4th semester- Special Pops Flashcards
DEXAMETHASONE (Decadron)
Classification: Corticosteroid
Mechanism of Action: Suppresses acute and chronic inflammation; immunosuppressive effects Indications: Asthma, anaphylaxis, croup, spinal cord injury (controversial Contraindications: Hypersensitivity, systemic sepsis, bacterial infection.
Precautions: Hypertension, sodium and water retention, GI bleeding
Dosage/Route:
Adult: 10-100 mg IV (1 mg/kg slow IV bolus)
Pediatric: 0.25-1.0 mg/kg IV/IO, or IM. (Max dose 16mg)
ETOMIDATE (Amidate)
Classification: Sedative-hypnotic
Mechanism of Action: Short acting hypnotic that acts at the level of the reticular activating system. Indications: Premedication for rapid sequence intubation and cardioversion. Contraindications: Hypersensitivity, labor, septic shock.
Precautions: Marked hypotension, severe asthma, or severe cardiovascular disease. Pregnancy C. Dosage/Route:
Adults: 0.2 to 0.4 mg/kg IV over 30 to 60 seconds
Pediatrics: Children > 10, same as adults (Max dose 20 mg)
KETAMINE (Ketalar)
Classification: Anesthetic, analgesic
Mechanism of Action: Blocks afferent (sensory) transmission of impulses associated with pain perception; causes short-acting amnesia without muscle relaxation.
Indications: Used as a sedative, for pain control, and as an induction agent for rapid sequence intubation. Contraindications: Hypersensitivity, should not be given to hypertensive patients or patients with increased intracranial pressure; children under 2 years old.
Precautions: Pregnancy C; chronic alcoholism; acute alcohol intoxication
Adverse Effects: Hypertension, dysrhythmia, bronchodilation, respiratory depression. Dosage:
Adult / Pediatric: 1-2mg/kg IV over 1-2 minutes.
MIDAZOLAM
Classification: Benzodiazepine
Mechanism of Action: Reversibly interacts with GABA receptors in the CNS causing sedative, anxiolytic, amnesic, and hypnotic effects.
Indications: Seizures, sedation for medical procedures, chemical restraints.
Contraindications: Glaucoma, shock, pregnancy, alcohol intoxication and other concomitant CNS depressant use.
Adverse Effects: Hypotension, respiratory suppression, cardiac arrest, headache, NV Dosage:
Adult:
Seizures: .2mg/kg IM/IN (Max single dose 10mg), .1mg/kg IV (Max single dose 4mg) Procedural sedation: .5-2.5mg IV, may be repeated (Max dose .1mg/kg)
Chemical restraint: 5mg IV/IN/IM
Pediatric:
Seizures: .2mg/kg IN, .1-.3mg/kg IM/IV (Max single dose 10mg)
Procedural sedation: .05-.5mg/kg IV
Chemical restraint: .05-.1mg/kg IV, .1-.15mg/kg IM, .3mg IN
OXYTOCIN (Pitocin)
Classification: Hormone
Mechanism of Action: Increases uterine contraction, thereby inducing labor, encouraging delivery of the placenta, and controlling postpartum hemorrhage.
Indications: Postpartum hemorrhage after infant and placenta delivery.
Contraindications: Second fetus (not delivered yet), prehospital administration before delivery of the infant or infants, unfavorable fetal position.
Precautions: Before delivery may induce uterine rupture and fetal dysrhythmias, hypertension, intracranial bleeding, or asphyxia. Uterine tone, ECG, and vital signs should be monitored during administration.
Adverse Reactions: Hypotension, tachycardia, angina
Dosage/Route:
Adult:
IM: 10 units after delivery of the placenta.
IV: Mix 10 to 40 units in 1,000 mL, of nonhydrating dilutant, infused at 20-40
milliunits/min. Titrated to severity of bleeding and uterine response.
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TERBUTALINE (Brethine)
Classification: Beta-2 adrenergic agonist, bronchodilator, tocolytic.
Mechanism of Action: Selective beta-2 adrenergic receptor activity resulting in relaxation of smooth muscle of the bronchial tree and peripheral vasculature with minimal cardiac effects. Indications: Bronchial asthma, reversible bronchospasm associated with exercise, chronic bronchitis, emphysema, premature contractions.
Contraindications: Hypersensitivity, tachydysrhythmias.
Adverse Reactions: CNS stimulation, headache, seizure, restlessness, apprehension, wheezing, coughing, bronchospasm, bradycardia, tachycardia, ST wave changes, PVCs, PACs, chest pain. Dosage/Route:
Adult: 0.25 mg subcutaneous, may repeat in15 to 30 minutes. Maximum dose 0.5 mg in 4-hours Pediatric: Not recommended under 12 years
LIDOCAINE HYDROCHLORIDE
Classification: Antidysrhythmic
Mechanism of Action: Suppresses automaticity and raises stimulation threshold of the ventricles. Indications: Alternate to amiodarone in cardiac arrest from V-fib/pulseless V-tach, stable monomorphic ventricular tachycardia, stable polymorphic V-tach with normal baseline QT interval. Contraindications: Hypersensitivity, 2nd or 3rd degree heart blocks, Stokes-Adams syndrome, prophylactic use in acute myocardial infarction (AMI), wide-complex ventricular escape beats with bradycardia
Adverse Reactions: Slurred speech, seizures (with high doses), confusion, bradycardia, blurred vision Precautions: : Pregnancy C, Hepatic or renal impairment, CHF, hypoxia, respiratory depression, hypovolemia, myasthenia gravis, shock, debilitated patients, elderly, family history of malignant hypothermia.
Dosage/Route:
Adult:
Cardiac arrest: 1-1.5mg/kg IV/IO, repeat dose .5-.75mg/kg IV/IO (Max dose 3g/kg) Stable wide complex: 1-1.5mg/kg IV/IO, repeat dose .5-.75mg/kg IV/IO (Max dose 3g/kg)
Maintenance infusion: 1-4mg/min
Pediatric:
Cardiac arrest: 0.1 mg/kg/dose IV/IM/SC or ET max dose 0.8 mg; if no response in 10 min, administer 1 mg/kg rapid IV/IO (Max dose 100 mg)
Continuous IV/IO infusion: 20-50mcg/kg
PROCAINAMIDE (Pronestyl)
Classification: Antidysrhythmic
Mechanism of Action: Suppresses phase 4 depolarization in normal ventricular muscle and Purkinje fibers, reducing ectopic pacemaker’s automaticity; suppresses intraventricular conduction. Indications: Stable monomorphic VT with normal QT interval, reentry SVT uncontrolled by vagal maneuvers and adenosine, stable wide-complex tachycardia of unknown origin, AF with rapid ventricular rate in patients with Wolff-Parkinson-White syndrome.
Contraindications: Torsades de pointes, second- and third-degree heart AV block (without functioning artificial pacemaker), preexisting QT prolongation, digitalis toxicity, tricyclic antidepressant overdose. Adverse reactions: Confusion, seizures, hypotension, bradycardia, reflex tachycardia, ventricular dysrhythmias, AV blocks, asystole, widening of PR, QRS, and QT intervals, nausea, vomiting. Dosage/Route:
Adult:
Recurrent VF/pulseless VT: 20 mg/min slow IV infusion until the dysrhythmia is suppressed. (Max dose 17mg/kg)
Other indications: 20 mg/min slow IV infusion until any one of the following occurs: dysrhythmia suppression, hypotension, QRS widens by >50% of its pretreatment width, or total dose of 17 mg/kg has been given.
Maintenance infusion: 1 to 4 mg/min (diluted in D W or normal saline).
Pediatric: Loading dose 15 mg/kg IV/IO over 30 to 60 minutes.
PRALIDOXIMINE (Protopam)
Classification: Cholinesterase reactivator, antidote.
Mechanism of Action: Reactivates cholinesterase to effectively act as an antidote to organophosphate and pesticide poisonings. This action allows for destruction of accumulated acetylcholine at the paralysis of skeletal muscle.
Indication: Antidote in the treatment of poisoning by organophosphate pesticides and chemicals, anticholinesterase overdoses.
Contraindications: Reduce dose in patients with impaired renal function, patients with myasthenia gravis, and inorganic phosphate poisoning.
Precautions: Pregnancy safety: Category C. Slow IV infusion prevents tachycardia, laryngospasm, and muscle rigidity. Consider drawing a blood sample prior to administration for hospital to run pretreatment levels.
Adverse Reactions: Dizziness, drowsiness, headache, neuromuscular blockade, seizure, laryngospasm, hyperventilation, apnea, tachycardia, cardiac arrest, nausea, muscle rigidity, muscle weakness, rash, pain at injection site.
Dosage: Consult with medical direction, commercially available autoinjectors contain 600 mg of pralidoxime chloride
HYDROMORPHONE (Dilaudid)
Classification: Analgesic; schedule II drug.
Mechanism of Action: Binds to the opioid receptors in the CNS.
Indications: Moderate to severe pain.
Contraindications: Hypersensitivity, GI obstruction, respiratory depression.
Precautions: Pregnancy category C., respiratory depression from HYDROmorphone administration is managed with naloxone.
Adverse Reactions: Hypotension, syncope, increased intracranial pressure, apnea. Dosage:
Adult: 1-2mg IM, 0.2-1mg IV, 2-8mg every 4 to 6 hours PO.
Pediatric: .8-2 mg IM, 0.2 to 0.6 mg IV.
RACEMIC EPINEPHRINE (Susphrine)
Classification: Sympathomimetic; Catecholamine; Bronchodilator
Mechanism of Action: Stimulates both Alpha and Beta receptors, causes bronchodilation and vasoconstriction Indications: Bronchial asthma, prevention of bronchospasm, croup, laryngotracheobronchitis, laryngeal edema.
Contraindications: Hypertension, epiglottitis, underlying cardiovascular disease. Precautions: May result in tachycardia and other dysrhythmias. Patient vital signs and ECG should be monitored. Pregnancy C
Adverse Reactions: Anxiety, dizziness, headache, tremor, palpitations, tachycardia, cardiac arrhythmias, hypertension
Dosage/Route:
Adult:
Metered-dose inhaler (MDI): 2-3 inhalations repeated every 5 min.
Solution: dilute 5 mL (1%) in 5.0 mL normal saline (NS), administer over 15 min. (Neb) Pediatric:
Solution: (if less than 20 kg) dilute 0.25 mL (0.1%) in 2.5 mL NS (Neb)
Solution: (if greater than 40 kg).dilute 0.75 mL in 2.5 mL NS (Neb)
