Pharmacology Drugs Flashcards
Morphine: Duramorph
Class: Narcotic (Opioid)
Action: Analgesia & Sedation through Opioid Receptor Binding
Inidcations: Moderate-Severe Pain
Contraindications: Hypotension, Hypersensitivity
Dose: 2-10mg
Routes: IV,IO,IM, SQ, PO
Adverse Effects: Hypotension, Syncope, Tachycardia, Bradycardia, Apnea, Nausea, Vomiting, Resp. Depression.
Other: Use appropriate monitors. Naloxone is an antagonist.
Hydromorphone: Dilaudid
Class: Narcotic (Opioid) Action: Analgesia & Sedation through Opioid Receptor Indications: Moderate-Severe Pain Contraindications: Hypersensitivity Dose: 0.5-2.0mg Routes: IV, IO, IM, SQ, PO
Adverse Effects: Nausea, Vomiting, Cramps, Resp. Depression
Other: Use appropriate monitors. Naloxone is an antagonist.
Fentanyl:
Class: Narcotic (Opioid)
Action: Analgesia through binding to opiate receptors.
Indications: Moderate-Severe Pain, Anesthetic
Contraindications: Hypersensitivity
Dose: 50-100mcg (25-75mcg/GC Policy)
Routes: IV, IO, IM, SQ, IN
Adverse Effects: Nausea, Vomiting, Cramps, Chest Wall Rigidity (If Fast Push), Resp. Depression.
Other: Use appropriate monitors. Naloxone is an antagonist.
Meperidine: Demerol
Class: Narcotic (Opioid)
Action: Analgesia through binding to opiate receptors.
Indications: Moderate-Severe Pain
Contraindications: Hypersensitivity, Patients receiving MAOI’s
Dose: 25-100mg
Routes: IV, IO, IM, SQ, PO
Adverse Effects: Nausea, Vomiting, Euphoria, Dysphoria, Resp. Depression
Other: Use appropriate monitors. Naloxone is an antagonist.
Acetaminophen: Tylenol
Class: Nonnarcotic analgesic antipyretic
Action: Exact mech. uncertain. Felt to inhibit cyclooxygenase.
Indications: Mild-Moderate Pain, Fever
Contraindications: Hypersensitivity, Alcoholism, Chronic Liver Disease
Dose: 325-600mg
Routes: PO
Adverse Effects: Rare/None
Other: Can be liver toxic, use minimal dose necessary.
How much is too much? 4 grams in 24hrs. For peds: 200mg/kg is a toxic exposure. Same with elderly/alcoholics/liver failure/sepsis.
Ibuprofen: Motrin, Advil
Class: NSAID
Action: Anti-inflammatory & Anti-pyretic through inhibition through prostaglandins.
Indications: Mild-Moderate Pain, Fever, Inflammation
Contraindications: Hypersensitivity, Bronchospasm, Angioedema
Dose: 200-800mg
Routes: PO
Adverse Effects: Nausea, Vomiting, GI Bleeding, Allergic Reactions
Other: Commonly causes GI Upset. Peds toxicity is 200mg/kg. Can form a besor. 3,200mg is the MAX daily dose can lead to GI Bleeding/Distress. Elderly: More susceptible to toxicity due to decreased kidney function.
Ketorolac: Toradol
Class: NSAID
Action: Anti-inflammatory & Anti-pyretic through inhibition through prostaglandins.
Indications: Mild-Moderate Pain, Fever, Inflammation, Renal Colic
Contraindications: Hypersensitivity, Bronchospasm, Angioedema
Dose: 30mg (IV and elderly), 60mg IM
Routes: IV, IM
Adverse Effects: Nausea, Vomiting, GI Bleeding, Allergic Reactions
Other: Can cause dizziness and headache.
Aspirin
Class: NSAID
Action: Anti-inflammatory & Anti-pyretic through inhibition through inhibition of thromboxane A2.
Indications: Mild-Moderate Pain, Fever, Inflammation, Platelet aggregation inhibitor.
Contraindications: Hypersensitivity, Bronchospasm, Angioedema, Patients receiving MAOI’s. Erectile dysfunction medication use w/in 24hrs.
Dose: 350-650mg (4X81mg tablets=324mg per/GC Chest pain protocol)
Routes: PO
Adverse Effects: Nausea, Vomiting, GI Bleeding, Allergic Reactions
Other: Commonly causes GI Upset. Avoid enteric-coated aspirin in chest pain. Elderly: Can cause GI Bleeding in high doses. Peds: 81mgX36tablets in one bottle to prevent lethal dose of 50% of peds under 20lbs.
Naloxone: Narcan
Class: Opiate Antagonist
Action: Opioid antagonist w/o opiate agonist properties.
Indications: Partial reversal of opiate drug effects. Opiate OD.
Contraindications: Hypersensitivity
Dose: 0.4-2.0mg (titrate 0.2mg dose to 2.0mg max per GC Toxic Overdose Protocol)
Routes: IV, IM, IO, SQ, IN, Nebulizer
Adverse Effects: Fever, Chills, Nausea, Vomiting, Diarrhea, Opiate Withdrawal
Other: Administer enough to reverse resp. depression while avoiding full narcotic withdrawal syndrome. Give doses slowly.
Diazepam: Valium
Class: Benzodiazepine
Action: Binds to Type A GABA receptors causing sedation.
Indications: Anxiety, Seizures, Muscle Relaxation.
Contraindications: Hx of Hypersensitivity
Dose: 2-10mg
Route: IV, IM, IO, PO, Rectal
Adverse Effects: Hypotension, Sedation, Amnesia, Resp. Depression, Nausea, Vomiting.
Other: Incompatible w/other meds because it’s not as water soluble. Can cause irritation with injection. Flumazenil is an antagonist. Fast Onset Time: Longest Duration of Action of the Benzodiazepines
Midazolam: Versed
Class: Benzodiazepine
Action: Binds to Type A GABA receptors causing sedation.
Indications: Anxiety, Seizures, Sedation.
Contraindications: Hx of Hypersensitivity
Dose: 1-5mg
Route: IV, IM, IO
Adverse Effects: Hypotension, Sedation, Amnesia, Resp. Depression, Nausea, Vomiting.
Other: Flumazenil is an antagonist. Fastest Onset Time: Shortest Duration of Action of the Benzodiazepines.
Lorazepam: Ativan
Class: Benzodiazepine
Action: Binds to Type A GABA receptors causing sedation.
Indications: Anxiety, Seizures, Sedation.
Contraindications: Hx of Hypersensitivity
Dose: 1-4mg
Route: IV, IM, IO, PO, Rectal
Adverse Effects: Hypotension, Sedation, Amnesia, Resp. Depression, Nausea, Vomiting.
Other: Flumazenil is an antagonist. Longer duration of action than Versed, not as long as Valium.
Ketamine: Ketalar
Class: Dissociative Anesthetic
Action: Causes dissociation between the cortical and limbic systems.
Indications: Sedation, Analgesia.
Contraindications: Hx or Hypersensitivity, Hypertension
Dose: 0.5-1.0mg/kg (IV); 1-4mg/kg (IM)
Route: IV, IM
Adverse Effects: Hallucinations
Other: All monitors should be placed. Resuscitative equipment should be available.
Propofol: Diprivan
Class: Nonbarbiturate, nonbenzodiazepine sedative.
Action: Uncertain, appears to potentiate GABA receptors.
Indications: Sedation
Contraindications: Hx of Hypersensitivity, Hypersensitivity to Egg or Soy products.
Dose: 25-75mcg/kg/min
Route: IV
Adverse Effects: Pain on induction, Nausea, Vomiting, Resp. Depression.
Other: All monitors should be placed. Resuscitative equipment should be available.
Etomidate: Amidate
Class: Nonbarbiturate, nonbenzodiazepine sedative.
Action: Appears to modulate GABA Receptors
Indications: Sedation
Contraindications: Hx of Hypersensitivity
Dose: 0.1-0.3 mg/kg
Route: IV
Adverse Effects: Myoclonic jerks, Resp. Depression, Laryngospasm.
Other: Does not have analgesic properties. Ca2+ Channel blockers can prolong Resp. Depression. Can cause increased cortisol levels. All monitors should be placed. Resuscitative equipment should be available.
Haloperidol: Haldol
Class: Butyrophenone
Action: Blocks dopamine receptors associated w/mood and behavior.
Indications: Psychosis
Contraindications: Hypotension, Hypersensitivity
Dose: 2-10mg
Route: IM, PO
Adverse Effects: Extrapyramidal reactions, Insomnia, Restlessness, Drymouth, Hypotension, Tachycardia
Other: Hypotension more common in patients taking anti-hypertensivies.
Atropine
Class: Muscarinic anticholinergic (Parasympatholytic)
Action: Selectively blocks muscarinic receptors inhibiting parasympathetic stimulation.
Indications: Bradycardia, Antidote for Organophosphate poisoning. Pre-medication for RSI.
Contraindications: Hypersensitivity
Dose: 0.5-2.0mg
Route: IV, IO
Adverse Effects: Blurred Vision, Dry Mouth, Dilated pupils, Confusion.
Other: Organophosphate poisoning may require significantly higher doses.
Ipratropium: Atrovent
Class: Muscarinic anticholinergic (Parasympatholytic)
Action: Selectively blocks muscarinic receptors inhibiting parasympathetic stimulation.
Indications: Bronchospasm associated w/ COPD/Asthma.
Contraindications: Hypersensitivity
Dose: 500mcg
Route: Inhaled/Nebulizer
Adverse Effects: Blurred vision, Dry mouth, Dilated pupils, cough, confusion.
Other: Typically administered w/ a beta agonist (Albuterol)
Succinylcholine: Anectine
Class: Depolarizing neuromuscular blocker.
Action: Binds to ACh receptors at neuromuscular junction causing depolarization and subsequent paralysis.
Indications: RSI
Contraindications: Hyperkalemia, Neuromuscular Disease, Crush injury, Burns, Increased ICP, Severe Trauma.
Dose: 1-2mg/kg
Route: IV, IO
Adverse Effects: Hyperkalemia, Bradycardia, Prolonged Paralysis, Malignant hyperthermia, increased ICP, Muscle fasciculations, Trismus.
Other: Should only be used by people skilled in their use, competent at airway management, and with all necessary resucitative equipment available.
Vecuronium: Norcuron
Class: Nondepolarizing neuromuscular blocker.
Action: Binds to ACh receptors at neuromuscular junction causing depolarization and subsequent paralysis.
Indications: RSI
Contraindications: Hypersensitivity
Dose: 0.1-0.15mg/kg
Route: IV, IO
Adverse Effects: Skeletal Muscle weakness, Malignant hyperthermia, Apnea.
Other: Should only be used by people skilled in their use, competent at airway management, and with all necessary resucitative equipment available.
Rocuronium: Zemuron
Class: Nondepolarizing neuromuscular blocker.
Action: Binds to ACh receptors at neuromuscular junction causing depolarization and subsequent paralysis.
Indications: RSI
Contraindications: Hypersensitivity
Dose: 1mg/kg
Route: IV, IO
Adverse Effects: Hypertension, Hypotension, Skeletal muscle weakness, Malignant hyperthermia, Apnea.
Other: Should only be used by people skilled in their use, competent at airway management, and with all necessary resucitative equipment available.
Epinephrine
Class: Sympathetic Agonist
Action: Alpha & Beta Adrenergic Agonist (beta effects more pronounced although dose related)
Indications: Cardiac Arrest, Symptomatic Bradycardia, Normovolemic Hypotension, Allergies/Anaphylaxis, Severe Bronchospasm
Contraindications: Few/None in the EMS Setting
Dose: 0.3-1.0mg
Route: IV, IO, IM, SQ, ET, Inhaled
Adverse Effects: Palpitations, Anxiety, Tremulousness, Headache, Dizziness, Hypertension, Can worsen cardiac ischemia.
Other: Two preparations commonly available 1:1000 and 1:10,000.
Norepinephrine: Levophed
Class: Sympathetic Agonist
Action: Alpha & Beta Adrenergic Agonist (Alpha effects more pronounced)
Indications: Normovolemic hypotension, Septic Shock, Cardiogenic shock.
Contraindications: Should not be used in hypovolemia until volume replacement has occurred.
Dose: 0.1-0.5 mcg/kg/min
Route: IV
Adverse Effects: Palpitations, Anxiety, Tremulousness, Headache, Dizziness, Hypertension, Can worsen cardiac ischemia, Reflex Bradycardia.
Other: Extravasation can cause tissue damage. Best administered through a central line.
Dopamine: Intropin
Class: Sympathetic Agonist
Action: Alpha & Beta Adrenergic Agonist
Indications: Normovolemic hypotension, Symptomatic bradycardia, Septic Shock, Cardiogenic shock.
Contraindications: Should not be used in hypovolemia until volume replacement has occurred.
Dose: 2-20mcg/kg/min
Route: IV
Adverse Effects: Palpitations, Anxiety, Tremulousness, Headache, Dizziness, Hypertension, Can worsen cardiac ischemia, Reflex Bradycardia.
Other: Extravasation can cause tissue damage. Best administered through a central line. Proposed renal benefit has been disproven.
Dobutamine: Dobutrex
Class: Sympathetic Agonist
Action: Alpha & Beta Adrenergic Agonist (Inotropic properties more pronounced than chronotropic)
Indications: Congestive Heart Failure
Contraindications: Should not be used in hypovolemia until volume replacement has occurred.
Dose: 2-20 mcg/kg/min
Route: IV
Adverse Effects: Palpitations, Anxiety, Tremulousness, Headache, Dizziness, Hypertension, Can worsen cardiac ischemia, Reflex Bradycardia.
Other: Extravasation can cause tissue damage. Best administered through a central line. Other agents preferred in cardiogenic shock.
Albuterol: Ventolin, Proventil
Class: Beta Agonist
Action: Beta Agonist w/preference for B2 Adrenergic receptors.
Indications: Bronchospasm, Allergies/Anaphylaxis, Hyperkalemia
Contraindications: Hypersensitivity
Dose: 2.5mg (Nebulizer), 90mcg (MDI)
Route: Inhalation
Adverse Effects: Palpitations, Anxiety, Tremulousness, Headache, Dizziness, Tachycardia.
Other: Patients HR and SPO2 should be monitored during treatment.
Racemic Epinephrine: S2
Class: Sympathetic Agonist Action: Relatively nonselective Beta Agonist. Indications: Croup Contraindications: Hypersensitivity Dose: 0.25-0.75ml of a 2.5% solution Route: Inhalation
Adverse Effects: Palpitations, Anxiety, Tremulousness, Headache, Dizziness, Tachycardia.
Other: Patients HR and SPO2 should be monitored during treatment.
Amiodarone: Cordarone
Class: Class III Antiarrhythmic
Action: Prolongs action potential and duration in cardiac tissues through Na+, K+ and Ca2+ Channels; blocks alpha and beta adrenergic receptors.
Indications: V.Tach, V.Fib, Narrow Complex Tachycardias
Contraindications: Breast Feeding, Bradycardia, High-Grade heart block, Hypersensitivity.
Dose: 150-300mg
Route: IV
Adverse Effects: Hypotension, Bradycardia, Prolonged PR, QRS and QT.
Other: Constant ECG Monitoring. First in line drug for V. Fib and V. Tach.
Lidocane: Xylocaine
Class: Class 1B Antiarrhythmic; Local Anesthetic
Action: Amide-type local anesthetic; slows depolarization and automaticity
Indications: V. Tach & V. Fib refractory to Amiodarone. Local anesthetic.
Contraindications: Should not be administered to pts. receiving IV Calcium Channel Blockers.
Dose: 1.0-1.5mg/kg
Route: IV
Adverse Effects: Drowsiness, Slurred Speech, Confusion, Seizures, Hypotension.
Other: Use w/caution when administered with other antiarrhythmics.
Procainamide: Pronestyl
Class: Class 1A Antiarrhythmic; Local Anesthetic
Action: Ester-type local anesthetic; Reduces automaticity and AV conduction.
Indications: V. Tach w/a Pulse, Pre-excited A. Fib.
Contraindications: Should not be administered to pts. receiving IV Calcium Channel Blockers.
Dose: 20-50mg/min
Route: IV
Adverse Effects: Drowsiness, Slurred Speech, Confusion, Seizures, Hypotension.
Other: Carefully monitor ECG (QRS duration) during administration.
Phenytoin: Dilantin
Class: Class 1B Antiarrhythmic; Anticonvulsant
Action: Depresses automaticity and AV Conduction; reduces voltage and spread of electrical disharges in motor cortex.
Indications: Life-threatening Arrhythmias from digitalis toxicity. Seizures.
Contraindications: Bradycardia, High-grade heart block, Hypersensitivity.
Dose: 15-18mg/kg
Route: IV
Adverse Effects: Drowsiness, Dizziness, Headache, hypotension, Arrhythmias, Nausea, Vomiting
Other: Fosphenytoin is preferred for seizure management.
Adenosine: Adenocard
Class: Nucleoside
Action: Slows AV Conduction; Short Half-life
Indications: Supraventricular Tachyarrhythmias
Contraindications: A. Fib, Torsades des pointes
Dose: 6mg, 12mg, 12mg
Route: IV
Adverse Effects: Facial Flushing, Headache, Chest pain, Nausea
Other: Needs to be given in line closest to heart via rapid IV push with rapid IV flush/saline bolus due to short half-life. Arrhythmias common following administration.
Labetalol: Trandate, Normodyne
Class: Class II antiarrhythmic; beta-blocker
Action: Lowers blood pressure though nonselective blockade of beta receptors (and limited blockade of alpha2)
Indications: Hypertensive emergency
Contraindications: Asthma, heart block, bradycardia, cardiogenic shock.
Dose: 10-20mg,
Route: IV, PO
Adverse Effects: Bradycardia, hypotension, congestive heart failure, lethargy.
Other: Should not be administered to patients receiving calcium channel blockers.
Diltiazem: Cardizem
Class:Class IV antiarrhythmic; calcium channel blocker
Action: Lowers BP by relaxing vascular smooth muscle; slows AV conduction.
Indications: Rapid ventricular rate associated with A. Fib, stable narrow-complex tachyarrhythmias.
Contraindications: Hypotension, congestive heart failure, cardiogenic shock, Wide-complex ventricular tachycardia.
Dose: 15-20mg
Route: IV
Adverse Effects: Nausea, vomiting, dizziness, headache, hypotension.
Other: Can drop blood pressures by 20-40mmHG. Can be given as IV bolus or IV infusion. Calcium chloride can reverse some of the untoward effects.
Magnesium Sulfate
Class: Mineral/electrolyte
Action: Physiologic calcium-channel blocker; bronchodilator.
Indications: Torsades des points, asthma, hypertensive disorders of pregnancy.
Contraindications: High-degree heart blocks, shock, dialysis, hypocalcemia.
Dose: 1-2g
Route: IV
Adverse Effects: Flushing, sweating, bradycardia, respiratory depression, hypothermia.
Other: Can cause cardiac conduction problems in conjunction w/digitalis.
Nitroglycerin: Nitrostat
Class: Nitrate
Action: Relaxes vascular smooth muscle causing vasodilation, decreased cardiac work and improved coronary blood flow.
Indications: Chest pain, Congestive Heart Failure
Contraindications: Hypotension, Increased ICP
Dose: 0.4mg
Route: SL tablet or spray
Adverse Effects: Headache, weakness, dizziness, tachycardia, hypotension
Other: Tablets will lose effectiveness after exposure to air. Monitor BP closely.
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