PHARMACOLOGY Flashcards
ADENOSINE
INDICATIONS
SVT with ventricular rates greater than 150
CONTRAINDICATIONS
• 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.
ADMINISTRATION
• ADULT
• 12mg rapid IV/IO, over 1-2 seconds with a simultaneous 20mL flush.
• PEDIATRIC
• 0.1mg/kg rapid IVP with simultaneous 10mL flush. Max single dose 6mg.
• If no change in one minute, administer 0.2mg/kg rapid IVP with simultaneous 10mL flush. Max single
dose 12mg.
• Dilute 1ml in 9ml of NS, = 0.3mg/ml
ALBUTEROL
INDICATIONS • Bronchospasm • Hyperkalemia CONTRAINDICATIONS • None ADMINISTRATION • ADULTS & PEDIATRICS • 2.5mg via nebulizer. May repeat prn for bronchospasm. • 2.5mg via nebulizer. Continuous treatments for Hyperkalemia
AMIODARONE
INDICATIONS
• Ventricular Fibrillation/Pulseless V-Tach
• Ventricular Tachycardia
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.
SIDEEFFECTS
• Hypotension
• Bradycardia
ADMINISTRATION
• ADULT
• VF/Pulseless V-Tach: 300mg slow IV/IO. Repeat with 150mg in 3-5 minutes prn for continued
VF/Pulseless V-Tach.
• V-Tach with a Pulse: 150mg in a 50mL bag of Normal Saline, infuse over 10 minutes. May repeat 1x
prn. Administer entire 150mg bolus, even if the rhythm terminates.
• PEDIATRIC
• VF/Pulseless V-Tach: 5mg/kg slow IVP. May repeat up to 15mg/kg. Max single dose 300mg.
• V-Tach with a Pulse: 5mg/kg in a 50mL bag of Normal Saline infused over 25 minutes. Max single dose
150mg.
ASPIRIN
INDICATIONS • Chest pain • STEMIAlerts CONTRAINDICATIONS • Allergy to aspirin • Active GI bleeding • Children under 16 years of age ADMINISTRATION • ADULT • Chew and swallow four 81mg tablets
ATROPINE
INDICATIONS
• Symptomatic bradycardia
• Organophosphate poisonings
• Adverse reaction to Ketamine
CONTRAINDICATIONS
• None in emergency situations
SIDEEFFECTS
• 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.
ADMINISTRATION
• ADULT
• Bradycardia: 0.5mg IV/IO. Repeat every 5 minutes prn to a maximum dose of 3mg.
• Adverse reaction to Ketamine (hypersalivation): 0.5 mg IV/IM/IO.
• PEDIATRIC
• Bradycardia: 0.02mg/kg IV/IO every 3-5 minutes. Minimum single dose 0.1mg. Maximum single dose
0.5mg. Max total dose 1mg.
• ADVANCED AIRWAY MANAGEMENT: UNDER 36MONTHS: 0.02mg/kg IV/IO. Minimum single dose
0.1mg. Max single dose 0.5mg.
BENADRYL
INDICATIONS
• Allergic Reaction
• Anaphylaxis
• Dystonic Reaction
CONTRAINDICATIONS
• Newborn infants
SIDEEFFECTS
• Drowsiness
PRECAUTIONS
• Potentiated with alcohol and other CNS depressants
ADMINISTRATION
• ADULT
• Allergic and Dystonic Reaction: 50mg IV/IO/IM. Administer over 2 minutes for IV/IO usage. (See Box
Below)
• Anaphylaxis: 50mg IV/IO/IM. Administer over 2 minutes for IV/IO usage. (See Box Below)
• PEDIATRIC
• Allergic and Dystonic Reaction: 1mg/kg IV/IO OR IM if unable to obtain IV access. Max total dose
50mg. Administer over 2 minutes for IV/IO usage. (See Box Below)
• Anaphylaxis: 1mg/kg IV/IO OR IM if unable to obtain IV access. Max total dose 50mg.
Administer over 2 minutes for IV/IO usage. (See Box Below)
• 1ml in 9ml NS = 5mg/ml
BENADRYL ADMINISTRATION IV/IO:
Dilute with 9 mL of Normal Saline.
CALCIUM CHLORIDE
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
SIDEEFFECTS
• 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.
ADMINISTRATION
• ADULT
• Calcium Channel Blocker Overdose : 1g slow IV/IO
• Hyperkalemia: 1g slow IV/IO
• Cardizem-induced hypotension: 500mg slow IV/IO
• PEDIATRIC
• Calcium Channel Blocker Overdose: 20mg/kg, slow IV/IO. Max dose 1g.
CARDIZEM
INDICATIONS
• Atrial Fibrillation &Atrial Flutter with a rapid ventricular response
• Stable SVT when vagal maneuvers and Adenosine fail to convert the rhythm
CONTRAINDICATIONS
• Hypotension
• Wide complex QRS
• Heart Blocks
• WPW
• Sick Sinus Syndrome
SIDEEFFECTS
• Hypotension: If hypotension develops, administer 500mg of Calcium Chloride and 500mL of Normal
Saline.
ADMINISTRATION
• ADULT
• 10mg (2mL) IV push over 2 minutes. May repeat in 5 minutes prn with 15mg (3mL).
DEXTROSE
INDICATIONS • Hypoglycemia (BGL less than 60mg/dL) CONTRAINDICATIONS • None for a glucose less than 60mg/dL PRECAUTIONS • Tissue necrosis due to infiltration. Less likely to occur when using D10. ADMINISTRATION • ADULT • D10: 100 mL IV/IO, retest glucose. If patient remains less than 60 mg/dL, administer another 100 mL of D10. • PEDIATRIC • D10: 5mL/kg IV/IO max single dose of 100mL. Retest glucose may repeat 1x prn if BGL remains less than 60 mg/dL. • NEONATE • D10: 5mL/kg IV/IO. Retest glucose may repeat 1x prn if BGL remains less than 60mg/dL. HYPOGLYCEMIC CARDIAC ARREST: Administer 250mL of D10
DOPAMINE
INDICATIONS
• Post resuscitation maintenance of blood pressure, after fluid challenges
• Cardiogenic shock
• Hypotension, unresponsive to fluid challenges
• Neurogenic (Spinal) Shock, if fluid challenges fail to increase blood pressure, if multi- systems
trauma is not suspected
• Adult Bradycardia, if no response to Atropine or transcutaneous pacing
CONTRAINDICATIONS
• Patients with pheochromocytoma (adrenal gland tumor)
• Hypotension secondary to blood loss
SIDEEFFECTS
• Severe tissue necrosis and sloughing with extravasations from an infiltrating IV
PRECAUTIONS
• Dopamine is inactivated by Sodium Bicarbonate. Do not administer through the same IV/IO line
without thoroughly flushing the IV line.
• For patients on monoamine oxidase (MAO) inhibitors, decrease the dose to 1/10th of the regular
dose.
PREPARATION
• ADULT
• Adult preparation: Mix 400mg of Dopamine in 250mL of Normal Saline, which yields a
concentration of 1600mcg/mL.
• Alternate preparation: Mix 200mg of Dopamine in 125mL of Normal Saline which yields a
concentration of 1600 mcg/mL.
ADMINISTRATION
• ADULT
• 5-20mcg/kg/minute titrated to maintain a SBP of 90 mmHg systolic.
• NO DOPAMINE FOR KIDS
EPINEPHRINE
INDICATIONS
• Bronchospasm
• Allergic Reaction
• Anaphylaxis
CONTRAINDICATIONS
• None
SIDEEFFECTS
• Cardiac arrhythmias, nervousness, HTN, chest pain
ADMINISTRATION
• ADULT
• Adult Dose 0.3mg IM. May repeat 2x prn, in 5 minutes prn.
• PEDIATRIC
• Pediatric Allergic Reactions/Anaphylaxis: 0.01 mg/kg (0.01mL/kg). May repeat 2x prn, in 5 minutes
if needed. Max dose 0.3mg IM.
• For Croup and Epiglotitis: (1:1,000) 3mL (3mg total) delivered via nebulizer.
EPINEPHRINE CONTINUED
INDICATIONS
• Cardiopulmonary arrest
• Severe anaphylactic reactions
• Pediatric Bradycardia
CONTRAINDICATIONS
• None
SIDEEFFECTS
• Tachycardia, ventricular dysrythmias, hypertension, angina, and palpitations
PRECAUTIONS
• Epinephrine is inactivated by alkaline solutions. Never mix with Sodium Bicarbonate.
ADMINISTRATION
• ADULT
• Cardiac Arrest: 1mg IV/IO, push every 3-5 minutes during cardiac arrest.
• Anaphylaxis: (1:10,000) 0.1mg (diluted in 9mL of Saline), IV/IO over 1-2 mins. May repeat 2x prn, in
five minute intervals. Max total dose 0.3mg (See Box Below)
• PEDIATRIC
• Cardiac Arrest: 0.01mg/kg (0.1mL/kg) IV/IO, repeat every 3-5 minutes prn. Max single dose1mg.
• EPINEPHRINE: (1:10,000) 0.1mg (diluted in 9mL of Saline), titrate slowly over 5-10 minutes IV/IO
(titrate to effect). May repeat 2x prn, in five minute intervals. (See Box Below)
Discard 9 mL of Epi 1:10,000 and draw up 9 mL of Saline and administer over 5-
10 minutes (titrate to effect) .You may repeat 2x prn, in five minute intervals.
ETOMIDATE
INDICATIONS
• Sedation for: Cardioversion/Pacing, Ventilatory Management, RSI, 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.
SIDEEFFECTS
• Apnea, hypoventilation, laryngospasm, N/V, tachycardia, muscle jerking
ADMINISTRATION
• SEDATION FOR AIRWAY CONTROL
• ADULT: 30mg or 0.3mg/kg IV/IO over 30-60 seconds. May repeat 1x prn.
• PEDIATRIC: 0.3mg/kg, IV/IO over 30-60 seconds. Max single dose 20mg. May repeat 1x prn.
• SEDATION FOR CARDIOVERSION/PACING
• ADULT: 6mg IV/IO, over 15-30 seconds. May repeat 1x prn.
• PEDIATRIC: 0.1mg/kg IV/IO over 15-30 seconds. Max single dose 6mg. May repeat 1x prn.
FENTANYL
NDICATIONS
• 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
SIDEEFFECTS
• Respiratory depression, hypotension, increased ICP, N/V, chest wall rigidity
A D M I N I S T R A T I O N
• A D U L T S
• FENTANYL: 50mcg slow IV/IO OR 100mcg IM/IN. May repeat every 5 minutes prn. Max total dose
200mcg.
• PEDIATRIC (Greater than 6 months old)
• FENTANYL: (Greater than 6 months old) 1mcg/kg slow IV/IO/IM May repeat every 5-10 mins prn.
Max single dose 50mcg. Max total dose 150mcg.
• FENTANYL: (Greater than 6 months old) 1.5mcg/kg IN. May repeat every 5-10 mins prn. Max single
dose 50mcg. Max total dose 150mcg.
• Dilute 1ml in 9ml NS = 5mcg/ml
**Narcan reverses all adverse reactions of Fentanyl.
GLUCAGON
INDICATIONS
• Hypoglycemia when unable to establish IV access and the patient is too obtunded for oral glucose
administration.
• Beta Blocker Overdose
CONTRAINDICATIONS
• Pheochromocytoma (adrenal gland tumor)
SIDEEFFECTS
• Nausea and vomiting, ensure airway is protected for patients with a decreased level of
consciousness.
ADMINISTRATION
• ADULT
• Hypoglycemia: 1mgIN/IM
• Beta Blocker OD: 1mg/minute, slow IV/IO. Max dose of 5mg.
• PEDIATRIC
• Hypoglycemia: Less than 20kg (0.5mg IN/IM), greater than 20kg (1mg IN/IM)
• Beta Blocker Overdose: 1mg IV/IO every minute until hypotension resolves or max dose.
• Children 20kg or less, maximum dose 4mg
• Children greater than 20kg, maximum dose 5mg
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.