Fall Final Flashcards
Glucagon pharmacokinetics
onset: 5-20 min (IM)
aspirin
precautions
None in prehospital setting.
Atropine Sulfate: Indications
Symptomatic bradycardia, organophosphate poisoning, nerve agent poisoning. Atropine is considered ineffective for bradycardia associated with high-level AV blocks (2nd degree type II and 3rd degree). In these cases , consider pacing or dopamine first.
epinephrine: side effects
increased myocardial oxygen demand, ischemia, tachydysrhythmias, and anxiety.
Lorazepam (Ativan): Contraindications
Hypotension, head injury and/or decreased mental status unless being given during RSI
lidocaine: interactions
Except for V-fib and pulseless V-tach, lidocaine should not be given concurrently with other antidysrhythmics.
Glucagon Mechanism of Action
Causes a breakdown of glycogen stores in the liver into glucose, raising circulating blood glucose. Glucagon has positive inotronic and chronotropic effects on the heart that are independent of beta-adrenergic receptors which is why it is useful with beta blocker overdose.
Naloxone Hydrochloride: Contraindications
None
Albuterol (Ventolin): Pharmokinetics
Onset: Immediate
Albuterol (Ventolin): Contraindications
None in prehospital setting
Lorazepam (Ativan): class
benzodiazepine, anticonvulsant, sedative, hypnotic
amiodarone: how supplied
Vial or preload syringe of 150 mg/3 mL.
Glucagon supplied
Powder form, must be reconstituted
dopamine: side effects
increased myocardial oxygen demand, ischemia, tachydysrhythmias.
Naloxone Hydrochloride: Mechanism of action
Competitively displaces opioid analgesics from their receptor sites, reversing their effects. Respiratory depression, sedation, papillary miosis, and euphoric effects will be reversed.
diazepam (Valium):pharmacokinetics
Onset: 2-4 minutes
Duration: 30-90 minutes
Morphine Sulfate: Interactions
Potentiates other CNS depressants. Use caution with patients who have been drinking alcohol.
Dopamine: how supplied
prefilled syringes and ampoules of either 400 or 800 mg. Premix bags with either 400 or 800 mg in 250 to 500 mL. Concentrations of mixtures vary, but most commonly are 1600 mcg/mL
Albuterol (Ventolin): Indications
Asthma, COPD, wheezing associated with pulmonary edema (cardiac asthma), shortness of breath associated with pneumonia or anaphylaxis. May be used for symptomatic hyperkalemia
Albuterol (Ventolin): Side Effects
Hypertension, tachycardia, anxiety, palpatations
amiodarone: mechanism of action
Antidisrhythmic blocking sodium, potassium, and calcium channels. It is also a week, noncompetitive, alpha and beta blocking agent. amiodarone depresses automaticity of the sinoatrial node. It slows conduction and decreases refractoriness of the AV node. Amiodarone increases atrial and ventricular refractoriness and prolongs the QT interval.
Dopamine: interactions
sodium bicarbonate can deactivate catecholamines. MAO inhibitors potentiate the effects of dopamine (Marplan, Eutonyl, Parnate, Nardil)
diazepam (Valium): mechanism of action
Enhances action of GABA, an inhibitory
neurotransmitter, which inhibits spread of electrical
activity from irritable focus during seizures, calms CNS.
Also a muscle relaxant.
Glucagon precautions
Ineffective with patients who have reduced glycogen stores
Nitroglycerne: Mechanism of action
Causes vasodialation that reduces preload, reducing cardiac workload and myocardial oxygen demand. Dialates coronary arteries, resulting in improved perfusion to ischemic myocardium. Relief of ischemia alleviates chest pain.
diazepam (Valium): interactions
Effects are additive when used with other CNS depressants, for example, alcohol
activated charcoal
mechanism of action
Adsorbs toxin molecules to the outside surface of charcoal. The combined complex is then excreted from the body.
midazolam (Versed): interactions
Effects are additive when used with other CNS depressants, for example, alcohol.
Dextrose (D50) side effects
Nausea if given too rapidly.
Adenosine (Adenocard): Dosage
6 mg IV bolus followed with 20 mL flush. If no response, repeat in 1-2 minutes with 12 mg followed with 20 mL flush. This dose can be repeated one more time.
Dextrose (D50) pharmacokinetics
Onset: immediate if given IV
amiodarone: pharmacokinetics
Rapidly absorbed after IV administration. Long duration of action, immediate maintenance drip usually not required (protocol dependent)
activated charcoal
dosage
1 g per kilogram
Activated charcoal comes in bottles of 25 – 50 g in slurry with water or sorbitol.
Asprin
Classes
platelet inhibitor EMS use,
analgesic,
antipyretic,
nonsteroidal anti-inflammatory
Albuterol (Ventolin): Interactions
Side effects may increase when administered with other sympathomimetics. ß-blockers may blunt effects of albuterol.
Naloxone Hydrochloride: Dosage
0.1 - 2 mg(IV, IM, SQ, ETT, nasal), repeated to a max of 8 mg. Naloxone is shorter acting than most opiates, repeated doses may be required.
Dextrose (D50) class
Carbohydrate
Atropine Sulfate: Mechanism of Action
Atropine is a competitive antagonist for acetylcholine at the muscarinic receptors on the target organs of the parasympathetic system (e.g. heart, lungs. salivary glands etc.). In this way, atropine blocks the action of the parasympathetic system.
Atropine Sulfate: Side effects
Acute psychosis, vasodialation, dehydration, elevated temperature, and mydriasis (pupil dialation). Hint: Mad as a hatter, hot as a hare, red as a beet, dry as a bone, and blind as a bat.
diazepam (Valium): side effects
hypotension, respiratory depression
Ipratropium Bromide (Atrovent): Class
Anticholinergic bronchodilator, parasympatholytic, anti muscarinic
Dextrose (D50) mechanism of action
Increases blood glucose
Glucagon: dosage
Antihypoglycemic: 1mg IM, large doses Beta blocker, calcium channel blocker: 3mg-10mg IV
dopamine: class
sympathomimetic, vasopressin
activated charcoal
contraindications
Altered mental status unless administered by NG tube and airway protected with ET tube.
Lorazepam (Ativan): Indications
Major motor seizures, premedication for cardioversion ot TCP, sedation associated with intubation, muscle spasms, acute anxiety, agitation (amphetamine or cocaine OD)
Diazapam (Valium): Indications
Major motor seizures, premedication for cardioversion ot TCP, sedation associated with intubation, muscle spasms, acute anxiety, agitation (amphetamine or cocaine OD)
amiodarone: side effects
hypotension; bradycardia; prolonged QT interval (may be prodisrhythmic)
Midazolam (Versed): Dosage
RSI: 0.1mg/kg IV, Max 10mg
Other sedation, seizure: 2.5mg-10mg IV/IM
Morphine Sulfate: Side effects
Respiratory depression, hypotension, decreased mental status, histamine release.
Furosemide: Interactions
May increase digitalis toxicity secondary to hypokalemia
Atropine Sulfate: Class
Parasympathetic, anticholinergic, antimuscarinic, vagolytic
Dextrose (D50) dosage
Adult: initial dose 25g, slow bolus. Second dose of 25g may be given if needed. Pediatric: 0.5 g/kg given as D50 to children older than infancy, as D25 to infants and as D10 to neonates
lidocaine: mechanism of action
As an antidisrhythmic, lidocaine suppresses automaticity, excitability, and spontaneous depolarization of the ventricles. As an anesthetic, lidocaine produces local anesthesia by inhibiting transport of ions across neuronal membranes, conduction of normal pulses
epinephrine: dosage
Cardiac arrest: 1 mg/3-5 minutes IV (1:10,000)
Bradycardia: 2-10 mcg/minute
Anaphylaxis: 0.3–0.5 mg IM every 5–15 minutes (1:1000), 0.3-0.5 mg 3-5 minutes slow IV (1:10000).
Croup 0.5 mL via nebulizer (2.25% racemic epinephrine added to 3 mL saline)
aspirin
side effects
There are few significant side effects to one dose of aspirin.
Morphine Sulfate: Dosage
2-5 mg slow IV push, titrated to effect. Max dose usually not to exceed 20 mg without OLMC approval. MS can be given IM.
Epinephrine: Class
sympathomimetic
lidocaine: contraindications
(viscous form is exempt)
High degree heart blocks (second degree type II or third degree).
Ventricular ectopy in conjunction with hypoxia or bradycardia;
Relative: HR
Adenosine (Adenocard): Class
Endogenous chemical; exogenous form is used as antidysrhythmic
dopamine: contraindications
pheochromocytoma, uncorrected tachydysrhythmia (except sinus tachycardia).
Morphine Sulfate: Notes
Patients with allergy to sulfa are not allergic to MS. Morphine is the standard which all other analgesics are compared. 60 mg oral MS is same as 10 mg IV MS. MS is a schedule II narcotic.
lidocaine: dosage
- pulseless V-tach, V-fib: 1.5 mg/kg IV every 3-5 min, max dose 3mg/kg.
- V-tach with a pulse: 1.0- 1.5 mg/kg slow IV, may repeat at 1/2 dose in 5-10 min, max dose 3mg/kg. if patient is >70 years, has hepatic failure, or CHF; decrease second dose to 1/4 of first dose.
- Post conversion: 1-4 mg/min (this is the drip rate est. after a bolus medication is associated with conversion out of V-tach or V-fib.
- Intubation: 1mg/kg
Nitroglycerin: Indications
Chest pain thought to be cardiac in origin, acute pulmonary edema, may be used in hypertensive crisis.
Adenosine (Adenocard): How Supplied
6 mg or 12 mg prefilled syringes
Nitroglycerin: Dosage
1 tablet (0.4 mg) given sublingually q 5 minutes. 1 metered dose spray (0.4mg) sublingually q 5 minutes. 1-2” of paste. 5mcg/min IV (titrate to 5mcg/min q 5 minutes untill desired effect is achieved.)
lidocaine: indications
Ventricular dysrhythmias: hemodynamically compromising PVCs; stable, unstable V-Tach; and V-Fib. Lidocaine is also used as a premedication rapid sequence intubation, and as a local anesthetic for IVs and suturing. Viscous form is used as a local anesthetic prior to nasal intubation or NG tube placement.
Glucagon Indications
Hypoglycemia when IV is unobtainable, beta blocker overdose, calcium channel blocker overdose.
aspirin
contraindications
confirmed allergy, active G.I. bleeding, suspected aortic dissection
(Local protocols may permit administration of ASA to patients on anticoagulants, although it is not an actual contraindication since warfarin does not inhibit platelet aggregation).
Children or adolescents with viral infection should not take aspirin (Reye’s syndrome).
Nitroglycerin: Note
Nitroglycerin paste is not indicated for the treatment of acute chest pain. some protocols will use paste in conjunction with sublingual doses.
Naloxone Hydrochloride: Pharmacokinetics
Onset: 1-2 minutes IV, 2-5 minutes IM.
diazepam (Valium): class
benzodiazepines, anticonvulsant, sedative, hypnotic
Lorazapam (Ativan): pharmacokinetics
Onset: 1-2 min IV; 15 min IM
Duration: 30-60 min IV, IM
dopamine: mechanism of action
Dopamine stimulates alpha, beta-1, and dopaminergic receptors. It also acts indirectly by causing release of norepinephrine from storage sites in the sympathetic nerve endings. The effects of dopamine are dose-related. At low doses, beta-1 and dopaminergic receptors are stimulated. At high doses alpha effects predominate.
Lorazepam (Ativan): Dosage
0.05mg/kg IV, max is generally 4mg
Glucagon contraindications
None in prehospital setting
lidocaine: class
antidisrhythmic, anesthetic
Albuterol (Ventolin): Class
Sympathomimetic ( ß-2 agonist)
Naloxone Hydrochloride: Notes
Larger doses may be required to reverse the effects of synthetic narcotics (propoxyphene, buprenorphine, butorphanol, nalbuphine, or pentazocine). Not useful in cardiac arrest even if cardiac arrest was a result of respiratory arrest caused by narcotic overdose. Naloxone will not restart an arrested heart.
activated charcoal
indications
Selected indications. because activated charcoal will not bind to all substances (for example; not to alcohol or petroleum products), treatment is best dictated by OLMC and/or poison center. Treatment is usually not indicated unless it has been less than two hours since ingestion.
Naloxone Hydrochloride: Indications
Symptomatic opiate overdose (respiratory depression), Clonidine overdose.
Ipratropium Bromide (Atrovent): Mechanism of Action
Ipratropium is a form of atropine given by inhalation. It antagonizes muscarinic cholinergic receptors in the bronchi, producing bronchodilation.
Adenosine (Adenocard): Precautions
Transient periods of asystole, sinus bradycardia, and ventricular ectopy are not uncommon after administration
Ipratropium Bromide (Atrovent): Indications
Asthma and reversible bronchospasm associated with COPD or anaphylaxis.
diazepam (Valium): precautions
Cannot be given IM. If possible use large vein and give slowly because of possible venous irritation. Monitor respiratory status
Nitroglycerin: Side effects
Hypotension, headache, dizziness, dry mouth.
aspirin
indications
Acute chest pain of suspected cardiac origin.
Morphine Sulfate: Pharmacokinetics
Onset: IV < 5 minutes; IM~10 to 30 minutes.
Duration: 4 to 6 hours.
Ipratropium Bromide (Atrovent): Precautions
Delayed onset of action; not used as a sole bronchodilator in emergent setting
epinephrine: mechanism of action
Epinephrine stimulates alpha and beta adrenergic receptors. Because of these effects the drug causes: peripheral vasoconstriction, increased inotropic, chronotropic, and dromatropic responses; and bronchodilation. Inhibits mast cell degranulation.
Midazolam (versed): Contraindications
Hypotension, head injury and/or decreased mental status unless being given during RSI.
Glucagon side effects
Nausea/vomiting if given rapid IV
Dextrose (D50) contraindications
None when used in emergency situations
dopamine: dosage
2-20mcg/kg/minute IV infusion.
Improve cardiac output (beta):5-10 mcg/kg/minute.
Increase peripheral vascular resistance (Alpha): 10-20 mcg/kg/minute.
Nitroglycerin: phamacokineics
Onset:1-2 minutes
Dopamine: indications
1 Significantly symptomatic hypotension (most commonly septic or cardiogenic shock). With the possible exception of cardiogenic shock, fluid resuscitation mast be attempted before the administration of dopamine.in the prehospital setting, dopamine is not used for shock in the setting of trauma.
Morphine Sulfate: Precautions
Consider calling OLMC in the setting of multi-systems trauma. May cause N&V if given rapidly.
Ipratropium Bromide (Atrovent): Dosage
Usually administered with a ß-agonist (albuterol). 500mcg nebulized
Furosemide: Pharmacokinetics
Onset: Venous dilation- 5 minutes
Diuresis- 5-15 minutes
lorazepam (Ativan): mechanism of action
Enhances action of GABA, and inhibitory neurotransmitter, inhibits spread of electrical activity from irritable focus during seizures, calmes CNS. Also a muscle relaxant.
Glucagon Class
Hormone, antihypoglycemic
amiodarone: dosage
- Cardiac arrest: 300 mg IV bolus, if needed repeat 150 mg in 3-5 min. If converted, maintenance infusion is 1 mg/min.
- Tachicardia: infusion of 150 mg over first 10 minutes (15 mg/min). May repeat every 10 minutes as needed.
Morphine Sulfate: Mechanism of action
Combines with opioid receptors in the brain. Peripheral vasodialation of the veins and arteries resulting in decreased preload (not usually altering heart rate or blood pressure at usual doses).
lidocaine: precautions
use caution in patients with hepatic failure, CHF, age greater than 70 years
Albuterol (Ventolin): Precations
Monitor ECG. Treatment with albuterol rarely produces appreciable cardiac or systemic effects
Naloxone Hydrochloride: Side effects
Nausea, vomiting (if administered rapidly). Narcotic withdrawal symptoms: dizziness, hypertension, tachycardia, sweating, nervousness, abdominal cramps, headache, weakness, joint and muscle pain, insomnia, and untreated pain.
Nitroglycerine: Class
Nitrate
lorazepam (Ativan): interactions
Effects are additive when used with other CNS depressants, for example, alcohol
midazolam (Versed): side effects
Laryngospasm, bronchospasm, respiratory depression, drowsiness, amnesia, altered mental status
Adenosine (Adenocard): Contraindications
Atrial flutter or atrial fibrillation with history WPW
Dextrose (D50) indications
Hypoglycemia, hyperkalemia, (if given concurently with insulin)
midazolam (Versed): pharmacokinetics
Onset: 1-2 min IV; 15 min IM
Duration: 30-60 min IV, IM
Atropine Sulfate: Interactions
Additive anticholinergic effects with other anticholinergic compounds, including antihistamines,TCA’s.
Adenosine (Adenocard): Mechanism of action
Decreases impulse formation in the SA node, conduction through the AV node, and depresses left ventricular function. Thus, it depresses AV node and sinus node activity and interferes with reentrant pathways, as well as accessory bypass tracts, that cause SVT
Morphine Sulfate: Class
Narcotic analgesic
Ipratropium Bromide (Atrovent):Contraindications
None
Ipratropium Bromide (Atrovent): How Supplied
Unit dose vials (fish) containing 500 mcg (0.02 % inhalation solution) of the drug already diluted in 2.5 mLsaline.
Furosemide: Contraindications
Severe volume depletion, anuria unresponsive to a trial dose of furosemide, pregnancy (use only in life threatening situations, may cause fetal abnormalities.
Atropine Sulfate: Dosage
Bradycardia: 0.5-1mg every 3-5 minutes (max dose is 0.04mg/kg). Poisoning: 1-2mg initially, can be repeated every 5-60 minutes as needed.
epinephrine: pharmacokinetics
onset: IV immediate onset: IM 5 to 10 minutes onset: SQ 6 to 15 minutes
midazolam (Versed): class
benzodiazepine, anticonvulsant, sedative, hypnotic
Naloxone Hydrochloride: Precautions
Can precipitate severe withdrawal symptoms in individuals physically dependent on opioids. Use repeated small doses (0.1-0.2 mg IV) in patients taking chronic narcotics. Consider physical restraints (and your personal safety) prior to, or concurrent with naloxone hydrochloride administration. may precipitate seizures in the neonate.
Atropine Sulfate: Supplied
1mg/10ml preloaded syringe.
Morphine Sulfate: Indications
Pain, cardiac pain refractory to NTG, burns, acute pulmonary edema.
Albuterol (Ventolin): Mechanism of Action
Bronchodilation by stimulating ß-2 receptors of the bronchi. Has minimal ß-1 stimulation. Also stimulates cellular uptake of potassium
aspirin
dosage
324 mg
(four baby chewable aspirin)
Adenosine (Adenocard): Side Effects
Apprehension, dizziness, shortness of breath, chest pain, and facial flushing. Because of short half-life and duration, side effects usually resolve in a few minutes.
Furosemide: Dosage
20-80 mg IV/IM (Varies greatly by protocol, generally don’t administer an initial dose of more than 20 mg to a patient who does not take furosemide)
amiodarone: indications
V-fib, pulseless V-tach, and wide complex regular tachycardia with pulse (this includes VT and WCT of uncertain origin.)
activated charcoal
side effects
abdominal cramping, constipation
epinephrine: indications
Cardiac arrest: asystole and V-fib/tach without a pulse, PEA.
Bradycardia: (as a drip medicine only).
Anaphylaxis bronchospasm/constriction.
Croup (racemic)
aspirin
note
Aspirin given at the onset of an acute MI reduces mortality and is one of the most effective treatments medics can offer. Don’t forget to give aspirin to patients with cardiac chest pain!
epinephrine: contraindications
none when used in emergency situations, however in patients with a pulse, use caution if they have underlying cardiovascular disease, hypertension, or tachydysrhythmias.
Adenosine (Adenocard): Interactions
The effects of adenosine are decreased by theophylline and caffeine (higher doses may be needed). Carbamazepine and dipyridamole (Persantine or Aggrenox) potentiate the effects of adenosine ( use with caution, if at all, consider OLMC consult)
Dextrose (D50) interactions
None
amiodarone: contraindications
None in prehospital setting.
midazolam (Versed): precautions
monitor respiratory status
Dopamine: pharmacokinetics
IV drip administration has a rapid onset and will last as long as the drug is being infused.
Adenosine (Adenocard): Indications
SVT, including those associated with accessory bypass tracts (WPW, LGL)
midazolam (Versed): mechanism of action
Enhances action of GABA, an inhibitory neurotransmitter; inhibits spread of electrical activity from irritable focus during seizures, calms CNS. Also a muscle relaxant.
Dopamine: precautions
extravasation will cause tissue necrosis
activated charcoal
class
adsorbent
Albuterol (Ventolin): Dosage
2.5 mg in 3 mL saline, supplied in plastic “fish” to be administered in med-neb. Dosage intervals vary by protocol, acceptable to administer continuous nebulizer treatments if needed
Furosemide: Class
Loop diuretic
Furosemide: Precautions
Avoid giving to patients with pneumonia; hypersensitivity to sulfa
Morphine Sulfate: Contraindications
Head injury and /or decreased mental status, hypotension, abdominal pain associated with trauma (some EMS systems don’t permit use of morphine in undiagnosed abdominal pain of any origin.
Atropine Sulfate: Contraindications
None when used in emergency situations.
lorazepam (Ativan): side effects
Hypotension, respiratory depression
epinephrine: interactions
sodium bicarbonate can deactivate catecholamines. MAO inhibitors potentiate the effects of epinephrine (Marplan, Eutonyl, Parnate, Nardil)
Nitroglycerin: Precautions
Check vitals after each administraton, NTG induced hypotension responds well to supine positioning and fluids. It is preferable to establish IV access prior to adminstering NTG. Right-sided MI and use of NTG can result in sever hypotension
Dextrose (D50) precautions
Infiltration causes tissue necrousis Use large bore IV if available. Give thiamine before D50 if patient is suspected to be malnourished e.g. alcoholic, homeless, elderly (protocol dependent)
Furosemide: Side Effects
Hypotension, potassium depletion, muscle cramps.
epinephrine: side effects
increased myocardial oxygen demand, ischemia, tachydysrhythmias, and anxiety.
Atropine Sulfate: Precautions
Paradoxical bradycardia can occur after slow administration or with small doses (minimum dose 0.5mg adults. 0.1mg children). Avoid in hypothermic bradycardia.
aspirin
pharmacokinetics
Onset: 5– 30 min.
Peak: 15 min.-2 hours
Atropine Sulfate: Pharmacokinetics
Onset: immediate
Naloxone Hydrochloride: Class
Opiate antagonist
aspirin
mechanism of action
Inhibits the production of certain prostaglandins, which accounts for it’s antiplatelet, anti-inflammatory, antipyretic, and analgesic actions.
Aspirin inhibits platelet aggregation for the life of the platelet (7 to 10 days).
Furosemide: Mechanism of action
Blocks reabsorption of Na and Cl in kidney, causing increased diuresis. Venodilator
Ipratropium Bromide (Atrovent): Side Effects
Palpitations, anxiety, dizziness
Diazapam (Valium): Contraindications
Hypotension, head injury and/or decreased mental status unless being given during RSI
lidocaine: side effects
Serious adverse reactions are uncommon, high doses can produce bradycardia, hypotension, AV block, and cardiovascular collapse. Signs of toxicity include tinnitus, perioral twitching, slurred speech, altered mental status, and seizures (higher incidence in geriatric patients). Stinging at the administration site when used as local anesthetic
Nitroglycerin: Contraindications
BP <100, viagra type <24 hours, ciallis type <48 hours.
Naloxone Hydrochloride: Interactions
None
Diazapam (Valium): Dosage
5-15 mg IV
Furosemide: Indications
Pulmonary edema, hypertensive crisis,
Hyperkalemia (coontroversial)- Furosemide is sometimes given in the management of hyperkalemia to increase potassium excretion from the body. However many ED physicians discourage prehospital use of furosemide in this way preferring to use resin exchangers and/or dialysis. As always, follow your protocols.
Midazolam (Versed): Indications
Major motor seizures, premedication for cardioversion ot TCP, sedation associated with intubation, muscle spasms, acute anxiety, agitation (amphetamine or cocaine OD)
