MEDICATIONS Flashcards

Question

Furosemide | Adverse Effects, Precautions

Answer 1

Adverse Effects: Hypotension, Electrolyte Imbalance Precaution: Flush line well before & after administration

Answer 2

Dosage: 0.5mg-1mg / kg IV/IO (40mg if not taking Lasix, 80mg If taking lasix)

Answer 3

Class: Antihistamine MoA: H1 Receptor antagonist blocking histamine from binding. Reducing Allergic & anaphylactic response. Pharma: Effects begin 1-5 Min after IV Dose, peak effect 1-4 hours, metabolized by liver

Answer 4

Indications: Allergic Reaction, Anaphylaxis, Dystonic Reactions, chemical restraint Contraindications: Asthma Exacerbation Adverse Effects: Drowsiness, Loss of Coordination, Blurred Vision, Headache, Hypotension, Tachycardia, Palpitations, Thickening of bronchial secretions leading to chest tightness & wheezing.

Answer 5

Adult: 25-50mg Slow IV/IO or IM Pediatric: 1mg / kg (not to exceed 25mg) Slow IV/IO or IM

Answer 6

Class: Nitrate, Vasodilator MoA: Vasodilator effect on veins more than arteries, decreases right side heart return (preload), by venous pooling, decreasing Myocardial workload and oxygen consumption. Pharma: Absorbed thru oral mucosa or skin, antianginal and vasodilator effects within 1-2 min after admin, half life 1-4 min duration of action less than 5 min.

Answer 7

Indications: Treatment of angina, CHF, acute pulmonary Edema, Symptomatic hypertensive crisis Contraindications: Pediatric under 12yoa, viagra or levitra ingestion within 24 hours, Cialis ingestion within 48 hours, asymptomatic hypotension, BP Systolic below 90mmHg Adverse Effects: Headache, hypotension, nausea, dizziness, decreased LOC

Answer 8

Chest Pain- 0.4mg sublingual every 3-5min 1.2mg max dosage Pulmonary Edema/CHF; Low dose 0.4mg SL x3 Dose (repeat in 3-5 min if symptoms persist) Nitro paste 1” applied to chest wall.

Answer 9

Class: Narcotic Analgesic MoA: Decreases pain perception & anxiety producing euphoria Decreases respiratory effort, causes peripheral dial action decreasing preload Decreases left ventricular afterload. Pharma: Binds w/ opiate receptors in the CNS, altering perception and response to pain. Onset in less than 5 min after IV Dose, Lasts 4-5 hours, Causes peripheral arterial and venous dilation

Answer 10

Indications: Acute MI, Burns, Isolated injuries requiring pain relief, Pulmonary Edema / CHF Contraindications: Head Injury, Multisystem trauma, COPD w/ compromised respiratory effort, hypotension Adverse Effects: Respiratory depression & arrest, altered mental status, increased fatal tone due to suppression of sympathetic pathways, nausea & vomiting, Bronchospasm, itch,

Answer 11

Adult: AMI/ Pulmonary Edema: 2mg-10mg slow IV/IO/IM (if systolic over 90mmHg) for pain not relieved by nitro Isolated Injury: Single Dose 2-10mg slow IV/IO/IM Addl’ 2-10mg MAX 20MG until pain relieved. Burn: 2-20mg slow IV/IO/IM Pediatric: Isolated Inj (including burns eye trauma, frostbite) Single dose: 0.1mg / kg slow IVP or IM (If systolic over 100mmHg) Max of 10mg

Answer 12

Class: Antiplatelet, Antipyretic, Analgesic, anti inflammatory MoA: Prevents formation of Thromboxane A1, inhibiting the clotting cascade by decreasing platelet aggregation, prolongs bleeding time.

Answer 13

Indications: Chest Pain, of suspected cardiac origin acute Coronary syndrome Contraindications: Any bleeding disorder Adverse Effects: Bleeding

Answer 14

81mg - 324mg

Answer 15

• Classification: ▪ Antidysrhythmic Agent • Mechanism of Action: ▪ Slows conduction by decreasing automaticity in SA and AV Nodes, therefore decreasing tachycardias that originate above the ventricles. • Pharmacokinetics: ▪ Onset of action within 5 to 20 seconds following an IV dose; half-life is 6 - 10 seconds.

Answer 16

• Indications: ▪ SVT/PSVT ▪ Wide Complex-Regular Tachycardias of unknown origin (Diagnostic Treatment) • Contraindications: ▪ Knownhypersensitivity ▪ WPW (Consultation with MED control required) ▪ Confirmed Ventricular Tachycardia, Atrial fibrillation, and Atrial flutter. • Adverse Effects: ▪ Flushing, dyspnea, chest pressure, nausea, headache, dizziness, and hypotension, Feeling of impending doom • Precautions: ▪ Metabolized rapidly, deliver via proximal IV site (antecubitus) or humerol IO. ▪ Caution in asthmatic patients or patients with known heart disease. ▪ Be prepared for up to 40 seconds of asystole.

Answer 17

• Dosage: ▪ Administer via rapid IV/IO followed by a rapid NS flush. • Adult: • First dose: 6 mg • Second dose: 12 mg if no response within 2 minutes • Pediatric: • First dose: 0.1 mg/kg, maximum dose 6 mg • Second dose: 0.2 mg/kg, maximum dose 12 mg

Answer 18

• Classification: ▪ Antiarrhythmic • Mechanism of Action: ▪ Blocks multiple channels : sodium, potassium,and calcium ▪ Blocks alpha and beta-adrenergicreceptors. ▪ Prolongs the effective refractory period ▪ Exerts an anti-fibrillation effect without altering myocardial membrane potential. (Chemical Defibrillator) ▪ Slows conduction through the HIS-Purkinje system. ▪ Slows conduction through accessory pathways. (WPW)

Answer 19

• Indications: ▪ Ventricular fibrillation ▪ Ventricular tachycardia with and without a pulse ▪ Refractory supraventricular tachycardias to include atrial fibrillation and atrial flutter ▪ Reentry tachycardia rate control (WPW) • Contraindications: ▪ None in cardiac arrest ▪ SA node dysfunction ▪ Cardiogenic shock ▪ High degree heart block (2nd Degree Type II and 3rd Degree) ▪ Iodine Allergy

Answer 20

• Adverse Effects: ▪ Hypotension ▪ Bradycardia ▪ Congestive heart failure ▪ Nausea and vomiting • Precautions: ▪ Combination with other antiarrhythmics may potentiate arrhythmias ▪ Medication must be carefully withdrawn from vial to avoid air bubbles – Do not agitate vial ▪ In case of hypotension/bradycardia, STOP infusion and administer fluid bolus of 250 ml – 2 Liters.

Answer 21

Adult VF/Pulseless VT: • 1st Dose: 300 mg (diluted in D5W for a total of 20 - 30 ml) IV/IO. • 2nd Dose:150mg (diluted in D5W for a total of 20-30ml) in 3-5 minutes (for a maximum total bolus of 450 mg) Wide Complex Tachycardia with a pulse: • 150 mg (diluted in D5W for a total of 50 - 100 ml) over 10 minutes Maintenance infusion: • 1 mg/min (100 mg in 100 ml D5W) ▪ Pediatric: VF/Pulseless VT: • 5 mg/kg IV/IO bolus diluted in 20 - 30ml D5W. Repeat every 3 - 5 minutes max 15 mg/kg VT with a pulse: • 5 mg/kg IV/IO diluted in 100 ml D5W infused over 20 - 60 minutes Maintenance Infusion: • No current AHA recommendations

Answer 22

• Classification: ▪ Parasympatholytic (vagolyticaction) ▪ Anticholinergic (accelerates the heart rate) • Mechanism of Action: ▪ Inhibits parasympathetic stimulation by blocking acetylcholine receptors. ▪ Decreases vagal tone resulting in increased heart rate and AV conduction. ▪ Dilates bronchioles and decreases respiratory tract secretions. ▪ Decreases GI secretions. • Pharmacokinetics: ▪ Accelerated heart rate within minutes of IV injection ▪ Peak effect is seen within the first 15 minutes

Answer 23

• Indications: ▪ Symptomatic bradycardia ▪ Cholinergic/Nerve Agent poisoning ▪ Organophosphate Poisoning • Contraindications: ▪ Known hypersensitivity ▪ Dysrhythmias in which enhancement of conduction may accelerate the ventricular rate and cause decreased cardiac output.(e.g.atrial fibrillation, atrial flutter, or PAT with block) • Adverse Effects: ▪ Excessive doses of atropine can cause delirium, restlessness, disorientation, tachycardia, coma, flushed and hot skin, ataxia, blurred vision, dry mucous membranes. ▪ Ventricular fibrillation and tachycardia have occurred following IV administration of atropine.

Answer 24

▪ Bradycardia: Adult: • Administer 0.5 mg IV/IO/ET repeated every 3 - 5 minutes to a maximum dose of 3 mg Pediatric: • Administer 0.02 mg/kg IV/IO/ET (minimum dose 0.1 mg) ▪ Cholinergic/ Organophosphate poisoning: Adult: • Administer 1 - 4 mg IV/IO/ET or IM every 5 - 10 minutes or until Atropinization occurs. Pediatric: • Administer 0.01 - 0.04 mg/kg IV/IO/ET or IM every 5 - 10 minutes

Answer 25

• Classification: ▪ Calcium channel blocker ▪ Antidysrhythmic • Mechanism of Action: ▪ Binds to open calcium channels preventing repolarization until dissociation. ▪ Decreases SA nodal discharge, AV nodal conduction, afterload, and myocardial contractility.

Answer 26

``` • Indications: ▪ Stable uncontrolled atrial flutter or fibrillation with sustained rates greater than 120/min. ▪ Second-line medication for stable regular-narrow complex tachydysrhythmias. (SVT,PSVT) • Contraindications: ▪ Known hypersensitivity ▪ Shock or hypotension ▪ High degree heart block (2nd Type II or 3rd degree) ▪ Heart failure ▪ Ventricular tachycardia • Adverse Effects: ▪ Hypotension ▪ Dysrhythmias ▪ Nausea and vomiting ▪ Headaches ```

Answer 27

▪ Adult: Initial: • 0.25 mg/kg slow IV/IO over 5 minutes (Generally accepted max of 20 mg first dose) Repeat in 15 minutes: • 0.35 mg/kg slow IV/IO over 5 minutes (Generally accepted max of 25 mg second dose) Maintenance Infusion: • 5 - 15 mg/hour titrated to rate

Answer 28

• Classification: ▪ Sympathomimetic ▪ Inotropic Agent ▪ Vasopressor • Mechanism of Action: ▪ Alpha-and beta-adrenergic receptor stimulator ▪ Dopaminergic receptor stimulator ▪ Precursor of norepinephrine • Low dose: 1 - 2 mcg/kg/min (Renal Dose) - Dilates renal and mesenteric blood vessels • Moderate Dose: 2 - 10 mcg/kg/min (Cardiac Dose) - Beta1 stimulating effecton heart results in increased cardiac output and chronotropy • High dose: 10 - 20 mcg/kg/min (Vasopressor Dose) - Alpha1 stimulating effects may reverse mesenteric and renal artery dilatation resulting in decreased blood flow, causing increased preload due to effects on venous system. - Widespread peripheral vasoconstriction.

Answer 29

• Pharmacokinetics: ▪ Extremely rapid onset of action ▪ Extremely brief duration of action ▪ The rate of administration may be used to control the effect of dopamine. ``` • Adverse Effects: ▪ Anginal pain ▪ Tachydysrhythmias ▪ Nausea and vomiting ▪ Hypertension ```

Answer 30

• Indications: ▪ Cardiogenic shock (after conservative volume replacement = 5-10ml/kg) ▪ Shock (All Etiologies - after sufficient volume replacement) ▪ Symptomatic bradycardia (after Atropine administration) • Contraindications: ▪ Pre-existing tachydysrhythmias ▪ Uncorrected hypovolemia

Answer 31

▪ For IV infusion use only. ▪ In general, the infusion rate is adjusted to blood pressure and clinical response. (Systolic BP less than 90) ▪ Adult: • 2 - 20 mcg/kg/min IV drip titrated to BP of 90mmHg systolic. Initial infusion typically starts at 5 mcg/kg/min, titrate to desired response. ▪ Pediatric: • 2 - 20 mcg/kg/min IV drip titrated age specific BP or medical consultation selected BP; Initial infusion rate is 2 mcg/kg/min

Answer 32

• Classification: ▪ Antidysrhythmic ▪ Na+ (Sodium) Channel blocker • Mechanism of Action: ▪ Suppresses ventricular dysrhythmias by stabilizing cell membranes. ▪ Blocks fast sodium channels increasing recovery period during repolarization. ▪ Increases Ventricular fibrillation threshold. ▪ Acts only on Ventricular rhythms.

Answer 33

• Indications: ▪ Ventricular tachycardia (VT) with/without a pulse ▪ Ventricular fibrillation(VF) ▪ Prevent recurrence of ventricular fibrillation/tachycardia after defibrillation and conversion to supraventricular, perfusing rhythm. (Maintenance Drip) ▪ Reduce or eradicate ventricular ectopy (Malignant PVC’s) ▪ Decrease intracranial pressure with Rapid Sequence Intubation (Controversial) ▪ Via IO for numbing from pain experienced from IO Infusion • Contraindications: ▪ AV blocks ▪ Sensitivity to lidocaine ▪ Idioventricular escape rhythms ▪ Accelerated idioventricular rhythm ▪ Sinus bradycardia or arrest or block ▪ Stokes-Adams Syndrome ▪ Wolff-Parkinson-White (WPW)

Answer 34

• Adverse Effects: ▪ Lidocaine may cause clinical evidence of toxicity usually related to the central nervous system. ▪ Toxicity: • Early: muscle twitching, slurred speech, altered mental status, decreased hearing, paresthesia(pinsandneedles), anxiety,apprehension,visual disturbances,nausea, numbness, difficulty breathing or swallowing, decreased heart rate. • Late:convulsions, hypotension, coma, widening of QRS complex, prolongation of the P-R interval, hearing loss, hallucinations. • Precautions: ▪ Reduce the dosage in patients with decreased cardiac output, liver dysfunction, and the elderly. (Age over 70) ▪ Bolus doses should be administered over a 1-minute period, except in ventricular fibrillation/ pulseless ventricular tachycardia, when they are administered IV/IO. ▪ Inactivated in alkaline solutions such as Sodium Bicarb. Use a separate IV line or flush thoroughly before administration through same line.

Answer 35

▪ Adult VT with pulse: • 0.5 - 1.5 mg/kg slow IV/IO every 5 - 10 minutes as needed, up to 3 mg/kg. • Repeat doses are half of initial doses when using 1mg/kg or greater. ▪ Adult VT without pulse: • 1 - 1.5 mg/kg IV/IO bolus initially followed by repeat doses every 5 - 10 minutes to a maximum of 3 mg/kg. • Repeat doses are half of initial dose. ▪ Pediatric VT With/Without pulse: • 1 mg/kg slow IV/IO bolus every 5 - 10 minutes, as needed, to maximum of 3 mg/kg. ▪ IO administration for numbing during IO Infusion: Adult: • 20 - 40 mg slow IO push Pediatric • 0.5 mg/kg slow IO push ▪ For maintenance infusion of post arrest patients:(ROSC) • 1-4mg/min. Calculate the total lidocaine administered and administer your maintenance at the next whole number of milligrams per minute. (i.e.administered 1.5mg/kg during arrest, your maintenance infusion will be 2 mg/min) ▪ How to Mix: 1 gm/250ml D5W ▪ Concentration: 4 mg/ml ▪ Dose:1–4mg/min

Answer 36

• Classification: ▪ Beta blocker • Mechanism of Action: ▪ Decreases chronotropy, dromotropy, and inotropy, thus reducing cardiac output as well as O2 demand. Blocks beta receptors in the bronchial smooth muscle, inhibiting bronchodilation.

Answer 37

• Indications: ▪ Refractory PSVT/SVT ▪ Atrial Fibrillation / Atrial flutter with a sustained ventricular rate greater than 120 ▪ Acute Coronary Syndromes associated with STEMI and Tachycardia • Contraindications: ▪ Heart rate less than 100 bpm (relative) ▪ Systolic blood pressure less than 90 mmHg ▪ 2nd or 3rd degree AV heart block ▪ Asthma attack or COPD exacerbation ▪ Shock

Answer 38

• Adverse Effects: ▪ Hypotension ▪ Dysrhythmias ▪ CHF ▪ Nausea and Vomiting ▪ CNS changes

Answer 39

``` ▪ Adult: • 5 mg slow IVP over 5 minutes • May repeat x2 every 5 minutes • Stop infusion if SBP less than 90 mmHg or patient develops trouble breathing ▪ Pediatric: • Not included in any pediatric protocol ```

Answer 40

• Classification: ▪ Calcium channel blocker ▪ Antidysrhythmic • Mechanism of Action: ▪ Binds to open calcium channels preventing repolarization until dissociation. ▪ Decreases SA nodal discharge, AV nodal conduction, afterload and myocardial contractility. ▪ Dilates coronary arteries.

Answer 41

• Indications: ▪ Stable uncontrolled atrial flutter or fibrillation with RVR ▪ Second line medication for stable narrow complex tachydysrhythmias (PSVT/SVT) • Contraindications: ▪ Known hypersensitivity ▪ Shock or Hypotension ▪ WPW ▪ Sick sinus syndrome ▪ High degree heart block (2nd Type II or 3rd) ▪ Heart failure ▪ Ventricular tachycardia

Answer 42

``` • Adverse Effects: ▪ Hypotension ▪ Dysrhythmias ▪ Nausea and vomiting ▪ Headaches • Precautions: ▪ Avoid in nursing mothers and administer during pregnancy only if benefits justify risk to fetus ```

Answer 43

``` ▪ Adult: Initial: • 2.5 - 5 mg IV/IO over 2 minutes. Repeat: • 5 - 10mg in 15 to 30 minutes. Max 20 mg. ▪ Pediatric: • Not Indicated ```