Drug Profiles Flashcards
1
Q
Adenosine/Adenocard classification
A
Antiarrhythmic
Endogenous Nucleoside
2
Q
Adenosine/Adenocard MOA
A
Slows conduction time through AV node
slows sinus rate
3
Q
Adenosine/Adenocard Indications
A
SVT.
Wide complex tachycardia of uncertain origin unresponsive to lidocaine.
4
Q
Adenosine/Adenocard contraindications
A
Sick Sinus Syndrome.
2nd/3rd* AV blocks - except in patients with pacemakers.
Known A-fib/A-flutter.
Pregnancy.
5
Q
Adenosine/Adenocard adverse reactions
A
Transient dysrhythmias (asystole, bradycardia, PVC’s, V-tach)
6
Q
Adenosine/Adenocard routes of administration
A
Recommended IV site is antecubital fossa.
IV/IO only.
7
Q
Adenosine/Adenocard Adult dose
A
Initial: 12mg Rapid IV bolus over 1-3 sec followed by 20cc NS flush.
Repeat dose: 1x repeat only. Same as initial dose.
8
Q
Adenosine/Adenocard Pediatric dose
A
Initial: 0.1mg/kg Rapid IV bolus with 2-3cc NS flush.
Repeat: 1x repeat only. .2mg/kg Rapid IV bolus with 2-3cc NS flush.
9
Q
Adenosine/Adenocard onset of action
A
seconds
10
Q
Adenosine/Adenocard special notes
A
Dysrhythmias may recur and appear in 55% of patients, lasting for a few seconds. Use cautiously in patients on theophylline and related methylxanthines, dipyridomole (Persantine), or carbamazepine (Tegretol).
11
Q
Adenosine/Adenocard forms/packaging
A
Flip top vials 6mg/2ml (3mg per ml)
Prefilled syringe 6mg/2ml (3mg per ml)
Prefilled syringe 12mg/4ml
12
Q
Adenosine/Adenocard AZ drug box supply
A
Paramedics: 5-6 vials (2+ 12mg doses)
13
Q
Albuterol Sulfate/Proventil/Ventolin classification
A
Sympathomimetic
Brochodilator
14
Q
Albuterol Sulfate/Proventil/Ventolin MOA
A
Stimulates Beta2 receptors in the smooth muscle of the bronchial tree
15
Q
Albuterol Sulfate/Proventil/Ventolin Indications
A
Bronchospasm
16
Q
Albuterol Sulfate/Proventil/Ventolin contraindications
A
Use caution in patients with diabetes, hyperthyroidism, and cerebrovascular disease
Tricyclic antidepressants
MAO inhibitors
17
Q
Albuterol Sulfate/Proventil/Ventolin Adverse reactions
A
dysrhythmias tachycardia tremors nervousness N/V
18
Q
Albuterol Sulfate/Proventil/Ventolin adult dose
A
2.5mg of premixed solution for inhalation (0.083%) via SVN. May repeat as needed.
19
Q
Albuterol Sulfate/Proventil/Ventolin pediatric dose
A
<40lbs, administer half of 0.083% premixed solution by adding 1-1.5ml NS to make 2.5-3cc and administer via SVN
20
Q
Albuterol Sulfate/Proventil/Ventolin route of administration
A
nebulized via mouth piece or in-line mask, or nebulized through ET/NT in-line
21
Q
Albuterol Sulfate/Proventil/Ventolin onset of action
A
5-15 minutes
22
Q
Albuterol Sulfate/Proventil/Ventolin AZ drug box supply
A
Paramedics: 2-6 independant doses
23
Q
Albuterol Sulfate/Proventil/Ventolin dosage forms/packaging
A
2.5mg albuterol premixed solution tube
24
Q
acetylsalicylic acid/aspirin/ASA/Bufferin/Anacin/APC classification
A
analgesic (pain relief)
antipyretic (fever reducing)
anti-inflammatory
25
acetylsalicylic acid/aspirin/ASA/Bufferin/Anacin/APC MOA
aspirin blocks thromboxane A2 (a potent platelet aggregate) and decreases platelet aggregation
26
acetylsalicylic acid/aspirin/ASA/Bufferin/Anacin/APC indications
chest pain
27
acetylsalicylic acid/aspirin/ASA/Bufferin/Anacin/APC contraindications
bleeding ulcer
hemorrhagic states
hemophilia
known hypersensitivity to salicylates or other non-steroidal anti-inflammatories
28
acetylsalicylic acid/aspirin/ASA/Bufferin/Anacin/APC adverse reactions
anaphylactic reaction in sensitive patients have occurred
29
acetylsalicylic acid/aspirin/ASA/Bufferin/Anacin/APC adult dose
324mg PO (4 x 81mg pediatric chewable tabs)
30
acetylsalicylic acid/aspirin/ASA/Bufferin/Anacin/APC pediatric dose
not recommended for peds
31
acetylsalicylic acid/aspirin/ASA/Bufferin/Anacin/APC onset of action
20-30 minutes
32
acetylsalicylic acid/aspirin/ASA/Bufferin/Anacin/APC special notes
baby ASA is heat and light sensitive. The odor of acetic acid (vinegar-like smell) indicates degradation of product.
33
acetylsalicylic acid/aspirin/ASA/Bufferin/Anacin/APC dosage forms
81mg-325mg tablets
34
acetylsalicylic acid/aspirin/ASA/Bufferin/Anacin/APC AZ drug box supply
Paramedics: 36 to 100 tablets
35
atropine sulfate/Atropine classification
parasympatholytic (decreases parasympathetic nervous system - the PSNS slows heart rate among other things)
antimuscarinic
parasympathetic antagonist
36
atropine sulfate/Atropine MOA
competitively blocks acetylcholine (Ach) at muscarinic receptor sites
37
atropine sulfate/Atropine indications
```
symptomatic bradycardia (sinus, junctional, & AV blocks)
Asystole (no longer in AHA or PFD guidelines)
PEA (no longer in AHA or PFD guidelines)
Organophosphate/Cholinergic poisonings
```
38
atropine sulfate/Atropine contraindications
glaucoma
| acute narrow angle glaucoma (relative contraindication)
39
atropine sulfate/Atropine adverse reactions
tachydysrhythmias
exacerbation of glaucoma
precipitation of myocardial ischemia (insufficient blood flow to the heart)
40
atropine sulfate/Atropine adult dose
Symptomatic bradycardia: 0.5-1.0mg Rapid IVP every 3-5 minutes, to a total dose of 3mg.
Cholinergic/Organophosphate poisoning: 2.0-5.0mg IV. May repeat in 5 minutes. No max dose.
41
atropine sulfate/Atropine pediatric dose
Symptomatic bradycardia: 0.02mg/kg IV/IO.
| May repeat once. Max dose: Child - 0.5mg. Adolescent - 1.0mg
42
atropine sulfate/Atropine routes of administration
IV/IO/ET
43
atropine sulfate/Atropine onset of action
1 minute
44
atropine sulfate/Atropine special notes
administering too small of doses or too slowly may result in paradoxical bradycardia.
Patient that describes their glaucoma as painful probably has acute narrow angle glaucoma.
45
atropine sulfate/Atropine dosage forms
1mg/10ml prefilled syringes
| 8mg/20ml multi-dose vial
46
atropine sulfate/Atropine AZ drug box supply
```
Paramedics: 4 x (1mg/10ml) prefilled syringes
1 x (8mg/20ml) multidose vial which is .4mg/ml.
```
47
ipratropium bromide/Atrovent classification
anticholinergic
| bronchodilator
48
ipratropium bromide/Atrovent MOA
produces preferential dilation of the larger central airways
49
ipratropium bromide/Atrovent indications
bronchospasm
50
ipratropium bromide/Atrovent contraindications
hypersensitivity to ipratropium bromide or to atropine and its derivatives
51
ipratropium bromide/Atrovent adverse reactions
```
coughing
sputum increase
dizziness
tremors
nausea
```
52
ipratropium bromide/Atrovent administration notes
it is a safe and effective bronchodilator when used in conjunction with beta adrenergic bronchodilators (albuterol).
53
ipratropium bromide/Atrovent adult dose
2.5ml of a 0.02% solution via SVN may be used one time.
54
ipratropium bromide/Atrovent pediatric
2.5ml of a 0.02% solution via SVN may be added to each SVN treatment.
55
ipratropium bromide/Atrovent routes of administration
nebulized via SVN
56
ipratropium bromide/Atrovent onset of action
5-15 minutes
57
ipratropium bromide/Atrovent special notes
may mix one unit dose vial of ipratropium with one unit dose vial of albuterol.
Should be kept out of light in foil pouch to avoid excessive humidity.
58
ipratropium bromide/Atrovent dosage forms
inhalation solution: Unit dose vial is supplied as 0.02% clear, colorless solution containing 2.5ml, with 25 vials per foil pouch.
59
ipratropium bromide/Atrovent AZ drug box supply
Paramedics: 2 - unit doses
60
Bumetinide/Bumex indications
pulmonary edema
61
Bumetinide/Bumex contraindications
Hypersensitivity, anuria, electrolyte deficiencies
62
Bumetinide/Bumex adverse reactions
```
dizziness
headache
muscle cramps
hypotension
EKG changes
```
63
Bumetinide/Bumex adult dose
0.5-1.0mg slwo IVP over 1-2 minutes, or IM
64
Bumetinide/Bumex pediatric dose
not used for pediatrics
65
40mg furosemide = how much bumetanide?
1mg bumetanide = 40mg furosemide
66
Calcium Chloride inidications for field use
significant hypocalcemia or hyperkalemia
Calcium channel blocker OD.
Pre-treat for IV verapamil administration
67
Calcium Chloride contraindications
hypercalcemia.
| concurrent digoxin therapy (relative)
68
Calcium Chloride adverse reactions
brady-asystolic arrest.
| servere tissue necrosis if solution extravasates.
69
Calcium Chloride adult dose
For hypocalcemia, calcium channel blocker OD, hyperkalemia, and hypermagnesemia:
5-10 ml (0.5-1gm) of 10% calcium chloride. May repeat in 10 minutes.
For verapamil pre-treatment:
3ml of 10% solution. May be repeated once.
70
Calcium Chloride pediatric dose
For hypocalcemia, calcium channel blocker OD, hyperkalemia, and hypermagnesemia:
0. 2ml/kg of a 10% solution infused slowly
* May be diluted with 102ml of NS IV per ml of calcium chloride.
71
Activated Charcoal/Charcoal/Actidose-aqua indications for field use
prehospital therapy of oral ingestion of toxic substances
72
Activated Charcoal/Charcoal/Actidose-aqua contraindications
ingestion of caustics or hydrocarbons
73
Activated Charcoal/Charcoal/Actidose-aqua adverse reactions
may provoke vomiting
74
Activated Charcoal/Charcoal/Actidose-aqua adult dose
50grams, orally
75
Activated Charcoal/Charcoal/Actidose-aqua pediatric dose
0.5-1g/kg
76
Dextrose 50%/D50 indications for field use
ALOC
seizures
known hypoglycemia
77
Dextrose 50%/D50 contraindications
```
stroke (unless documented hypoglycemia)
intracranial hemorrhage (relative)
```
78
Dextrose 50%/D50 adverse reations
cerebral edema and intracranial hemorrhage in children when given IV undiluted.
Worsens elevated ICP
Extravasation leads to sever tissue necrosis
79
Dextrose 50%/D50 adult dose
For hypoglycemia, ALOC, or seizures of uknown etiology:
| 25-50ml of D50 (12.5-25g, or .5-1AMP) IV
80
Dextrose 50%/D50 pediatric dose
0.5-1g/kg (5-10cc/kg) of D10% solution, given slowly over a 20 minute period.
To make D10, waste 50ml of 250ml NS bag and add 50ml of D50. This makes D10 or 10g/ml.
81
Dyphenhydramine HCL/Benadryl indications for field use
anaphylaxis (2nd line)
phenothiazine reactions (extrapyramidal symptoms)
antiemetic (anti nausea)
82
Dyphenhydramine HCL/Benadryl contraindications
know hypersensitivity
newborn or premature infants; nursing mothers
caution with patients with glaucoma, acute narrow angle, stenosing or obstructive diseases of the GI tract, bronchial asthma, hyperthyroidism, cardiovascular disease or hypertension, older than 60 (all relative/benefit vs risk)
83
Dyphenhydramine HCL/Benadryl adverse reactions
CV:hypotension, palpitations, arrhythmias, hemolytic anemia
Resp: anaphylaxis, thickening of bronchial secretions, tightness in chest, wheezing, nasal stuffiness
CNS: sedation, visual disturbances, seizures
GU/GI: urinary frequency or retention, vomiting
PEDS: In children, may cause paradoxical CNS excitation, seizure, palpitations, thickening of pronchial secretions.
84
Dyphenhydramine HCL/Benadryl adult dose
Minor allergic RX: 25mg slow IVP or deep IM
Anaphylaxis: 50 mg slow IVP or deep IM
Extrapyramidal symptoms and antiemetic: 50mg IV or deep IM (dose should be individualized according to the needs and the patient response)
85
Dyphenhydramine HCL/Benadryl pediatric dose
Allergy/Anaphylaxis: 1-2mg/kg slow IVP or deep IM
86
Dopamine/Intropin indications for field use
sypmtomatic bradycardias
hemodynamically significant hypotension in the absence of hypovolemia
cardiogenic shock (post code)
87
Dopamine/intropin contraindications
hypovolemic shock
pheochromocytoma
MAO inhibitors (Marplan, Nardil, or Parnate)
88
Dopamine/intropin adverse reactions
tachyarrhythmias
precipitation of mycardial ischemia and/or MI
hypertension
89
Dopamine/intropin adult dose
If premixed not carried, add 400mg to 250ml NS which = 1600mcg/ml. Start at 5mcg/kg/min (1 micro drop per min equals 1cc per hour)
90
Dopamine/intropin pediatric dose
2-20 mcg/kg/min for circulatory shock or shock unresponsive to fluid administration.
To prepare infusion for small children: 6x body weight (kg) = mg added to make 100ml. With this mixture, 1ml/hr delivers 1mcg/kg/min.
Titrate to effect.
91
Dopamine/intropin effects in 1-2mcg/kg/min range
1-2mcg/kg/min gets renal and mesenteric vasodilation
92
Dopamine/intropin effects in 2-10mcg/kg/min range
2-10mcg/kg/min gets renal and mesenteric vasodilation with increased cardiac output, and a modest increase in Systemic Vascular Resistance (SVR)
93
Dopamine/intropin effects in 10-20mcg/kg/min range
10-20mcg/kg/min range: peripheral vasoconstriction with marked increase in systemic vascular resistance, pulmonary vascular resistance, and further increase in preload
94
Dopamine/intropin effects in >20mcg/kg/min range
>20mcg/kg/min produces hemodynamic effects similar to norepinephrine, and may increase heart rate and O2 demand.
95
Epi indications for field use
anaphylaxis
cardiac arrest (VT, pulseless VF, asystole, PEA)
severe bronchospasm - bronchiolitis, asthma, croup, stridor (NOT COPD)
bradycardia with hypotension
96
Epi contraindications
none for cardiac arrest
97
Epi adverse reactions
hypertension
ventricular dysrhythmias - tachycardia, angina
muscle tremors
98
Epi adult dose
Asmtha/Anaphylaxis (age < 35): .3mg IM 1:1K
Cardiac Arrest: IV: 1mg 1:10K q 3-5min.
Cardiac Arrest: ET: 2-2.5mg 1:1K mixed with NS to equal 10ml)
Infusion: 2-10mcg/min IV
99
Epi pediatric dose
Asthma/Anaphylaxis: .01mg/kg IM up to .5mg (.5ml) of 1:1k
Cardiac Arrest: IV: .01mg/kg 1:10K q 3-5min
Cardiac Arrest: ET: 01mg/kg 1:1K
Croup: or equal to 5y/o: 5mg 1:1K with 3cc NS SVN
100
Furosemide/Lasix indications for field use
pulmonary edema
| congestive heart failure (CHF)
101
furosemide/Lasix contraindications
anuria (not urinating - relative)
hypovolemia
hypotension
102
furosemide/Lasix adverse reactions
may exacerbate hypovolemia
| hypokalemia
103
furosemide/Lasix adult dose
If patient on oral lasix, give 2x daily oral amount. If not result in 20 minutes, double dose and repeat.
If patient not on oral lasix, .5-1mg/kg to a maximum of 2mg/kg (usually 20-40mg) IV slowly.
104
furosemide/Lasix pediatric dose
1mg/kg IV slowly
105
glucagon indications for field use
symptomatic hypoglycemia when IV access is delayed.
| Beta blocker overdose.
106
glucagon contraindications
known hypersensitivity.
Pheochromocytoma
Insulinoma
107
glucagon adverse reactions
nausea/vomiting
108
glucagon adult dose
1mg IM. May repeat in 8-10 minutes.
109
glucagon pediatric dose
20kg/44lb: 1mg IM, may repeat in 8-10 minutes
110
lidocaine HCl indications for field use
suppression of ventricular arrythmias (v-tach, lv-fib, PVC's)
Prophylaxis against recurrence after conversion from V-tach of V-fib.
Frequent PVC's (>6/min, 2 or more in a row, multiform, R-onT phenomenon)
111
lidocaine HCl contraindications
known hypersensitivity
Do NOT treat ectopic beats if HR<60. They are probably compensating for the bradycardia. Instead, treat the bradycardia!
112
lidocaine HCl adverse reactions
CV: May also cause SA nodal depression or conduction problems and hypotension in large doses, or if given too rapidly. Excessive doses in pediatric patient may produce myocardial and circulatory depression.
CNS: In large doses causes drowsiness, disorientation, paresthesias, decreases hearing acuity, muscle twitching, agitation, focal or generalized seizures.
113
lidocaine HCl adult dose
Pulseless VF/VT or Antidysrhythmic/rhythm with pulse: Initial bolus of 1-1.5mg/kg IVP, then repeat at half initial dose q 5-10 minutes, to a total of 3mg/kg. An initial bolus of 1.5mg/kg may be given for cardia arrest situations. Following return of a spontaneous rhythm, initiate a drip of 2-4mg/min.
Reduce infusion by half for patients >70y/o or with liver disease.
Maintenance infusion: 2gm in 500NS premixed solution. Drip rate at 2-4mg/min using clock (1:15, 2:30, 3:45, 4:60)
114
lidocaine HCl pediatric dose
Initial bolus: 1mg/kg. May repeat 1 time in 15 minutes for VF/Pulseless VT or in 15 minutes if used for refractory dysrhytmias with a pulse.
Infusion: 20-50 mcg/kg/min, prepared by adding 120mg (3cc) of 1gm/25ml (40mg/ml) solution to 97ml of NS, yielding 1200mcg/ml. 1ml/kg/hr delivers 20mcg/kg/min. 2.5ml/kg/hr delivers 50mcg/kg/min. Reduce to < or equal 20mcg/kg/min for children with low cardiac output, severe CHF, or compromised hepatic blood flow.
Infusion should be avoided unless infusion pump is available.
115
magnesium sulfate indications for field use
```
torsade de pointes (first line drug)
VF/Pulseless VT refractory to lidocaine
pregnancy-induced hypertension (PIH, toxemia of pregnancy, pre-eclampsia and/or eclampsia)
severe bronchospasm (asthma only)
```
116
magnesium sulfate contraindications
hypermagnesemia
| Use cautiously in patients with impaired renal function and pre-existing heart blocks (relative)
117
magnesium sulfate adverse reactions
CV: hypotension, flushing circulatory collapse, depressed cardiac function, heart block, asystole, smooth muscle relaxant (antihypertensive effects)
RESP: respiratory depression and/or paralysis may occur in both mother and/or infant during or up to 24 hours after the administration of Mag.
CNS: sweating, drowsiness, hypothermia, depressed reflexes pressing to flaccidity and paralysis which may occur in both mother and/or infant during the administration of or up to 24 hours after the administration of Mag.
GI: nausea
GU: mild diuretic
Metabolic: hypocalcemia, hypomagnesemia
118
magnesium sulfate adult dose
VF/pulseless VT: 1-2g IV in 1-2min or dilute 1-2g in 50cc NS administered over 1-2min.
Torsade de pointes: 1-2g IV in 1-2min or dilute 1-2g in 50cc NS administered over 1-2min, then repeat same dose infused over 1hour.
Pregnancy induced hypertension/pre-eclampsia/eclampsia: 4-6g in 50cc NS over 20minutes
Bronchospasm: 2g in 50cc NS infused over 10minutes
119
magnesium sulfate pediatric dose
bronchospasm: 25-50mg/kg in 50cc NS infused over 10 minutes (to a max of 2g)
120
solu-medrol indications for field use
reactive airway disease.
| Acute exacerbation of emphysema, chronic bronchitis, asthma, or anaphylaxis.
121
solu-medrol contraindications
none
122
solu-medrol adverse reactions
none from single dose
123
solu-medrol adult dose
125mg IV
124
solu-medrol pediatric dose
2.0mg/kg IV (up to 125mg)
125
midazolam indications for field use
anti-convulsant.
sedation
management of acute agitation/treat causes first.
sedation for intubation.
126
midazolam contraindications
hypersensitivity to midazolam
127
midazolam adverse reactions
CV: hypotension, cardiac arrest, irregular or fast heart beat.
RESP: apnea, respiratory depression, respiratory arrest, hyperventilation, wheezing or difficulty in breathing, hiccups, coughing.
CNS: emergence delirium, muscle tremors, uncontrolled or jerky movements of body, unusual excitement, irritability or restlessness, dizziness, light-headed or feeling faint, prolonged drowsiness, headache.
GI: nausea/vomiting
128
midazolam adult dose
2.5-5mg IV/IM SIVP over 1-2minutes. No more than 2.5mg at one time. Max dose of 20mg.
Seizures: 0.2mg/kg IM for status seizures if no IV access.
129
midazolam pediatric dose
.1mg/kg slow IVP
| Seizures: .2mg/kg IM for status seizures if no IV access.
130
morphine sulfate indications for field use
analgesia (pain management), especially in patients with burns, MI, or renal colic
131
morphine sulfate contraindications
respiratory depression
| head injuries
132
morphine sulfate adverse reactions
CV: brady or tachydysrhythmias, hypotension
RESP: respiratory depression or arrest
CNS: excess sedation, seizures to coma and arrest, pupillary constriction
GI: Nausea/vomiting
133
morphine sulfate adult dose
2-4mg increments IVP until desired effect (max 10mg, or 20mg for burns)
can be given IM or IO
134
morphine sulfate pediatric dose
.1mg/kg SIVP
may repeat up to 4mg max
can be given IM or IO
