Drugs Flashcards
Adenosine
Other name for it?
Adenocard
Adenosine
Action?
Slows the conduction through the AV Node.
Blocks re-entrant pathways in SVT
Adenosine
Indications
Treatment of SVT
Adenosine
Contraindications
- Heart Blocks
- AFlutter/Afib
- VTach
- Wolff Parkinsons
- Asthma
Albuterol
Action?
Bronchodilator
Beta 2 Smooth Muscle relaxer
Albuterol
Indications?
Contraindications?
Indications
Bronchospasms
Asthma-COPD
Contraindications
Hypertension
Albuterol
Side Effects
Headache Drowsiness Vertigo Nausea Hypertension
Albuterol
Adult
Pediatric
Both are 2.5mg in 3-6ml
Amiodarone
Action
Antiarrhythmic medication
Calcium, potassium, and sodium channel blocker.
negative chronotropic, negative dromotropic, and vasodilator.
6 Rights
Patient Route Time Drug Dose Date
Amiodarone
Indications
V fib
PVtach
Adjunct to elecrical cardioversion of SVT and PSVT
Amiodarone
Contraindications
Cardiogenic shock
sinus bradycardia
high degree AV block
Amiodarone
Side effects
Bradycardia
Nausea
AV block
Vasodilation/Hypotension
Amiodarone
Dose in Cardiac Arrest?
300 mg IV/IO push followed by 20-30ml flush.
second dose 150mg IV/IO push followed by 20-30ml flush
Amiodarone
Other name?
Cordarone
Amiodarone
VTach with pulse and unstable PSVT
150mg in 100ml
D5W over 10 minutes
Amiodarone Drop ROSC
recurrent Vfib
150mg IV over 10 minutes
Aspirin
Action
Interferes with platelet aggregation and is known as an anti-platelet medication
Aspirin
Indications
Myocardial Infarction
Unstable Angina
Chest Pain
Aspirin
Contraindications
Hypersensitivity
Ulcers
Diabetice Meds
GI Bleeds
Aspirin
Dosage
324mg PO
4 baby aspirin
Atropine
Action?
parasympatholytic drug that inhibits the actions of acetylcholine at
the postganglionic parasympathetic neuroeffector sites. Effects include dilation of the
pupils, relaxation of the bronchioles, decreased gastric motility and increased heart rate.
It produces both positive chronotropic and positive dromotropic effects.
Atropine
Indications
INDICATIONS
• symptomatic bradycardia
• organophosphate poisoning
Atropine
CONTRAINDICATIONS
CONTRAINDICATIONS
tachycardia
• narrow angle glaucoma
• myasthenia gravis
Atropine
SIDE EFFECTS
palpitations tachycardia
headache vertigo
dry mouth blurred vision
urinary retentio
Atropine
Dosage and Admin
Adult Bradycardia
Adults:
• 0.5mg IV push, rapidly
• May be repeated every 3 - 5 minutes
• Maximum dose is 3 mg.
Atropine
Dosage and Admin
Pedi Bradycardia
Pediatric:
• 0.02 mg/kg, minimum dose 0.1 mg, maximum dose 0.5 mg
• May repeat for a second dose
• Refer to “Weight Based Resuscitation Tape” for pediatric dosing.
Atropine
Dosage and Admin
Adult Organophosphate OD/Toxic Ingestion
Adults:
• 2 mg every 5 minutes until symptoms controlled, no maximum dose
Atropine
Dosage and Admin
Pedi Organophosphate OD/Toxic Ingestion
Pediatrics:
• 0.02 mg/kg IV (minimum dose 0.1mg), repeat every 5 minutes until respiratory
secretions subside
Atropine
Dosage and Admin
Notes and
Warnings
Note:
• Atropine may be given via E.T. tube, by adding 2 - 2.5 times the IV dose, mixed
with 5 to 10 mL of sterile water or saline, and injected directly into the ETT.
• Use caution in patients with MI history or myocardial ischemia due to increased
myocardial oxygen consumption
Calcium Chloride
Action
ACTION
Calcium chloride is an essential electrolyte for functional integrity of the nervous and
muscular system, cardiac contractility and coagulation of blood.
Calcium Chloride
Indications
INDICATIONS
- hypocalcemia
- hyperkalemia
- calcium channel blocker toxicity
- magnesium sulfate overdose
- cardiac resuscitation
Calcium Chloride
Contraindications
CONTRAINDICATIONS
- ventricular fibrillation during arrest
- hypercalcemia
- digitalis toxicity
Calcium Chloride
Precautions
PRECAUTIONS
- use caution in patients taking digitalis
- patients with renal disease
- calcium precipitates on contact with sodium bicarbonate
Calcium Chloride
Side effects
SIDE EFFECTS
bradycardia hypotension
peripheral vasodilation tissue sloughing (following accidental IM
administration or secondary to extravasation of
medication)
Calcium Chloride
DOSAGE AND ADMINISTRATION
Adult and Pedi
Hyperkalemia
Hyperkalemia:
Adult:
• 1 gram, IV/IO
Pediatric:
• 20 mg/kg, IV/IO, maximum dose 1 gram
• Refer to “Weight Based Resuscitation Tape” for pediatric dosing.
Calcium Chloride
Calcium Channel Blocker Overdose/Toxicity:
Adult
1 gram, IV/IO slowly
Pediatric:
- 20 mg/kg (0.2 ml/kg), IV/IO slowly
- Refer to “Weight Based Resuscitation Tape” for pediatric dosing.
Dextrose
Action
ACTION
Dextrose is a carbohydrate (monosaccharide) in a hypertonic solution which, when
given intravenously, increases blood glucose levels.
Dextrose
Indications
INDICATIONS
- hypoglycemia
- altered levels of consciousness
- coma or seizure of unknown etiology
Dextrose
DOSAGE AND ADMINISTRATION
Adults and Pedi
DOSAGE AND ADMINISTRATION
Adult:
• 25 grams IV slow
Pediatric:
• Preferentially use Dextrose 25% if age is <8 years old
• Refer to “Weight Based Resuscitation Tape” for pediatric dosing
Valium
alternate names
Diazepam
and
Diastat
Valium
Action
ACTION
Diazepam is a sedative-hypnotic benzodiazepine. It acts on the limbic, thalamic and
hypothalamic regions of the CNS to potentiate the effects of inhibitory
neurotransmitters. It raises the seizure threshold and produces sedation and amnesia
Valium
Indications
INDICATIONS
- Seizure control
- Acute anxiety
- Muscle relaxant
- Pre-medication prior to cardioversion
Valium
Side Effects
SIDE EFFECTS
- Hypotension
- Respiratory depression
- Ataxia
- Confusion
- Nausea
- CNS depression
Valium
Contraindications
CONTRAINDICATIONS
- Shock
- Coma
- Respiratory depression
- Substance abuse of CNS depressants
- Hypersensitivity to this medication
Valium
DOSAGE AND ADMINISTRATION
DOSAGE AND ADMINISTRATION
Adult:
• 5 mg IV/IO or MAD. May repeat as needed after 5 minutes, up to max dose of
10mg
Pediatric:
• 0.2 mg/kg IV/IO or MAD (maximum 5 mg dose), may repeat as needed after 5
minutes to a maximum of 10mg
Cardizem
Alternate Name
Diltiazem
Cardizem
Action
ACTION
Diltiazem is a calcium channel blocker which inhibits transport of calcium into
myocardial and vascular smooth muscle cells resulting in inhibition of excitationcontraction
coupling and subsequent contraction. It causes systemic vasodilation with
resultant decrease in blood pressure and coronary vasodilation
Cardizem
Indications
INDICATIONS
- management of supraventricular tachycardia
- rapid ventricular rates in atrial flutter or fibrillation
Cardizem
Contraindications
CONTRAINDICATIONS
Hypersensitivity Sick Sinus Syndrome
2nd or 3rd degree AV block Hypotension (<90 mmHg systolic)
Recent myocardial infarction Pulmonary congestion
Wolff-Parkinson-White syndrome (WPW)
Cardizem
Precautions
PRECAUTIONS
- patients with renal or hepatic insufficiency or CHF
- geriatric patients
- pregnancy, lactation or children
- history of serious ventricular dysrhythmias
Cardizem
SIDE EFFECTS / ADVERSE EFFECTS
SIDE EFFECTS / ADVERSE EFFECTS
epistaxis dyspnea dysrhythmias CHF peripheral edema bradycardia chest pain hypotension palpitations syncope tachycardia nausea / vomiting flushing diaphoresis urticaria hyperglycemia muscle cramps paresthesia / tremor
Cardizem
DOSAGE AND ADMINISTRATION
DOSAGE AND ADMINISTRATION
Adult:
• Consider vagal maneuvers as first line for a regular, narrow complex tachycardia
suggestive of SVT (AVNRT)
• 0.25 mg/kg IV over 2 minutes, maximum of 20mg
• May be repeated in 15 min if initial dose is ineffective
Pediatrics
• Consider expert consultation; typical dose is 0.25 mg/kg IV over 2 minutes
• Avoid use in infants
Benadryl
Alternate name
Diphenhydramine
Benadryl
Indications
INDICATIONS
- anaphylaxis
- extrapyramidal reaction to phenothiazine medications
- mild to moderate allergic reactions
Benadryl
CONTRAINDICATIONS
CONTRAINDICATIONS
- asthma (relative contraindication)
- narrow angle glaucoma
- patients taking MAO inhibitors
Benadryl
Precautions
PRECAUTIONS
• Use caution in pregnant patients
• Benadryl may have additive effects when used with other CNS depressant
medications
Benadryl
Side Effects
SIDE EFFECTS
drowsiness sedation
hypotension tachycardia
palpitations drying of bronchial secretions
dry mouth urinary retention
Benadryl
DOSAGE AND ADMINISTRATION
DOSAGE AND ADMINISTRATION
Adults:
• 1 mg/kg (max 50 mg) IV, or IM if no IV access
• Dystonic reaction: give 25 – 50 mg IV/IM
Pediatric:
• 1 mg/kg (max 50 mg) IV, or IM if no IV access
Dopamine
Action
ACTION
Dopamine is an endogenous catecholamine, which is a precursor to norepinephrine.
Primarily acts upon alpha-1 and beta-1 receptors. Low dose ranges <2mcg/kg/min
results in vasodilation of the renal, mesenteric and cerebral arteries. Dose ranges of 2-
10 mcg/kg/min cause beta stimulation which results in increased cardiac output with
minimal changes in SVR or preload. Dose ranges of 10-20 mcg/kg/min result in alpha
response with vasoconstriction of the renal, mesenteric and peripheral vasculature.
Dopamine
Indications
INDICATIONS
• Hypotension with signs and symptoms of shock, which do not respond to volume
replacement
• Second line drug for symptomatic bradycardia
Dopamine
CONTRAINDICATIONS
CONTRAINDICATIONS
- tachydysrhythmias
- patients with Pheochromocytoma
- hypovolemic shock prior to fluid replacement
Dopamine
PRECAUTIONS
PRECAUTIONS
• Can cause an increase in myocardial oxygen consumption thus worsening the
cardiac status of the patient. Should be carefully monitored.
• Use with caution in cardiogenic shock with accompanying CHF.
Dopamine
Side Effects
SIDE EFFECTS
hypertension tachydysrhythmias (dose related) headache nausea and vomiting
Dopamine
DOSAGE AND ADMINISTRATION:
Hypotension/shock refractory to fluid resuscitation
and
Bradycardia w/ a pulse
Adult
Hypotension/shock refractory to fluid resuscitation
Adult:
Infusion rate 5-20 mcg/kg/min IV and titrate for response.
Bradycardia with a pulse
Adult
• Infusion rate 2-20 mcg/kg/min IV and titrate for response.
Epinephrine
Action
ACTION
Epinephrine is an endogenous catecholamine with beta-1, beta-2 (bronchodilation and
vasoconstriction of skeletal muscle) and alpha 1 (peripheral vasoconstriction)
adrenergic effects. It has positive inotropic, chronotropic and dromotropic effects, along
with increased SVR, increased coronary and cerebral perfusion and increased
automaticity. It causes an increase in myocardial oxygen demand.
Epinephrine
Indications
INDICATIONS
- cardiac arrest
- acute bronchospasm from asthma or COPD
- anaphylaxis
Epinephrine
Precations
PRECAUTIONS
- hyperthyroidism
- diabetes mellitus
- glaucoma
- may exacerbate angina, hypertension, SVT and CHF
- protect solution from intense light sources
- is unstable in alkaline solutions
Epinipherine
SIDE EFFECTS
CNS stimulation anxiety
headache nausea, vomiting
palpitations tachycardia
dizziness hyperglycemia
Epinepherine
DOSAGE AND ADMINISTRATION
Cardiac Arrest
Adult/Pedi
Cardiac arrest:
Adult
- 1 mg IV / IO of Epinephrine (1:10,000) push every 3-5 minutes
- Can be given via ET tube at 2 - 2.5 times the normal dose diluted in 10ml of NS
Pediatric
• Epinephrine (1:10,000) 0.01 mg/kg IV or IO every 3-5 minutes
Epinepherine
DOSAGE AND ADMINISTRATION
Anaphylaxis:
Anaphylaxis:
Adult:
• 0.3mg of Epinephrine 1:1,000 via intramuscular injection
• May repeat if signs and symptoms of shock persist after the initial dose
• If patient appears to be nearing cardiac arrest or develops cardiac arrest, give
1mg IV of 1:10,000 epinephrine
Pediatric:
• Per weight-based tape, inject the 1:1,000 epinephrine intramuscularly
• May repeat if signs and symptoms of shock persist after the initial dose
• If patient develops cardiac arrest, give 1:10,000 epinephrine IV per weight-based
tape dosing
Epinepherine
DOSAGE AND ADMINISTRATION
Severe respiratory distress/bronchospasm secondary to asthma/COPD:
Severe respiratory distress/bronchospasm secondary to asthma/COPD:
Adult:
• 0.3mg of 1:1000 via intramuscular injection
o Discuss with online medical control prior to use if >55 years old or known
use of beta blockers
Pediatric:
• Per weight-based tape, inject the 1:1,000 epinephrine intramuscularly
Epinepherine
DOSAGE AND ADMINISTRATION
Bradycardia with a pulse
Bradycardia with a pulse
Adult
• Epinephrine 2-10 mcg/min IV is one option (alternatives are transcutaneous
pacing and Dopamine)
Pediatric (if refractory to chest compressions/oxygenation)
• Epinephrine (1:10,000) 0.01 mg/kg IV or IO every 3-5 minutes
Etomidate
Alternate name
Amidate
Etomidate
Action
ACTION
Etomidate is a hypnotic drug without analgesic or muscle relaxing properties. It usually
causes myoclonus on injection; for this reason, it is usually given concomitantly with
neuromuscular blocking agents and analgesics
Etomidate
INDICATIONS
INDICATIONS
- induction prior to use of neuromuscular blocking agents and/or analgesics
- supplement to use of neuromuscular blocking agents and/or analgesics
Etomidate
CONTRAINDICATIONS
CONTRAINDICATIONS
- hypersensitivity
- pregnancy or lactation
- patients under 3 months of age
Etomidate
PRECAUTIONS
PRECAUTIONS
• Patients with renal or hepatic insufficiency
Etomidate
SIDE EFFECTS / ADVERSE EFFECTS
SIDE EFFECTS / ADVERSE EFFECTS
- Transient venous pain at injection site
- Transient skeletal muscle spasms/ twitching (myoclonus).
Etomidate
COMPLICATIONS
COMPLICATIONS
• Anticipate that the patient will awaken rapidly and be left without residual
analgesia.
• Medicate with additional narcotics and neuromuscular blockers, as needed.
Etomidate
DOSAGE AND ADMINISTRATION
Adult/Pediatrics Dose:
• 0.3 mg/kg IV
• Administered IV, the onset of action is usually within 1 minute with duration of
action of 5 minutes
• Patient is usually fully awake within 7-14 minutes
Fentanyl
Alternate Name
Sublimaze
Fentanyl
Action
ACTION
Fentanyl is an opioid analgesic. It binds to opiate receptors in the CNS, altering the
response to and the perception of pain. It may produce CNS and/or respiratory
depression in higher doses
Fentanyl
INDICATIONS
• Pain control
• Sedation of the intubated patient
INDICATIONS
- Pain control
- Sedation of the intubated patient
Fentanyl
CONTRAINDICATIONS
CONTRAINDICATIONS
- Patients currently taking MAO inhibitors
- Hypersensitivity to this medication
- Hypotension
- Abnormalities in lead V4R or other indications of inferior wall myocardial infarct
Fentanyl
Precautions
USE WITH PRECAUTION
- Head injury
- COPD history
- Respiratory difficulty
Fentanyl
Side Effects
SIDE EFFECTS
apnea laryngospasm respiratory depression arrhythmia bradycardia circulatory depression hypotension nausea and vomiting skeletal and thoracic muscle rigidity
Fentanyl
DOSAGE AND ADMINISTRATION
Pain Control
Adult
Pain Control
Adult:
• 50 - 100 mcg, IV push slowly over 1-2 minutes, or IM injection, may repeat every
5 minutes to a total of three doses or a maximum cumulative dose of 250 mcg
• Recheck a pain score & vitals including a HR, RR, and BP between doses
Fentanyl
DOSAGE AND ADMINISTRATION
Pain Control
Pedi
Pain Control
Pediatric:
• 0.5 mcg/kg, IV push slowly over 1-2 minutes, not to exceed 100 mcg.
• 1.5mcg/kg via mucosal atomization device if IV access unsuccessful or not
otherwise needed.
• May repeat every 5 minutes to a total of three doses or a maximum cumulative dose of 250 mcg
• Recheck a pain score & vitals including a HR, RR, and BP between doses
Fentanyl
DOSAGE AND ADMINISTRATION
Sedation in a patient with an advanced airway
Adult
Sedation in a patient with an advanced airway
Adult:
- 100 to 250 mcg IV, may repeat to a maximum cumulative dose of 250mcg
- Discuss with online medical control if additional doses are needed
