Dicer Flashcards
Albuterol
Class - bronchodilator
MoA - Direct and selective beta-2 agonist. Bonds with beta-2 receptors relaxing the smooth muscles of the bronchi
D - Adult 2.5-5mg neb, repeat 15min
Pedi 2.5mg neb, repeat 15min
I - Bronchospasms 2ndary to reactive airway disease, asthma, COPD, emphysema, anaphylaxis, PNA
C - Malignant tachycardias, bronchospasms 2ndary to pulm edema (left sided HF) 1 is 2.5mg in 3ml NS
E
R - Neb kit, O2 at 8LPM
Ipratropium Bromide (Atrovent)
Class - anticholinergic bronchodilator
MoA - blocks acetylcholine on muscarinic receptor sites causing bronchodilation + dries bronchial secretions
D - 500mcg in 2.5mL neb
I - COPD, emphysema, anaphylaxis, asthma
CI - Tachycardia, arrhythmia
R - tremors, tachycardia, nausea
Special - Nebulized. May give concurrently with albuterol treatment
Aspirin (Acetylsalicylic acid)
Class - Platelet aggregate inhibitor
MoA - disrupts platelet aggregation by inhibiting prostaglandin
D - 162-324mg PO chewed, Pedi not indicated
I - AMI
CI - active GI bleed, pregnancy
R - Prolonged bleeding
Special - Sensitivities except ANA should be considered. Increased bleeding times if taking other anticoagulants
Nitroglycerin (Nitrostat)
Class - Vasodilator
MoA - Relaxes smooth muscle, creating instant vasodilation decreasing preload & afterload, decreasing heart workload thus decreasing myocardial O2 demand
D - 0.4mg SL q3-5min (max 3 doses)
NTG spray 0.4mg SL q 3-5min (max 3 doses), pedi not rec
I - AMI, angina, HTN, pulmonary edema 2ndary to CHF
CI - Hypotension, head injury. Concurrent use of erectile dysfunction meds. Viagra, Levitra, Rovatio 24hrs. Cialis 36 hrs
R - Hypotension, headache, syncope, tachycardia, nausea, vomiting
Special - Photosensitive, will deactivate. Ask both genders about ED drugs as they are taken for off label use. Pt must be sitting or recline, standing may increase hypotension and cause syncope.
Morphine
Class - Opioid analgesic
MoA - binds to MU and KAPPA receptors to create CNS depression and alter pain response. Vasodilatory properties reduce venous return to heart, decreasing preload and afterload, which lowers myocardial O2 demand
D - Analgesia - 2-5mg SIVP/IM, repeat prn 5min (max 15mg)
CHF/AMI - 2-4mg SIVP/IO, repeat prn 5 min (max 15mg)
Pedi - Analgesia - IV 0.05mg/kg SIVP (max single dose 2.5mg) repeat 5 min OR IM 0.1mg/kg (max single dose 5mg) repeat 20 min
I - Severe pain, CHF, AMI
CI - Head injury, hypotension, COPD exacerbation, respiratory depression, decreased LOC, MAOI use in last 14 days
R - Hypotension, respiratory depression, bradycardia, apnea, nausea, vomiting
Special - Have narcan available to reverse severe hypotension and respiratory depression. Rapid administration may cause dizziness, nausea/vomiting, hypotension.
Epinephrine
Class - sympathomimetic
MoA - Catecholamine stimulates alpha & beta adrenergic receptors.
Alpha 1 - vasoconstrictions
Beta 1 - inotropy, chronotropy, dromotropy
Beta 2 - bronchial smooth muscle relaxation
D - Adult Asthma - 0.01mg/kg IM (max 0.5mg)
ANA - 0.3-0.5mg IM, repeat 15 min
ANA Shock - 0.1mg slow IVP/IO repeat 10 min
Cardiac arrest - 1mg RIVP/IO q 3-5min
Pedi Asthma - 0.01mg/kg IM (max 0.3mg) repeat 20 min
ANA - 0.01mg/kg IM (min 0.1mg/max 0.5mg) repeat 15 min
Cardiac arrest - 0.01mg/kg RIVP q 3-5min
Systemic brady - 0.01mg/kg w/ maintenance infusion
I - cardiac arrest, anaphylaxis, status asthmaticus, hypotension refractory to TCP & dope
CI - AMI, HTN, hypovolemic shock
R - HTN, tachycardia, arrhythmias, angina, anxiety, restlessness, psychomotor agitation, increased myocardial O2 demand
Special - Beta blockers may blunt effects, 1:1000 epi should never be given IV without dilution, is cardio toxic and heavily increases myocardial O2 demand
Adenosine
Class - Antiarrhythmic, endogenous nucleoside
MoA - Slows cardiac electrical conduction through AV node and interrupts re-entry pathways of the heart
D - 1st rd 6mg RIVP, 2nd rd 12mg RIVP (each followed by 20mL flush)
Pedi - 1st rd 0.1mg/kg RIVP/IO (max single dose 6mg), 2nd rd 0.2mg/kg RIVP/IO (max single dose 12mg)
I - Supraventricular tachycardia SVT
CI - Afib, atrial flutter, afib with WPW, Vtach, non-malignant tachycardia
R - SOB, CP, arrhythmia, nausea
Special - Large bore IV 18G+ in right AC facilitates quick action on heart due to extremely short half life of drug. Consider non re-entry causes for tachycardia (fever, shock, pain, anxiety)
Atropine
Class - Anticholinergic agent
MoA - Blocks acetylcholine on cardiac receptor sites and interrupts parasympathetic nerve fibers which increases SA node electrical activity resulting in increased HR.
Organophosphate poisonings - Blocks the accumulation of acetylcholine in the synapse reducing cholinergic overload
D - Bradycardia - 0.5mg RVIP q 3-5min (max 3mg)
Organophosphate poisoning - large doses of 2mg or more may be administered, base order indicated.
Pedi - 0.02mg/kg IV/IO (single max 0.5mg, total 3mg)
Organophosphate poisoning - base order indicated
I - Symptomatic bradycardia - bradycardia with hypotension and other signs of poor perfusion, organophosphate poisoning
C - Symptomatic bradycardia in heart transplant pts, high degree AV block with wide complexes, bradycardias with reversible causes (narcotic OD)
R - Tachycardia, arrhythmia, paradoxical bradycardia
Special - Med must be delivered RIVP to reduce chance of refractory bradycardia. May cause pupil dilation.
Amiodarone
Class - Antiarrhythmic
MoA - Prolongs the action potential and refractory period in cardiac tissues including multiple pacemakers of the heart. Decreases myocardial automaticity and prolongs AV conduction.
D - Vfib/Pulseless Vtach - 300 mg RIVP/IO, repeat 5 min with 150mg RIVP/IO
Stable perfusing Vtach - 150mg IV/IO drip over 10 min
Pedi - Vfib/Pulseless Vtach - 5 mg/kg RIVP/IO q 5 min to total dose of 15 mg/kg
I - Vfib, pulseless and perfusing Vtach
CI - Bradycardia, heart blocks, junctional beats, idioventricular rhythms
R - Bradycardia, hypotension, ataxia, tremors, pulmonary edema, decreased inotropy, prolonged QT interval
Special - Concurrent digoxin use may cause digitalis toxicity. Other antiarrhythmics potentiate. Beta blockers or calcium channel blockers may increase risk of bradycardias and heart blocks.
