2110 Drugs #2 Flashcards
Clopidogrel
Brand name
Brand name: plavix
Clopidogrel
Drug class
Drug class: thienopyridine antiplatelet
Clopidogrel
Indications
Indications: ST elevation MI (STEMI), moderate to high risk non-ST elevation (NSTEMI), acute coronary syndrome, substitute for aspirin in patients unable to take aspirin
Clopidogrel
Mechanism of action
Mechanism of action: inhibits platelet aggregation by blocking activation of the glycoprotein llb/llla complex
Clopidogrel
Contraindications
Contraindications: active GI bleeding, intracranial hemorrhage, known hypersensitivity
Clopidogrel
Adverse effects
Adverse effects: severe neutropenia, thromobic thromobocytopenic purpura (TTP), GI hemorrhage, cerebral hemorrhage, angioedema, stevens-johnson syndrome, rash, flulike symptoms
Clopidogrel
Precautions
Precautions: nexium and prilosec (proton pump inhibitors) may inhibit the effects of plavix
Clopidogrel
Dose & Administration
Dose & Administration: adult loading dose 300-600mg PO. Pedi not recommended
Aspirin
Brand name
Brand name: ASA, Bayer, ecotrin, st. Joseph
Aspirin
Drug class
Drug class: anti-platelet medication
Aspirin
Indications
Indications: onset of chest pain suggestive to myocardial infarction
Aspirin
Mechanism of action
Mechanism of action: noncompetitive platelet antagonists. Prevents release of thromboxane A2 granules from activated platelets, reducing their ability to activate further platelets. This reduces platelet aggregation
Aspirin
Contraindications
Contraindications: Hypersensitivity (never give), relative contraindication in active ulcer, disease and asthma (consider the risk)
Aspirin
Adverse effects
Adverse effects: bronchospasm, prolonged bleeding, GI bleeding, epigastric distress, N/V, heartburn, Reye syndrome ( brain swelling in kids)
Aspirin
Precautions
Precautions: caution in patients allergic to other NSAID’S acidic properties may damage stomach lining
Aspirin
Dose & Administration
Dose & Administration: 160 to 325mg p.o. chewing preferred for faster absorption. Pediatric not recommended
Thiamine
Brand name
Brand name: betaxin
Thiamine
Drug class
Drug class: vitamin b
Thiamine
Indications
Indications: coma of unknown origin (given with dextrose), delirium tremens, beriberi, wernicke encephalopathy
Thiamine
Mechanism of action
Mechanism of action: combines with ATP to form thiamine pyrophosphate coenzyme, which is a necessary component for carbohydrate metabolism. The brain is extremely sensitive to thiamine deficiency
Thiamine
Contraindications
Contraindications: none
Thiamine
Adverse effects
Adverse effects: anxiety, dyspnea, respiratory failure, vasodilation, hypotension, nausea and vomiting
Thiamine
Precautions
Precautions: dilute prior to delivery (pain at iv site) should always be given with glucose
Thiamine
Dose & Administration
Dose & Administration: adult 100mg slow iv or Im pediatrics 10-25 mg slow iv or Im
Hydroxocobalamin
Brand name
Brand name: cyanokit
Hydroxocobalamin
Drug class
Drug class: antidote
Hydroxocobalamin
Indications
Indications: treatment of known or suspected cyanide poisoning
Hydroxocobalamin
Mechanism of action
Mechanism of action: binds to cyanide to form nontoxic cyanocobalamin ( vitamin b12), preventing it’s toxic effects; excreted renally
Hydroxocobalamin
Contraindications
Contraindications: none in the emergency setting
Hydroxocobalamin
Adverse effects
Adverse effects: Hypertension, allergic reactions, GI bleeding, nausea and vomiting, dyspepsia, dyspnea, dizziness, headache, injection site reaction
Hydroxocobalamin
Precautions
Precautions: not compatible in the same iv line with many other medication
Hydroxocobalamin
Dose & Administration
Dose & Administration: adult 5 grams iv infusion over 15 minutes at a rate of 15ml/min. May repeat x1 at the same dose to a maximum of 10 grams. Pediatrics 70mg/kg iv. May be repeated one time at the same dose.
Atropine sulfate
Brand name
Brand name: atropine sulfate
Atropine sulfate
Drug class
Drug class: anticholinergic
Atropine sulfate
Indications
Indications: severe bradycardia, organophosphate poisonings, nerve agent exposure, RSI in pediatrics, beta blocker, and calcium channel blocker overdose.
Atropine sulfate
Mechanism of action
Mechanism of action: inhibits the action of acetylcholine at postganglionic parasympathetic neuroeffector site. Allows sympathetic control to increase heart rate.
Atropine sulfate
Contraindications
Contraindications: tachycardia, hypothermic bradycardia unstable cardiovascular status with bleeding & myocardial ischemia, narrow angle glaucoma
Atropine sulfate
Adverse effects
Adverse effects: drowsiness, confusion, headache, tachycardia palpitations, N/V, pupil dilation, dry mouth, blurred vision, flushed dry hot skin, paradoxical bradycardia when given at low doses
Atropine sulfate
Precautions
Precautions: effects are enhanced by antihistamines, procainamide, quinidine, antipsychotic, benzodiazepines and antidepressants
Atropine sulfate
Dose & Administration
Dose & Administration: adult bradycardia 0.5mg iv every 3-5 minutes as needed not to exceed total dose of 0.04mg/kg (maximum of 3mg total) pediatrics bradycardia 0.02mg/kg iv/io (minimum dose of 0.1mg)
Morphine
Brand name
Brand name: roxanol, M.S. contin
Morphine
Drug class
Drug class: opioid analgesic (schedule ll narcotic)
Morphine
Indications
Indications: severe CHF, acute pulmonary edema, chest pain associated with acute MI, analgesia for moderate to severe acute and chronic pain
Morphine
Mechanism of action
Mechanism of action: alleviates pain through CNS action, suppresses fear and anxiety centers in the brain, depresses brainstem respiratory centers, increases peripheral venous capacitance and decreases venous return, decreases preload and afterload, which decreases myocardial oxygen demand
Morphine
Contraindications
Contraindications: head injury, exacerbated COPD, depressed respiratory drive, hypotension, undiagnosed abdominal pain, decreased LOC, suspected hypovolemia, patients who have taken MAOIs within 14 days
Morphine
Adverse effects
Adverse effects: confusion, sedation, headache, CNS depression, respiratory depression, apnea, bronchospasm, dyspnea, hypotension, syncope, bradycardia, tachycardia, NV, dry mouth
Morphine
Precautions
Precautions: potentiates sedation effects of phenothiazine’s (promethazine) CNS depressants may potentate effects, MAOI’S may cause paradoxical excitation
Morphine
Dose & Administration
Dose & Administration: adult STEMI 2-4mg SIVP repeat dose 2-8mg at 15 minutes intervals. Pain control (medical direction) pediatrics 0.1-0.2mg/kg iv/io/im/SC with max dose of 5mg
Nitroglycerin
Brand name
Brand name: nitro- stat, nitro-bid, tridil
Nitroglycerin
Drug class
Drug class: vasodilator
Nitroglycerin
Indications
Indications: acute angina pectoris, ischemic chest pain, hypertension, CHF, pulmonary edema
Nitroglycerin
Mechanism of action
Mechanism of action: smooth muscle relaxant acting on vasculature, uterine, intestinal smooth muscle. Dilation of arterioles and viens in the periphery. Reduce preload and afterload, decreasing workload of the heart and thereby myocardial oxygen demand
Nitroglycerin
Contraindications
Contraindications: hypotension, hypovolemia, intracranial bleeding or head injury, pericardial tamponade, severe bradycardia or tachycardia, RV infarction, previous administration in the last 24 hours: tadalafil (cialis) (48 hours), vardenafil (levitra), sildenafil (Viagra)
Nitroglycerin
Adverse effects
Adverse effects: headache, dizziness, weakness, reflex tachycardia, syncope, hypotension, NV, dry mouth, muscle twitching, diaphoresis.
Nitroglycerin
Precautions
Precautions: not to be given if the patient has had any ED medication in the last 48 hours. Cialis (tadalafil) levitra (vardenafil) Viagra (sildenafil)
Nitroglycerin
Dose & Administration
Dose & Administration: adult 0.4mg sl repeat in 5 minutes to a maximum of 3 doses. IV infusion 10mcg/min increase by 10mcg/min every 3-5 minutes until desired effect with a maximum dose of 200mcg/min. Pediatrics not recommended
