Drug Indication And Contraindication

Question 1

Acetazolamide

Answer 1

Indications: Acute mountain sickness (treatment
and prophylaxis), adjunctive therapy for
glaucoma, edema, epilepsy, drug-induced edema
or edema due to heart failure.

Contraindications: Hypersensitivity, hypokalemia,
hyponatremia, renal dysfunction, liver
dysfunction

Question 2

Acetaminophen

Answer 2

Indications: Pain control, fever control

Contraindications: Hypersensitivity, severe acute liver disease

Question 3

Acetic acid

Answer 3

Indications: Otitis externa,
Pain control for jellyfish envenomation (outside of the USA)

Question 4

Acetylcysteine

Answer 4

Indications: Antidote for Acetaminophen overdose,
atelectasis, bronchopulmonary disease,
tracheostomy care

Contraindications Hypersensitivity, acute asthma

Question 5

Activated Charcoal

Answer 5

Indications Most oral poisonings and medication
overdoses; can be used after evacuation of poisons

Contraindications Oral administration to
comatose patients; after ingestion of corrosives,
caustics, petroleum distillates (ineffective
and may induce vomiting); simultaneous
administration with other oral drugs. Use
caution in patients experiencing abdominal pain
of unknown origin or known GI obstruction, Unprotected airway (beware of aspiration), caustic ingestions, intestinal obstruction

Question 6

Adenosine

Answer 6

Indications: Conversion of narrow-complex
regular tachycardia to sinus rhythm. May
convert reentry SVT due to Wolff-ParkinsonWhite syndrome. Can be used diagnostically
for stable, regular, monomorphic wide-complex
tachycardia. Adenosine may treat the VT or it
may help diagnose the underlying rhythm

Contraindications: Known hypersensitivity.
Second- or third-degree AV block or sick
sinus syndrome or other sinus node disease
unless a functioning artificial pacemaker is
present; bronchoconstrictive or bronchospastic
lung disease (asthma, COPD); poison- or
drug-induced tachycardia

Question 7

Albuterol

Answer 7

Indications: Treatment of bronchospasm in
patients with reversible obstructive airway
disease (COPD/asthma). Prevention of
exercise-induced bronchospasm

Contraindications: Known prior hypersensitivity
reactions to albuterol. Tachycardia, dysrhythmias,
especially those caused by digitalis. Synergistic
with other sympathomimetics

Question 8

Amiodarone

Answer 8

Indications: Stable, regular narrow complex
tachycardia if the rhythm persists despite vagal
maneuvers or adenosine or the tachycardia
is recurrent; to control the ventricular
rate in stable, irregular narrow complex
tachycardia (ie, AF); to control the ventricular
rate in preexcited atrial dysrhythmias with
conduction over an accessory pathway;
stable monomorphic VT; polymorphic VT
with a normal QT interval; cardiac arrest
resulting from VF or pulseless VT after CPR,
defibrillation, and a vasopressor

Contraindications: Known hypersensitivity,
cardiogenic shock, second- or third-degree AV
block or sick sinus syndrome or other sinus
node disease unless a functioning artificial
pacemaker is present

Question 9

Amyl Nitrite

Answer 9

Indications: Cyanide poisoning

Contraindications: None in the emergency setting

Question 10

Aspirin

Answer 10

Indications: New onset chest discomfort suggestive
of ACS

Contraindications: Hypersensitivity. Relatively
contraindicated in patients with active ulcer
disease or asthma

Question 11

Atropine

Answer 11

Indications: Hemodynamically unstable
bradycardia, organophosphate poisoning, nerve
agent exposure, RSI in pediatrics, beta-blocker or
calcium channel blocker overdose

Contraindications: Tachycardia, hypersensitivity,
unstable cardiovascular status in acute
hemorrhage with myocardial ischemia, narrow-angle glaucoma, hypothermic bradycardia

Question 12

Calcium Chloride

Answer 12

Indications: Hypocalcemia, hyperkalemia,
hypermagnesemia, beta-blocker and calcium
channel blocker toxicity, use in topical burns (hydrofluoric acid) or calcium channel blocker overdose

Contraindications: Hypercalcemia, VF (relative),
digitalis toxicity, documented hypersensitivity, life threatening cardiac arrhythmias may occur in known or suspected severe hypokalemia

Question 13

Calcium Gluconate

Answer 13

Indications: Hyperkalemia, hypocalcemia,
hypermagnesemia, beta-blocker and calcium
channel blocker overdose
For use in topical burns (hydrofluoric acid) or calcium channel blocker overdose

Contraindications: VF, digitalis toxicity,
hypercalcemia
documented hypersensitivity, sarcoidosis, life-threatening cardiac arrhythmias may occur in known or suspected severe hypokalemia

Question 14

Cimetidine

Answer 14

Indications: For the management of gastric or duodenal ulcers, gastroesophageal reflux, as an adjunct in the treatment of urticarial and pruritis in pts suffering from allergic reaction

Contraindications Hypersensitivity to cimetidine or other H2-receptor antagonists

Question 15

Dexamethasone

Answer 15

Indications: Used in teh management of croup and bronchospasm, as well as the management of pts suffering from high altitude cerebral edema (HACE)

Contraindications: Documented hypersensitivity, systemic fungal infection, cerebral malaria

Question 16

Dextrose

Answer 16

Indications: Used for the management of hypoglycemia

Contraindications: Hyperglycemia, anuria, diabetic coma, intracranial or intraspinal hemorrhage, dehydrated pts with delirium, glucose-galactose malabsorption syndrome, and documented hypersensitivity

Question 17

Diazepam

Answer 17

Indication: For use in agitated or violent pts, as well as for the management for seizures

Contraindications: Documented hypersensitivity, severe respiratory depression

Question 18

Diltiazem

Answer 18

Indication: For management of narrow complex tachycardias

Contraindications: Documented hypersensitivity, Wolff-parkinson-White syndrome, Lown-Ganong-Levine syndrome, severe symptomatic hypotension (systolic BP < 90 mmHg), sick sinus syndrome (if no pacemaker), second and third-degree heart block (if no pacemaker present), and complete heart block. Contraindications for IV administration: Use in newborns (because of benzyl alcohol), concomitant beta-blocker therapy, cardiogenic shock, ventricular tachycardia (must determine whether the origin is supraventricular or ventricular)

Question 19

Diphenhydramine

Answer 19

Indications: For urticarial and pruritis in the management of pts suffering from the allergic reaction as well as for the management of pts suffering from dystonia/akasthisia

Contraindications: Documented hypersensitivity, use controversial in lower respiratory tract disease (such as acute asthma), premature infants and neonates

Question 20

Dopamine

Answer 20

Indications: As a pressor agent used in the management of shock

Contraindications: Hypersensitivity to dopamine, pheochromocytoma, ventricular fibrillation, uncorrected tachyarrhythmias

Question 21

Droperidol

Answer 21

Indications: For use in the pt when acute delirium or psychosis

Contraindications: Hypersensitivity, known or suspected prolonged QT interval; QTc interval > 450 msec in females or > 440 msec in males

Question 22

Epinephrine

Answer 22

Indications: For use in the management of pts suffering anaphylaxis, shock, cardiac arrest, bradycardia, or in the nebulized form for coup/bronchiolitis and IM form for refractory acute asthma

Contraindications: Hypersensitivity, cardiac dilatation, and coronary insufficiency

Question 23

Famotidine

Answer 23

Indications: For the management of gastric or duodenal ulcers gastroesophageal reflux, as an adjunct in the treatment of urticarial and pruritus in pts suffering from an allergic reaction

Contraindications: Hypersensitivity to famotidine or other H2-receptor antagonists

Question 24

Fentanyl

Answer 24

Indications: management of acute pain

Contraindications: Hypersensitivity

Warning: Should be used with caution in the elderly and pts with hypotension, suspected gastrointestinal obstruction, head injury, and concomitant CNS depressants

Question 25

Glucagon

Answer 25

Indications: For the management of hypoglycemic pts as well as pts suffering symptomatic bradycardia after beta-blocker or calcium channel blocker overdose Contraindications: Hypersensitivity, pheochromocytoma, insulinoma *Warning:* Nausea and vomiting are common adverse effects following the administration of glucagon

Question 26

Haloperidol

Answer 26

Indications: For the management of acute psychosis or agitated/violent behavior refractory to non-pharmacologic interventions Contraindications: Documented hypersensitivity, Severe CNS depression (including coma), neuroleptic malignant syndrome, poorly controlled seizure disorder, Parkinson's disease *Warning:* Risk of sudden death, torsades de pointed, and prolonged QT interval from off-label IV administration of higher than the recommended dose. Continuous cardiac monitoring is required if administering IV

Question 27

Helium Gas Mixture

Answer 27

Indications: Persistent or severe bronchospasm in non-intubated pts with obstructive airway disease or pediatric pts with croup unresponsive to all other evidence-based medical interventions Contraindications: None

Question 28

Hydralazine

Answer 28

Indications: Severe hypertension with pre-eclampsia symptoms Contraindications: Hypersensitivity, coronary artery disease, mitral valve rheumatic heart disease. Use with caution in CVA, known renal disease, hypotension

Question 29

Hydrocortisone succinate

Answer 29

Indications: For the management of adrenal insufficiency Contraindications: Untreated serious infections (except tuberculous meningitis or septic shock), idiopathic thrombocytopenic purpura, intrathecal administration (injection), documented hypersensitivity

Question 30

Hydromorphone

Answer 30

Indications: Management of acute pain Contraindications: Hypersensitivity *Warning:* Should be used with caution in the elderly and pts with hypotension, suspected

Question 31

Hydroxocobalamin

Answer 31

Indications: For the management of cyanide toxicity Contraindications: Documented hypersensitivity *Warning:* This will cause discoloration of the skin, and urine can interfere with pulse oximetry. Due to its interference with specific diagnostic blood tests, the performance of prehospital phlebotomy is preferable prior to the administration of hydroxocobalamin

Question 32

Ibuprofen

Answer 32

Indications: For the acute management of pain or as an antipyretic Contraindications: Aspirin allergy; perioperative pain in the setting of coronary artery bypass graft (CABG) surgery; preterm infants with untreated proven or suspected infection; bleeding with active intracranial hemorrhage or GI bleed; thrombocytopenia, coagulation defects, proven or necrotizing enterocolitis, significant renal impairment, congenital heart disease where patency or the pt ductus arteriosis (PDA) is necessary for pulmonary or systemic blood flow.

Question 33

Ipratropium

Answer 33

Indications: For the management of asthma and COPD Contraindications: Documented hypersensitivity to ipratropium, atropine, or derivatives

Question 34

Isopropyl Alcohol

Answer 34

Indications: Nausea and vomiting Contraindications: None

Question 35

Ketamine

Answer 35

Indications: For the management of agitated or violent behavior Contraindications: Hypersensitivity * RELATIVE/CONTROVERSIAL CONTRAINDICATIONS:* Head trauma, intracranial mass/hemorrhage, hypertension, angina, and stroke, underlying psychiatric disorder * Warning:* Overdose may lead to panic attacks and aggressive behavior; rarely seizures, increased ICP, and cardiac arrest. Very similar in chemical makeup to PCP (phencyclidine), but it is shorter acting and less toxic

Question 36

Ketorolac

Answer 36

Indications: for the acute management of moderately severe pain Contraindications: allergy to aspirin, ketorolac, or other NSAIDS; women who are in active labor or are breastfeeding, significant renal impairment particularly when associated with volume depletion, previous or current GI bleeding, intracranial bleeding, coagulation defects, pts with a high risk of bleeding

Question 37

Labetalol

Answer 37

Indications: Severe hypertension with pre-eclampsia symptoms Contraindications: Asthma or obstructive airway disease, severe bradycardia, second-degree or third-degree heart block (without pacemaker), cardiogenic shock, bronchial asthma, uncompensated cardiac failure, hypersensitivity, sinus bradycardia, sick sinus syndrome without permanent pacemaker; conditions associated with prolonged and severe hypotension. Use caution in pts taking calcium channel blockers. Hypotension with or without syncope may occur; monitor. Consider pre-existing conditions, such as sick sinus syndrome, before initiating therapy. Use caution in pts with a history of severe anaphylaxis to allergens; pts taking beta-blockers may become more sensitive torepeated challenges; treatment with epinephrine in pts taking beta-blockers may be ineffective or promote undesirable effects. Use with caution in pts with myasthenia gravis, psoriasis, or psychiatric illness (may cause or exacerbate CNS depression)

Question 38

Lidocaine

Answer 38

Indications: For the management of refractory or recurrent ventricular fibrillation or pulseless VT Contraindications: Hypersensitivity to lidocaine or amide-type local anesthetic, Adams-Stokes syndrome, SA/AV/intraventricular heart block in the absence of artificial pacemaker. CHF, cardiogenic shock, second and third-degree heart block (if no pacemaker is present), Wolff-Parkinson-White Syndrome

Question 39

Lorazepam

Answer 39

Indications: For the management of seizures, uncontrolled shivering in hypothermia, and for the management of agitated or violent pts suffering behavioral emergencies Contraindications: Documented hypersensitivity, acute narrow-angle glaucoma, severe respiratory depression, sleep apnea

Question 40

Magnesium sulfate

Answer 40

Indications: For the management of torsades de pointed or severe bronchoconstriction with impending respiratory failure, seizure during the third trimester of pregnancy or in the postpartum pt Contraindications: Hypersensitivity, myocardial damage, diabetic coma, heart block, hypermagnesemia, hypercalcemia

Question 41

Methylprednisolone

Answer 41

Indications: For the management of acute bronchospastic disease as well as for adrenal insufficiency Contraindications: Untreated serious infections, documented hypersensitivity, IM route is contraindicated in idiopathic thrombocytopenic purpura, traumatic brain injury (high doses)

Question 42

Metoclopramide

Answer 42

Indications: For the management of nasea and vomiting Contraindications: Hypersensitivity to metoclopramide or procainamide, GI hemorrhage, mechanical obstruction, perforation, history of seizures, pheochromocytoma. Other drugs causing extrapyramidal symptoms (e.g., phenothiazines, butyrophenones)

Question 43

Metoprolol

Answer 43

Indications: For management of narrow complex tachycardias Contraindications: Hypersensitivity. When administered for hypertension or angia: Sinus bradycardia, second or third-degree AV block, cardiogenic shock, sick sinus syndrome (unless permanent pacemaker in place), severe peripheral vascular disease, pheochromocytoma. When administered for myocardial infarction: Severe sinus bradycardia with heart rate \< 45 beats/minute, systolic BP \< 100 mmHg, significant first-degree heart block (PR interval at least 0.24 seconds), moderate-to-severe cardiac failure Warning: May cause first, second, or 3rd degree AV block

Question 44

Midazolam

Answer 44

Indications: For the management of seizures, uncontrolled shivering in hypothermia, and for the management of agitated or violent pts suffering behavioral emergencies Contraindications: Documented hypersensitivity, severe respiratory depression, sleep apnea *Warning:* May cause respiratory depression, arrest, or apnea

Question 45

Morphine Sulfate

Answer 45

Indications: Management of acute pain Contraindications: Hypersensitivity, paralytic ileus, toxin-mediated diarrhea, respiratory depression, acute or severe bronchial asthma, upper airway obstruction, GI obstruction (extended-release), hypercarbia (immediate-release tablets/solution), upper airway obstructions (epidural/intrathecal), heart failure due to chronic lung disease, head injuries, brain tumors, delirium tremens, seizure disorders, during labor when premature birth anticipated (injectable formulation), cardiac arrhythmia, increased intracranial or cerebrospinal pressure, acute alcoholism, use after biliary tract surgery, surgical anastomosis (suppository formulation)

Question 46

Naloxone

Answer 46

Indications: Reversal of acute opioid toxicity Contraindications: Hypersensitivity *Warning:* Administration of naloxone can result in the sudden onset of opiate withdrawal (agitation, tachycardia, pulmonary edema, nausea, vomiting, and, in neonates, seizures)

Question 47

Nifedipine

Answer 47

Indications: For the management of high altitude pulmonary edema (HAPE) Contraindications: Hypersensitivity of nifedipine or other calcium-channel blockers, cardiogenic shock, concomitant administration with strong CYP34A4 inducers (e.g., rifampin, rifabutin, phenobarbital, phenytoin, carbamazepine, St. John's wort) significantly reduces nifedipine efficacy, Immediate release preparation (sublingually or orally) for urgent or emergent hypertension

Question 48

Nitrous Oxide

Answer 48

Indications: Analgesia in the pt who is capable of self-administration of this medication Contraindications: Significant respiratory compromise, suspected abnormal air-filled cavities (e.g., pneumothorax, bowel obstruction, air embolism) *RELATIVE CONTRAINDICATIONS:* History of stroke, hypotension, pregnancy, known cardiac conditions, known vitamin B12 deficiency

Question 49

Nitroglycerin

Answer 49

Indications: As an anti-anginal medication for the management of chest pain as well as a reducer of preload for pts suffering from acute pulmonary edema Contraindications: Hypersensitivity, acute myocardial infarction, severe anemia, recent use of erectile dysfunction medications (sildenafil (viagra--within the last 24 hours), tadalafil (Cialis--within last 48 hours), vardenafil (Levitra--within last 48 hours), or other phosphodiesterase-5 inhibitors). There is potential for dangerous hypotension narrow-angle glaucoma (controversial: may not be clinically significant). Nitrates are contraindicated in the presence of hypotension (SBP \< 90 mmHg or \> mmHg below baseline), extreme bradycardia (\< 50 bpm), tachycardia in the absence of heart failure (\>100bpm), and right ventricular infarction

Question 50

Norepinephrine

Answer 50

Indications: As a pressor agent used in the management of shock Contraindications: Hypersensitivity, hypotension due to blood volume deficit, peripheral vascular thrombosis (except for lifesaving procedures) * RELATIVE CONTRAINDICATIONS:* Concomitant use with some general anesthetics: chloroform, trichloroethylene, cyclopropane, halothane * WARNING:* Norepinephrine is a vesicant and can cause severe tissue damage if extravasation occurs. Do not use the same IV line as alkaline solutions as these may deactivate it

Question 51

Olanzapine

Answer 51

Indications: For the management of agitated or violent pts suffering a behavioral emergency Contraindications: Documented hypersensitivity *WARNING:* Pts are at risk for severe sedation (including coma) or delirium after each injection and must be observed for at least 3 hours in a registered facility with ready access to emergency response services. Pts are at significant risk of severe sedation when olanzapine is administered with benzodiazepines or to pts who have been taking benzodiazepines

Question 52

Ondansetron

Answer 52

Indications: For the management of nausea or vomiting *NOTE:* EKG monitoring is recommended in pts who have electrolyte abnormalities, CHF, or bradyarrhythmias or who are also receiving other medications that cause QT prolongation Contraindications: Hypersensitivity, coadministration with apomorphine; combination reported to cause profound hypotension and loss of consciousness *WARNING:* May cause dose-dependent QT prolongation, avoid in pts with congenital long QT syndrome

Question 53

Oxymetazoline

Answer 53

Indications: For the management of epistaxis in the pt suffering facial trauma Contraindications: hypersensitivity

Question 54

Potassium iodide

Answer 54

Indications: Indicated during environmental radiation emergency to block uptake of radioactive iodine isotopes in thyroid and reduce risk of thyroid cancer Contraindications: Iodine sensitivity (although an allergy to radiocontrast media, contact dermatitis from iodine-containing antibacterial, allergy to seafood should not be considered evidence of potassium iodide allergy), hyperthyroidism, respiratory failure

Question 55

Pralidoxime chloride (2-PAM)

Answer 55

Indications: For the management of toxicity caused by organophosphate insecticides and related nerve gases (e.g., tabun, sarin, soman) Contraindications: Documented hypersensitivity

Question 56

Procainamide

Answer 56

Indications: For the management of stable pts with regular, wide complex tachycardia Contraindications: Hypersensitivity to procainamide or other ingredients, complete heart clock, second or third-degree AV block, systemic lupus erythematosus (SLE), torsades de pointes *RELATIVE CONTRAINDICATION:* Pts with QT prolongation

Question 57

Prochlorperazine

Answer 57

Indications: For the management of nausea and vomiting Contraindications: Documented hypersensitivity to phenothiazines, coma, severe CNS depression, concurrent use of large amounts of CNS depressants, poorly controlled seizure disorder, subcortical brain damage, pediatric surgery, children \< 2 years or weighing \< 9kg

Question 58

Sildenafil

Answer 58

Indications: As an adjunct to descent in the management of high altitude pulmonary edema (HAPE) Contraindications: Concomitant use of organic nitrates in any form (e.g., nitroglycerin, isosorbide, illicit “poppers”) either regularly or intermittently, increases risk of severe or potentially fatal hypotension, hypersensitivity *WARNING:* Hypotension may occur due to vasodilation

Question 59

Sodium Bicarbonate

Answer 59

Indications: For the management of cardiac arrest in cases in which either hyperkalemia or tricyclic antidepressants (TCA) overdose are suspected as contributory, QRS prolongation in known or suspected TCA overdose Contraindications: Documented hypersensitivity, severe pulmonary edema, known alkalosis, hypernatremia, or hypocalcemia

Question 60

Sodium Nitrite

Answer 60

Indications: For the management of cyanide toxicity Contraindications: Documented hypersensitivity, suspected or confirmed smoke inhalation, and carbon monoxide poisoning *WARNING:* There is a risk of worsening hypoxia due to methemoglobin formation. In addition, sodium nitrite can cause severe adverse reactions and death from hypotension and methemoglobin formation. Monitor to ensure adequate perfusion and oxygenation during treatment with sodium nitrite

Question 61

Sodium Thiosulfate

Answer 61

Indications: For the management of cyanide toxicity Contraindications: Documented hypersensitivity

Question 62

Sorbitol

Answer 62

Indications: Administered for the management of pts suffering from toxic ingestions Contraindications: Acute abdominal pain, nausea, vomiting, or other symptoms of appendicitis or underdiagnosed abdominal pain, documented hypersensitivity *WARNING:* Sorbitol is no longer recommended to be given with activated charcoal

Question 63

Tadalafil

Answer 63

Indications: As an adjunct to descent in the management of high altitude pulmonary edema (HAPE) Contraindications: Concomitant use of any form of organic nitrates (e.g., nitroglycerin, isosorbide dinitrate, isosorbide mononitrate, illicit “poppers”), either regularly or intermittently; may potentiate hypotensive effect of nitrates. Hypersensitivity, including Stevens-Johnson syndrome and exfoliative dermatitis *WARNING:* Hypotension may occur due to vasodilation

Question 64

Ziprasidone

Answer 64

Indications: For the management of agitated or violent pts suffering a behavioral emergency Contraindications: Documented hypersensitivity, any drugs or conditions that prolong QT interval, recent acute myocardial infarction, uncompensated heart failure