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1
Q

Parasympatholytics

A

Parasympatholytics (Anticholinergic Drugs)

MOA: competitive antagonist of muscarinic acetylcholine receptors, reduces the activity of the parasympathetic nervous system, increases HR, inhibits mucous glands

IND: bradycardia, shock, bronchospasms, hypotension,organophosphate poisoning

CONS: Tachy dysrhythmias, high degree heart blocks, glaucoma, cardiac ischemia

Adverse: tachy dysrhythmias, v-fib, dizziness, nausea, dissociative hallucinations, HTN, increases myocardial oxygen demand, anticholinergic toxidrome

Special: Will not work on transplant hearts (Vagus nerve is severed during transplant) May cause Bradycardia at incorrect doses

Examples: Atropine, Diphenhydramine, Atrovent, Spiriva

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2
Q

Parasympathomimetics

A

Parasympathomimetics

MOA: Bind to cholinergic receptors, mimic the effects of parasympathetic nervous system

IND: Anxiety, Refractory vomiting, Gastroparesis, Alzheimer’s, HTN, Glaucoma, Myasthenia gravis, Anticholinergic overdose

CON: Bradycardia, Hypotension, GI bleeding, GI blockage

Adverse: Tardive Dyskinesia, Bradycardia, Hypotension, Diarrhea, SLUDGEM, Mydriasis

Special:

Examples: Nicotine, Aricept, Reglan, Clonidine, Atenolol, Propanolol, Minipress, Sain, VX, Tear gas, Organophosphate pesticides

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3
Q

Sympathomimetics

A

Sympathomimetics

MOA: Bind to adrenergic receptors, mimic the effects of the sympathetic nervous system, activate the flight or flight response, raise HR and force of contractions, raise RR and depth, cause bronchodilation, peripheral vasoconstriction, coronary and skeletal muscle vasodilation

IND: Bradycardia, Hypotension, cardiac arrest, bronchospasm, shock

Con: MI, Tachy dysrhythmias, HTN, Heart failure, CAD, Hypersensitivity

Adverse: Tachycardia, Dysrhythmias, HTN, Palpations, Mydriasis, anxiety, tremors, increase myocardial workload, Cardiac ischemia, Cardiac arrest

Special: Use caution in Elderly PT’s, Do not mix with sodium bicarbonate(deactivates), Pregnancy class C, Half-life Minutes

Examples: Epinephrine, Norepinephrine, Dopamine, Albuterol, Amphetamines, Ritalin, Cocaine, Ephedrine/pseudoephedrine

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4
Q

Calcium Channel Blocker

A

Calcium Channel Blockers

MOA: Blocks voltage-gated calcium channels in cardiac muscle and blood vessels, Decrease in intracellular calcium decreases cardiac conductivity, Arterial vasoconstriction leads to decreased SVR

IND: Hypertension, Seizure disorders, Supra-ventricullar tachycardias (a-fib, a-flutter, refractory PSVT), Migraines

CON: Hypotension, Bradycardia, Hypersensitivity, Pre-existing syndromes (WPW, LGL) AV blocks

Adverse: Reflex tachycardia, Bradycardia, Hypotension, Facial flushing, Peripheral edema.

Special: potentiated by magnesium

Examples: Cardizem, Norvasc, Verapamil

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5
Q

Beta Blocker

A

Beta blocker

MOA: Block the actions of catecholamines on Beta 1 receptors Beta 2 receptors or both, Decrease effects of the sympathetic nervous system effecting bronchodilation, heart rate and force

IND: Tachy dysrthythmias, CHF, Glaucoma, Post-MI, Migrane prophylaxis, aortic dissection

CON: Coccaine or bath salts use, Asthma, Bradycardia, Hypersensitivity, Hypotension

Adverse: Bronchospasms, Hypotension, Bradycardia, Heart failure, Hallucinations, Hyperkalemia

Special: some can’t be given with calcium channel blockers

Examples: Labetolol, Atenolol, Metoprolol, Esmolol, Propanolol

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6
Q

Dopamine

A

Dopamine Sympathomimetic
Brand: Intropin

MOA: Alpha, Beta, & Dopaminergic Agonist. Increase cardiac contractility and cause peripheral vasoconstriction

IND: Hypotension (not due to hypovolemia), symptomatic bradycardia.

CON: Hypersensitivity, hypovolemic shock, pheochromocytoma. VF/VT

Adverse: Arrhythmias, HTN, palpitations, N/V
Dose/Route: 2-5mcg/kg/min (kidneys) dopaminergic effect
5-10mcg/kg/min (Cardiac) Beta effect
10-20mcg/kg/min (Vasculature) Alpha Effect
Infussion only Pedi dose is the same
Spec Special: Pregnancy Class C, irritant to vasculature. No benefits gained at doses +20mcg/kg/min.

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7
Q

Epinepherine

A

Epinephrine Sympathomimetic
Brand: epi pen, addrenaline
MOA: Alpha & Beta agonist, positive inotrope & positive chronotrope, vasoconstricts,bronchodilation
IND: Bronchospasm, Cardiac Arrest, Anaphylaxis, Symptomatic bradycardia.
CON: Sensitivity, HTN, dysrhythmias, cardiovascular disease.
Adverse: N/V, tremors, nervousness, anxiety, dysrhythmia.
DOSE: Cardiac- 1mg 1:10,000 every 3-5 min IV/IO/ET
Pedi- 0.01mg/kg 1:10,000 up to 1mg IV/IO/ET
Anaphylaxis- 0.1mg 1:10,000 SLOW IV push // 0.3mg-0.5mg 1:1,000 IM
Pedi- 0.1-1mcg/kg/min INFUSION// 0.01mg/kg up to 0.3mg IM
Bradycardia 2-10 mcg/min 1:10,000 INFUSION
Pedi- 0.01mg/kg 1:10,000 INFUSION
Status Asthmaticus- 0.3mg 1:1,000 IM
Pedi- 0.01mg/kg 1:1,000 IM

Special: Pregnancy Class C, photophobic, alkaline deactivated.

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8
Q

Norepinephrine

A

Norepinephrine Sympathomimetic

Brand: Levophed
MOA: Alpha (vasoconstrict) & Beta (Inotrope) Agonist.
IND: Hypotension (not due to hypovolemia).
CON: Hypersensitivity, Hypovolemia, HTN
Adverse: HTN, anxiety, palpitations, N/V

Dose/Route: 0.5-30mcg/min INFUSION
Pedi: 0.01mcg/kg/min up to 0.5mcg.
**Titrate to effect
Systolic 90 map of 60

Special: Preg. Class C, deactivated by alkaline solutions, extravasation (necrosis of the tissue), “leave’m dead with Levophed.”

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9
Q

Vasopressin

A

Vasopressin Pressor-Antidiuretic Hormone (ADH)

Brand: Pitressin

MOA: Pure synthetic alpha agonist; vasoconstriction. Sympathomimetic

IND: cardiac arrest, hypotension (not due to hypovolemia)

CON: none in emergency setting, hypovolemia, HTN, Cardiovascular disease

Adverse: HTN, bradycardia, bronchoconstriction, palpitations, N/V.

Dose/Route: 40 units IV, IO, ET
Pedi—0.4-1unit/kg IV/IO

Special: Class C Pregnancy, given instead of epi

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10
Q

Ondansetrone

A

Ondansetrone Antiemetic

Brand: Zofran

MOA: Selectively antagonizes Serotonin receptors. Causes CNS depression.

IND: N/V (More specifically to cardiac patients; prevents extra workload and anxiety) motion sickness

CON: Hypersensitivity, Liver disease, GI obstruction

Adverse: headache, light headed/dizzy, tired, constipated, prolonged QT

Dose/Route: 4-8 mg SLOW IV push, IO, PO
Pedi—0.1mg/kg up to 4mg SLOW IV push

Special: Pregnancy Class B, lowers mentation of patients on SSRI (Serotonin, selective reuptake inhibitors).

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11
Q

Ketorolac

A

ketorolac NSAID

Brand: Toradol

MOA: Decrease responsiveness of pain receptors; inhibits inflammation & pain. Antipyretic, analgesia, anti-inflammatory

IND: Acute moderate-severe pain.

CON: Hypersensitivity, Peptic ulcers, GI Bleed, renal insufficiency and hypovolemia,

Adverse: headache, drowsiness, N/V/D, dyspepsia, edema

Dose/Route: 30mg IV not to exceed 120mg daily
60mg IM not to exceed 120mg daily (IV, IO, IM, PO)
*65 y/o use ½ dose as adult
Pedi not indicated

Special: Pregnancy Class C, solution yellow tint, be mindful of bleeding or surgical procedures.

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12
Q

Hydromorphone

A

hydromorphone Narcotic Opioid analgesic

Brand: Dilaudid

MOA: Pure opioid agonist. Bind to opiate receptors.

IND: Severe Pain.

CON: Hypersensitivity Shock, hypoperfusion, hemorrhage, head injury

Adverse: Respiratory depression, decreased level of consciousness, hypotension, bradycardia, nausea, dizziness, constipation.

Dose/Route: 1-2mg IM
0.2-1mg IV q2-3 hrs
2-4 mg tablet q4-6 hrs
Pedi—0.015mg/kg SIVP

Special: Avoid other CNS substances (drugs, alcohol). Class II Narcotic

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13
Q

Sublimaze

A

sublimaze Narcotic Opioid Analgesic

Brand: Fentanyl

MOA: Pain reduction. Binds to opiate receptors & produces euphoria and analgesia.

IND: moderate to severe Pain, pretreatment for RSI

CON: Hypersensitivity, TBI, Respiratory Depression, M.A.O.I, Head injury

Adverse: Respiratory Depression, Hypotension, bradycardia, syncope, N/V, dizziness

Dose/Route: pedi/adult 1-2 mcg/kg IM, IV, IO, IN
RSI induction 3mcg/kg IV push 3 min before intubation

Special: Pregnancy Class C. Dose should be individualized, Class II narcotic

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14
Q

Albuterol

A

Albuterol BETA Agonist

Brand Proventil, Ventolin

MOA: Binds and stimulates beta 2 receptors; relaxation of bronchial smooth muscle; Bronchodilation

IND: bronchospasm, asthma, COPD exacerbation

CON: hypersensitivity, cardiac disorder, angioedema, arrhythmia, symptomatic tachycardia, xopenex hypersensitivity

Adverse: anxiety, tremor, N/V, palpitations, hyperglycemia, hypokalemia.

Dose/Route: 2.5-5 mg Neb. Every 20 minutes. Max 3 doses.
Pedi— 0.15mg/kg Neb every 20 min max 3 doses

Special: Class C pregnancy, monitor for arrhythmias.

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15
Q

levalbuterol

A

levalbuterol Sympathomimetic

Brand: Xopenex

MOA: Stimulates Beta 2 receptors; smooth muscle relaxer of the lungs, uterous, and vascular muscles

IND: Bronchospasm, prophylactic patient with asthma.

CON: hypersensitivity, Beta blocker use, angio edema, sensitivity to albuterol

Adverse: anxiety, tremors, N/V, palpitations, hyperglycemia, hypokalemia.

DOSE: 0.63mg Neb with 3 mL NS
Pedi: 0.31mg Neb with 3 mL NS
Acute exasterbation COPD 1.23-2.5 mg q25min

SPCL: Class C pregnancy

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16
Q

ipratropium bromide

A

ipratropium bromide Parasypatholitic

Brand: Atrovent

MOA: antagonizes acetylcholine receptors resulting in bronchodilation; dries secreations

IND: Bronchospasm, asthma, COPD exacerbation.

CON: hypersensivity, heart disease, GLAUCOMA, bladder neck obstruction.

Adverse: dehydration, throat irritation, palpitations, dizziness

Dose/Route: 0.5mg Neb q20 min
Pedi: 0.25mg Neb

Special: Class B pregnancy, not given as a sole med (mixed with albulterol), administered post Beta agonist.

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17
Q

duo-neb

A

duo-neb combination bronchodilator

Brand: Combivent

MOA: Beta 2 agoinist causing bronchodiliation while antagonizing acetylcholine receptors. Inhibits parasympathetic stimulation

IND: 2nd line treatment; bronchospasm, asthma, COPD exacerbation.

CON: hypersensitivity, HTN, cardiac disorders, arrhythmias, heart disease. Symptomatic tachycardia

Adverse: anxiety, tremors, N/V, palpitations, throat irritation, dehydration, arrhythmias, headaches, tachycardia

Dose/Route: albuterol –2.5mg, ipratropium 0.5mg in 3mL NS.
Pedi—Not recommended

Special: Class C pregnancy. Applied every 4-6 hours. Caution with: DM, seizures, and cardiac disease.

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18
Q

Methylprednisolone

A

Methylprednisolone Corticosteroid

Brand: Solu-Medrol

MOA: Anti-inflammatory. Suppress immune response; decrease inflammation.

IND: Anaphylaxis, COPD, asthma.

CON: Sensitivity, measles, Varicella, Cushing syndrome, fungi infection.

Adverse:G.I. Bleed, extended time to heal, suppression of natural steroids, HTN, fluid retention.

Dose/Route: 40-125mg IV, IO, IM
Spinal injury: 30mg/kg
Pedi: 1-2mg/kg

    special: onset 1-2 hrs, may cause signs of infection, reconstitute & use immediately, pregnancy class C.
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19
Q

sodium bicarbonate

A

sodium bicarbonate Electrolyte-Alkalizing Agent

MOA: Alkalizes pH. Combines with excessive Hydrogen reversing clinical acidosis manifestations.

IND: Hyperkalemia, severe acidosis due to hyperventilation, tricyclic antidepressant OD, cardiac arrest with prolonged down time, compartment syndrome(release)

CON: Alkalotic state.

Adverse: Overcompensation (alkalosis), seizures, hypernatremia, fluid retention, peripheral edema

Dose/Route: 0.5-1mEq/kg IV, IO every 10 min

Special: IV flush after use! Class C pregnancy, deactivates catecholamine, precipitation of Calcium (chalk), Na+ overload.

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20
Q

magnesium sulfate

A

magnesium sulfate Electrolyte-Antidysrhythmic-Anticonvulsant
MOA: CNS depressant, smooth muscle relaxant, dilation of bronchial

IND: Polymorphic V-tach (torsades de pointes) (often caused by malnutrition). Bronchospasm

CON: Shock, heart block, GI obstruction hypotension, hypothermia, bradycardia, dialysis, renal insufficiency.
Adverse: potentiates digoxin/digitalis, flushing respiratory depression, hypotension, hypothermia, bradycardia.

Dose/Route: VF or VT—1-2g in 1-2 min. (3rd/4th line treatment)
Torsade de Pointes—5-10g @ 1g/min
Pedi—25-50mg/kg over 2-5 min.
Infusion—max 2g/30-60min.
Resp.—1-2g @ 1g/min
Pedi 25-50mg/kg over 2-5min.
OBGYN/Eclamptic Seizures—2-4g IV Drip @ 1g/min
Special: Prego Class A. Do not exceed 1g a minute, burns injection site. Ca++ is antidote. Renal failure = electrolyte dysfunction.

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21
Q

dextrose 50%

A

dextrose 50% Carbohydrate

MOA: elevate BGL; glucose for cellular metabolism.

IND: Hypoglycemia.

CON: intracranial hemorrhage, Delirium Tremens (DT’s).

Adverse: Venous irritation, hyperglycemic.

Dose/Route: 10g-25g SIVP, IO

Pedi: 0.5 g/kg slow IV push, diluted 1:1 in sterile water, 25% solution

SPCL: Class C pregnancy, Necrosis of the tissue if infiltrated.

22
Q

etomidate

A

etomidate Hypnotic-Anesthetic

Brand: Amidate

MOA: Works in CNS & suppresses mentation; GABA-like effects. Depresses brainstem.

IND: Anesthesia.

CON: Sensitivity, active labor, nursing mother (risk-benefit)

Adverse: Hypotension, respiratory depression, apnea, dysrhythmias, n/v, laryngospasm

Dose/Route: 0.2-0.6mg/kg over 30-60 seconds SLOW IV push/IO
Pedi: >10 as adult.
<10 not advised

SPCL: Pain at ejection site, used to prepare RSI, Preg. Class C

23
Q

succinylcholine

A

succinylcholine Depolarizing Neuromuscular Blocker

Brand: Anectine

MOA: skeletal muscle relaxant; paralytic. Competes with acetylcholine of the motor end plate of the
muscle cell.

IND: RSI

CON: Sensitivity, ICP, glaucoma, penetrating eye injury, crush injury, post acute burns

Adverse: Malignant hyperthermia, respiratory depression, apnea, dysrhythmia, HTN, Hyperkalemia, brady cardia

Dose/Route: 1-1.5mg/kg IV/IO
Pedi: 2-2.5mg/kg IV/IO

Special: IV 30-60 sec. onset; lasts 8 min. Prego class C. prolonged effect with nerve agents, causes muscle fasciculation(twitching), short term induction of coma

24
Q

propofol

A

propofol Sedative Hypnotic-Anesthetic

Brand: Diprivan

MOA: rapid & brief state of anesthesia.

IND: anesthesia, induction and maintenance of sedation

CON: sensitivity, hypovolemia, egg or soybean allergy.

Adverse: Hypotension, apnea, bradycardia, dysrhythmia, pain @ injection site, seizures, priapism, coma, death

Dose/Route: 1-3mg/kg induction IV/IO
Pedi: 2.5-3.5 mg/kg IV, IO
Maintenance Infusion: 25-75 mcg/kg/min
Pedi: 125-300mcg/kg/min

Special: Prego Class c, short recovery time, geriatrics 80% of dose

25
Q

midazolam

A

midazolam Benzodiazepine

Brand: Versed

MOA: short acting CNS depressant. Enhances GABA brain neurotransmitters. Sedative hypnotic, used as a tranquilizer

IND: Sedation, anxiety, pre-med for cardioversion, seizures, chemical restraint

CON: Sensitivity, pregnancy, glaucoma, shock, alcohol coma

Adverse: respiratory depression/arrest, drowsiness, hypotension, n/v, headache, “transient retrograde amnesia.” PVC, Hypotension

Dose/Route: 1-2 mg IV/IO/IN
0.07-0.8 mg/kg IM
Pedi: 0.05-0.07mg/kg up to 0.4mg

Special: Prego Class D, caution with other CNS depressants, Flumazenil is antidote

26
Q

aspirin

A

aspirin Antiplatelet-Anti inflammatory

Brand: Bayer

MOA: Prevents platelet aggregation. Prevents clot formation (Non-sticky), Anti pyretic

IND: Cardiac Chest Pain.

CON: Sensitivity, bleeding disorder (GI, hemorrhagic stroke), ulcers.

Adverse: Angioedema, bronchospasm, bleeding, stomach irritation, n/v.

Dose/Route 81-324mg non-coated chewable PO
Pedi not indicated

Special: Pregnancy Class D

27
Q

nitroglycerin

A

nitroglycerin Nitrate-Vasodilator

Brand: Nitrostat

MOA: Relaxes Vascular smooth muscle; dilates peripheral arteries & veins. Decreases venous return decreases preload. Decreases ventricular systolic wall tension, decreased afterload

IND: Acute coronary syndrome, CHF. Acute pulmonary edema

CON: Hypotension, ED drugs (24-48 hours), sensitivity, hypovolemia, severe Brady/Tachycardia, increased ICP, right side ventricle infarct

Adverse: Hypotension, headache, bradycardia, syncope, nausea vomiting

Dose/Route: 0.4mg SL at 3-5 min. intervals max of 3 doses
1-2” of 2% Transdermal

Special: Photophobic, Pregnancy Class C, avoid when damaged by light

28
Q

morphine sulfate

A

morphine sulfate Narcotic Opiate Agonist

MOA: Binds with opioid receptors; depression of vasomotor centers of the brain (CNS depression). Reduces sympathetic nervous system (HR, cardiac workload, oxygen demand).

IND: Moderate-Severe pain. CHF & Pulmonary edema, decreases workload.

CON: Sensitivity, shock, respiratory depression, hypotension, head injury.

Adverse: respiratory depression, hypotension, n/v, dizziness, bradycardia, syncope, bradypnea

Dose/Route: cardiac 2mg q 5min titrated
Pain 2mg-10mg slow IV/IO
Pedi: 0.1-0.2mg/kg
**Until pain dissipates or respiratory drive is compromised.

SPCL: Pregnancy Class C, Narcan used for OD, Schedule II Narcotic

29
Q

naloxone HCL

A

naloxone HCL Opioid Antagonist

Brand: Narcan

MOA: Binds with opiate receptors; blocks effects of opiates

IND: Respiratory depression due to OD of opiates.

CON: Sensitivity.

Adverse: N/V, restlessness, seizures, cardiac arrest, withdrawal

Dose/Route: 0.4-2mg, IV/IO/ET/IM/IN
Pedi: 0.1mg/kg

Special: Pregnancy Class C

30
Q

Metoprolol

A

metoprolol Beta Blocker

Brand: Lopressor

MOA: Decreases heart rate, conduction, contractility, and cardiac output. selective Beta Blocker.

IND: SVT & stable narrow complex tachycardia, A-fib, A-flutter, suspected MI

CON: Hemodynamically unstable patients, signs of low cardiac output, sensitivity, 2nd & 3rd degree heart block, WPW, asthma

Adverse: Bradycardia, AV delays, hypotension, palpitations, n/v, clinical depression.

Dose/Route: 5mg every 2-5 min. intervals total of 15mg IV/IO
Pedi—NOPE

Special: Prego Class C, careful if used with Calcium Channel blockers

31
Q

Atropine

A

atropine sulfate Anticholinergic

MOA: inhibits actions of acetylcholine at postganglionic parasympathetic receptor sites. Blocks parasympathetic stimulation. Increases chronotrope, little inotrope effect

IND: symptomatic bradycardia, organophosphate poisoning.

CON: none in emergency setting, HTN, tachy, acute MI

Adverse: Tachycardia, palpitation, dysrhythmias, headache, dizziness, n/v

Dose/Route:
Brady: 0.5mg every 3-5 min. up to 3mg max single dose IV/IO
Pedi—0.02mg/kg repeated once up to max 0.5mg IV/IO
Poisoning—3-5mg every 5-15min IV/IO
Pedi—0.02-0.05mg/kg IV/IO
RSI: 0.01-0.02mg/kg max single dose 0.5mg IV/IO

Special: Prego Class C, causes pupil dilation. 1st line drug for symp brady, DON’T use in heart transplant patients, Used in RSI to prevent vagal nerve activation

32
Q

Diltiazem

A

diltiazem Calcium Channel Blocker
Brand: Cardizem

MOA: slows conduction, increases AV node refractory & causes coronary/peripheral vasodilation. Used after Adenosine for reentry SVT in patients with narrow QRS. Blocks Calcium, decreases ventricular response.

IND: A-Flutter or A-FIB with RVR, recurrent SVT

CON: Wide QRS tachycardias, 2nd & 3rd degree heart block, hypotension, cardiogenic shock, sensitivity, dysrhythmias associated with reentry (WPW) & short P-R interval, V-tach, M.I., large amount of depressants.

Adverse: A-flutter, 1st & 2nd degree heart block, bradycardia, hypotension, syncope, n/v, dizziness, headache

Dose/Route: 0.25mg/kg IV over 2 min 2nd dose 0.35mg/kg
(5-15mg/hr IV drip) Pedi- not indicated
SPCL: Prego Class C, caution in renal & hepatic patients, patients on beta blockers, must be refrigerated/shelf life 1 month post room-temperature. Ca++ antidote. Atropine (to support heart rate)

33
Q

Adenosine

A

Adenosine 6 second half life Antidysrhythmic
Brand: Adenocard

MOA: Slows SVTs; decreases conduction through the AV node without causing negative inotropic effects. Acts on sinus pacemaker cells and vagal nerve terminal to decrease chronotropic effects.

IND: narrow complex SVT

CON: drug induced tachycardia, 2nd & 3rd degree block, sensitivity, (A-fib, A-flutter) not going to do anything, WPW

Adverse: light headed, diaphoresis, palpitations, chest pain flushing, hypotension, sinus brady/pause, metallic taste, asystole, block.

Dose/Route: 6mg rapid RAPID IV push
2nd DOSE: 12mg IV, IO with procedure.
Pedi—initial 0.1mg/kg
2ND dose: 0.2 mg/kg RAPID IV push, MAX single dose 12mg (<50kg)

SPCL: Pregnancy Class C, may produce a brief period of asystole. Caffeine inhibits interaction, proximal vein, large bore, fast push elevate.

34
Q

Fibrinolytics

A

Fibrinolytics (Thrombolytics)

MOA: digest fibrin and fibrogen to dissolution of thrombus/embolus occluding coronary artery(ies)

IND: Stroke, STEMI, DVT, PE

CON: Bleeding complication, cerebral hemorrhage stroke, Trauma, gi bleeding, HTN, cardiogenic shock, liver disfunction, pt over 75, pt taking coumadin, recent surgery

Adverse: Bleeding, fever, N/V, bruising, CVA

Special: Re-thrombosis can occur following thrombolysis, and therefore anticoagulants such as heparin are usually co-administered, and continued after thrombolytic therapy for a period of time. Prego C

Examples: Activase, Kinlytic, Retavase, Streptase, TPA,

35
Q

Plavix

A

Plavix Antiplatelets/Blood thiner

Brand: Clopidogrel

MOA: 2ba3 receptor antagonist

IND: MI, Stroke, Peripherial Arterial disease

CON: Hypersensitivity, Active bleeding, renal impairment, trauma, GI disorder

Adverse: Bleeding, Hemorrhage, anemia, Stevens-Johnson syndrome, pneumonia, fever, rash

Dose/Route 300 mg PO loading dose
75 mg PO qd
Pedi not indicated

Special: Pregnancy class c

36
Q

Heparin

A

Heparin Anticoagulant

Brand: Heparin

MOA:Rapid onset anticoagulant. Direct effect on blood clotting by enhancing inhibitory actions of antithrombin III. Blocking conversion of prothrombin to thrombin and fibrinogen to fibrin. Does not lyse all ready existing thrombi, inhibits formation of new clots

Indications: ACS, acute PE, DVT
CON: Hypersensitivity, active bleeding, bleeding tendencies, asthma, eczema,

Adverse: Numbness and tingling, Headache, bleeding, cyanosis, HTN, CP, bronchospasm

Dose/Route: cardiac 60 unit per kg max of 4000 unit
infusion 12 units/kg per hour max 1000 unit per hour
PE, DVT 80 unit/kg
infusion 18 units/kg/hour
Pedi 75 unit /kg loading
infusion 20 unit/kg/hour
Special: Pregnancy C, continuous IV infusion requires pump, watch for signs of hemorrhage (fever, drop in BP, rapid pulse) half life about 90 min

37
Q

Integrilin

A

Integrilin Antithrombotic/antiplatelet

Brand: Eptifibatide

MOA: inhibits platelet aggregation by blocking the glycoprotein 2b3a receptors on activated platelets

IND: acute coronary syndromes (ACS), percutaneous coronary interventions

CON: Active internal bleeding, GI/GU bleeding, HX of stroke with deficit, thrombocytopenia, recent major surgury or Trauma, aneurysm, uncontrolled HTN

Adverse: Intercranial bleeding, GI/GU bleeding, bleeding, anemia, thrombocytopenia

Dose/ route 180 mcg/kg max 22.6mg
infusion 2 mcg/kg/min max 15 mg/hr IV

Special: Pregnancy class B, Half life 90-120 min

38
Q

Trebutaline

A

Trebutaline Beta Agonist-Bronchodilator
Brand: Breathine

MOA: Relaxes uterus to prevent contractions (tocolytic)

IND: pre term contractions, bronchospasm, uterine hyperstimulation

CON: use past 72 hours, hypersensitivity, HTN, Hypokalemia

Adverse: Adult: heart problems, tachycardia, tremors, pulmonary edema, headache, hyperglycemia, anxiety, paradoxical bronchospasm
Fetus: tachycardia, hypoglycemia

Dose/Route: 0.25mg/ 20min max 3 doses SQ
5-80 mcg/min titrated infusion

Special Notes: Preggo Class B, DON’T use for more than 48-72hr

39
Q

Oxytocin

A

Oxytocin Horomone

Brand: Pitocin

MOA: Uterine stimulant that causes uterine contractions, lactation and control post-partum hemorrhage

IND: post-partum hemorrhage

CON: 2nd placenta needs to be delivered, don’t use for anything other than what its intended for!

Adverse: angina, anxiety, uterine rupture, nausea, vomiting, hyper/hypotension

Dose/Route: 3-10units IM
10-40units IV/IO Drip in 500-1000ml NS

Special Notes: Preggo Class X, use w/ caution in pregnant PTs, renal impairment & elderly PTs

40
Q

Methergine

A

Methyergonovine Maleate Ergot Alkaloid

Brand: Methergine

MOA: increases force & frequency of contractions to control post-partum hemorrhage

IND: post-partum hemorrhage

CON: hypertension, toxemia, hypersensitivity,pre eclampsia, breast feeding

Adverse: seizure, hypertension, vasospasm, Diff breathing, CP

Dose/Route: 0.2mg IM/IV/IO
every 2-4 hours
Special Notes: Preggo C, use caution in sepsis, liver/kidney disease

41
Q

Mag sulfate

A

magnesium sulfate Electrolyte-Antidysrhythmic-Anticonvulsant

MOA: CNS depressant, smooth muscle relaxant, dilation of bronchial

IND: Polymorphic V-tach (torsades de pointes) (often caused by malnutrition). Bronchospasm, Pre eclamptic seizures
CON: Shock, heart block, GI obstruction hypotension, hypothermia, bradycardia, dialysis, renal insufficiency.
Adverse: potentiates digoxin/digitalis, flushing respiratory depression, hypotension, hypothermia, bradycardia.
Dose/Route: VF or VT—1-2g in 1-2 min. (3rd/4th line treatment)
Torsade de Pointes—5-10g @ 1g/min
Pedi—25-50mg/kg over 2-5 min.
Infusion—max 2g/30-60min.
Resp.—1-2g @ 1g/min
Pedi 25-50mg/kg over 2-5min.
OBGYN/Eclamptic Seizures—4-6g over 20 min IV Drip
Special: Prego Class A. Do not exceed 1g a minute, burns injection site. Ca++ is antidote. Renal failure = electrolyte dysfunction.

42
Q

Bumetanide

A

Bumetanide Diuretic

Brand: Bumex

MOA: Potent loop diuretic w/ rapid onset & short duration. Inhibits reabsorption of sodium & chloride, enhances secretion of potassium

IND: Pulmonary edema induced hypervolemia, CHF

CON: hypersensitivity, anuria, electrolyte depletion, hypotension, Pnemonia

Adverse: dehydration, dizziness, nausea, hypokalemia, hypotension, hypochloremia, hyperuricemia, muscle cramping

Dose/Route: 0.5-1mg PO/IM/IV.IO
Pedi: NOPE

Special Notes: Preggo C, can cause profound diuresis, use caution w/ sulfa allergies, can be used in cases of Lasik allergies

43
Q

Acetylcysteine

A

Acetylcysteine Mucolytic

Brand: Mucomyst

MOA: protects liver against acetaminophen OD & loosens mucus viscosity

IND: Acetaminophen OD, asthmatic bronchitis, atelectasis, chronic bronchopulmonary disease (w/ abnormal mucus secretions [cystic fibrosis, etc.])

CON: hypersensitivity

Adverse: bronchospasm, nausea, vomiting, chest tightness, fever, runny nose

Dose/Route: 1-20mL of 10% solution every 1-6hr NEB
1-10mL of 20% solution every 1-6hr NEB
Pedi: SAME

Special Notes: Preggo B

44
Q

Activated Charcoal

A

Activated Charcoal Antidote/Absorbent

Brand: Actidose

MOA: Chemicals bind to surface & become trapped

IND: Oral poisoning

CON: ingestion of acid, alkaloid, ethanol, iron salts, lithium poisonings, AMS, GI obstruction

Adverse: nausea, vomiting, GI obstruction, hypotension, contripation, diarrhea, aspiration pneumonia

Dose/Route: 50-100g PO
Pedi: 1-2g/kg PO

Special Notes: Preggo C, if it burns on the way down it burns on the way down
Milk decreases ability to work

45
Q

Tricyclic Anti-Depressants

A

Tricyclic Anti-Depressants
MOA: Inhibits reuptake of norepi & serotonin in the CNS. Effect’s sodium flow in myocardium
Example: Amitriptoline

OD Signs & Symptoms (Adverse): AMS, seizure, coma, death, profound hypotension (caused by vasodilation), wide QRS, resting tachycardia, V-Tach, Torsades, and eventually V-fib arrest

Treatment: Consider RSI (in signs of severe toxicity)
Sodium Bicarb: 1meq/kg up to 50meq IV/IO
Versed(seizure) 1-2.5mg IV/IO
Pedi: 0.03-0.05mg/kg up to 0.4mg IV/IO
Magnesium(torsades): 5-10g at 1g/min IV/IO
Pedi: 25-50mg/kg over 2-5min IV/IO
Infusion: 2g/30-60minutes MAX

Special Notes: difficult to detect in field, PT decompensate RAPIDLY, O2/IV/MONITOR/ECG
TREAT EACH PRESENTATION

46
Q

Thiamine (vitamin B1)

A

Thiamine (vitamin B1) Vitamin B

MOA: combines w/ ATP to form coenzyme Thiamine Phosphate, necessary for carbohydrate metabolism

IND: vitamin B1 deficiency, Wernicke-Korsakoff Syndrome (often seen in alcoholics), malnourishment diabetics w/ alcohol abuse, coma of unknown origin, Delirium tremors

CON: hypersensitivity

Adverse: pain at injection site, nausea, restlessness, weakness, sweating, rash

Dose/Route: IV/Io/PO 100mg IV/IO
Pedi: NO

Special Notes: fetal risk MINIMAL, use w/ caution in burn PTs, prolonged infection, & decreased intestinal absorption. Can be given PO as supplement

47
Q

Lorazepam

A

Lorazepam Benzodiazepine-Anticonvulsant-Sedative Hypnotic

Brand: Ativan

MOA: Binds to GABA receptor, reducing activity in brain, most potent benzo available

IND: Anxiety, status epilepticus, sedation before anesthesia, premed before cardioversion, chemical restraints

CON: hypersensitivity to benzos, intra-arterial administration, narrow-angle glaucoma, respiratory insufficiency, Hypotension, shock

Adverse: respiratory depression, sedation, dizziness, weakness, unsteadiness, AMS, hypotension, retrograde amnesia

Dose/Route: 0.5-2mg IV/IO
1-4mg IM
Pedi: 0.05-0.1mg/kg IM/IV/IO
Special Notes: Pregnancy Class D, short half-life, don’t mix w/ other CNS depressants

48
Q

Romazicon

A

Romazicon Benzodiazepine Agonist

Brand: Flumazenil

MOA: It reverses the effects of benzodiazepines by competitive inhibition at the benzodiazepine binding site

IND: Benzo OD, complete or partial reversal of sedative effects of benzos, signs of TCA OD

CON: hypersensitivity, patients given benzo to control life threatening condition

Adverse: Nausea, dizziness, headache, dyspnea, hyperventilation, agitation, vomiting, visual disturbances

Dose/Route: 0.2mg over 30sec IV/IO 2nd dose 0.2mg over 30 sec IV/IO
Pedi: 0.01mg/kg up to 0.2mg IV/IO max of 0.2mg over 15 sec

Special Notes: Pregnancy Class C, short unpredictable half life

49
Q

Haloperidol

A

Haloperidol Antipsychotic

Brand: Haldol

MOA: CNS depressant, selectively blocks post synaptic dopamine receptors

IND: psychiatric problems, agitation

CON: comatose, hypersensitivity, parkinsons disease, toxic CNS depressions

Adverse: hypotension, blurred vision, prolonged QT interval, sudden cardiac death, torsades, seizure, dystonia

Dose/Route: 0.5mg-5mg PO/IM
Pedi: 0.5mg-5mg PO/IM

Special Notes: Preg Class c

50
Q

Diazepam

A

Diazepam Benzodiazepine-Sedative

Brand: Valium

MOA: Binds to GABA receptor, reducing activity in brain

IND: anxiety, alcohol withdrawal, sedation, seizure, status epilepticus, chemical restraint

CON: hepatic insufficiency, hypersensitivity to benzos, myasthenia gravis, acute narrow angle glaucoma, pediatrics less than 6mo, respiratory insufficiency, sleep apnea, Retro grade Amnesia, Hypotension

Adverse: hypotension, rash, euphoria, respiratory depression, dizziness, drowsiness

Dose/Route:    IV/IO/PO		2-10 mg	IV/IO
			Seizures: 	5-10mg	IV/IO
			Pacing: 	5-15mg	IV/IO
			Pedi:	0.2-0.5mg/kg	IV/IO
Special Notes: Preg Class D, don’t give IM!

CCC Drug Cards (18 decks)

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