Medications Flashcards
Norepinephrine dose
.1 mcg/kg/min IV
Norepinephrine therapeutic effect
increases BP and cardiac output
Norepinephrine mechanism
Stimulates alpha adrenergic receptors located mainly in blood vessels
Causes constriction of both capacitance and resistance of blood vessels
Minor beta adrenergic activity that includes myocardial stimulation
How long is norepinephrine active in the blood
1-2 minutes
Norepinephrine contraindication
Vascular, mesenteric or peripheral thrombosis
Norepinephrine side effects
anxiety, dizziness, h/a, dyspnea, arrhythmias, chest pain, htn, bradycardia, metabolic acidosis
Norepinephrine nursing instructions for frequency of monitoring
check bp every 2-3 minutes until stabilized and every 5 mins after. continuously check ecg
Norepinephrine toxicity treatment
discontinue norepi and administer fluid and electrolyte replacement therapy. and phentolamine (alpha adrenergic blocking agent)
Norepinephrine what to correct before initiation
volume depeletion
Norepinephrine continuous infusion instructions
dilute 4 mg in 1000 ml of d5w or d5/.9% saline. this creates 4 mcg/ml
Norepinephrine how to stop
discontinue gradually.
Midazolam indication
reduce anxiety, preop sedation, anti seizure
Midazolam mechanism
acts at different levels within the CNS to produce generalized CNS depression. Mediated by GABA, an inhibatory neurotransmitter
Midazolam therapeutic effect
induce short term sedation
Midazolam half lfie
3-7 hours in children
Midazolam time to start working
15 mins im, peaks in 30-60 mins
Midazolam side effects
agitation, drowsiness, excess sedation, headache, respiratory depression, bronchospasm, coughing, cardiac arrest, arrhythmias
Midazolam drug drug interaction
alcohol, opioid analgesics, sedatives (dec midazolam dose by 50% if given in conjunction with these drugs)
Midazolam metabolism
P450 enyzme
Midazolam dose PO 6months to 16 years for conscious sedation
.25-.5mg/kg
Midazolam dose IM for conscious sedation
.1-.15 mg/kg
Midazolam dose for status epilepticus kids >2mos IV
.15mg/kg load followed by a continuous infusion of 1 mcg/kg/min. titrate dose upward q5min until seizure controlled 1-18 mcg/kg/min
Midazolam nursing instructions for monitoring
monitor level of sedation and level of consciousness during and throughout for 2-6 hours after administration
What to monitor specifically in midazolam administration
BP, pulse, respiration continuously during iv admin
Midazolam rescue drug
flumazenil (romazicon)
How to administer midazolam IV
administer undiluted or diluted with D5W .9% NaCl.
Undiluted concentration of 1 mg/ml or 5mg/ml.
Diluted: .02-3mg/ml
Midazolam IV rate
2-5 min. titrate dose to patient response
Midazolam continuous IV instructions
dilute with .9% NaCl or D5W. get a concentration of .5-1mg/mL
Midazolam intranasal route, 6 mo and older dose
0.2 mg/kg intranasally x1; Max: 10 mg/dose; Info: may repeat dose x1 after 5-15min
Acetaminophen indication
mild pain, fever
Acetaminophen mechanism
inhibits synthesis of prostaglandins that may serve as mediators of pain and fever in the CNS. Has no significant anti inflammatory properties
Acetaminophen therapeutic effect
analgesia
Acetaminophen half life
1-3 hours
Acetaminophen onset for po and iv
PO onset in .5-1 hr peaks in 1-3 hours and lasts 3-8 hours
IV onset in 30 mins peaks in 30 minutes and lasts 4-6 hours`
Acetaminophen contraindication
alcohol. use cautiously in patients with hepatic disease
Acetaminophen side effects
agitation, anxiety, headache, fatigue, insomnia, atlectasis, dyspnea, htn, vomiting.
Acetaminophen PO dose >12 years old
325-650 mg q4-6 hours or 1g 3-4 times daily
Acetaminophen PO dose kids 1-12 years
10-15mg/kg/dose q4-6 hours
Acetaminophen IV dose >13 years
1000mg q 6hrs or 650 mg q4hr not exceed 4g/day
Acetaminophen IV dose 2-12 years
15mg/kg q6hr or 12.5 mg/kg q4hr not to exceed 75 mg/kg/day
Acetaminophen nursing, when to recheck patient
30-60 minutes after administration.
Acetaminophen toxicity treatment
acetylcysteine
Acetaminophen IV infusion rate
infuse over 15 minutes. no need to dilute
Morphine indication
severe pain and pulmonary edema
Morphine mechanism
binds to opiate receptors in the CNS to alter perception of and response to painful stimuli. it also causes CNS depression.
Morphine therapeutic effect
decrease severity of pain.
Morphine onset
PO onset=unknown
IM onset=10-30 mins, peaks in 30-60
IV onset=rapid and peaks in 20 mins
Morphine contraindication
avoid in patients w hypersensitivity or who have had alcohol
Morphine: when to use cautiously
in patients with head trauma, increased ICP, renal or hepatic disease.
Morphine adverse effects
confusion, sedation, dizziness, hallucinations, headache, unusual dreams, blurry vision, respiratory depression, hypotension, constipation
Morphine drug drug interaction
Use cautiously in patients receiving MAO inhibitors within 14 days prior
Morphine dose for PO
.2-.5 mg/kg/dose q4-6 hours as needed
Morphine dose for IV kids <50kg
.05-.2 mg/kg/ q3-4hr. maximum 15mg/dose
Morphine dose IV > 50 kg
initial 4-10 mg q3-4 hr. For very severe pain additional smaller doses may be given every 3-4 hours.
Morphine dose for continuous administration
.01-.04 mg/kg/hr. If cancer or sickle cell pain, can give .02-2.6 mg/kg/hr
Morphine: what to assess for after administration
type, location, and intensity of pain prior to and 1 hr following administration.
Morphine: how to titrate up
increase doses 25-50% until patients pain is decreased by 50%.
Morphine: for pts on continuous drip, when can boluses be given?
every 15-30 min as needed for pain. The bolus amount is set to the amount of drug infused each hour by continuous infusion.
Morphine what to assess for
bp, respiratory rate, level of consciousness. if respiratory rate is <10/min, assess level of sedation. physical stimulation may be enough to prevent significant hypoventilation.
Morphine, when to give laxatives
after 2-3 days of opioid administration.
Morphine toxicity treatment
naloxone (narcan) dilute .4mg of naloxone in 10ml of .9% nacal and administer .5ml (.02mg) by direct iv push every 2 minutes. if less than 40Kg administer .1mg in 10ml (0.5mcg/kg)
Morphine direct IV administration
dilute with at least 5ml of sterile water or .9% NaCl for injection. concentration of .5-5 mg/ml. Administer 2.5-15 mg over 5 min
Epinephrine indications
cardiac arrest (aystole and pulseless electrical activity) and in bradycardia and hypotension.
Epinephrine effects
It increases heart rate, myocardial contractility, systemic vascular resistance and cardiac automaticity. SE=causes inc myocardial demand
Epinephrine IV dose
0.01mg/kg (0.1 mL/kg) 1:10,000 concentration every 3-5 minutes
Atropine effects
a parasympathetic drug that inhibits vagal activity, accelerates sinoatrial pacemakers, and enhances atrioventricular conduction.
Atropine indication
indicated for symptomatic bradycardia due to increased vagal tone, cholinergic drug toxicity, or AV heart block.
Atropine dose
0.02 mg/kg IV
