Medication Info

Question 1

Oxygen

Answer 1

Class: Element Gas

Action: Facilitates cellular energy metabolism

Indications: Hypoxia, ischemic CP, resp. distress, CO Poisoning, Trauma, Shock, Cardiac arrest

Adverse Effects: high concentrations can cause AMS and resp depression in PT with chronic lung disease.

Contraindications: Known Paraquat Poisoning

Special Considerations: Pregnancy Class A

Question 2

Atropine sulfate

Answer 2

Class: Anticholinergic (antimuscarinic)

Action: competes reversibly with Acetylcholine at muscarinic receptor. receptors affected from most to least sensative including salivary, bronchial, sweat glands, eyes, heart and GI tract.

Indications: Symptomatic Bradycardia, asystole/PEA, nerve agent exposure, organophosphate poisoning

Adverse effects: decrease secretions, hot skin, flushing, blurred vision, pupil dilation, tachycardia, restelessness, paradoxial bradycardia if administered to slowly or dose too small.

Contraindications: AMI, myasthenia gravis, GI obstruction, glaucoma, know sensativity to atropine, belladonna alkaloids and sulfites, not effective on type II infranodal AV block and new 3rd degree block with wide QRS

Special Considerations: Half life 2.5hrs, Preg. class C possibly unsafe in lactating mothers.

Question 3

Epinephrine

Answer 3

Class: Adrenergic Agent, Inotrope

Action: binds strongly with both a&b receptors increasing BP and HR, bronchodilation

Indications: Bronchospasm, Allergic Reaction/ Anaphylaxis, Cardiac Arrest

Adverse Effects: Anxiety, headache, arrythmias, HTN, nervousness, tremors, CP, N/V

Contraindications: Arrythmia other than VF/VT, asystole or PEA, cardiovascular disease, HTN, Cerebrovascular disease, shock 2nd to causes other than anaphylaxis ,glaucoma, DM, active labor, known sensativity to sulfates

Special Considerations: Half life 1min, Pregnancy class C

Question 4

Amiodarone (Cordarone)

Answer 4

Class: Antiarrhythmic, Class III

Action: acts on the myocardium to delay repolarization, increase duration of action potential

Indications: Ventricular Arrhythmias, 2nd line agent for Atrial arrhythmias

Adverse Effects: burning at IV site, Low BP, Bradycardia

Contraindications: sick sinus syndrome, 2nd and 3rd degree block, cardiogenic shock, senativity to benzyl alcohol and iodine, bradycardia caused syncope

Special Consideration: Pregnancy Class D

Question 5

Lidocaine (Xylocaine)

Answer 5

Class: Antiarrhythmic, Class IB

Action: Blocks sodium channels, increases recovery period after repolarization, supresses automaticity in the his-purkinje system and depolarization in the ventricles

Indications: Ventricular arrhythmias, when Amio is not available: cardiac arrest from VF/VT, stable monomorphic VT with preserved ventricular function, stable polymorphic VT with normal baseline QT interval and preserved left ventricular function (when ischemia and electrolyte imbalance are treated) stable polymorphic VT with baseline QT- prolongation, suggestive torsades.

Adverse Effects: Toxicity (anxiety apprehension, euphoria, nervousness, disorientation, dizziness, blurred vision, facial paralysis, tremors, hearing disturbances, slurred speach, seizures, sinus bradycardia) cardiac arrhymthias, low BP, Cardiac arrest, pain at injection site

Contraindications: AV Block, bleeding, thrombocytopnea, known sensativity to lido, sulfites, or parabens. Use caution with bradycadia, hypovolemia, cardiogenic shock, Adams-Strokes syndrome, WPW.

Special Considerations: Half Life approx. 90mins, Pregnancy Class B

Question 6

Magnesium sulfate

Answer 6

Class: Electrolyte, tocolytic, mineral

Action: required for normal physiologic function, is a cofactor in neruochemical transmission and muscular excitability. controls seizures by bloking peripheral neuromuscular transmission, peripheral vasodilator and platlelet function inhibitor.

Indications: Torsades, hypomagnesemia associated arrhythmias, sclampsia and seizure prophylaxis in preeclampsia, status asthmaticus.

Adverse Effects: Magnesium Toxicity (flushing diaphoresis, hypotension, muscle paralysis, weakness, hypothermia, cardiac CNS and resp depression)

Contraindications: AV Block, GI obstruction, caution with renal impairment

Special Considerations: Pregnancy Class A

Question 7

Vasopressin

Answer 7

Class: Nonadrenergic vasoconstrictor

Action: causes vasoconstriction independent of adrenergic receptors or neural innervation

Indications: Adult shock refractory VF, pulseless VT asystole, PEA, vasodilatory shock

Adverse Effects: Cardiac ischemia, angina

Contraindications: Responsive PT with Cardia Disease

Special Considerations: Pregnancy Class C

Question 8

Dopamine (Intropin)

Answer 8

Class: Adrenergic Agonist, inotrope, vasopressor

Action: Stimulates a&b adrenergic receptors moderate doses stimulates b1 receptors causing inotropy and increased cardiac output while maintaining dopaminergic-induced vasodilatory effects. high doses- a receptors predominate, increasing PVR and Vasoconstriction

Indications: hypotension and decreased CO associated with cardiogenic shock and septic shock, low BP after ROSC, symptomatic brady not active to atropine

Adverse Effects: Tachycardia, arrhythmias, necrosis of skin and tissues, severe HTN from excessive vasoconstriction, , angina, dyspnea, headache, N/V

Contraindications: Pheochromocytoma, VF, VT, other ventricular arrhythmia, known sensativity (including sulfites) correct hypovolemia with volume first

Special Considerations: Pregnancy Class C, Half life 2 mins

Question 9

Dobutamine

Answer 9

Class: Adenergic Agent

Action: Acts primarily as b1 agonist adrenergic receptors with minor b2 and a1 effects, increases mycardial contractility and SV with minor chronotropic effects increasing CO

Indications: CHF, Cardiogenic Shock

Adverse effects: Tachycardia, PVCs, HTN, Hypotension, palpitations, arrhythmias.

Contraindications: poisoning or drug induced shock, systolic BP <100 with signs of shock, idiopathic hypertrophic subaortic stenosis, known sensativity (including sulfites), use caution with HTN, recent MI, arrhythmias, hypovolemia

Special Considerations: Pregnancy Class C, Half life 2mins

Question 10

Adenosine (Adenocard)

Answer 10

Classification: Antiarrhythmic

Action: Slows the conduction of electrical impulses at the AV Node.

Indications: Stable Reentry SVT, will not convert AF, AFlutter, or VT.

Adverse Effects: Generally mild and short lived: feeling of impending doom, flushing, chest pressure, throat tightness, numbness. PT will have brief period of Asystole after administration.

Contraindications: Sick Sinus syndrome, 2nd or 3rd degree heart block, poison/drug induced tachycardia, asthma.

Special Considerations: Use caution with PT with preexisting bronchospasm and Hx of AF. Elderly with no Hx of PSVT should be evaluated for dehydration and rapid sinus tach treatable with fluid replacement rather than adenosine. Pregnancy Class C.

Question 11

Diltiazem (Cardizem)

Answer 11

Classification: Calcium Channel Blocker, Class IV Antiarrhythmic

Action: Blocks calcium from moving into the heart muscle cell, which prolongs the conduction of electrical impulses through the AV Node.

Indications: Ventricular Rate control in rapid AF.

Adverse Effects: Flushing, headache, bradycardia, hypotension, heart block, myocardial depression, severe AV Block, cardiac arrest.

Contraindications: Hypotension, Heart Block, heart failure.

Special Considerations: Use extreme caution with PT who are taking beta blockers because the two drugs potentiate each others effects and toxicities,. PT with Heart Failure and heart block are at high risk for toxicitiy, pregnancy class C.

Question 12

Verapamil (Isoptin)

Answer 12

Classification: Calcium Channel Blocker, Class IV Antiarrhythmic.

Action: Blocks Calcium from moving into the Heart Muscle cell, prolonging the conduction of electrical impulses through the AV Node. Also dilates the Arteries.

Indications: AF, HTN, PSVT, PSVT Prophylaxis

Adverse Effects: Sinus Brady, 1st,2nd,or 3rd Degree AV Block, CHF, reflex sinus tach, transient asystole, AV Block, hypotension.

Contraindications: 2nd, or 3rd Degree block, except PT with a functioning artificial pacemaker, hypotension (<90mmHg), Cardiogenic Shock, sick sinus syndrome (except with funcitoning pacemaker), WPW, Lown-Ganong-Levine syndrome, Severe left ventricular dysfunction, known sensativity AF, Aflutter, infants.

Pregnancy Class C

Question 13

Aspirin, ASA

Answer 13

Classification: Antiplatlet, Nonnarcotic Analgesic, antipyretic

Action: Prevents formation of chemical known as Thromboxane A2, which causes platelets to clump together or agregate, and form plugs that cause obstruction or constriction of small coronary ateries.

Indications: Fever, Inflammation, angina, AMI, Pain, Pressure, or squeezing in the Chest that may be cardiac in origin.

Adverse effects: Anaphylaxis, angioedema, bronchospasm, bleeding, stomach irritation, N/V.

Contraindications: GI Bleeding, active ulcer disease, hemorrhagic stroke, bleeding disorders, children with chicken pox or flu like symptoms, known sensativity.

Special Considerations: Pregnancy Class C except last three months when it is class D.

Question 14

Nitroglycerin (Nitrolingual, NitroQuick, Nitro-Dur)

Answer 14

Classification: Antianginal Agent

Action: Relaxes Vascular smooth muscle, thereby dilating peripheral arteries and veins. Causing pooling of venous blood return and decreased return of venous blood to the heart decreasing preload. NTG also reduces L ventricular Systolic wall tension, decreasing afterload.

Indication: Angina, ongoing ischemic chest discomfort, HTN, Myocardial ischemia associated with Cocaine intoxication

Adverse Effects: Headache, hypotension, Bradycardia, lightheadedness, flushing, cardiovascular collapse, methemoglobinemia.

Contraindications: hypotension, severe bradycardia or tachycardia, ED meds, known sensativity to nitrates, use caution with anemia, closed angle glaucoma, hypotension, postural hypotension, uncorrected hypovolemia.

Special Considerations: Admin to PT with R sided MI will cause Hypotension, Pregnancy Class C.

Question 15

Morphine sulfate

Answer 15

Classification: Opioid Agonist, Schedule Class C-II

Action: Binds with opioid receptors, morphine is capable of inducing hypotension by depression of the vasomotor centers in the brain, as well as release of chemical histamine, in the management of angina, morphine reduces stimulation of the sympathetic nervous system caused by pain and anxiety. Reduction of sympathetic stimulation reduces heart rate, cardiac work, and myocardial Oxygen demand.

Indications: Moderate to severe pain, CP associated with ACS, CHF, Pulmonary edema.

Adverse Effects: Respiratory Depression, hypotension, N/V, dizziness, lightheadedness, sedation, diaphoresis, euphoria, dysphoria, worsening brady cardia or heart block in Acute inferior wall MI, seizures, Cardiac arrest, anaphylactoid reactions.

Contraindications: Respiratory Depression, Shock, Known sensativity, use caution with hypotension, acute bronchial asthma, respiratory insufficiency, head trauma.

Special Considerations: Monitor VS and SpO2 closely, be prepared to support airway and ventilations, Treat OD with naloxone, Pregnancy Class C.

Question 16

Metoprolol (Lopressor, Toprol XL)

Answer 16

Classification: Beta Adrenergic Antagonist, Antianginal, Antihypertensive, Class II Antiarrhythmic.

Action: Inhibits Strength of the hearts contractions, as well as the heart rate. Resulting in a decrease in cardiac oxygen consumption.

Indications: ACS, HTN, SVT, AFlutter, Thyrotoxicosis.

Adverse Effects: Tiredness, dizziness, diarrhea, Heart block, bradycardia, bronchospasm, drop in BP.

Contraindications: Cardiogenic Shock, AV Block, Bradycardia, known sensitivity, use caution with Hypotension, asthma and COPD.

Special Considerations: BP, HR, and ECG should be monitored closely, use caution in PT with asthma, Pregnancy Class C.

Question 17

Furosemide (Lasix)

Answer 17

Classification: Loop Diuretic

Action: inhibits absoption of the sodium and chloride ions and water in the loop on Henle, as well as the convoluted tubule of the nephron. This results in decreased absorption of water and increased production of urine.

Indications: Pulmonary Edema, CHF, HTN Emergency

Adverse Effects: Vertigo, Dizziness, weakness, orthostatic hypotension, hypokalemia, thrombophlebitis. PT with Anuria, severe renal failure, untreated hepatic coma, increasing azotmia, and electrolyte depletion can develop life threatening consequences.

Contraindications: Known sensitivities to sulfonamides or furosemide.

Special Considerations: Onset of action occurs within 5 minutes and will peak within 30 minutes. PT will have urinary urgency. be prepared to held the PT void. Pregnancy Class C.

Question 18

Digoxin (Lanoxin)

Answer 18

Classification: Cardiac Glycoside

Action: Inhibits sodium-potassium-adenosine triphosphate membrane pump, resulting in an increase in calcium insde the heart muscle cell, which causes an increase in the force of contraction of the heart.

Indications: CHF, control ventricular rate in chronic AF and A flutter, narrow complex PSVT.

Adverse Effects: Headache, Weakness, Gi disturbances, Arrhythmias, N/V Diarrhea, visual disturbances.

Contraindications: Digitalis allergy, VT and VF, Heart Block, Sick sinus syndrome, tachycardia without heart failure, pulse lower than 50 or 60 bpm., MI, ischemic heart disease, PT with preexcitation AF or Aflutter (Delta Wave, WPW).

Special Considerations: Low levels of serum potassium can lead to digoxin toxicity and bradycardia. Conditions such as administration of steroids or diruetics or vomiting and diarrhea can produce low levels of potassium and subsequent digoxin toxicity, Pregnancy Class C.

Question 19

Sodium Bicarbonate

Answer 19

Classification: Electrolyte Replacement

Action: Counteracts Existing Acidosis

Indications: Acidosis, Drug Intoxications (barbituates, Salicylates, methyl alcohol)

Adverse Effects: Metabolic Alkalosis, hypernatremia, injection site reaction, sodium and fluid retention, peripheral edema.

Contraindications: Metabolic Alkalosis hypocalcemia

Special Considerations: Do not administer into an IV line that another medication is being given, because of the high concentration of sodium within each ampule of sodium bicarb, use caution with PT with CHF and Renal disease. Pregnancy Class C.

Question 20

Calcium Chloride

Answer 20

Classification: Element/ Electrolyte

Action: Increases contractile force and ventricular automaticity.

Indications: Hyperkalemia, Hypocalcemia, Hypermagnesmia, Calcium Channel Blocker Toxicity

Contraindications: VF, Hypercalcemia, Possible Digitalis Toxicity.

Special Considerations: Large Vein and Flush before and after.

Question 21

Albuterol (Proventil, Ventolin)

Answer 21

Classification: Beta Agonist, Bronchodilator

Action: Binds and stimulates Beta2 receptors resulting in relaxation of bronchial smooth muscle.

Indications: Asthma, Bronchitis with Bronchospasm and COPD

Adverse Reactions: Hyperglycemia, Hypokalemia, Palpitations, Sinus Tach, Anxiety, Tremors, N/V, Throat Irritation, dry mouth, HTN, dyspepsia, insomnia, headache, epistaxis, paradoxical bronchospasm.

Contraindications: Angioedema, sensitivity to albuterol or levalbuterol, use caution with lactating patients, cardiovascular disorders and arrhythmias.

Special Considerations: Pregnancy Class C

Question 22

Levalbuterol (Xopenex)

Answer 22

Classification: Beta Agonist

Action: Stimulates Beta 2 receptors, resulting in relaxation of the smooth muscle in the lungs, uterus, and vasculature that supply the skeletal muscle.

Indications: Acute Bronchospasm or bronchospasm prophylaxis in asthma.

Adverse Effects: Hyperglycemia, hypokalemia, palpitations, sinus tachycardia, anxiety, tremors, N/V, Throat Irritation, HTN, dyspepsia, headache, insomnia.

Contraindications: Angioedema, sensativity to levalbuterol/albuterol, Use caution with lactating patients, cardiovascular disorders, cardiac arrhythmias. Do not use in patients taking phenothiazines because this may cause prolonged QT interval and cardiac arrhythmias. Avoid in PT getting Sotalol because this decreases the bronchodilating effects and may cause bronchospasm, prolonged QT interval and cardiac arrhythmias.

Special Considerations: Pregnancy Class C

Question 23

Glucagon

Answer 23

Classification: Hormone

Action: Converts Glycogen to Glucose

Indications: Hypoglycemia, Beta Blocker OD

Adverse Effects: N/V, Hyperglycemia, Hypotension, Sinus Tach

Contraindications: Pheochromocytoma, Insulinoma

Special Considerations: Pregnancy Class B

Question 24

Ipratropium bromide (Atrovent)

Answer 24

Classification: Bronchodilator, Anticholonergic

Action: Antagonizes the acetylcholine receptor on bronchial smooth muscle, producing bronchodilation

Indications: Asthma, Bronchospasm associated with COPD

Adverse Reactions: Paradoxical acute bronchospasm, cough, throat irritation, headache, dry mouth, dizziness, palpitations.

Contraindications: Closed Angle Glaucoma, Bladder neck obstruction, prostatic hypertrophy, known sensativity including peanuts, soybeans, and atropine and atropine derivatives.

Special Considerations: Not typically used as the sole medication in the treatment of acute exasperation of asthma. Commonly administered after a beta agonist. do not allow aerosol spray to come into contact with the eyes, causing temporary blurring that will self resolve in 4 hours. Pregnancy Class B

Question 25

Albuterol/ipratropium (Combivent)

Answer 25

Classification: Combination Bronchodilator

Action: Binds and stimulates beta 2 receptors, resulting in relaxation of bronchial smooth muscle, and antagonizes the acetylcholine receptor causing bronchodilation.

Indications: Second Line Treatment in COPD or severe acute asthma exasperations during medical transport.

Adverse Effects: Headache, Cough, Nausea, Arrhythmias, paradoxical acute bronchospasm.

Contraindications: Allergy to soybeans or peanuts, known sensitivity to atropine, albuterol, or respective derivatives. Use caution in PT with asthma, HTN, angina, arrhythmias, tachycardias, cardiovascular disease, long QT syndrome, and closed angle glaucoma.

Special Considerations: Pregnancy Class C

Question 26

Methylprednisolone sodium succinate (Solu-Medrol)

Answer 26

Classification: Corticosteroid

Action: Reduces inflammation by multiple mechanisms

Indications: Anaphylaxis, Asthma, COPD

Adverse Effects: Depression, Euphoria, headache, restlessness, HTN, Bradycardia, N/V, Swelling, Diarrhea, Weakness, Fluid retention, Paresthesias.

Contraindications: Cushings syndrome, fungal infection, measles, varicella, known sensitivity (including sulfites), USe cautions with active infections and renal disease, penetrating spinal cord injury, HTN, Seizures and CHF.

Special Considerations: Pregnancy Class C, May mask signs and symptoms of infection

Question 27

Hydrocortisone sodium succinate (Cortef, Solu-Cortef)

Answer 27

Classification: Corticosteroid

Action: Reduces inflammation by multiple mechanisms. As a steroid, it replaces the steroids that are lacking in adrenal insufficiency.

Indications: Adrenal insufficiency, allergic Reactions, anaphylaxis, asthma, COPD

Adverse Effects: Leukocytosis, hyperglycemia, increased infection, decreased wound healing, increased rate of death by sepsis.

Contraindications: Cushings syndrome, known sensitivity to benzyl alcohol, use caution with DM, HTN, CHF, Systemic fungal infection, renal disease, idiopathic thrombocytopenia, psychosis, seizure disorder, GI disease, glaucoma, known sensitivity.

Special Considerations: Pregnancy Class C

Question 28

Racemic epinephrine/racepinephrine (microNefrin, S2)

Answer 28

Classification: Bronchodilator, Adrenergic Agent

Action: Stimulates both alpha and beta receptors, causing vasoconstriction, reduced mucosal edema, and bronchodilation.

Indications: Bronchial Asthma, Croup

Adverse Effects: Anxiety, dizziness, headache, Tremor, palpitations, tachycardia, cardiac arrhythmias, HTN, N/V

Contraindications: Glaucoma, elderly, Cardiac disease, HTN, thyroid disease, DM, known sensitivity to sulfites.

Special Considerations: Monitor BP, HR, Rhythm for changes, Onset of action is 1 to 5 mins, Pregnancy Class C

Question 29

Fentanyl citrate (Sublimaze)

Answer 29

Classification: Narcotic Analgesic, Schedule C-II

Action: Binds to opiate receptors, producing analgesic and euphoria.

Indications: Pain

Adverse Effects: Respiratory depression, apnea, hypotension, N/V, dizziness, sedation, euphoria, sinus bradycardia, palpitations, HTN, diaphoresis, syncope, pain at injection site.

Contraindications: Know Sensitivity, use caution with TBI, respiratory depression.

Special Considerations: Pregnancy Class B

Question 30

Meperidine (Demerol)

Answer 30

Narcotic Analgesic, Schedule C-II

Action: Binds to opiate receptors causing analgesia and euphoria.

Indications: Moderate to Severe Pain

Adverse effects: Respiratory depression, N/V, dizziness, Sinus Brady, Sinus tach, Palpitations, HTN, Hypotension, orthostatic hypotension, diaphoresis, syncope, shock, cardiac arrest

Contraindications: PT who may have taken MAOI in the past 2 weeks, PT using other CNS depressants or ETOH, known sensitivity, use caution with chronic respiratory conditions, COPD asthma, pregnant or nursing women, aflutter.

Special Considerations: Adults: Half life approximately 4 hours, but its active metabolites may last 30 hours. Pregnancy Class C, D near term.

Question 31

Butorphanol (Stadol)

Answer 31

Classification: Narcotic analgesic, Schedule C-IV controlled substance.

Action: Produces analgesia by binding to opiate receptors.

Indications: Moderate to Severe Pain

Adverse Effects: Drowsiness, dizziness, N/V, confusion, respiratory depression, bradycardia, Hypotension

Contraindications: PT with active substance abuse, sensitivity to opiate agonists, Use caution with kidney, liver, or pulmonary problems.

Special Considerations: Pregnancy Class C

Question 32

Nitrous oxide

Answer 32

Classification: inorganic gas, inhaled anesthetic

Action: Exact Mechanism Unknown

Indications: Mild to severe pain

Adverse Effects: Delirium, hypoxia, respiratory depression, N/V.

Contraindications: Use caution with head trauma, increased ICP, pneumothorax, bowel obstruction, PT with COPD who require a hypoxic respiratory drive.

Special Considerations: ensure the safety of healthcare professionals, use only with a scavenger gas system to ensure that unused gas is collected or scavenged, an that providers are not exposed to significant levels of the agent.
Pregnancy Class not noted.

Question 33

Ketamine (Ketalar)

Answer 33

Classification: General Anesthetic

Action: produces a state of anesthesia while maintaining airway reflexes, HR and BP.

Indications: Pain and as anesthesia for procedures or short duration.

Adverse Effects: Emergence Phenomena, HTN, sinus tach, hypotensions and sinus brady, other cardiac arrhythmias, respiratory depression, apnea, laryngospasms, other forms of airway obstruction (rare), tonic clonic movements and vomiting.

Contraindications: Cases where HTN will be a hazard, Use caution with increased ICP or Increased intraocular pressure. hypovolemia, dehydration, cardiac disease. especially angina or CHF.

Special Considerations: Pregnancy Class C.

Question 34

Etomidate (Amidate)

Answer 34

Classification: Hypnotic, anesthesia induction agent

Action: Exact mechanism unknown, appears to have a GABA- like effect

Indications: Induction for RSI/MAI, induction of anesthesia

Adverse Effects: Hypotension, respiratory depression, pain at injection site, involuntary muscle movements, N/V, adrenal insufficiency, Hyperventilation, hypoventilation, apnea of short duration, hiccups, larygospasm, snoring, tachypnea, HTN, arrhythmias

Contraindications: Known Sensitivity, use in pregnancy only if the potential benefits justify the potential risk to the fetus, do not use in labor and avoid use in nursing mothers.

Special Considerations: Etomidate is used to prepare a PT for Orotracheal intubation, both personnel and equipment must be available to manage airway before administration. Pregnancy Class C

Question 35

Propofol (Diprivan)

Answer 35

Classification: Anesthetic

Action: Produces Rapid and brief states of general anesthesia

Adverse Effects: Apnea, arhythmias, asystole, hypotension, HTN, Pain at injection site.

Contraindication: Hyplovolemia, known sensitivity, including soybean and eggs

Special Considerations: Propofol should be administered only by personnel trained and equipped to manage the patients airway and provide mechanical ventilation. in elderly and debilitated patients avoid rapid administration to prevent hypotension apnea, airway obstruction, and or O2 desat. Continue to monitor PT VS and try to limit use to patients that are intubated. Propofol should not be administered through the same IV catheter as blood or plasma. Pain can occur at the site of injection, which can be minimized by use of large veins, slow administration rates, and administration or 1mL 1% lidocaine before administration. Pregnancy Class B, Should be avoided in pregnant women because it crosses the placenta and can cause neonatal depression.

Question 36

Diazepam (Valium)

Answer 36

Classification: Benzodiazepine, Schedule C-IV

Action: Binds to benzo receptor and enhances effects of GABA. Benzos act at the level of the limbic, thalamic, and hypothalamic regions of the CNS and can produce any level of CNS depression required (including sedation, skeletal muscle relaxation, and anticonvulsant activity.)

Indications: Anxiety, Skeletal Muscle relaxation, ETOH withdrawl, Seizures.

Adverse Effects: Respiratory Depression, Drowsiness, Fatigue, headache, pain at injection site, confusion, N/V, Hypotension, Oversedation

Contraindications: Children younger than 6 months, glaucoma, CNS depression, ETOH, known sensitivity.

Special Considerations: Make sure IV line well secured, infiltration can cause tissue necrosis, insoluble in waterand must be dissolved in propylene glycol, this produces a viscous solution, give slowly to reduce pain at injection site. Pregnancy Class D

Question 37

Midazolam (Versed)

Answer 37

Classification: Benzo, Schedule C-IV

Action: Binds to benzo receptor and enhances effects of GABA. Benzos act at the level of the limbic, thalamic, and hypothalamic regions of the CNS and can produce any level of CNS depression required (including sedation, skeletal muscle relaxation, and anticonvulsant activity.) Short Acting

Indications: Sedation, Anxiety, Skeletal Muscle Relaxation

Adverse Effects: Respiratory Depression, respiratory Arrest, Hypotension, N/V, Headache, Hiccups, Cardiac Arrest

Contraindications: glaucoma, pregnant women, known sensitivity

Special Considerations: Frequently monitor VS and SpO2, prepare to support airway and ventilations
Pregnancy Class D

Question 38

Lorazepam (Ativan)

Answer 38

Classification: Benzo, Schedule C-IV

Action: Binds to benzo receptor and enhances the effects of GABA, an inhibitory transmitter, and may result in a state of sedation, hypnosis, skeletal muscle relaxation, anticonvulsant activity, and coma

Indications: Procedural Sedation induction, status epilepticus, anxiety

Adverse Effects: Headache, Drowsiness, N/V, ataxia, amnesia, depression, dysarthria, euphoria, syncope, fatigue, tremor, vertigo, respiratory depression, paradoxical CNS stimulation.

Contraindications: Known sensitivity to benzos including polyetheline glycol, propylene glycol, benzyl alcohol, copd, sleep apnea, shock, coma, glaucoma,

Special Considerations: be prepared to support airway and ventilations
Pregnancy Class D

Question 39

Flumazenil (Romazicon)

Answer 39

Classification: Benzo receptor antagonist, antidote

Action: competes with benzos for binding at benzo receptor, reverses sedative effects from benzos

Indications: Benzo oversedation

Adverse Effects: Resedation, seizures, dizziness, pain at injection site, N/V, diaphoresis, headache, visual impairment.

Contraindications: Cyclic antidepressant OD, Life threatening conditions that require treatment by benzos, status epilepticus, intracranial HTN, known sensitivity, use caution where there is the possibility of unrecognized benzo dependence, and in PT who have HX of substance abuse or who are substance abusers.

Special Considerations: Monitor for hypoventilation and hypoxia for 2 hours, if half life of benzo is longer than flumazenil, additional dose may be required. May precipitate withdrawl symptoms in dependant patients. not been shown to benefit polypharm OD. Pregnancy Class C.