All doses

Question 1

Acetaminophen) Dynamics:
Indications:
Contra:
Dose:

Answer 1

= Nonopioid Analgesic/Antipyretic Fever,
= pain management
= AMS
= IV/IO: 1 gram over 10 - 15 minutes, PO: 15 mg/kg

Question 2

Activated Charcoal) Dynamics:
Indications:
Contra:
Dose:

Answer 2

= Binds & adsorbs toxic substances in digestive tract
= Most oral poisonings/overdoses
= ↓ LOC, OD of corrosives, caustics, petroleum substances.
= PO: 1-2 g/kg

Question 3

Diazepam/Vallium) Dynamics:
Indications:
Contra:
Dose:

Answer 3

= Benzodiazepine. Binds w/ GABA receptors causing an influx of Cl
= Tcardia due to stimulant OD, Substained seizures. Anxiety. Sedation.
= Hypersensitivity
= 2.5-10 mg in 2.5 mg increments slow IV/IO/IM

Question 4

Etomidate) Dynamics:

Indications:
Contra:
Dose:

Answer 4

= Nonbarbiturate, nonbenzodiazepine sedative Interacts w/ GABA receptors. Anesthetic w/o analgesic.
= Sedation / SFI/RSI
= Hypersensitivity
= 0.2-0.4 mg/kg (limit to 1 dose). Onset 30 secs Duration: 5-10 mins

Question 5

Flumazenil) Dynamics:

Indications:
Contra:
Dose:

Answer 5

= Benzodiazepine Antagonist. Competitively blocks benzos @ GABA/benzo receptor complex
= Benzodiazepines OD
= Hypersensitivity
= 0.2 mg IV/IO every30 seconds max 3 mg

Question 6

Hydroxocobalamin) Dynamics:

Indications:
Contra:
Dose:

Answer 6

= Binds w/ cyanide to form nontoxic cyanacobalamin (Vitamin B12), preventing its toxic effects.
= Suspected cyanide poisoning
= Hypersensitivity
= 5Gs IV/O over 15 mins. May repeat 2nd 5G dose (max 10G)

Question 7

Ketamine) Dynamics:
Indications:
Contra:
Sedation Dose:
Pain dose:

Answer 7

= Dissociative anesthetic. NMDA Receptor Antagonist Anesthetic
= Sedation, SFI/RSI, Analgesic
= Hypersensitivity
= Sedation: 1-2 mg/kg Onset: 30-60 secs, Duration: 10-20 mins
= Pain: 0.2 mg/kg IV/IO (max single dose 20 mg), 0.5 mg/kg IM/IN (if no IV/IO)

Question 8

Lorazepam/ Ativan) Dynamics:
Indications:
Contra:
Dose:

Answer 8

= Benzodiazepines, Binds w/ GABA receptors causing an influx of Cl
= Sustained seizures, anxiety, sedation, chemical restraint
= Hypersensitivity
= 2-4 mg (may repeat to a max dose of 8 mg)

Question 9

Methylene Blue) Dynamics:
Indications:
Contra:
Dose:

Answer 9

= Water soluable thiazine dye helps metHb to hemoglobin conversion
= Methemoglobinemia (metHb), Nitrate OD/poisoning
= Hypersensitivity
= 1 mg/kg IV/IO over 5-30 minutes.

Question 10

Midazolam (Versed) Dynamics:
Indications:
Contra:
Seizures Dose:
RSI Dose:

Answer 10

= Benzodiazepine, binds w/ GABA receptors causing an influx of Cl
= Active seizures, Chemical restraint, Anxiety, RSI/SFI, Sedation
= Hypersensitivity
= 0.2 mg/kg in 2 mg increments IV/IO (max 10 mg). 5 mg IM/IN
= 0.1-0.3 mg/kg slow IV/IO (max 10 mg) Onset: 2-5 mins. Duration: 15-30 mins.

Question 11

Morphine) Dynamics:

indications:
Contra:
Analgesia:
STEMI:
NSTEMI-ACS:

Answer 11

= Narcotic (Schedule II Opioid) Analgesia & sedation via binding to opiate receptor
= Ischemic chest pain not relieved by Nitroglycerin
= Hypersensitivity. Uncorrected hypotension (<90 SBP)
= 2-10 mg up to max 20 mg.
= 2-4mg slow IV/O, may admin 2nd dose 2-8mg IV/IO q5-15 mins
= 0.1 mg/kg slow IV/IO or IM up to 10 mg

Question 12

Sodium Bicarbonate 8.4%) Dynamics:

Indications:

Contra:
Suspected acidosis Dose:
Hyperkalemia Dose:

Answer 12

= Alkalinizing Agent. Increases plasma bicarbonate, buffers excess hydrogen ion concertration, raises blood pH & reverses clinical manifestations of acidosis.
= Suspected hyperkalemia, suspected bicarbonateresponsive acidosis (DKA, OD on TCA’s, Aspirin or Cocaine)
= Patients in cardiac arrest
= 1 mEq/kg, Hyperkalemia:
= 50 mEq IV bolus.

Question 13

Succinylcholine) Dynamics
Indications:
Contra:
Dose:

Answer 13

= Depolarizing neuromuscular blocker. Binds to Ach recptors
= DSI/RSI
= Hyperkalemia(burns, crush injury), Increased ICP, Severe trauma
= 1-1.5 mg/kg IV/IO. TTP: 45-60 seconds. DOP: 5-10 mins.

Question 14

Epinephrine 1:10) Dynamics:
Indications:
Contra:
Dose:

Answer 14

=SNS agonist. Powerful αß agonist
=Cardiac arrest, S/S bradyC.Normovolemic hypoBP, anaphylaxis
= Few in the emergency setting Benefits outweigh risks
= Cardiac arrest: 1 mg IVP/IOP q3-5
= Bradycardia: 2-10 mcg/min IV/IO infusion
= Normovolemic hypoBP & anaphylaxis: 0.1-0.5 mcg/kg/min. Mix 1mg of Epi 1:10,000 into 1L bag of fluid.

Question 15

Etomidate) Dynamics:
Indications:
Contra:
Dose:

Answer 15

= Nonbarbiturate, nonbenzodiazepine sedative Interacts w/ GABA receptors
=Anesthetic w/o analgesic & Sedation / SFI/RSI
=Hypersensitivity
= 0.2-0.4 mg/kg (limit to 1 dose). Onset w/in 30 secs, Lasts: 5-10 mins

Question 16

Fentanyl) Dynamics:
Indications:
Contra:
Dose:

Answer 16

=Synthetic Narcotic (Schedule II Opioid)
= Analgesia & sedation via binding to opiate receptor, sig/ more potent than morphine (100 mcg = 10 mg of Morphine)
= Moderate-Severe pain
= Hypersensitivity, SBP<90
=1mcg/kg to a max dose 100 mcg (IV/IO/IM/) may repeat PRN in 5-10
= 1mcg/kg IN may repeat PRN 5-10mins (Max 1mL PRN if admin/ed IN)

Question 17

Flumazenil) Dynamics:
Indications:
Contra:
Dose:

Answer 17

= Benzodiazepine Antagonist
= Competitively blocks benzos @ GABA/benzo receptor complex
= Benzodiazepines overdose
= Hypersensitivity
= 0.2 mg IV/IO q30 seconds Max up to 3 mg total dose

Question 18

Furosemide) Dynamics:
Indications:
Contra:
Dose:

Answer 18

= Loop-Diuretic stops Na,Cl,&H2O from kidney tubules thus +urine
= Acute pulmonary edema in PTs w/ SBP>90-100 (w/o signs of shock), Hypertensive emergencies.
= Hypovol, HypoBP, HypoK or other pos/ electrolyte abnormalities
= 1st: 0.5-1 mg/kg/ 1-2 mins, 2nd: double 1st dose to 2 mg/kg/1-2 mins
Acute pulmonary edema w/ suspected hypovol:<0.5 mg/kg slow IV.

Question 19

Glucagon) Dynamics:
Indications:
Contra:
Dose:

Answer 19

= Hormone Binds to Glucagon receptors & stim/s adenyal clyclase, thus +cAMP which up-regulation of Ca cAMP channels in SA & AV cells
= Hypoglycemia, BradyC suspected from ßeta/Ca channel blocker OD
= Hypersensitivity, Bradycardia from other etiology
=Hypoglycemia: 1 mg IM.
=BradyC suspected from ßeta/Ca channel blocker OD: 3-10 mg IV/3-5 mins Followed by an infusion of 3-5 mg per Hr

Question 20

Ketamine) Dynamics:
Indications:
Contra:
Dose:

Answer 20

= Dissociative anesthetic. NMDA Receptor Antagonist
=Anesthetic Sedation / SFI/RSI /
= Hypersensitivity
= Sedation: 1-2 mg/kg Onset: 30-60 secs, Lasts: 10-20 mins
= Analgesia/Pain: 0.2 mg/kg IV/IO (max single dose 20 mg), 0.5 mg/kg IM/IN (if no IV/IO)

Question 21

Labetalol) Dynamics:
Indications:
Contra:
Dose:

Answer 21

ß Blocker thus slowing of HR
= 2nd line med for SVT after Adenosine, A-fib& flutter w/RVR, Reduce MC ischemia in AMI PT’s w/elevated HR, Antihypertensive
= Don’t administer to PT’s w/STEMI if any of the following are present: Signs of heart failure, Low cardiac output, Increased risk of cardiogenic shock. Hypotension. Bradycardia.
= 10mg IV/O push/1-2 mins. May repeat q10 mins to max of 150mg

Question 22

Lidocaine) Dynamics:
Indications:
Contra:
Dose:

Answer 22

= Class Ib Antiarrhythmic. Blocks Na channels in cardiac cells thus depolarization to slow and decrease in automaticity
= Alterative to Amiodarone in cardiac arrest, V-Fib/pVT Stable monomorphic Ventricular Tachycardia w/ a presserved LVF
= Should not use if PT has received IV Ca-channel blockers, Not given prophylactically in AMI setting
= VF/pVT: 1-1.5 mg/kg IV/IO, may give additional: 0.5-0.75 mg/kg IV/IO in 5-10 mins-Max 3 mg/kg
= Arrhythmia w/pulse: 1-1.5 mg/kg IV/IO, may give add: 0.5-0.75 mg/kg IV/IO in 5-10 mins-Max 3 mg/kg
= Maintenance infusion: 1-4 mg/min (30-50mcg/kg/min)

Question 23

Magnesium Sulfate) Dynamics:
Indications:
Contra:
Dose:

Answer 23

= Organic Salt act as a physiologic Ca channel blocker
= Bronchial Asthma, Torsades de Pointes (TdP) w/ or w/o a pulse, Eclampsia w/ active seizures
= Routine admin in PT’s w/AMI not recommended, High-degree HB, Shock, Dialysis, Hypocalcemia, V-fib/pulseless V-Tach,
= Respriatory: 1-2 grams IV/IO over 10-20 minutes
Tdp w/pulse: 1-2 grams mixed in 50-100 mL over 5-60 minutes
Cardiac arrest due to hypomagnesemia or TdP: 1-2 grams in 10 mL
Eclampsia: 1-4 grams

Question 24

Methylene Blue) Dynamics:
Indications:
Contra:
Dose:

Answer 24

= H20 soluable thiazine dye promotes converting metHb>hemoglobin
= Methemoglobinemia (metHb), Nitrate overdose/poisoning = Hypersensitivity
= 1 mg/kg IV/IO over 5-30 mins

Question 25

Metoprolol) Dynamics: Indications: Contra: Dose:

Answer 25

= ß-Blocker = Hypertension, 2nd line med for A-Fib or A-Flutter w/ RVR, & SVT = HR<45, 2nd or 3rd degree heart block = 5 mg IV/IO q 5 min (up to 3 doses)

Question 26

Midazolam/Versed) Dynamics: Indications: Contra: Dose:

Answer 26

= Benzo binds w/ GABA receptors causing an influx of Cl = Active seizures, Chem restraint, Anxiety, Induct RSI/SFI), Sedation = Hypersensitivity = Seizures: 0.2 mg/kg in 2 mg increments IV/IO (max 10 mg) = RSI: .1-0.3 mg/kg IV/O (max 10mg)Onset: 2-5 mins, Last: 15-30 mins.

Question 27

Morphine) Dynamics: Indications: Contra: Dose:

Answer 27

Narcotic (Schedule II Opioid). Analgesia & sedation w/ binding to opiate receptor = Ischemic chest pain not relieved by Nitro = Hypersensitivity. Uncorrected SBP<90 = Analgesia: 2-10 mg up to max 20 mg STEMI: 2-4 mg slow IV/IO, may admin 2nd dose of 2-8 mg IV/IO q5-15 mins intervals NSTEMI-ACS: 0.1mg/kg slow IV/IO or IM up to 10 mg.

Question 28

Naloxone (Narcan) Dynamics: Indications: Contra: Dose:

Answer 28

= Opiate Competitive Antagonist = Suspected Opiate overdose w/ respiratory depression = Hypersensitivity = 0.4-2 mg IV/IO/IM/IN

Question 29

Nitroglycerin) Dynamics: Indications: Contra: Dose:

Answer 29

= Nitrate. Potent vasodilator opens coronary vessels to improve blood flow to the myocardium & 100 BPM, RVI, Use of phosphodiesterase inhibitors (Boner Pills) last 48hours), Increased ICP =0.4 mg tablet or spray - repeat X 3 (q5mins) for total max dose 1.2 mg. *Do not shake aerosol spray because this affects the metered dose*

Question 30

Norepinephrine) Dynamics: Indications: Contra: Dose:

Answer 30

= αß adrenergic agonist (α > ß effects) = Normovolemic hypoBP, Sepsis, Cardiogenic shock = Shouldn't use in hypovol/ til' vol/ replacement occurred = 0.1-0.5 mcg/kg/min IV/IO infusion

Question 31

Nubain) Dynamics: Indications: Contra: Dose:

Answer 31

Synthetic opiate agonist/antagonist = Moderate to severe pain = Hypersensitivity, respiratory depression = 10-20 mg IV/IO/SQ/IM

Question 32

Ondansetron (Zofran) Dynamics: Indications: Contra: Dose:

Answer 32

= Selective serotonin 5-HT3 receptor blocker = Prevention & control of Nausea and/or vomiting = Hypersensitivity = 4-8 mg IV slow push, IM, PO.

Question 33

Procainamide) Dynamics: Indications: Contra: Dose:

Answer 33

=Class Ia Antiarrhythmic Blocks Na channels in cardiac cells thus slower depolarization &

Question 34

Promethazine (Phenergan) Dynamics: Indications: Contra: Dose:

Answer 34

=Antiemetic. H1-receptor blocker =Nausea & Vomitinf, Peroperative sediation, motion sickness. = Hypersensitivity, Respiratory diseases(Asthma), Pedi <2 y/o = IV/IM: 12.5-25 mg, May cause tissue injury if IV extravasation.

Question 35

Terbutaline (Brethine) Dynamics: Indications: Contra: Dose:

Answer 35

= ß2Agonist, reliefs bronchospasm,

Question 36

Thiamine) Dynamics: Indications: Contra: Dose:

Answer 36

= Vitamin B1 Forms thiamine pyrophosphate by combining w/ ATP, an essential coenzyme for carbohydrate metabolism = Coma of unknown orgin, Wernicke's encephalopathy, Delirium tremens =Hypersensitivity = 100 mg IV/IO/IM

Question 37

Tranexamic Acid (TXA) Dynamics: Indications: Contra: Dose:

Answer 37

= Binds to plasminogen, blocking plasminogen fibrin interactions (fibrinolysis) = Sig/ hemorrhage, either in/external (after external hemorrhage is controlled) = SP 3 hrs past injury, allergy/Sensitivity, Suspected thromboembolism 1 gram over 10 minutes (mix in 50 mL bag of NS), Followed by 1 gram over 8 hours (500 mL bag NS).

Question 38

Vecuronium) Dynamics: Indications: Contra: Dose:

Answer 38

= Nondepolarizing neuromuscular blocker Binds to ACh receptors = DSI/RSI = Hypersensitivity = 0.1-0.2 mg/kg IV/IO. TTP: 1-3 mins DOP: 45-90mins

Question 39

Verapamil) Dynamics: Indications: Contra: Dose:

Answer 39

Class IV Antiarrhythmic. Slows AP of cardiac autorhythmic cells by blocking Ca channels = 2nd line med for A-Fib & A-Flutter w/ RVR. May use as alterative med (after adenosine) narrow QRS complex tachycardia w/ preserved LV Fn = HypoBP, CHF/Cardio shock, WPW, Wide-complex TachyC, sensitivity =1st dose: 2.5-5 mg IV/Io bolus over 2-3 mins. =2nd dose: 5-10 mg over 2-3 mins. Max total dose: 20 mg

Question 40

Hypotensive therapy) Dynamics: Indications: Normovelmic Dose:

Answer 40

= giving enough fluids to get a radial pulse to perfuse = incontrollable hemorrhage = 20mL/Kg till radial pulse

Question 41

Promethazine (Phenergan) Dynamics: Indications: Contra: Dose:

Answer 41

=Antiemetic. H1-receptor blocker =Nausea & Vomitinf, Peroperative sediation, motion sickness. = Hypersensitivity, Respiratory diseases(Asthma), Pedi <2 y/o = IV/IM: 12.5-25 mg, May cause tissue injury if IV extravasation.

Question 42

Adenosine) indications: contraindications

Answer 42

= 1st for stable narrow complex SVT, Regular & monomorphic wide-complex Tcardia thought from a reentry SVT (SVT w/ BBB) = Torsades de pointes, Poison/drug-Tcardia, 2nd or 3rd AVB, WPW,DOESNT CONVERT A-FIB/FLUTTER

Question 43

Adenosine) class: Dynamics:

Answer 43

= Misc antiarrhythmic binds to adenosine A1 receptors causes efflux of K & inhibits Ca influx (in autoarhythmic cells) = Causes hyperpolarization of autorhythmic cells (SA/AV node) Slows AV conduction w/ very short half-life

Question 44

Adenosine) Effects: Dose: admin notes:

Answer 44

= periods of sinus Bcardia/asystole & ventricular ectopy after admin = 1st dose 6mg rapid IV/IO push followed w/ rapid flush &2nd dose 12mg also rapid push & flush = rapid push followed by rapid flush 20mL fluid best accomplished w/ 3-way stopcock & 1/2 initial dose in PTs receiving dipyridamole or carbamazepine, heart transplant, or if given by central venous access

Question 45

Albuterol) Dynamics: Indications: Contraindications:

Answer 45

=B agonist w/ preference of B2 receptors =Brocospasm, Anaphylaxsis/ asthma/ Allergies, Hyperkalemia = jitters & Known hypersensitivity

Question 46

Albuterol) Adverse effects: Adult Broncospasm dose: Hyperkalemic dose: Pedi Dose:

Answer 46

= Palp/s, Anxiety, Jitters, Dizzy, Tcardia = 2.5mg/3mg via SVN→ repeat 15-20mins as needed = 10-20mg via LVN over 15 mins→ repeat as needed = 1.25-2.5mg/1.5-3mL SVN

Question 47

Amiodarone class & indication

Answer 47

Class 3 K channel blocker> VF/Pulseless VT unresponsive to shock, CPR & Epi, BradyCs to include AV blocks, Recurrent, hemodynamically unstable VT w/ pulse

Question 48

Amiodarone) Max total dose per day: Slow Infusion dose: Maintenance Infusion dose: VF/Pulseless & VT Cardiac Arrest Unresponsive 1st Dosage: VF/Pulseless & VT Cardiac Arrest Unresponsive 2nd Dosage: Life-Threatening Arrhythmia 1st Dosage: Life-Threatening Arrhythmia 2nd Dosage:

Answer 48

= 2.2 grams = 360 mg IV 6Hrs (1mg/min) = 540 mg IV 18Hrs (0.5 mg/min) = 300 mg IV/O push = 150 mg IV/O push if needed = 1st Dose: Rapid Infusion 150 mg/10 mins (15 mg/min) = 2nd Dose: 150mg/10 mins (15 mg/min) if needed

Question 49

Amiodarone) Max total dose per day: Slow Infusion dose: Maintenance Infusion dose: VF/Pulseless & VT Cardiac Arrest Unresponsive 1st Dosage: VF/Pulseless & VT Cardiac Arrest Unresponsive 2nd Dosage: Life-Threatening Arrhythmia 1st Dosage: Life-Threatening Arrhythmia 2nd Dosage:

Answer 49

= 2.2 grams = 360 mg IV 6Hrs (1mg/min) = 540 mg IV 18Hrs (0.5 mg/min) = 300 mg IV/O push = 150 mg IV/O push if needed = 1st Dose: Rapid Infusion 150 mg/10 mins (15 mg/min) = 2nd Dose: 150mg/10 mins (15 mg/min) if needed

Question 50

Amiodarone) Class: Dynamics: Indi: B/c its toxicity indi: W/ expert consultation may be used for: Terminal elimination:

Answer 50

= Class III antiarrhythmic = Slows K+ efflux delaying repolarization on all of heart = VF/Pulseless VT-no/response to shock CPR & Epi, Recurrent hemodynamically unstable VT w/ pulse = PT w/ life-threatening arrhythmias w/ monitoring = some atrial & ventricular rhythms w/ life-threatening hypoBP = Extremely long (half-life lasts max 40 days)

Question 51

Amiodarone) Contra: Effects: Caution b/c:

Answer 51

= Allergic, Bradycardias w/ AV blocks, Breastfeeding mothers = Severe hypotension, Bradycardia, Prolong QT which can lead to TdP = Toxicity, Causes severe BP drop, Prolong QT which can lead to TdP

Question 52

Antiarrhythmics for pVT, TdP, VF

Answer 52

pVT/ TdP= Lidocaine & Aminodarone Tdp= Mag-Sulfate

Question 53

Aspirin) indications: Contraindications:

Answer 53

= Cardiac S/S w/ ischemia etiology = common allergy, Bronchospasm, Angiodema

Question 54

Aspirin) effects: Avoid: dose:

Answer 54

=Can cause bromchoconstriction in ~10% asthmatic PTs, N/V, upset GI = enteric-coated Aspirin when admin/ing to PT w/ cardiac S/S = 160-325mg PO of non-entric coated ASA

Question 55

Aspirin) Class: Dynamics:

Answer 55

= NSAID & COX inhibiter = Blocks cyclooxygenase (enzyme that’s basically alarm bell for body) COX acts upon Arachidonic Acid which in turn gen/s Thromboxane A2, a compound that reg/s the activation of platelets to form a clot

Question 56

Atropine) class: Dynamics:

Answer 56

= parasympatholytic = selectively blocks muscarinic receptors inhibiting the parasympathetic NS “Vagus N. Blocker”- letting sympathetic take over

Question 57

Atropine) indications: Contraindications: Avoid:

Answer 57

= 1st med/ for symptomatic sinus Bcardia, Maybe beneficial AV block, Organophosphate poisoning (large dose r/q) hypothermic Bcardia = Allergic to drug, Use w/ extreme caution w/ myocardial ischemia = causes increased myocardial O2 demand so caution w/ Hblock & Doses <0.5mg may result in paradoxical slowing of the heart May not be effective for infranodal blocks- be prepared to pace

Question 58

Calcium Chloride) indications: Contraindications:

Answer 58

= Hyper/o/kalemia, Treatment of affects by Ca Chanel blocker OD, HypoBP 2ndary to admin/ of Diltiazem = cardiac arrest (Unless hyperkalemia suspected)PTs taking Digoxin w/ suspected calcium Chanel blocker OD

Question 59

Cardioversion/vert) Indication Rhythms intial & after Doses:

Answer 59

= UNSTABLE} SBP <90 & AMS = Bradycardia, AF w/ SVR, = 50-100J then 200J 300J 360J

Question 60

Defibrillation) Measuring unit: Max Biphasic setting: Max Monophasic setting:

Answer 60

= Joules = (Zoll) 200J = (Lifepak) 360J

Question 61

Dexamethasone) Dynamics: Indications: Contra: Dose:

Answer 61

Dexamethasone Anti-inflammatory: supresses immune response Anaphylaxis, Bronchial asthma, COPD Hypersensitivity, Fungal infection 10 mg IV/IO/PO

Question 62

Dextrose 50%) Dynamics: Indications: Contra: Dose:

Answer 62

Dextrose 50% Electrolyte / Carbohydrate. Water-soluble monosaccharide Correction of hypoglycemia Known hyperglycemia D50: 25 grams IV/IO, D10 in 50 mL (5 grams) IV/IO boluses (max 250 mL)

Question 63

Dextrose Pedis) Above 2Yrs 2Mns -2Yrs Birth to 2Mn:

Answer 63

= D50 (1-2 mL’s/kg) = D25 (2-4 mL’s/kg) = Birth to 2 months – D10 (5-10 mL’s/kg) "Bigger kid Big sugars"

Question 64

Diltiazem) Dynamics: Indications: Contra: Dose:

Answer 64

= Class IV Antiarrhythmic (Calcium Channel Blocker). Slows action potential of autorhythmic cells in the heart by blocking calcium channels. = 1st line med for A-Fib & A-Flutter with RVR (>150 bpm)2nd line med for SVT that is refractory to adenosine. = SBP<90, CHF/Cardio shock, Wide-complex TachyC, WPW, sensitivity = 1st dose: 0.25 mg/kg (max 20mg) & 2nd: 0.35 mg/kg (max 25mg)

Question 65

Diltiazem/Cardizem)effects: 1st dose: 2nd dose:

Answer 65

= HypoBP, Pos/ CHF if used w/ beta-blockers , N/V/D, Dizziness, H/A = 0.25mg/kg w/ max dose of 20mg = 0.35 mg/kg w/ max dose of 25mg

Question 66

Diphenhydramine) Dynamics: Indications: Contra: Dose:

Answer 66

= H1&2 Histamine Blocker = Allergic reaction, anaphylaxis, extrapyramidal reactions, sedation = Hypersnesitivity = 25-50 mg slow IV/IO or IM

Question 67

Dobutamine) Dynamics: Indications: Contra: Dose:

Answer 67

= αß agonist. Inotropic prop/s > prounced vs chronotropic =Cardiac pump problems (CHF) w/ hypoBP, Shouldn't use in =hypovol/ til fluid replacemed. Never mix w/ Na-Bicarb. = 2-20 mcg/kg/min - titrate so heart rate does not increase by >10% of baseline.

Question 68

Dopamine) class: pharmacodynamics

Answer 68

= sympathetic agonist = A/B agonist rate dependent vasopressor +chron/in/Drom/otropic

Question 69

Dopamine) indications: Contraindications:

Answer 69

= CHF, HypoBP w/ shock signs, 2nd med for sympathetic Bcardia (after Atropine) = hypovolemic PTs til' vol/ replaced, pheochromocytoma, Dont mix w/ sodium bicarb

Question 70

Dopamine) Effects: Dosing: Adult & Pedi Cardiac dose: Adult & Pedi Vasopressor dose:

Answer 70

= HyperBP, Palp/s, H/A, Dizzy, Can worsen C-ischemia, necrosis W/ Extravasation = 2–20 mcg/kg/min Titrate to response = 5-10mcg/kg/min = 10-20 mcg/kg/min

Question 71

Dopamine) Effects: Dosing: Adult & Pedi Cardiac dose: Adult & Pedi Vasopressor dose:

Answer 71

= HyperBP, Palp/s, H/A, Dizzy, Can worsen C-ischemia, necrosis W/ Extravasation = 2–20 mcg/kg/min Titrate to response = 5-10mcg/kg/min = 10-20 mcg/kg/min

Question 72

Dopamine) Dynamics: Indications: Contra: Dose:

Answer 72

= α & ß agonist, Rate dependent, vasopressor, +Chron/In/Dromotropic = CHF, hypoBP w/ shock S/S, 2nd med w/ S/S bradyC (after atropine) = Shouldn't use in hypovolemic PTs til' appropriate vol/ replacement occurred, Known Hx Pheochromocytoma, Don't mix w/ Sodium Bicarb. 2 - 20 mcg/kg/min, titrate to PT response (DO NOT OPEN WIDE OPEN)

Question 73

Enalapril) Dynamics: Indications: Contra: Dose:

Answer 73

ACE Inhibitor Prevents making of angiotensin II by inhibiting (ACE) thus vasodilation & helps reduce amount of water held back by the kidneys = Severe CHF (W/ HTN) in conjunction w/ Nitrates & CPAP. = Pregnancy, Angioedema, Hypersensitivity to ACE inhibitors = Pregnancy or Angioedema Initial dose of 2.5 mg PO = Sensitivity to ACE inhibitors; Titrate20mg PO(1st dose 2.5mg PO)

Question 74

Epinephrine 1:1) Dynamics: Indications: Contra: Dose:

Answer 74

= Potent α and ß agonist =Severe bronchospasm, Allergies/anaphylaxis =Few, Benefits vs. risk = 0.01 mg/kg IM (max 0.3 mg)

Question 75

Epinephrine 1:10) Pedi BradyC/Arrest: Hypoperfusion & Severe anaphylaxis:

Answer 75

= 0.01 mg/kg or 0.1 mL/kg (bc 1mg in 10mL) = 0.1-1 mcg/kg/min infusion Mix 1 mg of Epi 1:10 into 1L bag

Question 76

Epinephrine 1:10,000) Effects: Admin via: (Adult) Cardiac Arrest dose: (Adult) Bradycardia dose: (PEDI) Bradycardia/Cardiac Arrest dose: (PEDI) Hypoperfusion & Severe anaphylaxis dose:

Answer 76

= Palpitations, Anxiety, Jitters, H/A, Dizziness, HyperBP, Tcardia, Can worsen cardiac ischemia = IV infusion drip = 1mg IVP/IOP every 3-5 mins = 2-10 mcg/min IV/IO infusion = 0.01 mg/kg or 0.1 mL/kg = 0.1-1 mcg/kg/min infusion by Mixing 1mg of Epi 1:10 into 1L IV bag

Question 77

Furosemide/ Lasix) effects Adult Dose: intial dose doesnt work: new-onset pulmonary edema w/ suspected hypovolemia:

Answer 77

= pos/ dehydration/acute electrolyte imbalance, Tinnitus/deaf = 0.5-1 mg/kg over 1-2 mins. IVP = double 1st dose to 2 mg/kg over 1-2 mins = <0.5mg/kg slow IV

Question 78

Labetalol) class: pharmacodynamics:

Answer 78

= beta-blocker = Blocks adrenergic stim/ on B-receptors, causing a slowing of HR

Question 79

Labetalol) Indications: Contraindications: Do not administer to PTs w/ STEMI if following present:

Answer 79

= 2nd med/ for SVT after admin/ Adenosine, A-Fib/Flutter w/ RVR Reduce myocardial ischemia in AMI PTs w/ +HRs, Antihypertensive = Increased risk of cardiogenic shock Hypotension Bradycardia = signs of heart failure Low cardiac output

Question 80

Labetalol) Adverse Effects: Max dose: Adult Dose:

Answer 80

= admin/ after IV Ca-channel blockers can cause severe hypotension, Bcardia, heart blocks & CHF = 150mg = 10 mg IV/O push 1-2 mins & May repeat every 10 mins to max dose

Question 81

Labetalol) Adverse Effects: Max dose: Adult Dose:

Answer 81

= admin/ after IV Ca-channel blockers can cause severe hypotension, Bcardia, heart blocks & CHF = 150mg = 10 mg IV/O push 1-2 mins & May repeat every 10 mins to max dose

Question 82

Mag-Sulfate) Effects: Cardiac Arrest from hypomagnesemia or TdP: TdP w/ pulse:

Answer 82

= Flushing, Sweating, B-cardia, Resp/ depres/, Hypothermia = 1-2Gs diluted in 10 mL = 1-2Gs mixed in 50-100 mL admin/ed over 5-60mins

Question 83

Midazolam) Adult dose (active seizures): Pediatric dose (active seizures) IV/O: Pediatric dose (active seizures) IM/IN: Adult & Pedi dose for induction agent (RSI): ET Tube bucking:

Answer 83

= 0.1mg/kg in 2mg increments IV/IO (max 5mg) → 5mg IM/IO = 0.1mg/kg in 2mg increments IV/IO (max 5mg) = 0.2mg/kg (max 5mg) = 0.1-0.3mg/kg (max 10mg), Onset=2-5mins, Duration= 15-30mins = 0.05mg/kg IV/IO 1-2mins (maintain SBP) stop when bucking stopped

Question 84

Monophasic monitor Jules max Biphasic monitor Jules max

Answer 84

360J 200J

Question 85

Morphine) effects STEMI dose: NSTEMI-ACS dose:

Answer 85

= Resp/ depres/arrest, HypoBP, N/V/D = 2-4mg IV/O (slow) may admin/ addition/ 2-8mg IV 5-15min intervals = 0.1mg/kg IV/IO (slow) or IM up to 10mg

Question 86

NORepi/ Levaphed) Adult Dose: Pediatric Dose:

Answer 86

= 0.1–0.5 mcg/kg/min IV/IO infusion = 0.1–2 mcg/kg/min IV/IO infusion

Question 87

Nubain) Dynamics: Indications: Contra: Dose:

Answer 87

= Synthetic opiate agonist/antagonist = Moderate to severe pain = Hypersensitivity, respiratory depression. = 10-20 mg IV/IO/SQ/IM

Question 88

Ondansetron/ Zofran) effect: dose:

Answer 88

= HypoBP, Tcardia, Extrapyramidal reaction (=impaired motor control), Prolong QT = 4-8mg IV (slow), IM, PO

Question 89

Pacing) indication Rhythms Initial & after:

Answer 89

= "pick up the pace" <50BPM UNSTSBLE} SBP <90 & AMS = BPM <50 = 80BPM mA till' capture

Question 90

Procainamide & Lidocaine) class

Answer 90

= class 1A&B Na Channel Blockers = Alterative to Amiodarone in cardiac arrest V-Fib/pVT, Stable monomorphic Ventricular TachyC w/ presserved LVF = V-Tach with a pulse, pre-excitation rhythms (WPW) >50% QRS width

Question 91

(Procainamide)class: Dynamics:

Answer 91

= 1a antiarrhythmic = Blocks Na channels in cardiac cells which causes depolarization to slow & decrease automaticity

Question 92

(Procainamide) indications: Contra:

Answer 92

=V-Tach w/ pulse, Pre-excitation rhythms (WPW) =Shouldn’t admin to PTs received IV Ca channel blocker

Question 93

Procainamide) max dose: Recurrent VF/VT: Urgent situations: Maintenance Infusion:

Answer 93

= (max total dose: 17mg/kg) = 20mg/min (max total dose: 17mg/kg) = up to 50mg/min may admin/ to total dose (max 17mg/kg) = 1-4mg/min

Question 94

Procainamide) max dose: Recurrent VF/VT: Urgent situations: Maintenance Infusion:

Answer 94

= (max total dose: 17mg/kg) = 20mg/min (max total dose: 17mg/kg) = up to 50mg/min may admin/ to total dose (max 17mg/kg) = 1-4mg/min

Question 95

Procainamide)effect: 4 ending points:

Answer 95

= Drowsy, Slurred speech, Confusion, Seizures, HypoBP = 1. Termination of rhythm, 2. HypoBP, 3. Widening QRS>50%, 4. Meet the max total dose

Question 96

Procainamide)effect: 4 ending points:

Answer 96

= Drowsy, Slurred speech, Confusion, Seizures, HypoBP = 1. Termination of rhythm, 2. HypoBP, 3. Widening QRS>50%, 4. Meet the max total dose

Question 97

Propranolol, Labetalol, Metoprolol) class Labetalol Metoprolol

Answer 97

= class 2 Beta Blockers = 2nd line med for SVT after Adenosine, A-fib/flutter w/RVR, Reduce myocardical ischemia in AMI PT's w/elevated HR, Antihypertensive = Hypertension, 2nd line med for A-Fib/A-Flutter w/ RVR, & SVT

Question 98

Rocuronium) Dynamics Indications: Contra: Dose:

Answer 98

= Nondepolarizing neuromuscular blocker. Binds to ACh receptors =DSI/RSI = Hypersensitivity = 0.6-1.2 mg/kg. TTP: 60-90 secs. DOP: 45-120 mins

Question 99

Sodium Bicarbonate) effects: Suspected acidosis dose: Hyperkalemia:

Answer 99

= May precipitate when admin/ w/ other meds, May cause alkalosis, Hyperirritability, Tetany = 1mEq/kg IV Bolus = 50mEq IV Bolus

Question 100

Vecuronium) Dynamics: Indications: Contra: Dose:

Answer 100

= Nondepolarizing neuromuscular blocker. Binds to ACh receptors = DSI/RSI = Hypersensitivity = 0.1-0.2 mg/kg IV/IO. TTP: 1-3 mins. DOP: 45-90 mins.

Question 101

Verapamil) class: pharmacodynamics:

Answer 101

= IV antiarrhythmic Ca channel blocker = Slows AP of autorhythmic cells in heart by blocking Ca channels

Question 102

Verapamil) indications: Contraindications:

Answer 102

= 2nd med for A-Fib/Flutter w/ RVR, May use as alterative med (after adenosine), narrow QRS complex Tcardia w/ preserved LV function = HypoBP (SBP<90), CHF/cardio/ shock, Wide-complex Tcardia, WPW Hypersensitivity to med

Question 103

Verapamil)1.May cause: 2. Effects: 3. Max total dose: 4. 1st dose: 5. 2nd dose:

Answer 103

1.= more profound hypotension response than that of Diltiazem 2.= Severe CHF may result if used w/ beta-blocker, N/V/D, Dizziness, H/A 3.= 20mg 4.=2.5-5mg IV/O bolus 2-3min 5.= 5-10mg over 2-3 mins