Drug contra-indications

Question 1

ADENOSINE / ADENOCARD®

Answer 1

1. Second or third degree heart block (except in patients with a functioning artificial pacemaker)
2. Sick sinus syndrome (except in patients with a functioning artificial pacemaker)
3. Pregnancy (relative contraindication since no studies have been performed)

Question 2

ALBUTEROL 0.083 %

Answer 2

Known hypersensitivity

Question 3

AMIODARONE / CORDARONE

Answer 3

1. Cardiogenic shock
2. Marked sinus bradycardia,
3. Second or third degree AV block in the absence of a functioning pacemaker.

Question 4

ASPIRIN (ACETYLSALICYLIC ACID))

Answer 4

1. Known allergy

2. Active or recent GI bleed

Question 5

ATROPINE SULFATE

Answer 5

Precaution ONLY

1. Used cautiously in atrial fibrillation and flutter because increased conduction may speed ventricular rate excessively.
2. Initiate pacing if any delay in administering atropine.
3. Bradycardia in the setting of an acute MI is common and probably beneficial. Do not treat unless there are signs of poor perfusion (low blood pressure, mental confusion). Chest pain could be due to an MI or to poor perfusion caused by the bradycardia itself.

Question 6

ATROVENT / IPRATROPIUM

Answer 6

Known allergy to atrovent or atropine.

Question 7

CALCIUM CHLORIDE 10%

Answer 7

Precaution ONLY

1. Do not give simultaneously with sodium bicarbonate. Flush tubing well between medications.
2. Use with caution in patients on digoxin. May precipitate digoxin toxicity. May cause arrhythmias.
3. Necrosis can occur if the medication infiltrates.

Question 8

CHARCOAL, ACTIVATED / ACTIDOSE® WITH SORBITOL

Answer 8

Patients who are unconscious or with altered mental status.

Question 9

CYANIDE ANTIDOTE: CYANOKIT

Answer 9

Precaution ONLY

A separate IV should be established for other medications to prevent precipitation.

Question 10

DEXTROSE

Answer 10

Precaution ONLY

1. If feasible, check blood glucose to confirm hypoglycemia prior to administration of dextrose. Certain neurological problems may be worsened with hyperglycemia.
2. Extravasation of dextrose will cause necrosis of tissue. IV should be secure and free return of blood into the syringe or tubing should be checked multiple times during administration.

Question 11

DILAUDID® / HYDROMORPHONE HYDROCHLORIDE

Answer 11

1. Pediatric patients, labor, respiratory depression or when ventilatory function is depressed such as status asthmatics, COPD, emphysema.
2. Patients who are hypersensitive to dilaudid or other opiates; those with intracranial lesions associated with ICP.
3. Acute exacerbation of chronic pain is not an indication for dilaudid.
4. Hypotension.

Question 12

DIPHENHYDRAMINE HCL / BENADRYL®

Answer 12

Precaution ONLY
May cause hypotension when given IV.
1. Drowsiness, confusion, dizziness, blurred vision, confusion wheezing and thickening of bronchial secretions as well as tachycardia, palpitations, dry mouth., especially in elderly
2. May have additive effect with alcohol or other depressants.

Question 13

DOPAMINE / INTROPIN®

Answer 13

Hypovolemic Shock.

Question 14

DROPERIDOL / INAPSINE®

Answer 14

1. Coronary artery disease
2. Cardiac medications
3. Liver or kidney disease
4. Use of tricyclic antidepressants
5. <2 Years of age.

Question 15

EPINEPHRINE

Answer 15

Precaution ONLY

1. Must be used very cautiously in patients with hypertension, hyperthyroid-ism, ischemic heart disease, or cerebrovascular insufficiency.
2. Should not be added directly to bicarbonate infusion

Question 16

ETOMIDATE / AMIDATE®

Answer 16

Known allergy

Question 17

FENTANYL / SUBLIMAZE

Answer 17

Known allergy

Question 18

GLUCAGON

Answer 18

Side Effect ONLY

Nausea and vomiting may occur.

Question 19

GLUCOSE, ORAL

Answer 19

Diminished level of consciousness resulting in the patient’s inability to protect their airway.

Question 20

LIDOCAINE / XYLOCAINE®

Answer 20

Precaution ONLY
Lidocaine toxicity symptoms include: drowsiness, disorientation, decreased hearing, paresthesia, muscle twitching, and agitation.

Question 21

MAGNESIUM SULFATE 10%

Answer 21

Precaution ONLY

1. Since magnesium sulfate affects neuromuscular transmission in body it must be given carefully and monitored closely in the patient with a pulse.
2. Early warning that magnesium toxicity is developing is decrease in reflexes measured at patella, antecubital area or heel.

Question 22

MIDAZOLAM /VERSED®

Answer 22

Precaution ONLY

1. Can cause marked respiratory depression.
2. Use with caution in patients who have ingested alcohol or other depressant medications.
3. Use with caution in patients that are hypotensive.

Question 23

NALOXONE HCL / NARCAN®

Answer 23

Precaution & Side Effect
1. In patients physically dependent on narcotics, frank and occasionally violent withdrawal symptoms may be precipitated, titrate to reversal of respiratory depression.
2. Be prepared to restrain the patient.
May result in nausea, vomiting, sweating, tachycardia, increased BP, tremulousness or dysrhythmias and rarely flash pulmonary edema.

Question 24

NITROGLYCERIN

Answer 24

Systolic BP < 90 mmHg.
Precaution
1. Generalized vasodilatation may cause reflex tachycardia.
2. Erectile dysfunction drugs within 24 hours. MD order
3. Use with caution with inferior MI, may cause severe hypotension.

Question 25

ONDANSETRON / ZOFRAN®

Answer 25

1. Known allergy
2. Patient is <one month of age
   Side Effect
3. Possible QT prolongation.
4. Headache, localized redness at injection site, dizziness/lightheadedness, drowsiness, and hypoxia can occur rarely.

Question 26

PROPARACAINE HCL / ALCAINE®

Answer 26

1. Ruptured globe.

2. Allergy to proparacaine.

Question 27

ROCURONIUM / ZEMURON®

Answer 27

Known allergy to rocuronium.

Question 28

SODIUM BICARBONATE

Answer 28

Precaution ONLY

Should not be given in mixture with epinephrine, norepinephrine, dopamine, or calcium.

Question 29

SOLU-MEDROL /METHYLPREDNISOLONE

Answer 29

Allergy to steroids

Question 30

SUCCINYLCHOLINE / ANECTINE®, QUELICIN®

Answer 30

1. Known allergy to succinylcholine.
2. Documented hyperkalemia from physician’s office and EKG changes (peaked T-waves and QRS widening.)
3. Suspected hyperkalemia:
   • Signs of hyperkalemia: Peaked T waves, lowered P wave amplitude, prolonged P-R interval, second degree AV blocks, and widened QRS complexes.
   • Causes of hyperkalemia:
   • Renal failure/insufficiency (acute or chronic)
   • Addison’s Disease (Adrenal Insufficiency)
   • Sepsis/DKA (acidosis)
   • Severe Dehydration
   • Transplant rejection
   • Rhabdomyolysis
   • Muscular dystrophy patients
   • Paraplegia/quadriplegia patients
   • Crush injuries
   • Serious burns (onset after several hours)
   • Angiotensin-converting enzyme (ACE) inhibitors
   • Excessive use of potassium supplements
4. Known personal or family history of malignant hyperthermia or pseudocholinesterase deficiency.

PRecaution & Side Effect

1. May cause bradycardia especially with repeat doses and in patients < 5 years. This will usually respond to oxygenation and atropine.
2. Burn > 72 hours.
3. Tachycardia, hypotension, hypertension and cardiac arrest.
4. Transient hyperkalemia
5. Increases intracranial pressure, pre-medication with lidocaine or fentanyl will blunt this effect.