PHARMACOLOGY Flashcards
(38 cards)
ADENOSINE
INDICATIONS
SVT with ventricular rates greater than 150
CONTRAINDICATIONS
• Patients with a history of second or third degree AV block (except in patients with a functioning
artificial pacemaker)
• Sick Sinus Syndrome without cardiac pacemaker in place
• Persons taking Carbamazepine (Tegretol)
• Active bronchospasm
• Patients with a heart transplant.
ADMINISTRATION
• ADULT
• 12mg rapid IV/IO, over 1-2 seconds with a simultaneous 20mL flush.
• PEDIATRIC
• 0.1mg/kg rapid IVP with simultaneous 10mL flush. Max single dose 6mg.
• If no change in one minute, administer 0.2mg/kg rapid IVP with simultaneous 10mL flush. Max single
dose 12mg.
• Dilute 1ml in 9ml of NS, = 0.3mg/ml
ALBUTEROL
INDICATIONS • Bronchospasm • Hyperkalemia CONTRAINDICATIONS • None ADMINISTRATION • ADULTS & PEDIATRICS • 2.5mg via nebulizer. May repeat prn for bronchospasm. • 2.5mg via nebulizer. Continuous treatments for Hyperkalemia
AMIODARONE
INDICATIONS
• Ventricular Fibrillation/Pulseless V-Tach
• Ventricular Tachycardia
CONTRAINDICATIONS
• Cardiogenic Shock
• Marked sinus bradycardia and second or third degree AV blocks
PRECAUTIONS
• Used in conjunction with beta and calcium channel blockers could increase the risk of hypotension
and bradycardia.
• Do not shake the vial as the solution will foam up and will not be able to be drawn up.
SIDEEFFECTS
• Hypotension
• Bradycardia
ADMINISTRATION
• ADULT
• VF/Pulseless V-Tach: 300mg slow IV/IO. Repeat with 150mg in 3-5 minutes prn for continued
VF/Pulseless V-Tach.
• V-Tach with a Pulse: 150mg in a 50mL bag of Normal Saline, infuse over 10 minutes. May repeat 1x
prn. Administer entire 150mg bolus, even if the rhythm terminates.
• PEDIATRIC
• VF/Pulseless V-Tach: 5mg/kg slow IVP. May repeat up to 15mg/kg. Max single dose 300mg.
• V-Tach with a Pulse: 5mg/kg in a 50mL bag of Normal Saline infused over 25 minutes. Max single dose
150mg.
ASPIRIN
INDICATIONS • Chest pain • STEMIAlerts CONTRAINDICATIONS • Allergy to aspirin • Active GI bleeding • Children under 16 years of age ADMINISTRATION • ADULT • Chew and swallow four 81mg tablets
ATROPINE
INDICATIONS
• Symptomatic bradycardia
• Organophosphate poisonings
• Adverse reaction to Ketamine
CONTRAINDICATIONS
• None in emergency situations
SIDEEFFECTS
• Increased heart rate may worsen ischemia and increase the size of a myocardial infarction.
PRECAUTIONS
• Do not administer less than 0.5mg to an adult or 0.1mg to a pediatric.
• If pushed too slowly, Atropine may initially cause the heart rate to decrease.
ADMINISTRATION
• ADULT
• Bradycardia: 0.5mg IV/IO. Repeat every 5 minutes prn to a maximum dose of 3mg.
• Adverse reaction to Ketamine (hypersalivation): 0.5 mg IV/IM/IO.
• PEDIATRIC
• Bradycardia: 0.02mg/kg IV/IO every 3-5 minutes. Minimum single dose 0.1mg. Maximum single dose
0.5mg. Max total dose 1mg.
• ADVANCED AIRWAY MANAGEMENT: UNDER 36MONTHS: 0.02mg/kg IV/IO. Minimum single dose
0.1mg. Max single dose 0.5mg.
BENADRYL
INDICATIONS
• Allergic Reaction
• Anaphylaxis
• Dystonic Reaction
CONTRAINDICATIONS
• Newborn infants
SIDEEFFECTS
• Drowsiness
PRECAUTIONS
• Potentiated with alcohol and other CNS depressants
ADMINISTRATION
• ADULT
• Allergic and Dystonic Reaction: 50mg IV/IO/IM. Administer over 2 minutes for IV/IO usage. (See Box
Below)
• Anaphylaxis: 50mg IV/IO/IM. Administer over 2 minutes for IV/IO usage. (See Box Below)
• PEDIATRIC
• Allergic and Dystonic Reaction: 1mg/kg IV/IO OR IM if unable to obtain IV access. Max total dose
50mg. Administer over 2 minutes for IV/IO usage. (See Box Below)
• Anaphylaxis: 1mg/kg IV/IO OR IM if unable to obtain IV access. Max total dose 50mg.
Administer over 2 minutes for IV/IO usage. (See Box Below)
• 1ml in 9ml NS = 5mg/ml
BENADRYL ADMINISTRATION IV/IO:
Dilute with 9 mL of Normal Saline.
CALCIUM CHLORIDE
INDICATIONS
• Calcium Channel Blocker overdose
• Hyperkalemia
• Cardizem-induced hypotension
CONTRAINDICATIONS
• V-Fib, not associated with hyperkalemia (Patients with a history of renal failure/dialysis), Digitalis
toxicity or hypercalcemia
SIDEEFFECTS
• Hypotension, bradycardia, heart block, asystole, tissue necrosis
PRECAUTIONS
• Calcium Chloride should not be administered in the same infusion with sodium bicarbonate
without thoroughly flushing the IV line.
ADMINISTRATION
• ADULT
• Calcium Channel Blocker Overdose : 1g slow IV/IO
• Hyperkalemia: 1g slow IV/IO
• Cardizem-induced hypotension: 500mg slow IV/IO
• PEDIATRIC
• Calcium Channel Blocker Overdose: 20mg/kg, slow IV/IO. Max dose 1g.
CARDIZEM
INDICATIONS
• Atrial Fibrillation &Atrial Flutter with a rapid ventricular response
• Stable SVT when vagal maneuvers and Adenosine fail to convert the rhythm
CONTRAINDICATIONS
• Hypotension
• Wide complex QRS
• Heart Blocks
• WPW
• Sick Sinus Syndrome
SIDEEFFECTS
• Hypotension: If hypotension develops, administer 500mg of Calcium Chloride and 500mL of Normal
Saline.
ADMINISTRATION
• ADULT
• 10mg (2mL) IV push over 2 minutes. May repeat in 5 minutes prn with 15mg (3mL).
DEXTROSE
INDICATIONS • Hypoglycemia (BGL less than 60mg/dL) CONTRAINDICATIONS • None for a glucose less than 60mg/dL PRECAUTIONS • Tissue necrosis due to infiltration. Less likely to occur when using D10. ADMINISTRATION • ADULT • D10: 100 mL IV/IO, retest glucose. If patient remains less than 60 mg/dL, administer another 100 mL of D10. • PEDIATRIC • D10: 5mL/kg IV/IO max single dose of 100mL. Retest glucose may repeat 1x prn if BGL remains less than 60 mg/dL. • NEONATE • D10: 5mL/kg IV/IO. Retest glucose may repeat 1x prn if BGL remains less than 60mg/dL. HYPOGLYCEMIC CARDIAC ARREST: Administer 250mL of D10
DOPAMINE
INDICATIONS
• Post resuscitation maintenance of blood pressure, after fluid challenges
• Cardiogenic shock
• Hypotension, unresponsive to fluid challenges
• Neurogenic (Spinal) Shock, if fluid challenges fail to increase blood pressure, if multi- systems
trauma is not suspected
• Adult Bradycardia, if no response to Atropine or transcutaneous pacing
CONTRAINDICATIONS
• Patients with pheochromocytoma (adrenal gland tumor)
• Hypotension secondary to blood loss
SIDEEFFECTS
• Severe tissue necrosis and sloughing with extravasations from an infiltrating IV
PRECAUTIONS
• Dopamine is inactivated by Sodium Bicarbonate. Do not administer through the same IV/IO line
without thoroughly flushing the IV line.
• For patients on monoamine oxidase (MAO) inhibitors, decrease the dose to 1/10th of the regular
dose.
PREPARATION
• ADULT
• Adult preparation: Mix 400mg of Dopamine in 250mL of Normal Saline, which yields a
concentration of 1600mcg/mL.
• Alternate preparation: Mix 200mg of Dopamine in 125mL of Normal Saline which yields a
concentration of 1600 mcg/mL.
ADMINISTRATION
• ADULT
• 5-20mcg/kg/minute titrated to maintain a SBP of 90 mmHg systolic.
• NO DOPAMINE FOR KIDS
EPINEPHRINE
INDICATIONS
• Bronchospasm
• Allergic Reaction
• Anaphylaxis
CONTRAINDICATIONS
• None
SIDEEFFECTS
• Cardiac arrhythmias, nervousness, HTN, chest pain
ADMINISTRATION
• ADULT
• Adult Dose 0.3mg IM. May repeat 2x prn, in 5 minutes prn.
• PEDIATRIC
• Pediatric Allergic Reactions/Anaphylaxis: 0.01 mg/kg (0.01mL/kg). May repeat 2x prn, in 5 minutes
if needed. Max dose 0.3mg IM.
• For Croup and Epiglotitis: (1:1,000) 3mL (3mg total) delivered via nebulizer.
EPINEPHRINE CONTINUED
INDICATIONS
• Cardiopulmonary arrest
• Severe anaphylactic reactions
• Pediatric Bradycardia
CONTRAINDICATIONS
• None
SIDEEFFECTS
• Tachycardia, ventricular dysrythmias, hypertension, angina, and palpitations
PRECAUTIONS
• Epinephrine is inactivated by alkaline solutions. Never mix with Sodium Bicarbonate.
ADMINISTRATION
• ADULT
• Cardiac Arrest: 1mg IV/IO, push every 3-5 minutes during cardiac arrest.
• Anaphylaxis: (1:10,000) 0.1mg (diluted in 9mL of Saline), IV/IO over 1-2 mins. May repeat 2x prn, in
five minute intervals. Max total dose 0.3mg (See Box Below)
• PEDIATRIC
• Cardiac Arrest: 0.01mg/kg (0.1mL/kg) IV/IO, repeat every 3-5 minutes prn. Max single dose1mg.
• EPINEPHRINE: (1:10,000) 0.1mg (diluted in 9mL of Saline), titrate slowly over 5-10 minutes IV/IO
(titrate to effect). May repeat 2x prn, in five minute intervals. (See Box Below)
Discard 9 mL of Epi 1:10,000 and draw up 9 mL of Saline and administer over 5-
10 minutes (titrate to effect) .You may repeat 2x prn, in five minute intervals.
ETOMIDATE
INDICATIONS
• Sedation for: Cardioversion/Pacing, Ventilatory Management, RSI, ICE
CONTRAINDICATIONS
• None
PRECAUTIONS
• May cause respiratory arrest. Continuously monitor ventilatory status.
• Use with caution in patients with severe hypotension, severe asthma or severe cardiovascular
disease.
SIDEEFFECTS
• Apnea, hypoventilation, laryngospasm, N/V, tachycardia, muscle jerking
ADMINISTRATION
• SEDATION FOR AIRWAY CONTROL
• ADULT: 30mg or 0.3mg/kg IV/IO over 30-60 seconds. May repeat 1x prn.
• PEDIATRIC: 0.3mg/kg, IV/IO over 30-60 seconds. Max single dose 20mg. May repeat 1x prn.
• SEDATION FOR CARDIOVERSION/PACING
• ADULT: 6mg IV/IO, over 15-30 seconds. May repeat 1x prn.
• PEDIATRIC: 0.1mg/kg IV/IO over 15-30 seconds. Max single dose 6mg. May repeat 1x prn.
FENTANYL
NDICATIONS
• Moderate to severe pain relief
CONTRAINDICATIONS
• Respiratory Depression
• Less than 6 months old
PRECAUTIONS
• Push slowly to prevent rigid chest wall syndrome which can be reversed with Narcan.
• Head injuries due to risk of respiratory depression and increased ICP
SIDEEFFECTS
• Respiratory depression, hypotension, increased ICP, N/V, chest wall rigidity
A D M I N I S T R A T I O N
• A D U L T S
• FENTANYL: 50mcg slow IV/IO OR 100mcg IM/IN. May repeat every 5 minutes prn. Max total dose
200mcg.
• PEDIATRIC (Greater than 6 months old)
• FENTANYL: (Greater than 6 months old) 1mcg/kg slow IV/IO/IM May repeat every 5-10 mins prn.
Max single dose 50mcg. Max total dose 150mcg.
• FENTANYL: (Greater than 6 months old) 1.5mcg/kg IN. May repeat every 5-10 mins prn. Max single
dose 50mcg. Max total dose 150mcg.
• Dilute 1ml in 9ml NS = 5mcg/ml
**Narcan reverses all adverse reactions of Fentanyl.
GLUCAGON
INDICATIONS
• Hypoglycemia when unable to establish IV access and the patient is too obtunded for oral glucose
administration.
• Beta Blocker Overdose
CONTRAINDICATIONS
• Pheochromocytoma (adrenal gland tumor)
SIDEEFFECTS
• Nausea and vomiting, ensure airway is protected for patients with a decreased level of
consciousness.
ADMINISTRATION
• ADULT
• Hypoglycemia: 1mgIN/IM
• Beta Blocker OD: 1mg/minute, slow IV/IO. Max dose of 5mg.
• PEDIATRIC
• Hypoglycemia: Less than 20kg (0.5mg IN/IM), greater than 20kg (1mg IN/IM)
• Beta Blocker Overdose: 1mg IV/IO every minute until hypotension resolves or max dose.
• Children 20kg or less, maximum dose 4mg
• Children greater than 20kg, maximum dose 5mg
WARNING: The needle that comes with the Glucagon is NOT for IM use. Draw up the
medication in a syringe and attach the appropriate size needle for an IM injection.
KETAMINE (100MG/ML)
INDICATIONS • Violent Agitated Patient • Suspected Excited Delirium • Advanced Airway Management • Post Intubation Sedation • CPR Induced Consciousness • PainControl CONTRAINDICATIONS • Allergy • Penetrating Eye Injury ADVERSE REACTIONS • Hypertension and tachycardia, generally self limited • Laryngospasm may produce mild stridor. Correct in the order of: 1. High Flow O2 2. Ventilation with a BVM 3. Advanced Airway (RSI) • Hypersalivation • Nausea and vomiting • Tonic and clonic muscle movements • Transient respiratory depression occasionally occurs • Roving eye movements and nystagmus PSYCHOLOGICAL ADVERSE REACTIONS • Visual Hallucinations • Emergence Delirium • Sensation of detachment from the body ADMINISTRATION CPR INDUCED CONSCIOUSNESS / VILOENT ANDCOMBATIVE • ADULT • 200mg IV/IO. May repeat x1 prn. Max single dose 200mg. THIS MUST BE DILUTED. • PEDIATRIC N/A
KETAMINE
CONTINUED
EXCITED DELIRUM / VILOENT AND COMBATIVE
• ADULT: 400mg IM. May repeat 1x prn. Max single dose 400mg.
• PEDIATRIC: N/A
PAIN MANAGEMENT
• ADULT: 25mg IV/IO. May repeat 2x every 5 minutes prn. Max total dose 75mg IV/IO. THIS MUST BE DILUTED.
• PEDIATRIC: N/A
ADVANCED AIRWAYMANAGEMENT
• ADULT: 200mg IV/IO. May repeat 1x prn. Max single dose 200mg. THIS MUST BE DILUTED.
• PEDIATRIC 36MONTHS AND OVER: 1mg/kg IV/IO/IM. May repeat 1x prn. Max single dose 50mg. THIS MUST BE
DILUTED.
POST INTUBATION SEDATION
• ADULT: 200mg IV/IO as needed to maintain sedation. May repeat 1x prn. Max single dose 200mg. THIS MUST BE
DILUTED.
• PEDIATRIC 36MONTHS AND OVER: 1mg/kg IV/IO/IM. May repeat 1x prn. Max single dose 50mg. THIS MUST BE
DILUTED.
KETAMINE ADMINISTRATION INSTRUCTIONS FOR PAIN:
Using a 1mL syringe, draw up 0.25mL of Ketamine followed by 0.75mL of Normal Saline. This will equal a
concentration of 25mgs in 1mL. Administer this slowly over 1 minute. This may be repeated in 5 minutes 2x prn
to a max total dose of 75mgs.
KETAMINE ADMINISTRATION INSTRUCTIONS FOR SEDATION:
Using a 10ml syringe draw 1ml ketamine followed by 9ml NS. = 10mg/ml
WARNING:
Deliver this medication slowly unless giving it IM all IV/IO ketamine must be
diluted in normal saline: pain management: follow instructions per that protocol
page.
• ALL ADULT: 200mg IV/IO MUST BE DILUTED IN 8ml of NORMAL SALINE.
• ALL PEDIATRIC: DILUTE DOSE IN 1ml and ADMINISTER OVER 1 MINUTE.
LIDOCAINE 1%
INDICATIONS • EZ IO for the conscious patient CONTRAINDICATIONS • 2nd and 3rd degree heart block SIDEEFFECTS • Dizziness • Blurred vision • Muscle Twitching • Seizures DOSAGE • ADULT • LIDOCAINE: 40MG IO over one minute. Allow Lidocaine to dwell in IO space for one minute and flush with NORMALSALINE 10mL. Mayadminister additional LIDOCAINE: 20mg IO over one minute prn.
MAGNESIUM SULFATE
INDICATIONS
• Pre- Eclampsia
• Eclampsia
• Torsades de Pointes
• Severe Asthma
CONTRAINDICATIONS
• 2nd and 3rd Degree Heart Blocks
SIDEEFFECTS
• Circulatory Collapse, respiratory paralysis, heart block
ADMINISTRATION
• ADULTS
• With a Pulse Torsades de Pointes Stable: 2g IV/IO, in 50 mL of Normal Saline attached to a 60 gtt set
and run wide open.
• Pulseless Torsade: 2g IV/IO IVP Slowly
• Torsades de Pointes Post Cardiac Arrest or Defibrillation of a patient with a PULSE: (2g IV/IO into
50mL of Normal Saline, infused over 10 minutes) if patient did not receive Mag Sulfate during
arrest.
• Severe Pre-Eclampsia: 2g in 50mL of Normal Saline, infuse over 10 minutes. MUST REPEAT 1x.
• Eclampsia: 4g IV/IO, in 50 mL of Normal Saline attached to a 60 gtt set and run wide open..
Max total dose 4g.
• For severe asthma not responding to other treatments: 2g IV/IO in 50 mL of Normal Saline over 10
minutes.
• PEDIATRIC
• Pulseless Torsades de Pointes: 40 mg/kg IV/IO, Slow IVP
• Stable PVT 40mg/kg IV/IO, in 50 mL of Normal Saline over 10 minutes. Max of 2g.
• Severe Asthma: 40 mg/kg in 50 mL of Normal Saline over 25 minutes. Max of 2g.
• Dilute 4ml in 46 ml NS = 40mg/ml
NARCAN
INDICATIONS
• Reversal of respiratory depression and/or hypotension secondary to a narcotic overdose
• Reverse rigid chest wall syndrome secondary to Fentanyl administration
CONTRAINDICATIONS
• None
PRECAUTIONS
• Administered cautiously to patients who are known or suspected to be physically dependent on
opiates, as Narcan administration can cause withdrawals in these patients, including newborns of
addicted mothers.
• Use caution during administration, as patient may become violent as level of consciousness
increases.
ADMINISTRATION
• ADULT
• 0.5mg IV/IO/IM. Repeat every 1-2 minutes prn for a respiratory rate less than 12 BPM up to 2mg. If
no change is noted increase the dose to 2mg increments. Max total dose 10mg.
• 2 mg IN. May repeat in 2-3 minutes prn for a respiratory rate less than 12 BPM.
• PEDIATRIC
• 0.5mg IV/IO/IM or 1mg IN. May repeat every 2-3 minutes prn for a respiratory rate less than 20 BPM
for children and less than 40 BPM for neonates. Max single dose 0.5mg IV/IO/IM or 1 mg IN.
• Max total dose 2mg IV
NOTE: Methadone, Darvon, Talwin and Fentanyl may require
higher doses of Narcan, contact medical control.
NITRO PASTE
INDICATIONS
• Pulmonary edema
CONTRAINDICATIONS
• Hypotension
• Erectile Dysfunction Drugs (Viagra and Levitra within 24 hours and Cialis within 48 hours)
• Right Ventricular Infarction
• No IV/IO access
SIDEEFFECTS
• Headache, nausea and vomiting, hypotension, reflex tachycardia
• For NTG-induced hypotension, place patient in a supine position and administer a 500mL fluid bolus
of Normal Saline, and remove the NTG paste.
ADMINISTRATION
• ADULT
• Apply 1” of nitro paste to patient’s anterior upper chest.
• PEDIATRIC
N/A
• (Nitroglycerine may be given as a first line drug ahead of Fentanyl for stable patients with history
ofopiate abuse or in whom drug seeking behavior is suspected)
NITROGLYCERINE
INDICATIONS
• Ischemic chest pain after maximum Fentanyl administration
• Pulmonary edema
CONTRAINDICATIONS
• Hypotension
• Erectile Dysfunction Drugs (Viagra and Levitra within 24 hours and Cialis within 48 hours)
• Right Ventricular Infarction
• For Chest Pain/MI Only - Heart Rate less than 50 BPM or greater than 100 BPM
SIDEEFFECTS
• Headache, nausea and vomiting, hypotension, reflex tachycardia
• For NTG-induced hypotension, place patient in a supine position and administer a 500mL fluid bolus
of Normal Saline.
ADMINISTRATION
• ADULT
• Chest Pain: 0.4mg every 3-5 minutes. Maximum 3 doses
• CHF: 0.4mg every 3-5 minutes for an SBP greater than 90mmHg. Maximum 3 doses. Or NTG Paste 1 inch
to ACW
• PEDIATRIC
N/A
ORAL GLUCOSE
INDICATIONS
• For documented hypoglycemia (less than 60 mg/dL), before unconsciousness occurs.
CONTRAINDICATIONS
• Patients who are not conscious enough to swallow
• Patients less than 2 years old
PRECAUTIONS
• Patient must be conscious enough to be able to swallow.
ADMINISTRATION
• ADULT & PEDIATRIC
• 15g PO, squeeze the entire tube of glucose in the patient’s mouth and have them swallow. May
repeat 1x in 15 minutes prn.
SODIUM BICARBONATE
INDICATIONS
• Hyperkalemia
• TCAOverdose
• Excited Delirium
CONTRAINDICATIONS
• None, if given for above indications.
PRECAUTIONS
• Do not administer Sodium Bicarbonate in the same IV line as other medications without
adequately flushing the IV line.
ADMINISTRATION
• ADULT
• Hyperkalemia: 50 mEq slow IV/IO.
• TCA Overdose: 50 mEq slow IV/IO every 5 minutes until ECG changes are resolved. Maximum
150 mEq.
• Excited Delirium: 50 mEq slow IV/IO. If patient is in cardiac arrest,100mEq as first line drug.
• PEDIATRIC
• Hyperkalemia/TCA Overdose: 1 mEq/kg of an 8.4% solution. For neonates, 1 mEq/kg of a 4.2%
solution.
SODIUM BICARBONATE 4.2%: Discard 25mL of 8.4% and draw up 25mL of Normal Saline.
