomas Extrapiramidales inducidos por frmacos (Metoclopramida
o Primperan). Enf. Parkinson. (Trat. crnico)
3.- POSOLOGIA:
-Adultos:(Preparacin: 5 mg. en SSF. hasta 10 ml. (0,5 mg. = 1 ml.) DI:
iv. lenta 2 mg. o 4 ml., cada 30 min. Dmx: 8 mg./24 h. (En Enf.
Parkinson DI: vo. 1-2 mg./ 8-12 h.)
-Peditrca: No recomendado, pero si es necesario: (Preparacin: 5
mg. en SSF. hasta 10 ml. (0,5 mg. = 1 ml.)) DI: iv. lento 0,04-0,1 mg./kg.
o 0,08-0,2 ml./kg., repetible cada 30 min. Dmx: 3 veces la DI.
4.- CONTRAINDICACIONES:
-Obstruccin intestinal, -Miastenia Gravis, -Glaucoma de Angulo
cerrado, -Retencin urinaria.
5.- OBSERVACIONES:
-Embarazo: Categora C. Lactancia: Puede inhibir la lactancia. -Foto y
Termosensible (15-30C).

30-ATROPINA
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Atropina (Braum, Sulf Serra palies.) (Amp. 1mg./1 ml.; 0,5 mg./1 ml.)
2.- INDICACIONES:
-Asistolia ventricular (IIb) y AESP con ritmo bradicrdico ( IIb). Bradicardia sinusal sintomtica (clase I), -Bradicardia relativa. Bloqueo AV nodal (clase IIa). -Hipotensin sintomtica. -Arritmia
postinfarto. -Antdoto en intoxicacin por Organofosforados y otros
inhibidores de la Colinesterasa ( Carbamatos), frmacos
Parasimpaticomimticos ( Fisostigmina, Pilocarpina) y Setas venenosas
que produzcan Sndr. Muscarnico ( Amanita Muscaria ), Sustancias
colinrgicas en general.
-Induccin en anestesia general. -Prevencin y tratamiento de la
Bradicardia por estmulo vagal durante la IOT. -Inhibidor de las
secreciones del tracto respiratorio. Sndr. del Intestino Irritable. Espasmos abdominales ( del tracto biliar, clico ureteral o renal,
dismenorrea...)
3.- POSOLOGIA:
Adultos: -Asistolia. DI: iv. en bolo 3 mg. o 0,04 mg./kg. en el 1 ciclo
de RCP. (Va TET: 3 mg. + 10 ml. SFF.) -AESP con ritmo ECG lento (< 60
lpm), DI: iv. 1 mg. cada 3-5 min. hasta un total de 0,04 mg./kg. -

32-BIVALIRUDINA
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Angiox, Angiomax, (Vial 250 mg.)
2.- INDICACIONES:
-IAM que se someten a Coronariografa-Angioplastia
(Coadyuvante con AAS y Clopidogrel). -Angina Inestable. IAM sin
elevacin ST.
3.- POSOLOGA:
(Preparacin: 250 mg. en SFF. hasta 50 ml. (1 ml. = 5 mg.)).
-Durante la Intervencin coronario percutanea (ICP). DI: iv. en bolo
0,75 mg./kg. o 0,15 ml./kg.; Seguido de DM: iv. 1,75 mg./kg./h. o 0,35
ml./kg./h. mientras dure la intervencin, incluso hasta 4 h. despus.
-Angina Inestable o IAM sin elevacin ST. DI: iv. en bolo 0,1 mg./kg. o
0,02 ml./kg.; Seguido de DM: iv. 0,25 mg./kg./h. o 0,05 ml./kg./h.
(hasta 72 h.). (Si se le hace ICP, dar un bolo adicional de 0,5 mg./kg.
antes de la ICP, y 1,75 mg./kg./h. mientras dure la intervencin)
Peditrca: No hay indicacin relevante en <18 aos
4.- CONTRAINDICACIONES:
-IR. severa y Dilisis. -Hemorragia Activa. -HTA grave. -Endocarditis

921

URGENCIAS Y EMERGENCIAS EXTRAHOSPITALARIAS GUETS - SESCAM

Bacteriana Subaguda.
5.- OBSERVACIONES:
-No administrar im. -Al disolver el Vial, debe quedar en 5 mg./ml. -No
tiene antdoto, pero su efecto desaparece en 35 a 40 min. -No debe
administrarse en Embarazadas.

33-BRETILIO
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Bretilate (Amp. 500 mg./10 ml. (1 ml = 50 mg))
2.- INDICACIONES:
-Arritmias Ventriculares Recurrentes (FV) y refractarias a otros Trat
incluida la cardioversin elctrica. (No recomendado por la AHA)
3.- POSOLOGIA:
DI: 1 dosis iv. sin diluir. en bolo 5 mg./Kg. o 0,1 ml./kg. en 1 min. Si
no responde a los 5 min. dar una 2 dosis (repeticin de 1 dosis). Si
no responde dar una 3 dosis pero a 10 mg./kg. o 0,2 ml./kg. Si no
responde dar una 4 dosis a 10 mg./kg. o 0,2 ml./kg. (No superar un
total de 30 mg./kg.).
DM.: Preparacin: 0,84 a 6,84 mg./kg. o 0,016 a 0,136 ml./ kg. en SSF.
SG. hasta 100 ml. a pasar en 2 h. a 50 ml./h.
4.- CONTRAINDICACIONES:
-Estenosis Artica, -Hipertensin pulmonar severa, - Disminucin del
gasto cardaco, -Arritmias secundarias a Intoxicacin Digitlica, -IAM
reciente, -Hipotensin, -Bradicardia, -Bloqueo AV.
5.- OBSERVACIONES:
-Precaucin en IR y Insuf. Heptica. -Fotosensible. En Pediatra no est
indicado actualmente. -Embarazo: Categora C (slo si no hay otra
alternativa). -Lactancia: No recomendado

34-BUDESONIDA
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Pulmicort, Miflonide, Novopulm Novolizer, Olfex Bucal, Pulmictan,
Ribujet. (Susp. para Nebul. amp. 0,5 mg. y 1mg./2 ml.,) (Aerosol 2
mg./inh. 0,05 mg./inh.) (Turbuhaler polvo para inh. 100-200-400
mcg./dosis.)
2.- INDICACIONES:
-Asma Bronquial moderado y grave. -Broncoespasmo secundario a
inhalacin de txicos, -EPOC moderado-severo, -Laringitis aguda.
3.- POSOLOGIA:
Adultos: -Asma: DI: Nebu. 1- 2 mg. (0,50 mg./ml.) 2 a 4 ml. cada 12 h.
(Preparacin: DI + SSF hasta 5 ml, en la canuleta del aerosol. Dar Aire
comprimido u O2 a 6-8 l./min. durante 4-8 min.) DI: con Cmara
turbuhaler: -Sin Trat. corticoideo oral previo: 200-400 mcg./24h. o
100-400 mcg./12h. -Con Trat. corticoideo oral previo: 400-800
mcg/24h. Dmx: 1600 mcg./da ( 2000mcg./da segn la SEPAR). DI:
con Aerosol (mejor con cmaras espaciadoras, repartidos en 2-4 dosis)
200-1600 mcg./da (llegando a 2000 mcg./da segn la SEPAR) -Nota:
cuando la dosis de mantenimiento para controlar los sntomas supera
los 1000 mcg/da la SEPAR aconseja asociar beta-2-agonistas de larga
duracin.
-EPOC: DI: 400 mcg./12 h, preferiblemente en forma de polvo seco
(turbuhaler), -Laringitis aguda: DI: Nebu. 2 mg. 4 ml. sin diluir, con
O2 a 6 l./min. -Broncoespasmo secundario a inhalacin de amonaco:
DI: Nebu. Primero con con 6 ml. de bicarbonato 1 Molar + 4 ml de SSF.
Despus dar dosis de Budesonida igual que en el Asma.
(No debe mezclarse en la misma cazoleta).
Peditrica: -Asma: >2 aos. DI: con Nebu. 0,5-1 mg. 1 a 2 ml. cada
12 h. (Preparacin: DI + SSF hasta 5 ml, en la canuleta del aerosol. Dar
Aire comprimido u O2 a 6-8 l./min. durante 4-8 min.). > 6 aos. DI:
con Camara Turbohaler: -Sin Tto. corticoideo oral previo: 100-200
mcg./12 h. -Con Tto. corticoideo oral previo: 200-400 mcg./12 h.
(Dmx.: 800 mcg./da). DI: con Aerosol (mejor con cmaras
espaciadoras, repartidos en 2-4 dosis). En >2 <6 aos: (100) 200-400
mcg./da; En >6 aos: 200-800 mcg./da. (Nota: en pediatra se
prefieren corticoides de menor potencia como la Beclometasona).
4.- CONTRAINDICACIONES:
Relativas: -Tuberculosis Pulmonar Activa, -Micosis e Infeccin de vas
respiratorias, -Alteracin severa de la funcin heptica.
5.- OBSERVACIONES:
-Embarazo Categora C. -Lactancia: Recomendado suspender lactancia

922

GUA FARMACOLGICA

o el medicamento.

35-BUTIL-ESCOPOLAMINA
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Buscapina (Amp. 20 mg./1 ml.) (Comp. 10 mg.) (Supos. 10 mg.)
2.- INDICACIONES:
Espasmos del tracto gastrointestinal, genitourinario y de las vas
biliares. (Incluye clico Biliar y Renal)
3.- POSOLOGIA:
Adultos (Incluidos >12 aos): DI: iv. im. o sc. 0,3-0,6 mg./kg. (o 0,0150,03 ml./kg.) en 2 min. o en infu. Iv. (Preparacin: DI. en SSF. hasta 100
ml.) a pasar en 5-10 min. a 1200-600 ml./h. Dmx: 100 mg.
Peditrica: Nios y lactantes: DI: igual que en adultos, salvo Dmx:
1,5 mg./kg. (Preparacin: 20 mg. en SSF. hasta 10 ml. (2 mg. = 1 ml.)
por tanto dar 0,15-0,3 ml./kg.).
4.- CONTRAINDICACIONES:
-Glaucoma de ngulo Estrecho, -Hipertrofia Prosttica, -Estenosis
mecnica gastrointestinal, -Miastenia Gravis.
5.- OBSERVACIONES:
-En Embarazo: Utilizar con precaucin sobre todo en primer trimestre. En Lactancia con precaucin, puede inhibir la secrecin lctea. Antdoto: Parasimpaticomimticos.

36-CALCIO, CLORURO
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Cloruro Clcico Braun al 10%; (Amp. 1 g./10 ml.) (1 ml.=100 mg.)
2.- INDICACIONES:
-Hipocalcemia severa. -Intoxicacin por antagonistas del calcio. Hipermagnesemia. Hiperpotasemia. PCR. Por cualquiera de las
indicaciones anteriores.
3.- POSOLOGIA:
-Adultos: DI: infu. Iv. 2-4 mg./Kg. o 0,02-0,04 ml./kg. (Preparacin: DI.
en SSF hasta 100 ml. a 600-1200 ml./h.). Se repetir a los 10 min. si es
necesario. En Intoxicacin por Antagonistas del Calcio: se administrar
1 g. o 10 ml. (Preparacin: 1 g. en 100 ml. a 600 ml./h. en 10 min.)
-Pediatra: DI: Infu. Iv. 20 mg./kg. o 0,2 ml./kg. (Preparacin: DI. en SSF.
hasta 100 ml.) a 300-600 ml./h. en 10 a 20 min.
4.- CONTRAINDICACIONES:
-Hipercalcemia, -Hipercalciuria. -FV, -Insuf. Renal, -Litiasis Clcica.
9.- OBSERVACIONES:
-Necrosis si hay extravasacin. No administrar por va im. ni sc.
Termosensibilidad, -Fotosensibilidad, -No se administrar a una
velocidad >100 mg./min. -No se mezclar con digoxina ni bicarbonato. En Embarazo: Categora A, Se puede utilizar. -Lactancia: sin riesgo

37-CALCIO EDETATO SDICO (EDTA)

1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Calciteracemato Disdico, Complecal, Kedato, Calcioum Edatate de
Sodium Serb (Amp. 935 mg./5 ml. y 500 mg./10 ml.) (Comp. 500 mg.)
2.- INDICACIONES:
Intoxicacin por: (-Plomo, -Zinc, -Cromo, -Nquel, -Magnesio, -Vanadio,
-Plutonio, -Uranio.) -(Saturnismo y Encefalopata por plomo)
3.- POSOLOGA:
-Adultos (Hasta nios > 10 aos): En Intoxicaciones graves: DI: iv.
3,74-5,6 g./da (30-50 mg./kg./da en 2 veces).
En Intoxicaciones medias o ligeras: 0,935-1,87 g./da (Preparacin:
15-25 mg./kg. en SG. hasta 250 ml.)
-Pediatra: Nios (<10 aos): DI: im. o iv. 15-35 mg./kg./da en 2
veces, Dmx: 75 mg./kg./da (Preparacin: DI im. en soluc. al 20 % de
SG. cada 12 h. o DI. iv. en en soluc. 0,2-0,4 % SG. cada 12 h.)
4.- CONTRAINDICACIONES:
-Enf. Renales. -Tuberculosis activa o latente. -Anuria u oliguria severa.
-Precaucin en: -Deshidratacin, -Hipercalcemia.
5.- OBSERVACIONES:
-Incompatibles con soluciones con sales de Calcio. -La teraputica
combinada con Dimercaprol (BAL) es el Trat. de preferencia. -Cada
frmaco se administrar por va im. profunda en lugares separados y
simultneamente. Sin datos encontrados sobre su uso en Embarazo y
Lactancia.

URGENCIAS Y EMERGENCIAS EXTRAHOSPITALARIAS GUETS - SESCAM

GUA FARMACOLGICA

38-CALCIO, GLUCONATO

41-CARBOPROST

1.- NOMBRES COMERCIALES Y PRESENTACIONES:

Calcium Sandoz Suplecal (Amp. 687,5 mg. o 2,3 mEq./5 ml. o 1375 mg.
o 4,6 mEq./10 ml.) (Cada 1 ml.=0,1 mg. Gluconato Calcico = 9,3 mg.
Calcio = 0,46 mEq.)
2.- INDICACIONES:
-Hipocalcemia severa. -Intoxicacin por Antagonistas del Calcio. Dficit Vit. D. Osteomalacia. Osteoporosis. Tetania. Raquitismo. Coadyuvante en tratamiento de:
(-Procesos exudativos,
inflamatorios, y alrgicos.) -Intoxicacin por: (-Pb (Plomo), -Arsnico,
(u otros), -Ac. Oxlico, -Ac. Fluorhdrico. Magnesio.) -Mordedura de la
araa viuda negra. Hipoparatiroidismo. -Dermatitis herpetiforme. Dermatosis
exudativa.
-Prurito
secundario
a
reacciones
farmacolgicas. -Prpura no trombocitopnica.
-Hipocalcemia
secundaria al embarazo. -Adyuvante en el tratamiento del raquitismo.
-Hiperpotasemia
3.- POSOLOGIA:
-Adultos: DI: infu. Iv. 20-60 mg./kg. (0,14-0,43 ml./kg.) (Preparacin:
DI. en SSF. o SG. hasta 100 ml. en 10-15 min. a 400-600 ml./h). -DM:
Infus. iv. 2-4 mg./kg./h. o 0,014 -0,29 ml./kg./h. (Preparacin: DM
para 2 h. en SF. SG. hasta 100 ml. a 50 ml./h.)
-Peditrca: DI: iv. lenta 10 a 20 mg./kg. 0,072-0,145 ml./kg. cada 4
a 6 h.
4.- CONTRAINDICACIONES:
-Hipercalcemia. Hipercalciuria. Clculos Renales.
5.- OBSERVACIONES:
-Incompatible con sustancias alcalinas. Si se extravasa en im. o iv.
puede producir: -Necrosis Cutnea, Calcificacin
-En Embarazo: Categora B, -En Lactancia: compatible.

1.- NOMBRES COMERCIALES Y PRESENTACIONES:

Hemabate, Deviprost, Prostin 15M, Prostinfenem (Amp. 250 mcg./ml.)
2.- INDICACIONES:
-Hemorragia post parto por atona uterina que no responden ni a
Oxitocina ni a Ergometrina.
3.- POSOLOGA:
DI: im. (profunda) 250 mcg. (Repetir si no tiene efecto pero no antes
de 15 min. ni despus de 90 min.) Dmx: 2 mg.
4.- CONTRAINDICACIONES:
Enf. Plvica Inflamatoria Aguda. Enf. Activa: Cardiaca, Pulmonar,
Renal o Heptica.
5.- OBSERVACIONES:
Ultimo recurso antes de intervencin quirrgica ante una hemorragia
postparto resistente a otros Trat. Mdicos.
-En Embarazo: Categora C. En Lactancia: Desconocida su excresin
en la leche.

39-CAPTOPRIL
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Alopresin, Capoten, Captopril, Cesplon, Dilabar, Tensoprel (Comp. 25,
50 y 100 mg.)
2.- INDICACIONES:
Hipertensin arterial
3.- POSOLOGIA:
-Adultos: En urgencias HTA: DI: Sublingual 25 mg. Si es necesario
repetir la dosis. Dmx: 150 mg./da
-Peditricos: DI: vo. 0,3 mg./kg. (La eficacia y seguridad no se ha
establecido.)
4.- CONTRAINDICACIONES:
-Hiperpotasemia. -iR.
5.- OBSERVACIONES:
-Termosensibilidad. no a Temp. >30C. -Embarazo: Contraindicado en 2
y 3 trimestre. -Lactancia: contraindicado. -Insuf. Heptica: Reajustar
dosis.

40-CARBN ACTIVADO
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Carbn ultra adsorbente Lainco. (Frascos de 25 y 50 gr.)
2.- INDICACIONES:
Intoxicaciones agudas por sobredosis de medicamentos o ingestin
productos txicos. (Es ms eficaz si se administra dentro de la primera
hora. Y sigue siendo til hasta las 4 a 6 h. de la intoxicacin).
3.- POSOLOGIA:
-Adultos: DI: vo. 50 g./4-6 h.,(Preparacin: 50 gr. en Agua Normal o
Destilada de hasta un 400 ml.)
-Peditrica. DI: vo. 1 g./Kg. (Preparacin: Por cada 1 gr. disolver en 8
ml. de Agua normal o Destilada)
4.- CONTRAINDICACIONES:
-En intoxicaciones por derivados del petrleo y custicos
5.- OBSERVACIONES:
-Utilizar el adaptador en sonda bucogstrica. -Apenas es til en
intoxicaciones por: Cianuros. Insecticidas rgano fosforados y
rganoclorados. Etanol. Etilenglicol. Sales de hierro. Litio. cidos y
bases fuertes. -Si el paciente est inconsciente, la administracin se
har por sonda buco gstrica (si est asegurada va area). -Embarazo.
No se ha observado toxicidad. -Lactancia: Uso aceptado

42-CARVELIDOL
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Dilatrend, Carvedilol, Coropres, Dilatrans, Palacimol (Comp. 6,25 mg.,
12,5 mg. y 25 mg.)
2.- INDICACIONES:
-HTA esencial: Angina de Pecho; Trat. Coadyuvante en ICC.
Sintomtica de moderada a grave.
3.- POSOLOGA:
-En HTA y Angina de Pecho. DI: vo. 12,5 mg. cada 12 h. -En ICC. DI:
vo. 3,125 mg. (la mitad de un comp. 6,25 mg.)
Dmx: en <85 kg. 25 mg./12 n. y en >85 kg. 50 mg./12 h.
4.- CONTRAINDICACIONES:
Insuf. Cardiaca de lclase IV. -EPOC con obstruccin bronquial. Disfuncin heptica. -Asma bronquial. Bloqueo A-V de 2 y 3. Bradicardia grave (< 50 lpm.). -Shock cardiognico. -Enf. Sinusal
(incluido el Bloqueo del Ndulo Sino-Auricular). -Hipotensin grave
(presin sistlica <85 mmHg.). -Acidosis Metablica. -Angina de
Prinzmetal. -Feocromocitoma no tratado. -Alteraciones circulatorias
arteriales perifricas graves. -Trat. concomitante iv. con Verapamilo o
Diltiazem.
5.- OBSERVACIONES:
En caso de ICC, dar con alimentos para evitar Hipotensin Ortosttica.

43-CEFTRIAXONA
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Rocephin, Ceftriaxona, Rocefalin (Viales polvo 500, 1000, 2000 mg.)
2.- INDICACIONES:
Sepsis Sistema Respiratorio, GenitoUrolgico, SNC.
3.- POSOLOGA:
-Adultos: DI: iv. infu. 2-4 gr./da (cada12 24 h.).
(Preparacin: DI. en SSF. o SG. hasta 50-100 ml. a pasar en 15-20 min.)
-Peditrica: DI: iv. infu. En Neonatos <7 das y <2 kg.=50 mg./kg./da.
En Neonatos <7 das y >2 kg.=75 mg./kg./da.
En Lactantes y nios = 50-100 mg./kg./da (cada 12 o 24 h.)
(Preparacin: DI. en SSF. o SG. hasta 50 ml. a pasar en 15-20 min.)
4.- CONTRAINDICACIONES:
-Hipersensibilidad a penicilinas y Cefalosporinas. -En RN. Prematuros o
con riesgo de Encefalopata por Hiperbilirrubinemia.
5.- OBSERVACIONES:
-Riesgo de contraer Colitis Pseudomembranosa. -Riesgo de
Hiperbilirrubinemia. -En Insuf. Renal en adultos no dar ms de 2
gr./da. -En preparados para va im. no poner en iv. En iv. si es en bolo
y <50 mg./kg. se realiza en 2 a 4 min.
-En el Embarazo: Categora B. En Lactancia: Precaucin

44-CHITOSAN
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Celox TM (Granulado en sobres de 35 g.) y en Vendas.
2.- INDICACIONES:

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URGENCIAS Y EMERGENCIAS EXTRAHOSPITALARIAS GUETS - SESCAM

Hemorragias externas que comprometan la vida del paciente y que no
sean controlables, ni con torniquete, ni con compresin continua.
3.- POSOLOGA:
Preparacin y Uso: Secar la zona. Aplicar inmediatamente los grnulos
hasta rellenar la herida (si precisara usar un 2 sobre). Presionar
intensamente con una gasa 5 minutos o ms. Aplicar sobre la herida
un vendaje fuerte. Desechar el material sobrante.
4.- CONTRAINDICACIONES:
No conocidas.
5.- OBSERVACIONES:
Acta en condiciones hipodrmicas. Para retirar eliminar el material,
limpiar la herida con agua o solucin salina.

45-CIMETIDINA
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Tagamet, Aliveg (Amp. 200 mg./2 ml.)
2.- INDICACIONES:
-Anticido Gstrico. Ulceras. -Hemorragias gstricas
3.- POSOLOGA:
-Adultos: DI: im. o iv. 200-400 mg.
-Peditrica: No es aconsejable
4.- CONTRAINDICACIONES:
-Patologa Cardiovascular Grave, y en Pacientes Crticos.
5.- OBSERVACIONES:
-Proteger las Amp. de la luz. -En Embarazo: Categora B. En
Lactancia: Evitar.

46-CIPROHEPTADINA
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Periactn, Viternum, (Compr. 4 mg.) (Sol. oral 100 ml. (2 mg./5 ml.))
2.- INDICACIONES:
-Alergia, -Prurito agudo y crnico, anogenital y varicela, Reaccin Anafilctica con Epinefrina tras controlar reacciones agudas,
-Cefalea vascular, -Migraa, -Cefalalgia Histamnica
3.- POSOLOGA:
-En Alergias o Prurito: Adultos: DI: vo. 4 mg./8 h. Peditrica: En <14 y
>7 aos: DI: vo. 4 mg./8 h.; En <7 y >2 aos. DI: vo. 2 mg./8 h. En <2
aos: Evitar.
-En Jaquecas y Cefalea Vascular: Adultos: DI: vo. 4-8 mg./4-6 h.
4.- CONTRAINDICACIONES:
-Crisis Asmtico Aguda, -Glaucoma de ngulo Cerrado, -lcera pptica
estenosante, -Hipertrofia Prosttica sintomtica, -Obstruccin de
cuello vesical o piloroduodenal. -Ancianos debilitados. RN. y
prematuros
5.- OBSERVACIONES:
-En Embarazo: No hay estudios ni est clasificada por la FDA. -En
Lactancia evitar. -Evitar el sol tras su administracin.

47-CISATRACURIO
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Nimbex.. Cisatracurio. (Vial o Amp. 150 mg./30 ml.; 20 mg./10 ml.; 10
mg./5 ml.; 5 mg./2,5 ml.)
2.- INDICACIONES:
-Bloqueo neuromuscular en intubacin orotraqueal y para facilitar la
ventilacin mecnica. -Se utiliza para relajar los msculos en
operaciones quirrgicas, incluyendo ciruga cardiaca, tanto en adultos
como en nios de ms de 1 mes de edad. -(Especialmente til en
pacientes con disfuncin renal o heptica conocida).
3.- POSOLOGA:
Adultos: DI: iv. en bolo 0,10-0,15-0,4 mg./kg. = 0,07-0,075-0,2 ml./kg.
en 5-10 seg. -DM: infu. Iv. 0,03-0,18 mg./kg./h. = 0,015-0,09
ml./kg./h.) (Preparacin: DM. en SSF. hasta 100 ml. a 100 ml./h.)(Ej.:
paciente de 70 Kg.-DI: Bolo de 5,25 ml.-Seguido de DM: de 12,6 mg
6,3 ml completado hasta 100 ml de SF a una velocidad de 100 ml/h.)
Pediatra: >1 mes a <12 aos: DI y DM. igual que en Adultos. (Salvo
preparacin en DM, que ser de 50 ml.)
4.- CONTRAINDICACIONES:
Hipersensibilidad al frmaco.

924

GUA FARMACOLGICA

5.- OBSERVACIONES:
-Conservar entre 2 y 8 C. No congelar. Conservar protegido de la luz. No mezclar en la misma jeringa con sustancias alcalinas ya que se
inactiva. -Puede diluirse en SSF. o SG. no en S. Ringer. -No se
recomienda en nios <1 mes. -Embarazo Categora B. -Lactancia: Se
ignora si es excretado con la leche materna. -En IR. Precaucin.

48-CITICOLINA
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Somazina, Ceraxn, (Amp. 500-1000 mg./4 ml.)
2.- INDICACIONES:
-Ictus, -TCE, reciente. -Estimulante neurolgico
3.- POSOLOGA:
DI: im. vo. Iv. 500-1000 mg. (si es iv. entre 3 a 5 min.) (si es vo.
Disolver en 120 ml. de agua)
4.- CONTRAINDICACIONES:
Hipertona del Sistema Nervioso Parasimptico.
5.- OBSERVACIONES:
En hemorragia cerebral persistente no superar los 1000 mg.

49-CLINDAMICINA
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Dalacn, Clindamicina Normon, Clinwas. (Amp. 300 mg./2 ml.; 600
mg./4 ml.; 900 mg./6 ml.) (Caps. 150, 300 mg.)
2.- INDICACIONES:
-Sepsis por infecciones de Piel y Tejidos Blandos.
3.- POSOLOGA:
-Adultos: DI: iv. 600-900 mg./8 h. (Preparacin: DI. en SSF. o SG. hasta
50-100 ml. a pasar 30 min.). Dmx: iv. 1,2 gr./6 h.
DI: vo. 150-450
mg./6-8 h.
-Peditrica; <7 das y <2 kg. DI: iv. 5 mg./kg./12 h.; <7 das y >2 kg. DI:
iv. 5 mg./kg./8 h.; >7 das y <2 kg. DI: iv. 5 mg./kg./8-12 h.; >7 das y >2
kg. DI: iv. 5 mg./kg./6-8 h.;
Lactantes y nios. DI: iv. 5-10
mg./kg./6-8 h. (Preparacin: DI. en 50 ml. de SF o SG, sin sobrepasar la
concentracin 12 mg./ml.). DI: vo. 3,5-7,5 mg./6-8 h.
4.- CONTRAINDICACIONES:
Hipersensibilidad a Clindamicina o Lincomicina. Especial precaucin
en Enf. Gastrointestinales.
5.- OBSERVACIONES:
-Monitorizar porque puede provocar Arritmias severas. -En Embarazo:
Categora B. -En Lactancia: Precaucin.

50-CLOMETIAZOL
1.- NOMBRE COMERCIAL Y PRESENTACION:
Distraneurine, (Cp. 192 mg.) (Vial. 4 gr.)
2.- INDICACIONES:
-Alteraciones del sueo en el anciano. -Inquietud, agitacin y estados
confusionales en el anciano. -Deprivacin Alcohlica (clase A)
incluyendo Delrium Tremens como alternativa a las Benzodiacepinas
(clase B como indicacin de tratamiento, y clase C como profilaxis). Status Epilptico: alternativa de tercer escaln tras Benzodiazepinas y
Barbitricos en crisis secundarias a deprivacin alcohlica (clase C). Es
Trat. iv. en UCI.
3.- POSOLOGIA:
-Adultos: -Status Epilptico 2 a deprivacin alcohlica: DI: infu. iv.
20,57-51,42 mg./kg./h. o 2,57-6,42 ml./kg./h. durante 10 min. Al cesar
la crisis: -DM: Infu. iv. 3,42-6,85 mg./kg./h. (Preparacin de DI y DM:
4 gr. en SSF. hasta 500 ml. (0,8 mg./ml.). -Hipntico: DI: vo. 384 mg. o
2 cp. 15 min. antes de acostarse. -Deprivacin alcohlica: DI: vo.
384-768 mg. o 2-4 caps. cada 6-8 h. -Delirium Tremens: DI: vo. 384768 mg. o 2-4 caps. -Dosis suplementarias: 1-2 cp. cada 1-2 h hasta
la sedacin. -Dmx.: vo. 1920-2304 mg./da. -Peditra: no indicado
4.- CONTRAINDICACIONES:
-Insuf. Respiratoria. -Depresin del SNC por frmacos o Alcohol.
5.- OBSERVACIONES:
-Fotosensible -Almacenar en nevera -Se adhiere a sustancias plsticas
como el PVC de los sistemas de infusin. -Ancianos: 30-50% de la
dosis.

URGENCIAS Y EMERGENCIAS EXTRAHOSPITALARIAS GUETS - SESCAM

-Embarazo y Lactancia: Sin clasificar. No recomendado. IR. e Insuf.
Heptica: Reducir dosis inicial

51-CLONAZEPAM
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Rivotril. (Amp. 1 ml./1 mg.) (Comp. 0,5 y 2 mg.) (Sol. Gotas. 2,5 mg. /
ml.)
2.- INDICACIONES:
-En Ausencias Tpicas (Petit Mal). -Ausencias Atpicas (Sindr. de LennoxGastaut). -Convulsiones Mioclnicas. Sndr. Fbicos, Convulsiones
Tonico-Clnicas (Gran Mal). -Convulsiones Parciales Simples y
complejas. -"Status Epilptico en todas sus manifestaciones clnicas.
3.- POSOLOGIA:
Adultos: (Preparacin: 1 mg. en SSF. hasta 10 ml. (1 ml.= 0,1 mg.) DI:
iv. 0,014 mg./kg. = 0,14 ml./kg. en 2-3 min. (No superar velocidad
0,25-0,5 mg./min.). Si es necesario repetir dosis, hasta Dmx: 10
mg./da. (1-4 mg suelen ser suficientes para anular el estado
epilptico).
Peditrica: (Preparacin: 1 mg. en SSF. hasta 10 ml. (1 ml.= 0,1 mg.)
DI: iv. 0,01-0,09 mg./kg. o 0,1-0,9 ml./kg. en 2 min. Dmax.: 2 mg.
4.- CONTRAINDICACIONES:
-Especial precaucin en: -Ataxia medular, -Ataxia cerebelosa, Intoxicacin aguda por alcohol o frmacos, -Insuficiencia heptica
grave (p. ej.: cirrosis heptica) y en pacientes con -Apnea del sueo. Antecedentes de alcoholismo o drogadiccin. En Ancianos con EPOC.
-Nefropatas.
-Hepatopatas, -En quienes estn recibiendo
antiepilpticos u otros frmacos de accin central.
5.- OBSERVACIONES:
Antdoto por Intoxicacin: Flumazenilo. -Cuando no se pueda usar la
via iv. se puede usar va im. -En Ancianos: Limitar la dosificacin a la
mnima eficaz. En Embarazo: Categora D. -Lacatancia: pasa a la leche
materna, evitar. -En lactantes y nios pequeos, evitarlo en lo posible.
-Nunca suspender de forma brusca el Trat. con Rivotril en epilpticos.
-Cuando se reduzca la dosis ha de ser de forma paulatina. -Durante la
administracin iv. existe riesgo de tromboflebitis.

52-CLONIDINA
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Catapresan, Catapres. (Amp. 0,15 mg./1 ml.; 0,50 mg./1 ml.) (Comp.
0,1 mg.)
2.- INDICACIONES:
-HTA. -En Dolor Severo en combinacin con opiceos en pacientes con
cncer que no se alivia adecuadamente por analgsicos opioides
solos. -Profilaxis / trat. del Sndr. de abstinencia a opiceos
3.- POSOLOGA:
Adultos: -HTA leve a Moderada: DI: vo. 100-200 mcg./da en 1 2
dosis. -HTA grave: DI: Infu. iv. 0,2-0,5 mcg./kg./min. (No superar 150
mcg. o una amp. en una infu. iv.) (Preparacin: 150 mcg. en SF. hasta
100 ml. (1,5 mcg./ml.) a 8-20 ml./kg./h.), pero se puede dar como
mximo 4 infu. iv. al da. -Dolor severo: va epidural: 30 mcg./h.
Sindr. Abstinencia Opiaceos: DI: iv. 17 g./kg./da hasta Dmx: 1,5
mg./da repartidas en 3-4 dosis dia. o infu. iv. 1 g./kg./h.
(Preparacin: 500 mcg. en SF. hasta 100 ml. (5 mcg./ml.) 0,2
ml./kg./h.)
-Peditrica: Dolor severo. Va epidural. 0,5 mcg./kg./h. (Preparacin:
150 mcg. en SFF. hasta 100 ml. (1,5 mcg./ml.) a 0,33 ml./kg./h.)
4.- CONTRAINDICACIONES:
-Bradiarritmia grave. Enf. Ndulo Sinusal o Bloqueo AV de 2 o 3
grado
5.- OBSERVACIONES:
-Mientras se da por va iv. el paciente debe estar en decbito y
monitorizado. -Se puede usar las vas sc. e im. -En Embarazo:
Categora C. Lactancia: se excreta en la leche pero no tiene efectos,
aunque apenas hay estudios. -Para el dolor se puede dar por va
epidural. -No retirar nunca esta medicacin bruscamente, por el riesgo
de crisis hipertensiva de rebote

GUA FARMACOLGICA

53-CLOPIDOGREL:
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Iscover, Plavix. (Comp. 75 mg.)
2.- INDICACIONES:
-SCA (SCACEST y SCASEST) -Infarto cerebral, -Arteriopatia perifrica. Intervencin coronaria percutnea (ICP).
3.- POSOLOGA:
-SCACEST que se le realizar PCI y que no hay Presugrel ni Ticagrelor
DI: vo. 600 mg. (OtrAut.: 900 mg.). -SCACEST que se le realizar
Trombolisis. En <75 aos. DI: vo. 300 mg. en >75 aos. DI: vo. 75 mg.
(OtrAut.: 600-900 mg). DM: vo. 75 mg./da. -Si no se va a hacer PCI ni
Trombolisis: DI: vo. 75 mg.
4.- CONTRAINDICACIONES:
Absolutas: -Insuficiencia heptica severa, -Hemorragia patolgica
activa. Relativas: -En ciruga, -Lesiones propensas a hemorragias.
5.- OBSERVACIONES:
-En Peditrica: No est indicado. -En Embarazo: no hay datos clnicos.
-En lactancia: No indicaco. En IR. no necesita reajuste.

54-CLORACEPATO DIPOTASICO
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Tranxilium, Nansius. (Amp. 20 mg./2 ml.; 50 mg./2,5 ml.; 100 mg./5
ml.) (Comp.: 5, 10, 15 y 50 mg. Sobres 2,5 mg.)
2.- INDICACIONES:
-Ansiedad, -Angustia, -Neurosis, -Agitacin Psicomotriz, -Insomnio, Coadyuvante en Sindr. Abstinencia (alcohol, drogas). Coadyuvante en
Ttanos, IAM, Crsis Asmtica, Preparacin y desarrollo del parto.
Premedicacin ante intervencin quirrgica.
3.- POSOLOGA:
-Adultos: En estados de agitacin psicomotriz, confusin o
agresividad: DI: im. o iv. 20 a 200 mg./da. o 0,28-1,42 mg./kg.
(Preparacin: DI. en SSF. hasta 100 ml. a pasar en 10 min. a 600
ml./h.). En Premedicaciones antes de intervencin quirrgica: DI: iv.
20-50 mg./da o 0,28-0,71 mg./kg. a 15-30 min. antes de la
intervencin. (si es im. 30 a 60 min. antes.) En Alcoholismo
(Predelirio, Delirium Tremens): DI: iv. o im. 50-100 mg. cada 3 4 h.
En Ttanos: Ttanos benigno, que no requiere traqueotoma: DI:
Infu. iv. 120 a 500 mg./da o 1,71-7,14 mg./kg./da. Ttanos maligno,
que requiere traqueotoma y ventilacin asistida: DI: Infu. iv. 5002000 mg./da. o 7,14 -28,56 mg./kg./da. Estados de Ansiedad: DI:
vo. 5-25 mg./6-12 h. Dmx. 100 mg./da.
-Peditrica: DI. iv. 0,25 mg./kg./12 h, Dmx: 1 mg./Kg./12 h (2
mg./kg./da). (OtroAut: iv. 0,2 -0,5 mg./kg. en 100 ml. SG.) (No
recomendado en <30 meses )
-Geriatra: 5 mg./8-24 h, hasta un mximo de 10 mg./6 h. (40 mg./da).
4.- CONTRAINDICACIONES:
-Alergia a benzodiacepinas, -Miastenia grave, -Insuf. Respiratoria
Severa, -Glaucoma de ngulo estrecho, -Apnea del sueo, Insuficiencia heptica severa e Intoxicacin etlica, -Coma o sncope.
5.- OBSERVACIONES:
Embarazo: Categora D. Lactancia: Suspender lactancia o Trat.
Manejo: El diluyente nicamente se puede utilizar por va im. Para
administracin iv usar SG Agua Estril . Antdoto: Flumazenilo.

55-CLORHEXIDINA
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Chorhexidina, Cristalcom, Cristalmina, Curafil, Cuvelfilm, Deratin,
Hibimax, Menalmina, Septisan. (Sol. 0,1% 500 ml.) (Sol. 1% 25, 30,
40, 50, 60, 125, ml.) (Sol. 2% 500 ml.) (Sol. 5% 500 ml.) (Gel 1% 30,
100 gr.) (Spray 1% 30, 60 ml.) (Nebulizado 1% 50 ml.)
2.- INDICACIONES:
-Antisepsia de piel sana. Heridas. -Antisepsia de la piel en el
preoperatorio. -Antisepsia antes de insercin de catteres. -Antisepsia
del ombligo del recin nacido. -Antisepsia de cavidades corporales. Desinfeccin del material instrumental
3.- POSOLOGIA:
Va tpica: -En Irrigacin vesical: Sol. Acuosa al 0,02%. -En Antisepsia
de heridas: Sol. Acuosa al 0,05%. -En Antisepsia de piel previa a la
insercin de catter percutneo: Sol acuosa al 2%. -En limpieza

925

URGENCIAS Y EMERGENCIAS EXTRAHOSPITALARIAS GUETS - SESCAM

preoperatorio de piel: Sol. Jabonosa al 4%. -En lavado de manos
prequirrgico: Sol. Jabonosa al 4%. -En limpieza en infeccionas
cutneas superficiales (Foliculitis, imptigo): Sol. Jabonosa al 4%. -En
desinfeccin de quemaduras leves: Film 1%. -En desinfeccin de
pequeas heridas superficiales, grietas y rozaduras: (Despus de
lavar y secar bien la herida) Film 1% y Sol. 0,5%, 1%. -Limpieza
obsttrica: Sol. 5%. -Limpieza de heridas: Sol. 5%. -Limpieza de
quemaduras: Sol. 5%
-En almacenamiento de material quirrgico: Sol. 5%
4.- CONTRAINDICACIONES:
Alergia a principio activo.
5.- OBSERVACIONES:
Preservar de la luz

56-CLORPROMAZINA
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Largactil. (Amp. 25 mg./5 ml. (1 ml.=5 mg.)) (Comp. 25 y 100 mg. ) (Sol.
Gotas 40 mg./ml.)
2.- INDICACIONES:
-Agitacin severa. -Neurosis de ansiedad. -Esquizofrenia, -Paranoia.
Delirio. -Mana. -Hipo incoercible. -Nuseas y vmitos inducidos por
quimioterapia. -Sndrome de Gilles de la Tourette. -Corea. Antecedentes de drogodependencia o alcoholismo. -Alteraciones
graves del comportamiento en los trastornos de personalidad.
3.- POSOLOGA:
-Adultos: DI: iv. 2 mg. (0,5ml.) en intervalos; hasta un mximo de 25
mg. o 0,0280,357 mg./kg.=0,0050,071 ml./kg. (OtrAut: nunca en
bolo. Pero si: 25-50 mg. en 25 50 SF. (1 ml. = 1mg.) en 2550 min. (a
60 ml./h.) (Preparacin: DI: infu. iv. 0,35-0,71 mg./kg.=0,070,14
ml./kg. en SSF. hasta 100 ml. a 100 ml./h.)(Concentracin mnima 1
mg. por no menos de 1 ml y velocidad mxima, no mas de 1 mg. por 1
min.) o DI: im. 2550 mg./ 6 8 h. o DI: vo : DI: 25 - 500 mg. / 24 h.
DM: 75 y 150 mg. / 24 h.
-Pediatra: DI: im. 0,5-1 mg./kg 0,1-0,2 ml./kg. cada 6-8 h. (OtrAut:
4-6 h.)
4.- CONTRAINDICACIONES:
Hipersensibilidad a la clorpromazina o a fenotiazinas, -En Depresin
Severa del SNC o de la Mdula sea., -Estados de coma, Ffeocromocitoma.
5.- OBSERVACIONES:
-Embarazo: Categora C. -Lactancia: Se excreta por leche. -Evitar en
insuficiencia heptica. En sobredosis puede dar sgnos
extrapiramidales. Antdoto: Biperideno (Akinetn 0,05 mg/kg. im.
iv., repetible a los 30 min.).

57-CLORURO DE ETILO
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Cloretilo Chemirosa (ERN). Spray 100 gr.
2.- INDICACIONES:
-Anestsico local en: traumas, Infiltraciones.
3.- POSOLOGA:
Adultos y Peditrica. DI: va tpica: -Una o dos aplicaciones en la zona
afectada. El efecto anestsico aparece al cabo de 15-20 seg. Pulverizar a
30 cm. de distancia.
4.- CONTRAINDICACIONES:
Alergias al cloruro de etilo
5.- OBSERVACIONES:
-Mantenerse en lugar fresco y alejado del fuego. -Embarazo: evitando
siempre tratamientos prolongados y grandes dosis. -Lactancia: Se
ignora.

58-COLIRIO ANESTESICO DOBLE

1.- NOMBRES COMERCIALES Y PRESENTACIONES:
-Colircusi Anestsico Doble: (Colirio 10 ml.(Oxibuprocaina 4 mg. +
Clorhidrato Tetracana 1 mg. + Vlorhidrato de Clorobutanol
(excipiente) por 1 ml.) -Colircusi Anestsico: Colirio 10 ml .(Nafazolina
Clorhidrato 0,5 mg + Tetracaina Clorhidrato 5 mg )/ ml.
2.- INDICACIONES:

926

GUA FARMACOLGICA

-Afecciones dolorosas oculares, -Extraccin de cuerpos extraos,

ciruga menor del ojo.
3.- POSOLOGIA:
Adultos y Peditrica: DI: va tpica de 1-2 gotas en el ojo afectado.
Instilar las gotas en el saco conjuntival.
4.- CONTRAINDICACIONES:
-Glaucoma del ngulo estrecho. (Precaucin en: -Epilepsia, Insuficiencia cardiaca, -IR. -Insuf. Heptica.)
5.- OBSERVACIONES:
-En Embarazo: Categora C. En Lactancia: sin datos

59-COLIRIO DE FLUORESCEINA
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Colircusi Fluorescena : Colirio 2% 10 ml. Colircusi Fluotest: Colirio 3
ml. Fluorescena Oculos: 20% 10 amp. 3 ml
2.- INDICACIONES:
-Deteccin de defectos en el epitelio corneal. -Deteccin de cuerpos
extraos oculares, -Colocacin de lentes de contacto duras.
3.- POSOLOGIA:
Adultos y Peditrica. DI: va Tpica: 1 gota y despus mantener los
prpados cerrados durante unos 60 seg. Despus lavar con SSF. para
eliminar el exceso de colorante.
4.- CONTRAINDICACIONES:
Hipersensibilidad al medicamento
5.- OBSERVACIONES:
Proteger de la luz

60-COLIRIO MIDRIATICO
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Colirio Llorens Midritico: Colirio 10 ml (Fenilefrina 40 mg +
Clorhidrato Atropina 20 mg + Sulfato Escopolamina 5 mg +
Bromhidrato Sulfitos 1 mg (excipiente) + Sales de Fenilmercurio 15 mg
(excipiente)) / ml.
2.- INDICACIONES:
-Ulceras cornales, -Iritis, -Iridociclitis, -Uveitis, -Queratitis y -En
aquellos casos en los que se desee una midriasis.
3.- POSOLOGIA:
Adultos y peditrica: DI: va tpica: Instilar 1 gota 1-3 veces al da.
Oftlmica.
4.- CONTRAINDICACIONES:
-Glaucoma en Angulo Cerrado, -Asma Crnico, -Hipertensin Ocular.
5.- OBSERVACIONES:
-Embarazo: Categora C. -Administrar con precaucin en ancianos y
nios <2 aos. -Para evitar una excesiva absorcin sistmica presionar
con el dedo el saco conjuntival durante 1-2 minutos despus de la
aplicacin.

61-COLIRIO MIOTICO
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Colircusi Pilocarpina, Colirio Ocul. Pilocarpina, Isoptocarpina,
Pilocarpina Llorens. (Colirio (10 ml al 2%, 4% y 5%)(15 ml. al 1%, 2%,
4% y 7%)).
2.- INDICACIONES:
-Glaucoma, -Induccin de miosis.
3.- POSOLOGIA:
Adultos y Peditrica: -Glaucoma DI: va tpica.1 gota/ 4 h. o 1
aplicacin Pomada o gel/ 24 h.) -Induccin a Miosis: DI: va Tpica 1
gota al 1%.
4.- CONTRAINDICACIONES:
Relativas: -Asma Crnico, -Iritis aguda.
5.- OBSERVACIONES:
Embarazo: Categora C. -En nios puede provocar espasmo de la
acomodacin que persiste durante 30-40 min. -En lactantes no se
aconsejan concentraciones superiores al 1 %. -Para evitar una
excesiva absorcin sistmica presionar con el dedo el saco conjuntival
durante 1-2 min. despus de la aplicacin.

URGENCIAS Y EMERGENCIAS EXTRAHOSPITALARIAS GUETS - SESCAM

62-COTRIMOXAZOL
(Sulfametoxazol + Trimetoprim)
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Septrim, Soltrim, Bactrim, Septra (Comp. 800/160; 400/80; 100/20
mg.) (Amp. 200/40 mg./5 ml.)
2.- INDICACIONES:
-Sepsis del Sistema Nervioso Central. -Infecciones por: Haemfilus
Infuenzae, Estreptococo Pneumoniae, Neumocistis Carinii. Infecciones: Sistema Genitourinario, Pulmonar, Gastrointestinal. Pediculosis resistentes a la Permetrinas,
3.- POSOLOGA:
Adultos: Sepsis Graves: DI: iv. 25/5 mg./kg. cada 6 h. en infusin lenta
(60-90 min.)(Preparacin: iv. DI. en SSF. SG. hasta 250 ml.)-Otras
Infecciones: DI: vo. 800/120 mg. cada 12-24 h.
Peditrica: (A partir de 1 mes de vida) -Sepsis Graves: DI: v. 25/5
mg./kg. cada 6 h. en infusin lenta (60-90 min.)
(Preparacin: DI. en SSF. o SG. hasta 100 75 ml.) -Otras infecciones:
DI: vo. 20/4 30/6 mg./kg. cada 12 h.
4.- CONTRAINDICACIONES:
-Alergia a las sulfamidas, -Embarazadas, sobre todo a trmino, -En
nios <1 mes., -Anemia Megaloblstica por dficit de cido Flico, Porfirias, -Lupus Eritematoso, -Obstruccin urinaria, -En quienes usan
cremas fotoprotectoras que contengan PABA.
5.- OBSERVACIONES:
-Las preparaciones iv. son estables slo 2 h. -En el Embarazo:
Categora C. En la Lactancia: Precaucin (Se eliminan por la leche
materna pero su administracin en mujeres en periodo de lactancia
no representa un peligro significativo para el nio.

63-DALTEPARINA SDICA
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Fragmin, Boxol, (Amp. 2500 UI/0,2 ml.; 5000 UI/0,2 ml; 7500 UI/0,3
ml.; 10000 UI/0,4 ml.; 12500 UI/0,5 ml. 15000 UI/0,6 ml.; 18000
UI/0,72 ml.; 10000 UI/1,0 ml.)
2.- INDICACIONES:
-Trombosis Venosa Profunda con o sin Embolia Pulmonar. -Prevencin
en Hemodilisis. -Enf. Tromboemblica en Ciruga. -Angina Inestable. IAM sin onda Q. -Prevencin Enf. Tromboemblica en inmovilizados
no quirrgicos. -Prevencin en pacientes oncolgicos.
3.- POSOLOGA:
Adultos: -Trombosis Venosa Profunda con o sin Embolia Pulmonar:
DI: sc. 200 UI/Kg./da, no superar 18000 UI. -Prevencin de Cogulos
en Hemodilisis en Hemodilisis <4 h. DI: sc. 5000 UI; -En
Hemodilisis >4 h. DI: sc. 30-40 UI./kg., seguido de Infu. iv. de 10-15
UI./kg./h. -Profilaxis de la Enf. Tromboemblica en Ciruga. DI: sc.
2500 UI. 2 a 4 h. antes. -Profilaxis de la Enf. Tromboemblica en
Inmovilizados no Quirrgicos. DI: sc. 2500 UI./da. -Angina Inestable
e IAM no Q. DI: sc. 120 UI./kg. cada 12 h. (Dmx. 10000 UI./12 h. ). Prevencin de Enf. Tromboemblica en pacientes Oncolgicos: DI: sc.
200 UI./kg./da. (Dmx. 18000 UI.)
4.- CONTRAINDICACIONES:
-Hipersensibilidad a derivados del cerdo. -Trombocitopenia
inmunolgica.
-Sangrados Activos. -Alteraciones Graves de
Coagulacin. -Endocarditis Sptica. -Traumatismo reciente o ciruga
reciente del Sistema Nervioso Central, ojos y odos.
5.- OBSERVACIONES:
-No administrar va im. -Puede provocar Hiperpotasemia, -Embarazo:
Categora B. -Lactancia: Se excreta en la leche materna. Si hay
sobredosis, dar como antdoto la Protamina, 1 mg. por cada 100 UI. de
Deltaparina.

64-DANTROLENO
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Dantroleno, Dantrium, Dantralen (Vial 20 mg.) (Caps. 25 y 100 mg.)
2.- INDICACIONES:
-Crisis de Hipertermia Maligna. -Espasticidad muscular por Esclerosis
Mltiple o por Lesiones Medulares y otras condiciones espsticas. Sindr. Neurolptico Maligno.
3.- POSOLOGA:

GUA FARMACOLGICA

-Adultos: Hipertermia Maligna: DI: iv. 1 mg./kg. en 15 min., se puede

repetir cada 10-15 min. hasta Dmx . 10 mg./kg. (Preparacin Vial de
20 mg. en 60 ml. sol. de Agua Estril (0,33 mg./ml.) o bien (50 mg./250
ml. sol. inyectable.) Normalmente la reversin de la hipertermia se
consigue a la dosis de 2,5 mg./kg.). -Sndr. Neurolptico Maligno: DI:
iv. 1,25-1,50 mg./kg. -Espasticidad o Espasmos Musculares: DI. vo.
25 mg./da (dosis nica)
-Peditrica: (igual que en Adultos)
4.- CONTRAINDICACIONES:
-No administrar simultneamente con Antagonistas del Calcio
(Diltiazem, Verapamilo, etc..), -Hepatitis o Cirrosis Aguda. -En
Cardiopata. -Obstruccin Crnica Pulmonar.
5.- OBSERVACIONES:
-No meter en contenedor de cristal. -Proteger de la luz. -No
administrar va sc o im. -Por va oral se facilita su absorcin dando
zumo de naranja. -Evitar la extravasacin. -No preparar las soluciones
con SSF. o SG.
Embarazo: Categora C.

65-DESFERROXAMIA (Mesilato)
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Desferin, Desferal (Vial 500 mg. y 2 gr. en polvo)
2.- INDICACIONES:
-Intoxicacin Hierro. -Sobrecarga crnica de Fe. -Hemosiderosis por
transfusin, -Hemocromatosis idioptica excluda flebotoma, Sobrecarga de Fe asociada a porfiria cutnea. -Sobrecarga crnica por
Aluminica (Al) en IR. Terminal, sometidos a dilisis continua con
osteopata y/o encefalopata por dilisis y/o anemia dependiente del
Al. -Diagnstico de sobrecarga por Fe y Al.
3.- POSOLOGA:
Va administracin: sc. Im. iv,
-Intoxicacin Crnica: DI: iv. 20-40 mg./kg./da. --Intoxicacin Aguda
Grave con Shock: (Previamente si es posible 5-10 gr. vo.).
Normotenso. Adulto DI: im. Adulto: 2 gr. -Normotenso Pediatra. DI:
im. 1 gr. Hipotenso Adultos y Pediatra: DI: iv. 15 mg./kg./h. al
menos las primeras 4 h. despus reducir (no superar 80 mg./kg./da).
(Preparacin: 500 mg. en 5 ml. de agua para inyeccin, seguidamente
se puede diluir en 50 o 100 ml. de SSF. o SG.)
4.- CONTRAINDICACIONES:
Hipersensibilidad a Deferroxamina
5.- OBSERVACIONES:
-Aunque se puede administrar por va sc. im. o iv., cuidado al
administrar im. si entra por va iv, puede provocar un colapso
circulatorio. -Si es iv. en Infu. lenta. -La Sol. puede estar transparente
o levemente amarillenta. Rechazar si est opaca. -Se puede suspender
el trat. cuando desaparezca el color rojo vino de la orina o
desaparezcan los signos de intoxicacin. -Cuidado al tomar con cido
Ascrbico. En Embarazo: Precaucin, teratgeno en animales;
administrar slo en caso de vital necesidad, especialmente en los 3
primeros meses. En Lactancia: Se desconoce si la sustancia activa pasa
a la leche materna. Se sopesar en cada caso las ventajas para la
madre frente al riesgo para el feto.

66-DEHIDROBENZILPERIDOL (DROPERIDOL)
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Xomolix (Amp. 7,5 mg./3 ml. = 2,5 mg./ml.)
2.- INDICACIONES:
-Agitacin Psicomotriz. -Coadyuvante en la anestesia regional y
general. -Sedante y antiemtico en procedimientos quirrgicos y/o
diagnsticos. Neurolepto Analgesia (en combinacin con analgsicos
narcticos).
3.- POSOLOGA:
-Adultos:-Agitacin Psicomotriz DI: im. iv. lenta: 0,1-0,15 mg./kg. o
0,04-0,06 ml./kg. cada 4-6 h. (Dmx; 15 mg.) o DI: vo. 0,1-0,4 mg./kg.
cada 4-8 h. (Dmx: 20 mg.) - Premedicacin. 3060 min. antes del
acto quirrgico DI: im. iv.: 2,55 mg. -Coadyuvante de la anestesia
general. Induccin: DI: iv. 0,220,275 mg./kg. o 0,088-0,11 ml./kg.
DM: iv. 1,252,5 mg/dosis. -Coadyuvante de la anestesia local: DI:
2.5-5 mg. -Nuseas y vmitos: DI: im. o iv. 2.5-5 mg cada 3-4 horas
-Pediatra(nios 2-12 aos): Premedicacin. 30-60 minutos antes del

927

URGENCIAS Y EMERGENCIAS EXTRAHOSPITALARIAS GUETS - SESCAM

acto quirrgico. DI: Im. 100150 mg./kg., -Coadyuvante de la
anestesia general. DI: Iv.: 88165 mg./kg. -Nuseas y vmitos. DI:
Im. iv.: 50 mg./kg. cada 4-6 horas
4.- CONTRAINDICACIONES:
-Enf. Parkinson. -Alergia a butirofenonas
5.- OBSERVACIONES:
-Ha sido utilizado en Nuseas y vmitos en embarazada sin observarse
efectos en el feto. -Puede provocar alucinaciones. -Puede disminuir el
efecto arritmognico de la Adrenalina. -En la Lactancia: evitar

67-DEXAMETASONA
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Fortecortn, Decadrn, Indukern. (Amp. 4 mg./1; 8 mg./2 ml.; ml.; 40
mg./5 ml.; 200 mg./10 ml.)
2.- INDICACIONES:
-Edema cerebral. -Hiperplasia adrenal. -Insuficiencia suprarrenal. Reacciones alrgicas graves: (-Anafilaxia. -Shock anafilctico. Broncoespasmo). -Asma. -Shock refractario. -Meningitis bacteriana en
nios. -Enf. inflamatorias que no responden a terapia convencional. Rechazo de rganos transplantados. -Anemia hemoltica. -Prpura
trombtica Trombocitopnica. -Reaccin transfusional. -Neumonas
por aspiracin. -Tratamiento crnico de tumores de SNC. -Crup
larngeo en nios
3.- POSOLOGIA:
-Adultos: Procesos vitales. DI: iv. 1-6 mg./Kg. 40 mg. cada 4-6 h.;
DM. iv. 3 mg./Kg./da. Edema cerebral: DI: iv. 10-20 mg. o 0,14-0,28
mg./kg.; DM: iv. 4 mg./6 h.
-Pediatra: Crup Leve: vo. 0,15 mg./Kg.; Grup Moderado: DI: vo. o
im. 0,3 -0,6 mg./kg.; Crup Severo iv. im. 0,6 mg./Kg. Dmx.: 10 mg.
Antiinflamatorio: DI: iv. im. 0,03-0,15 mg./kg./da (en 2-4 dosis).
Meningitis: DI: iv. 0,15 mg./kg./6 h. Edema Cerebral: DI: iv. 1,5
mg./kg.
4.- CONTRAINDICACIONES:
Absolutas: Hipersensibilidad a corticoides. Relativas: -ICC, -HTA, Tromboembolismo, -Psicosis aguda.
5.- OBSERVACIONES:
-Embarazo: Categora C. -Lactancia: Excrecin lctea.
-En caso de Intoxicacin como Antdoto: Fenobarbital (Reduce la vida
media de la Dexametasona en un 44%). -La administracin iv suele
hacerse en 15 minutos

68-DEXCLORFENIRAMINA, Maleato
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Polaramine. (Amp. 5 mg./1 ml.) (Comp. 2 mg. y 6 mg.) (Sol. 2 mg./5 ml.
Frasco de 60 mg./150 ml.)
2.- INDICACIONES:
-Crisis Anafilctica (Trat. Coadyuvante). -Dermatosis Alrgicas, Picaduras de insectos, -Urticaria, -Prurito, -Fiebre del Heno, -Rinitis
alrgicas
3.- POSOLOGIA:
Adultos: En cuadros Moderados: DI: iv. lenta 5 -10 mg. o 0,071-0,142
mg./kg. iv (Preparacin: DI en SSF. en 10 ml.) o directa im., sc. En
cuadros graves o severos: DI: iv. 20 mg . (Preparacin: DI en SSF. hasta
10 ml.). Dmx: 40 mg./24 h. Si se usa vo. 2 mg./4-6 h (Dmx.12 mg/24
h).
Pediatra: Nios >2 aos. DI: iv. 0,04 mg./kg./6 h. (Preparacin: DI en
SSF. hasta 10 ml.)
4.- CONTRAINDICACIONES:
Alergia al frmaco.
5.- OBSERVACIONES:
Embarazo: Categora B. Lactancia: Suspender lactancia o evitar
frmaco. No recomendado en nios <2 aos.

69-DEXKETOPROFENO
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Enantyum, Adolquir, Ketesse, Pyrsal, Quiralam (Comp. 12,5 y 25 mg.)
(Sobr. 25 mg.) (Amp. 50 mg./2 ml.)
2.- INDICACIONES:

928

GUA FARMACOLGICA

-Analgsico, -Antiinflamatorio. -Dolor de intensidad leve o moderada,

(Dolor MsculoEsqueltico, Dismenorrea, Odontlgica. (vo.)). -Dolor
de moderado a intenso (Dolor postoperatorio, Clico Renal de
intensidad moderada a severa y Dolor Lumbar. (im. o iv.))
3.- POSOLOGA:
Adultos: DI.: vo. 12,5 mg./4-6 h. 25 mg./8 h., (sin exceder de 75
mg./da.). DI: im. o iv. 50 mg./8-12 h., Si es necesario repetir a las 6 h.
Dmx.: 150 mg./da, no ms de 2 das. (Preparacin: Si bolo iv. lenta
en >15 seg. Si Infu. iv: DI en SSF o SG. S.Ringer hasta 100 ml. en 10-30
min. a 200-600 ml./h.
4.- CONTRAINDICACIONES:
-Alergia a AINES. -Hemorragia Cerebral, Digestiva o Esofgica. -lcera
Pptica.
5.- OBSERVACIONES:
-En ancianos no mas de 50 mg./da (inicialmente). -En infu. iv.
proteger de la luz. -Embarazo: Contraindicado sobre todo en 3
trimestre. En -Lactancia, contraindicaco

70-DIAZEPAM
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Valium, Diazepam, (Amp. 10 mg./2 ml.) (Comp. 5 y 10 mg.) Stesolid
(Microenemas: 5 mg./2,5 ml. y 10 mg./2,5 ml.)
2.- INDICACIONES:
-Ansiedad (no deben usarse solas por riesgo de suicidio). -Deprivacin
alcohlica. Convulsiones (Status epilptico, Ttanos, Preeclampsia o
Eclampsia.). -Relajante muscular.
-Antiespasmdico (Parlisis cerebra, Paraplejia, Atetosis, Sndr. Rigidez
Generalizada.).
3.- POSOLOGIA:
-En Convulsiones: Adultos: DI: iv. lenta 0,2 mg./kg. a 2-5 mg./min. =
(0,04 ml./kg. a 0,4-1 ml./min.) (Repetir DI. cada 10 min. hasta parar
convulsiones o hasta Dmx. 40 mg. o 8 ml.) (Preparacin: si en vez de
bolo lento, se hace en Infu. iv. poner DI. en SSF hasta 100 ml. a 600 o
1500 ml./h.) Pediatra: DI: va rectal. 0,5 mg./kg. o DI: iv. 0,2-0,5
mg./kg. Dmx. 10 mg. (Preparacin: DI. en SSF. hasta 10 ml. a no mas
de 2 mg./min.). -En Estados de ansiedad media/grave: -Deprivacin
alcohlica -Ttanos: -Espasmos musculares: Adultos: im. o iv. bolo
lento. 0,028-0,142 mg./kg. (Repetir a las 3-4 h. si es necesario.)
-En Premedicacin una hora antes de inducir a la anestesia. Preeclampsia y eclampsia: Adultos: DI: im. 0,142-0,285 mg./kg.
Pediatra: DI: im. 0,1-0,2 mg./kg. = 0,02 0,04 ml./kg.). -Induccin
anestsica: Adultos: DI: iv. 0,2-0,5 mg./kg.= 0,040,10 ml./kg. Sedacin previa a intervenciones: Adultos: DI: iv. 0,142-0,428 mg./kg.
=0,0280,085 ml./kg. (o 5 mg inicialmente y cada 30 segundos 2,5 mg
hasta cada de los prpados a media pupila). Pediatra: DI: iv. 0,1-0,2
mg./kg. iv.)
4. CONTRAINDICACIONES:
-Miastenia gravis, -Hipersensibilidad a las benzodiazepinas, insuficiencia respiratoria severa, -Sindr. de apnea del sueo, Insuficiencia heptica severa, -Intoxicacin alcohlica.
5.- OBSERVACIONES:
-Embarazo: Categora D. -Lactancia: Excrecin lctea.
-Reducir dosis en ancianos y en Insuf. Heptica e IR.
-Antdoto: Flumazenilo (Anexate)

71-DIAZXIDO
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Hyperstat (Amp. 300 mg./20 ml.) (1 ml = 15 mg).
2.- INDICACIONES:
-HTA Maligna, -Toxemia Gravdica, Emergencias Hipertensivas
3.- POSOLOGIA:
-Adultos: DI: iv en Bolo (sin diluir) rpido (< 30 seg): 1-3 mg./ kg.
(Dmx. 150 mg.). Repetir a los 5-15 min. si es necesario o iniciar
perfusin iv. a 7,5 30 mg./min (Hasta respuesta de PAD <100 mmHg.)
-Pediatra: DI: iv. Bolo (sin diluir) rpido de 1-3 mg./Kg. Repetir a los
30 min. si es necesario.
4.- CONTRAINDICACIONES:
-SCA, cardiopata isqumica, aneurisma de aorta, anticoagulacin,
hemorragia cerebral, descompensacin de DM, feocromocitoma.

URGENCIAS Y EMERGENCIAS EXTRAHOSPITALARIAS GUETS - SESCAM

GUA FARMACOLGICA

5.- OBSERVACIONES:
-Embarazo: Categora C. -Lactancia: no hay datos de su excrecin en
leche, valorar riesgo / beneficio. -Control estricto de T.A. -No
administrar por va IM, SC. Evitar extravasacin (Sol. irritante).

WPW, - Sindr. Seno Carotdeo. -TV. Trat previo Bloqueantes Beta

Adrenrgicos.
5.- OBSERVACIONES:
Sin datos sobre dosis txicas. No hay antdoto. Se puede administras en
sobredosificacin, Gluconato Clcico y Glucagn.

72-DICLOFENACO

75-DIMENTINDENO o DIMEPIRINDENO

1.- NOMBRES COMERCIALES Y PRESENTACIONES:

Dolotren, Voltarn, Diclofenaco. (Amp. 75 mg./3 ml.) (Comp. 50, 75,
100 mg.) (Sup. 100 mg.)
2.- INDICACIONES:
-Dolores agudos e intensos en: -Formas inflamatorias y degenerativas
del reumatismo, -Gota, -Clico Renal, -Postraumticos, Posquirrgicos, -Lumbalgia. -Artritis Reumatoide.
Dismenorrea
Primaria. Cefaleas. -Fiebre
3.- POSOLOGIA:
-Adultos: DI: im. 75 mg./24h. Casos graves: DI: im. 75 mg./12 h. Pediatra: DI: im. 0,25-1,5 mg./kg. (Dmx: 1-3 mg/Kg. /24 h.) repartido
de 2 a 4 dosis da.) (No se recomienda en <14 aos., pero si no hay
otra posibilidad se puede usar la anterior dosisi))
4.- CONTRAINDICACIONES:
-Hipersensibilidad a AINES, -Patologas gastrointestinales activas, -Enf.
de Crohn, -Colitis ulcerosa, -Coagulopatas, -Hemorragias.
5.- OBSERVACIONES:
-Embarazo: 1 y 2 trimestre categora B. En 3 trimestre categora D.
-Lactancia: se excreta en leche materna.
Precaucin en Insuf. Heptica e IR. No administrar iv.

1.- NOMBRES COMERCIALES Y PRESENTACIONES:

Fenistil (Amp. 4 mg./4 ml.) (Compr. 1 mg.)
2.- INDICACIONES:
-Reacciones alrgicas Agudas, -Profilaxis para evitar Reaccin por
Suero Hemoce o Sueros Sustitutos del Plasma.
3.- POSOLOGA:
-Reacciones alrgicas Agudas: DI: iv. 0,05-0,1 mg./kg. (o 1 a 2 amp. en
30 seg.). -Profilaxis de Reaccin del Suero de Plasma y Hemoc: DI:
iv. 1 ml. o 1 mg./10 kg. lentamente en 2 min. (agregar antes o despus
una Cimetidina iv.)
4.- CONTRAINDICACIONES:
-Evitar en menores de 12 aos. Precaucin: Glaucoma, Retencin
Urinaria, Hipertrofia de prstata.
5.- OBSERVACIONES:
-Embarazo: pocos estudios, usar en 1 trimestre si es necesario. Lactancia: se excreta poca cantidad, no recomendable. -No tiene
antdoto.

73-DIGOXINA
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Digoxina, Lanacordin, (Amp. 0,25 mg./1 ml. y 0,25 mg./2 ml.) (Sol. oral
0,25 mg./5 ml. y 0,5 mg./ml.) (Comp. 0,25 mg.)
2.- INDICACIONES:
-ICC, -Arritmias Supraventriculares (TSPV, FA, Flutter Auricular)
3.- POSOLOGIA:
-Adultos: DI. iv. 3,5-7,1 mcg./kg. (Preparacin: 1-2 amp. (0.25 0,5
mg.) en SSF. hasta 10 ml. (25 50 mcg./ml.) en bolo en 2-3 min. que
puede repetirse a los 60 min. hasta Dmx de impregnacin (28
mcg./kg./da) 1-2 mg./da.
-Pediatra:(Preparacin: iv. 0,25 mg. en SSF. hasta 10 ml. (25 mcg./ml.)
En RN. DI: iv. 15-30 mcg.(kg. o 0,6-1,2 ml./kg. En Nios >2 sem. a <2
aos: DI: iv. 30-50 mcg./kg. 1,2 -2 ml./kg. En Nios >2 aos a <10
aos: DI: iv. 15-35 mcg./kg. 0,6-1,4 ml./kg.
4.- CONTRAINDICACIONES:
-TV, -FV, -Sndr. WPW, -B.A-V, -Insuf. Coronaria (infarto o angina), Pericarditis Obstructiva, -Cardiomiopata Obstructiva.
5.- OBSERVACIONES:
-Embarazo: Categora C. -Lactancia: Se excreta por leche materna. Precaucin en IR. -Intoxicacin grave si se ingiere 2-3 g. vo. -Antdoto:
FAB (Anticuerpos Antidigoxina).

74-DILTIAZEM
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Masdil, Angiodrox, Cardiser, Dinisor, Diltiwas, Lacerol, ( Vial 25 mg./4
ml.) (Comp. 60, 120, 180, 240 y 300 mg.)
2.- INDICACIONES:
-TPSV, -FA, -Flutter Auriculares, -Cardiopata Isqumica, -HTA, Prevencin Vasoespasmo Intervencin Injerto Arterial Ciruga
Cardiada.
3.- POSOLOGIA:
Adultos:-TPSV, FA, Flutter Auricular: DI: iv. 0,25 mg./kg. 0,04 ml./kg.
en 2 min. Si no respuesta en 15 min. segundo bolo de 0.35 mg./kg.
0,056 ml./kg. en 2 min. En FA y Fllutter Auricular: DM: Infu. iv. 5-15
mg./h. 0,28-0,57 ml./kg./h. (Preparacin: DM: 25 mg. en SSF. hasta
100 ml.) -Cardiopata isqumica: DI: vo. 30 mg./6 h. (Dmx. 360
mg./da. HTA: DI: vo. 30 mg./8 h.
Pediatra: No establecido su seguridad y eficacia.
4.- CONTRAINDICACIONES:
-Shock Cardiognico, -Hipotensin, -Bradiarritmias, -B,A-V. Sindr.

76-DIMERCAPROL
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Dimercaprol, BAL, Sulfactin (Amp. 100 mg./2 ml.; 200 mg./2 ml.)
2.- INDICACIONES:
Intoxicacin por Arsnico, Mercurio, Plomo, Oro, Cobre, Nquel
3.- POSOLOGA:
DI: im. 2,5-5,0 mg./kg./4 h.
4.- CONTRAINDICACIONES:
-Contraindicada en dermatitis exfoliativa, -Embarazo, -Insuficiencia
heptica, y -Dficit de G6PDH. -Evitar en intoxicacin por Cadmio,
Hierro y Selenio.
5.- OBSERVACIONES
-Embarazo: Evitar su uso. Si no hay otra opcin usar con precaucin.
En Lactancia: Es de bajo riesgo, ya que per se debido a la intoxicacin
no est indicada la lactancia, usar por tanco con precaucin. -Produce
un marcado aumento de tensin arterial, cefaleas, quemazn
peribucal. -Proteger de la luz. -Conservar a temperatura ambiente
(<25 C).

77-DINOPROSTONA PROSTAGLANDINA E2
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Prepidil, Propess, Prostaglandina E2 (Gel jeringa 0,5 mg./2,5 ml.)
(vulos, Comp. 0,5 mg.) ( Amp. 10 mg./ml.)
2.- INDICACIONES:
-Induccin Parto a Termino; -Aborto -Mola Hidatiforme; (Uterotnico)
3.- POSOLOGA:
-Induccin Parto a Trmino: DI: vo. 0,5-1,0 mg./h.
-Maduracin Cervical del Cuello Uterino: DI: Gel Intracervical. Expulsin del feto en caso de aborto o la expulsin de la Mola
Hidatiforme: DI.: Infu. iv. 0,0025-0,0050 mg./min./durante 30 min.
(Preparacin: 10 mg. en SSF. o SG. hasta 500 ml. (0,02 mg./ml.), Se
coge 10 ml. = 0,2 mg. y se disuelve en SSF. o SG. hasta 100 ml. (0,0020
mg./ml.)). Administrar 1,25-2,50 ml./min.= 75-150 ml./h. durante 30
min.
4.- CONTRAINDICACIONES:
-Si ha tenido previamente un parto por cesrea Si ha sufrido alguna
intervencin quirrgica en el tero.
-Si hay sufrimiento del feto, -Si tiene mala postura del feto, Antecedentes de un parto difcil, -Mujeres que han tenido 6 ms
embarazos anteriores, -Enf. inflamatoria de la pelvis o infeccin en la
pelvis. -Problemas de coagulacin. Enf. pulmonar o cardiaca no
controlada.
5.- OBSERVACIONES:
Conservar entre 2 a 8C. Proteger de la Luz.

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URGENCIAS Y EMERGENCIAS EXTRAHOSPITALARIAS GUETS - SESCAM

78-DIPHOTERINE
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Diphoterine. (Tipos de envases: Lis, Lavaojos porttil, Estacin LMDAS,
Micro DAP, Mini DAP, DAP)
2.- INDICACIONES:
Quemaduras Qumicas
3.- POSOLOGA:
Modo de empleo: DI: uso tpico: -Envase Lis (Verter 50 ml. en los
primeros 10 seg. en la lesin). -Lavaojos Porttil (Verter 500 ml. en el
primer min. en los ojos). -Estacin LMDAS (Verter 500 ml. en el primer
min. en cualquier lesin). -Micro DAP (Verter 100 ml. en el primer
min. en una mano). -Mini DAP (Verter 200 ml, en el primer min. en un
brazo). -DAP (Verter 5 litros en el primer min. en el cuerpo)
4.- CONTRAINDICACIONES:
No hay
5.- OBSERVACIONES:
No es eficaz en el Ac. Fluorhdrico, ni Fsforo Blanco (En cuyo caso se
usa el Hexafluorine, no descrito en esta Gua Farmacolgica). Usar
AfterWashii, (no descrito en esta Gua Farmacolgica) tras lavado con
Diphoterine.

79-DOBUTAMINA
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Dobutrex, Dobucor (Amp. 5 ml./250 mg. y 20 ml./250 mg.)
2.- INDICACIONES:
-Insu ciencia cardiaca severa. -Hipotensin y Shock. Alternativa a la
Dopamina. -Pruebas de esfuerzo y Ecografas de estrs. allternativa al
ejercicio. -Durante la Ciruga Cardiaca.
3.- POSOLOGA:
Adultos: DI: Infu. iv. 2.5-10 mcgr./Kg./min. Dmx: 20-40
mcg./Kg./min. (Preparacin: 250 mg. en SFF. hasta 250 ml. (1 mg./1
ml.) Infu. mnima = 0,15 ml./kg./h. Infu. mxima = 2,4 ml./kg./h.
4.- CONTRAINDICACIONES:
Miocardiopata hipertr ca con estenosis subartica
5.- OBSERVACIONES:
-No mezclar con: Bicarbonato, Heparina, Penicilina, o Cefalosporinas. Embarazo: No recomendado, -Lactancia:, No encontramos estudios.

80-DOPAMINA
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Dopamina Fides . (Amp. 200 mg./10 ml. (1 ml.= 20 mg.))
4.- INDICACIONES:
-Aumentar el Gasto Cardiaco y mejorar la perfusin renal en estados de
Shock secundarios a: -IAM, -Sepsis, -Traumatismos, -IR. Aguda, Miocardiopata Dilatada, -Ciruga Cardiaca, -ICC. -EAP. Control de la
Presin de Perfusin Cerebral (PPC).
3.- POSOLOGIA:
-Adultos:. DI: Infu. iv. 3-5 mcg./Kg./min. o 0,225-0,375 ml./kg./h. Si no
mejora, aumentar de 1-4 mcg./kg./min. o 0,075-0,300 ml./kg./h. cada
1030 min. hasta una Dmx. de 2050 mcg./Kg./min. o 1,50-3,75
ml./kg./h. o hasta objetivo Trat. PAS >90 mmHg y Diuresis >30 ml./h.
(Preparacin: 200 mg. en SG. hasta 250 ml. (800 mcg./ml.)
-Peditrico: DI: Infu. iv. 60 mcg./Kg./h. 0,3 ml./kg./h. (Preparacin: 20
mg. en SG. hasta 100 ml. (200 mcg./ml.)) 4.- CONTRAINDICACIONES:
-Insuficiencia Coronaria. -Miopata Hipertrfica Obstructiva (MHO). Feocromocitoma. -Taquiarritmias. -TV/FV.
5.- OBSERVACIONES:
-No utilizar conjuntamente (mismo envase) con Bicarbonato o
sustancias alcalinas. -Fotosensible.
-Embarazo:-Categora C. -Lactancia:-Precaucin

81-EDROFONIO
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Anticude, Tensiln, (Amp. 10 mg./ml.)
2.- INDICACIONES:
Antdoto de Inhibidor de relajacin Muscular, sobre todo curarizantes.
Se utiliza como prueba diagnostico diferencial de Miastenia Grave.

930

GUA FARMACOLGICA

Diagnstico y Trat. de TSV.(Si es por intoxicacin digitlica mejora).

3.- POSOLOGA:
Adultos:-Reversin del bloqueo neuromuscular: DI: iv. lenta 0.5-1
mg./kg., Dmx. 40 mg. (Compensar efectos muscarnicos con Atropina
7-10 mcg./kg. administrandose al menos 3 min. antes que el
Edrofonio). -Valoracin o prueba diagnstica de la crisis miastnica o
miastenia grave. DI: iv. lenta, 0,25 mg./kg. o 1 mg cada 2 min. hasta la
desaparicin de los sntomas (o Dmx. 10 mg.). -TSV. DI: iv lenta, 2
mg. cada 2 min. hasta que disminuya la frecuencia cardiaca (Dmx. en
10 min.).
-Pediatra: slo en Miastenia gravis, igual dosis/kg. adultos.
4.- CONTRAINDICACIONES:
Peritonitis. -Obstruccin intestinal. Obstruccin del tracto urinario.
5.- OBSERVACIONES:
En caso de sobredosis de Edrofonio, administrar Atropina (iv. 10
mcg./kg. cada 2-3 min.) y Pralidoxina (iv.15 mg./kg. en 2 min.). En
Embarazo: Categora C. Lactancia: Se ignora si es excretado en la
leche. Precaucin

82-EDTA DICOBALTICO
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Kelocyanor (Amp. 300 mg./20 ml.)
2.- INDICACIONES:
Intoxicacin Cianuro
3.- POSOLOGA:
Adultos: DI. iv. 600 mg. (o 300 mg. durante 1 min., se puede repetir a
los 5 min. con otra dosis de 300 mg.)
4.- CONTRAINDICACIONES_
Evitar en personas no intoxicadas.
5.- OBSERVACIONES:
Tras cada dosis de Edta Dicobltico, se puede dar 50 ml. de
S.Glucosado al 50%. (Sin encontrar datos sobre su uso en Embarazo y
Lactancia.)

83-EFEDRINA
1.-NOMBRES COMERCIALES Y PRESENTACIONES:
Efedrina. (Amp. 50 mg./1 ml. al 5 %.)
2- INDICACIONES:
-Hipotensin, -Shock, -Hemorragias o -Asma bronquial (-Espasmo
bronquial en ataque agudo de asma bronquial, -Bronquitis espstica, Enfisema pulmonar, -Status Asmtico y -Asma crnica severa.) -Es til
en la reversin de la hipotensin inducida por anestsicos e
intubacin endotraqueal. Trat. Coadyuvante de: -Jaquecas, Urticaria, -Eczema, -Neurodermitis, -Exantemas sricos, -Edema de
Quincke. -Va oral est indicada en el Trat. de:
(-La Rinitis vasomotora, -Sinusitis aguda, -Fiebre del heno, -Congestin
sinusal.) -Como estimulante del SNC, en el Trat. de: (-La Narcolepsia y
-Estados depresivos.)
3-POSOLOGIA:
-Adultos: DI: iv. lenta 2.5-10 mg. repetir DI. pasados de 5 a 10 min.,
hasta que remonte la Hipotensin o hasta Dmx. 25-50 mg./24 h.
(Preparacin: 50 mg. en SSF. hasta 10 ml. en jeringa, (1 ml.=5 mg.)
(Alternativas: DI: im. 25-50 mg. o DI: sc. 25-50 mg.) -Para congestin
nasal: DI: IntraNasal (in.) al 0,5 o 0,6% cada 4 h.
-Peditricos: DI: im. 0,3 a 0,4 mg./Kg. cada 4 a 6 h. Para Congestin
Nasal: DI: in. Al 0,5-0,6%
4-CONTRAINDICACIONES:
Hipersensible a Efedrina, Adrenalina y Simpaticomimticos. -Anestesia
inhalatoria con Halotano. -Hipertensin arterial severa, -Enf. coronaria
severa, -Miocardiopata dilatada, -Taquicardia, -Glaucoma de ngulo. Cerrado, -Feocromocitoma, -Hipertiroidismo, -Neurosis, -En pacientes
con uso de IMAO.
5.-OBSERVACIONES:
Se desaconseja Va iv. en nios <6 aos. Embarazo: Categora C,
Atraviesa la barrera placentaria. Lactancia: Se desaconseja la
utilizacin

URGENCIAS Y EMERGENCIAS EXTRAHOSPITALARIAS GUETS - SESCAM

GUA FARMACOLGICA

84-ENALAPRIL

87-ESOMEPRAZOL

1.- NOMBRES COMERCIALES Y PRESENTACIONES:

Renitec (Comp. 5, 10, 20 mg.) (Amp. 1 mg./1 ml.)
2.- INDICACIONES:
-HTA. -Insuficiencia Cardiaca.
3.- POSOLOGA:
Adultos: -HTA: DI: iv. lento 1 mg., en >5 min. si no mejora en 1 a 2 h.
repetir 1-2 mg. -ICC: DI: iv. 0,5 mg., si no mejora en 1 h. repetir con 0,5
a 1 mg.
4.- CONTRAINDICACIONES:
-Alergia a los IECA. -Angioedema. -Transplante Renal reciente. -2 y 3
trimestre de embarazo.
5.- OBSERVACIONES:
-Se puede administrar en infusin en 50 ml. de diluyente compatible,
a pasar en 1 h. Administracin Pediatrica sin datos (No evaluado). Embarazadas, Categora C. -Lactancia Evitar.

1.- NOMBRES COMERCIALES Y PRESENTACIONES:

Nexium, Axiago, Esomeprazol, Gletop, Esoz (Comp. 20, 40 mg.) (Vial
40 mg.)
2.- INDICACIONES:
-Protector Gstrico. -Esofagitis erosiva por reflujo. -Cicatrizacin de
lceras gstricas asociadas a AINE. - Trat. continuacin de prevencin
del resangrado por lcera pptica. Sindr. Zollinger-Ellison. -lcera
Gastro duodenal sangrante.
-Prevencin del resangrado tras
endoscopia teraputica realizada en hemorragia aguda por lcera
Pptica.
3.- POSOLOGA:
Adultos:-Esofagitis por reflujo. DI: iv. 40 mg./24 h.
-Cicatrizacin de lceras gstricas asociadas a AINE, y prevencin de
lceras gstricas y duodenales asociadas a AINE en pacientes de
riesgo. DI: iv. 20-40 mg./24 h. en 3 min. o en Infu. iv. en10 a 30 min. Prevencin del resangrado tras endoscopia teraputica realizada en
hemorragia aguda por lcera pptica. DI: Infu. iv. 80 mg. en 30 min.,
Seguidos de DM: Infu. iv. 8 mg./h. durante 72 h. -lcera sangrante:
DI: iv. 40 mg. en 3 min. Seguidos de DM: Infu. iv. 4 mg./h. durante 72
h. (Preparacin: 40 mg. en polvo del vial en 5 ml. de SSF. y si se da
Infu. iv. disolver los 5 ml. en SSF hasta 100 ml. (1 ml.=0,4 mg.)
Peditrica: En nios >1 ao: DI: iv. 0,5-1 mg./kg./da. (Dmx: 40
mg./24 h.) -En Esofagitis por Reflujo: <11 aos: -Si Pesa >20 kg. DI: iv.
10-20 mg./24 h. -Si Pesa <20 kg. DI: iv. 10 mg./24 h.
4.- CONTRAINDICACIONES:
-Hipersensibilidad a Benzimidazoles. -No tomar a la vez que
Atazanavir. -Precaucin en intolerantes fructosa o dficit de sacarasaisomaltasa. -Hepatopatas severas.
5.- OBSERVACIONES:
-En Insuf. Heptica Grave, dar slo la mitad de la dosis en la DM. En
Embarazadas (Categora B). En Lactancia Evitar. -Proteger al paciente
de la Luz solar.

85-ENOXAPARINA SODICA
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Clexane. Decipar. (Amp. 20 mg.=2000 UI./0,2 ml.; 40 mg.= 4000 UI./0,4
ml. (1 ml.=10000 UI.) (Jeringas: 20, 40, 60, 80, 100 mg. (1 ml.=10000
UI.) 90, 120, 150 mg.(1 ml.=50000 UI.)
2.- INDICACIONES:
-Trombosis Venosa Profunda. -Angina Inestable. -IAM -Profilaxis del
Tromboembolismo en Ciruga general y Ortopedia.
3.- POSOLOGIA:
-Adultos: En Riesgo elevado de trombosis: DI: sc. 40 mg./24 h. En
Riesgo bajo de trombosis: DI: sc. 20 mg./24 h. En TVP, Angina
Inestable, IAM: DI: sc. 1 mg./kg./12 h. 1,5 mg./kg./24 h.
-Pediatra: DI: sc. 1-1,5 mg./kg./12 h. (Poca experiencia.).
4.- CONTRAINDICACIONES.
-Hemorragias intensas activas o en condiciones de alto riesgo. Trombocitopenia
5.- OBSERVACIONES.
-Conservar en envases hermticos y a temperatura ambiente. -No debe
administrarse por va im. -No se debe mezclar con otros frmacos. Embarazo: Categora B. Lactancia: No hay estudios; -IR.: reducir dosis.
Insuf. Heptica: reducir dosis. -Tiene antdoto: Protamina: 1 mg.
neutraliza 100 UI. de Enoxaparina

86-ESMOLOL
1.-NOMBRES COMERCIALES Y PRESENTACIONES:
Brevibloc (Bolsa 2,5 g./250 ml. SG. (1 ml.=10 mg.) (Vial 100 mg./10 ml.)
2.- INDICACIONES:
-Arritmias Supraventriculares: (Control de la frecuencia ventricular en
fase aguda de: -FA.,-Flutter Auricular, -Taquicardia Auricular
Automtica y -TSV por reentrada.)
-Control de la HTA peri- y postoperatoria en la ciruga cardiaca. Diseccin Aguda de Aorta. -Cardiopata Isqumica: -En fase aguda del
IAM y -Angina Inestable.
-(Se puede utilizar incluso con EPOC)
3.- POSOLOGIA:
-Adultos: DI: iv. 500 mcg./kg. o 0,05 ml./kg. en 1 min. DM: Infu. iv. 50200
mcg./kg./min. o 0,3-1,2 ml./kg./h. (-En Arritmias
supraventriculares: DI: iv. 571 mcg./kg. o 0,0571 ml./kg. en 1 min. DM:
Infu. iv. 57-171 mcg./kg. o 0,32-1,02 ml./kg./h. -En HTA: DI: iv. 1,141,42 mg./kg. o 0,114-0,142 ml./kg. en 1 min.
-Peditrica: DI: iv. 200-500 g./Kg. o 0,02-0,05 ml./kg. en 1 min. DM:
Infu. iv. 50-300 g./Kg./min. o 0,3-1,8 ml./kg./h. Aumentando cada 5
min. si no mejora, 0,3 ml./kg./h. sobre la dosis anterior.
4.- CONTRAINDICACIONES:
-Bradicardia sinusal, -Bloqueo cardiaco -Fallo cardiaco, -enf.
Broncoespstica (slo precaucin).
5.- OBSERVACIONES:
-Embarazo: Categora C. -LACTANCIA: Sin datos.

88-ESTREPTOQUINASA
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Streptase, Kabikinase. (Vial 250.000 UI./5 ml. SSF; 750.000 UI. /5 ml.
SSF.)
2.- INDICACIONES:
-IAM: (Preferentemente ms recomendado en los casos: -en persona
>75 aos o con IAM de ms de 4 h. de evolucin y menos de 6 h.) Tromboembolismo Arterial. -Trombosis Venosa Profunda. -TEP.
3.- POSOLOGIA:
-IAM: DI: Infu. iv. 21.428 UI./kg.=0,14 ml./kg. (con amp. 5 ml./750.000
UI.) (Preparacin: Dosis en SSF. hasta 100 ml. a 200-100 ml./h.)
Durando 30 a 60 min.
-Enf. Tromboemblica: -(TVP) o -(TEP) DI: Infu. iv. 3571 UI./kg. 0,07
ml./kg (con amp. 5 ml./250.000 UI.) (
Presentacin: DI. en SF.
hasta 100 ml. a 200-100 ml./h.) Durante 30 a 60 min. Seguir con DM:
Infu. iv.1428 UI./kg./h. 0,02 ml./kg./h. (con amp. 5 ml./250000 UI.)
(Preparacin: DM. para 4 h. en SF. hasta 100 ml. a 25 ml./h.)
4.- CONTRAINDICACIONES:
-Alrgicos a Estreptoquinasa, Anistreplasa o Albmina.
-Hemorragia potencial, -Ditesis hemorrgica, -lceras en los ltimos
6 meses, -Traumatismo o procedimiento traumtico reciente (10 das),
como por ejemplo ciruga, accidente cerebrovascular previo (hasta 3
meses),
-HTA severa o mal controlada. -No debe repetirse el tratamiento
durante los 3 a 6 meses siguientes debido a la formacin de
Anticuerpos Antiestreptoquinasa. (Utilizar con precaucin en: Defectos de la vlvula mitral. -Fibrilacin auricular -En pacientes que
estn siendo sometidos a terapia anticoagulante o antiagregantes
plaquetarios.)
5.- OBSERVACIONES:
-Disolver el contenido del vial en 5 ml de agua para inyeccin,
evitando la formacin de espuma. -No usar catteres rgidos. -En la
reconstitucin no agitar. -Compatible con SSF. y SG. -Evitar punciones
arteriales e inyecciones intramusculares. -En Pediatra: Eficacia y
seguridad no establecida. En Embarazo: Categora C. En Lactancia: Se
desconoce.

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URGENCIAS Y EMERGENCIAS EXTRAHOSPITALARIAS GUETS - SESCAM

89-ETOMIDATO
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Hypnomidate. Etomidato (Amp. 20 mg./10 ml. (1 ml.=2 mg.)
2.- INDICACIONES:
-Inductor anestsico de eleccin en pacientes inestables: (Cardiovasculares, -Con Hipovolemia, -Con Asma, -Con aumento de la
PIC Hipertensin intracraneal) Sedacin.
3.- POSOLOGIA:
-Adultos: -Induccin Anestesia: DI: iv. 0,2-0.4 mg./Kg. o 0,1-0,2 ml./kg.
entre 15 -60 seg. DM: inf.. iv. 0.01-0,04 mg./Kg./min. 0,3-1,2
ml./kg./h. (Preparacin: DM para 1 h. en SSF. hasta 100 mll. a pasar a
100 ml./h.) -Sedacin: DI: iv. 60 mcg./kg. durante 10 min. (Preparacin:
DI en SSF. hasta 100 ml a 600 ml./h.). DM: Infu. iv. 5-7 mcg./kg./min. o
0,15-0,21 ml./kg./h. (Preparacin: DM. para 1 h. en SSF. hasta 100 ml. a
100 ml./h.)
-Peditrica: No se recomienda en <10 aos. Pero en caso de usarla. DI:
iv. 0,2-0,6 mg./kg. o 0,1-0,3 ml./kg. DM: iv. 0,1-0,2 mg./kg. segn
necesidad.
4.- CONTRAINDICACIONES:
Hipersensibilidad. Inmunodeprimidos. Precaucin con los pacientes
epilpticos
5.- OBSERVACIONES:
-Buena tolerancia hemodinmica. -No se recomienda en perfusin para
mantenimiento de la anestesia. -Embarazo: Categora C. -Lactancia: Se
excreta en la leche Evitar. En Insuf. Heptica: Reducir la dosis a la
mitad

90-FENILEFRINA
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Hidrocloruro de Fenilefrina Genfarma (Amp. 10 mg./ml.)
2.- INDICACIONES:
-Hipotensin, -Shock hipotensivo. -Hipotensin en Anestesia Epidural.
- Hipotensin inducida por frmacos.
3.- POSOLOGA:
-Adultos: DI.: sc. o im. 2-5 mg., que puede suplementar segn
respuesta con hasta 1-10 mg. DI: iv. lenta 100-500 mcg. en solucin
al 0,1% repitiendo segn respuesta tras 15 min. (Preparacin: 10 mg.
en SSF. o SG. hasta 500 ml. (1 ml.=20 mcg.) a 180 mcg./min. o 540
ml./h. reduciendo segn respuesta a 30-60 mcg./min. o 90-180 ml./h.
-Peditrica: DI: sc. im. 100 mcg./kg. o 0,01 ml./kg.
4.- CONTRAINDICACIONES:
-Pacientes en tratamiento con inhibidores de la MonoAminoOxidasa o
dentro de los 14 das despus de
haber interrumpido el tratamiento con este frmaco. -Hipertensin
grave. -Hipertiroidismo.
5.- OBSERVACIONES:
-Incompatible con lcalis, sales frricas, Fenitona de sodio y agentes
oxidantes. -En caso de intoxicacin: antdoto: Bloqueante de los
receptores -adrenrgicos, (Fentolamina, DI: iv. 5-60 mg. en 10-30
min. repitiendo si fuera necesario)

GUA FARMACOLGICA

hasta 100 ml. a 600 ml./h. Se puede repetir cada 10 15 min. hasta
que revierta la arritmia, aparezcan efectos secundarios o se acumulen
hasta 15 mg./kg. o 1000 mg.
-Peditricas: Estatus Epilptico y Crisis tnico-clnicas: DI: iv. 15-20
mg./kg. o 0,3-0,4 ml./kg. (Preparacin: DI. en SSF. hasta 50 ml. a 300
ml./h.) DM: iv. 5 mg./kg./da. o 1,6 mg./kg./8h. (Preparacin: 50 mg. en
SSF. hasta 10 ml. (1 ml.=5 mg.) Despus DM. o 0,33 ml./kg. en SSF.
hasta 50 ml. a 100 ml./h. Arritmias: DI: iv. 2-5 mg./kg. en 5 min.
(Preparacin: 100 mg. en SSF. hasta 10 ml. (1 ml.=10 mg.)) o 0,2-0,5
ml./kg en 5 min.
4.- CONTRAINDICACIONES:
-Bradicardia sinusal. -Bloqueo SinoAuricular,
5.- OBSERVACIONES:
-Debe administrarse lentamente. Embarazo: Categora D. -Lactancia:
Aunque se excreta por la leche, si se usa poner especial control clnico.
No se recomienda ninguna otra solucin a la de SSF. para infusin
intravenosa debido a la poca solubilidad del medicamento a pH
inferiores a 10

92-FENOBARBITAL
1.-NOMBRES COMERCIALES Y PRESENTACIONES.
Luminal. Luminaletas. Gardenal. Gratusminal. Epilantin, Comital L.
(Amp. 200 mg./1ml.) (Comp. 15, 50 y 100 mg.) (Sol. Gotas 126 mg./ml.)
2.- INDICACIONES:
(Anticonvulsivante de 2 lnea). -Convulsiones, -Epilepsia: (-Estatus
Epilptico, -Crisis Generalizada Tnico-Clnicas, - Crisis Parcial simple.)
Trat a corto plazo del insomnio.
-Induccin y mantenimiento de la anestesia.
3.- POSOLOGIA:
Adultos: -Control de emergencia de convulsiones: DI: iv. 10-20
mg./kg. 0,05-0,1 ml./kg. a veloc. max. de 50 mg./min. (Preparacin:
DI en SG. hasta 100 ml. a 150 ml./h.). -Estatus epilptico: DI: iv. 15
mg./Kg. (diludo 1/10) (Preparacin: DI en SG. hasta 100 ml. a 300
ml./h.)
Peditrica: -Anticonvulsivante:(Preparacin: 200 mg. en SG. hasta 10
ml. (1 ml. = 20 mg.)) En Nios: DI: iv. 3-5 mg/kg./da repartidos en 1 o
2 dosis. En Lactantes (hasta 10 kg.): DI: iv. 5-8 mg/kg./da repartidos
en 1 o 2 dosis.). En Neonatos: (hasta 5 kg.): DI: iv. 2-5-mg./kg./da
repartidos en 1 o 2 dosis. -Estatus epilptico: DI: iv.15-20 mg./kg.
(Dmx.= 300 mg.) en una dosis, (Preparacin: 300 mg. en SF. hasta 10
ml. (1 ml. = 30 mg.). Seguir con DM: iv. 5-10 mg/kg./dosis A intervalos
de 20 min. (Dmx.: 40 mg./kg.).
-Hipntico o sedante: DI: iv. 2-3 mg./kg. (Repetir a las 8 h.)
4.- CONTRAINDICACIONES:
-Alergia al fenobarbital o a los barbitricos, -EPOC, -Estados Depresivos,
-Hepatopata grave, -Porfiria.
5.- OBSERVACIONES:
-La utilizacin iv. requiere monitorizacin. -Administrar solo. No mezclar
con otros frmacos. Embarazo: categora D.
-Lactancia:
Contraindicada. En Insuf. Heptica. e IR. ajustar la posologa.

93-FENTANILO
91-FENITOINA
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Epanutin, Neosidantoina, Sinergina, Fenitona. (Amp. 100 mg./2 ml.;
250 mg./5 ml. (1 ml = 50 mg)) (Comp. 100 mg.).
2.- INDICACIONES:
-Crisis Epilpticas tnico-clnicas generalizadas. -Crisis parciales simples
o complejas. -Arritmias Auriculares y Ventriculares especialmente las
causadas por Intoxicacin digitlica.
3.- POSOLOGIA:
-Adultos: Estatus Epilptico y Crisis tnico-clnicas. DI: Infu. iv. 18-20
mg./kg. o 0,36-0,40 ml./kg. (Preparacin: DI. en SSF. hasta 250 ml.) a
pasar en 20 30 min. o a 500-750 ml./h. (No superar los 50 mg./min.).
(Dmx. 1500 mg.) DM: Infu. iv. 4-6 mg./kg./da (Repartida en 4 dosis)
o 1-1,5 mg./kg./6 h. durante 30 min. cada vez. (Preparacin: 2 ml. o
100 mg. en SF. hasta 10 ml. (1 ml. = 10 mg.), Despus DM. o 0,1-0,15
m./kg. en SSF. hasta 100 ml. a 200 ml./h.
Arritmias: DI: Infu. iv. 0,71-1,42 mg./kg. (Preparacin: 100 mg. en SSF.
hasta 10 ml. (1 ml.=10 mg.). Despus DI: 0,071-0,142 ml./kg. en SSF.

932

1.- NOMBRES COMERCIALES Y PRESENTACIONES:

Fentanest (Amp. 0,15 mg./3 ml. (1 ml.=50 mcg.)).
2.- INDICACIONES:
-Dolor en Politraumatizado: (-En situaciones inestables es
hemodinamicamente, -En Broncoespasmo). -Complemento anestsico
(asociado a Benzodiacepina)-Sedoanalgesia en la induccin a la
anestesia. -Durante la ventilacin mecnica.
3.- POSOLOGIA:
-Adultos: En Dolor: DI: iv. en bolo: 1-2-3 mcg./kg. ( 0,02-0,04-0,06
ml. de Fentanilo)(Preparacin: 2 amp. Fentanilo en SF. hasta 20 ml. (1
ml. = 15 mcg.)) Administrar: Una vez escogida la dosis, repartirla en 3
tiempos. 3,3 ml. (1 dosis), si no responde, a los 3 min. dar la mitad de
lo que quede de dosis (2 dosis), si sigue sin responder, dar lo que
queda de la dosis escogida (3 dosis). -Se puede repetir cada 15 min.
este ciclo o pasar a DM. 1-4 mcg./kg./h. 0,02-0,08 ml./kg./h.
(Preparacin: 2 amp. Fentanilo en SF. hasta 100 ml. (1 ml. = 3 mcg.).
Como Coadyuvante en Induccin de Anestesia: DI: iv. 2-15 mcg./kg.
en bolo. Sin dilucin. Asociacin con un hipntico (Benzodiacepina)

URGENCIAS Y EMERGENCIAS EXTRAHOSPITALARIAS GUETS - SESCAM

(Dmx.: 50 mcg./kg. raramente) -Repetir la misma dosis cada 2-3 min.
-Hasta el efecto deseado.
-Peditrica: En Dolor: DI: iv. 1-2 mcg/kg (Sedoanalgesia
prolongada)(Preparacin: 1 amp. en SF. hasta los 20 ml. ( 1 ml. = 7,5
mcg.). Previamente Premedicacin Atropia 20 mcg./kg. DM: Infu. iv. 25 mcg./kg./h. (Preparacin: 2 amp. en SF. hasta 100 ml. (1 ml. = 3
mcg.) a 0,66-1,66 ml./kg./h.)
4.- CONTRAINDICACIONES:
No recomendado en: -Nios <10 aos, -Insuf. Heptica. Asma.
EPOC. Adenoma de Prstata. Bradiarrtmias. Hipotiroidismo.
Lesin Intracraneal. Hipertensin Intracraneal. TCE.
5.- OBSERVACIONES:
-Embarazo: Categora C. En parto y cesrea puede producir depresin
respiratoria al RN. -Lactancia: Se excreta en leche materna. Es
compatible, interrumpir lactancia 4-6 h. tras de la administrar el
frmaco -Si se usan dosis altas, debe administrarse simultneamente
un relajante muscular, para evitar la rigidez muscular marcada. Antdoto: Naloxona: 04 mg. en bolo iv. cada 5 min. segn respuesta.
Mximo 10 mg. Fotosensible

94-FENTOLAMINA
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Regitine, Vasomax, Oraverse (Amp. 10 mg./ml. 400 mcg/1,7 ml.)
2.- INDICACIONES:
-Intoxicacin por: (-Cocana, -Anfetamina, -Norepinefrina, -Fenilefrina,
-Adrenalina y otras Aminas simpaticomimticas, -Pralidoxima, -IMAO, Tiramina. (Para tratar sus efectos vasoconstrictores e HTA)) Prevencin o trat. de la Dermatonecrosis secundaria a la
extravasacin de drogas con efectos alfa-adrenrgicos.
-(HTA.
Diagnstico del feocromocitoma).
3.- POSOLOGA:
-Adultos: Por Intoxicacin e HTA. DI: Infu. iv. 5-20 mg. en 15-20 min.
Repetir cada 2 a 4 h. si es necesario y segn controles. Por
Extravasacin de drogas vasopresoras: DI: Infiltrar el rea con una
pequea cantidad (1 ml.) de solucin (Preparacin: 5-10 mg. en SG.
hasta 10 ml.) en las primeras 12 h. de la extravasacin.
-Peditricas: DI: iv. 0,05-0,1 mg./kg. (Dmx. 5 mg.). Repetir cada 2-4 h
segn controles. Y luego si es necesario repetir cada 4 h. o Infu. iv. 2,515 mcg./kg./min. Por Extravasacin de drogas vasopresoras: DI:
Infiltrar el rea con una pequea cantidad (1 ml.) de solucin (Dmx.
0.1-0.2 mg./kg. o 5 mg. totales).
4.- CONTRAINDICACIONES:
-Uso concomitante con inhibidores de la 5-fosfodiesterasa incluyendo
Sildenafilo, Tadalafilo o Vardenafilo. -Precaucin en: -Cardiopata
isqumica, -Gastritis, -Ulcus Pptico, -Taquicardia.
5.- OBSERVACIONES:
En infiltracin, precaucin de no producir edema excesivo de la
extremidad o dedos (riesgo de ocasionar un sndrome
compartimental). -En Embarazo: Categora C. -Lactancia: Excrecin
desconocida, usar con precaucin.

95-FISOSTIGMINA
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Anticholium (Amp. 2 mg./5 ml.) (im., iv.)
2- INDICACIONES:
-Intoxicacin por Anticolinrgicos: (-Atropina, -Glucopirrolato, Escopolamina). Reversin Efectos sobre SNC y Cardiovascular por:
(-Antihistamnicos,
-Antiespasmdicos) -Antiparkinsonianos con
accin
anticolinrgica:
(-Benzotropina,
-Prociclidina,
Trihexifenidilo...)).
3.- POSOLOGIA:
Adultos: DI: iv. lento 0,5-2 mg (1 mg./min.) Repetir cada 10 min.
Dmx. 4 mg. No usar en perfusin ni va im.
Pediatria: DI: iv. muy lento. 0,02 mg./kg. diluido en SF. (Dmx. 0,5
mg./dosis). Se puede repetir cada 15 min. (mximo 2 mg.).
4.- CONTRAINDICACIONES:
-Asma, -Enf. Cardiovascular, -Obstruccin mecnica de tracto
gastrointestinal o va urinaria, -Estados vagotnicos. Intoxicaciones
por Antidepresivos Tricclicos.
5.- OBSERVACIONES:

GUA FARMACOLGICA

-Embarazo: Categora C. -Antidoto: (-Atropina, en dosis de 0.6 mg. iv.

que pueden ser repetidos cada 3-10 min. -Pralidoxima para controlar
los efectos musculares. DI: iv. 1-2 g. en 100 ml. de SF. en 15-30 min. Se
puede repetir en 1h. Peditrica: DI: iv. 20-40 mg./kg.). -En Lactancia es
seguro y compatible.

96-FITOMENADIONA O VITAMINA K1
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Konakion (Amp. 10 mg./1 ml.)
2.- INDICACIONES:
Intoxicaciones por derivados cumarnicos o de indandiona.
Intoxicaciones de frmacos, pesticidas y raticidas que provoca
Hipoprotrombinemia. Picaduras de Ofidios (venenos). -Profilaxis de
la Enf. Hemorrgica del RN.
3.- POSOLOGIA:
-Adultos: Hemorragia grave: DI: Infu. iv. 142-284 mcg./kg. 0,0140,028 ml. (Preparacin: DI. en SF. SG. hasta 50 ml. a 300 ml./h.).
Hemorragia menos grave o tendencia a hemorragias. DI: im. 10 mg.
o 142 mcg./kg. = 0,014 ml./kg.
-Peditricas: Profilaxis de la hemorragia en RN. DI: im. 1 mg. ( 0,4
mg./kg.) = 0,1 ml. 0,04 ml./kg. -En En Nios >1 ao, DI: im. o iv. 0,3
mg./kg.=0,03 ml./kg. Dmx.=10 mg. 1 ml. (im. iv.)
4.- CONTRAINDICACIONES:
-Dficit de glucosa 6 fosfato deshidrogenosa. -Disfuncin heptica
5.- OBSERVACIONES:
-Administrar lentamente. -No administrar, porque no es efectivo, en
casos de intoxicacin por heparina. -Embarazo: categora C.
Lactancia: No se recomienda.

97-FLECAINIDA
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Apocard, Tambocor (Amp. 150 mg./15 ml. (1 ml = 10mg)) (Comp. 100
mg.)
2.- INDICACIONES:
En pacientes sin cardiopata de base: -Reversin a ritmo sinusal de la
Fibrilacin Flutter Supraventriculares Paroxsticos sintomticos. -FA
asociada a la presencia de vas accesorias (Sindr. WPW). -EV y/o TV
sostenida o no, resistente o cuando no toleren otro tratamientos.
3.- POSOLOGIA:
-Adultos: DI: Infu. iv. 2 mg./kg. en 10 a 30 min. (se puede dar sin
dilur) (Preparacin: DI. en SG hasta 100 ml. a 200-600 ml./h.) -DM:
Infu. iv. 1,5 mg./kg./h. (Preparacin: DM. en SG. hasta 100 ml. a 100
ml./h.). -Se seguira con 0,1-0,25 mg./kg. (2 h. y siguientes.). Dmx:
150 mg.
-Pediatria: Actualmente se dispone de datos limitados.
4.- CONTRAINDICACIONES:
-IC. -Shock cardiognico. -Bloqueo AV de 2 y 3 o -BRD asociado a
hemibloqueo izquierdo. -IAM reciente, salvo que la arritmia
ventricular amenace el pronstico. -FA de larga evolucin en la que no
se ha intentado la conversin a ritmo sinusal. -Valvulopata
clnicamente significativa.
5.- OBSERVACIONES:
No diluir en SSF. pues precipita. -Disminuir dosis si el ensanchamiento
del complejo QRS aumente ms del 25%. -Embarazo: Categora C. Lactancia: Compatible. -IR. e Insuf. Heptica: Reducir dosis a la mitad
la DI no > 100mg./ dia. -Precauciones: paciente con marcapasos, y en
la Enf. Seno Coronario,(interrumpir tratamiento si aparece bloqueo
AV, bloqueo de rama completa o bloqueo SA).

98-FLUMAZENILO
1.- NOMBRE COMERCIAL Y PRESENTACIONES:
Anexate (Amp. 0.5 mg./5ml. y 1 mg./10 ml. (0.1 mg./ml.))
2.- INDICACIONES:
-Intoxicacin y Reversin efectos de las Benzodiacepinas. -Diagnstico
diferencia de la inconsciencia de etiologa desconocida.
3.- POSOLOGIA:
Adultos: DI: iv. 0,2-0,3 mg. o 2-3 ml. en 15 seg. Dosis media

933

URGENCIAS Y EMERGENCIAS EXTRAHOSPITALARIAS GUETS - SESCAM

requerida: 0,6 -1 mg. -Si no se recupera se puede repetir cada 1 min.
hasta que recupere la consciencia o hasta dosis mx: 3 mg. -DM: Infu.
iv. 0.1-0.4 mg./h. (Preparacin: 1 mg. en SSF. hasta 100 ml. a 10-40
ml./h. (70 kg)
Peditrica: DI: iv. 0.01 mg./kg. en seg. (Dmax. 0,2 mg.). Se puede
repetir cada 1 min. hasta mximo 2 mg. -DM: Infu. iv. 0,005-0,01
mg./kg./h. (Preparacin: 1 amp. de 5 ml (0,5 mg.) en SG. hasta 100 ml
(1 ml = 0,005 mg)).
4.- CONTRAINDICACIONES:
-Sospecha de sobredosis grave de antidepresivos tricclicos.
Pacientes epilpticos o PIC que han recibido trat. crnico con
Benzodiacepinas. -Precaucin en pacientes con dependencia a las
Benzodiazepinas puede precipitar un Sndr. de Abstinencia.
5-OBSERVACIONES:
-En caso de convulsiones dar Benzodiacepinas, Fenitona o
Barbitricos. -Embarazo: categora C (En Embarazo y Lactancia no
estn contraindicacos en caso de urgencia.)

99-FOMEPIZAL o 4-Metil-Pirazol
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Antizol (EFG), Fomepizol (OPI) (Amp. 1500 mg./1,5 ml. (1 gr./ml.)),
(Amp. 100 mg./20 ml. (5 mg./ml.)
2.- INDICACIONES:
-Intoxicacin por: Metanol (Alcohol de Quemar), Tilenglicol (Alcohol
de Anticongelantes), Etanol-Disulfiram.
3.- POSOLOGA:
Adultos: DI: Infu. iv. 15 mg./kg., Seguido de 10 mg./kg./12 h.
(Preparacin: DI. en SF. SG. hasta 100 ml. a pasar en 30 min. a 200
ml./h.)
4.- CONTRAINDICACIONES:
-Contraindicacin absoluta en el embarazo por falta de informacin
sobre sus riesgos. -Alergia al fomepizol o a otros pirazoles y
pirazolonas (Metamizol, Fenilbutazona,)
5.- OBSERVACIONES:
-Si se solidifica por el fro no pierde su eficacia, calentndolo vuelve a
estar normal. -Es una alternativa frente al tratamiento con Etanol.

100-FORMOTEROL
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Formoterol (Aldo Unin) (Caps. polvo para inhalador de 12 mcg.),
Foradil (Inhalados)
2.- INDICACIONES:
Asma, Bronquitis crnica con o sin efisema. (Tambin trat. de
mantenimiento y preventivo de Asma y Epoc)
3.- POSOLOGA:
-Adultos: DI: inh. 12 mcg. -En casos ms graves hasta 24 mcg. 2
veces/da. si necesidad, 12-24 mcg./da adicionales Dmx./da: 48
mcg.
Peditirica: Nios 6 aos. DI: inh. 4,5-9 mcg.
4.- CONTRAINDICACIONES
-En Nios < 6 aos. Arritmias y B-AV 3. -Estenosis artica
subvalvular idioptica, -Cardiomiopata Obstructiva Hipertrfica, Tirotoxicosis.
5.- OBSERVACIONES
-No usar como 1 tratamiento en Asma y Epoc Agudo. -En Embarazo
Categora C. No usar en 1 Trimestre de embarazo ni en el parto. Puede producir una reaccin paradjica de Broncoespasmo. Antdoto:
En caso de reaccin adversa o sobredosis dar Bloqueantes adrenrgicos cardioselectivos,

101-FUROSEMIDA
1.- NOMBRES COMECIALES Y PRESENTACIONES:
Seguril, Salidur (Amp. 20 mg./2 ml. (1 ml.=10 mg.) Amp. 250 mg./25
ml. (1 ml = 10 mg)).
2.- INDICACIONES:
-EAP. Edemas Asociados a: (-IC, -Cirrosis Heptica. IR. o Sindr.
Nefrtico. Quemaduras.) Trat. Coadyuvante: (-Crisis HTA. -Edema
cerebral.)

934

GUA FARMACOLGICA

3.- POSOLOGIA:
Adultos: DI: iv. 0,5-1 mg./kg. (bolo directo lento sin diluir) en 2 a 4 min.
DM: Infu. iv. 0,1-0,4 mg./kg./h. (poco uso) (Preparacin: 100 mg. en
SF. o SG. 100 ml. (1 ml.=1 mg.) 0,1-0,4 ml./kg./h. -EAP: DI: iv. 40 mg
dosis nica. Tras 20 min si es necesario, 20 mg ms. -ICC aguda: iv. 2040 mg./24 h. en bolos. -Crisis HTA. DI: iv. 20-40mg en bolos.
Peditrica: DI: iv. 0,5-1 mg./kg./dosis, lento. Se puede repetir tras 2 h.
Dmx: 20 mg./24 h.
4.- CONTRAINDICACIONES:
-Alergia a sulfonamidas. -Desequilibrio electroltico grave y no
corregido.
(Hipopotasemia,
Hiponatremia,
Hipocalcemia,
Hipocloremia, Hipomagnesemia). -Anuria. -Encefalopata heptica. Porfiria
5.- OBSERVACIONES: -Termosensibilidad: La refrigeracin puede causar
precipitacin o cristalizacin, que se redisuelve con un ligero
calentamiento o a temperatura ambiente. -Fotosensibilidad: Inestable,
decoloracin. No utilizar si presenta coloracin amarillenta. -Embarazo:
Categora C. Probables indicaciones: edema pulmonar, HTA severa e
ICC. -Lactancia: Se excreta con la leche materna, evitar su utilizacin o
suspender la lactancia.

102-GLICOPIRROLATO
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Acpan, Robinul (Amp. 1 mg./5 ml.; 4 mg./20 ml. (0,2 mg./ml.))
2.- INDICACIONES:
-Intoxicacin por Relajante Bloqueador Muscular, Miorelajantes no
Despolarizantes. -Broncoespasmo. -Medicacin Preanestsica, en
situaciones en las que se requiera inhibir la secrecin excesiva de
saliva y del tracto respiratorio.
3.- POSOLOGA:
Adultos: DI: im iv. 4-10 mcg./kg./4-8 h. Dmx: 0.2 mg./dosis
4.- CONTRAINDICACIONES:
Es incompatible con: Dimenhidrinato, Metohexital sdico,
Pentobarbital, Secobarbital o Tiopental sodicos, y Bicarbonato de
sodio. -Obstruccin de la vejiga u otros problemas urinarios. Obstruccin de los intestinos (leo paraltico). -Estreimiento severo. Colitis ulcerosa severa. -Megacolon txico. Glaucoma. -Miastenia
grave.
5.- OBSERVACIONES:
En Embarazo es de categora B.

103-GLUCAGON
3.- NOMBRES COMERCIALES Y PRESENTACIONES:
Glucagn-gen Hypokit Novo Nordisk. (Vial con glucagon liofilizado a
reconstruir con 1,5 ml de disolvente en jeringa precargada,
obtenindose una solucin de 1 mg. de glucagon.)
2.- INDICACIONES:
-Hipoglucemias en DMID, siempre que el paciente tenga glucgeno
heptico. -Intoxicaciones por Beta Bloqueantes Adrenrgicos o por
Calcioantagonistas, sin respuesta al isoproterenol.
3.- POSOLOGIA:
Adultos: -Hipoglucemia grave: DI: sc./im/iv. 0,5-1 mg. Se puede
repetir a los 20 min. -Antdoto inotrpico. DI: iv. 0,05-1 mg./kg. en 1
min. Si no hay respuesta a los 5-10 min. DM: Infu. iv. 0,07 mg./kg./h.
Peditrica: -Hipoglucemia grave: DI: sc./im./iv. 0,03-0,1 mg/kg/dosis
(Dmx: 1 mg./dosis). Se puede repetir a los 20 min. -Hipoglucemia
neonatal. DI: sc./im./iv 0,3 mg./kg./dosis, repetir cada 4 h.
-Antdoto inotrpico: DI: iv. 0,025 mg./kg./dosis. En Nios <25kg o 6-8
aos. DI: iv. 0,5 mg.
4.- CONTRAINDICACIONES:
-Hipersensibilidad a protenas de cerdo o vaca, y lactosa.
-Feocromocitoma. -Tumores de Glndula Adrenal, -Glucagonomas. Insulinomas.
5.- OBSERVACIONES:
Una vez reconstituido debe administrarse inmediatamente despus de
ser preparado. -Precauciones: Ayuno largo, desnutricin, insuficiencia
adrenal o hipoglucemia crnica. -Fotosensibilidad: proteger de la luz.
Desechar si aspecto viscoso o materia insoluble. -Termosensibilidad:
almacenar entre 2C y 8C. Evitar la congelacin Puede almacenarse a
temperatura ambiente (mximo 25C) durante 18 meses. -Embarazo:

URGENCIAS Y EMERGENCIAS EXTRAHOSPITALARIAS GUETS - SESCAM

Categora B-El glucagon no atraviesa la barrera placentaria humana. Lactancia: la cantidad excretada en la leche materna ser
extremadamente pequea.

104-GLUCOSA
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Glucosmon (Amp. 50% 10 g./20 ml. (1 ml=0,5 g. 500 mg.); Amp. 33%
3,3 g./10 ml. (1 ml.=0,33 g. 330 mg.)
2.- INDICACIONES:
-Hipoglucemias Agudas. -Hiperpotasemia, junto con la insulina. Intoxicacin Etlica. -Coma de origen desconocido
3.- POSOLOGIA:
Adultos: -Hipoglucemia aguda: DI: iv. en bolo. 10-20 gr. (1-2 amp.
50%) repitiendo la dosis cada 5 min hasta desaparecer los signos
hipoglucemicos. -Hiperpotasemia: DI: iv. 25 g. + 10 UI. de insulina
rpida. -En hipoglucemias asociadas a alcoholismo: DI: iv. 1-2 amp,
siempre previamente Tiamina (100 mg) para evitar la encefalopata.
Peditrica: DI: iv. 0,5-1 gr./kg. 2-4 ml./kg. a 60 ml./h. (Preparacin: 1
amp glucosmon R-50 + 20cc de SF. (total 40cc)).
4.- CONTRAINDICACIONES:
-Hemorragia Intracraneal o con ACVA reciente. Enf. Addison no
tratada. -Delirium tremens. -Deshidratacin hipotnica. -Deplecin
electroltica. Anuria. -Alergia al maz. -Intolerancia a los
carbohidratos. -Etilismo severo o sospecha de encefalopata de
Wernicke
5.- OBSERVACIONES:
-Embarazo: Puede administrarse. -Lactancia: Puede administrarse. -No
usar im. ni iv. Puede provocar Flebitis.

105-HALOPERIDOL
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Haloperidol (Amp. 50 y 100 mg. (5 mg./ml.) (Comp. 05 y 10 mg.) (Sol.
gotas 2 mg./ml. (1 gota = 01 mg)).
2.- INDICACIONES:
-Ansiedad. -Agitacin psicomotriz en: (-Mana, -Demencia, Delirium
Tremens. -Delirios, -Psicosis.). Alucinaciones. -Movimientos
anormales: (-Tics, -Sndr. Gilles Tourette, -Corea.).
3.- POSOLOGIA:
Adultos: DI: im iv lenta: 5 mg. si no revierte, doblar dosis cada 15
20 min. hasta Dmx de 30 mg./dosis. DM: iv. 5 mg./h. (Dmx: 60
mg./dia). (Preparacin: 25 mg. en SSF. o SG. 250 ml. a 50 ml./h.)
Peditrica: Nios 6-12 aos: DI: im. 005 mg./Kg./da o 1-3 mg. o 0,,20,6 ml. (Dmx.: 015 mg./Kg./da o 0,03 ml./kg./da).
4.- CONTRAINDICACIONES:
-Alergia a butirofenonas. -Epilepsia. -Parkinsonismo. -Diabetes. -Enf.
Respiratorias (-Asma crnico, -EPOC). -Precaucion en IC: puede
precipitar a Angina. -Feocromocitoma: puede producir HTA. QT largo.
-Bajo nivel de consciencia.
5.- OBSERVACIONES:
-Suspender inmediatamente si aparece fiebre (41 C) o rigidez
muscular grave. -Proteger de la luz. No tiene Antdoto. En caso de
Hipotensin dar Norepinefrina. En caso de reaccin extrapiramidad,
dal Biperideno 0,05 mg./kg. im. o iv. repetible a los 30 min. No dar por
va sc. En Embarazo: Categora C. -Lactancia: Se excreta con la leche
materna. IR. y/o Insuf. Heptica: Ajustar dosis. -Geriatria: Utilizar la
mitad de dosis.

106-HELIOX
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Heliox (70% Helio, 30% Oxigeno) (5, 10, 20 y 30 litros)
2.- INDICACIONES:
-Asma, -Bronquiolitis, -Insuf. Respir. Nios: 2.1. Obstruccin de la va
area superior: (2.1.1. Viral y despus de la extubacin crup;
2.1.2. Anafilaxia; 2.1.3. Parlisis de las cuerdas vocales; 2.1.4. Masas
de las vas respiratorias superiores, incluyendo tumores)
2.2. Obstruccin de las vas respiratorias inferiores: (2.2.1. Asma;
2.2.1.EPOC; 2.2.3.Bronquiolitis; 2.2.4. Displasia broncopulmonar).
2.3.Insuficiencia respiratoria aguda producida por una obstruccin de

GUA FARMACOLGICA

las vas areas

de origen espasmdico 2.3.1.como el estatus asmtico
de origen mecnico 2.3.2. como la estenosis larngea o traqueal o
2.3.3.bien por reaccin a la extubacin o 2.3.4. desconexin de la
ventilacin mecnica.
2.4.Normalmente se utiliza en lactantes o nios que presenten una
saturacin de oxigeno inferior al 90%, teniendo en cuenta que no
debe utilizarse en pacientes que requieran altas concentraciones de
oxgeno ya que la mezcla slo tiene un 30% de este gas
3.- POSOLOGA:
DI: Lo mejor: el 80% de helio / 20% de oxgeno
4.- CONTRAINDICACIONES:
No conocidos
5.- OBSERVACIONES:
Poco efecto si est a menos de 60%

107-HEPARINA SODICA
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Heparina Rovi , Heparina Leo Pharma, 1%. (Vial 1% = 5 ml./ 50 mg.
(5000 UI.) (1 ml.=10 mg.=1000 UI.) (Vial 5% = 5 ml./ 250 mg. (25000
UI.) (1 ml.=50 mg.=5000 UI.)
2.- INDICACIONES:
-Profilaxis y trat. de Enf. tromboemblica. Trat. de Enf. Coronaria:
Angina Inestable e IAM.
3.- POSOLOGIA:
Adultos: DI: iv. 5000-10000 UI. sin diluir o diluida en 50-100 cc de SF.
DM: Infu. i.v. 1000-2000 UI./h. (Preparacin. 1 vial 1% en SSF. o SG.
hasta 100 ml.) a 20-40 ml./h. (20 UI./kg./h.)
En Angina inestable: DI: iv. 75 UI./Kg. DM: Infu. iv. de 1200 UI./h. (24
ml./h.) En IAM: Con terapia tromboltica previa: DI: iv. 60 UI/kg,
Dmx: 4000 UI. DM: Infu. iv. 12 UI./Kg./h. (17 ml./h.) (Dmx: 1000
UI./h, o 20ml./h). Sin terapia tromboltica previa: DI: 75 UI./Kg., y DM:
Infu. iv. de 1.000-1.200 UI/h (20-24 ml/h) (Consultar protocolo en
vigor)
Peditrica: DI: iv. 75 UI./kg. en 10 min. DM: nios <1 ao Infu. Iv. 28
UI./kg./h. >1 ao: Infu. iv. 20 UI./kg./h.
4.- CONTRAINDICACIONES:
-Sangrado incontrolable salvo CID, -Trombocitopenia, hepatopata con
hipoprotombinemia.
5.- OBSERVACIONES:
-No administrar por va im. Antdoto: Sulfato de protamina. 1 mg.
neutraliza 100 UI. de heparina. Dosis segn tiempo transcurrido:
Inmediatamente tras heparina: 1-1.5 mg./100 UI.; tras 30-60min: 0.50.75 mg./100 UI; tras 2 h.: 0.25-0.375 mg./100U. iv. lenta, mximo 50
mg./10 min. Repetible en 10-15 min. -Lactancia: compatible.
Embarazo: Categora C. -Uso en la Enf. Tromboemblica Venosa. IR. y/o
Insuf. Heptica: Contraindicado -Geriatria: Reducir la dosis, en mujeres
ancianas son ms proclives a sufrir hemorragias.

108-HESA-CIANO-FERRATO FERRICO DE POTASIO o

FERROCIANURO FERRICO
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Azul de Prusia O Antidotum Thalli-Heyl (polvo en caps. de 500 mg.)
2.- INDICACIONES:
Intoxicacin de Talio y CesioRadio
3.- POSOLOGA:
Adultos: DI: vo. 250 mg./kg./da en 4-5 tomas. Si est en coma dar
por
sonda
4.- CONTRAINDICACIONES:
leo paraltico
5.- OBSERVACIONES:
Preparacin de DI: Azul de Prusia con agua tibia (produciendo una
suspensin) o con una sol. de Manitol (1 g. de Azul de Prusia por cada
10 ml. de Manitol 15%) y dar por vo. o con sonda nasogstrica.

109-HEXADIMETRINA o POLIBRENO
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Hexadimetrina Polybrene (amp. 10 mg./ml.)

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URGENCIAS Y EMERGENCIAS EXTRAHOSPITALARIAS GUETS - SESCAM

2.- INDICACIONES:
Intoxicacin por Heparina
3.- POSOLOGA:
Adultos: DI: iv. la misma dosis de Heparina previamente administrada.
Por cada 1 mg./kg. de Heparina, 1 mg./kg. de Hexadimetrina.
4.- CONTRAINDICACIONES:
Sin datos encontrados
5.- OBSERVACIONES:
Sin datos encontrados

110-HEXOPRENALINA, SULFATO
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Ipradol, Argocian, Gynipral (Comp 05 mg.) (Amp. 5 mcg./2 ml,; 10
mcg./2 ml,; 25 mcg./5 ml.) (Spray aerosol).
2.- INDICACIONES:
-Asma bronquial o Broncoespasmo reversible asociado a EPOC-Status
Asmtico. -Parto prematuro: Inhibicin de las contracciones en
pacientes que presenten trabajo de parto prematuro.
3.- POSOLOGIA:
Adultos: -Asma bronquial y broncoespasmo: DI: vo. 05-1 mg./8 h. Status Asmtico: DI: im. o iv. lenta (3-5min.) 5 mcgr en 3-5 min./6 -8 h.
-Parto prematuro: DI: vo. 15 mg./8 h. -Parto prematuro inminente:
DI: Infu. iv. 05-2 mcgr./min.
4.- CONTRAINDICACIONES:
-Tirotoxicosis. -Cardiopatias: (-Taquiarritmias, -Miocarditis, -Defectos
de la Vlvula Mitral.). -Insuficiencia heptica y renal graves. Precauciones con: (-HTA severa. -Diabetes Mellitus).
5,- OBSERVACIONES:
-Antidoto: No se conoce. -Embarazo: Categora A.

111-HIDRALAZINA
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Hydrapres (Amp: 20 mg./1 ml.) (Comp. 25 mg, y 50 mg.)
2.- INDICACIONES:
-HTA General. HTA Embarazo. (Preeclampsia/Eclampsia). -ICC
3.- POSOLOGIA:
-Adultos: Crisis HTA: DI: iv. 10-20 mg. (Preparacin: DI en SSF. hasta 10
ml. (1 ml.=2 mg.) Se puede repetir tras 20 min. hasta TAD <100 mmHg.
o Dmx: 40 mg.
-Peditrica: No est establecida su seguridad y eficacia (Preparacin:
20 mg. en SF. (No SG.) hasta 10 ml. (1 ml. = 2 mg.) Crisis HTA. DI: iv.
0,42-0,87 mg./kg. en 2 min. cada 6 h. (Dmx.: 1,7-3,5 mg./kg./da <20
mg./da. -Neonatos. DI: iv. 1-3 mg/kg./da = 0,25-0,75 mg./kg. cada 6
h.
-Embarazo: Categora C. de eleccin en Preeclampsia.
(Preparacin: 20 mg. en SF. (No SG.) hasta 10 ml. (1 ml. = 2 mg.).
Preeclampsia. DI: iv. lento 5-10 mg. (2,5-5,0 ml.)
Repitiendo
cada 20-30 min. hasta TAD <100 mmHg.),
-Si no hay respuesta
tras una dosis total de 40 mg, utilizar otro hipotensor.
4.- CONTRAINDICACIONES:
-Valvulopata Mitral Reumtica, -Cardiopata Isqumica, -Taquicardia. Precaucin: -IR., -IC, -ACV, -HTA, -Lupus Eritematoso Sistmico. Aneurisma
Disecante Aorta
5.- OBSERVACIONES:
-No tiene antdoto pero en caso de provocar taquicardia grave usar
bloqueantes. -Lactancia: Precaucin. -No conservar a temperatura
superior a 25C. -No mezclar con SG. -Reacciona con metales, por lo
que debe utilizarse rpidamente una vez preparado tras extraerse con
aguja a una jeringa. -No refrigerar las amp. -Proteger de la luz.

112-HIDROCORTISONA
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Actocortina (Vial 100, 500, 1000 mg.) Hidroaltesona (Comp. 20 mg.)
2.- INDICACIONES:
-Sndr. Inflamatorios Agudos, -Reacciones Transfusionales, -Shock de
cualquier etiologa, -Tumores del SNC, -Insuf. Suprarrenal aguda o
crnica, -Reacciones Alrgicas graves, -Anafilaxia, -Crisis y Status

936

GUA FARMACOLGICA

Asmtico, -Edema de Glotis, -Rechazo de rganos trasplantados, Coma Hipotiroideo, -Crisis Tiroidea, -Vasculitis Necrosante, -Trat.
Coadyuvante en exacerbaciones de Enf. Reumticas, -Enf.
Dermatologicas Graves.
3.- POSOLOGA:
Adultos: -Asma. DI: iv. 5-10 mg./kg. repetir cada 4-6 h. (Dmx.=6
g./da) (Preparacin: 1000 mg. en SF. hasta 100 ml. (1 ml.=10 mg.) (DI.
en ml./h. durante 4 min.).
-Anafilaxia, Shock y Procesos Vitales. DI: iv. 50-100 mg./kg. en 2 a 4
min. (Dmx.= 6 g./da) (Preparacin: 6000 mg. en SF. hasta 100 ml. (1
ml. = 60 mg.)) (DI. ml./h. durante 4 min.) (Si se da menos dosis repetir
cada 2-12 h. Dmx. 6 gr./da). -Procesos no vitales: DI: iv. 50-200 mg.
cada 2-10 h. -Antiinflamatorio: DI: iv. 1-2 mg./kg. cada 2-10 h.
(Preparacin: 200 mg. en 100 ml. (1 ml. = 2 mg.)) (Pasar dosis en
ml./h. en 4 min.) repetir cada 2-10 h. -Sustitucin Esteroidea: DI: iv.
50-100 mg. Pre, Intra y Postoperatorio. Terapia de
reemplazamiento:
DI: vo. 20-30 mg./da, en varias dosis. -Infiltraciones Intraarticular y
tejidos blandos: (Preparacin: 100 mg. en SF. hasta 10 ml. (1 ml. = 10
mg.)).(infiltracin cuando se limita a una o dos localizaciones). Articulaciones grandes. DI: Infiltr. 25,0 mg.=2,5 ml.; -Articulaciones
pequeas. DI: Infiltr. 10,0 mg.=1,0 ml. -Bursas serosa, incluidos
juanetes. DI: Infiltr. 25,0-37,5 mg.=2,5-3,7 ml.; -Vainas tendinosas. DI:
Infiltr. 5,0-12,5 mg. = 0,5-1,2 ml.; -Infiltracin en tejidos blandos. DI:
Infiltr. 25,0-50,0 mg.=2,5-5,0 ml. -Gangliones. DI: Infiltr. 12,5-25,0
mg.=1,2-2,5 ml.
Peditricos: -Obstruccion bronquial Aguda. DI: iv. 10-15 mg./Kg.
(Dmx.=500 mg.) (Preparacin: 500 mg. en SF. hasta 100 ml. (1 ml. = 5
mg.) (DI. en ml./h. durante 4 min.) -Asma. DI: iv. 3 mg./kg.
(Preparacin: 200 mg. en SF. hasta 100 ml. (1 ml. = 2 mg.) (DI. en
ml./h. durante 4 min.)
-Insuficiencia Adrenocortical Aguda. DI: iv. 1-2 mg./kg. seguido de 25150 mg./da (im., iv., sc.) (Preparacin: 100 mg. en SF. hasta 100 ml. (1
ml. = 100 mg.) (DI. en ml./h. durante 4 min.) -Shock. DI: im. o iv. 50
mg./kg. repetido cada 4 h. (Preparacin: 2000 mg. en SF. hasta 100 ml.
(1 ml. = 20 mg.)) (DI. en ml./h. durante 4 min.)
4.- CONTRAINDICACIONES:
-Hipersensibilidad, -Infecciones Fngicas Sistmicas, Relativas: (-lcera
Pptica activa, -Gastritis. -Esofagitis, -Viremias, -Herpes Zster agudo, Inmediatamente tras administracin de vacunas vivas, -Amebiasis, Miastenia gravis.
5.- OBSERVACIONES:
-Embarazo: Categora C. -Lactancia: Se excreta en la leche materna
por lo que no se recomienda. -En Geriatria: Se recomienda precaucin
en trat. prolongados por riesgo de Osteoporosis y de HTA. -No es
necesario ajustar dosis en IR. ni en insuf. Heptica. -El vial
reconstituido puede conservarse 24 h a 4C. No tiene antidoto.

113-HIDROXICOBALAMINA (Vit. B12)

1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Cyanokit (Vial 2,5 gr. (2 envases)) (tras su dilucin en 100 ml de SSF. (1
ml.=25 mg.).
2.- INDICACIONES:
Intoxicaciones por Cianuro mineral u orgnico, cido cianhdrico y sus
derivados. Sindr. de inhalacin de humos en los incendios.
3.- POSOLOGA:
Adultos: DI: Infu. iv. 70-140 mg./kg. (Preparacin: 5 gr. en SSF. 100
ml. en 15 min.) (puede repetirse la misma dosis hasta 3 veces en
funcin de la gravedad del cuadro clnico.). Dmx. 10 gr.
-Peditrica: DI: Infu. iv (Igual a Adultos)
4.- CONTRAINDICACIONES:
Hipersensibilidad conocida a la vitamina B12.
5.- OBSERVACIONES:
Embarazo: No existen datos suficientes, valorar en funcin de la
gravedad. -Conservar a una temperatura inferior a 25C. -Sensible a la
luz. -Puede ser utilizada sin esperar los resultados de laboratorio sobre
la concentracin de cianuro en sangre. No debe retrasarse su
administracin. -Su eficacia depende de la rapidez con que se
administre. -Al disolver el vial hacerlo enrgicamente.

URGENCIAS Y EMERGENCIAS EXTRAHOSPITALARIAS GUETS - SESCAM

114-IMIPENEM
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Tienam, Imipenem+Cilastatina (Val 500 mg.)
2.- INDICACIONES:
-Sepsis. -Infecciones complicadas intraabdominales,, -Infecciones del
Tracto Urinario, -Infecciones de piel y tejidos blandos, -Infeccin
intraparto y postparto, -Neumona grave, incluidas nosocomial y
asociada a ventilacin. -Sospecha de infeccin bacteriana en
pacientes neutropnicos con fiebre.
3.- POSOLOGA:
Adultos: DI: Infu. iv. 7,14 mg./kg./6-8 h. (Preparacin: 500 mg. en SSF.
hasta 10 ml. y despus la solucin resultante en SSF. hasta 100 ml. (1
ml./5 mg.) Para dosis <500 mg. pasar en 20 a 30 min. a 300-200 ml./h.
Para dosis > 500 mg. pasar en 40-60 min. o 150-100 ml./h. Si se
producen nuseas puede reducirse la velocidad de inf.. iv. En
Infecciones muy graves: DI: Infu. iv. 14,28 mg./kg./6-8 h. (Preparacin:
100 mg. en SSF. hasta 20 ml. y despus la solucin resultante en SSF.
hasta 200 ml. (1 ml./5 mg.). Dmx. 4000 mg./da.
Peditrica: Nios 1 ao: 15-25 mg./kg./6-8 h. (Preparacin: 500 mg.
en SSG. Hasta 10 ml. y despus la solucin resultante en SSF. hasta 100
ml. (1 ml./5 mg.)) a pasar en 20-30 min. (Dmx: 2000 mg./da).
4.- CONTRAINDICACIONES:
-Hipersensibilidad a componentes y a carbapenmicos. -Antecedente
de hipersensibilidad grave a - lactmicos,
5.- OBSERVACIONES:
-Riesgo de convulsiones con: Ganciclovir y Valganciclovir (no asociar
salvo beneficio > riesgo). -Puede potenciar efecto anticoagulante de:
anticoagulantes orales (incluida warfarina), vigilar INR. -Incompatible
con: diluyentes que contengan lactato. -Puede dar falsos + en test de
Coombs. -No es til en la Meningitis. -Embarazo: No hay estudios
adecuados y bien controlados en mujeres gestantes. Usar slo si
beneficio supera riesgo. -Lactancia: se excretan en la leche materna
en pequeas cantidades. Se debe sopesar el beneficio de la lactancia
materna.

115-INSULINA HUMANA
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Humulina Regular, Actrapid (vial 10 ml (100 UI./ml.))
2.- INDICACIONES:
-Diabetes Mellitus tipo 1, -Diabetes Mellitus tipo 2 en caso de
resistencia a antidiabticos vo., -Descompensaciones Hiperglucmicas
agudas, -Cetoacidsis diabtica, -Diabetes gestacional, si estan
contraindicados lo hipoglucemiantes vo.
3.- POSOLOGIA:
Adultos: -Con Hiperglucemia > 200 mg./dl. DI: iv. o sc. 0,2-0,3 UI./kg.
(Preparacin: 50 UI. en SSF. hasta 10 ml. (1 ml. = 5 UI.) DM: Infu. iv.
0,1-0,2 UI./kg./h. (Preparacin: 50 UI. en SF. hasta 100 ml. (1 ml. = 0,5
UI.)) a 0,2-0,4 ml./kg./h. -Con Hiperglucemia < 200 y > 150 mg./dl.
DM: Infu. iv. 0,05 UI./kg./h.(Preparacin: 50 UI. en SF. hasta 100 ml.
(1 ml. = 0,5 UI.) a 0,1 ml./kg./h.
Peditrica: DI: Infu. iv. 0,1 UI./kg./h. (Preparacin: 50 UI. en SSF. hasta
100 ml.)(0,1 UI./kg./h.= 0,2 ml./kg./h.)
4.- CONTRAINDICACIONES:
-Hipoglucemia.
5.- OBSERVACIONES:
-Embarazo: Categora B. No hay limitacin al trat. de la Diabetes con
insulina durante el embarazo, ya que la insulina no pasa la barrera
placentaria. -Lactancia: El trat. insulnico a madres en periodo de
lactancia no implica riesgo para el beb. Trat. Efectos 2 de Insulina:
hipoglucmia leve: con glucosa oral o productos azucarados.
Hipoglucemia grave: en inconsciente, se trata con Glucagon im. sc.
(0,5-1 mg) o Glucosa iv., si no responde al Glucagon en 10-15 min. Una
vez recuperada la consciencia, dar glucosa oral a fin de prevenir una
recada. -Conservar en nevera. -Los preparados de insulina que se
hayan congelado no deben utilizarse.

116-IPECACUANA
1.- NOMBRE COMERCIAL y PRESENTACIONES:

GUA FARMACOLGICA

Jarabe de Ipecacuana (frmula magistral) En frascos de 100 ml.

(Alcaloides 1,23-1,57 mg./ml.).
2.- INDICACIONES:
Intoxicacin o Sobredosis de frmacos o Ingesta de algunos venenos.
(Util si desde su ingesta no se han superado los 60 min.)
3.- POSOLOGA:
Adultos: DI: vo.,15-30 ml. del jarabe seguidos de 250 ml. de agua. Si
no vomita antes de 15-20 min. repetir dosis.
Peditrica: En nios de 1 -12 aos: DI: vo. 15 ml. del jarabe seguidos
de 240 ml. de agua. En nios de 6 meses a 1 ao: DI: vo. 5-0 ml. del
jarabe seguidos de 5 ml./kg. de agua. Si no vomita antes de 15-20 min.
repetit dosis.
4.- CONTRAINDICACIONES:
-Ingestin de productos custicos corrosivos: cidos fuertes, lcalis,
aceites esenciales. -Ingestin de productos derivados del petrleo y
ciertos
hidrocarburos
(gasolina,
queroseno).
-Pacientes
semiinconscientes, inconscientes, en coma. -Crisis convulsivas activas
o inminentes. -Presencia de hematemesis. -Pacientes con insuficiencia
respiratoria. -Ingestin de cuerpo extrao.
5.- OBSERVACIONES:
Embarazo: No hay datos. -Lactancia: No hay datos
-El jarabe de ipecacuana debe almacenarse en frasco de cristal. -No
existe antidoto. -Se recomienda administrar carbn activado (1 gr./kg.)
despus de la ingestin del jarabe de Ipecacuana y una vez que se
haya vomitado.
-Una vez ingerido el jarabe de Ipecacuana con agua, se debe mantener
al paciente en posicin erguida, nunca tumbado. -En nios menores
de un ao se incrementa el riesgo de aspiracin del vmito por lo que
se le colocar la cabeza hacia abajo. -Aproximadamente en el 90% de
los casos el vmito se produce a los 30 min. -No administrar carbn
activado hasta que se produzca vmito.

117-IPRATROPIO, BROMURO DE
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Atrovent. Bromuro de Iprtropio Aldo Unin (Monodosis 250-500 g./2
ml. Sol. Inhal.) (Aerosol 20 g./puls.) (Inhaletas caps de 40 g.)
2.- INDICACIONES:
Broncoespasmo Agudo asociado a Obstruccin reversible de las vas
areas, potencia la accin de los adrenrgicos. Trat. Coadyuvante
de mantenimiento en EPOC.
3.- POSOLOGA:
-Adultos: Broncoespasmo agudo: DI: Inh. Sol. 500 g. asociado a
adrenrgico en 5 ml. de SSF. en nebulizacin. Se puede repetir 3 a 4
veces al da. Dmx. 2 mg./da.
-Peditrica: Broncoespasmo agudo: En Nios >20 kg. de 6 a 10 aos.
DI: (Igual a adultos). En Nios <20 kg. o de 6 aos a Lactantes. DI: Inh.
Sol. 250 mg. asociado a DI. de Salbutamol en 5 ml, de SSF. en
nebulizacin. Se puede repetir 3 a 4 veces al da. Dmx. 1 mg./da. En
Nios <6 aos hasta lactantes: DI: Inh. Sol. 125-250 mcg. en 3 ml. de
SSF. en nebulizacin. En Neonatos: DI: Inh. Sol. 25 g./kg. 0,25
ml./kg. diluido en 1,5 -3 ml de SSF. en nebuliazacin.
4.- CONTRAINDICACIONES:
Hipersensibilidad a sustancias afines a la atropina o a cualquier otro
componente del producto. No indicado como monofrmaco en el
trat. de episodios agudos de broncoespasmo donde se requiera una
respuesta rpida.
5.- OBSERVACIONES:
Embarazo: Categora B. Lactancia: Administrar con precaucin. Disminuir dosis en IR. e Insuf. Heptica, en Fibrosis Qustica y en Enf.
que cursan con trastornos de la motilidad intestinal. -Baja toxicidad
oral debida a una pobre absorcin gastrointestinal. -No tiene antdoto

118-ISOPROTERENOL o ISOPRENALINA
1.- NOMBRES COMERCIALES y PRESENTACIONES
Aleudrina, (Amp. 200 gr./1 ml.)
2.- INDICACIONES:
-Bloqueo AV2 Mobitz II, -Bloqueo AV3, -Bradicardia resistente a
Atropina, Dopamina, Dobutamina, Adrenalina, -Bradicardia
postrasplante cardiaco, si no se dispone de Marcapasos, -Torsada de
Pointes en el contexto de una bradicardia, -Bradicardia con sindrome

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URGENCIAS Y EMERGENCIAS EXTRAHOSPITALARIAS GUETS - SESCAM

QT largo, -Sindr. de Stokes-Adams, -Broncoespasmo durante Anestesia,
-Hipersensibilidad del Seno Carotideo, -Sobredosis de -bloqueantes.
3.- POSOLOGA:
Adultos: DI: Infus. iv. 1-10 mcg./min. durante 90 min. o 0,85-8,5
mcg./kg./h. (Preparacin: 200 g. en SF. o SG. hasta 100 ml. (1 ml.=2
g.) Iniciamos a 0,42 ml./kg./h. cada 5 min. aumentar la dosis 15
ml./h. hasta conseguir el efecto deseado o hasta Dmx. 300 ml./h.
-Peditrica: Infus. iv. 0,25-5 g./min. durante 90 min. 0,05-0,5
mcg./kg./min. (Preparacin: 200 g en SFF. o SG. 100 ml. (1ml.=2 g.)
iniciamos a 1,5-15 ml./kg./h. y aumentar 10 ml./h. cada 5 min. hasta
conseguir efecto deseado.
4.- CONTRAINDICACIONES:
Absolutas: arritmias cardiacas secundarias a intoxicaciones digitalica,
angina de pecho, estenosis artica.
Relativas: IAM, ICC descompensada, hipertiroidismo.
5.- OBSERVACIONES:
Embarazo: Categora C. inhibe las contracciones uterinas. -Lactancia:
No hay datos, suspender lactancia materna si se precisa su
administracin. -Ajustar dosis en IR. e Insuf. Heptica. -Conservacion
entre 2-8C. Antidoto: son los -bloqueantes. -Incompatible con
Furosemida y Bicarbonato Sdico.

119-KETAMINA
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Ketolar (Amp. 500 mg./10 ml. (1 ml. =50 mg.)).
2.- INDICACIONES:
Anestsico nico en cirugia menor, ortopdica y ginecolgica menor
(raspados, dilataciones, etc), desbridamiento de quemaduras,
operaciones dentales, etc. Muy til en pacientes con grave
compromiso hemodinmico y/o broncoespasmo refractario grave,
tambien en pacientes asmticos y en politraumatizados atrapados
mientras se procede a su extricacin y en grandes quemados.
3.- POSOLOGA:
-Adultos:
-Induccin anestsica: DI: iv. 0,5-4,5 mg./kg. o 0,1-0,9 ml./kg. (ideal
de 1-2 mg./kg. o 0,2-0,4 ml./kg.) (no >0,5 mg./kg./min., o >6 ml./kg./h.
ni en <60 seg.) (Evitar soluciones con concentracin superior al 10%.)
(Preparacin: 500 mg. en SF SG hasta 100 ml. a pasar entre >1 min.
y <9 min. )(Si se da DI: im. 6,5-13 mg./kg.) DM: Infus. iv. 1-2
mg./kg./h. o dosis adicionales correspondiente a la mitad de la DI.
dada.
(Premedicacin: -Diazepam. DI: vo. 0,15 mg./kg. 1 h. antes y Atropina:
DI: im. 20 g./kg. 30 min. antes.) -Analgesia: DI: iv. 0,2-1,0 mg./kg. o
0,04-0,2 ml./kg. en 2-3 min (Preparacin: 100 mg. o 2 ml. en SSF.
hasta 20 ml. (1 ml./5 mg.). Si usamos DI: im. 2-5 mg/kg. Si usamos DI:
va Intranasal. 0,25-0,5 mg./kg. Dosis posteriores iv. (Preparacin:
500 mg. en SSF. SG. hasta los 250 ml. (1 ml. =2 mg.) 25-75
g./kg./min. 20 mg.). -Si se administra con NO2. DI: iv. 10-30
g./kg./min. -Analgesia en Parto vaginal asistido con Frceps bajo y
Frceps normal: (en el momento en que la cabeza del beb corona el
Perineo). DI: iv. <5 mg./kg.=<0,1 ml./kg. (Produce: 5-8 minutos de
analgesia satisfactoria y amnesia completa).(Si previamente ha
recibido un agente analgsico inyectable durante el parto, reducir
dosis al 50%).-Analgesia en Parto Durante el segundo perodo. DI:
Infu. iv. 8 mcg./kg./min. con o sin una mezcla de 40-60% de xido
Nitroso / Oxgeno. (Preparacin: 100 mg. o 2 ml. en SSF. SG. hasta
100 ml. (1 ml.=1 mg.) -Anestesia en Cesrea. DI: iv. <1 mg./kg. o 0,1
ml./kg. con xido Nitroso, Oxgeno y Relajantes Musculares.
(Preparacin: 100 mg. o 2 ml. en SSF. SG. hasta 10 ml. (1 ml.=10
mg.)
-Peditrica:
En Induccin anestsica: DI: iv. 1-2 mg./kg. o 1-2 ml./kg.
(Preparacin: 100 mg. o 2 ml. en SSF. o SG. hasta 100 ml. (1 ml.=1
mg.)). -(Premedicacin: -Diazepam 0,1 mg./kg. bolo iv. 5 min. -Antes
puede aadirse Atropina 0,02 mg./kg. Dosis de carga: 0,5-1 mg./kg.
bolo iv. en 2-3 min. -Prometazina: 0,5 mg./kg. por vo.l 1 h. antes.) En
Sedacin en procedimientos cortos DI: iv. 0,5-1 mg./kg. Si se usa DI:
im. 3-10 mg./kg. En Sedacin. DI: Infu. iv. 5-20 mcg./kg./min.
4.- CONTRAINDICACIONES:
-Sospecha de PIC elevada, -HTA severa, -Cardiopatia isqumica, Epilepsia, -Enf. Psiquitricas, -ACV previos, -Hipertensin intraocular, Hipertiroidismo, -Alcoholismo.

938

GUA FARMACOLGICA

5.- OBSERVACIONES:
-Embarazo: Categora B. -Lactancia: Evitar su utilizacin, en caso de
precisar, suspender lactancia materna. -No existe antidoto.

120-KETOROLACO
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Droal, Toradol, Agikey. (Amp 30 mg./1 ml.) (Comp. 10 mg.)
2.- INDICACIONES:
-Dolor moderado a severo, -Dolor postoperatorio, -Clico Renal.
3.- POSOLOGA:
-Adultos: DI: im. o iv. 0,4-1,0 mg./kg. en >15 seg. (DI. estandar 10-30
mg.) (Preparacin: 60 mg. en SF. hasta 10 ml. (1 ml. = 6 mg. )). Seguir a
los 30 min. con otra DI. y repetir cada 4 a 6 h. (Dmx. 120 mg./da)
(Otra preparacin: DI en SSF. hasta 100 ml. en 5 min. o 1200 ml./h.)
-Peditrica: Aunque no recomendado en <16 aos, y no debe
utilizarse en <3 aos. En caso de usarse: DI. im. o iv. 0,2-1,0 mg./kg.
(Preparacin: 60 mg. en SSF. hasta 20 ml. (1 ml.=3 mg.), Despus DI:
en SSF. hasta 100 ml. en 20 min. o 300 ml./h. cada 4-6 h. Dmx: 60
mg.
4.- CONTRAINDICACIONES:
-Hipersensibilidad a AINES. -Plipos Nasales, -Angioedema, Broncoespasmo, -lcera Gastroduodenal Activa, -Hemorragia
Digestiva, -Paerforacin Gastrointestinal, IR. moderada a severa, Hipovolemia o Deshidratacin, -Ditesis hemorrgica y trastornos de
la coagulacin. -Hemorragia cerebral, -Epilepsia, -Alcoholismo, -Daos
o Lesiones Cerebrales.
5.- OBSERVACIONES:
-Embarazo: Categora C, en 1 y 2 trimestre, categoria D en 3
trimestre, durante el parto puede producir metrorragias. -Lactancia:
No administrar o suspender la lactancia porque se secreta en la leche
materna. -No existe un antdoto especfico. -No administrar en Insuf.
heptica, -En IR. disminur dosis.

121-LABETALOL
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Trandate (Amp. 100 mg./20 ml. (1 ml.=5 mg.). (Comp. 100 y 200 mg.)
2.- INDICACIONES:
-Crisis HTA. Feocromocitoma. -Intoxicacin por Cocana y
Anfetaminas (como trat. en HTA secundaria), -Manejo de HTA en
patologa vascular cerebral y en cardiopata isqumica, -HTA
perioperatoria, -Control de HTA en Aneurisma Disecante de Aorta, Control de HTA en eclampsia.
3.- POSOLOGA:
Adultos: DI: iv. 20-80 mg. (4-8 ml.) en 2 min., repetir dosis cada 5-10
min. hasta alcanzar cifras adecuadas de TA o hasta Dmx de 200 mg.
DM: Infu. iv. (Preparacin: 100 mg. en SSF. o SG. hasta 100 ml.
administrar a 0,9-1,5 mg./Kg./h. o 0,9-1,5 ml./kg./h. hasta alcanzar
cifras adecuadas de TA, Dmx: 300 mg.
Peditrica: DI: iv. 0,2-2 mg./kg. en 2 min, repetir dosis cada 5-10 min
hasta alcanzar cifras adecuadas de TA. DM: Infu. iv. 100 mg. en SSF. o
SG. hasta 100 ml. administrar 0,253 mg./kg./h. o 0,25-3 ml./kg./h.
4.- CONTRAINDICACIONES:
-Insuf. Cardiaca. -Isquemia arterial perifrica, -Bradicardia, -Bloqueo
AV, -EPOC. (Relativas: -Asma Bronquial, -Diabticos). -Evitar el uso iv.
simultneo de: Verapamilo o Diltiazem.
5.- OBSERVACIONES:
-Embarazo: Categora C. -Lactancia: se secrega en leche materna,
suspender la lactancia si se precisa. -No existe un antdoto especfico.

122-LEVETIRACETAM
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Levetiracetam Stada. Keppra (Comp. 250, 500 y 1000 mg.) (Sol. Oral
100 mg./ml.) (Amp. 5 ml./500 mg.)
2.- INDICACIONES:
-Estatus Epilptico(Alternativa a Fenitona y Ac.Valproico). Epilepsia
Refractaria.
3.- POSOLOGA:
-Adultos: DI: Infu. iv. o vo. 500 mg./12 h. (Preparacin: 500 mg. en

URGENCIAS Y EMERGENCIAS EXTRAHOSPITALARIAS GUETS - SESCAM

SSF. o SG. o S.Ringer hasta 100 ml. (1 ml.=5 mg.) a pasar en 15 min. a
400 ml./h.) (Dmx. 1500 mg./12 h.)
-Pedatrica: En Nios >12 aos y >50 kg. DI: iv. y vo. igual a adultos.
En Nios 11 a 4 aos >12 aos y <50 kg. DI: iv. 10 mg./kg./12 h.
(Preparacin: DI. en SSF o SG o S.Ringer hasta 100 ml. a pasar en 15
min. a 400 ml./h.) (Dmx. 30 mg./kg./12 h.) En Nios <4 aos, es
preferible vo. En Nios 1-6 meses DI: iv. 7 mg./12 h.
4.- CONTRAINDICACIONES:
Hipersensibilidad a derivados de Pirrolidona
5.- OBSERVACIONES
-No hay antdoto especfico. -Lactancia: Se excreta en la leche materna
humana, por lo que no se recomienda la lactancia natural. -Embarazo:
Categora C.

123-LEVOFLOXACINO
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Levofloxacino, Tavanic (Comp. 250, 500 mg.) (Viales-Bolsa 100 ml. al
5% (500 mg.) 50 ml. al 5% (250 mg.)
2.- INDICACIONES:
-Sepsis Respiratorio. -Neumonas, -Prostatitis, -Pielonefritis, Infecciones piel y tejidos blandos. -Inhalacin Antrax
3.- POSOLOGA:
-Adultos: DI: Infu. iv. 500 mg./12 h. (Se administra en no menos de 60
min. o 100 ml./h.)
4.- CONTRAINDICACIONES:
Insuf. Heptica Grave. -Embarazadas, -Lactancia, -Nios hasta pasada
la adolescencia. -En pacientes con dficit de glucosa-6-fosfatodeshidrogenasa puede producir un aumento de hemlisis. -En
epilpticos puede desencadenar crisis.
5.- OBSERVACIONES:
-Evitar la luz en el envase ms de 24 h. -No mezclar ni con heparina ni
con Soluciones Alcalinas.

124-LEVOMEPROMAZINA
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Sinogn, Nozinan, Togrel (Amp. 25 mg./1ml.) (Comp. 25 y 100 mg.) (
Sol. oral 40 mg./ml.)
2- INDICACIONES:
-Esquizofrenia, -Trastorno paranoide, -Mana, -Trastorno por ansiedad, Agitacin, -Antiemesis -Analgesia coadyuvante en terapia oncolgica, Hipo rebelde, -Alucinosis Alcohlica, -Sndr. Pilles Tourette, -Corea de
Huntington, -Coadyuvante del trat. del dolor, -Psicosis, -Neurosis, Delirios, -Sedacin en la agitacin psicomotriz con o sin delirios.
3.- POSOLOGA:
-Adultos: (Evitar si es posible dosis iv.) DI: im. 25-50 mg. (0,5 mg./kg.)
Dmx: 200 mg./da (Preparacin: 50 mg. en SSF. hasta 10 ml. (1 ml.= 5
mg.) Repetir en 15 a 30 min. si an no se ha producido el efecto. Y
despus cada 6 h.
-Peditrico: No recomendado. Si se usa, con vigilancia estricta. En
nios <12 aos a >3 aos: DI: im. 0,25-1 mg./kg. o 0,5-2 mg./kg./da
en 2-3 tomas. Dmx. 40 mg./da. (Preparacin: 25 mg. en SF. hasta 10
ml. (1 ml.=2,5 mg.))
4.- CONTRAINDICACIONES:
Absolutas: -Hipersensibilidad a fenotiazinas, -Agranulocitosis, Disminucin del nivel de consciencia, -Coma, -Feocromocitoma, Glaucoma, -Parkinson, -Hipotensin Severa. Relativas: -Enf. Hepticas,
Enf. Cardiovasculares grave, -Trastornos respiratorios crnicos, Epilepsia, -Miastenia Gravis.
5.- OBSERVACIONES:
-Embarazo: Categora D. -Lactancia: No recomendado. Se excreta en
leche materna. IR. e Insuf. Hepatica, reajustar dosis. -No existe
antdoto especfico. Tras la administracin im. colocar al paciente en
sedestacin o en decbito al menos 30 o 60 min.

125-LEVOSIMENDAN
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Simdax (Amp. 5 ml./12,5 mg.; 10 ml./25 mg.) (1 ml.= 2,5 mg.)
2.- INDICACIONES:
-ICC. -EAP. Trat. a corto plazo de la descompensacin Aguda Severa

GUA FARMACOLGICA

de la Insuf. Cardiaca Crnica resistente a otros trat convencionales.

3.- POSOLOGA:
Adultos: DI: Inf. iv. 6-12 mcg./kg. o 0,24-0,48 ml./kg. en 10 min.; DM:
Infu. iv. 0,1 mcg./kg./min. o 0,24 ml./kg./h. (evaluar a los 30-60 min.)
(Preparacin: 12,5 mg. en SG. hasta 500 ml. (1 ml.=25 mcg.))
4.- CONTRAINDICACIONES:
-Hipotensin Grave y Taquicardia. -Obstrucciones mecnicas
significativas que afecten al llenado o al vaciado ventricular o a ambos.
-IR. grave (aclaramiento de Creatinina <30 ml./min.) -Insuf. Heptica
grave. -Historia de Torsades de Pointes. -No se administra en nios.
5.- OBSERVACIONES:
>0,4 mcg./kg./min. provoca sobredosis. -Conservar entre 2 y 8C. -Si
cambia a color anaranjado no disminuye la potencia. -Embarazo:
Categora C, no utilizar en lo posible. -Lactancia: evitar.

126-LIDOCANA
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Lidocana Braun iv: (Amp. al 1% 100 mg./10 ml.: al 2% 200 mg./10 ml.;
al 5% 500 mg./10 ml.) Xilonibsa. (Spray-Aerosol cutaneo 10%) (Gel al
2%) Xilocaina. (Pomada al 5%)
2.- INDICACIONES:
-Arritmias: (-TV, -Extrasstoles Vent. -TV-FV refractarias, -PCR (2 a
IAM).) -Anestsico local.
3.- POSOLOGA:
-Adultos: Como Antiarrtmico: DI: iv. 1-1,5 mg./kg. o 0,05-0,075 ml./kg.
(en amp. 2%) en 1-2 min., se puede repetir en caso de arritmia
refractaria, 0,5 mg/kg cada 5 min. hasta un mximo de 3 mg./kg. 200300 mg. en 1 h. DM.: Infu. iv. a 30-60 mcg./Kg./min. o 0,45-0,9
ml./kg./h. (a 30-60 ml./h. para 70 Kg.) (Preparacin: 2 gr. en SG. hasta
500 ml. (1 ml.=4 mg.)). DI: Endotraqueal: doble de la DI. iv. y completar
con SSF. hasta 10 ml.. Como anestsico local: DI: Infiltracin sc.
mxima de 4,5 mg./Kg. o 0,225 ml./kg. (en amp. al 2%) en disitintos
planos.
-Peditrica: DI: iv. (igual que en adultos). DM: Infu. iv. 2 gr. en SG. hasta
500 ml. (1 ml.=4 mg.), a 10-50 microgr/Kg/min o 0,15-0,75 ml./kg./h.
Como anestsico local: DI: Infiltracin sc. (igual que en adultos)
4.- CONTRAINDICACIONES:
-Hipersensibilidad a anestsicos locales tipo amdico, -Sndr. StokesAdams, -Sindr. WPW, -Bloqueos AV o intraventricular, -Shock
cardiognico de causa no arrtmica.
5.- OBSERVACIONES:
-Embarazo: Categora B. -Lactancia: No se excreta en la leche materna.
IR. e Insuf. Heptica (50% de la dosis a administrar segn peso). -No
existe antidoto

127-LORAZEPAM
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Idalprem, Lorazepam Normon, Orfidal Wyeth (Comp. 1, 2 y 5 mg vo.)
(Amp. 4 mg./ml. extranjero)
2.- INDICACIONES:
Ansiedad, fobias e histeria, Insomnio, Agitacin en alcoholismo crnico,
Pnico, Nauseas y vmitos inducidos por quimioterapia
3.- POSOLOGA:
-Adultos (70 kg.): En Ansiedad: DI: vo. 1-2 mg cada 8 -12 h. Dmx: 10
mg./da. En Insomnio: DI: vo. 2-4 mg./24 h. al acostarse.
(Uso iv: (slo extranjero):
Como amnsico: DI: im. 50 mcg./kg. hasta Dmx: de 4 mg. (2 h. antes
de la Intervencin Quirrgica).
DI: iv. 44-50 mcg./kg. hasta Dmx: 2-4 mg. (15-20 min. antes de la
Intervencin Quirrgica).
Como anticonvulsivante: Estatus Epileptico: DI: iv. 4 mg. en >2 min.
Repetir dosis si continun las convulsiones o vuelven a aparecer a los
15 20 min. Dmx: 8 mg./12 h. En Vmitos en Quimioterapia: DI: iv.
2 mg. (30 min. antes de quimioterapia), seguidos de 2 mg./4 h. segn
sea necesario. (Preparacin iv.: DI. en SSF. o SG. Agua Esteril
inyectable. Hasta el doble de la DI.
-Pediatria: Uso aceptado en nios >5 aos. En vo. Pero en iv. Uso en el
que no se ha establecido la segudirdad y eficiacia en <18 aos.
4.- CONTRAINDICACIONES:
Hipersensibilidad. Miastenia grave. Insuficiencia respiratoria severa.

939

URGENCIAS Y EMERGENCIAS EXTRAHOSPITALARIAS GUETS - SESCAM

Glaucoma de ngulo estrecho.
5.- OBSERVACIONES:
-Embarazo: Categora D. Atraviesa la barrera placentaria.
-Lactancia: Se excreta con la leche materna en bajas concentraciones.
Se recomienda suspender la lactancia.
-En IR. e Insuf. Hepticas: Requiere ajustar dosis. -En Adultos >50 aos:
DI: vo.1 mg./24 h. (Dmx: 5 mg./24 h.). -Antdoto:
Flumazenilo

128-LUBRICANTE HIDROSOLUBRE Hidroxietilcelulosa

1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Lubricante K -Y Jelly, Sulky gel lubricante hidrosoluble (Gel 10, 82, 100
gr.)
2- INDICACIONES:
Lubrificacin SNG, Sonda Urolgica, IOT, Citoscopia, Electroterapia,
Examenes digitales, Lubricacin vaginal y anal
3.- POSOLOGA:
Aplicar en las superficies a usar o tratar
4.- CONTRAINDICACIONES:
Salvo la alergia al mismo, Sin datos encontrados.
5.- OBSERVACIONES:
-Se recomienda no utilizarlo con Aminas Primarias y Secundarias o en
medios reductores

129-LUBRICANTE ANESTESICO. (con Tetracana)

1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Lubricante Urolgico Organon (Pomada al 0,75 % o Tubo25 gr. con
187,5 mg. de Tetracaina) Lubricante Urolgico Braun. (Gel al 0,75 % o
canuleta 6 gr. con 45 mg. de Tetracana).
2.- INDICACIONES:
Anestsico y lubricante de superficie para: -Cateterismos, Citoscopias, -uretroscopias, -Sondajes Uretrales e Intubacin en
anestesiologa.
3.- POSOLOGA:
Aplicacin tpica sobre superficies del instrumental para el sondaje, o
introduciendo previamente en la entrada de los orificios a sondar, si
es posible unos 10 minutos antes si el paciente est consciente y no
es vital, y an mejor si el lubricante est frio, (OtrAut. a <4C)
4.- CONTRAINDICACIONES:
Incompatibles con Alcalis, Yoduros, sales inorgnicas de Plata y
Mercurio.
5.- OBSERVACIONES:
-Embarazo: No se tiene informacin especfica sobre la seguridad en
el embarazo, aunque se ha empleado muchos aos sin consecuencias
nocivas. -Lactancia: Evitar en lo posible.

130-MAGNESIO, Sulfato de
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Sulmetin simple, (Amp. 1,5 g./10 ml.(iv.)) (Amp. 750 mg / 5 ml (im.))
2.- INDICACIONES:
-Hipomagnesemia severa. -Estados convulsivos especialmente en
eclampsia y Preeclampsia. -TV tipo "Torsade de Pointes". -Arritmias
ventriculares asociadas a la hipopotasemia e hipomagnesemia. Intoxicacin por Bario. -PCR con sospecha de hipomagnesemia
3.- POSOLOGA:
-Adultos: En Eclampsia: DI: Infu. iv. 57 mg./kg. o 0,38 ml./kg. en 15-30
min. (Preparacin: DI en SG. hasta 100 ml. a 200-400 ml./h.) DM: Infu.
iv. 14-28 mg./kg./h. (Preparacin: 3 gr. en SG. hasta 100 ml. (1 ml. =
30 mg.) a 0,46-0,93 ml./kg./h. En PCR, Arritmias, e Intoxicacin de
Bario. DI: Infu. iv. 14,3-28,6 mg./kg. 0,095-0,19 ml./kg. en 15-30
min. (En PCR. en bolo sin diluir) (Preparacin: DI. en SG. hasta los 100
ml. a 200-400 ml./h.) DM: Infu. iv. 7,1-14,2 mg./kg./h. (Preparacin:
1,5 gr. en SG. hasta 100 ml. (1 ml.=15 mg.) a 0,473-0,946 ml./kg./h.).
En Hipomagnesemia Leve. DI: Infu. iv. 14,3 mg./kg./6 h. 0,095
ml./kg./6 h. (Preparacin: DI en SG. hasta 100 ml. a 400 ml./h.) En
Hipomagnesemia Grave. DI: Infu. iv. 0,29-0,39 mg./kg./min.
(Preparacin: 5 gr. o 33 ml. en SG. hasta 100 ml. (1 ml.= 49,5 mg.) a
0,35-0,47 ml./kg./h.)
-Peditrica: En Hipomagnesemia e Hipocalcemia refractaria: DI: Infu.

940

GUA FARMACOLGICA

iv. 25-50 mg./kg. (Preparacin: DI en SF. hasta 50 ml. en 5-20 min.) a

150-600 ml./h. DM: Infu. iv. 1-2 mg./kg./h. (Preparacin: 0,9 gr. o 6
ml. en SF. en 100 ml. (9 mg./ml.) a 0,11-0,22 ml./kg./h.)(Dmx: 1
gr./da)
4.- CONTRAINDICACIONES:
Hipersensibilidad, Insuficiencia renal
grave,
bloqueo AV
cardiaco,lesin miocrdica, parto inminente en las dos horas previas al
parto, miastenia gravis,ausencia del reflejo rotuliano, en pacientes
digitalizados
5.- OBSERVACIONES:
-Proteger de la luz. -Administrar iv. lenta sin exceder de 150 mg/min. Sospechar sobredosis e intoxicacin si aparece: Abolicin del reflejo
Rotuliano, Depresin respiratoria y Oliguria. -Conservar entre 15 y 30
C. -No congelar. -Precipita con otros iones como Bicarbonato. Antdotos: Gluconato de Calcio. Fisostigmina. Si hay hipotensin
Dopamina. -Embarazo: Categora B. -Lactancia: Se secreta con la leche
materna. Precaucin.

131-MEFENAMICO, cido
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Coslan. (Cap. 250 mg.) (Supo. 125, 250 y 500 mg.)
2.- INDICACIONES:
-Procesos dolorosos. -Dismenorrea y menorragia. -Artritis reumatoide.
-Gota aguda o cronica. -Migraa hemicrnea. Sndr. Febriles
3.- POSOLOGA:
-Adultos y >14 aos: DI: vo. o va rectal 500 mg./8 h. Si no tolera,
puede ser 250 mg./6 h. (con alimentos). Dmx: 1500 mg./da. En
dismenorrea y menorragia la dosis debe empezar cuando empiece la
menstruacin.
-Peditica: >2 aos. DI: va rectal 8,33 mg./kg./8 h. De 2 a 8 aos. DI:
va rectal 1 sup. 125 mg./8 h.; De 8 a 14 aos. DI: va rectal 1 sup. 250
mg./8 h.
4.- CONTRAINDICACIONES:
-Hipersensibilidad Salicilatos. -Ulcera Gstrica. -Colitis Ulcerosa. Hemorragia Gastrointestinal. -Hemorragias menstruales idiopticas. Asma
5.- OBSERVACIONES:
-Embarazo: Categora C. Contraindicado. -Lactancia: Contraindicado. (No se aconseja en <2 aos.)

132-MEPERIDINA o PETIDINA
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Dolantina (Amp. 100 mg./2 ml. (1 ml.=50 mg.) (Cap. 50 mg.) (Sup. 100
mg.)
2.- INDICACIONES:
-Espasmos Agudos: De la musculatura lisa de las vas biliares
eferentes, del aparato-genito-urinario y del canal gastrointestinal. Espasmos vasculares, Angina de pecho, -IAM con hipertona vagal. EAP por insuficiencia ventricular izquierda. -Crisis tabticas. Espasmos y rigidez del Hocico de Tenca (Facilitacin del parto
indoloro). -Temblor inducido por administracin iv. de Anfotericina B
-Dolor Agudo Severo: En obstetricia, contracturas dolorosas y dolores
de parto en periodo de expulsin. Dolor "quirrgico", como dolores o
temblores postoperatorios, debidos a fracturas, etc. Estados
dolorosos graves del sistema nervioso perifrico (neuralgias).
Premedicacin antes de intervencin quirrgica: antes y durante la
anestesia
3.- POSOLOGA:
-Adultos:-Dolores clicos y muy agudos. DI: iv. 0,75-1,5 mg./kg.
(Preparacin: 100 mg. en SG. SF. hasta 10 ml. (1 ml.=10 mg.) 0,0750,15 ml./kg./3-4 h. en 1-2 min. -En IAM. DI: iv. 0,28-0,42 mg./kg.
(Preparacin: 100 mg. en SG. SF. hasta 10 ml. (1 ml.=10 mg.) 0,0280,042 ml./kg./3-4 h. en1-2 min. -Si sigue el dolor repetir cada 5-10
min. hasta 100 mg. -En Dolor Moderado a Severo: DI: vo. sc. o im. 50150 mg./3-4 h. segn necesidades. -En Premedicacin Anestsica 3090 min. antes de la ciruga: DI: sc. o im. 50-100 mg. -En Dolor o
Temblores del Postoperatorio, o inducido Anfotericina B. DI: iv. 0,350,71 mg./kg./2-4 h. (Preparacin: 100 mg. en SF. hasta 100 ml.) 0,0350,071 ml./kg./2-4 h.
-Peditrica:(usarlo en casos excepcionales) DI: im. sc. 1-2 mg./Kg./2-3

URGENCIAS Y EMERGENCIAS EXTRAHOSPITALARIAS GUETS - SESCAM

h. DI: iv. (igual a adultos)
4.- CONTRAINDICACIONES:
-Alergia Opiceos. -Depresin o Insuficiencia Respiratoria grave, EPOC severo. -Hipertensin Craneal Severa.
5.- OBSERVACIONES:
-Antdoto: Naloxona o Nalorfina, o Levalorfan, o Amifenazol. Embarazo: Categora C. Slo usar si no hay otras teraputicas ms
seguras. -Lactancia: Se recomienda esperar 4-6 horas antes de la
lactancia. (La Academia Americana de Pediatra considera su uso
compatible con la lactancia materna. -Puede alterar la CPK en sangre
de CPK con aumento (biolgico). -Se suele asociar antiemticos si hay
nauseas. -Puede ocasionar dependencia y tolerancia. -Existe tolerancia
cruzada y dependencia cruzada entre opiceos que acten en los
mismos receptores del dolor. -Puede precipitar un Sndr. de
Abstinencia. La va im. puede provocar Fibrosis grave del tejido
muscular, y dolor en el punto de inyeccin. -En Obstetricia administrar
por va im.

GUA FARMACOLGICA

1.- NOMBRES COMERCIALES Y PRESENTACIONES:

Nolotil, Lasain, Metamizol Normon; Neomelubrina, Algimabo. Amp. 2
g./5 ml. (1 ml.=400 mg.), Caps. 500 mg.
2.- INDICACIONES:
Dolor leve o moderado. Fiebre alta refractaria a otros antitrmicos
3.- POSOLOGA:
Adultos. DI: iv. 15-30 mg./kg./6-8 h. (Dmx: 2 gr.) (Preparacin: DI. en
SG. SFF. hasta 100 ml. en 3-5 min.)
Peditrica: En Fiebre alta: DI: im. o iv. 11 mg./ Kg.
En Dolor agudo. (slo en >1 ao)DI: im. o iv. 20-40 mg./kg./6-8 h.
4.- CONTRAINDICACIONES:
-Hipersensibiidad a Pirazolonas, neutropiania, -Agranulocitosis.
Neutropenia. -No recomendado en menos de 3 meses o menos de 5
Kg. de peso. Precaucin en Asma.
5.- OBSERVACIONES:
-Dosis Txicas > 10 g. de una sola vez. -No existe antdoto. -Al
Administrar iv. colocar al paciente en decbito, no excediendo de 1
ml./min, para reducir al mximo el riesgo de hipotensin. -En
Embarazo: Categora C. -En Lactancia no recomendado.

133-MEPIVACAINA, Clorhidrato
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Scandinibsa, Mepivacaina Normon. Amp. 1%, 2, 10 ml. (1 ml.=10 mg.
Mepivacaina + 10 mcg. Epinefrina) Amp. 2%, 2, 10 ml. (1 ml.= 20 mg.
Mepivacaina + 5 mcg. Epinefrina)
2.- INDICACIONES:
-Anestesia local infiltracin, -Bloqueo de nervios perifricos, -Bloqueo
troncular
3.- POSOLOGA:
DI: y Dmx: sc. o im. 7 mg./kg./90 min.
4.- CONTRAINDICACIONES:
-Hipersensibilidad a anestsicos locales tipo amida. -Disfunciones
severas de la conduccin cardiaca, -Insuf. cardiaca descompensada, Shock Cardiognico e Hipovolmico. -Enf. nerviosa degenerativa
activa. -Defectos de coagulacin.
5.- OBSERVACIONES:
No colocar en zona infectada, ni por via iv

134-MEROPENEN
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Meropenem, Rostemeop, Meronem, Merozen , Zeropenem (Vial
polvo 500 mg., 1 gr.)
2.- INDICACIONES:
Antibitico Sepsis Sin Foco, Abdominal, Urolgico, Piel y Tejidos
Blandos. Neumona, incluyendo neumona adquirida en la comunidad
y neumona nosocomial. Infecciones broncopulmonares en fibrosis
qustica, del tracto urinario, complicadas intra-abdominales, intra- y
post-parto, complicadas de la piel y tejidos blandos, Meningitis
bacteriana aguda.
3.- POSOLOGA:
Adultos: DI: iv. 500 a 2000 mg. (Preparacin: 2000 mg. en SF. SG.
hasta 100 ml. (20 mg./ml.) a pasar en 15 a 30 min. o 400-800 ml./h.)
Peditrica: <3 meses. DI: iv. 20 mg./kg./8 h.; >3 meses a <11 aos. DI:
iv. 10-40 mg./kg./8h.; >11 aos. DI: iv. (Igual a Adultos.)
4.- CONTRAINDICACIONES:
-No se recomienda el uso concomitante de Meropenem y cido
Valproico/Valproato de Sodio. -Alergia a los carbapenmicos o lactmicos. -En Embarazo y Lactancia.
5.- OBSERVACIONES:
En Embarazo y Lactancia, no usarlo. En Intoxicacin, la hemodilisis
eliminar Meropenem y su metabolito.

135-METAMIZOL (DIPIRONA MAGNSICA)

136-METILERGOMETRINA, Maleato de
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Methergn (Amp. 200 mcg ./1 ml.) (Gotas: 0,25 mg ./1 ml.)
2.- INDICACIONES:
Sangrado uterino anormal de causa obsttricca con tero vacio.
Hemorragias posrparto o postaborto, Hemorragias tardas, Atona
uterina. Maniobra de Crede (alumbramiento dirigido) y Legrados
3.- POSOLOGA:
Adultos: DI: iv. o im. 2,8 mcg./kg. en 1-2 min. (Dmx. 200 mcg.)
(Preparacin: 200 mcg. en SF. hasta 10 ml. (20 mcg./ml.) (En
hemorragia PostParto o Aborto, cada 2-4 h. En Atonia Uterina cada 6
h. En Alumbramiento dirigido slo una dosis)
4.- CONTRAINDICACIONES:
-En Embarazo, periodos de dilatacin hasta que no corone la cabeza. Induccin al parto, -Amenaza de aborto. -Pre y eclamsia, -Angor
pctoris, -HTA, -IR. o insuf. heptica grave.
5.- OBSERVACIONES:
En Embarazo: Categora D. En Lactancia: No prescrito. En Pediatra: No
Prescrito. Intoxicacin a partir de 200 mcg. 4 veces al da. No tiene
antdoto.

137-METILPREDNISOLONA
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Urbasn, Solu-Modern, (Vial: 8, 20, 40, 125, 250, 500 mg, 1, 2 g.)
2.- INDICACIONES:
-Insuf. Suprarrenal, -Asma, -Broncoespasmo, -Anafilaxia, -Estados de
Shock, -Reacciones Transfusionales, -Lesiones medulares agudas.
3.- POSOLOGA:
-Adultos: En Emergencias: DI: iv. 4-8 mg./kg. (Preparacin: DI. en SF.
o SG. en 100 ml. en 30 min. a 200 ml./h.) En Lesin aguda de mdula
espinal. DI. iv: 30 mg./kg. en 15 min. (Preparacin: DI. en SF. SGr. en
100 ml a 400 ml./h.) tras 45 min. DM. Inf. Iv. 5,4 mg./kg./h.
(Preparacin de DM para 4 h., 21,6 mg./kg. en SF. o SG. hasta 100 ml.
a 25 ml./h.) En resto de patologas no Emergencias: (Antiinflamatoria
s/Antialrgicas). DI: iv. o im. 1-2 mg./kg. en 1 min. Seguido de DM: iv.
im. 0,5-1 mg./kg./4-6 h.
-Peditrica, Situaciones graves: DI: iv. o im. 1-2 mg./kg.
4.- CONTRAINDICACIONES:
-Infecciones sistmicas por hongos, -Tras administracin de vacunas
vivas, -Herpes Zoster. (Precauciones: -En herpes ocular, -Ulcera
gastroduodenal, -Diabetes, -Insuficiencia cardiaca, -HTA, -Miastenia
Gravis, -lcera pptica, -Esofagitis, Infecciones, -Osteoporosis, -IR.)
5.- OBSERVACIONES:
-Toxicidad a partir de 30 mg./kg. -No tiene antdoto. -Administrar
Ranitidina u Omeprazol iv como proteccin gstrica. -En Embarazo:
Categora C. -En Lactancia: Evitar.

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URGENCIAS Y EMERGENCIAS EXTRAHOSPITALARIAS GUETS - SESCAM

138-METILTIONINA, Cloruro de
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Azul de Metileno (Amp. 1% 10 ml./100 mg. (10 mg./ml.))
2.- INDICACIONES:
-Metahemoglobinemia Aguda txica por: Nitritos, Nitroprusiato,
Anilinas, Paracetamol. -Vasoplejia o Hipotensin refractaria a otros
tratamientos. -Shock por Protamina o Radiocontraste. -Como
antisptico en uso tpico. -Como tcnica para delimitar estructuras
orgnicas, como por ejemplo confirmar la ruptura de la membrana
amnitica.
3.- POSOLOGA:
Adultos: DI: iv. 1-2 mg./Kg. (Preparacin: DI en SG. hasta 100 ml.) en
15 min. o 400 ml./h. Repetir si es necesario a los 45-60 min. (Dmx. iv.
<7 mg./kg. (ya que a estas dosis puede actuar como oxidante y en vez
de convertir la Metahemoglobina en hemoglobina lo hace a la
inversa)).
Peditrica: (igual a Adultos)
4.- CONTRAINDICACIONES:
-No utilizar en nios muy pequeos y en caso de dficit de G-6PDeshidrogenasa ya que puede inducir Anemia Hemoltica. (Usar como
Alternativa Acido Ascrbico 1 gr./ h. (mximo 10 gr)) -IR. -Intoxicacin
por cianuro.
5.- OBSERVACIONES:
-Proteger de la luz. -La tincin azul de la piel se decolora con
hipoclorito de sodio. -Puede teir la orina. -Interfiere la pulsioximetra
dando falsos resultados de baja saturacin.
No usar va sc. (puede producir necrosis) e intratecal. En Embarazo:
Categora C. En Lactancia: sese solamente cuando los beneficios
sobrepasen el riesgo. (Puede ser ltima alternativa tras Noradrenalina
en los Shock Cardiognicos, incluso en el sptico. Pero an est en
estudio)

139-METOCLOPRAMIDA, Clorhidrato de
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Primpern (Amp. 10 mg./2 ml.; 100 mg./5 ml.) (Gotas 60 ml. a 2,6
mg./ml.) (Sol. Oral 250 ml. a 5 mg./ml.)
2.- INDICACIONES:
-Nauseas y Vmitos. (Antiemtico), -Gastroparesia, -Reflujo
GastroEsofgico. -Profilasis de Vmitos en quimioterpia, -Emesis
Aguda por cisplatino, -Emesis retardada, -Gastroparesia Diabtica.
3.- POSOLOGA:
-Adultos: En Nuseas y Vmitos. DI: iv. im. 10 mg./4-6-8 h.. sin
diluir, en 1-2 min. En Prevencin de Vmitos en quimioterapia o
Gastroscopias (30 min. antes) DI: Infu. iv. 1-2 mg./kg. (Preparacin:
DI. en SF. o SG. hasta 100 ml en 15 min. ( 400 ml./h.)). En Emesis
Agudas (o por tomar Cisplatino). DI: Infu. iv. 3 mg./kg. (Preparacin:
DI. en SG. SF. hasta 100 ml. a 100 ml./h. (a no mas de 5 mg./min.))
-Peditrica: En Emesis en Neonatos: DI: vo iv. 33-100 mcg./kg./8 h.
(Preparacin: 5 mg. o 1 ml. en SF. o SG. hasta 10 ml. (500 mcg./ml.)).
En Reflujo gastro-esofgico o dismotilidad intestinal, DI: vo. im. iv,
0,1-0,2 mg./kg./6-8 h.
En Emesis postoperatorio. DI: iv. 0,1-0,2 mg./kg./6-8 h. En Profilaxis
emesis postquimioterapia. DI: vo. im. iv. 1-2 mg./kg./2-4 h.
4.- CONTRAINDICACIONES:
-Feocromocitomas, -En pacientes tratados con Fenotiacidas o
Butirofenonas o Levodopa. -Hemorragias y perforaciones
gastrointestinales.
5.- OBSERVACIONES:
-Dosis txica: 0,5-1 mg./Kg./da. -Antdoto: Biperideno (Akineton) 2
mg cada 30 (En Adultos) Benzodiacepinas en nios. -Evitar mezclar
con Soluciones Alcalinas por riesgo de precipitacin. -En Embarazo,
Categora B. administrar con precaucin. -En Lactancia: Se excreta por
leche materna. Contraindicado.

140-METOPROLOL
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Beloken, Lopresor (Comp. 50, 100 mg.) (Amp. 5 mg./5 ml.)
2.- INDICACIONES:
-Arritmias Cardiacas (Especialmente TSV). -IAM

942

GUA FARMACOLGICA

-HTA, -Angina de Pecho, -Control de Taquicardia Sinusal no apropiada

y de Extrasstoles supra y ventriculares (frmaco de eleccin). -Control
de la respuesta ventricular en Taquicardia Auricular, Flutter o FA
(frmaco de eleccin). -Supresin y prevencin de TPSV. -Prevencin
de Arritmias Ventriculares (Post-IAM, DAVD o Displasia Arritmognica
del Ventrculo Derecho, TV idiopticas)
3.- POSOLOGA:
-Adultos: DI: iv. 5 mg. o 5 ml. en 2 min. cada 5 min. hasta 3 dosis o 15
mg. continuar a los 15 min. de la ltima dosis iv. con 50 mg. vo.
-Peditrica: Experiencia limitada. En HTA. DI: vo. 1 mg./kg./12 h.
4.- CONTRAINDICACIONES:
-Bradicardia sinusal marcada y BAV no protegidos con MP, -Shock, -I.C.
moderada-grave, -PA <90 mmHg. Sndr. Brugada. -Precaucin en IR.
5.- OBSERVACIONES:
-Reducir dosis o interrumpir si FC < 45 lpm, PA < 90 mmHg, -En el
Embarazo y la Lactancia, no debe ser administrado, a menos que su
utilizacin seconsidere imprescindible.

141-METOXAMINA (2,5-dimetoxinorefedrina)
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Vasoxyl, Idasal (Amp. 20 mg./1 ml.)
2.- INDICACIONES:
-Hipotensin Aguda, -Finalizar o detener la TSV, -Estados hipotensivos
por Anestsicos Raqudeos y Antihipertensivos, -Durante o despus de
la administracin de Ciclopropano o de Anestsicos Halogenados.
3.- POSOLOGA:
-Adultos: En Hipotensin durante la Anestesia: DI: iv. iv. 3-5 mg. y
suplementar va im. con 10-15 mg. (Preparacin: 20 mg. en SF. hasta
10 ml. (2 mg./ml.) DM: Infu. iv. 5 mcg./min. (Preparacin: 10 mg. en
SF. hasta 100 ml. (0,1 mg./ml.) a 3 ml./h.) En TSVP. DI: iv. 5-15 mg. en
3-5 min., o im. 10-20 mg. dejar pasar 15 min. antes de administrar
otra dosis.
Peditrica: DI: iv. 80 mcg./kg. o im. 250 mcg./kg. (Preparacin: 10 mg.
en SF. hasta 100 ml. (100 mcg./ml.))
4.- CONTRAINDICACIONES:
HTA grave preexistente.
5.- OBSERVACIONES:
-Antdoto: Fentolamina (iv. 5 mg.) -Interrumpir el medicamento si la TA
sistlica se hace >160 mmHg. -En Embarazo no administrar. En
Lactancia no administrar.

142-MIDAZOLAM
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Dormicum, Midazolam, (Amp. 5 mg./5 ml.; 15 mg./3 ml.; 25 mg./5
ml.; 50 mg./10 ml.) (Comp. 7,5 mg).
2.- INDICACIONES:
-Sedacin prolongada, -Induccin y mantenimiento de Anestesia en
IOT. en combinacin con un analgsico, -Anticonvulsivante. -Induccin
de la anestesia en nios (en combinacin con ketamina).
3.- POSOLOGA:
-Adultos: En Sedacin Consciente: DI: iv. 0,03-0,04 mg./kg. en 2 min.
si no responde a los 10 min. Dar 0,014 mg./kg. (Hasta Dmx total:
0,11 mg./kg.) (Preparacin: 5 mg. en SF. o SG. hasta 10 ml. (0,5
mg./ml.)) Si se usa va intranasal, sin diluir. -DI: 0,2-0,3 mg./kg. (con
amp. 15 mg./3 ml.) 0,04-0,06 ml./kg. En Premedicacin de la
Anestsica: (30 a 60 min. antes de la Ciruga) DI: iv. 0,014-0,028
mg./kg. en 2 min. o DI: im. profunda 0,07-0,10 mg./kg. en 2 min.
(Preparacin: iv. o im. 10 mg. en SF. SG. hasta 10 ml. (1 mg./ml.)). En
Induccin Anestesia sin premedicacin con IOT. : DI: iv. 0,30-0,35
mg./kg. en 20 a 30 seg. Seguido de DM: Infu. iv. 0,15-0,4 mg./kg./h.
(Preparacin: 15 mg. en SF. o SG. hasta 100 ml. (0,15 mg./ml.) a 1,02,6 ml./kg./h.). En Convulsiones: DI: iv. 0,1-0,2 mg./kg. lento, Seguido
de DM: Infu. iv. 0,1-0,2 mg./kg./h. (Preparacin: 10 mg. en SF. o SG.
hasta 100 ml. (0,1 mg./ml.) a 1-2 ml./kg./h.).
-Peditrica: En Sedacin Consciente: Va iv.: >6 meses y <5 aos: DI:
0,05-0,1 mg/kg. (Dmx. total: <6 mg.); >5 aos y <12 aos: DI: 0,0250,05 mg./kg. (Dmx. total: <10 mg.); Via im.: >1 ao y <15 aos. DI:
0,05-0,15 mg./kg. (Preparacin: iv. o im. 5 mg. en SF. hasta 10 ml. (0,5
mg./ml.); Va rectal: >6 meses: DI: 0,3-0,5 mg. (Preparacin: 5 mg. en
10 ml. de Agua Destilada. (0,5 mg./ml.)). En Premedicacin de la

URGENCIAS Y EMERGENCIAS EXTRAHOSPITALARIAS GUETS - SESCAM

Anestsia: (15-30 min. antes de la Anestesia). En >6 meses: DI: Va
rectal: 0,3-0,5 mg./kg. (Preparacin: 5 mg. en Agua Destilada hasta 10
ml.) Va im. 0,08-0,20 mg./kg. (Preparacin: 10 mg. en SF. o SG. hasta
10 ml. (1 mg./1 ml.). En Induccin de Anestesia: DI: iv. 0,1 -0,2 mg/kg
iv en 20-30 seg., DM: Infu. iv. 0,1-0,4 mg/kg/h. En Convulsiones: DI:
0,15 mg./kg.(Preparacin: 15 mg. en SF. hasta 10 ml. (1,5 mg./ml.),
DM: 0,05-3 mg./kg./h. (Preparacin: 15 mg. en SF. hasta 100 ml. (0,15
mg./ml.) 0,3-2,0 ml./kg./h. En Ataranalgesia: (Asociacin de Sedantes,
An algsicos y relajantes musculares) DI: im. 0,5-0,2 mg./kg. +
Ketamina (im.)
4.- CONTRAINDICACIONES:
-Alergia a Benzodiazepinas. Insuf. Resp. Severa. -Apnea del sueo:
puede producirse una exacerbacin. Intox. Etlica aguda, coma o
shock: debido a la depresin aditiva sobre el SNC. -Miastenia gravis, Glaucoma de ngulo Cerrado.
5.- OBSERVACIONES:
-Antdoto: Flumazenilo. -En Embarazo: categora D. En Lactancia:
mejor no utilizar o no seguir con la lactancia.

143-MILRINONA
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Corotrope. (Amp. 20 mg./20 ml.)
2.- INDICACIONES:
ICC. Aguda. (Trat. corto plazo)
3.- POSOLOGA:
-Adultos: DI: iv. 50 mcg./kg. en 10 min. (Preparacin: 20 mg. en SF. o
SG. hasta 100 ml. (200 mcg./ml.) o 0,4 ml./kg. a pasar en 10 min.)
seguido de DM: Infu. iv. 0,375-0,75 mcg./kg./min. o 22,5-45,0
mcg./kg./h. (Preparacin: 20 mg. en SF. o SG. hasta 100 ml. (200
mcg./ml.) o 0,11-0,22 ml./kg./h.
4.- CONTRAINDICACIONES:
-Puede agravar la obstruccin del tracto de salida en la estenosis
subvalvular artica hipertrfica. -Su uso durante la fase aguda del IAM
puede llevar a un aumento indeseado del consumo minuto de
oxgeno.
5.- OBSERVACIONES:
-Intoxicacin: (Dmx. 1,13 mg./kg./da 90 mg./da.), No tiene
Antdoto. -En Embarazo: No se dispones de estudios adecuados. -En
Lactancia: No se dispone de informacin suficiente.

144-MIVACURIO
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Mivacrom. (Amp. 10mg./5ml. ; 20 mg./10 ml.)
2.- INDICACIONES:
Miorelajante Muscular: En anestesia general. -Facilitar la intubacin
traqueal. -Ventilacin mecnica (en perfusin). Ttanos.
3.- POSOLOGA:
Adultos: DI: iv. 0,15 mg./Kg. en 10 seg. (Para IOT 0,2 mg./kg.). Seguido
a los 30 seg. de 0,10 mg./kg. (efecto a los 1,5-2 min.) DM: Infu. iv. 0,01
mg./kg./min. o 0,6 mg./kg./h. (Preparacin: 80 mg. en SF. hasta 100
ml. (0,8 mg./ml.) a 0,75 ml./kg./h.)
Peditrica: De 2-6 meses. DI: iv. 0,1-0,15 mg./kg. en 5-15 seg.; De 7
mes a 12 aos: DI: iv. 0,1-0,2 mg./kg. DM: De 2 meses a 2 aos: Infu.
iv. 11 mcg./kg./min. o 0,66 mg./Kg./h.; DM: De 2 aos a 12 aos: Infu.
iv. 13-14 mcg./kg./min. o 0,78-0,84 mcg./kg./h.
4.- CONTRAINDICACIONES:
-Precaucin en la Miastenia Gravis. -Sensibilidad incrementada a los
efectos de la histamina, como el asma. Otras enfermedades
neuromusculares, -Pacientes Caqucticos.
5.- OBSERVACIONES:
-Antdoto: (Neostigmina. -La recuperacin puede acelerarse con la
anticolinesterasa combinado con Atropina o Glicopirrolato, una vez
que haya evidencia de recuperacin espontnea.) -Conservar a <25C.
-No congelar. No mezclar con soluciones alcalinas. -En Embarazo: No
hay informacin disponible, no debe ser utilizado a menos que el
beneficio clnico sea mayor. En Lactancia, No se sabe si se excreta en
la leche humana tras la administracin a la madre.

GUA FARMACOLGICA

145-MORFINA, Clorhidrato o Sulfato de

1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Morfina, Oramorph (Amp. 1% 10 mg./1 ml.; 2% 20 mg./1 ml.) (Sol. oral
100 ml. a 2 mg./ml.; 20 ml. a 20 mg./ml.) (Comp. 20 mg. y 200 mg.)
2.- INDICACIONES:
-Dolor severo, -Dolor crnico, -Dolor asociado a IAM, -Disnea de
origen cardiaco: IAM, -EAP, -ICC, -TEP.
3.- POSOLOGA:
-Va iv: Adultos: En Dolor: DI: 0,05-0,2 mg./kg. (Preparacin: 10 mg.
en SF. hasta 10 ml. (1 ml./1 mg.)) o 0,05-0,2 ml./kg. cada 5 a 30 min.
Dmx: 20-25 mg. DM: Infu. Iv. 0,01-0,05 mg./kg./h. (Preparacin: 10
mg. en SF. hasta 100 ml. (1 ml./0,1 mg.) a 0,1-0,5 ml./kg./h.) En IAM
EAP ICC. DI: 0,05-0,1 mg./kg. lento a ritmo de <2 mg./min. Repetir
cada 5 a 30 min. Hasta Dmx: iv. 20-25 mg (Preparacin: 10 mg. en SF.
hasta 10 ml. (1 mg./ml.) a 0,05-0,1 ml./kg.
-Va iv: Peditrica: En RN. DI: Infu. iv. 0 ,025 mg./kg., En 2 a 6 meses.
DI: Infu. iv. 0,05 mg./kg.; En 6 a 12 meses: DI: Infu. iv. 0,075 mg./kg.;
En >1 ao. DI: Infu. iv. 0,1-0,15 mg./Kg. (Preparacin: DI en SF. hasta
100 ml. en 15 a 20 min. a 400-300 ml./h.)
-Va sc. im. Adultos: DI: 5-20 mg./4 h.
-Va sc. im. Peditrica: DI: 0,1-0,2 mg./kg./4 h., Dmx.: 15 mg./24 h.
-Va Epidural lumbar: Adultos: DI: 5 mg.; si puede repetir, dosis
adicionales de 1-2 mg. al cabo de 1 h; Dmx. 10 mg./24 h.;
-Va Intratecal Lumbar. Adultos: DI: 0,2-1 mg/24 h.;
-Va vo. Adultos y >13 aos: DI: 10-20 mg./4-6 h.; Adultos en dolor
posquirrgico (tras recuperar funcin renal) en <70 kg. 20 mg./12 h.;
en <70 kg. 30 mg./12 h.
-Va vo. Peditrica: de 5-12 aos: DI: 5-10 mg./4h; De 1-5 aos. DI:
2,5-5 mg/4h. No usar en < 1 ao. En Dolor Oncolgico Intenso: DI:
0,2-0,8 mg./kg./12 h. (Se puede ajustar la dosis aumentando el 25-50%
de la DI.)
4.- CONTRAINDICACIONES:
-Depresin respiratoria, -Status Asmtico. EPOC Grave. -Shock. -IAM
Inferior. -IAM posterior. -IAM con Bloqueo AV. -IAM con Bradicardia. IAM con Hipotensin. -Aumento de la PIC. -Abdomen Agudo no
diagnsticado. -Colico Biliar. -Diarrea por intoxicacin. Trat previo
con IMAOS.
-Precauciones en: Asma y Epilepsia.
5.- OBSERVACIONES:
-Antdoto: Naloxona. -En Embarazo: Categora C. -En Lactancia: Se
excreta por la leche, no utilizar. -Se puede dar Metoclopramida
(Primpern) previo a la Morfina, para evitar vmitos. -Proteger de la
luz en el almacenamiento.

146-NADROPARINA
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Fraxiparina (amp. 0,6 ml.=11.400 UI.; 0,8=15.200 UI.; 1,0 ml.=19.000
UI.)
2.- INDICACIONES:
-Trombosis venosa profunda en extremidades inferiores con o sin
embolia pulmonar.
3.- POSOLOGA:
Adultos: DI.: sc.174 UI./kg./da (<50 kg.=0,4 ml. (7.600 UI.);
50-59 kg.=0,5 ml. (9.500 UI.); 60-69 kg.=0,6 ml. (11.400 UI.);
70-79 kg.=0,7 ml. (13.300 UI.); 80-89 kg.=0,8 ml. (15.200 UI.);
>90 kg.= 0,9 ml. (17.100 UI.)).
4.- CONTRAINDICACIONES:
-Antecedente de trombocitopenia inducida por nadroparina clcica. Anestesia espinal o epidural. -Hemorragia activa o incremento del
riesgo hemorrgico en relacin con alteraciones de la hemostasia,
excepto las debidas a coagulacin intravascular diseminada (CID) no
inducida por heparina. -Lesiones orgnicas susceptibles de sangrar
(como lcera pptica activa). -Accidente cerebrovascular hemorrgico.
-Endocarditis bacteriana aguda. IR. grave (aclaramiento de creatinina
<30 ml/min). -Utilizacin durante la anestesia regional en las
intervenciones quirrgicas programadas.
5.- OBSERVACIONES:
En el embarazo no es aconsejable a menos que los beneficios
derivados del tratamiento sean superiores a los riesgos. -No es
aconsejable el uso durante la lactancia materna. -No es consejable su
uso en Pediatra. -No administrar va im.

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URGENCIAS Y EMERGENCIAS EXTRAHOSPITALARIAS GUETS - SESCAM

GUA FARMACOLGICA

147-NALOXONA

149-NIFEDIPINO

1.- NOMBRES COMERCIALES Y PRESENTACIONES:

Naloxone (Amp. 0,4 mg./1 ml.)
2.- INDICACIONES:
Intoxicacin y Reversin de: -Opiaceos naturales: (morfina, codena); Opiaceos semisintticos (Herona, Dihidromorfina, Dihidrocodena). Opiceos sintticos (Dextropropoxifeno. Pentazocina, Meperidina,
Metadona, Tramadol). -Herramienta diagnstica y terapetica. (por Ej.
Coma de origen desconocido). -Terapia coadyuvante en el Shock
Sptico.
3.- POSOLOGA:
-Adultos: DI: iv. ( im. sc. va orotraqueal). 0,01-0,03 mg./kg.
0,025-0,75 ml./kg. Si no mejora, repetir cada 2-3 min. hasta que
responda, o hasta Dmax.: 10 mg. 25 ml. DM: Infu. iv. 5-15
mcg./kg./h. durante 10 h. (a partir de 20 60 min de la DI)
(Preparacin inicial: 4 mg. en SF. hasta 100 ml. ( 1 ml./0,04 mg.) a
1,25-3,75 ml./kg./h.). En Trat
-Peditrica: DI: iv. ( im. sc. va orotraqueal). 0,01-0,1 mg./kg. o
0,025-0,25 ml./kg. Si no mejora, repetir cada 2-3 min. hasta que
responda, o hasta Dmax.: 8-10 mg. DM: Infu. iv. 5-15 mcg./kg./h.
(Preparacin inicial: 4 mg. en SF. hasta 100 ml. ( 1 ml./0,04 mg.) a
1,25-3,75 ml./kg./h.)
4.- CONTRAINDICACIONES:
-No se conocen salvo la alergia a la misma.
5.- OBSERVACIONES:
-No se han descritos casos de intoxicacin aguda por Naloxona, salvo
en toxicmanos que pueden precipitar en un Sindr. de Abstinencia. Evitar mezclar con soluciones alcalinas. -En Embarazo: Categora B. En Lactancia, se desconoce si se excreta en la leche, se aconseja no
dar lactancia hasta 24 h. despus de dar la Naloxona.

1.- NOMBRES COMERCIALES Y PRESENTACIONES:

Adalat, Cordilan, Dilcor, Nifedipino, Pertensal. (Caps. 10, 30, 60 mg.)
2.- INDICACIONES:
-HTA esencial o secundaria, -Crisis HTA. -Cardiopata Isqumica:
(Angina de pecho y Angina de Prinzmetal) -Sndr. de Raynaud.
3.- POSOLOGA:
-Adultos: DI: Sublingual: 10-20 mg (extraida de la capsula o rota esta).
Se puede repetir cada 15-30 min, hasta el efecto o Dmx: 40 mg.,
DI: vo. 10-30 mg./6-8 h. Dmx: 30 mg. Dmx./da: 120 mg.
-Peditrica: DI: sublingual vo. 0,25-0,5 mg./kg. Dmx: 10 mg.
Dmx./da: 1-2 mg./kg.
4.- CONTRAINDICACIONES:
-Alergia a Dihidropiridina, -Shock cardiognico, -Hipotensin grave
(TAS <90 mmHg), -Estenosis artica grave, -Bloqueo AV de 2 3. Pacientes tratados con Beta-Bloqueantes o Nitritos.
5.- OBSERVACIONES:
-No se documenta antdoto. En caso de Intoxicacin dar:
Sueros Fisilogicos, Beta adrenrgicos y Calcio iv. -En Embarazo:
Categora C. -En Lactancia: se excreta en la leche materna, se debe
evitar la lactancia.

148-NEOSTIGMINA
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Neostigmina, Prostigmine (Amp. 1 ml. y 5 ml. (0,5 mg./ml.))
2.- INDICACIONES:
-Intoxicacin o Reversin de Bloqueantes neuromusculares no
despolarizantes. -Miastenia Gravis. -Espasmos musculares. -Trat.
Coadyuvante en Taquicardia Sinusal.
3.- POSOLOGA:
-Adultos. En Intoxicacin o reversin de los relajantes musculares no
despolarizantes: (Asociar Atropina 5 min. antes o mejor si se usa
previamente Glicopirrolato). D: iv. 14-42-60 mcg./kg. lento (no mas de
1 mg./min.) Repetir cada 5-10 min. hasta la reversin o Dmx: 5 mg.
En Miastenia Gravis: DI: iv.( im. sc.) 0,5 a 2 mg. 7-28 mcg./kg.
(lento). Segn respuesta, dosis adicionales cada 2-3 h. En Trat.
Coadyuvante de Taquicardia Sinusal: DI: iv. 0,25-0,5 mg. o 3-7
mcg./kg. lento. En Atona Vesical e ileo paraltico en el
postoperatorio o Espasmo muscular: DI: iv. (im. sc.) 0,5-1 mg 714 mcg./kg./4-5 h.
-Peditrica: En Intoxicacin o Reversin del Bloqueo Neuromuscular
no despolarizantes: DI: iv. 0,025-0,080 mg./kg. iv. lento. Repetir cada
5-10 min. hasta la reversin o Dmx 2,5 mg. (Dar previamente (unos 5
min. antes) Atropina o Glicopirrolato). En Miastenia Gravis: DI: iv. 0,02
mg./kg. (im. 0,4 mg./kg.)
4.- CONTRAINDICACIONES:
-Peritonitis. -Obstruccin mecnica urinaria. -Obstruccin mecnica
intestinal. -En situaciones donde un incremento de la actividad
muscular del tracto gastrointestinal o urinario pueda resultar
peligroso. -Crisis colinrgicas
Precauciones en: -Asma, -Broncoespasmo, -IAM reciente, -Insuf.
Cardaca, -Bradicardia.
5.- OBSERVACIONES:
-Si produce una crisis anticolinergica, dar mas Atropina a 0,01 mg./kg.
iv, cada 3-10 min. hasta que cese la crisis junto con soporte vital
(ventilacin mecnica). -En Embarazo: Categora C. Su uso en
Miastenia Gravis, parece seguro. -En Lactancia: Se excreta en leche.
No obstante no se han descrito problemas

944

150-NIMODIPINO
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Brainal, Admn., Nimodipino, Chalet, Kenesi, Nimotop, Remontal,
Modus, (Amp. 10 mg./50 ml.) (Comp. 30 mg.)
2.- INDICACIONES:
-Prevencin de espasmo vascular tras Hemorragia Subaracnoidea por:
(-Ruptura de aneurisma congnito o
-Etiologa traumtica) -Deterioro mental relacionado con la edad. Profilaxis de Cefala Migraosa. HTA. -Ataque isqumico agudo
(Cerebral). -Sndrome cerebral orgnico.
3.- POSOLOGA:
Adultos: DI: Infu. iv. a 1 mg./h. o 5 ml./h., o 15 mcg./kg./h. o 0,075
ml./kg./h. durante 2 h. Si se tolera bien y no se aprecian cadas
pronunciadas de la presin arterial, se aumenta a 2 mg./h. o 10 ml./h.
o 30 mcg./kg./h. o 0,15 ml./kg./h. Seguidamente: DM: vo. 60 mg./4 h.
4.- CONTRAINDICACIONES:
-Alergia a Dihidropirinas. Precauciones en: -Hipotensin (TAS < 90
mmHg). -Shock cardiognico. -Hipertensin Intracraneal (edema
cerebral generalizado). IAM. Insuf. Cardiaca. -Bradicardia extrema.
5.- OBSERVACIONES:
-Antdoto: No se conoce ninguno especfico. -En Embarazo: Categora
C, -En Lactancia: Se excreta en la leche materna, se aconseja
suprimirla. En Pediatra no hay suficientes estudios.

151-NITRATO DE PLATA
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Argenpal (Barra cutnea 50,0 mg.)(Uso tpico)
2.- INDICACIONES:
-Epixtasis anterior, -Verrugas y Granulomas de la piel, -Aftas bucales.
3.- POSOLOGA:
-Con la barra cutnea, previamente humedecida en agua durante unos
segundos, debe pincelarse la zona a tratar durante unos segundos,
procurando limitar su aplicacin a la zona afectada (para evitar la
aparicin de manchas negras innecesarias en la piel). Finalmente, se
debe cubrir la zona tratada con una venda o similar.
4.- CONTRAINDICACIONES:
-No aplicar sobre piel herida, infectada, irritada o enrojecida. -No
aplicar sobre lunares, manchas de nacimiento u otras manchas de la
piel, verrugas genitales, verrugas de la cara o de las mucosas. -No
aplicar en la regin anogenital o grandes reas.
5.- OBSERVACIONES:
-Proteger la piel sana de alrededor de la lesin con una pomada o
crema oleosa, por ejemplo vaselina. -En el Trat. de la Epistaxis
anterior, debe tenerse la precaucin de no realizar otra cauterizacin
simultneamente en el mismo lugar del lado opuesto del septo, para
evitar posibles perforaciones del mismo. -Se desconoce la eficacia y
seguridad de la utilizacin en Embarazadas.
-Cada barra cutnea de Argenpal es de un solo uso y aplicacin.

URGENCIAS Y EMERGENCIAS EXTRAHOSPITALARIAS GUETS - SESCAM

152-NITRITO DE AMILO
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Nitrito de Amilo (Amp. 0,5 ml./0,2 mg.; 0,3 ml.; 1 m.) o (hay en Spray)
2.- INDICACIONES:
-Intoxicacin por Cianuro, -Angina de pecho (raramente)
3.- POSOLOGA:
-Adultos: En Intoxicacin por Cianuro. DI: Inhalado. 0,4 mg. en 30 seg
a 1 min. (durante al menos 3 min. o hasta que el paciente est
Consciente; En Angina de Pecho: DI: Inhalar 0,18-0,30 ml. en menos
de 1 min. Repitiendo si es necesario a los 3-5 min.
-Peditrica: En Intoxicacin por Cianuro. DI: Inhalado (igual que en
adultos)
4.- CONTRAINDICACIONES:
-Anemia, -Glaucoma, -TCE o ACVA, Embarazo, Lactancia
5.- OBSERVACIONES:
-En la emergencia se puede impregnar un pauelo con 2 amp. e
inhalar durante 30 seg. -Conservar de 2 a 8C.
Es Inflamables. -Protejer de la luz. -Antdoto: Azl de Metileno. -En
Embarazo no utilizar, -En Lactancia no utilizar.

153-NITRITO SODICO
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Nitrito sdico (Amp. 10 ml./300 mg.)
2.- INDICACIONES:
Intoxicacin Cianuro
3.- POSOLOGA:
Adultos: DI: iv. 300 mg., en 3 a 4 min.; DM: Infu. iv. 7,5 mg./min.
Dmx. 300 mg. (Preparacin: 300 mg. en SF. hasta 100 ml. a 150
ml./h.)
Peditrica: DI: iv. 0.33 ml./Kg. 10 mg./Kg. no pasar mas de 10 ml. o
300
mg.
4.- CONTRAINDICACIONES:
-Metahemoglobinemia preexistente >40%. -Intoxicacin por
monxido de carbono
5.- OBSERVACIONES
-En otras cantidades, es utilizado en Industria textil e industria del
metal y mas restringida en la alimentaria. Sin datos sobre su uso en
Embarazo y Lactancia.

154-NITROGLICERINA
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Vernies, Cafinitrina, Solinitrina, Trinispray, Cordiplast (Comp. Subling.
0,4, 0,8 mg.)(Spray Sublingual 0,4 mg./puff) (Parches Transdermicos)
(Amp. 5 mg./5 ml.; 50 mg./10 ml.)
2.- INDICACIONES:
-Crisis aguda de angina estable. -Profilaxis Angina Estable, IAM y
postinfarto, -Trat. Coadyuvante en IAM, ICC, EAP. Induccin de
Hipotensin en Ciruga. -HTA.
3.- POSOLOGA:
-Adultos: DI: sl. vo. (comp. masticado) puff spray (cada puff 0,4
mg.) 04-0,8 mg. Si no responde, repetir cada 5 min. hasta 3 veces.
(Dmx.: 10 mg./da)
-Adultos: DI. Infu. Iv. 8,5 mcg./kg./h. (Preparacin: 10 mg. en SG.
(mejor) o SF. hasta 100 ml. o 25 mg. en SG. SF. hasta 250 ml. (En
envases de vidrio o polietileno, no de PVC, ni tampoco el sistema) (100
mcg./ml.) o 0,085 ml./kg./h. Seguidamente ir aumentando 0,042
ml./kg./h. cada 3-5 min. hasta controlar el dolor o que la TAS
descienda al 10% de la inicial o que la TAS sea <90 mmHg. o hasta una
Dmx. 171 mcg./kg./h o 1,71 ml/kg./h., aunque a partir de 0,86
ml./kg./h. (puede aumentar la isquemia cardiaca).
-Peditrica: DI: Infu. iv. 0,25-0,50 mcg./kg./min. o 15-30 mcg./kg./h.
(Preparacin: 10 mg. en SG. SF. hasta 100 (1 ml./100 mcg.) Iniciamos
con 0,15-0,30 ml./kg./h. (si no responde incrementar 0,50 a 1,0
mcg./kg./min. o 30-60 mcg./kg./h. o 0,3-0,6 ml./kg./h. cada 3-5 min.
hasta Dmx en Neonatos: 5 mcg./kg./min. o 300 mcg./kg./h. o 3
ml./kg./h. (Segn OtrAut: Dmx en nios 20-60 mcg.Kg./min. o 12003600 mcg./kg./h. o 12-36 ml./kg./h.)
se conoce si se elimina por la leche materna.

GUA FARMACOLGICA

4.- CONTRAINDICACIONES:
-Angina causada por: Miocardiopata Hipertrfica obstructiva,
Estenosis Artica severa o estenosis mitral. -Taponamiento cardaco, Pericarditis constrictiva. -Hipovolemia y/o Hipotensin. -IAM de
ventrculo derecho. -TCE. -Toma reciente de Viagra.
5.- OBSERVACIONES: -No tiene antdoto. -En caso de Hipotensin con
Taquicardia, como Vasopresor dar Metoxamina (Ya que la A drenalina
est contraindicada). -Si al dar por va sublingual (sl.) la boca est seca,
humedecer con agua previamente o dar en spray. -En el Embarazo:
Categora C. -En Lactancia: No se conoce si se elimina por la leche
materna.

155-NITROPRUSIATO, Sdico
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Nitroprussiat Fides., (Vial 50 mg. Disolvente de 5 ml (SG 5%) (1 ml = 10
mg)
2.- INDICACIONES:
-Crisis HTA de Emergencia. -Trat. Coadyuvante en ICC Severa
Refractaria. -Hipertensin pulmonar. Shock Cardiognico, EAP sin
hipotensin. Aneurisma Disaecante de Aorta. -Intoxicacin con
vasoespasmo por Alcaloides del Cornezuelo del Centeno.
(Ergometrina, Ergotamina, Ac. Lisergico, LSD)
3.- POSOLOGA:
Adultos: DI: Infu. iv. 0,3 mcg./kg./min. o 18 mcg./kg./h. o 0,09
ml./kg./h. (Preparacin: 50 mg. disuelto en 5 ml. para disolverlo de
nuevo en SG. hasta 250 ml. (200 mcg./ml.)). Ir aumentado la Dosis
cada 3-5 min. 0,5 mcg./kg./min. o 30 mcg./kg./h. o 0,15 ml./kg./h.
hasta el efecto deseado o hasta Dmx de 10 mcg./kg./min. o 600
mcg./kg./h. o 3 ml./kg./h.
Pediatrica: DI: Infu. iv. (Dosis/kg. Igual que en adultos) (Dmx en
Neonato 6 mcg./kg./min. o 360
mcg./kg./h. o
1,8
ml./kg./h.)(Dmx./kg. en nios igual que adultos).
4.- CONTRAINDICACIONES:
-Hipertensin compensatoria (derivaciones arteriovenosas, coartacin
de aorta) Precaucin en: (-Insuf. coronaria. -Hipotiroidismo, -Dficit
de Vitamina B12, por interferencias en el metabolismo del Yodo y la
Hidroxicobalamina. -Hipertensin endocraneal)
5.- OBSERVACIONES:
-Intoxicacin. Si se da >10 mcg./kg./h. o >24 h. Para prevenir efectos
secundarios dar: Hidroxicobalamina o Vit. B12. DI: Infu. iv. 12,5 mg. en
30 min. En caso de Intoxicacin: Dar Nitrito de Amilo, ihalado en 30
seg. cada 2 min. Inmediatamente despues Nitrito de Sodio (no junto a
Nitrito de Amilo) 10 ml. al 3% iv. en 3 min. y despus 50 ml. de
Tiosulfato de Sdio al 25% en Infu. iv. durante 10 min. -Desechar
cualquier solucin que presente color naranja fuerte, marrn oscuro o
azul, indica degradacin total del preparado. -Administrar con bomba
de infusin y sistema opaco. -En Embarazo: Categora C. -En
Lactancia: se ingonra si se excreta en cantidades significativas en la
leche materna. Se desaconseja su uso durante el periodo de lactancia.

156-NORADRENALINA o Norepinefrina
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Noradrenalina, Levopeh, Norages. (Amp. 1 mg./1 ml.; 10 mg./10 ml.; 8
mg./4 ml.; 4 mg./1 ml.; 10 mg./1 ml.)
2.- INDICACIONES:
-Hipotensin aguda asociada a depresin miocrdica grave, con
resistencias
perifricas
disminuidas,
producidas
por:
Feocromocitoma, Simpatectoma, Poliomelitis, Anestesia espinal,
IAM, Shock Sptico, Transfusiones y reacciones a frmacos. -Trat.
Coadyuvante temporal en PCR. -Shock cardiognico. -Shock con
Hipotensin Severa y/o resistencia a volumen y Dopamina. -Shock
Neurognico.
3.- POSOLOGA:
-Adultos: DI: Infu. Iv. 0,05 mcg./kg./min. o 3 mcg./kg./h. o 0,15
ml./kg./h. (Preparacin: 2 mg. de NorAdrenalina Base en SG. hasta
100 ml. (20 mcg./ml.), aumentar cada 5 min. otros 3 mcg./kg./h. o
0,15 ml./kg./h. hasta conseguir una TAS >90 mmHg. o Dmx. 0,6
mcg./kg./min. o 36 mcg./kg./h. o 1,8 ml./kg./h. Si conseguimos que la
TAS sea > de 90 mmHg. Se sigue con DM: Infu. Iv. 0,1-0,4
mcg./kg./min. o 6-24 mcg./kg./h. o 0,3-1,2 ml./kg./h. En Shock
Sptico: DI: Infu. Iv. 0,5-1,0 mcg./kg./min. o 30-60 mcg./kg./h. o 1,5-

945

URGENCIAS Y EMERGENCIAS EXTRAHOSPITALARIAS GUETS - SESCAM

3,0 ml./kg./h. (Se recomienda asociar a Dopamina 2-2,5
mcg./kg./min.) En Parada Cardiaca: DI: iv. o Va Intracardiaca 100-150
mcg. o 5,0-7,5 ml.
-Peditrica: DI: Infu. iv. 0,05-0,1 mcg./kg./min. o 3-6 mcg./kg./h. o
0,15-0,30 ml./kg./h. (Preparacin: 2 mg. en SG. hasta 100 ml. (20
mg./ml.)) aumentar cada 5 min. 0,15 ml./kg./h. hasta tener buena
respuesta, o hasta Dmx. 3 ml./kg./h. Si hay buena respuesta. Seguir
con DM: Infu. iv. 0,1-0,3 mcg./kg./min. o 0,30-0,90 ml./kg./h.
4.- CONTRAINDICACIONES:
No de forma nica en Hipotensin por Hipovolemia. En Intoleracia a
los Sulfitos. Trombosis vascular perifrica o mesentrica. En lceras y
sangrados Gastrointestinales.
5.- OBSERVACIONES:
-No tiene antdoto. -No usar SF. para su dilucin. -En caso de
extravasacin tisular, infiltrar en la zona 5-10 mg. de Fentolamina. -La
dilucin se oscurece con la luz o el aire. -Desechar si la solucin no es
transparente. -En Embarazo: Categora C. -En Lactancia: Se desconoce
si se excreta en la leche materna. -Retirar siempre el compresor para
buscar va venosa, antes de inyectar. -No mezclar con soluciones
alcalina.

157-OBIDOXIMA Obiodoxina Oxiomas

1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Toxogonin (Amp. 1 ml./250 mg.)
2.- INDICACIONES:
Intoxicacin Plaguicidas Organofosforados
3.- POSOLOGA:
-Adulto: DI: iv. lenta 250 mg. 1 a 2 veces cada 2 h., no dar despus de
las 6 h. de la intoxicacin
-Peditrica: DI: iv. lenta im. 4-8 mg./kg.
4.- CONTRAINDICACIONES:
En intoxicaciones con insecticidas del grupo de los carbonatos. (No es
til)
5.- OBSERVACIONES:
-Puede haber una sensacin de calor y de tensin a los 10-15 min.
despus de la administracin iv. -Su administracin se debe asociar
con Atropina. -Sin datos de su uso en Embarazo y Lactancia.

158-OLANZAPINA
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Zyprexa, Midax, ZALASTA, ZOLAFREN, OLZAPIN, REXAPIN (amp. 2
ml./10 mg.), (Comp. 2,5-5,0-7,5-10,0-15,0-20,0 mg.)
2.- INDICACIONES:
-Agitacin Psicomotriz, -Estabilizador del nimo, -Esquizofrenia, Episodio Manaco de moderado a grave. -Trastorno bipolar
3.- POSOLOGA:
Adultos: DI: im. 10 mg. a las 2 h. se puede repetir 10 mg. no superar
20 mg./24 h. (Preparacin: Vial de 10 mg. en polvo, disolver en los 2
ml. del disolvente)
Peditrica: No usar en menores de 18 aos
4.- CONTRAINDICACIONES:
-Glaucoma de Angulo Estrecho -Precaucin en: (- Demencia, Parkinson, -Sndr. Neurolptico Maligno, -Diabetes, -Dislipmicos, Hipertrofia Prosttica, -leo Paraltico, -Neutropenia, -Enfer. que
prolonguen el QT, -Tromboembolismo venoso, -Epilpticos.)
5.- OBSERVACIONES:
-No usar en Embarazo: Categora C. -En la Lactancia se desaconseja la
misma durante el uso del medicamento. -No tiene antdoto especfico.
-La solucin es de color amarillo. -No se debe usar ni sc. ni iv. (salvo en
algunos casos extremos la iv., apenas estudios). En IR. e Insuf. Heptica
y Ancianos de >60 aos, no dar mas de 5 mg./24 h. Proteger de la luz
durante su almacenamiento. En Ancianos de >60 aos

159-OMEPRAZOL
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Mopral, Losec . Miol, Omapen, Omeprazol (Amp. 40 mg./10ml.)
(Comp. 10, 20, 40 mg.)

946

GUA FARMACOLGICA

2.- INDICACIONES:
-lcera duodenal, -lcera gstrica benigna, -Esofagitis de Reflujo, Profilaxis HDA. Sndr. de Zollinger Ellison. -Profilaxis de lcera de
estrs en pacientes graves, -Profilaxis de Aspiracin Acida, Mastocitosis sistmica. En combinacin con determinados
Antibioticos, Trat. lcera pptica por Helicobacter Pylori. -Prevencin
de lceras Gastricas y Duodenales por AINES.
3.- POSOLOGA:
-Adultos: DI: Inf. i.v. : 0,571 mg./kg./24 h. o 0,142 ml./kg./24
h.(Preparacin: DI. en SF. hasta 100 ml. a 200-300 ml./h.) a pasar en
20-30 min. En caso de HDA, duplicar la DI.
-Peditrica: No recomendada en emergencias peditricas. DI: Infu. iv.
no establecida. Pero n caso de usarla, sera 0,25-0,5 mg./kg./12 h. en
20-30 min. (Preparacin: 40 mg. en SF. hasta 100 ml. (1 ml.=0,4 mg.),
Extraer DI o 0,62-1,25 ml./kg. a pasar en 20 30 min. cada 12 h.).
4.- CONTRAINDICACIONES:
Hipersensibilidad
5.- OBSERVACIONES:
-No se han encontrado sntomas severos hasta dosis de 270 mg./da. No tiene antdoto. -Reconstituir previamente el vial con 10 ml de SF. La solucin iv. no puede administrarse por vo. En Embarazo:
Categora C. En Lactancia: No hay suficiente experiencia, Evitar, salvo
que su uso sea imprescindible.

160-ONDANSETROM
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Zofran, Yatrox, Fixca, Helmine (Amp. 4 mg./2 ml. y 8 mg./2 ml.)(Comp.
4 y 8 mg.)
2.- INDICACIONES:
Nauseas y Vmitos tras quimioterapia o radioterapia citotxicas o
postquirrgico.
3.- POSOLOGA:
-Adultos: En Previo a Quimioterapia: DI.: Infu. iv. 8 a 32 mg.
(Preparacin: DI. (si es <8 mg.) en SG. o SF. hasta 100 ml. a menos de
400 ml./h. o en ms de 15 min.) En PostQuirrgico: DI.: iv. lenta 4 mg.
-Peditrica: En >6 meses y <18 aos. (Aunque hay poca experiencia
en nios <2 aos)En Previo a Quimioterapia: DI: iv. 5 mg./m2 0,15
mg./kg./4 h. no superar en la misma dosis 8 mg. En PostQuirrgico.
DI: iv. 0,1 mg./kg. hasta Dmx: 4 mg.
4.- CONTRAINDICACIONES:
Precaucin en : -Obstruccin Intestinas Subaguda. -En alteracin
previa del intervalo QT. -Cuando se usa Apomorfina.
5.- OBSERVACIONES:
-No se recomienda Lactancia. -No tiene antdoto. -En Embarazo es
Categora B. (Solo usar si es claramente necesario)

161-OXIDO NITROSO
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Kalinox, Entonox (xido Nitroso-50%/Oxgeno-50% a 170 bar y15 C ).
Bala de 5 Litros, (1,4 m3 de gas), 11 Litros, (3,23 m3 de gas), 15 Litros,
(4,1 m3 de gas) administrar a 1 bar.
2.- INDICACIONES:
Dolores de intensidad suave a moderada, -Insufic.Respirat.Neonatos, Hipertensin Pulmonar (nios y adultos), -TEP, -En Maniobras o
intervenciones de corta duracin y dolorosas. (trat. corto Plazo como
manipulacin y limpieza de heridas, reduccin o alineacin de
fracturas, reduccin de stress, quemaduras) En el parto
3.- POSOLOGA: (y forma de administracin)
-Adultos: DI: Inhalacin: con mascarilla facial (con vlvula
antirretroceso). a 9 L./min., a las 4 5 inspiraciones, comienza a hacer
efecto, su mximo efecto a los 2-3 min. El caudal de la mezcla viene
determinado por la ventilacin espontnea del paciente. Duracin
mxima continua = 60 min. Debe estar consciente el paciente e
invitarle a respirar normalmente, Si se pierde contacto verbal o de
consciencia interrumpir inmediatamente el gas. Como medida de
seguridad se deja en lo posible al paciente que sostenga la mascarilla,
de tal forma que si se administra demasiado suelta solo la mascarilla y
evita la sobredosis.
En el parto DI: Inhalar a partir del comienzo de las contracciones,
antes de que aparezca el dolor. Debe respirar normalmente en el

URGENCIAS Y EMERGENCIAS EXTRAHOSPITALARIAS GUETS - SESCAM

curso de la contraccin y abstenerse de hiperventilar. La inhalacin se
interrumpir a partir del momento en que disminuya el dolor,
vigilando continuamente la saturacin de oxgeno.
-Peditrica: DI: Inhalacin. A 6 L./min. se puede utilizar con nios que
puedan seguir las instrucciones de cmo utilizar el equipo. En nios
ms pequeos, que no sean capaces seguir instrucciones, puede
requerirse el uso de flujo continuo de gas. Se aconseja que despus de
cesar la aplicacin del gas, prevenir una hipoxia con la suplementacin
de oxgeno.
4.- CONTRAINDICACIONES:
-Pacientes que precisan ventilacin de oxgeno puro. Hipertensin
intracraneal. -Cualquier alteracin en el estado de conciencia que
impida la colaboracin del paciente. -Neumotrax. -Bulla
enfisematosa. -Embolia gaseosa. -Accidente por inmersin. Distensin gaseosa abdominal. -Traumatismo facial que afecta a la
zona de aplicacin de la mascarilla. -Pacientes que recibieron gases
del tipo (SF6, C3F8, C2F6) utilizados en ciruga oftalmolgica, al menos
despus de 3 meses de la ciruga.
5.- OBSERVACIONES:
-Puede producirse sobredosis (anoxia) en caso de almacenamiento
inadecuado a una temperatura inferior a 0 C. (OtrAut: a -5C) -Si
apareciese una cianosis suspensin inmediata del tratamiento. -Tras la
suspensin de la inhalacin, el regreso a la situacin inicial es casi
inmediato y sin efecto residual. No obstante seguiremos controlndole
las constantes hasta 5 min. tras su recuperacin -Con objeto de
obtener la colaboracin absoluta del paciente, es indispensable
explicarle el objetivo y el efecto del tratamiento. En la Lactancia se
puede usar, siempre que no sea a la vez que se est amantando. En el
Embarazo no usar en los primeros meses de embarazo, si se puede
usar en el ltimo trimestre y en el parto.

162-OXIGENO
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Oxigeno Medicinal Lquido (Balas Oxigeno o Recipientes criognicos
de 0,6-1,2-5,0-10,0-20,0-21,0-30,0-31,0 Litros, etc.. a una presin de
200 Bar)
2.- INDICACIONES:
-Hipoxemia. (Presin arterial O2<60 mmHg. o Sat. O2 pulsioximetro
<90%). -Alimentacin de los respiradores en anestesia. -Reanimacin. Vector de los medicamentos para inhalacin administrados mediante
nebulizador. -Cefalea tipo Cluster o en Racimos.
3.- POSOLOGA: (y mtodos y formas de administracin)
-Fuentes de donde procede el O2:
Aire Expirado (Boca a Boca suministran del 16 al 18% de O2); Aire
Ambiente (Respirador o ventilador artificial manual suministra 21% de
O2); Aire Artificial (Balas de O2, suministran del 24 al 100% O2)
-Formas de Administrarlo, Indicaciones e inconvenientes de cada
dispositivo:
Canula o Gafa nasal (Sistema de Bajo Flujo) FiO2 (24% con 1 L./min.;
26% con 2 L./min.; 28% con 3 L./min.; 33% con 4 L./min.; 40% con 5
L./min.; 44% con 6 L./min.). En nio Dmx = 2 L./min. Indicado en:
Enferm. Pulmonar Crnica no obstructiva (Inconveniente:
Permeabilidad fosas nasales, Duracin inspiracin, Vol. Min.
Ventilacin, Posicin del paciente.). Mascarilla Simple (Sistema de
Bajo Flujo) FiO2 de 35% a 50% con flujo de 5 a 10 L./min.; Mascarilla
con Reservorio (Sistema de Bajo Flujo) De Rehinalacin parcial: FiO2
40%-70% con flujo de 6 a 10 L./min. -De no Rehinalacin, con vlvula:
FiO2 60%-80% con flujo mnimo de 10 L./min. Cnula Transtraqueal
(Sistema de Bajo Flujo), Colocacin de un tubo o cateter de bajo flujo
directamente en la Traquea. Mascarilla Venturi (Ventimak) (Sistema
de Alto Flujo) Util en pacientes con Hipercapnia. FiO2 (24% con 3
L./min.; 26% con 4 L./min.; 28% con 5 L./min.; 31% con 8 L./min.; 35%
con 10 L./min.; 40% con 12 L./min.; 50% con 15 L./min.). Conexin en
T (Sistema de Alto Flujo) Util en paciente intubado que respira
espontneamente; Campana O2 (Sistema de Alto Flujo) Cmara
cerrada en lactantes, util para mantener alto flujo, alta humedad y
control temperatura. Entre 34,5 y 35,6C.; Tienda Facial (Sistema de
Alto Flujo) Util en trauma facial o intolerancia a la Mascarilla.
Inconveniente: sensacin de calor y confinamiento. Baln
Resucitacin Autoinflable: (Amb) (Sistema de Alto Flujo) FiO2 (24%
sin O2 sin Reservorio; 40%-60% con O2 sin Reservorio; 90-100% con
O2 con Reservorio): Capacidad: Amb lactantes (250 ml.); Amb
Infantil (450-500 ml.) Amb Adulto (1600-200 ml.). Cmaras

GUA FARMACOLGICA

Hiperbricas (Sistema de Alto Flujo) con mas de 1 atmofera o 1 bar de

presin. (En Intox. Monxido Carbono, Anemias Graves, Gangrena
Gaseosa, Pie Diabtico, Fascitis Necrosante, Enfermedad
Descompresiva,
Lesiones
postradioterapia,
Aeroembolismo,
Osteomielitis Crnica Refractaria.)
-Caractersticas de las Balas de O2: Litros totales = Litros que marca la
bala x Kg. que marca el manoreductor.
Tiempo que durar el suministro de O2 = Litros totales dividido por
L./min. que marca el caudalmetro.
4.- CONTRAINDICACIONES:
-No tiene apenas contraindicaciones. -No dar en intoxicaciones por
Herbicidas Bipiridlicos (Paraquat, Diquat). Precaucin: En Neonatos
Prematuros; En Bronquitis Crnicas; En Enfisema. -Evitar Retinopata
(Fibroplastia Retrolateral) en R.N. y Neonatos, no superando la PO2 >
80 mmHg. en Prematuros.
5.- OBSERVACIONES:
-Toxicidad aumentada por: Corticosteroides, Citostticos, Paraquat,
Simpaticomimticos, Rayos X, o en casos de Hipertiroidismo o
Carencia de vitaminas C y E o de Deficiencia de Glutatin.

163-OXITOCINA
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Syntocinn. (Amp. 10 UI./ml.)
2.-.INDICACIONES:
-Induccin o estimulacin del parto a trmino, -Atona uterina, Hemorragia postparto
3.- POSOLOGA:
En Induccin o estimulacin del parto: -DI: Infu. iv. 1-2 mUI./min., (36 ml./h.) (Preparacin: 10 UI. en SF. SG. hasta 500 ml. (1 ml. = 20
mUI.) DM:-Incrementar la dosis en 1-2 mUI./min. 3-6 ml./h. cada 2030 min. hasta lograr las constracciones deseadas (3-4 contracciones
cada 10 min.) o hasta Dmx. de 20 mUI./min. (60 ml./h.). En
Hemorragia Postparto inmediato: tras expulsin de la placenta: DI:
Infu. iv. 42-67 mUI./min. (63-100 ml./h.) (Preparacin 20 UI. en SF.
SG hasta 500 ml. (1 ml. = 40 mUI.) (Alternativas: DI: iv. 5 UI. en bolo
directo (no se recomienda) DI: im. 10 UI.) Despus DM: 5 UI. en 500
ml SG.5% en 30 min. (1000 ml./h.)
4.- CONTRAINDICACIONES:
-Toxemia aguda. Placenta previa. -Desprendimiento prematuro de
placenta. -Desproporcin plvico-ceflica. -Distocias mecnicas. -Feto
muerto intrautero. -Gestacin mltiple. -Historia de cesrea o
cualquier otra intervencin mayor uterina. -Parto prematuro. Presentacin anormal. Enfer. inflamatoria plvica
5.- OBSERVACIONES:
-En un 10- 25% de los casos se produce hiperactividad uterina con
contracciones tetnicas o incluso ruptura del tero. -En bolo puede
producir: hipotensin arterial, taquicardia, arritmias, nauseas,
vmitos. -No tiene antdoto. -En trastornos cardiovasculares, reducir
volumen de perfusin. -No uso peditrico. -No uso en Embarazadas
de 1 trimestre. Conservar entre 2-8C, y protegido de la Luz.

164-PANCURONIO
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Pavuln. Bemicin, Pancuron, Pancuronio. (Amp. 4 mg./2 ml. (1 ml. = 2
mg.))
2.- INDICACIONES:
En Anestesia General (Coadyuvante). Para relajacin de la musculatura
esqueltica en la IOT. y durante la ciruga o ventilacin mecnica.
(Incluso en convulsiones que no ceden y ttanos)
3.- POSOLOGA:
-Adultos: DI: iv. 0,04-0,1 mg./kg. (Preparacin: 8 mg. en SF. hasta 10
ml. (0,8 mg./ml.) a 0,05-0,125 ml./kg. en bolo. DM: iv. 0,01-0,02
mg/kg cada 20-40 min. (Preparacin: 4 mg. en SF. hasta 10 ml. (0,4
mg./ml.) a 0,025-0,05 ml./kg./20-40 min.) en bolo.
-Peditrica: DI./kg. : iv. Igual que en adultos, salvo menores de 1 mes.
Neonatos: dosis de prueba de 0,01-0.02 mg/kg para verificar
respuesta.
4.- CONTRAINDICACIONES:
Precauciones: En quemados >25% de su superficie corporal, se hace
resistente, por lo que se debe aumentar la dosis. En Miastenia Gravis

947

URGENCIAS Y EMERGENCIAS EXTRAHOSPITALARIAS GUETS - SESCAM

dar dosis minimas.
5.- OBSERVACIONES:
-Antdoto: Pridostigmina o Neostigmina,en conjuncin con un
antimuscarnico como Atropina o Glicopirrolato, una vez que exista
evidencia de recuperacin espontnea. -En Embarazo: Categora C. Es
seguro en la Cesarea. -En Lactancia no hay datos, usar solo cuando se
consideren los beneficios superiores a los riesgos. -Debe de
almacenarse en nevera (2 a 8 C). -No olvidar asociarlo con ansiolticos
y analgsicos.

165-PANTOPRAZOL
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Pantocarm, Anagastra, Pantoprazol. (Vial 40 mg.) (Comp. 20, 40, 45
mg.)
2.- INDICACIONES:
Ulcera duodenal, lcera gstrica, Esofagitis por reflujo, Hemorragia
Digestiva, Profilaxis de lcera Grastro Duodenal en Trat. continuado
por AINEs. -Sindr. De Zollinger-Ellison. -Profilaxis lceras de Estrs
3.- POSOLOGA:
-Adultos: DI: iv. 0,57-1,14 mg./kg. 0,14-0,28 ml./kg. iv. lenta en 2-3
min. disuelto en 100 ml. a pasar en 10-15 min. (Preparacin: 40 mg.
en SF. hasta 10 ml. (4 mg./ml.) o una vez realizada la anterior
preparacin, diluir DI. en SF. hasta 100 ml. a pasar en 600-400 ml./h.)
-Peditricos: No recomendado. No hay experiencia en <18 aos.
4.- CONTRAINDICACIONES:
-Hipersensibilidad a Benzimidazoles. -Erradicacin de H. pylori en
pacientes con Insuf. Heptica o IR. moderada-grave.
5.- OBSERVACIONES:
-Difcil sobredosificacin, dosis de hasta 240 mg. iv., en 2 min. fueron
bien toleradas. -No tiene antdoto. -En Embarazo: Categora B. -En
Lactancia se desconoce si se excreta por la leche. por tanto evitar
salvo que su uso sea imprescindible

166-PARACETAMOL
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Perfalgn. (Vial 1 gr./100 ml. (1 ml.=10 mg.) (Comp. 250, 300, 500,
650, 1000 mg.) (Supos.) (Soluc. Gotas).
2.- INDICACIONES:
Dolor agudo leve-moderado. Fiebre. Hipertermia
3.- POSOLOGA:
-Adultos: En >50 kg. DI: Infu. iv. 1 g./4-6 h. en 15 min. Dmx: 4 g./da
-Peditrica: En >10 kg. y <50 kg. DI: Infu. iv. 15 mg./Kg./4-6 1,5
ml./kg./4-6 h. Dmx: 60 mg./kg./da. o 6 ml./kg./da En <10 kg. DI:
Infu. iv. 7,5 mg./kg. o 0,75 ml./kg./4-6 h. Dmx: 30 mg./kg./da o 3
ml./kg./da En RN. Prematuros: No hay datos, no utilizar
(En caso del principio activo Pro-Paracetamol, se da el doble de dosis)
4.- CONTRAINDICACIONES:
Insuf. Heptica grave o severa.
5.- OBSERVACIONES:
-Sobredosis si se da >7,5 gr./da o >140 mg./kg./da en nios. -No
utilizar la va iv. directa (siempre en infu. iv.). -No utilizar va im. En
Embarazo: Categora B. Utilizar slo si no existe otra alternativa ms
segura. -Lactancia: Compatible. Utilizar si no existe otra alternativa
ms segura y despus de las tomas. Antdoto: N-Acetilcisteina si es
posible antes de que pasen >10 h. desde la sobredosis.

167-PARALDEHIDO
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Paraldehido, Paral (Amp. 5 ml.)
2.- INDICACIONES:
-Convulsiones en: Ttanos, Estatus Epilptico, Intox. por drogas
convulsivas. Convulsiones refractarias a otros Trat. -Ansiedad por
Abstinencia Drogas (Narcticos o Barbitricos. -Agitacin Aguda o
Delirium Tremens por Abstinencia de Alcohol
3.- POSOLOGA:
Adulto: DI. im. 0,1-0,2 ml./kg./2-4 h. (no superar 5 ml. en im.)

948

GUA FARMACOLGICA

(Preparacin: en caso de usar va iv. Solucin al 4%: 20 ml. en SF. hasta

500 ml. a 3,75 ml./kg./h.) 200-500 mg./kg. En crisis por Abstinencia
de Alcohol: DI: Va Rectal 10 ml./30 min. repitiendo dosis hasta
mejorar.
Peditrica: DI. im. 0,2 ml./kg.; DI.: Va Rectal 0,3 ml./kg en enema de
10-20 ml. de solucin al 50 % diluidos en SF. En Neonatos con
Convulsiones refractarias: DI: Infu. IV. 150 mg./kg./h. durante 3 h.
4.- CONTRAINDICACIONES:
Enfer. crnicas pulmonares y hepticas
5.- OBSERVACIONES:
-No usar envases ni jeringas de plastico, si de cristal. -Proteger de la
luz. -Se descompone rpidamente en contacto con el aire. -En
Lactancia: No hay estudios suficientes, usar con precaucin. -En
Embarazo, atraviesa la placenta, evitar su uso en lo posible.

168-PENICILAMINA o D-PENICILAMINA
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Cupriden, Cuprimine, Artamina, Penicilamina (Comp. 50 250 mg.)
2.- INDICACIONES:
-Intoxicaciones por: Plomo, Arsnico, Mercurio, Cobre. Hierro. Talio. Artritis Reumatoide. -Enfer. de Wilson. -Cistinuria
3.- POSOLOGA:
-Adultos: En Intoxicaciones. DI: vo. 500-1000 mg./da 20-30
mg./kg./da en 2 3 dosis. ( 250 mg./6 h.) En Artritis Reumatoide.
DI: vo. 125-250 mg. En Enfer. Wilson y Cistinuria. DI: vo. 1000-2000
mg./da.
-Peditrica: En Intoxicaciones. DI: vo. 15 mg./kg./da dividido 3-4
veces al da. En Artritis Reumatoide. DI: vo. 10-20 mg./kg./da. En
Enfer. Wilson y Cistinuria. DI: vo. 10-20 mg./kg./da
4.- CONTRAINDICACIONES:
-Alteraciones graves del sistema hematopoytico. -IR. -Alrgicos a la
Penicilina
5.- OBSERVACIONES:
-En Embarazo, no se sabe el efecto, evitar. -En Lactancia no se sabe el
efecto, evitar. -Por va vo. no con leche o alimentos a la vez.

169-PENICILINA G SODICA
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Penilevel (Vial polvo 1.000.000 U./5 ml.; 2.000.000 U./5 ml.; 5.000.000
U. /10 ml.) (1.000.000 UI.=600 mg.)
2.- INDICACIONES:
Infecciones: respiratorias, urinarias, otorrinolaringolgicas y
odontolgicas, ginecolgicas, digestivas, dermatolgicas, venreas y
vasculares centrales o perifricas. (Neumona, pleuritis y meningitis,
por neumococos. Amigdalitis, faringitis, otitis media, sinusitis aguda,
escarlatina, absceso pulmonar, fiebre puerperal, septicemia y
endocarditis, por estreptococos. Bronconeumona, osteomielitis,
septicemia, empiema, enterocolitis aguda, aborto sptico,
endocarditis subaguda y meningitis, por estafilococo no productor de
penicilinasa. Gonorrea y complicacin genitourinaria, por gonococo.
Meningitis meningoccica, gangrena gaseosa, difteria y ttanos.
Estomatitis y angina de Vicent, por espiroquetas. Actinomicosis. Sfilis
por T. pallidum.) -Profilaxis infecciosa pre y postquirurgicas. Intoxicacin por Setas Hepatotxicas
3.- POSOLOGA:
-Adultos: En Infecciones. DI: im. profunda. 600.000 UI./da. En
Infecciones Severas. DI: im. profunda. 1.000.000 UI./da a 4.000.000
UI./da. En Infeccin Sifiltica: DI: im. profunda 1.200.000 UI./da. En
Infeccin Grave o Sepsis. DI: iv. 50.000-300.000 UI./Kg./da (Repartida
en dosis cada 4-6 h.) Dmx. 24.000.000 UI. 17.000-42.000 UI./kg./4
h. En Meningitis y Endocarditis. DI: iv. 300.000 UI./kg./dia (Repartidas
en dosis cada 4 h.) o 50.000 UI./kg./4 h. En Intoxicacn por Amanita
Phalloides y otras Setas Hepatotxicas. DI: iv. 300.000 UI./kg./da
(Repartidas en dosis cada 1-4 h.)
(Preparacin: DI. Infu. iv. en SF. hasta 100 ml. a 50-100 ml./h.)
(Se puede administras por otras vas: Intrarraqudea, Intrapleural,
Pericrdica e Intraperitoneal.)
-Peditrica: En Infecciones. DI: 300.000 UI./da. En Infecciones
Severas. DI: iv. 25.000-40.000 UI./kg./da cada 4-6 h. En Infeccion
grave o Sepsis. DI.: iv. 50.000-300.000 UI./kg./da cada 4-6 h. En

URGENCIAS Y EMERGENCIAS EXTRAHOSPITALARIAS GUETS - SESCAM

Meningitis y endocarditis. DI: iv. 300.000 UI./kg./da cada 4 h. (50.000
UI./kg./4 h.). En Intoxicacin Amanitas Phalloides y otras setas
hepatotxicas. DI: iv. 300.000 UI./kg./da repartidas cada 1 a 4 h.
(Preparacin: DI. Infu. iv. en SF. hasta 50 ml. a 100-200 ml./h.
4.- CONTRAINDICACIONES:
Alergia a la Penicilina o Cefalosporina. Precauciones en Enf. de Crohn,
en Colitis Ulcerosa o pseudomembranosa, en Asma, en ICC.
5.- OBSERVACIONES:
-Tetraciclinas, Cloranfenicol y Eritromicina o Bacteriostticos pueden
antagonizar la actividad de la Penicilina. Se inactiva con SG. -En
Embarazo: Categora B. En Lactancia se excreta en escasa cantidad,
usar con precaucin.

170-PERXIDO DE HIDRGENO
(Agua Oxigenada)
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
-Agua Oxigenada: Cinfa, Arafarma, Betafar, Cuve, etc. (Sol. tpica: 125, 250, 500, 1000 ml. al 3% (100 ml.=97 ml. agua + 3 ml. Perxido
de Hidrgeno)
2.- INDICACIONES:
-Lavado de heridas superficiales de piel. -Separacin de apsitos o
vendajes adheridos a las heridas. -Lavado tras extracciones dentarias
(sol. 1,5%). -Reblandecedor de cerumen (sol. 1,5%). -Taponamiento
nasal en caso hemorragia nasal
3.- POSOLOGA y Preparacin:
-Uso tpico sobre la lesin, directamente o impregnando gasas o
algodn, (Su efecto es bastante corto, por lo que no se aconseja como
nico antisptico). -En caso de uso como Antisptico en el lavado de
lceras y heridas (ayuda a la eliminacin de detritus tisulares en
regiones inaccesibles). Se utiliza en soluciones al (3%) que es la
presentacin mas comn de presentacin al pblico. -En caso en
amigdalitis, estomatitis aguda, halitosis, extracciones dentales e
infecciones de la boca. Se hacen enjuagues bucales (Preparacin:
diluir a partes iguales el medicamento con agua natural, creando una
concentracin al 1,5%.). -En profilaxis: para desinfectar manos, piel y
mucosas: aunque por s solo no es eficaz sobre la piel intacta, se
emplea combinado con otros antispticos.
4.- CONTRAINDICACIONES:
-En cavidades orgnicas cerradas (por riesgo de producir lesiones
titulares y embolia gaseosa. -No utilizar como enjuague bucal en caso
de heridas gingivales. -No utilizar como enjuague bucal en nios
menores de 2 aos. -Evitar contacto con ojos. -No ingerir.
5.- OBSERVACIONES:
-En Embarazo y en Lactancia: No se han descrito advertencias
especiales. -En caso de ingesta accidental, ingerir abundante agua
natural. -Se degrada espontneamente en reposo y por eso necesita
incorporar agentes estabilizantes. -La descomposicin gradual
aumenta por accin de la luz, de la agitacin y del calor. Por lo que
debe conservarse en envases aislados de la luz y del aire entre 1530C. Si no contiene agentes estabilizantes debe guardarse a
temperatura inferior a 15C. -Las soluciones ms concentradas son
ms estables que las diluidas. --Como desinfectante de aparatos de
medicina se podra utilizar (a mas concentracin 6% y en forma de
vapor) y aunque no producie productos txicos, tiene como
desventaja el deteriorar gomas y plasticos, por lo que apensa se usa.

GUA FARMACOLGICA

Infecciones Moderadas. DI: im. o iv. :125-200 mg./kg./da repartidas

cada 6-8 h.; En Gonorrea. DI:
im. 2 g. en administracin
nica, (30 min. antes adminitrar vo. 1 g. de Probenecid). En
Infecciones urinarias complicadas. DI: iv. 2-4 g./6 h. 3-4 g./8 h.; En
Infecciones urinarias no complicadas. DI: iv. o im. 1,5-2 g./6 h. 3-4
g./12 h.; En Cesrea. DI: iv. 4 g. (tras el corte del cordn umbilical.); En
Profilaxis antibitica en ciruga abdominal o histerectoma vaginal y
abdominal. DI: iv. 4 g. (dosis nica en el momento de la induccin
anestsica.)
-Peditrica: im. iv.: En <12 aos: 100-300 mg./kg./da en 3-4 dosis.;
En Neonatos (0-1 mes de vida): <7 das y < 2 kg: 150 mg./kg./da, en 3
dosis. En Neonatos (0-1 mes de vida): >7 das y >2 kg: 300
mg./kg./da, en 3-4 dosis.
(Preparacin: En Adultos y Peditrica.; im.: dosis en 5 ml de
disolvente o agua para inyeccin.; iv: Bolo lento en 3-5 min. en 5 ml
de agua para inyeccin.; Infu. iv. continua (1-3 h.) o Infu. iv.
intermitente (30 min), 1 gr./5 ml. en 50-100 ml. de SG. o SSF.)
4.- CONTRAINDICACIONES:
-Alergia a Penicilinas y Cefalosporinas. -Precauciones en: Colitis
Ulcerosa, Enfermedad de Crohn o Colitis Pseudomembranosa,
Insuficiencia Renal, Ditesis Hemorrgica, Desequilibrio Electroltico,
Insuf. Heptica.)
5.- OBSERVACIONES:
-En Embarazo: Categora B. En la Lactancia se excreta pero no hay
efectos adversos. -Normalmente se administra conjuntamente con
Tazobactam (Ver Medicamento 220-Tazobactam).

172-PIRIDOSTIGMINA
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Mestinon, kalymin, Regonol (Amp. 1 mg./1 ml. ; 10 mg./2 ml.) (Comp.
60 mg.)
2.- INDICACIONES:
-Intoxicacin o Reversin de relajantes musculares no despolarizantes.
-Miastenia Gravis.
3.- POSOLOGA:
Adultos: En Intoxicacin o Reversion de relajantes musculares: DI: iv.
0,1-0,25 mg./kg. (usulmente 10-20 mg.), administrar lentamente a no
ms de 5 mg./min. -Administrar previamente Atropina (0,61,2 mg.
iv.) para minimizar efectos indeseables muscarnicos, y mantener la
ventilacin. En miastenia: DI: iv. 2 mg. lentamente, no ms de 0,5
mg/min.
-Peditrica: DI./kg. la mitad que la de adultos. Aunque hay pocos
estudios.
4.- CONTRAINDICACIONES:
-Obstruccin intestinal o urinaria. -Crisis colinrgicas. -Precaucin en.
(Asma, Bradicardia, IAM reciente, Epilepsia, Hipotensin,
Parkinsonismo, Vagotona.)
5.- OBSERVACIONES:
-Puede administrarse va im. y sc. -Embarazo: Categora C. (No es
teratgeno. Puede provocar debilidad muscular transitoria en el
recin nacido. Puede aparecer aumento de contractilidad uterina y
precipitar el parto.) -En Lactancia se excreta por la leche pero es
compatible. -Antdoto: Pralidoxima y Ventilacin mecnica. (Adems
de aumentar la dosis de Atropina). Proteger de la luz.

173-PIRIDOXINA o Vitamina B6
171-PIPERACILINA o Piperazilina
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Pipril (Vial 2 y 4 gr.)
2.- INDICACIONES:
-Sepsis: (Urolgico, Abdominal, Sin Foco); -Absceso Cerebral; Infecciones: (Digestivas, Vas Hepatobiliares, Piel, Tejidos blandos,
Genitourinarias, seas) Infecciones en Quemaduras, -Meningitis, Neumona, -Bacteriemia, -Uretritis Gonococica, -En asociacin a
antibiticos aminoglucsidos: episodios febriles en pacientes
inmunodeficientes granulocitopnicos. -Profilaxis de: infecciones
perioperatorias en ciruga abdominal y ginecolgica..
3.- POSOLOGA:
-Adultos: En Infecciones Graves. DI: im. iv. 200-300 mg./Kg./da
repartida cada 4-6 h. Dmx.: im. 2 gr. ; Dmx.: iv. 24 g./da; En

1.- NOMBRES COMERCIALES Y PRESENTACIONES:

Benadon, Nestrex, Vitamina B6 (Amp. 300 mg./2 ml. (1 ml.=150 mg.))
(Comp. 300 mg.)
2.- INDICACIONES:
-Intoxicaciones por: (Setas (Giromitra Escrufulosa); Etilica Aguda;
Etilnglicol; Isoniacida). -Nauseas y vmitos del embarazo. Convulsiones del lactante. -Trastornos neuromusculares en:
(Parkinson, Corea, Temblor idipatico.) -Agranulocitosis y Leucopenia. Anemia hipocromica por carencia de Vit. B6.
3.- POSOLOGA:
-Adultos: En intoxicacin por isoniacida: DI: iv. igual dosis que la que
ingiri de Isoniacida si se conoce. (Generalmente: DI: iv. 1-5 g. seguido
de 1 g. im., cada 30 min. hasta completar o igualar la cantidad ingerida
de isoniacida. En intoxicaciones por setas: DI: iv. 25 mg./kg. en 20-30

949

URGENCIAS Y EMERGENCIAS EXTRAHOSPITALARIAS GUETS - SESCAM

min. (Preparacin: DI. en SG. hasta 100 ml. a 300-200 ml./h. cada 6-8
h. En nauseas del embarazo: DI: iv. 300 mg. (Preparacin: DI. en SG.
hasta 100 ml.) DI: vo. 300 mg./12 h. En Intoxicacin Etlica Aguda.
DI: Infu. iv. 300 mg. en 10 min. (Preparacin: DI. en SG. hasta 100 ml.
a 600 ml./h.). En Intoxicacin Etilenglicol: DI. Infu. Iv. 100 mg. en 10
min.
-Peditrica: En intoxicacin por alcoholes: DI: im. iv. 1-2 mg./kg./6
h., Dmx.: 50 mg. En convulsiones neonatos. DI: iv. 50 mg. En
convulsiones en nios: DI: iv. 100 mg.
4.- CONTRAINDICACIONES:
No se han descrito. Precaucin en Parkinson.
5.- OBSERVACIONES:
-En Embarazo: Categoria A. (Pero a dosis altas puede producir
convulsiones del neonato. Y pasara a categora C). -En Lactancia:
compatible, pero dosis elevadas de 200 mg./da puede inhibir la
lactancia. -Proteger de la luz en el almacenamiento. Se suele
administrar va iv. pero si se usa im. debe ser profunda.

174-POLIETILENGLICOL
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Soluc. Evacuante Bohm. (Polietilenglicol 4000=15.000 mg, Cloruro
sdico=365,25 mg, Cloruro potsico=186,25 mg, Sulfato
sdico=1.408,5 mg, Bicarbonato sdico=420 mg, Bifosfato sdico=120
mg.) Cada sobre de 17,52 gr.
2.- INDICACIONES:
Laxante o Lavado Intestinal. -En Toxicologa: Ingesta Paracetamol, de
Litio, hierro y plomo y frmacos de liberacin retardada (con cubierta
entrica). -En la movilizacin de paquetes de droga ingeridos (BodyPacker). -En Exploraciones colorrectales, -En diagnsticos radiolgicos,
-En intervenciones gastrointestinales. En Estreimiento crnico.
3.- POSOLOGA:
-Adultos: En Toxicologa. DI: vo. 20 gr. disueltos en 200 a 250 ml. de
agua cada 15 minutos, durante 3 h.
o
1500 a 2000 ml./h. hasta objetivar en 2 a 6 h. una defecacin clara.
Con fines diagnsticos o exploratorios: DI.: vo.: 1 sobre en 200-250
ml. cada 10-15 min. Hasta un total de 16 sobres o hasta que la
deposicin sea clara. No tomar ningn alimento solidos en las 2 h.
anteriores. o Va Sonda Nasogstrica: 20-30 ml./min. (1,2-1,8
litros/h.)
-Peditrica: En Toxicologa, en >6 aos y <12 aos. DI: vo. mitad de la
dosis de adultos o con Sonda Nasogstrica: 500 ml./h.; En >9 meses y
<6 aos. DI: vo. cuarta parte de la dosis de adultos o con Sonda
Nasogstrica: 250 ml./h.
4.- CONTRAINDICACIONES:
-Obstruccin o perforacin gastrointestinal conocida o sospechada, leo, -Retencin gstrica, -lcera aguda gstrica o intestinal, Megacolon, -Hipersensibilidad a alguno de sus componentes.
5.- OBSERVACIONES:
-El primer movimiento intestinal suele ocurrir, una hora despus del
comienzo de la administracin de la solucin.
-En Embarazo se desconoce el riesgo, no usar a no ser que no haya
otra alternativa. En Lactancia, no hay problemas para su uso. Almacenar entre 15-30C.

175-POTASIO, Cloruro
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
-Cloruro Potasico. Apir-Inyecc. Meinsol. Potasin. (Amp. 1 M./10 ml.
(10 mEq./10 ml.)(10 ml.=750 mg.) (1 ml.=1 mEq.=75 mg.)) (Amp. 2
M./10 ml. (20 mEq./10 ml.) (10 ml.=1500 mg)(1 ml.=2 mEq.=150
mg.)) (Envase. (0,9 % Sol. para perfusin 10 mEq./500 ml.; Envase.10%
(1 g./10 ml.) (Caps. 600 mg.)
2.- INDICACIONES:
-Hipopotasemia (con o sn alcalosis metablica). -Arritmias cardiacas
causadas por digital (Intoxicacin digitlica). -Trastornos de la
conduccin cardiaca que implique un riesgo vital.
3.- POSOLOGA:
-Adultos: En Hipopotasemia leve (3-3,5 mEq./L. de plasma), DI: Infu.
iv. 40-100 mEq./da ( Preparacin: 20 mEq. en SSF. hasta 500 ml. a 63
ml./h. cada 8 h.) -En Hipopotasemia moderada (2,5-3 mEq./L.), DI:
Infu. iv. 100-200 mEq./da (Preparacin: 20 mEq. en SSF. hasta 500 ml.

950

GUA FARMACOLGICA

a 63 ml./h. cada 4 h.). -En Hipopotasemia grave: (<2,5 mEq./L) DI:

Infu. iv. 20 mEq./h. las 2 primeras h. (Preparacin: 40 mEq. en SSF.
hasta 500 ml. a 250 ml./h.) seguir con DM: Infu. iv. 5 mEq./h.
(Preparacin: 20 mEq. en SSF. hasta 500 ml. a pasar en 4 h. a 126
ml./h.), repetir hasta revertir la Hipopotasemia o Dmx: 200 mEq./da.
-Peditrica: En Hipopotasemia Leve. DI: Infu. iv.1-2 mEq. por cada
100 ml. que se le administre. (Preparacin: 10 mEq. en SSF. hasta 500
ml.) En Hipopotasemia Moderada. DI: Infu. iv. 0,5 mEq./kg.
(Preparacin: 20 mEq. en SSF. hasta 500 ml.) En Hipopotasemia
Grave. DI: Infu. iv. 1 mEq./kg. (Preparacin: 20 mEq. en SSF. hasta 500
ml.), Dmx: 3 mEq./kg./da.
4.- CONTRAINDICACIONES:
Hiperpotasemia (>5 mEq./L.), salvo en Cetoacidosis Diabtica. IR.
grave (aclaracin creatinina <20 ml./min.). -Deshidratacin severa. Precaucin en: Obstruccin intestinal; Hernia de Hiato; Enf. de
Addison no tratada; Hipopotasemia coexistente con Hipercloremia en
pacientes con acidosis tubular renal que desarrollan acidosis
metablica; concentraciones sricas de potasio >5 mmol/l, tratados
con digitlicos con severo o completo bloqueo cardiaco; Oliguria
postoperatoria; Shock con reacciones hemolticas y/o deshidratacin;
Tratados con diurticos ahorradores de potasio.
5.- OBSERVACIONES:
-No administrar a una velocidad mayor de 20 mEq/h. -Nunca
administrar en bolo directo. -Precauciones en Acidosis metablica. Detener si se produce I.R. aguda con oliguria y/o elevacin de
creatinina srica. -Gran irritante venoso -En Embarazo: Categora A,
aceptada si tiene buena funcin renal. -En Lactancia: No hay datos
sobre si pasa a la leche, evitar en lo posible la lactancia durante el uso
de Potasio. -En caso de Intoxicacin o Sobredosis: Sobre todo cambios
en el EEG (incluyendo aumento de la amplitud de la onda T,
disminucin de la amplitud de la onda R, descenso por debajo de la
lnea basal de la onda S, desaparicin de la onda P y prolongacin del
segmento PR), administrar como Antdoto: Cloruro Clcico al 10% de
5-10 ml. iv. en 1-2 ml/min. repetible a los 10 min.(Reducir dosis si hay
impregnacin digitlica); Bicarbonato Sdico al 8,4% 1 Molar 50 ml.
en 5 min. repetible a los 15 min.; Insulina normal de 10-15 UI. (Si tiene
Normoglucemia, prepararla en 500 ml. SG10% a pasar en 60 min.);
Salbutamol inhalado nebulizado 10-20 mg. (2-4 ml. de solucin al
0,5%) diluidos en al menos 5 ml. de SF (indicado sobre todo en
pacientes hemodializados); Poliestirensulfonato (Resincalcio)(cada 1 g.
cambia 1 mEq. k+)15-30 gr. (3-6 cucharadas) disueltas en agua, cada 68 h. y Hemodilisis.

176-POVIDONA IODADA
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Betadine. Curadona. Povidona Yodada Cuve. Topionic. (Sol. Dermica:
10% : 30, 40, 50, 60, 100, 125, 250, 500 ml.) (Sol. Jabonosa: 4%: 125,
500 ml.) (Pomada: 10% : 100 gr.) (Jabn: 7,5%.)
2.- INDICACIONES:
Desinfectante de la piel de uso general en: pequeas heridas y cortes
superficiales, quemaduras leves, Rozaduras. -Antisepsia vaginal Lavado
quirrgico de manos. -Lavados vesicales. -Irrigaciones pleurales. Irrigaciones peritoneales. -Se emplea en forma de champ como
antisptico en cuero cabelludo y zonas pilosas.
3.- POSOLOGA:
En Antisepsia de heridas y quemaduras leves: Sol. 10% aplicar
directamente en el rea afectada 1-3 veces/da. En Lavado quirrgico
de manos: Sol. Jabonosa al 7,5%; En Limpieza preoperatoria de la
piel: Sol. Jabonosa al 7,5%: En Antisepsia del Cuero Cabelludo: Sol.
Jabonosa al 7,5%; En Lavados Vesicales: Sol. al 5%; En Antisepsia de
piel sana: Sol. alcohlica al 1%.
4.- CONTRAINDICACIONES:
-Hipersensibilidad al yodo o derivados iodados, -Neonatos (0 a 1 mes)
-Precaucin en: Nios < 30 meses. -Evitar en ojos, odos y otras
mucosas. -En Grandes quemaduras, -En Heridas grandes y profundas, En Enfer. con fallo renal, -En Enfer. con trastornos tiroideos.
5.- OBSERVACIONES:
Si se utiliza prolongadamente, pruebas de funcin tiroidea.
Embarazo: Categora D. Potencialmente puede afectar al feto. En
Lactancia: utilizar con precaucin. -En Sol. jabonosa: Aplicar, frotar 2-5
min. hasta obtener espuma, aclarar con agua.

URGENCIAS Y EMERGENCIAS EXTRAHOSPITALARIAS GUETS - SESCAM

177-PRALIDOXIMA
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Contrathion 2%, (Vial 200 mg./10 ml.)
2.- INDICACIONES:
-Intoxicaciones insecticidas, derivados Orgafosforados. -Sobredosis o
Intoxicacin por Inhibidores de la Colinesterasa (Neostigmina,
Piridostigmina). -Intoxicacin agentes nerviosos de guerra (Sarin,
Tabun, Soman)
3.- POSOLOGA:
-Adultos: En Intoxicacin por organofosforados: -DI: Infu. iv. 15-30
mg./kg. 1-2 gr. en 30 min. (Preparacin: Tras reconstituir los viales,
diluirlos de nuevo hasta DI. en SF. hasta 100 ml. a 200 ml./h.), repetir
segn sntomas despus de 1 h. (Iniciar trat. en las primeras 24 -48 h.
tras el accidente txico, ms tarde no resulta eficaz.; Previamente
siempre Atropina (coadyudante) Se puede utilizar via im o sc si no hay
posibilidad de iv.) -DM: Repetir dosis inicial cada 6-8 horas.
-Peditrica: DI: Infu. iv. 25-30 mg./kg. en 15-30 min, (Preparacin: DI.
en SF. o SG. hasta 100 ml. a 200-400 ml./h.) segn la gravedad y la
respuesta al trat. repetir cada 6-8 h.; o bien 10 mg./kg./h.
4.- CONTRAINDICACIONES:
-Intoxicacin
por Insecticidas Carbamatos (sin actividad
anticolinesterasa). -Precaucin: IR.; Miastenia Gravis.
5.- OBSERVACIONES:
-Pobre absorcin por va oral. -Conservar en la oscuridad (protegido
de la luz). -En Embarazo: Categora C. A utilizar si no existe otra
alternativa ms segura. -En Lactancia: Se desconoce si se elimina por
la leche. -La administracin de Mesilato de Fentolamina evita el efecto
secundario de Hipertensin.

178-PRASUGREL
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Efient (Comp. 5 y 10 mg.)
2.- INDICACIONES:
Profilaxis Anticoagulante, Antiagregante de SCA. (En Angina Inestable,
IAM (SCASEST/SCACEST), IAM sometidos a intervencin coronaria
percutnea (ICP) primaria o aplazada
3.- POSOLOGA:
-Adultos: DI.: vo. 60 mg. (Se administra con AAS).
4.- CONTRAINDICACIONES:
Hemorragia patolgica activa. Historia de ictus o AIT. Insuf. Heptica
Grave (Clase C de la escala Child Pugh).
5.- OBSERVACIONES
-No se recomienda en Pacientes >75 aos. -No se recomienda en
menores de 18 aos (no hay estudios). -En Lactancia: No se
recomienda su uso. -En Embarazo: solo debe usarse siempre que el
beneficio potencial para la madre justifique el riesgo potencial para el
feto.

179-PROCAINAMIDA
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Biocoryl. (Amp. 1 gr./10 ml. (1 ml.=100 mg.))
2.- INDICACIONES:
-Taquiarritmias Ventriculares (alternativa a Amiodarona y a Lidocaina):
EV., TV. -Arritmias Supraventriculares: FA., Fluter Auricular. TSVP. Arritmia en la hipertermia maligna. -Arritmias de la anestesia. TSV
aguda refractaria a maniobras vagales y adenosina. TV aguda que no
responde a cardioversin ni adenosina. -Arritmias en Anestesia.
3.- POSOLOGA:
-Adultos: DI: Infu. iv. 7-10 mg./kg. en 1 h. (Preparacin: DI en SF.
Hasta 100 ml. a 100 ml./h.) Dmax: iv. 17 mg./kg. Si se suprime la
arritmia seguir con DM: Infu. iv. 1,2-4,8 mg./kg./h. (Preparacin: 1 g.
en SSF. hasta 100 ml. a 0,12-0,48 ml./kg./h.)
-Peditrica: DI: Infu. iv. 10-15 mg./kg. en 15-30 min. (Preparacin: DI
en SSF. hasta 100 ml. a 200-400 ml./h.) DM: Infu. iv. 1,2-3,0 mg./kg./h.
(Preparacin: 1 g. en SSF. hasta 100 ml. a 0,12-0,30 ml./kg./h.)
4.- CONTRAINDICACIONES:
-Hipersensibilidad a anestsicos tipo ster, -BAV de 2 y 3, -Torsade
de pointes, -Lupus Eritematoso Sistmico, - Miastenia gravis, -IR, -

GUA FARMACOLGICA

Insuf. Heptica grave, -IAM, -ICC.

5.- OBSERVACIONES:
-Administrar de manera muy lenta. Administrar bajo monitorizacin
EKG. Suspender si aparece hipotensin o ensanchamiento del QRS. -En
Embarazo: Categora C (por riesgo de hipotensin mantenida que de
lugar a insuficiencia uteroplacentaria y arritmias ventriculares) En
Lactancia: Es compatible. No utilizar con SG.

180-PROPAFENONA
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Rytmonorm (Amp. 70 mg./20 ml. (1 ml.=3,5 mg.) (Comp. 150, 300 mg.
)
2.- INDICACIONES:
Arritmias: -EV., -Extrasstoles Supraventriculares., -TV., -TSV., -Sndr. de
WPW.
3.- POSOLOGA:
-Adultos: DI: iv. 1 mg./kg. o 0,29 ml./kg. (Dmx.: 2 mg./kg. o 0,57
ml./kg.) en 3 a 5 min. Se puede repetir a los 90 120 min. hasta frenar
la arritmia. DM: Infu. iv. 30-60 mg./h. de 1 a 3 h. (Preparacin: 140
mg. en SG. hasta 100 ml. (1,40 mg.=1 ml.) a 21,42-42,85 ml./h.
-Peditrica: DI: iv. 0,3-2,0 mg./kg. en 3-5 min. (Preparacin: 70 mg. en
SG. hasta 100 ml. (1 ml.=0,7 mg.) dar 0,42-2,85 ml./kg.). DM: Infu. iv.
0,24-0,42 mg./kg./h. (Preparacin: 70 mg. en SG. hasta 100 ml. (1
ml.=0,7 mg.) a 0,34-0,60 ml./kg./h.)
4.- CONTRAINDICACIONES:
-Insuf. Cardiaca manifiesta, -Shock Cardiognico (con la excepcin del
debido a la arritmia), -Hipotensin marcada, -Bradicardia severa, Trastornos
de
conduccin:
Sinoatriales.
Atrioventriculares.
Intraventriculares. Sndr. del Ndulo Sinusal: (Sndr. de Bradicardia y
Taquicardia). -Trastornos manifiestos del Equilibrio Electroltico. -EPOC
grave, -Miastenia grave.
5.- OBSERVACIONES:
-Monitorizar EKG y Tensin Arterial, mientras se administra. -No diluir
en SSF. -No almacenar a menos de 15C. -Proteger de la luz. -En
Embarazo: Categora C sopesar en los 3 primeros meses, no dar salvo
que no haya otra alternativa. -En Lactancia, no darla salvo que no haya
otra alternativa.

181-PROPRANOLOL
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Sumial, Propanolol (Amp. 5 mg./5 ml. (1 ml.=1 mg.))
2.- INDICACIONES:
En Taquiarritmias: -TV, -TSV, Taquicardias por: (Digital. Catecolaminas,
Angina de Pecho, Crisis Tirotxica). En Trat. Coadyuvante: (IAM, HTA,
Feocromocitoma Miocardiopata hipertrfica, Temblor esencial,
Control de la ansiedad. Estenosis subaortica Hipertrfica,) En Profilaxis
Migraa, Reinfarto del IAM.
3.- POSOLOGA:
-Adultos; DI: iv. 0,5-1 mg. o 0,5-1 ml. a no mas de 1 ml./min., repetir
cada 2-5 min. hasta obtener respuesta o hasta Dmx acumulada: 10
mg. (o 0,1 mg./kg.) en pacientes conscientes, y 5 mg. en pacientes
anestesiados
-Peditrica: DI: iv. 0,025-0,05 mg./kg. en 10 min. cada 6-8 h. si fuera
necesario (Preparacin: 1 mg. 1 ml. en SSF. hasta 10 ml. (0,1 mg.=1
ml.) dar 0,25-0,5 ml./kg. en 10 min.
4.- CONTRAINDICACIONES:
-Hipersensibilidad Betabloqueantes, -BAV de 2 o 3, -Bradicardia,
Sndr. del Seno, -Angina de Prinzmetal, -ICC, -Shock Cardiognico, Hipotensin, -Feocromocitoma no tratado, -Enfer. Broncoespstica, Arteriopata perifrica grave. -Precaucin en: (Hipertiroidismo, IR.,
Insuf. Heptica.)
5.- OBSERVACIONES:
-Proteger de la luz. -Las soluciones coloreadas no deben ser utilizadas.
-En caso de respuesta vagal excesiva dar Aropina 1-2 mg. iv. En
Embarazo: Clasificacin C. Utilizar cuando no exista alternativa ms
segura. En Lactancia: Pasa a la leche materna, no se aconseja la
lactancia durante su uso.

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182-PROPOFOL
1.- NOMBRE COMERCIAL Y PRESENTACIONES:
Diprivn, Ivofol, Propofol Abbott, Recofol. (Amp. Jeringa: 200 mg./20
ml. (1 ml.=10 mg.); 500 mg./50 ml. (1 ml.=10 mg.); 1000 mg./100 ml.(1
ml.=10 mg.); 1000 mg./50 ml. (1 ml.=20 mg.); 200 mg./10 ml. (1
ml.=20 mg.).
2.- INDICACIONES:
-Induccin y Mantenimiento de Anestesia General. Sedacin en
Adultos ventilacin mecnica. Sedacin superficial para realizar
procedimientos diagnsticos y ciruga.
3.- POSOLOGIA:
(Con preparaciones de 1 ml.=20 mg.)
-Adultos: En Induccin de Anestesia General: en <55 aos. DI: iv. 40
mg. o 2 ml. cada 10 seg. hasta el efecto deseado, generalmente de
1,5-2,5 mg./kg. o 0,075-0,125 ml./kg.; en >55 aos o Hipovolmico o
Debilitados. DI: iv. 20 mg. cada 10 seg. hasta el efecto deseado,
generalmente de 1,0-1,5 mg./kg. 0,05-0,075 ml./kg. En
Mantenimiento de la Anestesia General: en <55 aos. DM: Infu. iv. 612 mg./kg./h. o 0,3-0,6 ml./kg./h. (o iv. en bolo de 20-50 mg.); en >55
aos. Dm: Infu. iv. 4-6 mg./kg./h. o 0,2-0,3 ml./kg./h. En Sedacin
consciente: DI: iv. lenta 0,5-1 mg./kg. o 0,025-0,05 ml./kg.; DM: Infu.
iv. 1-4 mg./kg./h. 0,05-0,20 ml./kg./h.
-Peditrica: En Induccin de Anestesia General: DI: iv. 2-3 mg./kg. o
0,10-0,15 ml./kg. en al menos 30 seg. DM: Infu. iv. 4-10 mg./kg./h. o
0,2-0,5 ml./kg./h. En Sedacin consciente. DI: iv. lenta 0,5-1 mg./kg. o
0,025-0,05 ml./kg.; DM: Infu. iv. 1-4 mg./kg./h. 0,05-0,20 ml./kg./h.
4.- CONTRAINDICACIONES:
-Alergia a aceite de soja, lecitina de huevo y cacahuete.
-Anestesia obsttrica (posibilidad de depresin neonatal). Precauciones: (Epilepsia; Hiperlipemia; Insuf. Cardiaca;) -En nios <3
aos, no se conoce la seguridad y eficacia por lo que no se
recomienda su uso.
5.- OBSERVACIONES:
-Puede ser utilizado en infusin sin diluir con jeringas de plstico o en
fracscos de vidrio para infusin. -Puede mezclarse la dosis de
induccin de propofol con lidocana (1 parte de lidocana por cada 20
de propofol). -Conservar <25C. no guardar en nevera y evitar su
congelacin. -Agitar los envases antes de usar. -En Embarazo:
Categora B, se acepta su uso en ausencia se alternativas teraputicas
ms seguras. En Lactancia se excreta por la leche, no se recomienda.

183-PROSTAGLANDINA E1
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Alprostadilo, Alprostadil, Caverject, Sugiran, (Amp. 500 mcg./1 ml.
Amp. 20 mcg./5ml.)
2.- INDICACIONES:
-Hipertensin Pulmonar. -En cardiopatias con Ductus dependientes
mantiene el ductus permeable. -Atresia Vlvula Pulmonar. -Estenosis
Vlvula Pulmonar. -Atresia Vlvula Tricuspdea. -Trasposicin grandes
vasos. -Interrupcin o coartacin del arco artico. -Tetraloga de Fallot
severa. -Arteriopata perifrica. -Arteriopata oclusiva de miembros
inferiores, (excluyendo los pacientes candidatos a amputacin). Disfuncin erctil.
3.- POSOLOGA:
-Adultos: En Arteriopata oclusiva de miembros inferiores. DI: Infu.
iv. 40 mcg./12 h. (Preparacin: 40 mcg. en SSF. hasta 100 ml. a 50
ml./h.)
-Peditrica: En mantenimiento de la apertura del Ductus Arterioso.
DI: Infu. iv. 0,05-0,1 mcg./kg./min. o 3-6 mcg./kg./h. Se puede
aumentar hasta 4 mcg./kg./min. o 240 mcg./kg./h. ajustar segn
respuesta. (Preparacin: 500 mcg. en SSF SG. hasta 100 ml. (1 ml.=5
mcg.) iniciar a 0,6-1,2 ml./kg./h. elevar dosis si no mejora hasta 48
ml./kg./h. Si conseguimos elevar la Sat. O2, se sigue con DM: Infu. iv.
0,01-0,03 mcg./kg./min. 0,6-1,8 mcg./kg./h. (Preparacin: 100 mcg.
en SSF SG. hasta 100 ml. (1 ml.=10 mcg.) a 0,06-0,18 ml./kg./h.)
4.- CONTRAINDICACIONES:
-Cardiopatas Congnitas no incluidas en las Indicaciones. -Neonatos
con Enfer. Membrana Hialina. Insuf. Cardiaca grado III-IV de la NYHA.
IAM. -Angor inestable. B.AV 2 y 3. -Hipotensin Arterial. Glaucoma. -Alteraciones Hepaticas. -Ulceras Gastrointestinales
Activas. -Politraumatizados. Insuf. Resp. Crnica.

952

GUA FARMACOLGICA

5.- OBSERVACIONES:
Monitorizar la TA y la FR. -Mantener en frio entre 2-8C. -Evitar bolo
directo. -En Embarazo: No debe ser administrado. -En Lactancia: No
debe ser administrado.

184-PROTAMINA
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Protamina (Vial 50 mg./5ml. (1 ml.=10 mg.))
2.- INDICACIONES:
-Sobredosificacin o Reversin de Heparina (Mejor efecto sobre
Heparina Sdica, y del 30-60% sobre Heparinas de bajo peso
molecular).
3.- POSOLOGA:
-Adultos: Si se adminitr la Heparina hace menos de 15 min. DI: iv. 1
mg. o 0,1 ml. por cada 100 UI. de heparina administrada. -Velocidad:
Administrar 10 mg. en 2 -3 min. No superando 50 mg en 10 min. Se
puede repetir la dosis a los 10-15 min, si es necesario. Y nunca superar
100 mg en 2 h. (Preparacin: 0,1 ml. por cada 100 UI. de heparina
administrada en SSF. o SG. hasta 100 ml. a 600 ml./h.)
(Si ha pasado ms de 30 min. desde que se administr Heparina: DI:
iv. 0,5 mg por cada 100 UI. de heparina administrada. (Preparacin:
0,05 ml. por cada 100 UI. de heparina administrada en SSF. o SG. hasta
100 ml. a 600 ml./h.)
Peditrica: Eficacia y seguridad no establecida, Pero si se utiliza la
dosis es la misma que en adultos.
4.- CONTRAINDICACIONES:
-Hipersensibles al pescado o al marisco, -Precaucin en pacientes
vasectomizados o infrtiles.
5.- OBSERVACIONES:
-En alrgicos a la protamina, se puede usar la Hexadimetrina como
alternativa. -Almacenar refrigerada. (pero puede mantenerse 2
semanas estable a temperatura ambiente). -En Embarazo: Categora C.
se puede utilizar si no existe alternativa ms segura. En Lactancia:
apenas informacin sobre su excrecin en la leche, por lo que se
recomienda que cuando se use se evite la lactancia

185-RANITIDINA
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Coralen. Ranitidina. Toriol. Zantac. (Amp. 50 mg./5 ml. (1 ml.=10 mg.))
(Comp. 150 y 300 mg.)
2.- INDICACIONES:
-Profilaxis lcera en IAM (Primera eleccin). -lcera duodenal. -lcera
gstrica benigna. -Sndr. Zollinger-Ellison.
-Hemorragia esofgica y gstrica con hipersecrecin. -Profilaxis de la
hemorragia recurrente por lcera sangrante. -Reflujo gastroesofgico.
-Profilaxis de la hemorragia gastrointestinal debida a lcera de estrs,
en enfermos graves. -En el preoperatorio, con riesgo de sndrome de
aspiracin cida (Sndr. Mendelson), especialmente durante el parto.
3.- POSOLOGA:
-Adultos: DI: im.: 50 mg. o 5 ml. cada 6-8 h. DI: iv. lenta, 50 mg. en >2
min. o Infu. iv. en 20 min.(Preparacin: 50 mg. en SSF. hasta 20 ml. en
>2 min. Infu. iv. 50 mg. en SSF. hasta 100 ml. a 300 ml./h. DM: Infu.
iv. repetir DI. cada 6-8 h. pero a 100-200 ml./h. o 0,125-0,250
mg./kg./h.)
-Peditrica: DI: iv. lenta 2-4 mg./Kg./12 h., o 0,2-0,4 ml./kg./12 h.
(Preparacin: DI en SSF hasta 50 ml. a 300 ml./h.) Dmx. 300 mg./dia.
4.- CONTRAINDICACIONES:
-Hipersensibilidad o alergia a la Ranitidina. -No utilizar iv rpida sobre
todo en pacientes con trastornos del ritmo. -Usar con precaucin en
pacientes con Enfer. Hepticas e IR. dado el riesgo de acumulacin.
5.- OBSERVACIONES:
-En Embarazo: Categora B. No administrar en el primer trimestre de
embarazo. En Lactancia: Se excreta en la leche materna, evitar su uso
durante la lactancia.

186-REMIFENTANIL
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Ultiva. Remifentanil (Vial de 1, 2, 5 mg.)

URGENCIAS Y EMERGENCIAS EXTRAHOSPITALARIAS GUETS - SESCAM

2.- INDICACIONES:
Analgsico para induccin y mantenimiento de la anestesia general. Alternativa a la sedacin con Propofol en ciruga bajo anestesia local.
3.- POSOLOGA:
-Adultos: DI. Infu. iv. 0,5-1 mcg./kg./min. o 30-60 mcg./kg./h.
(Preparacin: Reconstituir 1 mg./1 ml. de diluyente. Despus en 20 ml.
SSF. o SG. (50 mcg./ml) y pasar a 0,6-1,2 ml./kg./h.), Se puede dar un
bolo previo inicial de 1 mcg./kg. o 0,02 mcg./kg. en >30 seg. Si hay
que intubar, se podr a los 10 min. de comenzar la Infu. iv. Para
Extubar: bajar a 6 mcg./kg./h. o 0,12 ml./kg./h. una hora previa a la
extubacin.
-Peditrica: Evitar. Pero si lo damos debe ser en >2 aos. DI: Infu. iv.
0,5-1 mcg./kg./min. o 30-60 mcg./kg./h. (Preparacin: Primero
reconstituir 1 mg. en 1 mg./1 ml. para diluirlo en SSF. SG. hasta 40
ml. (25 mcg./ml.) a 1,2-2,4 ml./kg./h. Tanto para la Intubacin como
para la extubacin se hace lo mismo que en Adultos.
4.- CONTRAINDICACIONES:
-En administracin epidural y espinal, por contener glicina. Hipersensibilidad a los anlogos del Fentanilo. Evitar como nico
medicamento en la Induccin de la anestesia.
5.- OBSERVACIONES:
-Es recomendable que previamente se use Atropina, y a la vez que el
Remifentanilo el Propofol.
-En Embarazo: Categora C, no utilizar. -No usar en nios <2 aos. -En
Lactancia: evitar. -Antdoto: Naloxona. -No utilizar en otras vas que
no sea iv.

187-RETEPLASA
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Rapilysin (Vial de 10 UI en 10 ml (reconstitudo 1ml=1U))
2.- INDICACIONES:
IAM (en las primeras 12 h. de aparicin de los sntomas). (Fibrinolisis)
3.- POSOLOGA:
-Adultos: DI: iv. bolo 10 UI. en 2 min. Seguidamente a los 30 min. otra
dosis iv. de 10 UI.
-Peditrica: No se usa, no estudios.
4.- CONTRAINDICACIONES:
-Antecedentes de ditesis hemorrgica, -Hemorrafia activa reciente, Alteraciones hemorrgicas oculares, -Neoplasias intracraneales, ACVA, -Ciruga intracraneal o intraespinal (en los ltimos 3 meses), HTA severa o no controlada, -Traumatismo grave o intervenciones
quirrgicas mayores (dentro de 10 das), -Trauma subsiguiente a
reanimacin cardiopulmonar, -Tratamiento con anticoagulantes orales.
5.- OBSERVACIONES
-En Embarazo: No se disponen datos sobre su uso. -En Lactancia:
evitarla 24 horas despus del inicio del trat. -Antdoto: cido
Tranexmico y cido Aminocaproico. -Previo a su usa Administrar 250350 mg. vo, y Heparina Sdica iv. 5000 UI. en bolo. Posteriomremente
Dar Heparina Sdica Infu. iv. 1000 UI./h. durante 24-48 h.

188-RIBAVIRINA
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Vilona, Virazide (Amp. 1200 mg./12 ml. (100 mg.=1 ml.) (Caps. 400
mg.) (Sol. Oral de 120 ml. a 100 mg./5 ml.) (Gotas de 15 ml. a 40 mg./1
ml.)
2.- INDICACIONES:
Infecciones virales:
Varicela (en inmunocompetentes e
inmunodeprimidos), Herpes Zoster (Herpes genital primario y
recurrente, Herpes labial, Gingivostomatitis herptica), Parotiditis,
Hepatitis viral A, Hepatitis viral B y C (agudas y crnicas), Infecciones
Respiratorias (por Virus Sincitial respiratorio influenza, Parainfluenza),
Profilaxis del Herpes Genital recurrente. Se ha utilizado (en
combinacin con Ketamina, Midazolam, y Amantadina) en el Trat. de
la Rabia.
3.- POSOLOGA:
Adultos: DI: iv. im. 400 mg. 4 ml./8 h. (15 mg./kg./da=1200
mg./da divididos en 3 tomas), vo. 400 mg./8 h.
Peditrica: DI: iv. im. 0,2 ml./ 8 h. (15-20 mg/kg/da divididos en 3
tomas) vo. 1 ml./kg./da (Repartido en 3 dosis). En Lactante: DI: la
mitad de la dosis anterior.

GUA FARMACOLGICA

4.- CONTRAINDICACIONES:
-Enfer. Cardiaca grave preexistente, incluida la cardiopata inestable o
no controlada, en los 6 meses anteriores. -Disfuncin heptica grave o
Cirrosis heptica descompensada. -Hemoglobinopatas (Talasemia,
Anemia de Clulas Falciformes).
5.- OBSERVACIONES:
-En Embarazo: No utilizar. -En Lactancia: No utilizar. -Provoca
fotosensibilidad en el paciente. -Dosis >12.6 g. provoca Anemia
moderada. -En Hepatitis Crnica se asocia a interfern alfa-2b o Intron
A. (3.000.000 UI.).

189-RITODRINA
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Pre Par (Amp. 50 mg./5ml, (1ml.=10 mg.) (Comp.10 mg.)
2.- INDICACIONES:
-Amenaza de Parto prematuro no complicado, -Sufrimiento fetal
agudo, -Prevencin del trabajo de parto prematuro tras
intervenciones quirrgicas.
3.- POSOLOGA:
Adultos: DI. Infu. iv. 0,05 mg./min. segn respuesta se aumenta 0,05
mg./min. hasta obtener efectos deseados. (Preparacin: 100 mg. o 10
ml. en SG. hasta 100 ml. (1 mg./1 ml.) a 3 ml./h. aumentando cada 10
min. otros 3 ml./h. hasta el efecto deseado. Si no podemos iv. Se
puede DI: im. 10 mg. o 1 ml. si no responde repetir a la hora, si n,
continuar de 10 a 20 mg. cada 2 a 6 h.
4.- CONTRAINDICACIONES:
-Hemorragia anteparto, -Infecciones intrauterinas, -HTA severa, Cardiopatas mal compensadas, -Hipertiroidismo, -Muerte fetal
intratero, -Compresin del Cordn Umbilical, -Eclampsia y
Preeclampsia agudas. -Precaucin: Diabticos, Asmticos con Trat.
corticoideo, Hipopotasemia.
5.- OBSERVACIONES:
-Administrar con el paciente en decbito lateral izquierdo, por riesgo
de hipotensin. -Evitar durante el trat. que supere una FC. 140 lpm. Evitar tratamiento prolongado, mayor de 48 horas. -En Embarazo:
contraindicado en Gestacin <20 sem., y Categora B, en embarazadas
de > 20 sem. En Lactancia: No utilizar, no existe experiencia. Antdoto: Betabloqueantes.

190-ROCURONIO
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Esmern, (Vial 50 mg./5 ml.; 100 mg./10 ml. (1ml=10mg))
2.- INDICACIONES:
Anestesia: En intubacin endotraqueal, En Relajacin muscular
durante la intervencin quirrgica. En Relajacin muscular durante la
ventilacin mecnica.
3.- POSOLOGA:
-Adultos: DI: iv. en bolo 0,6 mg./kg. 0,06 ml./kg. (OtrAut. hasta 1,2
mg./kg.) Posteriormente cuando la recuperacin alcance el 25%. se
pone una 2 dosis iv. en bolo de 0,15 mg./kg. (Preparacin: 20 mg. o 2
ml. en SSF. hasta 20 ml. (1 mg./1 ml.)) Seguidamente: DM: iv. 0,15
mg./kg. repitiendo cada 15-25 min. Infu. iv. 5-10 mcg./kg./min.
0,3-0,6 mg./kg./h. durante la 1 h., ajustando segn respuesta.
(Preparacin: 50 mg. en SSF. hasta 100 ml. (0,5 mg./1 ml.) a 0,6-1,2
ml./kg./h.)
-Peditrica: DI: iv. y DM. igual que en adultos.El comienzo de accin
es ms rpido en lactantes y nios que en adultos. No recomendado
en <1 mes. seguridad No establecida en <3 meses.
4.- CONTRAINDICACIONES:
Precaucin en: -Cncer broncognico, -Hipo-hipertermia, -Miastemia
Gravis u otras enfermedades neuromusculares, -EPA y/o Insuf. Respir.,
-Trastornos tiroideos, -Enfer. Colgeno, -Alteraciones hemorrgicas, Enfer. Cardiovasculares.
5.- OBSERVACIONES:
En nios pueden ser ms sensibles a: Mioglobinemia, Bradicardia,
Hipotensin, Arritmias. (debiendo poner la mnima dosis.) -Antdotos:
Anticolinestersios (Neostigmina, Fisostigmina, Adrofonio) asociado a
algn Antimuscarnico (Atropina o Glicopirrolato). -Conservar en
Nevera, pero no congelar. -En Embarazo: Categora C. Atraviesa la
barrera placentaria por lo que pueden producir depresin respiratoria

953

URGENCIAS Y EMERGENCIAS EXTRAHOSPITALARIAS GUETS - SESCAM

en el RN. por cesrea. Se acepta su uso en ausencia de alternativas
terapeticas ms seguras. -En Lactancia: Evitar

191-SALBUTAMOL
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Buto Air, Buto Asma, Salbutamol, Ventilastn, Ventoln. (Sol. inhalacin
0,5% envase de 20 ml. (1ml.=5mg.)) (Aerosol inhalador 100
mcg./pulsin (envase de 200 dosis)) (Polvo inhalador (cartucho) 100
mcg./pulsin) (Amp. 1 ml./500 mcg.)
2.- INDICACIONES:
-Asma; -Obstruccin reversible de la va area, -Hiperactividad
Bronquial, -Parto Prematuro no complicado, -Hiperpotasemia.
3.- POSOLOGA:
-Adultos: En Broncoespasmo, Agudizacin y Estatus Asmtico: En
Episodios Moderados. DI: Va Inh. 2 pulsaciones o 0,2 mg. cada 5 min.
hasta mejorar o Dmx. 0,8 mg. DM: Va Inh 1-2 pulsaciones cada 4 a
6 h. DI: Via Nebulizador. 2,5-5 mg. en 15 min. (Preparacin: 0,5-1
ml. en SSF hasta 5 ml. en canuleta de mascarilla con nebulizador,
conectando a una fuente de O2 con un caudal de 6-8 L./min. durante
15 min.) Se puede repetir la dosis pasados 20 min. En Episodios
Severos. DI: Va sc. o im. 0,25-0,50 mg. o 0,5-1,0 ml., se puede repetir
la dosis pasados 20 min. si no hay respuesta. o DI: Va Infu. iv. 4-5
mcg./kg. en 20 min. (Preparacin: 500 mcg. en SSF. SG. hasta 10 ml.
(1 ml./50 mcg.) De aqu extraer DI 0,08-0,1 ml./kg. y diluirla en SF.
SG. hasta 100 ml. a 300 ml./h.) repetir dosis a los 20 min. si fuera
necesario. Infu. iv. continua: 5 mcg./min. o 300 mcg./h. con
incrementos de 300 mcg./h. cada 5 min. hasta respuesta o Dmx 1200
mcg./h. o Efectos secundarios. (Preparacin: 2500 mcg. en SSF SG.
hasta 250 ml, (1 ml./10 mg.) a 30 ml./h. aumentar otros 30 ml./h. cada
5 min. hasta su efecto o Dmx 120 ml./h.)
En Parto Prematuro. DI: Infu. iv. 100-250 mcg. y aumentar segn
respuesta. (disminucin de las contracciones) hasta Dmx de 1 mg.
(Preparacin: 500 mcg. en SSF. SG. hasta 100 ml. (1 ml./5 mg.) Dar
inicialmente 20 ml. en 15 min. a 80 ml./h. o 50 ml. en 15 min. a 200
ml./h. Repetir dosis hasta respuesta o Dmx expuesta.
En Hiperpotasemia. DI: Infu. iv. 0,5 mg. en 20 min. (Preparacin: 500
mcg. en SSF, SG. hasta 100 ml. a 300 ml./h.)
-Peditrica: En Broncoespasmo, Agudizacin y Estatus Asmtico: En
Episodios Moderados. DI: Va Inh. 2-4 pulsaciones o 0,2-0,4 mg. cada
20 min. hasta mejorar o Dmx. 0,7 mg. DM: Va Inh 1-2 pulsaciones
cada 4 a 6 h. DI: Via Nebulizador. 0,1-0,15 mg./kg. en 20 min.
(Preparacin: 0,02-0,03 ml./kg. (no superar 1 ml. en total) en SSF
hasta 5 ml. en canuleta de mascarilla con nebulizador, conectando a
una fuente de O2 con un caudal de 6-8 L./min. durante 15 min.) Se
puede repetir la dosis pasados 20 min. En Episodios Severos. DI: Va
sc. 8 mcg./kg. 0,015 ml./kg. se puede repetir la dosis pasados 20
min. si no hay respuesta. o DI: Va Infu. iv. (En nios >12 aos igual
que en adultos) En nios <12 aos no est bien establecida su
eficacia, pero si se utiliza ser de la siguiente forma: 4-5 mcg./kg. en
20 min. (Preparacin: 500 mcg. en SSF. SG. hasta 10 ml. (1 ml./50
mcg.) De aqu extraer DI 0,08-0,1 ml./kg. y diluirla en SF. SG. hasta
100 ml. a 300 ml./h.) repetir dosis a los 20 min. si fuera necesario.
Infu. iv. continua: 0,2 mcg./kg./min. o 12 mcg./Kg./h. con incrementos
de 12 mcg./kg./h. cada 5 min. hasta respuesta o Dmx 60 mcg./h. o
Efectos secundarios. (Preparacin: 1000 mcg. en SSF SG. hasta 100
ml. (1 ml./10 mg.) a 1,2 ml./kg./h. aumentar otros 1,2 ml./h. cada 5
min. hasta su efecto o Dmx 6 ml./Kg./h.)
4.- CONTRAINDICACIONES:
-No existen contraindicaciones absolutas. -Precaucin en:
(Hipertiroidismo, Cardiopata Isqumica, Arritmias, Diabticos).
5.- OBSERVACIONES:
-Antdoto: Beta Bloqueante. -Monitorizar al paciente en caso de
administracin iv. -la va im. puede ser muy dolorosa. -En Embarazo.
Categora C. No debe administrarse por va iv. en el 1 y 2 trimestre. En Lactancia: Se excreta en leche materna, pero no se conoce el
efecto en el lactante. No se recomienda su utilizacin durante la
lactancia.

192-SANDOSTATINA u OCTREOTIDA
1.- NOMBRES COMERCIALES Y PRESENTACIONES:

954

GUA FARMACOLGICA

Sandostatin, Octreotida. Oktidel, (Amp. 50, 100, 200, 500, 1000 mcg.
en 1 ml.)
2.- INDICACIONES:
-Hemorragia y su prevencin en Varices Gastroesofgicas en Cirroticos
(en asociacin a Escleroterapia Endoscpica). -Prevencin de
complicaciones tras Ciruga Pancretica. -Control de Diarrea
Refractaria asociada al Sida., -En tumores Endocrinos: (Acromegalia,
Vipomas, Glucagonomas, Gastrinomas o Sindr. de Zollinger Ellison,
Insulinomas, etc..)
3.- POSOLOGA:
-Adultos: En Hemorragias de Varices Esofgicas. DI: Infu. iv. 25-50
mcg./h. durante 5 das (Preparacin: 100 mcg. en SSF. hasta 100 ml. a
25-50 ml./h. (dosis para 2 a 4 h.) En resto de indicaciones
mencionadas: DI: sc. 50-100 mcg. (cada 8 12 e incluso 24 h.)
-Peditrica: En Esofagitis/ hemorragia digestiva alta DI: iv. en bolo 1-2
mcg./kg. (Preparacin 50 mcg. en SSF. hasta 10 ml. (1 ml.=5 mcg.) a
0,2-0,4 ml./kg. seguido de DM: Infu. iv. 1-2 mcg./kg./h. (Preparacin:
100 mcg. en SSF. hasta 100 ml. (1 mcg./1 ml.), a 1-2 ml./kg./h.) Cuando
el sangrado no sea activo disminuir dosis al 50%. En Hipoglucemia
debido a hiperinsulinismo persistente: DI: sc. 1,25-5 mcg./kg./6 h. o
DI: Infu. iv. 0,08-0,4 mcg./kg./h. Dmx.: 40 mcg./kg./da. En
Quilotrax DI: sc. 3,3 mcg./kg./8 h. o DI: Infu. iv. 0,3-10 mcg./kg./h.
(OtrAut. en Pancreatitis Aguda DI: sc. 60 mcg./m2/da)
4.- CONTRAINDICACIONES:
Hipersensibilidad conocida a la octetrida.
5.- OBSERVACIONES:
En Embarazo: Categora B. En lactancia: Evitar. El uso prolongado
puede producir la formacin de clculos biliares. -Conservar en
frigorfico entre 2-8C.

193-SILIBININA o SILIMARINA
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Legaln, Selarine, Silimaz, Silimarina Mdical (Amp. 350 mg.)(Caps.
80 y 150 mg.)
2.- INDICACIONES:
-Intoxicacin por: Setas tipo Amanita phalloides (Anti Toxina
Anatoxina) (Alternativa a la Penicilina G), Alcohol y de medicamentos
hepato-txicos, -Esteatosis Heptica, -Hepatitis Alcohlica y -Cirrosis
Heptica.
3.- POSOLOGA:
-Adultos: DI: Infu. iv. 5 mg./kg. en 2 h. (Preparacin: DI en SG. hasta
250 ml. a 125 ml./h.) Repetir cada 6 h. (Se inicia el trat al menos 72 h,
tras ingesta en caso de Intoxicacin.) Dmx: 20 mg./kg./da
-Peditrica: DI: vo. 12 mg./kg./da
4.- CONTRAINDICACIONES:
Obstruccin severa de las vas biliares
5.- OBSERVACIONES:
-Es un Hepatoprotector. -En Embarazada: Categora B. -En Lactancia
No hay estudios que avalen su utilidad y riesgo. -Puede haber
sensacin de calor o flush durante la Infu. iv. -Se puede iniciar trat
cuando se tenga sospecha, hasta la espera de confirmar el
diagnstico.

194-SOMATOSTATINA
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Somatostatin, Somatostatina, Somonal (Amp. 0,25 mg./2 ml.; 3 mg./2
ml.; 6 mg.)
2.- INDICACIONES:
-Hemorragia Digestiva Alta con o sin hipertensin portal, no
susceptible de tratamiento quirrgico o por esclerosis de varices. Terapia coadyuvante de fstulas pancreticas secretoras de ms de 500
ml./da.
3.- POSOLOGA:
-Adultos: DI. iv. bolo 0,25 mg. en 3 min. seguido de DM: Infu. iv 3,5
mcg./Kg./h. (Preparacin: 1,5 mg. 1 ml. en SSF. hasta 100 ml. o (15
mcg./1 ml.) a 0,233 ml./kg./h.
-Peditrica: DI. iv. bolo 3,5 mcg./Kg. en 5 min. (Preparacin: 0,25 mg.
en SSF. hasta 10 ml. (25 mcg./1 ml.) dar 0,14 ml./kg. en 5 min.
seguidos DM: Infu. iv. 3,5 mcg./Kg./h. (Preparacin: 1,5 mg. 1 ml. en
SSF. hasta 100 ml. o (15 mcg./1 ml.) a 0,233 ml./kg./h.

URGENCIAS Y EMERGENCIAS EXTRAHOSPITALARIAS GUETS - SESCAM

4.- CONTRAINDICACIONES:
-Hipersensibilidad al frmaco, -En el parto.
5.- OBSERVACIONES:
-No administrar con sustancias alcalinas. -Proteger de la luz.
Mantener al paciente en decbito supino 15 min. Tras la
administracin. -La inyeccin rpida puede producir ruboracin,
sensacin de calor y naseas. -En Embarazo: Evitar, Categora D
(inhibe la hormona del creciemiento). En Lactancia est
contraindicado, pero si es necesario usarla, evitar la lactancia.

195-SORBITOL o GLUCITOL
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Sugarbil 90 y 150 gr. (granulado)(555)
2.- INDICACIONES:
-Intoxicacin por Carbn Activo (Antdoto Laxante, aumentando la
motilidad intestinal y por tanto la excrecin del carbn y el txico.), Otros Trat. (Dispepsias, Colecistitis, xtasis Biliar, Colangitis,
Estreimiento,
etc..)
3.- POSOLOGA:
Adultos. DI: vo. 1-2 ml./kg. (Sorbitol al 70%) (Preparacin: 90 gr. en
Agua hasta 130 ml. (70 gr./100 ml.)
Peditrica: DI: vo. 1,5-2,3 ml./kg. (Sorbitol al 35%) (Preparacin: 90 gr.
en Agua hasta 250 ml. (35 gr./100 ml.)) (Dmx.=50 gr. o 147 ml. de la
preparacin
mencionada)
4.- CONTRAINDICACIONES:
-Intoxicaciones Severas con organofosforados, Carbamatos,
Compuestos Arseniacales. Diquat y Paraquat. -Colitis Crnica. -Clico
Heptico. -Obstruccin va Biliares.
5.- OBSERVACIONES:
-El carbn activado se mezcla a menudo con sorbitol para que pase a
travs del sistema gastrointestinal ms rpido y prevenir el
estreimiento que produce el carbn activado, por lo que en general
se incluye en algunas presentaciones de Carbn Activado. En
Embarazo usarlo con precaucin. En Lactancia usarlo con precaucin.

196-SUCCINIL COLINA (Suxametonio)

1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Anectine. Mioflex. (Amp. 100 mg./2 ml.; 500 mg./10 ml. (1ml.=50
mg.)).
2.- INDICACIONES:
-Relajacin Neuromuscular Rpido y Completo (Para Intubacin,
Ventilacin Mecnica, reduccin contracciones musculares asociadas a
convulsiones inducidas por medios farmacolgicos o elctricos.)
3.- POSOLOGA:
-Adultos: DI: iv. 1-1,5 mg./kg. im. 2,5-4 mg./kg. (Preparacin: 100
mg. en SSF. hasta 10 ml. (1 ml.=10 mg.) dar 0,1-0,15 ml./kg. iv. o 0,250,4 ml./kg. im.). Repetir si es necesario cada 5-10 min. hasta 3 veces o
Dmx. 500 mg. DM: Infu. iv. 1,2-3 mg./kg./h. (Preparacin: 500 mg.
en SSF. hasta 100 ml. a 0,24-0,6 ml./kg./h. hasta Dmx. 500 mg./h.)
-Peditrica: DI: iv. 1-2 mg./kg. (Preparacin: 100 mg. en SSF. hasta 10
ml. (1 ml.=10 mg.) dar 0,1-0,2 ml./kg. Se puede repetir 0,3-0,6 mg./kg.
cada 5-10 min. En RN y lactantes: DI: iv. 2-3 mg./Kg. (Preparacin: 100
mg. en SSF. hasta 10 ml. (1 ml.=10 mg.) dar 0,2-0,3 ml./kg.)
Si no se puede va iv. dar En nios DI: im. 4 mg./kg. Dmx. 150 mg. En
Lactantes DI: im. 4-5 mg./kg.
4.- CONTRAINDICACIONES:
-Historia familiar de Hipertermia Maligna o Miopatas asociadas a un
aumento de CPK, -Alteraciones neuromusculares, -Glaucoma de
ngulo agudo, -Heridas oculares penetrantes, -Hiperpotasemia
(Grandes Quemados, Traumatismo Severos), Precaucin en Nios
menores de 14 aos (Relativo), salvo para intubacin traqueal de
emergencia, -Precaucin en Dficit neurolgico que implique Lesin
de Mdula, Nervios Perifricos...
5.- OBSERVACIONES:
-En Embarazo: Categora C. -Almacenar a 2-8C. -No existe antdoto
especfico. -Previamente a su uso dar Sedantes y Atropina. Su efecto
comienza a los 30-60 seg. en iv. y 3 min. en im. y dura de 2 a 6 min. En Lactancia: Evitar. Se desconoce si se excreta en leche materna.

GUA FARMACOLGICA

197-SUERO AGUA DESTILADA O ESTRIL

1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Agua estril para inyeccin, Agua bidestilada, (Envases de 5, 10,
20,100, 250, 500, 1000 ml.)
2.- INDICACIONES:
-Vehculo para dilucin y reconstitucin de medicamentos de
administracin parenteral. -Segn la aplicacin puede ser para
inyectables, para irrigacin o para inhalacin. -Indicado en limpieza de
quemaduras de 2 en el que se vaya a utilizar posteriormente cremas
con componente de plata.
3.- POSOLOGA:
Segn necesidad tanto para dilucin de medicamentos, como para
irrigaciones, como para la inhalacin.
4.- CONTRAINDICACIONES:
-No se han descrito. -No administrarse slo (en el caso de los
inyectables). -No utilizar va rectal.
5.- OBSERVACIONES:
-Una sobredosificacin puede provocar una hemodilucin. -En el
Embarazo y Lactancia: No se han descrito alteraciones, el riesgo de su
uso viene determinado por la naturaleza del medicamento aadido.

198-SUERO AMNICO
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Cloruro Amnico 1/6 M Mein (Envase 500 ml. (830 mg./100 ml.))
2.- INDICACIONES:
-Alcalosis metablica pura. -Alcalosis metablica hipoclormica por
vmitos que no se controlen con suero salino y potasio. -Acidificacin
de la orina en diuresis forzada cida.
3.- POSOLOGA:
-Adultos. DI: Infu. Iv. Clculo de dosis (Exceso de bicarbonato en
mmol./L. x 3 x kg.=ml. de S. Amnico 1/6 molar) a 90-120 ml./h.
(Dmx.=150 ml./h.)
-Peditrica slo en casos muy graves de Alcolosis. DI: iv. La mitad de
dosis de Adultos pero a pasar ente 2 a 6 h. (poca experiencia
extrahospitalaria)
4.- CONTRAINDICACIONES:
-Insuficiencia heptica. IR. -Acidosis Metablica. Hiperamonemia.
Hiperazotemia. -Mioglobinuria.
5.- OBSERVACIONES:
-Administrar de forma lenta por riesgo de intolerancia venosa. Realizar controles del Ph durante la Infu. iv. -Administrar con
precaucin en pacientes con lcera pptica. -Ya no est indicada la
diuresis forzada cida en ningn trat. para intoxicaciones. -La nica
indicacin que exista, la intoxicacin por Anfetaminas, debe evitarse
hasta que nuevos estudios demuestren su beneficio. -Su toxicidad
(puede desencadenar alteraciones respiratorias, bradicardia y
contracciones musculares). -Sin encontrar datos sobre su uso en
Embarazo y Lactancia.

199-SUERO ANTIBOTULINICO
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
-Suero Antibotulnico A+ B+ E: (Amp. 20 ml. (1 ml.= 500 UI. A+ 500 UI.
B + 50 UI. E)) -Botulismus Medicamento extranjero (Amp. 10 ml. (1
ml. = 500 UI. + 500 UI. + 0,1 mg. Thiomersal)) -Botulismus-Antitoxin
Behring: (Vial 250 ml. (1 ml.= 750 UI. A + 500 UI. B + 50 UI. E))
2.- INDICACIONES:
Intoxicacin por toxina botulnica en el adulto. (No es efectiva en el
botulismo infantil.)
3.- POSOLOGA:
Adultos: DI: Infu. iv. 0,5-1,0 ml./Kg. en 4 h. (Preparacin: DI. en SFF.
hasta 500 ml. a 125 ml./h.). Se pueden dar otros 250 ml. de igual
preparacin a las 4-6 h. segn sintomatologa desde la DI. En caso de
slo sospecha de comer alimentos con la toxina. DI: im. 20 ml. (Slo
sospecha de comer alimentos con la toxina) En Intoxicaciones muy
graves. DI: intralumbar o intrarraqudea 20 ml. (retirar previamente
20 ml de LCR.).
4.- CONTRAINDICACIONES:
Hipersensibilidad a estos sueros
5.- OBSERVACIONES:

955

URGENCIAS Y EMERGENCIAS EXTRAHOSPITALARIAS GUETS - SESCAM

-Debe administrarse incluso en fases avanzadas, aunque el dficit
neurolgico no se recupere. -Las reacciones alrgicas o anafilaxicas se
tratan con hidrocortisona y antihistamnicos, pero para prevenirlas:
una vez disuelto el vial en fisiolgico, tomar 0'1 ml de la solucin e
inyectar va sc. en el antebrazo, inyectando 0'1 ml de fisiolgico limpio
en el otro antebrazo (testigo) y esperando 15 min. En caso
de reaccin positiva, valorar la relacin entre beneficio y
riesgo. -Conservar en nevera. -En el embarazo no es una
contraindicacin para el uso de la antitoxina. -La antitoxina slo
neutraliza la toxina circulante, no la fijada a tejidos.

200-SUERO ANTIOFDICO
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Suero Antiofdico, Viperfav (Vial 4 ml.)
2.- INDICACIONES:
-Mordeduras por serpientes venenosas (En Espaa: Vboras del tipo:
Hocicuda, Aspid y Comn o Europea). -Tambin es eficaz en las
mordeduras de otras serpientes como: Bothierichis Schlelii,
Botrhiopsis Taeneiata, Portidium sp, Bothorps Xanthogramma. (de
otros pases)
3.- POSOLOGA:
Adultos y Peditrica: DI: sc. 0,1 ml, esperar 15 min. (si no hay reaccin
alrgica) Seguir con otra dosis sc. 0,25 ml. y esperar otros 15 min. si no
hay reaccin, dar el resto dosis en 4 h. (Preparacin de ltima dosis:
3,65 ml. en 500 ml. de SFF. a 125 ml./h.) se puede repetir a las 5 h. si
persiste la clnica grave.
4.- CONTRAINDICACIONES:
-Alergia previa al suero heterlogos, -Alergias previas a los sueros de
origen equino (antiofdico, antirrbico, antidiftrico). Alergia a los
excipientes: Thiomersal o Fenol.
5.- OBSERVACIONES:
-Conservacin: 2-8 C. -No congelar. -No debe administrarse en el
lugar de la herida, porque aumenta el edema y la necrosis. -Puede
administrarse por va sc. o im. en la raz del miembro afecto, en caso
de disponer del antdoto y no disponer de va iv. -Para reducir la
posibilidad de reacciones alrgicas, dar Adrenalina al 1:1000, en dosis
de 0,25 mg. ( 0,25 ml.), por va sc., inmediatamente antes de la
perfusin del suero, si no est contraindicada. Otra posibilidad es dar
Metilprednisolona en dosis de 1 mg./kg. va iv. y Cimetidina (Tagamet)
en dosis de 5 mg./kg. -El suero antiofdico debe administrarse en las
primeras 4 horas despus de la mordedura, conserva su mxima
efectividad durante 6-9 horas y puede ser ineficaz si se administra 1224 horas despus. (Es sobre todo adecuada sobre todo en nios y
ancianos.) -En Embarazo, se puede utilizar.

201-SUERO BICARBONATADO
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Bicarbonato sdico, Venofusn (Envases 100, 250, 500 y 1000 ml. (1/6
Molar=1,4 gr./100 ml. 1,4% 1 ml.=14 mg. 1 mEq.=6 ml.) (1 Molar
8,4 gr./100 ml. 8,4% 1 ml.=84 mg.) 1 mEq.=1 ml.)
2.- INDICACIONES:
-En paro cardiaco ante la sospecha de situacin de acidosis metablica
o tras 30 min de RCP sin xito. -Acidosis Metablica de diferente
etiologa (cetoacidosis, insuficiencia renal, shock..), -Intoxicacin
aguda por barbitricos o salicilatos para alcalinizar la orina. -Acidosis
respiratoria grave y severa descompensada, hiperpotasemia,
hiponatremia localmente como anticido. -Intoxicacin por ADT. En
inhalacin de Cloro.
3.- POSOLOGA:
-Adultos: En la PCR presenciada despus de 10 30 min. de RCP
correcta: DI. Infu. iv. 1 mEq./Kg. (Preparacin: 6 ml./kg. en (1/6 Molar)
1 ml./kg. (1 Molar) continuando con DM: Infu. iv. 0,5 mEq./kg.
(Preparacin: 3 ml./kg. en (1/6 Molar) 0,5 ml./kg. en (1 Molar) cada
10 min. En Intoxicacin grave por ADT. DI: Infu. iv. 1-2 mEq./Kg.
-Peditrica: En PCR igual que en adultos 1 mEq./kg. diluda al 50%.
(Preparacin: 50 ml. de Suero Bicarbonatado 1 M. en SG.5% hasta 100
ml. a 2 ml./kg. 100 ml. de Suero Bicarbonato 1/6 Molar en SG.5%
hasta 200 ml. a 12 ml./kg.)
4.- CONRAINDICACIONES:
-Extremar precaucin en caso de Hipocalcemia, Hipocloremia,

956

GUA FARMACOLGICA

Alcalosis Metablica, Acidosis respiratoria, Alcalosis respiratoria. Precaucin en fracaso renal, en tratamiento con corticoides, en
situaciones con retencin de sodio, en insuficiencia cardiaca, en HTA,
y en Cirrosis.
5.- OBSERVACIONES:
-Evitar la administracin rpida (riesgo de arritmias y alcalosis). Monitorizar ECG. -En Embarazo: Categora C. -La dosis a administra
depende del ph, paCo2, dficit de Bases, respuesta clnica y estado de
hidratacion del paciente. -Control con Gasometra y ajustar la dosis
cada 3-4 horas. Evitar mezclar con drogas vasoactivas. -En caso de
sobredosis que provoque Alcalosis Metablica dar SFF. si se hace
severa dar Infu. iv. de Cloruro Potsico y/o Cloruro Amnico, si llega
a provocar tetania dar Gluconato Clcico

202-SUERO COLOIDE ALBUMINA

1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Albiomin, Albmina Humana Behring, Albutein (Vial 10, 50 y 100 ml.
al 20% ( 200 mg./ml.)). 250 ml. al 5% (50 mg./ml.)
2.- INDICACIONES:
-Restablecimiento y mantenimiento del volumen circulatorio. -Shock
hipovolmico. -Reposicin de volumen en Quemaduras. Hipoproteinemia Crnica como en: Cirrosis Heptica, Sndr. Nefrtico
o Desnutricin Grave. -Hipovolemia en la mujer embarazada, con
Reaccin Anafilctica Fetal a Corticoides artificiales.
3.- POSOLOGA:
Adultos: DI. iv. 0,5-0,1 g./kg./da. 2,5-5,0 ml./kg./da (Dmx.= 6
g./kg./da 30 ml./kg./da) a no mas de 120 ml./h. (Aunque en
pacientes chocados se puede aumentar)
Peditrica: DI. iv. 0,6 g./kg./da (Preparacin: si es al 5%, Diluir 50 ml.
en SSF SG. hasta 200 ml. (1 ml.=50 mg.) 12 ml./kg./da a 120 ml./h.;
si es al 20% (1 ml.=200 mg.) 3 ml./kg./da a 60 ml./h.)
4.- CONTRAINDICACIONES:
-ICC. -Asistolia. -Edema pulmonar. -Anuria renal y Posrenal.
5.- OBSERVACIONES:
-Proteger de la luz. -Puede usarse sola o diluida en SSF SG. -Cuando
se administra ms de 200 ml. de Albmina al 20%, por el efecto
coloide-osmtico, hay que asegurarse que el paciente recibe la
suficiente hidratacin.
-En Embarazo: Categora C. -En Lactancia: La seguridad de su uso en
periodo de lactancia no ha sido establecida en ensayos clnicos
controlados.

203-SUERO COLOIDE ALMIDN (Hidroxietil)

1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Voluvn, Expafusin, Hemohes, Elohes, Hes (Envases Vidrido, PVC o
Poliolefina de 250 y 500 ml.) (10%=1 g./10 ml.) (6%=0,6 g./10 ml.)
2.- INDICACIONES:
-Hipovolemia. Sobre todo en pacientes con mayor riesgo de anafilaxia
por coloides. -Terapia de choque en reemplazo de volumen sanguneo
relacionado con: Cirugas, Heridas.
3.- POSOLOGA:
-Adultos: DI: Infu. iv. 3 g./kg./24 h. al 6%=20-50 ml./kg./24 h.
(Sustitucin en la proporcin 1:1. (Cantidad de Suero 200/0.5 al 6% =
Cantidad de Sangre). o 10%=30 ml./kg./24 h. (Forma de
Administracin: DI: Iniciar Infu. iv. 10-20 ml. en 10 min. Si no hay
reaccin alrgica, administrar 1000 ml. en 15 a 30 min. a 2000-4000
ml./h. respectivamente. (Seguidamente resto hasta completar la dosis
de 24 h.)
-Peditrica: En RN. y <2 aos. DI: Infu. iv. 8-25 ml./kg./24 h (al 6%) De
0-10 kg.=4 ml./kg./h.; De 10-20 kg.=(40 ml. + 2 ml./kg.)/h.; En > 20
kg.=(60 ml. + 1 ml./kg.)/h.
4.- CONTRAINDICACIONES:
-EAP, -ICC, -IR. grave. -Hemorragia Intracraneal. -Hipernatremia severa.
-Hipercloremia severa. -Enf. Heptica grave. -Pacientes en Dilisis. -No
usar en Sepsis en estado critico. -No usar en Quemaduras
5.- OBSERVACIONES:
-En Embarazo: En el 1 trimestre solo en caso vital. En 2 y 3
trimestre cuando el beneficio potencial justifica el riesgo para el feto,
valorando el riesgo-beneficio. -Toxicidad a partir >50 ml./kg./24 h. -En
la Lactancia: se desconoce si se excreta.

URGENCIAS Y EMERGENCIAS EXTRAHOSPITALARIAS GUETS - SESCAM

204-SUERO COLOIDE DEXTRANO
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Macrodex : 70.000 Daltons, al 6% y 10%; Rheomacrodex : 40.000
Daltons, al 10% en SFF o SG. (Envase 500 ml. (10 g./100 ml.)
2.- INDICACIONES:
-Hipovolemia por Shock (Hemorrgico, Traumtico) -En aquellas
situaciones en las que mediante la reposicin de volumen se pueda
mejorar la perfusin tisular. -Mejora microcirculacin en estados de
shock e Hiperviscosidad sangunea. -Ciruga traumtica, como
profilaxis del tromboembolismo. -Embolismo pulmonar grave. -Shock
cardiognico en pacientes con baln de contrapulsacin.
3.- POSOLOGA:
Adultos: DI.: Infu. iv. 10-15 ml./kg./24 h. (Dmx.= 20 ml./kg./da
Dextrano 40)(Dmx.=15 ml./kg./da Dextrano 70). La mitad o 2/3 de la
dosis de 24 h. se administra en los 30 a 60 primeros min. (Peditrica:
su uso es casi inexistente tanto en nios como adolescentes, por las
alteraciones de la hemostasia- dosis dependientes y alteraciones
renales.
4.- CONTRAINDICACIONES:
-Tendencia hemorrgica grave (por trombocitopenia), -ICC. grave. -IR.
con anuria. Shock sptico. -Paciente donante de rganos.
Hipervolemia. -EAP.
5.- OBSERVACIONES:
-Debe administrarse junto a soluciones hidroelectrolticas
-No superar dosis de 1,5 g./kg. puede provocar hemorragias. -En
Embarazo: utilizar nicamente en casos absolutamente necesarios. En Lactancia: no usar.

205-SUERO COLOIDE DE GELATINA

1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Gelafundina. (Envases 500, 1000 ml. (1 ml.=40 mg. de Gelatina.)).
2.- INDICACIONES:
Hipovolemia por Shock: -Hemorrgico, -Traumtico, -Sptico Quemaduras. (Indicado mas especficamente en pacientes con
trastornos previos de la coagulacin).
3.- POSOLOGA:
Adultos: DI: Infu. iv. 2,14-3,42 ml./kg./h. (Dmx.: 20 ml/kg/da (25,71
ml./kg./h )(slo 20 min.))
Pediatra: No se disponen de datos sobre su utilizacin en nios. En
caso de usarlo para el tratamiento de shock asociado con
deshidratacin o infeccin. DI: Infu. iv. 0,5-1,5 g./kg.
4.- CONTRAINDICACIONES:
-Hipervolemia. -ICC severa. -Estados de sobrecarga circulatoria. Alteraciones severas de la coagulacin sangunea. -Hipercalcemias. Pacientes Digitalizados. Precaucin en Insuf. Heptica, IR.
Hipernatremia, EAP, Deshidratacin.
5.- OBSERVACIONES:
-En Embarazo: Valorar riesgo/beneficio. En Lactancia: No existe
informacin

206-SUERO GLUCOSADO AL 5 %
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Suero Glucosado (Vitulia. Bieffe Medital, Braun). (Envases de
polietileno y cristal, de 50, 100, 250, 500 y 1000 ml. (1 ml.=50 mg.
Glucosa)).
2.- INDICACIONES:
-Vehculo y diluyente de otros medicamentos o de soluciones con
electrolitos (sustancias con carga elctrica como sodio, potasio y
cloruros). -Deshidrataciones hipertnicas (Vmitos y diarreas). Hipoglucemia. -Aporte parenteral de energa en dieta absoluta o
alimentacin por boca limitada. -Casos de Fstulas intestinales, biliares
y pancreticas, estenosis pilrica, hemorragias, shock, sudacin
profusa, hiperventilacin, poliurias, diabetes inspida, etc. Alteraciones del metabolismo de los carbohidratos (dficit de glucosa
o hipoglucemia, coma por exceso de insulina, coma heptico,
vmitos).. -Alteraciones ph
3.- POSOLOGIA:
Adultos: DI: Infu. iv. 5 ml./kg./h. (Dmx: 0,8 g./kg./h. 16 ml./kg./h.
360 ml./h. o 40 ml./kg./da)

GUA FARMACOLGICA

Pediatria: DI: Infu. iv. 10-18 mg./kg./min.=12-21,6 ml./kg./h.

(OtrAut.= 20 ml./kg. en 20 min.; Dmx.=90 ml./h.)
4.- CONTRAINDICACIONES:
-Enfermos Addisonianos. -Deshidrataciones hipotnicas. -Deplecin
electroltica. -Anuria. -Edema cerebral o -Hemorragia cerebral. TCE. Edema por acumulacin de lquido en tejidos. -Hiperglucemia). -Falta
de Potasio (Hipokaliemia). Hiperlactacidemia. -alteracin importante
de la tolerancia a la glucosa. -Exceso de agua (Hiperhidratacin). Diabetes mellitus, se puede usar si antes se inicia el tratamiento
adecuado con insulina. Insuficiencia Renal. -Hipertensin intracraneal.
-Ataques isqumicos agudos. -Alteraciones del equilibrio cido-base. Malnutricin con deficiencia de vitamina B1.
No administrar 24 horas despus de un TCE. Precauciones: Delirium
tremens, alcoholismo severo, diabetes no tratada o intolerancia a los
hidratos de carbono.
5.- OBSERVACIONES:
-Precipita con Fenitona, no infudir por la misma va. -No mezclar con
sangre:
Riesgo de hemlisis. -En Embarazo: compatible, -En
Lactancia: compatible pero usar con precaucin.

207-SUERO GLUCOSADO HIPERTNICO

1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Suero Glucosado (Envases 250, 500, 1000 ml. al 10%, 20%, 40% que
corresponde en 1 ml.=100 mg., 200 mg., 400 mg. respectivamente.)
2.- INDICACIONES:
-Hipoglucemia. -Tratamiento del colapso circulatorio. (OtrAut.
incluyen el Edemas cerebral y pulmonar (El agua fluye haca el espacio
vascular, disminuyendo la presin del lquido cefalorrqudeo y
pulmonar)).
3.- POSOLOGA:
Adultos: En Suero al 10%. DI: Inf. Iv. (preferentemente Va Central):
20 ml./kg./da o 2 g./kg./da a 2,5 ml./kg./h. 250 mg./kg./h. Dmx:
500 mg./kg./h. o 5 ml./kg./h. no exceder de 30 g./h. o 300 ml./h.
En Suero al 20% DI: Infu. iv. (Preferentemente Va Central) entre
250-1500 ml./da. a 60-120 ml./h. Dmx. 300 ml./h. 60 g./h.
-Peditrica: En hipoglucemia: RN. y Neonatos. DI: Infu. iv. 2-2,5
ml./kg. al 10 % en 2-3 min. Si persiste hipoglucemia: dar 5
mg./kg./min. 300 mg./kg./h. 3 ml./kg./h. En Nios mayores de 1
ao DI: Inf. Iv. 0.5-1 g./kg. (Preparacin: 5-10 ml./kg. al 10%) a
1ml./min. o o 60 ml./h. 3 ml./kg./h.)
4.- CONTRAINDICACIONES:
-Deshidratacin hipotnica. -Coma Addisoniano.
-Hiperglucemia o hiperlactatemia. -Diabetes mellitus inspida. Hipocaliemia o hiponatremia. IR. con oliguria o anuria. -TCE, hasta 24
horas despus. -Ictus. -Hipovolemia y hipoxia.
5.- OBSERVACIONES:
-En diabticos con Hipoglucemia se puede poner va rectal a parte de
por va venosa. -En pacientes con tratamiento con digitlicos, puede
producir intoxicacin digitlica. -Debido a la alta osmolaridad no
mezclar con otros medicamentos. -En pacientes Alcohlicos y con
Malnutricin, dar previamente Vitamina B1. -En Embarazo: es
compatible. -En Lactancia es compatible, pero se debe dar con
precaucin. -(Para concentraciones de Suero Glucosado Hipertnico
superior al 20% ver el medicamento Glucosa)

208-SUERO GLUCOSALINO
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Suero Glucosalinos Brauns (Isotnicos, (Glucosa 3,6 g. + Sodio 0,3 g.)
Hipertnicos (Glucosa 5 g. + Sodio 0,9 g) Hipotnicos) (Envases: 50,
100, 250, 500 y 1000 ml.)
2.- INDICACIONES:
-Estados de deshidratacin acompaados por prdidas salinas. Estados de acidosis: Coma urmico, Coma diabtico (con
administracin de insulina). -Estados de alcalosis dbil. Sndr.
Abdomen Agudo: Peritonitis, Clico Heptico, Invaginacin Intestinal,
Trombosis Mesentrica.
Vmitos Acetonmicos. -Como vehculo para administrar otros
medicamentos junto con un ligero aporte energtico.
3.- POSOLOGA:
Adultos: DI: Infu. iv. 5 ml./Kg./h. Dmx.: 40 ml./Kg./da.

957

URGENCIAS Y EMERGENCIAS EXTRAHOSPITALARIAS GUETS - SESCAM

Peditrica: Utilizar la Regla de Holiday para el clculo de necesidades
basales/dia: En <10 Kg. DI: Infu. iv. 100 ml./ Kg. De 10 a 20 Kg. DI:
Infu. iv. 1000 ml.+50 ml./kg. En >20 Kg. DI: Infu. iv. 1450 ml.+20
ml./Kg.
4.- CONTRAINDICACIONES:
-Alrgico a los principios activos. -Hiperhidratacin. -Edema
generalizado. -Cirrosis asctica. -Hiperglucemia. - Hipokaliemia. Hiponatremia.
-Hipocloremia.
-Coma
hiperosmolar.
Hiperlactacidemia.- En casos graves de insuficiencia en corazn,
hgado o rin. -Durante las primeras 24 horas despus de un
traumatismo craneal
5.- OBSERVACIONES:
-Si le administran prolongadamente, se recomienda adicionar potasio
a la solucin, como medida de seguridad. -En Malnutricin puede
ocasionar deficiencia de vitamina B1 (Por lo que habr que agregar a
su vez un complemento de la misma). -No mezclar con: Fenitoina,
Tiopental sdico, Eritromicina.

209-SUERO MANITOL
1.- NOMBRES COMERCIALES Y PRESENTACIONES
Manitol Mein. Osmofundina. (Envases 250, 500 ml. al 10% (1 ml.=100
mg.) al 20% (1 ml.=200 mg.))
2.- INDICACIONES:
-Glaucoma. -Hipertensin intracraneal. -Edemas y (Edemas
generalizados). -Ascitis. -Accidentes transfusionales. -Intoxicaciones
por Salicilatos, Barbitricos, Litio, Bromuro, Imipramina. Prueba
Diagnstico diferencial de las Oligo-Anurias. -Neurociruga. -Diuresis
forzada. -Prevencin y/o tratamiento de Oliguria en Fracaso Renal
Agudo. -Mioglobinuria. -Hemoglobinuria. -Aneurismectoma Artica. Irrigacin en ciruga urolgica transuretral. -Ictus con HTIC. -TCE con
HTIC
3-POSOLOGA:
-Adultos: Pauta General: DI: Infu. iv. al 20% 250-500 ml./da. a 120180 ml./h. En HTIC. DI. Infu. iv. 1-1,5 g./kg. en 20 min. al 20% 10-15
ml./kg. a 30-45 ml./kg./h. DM: Infu. iv. 0.25-0.5 g./kg. en 30-60 min.
cada 6 h. o al 20% 2.5-5 ml./kg. a 2,5-5 10 ml./kg./h. cada 6 h. En
Oliguria: DI. iv. 0,25-1 gr./kg. Dmx: 50 gr. al 20% 2,5-10 ml./kg. en 30
min. Reduccin de la PIC/PIO. DI.: Infu. iv. 0,25-1,5-2,0 gr./kg. al en
30-60 min. al 20% 1,25-20 ml./kg. a 1,25-40 ml./kg./h. En
Emergencia de PIC/PIO. DI: Infu. iv. 12,5-25 gr. en 5-10 min. (1
ml.=0,2 gr.) 62,5-125 ml. a 750-1500 ml./h. (5 min.) 375-750 ml./h.
(10 min.) En Intoxicaciones para eliminacin urinaria de txicos. DI:
Infu. iv. 50-200 gr. para mantener un flujo urinario de 100-500 ml./h.
Dmx.: 5 gr./kg./24 h. En Edema Cerebral y Glaucoma: DI. Infu. iv.
probar primero con 200 mg./kg. muy lenta, Luego dar 0,5-1 gr./kg. en
20-30 min. DM.: Infu. iv. 0,25-0,5 gr./kg. en 20 min. cada 4-6 h. En
Irrigacin en Ciruga Urolgica Transuretral: DI: va local (Solucin al
2.5% exclusivamente). En TCE para control de la PIC. DI: Infu. iv. al
0,5-1,0 gr./kg. en 20 min. al 20% 2,5-5 ml./kg. a 7,5-15 ml./kg./h.
durante 20 min. DM: Infu. iv. 0,25-0,50 gr./kg. o al 20% 1,25-2,5
ml./kg. en 20 min.cada 4-6 h.
-Peditrica: En HTIC. DI: Infu. iv. 0.25-0.5 g./kg. en 30 min. DM.: 0,250,5 g./kg. cada 4- 6 h. En Oliguria marcada o fracaso renal agudo: DI:
Infu. iv. previamente probar con 200 mg./kg. al 20% en 3-5 min.
(Dmx. 12,5 gr.)(Objetivo: obtener diuresis de al menos 1 ml./kg./h.
durante 1-3 horas). DM: Infu. iv. 0,25-0,5 gr./kg./4-6 h. En Edema
cerebral: DI.: Infu. iv. 0,25-0,5 gr./kg./al 20% en 30 min. En TCE para
control de la PIC. DI: Infu. iv. 0,25-0.5 gr./kg. (1,25-2,5 ml./kg.) en 20
min.
Su uso no est recomendado a menores de 12 aos.
4.- CONTRAINDICACIONES:
-Anuria. -Deshidratacin grave. -Hipovolemia. -HTA grave. -EAP. -ICC. Hemorragia intracranea.
5.- OBSERVACIONES:
-Embarazo: Categora C. Administrar solo cuando sea absolutamente
necesario. -Lactancia: Se desconoce si se secreta con la lactancia
materna. -Termosensibilidad: Precipita con el fro. Eliminar los
cristales con el calienta-sueros o calentar el frasco al bao mara (50).
Inyectar a temperatura ambiente. Tambin es aconsejable utilizar
equipo de suero con filtro. -Su extravasacin puede producir edema
local y necrosis de la piel. -En Anuria. Previamente realizar el test de
repuesta del Manitol. DI. 60-100 ml. en 20 min. esperar la respuesta

958

GUA FARMACOLGICA

diurtica, si la Anuria persiste o la diuresis es muy baja (menor de 60

ml/h de orina) se trata de una lesin renal grave que contraindica el
uso de Manitol.)

210-SUERO RINGER LACTATO

1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Suero Ringer Lactaro. (Envase. 100, 250, 500 y 1000 ml.)
2.- INDICACIONES:
-Hipovolemia: Shock, Hemorragias, Quemaduras -Deshidratacin con
prdida elevada de electrolitos y agua (Vmitos, Diarreas, Fstulas,). Solucin preferente en Acidosis Metablica. -Cuando hay que
administrar cantidades masivas de cristaloides
3.- POSOLOGA:
-Adultos: Estandar: DI: Infu. iv. 500-3000 ml./dia a 21-125 ml./h.
(Dmx: 40 ml./Kg. a 5 ml./kg./h.) En Shock Sptico: DI: Infu. iv. 500
ml. y repetir cada 10-15 min, evaluando peridicamente. En Shock
hemorrgico: Hemorragias grado III y IV, DI: Infu. iv. 2000 ml. rpido
En Shock cardiognico. DI: Infu. iv. 250 ml. en 20 min. a 750 ml./h. y
si la TA no mejora y no aparecen signos de sobrecarga de volumen.
Repetir la misma pauta hasta conseguir una adecuada reposicin de la
volemia. En Deshidratacin Aguda. DI: Infu. iv. 100 ml./kg. en 3 h. (30
ml./kg. en 30 min.) + (70 ml./kg. en 2,5 h.) En Gran Quemado. DI:
Infu. Iv. Frmula Parkland: % Superficie Quemadura x Kg. x 4 ml. (la
mitad de la dosis en las primeras 8 h.)
-Peditrica: Estandar en Nios de 0-10 kg. DI: Infu. iv. 100 ml./kg./da.
Estandar en Nios de 10-20 kg. DI: Infu. iv. 1000 ml. + 50 ml. por cada
kg. a partir de 10 kg. a pasar en 24 h. Estandar en Nios >20 kg. DI:
Infu. iv. 1500 ml. + 20 ml. por cada kg. a partir de 20 kg a pasar en 24
h. En el shock. DI: Infu. iv. 20 ml./kg. en pocos min. En Gran
Quemado. DI: Infu. iv. Frmula Parkland: % Superficie Quemadura x
Kg x 3 ml. (la mitad de la dosis en las primeras 8 h.)
4.- CONTRAINDICACIONES Y PRECAUCIONES
-Hipertensin. -Edema de origen cardiaco. -IR. grave (con
oliguria/anuria). -Fallo cardiaco no compensado. -Hiperpotasemia. Hipernatremia. -Hipercalcemia. -Hipercloremia. -Alcalosis metablica.
-Acidosis metablica grave. -Acidosis lctica. -Insuficiencia
hepatocelular grave o metabolismo de lactatos deteriorado. -Edema
general o cirrosis asctica.
5.- OBSERVACIONES:
-No conservar a temperatura superior a 30C. -En Embarazo:
Compatible. -En Lactancia: Compatible. -No administrar
simultneamente o mezclado con componentes sanguneos.

211-SUERO SALINO FISIOLGICO (Isotnico)

1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Suero Fisiolgico (Vitulia, Grifols, Braun, etc.) (Envases de 10, 50, 100,
250, 500 y 1.000 ml con Cloruro sdico 0,9%)
2.- INDICACIONES:
-Estados de hipovolemia por reposicin a corto plazo del volumen
intravascular en: hemorragias, quemaduras extensas, shock, Estados de deshidratacin hipotnica o isotnica acompaados de
prdidas salinas: Diarreas, Vmitos, Aspiracin Gstrica continua. Estados leves de Alcalosis hipoclormica: Estenosis Pilrica,
Obstrucciones Intestinales altas, Alcalosis medicamentosas. -Solucin
vehculo de medicamentos y soluciones electrolticas compatibles.
3.- POSOLOGA:
Adulto. Estandar: DI: Infu. iv. 40 ml./kg./da a 5 ml./kg./h.. En caso de
Shock: DI: Infu. iv. 20-50 ml./kg,/da a una velocidad de 12 ml/min.
720 ml./h. en casos muy graves hay que suministrar hasta 6
ml,/kg./min. durante 5 min. y sin pasar mas de 50 ml./kg./da. Para el
resto de las patologas en el medio extrahospitalario al no poder tener
pruebas complementarias utilizaremos la dosis Estandar hasta que se
puedan realizar dichas prubas y ajustar la dosis a los resultados.
-Peditrica: Estandar en bebes <10 Kg. DI: Infu. iv. 100 ml./Kg. para 24
h. Estandar en nios de 10 a 20 Kg. DI: Infu. iv. 1000 ml.+a partir de
10 kg. dar 50 ml./kg. para 24 h. Estandar en nios < 20 Kg. DI: Infu. iv.
1450 ml.+a partir de 20 kg. dar 20 ml./kg. para 24 h. En Shock
hipovolmico, shock distributivo( anafilctico, sptico) DI: Infu. iv. 20
ml/kg en 10-20 min. a 60-120 ml./kg./h. se puede repetir dosis hasta
60 ml./kg. en 10 a 20 min. a 180-360 ml./kg./h., en casos muy

URGENCIAS Y EMERGENCIAS EXTRAHOSPITALARIAS GUETS - SESCAM

especficos, si la clnica del paciente lo permite y no hay signos o
sntomas de sobrecarga hdrica.
4.- CONTRAINDICACIONES:
-Absolutas: Hipokaliemia Hipercloremia, Hipernatremia. Estados de
hiperhidratacin. -Relativas y Precauciones: ICC, HTA, Insuficiencia
renales grave. Cirrosis. Edemas, EAP
Acidosis metablica hiperclormica, Trat previo con Corticoides y
ACTH.
5.- OBSERVACIONES:
-Desechar cualquier suero que presente aspecto turbio. -En Embarazo.
Compatible. -En Lactancia: compatible.

212-SUERO
LAVADO

SALINO

FISIOLGICO

IRRIGACION

1.- NOMBRES COMERCIALES Y PRESENTACIONES:

Suero lavado irrigacin Baxter, Braun (Envases de 100, 500, 1000 y
3000 ml.)
2.- INDICACIONES:
-Irrigacin en exploraciones diversas intracavitarios, sobre todo en
procesos urolgicos, en lavados de estmago, etc. -Irrigacin para
eliminar sangre y restos de tejidos.
3.- POSOLOGA:
-Uso tpico. Tanta cantidad como precise para lavar las heridas o
limpiar sobre la piel de restos de sangre y otras materias orgnicas, o
drenar organos o cavidades internas. (Vedija, Estmago, etc)
4.- CONTRAINDICACIONES:
No consta
5.- OBSERVACIONES:
-Raramente la absorcin de grandes volmenes de solucin para
irrigacin a travs de una perforacin o heridas abiertas puede dar
lugar a una sobrecarga circulatoria, fallo cardiaco o desequilibrio
electroltico o hemlisis, produciendo Sndr. Intox. Hdrica. -En
Embarazo: Compatible. -En Lactancia: Compatible. -No usar va iv.

213-SUERO SALINO HIPERTNICO

1.- NOMBRES COMERCIALES Y PRESENTACIONES:
S. Cloruro Sdico al 20% (Amp. de 10 ml.). Preparacin S.Salino
Hipertnico 3% (Por cada 100 ml. de SSF. al 0,9%, retirar 11 ml. y
agregar 11 ml. de S. Cloruro Sdico al 20%.) Preparacin S.Salino
Hipertnico 7,5% (Por cada 100 ml. de SSF. al 0,9%, retirar 34,5 ml. y
agregar 34,5 ml. de S. Cloruro Sdico al 20%)
2.- INDICACIONES:
En Adultos: -TCE grave con HTIC (hipertensin intracraneal) o con
Shock Hipovolmico asociaco. -En Politraumatizados con Shock
Hemodinmica grave, cuando el tiempo de traslado sea superior de 30
min. Valorar posible administracin pasados 15 min. de traslado.
En Pediatra: -Bronquiolitis en nios Fibrosis qustica. (Sin evidencia
cientfica suficiente, en TCE grave, Edema cerebral y hemorragia
cerebral.)
3.- POSOLOGA:
-Adultos: DI. Infu. iv. 4 ml./kg. al 7,5% en 5-10 min. (Preparacin: Una
vez tenemos la cantidad de SS.Hipertnico 7,5% para el peso del
paciente lo administramos a 24-48 ml./kg./h.)(Ejemplo: En Paciente
de 70 kg. necesitar a 4 ml./70 kg.=280 ml. de SS.Hipertnico al 7,5%.a
administrr en 5-10 min. Cmo preparar 280 ml. SS.Hipertnico al
7,5%? (Por cada 65,5 ml. de SSF. se dan 34,5 de cloururo sdico al
20%, por lo que se mezclara 183,5 ml. de SSF. + 96,5 ml. S.Cloruro
Sdico al 20%) y se administran los 280 ml. a 1680-3360 ml./h.)
-Peditrica: En Bronquiolitis y en Fibrosis Qustica: DI: va
nebulizacin de 3 ml. de SS.Hipertnico al 3 %, repetir dosis si es
necesario. -En TCE Grave slo o asociado a Edema Cerebral y HITC,
(aunque an no hay evidencia cientfica) DI: Infu. iv. 5,4 ml./kg.
SS.Hipertnico al 3% en 5-10 min.
4.- CONTRAINDICACIONES:
-Edema en Insuf. Cardiada y Cirrosis Heptica. -Eclampsia, Hipernatremia, -Hipercloremia, -Acidosis Metablica
5.- OBSERVACIONES:
-En Politraumatizados con Shock hemodinamico grave si se sospecha
resangrado una vez que se pone el SS.Hipertnico o se deteriora mas,
pasar de nuevo a cristaloides a ritmo de 1000 ml. en 30 min. -No

GUA FARMACOLGICA

administrar nunca al 20%. -En el Embarazo: es compatible. -En la

Lactancia: es compatible

214-SUERO SALINO HIPOSDICO (0,45%)

1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Suero Salino fisiolgico al 0.45% (Envases de 500 y 1000 ml.)
2.- INDICACIONES:
-Deshidratacin con hipernatremia grave o por Diuresis Osmtica. Coma hiperosmolar diabtico.
3.- POSOLOGA:
-Adulto: DI. Infu. iv.10-20 ml./kg. en la 1 h. (Dmx.1000 ml.)
-Peditrica: En Nios de 3 a 9 kg. DI: Infu. Iv. 6 ml./Kg./h. En Nios de
10 a 20 kg. DI: Infu. iv. 5 ml./kg./h. En Nios >20 kg. DI: Infu. iv. 4
ml./kg./h.
4.- CONTRAINDICACIONES:
-Estados de hiperhidratacin. -Intoxicacin hdrica
-Edema en alteraciones cardacas, hepticas o renales e hipertensin
grave.
5.- OBSERVACIONES:
-Preparacin de SS.Hiposdico al 0,45% en caso de no tener
presentacin comercial: Mezclar 250 ml. de Suero de Agua Destilada
con 250 ml. SSF. al 0.9%. -En Embarazo usar con precaucin. -En
Lactancia usar con precaucin.

215-SUGAMMADEX
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Bridion (Viales de 2 y 5 ml. (100 mg./ml.))
2.- INDICACIONES:
Reversin del bloqueo neuromuscular inducido por Rocuronio o
Vecuronio. En nios y adolescentes, reversin de rutina del bloqueo
inducido por Rocuronio.
3.- POSOLOGA:
-Adultos. En reversin de rutina. DI: iv. 4 mg./Kg. o 0,04 ml./kg. en 10
seg. En reversin inmediata. DI: iv. 16 mg./Kg. o 0,16 ml./kg. en 10
seg.
-Peditrica: DI: iv. 2 mg./kg. 0,02 ml./kg. en 10 seg. (slo en casos de
reversin de rutina de Rocuronio, no experiencia en Vecuronio)
4.- CONTRAINDICACIONES:
Precaucin: No usar en la reversin de otros Bloqueantes
Neuromusculares que no sean Norcuron y Vecuronio. Cuidado en IR.
(Va de eliminacin).
5.- OBSERVACIONES:
El tiempo medio de reversin es de 3 min. Se necesita ms de 40
mg./kg. para tener efectos adversos. En Embarazo se puede usar pero
con precaucin. En Lactancia se puede usar.

216-SULFADIAZINA ARGENTICA
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Flammazine. Silverderma. (Crema, 50, 500 g. (1 gr.=10 mg.
Sulfadiazina + 70 mg. Propilenglicol + Alcohol Cetlico 40 mg). Aerosol
2.- INDICACIONES:
-Trat. y Prevencin de Infecciones en quemaduras de segundo y
tercer grado. Trat. y Prevencin de Infecciones en lceras varicosas y
de decbito.
3.- POSOLOGA:
-Uso tpico: Inicialmente se debe lavar y limpiar la herida
adecuadamente. Con una esptula estril o con la mano cubierta con
un guante estril, se debe aplicar una capa de crema de 3 mm. de
espesor sobre la superficie lesionada, cubrindola con un vendaje
adecuado y no compresivo. (Si la quemadura apenas est
contaminada, se da cada 12 a 24 h. Si est muy contaminada se da
cada 4-6 h.).
4.- CONTRAINDICACIONES:
S la extensin de la quemadura es grande, debido a la posibilidad de
absorcin sistmica no dar en RN., ni en Prematuras ni en Embarazo a
trmino.Debido al riesgo de ictericia nuclear, no debe administrarse a:
recin nacidos y prematuros cuando la extensin de las lesiones sea
tal que permita prever una amplia absorcin sistmica. -Bajo la

959

URGENCIAS Y EMERGENCIAS EXTRAHOSPITALARIAS GUETS - SESCAM

influencia de la luz solar, puede producirse una decoloracin cutnea
local y coloracin gris de la crema, por lo que se recomienda no
exponer las zonas tratadas a la luz directa del sol.
5.- OBSERVACIONES:
No conservar a temperatura superior a 25C -Embarazo: No debe
administrarse en embarazo a trmino por el riesgo de ictericia nuclear.
-Lactancia: No debe administrarse por riesgo de ictericia nuclear. Insuf. Heptica y/o IR.: evitar la aplicacin en lesiones de gran
superficie y abiertas, sobre todo lceras. -El trat. no debe ser
suspendido mientras exista la posibilidad de infeccin. -Cada envase
debe ser utilizado para un solo paciente.

217-SULPIRIDA
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Dogmatil. Tepavil. Digton. Guastil. Lebopride, Psilocen. (Amp. 2
ml./100 mg.) (Comp. 50 y 200 mg.) (Soluc. 25 mg./ 5 ml.)
2.- INDICACIONES:
-Ansiedad. -Vrtigo. -Esquizofrenia. -Agitacin psico-motriz. -Fobias. Trastorno obsesivo compulsivo. -Paranoia. -Delirio. -Mania. -Neurosis.
3.- POSOLOGIA:
-Adultos DI: im. 100-800 mg./8 h. 2-16 ml./8 h. (300-2400 mg./da)
vo. 50-800 mg./8h. (150-2400 mg./da En Neurosis. DI: im. 150-300
mg. 3-6 ml. vo. 150-300 mg./d. En Vrtigos. DI: im. 150-300 mg.
3-6 ml. vo. 150-450mg/d. En Psicosis. DI: im. 200-800 mg. 4-16 ml.
vo. 400-2400 mg./d.
-Peditrica. DI: vo. 5-10 mg./Kg./24 h. 0,1-0,2 ml./kg./24 h.
4.- CONTRAINDICACIONES:
-Alergia a Benzamidas. -Feocromocitoma. -Prolongacin del intervalo
QT (QTc>440 msg.). -Prolactinoma de Glndula Pituitaria. -Cancer de
Mama. -Precaucin en: Epilepsia, Parkinson, Sndr. Neurolptico
Maligno. ACVA. Demencia. Tromboembolismo venoso. Crisis
Hipertensivas.
5.- OBSERVACIONES:
-No es recomendable el uso iv. -En Embarazo: Categora C. slo se
acepta en caso de ausencia de alternativas teraputicas ms seguras. Lactancia: Se excreta con la leche. No se recomienda la lactancia
mientras se usa. -En IR. reducir la dosis y usarla con precaucin. Antdoto: No especfico pero en caso de sntomas extrapiramidales
graves dar anticolinrgicos (Biperideno o Akinetn).

218-SURFACTANTE PULMONAR PORCINO (Poractan

Alfa)
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Curosurf, Survanta, Alveofact, Infasurf, Surfaxil (Viales de 1,5 ml.=120
mg. y 3 ml.=240 mg. (80 mg./ml.))
2.- INDICACIONES:
-SDR o Enfer. de la Membrana Hialina en Neonatos de ms de 700 gr. Profilctico de SDR en prematuros de <30 sem. de gestacin o con
evidencia de dficit de surfactante.
3.- POSOLOGA:
-Peditrica: En Ventilacin mecnica: Detenindola o sin detener y a
ser posible en los primeros 15 min. DI: Va Intratraqueal 100-200
mg./kg. 1,25-2,5 ml./kg. Si se necesita se puede repetir a las 12 h.
(En caso de detener la ventilacin asistida, tras la administracin dar 1
min. de ventilacin con amb, para proseguir con Ventilacin
Asistida.)
4.- CONTRAINDICACIONES:
No dar mas de 300-400 mg./kg. 3,75-5 ml./kg.
5.- OBSERVACIONES:
-Conservar en nevera entre +2 y +8C, -Proteger de la luz hasta el
momento de su uso. -Antes de la instilacin debe calentarse a 37C. y
una vez calentados no se deben conservar en nevera. -Slo debe
administrarse a travs del tubo endotraqueal. -No hay antdoto.

219-TAPENTADOL
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Yantil, Palexia, Nucynta ( Comp. 50,100,150, 200 y 250 mg.)(Amp. 30
mg. en experimentacin)

960

GUA FARMACOLGICA

2.- INDICACIONES:
Dolor intenso y Dolor neuroptico
3.- POSOLOGA:
-Adultos. DI: vo. 50 mg./4-6 h., aunque se puede repetir a la hora.
(Dmx.= 500 mg./da)
(An estudio en Adultos. DI: iv. 30 mg.)
-Peditrica: (No establecida su eficacia y seguridad en <18 aos)
4.- CONTRAINDICACIONES:
-Insuficiencia respiratoria, -Asma bronquial aguda o grave, Hipercapnia, -leo Paraltico, -Intoxicacin Aguda por Alcohol, Hipnticos, -Analgsicos de accin central, o Psicotropos
5.- OBSERVACIONES:
-Antdoto: Naloxona. -En Embarazo: Existen pocos datos. Solo debe
usarse durante el embarazo si los efectos beneficiosos justifican los
riesgos potenciales para el feto. -En Lactancia: Evitar.

220-TAZOBACTAN
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Tasovak, Tazocin o Piperacilina/Tazobactam (Viales polvo (Piperacilina
+ Tazobactam) 2 g./0,25 g. y 4 g./0,50 g.)(Se reconstituyen con Agua
esteril o SFF.)
2.- INDICACIONES:
-Adultos: Neumona nosocomial, Infecciones complicadas del aparato
urinario (incluyendo pielonefritis), Infecciones intraabdominales,
Infecciones cutneas y de partes blandas, Infecciones bacterianas en
adultos neutropnicos
-Nios (2-12 aos): Infecciones bacterianas en nios neutropnicos
3.- POSOLOGA:
Adultos: DI. Infu. iv. 2 g./0,25 g. 4 g./0,5 en 3-5 min. (Preparacin: DI
en SSF. o Agua Esteril hasta 10-20 ml. a pasar en 3-5 min.)
(Preparacin: DI diluidas previamente en 10 a 20 ml. en SSF. SG.
hasta 100 ml. a pasar en 20-30 min. 200-300 ml./h.)
-Peditrica: En nios <40 kg. y >2 aos. DI: Infu. iv. 80 mg./10 mg. por
Kg. cada 6 h. a pasar en 30 min. (Dmx.= 4 g./0,5 g. cada 6 h.)
(Preparacin: DI en SSF. hasta 50 ml. a 100 ml./h.)
4.- CONTRAINDICACIONES:
-Hipersensibilidad
a
cualquier
antibitico
-lactmico.
5.- OBSERVACIONES:
-En la Lactancia: Evitar. -En Embarazo: Atraviesa la barrera
hematoenceflica. Slo usar cuando los beneficios superen al riesgo.
En nios <2 aos no se ha establecido seguridad y eficacia. -Se asocia
a la Piperacilina (Ver medicamento con n referencia 171)

221-TENECTEPLASA (TNK)
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
METALYSE. (Viales 8000 UI. (40 mg.) y 10000 UI. (50 mg.) con jeringa
precargada de 1 ml./1000 UI.).
2.- INDICACIONES:
IAM con elevacin del ST o BRI reciente, antes de las 6 h. siguientes a
la aparicin de los sntomas.
3.- POSOLOGA:
Adultos: (Administrar en bolo en 10 seg.) En <60 kg. DI: iv. 6000 UI.
30 mg. o 6 ml. En >60 y <70 kg. DI: iv. 7000 UI. 35 mg. 7 ml. En >70
y <80 kg. DI: iv. 8000 UI. 40 mg. 8 ml. En >80 kg. y <90 kg. DI: iv.
9000 UI. 45 mg. 9 ml. En >90 kg. DI: iv. 10000 UI. 50 mg. 10 ml.
(Dmx 10000 UI. 50 mg. 10 ml.)
Trat Coadyuvante: Administrar Heparina y AAS lo antes posible tras el
diagnstico.
4.- CONTRAINDICACIONES:
-Trastorno hemorrgico actual o en los ltimos 6 meses. -Ciruga
mayor, biopsia o traumatismo significativo en los ltimos 2 meses. Aneurisma arterial, malformacin arteial/venosa. ICTUS, AIT,
demencia. Neoplasia intracraneal. -Precauciones en: Trat. con
anticoagulante oral (INR> 3). Pericarditis y/o endocarditis. Estenosis
mitral con FA. HTA no controlada. Hipotension. Enfermedad cerebrovascular. lcera pptica activa. Hemorragia gastrointestinal o
genitourinaria en los 10 ltimos das. RCP prolongada en las ltimas
semanas. Pancreatitis aguda. Enfermedad heptica grave. Inyeccin im
en los ltimos 2 das. Mayor de 75 aos. Peso inferior a 50-60 kg.
5.- OBSERVACIONES:

URGENCIAS Y EMERGENCIAS EXTRAHOSPITALARIAS GUETS - SESCAM

-Evitar catteres rgidos, Evitar inyecciones im y arteriales. No
mezclar con SG. -Termosensibilidad: No conservar a temperatura
superior a 30C. -Embarazo: Categora C Valorar riesgo/beneficio. Lactancia: La leche materna debe desecharse las primeras 24 h
despus del trat.

222-TERBUTALINA
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Terbasmin (Aerosol: 1 pulsacin=250 mcg.) (Soluc. Nebuliz 1%, 1
ml=10 mg.) (Amp. 1 ml./0,5 mg.)
2.- INDICACIONES:
-Crisis Broncoespasmo (En EPOC. En Estatus Asmtico. En Enfisema). Amenaza de parto prematuro
3.- POSOLOGA:
-Adultos: En Broncoespasmo Moderado DI: inh. (2 puff) 500 mcg./1020 min. Hasta 3 veces en 1 h. DM: 500 mcg./4-6 h. DI: Nebuliz. 0,3
mg./kg./dosis 0,3 ml./kg. (Dmx: 10 mg. 1 ml.) en 3 ml. SSF con O2
a 6-8 l/min en 15-20 min. Hasta 3 veces en 1 h. DM: 2,5-5 mg. 0,250,5 ml. en 3 ml. SSF con O2 en 20 min cada 4 -6 h. En Broncoespasmo
Severo. DI: iv. sc. 10 mcg./kg./dosis (Dmx: 0,4 mg. 0,8 ml.) cada
20 min. hasta 3 veces en 1 h. En Parto prematuro. DI: iv. 2,5 mg. cada
4-6 h. hasta trmino.
-Peditrica. DI: Inh. (1-2 puff) 250-500 mcg. cada 20 min. hasta 3 dosis
en 1 h. DM: Inh. 250-500 mcg/4 -6 h. DI: Nebuliz. 0,05 ml./kg./dosis
(Dmx. 1 ml.) en 3 ml SSF. y O2 a 6-8 L./min. en 20 min. Se puede
repetir a los 20 min. DI: sc. 0,01 mg./kg. 0,02 ml./kg. (Dmx. 0,4
mg. o 0,8 ml.) Se puede repetir cada 20 min. hasta 3 dosis. DI: iv. 210 mcg./kg./dosis (Preparacin: 500 mcg. en SSF. hasta 100 ml. (1
ml.=5 mcg.) a 0,4-2 ml./kg./dosis. DM: iv. 0,08-0,4 mcg./kg./min.
4,8-24 mcg./kg./h. (Preparacin: 500 mcg. en SSF. hasta 100 ml. (1
ml.=5 mcg.) a 1-5 ml./kg./h. aumentando la dosis cada 30 min. en 0,1
mcg./kg./min. o 6 mcg./kg./h. 1,2 ml./kg./h. hasta Dmx. 6
mcg/kg/min.
4.- CONTRAINDICACIONES:
-Toxemia Gravdica, -Hemorragia Anteparto, -Riesgo de aborto en el
1 2 trimestre. -No usar iv en hipertiroidismo ni en cardiopata
isqumica grave. -Intolerancia a la fructosa. -HTA. -Ancianos. Diabetes
5.- OBSERVACIONES:
-Embarazo: Categora B. En prematuros, se ha observado una
hipoglucemia transitoria. Puede aumentar el riesgo de ictericia en RN.
-Lactancia: Pasa a la leche, la influencia en el nio es improbable a
dosis teraputicas, usar con precaucin. -IR.: Disminuir dosis al 50% si
aclaracin de creatinina es de 10- 50 ml/min. -Antidoto: -bloqueante
Cardioselectivo. (Atenolol, Labetalol, Metoprolol)

223-TERLIPRESINA
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Variquel, Glypressin (Amp. 1 mg./1 ml.)
2.- INDICACIONES:
-Hemorragias digestivas por rotura de varices esofgicas. Trat. de
urgencia del sndrome hepatorrenal de tipo I y II
3.- POSOLOGA:
-Adultos: En < 50 Kg. DI: iv. 1 mg./4 h. hasta controlar la hemorragia.
Duracin mxima 48 h. Entre 50-70 Kg. DI: iv. 1,5 mg./4 h. En >70 Kg.
DI: iv. 2 mg./4 h.
-Peditrica: No existe apenas experiencia (Estudios aislados con buen
resultado dando DI: iv. 0,02 mg./kg, en caso de Shock hipovolmico
resistente a Sueroterapia y Catecolaminas)
4.- CONTRAINDICACIONES:
-Shock sptico, -IR. Crnica, -Asma Bronquial, -Insuf. Resp., -Embarazo,
-Ancianos >70 aos
5.- OBSERVACIONES:
-Es antidiurtico y vasopresor. -En Lactancia: Evitar. -En Embarazo: No
usar. -Antdoto: en caso de provocar Crisis HTA dar AlfaBloqueante
(Clonidina. DI: iv. 150 mcg.)

224-TIAMINA (Vitamina B1)

GUA FARMACOLGICA

1.- NOMBRES COMERCIALES Y PRESENTACIONES:

Benerva (Amp. 100 mg./1 ml.) (Comp. 300 mg)
2.- INDICACIONES:
-Intoxicacin Alcohlica -Dficit especfico severo de vitamina B1. Encefalopata de Wernike. -Prevencin y trat. de formas de Beriberi y
trastornos cardiovasculares asociados al mismo. -Ciatica y Lumbalgia, Neuralgia intercostal, -Neuroaptia diabtica, -Neuritis ptica, -Neuritis
durante el embarazo. -Parlisis facial. -Trastornos gastrointestinales. Nuseas y calambres del embarazo.
3.- POSOLOGA:
Adultos: DI: im: 100 mg (recomendada) DI: iv. 100-200 mg.
(Preparacin: (1-2 amp) + 8 ml SSF. en bolo lento.) DI: vo. 600-1200
mg./da
Peditrica: DI: im. 10-25 mg./da
4.- CONTRAINDICACIONES:
-Hipersensibilidad conocida a la tiamina.
5.- OBSERVACIONES:
-Sensible a la luz. -Conservar en envases que no sean metlicos. Administracin muy lenta tanto i.v. como i.m. -Irritabilidad en el lugar
de administracin. -La va iv. slo debe utilizarse en condiciones
especiales y en pacientes hospitalizados (ya que son mas frecuentes
las reacciones de hipersensibilidad). -En Embarazo: Categora A
(categora C a altas dosis). En Lactancia: Compatible con lactancia
materna. Se excreta en leche. Utilizar con precaucin. -(En estudios
experimentales se usa como trat. coadyuvante en Intoxicaciones por
Herbicidas, tipo Paraquat, a dosis de 100 mg./kg.).

225-TIAPRIDA
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Tiaprizal, Sereprid, Tiapridal (Amp. 2 ml./100 mg.)(Comp. 100 mg.)
(Sol. Gotas: 60 ml. de 12 mg./ml.)
2.- INDICACIONES:
-Intoxicacin Etilca, Aguda (agitacin) o Crnica. -Deprivacin
Alcohlica, (Agitacin Psicomotriz en adultos dementes y en nios). Antihmetico y Discinesias Motoras.
3.- POSOLOGA:
-Adultos. En Intoxicacin Etlica con Agitacin. DI: iv. im. 100-200
mg. En Deprivacin alcohlica. DI: iv. 300-400 mg./24 h. En
Discinesias espontneas. DI: iv. 150 mg./24 h. En Discinesias de Corea
de Huntington. DI: iv. 400 mg./8 h. (1200 mg./24 h.). En Trastornos
comportamientos en adultos dementes. DI: iv. 50-100 mg./12 h.
Dmx.=400 mg./da.
-Peditrica. DI: vo. 2.5-5 mg./Kg./da en 3 o 4 dosis. (1 gota =0.5 mg.)
Dmx. 300 mg./da. (Dar esta dosis si fallan otros trat. de primera
eleccin Tanto trastornos graves de comportamiento en nios en
estado de agitacin y agresividad. Como en nios con Corea de
Huntington.)
4.- CONTRAINDICACIONES:
-Alergia a la sustancia o a las benzamidas. -En el feocromocitoma. -En
tumores que producen Prolactina (Cancer de Mama o Prolactinomas
Hipofisarios) -En el carcinoma de mama. -En trat. asociado a la
levodopa. -Evitar en Enfer. Parkinson.
5.- OBSERVACIONES:
En Lactancia: No hay evidencias de su excresin, evitar su uso, o evitar
la Lactancia si se usa. En Embarazo: Estudio limitado, slo usar si el
beneficio es mayor que el riesgo. -Es un Antipsictico y Neurolptico. Se puede administrar por vas: vo. im. iv.

226-TICAGRELOR
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Brilique, Possia (Comp. 90 mg.)
2.- INDICACIONES:
-Antiagregante y Anticoagulante en IAM. -Prevencin de
acontecimientos aterotrombticos: En SCA (angina inestable, IAM sin
elevacin del segmento ST (IMSEST SCASEST) o IAM con elevacin
del segmento ST (IMCEST SCACEST). En pacientes sometidos a una
intervencin coronaria percutnea (ICP) o a un injerto de derivacin
de arteria coronaria (IDAC).
3.- POSOLOGA:

961

URGENCIAS Y EMERGENCIAS EXTRAHOSPITALARIAS GUETS - SESCAM

-Adultos: DI. vo. 180 mg. (Asociado con AAS.) DM: vo. 90 mg./12 h.
4.- CONTRAINDICACIONES:
-Hemorragia patolgica activa. -Historial de hemorragia intracraneal.
Insuf. heptica moderada a grave. No usar si est siendo tratado con
Ketoconazol, Claritromicina, Nefazodona, Ritonavir y Atazanavir.
5.- OBSERVACIONES:
Dar previamente AAS. En Embarazo: Categora C. -En Lactancia: Evitar
su uso o Evitar la Lactancia si se utiliza. -En Trat. crnico no se debe
interrumpir.

227-TICLOPIDINA
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Tiklid. Ticlodone. (Comp 250 mg.)
2.- INDICACIONES:
-Profilaxis de: Ictus tromboemblico inicial o recurrente y Accidentes
Trombticos, coronarios o arteriales. O tras Angioplastia coronaria,
con colocacin de STENT. Alternativa al Acido Acetil Saliclico o al
Clopidogrel (si el paciente fuera alrgico a los mismos)
3.- POSOLOGA:
Adultos: DI: vo. 250 mg. (1 comp.) cada 12 h. preferentemente con
alimento. Tras Colocacin de STENT. DI: vo. 500 mg. asociado a AAS.
4.- CONTRAINDICACIONES:
-Alteraciones de la coagulacin. Insuf. heptica grave (disminucin de
los factores de la coagulacin). -Ulcus activo. -Antecedentes de:
leucopenia, trombopenia y agranulocitosis.
5.- OBSERVACIONES:
-Embarazo: Categora B. Se acepta en caso de falta de alternativas
teraputicas ms seguras. -Lactancia: Se recomienda suspender la
lactancia materna o evitar la administracin de este medicamento. No tiene antdoto.

228-TIERRA DE FULLER
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Tierra de Fuller Ici-Zeltia (Envase con 60 gr. de polvo.)
2.- INDICACIONES:
Intoxicacin por Herbicida Paraquat o Diquat en las 12 horas
precedentes (Antdoto Absorbente Gstrico)
3.- POSOLOGA:
-Adultos: DI: vo. 200 ml./2 h. hasta un mximo de 48 h. o hasta que no
haya Paraqual o Diquat en orina durante 3-6 h. (Preparacin: 60 gr.en
200 ml. de agua.)
-Peditrica: DI: vo. 50 ml./2 h. hasta un mximo de 48 h. o que no
haya Paraqual o Diquat en orina durante 3-6 h.
4.- CONTRAINDICACIONES:
No se conocen
5.- OBSERVACIONES:
-Aunque apenas tienen efectos secundarios pueden dar Estreimiento
y Hiperkaliemia. -Se puede asociar a un catrtico: Sulfto sdico
(Adultos: 30 g. en 300 ml.; Nios: 0,25 g. en soluc. 10%)

229-TIOPENTAL SDICO
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Penthotal Sdico. Tiobarbital. (Vial. 0,5 g. + disolvente 20 ml. (1
ml.=25 mg. o 2,5%) 1 gr. + disolvente 20 ml. (1 ml.=50 mg. 5%))
2.- INDICACIONES:
-Induccin rpida de la anestesia, solo en intervenciones cortas. Anticonvulsivo. Epilepsia, status epilptico. -Disminuir la PIC en
Hipertensin Intracraneal en TCE. -Proteccin cerebral (Coma
barbitrico)
3.- POSOLOGA:
-Adultos: En Anestesia DI: iv. 3-5 mg./kg. en >1 min. (Preparacin: Si
se usa al 2,5% dar 0,12-0,2 ml./kg Si se usa al 5% dar 0,06-0,1
ml./kg.) DM: Infu. iv. 1-5 mg./kg./h. (Preparacin: Una vez
reconstituido el vial 0,5 gr. a su vez se diluye en SSF. SG. hasta 250
ml. (1 ml.=2 mg. 0,2%) a 0,5-2,5 ml./kg./h. (tambien se puede diluir
al 0,4% con vial de 1 gr.). En Convulsiones: DI: iv. 0,5-2 mg./kg. en >1
min. (Preparacin: Si se usa al 2,5% dar 0,02-0,08 ml./kg Si se usa al
5% dar 0,01-0,04 ml./kg.) Repetir si es necesario. En Estatus

962

GUA FARMACOLGICA

Epilptico: DI: iv. Pueden precisarse dosis de hasta 250 mg.

(Preparacin: Si se usa al 2,5% dar 10 ml./kg Si se usa al 5% dar 5
ml.) DM: Infu. iv. 2 mg./kg./h. (Preparacin: Una vez reconstituido el
vial 0,5 gr. a su vez se diluye en SSF. SG. hasta 250 ml. (1 ml.=2 mg.
0,2%) a 1 ml./kg./h.) En Disminucin de la PIC en TCE: DI: iv. 1-4
mg./kg. a >1 min. (Preparacin: Si se usa al 2,5% dar 0,04-0,16 ml./kg
Si se usa al 5% dar 0,02-0,08 ml./kg.) DM: Infu. iv. 2-4 mg./kg./h.
(Preparacin: Una vez reconstituido el vial 0,5 gr. a su vez se diluye en
SSF. SG. hasta 250 ml. (1 ml.=2 mg. 0,2%) a 1-2 ml./kg./h.)
-Peditrica: En Anestesia: DI: iv. 2-6 mg./kg. en >1 min. (Preparacin:
Si se usa al 2,5% dar 0,08-0,24 ml./kg Si se usa al 5% dar 0,04-0,12
ml./kg.) DM: Infu. Iv. 1 mg./kg./h. (Preparacin: Una vez reconstituido
el vial 0,5 gr. a su vez se diluye en SSF. SG. hasta 250 ml. (1 ml.=2 mg.
0,2%) a 0,5 ml./kg./h.) En Convulsiones: DI: iv. 2-3 mg./kg. en >1
min. (Preparacin: Si se usa al 2,5% dar 0,08-0,12 ml./kg Si se usa al
5% dar 0,04-0,06 ml./kg.) DM: Infu. iv. 1 mg./kg./h. (Preparacin: Una
vez reconstituido el vial 0,5 gr. a su vez se diluye en SSF. SG. hasta
250 ml. (1 ml.=2 mg. 0,2%) a 0,5 ml./kg./h.)
4.- CONTRAINDICACIONES:
-Inestabilidad hemodinmica. -Shock hipovolmico. -Enfer.
Cardiovascular. -Hipotensin. -Estatus Asmtico. -Uremia. -Porfiria. Miotonias. -Hipersensibilidad a barbitricos.
5.- OBSERVACIONES:
-La extravasacin puede causar necrosis tisular. -Dolor en el punto de
inyeccin. -En Embarazo: Categora C. -En Lactancia: Es excretado con
la leche materna. Usar con precaucin. -En IR. Intentar evitar en
disfuncin renal. -No se documenta Antdoto. Se aconseja no
administrarlo a una concentracin >2,5% -Tiene mala tolerancia
hemodinmica. Por lo que se aconseja su no uso en Emergencias al
menos como medicacin de primera eleccin.

230-TIOSULFATO SODICO
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Tiosulfato Sdico (Amp. 25 ml. al 50% (12,5 g./25 ml.=0,5 g./ml.)
(Amp. 50 ml. al 25% (12,5 g./50 ml.=0,25 g./ml.) (Suele presentarse en
un Kit de antdoto con el Nitrito de Amilo, y con Azul de Metileno.)
2.- INDICACIONES:
Intoxicacin por Cianuro, Cisplatino y Nitroprusiato
3.- POSOLOGA:
-Adultos. DI: iv. 7 gr./m 14 ml./m aproximadamente 0,2 gr./kg o
0,4 ml./kg. (al 50%) en 10 min. (Dmx. 12,5 g. o 25 ml.)
-Peditrica. DI: iv. 7 gr./m o 28 ml./m aproximadamente 0,4 gr./kg. o
1,65 ml./kg. (al 25%) en 10 min. (Dmx. 12,5 g. 50 ml.)
4.- CONTRAINDICACIONES:
Precaucin en: -Insuf. Cardiaca, -IR., -Diabticos.
5.- OBSERVACIONES:
-Suele presentarse en un Kit de antdoto con el Nitrito de Sodio, y con
Azul de Metileno. Por lo que en una intoxicacin de Cianuro,
previamente habr que administra Nitrito de Sdio: En adultos 300
mg. que se pueden repetir a los 30 min. En Peditrica, 4,5-10 mg./kg.
que se puede repetir a los 30 min. -En el Embarazo: Categora C. -En la
Lactancia: No hay estudios. Sopesar beneficios sobre riesgos.

231-TIROFIBAN
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Agrastat. (Envase Bolsa 250 ml. (50 mcg./ml.)).(Vial 50 ml. (250
mcg./ml.)).
2.- INDICACIONES:
-Prevencin del IAM precoz en pacientes con angina inestable. -IAM
sin onda Q cuyo ltimo episodio de dolor torcico se ha producido en
las ltimas 12 horas y que presentan cambios en el ECG y/o aumento
de las enzimas cardiacas. -SCA en los que se tiene planteado hacer
Coronariografa y/o Angioplastia entre 4 a 12 h. despus de su
diagnstico. -Prevencin del IAM tras Intervencin Coronaria
Percutnea (ICP)
3.- POSOLOGA:
Adultos: DI: Infu. iv. 0.4 mcg./Kg./min. durante 30 min. 12 mcg./kg.)
para seguir con DM: Infu. iv. 0,1 mcg./kg./min. 6 mcg./kg./h.
(Preparacin: Usando el preparado de 50 mg./ml. en DI: Infu. iv. 0,48
ml./kg./h. durante 30 min. siguiendo en DM: Infu. iv. 0,12 ml./kg./h.).

URGENCIAS Y EMERGENCIAS EXTRAHOSPITALARIAS GUETS - SESCAM

En pacientes sometidos a ICP. DI: iv. 25 mcg./kg. 0,5 ml./kg. en 3
min. seguidos de DM: Infu. iv. 0,15 mcg./kg./min. (Preparacin DM:
Usando el preparado de 50 mg./ml. dar 0,36 ml./kg./h.)
4.- CONTRAINDICACIONES:
-Antecedente de ictus en los 30 das previos o cualquier antecedente
de ictus hemorrgico. Enfer. intracraneal conocida (p. ej., neoplasias,
malformaciones arteriovenosas, aneurismas). -Hemorragia activa o
reciente (dentro de los 30 das previos al tratamiento) clnicamente
relevante (p. ej., hemorragia gastrointestinal). -Hipertensin maligna. Traumatismo importante o intervencin de ciruga mayor en las
ltimas 6 sem. -Trombocitopenia (recuento plaquetario <
100.000/mm) o alteraciones de la funcin plaquetaria.
-Alteraciones de la coagulacin (p. ej., tiempo de protrombina > 1,3
veces de lo normal). -Insuf. heptica grave.
5.- OBSERVACIONES:
-Debe administrarse previamente AAS y Heparina no fraccionada. -No
es necesario suspender la perfusin durante la coronariografa, o
angioplastia. -Es un Anticoagulante y Antiagregante. -En IR. reducir la
dosis a la mitad. -En Pediatra no existe experiencia teraputica. -En
Embarazo: Categora B, no debe utilizarse a no ser que sea claramente
necesario. -En Lactancia: evitar o interrumpir la lactancia durante el
trat. o no usar el medicamento durante la lactancia.

232-TORASEMIDA
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Sutril, Dilutol, Isodiur, Torasemida (Amp. 10 mg./2 ml. y 20 mg./4
ml.)(Comp. 2,5 o 5 y 10 mg.)
2.- INDICACIONES:
-ICC. -Procesos que retienen lquido corporal. -Hipertensin Arterial. Ascitis.
3.- POSOLOGA:
Adultos: En Edema por ICC. DI. iv. 10-20 mg./24 h. en 2 min. En
Edema por IR. Crnica. DI. iv. 20 mg./24 h. en 2 min. En Edema por
Cirrosis Heptica. DI. iv. 5-10 mg./24 h. en 2 min. En HTA. DI. iv. 2,5-5
mg./24 h. en 2 min. (En todos los casos si no mejora, se puede dar otra
dosis duplicada como Dmx.)
4.- CONTRAINDICACIONES:
Anuria
5.- OBSERVACIONES:
-Es un Diurtico de asa. -Ventajas con respecto a la Furosemida:
Elimina menos K+. -En Embarazo: Categora B -En Lactancia: Usar con
precaucin -En Pediatra: No debe utilizarse en menores de 18 aos. Se puede diluir la dosis en SSF.

233-TRAMADOL
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Adolonta. Tralgiol. Zaldiar. Zytram. Tramadol. (Amp. 100 mg./2 ml. (1
ml.=50 mg.)) (Comp. 50, 100, 150, 200 mg.) (Sol. got. 100 mg./ml.)
2.- INDICACIONES:
-Dolor agudo o crnico, de moderado a intenso. -Dolor de intensidad
severa asociado a AINES
3.- POSOLOGA:
Adultos: DI: iv. im. 100 mg. (Preparacin: DI. iv. 1 mg. en SSF. hasta
100 ml en 2-3 min.) Durante la primera hora despus de la DI. se
pueden dar dosis complementarias de 50 mg. cada 10 a 20 min. sin
superar en total con la DI. 250 mg. Despus se puede repetir 50
mg./4-6 h. hasta Dmx. 400 mg./da)
Peditrica en nios >1 ao, DI: iv im. sc. 1-2 mg./kg. (Preparacin:
DI. iv. en SSF. hasta 100 ml en 15 min.) Se puede repetir cada 6-8 h.
Dmx: 8 mg./kg./da. (no superando los 400 mg.)
4.- CONTRAINDICACIONES:
-Depresin Respiratoria. -EPOC grave -Precauciones en: Ancianos.
Epilepsia. Convulsiones. Shock Hipertensin. Arritmias. Aumento de
presin intracraneal. TCE. Hipotiroidismo. Asma. Intoxicacin etlica.
5.- OBSERVACIONES:
-En Embarazo: Categora C. -En Lactancia: se excrecin en la leche, Se
recomienda evitar. -En IR. e Insuf. Heptica: No est recomendado o
Reducir dosis. -Antdoto: Naloxona. -Si convulsiones Diazepam.

GUA FARMACOLGICA

234-TRANEXAMICO, CIDO
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Amchafibrin, (Amp. 500 mg./5 ml. (1 ml.=100 mg.)) (Comp. 500 mg.)
2.- INDICACIONES:
-Hemorragia asociada a hiperfibrinolisis. -Sangrado excesivo uterino. Hemorragia subaracnoidea. -Hemorragia por sobredosis con
fibrinolticos. Epixtasis. -Gingivorragias
3.- POSOLOGA:
-Adultos: DI: iv. 10-15 mg./kg./8 h. 0,1-0,15 ml./kg. a 1 ml./min. o
DI: Infu. iv. (Preparacin: DI. en SSF. SG. hasta 100 ml. a 100-200
ml./h.)
-Peditrica: en nios >1 ao. DI: iv. lenta 6,6 mg./kg./8 h. 20
mg./kg./da (Preparacin: Diluir 2 ml. o 200 mg. en SSF. SG. hasta 10
ml. (20 mg./ml.) dar 0,33 ml./kg./8 h. a una velocidad de 60 ml./h.
4.- CONTRAINDICACIONES:
-CID. -Antecedentes Tromboembolismo. -Adenocarcinoma Mucinoso.
-Hemorragia del tracto urinario superior
5.- OBSERVACIONES:
-No administrar mezclado con sangre o con soluciones para infusin
que contengan penicilina. -Mantener en un lugar fresco el
medicamento, alejado de la luz directa y de fuentes de calor. En
Embarazo: Categora B. Sopesar riesgo/beneficio. En Lactancia: Se
recomienda con precaucin.

235-TRIMETAFAN
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Arfonad (Vial 50 mg./ml.; 500 mg./ml.; 250 mg./5 ml.)
2.- INDICACIONES:
-Control de la presin sangunea en pacientes con Aneurisma
Disecante de Aorta agudo. -Alternativa en pacientes resistentes al
nitroprusiato. -Fallo ventricular izquierdo agudo. -Encefalopata
hipertensiva. -Hemorragia intracraneal. -Control de la hipotensin en
ciruga. -Control de corta duraccin de la presin sanguena en
emergencias hipertensivas. -Trat de emergencia del edema pulmonar
en pacientes con hipertensin pulmonar asociada con hipertensin
sistmica.
3.- POSOLOGA:
-Adultos: DI: iv. 0,5-20 mg. (Preparacin: 250 mg. en SSF. SG. hasta
250 ml. (1 mg./ml.) Extraer de 0,5 a 20 ml. a 1 ml./1 min. Con el resto
de la disolucin seguir con DM: Infu. iv. 0,5-6 mg./min. 30 a 360
ml./h. parando si ha mejorado la clnica.)
-Peditrica: DI: iv. 50-150 mcg./min. (Preparacin: 250 mg. en SSF.
SG. hasta 250 ml. (1 mg./1 ml.) a 3-9 ml./h.)
4.- CONTRAINDICACIONES:
-Hipersensibilidad a la histamina. Insuf. respiratoria. -Asma. -Enfer.
Coronaria. -IAM reciente. -Arterioesclerosis. -Hipovolemia. -Shock. Anemia. Enfer. Addison. -Diabetes. -Glaucoma. Enfer. degenerativas
del SNC. Insuf. Cerebrovascular. -Hipertrofia Prosttica. -Estenosis
pilrica. Enfer. heptica. Insuf. renal. -Pielonefritis Crnica. Estenosis uretral. -Obstruccin vesical.
5.- OBSERVACIONES:
-Conservar en frigorfico. -En Embarazo: Categora D Riesgo fetal. En
casos graves puede ser aceptado su uso. En Lactancia: Se
desaconseja la lactancia.

236-URAPIDIL, Clorhidrato
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Elgadil. (Amp 50 mg./10 ml. (1 ml.=5 mg.))
2.- INDICACIONES:
-Crisis Hipertensivas. -Hipertensin arterial en los perodos peri y postoperatorio, especialmente en neurociruga y ciruga cardaca en
adultos y nios. -Proteccin peri-operatoria contra incrementos
tensionales provocados por maniobras indispensables en el curso de
la anestesia (intubacin, extubacin, etc.).
3.- POSOLOGA:
Adultos: DI: iv. 25 mg. 5 ml. en 20 seg. si no se reduce la TA lo
suficiente a los 5 min., se administran otros 25 mg. 5 ml. en 20 seg.
si sigue sin reducirse la TA a los 5 min., se administra una 3 dosis de
50 mg. 10 ml. en 20 seg. Dmx.: 100 mg. Si responde a cualquiera

963

URGENCIAS Y EMERGENCIAS EXTRAHOSPITALARIAS GUETS - SESCAM

de las dosis anteriores, se sigue inmediatamente con DM: Infu. iv. 930 mg./h. (Preparacin: 100 mg. (2 Amp.) en SSF. hasta 100 ml. (1
mg./ml.) a 9-30 ml./h.)
-Peditrica: sobre todo en Perioperatorios: DI: Infu. iv. 2 mg./kg./h.
(Preparacin: 100 mg. 2 Amp. en SSF. hasta 100 ml. (1 mg./ml.) dar
a 2 ml./kg./h. hasta que se reduzca la TA, si lo hace se pasa a DM: Infu.
iv. 0,8 mg./Kg./h. (Preparacin: con la dilucin anterior para DI, se
pasa a 0,8 ml./kg./h.)
4.- CONTRAINDICACIONES:
-Estenosis Artica. -Shunt arteriovenoso, Alergia al medicamento.
5.- OBSERVACIONES:
-Se recomienda usar la va central. -En Embarazo: Categora B. Slo
utilizar si es estritamente necesario -En Lactancia: se recomienda no
utilizarlo por desconocer si pasa a leche materna. -Antdoto: No existe
un antdoto especfico. En caso preciso, de gran hipotensin, dar
Adrenalina.

237-VALPROICO, CIDO
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Depakine. Milzone. (Amp. 400 mg./4 ml.; 300 mg./3 ml. (1 ml.=100
mg.) (Comp. 200 y 500 mg.) (Sol. 200 mg./ml.)
2.- INDICACIONES:
-Crisis epilpticas. -Ausencias y Mioclnias. -Epilepsias generalizadas o
parciales. -Convulsiones febriles en la infancia. -Tics infantiles.
3.- POSOLOGA:
-Adultos: DI: iv. 15-20 mg./kg. 0,15-0,2 ml./kg. en 3-5 min., a los 30
min. dar DM: Infu. Iv. 1 mg./kg./h. (Preparacin: 400 mg. o 4 ml. en
SG. hasta 100 ml. (4 mg./1 ml.) a 0,25 ml./kg./h.) Dmx: 25
mg./kg./da (Si el paciente tomaba Acido Valproico previamente vo.
pasar directamente a DM.)
-Peditrica: En nios de 28 das a 11 aos. DI: iv. 20-30 mg./kg. 0,20,3 ml./kg. en 5 min. En nios de 12 a 18 aos: DI: iv. 15-20 mg./kg.
0,15-0,2 ml./kg. en 5 min. Dmx: 800 mg. a los 30 min. dar En Nios y
Adolescentes: DM: Infu. iv. 1 mg./kg./h. (Preparacin: 400 mg. o 4 ml.
en SG. hasta 100 ml. (4 mg./1 ml.) a 0,25 ml./kg./h.) Dmx: 25
mg./kg/da. En Neonatos: DM: Inf. Iv. 0,3-0,5 mg./kg./h (Preparacin:
400 mg. o 4 ml. en SG. hasta 100 ml. (4 mg./1 ml.) a 0,075-0,125
ml./kg./h.)
4.- CONTRAINDICACIONES:
-Insuf. Heptica. -Hepatitis aguda. -Hepatitis crnica. -Antecedentes
personales o familiares de hepatitis grave, especialmente la
relacionada con frmacos. -Porfiria heptica. -Hepatopata previa o
actual y/o disfuncin actual grave de hgado o pncreas. -Trastornos
del metabolismo de aminocidos ramificados y del ciclo de la urea.
Trastornos graves de la coagulacin. Precauciones: I R. -Lupus
eritematoso sistmico.
5.- OBSERVACIONES:
-No administrar por via im. -En Embarazo: Categora D. Se conoce
incidencia de malformaciones mayores o menores. -Lactancia: La
excrecin en la leche materna es escasa. -Antdoto: No hay antdoto
especfico. Puede ser til la Naloxona. -En Geriatra: Mitad de la dosis
que el adulto.

238-VANCOMICINA
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Vancomicina, Diatracin. (Viales 500 mg. y 1g.) (Caps. 250 mg.)
2.- INDICACIONES:
-Absceso cerebral, -Erisipela, -Meningitis, -Alternativa a alrgicos a
Penicilinas. -Profilaxis quirrgica o en implantacin e prtesis con
riesgo de infeccin por estafilococos resistentes a la meticilina. -En
procedimientos dentales o quirrgicos de otro tipo, -Endocarditis, Septicemia, -Infecciones seas, -Infecciones de las vas respiratorias
inferiores, -Infecciones no complicadas de la piel y tejidos blandos.
3.- POSOLOGA:
-Adultos: DI. iv. 30-50 mg./kg./da. 1 g./12 h. 500 mg./6 h.
(Preparacin: 500 mg. en SSF. SG. en 100 ml. (5 mg./ml.) a 100
ml./h.) En Infecciones por estafilococo del SNC. DI: iv. 60 mg./Kg./24
h.
-Peditrica: En nios >12 aos. DI: iv. igual que en Adultos. En nios
<12 aos hasta >1 mes DI: iv. 10 mg./Kg./6 h. (40 mg./Kg./24 h.) En

964

GUA FARMACOLGICA

bebes de >1 semana hasta 1 mes. DI: iv. 15 mg./kg. para seguir con 10
mg./kg./8 h. En RN. hasta bebes de >1 semana. DI: iv. 15 mg./kg. para
seguir con 10 mg./kg./12 h.
4.- CONTRAINDICACIONES
-Alergia al producto. -Precauciones en: -Ancianos, -IR., -Prdida
auditiva previa.
5.- OBSERVACIONES
-En Embarazo: Categora C. -En Lactancia: Evitar. -Evitar extravasacin
en infus. iv. -Siempre administrar a concentracin <5 mg./ml. y
velocidad <10 mg./min.

239-VASELINA (Petrolato)
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Vaselina Esterilizada o Pura (Crema: 18, 25, y 32 gr.) (Pomada: 5, 12,
20, 30, 33, 60, y 100 gr.)
2.- INDICACIONES:
-Como lubricante en general. -Xerodermia. -Hiperqueratosis. Irritaciones y escoriaciones de la piel. -Eliminacin de costras de la
piel. -Como protector por sus propiedades emolientes (ablanda las
zonas resecas de la piel). -Para tacto rectal, -Colocacin sonda uretral.
3.- POSOLOGA:
-Tpica, aplicar sobre la zona cada 8 h. cada 12 h. -Se puede aplicar
directamente sobre la piel, o sobre un apsito estril.
4.- CONTRAINDICACIONES:
-No aplicar en el rostro del paciente si se va a administrar oxigeno al
paciente (riesgo de quemadura). -Evitar el contacto con los ojos
(aunque hay preparados especiales para la vaselina que pueda estar
en contacto con los ojos). -Evitar en caso de una enfermedad
inflamatoria de la piel, dermatitis inflamatoria.
8.- OBSERVACIONES:
-Mantener en lugar fresco, no hmedos, lejos de fuentes de calor y luz
directa. -En Embarazo: Su uso est generalmente aceptado. -En
Lactancia: No se sabe si pasa a leche materna, pero al no tener
toxicidad, al parecer se puede utilizar.

240-VASOPRESINA
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Pitressin (Amp. 20 UI./ml. = 0,4 mg./ml.)
2.- INDICACIONES:
-En SVA, -Paro Cardiaco, -Hipotensin, -Shock. -Hipotensin refractaria
a catecolaminas. -Hemorragias Gastro Intestinal. -Shock en el Gran
Quemado.
3.- POSOLOGA:
-Adultos: DI. Infu. iv. 0,01-0,15 UI./kg./h. (Preparacin:
Perfusin: 100 UI. 5 ml. en SSF. hasta 100 ml. (1 UI./ml.) a 0,01-0,15
ml./kg./h.) En Shock vasodilatador y Sptico. DI: Infu. iv. 0,04 UI./min.
(Preparacin: 60 UI. 3 ml. en SSF. hasta 100 ml. a 4 ml./h.) En
Diabetes Insipida. DI: sc. im. 5-10 UI. 0,25-0,5 ml. DI: Infu. iv.
0,0005 UI./Kg./h. se duplica cada 30 min. hasta Dmx 0,01 UI./Kg./h. o
provocar anuria. (Preparacin: 20 UI en SSF. hasta 20 ml. (1 UI./ml.).
Seguidamente 1 UI. 1 ml. en SSF hasta 100 ml. (0,01 UI./ml.) a 0,05
ml./kg./h. duplicando dosis cada 30 min. hasta 1 ml./kg./h.). o UI. En
Hemorragia Gastro Intestinal. DI: Infu. iv. 0.2-0.4 UI./min. 12-24
UI./h. 0.012-0.030 U./kg./h. aumentar hasta 0.9 UI./min. 54 UI./h.
o 0.6 UI./Kg./h. En Paro Cardiaco: TV sin pulso y FV (Recomendacin
IIb) DI. iv. bolo nico 40 UI. 2 ml. seguido de 20 ml. de SSF. si no se
reestablece la circulacin repetir la dosis.
-Peditrica: En Hemorragia por varices esofgicas. DI: Infu. iv. 0,0020,005 UI./kg./min. 0,12-0,3 Ui./kg./h. Dmx: 0,01 UI./kg./min. 0,6
UI./kg./h. (Preparacin: 10 UI. en SSF. hasta 100 ml. (0,1 UI./ml.) a 1,23 ml./kg./h. hasta Dmx. 6 ml./kg./h.) En Asistolia, FV y TV sin pulso.
DI: iv. 0,4 UI./kg. (Preparacin: 20 UI. en 10 ml. (2 UI./ml.) dar 0,2
ml./kg.)
4.- CONTRAINDICACIONES:
Precaucin en pacientes con coronariopatas
5.- OBSERVACIONES:
-En Embarazada: Categora C En Lactancia es compatible. Actualmente en estudio y con buenos resultados, como alternativa a
Adrenalina, Noradrenalina y Dopamina. (Otros tipos de Vasopresinas
son: Dermopresina, Terlipresina..)

URGENCIAS Y EMERGENCIAS EXTRAHOSPITALARIAS GUETS - SESCAM

241-VECURONIO, Bromuro
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Norcuron. Vecuronio (Vial liofilizado 4 y 10 mg.)
2.- INDICACIONES:
Relajacin Neuromuscular: -Facilita la IOT y -Ventilacin Mecnica
3.- POSOLOGA:
-Adultos. DI: iv. 0,08-0,1 mg./kg. (Preparacin: 10 mg. en 10 ml. SFF.
(1 ml./1 mg.) pasar 0,08-0,1 ml./kg. En IOT. rpida DI: iv. 0,3 mg./kg.
(Preparacin: 10 mg. en SSF. hasta 10 ml. (1 ml./1 mg.). Seguir a los
25-40 min. con DM. iv. 0,03-0,05 mg./kg. o,03-0,05 ml./kg./15 min.
DM: Infu. iv. 0,03-0,12 mg./kg./h. (Preparacin: 10 mg. en SSF. 100
ml. (0,1 mg./ml.) a 0,3-1,2 ml./kg./h.
-Peditrica: En nios de <4 meses DI: iv 0,01-0,02 mg./kg.
(Preparacin: 4 mg. en SSF. hasta 20 ml. (1 ml./0,2 mg.) dar 0,05-0,1
ml./kg. repetir hasta el efecto deseado.) o hasta Dmx. 0,1 mg./kg. En
nios >4 meses. DI: iv. como adultos
4.- CONTRAINDICACIONES:
-Hipersensibilidad al in de Bromuro. Insuf. heptica severa.
(Precauciones: -Enfer. cardiovascular. -Edad avanzada. -Estados
edematosos. -Enfer. osteomuscular. -Miastenia gravis. -Hipotermia. Obesidad. -Quemados. -Alteracin del pH sanguneo. -Deshidratacin.
Hipopotasemia. -Hipocalcemia. -Hipermagnesemia. -En IR. En Insuf,
Heptica
5.- OBSERVACIONES:
-En Embarazo: Categora C. Disminuir dosis si toma Sulmetn
-En Lactancia: No existen datos. Evitar. -Antdoto: Inhibidor de la
acetilcolinesterasa: Neostigmina, Edrofonio, o Piridostigmina.

242-VERAPAMILO
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Manidn. Redupres, Veratensin. (Comp. 80 120, 180 y 240 mg.) (Amp.
5 mg./2 ml.)
2.- INDICACIONES:
-TSV TSVP, incluso la asociada con vas accesorias de conduccin
(controvertido). -Flutter o FA excepto cuando se asocien a la existencia
de vas accesorias de conduccin.
3.- POSOLOGA:
-Adultos: DI: iv. 5-10 mg. (0,075-0,15 mg./kg. 0,03-0,06 ml./kg.) en
no menos de 2 min. Si no responde, a los 30 min. repetir dosis con 10
mg (0,15 mg./kg. 0,06 ml./kg.).
-Peditrica: En nios <1 ao: DI: iv. 0,1-0,2 mg./Kg. 0,04-0,08 ml/kg.
(Si se prepara: 5 mg. en SSF. hasta 10 ml. (0,5 mg./ml.) se dara 0,2-0,4
ml./kg.) Se puede repetir a los 30 min. En nios 1-15 aos: DI: iv. 0,10,3 mg./Kg. 0,04-0,16 ml./kg. Dmx: 5 mg. 2 ml. Se puede repetir

GUA FARMACOLGICA

a los 30 min. (Si se prepara 5 mg. en SSF. hasta 10 ml. (0,5/ml.) dar
0,2-0,6 ml./kg. y como Dmx: 10 ml.
4.- CONTRAINDICACIONES:
-Hipotensin Severa, -Shock cardiognico. -ICC severa. -TV. -IAM. Bradicardia, -BAV de 2 y 3, Enfer. Seno (excepto si tiene marcapasos
implantado). -Pacientes en trat con Betabloqueantes (riesgo de
asistolia, hipotensin). Flutter o FA que tengan va accesoria de
conduccin. (Sndr. WPW, Sndr. Lown-Ganong-Levine).
5.- OBSERVACIONES:
-En Embarazo: Categora C. -En Lactancia: Pasa a la leche materna,
suspender la lactancia. -Antdoto: til Cloruro Clcico 10% o
Gluconato Clcico 10%. El Calcio mejora ms la PA que la FC. El
Glucagn puede mejorar tanto la PA como la FC as como inducir el
vmito. -Proteger de la luz.

243-VERNAKALANT
1.- NOMBRES COMERCIALES Y PRESENTACIONES:
Brinavess (Vial de 200 mg./10 ml. y 500 mg./25 ml.) (1 ml.=20 mg.)
2.- INDICACIONES:
FA.(de inicio reciente de <7 das) para conversin rpida a ritmo
sinusal y (en Ciruga Cardiaca con FA de <3 das.)
3.- POSOLOGA:
-Adultos. En <113 kg. DI: Infu. iv. 3 mg./Kg. en 10 min. (Preparacin:
400 mg. en SSF. hasta 100 ml. (4 mg./ml.) a 4,5 ml./kg./h. durante 10
min.) En >113 kg. DI: Infu. iv. 339 mg. 87,4 ml. en una solucin de 4
mg./ml. (Preparacin: 400 mg. en SSF. hasta 100 ml. a 520,5 ml./h.
durante 10 min ). Si no revierten a los 15 min. Repetir una 2 dosis En
<113 kg. Infu. iv. 2 mg./kg. 0,1 ml./kg. en 10 min. (Preparacin: 0,1
ml./kg. en SSF. SG. en 100 ml. a 600 ml./h.) 2 dosis En >113 kg.
Infu. iv. 226 mg. 56,5 ml. (Preparacin: 400 mg. en SSF. hasta 100
ml. a 339 ml./h. durante 10 min.)
-Peditrica: No se usa
4.- CONTRAINDICACIONES:
-Estenosis Artica Grave. -Presin Arterial Sistlica <100 mmHg.
Insufic. Cardiaca de clase NYHA III y IV. -Intervalo QT prolongado en la
situacin inicial (> 440 mseg. no corregido). -Bradicardia grave, Disfuncin del Nodo Sinusal o -BAV de 2 y 3, en ausencia de
marcapasos. - SCA dentro de los ltimos 30 das. -Uso de
antiarrtmicos intravenosos para el control del ritmo (clase I y clase III)
dentro de las 4 horas previas a la administracin y en las 4 primeras
horas despus de la misma.
5.- OBSERVACIONES:
-Vigilar al menos cada 15 min. la TA y la Frecuencia Cardiaca. -No
administrar en bolo o inyeccin rpida -En Embarazo: No utilizar. En
Lactncia: No utilizar. - Si se produce la conversin a ritmo sinusal
durante la perfusin inicial o la segunda perfusin, debe continuarse
dicha perfusin hasta su terminacin.

965

URGENCIAS Y EMERGENCIAS EXTRAHOSPITALARIAS GUETS - SESCAM

GUA FARMACOLGICA

INDICE ALFABETICO POR NOMBRE COMERCIAL MEDICAMENTOS

Nombre Comercial
AAS
Acpan
Actilyse
Actocortina
Actrapid
Adalat
Adenocor
Adenoscan
Adiro
Admn
Adolonta
Adoquir
Adrenalina
Agrastat
Agua Albuminosa
Agua Destilada
Agua Esteril para
Inyeccin
Agua Oxigenada
Akineton
Albiomin
Albumina Humana
Albuten
Alcohol 70
Alcohol 96
Aleudrina
Algikey
Algimabo
Aliver
Almidon
Alopresn
Alprostadil
Alprostadilo
Alveofact
Amchafibrin
Amoxiclav
Amoxiplus
Ampicilina
Ampyra
Anagastra
Anectine
Anexate
Angiodrox
Angiomax
Angiox

966

Principio Activo
Acido Acetil Saliclico
Glicopirrolato
Alteplasa (RTPA)
Hidrocortisona
Insulina
Nifedipino
Adenosina Difosfato
Adenosina Difosfato
Acido Acetil Saliclico
(AAS)
Nimodipino
Tramadol
Dexketoprofeno
Adrenalina
Tirofiban
Agua Albuminosa o
Albumina Seca
Suero Agua Destilada o
Esteril
Suero Agua Destilada o
Esteril
Peroxido Hidrgeno o
Agua Oxigenada
Biperideno
Suero Coloide Albmina
Suero Coloide Albmina
Suero Coloide Albmina
Alcohol Etlico o Etanol
Alcohol Etlico o Etanol
Isoproterenol
Ketorolaco
Metamizol, Dipirona
Magnsica
Cimetidina
Almidn
Captopril
Prostaglandina E1
Prostaglandina E1
Surfactante Pulmonar
Porcino
Tranexamico, Acido
Amoxicilina + Acido
Clavulnico
Amoxicilina + Acido
Clavulnico
Ampicilina
4-Aminopiridina
Pantoprazol
Succinil Colina o
Suxametonio
Flumazenilo
Diltiazem
Bivalirudina
Bivalirudina

Refer.
7
102
19
112
115
149
11
11
7
150
233
69
13
231
14
197

Nombre Comercial
Anticholium
Anticude
Antidotum Thalli-Heyl
Antizol
Apo Go Pen
Apocard
Apokinos
Apomorfina Archimedes
Arponad
Argenpal
Artamina
Atenolol
Atepodn
Atropina
Atrovent
Augmentine

197
170
31
202
202
202
16
16
118
120
135
45
17
39
183
183
218
234
22
22
23
1
165
196
98
74
32
32

Axiago
Azul de Metileno
Azul de Prusia
Bactrim

BAL
Bemicin
Benadon
Benerva
Besilato de Atracurio
Inibsa
Betadine
Biocoryl
Blokium
Boxol
Brainal
Bretilate
Brevibloc
Bridion
Brilique
Brinavess
Britapen
Bromuro de Ipratropio
Aldo Unin
Bromuro de Vecuronio
Burnoaid Gel
Buscapina
Buto Air
Buto Asma
Cafinitrina
Calcio Sndoz Suplecal

Principio Activo
Fisostigmina, Salicilato
Edrofonio
HesCianoFerrato Ferrico
Potasio
Fomepizal o 4-MetilPirazol
Apomorfina
Flecainida, Acetato
Apomorfina
Apomorfina
Trimetafan
Nitrato Plata
Penicilamina o DPenicilamina
Atenolol
Adenosina Trifosfato
Atropina
Ipratropio, Bromuro
Amoxicilina + Acido
Clavulnico
Esomeprazol
Metiltionina, Cloruro
HesCianoFerrato Ferrico
Potasio
Cotrimoxazol
(Sulfametoxazol +
Trimetoprima)
Dimercaprol
Pancuronio
Piridoxina o Vitamina B6
Tiamina o Vit. B1
Atracurio, Besilato

Refer.
95
81
108
99
26
97
26
26
235
151
168
27
12
30
117
22
87
138
108
62

76
164
173
224
29

Povidona Iodada
Procainamida
Atenolol
Deltaparina Sdica
Nimodipino
Bretilio
Esmolol
Sugammadex
Ticagrelor
Vernakalant
Ampicilina
Ipratropio, Bromuro

176
179
27
63
150
33
86
215
226
243
23
117

Vecuronio
Agua Gel
Butil-Escopolamina
Salbutamol
Salbutamol
Nitroglicerina
Calcio, Gluconato

241
15
35
191
191
154
38

URGENCIAS Y EMERGENCIAS EXTRAHOSPITALARIAS GUETS - SESCAM

Nombre Comercial
Calciteracemato Disdico
Capotn
Caproamin
Captopril
Carbn Ultra Absorbente
Lainco
Cardiser
Carvediol
Catapresan
Cebion
Ceftriaxona
Celox
Ceraxon
Cespln
Chalet
Citrovit
Clexane
Clindamicina
Clinwas
Clirio Llorens Midriatico
Cloretilo Cheminosa
Clorhexidina
Cloruro Amnico 1/6 M
Cloruro Calcio Braun
Cloruro Potsico
Colircuri Fluotest
Colircusi Anestsico
Colircusi Anestsico Doble
Colircusi Fluoresceina
Colircusi Pilocarpina
Colirio Oculos Pilocarpina
Comital
Complecal
Contrathion
Coralen
Cordilan
Coropres
Corosurf
Corotrope
Coslan
Cristalmina
Cupriden
Curadona
Curaf
Cuvelfilm
CyanoKit
Dalacin
Dalfampridina
Dantralen
Dantrium
Dantroleno

Principio Activo
Calcio Edetato Sdico
(EDTA)
Captopril
Acido Aminocaprico
Captopril
Carbn Activado

Refer.
37
39
8
39
40

Nombre Comercial
Decadran
Decipar
Depakine
Deratin
Desferal
Desfern

Diltiazem
Carvelidol
Clonidina
Acido Ascrbico (Vit. C)
Ceftrixona
Chitoxan
Citicolina
Captopril
Nimodipino
Acido Ascrbico (Vit. C)
Enoxaparina Sdica
Clindamicina
Clindamicina
Colirio Midritico
Cloruro Etilo
Clorhexidina
Suero Amnico
Calcio, Cloruro
Potasio, Cloruro
Colirio Fluoresceina
Colirio Anestsico Doble
Colirio Anestsico Doble
Colirio Fluoresceina
Colirio Mitico
Colirio Mitico
Fenobarbital
Calcio Edetato Sdico
(EDTA)
Pralidoxima
Ranitidina
Nifedipino
Carvelidol
Surfactante Pulmonar
Porcino
Milrinona
Mefenmico, cido
Clorhexidina
Penicilamina o DPenicilamina
Povidona Iodada
Clorhexidina
Clorhexidina
Hidroxivobalamina o
Vitamina B12
Clindamicina
4-Aminopiridina
Dantroleno
Dantroleno
Dantroleno

74
42
52
9
43
44
48
39
150
9
85
49
49
60
57
55
198
36
175
59
58
58
59
61
61
92
37
177
185
149
42
218
143
131
55
168
176
55
55
113
49
1
64
64
64

Desmopresin
Deviprost
Diatracn
Diazepam
Diclofenado
Digibind
Digoxin Immune Fab
Digoxina
Digton
Dilabar
Dilatrans
Dilatrend
Dilcor
Diltiwas
Dilutol
Dimaval

Dimercaprol
Dinisor
Dipheterine
Diprivan
Distraneurine
Dobucor
Dobutrex
Dogmatil
Dolantina
Dolotrn
Dopamina
Dormicum
Droal
Droperidol
Efedrina
Efient
Elgadil
Elohes
Enantyum
Entonox
Epanutin
Epilantin
Esmeron
Esomeprazol
Esoz
Etomidato Lipuro
Eufilina

GUA FARMACOLGICA
Principio Activo
Refer.
Dexametaxona
67
Enoxaparina Sdica
85
Valproico, Acido
237
Clorhexidina
55
Desferroxamina
65
(Mesilato)
Desferroxamina
65
(Mesilato)
Vasopresina
240
Carboprost
41
Vancomicina
238
Diazepam
70
Diclofenado
72
Anticuerpos AntiDigoxina
25
Anticuerpos AntiDigoxina
25
Digoxina
73
Sulpirida
217
Captopril
39
Carvelidol
42
Carvelidol
42
Nifedipino
149
Diltiazem
74
Torasemida
232
5
Acido 2,3
Dimercaptopropanilsulf
nico (DMPS)
Dimercaprol
76
Diltiazem
74
Diphoterine
78
Propofol
182
Clometiazol
50
Dobutamina
79
Dobutamina
79
Sulpirida
217
Meperidina o Petidina
132
Diclofenado
72
Dopamina
80
Midazolam
142
Ketorolaco
120
Dehidrobenzilperidol
66
Efedrina
83
Plasugrel
178
Urapidil
236
Suero Coloide Almidn o
203
Hidroxietil-Almidon
Dexketoprofeno
69
Oxido Nitroso
161
Fenitoina o
91
DifenilHidantona
Fenobarbital
92
Rocuronio
190
Esomeprazol
87
Esomeprazol
87
Etomidato
89
Aminofilina o Teofilina
20
Monohidrato

967

URGENCIAS Y EMERGENCIAS EXTRAHOSPITALARIAS GUETS - SESCAM

Nombre Comercial
Principio Activo
Refer.
Evacuante Bohm, Solucin Polietilenglicol
174
Expafusin
Suero Coloide Almidn o
203
Hidroxietil-Almidon
Fab-Antidigoxina
Anticuerpos AntiDigoxina
25
Fampridina
4-Aminopiridina
1
Fampyra
4-Aminopiridina
1
Fenistil
Dimentindeno o
75
Dimepirindeno
Fentanest
Fentanilo Citrato
93
Finetoina
Fenitoina o
91
DifenilHidantona
Fixa
Ondansetrom
160
Flammazine
Sulfadiazina Argntica
216
Fluimucil
Acetilcisteina (N3
Acetilcistena)
Fluoresceina Oculos
Colirio Fluoresceina
59
Folidan
Acido Folnico (Folinato
10
Clcico)
Folinato Clcico
Acido Folnico (Folinato
10
Clcico)
Fomepizol
Fomepizal o 4-Metil99
Pirazol
Foradil
Formoterol
100
Formoterol
Formoterol
100
Fortecortin
Dexametaxona
67
Fragmin
Deltaparina Sdica
63
Fraxiparina
Nadroparina
146
Gardenal
Fenobarbital
92
Gelafundina
Suero Coloide de
205
Gelatina Succinilada
Gletop
Esomeprazol
87
Glucagn-gen Hypokit
Glucagn
103
Novo Nordik
Glucosmon
Glucosa
104
Glypressin
Terlipresina
223
Gobemicina
Ampicilina
23
Gratusminal
Fenobarbital
92
Guastil
Sulpirida
217
Haloperidol
Haloperidol
105
Heliox
Heliox
106
Helmine
Ondansetrom
160
Hemobate
Carboprost
41
Hemohes
Suero Coloide Almidn o
203
Hidroxietil-Almidon
Heparina Leo
Heparina Sdica
107
Heparina Rovi
Heparina Sdica
107
Hes Grifols
Suero Coloide Almidn o
203
Hidroxietil-Almidon
Hexadimetrina
Hexadimetrina o
109
Polibreno
Hibimax
Clorhexidina
55
Hidroatesona
Hidrocortisona
112
Hidrocloruro de
Fenilefrina
90
Fenilefrina Genfarma
Humulina Regular
Insulina
115
Hydrapres
Hidralazina
111
Hyperstat
Diazxido
71
Hypnomidate
Etomidato
89

968

Nombre Comercial
Idalprem
Idasal
Imipenem/Cukastatina
Indukern
Infasurt
Inocor
Inyesprin
Ipradol
Iscover
Isodiur
Isoptocarpina
Ivovol
Jarabe Ipecacuana
Kabikinase
Kalinox
Kalten
Kedato
Kelocyanor
Kenesi
Keppra
Ketesse
Ketolar
Konakion
Lacerol
Lanacordn
Largactil
Lasan
Laurak
Lebopride
Legaln
Levetiracetam Stada
Levofloxacino
Levopen
Lidocaina iv
Lopresor
Lorazepam
Losec
Lubricante K-Y Jely
Lubricante Urolgico
Organn
Luminal
Luminaletas
Macrodex
Manidon
Manitol
Masdil
Meinsol
Meinsol
Menalmina

GUA FARMACOLGICA
Principio Activo
Lorazepam
Metoxamina o 2,5Dimetoxinorefedrina
Imipenem
Dexametaxona
Surfactante Pulmonar
Porcino
Amrinona
Acetil Salicilato de Lisina
Hexoprenalina, Sulfato
Clopidogrel
Torasemida
Colirio Mitico
Propofol
Ipecacuana
Estreptoquinasa
Oxido Nitroso
Atenolol
Calcio Edetato Sdico
(EDTA)
EDTA Dicobltico
Nimodipino
Levetiracetam
Dexketoprofeno
Ketamina
Fitomenadiona o
Vitamina K
Diltiazem
Digoxina
Clorpromazina
Metamizol, Dipirona
Magnsica
Atracurio, Besilato
Sulpirida
Silibinina o Silimarina
Levetiracetam
Levofloxacino
Noradrenalina o
Norepinefrina
Lidocana
Metoprolol
Lorazepam
Omeprazol
Lubricante Hidrosoluble,
HidrosietilCelulosa
Lubricante Anestsico,
Tetracana Clorhidrato
Fenobarbital
Fenobarbital
Suero Coloide Dextrano
Verapamilo
Suero Manitol
Diltiazem
Potasio, Cloruro
Suero Manitol
Clorhexidina

Refer.
127
141
114
67
218
24
4
110
53
232
61
182
116
88
161
27
37
82
150
122
69
119
96
74
73
56
135
29
217
193
122
123
156
126
140
127
159
128
129
92
92
204
242
209
74
175
209
55

URGENCIAS Y EMERGENCIAS EXTRAHOSPITALARIAS GUETS - SESCAM

Nombre Comercial
Mepivacana
Meronem
Meropenen
Merozen
Mestinn
Metalyse
Metamizol Normon

Principio Activo
Mepivacana, Clohidrato
Meropenen
Meropenen
Meropenen
Piridostigmina
Tenecteplasa
Metamizol, Dipirona
Magnsica
Methergin
Metilergometrina,
Maleato
Midax
Olanzapina
Midazolam Rovi
Midazolam
Miflonide
Budesonida
Minurin
Vasopresina
Mioflex
Succinil Colina o
Suxametonio
Miol
Omeprazol
Mivacrom
Mivacurio
Mizone
Valproico, Acido
Modus
Nimodipino
Mopral
Omeprazol
Morfina
Morfina, Clorhidrato
Naetenol
Atenolol
Naloxone
Naloxona
Nefidipina
Nifedipino
Neomelubrina
Metamizol, Dipirona
Magnsica
Neosidantoina
Fenitoina o
DifenilHidantona
Neostigmina
Neostigmina
Nexium
Esomeprazol
Nimbex
Cisatracurio
Nimodipina
Nimodipino
Nimotop
Nimodipino
Nitrito Amilo
Nitrito Amilo
Nitrito Sdico
Nitrito Sdico
Nitroprussiat
Nitroprusiato Sdico
Nolotil
Metamizol, Dipirona
Magnsica
Noradrenalina
Noradrenalina o
Norepinefrina
Norages
Noradrenalina o
Norepinefrina
Norcuron
Vecuronio
Novopulm Novlizer
Budesonida
Nucynta
Tapentadol
Nuvapen
Ampicilina
Octreotida
Sandostatina u
Octreotida
Olfex Bucal
Budesonida
Olzapin
Olanzapina
Omapen
Omeprazol
Orfidal
Lorazepam
Osmofundina
Suero Manitol
Oxigeno Medicinal Lquido Oxgeno
Palacimol
Carvelidol
Palexia
Tapentadol

Refer.
133
134
134
134
172
221
135

Nombre Comercial
Pancuron
Pancuronio
Pantocarm
Pantoprazol
Paral
Paraldehido
Pavuln
Penicilamina

136
158
142
34
240
196
159
144
237
150
159
145
27
147
149
135
91
148
87
47
150
150
152
153
155
135
156
156
241
34
219
23
192
34
158
159
127
209
162
42
219

Penilevel
Penthotal
Perfalgan
Periactin
Pertensal
Pilocarpina Llorens
Piperacilina/Tazobactam
Pipril
Pitressin
Plavix
Plumier
Polaramine
Polybrene
Potasion
Povidona Yodada
Pre-par
Prepidil
Primperan
Pro-efferelgan
Propess
Propofol Abbott
Prostaglandina E2
Prostigmine
Prostin
Prostinfenem
Protamina
Psilocen
Pulmicort
Pulmictan
Pyrsal
Quiralam
Ranitidina
Rapilysin
Recephin
Recofol
Redoxon
Redupres
Regitine
Remifentanil
Remontal
Renitec

GUA FARMACOLGICA
Principio Activo
Refer.
Pancuronio
164
Pancuronio
164
Pantoprazol
165
Pantoprazol
165
Paraldehido
167
Paraldehido
167
Pancuronio
164
Penicilamina o D168
Penicilamina
Penicilina G Sdica
169
Tiopental Sdico
229
Paracetamol
166
Ciprohetadina
46
Nifedipino
149
Colirio Mitico
61
Tazobactan
220
Piperacilina o Piperazilina
171
Vasopresina
240
Clopidogrel
53
Pancuronio
164
Dexclorfeniramina,
68
Maleato
Hexadimetrina o
109
Polibreno
Potasio, Cloruro
175
Povidona Iodada
176
Ritodrina
189
Dinoprostona o
77
Prostaglandina E2
Metoclopramida,
139
Clorhidrato
Paracetamol
166
Dinoprostona o
77
Prostaglandina E2
Propofol
182
Dinoprostona o
77
Prostaglandina E2
Neostigmina
148
Carboprost
41
Carboprost
41
Protamina
184
Sulpirida
217
Budesonida
34
Budesonida
34
Dexketoprofeno
69
Dexketoprofeno
69
Ranitidina
185
Reteplasa
187
Ceftrixona
43
Propofol
182
Acido Ascrbico (Vit. C)
9
Verapamilo
242
Fentolamina
94
Remifentanil
186
Nimodipino
150
Enalapril o Enalprilato
84

969

URGENCIAS Y EMERGENCIAS EXTRAHOSPITALARIAS GUETS - SESCAM

Nombre Comercial
Rexapin
Rheomadrodex
Ribujet
Rivotril
Robinul
Rocefalin
Rostemeop
Rytmonorm
Salbutamol
Salidur
Sandostatina
Scandinibsa
Seguril
Selarine
Seloken
Septisan
Septra

Septrn

Sereprid
Setesolid
Silimarina Mdical
Silimaz
Silvederma
Simdax
Sinergina
Sinogan
Sintrom
Solinitrina
Soltrim

Solu-Modern
Solusprin
Somanal
Somatostatin
Somatostatina
Somazina
Steptase
Succimer
Suero Antibotulnico
A+B+C
Suero Antiofdico Viperfav
Suero Bicarbonato Sdico
Suero Botulismus Atitoxin
Benring
Suero Fisiolgico
Suero Glucosado 10, 20 y
40%
Suero Glucosado 5%

970

Principio Activo
Olanzapina
Suero Coloide Dextrano
Budesonida
Clonazepam
Glicopirrolato
Ceftrixona
Meropenen
Propafenona
Salbutamol
Furosemida
Sandostatina u
Octreotida
Mepivacana, Clohidrato
Furosemida
Silibinina o Silimarina
Metoprolol
Clorhexidina
Cotrimoxazol
(Sulfametoxazol +
Trimetoprima)
Cotrimoxazol
(Sulfametoxazol +
Trimetoprima)
Tiaprida
Diazepam
Silibinina o Silimarina
Silibinina o Silimarina
Sulfadiazina Argntica
Levosimendan
Fenitoina o
DifenilHidantona
Levomepromazina
Acenocumarol
Nitroglicerina
Cotrimoxazol
(Sulfametoxazol +
Trimetoprima)
Metilprednisolona
Acido Acetil Saliclico
(AAS)
Somatostatina
Somatostatina
Somatostatina
Citicolina
Estreptoquinasa
Acido 2,3 Dimercapto
succinico (DMSA)
Suero Antibotulnco

Refer.
158
204
34
51
102
43
134
180
191
101
192
133
101
193
140
55
62

62

225
70
193
193
216
125
91
124
2
154
62

137
7
194
194
194
48
88
6
199

Suero Antiofdico
Suero Bicarbonatado
Suero Antibotulnco

200
201
199

Suero Salino Fisiolgico

Suero Glucosado
Hipertnico > 10%
Suero Glucosado 5%

211
207
206

Nombre Comercial
Suero Glucosalino Brauns
Suero Lavado Irrigacin
Baxter
Suero Rescueflow
Suero Ringer Lactato
Suero Salino Fisiolgico al
0,45%
Suero Salino Hipertnico
Suero Venofusin
Sugarbil
Sugiran
Suky Gel Lubricante
Hidrosoluble
Sulmetn Papaverina
Sulmetin Simple
Sumial
Surfaxuk
Survanta
Sutril
Syntocinn
Tagamet
Tambocor
Tanser
Tasovak
Tavanic
Tazocin
Tenoretic
Tenormin
Tensiln
Tensoprel
Tepavil
Terbasmin
Tiaprida
Tiaprizal
Ticlodone
Tienam
Tierra de Fuller Ici-Zeltia
Tiklid
Tiobarbital
Tiosulfato Sdico
Topionic
Toradol
Torasemida
Toriol
Toxogonn
Tracrium
Tractocile
Tralgiol
Tramadol
Trandate
Trangorex
Trankimazin

GUA FARMACOLGICA
Principio Activo
Suero Glucosalino
Suero Salino Fisiolgico
Irrigacin
Suero Salino Hipertnico
Suero Ringer Lactato
Suero Salino Hiposdico

Refer.
208
212

Suero Salino Hipertnico

Suero Bicarbonatado
Sorbitol o Glucitol
Prostaglandina E1
Lubricante Hidrosoluble,
HidrosietilCelulosa
Magnesio, Sulfato
Magnesio, Sulfato
Propranolol
Surfactante Pulmonar
Porcino
Surfactante Pulmonar
Porcino
Torasemida
Oxitocina
Cimetidina
Flecainida, Acetato
Atenolol
Tazobactan
Levofloxacino
Tazobactan
Atenolol
Atenolol
Edrofonio
Captopril
Sulpirida
Terbutalina
Tiaprida
Tiaprida
Ticlopidina
Imipenem
Tierra de Fuller, Tierra de
Jardn
Ticlopidina
Tiopental Sdico
Tiosulfato Sdico
Povidona Iodada
Ketorolaco
Torasemida
Ranitidina
Obidoxima o Obiodoxina
o Oxiomas
Atracurio, Besilato
Atosiban
Tramadol
Tramadol
Labetalol
Amiodarona
Alprazolam

213
201
195
183
128

213
210
214

130
130
181
218
218
232
163
45
97
27
220
123
220
27
27
81
39
217
222
225
225
227
114
228
227
229
230
176
120
232
185
157
29
28
233
233
121
21
18

URGENCIAS Y EMERGENCIAS EXTRAHOSPITALARIAS GUETS - SESCAM

Nombre Comercial
Tranxilium
Tromalyt
Ultiva
Unithiol

Urbasn
Valium
Vancomicina
Variquel
Vaselina Esterilizada
Vaselina Pura
Vasomax
Vasoxyl
Ventilastn
Ventolin
Veratensin
Vernies
Vilona

Principio Activo
Cloracepato Dipotsico
Acido Acetil Saliclico
(AAS)
Remifentanil
Acido 2,3
Dimercaptopropanilsulf
nico (DMPS)
Metilprednisolona
Diazepam
Vancomicina
Terlipresina
Vaselina (Petrolato)
Vaselina (Petrolato)
Fentolamina
Metoxamina o 2,5Dimetoxinorefedrina
Salbutamol
Salbutamol
Verapamilo
Nitroglicerina
Ribavirina

Refer.
54
7
186
5

137
70
238
223
239
239
94
141
191
191
242
154
188

Nombre Comercial
Virazide
Vitamina C
Viternum
Voltarn
Voluven
Water-Jet
Wincoram
Xilonibsa
Ximolix
Yantil
Yatrox
Zalasta
Zaldiar
Zantac
Zeropenem
Zofrn
Zolafren
Zyprexa
Zytram

GUA FARMACOLGICA
Principio Activo
Ribavirina
Acido Ascrbico (Vit. C)
Ciprohetadina
Diclofenado
Suero Coloide Almidn o
Hidroxietil-Almidon
Agua Gel
Amrinona
Lidocana
Droperidol
Tapentadol
Ondansetrom
Olanzapina
Tramadol
Ranitidina
Meropenen
Ondansetrom
Olanzapina
Olanzapina
Tramadol

Refer.
188
9
46
72
203
15
24
126
66
219
160
158
233
185
134
160
158
158
233

971

URGENCIAS Y EMERGENCIAS EXTRAHOSPITALARIAS GUETS - SESCAM

GUA FARMACOLGICA

INDICE ALFABETICO POR PROCESOS CLINICOS

El motivo de que se repiten varias veces el mismo proceso clnico, Es porque se pueden utilizar varios medicamentos para
un mismo proceso. Y como siempre el n de Ref. (Slo hay 243 nmeros de Referencia y por tanto 243 Principios Activos),
es el que nos sirve para buscar los medicamentos ya desarrollados anteriormente a texto completo.
Patologa

Principio Activo

Aborto (Uterotnico)

Absceso Cerebral

Dinoprostona o
Prostaglandina E2
Amoxicilina + Acido
Clavulnico
Piperacilina o Piperazilina

171

Absceso Cerebral

Vancomicina

238

Absceso Dental con

Celulitis Diseminada
Accidentes
Transfusionales
Acidificacin Orina

Amoxicilina + Acido
Clavulnico
Suero Manitol
Acido Ascrbico (Vit. C)

Acidosis Gstrica

Cimetidina

Acidosis Metablica por

Cetoacidosis
Acidosis Metablica por
Insuficiencia Renal
Acidosis Metablica por
Shock
Acidosis Respiratoria
Grave
Aftas Bucales

Suero Bicarbonatado

201

Suero Bicarbonatado

201

Suero Bicarbonatado

201

Suero Bicarbonatado

201

Aborto Sptico

Ref.
77
22

Patologa

Principio Activo

Alcalosis Metablica
Hipoclormica por
Vmitos
Alcalosis Metablica
Pura
Alergia

Suero Amnico

Ref.
198

Suero Amnico

198

Ciprohetadina

46
75

22

Alergia, Reaccin Aguda

209

Alergia, Reaccion Grave

Dimentindeno o
Dimepirindeno
Hidrocortisona

Alergia, Reaccin Grave

Dexametaxona

67

Alergia, Reaccin por

Suero Hemoc y Plasma,
Profilaxis
Alergia, Urticaria

Dimentindeno o
Dimepirindeno

75

Dexclorfeniramina,
Maleato
Suero Glucosado 5%

68
206

Suero Glucosado 5%

206

Suero Glucosado 5%

206

9
45

Alimentacin Parenteral
Alteracin Metabolismo
Carbohidratos
Alteracin pH

Agitacin Psicomotriz

Clometiazol

50

Alteracin Sueo
Anciano
Anafilaxia

Agitacin Psicomotriz

Cloracepato Dipotsico

54

Anafilaxia

Agitacin Psicomotriz

Clorpromazina

56

Anafilaxia

Metilprednisolona

137

Agitacin Psicomotriz

Dehidrobenzilperidol

66

Anafilaxia, Coadyuvante

68

Agitacin Psicomotriz

Haloperidol

105

Agitacin Psicomotriz

Levomepromazina

124

Dexclorfeniramina,
Maleato
Ciprohetadina

Agitacin Psicomotriz

Olanzapina

158

Agitacin Psicomotriz

Sulpirida

217

Agitacin Psicomotrz en
Abstinencia Alcohol
Agitacin Psicomotrz en
Alcoholismo Crnico
Agitacin Psicomotriz en
Delirium Tremens
Agitacin Psicomotrz en
Demencia
Agitacin Psicomotrz en
Demencia
Agitacin Psicomotriz en
Mania
Agitacin Psicomotrz en
Nios
Agranulocitosis

Paraldehido

167

Lorazepam

127

Alcalosis leve por

Estenosis Pilrica
Alcalosis leve por
Medicacin
Alcalosis leve por
Obstrucciones
Intestinalesa Altas

972

Nitrato Plata

151

Haloperidol

105

Haloperidol

105

Tiaprida

225

Haloperidol

105

Tiaprida

225

Piridoxina o Vitamina B6

173

Suero Salino Fisiolgico

211

Suero Salino Fisiolgico

211

Suero Salino Fisiolgico

211

Anafilaxia, Reaccin

Clometiazol

112

50

Dexametaxona

67

Hidrocortisona

112

Anemia Hipocrmica por Piridoxina o Vitamina B6

falta de Pifidoxina
Anemia Megaloblstica
Acido Folnico (Folinato
Clcico)
Anestesia
Oxido Nitroso

46
173
10
161

Anestesia en Asmticos

Ketamina

119

Anestesia en
Broncoespasmo
Refractario Grave
Anestesia en Ciruga
Dental
Anestesia en Ciruga
Menor
Anestesia en Ciruga
Menor Ginecolgica
Anestesia en Ciruga
Menor Ortopdica
Anestesia en Grandes
Quemados
Anestesia en pacientes
hemodinamicamente
inestables
Anestesia en
Politraumatizados
Atrapados

Ketamina

119

Ketamina

119

Ketamina

119

Ketamina

119

Ketamina

119

Ketamina

119

Ketamina

119

Ketamina

119

URGENCIAS Y EMERGENCIAS EXTRAHOSPITALARIAS GUETS - SESCAM

Patologa

Principio Activo

Anestesia en
Quemaduras
Desbridamiento
Anestesia General
Alternativa a la sedacin
con Propofol
Anestesia General
Coadyuvante Analgsico
Anestesia General
Coadyuvante Inhibicin
Hipersecrecin
Mucosidad
Anestesia General
Coadyuvante
Miorelajante Muscular
Anestesia General
Coadyuvante Sedacin,
induccin,
Mantenimiento
Anestesia General
Induccin
Anestesia General Nios,
Coadyuvante con
Ketamina
Anestesia General,
Coadyuvante,
premediacacin
Anestesia General, como
Coadyuvante
Anestsia General,
Induccin
Anestesia General,
induccin rpida
Anestesia General,
Induccin,
Mantenimiento
Anestesia Local

Ketamina

Remifentanil

Remifentanil
Glicopirrolato

Ref.
119

186

186
102

Mivacurio

144

Midazolam

142

Atropina
Midazolam

Meperidina o Petidina

30
142

132

Dehidrobenzilperidol

66

Etomidato

89

GUA FARMACOLGICA

Patologa

Principio Activo

Angina Pecho

Nitrito Amilo

152

Angina Pinzmetal

Nifedipino

149

Ansiedad

Cloracepato Dipotsico

Ansiedad

Diazepam

Ansiedad

Haloperidol

105

Ansiedad

Levomepromazina

124

Ansiedad

Lorazepam

127

Ansiedad

Propranolol

181

Ansiedad

Sulpirida

217

Ansiedad con Angustia

Cloracepato Dipotsico

54

Ansiedad con Angustia,

Agarofobia, Trastorno
Ansiedad con Angustia,
Trastorno
Ansiedad en Abstinencia
de Narcticos o
Barbitricos
Ansiedad en Depresin

Alprazolam

18

Alprazolam

18

Paraldehido

167

Alprazolam

18

Ansiedad en Neurosis

Alprazolam

18

Ansiedad Generalizada

Alprazolam

18

Antisptico

Alcohol Etlico o Etanol

16

Antisptico

Clorhexidina

Antisptico

Peroxido Hidrgeno o
Agua Oxigenada
Povidona Iodada

Antisptico

Tiopental Sdico

229

Antisptico tras
extraccin dentaria
Apnea Neonatal

Propofol

182

Arritmias

Peroxido Hidrgeno o
Agua Oxigenada
Aminofilina o Teofilina
Monohidrato
Propranolol

Arritmias en Anestesia

Procainamida

Cloruro Etilo

57

Anestesia Local

Lidocana

126

Anestesia Local

Mepivacana, Clohidrato

133

Anestesia Local Ocular.

Colirio Anestsico Doble

58

Anestsia Regional
Troncular
Anestesia Regional,
como Coadyuvante
Anestesia, Induccin
Analgsica
Aneurisma Artico

Mepivacana, Clohidrato

133

Dehidrobenzilperidol

66

Fentanilo Citrato

93

Suero Manitol

209

Aneurisma Disecante
Aorta (Control TA)
Angina Estable

Trimetafan

235

Nitroglicerina

154

Angina Inestable

Deltaparina Sdica

63

Angina Inestable

Enoxaparina Sdica

85

Angina Inestable

Heparina Sdica

107

Angina Inestable

Plasugrel

178

Angina Inestable,
profilaxis
Angina Pecho

Acido Acetil Saliclico (AAS)

Metoprolol

140

Angina Pecho

Nifedipino

149

Angina Pecho

Propranolol

181

Angina Pecho

Carvelidol

42

Ref.

54
70

55
170
176
170
20
181
179

Arritmias en Hipertermia Procainamida

Maligna
Arritmias por Digital
Potasio, Cloruro

179

Arritmias, Bloqueo AV 2 Isoproterenol

Mobitz II
Arritmias, Bloqueo AV 3 Isoproterenol

118

Arritmias, Bloqueo AV
nodal
Arrtmias, Bloqueo
Cardiaco
Arritmias, Bradicardia

175

118

Atropina

30

Adrenalina

13

Atropina

30

Arritmias, Bradicardia,
con Sindrome QT larco
Arritmias, Bradicardia,
postTransplante Cardiaca
Arritmias, Bradicardia,
resistente a Atropina,
Dobutamina y
Adrenalina
Arritmias, ESPV y EV

Isoproterenol

118

Isoproterenol

118

Isoproterenol

118

Metoprolol

140

Arritmias, EV

Lidocana

126

Arritmias, EV

Procainamida

179

Arritmias, EV

Propafenona

180

Arritmias, EV sostenida o Flecainida, Acetato

no sostenida, resistente
a otros tratamientos
Arritmias, FA
Digoxina

97

73

973

URGENCIAS Y EMERGENCIAS EXTRAHOSPITALARIAS GUETS - SESCAM

Patologa

Principio Activo

Arritmias, FA

Diltiazem

Arritmias, FA

Patologa

Principio Activo

74

Arritmias, TSV

Edrofonio

Metoprolol

140

Arritmias, TSV

Metoprolol

140

Arritmias, FA

Procainamida

179

Arritmias, TSV

Verapamilo

242

Arrtmias, FA

Adenosina Difosfato

Arritmias, TSVP

Metoxamina o 2,5Dimetoxinorefedrina
Adenosina Trifosfato

141

Arritmias, FA
Arrtmias, FA crnica,
Profilaxis
Arrtmias, FA,
(Cardioversin Rpida)
Arritmias, Fibrilacin
Supraventricular
Sintomtica
Arritmias, Flutter
Auricular
Arritmias, Flutter
Auricular
Arritmias, Flutter
Auricular
Arritmias, Flutter
Auricular
Arritmias, Flutter
Auricular
Arritmias, Flutter
Auricular
Arritmias, Flutter
Supraventricular
Sintomtica
Arrtmias, FV

Acenocumarol

Arritmias, TSVP

Digoxina

Arritmias, TSVP

Diltiazem

Arritmias, TSVP

Metoprolol

140

Arritmias, TSVP

Procainamida

179

Arritmias, TSVP

Propafenona

180

Arritmias, TSVP

Verapamilo

242

Arritmias, TSVP

Adenosina Difosfato

11

Arritmias, TSVP por

Sindr, WPW
Arritmias, TSVP
Sintomtica
Arritmias, TV

Adenosina Difosfato

11

Flecainida, Acetato

97

Amiodarona

Arritmias, TV

Lidocana

Arritmias, FV, tras fallar

otros Antiarritmicos y
Cardioversin Elctrica
Arritmias,
Supraventriculares
Arritmias,
Supraventriculares
Arritmias,
Supraventriculares
Arritmias,
Supraventriculares
Arritmias, Taquiarrtmias

Vernakalant
Flecainida, Acetato

Adenosina Difosfato

Ref.

GUA FARMACOLGICA

11
2
243
97

11

Digoxina

73

Diltiazem

74

Metoprolol

140

Procainamida

179

Verapamilo

242

81

12
73
74

21
126

Arritmias, TV

Procainamida

179

Arritmias, TV

Propafenona

180

Arritmias, TV

Propranolol

181

Arritmias, TV por
Adenosina Difosfato
Ejercicio
Arritmias, TV refractarias Lidocana

Flecainida, Acetato

97

Adrenalina

13

Arritmias, TV sin Pulso

Bretilio

33

Digoxina

73

Arritmias, TV sostenida o Flecainida, Acetato

no sostenida, Resistente
a otros tratamientos
Arritmias, TVP, profilaxis Acenocumarol

Adrenalina

11
126
13
97

Arritmias, Ventriculares

Lidocana

126

Arritmias, Ventriculares
(Alternativa a
Amiodarona y Lidocaina)
Arritmias, Ventriculares
por Hipopotasemia o
Hipomagnesemia
Arteriopata Oclusiva
Minembros Inferiores
Arteriopata Perifrica

Procainamida

179

Magnesio, Sulfato

130

Prostaglandina E1

183

Clopidogrel

Arteriopata Perifrica

Prostaglandina E1

183

140

Artrtis Reumatoide

168

Flecainida, Acetato

97

Adenosina Difosfato

11

Artritis Reumatoidea
Juvenil
Ascitis

Penicilamina o DPenicilamina
Acido Acetil Saliclico (AAS)
Suero Manitol

209

Esmolol

86

Procainamida

179

Propranolol

181

Atenolol

Arritmias, Taquiarrtmias Propranolol

Adenosina Difosfato

27
181

Arritmias, Taquicardia
Auricular
Arritmias, Taquicardia
Auricular
Arritmias, Taquicardia
por Sindr, WPW
Arritmias, Taquicardia
Reentrada del Ndulo
Sinusal
Arritmias, Taquicardia
Sinusal no apropiada
Arritmias, Taquicardia
Sinusal, Trat.
Coadyuvante
Arritmias, Taquicardias
por Catecolaminas
Arritmias, Taquicardias
por Digital
Arritmias, TSV

Adenosina Difosfato

11

Arritmias, TSV

Amiodarona

21

974

Ref.

Metoprolol

11

Metoprolol

140

Neostigmina

148

Propranolol

181

Propranolol

181

53

Asma

Metilprednisolona

137

Asma

Salbutamol

191

Asma

Formoterol

100

Asma, Bronquial

Hexoprenalina, Sulfato

110

Asma, Bronquial

Efedrina

83

Asma, Bronquial,
moderado y grave
Asma, Estatus

Budesonida

34

Heliox

106

Asma, Estatus

Hexoprenalina, Sulfato

110

Asma, Estatus

Terbutalina

222

Asma, Estatus o Crisis

Hidrocortisona

112

URGENCIAS Y EMERGENCIAS EXTRAHOSPITALARIAS GUETS - SESCAM

Patologa

Principio Activo

Aspiracin cida,
Profilaxis
tresia Pulmonar

Omeprazol
Prostaglandina E1

Atresia Tricuspdea

Prostaglandina E1

Broncoespasmo

Adrenalina

Broncoespasmo
Broncoespasmo

Aminofilina o Teofilina
Monohidrato
Dexametaxona

Broncoespasmo

Glicopirrolato

Broncoespasmo

Metilprednisolona

Broncoespasmo

Salbutamol

Broncoespasmo, Agudo

Patologa

Principio Activo
Paraldehido

167

183

Convulsiones resistentes
a otros Trat
Corea

Haloperidol

105

183

Corea

Piridoxina o Vitamina B6

173

13

Corea Huntington

Levomepromazina

124

20

Corea Huntington

Tiaprida

225

Crup Larngeo

Dexametaxona
Sandostatina u Octreotida

192

137

Dficit Hormona
Crecimiento
Dficit Vitamina B1

Tiamina o Vit. B1

224

191

Delirium

Haloperidol

105

Ipratropio, Bromuro

117

Delirium

Levomepromazina

124

Broncoespasmo, Crisis

Terbutalina

222

Delirium

Sulpirida

217

Broncoespasmo, en
Anestesia
Broncoespasmo, en
EPOC
Broncoespasmo, en
Inhalacin de Txicos
Bronconeumona

Isoproterenol

118

Levomepromazina

124

Hexoprenalina, Sulfato

110

Delirium Alucinosis
Alcohlica
Delirium Tremens por
Abstinencia o
Deprivacin Alcohlica
Delirium Tremens por
Abstinencia o
Deprivacin Alcohlica
Dermatitis Alrgica

Bronquiolitis

Ref.

GUA FARMACOLGICA

159

67
102

Budesonida

34

Amoxicilina + Acido
Clavulnico
Helios

22
106

Suero Salino Hipertnico

213

Bronquiolitis en nios
(Nebulizado)
Bronquitis Crnica,
Exacerbacin Aguda
Cardiopata Isqumica

Amoxicilina + Acido
Clavulnico
Diltiazem

22

Cardiopata Isqumica

Esmolol

86

Cefalea Histamnica

Ciprohetadina

46

Cefalea Tipo Cluster o en Oxgeno

Racimos
Cefalea Vascular
Ciprohetadina

162

74

Dermatonecrosis por
Extravasacin Drogas
Alfa Adrenergicas,
Profilaxis
Deshidratacin

Ref.

67

Clometiazol

50

Paraldehido

167

Dexclorfeniramina,
Maleato
Fentolamina

68
94

Suero Glucosalino

208

Suero Glucosado 5%

206

Suero Salino Fisiolgico

211

Suero Ringer Lactato

210

Suero Salino Fisiolgico

211

Suero Ringer Lactato

210

Suero Salino Hiposdico

214

Suero Ringer Lactato

210

Suero Salino Fisiolgico

211

Cetoacidosis Diabticas

Insulina

115

Citica

Tiamina o Vit. B1

224

Cirrosis Heptica

Silibinina o Silimarina

193

Coartacin de Arco
Aortico
Coma Hiperosmolar
Diabtico
Coma Hipotiroidieo

Prostaglandina E1

183

Suero Salino Hiposdico

214

Hidrocortisona

112

Coma Idioptico

Glucosa

104

Coma Idioptico

Naloxona

147

Convulsiones

Fenobarbital

Convulsiones

Midazolam

142

Deshidratacion
Hipertnicas (Vmitos y
Diarreas)
Deshidratacin por
Aspiracin Gstrica
Continua
Deshidratacin por
Diarreas
Deshidratacin por
Diarreas
Deshidratacin por
Fstulas
Deshidratacin por
Hipernatremia Grave
Deshidratacin por
Vmitos
Deshidratacin por
Vmitos
Diabetes Gestacional

Insulina

115

Convulsiones en
Eclampsia
Convulsiones Nios

Magnesio, Sulfato

130

Diabetes Mellitus Tipo 1

Insulina

115

Levetiracetam

122

Insulina

115

Piridoxina o Vitamina B6

173

Sandostatina u Octreotida

192

Valproico, Acido

237

Diabetes Mellitus Tipo 2

resistentes a
Antidiabticos vo.
Diarrea refractaria
(Asociada al SIDA)
Diseccin Aguda de
Aorta
Disfuncin Erectil

Apomorfina

Convulsiones Nios
Lactantes
Convulsiones Nios por
Fiebre
Convulsiones parciales
simples y complejas
Convulsiones por
Medicamentos, Trat
Coadyuvante
Convulsiones por
Ttanos

Clonazepam

46

92

51

Esmolol

86
26

Succinil Colina o
Suxametonio

196

Disfuncin Erectil

Prostaglandina E1

183
166

167

Dolor Agudo Leve a

Moderado
Dolor Angina Pecho
(Espasmos Vasculares)

Paracetamol

Paraldehido

Meperidina o Petidina

132

975

URGENCIAS Y EMERGENCIAS EXTRAHOSPITALARIAS GUETS - SESCAM

Patologa

Principio Activo

Dolor Artritis
Reumatoide, intenso

Diclofenado

Dolor Artritis
Reumatoide, intenso
Dolor Clico Biliar

Mefenmico, cido

131

Meperidina o Petidina

132

Meperidina o Petidina

132

Dolor Clico
GastroIntestinal
Dolor Clico Renal
Dolor Clico Renal,
intenso
Dolor Clico Renal,
moderado a intenso
Dolor Crnico

Ref.
72

Ketorolaco

120

Diclofenado

72

Dexketoprofeno

69

Morfina, Clorhidrato

Dolor Dismenorrea leve

o moderado
Dolor Dismenorrea leve
o moderado
Dolor EAP por
Insuficiecia Ventricular
Izquierda
Dolor EAP por
Insuficiecia Ventricular
Izquierda
Dolor Espasmos Genitos
Urinarios
Dolor General

Dexketoprofeno
Mefenmico, cido
Meperidina o Petidina

Morfina, Clorhidrato

GUA FARMACOLGICA

Patologa

Principio Activo

Dolor Parto

Meperidina o Petidina

Ref.

Dolor Politraumatizados
inestables

Fentanilo Citrato

93

Dolor Posquirrgico,
intenso
Dolor Postoperatorio

Diclofenado

72

Acetil Salicilato de Lisina

Dolor Postoperatorio

Ketorolaco

Dolor Postoperatorio,
moderado a intenso
Dolor Postparto

Dexketoprofeno
Acetil Salicilato de Lisina

Dolor Postraumtico

Acetil Salicilato de Lisina

132

4
120
69

145

Dolor Postraumtico

Meperidina o Petidina

69

Dolor Postraumtico,
intenso
Dolor Quirrgico

Diclofenado

Dolor Reumtico

Acetil Salicilato de Lisina

Dolor Somtico

Acido Acetil Saliclico (AAS)

Dolor Tabtico, Crisis

Meperidina o Petidina

132

Dolor TEP

Morfina, Clorhidrato

145

Dolor, Coadyuvante

Levomepromazina

131
132

145

Meperidina o Petidina

132
72
132
4
7

124

Meperidina o Petidina

132

Mefenmico, cido

131

Dolor General

Oxido Nitroso

161

Ductus Arterioso,
Prostaglandina E1
Mantenimiento Apertura
EAP
Aminofilina o Teofilina
Monohidrato
EAP
Furosemida

Dolor Gota Aguda o

Cronica
Dolor Gota intenso

Mefenmico, cido

131

EAP

Levosimendan

125

Diclofenado

EAP

Morfina, Clorhidrato

145

Dolor IAM

Meperidina o Petidina

132

EAP

Nitroglicerina

154

Dolor IAM

Morfina, Clorhidrato

145

Eclampsia

Hidralazina

111

Dolor ICC

Morfina, Clorhidrato

145

Edema Cerebral

Dexametaxona

Dolor intenso

Morfina, Clorhidrato

145

Dolor intenso

Remifentanil

186

Suero Glucosado
Hipertnico > 10%
Furosemida

101

Dolor intenso

Tapentadol

219

Dolor Leve a Moderado

Metamizol, Dipirona
Magnsica
Dexketoprofeno

135

Edema Cerebral y
Pulmonar
Edema Cerebral, Trat
Coadyuvante
Edema Cirrosis Heptica

Furosemida

101

Edema Generalizado

Suero Manitol

209

Edema Glotis

Hidrocortisona

112

Edema Insuficiencia
Cardiaca
Edema Insuficiencia
Renal
Edema Retencin
Liquidos Corporales
Edema Sindrome
Nefrtico
Embolia Pulmonar

Furosemida

101

Furosemida

101

Torasemida

232

Furosemida

101

Alteplasa (RTPA)

19

Embolia Pulmonar

Deltaparina Sdica

63

Embolia Pulmonar

Nadroparina

Dolor leve, moderado e

intenso
Dolor Lumbar, moderado Dexketoprofeno
a intenso
Dolor Menorragia
Mefenmico, cido
Dolor Migraa
Hemicraneal
Dolor Moderado a
Severo
Dolor Moderado a
Severo
Dolor
Musculoesqueltico leve
o moderado
Dolor Neoplaxico

Acetil Salicilato de Lisina

Dolor Neuralgias

Meperidina o Petidina

Dolor Neurlgico

Acetil Salicilato de Lisina

Dolor Neuroptico

Tapentadol

Dolor Odontalgia leve o

moderado

Dexketoprofeno

976

72

69
69
131

Mefenmico, cido

131

Ketorolaco

120

Tramadol

233

Dexketoprofeno

69

4
132
4
219
69

183
20
101

67
207

146

Embolia Pulmonar Grave Suero Coloide Dextrano

204

Embolismo Graso

Suero Coloide Dextrano

204

Encefalopata de
Wernike
Encefalopata
Hipertensiva
Endocarditis Bacteriana

Tiamina o Vit. B1

224

Trimetafan

235

Vancomicina

238

Enfermedad Alzheimer

4-Aminopiridina

URGENCIAS Y EMERGENCIAS EXTRAHOSPITALARIAS GUETS - SESCAM

Patologa

Principio Activo

Patologa

Principio Activo

Enfermedad BeriBeri

Tiamina o Vit. B1

224

EPOC

Formoterol

100

Enfermedad de Wilson

Penicilamina o DPenicilamina

168

EPOC

Terbutalina

222

EPOC, moderado y
severo

Budesonida

34

EPOC, Tratamiento
Coadyuvante
Erisipela

Ipratropio, Bromuro

117

Vancomicina

238

Esclerosis Mltiple

4-Aminopiridina

Escorbuto

Acido Ascrbico (Vit. C)

Enfermedad Fiebre del

Heno
Enfermedad Mebrana
Hialina Neonatos
Enfermedad Oncolgica,
Coadyuvante como
Antiemesis y Analgesia
Enfermedad Parkinson

Apomorfina

Enfermedad Parkinson

Piridoxina o Vitamina B6

Enfermedad Parkinson,
Trat. Crnico
Enfermedad Saturnismo

Biperideno

Enfermedades
Dermatolgicas Graves,
Coadyuvante
Enfermedades
Oncolgicas, Profilaxis
Enfermedades
Reumaticas,
Coadyuvantes
Enfisema Pulmonar

Dexclorfeniramina,
Maleato
Surfactante Pulmonar
Porcino (Poractan Alfa)
Levomepromazina

Calcio Edetato Sdico

(EDTA)
Hidrocortisona

Deltaparina Sdica
Hidrocortisona

Ref.

GUA FARMACOLGICA

68
218
124

Ref.

26

Esofagitis de Reflujo

Esomeprazol

87

173

Esofagitis de Reflujo

Pantoprazol

165

31

Esofagtis de Reflujo

Omeprazol

159

Espasmos Abdominales
Gastrointesnal
Espasmos Abdominales
por Clico Biliar
Espasmos Abdominales
por Clico Ureteral o
Renal
Espasmos Abdominales
por Clico Biliar
Espasmos Abdominales
por Dismenorrea
Espasmos
Genitourinarios
Espasmos Larngeo

Butil-Escopolamina,

35

Atropina

30

Atropina

30

Butil-Escopolamina,

35

Atropina

30

Butil-Escopolamina,

35

Adrenalina

13

37
112

63
112

Terbutalina

222

Epilepsia

Diazepam

70

Epilepsia

Fenobarbital

92

Epilepsia

Levetiracetam

122

Espasmos Musculares

Diazepam

70

Epilepsia, Ausencias

Valproico, Acido

237

Dantroleno

64

Epilpsia, Ausencias
Atpicas

Clonazepam

Espasticidad Muscular
por Esclerosis Mltipe
Espasticidad Muscular
por Lesiones Medulares
Espasticidad Muscular
por otras condiciones
Esquizofrenia

Dantroleno

64

Dantroleno

64

Levomepromazina

124

Esquizofrenia

Olanzapina

158

Esquizofrenia

Sulpirida

217

Estados Confusionales

Clometiazol

Estados Inquietud

Clometiazol

Esteatosis Heptica

Silibinina o Silimarina

193

Estenosis Pilrica

Suero Glucosado 5%

206

Estenosis Pulmonar

Prostaglandina E1

183

Estenosis Subartica
Hipertrofia, Trat
Coadyuvante
Estreimiento Crnico

Propranolol

181

Epilepsia, Convulsiones o Fenitoina o

Crisis Tonicos-Clnicas
DifenilHidantona
Generalizadas
Epilepsia, Crisis
Valproico, Acido

51

91

237

Epilepsia, Crisis
Generalizada TonicoClnico
Epilepsia, Crisis parciales
simples o complejos
Epilepsia, Crisis Parcias
Simple, 2 lnea
Epilepsia, Estatus

Fenobarbital

Diazepam

70

Epilepsia, Estatus

Fenobarbital

92

Epilepsia, Estatus

Paraldehido

167

Epilepsia, Estatus

Tiopental Sdico

229

Epilpsia, Estatus por

Clometiazol
Abstinencia o
Deprivacin Alcohlica
Epilepsia, Estatus, (todos Clonazepam
los tipos)
Epilepsia, Generalizada
Valproico, Acido

50

237

Epilepsia, Mioclnias

Valproico, Acido

237

Epilepsia, Parcial

Valproico, Acido

237

Epilepsia, Petit Mal

Clonazepam

51

EPOC

Aminofilina o Teofilina
Monohidrato

20

Fenitoina o
DifenilHidantona
Fenobarbital

92

91
92

51

Fallo Ventricular
Izquierdo Agudo
Feocromocitoma
Feocromocitoma, Trat
Coadyuvante
Fibrosis Qustica
Pulmonar en nios
(Nebulizado)
Fistulas Intestinales,
Biliares y Pancreticas
Fistulas Pancreticas,
Trat. Coadyuvante
Fobias

50
50

Polietilenglicol

174

Trimetafan

235

Labetalol

121

Propranolol

181

Suero Salino Hipertnico

213

Suero Glucosado 5%

206

Somatostatina

194

Lorazepam

127

977

URGENCIAS Y EMERGENCIAS EXTRAHOSPITALARIAS GUETS - SESCAM

Patologa

Principio Activo

Fobias

Sulpirida

Ref.
217

Gastrinomas

Sandostatina u Octreotida

192

Gastritis

Cimetidina

Gastroparesia Diabtica

139

Glaucoma

Metodlopramida,
Clorhidrato
Colirio Mitico

Glaucoma

Suero Manitol

209

Glucagonomas

Sandostatina u Octreotida

192

45

61

Granulomas piel

Nitrato Plata

Hemocromatosis
Idioptica
Hemodialisis, Profilaxis
Trombosis
Hemoglobinuria

Desferroxamina (Mesilato)

65

Deltaparina Sdica

63

Suero Manitol

151

209

Patologa

Principio Activo

Hemorragia Uterina
Anormal
Hemorragia Uterina
Postparto
Hemorragia Varices
Gastroesofgica
Hemosideremia por
Transfusiones
Hepatitis Alcohlica

Metilergometrina,
Maleato
Metilergometrina,
Maleato
Sandostatina u Octreotida

192

Desferroxamina (Mesilato)

65

Silibinina o Silimarina

Hepatitis Viral B y C,
Ribavirina
Agudas y Crnicas
Herpes Genital
Ribavirina
Recurrente, profilaxis
Hiperactividad bronquial Salbutamol

Ref.
136
136

193
188
188
191

Hiperglucemias Agudas
Descompensadas
HiperMagnesemia

Insulina

115

HiperNatremias Graves

Suero Salino Hiposdico

HiperPotasemia

Calcio, Cloruro

36

HiperPotasemia

Calcio, Gluconato

38

Hemorragia

Acido Aminocaprico

Hemorragia

Adrenalina

13

Hemorragia

Efedrina

83

Hemorragia

Fitomenadiona o Vitamina
K
Suero Glucosado 5%

96
206

HiperPotasemia

Salbutamol

Somatostatina

194

HiperPotasemia

Suero Bicarbonatado

201

HiperPotasemia,
(concomitante con
Insulina)
Hiperqueratosis

Glucosa

104

Vaselina (Petrolato)

239

Hemorragia

GUA FARMACOLGICA

Hemorragia Digestiva
Alta (con o sin
Hipertensin Portal)
Hemorragia Digestiva
Gstrica
Hemorragia Digestiva
GastroIntestinal
Hemorragia Digestiva
por Rotura Varices
Esofgicas
Hemorragia Digestiva
lcera Pptica, Profilaxis
resangrado
Hemorragia Digestiva,
Profilaxis
Hemorragia Externa, por
herida
Hemorragia Gingival

Tranexamico, Acido

234

Hemorragia Intracraneal

Trimetafan

235

Hemorragia Nasal,
Epixtasis
Hemorragia Nasal,
Epixtasis
Hemorragia Nasal,
Epixtasis, con
taponamien.
Hemorragia Post Parto
por Atona Uterina (que
no cede con otros
medic.)
Hemorragia Postparto

Nitrato Plata

151

Tranexamico, Acido

234

Peroxido Hidrgeno o
Agua Oxig.

170

Hemorragia RN,
Profilaxis
Hemorragia
SubAracnoidea
Hemorragia
SubAracnoidea
Hemorragia Urterina por
Atona
Hemorragia Uterina

978

Cimetidina

45

Vasopresina

240

Terlipresina

223

Esomeprazol

87

Omeprazol
Chitoxan

Carboprost

Oxitocina

159
44

41

163

Fitomenadiona o Vitamina
K
Nimodipino

96
150

Tranexamico, Acido

234

Metilergometrina,
Maleato
Tranexamico, Acido

136
234

Calcio, Cloruro

Hipersecreciones del
tracto Respiratorio
Hipersensibilidad del
Seno Carotideo
Hipertensin Pulmonar

Atropina

Amrinona

Hipertensin Pulmonar

Nitroprusiato Sdico

Isoproterenol

36
214

191

30
118
24
155

Hipertensin Pulmonar

Oxido Nitroso

161

Hipertensin Pulmonar

Prostaglandina E1

183

Hipertermia Maligna,
Crisis
Hipertermia, Fiebre

Dantroleno

Hipertermia, Fiebre

Acido Acetil Saliclico (AAS)

Hipertermia, Fiebre

Paracetamol

Acetil Salicilato de Lisina

64
4
7
166

Hipertermia, Fiebre

Mefenmico, cido

131

Hipertermia, Fiebre alta,

resistente a otros
Antitrmicos
Hipertermia, Fiebre en
Inmunodeficientes
Granulocitopnicos
Hiperventilacin

Metamizol, Dipirona
Magnsica

135

Piperacilina o Piperazilina

171

Suero Glucosado 5%

206

Hipo incoercible

Clorpromazina

Hipo incoercible

Levomepromazina

Hipocalcemia severa

Calcio, Cloruro

Hipocalcemia severa

Calcio, Gluconato

Hipoglucemia

Suero Glucosado 5%

206

Hipoglucemia

207

Hipoglucemia Aguda

Suero Glucosado
Hipertnico > 10%
Glucosa

104

Hipoglucemia en DMID

Glucagn

103

HipoMagnesemia Severa Magnesio, Sulfato

56
124
36
38

130

URGENCIAS Y EMERGENCIAS EXTRAHOSPITALARIAS GUETS - SESCAM

Patologa

Principio Activo

HipoNatremia

Suero Bicarbonatado

201

HipoPotasemia con o sin

Alcalosis metablica
Hipoproteinemia Crnica
por Cirrosis Heptica
Hipoproteinemia Crnica
por Desnutricin Grave
Hipoproteinemia Crnica
por Sndrome Negrtico
Hipoprotrombinemias
por Medicamentos
Hipoprotrombinemias
por Mordeduras Ofidios
Hipoprotrombinemias
por Pesticidas
Hipoprotrombinemias
por Raticidas
Hipotensin

Potasio, Cloruro

175

Suero Coloide Albmina

202

Suero Coloide Albmina

202

Suero Coloide Albmina

202

Hipotensin Aguda
Hipotensin Grave
Hipotensin Grave (2
Alternativa)
Hipotensin por
Anestesia Epidural
Hipotensin por
Anestesia Espinal
Hipotensin por
Anestsicos Halogenados
Hipotensin por
Anestsicos Radiculares
Hipotensin por
Antihipertensivos
Hipotensin por
Ciclopropano
Hipotensin por Ciruga
Cardiaca, Profilaxis
Hipotensin por
Frmacos
Hipotensin por
Feocromocima
Hipotensin por IAM

Fitomenadiona o Vitamina
K
Fitomenadiona o Vitamina
K
Fitomenadiona o Vitamina
K
Fitomenadiona o Vitamina
K
Efedrina
Metoxamina o 2,5Dimetoxinorefedrina
Adrenalina

Ref.

96
96
96
96
83
141
13

Dobutamina

79

Fenilefrina

90

Noradrenalina o
Norepinefrina
Metoxamina o 2,5Dimetoxinorefedrina
Metoxamina o 2,5Dimetoxinorefedrina
Metoxamina o 2,5Dimetoxinorefedrina
Metoxamina o 2,5Dimetoxinorefedrina
Dobutamina
Fenilefrina

Noradrenalina o
Norepinefrina
Noradrenalina o
Norepinefrina
Hipotensin por
Noradrenalina o
Poliomelitis
Norepinefrina
Hipotensin por
Noradrenalina o
Reaccin Frmacos
Norepinefrina
Hipotensin por Shock
Noradrenalina o
Sptico
Norepinefrina
Hipotensin por
Noradrenalina o
Simpatectoma
Norepinefrina
Hipotensin por
Noradrenalina o
Transfusiones
Norepinefrina
Hipotensin refractaria a Vasopresina
Catecolaminas
Hipotensin sintomtica Atropina

156
141
141
141
141
79
90
156
156
156
156
156
156
156
240
30

Patologa

Principio Activo

Hipovolemia por
Hemorragias
Hipovolemia por
Hemorragias
Hipovolemia por
Quemaduras

Suero Ringer Lactato

210

Suero Salino Fisiolgico

211

Suero Ringer Lactato

210

Hipovolemia por
Quemaduras
Hipovolemia por Shock

Suero Salino Fisiolgico

211

Suero Ringer Lactato

210

Hipovolemia por Shock

Suero Salino Fisiolgico

211

Hipovolemia por Shock

Hemorrgico
Hipovolemia por Shock
por Quemadura
Hipovolemia por Shock
Sptico
Hipovolemia por Shock
Traumtico
Hipoxemia

Suero Coloide de Gelatina

Succinilada
Suero Coloide de Gelatina
Succinilada
Suero Coloide de Gelatina
Succinilada
Suero Coloide de Gelatina
Succinilada
Oxgeno

205

162

Hipoxemia con Presin

Arterial de O2 < 60
mmHg
Hipoxemia con
Saturacin O2 <90%
Histeria

Oxgeno

162

Oxgeno

162

Lorazepam

127

HTA

Atenolol

27

HTA

Captopril

39

HTA

Diltiazem

74

HTA

Enalapril o Enalprilato

84

HTA

Hidralazina

111

HTA

Metoprolol

140

HTA

Nifedipino

149

HTA

Nitroglicerina

154

HTA

Torasemida

232

HTA, Crisis

Labetalol

121

HTA, Crisis

Nifedipino

149

HTA, Crisis

Nitroprusiato Sdico

155

HTA, Crisis

Urapidil

236

HTA, Crisis, Trat

Coadyuvante
HTA, en Aneurisma
Disecante de Aorta
HTA, en Cardiopata
Isqumica
HTA, en Eclampsia

Furosemida

101

Labetalol

121

Labetalol

121

Labetalol

121

HTA, en Embarazo

Hidralazina

111

HTA, en Intoxicacin
Medicamentosa
HTA, en patologia
vascular cerebral
HTA, Esencial

Fentolamina

94

Labetalol

Ref.

205
205
205

121

Carvelidol

42

Clonidina

52

203

HTA, Leve, Moderada y

Grave
HTA, Malgna

Diazxido

71

202

HTA, PeriQuirrgica

Labetalol

121

HTA, Resistente a
Nitroprusiato

Trimetafan

235

204

Hipovolemia

Suero Glucosado 5%

206

Hipovolemia

Suero Coloide Almidn o

Hidroxietil-Almidon
Suero Coloide Albmina
Suero Coloide Dextrano

Hipovolemia en
Embarazada
Hipovolemia por Ciruga
Traumtica, Profilaxis

GUA FARMACOLGICA

979

URGENCIAS Y EMERGENCIAS EXTRAHOSPITALARIAS GUETS - SESCAM

Patologa

Principio Activo

Patologa

Principio Activo

HTA, Trat Coadyuvante

Propranolol

181

Ileo Paralcito

Suero Coloide Dextrano

HTIC. Hipertencin
Intracraneal
IAM

Suero Manitol

209

Clopidogrel

53

Amoxicilina + Acido
Clavulnico
Tazobactan

220

IAM

Enoxaparina Sdica

85

IAM

Heparina Sdica

107

Vancomicina

238

IAM

Nitroglicerina

154

IAM, Alternativa a AAS

Ticlopidina

227

IAM, Antiagregante y
Anticoagulante
IAM, Antiagregante,
Anticoagulante
IAM, Antiagulante previo
Intervencin Coronara
Percutanea
IAM, Bradiarritmia post
IAM
IAM, con Disnea

Ticagrelor

226

Tirofiban

231

Infecciones,
Abdominales
Infecciones,
Abdominales
Infecciones, Alternativa a
Penicilinas
Infecciones, Amigdalitis
Recurrente
Infecciones, Antrax,
inhalado
Infecciones, Bacteriemia

Morfina, Clorhidrato

IAM, Fibrinolisis

Estreptoquinasa

Plasugrel

Atropina

Ref.

GUA FARMACOLGICA

178

30
145
88

IAM, Fibrinolisis

Reteplasa

187

IAM, Fibrinolisis

Tenecteplasa

221

IAM, Fibrinolisis, En
Alteplasa (RTPA)
Extenso y/o Anterior en
< 75 aos
IAM, Prevencin Arritmia Atenolol

Infecciones, Bacteriemia
con Neutropenia
Infecciones,
Broncopulmonares en
Fibrosis Qustica
Infecciones, Celulitis

19

Infecciones, Cistinuria
Infecciones, Cistitis

Ref.
204
22

Amoxicilina + Acido
Clavulnico
Levofloxacino

22
123

Piperacilina o Piperazilina

171

Imipenem + Cilastatina

114

Meropenen

134

Amoxicilina + Acido
Clavulnico
Penicilamina o DPenicilamina
Amoxicilina + Acido
Clavulnico
Amoxicilina + Acido
Clavulnico
Levofloxacino

22

123

Tazobactan

220

Penicilina G Sdica

169

168
22

IAM, Previo
Coronariografa o
Angioplastia,
Anticoagulacin
IAM, profilaxis

Acenocumarol

Infecciones, Cutneas y
Tejidos Blandos
Infecciones, Cutneas y
Tejidos Blandos
Infecciones, Cutneas y
Tejidos blandos
Infecciones,
Dermatolgicas
Infecciones, Digestivas

Penicilina G Sdica

169

IAM, profilaxis

Acido Acetil Saliclico (AAS)

Infecciones, Digestivas

Piperacilina o Piperazilina

171

IAM, Profilaxis
Antiagregante
IAM, profilaxis Arritmias
Ventriculares
IAM, Sin onda Q

Plasugrel

178
140

Amoxicilina + Acido
Clavulnico
Piperacilina o Piperazilina

22

Metoprolol

Infecciones,
GenitoUrinarias
Infecciones,
GenitoUrinarias
Infecciones,
Ginecolgicas
Infecciones,
Gingivostamtitis
Herptica
Infecciones, Hepatitis
Viral
Infecciones, Herpes
Labial
Infecciones, Herpes
Zoster Genital Primario
Infecciones, Meningitis

171

Penicilina G Sdica

169

Ribavirina

188

Ribavirina

188

Ribavirina

188

Ribavirina

188

Piperacilina o Piperazilina

171

Infecciones, Meningitis

Vancomicina

238

Infecciones, Meningitis
Bacteriana
Infecciones, Meningitis
Bacteriana Aguda
Infecciones,
Odontolgicas
Infecciones,
Odontolgicas
Infecciones, ORL

Dexametaxona

Infecciones, Osteitis

Bivalirudina

Deltaparina Sdica

27
32

63

IAM, Trat Coadyuvante

Propranolol

ICC
ICC

Aminofilina o Teofilina
Monohidrato
Nitroglicerina

154

ICC

Hidralazina

111

ICC

Levosimendan

125

ICC (Diuresis)

Torasemida

232

ICC Aguda

Milrinona

143

ICC Aguda o Crnica

Refractaria
ICC Severa, Refractaria,
Trat Coadyuvante
ICC Sintomtica

Amrinona

24

Carvelidol

42

ICC Sintomtica

Digoxina

73

ICTUS

Citicolina

48

ICTUS Isqumico,
Fibrinolisis
ICTUS, con HTIC

Alteplasa (RTPA)

19

Suero Manitol

ICTUS, Infarto Cerebral

Clopidogrel

ICTUS, Profilaxis
Tromboemblica

980

Nitroprusiato Sdico

Ticlopidina

181
20

155

209
53
227

22

67

Meropenen

134

Penicilina G Sdica

169

Vancomicina

238

Penicilina G Sdica

169

Vancomicina

238

Infecciones, Otitis Media Amoxicilina + Acido

Clavulnico

22

URGENCIAS Y EMERGENCIAS EXTRAHOSPITALARIAS GUETS - SESCAM

Patologa

Principio Activo

Infecciones, Parotidits

Ribavirina

Infecciones, Peritonitis
Infecciones, Peritonitis

Amoxicilina + Acido
Clavulnico
Suero Coloide Dextrano

204

Intoxicacin Adrenalina

Fentolamina

94

Infecciones, Pielonefritis

Levofloxacino

123

Pralidoxima

177

Infecciones, por
Escherichia Coli
Infecciones, por
Haemophilus
Infecciones, por Proteus

Ampicilina

23

Nitroprusiato Sdico

155

Ampicilina

23

Intoxicacin Agentes
Nerviosos de Guerra
Intoxicacin Alcaloides
Cornezuelo de Centeno
Intoxicacin Alcohol

Silibinina o Silimarina

193

Ampicilina

23

Intoxicacin Alcohlica

Tiamina o Vit. B1

224

Ampicilina

23

4-Aminopiridina

Ampicilina

23

Intoxicacin Alimento
Pez Globo
Intoxicacin Aluminica

Desferroxamina (Mesilato)

Amoxicilina + Acido
Clavulnico
Piperacilina o Piperazilina

22

Intoxicacin Amidopino

4-Aminopiridina

Infecciones, por
Salmonella
Infecciones, por Shigella
Infecciones,
Postquirrgicas
Infecciones, Profilaxis en
Ciruga Ginecolgica
Infecciones, Profilaxis
Implantacin Prtesis
Infecciones, Profilaxis, en
Cirugia Abdominal
Infecciones, Prostatitis

Ref.

Patologa

GUA FARMACOLGICA

188
22

171

Vancomicina

238

Piperacilina o Piperazilina

171

Levofloxacino

123

Infecciones, Quirrgicas

Penicilina G Sdica

169

Infecciones, Respiratoria
por Virus Sincicial
respiratorio Influenza y
Parainfl.
Infecciones,
Respiratorias
Infecciones, Septicemia

Ribavirina

188

Infecciones, Septicemia
Infecciones, Sinusitis

Penicilina G Sdica

169

Amoxicilina + Acido
Clavulnico
Vancomicina

22

Amoxicilina + Acido
Clavulnico
Piperacilina o Piperazilina

238
22

Infecciones, Uretritis
Gonoccica
Infecciones, Urolgicas

171

Meropenen

134

Infecciones, Urolgicas

Penicilina G Sdica

169

Infecciones, Urolgicas

Tazobactan

220

Infecciones, Varicela

Ribavirina

188

Infecciones, Vasculares

Penicilina G Sdica

169

Infecciones, Venreas

Penicilina G Sdica

169

Infecciones, Virales

Ribavirina

188

Inflamaciones

Acido Acetil Saliclico (AAS)

Insomnio

Cloracepato Dipotsico

Insomnio

Lorazepam

Insuficiencia Cardiaca

Enalapril o Enalprilato

Insuficiencia Cardiaca
Crnica descompensada,
resistente a otros Trat.
Insuficiencia Cardiaca
Severa
Insuficiencia Respiratoria
en Lactantes o Nios con
Sat. O2 < 90%
Insuficiencia Respiratoria
Neonatos
Insuficiencia Suprarrenal

Levosimendan

Dobutamina

7
54
127
84
125

Intoxicacin Anfetaminas Fentolamina

Intoxicacin Anilinas

Metiltionina, Cloruro

Intoxicacion
Antagonistas Calcio
Intoxicacin
Antagonistas Calcio
Intoxicacin
Antagonistas Calcio
Intoxicacin Antetaminas
(Trat HTA)
Intoxicacin
Anticolinergicos
Intoxicacin Arsnico

Calcio, Cloruro

106

Oxido Nitroso

161

Metilprednisolona

137

Ref.
112
192

1
65
1
94
138
36

4-Aminopiridina

Calcio, Gluconato

38

Labetalol
Fisostigmina, Salicilato

121
95

Intoxicacin Arsnico

Acido 2,3
Dimercaptosuccinico
(DMSA)
Calcio, Gluconato

Intoxicacin Arsnico

Dimercaprol

Intoxicacin Arsnico

Penicilamina o DPenicilamina
Fisostigmina, Salicilato

168

Suero Manitol

209

Magnesio, Sulfato

130

Intoxicacin Atropina
Intoxicacin Barbitricos
(Diuresis Forzada)
Intoxicacin Bario
Intoxicacin
Benzodiacepinas
Intoxicacin Beta
Bloqueantes
Intoxicacin
Bloqueadores
Adrenergicos
Intoxicacin
Bloqueadores Canales
Calcio
Intoxicacin Botulismo
Intoxicacin Bromuro
(Diuresis Forzada)
Intoxicacin Cadmio

79

Heliox

Principio Activo

Insuficiencia Suprarrenal Hidrocortisona

Aguda y Crnica
Insulinomas
Sandostatina u Octreotida

Intoxicacin
Calcioantagonistas,
resistente al
Isoproterenol
Intoxicacin Carbn
Activo (Laxante)
Intoxicacin Causticos

38
76

95

Flumazenilo

98

Isoproterenol

118

Glucagn

103

Amrinona

24

4-Aminopiridina
Suero Manitol

1
209

Acido 2,3
Dimercaptopropanilsulfni
co
Glucagn

103

Sorbitol o Glucitol

195

Agua Albuminosa o
Albumina Seca

14

981

URGENCIAS Y EMERGENCIAS EXTRAHOSPITALARIAS GUETS - SESCAM

Patologa

Principio Activo

Intoxicacin Cesio

HesCianoFerrato Ferrico
Potasio
EDTA Dicobltico

108

Hidroxivobalamina o
Vitamina B12
Nitrito Amilo

113

Intoxicacin Cianuro
Intoxicacin Cianuro
Intoxicacin Cianuro

Ref.

82

152

Intoxicacin Cianuro

Nitrito Sdico

153

Intoxicacin Cianuro

Tiosulfato Sdico

230

Intoxicacin Cinarizina

4-Aminopiridina

Intoxicacin Cisplatino

Tiosulfato Sdico

Intoxicacin
Clorpromazina
(Primperan)
Intoxicacin Cobalto

Biperideno

Intoxicacin Cobre

Intoxicacin Cobre

Intoxicacin Cobre
Intoxicacin Cobre

Acido 2,3
Dimercaptopropanilsulfni
co
Acido 2,3
Dimercaptopropanilsulfni
co
Acido 2,3
Dimercaptosuccinico
(DMSA)
Dimercaprol

Acido Aminocaprico

4-Aminopiridina

184

Naloxona

147

Intoxicacin Hierro

Acido Ascrbico (Vit. C)

Intoxicacin Hierro

Desferroxamina (Mesilato)

Intoxicacin Hierro

Penicilamina o DPenicilamina
Polietilenglicol

Intoxicacin Hierro
(Laxante)
Intoxicacin IMAO

Intoxicacin Imipramina
(Diuresis Forzada)
Intoxicacin Indandiona

76

147

Intoxicacin Cromo

Acido Ascrbico (Vit. C)

94

9
37
96
147
175
91

25
147

Intoxicacin Inhibidores
Colinesterasa
Intoxicacin Inhibidores
Colinesterasa
Intoxicacin Insecticidas
Intoxicacin Litio
(Diuresis Forzada)
Intoxicacin Litio
(Laxante)
Intoxicacin
Medicamentos (Emtico)
Intoxicacin
Medicamentos (Laxante)
Intoxicacin
Medicamentos
Convulsivos
Intoxicacin
Medicamentos
Hepatotxicos
Intoxicacin Meperidina
Intoxicacin Mercurio

147

Fentolamina
Suero Manitol
Fitomenadiona o Vitamina
K
Atropina

174

Ipecacuana

116

Sorbitol o Glucitol

195

Paraldehido

167

Silibinina o Silimarina

193

Naloxona

147

Acido 2,3
Dimercaptosuccinico
(DMSA)
Dimercaprol

99

Intoxicacin Metadona

16

Intoxicacin Etilenglicol

Alcohol Etlico o Etanol

16

Intoxicacin Metanol

99

Intoxicacin Metanol
Fomepizal o 4-Metil(Alcohol de Quemar)
Pirazol
Intoxicacin Metotrexate Acido Folnico (Folinato
Clcico)
Edrofonio
Intoxicacin relajante
Muscular (Revierte
Bloqueo Neuromuscular)

982

Tiaprida

225

30

Polietilenglicol

Fomepizal o 4-MetilPirazol
Alcohol Etlico o Etanol

Intoxicacin Etlica
Aguda o Crnico

96

209

Intoxicacin Mercurio

104

94
209

177

Intoxicacin Mercurio

Glucosa

174

Suero Manitol

Fomepizal o 4-MetilPirazol

168

Pralidoxima

95

Intoxicacin Etilenglicol
(Alcohol de
Anticongelantes)
Intoxicacin Etlica

9
65

177

Fisostigmina, Salicilato

Intoxicacin Metanol

95

Pralidoxima

Intoxicacin
Escopolamina
Intoxicacin EtanolDisulfiram
Intoxicacin Etilenglicol

4-Aminopiridina

Intoxicacin Herona

Fisostigmina, Salicilato

234

31

Naloxona

Naloxona

Tranexamico, Acido

109

Intoxicacin Codena

Naloxona

Intoxicacin
Fibrinolticos
Intoxicacin
Fibrinolticos
Intoxicacin Flunarizina

1
94

Hexadimetrina o Polibreno

121

Anticuerpos AntiDigoxina

Fentolamina

Protamina

Labetalol

Intoxicacin
Dihidrocodena
Intoxicacin
Dihidromorfina
Intoxicacin Diltiazem

Intoxicacin Fenilefrina

Ref.

Intoxicacin Heparina

Intoxicacin Cocana

Fenitoina o
DifenilHidantona

4-Aminopiridina

230

Intoxicacin Cocaina

Intoxicacin Digitlica,
slo para Arrtmias
Auriculares y
Ventriculares
Intoxicacin Digoxina

Principio Activo

Intoxicacin Felodipino

168

Calcio Edetato Sdico

(EDTA
Intoxicacin Cumarnicos Fitomenadiona o Vitamina
K
Intoxicacin
Naloxona
Dextropropoxifeno
Intoxicacin Digital
Potasio, Cloruro

Patologa

Intoxicacin
Glucopirrolato
Intoxicacin Heparina

Penicilamina o DPenicilamina
Fentolamina

Intoxicacin Cromo

GUA FARMACOLGICA

Penicilamina o DPenicilamina
Naloxona
Acido Folnico (Folinato
Clcico)
Alcohol Etlico o Etanol

76
168
147
10
16
99
10
81

URGENCIAS Y EMERGENCIAS EXTRAHOSPITALARIAS GUETS - SESCAM

Ref.

GUA FARMACOLGICA

Patologa

Principio Activo

Intoxicacin
Miorelajante Muscular
No Despolarizante
(Revierte Bloq Neur.)

Glicopirrolato

Intoxicacion
Miorelajante Muscular
No Despolarizantes
Intoxicacin
Miorelajante Muscular
No Despolarizantes
Intoxicacin
Miorelajante Muscular
Rocuronio
Intoxicacin
Miorelajante Muscular
Vecuronio
Intoxicacin Morfina

Piridostigmina

172

Neostigmina

148

Sugammadex

215

Intoxicacin Plomo

Sugammadex

215

Intoxicacin Plomo

Acido 2,3
Dimercaptosuccinico
(DMSA)
Calcio, Gluconato

Intoxicacin Plomo

Dimercaprol

Intoxicacin Plomo

Penicilamina o DPenicilamina
Polietilenglicol

102

Naloxona

147
177

Intoxicacin Nicardipina

4-Aminopiridina

Intoxicacion Nquel

Intoxicacin Nquel

Calcio Edetato Sdico

(EDTA)
Acido 2,3
Dimercaptopropanilsulfni
co
Dimercaprol

Intoxicacin Nitritos

Metiltionina, Cloruro

138

Intoxicacin
Nitroprusiato
Intoxicacin
NorEpinefroma
Intoxicacin Opiceos
naturales
Intoxicacin Opiceos
Semisintticos
Intoxicacin Opiceos
Sintticos
Intoxicacin Opiaceos,
slo efecto diurtico
Intoxicacin Oro

Metiltionina, Cloruro

138

Fentolamina

177

Tierra de Fuller, Tierra de

Jardn

228

Calcio Edetato Sdico

(EDTA)
Acido 2,3
Dimercaptopropanilsulfni
co

37

37
5

76

Intoxicacin Plomo
(Laxante)
Intoxicacin Plutonio

Ref.

38
76
168
174

Intoxicacin Pralidoxima

Calcio Edetato Sdico

(EDTA)
Fentolamina

94

Intoxicacin Protamina

Metiltionina, Cloruro

138

Intoxicacin Radio

HesCianoFerrato Ferrico
Potasio
Metiltionina, Cloruro

108

Intoxicacin
Radiocontraste
Intoxicacin Raticidas

94

37

138

Fitomenadiona o Vitamina
K
Suero Manitol

96
209
177

147

Intoxicacin Salicilatos
(Diuresis Forzada)
Intoxicacin Sarin

Pralidoxima

Naloxona

147

Intoxicacin Setas

Piridoxina o Vitamina B6

173

Intoxicacion Setas
(Alternatia a Penicilina
G)
Intoxicacin Setas
Hepatottxicas
Intoxicacin Soman

Silibinina o Silimarina

193

Penicilina G Sdica

169

Pralidoxima

177

Intoxicacin Tabun

Pralidoxima

177

Intoxicacin Talio

HesCianoFerrato Ferrico
Potasio
Penicilamina o DPenicilamina
Fentolamina

108

Suero Antibotulnco

199

Naloxona

147

Naloxona
Alcohol Etlico o Etanol

Intoxicacin Oro
Intoxicacin Papaverina

4-Aminopiridina

Intoxicacin Paracetamol Acetilcisteina (NAcetilcistena)

Intoxicacin Paracetamol Metiltionina, Cloruro
Intoxicacin Paracetamol Polietilenglicol
(Laxante)
Intoxicacin Pentazocina Naloxona
Intoxicacin Pesticidas
Difencoum
Intoxicacin
Piridostigmina
Intoxicacin Plaguicidas
Organofosforados
Intoxicacin Plaguicidas
Organofosforados

Pralidoxima

Naloxona

Acido 2,3
Dimercaptopropanilsulfni
co
Acido 2,3
Dimercaptosuccinico
(DMSA)
Dimercaprol

Intoxicacin Oro

Principio Activo

Intoxicacin Plaguicidas
Organofosforados
Intoxicacin Plaguicidas
Paraquat o Diquat
(Absorbente)
Intoxicacion Plomo
Intoxicacin Plomo

Intoxicacin Neostigmina Pralidoxima

Intoxicacin Nquel

Patologa

Fitomenadiona o Vitamina
K
Pralidoxima
Atropina
Obidoxima o Obiodoxina o
Oxiomas

147
16
5

Intoxicacin Talio
76
1

Intoxicacin Tiramina

Intoxicacin Toxina
Botulnica
Intoxicacin Tramadol

138
174
147
96
177
30
157

168
94

Intoxicacin Triamterene Acido Folnico (Folinato

Clcico)
Intoxicacin Trimetropin Acido Folnico (Folinato
Pirimetemina
Clcico)
Intoxicacion
Acido Aminocaprico
Tromboliticos
Intoxicacin Uranio
Calcio Edetato Sdico
(EDTA)
Intoxicacin Vanadio
Calcio Edetato Sdico
(EDTA)
Intoxicacin Verapamil
4-Aminopiridina

10

Intoxicacin Yodo

17

Almidn

10
8
37
37
1

983

URGENCIAS Y EMERGENCIAS EXTRAHOSPITALARIAS GUETS - SESCAM

Patologa

Principio Activo

Intoxicacin Zinc

Acido 2,3
Dimercaptosuccinico
(DMSA)
Calcio Edetato Sdico
(EDTA)
Carbn Activado

Intoxicacin Zinc
Intoxicaciones General,
(como absorbente
gastrointestinal)
Intoxicaciones General,
(como emtico)

Apomorfina

Ref.
6

37
40

26

Intoxicaciones General,
Lavados Gastricos
Iritis

Suero Salino Fisiolgico

Irrigacin
Colirio Midritico

212

Laringitis Aguda

Budesonida

34

Laringitis Aguda, Crup

Larngeo
Leucopenia

Dexametaxona

67

Piridoxina o Vitamina B6

173

Lumblgia

Tiamina o Vit. B1

224

Mania

Olanzapina

158

Mana

Levomepromazina

124

Mana

Sulpirida

217

60

GUA FARMACOLGICA

Patologa

Principio Activo

Miorelajante Muscular,
Intubacin
Miorelajante Muscular,
Ventilacin Mecnica
Miorelajante Muscular,
Ventilacin Mecnica
Miorelajante Muscular,
Ventilacin Mecnica
Miorelajante Muscular,
Ventilacin Mecnica
Miorelajante Muscular,
Ventilacin Mecnica
Mola Hidatiforme
(Uterotnico)
Mordedura Animales

Vecuronio

241

Mivacurio

144

Pancuronio

164

Rocuronio

190

Succinil Colina o
Suxametonio
Vecuronio

196

Mordedura Ofidios
(Serpientes)
Mordedura Serpientes
Venenosas
Nauseas (Antiemtico)
Nauseas (Antiemtico)

Dinoprostona o
Prostaglandina E2
Amoxicilina + Acido
Clavulnico
Fitomenadiona o Vitamina
K
Suero Antiofdico

Ref.

241
77
22
96
200

Metodlopramida,
Clorhidrato
Ondansetrom

139
160

Piridoxina o Vitamina B6

173

Nauseas (Antiemtico)
en Embarazo
Neumona

Levofloxacino

123

Neumona

Piperacilina o Piperazilina

171

Neumona Adquirida
Comunidad
Neumona Grave

Meropenen

134

Imipenem + Cilastatina

114

Neumona Nosocomial

Imipenem + Cilastatina

114

172

Neumona Nosocomial

Meropenen

134

46

Neumona Nosocomial

Tazobactan

220
224

Maniobra de Crede
(Alumbramiento
Dirigido)
Mastocitosis Sistmica

Metilergometrina,
Maleato

136

Omeprazol

159

Metabemoglobinemia

Acido Ascrbico (Vit. C)

Metahemoglobinemia
Aguda Txica
Miastenia Gravis

Metiltionina, Cloruro
4-Aminopiridina

Miastenia Gravis

Piridostigmina

9
138

Migraa

Ciprohetadina

Migraa, Profilaxis

Propranolol

181

Neuralgia Intercostal

Tiamina o Vit. B1

Miocardiopata
Hipertrfica, Trat
Coadyuvante
Mioglobinuria

Propranolol

181

Neuritis Artica

Tiamina o Vit. B1

224

Neuritis Embarazo

Tiamina o Vit. B1

224

Suero Manitol

Neuropata Diabtica

Tiamina o Vit. B1

224

Miorelajante Muscular

Diazepam

70

Piridoxina o Vitamina B6

173

Miorelajante Muscular,
Anestesia General
Miorelajante Muscular,
Anestesia General
Miorelajante Muscular,
Anestesia General
Miorelajante Muscular,
Anestesia General
Miorelajante Muscular,
Induccin Rpida
Miorelajante Muscular,
Intubacin
Miorelajante Muscular,
Intubacin
Miorelajante Muscular,
Intubacin
Miorelajante Muscular,
Intubacin
Miorelajante Muscular,
Intubacin
Miorelajante Muscular,
Intubacin

Atracurio, Besilato

29

Neuropata por
Isoniacida
Neurosis

Cloracepato Dipotsico

Neurosis

Levomepromazina

124

Obsesivo Compulsivo

Sulpirida

217

Obstruccin Vas Areas

Inferiores por Asma
Obstruccin Vas Areas
Inferiores por
Bronquiolitis
Obstruccin Vas Areas
Inferiores por Displasia
Broncopulmonar
Obstruccin Vas Areas
Inferiores por EPOC
Obstruccin Vias Areas
Reversible
Obstruccin Vas Areas
Reversible, Coadyuvante
a Beta-Adrenrgicos
Obstruccin Vias Aereas
Superiores por Anafilaxia

Heliox

106

Heliox

106

Heliox

106

Heliox

106

Salbutamol

191

Ipratropio, Bromuro

117

Heliox

106

984

209

Cisatracurio

47

Pancuronio

164

Rocuronio

190

Succinil Colina o
Suxametonio
Atracurio, Besilato

196

Cisatracurio

29
47

Mivacurio

144

Pancuronio

164

Rocuronio

190

Succinil Colina o
Suxametonio

196

54

URGENCIAS Y EMERGENCIAS EXTRAHOSPITALARIAS GUETS - SESCAM

Patologa

Principio Activo

Obstruccin Vias Aereas

Superiores por Crup
Laringeo
Obstruccin Vias Aereas
Superiores por
Desconexin a
Ventilacin Mecn.
Obstruccin Vias Aereas
Superiores por
Extubacin
Obstruccin Vias Aereas
Superiores por Parlisis
Cuerdas Vocales

Heliox

106

Heliox

106

Obstruccin Vias Aereas

Superiores por
Tumoracin
Pancreatitis

Heliox

106

Suero Coloide Dextrano

204

Panico

Lorazepam

127

Panico, Crisis

Alprazolam

18

Heliox

Heliox

Ref.

106

106

Parada Cardiaca, AESP

Adrenalina

13

Parada Cardiaca, AESP

Atropina

30

Parlisis Facial

Tiamina o Vit. B1

224

Paranoia

Levomepromazina

124

Paranoia

Sulpirida

217

Parto a Trmino por

Atona Uterina
Parto a Termino,
Induccin (Uterotnico)
Parto Prematuro,
(Tocoltico)
Parto Prematuro,
Amenaza
Parto Prematuro,
Amenaza (Embarazo 24 a
33 semanas)
Parto Prematuro,
Amenaza, (Tocoltico)
Parto Prematuro, No
complicado
PCR

Oxitocina

163

Dinoprostona o
Prostaglandina E2
Hexoprenalina, Sulfato

77
110

Terbutalina

222

Atosiban

28

Ritodrina

189

Salbutamol

191

Vasopresina

240

PCR, Asistolia

Adrenalina

13

PCR, Asistolia

Atropina

30

PCR, secundarias a IAM

Lidocana

126

PCR, sospecha
Hipomagnesemia
PCR, tras 10 min. RCP

Magnesio, Sulfato

130

Suero Bicarbonatado

201

Noradrenalina o
Norepinefrina
Cotrimoxazol

156

PCR, Trat Coadyuvante

Pediculosis, resistentes a
Permetrinas
PIC/PIO Alto
PIC/PIO Alto (Profilaxis,
Coma Barbitrico)
Picaduras Insectos

62

Suero Manitol

209

Tiopental Sdico

229

Dexclorfeniramina,
Maleato
Suero Salino Hipertnico

Politraumatizado con
Shock, Si Traslado < 30
min.
Poliuria Diabetes Inspida Suero Glucosado 5%

68
213

206

GUA FARMACOLGICA

Patologa

Principio Activo

Postquirrgico,
Coadyuvante Trat.
Nuseas y Vmitos
Preeclampsia

Ondansetrom

160

Hidralazina

111

Peroxido Hidrgeno o
Agua Oxigenada

170

Suero Manitol

209

Procedimiento
Desbridaje de apsitos y
vendajes adheridos a
heridas
Procedimiento
Diagnstico Anuria
Oliguria
Procedimiento
Diagnstico de Esfuerzo,
Alternativa al Ejercicio
Procedimiento
Diagnstico deteccin
defectos en epitlico
corneal
Procedimiento
Diagnostico Diferencial
Miastenia Gravis
Procedimiento
Diagnstico Ecogrficas
de Estress, Alternativa al
Ejercicio
Procedimiento
Diagnstico exploratorias
intracavitarias, con
irrigacin
Procedimiento
Diagnstico
Feocromocitoma
Procedimiento
Diagnstico Fondo de
Ojo
Procedimiento
Diagnstico
Inconsciencia Idiopatica
Procedimiento
Diagnstico Induccin
Miosis
Procedimiento
Diagnstico Miatemia
Gravis
Procedimiento
Diagnstico o Quirrgico,
Sedacin
Procedimiento
Diagnstico Radiolgica
Procedimiento
Diagnstico, Sedacin
Procedimiento
Diagnstico, Sonda
uretral
Procedimiento
Diagnstico, Tacto Rectal
Procedimiento Dilucin
Medicamentos
Procedimiento Diuresis
Forzadas cidas,
Acidificando la Orina
Procedimiento
Eliminacin Costras de la
piel

Ref.

Dobutamina

79

Colirio Fluoresceina

59

Edrofonio

81

Dobutamina

79

Suero Salino Fisiolgico

Irrigacin

212

Fentolamina

94

Colirio Midritico

60

Flumazenilo

98

Colirio Mitico

61

Neostigmina

Dehidrobenzilperidol

148

66

Polietilenglicol

174

Propofol

182

Vaselina (Petrolato)

239

Vaselina (Petrolato)

239

Suero Agua Destilada o

Esteril
Suero Amnico

197
198

Vaselina (Petrolato)

239

985

URGENCIAS Y EMERGENCIAS EXTRAHOSPITALARIAS GUETS - SESCAM

Patologa

Principio Activo

Procedimiento en ciruga
urolgica transuretral,
Lavado Irrigacin
Procedimiento en
heridas, Lavado por
irrigacin para eliminar
sangre y teji.
Procedimiento en
Irritaciones y
Escoriaciones Piel
Procedimiento en
Legrados Uterinos
Procedimiento
Endoscopia Terapeutica,
Profilaxis de Hemorragia
Procedimiento
Evacucacin Body Packer
Procedimiento
Lubricacin Cateterismo
Procedimiento
Lubricacin Citoscopia
Procedimiento
Lubricacin Citoscopia
Procedimiento
Lubricacin
Electroterapia
Procedimiento
Lubricacin Examen Anal
Procedimiento
Lubricacin Examen
Vaginal
Procedimiento
Lubricacin Intubacin
Procedimiento
Lubricacin Sondaje
Uretral
Procedimiento
Lubricacin Sondas
NasoGastrica
Procedimiento
Lubricacin Sondas
Urolgicas
Procedimiento
Lubricacin Tubo
Endotraquel
Procedimiento
Lubrificante
Procedimiento
Neurolepto Analgesia
(con Analgsicos
Narcticos)
Procedimiento Protector
piel, evita resecarse la
piel
Procedimiento Vehculo
administracin Farmacos
Procedimiento Vehculo
para Inhalar
Medicamentos
Protesis Valvulares
Cardiacas, Profilaxis
Prurito

Suero Manitol

Prurito Agudo y Crnico

986

Suero Salino Fisiolgico

Irrigacin

Vaselina (Petrolato)

Ref.
209

212

239

GUA FARMACOLGICA

Patologa

Principio Activo

Prurito Anogenital

Ciprohetadina

Prurito Varicela

Ciprohetadina

Psicosis

Haloperidol

Psicosis

Levomepromazina

124

Quemaduras Qumicas
Acidas (Anticido Local)
Quemaduras

Suero Bicarbonatado

201

Quemaduras

Furosemida

101

Quemaduras

Piperacilina o Piperazilina

171

Quemaduras

Suero Coloide Albmina

202

Quemaduras

Suero Coloide Almidn o

Hidroxietil-Almidon
Sulfadiazina Argntica

203

Agua Gel

Ref.
46
46
105

15

Metilergometrina,
Maleato
Esomeprazol

136

Polietilenglicol

174

Quemaduras de 2 y 3,
Prevencin Infeccin
Quemaduras Qumicas

Diphoterine

78

Lubricante Anestsico

129

Queratitis Ocular

Colirio Midritico

60

Lubricante Anestsico,

129

Lorazepam

127

Lubricante Hidrosoluble,
HidrosietilCelulosa
Lubricante Hidrosoluble,
HidrosietilCelulosa

128

Metodlopramida,
Clorhidrato

139

Ondansetrom

160

Lubricante Hidrosoluble,
HidrosietilCelulosa
Lubricante Hidrosoluble,
HidrosietilCelulosa

128

Ribavirina

188

Lubricante Anestsico

129

Ondansetrom

160

Lubricante Anestsico

129

Quimioterapia,
Coadyuvante Trat
Nauseas u Vmitos
Quimioterapia,
Coadyuvante Trat
Nauseas u Vmitos
Quimioterapia,
Coadyuvante Trat
Nauseas u Vmitos
Rabia (concomitante con
Ketamina, Midazolam y
Amantadina)
Radioterapia Citotxica,
Coadyuvante Trat.
Nuseas y Vmitos
Raquitismo

Calcio, Gluconato

38

Reaccion Transfusiones

Metilprednisolona

137

87

128

128

216

Lubricante Hidrosoluble,
HidrosietilCelulosa

128

Reaccin Transfusiones

Hidrocortisona

112

128

Peroxido Hidrgeno o
Agua Oxigenada
Hidrocortisona

170

Lubricante Hidrosoluble,
HidrosietilCelulosa

Reblandecedor de
Cerumen auditivo
Rechazo Transplantes
Reflujo Gastroesofgico

Lubricante Hidrosoluble,
Hidrosie.

128

Metodlopramida,
Clorhidrato
Ranitidina

Vaselina (Petrolato)

239

Dehidrobenzilperidol

Vaselina (Petrolato)

66

239

Suero Glucosado 5%

206

Suero Agua Destilada o

Esteril

197

Acenocumarol
Dexclorfeniramina,
Maleato
Ciprohetadina

2
68
46

Reflujo Gastroesofgico
Reversin Efectos
Benzodiacepinas
Reversin Efectos
Heparina
Reversin Efectos
Miorelajantes
Musculares no
Depolarizantes
Reversion Efectos SNC y
Cardiovascular
Anticolinrgica de
Antiespasmdi.
Reversion Efectos SNC y
Cardiovascular
Anticolinrgica de
Antihistamnicos
Reversion Efectos SNC y
Cardiovascular
Anticolinrgica de
AntiParkinsonia.

Flumazenilo

112
139
185
98

Protamina

184

Piridostigmina

172

Fisostigmina, Salicilato

95

Fisostigmina, Salicilato

95

Fisostigmina, Salicilato

95

URGENCIAS Y EMERGENCIAS EXTRAHOSPITALARIAS GUETS - SESCAM

Patologa

Principio Activo

Reversion Efectos SNC y

Cardiovascular
Anticolinrgica de
Benzotropina
Reversion Efectos SNC y
Cardiovascular
Anticolinrgica de
Prociclidina
Reversion Efectos SNC y
Cardiovascular
Anticolinrgica de
Trinexifenidilo
Reversin Fibrinolisis

Fisostigmina, Salicilato

Reversin Miorejante
Muscular (o Bloqueo
Neuromuscuar)
Rocuronio
Reversin Miorelajantes
Musculares no
despolariazntes
Reversin Temblor por
Anfotericina B
Rinitis Alrgica

Ref.
95

Patologa

Principio Activo

Sepsis Plvica

Sepsis Puerperal

Amoxicilina + Acido
Clavulnico
Amoxicilina + Acido
Clavulnico
Imipenem + Cilastatina

Sepsis Pulmonar

Cotrimoxazol

62

Sepsis Respiratoria

Ceftrixona

43

Sepsis Puerperal
Fisostigmina, Salicilato

Fisostigmina, Salicilato

Tranexamico, Acido

Sugammadex

Neostigmina

Meperidina o Petidina

95

95

234

215

148

132

GUA FARMACOLGICA
Ref.
22
22
114

Sepsis Respiratoria

Levofloxacino

123

Sepsis sin foco

Meropenen

134

Sepsis sin foco

Piperacilina o Piperazilina

171

Sepsis SNC

Ampicilina

23

Sepsis SNC

Ceftrixona

43

Sepsis SNC

Cotrimoxazol

62

Sepsis Urolgica

Meropenen

134

Sepsis Urolgica

Piperacilina o Piperazilina

171

Shock

Suero Glucosado 5%

206

Shock

Vasopresina

240

Shock Anafilactico

Adrenalina

13

Shock Anafilactico

Dexametaxona

67

Shock Cardiognico

Adrenalina

Shock Cardiognico

Suero Coloide Dextrano

204

Shock Cardiognico

Suero Ringer Lactato

210

Noradrenalina o
Norepinefrina
Hidrocortisona

156

137

13

68

SCA

Dexclorfeniramina,
Maleato
Acetil Salicilato de Lisina

SCA

Clopidogrel

53

SCA

Plasugrel

178

Shock Cardiognico,
Trat Coadyuvante
Shock General

SCA, Coronariografa,
Previa
SCA, Previa a
Intevencin Coronaria
Percutnea (ICP)
SCA, Previo a Injerto de
Derivacin de Arteria
Coronaria (IDAC)
SCA, Profilaxis
Tromboemblica
SCA. Angioplastia, Previa

Tirofiban

231

Shock General

Metilprednisolona

Shock Hipotensin

Dopamina

Shock Hipotensin

Efedrina

83

Shock Hipotensin

Fenilefrina

90

SCA. Previo a
Intervencion Coronaria
Per.(ICP)
SDR (Sindrome Distress
Respiratorio), Neonatos
Sedacin
Sepsis Abdominal

Ticagrelor

Ticagrelor

226

226

Ticlopidina

227

Tirofiban

231

Clopidogrel

Suero Coloide Albmina

202

Shock Neurognico

Noradrenalina o
Norepinefrina
Suero Coloide Almidn o
Hidroxietil-Almidon
Suero Coloide Almidn o
Hidroxietil-Almidon
Dopamina

156

203

Shock por Sepsis

Suero Coloide Almidn o

Hidroxietil-Almidon
Dopamina

Shock por Trauma

Dopamina

Shock por Ciruga

Shock por Heridas

53

218
142

Shock por Infecciones

203
203
80

80
80

Shock Quemado

Vasopresina

Sepsis Abdominal

Amoxicilina + Acido
Clavulnico
Imipenem + Cilastatina

114

Shock Refractario

Dexametaxona

67

Sepsis Abdominal

Meropenen

134

Piperacilina o Piperazilina

171

Noradrenalina o
Norepinefrina

156

Sepsis Abdominal
Sepsis Cutneas y Tejidos
Blandos
Sepsis Cutneas y Tejidos
Blandos
Sepsis Cutneas y Tejidos
Blandos
Sepsis Gastrointestinal

Clindamicina

Shock resistente a Trat

con Volumen y
Dopamina
Shock Sptico

Suero Ringer Lactato

210

Shock, (2 Alternativa)

Dobutamina

Shock, Colapso
Circulatorio
Sindr. Abstinencia o
Deprivacin Alcohol o
Drogas
Sindr. Abstinencia o
Deprivacin Alcohol o
Drogas

Suero Glucosado
Hipertnico > 10%
Cloracepato Dipotsico

Imipenem + Cilastatina

22

80

Shock Hipovolmico

Shock por IAM

Surfactante Pulmonar
Porcino
Midazolam

112

49
114

Meropenen

134

Cotrimoxazol

62

Sepsis Genitourinario

Ceftrixona

43

Sepsis GenitoUrinario

Cotrimoxazol

62

Sepsis GenitoUrinario

Imipenem + Cilastatina

114

Clorpromazina

240

79
207
54

56

987

URGENCIAS Y EMERGENCIAS EXTRAHOSPITALARIAS GUETS - SESCAM

Patologa

Principio Activo

Sndr. Abstinencia o
Deprivacin Alcohol
Sindr. Abstinencia o
Deprivacin Alcohol
Sindr. Abstinencia o
Deprivacin Alcohol
Sindr. Abstinencia o
Deprivacin Alcohol
Sindr. Eaton-Lambert

Acido Ascrbico (Vit. C)

Ref.
9

Diazepam

70

Tiaprida

225

Clometiazol
4-Aminopiridina

50
1

GUA FARMACOLGICA

Patologa

Principio Activo

Tirotoxica, Crisis

Propranolol

Ref.

Toxmia Gravdica

Diazxido

71

Trastorno Bipolar

Olanzapina

158

Trastornos Psicticos

Clorpromazina

56

Tromboembolismo
Arterial
Tromboembolismo en
Ciruga General y
Ortopedia, Profilaxis
Tromboembolismo
inmovilizados no
quirrgicos
Tromboembolismo
Quirrgico

Estreptoquinasa

88

Enoxaparina Sdica

85

Deltaparina Sdica

63

Deltaparina Sdica

63

Tromboembolismo,
Profilaxis
Tromboembolismo
Profilaxis
Tromboembolismo,
Profilaxis
Trombosis Arteriales

Heparina Sdica

Trombosis Venosa
Profunda (TVP)
TVP Estremidades
Inferionres
TVP, Profilaxis

Estreptoquinasa

Acenocumarol

TVP, Profilaxis

Deltaparina Sdica

63
85

181

Sindr. Extrapiramidal por

induccin de
Clorpromazina
(Primperan)
Sindr. Gilles Tourette

Biperideno

31

Haloperidol

105

Sndr. Gilles Tourette

Levomepromazina

124

Sindr. Hepatorrenal Tipo

I y II
Sindr. Inflamatorios
Agudos
Sindr. Inhalacin humos
incendios
Sndr. Lennox-Gastaut.
Epilepsia, Ausencias
Atpicas
Sindr. Mdula Espinal
por Lesin Crnica
Sindr. Medular Espinal,
por Lesin
Sindr. Neurolptico
Maligno
Sndr. Raynaud

Terlipresina

223

Hidrocortisona

112

Hidroxivobalamina o
Vitamina B12
Clonazepam

113

Dantroleno

64

TVP, Profilaxis

Enoxaparina Sdica

Nifedipino

149

Trombosis Venosas

Acido Acetil Saliclico (AAS)

Sindr. Stokes Adams

Isoproterenol

118

Tumores Carcinoides

Sandostatina u Octreotida

192

Sindr. Tetralogia de Falot

Severa
Sindr. Transposicin
Grandes Vasos
Sindr. WPW

Prostaglandina E1

183

Sandostatina u Octreotida

192

Prostaglandina E1

183

Tumores Gastro EnteroPancreticos

Tumores SNC

Hidrocortisona

112

lcera Corneal

Colirio Midritico

Ulcera Decbito,
Prevencin Infeccin
lcera Gstrica

Sulfadiazina Argntica
Cimetidina

45

87

lcera Gstrica Benigna

Omeprazol

159

4-Aminopiridina
Metilprednisolona

Amiodarona

51

1
137

21

107

Acetil Salicilato de Lisina

Suero Coloide Dextrano

204

Acido Acetil Saliclico (AAS)

Nadroparina

7
88
146
2

60
216

Sndr. WPW

Propafenona

180

Sndr. Zollinger-Eilison

Omeprazol

159

Sindr. Zollinger-Ellison

Esomeprazol

Sndr. Zollinger-Ellison

Pantoprazol

165

lcera Gstrica por AINE

Esomeprazol

87

Sindr. Zollinger-Ellison

Sandostatina u Octreotida

192

lcera GstroDuodenal

Pantoprazol

165

Suroracin Profusa

Suero Glucosado 5%

206

lcera GastroDuodenal

Omeprazol

159

TCE

Citicolina

48

Omeprazol

159

TCE con HTIC

Suero Manitol

209

TCE grave con HTIC

Suero Salino Hipertnico

213

Ranitidina

185

TCE grave con Shock

Hipovolmico
Temblor Esencial, Trat
Coadyuvante
Temblor Idioptico

Suero Salino Hipertnico

213

Propranolol

181

lcera GastroDuodenal
de Estrs, Profilaxis
lcera GastroDuodenal
de Estrs, Profilaxis
lcera GastroDuodenal
Sangrante
lcera GastroDuodenal

Piridoxina o Vitamina B6

173

TEP

Estreptoquinasa

TEP

Morfina, Clorhidrato

145

88

TEP

Oxido Nitroso

161

TEP, Profilaxis

Acenocumarol

Tics

Haloperidol

105

Tics infantiles

Valproico, Acido

237

Tiroiditis, Crisis

Hidrocortisona

112

988

Esomeprazol

87

Ranitidina

185

Ulcera Varicosa,
Prevencin Infeccin
Uvetis

Sulfadiazina Argntica

216

Vasculitis Necrosante

Hidrocortisona

112

Ventilacin Mecanica,
Sedacin
Ventilacin Mecnica,
SedoAnalgesia
Verrugas piel

Propofol

182

Colirio Midritico

Fentanilo Citrato
Nitrato Plata

60

39
151

URGENCIAS Y EMERGENCIAS EXTRAHOSPITALARIAS GUETS - SESCAM

Patologa

Principio Activo

Vrtigo

Sulpirida

Ref.
217

Vmitos (Antiemtico)

139

Vmitos (Antiemtico)

Metodlopramida,
Clorhidrato
Ondansetrom

160

Vmitos (Antiemtico)

Tiaprida

225

Vmitos (Antiemtico)
en Embarazo

Piridoxina o Vitamina B6

173

GUA FARMACOLGICA

Patologa

Principio Activo

Vomitos Agudos por

Cisplatino
Vmitos y Nuseas en
Procedimientos
Diagnsticos y
Quirrgicos
Xerodermia

Metodlopramida,
Clorhidrato
Dehidrobenzilperidol

Ref.
139

Vaselina (Petrolato)

239

66

CATEGORA DE RIESGO DE LOS MEDICAMENTOS EN EL EMBARAZO SEGN LA FDA:

Categoria A:
Uso seguro durante todo el embarazo avalado por estudios clnicos en humanos.
Categoria B:
Uso seguro en animales (usando dosis superiores a las humanas). No hay estudios clnicos especficos en humanos. Se
acepta su uso durante el embarazo.
Categoria C:
Estudios en animales, usando dosis superiores a las humanas, han registrado efectos embriotxicos o teratgenos en
alguna o varias especies. No hay estudios clnicos especficos en humanos. Su beneficio teraputico puede ser
eventualmente superior a su eventual riesgo teratgeno, pudiendo estar justificado su uso en embarazadas bajo riguroso
control mdico.
Categoria D:
Hay evidencias de riesgo para el feto humano. En ciertos casos su beneficio podra ser superior a su potencial teratgeno
usados bajo riguroso control mdico.
Categoria X:
Son teratgenos. Contraindicados en el embarazo.

989