All Cards Flashcards

Question

midazolam

Answer 1

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

Answer 2

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

Answer 3

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

Answer 4

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

Answer 5

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

Answer 6

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

Answer 7

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

Answer 8

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)

Answer 9

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.

Answer 10

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,

Answer 11

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

Answer 12

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

Answer 13

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

Answer 14

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

Answer 15

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

Answer 16

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

Answer 17

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.

Answer 18

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

Answer 19

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

Answer 20

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

Answer 21

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**

Answer 22

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

Answer 23

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

Answer 24

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

Answer 25

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

Answer 26

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! ```