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Medic School > Medications > Flashcards

Medications Flashcards

1
Q

Oxygen Adult dosage

A

1-6LPM NC, 12-15LPM NRB/BVM
CPAP/Vent- Flow rate varies by 02 demand to meet cmH2O requirement
Venturi Mask- Flow rate varies by adaptor to meet specific O2 24-40%

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2
Q

Oxygen Pediatric dose

A

1-6LPM NC, 10-15LPM NRB/BVM

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3
Q

Oxygen Classification/Mechanism

A

Gas; Enters body va respiratory system, tansported to cells by hemoglobin, required for efficient breakdown of glucose into energy

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4
Q

Oxygen Pharmacokinetics

A

Onset: Immediate, Peak Effects: <1 min, Duration: <2mins,

Half Life: N/A

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5
Q

Oxygen Indications

A

Hypoxia, Difficulty Breathing, SpO2 < 94%

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6
Q

Oxygen Contraindications

A

ROSC post cardiac arrest with SpO2 >94%, Chest pain/Acute MI, suspected cellular injury/death with SpO2 >94%

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7
Q

Oxygen Side Effects

A

Free radical formation in presence of injured tissues, 2nd cell death

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8
Q

Oxygen Precautions

A

Avoid hyperoxia; high concentration to neonates can cause eye damage

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9
Q

Oxygen Drug-Drug Interactions

A

None

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10
Q

Albuterol Sulfate Adult Dosing

A
  1. 5mg nebulized at 8LPM O2 every 5 minutes for Asthma/COPD/RAD/Anaphylaxis
  2. 5mg nebulized at 8LPM O2 continuously up to max dose of 20mg for HyperKalemia
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11
Q

Albuterol Sulfate Pediatric Dosing

A

2.5mg nebulized at 8LPM O2 every 5 minutes for Asthma/COPD/RAD/Anaphylaxis
Not indicated for HyperKalemia

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12
Q

Albuterol Sulfate Classification/Machanism

A

Sympathomimetic/Sympathetic Agonist (Beta 2 Selective)
Beta 2 Agonist- promotes sympathetic stimulation of bronchial SMC, reducing interaction between actin/myosin causing SM relaxation causing bronchodilation
HyperKalemia- potentiates Na/K pump, promotes extracellular K uptake into cells

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13
Q

Albuterol Sulfate Pharmacokenetics

A

Onset: 5-15 mins, Peak Effects: 1-1.5 hrs, Duration: 3-6 hrs, Half Life: <3 hrs

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14
Q

Albuterol Sulfate Indications

A

Asthma/COPD/RAD, Allergic Reaction/Anaphylaxis, Moderate/Severe HyperKalemia

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15
Q

Albuterol Sulfate Contraindications

A

Symptomatic Tachycardia

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16
Q

Albuterol Sulfate Side Effects

A

Tachycardia, palpitations, chest pain, HTN, sweating, dizziness, headache, nervousness, anxiety, tremor, nausea/vomiting

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17
Q

Albuterol Sulfate Precautions

A

First 3 doses to be given concurrently with ipratropium bromide for Asthma/COPD
May worsen cardiac asthma/pulmonary edema and precipitate dysrhythmias
Moderate/severe HyperKalemia characterized by wide QRS complex on ECG
In some preparations, must be mixed with 2.5mL NS

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18
Q

Albuterol Sulfate Drug-Drug Interactions

A

Side effect may increase with other sympathetic agonist

Beta Blockers may blunt effects of this drug

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19
Q

Levalbuterol/Xopenex Adult Dosage

A

1.25mg nebulized with 8LPM O2 every 5 minutes for Asthma/COPD/RAD/Anaphylaxis

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20
Q

Levalbuterol/Xopenex Pediatric Dosage

A

0.31mg nebulized with 8LPM O2 every 5 minutes for Asthma/COPD/RAD/Anaphylaxis

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21
Q

Levalbuterol/Xopenex Classification/Mechanism

A

Sympathomimetic/Sympathetic Agonist
Beta 2 Selective Agonist- promotes sympathetic stimulation of bronchial SMC, inhibits interaction between actin/myosin relaxing SM causing bronchodilation

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22
Q

Levalbuterol/Xopenex Pharmacokinetics

A

Onset: 5-15 mins, Peak Effects: 1-1.5 hrs, Duration: 3-6 hrs Half Life: 3.3 hrs

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23
Q

Levalbuterol/Xopenex Indications

A

Asthma/COPD/RAD, Allergic Reaction/Anaphylaxis

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24
Q

Levalbuterol/Xopenex Contraindications

A

Symptomatic Tachycardia

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25
Q

Levalbuterol/Xopenex Side Effects

A

Palpitations, HTN, dizziness, headache, anxiety, nausea

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26
Q

Levalbuterol/Xopenex Precautions

A

First 3 doses with Albuterol concurrently, Caution with cardiac ischemia

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27
Q

Levalbuterol/Xopenex Drug-Drug Interactions

A

Side effects increase with other sympathetic agonists,

Beta Blockers may blunt effects

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28
Q

Ipratropium Bromide Adult Dosage

A

500mcg nebulized with 8LPM O2 every 5 minutes up to max total of 3 doses

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29
Q

Ipratropium Bromide Pediatric Dosage

A

500mcg nebulized with 8LPM O2 every 5 minutes up to max total of 3 doses

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30
Q

Ipratropium Bromide Classification/Mechanism

A

Anticholinergic/Parasympathomimetic
Muscarinic ACh Receptor Antagonist, inhibits parasympathetic stimulation of bronchial SMC, submucosal glans/goblet cells drying respiratory tract secretions and allows bronchodilation

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31
Q

Ipratropium Bromide Pharmacokinetics

A

Onset: Varies, Peak Effects: 1.5-2 hrs, Duration: 4-6 hrs,
Half Life: 1.5-2hrs

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32
Q

Ipratropium Bromide Indications

A

Asthma/COPD/RAD

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33
Q

Ipratropium Bromide Contraindications

A

None

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34
Q

Ipratropium Bromide Side Effects

A

Palpitations, dizziness, headache, anxiety, nervousness, rash, dry mouth, nausea/vomiting

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35
Q

Ipratropium Bromide Precautions

A

Administer concurrently with Albuterol x3 doses

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36
Q

Ipratropium Bromide Drug-Drug Interactions

A

None

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37
Q

Racemic Epinephrine Adult Dosage

A

None

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38
Q

Racemic Epinephrine Pediatric Dosage

A

5mg 1:1,000 in 2.5-3mg NS nebulized with 8LPM O2

0.5mL of 2.25% solution of Vaponephrine/Racepinephrine in 2mL NS nebulized 8LPM O2

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39
Q

Racemic Epinephrine Classification/Mechanism

A

Sympathomimetic
Alpha/Beta agonist (Slightly Beta 2 Selective), bronchodilation, decreased mucous membrane secretions, relieves subglottic edema

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40
Q

Racemic Epinephrine Pharmacokinetics

A

Onset: <5mins inhaled, Peak Effects: 5-15mins,
Duration: 1-3 hrs, Half Lift: N/A

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41
Q

Racemic Epinephrine Indications

A

Croup (Laryngotracheobronchitis) with stridor at rest

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42
Q

Racemic Epinephrine Contraindications

A

Doesn’t have stridor at rest

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43
Q

Racemic Epinephrine Side Effects

A

Tachycardia, HTN, dizziness, headache, anxiety, restlessness, nausea/vomiting

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44
Q

Racemic Epinephrine Precautions

A

Rebound effects following clearance of medication

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45
Q

Racemic Epinephrine Drug-Drug Interations

A

Additive effects with other sympathomimetics

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46
Q

Methylprednisolone/Solu-Medrol Adult Dosage

A

125mg slow IVP

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47
Q

Methylprednisolone/Solu-Medrol Pediatric Dosage

A

2mg/kg (max 125mg) slow IVP

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48
Q

Methylprednisolone/Solu-Medrol Classification/Mechanism

A

Corticosteroid/Anit-inflammatory
Diffuses across the cell membranes of various cells present in all tissues, binds to DNA, regulates gene expression and increases synthesis of proteins/enzymes that inhibit inflammatory agents; inhibits synthesis of pro-inflammatory enzymes

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49
Q

Methylprednisolone/Solu-Medrol Pharmacokinetics

A

Onset: 2-6 hrs, Peak Effects: 4-8 days, Duration: 1-5 Weeks Half Life: 3.5 hrs

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50
Q

Methylprednisolone/Solu-Medrol Indications

A

Allergic Reactions/Anaphylaxis, Asthma/COPD/RAD, Adrenal insufficiency

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51
Q

Methylprednisolone/Solu-Medrol Contraindications

A

None

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52
Q

Methylprednisolone/Solu-Medrol Side Effects

A

HTN, CHF, fluid retention, headache, vertigo, malaise, nausea, ABD distention, hiccups, psychosis

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53
Q

Methylprednisolone/Solu-Medrol Precautions

A

Give only one dose prehospitally, Prolong use can cause GI bleeding, prolong wound healing, suppressed adrenocortical steroids

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54
Q

Methylprednisolone/Solu-Medrol Drug-Drug Interactions

A

Decreased effects with phenytoin, phenobarbital, rifampin

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55
Q

Hydrocortisone/Solu-Cortef Adult Dosage

A

100mg slow IVP/IM

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56
Q

Hydrocortisone/Solu-Cortef Pediatric Dosage

A

2mg/kg (max 100mg) slow IVP/IM

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57
Q

Hydrocortisone/Solu-Cortef Classification/Mechanism

A

Corticosteroid/Anti-inflammatory
Diffuses across cell membranes of various cells present in all tissues, binds to DNA, regulates gene expression/increases synthesis of proteins/enzymes inhibiting inflammatory agents; inhibits synthesis of pro-inflammatory enzymes

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58
Q

Hydrocortisone/Solu-Cortef Pharmacokinetics

A

Onset: Immediate, Peak Effects: 4-8 hrs, Duration: 1-1.5 days Half Life: 90 mins

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59
Q

Hydrocortisone/Solu-Cortef Indications

A

Allergic Reaction/Anaphylaxis, Asthma/COPD/RAD, Adrenal Insufficiency

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60
Q

Hydrocortisone/Solu-Cortef Contraindications

A

None

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61
Q

Hydrocortisone/Solu-Cortef Side Effects

A

Fluid Retention, CHF, ABD distention, nausea, hiccups, HTN, headache, vertigo, malaise

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62
Q

Hydrocortisone/Solu-Cortef Precautions

A

Give only one dose prehospitally, Long term steroid use can cause GI bleeding, prolonged wound healing and suppressed adrenocortical steroids

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63
Q

Hydrocortisone/Solu-Cortef Drug-Drug Interactions

A

None

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64
Q

Dexamethasone/Decadron Adult Dose

A

10mg slow IVP for Asthma/COPD/RAD, Anaphylaxis, Adrenal Insufficiency

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65
Q

Dexamethasone/Decadron Pediatric Dose

A
  1. 6mg/kg (max 10mg) slow IVP for Asthma/COPD/RAD, Anaphylaxis, Adrenal Insufficiency
  2. 6mg (max 10mg) PO/IV/IO/IM for croup (PO preferred)
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66
Q

Dexamethasone/Decadron Classification/Mechanism

A

Corticosteroid/Anti-Inflammatory
Diffuses across cell membranes of various cells present in all tissues, binds to DNA, regulates gene expression, increases synthesis of proteins/enzymes tha inhibit inflammatory agents; inhibits synthesis of pro-inflammatory agents

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67
Q

Dexamethasone/Decadron Pharmacokinetics

A

Onset: < 1hr, Peak Effects: <1 hr, Duration: Varies, Half Life: 3-4 hrs

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68
Q

Dexamethasone/Decadron Indications

A

Allergic Reaction/Anaphylaxis, Asthma/COPD/RAD, Croup, Adrenal Insufficiency

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69
Q

Dexamethasone/Decadron Contraindications

A

None

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70
Q

Dexamethasone/Decadron Side Effects

A

Fluid retention, CHF, ABD distention, Nausea, hiccups, HTN, headache, vertigo, malaise psychosis

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71
Q

Dexamethasone/Decadron Precautions

A

Give only one dose prehospitally, long term use of steroids can cause GI bleeding, prolonged wound healing, suppression of adrenocortical steroids

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72
Q

Dexamethasone/Decadron Drug-Drug Interactions

A

None

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73
Q

Famotidine/Pepcid Adult Dosage

A

20mg slow IVP

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74
Q

Famotidine/Pepcid Pediatric Dosage

A

0.4mg/kg (max 20mg) slow IVP

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75
Q

Famotidine/Pepcid Classification/Mechanism

A

Antihistamine
H2 Receptor Antagonist, reduces gastric secretion of H+ ions from parietal cells of the stomach, inhibits VSMC relaxation and vasodilation, reduces capillary permeability caused by histamine release

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76
Q

Famotidine/Pepcid Pharmacokinetics

A

Onset: 30mins, Peak Effects: 0.5-3 hrs, Duration: 1012 hrs Half Life: 2-4hrs

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77
Q

Famotidine/Pepcid Indications

A

Allergic Reaction/Anaphylaxis

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78
Q

Famotidine/Pepcid Contraindications

A

None

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79
Q

Famotidine/Pepcid Side Effects

A

Dizziness, headache, diarrhea, constipation

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80
Q

Famotidine/Pepcid Precautions

A

Caution in pt with liver disease, stomach cancer and renal disease

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81
Q

Famotidine/Pepcid Drug-Drug Interactions

A

None

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82
Q

Diphenhydramine/Benadryl Adult Dosage

A

25-50mg IV/IO/IM/PO

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83
Q

Diphenhydramine/Benadryl Pediatric Dosage

A

1mg/kg (max 50mg) IV/IO/IM/PO

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84
Q

Diphenhydramine/Benadryl Classification/Mechanism

A

Antihistamine
Non-specific competitive H1/H2 antagonist- blocks histamine release, suppresses central cholinergic activity and inhibits reuptake/storage of dopamine, prolonged action of dopamine/reduction of bronchoconstriction, vasodilation and increased vascular permeability

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85
Q

Diphenhydramine/Benadryl Pharmacokenitics

A

Onset: 10-15mins IV, 15-30mins PO, 20-30mins IM

Peak Effects: 1-4hrs, Duration: 6-8hrs, Half Life: 1-4hrs

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86
Q

Diphenhydramine/Benadryl Indications

A

Allergic Reaction/Anaphylaxis, Dystonic Reaction/Akalthisia

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87
Q

Diphenhydramine/Benadryl Contrainidcation

A

None

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88
Q

Diphenhydramine/Benadryl Side Effects

A

Palpitations, hypotension, sedation, drowsiness, dizziness, headache, euphoria, fatigue, blurred vision

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89
Q

Diphenhydramine/Benadryl Precautions

A

Caution in pts with severe liver disease and acute asthma

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90
Q

Diphenhydramine/Benadryl Drug-Drug Interactions

A

Potentiates sedative effects with benzodiazepines, alcohol, MAOI’s and CNS depressants

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91
Q

Epinephrine Adult Dosage

A

Cardiac Arrest: 1mg 1:10,000 rapid IVP every 3-5mins
Asthma/Anaphylaxis: 0.3mg (1:1,000) IM every 5 mins, max 3 doses
Refractory Anaphylaxis: 2-10mcg/min IV/IO infusion
Bradycardia: 2-10mcg/min IV/IO infusion

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92
Q

Epinephrine Pediatric Dosage

A

Cardiac Arrest: 0.01mg/kg (max 1mg) rapid IVP 1:10,000 every 3-5mins
Asthma/Anaphylaxis: 0.01mg/kg (max 0.3mg) IM every 5 minutes, until S/S resolve
Refractory Anaphlyaxis: 0.1-2mcg/kg/min (max 10mcg/min) IV/IO infusion
Bradycardia: 0.01mg/kg (max 1mg) rapid IVP 1:10,000 every 3-5mins

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93
Q

Epinephrine Classification/Mechanism

A

Sympathomimetic/ Sympathetic Agonist/ Catecholamine
Alpha 1 Agonist: 2nd messenger release of Ca into VSMC causing peripheral vasoconstriction, increasing SVR, increasing BP
Beta 1 Agonist: increased intracellular Ca in cardiac cells, positive ino/chrono/dromotropy
Beta 2 Agonist: bronchial SM relaxation, bronchodilation
Blocks release of Ca in and subsequent destruction of MAST cells

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94
Q

Epinephrine Pharmacokinetics

A

Onset: <2mins IV, 3-10min IM, Peak: <5min IV, 20mins IM
Duration: 5-10mins IV, 20-30mins IM, Half Life: 5mins IV

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95
Q

Epinephrine Indications

A

Cardiac Arrest, Anaphylaxis/Allergic Reaction/Refractory Anaphylaxis, Severe RAD/Asthma, Symptomatic Bradycardia/Hypotension

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96
Q

Epinephrine Contraindications

A

Tachydysrhythmias

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97
Q

Epinephrine Side Effects

A

Dysrhythmias, dizziness, anxiety, tremulousness, headache, nausea/vomiting

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98
Q

Epinephrine Precautions

A

Leads to increased myocardial oxygen demand; after 3 doses of 1:1,000 for anaphylaxis, consider refractory anaphylaxis, administer infusion

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99
Q

Epinephrine Drug-drug Interactions

A

pH dependent, deactivated by alkaline solutions; affects intensified with pt taking antidepressants; reacts with CaCl and NaHCO3 to form precipitate in IV tubing, flush line

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100
Q

Magnesium Sulfate Adult Dosage

A

Asthma: 2g in 100mL NS infusion over 10 mins
Cardiac Arrest: 25-50mg/kg (max 2g) over 1-2mins
Torsades: 1-2g in 50-100mL NS over 5mins
Eclampsia: 4g in 100mL NS infusion over 10mins, 1g/hr maintenance infusion

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101
Q

Magnesium Sulfate Pediatric Dosage

A

Asthma: 25-50mg/kg (max 2g) infusion over 15-30mins
Cardiac Arrest: 25-50mg/kg (max 2g) infusion over 1-2mins
Torsades: 25-50mg/kg (max 2g) over 10-20mins
Eclampsia: None

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102
Q

Magnesium Sulfate Classification/Mechanism

A

Electrolyte/ Antidysrhythmic
Ca Channel Blocker: inhibits Ca entry and subsequent interaction between actin/myosin in SMC, SM relaxation, bronchodilation
Ca Channel Blocker: negative ino/chrono/dromotropy

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103
Q

Magnesium Sulfate Pharmacokinetics

A

Onset: Immediate, Peak Effects: Varies, Duration: 1hr,

Half Life: N/A

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104
Q

Magnesium Sulfate Indications

A

Severe Asthma/Bronchospasm, Severe Refractory VF or pulseless V-Tach with HypoMagnesium, Torsades, Eclampsia

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105
Q

Magnesium Sulfate Contraindications

A

3 Degree Heart Block, Hypotension

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106
Q

Magnesium Sulfate Side Effects

A

Bradycardia, dysrhythmias, hypotension, respiratory depression, drowsiness, sweating, flushing, itching, rash

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107
Q

Magnesium Sulfate Precautions

A

Caution with impaired renal function; Watch for respiratory depression

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108
Q

Magnesium Sulfate Drug-drug Interactions

A

Cardiac conduction abnormalities with digitalis

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109
Q

Adenosine Adult Dosage

A

1st dose: 6mg rapid IVP, followed by 20mL NS flush in proximal vein
2nd Dose: 12mg rapid IVP, followed by rapid 20mL NS flush

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110
Q

Adenosine Pediatric Dosage

A

1st dose: 0.1mg/kg (max 6mg) rapid IVP followed by rapid NS flush in proximal vein
2nd dose: 0.2mg/kg (max 12mg) rapid IVP followed by rapid NS flush

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111
Q

Adenosine Classification/Mechanism

A

Antidysrhythmic/ Nucleoside
Adenosine A1 Receptor Agonist- slows AV conduction by activation of G-Protein 2nd messenger, decreasing cAMP and inhibiting Ca entry into cardiac pacemaker cell

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112
Q

Adenosine Pharmacokinetics

A

Onset: Immediate, Peak Effects: Immediate, Duration:30-45secs, Half Life: 6sec

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113
Q

Adenosine Indications

A

Stable Narrow Complex Tach (SVT), Stable Wide Complex Tachycardia (regular, monomorphic)

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114
Q

Adenosine Contraindications

A

WPW

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115
Q

Adenosine Side Effects

A

Facial Flushing, headache, chest pain, dizziness, sense of pending doom

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116
Q

Adenosine Precautions

A

Being printing rhythm before administration

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117
Q

Adenosine Drug-Drug Interactions

A

Methylxanthines (caffeine) non-specific competitive antagonist for adenosine receptors- double dose if pt taking large amounts

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118
Q

Atropine Adult Dosage

A

Bradycardia: 0.5mg IVP every 3-5mins up to 3mg
RSI: 0.5-1mg IVP
Organophosphate: 2-5mg IV/IO/IM, double dose every 5mins until S/S resolve or out of atropine

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119
Q

Atropine Pediatric Dose

A

Bradycardia: 0.02mg/kg (max 0.5mg) IVP, min. dose 0.1mg
RSI: 0.02mg/kg (max 1mg) IVP, min. dose 0.1mg
Organophosphate: 0.05mg/kg (max 5mg) IV/IO/IM every 5mins until S/S resolve

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120
Q

Atropine Classification/Mechanism

A

Anticholinergic/Parasympathomimetic
Muscarinic ACh-Receptor antagonist- inhibits parasympathetic stimulation in SA+AV Nodal cells, prevents K efflux and hyperpolarization causing positive chronotropy, no inotropic effect

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121
Q

Atropine Pharmacokinetics

A

Onset: Immediate, Peak Effects: 2-4mins,

Durations: 4hrs, Half Life: 2-3hrs

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122
Q

Atropine Indications

A

Symptomatic Bradycardia, Premed for RSI with bradycardia <50bpm, Organophosphate poisoning

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123
Q

Atropine Contraindications

A

None

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124
Q

Atropine Side Effects

A

Tachycardia, dilated pupils, blurred vision, drowsiness, confusion, dry mouth

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125
Q

Atropine Precautions

A

Minimum dose 0.1mg for pediatrics and 0.5mg for adults as less can cause paradoxical effects; May cause paradoxical slowing/ineffective for 2 Type II and 3 Degree heart blocks; Caution with AMI

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126
Q

Atropine Drug-Drug Interaction

A

None

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127
Q

Diltiazem/Cardizem Adult Dosage

A

1st dose: 0.25mg/kg (max 20mg) slow IVP over 2mins
2nd dose: 0.35mg/kg (max 20mg) slow IVP over 2mins
5-15mg/hr IV/IO infusion

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128
Q

Diltiazem/Cardizem Pediatric Dosage

A

None

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129
Q

Diltiazem/Cardizem Classification/Mechanism

A

Ca Channel Blocker
SMC Ca Blocker: inhibits Ca entry and subsequent interaction between actin/myosin in SMC, SM relaxation, vasodilation
Cardiac: Ca Channel Blocker- Negative ino/chron/dromotropy

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130
Q

Diltiazem/Cardizem Pharmacokinetics

A

Onset: 3mins, Peak Effects: 7mins, Duration: 1-3hrs,

Half Life: 2hrs

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131
Q

Diltiazem/Cardizem Indications

A

Stable Narrow Complex Tachycardia (A-Fib/A-Flutter), Stable SVT Refractory to Adenosine

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132
Q

Diltiazem/Cardizem Contraindications

A

Hypotension, Decompensated cardiogenic shock, V-Tach, WPW

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133
Q

Diltiazem/Cardizem Side Effects

A

Bradycardia, hypotension, heart block, dizziness, headache, nausea/vomiting

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134
Q

Diltiazem/Cardizem Precautions

A

Discard one month after refridgeration

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135
Q

Diltiazem/Cardizem Drug-Drug Interactions

A

Increased risk of bradycardia if pt receiving IV Beta Blockers

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136
Q

Metoprolol Adult Dosage

A

5mg slow IVP, max 15mg

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137
Q

Metoprolol Pediatric Dosage

A

None

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138
Q

Metoprolol Classification/Mechanism

A

Beta Blocker
Beta 1 antagonist- inhibits extracellular Ca entry and Ca release from the sarcoplasmic reticulum in cardiac cells, negative ino/chrono/dromotropy

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139
Q

Metoprolol Indications

A

Stable Narrow Complex Tachycardia (A-Fib/A-Flutter), Stable SVT Refractory to Adenosine

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140
Q

Metoprolol Contraindications

A

Hypotension, Decompensated Cardiogenic shock, Cocaine use

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141
Q

Metoprolol Side Effects

A

Bradycardia, hypotension, lethargy, dyspnea, wheezing, dizziness

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142
Q

Metoprolol Precautions

A

May exacerbate Asthma/COPD/bronchospasms/CHF

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143
Q

Metoprolol Drug-Drug Interaction

A

Profound bradycardia if pt getting IV Ca Channel Blocker; additive effects with digioxin

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144
Q

Nitroglycerin Adult Dosage

A

1-2” topical paste; 0.4mg SL tablet/spray every 3-5mins until effect achieved or BP drops (3x doses in 25mins)

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145
Q

Nitroglycerin Pediatric Dosage

A

None

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146
Q

Nitroglycerine Classification/Mechanism

A

Vasodilator/Nitrate
A pro-drug which must be de-nitrated to form the active metabolite nitric oxide. Activates conversion GTP to cGMP+2Pi in VSMC. cGMP creates cascade reactions causing reduction in intracellular Ca, VSMC relaxation and decreases cardiac preload/afterload

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147
Q

Nitroglycerine Pharmacokinetics

A

Onset: 1-3mins SL, 30 mins topical Peak Effects: 15-30mins SL, Varies topical. Duration: 20-30mins SL, 3-6hrs topical. Half: 1-4mins

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148
Q

Nitroglycerine Indications

A

Chest pain associated with angina/MI, Acute Pulmonary Edema/CHF

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149
Q

Nitroglycerine Contraindications

A

Shock/hypotension, Increases ICP, <12 yo, ED medications in last 48hrs, Inferior Wall MI

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150
Q

Nitroglycerine Side Effects

A

Hypotension, tachycardia, weakness, dizziness, headache, nausea/vomiting, rash, dry mouth

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151
Q

Nitroglycerine Precautions

A

Expect headache from cerebral vasodilation,; Routine use may cause tolerance; 12-Lead ECG prior to administration; Does not improve morbidity or mortality, only for pain; Extreme caution with inferior wall MI

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152
Q

Nitroglycerine Drug-Drug Interactions

A

Orthostatic hypotension with Beta Blockers, severe hypotension with alcohol

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153
Q

Aspirin Adult Dose

A

324mg PO (81mg Baby ASA)

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154
Q

Aspirin Pediatric Dose

A

None

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155
Q

Aspirin Classification/Mechanism

A

Platelet Aggregation Inhibitor/Anti-inflammatory/Salicylate
Inhibits platelet aggregation by blocking formation of Thromboxane A2 (which is responsible for platelet aggregation and atrial constriction); COX inhibitor- inhibits prostaglandin synthesis and reduce spread of inflammation

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156
Q

Aspirin Pharmacokinetics

A

Onset: 5-30mins. Peak: 15-120mins. Duration: 1-4hrs. Half Life: 15-20mins

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157
Q

Aspirin Indications

A

Chest pain suggestive of AMI/ACS

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158
Q

Aspirin Contraindications

A

Active GI Bleeding

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159
Q

Aspirin Side Effects

A

GI Bleeding, prolongs bleeding, heartburn, nausea/vomiting, wheezing

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160
Q

Aspirin Precautions

A

Pt takes ASA daily, may supplement dose if taken within 24 hours, GI upset

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161
Q

Aspirin Drug-Drug Interactions

A

Enhanced side effects with other anti-inflammatory agents; Decreased absorption with concurrent antacids

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162
Q

Calcium Gluconate Adult Dosage

A

2g slow IVP over 5mins

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163
Q

Calcium Gluconate Pediatric Dosage

A

60mg/kg (max 2g) slow IVP over 5mins

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164
Q

Calcium Gluconate Classification/Mechanism

A

Mineral/Electrolyte
HyperK: raises the action potential threshold for cardiac contracting cells to compensate for elevated resting potential and hyper-excitability- reduces likelyhood of dysrhythmia
Ca Channel Blocker OD- replacement of elemental Ca, disassociates rapid to Ca and Gluconate, releases extracellular Ca concentration to overcome Ca channel blockade, positive ino/chronotropy and peripheral vasoconstriction

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165
Q

Calcium Gluconate Pharmacokinetics

A

Onset: Immediate. Peak: Unknown Duration: Varies Half Life: N/A

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166
Q

Calcium Gluconate Indications

A

Moderate/Severe HyperKalemia, Ca Channel Blocker toxicity, ABD spasms, Cardiac Arrest

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167
Q

Calcium Gluconate Contraindications

A

Hypercalcemia, Pt taking digoxin

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168
Q

Calcium Gluconate Side Effects

A

Bradycardia, dysrhythmias, syncope, nausea/vomiting, cardiac arrest

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169
Q

Calcium Gluconate Precautions

A

Can cause necrosis at injection site, patent IV; Moderate/severe HyperKalemia characterized by wide QRS

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170
Q

Calcium Gluconate Drug-Drug Interaction

A

Forms precipitate with NaHCO3, flush the line between administration; Digitalis toxicity when administered with pt taking digitalis/dixogin inhibiting Ca Channels causing stone heart

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171
Q

Calcium Chloride Adult Dosage

A

1g slow IVP over 5mins

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172
Q

Calcium Chloride Pediatric Dosage

A

20mg/kg (max 1g) slow IVP over 5mins

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173
Q

Calcium Chloride Classification/Mechanism

A

Mineral/Electrolyte
HyperKalemia- raises action potential threshold in cardiac contracting cells to compensate for elevated resting potential and hyperexcitability reduces likelyhood of dysrhythmia
Ca Channel Blocker OD- replacement of elemental Ca, disassociates rapidly to Ca and Cl ions, increases extracellular Ca concentration to overcome Ca Channel Blockade, positive ino/chronotropy and increases vasoconstriction

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174
Q

Calcium Chloride Pharmacokinetics

A

Onset: Immediate. Peak: Unknown. Duration: Varies. Half Life: N/A

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175
Q

Calcium Chloride Indications

A

Moderate/Sever HyperKalemia (crush, dialysis and rhabdo), Ca Channel Blocker toxicity, ABD spasms from Man of War jellyfish and brown recluse spider, Cardiac Arrest (suspected HyperKalemia)

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176
Q

Calcium Chloride Contraindications

A

Hypercalcemia, Pt taking digoxin

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177
Q

Calcium Chloride Side Effects

A

Bradycardia, dysrhythmias, syncopy, nausea/vomiting, cardiac arrest

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178
Q

Sodium Bicarbonate Adult Dosage

A

2mEq/kg initial IVP

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179
Q

Sodium Bicarbonate Pediatric Dosage

A

2mEq/kg initial IVP

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180
Q

Sodium Bicarbonate Classification/Mechanism

A

Alkalizing Agent/Electrolyte
Metabolic Acidosis-alkaline electrolyte that buffers extra H+ ions
Na Channel Blocker OD- Replacement of elemental of Ana, disassociates rapidly to Na+HCO3 ions, increases extracellular Na concentration to overcome Na Channel Blockade, increases rate of depolarization of pacemaker/non-pacemaker cells to return sinus pacing

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181
Q

Sodium Bicarbonate Pharmacokinetics

A

Onset: Immediate, Peak: <15mins, Duration: 1-2hrs, Half Life: N/A

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182
Q

Sodium Bicarbonate Indications

A

Na Channel Blocker OD (TCA, Cocaine, Benadryl) ASA OD, cardiac arrest with known/suspected HyperKalemia, Crush Syndrome, prior to intubation of suspected DKA

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183
Q

Sodium Bicarbonate Concentration

A

Respiratory Acidosis

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184
Q

Sodium Bicarbonate Side Effects

A

None

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185
Q

Sodium Bicarbonate Precautions

A

Metabolic alkalosis in large dosage

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186
Q

Sodium Bicarbonate Drug-Drug Interactions

A

Deactivates catecholamine and vasopressors; Preforms precipitate in CaCl2 in IV tubing

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187
Q

Amiodarone HCl/Cordarone Adult Dosage

A

Cardiac Arrest: 300mg IVP, repeat 150mg in 3-5mins
WTC: 150mg IVP over 10mins, repeat in 10mins
WCT Maintenance: 1mg/min 1st 6hrs, 0.5mg/min for 18hrs

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188
Q

Amiodarone HCl/Cordarone Pediatric Dosage

A

Cardiac Arrest: 5mg/kg (max 300mg) IVP, max total of 15mg/kg
WCT: 5mg/kg (max 300mg) IVP over 20-60mins, repeat once
WCT Maintenance: Not recommended

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189
Q

Amiodarone HCl/Cordarone Classification/Mechanism

A

Antidysrhythmic
Class III Antiarrhythmic/K Channel Blocker- Prolongs Phase 3 depolarization + refractory period of non-pacemaker action potential
Class IA Antiarrhythmic/Na Channel Blocker- Decreases amplitude of Phase 0 depolarization of non-pacemaker action potential
Class II Antiarrhythmic/Beta Blocker- Negative Ino/chronotropy/dromotropy
Class IV Antiarrhythmic/Ca Channel Blocker- negative ino/chronotropy/dromotropy

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190
Q

Amiodarone HCl/Cordarone Pharmacokinetics

A

Onset: Immediate, Peak Effects: 30-45mins, Duration: Varies, Half Life: 40-50 days

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191
Q

Amiodarone HCl/Cordarone Indication

A

Cardiac Arrest (V-fib, Pulseless V-Tach) and Stable WCT

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192
Q

Amiodarone HCl/Cordarone Contraindications

A

None

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193
Q

Amiodarone HCl/Cordarone Side Effects

A

Hypotension, Bradycardia, dyspnea, cough, dizziness, prolonged PR QRS and QT interval

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194
Q

Amiodarone HCl/Cordarone Precautions

A

Caution with pt with heart failure

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195
Q

Amiodarone HCl/Cordarone Drug-Drug Interactions

A

Reduces renal/non-renal clearance of digoxin. Enhances anticoagulantion

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196
Q

Lidocaine/Xylocaine Adult Dosage

A

Cardiac Arrest: 1st dose- 1-1.5mg IVP, 2nd- 0.5-0.75mg/kg IVP, repeat 5-10mins up to three doses, max 3mg/kg
WCT: 0.5mg-1.5mg/kg IVP
WCT Maintenance: 1-4mg/min
Anesthetic: 0.5mg/kg (max dose 40mg)

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197
Q

Lidocaine/Xylocaine Pediatric Dosage

A

Cardiac Arrest: 1mg/kg IVP repeat after 15min PRN
WCT: 1mg/kg IVP, repeat in 15mins PRN
WCT Maintenance: 20-50mcg/kg/min
Anesthetic: 0.5mg/kg (max 40mg)

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198
Q

Lidocaine/Xylocaine Classification/Mechanism

A

Antidsyrhythmic
Class 1B Antiarrhythmic/Na Channel Blocker- Decreases slope/amplitude of Phase 0 depolarization of non-pacemaker action potential

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199
Q

Lidocaine/Xylocaine Pharmacokinetics

A

Onset: <3mins, Peak: 5-7mins, Duration: 10-20mins, Half Life: 1.5-2hrs

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200
Q

Lidocaine/Xylocaine Indicatiosn

A

Cardiac Arrest (V-Fib and pulseless V-Tach), Stable V-Tach, Anesthetic for IO

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201
Q

Lidocaine/Xylocaine Contraindication

A

None

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202
Q

Lidocaine/Xylocaine Side Effects

A

Bradycardia, heart block, hypotension, seizures, drowsiness, confusion, nausea/vomiting, sweating, flushing, itching, rash

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203
Q

Lidocaine/Xylocaine Precautions

A

Pt 70+ years or known hepatic failure- reduce maintenance dose by half

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204
Q

Lidocaine/Xylocaine Drug-Drug Interactions

A

Potentiates procainamide, phenytoin, quinidine and Beta Blockers

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205
Q

Procainamide Adult Dosage

A

Cardiac Arrest: 20mg/min IV/IO infusion, max total of 17mg/kg
WCT: 20-50mg/min IV/IO infusion, DC when precautions observed
WCT Maintenance- 1-4mg/min

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206
Q

Procainamide Pediatric Dosage

A

Cardiac Arrest: 15mg/kg IV/IO infusion over 30-60mins
WCT: 15mg/kg IV/IO infusion over 30-60mins
WCT Maintenance: Not recommended

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207
Q

Procainamide Classification/Mechanism

A

Antiarrhythmic
Class 1A Antiarrhythmic/Moderate Na Channel Blocker- decreases the slope and amplitude of Phase 0 depolarization of non-pacemaker action potential

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208
Q

Procainamide Pharmacokinetics

A

Onset: 10-30mins, Peak: 15-20mins, Duration: 3-6hrs, Half Life: 3hrs

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209
Q

Procainamide Indications

A

Cardiac Arrest (V-fib and Pulseless V-Tach), Stable WCT

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210
Q

Procainamide Contraindications

A

Severe conduction disturbances, 2nd Type II/3rd Degree Heart Block, PVCs with bradycardia

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211
Q

Procainamide Side Effects

A

Bradycardia, heart block, hypotension, seizures, drowsiness, confusion, nausea/vomit, respiratory/cardiac arrest

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212
Q

Procainamide Precautions

A

D/C if dysrhythmia is suppressed, hypotension, QRS complex widens, 17mg/kg administered

213
Q

Procainamide Drug-Drug Interaction

A

Chance of neurotoxicity increases if given with Lidocaine

214
Q

Ondansetron/Zofran Adult Dose

A

4mg IV/IO/IM/PO, may repeat once

215
Q

Ondansetron/Zofran Pediatric Dose

A

0.1mg/kg (max 4mg) slow IV/IO/IM or 4mg PO if >5 yo

216
Q

Ondansetron/Zofran Classification/Mechanism

A

Antiemetic

5HT3/Seratonin Receptor Antagonist- blocks binding to receptors at vagal nerve terminals, inhibits vomiting reflex

217
Q

Ondansetron/Zofran Pharmacokinetics

A

Onset: Rapid, Peak: 15-30mins, Duration: 4-8hrs, Half Life: 4hrs

218
Q

Ondansetron/Zofran Indications

A

Nausea/vomiting

219
Q

Ondansetron/Zofran Contraindications

A

None

220
Q

Ondansetron/Zofran Side Effects

A

Tachycardia, prolonged QT interval, dizziness, headache

221
Q

Ondansetron/Zofran Precautions

A

Hypersensitivity to other 5HT3 selective antagonist

222
Q

Ondansetron/Zofran Drug-Drug Interaction

A

Potentiates prolonged QT interval with drug combinations causing same effect

223
Q

Metoclopramide/Reglan Adult Dosage

A

Nausea/Vomit: 5-10mg IV/IO infusion over 15mins or 5-10mg IM
Migraine: 10mg IV/IO infusion over 15mins or 10mg IM

224
Q

Metoclopramide/Reglan Pediatric Dose

A

Nausea/vomit: None

Migraine: None

225
Q

Metoclopramide/Reglan Classification/Mechanism

A

Antiemetic
D2/Dopamine Receptor antagonist- inhibits communication from chemoreceptor trigger zone, recognizing emetic toxins, to the vomiting center of the brain; inhibits gastric SMC relaxation, increasing mobility of stomach content in small intestine

226
Q

Metoclopramide/Reglan Pharmacokinetics

A

Onset: 1-3mins IV, 10-15mins IM. Peak: 1-2hrs. Duration: 1-3hrs. Half Life: 2.5-6hrs

227
Q

Metoclopramide/Reglan Indication

A

Nausea/Vomiting, Migraine headache

228
Q

Metoclopramide/Reglan Contraindications

A

Bowel obstruction, Seizure, Pheochromocytoma

229
Q

Metoclopramide/Reglan Side Effects

A

Bradycardia, Tachycardia, hypotension, HTN, CNS depression, sedation

230
Q

Metoclopramide/Reglan Precautions

A

May cause dystonia; Give slowly

231
Q

Metoclopramide/Reglan Drug-Drug Interaction

A

Opposed by anticholinergics; additive effects with CNS Depressants

232
Q

Prochloperazine/Compazine Adult Dosage

A

Nausea/Vomiting: 5-10mg IV/IO infusion over 15mins or 5mg IM

Migraine: 10mg IV/IO infusion over 15mins or 10mg IM

233
Q

Prochloperazine/Compazine Pediatric Dosage

A

Nausea/Vomiting: None

Migraine: None

234
Q

Prochloperazine/Compazine Classification/Mechanism

A

Antiemetic
D1/Dopamine antagonist- inhibits communication from the chemoreceptor trigger zone, recognizes emetic toxins, to the vomiting center of brain; inhibits gastric SMC relaxation, leading increased mobility of stomach contents into small intestine

235
Q

Prochloperazine/Compazine Pharmacokinetics

A

Onset: 10-20mins. Peak: Varies. Duration: 4-12hrs. Half Life: 24-48hrs

236
Q

Prochloperazine/Compazine Indications

A

Nausea/Vomiting, Migraines

237
Q

Prochloperazine/Compazine Contraindications

A

CNS Depression

238
Q

Prochloperazine/Compazine Side Effects

A

Bradycardia, tachycardia, hypotension, HTN, CNS Depression, sedation

239
Q

Prochloperazine/Compazine Precautious

A

May cause dystonia; Concurrent administration of Benadryl for migraine

240
Q

Prochloperazine/Compazine Drug-Drug Interactions

A

Opposed by anticholinergics; Additive Effects with CNS depressants

241
Q

Oxytocin/Pitocin Adult Dosage

A

3-30 units IM or 10-20 units in 500-1000mL NS infusion

242
Q

Oxytocin/Pitocin Pediatric Dosage

A

Not indicated

243
Q

Oxytocin/Pitocin Classification/Mechanism

A

Hormone
Oxytocin binds to oxytocin receptors in uterine SMC, initiates activity of 2nd messengers which results in increased intracellular Ca, and in turn promotes contraction of uterine muscle

244
Q

Oxytocin/Pitocin Pharmacokinetics

A

Onset: Immediate IV, 3-7 minutes IM. Peak: Varies. Duration: 1 hr IV, 2-3 HRS .Half: 3-5mins

245
Q

Oxytocin/Pitocin Indications

A

Post partum Hemorrhage

246
Q

Oxytocin/Pitocin Contraindications

A

Baby+placenta not delivered; Additional fetus present; if given prior to fetal delivery causes fetal hypoxia, fetal asphyxia, fetal intracranial bleeding

247
Q

Oxytocin/Pitocin Side Effects

A

Hypotension, tachycardia, dysrhythmias, seizures, coma, nausea/vomiting

248
Q

Oxytocin/Pitocin Precautions

A

Can cause overstimulation of uterus and uterine rupture

249
Q

Oxytocin/Pitocin Drug-Drug Interaction

A

HTN with vasoconstrictors

250
Q

Glucagon/Glucagen Adult Dose

A

Hypoglycemia: 1mg IM, repeat once in 15mins

Ca Channel/Beta Blocker OD: 5mg IV/IO, repeat in 5mins

251
Q

Glucagon/GlucaGen Pediatric Dose

A

Hypoglycemia: 0.02mg/kg (max 1mg) IM

Ca Channel/Beta Blocker OD: 0.05mg/kg IV/IO

252
Q

Glucagon/GlucaGen Classification/Mechanism

A

Hormone
Liver: Glucagon causes activation of glucagon G-Protein 2nd Messenger cAMP, cascade of reactions allowing glucose release from glycogen polymers
Heart: Increased cAMP, Ca entry from ECF + release from sarcoplasmic reticulum, positive chrono/ino/dromotropy

253
Q

Glucagon/GlucaGen Pharmacokinetics

A

Onset: 5-20mins. Peak: 30mins. Duration: 1-2hrs. Half Life: 5-10mins

254
Q

Glucagon/GlucaGen Indications

A

Hypoglycemia (unable to get IV), Esophageal Food Bolus, Beta Blocker/ Ca Channel OD

255
Q

Glucagon/GlucaGen Contraindications

A

None

256
Q

Glucagon/GlucaGen Side Effects

A

Hypotension, dizziness, headache, nausea/vomiting

257
Q

Glucagon/GlucaGen Precautions

A

Must be reconstituted in 1mL sterile water; Effective if sufficient glycogen in liver

258
Q

Glucagon/GlucaGen Drug-Drug Interaction

A

None

259
Q

Dextrose 10% Adult Dosage

A

25g slow IV/IO infusion until dose administration yields appropriate result

260
Q

Dextrose 10% Pediatric Dosage

A

0.5-1mg/kg slow IV/IO infusion

261
Q

Dextrose 10% Classification/Mechanism

A

Carbohydrate

Raises blood glucose simply by adding presence directly into the vasculature

262
Q

Dextrose 10% Pharmacokinetics

A

Onset: <1min. Peak: Varies. Duration: Varies. Half Life: N/A

263
Q

Dextrose 10% Indications

A

Hypoglycemia, hypoglycemia during neonatal resuscitation

264
Q

Dextrose 10% Contraindications

A

None

265
Q

Dextrose 10% Side Effects

A

Tissue necrosis/phlebitis at injection site

266
Q

Dextrose 10% Precautions

A

Local venous irritation may occur in smaller vein; Caution in pt with increased ICP/cerebral edema

267
Q

Dextrose 10% Drug-Drug Interaction

A

None

268
Q

Oral Glucose/Glutose Adult Dose

A

15g PO

269
Q

Oral Glucose/Glutose Pediatric Dose

A

15g PO

270
Q

Oral Glucose/Glutose Classification/Mechanism

A

Carbohydrate

Raises blood glucose by absorption through oral/intestinal mucosa

271
Q

Oral Glucose/Glutose Pharmacokinetics

A

Onset: 2-5mins. Peak: 2-5mins. Duration: 2-5mins. Half Life: 5mins

272
Q

Oral Glucose/Glutose Indications

A

Hypoglycemia

273
Q

Oral Glucose/Glutose Contraindications

A

Alter level of consciousness (unable to protect airway/follow commands)

274
Q

Oral Glucose/Glutose Side Effects

A

Nausea/vomiting

275
Q

Oral Glucose/Glutose Precautions

A

Pt must be able to swallow

276
Q

Oral Glucose/Glutose Drug-Drug Interactions

A

None

277
Q

Haloperidol/Haldol Adult Dosage

A

5-10mg IM

278
Q

Haloperidol/Haldol Pediatric Dosage

A

1-3mg IM

279
Q

Haloperidol/Haldol Classification/Mechanism

A

Butyrophenone Antipsychotic/Neuroleptic
Musolimbic D1/D2 antagonist- depresses release of hypothalamic + hypophyseal hormones; depresses the RAS, affecting basal metabolism, body temperature, wakefulness, vasomotor tone and emesis.

280
Q

Haloperidol/Haldol Pharmacokinetics

A

Onset: 10-20mins. Peak: 30-45mins. Duration: Varies. Half Life:3-35hrs

281
Q

Haloperidol/Haldol Indications

A

Acute Psychotic Episode, Chemical Restraint/Extreme Agitation/Combativeness

282
Q

Haloperidol/Haldol Contraindications

A

CNS Depression, Agitation secondary to shock/hypoxia

283
Q

Haloperidol/Haldol Side Effects

A

Tachycardia, hypotension, prolong QT syndrome, Torsades, Respiratory depression, extrapyramidal symptoms, seizures, drowsiness, restlessness, insomnia, dry mouth, constipation

284
Q

Haloperidol/Haldol Preautions

A

May impair physical/mental abilities; May cause orthostatic hypotension, dystonia reactions

285
Q

Haloperidol/Haldol Drug-Drug Interactions

A

Caution pt taking lithium (encephalopathic syndrome), Potentiates anti hypertensives

286
Q

Olanzapine/Zyprexa Adult Dosage

A

10mg IM

287
Q

Olanzapine/Zyprexa Pediatric Dosage

A

None

288
Q

Olanzapine/Zyprexa Classification/Mechanism

A

Antipsychotic
Seratonin, dopamine (D1/D2), muscarinic ACh, Alpha adrenergic Receptor antagonist- antipsychotic + anticholinergic effects

289
Q

Olanzapine/Zyprexa Pharmacokinetics

A

Onset: <30mins. Peak: 6hrs. Duration: Varies. Half Life: 21-54hrs

290
Q

Olanzapine/Zyprexa Indications

A

Acute Psychotic Episode, Alzheimer’s Disease, Chemical Restraint

291
Q

Olanzapine/Zyprexa Contraindications

A

None

292
Q

Olanzapine/Zyprexa Side Effects

A

Tachycardia, postural hypotension, dizziness, tremor, myalgia, nausea, dry mouth, somnolence

293
Q

Olanzapine/Zyprexa Precautions

A

Reconstituted in 3mL sterile water; Caution pt with cardiovascular disease, predisposed for hypotension + Parkinson’s; May cause extrapyramidal symptoms or dystonia reaction

294
Q

Olanzapine/Zyprexa Drug-Drug Interactions

A

Potentiates hypotensive effect of antihypertensives

295
Q

Naloxone/Narcan Adult Dosage

A

0.04-2mg IV/IO/IM or 0.4-4mg IN every 3-5mins until respiratory status improves, max 10mg

296
Q

Naloxone/Narcan Pediatric Dosage

A

0.1mg/kg (max 2mg) IV/IO/IM or 0.4-4mg IN every 5mins until respiratory status improves, max 10mg

297
Q

Naloxone/Narcan Classification/Mechanism

A

Opioid Antagonist/Antidote
Competitive Opiate Receptor antagonist- displaces narcotic molecules greater affinity for receptor site but shorter duration

298
Q

Naloxone/Narcan Pharmacokinetics

A

Onset: <2mins IV, 2-10mins IM. Peak: <2mins IV, 2-10mins IM.
Duration: 20-120mins. Half Life: 60-90mins

299
Q

Naloxone/Narcan Indications

A

Respiratory depression from narcotics/opiates/suspected polypharm OD

300
Q

Naloxone/Narcan Contraindications

A

None

301
Q

Naloxone/Narcan Side Effects

A

Hypotension, Hypertension, Ventricular dysrhythmias, seizures, nausea/vomiting

302
Q

Naloxone/Narcan Precautions

A

May induce withdrawal in newborns with addicted mothers; Oral opiates may require higher doses for reversal; Rule out narcotic prior to RSI

303
Q

Naloxone/Narcan Drug-Drug Interations

A

May induce withdrawal on opiate-dependent pt

304
Q

Amyl Nitrate Adult Dose

A

0.3ml ampule crushed, inhaled over 15-30secs every 1min until sodium nitrate infusion available

305
Q

Amyl Nitrate Pediatric Dosage

A

0.3mL ampules crushed, inhaled over 15-30secs every 1min until sodium nitrate infusion available

306
Q

Amyl Nitrate Classification/Mechanism

A

Antidote/Nitrate Vasodilator
Short acting vasodilator + SMC relaxant that oxidizes hemoglobin to become methemoglobin, which forms a non-toxic complex with the cyanide ion form cyanomethemoglobin, which can be enzymatically degraded

307
Q

Amyl Nitrate Pharmacokinetics

A

Onset: 10-20secs. Peak: 30secs. Duration: 3-5mins.

Half Life: N/A

308
Q

Amyl Nitrate Indications

A

Cyanide Poisoning

309
Q

Amyl Nitrate Contraindications

A

None

310
Q

Amyl Nitrate Side Effects

A

Tachycardia, orthostatic hypotension, syncope, weakness, dizziness, headache, flushing, cold sweats, nausea/vomiting

311
Q

Amyl Nitrate Precautions

A

May be abused, stored in secure place; Smells like dirty, sweaty socks; Ensures pt is sitting prior to administration as syncope/hypotension maybe sudden

312
Q

Amyl Nitrate Drug-Drug Interaction

A

Hypotension potentiated by antihypertensives, Beta Blockers and certain antiemetic

313
Q

Sodium Thiosulfate Adult Dosage

A

12.5g IV/IO infusion over 10mins, repeat once with 1/2 dose PRN

314
Q

Sodium Thiosulfate Pediatric Dosage

A

300-500mg/kg IV/IO infusion over 10mins, repeat once with 1/2 dose PRN

315
Q

Sodium Thiosulfate Classification/Mechanism

A

Antidote
Cyanide inhibits cytochrome oxidase and interrupts cell respiration at the final stage of electron transport chain. Sodium Thiosulfate rests with cyanide to form thiocyanate, a stable molecule that’s excreted via urine

316
Q

Sodium Thiosulfate Pharmacokinetics

A

Onset: 2-5mins. Peak: Varies. Duration: Varies. Half Life: N/A.

317
Q

Sodium Thiosulfate Indication

A

Cyanide Poisoning

318
Q

Sodium Thiosulfate Contraindications

A

None

319
Q

Sodium Thiosulfate Side Effects

A

Nausea/vomiting and joint pain

320
Q

Sodium Thiosulfate Precautions

A

Must be given with/following amyl Nitrate and sodium nitrate

321
Q

Sodium Thiosulfate Drug-Drug Interactions

A

None

322
Q

Hydroxocobalamin/CyanoKit Adult Dosage

A

5g slow IV/IO over 15mins, may repeat once

323
Q

Hydroxocobalamin/CyanoKit Pediatric Dosage

A

Not recommended

324
Q

Hydroxocobalamin/CyanoKit Classification/Mechanism

A

Antidote
Cyanide inhibits cytochrome oxidase + interrupts cell respiration at final stage of electron transport chain. Hydroxocobalamin reacts with cyanide to form cyanocabalamin, stable molecule that can be exerted in urine

325
Q

Hydroxocobalamin/CyanoKit Pharmacokinetics

A

Onset: Varies. Peak: Varies. Duration: Varies. Half Life: 26-31hrs

326
Q

Hydroxocobalamin/CyanoKit Indications

A

Cyanide Poisoning

327
Q

Hydroxocobalamin/CyanoKit Contraindications

A

None

328
Q

Hydroxocobalamin/CyanoKit Side Effects

A

Hypertension, nausea/vomiting

329
Q

Hydroxocobalamin/CyanoKit Precautions

A

May cause allergic reaction

330
Q

Hydroxocobalamin/CyanoKit Drug-Drug Interactions

A

None

331
Q

Pralidoxime Chloride/2-Pam/Protopam Adult Dosage

A

600mg IM, repeat with escalating dosages of 1200mg, 1800mg if symptoms worsen/severe

332
Q

Pralidoxime Chloride/2-Pam/Protopam Pediatric Dosage

A

600mg IM

333
Q

Pralidoxime Chloride/2-Pam/Protopam Classification/Mechanism

A

Antidote
Organophosphates donate phosphates to cholinesterase, cannot breakdown ACh and not recycled for release a NMJ. Pralidoxime reactivates cholinesterase

334
Q

Pralidoxime Chloride/2-Pam/Protopam Pharmacokinetics

A

Onset: 10-30mins. Peak: 15-20mins. Duration: 3-6hrs.

Half Life: 3hrs

335
Q

Pralidoxime Chloride/2-Pam/Protopam Indications

A

Organophosphate poisoning

336
Q

Pralidoxime Chloride/2-Pam/Protopam Contraindications

A

None

337
Q

Pralidoxime Chloride/2-Pam/Protopam Side Effects

A

Tachycardia, HTN, hyperventilation, dizziness, drowsiness, headache, blurred vision, diplopia, nausea, pain at IM site

338
Q

Pralidoxime Chloride/2-Pam/Protopam Precautions

A

Supplied as auto-injector, packaged separated atropine auto injector (Mark I Kit) or supplied with atropine in autoinjector (Mark II Kit). Given before atropine in Mark I Kit

339
Q

Pralidoxime Chloride/2-Pam/Protopam Drug-Drug Interaction

A

None

340
Q

Normal Saline 0.9% NaCl Adult Dosage

A

Dehydration/Shock/DKA: 200-250mL until systolic >90mmHg
Burns: <1hr- 500mL, >1hr- (1-2mL/kg x BSA% burned)/8
Cardiogenic Shock: N/A consider early vasopressor

341
Q

Normal Saline 0.9% NaCl Pediatric Dosage

A

Dehydrated/Shock/DKA: 20mL/kg >1 month, 10mL/kg < 1month
Burns: <1hr- 100-250mL, >1hr- (2mL/kg x BSA%)/8
Cardiogenic Shock: 5-10mL/kg

342
Q

Normal Saline 0.9% NaCl Classification/Mechanism

A

Isotonic Crystalloid Solution

Volume replacement, water and electrolytes

343
Q

Normal Saline 0.9% NaCl Pharmacokinetics

A

Onset: Immediate. Peak: Immediate. Duration: Varies.

Half Life: N/A

344
Q

Normal Saline 0.9% Na/Cl Indications

A

Dehydration, Shock/Hypotension/Hypovolemia, DKA, KTO, Burns

345
Q

Normal Saline 0.9% NaCl Contraindications

A

Pulmonary Edema

346
Q

Normal Saline 0.9% NaCl Side Effects

A

May induce pulmonary edem in pt with CHF hx

347
Q

Normal Saline 0.9% NaCl Precautions

A

May cause depletion of other electrolytes if given in large volumes; May dilute O2 carrying capacity if bleeding severe; Vasopressor if hypotensive after 2000mL

348
Q

Normal Saline 0.9% NaCl Drug-Drug Interactions

A

None

349
Q

Lactated Ringer’s Adult Dosage

A

Dehydration/Shock/DKA: 200-250mL until systolic >90mmHg
Burns: <1hr- 500mL, >1hr- (1-2mL/kg x BSA % burned)/8
Cardiogenic Shock: N/A, consider early vasopressor

350
Q

Lactated Ringer’s Pediatric Dosage

A

Dehydrated/Shock/DKA: 20mL/kg > 1month, 10mL/kg <1 month
Burns: <1 hr- 100-250mL, >1hr- (2mL/kg x BSA %)/8
Cardiogenic Shock: 5-10mL/kg

351
Q

Lactated Ringer’s Classification/Mechanism

A

Isotonic Crystalloid Solution

Volume replacement, water + electrolytes

352
Q

Lactated Ringer’s Pharmacokinetics

A

Onset: Immediate. Peak: Immediate. Duration: Varies.

Half Life: N/A

353
Q

Lactated Ringer’s Indications

A

Dehydration, Shock/Hypotension/Hypovolemia, DKA, KVO, Burns

354
Q

Lactated Ringer’s Contraindications

A

Pt with CHF or Dialysis

355
Q

Lactated Ringer’s Side Effects

A

May cause pulmonary edema if hx of CHF or dialysis

356
Q

Lactated Ringer’s Precautions

A

Monitor pt for circulatory overload

357
Q

Lactated Ringer’s Drug-Drug Interaction

A

Forms precipitate in IV tubing with Ceftriaxone

358
Q

Norepinephrine/Levophed Adult Dosage

A

1-30mcg/min IV/IO infusion- titrate to BP >90mmHg

359
Q

Norepinephrine/Levophed Pediatric Dosage

A

0.1-2mcg/min IV/IO- titrated to normotensive systolic BP

360
Q

Norepinephrine/Levophed Classification/Mechanism

A

Sympathomimetic/Sympathetic Agonist/Catecholamine
Alpha 1 Agonist: 2nd messenger release of Ca in VSMC, peripheral vasoconstriction, increase SVR, increased BP
Beta 1 Agonist: increased intracellular Ca in cardiac cells, positive ino/chrono/dromotropy

361
Q

Norepinephrine/Levophed Pharmacokinetics

A

Onset: <1min. Peak: <2mins. Duration: 1-2min. Half Life: 3mins.

362
Q

Norepinephrine/Levophed Indications

A

Cardiogenic Shock, Septic Shock following fluid resuscitation, Neurogenic Shock

363
Q

Norepinephrine/Levophed Contraindications

A

Hypovolemia

364
Q

Norepinephrine/Levophed Side Effects

A

Reflex bradycardia, dysrhythmias, dizziness, headache, anxiety, tremulousness, nausea/vomiting

365
Q

Norepinephrine/Levophed Precautions

A

Cause tissue necrosis with extra action, caution in coronary disease, increases myocardial oxygen demand

366
Q

Norepinephrine/Levophed Drug-Drug Interaction

A

MAIO/TCA May potentiate cardiovascular Effects

367
Q

Dopamine HCl Adult Dosage

A

2-5mcg/kg/min IV/IO infusion (low dose)
5-10mcg/kg/min IV/IO infusion (medium/Beta effects)
10-20mcg/kg/min IV/IO infusion (high/Alpha Effects)

368
Q

Dopamine HCl Pediatric Dosage

A

2-20mcg/kg/min IV/IO infusion

369
Q

Dopamine HCl Classification/Mechanism

A

Sympathomimetic/Sympathetic Agonist/Catecholamine
Alpha 1 Agonist- 2nd messenger release of Ca into VSMC, peripheral vasoconstriction, increased SVR, increased BP
Beta 1 Agonist- increased intracellular Ca in cardiac cells, positive ino/chrono/dromotropy

370
Q

Dopamine HCl Pharmacokinetics

A

Onset: <5mins. Peak: 5-8mins. Duration:<10 mins.

Half Life: 2mins

371
Q

Dopamine HCl Indications

A

Cardiogenic Shock, Symptomatic Bradycardia, Septic Shock following fluid resuscitation

372
Q

Dopamine HCl Contraindications

A

Uncorrected Hypovolemia (May give concurrently with IV fluids)

373
Q

Dopamine HCl Side Effects

A

Tachycardia, dysrhythmias (A-Fib/PVC), chestpain, dyspnea, nervousness, headache, nausea/vomit, extravasation necrosis

374
Q

Dopamine HCl Precautions

A

Must be kept out of direct sunlight

375
Q

Dopamine HCl Drug-Drug Interactions

A

None

376
Q

Phenylephrine/Neo-Synephrine Adult Dosage

A

100-180 mcg/min IV/IO infusion until systolic >90mmHg

377
Q

Phenylephrine/Neo-Synephrine Pediatric Dosage

A

0.1-0.5mcg/kg/min IV/IO infusion

378
Q

Phenylephrine/Neo-Synephrine Classification/Mechanism

A

Sympathomimetic/ Sympathetic Agonist

Alpha 1 Agonist: 2nd messenger release of Ca in VSMC, peripheral vasoconstriction, increased SVR, increased BP

379
Q

Phenylephrine/Neo-Synephrine Pharmacokinetics

A

Onset: Immediate. Peak: <1min. Duration: 15-20mins.

Half Life: 2mins

380
Q

Phenylephrine/Neo-Synephrine Indications

A

Septic Shock following fluid resuscitation, Neurogenic Shock

381
Q

Phenylephrine/Neo-Synephrine contraindications

A

Cardiogenic Shock

382
Q

Phenylephrine/Neo-Synephrine Side Effects

A

Dysrhythmias, HTN, tremulousness, nausea/vomiting

383
Q

Phenylephrine/Neo-Synephrine Precautions

A

Can cause tissue necrosis with extravasation

384
Q

Phenylephrine/Neo-Synephrine Drug-Drug Interactions

A

Deactivated by alkaline solutions, Caution in pt with digitalis toxicity, May aggrevate tachydysrhythmias

385
Q

Midazolam/Versed Adult Dosage

A

Seizures: 5mg IV/IO/IN every 5mins, 5-10mg IM every 10mins

2.5-5mg IV/IO/IM/IN every 5-10mins

386
Q

Midazolam/Versed Pediatric Dosage

A

Seizures: 0.2mg/kg (max 5mg) slow IV/IO/IN/IM

0.2mg/kg (max 5mg) IV/IO/IN/IM

387
Q

Midazolam/Versed Classification/Mechanism

A

Benzodiazepine/Anticonvulsant/Sedative/Hypnotic/Aniolytic
Positive allosteric modulator of GABAa Receptor, binds to benzo receptor site on Cl Channel + potentiates bing/effects of GABA, increases intracellular Cl concentration, causing cellular hyperpolarization

388
Q

Midazolam/Versed Pharmacokinetics

A

Onset: 3-5mins IV, 15mins IM. Peak: 20-60mins.
Duration: <2hrs IV, 1-6hrs IM. Half Life: 1-4hrs

389
Q

Midazolam/Versed Indications

A

Active seizure,/status epileptics, Premedication for cardioversion/pacing, Anxiety, Post intubation sedation, Acute TBI, Restraint, Hyperthermia/Delerium, Poisoning, Alcohol withdrawal/Delerium Tremens

390
Q

Midazolam/Versed Contraindications

A

Narrow Angle Glaucoma, Hypotension

391
Q

Midazolam/Versed Side Effects

A

Respiratory depression, hypotension, AMS, drowsiness, amnesia, nausea/vomiting

392
Q

Midazolam/Versed Precautions

A

Caution with ETOH, CNS/Respiratory depression; Paradoxical effect if given to elderly for anxiety, half the dose

393
Q

Midazolam/Versed Drug-Drug Reactions

A

Additive effects with CNS Depressants

394
Q

Lorazepam/Ativan Adult Dosage

A

Sedation/Seizures/Withdrawal: 2-4mg IV/IO/IM

0.5-1mg slow IVP, 1-4mg IM

395
Q

Lorazepam/Ativan Pediatric Dosage

A

Sedation/Seizures/Withdrawal: 0.05-0.1mg/kg (max 4mg)

0.05mg/kg (max 2mg) slow IV/IO/IM

396
Q

Lorazepam/Ativan Classification/Mechanism

A

Benzodiazepine, Anticonvulsant, Sedative, Hypnotic, Anxiolytic
Positive allosteric modulator of GABAa Receptor, binds to benzo site on Cl Channel, potentiates binding/effects of GABA, increasing intracellular Cl concentration causing hyperpolarization of cell

397
Q

Lorazepam/Ativan Pharmacokinetics

A

Onset: 1-5mins IV, 15-30mins IM. Peak: 15-20mins IV, 2hrs IM.
Duration: 6-8hrs. Half Life: 10-20hrs

398
Q

Lorazepam/Ativan Indications

A

Active seizures/status epileptics, Premedication for cardioversion/pacing, Anxiety, Post intubation sedation, Acute TBI, Restraint, Hyperthermia/Delirium, Poisoning, Alcohol Withdrawal/Delirium Tremens

399
Q

Lorazepam/Ativan Contraindications

A

None

400
Q

Lorazepam/Ativan Side Effects

A

Respiratory Depression, hypotension, AMS, drowsiness, amnesia, nausea/vomiting

401
Q

Lorazepam/Ativan Precautions

A

Caution with ETOH, CNS/Respiratory depression, Paradox effect with the elderly for anxiety, 1/2 dose

402
Q

Lorazepam/Ativan Drug-Drug Reactions

A

Additive Effects with CNS Depressants

403
Q

Diazepam/Valium Adult Dosage

A

Seizures/Sedation/Withdrawal: 5-10mg slow IV/IO

2-5mg slow IV/IO, 5-10mg IM

404
Q

Diazepam/Valium Classification/Mechanism

A

Benzodiazepine, Anticonvulsant, Sedative, Hypnotic, Anxiolytic
Positive allosteric modulator of GABAa receptor, binds to benzo Receptor on Cl Channels and potentiates binding/affects of GABA, increasing intracellular Cl concentration causing hyperpolarization of the cell

405
Q

Diazepam/Valium Pharmacokinetics

A

Onset: 1-5mins IV. Peak: 10mins IV. Duration: 15-60mins

Half Life: 20-50hrs

406
Q

Diazepam/Valium Indications

A

Active Seizure/Status Epileptics, Premedication for cardioversion/pacing, Acute anxiety, Acute TBI, Restraint/agitation/combativeness, Hyperthermia/Excited Delirium, Poisoning, Alcohol Withdrawal/Delirium Tremens

407
Q

Diazepam/Valium Contraindications

A

None

408
Q

Diazepam/Valium Side Effects

A

Respiratory depression, Hypotension, AMS, drowsiness, hallucinations, amnesia, blurred vision, nausea/vomiting

409
Q

Diazepam/Valium Precautions

A

Caution with ETOH, CNS/Respiratory Depression, Paradoxical effect in elderly for anxiety 1/2 dose

410
Q

Diazepam/Valium Drug-Drug Interactions

A

Additive effects with CNS Depressants

411
Q

Ketamine/Kerala Adult Dosage

A

Induction/Sedation: 2mg/kg slow IVP
Excited Delirium/Restraint: 1-2mg/kg slow IVP, 4-5mg/kg IM, 2-3mg/kg IN
Analgesia: 0.1-0.3mg/kg slow IVP

412
Q

Ketamine/Ketalar Pediatric Dosage

A

Induction/Sedation: 2mg/kg slow IVP
Excited Delirium/Restraint: 1-2mg/kg slow IVP, 4-5mg IM
Analgesia: 0.5-2mg/kg

413
Q

Ketamine/Ketalar Classification/Mechanism

A

Sedative, Hypnotic, Analgesic, Anesthetic
Non-competitive NMDA receptor antagonists- inhibits glutamate binding and subsequent depolarizing of afferent neurons, prevents transmission of pain impulses + generates dissociative state

414
Q

Ketamine/Ketalar Pharmacokinetics

A

Onset: <1min IV, <5min IM. Peak: Varies.
Duration: 5-15mins IV, 20-30 mins IM. Half Life: 1-2hrs

415
Q

Ketamine/Ketalar Indication

A

Induction for RSI, Post Intubation Sedation, Excited Delirium, Chemical Restraint, Acute Psychotic Episode, Pain Management

416
Q

Ketamine/Ketalar Contraindications

A

Pt <3 months, Gluacoma

417
Q

Ketamine/Ketalar Side Effects

A

Tachycardia, dysrhythmia, HTN, increased ICP, hypersalivation, nausea/vomit, emergent reaction

418
Q

Ketamine/Ketalar Precations

A

Consider prophylactic administration of antiemetic; Purposeless tonic-colonic movement doesn’t indicate need for additional sedation; Consider premedication with atropine for hypersalivation in Pediatric pt; Doses should be low/high, medium dosage causes hallucinations + agitation

419
Q

Ketamine/Ketalar Drug-Drug Interactions

A

Prolonged recovery time given with barbiturates or opiates

420
Q

Fentanyl Citrate/Sublimaze Adult Dosage

A

1mcg/kg (max 100mcg) IV/IO/IM/IN every 5 mins, max 300mcg

Pt >65 yo: 0.5mcg/kg IV/IO/IM/IN (max 50mcg) every 5mins, up to 3 doses

421
Q

Fentanyl Citrate/Sublimaze Pediatric Dosage

A

1mcg/kg (max 100mcg) IV/IO/IM/IN

422
Q

Fentanyl Citrate/Sublimaze Classification/Mechanism

A

Opiate Analgesic
Opiate receptor agonist- hyperpolarization of interneurons and decreased release of neurotransmitters responsible for transmission of pain to thalamus and cerebral cortex

423
Q

Fentanyl Citrate/Sublimaze Pharmacokinetics

A

Onset: Immediate. Peak: 3-5mins IV. Duration: 30-60mins.

Half Life: 6-8hrs

424
Q

Fentanyl Citrate/Sublimaze Indications

A

Pain management, Chest Pain/suspected ACS, Premedication for RSI, Postintubation sedation

425
Q

Fentanyl Citrate/Sublimaze Contraindications

A

Respiratory depression/Insufficiency, Uncorrected hypotension (systolic<100mmHg)

426
Q

Fentanyl Citrate/Sublimaze Side Effects

A

Bradycardia, chest wall rigidity

427
Q

Fentanyl Citrate/Sublimaze Precautions

A

Fentanyl causes reduced chemoreceptors response to increased CO2- Respiratory depression; Caution in pt with kidney + liver dysfunction

428
Q

Fentanyl Citrate/Sublimaze Drug-Drug Interactions

A

Additive effects with CNS Depressants; Not given MAOI’s within last 14 days as causes Serotonin syndrome

429
Q

Morphine Sulfate Adult Dosage

A

0.1mg/kg (max 10mg) slow (2mg/min) IV/IO/IM every 10 mins up to 3x doses
Pt >65 yo: 0.05mg/kg (max 10mg) slow (2mg/min) IV/IO/IM every 10mins up to 3x doses

430
Q

Morphine Sulfate Pediatric Dosage

A

0.1mg/kg (max 10mg) slow IV/IO/IM

431
Q

Morphine Sulfate Classification/Mechanism

A

Opiate Analgesic
Opiate receptor antagonist- hyperpolarization of interneurons and decreased release of neurotransmitters responsible for transmission of pain impulses to thalamus and cerebral cortex

432
Q

Morphine Sulfate Pharmacokinetics

A

Onset: Immediate IV, 15-30mins IM. Peak: 20mins IV, 30-60min IM. Duration: 2-7hrs. Half Life: 1-7hrs

433
Q

Morphine Sulfate Indications

A

Pain Management, Chest Pain/suspected ACS

434
Q

Morphine Sulfate Contraindications

A

Respiratory depression/insufficiency, Uncorreted hypotension (systolic<100mmHg)

435
Q

Morphine Sulfate Side Effects

A

AMS, headache, blurred vision, constricted pupils, ABD cramping, nausea/vomit

436
Q

Morphine Sulfate Precautions

A

Morphine causes reduced chemoreceptor responsiveness to increases in CO2; Caution in pt with hypersensitivity to morphine analogs

437
Q

Morphine Sulfate Drug-Drug Interactions

A

Additive effects (CNS Depression) given with antihistamines, antiemetic, sedatives, hypnotics

438
Q

Hydromorphone/Dilaudid Adult Dosage

A

0.5-1mg slow IVP every 5mins, max total dose 4mg

439
Q

Hydromorphone/Dilaudid Pediatric Dosage

A

0.015mg/kg slow IVP

440
Q

Hydromorphone/Dilaudid Classification/Mechanism

A

Opiate Analgesic
Opiate receptor agonist- hyperpolarization of interneurons + decreased release of neurotransmitters responsible for the transmission of pain to thalamus + cerebral cortex

441
Q

Hydromorphone/Dilaudid Pharmacokinetics

A

Onset: 15-30mins. Peak: 30-90mins. Duration: 4-5hrs.
Half: 2.6hrs

442
Q

Hydromorphone/Dilaudid Indications

A

Pain management

443
Q

Hydromorphone/Dilaudid Contraindications

A

Respiratory Depression/Insufficiency, Uncorrected hypotension (systolic BP<100mmHg)

444
Q

Hydromorphone/Dilaudid Side Effects

A

AMS, drowsiness, headache, constricted pupils, ABD cramping, nausea/vomiting

445
Q

Hydromorphone/Dilaudid Precautions

A

Hydromorphone causes reduced chemoreceptor responsiveness to increased CO2- Respiratory depression

446
Q

Hydromorphone Drug-Drug Interaction

A

Additive effects with CNS Depressants with antihistamines, antiemetics, sedatives, hypnotics, barbiturates and ETOH

447
Q

Ketorolac/Toradol Adult Dosage

A

15-30mg IVP/IM

448
Q

Ketorolac/Toradol Pediatric Dosage

A

None

449
Q

Ketorolac/Toradol Classification/Mechanism

A

NSAID
Nonselective competitive antagonist of COX- prostaglandin synthesis inhibition-Analgesic, anti-inflammatory, antipyretic properties
Acts peripherally, not centrally, and therefor does not possess the sedative effects of narcotics

450
Q

Ketorolac/Toradol Pharmacokinetics

A

Onset: 30mins. Peak: 45-60mins. Duration: Varies.

Half Life: 4-6hrs

451
Q

Ketorolac/Toradol Indications

A

Pain Management

452
Q

Ketorolac/Toradol Contraindications

A

Pregnancy, peptic ulcer, renal insufficiency, suspected fractures, undifferentiated ABD pain

453
Q

Ketorolac/Toradol Side Effects

A

HTN, dizziness, drowsiness, edema, nausea, heart burn, diarrhea, constipation, rash, itching

454
Q

Ketorolac/Toradol Precautions

A

May cause GI irritation+hemorrhage

455
Q

Ketorolac/Toradol Drug-Drug Interactions

A

Worsened side effects when given with other NSAIDS

456
Q

Ibuprofen/Advil Adult Dosage

A

400mg PO

457
Q

Ibuprofen/Advil Pediatric Dosage

A

10mg/kg (max 400mg) PO

458
Q

Ibuprofen/Advil Classification/Mechanism

A

NSAID
Nonselective Competitive of COX- prostaglandin synthesis inhibition- analgesic, anti-inflammatory and antipyretic properties. Acts peripherally, no centrally, therefore does not possess the sedative effects of narcotics

459
Q

Ibuprofen/Advil Pharmacokinetics

A

Onset: 30-60mins. Peak: 1-2hrs. Duration: 6-8hrs.

Half Life: 2-4hrs

460
Q

Ibuprofen/Advil Indications

A

Pain Medications

461
Q

Ibuprofen/Advil Contraindications

A

Pregnancy, Peptic ulcer, Renal insufficiency, Suspected fractures, Undifferentiated ABD pain

462
Q

Ibuprofen/Advil Side Effects

A

HTN, dizziness, drowsiness, edema, nausea, heartburn, diarrhea, rash, constipation, itching

463
Q

Ibuprofen/Advil Precautions

A

May cause GI irritation+hemorrhage

464
Q

Ibuprofen/Advil Drug-Drug Interactions

A

Worsened side effects when given with other NSAIDs

465
Q

Acetaminophen/Tylenol Adult Dosage

A

Pain: 1g IV/IO infusion over 15mins or 1g PO
Fever: None

466
Q

Acetaminophen/Tylenol Pediatric Dose

A

Pain: 15mg/kg (max dose 1g) PO every 4-6hrs PRN
Fever: 15mg/kg (max dose 1g) PO every 4-6hrs PRN

467
Q

Acetaminophen/Tylenol Classification/Mechanism

A

Antipyretic/Analgesic

COX Inhibitor- prostaglandin synthesis inhibition- analgesic, anti-inflammatory and anti-pyretic properties

468
Q

Acetaminophen/Tylenol Pharmacokinetics

A

Onset: 15mins IV, 15-30mins PO. Peak: 1hr IV, 30-120mins PO
Duration: 4-6hrs IV, 3-4hrs PO. Half Life: 1-3hrs

469
Q

Acetaminophen/Tylenol Indications

A

Pain management, Pediatric Fever

470
Q

Acetaminophen/Tylenol Contraindications

A

Liver Failure

471
Q

Acetaminophen/Tylenol Side Effects

A

None

472
Q

Acetaminophen/Tylenol Precautions

A

Metabolized by liver- overdose can be toxic; Does not have anti-platelet aggregation effect; Doesn’t have peripheral anti-inflammatory effect; Be aware of multiple over the counter Tylenol containing products

473
Q

Acetaminophen/Tylenol Drug-Drug Interactions

A

Chronic excessive use of alcohol increases risk of hepatotoxicity

474
Q

Proparacaine/Alcaine Adult Dosage

A

1-2 drops 0.5% solution every 5-10mins, max dose 6 drops/eye

475
Q

Proparacaine/Alcaine Pediatric Dosage

A

1-2 drops 0.5% solution every 5-10mins, max dose 6 dose/eye

476
Q

Proparacaine/Alcaine Classification/Mechanism

A

Topical Anesthetic
Na Channel Blocker stabilizes the neuronal membrane by inhibiting the ionic fluxes required for initiation+conduction of pain impulses, causing local anesthetic action

477
Q

Proparacaine/Alcaine Pharmacokinetics

A

Onset: 20secs. Peak: 20secs. Duration: 15mins. Half: N/A.

478
Q

Proparacaine/Alcaine Indications

A

Pain control for chemical burns to eyes, facilitate insertion of Morgan Lens

479
Q

Proparacaine/Alcaine Contraindications

A

Penetrating trauma to globe of eye, Allergy to tetracaine/novacaine

480
Q

Proparacaine/Alcaine Side Effects

A

Stinging, ocular irritation, redness, delayed ocular wound healing

481
Q

Proparacaine/Alcaine Precautions

A

Avoid prolonged use

482
Q

Proparacaine/Alcaine Drug-Drug Interactions

A

None

483
Q

Calcium Chloride Precautions

A

Can cause tissue necrosis at injection site, ensure patent IV; Moderate/Severe HyperKalemia characterized by wide QRS on ECG

484
Q

Calcium Chloride Drug-Drug Precautions

A

Forms precipitate with NaHCO3, flush tubing between administrations; Digitalis toxicity when administered to pt taking digitalis/digoxin as it inhibits Ca Channels causing stone heart

485
Q

Tetracaine Adult Dosage

A

1-2 drops 0.5% solution every 5-10mins, max dose 6 drops per eye

486
Q

Tetracaine Pediatric Dosage

A

1-2 drops 0.5% solution every 5-10mins, max dose 6 drops per eye

487
Q

Tetracaine Classification/Mechanism

A

Topical Anesthetic
Na Channel Blocker- stabilizes neuronal membrane by inhibiting the ionic fluxes required for the initiation and conduction of pain impulses, thus causing local anesthetic action

488
Q

Tetracaine Pharmacokinetics

A

Onset: 30sec, Peak: 30secs, Duration: 10-15mins

Half Life: N/A

489
Q

Tetracaine Indications

A

Pain control for chemical burns to eye, Facilitate Morgan Lens insertion

490
Q

Tetracaine Contraindications

A

Penetrating trauma to globe of eye, Allergy to proparacaine/novacaine

491
Q

Tetracaine Side Effects

A

Stinging, ocular irritation, redness, delayed ocular wound healing

492
Q

Tetracaine Precautions

A

Avoid prolonged use

493
Q

Tetracaine Drug-Drug Interactions

A

None

494
Q

Etomidate Adult Dosage

A

0.3mg/kg (max 40mg) IV/IO over 15-30secs

495
Q

Etomidate Pediatric Dosage

A

0.3mg/kg (max 40mg) IV/IO over 15-30secs

496
Q

Etomidate Classification/Mechanism

A

Sedative/Hypnotic

Depresses RAS of the brain and potentiates GABA, causes sedation

497
Q

Etomidate Pharmacokinetics

A

Onset: 10-20secs, Peak: <1min, Duration: 3-5mins

Half Life: 30-70secs

498
Q

Etomidate Indication

A

Induction agent for RSI

499
Q

Etomidate Contraindications

A

None

500
Q

Etomidate Side Effects

A

Bradycardia, tachycardia, hypotension, HTN, apnea, hypoventilation, hyperventilation, myoclonic skeletal musle movement, trismus, laryngospasm, nausea/vomiting

501
Q

Etomidate Precautions

A

None

502
Q

Etomidate Drug-Drug Interactions

A

May prolong respiratory depression and apnea with Verapamil

503
Q

Vecuronium/Norcuron Adult Dosage

A

0.1mg/kg IV/IO

504
Q

Vecuronium/Norcuron Pediatric Dosage

A

0.1mg/kg IV/IO

505
Q

Vecuronium/Norcuron Classification/Mechanism

A

Non-depolarizing Neuromuscular Blocker
Nicotinic ACh Receptor Antagonist- competes with ACh at neuromuscular junction and prevents binding thus inhibiting skeletal muscle depolarization.

506
Q

Vecuronium/Norcuron Pharmacokinetics

A

Onset: <1min, Peak: 3-5mins, Duration: 30-80mins

Half Life: 30-80mins

507
Q

Vecuronium/Norcuron Indications

A

Need for temporary paralysis to facilitate intubation; Need for continued paralysis following intubation

508
Q

Vecuronium/Norcuron Contraindications

A

None

509
Q

Vecuronium/Norcuron Side Effects

A

Bradycardia, Hypotension

510
Q

Vecuronium/Norcuron Precautions

A

Presence of neuromuscular diseases may be associated with prolonged paralysis

511
Q

Vecuronium/Norcuron Drug-Drug Interactions

A

Potentiated by lidocaine, procainamide, Beta Blockers, Magnesium Sulfate and other neuromuscular blockers

512
Q

Rocuronium/Zemuron Adult Dosage

A

1mg/kg IV/IO

513
Q

Rocuronium/Zemuron Pediatric Dosage

A

0.6mg/kg IV/IO

514
Q

Rocuronium/Zemuron Classification/Mechanism

A

Non-depolarizing Neuromuscular Blocker
Nicotinic ACh-Receptor antagonist- competes with ACh at neuromuscular junction and prevents binding thus inhibiting skeletal muscle depolarization

515
Q

Rocuronium/Zemuron Pharmacokinetics

A

Onset: 60-70secs, Peak: 1-3mins, Durations: 25-40mins

Half Life: 14-18mins

516
Q

Rocuronium/Zemuron Indications

A

Need for temporary paralysis to facilitate intubation; Need for continued paralysis following intubation

517
Q

Rocuronium/Zemuron Contraindications

A

None

518
Q

Rocuronium/Zemuron Side Effects

A

Tachycardia, HTN, hypotension, bronchospasms (rare)

519
Q

Rocuronium/Zemuron Precautions

A

Presence of neuromuscular diseases may be associated with prolonged paralysis

520
Q

Rocuronium/Zemuron Drug-Drug Interactions

A

Potentiated by lidocaine, procainamide, Beta Blockers, Potassium-sparing diuretics, Magnesium Sulfate and other neuromuscular blockers including succinylcholine

521
Q

Succinylcholine/Anectine Adult Dosage

A

1.5mg/kg IV/IO

522
Q

Succinylcholine/Anectine Pediatric Dosage

A

1mg/kg IV/IO

523
Q

Succinylcholine/Anectine Classification/Mechanism

A

Depolarizing Neuromuscular Blocker
Nicotinic ACh-Receptor agonist- competes with ACh at neuromuscular junction; when bound, causes initial wave of widespread neuromuscular depolarization and prevents ACh binding and secondary muscle stimulation

524
Q

Succinylcholine/Anectine Pharmacokinetics

A

Onset: 45-60secs IV, 2-3mins IM, Peak: 1-3mins,
Duration: 6-10mins IV, 10-30mins IM, Half Life: 5-10mins

525
Q

Succinylcholine/Anectine Indications

A

Need for temporary paralysis to facilitate intubation

526
Q

Succinylcholine/Anectine Contraindications

A

Penetrating eye injury, narrow angle glaucoma, known/suspected HyperKalemia, hx of malignant hyperthermia, hx myasthenia gravis, burns >24hrs old

527
Q

Succinylcholine/Anectine Side Effects

A

Bradycardia, dysrhythmias, hypotension, increases ICP, increased intraocular pressure

528
Q

Succinylcholine/Anectine Precautions

A

May cause dysrhythmias and cardiac arrest, particularly in pt with HyperKalemia

529
Q

Succinylcholine/Anectine Drug-Drug Interactions

A

Potentiated by lidocaine, procainamide, Beta Blockers, Magnesium Sulfate, and other neuromuscular blockers.

Medic School (2 decks)

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