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BSO EMS Protocols > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

Amiodarone Infusion

Adult

A
  • Stable VT with pulse
  • WPW

Mixture = 150 mg in 50ml NS

Dose = 150mg over 10 min

Administration = 60 gtts/min with a 10gtt set, 1gtt every sec
= 6ml/min = 8min

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2
Q

Magnesium Sulfate Infusion

Adult

A
  • Pre-Eclampsia or Eclampsia
  • Asthma
  • Torsades de Pointes

Mixture = 4ml or 2g in 50ml

Dose = 2g over 10min

Administration
 =60 gtts/min with a 10gtt
set, 1gtts every sec
=6ml/min
=8 min
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3
Q

Cardiac Epinephrine Infusion

Adult

A
  • Cardiac Arrest

Mixture = 1mg
(1:1,000 or 1:10,000) epinephrine per 50 ml NS

Dose = 1 mg in 50 ml NS
over 8 minutes; or
2 mg in 100 ml NS
over 16 minutes

Administration = 
60gtts/min with a 10gtt set,
1 gtt/sec
=6ml/min
50 ml infusion in approx.
8 minutes
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4
Q

Amiodarone Infusion

Pediatric

A
  • Stable VT with pulse

Mixture = # ml (as per Ped
Med Tool) in 50mL NS

Dose = 5mg/kg- as per Ped
Med Tool (max of ml or 150mg)

Administration = 20gtts/min with a 10gtt set,
1 gtt every 3 secs
=2ml/min
50 ml infusion in 25 min

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5
Q

Magnesium Sulfate Infusion

Pediatric

A
  • Severe Asthma
  • Torsades de Pointes

Mixture = # ml (as per Ped
Med Tool) in 50mL

Dose = 40 mg/kg as per
Ped Med Tool (Max of 2g or 4ml)

Administration = 60gtts/min with a 10gtt set,
1 gtt/sec
=6ml/min
50 ml infusion in approx.
8 minutes
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6
Q

Cardiac Epinephrine infusion

Pediatric

A
  • Cardiac Arrest

Mixture = # ml (as per Ped
Med Tool) in 100 ml NS

Dose = Use Epinephrine dose then multiply by 2. Place that
volume in 100 ml

Administration = 60gtts/min with a 10gtt set,
1 gtt/sec
=6ml/min
100 ml infusion in approx.
16 minutes
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7
Q

Diphenhydramine Dilution

A

50mg/ml, Dilute 1ml in 9ml NS = 5mg/ml

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8
Q

Fentanyl Dilution

A

50mcg/ml, Dilute 2ml in 8ml NS = 10mcg/ml

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9
Q

Ketamine Dilution

A

100mg/ml, Dilute 5ml (500mg) in 50 ml NS = 10mg/ml

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10
Q

Sodium Bicarb Dilution

A

8.4%, Discard 25ml of 8.4% and draw up 25ml of NS = 4/2%

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11
Q

Adenosine (Adenocard)

Dose and Indications

A
  • 12mg (3mg/ml) 4ml vol

* SVT with ventricular rates greater than 150

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12
Q

Adenosine (Adenocard)

Contraindications

A
  • Patients with a history of second or third degree AV block (except in patients with a functioning artificial pacemaker)
  • Sick Sinus Syndrome without cardiac pacemaker in place
  • Persons taking Carbamazepine (Tegretol)
  • Active bronchospasm
  • Patients with a heart transplant.
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13
Q

Adenosine (Adenocard)

Side Effects

A

• Flushing, headache, chest pain, and dyspnea are transient and will abate in 1-2 minutes after administration.
• Transient periods of sinus bradycardia and ventricular ectopy are common after the termination of SVT.
Note: It is imperative that Adenosine rapidly reaches the central circulation. In order to ensure proper administration, an 18g IV in the AC is preferable. An extension set should be used due to the close proximity of the medication ports.
Attach the Adenosine to the port closest to the IV site. Begin recording the ECG and
simultaneously push the Adenosine and a 20mL Normal Saline flush rapidly (over 1-2 seconds).

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14
Q

Albuterol

Indications & Contraindications

A
  • Bronchospasm
  • Hyperkalemia
  • None
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15
Q

Amiodarone

Concentration & Indications

A
  • 150mg/3ml, 50mg/ml
  • Ventricular Fibrillation/ Pulseless V-Tach
  • Ventricular Tachycardia
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16
Q

Amiodarone

Contraindications, Precautions, & Side Effects

A

Contraindications
• Cardiogenic Shock
• Marked sinus bradycardia and second or third degree AV blocks

Precautions
• Used in conjunction with beta and calcium channel blockers could increase the risk of hypotension
and bradycardia.
• Do not shake the vial as the solution will foam up and will not be able to be drawn up.

Side Effects
• Hypotension
• Bradycardia

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17
Q

Aspirin

Indications & Contraindications

A

Indications

  • Chest Pain
  • STEMI Alerts

Contraindications

  • Allergy to Aspirin
  • Active GI bleeding
  • Children under 16 years of age
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18
Q

Atropine

Concentration, Indications, & Contraindications

A
  • 0.5mg/ml

Indications
• Symptomatic bradycardia
• Organophosphate poisonings
• Adverse reaction to Ketamine

Contraindications
* None in emergency situations

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19
Q

Atropine

Side Effects, Precautions

A

Side Effects
• Increased heart rate may worsen ischemia and increase the size of a myocardial infarction.

Precautions
• Do not administer less than 0.5mg to an adult or 0.1mg to a pediatric.
• If pushed too slowly, Atropine may initially cause the heart rate to decrease.

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20
Q

Benadryl

Concentration, Indications, & Contraindications

A
  • 50mg/ml

Indications
• Allergic Reaction
• Anaphylaxis
• Dystonic Reaction

Contraindications
* Newborn infants

21
Q

Benadryl

Side Effects, & Precautions

A

Side Effects
* Drowsiness

Precautions
* Potentiated with alcohol and other CNS depressants

Note: Benadryl administration IV/IO: Dilute with 9ml or NS

22
Q

Calcium Chloride

Concentration, Indications, & Contraindications

A
  • 1 gram/10ml

Indications
• Calcium Channel Blocker overdose
• Hyperkalemia
• Cardizem-induced hypotension

Contraindications
• V-Fib, not associated with hyperkalemia (Patients with a history of renal failure/ dialysis), Digitalis
toxicity or hypercalcemia

23
Q

Calcium Chloride

Side Effects, Precautions

A

Side Effects
• Hypotension, bradycardia, heart block, asystole, tissue necrosis

Precautions
• Calcium Chloride should not be administered in the same infusion with sodium bicarbonate without thoroughly flushing the IV line.

24
Q

Cardizem

Indications, Contrindications, & Side Effects

A

Indications
• Atrial Fibrillation & Atrial Flutter with a rapid ventricular response
• Stable SVT when vagal maneuvers and Adenosine fail to convert the rhythm

Contrindications
• Hypotension
• Wide complex QRS
• Heart Blocks
• WPW
• Sick Sinus Syndrome

Side Effects
• Hypotension: If hypotension develops, administer 500mg of Calcium Chloride and 500mL of Normal Saline.

25
Q

Cyanokit

Indications, Contrindications, & Side Effects.

A

Indications
* Treatment of known or suspected cyanide poisoning

Contraindications
* None

Side Effects
* Allergic reaction, increased blood pressure

26
Q

Cyanokit

Precautions, & Preparation

A

Precautions
• Do not administer Cyanokit simultaneously through the same IV line as: Valium, Dopamine or NTG.
• If the reconstitution solution is not dark red, or if particulate matter is seen after it has been
appropriately mixed, the solution should be discarded.
• The CYANNOKIT should be administered through a separate/dedicated IV/IO line.

Preparations
• Reconstitute 5g vial by adding 200 mL of normal saline to the vial using the transfer spike. With the
vial in the upright position, fill to the “fill line”. Mix by rocking or rotating the vial for 30 seconds.
DO NOT SHAKE.
• Infuse the first vial: Use vented IV tubing and infuse as indicated below.

Note: CARDIAC ARREST: All patients that are suspected to be in cardiac arrest secondary to cyanide poisoning should be treated as a SECONDARY cardiac arrest and administered the CYANOKIT.

27
Q

Dextrose

Indications, Contraindication, & Precautions

A

Indications
* Hypoglycemia (BGL less than 60mg/dl)

Contraindications
* None for a glucose less than 60 mg/dl

Precautions
* Tissue necrosis due to infiltration. Less likely to occur when using D10

28
Q

Epinephrine 1:1000

Indications, Contraindications, & Side Effects

A

Indications
* Bronchospasm
* Allergic Reaction
Anaphylaxis

Contraindications
* None

Side Effects
* Cardiac arrhythmias, nervousness, HTN, chest pain

29
Q

Epinephrine (Cardiac)

Indications, Contraindications, Side Effects, Precautions.

A

INDICATIONS
• Cardiopulmonary arrest
• Severe anaphylactic reactions
• Pediatric Bradycardia

CONTRAINDICATIONS
• None

SIDE EFFECTS
• Tachycardia, ventricular dysrhythmias, hypertension, angina, and palpitations

PRECAUTIONS
• Epinephrine is inactivated by alkaline solutions. Never mix with Sodium Bicarbonate

30
Q

Etomidate

Concentration, Indications, Contraindications, Precautions, Side Effects.

A

Concentration: 20mg/10ml, 2mg/ml
I
NDICATIONS
• Sedation for: Cardioversion/Pacing, Ventilatory Management, ICE

CONTRAINDICATIONS
• None

PRECAUTIONS
• May cause respiratory arrest. Continuously monitor ventilatory status.
• Use with caution in patients with severe hypotension, severe asthma or severe cardiovascular disease.

SIDE EFFECTS
• Apnea, hypoventilation, laryngospasm, N/V, tachycardia, muscle jerking

31
Q

Fentanyl

Concentration, Indications, Contraindications, Precautions, & Side Effects.

A

Concentration: 50mcg/ml

INDICATIONS
• Moderate to severe pain relief

CONTRAINDICATIONS
• Respiratory Depression
• Less than 6 months old

PRECAUTIONS
• Push slowly to prevent rigid chest wall syndrome which can be reversed with Narcan.
• Head injuries due to risk of respiratory depression and increased ICP

SIDE EFFECTS
• Respiratory depression, hypotension, increased ICP, N/V, chest wall rigidity

Note: Narcan reverses all
adverse reactions of Fentanyl.

32
Q

Glucagon

Indications, Contraindications, & Side Effects

A

INDICATIONS
• Hypoglycemia when unable to establish IV or IO access and the patient is too obtunded for oral
glucose administration.
• Beta Blocker Overdose

CONTRAINDICATIONS
• Pheochromocytoma (adrenal gland tumor)

SIDE EFFECTS
• Nausea and vomiting, ensure airway is protected for patients with a decreased level of
consciousness.

WARNING: The needle that comes with the Glucagon is NOT for IM use. Draw up the medication in a syringe and attach the appropriate size needle for an IM injection.

33
Q

Ketamine

Concentration, Indications, & Contraindications

A

100mg/ml

Indications
• Violent Agitated Patient
• Suspected Excited Delirium
• Advanced Airway Management
• Post Intubation Sedation
• CPR Induced Consciousness
• Pain Control

Contraindications
• Allergy
• Penetrating Eye Injury

34
Q

Ketamine

Adverse Reactions, & Psychological Adverse Reactions

A

ADVERSE REACTIONS
• Hypertension and tachycardia, generally self limited
• Laryngospasm may produce mild stridor. Correct in the order of:
1. High Flow O2
2. Ventilation with a BVM
3. Advanced Airway (RSI)
• Hypersalivation
• Nausea and vomiting
• Tonic and clonic muscle movements
• Transient respiratory depression occasionally occurs
• Roving eye movements and nystagmus

PSYCHOLOGICAL ADVERSE REACTIONS
• Visual Hallucinations
• Emergence Delirium
• Sensation of detachment from the body

35
Q

Lidocaine 1%

Indications, Contrindications, & Side Effects

A

INDICATIONS
• EZ IO for the conscious patient

CONTRAINDICATIONS
• 2nd and 3rd degree heart block

SIDE EFFECTS
• Dizziness
• Blurred vision
• Muscle Twitching
• Seizures
36
Q

Magnesium Sulfate

Concentration, Indications, Contraindications, & Side Effects.

A

Concentration 1GM/2ml

INDICATIONS
• Pre- Eclampsia
• Eclampsia
• Torsades de Pointes
• Severe Asthma

CONTRAINDICATIONS
• 2nd and 3rd Degree Heart Blocks

SIDE EFFECTS
• Circulatory Collapse, respiratory paralysis, heart block

37
Q

Narcan

Indications, Contraindications, & Precautions

A

INDICATIONS
• Reversal of respiratory depression and/or hypotension secondary to a narcotic overdose
• Reverse rigid chest wall syndrome secondary to Fentanyl administration

CONTRAINDICATIONS
• None

PRECAUTIONS
• Administered cautiously to patients who are known or suspected to be physically dependent on opiates, as Narcan administration can cause withdrawals in these patients, including newborns of addicted mothers.
• Use caution during administration, as patient may become violent as level of consciousness increases.
NOTE: Methadone, Darvon, Talwin and Fentanyl may require higher doses of
Narcan, contact medical control.

38
Q

Nitroglycerin Paste

Indications, Contraindications, & Side Effects

A

INDICATIONS
• Pulmonary edema

CONTRAINDICATIONS
• Hypotension
• Erectile Dysfunction Drugs (Viagra and Levitra within 24 hours and Cialis within 48 hours)
• Right Ventricular Infarction
• No IV/IO access

SIDE EFFECTS
• Headache, nausea and vomiting, hypotension, reflex tachycardia
• For NTG-induced hypotension, place patient in a supine position and administer a 500mL fluid bolus
of Normal Saline, and remove the NTG paste.

39
Q

Nitroglycerin

Indications, Contraindications, & Side Effects.

A

INDICATIONS
• Ischemic chest pain after maximum Fentanyl administration
• Pulmonary edema

CONTRAINDICATIONS
• Hypotension
• Erectile Dysfunction Drugs (Viagra and Levitra within 24 hours and Cialis within 48 hours)
• Right Ventricular Infarction
• For Chest Pain/MI Only - Heart Rate less than 50 BPM or greater than 100 BPM

SIDE EFFECTS
• Headache, nausea and vomiting, hypotension, reflex tachycardia
• For NTG-induced hypotension, place patient in a supine position and administer a 500mL fluid bolus
of Normal Saline.

40
Q

Nitrous Oxide

Concentration, Class, & Actions

A

Nitrous Oxide 50% Blended in Oxygen
(Nitronox®)

CLASS: Anesthetic

ACTIONS
Nitrous oxide is a colorless gas, which acts on the central nervous system. When mixed with 50% oxygen and inhaled, it produces an effect similar to a mild intoxicant. The patient laughs and talks but does not go to sleep. When inhaled, nitrous oxide has potent analgesic effects, which dissipate within 2-5 minutes after stopping administration.

41
Q

Nitrous Oxide

Indications, & Contraindications

A

INDICATIONS
Moderate to severe pain as in trauma, acute MI, burns, renal colic and labor.

CONTRAINDICATIONS
Nitrous oxide is contraindicated in any altered state of consciousness, (eg. head injury, alcohol ingestion, drug OD). It is also contraindicated in COPD patients, acute pulmonary edema, pneumothorax, decompression sickness, air embolus, and abdominal pain with distention or suspicion of obstruction, pregnancy (except
during delivery), and patients that are unable to self-administer Nitronox.

42
Q

Nitrous Oxide

Warnings, & Side Effects

A

WARNINGS
Since nitrous oxide is heavier than air, it may accumulate on the floor of ambulance. During transits of more than 15 minutes, nitrous oxide may effect ambulance personnel.
SIDE EFFECTS
Light-headedness, confusion, drowsiness, nausea and vomiting.

43
Q

Oral Glucose

Indications, Contraindications, & Precautions

A

INDICATIONS
• For documented hypoglycemia (less than 60 mg/dL), before unconsciousness occurs.

CONTRAINDICATIONS
• Patients who are not conscious enough to swallow
• Patients less than 2 years old

PRECAUTIONS
• Patient must be conscious enough to be able to swallow.

44
Q

Rocuronium

Concentration, Indications, Contraindications, & Precautions

A

Concentration: 10mg/ml

INDICATIONS
• POST INTUBATION

CONTRAINDICATIONS
• None

PRECAUTIONS
• Cardiovascular disease or advanced age may slow onset time.
• Use with caution and even consider using a lower dose for patients with renal failure.
• Reconstitute with 10mL of Normal Saline.

45
Q

Sodium Bicarbonate

Indications, Contraindications, & Precautions

A

INDICATIONS
• Hyperkalemia
• TCA Overdose
• Excited Delirium

CONTRAINDICATIONS
• None, if given for above indications.

PRECAUTIONS
• Do not administer Sodium Bicarbonate in the same IV line as other medications without adequately flushing the IV line.

SODIUM BICARBONATE 4.2%: Discard 25mL of 8.4% and draw up 25mL of Normal Saline.

46
Q

SoluMedrol

Indications, Contraindications, & Precautions

A

INDICATIONS
• COPD
• Asthma

CONTRAINDICATIONS
• None, if given for above indications.

PRECAUTIONS
• This onset of this medication will not take affect for at least one hour

47
Q

Tylenol (Acetaminophen)

Indications, & Contraindications

A

INDICATIONS
• FEVER
• PAIN

CONTRAINDICATIONS
• Inability to tolerate PO
• Allergy

48
Q

Versed

Concentration, Indications, Contraindications, Precautions, & Side Effects

A

Concentration: 5mg/2ml, 2.5mg/ml

INDICATION
• Seizures
• Airway Management
• Cocaine Overdose
• Excited Delirium/Violent Patient

CONTRAINDICATIONS
• Hypotension

PRECAUTIONS
• Respiratory depression
• Push IV/IO slowly over 2 minutes

SIDE EFFECTS
• Nausea and vomiting
• Hypotension

49
Q

Zofran

Indications, Contraindications, & Side Effects.

A

INDICATION
• Nausea
• Vomiting

CONTRAINDICATION
• None

SIDE EFFECTS
• Blurred Vision
• Dizziness
• Anxiety
• Headache

ZOFRAN ADMINISTRATION: If IV access is unobtainable, it is acceptable to administer the IV formulation of Zofran via the PO route to the patient.

BSO EMS Protocols (13 decks)

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