PHARM 1st semester Drugs Flashcards
!!!(Adenosine) Class:
Dynamics:
Administering notes:
= Nucleoside, Misc/ Antiarrhythmic
= binds to adenosine A1 receptors thus efflux of K & inhibits Ca influx (in AR cells), thus hyperpolarization/slows AV of ARcells (SA/AV node)
= rapid IVP followed by rapid flush(20ml) & can be accomplished best w/ utilizing 3-way stopcock
!!!(Adenosine) Indications:
Contra:
Side Effects:
1st dose:
2nd dose:
Dosage note:
= 1st line med w/ stable narrow complex SVT, Regular & monomorphic wide-complex tachycardia thought from reentry SVT (SVT w/ BBB)
= A-fib/ A-flutter, Torsades de pointes, Poison/drug-induced T-cardia, 2/3rd AVB, WPW, DOESNT CONVERT A-FIB/FLUTTER
= small period asystole & ventricular ectopy are common after admin
= 6mg rapid IV/O push followed w/ rapid flush of fluid
= 12mg rapid IV/O push followed w/ rapid flush of fluid
= half 1st dose in PTs receiving dipyridamole or carbamazepine, heart transplant, Or if by central access
!!!(Albuterol) Class:
Dynamics:
Indi:
Contra:
= B/Adrenergic agonist
= B agonist w/ preference for B2 receptors
= Bronchospasm, Allergies/anaphylaxis, Hyperkalemia
= hypersensitivity
!!!(Albuterol) Effects:
Adult Dose:
Pedi Dose:
= Palpitations, Anxiety, Jitters, H/A, Dizziness, Tachycardia
= 2.5mg/3ml SVN: Every 15-20 Mins as needed
= 1.25-2.5mg/1.5-3mL SVN: Every 15-20 Mins as needed
!!!(Amiodarone) Class:
Dynamics:
Indi:
B/c its toxicity indi:
W/ expert consultation may be used for:
Terminal elimination:
= Class III antiarrhythmic
= Slows K+ efflux delaying repolarization
= VF/Pulseless VT-no/response to shock CPR & Epi, Recurrent hemodynamically unstable VT w/ pulse
= PT w/ life-threatening arrhythmias w/ monitoring
= some atrial & ventricular rhythms w/ life-threatening hypoBP
= Extremely long (half-life lasts max 40 days)
!!!(Amiodarone) Contra:
Effects:
Caution b/c:
= Allergic, Bradycardias w/ AV blocks, Breastfeeding mothers
= Severe hypotension, Bradycardia, Prolong QT which can lead to TdP
= Toxicity, Causes severe BP drop, Prolong QT which can lead to TdP
!!!(Amiodarone) Max total dose per day:
Slow Infusion dose:
Maintenance Infusion dose:
VF/Pulseless & VT Cardiac Arrest Unresponsive 1st Dosage:
VF/Pulseless & VT Cardiac Arrest Unresponsive 2nd Dosage:
Life-Threatening Arrhythmia 1st Dosage:
Life-Threatening Arrhythmia 2nd Dosage:
= 2.2 grams
= 360 mg IV 6Hrs (1mg/min)
= 540 mg IV 18Hrs (0.5 mg/min)
= 1st Dose: 300 mg IV/O push
= 2nd Dose: 150 mg IV/O push if needed
= 1st Dose: Rapid Infusion 150 mg/10 mins (15 mg/min)
= 2nd Dose: 150mg/10 mins (15 mg/min) if needed
!!!(Atropine) Class:
Dynamics:
= Parasympatholytic
= Selectively blocks M-receptors inhibiting PSNS thus SNS takes over
!!!(Atropine) Ind:
Contra:
Caution w/ b/c med:
= 1st line med for sinus Bcardia, Maybe beneficial w/ AV nodal block, Organophosphate poisoning
=Allergic, caution w/ H. ischemia, hypothermBcardia (<84) <0.5mg dose make Parasympathomimetic effects
= Myocardial ischemia & hypoxia b/c med +myocardial O2 demands
!!!(Atropine) Effects:
Max dose:
Bradycardia (w/ or w/o ACS) dose:
Severe clinical conditions dose:
Organophosphate Poisoning Dose:
= Blurred vision, Dry mouth, Mydriasis, Confusion
= 0.04 mg/kg or 3 mg
= 1 mg IVP 3-5 mins as needed w/ max dose 3mg or 0.04 mg/kg
= 1 mg IVP every 3 mins w/ max dose 3mg or 0.04 mg/kg
= 2-4 mg (or higher) IVP
!!!(Ipratropium/Atrovent) Class:
Dynamics:
Indi:
Contra:
= Selective-Parasympatholytic
= Anticholinergic Selectively block M-receptors: Synergism w/ Albuterol
= Bronchospasm w/ obstructive lung-disease (asthma,COPD)
= hypersensitivity, No/Lil effect given by itself
!!!(Ipratropium/Atrovent) Effects:
Adult Dose:
Pedi Dose:
= Blurry-vision, Dry mouth, Dilated pupils, Dry Cough, Confusion
= 500 mcg/2.5 mL via neb
= 250-500 mcg/1.25-2.5 mL via neb
!!!(Dextrose) Class:
Dynamics:
Indi:
Contra:
Effects:
= Carbohydrate
= Water-soluble monosaccharide
= Correction of hypoglycemia
= Known hyperglycemia
= Tissue necrosis w/ extravasation, May worsen hyperglycemia
!!!(Dextrose) Adult Dose:
Pedi Dose:
= 25G IV/IO or D10 in 50 mL(5G) IV/IO boluses (max 250 mL)
= 5-10 mL’s/kg of D10
!!!(Diltiazem) Class:
Dynamics:
Indi:
Contra:
= Class IV Antiarrhythmic (Ca Channel Blocker)
= Slows AP of autorhythmic cells by blocking Ca-channels
= 1st line med for A-Fib/Flutter with RVR (>150BPM), 2nd line med for SVT after adenosine admin/
= SBP<90, CHF/Cardio Shock, Wide-Complex T/cardia, WPW, Hypersensitivity
!!!(Diltiazem) Effects:
1st dose:
2nd dose:
= HypoBP, Severe CHF used w/ Beta-Blockers, N/V/D, Dizziness, H/A
= 0.25 mg/kg (max dose 20 mg)
= 0.35 mg/kg (max dose 25 mg)
!!!(Dopamine) class:
Action:
= Sympathetic agonist
= A/B-adrenergic agonist, Rate dependent, vasopressor. +/otropics
!!!(Dopamine) Indi:
Contra:
DONT:
= CHF, HypoBP/shock signs, 2nd-line Bcardia (after Atropine w/Adult)
= hypovolemic PTs til Vol replacement, Pheochromocytoma his
= MIX W/ Sodium-Bicarb!!! & open WIDE OPEN!
!!!(Dopamine) Effects:
Dosing:
Adult & Pedi Cardiac dose:
Adult & Pedi Vasopressor dose:
= Hypertension, Palpitations, H/A, Dizziness, Can worsen cardiac ischemia, Tissue necrosis W/ Extravasation
= 2–20 mcg/kg/min Titrate to patients response
= 5-10mcg/kg/min
= 10-20 mcg/kg/min
!!!(Epi 1:10,) Class: SNS agonist, Sympathomimetic
Dynamics:
Indications:
Contraindications:
= SNS agonist, Sympathomimetic
= Powerful Alpha and Beta agonist
= Cardiac arrest, Bcardia, Normovolemic hypoBP, Anaphylaxis, Asthma
= rewards over risks so really none
!!!(Epi 1:10,) Effects:
Admin via:
(Adult) Cardiac Arrest dose:
(Adult) Bradycardia dose:
(PEDI) Bradycardia/Cardiac Arrest dose:
(PEDI) Hypoperfusion & Severe anaphylaxis dose:
= Palpitations, Anxiety, Jitters, H/A, Dizziness, HyperBP, Tcardia, Can worsen cardiac ischemia
= IV infusion drip
= 1mg IVP/IOP every 3-5 mins
= 2-10 mcg/min IV/IO infusion
= 0.01 mg/kg or 0.1 mL/kg
= 0.1-1 mcg/kg/min infusion by Mixing 1mg of Epi 1:10 into 1L IV bag
!!!(Epi 1:1,) Class:
Dynamics:
Indi:
Contra:
= Sympathomimetic, SNS
= Potent A/B-agonist
= Severe bronchospasm, Allergies/anaphylaxis
= Few in emergent setting, Benefits>Risks, NEVER WITH-HOLD
!!!(Epi 1:1,) Effects:
Admin/ via:
Adult Dose:
Pedi Dose:
= Can worsen H-ischemia, Palp/s, Anxiety, Jitters, H/A, Dizzy, Tcardia
= IM
= 0.3 mg(Asthma/COPD) & Up to 0.5 mg for anaphylaxis
= 0.01 mg/kg IM w/ max dose of 0.3 mg
!!!(Glucagon) Class:
Action:
= Hormone
= +BGL w/ lysis of glycogen to glucose (IM route) Binds to Glucagon receptors & stim/s adenyl cyclase raising cAMP (IV route). Increase cAMP makes up-regulation of Ca-channels in SA & AV nodal cells
!!!(Glucagon) Indi:
Contra:
Effects:
= Hypoglycemia w/ IV/IO not obtainable, Bradycardia suspected from Beta-Blocker or Ca-Channel Blocker OD
= Hypersensitivity & Bradycardia from other etiology
= Anxiety, Palp/s, H/A, N/V, Increased BGL(can led to hyperglycemia)
!!!(Glucagon) Hypoglycemia Adult Dose:
Hypoglycemia Pedi Doses:
= 1 mg IM/IN
= <20Kg 0.5 mg IM/IN & >20Kg 1mg IM/IN
!!!(Lidocaine) Class:
Dynamics:
= Class Ib Antiarrhythmic
= Blocks Na channels in cardiac cells thus depolarization slows & decreases automaticity
!!!(Lidocaine) Ind:
Contra:
Effects:
= Stable monomorphic VT w/ preserved LVF & Alternative to Amiodarone in cardiac arrest by VF/pVT
= Shouldn’t use if PT already received IV Ca channel blockers, Not given prophylactically in AMI setting
= Drowsiness, Slurred Speech, Confusion, Seizures, Hypotension
!!!(Lidocaine) Max dose:
Cardiac Arrest from VF/pVT dose:
Refractory VF dose:
Perfusing Arrhythmia dose:
Maintenance Infusion dose:
= 3 mg/kg
= 1-1.5 mg/kg IV/IO
= may give additional 0.5-0.75 mg/kg IV/IO in 5-10 mins
= may give additional 0.5-0.75 mg/kg IV/IO in 5-10 mins
= 1-4mg/min (30-50 mcg/kg/min)
!!!(Mag-Sulfate) Class:
Dynamics:
= Misc. Airway med, Mineral, powerful noradrenergic bronchodilator
= Organic Salt act as a physiologic Ca-channel blocker Bronchodilator
!!!(Mag-Sulfate) Indi:
Contra:
Effects:
= cardiac arrest only if Torsades de Pointes (Tdp) suspected, Tdp w/ pulse
= AMI not recommended, High degree AV block, HypoBP, VFib/Tach
= Bcardia, HypoBP, Diaphoresis, Resp/ depres/, Hypothermia
!!!(Mag-Sulfate) Effects:
Bronchodilation Adult Dose:
Bronchodilation Pedi Dose:
= Flushing, Sweating, B-cardia, Resp/ depres/, Hypothermia
= 1-2G IV/IO over 10-20 mins (Infusion)
= 25-50 mg/kg IV/IO (max 2G) over 15-30 mins (Infusion)
!!!(Narcan) Class:
Dynamics:
Indi:
Contra:
Effects:
Dose:
= Competitive opiate antagonist
= Finds & fights for opiate receptor spot
= Dilated pupils & resp/ depres/ suspected from opiate OD
= SBP<100 or DBP30<, SBP# drops 10/>, B-cardia (<50BPM), T-cardia (>100BPM), ingested ED meds in last 48 hours
= H/A, Hypotension,
= 0.4mg IN/IM w/ max 2ml
!!!(NORepi) Class:
dynamics:
= Synthetic hormone Vaso-pressor “Sepsis med”
= A/B-adrenergic agonist (A effects > B effects)
!!!(NORepi) Indi:
Contra:
Effects:
= Normovolemic hypotension, Septic shock, Cardiogenic shock
= hypovolemia PTs til’ Vol/replacement occurred
= Hypertension, Organ ischemia, Cardiac arrhythmia, Tissue necrosis w/ extravasation, Palpitations, Anxiety, N/V
!!!(NORepi) Adult Dose:
Pediatric Dose:
= 0.1–0.5 mcg/kg/min IV/IO infusion
= 0.1–2 mcg/kg/min IV/IO infusion
!!!(Solu-Medrol) Class:
Dynamic:
Indi:
Contra:
= Synthetic pulmonary glucocorticoid Anti-inflammatory
= Suppresses immune response
= Bronchial asthma, COPD, Anaphylaxis
= Hypersensitivity
!!!(Solu-Medrol) Effects:
Adult Dose:
Pedi Dose:
= Increase BGL, delayed effects (rarely seen Pre-hospital)
= 125-250 mg IV/IO
= 2 mg/kg IV/IO to Max 60 mg
!!!(Terbutaline) Class:
Dynamics:
= Smooth muscle relaxer, Selective Sympathetic agonist
= B agonist w/ relaxation of bronchospasm & Chronotropic effect< Epi
!!!(Terbutaline) Indi:
Contra:
Effects:
Dose:
= Asthma, Reversible airway obstruction from w/ bronchitis or emphysema, Preterm labor
= hypersensitivity, PTs <12 years
= Palpitations, Anxiety, Jitters, H/A, Dizziness, Tachycardia
= 0.25mg IM
(Furosemide) class :
Action:
= Loop diuretic
= Blocks absorption of Na,Cl,H2o from kidney tubules, + urine thus lowers cardiac output
(Furosemide) Indications:
Contraindications:
= Acute pulmonary edema>90-100 mmHg, Hypertensive emergencies
= Hypovolemia, Hypotension, Hypokalemia or other suspected electrolyte abnormalities.
(Furosemide) Adverse Effects:
Adult Dose:
intial dose doesnt work:
= May cause dehydration, May cause acute electrolyte imbalance, Tinnitus or deaf from too fast IVP
= 0.5-1 mg/kg over 1-2 mins. IVP
= double 1st dose to 2 mg/kg over 1-2 mins.
(Captopril) Ind:
Contra:
Adverse:
Dose:
= CHF w/ Hypertension in conjunction w/ Nitrates & CPAP
= Angioedema, Pregnancy, Hypersensitivity to ACE Inhibitors
= dry cough, dizziness, taste changes, allergic
= 25mg PO
(Captopril) class:
Dynamics:
= ACE inhibitor
= Prevents product of angiotensin II by inhibiting (ACE) thus vasodilation & reduces amount water held back by kidneys
- “pril”
= ACE inhibitor
(Dexamethasone)
Pharmacodynamics:
= (syringe saline pull for blood & push 5x)
= Synthetic glucocorticoid Anti-inflam/; suppresses immune response
(Dexamethasone) Indications:
Contraindications :
= Bronchial asthma, COPD, Anaphylaxis
= hypersensitivity & (Relative) Known fungal infection
(Dexamethasone)
Adverse Effects:
Adult Dose:
Pediatric Dose:
= Fluid retention (Peripheral edema) & May delay wound healing & small Increase in BGL (careful w/ diabetics)
= 10 mg IV/IO/PO
= 0.5 mg/kg (max of 10 mg IV/IO/PO) “better>sol-med”
(Diphenhydramine)
Pharmacodynamics:
= Anti-histamine
= H1 & H2 histamine blocker
(Diphenhydramine)Indications:
Contraindications:
Adverse Effects:
= Allergic reaction, Anaphylaxis, Extrapyramidal reactions, Sedation
= Hypersensitivity
= Drowsy, Dizzy, coordination loss, Blurred vision, HypoBP, Tcardia
(Diphenhydramine) Adult Dose:
Pediatric Dose:
= 25 – 50 mg slow IV/IO or IM
= 1 - 2 mg/kg slow IV/IO or IM (Max dose: 50 mg)
(Labetalol) Classification:
= Beta-Blocker, Class II Antiarrhythmic
= Blocks adrenergic B-receptors stimulation thus slowing of the HR
(Labetalol) Indications:
Contraindications:
Do not administer to PTs w/ STEMI if following present:
= 2nd med/ for SVT after admin/ Adenosine, A-Fib/Flutter w/ RVR Reduce myocardial ischemia in AMI PTs w/ +HRs, Antihypertensive
= Increased risk of cardiogenic shock Hypotension Bradycardia
= signs of heart failure Low cardiac output
(Labetalol) Adverse Effects:
Max dose:
Adult Dose:
= admin/ after IV Ca-channel blockers can cause severe hypotension, Bcardia, heart blocks & CHF
= 150mg
= 10 mg IV/O push 1-2 mins & May repeat every 10 mins to max dose
(Calcium-chloride) class:
pharmacodynamics:
= mineral & electrolyte
= Critical electrolyte in body to help propagate nerve impulses & M. Contraction
(Calcium Chloride) indications:
Contra:
= Hyper/Hypokalemia ,Treatment of effects from Ca-Channel blocker OD, Hypotension 2nd to the admin/ of Diltiazem
= Not for cardiac arrest except when hyperkalemia is suspected & PTs currently taking Digoxin w/ suspected calcium Chanel blocker OD
(Calcium Chloride) effects:
Dose:
Treatment of hypotension following admin/ of Diltiazem:
=Severe Bcardia after rapid admin May cause severe coronary spasm & asystole, Burning site of admin/, will precipitate w/ Na-bicarbonate
= 0.5-1G 3-5mins
= 250-500mg
(Diazepam) class:
pharmacodynamics:
= benzodiazepine
= binds w/ GABA receptors causing a influx of chloride
(Diazepam) indications:
Contraindications:
= Tcardia from stimulant OD, Sustained seizures, Anxiety, Sedation
= hypersensitivity
(Diazepam) effects:
dose:
= Resp/depress/, N/V, Sedation/amnesia
= 2.5-10mg in 2.5mg increments slow IV/IO/IM
(Dobutamine) class:
Action:
Ind:
Contra:
= synthetic sympathetic agonist “baby dopamine”
= A7B adrenergic agonist, Inotropic prop/s > chronotropic
= CHF
= hypovolemia, DONT MIX W/ SODIUM BICARB
(Dobutamine) Adverse:
Adult Dose:
Pedi:
= hyperBP, palp/s, H/A, can worsen ischemia, tissue necrosis
= 2-20mcg/kg/min- titrate so HR doesnt increase>10% baseline (pt HR arrival)
= 2-20mcg/kg/min
Nifedipine:
= 10mg potent vasodilator: Selective Ca-channel blocker thus vasodilation & decreases systemic vascular resistance
(Enalapril) class
pharmacodynamics
= ACE inhibitor
= Prevents angiotensin II by inhibiting angiotensin-converting enzyme (ACE)- causes vasodilation & helps reduce kidney’s water retention
(Fentanyl) class:
pharmacodynamics:
Know so:
= synthetic narcotic (schedule 2 opioid)
= opioid Analgesia & sedation by binding to opiate receptor
= Fentanyl potency > morphine (100mcg fentanyl = 10mg of Morphine)
(Enalapril) indications:
Contra:
= severe CHF (w/ HTN) in conjunction w/ Nitrates & CPAP
= Pregnancy, Angioedema, Hypersensitivity to ACE inhibitors
(Fentanyl) indications:
Contra:
= Moderate- severe pain
=Hypersensitivity & Uncorrected hypotension (<90mmHg Systolic)
(Enalapril) effects:
initial Dose:
Tritate
Allergic, Dry Cough, Dizziness, Taste changes (long term)
= Initial dose of 2.5mg PO
= Titrate to 20mg PO
(Fentanyl) effects:
Dose:
= Chest wall rigidity (admin/slow), Resp/ arrest/depress/,AMS, Bcardia & Prolongation of QT interval, Increased vagal tone from suppression of sympathetic pathways, Hypotension, N/V
= 1mcg/kg to max of 100mcg (IV/IO/IN) → may repeat PRN in 5-10mins
Max of 1mL per nare if admin/ed IN
(Succinylcholine) Pharmacodynamics:
Indications:
Contraindications:
= Depolarizing Neuromuscular Blocker Binds to ACh receptors at the neuromuscular junction causing it to depolarize
= RSI
= Hyperkalemia, Burns, Crush Injury, +ICP, Trauma, Neuromuscular disease
(Succinylcholine) Adverse Effects:
Adult Dose:
Pediatric Dose:
= Hyperkalemia, Bcardia, Prolonged paralysis, +ICP, Muscle fasciculations, Malignant hyperthermia,
= 1-1.5 mg/kg IV/IO TTP: 45-60 seconds DOP: 5-10 mins
= 1-1.5 mg/kg TTP: 45-60 seconds DOP: 4-6 mins
(Rocuronium) Pharmacodynamics:
Indications:
Contraindications:
= Nondepolarizing Neuromuscular-Blocker Binds to ACh receptors at the neuromuscular junction
= RSI
= Hypersensitivity
(Rocuronium) Adverse Effects:
Adult Dose:
Pediatric Dose:
= Hyper/hypotension, Skeletal M. weak, Malignant hyperther/, Apnea
= 0.6-1.2 mg/kg TTP: 60-90 seconds DOP: 45-120 minutes
= 0.6-1.2 mg/kg TTP: 30-60 seconds DOP: 30-60 minutes
(Vecuronium) Pharmacodynamics:
Indications:
Contraindications:
= Nondepolarizing Neuromuscular-Blocker Binds to ACh receptors at neuromuscular junction
= RSI
= Hypersensitivity
(Vecuronium) Adverse Effects:
Adult Dose:
Pediatric Dose:
= Skeletal M. weak, Malignant hyperther/, Apnea
= 0.1-0.2 mg/kg IV/IO TTP: 1-3 minutes DOP: 45-90 minutes
= 0.1-0.3 mg/kg IV/IO TTP: 1-3 minutes DOP: 30-60 minutes
Methylene blue:
= Antidote cyanide poisoning & methemoglobinemia (CO-H)
(Midazolam) class:
pharmacodynamics:
Indications:
Contraindications:
= benzodiazepine
= Binds w/ GABA receptors causing an influx of chloride
= Active seizures, RSI, Chemical restraint, Anxiety, Sedation
= History of hypersensitivity to drug
(Midazolam) indications:
Contraindications
= Active seizures, RSI, Chem/ restraint, Anxiety, Sedation
=History of hypersensitivity to drug
(Midazolam) Effects
Adult dose active seizures:
Pediatric dose active seizures:
Adult & Pedi dose for induction agent (RSI):
ET Tube bucking dose:
= Hypotension Respiratory depression/apnea N/V, Amnesia
= 0.1mg/kg in 2mg increments IV/IO (max 5mg) → 5mg IM/IO
=0.1mg/kg in 2mg increments IV/IO (max 5mg) 0.2mg/kg IN/M
= 0.1-0.3mg/kg (max 10mg), Onset=2-5mins, Duration= 15-30mins
= 0.05mg/kg IV/O 1-2mins (maintain SBP) → stop once bucking stops
(Sodium Bicarb) class:
Pharmacodynamics:
Indications:
Contraindications:
= Alkalinizing agent
= raises plasma bicarbonate, buffers excess hydrogen concentration, raises blood pH & reverses clinical manifestations of acidosis
= Suspected hyperkalemia/bicarbonate-responsive acidosis (DKA, OD on TCA’s, Aspirin, or Cocaine)
= PTs in cardiac arrest, Dont mix w/ calcium chloride
(Sodium Bicarb) Suspected Acidosis:
Hyperkalemia:
=1 mEq/kg IV Bolus
= 50 mEq IV Bolus
(Paralysis w/ RSI Induction med pushes) Etomidate:
Midazolam :
Ketamine:
Propofol:
(Push paralytic med RIGHT after med induction):
Succinylcholine:
Rocuronium:
Vecuronium:
= 0.2-0.4 mg/kg IV/IO
= 0.1-0.3 mg/kg IV/IO
= 1-2 mg/kg IV/IO
= 1-2 mg//kg IV/IO
= RSI when sedative admin
= 1-1.5 mg/kg IV/IO
= 0.6-1.2 mg/kg IV/IO (If succinylcholine is contraindicated)
= 0.1-0.2 mg/kg IV/IO, TTP 1-3mins, DOP 45-90mins
Succinylcholine:
Rocuronium:
Vecuronium:
= 1-1.5 mg/kg IV/IO, TTP 45-60secs, DOP 5-10mins
= 0.6-1.2 mg/kg IV/IO, TTP 60-90secs, DOP 45-120mins
= 0.1-0.2 mg/kg IV/IO, TTP 1-3mins, DOP 45-90mins
