MODULE 2 MEDICATIONS Flashcards
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ASPIRIN
CLASSIFICATION
- Antiplatetlet
- Antipyretic
- Anti-Inflammatory
- Analgesic
ASPIRIN
DOSAGE
ADULT
- 81mg - 324mg (1 - 4 pills)
ASPIRIN
INDICATION
- Chestpain of suspected cardiac origin
- Acuted cornonary syndromes (with or without suspected chest pain
ASPIRIN
CONTRADICTION
- Allergy to Asprin
- Any bleeding disorders
ASPIRIN
ADVERSE EFFECTS
- Allergic reaction
- Bleeding
ASPIRIN
MECHANISM OF ACTION
- Prevents formation of Thromboxane A2, inhibitiung the clotting caseade4 by decreasing platelet aggregation
- Prolongs bleeding times
DIPHENHYDRANMINE HYDROCHLORIDE
CLASSIFICATION
- Antihistamine
DIPHENHYDRANMINE HYDROCHLORIDE
INDICATIONS
- Allergic reactions
- Anaphyaxis
- Dystonic reatctions (Extrapyramidal symptoms)
- Chemical restraint
DIPHENHYDRANMINE HYDROCHLORIDE
ADULT
DOSAGE
- 25 - 50 mg IV/IO/IM
DIPHENHYDRANMINE HYDROCHLORIDE
DOSAGE
PEDIATRIC
- 1mg/kg IV/IO/IM
- MAX SINGLE DOSE 25mg
DIPHENHYDRANMINE HYDROCHLORIDE
CONTRAINDICATIONS
- Know allergy to Diphenhydranmine
- Acute Ashtma exacerbation
DIPHENHYDRANMINE HYDROCHLORIDE
ADVERSE EFFECTS
- Drowsiness
- Loss of coordination
- Blurred vision
- Headache
- Hypotension
- Tachycardia
- Palpitations
- Thickening of pronchial secertions leading to chest tighttness and wheezing
DIPHENHYDRANMINE HYDROCHLORIDE
MECHANISM OF ACTION
- H1 Receptor antagonist blocking histamine from binding, reducing allergic, and anaphylactic response and allergy cascade
DIPHENHYDRANMINE HYDROCHLORIDE
PHARMACOKINETICS
- Effect begins within 1-5 minutes of IV dose
- Peak effect 1 to 4 hours
- metabolized by the liver
EPINEPHRINE 1:1000/1:10000
CLASSIFICATION
- Adrenergic Catecholamine
- Sympathomimetic (Vasopressor)
EPINEPHRINE 1:1000/1:10000
DOSAGE
CARDIAC ARREST
- ADULT
- 1mg (1:10,000) IVP every 3 - 5 min
- PEDIACTRIC
- 0.01 mg/kg (0.1ml/kg) (1:10,000) IV/IO every 3 - 5 min
EPINEPHRINE 1:1000/1:10000
DOSAGE
ROSC
- 0.1 - 0.5 mcg/kg/min
- Standard concentration = 1mg EPI/250ml NS
EPINEPHRINE 1:1000/1:10000
SYMPTOMATIC BRADYCARDIA (UNSTABLE)
DOSAGE
- ADULT
- 2 - 10 mcg/min, mix 1 mg EPI in 250ml D5W
- PEDIATRIC
- 0.01 mg/kg (1:10,000) IO/IV, every 3-5 min
EPINEPHRINE 1:1000/1:10000
DOSAGE
ANAPHYLACTIC SHOCK / ASTHMA
- ADULT
- 0.3 - 0.5 mg (1:1,000) SQ/IM
- PEDIATRIC
- 0.01 mg/kg (1:10,000) SQ/IM… MAX SINGLE DOSE 0.3mg
EPINEPHRINE 1:1000/1:10000
ANAPHYLACTIC SHOCK / ASTHMA WITH LIFE THREATENING MANIFESTATIONS
DOSAGE
- Concider 0.1mg (1:10,000) Slow IV/IO Infusion over 5 min
EPINEPHRINE 1:1000/1:10000
CROUP
DOSAGE
- PEDIATRIC
- 1:1,000 3mg Via nebulizer: Dilute in 3ml normal saline
If no improvement, repeat initial dose ONCE
- 1:1,000 3mg Via nebulizer: Dilute in 3ml normal saline
EPINEPHRINE 1:1000/1:10000
INDICATIONS
- Cardiac arrest
- Anaphylaxis
- Bronchial sthma
- Respiratory stridor (suspected croup)
- Symptomatic Bradycardia
- Return Of Spontaneous Circulation (ROSC)
EPINEPHRINE 1:1000/1:10000
CONTRAINDICATIONS
- Hypertension
- None in cardiac arrest settings
EPINEPHRINE 1:1000/1:10000
ADVERSE EFFECTS
- Tachydysrhythmias (supraventricular and ventricular)
- Hypertension
- Headache
- Nervousness
- Tremors/Shakes
- May endude early labor in pregnant women
- Rebound edma in croup patients, 20 - 30 min after administration
EPINEPHRINE 1:1000/1:10000
MECHANISM OF ACTION
- Administration of Epinephen causes “Fight or Flight” response
- Alpha - Peripherial vasoconstriction
- Beta 1- Increases inotropy, chronotropy, dromotropy, & automaticity
- Beta 2 - Bronchodialation and skeletal muscle vasodialtion
EPINEPHRINE 1:1000/1:10000
PHARMACOKINETICS
- IV administation has VERY RAPID onset of action
- Rapidly inactivated by liver
- Subcutaneous administation slower due to local vasoconstriction
- Epi has vasoconstriction properties in respiratory tract, which result in reduction of mucosal and submucosal edema
EPINEPHRINE 1:1000/1:10000
PEARLS
- Do not mix with Sodium Bicarbonate or Furosemide as this deactivates Epinephrine
- Epi causes dramatic increase in myocardial oxygen demand
- IV Epi should be reserved for cardiac arrest and for impending cardiac arrest due to anaphylaxis
FUROSEMIDE
CLASSIFICATION
Loop diuretic
FUROSEMIDE
DOSAGE
- 0.5 - 1 mg/kg IV/IO
- 40 mg if taking Lasix
- 80 mg if NOT taking Lasix
FUROSEMIDE
INDICATIONS
- CHF
- Pulmonary edema
FUROSEMIDE
CONTRAINDICATION
- Hypovolemia / Dehydration
- Hypokalemia / Electrolyte depletion
FUROSEMIDE
ADVERSE EFFECTS
- Hypotension
- Electrolyte imbalances
FUROSEMIDE
MECHANISM OF ACTION
- Inhibits the reabsorbtion of Sodium Chloride in the Loop of Henle abnd proximal tubule of the nephron in the kidneys.
- Water follows salt…. water is not reabsorbed and is then excreted into the bladder and is released as urine
MORPHINE SULFATE
CLASSIFICATION
- Narcotic analgesic
MORPHINE SULFATE
ACUTE MYOCARDIAL INFARCTION/ PULMONARY EDEMA
DOSAGE
- 2 - 10 mg IV/IO/IM for pain not relieved by Nirtoglycerin
MORPHINE SULFATE
BURN INJURY
DOSAGE
- 2 - 20 mg IV/IO/IM
MORPHINE SULFATE
ISOLATED INJURIES
DOSAGE
- 2 - 10 mg IV/IO/IM
- Additional 2 - 10 mg UP TO 20 mg or until pain is relieved
MORPHINE SULFATE
ISOLATED INJURIES
PEDIATRIC
DOSAGE
- 0.1 mg/kg IV/IM
- Systolic BP must be over 100 mmHG
- MAX TOTAL DOSE 10mg
MORPHINE SULFATE
INDICATIONS
- Acute Myocardial Infarction
- Isolated injuries
- Pulmonary edema/CHF
- Burns
MORPHINE SULFATE
CONTRAINDICATIONS
- Head injury
- Multiple system trauma (Relative)
- COPD with compromised respiratory effort
- Hypotension
- Sensitivity to Morphine, Codeine, Percodan
MORPHINE SULFATE
ADVERSE EFFECTS
- Increased vagal tone due to suppresion of sympathetic pathways (slowed heart rate)
- Respiratoty depression / arrest
- Altered mental status
- Nausea
- Vomiting
- Bronchospasm
- itch
MORPHINE SULFATE
MECHANISM OF ACTION
- Decreases pain perception and anxiety
- Decreases respiratory effort
- Causes peripheral dialation which decreases preload
- Decreases left ventricular afterload
MORPHINE SULFATE
PHARMACOKINETICS
- Binds with opiate receptors in the CNS, altering perception to pain
- Onset of actions < 5 min after administration. Effects last 4 - 5 hrs
- Casuses peripheral arterial & venous vasodilation
NITROGLYCERIN
CLASSIFICATION
- Nitrate
- Vasodilator
NITROGLYCERIN
CHEST PAIN
DOSAGE
- 0.4 mg SL (Sublingual) every 3 - 5 min
- MAX DOSE 1.2 mg
NITROGLYCERIN
PULMONARY EDEMA / CHF
DOSAGE
- 0.4 mg SL (Sublingual) repeat 3 - 5 min if symptoms persist
- 1 inch Nitro paste to chest wall
*** If hypotension occurs due to administration, wipe site with gauze
NITROGLYCERIN
INDICATIONS
- Treatment of angina
- Congestive heart failure
- Acute pulmonary edema
- Symptomatic hypertensive crisis
NITROGLYCERIN
CONTRAINDICATIONS
- Known hypersensitivity
- Pediatrics under 12 y/o
- Viagra/Levitra/Cialis ingestion in the last 24hrs
- Asymptomatic Hypertension
- BP below 90 mmHg
- Right side MI (Positive ST segment elevation V4R)
NITROGLYCERIN
ADVERSE EFFECTS
- Headache
- Hypotension
- Nausea & Vomiting
- Dizziness
- Decreased LOC
NITROGLYCERIN
MECHANISM OF ACTION
- Vasodilator - effect on veins more than arteries
- Decrease right heart return (preload) by venous pooling, thereby decreasing myocardial workload and oxygen consumption
NITROGLYCERIN
PHARMACOKINETICS
- Absorbed through oral mucosa or scin
- Antianginal and vasodilatory effects within 1-2 min after administation
- Half-life is 1 - 4 min. Duration is less than 5 min.