Pharmacology Flashcards
1
Q
Atropine Sulfate- Indications
A
Indications: Organophosphate poisoning, symptomatic bradycardia, asystole or PEA, RSI pretreatment for peds <5yo
2
Q
Atropine Sulfate: Contraindications
A
Contraindications: Acute MI, myasthenia gravis, GI obstruction, closed-angle glaucoma, known sensitivity to atropine, belladonna alkaloids, sulfides.
3
Q
Atropine Sulfate: Adverse Reactions
A
Adverse Reactions: Dry mouth, hot skin temp, flushing, blurred vision, dilated pupils w/ photophobia, tachycardia, restlessness. May cause paradoxical bradycardia with low/slow dosing.
4
Q
Atropine Sulfate: Dose
A
Dose: Symptomatic Bradycardia: Adult: 0.5 mg IV/IO Q 3-5 min, up to 3 mg. Adolescent: 0.02 mg/kg, up to 2 mg.
Ped: 0.02 mg/kg, up to 1 mg.
Asystole/PEA: 1 mg IV/IO Q 3-5 min, up to 3 mg.
Organophosphate poisoning: Adult: 2-4 mg IV/IM, repeat Q 20-30 min until symptoms resolve. Severe cases initial dose can be 2-6 mg IV/IM Q 5-60 min Peds: 0.05 mg IV/IM Q 10-30 min. until symptoms resolve.
Infants <15 lb: 0.05 mg/kg IV/IM Q 5-20 min. until symptoms resolve.
5
Q
Atropine Sulfate: MOA, Half-life
A
MOA: Reversible competition with acetylcholine at the muscarinic receptor site. Effects salivary, bronchial, sweat glands, eye, heart, and GI receptors (in order of most to least sensitive).
Possibly unsafe for lactating mothers. Ineffective for infra-nodal (type II) AV block and new 3rd-degree blocks with wide QRS.
6
Q
Atropine Sulfate: Class
A
Class: Anticholinergic (antimuscarinic)
7
Q
Betamethasone: Class
A
Class: Corticosteroid
8
Q
Dexamethasone: Class
A
Class: Corticosteroid
9
Q
Dexamethasone: AKA
A
AKA: Decadron
10
Q
Dexamethasone: Indications
A
Indications: Inflammatory conditions, adrenal insufficiency, nonresponsive forms of shock. Assists in lung development in premature infants.
11
Q
Dexamethasone: Contraindications
A
Contraindications: Fungal infections, known sensitivity.
12
Q
Dexamethasone: Adverse Reactions
A
Adverse Reactions: Nausea/vomiting, edema, hypertension, hyperglycemia, immunosuppresion.
13
Q
Dexamethasone: Dose
A
Dose: Adult: 1-6 mg/kg IV, max 40 mg.
Peds: 0.03-0.3 mg/kg IV/IO, divided into doses Q 6 hrs.
14
Q
Dexamethasone: MOA
A
MOA: Reduces inflammation and immune responses.
Given via IV to mother for pre-term labor.
15
Q
Betamethasone: Indications
A
Indications: Steroid for assisting fetal lung development in premature infants.
16
Q
Betamethasone
A
Steroid for assisting fetal lung development in premature infants
17
Q
Calcium Chloride: Indications
A
Indications: For magnesium toxicity and for EKG changes in cases of crush injury
18
Q
Fosphenytoin (Cerebrex): Indications
A
Indications: Second line siezure therapy when benzodiazepines aren’t effective. Also given prophylactically for siezure treatment in TBI pts.
19
Q
Crofab: Class
A
Class: Antidote
20
Q
Crofab: Indications
A
Indications: Snake envenomation with acute symptoms of neuro disfunction or tissue compromise
21
Q
Crofab: Dose
A
Dose: Multiple vials over hrs for complete treatment
22
Q
Cyanokit: Class
A
Class: Antidote
23
Q
Cyanokit: Indications
A
Indications: Cyanide exposure (fire or Nipride infusion w/o protective bag). Symptoms include tachycardia and hypertension in the presence of toxicity
24
Q
Dantrolene: Class
A
Class: Antidote
25
Dantrolene: Indications
Indications: Cyanide exposure (fire or Nipride infusion w/o protective bag). Symptoms include tachycardia and hypertension in the presence of toxicity
26
DDAVP (Desmopressin): MOA
MOA: Works by targeting the hyperthalamus.
27
DDAVP (Desmopressin): Therapeutic Level
Therapeutic Level: 30-50 ml/hr in adults
28
DDAVP (Desmopressin): Indications
Indications: Diabetes Insipidus
29
Demerol: Indications
Indications: Pain management
Not used in most RSI protocols.
30
Phenytoin (Dilantin): Indications
Indications: Second line siezure therapy when benzodiazepines aren't effective. Also given prophylactically for siezure treatment in TBI pts.
31
Dobutamine: Class
Class: Vasopressor
32
Dobutamine: Indications
Indications: Cardiogenic shock patients
33
Epinephrine: Dose
Dose: Push Pressor: 1cc of 1:10,000 with 9cc NS. Administer 0.5-20 mcg. If more than 3 push doses given consider epi infusion at 2-10 mcg/min.
34
Dobutamine: MOA
MOA: Increases stroke volume
35
Dopamine: Indications
Indications: Hypotension
36
Dopamine: Contraindications
Contraindications: Use caution in patients with >lactate or cardiac dysfunction due to >O2 demand from >HR.
37
Epinephrine: Indications
Indications: ACLS Indications. Given to catecholamine dependant patient that are hypotensive before RSI. Administered for Hypotension.
38
Etomidate: Indications
Indications: Sedative for RSI
39
Etomidate: Contraindications
Contraindications: Septic patients or those with adrenal insufficiency
40
Etomidate: Dose
Dose: 0.3 mg/kg
41
Fentanyl: Indications
Indications: Pain management. RSI discomfort management during and post.
42
Heparin: Indications
Indications: Central line anticoagulant. Administered to AMI pts in the cath lab or during the clotting stages of DIC.
43
Heparin: Special considerations
Note: Withdraw 10-20 mL of blood from line and discard then accessing central lines.
44
Hydralazine: Indications
Indications: Hypertension, OB patients for pre-eclampsia prior to Mag. Sulfate.
45
Indomethacin: Indications
Indications: Patent fetal duct. Given in the NICU to close the duct.
46
Indomethacin: Contraindications
Contraindications: Ductal dependent cardiac lesion
47
Indomethacin: MOA
MOA: It is an NSAID. It decreases prostaglandin synthesis, allowing the duct to close. Prostaglandins keep the duct open.
48
Integrillin: MOA
MOA: Decreases clot extension and minimizes MI
49
Integrillin: Indications
Indications: Administered to NSTEMI patients in the cath lab.
50
Ketamine: Indications
Indications: RSI sedation, procedural sedation, pain management refractory to fentanyl.
51
Ketamine: Dose
Dose: RSI sedation: 2mg/kg Maintenance infusion post intubation: 0.75-1 mg/kg/hr to achieve RASS -4 to -5.
52
Labetalol: Indications
Indications: Beta-blocker given for hypertension
53
Labetalol: Dose
Dose: Administer 20 mg, then 40 mg after 5 minutes, and 80 mg after 5 more minutes. Continue 80 mg doses to a max of 300 mg total.
54
Levothyroxine: Indications
Indications: Hypothyroidism with
55
Magnesium Sulfate: MOA
MOA: Relaxes smooth muscles
56
Magnesium Sulfate: Indications
Indications: Given for pre-term labor, tachysystole, pre-eclampsia, and severe asthma.
57
Mannitol: Indications
Indications: Used to treat >ICP with head injuries.
58
Mannitol: Dose
Dose: Given as slow IV push at 1 mg/kg.
59
Mannitol: MOA
MOA: Osmotic diuretic. Decreases CSF to lower ICP to prevent herniation.
60
Methergine: Indications
Indications: Given post delivery for post-partum hemmorhage (>500 mL blood loss during and after labor).
61
Milrinone: Indications
Indications: Used for
62
Milrinone: MOA
MOA: Works on RV and LV to increase cardiac SV, increasing CO to treat hypotension.
63
Mucomyst (N-acetylcysteine): Class
Class: Antidote
64
Mucomyst (N-acetylcysteine): Indications
Indications: Tylenol OD
65
Mucomyst (N-acetylcusteine): MOA
MOA: Inhaled medication
66
Neostigmine: AKA
Prostigmin: AKA
67
Neostigmine (Prostigmin): Indications
Indications: Given to patients with muscular disorders like myasthenia gravis, or as a reversal for non-depolarizing NMB agents (paralytics) during surgery.
68
Neostigmine (Prostigmin): MOA
MOA: Cholinesterase inhibitor. Blocks acetylcholinesterase to increase acetylcholine levels. Stimulates muscarinic and nicotinic receptors.
69
Phyostigmine: Indications
Indications: Used to treat anticholinergic syndrome which can be caused by atropine, jimsonweed, diarrhea med OD, GHB, etc.
70
Phyostigmine: MOA
MOA: Cholinesterase inhibitor. Blocks acetylcholinesterase to increase acetylcholine levels. Can cross BBB, unlike Neostigmine.
71
Neosynephrine: AKA
Phenylephrine: AKA
72
Neosynephrine (Phenylephrine): Dose
Dose: Push pressor: Dissolve 10 mg in 250 mL NS, then draw 10 mL of the solution. Administer 0.5-2 mL, or 50-200 mcg per dose.
Can be given as an infusion.
73
Neosynephrine (Phenylephrine): Indications
Indications: Given for hypotension.
74
Nicardipine (Cardene): Indications
Indications: Hypertension
75
Nicardipine (Cardene): Duration of Action
Duration of Action: Rapid onset, short-acting once infusion is stopped.
76
Nicardipine (Cardene): Class
Class: Calcium-channel blocker
77
Nicardipine (Cardene): MOA
MOA: Calcium-channel blocker
78
Nimodipine: Indications
Indications: Given to subarachnoid hemorrhage patients to decrease vasospasms.
79
Nimodipine: Precaution
Precaution: Vasospasms can cause significant sequelae due to < blood supply, decreasing oxygenation to that brain area.
80
Nipride: AKA
Nitroprusside: AKA
81
Nipride (Nitroprusside): Precaution
Precaution: Requires a protective black bag over the IV bag. Light reaction causes formation of cyanide. Observed as >BP and HR with
82
Nipride (Nitroprusside): Indications
Indications: Hypertension
83
Nitric Oxide: Indications
Indications: Persistent pulmonary hypertension with pulmonary resistance of 2/3 or higher the systemic vascular resistance.
84
Nitric Oxide: Dose
Dose: Inhaled @ 10-20 ppm. Doses >60-80 ppm may require a vasopressor to increase SVR while decreasing PVR due to systemic vasodilation.
85
Norepinephrine: AKA
Levophed: AKA
86
Norepinephrine: MOA
MOA: Used as a first line pressor for distributive shock (sepsis or SCI) due to strong alpha effect leading to profound vasoconstriction without increasing HR. This also does not significantly increase oxygen demand so its good for patients who are oxygen demand intensive.
87
Norepinephrine: Indications
Indications: Given for severe hypotension as an infusion.
Not available as a push pressor.
88
Octreotide: AKA
Sandostatin: AKA
89
Octreotide (Sandostatin): Indications
Indications: Given to decrease portal hypertension in patients with esophageal varices and GI bleeds.
90
Octreotide (Sandostatin): MOA
MOA: Dilates the portal vein, decreasing portal hypertension.
91
Oxytocin: AKA
Pitocin: AKA
92
Oxytocin (Pitocin): Indications
Indications: Given in EMS and HEMS to stimulate uterine contraction after delivery to treat post-partum hemorrhage.
93
Oxytocin (Pitocin): Indications (hospital)
Indications (hospital): In hospital its used to induce labor and to increase contraction strength and regularity. If administered and noting >5 contractions in 10 minutes (tachysystole), stop or reduce infusion of pitocin.
94
Phenobarbital: Indications
Indications: Third line anti-seizure medication.
95
Phenobarbitol: MOA
MOA: Can induce coma to prevent seizure activity.
96
Prostoglandin E1 (PGE1): Indications
Indications: Given to NICU patients with congenital heart defects that are ductal dependent lesions.
97
Prostoglandin E1 (PGE1): MOA
MOA: Keeps ducts open so blood can mix until the patient can get to definitive care, or until surgical intervention can correct the defect.
98
Rhogam: Indications
Indications: Given to women of child-bearing years with an Rh- in their blood type and they are being given Rh+ blood products, deliver the baby, suffer trauma while pregnant, or have a miscarriage.
99
Rocuronium: Indications
Indications: Non-depolarizing paralytic for RSI.
100
Rocuronium: Dose
Dose: 1 mg/kg
20-30 minute duration of action
101
Rocuronium: Reversal
Reversal: Neostigmine
102
Romazicon: Indications
Indications: Benzodiazepine OD reversal agent.
103
Sodium Bicarbonate: Indications
Indications: Treatment of acidosis, increased ICP due to head injury, or crush injury.
104
Succinylcholine: Indications
Indications: Depolarizing paralytic
105
Succinylcholine: Contraindications
Contraindications: hyperkalemia, myasthenia gravis, burns >24 hrs, renal failure withouth dialysis, penetrating eye injury.
106
Succinylcholine: Dose
Dose: 1-1.5 mg/kg
107
Succinylcholine: Reversal
Reversal: Can be reversed with Dantrolene. Watch for malignant hyperthermia.
108
Terbutaline: Indications
Indications: Used to treat pre-term labor and severe asthma attacks.
109
Terbutaline: Contraindications
Contraindications: Use caution when administering simultaneously with mag sulfate. May cause pulmonary edema.
110
Terbutaline: Dose
Dose: 0.25 mg SQ
111
Tridil (IV nitroglycerin): Indications
Indications: AMI
112
Tranexamic Acid (TXA): Indications
Indications: Given to patients with severe hemorrhage to prevent breakdown of already formed clots.
113
Tranexamic Acid (TXA): Dose
Dose: 1 g in 100 mL over 10 minutes, then 1 g in 500 mL over 8 hrs and administered at 62.5 mL/hr.
114
Vasopressin (ADH): Indications
Indications: Hypotension, especially in septic and GI hemorrhage patients.
115
Vecuronium: Indications
Indications: Long-acting non-depolarizing paralytic for intubated patients.
116
Vecuronium: Duration of Action
Duration of Action: ~45 minutes. Not used in EMS often due to long DOA.
117
Vecuronium: Considerations
Considerations: Sometimes used in ARDS patients with 2:1 vent ratio to aid in vent tolerance due to severe oxemia.
118
Versed: Indications
Indications: Post-intubation sedation or for seizure management. Can be given to combative patients such as those on PCP, bath salts, etc.
119
ACE Inhibitors: AKA
AKA: Captopril (Capoten), Enalapril (Vasotec), Lisinopril (Prinivil, Zestril), Ramipril (Altace)
120
ACE Inhibitors: Indications
Indications: CHF, hypertension, post-MI
121
ACE Inhibitors: Contraindications
Contraindications: Angioedema related to previous ACE inhibitor use, known sensitivity. Use caution with aortic stenosis, acute kidney failure, elevated serum potassium levels, etc.
122
ACE Inhibitors: Adverse Effects
Adverse Effects: H/A, dizziness, fatigue, depression, chest pain, hypotension, palpitations, cough, dyspnea, N/V, upper resp. inf., rash, pruritus, angioedema, renal failure.
123
ACE Inhibitors: Dose
Dose: Adult: individualized oral dosages.
Pediatric: individualized oral dosages.
124
ACE Inhibitors: MOA
MOA: Decreases BP and cardiac remodeling. Blocks the enzyme responsible for angiotensin II production, lowering BP.
125
Albumin: Class
Class: Volume Expander, Colloid
126
Albumin: Indications
Indications: Low protein, extravasation to third spaces (post burn, sepsis, etc.) Used to expand intravascular volume.
127
Albumin: Contraindications
Contraindications: Severe anemia or cardiac failure with normal or increased intravascular volume. Solution appears turbid, or 4 hours after opening container. Known sensitivity
128
Albumin: Adverse Reactions
Adverse Reactions: Allergic reaction, CHF or pulmonary edema in susceptible patients.
129
Albumin: Dose
Dose: Available as 5% solution in 500 mL and 25% solution in 100 mL.
Adult: 5%- 500-1000 mL IV/IO 25%-50-200 mL IV/IO
130
Albumin: MOA
MOA: Increases oncotic pressure, drawing fluid back into the vasculature.
131
Amiodarone: MOA
MOA: Acts directly on the myocardium to delay repolarization and increase the duration of the action potential.
132
Dose: ACLS Dosing
V. fib and PV-tach: 300 mg IV/IO followed by 150 mg IV/IO after 3-5 min.
ACLS dose for V-tach with and w/o pulse; V-fib management dosing
Peds: 5 mg/kg(max 300 mg); may repeat 5 mg/kg IV/IO up to 15 mg/kg.
133
Amiodarone: Class
Class: Antiarrhythmic, Class III
134
Amiodarone: Indications
Indications: Ventricular arrhythmias, second-line atrial arrhythmia agent.
135
Amiodarone: Contraindications
Contraindications: Sick sinus syndrome, 2nd and 3rd degree heart blocks, cardiogenic shock, bradycardia resulting in syncope, sensitivity to benzyl alcohol and iodine.
136
Amiodarone: Adverse Reactions
Adverse Reactions: Burning at the IV site, hypotension, bradycardia.
