Indications, Contraindications, Adverse Reactions, Route, & Onset Flashcards by Jacob Harper

INDICATIONS
 Chest pain and/or signs and symptoms suggestive of the acute coronary syndrome
 ECG waveforms suggestive of the acute coronary syndrome

CONTRAINDICATIONS
 Known hypersensitivity to the drug
 Not recommended for use with pediatric patients

ADVERSE REACTIONS/SIDE EFFECTS
 None in the emergency setting

ROUTE OF ADMINISTRATION
 Oral - chewed

ONSET OF ACTION
 5 to 30 minutes

acetylsalicylic acid

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INDICATIONS
 Supraventricular tachycardia
 Wolff-Parkinson-White (WPW) syndrome
 Monomorphic wide-complex tachycardia

CONTRAINDICATIONS
 Atrial fibrillation
 Atrial flutter
 Polymorphic ventricular tachycardia (Torsades de pointes)
 Second-degree and third-degree heart block

ADVERSE REACTIONS/SIDE EFFECTS
 Transient dysrhythmias
 Chest pain
 Palpitations
 Dyspnea
 Dizziness
 Hypotension
 Blurred vision
 Cardiac arrest
 Asystole

ROUTES OF ADMINISTRATION
 IV
 IO

ONSET OF ACTION
 Immediate

adenosine

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INDICATIONS
 Asthma
 Bronchospasm associated with chronic bronchitis and emphysema
 Hyperkalemia
CONTRAINDICATION
 Known hypersensitivity to the drug
ADVERSE REACTIONS/SIDE EFFECTS
 Tachycardia
 Hypertension
 Dysrhythmias
 Tremors
 Palpitations
 Chest pain
 Nervousness
 Anxiety
 Headache
 Nausea, vomiting
ROUTE OF ADMINISTRATION
 Nebulized for inhalation
ONSET OF ACTION
 5 to 15 minutes

albuterol (Proventil, Ventolin)

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INDICATIONS
 Ventricular fibrillation
 Pulseless ventricular tachycardia
 Wide complex tachycardia
CONTRAINDICATIONS
 Cardiogenic shock
 Hemodynamically significant bradycardia
 Second-degree and third-degree heart block
 Hemodynamically significant hypotension

ADVERSE REACTIONS/SIDE EFFECTS
 Bradycardia
 Hypotension
 Heart block
 Congestive heart failure
 Headache
 Dizziness
 Nausea, vomiting

ROUTES OF ADMINISTRATION
 IV
 IO
 Infusion

ONSET OF ACTION
 1 to 3 minutes

amiodarone (Cordarone)

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INDICATIONS
 Hemodynamically significant bradycardia
 Organophosphate poisoning
 Carbamate poisoning
 Nerve agent exposure

CONTRAINDICATIONS
 Known hypersensitivity to the drug
 Tachycardia
 Hypothermic hemodynamically significant bradycardia

ADVERSE REACTIONS/SIDE EFFECTS
 Tachycardia
 Palpitations
 Flushed, hot, dry skin
 Dizziness
 Drowsiness
 Confusion
 Anxiety
 Headache
 Dilated pupils
 Blurred vision
 Dry mouth
 Nausea, vomiting

ROUTES OF ADMINISTRATION
 IV
 IO
 ET
ONSET OF ACTION
 Immediate

atropine sulfate

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INDICATIONS
 Acute hypocalcemia
 Calcium channel blocker overdose
 Beta-blocker overdose
 Hyperkalemia

CONTRAINDICATION
 None in the emergency setting

ADVERSE REACTIONS/SIDE EFFECTS
 Extravasation may cause tissue necrosis
 Syncope
 Asystole
 Bradycardia
 Dysrhythmias
 Nausea, vomiting

ROUTES OF ADMINISTRATION
 IV
 IO

ONSET OF ACTION
 1 to 3 minutes

calcium chloride

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INDICATIONS
 Oral poisonings
 Oral overdoses

CONTRAINDICATIONS
 The patient cannot protect their airway
 Ingestion of
o Caustics
o Hydrocarbons
o Acids
o Corrosives
o Cyanide
o Solvents
o Iron
o Lithium
o Lead
o Petroleum substances

ADVERSE REACTIONS/SIDE EFFECTS
 Aspiration
 Nausea, vomiting

ROUTE OF ADMINISTRATION
 Oral

ONSET OF ACTION
 Immediate

charcoal, activated

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INDICATIONS
 Hypoglycemia
 Unconsciousness of unknown etiology

CONTRAINDICATION
 Head injury

ADVERSE REACTIONS/SIDE EFFECTS
 Extravasation may cause tissue necrosis

ROUTES OF ADMINISTRATION
 IV
 IO
 Infusion

ONSET OF ACTION
 Less than 1 minute

dextrose 50%

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INDICATIONS
 Atrial fibrillation with rapid ventricular rate
 Atrial flutter with rapid ventricular rate
 Supraventricular tachycardia second-line to administration of adenosine

CONTRAINDICATIONS
 Known hypersensitivity to the drug
 Hypotension
 Myocardial infarction
 Cardiogenic shock
 Ventricular tachycardia
 Second-degree and third-degree heart block
 Wolff-Parkinson-White (WPW) syndrome
 Not recommended for use with pediatric patients

ADVERSE REACTIONS/SIDE EFFECTS
 Hypotension
 Dysrhythmias
 Bradycardia
 Dizziness
 Weakness
 Headache
 Nausea, vomiting

ROUTES OF ADMINISTRATION
 IV
 IO
 Infusion

ONSET OF ACTION
 2 to 5 minutes

diltiazem (Cardizem)

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INDICATIONS
 Allergic reaction
 Anaphylaxis
 Phenothiazine reaction with extrapyramidal symptoms

CONTRAINDICATION
 Known hypersensitivity to the drug

ADVERSE REACTIONS/SIDE EFFECTS
 Hypotension
 Dysrhythmias
 Sedation
 Euphoria
 Dizziness
 Headache
 Blurred vision
 Palpitations

ROUTES OF ADMINISTRATION
 IV
 IO
 IM

ONSET OF ACTION
 15 to 30 minutes

diphenhydramine (Benadryl)

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INDICATIONS
 Cardiogenic shock
 Hemodynamically significant bradycardia
 Hemodynamically significant hypotension
CONTRAINDICATION
 Hemodynamically significant hypovolemic shock
ADVERSE REACTIONS/SIDE EFFECTS
 Extravasation may cause tissue necrosis
 Increased myocardial oxygen demand
 Tachycardia
 Hypertension
 Dysrhythmias
 Dyspnea
 Tremors
 Palpitations
 Headache
 Nausea, vomiting

ROUTE OF ADMINISTRATION
 Infusion

ONSET OF ACTION
 1 to 4 minutes

dopamine

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INDICATIONS
 Cardiac arrest
o Asystole
o Pulseless electrical activity
o Ventricular fibrillation
o Pulseless ventricular tachycardia
 Hemodynamically significant hypotension from a cause other than hypovolemia
 Asthma
 Bronchospasm associated with chronic bronchitis and emphysema
 Allergic reaction
 Anaphylaxis
 Hemodynamically significant bradycardia

CONTRAINDICATION
 None in the emergency setting

ADVERSE REACTIONS/SIDE EFFECTS
 Extravasation of the IV/IO may cause tissue necrosis
 Tachycardia
 Increased myocardial oxygen demand
 Hypertension
 Dysrhythmias
 Dyspnea
 Palpitations
 Chest pain
 Nervousness
 Anxiety
 Dizziness
 Headache
 Tremors
 Nausea, vomiting

ROUTES OF ADMINISTRATION
 IV
 IO
 IM
 ET
 Infusion

ONSET OF ACTION
 Immediate

epinephrine

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INDICATION
 Procedural sedation for intubation
CONTRAINDICATION
 Known hypersensitivity to the drug
ADVERSE REACTIONS/SIDE EFFECTS
 Respiratory depression
 Respiratory arrest
 Laryngospasm
 Hypotension
 Hypertension
 Tachycardia
 Bradycardia
 Involuntary muscle movement
 Nausea, vomiting

ROUTES OF ADMINISTRATION
 IV
 IO

ONSET OF ACTION
 10 to 20 seconds

etomidate

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INDICATIONS
 Moderate to severe pain
 Procedural sedation including intubation

CONTRAINDICATIONS
 Known hypersensitivity to the drug
 Head injury
 Decreased level of consciousness
 Respiratory depression
 Hemodynamically significant hypotension

ADVERSE REACTIONS/SIDE EFFECTS
 Central nervous system depression
 Respiratory depression
 Respiratory arrest
 Hypotension
 Bradycardia
 Tachycardia
 Dysrhythmias
 Syncope
 Dyspnea
 Nausea, vomiting

ROUTES OF ADMINISTRATION
 IV
 IO
 IM

ONSET OF ACTION
 1 to 3 minutes

fentanyl

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INDICATIONS
 Pulmonary edema
 Congestive heart failure

CONTRAINDICATIONS
 Hemodynamically significant hypotension
 Hemodynamically significant hypovolemia

ADVERSE REACTIONS/SIDE EFFECTS
 Hypovolemia
 Hypokalemia

ROUTES OF ADMINISTRATION
 IV
 IO

ONSET OF ACTION
 5 to 10 minutes

furosemide (Lasix)

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INDICATIONS
 Hemodynamically significant hypoglycemia
 Beta-blocker overdose

CONTRAINDICATION
 Known hypersensitivity to the drug

ADVERSE REACTIONS/SIDE EFFECTS
 Nausea, vomiting

ROUTE OF ADMINISTRATION
 IM

ONSET OF ACTION
 1 minute

glucagon

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NDICATIONS
 Asthma
 Bronchospasm associated with chronic bronchitis and emphysema

CONTRAINDICATION
 Known hypersensitivity to the drug

ADVERSE REACTIONS/SIDE EFFECTS
 Tachycardia
 Tremors
 Palpitations
 Nervousness
 Anxiety
 Headache
 Nausea, vomiting

ROUTE OF ADMINISTRATION
 Nebulized for inhalation

ONSET OF ACTION
 1 to 3 minutes

ipratropium bromide (Atrovent)

INDICATION
 Procedural sedation for intubation

CONTRAINDICATIONS
 Known hypersensitivity to the drug
 Not recommended for use with pediatric patients

ADVERSE REACTIONS/SIDE EFFECTS
 Respiratory depression
 Respiratory arrest
 Bradycardia
 Tachycardia
 Dysrhythmias
 Hallucinations
 Nausea, vomiting

ROUTES OF ADMINISTRATION
 IV
 IO
 IM

ONSET OF ACTION
 30 seconds

ketamine

INDICATIONS
 Ventricular fibrillation
 Ventricular tachycardia
 Ventricular dysrhythmias
o Frequent premature ventricular complexes and couplets
o Monomorphic and polymorphic wide-complex tachycardia

CONTRAINDICATIONS
 Known hypersensitivity to the drug
 Premature ventricular complexes in conjunction with bradycardia
 Second-degree and third-degree heart block

ADVERSE REACTIONS/SIDE EFFECTS
 Drowsiness
 Confusion
 Anxiety
 Dizziness

ROUTES OF ADMINISTRATION
 IV
 IO
 ET
 Infusion

ONSET OF ACTION
 1 to 5 minutes

lidocaine

INDICATIONS
 Seizures caused by toxicity of pregnancy (toxemia)
 Pregnancy induced hypertension (pre-eclampsia and eclampsia)
 Pre-term labor
 Torsades de pointes (polymorphic ventricular tachycardia)
 Ventricular fibrillation and pulseless ventricular tachycardia refractory to amiodarone or lidocaine
 Reactive airway conditions including bronchoconstriction and bronchospasm

CONTRAINDICATION
 Hemodynamically significant heart block

ADVERSE REACTIONS/SIDE EFFECTS
 Central nervous system depression
 Drowsiness
 Hypotension
 Respiratory depression
 Dysrhythmias

ROUTES OF ADMINISTRATION
 IV
 IO
 Infusion

ONSET OF ACTION
 Immediate

magnesium sulfate

INDICATIONS
 Acute exacerbation of asthma, chronic bronchitis, emphysema, and other reactive airway
conditions
 Anaphylaxis
 Burns involving the airway

CONTRAINDICATION
 None in the emergency setting

ADVERSE REACTIONS/SIDE EFFECTS
 None for a single dosage

ROUTES OF ADMINISTRATION
 IV
 IO

ONSET OF ACTION
 1 to 6 hours

ADULT DOSAGE
 125 mg

methylprednisolone (Solu-Medrol)

INDICATIONS
 Seizure activity
 Status epilepticus
 Procedural sedation for intubation and cardioversion
 Chemical restraint for agitated (excited) delirium
- (3 only) Delirium tremens

CONTRAINDICATION
 Known hypersensitivity to the drug
- (3 only) Head injury

ADVERSE REACTIONS/SIDE EFFECTS
 Sedation
 Transient amnesia
 Respiratory depression
 Respiratory arrest
 Bradycardia
 Hypotension
 Dizziness
 Drowsiness
 Blurred vision
 Nausea, vomiting

ROUTES OF ADMINISTRATION
 IV
 IO
 IM
-(3 only) Rectal

(1) ONSETS OF ACTION
 IV/IO: 1 to 3 minutes
 IM: 15 minutes

(2) ONSETS OF ACTION
 IV/IO: 2 to 5 minutes
 IM: 15 to 30 minutes

(3) ONSETS OF ACTION
 IV/IO: 2 to 5 minutes
 IM: 15 to 30 minutes
 Rectal: variable

(1) midazolam (Versed) [PHX med]
(2) lorazepam (Ativan)
(3) diazepam (Valium)

INDICATIONS
 Moderate to severe pain
 Chest pain and/or signs and symptoms suggestive of the acute coronary syndrome
 Acute cardiogenic pulmonary edema

CONTRAINDICATIONS
 Known hypersensitivity to the drug
 Head injury
 Decreased level of consciousness
 Hemodynamically significant hypotension

ADVERSE REACTIONS/SIDE EFFECTS
 Central nervous system depression
 Respiratory depression
 Respiratory arrest
 Hypotension
 Bradycardia
 Tachycardia
 Dysrhythmias
 Syncope
 Dyspnea
 Nausea, vomiting

ROUTES OF ADMINISTRATION
 IV
 IO
 IM

ONSET OF ACTION
 Immediate

morphine sulfate

INDICATIONS
 Narcotic and synthetic analgesic drug overdoses
o morphine
o heroin
o oxycodone
o methadone
o codeine
o meperidine
o fentanyl
o hydrocodone
o hydromorphone
 Unconsciousness of unknown etiology

CONTRAINDICATION
 None in the emergency setting

ADVERSE REACTIONS/SIDE EFFECTS
 Withdrawal symptoms
o Confusion
o Hypotension
o Tachycardia
o Hypertension
o Dysrhythmias
o Diaphoresis
o Nausea, vomiting

ROUTES OF ADMINISTRATION
 IV
 IM
 IO
 ET
 Intra-nasal (IN)

ONSET OF ACTION
 2 to 10 minutes

naloxone

INDICATIONS  Chest pain and signs/symptoms suggestive of the acute coronary syndrome  Congestive heart failure with pulmonary edema CONTRAINDICATIONS  Hemodynamically significant hypotension  Hypovolemia  The patient has taken an erectile dysfunction (ED) medication in the previous 24 hours including: o sildenafil (Viagra®) o tadalafil (Cialis®) o vardenafil (Levitra®) o Or other phosphodiesterase-5 inhibitor medication in the previous 24 hours  Not recommended for use with pediatric patients ``` ADVERSE REACTIONS/SIDE EFFECTS  Hypotension  Bradycardia  Tachycardia  Headache  Dizziness  Weakness  Syncope  Nausea, vomiting ``` ROUTE OF ADMINISTRATION  Sublingual ONSET OF ACTION  1 to 3 minutes

nitroglycerin

INDICATION  Moderate to severe pain due to musculoskeletal trauma and burns ``` CONTRAINDICATIONS  The patient cannot understand verbal instructions for use  Alcohol intoxication  Head injury  Abdominal pain and distention ``` ``` ADVERSE REACTIONS/SIDE EFFECTS  Headache  Dizziness  Giddiness  Nausea, vomiting ``` ROUTE OF ADMINISTRATION  Inhaled by self-administration ONSET OF ACTION  Seconds

nitrous oxide 50%

INDICATION  Nausea and vomiting CONTRAINDICATION  Known hypersensitivity to the drug ADVERSE REACTIONS/SIDE EFFECTS  Headache  Dizziness ROUTES OF ADMINISTRATION  Oral  IV  IO ONSET OF ACTION  5 to 10 minutes

ondansetron (Zofran)

INDICATION  Hypoglycemia CONTRAINDICATION  The patient cannot protect their airway ADVERSE REACTIONS/SIDE EFFECTS  Nausea, vomiting ROUTES OF ADMINISTRATION  Buccal  Sublingual ONSET OF ACTION  Variable

oral glucose

INDICATIONS  Hypoxia  Suspected hypoxia CONTRAINDICATION  Oxygen supports combustion with an ignition source ADVERSE REACTIONS/SIDE EFFECTS  Oxygen that is not humidified may dry or irritate mucous membranes in the nose and throat ONSET OF ACTION  Varies according to the delivery device, ventilation device, and liter flow

oxygen

``` INDICATION  Postpartum hemorrhage following delivery of the newborn and placenta CONTRAINDICATIONS  Known hypersensitivity to the drug  Presence of a fetus with impending delivery  Not recommended for use with pediatric patients ADVERSE REACTIONS/SIDE EFFECTS  Hypotension  Nausea, vomiting ROUTES OF ADMINISTRATION  Infusion  IM ONSETS OF ACTION  Infusion: immediate  IM: 3 to 5 minute ```

oxytocin

``` INDICATION  Administered prior to insertion of the nasotracheal tube CONTRAINDICATION  Known hypersensitivity to the drug ADVERSE REACTIONS/SIDE EFFECTS  None in the emergency setting ROUTE OF ADMINISTRATION  Nasal ONSET OF ACTION  Immediate ```

phenylephrine (Neo-Synephrine)

``` INDICATIONS  Metabolic acidosis in these conditions: o salicylate overdose o tricyclic antidepressant overdose o hyperkalemia o pre-existing or known metabolic acidosis o acidosis refractory to effective ventilation o prolonged cardiac arrest CONTRAINDICATION  None in the emergency setting ADVERSE REACTIONS/SIDE EFFECTS  Extravasation may cause tissue necrosis ROUTES OF ADMINISTRATION  IV  IO ONSET OF ACTION  Immediate ```

sodium bicarbonate

``` INDICATION  Procedural adjunct for intubation CONTRAINDICATION  Known hypersensitivity to the drug ADVERSE REACTIONS/SIDE EFFECTS  Respiratory depression  Respiratory arrest  Dysrhythmias ROUTES OF ADMINISTRATION  IV  IO ONSET OF ACTION  1 minute ```

succinylcholine

``` INDICATIONS  Delirium tremens  Wernicke encephalopathy  Korsakoff syndrome  Unconsciousness of unknown etiology  Alcoholism  Malnutrition CONTRAINDICATION  None in emergency setting ADVERSE REACTIONS/SIDE EFFECTS  Nausea, vomiting ROUTES OF ADMINISTRATION  IV  IO  IM ONSET OF ACTION  Rapid ```

thiamine (vitamin B1)

``` INDICATIONS  Cardiac arrest: o ventricular fibrillation o pulseless ventricular tachycardia o asystole o pulseless electrical activity CONTRAINDICATION  Not recommended for use with pediatric patients ADVERSE REACTIONS/SIDE EFFECTS  Nausea, vomiting ROUTES OF ADMINISTRATION  IV  IO  ET ONSET OF ACTION  1 to 3 minutes ```

vasopressin

``` INDICATIONS  Atrial fibrillation with rapid ventricular rate  Atrial flutter with rapid ventricular rate  Supraventricular tachycardia CONTRAINDICATIONS  Known hypersensitivity to the drug  Hypotension  Myocardial infarction  Cardiogenic shock  Ventricular tachycardia  Second-degree and third-degree heart block  Wolff-Parkinson-White (WPW) syndrome  Not recommended for use with pediatric patients ADVERSE REACTIONS/SIDE EFFECTS  Hypotension  Dysrhythmias  Bradycardia  Dizziness  Weakness  Headache  Nausea, vomiting ROUTES OF ADMINISTRATION  IV  IO ONSET OF ACTION  2 to 5 minutes ```

verapamil

INDICATION | Contact with hydrofluoric acid

calcium gluconate

INDICATIONS  Type 1 (insulin-dependent) diabetes mellitus  Type 2 (non-insulin-dependent) diabetes mellitus unresponsive to diet and oral hypoglycemics

insulin

INDICATIONS Severe hypotension due to cardiogenic, septic, or neurogenic shock either refractory to intravascular fluid boluses or in which intravascular fluid blousing is contraindicated (e.g. pulmonary edema)

norepinephrine

INDICATION | Intensive care unit (ICU) sedation of intubated mechanically ventilated adult patients

propofol (Diprivan)