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2019 Paramedic Drug Profiles > Dosages & Special Considerations > Flashcards

Dosages & Special Considerations Flashcards

1
Q

ADULT DOSAGES
 160 to 325 mg
SPECIAL CONSIDERATION
 When administered with other anti-inflammatory drugs and anticoagulants such as warfarin
(Coumadin®), the drug may increase adverse reactions and side effects

A

acetylsalicylic acid

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2
Q

ADULT DOSAGES
 6.0 mg RAPID bolus over 1 to 3 seconds followed by 20 mL normal saline flush
 If no response to the initial bolus after 1 to 2 minutes, administer 12 mg RAPID bolus over 1 to 3
seconds followed by 20 mL normal saline flush
PEDIATRIC DOSAGES
 0.1 mg/kg (up to 6.0 mg) RAPID bolus over 1 to 3 seconds followed by
5 to10 mL normal saline flush
 If no response to the initial bolus after 1 to 2 minutes, administer 0.2 mg/kg
(up to 12 mg) RAPID bolus over 1 to 3 seconds followed by 5 to 10 mL normal saline flush
SPECIAL CONSIDERATIONS
 Constant monitoring of the cardiac rhythm is required during administration of the drug
 The onset of the drug is 20 to 30 seconds
 The peak effect of the drug is 20 to 30 seconds
 The half-life of the drug is 6 to 10 seconds
 The duration of the drug is 30 seconds

A

adenosine

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3
Q

ADULT DOSAGES
 2.5 mg in 3.0 mL normal saline (unit dose) via small volume nebulizer
 2.5 mg in 3.0 mL normal saline (unit dose) via in-line small volume nebulizer with a bag-valvemask
 May repeat the dosage
PEDIATRIC DOSAGES
 2.5 mg in 3.0 mL normal saline (unit dose) via small volume nebulizer
 2.5 mg in 3.0 mL normal saline (unit dose) via in-line small volume nebulizer with a bag-valve
mask
 May repeat the dosage
SPECIAL CONSIDERATION
 The drug may be used in conjunction with ipratropium bromide (Atrovent®)

A

albuterol (Proventil, Ventolin)

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4
Q

ADULT DOSAGES
 Cardiac arrest: 300 mg
 If no response, administer 150 mg over 3 to 5 minutes
 Tachydysrhythmias: 150 mg in 50 mL D5W infused over 10 minutes
 Infusion: 1.0 mg/minute
PEDIATRIC DOSAGES
 Ventricular fibrillation: 5.0 mg/kg
 May repeat the dosage every 5 minutes twice
 Maximum dosage 300 mg
 Ventricular tachycardia: 5.0 mg/kg over 20 minutes
 May repeat the dosage twice
SPECIAL CONSIDERATION
 Monitoring of the cardiac rhythm for prolonged PR interval and QT interval is required during
administration of the drug

A

amiodarone (Cordarone)

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5
Q

ADULT DOSAGES
 Hemodynamically significant bradycardia: 0.5 mg
 May repeat the dosage every 3 to 5 minutes to maximum dosage 3.0 mg
 Organophosphate poisoning/carbamate poisoning/nerve agent exposure:
1.0 to 4.0 mg
 May double the dosage every 5 minutes
 ET: 2.0 to 2.5 mg diluted in 10 mL normal saline
PEDIATRIC DOSAGES
 Hemodynamically significant bradycardia: 0.02 mg/kg
 May repeat the dosage every 3 to 5 minutes to maximum dosage 1.0 mg in children and 2.0 mg
in adolescents
 Organophosphate poisoning/carbamate poisoning/nerve agent exposure: 0.03 to 0.05
mg/kg every 10 to 20 minutes
SPECIAL CONSIDERATION
 Consider transcutaneous pacing for refractory bradydysrhythmias

A

atropine sulfate

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6
Q 
ADULT DOSAGES
 500 to 1,000 mg (0.5 to 1.0 Gm)
 May repeat the dosage in 10 minutes
PEDIATRIC DOSAGE
 0.2 to 0.25 mL/kg of a 10% solution
SPECIAL CONSIDERATIONS
 The drug may be used as a pretreatment to administration of diltiazem (Cardizem®)
 The drug may cause bradydysrhythmias when administered to a patient prescribed digoxin
(Lanoxin®)
A

calcium chloride

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7
Q 
ADULT DOSAGES
 30 to 60 Gm (1.0 to 2.0 Gm/kg)
PEDIATRIC DOSAGES
 0.5 to 1.0 Gm/kg
SPECIAL CONSIDERATION
 The drug may cause serious pulmonary complications if aspirated
A

charcoal, activated

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8
Q

ADULT DOSAGES
 12.5 to 25 Gm
PEDIATRIC DOSAGES
 IV/IO/infusion: 0.5 to 1.0 Gm/kg of a D10 solution over 20 minutes
SPECIAL CONSIDERATIONS
 Check the blood glucose level before administering the drug
 Check the blood glucose level after each additional dosage of the drug
 Confirm hypoglycemia before administering the drug to a stroke patient or a patient with a
possible traumatic brain injury
 The drug may be used in conjunction with thiamine (vitamin B1)
 An infusion pump should be used to administer the drug when possible

A

dextrose 50%

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9
Q 
ONSETS OF ACTION
 IV/IO: 2 to 5 minutes
 IM: 15 to 30 minutes
 Rectal: variable
ADULT DOSAGES
 2.0 mg increments over 2 minutes
PEDIATRIC DOSAGES
 IV/IO: 0.2 to 0.3 mg/kg
 IM: 0.1 to 2.0 mg/kg
 Rectal: 0.2 to 0.5 mg/kg
SPECIAL CONSIDERATION
 The drug may be administered rectally to pediatric patients, but efficacy of rectal administration to
adults has not been established
A

diazepam (Valium)

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10
Q

ONSET OF ACTION
 2 to 5 minutes
ADULT DOSAGES
 0.25 mg/kg (usually 20 mg) over 2 minutes
 May repeat the dosage 0.35 mg/kg (usually 25 mg) in 15 minutes
 Infusion: 5.0 to 15 mg/hour
SPECIAL CONSIDERATIONS
 Consider decreasing the dosage for elderly patients
 Consider pretreatment with calcium chloride
 An infusion pump should be used to administer the drug when possible

A

diltiazem (Cardizem)

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11
Q

ADULT DOSAGES
 Allergic reaction/anaphylaxis: 25 to 50 mg
 Phenothiazine reaction with extrapyramidal symptoms: 10 to 50 mg
PEDIATRIC DOSAGES
 1.0 to 1.25 mg/kg
SPECIAL CONSIDERATION
 Consider the dosage of the drug according to severity of the allergic reaction or anaphylaxis

A

diphenhydramine (Benadryl)

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12
Q 
THERAPEUTIC DOSAGE RANGE & RESPONSES
 2.0 to 5.0 mcg/kg/minute:
o Negligible beta-adrenergic response
 5.0 to 10 mcg/kg/minute:
o Beta-adrenergic responses
 Positive chronotropic effects
 Positive inotropic effects
 10 to 20 mcg/kg/minute:
o Alpha-adrenergic responses
 Vasoconstriction
 Increased blood pressure
 Increased preload
 > 20 mcg/kg/minute:
o May increase the heart rate and myocardial oxygen demand to undesirable limits

ADULT DOSAGES
 Infusion: 2.0 to 20 mcg/kg/minute

PEDIATRIC DOSAGES
 Infusion: 2.0 to 20 mcg/kg/minute

SPECIAL CONSIDERATION
 An infusion pump should be used to administer the drug when possible

A

dopamine

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13
Q

ADULT DOSAGES
 Cardiac arrest: 1.0 mg (1:10,000) IV/IO
 May repeat the dosage every 3 to 5 minutes during resuscitation
 Cardiac arrest: 2.0 to 2.5 mg (1:1,000) ET diluted in 10 mL normal saline
 May repeat the dosage every 3 to 5 minutes during resuscitation
 Hemodynamically significant bradycardia: 2.0 to 10 mcg/minute infusion
 Hemodynamically significant hypotension: 2.0 to 10 mcg/minute infusion
 Bronchospasm associated with chronic bronchitis and emphysema/allergic
reaction/anaphylaxis: 0.3 to 0.5 mg (1:1,000) IM
o Adult EpiPen® auto-injector 0.3 mg IM

PEDIATRIC DOSAGES
 Cardiac arrest: 0.01 mg/kg (1:10,000) IV/IO
 May repeat the dosage every 3 to 5 minutes during resuscitation
 Cardiac arrest: 0.1 mg/kg (1:1,000) ET diluted in 3.0 to 5.0 mL normal saline
 May repeat the dosage every 3 to 5 minutes during resuscitation
 Hemodynamically significant bradycardia: 0.01 mg/kg (1:10,000) IV/IO
 Hemodynamically significant bradycardia: 0.1 mg/kg (1:1,000) ET diluted in 3.0 to 5.0 mL
normal saline until IV/IO access
 Bronchospasm associated with asthma/allergic reaction/anaphylaxis: 0.01 mg/kg (1:1,000)
IM
o EpiPen Jr. ® auto-injector 0.15 mg IM

SPECIAL CONSIDERATIONS
 The drug can increase adverse reactions and side effects when administered with another
sympathomimetic drug
 An infusion pump should be used to administer the drug when possible

A

epinephrine

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14
Q

ADULT DOSAGES
 0.2 to 0.6 mg/kg (usually 20 mg) over 30 to 60 seconds

PEDIATRIC DOSAGES
 Older than 10 years: 0.2 to 0.4 mg/kg over 30 to 60 seconds
 Maximum dosage 20 mg

SPECIAL CONSIDERATIONS
 Duration of the drug is 3 to 5 minutes
 Peak effects of the drug is less than 1 minute

A

etomidate

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15
Q

ADULT DOSAGES
 25 to 50 mcg
 Maximum dosage 200 mcg

PEDIATRIC DOSAGES
 1.0 to 2.0 mcg/kg
 Maximum dosage 50 mcg

SPECIAL CONSIDERATIONS
 Duration of the drug is 30 to 60 minutes
 100 mcg of the drug is equivalent to 10 mg morphine

A

fentanyl

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16
Q

ADULT DOSAGES
 1.0 mg
 May repeat the dosage in 7 to 10 minutes

PEDIATRIC DOSAGES
 5 years or younger or less than 44 pounds (20 kg): 0.5 mg
 5 years or older or more than 44 pounds (20 kg): 1.0 mg
 May repeat the dosage in 7 to 10 minutes

SPECIAL CONSIDERATIONS
 Check the blood glucose level before administering the drug
 Check the blood glucose level after an additional dosage of the drug
 The drug may be used in conjunction with dextrose 50% (D50®)

17
Q

ADULT DOSAGES
 500 mcg (0.5 mg) in 2.5 mL normal saline (unit dose) via small volume nebulizer (SVN)
 In-line with a bag-valve mask (BVM): 500 mcg (0.5 mg) in 2.5 mL normal saline (unit dose) via
SVN
 May repeat the dosage

PEDIATRIC DOSAGES
 500 mcg (0.5 mg) in 2.5 mL normal saline (unit dose) via small volume nebulizer (SVN)
 In-line with a bag-valve mask (BVM): 500 mcg (0.5 mg) in 2.5 mL normal saline (unit dose) via
SVN
 May repeat the dosage

SPECIAL CONSIDERATION
 The drug may be used in conjunction with albuterol (Proventil®)

A

ipratropium bromide (Atrovent)

18
Q

ADULT DOSAGES
 IV/IO: 1.0 to 2.0 mg/kg over 1 minute
 IM: 2.0 to 4.0 mg/kg

SPECIAL CONSIDERATION
 Duration of the drug is 5 to 10 minutes

19
Q

ADULT DOSAGES
 VF and pulseless VT: 1.0 to 1.5 mg/kg
 May repeat the dosage 0.5 to 0.75 mg/kg every 3 to 5 minutes during resuscitation
 Maximum dosage 3.0 mg/kg
 Ventricular dysrhythmias with a pulse: 1.0 to 1.5 mg/kg
 May repeat the dosage 0.5 to 0.75 mg/kg in 5 to 10 minutes
 Maximum dosage 3.0 mg/kg
 Maintenance infusion: 2.0 to 4.0 mg/minute
 ET: 2.0 to 2.5 times the bolus dosage diluted in 10 mL normal saline

PEDIATRIC DOSAGES
 VF and pulseless VT: 1.0 mg/kg
 May repeat the dosage 1.0 mg/kg one time in 3 to 5 minutes during resuscitation
 Ventricular dysrhythmias with a pulse: 1.0 mg/kg
 May repeat the dosage in 5 to 10 minutes
 Maximum dosage 3.0 mg/kg
 Maintenance infusion: 20 to 50 mcg/kg/minute
 ET: 2.0 to 2.5 times the bolus dosage diluted in 3.0 to 5.0 mL normal saline

SPECIAL CONSIDERATIONS
 Consider decreased dosages for elderly patients and patients with liver disease due to reduced
metabolic function
 An infusion pump should be used to administer the drug when possible

20
Q

ADULT DOSAGES
 Seizure IV/IO: 2.0 to 5.0 mg over 2 minutes
 Seizure IM: 2.0 to 5.0 mg
 Procedural sedation IV/IO: 2.0 mg over 2 minutes
 Procedural sedation IM: 4.0 mg
 Maximum dosage: 10 mg

PEDIATRIC DOSAGES
 Seizure IV/IO/IM: 0.05 to 0.1 mg/kg over 2 minutes
 Maximum dosage 4.0 mg

SPECIAL CONSIDERATION
 The drug may produce longer periods of sedation with elderly patients

A

lorazepam (Ativan)

21
Q

ADULT DOSAGES
 Torsades de pointes infusion: 1.0 to 2.0 Gm in 50 to 100 mL over 5 minutes
 May repeat the dosage 1.0 to 2.0 Gm over 1 hour
 Pre-term labor/pre-eclampsia/eclampsia infusion: 3.0 to 6.0 Gm in 100 mL over 10 to 20
minutes
 May repeat the initial dosage
 Maintenance infusion: 1.0 to 4.0 Gm/hour
 Reactive airway conditions: 2.0 Gm in 50 mL over 5 to 10 minutes
 Cardiac arrest IV/IO: 1.0 to 2.0 Gm over 1 to 2 minutes

PEDIATRIC DOSAGES
 Reactive airway conditions infusion: 25 to 50 mg/kg of a 10% solution infused over 15 to 30
minutes
 Maximum dosage 2.0 Gm

SPECIAL CONSIDERATION
 An infusion pump should be used to administer the drug when possible

A

magnesium sulfate

22
Q

ADULT DOSAGE
 125 mg

PEDIATRIC DOSAGES
 2.0 to 4.0 mg/kg

SPECIAL CONSIDERATIONS
 Peak effect of the drug is 8 hours
 Duration of the drug is 18 to 36 hours

A

methylprednisolone (Solu-Medrol)

23
Q

ADULT DOSAGES
 Seizure IV/IO: 0.1 mg/kg
 Maximum dosage: 4.0 mg
 Seizure IM: 0.2 mg/kg
 Maximum dosage: 10 mg
 Procedural sedation IV/IO: 0.5 to 2.5 mg
 Maximum dosage: 0.1 mg/kg
 Chemical restraint IV/IO: 0.05 to 0.1 mg/kg
 Chemical restraint IM: 0.1 to 0.15 mg/kg

PEDIATRIC DOSAGES
 Seizure IV/IO: 0.05 to 0.1 mg/kg
 Seizure IM: 0.2 mg/kg
 Maximum dosage: 10 mg
 Procedural sedation IV/IO: 0.05 to 0.5 mg/kg
 Maximum dosage 0.1 mg/kg

SPECIAL CONSIDERATIONS
 Consider decreased dosages for elderly patients and patients with liver and kidney disease due
to reduced metabolic function

A

midazolam (Versed)

24
Q

ADULT DOSAGES
 1.0 to 4.0 mg increments over 1 to 5 minutes

PEDIATRIC DOSAGES
 0.1 to 0.2 mg/kg

SPECIAL CONSIDERATIONS
 Duration of the drug is 2 to 7 hours
 Respiratory arrest/depression can be revered by naloxone (Narcan®)

A

morphine sulfate

25
Q

ADULT DOSAGES
 2.0 mg
 May repeat the dosage every 2 minutes
 ET: 4.0 mg diluted in 10 mL normal saline
 Intra-nasal (IN): 1.0 mg sprayed in each nostril with a mucosal atomizer device (MAD)
 May repeat the dosage every 2 minutes

PEDIATRIC DOSAGES
 0.1 mg/kg (up to 2.0 mg per dosage)
 May repeat the dosage every 2 minutes
 ET: 2.0 to 4.0 mg diluted in 3.0 to 5.0 mL normal saline
 Intra-nasal (IN): 1.0 mg sprayed in each nostril with a mucosal atomizer device (MAD)
 May repeat the dosage every 2 minutes

SPECIAL CONSIDERATION
 Duration of the drug is 20 minutes to 2 hours

26
Q

ADULT DOSAGES
 Tablet: 0.4 mg
 Single spray: 0.4 mg
 May repeat the dosage in 3 to 5 minutes twice after the initial dosage

SPECIAL CONSIDERATION
 Peak effect of the drug is 5 to 10 minutes

A

nitroglycerin

27
Q

ADULT DOSAGE
 Self-administered and self-regulated by the patient

PEDIATRIC DOSAGE
 Self-administered and self-regulated by the patient

SPECIAL CONSIDERATIONS
 The patient must hold the mask to the face while inhaling the drug
 Duration of the drug is 2 to 5 minutes

A

nitrous oxide 50%

28
Q

ADULT DOSAGES
 Oral: 8.0 mg
 IV/IO: 4.0 to 8.0 mg over 2 to 5 minutes

PEDIATRIC DOSAGES
 4 to 14 years oral/IV/IO: 4.0 mg
 Maximum dosage 4.0 mg

SPECIAL CONSIDERATIONS
 Peak effect of the drug is 2 hours
 Duration of the drug is 3 to 6 hours

A

ondansetron (Zofran)

29
Q 
ADULT DOSAGES
 15 to 50 Gm
 May repeat the dosage
PEDIATRIC DOSAGES
 5.0 to 50 Gm
 May repeat the dosage
SPECIAL CONSIDERATIONS
 Check the blood glucose level before administering the drug
 Check the blood glucose level after each additional dosage of the drug
A

oral glucose

30
Q

Oxygen Delivery &
Ventilation Devices
Delivery Rate Oxygen Percentages

nasal cannula 1 to 6 L/minute 24 to 44%
simple face mask 8 to 10 L/minute 40 to 60%
partial nonrebreather mask 15 L/minute 80 to 90%
nonrebreather mask 10 to 15 L/minute up to 90%
Venturi® mask variable 24 to 40%
mouth-to-mask device without supplemental
oxygen N/A 16 to 17%
mouth-to-mask device with supplemental
oxygen 15 L/minute up to 55%
bag-valve mask with reservoir 15 L/minute up to 100%
continuous positive air pressure (CPAP)
variable up to 80%

SPECIAL CONSIDERATION
 In the emergency setting, delivery of high-flow oxygen does not have a significant respiratory
depressive effect on the patient with a cardiovascular condition or chronic obstructive pulmonary
disease specifically emphysema

31
Q

ADULT DOSAGES
 Infusion: 10 to 20 U in 1,000 mL (1.0 L) of NS or LR titrated to the severity of hemorrhage and
uterine response
 IM: 10 U

SPECIAL CONSIDERATION
 An infusion pump should be used to administer the drug when possible

32
Q

ADULT DOSAGES
 1 to 2 sprays in the nostril

SPECIAL CONSIDERATION
 The drug is used in conjunction with a properly-sized nasotracheal tube and lubrication

A

phenylephrine (Neo-Synephrine)

33
Q

ADULT DOSAGES
 1.0 mEq/kg
 May repeat the dosage 0.5 mEq/kg every 10 minutes

PEDIATRIC DOSAGES
 1.0 mEq/kg
 May repeat dosage 0.5 mEq/kg every 10 minutes

SPECIAL CONSIDERATION
 The drug must be used in conjunction with effective ventilation

A

sodium bicarbonate

34
Q

ADULT DOSAGES
 0.6 to 2.0 mg/kg
 May repeat the dosage once in 2 to 3 minutes

PEDIATRIC DOSAGES
 1.0 to 2.0 mg/kg
 May repeat the dosage once in 2 to 3 minutes

SPECIAL CONSIDERATION
 Duration of the drug is 8 minutes

A

succinylcholine

35
Q

ADULT DOSAGE
 100 mg

PEDIATRIC DOSAGES
 10 to 25 mg

SPECIAL CONSIDERATION
 The drug may be administered prior to dextrose 50% (D50)

A

thiamine (vitamin B1)

36
Q

ADULT DOSAGES
 Cardiac arrest IV/IO: 40 U administered once
 Cardiac arrest ET: 40 U diluted in 10 mL normal saline

SPECIAL CONSIDERATION
 Duration of the drug is 30 to 60 minutes

A

vasopressin

37
Q

ADULT DOSAGES
 2.5 mg over 2 minutes
 May repeat the dosage 5.0 to 10 mg in 15 to 30 minutes
 Maximum dosage 30 mg

SPECIAL CONSIDERATION
 Administer the drug over 3 minutes to elderly patients

2019 Paramedic Drug Profiles (4 decks)

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