Med. Ind/Contraindications Flashcards
Acetaminophen (Tylenol)
Indications
a. Pain and fever control
4. Contraindications
a. Known hypersensitivity
b. Severe active liver disease
AcetaZOLAMIDE (Diamox, Diamox Sequels)
Indications
a. AMS (treatment and prophylaxis)
b. Prevention of HACE
4. Contraindications
Hypersensitivity to acetaZOLAMIDE or sulfa
Known hypokalemia or hyponatremia
Renal or liver dysfunction
Should not be used for the treatment of HAPE
Acetic Acid (vinegar)
Indications
a. Otitis externa
b. Pain control for envenomation by jellyfish from outside the United States
4. Contraindications
a. Hypersensitivity
b. Perforated tympanic membranes
c. May increase nematocyst discharge for US jellyfish and should be used only outside the United States
Acetylcysteine (Mucomyst, Acetadote)
Indications
a. Acetaminophen overdose
Contraindications
a. Known hypersensitivity
b. Acute asthma
Activated Charcoal (Insta-Char, Actidose-Aqua, Liqui-Char)
Indications
a. Most oral poisonings and medication overdoses in the alert patient
b. Can be used after evacuation of poisons
Contraindications
a. Known hypersensitivity
b. Unprotected airway
c. Absence of a gag reflex
d. Ileus
e. Intestinal obstruction
f. Do not use after ingestion of petroleum distillates, hydrocarbons, heavy metals, acids or alkalis (corrosives), alcohols, iron, lithium, solvents.
g. Use caution in patients experiencing abdominal pain of unknown origin.
Adenosine (Adenocard)
Indications
a. First-line drug for most forms of stable, regular, narrow-complex SVT
b. Considered for marrow-complex reentry tachycardia while preparing for cardioversion
c. Can be used diagnostically for stable, regular, monomorphic wide-complex tachycardia
Contraindications
a. Known hypersensitivity
b. Second- or third-degree AV block or sick sinus syndrome or other sinus node disease
c. Poison- or drug-induced tachycardia
d. Use with caution in patients with a history of seizure disorder.
e. May induce bronchospasm in a patient with bronchoconstrictive or bronchospastic lung disease
Albuterol (Proventil, Ventolin, Proair, Accuneb)
Indications
a. Treatment and prevention of bronchospasm in patients with reversible obstructive airway disease
b. Treatment of inhaled airway/respiratory irritant agents
c. Hyperkalemia treatment
Contraindications
a. Known hypersensitivity
b. Dysrhythmias
c. Synergistic with other sympathomimetics
Amiodarone (Cordarone, Pacerone)
Indications
a. Cardiac arrest resulting from VF or pulseless VT after CPR, defibrillation, and epinephrine
b. Stable, regular narrow-complex tachycardia if the rhythm persists despite vagal maneuvers or adenosine or the tachycardia is recurrent
c. To control the ventricular rate in AF with a rapid ventricular response without preexcitation
d. Stable wide-complex tachycardia
e. Stable monomorphic VT
f. Polymorphic VT with a normal QT interval
Contraindications
a. Known hypersensitivity
b. Iodine hypersensitivity
c. Cardiogenic shock
d. Second- of third-degree AV block
e. Sick sinus syndrome
Aspirin (Acetylsalicylic Acid)
Indications
a. New-onset chest discomfort suggestive of ACS
Contraindications
a. Hypersensitivity to ASA or NSAIDs
b. Bleeding disorders
c. Hemolytic anemia
d. Lactating mothers
Atropine Sulfate
Indications
a. Hemodynamically unstable bradycardia
b. Acetylcholinesterase inhibitor poisoning
c. RSI in pediatrics
d. Beta blocker or calcium channel blocker overdose
Contraindications
a. Known hypersensitivity
b. Narrow-angle glaucoma
c. GI obstruction
d. Severe ulcerative colitis
e. Toxic megacolon
f. Bladder outlet obstruction
g. Myasthenia gravis
h. Hemorrhage with cardiovascular instability
i. Thyrotoxicosis
Benzocaine Spray (Hurricane)
Indications
a. Topical anesthetic
b. Suppresses the pharyngeal and tracheal gag reflex
Contraindications
a. Hypersensitivity
Bumetanide (Bumex)
Indications
a. Pulmonary edema, heart failure
Contraindications
a. Hypersensitivity to bumetanide, furosemide, or sulfonamides
b. Hypovolemia, anuria, acid-based imbalance, electrolyte imbalance, hepatic coma
c. Use with caution in patients with hepatic cirrhosis, ascites, or diabetes.
Calcium Chloride
Indications
a. Hypocalcemia
b. Hyperkalemia
c. Beta blocker and calcium channel blocker toxicity
d. Antidote for magnesium sulfate overdose
Contraindications
a. Known hypersensitivity
b. Digoxin toxicity
c. Hypercalcemia
d. Suspected severe hypokalemia
Calcium Gluconate
Indications
a. Topical use in hydrofluoric acid burn management
b. Hypocalcemia
c. Hyperkalemia
d. Beta blocker and calcium channel blocker toxicity
Contraindications
a. Known hypersensitivity
b. Digoxin toxicity
c. Hypercalcemia
d. Suspected severe hypokalemia
Cimetidine (Tagamet)
Indications
a. Gastric or duodenal ulcers
b. GERD
c. Adjunct in treating hives and/or itching
Contraindications
a. Known hypersensitivity to cimetidine or other H2 blockers
Dexamethasone Sodium Phosphate (Decadron)
Indications
a. Anaphylaxis
b. Acute exacerbation of bronchial asthma
c. AMS
d. HACE
e. Spinal cord injury
f. Croup
g. Elevated ICP
h. Adjunct in treatment of shock
i. COVID-19
Contraindications
a. Documented hypersensitivity
b. Systemic fungal infection
c. Preterm infants
Dextrose
Indications
a. Hypoglycemia
b. Acutely altered mental status
c. Coma or seizure of unknown origin
d. Status epilepticus
Contraindications
a. Documented hypersensitivity
b. Hyperglycemia
c. Severe dehydration
d. Anuria
e. Diabetic coma
f. Intracranial or intraspinal hemorrhage
g. Glucose-galactose malabsorption syndrome
Diazepam (Valium, Diastat AcuDial)
Indications
a. Uncontrolled shivering
Contraindications
a. Documented hypersensitivity
b. Neurologic or respiratory depression
c. Narrow-angle glaucoma
d. Myasthenia gravis
e. Head injury
Diltiazem (Cardizem, Dilacor, Diltiaz)
Indications
a. Stable narrow-QRS tachycardia
i. Rhythm persists despite vagal maneuvers or administration of adenosine.
ii. Recurrent
b. To control the ventricular rate in patients with AF or atrial flutter without preexcitation
Contraindications
a. Known hypersensitivity
b. Hypotension
c. Cardiogenic shock
d. Wide-complex tachycardia
e. Second- or third-degree AV block
f. Sick sinus syndrome or other sinus node disease
g. Poison- or drug-induced tachycardia
h. AF or atrial flutter associated with an accessory bypass tract
i. Avoid use in patients with left ventricular systolic dysfunction or decompensated heart failure.
j. Use with extreme caution in patients taking oral beta blockers.
DiphenhydrAMINE (Benadryl)
Indications
a. Symptomatic allergic reactions
b. Symptomatic dystonia
c. Extrapyramidal signs or symptoms caused by phenothiazines
d. Antiemetic
e. Chemical restraint
Contraindications
a. Known hypersensitivity, newborns and premature infants, breastfeeding
b. Use with caution in patients with severe vomiting, asthma, narrow-angle glaucoma, benign prostatic hypertrophy, or alcohol intoxication.
c. Use is controversial in patients with lower respiratory tract disease.
DOBUTamine Hydrochloride (Dobutrex)
Increases renal blood flow secondary to increased cardiac output
3. Indications
a. Heart failure with a SBP of 70 to 100 mm Hg and no signs of shock
Contraindications
a. Known hypersensitivity
b. Suspected or known poison/drug-induced shock
c. SBP less than 10 mm Hg and signs of shock
d. Idiopathic hypertrophic subaortic stenosis
DOPamine Hydrochloride (Intropin)
Indications
a. Refractory cardiogenic or distributive shock
b. Hypotension with low cardiac output states
c. Second-line drug from symptomatic bradycardia
Contraindications
a. Known hypersensitivity
b. Hypovolemia
c. Pheochromocytoma
d. Uncorrected tachydysrhythmias
e. VF
Droperidol (Inapsine)
Indications
a. Chemical restraint
b. Acute delirium or psychosis
Contraindications
a. Known hypersensitivity
b. Known or suspected prolonged QT interval
c. Use with extreme caution in patients with bradycardia, cardiac disease, concurrent MAOI therapy, or use of Class I and Class III antidysrhythmics or other drugs.
Epinephrine (Adrenalin, EpiPen, AsthmaNefrin)
Indications
a. Cardiac arrest
b. Bradycardia
c. Shock
d. Anaphylaxis
e. Sever refractory wheezing (IM)
f. Coup/bronchiolitis (nebulized)
Contraindications
a. Known hypersensitivity, coronary insufficiency, cardiac dilation
b. Uncontrolled hypertension
c. Hypothermia
d. Pulmonary edema
e. Myocardial ischemia
f. Hypovolemic shock
Etomidate (Amidate)
Indications
a. Premedication for medication-facilitated intubation or procedural sedation
Contraindications
a. Known hypersensitivity
b. Labor/delivery
c. Septic shock (particularly in children)
Famotidine (Pepcid)
Indications
a. GI ulcer
b. Suspected upper GI bleeding
c. GERD
d. As an adjunct in the treatment of urticaria and/or pruritus
Contraindications
a. Known hypersensitivity to famotidine or other H2 blockers
Fentanyl Citrate (Sublimaze)
Indications
a. Pain management
b. Anesthesia adjunct
c. Severe respiratory distress (palliative care)
4. Contraindications
a. Known hypersensitivity
b. Patients who have taken an MAOI in the previous 14 days
c. Administer with caution to patients with a Glasgow Coma Scale (GCS) score less than 15.
d. Hypotension
e. Hypoxia after maximal supplemental oxygen therapy
f. Signs of hypoventilation
Glucagon (GlucaGen)
Indications
a. Altered mental status when hypoglycemia is suspected
b. Antidote for symptomatic bradycardia caused by beta blocker or calcium channel blocker overdoses
Contraindications
a. Known hypersensitivity, pheochromocytoma, hyperglycemia, insulinoma
5. Adverse reactions/side effects
a. Dizziness/headache
b. Hypotension
c. Tachycardia
d. Nausea/vomiting
e. Rebound hypoglycemia
Haloperidol (Haldol)
Indications
a. Acute psychotic episodes or agitated/violent behavior
b. Anxiety
Contraindications
a. Documented hypersensitivity
b. Severe CNS depression
c. Neuroleptic malignant syndrome
d. Poorly controlled seizure disorder
e. Parkinson disease
f. Agitation secondary to shock and hypoxia
Helium Gas Mixture (Heliox)
Indications
a. Persistent or severe bronchospasm
Contraindications
a. None
HydrALAZINE (Apresoline)
Indications
a. Pregnancy-induced hypertension lasting more than 15 minutes with associated preeclampsia symptoms
Contraindications
a. Known hypersensitivity, CAB, mitral valve rheumatic heart disease
b. Use with caution in patients with stroke, known renal disease, or hypotension.
Hydrocortisone Sodium Succinate (Solu-Cortef)
Indications
a. Shock with history of adrenal insufficiency or long-term steroid dependence
i. Anaphylaxis, asthma, and COPD
Contraindications
a. Known hypersensitivity
b. Systemic fungal infections
c. Premature infants
HYDROmorphone (Dilaudid)
Indications
a. Management of acute moderate to severe pain
Contraindications
a. Known hypersensitivity
b. MAOI use during the previous 14 days
c. GI obstruction
d. Administer with caution in:
i. Older adults
ii. Patients with a GCS score less than 15
iii. Patients with hypotension, hypoxia, signs of hypoventilation, head injury, or concomitant use of CNS depressants
Hydroxocobalamin (Cyanokit)
Indications
a. Known or suspected cyanide poisoning
Contraindications
a. Documented hypersensitivity
Ibuprofen (Advil, Motrin)
Indications
a. Acute pain management
b. Antipyretic
Contraindications
a. Known ASA/NSAID hypersensitivity
b. ASA-sensitive asthma
c. Significant renal function impairment
d. Pregnancy
e. Known peptic ulcer disease
f. Active intracranial hemorrhage or GI bleeding
g. Thrombocytopenia
h. Coagulation defects
i. Proven or suspected necrotizing enterocolitis
j. Perioperative pain in the setting of coronary artery bypass graft surgery
Ipratropium Bromide (Atrovent)
Indications
a. Persistent bronchospasm
b. COPD exacerbation
c. Toxic inhalation (in conjunction with albuterol)
Contraindications
a. Hypersensitivity to ipratropium, atropine, alkaloids, or peanuts
b. Use with caution in patients with urinary retention, narrow-angle glaucoma, cardiovascular disease, or hypertension.
Isopropyl Alcohol
Indications
a. Nausea and vomiting
Contraindications
a. None
Ketamine (Ketalar)
Indications
a. Procedural sedation
b. Management of agitated or violent behavior
c. Pain control
Contraindications
a. Known hypersensitivity
b. Infants younger than 3 months of age
c. Pregnancy
d. Angina
e. Heart failure
f. Symptomatic hyperthyroidism
g. Known or suspected schizophrenia
h. Conditions where hypertension would be hazardous to a patient’s care
i. Use with caution in any patient with the potential for increased ICP.
Ketorolac Tromethamine (Toradol)
Indications
a. Acute management of moderate to severe pain
Contraindications
a. NSAID or ASA allergy
b. ASA-sensitive asthma
c. Renal insufficiency
d. Pregnancy
e. Known peptic ulcer disease
f. Hypotension
g. Women who are in active labor or breastfeeding
h. Significant renal impairment
i. Previous or current GI bleeding
j. Intracranial bleeding
k. Coagulation defects
l. Patients at high risk of bleeding
m. Use with caution in older patients due to a higher risk of renal and fatal GI adverse reactions.
Levalbuterol (Xopenex)
Indications
a. Treatment of acute bronchospasm in patients with reversible obstructive airway disease (COPD/asthma)
b. Bronchospasm prophylaxis in patients with asthma
Contraindications
a. Known hypersensitivity to the drug, other sympathomimetics, or peanuts
b. MAOI use within 14 days
c. Angioedema, tachydysrhythmias, and severe cardiac disease
d. Avoid administration with other drugs that prolong the QT interval.
e. Use with caution in patients with cardiac dysrhythmias and cardiovascular disorders.
Lidocaine Hydrochloride (Xylocaine)
Indications
a. Alternative to amiodarone in patients with cardiac arrest from:
i. VT, VF
ii. Stable monomorphic VT
iii. Stable polymorphic VT with normal baseline QT interval when ischemia is treated with electrolyte balance is corrected
b. Can be used for stable polymorphic VT with baseline QT interval prolongation if TdP is suspected
c. Can be used as a local anesthetic for various procedures
Contraindications
a. Hypersensitivity to lidocaine or amide-type local anesthetics, second- or third-degree AV block
b. Prophylactic use in AMI is contraindicated.
5. Adverse reactions/side effects
a. Drowsiness
b. Confusion
c. Seizures
d. Slurred speech
e. Hypotension
f. Dysrhythmias
g. Cardiac arrest
h. Nausea/vomiting
Lorazepam (Ativan)
Indications
a. Uncontrolled shivering associated with hyperthermia/heat exposure
b. Active seizures
c. Anxiety/sedation
d. Chemical restraint
Contraindications
a. Documented hypersensitivity
b. Neurologic or respiratory depression
c. Acute narrow-angle glaucoma
d. Sleep apnea
e. Shock
f. Suspected drug abuse
Magnesium Sulfate
Indications
a. Management of TdP
b. Severe bronchoconstriction with impending respiratory failure
c. Seizure during the third trimester of pregnancy or in the postpartum patient
Contraindications
a. Known hypersensitivity, heart block, myocardial damage, diabetic coma, hypermagnesemia, hypercalcemia
b. Use with caution in patients with known renal insufficiency.
Mannitol (Osmitrol)
Indications
a. Reduction of ICP in managing neurologic emergencies
b. Promotes diuresis for excretion of toxic substances and metabolites
Contraindications
a. Known hypersensitivity, hypotension, pulmonary edema
b. Severe pulmonary congestion
c. Electrolyte abnormalities
d. Severe dehydration
e. Intracranial bleeding
f. Heart failure
g. Use with caution in patients with impaired renal function (fluid overload can result).
Meperidine Hydrochloride (Demerol)
Indications
a. Analgesia for moderate to severe pain
Contraindications
a. Known hypersensitivity
b. Diarrhea caused by poisoning
c. Patients who have taken an MAOI during the previous 14 days
d. During labor or delivery for a premature infant.
e. Administer with caution to patients with:
i. A GCS score less than 15
ii. Hypotension
iii. Hypoxia after maximal supplemental oxygen therapy
iv. Signs of hypoventilation
f. Decrease the dose for patients with hepatic or renal insufficiency.
5. Adverse reactions/side effects
a. Seizures
b. Confusion
c. Sedation
d. Headache
e. Hallucinations
f. Increased ICP
g. Respiratory depression
h. Apnea
i. Hypotension/orthostatic hypotension
j. Syncope
k. Dysrhythmias
l. Nausea/vomiting
m. Constipation
n. Sweating
MethyIPREDNISolone Sodium Succinate (Solu-Medrol)
Indications
a. Allergic reaction
b. Anaphylaxis
c. Acute bronchospastic disease management
d. Shock with a history of adrenal insufficiency or long-term steroid dependence
Contraindications
a. Known hypersensitivity
b. Serious untreated infections
c. Premature infants
d. Use with caution in patients with:
i. GI bleeding
ii. Heart failure
iii. Hypertension
iv. Recent AMI
v. Renal disease
vi. Seizure disorder
vii. Cushing disease
Metoclopramide (Reglan)
Indications
a. Nausea/vomiting
Contraindications
a. Known hypersensitivity to metoclopramide or procainamide
b. GI hemorrhage, mechanical obstruction, or perforation
c. History of seizures, tardive dyskinesia, or a dystonic reaction
d. Pheochromocytoma
e. Parkinson disease
f. Administration with other drugs that can cause extrapyramidal symptoms
Midazolam Hydrochloride (Versed)
Indications
a. Uncontrolled shivering associated with hyperthermia/heat exposure
b. Active seizures
c. Chemical restraint
d. Severe respiratory distress
e. Sedation for medical procedures
f. Poisoning/overdose care
Contraindications
a. Documented hypersensitivity
b. Neurologic or respiratory depression
c. Acute narrow-angle glaucoma
d. Sleep apnea
e. Shock
f. Alcohol intoxication
g. Overdose
h. Depressed vital signs
i. Concomitant use with barbiturates, alcohol, opioids, or other CNS depressants
Milrinone (Primacor)
Indications
a. Heart failure in postoperative cardiovascular surgical patients
b. Shock with high systemic vascular resistance
Contraindications
a. Known hypersensitivity
b. Reduce the dose in patients with renal dysfunction
Morphine Sulfate (Roxanol, MS Contin)
Indications
a. Management of acute pain
Contraindications
a. Known hypersensitivity
b. Patients who have taken an MAOI during the previous 14 days
c. Paralytic ileus
d. Toxin-mediated diarrhea
e. Heart failure due to chronic lung disease
f. Head injuries
g. Brain tumors
h. Delirium tremens
i. Seizure disorders
j. During labor when premature birth is anticipated
k. Acute or severe bronchial asthma
l. Upper airway obstruction
m. Administer with caution to patients with:
i. A GCS score less than 15
ii. Hypotension
iii. Hypoxia after maximal supplemental oxygen therapy
iv. Signs of hypoventilation
Naloxone Hydrochloride (Narcan, EVZIO)
Indications
a. Complete or partial reversal of CNS and respiratory depression induced by opioids or synthetic opioids
Contraindications
a. Known hypersensitivity or allergy
b. Use with caution in opioid-dependent patients
c. Use with caution in neonates of opioid-addicted mothers
NIFEdipine (Procardia, Adalat, Nifedical)
Indications
a. HAPE prevention and treatment
b. Pregnancy-induced hypertension lasting more than 15 minutes with associated preeclampsia symptoms
Contraindications
a. Known hypersensitivity to calcium channel blockers
b. Cardiogenic shock
c. Immediate-release preparation for urgent or emergent hypertension
Nitroglycerin (Nitrostat, Nitrolingual Pumpspray, NitroQuick, Nitro-Bid, Tridil)
Indications
a. Ischemic-type chest pain
b. Acute and symptomatic hypertension
c. Heart failure
d. Pulmonary edema
Contraindications
a. Known hypersensitivity
b. Hypotension
c. Hypovolemia
d. Intracranial bleeding or head injury
e. Pericardial tamponade
f. Severe bradycardia or tachycardia
g. RV infarction
h. Previous administration of sildenafil or vardenafil within 24 hours or tadalafil within 48 hours
i. Use with caution in patients with:
i. Hepatic disease
ii. Anemia
iii. Diabetes mellitus
iv. Pregnancy
v. Breastfeeding
Nitroprusside (Nitropress)
Indications
a. Heart failure
b. Acute and symptomatic hypertension
Contraindications
a. Known hypersensitivity
b. Hypotension
c. Decreased cerebral perfusion
d. Heart failure with reduced peripheral vascular resistance
5. Adverse reactions/side effects
a. Confusion
b. Restlessness
c. Flushing
d. Dizziness
e. Headache
f. Palpitations
g. Dysrhythmias
h. Hypotension
i. Methemoglobinemia
j. Cerebrovasodilation leading to increased ICP
Nitrous Oxide 50:50 (Nitronox)
Indications
a. Analgesia in the patient who can self-administer this medication
Contraindications
a. Known hypersensitivity
b. Impaired level of consciousness
c. Head injury
d. Inability to follow or comply with instructions
e. Decompression illness
f. Significant respiratory compromise
g. Suspected abnormal air-filled cavities
h. Maxillofacial trauma or facial burns.
i. Relative contraindications include: stroke history, hypotension, pregnancy, known cardiac conditions, and known vitamin B12 deficiency.
Norepinephrine Bitartrate (Levophed, Levarterenol)
Indications
a. First-line vasopressor in neurogenic shock
b. Hypotension unresponsive to IV/IO fluid resuscitation
Contraindications
a. Known hypersensitivity
b. Hypotension caused by hypovolemia
c. Pregnancy (relative)
Octreotide (Sandostatin)
Indications
a. Treatment of active GI bleeding during transport
Contraindications
a. Known hypersensitivity
5. Adverse reactions/side effects
a. Nausea/vomiting
b. Bloating
c. Dizziness
d. Headache
e. Dysrhythmias
f. Pain and irritation at the injection site
Olanzapine (Zyprexa)
Indications
a. Agitated or violent patients experiencing a behavioral emergency
b. Chemical restraint
Contraindications
a. Documented hypersensitivity
b. Use with caution in patients who:
i. Have dehydration or heat exposure
ii. Are taking medications with anticholinergic effects
c. Impaired core body temperature regulation may occur.
d. Use with caution in patients with a history of seizures or urinary retention.
Ondansetron Hydrochloride (Zofran, Zofran ODT, Zuplenz)
Indications
a. Prevention and control or nausea or vomiting.
Contraindications
a. Known hypersensitivity to ondansetron or other 5-HT3 receptor antagonists
b. Known or suspected long QT syndrome
c. Coadministration with apomorphine
Oxygen
Indications
a. Any suspected cardiopulmonary emergency
b. Complaints of shortness of breath and ischemic chest discomfort
c. All other causes of decreased tissue oxygenation
Contraindications
a. Observe closely when using with patients who have pulmonary conditions that are known to be dependent on hypoxic respiratory drive.
Oxymetazoline (Afrin, Dristan 12-Hour, Vicks Sinus-12 Hour)
Indications
a. Epistaxis in a patient experiencing facial trauma
Contraindications
a. Known hypersensitivity
b. Severe hypertension
Oxytocin (Pitocin)
Indications
a. Postpartum hemorrhage due to uterine atony after infant and placental delivery
Contraindications
a. Known hypersensitivity
b. Presence of a remaining fetus
c. Unfavorable fetal position
d. Anticipated nonvaginal delivery
e. Fetal distress when delivery is not imminent
f. Prolonged use in severe toxemia
Pancuronium Bromide (Pavulon)
Indications
a. Adjunct to provide skeletal muscle relaxation and facilitate tracheal intubation and ventilation
Contraindications
a. Known hypersensitivity to pancuronium or a bromide hypersensitivity
b. Inability to control the airway and/or support ventilation with oxygen and positive pressure
c. Neuromuscular disease
d. Hepatic or renal failure
e. Use with extreme caution in patients with pulmonary disease, such as COPD.
Phenylephrine (Neo-Synephrine)
Indications
a. Epistaxis
b. To reduce bleeding during nasotracheal intubation
Contraindications
a. Known hypersensitivity
b. Use with extreme caution in geriatric patients with preexisting cardiovascular disease.
Potassium Iodide (Pima Syrup, SSKI, ThyroSafe, ThyroShield)
Indications
a. Environmental radiation emergency to block uptake of radioactive iodine isotopes in the thyroid and reduce thyroid cancer risk
Contraindications
a. Known iodine hypersensitivity
b. Hyperthyroidism
c. Respiratory failure
Pralidoxime (2-PAM, Protopam)
Indications
a. Antidote in treating poisoning by organophosphate pesticides and related nerve gases
Contraindications
a. Known hypersensitivity
b. Reduce the dose in:
i. Patients with impaired renal function
ii. Older adults with hypertension
iii. Patients with myasthenia gravis
Procainamide Hydrochloride (Pronestyl)
Indications
a. Stable monomorphic VT with normal QT interval
b. Reentry SVT uncontrolled by vagal maneuvers and adenosine if BP is stable
c. Stable wide-complex tachycardia of unknown origin
d. AF with a rapid ventricular rate in patients with Wolff-Parkinson-White syndrome
Contraindications
a. Known hypersensitivity to procainamide or other ingredients
b. TdP
c. Second- and third-degree heart AV block
d. Systemic lupus erythematosus
e. Preexisting QT prolongation
f. Digitalis toxicity
g. TCA overdose
h. Administer with caution to patients with:
i. Asthma or digitalis-induced dysrhythmias
ii. Myasthenia gravis
iii. Cardiac, hepatic, or renal insufficiency
Prochlorperazine (Compazine)
Indications
a. Nausea and vomiting
Contraindications
a. Documented hypersensitivity to phenothiazines
b. Concurrent use of large amounts of CNS depressants leading to sedation
c. Concomitant use of anticholinergic medications
d. Preexisting cardiac conduction abnormalities
e. Poorly controlled seizure disorder
f. Narrow-angle glaucoma
g. Prostatic hypertrophy
h. Past or current history of tardive dyskinesia
i. Subcortical brain damage
j. Pediatric surgery
k. Children younger than age 2 years
Promethazine Hydrochloride (Phenergan)
Indications
a. Nausea and vomiting
Contraindications
a. Known hypersensitivity to any phenothiazines
b. Concurrent use of large amounts of CNS depressants
c. Reye syndrome
d. Lower respiratory symptoms
e. Children younger than 2 years
f. Use with caution, if at all, in patients with a history of sleep apnea, acute or chronic respiratory impairment, or seizure disorders.
Proparacaine Ophthalmic (Alcaine, Ophthaine)
Indications
a. Induction of topical anesthesia before eye irrigation in the management of a chemical injury to the eye
Contraindications
a. Known hypersensitivity
b. Known or suspected trauma that may have results in intraocular injury
c. Use with caution in patients with cardiac disease or hyperthyroidism.
Propofol (Diprivan)
Indications
a. Maintenance of sedation in mechanically ventilated patients
Contraindications
a. Hypovolemia
b. Known sensitivities, including to soybean oil, peanuts, and eggs
Sildenafil (Revatio, Viagra)
Indications
a. HAPE prevention
Contraindications
a. Known hypersensitivity
b. Coadministration with nitrates
c. Significant cardiovascular disease
Sodium Bicarbonate
Indications
a. Management of cardiac arrest in which either hyperkalemia or TCA overdose is suspected
b. QRS prolongation in known or suspected TCA overdose
c. Crush syndrome
Contraindications
a. Documented hypersensitivity
b. Known metabolic or respiratory alkalosis
c. Hypokalemia
d. Hypernatremia
e. Hypocalcemia
f. Use with caution in patients with heart failure and renal disease due to high sodium concentration it produces.
Sodium Thiosulfate (Nithiodote)
Indications
a. Known or suspected cyanide poisoning
Contraindications
a. Documented hypersensitivity
Succinylcholine Chloride (Anectine)
Indications
a. Adjunct to provide skeletal muscle relaxation and facilitate tracheal intubation and ventilation
Contraindications
a. Known hypersensitivity
b. Inability to control the airway or support ventilation with oxygen and positive pressure
c. Renal failure
d. Muscular dystrophy and other neuromuscular diseases
e. Paraplegia/quadriplegia
f. Penetrating eye injuries
g. Prolonged immobilization
h. Stroke with residual motor dysfunction
i. History of malignant hyperthermia
j. Acute injury after multisystem trauma, major burns, known or suspected hyperkalemia, or extensive muscle injury that may result in hyperkalemia
k. Use with caution if a difficult airway is anticipated.
Tadalafil (Cialis, Adcirca)
Indications
a. HAPE prevention
Contraindications
a. Known hypersensitivity
b. Coadministration with nitrates
c. Stevens-Johnson syndrome
d. Exfoliative dermatitis
Tetracaine Ophthalmic Solution (Pontocaine)
Indications
a. Induction of topical anesthesia before eye irrigation in the management of a chemical injury to the eye
Contraindications
a. Known hypersensitivity
b. Known or suspected trauma that may have resulted in intraocular injury
Thiamine Hydrochloride (Vitamin B1)
Indications
a. Adjunctive therapy that should precede the administration of dextrose 50% or glucagon in an adult patient if alcoholism or malnourishment is suspected
Contraindications
a. Known hypersensitivity
Tranexamic Acid (Cyklokapron, Lysteda)
Indications
a. Blunt or penetrating trauma less than 3 hours from onset with hemodynamic compromise, bleeding
Contraindications
a. Known hypersensitivity
b. Mechanism of injury more than 3 hours prior to EMA care
c. Subarachnoid hemorrhage
d. History of PE, DVT, or other thromboembolic disorder
e. Reduce the dose in patients with renal insufficiency
Vecuronium Bromide (Norcuron)
Indications
a. Adjunct to provide skeletal muscle relaxation and facilitate tracheal intubation and ventilation
Contraindications
a. Known hypersensitivity to vecuronium or bromide
b. Inability to control the airway or support ventilation with oxygen and positive pressure
c. Neuromuscular disease
d. Acute narrow-angle glaucoma
e. Penetrating eye injuries
f. Newborns
g. Hepatic or renal failure
Verapamil Hydrochloride (Isoptin, Calan)
Indications
a. Stable narrow-QRS tachycardia if the rhythm persists despite vagal maneuvers or adenosine or if the tachycardia is recurrent
b. To control the ventricular rate in patients with AF or atrial flutter without preexcitation
Contraindications
a. Known hypersensitivity
b. Wolff-Parkinson-White syndrome, Lown-Ganong-Levine syndrome
c. Second- or third-degree AV block, sick sinus syndrome, or other sinus node disease without an artificial pacemaker present
d. Hypotension, cardiogenic shock, severe left ventricular dysfunction, wide-complex tachycardias
e. Children younger than age 12 months
f. Use with extreme caution in patients receiving oral beta blockers.
Ziprasidone (Geodon)
Indications
a. For the management of agitated or violent patients experiencing a behavioral emergency
b. Anxiety (palliative care)
Contraindications
a. Known hypersensitivity
b. History of QT prolongation
c. Use of any drugs that prolong the QT interval
d. Recent AMI
e. Uncompensated heart failure
f. Use with caution in patients with impaired renal function
