FIELD Meds Flashcards
Dosages
Mag Sulfate Drug class
Electrolyte
Anticonvulsant
Mag MOA
Reduces striated muscle contractions &
blocks peripheral neuromuscular transmission by reducing acetylcholine release at the myoneural junction
(seizure control, uterine relaxation, bronchodilation)
Mag Sulfate indications
Hypomagnesemia
Eclampsia seizures
Respiratory distress
Torsades
Mag Sulfate contraindications
Hypermagnesemia or Hypercalcemia
Hypotension
Heart Block or Myocardial damage
Myasthenia Gravis
Diabetic coma
Pulmonary Edema
Mag Special Considerations
- CNS depressant effects can be amplified if the pt is on downers
- Not recommended 2 hrs prior Delivery (Calcium is antagonist)
- Caution in pt’s w/ Renal Failure (cleared by the kidneys & toxicity can be achieved w/ ease)
Mag Supplied
10mL Vial of 5g of 50% Mag Sulfate
0.5g/mL
Mag Sulfate Respiratory
14 y/o & over =
2g (4ml) infused in 50ml of NS over 15 minutes
13 y/o & under =
25mg/kg (2g Max) infused in 50ml of NS over 15 minutes
Mag Sulfate Eclampsia
5g (10ml) infused in 50ml of NS over 15 minutes
Mag Sulfate for Torsades
2g SIVP push over 1-2 minutes
13y/o & under =
Pulse: 25mg/kg (2g Max) infusion over 15 minutes
CA: 25mg/kg SIVP over 2-3 minutes
Methylprednisolone Drug Class
Glucocorticoid Steroid
Methylprednisolone MOA
Synthetic steroid that suppresses acute & chronic inflammation
Increases vascular smooth muscle relaxation by beta adrenergic agonists (alter airway hypersensitivity)
Methylprednisolone Indications
Anaphylaxis
Respiratory distress
Adrenal Insufficient Hypotension
Methylprednisolone Contraindications
Pulmonary Edema
TBI
Severe Infection
IM administration w/ Idiopathic thrombocytopenic purpura
Methylprednisolone Special Considerations
Caution:
- GI bleeds
- Diabetes
May blunt hypoglycemia responses to Insulin & Oral hypoglycemic agents
Potassium-Depleting agents may enhance hypokalemia
Methylprednisolone Supplied
ACT-O Vial w/ sterile powder of the compound w/ 2mL of bacteriostatic water to equal 125mg
Methylprednisolone Dosage
IV/IM
2mg/kg
*125mg Max Dose, 60mg for Peds
Ondansetron Drug Class
Serotonin 5-HT3 receptor antagonists
Antiemetic
Ondansetron MOA
Binds to the serotonin receptors located on the vagal neurons lining the GI tract, which then blocks signaling to the vomiting center in the brain
Ondansetron Contraindications
<3 Month
Prolonged QT
Liver Disease
GI Obstruction
Apomorphine
Ondansetron Special Considerations
May prolong QT interval
QT Prolongation Causes
Hypokalaemia
Hypomagnesaemia
Hypocalcaemia
Hypothermia
MI’s
ROSC Post-cardiac arrest
Raised ICP
Congenital long QT syndrome
Medications/Drugs (Psych Meds)
Ondansetron Supplied
2mL Vial of 4mg
2mg/mL
2 Total Vials
Ondansetron Dosage
IV/PO/SL
0.15mg/kg (4mg Max Single Dose)
*May repeat in 15 minutes for a max total of 8mg
Diphenhydramine Drug Class
Antihistamine
Diphenhydramine MOA
Acts as an inverse agonist at the H1 receptor, thereby reversing the effects of histamine on capillaries, reducing allergic reaction symptoms. The H1 receptor is similar to muscarinic receptors
Diphenhydramine Indications
Allergic reactions
Anaphylaxis (after Epi)
Dystonic reactions from antipsychotics
Diphenhydramine Contraindications
Caution in pts w/ CNS depression or lower respiratory tract diseases (asthma)
Newborns & Nursing Moms
Nonselective MAO inhibitors (rare)
Diphenhydramine Special Considerations
Drowsiness
Hypotension
Downers
Diphenhydramine Supplied
1mL Vial of 50mg
Diphenhydramine Dosage
1mg/kg Slow IV Push
Adults = 50mg Max
<13yrs = 25mg max
Tranexamic Acid Drug Class
Antifibrinolytic
Hemostatic Agent
TXA MOA
A synthetic version of enzyme Lysine, which disrupts the cycle of clot formation & breakdown during bleeding episodes
Binds w/ lysine sites on plasminogen, prevent it from forming into plasmin, ultimately inhibiting the breakdown of fibrin (what forms clots)
May promote platelet function & decrease inflammation
Tranexamic Acid Indications
Trauma
Excessive Bleeding
Tranexamic Acid Contraindications
Coagulopathy
Thromboembolic Disorder
PE or DVT
Acute MI
Ischemic cerebrovascular accident
Ischemic retinopathy
TXA Special Considerations
Thromboembolisms
TXA Supplied
10mL Vial of 1000mg
100mg/mL
2 Total Vials
Tranexamic Acid Dosage
> 14yrs = 2g SIV/IOP over 2 minutes
<14yrs = 30mg/kg SIV/IOP over 2 minutes
*2g Max Total
Ketamine Drug Class
Anesthetic
Ketamine MOA
Derivative of PCP
Interrupts the afferent transmissions between the Limbic & Cortex systems associated w/ pain
Blocks the following receptors:
- NMDA
- Opiate (analgesia)
- Muscarinic
- Nicotinic Acetylcholine
Stimulates Catecholamine release:
- Increased HR, BP & Cardiac Output
- Bronchodilation
Ketamine Indications
Pain
Painful procedures
Ketamine contraindication
Pregnancy
Increased ICP
CHF
Cardiac Decompensation
Angina
Stroke
Severe Hypertension
Schizo HX
Ketamine Special Considerations
Can cause:
- Hallucinations/delusions/explicit dreams
- Hypotension, Bradycardia, Respiratory Depression if administered too quickly
Increases effects of:
- ETOH
- Opioids
- Downers
Older Adults should receive lower end dose first
Ketamine Supplied
5mL Vial of 500mg
100mg/mL
Ketamine Dosage
0.2mg/kg
Adult = 20mg SIVP Max single dose
*May repeat for a max total dose of 40mg
Ketamine Prep
Waste 1ml from a 10ml flush, draw 1ml of Ketamine into the syringe & MIX
Waste 6ml so 4ml (4Omg) is left, 2ml is a full dose of 20mg
Midazolam Drug Class
Benzodiazepine
Midazolam MOA
Acts on GABA-A receptor to reduce the excitability of neurons, resulting in impairment of multi-domain cognitive functions
Midazolam Indications
Seizures
Sedations
Agitation/Exited Delirium
Painful procedures
Uncontrolled shivering (hypothermia)
Midazolam Contraindications
Respiratory/CNS depression
Shock
Depressed vital signs
Downers (drugs/etoh or meds)
Severe Glaucoma
Midazolam Supplied
2mL Vial of 10mg
5mg/mL
4 Total Vials
Midazolam IM Seizure Dosages
> 60yrs = 5mg (1ml)
*May repeat if seizure continues for a max total of 10mg
> 12yrs - Adults = 10mg (2ml)
*10 max total if under 14yrs (call medical direction)
*May repeat in adults if seizure continues for a max total of 20mg
Midazolam Ped Seizure Dosages
IM
6 - 11yrs = 5mg (1ml)
*May repeat if seizure continues for a max total of 10mg
17mnths - 5yrs = 2.5mg (0.5ml)
*May repeat if seizure continues for a max total of 5mg
Midazolam IV Seizure Dosages
> 60yrs = 2.5 (0.5ml)
*May repeat if seizure continues for a max total of 5mg
Adult = 5mg (1ml)
*May repeat if seizure continues for a max total of 10mg
Midazolam Combative Dosages
IM
Adults = 10mg (2ml)
*May repeat half the dose for a max total of 15mg
<14yrs & >60yrs = 5mg (1ml)
*May repeat half the dose for a max total of 7.5mg
IV is Half the IM Dose
Midazolam Sedation Dosages
IM
Adults = 5mg (1ml)
*May repeat for a max total of 10mg
IV or >60 = 2.5mg (0.5ml)
*May repeat for a max total of 5mg
Morphine Drug Class
Opioid Analgesic
Morphine MOA
Activates:
Mu Receptors which are present in the brainstem & the thalamus
Kappa Receptors which are present in the limbic system (part of the forebrain called the diencephalon), the brain stem & spinal cord
Delta receptors which are widely distributed in the brain & also present in the spinal cord & digestive tract
=
- Pain Relief
- Sedation
- Euphoria
- Respiratory CNS Depression
- Peripheral Venous Capacity
- Decreases Venous Return
- Physical Dependence
Morphine Indications
Pain
Chest pain associated with ACS
Acute cardiogenic pulmonary edema
Morphine Contraindications
Hypersensitivity
Hypovolemia
Hypotension
Head injury/ increased ICP
Severe respiratory depression
MAO inhibitors w/in 14 days
Caution in right ventricular infarction
May worsen heartblock in inferior MI
Morphine Supplied
1mL Vial of 10mg
4 Total Vials
Morphine Dosages
0.1 mg/kg Slow IV/IM/IO (10mg Max Single dose)
*May repeat for a max total dose of 20mg
Albuterol Drug Class
Beta 2 Agonist
Sympathomimetic
Bronchodilator
Albuterol MOA
Relaxes smooth muscles of the bronchial tree & peripheral vasculature by stimulating adrenergic receptors of the sympathetic nervous system
Albuterol Indications
Bronchospasm/Wheezing
Anaphylaxis
Hyperkalemia
Albuterol Contraindications
Use w/ Caution:
Tachycardic Dysrhythmias
Albuterol Special Considerations
Other sympathomimetics may exacerbate adverse cardiovascular effects
MAO inhibitors & TCA’s may potentiate vasodilations
Beta Blockers may blunt effects
May potentiate diuretic induced hypokalemia
Caution:
- Diabetes
- Hyperthyroidism
- Seizure Disorder
- Cardiovascular Disorders
Albuterol Supplied
3mL Unit Dose Vial of 2.5mg
Albuterol Dosage
2.5mg SVN
*May repeat for a max dose of 7.5mg
Ipatropium Drug Class
Anticholinergic
Bronchodilator
Ipratropium MOA
Inhibits interaction of acetylcholine @ receptor sites on bronchial smooth muscle, resulting in decreased levels of cyclic guanosine monophosphate = Bronchodilation
Ipratropium Indications
Persistent Bronchospasm
COPD Exacerbation
Ipratropium Contraindications & Special Considerations
Atropine, Soy & Peanut Allergy
Caution in Pts w/ urinary retention
Ipratropium Supplied & Dosage
2.5mL Unit Dose Vial of 0.5mg
0.5mg Dose Total Max
Atropine Drug Class
Anticholinergic Agent
Atropine MOA
Inhibits actions of acetylcholine @ postganglionic parasympathetic (primarily muscarinic) receptor sites
Blocked vagal effects result in increased HR & enhanced AV conduction w/ limited or no inotropic effect
Antagonizes excess muscarinic receptor stimulation (from organophosphate insecticides or chemical nerve agents)
Atropine Indications
Bradycardia
Organophosphate, Carbamates, or nerve gas poisoning
Atropine Contraindications
Glaucoma
Obstructive GI tract disease
Obstructive uropathy
Thyrotoxicosis
Unstable cardiovascular status in acute hemorrhage w/ Myocardial ischemia
Atropine Special Consideration
Increased Effects/Vagal Blockade when used w/ other Anticholinergics:
- Antihistamines
- Psych Meds
- Thiazides
- Procainamide
- Quinidine
Atropine Supplied
10mL Stick of 1mg
0.1mg/mL
Atropine Bradycardia Dosage
IV
> 10yrs = 1mg FIVP
*May repeat every 3-5 minutes for a max total of 3 mg
> 1yrs - <10yrs = 0.02mg/kg RIVIOP
(0.1mg Minimum - 1mg Max Initial Dose)
*May repeat every 3-5 minutes for a
max total of 3 mg
Atropine SLUDGE Dosage
> 10yrs = 2mg IV/IO
<10yrs = 0.02mg/kg IV/IO or
0.04mg/kg IM
Naloxone Drug Class
Opioid Antagonist
Naloxone MOA
Acts as a competitive antagonist at various opioid receptors in the CNS
Naloxone Contraindication/Special Considerations
Withdrawal
Naloxone Supplied
2mL Stick of 2mg
1mg/mL
5 Sticks Total
Naloxone Dosage
Intranasal
4mg
*May repeat for a max total of 8mg
IV/IM/IO/IN
2mg
*May repeat as needed every 3-5 minutes
Epinephrine Drug Class
Sympathomimetic
Epi MOA
Acts on all Adrenergic Receptors
Alpha1 & 2
Beta1, 2, & 3
Alpha1 Activation = Smooth Muscle Contraction in Blood Vessels (Vasoconstriction)
Beta1 Activation = Impact the Heart’s Inotropy (Force of Contraction) & Chronotropy (Heart Rate)
Beta2 Activation = Smooth Muscle Relaxation of the Lungs
Epi Indications
Cardiac arrest (PEA, VF & Pulseless VT)
Anaphylaxis & Bronchial asthma
Symptomatic Bradycardia
Hypotension
Epi Contraindications
Hypovolemic shock w/out correcting hypovolemia
Dilated Cardiomyopathy
Epi 1:1,000 Supplied
1mL Vial of 1mg
1:1,000 Epi Anaphylaxis Dosage
> 30kg/9yrs - Adults = 0.3mg IM (upper lateral thigh)
<30kg/9yrs = 0.15mg IM (upper lateral thigh)
*May repeat every 5-15 minutes
1:1,000 Epi Respiratory Dosage
> 14yrs = 0.3mg IM (upper lateral thigh)
<14yrs = 0.01 mg/kg IM (upper lateral thigh)
*Max dose 0.3 mg
1:1,000 Epi Croup Dosage
3 mL by SVN
*May repeat x 1 in 20 minutes
Amiodarone Drug Class
Class 3 Antiarrhythmic
Potassium Channel Blocker
Amiodarone MOA
Blocks potassium currents that cause repolarization of the heart muscle during the third phase of the cardiac action potential, which increases the duration of the action potential as well as the effective refractory period for cardiac cells (myocytes)
Amiodarone Indications
VF
VT (monomorphic)
Cardiac arrest
<14 yrs SVT (2nd line of defense)
Amiodarone Contraindications
Pulmonary congestion
Cardiogenic shock
2nd or 3rd degree AV blocks (if no pacemaker present)
WPW
Severe sinus node dysfunction
Hyperkalemia
Torsades
Drugs that Prolong QT interval
Amiodarone Special Considerations
Rapid Infusion = Hypotension
Beta Blockers:
- Bradycardia
- Hypotension
CCB’s:
- AV block
- Bradycardia
- Hypotension
Increased Serum Levels of:
- Phenytoin
- Procainamide
- Quinidine
- Theophyllines
Amiodarone Supplied
3mL Vial of 150mg
50mg/mL
3 Total Vials
Amiodarone Stable Dosages
> 14 = 150mg infused in 50mg of NS over 10 minutes
*May repeat if no response for a max total of 300mg
<14yrs = 5 mg/kg (max 150 mg) infused in 100mg of D5W over 20 minutes
Amiodarone Cardiac Arrest Dosage
IV/IO
5mg/kg (300mg max) followed by 20ml saline bolus
*May repeat 2.5mg/kg (150mg max) followed by 20ml saline bolus
1:10,000 Epi Supplied
10mL Stick of 1mg
0.1mg/mL
5 Sticks total
1:10,000 Epi Cardiac Arrest Dosage
IV/IO
0.01mg/kg (1mg max) Stick as early as possible
*2nd & last dose @ 8 minute mark for a max total of 2mg
1:10,000 Epi Push Pressor for Hypotension/Bradycardia Dosage
IV/IO
> 14yrs ONLY = 10-20 mcg boluses every 2 minutes
1:10,000 Epi Push Pressor Prep
Mix 1 or 2mL with 9 or 8mL NS
Adenosine Drug Class
Class 5 Antiarrhythmic (Miscellaneous)
Endogenous nucleoside
Adenosine MOA
Decreases electrical conduction through the AV node w/out causing negative inotropic effects
Acts directly on sinus pacemaker cells & vagal nerve terminals to decrease chronotropic (HR) activity
*Conduction time is decreased by inducing potassium efflux and inhibiting calcium influx through channels in nerve cells, leading to hyperpolarization and an increased threshold for calcium dependent action potentials
Adenosine Indications
SVT
Diagnostics
Adenosine Contraindications
Drug induced tachycardia
2nd or 3rd degree AV block
WPW
Sick sinus syndrome
Obstructive Pulmonary Diseases (Asthma, COPD)
Adenosine Special Considerations
Methylxanthines (Caffeine, Theophylline) antagonizes the action of Adenosine = Larger Doses
Dipyridamole & Carbamazepine (potentiated effects) = 3mg Initial Dose
3mg Initial Dose = Heart Transplant or if by Central Venous Access
Adenosine Supplied
One 2mL Vial of 6mg (3mg/mL)
One 4mL Prefilled Syringe of 12mg
(3mg/mL)
Adenosine Dosage
Proximal IV
> 14yrs = 6mg FIVP followed by a 20ml saline fluid bolus
*May repeat 12mg FIVP followed by a 20 ml saline fluid bolus
<14yrs = 0.1 mg/kg (max 6mg) FIVP followed by a 10ml saline flush
*May repeat 0.2mg/kg (max 12mg) FIVP follow by a 10 mL saline flush
Nitroglycerin Drug Class
Vasodilator
Nitro MOA
Nitroglycerin forms free radical nitric oxide (NO) which activates
guanylate cyclase, resulting in an increase of guanosine 3’5’ monophosphate (cyclic GMP) in
smooth muscle and other tissues.
These events lead to dephosphorylation of myosin light chains, which regulate the contractile state in smooth muscle, and result in vasodilatation
Nitro Indications
Ischemic CP
Heart failure
Acute MI
Hypertensive emergencies w/ ACS
Pulmonary edema
Nitro Contraindications
Volume depletion
Hypotension (<110 or 30 below baseline)
Head injury
Extreme bradycardia
Extreme tachycardia in the absence of heart failure
Right ventricular infarction
Cerebral hemorrhage
PDE5 inhibitors
Aortic stenosis
Nitro Supplied & Dosage
Bottle of 25 SL 0.4mg Tabs
3 Total Max Doses = 1.2mg
Calcium Chloride Drug Class
Electrolyte
Calcium Chloride MOA
Increases serum ionized calcium concentration by dissociating into ionized calcium in plasma
Restores the normal gradient between threshold potential and resting membrane potential when in hyper-kalemia/magnesemia
Calcium Chloride Indications
Hyperkalemia (non-digitalis)
Hypermagnesemia
Hypocalcemia (eg, multiple transfusions)
Calcium Channel Blocker OD
Prevent Calcium Channel Blocker (Diltiazem) Hypotension
Calcium Chloride Contraindications
Hypercalcemia
VF during Cardiac Arrest
Digitalis OD
Calcium Chloride Considerations
Severe local necrosis & sloughing if infiltration occurs
Bradycardia/hypotension/dysrhythmia may occur if administered fast
Calcium Chloride Supplied
10mL Prefilled Syringe of 10% 1g
100mg/mL
Calcium Chloride Dosage
20mg/kg (0.2mL/kg) SIV/IOP
1g SIVP Max
Glucagon Drug Class
Pancreatic Hormone
Antihypoglycemic Agent
Glucagon MOA
Raises blood sugar through activation of hepatic glucagon receptors, stimulating glycogenolysis and the release of glucose
Increases Cardiac inotropy & Decreases Hepatic vascular resistance
Glucagon Indications
Hypoglycemia
Calcium Channel Blocker or Beta Blocker toxicity
Glucagon Contraindication & Special Considerations
Pheochromocytoma (type of neuroendocrine tumor)
Insulinomas (pancreatic tumors)
Avoid use in:
- Peds/Infants
- Anorexics/extremely lean/fasting pt’s
Glucagon Supplied
1mg Tab of Glucagon in the Vial accompanied w/ a 1ml prefilled syringe of diluent
Glucagon Dosage
0.1mg/kg IM/IN
1mg Max single dose
May repeat 1x
Dextrose Drug Class
Carbohydrate
Hypertonic Solution
Dextrose MOA
Dextrose is derived from corn & is considered a simple sugar. It is easily metabolized by the body’s cells into glucose thereby making it easy absorbed & utilized for a rapid raise in blood glucose levels & thereby energy
Dextrose Indications
Hypoglycemia
ALOC
Seizure/coma of unknown origin
Dextrose Contraindications
Hyperglycemia
Intracranial or intraspinal Hemorrhage
Increased ICP
Known or suspected stroke in absence of hypoglycemia
Dehydrated Delirium Pts
Dextrose 10% Supplied & Dosage
250mL bag of 25g of Dextrose (10g/100mL)
1mL/kg IV/IO, 250mL Max Single Dose
*May repeat for a max total of 500ml (50g)
Hypoglycemia High Risk Meds
Any non rapid meds or on multiple meds:
Glyburide
Glipizide
Glimepiride
Repaglinide
Nateglinide
Lantus
Regular insulin
Insulin lispro + glipizide
Diltiazem Drug Class
Class 4 Antiarrhythmic
Calcium Channel Blocker
Diltiazem MOA
inhibits the inflow of calcium ions into the cardiac muscle during depolarization, which slows conduction & increases refractoriness in the AZ node.
Reduced intracellular calcium concentrations increase smooth muscle relaxation, resulting in arterial vasodilation and decreased blood pressure
Diltiazem Indications
A fib & w/ RVR
A flutter
Junctional tach
SVT
Diltiazem Contraindications
Wide QRS tachs of unknown origin
Poison/drug induced tach
WPW > A fib or flutter
VT
Sick sinus syndrome
2nd or 3rd degree AV block (except w/ a functioning pacemaker)
Hypotension
cardiogenic shock & acute MI
Pulmonary Congestion
Diltiazem Special Consideration
Reduce the dose by 50% in older adults (>65)
Caution w/ pt’s using other meds that affect cardiac contractility &/or sinoatrial or AV node conduction
Can cause hypotension
Diltiazem Supplied
Add-Vantage vial contains Lyophilized powder containing 100mg of Diltiazem Hydrochloride & 75mg of Mannitol
Separate 100mL NS bag used to for infusion
Diltiazem Dosage
> 14yrs = Draw 20mg, give 10mg SIVP over 2 minutes
*Give the rest slowly as BP permits
> 65yrs = Draw 10mg, give 5mg SIVP over 2 minutes
*Give the rest slowly as BP permits
May repeat Dose 1x if needed
