Pharmacology

Question 1

Morphine Sulfate

Answer 1

Class- Narcotic

Route- IV, IM

Actions CNS depressant, Decreases sensitivity to pain, Peripheral vasodilation

Indications- Severe pain

Contraindications- Head injury, Volume depletion, Undiagnosed abdominal pain, hypersensitivity

Precautions- Respiratory depression, Hypotension, Nausea

Side effects- Dizziness, altered LOC

Adult-
2-5mg IV
5-15mg IM

Peds-
0.1-0.2mg/kg

Question 2

Hydromorphone “Dilaudid”

Answer 2

Class- Narcotic

Route- IV, IM, PO

Actions- CNS depressant, decreases sensitivity to pain

Indications- Severe pain

Contraindications- Shock, Severe hemorrhage, hypersensitivity

Precautions- Respiratory depression, Hypotension, Nausea

Side effects-Dizziness, altered LOC, Bradycardia

Adult-
1-2mg

Peds-
0.015mg/kg

***Double dose for IM

Question 3

Fentanyl Citrate

Answer 3

Class- Narcotic

Route- IV, IN

Actions- CNS depressant; decreases sensitivity to pain

Indications- severe pain, adjunct to RSI

Contraindications- Shock, Severe hemorrhage, hypersensitivity

Precautions- Respiratory depression, Hypotension, Nausea

Side effects- Dizziness, altered LOC, Bradycardia

Adult-
25-100mcg

Peds-
1-2mcg/kg

Question 4

Ketorolac “Toradol”

Answer 4

Class- NSAID

Route- IV, IM

Actions- Anti inflammatory, Peripheral analgesic

Indications- Mild to moderate pain

Contraindications- Hypersensitivity, pts allergic to aspirin

Precautions- GI bleed can occur

Side effects- Edema, Rash, Heartburn

Adult-
15-30mg

Peds-
0.5mg/kg

*** Double dose for IM

Question 5

Midazolam “Versed”

Answer 5

Class- Benzodiazepine (tranquilizer)

Route- IV, IN, PO

Actions- Hypnotic, Sedative

Indications- Premed before cardioversion, anxiety

Contraindications- Hypersensitivity, Narrow-angle glaucoma, Shock

Precautions- Dilute w/ D5W, Respiratory depression more common than other benzos

Side effects- Drowsiness, Hypotension, Amnesia, apnea

Adult-
1-2.5mg

Peds-
0.03mg/kg

Question 6

Lorazepam “Ativan”

Answer 6

Class- Benzodiazepine (Tranquilizer)

Route- IV, IM, rectal

Actions- Anticonvulsant, Sedative

Indications- Major motor seizures, Premedication before cardioversion, acute anxiety

Contraindications- Hypersensitivity

Precautions- Short duration, do not mix with other meds if possible, dilute w/ D5W prior to IV administration

Side effects- Drowsiness, Hypotension, apnea

Adult-
0.5-2.0mg

Peds-
0.05-1.0mg/kg

***Double dose for IM

Question 7

Ketamine

Answer 7

Class- Anesthetic and analgesic

Route- IV, IM

Onset-< 1 minute IV and <5 minutes IM
Duration- 10-15 minutes IV and 20-30 minutes IM
Contraindications- Hypersensitivity, significant BP elevation

Adults-
Analgesia: 0.1-0.3mg/kg
Sedation: 0.5-1.0mg/kg over 30-60 sec, or 2-4mg/kg IM

Question 8

Rocuronium Bromide

Answer 8

Class- Nondepolarizing neuromuscular blocker for RSI

Route- IV, IV Drip

Contraindications- Hypersensitivity

Side effects- Bronchospasm

Adults-
Initial RSI 0.6mg/kg
Maintenance dose 0.1-0.2mg/kg continuous infusion

Peds-
Initial RSI 0.6mcg/kg
Maintenance dose 75-125mcg/kg infusion

Question 9

Succinylcholine

Answer 9

Class- Depolarizing neuromuscular blocker for RSI
** INCLUDING RESPIRATIORY MUSCLES

Route- IV

Contraindications- Hypersensitivity

Paralysis within 1 minute and lasts ~8 minutes

Adult-
1-1.5mg/kg

Peds-
1mg/kg

Question 10

Vecuronium

Answer 10

Class- Nondepolarizing neuromuscular blocking agent for RSI

Route- IV

***Including respiratory muscles!

Contraindications- Hypersensitivity

Adult-
0.08-0.1mg/kg

Peds-
0.1mg/kg