PCIII Pharm List (OSP) Flashcards
Activated Charcoal*
Brand Name: Activated Charcoal
Classification: Absorbent
Action: A liquid suspension that adsorbs drugs and chemicals. It acts by binding / adsorbing toxic substances, thereby inhibiting their GI absorption, uptake into the liver, and thus, their presence in the bloodstream for action, also called “bioavailability”
Indications: Poisonings (including: acetaminophen, aspirin, atropine, barbiturates, digitalis, glycosides, phenytoin, propoxyphene, strychnine, and tricyclic antidepressants, among many others)
Contraindications: Poisoning via: (cyanide, mineral acids, caustic alkalis, organic solvents, iron, ethanol, and methanol) ; altered mental status, dysphagia, or vomiting
Dose: 1 gram/kg
Routes: PO
Adverse Effects: Nausea, vomiting, aspiration, constipation, black stool
Other: not frequently used (requires authorization by OLMC or OK Poison Center if transport is more that 30min)
Pharmacokinetics: Nonabsorbed; onset immediate; peak, duration, and half – life: unknown.
How Supplied: 25 grams of activated charcoal in aqueous suspension in bottle.
Dextrose 10% & 50%*
Brand Name: Dextrose, 10% & 50%
Classification: Carbohydrate
Action: Dextrose is the principal form of glucose used by the body to create energy and support critical metabolic processes
Indications: Anything that may indicate Hypoglycemia (<50mg/dL) (Respiratory Arrest, Specific Cause of Cardiac Arrest, Altered Mental Status, Seizure, Syncope, Dystonic Reaction, Behavioral Disorder, Poisonings, Dialysis Related Issues, Complications of Pregnancy)
Contraindications: Hyper/Normoglycemia
Dose:
Adult (pt weight >25) (D50) 1 mL/kg IVP up to 50 mL
Ped (pt weight <25(D25) 2 mL/kg IVP up to 50 mL
Adverse Effects: : Warmth, pain, or burning at the injection site. D50 extravasation can cause tissue necrosis, phlebitis, sclerosis, or thrombosis at the injection site.
Other: D50/25 should be administered using an INFUSING IV, NOT a saline lock. NO DIRECT IV PUSH
Pharmacokinetics: Onset with 60 seconds after IVP with peak effect and duration of action dependent upon degree and cause of hypoglycemia. Usually effective duration in excess of 30 minutes.
How Supplied:
Prefilled syringes of D50 - 25 grams dextrose in 50 mL of water (0.5 gram/mL)
Prefilled syringes of D25 - 2.5 grams dextrose in 10 mL of water (0.25 gram/mL)
Diazepam*
Brand Name: Valium
Classification: Benzodiazepine (Schedule IV)
(Sedative; Anticonvulsant; Muscle Relaxant; Anxiolytic)
Action: Binds to Type A GABA receptors, causing sedation ; it has no effect on pain. (Diazepam has considerably more muscle relaxant properties than midazolam, though no substantial amnestic effects as with midazolam)
Indications:
- Post RSI Sedation (onset delay does not favor pre
intubation use)
- Seizure (Midazolam preferred due to faster onset)
- Dystonic Reactions
- Chemical Restraint (Midazolam preferred due to faster
onset)
- Poisonings (Suspected stimulant toxicity)
- Head/Neck/Spine Injury (Midazolam preferred due to
faster onset)
- Heat Illness (Midazolam preferred due to faster onset)
Contraindications:
- Hypersensitivity
- Acute narrow - angle glaucoma, shock, or coma.
- Caution with use in patients with COPD, chronic
hepatic or renal failure, CHF, acute alcohol
intoxication, and the elderly due to increased risk of
respiratory depression.
Dose/Route :
- Post RSI Sedation (Adult)
0.1 mg/kg to max 5 mg IVP/IOP,
may repeat once if systolic BP > 100 mmHg
- Seizure ; Head/Neck/Spine Injury ; Heat Illness (Adult)
5 mg IVP/IOP or 10 mg IM for active seizure
May repeat once in 5 minutes if still seizing - Dystonic Reactions (Adult) 5mg IVP
- Chemical Restraint (Adult) 5mg IVP/IOP or 10 mg IM
- Poisoning (Susp Stimulant Toxic)(Adult) 2.5-5 mg IVP
Adverse Effects: Headache, euphoria, drowsiness, excessive sedation, confusion, dizziness, blurred vision, diplopia, nystagmus, respiratory arrest, hypotension, nausea, vomiting.
Pharmacokinetics: Onset is 3-5 minutes, IVP/IOP;
15-30 minutes IM with erratic absorption, mandating IM dosing only utilized as a last option in adults; peak effects in 15-45 minutes. Duration is 2+ hours IVP/IOP/IM; half – life can reach 20 – 50 hours
How Supplied: 10 mg/2 mL in vials, ampules, or pre-filled syringes.
Other: Incompatible with other medication because it is not water soluble. Can cause irritation with injection. Flumazenil is an antagonist
Diphenhydramine*
Brand Name: Benadryl
Classification: Antihistamine, Anticholinergic
Action: Competes for H1 - histamine receptor sites on
effector cells, thus blocking histamine release
Indications: Dystonic Reactions, Acute Allergic Reactions, Bee/Wasp Stings
Contraindications: Hypersensitivity
Dose: 50mg IV/IM (25-50PO but that not in protocol)
Adverse Effects: Drowsiness, dizziness, disturbed coordination.
Pharmacokinetics: Onset within 15 – 30 minutes; duration is approximately 6 hours
How Supplied: 50 mg/1 mL in vial, ampule, or pre-filled syringe.
Duo Dote Auto Injector*
Brand Name: Duo Dote Auto Injector
Class: Parasympatholytic & Cholinesterase Reactivator
Actions/Pharmacodynamics:
Atropine - Blocks parasympathetic impulses to the heart via the vagus nerve. Atropine increases the rate of cardiac sinoatrial (SA) node discharges, enhances conduction through the atrioventricular (AV) node, and by increasing heart rate, increases the cardiac output and blood pressure. Additionally, in the treatment of indicated poisonings (organophosphates, nerve agents), atropine reverses muscarinic effects of acetylcholine Atropine produces dilation of pupils by blocking stimulation of the ciliary muscle surrounding the pupils.
Pralidoxime chloride - reactivates cholinesterase (mainly outside the central nervous system) which has been inactivated by an organophosphate pesticide. The destruction of accumulated acetylcholine can then proceed and neuromuscular junctions will regain function. Pralidoxime chloride has its most critical effect in reversing paralysis of the muscles of respiration. Because Pralidoxime Chloride is less effective in relieving depression of the respiratory center, atropine is always required concomitantly to block the effect of accumulated acetylcholine at the site. Pralidoxime Chloride is short acting and repeated doses may be needed, especially when there is evidence of continuing toxicity.
Indications: Nerve Agents
Contraindications: None
Pharmacokinetics: With IM autoinjector use in nerve agent poisoning, effects may not be observed for 3-5+ minutes. Beneficial effects can persist in excess of 1hr
Side Effects: Headache, dizziness, vision changes (blurry vision and photophobia) due to papillary dilation, loss of coordination, laryngospasm, tachycardia, hypertension, palpitations, dry mouth.
Dosage: Adult (> 12 years of age) 2.1 mg atropine/ 600 mg pralidoxime IM
*May repeat every 5-15 minutes to cumulative maximum dose of 6.3 mg/1800 mg.
(In the setting of serious symptoms (cardiopulmonary distress), repeat doses in rapid succession.)
How Supplied: DuoDote® autoinjector
Special Comments: Ideally, every public safety professional should have ready access to THREE DuoDote® autoinjectors for self/buddy use should emergent conditions warrant. In the setting of suspected/actual nerve agent exposure, administration of the DuoDote® autoinjector(s) must occur within minutes of exposure for clinically effective results.
Epinephrine 1 : 1k & 1 : 10k*
Class: Vasoconstrictor, Bronchodilator (Catecholamine)
Actions: Stimulates alpha receptors in the peripheral vasculature, producing vasoconstriction-related increases in systemic blood pressure. Stimulates beta-1 receptors in the myocardium, producing increases in heart rate, myocardial contraction, and as a result, cardiac output. Stimulates beta-2 receptors in the lower respiratory tract smooth musculature, producing bronchodilation.
Indications: Dyspnea/Asthma (Severe & Refractory to Nebulization) , Asystole, V-Fib, Pulseless V-Tach, Pulseless Electrical Activity, Bradycardia (Pediatric), Anaphylaxis
Contraindications: None
Pharmacokinetics: Onset within 2 minutes after IVP/IOP; within 5-10 minutes after IM.
Duration of effect ranges from 3-5 minutes after IVP/IOP to upwards of 30 minutes after IM.
Side Effects: Restlessness, anxiety, generalized tremors, headache, dizziness, chest pain, palpitations,
hypertension, premature ventricular contractions, tachycardia.
Dose:
Anaphylaxis (Adult) 1:1000 0.5 mg IM
If anaphylaxis refractory to above IM dose:
1:10,000 1 mg slow IVP/IOP over 3 minutes
Dyspnea/Asthma (Adult) 1:1000 0.3 mg IM
**OLMC Order Required if pt ≥ 50 years old, heart illness history, or blood pressure > 140/90 mmHg.
Asystole/V-Fib/Pulseless V-Tach/Pulseless Electrical Activity - 1:10,000 1 mg IVP/IOP
Repeat every 3 - 5 minutes while resuscitating cardiac arrest
How Supplied:
Epinephrine 1:1000 in 1 mg/1mL ampules or 30 mg/30 mL vial
Epinephrine 1:10,000 in 1 mg/10 mL prefilled syringes
Epinephrine Auto Injector*
Brand Name: EPIPEN, Auvi-Q
Classification: Vasoconstrictor, Bronchodilator (Catecholamine)
Action: Stimulates alpha receptors in the peripheral vasculature, producing vasoconstriction-related increases in systemic blood pressure. Stimulates beta-1
receptors in the myocardium, producing increases in heart rate, myocardial contraction, and as a result, cardiac output. Stimulates beta-2 receptors in the lower respiratory tract smooth musculature, producing bronchodilation
Indications: Dyspnea/Asthma, Anaphylaxis
Contraindications: None
Dose: 0.3 mg of Epinephrine 1:1000 (adult)
0.15 mg of Epinephrine 1:1000 (ped)
Routes: IM lateral thigh
Adverse Effects: : Restlessness, anxiety, generalized tremors, headache, dizziness, chest pain, palpitations, hypertension, premature ventricular contractions, tachycardia
Other: massage injection site for 15 to 30 seconds to improve epinephrine absorption ; *OLMC Order required if heart illness history or blood pressure > 140/90mmHg
Pharmacokinetics: Onset of action within 5-10 minutes after IM administration. Duration of effect may range upwards of 30 minutes intramuscularly
Etomidate*
Brand Name: Amidate
Classification: Sedative/hypnotic (Non-barbiturate, non-benzodiazepine, non-narcotic)
Action: Appears to modulate GABA receptors ; Etomidate is an intravenous hypnotic drug without analgesia. Etomidate is safe to use in patients with cardiac illness and patients with traumatic injuries. Etomidate has little to no effect upon myocardial metabolism, cardiac output, or peripheral circulation. Etomidate has been shown to reduce cerebral blood flow, cerebral oxygen consumption, and intracranial pressure – helpful in head injury situations.
Indications: Sedation for RSI
Contraindications: History of Hypersensitivity
Dose: 0.3 mg/kg IVP/IOP over 15-30 seconds, given just prior to intubation
Routes: IV
Pharmacokinetics: Rapid onset of action, seen as desired sedation within as little as 10-15 seconds, but nearly always within less than 1 minute. Duration of action, based upon a standard dose of 0.3 mg/kg (70 kg adult dose of 20 mg) is 5-15 minutes.
Adverse Effects: Transient skeletal muscle movements, called (Myoclonic jerks), Transient venous pain at injection site, Nausea and/or vomiting, hypoventilation and apnea (very rare), hypotension on rapid push (rare)
How Supplied: 40 mg/20 mL (2 mg/mL) vial or pre-filled syringe
Other: Repeated doses of etomidate should be avoided to minimize its effect upon adrenal function. Repeated doses and continuous infusions of etomidate have been linked to adrenal suppression.
Fentanyl*
Brand Name: Sublimaze
Classification: Narcotic analgesic (opioid) (Schedule II)
Action: Stimulates central nervous system opiate receptors, producing systemic analgesia. Fentanyl is 50-100 times more potent than morphine but shorter lasting. An IV dose of 100 mcg of fentanyl is roughly equivalent to an IV dose of 10 mg of morphine. Fentanyl has less emetic effects than other narcotic analgesics.
Indications: acute pain in alert, hemodynamically stable patient
Contraindications: Hypersensitivity, Hypotension
Respiratory Depression, Minor Degrees of Pain
Dose: (ADULT) For acute pain - 1 mcg/kg slow IVP/IM/IN, maximum single dose of 100 mcg
*May repeat every 10 minutes to a maximum cumulative dose of 3 mcg/kg or 250 mcg, whichever is lesser
For unknown chest pain or acute coronary syndrome - 0.5 mcg/kg slow IVP/IM/IN, maximum single dose of 50 mcg
**May repeat every 10 minutes to a maximum cumulative dose of 1.5 mcg/kg or 125 mcg, whichever is lesser
Pharmacokinetics: Onset of action nearly immediate after IV administration. Peak effects occur within 3 – 5 minutes. Duration of effect is 30 - 60 minutes, with a half-life of 6 – 8 hours
Adverse Effects: Hypotension, respiratory depression, euphoria, dizziness. Nausea and/or vomiting if rapid IV push
Other: Use Appropriate monitors. Naloxone is an antagonist
How Supplied:
100 mcg/2 mL (50 mcg/mL) ampule, vial, or pre-filled syringe
250 mcg/5 mL (50 mcg/mL) ampule or vial
500 mcg/10 mL (50 mcg/mL) vial
Glucagon*
Brand Name: Glucagon
Classification: Hormone (glucagon)
Action: It is a hormone produced in the pancreas. When released in times of hypoglycemia, it causes a breakdown of glycogen (stored in the liver) to
glucose and inhibits the subsequent synthesis of glycogen from circulating glucose, increasing glucose levels. Glucagon also increases heart rate, myocardial contractility and improves AV conduction in a manner similar to that produced by catecholamines. Its actions are independent of beta blockade and therefore may be useful via IV/IO administration by paramedics for reversing cardiovascular collapse effects of suspected beta blocker toxicity.
Indications: Hypoglycemia (<50 mg/dL) without ability to safely administer oral glucose (due to aspiration concern) and without ability to establish IV and Beta-blocker overdose
Contraindications: Hypersensitivity
Dose: 1.0 mg (IM/IV/IO) adult >25kg
Pharmacokinetics: Onset 5 – 20 minutes; peak effects in 30 minutes; duration is 1 – 1.5 hours
Adverse Effects: Dizziness, headache, nausea/vomiting, hyperglycemia.
Other: Less effective in patients with decreased glycogen stores (e.g., alcoholics)
How Supplied: 1 mg dry powder in vial with 1 mL of diluting solute for reconstitution
Oral Glucose (Insta-Glucose)*
Brand Name: Oral Glucose
Classification: Carbohydrate
Action: Increases Blood Glucose levels
Indications: Conscious patient with suspected hypoglycemia
Contraindications: Decreased LOC, Nausea, Vomiting, cannot follow commands
Dose: 15 grams (1 tube) PO or SL for blood glucose < 50 mg/dL (adult) ; for pediatrics use HALF dosage
Pharmacokinetics: Onset of effect within several minutes of oral dosing. Duration of effect up to 30+ minutes, but patient should be advised to consume complex carbohydrates within minutes of restoration of normal blood sugar, unless otherwise contraindicated.
Adverse Effects: None
How Supplied: 15 grams of glucose for oral administration in a squeeze tube container.
Haloperidol*
Brand Name: Haldol
Classification: Antipsychotic
Action: A potent, long – acting antipsychotic agent. While its exact mechanism is unclear, it appears to block the dopamine receptors in the brain associated with mood and behavior. It exerts strong antiemetic effects and impairs central thermoregulation. It also produces weak central anticholinergic effects and transient orthostatic hypotension.
Indications: Chemical Restraint
Contraindications: Known hypersensitivity, Behavioral disorder etiology easily reversed (eg. hypoglycemia), Minor degrees of agitation, Parkinson’s disease, Known seizure disorders (lowers seizure threshold)
Dose: 5 mg IM (deep IM, lateral thigh if possible)
Adverse Effects: Extrapyramidal reactions, insomnia, restlessness, dry mouth, hypotension, tachycardia
Other: Dystonic reactions are common with haloperidol; diphenhydramine should be readily available
How Supplied: 5 mg/1 mL vial.
Hydromorphone*
Brand Name: Dilaudid
Classification: Narcotic analgesic (opioid) (Schedule II)
Action: Stimulates central nervous system opiate receptors, producing systemic analgesia. Modest vasodilation effects increase peripheral venous capacitance, and reduce venous return, myocardial workload, and myocardial oxygen demand. Hydromorphone is roughly 10 times more potent than morphine. An IV dose of 1 mg of hydromorphone is equivalent to an IV dose of 10 mg of morphine.
Indications: Acute pain control in alert, hemodynamically stable patient
Contraindications: Hypersensitivity, Hypotension, Respiratory Depression, Minor Degrees of Pain
Dose: For acute pain give 0.5 – 1 mg slow IVP
May repeat every 10 minutes to a maximum cumulative dose of 2 mg
For Unknown Chest Pain or Acute Coronary Syndrome give 0.25 mg slow IVP
May repeat every 10 minutes to a maximum cumulative dose of 1 mg
Routes: IV, IO, IM, SQ, PO
Pharmacokinetics: Onset of action within 5-10 minutes after IV administration. Duration of effect can reach 4 - 6 hours depending upon end-organ function.
Adverse Effects: Hypotension, respiratory depression, euphoria, dizziness. Nausea and/or vomiting if pushed fast b/c it causes a histamine release
Other: Use appropriate monitors. Naloxone is an antagonist
How Supplied: 2 mg/1 mL vial or pre-filled syringe
Hydroxocobalamin*
Brand Name: Cyanokit
Classification: cyanide antidote
Action: chelates cyanide from cytochrome oxidase forming cyanocobalamin (Vitamin B12)
Indications: cyanide or suspected cyanide poisoning
Contraindications: none in the emergency setting
Dose: 5 grams IVPB in 15 minutes (adult)
Pharmacokinetics: Near immediate onset of action following IVPB initiation. Effect is seen for hours, with duration of action seen predominantly in the first 24 hours following administration, but measurable for days.
Adverse: Redness of skin and mucous membranes, headache, dizziness, restlessness, eye irritation, throat irritation, dyspnea, pulmonary edema, chest tightness, hypertension, tachycardia, palpitations, nausea, vomiting, diarrhea, abdominal pain, dysphagia, red urine, and hives.
Other: Multiple drug-drug incompatibilities exist with hydroxocobalamin. Use a separate IV line for the administration of hydroxocobalamin.
Lactated Ringer’s (Hartman’s Solution)*
Brand Name: Lactated Ringer’s
CLASS: Isotonic electrolyte
ACTIONS:
• Fluid replacement or resuscitation.
• Often used in conjunction with Normal Saline
INDICATIONS:
• Hypovolemia
• Burns (usually used in conjunction with Normal Saline).
• Heat related illnesses
• Shock resuscitation (medical or traumatic)
CONTRAINDICATIONS:
• Do not use in the setting of possible lactic acidosis
SPECIAL NOTES:
• Do not administer through the same administration set
as blood, the relatively high calcium content may
precipitate coagulation.
• Due to relatively high calcium content, is
incompatible with some IV medications.
• Monitor for circulatory overload.
ADVERSE REACTIONS: • Rare, but may include • febrile response • infection • venous thrombosis or phlebitis • extravasation • hypervolemia.
ROUTE: IV infusion.
ADULT DOSAGE:
• Dependent upon clinical condition.
• Refer to specific protocol
PEDIATRIC DOSAGE: Same as adult.
