intermediate EMT drugs WY Flashcards
atropine sulfate brand name
Atro-Pen
atropine sulfate class
antiarrythmic, anticholinergic
atropine sulfate MOA
blocks action of acetylcholine in peripheral nervous system (PNS)
atropine sulfate indications
sinus bradycardia, heart block, reverse exercise-induced bronchospasms, organophosphate poisoning
atropine sulfate contraindications
known hypersensitivity, narrow-angle glaucoma, tachycardia secondary to cardiac insufficiency. Use with caution in patients with chronic renal, liver, pulmonary, or cardiac disease, intra-abdominal infection, or prostatic hyperplasia
atropine sulfate side effects
tachypnea, tachycardia, drowsiness, dry mouth
atropine sulfate dose
Cardiac: 0.5 to 1 mg every 3-5 mins, max dose 3 mg.
Respiratory: 0.25 to 0.5 mg/kg q.4-6h. nebulized, max dose 2.5 mg
Toxicology: 2 mg IV initial, then 1-2 mg every 10-20 mins until effects observed
amiodarone brand name
Cordarone
amiodarone class
Class III antiarrhythmic
amiodarone MOA
prolongs action potential and refractory period, slows sinus rate, prolonging PR interval; decreases PVR
amiodarone indications
VF/VT; life-threatening arrythmias
amiodarone contraindications
Known hypersensitivity, 2nd and 3rd degree AV blocks. Use caution with history of CHF or thyroid disorder, severe pulmonary or liver disease. NOTE: enters breast milk and can harm neonate
amiodarone side effects
ARDS; CHF; bradycardia; hypotension
amiodarone dose
Pulseless VF/VT: 300 mg IVSP, may repeat 150 mg in 3-5 mins.
Ventricular arrhythmias with pulse: 150 mg IVSP over 10 mins.
lorazepam brand name
Ativan
lorazepam class
benzodiazepine; anticonvulsant; antianxiety
lorazepam MOA
depresses CNS by potentiating GABA (inhibitory neurotransmitter)
lorazepam indications
decrease anxiety, seizure activity
lorazepam contraindications
Known hypersensitivity, pre-existing CNS depression, uncontrolled severe pain, narrow-angle glaucoma, severe hypotension. Use with caution in patients with severe liver, renal, or pulmonary impairment, COPD patients, history of suicide attempts or drug abuse.
lorazepam side effects
apnea, lethargy, drowsiness, slurred speech
lorazepam dose
50 mcg/kg, up to 4 mg
diazepam brand name
Valium
diazepam class
anti-anxiety, sedative/hypnotic
diazepam MOA
depresses the CNS
diazepam indications
sedation, treating seizure activity (uncontrolled seizures and status epilepticus), skeletal muscle relaxant
diazepam contraindications
Known hypersensitivity, severe liver dysfunction, severe pulmonary impairment. Use with caution in patients with severe renal impairment and in patients with history of drug dependence.
diazepam side effects
Respiratory depression, hypotension, dizziness, drowsiness, slurred speech, blurry vision. May cause respiratory arrest.
diazepam dose
5-10 mg IVP, may repeat every 10-15 mins, max dose 30 mg
diphenhydramine brand name
Benadryl, Allerdryl
diphenhydramine class
antihistamine
diphenhydramine MOA
antagonizes effects of histamine at the H1 receptor sites, CNS depressant, anticholinergic
diphenhydramine indications
relief of allergic symptoms caused by histamine release
diphenhydramine contraindications
Known hypersensitivity, asthma. Use with caution in patients with severe liver disease, narrow-angle glaucoma, seizure disorders, prostatic hyperplasia, and peptic ulcers. Geriatric patients more susceptible to adverse drug reactions and anticholinergic effects.
diphenhydramine side effects
chest tightness, hypotension, drowsiness, dizziness, headaches, tinnitus, blurred vision, anorexia, constipation, dry mouth
diphenhydramine dose
IM, IV 25-50 mg q.4h.
sodium bicarbonate class
alkalinizing agent
sodium bicarbonate MOA
Buffers excess acid to return blood to physiological pH. Causes increased urinary elimination of some drugs such as barbiturates and aspirin.
sodium bicarbonate indications
metabolic acidosis; in certain poisoning or overdoses of ethylene glycol, aspirin, and methanol
sodium bicarbonate contraindications
Known hypersensitivity. Don’t give to patients with metabolic or respiratory alkalosis, hypocalcemia, or excessive chloride loss. Use with caution in patients with CHF and kidney insufficiency and in those using corticosteroid therapy.
sodium bicarbonate side effects
edema, irritation at IV site
sodium bicarbonate dose
1 mEq/kg
levalbuterol brand name
Xopenex
levalbuterol class
adrenergic, bronchodilator
levalbuterol MOA
binds to beta2 adrenergic receptors in airway smooth muscle, causing bronchodilation
levalbuterol indications
short-term use for bronchodilation due to reversible airway disease
levalbuterol contraindications
Hypersensitivity to albuterol. Use with caution in patients with hypertension, coronary insufficiency, arrhythmias, history of seizures, hypokalemia, or diabetes.
levalbuterol side effects
paradoxical bronchospasm, tachycardia, anxiety, dizziness, headache, hyperglycemia
levalbuterol dose
0.63 mg via nebulization 3 times daily. Get baseline vitals prior to administering and watch for wheezing.
fentanyl brand name
Sublimaze
fentanyl class
opioid analgesic
fentanyl MOA
binds to opiate receptors in CNS, altering response to and perception of pain
fentanyl indications
severe pain, analgesia maintenance in the intubated patient
fentanyl contraindications
Known hypersensitivity. Use with caution in patients with diabetes; severe renal, pulmonary, liver, or cardiac disease; increased ICP, undiagnosed abdominal pain. Avoid in patients who have received MAOIs in the past 14 days, may cause potentially fatal reaction. Do not use with other CNS depressants.
fentanyl side effects
apnea, respiratory depression, bronchospasm, laryngospasm, arrhythmias, hypotension, confusion, nausea and vomiting
fentanyl dose
0.5 to 1 mcg/kg *Be prepared to manage airway and/or provide reversal agent. Use continuous monitoring.
morphine sulfate brand name
Astramorph, Duramorph
morphine sulfate class
opioid analgesic
morphine sulfate MOA
binds to opiate receptors in CNS, altering perception of and response to pain
morphine sulfate indications
severe pain, pulmonary edema, pain with AMI
morphine sulfate contraindications
Known hypersensitivity. Avoid in patients hypersensitive to tartrazine, bisulfates, ETOH. Use with caution in patients with head trauma, increased ICP, abdominal pain, renal/liver dysfunction, pulmonary disease, history of substance abuse. Use with caution in patients using MAOIs within last 14 days.
morphine sulfate side effects
respiratory depression, hypotension, confusion , constipation, physical/psychological dependence
morphine sulfate dose
4-10 mg IV/IM/SQ
furosemide brand name
Lasix
furosemide class
loop diuretic
furosemide MOA
inhibits reabsorption of sodium and chloride in the distal renal tubule and the loop of Henle; increases excretion of H2O, sodium, chloride, magnesium, and calcium, and potassium
furosemide indications
Edema due to heart failure, liver impairment, or renal disease. Can be used to treat hypertension.
furosemide contraindications
Known hypersensitivity, hepatic encephalopathy, anuria. Do not give to patients with severe liver disease or diabetes mellitus. Note: Geriatric patients may have increased risk of hypotension and electrolyte imbalance at normal doses.
furosemide side effects
dehydration, hypochloremia, hypokalemia, hypomagnesemia, hyponatremia, hypovolemia, hypocalcemia, metabolic acidosis
furosemide dose
20-40 mg IVSP or 2 times the amount the patient is already on
heparin sodium brand name
Heparin
heparin sodium class
anticoagulant, antithrombotic
heparin sodium MOA
potentiates inhibitory effect of antithrombin on factor Xa and thrombin
heparin sodium indications
used prophylactically for the treatment of various thrombotic disorders
heparin sodium contraindications
Known hypersensitivity. Should not be given to patients with uncontrolled bleeding, severe thrombocytopenia, or open wounds. Use extreme caution in patients with uncontrolled hypertension, bacterial endocarditis, bleeding disorders, hemorrhage, or stroke.
heparin sodium side effects
bleeding, anemia, thrombocytopenia
heparin sodium dose
Varies depending on protocol. Generally, 5000 IU loading dose IVSP, then 800 to 1200 IU/hr. Note: Continually monitor for evidence of bleeding.
vasopressin brand name
Pitressin
vasopressin class
antidiuretic hormone
vasopressin MOA
In high doses, acts as a nonadrenergic peripheral vasoconstrictor.
vasopressin contraindications
Known hypersensitivity. Should not be given to patients with chronic renal failure or to those who are hypersensitive to beef or pork. Use with caution in patients with history of seizures, asthma, heart failure, migraine headaches, and renal impairment.
vasopressin side effects
MI, angina, dizziness, abdominal cramps, diarrhea
vasopressin dose
40 units IV
thiamine brand name
Betaxin, vitamin B1, Blamine
thiamine class
water-soluble vitamin
thiamine MOA
metabolism of carbs and fats
thiamine indications
vitamin deficiencies, prevention of Wernicke encephalopathy
thiamine contraindications
Known hypersensitivity. Should not be given to patients with known alcohol intolerance. Use caution in patients with Wernicke encephalopathy.
thiamine side effects
pulmonary edema, vascular collapse, hypotension, angioedema, vasodilation, GI bleeding
thiamine dose
IM, IV 5 to 100 mg
ondansetron brand name
Zofran
ondansetron class
antiemetic
ondansetron MOA
blocks the effects of serotonin located in the chemoreceptor trigger zone (CTZ) in the CNS
ondansetron indications
prevention of nausea and vomiting
ondansetron contraindications
Known hypersensitivity. Use with caution in patients with liver impairment.
ondansetron side effects
headache, constipation, diarrhea
ondansetron dose
4-8 mg PO
Lactated Ringer’s Solution class
isotonic crystalloid solution
Lactated Ringer’s description
sterile water with electrolytes: sodium 130 mEq/L, potassium 4 mEq/L, calcium 30 mEq/L, chloride 109 mEq/L, lactate 28 mEq/L
Lactated Ringer’s MOA
replaces fluid and electrolytes
Lactated Ringer’s indications
significant burns and hypovolemia
Lactated Ringer’s contraindications
Heart failure, renal failure, suspected hyperkalemia. Do not use with blood product infusion.
Lactated Ringer’s side effects
rare in therapeutic dosages
Lactated Ringer’s dose
depends on condition being administered for. Follow protocols. Monitor closely for signs of circulatory overload. Keep open rate 30 mL/hr. (1000 mL bags)
5% dextrose in water for IV infusion class
hypotonic carbohydrate-containing solution
5% dextrose description
sterile water containing 5% dextrose (5 g/100 mL)
5% dextrose MOA
combines dextrose and water in a hypotonic concentration that will not remain in the vascular space, reducing danger of overload.
5% dextrose indications
for prophylactic IV access or to dilute concentrated drugs for IV infusion
5% dextrose contraindications
patients who require IV fluid replacement or who are hyperglycemic
5% dextrose side effects
Rare in therapeutic doses. *Do not use for blood product infusion
5% dextrose dose
Usually administered at keep open rate (30 mL/hr). Monitor IV site for irritation/swelling/redness. (250 mL or 500 mL bags)
normal saline IV infusion (0.9% sodium chloride) class
isotonic crystalloid
normal saline description
clear liquid containing water, 154 mEq/L sodium and approximately 154 mEq/L chloride to match concentration in human body
normal saline MOA
used to expand the vascular volume temporarily by replacing water and electrolytes
normal saline indications
hypovolemia, heat exhaustion, heat stroke, diabetic ketoacidosis
normal saline contraindications
heart failure (overload may occur)
normal saline side effects
may result in hemodilution and electrolyte imbalance
normal saline dose
Depends on condition. Follow protocols. Keep open rate 30 mL/hr. Monitor carefully for fluid overload in patients receiving large volumes of NS.
albuterol brand name
Proventil, Ventolin
albuterol class
beta2 adrenergic, bronchodilator
albuterol MOA
binds to beta2 receptors in airway smooth muscle causing bronchodilation
albuterol indications
reversible airway obstruction caused by asthma or COPD
albuterol contraindications
Known hypersensitivity, hypersensitivity to adrenergic amines. Use with caution in patients with cardiac disease, hypertension, hyperthyroidism, diabetes, glaucoma, seizure disorder.
albuterol side effects
anxiety, tachycardias
albuterol dose
MDI: 2 puffs q.4-6h.
SVN: 2.5 to 5 mg every 20 mins x3 doses
lidocaine brand name
Xylocaine, Xylocard
lidocaine class
1B antiarrhythmic
lidocaine MOA
Suppresses automaticity and spontaneous depolarization of the ventricles during diastole by altering the flux of sodium ions across cell membranes with little or no effect on the heart rate.
lidocaine indications
Alternative to amiodarone for cardiac arrest from V-fib/pulseless VT after successful conversion of perfusing rhythm; wide complex tachycardias of uncertain origin, and ventricular ectopy in acute MI. Also used in RSI to blunt the ICP rise.
lidocaine contraindications
Known hypersensitivity. Should not be given to patients with 3rd degree heart block. Use with caution in patients with liver disease, CHF, shock, respiratory depression, heart blocks.
lidocaine side effects
bronchospasm, cardiac arrest, arrhythmias, hypotension, seizures, blurred vision, dizziness, confusion, slurred speech, anaphylaxis, nause, and vomiting
lidocaine dose
1 to 1.5 mg/kg bolus. May repeat dose of 0.5 to 0.75 mg/kg every 5-10 mins, up to 3 mg/kg. Continuous infusion rate 1-4 mg/min.
Pediatric dose: 1 mg/kg
*Dosing is same for RSI. Monitor vital signs and ECG.
Advanced EMT: bolus
Intermediate EMT: drip
epinephrine brand name
Adrenalin
epinephrine class
vasopressor, sympathomimetic
epinephrine MOA
Affects B1 and B2 adrenergic receptor sites. Also affects A1 adrenergic sites.
epinephrine indications
symptomatic bradycardia, cardiac arrest, severe allergic reaction, reversible airway disease due to asthma or COPD
epinephrine contraindications
Known hypersensitivity, hypersensitivity to adrenergic amines or bisulfates, cardiac arrhythmias. Use with caution in patients with cardiac disease, hypertension, diabetes, hyperthyroidism, cerebral arteriosclerosis.
epinephrine side effects
angina, arrhythmias, hypertension, tachycardia
epinephrine dose
Cardiac arrest: 1 mg 1:10,000 IV/IO q.3-5min.
Allergic reaction: 0.3 mg to 0.5 mg 1:1,000 SQ/IM q.10-15min.
adenosine brand name
Adenocard
adenosine class
cardiac antidysrhythmic, nucleoside (a biologic molecule that serves as a building block of RNA and DNA
adenosine MOA
Decreases electrical conduction through the AV node. Also acts directly on the sinus node to decrease automaticity to slow the heart rate. Adenosine has an immediate onset but a duration of less than 10 seconds.
adenosine indications
Used for narrow complex tachycardia. Not indicated for atrial fibrillation with rapid ventricular response, atrial flutter, or ventricular tachycardia because it is ineffective in converting those rhythms.
adenosine contraindications
Do not use in patients with 2nd or 3rd degree AV node block, sick sinus syndrome, or hypersensitivity to adenosine.
adenosine side effects
lightheadedness, headache, chest pain, flushing, hypotension, shortness of breath, nausea, metallic taste, transient rhythm disturbances (bradydysrhythmia, sinus pause, ventricular ectopy, or asystole)
adenosine dose
Adults: 6 mg rapid IV bolus through a proximal IV, followed by a 20 mL saline bolus to ensure that adenosine reaches the central circulation. If there is no change in rhythm after 1-2 mins, give a 12 mg rapid IV bolus. If rhythm persists 1-2 mins following 2nd dose, one additional 12 mg rapid IV bolus may be given. Do not exceed 30 mg total.
Pediatrics: 0.1 mg/kg (up to 6 mg) initial dose. May repeat in 1-2 mins at double the initial dose. Follow each dose with a 20 mL saline flush.
adenosine special notes
Adenosine has a short half life (less than 10 seconds), so administer adenosine through an IV that has been established as near as possible to the central circulation, such as in the antecubital fossa. Use as large a catheter is practical (minimum 18 gauge) to facilitate a rapid bolus. Place the patient supine prior to administration, and warn the patient of possible sensations such as flushing or transient chest tightness when the drug is administered. Push the medication as rapidly as possible, immediately following each bolus with a 10 mL bolus of normal saline. Activate the recorder on the cardiac monitor prior to administration to document any rhythm changes.
ipratropium bromide brand name
Atrovent
ipratropium bromide class
anticholinergic, bronchodilator
ipratropium bromide MOA
antagonizes acetylcholine receptors, producing bronchodilation
ipratropium bromide indications
maintenance for airway obstruction due to COPD, including chronic bronchitis and emphysema
ipratropium bromide contraindications
Hypersensitivity to atropine or bromide, acute bronchospasm. Use with caution with bladder neck obstruction, prostatic hyperplasia, glaucoma, urinary retention.
ipratropium bromide side effects
hypotension, cough, blurred vision, dizziness, palpitations
ipratropium bromide dose
Nebulizer: (acute) 500 mcg every 30 min for 3 doses, then every 2-4 hrs as needed.
nitroglycerin brand name
Rectiv, Nitrolingual, Nitro-Time, Nitrostat, and GoNitro
nitroglycerin class
antianginal, nitrate
nitroglycerin MOA
Dilates coronary arteries increasing blood flow, decresases left ventricular end-diastolic pressure, decreases preload, decreases myocardial O2 consumption.
nitroglycerin indications
acute and long-term management of angina pectoris
nitroglycerin contraindications
Known hypersensitivity, pericardial tamponade, pericarditis, PDE-5 use within last 24 hrs. Use with caution in patients with head trauma, cerebral hemorrhage, glaucoma, hypertrophic cardiomyopathy, severe liver impairment.
nitroglycerin dose
0.4 mg SL x3
5 mcg/min drip titrated to desired effect
0.4 mg (1 tablet or spray) max 3 doses
*monitor vital signs frequently. *air/light/temp extremes may cause deterioration
naloxone brand name
Narcan
naloxone class
antidote (opioids)
naloxone MOA
blocks effects of opioids, including CNS and respiratory depression, without producing any opioid-like effects
naloxone indications
suspected opioid overdose
naloxone contraindications
Known hypersensitivity. Use with caution in patients with CV disease and in patients physically dependent on opioids. May cause withdrawal symptoms.
naloxone side effects
ventricular arrhythmias, hyper- or hypotension, vomiting, nausea
naloxone dose
0.4 to 1 mg IM, slow IV push, subcutaneous; 2 mg intranasal
glucagon brand name
GlucaGen
glucagon class
hormone
glucagon MOA
increases blood sugar by releasing glycogen from the liver. Causes smooth muscle relaxation and positive inotropic and chronotropic effects of the heart.
glucagon indications
severe hypoglycemia and when glucose is not feasible
glucagon contraindications
Known hypersensitivity, pheochromocytoma. Use with caution in patients with renal or CV disease.
glucagon side effects
hypotension, nausea, vomiting, anaphylaxis
glucagon dose
1 mg IV/IM/SQ, may be repeated in 15 mins. Should only be used IM/SQ if unable to establish an IV.
activated charcoal class
antidote, adsorbent
activated charcoal MOA
adsorbs toxic substances or irritants, inhibits GI absorption. May include sorbitol, which promotes elimination of toxic substance through the GI tract.
activated charcoal indications
toxic ingestion within 60 minutes, following emesis or lavage
activated charcoal contraindications
Known hypersensitivity, inability to maintain/protect airway. Use with caution in poisonings involving petroleum distillates and caustic ingestions.
activated charcoal side effects
may cause vomiting, dark stool
activated charcoal dose
25 to 100 g PO or via NG/OG
nitrous oxide brand name
Nitronox
nitrous oxide class
medicinal gas, analgesic
nitrous oxide MOA
produces CNS depression and pain relief
nitrous oxide indications
moderate to severe pain management
nitrous oxide contraindications
Known hypersensitivity; decreased LOC. Patients with thoracic trauma, respiratory compromise, or abdominal distension. *Closely monitor; watch for nausea/vomiting.
nitrous oxide side effects
apnea, nausea/vomiting
nitrous oxide dose
self administered via inhalation
oxygen class
medicinal gas
oxygen MOA
enables the cells to break down glucose into usable energy
oxygen indications
used to treat severe chest pain, hypoxemia, and cardiac arrest
oxygen contraindications
None in out of hospital use. If patient has COPD, begin oxygen at lower rate.
oxygen side effects
none
oxygen dose
1-6 lpm via nasal cannula, 10-15 lpm via NRB
dextrose class
carbohydrate, hyperglycemic (antihypoglycemic)
dextrose MOA
dextrose in water increases the circulatory blood sugar level to normal
dextrose indications
treat patients in coma from hypoglycemia and patients in a coma of unkown cause. hypoglycemic patients.
dextrose contraindications
Known hypersensitivity. Do not use in patients with increased ICP or intracranial bleeding. *Use caution in patients who cannot tolerate carbohydrate agents.
dextrose side effects
May aggravate hypertension, may cause neurological symptoms in alcoholics, may cause skin necrosis, may cause Wernicke encephalopathy or Korsakoff syndrome in alcoholics.
dextrose dose
10-50 g slowly. May be repeated.
aspirin brand name
Bayer, Bufferin
aspirin class
antipyretic, nonopioid analgesic, salicylate
aspirin MOA
produces analgesia, reduces inflammation and fever by reducing production of prostaglandin, decreases platelet aggregation
aspirin indications
prophylaxis use in MI and TIA
aspirin contraindications
Known hypersensitivity. Do not give w/ bleeding disorders. *Use with caution in patients with history of GI bleeding, ulcer disease, chronic use of ETOH, severe renal/liver disease.
aspirin side effects
tinnitus, GI bleed, anaphylaxis, laryngeal edema
aspirin dose
162-324 mg chewed and swallowed for MI. Do not use enteric coated aspirin.
