Pharmacology Flashcards
ACE Inhibitor
- Management of heart failure; Decreases BP; Decreases cardiac remodeling
- angioedema (benadryl)
Albumin
- Tx of low protein / patients with extravasation of fluid to the third spaces (think post burn or post resuscitation from sepsis)
- increases the oncotic pressure and draws fluid back into the vasculature and out of interstitial spaces
Amiodarone
ACLS Dosage:
- VTach without pulse/V-fib = 300 mg IV/IO; 150 mg IV/IO
- VTach with a pulse: 150 mg
- Cardiac Phase - 3 / Class III drug
Atropine
- Management of organophosphate poisoning
- Management of symptomatic bradycardia
- Pre-tx for RSI with pediatric pts (<5 yrs)
Betamethasone / Dexamethasone
- Steroid to assist with fetal lung development in premature infants
- Given via IV to mother for pre-term labor
Calcium Chloride
- For magnesium toxicity
- For EKG changes in presence of crush injury
Cerebryx (Fosphenytoin)
- Second line seizure therapy (if benzos are not working)
- Given for prophylactic seizure tx in TBI pts
Crofab
- Admin for snake envenomation with acute symptoms of neurological dysfunction or tissue compromise
- Multiple vials over hours are needed for complete tx
Cyanokit (Hydroxocobalamin)
(amyl nitrate/sodium nitrate/sodium thianosulfate)
- admin when exposed to cyanide (fire or Nipride infusion without protective bag)
- Sx of cyanide toxicity inc: tachycardia and hypertension with presence of toxicity pathology
Dantrolene
- antidote for malignant hyperthermia
- sx onset after paralytic is administered (inhaled anesthetics or Anectine)
- S/S inc: increased ETCO2, increased HR, increased temp
DDAVP (Desmopressin)
- Tx diabetes insipidus by working on the hypothalamus
- Therapeutic levels are present when pt has a decrease in urine output back to 30-50 ml/hr (adults)
Demerol
- Pain mgmt
- Not utilized with most RSI protocols
Diazoxide
- tx: hypoglycemia caused by pancreas cancer, surgery, or other conditions.
- works by preventing release of insulin from the pancreas
Dilantin (Phenytoin)
- Second line seizure therapy when benzos are not controlling seizures
- Prophylactic seizure tx in TBI pts
Dobutamine
- Vasopressor therapy
- Seen with cardiogenic shock patients as it increases SV
Dopamine
- Tx hypotension
- Caution with pts with increased lactate or cardiac dysfunction due to causing lg increase in O2 demand due to increased HR
Epinephrine
- ACLS protocols (epi every 3-5 min; IV/IO)
- Admin for catecholamine dependent pts that are hypotensive prior to RSI
- Admin for hypotension (push dose pressor for adults)
– 1cc of 1:10,000 Epi and mix with 9 cc NS
– Admin 0.5-2.0 mL per dose which is 5-20 mcg.
– Need more than 3? consider Epi infusion at 2-10 mcg/min
Etomidate
- sedative for RSI admin at 0.3 mg/kg
- can only utilize 1x, due to adrenal suppression
- contraindicated in septic pts or anyone with adrenal insufficiency
Fentanyl
- Tx: pain mgmt and post RSI to assist with discomfort
- Pt intubated? admin with sedation as well
Heparin
- Admin in central lines to keep them from occlusion
- Prior to using central line that was d/c, withdraw 10-20 mL of blood from the line and discard
- Also admin to AMI pts in the cath lab, or during the clotting stages of DIC
- reversal: protamine
Hydralazine
- Admin for hypertension
- Can be given to OB pts for pre-eclampsia tx of HTN while Mag Sulfate is being set up
- Also seen with acute HTN
Indomethacin
- Given in NICU for a pt with a fetal duct that is open and the presence of a ductal dependent cardiac lesion that is not present.
- When the doc wants to close the duct, Indomethacin is admin.
- NSAID - decreases the prostaglandin synthesis and allows the ducts to close (prostaglandins keep ducts open)
Integrillin
- Admin for NSTEMI pts or pts in the cath lab to decrease clotting size from extending (attempting to decrease the extension of the MI)
Ketamine
- Utilized for sedation with RSI at 2 mg/kg
- IV infusion to maintain sedation post intubation at 0.75-1 mg/kg/hr to achieve RASS -4 to -5
- Also used for procedural sedation and pain mgmt refractory to Fentanyl
Labetalol
- beta-blocker admin for hypertension
- admin 20 mg, then repeat at 40 mg after 5 mins, and then repeat at 80 mg after 5 mins. Continue at 80 mg per dose to a max total of 300 mg.
Levothyroxine
- Admin for hypothyroidism with lvls of T3/T4 are decreased and pt is symptomatic with bradycardia, decreased RR, declining LOC.
Lidocaine
- ACLS guidelines
Magnesium Sulfate
- Smooth muscle relaxer
- Admin for pre-term labor, tachysystole, pre-eclampsia, and severe asthma
Mannitol
- Osmotic diuretic used to treat increased ICP with head injuries
- Admin to decrease CSF to decrease ICP in attempt to prevent herniation
- Given as SIVP at 1 mg/kg
Methergine
- Admin to mothers post-delivery with post-partum hemorrhage (blood loss >500mL during and after delivery)
Milrinone
- Primarily used with pediatric heart failure with decreased cardiac output
- Works on RV (and LV) to increase cardiac SV and thus increases CO treating hypotension
Mucomyst (N-acetylcysteine)
- Admin for Tylenol OD
- Inhaled med
Neostigmine (Prostigmin)
- Cholinesterase inhibitor
- Blocks acetylcholinesterase / increases the amount of acetylcholine present
- Stimulates both muscarinic and nicotinic receptors
- Admin for pts with muscular disorders like myasthenia gravis or reversal of non-depolarizing NMB agents (paralytics) during surgery
- Does NOT cross the BBB
Phyostigmine
- Cholinesterase inhibitor
- Blocks acetylcholinesterase / increases the amount of acetylcholine present
- Crosses the BBB
- Tx: anticholinergic syndrome (cx by atropine, jimson weed, diarrhea meds OD, GHB, etc)
- S/S of anticholinergic syndrome are increased temp without sweating, tachycardia, agitation progressing to delirium
Neosynephrine (Phenlyephrine)
- Tx: hypotension as an infusion or a push dose pressor therapy
- For PDP - take 10 mg Neosynephrine and place in 250 mL NS. Take out 10 mL of the solution and admin 0.5-2 mL or 50-200 mcg/dose.
Nicardipine (Cardene)
- Calcium channel blocker
- Admin for hypertension
- Works quickly, but effects rapidly subside when infusion is stopped
Nimodipine
- Admin for subarachnoid hemorrhage
- Pts to decrease vasospasms, which – if present – cause significant sequelae due to decrease blood supply; and, therefore, decrease oxygenation to that brain area.
Nipride (Nitroprusside)
- Admin for HTN
- Needs protective black bag over the infusion IV bag or light will react with the med and cx a chemical reaction to cyanide. Observed as increased BP and HR with potential decreased LOC during infusion
Nitric Oxide
- Admin for persistent pulmonary HTN where the pulmonary resistance is 2/3 or higher the systemic vascular resistance
- Inhaled and is a pulmonary vasodilator at 10-20 ppm
- When doses are >60-80 ppm, can see systemic vasodilation and may need to be admin with a vasopressor to increase SVR while decreasing PVR
Norepinephrine
- admin for severe hypotension, as an infusion
- not available as a push dose pressor
- first line pressor in presence of distributive shock (sepsis/SCI) due to a strong alpha effect leading to profound vasoconstriction, but no increase in HR
- good for pts who are O2 demand intensive, as it does not increase demand substantially since there is not an increase in HR
Octreotide (Sandostatin)
- Admin to decrease portal hypertension by dilating the portal vein
- used with pts whom have esophageal varices so the blood can return the normal flow from the esophagus to the liver via decreased portal pressure
Oxytocin (Pitocin)
- admin for EMS and HEMS to stimulate uterine contraction after delivery to treat post-partum hemorrhage
- Admin in hospital to induce labor/increase the strength and regularity of contractions
- If being admin to pt and they are noted to have >5 contractions in 10 mins (tachysystole), then the infusion of oxytocin should be stopped / rate decreased
Phenobarbital
- Third line med to tx seizures
- Can induce coma with med to prevent seizure activity
Prostaglandin E1 (PGE1)
- Admin for NICU pts with congenital heart defects that are ductal dependent lesions; keeps ducts open so the blood can mix
- used to get the pt to definitive care (or until surgical intervention is performed to repair the defect)
Rhogam
- admin to women of child-bearing age when they are Rh- for their blood typing and they are either given blood products which are Rh+ or they deliver a baby, suffer a trauma while pregnant, or have a miscarriage.
Rocuronium
- Dosage: 1 mg/kg
- Non-depolarizing paralytic
- Duration of action 20-30 mins
- Reversal agent = Neostigmine
Romazicon
- Reversal agent for benzodiazepine OD
Sodium Bicarb
- Admin to tx acidosis
- Admin for increased ICP due to head injury
- Tx crush injury
Succinylcholine
- Dose: 1-1.5 mg/kg
- Depolarizing paralytic (+fasiculations)
- Contraindicated with hyperkalemia, myasthenia gravis, burns > 24 hours, renal failure without dialysis, penetrating eye injury, etc.
- Caution for malignant hyperthermia
- Reversed with Dantrolene
Terbutaline
- Admin at 0.25 mg SQ
- Smooth muscle relaxer used to tx pre-term labor and severe asthma attacks.
- Caution with simultaneous admin with Mag Sulfate (can cause pulmonary edema)
Tridil
- Nitroglycerin admin IV for pts with AMI
Tranexamic Acid
- Admin for pts with severe hemorrhage to prevent the breakdown of clots already formed by the pt
- Dose: 1 g in 100mL over 10 mins; then 1g in 500 mL over 8 hours and admin at 62.5 mL/hr
Vasopressin (ADH)
- Admin for hypotension esp in septic and GI hemorrhage pts
Vecuronium
- Non-depolarizing paralytic
- Duration of action about 45 mins
- Not often used in EMS unless airway already estb and prolonged paralysis desired (ex: ARDS pt in 2:1 ratio who requires sedation and paralysis to tolerate vent settings that treat their severe hypoxemia)
Versed
- Benzo
- admin for sedation post intubation or seizure mgmt
- admin for combative pts on PCP, bath salts, etc.