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%
2
Q
Oxygen Pediatric dose
A
1-6LPM NC, 10-15LPM NRB/BVM
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
4
Q
Oxygen Pharmacokinetics
A
Onset: Immediate, Peak Effects: <1 min, Duration: <2mins,
Half Life: N/A
5
Q
Oxygen Indications
A
Hypoxia, Difficulty Breathing, SpO2 < 94%
6
Q
Oxygen Contraindications
A
ROSC post cardiac arrest with SpO2 >94%, Chest pain/Acute MI, suspected cellular injury/death with SpO2 >94%
7
Q
Oxygen Side Effects
A
Free radical formation in presence of injured tissues, 2nd cell death
8
Q
Oxygen Precautions
A
Avoid hyperoxia; high concentration to neonates can cause eye damage
9
Q
Oxygen Drug-Drug Interactions
A
None
10
Q
Albuterol Sulfate Adult Dosing
A
- 5mg nebulized at 8LPM O2 every 5 minutes for Asthma/COPD/RAD/Anaphylaxis
- 5mg nebulized at 8LPM O2 continuously up to max dose of 20mg for HyperKalemia
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
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
13
Q
Albuterol Sulfate Pharmacokenetics
A
Onset: 5-15 mins, Peak Effects: 1-1.5 hrs, Duration: 3-6 hrs, Half Life: <3 hrs
14
Q
Albuterol Sulfate Indications
A
Asthma/COPD/RAD, Allergic Reaction/Anaphylaxis, Moderate/Severe HyperKalemia
15
Q
Albuterol Sulfate Contraindications
A
Symptomatic Tachycardia
16
Q
Albuterol Sulfate Side Effects
A
Tachycardia, palpitations, chest pain, HTN, sweating, dizziness, headache, nervousness, anxiety, tremor, nausea/vomiting
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
18
Q
Albuterol Sulfate Drug-Drug Interactions
A
Side effect may increase with other sympathetic agonist
Beta Blockers may blunt effects of this drug
19
Q
Levalbuterol/Xopenex Adult Dosage
A
1.25mg nebulized with 8LPM O2 every 5 minutes for Asthma/COPD/RAD/Anaphylaxis
20
Q
Levalbuterol/Xopenex Pediatric Dosage
A
0.31mg nebulized with 8LPM O2 every 5 minutes for Asthma/COPD/RAD/Anaphylaxis
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
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
23
Q
Levalbuterol/Xopenex Indications
A
Asthma/COPD/RAD, Allergic Reaction/Anaphylaxis
24
Q
Levalbuterol/Xopenex Contraindications
A
Symptomatic Tachycardia
25
Levalbuterol/Xopenex Side Effects
Palpitations, HTN, dizziness, headache, anxiety, nausea
26
Levalbuterol/Xopenex Precautions
First 3 doses with Albuterol concurrently, Caution with cardiac ischemia
27
Levalbuterol/Xopenex Drug-Drug Interactions
Side effects increase with other sympathetic agonists,
| Beta Blockers may blunt effects
28
Ipratropium Bromide Adult Dosage
500mcg nebulized with 8LPM O2 every 5 minutes up to max total of 3 doses
29
Ipratropium Bromide Pediatric Dosage
500mcg nebulized with 8LPM O2 every 5 minutes up to max total of 3 doses
30
Ipratropium Bromide Classification/Mechanism
Anticholinergic/Parasympathomimetic
Muscarinic ACh Receptor Antagonist, inhibits parasympathetic stimulation of bronchial SMC, submucosal glans/goblet cells drying respiratory tract secretions and allows bronchodilation
31
Ipratropium Bromide Pharmacokinetics
Onset: Varies, Peak Effects: 1.5-2 hrs, Duration: 4-6 hrs,
Half Life: 1.5-2hrs
32
Ipratropium Bromide Indications
Asthma/COPD/RAD
33
Ipratropium Bromide Contraindications
None
34
Ipratropium Bromide Side Effects
Palpitations, dizziness, headache, anxiety, nervousness, rash, dry mouth, nausea/vomiting
35
Ipratropium Bromide Precautions
Administer concurrently with Albuterol x3 doses
36
Ipratropium Bromide Drug-Drug Interactions
None
37
Racemic Epinephrine Adult Dosage
None
38
Racemic Epinephrine Pediatric Dosage
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
39
Racemic Epinephrine Classification/Mechanism
Sympathomimetic
Alpha/Beta agonist (Slightly Beta 2 Selective), bronchodilation, decreased mucous membrane secretions, relieves subglottic edema
40
Racemic Epinephrine Pharmacokinetics
Onset: <5mins inhaled, Peak Effects: 5-15mins,
Duration: 1-3 hrs, Half Lift: N/A
41
Racemic Epinephrine Indications
Croup (Laryngotracheobronchitis) with stridor at rest
42
Racemic Epinephrine Contraindications
Doesn't have stridor at rest
43
Racemic Epinephrine Side Effects
Tachycardia, HTN, dizziness, headache, anxiety, restlessness, nausea/vomiting
44
Racemic Epinephrine Precautions
Rebound effects following clearance of medication
45
Racemic Epinephrine Drug-Drug Interations
Additive effects with other sympathomimetics
46
Methylprednisolone/Solu-Medrol Adult Dosage
125mg slow IVP
47
Methylprednisolone/Solu-Medrol Pediatric Dosage
2mg/kg (max 125mg) slow IVP
48
Methylprednisolone/Solu-Medrol Classification/Mechanism
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
49
Methylprednisolone/Solu-Medrol Pharmacokinetics
Onset: 2-6 hrs, Peak Effects: 4-8 days, Duration: 1-5 Weeks Half Life: 3.5 hrs
50
Methylprednisolone/Solu-Medrol Indications
Allergic Reactions/Anaphylaxis, Asthma/COPD/RAD, Adrenal insufficiency
51
Methylprednisolone/Solu-Medrol Contraindications
None
52
Methylprednisolone/Solu-Medrol Side Effects
HTN, CHF, fluid retention, headache, vertigo, malaise, nausea, ABD distention, hiccups, psychosis
53
Methylprednisolone/Solu-Medrol Precautions
Give only one dose prehospitally, Prolong use can cause GI bleeding, prolong wound healing, suppressed adrenocortical steroids
54
Methylprednisolone/Solu-Medrol Drug-Drug Interactions
Decreased effects with phenytoin, phenobarbital, rifampin
55
Hydrocortisone/Solu-Cortef Adult Dosage
100mg slow IVP/IM
56
Hydrocortisone/Solu-Cortef Pediatric Dosage
2mg/kg (max 100mg) slow IVP/IM
57
Hydrocortisone/Solu-Cortef Classification/Mechanism
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
58
Hydrocortisone/Solu-Cortef Pharmacokinetics
Onset: Immediate, Peak Effects: 4-8 hrs, Duration: 1-1.5 days Half Life: 90 mins
59
Hydrocortisone/Solu-Cortef Indications
Allergic Reaction/Anaphylaxis, Asthma/COPD/RAD, Adrenal Insufficiency
60
Hydrocortisone/Solu-Cortef Contraindications
None
61
Hydrocortisone/Solu-Cortef Side Effects
Fluid Retention, CHF, ABD distention, nausea, hiccups, HTN, headache, vertigo, malaise
62
Hydrocortisone/Solu-Cortef Precautions
Give only one dose prehospitally, Long term steroid use can cause GI bleeding, prolonged wound healing and suppressed adrenocortical steroids
63
Hydrocortisone/Solu-Cortef Drug-Drug Interactions
None
64
Dexamethasone/Decadron Adult Dose
10mg slow IVP for Asthma/COPD/RAD, Anaphylaxis, Adrenal Insufficiency
65
Dexamethasone/Decadron Pediatric Dose
0. 6mg/kg (max 10mg) slow IVP for Asthma/COPD/RAD, Anaphylaxis, Adrenal Insufficiency
0. 6mg (max 10mg) PO/IV/IO/IM for croup (PO preferred)
66
Dexamethasone/Decadron Classification/Mechanism
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
67
Dexamethasone/Decadron Pharmacokinetics
Onset: < 1hr, Peak Effects: <1 hr, Duration: Varies, Half Life: 3-4 hrs
68
Dexamethasone/Decadron Indications
Allergic Reaction/Anaphylaxis, Asthma/COPD/RAD, Croup, Adrenal Insufficiency
69
Dexamethasone/Decadron Contraindications
None
70
Dexamethasone/Decadron Side Effects
Fluid retention, CHF, ABD distention, Nausea, hiccups, HTN, headache, vertigo, malaise psychosis
71
Dexamethasone/Decadron Precautions
Give only one dose prehospitally, long term use of steroids can cause GI bleeding, prolonged wound healing, suppression of adrenocortical steroids
72
Dexamethasone/Decadron Drug-Drug Interactions
None
73
Famotidine/Pepcid Adult Dosage
20mg slow IVP
74
Famotidine/Pepcid Pediatric Dosage
0.4mg/kg (max 20mg) slow IVP
75
Famotidine/Pepcid Classification/Mechanism
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
76
Famotidine/Pepcid Pharmacokinetics
Onset: 30mins, Peak Effects: 0.5-3 hrs, Duration: 1012 hrs Half Life: 2-4hrs
77
Famotidine/Pepcid Indications
Allergic Reaction/Anaphylaxis
78
Famotidine/Pepcid Contraindications
None
79
Famotidine/Pepcid Side Effects
Dizziness, headache, diarrhea, constipation
80
Famotidine/Pepcid Precautions
Caution in pt with liver disease, stomach cancer and renal disease
81
Famotidine/Pepcid Drug-Drug Interactions
None
82
Diphenhydramine/Benadryl Adult Dosage
25-50mg IV/IO/IM/PO
83
Diphenhydramine/Benadryl Pediatric Dosage
1mg/kg (max 50mg) IV/IO/IM/PO
84
Diphenhydramine/Benadryl Classification/Mechanism
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
85
Diphenhydramine/Benadryl Pharmacokenitics
Onset: 10-15mins IV, 15-30mins PO, 20-30mins IM
| Peak Effects: 1-4hrs, Duration: 6-8hrs, Half Life: 1-4hrs
86
Diphenhydramine/Benadryl Indications
Allergic Reaction/Anaphylaxis, Dystonic Reaction/Akalthisia
87
Diphenhydramine/Benadryl Contrainidcation
None
88
Diphenhydramine/Benadryl Side Effects
Palpitations, hypotension, sedation, drowsiness, dizziness, headache, euphoria, fatigue, blurred vision
89
Diphenhydramine/Benadryl Precautions
Caution in pts with severe liver disease and acute asthma
90
Diphenhydramine/Benadryl Drug-Drug Interactions
Potentiates sedative effects with benzodiazepines, alcohol, MAOI's and CNS depressants
91
Epinephrine Adult Dosage
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
92
Epinephrine Pediatric Dosage
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
93
Epinephrine Classification/Mechanism
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
94
Epinephrine Pharmacokinetics
Onset: <2mins IV, 3-10min IM, Peak: <5min IV, 20mins IM
Duration: 5-10mins IV, 20-30mins IM, Half Life: 5mins IV
95
Epinephrine Indications
Cardiac Arrest, Anaphylaxis/Allergic Reaction/Refractory Anaphylaxis, Severe RAD/Asthma, Symptomatic Bradycardia/Hypotension
96
Epinephrine Contraindications
Tachydysrhythmias
97
Epinephrine Side Effects
Dysrhythmias, dizziness, anxiety, tremulousness, headache, nausea/vomiting
98
Epinephrine Precautions
Leads to increased myocardial oxygen demand; after 3 doses of 1:1,000 for anaphylaxis, consider refractory anaphylaxis, administer infusion
99
Epinephrine Drug-drug Interactions
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
100
Magnesium Sulfate Adult Dosage
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
101
Magnesium Sulfate Pediatric Dosage
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
102
Magnesium Sulfate Classification/Mechanism
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
103
Magnesium Sulfate Pharmacokinetics
Onset: Immediate, Peak Effects: Varies, Duration: 1hr,
| Half Life: N/A
104
Magnesium Sulfate Indications
Severe Asthma/Bronchospasm, Severe Refractory VF or pulseless V-Tach with HypoMagnesium, Torsades, Eclampsia
105
Magnesium Sulfate Contraindications
3 Degree Heart Block, Hypotension
106
Magnesium Sulfate Side Effects
Bradycardia, dysrhythmias, hypotension, respiratory depression, drowsiness, sweating, flushing, itching, rash
107
Magnesium Sulfate Precautions
Caution with impaired renal function; Watch for respiratory depression
108
Magnesium Sulfate Drug-drug Interactions
Cardiac conduction abnormalities with digitalis
109
Adenosine Adult Dosage
1st dose: 6mg rapid IVP, followed by 20mL NS flush in proximal vein
2nd Dose: 12mg rapid IVP, followed by rapid 20mL NS flush
110
Adenosine Pediatric Dosage
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
111
Adenosine Classification/Mechanism
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
112
Adenosine Pharmacokinetics
Onset: Immediate, Peak Effects: Immediate, Duration:30-45secs, Half Life: 6sec
113
Adenosine Indications
Stable Narrow Complex Tach (SVT), Stable Wide Complex Tachycardia (regular, monomorphic)
114
Adenosine Contraindications
WPW
115
Adenosine Side Effects
Facial Flushing, headache, chest pain, dizziness, sense of pending doom
116
Adenosine Precautions
Being printing rhythm before administration
117
Adenosine Drug-Drug Interactions
Methylxanthines (caffeine) non-specific competitive antagonist for adenosine receptors- double dose if pt taking large amounts
118
Atropine Adult Dosage
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
119
Atropine Pediatric Dose
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
120
Atropine Classification/Mechanism
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
121
Atropine Pharmacokinetics
Onset: Immediate, Peak Effects: 2-4mins,
| Durations: 4hrs, Half Life: 2-3hrs
122
Atropine Indications
Symptomatic Bradycardia, Premed for RSI with bradycardia <50bpm, Organophosphate poisoning
123
Atropine Contraindications
None
124
Atropine Side Effects
Tachycardia, dilated pupils, blurred vision, drowsiness, confusion, dry mouth
125
Atropine Precautions
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
126
Atropine Drug-Drug Interaction
None
127
Diltiazem/Cardizem Adult Dosage
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
128
Diltiazem/Cardizem Pediatric Dosage
None
129
Diltiazem/Cardizem Classification/Mechanism
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
130
Diltiazem/Cardizem Pharmacokinetics
Onset: 3mins, Peak Effects: 7mins, Duration: 1-3hrs,
| Half Life: 2hrs
131
Diltiazem/Cardizem Indications
Stable Narrow Complex Tachycardia (A-Fib/A-Flutter), Stable SVT Refractory to Adenosine
132
Diltiazem/Cardizem Contraindications
Hypotension, Decompensated cardiogenic shock, V-Tach, WPW
133
Diltiazem/Cardizem Side Effects
Bradycardia, hypotension, heart block, dizziness, headache, nausea/vomiting
134
Diltiazem/Cardizem Precautions
Discard one month after refridgeration
135
Diltiazem/Cardizem Drug-Drug Interactions
Increased risk of bradycardia if pt receiving IV Beta Blockers
136
Metoprolol Adult Dosage
5mg slow IVP, max 15mg
137
Metoprolol Pediatric Dosage
None
138
Metoprolol Classification/Mechanism
Beta Blocker
Beta 1 antagonist- inhibits extracellular Ca entry and Ca release from the sarcoplasmic reticulum in cardiac cells, negative ino/chrono/dromotropy
139
Metoprolol Indications
Stable Narrow Complex Tachycardia (A-Fib/A-Flutter), Stable SVT Refractory to Adenosine
140
Metoprolol Contraindications
Hypotension, Decompensated Cardiogenic shock, Cocaine use
141
Metoprolol Side Effects
Bradycardia, hypotension, lethargy, dyspnea, wheezing, dizziness
142
Metoprolol Precautions
May exacerbate Asthma/COPD/bronchospasms/CHF
143
Metoprolol Drug-Drug Interaction
Profound bradycardia if pt getting IV Ca Channel Blocker; additive effects with digioxin
144
Nitroglycerin Adult Dosage
1-2" topical paste; 0.4mg SL tablet/spray every 3-5mins until effect achieved or BP drops (3x doses in 25mins)
145
Nitroglycerin Pediatric Dosage
None
146
Nitroglycerine Classification/Mechanism
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
147
Nitroglycerine Pharmacokinetics
Onset: 1-3mins SL, 30 mins topical Peak Effects: 15-30mins SL, Varies topical. Duration: 20-30mins SL, 3-6hrs topical. Half: 1-4mins
148
Nitroglycerine Indications
Chest pain associated with angina/MI, Acute Pulmonary Edema/CHF
149
Nitroglycerine Contraindications
Shock/hypotension, Increases ICP, <12 yo, ED medications in last 48hrs, Inferior Wall MI
150
Nitroglycerine Side Effects
Hypotension, tachycardia, weakness, dizziness, headache, nausea/vomiting, rash, dry mouth
151
Nitroglycerine Precautions
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
152
Nitroglycerine Drug-Drug Interactions
Orthostatic hypotension with Beta Blockers, severe hypotension with alcohol
153
Aspirin Adult Dose
324mg PO (81mg Baby ASA)
154
Aspirin Pediatric Dose
None
155
Aspirin Classification/Mechanism
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
156
Aspirin Pharmacokinetics
Onset: 5-30mins. Peak: 15-120mins. Duration: 1-4hrs. Half Life: 15-20mins
157
Aspirin Indications
Chest pain suggestive of AMI/ACS
158
Aspirin Contraindications
Active GI Bleeding
159
Aspirin Side Effects
GI Bleeding, prolongs bleeding, heartburn, nausea/vomiting, wheezing
160
Aspirin Precautions
Pt takes ASA daily, may supplement dose if taken within 24 hours, GI upset
161
Aspirin Drug-Drug Interactions
Enhanced side effects with other anti-inflammatory agents; Decreased absorption with concurrent antacids
162
Calcium Gluconate Adult Dosage
2g slow IVP over 5mins
163
Calcium Gluconate Pediatric Dosage
60mg/kg (max 2g) slow IVP over 5mins
164
Calcium Gluconate Classification/Mechanism
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
165
Calcium Gluconate Pharmacokinetics
Onset: Immediate. Peak: Unknown Duration: Varies Half Life: N/A
166
Calcium Gluconate Indications
Moderate/Severe HyperKalemia, Ca Channel Blocker toxicity, ABD spasms, Cardiac Arrest
167
Calcium Gluconate Contraindications
Hypercalcemia, Pt taking digoxin
168
Calcium Gluconate Side Effects
Bradycardia, dysrhythmias, syncope, nausea/vomiting, cardiac arrest
169
Calcium Gluconate Precautions
Can cause necrosis at injection site, patent IV; Moderate/severe HyperKalemia characterized by wide QRS
170
Calcium Gluconate Drug-Drug Interaction
Forms precipitate with NaHCO3, flush the line between administration; Digitalis toxicity when administered with pt taking digitalis/dixogin inhibiting Ca Channels causing stone heart
171
Calcium Chloride Adult Dosage
1g slow IVP over 5mins
172
Calcium Chloride Pediatric Dosage
20mg/kg (max 1g) slow IVP over 5mins
173
Calcium Chloride Classification/Mechanism
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
174
Calcium Chloride Pharmacokinetics
Onset: Immediate. Peak: Unknown. Duration: Varies. Half Life: N/A
175
Calcium Chloride Indications
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)
176
Calcium Chloride Contraindications
Hypercalcemia, Pt taking digoxin
177
Calcium Chloride Side Effects
Bradycardia, dysrhythmias, syncopy, nausea/vomiting, cardiac arrest
178
Sodium Bicarbonate Adult Dosage
2mEq/kg initial IVP
179
Sodium Bicarbonate Pediatric Dosage
2mEq/kg initial IVP
180
Sodium Bicarbonate Classification/Mechanism
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
181
Sodium Bicarbonate Pharmacokinetics
Onset: Immediate, Peak: <15mins, Duration: 1-2hrs, Half Life: N/A
182
Sodium Bicarbonate Indications
Na Channel Blocker OD (TCA, Cocaine, Benadryl) ASA OD, cardiac arrest with known/suspected HyperKalemia, Crush Syndrome, prior to intubation of suspected DKA
183
Sodium Bicarbonate Concentration
Respiratory Acidosis
184
Sodium Bicarbonate Side Effects
None
185
Sodium Bicarbonate Precautions
Metabolic alkalosis in large dosage
186
Sodium Bicarbonate Drug-Drug Interactions
Deactivates catecholamine and vasopressors; Preforms precipitate in CaCl2 in IV tubing
187
Amiodarone HCl/Cordarone Adult Dosage
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
188
Amiodarone HCl/Cordarone Pediatric Dosage
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
189
Amiodarone HCl/Cordarone Classification/Mechanism
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
190
Amiodarone HCl/Cordarone Pharmacokinetics
Onset: Immediate, Peak Effects: 30-45mins, Duration: Varies, Half Life: 40-50 days
191
Amiodarone HCl/Cordarone Indication
Cardiac Arrest (V-fib, Pulseless V-Tach) and Stable WCT
192
Amiodarone HCl/Cordarone Contraindications
None
193
Amiodarone HCl/Cordarone Side Effects
Hypotension, Bradycardia, dyspnea, cough, dizziness, prolonged PR QRS and QT interval
194
Amiodarone HCl/Cordarone Precautions
Caution with pt with heart failure
195
Amiodarone HCl/Cordarone Drug-Drug Interactions
Reduces renal/non-renal clearance of digoxin. Enhances anticoagulantion
196
Lidocaine/Xylocaine Adult Dosage
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)
197
Lidocaine/Xylocaine Pediatric Dosage
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)
198
Lidocaine/Xylocaine Classification/Mechanism
Antidsyrhythmic
Class 1B Antiarrhythmic/Na Channel Blocker- Decreases slope/amplitude of Phase 0 depolarization of non-pacemaker action potential
199
Lidocaine/Xylocaine Pharmacokinetics
Onset: <3mins, Peak: 5-7mins, Duration: 10-20mins, Half Life: 1.5-2hrs
200
Lidocaine/Xylocaine Indicatiosn
Cardiac Arrest (V-Fib and pulseless V-Tach), Stable V-Tach, Anesthetic for IO
201
Lidocaine/Xylocaine Contraindication
None
202
Lidocaine/Xylocaine Side Effects
Bradycardia, heart block, hypotension, seizures, drowsiness, confusion, nausea/vomiting, sweating, flushing, itching, rash
203
Lidocaine/Xylocaine Precautions
Pt 70+ years or known hepatic failure- reduce maintenance dose by half
204
Lidocaine/Xylocaine Drug-Drug Interactions
Potentiates procainamide, phenytoin, quinidine and Beta Blockers
205
Procainamide Adult Dosage
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
206
Procainamide Pediatric Dosage
Cardiac Arrest: 15mg/kg IV/IO infusion over 30-60mins
WCT: 15mg/kg IV/IO infusion over 30-60mins
WCT Maintenance: Not recommended
207
Procainamide Classification/Mechanism
Antiarrhythmic
Class 1A Antiarrhythmic/Moderate Na Channel Blocker- decreases the slope and amplitude of Phase 0 depolarization of non-pacemaker action potential
208
Procainamide Pharmacokinetics
Onset: 10-30mins, Peak: 15-20mins, Duration: 3-6hrs, Half Life: 3hrs
209
Procainamide Indications
Cardiac Arrest (V-fib and Pulseless V-Tach), Stable WCT
210
Procainamide Contraindications
Severe conduction disturbances, 2nd Type II/3rd Degree Heart Block, PVCs with bradycardia
211
Procainamide Side Effects
Bradycardia, heart block, hypotension, seizures, drowsiness, confusion, nausea/vomit, respiratory/cardiac arrest
212
Procainamide Precautions
D/C if dysrhythmia is suppressed, hypotension, QRS complex widens, 17mg/kg administered
213
Procainamide Drug-Drug Interaction
Chance of neurotoxicity increases if given with Lidocaine
214
Ondansetron/Zofran Adult Dose
4mg IV/IO/IM/PO, may repeat once
215
Ondansetron/Zofran Pediatric Dose
0.1mg/kg (max 4mg) slow IV/IO/IM or 4mg PO if >5 yo
216
Ondansetron/Zofran Classification/Mechanism
Antiemetic
| 5HT3/Seratonin Receptor Antagonist- blocks binding to receptors at vagal nerve terminals, inhibits vomiting reflex
217
Ondansetron/Zofran Pharmacokinetics
Onset: Rapid, Peak: 15-30mins, Duration: 4-8hrs, Half Life: 4hrs
218
Ondansetron/Zofran Indications
Nausea/vomiting
219
Ondansetron/Zofran Contraindications
None
220
Ondansetron/Zofran Side Effects
Tachycardia, prolonged QT interval, dizziness, headache
221
Ondansetron/Zofran Precautions
Hypersensitivity to other 5HT3 selective antagonist
222
Ondansetron/Zofran Drug-Drug Interaction
Potentiates prolonged QT interval with drug combinations causing same effect
223
Metoclopramide/Reglan Adult Dosage
Nausea/Vomit: 5-10mg IV/IO infusion over 15mins or 5-10mg IM
Migraine: 10mg IV/IO infusion over 15mins or 10mg IM
224
Metoclopramide/Reglan Pediatric Dose
Nausea/vomit: None
| Migraine: None
225
Metoclopramide/Reglan Classification/Mechanism
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
Metoclopramide/Reglan Pharmacokinetics
Onset: 1-3mins IV, 10-15mins IM. Peak: 1-2hrs. Duration: 1-3hrs. Half Life: 2.5-6hrs
227
Metoclopramide/Reglan Indication
Nausea/Vomiting, Migraine headache
228
Metoclopramide/Reglan Contraindications
Bowel obstruction, Seizure, Pheochromocytoma
229
Metoclopramide/Reglan Side Effects
Bradycardia, Tachycardia, hypotension, HTN, CNS depression, sedation
230
Metoclopramide/Reglan Precautions
May cause dystonia; Give slowly
231
Metoclopramide/Reglan Drug-Drug Interaction
Opposed by anticholinergics; additive effects with CNS Depressants
232
Prochloperazine/Compazine Adult Dosage
Nausea/Vomiting: 5-10mg IV/IO infusion over 15mins or 5mg IM
| Migraine: 10mg IV/IO infusion over 15mins or 10mg IM
233
Prochloperazine/Compazine Pediatric Dosage
Nausea/Vomiting: None
| Migraine: None
234
Prochloperazine/Compazine Classification/Mechanism
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
Prochloperazine/Compazine Pharmacokinetics
Onset: 10-20mins. Peak: Varies. Duration: 4-12hrs. Half Life: 24-48hrs
236
Prochloperazine/Compazine Indications
Nausea/Vomiting, Migraines
237
Prochloperazine/Compazine Contraindications
CNS Depression
238
Prochloperazine/Compazine Side Effects
Bradycardia, tachycardia, hypotension, HTN, CNS Depression, sedation
239
Prochloperazine/Compazine Precautious
May cause dystonia; Concurrent administration of Benadryl for migraine
240
Prochloperazine/Compazine Drug-Drug Interactions
Opposed by anticholinergics; Additive Effects with CNS depressants
241
Oxytocin/Pitocin Adult Dosage
3-30 units IM or 10-20 units in 500-1000mL NS infusion
242
Oxytocin/Pitocin Pediatric Dosage
Not indicated
243
Oxytocin/Pitocin Classification/Mechanism
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
Oxytocin/Pitocin Pharmacokinetics
Onset: Immediate IV, 3-7 minutes IM. Peak: Varies. Duration: 1 hr IV, 2-3 HRS .Half: 3-5mins
245
Oxytocin/Pitocin Indications
Post partum Hemorrhage
246
Oxytocin/Pitocin Contraindications
Baby+placenta not delivered; Additional fetus present; if given prior to fetal delivery causes fetal hypoxia, fetal asphyxia, fetal intracranial bleeding
247
Oxytocin/Pitocin Side Effects
Hypotension, tachycardia, dysrhythmias, seizures, coma, nausea/vomiting
248
Oxytocin/Pitocin Precautions
Can cause overstimulation of uterus and uterine rupture
249
Oxytocin/Pitocin Drug-Drug Interaction
HTN with vasoconstrictors
250
Glucagon/Glucagen Adult Dose
Hypoglycemia: 1mg IM, repeat once in 15mins
| Ca Channel/Beta Blocker OD: 5mg IV/IO, repeat in 5mins
251
Glucagon/GlucaGen Pediatric Dose
Hypoglycemia: 0.02mg/kg (max 1mg) IM
| Ca Channel/Beta Blocker OD: 0.05mg/kg IV/IO
252
Glucagon/GlucaGen Classification/Mechanism
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
Glucagon/GlucaGen Pharmacokinetics
Onset: 5-20mins. Peak: 30mins. Duration: 1-2hrs. Half Life: 5-10mins
254
Glucagon/GlucaGen Indications
Hypoglycemia (unable to get IV), Esophageal Food Bolus, Beta Blocker/ Ca Channel OD
255
Glucagon/GlucaGen Contraindications
None
256
Glucagon/GlucaGen Side Effects
Hypotension, dizziness, headache, nausea/vomiting
257
Glucagon/GlucaGen Precautions
Must be reconstituted in 1mL sterile water; Effective if sufficient glycogen in liver
258
Glucagon/GlucaGen Drug-Drug Interaction
None
259
Dextrose 10% Adult Dosage
25g slow IV/IO infusion until dose administration yields appropriate result
260
Dextrose 10% Pediatric Dosage
0.5-1mg/kg slow IV/IO infusion
261
Dextrose 10% Classification/Mechanism
Carbohydrate
| Raises blood glucose simply by adding presence directly into the vasculature
262
Dextrose 10% Pharmacokinetics
Onset: <1min. Peak: Varies. Duration: Varies. Half Life: N/A
263
Dextrose 10% Indications
Hypoglycemia, hypoglycemia during neonatal resuscitation
264
Dextrose 10% Contraindications
None
265
Dextrose 10% Side Effects
Tissue necrosis/phlebitis at injection site
266
Dextrose 10% Precautions
Local venous irritation may occur in smaller vein; Caution in pt with increased ICP/cerebral edema
267
Dextrose 10% Drug-Drug Interaction
None
268
Oral Glucose/Glutose Adult Dose
15g PO
269
Oral Glucose/Glutose Pediatric Dose
15g PO
270
Oral Glucose/Glutose Classification/Mechanism
Carbohydrate
| Raises blood glucose by absorption through oral/intestinal mucosa
271
Oral Glucose/Glutose Pharmacokinetics
Onset: 2-5mins. Peak: 2-5mins. Duration: 2-5mins. Half Life: 5mins
272
Oral Glucose/Glutose Indications
Hypoglycemia
273
Oral Glucose/Glutose Contraindications
Alter level of consciousness (unable to protect airway/follow commands)
274
Oral Glucose/Glutose Side Effects
Nausea/vomiting
275
Oral Glucose/Glutose Precautions
Pt must be able to swallow
276
Oral Glucose/Glutose Drug-Drug Interactions
None
277
Haloperidol/Haldol Adult Dosage
5-10mg IM
278
Haloperidol/Haldol Pediatric Dosage
1-3mg IM
279
Haloperidol/Haldol Classification/Mechanism
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
Haloperidol/Haldol Pharmacokinetics
Onset: 10-20mins. Peak: 30-45mins. Duration: Varies. Half Life:3-35hrs
281
Haloperidol/Haldol Indications
Acute Psychotic Episode, Chemical Restraint/Extreme Agitation/Combativeness
282
Haloperidol/Haldol Contraindications
CNS Depression, Agitation secondary to shock/hypoxia
283
Haloperidol/Haldol Side Effects
Tachycardia, hypotension, prolong QT syndrome, Torsades, Respiratory depression, extrapyramidal symptoms, seizures, drowsiness, restlessness, insomnia, dry mouth, constipation
284
Haloperidol/Haldol Preautions
May impair physical/mental abilities; May cause orthostatic hypotension, dystonia reactions
285
Haloperidol/Haldol Drug-Drug Interactions
Caution pt taking lithium (encephalopathic syndrome), Potentiates anti hypertensives
286
Olanzapine/Zyprexa Adult Dosage
10mg IM
287
Olanzapine/Zyprexa Pediatric Dosage
None
288
Olanzapine/Zyprexa Classification/Mechanism
Antipsychotic
Seratonin, dopamine (D1/D2), muscarinic ACh, Alpha adrenergic Receptor antagonist- antipsychotic + anticholinergic effects
289
Olanzapine/Zyprexa Pharmacokinetics
Onset: <30mins. Peak: 6hrs. Duration: Varies. Half Life: 21-54hrs
290
Olanzapine/Zyprexa Indications
Acute Psychotic Episode, Alzheimer's Disease, Chemical Restraint
291
Olanzapine/Zyprexa Contraindications
None
292
Olanzapine/Zyprexa Side Effects
Tachycardia, postural hypotension, dizziness, tremor, myalgia, nausea, dry mouth, somnolence
293
Olanzapine/Zyprexa Precautions
Reconstituted in 3mL sterile water; Caution pt with cardiovascular disease, predisposed for hypotension + Parkinson's; May cause extrapyramidal symptoms or dystonia reaction
294
Olanzapine/Zyprexa Drug-Drug Interactions
Potentiates hypotensive effect of antihypertensives
295
Naloxone/Narcan Adult Dosage
0.04-2mg IV/IO/IM or 0.4-4mg IN every 3-5mins until respiratory status improves, max 10mg
296
Naloxone/Narcan Pediatric Dosage
0.1mg/kg (max 2mg) IV/IO/IM or 0.4-4mg IN every 5mins until respiratory status improves, max 10mg
297
Naloxone/Narcan Classification/Mechanism
Opioid Antagonist/Antidote
Competitive Opiate Receptor antagonist- displaces narcotic molecules greater affinity for receptor site but shorter duration
298
Naloxone/Narcan Pharmacokinetics
Onset: <2mins IV, 2-10mins IM. Peak: <2mins IV, 2-10mins IM.
Duration: 20-120mins. Half Life: 60-90mins
299
Naloxone/Narcan Indications
Respiratory depression from narcotics/opiates/suspected polypharm OD
300
Naloxone/Narcan Contraindications
None
301
Naloxone/Narcan Side Effects
Hypotension, Hypertension, Ventricular dysrhythmias, seizures, nausea/vomiting
302
Naloxone/Narcan Precautions
May induce withdrawal in newborns with addicted mothers; Oral opiates may require higher doses for reversal; Rule out narcotic prior to RSI
303
Naloxone/Narcan Drug-Drug Interations
May induce withdrawal on opiate-dependent pt
304
Amyl Nitrate Adult Dose
0.3ml ampule crushed, inhaled over 15-30secs every 1min until sodium nitrate infusion available
305
Amyl Nitrate Pediatric Dosage
0.3mL ampules crushed, inhaled over 15-30secs every 1min until sodium nitrate infusion available
306
Amyl Nitrate Classification/Mechanism
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
Amyl Nitrate Pharmacokinetics
Onset: 10-20secs. Peak: 30secs. Duration: 3-5mins.
| Half Life: N/A
308
Amyl Nitrate Indications
Cyanide Poisoning
309
Amyl Nitrate Contraindications
None
310
Amyl Nitrate Side Effects
Tachycardia, orthostatic hypotension, syncope, weakness, dizziness, headache, flushing, cold sweats, nausea/vomiting
311
Amyl Nitrate Precautions
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
Amyl Nitrate Drug-Drug Interaction
Hypotension potentiated by antihypertensives, Beta Blockers and certain antiemetic
313
Sodium Thiosulfate Adult Dosage
12.5g IV/IO infusion over 10mins, repeat once with 1/2 dose PRN
314
Sodium Thiosulfate Pediatric Dosage
300-500mg/kg IV/IO infusion over 10mins, repeat once with 1/2 dose PRN
315
Sodium Thiosulfate Classification/Mechanism
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
Sodium Thiosulfate Pharmacokinetics
Onset: 2-5mins. Peak: Varies. Duration: Varies. Half Life: N/A.
317
Sodium Thiosulfate Indication
Cyanide Poisoning
318
Sodium Thiosulfate Contraindications
None
319
Sodium Thiosulfate Side Effects
Nausea/vomiting and joint pain
320
Sodium Thiosulfate Precautions
Must be given with/following amyl Nitrate and sodium nitrate
321
Sodium Thiosulfate Drug-Drug Interactions
None
322
Hydroxocobalamin/CyanoKit Adult Dosage
5g slow IV/IO over 15mins, may repeat once
323
Hydroxocobalamin/CyanoKit Pediatric Dosage
Not recommended
324
Hydroxocobalamin/CyanoKit Classification/Mechanism
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
Hydroxocobalamin/CyanoKit Pharmacokinetics
Onset: Varies. Peak: Varies. Duration: Varies. Half Life: 26-31hrs
326
Hydroxocobalamin/CyanoKit Indications
Cyanide Poisoning
327
Hydroxocobalamin/CyanoKit Contraindications
None
328
Hydroxocobalamin/CyanoKit Side Effects
Hypertension, nausea/vomiting
329
Hydroxocobalamin/CyanoKit Precautions
May cause allergic reaction
330
Hydroxocobalamin/CyanoKit Drug-Drug Interactions
None
331
Pralidoxime Chloride/2-Pam/Protopam Adult Dosage
600mg IM, repeat with escalating dosages of 1200mg, 1800mg if symptoms worsen/severe
332
Pralidoxime Chloride/2-Pam/Protopam Pediatric Dosage
600mg IM
333
Pralidoxime Chloride/2-Pam/Protopam Classification/Mechanism
Antidote
Organophosphates donate phosphates to cholinesterase, cannot breakdown ACh and not recycled for release a NMJ. Pralidoxime reactivates cholinesterase
334
Pralidoxime Chloride/2-Pam/Protopam Pharmacokinetics
Onset: 10-30mins. Peak: 15-20mins. Duration: 3-6hrs.
| Half Life: 3hrs
335
Pralidoxime Chloride/2-Pam/Protopam Indications
Organophosphate poisoning
336
Pralidoxime Chloride/2-Pam/Protopam Contraindications
None
337
Pralidoxime Chloride/2-Pam/Protopam Side Effects
Tachycardia, HTN, hyperventilation, dizziness, drowsiness, headache, blurred vision, diplopia, nausea, pain at IM site
338
Pralidoxime Chloride/2-Pam/Protopam Precautions
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
Pralidoxime Chloride/2-Pam/Protopam Drug-Drug Interaction
None
340
Normal Saline 0.9% NaCl Adult Dosage
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
Normal Saline 0.9% NaCl Pediatric Dosage
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
Normal Saline 0.9% NaCl Classification/Mechanism
Isotonic Crystalloid Solution
| Volume replacement, water and electrolytes
343
Normal Saline 0.9% NaCl Pharmacokinetics
Onset: Immediate. Peak: Immediate. Duration: Varies.
| Half Life: N/A
344
Normal Saline 0.9% Na/Cl Indications
Dehydration, Shock/Hypotension/Hypovolemia, DKA, KTO, Burns
345
Normal Saline 0.9% NaCl Contraindications
Pulmonary Edema
346
Normal Saline 0.9% NaCl Side Effects
May induce pulmonary edem in pt with CHF hx
347
Normal Saline 0.9% NaCl Precautions
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
Normal Saline 0.9% NaCl Drug-Drug Interactions
None
349
Lactated Ringer's Adult Dosage
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
Lactated Ringer's Pediatric Dosage
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
Lactated Ringer's Classification/Mechanism
Isotonic Crystalloid Solution
| Volume replacement, water + electrolytes
352
Lactated Ringer's Pharmacokinetics
Onset: Immediate. Peak: Immediate. Duration: Varies.
| Half Life: N/A
353
Lactated Ringer's Indications
Dehydration, Shock/Hypotension/Hypovolemia, DKA, KVO, Burns
354
Lactated Ringer's Contraindications
Pt with CHF or Dialysis
355
Lactated Ringer's Side Effects
May cause pulmonary edema if hx of CHF or dialysis
356
Lactated Ringer's Precautions
Monitor pt for circulatory overload
357
Lactated Ringer's Drug-Drug Interaction
Forms precipitate in IV tubing with Ceftriaxone
358
Norepinephrine/Levophed Adult Dosage
1-30mcg/min IV/IO infusion- titrate to BP >90mmHg
359
Norepinephrine/Levophed Pediatric Dosage
0.1-2mcg/min IV/IO- titrated to normotensive systolic BP
360
Norepinephrine/Levophed Classification/Mechanism
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
Norepinephrine/Levophed Pharmacokinetics
Onset: <1min. Peak: <2mins. Duration: 1-2min. Half Life: 3mins.
362
Norepinephrine/Levophed Indications
Cardiogenic Shock, Septic Shock following fluid resuscitation, Neurogenic Shock
363
Norepinephrine/Levophed Contraindications
Hypovolemia
364
Norepinephrine/Levophed Side Effects
Reflex bradycardia, dysrhythmias, dizziness, headache, anxiety, tremulousness, nausea/vomiting
365
Norepinephrine/Levophed Precautions
Cause tissue necrosis with extra action, caution in coronary disease, increases myocardial oxygen demand
366
Norepinephrine/Levophed Drug-Drug Interaction
MAIO/TCA May potentiate cardiovascular Effects
367
Dopamine HCl Adult Dosage
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
Dopamine HCl Pediatric Dosage
2-20mcg/kg/min IV/IO infusion
369
Dopamine HCl Classification/Mechanism
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
Dopamine HCl Pharmacokinetics
Onset: <5mins. Peak: 5-8mins. Duration:<10 mins.
| Half Life: 2mins
371
Dopamine HCl Indications
Cardiogenic Shock, Symptomatic Bradycardia, Septic Shock following fluid resuscitation
372
Dopamine HCl Contraindications
Uncorrected Hypovolemia (May give concurrently with IV fluids)
373
Dopamine HCl Side Effects
Tachycardia, dysrhythmias (A-Fib/PVC), chestpain, dyspnea, nervousness, headache, nausea/vomit, extravasation necrosis
374
Dopamine HCl Precautions
Must be kept out of direct sunlight
375
Dopamine HCl Drug-Drug Interactions
None
376
Phenylephrine/Neo-Synephrine Adult Dosage
100-180 mcg/min IV/IO infusion until systolic >90mmHg
377
Phenylephrine/Neo-Synephrine Pediatric Dosage
0.1-0.5mcg/kg/min IV/IO infusion
378
Phenylephrine/Neo-Synephrine Classification/Mechanism
Sympathomimetic/ Sympathetic Agonist
| Alpha 1 Agonist: 2nd messenger release of Ca in VSMC, peripheral vasoconstriction, increased SVR, increased BP
379
Phenylephrine/Neo-Synephrine Pharmacokinetics
Onset: Immediate. Peak: <1min. Duration: 15-20mins.
| Half Life: 2mins
380
Phenylephrine/Neo-Synephrine Indications
Septic Shock following fluid resuscitation, Neurogenic Shock
381
Phenylephrine/Neo-Synephrine contraindications
Cardiogenic Shock
382
Phenylephrine/Neo-Synephrine Side Effects
Dysrhythmias, HTN, tremulousness, nausea/vomiting
383
Phenylephrine/Neo-Synephrine Precautions
Can cause tissue necrosis with extravasation
384
Phenylephrine/Neo-Synephrine Drug-Drug Interactions
Deactivated by alkaline solutions, Caution in pt with digitalis toxicity, May aggrevate tachydysrhythmias
385
Midazolam/Versed Adult Dosage
Seizures: 5mg IV/IO/IN every 5mins, 5-10mg IM every 10mins
| 2.5-5mg IV/IO/IM/IN every 5-10mins
386
Midazolam/Versed Pediatric Dosage
Seizures: 0.2mg/kg (max 5mg) slow IV/IO/IN/IM
| 0.2mg/kg (max 5mg) IV/IO/IN/IM
387
Midazolam/Versed Classification/Mechanism
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
Midazolam/Versed Pharmacokinetics
Onset: 3-5mins IV, 15mins IM. Peak: 20-60mins.
Duration: <2hrs IV, 1-6hrs IM. Half Life: 1-4hrs
389
Midazolam/Versed Indications
Active seizure,/status epileptics, Premedication for cardioversion/pacing, Anxiety, Post intubation sedation, Acute TBI, Restraint, Hyperthermia/Delerium, Poisoning, Alcohol withdrawal/Delerium Tremens
390
Midazolam/Versed Contraindications
Narrow Angle Glaucoma, Hypotension
391
Midazolam/Versed Side Effects
Respiratory depression, hypotension, AMS, drowsiness, amnesia, nausea/vomiting
392
Midazolam/Versed Precautions
Caution with ETOH, CNS/Respiratory depression; Paradoxical effect if given to elderly for anxiety, half the dose
393
Midazolam/Versed Drug-Drug Reactions
Additive effects with CNS Depressants
394
Lorazepam/Ativan Adult Dosage
Sedation/Seizures/Withdrawal: 2-4mg IV/IO/IM
| 0.5-1mg slow IVP, 1-4mg IM
395
Lorazepam/Ativan Pediatric Dosage
Sedation/Seizures/Withdrawal: 0.05-0.1mg/kg (max 4mg)
| 0.05mg/kg (max 2mg) slow IV/IO/IM
396
Lorazepam/Ativan Classification/Mechanism
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
Lorazepam/Ativan Pharmacokinetics
Onset: 1-5mins IV, 15-30mins IM. Peak: 15-20mins IV, 2hrs IM.
Duration: 6-8hrs. Half Life: 10-20hrs
398
Lorazepam/Ativan Indications
Active seizures/status epileptics, Premedication for cardioversion/pacing, Anxiety, Post intubation sedation, Acute TBI, Restraint, Hyperthermia/Delirium, Poisoning, Alcohol Withdrawal/Delirium Tremens
399
Lorazepam/Ativan Contraindications
None
400
Lorazepam/Ativan Side Effects
Respiratory Depression, hypotension, AMS, drowsiness, amnesia, nausea/vomiting
401
Lorazepam/Ativan Precautions
Caution with ETOH, CNS/Respiratory depression, Paradox effect with the elderly for anxiety, 1/2 dose
402
Lorazepam/Ativan Drug-Drug Reactions
Additive Effects with CNS Depressants
403
Diazepam/Valium Adult Dosage
Seizures/Sedation/Withdrawal: 5-10mg slow IV/IO
| 2-5mg slow IV/IO, 5-10mg IM
404
Diazepam/Valium Classification/Mechanism
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
Diazepam/Valium Pharmacokinetics
Onset: 1-5mins IV. Peak: 10mins IV. Duration: 15-60mins
| Half Life: 20-50hrs
406
Diazepam/Valium Indications
Active Seizure/Status Epileptics, Premedication for cardioversion/pacing, Acute anxiety, Acute TBI, Restraint/agitation/combativeness, Hyperthermia/Excited Delirium, Poisoning, Alcohol Withdrawal/Delirium Tremens
407
Diazepam/Valium Contraindications
None
408
Diazepam/Valium Side Effects
Respiratory depression, Hypotension, AMS, drowsiness, hallucinations, amnesia, blurred vision, nausea/vomiting
409
Diazepam/Valium Precautions
Caution with ETOH, CNS/Respiratory Depression, Paradoxical effect in elderly for anxiety 1/2 dose
410
Diazepam/Valium Drug-Drug Interactions
Additive effects with CNS Depressants
411
Ketamine/Kerala Adult Dosage
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
Ketamine/Ketalar Pediatric Dosage
Induction/Sedation: 2mg/kg slow IVP
Excited Delirium/Restraint: 1-2mg/kg slow IVP, 4-5mg IM
Analgesia: 0.5-2mg/kg
413
Ketamine/Ketalar Classification/Mechanism
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
Ketamine/Ketalar Pharmacokinetics
Onset: <1min IV, <5min IM. Peak: Varies.
Duration: 5-15mins IV, 20-30 mins IM. Half Life: 1-2hrs
415
Ketamine/Ketalar Indication
Induction for RSI, Post Intubation Sedation, Excited Delirium, Chemical Restraint, Acute Psychotic Episode, Pain Management
416
Ketamine/Ketalar Contraindications
Pt <3 months, Gluacoma
417
Ketamine/Ketalar Side Effects
Tachycardia, dysrhythmia, HTN, increased ICP, hypersalivation, nausea/vomit, emergent reaction
418
Ketamine/Ketalar Precations
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
Ketamine/Ketalar Drug-Drug Interactions
Prolonged recovery time given with barbiturates or opiates
420
Fentanyl Citrate/Sublimaze Adult Dosage
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
Fentanyl Citrate/Sublimaze Pediatric Dosage
1mcg/kg (max 100mcg) IV/IO/IM/IN
422
Fentanyl Citrate/Sublimaze Classification/Mechanism
Opiate Analgesic
Opiate receptor agonist- hyperpolarization of interneurons and decreased release of neurotransmitters responsible for transmission of pain to thalamus and cerebral cortex
423
Fentanyl Citrate/Sublimaze Pharmacokinetics
Onset: Immediate. Peak: 3-5mins IV. Duration: 30-60mins.
| Half Life: 6-8hrs
424
Fentanyl Citrate/Sublimaze Indications
Pain management, Chest Pain/suspected ACS, Premedication for RSI, Postintubation sedation
425
Fentanyl Citrate/Sublimaze Contraindications
Respiratory depression/Insufficiency, Uncorrected hypotension (systolic<100mmHg)
426
Fentanyl Citrate/Sublimaze Side Effects
Bradycardia, chest wall rigidity
427
Fentanyl Citrate/Sublimaze Precautions
Fentanyl causes reduced chemoreceptors response to increased CO2- Respiratory depression; Caution in pt with kidney + liver dysfunction
428
Fentanyl Citrate/Sublimaze Drug-Drug Interactions
Additive effects with CNS Depressants; Not given MAOI's within last 14 days as causes Serotonin syndrome
429
Morphine Sulfate Adult Dosage
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
Morphine Sulfate Pediatric Dosage
0.1mg/kg (max 10mg) slow IV/IO/IM
431
Morphine Sulfate Classification/Mechanism
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
Morphine Sulfate Pharmacokinetics
Onset: Immediate IV, 15-30mins IM. Peak: 20mins IV, 30-60min IM. Duration: 2-7hrs. Half Life: 1-7hrs
433
Morphine Sulfate Indications
Pain Management, Chest Pain/suspected ACS
434
Morphine Sulfate Contraindications
Respiratory depression/insufficiency, Uncorreted hypotension (systolic<100mmHg)
435
Morphine Sulfate Side Effects
AMS, headache, blurred vision, constricted pupils, ABD cramping, nausea/vomit
436
Morphine Sulfate Precautions
Morphine causes reduced chemoreceptor responsiveness to increases in CO2; Caution in pt with hypersensitivity to morphine analogs
437
Morphine Sulfate Drug-Drug Interactions
Additive effects (CNS Depression) given with antihistamines, antiemetic, sedatives, hypnotics
438
Hydromorphone/Dilaudid Adult Dosage
0.5-1mg slow IVP every 5mins, max total dose 4mg
439
Hydromorphone/Dilaudid Pediatric Dosage
0.015mg/kg slow IVP
440
Hydromorphone/Dilaudid Classification/Mechanism
Opiate Analgesic
Opiate receptor agonist- hyperpolarization of interneurons + decreased release of neurotransmitters responsible for the transmission of pain to thalamus + cerebral cortex
441
Hydromorphone/Dilaudid Pharmacokinetics
Onset: 15-30mins. Peak: 30-90mins. Duration: 4-5hrs.
Half: 2.6hrs
442
Hydromorphone/Dilaudid Indications
Pain management
443
Hydromorphone/Dilaudid Contraindications
Respiratory Depression/Insufficiency, Uncorrected hypotension (systolic BP<100mmHg)
444
Hydromorphone/Dilaudid Side Effects
AMS, drowsiness, headache, constricted pupils, ABD cramping, nausea/vomiting
445
Hydromorphone/Dilaudid Precautions
Hydromorphone causes reduced chemoreceptor responsiveness to increased CO2- Respiratory depression
446
Hydromorphone Drug-Drug Interaction
Additive effects with CNS Depressants with antihistamines, antiemetics, sedatives, hypnotics, barbiturates and ETOH
447
Ketorolac/Toradol Adult Dosage
15-30mg IVP/IM
448
Ketorolac/Toradol Pediatric Dosage
None
449
Ketorolac/Toradol Classification/Mechanism
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
Ketorolac/Toradol Pharmacokinetics
Onset: 30mins. Peak: 45-60mins. Duration: Varies.
| Half Life: 4-6hrs
451
Ketorolac/Toradol Indications
Pain Management
452
Ketorolac/Toradol Contraindications
Pregnancy, peptic ulcer, renal insufficiency, suspected fractures, undifferentiated ABD pain
453
Ketorolac/Toradol Side Effects
HTN, dizziness, drowsiness, edema, nausea, heart burn, diarrhea, constipation, rash, itching
454
Ketorolac/Toradol Precautions
May cause GI irritation+hemorrhage
455
Ketorolac/Toradol Drug-Drug Interactions
Worsened side effects when given with other NSAIDS
456
Ibuprofen/Advil Adult Dosage
400mg PO
457
Ibuprofen/Advil Pediatric Dosage
10mg/kg (max 400mg) PO
458
Ibuprofen/Advil Classification/Mechanism
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
Ibuprofen/Advil Pharmacokinetics
Onset: 30-60mins. Peak: 1-2hrs. Duration: 6-8hrs.
| Half Life: 2-4hrs
460
Ibuprofen/Advil Indications
Pain Medications
461
Ibuprofen/Advil Contraindications
Pregnancy, Peptic ulcer, Renal insufficiency, Suspected fractures, Undifferentiated ABD pain
462
Ibuprofen/Advil Side Effects
HTN, dizziness, drowsiness, edema, nausea, heartburn, diarrhea, rash, constipation, itching
463
Ibuprofen/Advil Precautions
May cause GI irritation+hemorrhage
464
Ibuprofen/Advil Drug-Drug Interactions
Worsened side effects when given with other NSAIDs
465
Acetaminophen/Tylenol Adult Dosage
Pain: 1g IV/IO infusion over 15mins or 1g PO
Fever: None
466
Acetaminophen/Tylenol Pediatric Dose
Pain: 15mg/kg (max dose 1g) PO every 4-6hrs PRN
Fever: 15mg/kg (max dose 1g) PO every 4-6hrs PRN
467
Acetaminophen/Tylenol Classification/Mechanism
Antipyretic/Analgesic
| COX Inhibitor- prostaglandin synthesis inhibition- analgesic, anti-inflammatory and anti-pyretic properties
468
Acetaminophen/Tylenol Pharmacokinetics
Onset: 15mins IV, 15-30mins PO. Peak: 1hr IV, 30-120mins PO
Duration: 4-6hrs IV, 3-4hrs PO. Half Life: 1-3hrs
469
Acetaminophen/Tylenol Indications
Pain management, Pediatric Fever
470
Acetaminophen/Tylenol Contraindications
Liver Failure
471
Acetaminophen/Tylenol Side Effects
None
472
Acetaminophen/Tylenol Precautions
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
Acetaminophen/Tylenol Drug-Drug Interactions
Chronic excessive use of alcohol increases risk of hepatotoxicity
474
Proparacaine/Alcaine Adult Dosage
1-2 drops 0.5% solution every 5-10mins, max dose 6 drops/eye
475
Proparacaine/Alcaine Pediatric Dosage
1-2 drops 0.5% solution every 5-10mins, max dose 6 dose/eye
476
Proparacaine/Alcaine Classification/Mechanism
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
Proparacaine/Alcaine Pharmacokinetics
Onset: 20secs. Peak: 20secs. Duration: 15mins. Half: N/A.
478
Proparacaine/Alcaine Indications
Pain control for chemical burns to eyes, facilitate insertion of Morgan Lens
479
Proparacaine/Alcaine Contraindications
Penetrating trauma to globe of eye, Allergy to tetracaine/novacaine
480
Proparacaine/Alcaine Side Effects
Stinging, ocular irritation, redness, delayed ocular wound healing
481
Proparacaine/Alcaine Precautions
Avoid prolonged use
482
Proparacaine/Alcaine Drug-Drug Interactions
None
483
Calcium Chloride Precautions
Can cause tissue necrosis at injection site, ensure patent IV; Moderate/Severe HyperKalemia characterized by wide QRS on ECG
484
Calcium Chloride Drug-Drug Precautions
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
Tetracaine Adult Dosage
1-2 drops 0.5% solution every 5-10mins, max dose 6 drops per eye
486
Tetracaine Pediatric Dosage
1-2 drops 0.5% solution every 5-10mins, max dose 6 drops per eye
487
Tetracaine Classification/Mechanism
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
Tetracaine Pharmacokinetics
Onset: 30sec, Peak: 30secs, Duration: 10-15mins
| Half Life: N/A
489
Tetracaine Indications
Pain control for chemical burns to eye, Facilitate Morgan Lens insertion
490
Tetracaine Contraindications
Penetrating trauma to globe of eye, Allergy to proparacaine/novacaine
491
Tetracaine Side Effects
Stinging, ocular irritation, redness, delayed ocular wound healing
492
Tetracaine Precautions
Avoid prolonged use
493
Tetracaine Drug-Drug Interactions
None
494
Etomidate Adult Dosage
0.3mg/kg (max 40mg) IV/IO over 15-30secs
495
Etomidate Pediatric Dosage
0.3mg/kg (max 40mg) IV/IO over 15-30secs
496
Etomidate Classification/Mechanism
Sedative/Hypnotic
| Depresses RAS of the brain and potentiates GABA, causes sedation
497
Etomidate Pharmacokinetics
Onset: 10-20secs, Peak: <1min, Duration: 3-5mins
| Half Life: 30-70secs
498
Etomidate Indication
Induction agent for RSI
499
Etomidate Contraindications
None
500
Etomidate Side Effects
Bradycardia, tachycardia, hypotension, HTN, apnea, hypoventilation, hyperventilation, myoclonic skeletal musle movement, trismus, laryngospasm, nausea/vomiting
501
Etomidate Precautions
None
502
Etomidate Drug-Drug Interactions
May prolong respiratory depression and apnea with Verapamil
503
Vecuronium/Norcuron Adult Dosage
0.1mg/kg IV/IO
504
Vecuronium/Norcuron Pediatric Dosage
0.1mg/kg IV/IO
505
Vecuronium/Norcuron Classification/Mechanism
Non-depolarizing Neuromuscular Blocker
Nicotinic ACh Receptor Antagonist- competes with ACh at neuromuscular junction and prevents binding thus inhibiting skeletal muscle depolarization.
506
Vecuronium/Norcuron Pharmacokinetics
Onset: <1min, Peak: 3-5mins, Duration: 30-80mins
| Half Life: 30-80mins
507
Vecuronium/Norcuron Indications
Need for temporary paralysis to facilitate intubation; Need for continued paralysis following intubation
508
Vecuronium/Norcuron Contraindications
None
509
Vecuronium/Norcuron Side Effects
Bradycardia, Hypotension
510
Vecuronium/Norcuron Precautions
Presence of neuromuscular diseases may be associated with prolonged paralysis
511
Vecuronium/Norcuron Drug-Drug Interactions
Potentiated by lidocaine, procainamide, Beta Blockers, Magnesium Sulfate and other neuromuscular blockers
512
Rocuronium/Zemuron Adult Dosage
1mg/kg IV/IO
513
Rocuronium/Zemuron Pediatric Dosage
0.6mg/kg IV/IO
514
Rocuronium/Zemuron Classification/Mechanism
Non-depolarizing Neuromuscular Blocker
Nicotinic ACh-Receptor antagonist- competes with ACh at neuromuscular junction and prevents binding thus inhibiting skeletal muscle depolarization
515
Rocuronium/Zemuron Pharmacokinetics
Onset: 60-70secs, Peak: 1-3mins, Durations: 25-40mins
| Half Life: 14-18mins
516
Rocuronium/Zemuron Indications
Need for temporary paralysis to facilitate intubation; Need for continued paralysis following intubation
517
Rocuronium/Zemuron Contraindications
None
518
Rocuronium/Zemuron Side Effects
Tachycardia, HTN, hypotension, bronchospasms (rare)
519
Rocuronium/Zemuron Precautions
Presence of neuromuscular diseases may be associated with prolonged paralysis
520
Rocuronium/Zemuron Drug-Drug Interactions
Potentiated by lidocaine, procainamide, Beta Blockers, Potassium-sparing diuretics, Magnesium Sulfate and other neuromuscular blockers including succinylcholine
521
Succinylcholine/Anectine Adult Dosage
1.5mg/kg IV/IO
522
Succinylcholine/Anectine Pediatric Dosage
1mg/kg IV/IO
523
Succinylcholine/Anectine Classification/Mechanism
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
Succinylcholine/Anectine Pharmacokinetics
Onset: 45-60secs IV, 2-3mins IM, Peak: 1-3mins,
Duration: 6-10mins IV, 10-30mins IM, Half Life: 5-10mins
525
Succinylcholine/Anectine Indications
Need for temporary paralysis to facilitate intubation
526
Succinylcholine/Anectine Contraindications
Penetrating eye injury, narrow angle glaucoma, known/suspected HyperKalemia, hx of malignant hyperthermia, hx myasthenia gravis, burns >24hrs old
527
Succinylcholine/Anectine Side Effects
Bradycardia, dysrhythmias, hypotension, increases ICP, increased intraocular pressure
528
Succinylcholine/Anectine Precautions
May cause dysrhythmias and cardiac arrest, particularly in pt with HyperKalemia
529
Succinylcholine/Anectine Drug-Drug Interactions
Potentiated by lidocaine, procainamide, Beta Blockers, Magnesium Sulfate, and other neuromuscular blockers.
