MD Drugs Flashcards
(259 cards)
1
Q
Acetaminophen (Tylenol) - Adverse Effects
A
None
2
Q
Acetaminophen (Tylenol) - Contraindications
A
1 - Head Injury
2 - Hypotension
3 - Dose w/in previos 4 hrs
4 - Resp Distress
5 - Persistent Vomiting
6 - Liver disease - ETOH
7 - Allergy
3
Q
Acetaminophen (Tylenol) - Dose
A
2-4 - 160mg/5ml
5-12 2x 160mg/5ml
13+ 4x160mg/5ml or 2x 325mg pill w sips of water
4
Q
Acetaminophen (Tylenol) - Indications
A
Pt 2 yo+ mild to moderate pain (1-5)
5
Q
Activated Charcoal - Dose
A
1g/kg PO
6
Q
Adenosine (Adenocard) - Adult Dose
A
1 - 6mg w IV bolus w rapid 20ml flush (wait 2 min)
2 - 12mg IV bolus w rapid 20ml flush (wait 2 min)
3 - 12mg IV bolus w 20 mL flush (wait 1-2 min)
7
Q
Adenosine (Adenocard) - Adverse
A
Flushing, dyspnea, chest pressure, n/v, headache, dizziness, hypotension
8
Q
Adenosine - Contraindications
A
Hx of moderate to severe asthma
Active bronchospasm
9
Q
Adenosine (Adenocard) - Indications
A
Narrow complex tachycardia (SVT, PSVT w WPW)
No effect on Afib, Aflutter or VT
Pedi wide complex tachycardia (possible VT) can be used w caution
10
Q
Adenosine (Adenocard) - MOA
A
Slows conduction thru AV node
11
Q
Adenosine (Adenocard) - Pedi Dose
A
1 - 0.1mg/kg (max 6mg)
2 - 0.2mg/kg (max 12mg)
3 - 0.2mg/kg (max 12mg)
12
Q
Adenosine (Adenocard) - Precautions
A
- antagonized by theophylline
- enhanced by dipyridamole, digitalis, carbamazepine, CCB, and benzodiazepines
- up to 40 seconds of asystole
13
Q
Albuterol - Adult Dose for bronchospasm
A
Inhaler - 2 doses (4 puffs) over 30 min
Neb - 2.5mg w 6-8 lpm. repeat 1x
14
Q
Albuterol - Adult Dose for Hyperkalemia
A
Neb - 20mg w 6-8 lpm
15
Q
Albuterol - Adverse
A
tachycardia, palpitations, peripheral vasodilation, tremors, headache, sore throat, PVCs, N/V
16
Q
Albuterol - Contraindications
A
hypersensitivity
17
Q
Albuterol - Indications
A
1 - bronchospasm
2 - hyperkalemia
18
Q
Albuterol - MOA
A
Stimulates beta-2 adrenic receptors of the bronchioles
19
Q
Albuterol - Pedi Dose for bronchospasm
A
Inhaler - 2 doses (4 puffs) over 30 min
Neb 2yo+ - 2.5mg w 6-8 lpm. repeat 1x
Neb <2yo - 1.25mg w 6-8 lpm. repeat 1x
20
Q
Albuterol - Pedi Dose for Hyperkalemia
A
Neb 2yo+ - 2.5mg w 6-8 lpm.
Neb <2yo - 1.25mg w 6-8 lpm.
21
Q
Albuterol - Pharmacokinetics
A
Bronchodilation begins with 5-15 min
Peak - 30-120 min
Duration - 3-4 hrs
22
Q
Albuterol - Precautions
A
- Use w caution w Pts w hyperthyroidism or coronary artery disease.
- Use w caution w Pts on MAO inhibitors or tricyclic antidepressants as may be potentiated
- Med Direction for pregnant pts or pts w cardiac Hx
23
Q
Albuterol - Trade Names
A
Proventil
Ventolin
24
Q
Amiodarone - Adult Dose
A
(1) w pulse 150mg in 100ml over 10 min (repeat 1x)
(2) wo pulse - VF/VT/TdP (after mag w TdP) 300mg IV then 150mg after 3-5 min
25
Amiodarone - Adverse Effects
- Bradycardia
- Hypotension
- Prolonged QT
26
Amiodarone - Contraindications
- 2nd and 3rd Deg blocks
- Idioventricular Escape Rhythms
- Accelerated IVR
- Sinus brady, arrest or block
- Hypotension
- Cardiogenic Shock
- Ventricular conduction defects
- Iodine sensitivity
27
Amiodarone - Indications
- Prevent recurrence of VFib/VT after defib or conversion
- VT
- VF
28
Amiodarone - Pedi Dose (Medical Direction)
- w pulse 5mg/kg in 100 ml over 20 min
- w/o pulse 5mg/kg max does 300mg. May repeat twice to max dose of 15mg/kg
29
Amiodarone - Pharmacokinetics
Blocks potassium and sodium ion permiability across myocardia membrane, which in effect stabilizes the ion channels. Also has some effect on beta receptors and calcium channels
30
Amiodarone - Pharmacology
Prolongs duration and refractory period of action potential. Slows conduction, electrical pulse generation from SA node and conduction through accessory pathways. Also dilates blood vessels
31
Amiodarone - Precautions
- My prolong QT increasing risk to TdP and VF
- Inhibits atrioventricular conduction and decreases myocardia contractility increasing the risk of AV blocks and hypotension with an CCB
32
ASA - Adverse Effects
- Heartburn
- N/V
- Wheezing
33
ASA - Contraindications
```
Hypersinsitivity
Max dose (81mgx4=324mg) before EMS arrival
```
34
ASA - Dose
81mg x 4 = 324mg or 325 chewed
35
ASA - Indications
ACS or STEMI
36
ASA - Pharmacokinetics
Blocks platelet agragation
37
ASA - Pharmacology
- Platelet inhibitor
- Anti-inflammatory
38
ASA - Precautions
GI bleeding or upset
39
Atropine - Adult Dose - Bradycardia
0.5-1mg IVP every 3-5 min. Max dose 0.04mg/kg
40
Atropine - Adult Dose - Organophosphate Poison
2-4mg 3-5min (IVP or IM) every 5-10 min
41
Atropine - Contraindications
- Hypersensitive
- 2nd and 3rd Deg blocks
- Suspected AMI or ischemia
- Glaucoma
42
Atropine - Effects
Delirium, restlessness, disorientation, tachycardia, coma, flushed and hot skin, ataxia, blurred vision, dry mucous membranes
43
Atropine - Indications
- Bradycardia
- Organophosphate poison
- Nerve agents
44
Atropine - Pedi Dose - Bradycardia
0.02mg/kg. Max single dose 0.5mg - repeat 1x
ET - 0.04-0.06mg/kg dilute in 5mL - repeat 1x
45
Atropine - Pedi Dose - Organophosphate Poison
0.02mg/kg IVP or IM every 5-10 min
46
Atropine - Pharmacology
- Parasympatholytic (vagolytic action)
- Anticholinergic (accelerates the heart rate)
47
Calcium Chloride - Adult Dose
- 0.5 - 1g SLOW IVP over 10 min. Max dose 1g
- 0.5g SLOW IVP for hypotension following
- dilt administration
- Resp depression, decreased reflexes, flaccid
paralysis and apnea following mag sulfate admin
48
Calcium Chloride - Adverse Effects
- Bradycardia may occur w rapid injection
- Syncope, cardiac arrest, arrhythmias, bradycardia
49
Calcium Chloride - Contraindications
- Not indicated in cardiac arrest except when hyperkalemia, hypocalcemia, or CCB OD is suspected
- Pt taking digoxin w suspected CCB OD
50
Calcium Chloride - Indications
- Hypocalcemia
- Hyperkalemia
- CCB OD
- Hypotension due to dilt administration
- Mag sulfate admin complications
51
Calcium Chloride - Pedi Dose
20mg/kg SLOW IVP/IO 50mg/min. Max dose 1g
52
Calcium Chloride - Pharamacology
Increase contractile state (+ inotropic). Increase ventricular automaticity. Helps stabilize cell membrane
53
Calcium Chloride - Pharmacokinetics
- Rapid onset with IV administration
54
Dexamethasone (Decadron) - Adult Dosage
10mg IV or PO
55
Dexamethasone (Decadron) - Adverse Effects
- Headache
- Edema
- Vertigo
- Fluid retention
- Adrenal insufficiency and immunosupression w LT use
- HTN
- CHF
- N/V
- Dyspepsia
- Anaphylaxis
56
Dexamethasone (Decadron) - Contraindications
- Hypersensitive to the drug
- Known systemic fungal infection
- Premature infants
57
Dexamethasone (Decadron) - Indications
- Moderate to severe asthma exacerbation
- Croup
- Anaphylaxis
58
Dexamethasone (Decadron) - Pedi Dosage
Asthma - 0.5mg/kg (PO preferred) or IV to a max of 10mg
- Croup 0.5mg/kg PO/IV/IM max dose of 10mg
59
Dexamethasone (Decadron) - Precautions
- Caution w diabetes
- Known TB
- Osteoporosis
- Hepatic impairment
- CHF
- Seizure disorder
60
Dextrose - Contraindications
- Known hyperglycemia
61
Dextrose - Precautions
- Tissue necrosis if extravasation occurs
62
Dextrose - Adult Dose
- If blood is less than 70mg/dL admin 10% dextrose in 50mL (5g) bolus one min apart to max of 250mL or 25g of D50 IVP until
- Normal mental status
- Blood glucose is grater than 90mg/dL
- or if fully dosed and blood glucose less than
90mg/dL redose
63
Dextrose - Adverse
May worsen hyperglycemia
64
Dextrose - Indications
- Hypoglycemia
65
Dextrose - Pedi Dose
NEED TO DO
66
Dextrose - Pharacology
water-soluble monosaccharide found in corn syrup and honey
67
Dextrose - Pharmacokinetics
- Restores circulating blood sugar and is rapidly
utilized following IV injection
- Excess dextrose is rapidly excreted unchanged in urine
68
Diazepam (Valium) - Adult Dose
- 2.5mg SLOW IVP/IM
- Medical direction if IM
- Max of 10mg.
69
Diazepam (Valium) - Adverse effects
- Lightheadedness
- Motor impairment
- Ataxia
- Impairment of mental and psychomotor function, confusion, slurred speech, amnesia
- Paradoxical irritability and excitation
70
Diazepam (Valium) - Contraindications
- Hypersensitivity
- Head injury
71
Diazepam (Valium) - Indications
- Seizures
- Severe nerve agent exposure
72
Diazepam (Valium) - Nerve agent exposure
- No consult
- Adult 10mg IM
- Pedi if greater than 30kg - 0.1mg/kg max of 10mg
73
Diazepam (Valium) - Pedi Dose
- 0.1 mg/kg SLOW IVP/IM.
- max single dose 2.5mg.
- Max total dose 5mg
- Rectal dose 0.2mg/kg max dose of 10mg
74
Diazepam (Valium) - Pharmacokinetics
- rapid onset
- 1/2 life 20-90 min
75
Diazepam (Valium) - Pharmacology
- Sedation, hypnosis, alleviation of anxiety, muscle relaxation, anticonvulsant activity
- little cardiovascular effect
76
Diazepam (Valium) - Precautions
- Pts w altered mental status
- Hypotension
- Acute narrow glaucoma
- Resp depression if given to rapidly
- Resp support may be required
- Pregnant Pts
- ETOH
- Pt on sedatives
77
Diltiazem (Cardizem) - Adult Dose
- 0.25 mg/kg (max 20mg) over 2 min
- 15 min
- 0.35 mg/kg (max 25mg) over 2 min
- IF PT over 50yo w borderline BP, known renal failure, or CHF consider 5-10mg over 2 min
78
Diltiazem (Cardizem) - Adverse Effects
- Headache
- N/V
- Bradycardia
- Hypotension
79
Diltiazem (Cardizem) - Class
CCB
80
Diltiazem (Cardizem) - Contraindications
- Hypersensitivity
- Hypotension below 100mg.
- 2nd and 3rd deg heart block
- less than 18 yo
81
Diltiazem (Cardizem) - Indications
Afib and Aflutter
82
Diltiazem (Cardizem) - OD
- If hypotensive and clear lungs - fluid bolus of 20mL/kg of LR - titrate to systolic of 100
- If hypotensive and rales - max fluid bolus of 250mL of LR stop if obtain systolic of 100
- Calcium Chloride 500mg SLOW IVP
- If bradycardic consider 1mg of Atropine
- If unstable consider pacing
83
Diltiazem (Cardizem) - Pedi Dose
Consult
84
Diltiazem (Cardizem) - Pharmacokinetics
- Inhibits the movement of calcium ions across cardiac muscle cells
- Decrease conduction velocity and ventricular rate
85
Diltiazem (Cardizem) - Precautions
- CHF may result if used along with BB
86
Diltiazem (Cardizem) - Precautions
- CHF
- Pt w renal failure
87
DIPHENHYDRAMINE (Benadryl) - Adult Dosing
25-50mg SLOW IVP or IM
88
DIPHENHYDRAMINE (Benadryl) - Adverse Effects
- Drowsiness
- loss of coordination
- Blurred vision
- Headache,
- Hypotension
- Tachycardia
- Palpitations
- Thickening of bronchial secretions leading to chest
tightness
- Wheezing
89
DIPHENHYDRAMINE (Benadryl) - Contraindication
- Sensitivity to drug
90
DIPHENHYDRAMINE (Benadryl) - Indications
- Allergic reaction
- Anaphylaxis
- Dystonic reactions
91
DIPHENHYDRAMINE (Benadryl) - Pedi Dosing
1mg/kg SLOW IVP or IM
92
DIPHENHYDRAMINE (Benadryl) - Pharmacokinetics
- effects begin w/in 15 min
- 1/2 life of 2-10 hrs
- Peak effect 1-4 hrs
93
DIPHENHYDRAMINE (Benadryl) - Pharmacology
Antihistamine
94
DIPHENHYDRAMINE (Benadryl) - Precautions
Should be used with caution in patients with:
- Severe vomiting
- Alcohol intoxication
- Nursing mothers
95
Dopamine (Intropin) - Adult Dose
5-20 mcg/kg/min. Start at 5mcg. Titrate to 100 systolic
96
Dopamine (Intropin) - Adverse Effects
(1) Anginal pain
(2) Tachydysrhythmias
(3) Nausea and vomiting
(4) Hypertension
(5) Undesirable degree of vasoconstriction
97
Dopamine (Intropin) - Contraindications
(1) Preexisting tachydysrhythmias
(2) Uncorrected hypovolemia
98
Dopamine (Intropin) - Indications
(1) Cardiogenic shock
(2) Septic shock
(3) Anaphylactic shock
(4) Hypovolemic shock (after sufficient volume
replacement)
99
Dopamine (Intropin) - Pedi Dose
2-20 mcg/kg/min Start at 2mcg. Titrate to age appropriate BP
100
Dopamine (Intropin) - Pharmacokinetics
(1) Extremely rapid onset of action
(2) Extremely brief duration of action
(3) The rate of administration may be used to control
the effect of dopamine.
101
Dopamine (Intropin) - Pharmacology
(1) Alpha and beta adrenergic receptor stimulator
(2) Dopaminergic receptor stimulator
(3) Precursor of norepinephrine
(4) At low doses, less than 2 mcg/kg/min
(a) Dilates renal and mesenteric blood vessels
(b) Venoconstricts
(c) Arterial resistance varies
(5) At moderate doses, 2–6 mcg/kg/min beta1
stimulating effect on heart. Results in increased
cardiac output
(6) High dose, 6–10 mcg/kg/min. Exhibits
alpha1 effects; peripheral vasoconstriction
including renal and mesenteric vessels,
increases left and right ventricular preload
(7) Doses greater than or equal to 10 mcg/kg/min
Alpha1 stimulating effects may reverse mesenteric
and renal artery dilatation resulting in decreased
blood flow, causing increased preload due to effects
on venous system
102
Dopamine (Intropin) - Precautions
(1) Extravasation should be reported ASAP.
(2) Patients on monoamine oxidase (MAO) inhibitors are
extremely sensitive so should recive lower doses.
(3) Patients with pheochromocytoma are extremely
sensitive and may develop profound hypertension in
response to minimal doses.
103
Epinephrine (0.1mg/mL and 1mg/mL) - Adverse Effects
(1) Tachydysrhythmias (supraventricular and ventricular)
(2) Hypertension
(3) May induce early labor in pregnant women
(4) Headache
(5) Nervousness
(6) Decreased level of consciousness
(7) Rebound edema may occur 20–30 minutes after
administration to croup patients.
104
Epinephrine (0.1mg/mL and 1mg/mL) - Contraindications
(1) Hypertension
(2) Preexisting tachydysrhythmias with a pulse
(ventricular and supraventricular)
(3) Use with pregnant women should be avoided
whenever possible
(4) IV push epinephrine should not be administered to
any patient with a pulse
105
Epinephrine (0.1mg/mL and 1mg/mL) - Indications
(1) Medical cardiac arrest and pediatric traumatic arrest
(2) Moderate to severe allergic reaction/anaphylaxis
(3) Epinephrine infusion (IV/IO) should be reserved for patients in shock refractory to fluid bolus or for patients in anaphylactic shock
(4) Severe asthma
(5) Respiratory stridor (suspected croup)
106
Epinephrine (0.1mg/mL and 1mg/mL) - Pharmacokinetics
(1) IV administered epinephrine has an extremely rapid
onset of action.
(2) Is rapidly inactivated by the liver
(3) Subcutaneous administration of epinephrine results
in slower absorption due to local vasoconstriction.
(4) Local massage will hasten absorption.
(5) Topically applied nebulizer within the respiratory
tract, epinephrine has vasoconstrictor properties
that result in reduction of mucosal and submucosal
edema. It also has bronchodilator properties that
reduce airway smooth muscle spasms.
107
Epinephrine (0.1mg/mL and 1mg/mL) - Pharmacology
(1) The administration of epinephrine causes increases in:
(a) Systemic vascular resistance
(b) Systemic arterial pressure
(c) Heart rate (positive chronotropic effect)
(d) Contractile state (positive inotropic effect)
(e) Myocardial oxygen requirement
(f) Cardiac automaticity
(g) AV conduction (positive dromotropic effect)
(2) Causes bronchial dilation by smooth muscle
relaxation
108
Epinephrine (0.1mg/mL and 1mg/mL) - Precautions
(1) Do not mix with sodium bicarbonate as this
deactivates epinephrine.
(2) Epinephrine causes a dramatic increase in
myocardial oxygen consumption.
(3) Its use in the setting of an acute MI should be
restricted to cardiac arrest.
109
Epinephrine - Bradycardia Adult Dose
1mg in 100ml = COH of 10mcg/mL. Administer 10mcg/min on a 60 drop set
Infusion - 2-10 mcg/min
110
Epinephrine - Bradycardia Pedi Dose
(0.1mg/mL) - 0.01mg/kg IV/IO every 3-5 min (KEY for PEDS.....0.1mL/kg so 10kg kid gets 1mL of 0.1mg/mL)
111
Epinephrine - Cardiac Arrest Adult Dose
1mg 0.1mg/mL IVP/IO every 4 min (max dose of 4). If arrest after ROSC max dose of 2 more
112
Epinephrine - Cardiac Arrest Pedi Dose
0.01mg/kg of 0.1mg/mL IV/IO every 4 min (max dose of 4) if arrest after ROSC max dose of 2 more (KEY for PEDS.....0.1mL/kg so 10kg kid gets 1mL of 0.1mg/mL
113
Epinephrine - Croup Pedi Dose
(1mg/mL) 2.5mL via neb. (2 dose max)
Resp Distress/eminent failure - 0.01mg/kg (max dose of 0.5mg)
114
Epinephrine - Reaction/Anaphylaxis/Asthma Adult Dose
(1mg/mL) 0.5 mg every 5 min - (max dose 3x)
115
Epinephrine - Reaction/Anaphylaxis/Asthma Pedi Dose
(1mg/mL) \> 5 yo 0.15mg every 5 min (3 dose max)
\< 5yo 0.5mg every 5 min (3 dose max)
116
Fentanyl - Adult Dosage
(1) 1mcg/kg IV/IO/IM - Max 200mcg
(2) reassess in 5-10 min.
(3) one more dose at 1mcg/kg - max 200mcg
(4) med control for more
117
Fentanyl - Adverse Effects
(1) Respiratory depression/arrest
(2) Altered mental status
(3) Increased vagal tone due to suppression of
sympathetic pathways (slowed heart rate)
(4) Constricted pupils (pinpoint)
(5) Increased cerebral blood flow
118
Fentanyl - Contraindications
(1) Allergy
(2) Uncorrected respiratory distress or hypoxemia
refractory to supplemental oxygen
(3) Uncorrected hypotension, defined as a persistent
systolic pressure less than 90 mmHg
119
Fentanyl - Indications
(1) The patient reports moderate to severe pain.
(2) In the clinician’s judgment the patient will benefit
from treatment with an opioid analgesic, including
patients who are MOLST and/or EMS/DNR patients
or being pre-medicated for a procedure.
120
Fentanyl - Pedi Dose
1) 1mcg/kg IV/IO/IM - Max 200mcg
(2) reassess in 5-10 min.
(3) one more dose at 1mcg/kg - max 200mcg
(4) med control for more
121
Fentanyl - Pharmacokinetics
Onset of action is 2–3 minutes after IV dose and effects last 30 minutes to 1 hour.
122
Fentanyl - Pharmacology
(1) Synthetic opioid binds with opiate receptors in the
CNS, altering both perception and emotional
response to pain.
(2) Fentanyl is significantly more potent than morphine.
100 mcg of fentanyl is equivalent to 10 mg of
morphine.
123
Fentanyl - Precautions
(1) Naloxone reverses all effects.
(2) To reduce the risk of chest wall rigidity (especially in
children), fentanyl should be administered slowly
and titrated to effect.
(3) Vital signs should be monitored frequently.
(4) Hypotension is a greater possibility in volume-
depleted patients.
(5) Elderly patients and those with impaired renal
function may be more sensitive to the medication’s
effects.
124
Glucagon - Adverse Effects
N/V
125
Glucagon - Adult Dose - CCB OD
1mg IVP every 5 min
126
Glucagon - Adult Dose Hypoglycemia
1mg IM/IN max 3mg
127
Glucagon - Contraindications
Sensitivity
128
Glucagon - Indications
(1) Patients with altered mental status who are
suspected of being hypoglycemic where IV access
is not obtainable
(2) Beta blocker overdose
129
Glucagon - Pedi Dose - CCB OD
\>5yo 0.5mg IVP every 5 min
5yo or \< adult dose 1mg IVP every 5 min
130
Glucagon - Pedi Dose Hypoglucemia
\>5yo 0.5mg IM/IN max of 3mg
5yo or \< adult dose 1mg IM/IN max 3mg
131
Glucagon - Pharmacokinetics
(1) Destroyed by the GI tract and is not effective orally
(2) Maximum hyperglycemic activity occurs within 30
minutes and disappears after 1–2 hours.
(3) Relaxation of smooth muscle occurs within 8–10 minutes and persists for
12–27 minutes.
(4) The half-life is 3–10 minutes.
(5) Degraded in liver and kidneys
132
Glucagon - Pharmacology
(1) Hormone synthesized by the pancreas
(2) Increases blood glucose concentration
(3) Inhibits gastric and pancreatic secretions
(4) May increase heart rate and cardiac output
(5) May decrease blood pressure
(6) Increases metabolic rate
133
Glucagon - Precautions
Only works if liver has glycogen stores
134
Haloperidol (Haldol) - Adult Dose
\>69yo - 5mg IM
\<68yo - 2.5 mg IM
135
Haloperidol (Haldol) - Adverse Effects
(1) Dystonic reaction - Benadryl 25-50mg (adult) 1mg/kg - max 25mg
(pedi)
(2) Hypotension and tachycardia - LR fluid bolus
(3) TdP
136
Haloperidol (Haldol) - Contraindications
(1) Children under 5 years of age
(2) Parkinson’s disease
(3) CNS depression
(4) Acute CNS injury
(5) Severe agitation (see midazolam and ketamine)
137
Haloperidol (Haldol) - Indications
```
Moderate agitation (defined as behavior that puts the patient or clinician at risk of harm) due to suspected psychiatric emergency (e.g., schizophrenia) or medical
delirium
```
138
Haloperidol (Haldol) - Pedi Dose
\>5yo contraindicated
5-12 yo 0.05mg/kg IM max of 2.5mg IM
13yo+ 2.5-5mg IM
139
Haloperidol (Haldol) - Pharmacokinetics
Onset of action is within 10 minutes of the IM administration
140
Haloperidol (Haldol) - Pharmacology
Antipsychotic
141
Haloperidol (Haldol) - Precautions
(1) Violent patients may require physical restraint while
the medication is administered.
(2) Patients receiving haloperidol should be placed on
cardiac monitor to evaluate for dysrhythmias.
142
Ipratropium (Atrovent) - Adult Dose
(1) Single dose only
(2) 0.5mg (2.5mL) in combination w 2.5mg of Albuterol
143
Ipratropium (Atrovent) - Adverse Effects
(1) More common: dry mouth, cough, or unpleasant
taste
(2) Less common: vision changes, eye burning or pain,
dizziness, headache, nervousness, palpitations,
sweating, trembling, chest tightness, rash, hives, or
facial sweating
144
Ipratropium (Atrovent) - Contraindications
(1) Sensitive to drug or atropine
(2) \>1yo
145
Ipratropium (Atrovent) - Indications
(1) Allergic reactions/anaphylaxis
(2) Bronchial asthma
(3) Reversible bronchospasms associated with chronic
bronchitis and emphysema
146
Ipratropium (Atrovent) - Pedi Dose
(1) Single dose only
(2) less than 1yo - Contraindicated
(3) b/t 1 & 2 yo 0.25mg w Albuterol
(4) 3yo+ Adult dose
147
Ipratropium (Atrovent) - Pharmacokentics
(1) Improved pulmonary function in 15–30 minutes
(2) Peak effects occur in 1–2 hours.
(3) Duration of action is usually 4–5 hours.
148
Ipratropium (Atrovent) - Pharmacology
(1) Anticholinergic (parasympatholytic) bronchodilator
(2) Bronchodilator is site-specific, not systemic
(3) Dries respiratory tract secretions
(4) Most effective in combination with a beta-adrenergic
bronchodilator
149
Ipratropium (Atrovent) - Precautions
(1) Use with caution in patients with congestive heart
failure, heart disease, hypertension, glaucoma, and
with elderly patients.
(2) May worsen the condition of glaucoma if it gets into
the eyes. Having the patient close their eyes during
nebulization may prevent this.
(3) Not to be used as a single agent—must be used in
combination with a beta-agonist.
150
Ketamine - Adult Dose CPR Induced Awareness
1mg/kg IV/IO. Additional dose require medical consult
151
Ketamine - Adult Dose Pain
(1) 0.2mg/kg IV/IO over 2 min. Max 20mg - Reassess
after 5-10 min. If still pain, same dose as before over
2 min
(2) If IV unavailable 0.5mg/kg IM/IN. - Reassess after 15
min. If still pain same dose as before
152
Ketamine - Adult Dose Severe Agitation
(1) IV/IO - 1mg/kg. Max dose 100mg. If agitation
persists same dose as before. Max total dose
200mg
(2) IM/IN 4mg/kg max dose 400mg. Additional dose
requires medical consult.
153
Ketamine - Adult Dose Vent Bucking
2mg/kg IV/IO over 60 seconds. 2 additional doses at 1mg/kg
154
Ketamine - Adverse Effects
(1) Although respiration is frequently stimulated,
respiratory depression may occur with rapid IV
administration. Laryngospasm has been known to
occur.
(2) Although hypotension may occur, blood pressure
and heart rate are frequently stimulated.
(3) Involuntary myoclonus that may mimic seizure
activity – these movements should not be confused
for seizures of emergence from sedation.
(4) Possible enhanced secretions
(5) Possible unpleasant dreams and delirium upon
emergence from sedation
155
Ketamine - Contraindications
(1) Sensitivity
(2) Penetrating eye injury
(3) Chest, abdominal, flank pain or headache
156
Ketamine - Indications
(1) Moderate to severe pain; musculoskeletal, extremity,
and back pain
(2) Severe agitation
(3) Ventilatory difficulty secondary to bucking or
combativeness in intubated patients
(4) CPR-induced awareness
157
Ketamine - Pedi Dose CPR Induced Awareness
Need to consult
158
Ketamine - Pedi Dose Pain
SAME AS ADULT
(1) 0.2mg/kg IV/IO over 2 min. Max 20mg - Reassess
after 5-10 min. If still pain, same dose as before over
2 min
(2) If IV unavailable 0.5mg/kg IM/IN. - Reassess after 15
min. If still pain same dose as before
159
Ketamine - Pedi Dose Severe Agitation
SAME AS ADULT
(1) IV/IO - 1mg/kg. Max dose 100mg. If agitation
persists same dose as before. Max total dose
200mg
(2) IM/IN 4mg/kg max dose 400mg. Additional dose
requires medical consult.
160
Ketamine - Pedi Dose Vent Bucking
SAME AS ADULT
2mg/kg IV/IO over 60 seconds. 2 additional doses at 1mg/kg
161
Ketamine - Pharmacokinetics
A rapid-acting, non-barbiturate, sedative-hypnotic analgesic agent characterized by normal pharyngeal-laryngeal reflexes, normal or enhanced skeletal muscle
tone, and possible cardiovascular and respiratory stimulation. It may occasionally produce transient respiratory depression.
Onset - IV/IO 5-10 min. IM/IN 15-20 min
162
Ketamine - Pharmacology
Sedative-hypnotic; analgesic
163
Ketamine - Precautions
(1) Cardiac and respiratory function should be
continuously monitored
(2) Some patients who have received ketamine for
control of severe agitation may require advanced
airway management.
(3) Ketamine is supplied in multiple concentrations (10
mg/mL, 50 mg/mL and 100 mg/mL). DBL CK .
(4) Ketamine 100 mg/mL concentration is best for IM/IN.
(5) Ketamine 10 mg/mL concentration is preferable for
IV administration for analgesia.
164
Ketorolac (Toradol) - Adult Dose
```
15mg IV (1 dose)
30mg IM (1 dose)
```
165
Ketorolac (Toradol) - Adverse Effects
a) Burning or pain at the injection site
b) Rash / itching
c) GI distress
d) Nausea / vomiting
166
Ketorolac (Toradol) - Contraindications
a) Hypersensitivity to ketorolac, aspirin, and other NSAIDs
b) Current usage of aspirin or NSAIDs within 6 hours
c) Severe headache or head injury
d) Bleeding or clotting disorder
e) Renal disease or transplant
f) Active or history of peptic ulcer disease (PUD), active
or recent history of GI bleed, and active or history of
GI perforation
g) Pregnancy or breast feeding
h) Suspected ACS
i) Trauma with suspected bleeding
j) Younger than 2yo
167
Ketorolac (Toradol) - Indications
a) Management of moderate to severe acute pain
b) Consider as a first line medication for renal
stones/colic
c) Burns - mild to moderate
d) Non-traumatic neuromuscular pain
168
Ketorolac (Toradol) - Pedi Dose
0.5mg/kg IV - max 15mg (1 dose)
1mg/kg IM - max 30 mg (1 dose)
169
Ketorolac (Toradol) - Pharmacokinetics
a) Onset: Approximately 30 minutes
b) Peak effects: 1-2 hours
c) Half-life: 4-6 hours
170
Ketorolac (Toradol) - Pharmacology
a) Inhibits synthesis of prostaglandin, which, in turn,
reduces pain and inflammation
b) Antipyretic agent
c) Does not affect CNS, peripheral acting analgesic,
therefore, it does not possess the same sedative
properties as a narcotic
171
Lactated Ringers - Adult Dose Multiple/Sever Trauma w Head Injury
(1) Small boluses (max of 250mL) bf BP ck.
(2) Titrate to BP of 110 mmHg
(3) max dose of 2L
172
Lactated Ringers - Adult Dose Multiple/Sever Trauma wo Head Injury
(1) Small boluses (max of 250mL) bf BP ck.
(2) Titrate to BP of 90 mmHg
(3) max dose of 2L
173
Lactated Ringers - Adult Dose wo Multiple/Sever Trauma
(2) Titrate to 90 mmHg
(3) max dose of 2L
174
Lactated Ringers - Contraindications
Fluid overload states
175
Lactated Ringers - Indications
(1) Hypovolemia (limitation in multiple/severe trauma
without head injury)
(2) Keep vein open
(3) Fluid boluses
176
Lactated Ringers - Pedi Dose
(1) KVO
(2) For hypotension 20mL/kg IV/IO unless
neonate/volume sensitive than 10mL/kg
(3) If BP does not improve second bolus
(4) 3+ bolus need med consult
177
Lactated Ringers - Pharmacokinetics
Water and electrolyte replacement
178
Lactated Ringers - Pharmacology
Isotonic crystalloid solution
179
Lactated Ringers - Precautions
(1) Watch for fluid overload
(2) Use with caution in patients with CHF and renal failure.
180
Lidocaine (Xylocaine) - Adult Dose IO Infusion
20-40mg of 2% lidocaine (1-2mL)
181
Lidocaine (Xylocaine) - Adult Dose Nasal Pharyngeal Anesthesia
4mL of 4% (40mg/mL) and 2mL up each nares w atomizer
182
Lidocaine (Xylocaine) - Pedi Dose IO Infusion
(1) 13 or older - Adult dose 20-40mg of 2%
(2) Younger than 13 - med consult
183
Lidocaine (Xylocaine) - Pedi Dose Nasal Pharyngeal Anesthesia
1) 13 or older - 4mL of 4% (40mg/mL) and 2mL up each
nares w atomizer
(2) Younger than 13 - med consult
184
Lidocaine (Xylocaine) - Adverse Effects
(1) Lidocaine may cause clinical evidence of toxicity
usually related to the central nervous system.
(2) Toxicity:
(a) Early: muscle twitching, slurred speech, altered
mental status, decreased hearing, paresthesia (pins
and needles), anxiety, apprehension, visual
disturbances, nausea, numbness, difficulty breathing
or swallowing, decreased heart rate
(b) Late: convulsions, hypotension, coma, widening
of QRS complex, prolongation of the P-R interval,
hearing loss, hallucinations
185
Lidocaine (Xylocaine) - Contraindications
(1) Sensitivity to lidocaine
(2) AV blocks
(3) IVR escape rhythms
(4) Accelerated iIVR
(5) Sinus bradycardia or arrest or block
(6) Hypotension
(7) Shock
(8) Ventricular conduction defects
186
Lidocaine (Xylocaine) - Indications
(1) Anesthesia for IO infusions
(2) Nasal tracheal intubation
187
Lidocaine (Xylocaine) - Pharmacokinetics
(1) IV - Extremely rapid (within minutes) lasts approximately 10–20 minutes
(2) Mucosal anesthesia with onset in 1–5 minutes
188
Lidocaine (Xylocaine) - Precautions
Reduce the dosage in patients with decreased cardiac output, liver dysfunction, and the elderly (over age 70).
189
Mag Sulf - Adult Dose - Pregnancy Seizure
4g IV/IO mixed w 50-100mL over 10 min
190
Mag Sulf - Adult Dose - Refractory VT/VF
1-2g IV/IO over 2 min
191
Mag Sulf - Adult Dose - Severe Asthma/Bronchospasm
1-2g IV/IO mixed 50-100mL over 10-20min (MED DIRECTION)
192
Mag Sulf - Adult Dose - TdP
1-2g IV/IO over 2 min
193
Mag Sulf - Adverse Effects
(1) Respiratory depression
(2) Flushing
(3) Sweating
(4) Hypotension
(5) Depressed reflexes
194
Mag Sulf - Contraindications
(1) Heart blocks
(2) Renal impairment
(3) Hypermagnesemia
195
Mag Sulf - Pedi Dose - Pregnancy Seizure
4g IV/IO mixed w 50-100mL over 10 min
196
Mag Sulf - Pedi Dose - Severe Asthma/Bronchospasm
50mg/kg (max 2g) IV/IO mixed 50-100mL over 10-20min (MED DIRECTION) - Also think about LR fluid bolus of 20mL/kg to support BP
197
Mag Sulf - Pedi Dose - TdP
25mg/kg (max 2g) IV/IO over 2 min
198
Mag Sulf - Precautions
(1) May exaggerate effects of CNS depressants and
neuromuscular blocking agents
(2) Due to concern of hypotension, IV fluid bolus should
be initiated if hypovolemia is suspected.
(3) Mag tox presents with respiratory
depression, decreased reflexes, flaccid paralysis,
and apnea. Calcium chloride 500 mg SLOW IVP
antidote.
199
Mag Sulfate - Indications
(1) Torsades de pointes
(2) Seizures with pregnancy
(3) Refractory VF and VT after amiodarone
administration
(4) Moderate to severe asthma/bronchospasm
exacerbation
200
Mag Sulfate - Pharmacokinetics
With intravenous administration the onset of anticonvulsant action is immediate and
lasts about 30 minutes. Magnesium is excreted solely by the kidney at a rate proportional to the plasma concentration and glomerular filtration rate.
201
Mag Sulfate - Pharmacology
Physiologic calcium channel blocker and also blocks neuromuscular transmission. Hypomagnesemia can cause cardiac dysrhythmias. It is also a CNS depressant effective in the management of seizures during pregnancy. It does this by decreasing the amount
of acetylcholine liberated from motor nerve terminals. Magnesium is necessary for many biochemical processes and plays a role in the transmission of electrical impulses.
202
Midazolam (Versed) - Adult Dosing
(1) 0.1 mg/kg in 2mg increments SLOW IVP over 1-2 min per increment w max dosage of 5mg
(2) If IV unavailable 5mg IN/IM - IN max 1mL per nare
(3) Additional doses to 10mg require med control
203
Midazolam (Versed) - Adult Dosing - Agitation
(1) 18-69 yo 5mg IM/IV
(2) \>69 yo 2.5 mg IM/IV
(3) if you gave ketamine first 2.5mg IV/IO after med direction
204
Midazolam (Versed) - Adult Dosing - Nerve Agent Exposure
5mg IM wo Med Control
205
Midazolam (Versed) - Adverse Effects
(1) Respiratory depression or apnea
(2) Hypotension
206
Midazolam (Versed) - Contraindications
(1) Hypotension (See below for ET bucking)
(2) Hypersensitivity
207
Midazolam (Versed) - Indications
(1) Sustained and/or recurrent seizures
(2) Precardioversion to reduce anxiety
(3) Awake patient requiring transcutaneous pacing (TCP)
(4) Nasal Tracheal Intubation
(5) Implanted Cardioverter Defibrillator (ICD) Malfunction
(6) Nerve/organophosphate exposure
(7) Bucking Endotracheal Intubated patient
(8) Moderate to severe stimulant toxicity
(9) Moderate or severe agitation
208
Midazolam (Versed) - Pedi Dosing
(1) 0.1mg/kg in 2mg increments SLOW IVP over 1-2 min per increment w max dosage of 5mg
(2) If IV unavailable 0.2 mg/kg (Max 5mg) IN/IM - IN max 1mL per nare
209
Midazolam (Versed) - Pedi Dosing - Agitation
Med Direction required
(1) 13-18 if you gave ketamine first 2.5mg IV/IO
(2) 13-18 yo if IV/IO unavail and ketamine admin IM, give 5mg IM
210
Midazolam (Versed) - Pedi Dosing - Nerve Agent Exposure
5mg IM wo Med Control
211
Midazolam (Versed) - Pharmacokinetics
(1) Short-acting benzo with strong hypnotic,
anticonvulsant activity, and amnestic properties
(2) Extremely rapid onset - IV 1.5 minutes. IM 15 min
(3) Duration 1–4 hours - half-life of 1.5 to 3 hours in
healthy adult.
212
Midazolam (Versed) - Pharmacology
(1) Sedative
(2) Hypnotic
(3) Anticonvulsant
213
Midazolam (Versed) - Precautions
(1) Effects can be accentuated/potentiated by CNS
depressants, such as opioids or alcohol.
(2) 5x as potent as diazepam
(3) Increased risk of respiratory depression.
214
Morphine - Adult Dose
(1) 0.1 mg/kg max 20mg - IV/IM
(2) reassess 5-10 min
(3) 0.05 mg/kg max 10mg
(4) med control for more
215
Morphine - Adverse Effects
(1) Respiratory depression/arrest
(2) Altered mental status (Dec Loc)
(3) Increased vagal tone due to suppression of sympathetic pathways (slowed heart rate)
(4) Nausea and vomiting
(5) Constricted pupils (pinpoint)
(6) Increased cerebral blood flow
216
Morphine - Contraindications
(1) Hypersensitivity or known allergy to morphine
(2) Uncorrected respiratory distress or hypoxemia
(3) Uncorrected hypotension, e.g. \< 90 mmHg systolic
217
Morphine - Indications
(1) The patient reports moderate to severe pain.
(2) In the clinician’s judgment the patient will benefit
from treatment with an opioid analgesic, including
patients who are MOLST and/or EMS/DNR patients
or being pre-medicated for a procedure.
(3) Pulmonary Edema/Congestive Heart Failure (Pediatric only)
218
Morphine - Pedi Dose
Same as adult
(1) 0.1 mg/kg max 20mg - IV/IM
(2) reassess 5-10 min
(3) 0.05 mg/kg max 10mg
(4) med control for more
219
Morphine - Pedi Dose - Pulmonary Edema/CHF
(1) 0.1 mg/kg max 5 mg.
(2) SLOW IV/IO/IM push 1-2 mg/min
220
Morphine - Pharmacokinetics
(1) Binds with opiate receptors, altering both
perception and emotional response to pain
(2) Onset \<5 minutes after IV and lasts 4–5 hours.
(3) Causes peripheral arterial and venous vasodilation
221
Morphine - Pharmacology
(1) Decreases pain perception and anxiety
(2) Relaxes respiratory effort
(3) Causes peripheral dilation, which decreases preload
(4) Decreases left ventricular afterload
222
Morphine - Precautions
(1) Naloxone reverses all effects.
(2) Should be administered slowly and titrated to effect.
(3) Vital signs should be monitored frequently.
(4) Hypotension is a greater possibility in volume-
depleted patients.
223
Naloxone (Narcan) - Adult Dosage
(1) 0.4-2mg IVP/IO/IN - TITRATE
(2) max 1mL/nare
224
Naloxone (Narcan) - Adverse Effects
Opioid withdrawal
225
Naloxone (Narcan) - Contraindications
Patients under 28 days of age.
226
Naloxone (Narcan) - Pedi Dosage
(1) 0.1 mg/kg IV/IO/IN 2 mg max - TITRATE
(2) max 1mL/nare
227
Nitroglycerin - Adult Dose - Chest Pain
(1) w HX of Nitro use - 0.4mg SL 3x
(2) 3-5 min between
(3) no HX establish IV first that dose normally
228
Nitroglycerin - Adult Dose - Pulmonary Edema/CHF
(1) low dose - 0.4 mg SL 3x
(2) high dose (until CPAP or CPAP not tollerated)
(a) 0.4mg SL and 1 " of NTG paste
(b) 0.8mg SL
(c) continue 0.8 mg SL until 20% reduction of BP
229
Nitroglycerin - Adverse Effects
Headache, hypotension, nausea, vomiting, dizziness, and decreased level of consciousness
230
Nitroglycerin - Contraindications
(1) Hypersensitivity
(2) Under 13
(3) Pt taking meds for Pulmonary Artery Hypertension (e.g., Adcirca® or Revatio®)
(4) ED within past 48 hours. Med con to over-ride
(5) Asymptomatic hypertension
(5) BP below 90 mmHg systolic
(6) Heart rate \< 60 \> 150
231
Nitroglycerin - Indications
(1) For treatment of angina
(2) Congestive heart failure, acute pulmonary edema
232
Nitroglycerin - Pedi Dose
Med Consult
233
Ondansetron (Zofran) - Adult Dosing
(1) 8mg SLOW IV over 2-5 min
(2) 4-8mg IM
(3) 8mg orally disintegrating
(4) may repeat once wo Med Consult
234
Ondansetron (Zofran) - Adverse Effects
(1) Hypotension
(2) Tachycardia
(3) Extrapyramidal reactions
(4) Seizures
(5) QT interval prolongation
235
Ondansetron (Zofran) - Contraindications
(1) sensitivity
(2) under 28 days
236
Ondansetron (Zofran) - Indications
Prevention and control of nausea and/or vomiting
237
Ondansetron (Zofran) - Pedi Dosing
(1) 28 days to 12 - 0.1 mg/kg SLOW IV (2-5 min)
(2) 13-18 yo same as Adult except IM
(a) 8mg SLOW IV over 2-5 min
(b) 8mg orally disintegrating
(c) 0.1 mg/kg max of 8 mg IM
(3) may repeat once wo Med Consult
238
Ondansetron (Zofran) - Pharmacokinetics
Anti-nausea/Anti-emetic 5-15 min w IV 30 min w IM
239
Ondansetron (Zofran) - Pharmacology
A selective blocking agent of the serotonin 5-HT3 receptor type
240
Ondansetron (Zofran) - Precautions
Monitor EKG, pulse ox and BP
241
Sodium Bicarb - Adult Dosage
(1) after airway is secured
(2) 1mEq/kg IVP bolus w 0.5 mEq/kg at 10 min intervals
242
Sodium Bicarb - Adult Dosage - HyperK
(1) 50mEq SLOW over 5 min then
(2) 100mEq in 1L LR over 30-60 min
243
Sodium Bicarb - Adverse Effects
(1) Worsened intracellular acidosis due to carbon
dioxide formation
(2) Hyperosmolality
(3) May precipitate congestive heart failure
(4) Metabolic alkalosis
(5) Acute hypokalemia
(6) Exacerbation of central venous acidosis
(7) Shifting the oxyhemoglobin dissociation curve,
inhibiting the release of oxygen to the tissues
244
Sodium Bicarb - Contraindications
alkalosis
245
Sodium Bicarb - Indications
(1) Cardiac arrest (last try)
(2) Hyperkalemia
(3) Tricyclic and phenobarbital overdose
(4) Pretreatment for patients with decreased renal
function who will be receiving IV contrast dye
246
Sodium Bicarb - Pedi Dosage
(1) after airway is secured
(2) older than 1yo. Adult dose- 1mEq/kg IVP bolus w 0.5 mEq/kg at 10 min intervals
(3) if \<1yo Adult dose diluted 1:1 w LR
247
Sodium Bicarb - Pedi Dosage - HyperK
(1) 1mEq/kg IV over 5 min
(2) if \<1yo then 1mEq/kg diluted 1:1 w LR
248
Sodium Bicarb - Pharmacokinetics
(1) Rapid onset of action in the blood
(2) Delayed onset of action in the tissues
249
Sodium Bicarb - Pharmacology
Sodium bicarbonate corrects acidosis
250
Sodium Bicarb - Precautions
(1) Inactivates simultaneously-administered
catecholamines
(2) Priorities before use:
(a) Intubation
(b) Hyperventilation
(c) Defibrillation
(d) Epinephrine
(e) Antiarrhythmics
251
Verapamil (ISOPTIN) - Adult Dosage
(1) 2.5–10 mg slow IV over 2 minutes
(2) may repeat same dose in 15 min w Med Consult
252
Verapamil (ISOPTIN) - Adverse Effects
(1) Hypotension
(2) Bradycardia
(3) Vomiting
(4) Nausea
(5) Headache
253
Verapamil (ISOPTIN) - Contraindications
(1) BP below 100 mmHg, 2nd or 3rd heart block,
(2) PMHx of WPW
(3) Ventricular tachycardia
(4) Patients less than 18 years of age
254
Verapamil (ISOPTIN) - Indications
AFib & AFlutter
255
Verapamil (ISOPTIN) - OD
(1) Monitor Vitals and Admin O2
(2) Hypotension
(a) Lungs clear 20mL/kg fluid bolus of LR titrate to
100mmHG
(b) if rales present admin max of 250mL of LR titrate
to 100mmHg
(c) Admin Calcium Chloride 500mg SLOW IVP
(3) Brady Cardia
(a) Atropine 0.5 - 1mg
(b) pacing
256
Verapamil (ISOPTIN) - Pedi Dose
NONE
257
Verapamil (ISOPTIN) - Pharmacokinetics
(1) Inhibits calcium ions across cardiac muscle cells
(2) Decreases conduction velocity and ventricular rate
258
Verapamil (ISOPTIN) - Pharmacology
CCB
259
Verapamil (ISOPTIN) - Precautions
(1) Beta Blockers - u will kill them!
(2) Pts with renal or congestive heart failure
