Drugs

Question 1

Adenosine (adenocard)

Answer 1

• Narrow complex superventricular tachyarhythmia

• 12 mg rapid bolus IV/IO - combined with a 20 mL NS flush
  (May repeat once)

Contraindications:
• 2nd/3rd º block
• Any irregular tachycardia

Question 2

Albuterol sulfate

Answer 2

• Bronchospasm
- Single-dose neb
(2.5 mg repeat as needed every 10 minutes)
- Continuous neb
(Place 3 premixed containers of albuterol in a neb for a total dose of 7.5 mg)

• Hyperkalemia
- 10 mg via nebulizer
(administer back to back up to max dose of 20 mg)

Contraindications:
• Severe tachycardia

Question 3

Amiodarone

Answer 3

• Pulseless arrest in a patient with shock-refractory or recurrent VF/VT

• 300 mg IV/IO bolus
• additional 150 mg IV/IO bolus after 3 to 5 minutes

• Symptomatic (hemodynamically stable) VT and/or undifferentiated wide complex tachycardia with a pulse
- 150 mg in 50 mL NS over 10 minutes once

Contraindications:
• 2nd/3rd º block
• Cardiogenic shock
• Ventricular escape beats
• Irregular wide complex tachycardia

Question 4

Aspirin

Answer 4

• Symptoms secondary to suspected acute coronary syndrome
- 2 to 4 chewable tablets (162-324 mg to a total dose of 324 mg PO)

Contraindications:
• Severe allergic reactions

Question 5

Atropine sulfate

Answer 5

• Symptomatic bradycardia
- 0.5 mg IV/IO bolus every 3 to 5 minutes (max 3 doses)

• Extreme salvation
- 0.5 mg IV/IO bolus (not repeated)

• Beta blocker OD
- 1 mg IV/IO bolus (every minute until symptom resolution)

• Organophosphate poisoning
- 2 mg IV/IO bolus (every minute as needed for symptom resolution)

Contraindications:
• None in the emergency setting

Question 6

Ipratropium bromide (atrovent)

Answer 6

Adjunct bronchodilator for:
• asthma
• chronic bronchitis
• allergy/anaphylaxis
• emphysema
- 0.5 mg given with albuterol in nebulizer
(repeat as needed every 15 minutes)

Contraindications:
• Hx of hypersensitivity

Question 7

Calcium

Answer 7

• Hyperkalemia
• Calcium/beta channel blocker overdose
- 1 Gram over 2-5 min (may repeat q 10 min to max 3 dose)

• Crush injury/cardiac arrest from suspected hyperkalemia
- 1 Gram rapid push

Contraindications:
• known hypercalcemia
• Digoxin toxicity-would worsen cardiovascular function

Question 8

Dexamethasone

Decadron

Answer 8

• Moderate to severe allergic reaction
• Severe asthma
• COPD
• Croup (with resting strider ONLY)
• Addisonian crisis
- 10 mg bolus IV/IO/IM/PO

Contraindications:
• Known hypersensitivity

Question 9

Dextrose

Answer 9

• Hypoglycemia less than 60mg/dL
- 12.5-25 Grams IV/IO (May repeat 25 G after 5-10 min if unimproved)

Contraindications:
• Intracranial or intraspinal hemorrhage w/ >60 mg/dL
• Severe traumatic brain injuries w/ >60 mg/dL

Question 10

Diazepam

Valium

Answer 10

• Muscle spasm
• Agitated
• Combative
- up to 5 mg IV/IO/IM (repeat as needed q 10 min max dose 10 mg)

• Seizure
- 10 mg IV/IO/IM (repeat as needed q 10 min)

Contraindications:
• Known hypersensitivity
• Procedural sedation

Question 11

Diltiazem

Cardizem

Answer 11

• Reentrant narrow complex supraventricular tachydysrhythmias
• Atrial fib/flutter with rapid ventricular response
- 20 mg IV/IO bolus over 2-5 min (may repeat after 15 min @ 25 mg)

Contraindications:
• Patients with sick sinus syndrome or AV heart block.
• Any wide QRS tachycardia resulting from a poisoning or drug overdose, ventricular tachycardia, WPW syndrome associated with either atrial flutter or atrial fibrillation.
• Hypotension <100 systolic

Question 12

Diphenhydramine

Benadryl

Answer 12

• General allergic reaction
• Anaphylaxis
• Dystonic medication reaction
- 50 mg bolus IV/IO 2-5 min or IM/PO

Question 13

Epinephrine

Answer 13

• Cardiac arrest (1:10,000 IV/IO)

• 1 mg q 3-5 min max 3 doses
• 2 mg in 500 mL NS bag wide open (humoral head only)

• Allergic reaction (1:1,000 IM)
- 0.3 mg (repeat as needed q 5 min)

• Croup (1:1,000 nebulized)
- 5 mg (repeat as needed AFTER 30 min)

• Uncompensated shock or severe asthma (IV/IO)
- mix 1 mg in 1,000 mL NS bag wide open
(Titrate to BP)

Contraindications:
• Hypovolemic and/or hemorrhagic shock

Question 14

Fentanyl

Sublimaze

Answer 14

• Pain
• Post RSI sedation
• Shivering in heat stroke/hyperthermic pt after rapid cooling
- 50-100 mcg IV/IO/IM/IN
(repeat q 10 min as needed)

Contraindications:
• Known hypersensitivity

Question 15

Glucagon

Answer 15

• Hypoglycemia
- 1 mg IM

• Food impaction
- 1 mg IV/IO (slow push)

• Beta/Calcium channel blocker OD
- 5 mg IV/IO (repeat once if symptoms do not resolve)

Contraindications:
• Known hypersensitivity

Question 16

Hydromorphone

Dilaudid

Answer 16

• Pain

- 0.5 mg IV/IO/IM (repeat q 10 min as needed)

Question 17

Hydroxocobalamin

Cyanokit

Answer 17

• Cyanide toxicity or exposure

- 5 Grams IV/IO (may repeat once)

Question 18

IV solutions

Answer 18

• Hypovolemia
- 20mL/kg IV/IO (repeat as needed)

• Hemorrhagic shock
- 10mL/kg IV/IO (repeat as needed)

• Septic shock
- 30mL/kg IV/IO (repeat as needed)

• Burn therapy
- 500mL/hr IV/IO

Question 19

Ketamine

Ketalar

Answer 19

• Pain (repeat as needed q 20 min max 3 dose)

• 30 mg IV/IO (50 mL bag over 5-10 min)
• 50 mg IM/IN

• RSI
- 200 mg IV/IO

• Post RSI
- 100 mg IV/IO

• Chemical sedation of pt w/ ExDs
- 250-500 mg IM (contact med control for repeat doses)

Contraindications:
• < 13 years old in RSI and/or ExDS (for agitation)
• < 7 years old (for pain management)
• Known hypersensitivity

Question 20

Magnesium Sulfate

Answer 20

• Torsades de Pointes
- 2 Grams IV/IO (in 50 mL bag over 10 min)
(If cardiac arrest then rapid push)

• Status Asthmaticus
- 2 Grams IV/IO (in 50 mL bag over 10 min)

• Eclampsia
- 5 Grams IV/IO (in 50 mL bag over 10 min)
(If cardiac arrest then rapid push)

Contraindications:
• Patients with heart block

Question 21

Midazolam

Versed

Answer 21

Comfort measure:
• Muscle spasms
• anxious
• agitated
• combative
- up to 5 mg IV/IO/IM/IN
(repeat as needed q 10 min up to MAX dose 10 mg)

• Active seizures -
- 5 mg IV/IO/IM/IN (repeat as needed q 10 min)

• RSI induction
- 5 mg 1 dose IV/IO

Contraindications:
• Known hypersensitivity
• Procedural sedation

Question 22

Naloxone

Narcan

Answer 22

• Opioid OD
- 0.5-1 mg IV/IO/IM/IN (repeat as needed)

Contraindications:
• Known hypersensitivity

Question 23

Phenylephrine

Neosynepherine

Answer 23

• Nose bleed
- 2 sprays to each nostril with pt gently sniffing until pt can taste Afrin
(Repeat as needed q 20 min)

Contraindications:
• Known hypersensitivity

Question 24

Nitroglycerin

Nitrostat

Answer 24

• Hypertension control in CHF associated with pulmonary edema
- SBP 100 to 120 - 0.4 mg sublingual
- SBP 121 to 200 - 0.8 mg sublingual
- SBP > 200 - 1.2 mg sublingual
(Repeat 0.4 mg every 5 min to titrate symptoms & BP)

Contraindications:
• Hypotension SBP < 100
* Recent use of erectile dysfunction (ED) medication within 24 hours of Viagra or Levita and or 48 hours with Cialis

Question 25

Ondansetron

Zofran

Answer 25

• Nausea/vomiting
Prophylactic for:
• opioid pain management
• CPAP
• selective spinal splinting
- 4 mg ODT/IV/IO/IM/PO
(Repeat as needed q 10 min up to 2 total doses)

Contraindications:
• Known allergy

Question 26

Oral Glucose

Instaglucose

Answer 26

• Hypoglycemia (able to swallow)
- 1-2 full tubes or 15-30 Grams Buccal
(repeat as needed q 10 min)

Contraindications:
• Inability to swallow or protect airway
• Unable to take oral medications

Question 27

Rocuronium Bromide

Zemuron

Answer 27

• RSI (first line paralytic agent)
• Maintain paralysis of an intubated pt
- 100 mg IV/IO
(repeat after 20 min if needed to Max of 2 TOTAL doses)

Contraindications:
• Known hypersensitivity

Question 28

Sodium Bicarbonate

Answer 28

• Hyperkalemia
• Tricyclic/Antihistamine OD
- 100 mEq IV/IO slow bolus
(repeat as needed until cessation of seizures or QRS shortens to <100ms if applicable)

• In severe cases
- Mix 150 mEq in 1000 mL NS & administer @ 200 mL/hr

Contraindications:
• Metabolic and/or respiratory alkalosis
• Hypocalcemia
• Hypokalemia

Question 29

Succinycholine

Anectine

Answer 29

• RSI Paralytic agent (if Roc is NOT available)
- 200 mg IV/IO (NOT repeated)

Contraindications:
• Patients with personal or familial history of malignant hyperthermia and/or skeletal muscle myopathies (multiple sclerosis)
• Hypersensitivity