Drug Profiles (Mesa Drug Box) Flashcards
Fentanyl
-indications
- severe pain of any etiology
Fentanyl - pharmacology & actions
- opioid agonist-analgesic
- increases pain threshold
- produces analgesia and sedation
Fentanyl- absolute contraindications
- O2 sat < 90%
- significant respiratory depression
Fentanyl- precautions and side effects
- causes neurologic and respiratory depression; respiratory support must be available
- can be reversed with Narcan
Fentanyl- dosage
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
Fentanyl - how is it carried?
100 mcg / 2 mL
2 vials
EPINEPHRINE
“Push-dose”
1:100,000
- concentration? And how do we make it?
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)
EPINEPHRINE
1:100,000
“Push-dose”
- Guidelines containing indications
- Bradycardia
- Shock
EPINEPHRINE
1:100,000
“Push-dose”
- dosages
10-20 mcg (1-2 mL) every 2 minutes
Peds: 0.01 mcg/kg = (0.1mL) every 2 minutes
EPINEPHRINE
- pharmacology & actions
- catecholamine with alpha and beta effects which increase heart rate and blood pressure
- potent bronchodilator
EPINEPHRINE
- indications (all of them)
- cardiac arrest (1:10,000 “cardiac”)
- bradycardia (1:100,000 “Push dose”
- shock (hypotension) (1:100,000 “push dose”)
- anaphylaxis (1:1,000)
- severe wheezing (IM) (1:1,000)
- croup and bronchiolitis (nebulized) (1:1,000)
EPINEPHRINE
- absolute contraindications
- allergy
- uncontrolled hypertension (relative contraindication)
EPINEPHRINE
- precautions and side effects
- increases cardiac work and can precipitate angina, MI, or major dysrhythmias in patients with ischemic heart disease
EPINEPHRINE
1:10,000
“Code Epi”
- how do we carry it
1 mg/10 mL
6 boxes
EPINEPHRINE
1:10,000
“Code Epi”
- dosages
1 mg every 3-5 minutes; max 3 doses
Peds: 0.01 mg/kg (max 1 mg); max 3 doses
EPINEPHRINE
1:1,000
- How do we carry it?
1 mg/ mL
5 vials
EPINEPHRINE
1:1,000
- what guidelines contain indications
Anaphylaxis (IM)
Wheezing (IM)
Croup, bronchiolitis (nebulized)
EPINEPHRINE
1:1,000
- dosages
IM: 0.01 mg/kg; max 0.3 mg
Nebulized: 5 mg
SUCCINYLCHOLINE
- how do we carry it?
200 mg/ 10 mL
2 vials
SUCCINYLCHOLINE
- pharmacology and actions
- depolarizing neuromuscular blocker
- acts on the motor end plate receptors, inhibits neuromuscular transmission
- muscles are unable to be stimulated by Ach
SUCCINYLCHOLINE
- indications
Induction of paralysis to facilitate endotracheal intubation
SUCCINYLCHOLINE
- absolute contraindications
- malignant hyperthermia
- hyperkalemia
- penetrating eye injury
- paraplegia/quadraplegia
- prolonged immobilization
- allergy
SUCCINYLCHOLINE
- precautions and side effects
- use with caution in patients with anticipated difficult airway
- has no effect on consciousness - use with sedatives
SUCCINYLCHOLINE
- dosage
1.5 mg/kg IV/IO
One time dose only
AMIODARONE
- how do we carry it?
150 mg/ 3 mL
3 vials
AMIODARONE
- pharmacology and actions
- blocks potassium-, sodium-, calcium-channels
- decreases AV node conduction
- prolongs cardiac action potential and repolarization
- has some alpha- and beta-adrenergic blocking properties
AMIODARONE
- indications
V-fib
Pulseless v-tach
Regular/irregular wide complex tachycardia with a pulse
AMIODARONE
- absolute contraindications
-allergy
-second or third degree AV blocks
AMIODARONE
- precautions and side effects
May cause hypotension and bradycardia
AMIODARONE
- dosages
CODE: 5 mg/kg (max 300 mg); repeat at 1/2 dose
TACHYCARDIA: 150 mg over 10 min
PEDS: 5 mg/kg
ETOMIDATE
- how do we carry it?
40 mg/ 20 mL
2 vials
ETOMIDATE
- pharmacology and actions
- sedative and hypnotic
- depresses activity of the reticular activating system
ETOMIDATE
- contraindications
Allergy
ETOMIDATE
- dosage
IV/IO 0.3 mg/kg
MAX 20 mg
one time dose only
DILTIAZEM (CARDIZEM)
- how do we carry it
25 mg/ 5 ml
2 vials
DILTIAZEM (CARDIZEM)
- pharmacology and actions
- 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
DILTIAZEM (CARDIZEM)
- indications
- Atrial fibrillation/atrial flutter (irregular narrow complex tachycardia)
- SVT not responding to adenosine
DILTIAZEM (CARDIZEM)
- absolute contraindications
- heart block /bradycardia
- systolic BP < 90mmHg
- sick sinus syndrome
- V tach
- allergy
DILTIAZEM (CARDIZEM)
- precautions and side effects
- 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
DILTIAZEM (CARDIZEM)
- dosages
1st dose: 0.125 mg/kg; max 12.5 mg over 2 minutes; patients >65 years old, max 10 mg
2nd dose: AFTER 10 MINUTES: SAME DOSE
ATROPINE
- pharmacology and actions
-blocks action of ACH at muscarinic receptor sites
-blocks parasympathetic response, allowing sympathetic response to take over
-positive chronotropic effects: increases heart rate; increases conduction through AV node
-reverses muscarinic effects of cholinergic poisoning
ATROPINE
- indications
- symptomatic bradycardia
- organophosphate poisoning
ATROPINE
-absolute contraindications
- bradycardia without evidence of cardiopulmonary compromise
- atropine allergy
ATROPINE
- dosage
1 mg IV/IO every 3-5 minutes
Max total dose 3 mg
ADENOSINE
- pharmacology and actions
- slows conduction through the AV node
- interrupts AV nodal circuit, stopping tachycardia, restoring normal sinus rhythm
ADENOSINE
- indications
- to convert hemodynamically stable narrow complex regular tachycardia with a pulse (SVT)
ADENOSINE
- dosage
- 6 mg IV/IO; follow with 10 mL bolus
- 12 mg IV/IO; follow with 10 mL bolus
PEDS:
- 0.1 mg/kg IV/IO; max 6 mg
- repeat at 0.2 mg/kg IV/IO max 12 mg
ADENOSINE
- how do we carry it
6 mg/2 mL
3 vials
GLUCAGON
- pharmacology & actions
- increases serum glucose by releasing glycogen stores from the liver
GLUCAGON
- indications
- hypoglycemia (less than 60 mg/dL)
GLUCAGON
- absolute contraindications
- not the first line treatment for hypoglycemia and should only be used in symptomatic patients when unable to obtain IV/IO access
GLUCAGON
- precautions & side effects
- may cause nausea and vomiting
- slower onset than IV/IO dextrose
ALBUTEROL
- pharmacology and actions
- beta2-adrenergic bronchodilator
- relaxes bronchial smooth muscle
- also lowers serum potassium (shifts potassium intracellular)
ALBUTEROL
- indications
- treatment of bronchospasm
- treatment of hyperkalemia
ALBUTEROL
- absolute contraindications
- none other than ALBUTEROL allergy
ALBUTEROL
- our guidelines containing ALBUTEROL
- bronchospasm
- anaphylaxis & allergic reaction
- hyperglycemia (hyperkalemia)
- extremity trauma (hyperkalemia)
- dermal chemical burns (hyperkalemia)
ALBUTEROL
- dosage
5 mg nebulized
Repeat as neede
ALBUTEROL
- how do we carry it
- 2.5 mg / 0.5 mL
ASPIRIN
- how do we carry it
81 mg tablets
ASPIRIN
- pharmacology and actions
- disrupts platelet function and inhibits prostaglandin
ASPIRIN
- contraindications
CONTRA:
- active GI bleed
- if patient has taken 324 mg in last 24 hours
- allergy
ASPIRIN
- which guidelines
Chest Pain/ACS/STEMI
ATROPINE
- how do we carry it
1 mg / 10 mL
3 boxes
DIPHENHYDRAMINE (BENADRYL)
- how do we carry it
50 mg/ 1mL
2 vials
DIPHENHYDRAMINE (BENADRYL)
- pharmacology and actions
- blocks histamine receptors in respiratory tract and blood vessels
- also has anticholinergic actions (can treat acute dystonic reactions to antipsychotic drugs)
DIPHENHYDRAMINE (BENADRYL)
- indications
- treatment of allergic reactions: urticaria, rash, itching
- treatment or prevention of acute dystonic reactions to antipsychotic drugs
DIPHENHYDRAMINE (BENADRYL)
- contraindications
CONTRA:
- allergy
- newborns
DIPHENHYDRAMINE (BENADRYL)
- which guidelines
- Anaphylaxis and Allergic Reaction
- Poisoning / Overdose
DIPHENHYDRAMINE (BENADRYL)
- dosage
1 mg/kg
IV/IO/IM/PO
Max dose 50 mg
IPRATROPIUM BROMIDE (ATROVENT)
- how is it carried
0.5 mg/2.5 mL
(3 packets)
IPRATROPIUM BROMIDE (ATROVENT)
- pharmacology and actions
- anticholinergic: Antagonizes action of acetylcholine on the bronchial smooth muscle in the lungs
- causes bronchodilation
IPRATROPIUM BROMIDE (ATROVENT)
- indications
- bronchoconstriction (asthma and COPD)
- may be given in combination with albuterol
IPRATROPIUM BROMIDE (ATROVENT)
- contraindications
CONTRA
- none other than allergy
IPRATROPIUM BROMIDE (ATROVENT)
- dosage
0.5 mg nebulized with albuterol
Max 3 doses
Drugs indicated for Bronchospasm due to Asthma and COPD
- 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)
KETAMINE
- how do we carry it?
500 mg / 5 mL
KETAMINE
- pharmacology and actions
- functions as a dissociative, amnestic, analgesic, and anesthetic agent
- non-competitive NMDA receptor antagonist
KETAMINE
- indications
- delirium with agitated behavior
- induction agent for intubation
- pain control
KETAMINE
- absolute contraindications
- angina
- CHF
- pregnancy
- allergy
- not indicated for postictal patients
- not indicated in pediatric patients
KETAMINE
- precautions and side effects
- must be administered slowly
- 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
KETAMINE
- which guidelines
- Agitated or Violent Patients
- Acute Pain
- RSI
KETAMINE
- dosage
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
LIDOCAINE
- how do we carry it
100 mg / 5 mL
One box
LIDOCAINE
- pharmacology and actions
- antiarrhythmic drug that decreases automaticity by slowing depolarization
- local anesthesia for IO
LIDOCAINE
- indications
- cardiac arrest due to Vfib or Vtach
- wide complex tachycardia with a pulse
- pain management after IO insertion in conscious patients
LIDOCAINE
- absolute contraindications
CONTRA:
- bradycardia
- allergy
LIDOCAINE
- dosages
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
METHYLPREDNISOLONE (SOLU-MEDROL)
- pharmacology and actions
- anti-inflammatory corticosteroid
- reduces cell permeability
METHYLPREDNISOLONE (SOLU-MEDROL)
- how do we carry it
125 mg /2 mL
2 vials
METHYLPREDNISOLONE (SOLU-MEDROL)
- indications
- Acute bronchospastic disease: asthma/COPD
METHYLPREDNISOLONE (SOLU-MEDROL)
- contraindications
Traumatic brain injury
Allergy
METHYLPREDNISOLONE (SOLU-MEDROL)
- which guidelines
Bronchospasm
Shock
METHYLPREDNISOLONE (SOLU-MEDROL)
- dosages
2 mg/kg IV IO IM
Max dose 125 mg
** onset 1-6 hours / peak effect 8 hours
ONDANSETRON (ZOFRAN)
- pharmacology and actions
- selectively blocks serotonin 5-HT3 receptors
- primary effect is in GI tract
ONDANSETRON (ZOFRAN)
- indications
Nausea or vomiting
ONDANSETRON (ZOFRAN)
- contraindications
CONTRA
- patients with prolonged QT
- patients <1 month old
- allergy
ONDANSETRON (ZOFRAN)
- dosages
4 mg IV / IO / oral
Pediatrics: 0.15 mg/kg max 4 mg
ONDANSETRON (ZOFRAN)
- how do we carry it
4 mg / 2 mL
2 vials
MORPHINE
- how do we carry it
10 mg / 1 mL
2 vials
MORPHINE
- pharmacology and actions
- narcotic analgesic
MORPHINE
- indications
Analgesia (pain management)
MORPHINE
- absolute contraindications
- respiratory or CNS depression
- hypotension
- allergy
MORPHINE
- precautions and side effects
- 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
MORPHINE
- guidelines
Management of Acute Pain
Chest Pain/ACS/STEMI
MORPHINE
- dosages
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
NITROGLYCERIN
- how do we carry it
0.4 mg tablets
NITROGLYCERIN
- pharmacology and actions
- 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
NITROGLYCERIN
- indications
- chest pain, esp when ACS is suspected
- CHF with pulmonary edema
NITROGLYCERIN
- absolute contraindications
- hypotension (SBP below 90 mmHg)
- use of erectile dysfunction meds within last 48 hours
- not for use in pediatrics
- allergy
NITROGLYCERIN
- precautions and side effects
- may cause profound hypotension and reflex tachycardia
- common side effects include HA, flushing, dizziness, burning under the tongue
NITROGLYCERIN
- which guidelines
Chest Pain / ACS / STEMI
Pulmonary Edema
NITROGLYCERIN
- dosages
- 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
What drugs are indicated in our Chest Pain / ACS / STEMI protocol?
- 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
What drugs are indicated in Bradycardia protocol?
- (pace if unstable!)
- push dose Epi 10-20 mcg (1-2 mL) every 2 minutes
- atropine 1 mg every 3-5 min
What drugs are used in RSI
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
What drugs are used in SVT
- (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
What drug is indicated for stable A-Fib A-flutter with RVR
- Diltiazem/cardizem 0.125 mg/kg max 12.5 mg (max 10 mg if over 65)
- may repeat after 10 minutes
What drugs are indicated for stable wide complex tachycardias (Vtach)?
- 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
What drug is indicated for stable Torsades de pointes?
Magnesium sulfate 2 g over 5-10 minutes
What joule settings do we use on Zoll monitor for sync cardioversion?
(And what indications do we sync cardiovert?)
SVT
A flutter/Afib
V tach with a pulse
70 / 120 / 150 / 200
Pediatric tachycardia: 1 J/kg; 2 J/kg; 2 J/kg
What joule settings do we defibrillate on Zoll monitor? And for what indications?
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
ADENOSINE
-absolute contraindications
- second or third degree heart block
- poison or drug-induced tachycardia
- known allergy
ADENOSINE
- precautions and side effects
-may cause brief asystole, dizziness, facial flushing, HA, nausea
-may cause bronchospasm in asthmatic patients
-if patient becomes hemodynamically unstable, cardioversion should occur
ADENOSINE
- guidelines
Tachycardia with a pulse
ALBUTEROL
-precautions and side effects
-may cause dizziness, anxiety, palpitations, headache, sweating
-relative contraindications include symptomatic tachycardia, tachyarrhythmias, or angina chest pain
AMIODARONE
-guidelines containing it
-Cardiac Arrest (VF/VT/Asystole/PEA)
-Tachycardia with a pulse
ASPIRIN
-indications
Adult patients with suspected acute coronary syndrome
ASPIRIN
-precautions and side effects
-may cause GI discomfort and nausea
-may cause wheezing
ASPIRIN
-dosage
324 mg chewed
ATROPINE
- precautions and side effects
- avoid in hypothermic bradycardia
- paradoxical bradycardia may result from doses less than 0.5 mg, use with caution in pediatric patients
ATROPINE
-which guidelines contain it
-Bradycardia
-Organophosphate poisoning
DEXTROSE
- pharmacology and actions
Rapidly increase blood glucose
DEXTROSE
-indications
Hypoglycemia
DEXTROSE
-contraindications
None in prehospital setting
DEXTROSE
-precautions and side effects
-extravasation of dextrose may cause tissue necrosis
-use caution during administration
-if extravasation does occur, immediately stop administration of drug
DEXTROSE
-which guidelines contain it
Hypoglycemia
DEXTROSE
-dosage
D10 IV/IO: 1 ml/kg; max dose 250 mL
Max single dose 25 g
Repeat as needed: titrate to effect
(Same for peds)
DEXTROSE
-how do we carry it
D10
25gm/250mL
2 bags
DIAZEPAM (Valium)
-pharmacology and actions
-benzodiazepine
-decreases seizures by increasing the seizure threshold
-sedative
-amnestic effect
DILTIAZEM (CARDIZEM)
-what guidelines contain it
-tachycardia with a pulse
DIPHENHYDRAMINE (BENADRYL)
-precautions/side effects
-usually causes sedation, however it may paradoxically cause excitation in children
-may have additive sedation effect with alcohol or other CNS depressants
-may cause hypotension when given IV/IO
ETOMIDATE
-indications
Induction of anesthesia for RSI
ETOMIDATE
-precautions of side effects
Not intended for prolonged infusion
ETOMIDATE
-precautions / side effects
Not intended for prolonged infusion
ETOMIDATE
-which guidelines contain it
RSI
FENTANYL
-guidelines
-Management of Acute Pain
-Chest Pain/ACS/STEMI
-Pharmacological Management: Synch Cardioversion and NIPPV
GLUCAGON
-Guidelines
Hypoglycemia
GLUCAGON
-dosage
1 mg IM/IN
Peds:
1 mg IM/IN (if >20 kg or >5 yo)
0.5 mg IM/IN (if <20 kg or <5 yo)
GLUCAGON
- how do we carry it
1 mg/mL
(2 vials)
IPRATROPIUM BROMIDE (ATROVENT)
-precautions and side effects
-use with caution in patients with narrow angle glaucoma
-side effects may include palpitations, dizziness, anxiety, headache
IPRATROPIUM BROMIDE (ATROVENT)
-Guidelines
Bronchospasm
LIDOCAINE
-precautions and side effects
-at higher doses may cause CNS stimulation, seizure, depression
LIDOCAINE
-Guidelines
Conscious IO
Tachycardia with a Pulse
Cardiac Arrest (VF/VT/Asystole/PEA)
LORAZEPAM (ATIVAN)
-pharmacology and actions
Benzodiazepine that functions as a CNS depressant, anticonvulsant, and sedative
LORAZEPAM (ATIVAN)
-indications
-seizures
-pharmacologic management of painful/anxiety producing procedures
-delirium with agitated behavior
-uncontrolled shivering in hyperthermia
LORAZEPAM (ATIVAN)
-contraindications
-neurologic or respiratory depression
-acute angle glaucoma
-allergy
LORAZEPAM (ATIVAN)
-precautions and side effects
-respiratory depression and/or hypotension can occur (more likely when used with other depressants, or when given rapidly)
LORAZEPAM (ATIVAN)
-Guidelines
-Agitated or Violent Patient
-Bradycardia
-Seizures
-Hyperthermia/Heat Exposure
LORAZEPAM (ATIVAN)
- dosage
- 2-4 mg IM
OR - 2 mg IV/IO
May repeat once after 15 min
Max total dose 4mg
PEDS:
0.05 mg/kg IM/IV/IO
MAX dose 2 mg IV/IO
Max dose 4 mg IM
LORAZEPAM
- how do we carry it
2 mg/ 1mL
MAGNESIUM SULFATE
- pharmacology and actions
-smooth muscle relaxant
-reduces arrhythmias
-decreases seizure in eclampsia and preeclampsia
-CNS depressant
MAGNESIUM SULFATE
- indications
- eclampsia and preeclampsia
- tornadoes de pointes
- severe bronchospasm in asthma or COPD
MAGNESIUM SULFATE
- absolute contraindications
Known allergy
MAGNESIUM SULFATE
- precautions and side effects
-may cause hypotension and respiratory depression in large doses
- caution with use in patients with renal failure
MAGNESIUM SULFATE
- Guidelines
- Bronchospasm
- OB
- Childbirth
- Tachycardia with a pulse
- Seizures
- Cardiac Arrest
MAGNESIUM SULFATE
- dosages
BRONCHOSPASM
50 mg/kg over 5-10 minutes IV/IO
MAX dose 2 g
SEIZURES IN PREGNANCY
Prophylaxis: 4 g over 10-15 min
Management: 5 g slow push over 5-10 min
TORSADES
2 g over 5-10 minutes IV/IO
MAGNESIUM SULFATE
- how do we carry it
2 G / 50 mL (bags)
May also have vial (check concentration)
METHYLPREDNISOLONE (SOLU-MEDROL)
- precautions and side effects
None
MIDAZOLAM (VERSED)
- pharmacology and actions
Benzodiazepine that functions as a CNS depressant, anticonvulsant, and sedative
MIDAZOLAM (VERSED)
- indications
- seizures
- pharmacologic management of painful/anxiety producing procedures
- delirium with agitated behavior
- uncontrolled shivering in hyperthermia
MIDAZOLAM (VERSED)
- absolute contraindications
- respiratory and/or CNS depression
- allergy
MIDAZOLAM
- precautions and side effects
- a high potential to cause respiratory depression and/or hypotension
MIDAZOLAM
- Guidelines
- Seizures
- pharmacologic management when pacing
- Agitated or Violent Patient
MIDAZOLAM
- dosages
SEIZURES
0.2 mg/kg IM/IN
MAX 5-10 mg
0.1 mg/kg IV/IO Administer slowly over 2 minutes MAX 4 mg
AGITATED PATIENTS
5 mg IM/IN/IV/IO
May repeat every 3 minutes
MAX total 20 mg
PHARMACOLOGIC MGMT FOR PACING
1 mg IV/IO slowly every 2-3 doses
MAX 5 mg
MIDAZOLAM
- how do we carry it
Multiple concentrations — always double-check!
5 mg/ 1 mL
5 mg / 5 mL
10 mg/ 2 mL
NALOXONE (NARCAN)
- pharmacology and actions
-narcotic antagonist which competitively binds to opioid receptors in the brain
-displaces opioid molecules, reversing the effect of opioids on the brain
NALOXONE (NARCAN)
- indications
- reversal of acute opioid toxicity
NALOXONE (NARCAN)
- precautions and side effects
- may precipitate acute withdrawal symptoms: be prepared to manage
- duration of some narcotics is longer than NARCAN
- repeated doses may be necessary
NALOXONE (NARCAN)
- Guidelines
- Altered Mental Status
- Opioid Overdose
NALOXONE (NARCAN)
- dosages
-4 mg IN
-0.4 - 2 mg IV/IO/IM/IN
PEDS
0.1 mg/kg IV/IO/IM/IN
ONDANSETRON (ZOFRAN)
- precautions and side effects
May cause QT prolongation
ONDANSETRON (ZOFRAN)
- Guidelines
Nausea/Vomiting
SUCCINYLCHOLINE
- Guidelines
RSI
CALCIUM CHLORIDE
- pharmacology and actions
- increases calcium levels
- stimulates release of catecholamines
- increases cardiac contractility (positive inotropic effect)
- stabilizes myocardial cell membranes in hyperkalemia
CALCIUM CHLORIDE
- indications
- suspected hyperkalemia
- antidote for calcium channel blocker overdose
CALCIUM CHLORIDE
- contraindications
- do not use in suspected digoxin toxicity
- hypercalcemia
- suspected severe hypokalemia
- allergy
CALCIUM CHLORIDE
- precautions and side effects
- may cause discomfort at injection site
- will precipitate if mixed with sodium bicarbonate
CALCIUM CHLORIDE
- dosage
1 g IV/IO over 5 minutes
Ensure IV/IO latency and do not exceed 1 mL/minute
CALCIUM CHLORIDE
- how do we carry it
1 gm / 10 mL
PROPARACAINE OPHTHALMIC
- pharmacology and actions
- site of action is ophthalmic pain nerve cell membrane
- alleviates eye pain
PROPARACAINE
- indications
Topical anesthetic prior to irrigation of eyes with Morgan’s lens
PROPARACAINE
- contraindications
Allergy
PROPARACAINE
- precautions and side effects
- each bottle is single patient use only
- may dilate pupils, cause local irritation
PROPARACAINE
- Guidelines
Dermal Chemical Burns
PROPARACAINE
- dosages
1-2 drops in affected eye
Wait 30-60 seconds for anesthetic effect
PROPARACAINE
- how do we carry it
Single use bottle