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ACP Pharmacology > Fundamentals - Adult > Flashcards

Fundamentals - Adult Flashcards

Understand indications, contraindications, dosages, and timings for all ACP drugs

1
Q

Describe dosages and timings for all uses of midazolam

A
  • 2-5 mg IV/IO in increments to effect
  • 5-10 mg IM
  • May repeat as required in small increments
  • No specific timing is listed, but peak effect is 10-15 minutes, so wait at least 10 minutes between doses
  • Maximum dose from all sources is 30 mg
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2
Q

List indication(s) for diphenhydramine administration (1)

A

Adjunct treatment of hypersensitivity reaction

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3
Q

List contraindications for administration of midazolam (5)

A
  • Hypersensitivity to MIDAZOLam or other benzodiazepines
  • Acute narrow-angle glaucoma
  • Shock
  • Decreased level of consciousness
  • Hypotension
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4
Q

List contraindication(s) for administration of phenylephrine (4)

A
  • Known hypersensitivity or allergy to phenyLEPHRine
  • Hypersensitivity to sulfites (contained in the product preparation)
  • Severe hypertension or ventricular tachycardia
  • Pheochromocytoma
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5
Q

List all dosages and timings for epinephrine administration (7)

A
  • Anaphylaxis: 0.5 mg IM every 5 minutes; may repeat up to 3 times
  • Severe bronchospasm with impending respiratory arrest: 0.5 mg IM every 5-20 minutes
  • Pre-arrest anaphylaxis or bronchospasm: 50-100 mcg IV/IO; may repeat as necessary
  • Croup: 5mg via nebulizer mask
  • Cardiac arrest: 1 mg IV/IO every 3-5 minutes; suggested maximum dose 3-4 mg
  • Peri-arrest hypotension: 10 mcg IV/IO slow push every 2-3 minutes as required
  • Significant bradycardia: 2-10 mcg/minute IV/IO infusion
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6
Q

List contraindications for ketamine administration (4)

A
  • Hypersensitivity to ketAMINE
  • Unable to manage the adverse effects of ketAMINE (ex: hypersalivation, larygospasm, transient apnea)
  • Conditions where elevated blood pressure may be harmful (ex: Intracranial bleeding, MI or acute heart failure)
  • Age < 6 months
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7
Q

What is the typical duration of action of IV fentanyl?

A

30-60 minutes

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8
Q

List all indications for epinephrine administration (6)

A
  • Anaphylaxis
  • Severe bronchospasm
  • Severe croup
  • Cardiac arrest
  • Peri-arrest hypotension
  • Significant bradycardia
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9
Q

describe a pharmaceutical dosing and timing strategy for hemodynamically unstable bradycardia

A
  • Atropine: 0.6mg IV q.4m to a maximum of 3.0mg
  • Epinephrine: 10mcg q.2-3m if peri-arrest hypotension is present
  • Epinephrine: 2-10mcg/m infusion
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10
Q

List contraindications for administration of magnesium sulfate (2)

A
  • Hypersensitivity to magnesium sulfate
  • Second or third-degree AV block
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11
Q

List contraindication(s) to gravol administration (1)

A

Known sensitivity to dimenhydrinate, diphenhydramine, or caffeine derivatives

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12
Q

List contraindications for amiodarone administration (4)

A
  • Hypersensitivity
  • Cardiogenic shock
  • Marked symptomatic sinus bradycardia
  • Second or third-degree atrioventricular node block
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13
Q

List indication(s) for administration of entonox (1)

A

Relief from moderate to severe pain

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14
Q

Describe dosages and timings for all uses of salbutamol

A

Bronchospasm
* 5 mg nebulized; repeat doses back to back as necessary
* 4 x 100 mcg via metered dose inhaler; repeat as required

Adjunctive management of hyperkalemia
* 10-20 mg via nebulizer; may require multiple doses back-to-back to reach total dose
* 4 x 100 mcg via metered dose inhaler; repeat as required

onset is 5-15 minutes, be cautious not to provide too many repeat doses initially, allow a chance for the medication to take effect

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15
Q

For which medications is pheochromocytoma a contraindication?

A
  • Glucagon
  • Phenylephrine
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16
Q

List medications for which a RAPID IV push is particularly important (i.e. a slow push would lead to adverse outcomes)

A
  • Adenosine
  • Atropine
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17
Q

List indication(s) for administration of nitroglycerin (2)

A
  • Relief from chest pain suggestive of acute coronary syndrome
  • Reduction of preload in acute cardiogenic pulmonary edema
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18
Q

List indications for administration of midazolam (3)

A
  • Sedation of agitated patients
  • Control of seizures
  • Maintenance of anesthesia in intubated patients
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19
Q

List contraindication(s) for administration of acetaminophen (4)

A
  • Hypersensitivity to acetaminophen or any component of the formulation
  • Severe alcoholic hepatitis or liver dysfunction with active alcohol consumption
  • Acute liver injury
  • Acetaminophen-induced liver disease
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20
Q

List contraindication(s) for administration of morphine (1)

A

Known hypersensitivity to mORPHine or other opioid analgesics

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21
Q

Describe preparation of an epinephrine infusion for management of shock

A
  • add 1mg epinephrine to a 250mL bag
  • use a 60gtt/mL drip set
  • 1gtt/s = 4mcg/min. Adjust accordingly
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22
Q

List contraindication(s) for administration of nitroglycerin (7 + 1)

A
  • Known allergy or hypersensitivity to nitroglycerin
  • Use of Viagra (sildenafil) or Levitra (vardenafil) within the previous 24 hours
  • Use of Cialis (tadalafil) within the previous 48 hours
  • Severe anemia
  • Restrictive pericarditis or pericardial tamponade
  • Documented right sided acute myocardial infarction
  • Hypotension or uncorrected hypovolemia
  • Systolic blood pressure < 110 mmHg - for EMRs and PCPs
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23
Q

may gravol be given prophylactically for anticipated nausea from motion sickness or narcotic administration?

A

Yes!

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24
Q

List indication(s) for adenosine administration (1)

A

Conversion and termination of supraventricular tachycardias

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25
Q

List indication(s) for ipratropium administration (1)

A

Severe bronchospasm in asthma and chronic obstructive pulmonary disease

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26
Q

List contraindication(s) for administration of salbutamol (2)

A
  • Known hypersensitivity to salbutamol
  • Hemodynamically significant tachycardia
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27
Q

Summarize schedules for ongoing maintenance of IV analgesia, sedation, and anasthesia

A

Analgesia:
* Fentanyl: may repeat loading dose q5mins. 50mcg q10minutes recommended for long transport
* Ketamine: may repeat 1/2 loading dose q5mins. to a maximum of 2x loading dose total per 45 minutes.
* In general: repeat both at 5 minute intervals to effect, then every 10-15 minutes

Sedation:
* No specific guidance given. Repeat PSA dose as needed?

Anesthesia:
* Ketamine: 1/2 the induction dose every 10-15 minutes
* Midazolam: 2-5mg PRN

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28
Q

List the 6 “rights” of medication administration and how they apply to paramedic practice

A
  1. Right patient: does the patient meet the indications for the medication based on current clinical practice guidelines?
  2. Right medication: is the correct medication being prepared and has the identity of the medication been checked at each step of the preparation process and prior to administration?
  3. Right dose: have dosage calculations been verified and confirmed?
  4. Right time: is this the correct time to administer the medication based on the treatment plan that has been developed?
  5. Right route: is the proposed route of administration correct for both the medication and the clinical indication?
  6. Right documentation: has the administration of the medication been entered into the ePCR?
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29
Q

Describe dosing of glucagon, magnesium sulfate, and atropine in non-standard applications (i.e. CCB OD, eclampsia, organophosphate poisoning)

A
  • Glucagon: 5mg IV SLOW push for BB/CCB OD
  • Magnesium sulfate: 4-6mg over 20 minutes IV infusion. 4mg repeat if not successful in terminating seizure. 1-2mg/hr maintenance. 5mg IM if IV nto available
  • Atropine: 1-2mg IV bolus, repeat every 5-60 minutes
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30
Q

Briefly summarize dosages and timings for all drugs used in cardiac arrest management

A
  • Epinephrine: 1mg IV/IO q3-5min. Max total of 3-4mg
  • Amiodarone: 300mg IV/IO followed by 150mg IV/IO at 10min
  • Lidocaine: 1.0-1.5mg/kg IV/IO, followed by 0.5-1.0mg/kg (timing not specified)
  • Magnesium sulfate: 4 g IV push (no repeats)
  • Calcium chloride: 1-2g IV over 3 minutes. May repeat at 10 minutes
  • Sodium Bicarbonate: 1mEq/kg IV/IO slow push. May repeat 0.5 mEq/kg IV/IO slow push every 10-15 minutes as required
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31
Q

List indications for lidocaine administration (3)

A
  • Control of ventricular arrhythmias (including ectopy, brief or sustained ventricular tachycardia, and ventricular fibrillation)
  • Local anesthesia during intraosseous cannulation
  • Local anesthesia during awake intubation
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32
Q

Summarize preparation and dosing of all common ACP bolus infusions

A
  • Amiodarone: 150mg over 10 minutes (1gtt/s)
  • Magnesium sulfate (bronchospasm): 2g over 20 minutes (1gtt/2s)
  • Magnesium sulfate (TdP): 2g over 15 minutes (2gtt/3s)
  • Magnesium sulfate (eclampsia): 4-6g over 20 minutes (1gtt/2s)
  • TXA: 1g over 10 minutes (1gtt/s)
  • In all cases: add medication to a 50mL bag with 10gtt/mL extension set. 1gtt/s = 10minute infusion time.
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33
Q

List indications for dimenhydrinate administration (3)

A
  • Prevention or control of nausea caused by motion sickness
  • Relief of moderate to severe nausea and vomiting
  • Prevention or control of nausea caused by narcotic administration
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34
Q

Describe dosages and timings for all uses of nitroglycerin

A

Relief from chest pain suggestive of acute coronary syndrome:
* 0.4 mg SL every 3-5 minutes; systolic blood pressure must be ≥ 110 mmHg and heart rate must be between 50 and 150 beats/minute

Reduction of preload in acute cardiogenic pulmonary edema:
* 0.4 mg SL every 3-5 minutes

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35
Q

List indications for ibuprofen administration (2)

A
  • mild to moderate pain
  • pyrexia
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36
Q

Describe dosage and timing for IM/IV/IO or IN Fentanyl for management of moderate to severe pain

A
  • Loading dose: 0.5-1.0 mcg/kg IM/IV/IO; maximum single dose 100 mcg; may repeat every 5 minutes to a total dose of 300 mcg
  • Loading dose: 1.5-2.0 mcg/kg IN; maximum single dose 100 mcg; may repeat every 5 minutes to a total dose of 300 mcg
  • Consider reducing doses by half in patients > 65 years of age
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37
Q

Describe dosages and timing for ipratropium administration

A

160 mcg via metered-dose inhaler (8 x 20 mcg sprays)
Spacer use recommended, but not required

Duration is 6 hours, so may be repeated if patient has not used their prescirbed ipratropium in >6hrs

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38
Q

List indication(s) for administration of morphine (1)

A

Symptom relief in palliative or end-of-life patients with pain or shortness of breath

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39
Q

What kind of administration set should be used for ALL bolus IV medication infusions?

A
  • 10gtt/mL SECONDARY administration set
  • Using a primary admin set will reliably lead to underdosing of patients due to the large priming volume
  • All bolus infusions should use a secondary set “piggy-backed” off of a primary line
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40
Q

Describe dosages and timings for all uses of magnesium sulfate

A

Control of ventricular arrhythmias (including Torsades de Pointes):
* For perfusing rhythms: 2 g IV over 15 minutes
* In cardiac arrest: 4 g IV push

Bronchospasm refractory to bronchodilation
* 2 g IV over 20 minutes

Management of seizures in pregnancy associated with hypertension
* Cardiac monitoring is required with magnesium administration
* 4-6 g intravenously over 20 minutes as a loading dose followed by 1-2 g per hour; otherwise, 5 g can be given intramuscularly (use bilateral buttocks) followed by 5 g IM every four hours
* If seizures persist following the loading dose of magnesium, up to 4 g IV can be given over five minutes

41
Q

List contraindication(s) for administration of entonox (7)

A
  • Traumatic or spontaneous pneumothorax
  • Air embolism or decompression sickness following a recent SCUBA dive
  • Bullous emphysema
  • Gross abdominal distension
  • Altered mental status or an inability to comply with instructions
  • Inhalation injury (i.e., smoke or chemicals)
  • Nitroglycerin use within five minutes prior to administration of nitrous oxide

TABGAIN

42
Q

Describe dosages and timings for all uses of morphine

A
  • 0.1 mg/kg SC OR
  • 2.5-5 mg SC
  • May repeat every 10-30 minutes as required based on blood pressure (> 100 mmHg) or as per CliniCall/palliative care team plan
  • May be given as a breakthrough dose at 10% of previous TDD
43
Q

List contraindication(s) for administration of sodium bicarbonate (2)

A
  • Suspected metabolic alkalosis
  • History of excessive vomiting (i.e., evidence of chloride loss)
44
Q

Describe dosages and timings for all uses of phenylephrine

A
  • 100 mcg IV slow push every 2-5 minutes to maximum of 500 mcg
  • Administer dose over 20-30 seconds
45
Q

List medications for which a SLOW IV push is particularly important (i.e. a rapid administration would lead to adverse outcomes). Include suggested timing of the push.

A
  • Calcium Chloride: 3 minutes
  • Phenylephrine: 20-30s
  • Dimenhydrinate: 1-2 minutes
  • Epinephrine (push dose): no timing listed, but SLOW push specified
  • Glucagon for BB or CCB OD: no timing listed, but SLOW push specified
  • Ketamine: no timing listed, but SLOW push specified
  • Sodium Bicarbonate: no timing listed, but SLOW push specified
  • TXA: may be given as a 10 minute SLOW push in unusual situations
46
Q

Describe analgesic dosage and timing of ketamine by all routes

A

Intranasal:
* 0.75 mg/kg (see intranasal ketamine dosing chart)
* May repeat 0.5 mg/kg after 20 minutes
* Maximum single dose 100 mg

Intravenous/Intraosseous:
* 0.3 mg/kg slow push
* May repeat 0.15 mg/kg after 5 minutes
* Maximum cumulative dose 0.6 mg/kg in 45 minutes

Intramuscular:
* 0.5 mg/kg
* May repeat 0.3 mg/kg after 45 minutes

47
Q

Describe dosage and timing of amiodarone administration in cardiac arrest

A

300mg IV push, followed by 150mg IV push after 10 minutes if VF/pVT persists

48
Q

List contraindication(s) for administration of TXA (4)

A
  • Hypersensitivity to tranexamic acid
  • Gastrointestinal hemorrhage
  • Time since injury to administration > 3 hours
  • Age < 12 years (PCP) or < 1 year (ACP)
49
Q

List contraindications for atropine administration (6)

A
  • Hypersensitive to atropine or other anticholinergics
  • Tachycardia
  • Narrow-angle glaucoma
  • Thyrotoxicosis
  • Prostatic hypertrophy
  • Myasthenia gravis
50
Q

List contraindications for lidocaine administration (4)

A
  • Allergy or hypersensitivity to lidocaine
  • For systemic (IV/IO) administration, including rhythm control and IO anesthesia:
  • Third-degree AV block
  • Ventricular escape rhythms
  • Wolff-Parkinson-White syndrome
51
Q

List contraindication(s) to diphenhydramine administration (3)

A
  • Hypersensitivity to antihistamines
  • Neonates
  • Premature infants
52
Q

Describe dosage and timing of ketamine for procedural sedation

A
  • 0.1-0.5 mg/kg slow push every 60 seconds to effect
  • Consider starting at 0.5 mg/kg; use subsequent doses of 0.25 mg/kg or less as needed
  • Titrate to effect
53
Q

List indication(s) for administration of sodium bicarbonate (4)

A
  • Known or suspected hyperkalemia
  • Tricyclic or salicylate overdose
  • Suspected or confirmed metabolic acidosis
  • Pre-treatment prior to weight release in crush injury
54
Q

Describe dosing and timing of CaCl2 administration for ALL indications

A
  • 1 g IV over 3 minutes
  • May repeat once in 10 minutes if indications are still present
  • Exception is CCB OD: 1-2g IV over 10 minutes
55
Q

List indication(s) for administration of acetaminophen (2)

A
  • mild to moderate pain
  • pyrexia
56
Q

List all ACP drugs for which myasthenia gravis is a contraindication

A
  • atropine
  • fentanyl
57
Q

List indication(s) for administration of phenylephrine (1)

A

Maintenance of blood pressure in acute hypotensive states or shock following adequate fluid volume replacement in airway management

58
Q

Describe dosing and timing of atropine for treatment of symptomatic bradycardia

A
  • 0.6mg rapid IV pushes, repeated to effect. MAX total dose of 0.04mg/kg (3.0mg average)
  • No specific timing is listed, but peak effect should be seen in 2-4 minutes, so repeat dosing q.4min is reasonable
59
Q

Describe dosage and timing of Glucagon administration for reversal of hypoglycemia AND for Beta- or Calcium-channel blocker OD

A
  • Hypoglycemia: 1 mg IM/SC
  • Suspected beta or calcium channel blocker overdose: 5mg IV slow push
60
Q

List indications for administration of CaCl2 (3)

A
  • Cardiac arrest due to suspected hyperkalemia (e.g., renal failure, diabetic ketoacidosis)
  • Suspected hyperkalemia with cardiovascular toxicity (e.g., wide QRS complexes, peaked T waves, or hemodynamic instability)
  • Calcium channel blocker overdose with symptomatic bradycardia or hemodynamic instability
61
Q

List contraindications for ASA administration (4)

A
  • Hypersensitivity to ASA or drug components
  • Patients who have experienced bronchospasm or other respiratory reaction precipitated by ASA or nonsteroidal anti-inflammatory drugs
  • Active or recent bleeding of any kind, including head injury or peptic ulcer disease
  • Pediatric patients with signs and symptoms consistent with viral illnesses (due to Reye’s Syndrome)
62
Q

Should TXA be given for isolated closed head injury without signs of shock or hypoperfusion?

A

no!

63
Q

List indication(s) for administration of naloxone (1)

A

Reversal of respiratory depression caused by suspected narcotic intoxication

64
Q

Describe dosages and timings for all uses of naloxone

A
  • provide repeat dosing at 3 minute intervals
  • 0.4mg, 0.4mg, 0.8mg, 2.0mg, 4.0mg, 10.0mg
  • IM preferred for initial doses, IV preferred for all doses of 2.0mg or greater
65
Q

List indications for ketamine administration (4)

A
  • Analgesia: Moderate to severe pain
  • Induction of sedation prior to intubation
  • Procedural sedation
  • Severe agitation or excited delirium syndrome
66
Q

You are treating a patient with symptomatic bradycardia. They recently received plasmapheresis for “muscle weakness after an infection”. What special consideration should be made regarding pharcalogic treatment of this patient?

A

This patient is likely being treated for myasthenia gravis; atropine is contraindicated

67
Q

List indication(s) for amiodarone administration (4)

A
  • VF
  • Pulseless VT
  • Unstable VT
  • Recurrent VT following cardioversion
68
Q

Describe atropine dosing for treatment of organophosphate toxicity

A

1-2 mg IM/IV; repeat every 5-60 minutes until symptoms resolve

69
Q

List contraindications for administration of Glucagon (2)

A
  • Hypersensitivity
  • Pheochromocytoma
70
Q

Describe dosage and timing for diphenhydramine administration

A
  • 50 mg IM/IV or 1 mg/kg to maximum of 50 mg
  • No repeats
71
Q

Describe dosages and timings for all uses of acetaminophen

A
  • 500-1,000 mg PO
  • May repeat once after 4 hours
  • 24 hour maximum: 4 g
  • In patients with suspected or known liver dysfunction (e.g., advanced chronic liver disease or cirrhosis), the 24 hour maximum should be lowered to 1-2 g
72
Q

List contraindications for adenosine administration (2)

A
  • Hypersensitivity
  • Second or third-degree AV node block or sick sinus syndrome in patients without an artificial pacemaker
73
Q

List contraindications for CaCl2 administration (2)

A
  • Hypersensitivity to calcium chloride
  • Primary or secondary hypercalcemia
74
Q

List contraindications for ibuprofen administration (3)

A
  • Hypersensitivity to ibuprofen or other nonsteroidal anti-inflammatory drugs
  • Active GI hemorrhage or ulcers
  • Pregnancy (first, second, or third trimesters)
75
Q

List indication(s) for administration of salbutamol (2)

A
  • Bronchospasm
  • Adjunctive management of hyperkalemia
76
Q

List contraindications to epinephrine administration

A

There are no absolute contraindications to EPINEPHrine use in life-threatening situations such as anaphylaxis

77
Q

List indications for administration of Fentanyl (2)

A
  • Moderate to severe pain
  • Adjunct for awake intubation
78
Q

List indication(s) for administration of TXA (1)

A

Signs of shock or hypoperfusion, in association with an injury suggestive of occult or ongoing hemorrhage

79
Q

Describe dosages and timing for ibuprofen administration

A

300-400 mg PO; may repeat every 4-6 hours; maximum daily dose 1.2 g/day

80
Q

Describe dosages and timings for all uses of sodium bicarbonate

A
  • 1 mEq/kg IV/IO slow push
  • May repeat 0.5 mEq/kg IV/IO slow push every 10-15 minutes as required
  • Tricyclic overdoses may require doses as high as 2-3 mEq/kg IV/IO
81
Q

List indications for administration of Glucagon (2)

A
  • Suspected or confirmed hypoglycemia where IV access is unavailable
  • Suspected beta or calcium channel blocker overdose
82
Q

Give an example of the 6 “rights” of medication for the following: you have intubated an 80kg pt. using a loading dose of 160mg of ketamine (shock index is less than 1). You are now planning to administer a maintenance dose. Provide all relevant doses and timings.

A

Right patient: the patient requires ongoing maintenance of anesthesia (indication) and does not have contraindications to ketamine (hypersensitivity, conditions intolerant of hypertension, inability to manage adverse effects, pediatric)

Right medication: ketamine is appropriate for maintenance of anesthesia and may be provided undiluted or diluted. Safety checks are performed with partner to confirm the correct medication is given

Right dose: the correct dose is 1/2 of the loading dose, in this case 80mg. Confirm with partner that the correct dose is given

Right time: maintenance doses of ketamine should be provided at 10-15 minute intervals. Confirm that the dose is not given early or late. Set a timer for subsequent doses.

Right route: anasthesia maintenance should be provided via IV or IO. Confirm that the line remains patent.

Right documentation: at a bare minimum, event the administration on the monitor. Enter full details, including dose and time, into the ePCR ASAP

83
Q

Describe amiodarone administration for unstable or refractory VT following cardioversion

A
  • 150mg IV bolus over 10 minutes
  • Add to 50mL bag and use a secondary 10gtt/s drip set at 1gtt/s
  • alternatively, add to a 250mL bag with extension set and run at 5gtt/s (wide open)
84
Q

List contraindications for administration of Fentanyl (5)

A
  • Known hypersensitivity to opioids (including morphine)
  • Myasthenia gravis
  • Pre-existing respiratory depression
  • Acute asthma
  • Upper airway obstruction
85
Q

Describe an analgesic dosing strategy for an 80kg patient during a long transport using IV ketamine

A
  • loading dose: 24mg (0.3mg/kg)
  • Maintenance doses: 12mg (0.15mg/kg) every 5 minutes to a MAX total dose of 48mg (0.6mg/kg) in 45 minutes
86
Q

Describe dosages and timing for all uses of lidocaine

A
  • Ventricular rhythm control: 1.0-1.5 mg/kg IV bolus. May repeat at 0.5-1.0 mg/kg; total maximum dose 3 mg/kg
  • Local anesthesia during intraosseous cannulation (in conscious patients): Administer lidocaine, 40 mg. Instill the lidocaine slowly, over 120 seconds, making sure to flush the appropriate amount of lidocaine through the extension; allow it to dwell in the bone marrow cavity for 60 seconds
  • Local anesthesia for awake intubation: There is no consensus on a maximum permissible dose; avoid exceeding 5 mg/kg topically where possible
87
Q

Describe dosage and timing for dimenhydrinate administration for nausea

A
  • 25-50 mg IV/IM
  • 12.5 mg IV/IM in elderly or frail patients
  • May repeat dose once after 4-6 hours if required
  • Give IM dose as direct injection; IV dose should be diluted with saline; administer medication at rate of 25 mg/min
88
Q

Describe adult and pediatric dosing of adenosine for conversion of SVT

A
  • Adult: 6mg followed by 12mg
  • Pediatric: 0.1mg/kg followed by 0.2mg/kg to a MAX of 6mg/12mg
89
Q

Summarize intramuscular dosages and timings for analgesia using fentanyl and ketamine

A
  • Fentanyl: 0.5-1.0mcg/kg q.5min. Max single dose = 100mcg, Max total dose = 300mcg (1hr)
  • Ketamine: 0.5mg/kg. May repeat at 0.3mg/kg after 45 minutes
90
Q

Summarize intranasal dosages and timings for analgesia using fentanyl and ketamine

A
  • Fentanyl: 1.5-2.0mcg/kg q5min. Max single dose of 100mcg, Max total dose of 300mcg
  • Ketamine: 0.75mg/kg. Repeat at 0.5mg/kg after 20 minutes. Max single dose of 100mg
91
Q

List contraindication(s) for ipratropium administration (1)

A

Known hypersensitivity to ipratropium or any formulation components

92
Q

List indications for atropine administration (5)

A
  • Restoration of heart rate in bradydysrhythmias
  • Sinus bradycardia (rate < 50/minute) with hemodynamic compromise
  • Bradycardia secondary to atrioventricular nodal blocks
  • Treatment of organophosphate poisoning
  • Control of secretions in palliative care (requires additional endorsement)
93
Q

Describe dosage and timing of ketamine for management of extreme agitation or excited delirium syndrome. Include maximum volumes of administration by site for IM injections.

A
  • 4-5 mg/kg bolus
  • Maximum single/cumulative dose 500 mg
  • Maximum volume of administration:
  • Deltoid: 2 mL
  • Lateral thigh: 4-5 mL
  • Gluteal: 5 mL
  • No guidance given on repeat dosing
94
Q

Describe dosage and timing of ketamine for induction and maintenance of anesthesia

A
  • 2 mg/kg if shock index < 1
  • 1 mg/kg if shock index ≥ 1
  • Half of required induction dose every 10-15 minutes as required
95
Q

List contraindication(s) for administration of naloxone (2)

A
  • Allergy or known hypersensitivity to naloxone
  • Neonates
96
Q

Describe atropine dosing for secretion control in palliative care

A

0.6mg (IM), no repeat dosing is indicated

97
Q

List indications for administration of magnesium sulfate (5)

A
  • Treatment of ventricular fibrillation and ventricular tachycardia refractory to first-line antiarrhythmics
  • Recurrent, intermittent episodes of wide-complex tachycardia
  • Treatment of Torsades de Pointes
  • Bronchospasm refractory to bronchodilation in acute asthma
  • Management of seizures in pregnancy associated with hypertension
98
Q

Describe dosages and timings for all uses of TXA

A
  • 1 g IV over 10 minutes (via infusion)
  • Add 1g to 50mL bag. Attach 10gtt/mL secondary admin set. Administer at 1gtt/s

ACP Pharmacology (7 decks)

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