Contraindications Flashcards
acetaminophen
Severe active liver disease
activated charcoal
● Unprotected airway
● Altered mental status
● Absence of a gag reflex
● Ileus
● Intestinal obstruction
● Ingestion of petroleum distillates, hydrocarbons, heavy metals, acids, alkalis,
corrosives, alcohols, iron, lithium, and solvents
adenosine
● Second- and third-degree AV blocks
● Sick sinus syndrome or other sinus node disease (unless a functioning artificial
pacemaker is present)
● Poison/drug-induced tachycardia
● Atrial fibrillation, atrial flutter, and ventricular tachycardia
● Polymorphic wide complex tachycardia
● Hemodynamically unstable tachycardia
albuterol
● Dysrhythmias (especially those caused by digitalis)
● Symptomatic tachycardias
● CHF
amiodorone
● Iodine hypersensitivity
● Cardiogenic shock
● Second- and third-degree AV blocks
● Sick sinus syndrome or other sinus node disease (unless a functioning artificial
pacemaker is present)
aspirin
●Hypersensitivity to NSAIDs
● ASA-intolerant asthma
● Bleeding disorders
● Hemolytic anemia
● Lactating mothers
● Hemorrhagic stroke
● Active bleeding (relative)
atropine
Note: all the following contraindications listed are relative
● Evolving MI
● Narrow-angle glaucoma
● GI obstruction
● Severe ulcerative colitis
● Toxic megacolon
● Bladder outlet obstruction
● Myasthenia gravis
● Hemorrhage with cardiovascular instability
Note: all the following contraindications listed are relative
● Evolving MI
● Narrow-angle glaucoma
● GI obstruction
● Severe ulcerative colitis
● Toxic megacolon
● Bladder outlet obstruction
● Myasthenia gravis
● Hemorrhage with cardiovascular instability
Note: all the following contraindications listed are relative
● Evolving MI
● Narrow-angle glaucoma
● GI obstruction
● Severe ulcerative colitis
● Toxic megacolon
● Bladder outlet obstruction
● Myasthenia gravis
● Hemorrhage with cardiovascular instability
● Thyrotoxicosis
calcium chloride
● Digoxin toxicity
● Hypercalcemia
● Suspected severe hypokalemia
calcium gluconate
●Digoxin toxicity
● Hypercalcemia
● Suspected severe hypokalemia
dexamethasone
●Systemic fungal infections
● Preterm infants
● Penetrating spinal cord injury
dextrose
●Hyperglycemia
● Severe dehydration
● Anuria
● Diabetic coma
● Intracranial or intraspinal hemorrhage
● Glucose-galactose malabsorption syndrome
diazepam
●Neurologic or respiratory depression
● Narrow-angle glaucoma
● Myasthenia gravis
● Head injury
diltiazem
●Hypotension
● Cardiogenic shock
● Wide-complex tachycardia
● Second- and third-degree AV blocks
● Sick sinus syndrome or sinus node disease (without functioning artificial
pacemaker)
● Poison/drug-induced tachycardia
● A-fib or a-flutter associated with an accessory bypass tract (i.e. WPW or LGL)
● Left ventricular systolic dysfunction
● Decompensated heart failure
diphenhydramine hydrochloride
●Newborns and premature infants
● Late stage pregnancy
● Breastfeeding mothers
● Asthma
● Narrow-angle glaucoma
● Benign prostatic hypertrophy
● Alcohol intoxication
dopamine hydrochloride
● Hypovolemia
● Pheochromocytoma
● Uncorrected tachydysrhythmias
● V-fib
epinephrine
●Coronary insufficiency
● Cardiac dilation
● Active labor
● Hyperthyroidism (relative)
● Uncontrolled hypertension (relative)
● Hypothermia (relative)
● Pulmonary edema (relative)
● Myocardial ischemia (relative)
● Hypovolemic shock (relative)
etomidate
● Labor and delivery
● Septic shock (particularly in children)
fentanyl citrate
● MAOI use within the last 14 days
● Hypotension
● Hypoxia after oxygen therapy
● Hypoventilation
● Severe hemorrhage or shock
● Myasthenia gravis
● GCS <15 (relative)
flumazenil
●TCA overdose
● Known seizure history
● Altered level of consciousness of unknown etiology
furosemide
● Hypovolemia
● Anuria
● Hypotension (relative)
● Hepatic encephalopathy
● Suspected electrolyte imbalances
glucagon
●Pheochromocytoma
● Hyperglycemia
● Insulinoma
glucose, oral
● Decreased level of consciousness
● Nausea/vomiting
haloperidol
● Severe depression
● Neuroleptic malignant syndrome
● Poorly controlled seizure disorder
● Parkinson disease
● Agitation secondary to shock and hypoxia
dilaudid
● MAOI use during the previous 14 days
● GI tract obstruction
● Hypotension (relative)
● Hypoxia (relative)
● Respiratory depression (relative)
● Head injury (relative)
● Older adults (relative)
● Altered level of consciousness (relative)
hydroxycobalamin
None
ibuprofen
● Known ASA hypersensitivity
● ASA-sensitive asthma
● Renal function impairment
● Pregnancy
● Known peptic ulcer disease
● Active intracranial hemorrhage
● Active GI bleed
● Thrombocytopenia
● Coagulation defects
● Necrotizing enterocolitis
● Perioperative pain from CABG
ipratropium bromide
● Hypersensitivity to atropine, alkaloids, or peanuts
● Urinary retention (relative)
● Narrow-angle glaucoma (relative)
● Cardiovascular disease (relative)
● Hypertension (relative)
ketamine
● Infants <3 months
● Pregnancy and breastfeeding mothers
● Chest pain
● Heart failure
● Symptomatic hyperthyroidism
● Significant mental health history (i.e PTSD, schizophrenia)
● Conditions where hypertension would be hazardous to patient care
● Intracranial lesions
● Patients with potential for increased ICP (relative)
ketorolac tromethamine
● ASA-sensitive asthma
● ASA allergy
● Renal insufficiency/impairment/ transplant
● Pregnancy, breastfeeding, or active labor
● Known peptic ulcer disease
● Hypotension
● History of GI bleed
● Active bleeding including GI, intracranial, or traumatic injuries
● Current use of steroids or anticoagulants (may increase bleeding time)
● Coagulation defects
● Patients older than 65
labetolol
● Asthma
● Heart failure
● Cardiogenic shock
● Second- and third-degree AV block
● Bradycardia
lidocaine hydrochloride
● Hypersensitivity to amide-type local anesthetics or any of the “caines”
● Prophylactic use in AMI
● Second- and third- degree AV blocks (without functioning artificial pacemaker)
● Ventricular escape rhythm
● WPW
● SVT
lorazepam
● Neurologic or respiratory depression
● Shock states
● Acute narrow-angle glaucoma
● Sleep apnea
magnesium sulfate
● Heart blocks
● Myocardial damage
● Diabetic coma
● GI obstruction
● Hypermagnesemia
● Hypercalcemia
● Hypotension
● Known renal insufficiency (relative)
mannitol
● Hypotension
● Pulmonary edema and severe pulmonary congestion
● Electrolyte abnormalities
● Severe dehydration
● Intracranial bleeding
● Heart failure
● Impaired renal function (relative - can result in fluid overload)
methylprednisolone sodium succinate
● Premature infants
● Systemic fungal infections
● Cushing disease
● Hypertension
● Heart failure (relative)
● Penetrating spinal cord injury (relative)
● Active GI bleed (relative)
midazolam hydrochloride
● Neurologic or respiratory depression
● Acute narrow-angle glaucoma
● Sleep apnea
● Overdose of, and concomitant use with, CNS depressants (including alcohol)
● Depressed vital signs, including shock states
morphine sulfate
● MAOI use in the previous 14 days
● Paralytic ileus
● Toxin-mediated diarrhea
● Heart failure due to chronic lung disease
● Head injury
● Hypoventilation
● Hypotension
● Bradycardia
● Brain tumor
● Delirium tremens
● Seizure disorders
● Active labor of premature infant
● Acute or severe asthma
● Upper airway obstruction
● GCS <15 (relative)
● Older patients (relative)
● Breastfeeding mothers and pregnancy (relative)
● Hypoxia after supplemental oxygen (relative)
naloxone hydrochloride
● Neonates of opioid-addicted mothers (relative)
● Opioid dependency (relative)
nitroglycerin
● Hypotension (SBP <90 OR at least 30mmHg below baseline)
● Hypovolemia
● Intracranial bleeding
● Head injury
● Cardiac tamponade
● Severe brady/tachycardia
● Right ventricular infarct
● Sildenafil (Vaigra) or vardenafil (Levitra) within 24 hours
● Tadalafil (Cialis) within 48 hours
● Hepatic disease (relative)
● Anemia (relative)
● Diabetes (relative)
● Breastfeeding mothers and pregnancy (relative)
norepinephrine bitartrate
● Hypotension secondary to hypovolemia
● Current MAOI use
● Pregnancy (relative)
ondansetron hydrochloride
● Long QT syndrome
● Patients taking apomorphine (can cause significant hypotension and syncope)
oxygen
Paraquat and diquat poisoning
oxytocin
Active labor
pheylephrine
Geriatric patients with preexisting cardiovascular disease (relative)
pralidoxime
None
procainamide hydrochloride
● Torsades de Pointes
● Second- and third-degree AV block (without functioning artificial pacemaker)
● Systemic lupus erythematosus
● Preexisting QT prolongation
● Digitalis toxicity
● TCA overdose
● Asthma (relative)
● Digitalis-induced dysrhythmias (relative)
● Myasthenia gravis (relative)
promethazine hydrochloride
● Known hypersensitivity to any phenothiazines
● Concurrent use of large amounts of CNS depressants
● Reye syndrome
● Lower respiratory symptoms
● Children <2 years
● Sleep apnea
● Respiratory impairment
● Seizure disorders
● Breastfeeding mothers
● Concurrent administration of Haldol or droperidol
rocuronium bromide
● Hypersensitivity to bromides
● Inability to control the airway or support ventilation
● Neuromuscular disease
● Heart and liver disease (relative)
sodium bicarbonate
● Known metabolic or respiratory alkalosis
● Hypokalemia
● Hypernatremia
● Hypocalcemia
● Heart failure (relative)
● Renal disease (relative)
succinylcholine chloride
● Inability to control the airway or support ventilation
● Renal failure
● Neuromuscular diseases
● Para/quadriplegia
● Penetrating eye injury
● Prolonged immobilization
● Stroke with residual motor dysfunction
● History of malignant hyperthermia
● Multisystem trauma
● Burns
● Known or suspected hyperkalemia, including injury-induced hyperkalemia
terbutaline sulfate
● Tachydysrhythmias
● Prevention of preterm labor
thiamine hydrochloride
None
tranexiamic acid
● Mechanism of injury more than 3 hours prior to EMS care
● Subarachnoid hemorrhage
● Isolated head injury
● History of PE, DVT or other thromboembolic disorder
vecuronium bromide
● Hypersensitivity to bromides
● Inability to control the airway or support ventilation
● Neuromuscular disease
● Acute narrow-angle glaucoma
● Penetrating eye injury
● Newborns
● Hepatic or renal failure
verapamil hydrochloride
● WPW and LGL
● Second- and third-degree AV block, sick sinus syndrome, or other sinus node
disease*
● Hypotension
● Cardiogenic shock
● Severe left ventricular dysfunction
● Wide complex tachycardias
● Children <12 months
*Unless a functioning artificial pacemaker is present
