Region 1 Drugs Flashcards

Question

Amiodarone Physiological: Effects

Answer 1

Amiodarone is a complex, multiple anti-arrhythmic agent. Amiodarone prolongs the action potential and refractory period of the myocardium, while slowing the sinus rate. Amiodarone increases PR and QT intervals and decreases peripheral vascular resistance.

Answer 2

Do not administer with other medications that prolong QT intervals. Potentiates bradycardia / hypotension with β and Ca2+ Channel blockers. Increases the risk of AV block and hypotension with Ca2+ Channel blockers. Increases anticoagulation effects of Warfarin

Answer 3

Acetylsalicylic Acid

Answer 4

Non-Steroidal Anti-Inflammatory; Analgesic; Antipyretic; Anticoagulant

Answer 5

Cardiac Chest Pain (ACS), STEMI

Answer 6

Known hypersensitivity GI bleed requiring hospitalization or blood transfusion within last 6 months

Answer 7

Adult: Chest Pain / Suspected ACS 160-325mg PO

Answer 8

May slow heart rate, may cause hypotension with cumulative doses

Answer 9

Inhibits synthesis and the release of prostaglandins. Aspirin blocks the formation of thromboxane A-2 which causes platelets to aggregate and arteries to constrict. With the decrease in platelet aggregation the blood does not form clots easily.

Answer 10

Reduces the mortality associated with myocardial infarction. Aspirin can be administered to patients on anticoagulants but should be used with caution. Morphine may reduce aspirin’s ability to block platelet aggregation, which leads to higher mortality in AMI patients.

Answer 11

Atropisol (ophthalmic), Atreza

Answer 12

Anticholinergic, Sympatholytic

Answer 13

Symptomatic Bradycardia, Bradyarrhythmias Organophosphate Poisoning Pre-intubation in children requiring airway manipulation to prevent vagotropic bradycardia response

Answer 14

Known hypersensitivity Tachycardia (relative)

Answer 15

Adult: Symptomatic Bradycardia 1mg IV/IO, q 3-5min prn, max dose 3mg Organophosphate Poisoning 2mg IV/IO, q5min prn until secretions resolve, no max

Answer 16

Pediatric: Symptomatic Bradycardia 0.02mg/kg IV/IO, may repeat x1 prn Minimum single dose = 0.1mg Maximum single dose for child = 0.5mg Maximum single dose for adolescent = 1mg Organophosphate Poisoning 0.02mg/kg IV/IO, q5min prn until secretions resolve, no max

Answer 17

Pupil dilation, blurred vision, headache, restlessness, confusion, tachycardia, angina, palpitations, hypertension, flushing of skin, drying of secretions, dry mouth, difficulty swallowing.

Answer 18

Decreases action of the parasympathetic nervous system increasing conduction velocity (dromotrope) and heart rate (chronotropic), enhances conduction through the AV junction. Decreases bodily secretions.

Answer 19

Overdose will cause anticholinergic toxidrome – “red as a beet, dry as a bone, blind as a bat, mad as a hatter, and hot as a desert”

Answer 20

Calcium Replacement

Answer 21

Electrolyte, Antidote

Answer 22

Ca2+ Channel Blocker overdose Cardiac Arrest secondary to suspected hyperkalemia Suspected hypocalcemia Hypermagnesemia (Magnesium Sulfate overdose)

Answer 23

Known hypersensitivity Digoxin Overdose Hypercalcemia

Answer 24

Adult: Overdose / Acute Poisoning: Ca2+ Channel Blocker OD 500-1,000mg IV/IO infusion over 10-20min *w/Medical Control orders. Asystole/PEA 1g IV/IO for known/suspected hyperkalemia or renal disease/dialysis Traumatic Shock 2g IV/IO Crush Injury / Syndrome: Signs of Hyperkalemia present 1g IV/IO over 10min, not to exceed 1mL/min

Answer 25

Pediatric: Asystole/PEA 20mg/kg IV/IO, max 1g

Answer 26

Sensation of “heat wave” or tingling, local burning sensation

Answer 27

Calcium is an essential component for proper functioning nervous, muscular, skeletal, and endocrine systems and also includes positive inotrope and dromotrope effects.

Answer 28

Irritation with extravasation *(may cause tissue necrosis) Rapid IV administration may cause sensation related to side effects. Cardiotoxicity and local phlebitis with rapid IV administration Use caution in patients with renal insufficiency or history of cardiac disease.

Answer 29

Mineral supplement, Antidote

Answer 30

Ca2+ Channel Blocker Overdose Hydrofluoric Acid Exposure

Answer 31

Ventricular fibrillation Hypercalcemia Concurrent use of IV Calcium Gluconate

Answer 32

Adult: Hydrofluoric Acid Exposure Skin Exposure: Gel: 2.5% TD to affected area Inhalation Exposure: 4ml Nebulized 2.5-5%

Answer 33

Nausea, Constipation

Answer 34

Calcium is the fifth most abundant element in the body and is essential for maintenance of the functional integrity of nervous, muscular, and skeletal systems and cell membrane and capillary permeability.

Answer 35

Calcium Gluconate Gel Mix either of the following with 5 oz of water-soluble surgical lubricant (e.g. KY Jelly): • 10ml of 10% Calcium Chloride • 3.5g of Calcium Gluconate powder Calcium Gluconate Nebulized To obtain 100ml of a 2.5% solution, mix 75ml of NS with 25ml of Calcium Gluconate 10%

Answer 36

Take appropriate BSI precautions and decontaminate the patient as needed. Use transdermally on fingers by applying gel to the hand, squirting additional gel into a surgical glove, and inserting affected hand into the glove to keep the gel in place. Reapply every 15 minutes and massage until pain has abated. May cause precipitation if mixed in IV fluids that contain carbonates, phosphates, sulfates, or tartrates.

Answer 37

Decadron, Maxidex, Baycadron, DexPak, Ozurdex

Answer 38

Corticosteroid, Glucocorticoid

Answer 39

Anaphylaxis Bronchospasm, Bronchiolitis, Asthma COPD with acute exacerbation Croup, Stridor

Answer 40

Known hypersensitivity Hyperglycemia (relative)

Answer 41

Adult: Wheezing/Bronchospasm: Moderate/Severe 16mg PO/IV/IM/IO

Answer 42

Pediatric: Lower Airway Obstruction: Asthma/Wheezing > 2yo 0.6mg/kg PO/IV/IM/IO, max 16mg Upper Airway Obstruction: Croup/Stridor 0.6mg/kg PO/IV/IM/IO, max 16mg

Answer 43

Hyperglycemia, Immunosuppression, GI discomfort

Answer 44

Long acting corticosteroid with minimal sodium-retaining potential. It decreases inflammation by suppression of neutrophil migration, decreased production of inflammatory mediators, and reversal of increased capillary permeability; suppresses normal immune response.

Answer 45

It is safe the give the IV formulation via PO route Diabetes and hyperglycemia is a relative contraindication – administer the drug if antiinflammatory benefit is likely to outweigh the risk. The PO administration route is preferred in pediatric patients without an IV already established unless patient has altered LOC or airway compromise.

Answer 46

D10, D25, D50

Answer 47

Carbohydrate, Hyperglycemic

Answer 48

Carbohydrate, Hyperglycemic

Answer 49

Head Injury (unless documented hypoglycemia) Known or suspected Intracranial Hemorrhage (caution)

Answer 50

Adult: Diabetic Emergency / Hypoglycemia D50: 12.5g-25g IV/IO, (25g = 50mL of D50) D10: 12.5g-25g IV/IO, (25g = 250mL D10) Stroke: CBG < 60mg/dL D50: 12.5g-25g IV/IO, (25g = 50mL of D50) D10: 12.5g-25g IV/IO, (25g = 250mL D10)

Answer 51

Pediatric: Diabetic Emergency / Hypoglycemia D50: 1ml/kg IV/IO D25: 2mL/kg IV/IO, optimal for age 1-7yo D10: 5ml/kg IV/IO, optimal for age < 1yo Cardiac Arrest D50: 1ml/kg IV/IO D25: 2mL/kg IV/IO, optimal for age 1-7yo D10: 5ml/kg IV/IO, optimal for age < 1yo

Answer 52

Irritation, thrombosis, or necrosis can occur if dextrose is infiltrated into tissue.

Answer 53

Dextrose is a monosaccharide which provides calories for the metabolic needs of the cell as an aerobic metabolic substrate of APT synthesis. Dextrose reverses the CNS effects of hypoglycemia by rapidly elevating serum blood glucose when given parenterally

Answer 54

May worsen ICP or cerebral edema from trauma or CVA Extravasation leads to severe tissue necrosis * Incompatible with Sodium Bicarbonate and Diazepam, thoroughly flush IV between use of same administration access point

Answer 55

Benzodiazepine

Answer 56

Seizure Control Anxiolytic/Sedation

Answer 57

Known hypersensitivity Hypoglycemic seizure activity Patients with a compromised respiratory status (relative) *Do not give via IN route if patient is < 6yo

Answer 58

Adult: Seizure 5mg IV/IM/IO, q 2min prn, max 10mg Agitated/Combative Patient 5mg IV or 10mg IM, max 10mg If agitation persists after 5min, repeat initial dose if max dose not already reached Excited Delirium 10mg IV/IM If agitation persists after 5min, repeat initial dose Post Intubation Sedation 5mg IV or 10mg IM, q2min prn, max 10mg

Answer 59

Pediatric: Seizure: 0.2mg/kg IV/IO/IM, max 5mg if < 5yo / max 10mg if < 10yo 0.2mg/kg IN if ≥ 12yo 0.3mg/kg IN if 6-11yo 0.5mg/kg PR, max 20mg, use PR route as last resort

Answer 60

Rapid administration may cause respiratory depression/arrest. Paradoxical excitement or stimulation sometimes occurs.

Answer 61

Modulates post-synaptic effects of gamma-aminobutyric acid (GABA) transmission, which is a major inhibitory neurotransmitter in the brain.

Answer 62

Not to be mixed with any other injectable medication, may precipitate when administered in a D5W IV line.

Answer 63

Calcium Channel Blocker, Antihypertensive

Answer 64

Atrial Fibrillation with Rapid Ventricular Response Atrial Flutter SVT non-responsive to Adenosine Acute Hypertension Angina

Answer 65

Known hypersensitivity Heart blocks, Bradycardia Hypotension Sick Sinus Syndrome Ventricular Tachycardia

Answer 66

Adult: Narrow-Complex Tachycardia: Regular rhythm: Unresponsive to Adenosine 10mg slow IV/IO push, q5min prn, max 20mg total Narrow-Complex Tachycardia: Irregular rhythm: Stable 10mg slow IV/IO push, q5min prn, max 20mg total.

Answer 67

Pediatric: Probable SVT - Contraindicated

Answer 68

Hypotension, bradycardia, headache, dizziness, arrhythmias, nausea, vomiting. Prolongation of AV node conduction may result in 2nd/3rd degree blocks

Answer 69

Inhibits the influx of calcium ions during membrane depolarization of cardiac and vascular smooth muscle, related to its ability to slow AV nodal conduction time and prolong AV nodal refractoriness. Diltiazem slows ventricular rates, interrupts the reentry circuit in AV nodal re-entry tachycardias and reciprocating tachycardias (e.g. WPW). Diltiazem also prolongs sinus cycle length and decreases peripheral vascular resistance

Answer 70

: Monitor heart rate and blood pressure closely. Diltiazem should be used with caution in patients with impaired liver or renal function. Caution should be used in pregnant females and mothers that are nursing. Caution should be used if administered in the presence of CHF. Caution should be used when administering Diltiazem and anesthetics

Answer 71

Antihistamine

Answer 72

Blocks the cellular histamine receptors resulting in decreased capillary permeability; decreases itching, edema, bronchoconstriction, and vasodilation

Answer 73

Hypersensitivity

Answer 74

Adult: Anaphylaxis / Allergic Reaction 50mg IV/IM (I/O Anaphylaxis) Overdose / Acute Poisoning: Phenothiazines (Dystonic Reaction) 25-50mg IV/IO/IM

Answer 75

Pediatric: Anaphylaxis / Allergic Reaction 1mg/kg IV/IO/IM, max 50mg Overdose / Acute Poisoning: Phenothiazines (Dystonic Reaction) 1-2mg/kg IV/IM

Answer 76

Drowsiness, dry mouth and throat

Answer 77

Blocks the cellular histamine receptors resulting in decreased capillary permeability; decreases itching, edema, bronchoconstriction, and vasodilation.

Answer 78

Concomitant CNS depressants may enhance effect Diphenhydramine has anticholinergic effects when given at higher doses Diphenhydramine toxicity may cause cardiac arrhythmias such as torsade de pointes

Answer 79

Intropin, Myocard-DX

Answer 80

Sympathomimetic, Inotrope, Vasopressor

Answer 81

Cardiogenic Shock

Answer 82

Known hypersensitivity Hypovolemia secondary to trauma

Answer 83

Adult: CHF / Acute Pulmonary Edema 5-20mcg/min Titrate to MAP > 65mmHg Post ROSC: 5-20mcg/kg/min

Answer 84

Dopamine Infusion Mix 400mg Dopamine into 250mL NS/D5W, using microdrop (60 gtt/ml) set Makes 1.6mg/mL

Answer 85

Tachydysrhythmias

Answer 86

Chemical precursor of norepinephrine that stimulates dopaminergic, Beta2 adrenergic, and Alpha-adrenergic receptors.

Answer 87

If the heart rate exceeds 140bpm – the infusion should be discontinued. Can cause hypertensive crisis in susceptible patients.

Answer 88

Adrenaline

Answer 89

Sympathomimetic, Catecholamine

Answer 90

Cardiac Arrest Bradycardia Severe Allergic Reaction, Severe Reactive Airway Disease CHF exacerbation Croup/Stridor, Bronchiolitis

Answer 91

Known hypersensitivity Hemorrhagic Shock

Answer 92

Anaphylaxis 0.3-0.5mg IM (1:1,000), may repeat x1 after 5 min, prn 1mL IV/IO Push Dose Epi, q 3-5min, while preparing vasopressor infusion 2-20mcg/min IV/IO Infusion

Answer 93

Wheezing/Bronchospasm: Severe 0.3-0.5mg IM (1:1,000)

Answer 94

Wheezing/Bronchospasm: Severe 0.3-0.5mg IM (1:1,000)

Answer 95

Cardiac Arrest 1mg IV/IO (1:10,000), q 3-5min

Answer 96

Post ROSC 2-30mcg/min, titrate to MAP ≥ 65mmHg 1mL Push Dose Epi q 3-5min prn

Answer 97

Shock 2-20mcg/min, titrate to MAP ≥ 65mmHg 1ml IV/IO Push Dose Epi, q 3-5min, prn, while preparing vasopressor infusion

Answer 98

Bradycardia: In peri-arrest situations 1mL IV/IO Push Dose Epi, q 2min prn to maintain MAP ≥ 65mmHg

Answer 99

Bradycardia/Age-appropriate hypotension persists 0.01mg/kg IV/IO (1:10,000), q 5min prn, max 1mg total

Answer 100

Hypothermia Induced Cardiac Arrest: VF/pVT, Asystole 1mg IV/IO (1:10,000) ONCE until temp > 86°

Answer 101

Anaphylaxis < 25kg, 0.15mg IM (1:1,000), may repeat x1 after 5min, prn ≥ 25kg, 0.3mg IM (1:1,000) 0.01-0.5mcg/kg/min Infusion w/Medical Control orders

Answer 102

Croup/Stridor 3mg (1:1,000) in Nebulizers, repeat PRN if stridor still present at rest

Answer 103

Pediatric Lower Airway Obstruction: Wheezing due to Bronchiolitis 3mg (1:1,000) via Nebulizer with Medical Control orders

Answer 104

Asthma/Wheezing > 2yo: Severe ≥ 25kg = O.3mg IM (1:1,000) < 25kg = 0.15mg IM (1:1,000)

Answer 105

Cardiac Arrest 0.01mg/kg IV/IO (1:10,000), q 3-5min, max 1mg/dose

Answer 106

Shock 0.01-0.5mcg/kg/min Infusion Consider 1mL (10mcg) IV/IO Push Dose Epi

Answer 107

Neonatal Resuscitation 0.01-0.03mg/kg IV/IO, 0.1mg/ml (1:10,000)

Answer 108

Adults: Mix in syringe 1mL of Epi (1:10,000) with 9mL saline. Syringe = 10mcg/mL of Epi. Administer 1mL (10mcg) IV/IO, q 3-5min, prn. Consider while preparing vasopressor infusion.

Answer 109

Peds: 10mcg/mL (1:100,000), 1ml/1min IV/IO, not to exceed 1mL/1min. Using 1ml syringe, draw 0.1mL of (1:10,000) and 0.9mL saline = 10mcg/mL Titrate to maintain age appropriate SBP.

Answer 110

Mix 2mg Epinephrine (1:1,000) into 250mL NS/D5W = 8mcg/ml Infuse using microdrip (60gtt/ml) set

Answer 111

Sweating, dizziness, nervousness, palpitations, weakness, pale skin, headache

Answer 112

An endogenous catecholamine that stimulates the α-adrenergic and β-adrenergic receptor sites in the sympathetic nervous system. The general physiologic expectation is smooth muscle relaxation of the bronchi, vasoconstriction in the arterioles of the skin and mucosa, and an increase in heart rate and blood pressure.

Answer 113

IM administration of Epinephrine is recognized as generally safe regardless of age. Adverse cardiovascular events are most common when Epinephrine is given intravenously. Consider the risks and benefits of Epi use in patients > 60 years old or persons with a cardiac history. Contact Medical Control for use during pregnancy due to risk to fetus.

Answer 114

General Anesthetic Hypnotic

Answer 115

To induce general anesthesia to facilitate intubation

Answer 116

Known hypersensitivity

Answer 117

Adult: Delayed/Rapid Sequence Intubation (if approved by agency’s Medical Director) 0.3 mg/kg IV/IO

Answer 118

Transient injection site pain, myoclonic muscle events, adrenal suppression

Answer 119

Nonbarbiturate hypotonic that acts on the CNS by stimulating gamma-aminobutyric acid (GABA) receptors. Has minimal cardiovascular effects. Lacks analgesic activity.

Answer 120

Muscle spasm is most commonly seen when Etomidate is injected quickly. Airway should be directly observed at all times when this medication is administered.

Answer 121

Opioid Analgesic, Synthetic Opioid

Answer 122

Acute Pain Sedation

Answer 123

Known Hypersensitivity to Fentanyl or other opioid agonists Known or suspected gastrointestinal obstruction Significant respiratory depression Bradycardia

Answer 124

Adult: Post-Intubation Sedation 25-50mcg IV/IO, q 2min prn, max 200mcg Non-Traumatic Abdominal Pain / Nausea & Vomiting 25-50mcg IV/IO/IM/IN, q 2min prn for severe pain concerning for a surgical pathology that is not bowel obstruction or ileus (max 100 mcg) Chest Pain 25-50mcg IV/IO/IN/IM, q 2min prn, max 200mcg Traumatic Pain Management 25-50mcg IM or slow IV push, q 2min prn, max 150mcg If additional analgesia is needed for persistently severe pain (8-10) believed to be due to a surgical pathology contact Med Control

Answer 125

Pediatric: Traumatic Pain Management 1mcg/kg IV, 1-2mcg/kg IN, max 100mcg, may repeat x1 with Medical Control orders

Answer 126

Bradycardia, respiratory depression, apnea, muscle rigidity, diarrhea, nausea, constipation, dry mouth

Answer 127

Narcotic agonist of opiate receptors; inhibits ascending pain pathways thus altering response to pain. Produces analgesia, respiratory depression, and sedation.

Answer 128

Effects are related to the dose and speed of administration. May cause sudden respiratory depression/arrest. Usual effects last for 30-60 min, IM onset 7-8 min with duration of 1-2 hrs Use caution with elderly or debilitated patients Use caution in patients taking other CNS depressant medications/ETOH use Use caution in patients with respiratory disease

Answer 129

Cyanide antidote , Vitamin B12 precursor

Answer 130

Cyanide Poisoning (known or suspected)

Answer 131

Adult: Cyanide Poisoning 5g IV/IO

Answer 132

Pediatric: Cyanide Poisoning 70mg/kg IV/IO, max 5g

Answer 133

Elevated blood pressure, headache, nausea, erythema, rash, infusion site reaction, red colored urine

Answer 134

Vitamin B12 molecule with hydroxyl group linked to cobalt binds one cyanide ion by substituting the cobalt molecule. Cyanocobalamin is formed and renders cyanide inactive. Cyanocobalamin is excreted in the urine.

Answer 135

Consider cyanide poisoning regardless of SpO2 levels Cyanide can act independently from cyanide poisoning and synergistically

Answer 136

Anticholinergic (parasympatholytic), Bronchodilator

Answer 137

Relieve bronchospasm associated with asthma, emphysema, and chronic bronchitis

Answer 138

Known Hypersensitivity to Atrovent or Atropine

Answer 139

Adult: Wheezing / Bronchospasm 0.5mg Nebulized

Answer 140

Pediatric: Asthma / Wheezing > 2yo 0.5mg Nebulized, may repeat x2 while administering other treatments

Answer 141

Headache, dry mouth, dizziness, cough, upset stomach

Answer 142

Inhibits vagally mediated reflexes by antagonizing acetylcholine receptors on bronchial smooth muscle; this leads to localized bronchodilatation

Answer 143

Anaphylaxis / Allergic Reaction consideration: Patients who take β Blockers have an increased risk of developing a more severe reaction; these patients also may have a paradoxical response to Epinephrine. The use of inhaled Atrovent and Albuterol may help respiratory symptoms in these cases.

Answer 144

Dissociative Anesthetic

Answer 145

Agitation/Excited Delirium, Pain Management, Post-Intubation Sedation

Answer 146

Known hypersensitivity Hypertensive Crisis

Answer 147

Excited Delirium 2mg/kg IV/IO or 4mg/kg IM, max IM/IV dose = 400mg If agitation persists after 5 minutes, repeat Ketamine at half the initial dose.

Answer 148

Post-Intubation Sedation 2mg/kg IV/IO or 4mg/kg IM, q 10min prn, may repeat x1

Answer 149

Cardiac Arrest/Post ROSC: for occurrence of varying states of consciousness 1mg/kg IV/IO for sedation/amnesia

Answer 150

Bradycardia: Prior to TCP Premedicate with 1mg/kg IV/IO/IM, max 200mg, if possible

Answer 151

25mg IV/IO/Infusion, q15min prn, max 50mg IV/IO 50mg IN/IM, q15min prn, max 100mg IN/IM Contact Medical Control if additional analgesia in needed

Answer 152

Emergence reaction, visual hallucinations, tachycardia, hypertension, respiratory depression/laryngospasms when given rapidly, bronchodilation, hypersalivation

Answer 153

Dissociative agent that blocks the NMDA receptor, producing profound anesthesia and analgesia. In lower doses, ketamine is a potent analgesic. Unlike opiates, ketamine does not suppress the central nervous system, which makes it ideal for use when sedation or pain management is needed in the hemodynamically compromised patient

Answer 154

Ketamine delivers optimal therapeutic effects when administered via slow push (at least over 60 seconds IV or via infusion over 10-15 minutes). Administration delivered over shorter periods of time have reported increase in discomfort, laryngospasm, and severity of dissociation. If patient exhibits laryngospasms/respiratory depression/respiratory pause, assist ventilations with bag valve mask. Respiratory compromise is typically brief (i.e. less than 5-10 minutes) and does not require intubation. Emergence reactions may occur when ketamine begins to wear off and can be mitigated with benzodiazepines

Answer 155

Lidocaine CV, Xylocaine

Answer 156

Antidysrhythmic (class Ib), Local Anesthetic

Answer 157

Ventricular Arrhythmia Local Infiltration Anesthesia prior to IO infusion

Answer 158

Known Hypersensitivity to lidocaine or amide-type local anesthetic Congestive Heart Failure Cardiogenic Shock 2◦ and 3◦ heart block if no pacemaker is present

Answer 159

Cardiac Arrest Consider 1 mg/kg slow IV bolus over 2-3 min after defibrillation, CPR, and vasopressor administration. Repeat x 1 after 5 min for persistent VF/VT

Answer 160

Intraosseous Access 20-40mg IO after IO insertion for pain relief in conscious patients

Answer 161

Dermatologic: edema, erythema at injection site, petechiae. Cardiovascular: hypotension

Answer 162

Class Ib antidysrhythmic combines with fast Na channels and inhibits recovery after repolarization, resulting in decreasing myocardial excitability

Answer 163

Constant monitoring with and EKG is essential to the proper administration of IV lidocaine. When lidocaine is administered with other antiarrhythmic drugs such as amiodarone, phenytoin, procainamide, propranolol, or quinidine, the cardiac effects may be additive or antagonistic

Answer 164

Benzodiazepam

Answer 165

Known Hypersensitivity Narrow-Angle Glaucoma Patients with a history of sleep apnea syndrome

Answer 166

Seizure 2mg IV/IM/IO, q2min prn, max 8mg

Answer 167

Agitated/Combative Patient 2mg IV or 4mg IM, max 8mg If agitation persists after 5min, repeat initial dose if max dose not already reached

Answer 168

Excited Delirium 4mg IV/IM If agitation persists after 5min, repeat initial dose

Answer 169

Post Intubation Sedation: 2-4mg IV/IM, q2min prn, max 10mg

Answer 170

Seizure 0.1mg/kg IV/IO/IM, max 4mg, may repeat x1

Answer 171

Sedation, dizziness, fatigue, amnesia, drowsiness. Rapid administration may cause respiratory depression/arrest.

Answer 172

Sedative hypnotic increases the action of gamma-aminobutyric acid (GABA), which is a major inhibitory neurotransmitter in the brain.

Answer 173

Not to be mixed with any other agents or diluted with IV solutions. Administer via the proximal end of the IV tubing and flush well. Most likely to produce respiratory depression in patients who have taken other depressant drugs, especially alcohol and barbiturates. Can cause local venous irritation. Use relatively large veins, if possible

Answer 174

Antidysrhythmic, Electrolyte, Smooth Muscle Relaxant

Answer 175

Asthma, Reactive Airway Disease Eclampsia Torsade de Pointes

Answer 176

Known Hypersensitivity Heart blocks, Bradycardia, Myocardial damage (relative) Hypotension, Shock

Answer 177

Wheezing/Bronchospasm: Severe 2g IV/IO over 10min (mixed in 100mL NS/D5W)

Answer 178

Seizure in pregnancy > 20 weeks gestation 4g IV/IO in 100mL NS/D5W infusion over 10min or 10g IM (5g in each buttock) if unable to obtain IV access

Answer 179

Cardiac Arrest – Torsade de Pointes / Polymorphic VT 2g IV/IO

Answer 180

Tachycardia – Torsade de Pointes / Polymorphic VT 1-2g IV/IO over 10min

Answer 181

Asthma/Wheezing > 2yo: Severe 50mg/kg IV over 10min, max 2g

Answer 182

Cardiac Arrest – Torsade de Pointes / Polymorphic VT 50mg/kg IV/IO, max 2g

Answer 183

Tachycardia – Torsade de Pointes / Polymorphic VT 50mg/kg IV/IO over 10-20min

Answer 184

Waste 150mL of 250mL NS/D5W leaving 100mL in bolus. Add 2g of MgSO4 to bolus. Using a 15gtt/mL macrodrip set, administer infusion at a rate of 2.5gtts/sec (aka 150 gtt/min) to deliver 2g over 10 minute

Answer 185

Hypotension, flushing, drowsiness, respiratory depression/paralysis, CNS depression and paralysis,

Answer 186

Magnesium Sulfate reduces striated muscle contractions and blocks peripheral neuromuscular transmission by reducing acetylcholine release at the myoneural junction. Magnesium Sulfate effectively decreases the risk of preeclampsia progressing to eclampsia and effectively terminates seizures. The anticonvulsant activity is suspected to be due to magnesium’s role as an N-methyl-D-aspartate (NMDA) antagonist

Answer 187

Administer with caution if flushing and sweating occurs. Use with caution when co-administered with barbiturates, narcotics, other hypnotics, or systemic anesthetics. CNS depressants may be additive; dosages often require adjustments. Because Magnesium is removed from the body solely by the kidneys, the drug should be used with caution in patients with renal impairment. Consider the risk and benefit of its use prior to administering to patients with renal failure. High levels of magnesium can cause sinus bradycardia and blocks. Consider the risk and benefits of its prior to administering to patients with cardiac disease

Answer 188

Solu-Medrol, Medrol

Answer 189

Steroid-Glucocorticoid, Anti-Inflammatory Agent

Answer 190

Anaphylaxis, Allergic Reaction Asthma, COPD Adrenal Crisis

Answer 191

Known Hypersensitivity Use with caution in patients with diabetics Use with caution in patients with GI bleeding

Answer 192

Wheezing/Bronchospasm: Moderate/Severe 125mg IV/IO/IM

Answer 193

Anaphylaxis 125mg IV/IO/IM

Answer 194

Shock – if patient has Addison’s Disease or other forms of Adrenal Sufficiency 125mg IV/IO/IM with *Medical Control orders

Answer 195

Lower Airway Obstruction: Asthma/Wheezing > 2yo 2mg/kg IV/IM/IO, max 125mg

Answer 196

Anaphylaxis 2mg/kg IV/IM/IO, max 125mg

Answer 197

Dizziness, weakness, sleep disorders, sodium and water retention, nausea, hypokalemia, hyperglycemia

Answer 198

Methylprednisolone is a synthetic corticosteroid. Corticosteroids are hormones produced by the adrenal glands and are involved in several physiological systems such as stress response, Immune system response, and regulation of inflammation

Answer 199

Adrenal Crisis / Addison’s Disease presents with hypotension or shock out of proportion to the severity of the illness; it can be fatal if not diagnosed and treated aggressively with steroid replacement. Contact Medical Control for consultation

Answer 200

Lopressor, Toprol

Answer 201

Beta-Adrenergic Blocker

Answer 202

Atrial Fibrillation Uncontrolled, Atrial Flutter, SVT non-responsive to Adenosine

Answer 203

Known Hypersensitivity 2nd and 3rd degree Heart Blocks Bradycardia, Hypotension Cardiogenic Shock Bronchial Asthma

Answer 204

Narrow-Complex Tachycardia: Regular rhythm: Unresponsive to Adenosine 5mg slow IV/IO push, q5min prn (max 15mg total) Narrow-Complex Tachycardia: Irregular rhythm: Stable 5mg slow IV/IO push, q5min prn (max 15mg total)

Answer 205

Contraindicated

Answer 206

Bradycardia, headache, dyspnea, light-headedness, dizziness, weakness, nausea, vomiting, ankle swelling

Answer 207

Beta-adrenergic receptor blocker, with preferential effect on Beta1-adrenoceptors chiefly located in the cardiac muscle. The preferential effect is not absolute and at high doses, Beta2-adrenoreceptors chiefly located in the smooth bronchial muscles and vascular musculature can be affected. Beta-blocking activity is shown to reduce heart rate and cardiac output. Metoprolol has no intrinsic sympathomimetic activity

Answer 208

Monitor heart rate and blood pressure closely. Use with caution in pulmonary disease and CHF

Answer 209

Benzodiazepine, Anxiolytic

Answer 210

Seizure Control Anxiolytic, Sedation Pre-medication before TCP

Answer 211

Known Hypersensitivity Narrow-Angle Glaucoma Hypotension

Answer 212

Seizure 10mg IM if seizing upon arrival 2.5mg IV/IM/IO, q2min prn, max 10mg (not including initial IM dose if seizing upon arrival)

Answer 213

Agitated/Combative Patient 2.5-5mg IV/IM/IN, max 10mg If agitation persists after 5min, repeat initial dose if max dose not a

Answer 214

Excited Delirium 5mg IV/IM If agitation persists after 5min, repeat initial dose

Answer 215

Post Intubation Sedation 5mg IV/IO/IM, q2min prn, max 20mg

Answer 216

2.5-5mg IV/IO/IN, if possible, for sedation

Answer 217

2.5 mg IV/IO/IM x1 prn

Answer 218

0.2mg/kg IV/IO, max 5mg, if seizing on arrival, may repeat x1 q5min 0.1mg/kg IV/IO, max 2mg, may repeat x1 q5min

Answer 219

Rapid administration may cause respiratory depression/arrest Hypotension, cardiac arrhythmias, anterograde amnesia

Answer 220

Induces effects by acting on parts of the gamma-amino butyric acid (GABA) and benzodiazepine receptors, the major inhibitory neurotransmitters in the CNS. Contains anxiolytic, anticonvulsant, sedative, muscle relaxant, and amnesic properties

Answer 221

Potentiates the effects of other CNS depressants. Use lower end of dosing range in debilitated patients, including the elderly. Do not dilute for IM/IN administration. Considered to be twice as potent as Diazepam, milligram for milligram

Answer 222

MS, Contin

Answer 223

Opioid Analgesic

Answer 224

Chest pain unrelieved by Nitroglycerin Traumatic Injury Burn

Answer 225

Known Hypersensitivity to Morphine or other opioid agonists Paralytic ileus Head injury

Answer 226

Chest Pain 2-4mg IV/IO/IM, q2min prn, max 10mg

Answer 227

Traumatic Pain Management 2-4mg IV/IO/IM, q2min prn, max 10mg If additional analgesia is needed for persistently severe pain (8-10) believed to be due to a surgical pathology contact Med Control

Answer 228

Traumatic Pain Management < 1yo: 0.05mg/kg IV/IO ≥ 1yo: 0.1mg/kg IV/IO max 4mg May repeat x1 with Medical Control orders

Answer 229

Decreased blood pressure, nausea/vomiting, altered level of consciousness, respiratory depression

Answer 230

Narcotic agonist-analgesic that inhibits ascending pain pathways, thus altering response to pain. Acute administration causes vasodilatation and decreased sympathetic tone, resulting in bradycardia and decreased blood pressure. The Increases venous capacitance, decreases venous return, and produces mild peripheral vasodilation. Morphine also decreases myocardial oxygen demand

Answer 231

The effects of morphine are potentiated by alcohol, antihistamines, barbiturates, sedatives, and beta blockers. The decreased myocardial oxygen demand of morphine can be nullified if respiratory depression decreases oxygen supply. The use of morphine in NSTEMI is controversial, as it may inhibit the absorption and efficacy of antiplatelet agents. Use judiciously

Answer 232

Opioid Antagonist, Opioid Reversal Agent

Answer 233

Respiratory and neurologic depression due to opioid intoxication

Answer 234

Known hypersensitivity

Answer 235

Overdose / Acute Poisoning: Suspected Opiate Overdose 0.5-2 mg IV/IM/IO, q2-3 min prn 2-4 mg IN, q2-3min prn

Answer 236

Cardiac Arrest 2mg IV/IO if suspected opioid overdose (should not delay CPR)

Answer 237

Pediatric Altered Mental Status: Suspicion of Opiate/Opioid Ingestion 0.1mg/kg IV/IO/IN, q2-3min, titrate prn (max 2mg/dose

Answer 238

Cardiac Arrest 1-2mg IV/IO if suspected opioid overdose (should not delay CPR)

Answer 239

Withdrawal symptoms (especially in neonates), combativeness, hyperventilation, tachycardia, hypertension, nausea/vomiting

Answer 240

Naloxone competitively binds to the β-endorphin receptors in the central nervous system, thereby reversing the effects of opiates and their derivatives. Naloxone completely reverses the effects of opioids and causes a sudden onset of withdrawal symptoms

Answer 241

Naloxone doses should be used to reverse respiratory depression, not to fully awaken the patient. Anticipate combative behavior and ensure provider safety in advance. IV doses greater than 0.5mg increase the risk of flash pulmonary edema – this chance increases in proportion to the administration dose Synthetic opioids (e.g. fentanyl, carfentanil) frequently require doses greater than 2mg.

Answer 242

Nitrostat, NitroDur, Transderm Nitro

Answer 243

Vasodilator, Antianginal Agent

Answer 244

Chest Pain suspected to be cardiac in nature (ACS/STEMI) Congestive Heart Failure

Answer 245

Known Hypersensitivity Recent use of erectile dysfunction medications (Viagra/Levitra within 24 hours, Cialis within 48 hours) SBP < 100mHg Hypovolemia Suspected Right Ventricular Infarction (relative)

Answer 246

Chest Pain / Suspected ACS 0.4mg SL, q 3min prn for chest pain, max 3 doses – followed by – 1in paste TD, applied to left anterior chest wall

Answer 247

0.4mg SL, q5min prn (no max) if SBP > 100mmHg 0.8mg SL, q5min prn (no max) if age < 85 and SBP > 200mmHg – followed by – 1in paste TD, applied to left anterior chest wall prn

Answer 248

Headache, hypotension, palpitations, flushing, nausea/vomiting

Answer 249

Relaxes smooth muscles, thus producing vasodilator effects on arteries and veins and reducing preload and afterload. Causes coronary artery dilatation

Answer 250

Monitor blood pressure after each dose. Do not allow medication to come in contact with your skin. Use gloves for application.

Answer 251

Sympathomimetic, Vasopressor

Answer 252

Hypovolemia

Answer 253

Shock 2-12mcg/min IV/IO infusion, titrate to MAP ≥ 65mmHg

Answer 254

CHF/Acute Pulmonary Edema: 2-12mcg/min IV/IO infusion, titrate to MAP ≥ 65mmHg

Answer 255

Post ROSC: 2-12mcg/min IV/IO infusion, titrate to MAP ≥ 65mmHg

Answer 256

Shock 0.01-0.5mcg/kg/min Infusion

Answer 257

Mix 4mg Norepinephrine into 250mL NS/D5W = 16mcg/ml Infuse using microdrip (60gtt/mL) set

Answer 258

Hypertension, arrhythmias, reflex bradycardia ischemic injury due to vasoconstriction, headache, dyspnea (with or without respiratory difficulty)

Answer 259

Norepinephrine functions as a peripheral vasoconstrictor (α-adrenergic action) and as an inotropic stimulator of the heart and dilator of coronary arteries (β-adrenergic action).

Answer 260

Constantly monitor the blood pressure and adjust dose according to the MAP (Goal > 65). Avoid hypertension. When possible, Norepinephrine infusion should be given via a large vein, preferable a vein in the antecubital fossa. Ensure patient is not fluid depleted. Fluid resuscitation should be considered when appropriate.

Answer 261

Antiemetic

Answer 262

Nausea and Vomiting

Answer 263

Congenital Long QT Syndrome

Answer 264

Non-Traumatic Abdominal Pain / Nausea & Vomiting 4mg IV/IO/PO, q 15min prn, max 8mg Chest Pain 4mg IV, prn for nausea vomiting with active pain Post Intubation Sedation: Consider pre-intubation 4mg IV/IO to decrease aspiration risk

Answer 265

Constipation, fatigue, headache. Rare cardiac effects include arrhythmias, QT prolongation, palpitations

Answer 266

Selective 5-HT3 receptor antagonist that bind receptors in the CNS and GI tract. Mechanism not fully characterized.

Answer 267

Onset in seconds It is safe to give IV formulation orally, if tolerated

Answer 268

Glucose, Insta-Glucose

Answer 269

Monosaccharide

Answer 270

Hypoglycemia

Answer 271

Inability to Protect Airway or Follow Commands

Answer 272

Hypoglycemia 15g PO

Answer 273

Hypoglycemia 15g PO

Answer 274

Negligable

Answer 275

Increases blood serum glucose level by absorption through mucous membranes

Answer 276

May be administered by EMT/NRP provided there is no risk of aspiration related to the patient’s mental status

Answer 277

Neuromuscular Blocking Agent

Answer 278

Pharmacologically assisted endotracheal intubation

Answer 279

Hypersensitivity

Answer 280

Delayed & Rapid Sequence Intubation (if approved by agency’s Medical Director) 1.2 mg/kg IV/IO 1.6 mg/kg IV/IO if patient is hypotensive

Answer 281

Dose-related tachycardia, hypertension, transient hypotension, injection site edema

Answer 282

Nondepolarizing skeletal muscle relaxant; inhibits depolarization

Answer 283

Rapid onset of action (60-90 sec). Duration 45-120 min. Minimal cardiovascular effects. Additive/synergistic effect if administered with or following an opioid, sedative, or anesthetic agent

Answer 284

Electrolyte Buffer

Answer 285

Pre-existing metabolic acidosis (perfusing patient able to self-ventilate) Hyperkalemia TCA, Phenobarbital, or ASA overdose During cardiac arrest, after prolonged resuscitation efforts

Answer 286

Metabolic Alkalosis Hypokalemia Simultaneously with Calcium Chloride Simultaneously with Catecholamines (Epinephrine, etc.)

Answer 287

Overdose: ASA, TCA, or Unknown Medication OD with QRS > 120ms 1-2mEq/kg IV/IO, repeat prn until QRS ≤ 120ms *w/Medical Control orders

Answer 288

Cardiac Arrest: Suspected Acidosis / Hyperkalemia 1mEq/kg IV/IO

Answer 289

Excited Delirium: Cardiac Arrest 100mEq (2 amps) early in resuscitation -followed by- 50mEq (1 amp) q10min for remainder of resuscitation

Answer 290

Sodium Channel Blocker OD with QRS > 120ms 1mEq/kg IV/IO, w/ Medical Control orders

Answer 291

Crush Injury / Syndrome: Signs of Hyperkalemia NOT present 50mEq added per liter of NaCl

Answer 292

Crush Injury / Syndrome: Signs of Hyperkalemia present 100mEq Bolus IV/IO

Answer 293

Irritant Gas / Simple Asphyxiant Exposure: Chlorine Exposure 2.5ml mixed with 2.5mL sterile water Nebulized

Answer 294

Cardiac Arrest: Suspected Acidosis 1mEq/kg IV/IO of 8.4% solution

Answer 295

Metabolic Alkalosis CHF (edema secondary to sodium overload) Hypernatremia

Answer 296

Bicarbonate is an anion that forms a salt (sodium bicarbonate) when it combines with its conjugate acid. Bicarbonate serves as the principal buffer for the body’s acid/base buffer system maintaining the CO2 level

Answer 297

During cardiac arrest, sodium bicarbonate should not be administered prior to establishing a definitive airway. Sloughing will occur if infiltrated out of vein into tissue

Answer 298

Suxamethonium, Anectine

Answer 299

Neuromuscular Blocking Agent

Answer 300

Pharmacologically assisted endotracheal intubation

Answer 301

Known Hypersensitivity CVA or spinal cord injury within the last 6 months Chronic renal failure on hemodialysis Suspicion of hyperkalemia Known or suspected muscular disease (e.g. ALS, muscular dystrophy, myasthenia gravis, Guillain-Barre syndrome) History of malignant hyperthermia

Answer 302

Delayed & Rapid Sequence Intubation (if approved by agency’s Medical Director) 2 mg/kg IV/IO

Answer 303

Excessive salivation, muscle fasciculations, rise in intracranial, intraocular, intragastric pressure. May cause rhabdomyolysis

Answer 304

Depolarizing muscle relaxant

Answer 305

Rapid onset of action (45-60 sec). Duration 5-10 min. Do not use to maintain paralysis

Answer 306

TXA, Cyklokapron

Answer 307

Antifibrinolytic Agent

Answer 308

Major Hemorrhage (trauma

Answer 309

Known Hypersensitivity ≥ 3 hours from time of injury Subarachnoid Hemorrhage Active intravascular clotting

Answer 310

Traumatic Shock 2g IV/IO over 10 min, if available

Answer 311

Hypotension if given rapidly, diarrhea, nausea, vomiting, and blurred vision

Answer 312

TXA is a synthetic amino acid that prevents plasminogen from being converted to plasmin. Plasmin is responsible for breaking down already formed clots in the body in a process known as fibrinolysis. When TXA is administered, it will prevent the body from breaking down clots so that the natural clotting processes can work to control non- compressible hemorrhage.

Answer 313

May give IM as a last resort Administer TXA no later than 3 hours from time of injury TXA administered within 1 hour of time of injury has shown to significantly reduce the risk of death due to bleeding If hypotension occurs slow down infusion rate

Answer 314

70 - 80 bpm

Answer 315

100 joules Synchronized

Answer 316

200 joules Synchronized

Answer 317

200 joules Synchronized, max joules defibrillation if unable to capture