ME Meds Flashcards
Ipratropium/ Atrovent) Contraindications:
Adverse Effects:
= Known hypersensitivity
= Blurred vision, Dry mouth, Dilated pupils, Cough, Confusion
Ipratropium/ Atrovent) Pharmacodynamics:
Indications:
= Anticholinergic; Selectively blocks muscarinic receptors
= Bronchospasm associated w/ obstructive lung diseases (asthma, COPD)
Ipratropium/ Atrovent) route
Adult Dose:
Pediatric Dose:
= w/ SVN albuterol
= 500 mcg/2.5 mL
=250-500mcg/1.25-2.5 m
Glucagon dynamics for Ca-blockers OD
= heart has Glucagon receptors on SA & AV, opens up Ca via upregulation cells to allow Ca inflex, as a work around to increase HR (Ca-Cl> then gluc)
Dexamethasone) Indi:
Contra:
= Bronchial asthma, COPD, Anaphylaxis
= Known hypersensitivity, (Relative) Known fungal infection
Dexamethasone) Adult Dose:
Pediatric Dose:
Effects:
= 10 mg IV/IO/PO “better>sol-med”
= 0.5 mg/kg (max of 10 mg IV/IO/PO)
= Fluid retention (Peripheral edema) & May delay wound healing & small Increase in BGL (careful w/ diabetics)
Dexamethasone) Class:
Class/med Will:
= Synthetic glucocorticoid Anti-inflammatory
= Suppresses immune response
Diazepam/Vallium) Dynamics:
Indications:
Contra:
Dose:
= Benzodiazepine. Binds w/ GABA receptors causing an influx of Cl
= Tcardia due to stimulant OD, Substained seizures. Anxiety. Sedation.
= Hypersensitivity
= 2.5-10 mg in 2.5 mg increments slow IV/IO/IM
Flumazenil) Dose:
= 0.2 mg IV/IO q30 seconds max 3 mg
Hydroxocobalamin) Dynamics:
Indications:
Contra:
Dose:
= Binds w/ cyanide to form nontoxic cyanacobalamin (Vitamin B12), preventing its toxic effects.
= Suspected cyanide poisoning
= Hypersensitivity
= 5Gs IV/O over 15 mins. May repeat 2nd 5G dose (max 10G)
Hydroxocobalamin)Dose:
= 5Gs IV/O over 15 mins. May repeat 2nd 5G dose (max 10G)
Ketamine) Dynamics:
Indications:
Contra:
Sedation Dose:
Pain dose:
= Dissociative anesthetic. NMDA Receptor Antagonist Anesthetic
= Sedation, SFI/RSI, Analgesic
= Hypersensitivity
= Sedation: 1-2 mg/kg Onset: 30-60 secs, Duration: 10-20 mins
= Pain: 0.2 mg/kg IV/IO (max single dose 20 mg), 0.5 mg/kg IM/IN (if no IV/IO)
Ketamine) Sedation Dose:
Pain dose:
= Sedation: 1-2 mg/kg Onset: 30-60 secs, Duration: 10-20 mins
= Pain: 0.2 mg/kg IV/IO (max single dose 20 mg), 0.5 mg/kg IM/IN (if no IV/IO)
Lorazepam/ Ativan) Dynamics:
Indications:
Contra:
Dose:
= Benzodiazepines, Binds w/ GABA receptors causing an influx of Cl
= Sustained seizures, anxiety, sedation, chemical restraint
= Hypersensitivity
= 2-4 mg (may repeat to a max dose of 8 mg)
Lorazepam/ Ativan) Dose:
= 2-4 mg (may repeat to a max dose of 8 mg)
Magnesium Sulfate) Adult Bronchodilation dose:
Pediatric Bronchodilation dose:
= 1-2 grams IV / 10-20 minutes (Infusion)
= 25-50 mg/kg IV (max 2Gs) /15-30 mins (Infusion)
Magnesium Sulfate) Pharmacodynamics
Indications:
Contraindications
= Organic Salt act as physiologic Ca channel blocker thus Bronchodilator
= Bronchial asthma, Torsades des pointes, Eclampsia
= High-degree HB, Shock, Dialysis, Hypocalcemia, V-Fib/pulseless VTach
Methylene Blue) Dose:
= 1 mg/kg IV/IO over 5-30 minutes.
Midazolam (Versed) Dynamics:
Indications:
Contra:
Seizures Dose:
RSI Dose:
= Benzodiazepine, binds w/ GABA receptors causing an influx of Cl
= Active seizures, Chemical restraint, Anxiety, RSI/SFI, Sedation
= Hypersensitivity
= 0.2 mg/kg in 2 mg increments IV/IO (max 10 mg). 5 mg IM/IN
= 0.1-0.3 mg/kg slow IV/IO (max 10 mg) Onset: 2-5 mins. Duration: 15-30 mins.
Midazolam (Versed) Seizures Dose:
RSI Dose:
= 0.2 mg/kg in 2 mg increments IV/IO (max 10 mg). 5 mg IM/IN
= 0.1-0.3 mg/kg slow IV/IO (max 10 mg) Onset: 2-5 mins. Duration: 15-30 mins.
Morphine) Dynamics:
indications:
Contra:
= Narcotic (Schedule II Opioid) Analgesia & sedation via binding to opiate receptor
= Ischemic chest pain not relieved by Nitroglycerin
= Hypersensitivity. Uncorrected hypotension (<90 SBP)
Morphine) Analgesia:
STEMI:
NSTEMI-ACS:
= 2-10 mg up to max 20 mg.
= 2-4mg slow IV/O, may admin 2nd dose 2-8mg IV/IO q5-15 mins
= 0.1 mg/kg slow IV/IO or IM up to 10 mg
Sodium Bicarbonate 8.4%) Dynamics:
Indications:
Contra:
Suspected acidosis Dose:
Hyperkalemia Dose:
= Alkalinizing Agent. Increases plasma bicarbonate, buffers excess hydrogen ion concertration, raises blood pH & reverses clinical manifestations of acidosis.
= Suspected hyperkalemia, suspected bicarbonateresponsive acidosis (DKA, OD on TCA’s, Aspirin or Cocaine)
= Patients in cardiac arrest
= 1 mEq/kg, Hyperkalemia:
= 50 mEq IV bolus.
Sodium Bicarbonate 8.4%)
Suspected acidosis Dose:
Hyperkalemia Dose:
= Patients in cardiac arrest
= 1 mEq/kg, Hyperkalemia:
= 50 mEq IV bolus.
Solu-Medrol) Indications:
Contraindications :
= (same as Dexy) Bronchial asthma, COPD, Anaphylaxis
= Known hypersensitivity to medication
Solu-Medrol) Adult Dose:
Pediatric Dose:
Adverse Effects:
= 125-250 mg IV/IO
= 2 mg/kg IV/IO to a max of 60 mg
= Increases BGL , Effects delayed & usually not seen prehospital care
Epinephrine 1:10) Bradycardia dose:
Normovolemic hypoBP & anaphylaxis:
= 2-10 mcg/min IV/IO infusion
= 0.1-0.5 mcg/kg/min. Mix 1mg of Epi 1:10,000 into 1L bag of fluid.
Furosemide) Dynamics:
Indications:
Contra:
Dose:
= Loop-Diuretic stops Na,Cl,&H2O from kidney tubules thus +urine
= Acute pulmonary edema in PTs w/ SBP>90-100 (w/o signs of shock), Hypertensive emergencies.
= Hypovol, HypoBP, HypoK or other pos/ electrolyte abnormalities
= 1st: 0.5-1 mg/kg/ 1-2 mins, 2nd: double 1st dose to 2 mg/kg/1-2 mins
Acute pulmonary edema w/ suspected hypovol:<0.5 mg/kg slow IV.
Glucagon) Dynamics:
Indications:
Contra:
Dose:
= Hormone Binds to Glucagon receptors & stim/s adenyal clyclase, thus +cAMP which up-regulation of Ca cAMP channels in SA & AV cells
= Hypoglycemia, BradyC suspected from ßeta/Ca channel blocker OD
= Hypersensitivity, Bradycardia from other etiology
=Hypoglycemia: 1 mg IM.
=BradyC suspected from ßeta/Ca channel blocker OD: 3-10 mg IV/3-5 mins Followed by an infusion of 3-5 mg per Hr
Ipratropium (Atrovent) Dynamics:
Indications:
Contra:
Dose:
= Anticholinergic. Selectively blocks musarinic receptors.
= Bronchospasm associated w/ obstructive lung diseases
=Hypersensitivity
= 500 mcg/2.5 mL via SVN
Ketamine) Dynamics:
Indications:
Contra:
Dose:
= Dissociative anesthetic. NMDA Receptor Antagonist
=Anesthetic Sedation / SFI/RSI /
= Hypersensitivity
= Sedation: 1-2 mg/kg Onset: 30-60 secs, Lasts: 10-20 mins
= Analgesia/Pain: 0.2 mg/kg IV/IO (max single dose 20 mg), 0.5 mg/kg IM/IN (if no IV/IO)
Labetalol) Dynamics:
Indications:
Contra:
Dose:
ß Blocker thus slowing of HR
= 2nd line med for SVT after Adenosine, A-fib& flutter w/RVR, Reduce MC ischemia in AMI PT’s w/elevated HR, Antihypertensive
= Don’t administer to PT’s w/STEMI if any of the following are present: Signs of heart failure, Low cardiac output, Increased risk of cardiogenic shock. Hypotension. Bradycardia.
= 10mg IV/O push/1-2 mins. May repeat q10 mins to max of 150mg
Metoprolol) Dynamics:
Indications:
Contra:
Dose:
= ß-Blocker
= Hypertension, 2nd line med for A-Fib or A-Flutter w/ RVR, & SVT
= HR<45, 2nd or 3rd degree heart block
= 5 mg IV/IO q 5 min (up to 3 doses)
Midazolam/Versed) Dynamics:
Indications:
Contra:
Dose:
= Benzo binds w/ GABA receptors causing an influx of Cl
= Active seizures, Chem restraint, Anxiety, Induct RSI/SFI), Sedation
= Hypersensitivity
= Seizures: 0.2 mg/kg in 2 mg increments IV/IO (max 10 mg)
= RSI: .1-0.3 mg/kg IV/O (max 10mg)Onset: 2-5 mins, Last: 15-30 mins.
Naloxone (Narcan) Dynamics:
Indications:
Contra:
Dose:
= Opiate Competitive Antagonist
= Suspected Opiate overdose w/ respiratory depression
= Hypersensitivity
= 0.4-2 mg IV/IO/IM/IN
Nitroglycerin) Dynamics:
Indications:
Contra:
Dose:
= Nitrate. Potent vasodilator opens coronary vessels to improve blood flow to the myocardium & <overall workload of the heart & afterload.
= Symptoms suggest MI (farc/schem), CHF, SBP<90, <50 BPM
= >100 BPM, RVI, Use of phosphodiesterase inhibitors (Boner Pills) last 48hours), Increased ICP
=0.4 mg tablet or spray - repeat X 3 (q5mins) for total max dose 1.2 mg. Do not shake aerosol spray because this affects the metered dose
Norepinephrine) Dynamics:
Indications:
Contra:
Dose:
= αß adrenergic agonist (α > ß effects)
= Normovolemic hypoBP, Sepsis, Cardiogenic shock
= Shouldn’t use in hypovol/ til’ vol/ replacement occurred
= 0.1-0.5 mcg/kg/min IV/IO infusion
Ondansetron (Zofran) Dynamics:
Indications:
Contra:
Dose:
= Selective serotonin 5-HT3 receptor blocker
= Prevention & control of Nausea and/or vomiting
= Hypersensitivity
= 4-8 mg IV slow push, IM, PO.
Procainamide) Dynamics:
Indications:
Contra:
Dose:
=Class Ia Antiarrhythmic Blocks Na channels in cardiac cells thus slower depolarization & <automaticity.
= V-Tach with a pulse, pre-excitation rhythms (WPW).
= Should not be given to PT’s who have received an IV calcium channel
blocker.
= Recurrent VF/VT: 20 mg/min (max total dose: 17 mg/kg), Urgent situations: up to 50 mg/min to total dose of 17 mg/kg, Maintenance infusion: 1-4 mg/min
Promethazine (Phenergan) Dynamics:
Indications:
Contra:
Dose:
=Antiemetic. H1-receptor blocker
=Nausea & Vomitinf, Peroperative sediation, motion sickness.
= Hypersensitivity, Respiratory diseases(Asthma), Pedi <2 y/o
= IV/IM: 12.5-25 mg, May cause tissue injury if IV extravasation.
Sodium Bicarbonate 8.4%) Dynamics:
Indications:
Contra:
Dose:
= Alkalinizing Agent +plasma bicarbonate, buffers excess hydrogen ion
concertration, raises blood pH & reverses manifestations of acidosis.
= Suspected hyperkalemia, suspected bicarbonate responsive acidosis (DKA, OD on TCA’s, Aspirin or Cocaine)
= Patients in cardiac arrest
= Suspected acidosis:1 mEq/kg
=Hyperkalemia: 50 mEq IV bolus.
Terbutaline (Brethine) Dynamics:
Indications:
Contra:
Dose:
= ß2Agonist, reliefs bronchospasm, <Cardiovascular side
effect seen w/ Epi, Smooth M. relaxor
= Bronchial asthma,. Reversible airway obstruction
associated w/ brochitis or emphysema, Preterm labor,
= Hypersensitivity & PTs under 12 years old
= 0.25 mg IM
Thiamine) Dynamics:
Indications:
Contra:
Dose:
= Vitamin B1 Forms thiamine pyrophosphate by combining w/ ATP, an essential coenzyme for carbohydrate metabolism
= Coma of unknown orgin, Wernicke’s encephalopathy, Delirium tremens
=Hypersensitivity
= 100 mg IV/IO/IM
Tranexamic Acid (TXA) Dynamics:
Indications:
Contra:
Dose:
= Binds to plasminogen, blocking plasminogen fibrin interactions (fibrinolysis)
= Sig/ hemorrhage, either in/external (after external hemorrhage is controlled)
= SP 3 hrs past injury, allergy/Sensitivity, Suspected thromboembolism
1 gram over 10 minutes (mix in 50 mL bag of
NS), Followed by 1 gram over 8 hours (500 mL
bag NS).
Hypotensive therapy) Dynamics:
Indications:
Normovelmic Dose:
= giving enough fluids to get a radial pulse to perfuse
= incontrollable hemorrhage
= 20mL/Kg till radial pulse
Promethazine (Phenergan) Dynamics:
Indications:
Contra:
Dose:
=Antiemetic. H1-receptor blocker
=Nausea & Vomitinf, Peroperative sediation, motion sickness.
= Hypersensitivity, Respiratory diseases(Asthma), Pedi <2 y/o
= IV/IM: 12.5-25 mg, May cause tissue injury if IV extravasation.
Fentanyl) Dynamics:
Indications:
Contra:
Dose:
=Synthetic Narcotic (Schedule II Opioid)
= Analgesia & sedation via binding to opiate receptor, sig/ more potent than morphine (100 mcg = 10 mg of Morphine)
= Moderate-Severe pain
= Hypersensitivity, SBP<90
=1mcg/kg to a max dose 100 mcg (IV/IO/IM/) may repeat PRN in 5-10
= 1mcg/kg IN may repeat PRN 5-10mins (Max 1mL PRN if admin/ed IN)
Furosemide) Dynamics:
Indications:
Contra:
Dose:
= Loop-Diuretic stops Na,Cl,&H2O from kidney tubules thus +urine
= Acute pulmonary edema in PTs w/ SBP>90-100 (w/o signs of shock), Hypertensive emergencies.
= Hypovol, HypoBP, HypoK or other pos/ electrolyte abnormalities
= 1st: 0.5-1 mg/kg/ 1-2 mins, 2nd: double 1st dose to 2 mg/kg/1-2 mins
Acute pulmonary edema w/ suspected hypovol:<0.5 mg/kg slow IV.
Glucagon) Dynamics:
Indications:
Contra:
Dose:
= Hormone Binds to Glucagon receptors & stim/s adenyal clyclase, thus +cAMP which up-regulation of Ca cAMP channels in SA & AV cells
= Hypoglycemia, BradyC suspected from ßeta/Ca channel blocker OD
= Hypersensitivity, Bradycardia from other etiology
=Hypoglycemia: 1 mg IM.
=BradyC suspected from ßeta/Ca channel blocker OD: 3-10 mg IV/3-5 mins Followed by an infusion of 3-5 mg per Hr
Ketamine) Dynamics:
Indications:
Contra:
Dose:
= Dissociative anesthetic. NMDA Receptor Antagonist
=Anesthetic Sedation / SFI/RSI /
= Hypersensitivity
= Sedation: 1-2 mg/kg Onset: 30-60 secs, Lasts: 10-20 mins
= Analgesia/Pain: 0.2 mg/kg IV/IO (max single dose 20 mg), 0.5 mg/kg IM/IN (if no IV/IO)
Labetalol) Dynamics:
Indications:
Contra:
Dose:
ß Blocker thus slowing of HR
= 2nd line med for SVT after Adenosine, A-fib& flutter w/RVR, Reduce MC ischemia in AMI PT’s w/elevated HR, Antihypertensive
= Don’t administer to PT’s w/STEMI if any of the following are present: Signs of heart failure, Low cardiac output, Increased risk of cardiogenic shock. Hypotension. Bradycardia.
= 10mg IV/O push/1-2 mins. May repeat q10 mins to max of 150mg
Magnesium Sulfate) Dynamics:
Indications:
Contra:
Dose:
= Organic Salt act as a physiologic Ca channel blocker
= Bronchial Asthma, Torsades de Pointes (TdP) w/ or w/o a pulse, Eclampsia w/ active seizures
= Routine admin in PT’s w/AMI not recommended, High-degree HB, Shock, Dialysis, Hypocalcemia, V-fib/pulseless V-Tach,
= Respriatory: 1-2 grams IV/IO over 10-20 minutes
Tdp w/pulse: 1-2 grams mixed in 50-100 mL over 5-60 minutes
Cardiac arrest due to hypomagnesemia or TdP: 1-2 grams in 10 mL
Eclampsia: 1-4 grams
Midazolam/Versed) Dynamics:
Indications:
Contra:
Dose:
= Benzo binds w/ GABA receptors causing an influx of Cl
= Active seizures, Chem restraint, Anxiety, Induct RSI/SFI), Sedation
= Hypersensitivity
= Seizures: 0.2 mg/kg in 2 mg increments IV/IO (max 10 mg)
= RSI: .1-0.3 mg/kg IV/O (max 10mg)Onset: 2-5 mins, Last: 15-30 mins.
Morphine) Dynamics:
Indications:
Contra:
Dose:
Narcotic (Schedule II Opioid). Analgesia & sedation w/ binding to opiate receptor
= Ischemic chest pain not relieved by Nitro
= Hypersensitivity. Uncorrected SBP<90
= Analgesia: 2-10 mg up to max 20 mg
STEMI: 2-4 mg slow IV/IO, may admin 2nd dose of 2-8 mg IV/IO q5-15 mins intervals
NSTEMI-ACS: 0.1mg/kg slow IV/IO or IM up to 10 mg.
Naloxone (Narcan) Dynamics:
Indications:
Contra:
Dose:
= Opiate Competitive Antagonist
= Suspected Opiate overdose w/ respiratory depression
= Hypersensitivity
= 0.4-2 mg IV/IO/IM/IN
Nitroglycerin) Dynamics:
Indications:
Contra:
Dose:
= Nitrate. Potent vasodilator opens coronary vessels to improve blood flow to the myocardium & <overall workload of the heart & afterload.
= Symptoms suggest MI (farc/schem), CHF, SBP<90, <50 BPM
= >100 BPM, RVI, Use of phosphodiesterase inhibitors (Boner Pills) last 48hours), Increased ICP
=0.4 mg tablet or spray - repeat X 3 (q5mins) for total max dose 1.2 mg. Do not shake aerosol spray because this affects the metered dose
Norepinephrine) Dynamics:
Indications:
Contra:
Dose:
= αß adrenergic agonist (α > ß effects)
= Normovolemic hypoBP, Sepsis, Cardiogenic shock
= Shouldn’t use in hypovol/ til’ vol/ replacement occurred
= 0.1-0.5 mcg/kg/min IV/IO infusion
Nubain) Dynamics:
Indications:
Contra:
Dose:
Synthetic opiate agonist/antagonist
= Moderate to severe pain
= Hypersensitivity, respiratory depression
= 10-20 mg IV/IO/SQ/IM
Ondansetron (Zofran) Dynamics:
Indications:
Contra:
Dose:
= Selective serotonin 5-HT3 receptor blocker
= Prevention & control of Nausea and/or vomiting
= Hypersensitivity
= 4-8 mg IV slow push, IM, PO.
Procainamide) Dynamics:
Indications:
Contra:
Dose:
=Class Ia Antiarrhythmic Blocks Na channels in cardiac cells thus slower depolarization & <automaticity.
= V-Tach with a pulse, pre-excitation rhythms (WPW).
= Should not be given to PT’s who have received an IV calcium channel
blocker.
= Recurrent VF/VT: 20 mg/min (max total dose: 17 mg/kg), Urgent situations: up to 50 mg/min to total dose of 17 mg/kg, Maintenance infusion: 1-4 mg/min
Promethazine (Phenergan) Contra:
Dose:
= Hypersensitivity, Respiratory diseases(Asthma), Pedi <2 y/o
= IV/IM: 12.5-25 mg, May cause tissue injury if IV extravasation.
Thiamine) Dynamics:
Indications:
Contra:
Dose:
= Vitamin B1 Forms thiamine pyrophosphate by combining w/ ATP, an essential coenzyme for carbohydrate metabolism
= Coma of unknown orgin, Wernicke’s encephalopathy, Delirium tremens
=Hypersensitivity
= 100 mg IV/IO/IM
Tranexamic Acid (TXA) Dose:
1G/10mins (mix in 50 mL bag of NS)
Followed by 1G/8Hrs (500 mL bag NS).
Verapamil) Dynamics:
Indications:
Contra:
Dose:
Class IV Antiarrhythmic. Slows AP of cardiac autorhythmic cells by blocking Ca channels
= 2nd line med for A-Fib & A-Flutter w/ RVR. May use as alterative med (after adenosine) narrow QRS complex tachycardia w/ preserved LV Fn
= HypoBP, CHF/Cardio shock, WPW, Wide-complex TachyC, sensitivity
=1st dose: 2.5-5 mg IV/Io bolus over 2-3 mins.
=2nd dose: 5-10 mg over 2-3 mins. Max total dose: 20 mg
Hypotensive therapy) Dynamics:
Indications:
Normovelmic Dose:
= giving enough fluids to get a radial pulse to perfuse
= incontrollable hemorrhage
= 20mL/Kg till radial pulse
1) When GABA combines w/ Cl-receptors:
2) Cl (anion-) makes inside of the cell:
3 effect on the membrane:
1) channel “opens” & Cl diffuses through
2) more neg/ than outside & hyperpolarizes
3) membrane making it more difficult to depolarize & Depolarization therefore requires larger stimulus to cause cell to fire
- (Cardiac Pharmacology)
- NA Channel Blockers:
- Beta-Blockers:
- Potassium Channel Blockers:
- Calcium Channel Blockers:
- Miscellaneous:
1= (Vaugh-Will) Classes: 1]Na, 2]Beta, 3]K, 4]Ca, Misc] Adenosine
2= (Procainamide & Lidocaine) both Widened QRS & Prolongs QT
3= (Propranolol) Prolonged PRI & Bradycardias
4= (Amiodarone) Prolonged QT
5= (Diltiazem & Verapamil) Prolonged QT & Bradycardias
6= (Adenosine & Digoxin) Prolonged QT & Bradycardias
1st line IV med in cardiac arrest
Epi
1st line med in cardiac arrest
oxygen
According to AHA, when is Morphine or Fentanyl indicated for a patient presenting with chest pain After
admin of ASA & 3 Nitro doses
Adenosine & Digoxin class
class misc
adrenergic synapses=
Synapses that use norepinephrine as the postgamgliomic neurotransmitter
Albuterol) Dynamics:
Indications:
Contraindications:
=B agonist w/ preference of B2 receptors
=Brocospasm, Anaphylaxsis/ asthma/ Allergies, Hyperkalemia
= jitters & Known hypersensitivity
Albuterol) Adverse effects:
Adult Broncospasm dose:
Hyperkalemic dose:
Pedi Dose:
= Palp/s, Anxiety, Jitters, Dizzy, Tcardia
= 2.5mg/3mg via SVN→ repeat 15-20mins as needed
= 10-20mg via LVN over 15 mins→ repeat as needed
= 1.25-2.5mg/1.5-3mL SVN
Other meds used by PTs w/ COPD or asthma:
PTs w/ cardiac disease commonly use
= cromolyn sodium, methylxanthines (e.g., theophylline), and antibiotic agents.
= nitrates, Ca-channel blockers, diuretic agents, digoxin, and certain antiarrhythmic agents.
Amiodarone class & indication
Class 3 K channel blocker> VF/Pulseless VT unresponsive to shock, CPR & Epi, BradyCs to include AV blocks, Recurrent, hemodynamically unstable VT w/ pulse
Ipratropium Bromide admin note
= Anticholinergic, drys mucus for albuterol (500mcg)
Lorazepam / Ativan) Antidote:
Adult Doses) Anxiety / Seizures:
RSI Sedation:
= Flumazenil 0.2mg IV
= 1-4mg IV, IM, PR, IN
= 0.05 mg/kg IV/IO
Aspirin) indications:
Contraindications:
= Cardiac S/S w/ ischemia etiology
= common allergy, Bronchospasm, Angiodema
Aspirin) effects:
Avoid:
dose:
=Can cause bromchoconstriction in ~10% asthmatic PTs, N/V, upset GI
= enteric-coated Aspirin when admin/ing to PT w/ cardiac S/S
= 160-325mg PO of non-entric coated ASA
Aspirin) Class:
Dynamics:
= NSAID & COX inhibiter
= Blocks cyclooxygenase (enzyme that’s basically alarm bell for body)
COX acts upon Arachidonic Acid which in turn gen/s Thromboxane A2, a compound that reg/s the activation of platelets to form a clot
Benzodiazepines:
= hyperpolarize the membrane of CNS neurons, thus decreases response to stimuli. & increase GABA receptor–Cl ion channel affinity
Calcium Chloride) class:
Dynamics:
= mineral & electrolyte
= role as electrolyte in body to help propagate nerve impulses & M. Contraction
Calcium Chloride) indications:
Contraindications:
= Hyper/o/kalemia, Treatment of affects by Ca Chanel blocker OD, HypoBP 2ndary to admin/ of Diltiazem
= cardiac arrest (Unless hyperkalemia suspected)PTs taking Digoxin w/ suspected calcium Chanel blocker OD
Calcium Chloride) effects:
Dose:
Hypotension following admin/ Diltiazem:
= Bcardia w/ rapid injection, May produce severe coronary spasm & asystole, Burning sensation @ site of admin/, PERCIPITATE w/ Na-Bicarb
= 0.5-1gram slow IV over 3-5mins
= 250-500mg
Captopril) class:
Dynamics
= ACE inhibitors
= Prevents production of angiotensin II by inhibiting it (ACE)—> causes vasodilation & helps reduce amount of water held back by kidneys
Captopril) indications
Contraindications
= Severe CHF (w/ HTN) in conjunction w/ Nitrates & CPAP
=Pregnancy , Angioedema, Hypersensitivity to ACH inhibitors
Captopril) effects:
Dose:
=Allergic reaction, Dry cough, Dizziness ,Taste changes (long term)
=25mg PO
cholinergic synapses=
Synapses that use ACh as the post&preganglionic neurotransmitter
Resp/ Corticosteroids
Dexamethasone (10 mg IV/IO) & Solu-Medrol 125-250mg IV,IM
Dexamethasone) Dynamics:
Indications:
Contra:
Dose:
Dexamethasone Anti-inflammatory: supresses immune
response
Anaphylaxis, Bronchial asthma, COPD Hypersensitivity, Fungal infection 10 mg IV/IO/PO
Dextrose 50%)
Dose:
D50: 25 grams IV/IO, D10 in 50 mL (5 grams)
IV/IO boluses (max 250 mL)
Dextrose 50%) Dynamics:
Indications:
Contra:
Dose:
Dextrose 50% Electrolyte / Carbohydrate. Water-soluble
monosaccharide Correction of hypoglycemia Known hyperglycemia D50: 25 grams IV/IO, D10 in 50 mL (5 grams)
IV/IO boluses (max 250 mL)
Dextrose Pedis) Above 2Yrs
2Mns -2Yrs
Birth to 2Mn:
= D50 (1-2 mL’s/kg)
= D25 (2-4 mL’s/kg)
= Birth to 2 months – D10 (5-10 mL’s/kg)
“Bigger kid Big sugars”
Diazepam / Vallium) Indications:
Contraindications:
= Tcardia from stimulant OD, Sustained seizures, Anxiety, Sedation
= Known hypersensitivity to med
Diazepam / Vallium) Antidote:
Adult Dose:
= Flumazenil 0.2mg IV
= 2.5-10 mg in 2.5 mg increments slow IV/IO/IM
Diazepam / Vallium) Dynamics:
Effects:
= Benzo: Binds w/ GABA receptors causing Cl influx
= Resp/ depress/, HypoBP N/V, amnesia
Diazepam/ Vallium) class:
pharmacodynamics:
= benzodiazepine
= binds w/ GABA receptors causing a influx of chloride
Diazepam/ Vallium) indications:
Contraindications:
= Tcardia due to stimulant OD, Sustained seizures Anxiety Sedation
= known hypersensitivity
Diazepam/ Vallium) effects:
dose:
= Resp/ depres/, N/V, Sedation/amnesia
= 2.5-10mg in 2.5mg increments slow IV/IO/IM
Diphenhydramine) Dynamics:
Indications:
Contra:
Dose:
= H1&2 Histamine Blocker
= Allergic reaction, anaphylaxis, extrapyramidal reactions, sedation
= Hypersnesitivity
= 25-50 mg slow IV/IO or IM
Diphenhydramine) Dose:
= 25-50 mg slow IV/IO or IM
Dobutamine) Dynamics:
Indications:
Contra:
Dose:
= αß agonist. Inotropic prop/s > prounced vs chronotropic =Cardiac pump problems (CHF) w/ hypoBP, Shouldn’t use in =hypovol/ til fluid replacemed. Never mix w/ Na-Bicarb.
= 2-20 mcg/kg/min - titrate so heart rate does not
increase by >10% of baseline.
Dobutamine) class:
Dynamics:
= synthetic sympathetic agonist
= A&B agonist w/ inotropic prop/s > Chronotropic prop/s
Dobutamine)indi:
Contras:
= cardiac pump prob/s (CHF) w/ hypotension “baby Dope”
= hypovolemia til’ fluid replacing, DONT MIX W/ Sodium Bicarb
Dobutamine) effects:
dose:
= Hypertension, H/A, Dizziness, Can worsen cardiac ischemia, tissue necrosis w/ Extravasation
= 2-20mcg/kg/min- titrate so heart rate doesn’t increase by >10% of baseline
Dopamine) class:
pharmacodynamics
= sympathetic agonist
= A/B agonist rate dependent vasopressor +chron/in/Drom/otropic
Dopamine) indications:
Contraindications:
= CHF, HypoBP w/ shock signs, 2nd med for sympathetic Bcardia (after Atropine)
= hypovolemic PTs til’ vol/ replaced, pheochromocytoma, Dont mix w/ sodium bicarb
Dopamine) Effects:
Dosing:
Adult & Pedi Cardiac dose:
Adult & Pedi Vasopressor dose:
= HyperBP, Palp/s, H/A, Dizzy, Can worsen C-ischemia, necrosis W/ Extravasation
= 2–20 mcg/kg/min Titrate to response
= 5-10mcg/kg/min
= 10-20 mcg/kg/min
Dopamine) Dynamics:
Indications:
Contra:
Dose:
= α & ß agonist, Rate dependent, vasopressor, +Chron/In/Dromotropic
= CHF, hypoBP w/ shock S/S, 2nd med w/ S/S bradyC (after atropine)
= Shouldn’t use in hypovolemic PTs til’ appropriate vol/ replacement occurred, Known Hx Pheochromocytoma, Don’t mix w/ Sodium Bicarb.
2 - 20 mcg/kg/min, titrate to PT response (DO NOT OPEN WIDE OPEN)
Enalapril) Dynamics:
Indications:
Contra:
Dose:
ACE Inhibitor Prevents making of angiotensin II by inhibiting (ACE) thus vasodilation & helps reduce amount of water held back by the kidneys
= Severe CHF (W/ HTN) in conjunction w/ Nitrates & CPAP.
= Pregnancy, Angioedema, Hypersensitivity to ACE inhibitors
= Pregnancy or Angioedema Initial dose of 2.5 mg PO
= Sensitivity to ACE inhibitors; Titrate20mg PO(1st dose 2.5mg PO)
Enalapril) indications:
Contraindication:
= severe CHF (w/ HTN) in conjunction w/ Nitrates & CPAP
= Pregnancy, Angioedema, Hypersensitivity to ACE inhibitors
Enalapril) effects:
dose:
= Allergic, Dry Cough, Dizziness, Taste changes (long term)
= Initial 2.5mg PO & Titrate to 20mg PO
Epi 1:1,000 can be administered to a patient for the treatment of severe bronchoconstriction at a dose of:
The correct dose of Mag Sulfate for a patient with a severe asthma attack is
= 0.01mg/kg to max 0.3mg IM
= 1-2Gs IV / 10-20mins
EPI 1:1)Broncho constriction) Adult Dose:
Pedi Dose:
=0.3mg up to 0.5mg IM
=0.01mg/kg IM w/ max dose 0.3mgIM
EPI 1:1) class:
indi:
Adverse effects:
=potent A & B agonist
=bronchospasms, anaphylaxis
=worsen ischemia & heart probs, Jitters
Epinephrine 1:1) Dynamics:
Indications:
Contra:
Dose:
= Potent α and ß agonist
=Severe bronchospasm, Allergies/anaphylaxis
=Few, Benefits vs. risk
= 0.01 mg/kg IM (max 0.3 mg)
Epinephrine 1:10) Pedi BradyC/Arrest:
Hypoperfusion & Severe anaphylaxis:
= 0.01 mg/kg or 0.1 mL/kg (bc 1mg in 10mL)
= 0.1-1 mcg/kg/min infusion
Mix 1 mg of Epi 1:10 into 1L bag
Fentanyl) class:
pharmacodynamics:
Potency:
= synthetic narcotic (schedule 2 opioid)
= opioid Analgesia & sedation through binding to opiate receptor
= Fentanyl > morphine (100mcg fentanyl = 10mg of Morphine) 1F = 10M
Fentanyl) indications:
Contraindications:
= Moderate to severe pain
=Hypersensitivity to med, Uncorrected SBP<90
Fentanyl) effects:
dose:
Admin notes:
= Resp/ arrest/depres/, AMS, Bcardia & Prolong of QT interval, +vagal tone b/c suppress/ sympathetic path/s, HypoBP, N/V
= 1mcg/kg IV/O(max 100mcg) may repeat PRN in 5-10mins (Max 1mL per nare) if admin/ed IN
= Chest wall rigidity so admin slowly, Depresses every- thing/where
Furosemide/ Lasix) class:
pharmacodynamics:
= Loop diuretic
= Blocks absorption of Na, Cl, & water from kidney thus +urinination
Furosemide/ Lasix) indications:
Contraindications:
= Acute pulmonary edema in PTs w/ SBP >90-100mmHg (w/o signs of shock) Hypertensive emergencies
= Hypovolemia Hypotension Hypokalemia or other suspected electrolyte abnormalities
Furosemide/ Lasix) effects
Adult Dose:
intial dose doesnt work:
new-onset pulmonary edema w/ suspected hypovolemia:
= pos/ dehydration/acute electrolyte imbalance, Tinnitus/deaf
= 0.5-1 mg/kg over 1-2 mins. IVP
= double 1st dose to 2 mg/kg over 1-2 mins
= <0.5mg/kg slow IV
Glucagon) cardiac indications:
Contraindications:
= Bradycardia suspected from Beta-Blocker or Ca-Channel Blocker OD
= Bradycardia from etiology (disease origin), Known hypersensitivity
Glucagon) effects
Ca-blocker OD Dose:
Hypoglycemia dose:
= Anxiety, Chest palp/s, H/A, N/V, Hyperglycemia
= 3-10mg IV slowly over 3-5 mins Followed w/ infusion 3-5mg per hour
= 1mg IM
If arrive & active seizing
HOW BENZOs rework:
= protect w/ pillows don’t put anything in mouth
= Flows in making RMP more - (70 to 300) making it harder/longer to depolarize
Ipratropium/ Atrovent):
Indi:
Adverse effects:
= Anticholinergic, selectively blocks M receptors, goes w/ albuterol
=bronchospasm w/ obstructive lung diseases
=dry lungs out, dry mouth, confusion
Labetalol) class:
pharmacodynamics:
= beta-blocker
= Blocks adrenergic stim/ on B-receptors, causing a slowing of HR
Labetalol) Indications:
Contraindications:
Do not administer to PTs w/ STEMI if following present:
= 2nd med/ for SVT after admin/ Adenosine, A-Fib/Flutter w/ RVR Reduce myocardial ischemia in AMI PTs w/ +HRs, Antihypertensive
= Increased risk of cardiogenic shock Hypotension Bradycardia
= signs of heart failure Low cardiac output
Labetalol) Adverse Effects:
Max dose:
Adult Dose:
= admin/ after IV Ca-channel blockers can cause severe hypotension, Bcardia, heart blocks & CHF
= 150mg
= 10 mg IV/O push 1-2 mins & May repeat every 10 mins to max dose
Lorazepam / Ativan) Indications:
Contraindications:
= SFR/RSI, Anxiety, Seizures,
= Hypertension, Hypersensitivity
Lorazepam / Ativan) Dynamics:
Adverse Effects:
= Benzo: Binds w/ GABA receptors causing Cl influx
= Resp/ depress/, HypoBP N/V, amnesia
Mag-Sulfate) Indi:
Contra:
Effects:
= cardiac arrest only if Torsades de Pointes (Tdp) suspected, Tdp w/ pulse
= AMI not recommended, High degree AV block, HypoBP, VFib/Tach
= Bcardia, HypoBP, Diaphoresis, Resp/ depres/, Hypothermia
Mag-Sulfate) Effects:
Cardiac Arrest from hypomagnesemia or TdP:
TdP w/ pulse:
= Flushing, Sweating, B-cardia, Resp/ depres/, Hypothermia
= 1-2Gs diluted in 10 mL
= 1-2Gs mixed in 50-100 mL admin/ed over 5-60mins
Analgesics:
Anesthesia:
Endorphins:
= are meds that relieve the sensation of pain
= absence of all sensations
= hormones bind to opioid receptors aka natural painkillers
Midazolam / Versed) Contraindications:
Indications:
= Hx of hypersensitivity to the drug
= Active seizures, RSI induction agent, Chemical restraint, Anxiety, Sedation
Midazolam / Versed) Adult Active Seizures:
Pedi Active seizures:
= 0.1mg/kg 2mg increments IV(Max 5mg)
5mg IM/IN
= 0.1mg/kg 2 mg increments IV (Max 5 mg) 0.2mg/kg IN/IM
Midazolam / Versed) Adult & Pedi (RSI):
ET Tube Bucking:
= 0.1-0.3 mg/kg (Max 10 mg), Onset: 2-5 minutes, Duration: 15-30 minutes
= 0.05 mg/kg slow IV/ 1–2 mins (maintain SBP) – stop once bucking has resolved
Midazolam / Versed) Dynamics:
Antidote:
Adverse Effects:
= Binds w/ GABA receptors causing influx of Cl
= Flumazenil 0.2mg IV
= Hypotension, Respiratory depression/apnea, N/V, Amnesia
Midazolam/ Versed) class:
pharmacodynamics:
= benzodiazepine
= Binds w/ GABA receptors causing an influx of chloride
Midazolam/ Versed) indications:
Contraindications:
= Active seizures, RSI induction, Chemical restraint, Anxiety, Sedation
= History of hypersensitivity to drug
Midazolam) Adult dose (active seizures):
Pediatric dose (active seizures) IV/O:
Pediatric dose (active seizures) IM/IN:
Adult & Pedi dose for induction agent (RSI):
ET Tube bucking:
= 0.1mg/kg in 2mg increments IV/IO (max 5mg) → 5mg IM/IO
= 0.1mg/kg in 2mg increments IV/IO (max 5mg)
= 0.2mg/kg (max 5mg)
= 0.1-0.3mg/kg (max 10mg), Onset=2-5mins, Duration= 15-30mins
= 0.05mg/kg IV/IO 1-2mins (maintain SBP) stop when bucking stopped
Midazolam/ Versed) effects
= Hypotension, Respiratory depression/apnea, N/V Amnesia
Nitroglycerin) class:
pharmacodynamics:
= nitrate
= Potent vasodilator opens coronary vessels to improve blood flow to myocardium thus Decreases overall workload of heart/afterload
Nitroglycerin) indications:
Contraindications
= Symptoms suggestive of Myocardial ischemia CHF
= HypoBP (SBP<90 or >30 below baseline BP) Severe Bcardia<50bpm, Tcardia>100bpm, Use of phosphodiesterase inhibitors (Boner pills) in last 48 hours, Increased ICP, RVI
Nitroglycerin) effects:
dose:
=H/A, Dizziness, Weakness, Tcardia, HypoBP (tablets lose effectiveness after exposed to sun/air)
= 0.4mg SL (pill or spray) → repeat 3x (Q5 mins) for total dose of 1.2mg
DONT SHAKE SPRAY B/C AFFECTS DOSE
NORepi/ Levaphed) Class:
dynamics:
= Synthetic hormone Vaso-pressor “Sepsis med”
= A/B-adrenergic agonist (A effects > B effects)
NORepi/ Levaphed) Indi:
Contra:
Effects:
= Normovolemic hypotension, Septic shock, Cardiogenic shock
= hypovolemia PTs til’ Vol/replacement occurred
= Hypertension, Organ ischemia, Cardiac arrhythmia, Tissue necrosis w/ extravasation, Palpitations, Anxiety, N/V
NORepi/ Levaphed) Adult Dose:
Pediatric Dose:
= 0.1–0.5 mcg/kg/min IV/IO infusion
= 0.1–2 mcg/kg/min IV/IO infusion
Nubain) Dynamics:
Indications:
Contra:
Dose:
= Synthetic opiate agonist/antagonist
= Moderate to severe pain
= Hypersensitivity, respiratory depression.
= 10-20 mg IV/IO/SQ/IM
Ondansetron/ Zofran) class:
pharmacodynamics:
= selective Seratonin 5-HT3 receptor blocker/antagonist
= Serotonin 5-HT3 receptors @the vagal-N. Can initiate the gag reflex when stim/ed; Zofran is antiemetic/antag/ of 5-HT3 receptors inhibiting serotonin release on central/peripheral vagal nerve
Ondansetron/ Zofran) indi/s:
Contra:
= Prevent/control N/B
= Known hypersensitivity to med
Ondansetron/ Zofran) effect:
dose:
= HypoBP, Tcardia, Extrapyramidal reaction (=impaired motor control), Prolong QT
= 4-8mg IV (slow), IM, PO
Procainamide & Lidocaine) class
= class 1A&B Na Channel Blockers
= Alterative to Amiodarone in cardiac arrest V-Fib/pVT, Stable monomorphic Ventricular TachyC w/ presserved LVF
= V-Tach with a pulse, pre-excitation rhythms (WPW) >50% QRS width
(Procainamide)class:
Dynamics:
= 1a antiarrhythmic
= Blocks Na channels in cardiac cells which causes depolarization to slow & decrease automaticity
Propranolol, Labetalol, Metoprolol) class
Labetalol
Metoprolol
= class 2 Beta Blockers
= 2nd line med for SVT after Adenosine, A-fib/flutter w/RVR, Reduce myocardical ischemia in AMI PT’s w/elevated HR, Antihypertensive
= Hypertension, 2nd line med for A-Fib/A-Flutter w/ RVR, & SVT
What ion is responsible for benzodiazepine-induced neuronal inhibition?
= Chloride (Cl-) influx via GABA-A receptors.
RAAS→ Renin-angiotensin-aldosterone system
1(Kidneys monitor BP) reg/s cardiovascular sys/→ make sure fluids there
2. JG cells Juxtaglomerular granular cells= kidney cells
3. kidneys send renin to liver angiotensin to form angiotensin 1
4. angiotensin 1 flows around to heart to lungs for ACE to produce angiotensin 2 & aldosterone to adrenal glands
Solu-Medrol): Class:
Will/med:
= Synthetic glucocorticoid Anti-inflammatory
= Suppresses immune response
Terbutaline/ Brethine) Dose:
0.25mg IM (only in adults
Terbutaline/ Brethine) Class:
Indi:
Contra:
=B selective agonist relaxer w/ high affinity & give asthma, & CHF/heart prob PT
=asthma, emphysema, preterm labor, reversible airway
= hypersensitive, anxiety, dizzy/HA, NO PEDIS
The administration of an anticholinergic medication via a SVN is useful in a patient with asthma because it: Assists in drying up secretions in the bronchiole
correct dose of Atrovent for a patent experiencing an asthma attack is:
500mcg
The correct dose of Albuterol for a patent with bronchoconstriction is:
2.5mg/3mL SVN
2nd stage of asthma is most likely going to respond best to the administration of:
dex & Solu
Titrate to effect & CONSTANTLY check BP & HR:
= NORepi, Epi 1:10, Dopamine, Dobutamine
Upon arrival at a community pool you find a 20-year-old patient in obvious severe respiratory distress. The patent is only able to speak broken word sentences and does state they have a history of asthma. Besides the administration of oxygen and Albuterol via a SVN, what other medication would you want to deliver to this patient?
Epi 1:1 IM 0.3mg
Verapamil) class:
pharmacodynamics:
= IV antiarrhythmic Ca channel blocker
= Slows AP of autorhythmic cells in heart by blocking Ca channels
Verapamil) indications:
Contraindications:
= 2nd med for A-Fib/Flutter w/ RVR, May use as alterative med (after adenosine), narrow QRS complex Tcardia w/ preserved LV function
= HypoBP (SBP<90), CHF/cardio/ shock, Wide-complex Tcardia, WPW
Hypersensitivity to med
Verapamil)1.May cause:
2. Effects:
3. Max total dose:
4. 1st dose:
5. 2nd dose:
1.= more profound hypotension response than that of Diltiazem
2.= Severe CHF may result if used w/ beta-blocker, N/V/D, Dizziness, H/A
3.= 20mg
4.=2.5-5mg IV/O bolus 2-3min
5.= 5-10mg over 2-3 mins
How does chronic alcoholism cause AMS?
Treatment for Wernicke-Korsakoff Syndrome?
= Thiamine (B1) deficiency disrupts glucose metabolism, leading to Wernicke’s & Korsakoff’s syndromes
= Admin 100 mg thiamine IV, IM, or PO before glucose in suspected hypoglycemic alcoholic PTs.
What happens to neuronal RMP when benzodiazepines are administered?
What effect do benzodiazepines have on seizure activity?
= Neurons become hyperpolarized, reducing excitability
= Stops excessive neuronal firing by enhancing GABAergic inhibition.
Magnesium Sulfate) Adverse Effects:
= Hypotension, Flushing, Sweating, Bradycardia, Resp/ depression, Hypothermia
