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DH Protocols > Medications - Indications/Contraindications > Flashcards

Medications - Indications/Contraindications Flashcards

1
Q

Adenosine

Indications/Contraindications

A

Indications:
Narrow-complex supra ventricular tachyarrhythmia. Stable, undifferentiated, REGULAR, monomorphic wide-complex tachycardia

Contraindications:
Any irregular tachycardia. Specifically never administer to an irregular wide-complex tachycardia, which may be lethal.

Adverse reactions:
Chest pain, shortness of breath, diaphoresis, palpitations, and lightheadedness

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2
Q

Albuterol Sulfate

Indications/Contraindications

A

Indications:
Bronchospasm

Contraindications:
Severe tachycardia is a relative contraindication

Adverse reactions:
Tachycardia, palpitations, and dysrhythmias

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3
Q

Amiodarone

Indications/Contraindications

A

Indications:
Cardiac arrest in patients with shock refractory VF/VT. Stable wide complex tachycardia. Following successful cardioversion of VF/VT

Contraindications:
2nd or 3rd degree AV block
Cardiogenic Shock

Adverse Reactions:
Severe hypotension
Bradycardia

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4
Q

Aspirin

Indications/Contraindications

A

Indications:
Suspected acute coronary syndrome

Contraindications:
Active gastrointestinal bleeding
Aspirin allergy

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5
Q

Atropine Sulfate

Indications/Contraindications

A

Indications:
Symptomatic bradycardia
To improve conduction in 2nd and 3rd degree heart block or in pacemaker failure
Organophosphate poisoning

Adverse reactions: Anticholinergic toxidrome in overdose, think “blind as a bat, mad as a hatter, dry as a bone, and red as a beet”

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6
Q

Calcium Gluconate

Indications/Contraindications

A

Indications:
Adult pulseless arrest associated with any of the following clinical conditions:
Known hyperkalemia
Renal failure with or without hemodialysis history
Calcium channel blocker overdose
Not indicated for routine treatment of pulseless arrest.
Adult or pediatric calcium channel blocker overdose with hypotension, bradycardia

Contraindications:
Known hypercalcemia
Suspected digoxin toxicity (i.e. digoxin overdose)

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7
Q

Dextrose 50%

Indications/Contraindications

A

Indications:
Hypoglycemia
The unconscious or altered mental status patient with an unknown etiology

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8
Q

Diazepam (Valium)

Indications/Contraindications

A

Indications:
Status epilepticus, combative or severely agitated patients, sympathomimetic overdose (cocaine, meth), severe musculoskeletal back spasms, sedation for cardioversion or transcutaneous pacing.

Adverse reactions:
Respiratory depression
Loss of protective airway reflexes

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9
Q

Diphenhydramine (Benadryl)

Indications/Contraindications

A

Indications:
Allergic reactions, dystonic medication reactions, or akathisia (restlessness)

Adverse reactions:
Drowsiness
Dilated pupils
Dry mouth and throat
Flushing
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10
Q

Dopamine (Intropin)

Indications/Contraindications

A

Indications:
Hypotension refractory to adequate fluid resuscitation.
Symptomatic bradycardia with signs of poor perfusion

Contraindications:
Hypovolemia
Hemorrhagic shock

Adverse reactions:
Tachydysrhythmias
Hypertension
Increased myocardial oxygen demand

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11
Q

Droperidol (Inapsine)

Indications/Contraindications

A

Indications:
Primary use for management of agitated/combative patients.
Second line medication for management intractable vomiting requiring base contact.
Combative head injured patients.

Contraindications:
Suspected acute myocardial infarction.
Systolic blood pressure under 100mmHg, or the absence of a radial pulse.
Exhibiting signs of respiratory depression.

Side effects:
Due to the vasodilation effect, droperidol can cause a transient hypotension that is usually self-limiting and can be treated effectively with position and fluids. Droperidol has also been known to cause tachycardia which usually does not require pharmacologic intervention.
Some patients can have feelings of: restlessness, hyperactivity, anxiety, extra-pyramidal reactions.

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12
Q

DuoDote

Indications/Contraindications

A

Indications:

Suspected nerve agent exposure accompanied with signs and symptoms of nerve agent poisoning

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13
Q

Epinephrine

Indications/Contraindications

A

Indications:
Pulseless arrest, anaphylaxis, asthma, bradycardia with poor perfusion, airway obstruction secondary to croup or epiglottis

Adverse reactions:
Tachycardia and tachydysrhythmia
Hypertension
Anxiety
Angina pectoris

*Should not be added to sodium bicarbonate or other alkaloids as epinephrine will be deactivated.

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14
Q

Fentanyl (Sublimaze)

Indications/Contraindications

A

Indications:
Moderate to severe pain
Treatment of shivering after therapeutic induced hypothermia

Contraindications:
Hypotension, hemodynamic instability or shock
Respiratory depression

Side Effects:
Respiratory depression, hypotension, increased intracranial pressure, and chest wall rigidity

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15
Q

Glucagon

Indications/Contraindications

A

Indications:
Altered level of consciousness where hypoglycemia is suspected and IV access is unavailable. Hypotension, bradycardia from beta-blocker or calcium channel blocker overdose.

Side effects:
Tachycardia, headache, nausea/vomiting

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16
Q

Atrovent (Ipratropium Bromide)

Indications/Contraindications

A

Indications:
Bronchospasm

Contraindications:
Do not administer to children <2 years
This does not contain the allergen (soy/peanuts) that are contained in the metered dose inhaler.

Adverse reactions:
Palpitations
Tremors
Dry mouth

17
Q

Magnesium Sulfate

Indications/Contraindications

A

Indications:
Antiarrhythmic (torsades de pointes associated with prolonged QT interval)

Respiratory (severe bronchospasm unresponsive to continuous albuterol, ipratropium, and IM epinephrine.

Obstetrics (>20 weeks gestational age with evidence of eclampsia or pre-eclampsia:
Pre-eclampsia: hypertension >180mmHg systolic or > 120mmHg diastolic, localized edema, headache and/or altered mental status.
Eclampsia: preeclampsia + seizures)

Adverse reactions:
Bradycardia, hypotension, and respiratory depression

18
Q

Methylprednisolone (Solu-medrol)

Indications/Contraindications

A

Indications:
Anaphylaxis
Severe asthma
COPD

Contraindications:
Evidence of an active GI bleed

Adverse reactions:
GI bleeding
Hypertension
Hyperglycemia

19
Q

Midazolam (Versed)

Indications/Contraindications

A

Indications:
Status epilepticus
Sedation of the severely agitated/combative patient
Sedation for cardioversion or transcutaneous pacing (TCP)

Contraindications:
Hypotension

Adverse reactions:
Respiratory depression
Hypotension
Sedative effect of versed may be heightened by associated use of opioids, alcohol, or other CNS depressants

20
Q

Morphine Sulfate

Indications/Contraindications

A

Indications:
Pain Management
Cardiogenic Pulmonary edema

Contraindications:
Hypovolemia
Hypotension (relative)

Side effects:
Respiratory depression
Hypotension
Nausea/vomiting
Itching (Histamine release)
21
Q

Naloxone (Narcan)

Indications/Contraindications

A

Indications:
For reversal of suspected opioid-induced CNS and respiratory depression
Coma of unknown origin
Seizure of unknown etiology (rule out narcotic overdose, specifically propoxyphene)

Adverse reactions:
Tachycardia
Nausea/Vomiting
Pulmonary Edema

22
Q

Nitroglycerine

Indications/Contraindications

A

Indications:
Pain or discomfort due to suspected acute coronary syndrome
Pulmonary edema due to congestive heart failure

Contraindications:
Suspected right ventricular infarct (inferior STEMI pattern plus ST elevation in right sided precordial leads)
Hypotension SBP < 100
Recent use of erectile dysfunction medication

Adverse reactions:
Hypotension
Headache
Syncope

23
Q

Ondansetron (Zofran)

Indications/Contraindications

A

Indication:

Nausea/Vomiting

24
Q

Oxygen

Indications/Contraindications

A 
Indications:
Suspected hypoxemia or respiratory distress from any cause
Acute chest or abdominal pain
Hypotension/shock states from any cause
Trauma
Suspected carbon monoxide poisoning
Obstetrical complications, childbirth
25
Q

Phenylephrine (Intranasal)

Indications/Contraindications

A

Indications:
Prior to nasotracheal intubation to induce vasoconstriction of the nasal mucosa
Nose bleed

26
Q 
Racemic Epinephrine (Vaponephrine)
(Indications/Contraindications)
A

Indications:
Bronchospasm in bronchiolitis
Stridor at rest in croup
Suspected epiglottis in adults or children
Stridor from miscellaneous causes in adults

Side effects:
Tachycardia
Palpitations

27
Q

Sodium Bicarbonate

Indications/Contraindications

A

Indications:
Tricyclic overdose with arrhythmias, widened QRS complex, hypotension, seizures.
Suspected hyperkalemic pulseless arrest: consider in patients with renal failure

Contraindications:
Metabolic and respiratory alkalosis
Hypocalcemia
Hypokalemia

Adverse reactions:
Metabolic alkalosis
Hyperosmolarity may occur, causing cerebral impairment

28
Q

Topical Opthalmic Anesthetics

A

Indications:
Pain secondary to eye injuries and corneal abrasions
Topical anesthetic to facilitate eye irrigation

Contraindications:
Known allergy to local anesthetics
Global lacerations or rupture

Side effects:
Transient burning/ stinging when initially applied

DH Protocols (3 decks)

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