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Medication IV Guide Flashcards

0
Q

Adenosine (Adenocard)

Action?

A

Adenosine (Adenocard)

Action:

  1. Acts on AV node to slow conduction. May inhibit reentry pathways.
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1
Q

Adenosine (Adenovard)

Classification?

A

Adenosine (Adenocard)
Classification

ANTIARRHYTHMIC

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2
Q

Adenosine (Adenocard)

Onset of Action

Duration of Action

A

Adenosine (Adenocard)

Onset of Action: Immediate

Duration of Action: Less than 1 minute

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3
Q

Adenosine (Adenocard)

Indication

A

Adenosine (Adenocard)

Indication:

  1. Conversion of Paroxysmal SVT to Sinus Rhythm
  2. Wolff-Parkinson White Syndrome with Narrow QRS complex
    * ineffective w/ a-fib, a-flutter, ventricular tachycardia.
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4
Q

Adenosine (Adenocard)

Contraindications

A

Adenosine (Adenocard)

Contraindications

  1. 2nd and 3rd degree heart blocks, Sick Sinus Syndrome, unless patient has a pacemaker.
  2. Hypersensitivity to Adenosine
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5
Q

Adenosine (Adenocard)

Use with Caution

A
  1. May produce transient 1st,2nd,3rd degree blocks or Asystole for 10-15sec
  2. Asystolic pause may be longer in patients on Tegretol or Persantine
  3. Pt on theophyllines or caffeine may require higher dose
  4. PT w/Asthma poss bronchoconstrict
  5. May use w/ Wide QRS Complex SVT w/ base direct; may accelerate the rate
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6
Q

Adenosine (Adenocard)

Dosage and Administration

A

Dosage and Administration

  1. Adult 6mg by RAPID IV Push. No response 1-2min; give 12mg. Push fast as poss follow w/ NS bolus of 20ml, then elevate the extremity.
  2. PED- 0.1mg/kg up to 6mg;no response 1-2min; 0.2mg/kg up to 12mg
  3. Place IV in AC ; use min 18g cath
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7
Q

Adenosine (Adenocard)

Adverse Reactions

A

Adenosine (Adenocard)
1. Common but transient: Asystole, bradycardia(temp), hypotension, chest px, flushing, dyspnea, apprehension, back/neck px, blurred vision, burning sensation, dizziness, numbness, tingling in arms, sweating, palpitations, nausea

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8
Q

Amiodarone (Cordarone)

Classification

A

Amiodarone (Cordarone)

Classification:

Antiarrhythmic

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9
Q

Amiodarone (Cordarone)

Action

A

Amiodarone (Cordarone)

Action:
Rate control in a variety of atrial and ventricular tachyarrhythmias

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10
Q

Amiodarone (Cordarone)

Onset of Action

Duration of Action

A

Amiodarone (Cordarone)

Onset of Action: Immediate

Duration of Action: 40 days

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11
Q

Amiodarone (Cordarone)

Indication

A
  1. Shock refractory VF/pulseless VT.
  2. Polymorphic VT/wide complex tachycardia of uncertain origin.
  3. Control of hemodynamically stable VT when cardioversion is unsuccessful.
  4. Acceptable for termination of ectopic/multifocal atrial tach w/ preserved LV function.
  5. Used for rate control in tx of afib or flutter when other therapies ineffective.
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12
Q

Amiodarone (Cordarone)

Contraindications?

A

Amiodarone (Cordarone)
Contraindications:
1. Hypersensitivity to Cordarone.
2. Pt w/ cardiogenic shock, marked sinus bradycardia, 2nd or 3rd degree AV block unless a pacemaker is available.

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13
Q

Amiodarone (Cordarone)

Use with Caution?

A

Amiodarone(Cordarone) Use w/Caution

  1. May produce vasodilation and hypotension.
  2. May have neg inotropic effects and prolong QT interval.
  3. Renal failure, terminal elongation is long (half-life lasts up to 40 days)
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14
Q

Amiodarone (Cordarone)

Dosage and Administration?

A

Amiodarone (Cordarone) dosage/admin

  1. Cardiac arrest
    a. 300mg IV/IO push; consider repeating 150mg in 3-5 minutes.
    b. Max dose: 2.2gm IV/IO in 24 hours
    c. PED: 5mg/kg IV/IO push; up to 300mg; may repeat to total daily dose of 15mg/kg.
  2. Wide complex tachycardia
    a. Rapid infusion 150mg IV/ IO over 10 min; may repeat every 10 min prn.
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15
Q

Amiodarone (Cordarone)

Adverse Reactions

A

Amiodarone (Cordarone)
Adverse Reaction:
1. Vasodilation, Hypotension, Bradycardia

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16
Q

Aspirin (chewable)

Classification?

A

Aspirin (chewable)
Classification:

Non-steroidal anti-inflammatory (NSAID)

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17
Q

Aspirin (Chewable)

Action?

A

Aspirin (Chewable)
Action:
1. Inhibits platelet aggregation in patients w/ suspected acute MI.

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18
Q

Aspirin (Chewable)

Onset of Action?

Duration of Action?

A

Aspirin (Chewable)

Onset of Action: 5-30 minutes

Duration of Action: decreasing by 1/7 over 7days

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19
Q

Aspirin (Chewable)

Indication?

A

Aspirin (Chewable)
Indication:
Suspected ischemic chest pain

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20
Q

Aspirin (Chewable)

Contraindications:

A

Aspirin (Chewable) Contraindications:

  1. Pt w/ known allergy to salicylates.
  2. Pt w/ active ulcer disease
  3. Pt w/ Asthma
  4. Possible hemorrhagic stroke
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21
Q

Aspirin (Chewable)

Use with Caution?

A

Aspirin (Chewable)
Use with Caution:

  1. Patients taking anti-coagulants.
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22
Q

Aspirin (Chewable)

Dosage and Administration?

A

Aspirin(Chewable) Dosage and Admin:

  1. Adult: 162mg, or if not already taking ASA then give 325mg (chewing preferable). Assure aspirin is non-enteric coated.
  2. PED: Contact Mary Bridge
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23
Q

Aspirin (Chewable)

Adverse Reaction?

A

Aspirin (Chewable)

Adverse Reaction:

  1. None in the non-allergic patient with prescribed field dosage.
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24
Q

Atropine

Classification?

A

Atropine

Classification:

Parasympathetic blocker; Anticholinergic.

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25
Q

Atropine

Action?

A
  1. Cardiac
    a. Increases firing rate of SA node by blocking action of the vagus nerve, which increases pulse rate
    b. Increases conduction velocity through the AV node
  2. Non-Cardiac
    a. Decrease of all body secretions
    b. Dilation of pupils/paralysis ciliary muscle
    c. Decrease in bladder tone resulting in urinary retention
    d. CNS stimulation
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26
Q

Atropine

Onset of Action?

Duration of Action?

A

Atropine

Onset of Action: Immediate

Duration of Action: 4 hours

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27
Q

Atropine

Indication?

A
  1. Cardiac rhythms t work.
  2. Organophosphate anticholinesterase poisoning.
  3. Nerve agent poisoning
  4. Preintubation in Peds RSI
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28
Q

Atropine

Contraindications?

A

Atropine Contraindications:

  1. Atrial fibrillation, flutter
  2. Heart rate >60
  3. Bradycardia secondary to increased ICP (I.e. Stroke, head trauma).
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29
Q

Atropine

Use with Caution?

A

Atropine Use with Caution:

  1. Do not mix with Sodium Bicarbonate
  2. Be certain patient w/ bradycardia is not hypoxia or head injured in origin.
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30
Q

Atropine

Dosage and Administration-Adult
For Bradycardia?

A
  1. Bradycardia
    a. 0.5mg IV, every 3-5min prn, not to exceed total dose of 0.04mg/kg
    b. Use shorter dosing intervals (3min ) & higher doses in severe clinical conditions
    c. ET: 1 mg diluted in 10mL NS
31
Q

Atropine

Dosage and Administration- Pediatric
For Bradycardia?

A

d. Pediatric: 0.02mg/kg
i. Minimum single dose: 0.1mg
ii. Max child single dose 0.5mg, max child total dose 1.0 mg
iii. Max adolescent single dose: 1mg, Max adolescent total dose 2 mg
iv. May double for 2nd IV dose
v. ET: 0.05mg/kg diluted in 5ml NS

32
Q

Atropine

Dose and Administration - Adult
Anticholinesterase/organophosphate/nerve agent poisoning?

A

a. Adult: 1mg IV every 1 min until symptoms(bradycardia, bronchial secretions, etc.) clear up, up to 10 mg
b. If using the DuoDote/Mark I antidote kit, give one atropine injector(2mg) into the thigh followed w/ 2-PAM chloride injection. May give up to three sets.

33
Q

Atropine

Dosage and Administration - Pediatric
Anticholinesterase/organophosphate/nerve agent poisoning?
And RSI?

A

c. Pediatrics: 12 YO follow adult dosing.

RSI-Pediatric: 0.02mg/kg (minimum dose 0.1mg, max dose 0.5mg).

34
Q

Atropine

Adverse Reactions

A

Atropine - Adverse Reactions:

  1. Cardiac: tachycardia, palpitations, ventricular fibrillations
  2. Non-Cardiac: dryness of Mouth (common), pain in eyes or blurred vision(precipitates glaucoma), restlessness, irritability, changes in mental state, injection site pain.
35
Q

Diazepam (Valium)

Classification?

A

Diazepam (Valium)

Classification:
1. Anticonvulsant, anti-anxiety, sedative.

36
Q

Diazepam (Valium)

Action?

A

Diazepam (Valium) - Action:

  1. Depresses Central Nervous System
37
Q

Diazepam (Valium)

Onset of Action?

Duration of Action?

A

Diazepam (Valium)

Onset of Action: 1-5 min, peak actions at 5 - 10 minutes

Duration of Action: 15-60 minutes

38
Q

Diazepam (Valium)

Indication?

A
  1. Seizures secondary to head trauma/alcohol withdrawal
  2. Status epilepticus
  3. Prior to pacing, cardioversion, and RSI for relief of anxiety, tension, and diminish recall of procedures.
  4. Envenomations resulting in muscle spasm
  5. Severe Anxiety
39
Q

Diazepam (Valium)

Contraindications?

A

Diazepam (Valium) - Contraindications

  1. Known hypersensitivity
  2. Patients that have used other CNS depressant.
40
Q

Diazepam (Valium)

Use with Caution?

A

Diazepam (Valium) Use w/ Caution:

  1. Elderly
  2. PTs with inadequate pulmonary function
  3. PTs w/ liver and/or kidney disease
  4. PTs w/ hx of drug addiction
41
Q

Diazepam (Valium)

Dosage and Administration?

A

Diazepam (Valium)
1. Adult: 2-10mg IV/IO/IM, refer to dosage regimen referenced in appropriate protocol section
2. Pediatric: 0.2 mg/kg IV/IO in increments no greater than 2mg to a max dose of 10mg. Wait 1-2 min between doses to observe effect.
Rectally, 0.5 mg/kg to a max dose of 20mg. Wait at least 5 min between doses. Contact Mary Bridge for repeat dose

42
Q

Diazepam ( Valium)

Adverse reactions:

A
  1. Central Nervous System depression, ataxia, drowsiness, fatigue, dizziness, urticaria, skin rash, transient hypotension, respiratory depression.
  2. Venous thrombosis and phlebitis at injection site
43
Q

Etomidate (Amidate)

Classification?

A

Etomidate (Amidate) Classification-

  1. Non-narcotic, non-barbiturate, sedative hypnotic
44
Q

Etomidate (Amidate)

Action?

A

Etomidate (Amidate) Action-
1. Depresses the activity of the brain stem reticular system. It may lower intraocular and intracranial pressure, and lower the rate of cerebral oxygen utilization, all w/ minimal cardiovascular and respiratory depressant effects.

45
Q

Etomidate (Amidate)

Onset of Action?

Duration of Action?

A

Etomidate (Amidate)

Onset of Action: within 10-60 seconds

Duration of Action: Dose dependent but can be 3-5 minutes with full recovery in 15 minutes.

46
Q

Etomidate (Amidate)

Indication?

A

Etomidate (Amidate) - Indication

  1. Induction agent for RSI in adults and pediatric patients > 10 years old.
  2. Sedation prior to cardioversion.
47
Q

Etomidate (Amidate)

Contraindications?

A

Etomidate (Amidate)-Contraindications

  1. Known hypersensitivity to the agent.
  2. Not recommended for pregnant or nursing mothers
48
Q

Etomidate (Amidate)

Use with Caution

A

Etomidate (Amidate) Use w/ Caution

  1. While adrenal suppression has not been reported after a single dose, solumedrol 125mg should be considered for administration on patients on prednisone.
49
Q

Etomidate (Amidate)

Dosage and Administration

A

Etomidate (Amidate)

  1. Adult: 0.3mg/kg IV/IO push over 30-60 seconds
  2. PED: Contact Mary Bridge. 0.3mg/kg IV/IO push over 30-60 seconds
50
Q

Etomidate (Amidate)

Adverse reactions

A
  1. Painful myoclonus (diffuse muscle contraction) which may be painful after Pt awakens. This can be reduced by giving muscle relaxant immediately after Etomidate is given.
  2. Pain at the injection site, moderated by using a large vessel and giving with IV fluid
  3. Apnea, Hypotension, Tachycardia, Nausea, and Vomiting.
51
Q

Fentanyl (Sublimaze)

Classification?

A

Fentanyl (Sublimaze)

Classification:

  1. Narcotic Analgesic
52
Q

Fentanyl (Sublimaze)

Action?

A

Fentanyl (Sublimaze) - Action:

  1. Potent analgesic, sedative, euphoric
53
Q

Fentanyl (Sublimaze)

Onset of Action?

Duration of Action?

A

Fentanyl (Sublimaze)
Onset of Action:
1. 1 minute IV
2. 7-8 minutes IM

Duration of Action:

  1. 30-60 minutes IV
  2. 1-2 hours IM
54
Q

Fentanyl (Sublimaze)

Indication?

A

Fentanyl (Sublimaze) - Indication:

  1. Severe pain
  2. Acute low back pain with muscle spasm.
55
Q

Fentanyl (Sublimaze)

Contraindications?

A

Fentanyl (Sublimaze) Contraindications

  1. Known hypersensitivity
  2. Head trauma with increased ICP
  3. Altered state of consciousness
  4. Severe liver or renal insufficiencies.
56
Q

Fentanyl (Sublimaze)

Use with Caution?

A

Fentanyl (Sublimaze) Use w/ Caution

  1. Bradycardia
  2. Respiratory Depression
57
Q

Fentanyl (Sublimaze)

Dosage and Administration?

A
  1. Adults
    Traumatic: 50mcg IV/IO or 50-100mcg IN, every 5-10 min to max dose of 200mcg if BP>100/S
    Cardiac: 25mcg IV/IO or 50mcg IN every 2-3 minutes up to 100mcg if BP>100/S
    PEDS: 1-2mcg/kg IV/IO/IN/IM
58
Q

Fentanyl (Sublimaze)

Adverse reactions?

A

Fentanyl (Sublimaze)

  1. Hypotension
  2. Bradycardia
  3. CNS depression
  4. Nausea and Vomiting
  5. Respiratory depression
  6. Chest wall rigidity.
59
Q

Lidocaine 2% (Drips are Optional)

Dosage for RSI?

A

Lidocaine 2% (Drips are Optional)

Dosage for RSI:
For reactive airway or Increased ICP prophylaxis: 1.5mg/kg
PED: 1mg/kg IV/IO, or 2-3mg/kg in 5ml NS ET

60
Q

Furosemide

Classification

A

Furosemide

Non potassium sparing loop diuretic

61
Q

Furosemide

Mechanism of Action

A

Mechanism of action

Blocks the absorption of sodium and chloride at the distal and proximal tubules and the loop of Henle, causing increased urine output. Also reduces. Ardis. Preload by increasing venous capacitance.

62
Q

Furosemide

Dosage and Administration

A

40-80mg (or double the pt’s dose up to 100mg) slowly
Can be dosed at 0.5-1.0mg/kg

Peds: 2mg/kg

63
Q

Furosemide

Onset and Duration

A

Onset: 5 min for preload reduction,
30 minutes for diuresis

Duration: 2 hours

64
Q

Furosemide

Contraindications

A

Contraindications

Dehydration
Hypovolemia
Hypokalemia
Hepatic Coma

65
Q

Morphine Sulfate

Classification

A

Classification:

Narcotic analgesic

66
Q

Morphine Sulfate

Indication

A

Indication:

1) severe pain i.e. Myocardial infarct, burns, isolated extremity injuries. ABD pain
2) adjunct in treating pulmonary edema

67
Q

Morphine Sulfate

Dosage and administration

A

Dosage
Adults: give in 2mg increments every 2min up to 10mg slow IVP if systolic >100, to testing to pain relief. Can give I’m/IV for severe pain. IO only if reason appropriate.

68
Q

Morphine

Onset and duration

A

Onset

1) 5 min IV
2) 10-30 min IM

Duration
IV/IM 4-5 hours

69
Q

Morphine Sulfate

Contraindications

A

1) known hypersensitivity
2) head trauma
3) altered states of consciousness
4) systolic BP <100

70
Q

Fentanyl (Sublimaze)

Classification

A

Fentanyl (Sublimaze)

Narcotic analgesic

71
Q

Fentanyl (Sublimaze)

Mechanism of action

A

Potent analgesic, sedative, euphoric

Binds to opiate receptors as an agonist to alter PTs perception of pain.

72
Q

Fentanyl (Sublimaze)

Indications

A

Indications

1) severe pain
2) acute low back pain w/spasm
3) analgesia
4) pulmonary edema
5) acute MI

73
Q

Fentanyl (Sublimaze)

Dosage and Administration

A

Adult
Traumatic Emerg: 50mcg IV/IO or 50-100mcg IN, every 5-10min to a max dose of 200mcg if BP >100/S
Cardiac Emerg: 25mcg IV/IO or 50mcg IN every 2-3 minutes up to 100mcg if BP >100/S
Pediatric 1-2mcg/kg IV/IO/IN/IM

74
Q

Fentanyl (Sublimaze)

Onset and Duration

A

Onset:

1) one minute IV
2) 7-8min IM

Duration:
30-60 min IV
1-2 hours IM

75
Q

Fentanyl (Sublimaze)

Contraindications

A

1) known hypersensitivity
2) head trauma w/ increased ICP
3) altered state of consciousness
4) sever liver or renal insufficiencies

Pharmacology (4 decks)

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