Medications & Special Conditions Flashcards
Acetaminophen
Pregnancy safety: Category B | Limited dose of 325 mg when combined with other drugs
AcetaZOLAMIDE (Diamox, Diamox Sequels)
Pregnancy safety: Category C
Acetic Acid (Vinegar)
Pregnancy safety: Category C | Safety and efficacy have not been established in children younger than 3 years
Acetylcysteine (Mucomyst, Acetadote)
Pregnancy safety: Category B ; Use cautiously in pregnant and breastfeeding women and only if clearly indicated | When given IV, anaphylactoid-type reactions usually follow the first dose ; Can be minimized by ensuring that the medication is infused over 1 hour | Acetylcysteine smells like rotten eggs because of it’s sulfur content
Activated charcoal
Pregnancy safety: Category C | Shake vigorously before use | Contact medical direction before administering in cases of acetaminophen overdose
Adenosine (Adenocard)
Pregnancy safety: Category C | Monitor the ECG and record a rhythm, strip during administration | Ineffective in converting AF, atrial flutter, or VT | Should NOT be administered for hemodynamically unstable, irregularly irregular, or polymorphic wide-complex tachycardias
Albumin (Albumarc, Albutein, Flexbumin)
Pregnancy safety: Category C | Administered with 0.9% NS, D5W, or sodium lactate
Albuterol
Pregnancy safety: Category C | May precipitate angina pectoris and dysrhythmias | Patients may need to be coached on proper use of the MDI | Current research shows no benefit in use for in bronchiolitis tx
Amiodarone (Cordarone, Pacerone)
Pregnancy safety: Category D ; may cause fetal death ; Lactating women should not breastfeed following use | May worsen or precipitate new dysrhythmias | Monitor for hypotension and increasing PR and QT intervals | Dosage may change per the most current International Liaison Committee on Resuscitation (ILCOR) recommendations
Aspirin (Acetylsalicylic Acid)
Pregnancy safety: Category D | If there are no contraindications, non–enteric-coated, chewable aspirin should be given as soon as possible to all patients with a suspected ACS after symptom onset
Atropine sulfate
Pregnancy safety: Category C | Paradoxical bradycardia can occur w/ doses lower than 0.1mg | Ineffective in hypothermic bradycardia; May be ineffective in patients who have undergone heart transplantation or in infranodal AV blocks | Use with caution in the presence of myocardial ischemia because atropine increases myocardial oxygen demand
Benzocaine Spray (Hurricane)
Pregnancy safety: Category C | Quantity in a single spray varies among different manufacturers | Potentially dangerous methemoglobin levels from use in the mouth and throat
Bumetanide (Bumex)
Pregnancy safety: Category C | Not Recommended in breastfeeding women | Bumetanide does not have the vasodilatory effects of furosemide | Diuretic potency is about 40 times greater than furosemide
Calcium chloride
Pregnancy safety: Category C | Contains three times more elemental calcium than calcium gluconate, which is preferred in children | Essential for constant ECG and vital sign monitoring | Do NOT administer by either the IM or SubQ
Calcium gluconate
Pregnancy safety: Category C | Constant ECG and vital sign monitoring is essential | Central venous administration is the preferred route in pediatrics | Do NOT administer by either the IM or SubQ
Cimetidine (Tagamet)
Pregnancy safety: Category B | Can be given orally or IV in conjunction with diphenhydrAMINE for urticaria
Hetastarch (Hespan)
Pregnancy Safety: Category C
Plasma Protein Fraction (Plasmanate)
Do NOT use if the solution is cloudy or if sedimentation is seen
0.9% Sodium Chloride (Normal Saline)
N/A
0.45% Sodium Chloride
N/A
Lactated Ringer Solution (Hartmann Solution)
N/A
3% Sodium Chloride (Hypertonic Saline)
Should be administered through a central line due to its high osmolarity and tonicity
5% Dextrose in 0.45% Sodium Chloride
N/A
5% Dextrose in 0.9% Sodium Chloride
N/A
5% Dextrose in Lactated Ringer Solution
N/A
Total Parenteral Nutrition
Vary based on the specific mixture
Dexamethasone sodium phosphate (Decadron)
Pregnancy safety: Category C ; caution w/ breast feeding women too | Administer IV/IO doses slowly | Steroids can mask infection | Can increase blood glucose levels, so antidiabetic drug dosages may be needed to adjust | Hydrocortisone succinate is preferred over methylPREDNISolone and dexamethasone for pts w/ adrenal insufficiency because of its dual glucocorticoid and mineralocoricoid effects | High doses of glucocorticoids or prolonged use can result in many adverse reactions and side effects | It should NOT be used for AMS or HACE prevention in children
Dextran
In the management of burn shock, it is essential to follow standard fluid resuscitation regimens to prevent possible circulatory overload
Bacteriostatic Water
Pregnancy category: C | Due to the presence of a benzyl alcohol additive, other dilutional agents should be used if available | Solution should be made approximately isotonic before use
5% Dextrose in Water
D5W should NOT be administered simultaneously with blood through the same IV administration set because of the possibility of hemolysis.
10% Dextrose in Water
N/A
Dextrose
Pregnancy safety: Category C | Draw blood to determine the patient’s glucose level before administering | Document reassessment of vital signs and mental status after administration | for pt less than 8 y/o concentration of no more than 25% should be used | for neonates and infants less than 1 y/o no more than 10% to 12.5% should be used (their vasculature is extremely sensitive to high concentrations) | May induce acute thiamine deficiency (Wernicke-Korsakoff syndrome) in malnourished patients and those with chronic alcoholism; if suspected alcohol abuse or malnurition indicated try to give thiamine before giving dextrose (follow local protocols) | Extravasation may lead to tissue necrosis | Do NOT administer to patients with known stroke unless hypoglycemia is documented
Diazepam (Valium, Diastate, AcuDial)
Pregnancy safety: Category D | Consider decreasing dose by 50% in patients older than 60 years | Convulsive Antidote Nerve Agent (CANA) is a commercially available auto-injector | In cases of an axetylcholinesterase inhibitor agent exposure, administration of diazepam or midazolam id preferred over lorazepam because of their more rapid onset of action
Digoxin (Lanoxin)
Can prolong the PR interval and cause ST-segment changes on the EKG; careful cardiac monitoring is essential | Calcuim channel blockers or beta blockers are generally preferred for heart rate control in pts w/ AF; adenosine is preferred to tx reentry SVT | Cardioversion should be AVOIDED if pt is taking digoxin, but if the situation is life-threatening, use a lower energy dose (10 to 20 joules)
Diltiazem (Cardizem, Dilacor, Diltiaz)
Pregnancy safety: Category C | Dysrhythmias may be observed during pharmacologic conversion | Carefully monitor BP and EKG before, during, and after administration
DiphenhydrAMINE HCl (Benadryl)
Pregnancy safety: Category B | Increases the effectiveness of epinephrine | Can be given in conjunction with any H2-blocking antihistamine
DOBUTamine Hydrochloride (Dobutrex)
Pregnancy safety: Category B | BP and hemodynamic monitoring recommended | Titrate dose to maintain a heart rate increase of no greater than 10% of baseline | May increase infarct size in patients with MI | May precipitate or exacerbate ventricular ectopy | Older patients may have a significantly decreased response | Patients may become hypotensive from the vasodilatory effect
DOPamine Hydrochloride (Intropin)
Pregnancy safety: Category C | Correct hypovolemia before administering | Should be administered by infusion pump | Extravasation may cause necrosis and sloughing of surrounding tissue | Slow or stop the infusion if tachydysrhythmias or increased ventricular ectopy is observed | Sudden cessation of infusion can result in significant hypotension | Research suggests that pt in cardiogenic or septic shock who are tx’ed w/ norepinephrine have a lower mortality rate than those tx’ed w/ DOPamine
Droperidol (Inaspine)
Pregnancy safety: Category C | Cases of QT prolongation and/or TdP have occurred in pts w/ no known risk of QT prolongation; some have been fatal | Closely monitor vital signs and EKG | Monitor the QT interval with a 12-lead EKG if feasible | Document the QT interval and relay findings to the receiving facility staff
EPINEPHrine
Pregnancy safety: Category C ; contraindicated for pts in active labour | Carefully document the dosage, concentration, route, time of administration, and patient’s response to each dose | Administer epinephrine as soon as possible in cardiac arrest associated with PEA or asystole | Reduce the dose of epinephrine in patients taking MAOIs, per the local protocols