ALS Medication Flashcards
Sodium Bicarbonate (Bicarb, NaHCO2) Onset
2-10 minutes
Dextrose/ Glucose (50%, D50/ 10%, D10, D10W)
Side effects
- Local venous irritation/ infection
* Hyperglycemia
Cyanide KIT
Side effects
Amyl Nitrate - Hypertension, tachycardia, palpitations, syncope, headache and nausea Sodium Thiosulfate - Cirrhosis of liver - Congestive heart failure - Renal function impairment Hydroxocobalamin - Mild increase in Blood pressure - Reddish orange skin color which clears over days
Amiodarone Hydrochloride ( Cordarone, Pacerone, Nexterone) Onset
Minutes
Midazolam (Versed)
Contraindications
NONE
Epinephrine (Adrenalin, EPI)
Side effects
- Anxiety / restlessness
- Palpitations / tachyarrhythmias
- Ventricular irritability
- Increased myocardial Oxygen demand
- Hypertension
- Angina
Albuterol (Priventil, Ventilin)
Class
Bronchodilator: Sympathomimetic (Beta-2 specific)
Lidocaine (2% xylocaine)
Duration
10-20 minutes
Atrovent (Ipratropium Bromide)
Class
Bronchodilator: anticholinergic
Atrovent (Ipratropium Bromide)
Contraindications
NONE
Lidocaine (2% xylocaine)
Class
Anti-arrhythmic / Anesthetic
Naloxone (Narcan)
Contraindications
NONE
Fentanyl Citrate
Side effects
- Respiratory depression / Apnea
- Decreased LOC
- Transient Hypotension
- Nausea / Vomiting / Dizziness
- Muscular rigidity
- Bradycardia
Fentanyl Citrate
Contraindications
NONE
Adenosine(Adenocard)
Duration
1-2 minutes
Fentanyl Citrate
Onset
< 1 to 2 minutes
Ketamine (Ketalar)
Requirements
• > or equal too 15 years old
AND with GCS of 15
AND not pregnant
AND no known or suspected alcohol or drug intoxication
And have not received opioid analgesic in past 6 hours
(Prior to Medic arrival)
Ketamine (Ketalar)
Class
Anesthetic / Analgesic
Dopamine Hydrochloride(Intropin) Contraindications
NONE
Dopamine Hydrochloride(Intropin) Action
- At low and medium doses, Selectively dilates blood vessels supplying the brain, kidneys, heart and GI tract.
- At medium to high doses, Increases cardiac output by improving contractility and stroke volume, thereby increasing blood pressure.
- At high doses, causes vasoconstriction and increased heart rate.
Naloxone (Narcan)
Side effects
- Acute withdrawal symptoms
- Nausea / vomiting
- Tachycardia / hypertension
Epinephrine (Adrenalin, EPI)
Action
• On the Bronchi: bronchodilation (Beta-2)
• On the peripheral vasculature: vasoconstriction (Alpha)
• On the heart:
-Increased heart rate (Beta-1) / chronotropic
-Increased contractility / Inotropic
-Increased AV conduction/ dromotropic
-Increased automaticity / dromotropic
Atrovent (Ipratropium Bromide)
Action
- Antagonizes the action of acetylcholine, preventing the interaction of acetylcholine with muscarinic receptors in bronchial smooth muscles causing bronchodilation
- Dries respiratory tract secretions
Nitroglycerin ( NTG,Nitro)
Action
- Produces vasodilation by relaxing systemic venous & arterial vessels, thereby:
- Decreasing preload & afterload
- Decreasing myocardial workload
- Decreasing myocardial Oxygen consumption
- Dilates coronary arteries
Amiodarone Hydrochloride ( Cordarone, Pacerone, Nexterone) Contraindications
- Hypotension
- 2nd and 3rd degree heart block
- idioventricular rhythms
Diphenhydramine(Benadryl)
Class
Antihistamine
Ketamine (Ketalar)
Onset
IV 30 seconds
IN 2 minutes
Sodium Bicarbonate (Bicarb, NaHCO2) Side effects
• Electrolyte / PH imbalances
Morphine sulfate (MS, M50,) Class
Opioid
Narcotic Analgesic
Albuterol (Priventil, Ventilin)
Contraindications
- None in adults
* PEDS: for croup/strider (Nebulized saline / epinephrine is indicated)
Atrovent (Ipratropium Bromide)
Duration
4-5 hours
Amiodarone Hydrochloride ( Cordarone, Pacerone, Nexterone) Duration
Days
Cyanide KIT onset
Minutes
Normal saline (0.9% solution sodium chloride, NS) Contraindications
• Rales (except for sepsis S-143)
Sodium Bicarbonate (Bicarb, NaHCO2) Class
Electrolyte
Alkalinizing agent
Cyanide KIT Drugs
- Amyl Nitrate inhaler
- Sodium Thiosulfate 25%
- Hydroxocobalamin
Diphenhydramine(Benadryl)
Duration
6-12 hours
Sodium Bicarbonate (Bicarb, NaHCO2) Contraindications
NONE
Morphine sulfate (MS, M50,) Side effects
- Respiratory depression / apnea
- Decreased LOC
- Transient Hypotension
- Nausea / Vomiting
- Pinpoint pupils
Ondansetron (Zofran)
Duration
IV/IM and ODT 2 hours
Aspirin, ASA ( Acetysalicylic Acid)
Onset
15-30 minutes
Ketamine (Ketalar)
contraindications
- Pediatrics
- Pregnancy
- Severe Hypertension
- Alcohol intoxicated
Albuterol (Priventil, Ventilin)
Duration
Up to 5 hours
Nitroglycerin ( NTG,Nitro)
Side effects
- Orthostatic hypotension
- Dizziness / syncope
- Temporary pulsating headache
- Facial flushing
Lidocaine Jelly 2% (Xylocaine Jelly)
Side effects
NONE
Charcoal (Activated Charcoal)
Class
Absorbent
Nitroglycerin ( NTG,Nitro)
Class
Vasodilator
Atrovent (Ipratropium Bromide)
Peak
1-2 hours
Normal saline (0.9% solution sodium chloride, NS) Class
• Electrolyte / Isotonic crystalloid
Acetaminophen (Ofirmev)
Onset
15 minutes
Fentanyl Citrate
Use with caution: BHPO only
- Isolated head injuries
- Acute onset severe headache
- Drug/ETOH intoxication
- Multiple Trauma with GCS < 15
- Suspected Active Labor
Ondansetron (Zofran)
Side effects
- GI symptoms, especially diarrhea
* Headache
Lidocaine (2% xylocaine)
Action
- Depresses depolarization and automaticity in the ventricles
- Increases the ventricular fibrillation threshold by increasing phase IV re-polarization
- Amide-type local anesthetic
Ondansetron (Zofran)
Contraindications
NONE
Acetaminophen (Ofirmev)
Class
Analgesic/ Antipyretic
Atropine Sulfate
Action
- Competes with acetylcholine for receptor sites blocking the PNS response at SA and AV nodes.
- Incresses heart rate by increasing electrical conduction through the heart.
- Positive chronotropic properties with little or no inotropic effects.
- inhibits secretions by decreasing PNS effects on bronchial, Salivary, Sweat, and GI glands.
Albuterol (Priventil, Ventilin)
Onset
5 minutes
Morphine sulfate (MS, M50,) Use with caution: BHPO Only
- Isolated head injuries
- Acute onset severe headache
- Drug/ETOH intoxication
- Multiple Trauma with GCS < 15
- Suspected Active Labor
Ondansetron (Zofran)
Onset
IV/IM and ODT up to 30 minutes
Cyanide KIT Duration
Days
Dextrose/ Glucose (50%, D50/ 10%, D10, D10W)
Onset
1 minute
Naloxone (Narcan)
Class
Opioid antagonist
Calcium Chloride (10% CaCL2) Side effects
- Decressed heart rate (may cause asystole)
- Hypotension
- Syncope
- Nausea/Vomiting
- Metallic taste
Dopamine Hydrochloride(Intropin) Onset
<5 minutes
Ketamine (Ketalar)
Duration
15-30 minutes
Atropine Sulfate
Duration
2-6 hours
Calcium Chloride (10% CaCL2) Duration
May persist for 4 hours after IV/IO
Midazolam (Versed)
Onset
IV/IO/IN 2 minutes
IM 15 minutes
Aspirin, ASA ( Acetysalicylic Acid)
Action
- inhibits normal tendency for platelets to accumulate inside injured or occluded coronary arteries, thereby improving blood flow through vessels to better perfuse the heart.
- Blocks formation of Thromboxin A2
Adenosine(Adenocard)
Onset
Within 30 seconds
Adenosine (Adenocard)
Class
Antiarrhythmic
Dopamine Hydrochloride(Intropin) Class
Vasopressor: Sympathomimetic(both Alpha and Beta properties)
Sodium Bicarbonate (Bicarb, NaHCO2) Action
• Reduces acidosis or causes alkalosis by direct release of bicarbonate ion into the circulation
Lidocaine Jelly 2% (Xylocaine Jelly)
Action
- Prohibits the initiation and conduction of impulses thereby effecting local anesthetic action
- Decreases irritation when airway tube is inserted thereby decreasing intracranial pressure
Charcoal (Activated Charcoal)
Duration
4-12 hours
Ketamine (Ketalar)
indications
- Burns
- Envenomation injury
- Trauma
Charcoal (Activated Charcoal)
Indications
- Acetaminophen
- Colchicine
- Beta Blockers
- Calcium channel blockers
- Salicylates
- Valproate
- Oral anticoagulants including rodenticides
- Paraquat
- Amanita Mushrooms
Nitroglycerin ( NTG,Nitro)
Onset
Sublingual 2 minutes
Topical 30-60 minutes
Adenosine(Adenocard)
Side effects
• Shortness of Breath/ Dyspnea
[ May cause bronchospasm in COPD patients(BHO)]
• Chest pressure / palpitations
• Facial flushing / headache
• Dizzy / lightheadedness
• Nausea
• Transient arrhythmias
( PVC’s, PAC’s, Sinus Bradycardia, AV block, Sinus tach or asystole).
Generally not treated and are quickly self limiting
Ondansetron (Zofran)
Class
Antiemetic
Diphenhydramine(Benadryl)
Contraindications
NONE
Naloxone (Narcan)
Duration
IV 30-60 minutes
IM longer
Charcoal (Activated Charcoal)
Contraindications
- isolated alcohol
- Heavy metal
- Caustic agent
- hydrocarbons
- Iron ingestion
Diphenhydramine(Benadryl)
Side effects
- Drowsiness / Sedation(excitement in children)
- Dry mouth/ thickened bronchial secretions
- Hypotension
- Palpitations / Tachycardia
Amiodarone Hydrochloride ( Cordarone, Pacerone, Nexterone) Side effects
- Hypotension
- Exacerbation of the presenting arrhythmia
AFTER DAYS OF USE
- Liver injury
- Pulmonary injury: pulmonary infiltrates, bronchospasm, SOB cough, Hemoptysis, Hypoxia
Atropine Sulfate
Onset
IV/IO 2-4 minutes
IM 10-15 minutes
Aspirin, ASA ( Acetysalicylic Acid)
Class
• Platelet aggression inhibitor
Diphenhydramine(Benadryl)
Action
• Binds to histamine receptor sites, Blocking H1 and H2 receptors
- H1 causes Bronchoconstriction, Airway swelling and vasodilation
- H2 causes secretion of gastric acid
• Does not prevent histamine release
Albuterol (Priventil, Ventilin)
Side effects
- Tachycardia / Palpitations
- Dizziness, headache
- Tremors, nervousness
Sodium Bicarbonate (Bicarb, NaHCO2) Duration
30-60 minutes
Dextrose/ Glucose (50%, D50/ 10%, D10, D10W)
Contraindications
NONE
Nitroglycerin ( NTG,Nitro)
Contradiction
- Patients who have taken a sexual enhancement medication such as Viagra, Cialis, Levitra within 48 hours
- patients taking medication for pulmonary hypertension, usually sildenafil (trade names: Revatio, Flolan, and Veletri)
Midazolam (Versed)
Class
Benzodiazepine: Sedative / Anticonvulsant
Aspirin, ASA ( Acetysalicylic Acid)
Contraindications
• NONE
Naloxone (Narcan)
Action
• reverses respiratory depression, sedation and hypotensive effects of opioid overdose by occupying opiate receptor sites
Epinephrine (Adrenalin, EPI)
Contraindications
NONE
Acetaminophen (Ofirmev)
Peak
1 hour
Adenosine(Adenocard)
Contraindications
- 2nd and 3rd degree heart blocks
* Sick sinus syndrome (without pacemaker)
Morphine sulfate (MS, M50,) Duration
2-7 hours
Lidocaine (2% xylocaine)
Contraindications
- 2nd and 3rd degree heart block
* Idioventricular rhythms
Calcium Chloride (10% CaCL2) Onset
5-15 minutes
Aspirin, ASA ( Acetysalicylic Acid)
Duration
Days (antiplatelet effects)
Glucagon
Action
- Increases blood glucose by converting glycogen stores in the liver to glucose
- Inhibits synthesis of glycogen from glucose
Morphine sulfate (MS, M50,) Onset
1-2 minutes
Atropine Sulfate
Side effects
- Tachycardia/ Palpitations
- Dry mouth/ nausea / vomiting
- Pupil dilation / blurred vision
- Flushed/ hot / dry skin
Fentanyl Citrate
Action
• Potent narcotic analgesic and sedative
Diphenhydramine(Benadryl)
Onset
15-30 minutes
Fentanyl Citrate
Duration
30 to 60 minutes
Albuterol (Priventil, Ventilin)
Action
- Relaxes bronchial smooth muscles by stimulating beta-2 adrenergic receptors.
- Produces bronchodilation, relieves bronchospasm, and reduces airway resistance.
Ketamine (Ketalar)
Side effects
• Increased Heart Rate
• Increased Blood pressure
• Increased Respiratory Rate
• Nausea
• With higher doses and rapid infusion (“dissociative effects”)
-Euphoria (pleasant : dream-like states, vivid imagery
-Dysphoria (unpleasant: anxiety, disorientation, hallucinations)
Albuterol (Priventil, Ventilin)
Peak
1 hour
Glucagon
Side effects
- Nausea / Vomiting
* Tachycardia / Hypertension
Naloxone (Narcan)
Onset
IV/IN 1-2 minutes
IM 2-5 minutes
Charcoal (Activated Charcoal)
Action
- Binds and absorbs ingested toxins present in the GI tract
* Inhibits intestinal absorption, preventing systemic toxicity
Lidocaine (2% xylocaine)
Side effets Early
- Anxiety
- Euphoria
- Combative
- Nausea
- Twitching
- Numbness
Acetaminophen (Ofirmev)
Contraindications
- < 2 years of age
- Severe hepatic impairment
- Severe active liver disease
- If known or suspected total dose exceeding 4000 mg in a 24 hour period
Atrovent (Ipratropium Bromide)
Side effects
- Nervousness/ dizziness
- Headache
- Cough
- Paradoxical Bronchospasm
- Palpitations
- Blurred Vision / Eye irritation( with direct contact with mist)
Ketamine (Ketalar)
Action
- Low & slow dosing provides strong analgesic effects acting on the limbic system and cortex to block afferent transmission of impulses associated with pain perception
- High & rapid dosing provides fast acting dissociative anesthesia (blocks sensory perception) which can lead to distortion of sights, colors, sounds, self, and one’s environment
Dextrose/ Glucose (50%, D50/ 10%, D10, D10W)
Action
• increases blood glucose by providing a quick release of free sugar into the circulation
Normal saline (0.9% solution sodium chloride, NS) Action
• Electrolyte solution, which is osmotically equivalent to blood
• Increases the circulating volume of the vascular system
(2/3 of infused volume leaves vascular space within 1 hour)
Normal saline (0.9% solution sodium chloride, NS) Side effects
NONE
Acetaminophen (Ofirmev)
Action
- Inhibits the synthesis of prostaglandins which transmit pain signals and induce fever.
- Reduces pain by blocking the signals produced by prostaglandins
Midazolam (Versed)
Action
- CNS Depressant
- Produces anterograde Amnesia then sedation
- Stops and prevents seizures
Lidocaine (2% xylocaine)
Onset
1-2 minutes
Nitroglycerin ( NTG,Nitro)
Duration
Sublingual 30-60 minutes
Topical 24 hours
Lidocaine (2% xylocaine)
Side effets Late
- Seizure
- Decreased Blood pressure
- Coma
- Widening QRS
- Prolonged PRI
- V-FIB
Acetaminophen (Ofirmev)
Side effects
- Nausea, vomiting
- Headache, sleep problems
- Constipation
- itching , agitation
- Partial or total lung collapse in pediatric patients
Cyanide KIT Contraindications
NONE
Glucagon
Class
Anti-hypoglycemic: Pancreatic hormone
Fentanyl Citrate
Class
Analgesic: Opioid Agonist
Epinephrine (Adrenalin, EPI)
Onset
IV/IO 1-2 minutes
IM 5-10 minutes
Dopamine Hydrochloride(Intropin) Duration
Approximately 10 minutes after drip is stoped
Dopamine Hydrochloride(Intropin) Side effects
- At Hugh infusion rates, hypertension and extreme vasoconstriction may occur
- At low infusion rates, hypotension may occur
- Tachyarrythmias/ palpations
- Incressed myocardial oxygen demand
Amiodarone Hydrochloride ( Cordarone, Pacerone, Nexterone) Action
- Blocks sodium, potassium and calcium channels in cardiac cells slowing conduction and prolongs repolarization.
- Has alpha and beta adrenergic blocking properties causing negative inotropic effects and reduces peripheral vascular resistance(afterload).
Dextrose/ Glucose (50%, D50/ 10%, D10, D10W)
Duration
Depends on degree of hypoglycemia
Atrovent (Ipratropium Bromide)
Onset
Within 15-30 minutes
Glucagon
Contraindications
NONE
Epinephrine (Adrenalin, EPI)
Class
Catecholamine: Sympathomimetic (both Alpha and Beta effects)
Charcoal (Activated Charcoal)
Onset
Immediate
Lidocaine Jelly 2% (Xylocaine Jelly)
Contraindications
NONE
Atropine Sulfate
Class
- Antiarrythmic
* Anticholinergic
Charcoal (Activated Charcoal)
Side effects
- Nausea/ Vomiting
- Constipation/ diarrhea
- Abdominal cramping
Epinephrine (Adrenalin, EPI)
Duration
IV/IO 5-10 minutes
IM 1-4 hours
Dextrose/ Glucose (50%, D50/ 10%, D10, D10W)
Class
Carbohydrate
Midazolam (Versed)
Duration
1-4 hours
Atropine Sulfate
Contraindications
• Asystole
Aspirin, ASA ( Acetysalicylic Acid)
Side effects
- GI upset (Indigestion, Nausea/vomiting, Epigastric pain, heartburn)
- Occult or prolonged bleeding
Midazolam (Versed)
Side effects
• Respiratory depression / apnea
Ondansetron (Zofran)
Action
• Blocks serotonin receptors in vagus nerve terminals and in small intestine that trigger the vomiting reflex
Amiodarone Hydrochloride ( Cordarone, Pacerone, Nexterone) Class
Antiarrythmic
Calcium Chloride (10% CaCL2) Class
Electrolyte
Adenosine(Adenocard)
Action
• Slows electrical conduction through AV node, and interrupts re-entry pathway, converting SVT to normal sinus rhythm
Calcium Chloride (10% CaCL2) Contraindications
NONE
Calcium Chloride (10% CaCL2) Action
- Increases myocardial contractility
- Enhances Ventricular Automaticity
- Reverses cardio-electric changes produced by hyperkalemia
- Shifts potassium back into cells prevent intravascular hyperkalemia
Morphine sulfate (MS, M50,) Action
- CNS Depressant acting on opiate receptors in the brain
* Potent Analgesic and sedative
Lidocaine Jelly 2% (Xylocaine Jelly)
Class
Topical Anesthetic
Morphine sulfate (MS, M50,) Contraindications
NONE
Acetaminophen (Ofirmev)
Duration
Up to 4 to 6 hours