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Paramedic Shit > Drug Profiles > Flashcards

Drug Profiles Flashcards

1
Q

Fentanyl - what guidelines contain indications for use

A
  • STEMI chest pain unresponsive to nitrates
  • Management of Acute Pain
  • Synchronized Cardioversion & NIPPV
  • RSI (post-sedation)
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2
Q

Fentanyl - pharmacology & actions

A
  • opioid agonist-analgesic
  • increases pain threshold
  • produces analgesia and sedation
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3
Q

Fentanyl- absolute contraindications

A
  • O2 sat < 90%
  • significant respiratory depression
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4
Q

Fentanyl- precautions and side effects

A
  • causes neurologic and respiratory depression; respiratory support must be available
  • can be reversed with Narcan
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5
Q

Fentanyl- administration and dosage

A

IV / IO / IN

STEMI: 0.5 mcg/kg; max 200 mcg
PAIN: 1 mcg/kg; max initial dose 100 mcg; max total dose 200 mcg
Consider 1/2 dose if age > 60 years

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6
Q

Fentanyl - how is it carried?

A

100 mcg / 2 mL
2 vials

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7
Q

EPINEPHRINE
“Push-dose”
1:100,000
- concentration? And how do we make it?

A

10 mcg/mL
We make a concentration of 10 mcg/mL by adding 1 mL “Code Epi” (0.1 mg/mL) to 9 mL saline flush)

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8
Q

EPINEPHRINE
1:100,000
“Push-dose”
- Guidelines containing indications

A
  • Bradycardia
  • Shock
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9
Q

EPINEPHRINE
1:100,000
“Push-dose”
- dosages

A

10-20 mcg (1-2 mL) every 2 minutes

Peds: 0.01 mcg/kg = (0.1mL) every 2 minutes

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10
Q

EPINEPHRINE
- pharmacology & actions

A
  • catecholamine with alpha and beta effects which increase heart rate and blood pressure
  • potent bronchodilator
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11
Q

EPINEPHRINE
- indications

A
  • cardiac arrest
  • bradycardia
  • shock (hypotension)
  • anaphylaxis
  • severe wheezing (IM)
  • croup and bronchiolitis (nebulized)
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12
Q

EPINEPHRINE
- absolute contraindications

A
  • allergy
  • uncontrolled hypertension (relative contraindication)
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13
Q

EPINEPHRINE
- precautions and side effects

A
  • increases cardiac work and can precipitate angina, MI, or major dysrhythmias in patients with ischemic heart disease
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14
Q

EPINEPHRINE
1:10,000
“Code Epi”
- how do we carry it

A

1 mg/10 mL
6 boxes

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15
Q

EPINEPHRINE
1:10,000
“Code Epi”
- dosages

A

1 mg every 3-5 minutes; max 3 doses

Peds: 0.01 mg/kg (max 1 mg); max 3 doses

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16
Q

EPINEPHRINE
1:1,000
- How do we carry it?

A

1 mg/ mL
5 vials

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17
Q

EPINEPHRINE
1:1,000
- what guidelines contain indications

A

Anaphylaxis (IM)
Wheezing (IM)
Croup, bronchiolitis (nebulized)

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18
Q

EPINEPHRINE
1:1,000
- dosages

A

IM: 0.01 mg/kg; max 0.3 mg

Nebulized: 5 mg

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19
Q

SUCCINYLCHOLINE
- how do we carry it?

A

200 mg/ 10 mL
2 vials

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20
Q

SUCCINYLCHOLINE
- pharmacology and actions

A
  • depolarizing neuromuscular blocker
  • acts on the motor end plate receptors, inhibits neuromuscular transmission
  • muscles are unable to be stimulated by Ach
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21
Q

SUCCINYLCHOLINE
- indications

A

Induction of paralysis to facilitate endotracheal intubation

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22
Q

SUCCINYLCHOLINE
- absolute contraindications

A
  • malignant hyperthermia
  • hyperkalemia
  • penetrating eye injury
  • paraplegia/quadraplegia
  • prolonged immobilization
  • allergy
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23
Q

SUCCINYLCHOLINE
- precautions and side effects

A
  • use with caution in patients with anticipated difficult airway
  • has no effect on consciousness - use with sedatives
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24
Q

SUCCINYLCHOLINE
- dosage

A

1.5 mg/kg IV/IO
One time dose only

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25
Q

AMIODARONE
- how do we carry it?

A

150 mg/ 3 mL
3 vials

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26
Q

AMIODARONE
- pharmacology and actions

A
  • anti-arrhythmic
  • blocks potassium-, sodium-, calcium-channels
  • prolongs cardiac action potential and repolarization
  • decreases AV node conduction
  • has some alpha- and beta-adrenergic blocking properties
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27
Q

AMIODARONE
- indications

A

V-fib
Pulseless v-tach
Regular/irregular wide complex tachycardia with a pulse

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28
Q

AMIODARONE
- absolute contraindications

A

-allergy
-second or third degree AV blocks

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29
Q

AMIODARONE
- precautions and side effects

A

May cause hypotension and bradycardia

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30
Q

AMIODARONE
- dosages

A

CODE: 5 mg/kg (max 300 mg); repeat at 1/2 dose
TACHYCARDIA: 150 mg over 10 min

PEDS: 5 mg/kg

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31
Q

ETOMIDATE
- how do we carry it?

A

40 mg/ 20 mL
2 vials

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32
Q

ETOMIDATE
- pharmacology and actions

A
  • sedative and hypnotic
  • depresses activity of the reticular activating system
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33
Q

ETOMIDATE
- contraindications

A

Allergy

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34
Q

ETOMIDATE
- dosage

A

IV/IO 0.3 mg/kg
MAX 20 mg
one time dose only

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35
Q

CARDIZEM/DILTIAZEM
- how do we carry it

A

25 mg/ 5 ml
2 vials

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36
Q

CARDIZEM/DILTIAZEM
- pharmacology and actions

A
  • calcium channel blocker
  • inhibitory effects at AV node: slows ventricular rate associated with Afib and Aflutter
  • decreases cardiac contraction; thereby dilating main coronary and systemic arteries
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37
Q

CARDIZEM/DILTIAZEM
- indications

A
  • narrow complex tachyarrhythmias: Atrial fibrillation/atrial flutter
  • SVT not responding to adenosine
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38
Q

CARDIZEM/DILTIAZEM
- absolute contraindications

A
  • heart block /bradycardia
  • systolic BP < 90mmHg
  • sick sinus syndrome
  • V tach
  • allergy
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39
Q

CARDIZEM/DILTIAZEM
- precautions and side effects

A
  • prolongation of AV node conduction may result in second or third degree AV block
  • should not be administered to compromised myocardium (severe CHF, AMI …)
  • use caution when giving to hypotensive patients
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40
Q

CARDIZEM/DILTIAZEM
- dosages

A

1st dose: 0.125 mg/kg; max 12.5 mg over 2 minutes; patients >65 years old, max 10 mg

2nd dose: 0.125 mg/kg;

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41
Q

ATROPINE
- pharmacology and actions

A

-blocks action of ACH at muscarinic receptor sites
-blocks parasympathetic response, allowing sympathetic response to take over
-positive chronotropic with little/no inotropic effects: increases heart rate; increases conduction through AV node

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42
Q

ATROPINE
- indications

A
  • symptomatic bradycardia
  • organophosphate poisoning
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43
Q

ATROPINE
-absolute contraindications

A
  • bradycardia without evidence of cardiopulmonary compromise
  • atropine allergy
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44
Q

ATROPINE
- dosage

A

1 mg IV/IO every 3-5 minutes
Max total dose 3 mg

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45
Q

ADENOSINE
- pharmacology and actions

A
  • slows conduction through the AV node
  • interrupts AV nodal circuit, stopping tachycardia, restoring normal sinus rhythm
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46
Q

ADENOSINE
- indications / guidelines

A
  • to convert hemodynamically stable narrow complex regular tachycardia with a pulse (SVT)
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47
Q

ADENOSINE
- dosage

A
  • 6 mg IV/IO; follow with 10 mL bonus
  • 12 mg IV/IO; follow with 10 mL bonus

PEDS:
- 0.1 mg/kg IV/IO; max 6 mg
- repeat at 0.2 mg/kg IV/IO max 12 mg

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48
Q

ADENOSINE
- how do we carry it

A

6 mg/2 mL
3 vials

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49
Q

GLUCAGON
- pharmacology & actions

A
  • increases serum glucose by releasing glycogen stores from the liver
50
Q

GLUCAGON
- indications

A
  • hypoglycemia (less than 60 mg/dL)
51
Q

GLUCAGON
- absolute contraindications

A
  • not the first line treatment for hypoglycemia and should only be used in symptomatic patients when unable to obtain IV/IO access
52
Q

GLUCAGON
- precautions & side effects

A
  • may cause nausea and vomiting
  • slower onset than IV/IO dextrose
53
Q

ALBUTEROL
- pharmacology and actions

A
  • beta2-adrenergic bronchodilator
  • relaxes bronchial smooth muscle
  • also lowers serum potassium (shifts potassium intracellular)
54
Q

ALBUTEROL
- indications

A
  • treatment of bronchospasm
  • treatment of hyperkalemia
55
Q

ALBUTEROL
- absolute contraindications
- precautions/allergies

A
  • none other than ALBUTEROL allergy
  • may cause dizziness, palpitations, HA
  • significant arrhythmias may occur in cardiac patients
  • relative contraindications include tachycardia, tachyarrhythmias, or angina chest pain
56
Q

ALBUTEROL
- our guidelines containing ALBUTEROL

A
  • bronchospasm
  • anaphylaxis & allergic reaction
  • hyperglycemia (hyperkalemia)
  • extremity trauma (hyperkalemia)
  • dermal chemical burns (hyperkalemia)
57
Q

ALBUTEROL
- dosage

A

5 mg nebulized
Repeat as neede

58
Q

ALBUTEROL
- how do we carry it

A
  • 2.5 mg / 5 mL
59
Q

ASPIRIN
- how do we carry it

A

81 mg tablets

60
Q

ASPIRIN
- pharmacology and actions

A
  • disrupts platelet function and inhibits prostaglandin
61
Q

ASPIRIN
- contraindications/precautions/side effects

A

CONTRA:
- active GI bleed
- if patient has taken 324 mg in last 24 hours
- allergy

  • may cause: GI discomfort/nausea/wheezing
62
Q

ASPIRIN
- which protocols?

A

Chest Pain/ACS/STEMI

63
Q

ATROPINE
- how do we carry it

A

1 mg / 10 mL
3 boxes

64
Q

DIPHENHYDRAMINE (BENADRYL)
- how do we carry it

A

50 mg/ 1mL
2 vials

65
Q

DIPHENHYDRAMINE (BENADRYL)
- pharmacology and actions

A
  • blocks histamine receptors in respiratory tract and blood vessels
  • also has anticholinergic actions (can treat acute dystonic reactions to antipsychotic drugs)
66
Q

DIPHENHYDRAMINE (BENADRYL)
- indications

A
  • treatment of allergic reactions: urticaria, rash, itching
  • treatment or prevention of acute dystonic reactions to antipsychotic drugs
67
Q

DIPHENHYDRAMINE (BENADRYL)
- contraindications / precautions /side effects

A

CONTRA:
- allergy
- newborns

  • usually causes sedation, may cause paradoxical excitation in children
  • may cause hypotension when given IV/IO
68
Q

DIPHENHYDRAMINE (BENADRYL)
- which protocols?

A
  • Anaphylaxis and Allergic Reaction
  • Poisoning / Overdose
69
Q

DIPHENHYDRAMINE (BENADRYL)
- dosage

A

1 mg/kg
IV/IO/IM/PO
Max dose 50 mg

70
Q

IPRATROPIUM BROMIDE (ATROVENT)
- how is it carried

A

0.5 mg/2.5 mL
(3 packets)

71
Q

IPRATROPIUM BROMIDE (ATROVENT)
- pharmacology and actions

A
  • anticholinergic: Antagonizes action of acetylcholine on the bronchial smooth muscle in the lungs
  • causes bronchodilation
72
Q

IPRATROPIUM BROMIDE (ATROVENT)
- indications

A
  • bronchoconstriction (asthma and COPD)
  • may be given in combination with albuterol
73
Q

IPRATROPIUM BROMIDE (ATROVENT)
- contraindications / precautions / side effects

A

CONTRA
- none other than allergy

  • use with caution in patients with narrow angle glaucoma
  • may cause palpitations, dizziness, HA
74
Q

IPRATROPIUM BROMIDE (ATROVENT)
- dosage

A

0.5 mg nebulized with albuterol
Max 3 doses

75
Q

Drugs indicated for Bronchospasm due to Asthma and COPD

A
  • albuterol / atrovent (5 mg / 0.5 mg)
  • epinephrine (for severe respiratory distress) 0.3 mg IM of 1:1000
  • Solu-Medrol 2 mg/kg IV IO IM; max 125 mg
  • magnesium sulfate 50 mg/kg max dose 2 g
  • (NIPPV)
76
Q

KETAMINE
- how do we carry it?

A

500 mg / 5 mL

77
Q

KETAMINE
- pharmacology and actions

A
  • non-competitive NMDA receptor antagonist
  • functions as a dissociative, amnestied, analgesic, and anesthetic agent
78
Q

KETAMINE
- indications

A
  • delirium with agitated behavior
  • induction agent for intubation
  • pain control
79
Q

KETAMINE
- absolute contraindications

A
  • angina
  • CHF
  • pregnancy
  • allergy
  • not indicated for postictal patients
  • not indicated in pediatric patients
80
Q

KETAMINE
- precautions and side effects

A
  • transient periods of apnea (1-2 minutes) have occurred with rapid infusion of ketamine
  • may cause laryngospasm
  • may cause increased airway secretions
  • may cause nystagmus
  • use with caution in patients with schizophrenia
81
Q

KETAMINE
- which protocols?

A
  • Agitated or Violent Patients
  • Acute Pain
  • RSI
82
Q

KETAMINE
- dosage

A

PAIN
- 0.25 mg/kg IV/IO
-Max per dose 25 mg/ Max total dose 100 mg
- Should be administered slow IV push or may be diluted in 50 mL NS and administered over 3-5 minutes
AGITATION
- 4 mg/kg IM/IN max 250 mg
- may repeat once after 5 minutes

83
Q

LIDOCAINE
- how do we carry it

A

100 mg / 5 mL
One box

84
Q

LIDOCAINE
- pharmacology and actions

A
  • antiarrhythmic drug that decreases automaticity by slowing depolarization
  • local anesthesia for IO
85
Q

LIDOCAINE
- indications

A
  • cardiac arrest due to Vfib or Vtach
  • wide complex tachycardia with a pulse
  • pain management after IO insertion in conscious patients
86
Q

LIDOCAINE
- absolute contraindications / precautions / side effects

A

CONTRA:
- bradycardia
- allergy

  • at higher doses may cause CNS stimulation, seizure, respiratory failure
  • toxicity is more likely in elderly patients with CHF
87
Q

LIDOCAINE
- dosages

A

IO PAIN MANAGEMENT:
- Adults 40 mg IO (2mL)
- Peds 0.5 mg/kg MAX 40 mg

CARDIAC:
- 1-1.5 mg/kg every 5 minutes
- MAX 3 mg/kg
- may repeat at 1/2 original dose

88
Q

METHYLPREDNISOLONE (SOLU-MEDROL)
- pharmacology and actions

A
  • anti-inflammatory corticosteroid
  • reduces cell permeability
89
Q

METHYLPREDNISOLONE (SOLU-MEDROL)
- how do we carry it

A

125 mg /2 mL
2 vials

90
Q

METHYLPREDNISOLONE (SOLU-MEDROL)
- indications

A
  • Acute bronchospastic disease: asthma/COPD
91
Q

METHYLPREDNISOLONE (SOLU-MEDROL)
- contraindications

A

Traumatic brain injury
Allergy

92
Q

METHYLPREDNISOLONE
- which protocols contain it?

A

Bronchospasm
Shock

93
Q

METHYLPREDNISOLONE (SOLU-MEDROL)
- dosages

A

2 mg/kg IV IO IM
Max dose 125 mg
** onset 1-6 hours / peak effect 8 hours

94
Q

ONDANSETRON (ZOFRAN)
- pharmacology and actions

A
  • selectively blocks serotonin 5-HT3 receptors in brain
  • primary effect is in GI tract
95
Q

ONDANSETRON (ZOFRAN)
- indications

A

Nausea or vomiting

96
Q

ONDANSETRON (ZOFRAN)
- contraindications / precautions & side effects

A

CONTRA
- patients with prolonged QT
- patients <1 month old
- allergy

  • may cause QT prolongation
97
Q

ONDANSETRON (ZOFRAN)
- dosages

A

4 mg IV / IO / oral

Pediatrics: 0.15 mg/kg max 4 mg

98
Q

ONDANSETRON (ZOFRAN)
- how do we carry it

A

4 mg / 2 mL
2 vials

99
Q

MORPHINE
- how do we carry it

A

10 mg / 1 mL
2 vials

100
Q

MORPHINE
- pharmacology and actions

A
  • narcotic analgesic
101
Q

MORPHINE
- indications

A

Analgesia (pain management)

102
Q

MORPHINE
- absolute contraindications

A
  • respiratory or CNS depression
  • hypotension
  • allergy
103
Q

MORPHINE
- precautions and side effects

A
  • causes neurological and respiratory depression
  • can be reversed with halo one
  • check and document vital signs and patient response after each dose
  • goal is reduction of pain, not total elimination
104
Q

MORPHINE
- protocols

A

Management of Acute Pain
Chest Pain/ACS/STEMI

105
Q

MORPHINE
- dosages

A

PAIN MANAGEMENT
0.1 mg/kg IV/IO
Max 2-5 mg increments
Max total dose 15 mg

STEMI, unresponsive to nitrates
0.05 mg/kg IV/IO
Max single dose 3 mg
May repeat in 10 minutes to total max of 10 mg
**use with caution in unstable angina/non-STEMI due to increased mortality

106
Q

ATROPINE
- how do we carry it

A

1 mg / 10 mL
3 boxes

107
Q

NITROGLYCERIN
- how do we carry it

A

0.4 mg tablets

108
Q

NITROGLYCERIN
- pharmacology and actions

A
  • potent smooth muscle relaxant
  • systemic venodilation: decreases preload
  • arterial vasodilation: decreases after load
  • coronary artery vasodilation
  • increases blood flow to myocardium
  • decreases myocardial oxygen demand
109
Q

NITROGLYCERIN
- indications

A
  • chest pain, esp when ACS is suspected
  • CHF with pulmonary edema
110
Q

NITROGLYCERIN
- absolute contraindications

A
  • hypotension (SBP below 90 mmHg)
  • use of erectile dysfunction meds within last 48 hours
  • not for use in pediatrics
  • allergy
111
Q

NITROGLYCERIN
- precautions and side effects

A
  • may cause profound hypotension and reflex tachycardia
  • common side effects include HA, flushing, dizziness, burning under the tongue
112
Q

NITROGLYCERIN
- which protocols?

A

Chest Pain / ACS / STEMI
Pulmonary Edema

113
Q

NITROGLYCERIN
- dosages

A
  • 0.4 mg tablets sublingual
  • May repeat every 3-5 minutes, until pain resolves, as BP allows
  • location of infarct does not preclude use, however continuously monitor hemodynamic status
114
Q

What drugs are indicated in our Chest Pain / ACS / STEMI protocol?

A
  • aspirin 324 mg
  • nitroglycerin 0.4 mg
  • fentanyl 0.5 mcg/kg (50 mcg / 50 mcg) max 200 mcg
  • morphine 0.05 mg/kg; max single dose 3 mg; total max 10 mg
115
Q

What drugs are indicated in Bradycardia protocol?

A
  • (pace if unstable!)
  • push dose Epi 10-20 mcg (1-2 mL) every 2 minutes
  • atropine 1 mg every 3-5 min
116
Q

What drugs are used in RSI

A

SEDATE:
Etomidate 0.3 mg/kg max 20 mg
Ketamine 1.5 mg/kg max 150 mg

PARALYZE:
Succinylcholine 1.5 mg/kg

POST-INTUBATION:
Fentanyl 1 mcg/kg max 50 mcg
Morphine 0.1 mg/kg max 5 mg
Midazolam (versed) 0.1 mg/kg max 5 mg
Lorazepam (Ativan) 0.1 mg/kg max 2 mg
Ketamine 1 mg/kg max 150 mg

117
Q

What drugs are used in SVT

A
  • (vagal maneuvers if stable)
  • (sync cardiovert if unstable)
  • Adenosine 6 mg / 10 ml rapid NS bolus
  • Adenosine 12 mg / 10 ml rapid NS bolus
  • Diltiazem/Cardizem 0.125 mg/kg max 12.5 mg (max 10 mg if over 65)
  • Diltiazem/Cardizem repeat same dosage

Pediatrics: Adenosine 0.1 mg/kg

118
Q

What drug is indicated for stable A-Fib A-flutter with RVR

A
  • Diltiazem/cardizem 0.125 mg/kg max 12.5 mg (max 10 mg if over 65)
  • may repeat after 10 minutes
119
Q

What drugs are indicated for stable wide complex tachycardias (Vtach)?

A
  • Amiodarone 150 mg over 10 minutes
  • repeat Amio once as needed
    OR
  • Lidocaine 1-1.5 mg/kg repeat at 1/2 original dose every 5 minutes; max total dose 3mg/kg
120
Q

What drug is indicated for stable Torsades de pointes?

A

Magnesium sulfate 2 g over 5-10 minutes

121
Q

What joule settings do we use on Zoll monitor for sync cardioversion?
(And what indications do we sync cardiovert?)

A

SVT
A flutter/Afib
V tach with a pulse

70 / 120 / 150 / 200
Pediatric tachycardia: 1 J/kg; 2 J/kg; 2 J/kg

122
Q

What joule settings do we defibrillate on Zoll monitor? And for what indications?

A

V fib
V tach without a pulse
Torsades with or without a pulse

120 / 150 / 200 / 200

Pediatrics: 2 J/kg; 4 J/kg; 6 J/kg … up to 10 J/kg

Paramedic Shit (1 decks)

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