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
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.
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
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
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
6
Q
Atropine (AtroPen)
Functional Class
A
Parasympatholytic, anticholinergic agent
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.
8
Q
Atropine (AtroPen)
Indications/Contraindications
A
Indications: Symptomatic bradycardia. Organophosphate poisoning.
Contraindications: None in the emergency setting.
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.
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.
11
Q
Atropine (AtroPen)
Drug Intercations
A
Antihistamines, tricyclic antidepressants, and procainamide can lead to anticholinergic effects.
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
13
Q
Amiodarone
Functional Class
A
Class 3 Anti-arrhythmic, Potassium Channel Blocker
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.
15
Q
Amiodarone
Indications
A
V-Tach, V-Fib, A-Fib, A-Flutter, SVT, WPW
16
Q
Amiodarone
Contraindications
A
Cardiogenic shock, 2nd + 3rd degree blocks, bradycardia, hypersensitivity.
17
Q
Amiodarone
Precautions/Warnings
A
Bradycardia and HYPOtension.
Cautions in pt w/ severe liver disease due to possible hepatotoxicity.
Can exacerbate arrhythmia.
18
Q
Amiodarone
Adverse reactions
A
HYPOtension, AV Block, Bradycardia, Hepatotoxicity, Cardiogenic shock, nausea/vomiting, phospholipidemia.
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.
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.
21
Q
Metoprolol (Lopressor)
Class
A
Class 2 Anitarrhythmic, Beta Blocker
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
23
Q
Metoprolol (Lopressor)
Indications
A
Narrow complex tachycardias (>150 bpm)
Not considered a first line tx
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
25
Metoprolol (Lopressor)
Precautions & Warnings
Hx of severe anaphylaxis to allergens as pt taking beta-blockers may become more sensitive.
26
Metoprolol (Lopressor)
Adverse reactions
HYPOtension, bradycardia, dizziness
27
Metoprolol (Lopressor)
Drug Interactions
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
28
Metoprolol (Lopressor)
Dose and Route
5mg IV/IO over 2-5 min every 5 min up to 15 mg
29
Diltiazem (Cardizem)
Functional Class
Class 4 Antiarrhythmic, Calcium Channel Blocker
30
Diltiazem (Cardizem)
MOA
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.
31
Diltiazem (Cardizem)
Indications
SVT refractory to Adenosine.
Rapid A-fib, A-Flutter
32
Diltiazem (Cardizem)
Contraindications
Hypersensitivity, sick sinus syndrome, 2nd & 3rd degree blocks, HYPOtension, WPW, Wide-complex tachycardia, cardiogenic shock.
33
Diltiazem (Cardizem)
Precautions/Warnings
Monitor for HYPOtension resulting from peripheral vasodilation.
Avoid use in heart failure pt.
34
Diltiazem (Cardizem)
Adverse Reactions
AV Block, HYPOtension, palpitations, dizziness, edema, headache.
35
Diltiazem (Cardizem)
Drug Interactions
Calcium-channel blockers may potentiate HYPOtension.
36
Diltiazem (Cardizem)
Dose and Route
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
37
Diltiazem (Cardizem)
Pharmacokinetics
Onset = 2-5 min
Duration = unknown
Half-Life = 3-4.5 hours
38
Dopamine (Intropin)
Functional Class
Sympathomimetic
39
Dopamine (Intropin)
MOA
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)
40
Dopamine (Intropin)
Indications
Cardiogenic shock, hemodynamically significant hypotension (70-100 not resulting from hypovolemia), symptomatic bradycardia.
41
Dopamine (Intropin)
Contraindications
Tachyarrhythmias, v-fib, phenochromocytoma
42
Dopamine (Intropin)
Precautions/Warnings
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.
43
Dopamine (Intropin)
Adverse Reactions
Arrhythmias, palpitations, hypertension, dyspnea, tachycardia, bradycardia, headaches, anxiety, nausea, vomiting, tissue sloughing may result from extravasation.
44
Dopamine (Intropin)
Drug Interactions
Use caution with other vasoactive medications.
45
Dopamine (Intropin)
Dose, Route, Pharmacokinetics
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
46
Acetaminophen (Tylenol)
Functional Class
Analgesic, non-opioid
47
Acetaminophen (Tylenol)
MOA
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.
48
Acetaminophen (Tylenol)
Indications
Mild to moderate pain
49
Acetaminophen (Tylenol)
Contraindications
Hypersensitivity, severe hepatic impairment or active liver disease.
Do not use with other products containing acetaminophen.
50
Acetaminophen (Tylenol)
Precautions/Warnings
Has been associated with acute liver failure. Hepatotoxicity is usually associated with excessive acetaminophen intake. Use caution with alcoholics.
51
Acetaminophen (Tylenol)
Adverse Reactions
Nausea, vomiting, dizziness, hepatotoxicity, renal failure, HYPOglycemia.
52
Acetaminophen (Tylenol)
Drug Interactions
Increased chance of hepatotoxicity when taken chronically or with alcohol, rifampin, carbamazepine.
53
Acetaminophen (Tylenol)
Dose/Route
Adult: 325-1000mg PO/IV Q 4-6 hours
Pedi: 15mg/kg PO/PR Q 4-6 hours
54
Acetaminophen (Tylenol)
Pharmacokinetics
Onset: 15 min (IV) 60 min (PO)
Duration: 4-6 hours
Half-Life: 2-6 hours
55
Ibuprofen (Advil, Motrin)
Functional Class
Analgesic, non-opioid: NSAID
56
Ibuprofen (Advil, Motrin)
Mechanism
Inhibits cyclooxygenase 1 and 2 (COX-1 and 2), which results in decreased formation of prostaglandin precursors. Has antipyretic, analgesic, and anti-inflammatory properties.
57
Ibuprofen (Advil, Motrin)
Indications
Mild to moderate pain
58
Ibuprofen (Advil, Motrin)
Contraindications
Hypersensitivity, history of allergy to ASA or other NSAIDs
59
Ibuprofen (Advil, Motrin)
Precautions/Warnings
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.
60
Ibuprofen (Advil, Motrin)
Adverse Reactions
Abd pain, nausea, vomiting, headaches, dizziness, reduced hemoglobin.
61
Ibuprofen (Advil, Motrin)
Drug Interactions
Reduces the effectiveness of loop diuretics and ACE inhibitors.
Enhances effect of other agents with anti-platelet properties.
62
Ibuprofen (Advil, Motrin)
Dose and Route
Adult: 400mg-800mg PO q 6-8 hours
Pedi: 10mg/kg (max single 400mg) q 6-8 hours.
63
Ibuprofen (Advil, Motrin)
Pharmacokinetics
Onset: 30-60 min
Duration: 4-6 hours
Half-Life: 2 hours
64
Hydromorphone (Dilaudid)
Functional Class
Analgesic, opioid
65
Hydromorphone (Dilaudid)
Mechanism of Action
Binds to opioid receptors in the CNS. Alters the reception of, and response to, pain.
66
Hydromorphone (Dilaudid)
Indications
Moderate to severe pain
67
Hydromorphone (Dilaudid)
Contraindications
Hypersensitivity
SBP <100
68
Hydromorphone (Dilaudid)
Precautions/Warnings
CNS depression
Severe respiratory depression
HYPOtension
Elevated ICP or suspected head injury
69
Hydromorphone (Dilaudid)
Adverse Reactions
Severe respiratory depression, bronchoconstriction, chest wall rigidity
Sedation, bradycardia, hypotension, cardiac arrest
Nausea, vomiting, blurred vision, miosis
70
Hydromorphone (Dilaudid)
Drug Interactions
Effects may increase with other CNS depressants (alcohol, narcotics, sedatives/hypnotics)
MAOI use may cause serotonin syndrome.
71
Hydromorphone (Dilaudid)
Dose/Route
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.
72
Hydromorphone (Dilaudid)
Pharmacokinetics
Onset = 1-5 min
Durations = 3-4 hrs
Half Life = 2-3 hrs
73
Lidocaine
Functional Class
Class 1B Anti-arrhythmic, Sodium Channel Blocker
74
Lidocaine
Mechanism of Action
Suppresses depolarization and automaticity of His-Purkinjie system.
Suppresses ventricular ectopy and increases ventricular threshold for arrhythmias.
May decrease ventricular threshold for defibrillation.
75
Lidocaine
Indications
V-Fib, V-Tach, malignant PVCs (>6 unifocal/min), multiple PVCs, couplets, R on T.
76
Lidocaine
Contraindications
Hypersensitivity
Adam-Stokes Syndrome
WPW
2nd or 3rd degree blocks
77
Lidocaine
Precautions/ Warnings
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.
78
Lidocaine
Adverse Reactions
Headache, altered mental status
Arrhythmia, bradycardia, heart block
Coronary artery vasospasm
79
Lidocaine
Drug Interactions
Drug toxicity may result from use with beta blockers or procainamide.
80
Lidocaine
Dose and Route
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
81
Lidocaine
Pharmacokinetics
Onset=45-90 sec
Duration=10-20min
Half-Life=1.5-2hrs
82
Hydrocortisone (Solu-Cortef)
Functional Class
Corticosteroid
83
Hydrocortisone (Solu-Cortef)
Mechanism of Action
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.
84
Hydrocortisone (Solu-Cortef)
Indications
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.
85
Hydrocortisone (Solu-Cortef)
Contraindications
Hypersensitivity, systemic fungal infection, premi infants.
86
Hydrocortisone (Solu-Cortef)
Precautions/Warnings
Recent MI, GI ulcer, renal disease, HYPERtension, DM, HYPOthyroidism, cirrhosis, diverticulitis, ulcerative colitis, thromboembolic disorders, sz, myasthenia gravis, heart failure, tuberculosis.
87
Hydrocortisone (Solu-Cortef)
Adverse Reactions
Heart failure, arrhythmias, thromboembolism
88
Hydrocortisone (Solu-Cortef)
Drug Interactions
None in emergency setting
89
Hydrocortisone (Solu-Cortef)
Dose and Route
Adult:
100mg IV/IO
Pedi:
2mg/kg IV/IO/IM max 100mg
90
Hydrocortisone (Solu-Cortef)
Phamacokinetics
Onset=variable, peak 1-2hrs
Duration=variable
Half-Life= 8-12hrs
91
Methylprednisolone (Solu-Medrol)
Functional Class
Corticosteroid
92
Methylprednisolone (Solu-Medrol)
Mechanism of Action
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.
93
Methylprednisolone (Solu-Medrol)
Indications
Asthma/COPD exacerbation
Anaphylaxis
94
Methylprednisolone (Solu-Medrol)
Contraindications
None in management of anaphylaxis.
95
Methylprednisolone (Solu-Medrol)
Precautions/Warnings
CHF, Tuberculosis, and Peptic ulcer disease.
96
Methylprednisolone (Solu-Medrol)
Adverse Reactions
HTN, CHF, HYPERglycemia, circulatory collapse, nausea, vomiting, headache, HYPOkalemia, CNS depression, delayed wound healing.
97
Methylprednisolone (Solu-Medrol)
Drug Interactions
Caution in pt on salicylates (ASA), phenytoin (Dilantin; Seizures), rifampin (TB), theophylline (Bronchodilator), furosemide (Lasix), and thiazide diuretics (HCTZ)
98
Methylprednisolone (Solu-Medrol)
Dose & Route
Adult:
125mg IV/IO
Pedi:
2mg/kg IV/IO max dose 125mg
99
Methylprednisolone (Solu-Medrol)
Pharmacokinetics
Onset = Rapid
Duration = 7 Days
Half-Life = 2-3 Hours
100
Magnesium Sulfate
Functional Class
Electrolyte
101
Magnesium Sulfate
Mechanism of Action
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.
102
Magnesium Sulfate
Indications
Eclampsia, Torsade de Pointes, asthma exacerbation.
103
Magnesium Sulfate
Contraindications
Heart block, shock, HYPOcalcemia, myocardial damage.
104
Magnesium Sulfate
Precautions
Use extreme caution in patients with neuromuscular disease and renal impairment.
105
Magnesium Sulfate
Adverse Reactions
Can have adverse effects on neuromuscular function in patients with neuromuscular disease (myasthenia gravis).
HYPOtension, vasodilation, HYPERmagnesemia
106
Magnesium Sulfate
Drug Interaction
Can cause cardiac conduction abnormalities when used with digitalis. May enhance CNS depressant effects of other CNS depressants.
107
Magnesium Sulfate
Dose and Route
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.
108
Magnesium Sulfate
Pharmacokinetics
Onset = Immediate
Duration = 30 min
Half-Life = 20 hours
109
Dexamethasone (Decadron)
Functional Class
Corticosteroid
110
Dexamethasone (Decadron)
Mechanism of Action
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.
111
Dexamethasone (Decadron)
Indications
Asthma/COPD exacerbation.
Croup.
112
Dexamethasone (Decadron)
Contraindications
Hypersensitivity.
Active or suspected ocular or periocular infections/injury.
113
Dexamethasone (Decadron)
Precautions
May increase risk of CHF exacerbation, hypertension, and hyperglycemia.
114
Dexamethasone (Decadron)
Adverse Reactions
Hypertension, Cushing’s Syndrome, HYPERglycemia
115
Dexamethasone (Decadron)
Drug Interactions
None in the emergency setting.
116
Dexamethasone (Decadron)
Dose and Route
Adult: 10mg IV/IO
Pedi: 0.6 mg/kg PO/IV/IO/IM (PO preferred) max 10mg
117
Dexamethasone (Decadron)
Pharmacokinetics
Onset = 5-10 min
Duration = Variable (IV), 2.5 days (PO)
Half Life = 1-5 hours
118
Diphenhydramine (Benadryl)
Functional Class
Antihistamine
119
Diphenhydramine (Benadryl)
Mechanism of Action
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
Diphenhydramine (Benadryl)
Indications
Moderate to severe allergic reactions, including anaphylaxis.
Acute extrapyramidal (dystonic) reactions.
121
Diphenhydramine (Benadryl)
Contraindications
Hypersensitivity (to diphenhydramine or other structurally related antihistamines)
Newborns
Premature infants
122
Diphenhydramine (Benadryl)
Precautions/Warnings
Not considered first line treatment for severe allergic reaction or anaphylaxis.
May cause CNS depression.
Narrow Angle Glaucoma.
123
Diphenhydramine (Benadryl)
Drug Interactions
Potentiated by other CNS depressants, antihistamines, narcotics, and alcohol.
MAOIs may prolong or intensify anticholinergic effects.
124
Diphenhydramine (Benadryl)
Dose and Route
Adult: 25-50mg IV/IO/IM/PO
Pedi: 1-2mg/kg IV/IO/IM/PO max 50mg
125
Diphenhydramine (Benadryl)
Pharmacokinetics
Onset = Rapid
Duration = 4-6 Hours
Half Life = 4.5 Hours
126
Midazolam ( Versed)
Functional Class
Benzodiazepine
127
Midazolam ( Versed)
Mechanism of Action
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
Midazolam ( Versed)
Indications
Seizures
Sedation
Anxiety
129
Midazolam ( Versed)
Contraindications
Hypersensitivity to benzo’s
Acute narrow angle glaucoma (increases intraoccular pressure)
Severe respiratory depression (unless airway is controlled)
130
Midazolam ( Versed)
Precautions/Warnings
Causes:
CNS depression
Anterograde amnesia
Paradoxical reactions
131
Midazolam ( Versed)
Adverse Reactions
Severe respiratory depression
Hypotension
132
Midazolam ( Versed)
Drug Interactions
Use extreme caution when used simultaneously with other CNS depressants such as opioids.
133
Midazolam ( Versed)
Dose & Route
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
Midazolam ( Versed)
Pharmacokinetics
Onset = 3-5 minutes
Duration = 2 hours
1/2 Life = 1-4 hours
135
Diazepam (Valium)
Functional Classs
Benzodiazepine
136
Diazepam (Valium)
Mechanism of Action
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
Diazepam (Valium)
Indications
Anxiety, Seizures, Sedation
138
Diazepam (Valium)
Contraindications
Hypersensitivity, narrow angle glaucoma, untreated open angle glaucoma (increases intra-ocular pressure), severe respiratory depression (unless airway controlled).
139
Diazepam (Valium)
Precautions/Warnings
CNS depression, anterograde amnesia, paradoxical reactions.
140
Diazepam (Valium)
Adverse Reactions
Hypotension, drowsiness, tachycardia, ataxia, amnesia, slurred speech, edema, headache, dizziness, nausea/vomiting, blurred vision, respiratory depression.
141
Diazepam (Valium)
Drug Interactions
Extreme caution when used at the same time as other CNS depressants.
Cimetidine (Tagamet) may increase diazepam plasma levels.
142
Diazepam (Valium)
Dose & Route
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
Diazepam (Valium)
Pharmacokinetics
Onset = 1-5 minutes IV
Duration = 12 hours
1/2 Life = 20-50 hours
144
Lorazepam (Ativan)
Functional Class
Benzodiazepine
145
Lorazepam (Ativan)
Mechanism of Action
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
Lorazepam (Ativan)
Indications
Anxiety, seizures, sedation.
147
Lorazepam (Ativan)
Contraindications
Hypersensitivity, narrow angle glaucoma (increases intra-ocular pressure), severe respiratory depression (unless airway controlled).
148
Lorazepam (Ativan)
Precautions/Warnings
CNS depression
Anterograde amnesia
Paradoxical reactions
149
Lorazepam (Ativan)
Adverse Reactions
Respiratory failure, sedations, hypotension, dizziness, confusion, drowsiness.
150
Lorazepam (Ativan)
Drug Interactions
Extreme caution when used at that same time as other CNS depressants.
151
Lorazepam (Ativan)
Dose & Route
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
Lorazepam (Ativan)
Pharmacokinetics
Onset = 1-5 min IV, 20-30 min IM
Duration = 6-8 hours
1/2 Life = 10-20 hours
153
Dextrose
Functional Class
Endocrine-Metabolic Agent
154
Dextrose
Mechanism of Action
Principal form of glucose used by the body to create energy.
155
Dextrose
Indications
HYPOglycemia
156
Dextrose
Contraindications
HYPErglycemia
157
Dextrose
Precautions/Warnings
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
Dextrose
Adverse Reactions
Tissue necrosis, phlebitis, pain at injection site.
159
Dextrose
Drug Interactions
No known significant interactions
160
Dextrose
Dose & Route
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
Dextrose
Pharmacokinetics
Onset = Immediate
Duration = Unknown
1/2 Life = Unknown
162
Glucagon (GlucaGen)
Functional Class
Hormone
163
Glucagon (GlucaGen)
Mechanism of Action
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
Glucagon (GlucaGen)
Indications
HYPOglycemia w/out IV access
Adjuvant treatment of CCB and BB OD
165
Glucagon (GlucaGen)
Contraindications
Hypersensitivity
166
Glucagon (GlucaGen)
Precautions/Warnings
Only effective if there is enough stored glycogen in the liver.
167
Glucagon (GlucaGen)
Adverse Reactions
Hypotension, headache, dizziness, nausea, vomiting, HYPERglycemia, HYPOkalemia
168
Glucagon (GlucaGen)
Drug Interactions
None in the emergency setting
169
Glucagon (GlucaGen)
Dose & Route
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
Glucagon (GlucaGen)
Pharmacokinetics
Onset = Unknown (IM) Immediate (IV)
Duration = 60-90 minutes
1/2 Life = 30 minutes
171
Ondansetron (Zofran)
Functional Class
Antiemetic, Selective 5-HT3 Receptor Antagonist
172
Ondansetron (Zofran)
Mechanism of Action
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
Ondansetron (Zofran)
Indications
Nausea/Vomiting
174
Ondansetron (Zofran)
Contraindications
Hypersensitivity. Prolonged QT syndrome can cause lethal arrhythmias (such as Torsade de pointes)
175
Ondansetron (Zofran)
Precautions/Warnings
Can cause QT prolongations, torsades, and serotonin syndrome.
176
Ondansetron (Zofran)
Adverse Reactions
Headache, constipation, dizziness, fever, drowsiness.
177
Ondansetron (Zofran)
Drug interactions
Amiodarone, haloperidol, and other QT prolonging agents, may cause QT prolongation effect.
178
Ondansetron (Zofran)
Dose & Route
Adults:
4mg PO/IV/IO/IM
Pedi:
0.1 mg/kg (max single dose 4mg) PO/IV/IO/IM
179
Ondansetron (Zofran)
Pharmacokinetics
Onset = Immediate (IV) 10 min (IM)
Duration = 4 Hours
1/2 Life = 6 hours
180
Naloxone (Narcan)
Functional Class
Opiate Antagonist
181
Naloxone (Narcan)
Mechanism of Action
Pure opioid antagonist that competes and displaces opioids at opioid receptor sites.
182
Naloxone (Narcan)
Indications
Opioid overdose causing respiratory depression
183
Naloxone (Narcan)
Contraindications
Hypersensitivity
184
Naloxone (Narcan)
Adverse Reactions
Nausea, vomiting, pulmonary edema, hypertension, ventricular arrhythmias, tremors, withdrawal symptoms, seizures.
185
Naloxone (Narcan)
Drug Interactions
None
186
Naloxone (Narcan)
Dose & Route
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
Naloxone (Narcan)
Pharmacokinetics
Onset = 2-5 min, less than 2 IV
Duration = 30-120 min
1/2 Life = 30-90 min
188
Ketorolac (Toradol)
Functional Class
Analgesic, NSAID
189
Ketorolac (Toradol)
Mechanism of Action
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
Ketorolac (Toradol)
Indications
Pain management; considered first line pain management in acute renal colic.
191
Ketorolac (Toradol)
Contraindications
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
Ketorolac (Toradol)
Precautions/Warnings
Inhibits platelet function
193
Ketorolac (Toradol)
Adverse Reactions
Headache, GI pain
194
Ketorolac (Toradol)
Drug Interactions
Ketorolac (Toradol) exhibits anti-platelet activity, therefore can enhance effect of other anti-platelet exhibiting agents.
195
Ketorolac (Toradol)
Dose & Route
Adult:
15-30mg IV/IO/IM as a single dose. (No repeat)
196
Ketorolac (Toradol)
Pharmacokinetics
Onset = 20 min
Duration = 4-6 Hours
1/2 Life = 2-9 Hours
197
Morphine Sulfate
Functional Class
Analgesic, opioid
198
Morphine Sulfate
Mechanism of Action
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
Morphine Sulfate
Indications
Moderate to severe pain
200
Morphine Sulfate
Contraindications
Hypersensitivity, respiratory depression, acute or severe asthma, circulatory shock.
201
Morphine Sulfate
Precautions/Warnings
CNS depression, hypotension.
Caution in pt with hypovolemia, CVD (including acute MI), and drugs/agents that exaggerate hypotensive effects.
202
Morphine Sulfate
Adverse Reactions
CNS depression, dizziness, drowsiness, AMS, hypotension, miosis (pinpoint pupils), headache, N/V, constipation.
203
Morphine Sulfate
Drug interactions
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
Morphine Sulfate
Dose & Route
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
Morphine Sulfate
Pharmacokinetics
Onset = 5-10 min
Duration = 3-5 hours
1/2 Life = 2-4 hours
206
Fentanyl Citrate (Sublimaze)
Functional Class
Analgesic, opioid
207
Fentanyl Citrate (Sublimaze)
Mechanism of Action
Binds with opioid receptors at many sites within the CNS, increases pain threshold, alters pain reception, and inhibits ascending pain pathways.
208
Fentanyl Citrate (Sublimaze)
Indications
Moderate to severe pain
209
Fentanyl Citrate (Sublimaze)
Contraindications
Hypersensitivity
210
Fentanyl Citrate (Sublimaze)
Precautions & Warnings
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
Fentanyl Citrate (Sublimaze)
Adverse Reactions
May result in life threatening respiratory depression/arrest, bronchoconstriction, chest wall rigidity, sedation, bradycardia, diaphoresis, N/V, miosis, blurred vision, hypotension, cardiac arrest.
212
Fentanyl Citrate (Sublimaze)
Drug Interactions
Effects mat be increased with other CNS depressants such as alcohol, narcotics, and sedatives/hypnotics. MAOI use may cause serotonin syndrome.
213
Fentanyl Citrate (Sublimaze)
Dose & Route
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
Fentanyl Citrate (Sublimaze)
Pharmacokinetics
Onset = Immediate
Duration = 30-60 minutes
1/2 Life = 2-4 hours
215
Haloperidol (Haldol)
Functional Class
Antipsychotic
216
Haloperidol (Haldol)
Mechanism of Action
Causes sedation by decreasing nerve impulse transmission by blocking dopamine and serotonin receptors in the CNS.
217
Haloperidol (Haldol)
Indications
Chemical restraint/sedation
218
Haloperidol (Haldol)
Contraindications
Hypersensitivity, pediatrics, severe CNS depression.
(Including alcohol intoxication and opioid usage)
219
Haloperidol (Haldol)
Precautions/Warnings
Hx of seizures. Parkinson’s.
220
Haloperidol (Haldol)
Adverse Reactions
QT-Prolongation, torsade de pointes, dystonic reactions, sedations, dizziness, nausea, vomiting, HYPOtension, dry mouth, constipation, decreases seizure threshold.
221
Haloperidol (Haldol)
Drug Interactions
Increased sedation with concomitant use of narcotic agonists, benzos, alcohol, TCA, and antihistamines.
222
Haloperidol (Haldol)
Dose & Route
5-10mg IM, may repeat once in 5-10 min
223
Haloperidol (Haldol)
Pharmacokinetics
Onset = 20 min (Peak)
Duration = 2 Hours
1/2 Life = 21 Hours
224
Ketamine (Ketalar)
Functional Class
Anesthetic, Analgesic, Sedative (Depending upon dose)
225
Ketamine (Ketalar)
Mechanism of Action
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
Ketamine (Ketalar)
Indications
Analgesia, induction, post-intubation sedation, agitated/excited delirium.
227
Ketamine (Ketalar)
Contraindications
Hypersensitivity, Infants > 3 months.
228
Ketamine (Ketalar)
Precautions/Warnings
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
Ketamine (Ketalar)
Adverse Reactions
Prolonged emergence from anesthesia.
Emergence Reactions.
Critically ill pt may respond to ketamine with unexpected decreases in b/p and cardiac output.
230
Ketamine (Ketalar)
Drug Interactions
Enhances CNS depression when used in conjunction with other CNS depressants.
231
Ketamine (Ketalar)
Dose & Route
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
Ketamine (Ketalar)
Pharmacokinetics
Onset = 30 seconds
Duration = 5-10 min
1/2 Life = 10-15 min, 2.5 hours.
233
Oxytocin (Pitocin)
Functional Class
Hormone
234
Oxytocin (Pitocin)
Mechanism of Action
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
Oxytocin (Pitocin)
Indications
Postpartum hemorrhage.
236
Oxytocin (Pitocin)
Contraindications
Hypersensitivity.
Prior to delivery of fetus. (May cause fetal hypoxia, asphyxia, and arrhythmias)
237
Oxytocin (Pitocin)
Precautions/Warnings
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
Oxytocin (Pitocin)
Adverse Reactions
Hypertension, anxiety, nausea/vomiting, arrhythmias, seizures, dyspnea, coma, intracranial bleeding.
239
Oxytocin (Pitocin)
Drug Interactions
Can cause profound hypertension when used in conjunction with vasoconstrictors.
240
Oxytocin (Pitocin)
Dose & Route
10 units IM, as a single dose.
241
Oxytocin (Pitocin)
Pharmacokinetics
Onset = 3-5 min
Duration = 2-3 hours
1/2 Life = 3-5 min
242
Etomidate (Amidate)
Functional Class
General Anesthetic, Sedative
243
Etomidate (Amidate)
Mechanism of Action
Short acting, non-barbiturate general anesthetic used for rapid induction of anesthesia with minimal cardiovascular effects.
244
Etomidate (Amidate)
Indications
RSI, to facilitate endotracheal intubation
245
Etomidate (Amidate)
Contraindications
Hypersensitivity
246
Etomidate (Amidate)
Precautions/Warnings
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
Etomidate (Amidate)
Adverse Reactions
Nausea, vomiting, hiccups, adrenal suppression.
248
Etomidate (Amidate)
Drug Interactions
Do not use in pt taking taking/using benznidazole or metronidazole.
249
Etomidate (Amidate)
Dose & Route
0.3 mg/kg IV/IO ( Max single 30mg)
0.15mg/kg for elderly, shock, risk of hypotension
250
Etomidate (Amidate)
Pharmacokinetics
Onset = 30-60 seconds
Duration = 3-5 min
1/2 Life = 75 min
251
Rocuronium (Zemuron)
Functional Class
Non-depolarizing neuromuscular blocking agent.
252
Rocuronium (Zemuron)
Mechanism of Action
Blocks acetylcholine from binding to receptors on the motor endplate, inhibiting depolarization.
Does not affect level of consciousness.
253
Rocuronium (Zemuron)
Indications
RSI; to facilitate endotracheal intubation.
254
Rocuronium (Zemuron)
Contraindications
Hypersensitivity
255
Rocuronium (Zemuron)
Precautions/Warnings
Never paralyze without adequate sedation.
Can possibly cause anaphylactoid reaction.
Roc can cause a prolonged paralysis.
256
Rocuronium (Zemuron)
Adverse Reactions
Increased peripheral vascular resistance, tachycardia, hypertension, anaphylaxis.
257
Rocuronium (Zemuron)
Drug Interactions
Antibiotics, heavy metals (lithium) and some beta blockers are known to enhance the neuromuscular blocking affects of rocuronium.
258
Rocuronium (Zemuron)
Dose & Route
Adult:
1mg/kg IV/IO
Pedi:
1mg/kg IV/IO
259
Rocuronium (Zemuron)
Pharmacokinetics
Onset = 1 min
Duration = 30-40 min
1/2 Life = 1.5-2.5 hrs
260
Hydroxocobalamin (CyanoKit)
Functional Class
Antidote, vitamin (b12 supplement)
261
Hydroxocobalamin (CyanoKit)
Mechanism of Action
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
Hydroxocobalamin (CyanoKit)
Indications
Cyanide Poisoning
263
Hydroxocobalamin (CyanoKit)
Contraindications
Hypersensitivity to any component (including cobalt)
264
Hydroxocobalamin (CyanoKit)
Precautions/Warnings
Hypertension, usually resolves within 4 hours.
Photosensitivity.
Possible renal injury.
265
Hydroxocobalamin (CyanoKit)
Adverse Reactions
Hypertension, pruritus (itchy skin), headache, chomaturia (abnormal urine color, up to 5 weeks)
266
Hydroxocobalamin (CyanoKit)
Drug Interactions
Due to incompatibilities, use different tubing for :
Diazepam, dobutamine, dopamine, fentanyl, and nitro.
267
Hydroxocobalamin (CyanoKit)
Dose & Route
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
Hydroxocobalamin (CyanoKit)
Pharmacokinetics
Onset = Immediate
Duration = UNK
1/2 Life = 26-31 Hours
269
Nitro
Functional Class
Nitrate
270
Nitro
Mechanism of Action
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
Nitro
Indications
Chest pain associated with angina or acute myocardial infarction, acute pulmonary edema associated with congestive heart failure.
272
Nitro
Contraindications
Hypersensitivity.
Shock (Systolic BP<90mmHg)
Increased ICP (Head Trauma)
273
Nitro
Precautions/Warnings
Protect from light and air.
Monitor for hypotension.
274
Nitro
Adverse Reactions
Hypotension, headache, palpitations, tachycardia, syncope, dry mouth, nausea, vomiting, dizziness, skin rash.
275
Nitro
Drug Interactions
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
Nitro
Dose & Route
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
Nitro
Pharmacokinetics
Onset = Rapid (IV), 1-3 min (SL), 30 min (TD)
Duration = 5-10 min
1/2 Life = 10 min
