ALS MEDICATIONS Flashcards
Adenosine
Generic Name: Adenosine
Trade Name: Adenocard
Class: Endogenous nucleotide
Action: Ultra-short acting A-V nodal blocker
Onset/Duration: 30 seconds, duration 10 seconds
Indications: Conversion of PSVT to sinus rhythm (tachycardia-narrow complex with a pulse)
Contraindications: 2nd or 3rd degree A-V block or sick sinus syndrome, atrial flutter, atrial fibrillation, ventricular tachycardia, hypersensitivity to Adenosine
Adverse Reactions: Facial flushing, lightheadedness, diaphoresis, palpitations, chest pain, nausea, hypotension, SOB (may produce bronchospasm in PT’s with asthma)
Drug Interactions:
- Methylxanthines (i.e. caffeine and theophylline) antagonize action of Adenosine.
- Dipyridamole & Carbamazepine potentiates the effect of Adenosine
How Supplied: 12 mg/4 mL (3 mg/mL) prefilled syringe
Dosage:
- Rapid IV push, flush with 10 mL NS, elevate extremity after injection
-Adult: initial dose 6 mg IVP. If after 1-2 min no response, give 12 mg IVP (total max of 18 mg)
- Pediatric: 0.1 mg/kg rapid IVP (maximum single, first dose of 6 mg), may repeat at 0.2 mg/kg if needed (max single, second dose of 12 mg), total max dose of 18 mg
Amiodarone
Generic Name: Amiodarone
Trade Name: Cordarone
Class: Antiarrhythmic
Action: Converts atrial and ventricular arrhythmias
Indications: V-fib, pulseless V-Tach.
Contraindications: Hypersensitivity, cardiogenic shock, sinus bradycardia, 2nd and 3rd degree heart blocks
Adverse Reactions: Hypotension, bradycardia, ventricular arrhythmias
How Supplied: 150 mg / 3 mL (50 mg/mL) vial or ampule
Dosage:
-Adult:
1. Cardiac Arrest: 300 mg IV/IO, may repeat once @ 150 mg IV /IO
2. V-Tach with pulse: 150 mg mixed in 150 mL bag of NS infused over 10 min
-Pediatric:
1. Cardiac Arrest: 5 mg/kg IV/IO (max 300 mg); May repeat once @ 2.5 mg/kg IV/IO (mx. 150 mg)
2. V-Tach with pulse: 5 mg/kg in 150 mL bag of NS over 20-60 min
Atropine
Generic Name: Atropine Class: Parasympatholytic Action: Increases heart rate Indications: - Symptomatic bradycardia - Heart blocks - Organophosphate poisoning Contraindications: - None Adverse Reactions: - Palpitations - Tachycardia - Dizziness - Anxiety - Dry mouth - Pupillary dilation - Blurred vision - Headache How Supplied: - 1 mg / 10 mL (.1 mg/mL prefilled syringe) Dosage: 1. Adult: - Symptomatic Bradycardia: 1 mg IV/IO (max of .04 mg/kg) - Code Situations: 1 mg IV/IO (maximum of 0.04 mg/kg) 2. Pediatric - Symptomatic Bradycardia: 0.02 mg/kg IV/IO - RSI Situations: .02 mg/kg IV/IO
Calcium Chloride
Generic Name: Calcium Chloride Class: Electrolyte, Calcium Salt Action: Blocks harmful effects of elevated serum potassium on cardiac cell membrane Indications: PEA and asystole in a renal patient with possible elevate serum potassium Contraindications: Any other rhythms or patients other than those described in indications without contacting medical control Adverse Reactions: - Bradycardia - Flushing - Hypotension - Nausea - Irritation/burning at IV site - Skin necrosis How Supplied: 1 gram / 10 mL (100 mg/mL) prefilled syringe Dosage: 1. Adult - 1 gram (10 mL) IV/IO 2. Pediatric - .25 mL/kg., not to exceed 10 mL
NOTE: Only give in larger bore IV or IO lines without possibility of extravasation
Cardizem
Generic Name: Diltiazem Trade Name: Cardizem Class: Calcium Channel Blocker Action: Slows calcium channel antagonist, depression of cardiac contractility and conductivity Indications: Symptomatic atrial fibrillation with a rate > 130 BPM Contraindications: - Bradycardia - Hypotension - Heart failure Adverse Reactions: - Bradycardia - Hypotension - Headache - Dizziness - Nausea How Supplied: 100 mg powder to reconstitute in 100 mL of Normal Saline Dosage: 1. Adult: 10 mg slow IV push, may repeat up to 3 times 2. Pediatric: not recommended
Diphenhydramine (Benadryl)
Generic Name: Diphenhydramine Trade Name: Benadryl Class: Antihistamine Action: Blocks histamine receptors Indications: Anaphylaxis Contraindications: Use caution in asthmatic patients Adverse Reactions: - Sedation - Blurred vision - Headache - Palpitations - Hypotension How Supplied: 50 mg/mL Dosage: -Adult: 25 mg slow IVP or 50 mg IM - Pediatric: 1 mg/kg IV/IO or deep IM (max 25 mg)
Epinephrine 1:10,000 Drip
Class: sympathomimetic
Action: Bronchodilation, positive chronotrope and inotrope
Indications: No relief from subcutaneous epinephrine in severe allergic reactions
Contraindications: None
Adverse Effects:
- Palpitations
- Headaches
- Anxiety
How Supplied:
- 1 mcg/1 mL
- Can be achieved by adding 1 mg of Epi into 1000 ml NS bag (one vial or one syringe), or .5 mg of Epi (half the vial or syringe) into a 500 mL NS bag
Dosage:
1. Adults:
- start at 1 mcg/min, titrate up to 4 mcg/min (above 4 requires physicians orders)
2. Pediatrics:
- start at .1 mcg/kg/min, carefully titrate up to 1 mcg/kg/min
Epinephrine 1:10,1000
Class: Sympathomimetic Action: Increases heart rate and cardiac contractility In Indications: Cardiac arrest Contraindications: None Adverse Effects: - Tachycardia - Palpitations - Hypertension How Supplied: 1 mg/10 mL (0.1 mg/mL) prefilled syringe Dosage: 1. Adult: 1 mg IV/IO every 3-5 minutes 2. Pediatric: 0.01 mg/kg IV or IO every 3-5 minutes
NOTE: If giving via ET route, double dose as listed above
Etomidate (Amidate)
Class: Hypnotic
Action: Hypnotic without analgesic activity
Indications: Pre-medication for RSI or cardioversion
Contraindications: Hypersensitivity
Adverse Effects:
- Transient venous pain (immediately after administration)
- Transient skeletal muscle movement
How supplied:
- 40 mg in 20 mL (2 mg/mL)
Dosage:
- Adult:
- 10 mg IV (0.1 mg/kg) - Pre-medication for cardioversion
- 20 mg IV (0.25 mg/kg) - Initial induction for RSI or CFI
- Pediatric:
- 0.25 mg/kg - For RSI
- 0.125 mg/kg - pre medication for cardioversion (DO NOT EXCEED 10 mg)
Famotidine (Pepcid)
Class: H2 Antagonist
Action: Blocks H2 receptors, inhibiting the effects of histamine
Indications: Allergic reaction/Anaphylaxis
Contraindications: Hypersensitivity to Famotidine or other H2 antagonists
Adverse Effects: Headache, flushing
Dosage:
- Adult: 20 mg IV/IO infused over 10-15 min, or 20 mg PO
- Pediatric: 1 mg/kg IV/IO (max dose 20 mg) infused over 10-15 minutes, or 20 mg PO only if PT is >=20 kg and old enough to swallow with ease
Fentantyl (Sublimaze)
Class: Narcotic (Opioid) Analgesic
Action: Short acting analgesic
Indications: Pain
Contraindications: Respiratory depression
Adverse Effects: Respiratory depression, Hypotension (Rare)
How supplied: 100 mcg / 2 mL and 250 mcg / 5 mL
Dosage:
- Adult: 1 mcg/kg IV/IO, may repeat at 0.5 mcg/kg and titrate to effect
- Pediatric: 1 mcg/kg IV or IO, may repeat at 0.5 mcg/kg and titrate to effect, OR 2 mcg/kg IN (may repeat at 0.5 mcg/kg and titrate to effect)
Ketamine (Ketalar)
Class: Dissociative anesthetic
Action: Sedates and causes anesthesia for endotracheal intubation
Indications: Facilitated and rapid sequence intubation
Contraindications: Hypertension, tachy-arrhythmias, Acute coronary syndrome/MI
Adverse Effects: Abuse, hallucinations, emergent reaction, hypertension, tachycardia, salivation, laryngospasm, tremors, nystagmus
How supplied: 500 mg / 5 ml vial
Dosage:
- Adult:
- 1 - 2 mg/kg IV or IO for RSI
- 20 mg in conjunction with Morphine, if Morphine alone does not work
- Pediatric: 1 - 2 mg/kg IV or IO for RSI
Ketorolac (Toradol)
Class: NSAID (Non-Steroidal Anti-Inflammatory Analgesic
Action: Reduces inflammatory response by blocking action of cyclooxygenase, the enzyme responsible for prostaglandin production (COX-inhibitor)
Indications: Pain management of isolated musculoskeletal injuries, kidney stones, back pain
Contraindications:
- Anticoagulant use
- Recent gastrointestinal bleeding or peptic ulcer disease
- Hemophilia or other clotting disorders
- Asthma
- Hypersensitivity to NSAIDS
- Less than 16 years of age
- Major trauma or head injuries
- Chronic kidney disease
- Pregnant patient in third trimester or later (>28 weeks)
Adverse Effects: Drowsiness, prolonged clotting time, anaphylaxis, asthma exacerbation
How Supplied: 30 mg / 1 mL
Dosage:
- Adult: 30 mg IV or 60 mg IM (give half dose if >60 years old)
- Pediatric: Not currently being used for pediatric patients
Labetalol
Class: Beta Blocker
Action: Alpha and Beta-Adrenergic Blocker
Indications: Decrease BP in hypertensive crisis, pre-eclampsia and transfers carrying post or during tPA infusions from hospital to hospital
Contraindications: Asthma, COPD, Cardiogenic shock, Uncompensated CHF, 2nd and 3rd Degree Heart Blocks
Adverse Effects: Hypotension, Bradycardia, Severe Bronchospasm, may decrease the effects of Beta-Adrenergic bronchodilators
How Supplied: 100 mg/20 mL
Dosage:
- Adult:
- 10 mg slow IVP for SBP > 200 or DBP > 110 in Hypertensive Crisis patients. may repeat at 20 mg slow IVP q. 10 min as needed
- 10 mg slow IVP for SBP > 140 or DBP > 90 in preeclamptic patients. may repeat at 20 mg slow IVP q. 10 min as needed
- 10 mg slow IVP for SBP > 180 or DBP > 104 in acute ischemic stroke interfacility transfers during or after tPA administration. may repeat at 10 mg slow IVP if no response after 10 min
- Pediatric: Not currently in use
Lidocaine
Class: Antiarrhythmic
Action: Suppresses ventricular ectopy and increases V-Fib threshold
Indications: PVC’s, No longer used as premedication for RSI in head injury patients
Contraindications: Heart blocks, PVC’s in bradycardia
Adverse Effects: Dizziness, confusion, widening of the QRS, Anxiety, Seizures
How Supplied: 100 mg/5 mL (20 mg/mL)
Dosage:
- Adult:
- 1.5 mg/kg IV/IO bolus to a maximum of 3 mg/kg
- Drip: 2-4 mg/min and titrate to effect
- Premedication for RSI: 1.5 mg/kg IV/IO
- Pediatric:
- Premedication for RSI: 1 mg/kg IV/IO
Magnesium Sulfate
Class: Antiarrhythmic
Action: Bronchodilator and antiarrhythmic
Indications: Respiratory distress (after albuterol administration), Torsades, Eclampsia
Contraindications: Heartblocks
Adverse Effects: Respiratory Depression, Hypotension, Sweating
How supplied: 5 grams/10 mL
Dosage:
- Adult:
- Respiratory: 2 grams (4 mL) mixed in 150 mL bag of normal saline, infuse over 10 minutes
- Pregnancy Seizure: if PT > 20 weeks or 2 weeks post delivery, 4 grams (8 mL) mixed in 150 mL bag NS and infuse over 20 minutes (can be used in conjunction with Versed and Labetalol)
- Torsades: 2 grams IV/IO
- Pediatric:
- 20 mg/kg up to max of 2 grams to be mixed in 150 mL bag of NS and infused over 10 minutes
Morphine
Class: Opioid analgesic
Action: CNS depressant, decreases pain response
Indications: Chest pain after NTG administration, pulmonary edema, pain from burns or fractures
Contraindications: Hypersensitivity, head injury, abdominal pain
Adverse Effects: Dizziness, altered LOC, hypotension, respiratory depression
How supplied: 10 mg/mL
Dosage:
- Adult:
- Chest Pain: 2 mg IV and titrate to effect in 2 mg increments
- CHF: 2 mg IV and titrate to effect in 2 mg increments
- Burns and Fractures: 0.05-0.1 mg/kg IV/IO/IM, may repeat once if needed
- Pediatric: 0.05 mg/kg IV or IO, may repeat once if needed
Rocuronium (Zemuron)
Class: Paralytic
Action: Non-depolarizing muscle relaxant
Indications: To facilitate ventilations in a patient with a secured airway with an ET tube and position is secured
Contraindications: Airway is not absolutely confirmed, malignant hyperthermia
Adverse Effects: Hypotension, tachycardia
How Supplied: 100 mg/10 mL’s (10 mg/mL)
Dosage:
- Adult: 50 mg IV or IO
- Pediatric: 0.6 - 1.2 mg/kg IV or IO
Sodium Bicarbonate
Class: Alkalinizing agent
Action: Combines with acids to form a weaker acid and lower pH
Indications:
- Tricyclic overdose
- Known metabolic acidosis
- Coded dialysis patients
- Sepsis
- DKA
Contraindications: Alkalotic state
Adverse Effects: Alkalosis, deactivates catecholomines
How supplied:
- Adult:
- 50 mEq / 50 mL (1 mEq/ 1 mL) of an 8.4% solution
- Pediatric:
- 5 mEq / 10 mL (0.5 mEq/ 1 mL) of an 4.2% solution
Dosage:
Adult: 1 mEq/kg of a 8.4% solution
Pediatric: 1 mEq/kg of a 4.2% solutionSolu-Medrol (Methylprednisolone)
Class: Corticosteroid Action: Anti-inflammatory Indications: Allergic reactions and asthma Contraindications: Hypersensitivity Adverse Effects: Hypertension, Nausea How Supplied: 125 mg/ 2 mL (62.5 mg/mL) Dosage: - Adult: 125 mg IV or IM - Pediatric: 1 mg/kg IV or IM with a max of 125 mg
Succinylcholine (Anectine)
Class: Paralytic Action: Depolarizing Muscle Relaxant Indications: To facilitate endotracheal intubation Contraindications: - Hyperkalemia - Renal Failure - Penetrating eye injuries - Massive crush injuries - Burns greater than 8 hours old - Spinal cord injury greater than 24 hours old - Neuromuscular disease - Organophosphate poisoning - Malignant hyperthermia Adverse Effects: - Hyperkalemia - Cardiac Arrhythmias - Increased intraocular pressure How Supplied:200 mg / 10 mL (20 mg/mL) Dosage: - Adult: 1 mg/kg IV - Pediatric: 1.5 mg/kg IV Note: Be prepared to place a King or PtL airway if ET intubation fails after 2 attempts
Thiamine (Vitamin B1)
Class: Vitamin Action: Allows the breakdown of glucose Indications: Coma of unknown origins, alcoholism, delirium tremens Contraindications: None Adverse Effects: Anaphylaxis when given IV (rare) How Supplied: 200 mg / 2 mL (100 mg/mL) Dosage: - Adult: 100 mg IV - Pediatric: not indicated
Tranexemic Acid (TXA)
Class: Antifibrinolytic Agent
Action: Inhibits plasmin and reduces clot breakdown.
Indications: To be administered in Adult patients only, who have signs of shock from suspected blood loss in
severe / multisystem trauma.
Contraindications: Isolated head injuries, not given if it has been longer than 3 hours since time of injury (onset)
Adverse Effects: May increase the potential for blood clots, however in situations of injury threatening death due to blood loss, that risk is outweighed by benefits of reducing clot breakdown.
How Supplied: 1 gram of drug suspended in a 10 ml vial (100 mg / 1 ml)
Dosage:
-Loading dose: 1 gram (all 10 ml from the vial mixed in 100 ml bag) given over 10 minutes slow IV/IO infusion
- Maintenance dose: 1 gram given over 8 hours
Vecuronium (Zemeron)
Class: Paralytic
Action: Non-depolarizing muscle relaxant.
Indications: To facilitate ventilations in a patient with a secured airway with an endotracheal tube
and position is confirmed.
Contraindications: Airway which is not absolutely secured, malignant hyperthermia
Adverse Effects: Hypotension, tachycardia
How Supplied: 20 mg/10 mL’s (2 mg/mL) vial
Dosage:
- Adult: 0.1 mg/kg, or 10 mg (in average adult) IV or IO
- Pediatric: 0.1 mg/kg IV or IO
Versed (Midazolam)
Class: Sedative
Action: Short acting parenteral benzodiazepine, CNS depressant and muscle relaxant
Indications: Seizures, pre and post RSI sedation, agitated psychiatric PT
Contraindications: Hypersensitivity to benzodiazepines, hypotension
How Supplied:
- 10 mg / 2 mL (5 mg / mL)
- 5 mg / 5 mL (1 mg / mL) (most common)
Dosage:
- Adult:
- Seizures: 5 mg IM immediately, once IV obtained give 2 mg IV and repeat once at 2 mg IV. If IV unobtainable, may repeat once at 5 mg IM.
- Agitated Psych: 5 mg IV or IM
- Pediatric:
- Seizures: 0.2 mg/kg IM immediately; once vascular access obtained give 0.1 mg/kg IV and repeat once more only, or if no IV obtainable may repeat 0.2 mg/kg IM dose once
Zofran (Ondansetron)
NOTE: Be cautious with PT’s with COPD, CHF, chronic renal failure and the elderly.
Class: Antiemetic Action: Selective antagonist of the serotonin receptors in the CNS Indications: Severe nausea and vomiting Contraindications: Hypersensitivity Adverse Effects: Headaches, dizziness How Supplied: 4 mg / 2 mL (2 mg/mL) Dosage: - Adult (>40 kg): - 4 mg IV/IM, may repeat PRN - Pediatric (<40 kg): - 0.1 mg/kg
Note: May be given after administration of Fentanyl if PT becomes nauseous
