AZ Drug Profile Flashcards
Acetylsalicylic Acid (Aspirin, ASA) Class
Analgesic, antipyretic, anti-inflammatory
Aspirin MOA
In small doses aspirin blocks thromboxane A2, a potent platelet aggregate and vasoconstrictor
Decreased platelet aggregate
Aspirin Indications
Chest pain or other S/S suggestive of acute MI
ECG changes suggestive acute MI
Unstable Angina
Pain, discomfort, fever, in adult only
Aspirin Contraindications
Bleeding Ulcer, hemorrhagic states, hemophilia
Known hypersensitivity to salicylates or other non-steroidal anti-inflammatories that has led to hypotension and/or bronchospasm
Children and adolescents
Aspirin Adverse reactions
Use with caution if history of asthma, anaphylactic reactions have occurred
Aspirin Adult Dosages
Cardiac: 160-325 mg (2-4 pediatric chewable tabs), chew or swallow
Pain/discomfort/fever: 325 mg po
Adenosine Class
Antiarrhythmic, endogenous nucleoside
Adenosine MOA
Slows conduction time thru AV node; can interrupt re-entrant pathways through the AV node
Slows sinus rate
Larger doses increase BP by decreasing peripheral resistance
Adenosine Indications
Conversion of supraventricular tachycardias with no known atrial fibrillation or atrial flutter
Undifferentiated regular monomorphic wide-complex tachycardia
Adenosine Contraindications
Sick sinus syndrome, 2nd or 3rd degree AV block, except in pt with functioning ventricular pacemaker
Use cautiously in pts with known asthma
Pts on theophylline and related methylxanthines
Pts on dipyridamole or carbamazepine
Cardiac transplant patients are more sensitive to adenosine and require a small dose
Known a-fib or a-flutter
Pregnancy
Adenosine Incompatibilities
Adenosine is not blocked by Atropine
Theophylline and related methylxanthines in therapeutic concentrations decrease effectiveness
Dipryidamole and carbamazepine block uptake and potentiate effects
Adenosine Dosage
Adult: 6 mg IV fast push, follow with 20 mL flush, repeat in 1-2 min at 12mg
Pediatric: Initial: 0.1 mg/kg as a rapid IV bolus, 2-3 ml normal saline flush, repeat double dose 0.2 mg/kg
Albuterol Sulfate Class
Sympathomimetic, bronchodilator
Albuterol MOA
Beta agonist (primarily B2), relaxes bronchial smooth muscle, resulting in bronchodilation; relaxes vascular and uterine smooth muscle, decreases airway resistance
Albuterol Indications
Treatment of bronchospasm
Treatment of hyperkalemia
Albuterol Contraindications
Synergistic with other sympathomimetics
Use caution in patients with diabetes, hyperthyroidism, and cerebrovascular disease
Amiodarone Class
Antiarrhythmic Agent
Amiodarone MOA
- Multiple effects on sodium, potassium and calcium channels
- Prolongs action potential, refractory period
- Ventricular automaticity (potassium channel blockade)
- Slows membrane depolarization and impulse conduction (sodium channel blockade)
-Negative chronotropic activity in nodal tissue, rate reduction, and antisympathetic
activity
-Dilates coronary arteries due to calcium channel and alpha-adrenergic blocking action
Amiodarone Indications
-Treatment of: defibrillation-refractory VF/pulseless VT, polymorphic VT, and wide
complex tachycardia of uncertain origin
- Control hemodynamically stable ventricular tachycardia when cardioversion
unsuccessful.
-Adjunct to cardioversion of SVT and PSVT.
Rate control in atrial fibrillation or flutter
Amiodarone Contraindications
- Bradycardia
- Second or third degree heart block unless a functioning pacemaker is present
- Cardiogenic shock
- Hypotension
- Pulmonary congestion
Amiodarone Incompatibilities
-Beta blockers, calcium channel blockers, and other antiarrhythmics are additive and can
be proarrhythmic when given in combination with Amiodarone due to similar
mechanisms of action
-Amiodarone precipitates at certain concentrations when mixed at a Y-site with sodium
bicarbonate, furosemide, and heparin.
Amiodarone Dosage
VF/Pulseless VT
300 mg IV push over 30 – 60 seconds, may repeat in 3-5 minutes with 150 mg IV push
Wide-Complex Tachycardias, Atrial Flutter, Atrial Fibrillation, SVT with
cardioversion
150 mg IV over 10 minutes (mix in 50 mL bag of D5W) may repeat every 10 minutes
Maintenance Infusion Post Resuscitation/Conversion
After successful defibrillation, follow with up to 1mg/min IV infusion for 6 hours, then
up to 0.5 mg/min IV infusion for up to 18 hours, maximum daily dose is 2.2 grams
Mix 450 mg in 250 mL of D5W (special polyolefin bag), concentration 1.8 mg/mL, and
run at 33.3 mL/hr for 1 mg/min or 16.7 mL/hr for 0.5 mg/min
For Other Maintenance infusion
Rates range from 0.5 mg/min to 1mg/min. Maximum daily dose is 2.2 grams
Amiodarone Pediatric Dosage
VF/Pulseless VT
5 mg/kg IV push (max 300 mg single dose), may repeat every 5 minutes two times to a
total maximum of 15 mg/kg/day
Probable VT with pulse
5 mg/kg IV administered over 20 minutes may repeat two more times to a total of 15
mg/kg/day
Albuterol Incompatibilites
Tricyclic antidepressants (TCA’s) and monoamine oxidase (MAO) inhibitors
Other sympathomimetics (relative)
Albuterol Dosages
Adult:
2.5 mg of premixed solution via SVN with a mouth piece,
or in-line with a ventilatory device
Ped:
2.5 mg of premixed solution via SVN with a mouth piece,
or in-line with a ventilatory device
May administer up to 5mg per dose according to medical control preference
Bumetanide Class
Loop Diuretic
Bumetanide MOA
Inhibits electrolyte reabsorption in the ascending loop of Henle leading to diuresis
Bumetanide Indications
Pulmonary Edema
CHF
Bumetanide Contraindications
Hypersensitivity Anuria Electrolyte deficiencies Hepatic coma Cautious use: hepatic cirrhosis, ascites, history of gout, hypersensitivity to furosemide
Bumetanide Incompatibilities
NSAIDs reduce diuretic effect
May increase blood levels of lithium increasing risk of lithium poisoning
Potentiates effects of various antihypertensive drugs
Bumetanide Dosages:
0.5 to 1.0 mg IV slowly over 1-2 min
Not safe for peds
Calcium Chloride Class
Electrolyte
Calcium Chloride MOA
Increases extracellular and intracellular calcium levels
Stimulates release of catecholamines
Increases cardiac contractile state (positive inotropic effect)
May enhance ventricular automaticity
Inhibits the effects of adenosine on mast cells
Calcium Chloride Indications
Acute hypocalcemia
Calcium channel blocker OD
Acute hyperkalemia (known or suspected)
Hypermagnesemia (Magnesium OD)
Pre-treatment for IV calcium channel blocker administration
Calcium Chloride Contraindications
Hypercalcemia
Concurrent Digoxin therapy
Calcium Chloride Adult Dosages
Hypocalcemia, calcium channel blocker OD, hyperkalemia and hypermagnesemia:
5-10 ml (0.5-1 Gm) of 10% calcium chloride. May repeat in 10 minutes
Pre-treatment for IV calcium channel blocker administration: 3 ml of 10% calcium
chloride. May be repeated once
Calcium Chloride Ped Dosage
Hypocalcemia, calcium channel blocker OD hyperkalemia and hypermagnesemia:
0.2 - 0.25 ml/kg of a 10% solution infused slowly. Should not be repeated without
documented calcium deficiency
Succinylcholine Class
Ultra-short-acting depolarizing-type skeletal muscle relaxant
Succinylcholine MOA
Combines with cholinergic receptors of the motor end plate to produce depolarization
Hydrolyzed by acetylcholinesterase
Succinylcholine Indications
Endotracheal intubation requiring paralysis (RSI) by a qualified Paramedic with
authorization from the Paramedic’s administrative medical director
Succinylcholine Contraindications
Muscle disorders
Personal or family history of malignant hyperthermia
History of hyperkalemia
Burn injured patients*
Ocular injuries
Patients in whom successful endotracheal intubation is doubtful
Succinylcholine Incompatibilities
Beta-blockers, procainamide, lithium, and quinidine prolong the effects
Succinylcholine Dosage
Adult: 0.6-2 mg/kg IV push, may repeat once in 2-3 minutes if inadequate response to initial
dose to achieve paralysis
Ped: 1-2 mg/kg IV push, may repeat once in 2-3 minutes if inadequate response to initial dose to
achieve paralysis
Glucagon Class
Pancreatic hormone, polypeptide, hyperglycemic agent
Glucagon MOA
Acts only on liver glycogen, converting it to glucose.
Counteracts the
effect of insulin.
Relaxes GI smooth muscle causing dilation and decreased motility.
Cardiac inotrope
May reverse hypoglycemia (if patient has glycogen stored in liver)
within 4-8 minutes
Glucagon Indications
Symptomatic hypoglycemia when IV access is delayed.
Beta blocker poisoning
Glucagon Contraindications
Known hypersensitivity
Pheochromocytoma
Insulinoma
Should not be routinely used to replace dextrose when IV access has been obtained
Glucagon Dosage
Adult: Hypoglycemia: 1 mg IM, may repeat 7-10 min
Ped: Hypoglycemia 0.5 mg IM or a dose equivalent to 20-30 mcg/kg
Dopamine Class:
Sympathomimetic
Dopamine MOA:
2-10 g/kg/min, affects Beta1 Cardio Shock
1-2 megs/kg affects Dope receptors
Dopamine Indications:
Symptomatic brady (2nd line drug to Atropine)
Hemodynamically significant hypotension in the absence of hypovolemia
Cardiogenic/Septic Shock ONLY after fluid administration; assess breath sounds first
Dopamine Contrindications:
Pheochromocytoma Hypersensitivity Hypovolemic Shock MAO inhibitors (Marplan, Nardil, Parnate) Tachy-arrythmias / V-Fib
Dopamine Incompatibilities:
Incompatible in ant alkaline solution
On-board MAO inhibitors will cause hypertensive crisis
Dopamine Dosages:
Adult: Range (2-20 g/kg/min)
Prep: add 400mg/250 ml NS or Dextrose = 1600 g/ml
Brady: start at 5 g/kg/min
BP 70 start at 2.5 g/kg/min
Peds: 2-20 g/kg/min for circulatory shock or shock unresponsive to fluid administration
Prep: 6 x body weight in kg = mg added to NS to make 100ml
Lidocaine Class:
anti-arrhythmic, local anesthetic
Lidocaine MOA:
Decreases automaticity
Terminates re-entry
Increases VF threshold
Lidocaine Indications
Suppression of ventricular arrhythmias (Vtach, Vfib, PVCs)
Prophylaxis against recurrence after conversion from vtach or vfib
Pain management after IO insertion in conscious patients
Lidocaine Contraindications
Known hypersensitivity/allergy
Use extreme caution in patients with conduction disturbance
Do not treat ectopic beats if heart rate is
Lidocaine Adult Dosages
VF/pVT: Initial Bolus of 1.0-1.5 mg/kg every 3-5 minutes. Total 3 mg/kg
Cardiac Arrest: 1.5mg/kg
Antidysrhythmic: Initial boluses 0.5-0.75mg/kg up to 1.0-1.5mg/kg additional bolus at 0.5-0.75 mg/kg every 5-10 minutes. Total dose 3 mg/kg
Maintenance infusion: 2-4mg/min
IO pain management: 20-40mg
Lidocaine Pediatric Dosages
VF/pVT: 1 mg/kg may repeat 1 time in 3-5 minutes
ROSC: 20-50 mcg/kg/min
IO Pain Management: 0.1 mg/kg not to exceed adult dosage
Atropine Class:
Anti-cholinergic
Anti-arrhythmic
Anti-spasmatic antidote
Anti-muscarinic
Atropine MOA:
Block the action of ACh as a competitive antagonist at muscarinic receptor sites of smooth muscles
Blocks parasympathetic response to the Vagus nerve, allowing sympathetic response to take over, resulting in increased cardiac output and drying of secretions
Atropine Indications:
Symptomatic bradycardia causing severe hypotension
Chest pain
ALOC
Systole (after epi) monitored Pt only
PEA w/ actual or red bradycardia (after epi) monitored Pt only
Acetylcholinesterase inhibitor poisoning (organophosphate, carbamate, cholinergic poisoning)
Atropine Contraindications:
Hypersensitivity
Belladonna alkaloid allergy
Glaucoma, adhesions of iris & lens
Tachycardia; Mobitz type II block, 3rd degree heart blocks
Obstructive GI disease; paralytic, ulcerative colitis
Hepatic or Renal disease; obstructive uropathy
Myasthenia gravis (except to treat acetylcholinesterase inhibitor)
Atropine Bradycardia Dosages
Adult: IV/IO – 0.5 mg every 5 minutes. Do NOT exceed a total dose of 3 mg or 0.04mg/kg
Peds: IV/IO – 0.02 mg/kg (minimum of 0.1 mg), repeat every 5 minutes to a max total dose of 1 mg in children and 2 mg in adolescents
Atropine Organophosphate Dosage
Adult: IV/IO – Initially: 1-5 mg. Doses should be doubled every 5 minutes until signs of muscarinic excess abate
Peds:IV/IO – 0.03-0.05 mg/kg every 10 to 20 minutes until cholinergic symptoms minimize, then every 1 to 4 hours for at least 24 hours
Ipratropium Bromide Class
Anticholinergic
Bronchodilator
Ipratropium Bromide MOA
Anticholinergic (parasympatholytic) agent, antagonizes the action of acetylcholine
Ipratropium Bromide Indications
Tx of bronchospasm associated with COPD, alone or in combination with other bronchodilators
