Meds Flashcards by Connor Hancock

Ketamine) dynamics:
Indications:
Contraindications:
(Pain Management) Adult & Pediatric Dose:
Dissociation dose:

= + sympathetic response, Sedative-hypnotic & analgesic med
= Moderate to severe pain ØSFI/RSI
= History of hypersensitivity to the med, Hypertension
= 0.2mg/kg/1-2mins w/ max single dose 20mg(.5mg/kg IN/M)
= 1-2mg/kg ((0.5 mg/kg IN/IM)

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Acetaminophen) Dynamics:
Indications:
Contra:
Dose:

= Nonopioid Analgesic/Antipyretic Fever,
= pain management
= AMS
= IV/IO: 1 gram over 10 - 15 minutes, PO: 15 mg/kg

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Diazepam) Dynamics:
Indications:
Contra:
Dose:

= Benzodiazepine. Binds w/ GABA receptors causing an influx of Cl
= Tcardia due to stimulant OD, Substained seizures. Anxiety. Sedation.
= Hypersensitivity
= 2.5-10 mg in 2.5 mg increments slow IV/IO/IM

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Etomidate) Dynamics:

Indications:
Contra:
Dose:

= Nonbarbiturate, nonbenzodiazepine sedative Interacts w/ GABA receptors. Anesthetic w/o analgesic.
= Sedation / SFI/RSI
= Hypersensitivity
= 0.2-0.4 mg/kg (limit to 1 dose). Onset 30 secs Duration: 5-10 mins

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Ketamine) Dynamics:
Indications:
Contra:
Sedation Dose:
Pain dose:

= Dissociative anesthetic. NMDA Receptor Antagonist Anesthetic
= Sedation, SFI/RSI, Analgesic
= Hypersensitivity
= Sedation: 1-2 mg/kg Onset: 30-60 secs, Duration: 10-20 mins
= Pain: 0.2 mg/kg IV/IO (max single dose 20 mg), 0.5 mg/kg IM/IN (if no IV/IO)

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Ketorolac (Toradol) Dynamics:
Indications:
Contra:
Dose:

= Anti-inflammatory & antipyretic through inhibition of prostaglandins
= Mild-moderate pain, Fever, Inflammation, Renal calculi
= Hypersensitivity, Bronchospasm, Angioedema
= 15mg IV, 30mgIM

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Levalbuterol (Xopenex) Dynamics:

Indications:
Contra:
Dose:

= ß Agonist w/ preference for ß2 receptors. <effects on heart vs Albuterol.
= Bronchospasm, Allergies/anaphylaxis, Hyperkalemia
= Hypersensitivity
= 0.63 mg/3 mL via SVN

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Lorazepam) Dynamics:
Indications:
Contra:
Dose:

= Benzodiazepines, Binds w/ GABA receptors causing an influx of Cl
= Sustained seizures, anxiety, sedation, chemical restraint
= Hypersensitivity
= 2-4 mg (may repeat to a max dose of 8 mg)

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Methylene Blue) Dynamics:
Indications:
Contra:
Dose:

= Water soluable thiazine dye helps metHb to hemoglobin conversion
= Methemoglobinemia (metHb), Nitrate OD/poisoning
= Hypersensitivity
= 1 mg/kg IV/IO over 5-30 minutes.

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Midazolam (Versed) Dynamics:
Indications:
Contra:
Seizures Dose:
RSI Dose:

= Benzodiazepine, binds w/ GABA receptors causing an influx of Cl
= Active seizures, Chemical restraint, Anxiety, RSI/SFI, Sedation
= Hypersensitivity
= 0.2 mg/kg in 2 mg increments IV/IO (max 10 mg). 5 mg IM/IN
= 0.1-0.3 mg/kg slow IV/IO (max 10 mg) Onset: 2-5 mins. Duration: 15-30 mins.

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Morphine) Dynamics:

indications:
Contra:
Analgesia:
STEMI:
NSTEMI-ACS:

= Narcotic (Schedule II Opioid) Analgesia & sedation via binding to opiate receptor
= Ischemic chest pain not relieved by Nitroglycerin
= Hypersensitivity. Uncorrected hypotension (<90 SBP)
= 2-10 mg up to max 20 mg.
= 2-4mg slow IV/O, may admin 2nd dose 2-8mg IV/IO q5-15 mins
= 0.1 mg/kg slow IV/IO or IM up to 10 mg

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Rocuronium) Dynamics
Indications:
Contra:
Dose:

= Nondepolarizing neuromuscular blocker. Binds to ACh receptors
=DSI/RSI
= Hypersensitivity
= 0.6-1.2 mg/kg. TTP: 60-90 secs. DOP: 45-120 mins

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Sodium Bicarbonate 8.4%) Dynamics:

Indications:

Contra:
Suspected acidosis Dose:
Hyperkalemia Dose:

= Alkalinizing Agent. Increases plasma bicarbonate, buffers excess hydrogen ion concertration, raises blood pH & reverses clinical manifestations of acidosis.
= Suspected hyperkalemia, suspected bicarbonateresponsive acidosis (DKA, OD on TCA’s, Aspirin or Cocaine)
= Patients in cardiac arrest
= 1 mEq/kg, Hyperkalemia:
= 50 mEq IV bolus.

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Succinylcholine) Dynamics
Indications:
Contra:
Dose:

= Depolarizing neuromuscular blocker. Binds to Ach recptors
= DSI/RSI
= Hyperkalemia(burns, crush injury), Increased ICP, Severe trauma
= 1-1.5 mg/kg IV/IO. TTP: 45-60 seconds. DOP: 5-10 mins.

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Vecuronium) Dynamics:
Indications:
Contra:
Dose:

= Nondepolarizing neuromuscular blocker. Binds to ACh receptors
= DSI/RSI
= Hypersensitivity
= 0.1-0.2 mg/kg IV/IO. TTP: 1-3 mins. DOP: 45-90 mins.

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Diazepam) Dynamics:
Indications:
Contra:
Dose:

= Benzodiazepine Binds with GABA receptors causing an influx of Cl
= TachyC from stimulant OD, Sustained seizure, Anxiety, Sedation,
= Hypersensitivity
= 2.5-10 mg in 2.5 mg increments slow IV/IO/IM.

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Dobutamine) Dynamics:
Indications:
Contra:
Dose:

α and ß-adrenergic agonist. Inotropic properties
more prounced than chronotropic properties. Cardiac pump problems (CHF) with hypotension.
Should not be used in hypovolemia
until fluid replacement has been
administered. Do not mix with Sodium
Bicarb.
2-20 mcg/kg/min - titrate so heart rate does not
increase by >10% of baseline.

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Dopamine) Dynamics:
Indications:
Contra:

Dose:

= α & ß agonist, Rate dependent, vasopressor, +Chron/In/Dromotropic
= CHF, hypoBP w/ shock S/S, 2nd med w/ S/S bradyC (after atropine)
= Shouldn’t use in hypovolemic PTs til’ appropriate vol/ replacement occurred, Known Hx Pheochromocytoma, Don’t mix w/ Sodium Bicarb.
2 - 20 mcg/kg/min, titrate to PT response (DO NOT OPEN WIDE OPEN)

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Fentanyl) Dynamics:
Indications:
Contra:
Dose:

=Synthetic Narcotic (Schedule II Opioid)
= Analgesia & sedation via binding to opiate receptor, sig/ more potent than morphine (100 mcg = 10 mg of Morphine)
= Moderate-Severe pain
= Hypersensitivity, SBP<90
=1mcg/kg to a max dose 100 mcg (IV/IO/IM/) may repeat PRN in 5-10
= 1mcg/kg IN may repeat PRN 5-10mins (Max 1mL PRN if admin/ed IN)

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Hydroxocobalamin) Dynamics:
Indications:
Contra:
Dose:

Binds with cyanide to form nontoxic
cyanacobalamin (Vitamin B12), preventing its
toxic effects.
Suspected cyanide poisoning Hypersensitivity 5 grams IV/IO over 15 minutes. May repeat a
2nd 5 gram dose for a max of 10 grams

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Ketamine) Dynamics:
Indications:
Contra:
Dose:

= Dissociative anesthetic. NMDA Receptor Antagonist
=Anesthetic Sedation / SFI/RSI /
= Hypersensitivity
= Sedation: 1-2 mg/kg Onset: 30-60 secs, Lasts: 10-20 mins
= Analgesia/Pain: 0.2 mg/kg IV/IO (max single dose 20 mg), 0.5 mg/kg IM/IN (if no IV/IO)

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Levalbuterol (Xopenex) Dynamics:
Indications:
Contra:
Dose:

= ß Agonist w/ preference for ß2 receptors. Has <effects on heart vs. Albuterol
=Bronchospasm, Allergies/anaphylaxis, Hyperkalemia
=Hypersensitivity
= 0.63 mg/3 mL via SVN

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Lorazepam) Dynamics:
Indications:
Contra:
Dose:

= Benzo Binds w/ GABA receptors causing an influx of Cl
= Sustained seizures, anxiety, sedation, chem restraint
= Hypersensitivity
= 2-4 mg (may repeat to a max dose of 8 mg)

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Methylene Blue) Dynamics:
Indications:
Contra:
Dose:

= H20 soluable thiazine dye promotes converting metHb>hemoglobin
= Methemoglobinemia (metHb), Nitrate overdose/poisoning = Hypersensitivity
= 1 mg/kg IV/IO over 5-30 mins

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Morphine) Dynamics: Indications: Contra: Dose:

Narcotic (Schedule II Opioid). Analgesia & sedation w/ binding to opiate receptor = Ischemic chest pain not relieved by Nitro = Hypersensitivity. Uncorrected SBP<90 = Analgesia: 2-10 mg up to max 20 mg STEMI: 2-4 mg slow IV/IO, may admin 2nd dose of 2-8 mg IV/IO q5-15 mins intervals NSTEMI-ACS: 0.1mg/kg slow IV/IO or IM up to 10 mg.

Norepinephrine) Dynamics: Indications: Contra: Dose:

= αß adrenergic agonist (α > ß effects) = Normovolemic hypoBP, Sepsis, Cardiogenic shock = Shouldn't use in hypovol/ til' vol/ replacement occurred = 0.1-0.5 mcg/kg/min IV/IO infusion

Ondansetron (Zofran) Dynamics: Indications: Contra: Dose:

= Selective serotonin 5-HT3 receptor blocker = Prevention & control of Nausea and/or vomiting = Hypersensitivity = 4-8 mg IV slow push, IM, PO.

Rocuronium) Dynamics: Indications: Contra: Dose:

= Nondepolarizing neuromuscular blocker Binds to ACh receptors = DSI/RSI = Hypersensitivity = 0.6-1.2 mg/kg. TTP: 60-90 seconds. DOP: 45-120 minutes

Sodium Bicarbonate 8.4%) Dynamics: Indications: Contra: Dose:

= Alkalinizing Agent +plasma bicarbonate, buffers excess hydrogen ion concertration, raises blood pH & reverses manifestations of acidosis. = Suspected hyperkalemia, suspected bicarbonate responsive acidosis (DKA, OD on TCA's, Aspirin or Cocaine) = Patients in cardiac arrest = Suspected acidosis:1 mEq/kg =Hyperkalemia: 50 mEq IV bolus.

Tranexamic Acid (TXA) Dynamics: Indications: Contra: Dose:

= Binds to plasminogen, blocking plasminogen fibrin interactions (fibrinolysis) = Sig/ hemorrhage, either in/external (after external hemorrhage is controlled) = SP 3 hrs past injury, allergy/Sensitivity, Suspected thromboembolism 1 gram over 10 minutes (mix in 50 mL bag of NS), Followed by 1 gram over 8 hours (500 mL bag NS).

Vecuronium) Dynamics: Indications: Contra: Dose:

= Nondepolarizing neuromuscular blocker Binds to ACh receptors = DSI/RSI = Hypersensitivity = 0.1-0.2 mg/kg IV/IO. TTP: 1-3 mins DOP: 45-90mins

(Propofol/ Diprivan) Class: Dose:

= Sedative = 1-2 mg//kg IV/IO Onset: <1min, Lasts: 5-10mins

Fentanyl) 1. 2 dynamics: 3 Indications: 4 Contraindications: 5 Adverse Effects: 6 Adult & Pediatric Dose same:

1 = quicker but

Morphine) 1 2 Pharmacodynamics: 3 Indications: 4 Contraindications: 5 Adverse Effects: 6 Adult Dose: 7 Pediatric Dose:

1= (not same as Morphine Sulfate) 2= Narc (opioid) Schedule II & releases histamine 3= Moderate to severe pain 4= SBP< 90, Known hypersensitivity 5= HypoBP, Syncope, Tachy/BradyC, Resp/Depres/Apnea , N/V 6= 2-10mg or 0.1 mg/kg to max dose 20 mg 7= 0.1 mg/kg IV/IO (slow) or IM up to 10 mg

Water is contained in what 3 compartments in the human body? What are the percentages?

60% of body weight is water 45%=intracellular & 15% extracellular (outside cell) Interstitial 10.5% Intravascular 4.5%

If you were administering isotonic crystalloid solutions, how much would move out of the intravascular compartment within 1 hour?

2/3s would move out

What is hydrostatic pressure in the vascular system & what creates it? What is oncotic pressure in the vascular system and what creates it?

=Pressure from heart in blood vessels & forces water to cross the capillary membrane into the interstitial space. =Pulling water back into the blood vessels by the presence of large proteins in the blood (pulling back in)

Oxy Dissociation Curve: Bohr Effect: Haldane Effect:

= H-globin “Train” taking & dropping oxy = Acidotic with R-shift of hemoglobin w/ decrease oxy affinity = Alkalotic w/ L-shift Loves oxy in Lungs

Bohr Effect: Influences by: What does it do to hemoglobin:

= Acid> Hemoglobin droping oxy off in body = + CO2, +temp, -pH+ BPG 2,3 in body = -oxy affinity

Haldane Effect: Influences by: What does it do to the hemoglobin?

= Alk> Hemoglobin Loves oxy in Lungs = -CO2, -temp, +pH -BPG 2,3, in Lungs, = +oxy affinity

(Sedative meds) 1. 2. 3. 4. 5. 6.

1. Etomidate (Amidate) 2. Midazolam (Versed) 3. Ketamine (Ketalar) 4. Propofol (Diprivan) 5. Lorazepam (Ativan) 6. Diazepam (Valium)

(Paralytic/ Neuromuscular blocking meds) 1. 2. 3.

1. Succinylcholine (Anectine) 2. Rocuronium (Norcuron) 3. Vecuronium (Zemuron)

(Etomidate/ Amidate) class Dose:

= Sedative = 0.2-0.4 mg/kg IV/IO

(Etomidate/ Amidate) Onset: Duration:

= 30 sec = 5-10 mins

(Etomidate/ Amidate) Advan: Disadv:

= Little effect on B/P. decreases ICP = Suppresses cortisol, not good for head -injured patients long term.

(Midazolam/ Versed) Class: Dose:

= Sedative = 0.1-0.3 mg/kg IV/IO

(Midazolam/ Versed) Onset: Duration:

= 2-5 mins = 15-30 mins

(Midazolam/ Versed) Advan: Disadv:

= Excellent amnesia effects, good sedative = Hypotension

(Ketamine/ Ketalar) Class: Dose:

= Sedative = 1-2 mg/kg IV/IO

(Ketamine/ Ketalar) Onset: Duration:

= 30-60 secs = 10-20mins

(Ketamine/ Ketalar) Advan: Disadv:

= Decreases bronchospasm, little hypotension, amnesia. = Increases ICP, Hypertension, Tcardia, Laryngospasm, Hallucinations

(Propofol/ Diprivan) Class: Dose:

= Sedative = 1-2 mg//kg IV/IO

(Propofol/ Diprivan) Onset: Duration:

= < 1 min = 5-10mins

(Propofol/ Diprivan) Advan: Disadv:

= Rapid onset, good sedative effects = significant hypotension

(Lorazepam/Ativan) class: Dose:

= Sedative = 0.05 mg/kg IV/IO

(Succinylcholine/ Anectine) Class: Dose:

= Depolarizing Neuromuscular Blocker paralytic = 1-1.5 mg/kg IV/IO

(Succinylcholine/ Anectine) TTP: DOP:

= 45-60 secs = 5-10 mins

(Succinylcholine/ Anectine) Contra: Effects:

= Hyper/K, Neuro/M disease, Crush injury, Burns, raised ICP, trauma = Hyper/K, Muscle fasciculations, Bradycardia, Prolonged paralysis, Malignant hyperthermia, Increased ICP

(Rocuronium/ Norcuron) Class: Dose:

= Nondepolarizing Neuromuscular Blocker paralytic = 0.6-1.2 mg/kg IV/IO (If succinylcholine is contraindicated)

(Rocuronium/ Norcuron) TTP: DOP:

= 60-90 secs = 45-120 mins

(Rocuronium/ Norcuron) Contra: Effects:

= Hypersensitivity = Minimal cardiovascular side effects, Skeletal muscle weakness, Malignant hyperthermia

(Vecuronium/ Zemuron) Class: Dose:

= Nondepolarizing Neuromuscular Blocker Paralytic = 0.1 -0.2 mg/kg IV/IO

(Vecuronium/ Zemuron) TTP: DOP:

= 1-3 mins = 45-90 mins

(Vecuronium/ Zemuron) Contra: Effects:

= hypersensitivity = Minimal cardiovascular side effects, Skeletal muscle weakness, Malignant hyperthermia

(Diazepam/ Valium) class: pharmacodynamics:

= benzodiazepine (Sedative) = binds w/ GABA receptors causing a influx of chloride

(Diazepam/ Valium) indications: Contraindications:

= Tcardia from stimulant OD, Sustained seizures, Anxiety, Sedation = hypersensitivity

(Diazepam/ Valium) effects: dose:

= Resp/depress/, N/V, Sedation/amnesia = 2.5-10mg in 2.5mg increments slow IV/IO/IM