Drug Indication And Contraindication Flashcards
Acetazolamide
Indications: Acute mountain sickness (treatment
and prophylaxis), adjunctive therapy for
glaucoma, edema, epilepsy, drug-induced edema
or edema due to heart failure.
Contraindications: Hypersensitivity, hypokalemia,
hyponatremia, renal dysfunction, liver
dysfunction
Acetaminophen
Indications: Pain control, fever control
Contraindications: Hypersensitivity, severe acute liver disease
Acetic acid
Indications: Otitis externa,
Pain control for jellyfish envenomation (outside of the USA)
Acetylcysteine
Indications: Antidote for Acetaminophen overdose,
atelectasis, bronchopulmonary disease,
tracheostomy care
Contraindications Hypersensitivity, acute asthma
Activated Charcoal
Indications Most oral poisonings and medication
overdoses; can be used after evacuation of poisons
Contraindications Oral administration to
comatose patients; after ingestion of corrosives,
caustics, petroleum distillates (ineffective
and may induce vomiting); simultaneous
administration with other oral drugs. Use
caution in patients experiencing abdominal pain
of unknown origin or known GI obstruction, Unprotected airway (beware of aspiration), caustic ingestions, intestinal obstruction
Adenosine
Indications: Conversion of narrow-complex
regular tachycardia to sinus rhythm. May
convert reentry SVT due to Wolff-ParkinsonWhite syndrome. Can be used diagnostically
for stable, regular, monomorphic wide-complex
tachycardia. Adenosine may treat the VT or it
may help diagnose the underlying rhythm
Contraindications: Known hypersensitivity.
Second- or third-degree AV block or sick
sinus syndrome or other sinus node disease
unless a functioning artificial pacemaker is
present; bronchoconstrictive or bronchospastic
lung disease (asthma, COPD); poison- or
drug-induced tachycardia
Albuterol
Indications: Treatment of bronchospasm in
patients with reversible obstructive airway
disease (COPD/asthma). Prevention of
exercise-induced bronchospasm
Contraindications: Known prior hypersensitivity
reactions to albuterol. Tachycardia, dysrhythmias,
especially those caused by digitalis. Synergistic
with other sympathomimetics
Amiodarone
Indications: Stable, regular narrow complex
tachycardia if the rhythm persists despite vagal
maneuvers or adenosine or the tachycardia
is recurrent; to control the ventricular
rate in stable, irregular narrow complex
tachycardia (ie, AF); to control the ventricular
rate in preexcited atrial dysrhythmias with
conduction over an accessory pathway;
stable monomorphic VT; polymorphic VT
with a normal QT interval; cardiac arrest
resulting from VF or pulseless VT after CPR,
defibrillation, and a vasopressor
Contraindications: Known hypersensitivity,
cardiogenic shock, second- or third-degree AV
block or sick sinus syndrome or other sinus
node disease unless a functioning artificial
pacemaker is present
Amyl Nitrite
Indications: Cyanide poisoning
Contraindications: None in the emergency setting
Aspirin
Indications: New onset chest discomfort suggestive
of ACS
Contraindications: Hypersensitivity. Relatively
contraindicated in patients with active ulcer
disease or asthma
Atropine
Indications: Hemodynamically unstable
bradycardia, organophosphate poisoning, nerve
agent exposure, RSI in pediatrics, beta-blocker or
calcium channel blocker overdose
Contraindications: Tachycardia, hypersensitivity,
unstable cardiovascular status in acute
hemorrhage with myocardial ischemia, narrow-angle glaucoma, hypothermic bradycardia
Calcium Chloride
Indications: Hypocalcemia, hyperkalemia,
hypermagnesemia, beta-blocker and calcium
channel blocker toxicity, use in topical burns (hydrofluoric acid) or calcium channel blocker overdose
Contraindications: Hypercalcemia, VF (relative),
digitalis toxicity, documented hypersensitivity, life threatening cardiac arrhythmias may occur in known or suspected severe hypokalemia
Calcium Gluconate
Indications: Hyperkalemia, hypocalcemia,
hypermagnesemia, beta-blocker and calcium
channel blocker overdose
For use in topical burns (hydrofluoric acid) or calcium channel blocker overdose
Contraindications: VF, digitalis toxicity,
hypercalcemia
documented hypersensitivity, sarcoidosis, life-threatening cardiac arrhythmias may occur in known or suspected severe hypokalemia
Cimetidine
Indications: For the management of gastric or duodenal ulcers, gastroesophageal reflux, as an adjunct in the treatment of urticarial and pruritis in pts suffering from allergic reaction
Contraindications Hypersensitivity to cimetidine or other H2-receptor antagonists
Dexamethasone
Indications: Used in teh management of croup and bronchospasm, as well as the management of pts suffering from high altitude cerebral edema (HACE)
Contraindications: Documented hypersensitivity, systemic fungal infection, cerebral malaria
Dextrose
Indications: Used for the management of hypoglycemia
Contraindications: Hyperglycemia, anuria, diabetic coma, intracranial or intraspinal hemorrhage, dehydrated pts with delirium, glucose-galactose malabsorption syndrome, and documented hypersensitivity
Diazepam
Indication: For use in agitated or violent pts, as well as for the management for seizures
Contraindications: Documented hypersensitivity, severe respiratory depression
Diltiazem
Indication: For management of narrow complex tachycardias
Contraindications: Documented hypersensitivity, Wolff-parkinson-White syndrome, Lown-Ganong-Levine syndrome, severe symptomatic hypotension (systolic BP < 90 mmHg), sick sinus syndrome (if no pacemaker), second and third-degree heart block (if no pacemaker present), and complete heart block. Contraindications for IV administration: Use in newborns (because of benzyl alcohol), concomitant beta-blocker therapy, cardiogenic shock, ventricular tachycardia (must determine whether the origin is supraventricular or ventricular)
Diphenhydramine
Indications: For urticarial and pruritis in the management of pts suffering from the allergic reaction as well as for the management of pts suffering from dystonia/akasthisia
Contraindications: Documented hypersensitivity, use controversial in lower respiratory tract disease (such as acute asthma), premature infants and neonates
Dopamine
Indications: As a pressor agent used in the management of shock
Contraindications: Hypersensitivity to dopamine, pheochromocytoma, ventricular fibrillation, uncorrected tachyarrhythmias
Droperidol
Indications: For use in the pt when acute delirium or psychosis
Contraindications: Hypersensitivity, known or suspected prolonged QT interval; QTc interval > 450 msec in females or > 440 msec in males
Epinephrine
Indications: For use in the management of pts suffering anaphylaxis, shock, cardiac arrest, bradycardia, or in the nebulized form for coup/bronchiolitis and IM form for refractory acute asthma
Contraindications: Hypersensitivity, cardiac dilatation, and coronary insufficiency
Famotidine
Indications: For the management of gastric or duodenal ulcers gastroesophageal reflux, as an adjunct in the treatment of urticarial and pruritus in pts suffering from an allergic reaction
Contraindications: Hypersensitivity to famotidine or other H2-receptor antagonists
Fentanyl
Indications: management of acute pain
Contraindications: Hypersensitivity
Warning: Should be used with caution in the elderly and pts with hypotension, suspected gastrointestinal obstruction, head injury, and concomitant CNS depressants
Glucagon
Indications: For the management of hypoglycemic pts as well as pts suffering symptomatic bradycardia after beta-blocker or calcium channel blocker overdose
Contraindications: Hypersensitivity, pheochromocytoma, insulinoma
Warning: Nausea and vomiting are common adverse effects following the administration of glucagon
Haloperidol
Indications: For the management of acute psychosis or agitated/violent behavior refractory to non-pharmacologic interventions
Contraindications: Documented hypersensitivity, Severe CNS depression (including coma), neuroleptic malignant syndrome, poorly controlled seizure disorder, Parkinson’s disease
Warning: Risk of sudden death, torsades de pointed, and prolonged QT interval from off-label IV administration of higher than the recommended dose. Continuous cardiac monitoring is required if administering IV
Helium Gas Mixture
Indications: Persistent or severe bronchospasm in non-intubated pts with obstructive airway disease or pediatric pts with croup unresponsive to all other evidence-based medical interventions
Contraindications: None
Hydralazine
Indications: Severe hypertension with pre-eclampsia symptoms
Contraindications: Hypersensitivity, coronary artery disease, mitral valve rheumatic heart disease. Use with caution in CVA, known renal disease, hypotension
Hydrocortisone succinate
Indications: For the management of adrenal insufficiency
Contraindications: Untreated serious infections (except tuberculous meningitis or septic shock), idiopathic thrombocytopenic purpura, intrathecal administration (injection), documented hypersensitivity
Hydromorphone
Indications: Management of acute pain
Contraindications: Hypersensitivity
Warning: Should be used with caution in the elderly and pts with hypotension, suspected
Hydroxocobalamin
Indications: For the management of cyanide toxicity
Contraindications: Documented hypersensitivity
Warning: This will cause discoloration of the skin, and urine can interfere with pulse oximetry. Due to its interference with specific diagnostic blood tests, the performance of prehospital phlebotomy is preferable prior to the administration of hydroxocobalamin
Ibuprofen
Indications: For the acute management of pain or as an antipyretic
Contraindications: Aspirin allergy; perioperative pain in the setting of coronary artery bypass graft (CABG) surgery; preterm infants with untreated proven or suspected infection; bleeding with active intracranial hemorrhage or GI bleed; thrombocytopenia, coagulation defects, proven or necrotizing enterocolitis, significant renal impairment, congenital heart disease where patency or the pt ductus arteriosis (PDA) is necessary for pulmonary or systemic blood flow.
Ipratropium
Indications: For the management of asthma and COPD
Contraindications: Documented hypersensitivity to ipratropium, atropine, or derivatives
Isopropyl Alcohol
Indications: Nausea and vomiting
Contraindications: None
Ketamine
Indications: For the management of agitated or violent behavior
Contraindications: Hypersensitivity
- RELATIVE/CONTROVERSIAL CONTRAINDICATIONS:* Head trauma, intracranial mass/hemorrhage, hypertension, angina, and stroke, underlying psychiatric disorder
- Warning:* Overdose may lead to panic attacks and aggressive behavior; rarely seizures, increased ICP, and cardiac arrest. Very similar in chemical makeup to PCP (phencyclidine), but it is shorter acting and less toxic
Ketorolac
Indications: for the acute management of moderately severe pain
Contraindications: allergy to aspirin, ketorolac, or other NSAIDS; women who are in active labor or are breastfeeding, significant renal impairment particularly when associated with volume depletion, previous or current GI bleeding, intracranial bleeding, coagulation defects, pts with a high risk of bleeding
Labetalol
Indications: Severe hypertension with pre-eclampsia symptoms
Contraindications: Asthma or obstructive airway disease, severe bradycardia, second-degree or third-degree heart block (without pacemaker), cardiogenic shock, bronchial asthma, uncompensated cardiac failure, hypersensitivity, sinus bradycardia, sick sinus syndrome without permanent pacemaker; conditions associated with prolonged and severe hypotension. Use caution in pts taking calcium channel blockers. Hypotension with or without syncope may occur; monitor. Consider pre-existing conditions, such as sick sinus syndrome, before initiating therapy. Use caution in pts with a history of severe anaphylaxis to allergens; pts taking beta-blockers may become more sensitive torepeated challenges; treatment with epinephrine in pts taking beta-blockers may be ineffective or promote undesirable effects. Use with caution in pts with myasthenia gravis, psoriasis, or psychiatric illness (may cause or exacerbate CNS depression)
Lidocaine
Indications: For the management of refractory or recurrent ventricular fibrillation or pulseless VT
Contraindications: Hypersensitivity to lidocaine or amide-type local anesthetic, Adams-Stokes syndrome, SA/AV/intraventricular heart block in the absence of artificial pacemaker. CHF, cardiogenic shock, second and third-degree heart block (if no pacemaker is present), Wolff-Parkinson-White Syndrome
Lorazepam
Indications: For the management of seizures, uncontrolled shivering in hypothermia, and for the management of agitated or violent pts suffering behavioral emergencies
Contraindications: Documented hypersensitivity, acute narrow-angle glaucoma, severe respiratory depression, sleep apnea
Magnesium sulfate
Indications: For the management of torsades de pointed or severe bronchoconstriction with impending respiratory failure, seizure during the third trimester of pregnancy or in the postpartum pt
Contraindications: Hypersensitivity, myocardial damage, diabetic coma, heart block, hypermagnesemia, hypercalcemia
Methylprednisolone
Indications: For the management of acute bronchospastic disease as well as for adrenal insufficiency Contraindications: Untreated serious infections, documented hypersensitivity, IM route is contraindicated in idiopathic thrombocytopenic purpura, traumatic brain injury (high doses)
Metoclopramide
Indications: For the management of nasea and vomiting Contraindications: Hypersensitivity to metoclopramide or procainamide, GI hemorrhage, mechanical obstruction, perforation, history of seizures, pheochromocytoma. Other drugs causing extrapyramidal symptoms (e.g., phenothiazines, butyrophenones)
Metoprolol
Indications: For management of narrow complex tachycardias Contraindications: Hypersensitivity. When administered for hypertension or angia: Sinus bradycardia, second or third-degree AV block, cardiogenic shock, sick sinus syndrome (unless permanent pacemaker in place), severe peripheral vascular disease, pheochromocytoma. When administered for myocardial infarction: Severe sinus bradycardia with heart rate < 45 beats/minute, systolic BP < 100 mmHg, significant first-degree heart block (PR interval at least 0.24 seconds), moderate-to-severe cardiac failure Warning: May cause first, second, or 3rd degree AV block
Midazolam
Indications: For the management of seizures, uncontrolled shivering in hypothermia, and for the management of agitated or violent pts suffering behavioral emergencies
Contraindications: Documented hypersensitivity, severe respiratory depression, sleep apnea
Warning: May cause respiratory depression, arrest, or apnea
Morphine Sulfate
Indications: Management of acute pain
Contraindications: Hypersensitivity, paralytic ileus, toxin-mediated diarrhea, respiratory depression, acute or severe bronchial asthma, upper airway obstruction, GI obstruction (extended-release), hypercarbia (immediate-release tablets/solution), upper airway obstructions (epidural/intrathecal), heart failure due to chronic lung disease, head injuries, brain tumors, delirium tremens, seizure disorders, during labor when premature birth anticipated (injectable formulation), cardiac arrhythmia, increased intracranial or cerebrospinal pressure, acute alcoholism, use after biliary tract surgery, surgical anastomosis (suppository formulation)
Naloxone
Indications: Reversal of acute opioid toxicity
Contraindications: Hypersensitivity
Warning: Administration of naloxone can result in the sudden onset of opiate withdrawal (agitation, tachycardia, pulmonary edema, nausea, vomiting, and, in neonates, seizures)
Nifedipine
Indications: For the management of high altitude pulmonary edema (HAPE)
Contraindications: Hypersensitivity of nifedipine or other calcium-channel blockers, cardiogenic shock, concomitant administration with strong CYP34A4 inducers (e.g., rifampin, rifabutin, phenobarbital, phenytoin, carbamazepine, St. John’s wort) significantly reduces nifedipine efficacy, Immediate release preparation (sublingually or orally) for urgent or emergent hypertension
Nitrous Oxide
Indications: Analgesia in the pt who is capable of self-administration of this medication
Contraindications: Significant respiratory compromise, suspected abnormal air-filled cavities (e.g., pneumothorax, bowel obstruction, air embolism)
RELATIVE CONTRAINDICATIONS: History of stroke, hypotension, pregnancy, known cardiac conditions, known vitamin B12 deficiency
Nitroglycerin
Indications: As an anti-anginal medication for the management of chest pain as well as a reducer of preload for pts suffering from acute pulmonary edema
Contraindications: Hypersensitivity, acute myocardial infarction, severe anemia, recent use of erectile dysfunction medications (sildenafil (viagra–within the last 24 hours), tadalafil (Cialis–within last 48 hours), vardenafil (Levitra–within last 48 hours), or other phosphodiesterase-5 inhibitors). There is potential for dangerous hypotension narrow-angle glaucoma (controversial: may not be clinically significant). Nitrates are contraindicated in the presence of hypotension (SBP < 90 mmHg or > mmHg below baseline), extreme bradycardia (< 50 bpm), tachycardia in the absence of heart failure (>100bpm), and right ventricular infarction
Norepinephrine
Indications: As a pressor agent used in the management of shock
Contraindications: Hypersensitivity, hypotension due to blood volume deficit, peripheral vascular thrombosis (except for lifesaving procedures)
- RELATIVE CONTRAINDICATIONS:* Concomitant use with some general anesthetics: chloroform, trichloroethylene, cyclopropane, halothane
- WARNING:* Norepinephrine is a vesicant and can cause severe tissue damage if extravasation occurs. Do not use the same IV line as alkaline solutions as these may deactivate it
Olanzapine
Indications: For the management of agitated or violent pts suffering a behavioral emergency
Contraindications: Documented hypersensitivity
WARNING: Pts are at risk for severe sedation (including coma) or delirium after each injection and must be observed for at least 3 hours in a registered facility with ready access to emergency response services. Pts are at significant risk of severe sedation when olanzapine is administered with benzodiazepines or to pts who have been taking benzodiazepines
Ondansetron
Indications: For the management of nausea or vomiting
NOTE: EKG monitoring is recommended in pts who have electrolyte abnormalities, CHF, or bradyarrhythmias or who are also receiving other medications that cause QT prolongation
Contraindications: Hypersensitivity, coadministration with apomorphine; combination reported to cause profound hypotension and loss of consciousness
WARNING: May cause dose-dependent QT prolongation, avoid in pts with congenital long QT syndrome
Oxymetazoline
Indications: For the management of epistaxis in the pt suffering facial trauma
Contraindications: hypersensitivity
Potassium iodide
Indications: Indicated during environmental radiation emergency to block uptake of radioactive iodine isotopes in thyroid and reduce risk of thyroid cancer
Contraindications: Iodine sensitivity (although an allergy to radiocontrast media, contact dermatitis from iodine-containing antibacterial, allergy to seafood should not be considered evidence of potassium iodide allergy), hyperthyroidism, respiratory failure
Pralidoxime chloride (2-PAM)
Indications: For the management of toxicity caused by organophosphate insecticides and related nerve gases (e.g., tabun, sarin, soman)
Contraindications: Documented hypersensitivity
Procainamide
Indications: For the management of stable pts with regular, wide complex tachycardia
Contraindications: Hypersensitivity to procainamide or other ingredients, complete heart clock, second or third-degree AV block, systemic lupus erythematosus (SLE), torsades de pointes
RELATIVE CONTRAINDICATION: Pts with QT prolongation
Prochlorperazine
Indications: For the management of nausea and vomiting
Contraindications: Documented hypersensitivity to phenothiazines, coma, severe CNS depression, concurrent use of large amounts of CNS depressants, poorly controlled seizure disorder, subcortical brain damage, pediatric surgery, children < 2 years or weighing < 9kg
Sildenafil
Indications: As an adjunct to descent in the management of high altitude pulmonary edema (HAPE)
Contraindications: Concomitant use of organic nitrates in any form (e.g., nitroglycerin, isosorbide, illicit “poppers”) either regularly or intermittently, increases risk of severe or potentially fatal hypotension, hypersensitivity
WARNING: Hypotension may occur due to vasodilation
Sodium Bicarbonate
Indications: For the management of cardiac arrest in cases in which either hyperkalemia or tricyclic antidepressants (TCA) overdose are suspected as contributory, QRS prolongation in known or suspected TCA overdose
Contraindications: Documented hypersensitivity, severe pulmonary edema, known alkalosis, hypernatremia, or hypocalcemia
Sodium Nitrite
Indications: For the management of cyanide toxicity
Contraindications: Documented hypersensitivity, suspected or confirmed smoke inhalation, and carbon monoxide poisoning
WARNING: There is a risk of worsening hypoxia due to methemoglobin formation. In addition, sodium nitrite can cause severe adverse reactions and death from hypotension and methemoglobin formation. Monitor to ensure adequate perfusion and oxygenation during treatment with sodium nitrite
Sodium Thiosulfate
Indications: For the management of cyanide toxicity
Contraindications: Documented hypersensitivity
Sorbitol
Indications: Administered for the management of pts suffering from toxic ingestions
Contraindications: Acute abdominal pain, nausea, vomiting, or other symptoms of appendicitis or underdiagnosed abdominal pain, documented hypersensitivity
WARNING: Sorbitol is no longer recommended to be given with activated charcoal
Tadalafil
Indications: As an adjunct to descent in the management of high altitude pulmonary edema (HAPE)
Contraindications: Concomitant use of any form of organic nitrates (e.g., nitroglycerin, isosorbide dinitrate, isosorbide mononitrate, illicit “poppers”), either regularly or intermittently; may potentiate hypotensive effect of nitrates. Hypersensitivity, including Stevens-Johnson syndrome and exfoliative dermatitis
WARNING: Hypotension may occur due to vasodilation
Ziprasidone
Indications: For the management of agitated or violent pts suffering a behavioral emergency
Contraindications: Documented hypersensitivity, any drugs or conditions that prolong QT interval, recent acute myocardial infarction, uncompensated heart failure
