Emergency Medications COPY

Question 1

Adenosine

Adenocard

Answer 1

Class: Antidysrhythmic
MOA: slows conduction through AV node and interrupt reentry pathways. Drug choice for reentry SVT. Can be used for vtach after two doses of lidocaine
Indications: SVT. Not effective in afib or a flutter
Contraindications: high degree heart block, sick sinus syndrome,
Side Effects: headache, dizziness, brief asystole
Dosage: 6,12,12mg WBD of .1mg- .2mg/kg
Duration of Action: Onset is seconds and last twelve seconds
Special Considerations: may cause bronchoconstriction, consider pathological reason for SVT first

Question 2

Albuterol

Proventil, Ventolin

Answer 2

• Class: sympathomimetic, bronchodilator
• MOA: beta 2 Agonist that stimulates adrenergic receptors of sympathetic nervous system, results in smooth muscle relaxation of bronchial tree
• Indications: bronchospasm, COPD, asthma
• Contraindications: hypersensitivity, tachycardia, dysrhythmia,
• Side Effects: tachycardia
• Dosage: Adult: 2.5-5mg Ped: 1.25-2.5mg
• Duration of Action: 5-15 min and last 3-4 hours
• Special Considerations: cause Angina pectoris

Question 3

Alteplase

rTPA

Answer 3

• Class: Fibrinolytic
• MOA: enzyme binds to fibrin bound plasminogen at the clot site and converts plasminogen to plasmin. Plasmin digests the fibrin stands of clot, restoring perfusion
• Indications: AMI, STEMI, PE, CVA
• Contraindications: Internal Bleeding, recent surgery, aneurysm, uncontrolled hypertension
• Side Effects: Head bleed, chest pain, hypotension
• Dosage: 15mg
• Duration of Action: Onset within 30 minutes
• Special Considerations: observe for bleeding and monitor vitals

Question 4

Amiodarone

Cordarone, Pacerone

Answer 4

• Class: Antidysrhythmic
• MOA: blocks sodium and potassium channels, increases duration of action potential
• Indications: v fib, pulseless v tach,
• Contraindications: none other than indications
• Side Effects: prolonged QT interval
• Dosage: Adult: 300-150mg bolus, 150mg/10min with pulse Ped: 5mg/kg bolus, 5mg/kg/20-60 minutes
• Duration of Action: Onset is immediate, last 30-45 minutes
• Special Considerations: monitor for hypotension

Question 5

Amyl Nitrate

Answer 5

• Class: antidote for cyanide poisoning
• MOA: converts hemoglobin to methemoglobin which reacts with cyanide
• Indications: cyanide poisoning
• Contraindications: none
• Side Effects: headache, dizziness, weakness
• Dosage: 1-2 ampules crushed and inhaled for 30 seconds
• Duration of Action: 3-5 minutes
• Special Considerations: highly flammable

Question 6

Aspirin

Asa, Bayer, Ecotein

Answer 6

• Class: platelet inhibitor
• MOA: prevents platelets from clumping together or aggregating and forming emboli
• Indications: chest pain suggestive of MI
• Contraindications: Hypersensitivity, stomach ulcer disease or asthma
• Side Effects: bronchospasm, prolonged bleeding, Reye’s syndrome
• Dosage: 81-324mg tablets, 1-2” paste
• Duration of Action: 30-45minutes
• Special Considerations: GI bleeding

Question 7

Atenolol

Tenormin

Answer 7

• Class: beta blocker, antidysrhythmic
• MOA: decreases heart rate, myocardial contractiility, inhibits dilation of bronchial smooth muscle
• Indications: reduce myocardial ischemia, parosymsimal svt, a flutter, a fib, hypertension
• Contraindications: heart failure, cardiogenic Shock, Bradycardia, hypotension, high degree heart block
• Side Effects: dizziness, headache, hypotension
• Dosage: 5mg/5minutes
• Duration of Action: Onset 5 min, last 2-4 hours
• Special Considerations: given slowly, given with ca channel blockers causessevere hypotension

Question 8

Atropine Sulfate

Answer 8

• Class: Anticholinergic
• MOA: inhibits acetylcholine at receptor sites, increasing heart rate in Bradycardia
• Indications: hemodynamically unstable bradycardia, organophosphate poisoning, RSI in pediatrics, beta or calcium channel blocker OD
• Contraindications: Tachycardia, glaucoma, hypothermic bradycardia
• Side Effects: drowsiness, confusion, palpitations, paradoxical bradycardia when pushed too slow or at

Question 9

Bumetanide

Bumex

Answer 9

• Class: loop diuretic
• MOA: loop diuretic that inhibits reabsorption of sodium and Chloride in ascending loop of henle
• Indications: pulmonary edema, CHF
• Contraindications: hypovolemia, diabetes
• Side Effects: dizziness, headache, nsaids reduce diuretic effect
• Dosage: .5-1mg IV
• Duration of Action: onset is immediate and last 2-4 hours
• Special Considerations

Question 10

Calcium Chloride

Answer 10

• Class: Electrolyte (anion)
• MOA: increases cardiac contractile state (positive inotropic effect)
• Indications: hypocalcemia, hyperkalemia, hypermagnesia, beta blocker and calcium channel blocker overdose
• Contraindications: hypercalcemia, v fib, digitalis toxicity
• Side Effects: syncope, cardiac arrest, dysrhytmias, hypotension, nausea, vomiting
• Dosage: 500mg-1G Ped: 20mg/kg
• Duration of Action: Onset is 1-3 minutes and lasts up to 4 hours
• Special Considerations: none

Question 11

Calcium Gluconate

Answer 11

• Class: electrolyte
• MOA: same as Chloride
• Indications: s/a
• Contraindications: s/a
• Side Effects: s/a
• Dosage: 500mg-1G to Max of 3G Ped: 60-100mg/kg
• Duration of Action: onset is immediate and lasts up to 2 hours
• Special Considerations: Do not administer IM OR SQ

Question 12

Clopidogrel

Plavix

Answer 12

• Class: antiplatelet
• MOA: inhibits platelet aggregation by blocking activation of glycoproteins
• Indications: MI, substitute for aspirin unable to take aspirin
• Contraindications: active GI bleed, intracranial hemmorage, hypersensitivity
• Side Effects: GI bleeding, Steven Johnson syndrome
• Dosage: 300-600mg tablet
• Duration of Action: Onset immediate and lasts 7-10 days
• Special Considerations: none

Question 13

Dexamethasone

Decadron

Answer 13

• Class: corticosteroid
• MOA: suppresses acute and chronic inflammation; immunosuppressive effects
• Indications: anaphylaxis, asthma, COPD, spinal cord injury
• Contraindications: systemic sepsis
• Side Effects: headache, restlessness, hypertension
• Dosage: 1mg/kg Ped: .25-1mg/kg
• Duration of Action: onset takes hours and lasts 24-72 hours
• Special Considerations: none

Question 14

Dextrose

Answer 14

• Class: carbohydrate antihypolglycemic
• MOA: increases serum glucose levels with short term osmotic dieresis
• Indications: hypoglycemia, ams, seizures of unknown
• Contraindications: intracranial hemmorage
• Side Effects: tissue necrosis innapropiately applied, hyperglycemia
• Dosage: 25G mixtures D25 for >1yr and D10 <1 year
• Duration of Action: less than 1 minute onset, variable duration
• Special Considerations: administer thiamine for vitamin B1 deficiency in alcoholics

Question 15

Diazepam

Valium

Answer 15

• Class: benzodiazepine, sedative, anticonvulsant
• MOA: potentiates effects of inhibitory neurotransmitters, induces Amnesia and sedation
• Indications: seizures, anxiety, dt’s, sedation, cocaine od
• Contraindications: hypotension, hypopnea, head injury
• Side Effects: drowsiness, hypotension, resp depression
• Dosage: Seizure: 5-10mg, Cardioversion: 5-15mg/5-10min, Ped: Seizure: .2-.5mg/kg max of 10mg/kg, Rectal: .5mg/kg with rectal catheter, and flush with 2-3ml of air
• Duration of Action: Onset 1-5 minutes and last 20-50 minutes
• Special Considerations: reduce dose by 50% for elderly patients

Question 16

Digoxin

Lanoxin

Answer 16

• Class: inotropic agent, cardiac glycoside
• MOA: rapid cardiac glycoside, increases force of myocardial contractility, increase Refractory Period of av node
• Indications: CHF, re reentry svts, a flutter and a fib
• Contraindications: v fib, v tach, digitalis toxicity,
• Side Effects: seizures confusion, blurred vision, Bradycardia
• Dosage: 4-6mcg/kg
• Duration of Action: onset is 5-30 minutes and lasts 30-120 minutes
• Special Considerations: renal failure develops digitalis toxicity, and with hypokalemia, hypercalcemia,

Question 17

Diltiazem

Cardiazem

Answer 17

• Class: calcium channel blocker, antidysrhythmic
• MOA: slow calcium channel blocker that blocks calcium influx during depolarization or cardiac muscle
• Indications: a fib RVR, and reentry SVT
• Contraindications: hypotension, high degree heart block, sick sinus syndrome, v tach
• Side Effects: diZiness, weakness, headache, dyspnea, hypotension
• Dosage: .25mg/kg followed by .35mg/kg after 15 minutes. Maintanence infusion of 5-15mg/HR
• Duration of Action: onset is 2-5 minutes and lasts 1-3 hours
• Special Considerations: 500mg of calcium chloride prior to Cardiazem can help block Hypotensive effects. Blocks baroreceptors in great vessels

Question 18

Diphenhydramine

Benadryl

Answer 18

• Class: antihistamine, a Anticholinergic
• MOA: blocks cellular histamine receptors, decreases vasodilation, decreases motion sickness
• Indications: allergies, anaphylaxis, motion sickness, dystonia reactions,
• Contraindications: asthma, glaucoma, pregnancy, hypertension, infants
• Side Effects: sedation, drowsiness, dry mouth
• Dosage: 25-50mg IM, IV, PO Ped: 1-2mg/kg IV, IM, IO
• Duration of Action: Onset is 15-30 minutes and lasts 3-12 hours
• Special Considerations: not used in infants,

Question 19

Dobutamine

Doubtrex

Answer 19

• Class: sympathomimetic, inotropic agent
• MOA: synthetic catecholamines, increases myocardial contractility, Stroke Volume, and output. Increases renal blood flow
• Indications: cardiogenic Shock, CHF
• Contraindications: tachydysrhymthia, hypotension
• Side Effects: headache, hypertension, pvc, tachycardia
• Dosage: 2-20mcg/kg/min titration to effect
• Duration of Action: onset is 2 minutes and lasts 1-2 minutes after disconnected
• Special Considerations: monitor blood pressure and titration drug effects

Question 20

Dopamine

Inteopin

Answer 20

• Class: sympathomimetic, Vasopressor, inotropic
• MOA: positive inotropic and chronotropic effects. Dialate renal and splenic vasculature. Constricts systemic vasculature increasing blood pressure and preload, stroke volume and contractility.
• Indications: septic and cardiogenic Shock. Hypotension, distributive Shock, symptomatic Bradycardia
• Contraindications: hypovolemia Shock, tachydysrhythmia, v fib
• Side Effects: headache, hypertension, Tachycardia, chest pain
• Dosage: 2-20mcg/kg/min
• Duration of Action: onset 1-4 minutes
• Special Considerations: 2-5 mcg is dopaminergic receptors causing renal dialation, 5-10 mcg is beta 1 receptors causing inotropic effects and 10-20 mcg is alpha 1 receptors causing vasoconstriction

Question 21

Etomidate

Amidate

Answer 21

• Class: nonbarbituate, Hypnotic, anesthesia
• MOA: short acting Hypnotic that acts as the level of the reticular activating system
• Indications: RSI, Cardioversion
• Contraindications: Labor, hypersensitivity
• Side Effects: apnea of short duration, resp depression, hypotension, nausea, vomiting
• Dosage: .3mg/kg over 1 minute Ped: .3mg/kg over 1 minute > 10 years old
• Duration of Action: onset is <1 min and lasts 5-10 minutes
• Special Considerations: decrease dose in elederly patients with cardiac conditions

Question 22

Fentanyl

Sublimaze

Answer 22

• Class: opiod analgesic, schedule II narcotic
• MOA: binds to opiate receptors producing analgesia and euphoria
• Indications: pain management and anasthetic adjunct
• Contraindications: hypersesnitivity, TBI
• Side Effects: confusion, delirium, sedation, resp depression, Bradycardia, hypotension
• Dosage: 50-100mcg 1mcg/kg Ped: contraindicated < 2 years
• Duration of Action: onset is 1-3 minutes duration is 30-60 minutes
• Special Considerations: 100mcg is equivalent to 10mg of morphine

Question 23

Flumazenil

Romazicon

Answer 23

• Class: benzodiazepine antagonist, antidote
• MOA: antagonizes benzos of CNS reversing sedative effects
• Indications: resp depression, and sedative effects
• Contraindications: seizure prone patients, hypersensitivity
• Side Effects: seizures, dizziness, confusion, agitation
• Dosage: .2mg IV IO followed with .3mg IV IO
• Duration of Action: onset is 1-2 minutes and duration depends on concentration of benzodiazepines
• Special Considerations: none

Question 24

Furosemide

Lasix

Answer 24

• Class: loop diuretic
• MOA: blocks absorption of sodium and Chloride at distal and proximity tubule of loop of hinle causing increased urine output
• Indications: CHF, pulmonary edema, hypertensive Crisis
• Contraindications: hypovolemia, anuria, hypotension, electrolyte imbalances
• Side Effects: dizziness, headache, orthostatic hypotension, nausea, vomiting
• Dosage: .5-1mg/kg over 1-2 minutes
• Duration of Action: onset is 5 minutes and lasts 4-6 hours
• Special Considerations: monitor vitals carefully

Question 25

Glucagon | GlucaGen

Answer 25

- Class: pancreatic hormone, insulin anatagnoist - MOA: increases serum blood glucose levels by converting glycogen in liver to glucose. Positive inotropic and chronotropic agent in beta blocker and ca channel blocker od. Relaxes smooth muscle of GI tract - Indications: ams, hypoglycemia, beta and ca channel blocker overdose, airway obstruction - Contraindications: hyperglycemia - Side Effects: dizziness, headache, hypertension, hyperglycemia - Dosage: .5-1mg reconstituted. Ped: .1mg/kg - Duration of Action: onset is immediate and lasts 60-90 minutes - Special Considerations: if liver failure, may not work

Question 26

Heparin

Answer 26

- Class: - MOA: - Indications: - Contraindications: - Side Effects: - Dosage: - Duration of Action: - Special Considerations: