BLS Drugs Flashcards
Tylenol
Classification
• Analgesic, Anti-Pyretic
Indications
• Severe sepsis/septic shock adult
• Pyrexic child/adult
• Pain control
Contraindications
•Hypersensitivity to Acetaminophen
• Acetaminophen – induced liver disease
ADULT/ELDERLY
• Oral: 325 - 975 mg every 4 to 6 hours, do not exceed 4000 mg/24 hours
PEDIATRIC
• Oral/Rectal: 10mg - 15 mg/kg every 4 to 6 hours (max 4 g per 24hr)
ASA
Classification
• Analgesic
• Anti-Platelet
• Anti-Inflammatory
Indications
• Ischemic chest pain
Contraindications
• Hypersensitivity to ASA or other NSAIDS
• Contraindicated in children under 16 years
ADULT/ELDERLY
• 160 mg, uncoated
Activated charcoal
Indications
• Used in treatment of most oral poisonings except those caused by corrosive agents (e.g. strong acid or alkalis) or substances for which its absorptive capacity is too low to be clinically useful (e.g. iron salts, lithium, etc)
• Most commonly used agent for GI decontamination poisoned patients
Contraindications
• Before endoscopy and ingestion of corrosive agents, unless necessary to adsorb another ingested toxin; may obscure endoscopic evaluation of gastroesophageal lesion
• Patients with an unprotected airway, a GI tract that is not anatomically intact, and where risk or severity of aspiration may be increased (e.g. hydrocarbon ingestions)
• Multiple-dose regimen in presence of ileus or bowel obstruction
Dosing
Contact PADIS for treatment recommendations ADULT/ELDERLY
• 50 grams PEDIATRIC
• Contact PADIS
Dextrose/D50/D25/Glucose
Contraindications
• Hypersensitivity to dextrose solution or any component of formulation
• Hypersensitivity to corn or corn products
• Neonates and children less than 50 kg: maximum concentration used is D25W
• Diabetic coma while patient is hyperglycemic; hepatic coma
• Intracranial or intraspinal hemorrhage; glucose-galactose malabsorption syndrome
• In the presence of delirium tremens in dehydrated patients
• Severe dehydration
Cautions
• HIGH ALERT
• Diabetes mellitus or carbohydrate intolerance
• Ischemic stroke, as increased blood-glucose concentrations may worsen cerebral ischemic brain damage and
impair recovery
• Hyponatremia may result from low sodium or sodium-free dextrose solutions with no other source of sodium
• Use with caution with patients susceptible to excessive fluid accumulation
ADULT/ELDERLY
• Dose is dependent on use, weight, clinical condition and POCT results
• Oral glucose, if conscious and intact gag reflex administer in small amounts until desired effect obtained
• 12.5 to 25 grams D50W q 5 min. SIVP Repeat as required
PEDIATRIC
• Dose is dependent on use, weight, clinical condition and POCT results
• Oral glucose, if conscious and intact gag reflex administer in small amounts until desired effect obtained
• 2 to 4ml/kg D25W q 5 min. SIVP Repeat as required
Dimenhydrinate/Gravol
Indications
• Prevention and treatment of nausea, vomiting and/or vertigo; due to a variety of clinical scenarios including motion sickness, radiation sickness, postoperative vomiting, drug induced nausea and vomiting, Ménière’s disease and other labyrinthine disturbances
Not the first line choice as an antiemetic
Contraindications
Hypersensitivity to dimenhydrinate, diphenhydramine, propylene glycol, or any other component of formulation
Neonates
Dosing
Dilute to 10ml NACL given SIVP over 2 to 4 minutes or dilute in 50ml mini bag infused over 20min
ADULT/ELDERLY
• 25 to 50mg q4 hours PRN
• Maximum 100 mg every 4 hours as required
• Elderly may be more sensitive to side effects. Limit use to short-term therapy
PEDIATRIC
Children less than 12 years:
• 1 mg/kg (max 50mg) q 4 to 6 hours as required
Children 12 years or older:
• 25 to 50 mg every 4 to 6 hours as required
• Maximum dose: 300 mg in 24 hours
Entonox/Nitrous Oxide
Indications
• Pain associated with musculoskeletal injuries
• Cardiac chest pain
• Burns without inhalation injury
• Active labour
Contraindications
• Head injury with impaired consciousness
• Inebriation
• Heavily sedated (e.g. overdose, street drugs)
• Severe facial injuries
• Inability to self-administer (too young mentally challenged, senile)
• Chest trauma (e.g. pneumonia)
• Decompression sickness
Use with caution for suspected bowel obstruction
Dosing ADULT/ELDERLY
• Self-administered by patient until pain is relieved, PRN PEDIATRIC
• Self-administered by patient until pain is relieved, PRN NOTE: must document amount used by patient (psi) on PCR
Epinephrine
Classification
Sympathomimetic
Indications
Treatment of anaphylaxis and/or severe acute asthmatic attacks
Treatment of cardiac arrest
Croup
Contraindications
Hypersensitivity to EPINEPHrine or other sympathomimetics or sulfites. No absolute contraindications to use in life threatening conditions
HIGH ALERT/ ELDER ALERT
Elderly: may be more susceptible to beta-adrenergic effects (e.g. hypertension, hypokalemia,
tachycardia, tremor)
Dosing
Anaphylaxis (Normotensive):
Adults:
•0.5 mg Epi 1: 1,000 IM
•Peds: 0.01 mg/kg Epi 1:1,000 to a maximum of 0.5 mg IM (deltoid or vastus lateralis)
Status Asthmaticus:
o Adults: 0.3 mg-0.5 mg Epi 1:1,000 SC/IM
o Peds:0.01mg/kg Epi1:1,000 to a maximum of 0.5mg SC/IM
Croup:
< 5 kg: 0.5 mg/kg Epi 1:1,000 to maximum 2.5 mg in 2-3 mls NS nebulized
>5 kg: 2.5-5 mg Epi 1:1,000 mixed in 2-3 mls NS nebulized
Glucagon
Contraindications
• Hypersensitivity to glucagon or any component of formulation
• Phreochromocytoma: may cause release of catecholamines producing marked hypertension
Dosing
ADULT/ELDERLY
• Hypoglycemia: 1 mg. usually awakens an unconscious patient within 15 minutes. May repeat in 15 minutes as needed. Note: IV dextrose should be administered as soon as it is available; if patient fails to respond to glucagon, IV dextrose must be given
PEDIATRIC
• Hypoglycemia: <12 years: 0.1mg/kg to a max of 1mg > 12 years: 1 mg
• Usually awakens an unconscious patient within 15 minutes. May repeat in 15 minutes as needed. Note: IV dextrose should be administered as soon as it is available; if patient fails to respond to glucagon, IV dextrose must be given
NEONATE
• Hypoglycemia: 200 mcg/kg (0.2 mg/kg). Max dose 1 mg
• Continuous infusion: begin with 10 to 20 mcg/kg/hour (0.5 to 1 mg/day). Rise in blood glucose should occur
within one hour of starting infusion
Ipratropium/Atrovent
Indications
• Patient experiencing bronchospasm
Contraindications
• Hypersensitivity to ipratropium or atropine (and its derivates)
Dosing
ADULT/ELDERLY
NEBULIZED
• 250-500 mcg (usually repeated to max of 1 mg)
• MDI: 5 puffs @ 20 mcg/puff (no repeats) interspersed with Ventolin puffs (see below for instructions)
PEDIATRIC
• Nebulized: 125-250 mcg
• MDI: >20 kg: 5 puffs @ 20 mcg (no repeats) interspersed with Ventolin puffs (see below for instructions)
<20 kg: 4 puffs @ 20 mcg (no repeats) interspersed with Ventolin puffs (see below for instructions) <10 kg: not indicated
Dosing of Atrovent and Ventolin should look like this:
• 1 Ventolin puff at a time, waiting 30-60 seconds between up to 10 puffs.
• Follow each Ventolin with a puff of atrovent 10 seconds post.
• If the patient in extremis this wait time can be shortened as practitioner feels is appropriate
• Wait 5 - 10 minutes between sets of 10 puffs Ventolin to observe for effect.
• Repeat sets of 10 puffs Ventolin up to 3 times (30 puffs)
• Atrovent is only given during the first round of 10 puffs. Repeat sets are Ventolin only
Ketorolac/Toradol
Indications
Health Canada Approved
IM use only, for the short term management of moderate to severe pain Non Health Canada Approved indication but substantiated in the literature
IV use, for the short term management of moderate to severe pain
Contraindications
Hypersensitivity to ketorolac, any component of formulation, ASA or other non-steroidal anti-inflammatory drugs (NSAID’s)
Active or history of peptic ulcer disease; recent or history of GI bleeding or perforation, inflammatory bowel disease; may increase risk of gastrointestinal irritation, inflammation, ulceration, bleeding, and perforation
Suspected or confirmed cerebrovascular bleeding; hemorrhagic diathesis, incomplete hemostasis, or patient at high risk of bleeding; inhibits platelet function
Patients with advanced renal disease or risk of renal failure due to volume depletion
Severe hepatic impairment or active hepatic disease
Prophylaxis before major surgery; perioperative pain in setting of coronary artery bypass graft (CABG)
surgery; risk of MI and stroke may be increased with use following CABG surgery. Wound bleeding and
postoperative hematomas have been associated with use in perioperative setting
Labor and delivery; may inhibit uterine contractions and adversely affect fetal circulation
Cautions
ELDER ALERT
Elderly, frail, or debilitated patients: are more sensitive to adverse gastrointestinal and renal effects
Dosing
ADULT/ELDERLY
65 years or less
Initial Dose:
o o o
10 mg (if supply is 10mg/1ml), then 10 mg every 4 to 6 hours. 15mg (if supply is 30mg/1ml), then 15 mg every 4 to 6 hours. Total daily dose not to exceed 120 mg
Over age 65 years, patients under 50kg Initial Dose:
o o o
10 mg (if supply is 10mg/1ml), then lowest effective dose every 4 to 6 hours as required. 15mg (if supply is 30mg/1ml), then lowest effective dose every 4 to 6 hours as required. Total daily dose should not exceed 60 mg.
PEDIATRIC (Do not exceed 5 days of total therapy from all routes) Children less than 16 years:
0.2 to 0.5 mg/kg every 6 to 8 hours as required. Max 10 mg every 6 hours
Naloxone/Narcan
Indications
• Complete or partial reversal of narcotic depression, including respiratory depression, induced by opioids
• Diagnosis of suspected acute opioid overdose
Dosing
ADULT/ELDERLY
• 0.5 to 1.0mg IM q 2-3 minutes titrated until ventilations are adequate PEDIATRIC/NEONATE
• 0.1 mg/kg/dose, up to 1 mg/dose q 2-3 minutes titrated until ventilations are adequate
Naproxen/Naprosyn/Aleve
Indications
• Muscle-skeletal trauma
• Burns
• Amputation trauma
• Pain management
Contraindications
ABSOLUTE
• Hypersensitivity to naproxen, ASA, and NSAIDs
• Pregnancy (all trimesters)
RELATIVE
• During CABG surgery
• Renal failure
Cautions
• Ulcers
• GI bleed
• Risk of thrombotic events (CVA, TIA, MI)
• Mothers currently breast feeding (milk I unusable)
Dosing
ADULT/ELDERLY
• 250 – 500 mg PEDIATRICS
• 250 mg. Only to be administered in peds >50 kg
Nitroglycerin/Glyceryl Titrate
Classification
• Vasodilating agent
Indications
• Congestive heart failure associated with acute myocardial infarction
• Severe unstable angina that cannot be controlled by other measures
• Acute pulmonary edema
Contraindications
• Hypersensitivity to nitroglycerin, any component of formulation or a known idiosyncratic reaction to organic nitrates
• Hypotension or uncorrected hypovolemia (e.g. hemorrhage)
• Increased intracranial pressure (e.g. head trauma or cerebral hemorrhage)
• Constrictive pericarditis and pericardial tamponade
• Use of phosphodiesterase-5 inhibitors; sildenafil (viagra) or vardenafil within previous 24 hours: tadalafil within
48 hours
• When used for management of ST-elevation or non-ST-elevation myocardial infarctions avoid nitroglycerin in
the following conditions: Hypotension (SBP less than 90 mm Hg or greater than or equal to 30 mm Hg below baseline), marked bradycardia ( heart rate less then 50bpm) or tachycardia, and right ventricular infarction
Dosing
ADULT/ELDERLY
• 0.4 mg SL q 3-5min (max 3 sprays)
PCP’s must contact medical control if giving nitro in pulmonary edema of cardiac origin
Ondansetron/Zofran
Indications
• Prevention of nausea and vomiting associated with emetogenic chemotherapy and radiotherapy
• Prevention and treatment of post-operative nausea and vomiting in patients 65 years of age and younger
Contraindications
• Hypersensitivity to Ondansetron or any component of the formulation Cautions
• ELDER ALERT
• Elderly: increased risk of QT prolongation, decreased max single dose and rate of administration recommended
• GASTROINTESTINAL
Dosing
ADULT/ELDERLY
65 years or less
• Intravenous - doses 4 mg or less: diluted or undiluted; administer over 2 to 5 minutes q 6 hours
• Infusion – dilute in 50 mL minibag; infuse over 20 minutes
65 years or older
• Give via intermittent infusion – dilute in 50 mL minibag; may infuse over 20 minutes q 6 hours
Concentration: 4 mg in 4 mL
PEDIATRIC
Intravenous
• < 5 years 2mg Administer over 2 to 5 minutes q 6 hours
• > 5 years 4mg Administer over 2 to 5 minutes q 6 hours
Salbutamol/Albuterol/Ventolin
Indications
Health Canada Approved
• Severe bronchospasm associated with acute exacerbations of chronic bronchitis and bronchial asthma
• Treatment of status asthmaticus
Contraindications
• Hypersensitivity to salbutamol or any component of the formulation
• Tachyarrhythmias
• Risk of abortion during first or second trimester
Dosing
ADULT/ELDERLY
• MDI: 10 puffs@100mcg (interspersed with Atrovent) may repeat Ventolin up to 3 rounds; **see below
• Nebulized: 2.5mg – 5.0 mg, may repeat PRN
o HyperkalemiaACP10-20mgover10minutes
PEDIATRIC
• MDI: >20kg: 10 puffs@100mcg (interspersed with Atrovent) may repeat Ventolin up to 3 rounds; **see below
<20kg: 5 puffs @100 mcg (interspersed with Atrovent) may repeat Ventolin up to 3 rounds; **see below <10kg: not indicated
Nebulized: 1.25mg – 2.5mg, may repeat PRN
Dosing of Atrovent and Ventolin should look like this:
• 1 ventolin puff at a time, waiting 30-60 seconds between up to 10 puffs.
Follow each ventolin with a puff of atrovent 10 seconds post.
If the patient in extremis this wait time can be shortened as practitioner feels is appropriate Wait 5 - 10 minutes between sets of 10 puffs to observe for effect.
Repeat sets of 10 puffs up to 3 times (30 puffs)
Atrovent is only given during the first round of 10 puffs. Repeat sets are ventolin only.
