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Drugs Flashcards

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1
Q

Zofran - generic name

A

Ondansetron

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2
Q

Zofran (ondansetron) - Class:

A

Antiemetic

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3
Q

Zofran (ondansetron) - Action

A

Blocks serotonin receptors in the vagus nerve terminals and in small intestine that trigger the vomit reflex

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4
Q

Zofran (ondansetron) - Onset and Duration

A

Onset: IV/IM and ODT up to 30 minutes

Duration: IV/IM and ODT 2 hours

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5
Q

Zofran (ondansetron) - Indications

A

Abdominal Discomfort - GI/GU (non traumatic) - (S-120)
- for nausea or vomiting
Pain Management, (S-141)
- for nausea or vomiting after morphine administration

Pediatric:
GI/GU (non traumatic), (S-174)
- nausea or vomiting

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6
Q

Zofran (ondansetron) - Dosage

A

Adults:
4mg IV/IM/ODT
MR x1 in 10”

PEDS:
6mo - 3 years: 2mg ODT/IV
>3 years: 4mg ODT/IV
*if suspected head injury, BHPO

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7
Q

Zofran (ondansetron) - Contraindications

A

None

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8
Q

Zofran (ondansetron) - Side effects

A
  • GI issues (especially diarrhea)

- headache

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9
Q

Benadryl - generic name:

A

(Diphenhydramine Hydrochloride)

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10
Q

Benadryl (Diphenhydramine Hydrochloride) - Class:

A

Antihistamine

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11
Q

Benadryl (Diphenhydramine Hydrochloride - Action:

A
  • Binds with histamine receptors, blocking H1 and H2 receptors
    H1 causes bronchoconstriction, airway swelling, and vasodilation
    H2 causes secretion of gastric acid
  • does not prevent release of histamine
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12
Q

Benadryl (Diphenhydramine Hydrochloride - Onset and Duration

A

Onset: 15-30 minutes
Duration: 6-12 hours

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13
Q

Benadryl (Diphenhydramine Hydrochloride - Indications

A
  • Allergic Reaction/Anaphylaxis, (S-122, S-162)
    (Hives/Anaphylaxis Criteria/Angioedema)
  • Poisoning/OD, (S-134, S-165)
    Extrapyramidal reactions
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14
Q

Benadryl (Diphenhydramine Hydrochloride - Dosage/Route

A

Adults: 50mg slow IV/IM

PEDS: PDC IV/IM

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15
Q

Benadryl (Diphenhydramine Hydrochloride - contraindications

A

None

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16
Q

Benadryl (Diphenhydramine Hydrochloride - side effects:

A
  • Drowsiness/sedation (excitement in children)
  • Dry mouth/ thickened bronchial secretions
  • Hypotension
  • Palpitations/tachycardia
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17
Q

Epinephrine (Adrenalin, EPI) - Class

A

Catecholamine: Sympathomimetic (both alpha and beta effects)

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18
Q

Epinephrine (Adrenalin, EPI) - Action:

A
  • On the bronchi: bronchodilation (beta-2)
  • On the peripheral vasculature: vasoconstriction (alpha)
  • On the heart:
    • increased heart rate (beta-1)/chronotropic
    • increased contracility/inotropic
    • increased AV conduction/dromotropic
    • increased automaticity/dromotropic
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19
Q

Epinephrine (Adrenalin, EPI) - Onset and Duration

A

Onset:

 - IV/IO 1-2 minutes
 - IM/SC 5-10 minutes

Duration:

 - IV/IO 5-10 minutes
 - IM/SC 1-4 hours
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20
Q

Epinephrine (Adrenalin, EPI) - Indications (only)

A
  • Allergic Reaction/Anaphylaxis, (S-122, S-162)
    anaphylaxis/angioedema
  • Respiratory Distress, (S-136, S-167)
    Severe respiratory distress or inadequate response to Albuterol/ Atrovent
  • PEDS: Respiratory distress (S-167)
    With stridor at rest
  • PEDS: Burns (S-170)
    with respiratory distress with stridor
  • Dysrythmias (S-127, S-163)
    Cardiac arrest (pulseless patient)
  • PEDS: Dysrhythmias (S-163)
    Unstable bradycardia: after BVM for 30 seconds
  • PEDS: Newborn deliveries (S-166)
    If HR remains <60 after 30 seconds of CPR
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21
Q

Epinephrine (Adrenalin, EPI) - Dosage

Allergic Reaction/Anaphylaxis, (S-122; S-162)
- anaphylaxis/angioedema

A

Adult= .3mg IM 1:1,000 MR x2 q5”
.1mg IV/IO 1:10,000 BHO; MR x2 q3-5” BHO
PEDS= PDC IM 1:1,000; MR x2 q5”
PDC IV/IO 1:10,000 BHO; MR x2 q3-5” BHO

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22
Q

Epinephrine: Dosage for
PEDS: Newborn deliveries (S-166)
- (if HR remains <60 after 30 seconds of CPR)

A

PEDS: PDC IV/IO 1:10,000 - MR x2 q3-5” BHO

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23
Q

Epinephrine (adrenaline, EPI): Dosage

for PEDS: Dysrhythmias, (S-163)
- (unstable cradycardia: after BVM for 30 sec):

A

PEDS: PDC IV/IO 1:10,000 - MR x2 q3-5” BHO

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24
Q

Epinephrine (adrenaline, EPI): Dosage

Dysrhythmias, (S-127; S-163)
- cardiac arrest/pulseless patient

PEDS: Dysrhythmias (S-163)
- unstable bradycardia: after BVM for 30 sec

A

Adults: 1mg IV/IO 1:10,000 - MR q3-5”

PEDS: PDC IV/IO 1:10,000; MR x2 q3-5”; MR q3-5” BHO

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25
Epinephrine - Dosage: PEDS: Burns, (S-170) - with Respiratory distress with stridor:
PEDS: 1: 1,000 PDC via nebulizer MR x1 SO 1: 1,000 PDC IM, SO MR x2 q5” SO
26
Epinephrine (adrenaline, EPI): Dosage PEDS: Respiratory Distress, (S-167) - with stridor at rest:
PEDS: 1:,1000 PDC via nebulizer MR x1
27
Epinephrine: Dosage Respiratory Distress, (S-136, S-167) - severe respiratory distress or inadequate response to Albuterol/Atrovent):
Adults= .3mg IM 1:1,000; MR x2 q5” *if no definite history of asthma: dosing as above per BHPO PEDS= PDC - IM 1:1,000; MR x2 q5”
28
Epinephrine (Adrenalin, EPI) - Contraindications:
None
29
Epinephrine (Adrenalin, EPI) - side effects:
- anxiety/restlessness - palpitations/tachyarrhythmias - Ventricle irritability - increased myocardial 02 demands - hypertension - angina
30
Narcan (Naloxone Hydrochloride)- Class?
Opioid antagonist
31
Narcan (Naloxone Hydrochloride)- Action
Reverse respiratory depression, sedation and hypotension effects of opioid overdose by occupying opiate receptor sites
32
Narcan (Naloxone Hydrochloride)- Onset and Duration
Onset: IV/IN 1-2 min IM 2-5 min Duration: IV 30-60 min IM longer
33
Narcan (Naloxone Hydrochloride)- Indications
``` Adult: Poisoning/OD Altered Neurological (symptomatic suspected opioid OD with respirations <12 ``` ``` PEDS: Poisoning/OD Altered Neurological (symptomatic suspected opioid OD) ```
34
Narcan (Naloxone Hydrochloride)- Dosage/Route
Adult: 2mg IN/IM/IV; MR titrate IV dose to effect, to drive the respiratory rate IF patient refuses transport: 2mg IM additional dose PEDS: PDC IN/IM/IV; MR Adults/PEDS: for opioid dependent pain management patients: “use caution and titrate”
35
Narcan (Naloxone Hydrochloride)- Contraindications
None
36
Narcan (Naloxone Hydrochloride)- Side Effects
- Acute withdraws symptoms - Nausea/vomiting - Tachycardia/hypertension
37
Glucagon- Class
Antihypoglycemic: pancreatic hormone
38
Glucagon- Action
- Increases blood glucose by converting glycogen stored in the liver to glucose - Inhibits synthesis of glycogen from glucose
39
Glucagon- Onset and Duration
Onset: 20 min Duration: 60-90 min
40
Glucagon- Indications
- Altered Neurological Symptomatic Hypoglycemia: symptomatic patient with altered LOC Or... Unresponsive to organ glucose agents “IF no IV” and blood sugar: ``` Adults/PEDS/Infants = BS <60 Neonate= BS <45 ```
41
Glucagon- Dosage/Route
Adult: 1ml (1 unit) IM PEDS: PDC, IM
42
Glucagon- contraindications
None
43
Glucagon- side effects
- Nausea/vomiting | - Tachycardia/ HTN
44
Acetaminophen (Ofirmev) - Class
Analgesic/Antipyretic
45
Acetaminophen (Ofirmev) - Action
- Inhibits the synthesis of prostaglandins which transmit pain signals and induce fever - Reduces pain by blocking the signals produced by prostaglandins
46
Acetaminophen (Ofirmev) - Onset and duration
Onset: 15 min, PEAK = 1 hour Duration: up to 4-6 hours
47
Acetaminophen (Ofirmev) - Indications
For treatment of pain as needed (S-141, S173) - Abdominal Pain - Burns - Envenomation injury - Trauma - Pain or discomfort of suspected cardiac origin - Pain associated with external pacing
48
Acetaminophen (Ofirmev) - dosage and route
Adult: 1,000mg IV x1 SO. Infuse over 15 min. PEDS: ≤2 y/o PDC, SO x1 infuse over 15 min. BHPO required for: Chronic pain state; isolated head injury; acute onset severe headache; drug/etoh; intoxication; multiple trauma with GCS <15; suspected active labor Maximum total daily dose: 4,000mg in 24 hrs
49
Acetaminophen (Ofirmev) - Contraindications
- <2 years of age - Severe hepatic impairment - Severe active liver disease - If known or suspected total dose exceeding 4,000mg in 24hr period
50
Acetaminophen (Ofirmev) - side effects
- Nausea, vomiting - Headache, sleep problems - Constipation - Itching, agitation - Partial or total lung collapse in pediatric patients
51
Adenosine (Adenocard) - class
Antiarrhythmic
52
Adenosine (Adenocard) - Action
Slows electrical conduction through AV node and interrupts re-entry pathway, converting SVT to NSR
53
Adenosine (Adenocard) - Onset and Duration
Onset = within 30 seconds Duration = 1-2 minutes
54
Adenosine (Adenocard) - ADULT indications/dosage
Adult: Dsyrhythmias - SVT Dosage: 6mg rapid IV/IO; follow with rapid 20ml NS 12mg rapid IV/IO; follow with rapid 20ml NS If no sustained rhythm changes, MR x1 in 1-2” If patient has history of bronchospasm or COPD: Dosing as above per BHPO
55
Adenosine (Adenocard) - PEDS, indication/dosage
PEDS: Dysrhymtias -unstable SVT Dosage: 1st dose PDC Prado IV, BHPO... follow with NS 20ml rapid IV 2nd dose PDC rapid IV, BHPO... follow with NS 20ml rapid IV If no sustained rhythm change, MR x1 BHPO
56
Adenosine (Adenocard) - contraindications
- 2nd and 3rd degree AV heart blocks | - Sick sinus syndrome (without pacemaker)
57
Adenosine (Adenocard) - side effects
- SOB/dyspnea; may cause bronchospasm in COPD patients (BHO) - Chest pressure/palpitations - Facial flushing/headache - Dizzy/lightheaded ness - Nausea - Transient Arrhythmias (PVC’s, PAC’s, sinus bradycardia, AV block, sinus tach or asystole). These are generally not treated and are quickly self-limiting
58
Albuterol (proventil, ventolin) - class
Bronchodilator: sympathomimetic (beta-2 specific)
59
Albuterol (proventil, ventolin) - action
- Relaxes bronchial smooth muscles by stimulating beta-2 adrenergic receptors - Produces bronchodilation, relieves bronchospasm, and reduces airway resistance
60
Albuterol (proventil, ventolin) - Onset and Duration
Onset: 5 minutes, PEAK = 1 hour Duration: up to 5 hours
61
Albuterol (proventil, ventolin) - Indications
Respiratory Distress - suspected non-cardiac Allergic Reaction/Anaphylaxis - acute allergic reactions or anaphylaxis Burns - respiratory distress with bronchospasm * Hemodialysis Patient - symptomatic, suspected hyperkalemia if ≥72 hrs since last dialysis
62
Albuterol (proventil, ventolin) - Dosage/Route
Dosage for: respiratory distress; allergic reaction/Anaphylaxis; burns: Adult = 6ml (.083%) via nebulizer MR PEDS = PDC via nebulizer MR Dosage for Hemodialysis Patient: Adult= Continuous 6ml (.083%) via nebulizer MR
63
Albuterol (proventil, ventolin) - contraindications
- none in adults | - PEDS: for croup/stridor (nebulizer saline/epinephrine is indicated)
64
Albuterol (proventil, ventolin) - side effects
- Tachycardia/palpitations - Dizziness, headache - Tremors, nervousness
65
Aminodrone Hydrochloride (cordarone, pacerone, nexterone): Class
Antiarrhythmic
66
Aminodrone Hydrochloride (cordarone, pacerone, nexterone), Action
- Blocks sodium, potassium, and calcium channels in cardiac cells slowing conduction and prolongs repolarization - Has alpha and beta adrenergic blocking properties causing negative inotropic effects and reduces peripheral vascular resistance (afterload)
67
Aminodrone Hydrochloride (cordarone, pacerone, nexterone), Onset and Duration
Onset: minutes Duration: Days
68
Aminodrone Hydrochloride (cordarone, pacerone, nexterone), Indications
Dysrhythmias - stable ventricular tachycardia (SVT) Dysrhythmias - reported/witnessed ≥2 AICD with pulse ≥60 Dysrhythmias - VF/Pulseless VT: After 1st shock if still refractory
69
Aminodrone Hydrochloride (cordarone, pacerone, nexterone), Dosage/Route (per indication)
Dysrhythmias, Stable SVT: Adults ONLY: 150mg in 100ml of NS over 10” IV/IO. MR x1 in 10” BHPO Dysrhymias, reported witnessed ≥ x2 AICD with pulse ≥60: Adults ONLY: 150mg in 100ml of NS over 10” IV/IO BHO Dysrhymias, VF/Pulseless VT: after 1st shock if still refractory: Adult= 300mg IV/IO, MR 150mg (max of 450mg) PEDS= PDC IV/IO, MR q3-5” x2. SO
70
Aminodrone Hydrochloride (cordarone, pacerone, nexterone), Contraindications
- Hypotension - 2nd and 3rd degree heart block - Idioventricular rhythms
71
Aminodrone Hydrochloride (cordarone, pacerone, nexterone), Side effects
- Hypotension - Exacerbation of presenting arrhythmia after days of use - Liver injury - Pulmonary injury: pulmonary infiltrates, bronchospasm, SOB cough, he Optus is, hypoxia
72
Aspirin, ASA (acetylsalicylic acid)- Class:
platelet aggregation inhibitor
73
Aspirin, ASA (acetylsalicylic acid)- Actions:
- Inhibits normal tendency for platelets to accumulate inside injured or occluded coronary arteries, thereby improving blood flow through vessels to better perfume the heart - Blocks formation of Thromboxin A2
74
Aspirin, ASA (acetylsalicylic acid)- Onset and Duration
Onset= 15-30 min Duration = days (antiplatelet effects)
75
Aspirin, ASA (acetylsalicylic acid)- Indications and route/dosage
Indications= Discomfort/Pain of suspected cardiac origin Dosage/Route= Adult ONLY: 324mg PO (four 81mg chewable tablets)
76
Aspirin, ASA (acetylsalicylic acid)- Contraindications
None
77
Aspirin, ASA (acetylsalicylic acid)- Side effects
- GI upset (indigestion, nausea/vomiting, epigastric pain, heartburn) - Occult or prolonged bleeding
78
Atropine Sulfate- Class
- antiarrhythmic | - anticholinergic
79
Atropine Sulfate- Actions
- Competes with acetylcholine for receptor sites blocking the PNS response at SA & AV nodes - Increases heart rate by increasing electrical conduction through the heart - Positive chronotropic properties with little or no inotropic effects - Inhibits secretions by decreasing PNS effect on bronchial, salivary, sweat and GI glands
80
Atropine Sulfate- Onset and Duration
Onset= IV/IO 2-4 min; IM 10-15 min Duration= 2-6 hours
81
Atropine Sulfate- Indications
Adult: Dysrhymias - unstable bradycardia: narrow complex Adult: Dysrhymias - unstable bradycardia: wide complex if external pacemaker unavailable PEDS: Dysrhymias - unstable bradycardia: after BVM for 30 sec. and 3rd dose of Epinephrine Poisoning/OD - symptomatic organophosphate poisoning
82
Atropine Sulfate- Dosage/Route for Adult Dysrhymias (unstable bradycardia: narrow complex)
Adult: .5mg IV/IO for pulse <60; MR q3-5” to max 3mg
83
Atropine Sulfate- Dosage/Route for | Adult: Dysrhythmias (unstable bradycardia: wide complex if external pacemaker unavailable)
Adult: May give Atropine .5mg IV/IO for pulse <60, MR q3-5” to max 3mg
84
Atropine Sulfate- Dosage/Route for | PEDS: Dysrhymias (unstable bradycardia: after BVM for 30 sec and 3rd dose of epinephrine
PEDS: <9 years, HR<60 9-14 years, HR <40 PDC IV/IO; MR x1 in 5”
85
Atropine Sulfate- Dosage/Route for | Poisoning/OD (symptomatic organophosphate poisoning
Adults: 2mg IV/IM/IO, MR x2 q3-5”; MR q3-5” prn BHO PEDS: PDC IV/IO/IM MR x2 q3-5”; MR q3-5” prn BHO
86
Atropine Sulfate- Contraindications
Asystole
87
Atropine Sulfate- side effects
- Tachycardia/palpitations - Dry mouth/nausea/vomiting - Pupil dilation/blurred vision Flushed/hot/dry skin
88
Atrovent (Ipratropium Bromide)- Class
Bronchodilator: anticholinergic
89
Atrovent (Ipratropium Bromide)- Actions
- antagonizes the action of acetylcholine, preventing the interaction of acetylcholine with muscarinic receptors in bronchial smooth muscle causing bronchodilation - dries respiratory tract secretions
90
Atrovent (Ipratropium Bromide)- Onset and Duration
Onset= within 15-30 min Duration= 4-5 hours
91
Atrovent (Ipratropium Bromide)- Indications
Respiratory Distress - suspected non-cardiac Allergic Reaction/Anaphylaxis - acute allergic reactions or anaphylaxis
92
Atrovent (Ipratropium Bromide)- Dosage/Route
``` Adult: 2.5ml (.02%) via nebulizer added to first dose of Albuterol PEDS: PDC via nebulizer added to first dose of Albuterol ```
93
Atrovent (Ipratropium Bromide)- Contraindications
None
94
Atrovent (Ipratropium Bromide)- Side effects
- Nervous/dizziness - Headache - Cough - Paradoxical Bronchospasm - Palpitations - Blurred vision/eye irritation (with direct contact of mist)
95
Calcium Chloride (10% CaCl2)- Action
electrolyte
96
Calcium Chloride (10% CaCl2)- Action
- Increases myocardial contractility - Enhances ventricular automaticity - Reverses cardio-electric changes produced by hyperkalemia - Shifts potassium back into cell to prevent intravascular hyperkalemia
97
Calcium Chloride (10% CaCl2)- Indications and Dosage/Route
* Hemodialysis Patient - symptomatic, suspected hyperkalemia (widened QRS complex “or” peaked T waves) if ≥72 hrs since last dialysis: Dosage= Adult ONLY: 500mg IV/IO over 30 seconds * Trauma - crush injury of extremity or torso with compression ≥2 hours. Give just prior to extremity being released: Dosage= Adult ONLY: 500mg IV/IO over 30 sec. BHO
98
Calcium Chloride (10% CaCl2)- Contraindications
None
99
Calcium Chloride (10% CaCl2)- Side effects
- Decreased heart rate (may cause asystole) - Hypotension - Syncope - Nausea/vomiting - Metallic taste
100
Charcoal (activated charcoal)- Class
Absorbent
101
Charcoal (activated charcoal)- Action
- Binds and absorbs ingested toxins present in the GI tract | - Inhibits intestinal absorption, preventing systemic toxicity
102
Charcoal (activated charcoal)- Onset and Duration
Onset= immediate Duration= 4-12 hours
103
Charcoal (activated charcoal)- Indications
Adult: Poisoning/OD - ingestion with ANY of the following within 60 min, if no vomiting Acetaminophen, colchicine, beta blockers, calcium channel blockers, salicylates, valproate, oral anticoagulants (including rodenticides), Paraguay, amanita mushrooms (assure patient has a gag reflex and is cooperative) PEDS: Poisoning/OD - if ingestion within 60min & recommended by Poison Control Center (assure child has a gag reflex and is cooperative)
104
Charcoal (activated charcoal)- Dosage/Route
Adult: 50Gm PO PEDS: PDC PO
105
Charcoal (activated charcoal)- Contraindications
- Isolated alcohol - Heavy metal - Caustic agent - Hydrocarbons - Iron Ingestion
106
Charcoal (activated charcoal)- Side effects
- Nausea/vomiting - Constipation/diarrhea - Abdominal cramping
107
Dextrose/Glucose (50%, D50 / 10%, D10, D10W) Class
Carbohydrate
108
Dextrose/Glucose (50%, D50 / 10%, D10, D10W) Action
- Increases blood glucose by providing a quick release of free sugar into the circulation
109
Dextrose/Glucose (50%, D50 / 10%, D10, D10W) Onset and Duration
Onset= 1 minute Duration= depends on degree of hypoglycemia
110
Dextrose/Glucose (50%, D50 / 10%, D10, D10W) Indications
Altered Neurological - Symptomatic Hypoglycemia: symptomatic patient with altered LOC or unresponsive to glucose agents and blood sugar: Adults/PEDS/Infants = BS <60 Neonate = <45
111
Dextrose/Glucose (50%, D50 / 10%, D10, D10W) Dosage/Route
Adult/PEDS: If patient is awake and has no gag reflex: Oral glucose paste or 3 tablets (15 g) Adult: D50 25Gm IV; MR if patient remains symptomatic and BS <60 PEDS: D10 PDC IV; MR if patient remains symptomatic and BS <60 (neonate BS <45)
112
Dextrose/Glucose (50%, D50 / 10%, D10, D10W) Contraindications
None
113
Dextrose/Glucose (50%, D50 / 10%, D10, D10W) Side effects
- Local venous irritation/infection | - Hyperglycemia
114
Dopamine Hydrochloride (Intropin) Class
Vasopressin: Sympathomimetic (both alpha & beta properties)
115
Dopamine Hydrochloride (Intropin) Action
- At low and medium doses, selectively dilates blood vessels supplying the brain, kidneys, heart, and gastrointestinal tract - At medium to high doses, increases cardiac output by improving contractility and stroke volume, thereby increasing blood pressure - At high doses, causes vasoconstriction and increased heart rate
116
Dopamine Hydrochloride (Intropin) Onset and Duration
Onset= <5 min Duration= approx. 10” after drip is stopped
117
Dopamine Hydrochloride (Intropin) Indications
- Discomfort/Pain suspected Cardiac origin With associated shock IF BP is refractory to 2nd fluid bolus - Shock suspected Cardiac If BP is refractory to second fluid bolus - Shock suspected Anaphylactic, ?Neurogenic If BP refractory to fluid bolus - Sepsis If BP refractory to fluid bolus - Anaphylaxis shock refractory to fluid blouses and Epinephrine IV/IO - Dysrhythmias Bradycardia: after max atropine or initiation of TCP
118
Dopamine Hydrochloride (Intropin) Dosage/Route
Adult ONLY: 10-40 mcg/kg/min IV/IO drip infusion | Titrate to maintain systolic BP ≥90 not to exceed 120, BHO
119
Dopamine Hydrochloride (Intropin) Contraindications
None
120
Dopamine Hydrochloride (Intropin) Side effects
- At high infusion rates, hypertension and extreme vasoconstriction may occur - At low infusion rates, hypotension may occur - Tachyarrhythmias/palpating - Increased myocardial 02 demand
121
Fentanyl Citrate- Class
Analgesic; Opioid Agonist
122
Fentanyl Citrate- Action
- Potent narcotic analgesic and sedative
123
Fentanyl Citrate- Onset and Duration
Onset= <1-2 min Duration= 30-60 min
124
Fentanyl Citrate- Indications
For treatment of pain as needed: - Abdominal Pain - Burns - Envenomation injury - Trauma - Pain or discomfort suspected cardiac origin - Pain associated with external pacing
125
Fentanyl Citrate- Dosage/Route... If <65 years old
``` Titrate to pain and vital signs - Fentanyl up to 50mcg IVP over 2 min x1 SO MR 25mcg IV q5” x2 SO Maximum SO dose is 100mcg OR... - Fentanyl 50mcg IN q15 min x2 SO - 3rd IN dose Fentanyl 50mcg BHO ``` Treatment of pain if BP <100 systolic BHO
126
Fentanyl Citrate- Dosage/Route... If >65 years old
``` Titrate to pain and vital signs: - Fentanyl 25mcg IVP over 2” x1 SO MR 25mcg slow IVP q5” x2 SO Max SO dose is 75mcg OR..... - Fentanyl 25mcg IN q15” x2 SO - 3rd IN dose Fentanyl 25mcg BHO ``` Treatment of pain if BP <100 systolic, BHO
127
Fentanyl Citrate- Dosage/Route... PEDS:
<10kg - Fentanyl IV/IN PDC, BHO MR, PDC, BHO ≥10kg - Fentanyl IV/IN PDC, SO MR PDC, BHO max 75mcg
128
Fentanyl Citrate- Contraindications
None
129
Fentanyl Citrate- Use with caution: BHPO only:
- chronic pain states - isolated head injuries - acute onset severe headache - drug/ETOH intoxication - multiple trauma with GCS <15 - suspected active labor
130
Fentanyl Citrate- side effects
- respiratory depression/apnea - decreased LOC - transient hypotension - nausea/vomiting/dizziness - muscular rigidity - bradycardia
131
Lidocaine (2% xylocaine)- Class
Antiarrhythmic/anesthetic
132
Lidocaine (2% xylocaine)- Action
- depresses depolarization and automaticity in the ventricles - increases the ventricular fibrillation threshold by increasing phase IV repolarization - Amide-type local anesthetic
133
Lidocaine (2% xylocaine)- Onset and Duration
onset= 1-2 min Duration= 10-20 min
134
Lidocaine (2% xylocaine)- Indications
- Dysrhythmias Stable ventricular tachycardia (SVT) - Dysrhythmias Reported/witnessed ≥2x’s AICD with pulse ≥60 - Dysrhythmias VF/Pulseless VT: after 1st shock if still refractory - ALS Skills conscious patient prior to IO infusion
135
Lidocaine (2% xylocaine)- Dosage/ Route for Dysrhythmias - SVT (stable ventricular tachycardia)
Adult ONLY: 1.5mg/kg slow IV/IO MR .5mg/kg IV/IO q8-10” To max 3mg/kg (including initial bolus)
136
Lidocaine (2% xylocaine)- Dosage/ Route for Dysrhythmias - reported/witnessed ≥2x’s AICD with pulse ≥60
Adult ONLY: 1.5mg/kg slow IV/IO; MR .5mg/kg IV/IO q8-10” To max 3mg/kg (including initial bolus)
137
Lidocaine (2% xylocaine)- Dosage/ Route for Dysrhythmias - VF/Pulseless VT: after 1st shock if still refractory
Adult: - 1.5mg/kg IV/IO, MR x1 in 3-5” (max 3mg/kg) PEDS: - PDC, MR q3-5” x2 SO
138
Lidocaine (2% xylocaine)- Dosage/ Route for ALS Skills - conscious patient prior to IO infusion
Adult ONLY: - 40mg (2%) slow IO Prior to fluid administration
139
Lidocaine (2% xylocaine)- Contraindications
- 2nd and 3rd degree heart block | - Idioventricular rhythms
140
Lidocaine (2% xylocaine)- Side effects (toxicity); EARLY:
- anxiety - euphoria - combative - nausea - twitching - numbness
141
Lidocaine (2% xylocaine)- Side effects (toxicity); LATE:
- seizure - decreased BP - coma - widening QRS - prolonged PRI - V-fib
142
Lidocaine Jelly 2% (xylocaine jelly)- Class
Topical anesthetic
143
Lidocaine Jelly 2% (xylocaine jelly)- Action
- prohibits the initiation and conduction of impulses thereby effecting local anesthetic action - decreases irritation when airway tube is inserted, thereby decreasing intracranial pressure
144
Lidocaine Jelly 2% (xylocaine jelly)- Indications
- ALS medications List | Intubation or nasopharyngeal airway insertion
145
Lidocaine Jelly 2% (xylocaine jelly)- Dosage/Route
Adults & PEDS: | - topically prn to ET tube or nasal airway
146
Lidocaine Jelly 2% (xylocaine jelly)- Contraindications
None
147
Lidocaine Jelly 2% (xylocaine jelly)- Side effects
None
148
Morphine Sulfate (MS, MS04)- Class
- Opioid | - Narcotic analgesic
149
Morphine Sulfate (MS, MS04)- Action
- CNS depressant acting on opiate receptors in the brain | - Potent analgesic and sedative
150
Morphine Sulfate (MS, MS04)- Onset and Duration
Onset= 1-2 min Duration= 2-7 hours
151
Morphine Sulfate (MS, MS04)- Indications
For treatment of pain as needed: - Abdominal Pain - Burns - Envenomation injury - Trauma - Pain or discomfort of suspected cardiac origin - Pain associated with external pacing
152
Morphine Sulfate (MS, MS04)- Dosage/Route For treatment of pain as needed, BP >100: Initial IV Dose
- Morphine up to .1mg/kg IV over 2” SO | Max for ANY IV dose is 10mg
153
Morphine Sulfate (MS, MS04)- Dosage/Route For treatment of pain as needed, BP >100: Initial IM dose
- Morphine up to .1mg/kg IM SO | Max for ANY IM dose is 10mg
154
Morphine Sulfate (MS, MS04)- Dosage/Route For treatment of pain as needed, BP >100: 2nd IV/IM dose, if pain persists
- 5 min after IV morphine OR 15 after IM morphine | - administer half of initial Morphine dose, SO
155
Morphine Sulfate (MS, MS04)- Dosage/Route For treatment of pain as needed, BP >100: 3rd IV/IM dose, if pain persists
- 5” after IV morphine OR 15” after IM morphine | - administer half half of initial morphine dose
156
Morphine Sulfate (MS, MS04)- Dosage/Route For treatment of pain if BP <100 systolic?
BHO
157
Morphine Sulfate (MS, MS04)- Dosage/Route Special considerations administer morphine up to .05 mg/kg:
- cardiac chest pain | - discomfort due to external cardiac pacing
158
Morphine Sulfate (MS, MS04)- Dosage/Route PEDS:
With signs of adequate perfusion: PDC IV/IM; MR BHO
159
Morphine Sulfate (MS, MS04)- Contraindications
None
160
Morphine Sulfate (MS, MS04)- Use with caution, BHPO:
- chronic pain states - isolated head injuries - acute onset severe headache - drug/ETOH intoxication - multiple trauma with GCS <15 - Suspected active labor
161
Morphine Sulfate (MS, MS04)- Side effects
- respiratory depression/apnea - decreased LOC - transient hypotension - nausea/vomiting - pinpoint pupils
162
Nitroglycerin (NTG, Nitro)- class
Vasodilator
163
Nitroglycerin (NTG, Nitro)- Action
- produces vasodilation by relaxing systemic venous & arterial vessels, thereby: - decreasing preload and afterload - decreasing myocardial workload and - decreasing myocardial 02 consumption. - Dilates coronary arteries
164
Nitroglycerin (NTG, Nitro)- Onset and Duration
Onset= SL 2min; topical 30-60min Duration= SL 30-60min; topical 24 hours
165
Nitroglycerin (NTG, Nitro)- Indications
- Discomfort/Pain cardiac origin - Fluid overload with rales Hemodialysis patients - Respiratory Distress Respiratory distress, CHF/cardiac origin
166
Nitroglycerin (NTG, Nitro)- Dosage/Route For: discomfort/pain, cardiac origin
Adult ONLY: IF BP ≥100: .4mg SL; MR q3-5” Topical ointment/paste 1” IF BP <100: .4mg SL BHO; MR BHPO
167
Nitroglycerin (NTG, Nitro)- Dosage/Route for... - Fluid overload with rales - respiratory distress
Adult ONLY: - if BP ≥100: Topical ointment/paste 1” - if BP ≥100 but <150: .4mgSL; MR q3-5” - if BP ≥150: .8mg SL; MR q3-5” - if BP <100: .4mg SL BHO; MR BHPO
168
Nitroglycerin (NTG, Nitro)- Contraindications
- patient who has taken sexual enhancement meds such as Viagra, Cailin, Levitra within 48 hours - patients taking meds for Pulmonary Hypertension, usually Sildenafil (trade names: Revatio, Florian, and Veletri)
169
Nitroglycerin (NTG, Nitro)- Side effects
- orthostatic hypotension - dizziness/syncope - temporary pulsating headache - facial flushing
170
Normal Saline (0.9% Solution Sodium Chloride...NS): Class
Electrolyte/ isotonic crystalloid
171
Normal Saline (0.9% Solution Sodium Chloride...NS): Action
- electrolyte solution, which is osmotically equivalent to blood - increases the circulating volume of the vascular system. (2/3 of infused volume leaves vascular space within 1 hour)
172
Normal Saline (0.9% Solution Sodium Chloride...NS): Indications
- Definitive Therapy immediate or anticipated immediate need for administration of a fluid bolus or medications - Abdominal Discomfort GI/GU (non traumatic) Adult/PEDS: suspected volume depletion Adult: symptomatic suspected AAA to maintain BP at 80 - Anaphylaxis Adult: for BP <90 PEDS to maintain adequate perfusion - Altered Neurological Function Adult: CVA to maintain BP ≥120 Adult: Hyperglycemia - Burns Adult: with ≥20% BSA partial thickness or ≥5% BSA full thickness PEDS: with ≥10% BSA partial thickness or ≥5% BSA full thickness - Discomfort/Pain of suspected cardiac origin With associated shock - Dysrhythmias Adult: see protocols PEDS: see protocols - Environmental Exposure Adult: head exhaustion - Overdose Adult: stimulant intoxication with Excited Delirium - Shock Adult/PEDS: see protocol - Trauma Adults/PEDS: crush injury with extended compression ≥2 hrs Adult: to maintain BP at 80 PEDS: to maintain adequate perfusion - Sepsis Adult: see protocol - Respiratory Distress Adult/PEDS: with croup-like cough via NEBULIZER
173
Normal Saline (0.9% Solution Sodium Chloride...NS): Dosage/Route for Definitive Therapy (S-104; S101)
IV/IO; adjust prn
174
Normal Saline (0.9% Solution Sodium Chloride...NS): Contraindications
Rales (exception for sepsis - S-143)
175
Normal Saline (0.9% Solution Sodium Chloride...NS): Side effets
None
176
Sodium Bicarbonate (Bicarb, NaHC03)- Class
- Electrolyte | - Alkalinizing agent
177
Sodium Bicarbonate (Bicarb, NaHC03)- Action
- Reduces acidosis or causes alkalosis by direct release of bicarbonate ion into the circulation
178
Sodium Bicarbonate (Bicarb, NaHC03)- Onset and Duration
Onset= 2/10 min Duration= 30-60 min
179
Sodium Bicarbonate (Bicarb, NaHC03)- Indications
- Hemodialysis Patient Symptomatic, suspected hyperkalemia if ≥72 since last dialysis - Poisoning/OD Tricyclic OD with cardiac effects - Trauma Crush injury of extremity or torso with extended entrapment ≥2 hours just prior to extremity being released
180
Sodium Bicarbonate (Bicarb, NaHC03): dosage/route for: - Hemodialysis Patient Symptomatic, suspected hyperkalemia if ≥72 since last dialysis
Adult ONLY: 1mEq/kg IV/IO
181
Sodium Bicarbonate (Bicarb, NaHC03)- dosage/route for... - Poisoning/OD Tricyclic OD with cardiac effects
Adult: 1mEq/kg IV/IO PEDS: PDC IV/IO x1 BHO
182
Sodium Bicarbonate (Bicarb, NaHC03)- dosage/route for... - Trauma Crush injury of extremity or torso with extended entrapment ≥2 hours just prior to extremity being released
Adult: 1mEq/kg IV/IO BHO PEDS: PDC IV/IO x1 BHO
183
Sodium Bicarbonate (Bicarb, NaHC03)- Contraindications
None
184
Sodium Bicarbonate (Bicarb, NaHC03)- Side effects
None
185
Versed (Midazolam)- Class
Benzodiazepine: Sedative/Anticonvulsant
186
Versed (Midazolam)- Action
- CNS depressant - Produces anterograde amnesia, then sedation - stops and prevents seizures
187
Versed (Midazolam)- Onset/duration
Onset= IV/IO/IN 2min; IM 15min Duration= 1-4 hours
188
Versed (Midazolam)- Indications
* Seizures - generalized seizures lasting ≥5” (includes seizure time prior to arrival of prehospital provider) - recurrent tonic/clinic seizures without lucid interval - Eclamptic seizures of any duration * PEDS seizures - Generalized seizures lasting ≥5 min (includes seizure time prior to arrival of prehospital provider) - Partial seizure with respiratory compromise - Recurrent tonic/clinic seizures without lucid interval * Dysrhymias - unstable bradycardia: discomfort associated with TCP capture, after morphine if BP ≥100 - unstable conscious VT: precardioversion - conscious SVT: precardioversion - Unstable Conscious A-fib, A-flutter: precardioversion * Overdose - stimulant Intoxication with excited delirium * Psychiatric Behavioral Emergencies - combative patients
189
Versed (Midazolam)- Dosage for: * Seizures * PEDS seizures
Adult: IN, IM, IV, IO to max 5mg (D/C IV/IO dose if seizure stops).. MR x2 in 10” Max 10mg total PEDS: PDC IV/IM/IN
190
Versed (Midazolam)- Dosage/route for: Dysrhythmia - unstable bradycardia: discomfort associated with TCP capture, after morphine if BP <100 - unstable conscious VT: precardioversion
Adult ONLY: 1-5mg slow IV/IO (1mg/min) If age ≥60, consider lower dose with attention to age and hydration status
191
Versed (Midazolam)- Dosage/route for: Dysrhythmias - Conscious SVT: precardioversion
Adult: 1-5mg slow IV/IO (1mg/min) BHO If age ≥60, consider lower dose with attention to age and hydration status PEDS: PDC slow IV (1mg/min) BHPO
192
Versed (Midazolam)- Dosage/route for: Dysrhythmias - unstable conscious A-fib, A-flutter: precardioversion
Adult ONLY: 1-5mg slow IV/IO (1mg/min) BHPO If age ≥60, consider lower one with attention to age and hydration status
193
Versed (Midazolam)- Dosage/route for: * Overdose - stimulant intoxication with excited delirium * Psychiatric Behavioral Emergencies - combative patients
Adults ONLY: In, IM, IV 5mg MR x1 in 10”
194
Versed (Midazolam)- Contraindications
None
195
Versed (Midazolam)- Side effects
Respiratory depression/ apnea
196
Cyanide Kit - only if kit available on scene, not for prehospital inventory Drugs
- Amyl Nitrite inhaler - sodium thiosulfate 25% - hydroxocobalamin
197
Cyanide Kit - only if kit available on scene, not for prehospital inventory Action: Onset/Duration
Onset= minutes Duration = days
198
Cyanide Kit - only if kit available on scene, not for prehospital inventory Indications/dosage/route for: Amyl Nitrate inhalation
Indications: Significant symptoms such as seizures, LOC or cardiac arrest Dosage: given over 30 seconds BHPO
199
Cyanide Kit - only if kit available on scene, not for prehospital inventory Indications/dosage/route for: Sodium Thiosulfate 25%
Indications: Significant symptoms such as seizures, LOC or cardiac arrest Dosage/route: 12.5Gm IV BHPO
200
Cyanide Kit - only if kit available on scene, not for prehospital inventory Indications/dosage/route for: Hydroxocobalamin
Indications: Significant symptoms such as seizures, LOC or cardiac arrest Dosage/route: 5m given over 15” IV BHPO
201
Cyanide Kit - only if kit available on scene, not for prehospital inventory Contraindications
None
202
Cyanide Kit - only if kit available on scene, not for prehospital inventory Side effects of Amyl Nitrate
``` Hypertension Tachycardia Palpitations Syncope Headache and nausea ```
203
Cyanide Kit - only if kit available on scene, not for prehospital inventory Side effects for: Sodium Thiosulfate
Cirrhosis of liver Congestive heart failure Renal function impairment
204
Cyanide Kit - only if kit available on scene, not for prehospital inventory Side effects for: Hydroxocobalamin
Mild increase in BP | Reddish orange skin color which clears over days
205
Nitro: for BP ≥ 100?
Topical ointment/paste 1”
206
Nitro - if BP ≥100 but <150
.4mg SL; MR q3-5”
207
Nitro - for BP ≥150
.8mg SL; MR q3-5”
208
Nitro - for BP <100
.4mg SL BHO; MR BHPO
209
Examples of sexual enhancement drugs
Viagra, Cialis, Levitra
210
Examples of Pulmonary Hypertension medication
Usually Sildenafil (trade names: Revatio, Flolan, and Veletri)
EMS
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