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Medic School Decks > Drugs > Flashcards

Drugs Flashcards

1
Q

Acetylsalicylic Acid (Aspirin)

Functional class, MOA, Indications, Contraindications, Precautions/Warnings, Adverse Reactions, Drug Interactions, Dose/Route, Pharmacokinetics

A

Functional Class: Anti-platelet

MOA: Blocks production of cyclooxygenase, the precursor to Thromboxane A2. TA2 is what induces platelet aggregation. Anti-inflammatory actions contribute to analgesic effects. Reduces fever by causing peripheral vasodilation and sweating.

Indications: CP, ACS, Acute MI

Contraindications: Hypersensitivity to NSAIDs

Precautions/Warnings: Peptic ulcer disease, recent GI bleed, asthma, tinnitus

Adverse reactions: Bleeding

Drug interactions: Concurrent use with NSAIDs and anticoagulants increases bleeding risk.

Dose and Route: 324mg PO

Pharmacokinetics: Onset: 20 minutes
Duration: 4-6 Hours (Platelet inhibitory effects last approx 10 days)
Half Life: 3-6 Hours

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2
Q

Oxygen

Functional class, MOA, Indications, Contraindications, Precautions/Warnings, Adverse Reactions, Drug Interactions, Dose/Route, Pharmacokinetics

Note: Every 1L/min increase = 4% increase in concentration.
Room air = 21%, 1LPM = 25%, 2LPM = 29%

A

Functional Class: Oxidizer

MOA: Gas necessary for the breakdown of glucose into a usable energy form.

Indications: Presence or suspicion of hypoxia.

Contraindications: None in emergency setting.

Precautions/Warnings: Use caution with COPD pt. Monitor long-term high concentrations in neonates.

Adverse Reactions: Mouth and nasal dryness.

Drug Interactions: None

Dosage/Route: 25%-100% concentrations via BLS and ALS airway adjuncts to maintain SpO2 94%-99%

Pharmacokinetics: Onset = Immediate. Duration = 2 min from removal of source.

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3
Q

Albuterol ( Proventil, Ventolin)

Functional class, MOA, Indications, Contraindications, Precautions/Warnings, Adverse Reactions, Drug Interactions, Dose/Route, Pharmacokinetics

A

Functional Class: Sympathomimetic bronchodilator, Beta2 Agonist

MOA: Relaxes bronchiole smooth muscle, by direction action on Beta2 receptors, with little to no effect on heart rate.

Indications: Bronchospasm, reversible obstructive airway disease

Contraindications: Hypersensitivity

Precautions/Warnings: Can cause paradoxical bronchospasm. Use caution in patients with cardiovascular disease. Use caution in HYPOkalemic patients as albuterol can decrease serum potassium levels.

Adverse Reactions: Tremors, anxiety, HYPERtension, tachycardia, headache, palpitations, seizures, nausea, dizziness, rash.

Drug Interactions: Other sympathomimetic bronchodilators, beta blockers. Potentiation may occur in patients on MAOI’s and TCAs (antidepressants)

Dose/Route: Adult- 2.5 mg in 3mL 0.9% NaCl via nebulizer every 5 min as needed
Pedi- 1.25mg in 2-3mL 0.9% NaCl via nebulizer every 5 min as needed

Pharmacokinetics: Onset = 5-15 min
Duration = 2-6 hours
Half-life = 6 hours

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4
Q

Ipratropium Bromide (Atrovent)

Functional class, MOA, Indications, Contraindications, Precautions/Warnings, Adverse Reactions, Drug Interactions, Dose/Route, Pharmacokinetics

Note: When given in prehospital setting, ipratropium bromide is combined with albuterol to create “DuoNeb” and is not given as the sole agent.

A

Functional Class: Parasympatholytic bronchodilator, anticholinergic agent

MOA: Blocks action of acetylcholine at parasympathetic sites in bronchiole smooth muscle, causing bronchodilation. Inhibits serous and seromucous gland secretions.

Indications: Bronchospasm, reversible obstructive airway disease.

Contraindications: Hypersensitivity to ipratropium or atropine.

Precautions/Warnings: Can cause paradoxical bronchospasm, anaphylaxis.

Adverse Reactions: Headache, dizziness, nausea.

Drug Interactions: May infancy effects of other anticholinergic agents.

Dose/Route: Adult + Pedi (over 2 yrs) 0.5mg via nebulizer every 6 hours
Pedi (Under 2 yrs) 0.25mg via nebulizer every 6 hours

Pharmacokinetics: Onset = 20 minutes
Duration = 3-5 Hours
Half-life = 2 hours

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5
Q

Norepinephrine (Levophed)

Functional class, MOA, Indications, Contraindications, Precautions/Warnings, Adverse Reactions, Drug Interactions, Dose/Route, Pharmacokinetics

A

Functional Class: Sympathomimetic

MOA: Stimulates Beta1 and Alpha-Adrenergic receptors, causing increased contractility, increased heart rate, and vasoconstriction. This increases systemic blood pressure and coronary blood flow. Alpha effects (vasoconstriction) are greater than Beta effects (inotropic and chronograph).

Indications: HYPOtension in post-resuscitative care, sepsis, non-traumatic shock, and symptomatic bradycardia.

Contraindications: None in emergency setting.

Precautions/Warnings: Ensure adequate volume resuscitation prior to initiation of infusion. Can cause tissue necrosis with extravasation. May produce ventricular dysrhythmias in hypoxic or hypercarbic patients.

Adverse Reactions: Bradycardia, cardiac arrhythmia, cardiomyopathy, anxiety, dyspnea.

Drug Interactions: Alpha and/or Beta blockers may diminish effects. Enhances effects of Alpha and Beta agonists.

Dose/Route: 2-30 mcg/min IV/IO infusion.

Pharmacokinetics: Onset = Immediate
Duration = 1-2 minutes after infusion ends
Half-life = 1-2 minutes

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6
Q

Atropine (AtroPen)

Functional Class

A

Parasympatholytic, anticholinergic agent

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7
Q

Atropine (AtroPen)

MOA

A

Blocks action of acetylcholine at parasympathetic sites in smooth muscle, secretory glands, and the CNS.

Increased cardiac output and dries secretions.

Reverses muscarinic effects of cholinergic poisoning by acting as a competitive antagonist of acetylcholine.

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8
Q

Atropine (AtroPen)

Indications/Contraindications

A

Indications: Symptomatic bradycardia. Organophosphate poisoning.

Contraindications: None in the emergency setting.

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9
Q

Atropine (AtroPen)

Precautions/Warnings

A

May worsen bradycardia in 2nd Degree Type 2 and 3rd Degree heart blocks.

Use caution with patients with acute myocardial ischemia, infarction, and glaucoma.

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10
Q

Atropine (AtroPen)

Adverse Reactions

A

Paradoxical bradycardia (if pushed too slowly) blurred vision, dilated pupils, dry mouth, tachycardia, drowsiness, convulsions, hyper/hypotension, palpitations, AV dissociation, urinary retention.

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11
Q

Atropine (AtroPen)

Drug Intercations

A

Antihistamines, tricyclic antidepressants, and procainamide can lead to anticholinergic effects.

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12
Q

Atropine (AtroPen)

Dose/Route

A

Adult:
Symptomatic Bradycardia: 0.5mg IV/IO every 3-5 minutes up to 3mg

Organophosphate: 2mg IV/IO every 5 minutes as needed.

Pedi:
Brady: 0.02 mg/kg IV/IO (max 0.5mg)
Organophosphate: 0.05-0.1 mg/kg IV/IO/IM (min 0.1mg, max 2mg) every 2-5 as needed

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13
Q

Amiodarone

Functional Class

A

Class 3 Anti-arrhythmic, Potassium Channel Blocker

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14
Q

Amiodarone

MOA

A

Prolongs duration of action potential and refractory period by blocking potassium channels.

Exhibits some sodium and calcium channel blockage.

Inhibits adrenergic stimulations.

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15
Q

Amiodarone

Indications

A

V-Tach, V-Fib, A-Fib, A-Flutter, SVT, WPW

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16
Q

Amiodarone

Contraindications

A

Cardiogenic shock, 2nd + 3rd degree blocks, bradycardia, hypersensitivity.

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17
Q

Amiodarone

Precautions/Warnings

A

Bradycardia and HYPOtension.

Cautions in pt w/ severe liver disease due to possible hepatotoxicity.

Can exacerbate arrhythmia.

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18
Q

Amiodarone

Adverse reactions

A

HYPOtension, AV Block, Bradycardia, Hepatotoxicity, Cardiogenic shock, nausea/vomiting, phospholipidemia.

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19
Q

Amiodarone

Drug Interactions

A

Increased digoxin levels.

Increases pharmacological effects of procainamide, lidocaine, quinidine, and oral anticoagulants.

Concurrent use of calcium channel blockers, beta blockers, fentanyl, or cimetidine may potentiate bradycardia.

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20
Q

Amiodarone

Dose and Route

A

Adult;
With Pulse: 150mg in 50-100ml 0.9% NaCl IV/IO infused over 10 minutes. Repeat after 10 minutes

Pulseless: 300mg IV/IO; Repeat in 3-5 min at 150mg.

Pedi;
5mg/kg IV/IO, may repeat twice to max dose 15mg/kg.

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21
Q

Metoprolol (Lopressor)

Class

A

Class 2 Anitarrhythmic, Beta Blocker

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22
Q

Metoprolol (Lopressor)

MOA

A

Selectively inhibits Beta-1 adrenergic receptors located on cardiac muscle.

Completely blocks Beta-1 receptors with little to no effect on Beta-2 receptors (at oral dose <100mg)

Reduces heart rate, cardiac output, and blood pressure

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23
Q

Metoprolol (Lopressor)

Indications

A

Narrow complex tachycardias (>150 bpm)

Not considered a first line tx

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24
Q

Metoprolol (Lopressor)

Contraindications

A

Hypersensitivity, sinus bradycardia, 2nd and 3rd degree blocks (except in pt w/functioning artificial pacemaker), Cardiogenic shock, uncompensated cardiac failure, pregnancy, asthma, COPD

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25
Q

Metoprolol (Lopressor)

Precautions & Warnings

A

Hx of severe anaphylaxis to allergens as pt taking beta-blockers may become more sensitive.

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26
Q

Metoprolol (Lopressor)

Adverse reactions

A

HYPOtension, bradycardia, dizziness

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27
Q

Metoprolol (Lopressor)

Drug Interactions

A

Drugs that slow AV conduction (digoxin) may cumulate the effects.

May blunt the hyperglycemic action of glucagon.

May have synergistic pharmacological effects when given with calcium channel blockers

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28
Q

Metoprolol (Lopressor)

Dose and Route

A

5mg IV/IO over 2-5 min every 5 min up to 15 mg

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29
Q

Diltiazem (Cardizem)

Functional Class

A

Class 4 Antiarrhythmic, Calcium Channel Blocker

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30
Q

Diltiazem (Cardizem)

MOA

A

Inhibits calcium ions from entering “slow channels” or select voltage-sensitive areas of vascular smooth muscle and myocardium during depolarization.

Relaxes coronary vascular smooth muscle.

Produces coronary vasodilation.

Increases myocardial oxygen delivery in pt with vasospastic angina.

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31
Q

Diltiazem (Cardizem)

Indications

A

SVT refractory to Adenosine.

Rapid A-fib, A-Flutter

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32
Q

Diltiazem (Cardizem)

Contraindications

A

Hypersensitivity, sick sinus syndrome, 2nd & 3rd degree blocks, HYPOtension, WPW, Wide-complex tachycardia, cardiogenic shock.

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33
Q

Diltiazem (Cardizem)

Precautions/Warnings

A

Monitor for HYPOtension resulting from peripheral vasodilation.

Avoid use in heart failure pt.

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34
Q

Diltiazem (Cardizem)

Adverse Reactions

A

AV Block, HYPOtension, palpitations, dizziness, edema, headache.

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35
Q

Diltiazem (Cardizem)

Drug Interactions

A

Calcium-channel blockers may potentiate HYPOtension.

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36
Q

Diltiazem (Cardizem)

Dose and Route

A

Bolus: 0.25mg/kg slow IV/IO, may repeat in 15 min at 0.35mg/kg IV/IO (max single dose 20mg)

Infusion: 5-15mg/hr IV/IO, titrate to heart rate

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37
Q

Diltiazem (Cardizem)

Pharmacokinetics

A

Onset = 2-5 min

Duration = unknown

Half-Life = 3-4.5 hours

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38
Q

Dopamine (Intropin)

Functional Class

A

Sympathomimetic

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39
Q

Dopamine (Intropin)

MOA

A

Naturally occurring neurotransmitter and catecholamine

Acts on alpha and beta adrenergic receptors (dose-dependent) and dopaminergic receptors

Therapeutic doses: maintains blood flow in renal and mesenteric vascular beds

Positive inotrope (increased cardiac output and systolic b/p)

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40
Q

Dopamine (Intropin)

Indications

A

Cardiogenic shock, hemodynamically significant hypotension (70-100 not resulting from hypovolemia), symptomatic bradycardia.

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41
Q

Dopamine (Intropin)

Contraindications

A

Tachyarrhythmias, v-fib, phenochromocytoma

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42
Q

Dopamine (Intropin)

Precautions/Warnings

A

20 mcg/kg/min or greater, alpha effects dominate and causes severe vasoconstriction.

Monitor BP every 3-5 min.

Can be deactivated by sodium bicarb.

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43
Q

Dopamine (Intropin)

Adverse Reactions

A

Arrhythmias, palpitations, hypertension, dyspnea, tachycardia, bradycardia, headaches, anxiety, nausea, vomiting, tissue sloughing may result from extravasation.

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44
Q

Dopamine (Intropin)

Drug Interactions

A

Use caution with other vasoactive medications.

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45
Q

Dopamine (Intropin)

Dose, Route, Pharmacokinetics

A

2-20 mcg/kg/min IV/IO infusion. Titrate to effect blood pressure.

2-5 mcg/kg/min =Dopaminergic Effects
5-10 mcg/kg/min = Beta Effects
10-20 mcg/kg/min = Alpha Effects

Onset = 5 min
Duration = 10 min
Half-Life = 2 min

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46
Q

Acetaminophen (Tylenol)

Functional Class

A

Analgesic, non-opioid

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47
Q

Acetaminophen (Tylenol)

MOA

A

Analgesic effects believed to be due to activation of descending serotonergic inhibitory pathways (blocking pain) in the CNS. Exhibits some antipyretic properties, via the inhibition of hypothalamic heat-regulating center.

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48
Q

Acetaminophen (Tylenol)

Indications

A

Mild to moderate pain

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49
Q

Acetaminophen (Tylenol)

Contraindications

A

Hypersensitivity, severe hepatic impairment or active liver disease.

Do not use with other products containing acetaminophen.

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50
Q

Acetaminophen (Tylenol)

Precautions/Warnings

A

Has been associated with acute liver failure. Hepatotoxicity is usually associated with excessive acetaminophen intake. Use caution with alcoholics.

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51
Q

Acetaminophen (Tylenol)

Adverse Reactions

A

Nausea, vomiting, dizziness, hepatotoxicity, renal failure, HYPOglycemia.

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52
Q

Acetaminophen (Tylenol)

Drug Interactions

A

Increased chance of hepatotoxicity when taken chronically or with alcohol, rifampin, carbamazepine.

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53
Q

Acetaminophen (Tylenol)

Dose/Route

A

Adult: 325-1000mg PO/IV Q 4-6 hours

Pedi: 15mg/kg PO/PR Q 4-6 hours

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54
Q

Acetaminophen (Tylenol)

Pharmacokinetics

A

Onset: 15 min (IV) 60 min (PO)
Duration: 4-6 hours
Half-Life: 2-6 hours

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55
Q

Ibuprofen (Advil, Motrin)

Functional Class

A

Analgesic, non-opioid: NSAID

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56
Q

Ibuprofen (Advil, Motrin)

Mechanism

A

Inhibits cyclooxygenase 1 and 2 (COX-1 and 2), which results in decreased formation of prostaglandin precursors. Has antipyretic, analgesic, and anti-inflammatory properties.

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57
Q

Ibuprofen (Advil, Motrin)

Indications

A

Mild to moderate pain

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58
Q

Ibuprofen (Advil, Motrin)

Contraindications

A

Hypersensitivity, history of allergy to ASA or other NSAIDs

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59
Q

Ibuprofen (Advil, Motrin)

Precautions/Warnings

A

Anaphylactic reactions may occur even in pt without past reaction.

NSAIDs can cause increased risk of serious cardiovascular thrombotic events (MI, Stroke).

Increased risk of serious GI inflammation, ulceration, bleeding, and perforation. Elderly and pt w/ hx of peptic ulcers/GI bleed are at greater risk.

Platelet adhesion and aggregation may be decreased.

Caution in pt with liver and renal disease.

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60
Q

Ibuprofen (Advil, Motrin)

Adverse Reactions

A

Abd pain, nausea, vomiting, headaches, dizziness, reduced hemoglobin.

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61
Q

Ibuprofen (Advil, Motrin)

Drug Interactions

A

Reduces the effectiveness of loop diuretics and ACE inhibitors.

Enhances effect of other agents with anti-platelet properties.

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62
Q

Ibuprofen (Advil, Motrin)

Dose and Route

A

Adult: 400mg-800mg PO q 6-8 hours

Pedi: 10mg/kg (max single 400mg) q 6-8 hours.

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63
Q

Ibuprofen (Advil, Motrin)

Pharmacokinetics

A

Onset: 30-60 min

Duration: 4-6 hours

Half-Life: 2 hours

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64
Q

Hydromorphone (Dilaudid)

Functional Class

A

Analgesic, opioid

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65
Q

Hydromorphone (Dilaudid)

Mechanism of Action

A

Binds to opioid receptors in the CNS. Alters the reception of, and response to, pain.

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66
Q

Hydromorphone (Dilaudid)

Indications

A

Moderate to severe pain

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67
Q

Hydromorphone (Dilaudid)

Contraindications

A

Hypersensitivity

SBP <100

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68
Q

Hydromorphone (Dilaudid)

Precautions/Warnings

A

CNS depression

Severe respiratory depression

HYPOtension

Elevated ICP or suspected head injury

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69
Q

Hydromorphone (Dilaudid)

Adverse Reactions

A

Severe respiratory depression, bronchoconstriction, chest wall rigidity

Sedation, bradycardia, hypotension, cardiac arrest

Nausea, vomiting, blurred vision, miosis

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70
Q

Hydromorphone (Dilaudid)

Drug Interactions

A

Effects may increase with other CNS depressants (alcohol, narcotics, sedatives/hypnotics)

MAOI use may cause serotonin syndrome.

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71
Q

Hydromorphone (Dilaudid)

Dose/Route

A

Adult:

0.5mg - 1mg IV/IO q 10 min up to 4 mg
1mg - 2mg IM q 20 min up to 4mg

Pedi:

0.01 - 0.02mg/kg (max single 1mg) IV/IO q 10 minutes up to 4mg.

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72
Q

Hydromorphone (Dilaudid)

Pharmacokinetics

A

Onset = 1-5 min

Durations = 3-4 hrs

Half Life = 2-3 hrs

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73
Q

Lidocaine

Functional Class

A

Class 1B Anti-arrhythmic, Sodium Channel Blocker

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74
Q

Lidocaine

Mechanism of Action

A

Suppresses depolarization and automaticity of His-Purkinjie system.

Suppresses ventricular ectopy and increases ventricular threshold for arrhythmias.

May decrease ventricular threshold for defibrillation.

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75
Q

Lidocaine

Indications

A

V-Fib, V-Tach, malignant PVCs (>6 unifocal/min), multiple PVCs, couplets, R on T.

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76
Q

Lidocaine

Contraindications

A

Hypersensitivity

Adam-Stokes Syndrome

WPW

2nd or 3rd degree blocks

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77
Q

Lidocaine

Precautions/ Warnings

A

Constant EKG monitoring during IV administration.

Use caution in hepatic (liver) impairment, heart failure, and shock.

Monitor for signs of CNS toxicity.

Elderly more prone to CNS + cardiovascular side effects.

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78
Q

Lidocaine

Adverse Reactions

A

Headache, altered mental status

Arrhythmia, bradycardia, heart block

Coronary artery vasospasm

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79
Q

Lidocaine

Drug Interactions

A

Drug toxicity may result from use with beta blockers or procainamide.

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80
Q

Lidocaine

Dose and Route

A

Adult:
Ventricular Arrhythmia:
1-1.5mg/kg IV/IO.
0.50-0.75mg/kg if V-Fib/pVT persists.

Infusion:
1-4mg/min IV/IO using the “+1 rule”

Pedi:
Ventricular Arrhythmia:
1mg/kg IV/IO max dose 100mg

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81
Q

Lidocaine

Pharmacokinetics

A

Onset=45-90 sec

Duration=10-20min

Half-Life=1.5-2hrs

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82
Q

Hydrocortisone (Solu-Cortef)

Functional Class

A

Corticosteroid

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83
Q

Hydrocortisone (Solu-Cortef)

Mechanism of Action

A

Adrenocorticoid with glucocorticoid and mineralcorticcoid properties.

Weak anti-inflammatory but potent mineralcorticoid.

Potency similar to cortisone and 2x prednisone.

Drug of choice for replacement therapy in adrenal insufficiency.

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84
Q

Hydrocortisone (Solu-Cortef)

Indications

A

Chronic adrenal insufficiency pt who are critically ill/injured*

*Shock (any), fever, multi-system trauma, drowning, hyper-hypo thermos, multi long bone fx, resp distress, dehydration, burns, RSI.

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85
Q

Hydrocortisone (Solu-Cortef)

Contraindications

A

Hypersensitivity, systemic fungal infection, premi infants.

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86
Q

Hydrocortisone (Solu-Cortef)

Precautions/Warnings

A

Recent MI, GI ulcer, renal disease, HYPERtension, DM, HYPOthyroidism, cirrhosis, diverticulitis, ulcerative colitis, thromboembolic disorders, sz, myasthenia gravis, heart failure, tuberculosis.

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87
Q

Hydrocortisone (Solu-Cortef)

Adverse Reactions

A

Heart failure, arrhythmias, thromboembolism

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88
Q

Hydrocortisone (Solu-Cortef)

Drug Interactions

A

None in emergency setting

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89
Q

Hydrocortisone (Solu-Cortef)

Dose and Route

A

Adult:
100mg IV/IO

Pedi:
2mg/kg IV/IO/IM max 100mg

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90
Q

Hydrocortisone (Solu-Cortef)

Phamacokinetics

A

Onset=variable, peak 1-2hrs

Duration=variable

Half-Life= 8-12hrs

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91
Q

Methylprednisolone (Solu-Medrol)

Functional Class

A

Corticosteroid

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92
Q

Methylprednisolone (Solu-Medrol)

Mechanism of Action

A

Intermediate-acting synthetic adrenal corticosteroid.

Decreases inflammation by reversing increased capillary permeability. This suppresses the migration of leukocytes and fibroblasts to site of injury.

Stabilizes lysosomes.

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93
Q

Methylprednisolone (Solu-Medrol)

Indications

A

Asthma/COPD exacerbation

Anaphylaxis

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94
Q

Methylprednisolone (Solu-Medrol)

Contraindications

A

None in management of anaphylaxis.

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95
Q

Methylprednisolone (Solu-Medrol)

Precautions/Warnings

A

CHF, Tuberculosis, and Peptic ulcer disease.

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96
Q

Methylprednisolone (Solu-Medrol)

Adverse Reactions

A

HTN, CHF, HYPERglycemia, circulatory collapse, nausea, vomiting, headache, HYPOkalemia, CNS depression, delayed wound healing.

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97
Q

Methylprednisolone (Solu-Medrol)

Drug Interactions

A

Caution in pt on salicylates (ASA), phenytoin (Dilantin; Seizures), rifampin (TB), theophylline (Bronchodilator), furosemide (Lasix), and thiazide diuretics (HCTZ)

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98
Q

Methylprednisolone (Solu-Medrol)

Dose & Route

A

Adult:
125mg IV/IO

Pedi:
2mg/kg IV/IO max dose 125mg

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99
Q

Methylprednisolone (Solu-Medrol)

Pharmacokinetics

A

Onset = Rapid

Duration = 7 Days

Half-Life = 2-3 Hours

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100
Q

Magnesium Sulfate

Functional Class

A

Electrolyte

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101
Q

Magnesium Sulfate

Mechanism of Action

A

Torsades: Decreases acetylcholine in motor nerve terminals. Acts on myocardium by slowing rate of SA node impulse formation which prolongs conduction time. Mag is necessary for movement of calcium and potassium in and out of cell walls as well as stabilizing excitable membranes.

Asthma: Improves pulmonary function by causing bronchial smooth muscle relaxation.

Eclampsia: Thought to trigger cerebral vasodilation, reducing ischemia generated by cerebral vasospasm during eclampsia events. Competitively blocks the entry of calcium into the synaptic ending, altering neuromuscular transmission.

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102
Q

Magnesium Sulfate

Indications

A

Eclampsia, Torsade de Pointes, asthma exacerbation.

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103
Q

Magnesium Sulfate

Contraindications

A

Heart block, shock, HYPOcalcemia, myocardial damage.

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104
Q

Magnesium Sulfate

Precautions

A

Use extreme caution in patients with neuromuscular disease and renal impairment.

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105
Q

Magnesium Sulfate

Adverse Reactions

A

Can have adverse effects on neuromuscular function in patients with neuromuscular disease (myasthenia gravis).

HYPOtension, vasodilation, HYPERmagnesemia

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106
Q

Magnesium Sulfate

Drug Interaction

A

Can cause cardiac conduction abnormalities when used with digitalis. May enhance CNS depressant effects of other CNS depressants.

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107
Q

Magnesium Sulfate

Dose and Route

A

Eclampsia: 4g IV/IO (in 100mL 0.9% NaCl) bolus over 10 minutes; consider 1g/hr continuous infusion.

Torsades: 1-2g IV/IO over 5 min

Asthma: 2g IV/IO (in 100mL 0.9% NaCl) bolus over 10 minutes.

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108
Q

Magnesium Sulfate

Pharmacokinetics

A

Onset = Immediate

Duration = 30 min

Half-Life = 20 hours

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109
Q

Dexamethasone (Decadron)

Functional Class

A

Corticosteroid

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110
Q

Dexamethasone (Decadron)

Mechanism of Action

A

Has anti-inflammatory and immunosuppressive properties 30x higher than cortisol.

Inhibits inflammatory cells and suppresses expression of inflammatory mediators.

Works rapidly, within minutes, which makes it a good option for severe exacerbations.

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111
Q

Dexamethasone (Decadron)

Indications

A

Asthma/COPD exacerbation.

Croup.

112
Q

Dexamethasone (Decadron)

Contraindications

A

Hypersensitivity.

Active or suspected ocular or periocular infections/injury.

113
Q

Dexamethasone (Decadron)

Precautions

A

May increase risk of CHF exacerbation, hypertension, and hyperglycemia.

114
Q

Dexamethasone (Decadron)

Adverse Reactions

A

Hypertension, Cushing’s Syndrome, HYPERglycemia

115
Q

Dexamethasone (Decadron)

Drug Interactions

A

None in the emergency setting.

116
Q

Dexamethasone (Decadron)

Dose and Route

A

Adult: 10mg IV/IO

Pedi: 0.6 mg/kg PO/IV/IO/IM (PO preferred) max 10mg

117
Q

Dexamethasone (Decadron)

Pharmacokinetics

A

Onset = 5-10 min

Duration = Variable (IV), 2.5 days (PO)

Half Life = 1-5 hours

118
Q

Diphenhydramine (Benadryl)

Functional Class

A

Antihistamine

119
Q

Diphenhydramine (Benadryl)

Mechanism of Action

A

Blocks histamine H1 (bronchoconstriction, peripheral vasodilation) receptors

Blocks acetylcholine receptor sites. (Anticholinergic)

Useful in reversing dystonic reactions caused by some antipsychotic meds that block histamine receptor sites. (Compazine, reglan, haldol, phenergan)

120
Q

Diphenhydramine (Benadryl)

Indications

A

Moderate to severe allergic reactions, including anaphylaxis.

Acute extrapyramidal (dystonic) reactions.

121
Q

Diphenhydramine (Benadryl)

Contraindications

A

Hypersensitivity (to diphenhydramine or other structurally related antihistamines)

Newborns

Premature infants

122
Q

Diphenhydramine (Benadryl)

Precautions/Warnings

A

Not considered first line treatment for severe allergic reaction or anaphylaxis.

May cause CNS depression.

Narrow Angle Glaucoma.

123
Q

Diphenhydramine (Benadryl)

Drug Interactions

A

Potentiated by other CNS depressants, antihistamines, narcotics, and alcohol.

MAOIs may prolong or intensify anticholinergic effects.

124
Q

Diphenhydramine (Benadryl)

Dose and Route

A

Adult: 25-50mg IV/IO/IM/PO

Pedi: 1-2mg/kg IV/IO/IM/PO max 50mg

125
Q

Diphenhydramine (Benadryl)

Pharmacokinetics

A

Onset = Rapid

Duration = 4-6 Hours

Half Life = 4.5 Hours

126
Q

Midazolam ( Versed)

Functional Class

A

Benzodiazepine

127
Q

Midazolam ( Versed)

Mechanism of Action

A

Intensifies action of GABA, which causes a shift of chloride ions through the neuronal membrane. This results in hyperpolarization (a less excitable state) and stabilization.

Exhibits some sedative properties.

128
Q

Midazolam ( Versed)

Indications

A

Seizures

Sedation

Anxiety

129
Q

Midazolam ( Versed)

Contraindications

A

Hypersensitivity to benzo’s

Acute narrow angle glaucoma (increases intraoccular pressure)

Severe respiratory depression (unless airway is controlled)

130
Q

Midazolam ( Versed)

Precautions/Warnings

A

Causes:

CNS depression

Anterograde amnesia

Paradoxical reactions

131
Q

Midazolam ( Versed)

Adverse Reactions

A

Severe respiratory depression

Hypotension

132
Q

Midazolam ( Versed)

Drug Interactions

A

Use extreme caution when used simultaneously with other CNS depressants such as opioids.

133
Q

Midazolam ( Versed)

Dose & Route

A

Adult:
2.5-5mg IV/IO/IN
5-10mg IM
May repeat every 5-10 minutes

Pedi:
0.1-0.2mg/kg IV/IO/IN/IM
Max dose 10mg

134
Q

Midazolam ( Versed)

Pharmacokinetics

A

Onset = 3-5 minutes

Duration = 2 hours

1/2 Life = 1-4 hours

135
Q

Diazepam (Valium)

Functional Classs

A

Benzodiazepine

136
Q

Diazepam (Valium)

Mechanism of Action

A

Intensifies activity of GABA.

Causes shift of chloride ions through neuronal membrane, which results in hyperpolarization and stabilization.

Effective in management of stress, anxiety, and alcohol withdrawals due to its sedative properties.

137
Q

Diazepam (Valium)

Indications

A

Anxiety, Seizures, Sedation

138
Q

Diazepam (Valium)

Contraindications

A

Hypersensitivity, narrow angle glaucoma, untreated open angle glaucoma (increases intra-ocular pressure), severe respiratory depression (unless airway controlled).

139
Q

Diazepam (Valium)

Precautions/Warnings

A

CNS depression, anterograde amnesia, paradoxical reactions.

140
Q

Diazepam (Valium)

Adverse Reactions

A

Hypotension, drowsiness, tachycardia, ataxia, amnesia, slurred speech, edema, headache, dizziness, nausea/vomiting, blurred vision, respiratory depression.

141
Q

Diazepam (Valium)

Drug Interactions

A

Extreme caution when used at the same time as other CNS depressants.

Cimetidine (Tagamet) may increase diazepam plasma levels.

142
Q

Diazepam (Valium)

Dose & Route

A

Adult:

5-10mg IV/IO. May repeat 2.5mg q 5 minutes as needed up to 20mg.

Pedi:

0.1-0.2 mg/kg IV/IO (max single 10mg) May repeat once after 5 minutes.
0.5 mg/kg PR (max single PR dose 20mg) May repeat once after 5 minutes.

143
Q

Diazepam (Valium)

Pharmacokinetics

A

Onset = 1-5 minutes IV

Duration = 12 hours

1/2 Life = 20-50 hours

144
Q

Lorazepam (Ativan)

Functional Class

A

Benzodiazepine

145
Q

Lorazepam (Ativan)

Mechanism of Action

A

Intensifies activity of GABA which causes shift of chloride ions through neuronal membrane. Results in hyperpolarization and stability.

Ver effective in management of stress/anxiety and exhibits sedative properties.

146
Q

Lorazepam (Ativan)

Indications

A

Anxiety, seizures, sedation.

147
Q

Lorazepam (Ativan)

Contraindications

A

Hypersensitivity, narrow angle glaucoma (increases intra-ocular pressure), severe respiratory depression (unless airway controlled).

148
Q

Lorazepam (Ativan)

Precautions/Warnings

A

CNS depression

Anterograde amnesia

Paradoxical reactions

149
Q

Lorazepam (Ativan)

Adverse Reactions

A

Respiratory failure, sedations, hypotension, dizziness, confusion, drowsiness.

150
Q

Lorazepam (Ativan)

Drug Interactions

A

Extreme caution when used at that same time as other CNS depressants.

151
Q

Lorazepam (Ativan)

Dose & Route

A

Adult:

Seizures: 2-4mg IV/IO q 5 min

Sedation: 2mg IM, repeat 10 minutes
1mg IV , repeat 5 minutes

Post-Tube Placement: 1-2mg IV q 15 min as needed up to 10mg.

Pedi: 0.1mg/kg IV/IO (max single dose 4mg) q 5 minutes

152
Q

Lorazepam (Ativan)

Pharmacokinetics

A

Onset = 1-5 min IV, 20-30 min IM

Duration = 6-8 hours

1/2 Life = 10-20 hours

153
Q

Dextrose

Functional Class

A

Endocrine-Metabolic Agent

154
Q

Dextrose

Mechanism of Action

A

Principal form of glucose used by the body to create energy.

155
Q

Dextrose

Indications

A

HYPOglycemia

156
Q

Dextrose

Contraindications

A

HYPErglycemia

157
Q

Dextrose

Precautions/Warnings

A

Use w/ caution in pt with increased ICP as the added glucose can worsen cerebral edema.

Consider blood glucose monitoring before and after administration.

Monitor for localized venous irritation, may cause tissue necrosis with extravasation.

158
Q

Dextrose

Adverse Reactions

A

Tissue necrosis, phlebitis, pain at injection site.

159
Q

Dextrose

Drug Interactions

A

No known significant interactions

160
Q

Dextrose

Dose & Route

A

Adult:

10% solution IV/IO infusion until mental status returns to baseline and capillary BGL > 70mg/dL.

Pedi:

5mL/kg 10% solution IV/IO, repeat every 5 minutes until mental status returns to baseline AND BGL > 60mg/dL.

161
Q

Dextrose

Pharmacokinetics

A

Onset = Immediate

Duration = Unknown

1/2 Life = Unknown

162
Q

Glucagon (GlucaGen)

Functional Class

A

Hormone

163
Q

Glucagon (GlucaGen)

Mechanism of Action

A

Protein secreted by Alpha cells in the Islets of Langerhans.

Converts stored glycogen to glucose, and prevents synthesis of glycogen from glucose.

Enhances treatment of CCB and BB OD by producing positive chronotropic and inotropic effects on the heart via stimulation of glucagon receptors in the myocardium.

164
Q

Glucagon (GlucaGen)

Indications

A

HYPOglycemia w/out IV access

Adjuvant treatment of CCB and BB OD

165
Q

Glucagon (GlucaGen)

Contraindications

A

Hypersensitivity

166
Q

Glucagon (GlucaGen)

Precautions/Warnings

A

Only effective if there is enough stored glycogen in the liver.

167
Q

Glucagon (GlucaGen)

Adverse Reactions

A

Hypotension, headache, dizziness, nausea, vomiting, HYPERglycemia, HYPOkalemia

168
Q

Glucagon (GlucaGen)

Drug Interactions

A

None in the emergency setting

169
Q

Glucagon (GlucaGen)

Dose & Route

A

Adult:

Hypoglycemia: 1mg (unit) IM every 10-20 minutes
BB/CCB OD: 5mg IV/IO over 3-5 minutes

Pedi:
0.01-0.1mg/kg IM (max dose 1mg)

170
Q

Glucagon (GlucaGen)

Pharmacokinetics

A

Onset = Unknown (IM) Immediate (IV)

Duration = 60-90 minutes

1/2 Life = 30 minutes

171
Q

Ondansetron (Zofran)

Functional Class

A

Antiemetic, Selective 5-HT3 Receptor Antagonist

172
Q

Ondansetron (Zofran)

Mechanism of Action

A

Serotonin receptor antagonist that prevents acute emesis by blocking serotonin receptors in the CTZ and afferent vagal neurons in the upper GI tract.

Does not cause extrapyramidal syndrome (EPS) or acute dystonic reaction because it does not block dopamine receptors.

173
Q

Ondansetron (Zofran)

Indications

A

Nausea/Vomiting

174
Q

Ondansetron (Zofran)

Contraindications

A

Hypersensitivity. Prolonged QT syndrome can cause lethal arrhythmias (such as Torsade de pointes)

175
Q

Ondansetron (Zofran)

Precautions/Warnings

A

Can cause QT prolongations, torsades, and serotonin syndrome.

176
Q

Ondansetron (Zofran)

Adverse Reactions

A

Headache, constipation, dizziness, fever, drowsiness.

177
Q

Ondansetron (Zofran)

Drug interactions

A

Amiodarone, haloperidol, and other QT prolonging agents, may cause QT prolongation effect.

178
Q

Ondansetron (Zofran)

Dose & Route

A

Adults:
4mg PO/IV/IO/IM

Pedi:
0.1 mg/kg (max single dose 4mg) PO/IV/IO/IM

179
Q

Ondansetron (Zofran)

Pharmacokinetics

A

Onset = Immediate (IV) 10 min (IM)

Duration = 4 Hours

1/2 Life = 6 hours

180
Q

Naloxone (Narcan)

Functional Class

A

Opiate Antagonist

181
Q

Naloxone (Narcan)

Mechanism of Action

A

Pure opioid antagonist that competes and displaces opioids at opioid receptor sites.

182
Q

Naloxone (Narcan)

Indications

A

Opioid overdose causing respiratory depression

183
Q

Naloxone (Narcan)

Contraindications

A

Hypersensitivity

184
Q

Naloxone (Narcan)

Adverse Reactions

A

Nausea, vomiting, pulmonary edema, hypertension, ventricular arrhythmias, tremors, withdrawal symptoms, seizures.

185
Q

Naloxone (Narcan)

Drug Interactions

A

None

186
Q

Naloxone (Narcan)

Dose & Route

A

Adults & Pediatric (>5 y/o or >20kg)
0.4mg-2mg IV/IO/IM/SQ q 2–3 min max dose 10mg.
2mg IN (1mL/nostril via mucosal atomization device); q 3-5 min max 10mg.

Pedi <5y/o <20kg
0.1 mg/kg IV/IO/IN/IM/SQ q 2-3 min max 10mg

187
Q

Naloxone (Narcan)

Pharmacokinetics

A

Onset = 2-5 min, less than 2 IV

Duration = 30-120 min

1/2 Life = 30-90 min

188
Q

Ketorolac (Toradol)

Functional Class

A

Analgesic, NSAID

189
Q

Ketorolac (Toradol)

Mechanism of Action

A

Reversibly inhibits cyclooxygenase (COX 1&2), which results in decreased formation of prostaglandins (which cause pain, inflammation, and fever).

Ketorolac (Toradol) exhibits analgesic, anti-inflammatory, anti-pyretic properties.

190
Q

Ketorolac (Toradol)

Indications

A

Pain management; considered first line pain management in acute renal colic.

191
Q

Ketorolac (Toradol)

Contraindications

A

Hypersensitivity to NSAIDs or ASA.

Active hx of peptic ulcer disease, confirmed recent GI bleed, known/suspected renal failure, confirmed/recent cerebrovascular bleed, recent CABG, pregnancy.

192
Q

Ketorolac (Toradol)

Precautions/Warnings

A

Inhibits platelet function

193
Q

Ketorolac (Toradol)

Adverse Reactions

A

Headache, GI pain

194
Q

Ketorolac (Toradol)

Drug Interactions

A

Ketorolac (Toradol) exhibits anti-platelet activity, therefore can enhance effect of other anti-platelet exhibiting agents.

195
Q

Ketorolac (Toradol)

Dose & Route

A

Adult:

15-30mg IV/IO/IM as a single dose. (No repeat)

196
Q

Ketorolac (Toradol)

Pharmacokinetics

A

Onset = 20 min

Duration = 4-6 Hours

1/2 Life = 2-9 Hours

197
Q

Morphine Sulfate

Functional Class

A

Analgesic, opioid

198
Q

Morphine Sulfate

Mechanism of Action

A

Binds to opioid receptors in the CNS, causing inhibition of ascending pain pathways, altering the perception of and response to pain.

Produces generalized CNS depression.

199
Q

Morphine Sulfate

Indications

A

Moderate to severe pain

200
Q

Morphine Sulfate

Contraindications

A

Hypersensitivity, respiratory depression, acute or severe asthma, circulatory shock.

201
Q

Morphine Sulfate

Precautions/Warnings

A

CNS depression, hypotension.

Caution in pt with hypovolemia, CVD (including acute MI), and drugs/agents that exaggerate hypotensive effects.

202
Q

Morphine Sulfate

Adverse Reactions

A

CNS depression, dizziness, drowsiness, AMS, hypotension, miosis (pinpoint pupils), headache, N/V, constipation.

203
Q

Morphine Sulfate

Drug interactions

A

Concomitant use with benzos or other CNS depressants, including alcohol, can result in profound sedation, respiratory depression, coma, and death.

Tricyclic antidepressants and MAOIs may precipitate hypotensive crisis.

204
Q

Morphine Sulfate

Dose & Route

A

Adult:

1-5mg IV/IO/IM q 5 min up to 15mg

Pedi:

0.1mg/kg IV/IO, may repeat once after 10 min

205
Q

Morphine Sulfate

Pharmacokinetics

A

Onset = 5-10 min

Duration = 3-5 hours

1/2 Life = 2-4 hours

206
Q

Fentanyl Citrate (Sublimaze)

Functional Class

A

Analgesic, opioid

207
Q

Fentanyl Citrate (Sublimaze)

Mechanism of Action

A

Binds with opioid receptors at many sites within the CNS, increases pain threshold, alters pain reception, and inhibits ascending pain pathways.

208
Q

Fentanyl Citrate (Sublimaze)

Indications

A

Moderate to severe pain

209
Q

Fentanyl Citrate (Sublimaze)

Contraindications

A

Hypersensitivity

210
Q

Fentanyl Citrate (Sublimaze)

Precautions & Warnings

A

CNS depression, sever respiratory depression, hypotension, elevated ICP or suspected head injury.

Can cause serotonin syndrome when used in conjunction with agents that impair metabolism of serotonin.

211
Q

Fentanyl Citrate (Sublimaze)

Adverse Reactions

A

May result in life threatening respiratory depression/arrest, bronchoconstriction, chest wall rigidity, sedation, bradycardia, diaphoresis, N/V, miosis, blurred vision, hypotension, cardiac arrest.

212
Q

Fentanyl Citrate (Sublimaze)

Drug Interactions

A

Effects mat be increased with other CNS depressants such as alcohol, narcotics, and sedatives/hypnotics. MAOI use may cause serotonin syndrome.

213
Q

Fentanyl Citrate (Sublimaze)

Dose & Route

A

Adult: 25-100mcg IV/IO/IM/IN every 2-5 min, max 300mcg.

Pedi: 1mcg/kg IV/IO/IM/IN; may repeat at 0.5mcg/kg (max initial dose 100mcg)

214
Q

Fentanyl Citrate (Sublimaze)

Pharmacokinetics

A

Onset = Immediate

Duration = 30-60 minutes

1/2 Life = 2-4 hours

215
Q

Haloperidol (Haldol)

Functional Class

A

Antipsychotic

216
Q

Haloperidol (Haldol)

Mechanism of Action

A

Causes sedation by decreasing nerve impulse transmission by blocking dopamine and serotonin receptors in the CNS.

217
Q

Haloperidol (Haldol)

Indications

A

Chemical restraint/sedation

218
Q

Haloperidol (Haldol)

Contraindications

A

Hypersensitivity, pediatrics, severe CNS depression.

(Including alcohol intoxication and opioid usage)

219
Q

Haloperidol (Haldol)

Precautions/Warnings

A

Hx of seizures. Parkinson’s.

220
Q

Haloperidol (Haldol)

Adverse Reactions

A

QT-Prolongation, torsade de pointes, dystonic reactions, sedations, dizziness, nausea, vomiting, HYPOtension, dry mouth, constipation, decreases seizure threshold.

221
Q

Haloperidol (Haldol)

Drug Interactions

A

Increased sedation with concomitant use of narcotic agonists, benzos, alcohol, TCA, and antihistamines.

222
Q

Haloperidol (Haldol)

Dose & Route

A

5-10mg IM, may repeat once in 5-10 min

223
Q

Haloperidol (Haldol)

Pharmacokinetics

A

Onset = 20 min (Peak)

Duration = 2 Hours

1/2 Life = 21 Hours

224
Q

Ketamine (Ketalar)

Functional Class

A

Anesthetic, Analgesic, Sedative (Depending upon dose)

225
Q

Ketamine (Ketalar)

Mechanism of Action

A

Produces catatonic-like state, pt disassociates from surroundings via direct action on cortex and lymbic system.

Noncompetitive NDMA receptor antagonist that blocks glutamate. (How ketamine can relieves depression)

Low (sub-anesthetic) doses can produce analgesia.

226
Q

Ketamine (Ketalar)

Indications

A

Analgesia, induction, post-intubation sedation, agitated/excited delirium.

227
Q

Ketamine (Ketalar)

Contraindications

A

Hypersensitivity, Infants > 3 months.

228
Q

Ketamine (Ketalar)

Precautions/Warnings

A

Caution in patients with cardiovascular disease, catecholamine depletion, CNS depression.

Post-anesthetic emergence reactions (hallucinations, vivid dreams, and/or frank delirium). Consider benzodiazepine in emergence reactions.

229
Q

Ketamine (Ketalar)

Adverse Reactions

A

Prolonged emergence from anesthesia.

Emergence Reactions.

Critically ill pt may respond to ketamine with unexpected decreases in b/p and cardiac output.

230
Q

Ketamine (Ketalar)

Drug Interactions

A

Enhances CNS depression when used in conjunction with other CNS depressants.

231
Q

Ketamine (Ketalar)

Dose & Route

A

Adults:

Induction: 2mg/kg IV/IO; 4mg/kg IM

Post RSI : 1mg/kg IV/IO q 5-15 min

Analgesia: 10-20mg IV/IO in 100mL NS over 10 minutes. May repeat every 5 min up to total of 40mg.
25-50mg IM, may repeat every 30 min.

Sedation/Restraint: 4mg/kg IM rounded to nearest 50mg, max 500mg. Repeat 100mg IM in 5-10 min.

Pedi:

Analgesia: 0.5-1mg/kg IN.
0.1-0.25 mg/kg IV/IO in 50-100mL NS or D5W over 10 min.

232
Q

Ketamine (Ketalar)

Pharmacokinetics

A

Onset = 30 seconds

Duration = 5-10 min

1/2 Life = 10-15 min, 2.5 hours.

233
Q

Oxytocin (Pitocin)

Functional Class

A

Hormone

234
Q

Oxytocin (Pitocin)

Mechanism of Action

A

Causes phasic contraction of the uterine smooth muscle by direct action of myofibrils.

Promotes milk “letdown” in nursing mothers.

Effective in inducing labor and uterine contractions following delivery, thereby controlling postpartum hemorrhage.

235
Q

Oxytocin (Pitocin)

Indications

A

Postpartum hemorrhage.

236
Q

Oxytocin (Pitocin)

Contraindications

A

Hypersensitivity.

Prior to delivery of fetus. (May cause fetal hypoxia, asphyxia, and arrhythmias)

237
Q

Oxytocin (Pitocin)

Precautions/Warnings

A

May produce anti diuretic effect, monitor intake and output.

Can cause over-stimulation of the uterus resulting in uterine rupture. Vitals and uterus tone must be monitored frequently.

238
Q

Oxytocin (Pitocin)

Adverse Reactions

A

Hypertension, anxiety, nausea/vomiting, arrhythmias, seizures, dyspnea, coma, intracranial bleeding.

239
Q

Oxytocin (Pitocin)

Drug Interactions

A

Can cause profound hypertension when used in conjunction with vasoconstrictors.

240
Q

Oxytocin (Pitocin)

Dose & Route

A

10 units IM, as a single dose.

241
Q

Oxytocin (Pitocin)

Pharmacokinetics

A

Onset = 3-5 min

Duration = 2-3 hours

1/2 Life = 3-5 min

242
Q

Etomidate (Amidate)

Functional Class

A

General Anesthetic, Sedative

243
Q

Etomidate (Amidate)

Mechanism of Action

A

Short acting, non-barbiturate general anesthetic used for rapid induction of anesthesia with minimal cardiovascular effects.

244
Q

Etomidate (Amidate)

Indications

A

RSI, to facilitate endotracheal intubation

245
Q

Etomidate (Amidate)

Contraindications

A

Hypersensitivity

246
Q

Etomidate (Amidate)

Precautions/Warnings

A

Known to inhibit adrenal steroid production up to 8 hours, and up to 24 hours in elderly and debilitated patients.

Can exacerbate symptoms in known heart failure patients.

Use caution in pt with renal failure.

Consider 1/2 dose in elderly and suspected shock.

247
Q

Etomidate (Amidate)

Adverse Reactions

A

Nausea, vomiting, hiccups, adrenal suppression.

248
Q

Etomidate (Amidate)

Drug Interactions

A

Do not use in pt taking taking/using benznidazole or metronidazole.

249
Q

Etomidate (Amidate)

Dose & Route

A

0.3 mg/kg IV/IO ( Max single 30mg)

0.15mg/kg for elderly, shock, risk of hypotension

250
Q

Etomidate (Amidate)

Pharmacokinetics

A

Onset = 30-60 seconds

Duration = 3-5 min

1/2 Life = 75 min

251
Q

Rocuronium (Zemuron)

Functional Class

A

Non-depolarizing neuromuscular blocking agent.

252
Q

Rocuronium (Zemuron)

Mechanism of Action

A

Blocks acetylcholine from binding to receptors on the motor endplate, inhibiting depolarization.

Does not affect level of consciousness.

253
Q

Rocuronium (Zemuron)

Indications

A

RSI; to facilitate endotracheal intubation.

254
Q

Rocuronium (Zemuron)

Contraindications

A

Hypersensitivity

255
Q

Rocuronium (Zemuron)

Precautions/Warnings

A

Never paralyze without adequate sedation.

Can possibly cause anaphylactoid reaction.

Roc can cause a prolonged paralysis.

256
Q

Rocuronium (Zemuron)

Adverse Reactions

A

Increased peripheral vascular resistance, tachycardia, hypertension, anaphylaxis.

257
Q

Rocuronium (Zemuron)

Drug Interactions

A

Antibiotics, heavy metals (lithium) and some beta blockers are known to enhance the neuromuscular blocking affects of rocuronium.

258
Q

Rocuronium (Zemuron)

Dose & Route

A

Adult:

1mg/kg IV/IO

Pedi:

1mg/kg IV/IO

259
Q

Rocuronium (Zemuron)

Pharmacokinetics

A

Onset = 1 min

Duration = 30-40 min

1/2 Life = 1.5-2.5 hrs

260
Q

Hydroxocobalamin (CyanoKit)

Functional Class

A

Antidote, vitamin (b12 supplement)

261
Q

Hydroxocobalamin (CyanoKit)

Mechanism of Action

A

Precursor to cyanocobalamin (B12). Cyanocobalamin acts as a coenzyme for various metabolic functions (fat and carb metabolism, protein synthesis).

In presence of cyanide, each Hydroxocobalamin molecule can bind to 1 cyanide ion. Displaces it for the Hydroxo-ligand linked to the trivalent cobalt ion. This forms cyanocobalamin, which gets peed out.

262
Q

Hydroxocobalamin (CyanoKit)

Indications

A

Cyanide Poisoning

263
Q

Hydroxocobalamin (CyanoKit)

Contraindications

A

Hypersensitivity to any component (including cobalt)

264
Q

Hydroxocobalamin (CyanoKit)

Precautions/Warnings

A

Hypertension, usually resolves within 4 hours.

Photosensitivity.

Possible renal injury.

265
Q

Hydroxocobalamin (CyanoKit)

Adverse Reactions

A

Hypertension, pruritus (itchy skin), headache, chomaturia (abnormal urine color, up to 5 weeks)

266
Q

Hydroxocobalamin (CyanoKit)

Drug Interactions

A

Due to incompatibilities, use different tubing for :
Diazepam, dobutamine, dopamine, fentanyl, and nitro.

267
Q

Hydroxocobalamin (CyanoKit)

Dose & Route

A

1 Kit (5g) IV/IO infusion over 15 min.

May repeat 1 additional 5g kit over 15 minutes to 2 hours if needed based on symptoms.

268
Q

Hydroxocobalamin (CyanoKit)

Pharmacokinetics

A

Onset = Immediate

Duration = UNK

1/2 Life = 26-31 Hours

269
Q

Nitro

Functional Class

A

Nitrate

270
Q

Nitro

Mechanism of Action

A

Rapid vascular smooth muscle relaxant that increases coronary blood flow and improves perfusion of the ischemic myocardium.

Decreased venous return to the heart , alleviates chest pain, decreased preload and after-load in the left ventricle.

271
Q

Nitro

Indications

A

Chest pain associated with angina or acute myocardial infarction, acute pulmonary edema associated with congestive heart failure.

272
Q

Nitro

Contraindications

A

Hypersensitivity.

Shock (Systolic BP<90mmHg)

Increased ICP (Head Trauma)

273
Q

Nitro

Precautions/Warnings

A

Protect from light and air.

Monitor for hypotension.

274
Q

Nitro

Adverse Reactions

A

Hypotension, headache, palpitations, tachycardia, syncope, dry mouth, nausea, vomiting, dizziness, skin rash.

275
Q

Nitro

Drug Interactions

A

May cause hypotension when used in conjunction with alcohol and anti-hypertensives (beta-blockers).

Phosphodiesterase-type 5 (boner pills) use within 24-48 hours as profound hypotension can occur.

276
Q

Nitro

Dose & Route

A

0.4 mg (400mcg) SL tablet or spray q 5 min as needed (if systolic b/p > 100mmHg)

10 mcg/min IV/IO infusion pump increasing by 5-10 mcg/min every 5 min to relieve chest pain or pulmonary edema (if systolic b/p >100mmHg).

1” - 2” transdermal paste (least preferred)

277
Q

Nitro

Pharmacokinetics

A

Onset = Rapid (IV), 1-3 min (SL), 30 min (TD)

Duration = 5-10 min

1/2 Life = 10 min

Medic School Decks (2 decks)

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