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MD Drugs Flashcards

1
Q

Acetaminophen (Tylenol) - Adverse Effects

A

None

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2
Q

Acetaminophen (Tylenol) - Contraindications

A

1 - Head Injury
2 - Hypotension
3 - Dose w/in previos 4 hrs
4 - Resp Distress
5 - Persistent Vomiting
6 - Liver disease - ETOH
7 - Allergy

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3
Q

Acetaminophen (Tylenol) - Dose

A

2-4 - 160mg/5ml
5-12 2x 160mg/5ml
13+ 4x160mg/5ml or 2x 325mg pill w sips of water

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4
Q

Acetaminophen (Tylenol) - Indications

A

Pt 2 yo+ mild to moderate pain (1-5)

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5
Q

Activated Charcoal - Dose

A

1g/kg PO

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6
Q

Adenosine (Adenocard) - Adult Dose

A

1 - 6mg w IV bolus w rapid 20ml flush (wait 2 min)
2 - 12mg IV bolus w rapid 20ml flush (wait 2 min)
3 - 12mg IV bolus w 20 mL flush (wait 1-2 min)

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7
Q

Adenosine (Adenocard) - Adverse

A

Flushing, dyspnea, chest pressure, n/v, headache, dizziness, hypotension

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8
Q

Adenosine - Contraindications

A

Hx of moderate to severe asthma
Active bronchospasm

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9
Q

Adenosine (Adenocard) - Indications

A

Narrow complex tachycardia (SVT, PSVT w WPW)
No effect on Afib, Aflutter or VT
Pedi wide complex tachycardia (possible VT) can be used w caution

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10
Q

Adenosine (Adenocard) - MOA

A

Slows conduction thru AV node

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11
Q

Adenosine (Adenocard) - Pedi Dose

A

1 - 0.1mg/kg (max 6mg)
2 - 0.2mg/kg (max 12mg)
3 - 0.2mg/kg (max 12mg)

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12
Q

Adenosine (Adenocard) - Precautions

A
  • antagonized by theophylline
  • enhanced by dipyridamole, digitalis, carbamazepine, CCB, and benzodiazepines
  • up to 40 seconds of asystole
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13
Q

Albuterol - Adult Dose for bronchospasm

A

Inhaler - 2 doses (4 puffs) over 30 min
Neb - 2.5mg w 6-8 lpm. repeat 1x

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14
Q

Albuterol - Adult Dose for Hyperkalemia

A

Neb - 20mg w 6-8 lpm

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15
Q

Albuterol - Adverse

A

tachycardia, palpitations, peripheral vasodilation, tremors, headache, sore throat, PVCs, N/V

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16
Q

Albuterol - Contraindications

A

hypersensitivity

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17
Q

Albuterol - Indications

A

1 - bronchospasm
2 - hyperkalemia

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18
Q

Albuterol - MOA

A

Stimulates beta-2 adrenic receptors of the bronchioles

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19
Q

Albuterol - Pedi Dose for bronchospasm

A

Inhaler - 2 doses (4 puffs) over 30 min
Neb 2yo+ - 2.5mg w 6-8 lpm. repeat 1x
Neb <2yo - 1.25mg w 6-8 lpm. repeat 1x

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20
Q

Albuterol - Pedi Dose for Hyperkalemia

A

Neb 2yo+ - 2.5mg w 6-8 lpm.
Neb <2yo - 1.25mg w 6-8 lpm.

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21
Q

Albuterol - Pharmacokinetics

A

Bronchodilation begins with 5-15 min
Peak - 30-120 min
Duration - 3-4 hrs

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22
Q

Albuterol - Precautions

A
  • Use w caution w Pts w hyperthyroidism or coronary artery disease.
  • Use w caution w Pts on MAO inhibitors or tricyclic antidepressants as may be potentiated
  • Med Direction for pregnant pts or pts w cardiac Hx
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23
Q

Albuterol - Trade Names

A

Proventil
Ventolin

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24
Q

Amiodarone - Adult Dose

A

(1) w pulse 150mg in 100ml over 10 min (repeat 1x)
(2) wo pulse - VF/VT/TdP (after mag w TdP) 300mg IV then 150mg after 3-5 min

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25
Q

Amiodarone - Adverse Effects

A
  • Bradycardia
  • Hypotension
  • Prolonged QT
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26
Q

Amiodarone - Contraindications

A
  • 2nd and 3rd Deg blocks
  • Idioventricular Escape Rhythms
  • Accelerated IVR
  • Sinus brady, arrest or block
  • Hypotension
  • Cardiogenic Shock
  • Ventricular conduction defects
  • Iodine sensitivity
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27
Q

Amiodarone - Indications

A
  • Prevent recurrence of VFib/VT after defib or conversion
  • VT
  • VF
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28
Q

Amiodarone - Pedi Dose (Medical Direction)

A
  • w pulse 5mg/kg in 100 ml over 20 min
  • w/o pulse 5mg/kg max does 300mg. May repeat twice to max dose of 15mg/kg
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29
Q

Amiodarone - Pharmacokinetics

A

Blocks potassium and sodium ion permiability across myocardia membrane, which in effect stabilizes the ion channels. Also has some effect on beta receptors and calcium channels

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30
Q

Amiodarone - Pharmacology

A

Prolongs duration and refractory period of action potential. Slows conduction, electrical pulse generation from SA node and conduction through accessory pathways. Also dilates blood vessels

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31
Q

Amiodarone - Precautions

A
  • My prolong QT increasing risk to TdP and VF
  • Inhibits atrioventricular conduction and decreases myocardia contractility increasing the risk of AV blocks and hypotension with an CCB
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32
Q

ASA - Adverse Effects

A
  • Heartburn
  • N/V
  • Wheezing
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33
Q

ASA - Contraindications

A 
Hypersinsitivity 
Max dose (81mgx4=324mg) before EMS arrival
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34
Q

ASA - Dose

A

81mg x 4 = 324mg or 325 chewed

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35
Q

ASA - Indications

A

ACS or STEMI

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36
Q

ASA - Pharmacokinetics

A

Blocks platelet agragation

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37
Q

ASA - Pharmacology

A
  • Platelet inhibitor
  • Anti-inflammatory
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38
Q

ASA - Precautions

A

GI bleeding or upset

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39
Q

Atropine - Adult Dose - Bradycardia

A

0.5-1mg IVP every 3-5 min. Max dose 0.04mg/kg

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40
Q

Atropine - Adult Dose - Organophosphate Poison

A

2-4mg 3-5min (IVP or IM) every 5-10 min

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41
Q

Atropine - Contraindications

A
  • Hypersensitive
  • 2nd and 3rd Deg blocks
  • Suspected AMI or ischemia
  • Glaucoma
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42
Q

Atropine - Effects

A

Delirium, restlessness, disorientation, tachycardia, coma, flushed and hot skin, ataxia, blurred vision, dry mucous membranes

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43
Q

Atropine - Indications

A
  • Bradycardia
  • Organophosphate poison
  • Nerve agents
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44
Q

Atropine - Pedi Dose - Bradycardia

A

0.02mg/kg. Max single dose 0.5mg - repeat 1x
ET - 0.04-0.06mg/kg dilute in 5mL - repeat 1x

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45
Q

Atropine - Pedi Dose - Organophosphate Poison

A

0.02mg/kg IVP or IM every 5-10 min

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46
Q

Atropine - Pharmacology

A
  • Parasympatholytic (vagolytic action)
  • Anticholinergic (accelerates the heart rate)
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47
Q

Calcium Chloride - Adult Dose

A
  • 0.5 - 1g SLOW IVP over 10 min. Max dose 1g
  • 0.5g SLOW IVP for hypotension following
  • dilt administration
  • Resp depression, decreased reflexes, flaccid
    paralysis and apnea following mag sulfate admin
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48
Q

Calcium Chloride - Adverse Effects

A
  • Bradycardia may occur w rapid injection
  • Syncope, cardiac arrest, arrhythmias, bradycardia
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49
Q

Calcium Chloride - Contraindications

A
  • Not indicated in cardiac arrest except when hyperkalemia, hypocalcemia, or CCB OD is suspected
  • Pt taking digoxin w suspected CCB OD
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50
Q

Calcium Chloride - Indications

A
  • Hypocalcemia
  • Hyperkalemia
  • CCB OD
  • Hypotension due to dilt administration
  • Mag sulfate admin complications
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51
Q

Calcium Chloride - Pedi Dose

A

20mg/kg SLOW IVP/IO 50mg/min. Max dose 1g

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52
Q

Calcium Chloride - Pharamacology

A

Increase contractile state (+ inotropic). Increase ventricular automaticity. Helps stabilize cell membrane

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53
Q

Calcium Chloride - Pharmacokinetics

A
  • Rapid onset with IV administration
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54
Q

Dexamethasone (Decadron) - Adult Dosage

A

10mg IV or PO

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55
Q

Dexamethasone (Decadron) - Adverse Effects

A
  • Headache
  • Edema
  • Vertigo
  • Fluid retention
  • Adrenal insufficiency and immunosupression w LT use
  • HTN
  • CHF
  • N/V
  • Dyspepsia
  • Anaphylaxis
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56
Q

Dexamethasone (Decadron) - Contraindications

A
  • Hypersensitive to the drug
  • Known systemic fungal infection
  • Premature infants
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57
Q

Dexamethasone (Decadron) - Indications

A
  • Moderate to severe asthma exacerbation
  • Croup
  • Anaphylaxis
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58
Q

Dexamethasone (Decadron) - Pedi Dosage

A

Asthma - 0.5mg/kg (PO preferred) or IV to a max of 10mg
- Croup 0.5mg/kg PO/IV/IM max dose of 10mg

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59
Q

Dexamethasone (Decadron) - Precautions

A
  • Caution w diabetes
  • Known TB
  • Osteoporosis
  • Hepatic impairment
  • CHF
  • Seizure disorder
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60
Q

Dextrose - Contraindications

A
  • Known hyperglycemia
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61
Q

Dextrose - Precautions

A
  • Tissue necrosis if extravasation occurs
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62
Q

Dextrose - Adult Dose

A
  • If blood is less than 70mg/dL admin 10% dextrose in 50mL (5g) bolus one min apart to max of 250mL or 25g of D50 IVP until
  • Normal mental status
  • Blood glucose is grater than 90mg/dL
  • or if fully dosed and blood glucose less than
    90mg/dL redose
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63
Q

Dextrose - Adverse

A

May worsen hyperglycemia

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64
Q

Dextrose - Indications

A
  • Hypoglycemia
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65
Q

Dextrose - Pedi Dose

A

NEED TO DO

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66
Q

Dextrose - Pharacology

A

water-soluble monosaccharide found in corn syrup and honey

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67
Q

Dextrose - Pharmacokinetics

A
  • Restores circulating blood sugar and is rapidly
    utilized following IV injection
  • Excess dextrose is rapidly excreted unchanged in urine
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68
Q

Diazepam (Valium) - Adult Dose

A
  • 2.5mg SLOW IVP/IM
  • Medical direction if IM
  • Max of 10mg.
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69
Q

Diazepam (Valium) - Adverse effects

A
  • Lightheadedness
  • Motor impairment
  • Ataxia
  • Impairment of mental and psychomotor function, confusion, slurred speech, amnesia
  • Paradoxical irritability and excitation
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70
Q

Diazepam (Valium) - Contraindications

A
  • Hypersensitivity
  • Head injury
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71
Q

Diazepam (Valium) - Indications

A
  • Seizures
  • Severe nerve agent exposure
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72
Q

Diazepam (Valium) - Nerve agent exposure

A
  • No consult
  • Adult 10mg IM
  • Pedi if greater than 30kg - 0.1mg/kg max of 10mg
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73
Q

Diazepam (Valium) - Pedi Dose

A
  • 0.1 mg/kg SLOW IVP/IM.
  • max single dose 2.5mg.
  • Max total dose 5mg
  • Rectal dose 0.2mg/kg max dose of 10mg
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74
Q

Diazepam (Valium) - Pharmacokinetics

A
  • rapid onset
  • 1/2 life 20-90 min
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75
Q

Diazepam (Valium) - Pharmacology

A
  • Sedation, hypnosis, alleviation of anxiety, muscle relaxation, anticonvulsant activity
  • little cardiovascular effect
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76
Q

Diazepam (Valium) - Precautions

A
  • Pts w altered mental status
  • Hypotension
  • Acute narrow glaucoma
  • Resp depression if given to rapidly
  • Resp support may be required
  • Pregnant Pts
  • ETOH
  • Pt on sedatives
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77
Q

Diltiazem (Cardizem) - Adult Dose

A
  • 0.25 mg/kg (max 20mg) over 2 min
  • 15 min
  • 0.35 mg/kg (max 25mg) over 2 min
  • IF PT over 50yo w borderline BP, known renal failure, or CHF consider 5-10mg over 2 min
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78
Q

Diltiazem (Cardizem) - Adverse Effects

A
  • Headache
  • N/V
  • Bradycardia
  • Hypotension
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79
Q

Diltiazem (Cardizem) - Class

A

CCB

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80
Q

Diltiazem (Cardizem) - Contraindications

A
  • Hypersensitivity
  • Hypotension below 100mg.
  • 2nd and 3rd deg heart block
  • less than 18 yo
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81
Q

Diltiazem (Cardizem) - Indications

A

Afib and Aflutter

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82
Q

Diltiazem (Cardizem) - OD

A
  • If hypotensive and clear lungs - fluid bolus of 20mL/kg of LR - titrate to systolic of 100
  • If hypotensive and rales - max fluid bolus of 250mL of LR stop if obtain systolic of 100
  • Calcium Chloride 500mg SLOW IVP
  • If bradycardic consider 1mg of Atropine
  • If unstable consider pacing
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83
Q

Diltiazem (Cardizem) - Pedi Dose

A

Consult

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84
Q

Diltiazem (Cardizem) - Pharmacokinetics

A
  • Inhibits the movement of calcium ions across cardiac muscle cells
  • Decrease conduction velocity and ventricular rate
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85
Q

Diltiazem (Cardizem) - Precautions

A
  • CHF may result if used along with BB
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86
Q

Diltiazem (Cardizem) - Precautions

A
  • CHF
  • Pt w renal failure
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87
Q

DIPHENHYDRAMINE (Benadryl) - Adult Dosing

A

25-50mg SLOW IVP or IM

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88
Q

DIPHENHYDRAMINE (Benadryl) - Adverse Effects

A
  • Drowsiness
  • loss of coordination
  • Blurred vision
  • Headache,
  • Hypotension
  • Tachycardia
  • Palpitations
  • Thickening of bronchial secretions leading to chest
    tightness
  • Wheezing
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89
Q

DIPHENHYDRAMINE (Benadryl) - Contraindication

A
  • Sensitivity to drug
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90
Q

DIPHENHYDRAMINE (Benadryl) - Indications

A
  • Allergic reaction
  • Anaphylaxis
  • Dystonic reactions
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91
Q

DIPHENHYDRAMINE (Benadryl) - Pedi Dosing

A

1mg/kg SLOW IVP or IM

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92
Q

DIPHENHYDRAMINE (Benadryl) - Pharmacokinetics

A
  • effects begin w/in 15 min
  • 1/2 life of 2-10 hrs
  • Peak effect 1-4 hrs
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93
Q

DIPHENHYDRAMINE (Benadryl) - Pharmacology

A

Antihistamine

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94
Q

DIPHENHYDRAMINE (Benadryl) - Precautions

A

Should be used with caution in patients with:

  • Severe vomiting
  • Alcohol intoxication
  • Nursing mothers
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95
Q

Dopamine (Intropin) - Adult Dose

A

5-20 mcg/kg/min. Start at 5mcg. Titrate to 100 systolic

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96
Q

Dopamine (Intropin) - Adverse Effects

A

(1) Anginal pain
(2) Tachydysrhythmias
(3) Nausea and vomiting
(4) Hypertension
(5) Undesirable degree of vasoconstriction

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97
Q

Dopamine (Intropin) - Contraindications

A

(1) Preexisting tachydysrhythmias
(2) Uncorrected hypovolemia

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98
Q

Dopamine (Intropin) - Indications

A

(1) Cardiogenic shock
(2) Septic shock
(3) Anaphylactic shock
(4) Hypovolemic shock (after sufficient volume
replacement)

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99
Q

Dopamine (Intropin) - Pedi Dose

A

2-20 mcg/kg/min Start at 2mcg. Titrate to age appropriate BP

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100
Q

Dopamine (Intropin) - Pharmacokinetics

A

(1) Extremely rapid onset of action
(2) Extremely brief duration of action
(3) The rate of administration may be used to control
the effect of dopamine.

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101
Q

Dopamine (Intropin) - Pharmacology

A

(1) Alpha and beta adrenergic receptor stimulator
(2) Dopaminergic receptor stimulator
(3) Precursor of norepinephrine
(4) At low doses, less than 2 mcg/kg/min
(a) Dilates renal and mesenteric blood vessels
(b) Venoconstricts
(c) Arterial resistance varies
(5) At moderate doses, 2–6 mcg/kg/min beta1
stimulating effect on heart. Results in increased
cardiac output
(6) High dose, 6–10 mcg/kg/min. Exhibits
alpha1 effects; peripheral vasoconstriction
including renal and mesenteric vessels,
increases left and right ventricular preload
(7) Doses greater than or equal to 10 mcg/kg/min
Alpha1 stimulating effects may reverse mesenteric
and renal artery dilatation resulting in decreased
blood flow, causing increased preload due to effects
on venous system

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102
Q

Dopamine (Intropin) - Precautions

A

(1) Extravasation should be reported ASAP.
(2) Patients on monoamine oxidase (MAO) inhibitors are
extremely sensitive so should recive lower doses.
(3) Patients with pheochromocytoma are extremely
sensitive and may develop profound hypertension in
response to minimal doses.

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103
Q

Epinephrine (0.1mg/mL and 1mg/mL) - Adverse Effects

A

(1) Tachydysrhythmias (supraventricular and ventricular)
(2) Hypertension
(3) May induce early labor in pregnant women
(4) Headache
(5) Nervousness
(6) Decreased level of consciousness
(7) Rebound edema may occur 20–30 minutes after
administration to croup patients.

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104
Q

Epinephrine (0.1mg/mL and 1mg/mL) - Contraindications

A

(1) Hypertension
(2) Preexisting tachydysrhythmias with a pulse
(ventricular and supraventricular)
(3) Use with pregnant women should be avoided
whenever possible
(4) IV push epinephrine should not be administered to
any patient with a pulse

105
Q

Epinephrine (0.1mg/mL and 1mg/mL) - Indications

A

(1) Medical cardiac  arrest and pediatric traumatic arrest
(2) Moderate to severe allergic reaction/anaphylaxis
(3) Epinephrine infusion (IV/IO) should be reserved for patients in shock refractory to fluid bolus or for patients in anaphylactic shock
(4) Severe asthma
(5) Respiratory stridor (suspected croup)

106
Q

Epinephrine (0.1mg/mL and 1mg/mL) - Pharmacokinetics

A

(1) IV administered epinephrine has an extremely rapid
onset of action.
(2) Is rapidly inactivated by the liver
(3) Subcutaneous administration of epinephrine results
in slower absorption due to local vasoconstriction.
(4) Local massage will hasten absorption.
(5) Topically applied nebulizer within the respiratory
tract, epinephrine has vasoconstrictor properties
that result in reduction of mucosal and submucosal
edema. It also has bronchodilator properties that
reduce airway smooth muscle spasms.

107
Q

Epinephrine (0.1mg/mL and 1mg/mL) - Pharmacology

A

(1) The administration of epinephrine causes increases in:
(a) Systemic vascular resistance
(b) Systemic arterial pressure
(c) Heart rate (positive chronotropic effect)
(d) Contractile state (positive inotropic effect)
(e) Myocardial oxygen requirement
(f) Cardiac automaticity
(g) AV conduction (positive dromotropic effect)
(2) Causes bronchial dilation by smooth muscle
relaxation

108
Q

Epinephrine (0.1mg/mL and 1mg/mL) - Precautions

A

(1) Do not mix with sodium bicarbonate as this
deactivates epinephrine.
(2) Epinephrine causes a dramatic increase in
myocardial oxygen consumption.
(3) Its use in the setting of an acute MI should be
restricted to cardiac arrest.

109
Q

Epinephrine - Bradycardia Adult Dose

A

1mg in 100ml = COH of 10mcg/mL. Administer 10mcg/min on a 60 drop set
Infusion - 2-10 mcg/min

110
Q

Epinephrine - Bradycardia Pedi Dose

A

(0.1mg/mL) - 0.01mg/kg IV/IO every 3-5 min (KEY for PEDS…..0.1mL/kg so 10kg kid gets 1mL of 0.1mg/mL)

111
Q

Epinephrine - Cardiac Arrest Adult Dose

A

1mg 0.1mg/mL IVP/IO every 4 min (max dose of 4). If arrest after ROSC max dose of 2 more

112
Q

Epinephrine - Cardiac Arrest Pedi Dose

A

0.01mg/kg of 0.1mg/mL IV/IO every 4 min (max dose of 4) if arrest after ROSC max dose of 2 more (KEY for PEDS…..0.1mL/kg so 10kg kid gets 1mL of 0.1mg/mL

113
Q

Epinephrine - Croup Pedi Dose

A

(1mg/mL) 2.5mL via neb. (2 dose max)
Resp Distress/eminent failure - 0.01mg/kg (max dose of 0.5mg)

114
Q

Epinephrine - Reaction/Anaphylaxis/Asthma Adult Dose

A

(1mg/mL) 0.5 mg every 5 min - (max dose 3x)

115
Q

Epinephrine - Reaction/Anaphylaxis/Asthma Pedi Dose

A

(1mg/mL) > 5 yo 0.15mg every 5 min (3 dose max)
< 5yo 0.5mg every 5 min (3 dose max)

116
Q

Fentanyl - Adult Dosage

A

(1) 1mcg/kg IV/IO/IM - Max 200mcg
(2) reassess in 5-10 min.
(3) one more dose at 1mcg/kg - max 200mcg
(4) med control for more

117
Q

Fentanyl - Adverse Effects

A

(1) Respiratory depression/arrest
(2) Altered mental status
(3) Increased vagal tone due to suppression of
sympathetic pathways (slowed heart rate)
(4) Constricted pupils (pinpoint)
(5) Increased cerebral blood flow

118
Q

Fentanyl - Contraindications

A

(1) Allergy
(2) Uncorrected respiratory distress or hypoxemia
refractory to supplemental oxygen
(3) Uncorrected hypotension, defined as a persistent
systolic pressure less than 90 mmHg

119
Q

Fentanyl - Indications

A

(1) The patient reports moderate to severe pain.
(2) In the clinician’s judgment the patient will benefit
from treatment with an opioid analgesic, including
patients who are MOLST and/or EMS/DNR patients
or being pre-medicated for a procedure.

120
Q

Fentanyl - Pedi Dose

A

1) 1mcg/kg IV/IO/IM - Max 200mcg
(2) reassess in 5-10 min.
(3) one more dose at 1mcg/kg - max 200mcg
(4) med control for more

121
Q

Fentanyl - Pharmacokinetics

A

Onset of action is 2–3 minutes after IV dose and effects last 30 minutes to 1 hour.

122
Q

Fentanyl - Pharmacology

A

(1) Synthetic opioid binds with opiate receptors in the
CNS, altering both perception and emotional
response to pain.
(2) Fentanyl is significantly more potent than morphine.
100 mcg of fentanyl is equivalent to 10 mg of
morphine.

123
Q

Fentanyl - Precautions

A

(1) Naloxone reverses all effects.
(2) To reduce the risk of chest wall rigidity (especially in
children), fentanyl should be administered slowly
and titrated to effect.
(3) Vital signs should be monitored frequently.
(4) Hypotension is a greater possibility in volume-
depleted patients.
(5) Elderly patients and those with impaired renal
function may be more sensitive to the medication’s
effects.

124
Q

Glucagon - Adverse Effects

A

N/V

125
Q

Glucagon - Adult Dose - CCB OD

A

1mg IVP every 5 min

126
Q

Glucagon - Adult Dose Hypoglycemia

A

1mg IM/IN max 3mg

127
Q

Glucagon - Contraindications

A

Sensitivity

128
Q

Glucagon - Indications

A

(1) Patients with altered mental status who are
suspected of being hypoglycemic where IV access
is not obtainable
(2) Beta blocker overdose

129
Q

Glucagon - Pedi Dose - CCB OD

A

>5yo 0.5mg IVP every 5 min
5yo or < adult dose 1mg IVP every 5 min

130
Q

Glucagon - Pedi Dose Hypoglucemia

A

>5yo 0.5mg IM/IN max of 3mg
5yo or < adult dose 1mg IM/IN max 3mg

131
Q

Glucagon - Pharmacokinetics

A

(1) Destroyed by the GI tract and is not effective orally
(2) Maximum hyperglycemic activity occurs within 30
minutes and disappears after 1–2 hours.
(3) Relaxation of smooth muscle occurs within 8–10 minutes and persists for
12–27 minutes.
(4) The half-life is 3–10 minutes.
(5) Degraded in liver and kidneys

132
Q

Glucagon - Pharmacology

A

(1) Hormone synthesized by the pancreas
(2) Increases blood glucose concentration
(3) Inhibits gastric and pancreatic secretions
(4) May increase heart rate and cardiac output
(5) May decrease blood pressure
(6) Increases metabolic rate

133
Q

Glucagon - Precautions

A

Only works if liver has glycogen stores

134
Q

Haloperidol (Haldol) - Adult Dose

A

>69yo - 5mg IM
<68yo - 2.5 mg IM

135
Q

Haloperidol (Haldol) - Adverse Effects

A

(1) Dystonic reaction - Benadryl 25-50mg (adult) 1mg/kg - max 25mg
(pedi)
(2) Hypotension and tachycardia - LR fluid bolus
(3) TdP

136
Q

Haloperidol (Haldol) - Contraindications

A

(1) Children under 5 years of age
(2) Parkinson’s disease
(3) CNS depression
(4) Acute CNS injury
(5) Severe agitation (see midazolam and ketamine)

137
Q

Haloperidol (Haldol) - Indications

A 
Moderate agitation (defined as behavior that puts the patient or clinician at risk of harm) due to suspected psychiatric emergency (e.g., schizophrenia) or medical 
delirium
138
Q

Haloperidol (Haldol) - Pedi Dose

A

>5yo contraindicated
5-12 yo 0.05mg/kg IM max of 2.5mg IM
13yo+ 2.5-5mg IM

139
Q

Haloperidol (Haldol) - Pharmacokinetics

A

Onset of action is within 10 minutes of the IM administration

140
Q

Haloperidol (Haldol) - Pharmacology

A

Antipsychotic

141
Q

Haloperidol (Haldol) - Precautions

A

(1) Violent patients may require physical restraint while
the medication is administered.
(2) Patients receiving haloperidol should be placed on
cardiac monitor to evaluate for dysrhythmias.

142
Q

Ipratropium (Atrovent) - Adult Dose

A

(1) Single dose only
(2) 0.5mg (2.5mL) in combination w 2.5mg of Albuterol

143
Q

Ipratropium (Atrovent) - Adverse Effects

A

(1) More common: dry mouth, cough, or unpleasant
taste
(2) Less common: vision changes, eye burning or pain,
dizziness, headache, nervousness, palpitations,
sweating, trembling, chest tightness, rash, hives, or
facial sweating

144
Q

Ipratropium (Atrovent) - Contraindications

A

(1) Sensitive to drug or atropine
(2) >1yo

145
Q

Ipratropium (Atrovent) - Indications

A

(1) Allergic reactions/anaphylaxis
(2) Bronchial asthma
(3) Reversible bronchospasms associated with chronic
bronchitis and emphysema

146
Q

Ipratropium (Atrovent) - Pedi Dose

A

(1) Single dose only
(2) less than 1yo - Contraindicated
(3) b/t 1 & 2 yo 0.25mg w Albuterol
(4) 3yo+ Adult dose

147
Q

Ipratropium (Atrovent) - Pharmacokentics

A

(1) Improved pulmonary function in 15–30 minutes
(2) Peak effects occur in 1–2 hours.
(3) Duration of action is usually 4–5 hours.

148
Q

Ipratropium (Atrovent) - Pharmacology

A

(1) Anticholinergic (parasympatholytic) bronchodilator
(2) Bronchodilator is site-specific, not systemic
(3) Dries respiratory tract secretions
(4) Most effective in combination with a beta-adrenergic
bronchodilator

149
Q

Ipratropium (Atrovent) - Precautions

A

(1) Use with caution in patients with congestive heart
failure, heart disease, hypertension, glaucoma, and
with elderly patients.
(2) May worsen the condition of glaucoma if it gets into
the eyes. Having the patient close their eyes during
nebulization may prevent this.
(3) Not to be used as a single agent—must be used in
combination with a beta-agonist.

150
Q

Ketamine - Adult Dose CPR Induced Awareness

A

1mg/kg IV/IO. Additional dose require medical consult

151
Q

Ketamine - Adult Dose Pain

A

(1) 0.2mg/kg IV/IO over 2 min. Max 20mg - Reassess
after 5-10 min. If still pain, same dose as before over
2 min
(2) If IV unavailable 0.5mg/kg IM/IN. - Reassess after 15
min. If still pain same dose as before

152
Q

Ketamine - Adult Dose Severe Agitation

A

(1) IV/IO - 1mg/kg. Max dose 100mg. If agitation
persists same dose as before. Max total dose
200mg
(2) IM/IN 4mg/kg max dose 400mg. Additional dose
requires medical consult.

153
Q

Ketamine - Adult Dose Vent Bucking

A

2mg/kg IV/IO over 60 seconds. 2 additional doses at 1mg/kg

154
Q

Ketamine - Adverse Effects

A

(1) Although respiration is frequently stimulated,
respiratory depression may occur with rapid IV
administration. Laryngospasm has been known to
occur.
(2) Although hypotension may occur, blood pressure
and heart rate are frequently stimulated.
(3) Involuntary myoclonus that may mimic seizure
activity – these movements should not be confused
for seizures of emergence from sedation.
(4) Possible enhanced secretions
(5) Possible unpleasant dreams and delirium upon
emergence from sedation

155
Q

Ketamine - Contraindications

A

(1) Sensitivity
(2) Penetrating eye injury
(3) Chest, abdominal, flank pain or headache

156
Q

Ketamine - Indications

A

(1) Moderate to severe pain; musculoskeletal, extremity,
and back pain
(2) Severe agitation
(3) Ventilatory difficulty secondary to bucking or
combativeness in intubated patients
(4) CPR-induced awareness

157
Q

Ketamine - Pedi Dose CPR Induced Awareness

A

Need to consult

158
Q

Ketamine - Pedi Dose Pain

A

SAME AS ADULT
(1) 0.2mg/kg IV/IO over 2 min. Max 20mg - Reassess
after 5-10 min. If still pain, same dose as before over
2 min
(2) If IV unavailable 0.5mg/kg IM/IN. - Reassess after 15
min. If still pain same dose as before

159
Q

Ketamine - Pedi Dose Severe Agitation

A

SAME AS ADULT
(1) IV/IO - 1mg/kg. Max dose 100mg. If agitation
persists same dose as before. Max total dose
200mg
(2) IM/IN 4mg/kg max dose 400mg. Additional dose
requires medical consult.

160
Q

Ketamine - Pedi Dose Vent Bucking

A

SAME AS ADULT
2mg/kg IV/IO over 60 seconds. 2 additional doses at 1mg/kg

161
Q

Ketamine - Pharmacokinetics

A

A rapid-acting, non-barbiturate, sedative-hypnotic analgesic agent characterized by normal pharyngeal-laryngeal reflexes, normal or enhanced skeletal muscle
tone, and possible cardiovascular and respiratory stimulation. It may occasionally produce transient respiratory depression.
Onset - IV/IO 5-10 min. IM/IN 15-20 min

162
Q

Ketamine - Pharmacology

A

Sedative-hypnotic; analgesic

163
Q

Ketamine - Precautions

A

(1) Cardiac and respiratory function should be
continuously monitored
(2) Some patients who have received ketamine for
control of severe agitation may require advanced
airway management.
(3) Ketamine is supplied in multiple concentrations (10
mg/mL, 50 mg/mL and 100 mg/mL). DBL CK .
(4) Ketamine 100 mg/mL concentration is best for IM/IN.
(5) Ketamine 10 mg/mL concentration is preferable for
IV administration for analgesia.

164
Q

Ketorolac (Toradol) - Adult Dose

A 
15mg IV (1 dose) 
30mg IM (1 dose)
165
Q

Ketorolac (Toradol) - Adverse Effects

A

a) Burning or pain at the injection site
b) Rash / itching
c) GI distress
d) Nausea / vomiting

166
Q

Ketorolac (Toradol) - Contraindications

A

a) Hypersensitivity to ketorolac, aspirin, and other NSAIDs
b) Current usage of aspirin or NSAIDs within 6 hours
c) Severe headache or head injury
d) Bleeding or clotting disorder
e) Renal disease or transplant
f) Active or history of peptic ulcer disease (PUD), active
or recent history of GI bleed, and active or history of
GI perforation
g) Pregnancy or breast feeding
h) Suspected ACS
i) Trauma with suspected bleeding
j) Younger than 2yo

167
Q

Ketorolac (Toradol) - Indications

A

a) Management of moderate to severe acute pain
b) Consider as a first line medication for renal
stones/colic
c) Burns - mild to moderate
d) Non-traumatic neuromuscular pain

168
Q

Ketorolac (Toradol) - Pedi Dose

A

0.5mg/kg IV - max 15mg (1 dose)
1mg/kg IM - max 30 mg (1 dose)

169
Q

Ketorolac (Toradol) - Pharmacokinetics

A

a) Onset: Approximately 30 minutes
b) Peak effects: 1-2 hours
c) Half-life: 4-6 hours

170
Q

Ketorolac (Toradol) - Pharmacology

A

a) Inhibits synthesis of prostaglandin, which, in turn,
reduces pain and inflammation
b) Antipyretic agent
c) Does not affect CNS, peripheral acting analgesic,
therefore, it does not possess the same sedative
properties as a narcotic

171
Q

Lactated Ringers - Adult Dose Multiple/Sever Trauma w Head Injury

A

(1) Small boluses (max of 250mL) bf BP ck.
(2) Titrate to BP of 110 mmHg
(3) max dose of 2L

172
Q

Lactated Ringers - Adult Dose Multiple/Sever Trauma wo Head Injury

A

(1) Small boluses (max of 250mL) bf BP ck.
(2) Titrate to BP of 90 mmHg
(3) max dose of 2L

173
Q

Lactated Ringers - Adult Dose wo Multiple/Sever Trauma

A

(2) Titrate to 90 mmHg
(3) max dose of 2L

174
Q

Lactated Ringers - Contraindications

A

Fluid overload states

175
Q

Lactated Ringers - Indications

A

(1) Hypovolemia (limitation in multiple/severe trauma
without head injury)
(2) Keep vein open
(3) Fluid boluses

176
Q

Lactated Ringers - Pedi Dose

A

(1) KVO
(2) For hypotension 20mL/kg IV/IO unless
neonate/volume sensitive than 10mL/kg
(3) If BP does not improve second bolus
(4) 3+ bolus need med consult

177
Q

Lactated Ringers - Pharmacokinetics

A

Water and electrolyte replacement

178
Q

Lactated Ringers - Pharmacology

A

Isotonic crystalloid solution

179
Q

Lactated Ringers - Precautions

A

(1) Watch for fluid overload
(2) Use with caution in patients with CHF and renal failure.

180
Q

Lidocaine (Xylocaine) - Adult Dose IO Infusion

A

20-40mg of 2% lidocaine (1-2mL)

181
Q

Lidocaine (Xylocaine) - Adult Dose Nasal Pharyngeal Anesthesia

A

4mL of 4% (40mg/mL) and 2mL up each nares w atomizer

182
Q

Lidocaine (Xylocaine) - Pedi Dose IO Infusion

A

(1) 13 or older - Adult dose 20-40mg of 2%
(2) Younger than 13 - med consult

183
Q

Lidocaine (Xylocaine) - Pedi Dose Nasal Pharyngeal Anesthesia

A

1) 13 or older - 4mL of 4% (40mg/mL) and 2mL up each
nares w atomizer
(2) Younger than 13 - med consult

184
Q

Lidocaine (Xylocaine) - Adverse Effects

A

(1) Lidocaine may cause clinical evidence of toxicity
usually related to the central nervous system.
(2) Toxicity:
(a) Early: muscle twitching, slurred speech, altered
mental status, decreased hearing, paresthesia (pins
and needles), anxiety, apprehension, visual
disturbances, nausea, numbness, difficulty breathing
or swallowing, decreased heart rate
(b) Late: convulsions, hypotension, coma, widening
of QRS complex, prolongation of the P-R interval,
hearing loss, hallucinations

185
Q

Lidocaine (Xylocaine) - Contraindications

A

(1) Sensitivity to lidocaine
(2) AV blocks
(3) IVR escape rhythms
(4) Accelerated iIVR
(5) Sinus bradycardia or arrest or block
(6) Hypotension
(7) Shock
(8) Ventricular conduction defects

186
Q

Lidocaine (Xylocaine) - Indications

A

(1) Anesthesia for IO infusions
(2) Nasal tracheal intubation

187
Q

Lidocaine (Xylocaine) - Pharmacokinetics

A

(1) IV - Extremely rapid (within minutes) lasts approximately 10–20 minutes
(2) Mucosal anesthesia with onset in 1–5 minutes

188
Q

Lidocaine (Xylocaine) - Precautions

A

Reduce the dosage in patients with decreased cardiac output, liver dysfunction, and the elderly (over age 70).

189
Q

Mag Sulf - Adult Dose - Pregnancy Seizure

A

4g IV/IO mixed w 50-100mL over 10 min

190
Q

Mag Sulf - Adult Dose - Refractory VT/VF

A

1-2g IV/IO over 2 min

191
Q

Mag Sulf - Adult Dose - Severe Asthma/Bronchospasm

A

1-2g IV/IO mixed 50-100mL over 10-20min (MED DIRECTION)

192
Q

Mag Sulf - Adult Dose - TdP

A

1-2g IV/IO over 2 min

193
Q

Mag Sulf - Adverse Effects

A

(1) Respiratory depression
(2) Flushing
(3) Sweating
(4) Hypotension
(5) Depressed reflexes

194
Q

Mag Sulf - Contraindications

A

(1) Heart blocks
(2) Renal impairment
(3) Hypermagnesemia

195
Q

Mag Sulf - Pedi Dose - Pregnancy Seizure

A

4g IV/IO mixed w 50-100mL over 10 min

196
Q

Mag Sulf - Pedi Dose - Severe Asthma/Bronchospasm

A

50mg/kg (max 2g) IV/IO mixed 50-100mL over 10-20min (MED DIRECTION) - Also think about LR fluid bolus of 20mL/kg to support BP

197
Q

Mag Sulf - Pedi Dose - TdP

A

25mg/kg (max 2g) IV/IO over 2 min

198
Q

Mag Sulf - Precautions

A

(1) May exaggerate effects of CNS depressants and
neuromuscular blocking agents
(2) Due to concern of hypotension, IV fluid bolus should
be initiated if hypovolemia is suspected.
(3) Mag tox presents with respiratory
depression, decreased reflexes, flaccid paralysis,
and apnea. Calcium chloride 500 mg SLOW IVP
antidote.

199
Q

Mag Sulfate - Indications

A

(1) Torsades de pointes
(2) Seizures with pregnancy
(3) Refractory VF and VT after amiodarone
administration
(4) Moderate to severe asthma/bronchospasm
exacerbation

200
Q

Mag Sulfate - Pharmacokinetics

A

With intravenous administration the onset of anticonvulsant action is immediate and
lasts about 30 minutes. Magnesium is excreted solely by the kidney at a rate proportional to the plasma concentration and glomerular filtration rate.

201
Q

Mag Sulfate - Pharmacology

A

Physiologic calcium channel blocker and also blocks neuromuscular transmission. Hypomagnesemia can cause cardiac dysrhythmias. It is also a CNS depressant effective in the management of seizures during pregnancy. It does this by decreasing the amount
of acetylcholine liberated from motor nerve terminals. Magnesium is necessary for many biochemical processes and plays a role in the transmission of electrical impulses.

202
Q

Midazolam (Versed) - Adult Dosing

A

(1) 0.1 mg/kg in 2mg increments SLOW IVP over 1-2 min per increment w max dosage of 5mg
(2) If IV unavailable 5mg IN/IM - IN max 1mL per nare
(3) Additional doses to 10mg require med control

203
Q

Midazolam (Versed) - Adult Dosing - Agitation

A

(1) 18-69 yo 5mg IM/IV
(2) >69 yo 2.5 mg IM/IV
(3) if you gave ketamine first 2.5mg IV/IO after med direction

204
Q

Midazolam (Versed) - Adult Dosing - Nerve Agent Exposure

A

5mg IM wo Med Control

205
Q

Midazolam (Versed) - Adverse Effects

A

(1) Respiratory depression or apnea
(2) Hypotension

206
Q

Midazolam (Versed) - Contraindications

A

(1) Hypotension (See below for ET bucking)
(2) Hypersensitivity

207
Q

Midazolam (Versed) - Indications

A

(1) Sustained and/or recurrent seizures
(2) Precardioversion to reduce anxiety
(3) Awake patient requiring transcutaneous pacing (TCP)
(4) Nasal Tracheal Intubation
(5) Implanted Cardioverter Defibrillator (ICD) Malfunction
(6) Nerve/organophosphate exposure
(7) Bucking Endotracheal Intubated patient
(8) Moderate to severe stimulant toxicity
(9) Moderate or severe agitation

208
Q

Midazolam (Versed) - Pedi Dosing

A

(1) 0.1mg/kg in 2mg increments SLOW IVP over 1-2 min per increment w max dosage of 5mg
(2) If IV unavailable 0.2 mg/kg (Max 5mg) IN/IM - IN max 1mL per nare

209
Q

Midazolam (Versed) - Pedi Dosing - Agitation

A

Med Direction required

(1) 13-18 if you gave ketamine first 2.5mg IV/IO
(2) 13-18 yo if IV/IO unavail and ketamine admin IM, give 5mg IM

210
Q

Midazolam (Versed) - Pedi Dosing - Nerve Agent Exposure

A

5mg IM wo Med Control

211
Q

Midazolam (Versed) - Pharmacokinetics

A

(1) Short-acting benzo with strong hypnotic,
anticonvulsant activity, and amnestic properties
(2) Extremely rapid onset - IV 1.5 minutes. IM 15 min
(3) Duration 1–4 hours - half-life of 1.5 to 3 hours in
healthy adult.

212
Q

Midazolam (Versed) - Pharmacology

A

(1) Sedative
(2) Hypnotic
(3) Anticonvulsant

213
Q

Midazolam (Versed) - Precautions

A

(1) Effects can be accentuated/potentiated by CNS
depressants, such as opioids or alcohol.
(2) 5x as potent as diazepam
(3) Increased risk of respiratory depression.

214
Q

Morphine - Adult Dose

A

(1) 0.1 mg/kg max 20mg - IV/IM
(2) reassess 5-10 min
(3) 0.05 mg/kg max 10mg
(4) med control for more

215
Q

Morphine - Adverse Effects

A

(1) Respiratory depression/arrest
(2) Altered mental status (Dec Loc)
(3) Increased vagal tone due to suppression of sympathetic pathways (slowed heart rate)
(4) Nausea and vomiting
(5) Constricted pupils (pinpoint)
(6) Increased cerebral blood flow

216
Q

Morphine - Contraindications

A

(1) Hypersensitivity or known allergy to morphine
(2) Uncorrected respiratory distress or hypoxemia
(3) Uncorrected hypotension, e.g. < 90 mmHg systolic

217
Q

Morphine - Indications

A

(1) The patient reports moderate to severe pain.
(2) In the clinician’s judgment the patient will benefit
from treatment with an opioid analgesic, including
patients who are MOLST and/or EMS/DNR patients
or being pre-medicated for a procedure.
(3) Pulmonary Edema/Congestive Heart Failure (Pediatric only)

218
Q

Morphine - Pedi Dose

A

Same as adult

(1) 0.1 mg/kg max 20mg - IV/IM
(2) reassess 5-10 min
(3) 0.05 mg/kg max 10mg
(4) med control for more

219
Q

Morphine - Pedi Dose - Pulmonary Edema/CHF

A

(1) 0.1 mg/kg max 5 mg.
(2) SLOW IV/IO/IM push 1-2 mg/min

220
Q

Morphine - Pharmacokinetics

A

(1) Binds with opiate receptors, altering both
perception and emotional response to pain
(2) Onset <5 minutes after IV and lasts 4–5 hours.
(3) Causes peripheral arterial and venous vasodilation

221
Q

Morphine - Pharmacology

A

(1) Decreases pain perception and anxiety
(2) Relaxes respiratory effort
(3) Causes peripheral dilation, which decreases preload
(4) Decreases left ventricular afterload

222
Q

Morphine - Precautions

A

(1) Naloxone reverses all effects.
(2) Should be administered slowly and titrated to effect.
(3) Vital signs should be monitored frequently.
(4) Hypotension is a greater possibility in volume-
depleted patients.

223
Q

Naloxone (Narcan) - Adult Dosage

A

(1) 0.4-2mg IVP/IO/IN - TITRATE
(2) max 1mL/nare

224
Q

Naloxone (Narcan) - Adverse Effects

A

Opioid withdrawal

225
Q

Naloxone (Narcan) - Contraindications

A

Patients under 28 days of age.

226
Q

Naloxone (Narcan) - Pedi Dosage

A

(1) 0.1 mg/kg IV/IO/IN 2 mg max - TITRATE
(2) max 1mL/nare

227
Q

Nitroglycerin - Adult Dose - Chest Pain

A

(1) w HX of Nitro use - 0.4mg SL 3x
(2) 3-5 min between
(3) no HX establish IV first that dose normally

228
Q

Nitroglycerin - Adult Dose - Pulmonary Edema/CHF

A

(1) low dose - 0.4 mg SL 3x
(2) high dose (until CPAP or CPAP not tollerated)
(a) 0.4mg SL and 1 “ of NTG paste
(b) 0.8mg SL
(c) continue 0.8 mg SL until 20% reduction of BP

229
Q

Nitroglycerin - Adverse Effects

A

Headache, hypotension, nausea, vomiting, dizziness, and decreased level of consciousness

230
Q

Nitroglycerin - Contraindications

A

(1) Hypersensitivity
(2) Under 13
(3) Pt taking meds for Pulmonary Artery Hypertension (e.g., Adcirca® or Revatio®)
(4) ED within past 48 hours. Med con to over-ride
(5) Asymptomatic hypertension
(5) BP below 90 mmHg systolic
(6) Heart rate < 60 > 150

231
Q

Nitroglycerin - Indications

A

(1) For treatment of angina
(2) Congestive heart failure, acute pulmonary edema

232
Q

Nitroglycerin - Pedi Dose

A

Med Consult

233
Q

Ondansetron (Zofran) - Adult Dosing

A

(1) 8mg SLOW IV over 2-5 min
(2) 4-8mg IM
(3) 8mg orally disintegrating
(4) may repeat once wo Med Consult

234
Q

Ondansetron (Zofran) - Adverse Effects

A

(1) Hypotension
(2) Tachycardia
(3) Extrapyramidal reactions
(4) Seizures
(5) QT interval prolongation

235
Q

Ondansetron (Zofran) - Contraindications

A

(1) sensitivity
(2) under 28 days

236
Q

Ondansetron (Zofran) - Indications

A

Prevention and control of nausea and/or vomiting

237
Q

Ondansetron (Zofran) - Pedi Dosing

A

(1) 28 days to 12 - 0.1 mg/kg SLOW IV (2-5 min)
(2) 13-18 yo same as Adult except IM
(a) 8mg SLOW IV over 2-5 min
(b) 8mg orally disintegrating
(c) 0.1 mg/kg max of 8 mg IM
(3) may repeat once wo Med Consult

238
Q

Ondansetron (Zofran) - Pharmacokinetics

A

Anti-nausea/Anti-emetic 5-15 min w IV 30 min w IM

239
Q

Ondansetron (Zofran) - Pharmacology

A

A selective blocking agent of the serotonin 5-HT3 receptor type

240
Q

Ondansetron (Zofran) - Precautions

A

Monitor EKG, pulse ox and BP

241
Q

Sodium Bicarb - Adult Dosage

A

(1) after airway is secured
(2) 1mEq/kg IVP bolus w 0.5 mEq/kg at 10 min intervals

242
Q

Sodium Bicarb - Adult Dosage - HyperK

A

(1) 50mEq SLOW over 5 min then
(2) 100mEq in 1L LR over 30-60 min

243
Q

Sodium Bicarb - Adverse Effects

A

(1) Worsened intracellular acidosis due to carbon
dioxide formation
(2) Hyperosmolality
(3) May precipitate congestive heart failure
(4) Metabolic alkalosis
(5) Acute hypokalemia
(6) Exacerbation of central venous acidosis
(7) Shifting the oxyhemoglobin dissociation curve,
inhibiting the release of oxygen to the tissues

244
Q

Sodium Bicarb - Contraindications

A

alkalosis

245
Q

Sodium Bicarb - Indications

A

(1) Cardiac arrest (last try)
(2) Hyperkalemia
(3) Tricyclic and phenobarbital overdose
(4) Pretreatment for patients with decreased renal
function who will be receiving IV contrast dye

246
Q

Sodium Bicarb - Pedi Dosage

A

(1) after airway is secured
(2) older than 1yo. Adult dose- 1mEq/kg IVP bolus w 0.5 mEq/kg at 10 min intervals
(3) if <1yo Adult dose diluted 1:1 w LR

247
Q

Sodium Bicarb - Pedi Dosage - HyperK

A

(1) 1mEq/kg IV over 5 min
(2) if <1yo then 1mEq/kg diluted 1:1 w LR

248
Q

Sodium Bicarb - Pharmacokinetics

A

(1) Rapid onset of action in the blood
(2) Delayed onset of action in the tissues

249
Q

Sodium Bicarb - Pharmacology

A

Sodium bicarbonate corrects acidosis

250
Q

Sodium Bicarb - Precautions

A

(1) Inactivates simultaneously-administered
catecholamines
(2) Priorities before use:
(a) Intubation
(b) Hyperventilation
(c) Defibrillation
(d) Epinephrine
(e) Antiarrhythmics

251
Q

Verapamil (ISOPTIN) - Adult Dosage

A

(1) 2.5–10 mg slow IV over 2 minutes
(2) may repeat same dose in 15 min w Med Consult

252
Q

Verapamil (ISOPTIN) - Adverse Effects

A

(1) Hypotension
(2) Bradycardia
(3) Vomiting
(4) Nausea
(5) Headache

253
Q

Verapamil (ISOPTIN) - Contraindications

A

(1) BP below 100 mmHg, 2nd or 3rd heart block,
(2) PMHx of WPW
(3) Ventricular tachycardia
(4) Patients less than 18 years of age

254
Q

Verapamil (ISOPTIN) - Indications

A

AFib & AFlutter

255
Q

Verapamil (ISOPTIN) - OD

A

(1) Monitor Vitals and Admin O2
(2) Hypotension
(a) Lungs clear 20mL/kg fluid bolus of LR titrate to
100mmHG
(b) if rales present admin max of 250mL of LR titrate
to 100mmHg
(c) Admin Calcium Chloride 500mg SLOW IVP
(3) Brady Cardia
(a) Atropine 0.5 - 1mg
(b) pacing

256
Q

Verapamil (ISOPTIN) - Pedi Dose

A

NONE

257
Q

Verapamil (ISOPTIN) - Pharmacokinetics

A

(1) Inhibits calcium ions across cardiac muscle cells
(2) Decreases conduction velocity and ventricular rate

258
Q

Verapamil (ISOPTIN) - Pharmacology

A

CCB

259
Q

Verapamil (ISOPTIN) - Precautions

A

(1) Beta Blockers - u will kill them!
(2) Pts with renal or congestive heart failure

Drugs (2 decks)

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