Paramedic Drugs Flashcards by Tim Dibble

Midazolam (Versed)

Benzo/Sedative/Hypnotic/Anticonvulsant

Binds to benzo receptor site on chloride channels and potentiates binding and effects of GABA, increasing intracellular chloride concentration leading to hyperpolarization of cell

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

Premedication, seizures, sedation

Hypotension

AMS, resp depression, amnesia, n/v

Seizure: 2-6mg IV, 10mg IM, 5mg/nair
Premedication: 2-5mg slow IV/IM
Sedation: 2-5mg IV q 5-10min
PEDI: 0.2mg/kg slow, max 10mg

May cause CNS/respiratory depression, caution with acute alcohol intoxication

Additive effects with CNS depressants and alcohol

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Lorazepam (Ativan)

Benzo/Sedative/Hypnotic/Anticonvulsant

Binds to benzo receptor site on chloride channels and potentiates binding and effects of GABA, increasing intracellular chloride concentration leading to hyperpolarization of cell

Onset: 1-5min IV
Peak: 15-20min IV
Duration: 6-8hrs
Half-life: 10-20hrs

Seizures, premedication, anxiety, alcohol withdrawal, sedation

Hypersensitivity

AMS, resp depression, amnesia, n/v

Seizure: 4mg IV,IO
Anxiety/premed: 0.5-2mg slow
Sedation: 2-4mg slow q 5-10min
PEDI: 0.05mg/kg slow

May cause CNS/respiratory depression, caution with acute alcohol intoxication

Additive effects with CNS depressants and alcohol

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Atropine Sulfate

Anticholinergic/Parasympatholytic

Inhibits parasympathetic stimulation of SA and AV nodal cells, positive chronotropy, no inotropic effect

Onset: immediate
Peak: 2-4min
Duration: 4hrs
Half-life: 2-3hrs

Symptomatic bradycardia, premedication for RSI, organophosphate poisoning

None

Blurred vision, confusion, dilated pupils, drowsy

Brady: 0.5-1mg IV q3-5 up to 3mg
RSI: 0.5-1mg IV
Organo: 2-5mg IV/IM q20-30 min
PEDI BRADY: 0.02mg/kg (min 0.1mg, max 0.5mg)
PEDI RSI: 0.02mg/kg
PEDI ORGANO: 0.05mg/kg q20-30min

Do not give less than 0.5mg to adults or less than 0.1mg to pedi may cause paradoxical effects, may cause paradoxical slowing or be ineffective if used for 2•typeII or 3rd• heart block, caution with acute MI increases myocardial o2 demand

Few drug interactions

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Diltiazem (Cardizem)

Calcium channel blocker

Inhibits calcium entry and the subsequent interaction between actin and myosin, negative chrono, ino, dromo

Onset: 3min
Peak: 7min
Duration: 1-3hrs
Half-life: 2hrs

Rapid afib/aflutter >150, PSVT refractory to adenosine

Hypotension, decomp cardiogenic shock, vtach, WPW

Bradycardia, heart block, hypotension

1st: 0.25mg/kg slow over 2min
2nd: 0.35mg/kg
Maintenance: 5-15mg/hr
NOT FOR PEDI

Must be discarded after 1mos without refrigeration

Increases risk of bradycardia with beta blockers
I

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Diazepam (Valium)

Benzo/Sedative/Hypnotic/Anticonvulsant

Onset: 1-5min IV, 15-30min IM
Peak: 10min IV, 30-45min IM
Duration: 15-60min
Half-life: 20-50hrs

Anxiety: 2-5mg slow
Seizure: 5-10mg slow
Sedative: 5-15mg slow
PEDI: 0.2mg/kg, max of 5

REFERENCE VERSED FOR REMAINDER

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Dextrose

Carbohydrate

Raises blood glucose by added presence directly into vasculature

Onset: <1min
Peak: varies
Duration: varies
Half-life: n/a

Hypoglycemia, hypoglycemia during neonatal resuscitation (d10)

Hyperglycemia

Tissue necrosis, phlebitis at injection site

Adult: 25g slow IV (d10/d50), until dose yields good mental status
PEDI: 0.5-1g/kg slow (d10/d25)

Local venous irritation, caution with ICP and cerebral edema(hypertonic causes fluid shift), d50 should not be given to children but may be diluted 1:1 with sterile water to make d25

None

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Glucagon (Glucagon emergency kit)

Hormone

liver*glucose release from glycogen polymers
heart*calcium entry from ecf, positive ino, chrono, dromo
esophageal sphincter*SMC relaxation

Onset: 5-20min
Peak: 30min
Duration: 1-2hrs
Half-life: 5-10min

Hypoglycemia with no IV, esophageal food bolus, beta blocker calcium channel blocker OD

Pheochromocytoma, hypersensitive

HA, dizzy, n/v, hypotension

Hypoglycemia/bolus: 1mg IM
OD: 0.1mg/kg up to 5mg
PEDI: 0.02mg/kg IM max 1mg

Only effective if sufficient glycogen stores in liver

None

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Oxytocin (Pitocin)

Hormone

Blank

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Activated Charcoal (Actidose)

Antidote

Blank

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Epinephrine (Adrenalin)

Sympathomimetic/Sympathetic agonist/Catecholamine

A1:calcium release in vsmc causing peripheral vasoconstriction
B1:increased calcium in cardiac cells, positive ino,chrono,dromo
B2:bronchial smooth muscle relaxation

Onset: <5min IV, 20min IM
Duration: 5-10min IV, 20-30min IM
Half-life: 5min IV

Cardiac arrest, anaphylaxis, asthma, sever reactive airway disease, symptomatic bradycardia/hypotension

Tashydysrhythmia

Dysrhythmia, anxiety, ha, tremors

Arrest: 0.5-1mg IV 1:10 q3-5min
Airway: 0.3mg IM 1:1, then 0.1mg 1:10 over 3 min
Brady/hypo: 2-10mcg/min
PEDI arrest: 0.01mg/kg IV 1:10 q3-5min
PEDI airway: 0.01mg/kg 1:1 IM (max 0.3mg), then 0.01mg/kg 1:10 slow IV

Protect from light, caution with CAD and pregnancy; leads to increase myocardial o2 demand

Reacts with calcium and bicarb forming ppt in IV, deactivated by alkaline solutions, pH dependent, effects intensified with anti depressants

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Calcium Chloride

Mineral/Electrolyte

Replaces elemental calcium, positive inotropy and chronotropy

Onset: immediate
Peak: unknown
Duration: varies
Half-life: n/a

Acute hyperkalemia, calcium channel blocker tox, crush syndrome, abd spasm from brown recluse or man of war, arrest with suspected hyperK or dialysis

Hypercalcemia

Bradycardia, dysrhythmia, syncope, arrest

Adult: 1g slow IV over 1min
PEDI: 20mg/kg slow IV

Can cause tissue necrosis at injection site, ensure patent line

Forms PPT with bicarb, digitalis tox with pt’s taking dig

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Sodium Bicarbonate

Alkanilizing agent/Electrolyte

Alkaniline electrolyte that buffers excess H+
H*+HCO3-<>H2CO3<>H2O+CO2

Onset: immediate
Peak: <15min
Duration: 1-2hrs
Half-life: n/a

Metabolic acidosis from OD (asa/tca), arrest with hyperK

Respiratory acidosis

None

1meq/kg IV

Causes metabolic alkalosis in large quantities

Deactivates catecholamines and vasopressors, forms PPT in IV with calcium chloride

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Nitroglycerin (Nitrostat)

Vasodilator/Nitrate

Causes cascade of reactions that reduce intracellular calcium, resulting in VSMC relaxation and decreased preload and after load
*allows blood flow around thrombus to reduce ischemia and reduce CP

Onset: 1-3min SL, 30min topical
Peak: 5-10min SL, varies topical
Duration: 20-30min SL, 3-6hrs topical
Half-life: 1-4min

Chest pain associated with angina or mi, pulmonary edema or CHF

Shock, hypotension, increased ICP, children under 12, ed drugs in 48hrs

Ha, hypotension, dizzy, tachycardia

Spray/tab: 0.4mg SL q3-5min until effect achieved or BP drops (max3x25min)
Paste: 0.5-1 inch topical

Expect ha from vasodilation, routine use may cause tolerance, 12-lead prior use caution with right side mi

Ortho static hypotension with beta blockers, extreme hypotension with alcohol

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Aspirin, acetylsalicylic acid, ASA (Bayer)

Platelet aggregation inhibitor/Anti-inflammatory/ Salicylate

Inhibits platelet aggregation by blocking the formation of thromboxane a2, throm a2 causes platelet aggregation and arterial constriction
*cox inhibitor: reduces spread of inflammation

Onset: 5-30min
Peak: 15-120min
Duration: 1-4hrs
Half-life: 15-20 min

Chest pain suggestive of AMI/ACS

Hypersensitive, active GI bleed

GI bleed, prolonged bleeding, wheezing

Adult: 324mg (81mg baby asa preferred as it can be chewed and swallowed)
NOT FOR PEDI

Can cause GI upset

Enhanced SE with other anti-inflammatories, decreased absorption with antacids

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Amiodarone HCL (Cordarone)

Antidysrhythmic

K+ channel blocker prolongs phase 3 repolarization and refractory period
Na+ channel blocker decreases amplitude of phase 0 depolarization
Non competitive beta blocker/weak calcium channel blocker; negative ino, chrono, dromo

Onset: immediate
Peak: 30-45min
Duration: varies
Half-life: 40-55days

Wide complex tachycardia, VF/vt arrest

Bradycardia, 2nd/3rd degree heart block, hypersensitive

Prolonged pr/qrs/qt intervals, hypotension, bradycardia, dyspnea

Arrest: 300mg IV, repeat 150mg in 3-5 PRN
+pulse: 150mg over 10 min
Maintenance: 1mg/min first six hours then 0.5mg/min
PEDI arrest: 5mg/kg IV, max dose of 300mg, max total of 15mg/kg
PEDI +pulse: 5mg/kg IV over 20-60min, max of 300mg

Caution in pt’s with heart failure

Reduces clearance of digoxin, reduces clearance of warfarin (enhanced anti coagulation), potentials procainamide and quinidine

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Adenosine (Adenocard)

Antidysrhythmic/Nucleoside

Slows AV conduction by inhibiting calcium entry into cardiac pacemaker cells

Onset: immediate
Peak: immediate
Duration: 30-45sec
Half-life: 6sec

PSVT/narrow complex tachy, diagnostic maneuvers, wide regular monomorphic tachy

2nd/3rd degree heart block, sick sinus syndrome, torsades, poison or chemically induced SVT

HA, chest pain, dizziness

1: 6mg rapid IVP proximal vein followed by 20cc flush
2: 12mg
PEDI1: 0.1mg/kg rapid IVP proximal vein (max of 6mg)
PEDI2: 0.2mg/kg (max 12mg)

Begin printing strip prior to admin, caution with asthma/COPD may induce wheezing

Methylxanthines are antagonist or adenosine (double dose), carbamazepines potentiate so halve the dose

Lidocaine (Xylocaine)

Antidysrhythmic

Sodium channel blocker decreases slope and amplitude of phase 0 depolarization in action potential

Onset: s +70 or hepatic failure

Potentiates procainamide and beta blockers

Metoprolol (Lopressor)

Beta blocker

Beta1 R antagonist; inhibits calcium entry into cardiac cells; -ino, chrono, dromo

Onset: immediate
Peak: 20min
Duration: 13-19hrs
Half-life: 3-4hrs

Afib/aflutter >150, SVT refractory to adenosine

Hypotension, decompensated cardiogenic shock

Bradycardia, hypotension, wheezing, dyspnea

Adult: 5mg slow IV q5min, max 15mg
PEDI: not for pedi

May exacerbate COPD/asthma/bronchospasm/CHF

Dont give to pt’s on calcium channel blockers, additive effects with digoxin

Procainamide (Pronestyl)

Antidysrhythmic

Sodium channel blocker decreases slope and amplitude of phase 0 depolarization action potential

Onset: 10-30min
Peak: 15-20min
Duration: 3-6hrs
Half-life: 3hrs

Persistent VF/VT arrest refractory to lidocaine

PVC’s with bradycardia, sever conduction disturbances (2/3 degree heart blocks)

Resp/cardiac arrest, bradycardia, hypotension, seizures

Adult: 100mg infusion over 5min, maintenance 1-4mg/min
PEDI: 15mg/kg IV over 30-60min

D/C if: dysrhythmia is suppressed, hypotension occurs, QRS widens by 50%, 17mg/kg has been administered

Chance of neurotoxicity increases with lidocaine

Vasopressin (Pitressin)

Hormone/Vasopressor

Calcium release into VSMC causes sustained VSMC contractions leading to vasoconstriction

Onset: varies
Peak: varies
Duration: 30-60min
Half-life: 10-20min

Cardiac arrest

None in cardiac arrest

Minor dysthymia, HTN, bradycardia

Adult: 40units IV, single dose only to replace 1st/2nd epi dose
PEDI: not for pedi

May vasoconstriction of coronary arteries leading to increased myocardial o2 demand

None in acls

Dopamine HCL (Intropin)

Sympathomimetic/Sympathetic agonist/Catecholamine

A1 agonist: calcium release in VSMC leading to peripheral vasoconstriction
B1 agonist: increased calcium in cardiac cells, +ino, chrono, dromo
(moa is dose dependent)

Onset: <10min
Half-life: 2min

Cardiogenic shock, symptomatic bradycardia, septic shock following fluid resuscitation

Hypovolemia

Chest pain, dyspnea, palpitations, dysrhythmia

Adult: 2-5mcg/kg/min IV increases blood flow to mesentary and renal
Adult: 5-10mcg/kg/min stimulates beta
Adult: 10-20mcg/kg/min stimulates alpha
PEDI: 2-20mcg/kg/min IV infusion

Keep out of sunlight

Hypotension with Dilantin, deactivated by alkaline solutions and MAOI

Furosemide (Lasix)

Loop diuretic

decreased intracellular calcium and VSMC relaxation; venous dilation and reduced preload
impacts osmotic gradient in loop of Henley by inhibiting sodium and chloride re absorption, thus reducing water re absorption in kidneys

Onset: 5-10min vasodilate, 5-30min diuresis
Peak: 30min vasodilate, 20-60min diuresis
Duration: 2hrs vasodilate, 6hra diuresis
Half-life: 30min

Pulmonary edema from CHF

Pregnancy

Potassium depletion, dysrhythmia, dehydration, volume depletion, hypotension

Adult: 40mg slow IV; if pt takes Lasix daily including today, give their dose, if no Lasix today double dose
PEDI: 0.5-1mg/kg slow IVP (not for pedi under 12)

Protect from sunlight, caution with renal failure and sulfa allergy

May cause additive effects and/or electrolyte imbalance

Morphine Sulfate

Opiate analgesic

Decreased release of neurotransmitters and hyperpolarization of inter neurons responsible for transmission of pain impulse to brain

Onset: immediate IV, 15-30min IM
Peak: 20min IV, 30-60min IM
Duration: 2-7hrs
Half-life: 1-7hrs

Sever pain

Hypotension, head trauma with AMS

N/V, abd cramps, constricted pupils

Adult: 0.1mg/kg slow IV/IM (2mg/min), max single dose 10mg, q10min up to 3 doses (0.05mg/kg for >65)
PEDI: 0.1mg/kg slow IV/IM

Reduces chemoreceptors responsiveness to co2 may lead to respiratory depression

Additive CNS depression with antihistamines, antiemetics, sedatives, hypnotics, barbituates, ETOH

Ondansetron (Zofran)

Antiemetic

Blocks serotonin binding at vagal nerve and inhibits vomiting reflex

Onset: rapid
Peak: 15-30min
Duration: 4-8hrs
Half-life: 4hrs

N/V

Hypersensitivity

Prolonged QT, ha, dizziness

Adult: 4mg slow IV, may repeat once
PEDI: 0.1mg/kg (max 4mg), slow IV

Lower risk of sedation/dystonia than other antiemetics

Few drug interactions

Diphenhydramine (Benadryl) Antihistamine

Blocks histamine release and suppresses central cholinergic activity reducing bronchoconstriction, vasodilation, and vascular permeability Onset: 10-15min IV, 15-30min PO Peak: 1-4hrs Duration: 6-8hrs Half-life: 1-4hrs Allergic reaction, anaphylaxis, dystonia Hypersensitivity Dries bronchial secretion, drowsy, sedation, palpitation, HTN ADULT: 25-50mg IV, IM, PO PEDI: 1mg/kg IV, IM, PO (max 50mg) Caution with liver disease and acute asthma Potentiates sedative effects of ETOH, benzo, MAOI, CNS depressants

Albutetol Sulfate (Proventil, Proair) Sympathomimetic/sympathetic agonist (beta2 selective)

Beta2 agonist promotes sympathetic stimulation of bronchial SMC causing bronchodilation Onset: 5-15min Peak: 1-1.5hrs Duration: 3-6hrs Half-life: <3hrs Bronchospasm associated with COPD, asthma, allergic reaction, anaphylaxis Symptomatic tachycardia, hypersensitive Chest pain, dysrhythmia, anxiety, HTN SVN: 2.5mg in 2.5ml NS nebulized with o2 8lpm May worsen cardiac asthma and precipitate dysrhythmias, consider 12-lead with associated CP SE may increase with other sympathetic agonist, beta blockers may blunt effects

Ipratropium Bromide (Atrovent) Anticholinergic/Parasympatholytic

Inhibits parasympathetic stimulation of bronchial SMC, sub mucosal glands, and goblet cells; dries respiratory secretions allowing for bronchodilation Onset: varies Peak: 1.5-2hrs Duration: 4-6hrs Half-life: 1.5-2hrs Asthma, COPD Hypersensitivity to atropine, hypersensitivity HA, palpitations, anxiety, n/v SVN: 500mcg Typically administered with beta agonist None

Magnesium sulfate Electrolyte/Antidysrhythmic

* SMC* calcium channel blocker: inhibits calcium entry causing smooth muscle relaxation and dilation of blood vessels and bronchial tree * Cardiac* calcium channel blocker: negative ino, chrono, dromo Onset: immediate IV, 1hr IM Peak: varies Duration: 1hr Half-life: Na Sever asthma/bronchospasm, refractory VF or pulse less VT (hypomagnesium; torsades), eclampsia 3rd degree heart block, hypotension Bradycardia, hypotension, dysrhythmia, resp. depression Asthma: 2g in 100cc over 10min IV -pulse: 2g over 1-2 min IV +pulse: 1-2g in 50-100cc over 5-60min Eclampsia: 4g in 20ml over 5min IV PEDI asthma: 25-50mg/kg over 15-30min IV, max 2g PEDI -pulse: 25-50mg/kg IV, max 2g PEDI +pulse: 25-50mg/kg over 10-20min IV, max 2g Caution with impaired renal function, watch for resp. depression Cardiac conduction abnormalities with digitalis

Methylprednisolone (Solu-medrol) Corticosteroid/Anti-inflammatory

Binds to DNA to increase synthesis of proteins and enzymes that inhibit inflammatory agents, is an immunosuppressant Onset: 2-6hrs Peak: 4-8days Duration: 1-5weeks Half-life: 3.5hrs Allergic reaction/anaphylaxis, asthma, COPD None Fluid retention, abd distention, HTN, CHF Adult: 125mg slow IVP PEDI: 2mg/kg slow IVP, max 125mg Only one dose prehospital long term use causes GI bleeding, prolonged wound healing, suppression of adrenocortical steroids Lasix and diuretics increase potassium excretion

Racemic Epinephrine (Vaponephrine) Sympathomimetic

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Acetaminophen (Tylenol) Antipyretic/Analgesic

Elevation of pain threshold, antipyretic by action on hypothalamic heat regulatory center of brain Onset: 15-30min Peak: 30-120min Duration: 3-4hrs Half-life: 1-3hrs Pediatric fever Hypersensitivity Hypoglycemia, abd pain, n/v PEDI: 15mg/kg PO q4-6hrs PRN, max of 4g/day Metabolized by liver-od can be toxic, does not have peripheral anti-inflammatory effect Chronic etoh abuse increases risk of hapatotoxicity

Thiamine Vitamin

Corrects thiamine deficiency associated with malabsorption due to etoh abuse, allows for glucose utilization Onset: rapid Peak: varies Duration: varies Half-life: Na Hypoglycemia with chronic etoh None Dyspnea, hypotension, n/v 100mg IV/IM None None

Metoclopramide (Reglan) Antiemetic

Inhibits coms between chemoreceptors and the vomiting center in the brain, increases motility of stomach contents Onset: 1-3min IV, 10-15min IM Peak: 1-2hrs Duration: 1-3hrs Half-life: 2.5-6hrs Nausea/vomiting GI hemorrhage/bowel obstruction/perforation, seizure disorder, pheochromocytoma, hypersensitive CNS depression, sedation, HTN, hypotension, brady, tachy Adult: 10mg slow IV over 1-2min; 10-20mg IM PEDI: not for pedi May cause dystonia Additive effects with CNS depressants, opposed by anticholinergics such as atropine

Promethazine (phenergan) Antiemetic/Anticholinergic

Inhibits coms between chemoreceptors and vomiting center of brain Onset: 5min IV, 20min IM Peak: varies Duration: 4-6hrs Half-life: 10-14 hrs Nausea/vomiting Hypersensitivity Sedation, tachy, brady Adult: 12.5-25mg IV/IM PEDI: 0.5mg/kg May cause CNS depression or dystonia Potentiates CNS depressants, increased dystonia with MAOI

Naloxone (Narcan) Narcotic antagonist/antidote

Opiate R antagonist; displaces narcotic molecules from binding site Onset: <2min IV, 2-10min IM Duration: 20-120min Half-life: 60-90min Coma of unknown origin, r/o polypharmacy OD, reverse respiratory depression from narc/opiates Hypersensitivity Ventricular dusrhythmia, seizure, n/v Adult: 0.4-2mg q2-3min IV/IM/IN until respiratory status improves PEDI: 0.1mg/kg IV/IM/IN, max 2mg/dose Caution not to induce withdrawal, including infants with addicted mothers May induce withdrawal on dependent pt

Amyl Nitrate Antidote/Nitrate vasodilator

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Olanzapine (Zyprexa) Antipsychotic

Antipsychotic and Anticholinergic effects Onset: s disease, must reconstitute with 3ml sterile water Potentiates hypotension effects of anti hypertensives

Haloperidol (Haldol) Neuroleptic/butyrophenone antipsychotic

Depresses reticular activating system; affecting basal metabolism, body temp, wakefulness, vasomotor tone, emesis Onset: 30-45min Peak: 10-20min Duration: varies Half-life: 3-35 hrs Acute psychotic episode CNS depression, agitation secondary to shock or hypoxia EPS, resp depression, prolonged QT, torsades Adult: 5mg IM q4-8hrs PRN PEDI: 1-3mg IM q4-8hrs, max 0.15mg/kg/day Impairs physical/mental abilities, orthostatic hypotension, EPS or dystonic reactions Increased chance of hypotension with anti hypertensives, additive effects with depressants and other anti psychotics, caution in pt's taking lithium-may cause encephalopathic syndrome (irreversible brain damage)