BIG 10 FULL DRUG CARDS Flashcards
Acetaminophen
Class: CNS agent – non-narcotic, analgesic, antipyretic
TCCC Indications: For mild to moderate pain management
DOSE: 325–650 mg PO q4–6h (max: 4 g/d)
Onset / Peak / Duration: Onset Varies / Peak 1-3 hours / Duration 3-4 hours
Administration Instructions: PO
Contraindications: Acetaminophen hypersensitivity; use with alcohol; pregnancy category B
Adverse/Side Effects: Negligible with recommended dose; rash; acute poisoning: anorexia, nausea, vomiting, dizziness, lethargy, diaphoresis, chills, epigastric or abdominal pain, diarrhea; hepatotoxicity: elevation of liver function tests; hypoglycemia, acute renal failure; chronic ingestion, renal damage
INVANZ
Class: Antimicrobial – antibiotic, carbapenem, beta-lactam Indications: Recommended for all open combat wounds if unable to take PO meds
DOSE: 1 gram IV/IM q24h
Administration Instructions: For IV reconstitute with 10mL NS; for IM 3.2mL 1.0% lidocaine without epinephrine Contraindications: Carbapenem, beta-lactam, or amide-type local anesthetic (ie. Lidocaine) hypersensitivity; pregnancy
Side Effects: Injection site phlebitis or thrombosis; asthenia, fatigue, death, fever, leg pain, anxiety, altered mental status, dizziness, headache, insomnia; chest pain, hypo- or hypertension, tachycardia, edema; abdominal pain, diarrhea, acid reflux, constipation, dyspepsia, nausea, vomiting
FENTANYL ORAL LOZENGE
Class: CNS agent - potent narcotic (opiate) agonist Indications: For moderate to severe pain management for a casualty that IS NOT in shock or respiratory distress and IS NOT at significant risk of developing either condition.
DOSE: 800 mcg oral transmucossally, reassess in 15 min, add a second lozenge in other cheek as necessary.
Administration Instructions: Document AVPU prior to administration. Place lozenge between the cheek and gum; do not chew lozenge. Recommend taping lozenge-on-a-stick to casualty’s finger as an added safety OR utilizing a safety pin and rubber band to attach the lozenge (under tension) to the patient’s uniform or plate carrier. Monitor for respiratory depression. Administer Nalaxone as reversal if needed. Be prepared to provide ventilatory support with a BVM.
Contraindications: MAOIs; myasthenia gravis; pregnancy category C
Adverse/Side Effects: Sedation, euphoria, dizziness, diaphoresis, delirium, convulsions; bradycardia, hypotension, circulatory depression, cardiac arrest; miosis, blurred vision; nausea, vomiting, constipation, ileus; muscle and thoracic muscle rigidity; urinary retention, rash;
KETAMINE (KETALAR)
Class: Nonbarbiturate anesthetic, Dissociative
Indications: For moderate to severe pain management for a casualty that IS in hemorrhagic shock or respiratory distress or is at significant risk of developing either condition. Also a useful adjunct to reduce the amount of opioids required to manage pain.
DOSE: 50 mg IM or IN, Repeat doeses q30min prn IM or IN (max: 4 g/d)
OR 20 mg slow IV or IO, Repeat doses q20min prn IV or IO (max: 4g/d)
Onset / Duration: IM – Onset in 3-4 minutes / Duration 12-25 minutes
IV – Onset in 30 seconds / Duration 5-10 minutes
Administration Instructions: Document AVPU prior to administration. IV Ketamine should be administered slowly over 1 minute. End points: Control of pain or development of nystagmus (rhythmic bac-and-forth movement of eyes). Be prepared to suction as Ketamine can increase secretions. Be prepared to provide ventilatory support with a BVM.
Contraindications: Head injury (may worsen severe TBI), Hypersensitivity to ketamine, Pregnancy Category B
Side Effects: Hypertension, Respiratory Depression, Emergence Reactions (delirium, hallucinations, confusion),
Increased Intra-cranial pressure, Increased intra-ocular pressure
MELOXICAM (MOBIC)
Class: NSAID; COX2 Inhibitor, anti-inflammatory, analgesic, antipyretic
Indications: For mild to moderate pain management for a casualty that is still able to fight as a component of the Combat
Wound Medication Pack (CWMP)
DOSE: 7.5–15 mg PO daily
Administration Instructions: PO
Contraindications: NSAID or salicylate hypersensitivity; rhinitis, urticaria, angioedema, asthma; severe renal or hepatic disease; pregnancy category C (1st/2nd trimester) and category D (3rd trimester)
Adverse/Side Effects: Edema, flu-like syndrome, pain; abdominal pain, diarrhea, dyspepsia, flatulence, nausea, constipation, ulceration, GI bleed; anemia; arthralgia; dizziness, headache, insomnia; pharyngitis, upper respiratory tract infection, cough; rash, pruritus; urinary frequency, UTI
MORPHINE SULFATE
Class: CNS agent – narcotic (opiate) agonist; analgesic Indications: Alternative to OTFC moderate to severe pain management for a casualty for a casualty that IS NOT in shock or
respiratory distress and IS NOT at significant risk of developing either condition.
DOSE: 5 mg IV/IO, Reassess in 10 min, repeat dose every 10 min as necessary to control severe pain.
Onset / Peak / Duration: IV – Onset in 5-20 minutes / Peak in 20 minutes / Duration 4-5 hours
Administration Instructions: Document AVPU prior to administration. Monitor for respiratory depression. Administer Nalaxone as reversal if needed. Be prepared to provide ventilatory support with a BVM.
Contraindications: Opiate hypersensitivity; increased ICP; seizures; acute alcoholism; acute bronchial asthma, chronic pulmonary disease, severe respiratory depression; chemical-irritant induced pulmonary edema; BPH; diarrhea due to poisoning until toxic material has been eliminated; undiagnosed acute abdominal conditions; following biliary tract surgery and surgical anastomosis; pancreatitis; acute ulcerative colitis; severe liver or renal insufficiency; hypothyroidism; pregnancy category B
Adverse/Side Effects: Pruritus, rash, urticaria, edema, anaphylactoid reaction; sweating, skeletal muscle flaccidity; cold, clammy skin, hypothermia; euphoria, insomnia, disorientation, visual disturbances, dysphoria, paradoxic CNS stimulation (restlessness, tremor, delirium, insomnia), convulsions; decreased cough reflex, drowsiness, dizziness, deep sleep, coma; miosis; bradycardia, palpitations, syncope; flushing of face, neck, and upper thorax; orthostatic hypotension, cardiac arrest; constipation, anorexia, dry mouth, biliary colic, nausea, vomiting, elevated LFTs; urinary retention or urgency, dysuria, oliguria, reduced libido or potency; severe respiratory depression or arrest; pulmonary edema
MOXIFLOXACIN (AVELOX)
Class: Antimicrobial – antibiotic; fluoroquinolone
Indications: Recommended for all open combat wounds if unable to take PO meds as a component of the Combat Wound
Medication Pack (CWMP)
DOSE: 400 mg PO qd
Onset / Peak / Duration: Onset Varies / Peak 1-3 hours / Duration 3-4 hours
Administration Instructions: PO
Contraindications: Quinolone hypersensitivity; hepatic insufficiency; syphilis; arrhythmias; myocardial ischemia or infarction; QTc prolongation, hypokalemia, or those receiving Class IA or Class III antiarrhythmic drugs; pregnancy category C.
Adverse/Side Effects: Dizziness, headache, peripheral neuropathy, nausea, diarrhea, abdominal pain, vomiting, taste perversion, abnormal LFTs, dyspepsia, tendon rupture.
NALAXONE (NARCAN)
Class: CNS agent – narcotic (opiate) antagonist
Indications: For narcotic opiate overdose and reversal of effects, including respiratory depression, sedation, and
hypotension.
DOSE: 0.4–2.0 mg IV, repeat q2–3min up to 10 mg prn
Onset / Peak / Duration: IV – Onset in 1-2 minutes / Peak in 5-15 minutes / Duration 45 minutes or longer
IM – Onset in 2-5 minutes / Peak in 5-15 minutes / Duration 45 minutes or longer
Administration Instructions: Have available when administering opioids. Titrate to effect to manage negative opioid effects, but use caution that pain is still managed.
Contraindications: Non-opioid drug respiratory depression; pregnancy category B
ONDASETRON ORAL DISSOLVING TABLET (ZOFRAN)
Class: GI agent – 5-HT3 antagonist, antiemetic
Indications: For prevention and management of nausea and vomiting associated with pain management medications. DOSE: 325–650 mg PO q4–6h (max: 4 g/d)
Administration Instructions: PO
Contraindications: Hypersensitivity to ondansetron; pregnancy category B
Adverse/Side Effects: Dizziness, light-headedness, headache, sedation; diarrhea, constipation, dry mouth
TRANEXEMIC ACID (TXA, CYKLOKAPRON)
Class: Antifibrinolytic agent
Indications: For patients anticipated to need significant blood transfusion; hemorrhagic shock, one or more major
amputations, penetrating torso trauma, or evidence of severe bleeding.
DOSE: 1 gram in separate 100cc of NS or LR slow IV push over 10 min. Do not administer in same bag as blood products or Hextend. Administer a second infusion of 1 gram after 500cc fluid challenge.
Administration Instructions: Administer as soon as possible but not later than 3 hours after injury. Ensure documentation on casualty card and/or attach/write on patient’s chest wall.
Contraindications: subarachnoid hemorrhage, active intravascular clotting, Pregnancy Category B.
Adverse/Side Effects: Blurred vision or impaired color vision. Gastrointestinal disturbances (nausea, vomiting, diarrhea) may occur but disappear when the dosage is reduced. Hypotension has been observed when intravenous injection is too rapid. To avoid this response, the solution should not be injected more rapidly than 100mg per minute.
