All of Meds Flashcards
1
Q
Adenosine) Effects:
Dose:
admin notes:
1/2 initial dose in PTs:
A
= 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
= RIVP /20mL RIVP flush best done w/ 3-way stopcock &
= receiving dipyridamole or carbamazepine, heart transplant, or if given by central venous access
2
Q
Adenosine) Classification:
Pharmacodynamics:
A
= Nucleoside
= Binds to Adenosine A1 receptors causing efflux of K & inhibits Ca influx thus hyperpolarization of autorhythmic cells (SA/AV Node)
(Slows AV conduction, Has a very short half-life)
3
Q
Adenosine) Indications:
Contras:
A
= 1st med for stable SVT, Reg/ monomorphic wide-QRS Tcardia thought from reentry SVT (SVT w/ BBB)
= WPW & any accessory pathway tachycardia
4
Q
Adenosine) Adult doses:
A
SVT 1st Dose: 6 mg RIVP
SVT 2nd Dose 12 mg RIVP
5
Q
Adenosine) admin/ed best via:
Other efficient ways:
A
= RIVP flush w/ 3-way stop-cock
= Drawn up w/ 20/50mL flush ,Using IV Drip bag
6
Q
Adenosine) Pedi Doses:
A
1st Dose: 0.1 mg/kg (max 6 mg)
2nd Dose: 0.2 mg/kg (max 12 mg)
7
Q
Albuterol) Dynamics:
Indications:
Contraindications:
A
=B agonist w/ preference of B2 receptors
=Brocospasm, Anaphylaxsis/ asthma/ Allergies, Hyperkalemia
= jitters & Known hypersensitivity
8
Q
Albuterol)Bronchospasm) dose:
Pedi dose:
A
= 2.5mg/3ml via SVN repeat 12-20, 0.83mg/ml
=1.25-2.5mg/1.5-3mL SVN
9
Q
Albuterol) Adverse effects:
Adult Broncospasm dose:
Hyperkalemic dose:
Pedi Dose:
A
= 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
10
Q
Albuterol) Hyperkalemia:
A
= 10-20mg via LVN / 15mins. May repeat as needed.
11
Q
Albuterol) Pedi Dose
A
1.25 - 2.5 mg / 1.5 - 3 mL SVN /15 - 20 mins PRN
12
Q
Amiodarone/ Cordarone) Classification:
Pharmacodynamics:
Precautions:
A
= Class III antiarrhythmic K channel blocker
= Slows K efflux delaying repolarization
=Severe life-threatening hypotension
Terminal elimination is extremely long (half-life lasts up to 40 day
13
Q
Amiodarone/ Cordarone) Indications:
A
= pVF. VT unresponsive to shocks CPR & Epi, Stable VT
(W/ expert consultation, may be used for some atrial & ventricular rhythms)
14
Q
Amiodarone/ Cordarone) Contraindications:
Adverse Effects:
A
= Allergic, BradyC w/ or w/o AVB, Breastfeeding
= Severe hypotension, Bradycardia, Prolong QT which can lead to TdP
15
Q
Amiodarone/ Cordarone) Adult Max total dose:
Slow Infusion:
Maintenance Infusion:
A
= 2.2Gs per day
= 360 mg IV / 6Hrs (1 mg/min)
= 540 mg / 18Hrs (0.5 mg/min)
16
Q
Amiodarone/ Cordarone) pVT/VF arrest dose:
Stable VT dose:
A
= 1st 300 mg IVP 2nd 150mg
=1st Infusion 150mg /10Mins (15mg/min) repeat same dose if need every 10mins
17
Q
Amiodarone) PEDI arrest max dose:
Loading max single Dose:
max in 24Hrs:
A
= 15 mg/kg
= 300 mg
= 15 mg/kg & 2.2Gs in adolescents
18
Q
Amiodarone) PEDI pVT VF arrest dose:
VF & VT Loading Dose:
A
= 5mg/kg IV/O (PRN to max 15 mg/kg)
=5mg/kg IV / 20-60Mins (max single dose 300 mg)
19
Q
Aspirin) Classification:
Dynamics EZ:
Pharmacodynamics:
A
= NSAID COX Inhibitor
= Prevents platelet aggregation
= Blocks Cyclooxygenase (which is an enzyme that is basically an alarm bell for the body) COX acts upon Arachidonic Acid which in turn generates Thromboxane A2, a compound that regulates the activation of platelets to form a clot
20
Q
Aspirin) Indications:
Contraindications:
A
= Cardiac / stroke S/S w/ ischemia etiology
= Common Allergy, Bronchospasm, Angioedema
21
Q
Aspirin) Adult Dose:
A
160-325 mg PO of nonenteric coated ASA
22
Q
Aspirin) Adverse Effects:
Precation:
A
= N/V/GI Upset, Allergic, bronchoconstriction w/ ~10% of asthmatic PTs
= Avoid enteric-coated ASA when admin/ to a PT w/ cardiac symptoms
23
Q
Atropine) Classification:
Pharmacodynamics:
Adverse Effects:
A
= Parasympatholytic
= Selectively blocks muscarinic receptors inhibiting PSNS letting sympathetic take over
= Blurred vision, Dry mouth, Dilated pupils, Confusion
24
Q
Atropine) Contraindications:
Precautionary notes:
A
= Allergic, Hypothermia
= Doses <0.5mg Cause paradoxical HR swing, might not effect AVBs, Heart transplant pts have no effect
25
Atropine) Indications:
May not be effective/work for:
= 1st line med/ for symptomatic sinus B/cardia
Maybe beneficial w/ AVB, Organophosphate OD
= AVBs & non-innervated hearts ( Be TCP ready)
26
Atropine) Adult Bradycardia Dose:
Organophosphate OD:
= 1mg every 3-5mins (3mg max)
= 2-4 mg (def higher) IVP
27
Atropine) Pedi Indications:
Pedi increased PSNS dose:
Pedi Organophosphate OD dose:
= Bcardia w/ parasympathetic increase
= 0.02 mg/kg IVP every 3-5mins PRN
= 0.02-0.05 mg/kg (or higher) IVP/IO
28
Atropine) pedi Minimum dose:
Max single dose:
Max total doses:
= 0.1 mg
= 0.5mg
= Child 1mg & Adolescent 3mg
29
Charcoal) dose:
Contraindication
Not recommended for ingested
= 1G/Kg
= AMS / LOC
= acid, an alkali, or a petroleum product
30
Dexamethasone) Class:
Class/med Will:
= Synthetic glucocorticoid Anti-inflammatory
= Suppresses immune response
31
Dexamethasone) Indi:
Contra:
= Bronchial asthma, COPD, Anaphylaxis
= Known hypersensitivity, (Relative) Known fungal infection
32
Dexamethasone) Adult Dose:
= 10 mg IV/IO/PO “better>sol-med”
33
Dexamethasone) effects:
= Fluid retention (Peripheral edema) & May delay wound healing & small Increase in BGL (careful w/ diabetics)
34
Dexamethasone) Pedi dosing
0.5-0.6mg/kg up to 16mg
35
Dextrose 50%) Dynamics:
Indications:
Contra:
Dose:
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)
36
Dextrose Pedis) Above 2Yrs
2Mns -2Yrs
Birth to 2Mn:
= 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"
37
Dextrose 50%)
Dose:
D50: 25 grams IV/IO, D10 in 50 mL (5 grams)
IV/IO boluses (max 250 mL)
38
Dextrose 50%) D50:
D50 to D25:
D50 to D10:
= 25G/50mLs (0.5/mL)
= Dilute by a factor of 2 (add equal Vol of fluid)
= Dilute by a factor of 5 (add 4x Vol of fluid)
39
Dextrose Pediatric Dosing
- Neonate (<2 months): D10W, 5-10 mL/kg IV
- Infant (2Mn-2Yrs): D25W, 2-4 mL/kg IV
- Child (>2Yrs): D50W, 1-2 mL/kg IV
40
Dextrose birth - 2Mns dose:
5 - 10 mL / kg of D10
41
Dextrose 2Mns - 2Yrs dose:
2 - 4 mL / kg of D25
42
Dextrose >Yrs dose:
1 - 2 mL / kg of D50
43
Diazepam/ Vallium) class:
pharmacodynamics:
= benzodiazepine
= binds w/ GABA receptors causing a influx of chloride
44
Diazepam/ Vallium) indications:
Contraindications:
= Tcardia due to stimulant OD, Sustained seizures Anxiety Sedation
= known hypersensitivity
45
Diazepam/ Vallium) Adult dose:
Strength of 3 Benzos:
= 2.5-10mg in 2.5mg increments slow IV/IO/IM
= Weak Man
46
Diazepam / Vallium) Antidote:
Draw Syringe size:
= Flumazenil 0.2mg IV
= Use 1/3mL syringe for drawing up, Can come in Injectors/Pre-filled syringes or vials ranging 1-20mLs
47
Diazepam/ Vallium) effects:
Clinical notes:
= Resp/ depres/, N/V, Sedation/amnesia
= once drawled up 1st dose, Drawl up another
48
Diazepam (Valium) pedi dose
0.1mg/kg in 2.5 mg increments slow IV
(max 5mg)
0.2 mg/kg rectal dose (max 10 mg)
49
Diltiazem/Cardizem)class:
pharmacodynamics:
= IV (4) antiarrhythmic Ca channel blocker
= slows auto arrhythmic cells AP in heart atriums by blocking Ca channels
50
Diltiazem/Cardizem)indi/s:
Contraindications:
= 1st med for AFib/Flutter w/ RVR (>150bpm), 2nd med for SVT refractory to Adenosine
= hypoBP, CHF/cardio/shock, Wide-complex Tcardia, WPW, Hypersensitivity
51
Diltiazem/Cardizem)effects:
1st dose:
2nd dose:
= 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
52
Diltiazem/Cardizem) clinical notes:
= Ca-blocker so dilatate for HypoBP ~5mg/mL vials & use 10mL syringe to dilute for push
53
Diphenhydramine) Dynamics:
Indications:
Contra:
Dose:
= H1&2 Histamine Blocker
= Allergic reaction, anaphylaxis, extrapyramidal reactions, sedation
= Hypersnesitivity
= 25-50 mg slow IV/IO or IM
54
Diphenhydramine/Benadryl) when w/ Epi:
Concentration:
Syringe:
= 5~10mins for full affect so give after Epi
~ Single dose vials 50mg/mL
=Use 1mL syringe to draw
55
Diphenhydramine/Benadryl) Dose:
= 25-50 mg slow IV/IO or IM
56
Diphenhydramine/Benadryl) Pedi dose:
Side note:
=1-2 mg/kg slow IV/IO or IM (Max 50mg)
= if altered, try to hold off on admin b/c sedative
57
Dobutamine)indi:
Contras:
= cardiac pump prob/s (CHF) w/ hypotension “baby Dope”
= hypovolemia til’ fluid replacing, DONT MIX W/ Sodium Bicarb
58
Dobutamine) effects:
dose:
= Hypertension, H/A, Dizziness, Can worsen cardiac ischemia, tissue necrosis w/ Extravasation
= 2-20mcg/kg/min- titrate so heart rate doesn’t increase by >10% of baseline
59
Dobutamine) class:
Dynamics:
= synthetic sympathetic agonist
= A&B agonist w/ inotropic prop/s > Chronotropic prop/s
60
Dopamine) Effects:
Dosing:
Adult & Pedi Cardiac dose:
Adult & Pedi Vasopressor dose:
= 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
61
Dopamine) class:
pharmacodynamics
= sympathetic agonist
= A/B agonist rate dependent vasopressor +chron/in/Drom/otropic
62
Dopamine) indications:
Contraindications:
= CHF, HypoBP w/ shock signs, 2nd med for sympathetic Bcardia (after Atropine)
= hypovolemic PTs til' vol/ replaced, pheochromocytoma, Dont mix w/ sodium bicarb
63
Dopamine) Effects:
Dosing:
Adult & Pedi Cardiac dose:
Adult & Pedi Vasopressor dose:
= 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
64
Enalapril) class:
pharmacodynamics
= ACE inhibitor
= Prevents production of angiotensin II by inhibiting (ACE)- causes vasodilation & helps reduce amount of water held back by kidneys
65
Enalapril) indications:
Contraindication:
= severe CHF (w/ HTN) in conjunction w/ Nitrates & CPAP
= Pregnancy, Angioedema, Hypersensitivity to ACE inhibitors
66
Enalapril) effects:
dose:
= Allergic, Dry Cough, Dizziness, Taste changes (long term)
= Initial 2.5mg PO & Titrate to 20mg PO
67
Enalapril) indications:
Contraindication:
= severe CHF (w/ HTN) in conjunction w/ Nitrates & CPAP
= Pregnancy, Angioedema, Hypersensitivity to ACE inhibitors
68
Enalapril) Package notes:
Dose of pills max:
= tablets come in 2.5mg or 5mg
= 2.5mg/Tab (max 8)
69
Enalapril) Dynamics:
Indications:
Contra:
Dose:
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)
70
Epi 1:1) Concentration & Syringe
for MM instead of 0.01mg 0.1mL/Kg to save time
= 1mg/mL so usee 1mL syringe
=0.1mL/Kg to save time
71
Epinephrine 1:1) Dynamics:
Indications:
Contra:
Dose:
= Potent α and ß agonist
=Severe bronchospasm, Allergies/anaphylaxis
=Few, Benefits vs. risk
= 0.01 mg/kg IM (max 0.3 mg)
72
EPI 1:1) Pedi Asthma Dose:
=0.01mg/kg IM w/ max dose 0.3mgIM
73
Epi 1:1) Pedi SVN
= 1mL w/ 4mL NS
74
EPI 1:1) Syringe to drawl:
Concentration:
= 1mL syringe
= ALWAYS 1mg/ml
75
EPI 1:1) Adult Bronchoconstriction Dose:
=0.3mg up to 0.5mg IM
76
EPI 1:1) Pedi Broncho constriction Dose:
=0.01mg/kg IM w/ max dose 0.3mgIM
77
Epi 1:10 Pediatric Dosing:
Epi 1:1 Pediatric Dosing:
- Cardiac Arrest: 0.01 mg/kg IV/O every 3-5 min
- Anaphylaxis: 0.01 mg/kg IM (Max 0.3 mg)
78
Epinephrine 1:10) Effects:
Admin via:
(Adult) Cardiac Arrest dose:
(Adult) Bradycardia dose:
(PEDI) Bcardia/Cardiac Arrest dose:
(PEDI) Hypoperfusion & Severe anaphylaxis dose:
= 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
79
Epinephrine 1:10) Indications:
Contraindications:
= Cardiac arrest, Bcardia, Normovolemic hypoBP, Anaphylaxis, Asthma
= rewards over risks so really none
80
Epinephrine 1:10) Class:
Dynamics:
= SNS agonist, Sympathomimetic
= Powerful Alpha and Beta agonist
81
Epinephrine 1:10) Admin via:
Infusion
MM trick
= IV
= 0.1-1 mcg/kg/min infusion by Mixing 1mg of Epi 1:10 into 1L IV bag
= 0.1mL
82
Epinephrine 1:10) SVN
= 5-10mLs w/o NS dilution
83
Epinephrine 1:10) Pedi BradyC/Arrest:
Hypoperfusion & Severe anaphylaxis:
= 0.01 mg/kg or 0.1 mL/kg (bc 1mg in 10mL)
= 0.1-1 mcg/kg/min infusion (Mix 1mg of Epi 1:10 into 1L bag)
84
Epi 1:10) Bradycardia dose:
Hypoperfusion & Severe anaphylaxis:
= 2-10 mcg/min IV/IO infusion
= 0.1-0.5 mcg/kg/min. Mix 1mg of Epi 1:10,000 into 1L bag of fluid.
85
Etomidate / Amidate) Classification:
Pharmacodynamics:
= Nonbarbiturate non-benzodiazepine sedative
= sedative
86
Etomidate / Amidate) Indications:
Contraindications:
Adverse Effects:
= RSI induction agent
= Suppresses cortisol, not good for head-injured PTs long term
= Decreases ICP, Ca-Channel Blockers can prolong resp/ depress/, Myoclonic jerks, Laryngospasm
87
Etomidate / Amidate) Adult) RSI Induction:
Onset:
Duration:
= 0.2-0.4 mg/kg IV/IO
= 30secs
= 5-10mins
88
Etomidate / Amidate) Pedis dose:
Dose Limit & Max
= 0.2 - 0.4 mg / kg
= 1 dose max 20mg
89
Fentanyl) class:
pharmacodynamics:
Potency:
= synthetic narcotic (schedule 2 opioid)
= opioid Analgesia & sedation through binding to opiate receptor
= Fentanyl > morphine (100mcg fentanyl = 10mg of Morphine) 1F = 10M
90
Fentanyl) indications:
Contraindications:
= Moderate to severe pain
=Hypersensitivity to med, Uncorrected SBP<90
91
Fentanyl) Dose:
=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)
92
Fentanyl) effects:
Admin notes:
= Resp/ arrest/depres/, AMS, Bcardia & Prolong of QT interval, +vagal tone b/c suppress/ sympathetic path/s, HypoBP, N/V
= Chest wall rigidity so admin slowly, Depresses every- thing/where
93
Fentanyl) Syringe Drawl size:
= 1/3mL syringe
94
Fentanyl) pharmacodynamics:
= opioid Analgesia & sedation through binding to opiate receptor
95
Fentanyl) indications:
Contraindications:
= Moderate to severe pain
=Hypersensitivity to med, Uncorrected SBP<90
96
Fluids) Hypotensive therapy) Dynamics:
Indications:
Vol Dosing:
= giving enough fluids to get a radial pulse to perfuse
= incontrollable hemorrhage
= 20mL/Kg till radial pulse
97
Fluids) Pedi replacement after perfusion rule:
4 2 1rule/ formula :
= normovolemia Used for every hr after to maintain
4ml/kg 1st 10kg
2m/Kg 2nd 10kg
1ml/kG 3rd
98
Fluids) Parkland Burn Form for:
form:
= (BSA >20% only 2 & 3 degree burns)
= 4 mL x BSA x Weight (kg) = ½ 1st 8 Hrs & ½ next 16Hrs
99
Fluids)(Parkland Burn Form) EX: 32yo male found with 10% BSA 1st degree burns, 10% BSA 2nd degree burns, and 10% BSA 3rd degree burns. The patient is 110 pounds.
A) 4 mL x BSA x Weight (kg)
B) Total mL / 2 = (Amount to give for:
C) How many mL’s per hr?
D) How many gtts/min using a 10 gtt/mL IV drip set?
E) Know w/ formula:
A) 4mL X 20 (2nd + 3rd degree burns) X 50 (kg) = 4000 mL
B) 4000 mL / 2 = 2000 mL (Amount to give 1st 8 hours then next 16Hrs)
C) 2000 mL / 8 = 250 mL per/hour for 1st 8 hrs
D) 42 gtts/min
E) Pick closest option choice for gtts & Vol calculated. Use biggest bores& macro drips
100
Fluid Pedi doses) Hypovolemia& Distributive:
Cardiogenic Shock:
Poisoning CCB/BB:
DKA with Compensated Shock:
= 20 mL/kg / 5-10Mins PRN 3x
= 5-10 mL/kg / 10-20Mins PRN 3x
= 5-10 mL/kg / 10-20Mins PRN 3x
= 10-20 mL/kg / 60-120 Minutes 3x
101
Fluids) Pedi) Hypovolemia& Distributive fluid Form:
= 20 mL/kg / 5-10Mins PRN 3x
102
Fluids) Pedi) Cardiogenic Shock fluid form
= 5-10 mL/kg / 10-20Mins PRN 3x
103
Fluids) Pedi) Poisoning CCB/BB fluid form
= 5-10 mL/kg / 10-20Mins PRN 3x
104
Fluids) Pedi) DKA Comp Shock fluid form
= 10-20 mL/kg / 60-120 Minutes 3x
105
Flumazenil / Romazicon) Dynamics:
Indications:
Contra:
Dose:
= Benzodiazepine Antagonist. Competitively blocks benzos @ GABA/benzo receptor complex
= Benzodiazepines OD
= Hypersensitivity
= 0.2 mg IV/IO every30 seconds max 3 mg
106
Flumazenil / Romazicon) Dose:
Drawl & Push notes:
Concentrations:
= 0.2 mg IV/IO q30 seconds max 3 mg
= 5/3mL syringe for full vial so 2mLs= .2mg dose
0.1mg/mL for vials .5mg/5mL,
107
Flumazenil / Romazicon) Pedi dose:
Syringe:
= 0.01mg/kg every 15Secs to 0.05 mg/kg total/max dose
= 3mL
108
Furosemide/ Lasix) class:
pharmacodynamics:
= Loop diuretic
= Blocks absorption of Na, Cl, & water from kidney thus +urinination
109
Furosemide/ Lasix) indications:
Contraindications:
= Acute pulmonary edema in PTs w/ SBP >90-100mmHg (w/o signs of shock) Hypertensive emergencies
= Hypovolemia Hypotension Hypokalemia or other suspected electrolyte abnormalities
110
Furosemide/ Lasix) effects
Adult Dose:
intial dose doesnt work:
new-onset pulmonary edema w/ suspected hypovolemia:
= 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
111
Furosemide/ Lasix) Syringe
If pushed to fast:
= 5 mL syringe
= pos/ dehydration/acute electrolyte imbalance, Tinnitus/deaf
112
Glucagon) class:
Cardiac pharmacodynamics:
= Hormone
= Binds to Glucagon receptors & stim/s adenyl cyclase & +cAMP thus an up-reg/ Ca channels in SA & AV nodal cells
113
Glucagon) cardiac indications:
Contraindications:
= Bradycardia suspected from Beta-Blocker or Ca-Channel Blocker OD
= Bradycardia from etiology (disease origin), Known hypersensitivity
114
Glucagon) effects
Ca-blocker OD Dose:
Hypoglycemia dose:
= Anxiety, Chest palp/s, H/A, N/V, Hyperglycemia
= 3-10mg IV slowly over 3-5 mins Followed w/ infusion 3-5mg per hour
= 1mg IM
115
Glucagon) class:
hypoglycemia pharmacodynamics:
= Hormone
= helps promote glycolysis for ATP
116
Glucagon) dynamics for Ca-blockers OD
= heart has Glucagon receptors on SA & AV, opens up Ca via upregulation cells to allow Ca inflex, as a work around to increase HR (Ca-Cl> then gluc)
117
Glucagon) BradyC from ßeta/Ca channel blocker OD:
= 3-10 mg IV/3-5 mins Followed by an infusion of 3-5 mg per Hr
118
Hydroxocobalamin/ Cyanokit) Dynamics:
Indications:
Contra:
= Binds w/ cyanide to form nontoxic cyanacobalamin (Vitamin B12), preventing its
toxic effects.
= Suspected cyanide poisoning
= Hypersensitivity
119
Hydroxocobalamin/ Cyanokit) Adult Dose:
2nd Dose:
= 5Gs IV/ 15 mins.
= May repeat 5Gs for (max 10Gs)
120
Hydroxocobalamin/ Cyanokit) Kit has:
250mL bag w/ 10gtts:
= 2 vial (5Gs), 10gtts
=167 gtts/min
121
Hydroxocobalamin/ Cyanokit) pedi) dose
70mg/kg /15Mins (max 5Gs)
122
Ipratropium/ Atrovent) Pharmacodynamics:
Indications:
= Anticholinergic; Selectively blocks muscarinic receptors
= Bronchospasm associated w/ obstructive lung diseases (asthma, COPD)
123
Ipratropium/ Atrovent) Contraindications:
Adverse Effects:
= Known hypersensitivity
= Blurred vision, Dry mouth, Dilated pupils, Cough, Confusion
124
Ipratropium/ Atrovent) route
Adult Dose:
Pediatric Dose:
= w/ SVN albuterol
= 500 mcg/2.5 mL
=250-500mcg/1.25-2.5 m
125
Ipratropium Bromide/ Atrovent admin note
= Anticholinergic, drys mucus for albuterol (500mcg)
126
Ipratropium (Atrovent) pedi dose:
asthma: 250-500 mcg/1.25-2.5 mL via SV
127
Ketamine / Ketalar) dynamics:
Adverse Effects:
= Sedative-hypnotic & analgesic med
= Decreases bronchospasm, hypoBP, amnesia, Increases ICP, Tcardia, Laryngospasm, hallucinations, +Sympathetic response
128
Ketamine / Ketalar) Indications:
Contraindications:
= Moderate-Severe Pain, SFI/RSI, Anxious sedation
= Hx of hypersensitivity, HyperBP, +ICP
129
Ketamine / Ketalar) Adult & Pedi Pain Doses:
Dissociation/Induction:
= 0.2 mg/kg IV /1-2 mins w/ max single dose 20mg or 0.5 mg/kg IN/IM
= 1-2 mg/kg IV, Onset: 30-60secs, Duration: 10-20 min
130
Ketamine) Dynamics:
= Dissociative anesthetic. NMDA Receptor Antagonist Anesthetic
131
Ketamine) syringe:
= 1,3,5mL depends on concentration & weight
132
Ketamine) pedis) dosing:
= Same as adults RSI(1-2mg/kg) & Pain (0.2mg/kg)
133
Labetalol) class:
pharmacodynamics:
= beta-blocker
= Blocks adrenergic stim/ on B-receptors, causing a slowing of HR
134
Labetalol) Indications:
Contraindications:
Do not administer to PTs w/ STEMI if following present:
= 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
135
Labetalol) Adverse Effects:
Max dose:
Adult Dose:
= 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
136
Labetalol) notes
Dose:
= 5mg/mL vials (use 3mL syringe)
= 10mg IV/O push/1-2 mins. May repeat q10 mins to max of 150mg
137
Labetalol) class:
pharmacodynamics:
= beta-blocker
= Blocks adrenergic stim/ on B-receptors, causing a slowing of HR
138
Labetalol) Dynamics:
Indications:
Contra:
Dose:
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
139
Levalbuterol / Xopenex) Pharmacodynamics:
Indications:
Contraindications:
Adverse Effects:
Dose:
= β agonist w/ preference for β2 receptors & has less effects on the heart vs. Albuterol
=Bronchospasm, Allergies/anaphylaxis, Hyperkalemia
= Known hypersensitivity
= Palpitations, Anxiety, Tremulousness, H/A, Dizziness, Tachycardia
= 0.63 mg/3 mL SVN (same size a albuterol bullet)
140
Lidocaine) Class:
Dynamics:
= Ib Antiarrhythmic
= Blocks Na channels in cardiac cells thus depolarization slows & decreases automaticity in ventricles
141
Lidocaine) Ind:
Contra:
Effects:
= Stable monomorphic VT w/ preserved LVF & Alternative to Amiodarone in cardiac arrest by VF/pVT
= Shouldn’t use if PT already received IV Ca channel blockers, Not given prophylactically in AMI setting
= Drowsiness, Slurred Speech, Confusion, Seizures, Hypotension
142
Lidocaine) Max dose:
Cardiac Arrest from VF/pVT dose:
Refractory VF dose:
Perfusing Arrhythmia dose:
Maintenance Infusion dose:
= 3 mg/kg
= 1-1.5 mg/kg IV/IO
= may give additional 0.5-0.75 mg/kg IV/IO in 5-10 mins
= may give additional 0.5-0.75 mg/kg IV/IO in 5-10 mins
= 1-4mg/min (30-50 mcg/kg/min)
143
Lorazepam / Ativan) Dynamics:
Adverse Effects:
= Benzo: Binds w/ GABA receptors causing Cl influx
= Resp/ depress/, HypoBP N/V, amnesia
144
Lorazepam / Ativan) Indications:
Contraindications:
= SFR/RSI, Anxiety, Seizures,
= Hypertension, Hypersensitivity
145
Lorazepam / Ativan) Antidote:
Adult Doses) Anxiety / Seizures:
RSI Sedation:
= Flumazenil 0.2mg IV
= 1-4mg IV, IM, PR, IN
= 0.05 mg/kg IV/IO
146
Lorazepam/ Ativan) Dose:
= 2-4 mg (may repeat to a max dose of 8 mg)
147
Mag-Sulfate) Class:
Dynamics:
= Misc. Airway med, Mineral, powerful noradrenergic bronchodilator
= Organic Salt act as a physiologic Ca-channel blocker Bronchodilator
148
Mag-Sulfate) Indi:
Contra:
Effects:
= cardiac arrest only if Torsades de Pointes (Tdp) suspected, Tdp w/ pulse
= AMI not recommended, High degree AV block, HypoBP, VFib/Tach
= Bcardia, HypoBP, Diaphoresis, Resp/ depres/, Hypothermia
149
Mag-Sulfate) Effects:
Cardiac Arrest from hypomagnesemia or TdP:
TdP w/ pulse:
= 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
150
Magnesium Sulfate) Contraindications
before drawing
syringe
= Organic Salt act as physiologic Ca channel blocker thus Bronchodilator
= Bronchial asthma, Torsades des pointes, Eclampsia
= High-degree HB, Shock, Dialysis, Hypocalcemia, V-Fib/pulseless VTach
151
Magnesium Sulfate) Pedi Bronchodilation dose:
= 25-50 mg/kg IV (max 2Gs) /15-30 mins (Infusion)
152
Magnesium Sulfate) Vials:
Infusions:
= 50%, 25G/50mL vial is 0.5G/mL
= Draw max range of doses to save time
153
Mag-Sulfate Pedi dose
Resp: 25-50 mg/kg IV/O (max 2Gs)/ 15-30 mins (infusion)
154
Midazolam/ Versed) class:
pharmacodynamics:
= benzodiazepine
= Binds w/ GABA receptors causing an influx of chloride
155
Midazolam/ Versed) indications:
Contraindications:
= Active seizures, RSI induction, Chemical restraint, Anxiety, Sedation
= History of hypersensitivity to drug
156
Midazolam/ Versed) effects
= Hypotension, Respiratory depression/apnea, N/V Amnesia
157
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:
= 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
158
Midazolam / Versed) Dynamics:
Antidote:
Adverse Effects:
= Binds w/ GABA receptors causing influx of Cl
= Flumazenil 0.2mg IV
= Hypotension, Respiratory depression/apnea, N/V, Amnesia
159
Midazolam / Versed) Adult Active Seizures:
Pedi Active seizures:
= 0.1mg/kg 2mg increments IV(Max 5mg)
5mg IM/IN
= 0.1mg/kg 2 mg increments IV (Max 5 mg) 0.2mg/kg IN/IM
160
Naloxone (Narcan) Adult Doses:
Pedi Dose:
= 0.4-2mg SIV (just enough for resp/ drive)
= 0.1 mg/kg up to 2 mg IV/IO/IM/IN
161
Midazolam / Versed) Adult & Pedi (RSI):
ET Tube Bucking:
= 0.1-0.3 mg/kg (Max 10 mg), Onset: 2-5Mins, Duration: 15-30Mins
= 0.05 mg/kg slow IV/ 1–2 mins (maintain SBP) – stop once bucking has resolved
162
Morphine) class
pharmacodynamics
= narcotic (schedule II Opioid)
= Analgesia & sedation through binding to opiate receptor
163
Morphine) indications:
Contraindications:
= Ischemic chest pain not relieved by Nitro
= Known hypersensitivity to drug Uncorrected hypoBP (SBP<90)
164
Morphine) effects
STEMI dose:
NSTEMI-ACS dose:
= 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
165
Naloxone (Narcan) Dynamics:
Indications:
Contra:
Dose:
= Opiate Competitive Antagonist
= Suspected Opiate overdose w/ respiratory depression
= Hypersensitivity
= 0.4-2 mg IV/IO/IM/IN
166
Nitroglycerin/ Rectiv) class:
pharmacodynamics:
= nitrate
= Potent vasodilator opens coronary vessels to improve blood flow to myocardium thus Decreases overall workload of heart/afterload
167
Nitroglycerin/ Rectiv) indications:
Contraindications
= Symptoms suggestive of Myocardial ischemia CHF
= HypoBP (SBP<90 or >30 below baseline BP) Severe Bcardia<50bpm, Tcardia>100bpm, Use of phosphodiesterase inhibitors (Boner pills) in last 48 hours, Increased ICP, RVI
168
Nitroglycerin/ Rectiv) effects:
dose:
=H/A, Dizziness, Weakness, Tcardia, HypoBP (tablets lose effectiveness after exposed to sun/air)
= 0.4mg SL (pill or spray) → repeat 3x (Q5 mins) for total dose of 1.2mg
DONT SHAKE SPRAY B/C AFFECTS DOSE
169
Nitroglycerin/ Rectiv) class:
pharmacodynamics:
= nitrate
= Potent vasodilator opens coronary vessels to improve blood flow to myocardium thus Decreases overall workload of heart/afterload
170
NORepi/ Levaphed) Class:
dynamics:
= Synthetic hormone Vaso-pressor “Sepsis med”
= A/B-adrenergic agonist (A effects > B effects)
171
NORepi/ Levaphed) Indi:
Contra:
Effects:
= Normovolemic hypotension, Septic shock, Cardiogenic shock
= hypovolemia PTs til’ Vol/replacement occurred
= Hypertension, Organ ischemia, Cardiac arrhythmia, Tissue necrosis w/ extravasation, Palpitations, Anxiety, N/V
172
NORepi/ Levaphed) Adult Dose:
Pediatric Dose:
= 0.1–0.5 mcg/kg/min IV/IO infusion
= 0.1–2 mcg/kg/min IV/IO infusion
173
NORepi/ Levaphed) Infusion/Drip:
= 4mg/4ml 16mcg/mL in 250bag (10gtts)
174
NorEpi pedi dose
0.1-2 mcg/kg/min IV/IO infusion
175
Ondansetron/ Zofran) class:
pharmacodynamics:
= selective Seratonin 5-HT3 receptor blocker/antagonist
= Serotonin 5-HT3 receptors @the vagal-N. Can initiate the gag reflex when stim/ed; Zofran is antiemetic/antag/ of 5-HT3 receptors inhibiting serotonin release on central/peripheral vagal nerve
176
Ondansetron/ Zofran) indi/s:
Contra:
= Prevent/control N/B
= Known hypersensitivity to med
177
Ondansetron/ Zofran) effect:
dose:
= HypoBP, Tcardia, Extrapyramidal reaction (=impaired motor control), Prolong QT
= 4-8mg IV (slow), IM, PO
178
Ondansetron/ Zofran) Syringe:
= 3mL syringe for ~concentration 2mg/mL
179
Ondansetron (Zofran) Dynamics:
Indications:
Contra:
Dose:
= Selective serotonin 5-HT3 receptor blocker
= Prevention & control of Nausea and/or vomiting
= Hypersensitivity
= 4-8 mg IV slow push, IM, PO.
180
Procainamide)class:
Dynamics:
= 1a antiarrhythmic
= Blocks Na channels in cardiac cells which causes depolarization to slow & decrease automaticity
181
Procainamide) indications:
Contra:
=V-Tach w/ pulse, Pre-excitation rhythms (WPW)
=Shouldn’t admin to PTs received IV Ca channel blocker
182
Procainamide)effect:
4 ending points:
= Drowsy, Slurred speech, Confusion, Seizures, HypoBP
= 1. Termination of rhythm, 2. HypoBP, 3. Widening QRS>50%, 4. Meet the max total dose
183
Procainamide) max dose:
Recurrent VF/VT:
Urgent situations:
Maintenance Infusion:
= (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
184
(Procainamide) Concentration:
Infusion:
Infusion cheat sheet:
= 1G/10mL vile = 100mg/mL
= Mix 1G (10 mL) in 250 mL w/ 10gtts→ 4 mg/mL
= 20-50mg/min (20mg/min = 50gtt/min (+10 = +25)
185
Procainamide) 4 ending points:
= 1. Termination of rhythm
2. HypoBP
3. Widening QRS>50%
4. Meet the max total dose
186
Promethazine/Phenergan) Dynamics:
Indications:
Contra:
Dose:
=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.
187
Promethazine /Phenergan) Notes
= May cause tissue injury if IV extravasation. (syringe)
188
Racemic Epi ) Dynamics:
Indications:
Contra:
Dose:
= Nonselective ß sympathetic agonist
=Croup
=Hypersensitivity
=0.25-0.75 mL of a 2.25% solution diluted in 3mL of NS
189
Rocuronium) Class:
Dynamics:
= Nondepolarizing Paralytic
= Nondepolarizing Neuromuscular Blocker: binds to ACh receptors @ neuromuscular junction
190
Rocuronium) Adult Dose:
TTP:
DOP:
= 0.6-1.2 mg/kg
= 60-90 seconds
= 45-120 minutes
191
Rocuronium) Pediatric Dose:
TTP:
DOP:
= 0.6-1.2 mg/kg
= 30-60 seconds
= 30-60 minutes
192
Sodium Bicarbonate)class:
Dynamics:
= Alkalinizing agent
= raises plasma bicarbonates, buffers excess hydrogen concentration, raises blood pH & reverses clinical manifestations of acidosis
193
Sodium Bicarbonate) indications:
Contraindications:
= Suspected hyperkalemia & bicarbonate-responsive acidosis (DKA, OD w/: TCA, Aspirin, Cocaine)
= PTs in cardiac arrest, precipitates with med admin/ed
194
Sodium Bicarbonate) effects:
Suspected acidosis dose:
Hyperkalemia:
= May precipitate when admin/ w/ other meds, May cause alkalosis, Hyperirritability, Tetany
= 1mEq/kg IV Bolus
= 50mEq IV Bolus
195
Solu-Medrol) Indications:
Contraindications :
= (same as Dexy) Bronchial asthma, COPD, Anaphylaxis
= Known hypersensitivity to medication
196
Solu-Medrol) Adult Dose:
Pediatric Dose:
Adverse Effects:
= 125-250 mg IV/IO
= 2 mg/kg IV/IO to a max of 60 mg
= Increases BGL , Effects delayed & usually not seen prehospital care
197
Succinylcholine / Anectine) Class:
Dynamics:
= Depolarizing Paralytic
= Depolarizing Neuromuscular Blocker, Binds to ACh receptors @ neuromuscular junction causing it to depolarize
198
Succinylcholine / Anectine) Indications:
Contraindications:
Adverse Effects:
= RSI
= HyperK, Burns, Crush Injury, Increased ICP, Severe trauma, Neuromuscular disease
= HyperK, B/cardia, Prolonged paralysis, Increased ICP, Muscle fasciculations, Malignant hyperthermia
199
Succinylcholine / Anectine) Adult Dose:
TTP:
DOP:
= 1-1.5 mg/kg IV/IO
= 45-60 secs
= 5-10 mins
200
Succinylcholine / Anectine) Pediatric Dose:
TTP:
DOP:
= 1-1.5 mg/kg
= 45-60 secs
= 4-6mins
201
Terbutaline/ Brethine) Class:
Indi:
Contra:
=B selective agonist relaxer w/ high affinity & give asthma, & CHF/heart prob PT
=asthma, emphysema, preterm labor, reversible airway
= hypersensitive, anxiety, dizzy/HA, NO PEDIS
202
Terbutaline/ Brethine) Dose:
0.25mg IM (only in adults
203
Terbutaline/ Brethine) Syringe:
Concentration:
= 1mL syringe
= 1mg/1mL
204
Thiamine) Dynamics:
Indications:
Contra:
Dose:
= 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
205
How does chronic alcoholism cause AMS?
Treatment for Wernicke-Korsakoff Syndrome?
= Thiamine (B1) deficiency disrupts glucose metabolism, leading to Wernicke’s & Korsakoff’s syndromes
= Admin 100 mg thiamine IV, IM, or PO before glucose in suspected hypoglycemic alcoholic PTs.
206
Tranexamic Acid (TXA) Class:
Dynamics:
Adverse Effects:
= Antifibrinolytic
= Binds to plasminogen, blocking plasminogen fibrin interactions (fibrinolysis)
= Thromboembolism, Musculoskeletal pain
207
Tranexamic Acid (TXA) Indications:
Contra:
Dose:
= Sig/ hemorrhage, either in/external (after external hemorrhage is controlled)
= SP 3 hrs past injury, allergy/Sensitivity, Suspected thromboembolism
= 1G/10mins (mix in 50 mL bag of NS), Followed by 1G / 8Hrs (500 mL bag NS)
208
Tranexamic Acid (TXA) Dynamics:
Indications:
Contra:
Dose:
= 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).
209
Tranexamic Acid (TXA) Dose:
1G/10mins (mix in 50 mL bag of NS)
Followed by 1G/8Hrs (500 mL bag NS).
210
Tylenol
Dose: 105mg
211
Vecuronium) Class:
Dynamics:
= Nondepolarizing Paralytic
= Nondepolarizing Neuromuscular Blocker: Binds to ACh receptors @ neuromuscular junction
212
Vecuronium) Indications:
Contraindications:
Adverse Effects:
= RSI
= Hypersensitivity
= Malignant hyperthermia, Skeletal muscle weakness, Apnea
213
Vecuronium) Adult Dose:
TTP:
DOP:
= 0.1-0.2 mg/kg IV/IO
= 1-3 minutes
= 45-90 minutes
214
Vecuronium) Pediatric Dose:
TTP:
DOP: 30-60 minutes
= 0.1-0.3 mg/kg IV/IO
= 1-3 minutes
= 30-60 minutes
215
Verapamil) class:
pharmacodynamics:
= IV antiarrhythmic Ca channel blocker
= Slows AP of autorhythmic cells in heart by blocking Ca channels
216
Verapamil) indications:
Contraindications:
= 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
217
Verapamil)1.May cause:
2. Effects:
3. Max total dose:
4. 1st dose:
5. 2nd dose:
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
