Medications Flashcards
(44 cards)
1
Q
Acetaminophen
- Other names
- Class
- Form
A
Acetaminophen
- Other names: Tylenol, APAP
- Class
— Antipyretic (reduces fever)
— Analgesic (pain reliever) - Form
— 500 mg tablet
— Children’s Liquid Solution 32 mg/ml
2
Q
Acetaminophen
- Onset
- Duration
- Adult dose
- Pediatric dose
A
Acetaminophen
- Onset: 20 mins
- Duration: 4 hours
- Adult dose:
— 650-1000 mg
— May repeat every 6 hours
— Max of 4000 mg in 24 hours - Pediatric dose (<12 y/o) (tablet and liquid)
— 15 mg/kg, max of 1000 mg (1000 mg = 146 lb whopper of a child)
— May repeat every 4-6 hours
— Max of 75 mg/kg in 24 hours
3
Q
Acetaminophen
- Indications
- Contraindications
- Side effects and notes
A
Acetaminophen
- Indications:
— Fever (note: acetaminophen is the first-line medication for fever)
— Pain - Contraindications:
— Known hypersensitivity
— Severe liver disease/hepatic (liver) impairment - Side effects and notes
— Not an NSAID (no anti-inflammatory properties)
4
Q
Acetazolamide (APO)
- Other names
- Class
- Form
A
Acetazolamide (APO)
- Other names: Diamox
- Class: Carbonic anhydrase inhibitor (used to treat altitude sickness glaucoma, and certain types of seizures)
- Form: 125 or 250 mg tablet
5
Q
Acetazolamide (APO)
- Onset
- Duration
- Adult dose
- Pediatric dose
A
Acetazolamide (APO)
- Onset: 1-1.5 hours
- Duration: 8-12 hours
- Adult dose:
— Prophylaxis: 125 mg BID (twice per day), may be as low as 62.5 mg per day
— Treatment: 250 mg BID - Pediatric dose
— Treatment only: 2.5 mg/kg every 8-12 hours + call med control (doesn’t specify that you need to call before administration)
6
Q
Acetazolamide (APO)
- Indications
- Contraindications
- Side effects and notes
A
Acetazolamide (APO)
- Indications: Prophylaxis or treatment of acute mountain sickness
- Contraindications
— Severe renal (kidney) disease
— Cirrhosis (liver) - Side effects and notes
— Severe effects include tachypnea, tachycardia, tingling in fingers and toes
— Carbonated beverages taste flat
— May contribute to drowsiness
— May impair alertness or physical coordination in higher doses
7
Q
Albuterol (APO)
- Other names
- Class
- Form
A
Albuterol (APO)
- Other names: ProAir, Ventolin, Proventil
- Class:
— Sympathomimetic B2 agonist (bronchodilator)
— Bronchodilator (relaxes bronchial smooth muscle) - Form: MDI, nebulizer
8
Q
Albuterol (APO)
- Onset
- Duration
- Adult dose
- Pediatric dose
A
Albuterol (APO)
- Onset: Immediate
- Duration: 2-4 hours
- Adult dose: APO (check instructions-usually one to two inhalations)
- Pediatric dose: Same as adult
9
Q
Albuterol (APO)
- Indications
- Contraindications
- Side effects and notes
A
Albuterol (APO)
- Indications:
— Respiratory distress with bronchial spasms due to allergic reaction, asthma, or COPD (adult or pediatric)
— Suspected hyperkalemia (adult only) - Contraindications
— Chest pain of suspected cardiac origin, known active heart disease
— Severe hypertension
— Acute MI within the past 6 weeks - Side effects and notes
— Palpitations, tremors, or anxiety may occur (uncommon at recommended doses)
— Paradoxical bronchospasm may occur with excessive administration
— Stop treatment if HR increases by more than 20 bpm
— PTs rhythm should be observed for arrhythmias. Clinically significant arrhythmias may occur, especially in PTs with underlying cardiovascular disorders such as hypertension
10
Q
Aspirin
- Other names
- Class
- Form
A
Aspirin
- Other names: ASA, Bayer, Anacin
- Class
— NSAID (reduces pain, fever, and inflammation)
— Platelet inhibitor (blood thinner) - Form: 81 mg chewable tablets
11
Q
Aspirin
- Onset
- Duration
- Adult dose
- Pediatric dose
A
Aspirin
- Onset: 5-30 mins
- Duration
— Anti-inflammatory properties: 1-4 hours
— Anti-platelet activity: Slowly decreases over 10 days - Adult dose: 324 mg (four 81 mg tablets), chewed and then swallowed
- Pediatric dose: Not indicated for pediatric patients
12
Q
Aspirin
- Indications
- Contraindications
- Side effects and notes
A
Aspirin
- Indications: Suspected ischemic cardiac pain
- Contraindications
— Allergy to aspirin or other NSAIDs
— Aspirin induced asthma
— Active, uncontrolled bleeding
— If the PT takes aspirin daily and has already taken it within the past 12 hours. If there is doubt, give aspirin.
— Note: Some people have been told not to take aspirin because it upsets their stomach or because of a Hx of GI bleeding (ulcers). In the setting of cardiac pain, this is not a contraindication. - Side effects and notes
— May cause heartburn, nausea, or vomiting
— Contact med control before administering if the PT has a Hx of a bleeding disorder (I.e. hemophilia) or is on anticoagulants (i.e. Coumadin, Warfarin, Lovenox, Pradaxa). In communication failure, give aspirin.
— An acute aspirin overdose is potentially lethal. Signs/symptoms include tinnitus (ringing of the ears), vomiting, rapid respirations, high fever, seizure, hypoglycemia, or AMS
13
Q
Atropine Sulfate (AIO)
- Other names
- Class
- Form
A
Atropine Sulfate (AIO)
- Other names: Rafa auto-injector
- Class: Anticholinergic (antimuscarinic aka blocks parts of the parasympathetic nervous system)
- Form: Nerve agent autoinjector
14
Q
Atropine Sulfate (AIO)
- Onset
- Duration
- Adult dose
- Pediatric dose
A
Atropine Sulfate (AIO)
- Onset: Immediate
- Duration: 4 hours
- Adult dose: AIO (comes in 0.5, 1, or 2 mg doses)
- Pediatric dose: AIO (comes in 0.5, 1, or 2 mg doses)
15
Q
Atropine Sulfate (AIO)
- Indications
- Contraindications
- Side effects and notes
A
Atropine Sulfate (AIO)
- Indications
— Symptomatic bradycardia (defined as HR <50, SBP <90, AND symptoms: active chest pain, shortness of breath, N/V, or AMS)
— Organophosphate poisoning - Contraindications: None
- Side effects and notes
— Possible side effects: Tachycardia, palpitations, hypertension, dry mouth, increased thirst, headache, nervousness, weakness, dilated pupils, and blurred vision.
— Low dose or slow administration can cause paradoxical bradycardia
— Advanced anticholinergic effects may occur with the presence of antihistamines, Haldol, meperidine, procainamide, quinidine, and tricyclic antidepressants.
— In organophosphate poisoning, call for more medication early as large amounts are required.
— Bradycardia in an MI is common and beneficial. Therefore, do not treat with this medication unless there are signs of poor perfusion (low BP, mental confusion).
16
Q
Bacitracin Ointment
- Other names
- Class
- Form
A
Bacitracin Ointment
- Other names: None in protocols, but note that bacitracin is a medication in triple antibiotic ointment.
- Class: Topical (skin) antibiotic
- Form: Small foil pouches
17
Q
Bacitracin Ointment
- Onset
- Duration
- Adult dose
- Pediatric dose
A
Bacitracin Ointment
- Onset: N/A
- Duration: N/A
- Adult dose: After cleansing the area, apply a thin amount over the affected part and cover with a bandage. Apply only once.
- Pediatric dose: Same as adult.
18
Q
Bacitracin Ointment
- Indications
- Contraindications
- Side effects and notes
A
Bacitracin Ointment
- Indications:
— Minor cuts and scrapes
— Partial thickness burns covering <15% TBSA - Contraindications
— Known hypersensitivity
— Large, deep wounds (any you suspect require stitches)
— Puncture wounds, animal bites
— Partial thickness burns over >15% TBSA, full-thickness burns - Side effects and notes
— Possible side effects include local allergy (rash) and systemic allergy (wheezing, diffuse rash, anaphylaxis)
— May provide some pain relief
19
Q
Diphenhydramine
- Other names
- Class
- Form
A
Diphenhydramine
- Other names: Benadryl
- Class: Antihistamine
- Form: 25 mg tablet
20
Q
Diphenhydramine
- Onset
- Duration
- Adult dose
- Pediatric dose
A
Diphenhydramine
- Onset: According to the internet (this info not in protocols), approx. 30 mins with peak effectiveness at 1 hour.
- Duration: 4-6 hours
- Adult dose: 20-50 mg, may repeat every 6 hours
- Pediatric dose: 1-2 mg/kg (max 50 mg), may repeat every 6 hours
21
Q
Diphenhydramine
- Indications
- Contraindications
- Side effects and notes
A
Diphenhydramine
- Indications:
— Anaphylaxis and severe allergic reactions
— Mild allergic reactions
— Motion sickness and nausea. Diphenhydramine has mild anti-
nausea and sedative effects.
— To counteract acute dystonic reactions. Diphenhydramine has an anticholinergic and antiparkinsonian effect that is used to treat acute dystonic reactions to antipsychotic drugs (e.g., Haldol, Thorazine, Compazine, Inapsine) and other some other drugs. - Contraindications
— Known allergies or sensitivity
— PT takes MAO inhibitors (phenelzine/Nardil, tranylcypromine/Parnate). These can increase anticholinergic effects. - Side effects and notes
— Remember that epinephrine is the first-line drug for severe allergic reaction or anaphylaxis.
— Side effects can include tachycardia, thickening of bronchial secretions, sedation, dry mouth, and paradoxical agitation.
— This medication has direct CNS effects, which may act as either a stimulant or more commonly as a depressant, depending on the individual.
— May potentiate effects of alcohol or other CNS depressants. Half the dose of intoxicated or elderly.
— Although useful in acute dystonic reactions, it is not antidote for antipsychotic toxicity or overdose. Dystonic reactions can occur up to 48 hours after patient has taken certain medications (commonly antipsychotic or antiemetic). The reaction often involves twisting of facial or neck muscles.
— Contact MC prior to administration if patient is hyperthermic or in
a hot environment.
22
Q
Epinephrine
- Other names
- Class
- Form
A
Epinephrine
- Other names:
— Adrenaline
— Common brand names include EpiPen, Adrenaclick, Auvi-Q, and Symjepi - Class:
— Sympathetic alpha-beta-receptor agonist (sympathomimetic)
— Adrenergic catecholamine
— Bronchodilator - Form:
— Autoinjector (0.3mg/0.3ml)
— 1:1,000—1 mg/ml ampule or vial
23
Q
Epinephrine
- Onset
- Duration
- Adult dose
- Pediatric dose
A
Epinephrine
- Onset: 3-5 mins (IM)
- Duration: 1-4 hours
- Adult dose:
— 0.3 mg IM auto-injector (EPI 1:1,000)
— If worsening or no improvement, may repeat q 10 mins until severe symptoms resolve. Contact MC after 3rd dose.
*** Pediatric dose: Need to confirm because…
— Medication page states: 0.3 mg IM (EPI 1:1,000) for ALL AGES
— Anaphylaxis protocol states: Peds <30kg (66lbs): 0.15 mg IM
24
Q
Epinephrine
- Indications
- Contraindications
- Side effects and notes
A
Epinephrine
- Indications (for EMTs)
— Anaphylaxis (severe allergic reaction)
— Severe respiratory distress; severe asthma - Contraindications
— NONE if patient is hypoxic secondary to anaphylaxis or asthma
— Relative contraindications: Cocaine use, coronary artery disease - Notes
— Can expect to see increased heart rate, increased blood pressure, and bronchodilation.
— May cause anxiety, tremor, and headache.
— General cardiac side effects include tachycardia, palpitations, PVCs, angina, and hypertension. Can also cause MI or major dysrhythmias in individuals with ischemic heart disease.
— Double check the concentration before administering IM=1:1000 (1mg/ml) vs IV/IO=1:10,000 (0.1mg/ml)
— Consider pulmonary edema or a pulmonary embolus in an elderly person with wheezing.
25
Glucose - Oral (Paste)
- Other names
- Class
- Form
Glucose - Oral (Paste)
- Other names: Glutose15, Transcend, Insta-Glucose
- Class: Carbohydrate (sugar)
- Form: 15 g per tube
26
Glucose - Oral (Paste)
- Onset
- Duration
- Adult dose
- Pediatric dose
Glucose - Oral (Paste)
- Onset: Within 1 minute
- Duration: Variable
- Adult dose:
— 15 g (one tube)
— May repeat in 10 minutes if altered mental status persists and/or blood glucose is still under 80. Unsure if max dose exists.
- Pediatric dose: Same as adult
27
Glucose - Oral (Paste)
- Indications
- Contraindications
- Side effects and notes
Glucose - Oral (Paste)
- Indications:
— When glucose < 80
— OR altered LOC and unable to
determine glucose
- Contraindications: None
- Side effects and notes
— A little contradictory but… Hyperglycemia does not have clinically significant side effects. However, research suggests that hyperglycemia may complicate, or worsen, a number of medical conditions (i.e., myocardial infarction, stroke).
— If patient is unable to swallow, paste may be placed outside of the teeth, between the gum and the cheek while the patient is positioned on their side to protect airway.
— Do not overfill mouth, increasing potential for aspiration.
— May be more tolerable if administered with liquid between dosages.
— Effects will be delayed in the elderly and people with poor circulation.
28
Ibuprofen
- Other names
- Class
- Form
Ibuprofen
- Other names: Motrin, Advil
- Class: NSAID (reduces pain, fever, and inflammation)
- Form:
— 200 mg tablet
— 100mg/5ml liquid
29
Ibuprofen
- Onset
- Duration
- Adult dose
- Pediatric dose
Ibuprofen
- Onset: 20 mins
- Duration: 6-8 hours
- Adult dose: 600 mg, repeat every 6 hours
- Pediatric dose:
— Tablet: 200 mg, repeat every 6 hours, must be able to swallow tablet
— Liquid: 6 months-10 years old: 10 mg/kg (max 200 mg), repeat every 6 hours
30
Ibuprofen
- Indications
- Contraindications
- Side effects and notes
Ibuprofen
- Indications:
— Pain
— Fever, but note that acetaminophen is the first-line medication for fever
- Contraindications
— Known hypersensitivity
— Trauma other than isolated extremity
— Pregnancy
— Known ulcer or GI bleeding
— Known renal disease
- Side effects and notes: May cause GI upset
31
Ipratropium Bromide (APO)
- Other names
- Class
- Form
Ipratropium Bromide (APO)
- Other names: Atrovent
- Class:
— Anticholinergic (blocks the effects of a neurotransmitter that impacts various bodily functions such as bladder control)
— Parasympatholytic (inhibits the activity of the parasympathetic nervous system)
- Form: Nasal spray, inhaler, or nebulizer solution
32
Ipratropium Bromide (APO)
- Onset
- Duration
- Adult dose
- Pediatric dose
Ipratropium Bromide (APO)
- Onset: 15 minutes, peak effect is 1-2 hours
- Duration: 3-6 hours
- Adult dose:
— APO
— Ipratropium should only be given every 4 hours, whereas albuterol can be used continuously
— Contact MC for additional doses
- Pediatric dose:
— Same as adult
33
Ipratropium Bromide (APO)
- Indications
- Contraindications
- Side effects and notes
Ipratropium Bromide (APO)
- Indications: As a supplement to albuterol in patients with respiratory distress from secondary bronchospasm such as asthma and COPD
- Contraindications
— Severe glaucoma
— Peanut, soy, or lecithin allergy
- Side effects and notes
— CNS side effects: nervousness, dizziness, headache, delirium, psychosis, paresthesia, tremors.
— Other side effects: Dry mouth, palpitations, GI distress, blurred vision, pharyngeal irritation, increased intra-ocular pressure in glaucoma patients.
— For severe asthma, ipratropium taken in addition to a short acting beta agonist (such as albuterol) can provide greater bronchodilation and clinical benefit than the beta agonist alone.
— Ipratropium and albuterol can be mixed in a single nebulizer treatment.
— If PT gets significantly worse within 60 seconds of starting ipratropium or
starts coughing (and was not previously coughing) then stop administration of ipratropium but continue albuterol.
34
Naloxone (INO)
- Other names
- Class
- Form
Naloxone (INO)
- Other names: Narcan, Evzio
- Class: Opioid narcotic antagonist (reverses effects of opioids/narcotics)
- Form: Preloaded syringe, 2 mg/2 ml
35
Naloxone (INO)
- Onset
- Duration
- Adult dose
- Pediatric dose
Naloxone
- Onset: 5 mins
- Duration: 1-4 hours
- Adult dose:
— 0.5 - 2.0 mg (titrate to effect), additional doses every 2-5 minutes prn ALOC (max 10mg)
— Note: Nasal spray is usually 4 mg
- Pediatric dose (<20kg):
— 0.1 mg/kg (max 2 mg), additional doses every 2-5 minutes prn ALOC (max 10mg)
— Note: Nasal spray is usually 4 mg
36
Naloxone (INO)
- Indications
- Contraindications
- Side effects and notes
Naloxone
- Indications:
— Suspected narcotic intoxication with altered mental status AND apnea or slow, shallow breathing.
— Altered level of consciousness (ALOC) of unknown etiology
- Contraindications: None baby, none
- Side effects and notes
— In patients physically dependent on opioids, violent withdrawal symptoms
may occur (combativeness, pain, nausea, vomiting, diarrhea, hypertension, tachycardia, tremors). Be prepared to restrain the patient.
— Patients with damaged nasal mucosa or prolific nasal secretions may be unable to absorb intranasal naloxone and may require either higher doses or naloxone administration by a different route.
— Patients who have received naloxone must be transported. Symptoms may recur when naloxone wears off.
— Pinpoint pupils are a classic sign of narcotic use/overdose. However, pupil
findings may vary in multi-drug intoxications.
— For use of patient’s own nasal spray, follow instructions on drug packaging.
37
Nitroglycerin (APO)
- Other names
- Class
- Form
Nitroglycerin (APO)
- Other names: Nitrostat, NitroQuick, Nitrolingual, NitroMist
- Class:
— Nitrate (treat or prevent cardiac pain (angina, chest pain))
— Vasodilator
- Form:
— Pump spray or tablet (0.4 mg per spray or tablet)
— Paste (multi-dose or single dose tube)
38
Nitroglycerin (APO)
- Onset
- Duration
- Adult dose
- Pediatric dose
Nitroglycerin (APO)
- Onset
— Tablet/spray: Immediate to 2 minutes
— Paste: 10 minutes
- Duration
— Tablet/spray: 10-30 min
— Paste: 24 hours
- Adult dose (Indication: Chest pain):
— SL route: 0.4 mg tablet or one spray every 5 minutes prn chest pain (max 8 tablets/sprays)
— Topical route: One inch on special paper and applied to anterior chest wall, wipe paste off if SBP < 90
- Adult dose (Indication: Pulmonary Edema/CHF):
— SL route…
— SBP=100-120: 0.4 mg tablet or one spray
— OR SBP=120-200: Two 0.4 mg tablets/sprays
— OR SBP >200: Three 0.4 mg tablets/sprays and call medical control
*** Dose can be repeated per protocol; however, protocol does not state anything about repeating dose.
*** For more than one tablet, should they still be given at 5-minute intervals?
— Topical route…
— One inch on special paper and applied to anterior chest wall
— Wipe paste off if SBP < 90
- Pediatric dose: Not indicated for pediatric PTs
39
Nitroglycerin (APO)
- Indications
- Contraindications
- Side effects and notes
Nitroglycerin (APO)
- Indications: Chest pain thought to be related to cardiac ischemia pulmonary edema from CHF (aka not HAPE or noncardiogenic)
- Contraindications
— Hypotension (SBP < 100)
— Erectile dysfunction drug use in past 24 hours: Viagra (sildenafil citrate), Levitra (vardenafil HCl) or Cialis (tadalafil)
— Cerebral edema or increased intracranial pressure
- Side effects and notes
— Common side effects are headache, hypotension, tachycardia, flushing,
dizziness, diaphoresis, rash, burning under tongue
— Generalized vasodilation may cause tachycardia.
— Tablets should be placed under tongue, not chewed nor swallowed.
— Place nitro paste away from potential AED pad sites.
— Patients taking nitrates chronically may develop a tolerance and require
higher doses.
— Use with caution in patients with inferior/right side MI.
— Date bottle after opening. It is good for 2 months once opened.
40
Ondansetron
- Other names
- Class
- Form
Ondansetron
- Other names: Zofran
- Class: Antiemetic (reduces nausea and vomiting)
- Form: 4 mg ODT
41
Ondansetron
- Onset
- Duration
- Adult dose
- Pediatric dose
Ondansetron
- Onset: 2-5 mins
- Duration: 5-6 hours
- Adult dose: 4 mg, May repeat in 15 minutes x2 prn nausea (max 3 doses).
- Pediatric dose (3 mo-10 y/o or 14 y/o (it’s unclear on med page))
— 1/2 tablet (2 mg)
— ODT not indicated for PTs <3 months
42
Ondansetron
- Indications
- Contraindications
- Side effects and notes
Ondansetron
- Indications: Prevention and control of uncomplicated nausea and vomiting
- Contraindications
— Known hypersensitivity to ondansetron or similar medications (HT3 medications such as Anzemet or Kytrik)
— Prolonged QTc (cardiac interval)
- Side effects and notes
— Most common side effects: Headache, dizziness, drowsiness, diarrhea, dry mouth, and shivers
— Very uncommon side effects: Body aches, agitation, dysuria, hypotension, and rash
— Rare side effects: Angina and tachycardia.
— Commonly used in the treatment of nausea in patients who are receiving
chemotherapy or as a postoperative nausea treatment.
— Consider administration prior to transport in patients who are fully immobilized
— Ondansetron may precipitate (become a solid) if mixed with alkaline solutions (common examples are cleaning products)
— Patients with bowel obstruction should be monitored closely following
administration.
43
Oxygen
- Flow rates
— Nasal cannula
— NRB mask
— BVM
— CPAP
Oxygen
- Flow rates
— Nasal cannula: 2-6 L/min
— NRB mask: 10-15 L/min
— BVM: 15 L/min
— CPAP: 10-25 L/min (not in scope, but good info to know)
44
Oxygen
- Indications
- Contraindications
- Side effects and notes
Oxygen
- Indications
— Suspected hypoxemia or respiratory distress from any cause
— Acute chest pain, in which cardiac ischemia or myocardial infarction is suspected
— Shock from any cause
— Major trauma
— Carbon monoxide poisoning
— Irregular heart rhythms (Adult: HR<50 or HR >120)
— Acute altered mental status/neurologic symptoms
- Contraindications: None 🎉
- Side effects and notes
— With COPD patients, administration of oxygen may decrease respiratory drive. Do not withhold oxygen because of this possibility. Start O2 at 2L/min via nasal cannula. If patient is continuing to be dyspneic (difficulty breathing or SOB), increase oxygen gradually until cyanosis clears. Change to NRB and high flow if still cyanotic at 6L/min.
— If patient is experiencing cardiac chest pain, titrate to 90%. If 90% or greater, do NOT administer oxygen.
— In a patient with a head injury, altered mental status, or possible stroke, use low flow oxygen and titrate oxygen saturation to 94%. If 94% or above, DO NOT administer oxygen.
— Humidified oxygen should be used if the patient experiences airway discomfort or transport time is greater than 1 hour.
— Restlessness may be an important sign of hypoxia.
— Oxygen toxicity is not a risk in acute administration.
— Nasal cannula prongs work equally well on nose and mouth breathers (move nasal prongs to mouth).
