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AZ Drug Profile Flashcards

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1
Q

Acetylsalicylic Acid (Aspirin, ASA) Class

A

Analgesic, antipyretic, anti-inflammatory

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2
Q

Aspirin MOA

A

In small doses aspirin blocks thromboxane A2, a potent platelet aggregate and vasoconstrictor

Decreased platelet aggregate

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3
Q

Aspirin Indications

A

Chest pain or other S/S suggestive of acute MI

ECG changes suggestive acute MI

Unstable Angina

Pain, discomfort, fever, in adult only

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4
Q

Aspirin Contraindications

A

Bleeding Ulcer, hemorrhagic states, hemophilia

Known hypersensitivity to salicylates or other non-steroidal anti-inflammatories that has led to hypotension and/or bronchospasm

Children and adolescents

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5
Q

Aspirin Adverse reactions

A

Use with caution if history of asthma, anaphylactic reactions have occurred

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6
Q

Aspirin Adult Dosages

A

Cardiac: 160-325 mg (2-4 pediatric chewable tabs), chew or swallow

Pain/discomfort/fever: 325 mg po

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7
Q

Adenosine Class

A

Antiarrhythmic, endogenous nucleoside

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8
Q

Adenosine MOA

A

Slows conduction time thru AV node; can interrupt re-entrant pathways through the AV node

Slows sinus rate

Larger doses increase BP by decreasing peripheral resistance

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9
Q

Adenosine Indications

A

Conversion of supraventricular tachycardias with no known atrial fibrillation or atrial flutter

Undifferentiated regular monomorphic wide-complex tachycardia

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10
Q

Adenosine Contraindications

A

Sick sinus syndrome, 2nd or 3rd degree AV block, except in pt with functioning ventricular pacemaker

Use cautiously in pts with known asthma

Pts on theophylline and related methylxanthines

Pts on dipyridamole or carbamazepine

Cardiac transplant patients are more sensitive to adenosine and require a small dose

Known a-fib or a-flutter

Pregnancy

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11
Q

Adenosine Incompatibilities

A

Adenosine is not blocked by Atropine

Theophylline and related methylxanthines in therapeutic concentrations decrease effectiveness

Dipryidamole and carbamazepine block uptake and potentiate effects

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12
Q

Adenosine Dosage

A

Adult: 6 mg IV fast push, follow with 20 mL flush, repeat in 1-2 min at 12mg

Pediatric: Initial: 0.1 mg/kg as a rapid IV bolus, 2-3 ml normal saline flush, repeat double dose 0.2 mg/kg

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13
Q

Albuterol Sulfate Class

A

Sympathomimetic, bronchodilator

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14
Q

Albuterol MOA

A

Beta agonist (primarily B2), relaxes bronchial smooth muscle, resulting in bronchodilation; relaxes vascular and uterine smooth muscle, decreases airway resistance

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15
Q

Albuterol Indications

A

Treatment of bronchospasm

Treatment of hyperkalemia

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16
Q

Albuterol Contraindications

A

Synergistic with other sympathomimetics

Use caution in patients with diabetes, hyperthyroidism, and cerebrovascular disease

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17
Q

Amiodarone Class

A

Antiarrhythmic Agent

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18
Q

Amiodarone MOA

A
  • Multiple effects on sodium, potassium and calcium channels
  • Prolongs action potential, refractory period
  • Ventricular automaticity (potassium channel blockade)
  • Slows membrane depolarization and impulse conduction (sodium channel blockade)

-Negative chronotropic activity in nodal tissue, rate reduction, and antisympathetic
activity

-Dilates coronary arteries due to calcium channel and alpha-adrenergic blocking action

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19
Q

Amiodarone Indications

A

-Treatment of: defibrillation-refractory VF/pulseless VT, polymorphic VT, and wide
complex tachycardia of uncertain origin

  • Control hemodynamically stable ventricular tachycardia when cardioversion
    unsuccessful.

-Adjunct to cardioversion of SVT and PSVT.
Rate control in atrial fibrillation or flutter

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20
Q

Amiodarone Contraindications

A
  • Bradycardia
  • Second or third degree heart block unless a functioning pacemaker is present
  • Cardiogenic shock
  • Hypotension
  • Pulmonary congestion
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21
Q

Amiodarone Incompatibilities

A

-Beta blockers, calcium channel blockers, and other antiarrhythmics are additive and can
be proarrhythmic when given in combination with Amiodarone due to similar
mechanisms of action

-Amiodarone precipitates at certain concentrations when mixed at a Y-site with sodium
bicarbonate, furosemide, and heparin.

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22
Q

Amiodarone Dosage

A

VF/Pulseless VT
300 mg IV push over 30 – 60 seconds, may repeat in 3-5 minutes with 150 mg IV push

Wide-Complex Tachycardias, Atrial Flutter, Atrial Fibrillation, SVT with
cardioversion
150 mg IV over 10 minutes (mix in 50 mL bag of D5W) may repeat every 10 minutes

Maintenance Infusion Post Resuscitation/Conversion
After successful defibrillation, follow with up to 1mg/min IV infusion for 6 hours, then
up to 0.5 mg/min IV infusion for up to 18 hours, maximum daily dose is 2.2 grams
Mix 450 mg in 250 mL of D5W (special polyolefin bag), concentration 1.8 mg/mL, and
run at 33.3 mL/hr for 1 mg/min or 16.7 mL/hr for 0.5 mg/min

For Other Maintenance infusion
Rates range from 0.5 mg/min to 1mg/min. Maximum daily dose is 2.2 grams

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23
Q

Amiodarone Pediatric Dosage

A

VF/Pulseless VT
5 mg/kg IV push (max 300 mg single dose), may repeat every 5 minutes two times to a
total maximum of 15 mg/kg/day

Probable VT with pulse
5 mg/kg IV administered over 20 minutes may repeat two more times to a total of 15
mg/kg/day

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24
Q

Albuterol Incompatibilites

A

Tricyclic antidepressants (TCA’s) and monoamine oxidase (MAO) inhibitors

Other sympathomimetics (relative)

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25
Albuterol Dosages
Adult: 2.5 mg of premixed solution via SVN with a mouth piece, or in-line with a ventilatory device Ped: 2.5 mg of premixed solution via SVN with a mouth piece, or in-line with a ventilatory device May administer up to 5mg per dose according to medical control preference
26
Bumetanide Class
Loop Diuretic
27
Bumetanide MOA
Inhibits electrolyte reabsorption in the ascending loop of Henle leading to diuresis
28
Bumetanide Indications
Pulmonary Edema | CHF
29
Bumetanide Contraindications
``` Hypersensitivity Anuria Electrolyte deficiencies Hepatic coma Cautious use: hepatic cirrhosis, ascites, history of gout, hypersensitivity to furosemide ```
30
Bumetanide Incompatibilities
NSAIDs reduce diuretic effect May increase blood levels of lithium increasing risk of lithium poisoning Potentiates effects of various antihypertensive drugs
31
Bumetanide Dosages:
0.5 to 1.0 mg IV slowly over 1-2 min Not safe for peds
32
Calcium Chloride Class
Electrolyte
33
Calcium Chloride MOA
Increases extracellular and intracellular calcium levels Stimulates release of catecholamines Increases cardiac contractile state (positive inotropic effect) May enhance ventricular automaticity Inhibits the effects of adenosine on mast cells
34
Calcium Chloride Indications
Acute hypocalcemia Calcium channel blocker OD Acute hyperkalemia (known or suspected) Hypermagnesemia (Magnesium OD) Pre-treatment for IV calcium channel blocker administration
35
Calcium Chloride Contraindications
Hypercalcemia | Concurrent Digoxin therapy
36
Calcium Chloride Adult Dosages
Hypocalcemia, calcium channel blocker OD, hyperkalemia and hypermagnesemia: 5-10 ml (0.5-1 Gm) of 10% calcium chloride. May repeat in 10 minutes Pre-treatment for IV calcium channel blocker administration: 3 ml of 10% calcium chloride. May be repeated once
37
Calcium Chloride Ped Dosage
Hypocalcemia, calcium channel blocker OD hyperkalemia and hypermagnesemia: 0.2 - 0.25 ml/kg of a 10% solution infused slowly. Should not be repeated without documented calcium deficiency
38
Succinylcholine Class
Ultra-short-acting depolarizing-type skeletal muscle relaxant
39
Succinylcholine MOA
Combines with cholinergic receptors of the motor end plate to produce depolarization Hydrolyzed by acetylcholinesterase
40
Succinylcholine Indications
Endotracheal intubation requiring paralysis (RSI) by a qualified Paramedic with authorization from the Paramedic’s administrative medical director
41
Succinylcholine Contraindications
Muscle disorders Personal or family history of malignant hyperthermia History of hyperkalemia Burn injured patients* Ocular injuries Patients in whom successful endotracheal intubation is doubtful
42
Succinylcholine Incompatibilities
Beta-blockers, procainamide, lithium, and quinidine prolong the effects
43
Succinylcholine Dosage
Adult: 0.6-2 mg/kg IV push, may repeat once in 2-3 minutes if inadequate response to initial dose to achieve paralysis Ped: 1-2 mg/kg IV push, may repeat once in 2-3 minutes if inadequate response to initial dose to achieve paralysis
44
Glucagon Class
Pancreatic hormone, polypeptide, hyperglycemic agent
45
Glucagon MOA
Acts only on liver glycogen, converting it to glucose. Counteracts the effect of insulin. Relaxes GI smooth muscle causing dilation and decreased motility. Cardiac inotrope May reverse hypoglycemia (if patient has glycogen stored in liver) within 4-8 minutes
46
Glucagon Indications
Symptomatic hypoglycemia when IV access is delayed. Beta blocker poisoning
47
Glucagon Contraindications
Known hypersensitivity Pheochromocytoma Insulinoma Should not be routinely used to replace dextrose when IV access has been obtained
48
Glucagon Dosage
Adult: Hypoglycemia: 1 mg IM, may repeat 7-10 min Ped: Hypoglycemia 0.5 mg IM or a dose equivalent to 20-30 mcg/kg
49
Dopamine Class:
Sympathomimetic
50
Dopamine MOA:
2-10 g/kg/min, affects Beta1 Cardio Shock 1-2 megs/kg affects Dope receptors
51
Dopamine Indications:
Symptomatic brady (2nd line drug to Atropine) Hemodynamically significant hypotension in the absence of hypovolemia Cardiogenic/Septic Shock ONLY after fluid administration; assess breath sounds first
52
Dopamine Contrindications:
``` Pheochromocytoma Hypersensitivity Hypovolemic Shock MAO inhibitors (Marplan, Nardil, Parnate) Tachy-arrythmias / V-Fib ```
53
Dopamine Incompatibilities:
Incompatible in ant alkaline solution | On-board MAO inhibitors will cause hypertensive crisis
54
Dopamine Dosages:
Adult: Range (2-20 g/kg/min) Prep: add 400mg/250 ml NS or Dextrose = 1600 g/ml Brady: start at 5 g/kg/min BP 70 start at 2.5 g/kg/min Peds: 2-20 g/kg/min for circulatory shock or shock unresponsive to fluid administration Prep: 6 x body weight in kg = mg added to NS to make 100ml
55
Lidocaine Class:
anti-arrhythmic, local anesthetic
56
Lidocaine MOA:
Decreases automaticity Terminates re-entry Increases VF threshold
57
Lidocaine Indications
Suppression of ventricular arrhythmias (Vtach, Vfib, PVCs) Prophylaxis against recurrence after conversion from vtach or vfib Pain management after IO insertion in conscious patients
58
Lidocaine Contraindications
Known hypersensitivity/allergy Use extreme caution in patients with conduction disturbance Do not treat ectopic beats if heart rate is
59
Lidocaine Adult Dosages
VF/pVT: Initial Bolus of 1.0-1.5 mg/kg every 3-5 minutes. Total 3 mg/kg Cardiac Arrest: 1.5mg/kg Antidysrhythmic: Initial boluses 0.5-0.75mg/kg up to 1.0-1.5mg/kg additional bolus at 0.5-0.75 mg/kg every 5-10 minutes. Total dose 3 mg/kg Maintenance infusion: 2-4mg/min IO pain management: 20-40mg
60
Lidocaine Pediatric Dosages
VF/pVT: 1 mg/kg may repeat 1 time in 3-5 minutes ROSC: 20-50 mcg/kg/min IO Pain Management: 0.1 mg/kg not to exceed adult dosage
61
Atropine Class:
Anti-cholinergic Anti-arrhythmic Anti-spasmatic antidote Anti-muscarinic
62
Atropine MOA:
Block the action of ACh as a competitive antagonist at muscarinic receptor sites of smooth muscles Blocks parasympathetic response to the Vagus nerve, allowing sympathetic response to take over, resulting in increased cardiac output and drying of secretions
63
Atropine Indications:
Symptomatic bradycardia causing severe hypotension Chest pain ALOC Systole (after epi) monitored Pt only PEA w/ actual or red bradycardia (after epi) monitored Pt only Acetylcholinesterase inhibitor poisoning (organophosphate, carbamate, cholinergic poisoning)
64
Atropine Contraindications:
Hypersensitivity Belladonna alkaloid allergy Glaucoma, adhesions of iris & lens Tachycardia; Mobitz type II block, 3rd degree heart blocks Obstructive GI disease; paralytic, ulcerative colitis Hepatic or Renal disease; obstructive uropathy Myasthenia gravis (except to treat acetylcholinesterase inhibitor)
65
Atropine Bradycardia Dosages
Adult: IV/IO – 0.5 mg every 5 minutes. Do NOT exceed a total dose of 3 mg or 0.04mg/kg Peds: IV/IO – 0.02 mg/kg (minimum of 0.1 mg), repeat every 5 minutes to a max total dose of 1 mg in children and 2 mg in adolescents
66
Atropine Organophosphate Dosage
Adult: IV/IO – Initially: 1-5 mg. Doses should be doubled every 5 minutes until signs of muscarinic excess abate Peds:IV/IO – 0.03-0.05 mg/kg every 10 to 20 minutes until cholinergic symptoms minimize, then every 1 to 4 hours for at least 24 hours
67
Ipratropium Bromide Class
Anticholinergic Bronchodilator
68
Ipratropium Bromide MOA
Anticholinergic (parasympatholytic) agent, antagonizes the action of acetylcholine
69
Ipratropium Bromide Indications
Tx of bronchospasm associated with COPD, alone or in combination with other bronchodilators

AZ Drug Profiles (1 decks)

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