Indications, Contraindications, Adverse Reactions, Route, & Onset Flashcards
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
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
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)
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)
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
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
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
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%
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)
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)
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
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
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
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
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)
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
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)
