Drugs Flashcards

Question

Atropine Sulfate (Atropine and others)

Answer 1

Class: Anticholinergic agent Description: Atropine inhibits actions of acetylcholine at post ganglionic parasympathetic receptor sites. Small doses inhibit salivary and bronchial secretions; moderate doses dilate pupils and increases heart rate. Large doses decrease GI motility, inhibit gastric acid secretion, and may block nicotinic receptor sites at the autonomic ganglia and at the neuromuscular junction. Block vagal effects result in increased heart rate and enhanced AV conduction with limited or no inotropic effect. In emergency care, it is primary used to increase the heart rate in life-threatening or symptomatic bradycardia, and to antagonized excess muscarinic receptor stimulation caused by organophosphate insecticides or chemical nerve agents (sarin, soman, etc.) Indications: Hemodyamically significant bradycardia, asystole, PEA, Organophosphate or nerve gas poisoning, Bronchospastic pulmonary disorder (exercised-induced). Contraindications: Tachycardia, Hypersensitivity to Atropine, Obstructive disease of Gi tract, Obstructive uropathy, Unstable cardiovascular status in acute hemorrhage with myocardial ischemia, Narrow-angle glaucoma, Throtoxicosis. Adverse Reactions: Tachycardia, Paradoxical bradycardia when pushed too slowly or when used at doses less than 0.5 mg, Palpitations, Dysrhythmias, Headache, Dizziness, Anticholinergic effects, Nausea/Vomiting, Flushed hot, dry skin, Allergic Reaction. Dosage: Bradydysrhythmias Adult: 0.5-1mg, repeated at 5 minute intervals for desired response. (max 0.03-0.04mg/kg) Peds: 0.02mg/kg Iv, IO, ET (diluted to 3-5mL); min dose 0.1mg; max single dose of 0.5mg for a child and 1.0mg for an adolescent may be repeated in 5 min for a max total dose of 1.0mg for child and 2.0mg for adolescent ``` Dosage: ASYSTOLE Adult: 1 mg IV, ET (1-2 mg diluted to a total of 10mL) may repeated every 3-5 minutes Peds: Same as for bradydysrhythmias ``` ``` Dosage: PEA Adult: 1.0mg repeat every 3-5 minutes Peds: Safety and efficiency not established ``` Dosage: ANTICHOLINERIGIC Adult: 2mg IV push every 5-15 minutes to dry secretions, repeat as needed, then every 1-4 hours for at least 24 hours How Supplied: In emergency care Atropine is supplied in pre-filled syringes containing 1.0mg in 10 mL of solution.

Answer 2

Class: Analgesic, anti-inflammatory, antipyretic, antiplatelet Description: Aspirin blocks pain impulses in the CNS, dilutes peripheral vessels, and decreases platelet aggregation. The use of Aspirin is strongly recommended for all acute MI patients. Indications: Mild to moderate pain or fever, prevention of platelet aggregation in ischemia and thromboembolism, unstable angina, prevention of myocardial infarction or rein fraction Contraindications: Hypersensitivity, GI Bleed, Active ulcer disease, Hemorrhagic Stroke, Bleeding disorder, children with Flu like symptoms Adverse Reactions: Stomach irritation, Heart burn/indigestion, Nausea or vomiting, Allergic reaction . Dosage: Adult: Mild pain and fever 325-650 mg PO every 4 hours Myocardial Infarction: 160-325 mg PO (Patients should chew the first one) Peds: Mild pain and fever: 40-100 mg/kg/day in divided dosaes ``` How Supplied: Tablets (65, 81, 325, 500, 650, 975 mg) Capsules ( 325, 500 mg) Controlled Release tablets (800mg) Suppositories (varies from 60 mg to 1.2 gm) ```

Answer 3

Class: Electrolyte Description: Calcium is an essential component for functional integrity of the nervous and muscular systems, for normal cardiac contractility; and the coagulation of blood. Calcium chloride contains 27.7% element calcium. Calcium chloride is a hypertonic solution and should only be administered intravenously (slowly) Indications: Hyperkalemia (except when associated with digitalis toxicity), Hypocalcemia, Calcium channel blocker toxicity, Hypermagesemia, to prevent hypotensive effects of calcium channel blocking agents. Containdications: VF during cardiac resuscitation, in patients with digitalis toxicity, Hypercalcemia, Renal or cardiac disease Adverse Reactions: Bradycardia, (May cause asystole), Hypotension, Metallic taste, Severe local necrosis and sloughing following IM use or IV infiltration Dosage: Adult: 2-4mg/kg (usually 1-2) or 10% solution slow IV; repeat every 10 minutes if necessary Peds: 20-25%mg/kg of 10% solution slow IV (no faster than 100mg/min) may repeat in 10 min if necessary How Supplied: 10% solution in 10mL (100mg/mL) ampule, vitals, and pre-filled syringes.

Answer 4

Class: Glucocorticoid Description: Dexamethasone is a synthetic steroid that is chemically related to the natural hormones secreted by the adrenal cortex. The drug suppresses acute and chronic inflammation, potentiates the relaxation of the vascular and bronchial smooth muscle by beta adrenergic agonists, and possibly alters airway hyper-activity. In emergency care, Dexamethasone is generally used in the treatment of allergic reactions, and asthma. Indications: Endocrine, rheumatic, hematologic disorders, Allergic states, septic shock, chronic inflammation Contraindications: Hypersensitivity, Active untreated infections (relative) Adverse Reactions: Hypertension, GI bleeding ``` Dosage: Adult: This in considerable variance in recommended doses. The usual range in emergency care is 4-24mg IVP. Some physicians may prefer significantly higher doses up to 100 mg, for usual indications. Peds: 0.25-0.5mg/kg/dose IVP or IO ``` How Supplied: 4 mg/mL in 1, 5, 10, 25, 30 mL vials; 10mg/mL in 10 vials, 1 mL syringe, 1 mL ampule

Answer 5

Class: Cardiac Glucoside, Miscellaneous Antidysrhythmic Description: Digoxin is a cardiac glucoside derived primarily from the foxglove plant. Its primary action involves alteration of ion transport across cardiac cell membranes. Increased intracellular calcium improves myocardial contractility. Digoxin increases vagal tone and therefore indirectly decreases sinus node rate, reduces sympathetic tone and decreases AV node conduction velocity (with an increases in AV node refractory period). Sodium pumped out of cells may cause increased automaticity. Indications: SVTs especially A-Fib and A-flutter, CHF, and Cardiogenic shock Contraindications: VF, VT, AV block, Digitalis toxicity, hypersensitivity to digoxin, Second or third degree HB in the absence of artificial pacing Adverse Reactions: Headache, weakness, visual disturbances, confusion, seizures, dysrhythmia, nausea/vomiting, skin rash Dosage Adult: 0.5 mg slow IV (usually administered in 2-3 doses over 6-12 hours) Peds: Older than 2 years old: 0.015-0.035 mg/kg slow IV in divided doses; consult medical direction for dose recommendations in children > 5 years How Supplied: In emergency care 2mL ampules containing 0.5mg of the drug (0.25mg/mL) Pediatric: 0.1 mg/mL

Answer 6

Class: Benzodiazepine Description: Diazepam is a frequently prescribed medication to treat anxiety and stress. In emergency care, it is used to treat alcohol withdrawal and grand mal seizure activity. Diazepam acts on the limbic, thalamic, and hypothalamic regions of the CNS to potentiate the effects of inhibitory neuromuscular transmitters, raising the seizure threshold in the motor cortex. It may also be used in conscious patients during cardioversion and TCP to induce amnesia and sedation. Its use as an anticonvulsant may be short-lived due to rapid redistribution and excessive sedation, particularly in elderly patients. Indications: Acute anxiety, acute alcohol withdrawal, skeletal muscle relaxation, Seizure activity, Premedication prior to countershock ot TCP Contraindications: Hypersensitivity to the drug, substance abuse (use with caution), Coma (unless PT has seizures or severe muscle rigidity or myoclonus), Shock, CNS depression as a result of head injury, Respiratory depression Adverse Reactions: Hypotension, Reflex tachycardia (rare), Respiratory depression, Ataxia, Psychomotor impairment, Confusion, Nausea Dosage: SEIZURE ACTIVITY: Adult: 5mg over 2 min (up to 10mg for most adults) IV every 10-15 min as needed (maximum dose 30 mg) Peds: Dose for infants > 30 days to 5 years is 0.2mg to 0.5mg slow IV every 2-5 min to max 5mg. How Supplied: 5mg/mL vials, ampules, Tubex

Answer 7

Class: Carbohydrate, Hypertonic solution Description: The term "Dextrose" is used to describe the six carbon sugar d-glucose, the principal form of carbonhydrate utilized by the body. 50% dextrose solution (D50) is used in emergency care to treat hypoglycemia, and in the management of coma of unknown origin. Indications: Hyperglycemia, Altered level of consciousness, Coma of unknown etiology, seizure of unknown etiology. Contraindications: Intracranial hemorrhage, ICP, Known or suspected CVA in the absence of hypoglycemia Adverse Reactions: Warmth, pain, burning from medication infusion, hyperglycemia, thrombophlebitis ``` Dosage: Adult: 12.5-25 g slow IV; may be repeated once Peds: Dilute 1:1 with sterile water for a concentration of 25% dextrose in water, administer 0.5-1.0 g/kg/dose slow IV; may be repeated once ``` How Supplied: 25g /50mL prefilled syringe (500mg/mL)

Answer 8

Class: Slow calcium blocker or calcium channel antagonist Description: Diltiazem is a calcium channel blocking agent that slows conduction, increases refractoriness in AV node, and causes coronary and peripheral vasodilation. The drug is used to control ventricular response rate in patients with A-fib or flutter, multifocal atrial tachycardias and PSVT Indications: Atrial Fib, Atrial Flutter, PSVTs, and multifocal atrial tachycardias Containdications: Sick sinus syndrome, Second or Third degree AV block, hypotension (less than 90 mmHg), Cardiogenic shock, hypersensitivity to Diltiazem, A-fib or A-flutter associated with WPW syndrome or a short PR syndrome, Concomitant use of IV beta blockers, VT, Wide-complex tachycardia of unknown origin, AMI Adverse Reactions: A-flutter, first and second degree HB, Bradycardia, hypotension, chest pain, CHF, Peripheral edema, sweating, nausea/vomiting, Dizziness, Dry mouth, Dyspnea, headache Dosage: Adult: Bolus injection: 0.25mg/kg (20 mg for th average PT) IVP over 2 min, every 15 min (0.35 mg/kg; 25 mg for the average patient) IVP over 2-5 min. Maintenance Infusion: dilute 125 mg(25mL) in 100mL of solution; infuse 5-15 mg/hr titrate to heart rate Peds: Similar mg/kg doses as adults (rarely required in Ped Patients) How Supplied: 25 mg and 50 mg vials

Answer 9

Class: Antihistamine Description: Antihistamines prevent the physiologic actions of histamine by blocking H1 and H2 receptor sites. The effects of antihistamines are short lived and provide only symptomatic relief. Antihistamines are indicated for conditions in which histamine excess is present, but also are used as adjunct therapy (with Epinephrine) in the treatment of anaphylactic shock. Antihistamines also are effective in the treatment of extrapyramidal reactions and for relief of upper respiratory and sinus symptoms associated with allergic reactions. Indications: Moderate to severe allergic reactions (after epinephrine), anaphylaxis, Acute extrapyramidal reactions Contraindications: Patients taking monoamine oxidase (MAO) inhibitors, hypersensitivity, narrow angle glaucoma (relative), newborns and nursing mothers Adverse Reactions: Dose-related drowsiness, sedation, disturbed coordination, Hypotension, Palpitations, Tachycardia, Bradycardia, Thickening or bronchial secretions Dosage: Adult: 25-50 mg IM, IV every 6-8 hours (max 300 mg/day) Peds: 5 mg/kg/day in divided doses (max 300 mg/day) How Supplied: Parenteral: 10, 50 mg/mL vials and prefilled syringes

Answer 10

Class: Sympathomimetic Description: Dobutamine is a synthetic catecholamine that primarily stimulates beta1 adrenergic receptors, and has much less significant effects on beta 2 and Alpha adrenergic receptors. The clinical effects of this drug include positive Inotropic effects with minimal changes in chronotropic activity or systemic vascular resistance. For these reasons, this drug is useful in the management of CHF when an increase in heart rate is not desired. Indications: Inotropic support for patients with left ventricular dysfunction Contraindications: Tachydysrhythmias, (atrial fibrillation, atrial flutter), severe hypotension Adverse Reactions: Headache, Dose-related tachydysrythmias, hypertension, Ventricular ectopy Dose: Adult: 2.5-10 mcg/kg/min IV based on inotropic effect; max rate; 40 mcg/kg/min Peds: 2-20 mcg/kg/min IV/IO, titrated to desired effect How Supplied: 12.5 mg/mL Injectable

Answer 11

Class: Sympathomimetic (increases myocardial contraction) Description: Dopamine is chemically related to epinephrine and norepinephrine. It acts primarily on alpha1 and beta1 adrenergic receptors in dose dependent fashion. At low doses (renal doses), dopamine acts on dopaminergic receptors causing renal, mesenteric and cerebral vascular dilation. At moderate doses, dopamine stimulates beta adrenergic receptors increasing cardiac contractility, increased cardiac output, and a rise in blood pressure. At high doses, dopamine has alpha adrenergic effect, producing peripheral arterial and venous constriction. Dopamine is commonly used in the treatment of hypotension associated with cardiogenic shock. Indications: Hemodynamically significant hypotension in the absence of hypovolemia Contraindications: Tachydysrhythmias, Ventricular fibrillation, Patients with pheochromocytoma Adverse Reactions: Dose related tachydysrhythmias, Hypotension, Increased myocardial oxygen demand ``` Dosage: Adult: 1-5 mcg/kg/min IV (titrated to patient responses) Final dose range 5-20 mcg/kg/min is recommended. Dopaminergic response: 1-5 mcg/mg/min Beta Adrenergic response: 5-15 mcg/kg/min. Alpha Adrenergic response: >15 mcg/kg/min Peds: 10 mcg/kg/min IV/IO, titrated to patient response (not to exceed 20 mcg/kg/min) ``` How Supplied: 200 mg, 400 mg, 800 mg in 5 mL prefilled syringe and ampule

Answer 12

Class: Sympathomimetic Description: Epinephrine is an endogenous catecholamine that directly stimulates Alpha, beta1, and beta2 adrenergic receptors in dose-related fashion. It is the initial drug of choice for treating Bronchoconstriction and hypotension resulting from anaphylaxis as well as all forms of cardiac arrest. It is useful in the management of relative airway disease, but beta adrenergic agents are usually considered the drugs of choice since they are inhaled and have fewer side effects. Rapid injection produces a rapid increase in blood pressure, ventricular contractility, and heart rate. In addition, epinephrine causes vasoconstriction of the skin, mucosa, and spanchnic areas, and antagonizes the effects of histamine. Indications: Bronchial asthma, Acute allergic reaction (anaphylaxis), Cardiac arrest; asystole, PEA, VF, and pulseless ventricular tachycardia unresponsive to initial defibrillation, Profound symptomatic bradycardia Contraindications: Hypersensitivity, (not an issue especially in emergencies- the dose should be lowered or given slowly in non cardiac arrest patients with heart disease), Hypovolemic shock (as with other catecholamine, correct hypovolemia), Coronary insufficiency (use with caution) Adverse Reactions: Headache, Nausea, Restlessness, Weakness, Dysrhythmias (including ventricular tachycardia and ventricular fibrillation) Hypertension, Precipitation of angina pectoris, Tachycardia Dosage: ASYSTOLE, PEA, VF, PVT Adult: 1mg IV push or ET (2-2.5 times the IV dose) repeated every 3-5 min Peds: IV/IO 0.1 mL/kg (1:10,000); doses as high as 0.2 mL/kg may be effective ET dose is 0.1 mL/kg (1:1,000) dilutes to 3-5 mL SUBSEQUENT DOSES: IV/IO/ET 0.1 mL/kg (1:1,000) every 3-5 min; doses as high as 0.2 mL/kg may be effective ANAPHYLACTIC REACTIONS OR BRONCHOCONSTRICTION: Adult: Mild 0.3-0.5mL (1:1,000) SQ Moderate to Severe 1-2 mL (1:10,000) Slow IV Peds: Mild 0.01 mL/kg SQ (1:1,000) Max 0.3 mL Moderate to Severe 0.05-0.15 mcg/kg/min IV infusion How Supplied: 1mg/mL (1;1,000), 0.1mg/mL (1:10,000) ampule and prefilled syringe. Auto injector Pen (0.5mg/mL (1:2,000))

Answer 13

Class: Sympathomimetic Description: As with other forms of Epinephrine, racemic epinephrine acts as a bronchodilator that stimulates beta2 receptors in the lungs, resulting in relaxation of bronchial smooth muscle. This alleviates bronchospasms, increases vital capacity, and reduces airway resistance. It is also useful in treating laryngeal edema, Racemic epinephrine also inhibits the release of histamine. Indications: Bronchial asthma, Treatment of bronchospasms, Croup, Laryngeal edema Contraindications: Hypertension, underlying cardiovascular disease, epiglottitis Adverse Reactions: Tachycardia, dysrhythmias Dosage: MDI 2-3 inhalations, repeat once in 5 min as needed Adult: Dilute 5 mL (1%) in 5 mL saline, administer over 15 minutes Peds: Dilute 0.25 mL (0.1%) in 2.5 mL saline (if less than 20 kg); 0.5 mL in 2.5 mL saline (if 20-40 kg); 0.75 mL in 2.5 mL of saline (if greater than 40 kg) administered by aerosolization How Supplied: MDI: 0.16-0.25 mg/spray Solution: 7.5, 15, 30 mL in 1%, 2.25% solution

Answer 14

Class: Pancreatic hormone, insulin antagonist Description: Glucagon is a protein secreted by the alpha cells of the pancreas. When released, it results in blood glucose elevation by increasing the breakdown of glycogen to glucose (glycogenolysis) and stimulating glucose synthesis. The drug is only effective in treating hypoglycemia if live glycogen is available, and may therefore be ineffective in chronic states of hypoglycemia, starvation, and adrenal insufficiency. In addition, glucagon exerts positive inotropic action on the heart and decreases renal vasculature resistance. For this reason it is also used in managing patients with beta-blocker and calcium channel blocker cardiotoxicity who do not respond to saline infusions or other conventional therapy. Indications: Persistent hypoglycemia despite glucose supplementation Contraindications: Hypersensitivity (allergy to proteins) Adverse Reactions: Tachycardia, Hypotension, Nausea/Vomiting ``` Dosage: Adult: 0.5-1 mg IM; may repeat in 7-10 min Peds: 0.025-1 mg IM; may repeat in 7-10 min ``` How Supplied: Dilute 1 unit into 1 mL diluting solution

Answer 15

Class: Loop diuretic Description: Furosemide is a potent diuretic that inhibits the reabsorption of sodium and chloride in the proximal tubule and loop of Henle. Intravenous doses can also reduce cardiac reload by increasing venous capacitance. Indications: Pulmonary edema associated with CHF, hepatic or renal disease Contraindications: Anuria (though loop diuretics can be used in patients with reduced creatinine clearance), Hypersensitivity, Hypovolemia/dehydration, Hypersensitivities to sulfonamides, Severe electrolyte depletion (hypokalemia) Adverse Reactions: Hypotension, ECG changes associated with electrolyte disturbances, Dry Mouth, Hypokalemia, Hyponatremia, Hyperglycemia, Hearing loss can rarely occur after too rapid infusion of large doses especially in patients with renal impairment. ``` Dosage Adult: 20-40 mg (0.5-1 mg/kg) slow IV over 1-2 min; (not to exceed 20 mg/min); may repeat in 1-2 hours Peds: 1 mg/kg/dose (max 6 mg/kg total dose) ``` How Supplies: 10 mg/mL in 2, 4, 8 mL ampule, 10 mg/mL in 10 mL vial

Answer 16

Class: Benzodiazepine receptor antagonist, Antidote Description: Flumazenil antagonizes the actions of benzodiazepines in the central nervous system. It has been shown to reverse sedation, impairment of recall, and psychomotor impairment produced by benzodiazepines, Flumazenil is not, however, as effective in reversing hypoventilation. Flumazenil does not antagonize CNS effects of ethanol, barbiturates, or opioids. Indications: Reversal of excessive or prolonged benzodiazepine sedation Contraindications: Hypersensitivity, Cyclic antidepressant overdose, Cocaine or other stimulant intoxication. Adverse Reactions: Nausea, Vomiting, Dizziness, Headache, Agitation, Injection-site Pain, Cutaneous vasodilation, Abnormal vision, Seizures ``` Dosage Adult: 0.2 mg IV over 30 seconds; an additional dose of 0.3 mg (3 mL) may be given in 30 seconds, followed by 0.5 mg (5 mL) at 1 min intervals (max dose 3 mg) Peds: Not recommended ``` How Supplied: 5 and 10 mL vials (0.1 mg/mL)

Answer 17

Class: Non-barbiturate hypnotic, Anesthetic Description: Etomidate is a short acting drug that acts at the levels of the reticular activation system to produce anesthesia. Etomidate may be administered for conscious sedation to relieve apprehension or impaired memory prior to tracheal intubation or cardioversion. Indications: Premedication for tracheal intubation or cardioversion Contraindications: Hypersensitivity to Etomidate, Labor/delivery Adverse Reactions: Nausea/vomiting, dysrhythmias, breathing difficulties, hypotension, hypertension, involuntary muscle movement, pain at injection site ``` Dosage Adult: 0.2-0.6 mg/kg IVP over 30-60 sec Peds: Same as adult (over 10 years of age) ``` How Supplied: 2 mg/mL vial

Answer 18

Class: Antihypertensive, Vasodilator Description: Hydralazine is an arteriolar vasodilating agent that is used in the management of hypertensive crisis. The effects of the drug include a decrease in arterial pressure, a decrease in peripheral resistance, and increase in cardiac output (as result of reflex tachycardia) Indications: Hypertensive crisis, Hypertension associated with renal failure, preeclampsia, and eclampsia, Primary pulmonary HTN. Contraindications: Compensatory hypertension, Coronary artery disease, Dissecting aneurysm, Hypersensitivity, Mitral Valve/rheumatic heart disease Adverse Reactions: Reflex tachycardia, Palpitations, Hypotension, Facial flushing, Headache, Diaphoresis, Anxiety, Nausea/vomiting, Diarrhea Dosage: Adult: 10-40 mg IM or IV may be repeated in 10 min prn Infusion: 20 mg in 250 cc NS or LR at 5-20 mg/hr Peds: 0.1-0.2 mg/kg/dose every 4-6 hours IM or IV; may be repeated prn Infusion: 0.75-3 mg/kg every 6-12 hours How Supplied: 20 mg in 1 mL ampule (20 mg/mL)

Answer 19

Class: Anticoagulant Description: Heparin inhibits the clotting cascade by activating plasma proteins. The drug is used in the prevention and treatment of all types of thrombosis and emboli, DIC, arterial occlusion and thrombophlebitis, and prophylactically to prevent clotting before and after surgery. Heparin is also considered part of the "Thrombolytic package" administered to patients with acute myocardial infarction (along with aspirin and Thrombolytic agents) and acute coronary syndromes including unstable angina and non Q wave myocardial infarction. Indications: Acute myocardial infarction, Prophylaxis and treatment of Thrombolytic disorders. Contraindications: Hypersensitivity, Active bleeding, Recent intracranial, intraspinal, or eye surgery, severe hypertension, bleeding tendencies, severe thrombocytopenia Adverse Reactions: Allergic reaction, Thrombocytopenia, Hemorrhage, Bruising Dosage: Always obtain a blood sample for control of partial thromboplastin time before heparin administration. Heparin doses range from 100-500 Units (follow medical direction and local protocol) How Supplied: 10, 100, and 100-400 U/mL

Answer 20

Class: Antihistamine Description: Hydroxzine is a H1 receptor antagonist that is used to treat allergy-induced pruritus, and is used preoperatively for its antiemetic and sedative properties. It is also effective for treatment of anxiety and tension associated with neuroses and alcohol withdrawal. Concomitant use with analgesics may potentiate their effects. Indications: To potentiate the effects of analgesics, Nausea and vomiting, Anxiety reactions, Motion sickness, Alcohol withdrawal, Pruritus Adverse Reactions: Dry mouth, Drowsiness ``` Dosage Adult: 25-100 mg deep IM Peds: 1.0 mg/kg/dose deep IM ``` How Supplied: 25 and 50 mg/mL in 1 mL vials

Answer 21

Class: Antidiabetic agent Description: Insulin is secreted by the beta cells (islets of Langerhans) of the pancreas and is required for proper glucose utilization by the body. If insulin secretion is diminished (diabetes mellitus) supplemental insulin must be obtained by injection. Insulin preparations are classified as rapid acting (regular) intermediate (NPH) and long acting (Ultralente). Insulin is seldom is administered in the prehospital setting, and then only when ketoacidosis is confirmed. Indications: Type I, Type II, Diabetic ketoacidosis, Nonketotic hypermolar coma, Insulin and D50 are given together to lower K levels in hyperkalemia Contraindications: Hypoglycemia Adverse Reactions: Hypoglycemia, fatigue, weakness, confusion, headache, tachycardia, rapid shallow breathing ``` Dosage Adult: 10-20 units Peds: 0.1-0.2 units/kg/hr IM ``` How Supplied: 100 units/mL in 10 mL vials

Answer 22

Class: Sympathomimetic Description: Isoproterenol is a sympathetic catecholamine that stimulates both beta1 and beta2 adrenergic receptors (no alpha receptor stimulation). The drug affects the heart by increasing inotropic and chronotropic activity. In addition, Isoproterenol causes arterial and bronchial dilation, and is sometimes administered via aerolizaion as a bronchodilator to treat bronchial asthma and bronchospasms. Indications: Hemodynamically significant bradycardias unresponsive to atropine, TCP, Dopamine, and Epinephrine, Management of torsades de pointes Contraindications: Ventricular tachycardia, Ventricular fibrillation, Hypotension (relative), Pulseless idioventricular rhythm, Ischemic heart disease/angina (relative), Cardiac arrest Adverse Reactions: Dysrhythmias, Hypotension, Precipitation of angina pectoris, Facial flushing, Restlessness, Dry throat, Discoloration of saliva (pinkish-red) Dosage Adult: Dilute 1 mg in 250 mL D5W (4mg/mL); infuse at 2-20 mcg/min or until the desired heart rate is obtained Peds: Dilute 0.6 mg/kg to create solution of 100mL; begin infusion at 5 mL/hr (0.5 mcg/kg/min), titrate to patient response ``` How Supplied: 5 mL (0.2 mg/mL) vial; 0.02 mg/mL in 1 and 10 mL vials ```

Answer 23

Class: Benzodiazepine Description: Lorazepam is a benzodiazepine with antianxiety and anticonvulsant, skeletal muscle relaxant, anxiety reducing, amnesic and sedative effects. When given by injection, it appears to suppress the propagation of seizure activity produced by foci in the cortex, thalamus, and limbic areas. Indications: Seizure, Sedation for painful procedures or injuries or combative patients. Post RSI sedation. Agitation requiring sedation, Initial control of status epilepticus or severe recurrent seizures (investigation). Contraindications: Hypersensitivity to the drug, Substance abuse (relative), Coma (unless seizing), Severe hypotension, Shock, Pre-existing CNS Depression Adverse Reactions: Respiratory depression, Tachycardia/Bradycardia, Hypotension, Sedation, Ataxia, Psychomotor impairment, Confusion, Paradoxical excitement or agitation may occur. Use with caution in the presence of other sedating agents; alcohol, barbiturates, benzodiazepines, or opiates. Dosage Prior to IV administration, Lorazepam must be diluted with an equal volume of sterile water or sterile saline. When given IM, Lorazepam is not to be diluted. Adult: 1-4 mg slow IM/IV over 1-2 min; may be repeated in 15-20 min to max dose of 8 mg Peds: (Not FDA approved) 0.05-0.15 mg/kg slow IV/IO/IM over 2 min; may be repeated once in 5-10 min, max dose 4 mg How Supplied: 2 and 4 mg/mL concentrations in 1 mL vials

Answer 24

Class: Alpha and Beta Adrenergic blocker Description: Labetalol is a competitive alpha1 receptor block as well as a nonselective beta receptor blocker that is used for lowering blood pressure in hypertensive crisis. Because of alpha and beta blocking properties, blood pressure is reduced without reflex tachycardia, and total peripheral resistance is decreased without a significant alteration in cardiac output. In emergency care, Labetalol is administered intravenously. Indications: Hypersensitive emergencies ``` Contraindications: Bronchial asthma (relative), Uncompensated CHF, Second and third degree heart block, Cardiogenic shock, Bradycardia, Pulmonary edema ``` Adverse Reactions: Headache, dizziness, edema, fatigue, vertigo, ventricular dysrhythmias, dyspnea, allergic reaction, facial flushing, diaphoresis, dose related orthostatic hypotension (most common) Dosage Adult: 10-20 mg IV over 1-2 min. May repeat or double every 20 min to max dose of 150 mg Infusion: Mix 200 mg in 250 D5W (0.8mg/mL); infuse at rate of 2 mg/min, titrated to supine blood pressure Peds: Safety not established How Supplied: 5 mg/mL in 4, 8, 20 and 40 vitals

Answer 25

Class: Antidysrhythmic (Class I-B) Local anesthetic Description: Lidocaine decreases Phase 4 diastolic depolarization, and has been shown to be effective is suppressing PVCs. In addition, it is used to treat ventricular tachycardia and some cases of ventricular fibrillation. Lidocaine also raises the ventricular fibrillation threshold. Indications: Ventricular tachycardia, Ventricular fibrillation, Wide-complex tachycardia of uncertain origin, Significant ventricular ectopy in the setting of myocardial ischemia/infarction. Contraindications: Hypersensitivity, Adams-Stokes syndrome, Second- or Third-degree heart block in the absence of an artificial pacemaker Adverse Reactions: Lightheadedness, Confusion, Blurred Vision, Hypotension, Cardiovascular collapse, Bradycardia, ALOC, Irritability, Muscle Twitching, Seizures with high doses ``` Dosage CARDIAC ARREST: Adult: 1.0 - 1.5 mg/kg IV bolus or ET (2 - 2.5 times IV dose) Repeat 3-5 min (max total dose 3 mg/kg); a single dose of 1.5mg/kg is acceptable Peds: 1 mg/kg IV/IO or ET (diluted to 3 -5 mL) ``` MAINTENANCE INFUSION : AFTER RESUSCITATION FROM CARDIAC ARREST Adult: 2 mg in 500 mL D5W; infuse at 2-4 mg/min (4:1 concentration) Ped: Dilute 120 mg in 100 mL D5W; infuse at 20-50 mcg/kg/min (1-2.5 mL/kg/hr) WIDE-COMPLEX PSVT/WIDE COMPLEX TACHYCARDIA OR UNCERTAIN ORIGIN TYPE/STABLE VT Adult: Initial dose 1-1.5 mg/kg IV; if needed, give 0.5-0.75 mg/kg in 5-10 min (max total dose 3 mg/kg); after conversion start a drip 2-4 mg/min Ped: Initial loading dose 1 mg/kg IV/IO followed by an infusion of 20-50 mcg/kg/min How Supplied Prefilled 100 mg in 5 mL of solution, 1 and 2 gm additive syringes, 100 mg in 5 mL of solution vials, 1 and 2 gm vials in 30 mL of solution

Answer 26

Class: Adsorbent Actions: Adsorbs toxins by chemical binding and prevents gastrointestinal adsorption Indications: Poisoning following emesis or when emesis is contraindicated. Contraindications: None in severe poisoning Precautions: Should only be administered following emesis, in cases in which it is so indicated. Use with caution in patients with altered mental status. May adsorb Ipecac before emesis. If Ipecac is administered, wait at least 10 minutes to administer activated charcoal. Side Effects: Nausea, vomiting, and constipation Dosage: 1 g/kg (typically 50-75 grams) mixed with a glass of water to form a slurry Pediatric: 1 g/kg mixed with a glass of water to form a slurry Route: Oral

Answer 27

Class: antiarrhythmic Actions: Slows AV conduction Indications: Symptomatic PSVT Contraindications: Sencond- or third-degree heart block, sick-sinus syndrome, known hypersensitivity to the drug. Precautions: Arrhythmias, including blocks, are common at the time of cardioversion. Use with caution in patients with asthma. Side Effects: Facial flushing, headache, shortness of breath, dizziness, and nausea Dosage: 6 mg given as a rapid IV bolus over a 1-2 second period; if, after 1-2 minutes, cardioversion does not occur, administer a 12 mg dose over 1-2 seconds Pediatric Dose: Safety in children has not been established Routes: IV; should be administered directly into a vein or into the medication administration port closest to the patient and followed by flushing of the line with IV fluid

Answer 28

Class: Sympathomimetic (B2 selective) Actions: Bronochodilation Indications: Asthma reversible bronchospasm associated with COPD Contraindications: Know hypersensitivity to the drug, symptomatic tachycardia Precautions: Blood pressure, pulse, and EKG should be monitored use caution In patients with known heart disease Side Effects: Palpitations, anxiety, headache, dizziness, and sweating Dosage: Metered Dose Inhaler: 1-2 sprays (90 micrograms per spray) Small-Volume Nebulizer: 0.5 mL (2.5 mg) in 2.5 mL normal saline over 5-15 minutes Rotohaler: one 200-microgram rotocap should be placed in the inhaler and breathed by the patient Pediatric Dosage: 0.15 mg (0.03mL)/kg in 2.5 mL normal saline by small volume nebulizer Routes: Inhalation

Answer 29

Class: Solvent, depressant Description: A colorless, volatile, flammable liquid of the formula C2H5OH. Acts as a depressant on the CNS when taken in excessive amounts. Used IV to stop premature labor. The other "common" Alcohols are Isopropyl (C3H7OH, Isopropanol, IPA), and Methyl (CH3OH, Methanol, MeOH)

Answer 30

Class: Xanthine bronchodilator Actions: Smooth muscle relaxant, causes bronchodilation, has mild diuretic properties, increases heart rate Indications: Bronchial asthma, reversible bronchospasm associated with chronic, bronchitis and emphysema, congestive heart failure, pulmonary edema Contraindications: Patients with history of hypersensitivity to the drug, hypotension, patients with peptic ulcer disease. Precautions: Monitor for arrhythmias. Monitor blood pressure. Do not administer to patients on chronic theophylline. Preparations until the theophylline blood level has been determined. Side Effects: Convulsions, tremor, anxiety, and dizziness vomiting palpitations, PVCs, and tachycardia Dosages: Method 1: 250-500 mg in 90 or 80 mL of D5W, respectively, infused over 20-30 minutes (approximately 5-10 mg/kg/hour) Method 2: 250-500 mg (5-7 mg/kg) in 20 mL of D5W infused over 20-30 minutes Pediatric: 6 mg/kg loading dose to be infused over 20-30 minutes; maximum does not to exceed 12 mg/kg per 24 hours Routes: Slow IV infusion

Answer 31

Class: Cardiac inotrope Actions: Increases cardiac contractility, vasodilator Indications: Short-term management of severe CHF Contraindications: Patients with history of hypersensitivity to the drug Precautions: May increase myocardial ischemia. Blood pressure, pulse, and EKG should be constantly monitored. Amrinone should only be diluted with normal saline or 1/2 normal saline; no dextrose solutions should be used. FUROSEMIDE (LASIX) should not be administered into an IV line delivering Amrinone. Side Effects: Reduction in platelets, nausea and vomiting cardiac arrhythmias. Dosage: 0.75 mg/kg bolus given slowly over 2-3 minutes interval followed by maintenance infusion of 2-15 ug/kg/minute Pediatric Dosage: Safety in children has not been established Routes: IV bolus and infusion as described earlier.

Answer 32

Class: Platelet inhibitor/anit-flammatory Actions: Blocks platelet aggregation Indications: New-onset chest pain suggestive of MI signs and symptoms suggestive or recent CVA Contraindications: Patients with history of hypersensitivity to the drug. Precautions: GI bleeding and upset Side Effects: Heartburn, nausea and vomiting, wheezing Dosage: 150-325 mg PO or chewed Pediatric: NOT RECOMMENDED routes: PO

Answer 33

Class: Parasympatholytic (anticholinergic) Actions: Blocks acetylcholine receptors, increases heart rate, decreases gastrointestinal secretions. Indications: Hemodynamically-significant bradycardia, hypotension secondary to bradycardia, asystole, organophosphate poisoning Contraindications: None when used in emergency situations Precautions: Dose of 0.04 mg/kg should not be exceeded except in cases of organophosphate poisoning, tachycardia, hypertension. Side Effects: Palpitations and tachycardia, headache, dizziness, and anxiety, dry mouth, pupillary dilation, and blurred vision, urinary retention (especially older males). ``` Dosage: Bradycardia: 0.5 mg every 5 minutes to maximum of 0.04 mg/kg Asystole: 1 mg Organophosphate poisoning: 2-5 mg ``` Pediatric Dosage: Bradycardia: 0.02 mg/kg Maximum single dose (child 0.5 mg) (adolescent 1.0mg) Maximum total dose (child 1.0 mg) (adolescent 2.0 mg) Routes: IV, ET, (ET dose is 2-2.5 times IV dose)

Answer 34

Class: Antiarrhythmic Actions: Increases ventricular fibrillation threshold, blocks the release of Norepinephrine from peripheral, sympathetic nerves Indications: Ventricular fibrillation refactory to LIDOCAINE, ventricular tachycardia refactory to LIDOCAINE, PCVs refactory to first-line medications. Contraindications: None when used in the management of life-threatening arrhythmias Precautions: Postural hypotension occurs in almost 50% of patients receiving Bretylium. Patient must be kept supine decrease dosage in patients being treated with catecholamine sympathomimetics. Side Effects: Hypotension, syncope, and bradycardia. Increased frequency of arrhythmias, dizziness, and vertigo. Dosage: 5mg/kg may be repeated at dose of 10mg/kg up to total dose of 30 mg/kg Pediatric Dosage: 5 mg/kg Routes: Rapid IV bolus

Answer 35

Class: Electrolyte Actions: Increases cardiac contractility ``` Indications: Acute hyperkalemia (elevated potassium), acute hypocalcemia (decreased calcium), calcium channel blocker (Nifedipine, Verapamil, etc.), overdose, abdominal muscle spasm associated with spider bite and Portuguese man-o-war stings, antidote for MAGNESIUM SULFATE ``` Contraindications: Patients receiving digitalis Precautions: IV line should be flushed between calcium chloride and SODIUM BICARBONATE administration. Extravasation may cause tissue necrosis. Side Effects: Arrhythmias (bradycardia and asystole), hypotension. Dosage: 2-4 mg/kg of a 10% solution; may be repeated at 10 minute intervals Pediatric: 5-7 mg/kg of a 10% solution Route: IV

Answer 36

Class: Steroid Actions: Possibly decreases cerebral edema, anti-inflammatory, suppresses immune response (especially in allergic reactions). Indications: Cerebral edema, anaphylaxis (after Epinephrine and diphenhydramine), asthma, COPD Contraindications: None in the emergency setting Precautions: Should be protected from heat, onset of action may be 2-6 hours and thus should not be considered to be of use in the critical first hour following an anaphylactic reaction. Side Effects: Gastrointestinal bleeding, prolonged wound healing Dosage: 4-24 mg Pediatric: 0.2-0.5 mg/kg Routes: IV

Answer 37

Class: Carbohydrate Actions: Elevates blood glucose level rapidly Indications: Hypoglycemia Contraindications: None in the emergency setting Precautions: A blood sample should be drawn before administering 50% dextrose Side Effects: Local venous irritation ``` Dosage: 25 grams (50mL) ``` Pediatric: 0.5 g/kg slow IV; should be diluted 1:1 with sterile water to form a 25% solution. Routes: IV

Answer 38

Class: Tranquilizer (Benzodiazepine) Actions: Anticonvulsant, skeletal muscle relaxant, sedative Indications: Generalized seizures, status epilepticus, premedication before cardioversion, skeletal muscle relaxant, acute anxiety states. Contraindications: Patients with a history of hypersensitivity to the drug. Precautions: Can cause local venous irritation. Has short duration of effect. Do not mix with other drugs because of possible precipitation problems. Side Effects: Drowsiness, hypotension, respiratory depression, apnea Dosage: Status epilepticus: 5-10 mg IV Acute anxiety: 2-5 mg IM or IV Premedication before cardioversion: 5-15 mg IV Pediatric Dosage: Status epilepticus: 0.1 - 0.2 mg/kg Routes: IV (care must be taken not to administer faster than 1 mL/min)

Answer 39

Class: Cardiac glycoside Actions: Increases cardiac contractile force, increases cardiac output, reduces edema associated with congestive heart failure, slow AV conduction. Indications: Congestive heart failure, rapid atrial arrhythmias, especially atrial flutter and atrial fibrillation. Contraindications: Any patient with signs or symptoms of digitalis, toxicity, ventricular fibrillation. Precautions: Monitor for signs of digitalis toxicity, Patients who have recently suffered a myocardial infarction have greater sensitivity to the effects of digitalis. Calcium should not be administered o patients receiving digitalis. Side Effects: Nausea, vomiting, arrhythmias, yellow vision Dosage: 0.25-0.50 mg Pediatric: 25-40 ug/kg Route: IV

Answer 40

Class: Calcium channel blocker Actions: Slows conduction through the AV node, causes vasodilation, decreases rate of ventricular response, decreases myocardial oxygen demand Indications: To control rapid ventricular response associated with atrial fibrillation and flutter Contraindications: Hypotension, wide complex tachycardia, conduction system disturbances Precautions: Should not be used in patients receiving intravenous b blockers. Hypotension. Must be kept refrigerated or discarded one month after removal from refrigeration. Side Effects: Nausea, vomiting, hypotension, and dizziness Dosage: 0.25 mg/kg bolus (typically 20 mg) IV over 2 minutes. This should be followed by a maintenance infusion of 5-15 mg/hour Pediatric: Rarely used Route: IV, IV drip

Answer 41

Class: Antihistamine Actions: Blocks histamine receptors, antiemetic Indications: Nausea and vomiting, motion sickness to potentiate the effects of analgesics Contraindications: Comatose states, patients who have received large amounts of depressants (including alcohol) Precautions: Use with caution inpatients with seizure disorders, asthma Side Effects: May impair mental and physical ability, drowsiness, bronchial secretions. Dosage: 25-50 mg slow IVP (over 2 minute) 50-100 IM Pediatric: Not recommended Routes: IV, IM

Answer 42

Class: Antihistamine Actions: Blocks histamine receptors, has some sedative effects Indications: Anaphylaxis, allergic reactions, dystonic reactions due to phenothiazines Contraindications: Asthma, nursing mothers Side Effects: Sedation, dries bronchial secretions, blurred vision, headache, palpitations Dosage: 25-50 mg Pediatric: 2-5 mg/kg Routes: Slow IV push deep IM

Answer 43

Class: Sympathomimetic Actions: Increases cardiac contractility, little chronotropic activity Indications: Short-term management of congestive heart failure Precautions: Ventricular irritability. Use with caution following myocardial infarction. Can be deactivated by alkaline solutions. Side Effects: Increased heart rate, palpitations Dosage: 2.5-20 ug/kg/minute Pediatric: 2-20 ug/kg/minute Routes: IV drip

Answer 44

Class: Sympathomimetic Actions: Increases cardiac contractility, causes peripheral vasoconstriction. Indications: Hemodyamically significant hypotension (systolic BP of 70-100 mmhg) not resulting hypovolemia; cardiogenic shock Contraindications: Hypovolemic shock where complete fluid resuscitation has not occurred Precautions: Should not be administered in the presence of severe tachyarrhythmias. Should not be administered in the presence of ventricular fibrillation, ventricular irritability. Beneficial effects lost when dose exceeds 20 ug/kg/minutes Side Effects: Ventricular tachyarrhythmias, hypertension, palpitations Dosage: 2-20 ug/kg/minute. Start low and increase as needed Method: 800 mg should be placed in 500 mL of D5W giving a concentration of 1600 ug/mL Pediatric: 2-20 ug/kg/minute Route: IV drip only

Answer 45

Description: A hormone produces by the adrenal gland (attached to the kidneys) and synthesized commercially. It is employed therapeutically as a vasoconstrictor, as a cardiac stimulant, and to relax bronchioles. It is also used to treat asthmatic attacks and treat anaphylactic shock.

Answer 46

Class: Sympathomimetic Actions: Bronchodilation Indications: Bronchial asthma, exacerbation of COPD, allergic reactions Contraindications: Patients with underlying cardiovascular disease, hypertension, pregnancy, patients with tachyarrhythmias Precautions: Should be protected from light. Blood pressure, pulse, and EKG must be constantly monitored. Side Effects: Palpitations and tachycardia, anziousness, headache, tremor Dosage: 0.3-0.5 mg Pediatric: 0.01 mg/kg up to 0.3 mg Routes: Subcutaneous (IV and ET for pediatric cardiac arrest)

Answer 47

Class: Sympathomimetic ``` Actions: Increases heart rate and automaticity Increases cardiac contractile force Increases myocardial electrical activity Increases systemic vascular resistance Increases blood pressure Causes bronchodilation ``` Indications: Cardiac arrest, anaphylactic shock severe reactive airway disease Contraindications: Epinephrine 1;10,000 is for intravenous or endotracheal use; it should not be used in patients who do not require extensive resuscitative efforts Precautions: Should be protected form light. Can be deactivated by alkaline solutions. Side Effects: Palpitations, anxiety, tremulousness, nausea and vomiting ``` Dosage: cardiac arrest: 0.5-1.0 mg repeated every 3-5 minutes Severe Anaphylaxis: 0.3-0.5 mg (3-5 mL); occasionally and Epinephrine drip is required ``` Pediatric: 0.01 mg/kg initially with subsequent doses, Epinephrine 1:1,000 should be used at a dose of 0.1 mg/kg Route: IV, IV drip, ET

Answer 48

Class: Sympathomimetic Description: Epinephrine is an endogenous catecholamine that directly stimulates Alpha, beta1, and beta2 adrenergic receptors in dose-related fashion. It is the initial drug of choice for treating Bronchoconstriction and hypotension resulting from anaphylaxis as well as all forms of cardiac arrest. It is useful in the management of relative airway disease, but beta adrenergic agents are usually considered the drugs of choice since they are inhaled and have fewer side effects. Rapid injection produces a rapid increase in blood pressure, ventricular contractility, and heart rate. In addition, epinephrine causes vasoconstriction of the skin, mucosa, and spanchnic areas, and antagonizes the effects of histamine. Indications: Bronchial asthma, Acute allergic reaction (anaphylaxis), Cardiac arrest; asystole, PEA, VF and pulseless ventricular tachycardia unresponsive to initial defibrillation, Profound symptomatic bradycardia Contraindication: Hypersensitivity, (not an issue especially in emergencies-the dose should be lowered or given slowly in non cardiac arrest patients with heart disease), Hypovolemic shock (as with other catecholamine, correct hypovolemia), Coronary insufficiency (use with caution). Adverse Reactions: Headache, Nausea, Restlessness, Weakness, Dysrhythmias (including ventricular tachycardia and ventricular fibrillation), Hypertension, Precipitation of angina pectoris, Tachycardia Dosage: ASYSTOLE, PEA, VF, PVT Adult: 1 mg IV push or ET (2-2.5 times the IV dose) repeated every 3-5 min Peds: IV/IO 0.1mL/kg (1:10,000); doses as high as 0.2mL/kg may be effective ET dose is 0.1mL/kg (1:1,000) dilutes to 3-5mL SUBSEQUENT DOSES: IV/IO/ET 0.1mL/kg (1;1,000) every 3-5 min; doses as high as 0.2 mL/kg may be effective ANAPHYLACTIC REACTIONS OR BRONCHOCONSTRICTION Adult: Mild 0.3-0.5mL (1:1,000) SQ Moderate to Severe 1-2mL (1:10,000) Slow IV Peds: Mild 0.01mL/kg SQ(1:1,000) Max 0.3mL Moderate to Severe 0.05-0.15mcg/kg/min IV infustion How Supplied 1mg/mL (1:1,000), 0.1mg/mL (1:10,000) ampule and pre-filled syringe. Auto injector Pen (0.5mg/mL (1:2,000))

Answer 49

Class: Sympathomimetic, Bronchodilator, Beta 2 agonist Description: Albuterol is a Sympathomimetic that is selective for beta2 adrenergic receptors. It relaxes smooth muscles of the bronchial tree and peripheral vasculature by stimulating adrenergic receptors of the sympathetic nervous system. Indications: Relief of bronchospasms in patients with reversible obstructive airway disease. Prevention of exercise-induced bronchospasms Contraindications: Prior hypersensitivity reaction to Albuterol, cardiac dysrhythmias associated with tachycardia Adverse Reactions: Dose related, restlessness, apprehension, dizziness, palpitations, tachycardia, dysrhythmias Dosage: Adult MDI 1-2 inhalations (90-180 mcg) wait five minutes between inhalations, max 12 inhalations per day Solution: 2.5mg diluted to 3mL with 0.9% NS; administer over 5-15 minutes Peds MDI Same as adult Solution: 0.01-0.03mL/kg dose to maximum of 0.50mL/dose diluted in 2mL of 0.9% NS may be repeated every 20 minutes three times How Supplied; MDI: 90 mcg/metered spray (17g canister with 200 inhalations). Solution for aerosoliztion 0.5% (5mg/mL); 0.083% (2.5mg) in 3mL unit dose/nebulizer

Answer 50

Class: Antihistamine Description: Antihistamines prevent the physiologic actions of histamine by blocking H1 and H2 receptor sites. The effects of antihistamines are short lived and provide only symptomatic relief. Antihistamines are indicated for conditions in which histamine excess is present, but also are used as adjunct therapy (with Epinephrine) in the treatment of anaphylactic shock. Antihistamines also are effective in the treatment of extrapyramidal reactions and for relief of upper respiratory and sinus symptoms associated with allergic reactions Indications: Moderate to sever allergic reactions (after epinephrine), anaphylaxis, Acute extrapyramidal reactions Contraindications: Patients taking monoamine oxidase (MAO) inhibitors, hypersensitivity, narrow angle glaucoma (relative), newborns and nursing mothers Adverse Reactions: Dose-related drowsiness, sedation, disturbed coordination, Hypotension, Palpitations, Tachycardia, Bradycardia, Thickening of bronchial secretions Dosage: Adult: 25-50mg IM, IV every 6-8 hours (max 300mg/day) Peds: 5mg/kg/day in divided doses (max 300mg/day) How Supplied: Parenteral: 10, 50 mg/mL vials and pre-filled syringes

Answer 51

Class: Glucocorticoid Description: Methylprednisolone is a sympathetic steroid that suppresses acute and chronic inflammation. In addition, it potentiates vascular smooth muscle relaxation by beta adrenergic agonists, and may alter airway hyperactivity. A newer usage is for reduction of post-traumatic spinal cord edema Indications: Anaphylaxis, Bronchodilator-unresponsive asthma, Shock (controversial), Acute Spinal cord Injury Contraindications: Use with caution in patients with GI bleeding, diabetes mellitus, severe infection Adverse Reaction: Headache, hypertension, sodium and water retension, Hypokalemia, Alkalosis ``` Dosage: Adult: Variable; usually within the range of 40-125mg IV, except for spinal cord injury where the initial dose is 30 mg/kg IV bolus followed by an IV infusion of 5.4 mg/kg/hour Peds: 1-2 mg/kg/dose IV ``` How Supplied 20, 40, 80 mg/mL

Answer 52

Class: Naturally occurring atmospheric gas Description: Oxygen is an odorless, tasteless, colorless gas that is present in room air at a concentration approx. 21%. It is an important emergency drug that is used to reverse hypoxemia; in doing so, it helps oxidize glucose to produce ATP and helps reduce the size of infracted tissue during an AMI Indications: Confirmed or suspected hypoxia, Ischemic chest pain, respiratory insufficiency, Prophylactically during air transport, confirmed or suspected carbon monoxide poisoning and other causes of decreased tissue oxygenation (cardiac arrest) Contraindications: Oxygen should never be withheld in any critical patient Adverse Reactions: High concentration oxygen may cause decreased LOC and respiratory depression in patients with chronic carbon dioxide retention Dosage: Adult: High concentration 10-15 L/min via non-rebreather mask or high-flow oxygen delivery device. Low concentration 1-4 L/min via nasal cannula; Venturi mask concentration: 24%, 28%, 32%, 36% Peds: Same as adult

Answer 53

Class: Benzodiazepine antagonist Actions: Reverses effects of benzodiazepines Indications: To reverse CNS, respiratory depression associated with Benzodiazepines. Contraindications: Flumazenil should not be used as a diagnostic agent for Benzodiazepine overdose in the same manner NALOXONE is used for narcotic overdose. Known hypersensitivity to the drug. Precautions: Administer with caution to patients dependent upon Benzodiazepines as it may induce life-threatening Benzodiazepine withdrawal. Side Effects: Fatigue, headache, nervousness, dizzimess Dosage: 0.2 - 0.3mg IV over 30 seconds; repeat as needed to a maximum dose of 1.0mg Routes: IV Pediatric Dosage: Pediatric data unavailable

Answer 54

Class: Potent diuretic Actions: Inhibits reabsorption of sodium chloride, promotes prompt diuresis, vasodilation. Indications: Congestive heart failure, pulmonary edema Contraindications: Pregnancy, dehydration Precautions: Should be protected from light, dehydration Side Effects: Few in emergency usage. Dosage: 40-80 mg Routes: IV Pediatric Dosage: 1 mg/kg

Answer 55

Class: Hormone (antihypoglycemic agent) ``` Actions: Causes breakdown of glycogen to glucose. Inhibits glycogen synthesis Elevates blood glucose level Increases cardiac contractile force Increases heart rate. ``` Indications: Hypoglycemia Contraindications: Hypersensitivity to the drug. Precautions: Only effective if there are sufficient stores of Glycogen within the liver. Use with caution in patients with cardiovascular disease. Draw blood glucose before administration. Side Effects: Few in emergency situations Dosage: 0,25 - 0.50 mg (unit) IV 1.0 mg, IM Routes: IV, IM Pediatric Dosage: 0.03 mg/kg

Answer 56

Class: Major tranquilizer Actions: Blocks dopamine receptors in brain responsible for mood and behavior has antiemetic properties. Indications: Acute psychotic episodes. Contraindications: Should not be administered in the presence of other sedatives. should not be used in the management of dysphoria caused by Talwin. Precautions: Orthostatic hypotension. Side Effects: Physical and mental impairment, Parkinson-like reactions have been known to occur, especially in children. Dosage: 2 - 5 mg Routes: IM Pediatric Dosage: Rarely used

Answer 57

Class: Anticoagulant Actions: Functions as an anticoagulant by accelerating neutralization of activated clotting factors. Indications: Situations where a hypocoaguable state is required (i.e. post MI, post-CVA, pulmonary embolism) Contraindications: Should not be used unless there is a medical reason to anticoagulate the patient. Precautions: Sever, urticarial, and anaphylaxis have been reported following heparin administration skin necrosis can develop at site of subQ injections. Side Effects: Fever, bruising, oozing of blood Dosage: Loading dose: 5,000 iu IV is a typical loading dose although large patients and patients with heparin resistance may receive larger doses. Maintenance dose: Infusion therapy is typically started at 800 - 1,000 iu/hr, the dosage is modified based upon the patient's prothrombin (pt) time. ``` Routes: IV subQ (prophylaxis) ``` Pediatric Dosage: Rarely used

Answer 58

Class: Narcotic analgesic Actions: CNS depressant, decreases sensitivity to pain Indications: Relief of cough and moderate to severe pain Contraindications: Patients with a history of hypersensitivity to the drug or acetaminophen (Tylenol). Precautions: May exaggerate the effects of other CNS depressants. May cause respiratory depression at high dosages. May elevate intracranial and cerebrospinal fluid pressure in the presence of a head injury or a pre-existing increase in intracranial pressure. Side Effects: Lightheadedness, dizziness, drowsiness, nausea, and vomiting Dosage: 2.5 / 5.0 / 7.5 tablets; 1-2 every 4-6 hours Routes: Oral Pediatric Dosage: NOT RECOMMENDED

Answer 59

Class: Antihistamine Actions: Antiemetic, antihistamine, antianxiety, potentiates analgesic effects of narcotics and related agents. Indications: To potentiate the effects of narcotics and synthetic narcotics, nausea and vomiting, anxiety reactions. Contraindications: Patients with a history of hypersensitivity to the drug. Precautions: Orthostatic hypotension, analgesic dosages should be reduced when used with Hydroxyzine, urinary retention. Side Effect: Drowsiness Dosage: 50 - 100 mg Route: Deep IM Pediatric Dosage: 1 mg/kg

Answer 60

Class: Hormone (hypoglycemic agent) Actions: Causes uptake of glucose by the cells, decreases blood glucose level, promotes glucose storage. Indications: Elevated blood glucose, diabetic ketoacidosis Contraindications: Avoid overcompensation of blood glucose level; if possible, administration should wait until the patient is in the emergency department Precautions: Administration of excessive doe may induce hypoglycemia. Glucose should be available. Side Effects: Few in the emergency situations. Dosage: 10 - 25 units regular insulin IV followed by an infusion at 1.0 units/kg/hr Routes: IV subQ Pediatric Dosage: Dosage is based on blood glucose level

Answer 61

Class: Anticholinergic Actions: Causes bronchodilation, dries respiratory tract secretions. Indications: Bronchial asthma, reversible bronchospasm associated with chronic bronchitis and emphysema Contraindications: Patients with history of hypersensitivity to the drug, should not be used as primary agent in acute treatment of bronchospasm Precautions: Blood pressure, pulse, and EKG must be constantly monitored. Side Effects: Palpitations, dizziness, anxiety, tremors, headache, nervousness, dry mouth. Dosage: small-volume nebulizer: 500 ug should be placed in small volume nebulizer (typically administered with a B agonist). Routes: Inhalation only Pediatric Dosage: Safety in children has not been established

Answer 62

Class: Sympathomimetic (B2 selective) Actions: Bronchodilation, increases heart rate Indications: Asthma, reversible bronchospasm associated with chronic bronchitis and emphysema Contraindications: Patients with history of hypersensitivity of the drug Precautions: Blood pressure, pulse and EKG must be constantly monitored. Side Effects: Palpitations, tachycardia, anxiety and tremors, headache Dosage: Hand nebulizer: four inhalations Small-volume nebulizer: 0.5 ml (1:3 with saline) Routes: Inhalation only Pediatric Dosage: 0.25 - 0.5 ml diluted with 4 ml normal saline

Answer 63

Class: Non-steroidal anti-inflammatory agent Actions: Anti-inflammatory, analgesic (peripherally-acting) Indications: Mild to moderate pain Contraindications: Patients with a history of hypersensitivity to the drug, patients allergic to ASPRIN. Precautions: GI irritation or hemorrhage can occur Side Effects: Edema, rash, heartburn Dosage: IV 15 - 30 mg IM 30 - 60 mg Routes: IV, IM Pediatric Dosage: Safety in children has not been established

Answer 64

Class: Sympathetic blocker Actions: Selectively blocks y1 receptors an nonselectively blocks B receptors. Indications: Hypertensive crisis Contraindications: Bronchial asthma, congestive heart failure, heart block, bradycardia, cardiogenic shock Precautions: Blood pressure, pulse, and EKG must be constantly monitored. Atropine and transcutaneous pacing should be available Side Effects: Bradycardia, heart block, congestive heart failure, bronchospasm, postural hypertension Dosage: Method 1: 20 mg by slow IV infusion over 2 minutes: doses of 40 mg can be repeated in 10 minutes until desired supine blood pressure is obtained or until 300 mg of the drug has been given Method 2: 200 mg placed in 500 ml D5W to deliver 2 mg/min Routes: IV infusion or slow IV bolus as described earlier Pediatric Dosage: Safety in children had not been established

Answer 65

Class: Antiarrhythmic Actions: Suppresses ventricular ectopic activity, increases ventricular fibrillation threshold, reduces velocity of electrical impulse through conductive system Indications: Malignant PVC's, ventricular tachycardia, ventricular fibrillation, prophylaxis of arrhythmias associated with acute myocardial infarction and thrombolytic therapy, premedication prior to rapid sequence induction. Contraindications: High-degree heart blocks, PVC's in conjunction with bradycardia Precautions: Dosage should not exceed 300mg/hr. Monitor for CNS toxicity. Dosage should be reduced by 50% inpatients older than 70 years of age or who have liver disease in cardiac arrest, use only bolus therapy Side Effects: Anxiety, drowsiness, dizziness, and confusion, nausea and vomiting, convulsions, widening of QRS. Dosage: Bolus: Initial bolus of 1.5 mg/kg; additional boluses of 0.5 - 0.75 mg/kg can be repeated at 8 - 10 minute intervals until the arrhythmia has been suppressed or until 3 mg/kg of the drug has been administered; reduce dosage by 50% in patients older than 70 years of age. Drip: After the arrhythmia has been suppressed a 2 - 4 mg/min infusion may be started to maintain adequate blood levels. Routes: IV bolus IV infusion Pediatric Dosage: 1 mg/kg

Answer 66

Class: Anticonvulsant/Antiarrhythmic Actions: CNS depressant, anticonvulsant, antiarrhythmic ``` Indications: Obstetrical eclampsia (toxemia of pregnancy), pre-eclampsia/PIH, cardiovascular severe refractory ventricular fibrillation, pulseless ventricular tachycardia, post-MI as prophylaxis for arrhythmias, torsades de pointes (multi-axial ventricular tachycardia). ``` Contraindications: Shock, heart block Precautions: Caution should be used in patients receiving digitalis. Hypotension. Calcium Chloride should be readily available as an antidote if respiratory depression ensues. Use with caution in patients in renal failure. Side Effects: Respiratory depression, drowsiness. Dosage: 1 - 4 g Routes: IV, IM Pediatric Dosage: Not indicated

Answer 67

Class: Osmotic diuretic Actions: Decreases cellular edema, increases urinary output Indications: Acute cerebral edema, blood transfusion reactions Contraindications: Pulmonary edema, patients who are dehydrated, hypersensitivity to the drug. Precautions: Rapid administration can cause circulatory overload crystallization of the drug can occur at lower temperatures. An in-line filter should be used. Side Effects: Pulmonary congestion, sodium depletion, transient volume overload Dosage: 1.5 - 2.0 g/kg Routes: IV Pediatric Dosage: 0.25 - 0.5 g/kg IV over 60 minutes

Answer 68

Class: Steroid Actions: Anti-inflammatory, suppresses immune response (especially in allergic reactions). Indications: Severe anaphylaxis, asthma/COPD, possibly effective as an adjunctive agent in the management of spinal cord injury Contraindications: None in the emergency setting Precautions: Must be reconstituted and used promptly. Onset of action may be 2- 6 hours and thus should not be expected to be of use in the critical first hour following an anaphylactic reaction Side Effects: GI bleeding, prolonged wound healing, suppression of natural steroids ``` Dosage: General usage: 125 - 250 mg Spinal cord injury: Initial bolus of 30 mg/kg administered over 15 minutes, followed by a maintenance infusion of 5.4 mg/kg/hr ``` Routes: IV, IM Pediatric Dosage: 30 ug/kg

Answer 69

Class: Benzodiazepine tranquilizer Actions: Hypnotic, sedative Indications: Premedication prior to cardioversion/RSI, acute anxiety states. Contraindications: Patients with known hypersensitivity to the drug, narrow-angle glaucoma, shock Precautions: Emergency resuscitation equipment should be available. Flumazenil (Romazicon) should be available. Dilute with normal saline or D5W prior to intravenous administration. Respiratory depression more common with Midazolam than with other Benzodiazepines. Side Effects: Drowsiness, hypotension, amnesia, respiratory depression, apnea Dosage: 1.0 - 2.5 mg IV Routes: IV, IM intranasal Pediatric Dosage: 0.03 mg/kg

Answer 70

Class: Narcotic Actions: CNS depressant, causes peripheral vasodilation, decreases sensitivity to pain, Indications: Severe pain, pulmonary edema Contraindications: Head injury, volume depletion undiagnosed abdominal pain, patients with history of hypersensitivity to the drug. ``` Precautions: Respiratory depression (narcan should be available), hypotension, nausea. ``` Side Effects: Dizziness, altered level of consciousness ``` Dosage: IV: 2 - 5 mg followed by 2 mg every few minutes until the pain is relieved or until respiratory depression ensues.N IM: 5 - 15 mg based on patient weight ``` Routes: IV, IM Pediatric Dosage: 0.1 - 0.2 mg/kg IV

Answer 71

Class: Synthetic analgesic Actions: CNS depressant, decreases sensitivity to pain Indications: Moderate to severe pain Contraindications: Patients with a history of hypersensitivity to the drug Precautions: Use with caution in patients with impaired respiratory function, respiratory depression (Naloxone should be available). Patients dependent on narcotics may experience symptoms of withdrawal, nausea. Side Effects: Dizziness, altered level of consciousness Dosage: 5 - 10 mg Routes: IV, IM Pediatric Dosage: Rarely used

Answer 72

Class: Narcotic antagonist Actions: Reverses effects of narcotics Indications: Narcotic overdose including the following: codeine, Demerol, Dilaudid, Fentanyl, Herion, Lortabs, Methadone, Morphine, Paregoric, Percodan, Tylox, Viccodin, synthetic analgesics. Overdoses including the following: Darvon, Nubain, Stadol, Talwin, alcoholic coma, To rule out narcotics in coma of unknown origin Contraindications: Patients with a history of hypersensitivity to the drug. Precautions: Should be administered with caution to patients dependent on narcotics as it may cause withdrawal effects. Short-acting, should be augmented every 5 minutes. Side Effects: none Dosage: 1 -2 mg Routes: IV, IM ET(ET dose is 2.0 2.5 times IV dose) Pediatric Dosage: 0.1 mg/kg max 2.0 mg

Answer 73

Class: Antianginal Actions: Smooth-muscle relaxant, decreases cardiac work, dilates coronary arteries, dilates systemic arteries. Indications: Angina pectoris, chest pain associated with myocardial infarction. Contraindications: Hypotension Precautions Constantly monitor vital signs. Syncope can occur Side Effects: Dizziness, hypotension, headache. Dosage: One spray administered under the tongue; may be repeated in 10-15 minutes; no more than three sprays in a 15-minutes period. spray should not be inhaled. Routes: Sprayed under the tongue on mucous membrane Pediatric Dosage: NOT INDICATED

Answer 74

Class: Antianginal Actions: Smooth-muscle relaxant, decreases cardiac work, dilates coronary arteries dilates systemic arteries. Indications: Angina pectoris, chest pain associated with myocardial infarction Contraindications: Children younger than 12 years of age, hypotension Precautions: Constantly monitor blood pressure, syncope, drug must be protected from the light, expires quickly once the bottle is opened. Side Effects: Dizziness, hypotension Dosage: 1/2 to 3/4 inches Routes: Topical Pediatric Dosage: NOT INDICATED

Answer 75

Class: Sympathomimetic Actions: Causes peripheral vasoconstriction Indications: Hypotension refractory to other sympathomimetics, neurogenic shock. Contraindications: Hypotensive state due to hypovolemia Precautions: Can be deactivated by alkaline solutions. Constant monitoring of blood pressure is essential. Extravasation can cause tissue necrosis Side Effects: Anxiety, palpitations, hypertension Dosage: 0.5 - 30 ug/min. Method: 8 mg should be placed in 500 ml of D5W, giving a concentration of 16 ug/ml Routes: IV drip only Pediatric Dosage: 0.01 - 0.5 ug/kg/minute (RARELY USED)

Answer 76

Class: gas Actions: Necessary for cellular metabolism Indications: Hypoxia Contraindication: NONE Precautions: Use cautiously in patients with COPD, humidify when providing high-flow rates. Side Effects: Drying of mucous membranes Dosage: Cardiac arrest: 100% Other critical patients: 100% COPD: 35% Routes: Inhalation Pediatric Dosage: 24 - 100% as required

Answer 77

Class: Anticonvulsant/antiarrhythmic Actions: Inhibits spread of seizure activity through motor cortex, antiarrythmic Indications: Status epilepticus, arrhythmias due to digitalis toxicity Contraindications: Any arrhythmia except those due to digitalis toxicity, patients with history of hypersensitivity to the drug. Precautions: Should not be administered with glucose solutions. Hypotension. EKG monitoring during administration is essential Side Effects: Local venous irritation, central nervous system depression. Dosage: Status epilepticus; 150 - 250 mg (10 - 15 mg/kg) not to exceed 50 mg/minute. Digitalis toxicity: 100 mg over 5 minutes until the arrhythmia is suppressed or until symptoms of central nervous system depression occur. Routes: IV (dilute with saline) Pediatric Dosage: Status epilepticus: 8 - 10 mg/kg IV Digitalis toxicity: 3 - 5 mg/kg IV over 10 minutes

Answer 78

Class: Antiarrhythmic Actions: Slows conduction through myocardium, elevates ventricular fibrillation threshold, suppresses ventricular ectopic activity. Indications: Persistent cardiac arrest due to ventricular fibrillation and refractory to Lidocaine, PVCs refractory to Lidocaine, ventricular tachycardia refractory to Lidocaine. Contraindications: High-degree heart blocks, PVCs in conjunction with bradycardia. Precautions: Dosage should not exceed 17 mg/kg. Monitor for central nervous system toxicity. Side Effects: Anxiety, nausea, convulsions, widening of QRS Dosage: Initial: 20 mg/minute until arrhythmia abolished, hypotension ensues, QRS widened by 50% of original width total of 17 mg/kg has been given MAINTENANCE: 1 - 4 mg/minute Routes: slow IV bolus, IV drip Pediatric Dosage: Rarely used

Answer 79

Class: Phenothiazine antiemetic Actions: Antiemetic Indications: Nausea and vomiting, acute psychosis Contraindication: Comatose states, patients who have received a large amount of depressants (including alcohol), patients with a history of hypersensitivity to the drug. Precautions: EPS (extra-pyramidal seizure) (dystonic) reactions have been reported Side Effects: May impair mental and physical ability, drowsiness Dosage: 5 -10 mg slow IV or IM Routes: IV, IM Pediatric Dosage: NOT Recommended

Answer 80

Class: Antihistamine (h1 antagonist) Actions: Mild anticholinergic activity, potentiates actions of analgesics Indications: Nausea and vomiting, motion sickness, to potentiate the effects of analgesics, sedation Contraindications: Comatose states, patients who have received a large amount of depressants (including alcohol) Precautions: Avoid accidental intra-arterial injection Side Effects: May impair mental and physical ability, drowsiness Dosage: 25 mg Routes: IV Pediatric Dosage: 0.5 mg/kg

Answer 81

Class: Sympathomimetic Actions: Bronchodilation, increases heart rate, increases cardiac contractile force Indications: Croup (laryngotracheobronchitis) Contraindications: Epiglottitis, hypersensitivity to the drug. Precautions: Vital signs should be constantly monitored. Should be used only once in the prehospital setting. Side Effects: Palpitations, anxiety, headache Dosage: 0.5 - 0.75ml of a 2.25% solution in 2.0 ml normal saline ``` Routes: Inhalation only (small-volume nebulizer) ``` Pediatric Dosage: 0.25 - 0.75 ml of a 2.25% solution in 2.0 ml normal saline

Answer 82

Description: A sterile solution of specified amounts of calcium, potassium chloride, sodium chloride, and sodium lactate in water for injection. It is used intravenously to treat dehydration and replace electrolytes.

Answer 83

Class: Alkalinizing agent Actions: Combines with excessive acids to form a weak volatile acid, increases ph Indications: Late in the management of cardiac arrest, if at all, tricyclic antidepressant overdose, severe acidosis refractory to hyperventilation. Contraindications: Alkalotic states Precautions: Correct dosage is essential to avoid overcompensation of ph. Can deactivate catecholamines. Can precipitate with calcium preparations. Delivers large sodium load. Side Effects: Alkalosis Dosage: 1 mEq/kg initially followed by 0.5 mEq/kg every 10 minutes as indicated by blood gas studies Routes: IV Pediatric Dosage: 1 mEq/kg initially followed by 0.5 mEq/kg every 10 minutes

Answer 84

Class: Neuromuscular blocking agent (depolarizing) Actions: Skeletal muscle relaxant, paralyzes skeletal muscles including respiratory muscles. Indications: To achieve paralysis to facilitate endotracheal intubation Contraindications: Patients with known hypersensitivity to the drug Precautions: Should not be administered unless persons skilled in endotracheal intubation are present. Endotracheal intubation equipment must be available. Oxygen equipment and emergency resuscitative drugs must be available Paralysis occurs within 1 minutes and lasts for approximately 8 minutes. Side Effects: Prolonged paralysis, hypotension, bradycardia Dosage: 1 - 1.5 mg/kg (40 - 100mg in an adult) Routes: IV Pediatric Doage: 1 mg/kg

Answer 85

Class: Sympathomimetic Actions: Bronchodilator, increases heart rate Indications: Bronchial asthma, reversible bronchospasm associated with COPD, preterm labor Contraindications: Patients with known hypersensitivity to the drug Precautions: Blood pressure, pulse, and EKG must be constantly monitored Side Effects: Palpitations, tachycardia, and PVCs, anxiety, tremor, and headache Dosage: Metered-dose inhaler: Two inhalations, 1 minutes apart Subcutaneous injection: 0.25 mg; may be repeated in 15 - 30 minutes Preterm labor: 0.25 mg IM or IV may be repeated in 15 - 30 minutes as needed Routes: Inhalation, subcutaneous injection, IV (preterm labor only) Pediatric Dosage: 0.01 mg/kg subcutaneously

Answer 86

Class: Vitamin Actions: Allows normal breakdown of glucose Indications: Coma of unknown origin, alcoholism, delirium tremens Contraindications: None in the emergency setting Side Effects: Rare, if any Dosage: 100 mg Routes: IV, IM Pediatric Dosage: Rarely indicated

Answer 87

Class: Potent diuretic Actions: Inhibits reabsorption of sodium chloride, promotes prompt diuresis. Indications: Congestive heart failure, pulmonary edema Contraindications: Patients with known hypersensitivity to the drug, anuria Precautions: Should be used with caution in patients taking NSAIDS, dehydration Side Effects: Dizziness, headache, nausea Dosage: 10 - 20 mg Routes: IV Pediatric Dosage: Safety not established

Answer 88

Class: Neuromuscular blocking agent (non-depolarizing) Actions: Skeletal muscle relaxant, paralyzes skeletal muscles including respiratory muscles Indications: To achieve paralysis to facilitate endotracheal intubation Contraindications: Patients with known hypersensitivity to the drug. Precautions: Should not be administered unless persons skilled in endotracheal intubation are present. Endotracheal intubation equipment must be available. Oxygen equipment and emergency resuscitative drugs must be available. Paralysis occurs within 1 minute and lasts for approximately 30 minutes. Side Effects: Prolonged paralysis, hypotension, bradycardia Dosage: 0.08 - 0.10 mg/kg Routes IV Pediatric Dosage: 0.1 mg/kg

Answer 89

Class: Calcium channel blocker Actions: Slows conduction through the AV node, inhibits reentry during PSVT, decreases rate of ventricular response, decreases myocardial oxygen demand Indications: PSVT Contraindications: Heart block, conduction system disturbances Precautions: Should not be used in patients receiving intravenous b blockers, hypotension. Side Effects: Nausea, vomiting, hypotension, and dizziness Dosage: 2.5 - 5.0 mg repeat dose of 5 - 10 mg can be administered after 15 - 30 minutes if PSVT does not convert. Maximum dose id 30 mg in 30 minutes Routes: IV Pediatric Dosage: 0 - 1 year: 0.1 - 0.2 mg/kg (Maximum of 2.0 mg) administered slowly 1 - 15 years: 0.1 - 0.3 mg/kg (maximum of 5.0 mg) administered slowly

Drugs Flashcards

(113 cards)