Group 2 Flashcards
Amyl Nitrite
Class
Antidote, cyanide poisoning adjunct, nitrate.
Amyl Nitrite
Mechanism of Action
Converts hemoglobin to methemoglobin, which reacts with cyanide and chemically binds with it, preventing any toxic effects.
Amyl Nitrite
Indications
Cyanide poisoning
Amyl Nitrite
Contraindications
none in emergency setting
Amyl Nitrite
Adverse reactions/side effects
- Headache, dizziness, weakness, increased ICP, shortness of breath, orthostatic hypotension, tachycardia, syncope.
- Cyanosis of the lips, fingernails, or palms (signs of methemoglobinemia)
Amyl Nitrite
Drug Interactions
Increased hypotensive effects with antihypertensives, alcohol ingestion, phenothiazines, or beta-blockers
Amyl Nitrite
Dosage and administration
- Adult: 1 to 2 ampules crushed and inhaled for 30 seconds of each minute until sodium nitrite is prepared or administer for 30 to 60 seconds every 5 minutes until patient is conscious.
- Pediatric: 1 ampule crushed and inhaled for 30 seconds of each minute until sodium nitrite is prepared or for 30 to 60 seconds of each minute until sodium nitrite is prepared or administer for 30 to 60 seconds every 5 minutes until patient is conscious.
Amyl Nitrite
Duration of Action
- Oset: 30 seconds to 5 minutes
- Peak effect: Varies
- Duration 5 to 10 minutes
Amyl nitrite
Special Considerations
-Pregnancy safety: Category X
-May cause fetal harm by reducing maternal BP and
decreasing placental blood supply.
-Highly Flammable: Avoid exposure heat or flame.
-Patient should remain seated or supine during and after administration due to hypotension.
-This is the first step in a three-step treatment for cyanide poisoning followed by sodium nitrite and then sodium thiosulfate.
Aspirin (acetylsalicylic Acid [ASA])
Class
Platelet inhibitor, anti-inflammatory agent
Aspirin (acetylsalicylic Acid [ASA])
Mechanism of Action
-Prevents the formation of thromboxane A2, which causes platelets to clump together (aggregate) and form plugs that cause obstruction or constriction; has antipyretic and analgesic properties
Aspirin (acetylsalicylic Acid [ASA])
indications
-New onset chest discomfort suggestive of ACS
Aspirin (acetylsalicylic Acid [ASA])
Contraindications
Hypersensitivity
-Relatively contraindicated in patients with active ulcer disease or asthma.
Aspirin (acetylsalicylic Acid [ASA])
Adverse reactions/side effects
Bronchospasm, anaphylaxis, wheezing in allergic patients, prolonged bleeding, GI bleeding, epigastric distress, nausea, vomiting, heartburn, Reye syndrome.
Aspirin (acetylsalicylic Acid [ASA])
Drug interactions
Use with caution on patients allergic to NSAIDs
Aspirin (acetylsalicylic Acid [ASA])
Dosage and administration
- Adult: 160 mg to 325 mg PO. Chewed
- Pediatric: Not recommended
Aspirin (acetylsalicylic Acid [ASA])
Duration of action
- Onset: 5 to 30 minutes
- Peak effect: 1 to 3 hours
- Duration 3 to 6 hours
Aspirin (acetylsalicylic Acid [ASA])
Special Considerations
Pregnancy safety: Category D
- Use cautiously during pregnancy, weighing risks and benefits. If there are no contraindications, non-enteric- coated, chewable aspirin should be given as soon as possible to all patients with a suspected ACS as soon as possible after symptom onset.
Vasopressin (Pitressin)
Class
Vasopressor
Vasopressin (Pitressin)
Mechanism of Action
Stimulation of smooth muscle receptors; potent vasoconstrictor when given in high doses.
Vasopressin (Pitressin)
indications
Vasodilatory shock
Vasopressin (Pitressin)
Contraindications
Use with caution in patients with:
- CAD
- Epilepsy
- Heart failure
Vasopressin (Pitressin)
Adverse reactions/side effects
Dizziness, headache, bronchial constriction, MI, Chest pain, angina, cardiac dysrhythmia, decreased cardiac output, abdominal cramps, diarrhea, nausea, vomiting , paleness, sweating.
Vasopressin (Pitressin)
Drug Interactions
None Reported
Vasopressin (Pitressin)
Dosage and administration
- Adult: 0.02 to 0.07 unit/min IV infusion
- Pediatric: Safety and efficacy not established
Vasopressin (Pitressin)
Duration of action
- Onset: Unknown
- Peak effect: Unknown
- Duration: 30 to 60 minutes
Vasopressin (Pitressin)
Special Considerations
- Pregnancy Safety: Category C
- Use caution during pregnancy. Breastfeeding women should pump and discard breast milk for 1.5 hours after drug administration.
- May increase peripheral Vascular resistance and provoke cardiac ischemia and angina.
Nalbuphine Hydrochloride (Nubain)
Class
Synthetic opioid Agonist/antagonist
Nalbuphine Hydrochloride (Nubain)
Mechanism of action
- Activates opiate receptor in limbic system of the CNS.
- Analgesic, similar to morphine on a milligram-for-milligram basis
- Both agonist and antagonist properties
- Preferred for chest pain in setting of acute MI because it reduces the myocardial oxygen demand without reducing the BP.
Nalbuphine Hydrochloride (Nubain)
Indications
Chest pain associated with AMI moderate to severe acute pain.
Nalbuphine Hydrochloride (Nubain)
Contraindications
- Head Injury
- Undiagnosed abdominal pain, diarrhea caused by poison.
- Hypovolemia, hypotension
Nalbuphine Hydrochloride (Nubain)
Adverse reactions/side effects
Headache, dizziness, vertigo, seizure
- CNS depression, paradoxical CNS stimulation, respiratory depression, pulmonary edema.
- Hypotension, hypertension, palpitations, bradycardia, nausea, vomiting, dry mouth.
Nalbuphine Hydrochloride (Nubain)
Drug Interactions
CNS depressants may potentiate effects
Nalbuphine Hydrochloride (Nubain)
Dosage and Administration
- Adult: 2 to 5mg slowly IV. May repeat doses PRN to a maximum dose of 10mg
- Pediatric: NOT RECOMENDED
Nalbuphine Hydrochloride (Nabain)
Duration of action
- Onset: 2 to 3minutes
- Peak Effect: Variable
- Duration: 3 to 6 hours
Nalbuphine Hydrochloride (Nabain)
Special Considerations
- Pregnancy Safety: Category B
- Use with caution in patients with impaired respiratory function,
- May precipitate withdrawal syndromes in narcotic-dependent patients.
- Naloxone should be readily available
Norepinephrine Bitartrate (Levophed)
Class
- Sympathomimetic
- Vasopressor
Norepinephrine Bitartrate (Levophed)
Mechanism Of Action
- Potent alpha-agonist resulting in intense peripheral vasoconstriction
- Positive chronotropic and increased cardiac effect (from 10% beta effect) with increased cardiac output.
- Alpha-adrenergic activity resulting in peripheral vasoconstriction and beta-adrenergic activity leading to inotropic stimulation of the heart and coronary artery vasodilation.
Norepinephrine Bitartrate (Levophed)
Indications
- Cardiogenic shock
- Unresponsive to fluid resuscitation, significant hypotensive (<70mm Hg) states
- First-line vasopressor in septic shock.
Norepinephrine Bitartrate (Levophed)
Contraindications
- Hypotensive patients with hypovolemia.
- Pregnancy (relative).
Norepinephrine Bitartrate (Levophed)
Adverse Reactions/side effects
- Headache, anxiety, dizziness, restlessness
- Dyspnea, bradycardia, hypertension, dysrhythmias, chest pain, peripheral cyanosis, cardiac arrest.
- Nausea, vomiting,
- Urinary retention, renal failure,
- Decreased blood flow to the GI tract, kidneys, skeletal muscle, and skin, tissue necrosis from extravasation.
Norepinephrine Bitartrate (Levophed)
Drug interactions
- Can be deactivated by alkaline solutions.
- Sympathomimetic and phosphodiesterase inhibitors may exacerbate dysrhythmias.
- Bretylium may potentiate the effects of catecholamines
Norepinephrine Bitartrate (Levophed)
Dosage and administration
- Adult: 0.1 to 0.5 mcg/kg per minute ( in 70-kg adult, 7 to 35 mcg/min)
- Pediatric: Begin at 0.1 to 2mcg/kg per minute IV infusion, adjust the rate to achieve desired change in BP and systemic perfusion. Titrated to patient response
Norepinephrine Bitartrate (Levophed)
Duration of action
-Onset: 1 to 3 minutes
Peak effect: Variable
-Duration: 5 to 10 minutes, lasts only 1 minute after infusion discontinued.
Norepinephrine Bitartrate (Levophed)
Special considerations
- Pregnancy Safety: Category C.
- Use cautiously during pregnancy and while breastfeeding. May cause fetal anoxia when used in pregnancy.
- Infuse norepinephrine through a large, stable vein to avoid extravasation and tissue necrosis. Often used with low-dose DOPamine to spare decreased renal and mesenteric blood flow.
- Drug or poison-induced hypotension may require higher doses to achieve adequate perfusion.
Nitroglycerin (Nitrostat, Nitro-Bid, Tridil)
Class
-Vasodilator
Nitroglycerin (Nitrostat, Nitro-Bid, Tridil)
Mechanism Of Action
- Smooth muscle relaxant acting on vasculature, bronchial, uterine, intestinal smooth muscle.
- Dilation of arterioles and veins in the periphery.
- Reduces preload and afterload, decreasing workload of the heart and thereby myocardial oxygen demand.
Nitroglycerin (Nitrostat, Nitro-Bid, Tridil)
Indications
Acute angina pectoris, ischemic chest pain, hypertension, heart failure, pulmonary edema.
Nitroglycerin (Nitrostat, Nitro-Bid, Tridil)
Contraindications
Contraindications Hypotension, hypovolemia, intracranial bleeding or head injury, pericardial tamponade, severe bradycardia or tachycardia, RV infarction, previous administration in the last 24 hours: sildenafil (Viagra) or 48 hours: vardenafil (Levitra) or tadalafil (Cialis).
Nitroglycerin (Nitrostat, Nitro-Bid, Tridil)
Adverse reactions/side effects
- Headache, dizziness, weakness,
- Reflex tachycardia, syncope, hypotension, nausea, vomiting,
Nitroglycerin (Nitrostat, Nitro-Bid, Tridil)
Drug Interactions
Additive effects with other vasodilators. Incompatible with other drugs IV.
Nitroglycerin (Nitrostat, Nitro-Bid, Tridil)
Special considerations
-Pregnancy safety: Category C.
- Has been used safely during pregnancy. Use caution with breastfeeding women and monitor infants for adverse effects.
- Hypotension more common in older patients. If 12-lead ECG shows inferior wall infarct, rule out RV infarction via right-sided 12-lead ECG prior to administering NTG.
- NTG decomposes when exposed to light or heat, must be kept in airtight containers.
- Must be administered only with an infusion pump direct from bottle with a vented IV set and non-PVC tubing. Active ingredient may have stinging effect when administered.
Naloxone Hydrochloride (Narcan)
Class
Opioid antagonist, antidote.
Naloxone Hydrochloride (Narcan)
Mechanism of Action
Competitive inhibition at narcotic receptor sites. Reverses respiratory depression secondary to opiate drugs. Completely inhibits the effect of morphine.
Naloxone Hydrochloride (Narcan)
Indications
- Opiate overdose, complete or partial reversal of CNS and respiratory depression induced by opioids, decreased level of consciousness
- Coma of unknown origin.
- Narcotic agonist for the following: morphine sulfate, heroin, HYDROmorphone (Dilaudid), methadone, meperidine (Demerol), paregoric, fentaNYL (Sublimaze), oxycodone (Percodan), codeine, propoxyphene (Darvon).
- Narcotic agonist and antagonist for the following: butorphanol (Stadol), pentazocine (Talwin), nalbuphine (Nubain).
Naloxone Hydrochloride (Narcan)
Contraindications
Use with caution in narcotic-dependent patients. Use with caution in neonates of narcotic-addicted mothers.
Naloxone Hydrochloride (Narcan)
Adverse Reactions/side effects
Restlessness, seizures, dyspnea, pulmonary edema, tachycardia, hypertension, dysrhythmias, cardiac arrest, nausea, vomiting, withdrawal symptoms in opioid-addicted patients, diaphoresis.
Naloxone Hydrochloride (Narcan)
Drug interaactions
Incompatible with bisulfite and alkaline solutions.
Naloxone Hydrochloride (Narcan)
Dosage and Administration
-Adult: 0.4 to 2 mg IM/IV/IO/subcutaneous/ET/IN (diluted); minimum single dose recommended: 2 mg. Repeat at 5-minute intervals to a maximum total dose of 10 mg (medical control may request higher amounts). For IN route, administer half the dose in each nostril; maximum dose is 1 mL per nostril.
Naloxone Hydrochloride (Narcan)
Duration of Action
- Onset: Less than 2 minutes.
- Peak effect: Variable.
- Duration: 30 to 60 minutes.
Naloxone Hydrochloride (Narcan)
Special Considerations
Pregnancy safety: Category C. Any use during pregnancy. Use in breastfeeding women should be clearly indicated.
- Assist ventilations prior to administration to avoid sympathetic stimulation. Seizures without causal relationship have been reported.
- May not reverse hypotension. Use caution when administering to narcotic addicts (potential violent behavior).
- Half-life of naloxone is often shorter than the half-life of narcotics; repeat dosing may be required.
- In cardiac arrest, naloxone is generally not beneficial.
Morphine Sulfate (Roxanol, MS Contin)
Class
Opioid analgesic; schedule II drug.
Morphine Sulfate (Roxanol, MS Contin)
Mechanism of Action
Alleviates pain through CNS action. Suppresses fear and anxiety centers in the brain. Depresses brainstem respiratory centers. Increases peripheral venous capacitance and decreases venous return. Decreases preload and afterload, which decreases myocardial oxygen demand.
Morphine Sulfate (Roxanol, MS Contin)
Indications
Severe heart failure, acute cardiogenic pulmonary edema.
-Chest pain associated with AMI, analgesia for moderate to severe acute and chronic pain.
Morphine Sulfate (Roxanol, MS Contin)
Contraindication
Head injury, exacerbated COPD, depressed respiratory drive, hypotension.
- Undiagnosed abdominal pain, decreased level of consciousness,
- Suspected hypovolemia.
- Patients who have taken MAOIs within 14 days.
Morphine Sulfate (Roxanol, MS Contin)
Adverse reactions/side effects
- Confusion, sedation, headache,
- CNS depression, respiratory depression, apnea, bronchospasm, dyspnea,
- Hypotension, orthostatic hypotension, syncope, bradycardia, tachycardia, nausea, vomiting, dry mouth.
Morphine Sulfate (Roxanol, MS Contin)
Drug Interactions
Potentiates sedative effects of phenothiazines. CNS depressants may potentiate effects of morphine. MAOIs may cause paradoxical excitation.
Morphine Sulfate (Roxanol, MS Contin)
Dosage and Administration
- Adult: STEMI: Initial dose: 2 to 4 mg slow IV (over 1 to 5 minutes).
- Repeat dose: 2 to 8 mg at 5 to 15 minute intervals. NSTEMI/unstable angina: 1 to 5 mg IV push if symptoms not relieved by nitrates, use with caution.
-Pediatric: 0.1 to 0.2 mg/kg per dose IV, IO, IM, subcutaneous. Maximum dose: 5 mg.
Morphine Sulfate (Roxanol, MS Contin)
Duration of Action
- Onset: Immediate.
- Peak effect: 20 minutes.
- Duration: 2 to 7 hours.
Morphine Sulfate (Roxanol, MS Contin)
Special Considerations
Pregnancy safety: Category C. Use caution weighing risks and benefits during pregnancy. Use cautiously in breastfeeding women. Morphine rapidly crosses the placenta. Safety in neonates has not been established.
- Use with caution in older patients, those with asthma, and in those susceptible to CNS depression.
- Vagotonic effect in patients with acute inferior MI (bradycardia, heart block). Naloxone hydrochloride (Narcan) should be readily available as an antidote.
Atropine Sulfate
Class
Anticholinergic agent.
Atropine Sulfate
Mechanism of Action
Inhibits the action of acetylcholine at postganglionic parasympathetic neuroeffector sites. Increases heart rate in symptomatic bradydysrhythmias. Indications Hemodynamically unstable
Atropine Sulfate
Indications
Hemodynamically unstable bradycardia, organophosphate poisoning, nerve agent exposure, RSI in pediatrics, beta-blocker or calcium channel blocker overdose.
Atropine Sulfate
Contraindications
Tachycardia, hypersensitivity, unstable cardiovascular status in acute hemorrhage with myocardial ischemia, narrowangle glaucoma, hypothermic bradycardia.
Atropine Sulfate
Adverse Reactions/side effects
Drowsiness, confusion, headache, tachycardia, palpitations, dysrhythmias, nausea, vomiting, pupil dilation, dry mouth/nose/skin, blurred vision, urinary retention, constipation, flushed, hot, dry skin; paradoxical bradycardia when pushed too slowly or when given at low doses.
Atropine Sulfate
Drug Interactions
Potential adverse effects when administered with digitalis, cholinergics, physostigmine. Effects enhanced by antihistamines, procainamide, quinidine, antipsychotics, benzodiazepines, and antidepressants.
Atropine Sulfate
Dosage and Administration
- Adult: Unstable bradycardia: 0.5 mg IV/IO every 3 to 5 minutes as needed; maximum total dose 3 mg total. Use shorter dosing interval (3 minutes) and higher doses in severe clinical conditions. Organophosphate poisoning: Extremely large doses (2 to 4 mg or higher) may be needed.
- Pediatric: Unstable bradycardia: 0.02 mg/kg IV/IO (minimum dose: 0.1 mg). May repeat once. Maximum single dose: Child: 0.5 mg. Adolescent: 1 mg. Maximum total dose: Child: 1 mg. Adolescent: 3 mg. ET dose: 0.04 to 0.06 mg/kg.
Atropine Sulfate
Duration of action
- Onset: Immediate.
- Peak effect: 2 to 4 minutes.
- Duration: 4 to 6 hours.
Atropine Sulfate
Special Considerations
- Pregnancy safety: Category C.
- Moderate doses may cause pupillary dilation. Paradoxical bradycardia can occur with doses lower than 0.1 mg. May be ineffective in patients who have had a heart transplant or in infranodal AV blocks.
DOPamine Hydrochloride (Intropin)
Class
Adrenergic, vasopressor, inotropic agent.
DOPamine Hydrochloride (Intropin)
Mechanism of Action
- Immediate metabolic precursor to norepinephrine.
- Produces positive inotropic and chronotropic effects. Constricts systemic vasculature, increasing BP and preload. Increases myocardial contractility and stroke volume.
DOPamine Hydrochloride (Intropin)
Indications
Cardiogenic and septic shock, hypotension with low cardiac output states, distributive shock, second-line drug for symptomatic bradycardia.
DOPamine hydrochloride (Intropin)
Contraindications
Hypersensitivity, hypovolemic shock, pheochromocytoma, uncorrected tachydysrhythmias, VF.
DOPamine hydrochloride (Intropin)
Adverse reactions/side effects
Extravasation may cause tissue necrosis. Headache, anxiety, dyspnea, dysrhythmias, hypotension, hypertension, palpitations, chest pain, increased myocardial oxygen demand, nausea, vomiting.
DOPamine hydrochloride (Intropin)
Drug Interactions
Incompatible with alkaline solutions (sodium bicarbonate). MAOIs will enhance the effect of DOPamine. When administered with phenytoin, may cause hypotension, bradycardia, and seizures.
DOPamine hydrochloride (Intropin)
Dosage and administration
- Adult: IV/IO infusion at 5 to 20 mcg/kg per minute, slowly titrated to patient response.
- Pediatric: IV/IO infusion at 5 to 20 mcg/kg per minute, slowly titrated to patient response.
DOPamine hydrochloride (Intropin)
Duration of action
- Onset: 1 to 4 minutes.
- Peak effect: 5 to 10 minutes.
- Duration: Effects cease almost immediately after infusion is discontinued.
DOPamine hydrochloride (Intropin)
Special Considrations
Pregnancy safety: Category C.
-Use caution with pregnant and breastfeeding women.
- Effects are dosedependent.
- Beta-adrenergic response: 5 to 10 mcg/kg per minute: positive chronotropic and inotropic effects.
-Alpha-adrenergic response: 10 to 20 mcg/kg per minute: vasoconstriction and increase in BP. Greater than 20 mcg/kg per minute: alpha effects predominate and may compromise circulation in the limbs. Should be administered by infusion pump.
EPINEPHrine (Adrenalin)
Class
Sympathomimetic
EPINEPHrine (Adrenalin)
Mechanism of action
Direct-acting alpha and beta agonist.
- Alpha: vasoconstriction.
- Beta-1: positive inotropic, chronotropic, and dromotropic effects.
- Beta-2: bronchial smooth muscle relaxation and dilation of skeletal vasculature. Blocks histamine receptors.
EPINEPHrine (Adrenalin)
Indications
Cardiac arrest (asystole, PEA, VF, and pulseless VT), symptomatic bradycardia as an alternative infusion to DOPamine, hypotension from shock other than hypovolemia, allergic reaction, anaphylaxis, asthma.
EPINEPHrine (Adrenalin)
Contraindications
None in the emergency setting.
-Relative contraindications include hypertension, hypothermia, pulmonary edema, myocardial ischemia, hypovolemic shock.
EPINEPHrine (Adrenalin)
Adverse Reactions/Side effects
Nervousness, restlessness, headache, tremor, pulmonary edema, dysrhythmias, chest pain, hypertension, tachycardia, nausea, vomiting.
EPINEPHrine (Adrenalin)
Drug Interactions
Potentiates other sympathomimetics.
-Deactivated by alkaline solutions. MAOIs may potentiate effect. Beta-blockers may blunt effects.
EPINEPHrine (Adrenalin)
Dosage and administration
Adult:
- Allergic reactions and asthma: 0.3 to 0.5 mg (0.3 to 0.5 mL of 1 mg/mL [1:1,000]) IM.
- Cardiac arrest: IV/IO: 1 mg (10 mL of 0.1 mg/mL [1:10,000 solution]) 3 to 5 minutes during resuscitation. Follow each dose with a 20-mL flush and elevate arm for 10 to 20 seconds after dose. ET: 2 to 2.5 mg diluted in 10 mL normal saline.
- Continuous infusion: Add 1 mg to 250 mL normal saline or 5% dextrose in water (D5W; 4 mcg/mL).
- Profound bradycardia or hypotension: 2 to 10 mcg/min titrated to patient response. Higher dose: up to 0.2 mg/kg may be used for specific indications, such as beta-blocker or calcium channel blocker overdose.
-Pediatric: Anaphylaxis/severe status asthmaticus: 0.01 mg/kg (0.01 mL/kg) IM of a 1 mg/mL (1:1,000) solution (maximum single dose: 0.3 mg).
- Cardiac arrest: IV/IO dose: 0.01 mg/kg (0.1 mL/kg) of a 0.1-mg/mL (1:10,000) solution every 3 to 5 minutes during arrest.
- ET: 0.1 mg/kg (0.1 mL/kg) of a 1-mg/mL (1:1,000) solution mixed in 3 to 5 mL of saline until IV/IO access is achieved. Maximum single dose 1 mg IV/IO 2.5 mg ET.
- Stridor at rest: 0.25 to 0.5 mg/kg of a 1-mg/mL (1:1,000) solution (maximum of 5 mg per dose); this can be diluted with normal saline to bring the volume to 3 mL. Administer l-EPINEPHrine via handheld nebulizer.
- Symptomatic bradycardia: IV/IO: 0.01 mg/kg (0.1 mL/kg) of a 0.1-mg/mL (1:10,000) solution. ET: 0.1 mg/kg (0.1 mL/kg) of a 1-mg/mL (1:1,000) solution.22 Continuous IV/IO infusion: 0.1 to 1 mcg/kg per minute.22
-Neonates:
Bradycardia: 0.01 to 0.03 mg/kg of 0.1 mg/mL (1:10,000) EPINEPHrine (equal to 0.1 to 0.3 mL/kg) IV, followed by 0.5-mL to 1-mL normal saline flush to clear the line; 0.05 to 0.1 mg/kg of 0.1 mg/mL (1:10,000) ET until IV access can be obtained, but absorption is less reliable via this route. If IV access is not yet established, consider starting with the higher dose of 0.3 up to 1 mL/kg of 0.1 mg/mL (1:10,000) EPINEPHrine given via the ET tube. Dosing may be repeated every 3 to 5 minutes when there is persistent bradycardia.
EPINEPHrine (Adrenalin)
Duration of action
Onset: Immediate.
Peak effect: Minutes.
Duration: Several minutes.
EPINEPHrine (Adrenalin)
Special Considerations
Pregnancy safety: Category C. Contraindicated for patients in active labor. May cause syncope in asthmatic children. May increase myocardial oxygen demand.
