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EMS > Drugs > Flashcards

Drugs Flashcards

1
Q

Zofran - generic name

A

Ondansetron

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2
Q

Zofran (ondansetron) - Class:

A

Antiemetic

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3
Q

Zofran (ondansetron) - Action

A

Blocks serotonin receptors in the vagus nerve terminals and in small intestine that trigger the vomit reflex

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4
Q

Zofran (ondansetron) - Onset and Duration

A

Onset: IV/IM and ODT up to 30 minutes

Duration: IV/IM and ODT 2 hours

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5
Q

Zofran (ondansetron) - Indications

A

Abdominal Discomfort - GI/GU (non traumatic) - (S-120)
- for nausea or vomiting
Pain Management, (S-141)
- for nausea or vomiting after morphine administration

Pediatric:
GI/GU (non traumatic), (S-174)
- nausea or vomiting

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6
Q

Zofran (ondansetron) - Dosage

A

Adults:
4mg IV/IM/ODT
MR x1 in 10”

PEDS:
6mo - 3 years: 2mg ODT/IV
>3 years: 4mg ODT/IV
*if suspected head injury, BHPO

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7
Q

Zofran (ondansetron) - Contraindications

A

None

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8
Q

Zofran (ondansetron) - Side effects

A
  • GI issues (especially diarrhea)

- headache

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9
Q

Benadryl - generic name:

A

(Diphenhydramine Hydrochloride)

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10
Q

Benadryl (Diphenhydramine Hydrochloride) - Class:

A

Antihistamine

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11
Q

Benadryl (Diphenhydramine Hydrochloride - Action:

A
  • Binds with histamine receptors, blocking H1 and H2 receptors
    H1 causes bronchoconstriction, airway swelling, and vasodilation
    H2 causes secretion of gastric acid
  • does not prevent release of histamine
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12
Q

Benadryl (Diphenhydramine Hydrochloride - Onset and Duration

A

Onset: 15-30 minutes
Duration: 6-12 hours

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13
Q

Benadryl (Diphenhydramine Hydrochloride - Indications

A
  • Allergic Reaction/Anaphylaxis, (S-122, S-162)
    (Hives/Anaphylaxis Criteria/Angioedema)
  • Poisoning/OD, (S-134, S-165)
    Extrapyramidal reactions
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14
Q

Benadryl (Diphenhydramine Hydrochloride - Dosage/Route

A

Adults: 50mg slow IV/IM

PEDS: PDC IV/IM

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15
Q

Benadryl (Diphenhydramine Hydrochloride - contraindications

A

None

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16
Q

Benadryl (Diphenhydramine Hydrochloride - side effects:

A
  • Drowsiness/sedation (excitement in children)
  • Dry mouth/ thickened bronchial secretions
  • Hypotension
  • Palpitations/tachycardia
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17
Q

Epinephrine (Adrenalin, EPI) - Class

A

Catecholamine: Sympathomimetic (both alpha and beta effects)

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18
Q

Epinephrine (Adrenalin, EPI) - Action:

A
  • On the bronchi: bronchodilation (beta-2)
  • On the peripheral vasculature: vasoconstriction (alpha)
  • On the heart:
    • increased heart rate (beta-1)/chronotropic
    • increased contracility/inotropic
    • increased AV conduction/dromotropic
    • increased automaticity/dromotropic
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19
Q

Epinephrine (Adrenalin, EPI) - Onset and Duration

A

Onset:

 - IV/IO 1-2 minutes
 - IM/SC 5-10 minutes

Duration:

 - IV/IO 5-10 minutes
 - IM/SC 1-4 hours
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20
Q

Epinephrine (Adrenalin, EPI) - Indications (only)

A
  • Allergic Reaction/Anaphylaxis, (S-122, S-162)
    anaphylaxis/angioedema
  • Respiratory Distress, (S-136, S-167)
    Severe respiratory distress or inadequate response to Albuterol/ Atrovent
  • PEDS: Respiratory distress (S-167)
    With stridor at rest
  • PEDS: Burns (S-170)
    with respiratory distress with stridor
  • Dysrythmias (S-127, S-163)
    Cardiac arrest (pulseless patient)
  • PEDS: Dysrhythmias (S-163)
    Unstable bradycardia: after BVM for 30 seconds
  • PEDS: Newborn deliveries (S-166)
    If HR remains <60 after 30 seconds of CPR
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21
Q

Epinephrine (Adrenalin, EPI) - Dosage

Allergic Reaction/Anaphylaxis, (S-122; S-162)
- anaphylaxis/angioedema

A

Adult= .3mg IM 1:1,000 MR x2 q5”
.1mg IV/IO 1:10,000 BHO; MR x2 q3-5” BHO
PEDS= PDC IM 1:1,000; MR x2 q5”
PDC IV/IO 1:10,000 BHO; MR x2 q3-5” BHO

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22
Q

Epinephrine: Dosage for
PEDS: Newborn deliveries (S-166)
- (if HR remains <60 after 30 seconds of CPR)

A

PEDS: PDC IV/IO 1:10,000 - MR x2 q3-5” BHO

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23
Q

Epinephrine (adrenaline, EPI): Dosage

for PEDS: Dysrhythmias, (S-163)
- (unstable cradycardia: after BVM for 30 sec):

A

PEDS: PDC IV/IO 1:10,000 - MR x2 q3-5” BHO

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24
Q

Epinephrine (adrenaline, EPI): Dosage

Dysrhythmias, (S-127; S-163)
- cardiac arrest/pulseless patient

PEDS: Dysrhythmias (S-163)
- unstable bradycardia: after BVM for 30 sec

A

Adults: 1mg IV/IO 1:10,000 - MR q3-5”

PEDS: PDC IV/IO 1:10,000; MR x2 q3-5”; MR q3-5” BHO

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25
Q

Epinephrine - Dosage:

PEDS: Burns, (S-170)
- with Respiratory distress with stridor:

A

PEDS:

      1: 1,000 PDC via nebulizer MR x1 SO
      1: 1,000 PDC IM, SO MR x2 q5” SO
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26
Q

Epinephrine (adrenaline, EPI): Dosage

PEDS: Respiratory Distress, (S-167)
- with stridor at rest:

A

PEDS: 1:,1000 PDC via nebulizer MR x1

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27
Q

Epinephrine: Dosage

Respiratory Distress, (S-136, S-167)
- severe respiratory distress or inadequate response to Albuterol/Atrovent):

A

Adults= .3mg IM 1:1,000; MR x2 q5”
*if no definite history of asthma: dosing as above per BHPO
PEDS= PDC - IM 1:1,000; MR x2 q5”

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28
Q

Epinephrine (Adrenalin, EPI) - Contraindications:

A

None

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29
Q

Epinephrine (Adrenalin, EPI) - side effects:

A
  • anxiety/restlessness
  • palpitations/tachyarrhythmias
  • Ventricle irritability
  • increased myocardial 02 demands
  • hypertension
  • angina
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30
Q

Narcan (Naloxone Hydrochloride)- Class?

A

Opioid antagonist

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31
Q

Narcan (Naloxone Hydrochloride)- Action

A

Reverse respiratory depression, sedation and hypotension effects of opioid overdose by occupying opiate receptor sites

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32
Q

Narcan (Naloxone Hydrochloride)- Onset and Duration

A

Onset: IV/IN 1-2 min
IM 2-5 min

Duration: IV 30-60 min
IM longer

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33
Q

Narcan (Naloxone Hydrochloride)- Indications

A 
Adult:  Poisoning/OD 
             Altered Neurological (symptomatic suspected opioid OD with respirations <12
PEDS:  Poisoning/OD
               Altered Neurological (symptomatic suspected opioid OD)
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34
Q

Narcan (Naloxone Hydrochloride)- Dosage/Route

A

Adult: 2mg IN/IM/IV; MR titrate IV dose to effect, to drive the respiratory rate

IF patient refuses transport: 2mg IM additional dose

PEDS: PDC IN/IM/IV; MR

Adults/PEDS: for opioid dependent pain management patients: “use caution and titrate”

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35
Q

Narcan (Naloxone Hydrochloride)- Contraindications

A

None

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36
Q

Narcan (Naloxone Hydrochloride)- Side Effects

A
  • Acute withdraws symptoms
  • Nausea/vomiting
  • Tachycardia/hypertension
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37
Q

Glucagon- Class

A

Antihypoglycemic: pancreatic hormone

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38
Q

Glucagon- Action

A
  • Increases blood glucose by converting glycogen stored in the liver to glucose
  • Inhibits synthesis of glycogen from glucose
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39
Q

Glucagon- Onset and Duration

A

Onset: 20 min

Duration: 60-90 min

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40
Q

Glucagon- Indications

A
  • Altered Neurological
    Symptomatic Hypoglycemia: symptomatic patient with altered LOC
    Or…
    Unresponsive to organ glucose agents “IF no IV” and blood sugar:
Adults/PEDS/Infants = BS <60
Neonate= BS <45
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41
Q

Glucagon- Dosage/Route

A

Adult: 1ml (1 unit) IM

PEDS: PDC, IM

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42
Q

Glucagon- contraindications

A

None

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43
Q

Glucagon- side effects

A
  • Nausea/vomiting

- Tachycardia/ HTN

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44
Q

Acetaminophen (Ofirmev) - Class

A

Analgesic/Antipyretic

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45
Q

Acetaminophen (Ofirmev) - Action

A
  • Inhibits the synthesis of prostaglandins which transmit pain signals and induce fever
  • Reduces pain by blocking the signals produced by prostaglandins
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46
Q

Acetaminophen (Ofirmev) - Onset and duration

A

Onset: 15 min, PEAK = 1 hour

Duration: up to 4-6 hours

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47
Q

Acetaminophen (Ofirmev) - Indications

A

For treatment of pain as needed (S-141, S173)

  • Abdominal Pain
  • Burns
  • Envenomation injury
  • Trauma
  • Pain or discomfort of suspected cardiac origin
  • Pain associated with external pacing
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48
Q

Acetaminophen (Ofirmev) - dosage and route

A

Adult: 1,000mg IV x1 SO. Infuse over 15 min.

PEDS: ≤2 y/o PDC, SO x1 infuse over 15 min.

BHPO required for:
Chronic pain state; isolated head injury; acute onset severe headache; drug/etoh; intoxication; multiple trauma with GCS <15; suspected active labor

Maximum total daily dose: 4,000mg in 24 hrs

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49
Q

Acetaminophen (Ofirmev) - Contraindications

A
  • <2 years of age
  • Severe hepatic impairment
  • Severe active liver disease
  • If known or suspected total dose exceeding 4,000mg in 24hr period
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50
Q

Acetaminophen (Ofirmev) - side effects

A
  • Nausea, vomiting
  • Headache, sleep problems
  • Constipation
  • Itching, agitation
  • Partial or total lung collapse in pediatric patients
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51
Q

Adenosine (Adenocard) - class

A

Antiarrhythmic

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52
Q

Adenosine (Adenocard) - Action

A

Slows electrical conduction through AV node and interrupts re-entry pathway, converting SVT to NSR

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53
Q

Adenosine (Adenocard) - Onset and Duration

A

Onset = within 30 seconds

Duration = 1-2 minutes

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54
Q

Adenosine (Adenocard) - ADULT indications/dosage

A

Adult: Dsyrhythmias
- SVT
Dosage:
6mg rapid IV/IO; follow with rapid 20ml NS
12mg rapid IV/IO; follow with rapid 20ml NS
If no sustained rhythm changes, MR x1 in 1-2”

If patient has history of bronchospasm or COPD: Dosing as above per BHPO

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55
Q

Adenosine (Adenocard) - PEDS, indication/dosage

A

PEDS: Dysrhymtias
-unstable SVT
Dosage:
1st dose PDC Prado IV, BHPO… follow with NS 20ml rapid IV
2nd dose PDC rapid IV, BHPO… follow with NS 20ml rapid IV
If no sustained rhythm change, MR x1 BHPO

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56
Q

Adenosine (Adenocard) - contraindications

A
  • 2nd and 3rd degree AV heart blocks

- Sick sinus syndrome (without pacemaker)

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57
Q

Adenosine (Adenocard) - side effects

A
  • SOB/dyspnea; may cause bronchospasm in COPD patients (BHO)
  • Chest pressure/palpitations
  • Facial flushing/headache
  • Dizzy/lightheaded ness
  • Nausea
  • Transient Arrhythmias (PVC’s, PAC’s, sinus bradycardia, AV block, sinus tach or asystole).
    These are generally not treated and are quickly self-limiting
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58
Q

Albuterol (proventil, ventolin) - class

A

Bronchodilator: sympathomimetic (beta-2 specific)

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59
Q

Albuterol (proventil, ventolin) - action

A
  • Relaxes bronchial smooth muscles by stimulating beta-2 adrenergic receptors
  • Produces bronchodilation, relieves bronchospasm, and reduces airway resistance
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60
Q

Albuterol (proventil, ventolin) - Onset and Duration

A

Onset: 5 minutes, PEAK = 1 hour

Duration: up to 5 hours

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61
Q

Albuterol (proventil, ventolin) - Indications

A

Respiratory Distress
- suspected non-cardiac

Allergic Reaction/Anaphylaxis
- acute allergic reactions or anaphylaxis

Burns
- respiratory distress with bronchospasm

  • Hemodialysis Patient
    • symptomatic, suspected hyperkalemia if ≥72 hrs since last dialysis
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62
Q

Albuterol (proventil, ventolin) - Dosage/Route

A

Dosage for: respiratory distress; allergic reaction/Anaphylaxis; burns:
Adult = 6ml (.083%) via nebulizer MR
PEDS = PDC via nebulizer MR

Dosage for Hemodialysis Patient:
Adult= Continuous 6ml (.083%) via nebulizer MR

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63
Q

Albuterol (proventil, ventolin) - contraindications

A
  • none in adults

- PEDS: for croup/stridor (nebulizer saline/epinephrine is indicated)

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64
Q

Albuterol (proventil, ventolin) - side effects

A
  • Tachycardia/palpitations
  • Dizziness, headache
  • Tremors, nervousness
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65
Q

Aminodrone Hydrochloride (cordarone, pacerone, nexterone):

Class

A

Antiarrhythmic

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66
Q

Aminodrone Hydrochloride (cordarone, pacerone, nexterone),

Action

A
  • Blocks sodium, potassium, and calcium channels in cardiac cells slowing conduction and prolongs repolarization
  • Has alpha and beta adrenergic blocking properties causing negative inotropic effects and reduces peripheral vascular resistance (afterload)
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67
Q

Aminodrone Hydrochloride (cordarone, pacerone, nexterone),

Onset and Duration

A

Onset: minutes

Duration: Days

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68
Q

Aminodrone Hydrochloride (cordarone, pacerone, nexterone),

Indications

A

Dysrhythmias - stable ventricular tachycardia (SVT)

Dysrhythmias - reported/witnessed ≥2 AICD with pulse ≥60

Dysrhythmias - VF/Pulseless VT: After 1st shock if still refractory

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69
Q

Aminodrone Hydrochloride (cordarone, pacerone, nexterone),

Dosage/Route (per indication)

A

Dysrhythmias, Stable SVT:
Adults ONLY: 150mg in 100ml of NS over 10” IV/IO. MR x1 in 10” BHPO

Dysrhymias, reported witnessed ≥ x2 AICD with pulse ≥60:
Adults ONLY: 150mg in 100ml of NS over 10” IV/IO BHO

Dysrhymias, VF/Pulseless VT: after 1st shock if still refractory:
Adult= 300mg IV/IO, MR 150mg (max of 450mg)
PEDS= PDC IV/IO, MR q3-5” x2. SO

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70
Q

Aminodrone Hydrochloride (cordarone, pacerone, nexterone),

Contraindications

A
  • Hypotension
  • 2nd and 3rd degree heart block
  • Idioventricular rhythms
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71
Q

Aminodrone Hydrochloride (cordarone, pacerone, nexterone),

Side effects

A
  • Hypotension
  • Exacerbation of presenting arrhythmia after days of use
  • Liver injury
  • Pulmonary injury: pulmonary infiltrates, bronchospasm, SOB cough, he Optus is, hypoxia
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72
Q

Aspirin, ASA (acetylsalicylic acid)- Class:

A

platelet aggregation inhibitor

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73
Q

Aspirin, ASA (acetylsalicylic acid)- Actions:

A
  • Inhibits normal tendency for platelets to accumulate inside injured or occluded coronary arteries, thereby improving blood flow through vessels to better perfume the heart
  • Blocks formation of Thromboxin A2
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74
Q

Aspirin, ASA (acetylsalicylic acid)- Onset and Duration

A

Onset= 15-30 min

Duration = days (antiplatelet effects)

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75
Q

Aspirin, ASA (acetylsalicylic acid)- Indications and route/dosage

A

Indications= Discomfort/Pain of suspected cardiac origin

Dosage/Route= Adult ONLY: 324mg PO (four 81mg chewable tablets)

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76
Q

Aspirin, ASA (acetylsalicylic acid)- Contraindications

A

None

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77
Q

Aspirin, ASA (acetylsalicylic acid)- Side effects

A
  • GI upset (indigestion, nausea/vomiting, epigastric pain, heartburn)
  • Occult or prolonged bleeding
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78
Q

Atropine Sulfate- Class

A
  • antiarrhythmic

- anticholinergic

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79
Q

Atropine Sulfate- Actions

A
  • Competes with acetylcholine for receptor sites blocking the PNS response at SA & AV nodes
  • Increases heart rate by increasing electrical conduction through the heart
  • Positive chronotropic properties with little or no inotropic effects
  • Inhibits secretions by decreasing PNS effect on bronchial, salivary, sweat and GI glands
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80
Q

Atropine Sulfate- Onset and Duration

A

Onset= IV/IO 2-4 min; IM 10-15 min

Duration= 2-6 hours

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81
Q

Atropine Sulfate- Indications

A

Adult: Dysrhymias
- unstable bradycardia: narrow complex

Adult: Dysrhymias
- unstable bradycardia: wide complex if external pacemaker unavailable
PEDS: Dysrhymias
- unstable bradycardia: after BVM for 30 sec. and 3rd dose of Epinephrine

Poisoning/OD
- symptomatic organophosphate poisoning

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82
Q

Atropine Sulfate- Dosage/Route for Adult Dysrhymias (unstable bradycardia: narrow complex)

A

Adult: .5mg IV/IO for pulse <60; MR q3-5” to max 3mg

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83
Q

Atropine Sulfate- Dosage/Route for

Adult: Dysrhythmias (unstable bradycardia: wide complex if external pacemaker unavailable)

A

Adult: May give Atropine .5mg IV/IO for pulse <60, MR q3-5” to max 3mg

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84
Q

Atropine Sulfate- Dosage/Route for

PEDS: Dysrhymias (unstable bradycardia: after BVM for 30 sec and 3rd dose of epinephrine

A

PEDS: <9 years, HR<60
9-14 years, HR <40
PDC IV/IO; MR x1 in 5”

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85
Q

Atropine Sulfate- Dosage/Route for

Poisoning/OD (symptomatic organophosphate poisoning

A

Adults: 2mg IV/IM/IO, MR x2 q3-5”; MR q3-5” prn BHO

PEDS: PDC IV/IO/IM MR x2 q3-5”; MR q3-5” prn BHO

86
Q

Atropine Sulfate- Contraindications

A

Asystole

87
Q

Atropine Sulfate- side effects

A
  • Tachycardia/palpitations
  • Dry mouth/nausea/vomiting
  • Pupil dilation/blurred vision
    Flushed/hot/dry skin
88
Q

Atrovent (Ipratropium Bromide)- Class

A

Bronchodilator: anticholinergic

89
Q

Atrovent (Ipratropium Bromide)- Actions

A
  • antagonizes the action of acetylcholine, preventing the interaction of acetylcholine with muscarinic receptors in bronchial smooth muscle causing bronchodilation
  • dries respiratory tract secretions
90
Q

Atrovent (Ipratropium Bromide)- Onset and Duration

A

Onset= within 15-30 min

Duration= 4-5 hours

91
Q

Atrovent (Ipratropium Bromide)- Indications

A

Respiratory Distress
- suspected non-cardiac

Allergic Reaction/Anaphylaxis
- acute allergic reactions or anaphylaxis

92
Q

Atrovent (Ipratropium Bromide)- Dosage/Route

A 
Adult:
  2.5ml (.02%) via nebulizer
  added to first dose of Albuterol 
PEDS:
  PDC via nebulizer 
  added to first dose of Albuterol
93
Q

Atrovent (Ipratropium Bromide)- Contraindications

A

None

94
Q

Atrovent (Ipratropium Bromide)- Side effects

A
  • Nervous/dizziness
  • Headache
  • Cough
  • Paradoxical Bronchospasm
  • Palpitations
  • Blurred vision/eye irritation (with direct contact of mist)
95
Q

Calcium Chloride (10% CaCl2)- Action

A

electrolyte

96
Q

Calcium Chloride (10% CaCl2)- Action

A
  • Increases myocardial contractility
  • Enhances ventricular automaticity
  • Reverses cardio-electric changes produced by hyperkalemia
  • Shifts potassium back into cell to prevent intravascular hyperkalemia
97
Q

Calcium Chloride (10% CaCl2)- Indications and Dosage/Route

A
  • Hemodialysis Patient
    - symptomatic, suspected hyperkalemia (widened QRS complex “or” peaked T waves) if ≥72 hrs since last dialysis:
    Dosage= Adult ONLY: 500mg IV/IO over 30 seconds
  • Trauma
    - crush injury of extremity or torso with compression ≥2 hours. Give just prior to extremity being released:
    Dosage= Adult ONLY: 500mg IV/IO over 30 sec. BHO
98
Q

Calcium Chloride (10% CaCl2)- Contraindications

A

None

99
Q

Calcium Chloride (10% CaCl2)- Side effects

A
  • Decreased heart rate (may cause asystole)
  • Hypotension
  • Syncope
  • Nausea/vomiting
  • Metallic taste
100
Q

Charcoal (activated charcoal)- Class

A

Absorbent

101
Q

Charcoal (activated charcoal)- Action

A
  • Binds and absorbs ingested toxins present in the GI tract

- Inhibits intestinal absorption, preventing systemic toxicity

102
Q

Charcoal (activated charcoal)- Onset and Duration

A

Onset= immediate

Duration= 4-12 hours

103
Q

Charcoal (activated charcoal)- Indications

A

Adult: Poisoning/OD
- ingestion with ANY of the following within 60 min, if no vomiting Acetaminophen, colchicine, beta blockers, calcium channel blockers, salicylates, valproate, oral anticoagulants (including rodenticides), Paraguay, amanita mushrooms (assure patient has a gag reflex and is cooperative)

PEDS: Poisoning/OD
- if ingestion within 60min & recommended by Poison Control Center (assure child has a gag reflex and is cooperative)

104
Q

Charcoal (activated charcoal)- Dosage/Route

A

Adult: 50Gm PO

PEDS: PDC PO

105
Q

Charcoal (activated charcoal)- Contraindications

A
  • Isolated alcohol
  • Heavy metal
  • Caustic agent
  • Hydrocarbons
  • Iron Ingestion
106
Q

Charcoal (activated charcoal)- Side effects

A
  • Nausea/vomiting
  • Constipation/diarrhea
  • Abdominal cramping
107
Q

Dextrose/Glucose (50%, D50 / 10%, D10, D10W)

Class

A

Carbohydrate

108
Q

Dextrose/Glucose (50%, D50 / 10%, D10, D10W)

Action

A
  • Increases blood glucose by providing a quick release of free sugar into the circulation
109
Q

Dextrose/Glucose (50%, D50 / 10%, D10, D10W)

Onset and Duration

A

Onset= 1 minute

Duration= depends on degree of hypoglycemia

110
Q

Dextrose/Glucose (50%, D50 / 10%, D10, D10W)

Indications

A

Altered Neurological
- Symptomatic Hypoglycemia: symptomatic patient with altered LOC or unresponsive to glucose agents and blood sugar:

Adults/PEDS/Infants = BS <60
Neonate = <45

111
Q

Dextrose/Glucose (50%, D50 / 10%, D10, D10W)

Dosage/Route

A

Adult/PEDS: If patient is awake and has no gag reflex: Oral glucose paste or 3 tablets (15 g)

Adult: D50 25Gm IV; MR if patient remains symptomatic and BS <60

PEDS: D10 PDC IV; MR if patient remains symptomatic and BS <60 (neonate BS <45)

112
Q

Dextrose/Glucose (50%, D50 / 10%, D10, D10W)

Contraindications

A

None

113
Q

Dextrose/Glucose (50%, D50 / 10%, D10, D10W)

Side effects

A
  • Local venous irritation/infection

- Hyperglycemia

114
Q

Dopamine Hydrochloride (Intropin)

Class

A

Vasopressin: Sympathomimetic (both alpha & beta properties)

115
Q

Dopamine Hydrochloride (Intropin)

Action

A
  • At low and medium doses, selectively dilates blood vessels supplying the brain, kidneys, heart, and gastrointestinal tract
  • At medium to high doses, increases cardiac output by improving contractility and stroke volume, thereby increasing blood pressure
  • At high doses, causes vasoconstriction and increased heart rate
116
Q

Dopamine Hydrochloride (Intropin)

Onset and Duration

A

Onset= <5 min

Duration= approx. 10” after drip is stopped

117
Q

Dopamine Hydrochloride (Intropin)

Indications

A
  • Discomfort/Pain suspected Cardiac origin
    With associated shock IF BP is refractory to 2nd fluid bolus
  • Shock suspected Cardiac
    If BP is refractory to second fluid bolus
  • Shock suspected Anaphylactic, ?Neurogenic
    If BP refractory to fluid bolus
  • Sepsis
    If BP refractory to fluid bolus
  • Anaphylaxis
    shock refractory to fluid blouses and Epinephrine IV/IO
  • Dysrhythmias
    Bradycardia: after max atropine or initiation of TCP
118
Q

Dopamine Hydrochloride (Intropin)

Dosage/Route

A

Adult ONLY: 10-40 mcg/kg/min IV/IO drip infusion

Titrate to maintain systolic BP ≥90 not to exceed 120, BHO

119
Q

Dopamine Hydrochloride (Intropin)

Contraindications

A

None

120
Q

Dopamine Hydrochloride (Intropin)

Side effects

A
  • At high infusion rates, hypertension and extreme vasoconstriction may occur
  • At low infusion rates, hypotension may occur
  • Tachyarrhythmias/palpating
  • Increased myocardial 02 demand
121
Q

Fentanyl Citrate- Class

A

Analgesic; Opioid Agonist

122
Q

Fentanyl Citrate- Action

A
  • Potent narcotic analgesic and sedative
123
Q

Fentanyl Citrate- Onset and Duration

A

Onset= <1-2 min

Duration= 30-60 min

124
Q

Fentanyl Citrate- Indications

A

For treatment of pain as needed:

  • Abdominal Pain
  • Burns
  • Envenomation injury
  • Trauma
  • Pain or discomfort suspected cardiac origin
  • Pain associated with external pacing
125
Q

Fentanyl Citrate- Dosage/Route…

If <65 years old

A 
Titrate to pain and vital signs
   - Fentanyl up to 50mcg IVP over 2 min x1 SO
      MR 25mcg IV q5” x2  SO
      Maximum SO dose is 100mcg
OR...
   - Fentanyl 50mcg IN q15 min x2  SO
   - 3rd IN dose Fentanyl 50mcg BHO

Treatment of pain if BP <100 systolic BHO

126
Q

Fentanyl Citrate- Dosage/Route…

If >65 years old

A 
Titrate to pain and vital signs:
   - Fentanyl 25mcg IVP over 2” x1  SO
      MR 25mcg slow IVP q5” x2  SO
      Max SO dose is 75mcg
OR.....
  - Fentanyl 25mcg IN q15” x2  SO
  - 3rd IN dose Fentanyl 25mcg BHO

Treatment of pain if BP <100 systolic, BHO

127
Q

Fentanyl Citrate- Dosage/Route…

PEDS:

A

<10kg
- Fentanyl IV/IN PDC, BHO
MR, PDC, BHO

≥10kg
- Fentanyl IV/IN PDC, SO
MR PDC, BHO max 75mcg

128
Q

Fentanyl Citrate- Contraindications

A

None

129
Q

Fentanyl Citrate-

Use with caution: BHPO only:

A
  • chronic pain states
  • isolated head injuries
  • acute onset severe headache
  • drug/ETOH intoxication
  • multiple trauma with GCS <15
  • suspected active labor
130
Q

Fentanyl Citrate- side effects

A
  • respiratory depression/apnea
  • decreased LOC
  • transient hypotension
  • nausea/vomiting/dizziness
  • muscular rigidity
  • bradycardia
131
Q

Lidocaine (2% xylocaine)- Class

A

Antiarrhythmic/anesthetic

132
Q

Lidocaine (2% xylocaine)- Action

A
  • depresses depolarization and automaticity in the ventricles
  • increases the ventricular fibrillation threshold by increasing phase IV repolarization
  • Amide-type local anesthetic
133
Q

Lidocaine (2% xylocaine)- Onset and Duration

A

onset= 1-2 min

Duration= 10-20 min

134
Q

Lidocaine (2% xylocaine)- Indications

A
  • Dysrhythmias
    Stable ventricular tachycardia (SVT)
  • Dysrhythmias
    Reported/witnessed ≥2x’s AICD with pulse ≥60
  • Dysrhythmias
    VF/Pulseless VT: after 1st shock if still refractory
  • ALS Skills
    conscious patient prior to IO infusion
135
Q

Lidocaine (2% xylocaine)- Dosage/ Route for

Dysrhythmias
- SVT (stable ventricular tachycardia)

A

Adult ONLY:
1.5mg/kg slow IV/IO
MR .5mg/kg IV/IO q8-10”
To max 3mg/kg (including initial bolus)

136
Q

Lidocaine (2% xylocaine)- Dosage/ Route for

Dysrhythmias
- reported/witnessed ≥2x’s AICD with pulse ≥60

A

Adult ONLY:
1.5mg/kg slow IV/IO;
MR .5mg/kg IV/IO q8-10”
To max 3mg/kg (including initial bolus)

137
Q

Lidocaine (2% xylocaine)- Dosage/ Route for

Dysrhythmias
- VF/Pulseless VT: after 1st shock if still refractory

A

Adult:
- 1.5mg/kg IV/IO, MR x1 in 3-5” (max 3mg/kg)

PEDS:
- PDC, MR q3-5” x2 SO

138
Q

Lidocaine (2% xylocaine)- Dosage/ Route for

ALS Skills
- conscious patient prior to IO infusion

A

Adult ONLY:
- 40mg (2%) slow IO
Prior to fluid administration

139
Q

Lidocaine (2% xylocaine)- Contraindications

A
  • 2nd and 3rd degree heart block

- Idioventricular rhythms

140
Q

Lidocaine (2% xylocaine)- Side effects (toxicity); EARLY:

A
  • anxiety
  • euphoria
  • combative
  • nausea
  • twitching
  • numbness
141
Q

Lidocaine (2% xylocaine)- Side effects (toxicity); LATE:

A
  • seizure
  • decreased BP
  • coma
  • widening QRS
  • prolonged PRI
  • V-fib
142
Q

Lidocaine Jelly 2% (xylocaine jelly)- Class

A

Topical anesthetic

143
Q

Lidocaine Jelly 2% (xylocaine jelly)- Action

A
  • prohibits the initiation and conduction of impulses thereby effecting local anesthetic action
  • decreases irritation when airway tube is inserted, thereby decreasing intracranial pressure
144
Q

Lidocaine Jelly 2% (xylocaine jelly)- Indications

A
  • ALS medications List

Intubation or nasopharyngeal airway insertion

145
Q

Lidocaine Jelly 2% (xylocaine jelly)- Dosage/Route

A

Adults & PEDS:

- topically prn to ET tube or nasal airway

146
Q

Lidocaine Jelly 2% (xylocaine jelly)- Contraindications

A

None

147
Q

Lidocaine Jelly 2% (xylocaine jelly)- Side effects

A

None

148
Q

Morphine Sulfate (MS, MS04)- Class

A
  • Opioid

- Narcotic analgesic

149
Q

Morphine Sulfate (MS, MS04)- Action

A
  • CNS depressant acting on opiate receptors in the brain

- Potent analgesic and sedative

150
Q

Morphine Sulfate (MS, MS04)- Onset and Duration

A

Onset= 1-2 min

Duration= 2-7 hours

151
Q

Morphine Sulfate (MS, MS04)- Indications

A

For treatment of pain as needed:

  • Abdominal Pain
  • Burns
  • Envenomation injury
  • Trauma
  • Pain or discomfort of suspected cardiac origin
  • Pain associated with external pacing
152
Q

Morphine Sulfate (MS, MS04)- Dosage/Route

For treatment of pain as needed, BP >100: Initial IV Dose

A
  • Morphine up to .1mg/kg IV over 2” SO

Max for ANY IV dose is 10mg

153
Q

Morphine Sulfate (MS, MS04)- Dosage/Route

For treatment of pain as needed, BP >100: Initial IM dose

A
  • Morphine up to .1mg/kg IM SO

Max for ANY IM dose is 10mg

154
Q

Morphine Sulfate (MS, MS04)- Dosage/Route

For treatment of pain as needed, BP >100: 2nd IV/IM dose, if pain persists

A
  • 5 min after IV morphine OR 15 after IM morphine

- administer half of initial Morphine dose, SO

155
Q

Morphine Sulfate (MS, MS04)- Dosage/Route

For treatment of pain as needed, BP >100: 3rd IV/IM dose, if pain persists

A
  • 5” after IV morphine OR 15” after IM morphine

- administer half half of initial morphine dose

156
Q

Morphine Sulfate (MS, MS04)- Dosage/Route

For treatment of pain if BP <100 systolic?

A

BHO

157
Q

Morphine Sulfate (MS, MS04)- Dosage/Route

Special considerations administer morphine up to .05 mg/kg:

A
  • cardiac chest pain

- discomfort due to external cardiac pacing

158
Q

Morphine Sulfate (MS, MS04)- Dosage/Route

PEDS:

A

With signs of adequate perfusion: PDC IV/IM; MR BHO

159
Q

Morphine Sulfate (MS, MS04)- Contraindications

A

None

160
Q

Morphine Sulfate (MS, MS04)- Use with caution, BHPO:

A
  • chronic pain states
  • isolated head injuries
  • acute onset severe headache
  • drug/ETOH intoxication
  • multiple trauma with GCS <15
  • Suspected active labor
161
Q

Morphine Sulfate (MS, MS04)- Side effects

A
  • respiratory depression/apnea
  • decreased LOC
  • transient hypotension
  • nausea/vomiting
  • pinpoint pupils
162
Q

Nitroglycerin (NTG, Nitro)- class

A

Vasodilator

163
Q

Nitroglycerin (NTG, Nitro)- Action

A
  • produces vasodilation by relaxing systemic venous & arterial vessels, thereby:
    • decreasing preload and afterload
    • decreasing myocardial workload and
    • decreasing myocardial 02 consumption.
  • Dilates coronary arteries
164
Q

Nitroglycerin (NTG, Nitro)- Onset and Duration

A

Onset= SL 2min; topical 30-60min

Duration= SL 30-60min; topical 24 hours

165
Q

Nitroglycerin (NTG, Nitro)- Indications

A
  • Discomfort/Pain cardiac origin
  • Fluid overload with rales
    Hemodialysis patients
  • Respiratory Distress
    Respiratory distress, CHF/cardiac origin
166
Q

Nitroglycerin (NTG, Nitro)- Dosage/Route

For: discomfort/pain, cardiac origin

A

Adult ONLY:
IF BP ≥100:
.4mg SL; MR q3-5”
Topical ointment/paste 1”

IF BP <100: .4mg SL BHO; MR BHPO

167
Q

Nitroglycerin (NTG, Nitro)- Dosage/Route for…

  • Fluid overload with rales
  • respiratory distress
A

Adult ONLY:

  • if BP ≥100: Topical ointment/paste 1”
  • if BP ≥100 but <150: .4mgSL; MR q3-5”
  • if BP ≥150: .8mg SL; MR q3-5”
  • if BP <100: .4mg SL BHO; MR BHPO
168
Q

Nitroglycerin (NTG, Nitro)- Contraindications

A
  • patient who has taken sexual enhancement meds such as Viagra, Cailin, Levitra within 48 hours
  • patients taking meds for Pulmonary Hypertension, usually Sildenafil (trade names: Revatio, Florian, and Veletri)
169
Q

Nitroglycerin (NTG, Nitro)- Side effects

A
  • orthostatic hypotension
  • dizziness/syncope
  • temporary pulsating headache
  • facial flushing
170
Q

Normal Saline (0.9% Solution Sodium Chloride…NS):

Class

A

Electrolyte/ isotonic crystalloid

171
Q

Normal Saline (0.9% Solution Sodium Chloride…NS):

Action

A
  • electrolyte solution, which is osmotically equivalent to blood
  • increases the circulating volume of the vascular system. (2/3 of infused volume leaves vascular space within 1 hour)
172
Q

Normal Saline (0.9% Solution Sodium Chloride…NS):

Indications

A
  • Definitive Therapy
    immediate or anticipated immediate need for administration of a fluid bolus or medications
  • Abdominal Discomfort GI/GU (non traumatic)
    Adult/PEDS: suspected volume depletion
    Adult: symptomatic suspected AAA to maintain BP at 80
  • Anaphylaxis
    Adult: for BP <90
    PEDS to maintain adequate perfusion
  • Altered Neurological Function
    Adult: CVA to maintain BP ≥120
    Adult: Hyperglycemia
  • Burns
    Adult: with ≥20% BSA partial thickness or ≥5% BSA full thickness
    PEDS: with ≥10% BSA partial thickness or ≥5% BSA full thickness
  • Discomfort/Pain of suspected cardiac origin
    With associated shock
  • Dysrhythmias
    Adult: see protocols
    PEDS: see protocols
  • Environmental Exposure
    Adult: head exhaustion
  • Overdose
    Adult: stimulant intoxication with Excited Delirium
  • Shock
    Adult/PEDS: see protocol
  • Trauma
    Adults/PEDS: crush injury with extended compression ≥2 hrs
    Adult: to maintain BP at 80
    PEDS: to maintain adequate perfusion
  • Sepsis
    Adult: see protocol
  • Respiratory Distress
    Adult/PEDS: with croup-like cough via NEBULIZER
173
Q

Normal Saline (0.9% Solution Sodium Chloride…NS):

Dosage/Route for Definitive Therapy (S-104; S101)

A

IV/IO; adjust prn

174
Q

Normal Saline (0.9% Solution Sodium Chloride…NS):

Contraindications

A

Rales (exception for sepsis - S-143)

175
Q

Normal Saline (0.9% Solution Sodium Chloride…NS):

Side effets

A

None

176
Q

Sodium Bicarbonate (Bicarb, NaHC03)- Class

A
  • Electrolyte

- Alkalinizing agent

177
Q

Sodium Bicarbonate (Bicarb, NaHC03)- Action

A
  • Reduces acidosis or causes alkalosis by direct release of bicarbonate ion into the circulation
178
Q

Sodium Bicarbonate (Bicarb, NaHC03)- Onset and Duration

A

Onset= 2/10 min

Duration= 30-60 min

179
Q

Sodium Bicarbonate (Bicarb, NaHC03)- Indications

A
  • Hemodialysis Patient
    Symptomatic, suspected hyperkalemia if ≥72 since last dialysis
  • Poisoning/OD
    Tricyclic OD with cardiac effects
  • Trauma
    Crush injury of extremity or torso with extended entrapment ≥2 hours just prior to extremity being released
180
Q

Sodium Bicarbonate (Bicarb, NaHC03): dosage/route for:

  • Hemodialysis Patient
    Symptomatic, suspected hyperkalemia if ≥72 since last dialysis
A

Adult ONLY: 1mEq/kg IV/IO

181
Q

Sodium Bicarbonate (Bicarb, NaHC03)- dosage/route for…

  • Poisoning/OD
    Tricyclic OD with cardiac effects
A

Adult: 1mEq/kg IV/IO

PEDS: PDC IV/IO x1 BHO

182
Q

Sodium Bicarbonate (Bicarb, NaHC03)- dosage/route for…

  • Trauma
    Crush injury of extremity or torso with extended entrapment ≥2 hours just prior to extremity being released
A

Adult: 1mEq/kg IV/IO BHO

PEDS: PDC IV/IO x1 BHO

183
Q

Sodium Bicarbonate (Bicarb, NaHC03)- Contraindications

A

None

184
Q

Sodium Bicarbonate (Bicarb, NaHC03)- Side effects

A

None

185
Q

Versed (Midazolam)- Class

A

Benzodiazepine: Sedative/Anticonvulsant

186
Q

Versed (Midazolam)- Action

A
  • CNS depressant
  • Produces anterograde amnesia, then sedation
  • stops and prevents seizures
187
Q

Versed (Midazolam)- Onset/duration

A

Onset= IV/IO/IN 2min; IM 15min

Duration= 1-4 hours

188
Q

Versed (Midazolam)- Indications

A
  • Seizures
    • generalized seizures lasting ≥5” (includes seizure time prior to arrival of prehospital provider)
    • recurrent tonic/clinic seizures without lucid interval
    • Eclamptic seizures of any duration
  • PEDS seizures
    • Generalized seizures lasting ≥5 min (includes seizure time prior to arrival of prehospital provider)
    • Partial seizure with respiratory compromise
    • Recurrent tonic/clinic seizures without lucid interval
  • Dysrhymias
    • unstable bradycardia: discomfort associated with TCP capture, after morphine if BP ≥100
    • unstable conscious VT: precardioversion
    • conscious SVT: precardioversion
    • Unstable Conscious A-fib, A-flutter: precardioversion
  • Overdose
    • stimulant Intoxication with excited delirium
  • Psychiatric Behavioral Emergencies
    • combative patients
189
Q

Versed (Midazolam)- Dosage for:

  • Seizures
  • PEDS seizures
A

Adult: IN, IM, IV, IO to max 5mg
(D/C IV/IO dose if seizure stops).. MR x2 in 10”
Max 10mg total

PEDS: PDC IV/IM/IN

190
Q

Versed (Midazolam)- Dosage/route for:

Dysrhythmia

  • unstable bradycardia: discomfort associated with TCP capture, after morphine if BP <100
  • unstable conscious VT: precardioversion
A

Adult ONLY:
1-5mg slow IV/IO (1mg/min)
If age ≥60, consider lower dose with attention to age and hydration status

191
Q

Versed (Midazolam)- Dosage/route for:

Dysrhythmias
- Conscious SVT: precardioversion

A

Adult:
1-5mg slow IV/IO (1mg/min) BHO
If age ≥60, consider lower dose with attention to age and hydration status

PEDS:
PDC slow IV (1mg/min) BHPO

192
Q

Versed (Midazolam)- Dosage/route for:

Dysrhythmias
- unstable conscious A-fib, A-flutter: precardioversion

A

Adult ONLY:
1-5mg slow IV/IO (1mg/min) BHPO
If age ≥60, consider lower one with attention to age and hydration status

193
Q

Versed (Midazolam)- Dosage/route for:

  • Overdose
  • stimulant intoxication with excited delirium
  • Psychiatric Behavioral Emergencies
  • combative patients
A

Adults ONLY:
In, IM, IV 5mg
MR x1 in 10”

194
Q

Versed (Midazolam)- Contraindications

A

None

195
Q

Versed (Midazolam)- Side effects

A

Respiratory depression/ apnea

196
Q

Cyanide Kit - only if kit available on scene, not for prehospital inventory

Drugs

A
  • Amyl Nitrite inhaler
  • sodium thiosulfate 25%
  • hydroxocobalamin
197
Q

Cyanide Kit - only if kit available on scene, not for prehospital inventory

Action: Onset/Duration

A

Onset= minutes

Duration = days

198
Q

Cyanide Kit - only if kit available on scene, not for prehospital inventory

Indications/dosage/route for: Amyl Nitrate inhalation

A

Indications: Significant symptoms such as seizures, LOC or cardiac arrest

Dosage: given over 30 seconds BHPO

199
Q

Cyanide Kit - only if kit available on scene, not for prehospital inventory

Indications/dosage/route for: Sodium Thiosulfate 25%

A

Indications: Significant symptoms such as seizures, LOC or cardiac arrest

Dosage/route: 12.5Gm IV BHPO

200
Q

Cyanide Kit - only if kit available on scene, not for prehospital inventory

Indications/dosage/route for: Hydroxocobalamin

A

Indications: Significant symptoms such as seizures, LOC or cardiac arrest

Dosage/route: 5m given over 15” IV BHPO

201
Q

Cyanide Kit - only if kit available on scene, not for prehospital inventory

Contraindications

A

None

202
Q

Cyanide Kit - only if kit available on scene, not for prehospital inventory

Side effects of Amyl Nitrate

A 
Hypertension
Tachycardia
Palpitations
Syncope
Headache and nausea
203
Q

Cyanide Kit - only if kit available on scene, not for prehospital inventory

Side effects for: Sodium Thiosulfate

A

Cirrhosis of liver
Congestive heart failure
Renal function impairment

204
Q

Cyanide Kit - only if kit available on scene, not for prehospital inventory

Side effects for: Hydroxocobalamin

A

Mild increase in BP

Reddish orange skin color which clears over days

205
Q

Nitro: for BP ≥ 100?

A

Topical ointment/paste 1”

206
Q

Nitro - if BP ≥100 but <150

A

.4mg SL; MR q3-5”

207
Q

Nitro - for BP ≥150

A

.8mg SL; MR q3-5”

208
Q

Nitro - for BP <100

A

.4mg SL BHO; MR BHPO

209
Q

Examples of sexual enhancement drugs

A

Viagra, Cialis, Levitra

210
Q

Examples of Pulmonary Hypertension medication

A

Usually Sildenafil (trade names: Revatio, Flolan, and Veletri)

EMS (9 decks)

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