Drug Profile Maintenance Flashcards by Zach Capell

Activated charcoal:
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Activated charcoal:
Mechanism: adsorbs toxins to outside of charcoal

Indications: selected ingestions <2hrs prior

Contraindications: AMS unless administered by NG tube while airway is protected by endotracheal tube

Side effects: abdominal cramping, constipation

Dosage: OHSU: 1g/kg
Till: 50g adult, 1g/kg ped

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Acetaminophen

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Acetaminophen

Class: antipyretic

Mechanism: affects the hypothalmus heat regulation center

Indications: fever

Contraindications: none

Dose: adult - 650-1000 mg
Pediatric - 10-20 mg/kg

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Adenosine:
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Adenosine:
Class/Mechanism: antidysrhythmic; slows/blocks conduction through the AV node

Onset: immediate, half life of 10 seconds

Indications: SVT

Contraindications: AFib or aflutter w/history of WPW

Interactions: theophylline & caffeine decrease the effectiveness of adenosine. Carbamazepine & dipyridamole (seizure meds) potentiate adenosine.

Dosage: adult: 6mg/rapid flush. Follow with up to 2 additional 12mg doses/rapid flush.
Ped: 0.1mg/kg rapid flush, 2nd dose of 0.2mg/kg if needed.

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Albuterol:
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Onset: immediate
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Albuterol:
Class/mechanism: anti-asthmatic beta 2 adrenergic agonist (sympathomimetic)

Onset: immediate
Duration (tillamook): 4-6hrs

Indications: asthma, anaphylaxis, COPD, shortness of breath associated with pneumonia or CHF

Contraindications: none in the prehospital setting

Side effects: minimal beta 1 stimulation may cause hypertension, tachycardia, palpitations or anxiety.

Dosage: 2.5mg in 3mL saline nebulized

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Amiodarone:
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Amiodarone:
Class/mechanism: antidysrhythmic; depresses automaticity of the SA node, slows conduction and increases refractories of the AV node, increases atrial and ventricular refractory periods, prolongs QT interval.

Onset/duration: rapid onset with long duration

Indications: Vfib, pulseless Vtach, vtach w/pulse (wide complex tach)

Contraindications: none (Tillamook - pregnancy)

Side effects: hypotension, prolonged QT, bradycardia, AV block, may be prodysrhythmic.

Dosage: Vfib/pulseless vtach: 300mg, repeat once @ 150mg
Vtach w/pulse: 150mg over 10min.
Pediatric Vfib/pulseless vtach: 5mg/kg, repeat once @2.5mg/kg
Pediatric vtach w/pulse: 2.5mg/kg over 10min,

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Aspirin (ASA, acetylsalicylic acid)
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Aspirin (ASA, acetylsalicylic acid)
Class/mechanism: prostaglandin inhibitor causing platelet inhibition

Indications: cardiac chest pain

Contraindications: active GI bleed, suspected aortic dissection.

Dosage: 324mg

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Atropine
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Atropine
Class: parasympatholytic, anticholinergic, antimuscarinic

Mechanism: competitive antagonist for acetylcholine at the muscarinic receptors blocking the effects of the parasympathetic system.

Onset: immediate

Indications: symptomatic bradycardia, organophosphate poisoning, nerve agent poisoning.

Contraindications: none. Unlikely to be effective with high degree heart blocks. Avoid in hypothermic bradycardia.
Tillamook contraindications: a-flutter, hypothermia

Dosage: bradycardia: 0.5mg q. 3-5min. Max 3mg.
Poisoning: 2-5mg - OLMC for frequency
Pediatric dose (Brady or poison) 0.02 mg/kg q.3-5min. Max 3mg

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Calcium Chloride

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Calcium Chloride

Class/Mechanism: Electrolyte. Antagonizes cardiotoxicity of hyperkalemia by stabilizing cardiac cell membranes against unwanted depolarization.

Onset/Peak: Immediate

Indications: Hyperkalemia, CCB O.D., hypotension associated with mag sulfate, hydrofluoric acid burns.

Contraindications: None

Side Effects: Tissue necrosis; push slowly.

Interactions: Will precipitate if mixed with sodium bicarb

Dosage: 5-10ml slow IV push

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Dexamethasone

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Dexamethasone

Class: corticosteroid, anti-inflammatory

Mechanism: synthetic steroid suppresses chronic and acute inflammation. Reduces bronchial hyper reactivity and mucus production. Increases the number and responsiveness of beta 2 receptors in the lungs.

Indications: asthma, allergic reaction, COPD, croup

Side effects: nausea, vomiting, headache, dizziness

Dosage: adult - 10mg IV or IM
Pediatric - 0.3mg/kg IV or IM

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Dextrose (D50)

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Dextrose (D50)

Class: carbohydrate

Mechanism: increases blood sugar levels

Onset: immediate

Indications: hypoglycemia, hyperkalemia (if given concurrently with insulin)

Precautions: tissue necrosis, use large bore IV. Give concurrent thiamine if malnutrition is suspected.

Dosage: Adult: 25g bolus, may give 2nd 25g dose
Pediatric: 0.5g/kg
I

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Diltiazem (Cardizem)

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Diltiazem (Cardizem)

Class: Calcium Channel Blocker

Mechanism: Inhibits depolarization of the SA & AV nodes, slowing conduction through the AV node.

Onset/Peak: immediate
Duration: 1-3 hrs.

Indications: Afib/Aflutter w/RVR, SVT refractory to adenosine

Contraindications: hypotension, cardiogenic shock, WPW (Wolf Parkinsons White)

Side Effects: hypotension, headache, dizziness, bradycardia, heart block, asystole

Dosage: 0.25mg/kg SLOW IV, may repeat at 0.35mg/kg @ 15min. Max single dose: 20-25mg

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Diphenhydramine

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Diphenhydramine

Class: Antihistamine, H1 antagonist

Mechanism: antagonizes H1 receptors. Also posesses anticholinergic properties resulting in antidyskinetic, antiemetic, and sedative effects.

Onset: <2min IV, 15-30 min IM
Duration: 5-10 min. IV, 20-30 min. IM

Indications: anaphylaxis, allergic reaction, dystonic reaction

Contraindications: none

Side effects: anticholinergic effects

Dosage: 25-50 mg
Pediatric dose: 1mg/kg up to adult dose

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Dopamine

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Dopamine

Class: sympathomimetic, vasopressor

Mechanism: stimulates alpha, beta 1, and dopaminergic receptors.

Onset: rapid onset as long as drip is infused

Indications: Bradycardia, symptomatic hypotension (not in trauma).

Contraindications: pheochromocytoma, uncorrected tachydysrhythmias

Dosage: 5-20mcg/kg/min
5-10mcg/kg/min - increased cardiac output
10-20mcg/kg/min - peripheral vasoconstriction

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Droperidol (Inapsine) & Haloperidol (Haldol)

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Droperidol (Inapsine) & Haloperidol (Haldol)

Class: Sedative, antipsychotic

Mechanism: unknown

Indications: chemical restraint

Contraindications: Hypotension, prolonged QT

Precautions: cardiac monitoring required

Side Effects: extrapyramidal symptoms (have diphenhydramine ready)

Dosage: Droperidol: 14-60y/o = 2.5-5mg IV or IM
Droperidol: over 60 = 2.5mg IV or IM
Haldol: 2-5mg IM

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Epinephrine

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Epinephrine

Class: Sympathomimetic, adrenergic agonist

Mechanism: Alpha 1 stimulation: vasopressor
Beta 1 stimulation: + inotropic, chrono, dromo
Beta 2 stimulation: bronchial dilation, mast cell
inhibition

Onset: immediate (IM: 5-15 min)

Indications: Cardiac arrest per ACLS guidelines
Anaphylxis, bradycardia, croup

Contraindications: none

Interactions: Sodium bicarb will deactivate catecholemines

Dosage: Cardiac Arrest: 1mg 1:10,000
Anaphylaxis: 0.3mg IM 1:1000
Bradycardia: 2-10mcg/min drip
Croup: 0.5 mg nebulized racemic in 3ml saline

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Etomidate

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Etomidate

Class: General anesthetic/induction agent

Mechanism: Decreases activity of the reticular formation in the brain.

Onset: 10-20 sec
Duration: 3-5 min

Indications: RSI

Contraindications: none

Dose: 0.3mg/kg max 20mg

Fentanyl

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Fentanyl

Class: opioid analgesic (narcotic)

Mechanism: binds with opioid receptors in the brain to provide analgesia

Onset: less than 1 minute
Duration: 30-60 min

Indications: moderate to severe pain

Contraindications: hypotension, head injury

Dosage: 2mcg/kg max 100mcg

Glucagon

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Glucagon

Class: hormone, antihypoglycemic

Mechanism: breaks down glycogen stores in liver to raise blood glucose levels. Also stimulates the heart through non-adrenergic means to combat Beta Blocker O.D.

Onset: 5-20 min.

Indications: hypoglycemia when IV is unobtainable, BB O.D., Calcium Channel Blocker O.D.

Contraindications: none

Precautions: ineffective in patients with reduced glycogen stores.

Dosage: hypoglycemia: 1mg IM
BB/CCB O.D.: 3-10mg IV

Furosemide

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Furosemide

Class: Loop Diuretic

Mechanism: blocks reabsorption of Sodium and Chloride in the kindneys causing increased diuresis.

Onset: 5-15 min

Indications: Pulmonary edema, hypertensive crisis, hyperkalemia

Contraindications: hypotension, pregnancy

Precautions: avoid in patients with sulfa allergy or pneumonia

Side Effects: hypotension, hypokalemia, muscle cramps

Dosage: 20-80mg

Insulin

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Insulin

Class: hormone

Indications: hyperkalemia (concurrent D50 if CBG <400)

Dosage: 5-10 units

Lorazepam (what is the trade name)

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Lorazepam - Ativan

Class: Benzo, anticonvulsant, sedative, hypnotic

Mechanism: Enhances activity of GABA, the chief inhibitory neurotransmitter in the brain.

Onset: 1-2 min IV; 5-15 min. IM

Duration: 30-60 min.

Indications: Seizures, premed for cardioversion or TCP, intubation, muscle spasms, anxiety, agitation

Contraindications: hypotension, head injury/Altered mentation (unless for RSI),

Side Effects: Respiratory depression, hypotension

Dosage: 0.05mg/kg IV (max 4mg)

Ipratropium Bromide

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Ipratropium Bromide

Class: parasypatholytic, anticholinergic bronchodilator

Mechanism: Ipratropium is a form of atropine via inhalation. It antagonizes cholinergic muscarinic receptors causing bronchodilation.

Indications: asthma, COPD, anaphylaxis

Contraindications: none

Dosage: 0.5mg nebulized (not given alone - given with albuterol)

Ketorolac (Toradol)

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Ketorolac (Toradol)

Class: NSAID

Mechanism: cox inhibitor prevents the synthesis of prostaglandins

Indications: mild to moderate pain

Contraindications: allergy to NSAIDS

Dose: 30mg IV, 60mg IM (1/2 dose if >65)

Ketamine

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Ketamine

Class: Sedative, analgesic

Indications: RSI, painful procedures

Contraindications: Coronary artery disease, pregnancy, infants <3months, globe injury, schizophrenia

Side Effects: Emergence reaction - consider concurrent administration of 2.5mg versed

Dosage: Induction: 2mg/kg
Painful procedures: 1mg/kg (may repeat q3-5 as needed.

Lidocaine Class: Mechanism: Onset: Duration: Indications: Contraindictions: Dosage: Dosing Precaution:

Lidocaine Class: antidysrhythmic, anesthetic Mechanism: suppresses ventricles. as an anesthetic, it inhibits initiation and conduction of nerve impulses. Onset: <3min Duration: 10-20min Indications: Vfib, pulseless vtach, Wide Complex tachycardia, premed in RSI, local anesthetic Contraindictions: high degree heart block Dosage: Cardiac Arrest: 1.5mg/kg q.3-5min max 3mg/kg WCT: 1.5mg/kg slow bolus may repeat at 1/2 dose in 5-10 min. Post conversion: 1-4mg/min Intubation: 1mg/kg Dosing Precaution: 2nd dose should be 1/4 of 1st dose if: * CHF * Hepatic Failure * Over 70

Magnesium Sulfate Class: Mechanism: Indications: Contraindications: Precautions: Dosage:

Magnesium Sulfate Class: Antidysrhythmic, Electrolyte Mechanism: Increases magnesium levels (hypo magnesia is associated with cardiac dysrhythmias). Magnesium reduces muscle contraction in seizures and bronchoconstriction. Indications:Torsades or cardiac arrest preceded by torsades Eclampsia, pre-eclampsia refractory bronchoconstriction Contraindications: hypotension, heartblock Precautions: can cause respiratory depression - calcium is the antidote. Dosage: Cardiac Arrest preceded by Torsades: 1-2 g. IV push Torsades: 1-2 g. over 5-60 min Eclampsia/Preeclampsia: 2-4g over 5-60 min Refractory Bronchoconstriction: 2g. over 5-60 min

Midazolam (what is the trade name) Class: Mechanism: Onset: Duration: Indications: Contraindications: Side Effects: Dosage:

Lorazepam - Ativan Class: Benzo, anticonvulsant, sedative, hypnotic Mechanism: Enhances activity of GABA, the chief inhibitory neurotransmitter in the brain. Onset: 1-2 min IV; 5-15 min. IM Duration: 30-60 min. Indications: Seizures, premed for cardioversion or TCP, intubation, muscle spasms, anxiety, agitation Contraindications: hypotension, head injury/Altered mentation (unless for RSI), Side Effects: Respiratory depression, hypotension Dosage: 2.5-10mg IV or IM RSI: 0.1mg/kg

Methylprednisolone (solu-medrol) Class: Onset: Indications: Contraindications: Dosage:

Methylprednisolone (solu-medrol) Class: corticosteroid, anti-inflammatory Onset: several hours Indications: anaphylaxis, allergic reacation, asthma, COPD Contraindications: none Dosage: 60-125mg IV or IM

Naloxone (Narcan) Class: Mechanism: Onset: Duration: Indications: Contraindications: Side Effects: Dosage:

Naloxone (Narcan) Class: Opiate antagonist Mechanism: Competitively displaces opiods from their receptor sites, reversion their effects. Onset: 1-2 min Duration: shorter acting than most opioids Indications: symptomatic opioid overdose, clonidine overdose Contraindications: none Side Effects: nausea, vomiting if administered rapidly. Also, narcotic withdrawal symptoms: dizziness, hypertension, tachycardia, sweating, abdominal cramps, headache, weakness, joint & muscle pain Dosage: 0.1-2mg - max 8mg

Morphine Class: Mechanisms: Onset: Duration: Indications: Contraindications: Dosage:

Morphine Class: Opioid Narcotic Analgesic Mechanisms: Opioid agonist provides analgesia. Onset: <5min Duration: 4-6hrs Indications: pain, cardiac pain refractory to nitro, burns, acute pulmonary edema Contraindications: Head injury, AMS, hypotension, undiagnosed abdominal pain Dosage: 2-5mg max 20mg

Nitroglycerin Class: Mechanism: Onset: Indications: Contraindications: Precautions: Side Effects: Dosage:

Nitroglycerin Class: nitrate Mechanism: causes vasodilation which reduces preload. Also dilates coronary arteries improving perfusion. Onset: 1-2 min. Indications: Cardiac chest pain, acute pulmonary edema, hypertensive crisis Contraindications: hypotension >100, recent use of ED meds: Viagra (sildenafil) or Lavitra (vardenafil) <48hrs Precautions: start IV prior to administration, monitor vitals, consider Right sided MI prior to administration Side Effects: hypotension, headache, dizziness, dry mouth Dosage: 0.4mg

Ondansetron - Zofran Class: Mechanism: Indications: Contraindications: Dosage:

Ondansetron - Zofran Class: anti-emetic Mechanism: serotonin inhibitor (5-HT3 receptors) Indications: nausea/vomiting Contraindications: none Dosage: 4mg IV or IM

Sodium Bicarbonate Class: Mechanism: Indications: Contraindications: Interaction: Dosage:

Sodium Bicarbonate Class: Alkalinizing agent Mechanism: reduces hydrogen ion to combat acidosis. When administered for TCA O.D. it acts as an antidysrhythmic. Indications: TCA O.D. Contraindications: none Interaction: will precipitate if mixed calcium will deactivate catecholemines Dosage: 1 mEq/kg IV pushf

Promethazine Class: Mechanism: Onset: Indications: Contraindications: Precautions: Dosage:

Promethazine Class: antiemetic, antihistamine Mechanism: H1 antagonist, antihistamine and anticholinergic properties. Onset: 3-5 minutes Indications: nausea, vomiting, motion sickness, sedation Contraindications: nursing mothers, neonates Precautions: have diphenhydramine available for potential EPS. Dosage: nausea/vomiting: 12.5-25mg IV or IM

Thiamine (Vitamin B1) Class Mechanism Indications Contraindications Dose

Thiamine (Vitamin B1) Class: Vitamin Mechanism: Raises vitamin B1 levels in malnourished patients Indications: Delerium tremens; coma of unknown origin, especially if alcohol is involved. Contraindications: none Dose: 100mg IV

Succinylcholine Class: Onset/duration: Mechanism: Indications: Contraindications: Side effects: Dosage:

Succinylcholine Class: depolarizing neuromuscular blocker Onset/duration: 1-2 min., 6-10 min. Mechanism: acetylcholine agonist binds and depolarizes the nicotinic M receptors causing temporary muscular paralysis. Indications: RSI Contraindications: Hyperkalemia, penetrating eye injury, multiple sclerosis, paralysis >1day, crush injury >3 days, severe burns >3 days. Side effects: increased ICP, hyperkalemia Dosage: 1.5mg/kg Pediatric dose: 2mg/kg

Vasopressin Class: Mechanism: Onset: Duration: Indications: Dosage:

Vasopressin Class: ADH (hormone, vasopressor) Mechanism: ADH in large doses acts as a non-adrenergic peripheral vasoconstrictor. During CPR it increases coronary perfusion pressure. Onset: <2min Duration: 10-20min. Indications: Cardiac Arrest Dosage: 40units IV in accordance with ACLS guidelines

Vecuronium & Rocuronium Class: Onset: Duration: Mechanism: Indications: Contraindications: Rocuronium Dosage: Vecuronium Dosage:

Vecuronium & Rocuronium Class: non-depolarizing neuromuscular blocker Onset: 1 min Duration: 30 min Mechanism: acetylcholine antagonist blocks the nicotinic M receptors causing temporary muscular paralysis. Indications: RSI, paralysis maintenance Contraindications: none Rocuronium Dosage: 0.6mg/kg Vecuronium Dosage: 0.1mg/kg