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TEMS Protocols > Appendix K TEMS Medication Information > Flashcards

Appendix K TEMS Medication Information Flashcards

1
Q

Adenosine (Adenocard)

A

A chemical hyperpolarization agent and diagnostic aid for Narrow-Complex Tachycardias

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2
Q

Adenosine (Adenocard) How many vials in the drug box? 6 mg/ 2 mL vial

A

3 Vials in the Drug Box (Red metal box secured in unit) 3 x 6 mg/ 2 mL = 18 mg/ 6 mL

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3
Q

Indications for use of Adenosine (Adenocard)

A

Symptomatic Paroxysmal Supraventricular Tachycardia (SVT)

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4
Q

Functions and Characteristics of Adenosine (Adenocard)

A
  • Adenosine induces a transient heart block in the AV node, and may be able to break certain forms of SVT, converting to normal conduction (i.e., Sinus Rhythm, or Sinus Tachycardia) - Fast rhythms of the heart that are confined to the atria (e.g., atrial fibrillation, atrial flutter) or ventricles (e.g., monomorphic ventricular tachycardia) and do not involve the AV node as part of the re-entrant circuit are not typically converted [Ventricular response rate is temporarily slowed with adenosine in such cases and may be of use as a diagnostic aid] - Remarkably short half life - Must be administered fast IV push with ready bolus flush without delay - Use of a 3-way stopcock may facilitate delivery - Will not affect atrial fibrillation, atrial flutter, or ventricular tachycardia
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5
Q

Contraindications for use of Adenosine (Adenocard)

A
  • Second or third degree AV block (except in patients with a functioning pacemaker) - Sick Sinus Syndrome (except in patients with a functioning pacemaker) - Poison induced tachycardia - Patients with known hypersensitivity to Adenosine
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6
Q

Precautions of Adenosine (Adenocard)

A
  • The effects of Adenosine (Adenocard) are antagonized by methylxanthines such as caffeine and theophylline, so larger doses of Adenosine (Adenocard) may be required to by effective - Use with caution in patients with asthma
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7
Q

Adenosine (Adenocard) Dosage

A

Adult Dosage - Initial 6 mg rapid IV push with immediate 10 mL Normal Saline flush, if desired effect not obtained within 1-2 minutes, then consider repeat dosage of 12 mg rapid IV push Initial Dose - (6 mg/2 mL - Draw up 1 vial) Repeated Dose - (12 mg/4 mL - Draw up 2 vials) *At that point you are out of vials (3 Vials/Drug Box)* Pediatric Dosage - Initial dosage 0.1 mg/kg rapid IV push with 10 mL Normal Saline flush (not to exceed 6 mg rapid IV push), if desired effect not obtained within 1-2 minutes, then consider 0.2 mg/kg (not to exceed 12 mg rapid IV push)

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8
Q

Albuterol Sulfate (Proventil)

A

A sympathomimetic for bronchial dilation or potassium transport agent in Crush Syndrome Used for Allergic/Anaphylactic Reaction, Difficulty Breathing, Crush Syndrome, & Dialysis-Renal Failure

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9
Q

How is Albuterol Sulfate (Proventil) found and packaged in the Red Drug Box?

A

2.5 mg bullet x 6 (3 bullets in the Drug Box and 3 bullets in the IV Box) *Blue Packages mixed with 3 mL Normal Saline*

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10
Q

Functions of Albuterol

A
  • Albuterol produces bronchodilation by relaxing bronchial smooth muscle through beta-2 receptor stimulation. In addition, it can help drive potassium back in to cells afflicted by Crush Syndrome injuries, combating hyperkalemia-associated complications - For severe distress and/or breathing difficulty which has not responded to home treatments, a cocktail of 2.5 mg Albuterol (blue package) and 0.5 mg Atrovent (green package) may be a more appropriate first-line treatment (COMBI-Tx) - May commonly induce tachycardia and tremor(s) - Should be given any time a CHF patient is wheezing - Should be given on a continuous basis for Crush - HHN flow rate should be 4-6 L/minute or 8-10 L/minute when utilizing a mask (NRB) - May require coaching to properly administer to some patients (Respiratory Distress w/ bronchoconstriction pts.)
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11
Q

Indications for use of Albuterol Sulfate (Proventil)

A
  • Asthma, status asthmaticus - Crush injury - Bronchospasm in patients with reversible obstructive airway disease
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12
Q

Contraindications for use of Albuterol Sulfate (Proventil)

A
  • Symptomatic tachycardia - Any known hypersensitivity to the drug
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13
Q

Precautions of Albuterol Sulfate (Proventil)

A
  • Patients with cardiovascular disorders (coronary insufficiency, arrhythmias, hypertension, etc.) - Convulsive disorders and diabetes - Blood pressure, pulse should be monitored (Increases HR = Increases BP due to Increased CO)
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14
Q

Albuterol Sulfate (Proventil) Dosage

A
  • Adult Breathing Difficulty 2.5 mg HHN(*) - Adult Allergic Reaction/Anaphylaxis 2.5 mg HHN - Crush Syndrome 2.5 mg HHN continuous treatments - Pediatric Breathing Difficulty 2.5 mg HHN - Pediatric Allergic Reaction/Anaphylaxis 2.5 mg HHN - Renal Failure 2.5 mg HHN continuous treatments HHN* = Hand Held Nebulizer
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15
Q

Amiodarone (Cordarone)

A

A dysrhythmic for wide-complex tachycardias and ventricular fibrillation (& ROSC)

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16
Q

How is Amiodarone (Cordarone) packaged in the drug box?

A

150 mg/3 mL vial x 3 (Drug Box)

Total amount of drug 450 mg/9 mL

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17
Q

FYI Amiodarone

A
  • A complex dysrhythmic, its action is not entirely understood, though is thought to involve prolonging the action of potential duration, prolonging the refractory period, or interacting with K+ channels.
  • Never Given IV push to a perfusing rhythm, and never given via ETT
  • Remarkably long half-life (25-100 days, average 58 days) within the body
  • Viscous, and easily foams when draws up rapidly with smaller gauge needles
  • Flush IV line thoroughly when administered in the same IV line as furosemide, heparin or sodium bicarbonate
  • Use Zofran with caution due risk of dysrhythmias due to prolonged Q-T intervals
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18
Q

Indications for use of Amiodarone (Cordarone)

A
  • Ventricular fibrillation
  • Pulseless ventricular tachycardia
  • Ventricular tachycardia with a pulse
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19
Q

Contraindications for use of Amiodarone (Cordarone)

A
  • Hemodynamically significant bradycardia
  • 2nd and 3rd degree heart blocks unless patient has a functioning pacemaker
  • Any known hypersensitivity to the drug
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20
Q

Precautions for use of Amiodarone (Cordarone)

A
  • Use with caution with patients that are currently taking
    • Beta blockers
    • Calcium Channel Blockers
    • Anticoagulants
  • Heart Failure
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21
Q

Amiodarone (Cordarone) Dosage

A
  • Wide Complex Tachycardia
    • 150 mg in 100 mL NS given over 10 minutes
  • Ventricular Fibrillation
    • 1st Dose 300 mg rapid IVP/Bolus
    • 2nd Dose 150 mg rapid IVP/Bolus
  • Pediatric Wide Complex Tachycardia
    • 5 mg/kg over 20 minutes
  • Pediatric Ventricular Fibrillation
    • 5 mg/kg over 10 minutes
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22
Q

Aspirin (Acetylsalicylic acid, ASA)

A

An antiplatelet for suspected cardiac ischemia and barotrauma

(Chest Pain, Acute Myocardial Infarction, & Acute Coronary Syndrome)

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23
Q

How is Aspirin (Acetylsalicylic acid, ASA) packaged in the IV Box?

A

81 mg tablets x 8 (IV Box)

Total 648 mg

24
Q

FYI Aspirin (Acetylsalicylic acid, ASA)

A
  • Aspirin’s antiplatelet property works by inhibiting the production of thromboxane, a platelet binding agent, and is different from other common blood thinners such as plavix or coumadin
  • Early administration during chest pain serves as a cardioprotective agent to reduce the impact of infarct, and the risk of secondary myocardial infarction (MI)
  • EMT-B may administer with physician orders as well as your agency OMD approval (Standing Order)
  • If patient has taken aspirin within 1 day, administer additional aspirin up to the maximum protocol directed dose
25
Q

Indications for use of Aspirin (Acetylsalicylic Acid, ASA)

A
  • Suspected acute myocardial infarction
  • Diving medical disorders
26
Q

Contraindications for use of Aspirin (Acetylsalicylic Acid, ASA)

A
  • Aspirin should be used cautiously in patients with peptic ulcer disease or poor kidney function
  • Patients with hypersensitivity to aspirin and other non-steroidal anti-inflammatory drugs should not receive aspirin (NSAID Examples: Motrin, Aleve, & Advil)
  • Patients with a history of GI bleeding or other bleeding disorders, recent surgery (within 14 days), recently taken maximum dose of aspirin prior to EMS arrival and sensitivity/allergy to aspirin. Contact medical control for guidance
27
Q

Precautions for use of Aspirin (Acetylsalicylic Acid, ASA)

A
  • Aspirin should be avoided by patients with peptic ulcer disease or poor kidney function
  • Aspirin should be avoided by patients taking blood thinning medications (Coumadin)
    • *Plavix avoid ASA - Coumadin ASA should still be given*
28
Q

Ativan (Lorazepam)

A

A potent benzodiazepine anticonvulsant for seizures and seizures proximal to chemical exposure

(Seizures, Combative Patients)

29
Q

How is Ativan (Lorazepam) packaged in the Drug Box?

A

2 mg/mL x 2

Total 4 mg/2 mL

30
Q

FYI Ativan (Lorazepam)

A
  • Ativan (Lorazepam) is the preferred drug for seizures due to efficacy and duration
  • Dilute in an equal amount of NS (Normal Saline) for IV/IO administration
  • Dose 2 mg slow IV push (over 2 minutes)
  • May be administered IM if IV/IO access is not available. Do not dilute if administering IM
  • May repeat with a physician order up to maximum dose of 8 mg
  • Action is potentiated in conjunction with Haldol
  • Medical Control may order 1 mg for post seizure patients to prevent further seizures
  • Risk for respiratory depression and bradycardia, and should be administered with ECG/EKG and SPAO2/SpO2 monitoring
  • Inadvertent arterial injection may result in ateriospasms
  • Ineffective if administered rectally; administer Valium (Diazepam) rectally instead
31
Q

Indications for use of Ativan (Lorazepam)

A
  • Status Epilepticus
  • Major Motor Seizure
  • Premedication prior to cardioversion
  • Combative patients
32
Q

Contraindications for use of Ativan (Lorazepam)

A
  • Patients with a hypersensitivity to the medication
33
Q

Precautions for the use of Ativan (Lorazepam)

A
  • Should be diluted with normal saline prior to IV/IO administration
  • Use with caution in patients with acute narrow angle glaucoma
  • Coma, shock, or suspected drug abuse
  • Has a short duration of effect
34
Q

Ativan (Lorazepam) Dosage

A
  • Seizure - 2 mg IV/IM/IO, may repeat with physician order up to a maxium 8 mg
  • Pediatric Seizure - 0.1 mg/kg IV/IM/IO with a maximum of 2 mg, may repeat with a physician order
  • Combative Patient - 2 mg IM in large muscle mass
  • OB/GYN Pre-Eclampsia - 2 mg IV/IM/IO
35
Q

Atropine

A

An antimuscarinic to increase heart rate or dry secretions

(Used for Aystole*, PEA, Bradycardia, RSI, Chemical Exposure)

36
Q

How is Atropine packaged in the Drug Box?

A

1 mg/10 mL preloaded syringe x 3 (Drug Box)

Total Amount: 3 mg/30 mL

37
Q

FYI Atropine

A

Increases firing of the sinoatrial node (SA) and conduction through the atrioventricular node (AV) of the heart

  • May be less/not effective in PEA with rates above 60
  • Not an actual antidote for organophosphate poisoning, but blocks the action of acetylcholine at muscarinic receptors; as a treatment for SLUDGE-style poisons such as organophosphate insecticides and nerve gases, including Tabun (GA), Sarin (GB), Soman (GD) and VX.
    • Consider early alert to medical control as field supplies are insufficient for prolonged SLUDGE-management
38
Q

Indications for use of Atropine

A
  • Hemodynamically unstable sinus bradycardia
  • Asystole
  • Organophosphate poisoning
39
Q

Contraindications for use of Atropine

A

None when used in emergency situations

40
Q

Precautions for use of Atropine

A
  • Dose of 3 mg should not be exceeded except in cases of organophosphate poisoning
  • May cause tachycardia (caution in acute MI)
  • May cause hypertension
  • May be ineffective in patients that have 2nd degree type II or 3rd degree heart blocks with a widened QRS complex
41
Q

Atropine Dosage

A
  • Bradycardia - 0.5 mg every 3 to 5 minutes, as needed up to a maximum of 3 mg
  • Organophosphate poisoning - 2 to 5 mg
  • Pediatric Bradycardia - 0.02 mg/kg (0.1 mg minimum dose; maximum single dose 0.5 mg in a child; 1 mg in an adolescent)
  • RSI - Bradycardia Adult - 1 mg IV/IO
  • RSI - Pediatric 0.02 mg/kg IV/IO Minimum dose 0.1 mg
42
Q

Atrovent (ipratropium bromide)

A

An anticholinergic for bronchial dilation

Used for Difficulty Breathing (Asthma/COPD)

43
Q

How is Atrovent (ipratropium bromide) packaged in the IV and Drug Box?

A

0.5 mg bullet × 2 (1 Drug Box and 1 IV Box)

Total = 1 mg of two bullets of 5 mL (2.5 mL/unit dose)

44
Q

FYI Atrovent (ipratropium bromide)

A

 Atrovent is an anticholinergic (parasympatholytic) agent inhibiting vagally‐mediated reflexes by antagonizing the action of acetylcholine

 For severe distress and/or breathing difficulty which have not responded to home treatments, a combination treatment of 2.5 mg Albuterol and 0.5 mg Atrovent may be a more appropriate first‐line

 With a 2 hour half‐life, only 1 dose is allowed under standing orders

 HHN flow rates should be 4‐6 L/min or 8‐10 L/min when utilizing a mask

 May require coaching to properly administer to some patients

45
Q

Indications for use of Atrovent (ipratropium bromide)

A

 Asthma as an adjunct to Albuterol

 Bronchospasm associated with bronchitis and emphysema

46
Q

Contraindications for use of Atrovent (ipratropium bromide)

A

 Patients with known hypersensitivity to the drug or to atropine

47
Q

Precautions for use of Atrovent (ipratropium bromide)

A

 Caution when used in elderly and those with cardiovascular disease or hypotension

48
Q

Atrovent (ipratropium bromide) Dosage

A

 Adult Dosage O.5 mg in 2.5 ml (unit dose) mixed in nebulizer with 2.5 mg/3 ml (unit dose) Albuterol Sulfate (Proventil)

 Pediatric Dosage 0.5 mg in 2.5 ml (unit dose) mixed in nebulizer with 2.5 mg/3 ml (unit dose) Albuterol Sulfate (Proventil)

49
Q

Benadryl (diphenhydramine)

A

An antihistamine for allergic reaction and anticholinergic for dystonic reaction (Haldol)

Allergic Reaction, Combative Patient

50
Q

How is Benadryl (diphenhydramine) is package in the Drug Box?

A

50 mg/1 mL vial × 2 (Drug Box)

Total = 100 mg/2 mL

51
Q

FYI Benadryl (diphenhydramine)

A

 Benadryl works to combat and blunt the histamine response found in allergic reaction, and has a mild‐to‐moderate CNS sedative effect

 Consider if patient exhibits signs of a dystonic reaction following Haldol administration in the Combative Patient protocol

Although an antihistamine, also possesses significant anticholinergic properties; it may help in balancing cholinergic and dopaminergic activity

52
Q

Indications for use of Benadryl (diphenhydramine)

A

 Anaphylaxis

 Allergic reactions

 Dystonic reactions after Haldol administration

53
Q

Contraindications for use of Benadryl (diphenhydramine)

A

 Asthma

 Nursing Mothers

 Glaucoma

 Patients taking MAOI medications

54
Q

Precautions for use of Benadryl (diphenhydramine)

A

 Hypotension

55
Q

Benadryl (diphenhydramine) Dosage

A

 Adult Dosage 50 mg IV/IO/Deep IM

 Pediatric Dosage 1 mg/kg up to a total dose of 50 mg, may repeat once

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