Med Contraindications, Precautions, Side Effect & Special Notes Flashcards
(20 cards)
Adenosine
Contra: *Known hypersensitivity. * Second & third degree heart block.
Precautions: Adverse effects include flushing, dyspnea, CP, anxiety, Brady, & occasionally hemodynamic disturbances - all of which are short lived.
Side effects/special notes: * Whenever possible establish IV at AC. * Caffeine and theophylline antagonize adenosine’s effects. Larger doses may be required. * Warn pts to expect brief sensation of chest discomfort.
Albuterol
Contra: Known hypersensitivity.
Precautions: * Albuterol has sympathomimetic effects. Discontinue immediately if pt develops cp or dysrhythmia. * Inhaled, albuterol can result in paradoxical bronchospasm, which can be life threatening. If this occurs, the neb should be discontinued immediately.
Side effects/special notes: *Monitor BP, HR/rhythm closely and contact med control if any concerns arise. * Meds such as MAO inhibitors (antidepressants) and tricyclics may potentiate tachy and hypertension.
Amiodarone
Contra: * Heart block. * Cardiogenic shock. * Allergic.
Precautions: * N/V are common reactions, be prepared to administer Promethazine as needed. * Hypotension is common, monitor BP.
Side effects/special notes: flushing, edema, sinus arrest, hypotension, N/V.
Aspirin
Contra: * Known hypersensitivity to ASA or other NSAID (like Motrin) * GI bleeding.
Atropine
Contra: Known hypersensitivity.
Precautions: * Avoid in hypothermia. * Can cause increased cardiac O2 consumption.
Side effects/special notes: * Remember that in cardiac arrest situations that atropine dilates pupils. * Will not work in pts with heart transplants.
Dextrose 5%
Precautions: Pts at risk for elevated I.C.P. Elevated blood glucose concentrations.
Side effects/special notes: Local venous irritation.
Dextrose 50%
Precautions: * Use with caution w/stroke specific symptoms. (Unilateral weakness, paralysis, and paresis) * Extravasations of glucose can cause tissue necrosis. Ensure IV latency before and during administration.
Side effects/special notes: * One bolus should raise the blood sugar 50-100 mg/ml and, therefore, will be adequate for most pts. * Effect may be delayed in elderly pts with poor circulation. * Do not administer dextrose to a pt who is seizing due to trauma. * dextrose 50% should be diluted 1:1 with NS (to create D25) for pts 8yo & younger.
Diazepam
Contra: * Known hypersensitivity to drug. * Shock, coma, and acute alcohol intoxication.
Precautions: * May cause changes in HR & BP. * May cause decrease RR or apnea.
Side effects/special notes: Headache, over sedation, drowsiness, amnesia, N/V, hiccups.
Diphenhydramine
Contra: Do not administer to newborns and neonates or breast feeding females.
Precautions: May cause drowsiness which may be potentiated by alcohol or depressants.
Side effects/special notes: * Not the first line drug for allergic reactions, but may be useful for long transports. * may see CNS stimulation in children. * Side effects include dry mouth, dilated pupils, flushing, & drowsiness. * Diphenhydramine should be used with caution in pts with asthma/COPD, glaucoma, and bladder obstruction, as all of these can be exacerbated by its administration.
Diltiazem
Contra: * Severe hypotension or Cardiogenic shock. * 2nd or 3rd heart block (except with functioning pacemaker). * Sick sinus syndrome (except with functioning pacemaker). * Severe CHF (Unless secondary to SVT) * WPW, or Lown ganong Levine syndromes. * Wide complex tachy. * Known hypersensitivity.
Precautions: Do not give with IV beta blockers (labetalol)
Side effects/special notes: * May cause hypotension, Brady, dizziness, headache, & rarely seizures. * in elderly pts drug may be given over 3 min to reduce untoward effects. * Controlled studies in the US about 60% of pts with SVT convert to a sinus rhythm within 10 mins of IV Diltiazem. Uncontrolled studies reported in the world literature describe a conversion rate of > 80%. * The effect of a dingle injection last 30-60 min when conversion to sinus rhythm does not occur.
Epinephrine
Contra: Dysrhythmia, coronary insufficiency, organic brain damage.
Precautions: * Do not add to solutions containing bicarbonate. * Increase in myocardial o2 demand can cause angina or MI in pts with CAD. * Use with caution in hyperthyroidism, peripheral vascular disease, or cerebrovascular disease.
Side effects/special note: * Anaphylactic shock is a systemic allergic reaction with cardiovascular collapse. Angioedema involves swelling of the mucous membranes; potential exists for airway compromise. Mild or moderate allergic reactions with urticaria or wheezing may progress to anaphylaxis or severe angioedema. Monitor pt carefully and treat according to pt status. * Epi comes in 2 strengths. Use of the wrong formulation will result in a ten fold difference in dosage. Be sure you use the right one. * Anxiety, tremor, palpitations, vomiting and headache are common side effects.
Furosemide
Contra: * Hypersensitivity. * Pts with anuria (no urine production).
Side effects/special note: * Possible side effects include, hypotension, EKG changes, CP, dry mouth, hypochloremia, hypokalemia, hyponatremia, and hyperglycemia. * Onset occurs within t mins of admin; peak effects occur within 30 mins of admin.
Glucagon
Contra: Known hypersensitivity.
Precautions: * Only effective if there are stores of liver glycogen. * Return to consciousness may take between 5- 20 mins. * Use with caution in pts with a hx of cardiovascular or renal disease.
Side effects/special note: Glucagon exerts a positive inotropic action on the heart and decreases renal vascular resistance.
Glucose, instant
Contra: Semi conscious pts. Unconscious pts.
Labetalol
Contra: Pts with bronchial asthma, CHF, high degree AV block, Brady, Cardiogenic shock.
Precautions: When administering labetalol stay alert for signs and symptoms of CHF, bradycardia, shock, heart block, or bronchospasm. If any of these appear discontinue the drug immediately.
Side effects/special note: * Supine BP should be monitored immediately before the injection, at 5 min and 10 min after the injection and should be documented. * Postural hypotension should be anticipated.
Lactated ringers
Contra: Pulmonary edema.
Precautions: Fluid overload; potentially sensitive pts may include those with renal failure, pregnancy, near drowning and CHF.
Side effects/special note: Fluid overload; pulmonary edema.
Lidocaine
Contra: * Hypersensitivity. * Severe SA, AV or interventricular block in the absence of pacemaker.
Precautions: * High grade AV block is relative contraindication. * Do not treat ventricular escape beats or accelerated idioventricular rhythm with lidocaine. * Lidocaine is metabolized in the liver; elderly pts and those with liver disease or poor liver perfusion secondary to shock or CHF are more likely to experience side effects.
Side effects/special note: Drowsiness, confusion, convulsion, hypotension, Brady, tachy. * Head trauma requires careful airway management. If ET intubation is appropriate, pretreatment with lidocaine may help avoid further increase in ICP, if time permits. * Resist the urge to treat every PVC. Lido is a toxic drug. PVCs outside the setting of acute MI should not be treated. Hypoxia can generate PVCs, and lidocaine with not help; treat the cause. * best available evidence currently indicates that prophylactic lidocaine (in the setting of MI without PVCs) may actually increase mortality.
For pts over 70, or with liver dysfunction, the usual adult loading dose will be utilized. This dose then will be followed by half of the usual maintenance dose for lidocaine.
Lorazepam
Contra: Acute narrow angle glaucoma, acute alcohol intoxication.
Precautions: Impaired liver and kidney function.
Side effects/special note: Drowsiness, dizziness, in coordination, blurred vision, slurred speech.
Magnesium sulfate
Contra: * None in cardiac arrest. * Active labor.
Precautions: * AV block. * Decrease in resp or cardia function.
Side effects/special note: * Eclampsia is defined as pregnancy > 20 weeks with the following - BP >180 systolic or >120 diastolic with altered mental status, or seizures with BP > 140/90. * Principle side effect is resp depression, vent assistance may be needed. * Not for pedi use.
Midazolam
Contra: * Hypersensitivity. * Shock, coma, and acute alcohol intoxication.
Precautions: * May cause changes in HR and BP. * May cause decrease resp rate or apnea.
Side effects/special note: Headache, over sedation, drowsiness, amnesia, nausea, vomiting, hiccough.
