MEDICATION CARDS Flashcards
Brand name for Lactated Ringers?
Hartman’s solution
Lactated Ringers class?
Isotonic crystalloid solution
Lactated Ringer’s MOA?
Lactated Ringer’s replaces water and
electrolytes
Lactated Ringer’s indications?
Hypovolemic shock; keep open IV
Lactated Ringer’s contraindications?
Lactated Ringer’s should not be used in patients with congestive heart failure or renal failure
Lactated Ringer’s onset/duration?
Short-term therapy
Lactated Ringer’s side effects and adverse reactions?
Rare in therapeutic dosages
Lactated Ringer’s precautions/considerations?
None
Lactated Ringer’s route-does for adults and pets?
Hypovolemic shock; titrate according to patient’s physiologic response;
Lactated Ringer’s is supplied in 250-, 500-, and 1,000-mL bags, IV infusion
0.9% Sodium Chloride brand name?
normal saline flush
0.9% Sodium Chloride class?
Isotonic crystalloid solution
0.9% Sodium Chloride MOA?
Normal saline replaces water and electrolytes
0.9% Sodium Chloride indications?
Heat-related problems (heat exhaustion, heat stroke), freshwater drowning, hypovolemia, diabetic ketoacidosis, keep open IV
0.9% Sodium Chloride contraindications?
The use of 0.9% sodium chloride should not be considered in patients with congestive heart failure because circulatory overload can be easily induced
0.9% Sodium Chloride onset/duration?
Short-term therapy
0.9% Sodium Chloride side effects and adverse reactions?
Rare in therapeutic dosages
0.9% Sodium Chloride precautions/considerations?
None
0.9% Sodium Chloride route/dose for adult and peds?
The specific situation being treated will dictate the rate in which normal saline will be administered. In severe heatstroke, diabetic ketoacidosis, and freshwater drowning, it is likely that you will be called on to administer the fluid quite rapidly. In other cases, it is advis- able to administer the fluid at a moderate rate (for example, 100 mL/h).
Normal saline is supplied in 250-, 500-, and 1,000-mL bags. Sterile normal saline for irrigation should not be confused with that designed for intravenous administration
Brand name for 5% dextrose in water?
D5W
5% dextrose in water class?
Hypotonic dextrose-containing solution
5% dextrose in water MOA?
D5W provides nutrients in the form of dextrose as well as free water
5% dextrose in water indications?
IV access for emergency drugs; for dilution of concentrated drugs for intravenous infusion
5% dextrose in water contraindications?
D5W should not be used as a fluid replacement for hypovolemic states
5% dextrose in water onset/duration?
Short-term therapy
5% dextrose in water side effects and adverse reactions?
Rare in therapeutic dosages
5% dextrose in water precaution considerations?
D5W should not be used with phenytoin (Dilantin) or amrinone (Inocor)
5% dextrose in water route-dose in adults and peds?
D5W is usually administered through a minidrip (60 drops/mL) set at a rate of “to keep open” (TKO)
D5W is supplied in bags of 50, 100, 150, 250, 500, and 1,000 mL
Brand name for water is?
sterile water
Water pregnancy class?
Pregnancy Category C
Water MOA?
Water is hypotonic and will cause hemolysis; readily absorbed by the tissues
Water indications?
Sterile Water for Irrigation USP is indicated for use as an irrigating fluid or pharmaceutic aid. Sterile Water may also be used as an adjunct in the preparation of non-intravenously administered nutrient mixtures
Water contraindications?
Not for injection by usual parenteral routes
Water onset/duration?
immediate
Water side effects and adverse reactions?
Possible adverse effects arising from the irrigation of body cavities, tissues, or indwelling catheters and tubes are completely avoidable when proper procedures are followed. Displaced catheters or drainage tubes can lead to irrigation or infiltration of unintended structures or cavities. Excessive volume or pressure during irrigation of closed cavities may cause undue distention or disruption of tissues. Accidental contamination from careless technique may transmit infection.
Water precaution considerations?
Use only if solution is clear and container and seal are intact; After opening container, its contents should be used promptly to minimize the possibility of bacterial growth or pyrogen formation; Discard unused portion of irrigating solution since it contains no preservative
Water route-dose for adults and peds?
The dose is dependent upon the capacity or surface area of the structure to be irrigated and the nature of the procedure. When used as a diluent or vehicle for drugs, the manufacturer’s recommendations should be followed.
Sterile Water for Irrigation, USP is supplied in single-dose 1000, 2000 and 3000 mL flexible irrigation container, single-dose 250 and 500 mL semi-rigid irrigation container, and single-dose 1000 and 1500 mL semi-rigid irrigation container
Etomidate Brand Name?
Amidate
Etomidate class?
Nonbarbiturate hypnotic, anesthesia induction agent
Etomidate pregnancy class?
Pregnancy safety: Category C
Etomidate MOA?
Short-acting hypnotic that acts at the level of the reticular activating system
Etomidate indications?
Premedication for tracheal intubation or cardioversion
Etomidate contraindications?
Hypersensitivity, labor/delivery
Etomidate onset/duration?
Onset: <1 minute. Peak effect: 1 minute. Duration: 5–10 minutes
Etomidate side effects and adverse reactions?
Apnea of short duration, respiratory depression, hypoventilation, hyperventilation, dys- rhythmias, hypotension, hypertension, nausea, vomiting, involuntary muscle movement, pain at injection site
Etomidate precaution considerations?
Carefully monitor vital signs. Etomidate can suppress adrenal gland production of steroid hormones, which can temporarily cause gland failure. Consider decreasing dose in elderly and patients with cardiac conditions
Etomidate route-dose: adults and peds
supplied via 2 mg/ml vials
Adult: 0.2–0.6 mg/kg IV over 30–60 seconds (typical adult dose is 20 mg). Pediatric: 0.2–0.4 mg/kg IV/IO over 30–60 seconds for rapid sequence intubation (older than 10 years), 1 time only. Maximum dose: 20 mg
Aspirin brand name?
ASA, Bayer, Ecotrin, St. Joseph
Aspirin class?
Platelet inhibitor, anti-inflammatory agent
Aspirin pregnancy class?
Pregnancy safety: Category D
Aspirin MOA?
Prevents platelets from clumping together, or aggregating, and forming emboli
Aspirin indications?
New onset chest pain suggestive of acute myocardial infarction
Aspirin contraindications?
Hypersensitivity. Relatively contraindicated in patients with active ulcer disease or asthma
Aspirin onset/duration?
Onset: 30–45 minutes. Peak effect: Variable. Duration: Variable
Aspirin side effects and adverse reactions?
Bronchospasm, anaphylaxis, wheezing in allergic patients, prolonged bleeding, GI bleeding, epigastric distress, nausea, vomiting, heartburn, Reye syndrome
Aspirin precaution considerations?
Not recommended in pediatric population
Aspirin route-dose: Adult and Peds?
supplied via 81-mg, 160-mg, and 325-mg tablets. Chewable and standard
Adult: 160 mg to 325 mg PO. Chewing is preferable to swallowing. Pediatric: Not recommended
succinylcholine chloride brand name?
Anectine
succinylcholine chloride class?
Neuromuscular blocker, depolarizing; skeletal muscle relaxant
succinylcholine chloride schedule pregnancy?
Pregnancy safety: Category C
succinylcholine chloride MOA?
Ultra-short-acting depolarizing skeletal muscle relaxant that mimics acetylcholine as it binds with the cholinergic receptors on the motor end plate, producing a phase 1 block as manifested by fasciculations
succinylcholine chloride indications?
Rapid-sequence intubation
succinylcholine chloride contraindications?
Acute narrow-angle glaucoma, penetrating eye injuries, malignant hyperthermia. Acute injury after multi- system trauma, major burns, or extensive muscle injury. Inability to control airway or support ventilations with oxygen and positive pressure
succinylcholine chloride onset/duration?
Onset: 1 minute. Peak effect: 1–3 minutes. Duration: 5–10 minutes
succinylcholine chloride side effects and adverse reactions?
Apnea, respiratory depression, bradydysrhythmia, tachydysrhythmia, dysrhythmia, cardiac arrest, salivation, prolonged muscle rigidity, rhabdomyolysis, malignant hyperthermia, increased intraocular pressure, hyperkalemia (trauma patients)
succinylcholine chloride precaution considerations?
If the patient is conscious, explain the effects of the drug before administration. Consider premedication with atropine, particularly in pediatric age group. Premedication with lidocaine may blunt any increase in intracranial pressure during intubation. Etomidate, diazepam, or midazolam should be used in any conscious patient before undergoing neuromuscular blockade
succinylcholine chloride route-dose: Adult/Peds?
supplied via 20 mg/mL vials
Adult: 1–1.5 mg/kg rapid IV. Repeat once if needed. Pediatric: 1–1.5 mg/kg rapid IV/IO. Repeat once if needed. 2 mg/kg in infants
Vecuronium Bromide brand name?
Norcuron
Vecuronium Bromide class?
Neuromuscular blocker, nondepolarizing
Vecuronium Bromide schedule pregnancy?
Pregnancy safety: Category C
Vecuronium Bromide MOA?
Neuromuscular agent with intermediate duration of action that competes with acetylcholine for receptors at the motor end plate, resulting in neuromuscular
blockade
Vecuronium Bromide indications?
Rapid-sequence intubation
Vecuronium Bromide contraindications?
Acute narrow-angle glaucoma, penetrating eye injuries, inability to control airway or support ventilations with oxygen and positive pressure, newborns, myasthenia gravis, hepatic or renal failure
Vecuronium Bromide onset/duration?
Onset: 1–3 minutes. Peak effect: Varies. Duration: 45–90 minutes
Vecuronium Bromide side effects and adverse reactions?
Weakness, prolonged neuro- muscular block, bronchospasm, apnea, dysrhythmias, brady- cardia, tachycardia, PVCs, transient hypotension, cardiac arrest, excessive salivation
Vecuronium Bromide precaution considerations?
If patient is conscious, explain the effect of the medication before administration and always sedate the patient before using vecuronium. Intubation and ventilatory support must be readily available. Monitor the patient carefully. Vecuronium has no effect on consciousness or pain. Will not stop neuronal seizure activity. Pulse rate and cardiac output are increased. Decrease doses for patients with renal disease
Vecuronium Bromide route-dose: Adult/peds?
supplied via 10- and 20-mg powder (requires reconstitution before administration)
Adult: 0.1–0.2 mg/kg IV push. Maintenance dose within 45–60 minutes: 0.8–1.2 mg/kg IV push. Pediatric: 0.1–0.3 mg/kg IV/IO. Maintenance dose within 20–35 minutes: 0.01–0.05 mg/kg IV/IO push
Ketamine brand name?
Ketalar
ketamine class?
anesthetic
ketamine pregnancy class?
pregnancy class B
Ketamine MOA?
acts on cortex and limbic receptors, producing dissociative analgesia and sedation
Ketamine indications?
sole anesthetic agent for diagnostic and surgical procedures not requiring skeletal relaxation; induction prior to other general anesthesia; supplment to low potency agents
Ketamine contraindications?
Hypersensitivity; Conditions in which an increase in blood pressure would be hazardous; stroke
Ketamine onset/duration?
varied depending on dose, route, age. Rapid induction if administered intravenously
Ketamine side effects and adverse reactions?
emergency reactions, HTN, increased cardiac output, increased ICP, tachycardia, tonic clonic movements, visual hallucinations, vivid dreams
1-10% - bradycardia, diplopia, hypotension, increased IOP, injection site pain, nystagmus
<1% - anaphylaxis, cardiac arrhythmia, depressed cough reflex, fasciculations, hypersalivation, increased IOP, increased metabolic rate, hypertonia,, laryngospasm, respiratory depression
Ketamine precaution consideration?
administered under supervision of medical professionals with resuscitative equipment available for ready use. Overdosage may lead to respiratory depression; be cautious for use on patients with glaucoma, seizures, mental illness, hypertension, respiratory infections
Ketamine route-dose:
adult/peds?
adults
IV: 1-4.5 mg/kg slow IV once
0.5-2 mg/kg slow IV if adjuvant drugs (eg, midazolam) are used
IM: 6.5-13 mg/kg IM once
Alternatively (off-label): 4-10 mg/kg IM once if adjuvant drugs (eg, midazolam) are used
Peds, 3 months or older
IV: Various recommendations, 1.5-2 mg/kg over 30-60 sec
IM: 4-5 mg/kg IM once; may give a repeat dose (range 2-5 mg/kg) if sedation inadequate after 5-10 min or if additional doses are required
16 years or older
IV: 1-4.5 mg/kg slow IV once; 0.5-2 mg/kg slow IV if adjuvant drugs (eg, midazolam) are used
IM: 6.5-13 mg/kg IM once; 4-10 mg/kg IM once if adjuvant drugs (eg, midazolam) are used
Lorazepam brand name?
Ativan
Lorazepam class?
Benzodiazepine, short/intermediate acting; sedative, anticonvulsant, schedule IV drug
Lorazepam pregnancy class?
Pregnancy safety: Category D
Lorazepam MOA?
Anxiolytic, anticonvulsant, and sedative effect; suppresses propagation of seizure activity produced by foci in cortex, thalamus, and limbic areas
Lorazepam indications?
Initial control of status epilepticus or severe recurrent seizures, severe anxiety, sedation
Lorazepam contraindications?
Acute narrow-angle glaucoma, coma, shock, suspected drug abuse
Lorazepam onset/duration?
Onset: 1–5 minutes. Peak effect: Variable. Duration: 6–8 hours
Lorazepam side effects and adverse reactions?
Dizziness, drowsiness, CNS depression, headache, sedation, respiratory depression, apnea, hypotension, bradycardia
Lorazepam precaution considerations?
Monitor respiratory rate and blood pressure during administration. Have advanced airway equipment readily available. Inadvertent arterial injection may result in vasospasm and gangrene. Lorazepam expires in 6 weeks when not refrigerated
Lorazepam route-dose: Adult/Peds?
supplied via 2 and 4 mg/mL vials and Tubex syringes
When given IV/IO, must be diluted with equal volume of sterile water or sterile saline. When given IM, lorazepam is not diluted. Adult: 2–4 mg slow IM/IV at
2 mg/min; may be repeated in 15–20 minutes. Maximum dose of 8 mg. For sedation: 0.05 mg/kg up to 4 mg IM. Pediatric: 0.05– 0.20 mg/kg slow IV/IO/IM over 2 minutes. May be repeated once in 5–20 minutes. Maximum dose of 0.2 mg/kg
midazolam brand name?
Versed
midazolam class?
Benzodiazepine, short/intermediate acting; schedule IV drug
midazolam pregnancy class?
Pregnancy safety: Category D
midazolam MOA
Reversibly interacts with gamma-amino butyric acid (GABA) receptors in the central nervous system causing sedative, anxiolytic, amnesic, and hypnotic effects
midazolam indications?
Sedation for medical procedures (eg, intubation, ventilated patients, cardioversion)
midazolam contraindications?
Acute narrow-angle glaucoma, shock, coma, alcohol intoxication, overdose, depressed vital signs. Concomitant use with barbiturates, alcohol, narcotics, or other central nervous system depressants
midazolam onset/duration?
Onset: 1–3 minutes, IV and dose dependent. Peak effect: Variable. Duration: 2–6 hours, dose dependent
midazolam side effects and adverse reactions?
Headache, somnolence, respiratory depression, respiratory arrest, apnea, hypotension, cardiac arrest, nausea, vomiting, pain at the injection site
midazolam precaution considerations?
Administer immediately prior to intubation procedure. Requires continuous monitoring of respiratory and cardiac function. Decrease dose by 50% in patients with hepatic and renal dysfunction
midazolam route-dose adult/peds?
supplied via 1 mg/mL and 5 mg/mL vials and Tubex syringes
Adult: 2–2.5 mg slow IV (over 2–3 minutes). May be repeated to total maximum: 0.1 mg/ kg. Pediatric: 0.1–0.3 mg/kg IV/IO (maximum single dose: 10 mg)
morphine brand name?
Roxanol, MS Contin
morphine class?
Opioid analgesic (schedule II narcotic)
morphine schedule pregnancy class?
Category C
morphine MOA?
Alleviates pain through CNS action. Suppresses fear and anxiety centers in the brain. Depresses brainstem respiratory centers. Increases peripheral venous capacitance and decreases venous return. Decreases preload and afterload, which decreases myocardial oxygen demand
morphine indications?
Severe CHF, acute cardiogenic pulmonary edema, chest pain associated with acute myocardial infarction, analgesia for moderate to severe acute and chronic pain
morphine contraindications?
Head injury, exacerbated COPD, depressed respiratory drive, hypotension, undiagnosed abdominal pain, decreased level of consciousness, suspected hypovolemia, patients who have taken MAOIs within 14 days
morphine onset/duration?
Onset: Immediate. Peak effect: 20 minutes. Duration: 2–7 hours
morphine side effects/adverse reactions?
Confusion, sedation, headache, CNS depression, respiratory depression, apnea, bronchospasm, dyspnea, hypotension, orthostatic hypotension, syncope, bra- dycardia, tachycardia, nausea, vomiting, dry mouth
morphine precaution considerations?
Morphine rapidly crosses the placenta. Safety in neonates has not been established. Use with caution in the elderly, those with asthma, and in those susceptible to central nervous system depression. Vagotonic effect in patients with acute inferior MI (bradycardia, heart block). Naloxone hydrochloride (Narcan) should be readily available as an antidote
morphine route-dose in adults and peds?
supplied via 2 mg/mL, 4 mg/mL, 8 mg/mL, 10 mg/mL ampules, vials, and Tubex syringe
Adult: STEMI: Initial dose: 2–4 mg slow IV (over 1–5 minutes). Repeat dose: 2–8 mg at 5–15 min- ute intervals. NSTEMI/Unstable angina. 1–5 mg IV push if symptoms not relieved by nitrates, use with caution. Pediatric: 0.1–0.2 mg/kg/dose IV, IO, IM, SC. Maximum dose: 5 mg
Diazepam brand name?
Valium
Diazepam class?
Benzodiazepine, long-acting; sedative-hypnotic; anticonvulsant; schedule IV drug
Diazepam pregnancy class?
Pregnancy safety: Category D
Diazepam MOA?
Potentiates effects of inhibitory neu- rotransmitters. Raises the seizure threshold. Induces amnesia and sedation
Diazepam indications?
Acute anxiety states and agitation, acute alcohol withdrawal, muscle relaxant, seizure activity, sedation for medical procedures (eg, intubation, ventilated patients, cardiover- sion), may be helpful in acute symptomatic cocaine overdose
Diazepam contraindications?
Hypersensitivity, narrow-angle glaucoma, myasthenia gravis, respiratory insufficiency, coma, head injury
Diazepam onset/duration?
Onset: 1–5 minutes. Peak effect: 15 minutes. Duration: 20–50 minutes
Diazepam side effects and adverse reactions?
Dizziness, drowsiness, con- fusion, headache, respiratory depression, hypotension, reflex tachycardia, nausea, vomiting, muscle weakness, tissue necrosis, ataxia, thrombosis, phlebitis
Diazepam precaution considerations?
Short duration for anticonvulsant effect. Reduce dose by 50% in elderly patients
Diazepam route-dose in adults and peds?
supplied via 5 mg/mL prefilled syringes, ampules, vials, and Tubex syringes
Adult: Seizure activity: 5–10 mg IV q 10–15 minutes PRN (5 mg over 5 minutes) (maximum dose: 30 mg). Premedication for cardioversion: 5–15 mg IV over 5–10 minutes prior to cardioversion. Pediatric: Seizure activity: 0.2 mg/kg to 0.5 mg/kg slow IV q 2–5 minutes up to 5 mg (maximum dose 10 mg/kg). Rectal diazepam: 0.5 mg/kg via 2” rectal catheter and flush with 2–3 mL air after administration
