Pick 6 Review Flashcards
ativan drug class
anticonvulsant/sedative/hypnotic/benzodiazepine
ativan indications
major motor seizures, premed for cardioversion, acute anxiety
ativan contraindications
hypersensitivity
ativan SE
hypotension, drowsiness, HA, amnesia, respiratory depression, blurred vision, N+V
ativan pedi dose
0.05 mg/kg
ativan precautions
have benzo antagonist available
ativan interactions
additive effects with other CNS depressants and alcohol
versed drug class
benzodiazepine/anticonvulsant/sedative/hypnotic
versed moa
positive allosteric modulator for GABA receptors, hyperpolarizes cells by increasing Cl- concentration
versed indications
pre med for cardioversion, post-intubation sedation, seizure
versed contraindications
narrow-angle glaucoma, shock, depressed vitals, alcoholic coma
versed side effects
laryngospasm, bronchospasm, dyspnea, respiratory depression and arrest, drowsiness, amnesia, AMS, tachycardia, bradycardia, PVC’s, retching
versed pedi dose
0.2mg/kg max of 10mg
versed precautions
have resuscitative equipment available, more potent than other benzos, have benzo antagonist available
versed interactions
additive effects with other CNS depressants and alcohol
albuterol moa
b2 agonist causes bronchodilation
albuterol contraindications
hypersensitivity, symptomatic tachycardia
albuterol SE
anxiety, HA, palpitations, sweating, dizziness, nervousness, tremor, HTN, arrhythmias, chest pain, N+V
albuterol precautions
monitor vitals and EKG; caution with heart disease or HTN, check lungs before and after
albuterol interactions
SE increased with other sympathetic agonists, beta blockers blunt effects, MAOI’s and TCA’s may potentiate cardiovascular effects
solu-medrol MOA
upregulates genes that produce inhibit inflammatory response - is an immunosuppressant
solu-medrol onset
2-6 hrs
solu-medrol peak
4-8 days
solu-medrol duration
1-5 weeks
solu-medrol indicaitons
anaphylaxis,hives; asthma, copd; spinal cord injury
solu-medrol contraindications
none
solu-medrol SE
fluid retention, CHF, HTN, abd. distention, vertigo, HA, nausea, malaise, hiccups
solu-medrol spinal cord injury
30mg/kg iv over 15 min, maintenance 5.4 mg/kg/hr for 24-48 hrs
solu-medrol precautions
one dose prehospitally, can prolong wound healing, suppression of adrenocortical steroids
solu-medrol interactions
lasix and thiazide diuretics increase K+ loss; decreased effect with phenytoin, phenobarbital, rifampin
mag sulfate drug class
electrolyte/antidysrhythmic/mineral
mag sulfate moa
physiological Ca2+ channel blocker causes CNS depression and smooth muscle relaxation
mag indications
asthma/bronchospasm; severe refractory VF or pulseless VT, torsades; post MI prophylaxis of dysrhythmias; eclampsia, pre-term labor
mag contraindications
3rd degree heart block, shock, severe hypertension, impaired renal function, hypocalcemia
mag SE
flushing, sweating, bradycardia, decreased deep tendon reflexes, drowsiness, respiratory depression, dysrhythmias, hypotension, hypothermia, itching, rash
mag adult asthma dose
2g in 100cc infused over 10 min
mag vt, vf, torsades no pulse adult dose
2g over 1-2 min
mag vt/torsades with pulse adult dose
1-2g in 50-100cc over 5-60 min
mag eclampsia dose
2-4g over 25 min
mag pedi asthma dose
25-50mg/kg infused over 15-30 min
mag pedi vt no pulse dose
25-50mg/kg
mag pedi vt with pulse dose
25-50 mg/kg over 10-20 min
mag precautions
watch for respiratory depression, have cacl2 available if OD
mag interactions
cardiac conduction abnormalities with digitalis
epi moa
a1 agonist causes peripheral vasoconstriction (increases SVT and BP); b2 agonist causes positive inotropy, chronotropy, dromotropy; b2 agonist causes bronchodilation; blocks destruction of MAST cells in anaphylaxis
epi indications
cardiac arrest; anaphylaxis/severe asthma; symptomatic bradycardia/hypotension
epi contraindications
HTN and tachydysrhythmias, caution with pregnancy and CAD
epi SE
anxiety, dysrhythmias, tremulousness, dizziness, N+V, increased myocardial oxygen demand
epi adult cardiac arrest dose
.5-1mg 1:10,000 q3-5 min
epi pedi cardiac arrest dose
.01mg/kg 1:10,000 q 3-5 min
epi bradycardia/hypotension adult dose
2-10 mcg/min
epi adult anaphylaxis dose
.3-.5mg IM 1:1000, then .1mg 1:10,000 over 3 min
epi pedi anaphylaxis dose
.01mg/kg 1:1000 then .01mg/kg 1:10,000 max dose .3mg
epi precautions
protect from light
epi interactions
inactivated by alkaline solutions, effect intensified by antidepressants, reacts with cacl2 and nahco3 to form ppt in tubing
nitroglycerin trade
nitrostat
nitrostat generic
nitroglycerin
nitro drug class
nitrate/vasodilator
nitro moa
converted to NO, activates GTP to cGMP +2pi activates cascade that reduces intracellular Ca2+ causing VSMC relaxation, decreasing cardiac preload and afterload
nitro indications
angina, CHF/pulmonary edema
nitro contraindications
shock, ICP, children under 12, ED drugs w/in last 48 hrs
nitro SE
HA, dizziness, weakness, tachycardia, mg SL hypotension, rash, dry mouth, N+V
nitro adult dose
0.4mg SL q3-5min until BP drops or pain relief (max 3x25min)
nitro precautions
monitor vitals, expect HA, do 12 lead prior, don’t use w/ R sided MI
nitro drug interactions
orthostatic hypotension with b-blockers, severe hypotension with alcohol
zofran drug class
antiemetic
zofran moa
serotonin R antagonist, especially at the vagal nerve
zofran indications
nausea/vomiting
zofran contraindications
hypersensitivity
zofran SE
HA, dizziness, tachycardia, chest pain, constipation, diarrhea, dry mouth, prolonged QT
zofran adult dose
4mg iv
zofran pedi dose
0.1mg/kg iv
zofran precaution
lower risk of sedation and dystonia than other antiemetics
zofran interactions
affects clearance and half-life with inducers and inhibitors of cytochrome p-450 enzymes
benadryl drug class
antihistamine
benadryl moa
competitive h1/h2 antagonist, blocks histamine release, inhibits reuptake and storage of dopamine leading to reduction of bronchoconstriction, vasodilation, increased vascular permeability
benadryl indications
allergic rx; anaphylaxis; dystonia
benadryl contraindications
hypersensitivity; asthma; nursing mothers
benadryl SE
sedation, dries bronchial secretions, blurred vision, HA, palpitations, dizziness, drowsiness, fatigue, euphoria
benadryl precautions
caution with severe liver disease, asthma, narrow angle glaucoma, BPH; may cause hypotension
benadryl interactions
potentiates sedative effects of alcohol, benzos, narcotics, other anti-HTN’s
benadryl contraindications
hypersensitivity; asthma; nursing mothers
benadryl SE
sedation, dries bronchial secretions, blurred vision, HA, palpitations, dizziness, drowsiness, fatigue, euphoria
adenosine drug class
class v antidysrhythmic/ nucleoside
adeonise moa
adenosine R agonist, slows AV conduction
adenosine indications
SVT; wide complex tachycardia
adenosine contraindications
2/3rd degree blocks; chemical induced SVT’s; caution with asthma, bronchospasm, unstable angine; torsades
adenosine SE
facial flushing, HA, chest pain, dizziness
adenosine pedi dose
1st dose 0.1mg/kg (max 6); 2nd dose 0.2 mg/kg (max 12) all followed by flush
adenosine precautions
print a strip as you’re pushing it; give in AC or higher
adenosine interactions
double the dose with methylxanthines; halve the dose with carbamazepines
amiodarone drug class
antidysrhythmic
amiodarone moa
class III antidysrhythmic/ K+ channel blocker prolongs cardiac AP and refractory period; has properties of Na+/Ca2+ channel blocker
amiodarone indications
VF and VT; wide complex tachycardia
amiodarone contraindications
cardiogenic shock, sinus node dysfunction, symptomatic bradycardia, 2nd/3rd degree blocks
amiodarone SE
hypotension, bradycardia, dyspnea, cough, dizziness, prolonged PR, QRS, QT intervals, increased ventricular beats
amiodarone VF/pulseless VT dose
300mg, repeat 150mg q3-5
amiodarone VF/ VT with a pulse dose
150mg over 10 min
amiodarone maintenance dose
1mg/min first 6 hrs, then 0.5mg/min
amiodarone VF/pulselss VT pedi dose
5mg/kg, max 300mg, max total dose 15 mg/kg
amiodarone VT with pulse pedi dose
5mg/kg over 20-60 min; max 300mg
amiodarone precautions
caution in Pt’s with heart failure
amiodarone interactions
warfarin, digoxin, procainamide, quinidine, phenytoin
atropine drug class
anticholinergic
atropine MOA
Ach R antagonist, positive chronotropy, no inotropic effect
atropine indications
symptomatic bradycardia; premed for RSI hr<50 bpm; OP poisoning
atropine contraindications
no longer recommended for PEA and asystole
atropine SE
blurred vision, dilated pupils, dry mouth, tachycardia, drowsiness, confusion
atropine adult bradycardia dose
0.5mg q3-5min max 3mg
atropine RSI adult dose
.5-1mg
atropine adult OP dose
2-5mg
atropine pedi bradycardia dose
0.02mg/kg; min .1mg max .5mg in single dose
atropine RSI pedi dose
0.02mg/kg
atropine pedi OP dose
0.02-0.05mg/kg q 20-30min
atropine precautions
don’t give less than .5 adult or .1 pedi; may cause paradoxical effect; may be ineffective in 2nd degree type II/3rd degree blocks; increases myocardial o2 demand
atropine interactions
few ems
cardizem drug class
Ca2+ channel blocker
cardizem MOA
Ca2+ channel blocker, peripheral and coronary vasodilation, slowed conduction through AV node, negative inotropy, decreased myocardial O2 demand
cardizem indications
rapid a-fib/a-flutter; SVT refractory to adenosine
cadizem contraindications
severe hypotension, cardiogenic shock, CHF; wide complex tachycardia; WPW
cardizem SE
N+V, dizziness, HA, bradycardia, heart block, hypotension, asystole
cardizem adult dose
1st) 0.25mg/kg over 2 min (usually 15-20 mg; 2nd) 0.35mg/kg; maintenance dose 5-15 mg/hr
cardizem pedi dose
not for pedi’s
cardizem precautions
may cause hypotension, monitor BP, have CaCl2 available; lasts for 1 month out of refrigeration
cardizem interactions
do not give to Pt’s receiving IV B-blockers, increases risk of CHF, bradycardia
fentanyl moa
opiate receptor agonist causes analgesia
fentanyl indications
pain/adjunct for RSI
fentanyl contraindications
hemmorhage/shock, hypersensitivity
fentanyl SE
bradycardia, respiratory depression, apnea, chest wall rigidity
fentanyl adult dose
1 mcg/kg max 100mcg, q10
fentanyl pedi dose
1-2mcg/kg
fentanyl precautions
caution with kidney and liver disfunction, halve the dose for elderly and administer q5
fentanyl drug interactions
additive effects with CNS depressants, not for Pt who used MAOI’s w/in last 14 days
morphine moa
opiate r agonist causes analgesia; increases periopheral venous capacitance and decreases venous return, decreasing myocardial o2 demand
morphine indications
severe pain; pulmonary edema
morphine contraindications
hypovolemia/hypotension, head injury with AMS, hypersensitivity to morphine, codeine, percodan; copd/compromised respiratory status
morphine SE
N+V, abd. cramps, blurred vision, constricted pupils, AMS, HA, respiratory depression
morphine adult dose
2-10mg initial, then 2mg q3 until relief
morphine pedi dose
0.1mg/kg
morphine precautions
causes respiratory depression, have narcan available
morphine interactions
CNS depression with antihistamines, antiemetics, sedatives, hypnotics, barbituates, alcohol
aspirin trade
bayer
bayer generic
aspirin, acetylsalicylic acid, ASA
aspirin drug class
platelet aggregation inhibitor/NSAID
aspirin moa
inhibits platelet aggregation by blocking the formation of thromboxane a2; a cox inhibitor, inhibits prostaglandin synthesis and spread of inflammation
aspirin indications
ACS
aspirin contraindications
hypersensitivity, active ulcers and asthma
aspirin SE
GI bleeding, wheezing, N+V, heartburn, prolonged bleeding
aspirin adult dose
160-324mg of baby aspirin chewed
aspirin pedi dose
not for pedi
aspirin precautions
can cause GI upset
aspirin drug interactions
increased SE with other anti-inflammatories, decreased absorption with antacids
dopamine HCL trade
intropin
intropin generic
dopamine hcl
dopamine moa
a1 agonist causes peripheral vasoconstriction; b1 agonist causes positive inotropy
dopamine indications
hypotension not caused by hypovolemia, cardiogenic shock, symptomatic bradycardia
dopamine contraindications
hypovolemia where fluids have not been administered to max capacity, pheochromocytoma, tachydysrhythmias and VF
dopamine SE
nervousness, HA, dysrhythmias, palpitations, chest pain, dyspnea, N+V
dopamine dose
2-5mcg/kg/min mesentery dose; 5-10mcg/kg/min stimulates b effects; 10-20mcg/kg/min stimulates a effects
dopamine precautions
keep out of sunlight
dopamine interactions
deactivated by alkaline solutions; maoi’s; hypotension with dilantin
succinylcholine generic
anectine
anectine generic
succinylcholine
succ drug class
depolarizing neuromuscular blocker
succ moa
cholinergic r-agonist; causes initial wide-spread depolarization and prevents Ach from binding and causing further stimulation
succ indications
to paralyze Pt before intubating
succ contraindications
penetrating eye injuries, narrow angle glaucoma, hyperkalemia, malignant hyperthermia
succ SE
wheezing, respiratory depression, apnea, aspiration, dysrhythmias, bradycardia, sinus arrest, HTN, hypotension, increased intraocular pressure, increased ICP
succ adult dose
1-2mg/kg
succ pedi dose
1mg/kg
succ precautions
Fx in children, may cause dysrhythmias and CA, should be used by experienced providers, have rescue airways available
succ interactions
potentiated by lidocaine, procainamide, B blockers, mag sulfate, other neuromuscular blockers
etomidate trade
amidate
amidate generic
etomidate
etomidate drug class
sedative/hypnotic
etomidate moa
depresses reticular activating system and potentiates GABA
etomidate indications
induction agent for RSI
etomidate contraindications
hypersensitivity
etomidate SE
myoclonic skeletal muscle movement, apnea, hyperventilation, hypoventilation, laryngospasm, HTN, hypotension, tachycardia, bradycardia, N+V
etomidate adult dose
0.1-0.3mg/kg over 15-30 sec
etomidate pedi dose
0.1-0.3mg/kg over 15-30 sec
etomidate precautions
caution with hypotension, severe asthma, severe cardiovascular disease
etomidate interactions
prolonged respiratory depression with verapamil
Succ onset
30-60 sec iv; 2-3 min im
Succ peak
1-3 min
Succ duration
2-3 min iv, 10-30 min im
Etomidate onset
10-20 sec
Etomidate peak
<1 min
Etomidate duration
3-5 min
Albuterol onset
5-15 min
Albuterol peak
1-1.5hrs
Albuterol duration
3-6 hrs
Mag onset
Immediate iv, 1hr im
Mag peak
Varies
Mag duration
1 hr
Mag half life
N/a
epi onset
<2 min iv; 3-10 min im
epi peak
<20 min im, 5 min iv
epi duration
5-10 min iv; 20-30 min im
fentanyl onset
immediate
fentanyl peak
3-5 min
fentanyl duration
30-60 min
morphine onset
immediate iv; 15-30 min im
morphine peak
20 min iv; 30-60 min im
morphine duration
2-7 hrs
adenosine onset
immediate
adenosine peak
immediate
adenosine duration
30-45 seconds
amiodarone onset
immediate
amiodarone peak
30-45 min
amiodarone duration
varies
atropine onset
immediate
atropine peak
2-4 min
atropine duration
4 hrs
cardizem onset
3 min
cardizem peak
7 min
cardizem duration
1-3 hrs
vecuronium trade
norcuron
norcuron generic
vecuronium
vecuronium drug class
non-depolarizing neuromuscular blocker
vecuronium moa
cholinergic r-antagonist, prevents binding of Ach at neuromuscular junction
vecuronium onset
<1 min
vecuronium peak
3-5 min
vecuronium duration
25-40 min
vecuronium indications
paralytic for RSI
vecuronium contraindications
hypersensitivity
vecuronium SE
wheezing, respiratory depression, apnea, aspiration, dysrhythmias, bradycardia, sinus arrest, HTN, hypotension, increased intraocular pressure, increased ICP
vecuronium adult dose
0.08-0.1mg/kg
vecuronium pedi dose
0.1mg/kg
vecuronium precautions
skilled provider, have rescue airway device ready
vecuronium interactions
potentiated by lidocaine, procainamide, B blockers, mag sulfate, other neuromuscular blockers
rocuronium trade
zemuron
zemuron generic
rocuronium
rocuronium drug class
non-depolarizing neuromuscular blocker
rocuronium onset
30-60 sec
rocuronium moa
cholinergic R-antagonist, prevents Ach from binding at neuromuscular junction
rocuronium peak
1-3 min
rocuronium duration
30-60 min
rocuronium contraindications
hypersensitivity
rocuronium indications
paralytic for RSI
rocuronium SE
bronchospasms
rocuronium adult dose
0.6-1.2mg/kg
rocuronium pedi dose
0.6mg/kg
rocuronium precautions
skilled provider, have rescue airway available
rocuronium interactions
potentiated by procainamide, lidocaine, B blockers, mag sulfate, other neuromuscular blockers
nitro onset
1-3 min SL; 30 min topical
nitro peak
5-10 min SL; topical varies
nitro duration
20-30 min SL; 3-6 hrs topical
epi onset
<2 min iv, 3-10 min im
epi peak
<5 min iv, 20 min im
epi duration
5-10 min iv, 20-30 min im
