Drugs Flashcards
Albuterol
Names(s):
Proventil
Ventolin
Class:
Sympathomimetic
bronchodilator
MOA:
Bronchodilation
decreases airway resistance
**Packaging; **
2.5 mg/ 3mL unit does (Sulfite free)
**Indications: **
Bronchospasm
Contraindications
Known Allery
Use caution in combination with other sympathomimetics due to potentiating effects
Adverse Reactions
CV: dysrthynias, tachycardia
CNS: tremors, nervousness, restlessness
Adult Dose
2.5mg in 3 mL unit does via SVN or in-line BVM
May repeat per medical direction
May be combined with ipratopium
Dextrose
Name(s):
D10 (10% solution)
D50 (50% solution)
Class
Carbohydrate
hyperglycemic
MOA
Increases blood glucose levels
short-term osmotic diuresis
Packaging
D10: 1 gran per 10 mL (ex: 25 grams/250mL)
D50: 1 gram per 2 mL (ex: 25 grams/50Ml prefilled syringe)
Indications
known hypoglycemia
Altered LOC or seizures of unknown etiology
Hyperkalemia (in combination with sodium bicarbonate and calcium choride)
**Contraindications **
Head injury
**Note: Do NOT withhold dextrose from a stroke or TBI patient with known hypoglycemia **
**Adverse Reactions **
Cerebal edema
Increased ICP
Tissue necrosis (if IV infiltrates)
Adult Dose
12.5-50 grams IV
Peds Dose
0.5-1 gram per kg of D10 solution over 20 min
To make/admin D10
- Remove 50 mL from 250 Ml IV bag and add 50 Ml of D50
- Adminter 5-10 mL per kg of D10
Diazepam
Name(s)
Valium
**Class **
Benzodiazepine
MOA
CNS depressant, anti-convulsant, sedation
**Packaging **
10 mg /2mL prefilled syringe (5mg per mL)
**Inications **
Grand mal (generalized) seizure
Transient sedation for medical procedures
Delirium tremens
status epilepticus
**Contraindications **
Known allergry
Angle closure glaucoma (relative)
Adverse Reactions
CV: bradycardia, hypotension
Resp: resp depression
CNS: confussion, coma
Other: burning at injection site, tissue narcrosis fron infiltration
Adult Dose
IV: 2mg increment slow IVP (do not exceed 2 mg per min)
Note: for 10 mg/ 2 mL packaging quickly calculate Ml by doubling dose and moving decimal one left (ex 2mg = 0.4ml // 6mg = 1.2 mL)
**Peds Does **
IV: 0.2-0.3 mg/kg over at least 3 minutes or until sezure subsides
Rectal: (<6years) 0.3-0.5 mg/kg (Slow)
Ipratropium Bromide
Name(s):
Atrovent
Class:
Anticholinergic, Bronchodilator
MOA:
Inhibits parasympathetic NS, preferential dilation of larger central awaiways
Packaging:
500 mcg/ 2.5 mL unit dose
Inidications
-Bronchospasm
-Can be used alone or combination with albuterol
Contrainidications
-Known allergy
-Allergy to atropine
-Caution in patients with angles closure glaucoma
Adverse Reactions:
-Resp: cough, increased sputum production
-CNS: dizziness, insomnia, tremors, nevousness
-GI: nausea
**Adult Dose: **
-500 mcg in 2.5mL unit dose via SVN or in-line BVM
-Can be mixed with albuterol
Lorazepam
Name(s)
Ativan
Class:
Benzodiazepine
MOA:
CNS depression, anti-convulsant
Packaging
-2mg/mL or
-4mg/mL
Inidcations
-Seizures, status epilepticus
-Agitated (excited) delirium
Contraindications
-Known allergy
-Acute angle closure glaucoma
-Myasthenia gravis
-Pregnancy (relative)
Adverse Reaction
-Confusion
-Sedation
-Amnesia
-Hypotension
-Respiratory depression
Adult Dose:
-Seizures: 2-5mg slow IV/IO (at least 2 min) Max 10 mg
-Note may be given deep IM is no IV/IO access
Peds Dose:
-Seizures 0.05-0.1 mg/kg slow IV/IO (at least 2 min) Max 4mg
-Note may be given deep IM if no IV/IO access
Intravenous dosage Normal Saline 0.9% for Adults hypovolemic shock, dehydration
1,000 mL IV bolus. Repeat dose and/or titrate as needed to target hemodynamic stability
Intravenous dosage Normal Saline 0.9% for Adults septic shock
A
20 mL/kg IV or more within the first 3 hours of resuscitation. If further fluid therapy is required, use small repeat boluses guided by stroke volume or cardiac output
Intravenous dosage Normal Saline 0.9% for Adults cardiogenic shock
250 mL IV bolus in patients without evidence of fluid overload. Repeat dose and/or titrate as needed to target hemodynamic
stability
Intravenous dosage Normal Saline 0.9% for Adults diabetic ketoacidosis
15 to 20 mL/kg (or 1,000 to 1,500 mL) IV during the first hour of
treatment, then 250 to 500 mL/hour continuous IV infusion
Lactated Ringers Solution Adults hypovolemic shock, dehydration
1,000 mL IV bolus. Repeat dose and/or titrate as needed
to target hemodynamic stability
Lactated Ringers Solution Adults septic shock
20 mL/kg IV or more within the first 3 hours of
resuscitation.
If further fluid therapy is required, use small repeat
boluses guided by stroke volume or cardiac output.
Lactated Ringers Solution Adults cardiogenic shock
250 mL IV bolus in patients without evidence of fluid
overload. Repeat dose and/or titrate as needed to target
hemodynamic stability.
Lactated Ringers Solution Adults diabetic ketoacidosis
15 to 20 mL/kg (or 1,000 to 1,500 mL) IV during the first
hour of treatment, then 250 to 500 mL/hour continuous IV
infusion
Anti-Emetics (nausea control)
Zofran (Ondansetron)
Name — Zofran®, Zofran ODT®, Zuplenz®
Class — Antiemetic, selective 5-HT3 antagonist
**Pharmacologic Action **— Mechanism not fully characterized; selective 5-HT3 receptor antagonist; binds to 5-HT3 receptors both in periphery and in CNS, with primary effects in GI tract. Has no effect on dopamine receptors and therefore does not cause extrapyramidal symptoms
Indications — For the management of nausea or vomiting
Dose-4 mg, may repeat in 20 minutes
Supplied-4mg/2mL
Route-IV, IM, IO
Contraindications — Hypersensitivity, coadministration with apomorphine; combination reported to cause profound hypotension and loss of consciousness
Anti-Emetics (nausea control)
Phenergan (Promethazine)
Class - Anti-emetic
Mechanism of Action- Blocker of the emetic center in the brain, dopamine receptors and alpha-adrenergic receptors in the brain
Indication - Nasuea & Vomiting
Contraindications- Hypersensitivity, respiratory depressions
Red Flags/Warning- servere tissue injury can occur from perivascular extravasation, unitentional intra-arterial injection, and intranueronal or perineuronal infiltration
Dose - 12.5mg to 25 mg
Route - IV, IM, IO
Supplied- 25mg / 1mL
Analgesics (Pain Control)
Acetaminophen (Tylenol®)
Class — Analgesics, antipyretic, other
Mechanism of Action—May work peripherally to block pain impulse generation; may also inhibit prostaglandin synthesis in CNS
Indications—Pain control, fever control
Contraindications—Hypersensitivity, severe acute liver disease
Route-Oral
Dose 500 mg to 1000 mg every 6 hours, not to exceed 4 grams/day
Analgesics (Pain Control)
Fentanyl (Sublimaze)
Class — Synthetic opioid, opioid analgesics
**Mechanism of Action **— Narcotic agonist-analgesic of opiate receptors; inhibits ascending pain pathways, thus altering response to pain; increases pain threshold; produces analgesia, respiratory depression, and sedation
Indications— Management of acute pain
Contraindications — Hypersensitivity
Red Flags / Warnings: Should be used with caution in the elderly and in patients with hypotension, suspected gastrointestinal obstruction, head injury, and concomitant CNS depressants. Serious, life-threatening, or fatal respiratory depression may occur. Monitor for respiratory depression, especially during initiation or following a dose increase
Dose-50 mcg to 100 mcg slow IVP 1-2 mins.) IM, IO.
Supplied-100 mcg/2mL
Analgesics (Pain Control)
Morphine Sulfate
Class — Opioid analgesic
**Pharmacologic Action **— Narcotic agonist-analgesic of opiate receptors; inhibits ascending pain pathways, thus altering response to pain; produces analgesia, respiratory depression, and sedation; suppresses cough by acting centrally in medulla
Indications— Management of acute pain
Contraindications — Hypersensitivity, respiratory depression, acute or severe bronchial asthma, upper airway obstruction.
Red Flags/Warnings- Serious, life-threatening, or fatal respiratory depression may occur. Monitor for respiratory depression, especially during initiation or following a dose increase
Dose- IM, IV push: Dilute 2.5-15 mg in 4-5 mL of NS,
Supplied-5 mg/10 mL
Analgesics (Pain Control)
Ketorolac (Toradol)
Class — Non-steroidal anti-inflammatory drug (NSAID)
Mechanism of Action — Inhibits synthesis of prostaglandins in body tissues by inhibiting at least 2 cyclo-oxygenase (COX) isoenzymes, COX-1 and COX-2. May inhibit chemotaxis, alter lymphocyte activity, decrease proinflammatory cytokine activity, and inhibit neutrophil aggregation; these effects may contribute to anti-inflammatory activity
Indications — For the acute management of moderately severe pain
Contraindications — Allergy to aspirin, ketorolac, or other NSAIDS; women who are in active labor or are breastfeeding, significant renal impairment particularly when associated with volume depletion, previous or current GI bleeding, intracranial
bleeding, coagulation defects, patients with a high-risk of bleeding
Dose-Adults weighing 50 kg or more
* 30 mg IV or 60 mg IM.
Adults weighing less than 50 kg and Geriatric patients
* 15 mg IV or 30 mg IM.
Supplied form-30 mg / 1mL
Emergency Pharmacology for Endocrine Emergencies
Thiamine
Thiamine, also known as vitamin B₁, is a vitamin, an essential micronutrient, that cannot be made in the body. Thiamine is required by our bodies to properly use carbohydrates. It also helps maintain proper nerve function.
Indications-Alcoholism, delirium tremens Coma of unknown origin, especially if alcohol or malnourishment may be involved. Suspect Wernicke or Korsakoff Syndrome
Contraindications-Do not give intra-arterial
Adverse Reactions-Hypotension (rare)
Dose-100 mg /one minute
Emergency Pharmacology for Endocrine Emergencies
Dextrose 50%
Class- Carbohydrate
Indications- 50% Dextrose Injection is indicated in the treatment of insulin hypoglycemia (hyperinsulinemia or insulin shock) to restore blood glucose levels, and
seizures resulting from hypoglycemia
Contraindications- A concentrated dextrose solution should not be used when intracranial or intraspinal hemorrhage is present, nor in the presence of delirium tremens if the patient is already dehydrated.
Dose- Intravenous injection of 10 to 25 grams of dextrose (20 to 50 mL of 50% dextrose) is usually adequate. Repeated doses and supportive treatment may be required in severe cases. A specimen for blood glucose determination should be taken before injecting the dextrose. In such emergencies, dextrose should be administered promptly without awaiting pretreatment test results.
Adverse Reactions- Hyperosmolar syndrome, resulting from excessively rapid administration of concentrated dextrose may cause mental confusion and/or loss of consciousness.
Tissue necrosis may occur if extravasation occurs
