Medications Flashcards
Classification of acetaminophen
anti-pyretic and analgesic
- Action of acetaminophen
2. Onset and duration of onset
Fever reducer, pain blocker
10-30 min, 3-4 hrs
Indication of acetaminophen
Fever
Contraindication of acetaminophen
Hypersensitivity
Caution of acetaminophen
Anemia, Liver disease, renal disease
Dosage of acetaminophen
Pediatric 15mg/kg oral or rectal
Adverse reaction of acetaminophen
Nausea, vomiting, rash
Acetaminophen protocol reference
Medical emergencies, febrile pediatric patient
Classification of activated charcoal
Gastric decontaminant, absorbent
- Action of activated charcoal
2. Onset and duration of activated charcoal
- Adheres to meds and prohibits absorption in the GI tract
2. Immediate, Unknown
- Indication of activated charcoal
2. Contraindication
- Poisoning, overdose, consult poison control prior to administration
- DLOC, Ingestion of meds that may lead to abrupt DLOC
Caution of activated charcoal
Renders ipecac inactive, May give ipecac prior to but not after charcoal, Ingestion of corrosives, Fluid and electrolyte abnormalities, Fecal impaction, If gastric lavage is considered
Dosage of activated charcoal
Adult and pediatric 1gm/kg oral
Adverse reaction of activated charcoal
Nausea vomiting, black stools, diarrhea, cramping, bloating, constipation
Reference in protocol of activated charcoal
Medical Emergencies
Classification of Adenosine
Antiarrhythmic
- Action of Adenosine
2. Onset and Duration of Adenosine
- Slows conduction of AV node, may inhibit reentry pathways
2. Immediate, Less than 1 min
- Indication of Adenosine
2. Contraindication
- Conversion of paroxysmal SVT to sinus rhythm, Wolf-Parkinson-White Syndrome with narrow QRS complex
- 2nd & 3rd degree heart block, sick sinus syndrome unless pt has pacemaker, hypersensitivity
Caution of Adenosine
May produce transient 1st, 2nd, &3rd degree blocks or systole for 10-15 sec
Asystolic pause longer in pts. on Tegretol or Persantine
Pts. on theophyllines or caffeine may require higher dose
Asthma pts may experience bronchiospasm
May be used with wide QRS complex SVT at direction of base station, but may cause acceleration of the rate
Dosage of Adenosine
Adult: 6mg rapid IV push. If no response in 1-2 min give 12mg. Rapid push followed by 20ml NaCl bolus and elevate extremity.
Pediatric: .1mg/kg up to 6mg. If no response within 1-2 min, .2mg/kg up to 12mg rapid IV push
IV in AC with 18g or >
Adverse reaction of Adenosine
Common but transient asystole, bradycardia, hypotension, Cpx, flushing, dyspnea, numbness, tingling in arms, sweating, palpation, nausea
Reference in protocol of Adenosine
Cardiac emergencies and pediatric cardiac arrest guide
Classification of Afrin
Adrenergic sympathomimetic
- Onset of Afrin
2. Duration of Afrin
- < 5 min
2. < 12 hrs
- Indication of Afrin
2. Contraindication of Afrin
- Prep for nasotracheal intubation, control epistaxsis
2. hypersensitivity
Caution of Afrin
children < 6 years
Dosage of Afrin
2-3 sprays in each nostril
Adverse Reaction of Afrin
Headache, drowsiness, Insomnia, Palpitations, Hypertension, rebound congestion
Burning stinging sneezing if exceed dosage
Reference in Protocol of Afrin
General Principles (nasal intubation)
Classification of Albuterol
Bronchodilator, beta-2 selective, sympathetic agonist
Action of Albuterol
Relax bronchial and uterine smooth muscle by acting on beta adrenergic receptors
Causes K+ influx into the cell
- Onset of Albuterol
2. Duration of Albuterol
- 5-15 min
2. 3-6 hrs
- Indication of Albuterol
2. Contraindication of Albuterol
- Wheezing, allergic reaction, asthma
Suspected Hyperkalemia
Crush Injury Syndrome - Hypersensitivity
Caution of Albuterol
Cardiovascular disease Rx tricyclics Elderly require lower dose Monitor HR Lung sounds before and after Beta-blockers may blunt effect
Dosage and administration of Albuterol
Adult: 2.5mg in 3ml NS SVN continuously
Pediatric: < 6 mo. 1.25mg in 3 ml NS SVN continuously, >6 mo. 2.5mg in 3 ml NS SVN
If assisting with inhaler instruct pt. to clear throat, exhale fully, put mouthpiece in place and inhale deeply.
Adverse Reaction of Albuterol
Tremor, Nervousness, Dizzy, Headache, Tachycardia, Palpitations, Hypertension, Nausea, Vomiting, Ventricular Arrhythmias
Reference in Protocol of Albuterol
Shock (anaphylactic), Respiratory (diff breath), Medical (renal dialysis-hyperkalemia), Environmental (toxic inhalations and allergic reactions), Traumatic (crush injury syndrome)
Classification of Amiodarone
Antiarrhythmic
Action of Amiodarone
Rate control in a variety of atrial and ventricular tachyarrythmias
- Onset of Amiodarone
2. Duration of Amiodarone
- Immediate
2. up to 40 days
- Indication of Amiodarone
2. Contraindication of Amiodarone
- Shock Refractory/VF pulseless VT
- Polymorphic VT/wide complex tachycardia of unknown origin
- Control of hemodynamically stable VT when cardioversion is unsuccessful
- Acceptable for termination of ectopic or multifocal atrial tachycardia with preserved LV function
- Used for rate control in treatment of a fib or flutter when other testaments are unsuccessful - Hypersensitivity
- Cardiogenic shock with marked sinus bradycardia, 2nd or 3rd degree AV block unless a pacemaker is available
Caution of Amiodarone
- May produce vasodilation and hypotension
- May have negative inotropic effects and prolong QT interval
- Renal failure, terminal elimination is long (1/2 life up to 40 days)
Dosage and Administration of Amiodarone
- Cardiac Arrest:
a. 300mg IV/IO push, consider repeating 150mg in 3-5 min.
b. max dose 2.2g IV/IO in 24 hrs
c. Pediatric: 5mg/kg IV/IO push, up to max of 300mg, may repeat up to daily dose of 15mg/kg - Wide Complex Tachycardia
a. Rapid infusion of 150mg IV/IO over 10 min
b. May repeat every 10 min as needed
Adverse reaction of Amiodarone
Vasodilation, Hypotension, Bradycardia
Reference in Protocol of Amiodarone
Cardiac Emergencies (see AHA handbook)
Classification of Aspirin
Non steroidal anti-inflammatory
Action of Aspirin
Inhibits platelet aggregation in pts. with suspected MI
- Onset of Aspirin
2. Duration of Aspirin
- 5-30 min
2. Decreasing by 1/7th over 7 days
- Indication of Aspirin
2. Contraindication of Aspirin
- Suspected ischemic chest Px
- Allergy to salicylates
- active ulcer disease
- asthma
- hemorrhagic stroke
Caution of Aspirin
Pts. taking anticoagulation therapy
Dosage and administration of Aspirin
Adult: 162mg if already taking ASA, 324mg if not already taking ASA
Pediatric: Contact MBCH
Adverse Reaction of Aspirin
Hypersensitivty
Reference in Protocol of Aspirin
Cardiac Emergencies (Chest discomfort and possible ACS, AHA handbook)
Atropine Classification
Parasympathetic blocker, anticholinergic
Atropine Action
Cardiac: 1. Chronotropic effect of Increase SA node rate by blocking vagus nerve 2. Positive inotropic effect in AV Node Non-Cardiac: 1. decrease body secretions 2. dilate pupils and eye paralysis 3. Decrease bladder tone and increase urinary retention 4. CNS Stimulant
Atropine 1.Onset 2.Duration
- Immediate IV
2. 4 Hrs
Atropine Indication
- Bradycardia with HYPOTN, AMS, PVC, Cpx,
- 2nd, 3rd heart block, asystole but not very effective
- Organophosphate, Nerve agent poisoning
- Pre-medication for pediatric intubations
Atropine Contraindication
- Afib/flutter
- HR>60
- Bradycardia due to ICP (stroke/trauma)
Atropine Use with Caution
- Do not mix with sodium bicarb
2. Be certain bradycardia not due to hypoxia or ICP
Atropine Dosage and Administration
- Bradycardia
Adult: .5mg IV every 3-5 min as needed, not to exceed .04mg/kg, ET 1mg diluted in 10ml NS
Ped: .02mg/kg, min = 0.1mg, max single dose = 0.5mg, max total dose = 1mg
Adolescent single dose = 1mg, max total = 2mg
ET = .05mg/kg in 5ml NS - Poisoning
Adult: 1mg every 1 min until Sy clear, up to 10mg, If using MARK1 kit give up to 3 sets of meds
Ped: <12yo .5mg IV/IO every 1 min. until Sy clear, max total 10mg.
RSI = .02mg/kg, min dose = .1mg, max dose = .5mg
Atropine Adverse Reaction
Cardiac: tachy, palpitations, V-Fib
Non Cardiac: Dry mouth, diplopia, restless, irritability, AMS, injection site px
Atropine Reference
Cardiac
Environmental
RSI
Pediatric Cardiac Arrest Guide
Calcium Chloride Classification
Electrolyte
Calcium Chloride Action
- Regulate cell permeability to sodium and potassium
2. Increases force of myocardial and muscle contraction
Calcium Chloride 1. Onset 2. Duration
- Immediate
2. 30min-2hrs
Calcium Chloride Indication
- bradycardia 2nd to dialysis and hyperkalemia with peaked T-waves, prolonged QRS, low P-waves
- Calcium channel block or beta blocker OD
- Antidote for Mag Sulfate
- Crush Injury Syndrome
Calcium Chloride Contraindication
- V-fib
- Digitalis intoxication
- Hypercalcemia
Calcium Chloride Use with Caution
Extravasation
Flush line prior to giving in conjunction with sodium bicarb
Calcium Chloride Dosage and Administration
Adult: 500-1000mg (5-10ml) IV/IO
Ped: 20mg/kg IV/IO Push Slowly
Calcium Chloride Adverse Reaction
Bradycardia, Asystole, V-fib
Calcium Chloride Reference
Cardiac
Medical (Renal)
Trauma (Crush)
Diltiazem Classification
Calcium Channel Blocker
Diltiazem Action
Slows AV node conduction
Diltiazem 1.Onset 2.Duration
- 3 min
2. 1-3 hrs
Diltiazem Indication
- Symptomatic A-fib/flutter
2. PSVT (narrow complex)
Diltiazem Contraindication
- Sick Sinus Syndrome
- 2nd or 3rd degree block
- A-fib w/ WPW or short PR syndrome
- SBP <90
- Cardiogenic Shock
- Wide Complex Tachycardia
- Avoid use on patients taking beta blockers
Diltiazem Use with Caution
Hypotension, impaired renal and hepatic function
Diltiazem Dosage and Administration
Adult: initial dose- 15-20mg IV over 2 min. Second dose after 15 min, if needed is 20-25mg IV over 2 min.
Ped: Contact MBCH
Diltiazem Adverse Reaction
Bradycardia, Cpx, Syncope, Ventricular Arrhythmia, V-fib, dizzy, HA, dry mouth
Diltiazem Reference
Cardiac