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ROPE March 2022 > Region 1 Drugs > Flashcards

Region 1 Drugs Flashcards

1
Q

Adenosine
Additional Names

A

Adenocard
Adenoscan

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2
Q

Adenosine
Classification

A

Atrial Antiarrhythmic
Endogenous Nucleotide

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3
Q

Adenosine
Indication

A

Stable narrow complex tachycardia, refractory to vagal maneuvers

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4
Q

Adenosine
Contraindications

A

Known Hypersensitivity
Bradycardia
AV blocks >1°
Sick sinus syndrome

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5
Q

Adenosine
Adult Dosage

A

Stable Narrow Complex
1st: 6-12mg Rapid IV/IO
2nd: 12mg Rapid IV/IO
q 1-2min followed by 20ml flush

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6
Q

Adenosine Pediatric Dose

A

1st: 0.1 mg/kg max 6mg
2nd: x2 1st dose max 12mg
q1-2 min followed by NS flush

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7
Q

Adenosine
Side Effects

A

Transient periods of asystole, bradycardia, ventricular ectopy, hypotension, palpitations, chest pain, facial fluttering, dyspnea, dizziness, tingling, headache

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8
Q

Adenosine
Physiological Effects

A

Slows conduction through AV node, can interrupt re-entry pathways. Half life <10 seconds, immediate onset.

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9
Q

Albuterol
Additional Names

A

Proventil
Ventolin
Salbutamol

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10
Q

Albuterol
Classification

A

Beta Agonist
Bronchodilator
Sympathomimetic

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11
Q

Albuterol
Indication

A

Relief of bronchospasm
Asthma
COPD
Chronic bronchitis
Emphysema
Hyperkalemia

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12
Q

Albuterol
Contraindications

A

Hypersensitivity
Symptomatic Tachycardia(relative)
Cardio or Cerebrovascular disease(relative)
Use of beta blockers (relative)

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13
Q

ALBUTEROL Dosages Adult:

A

Wheezing/Bronchospasm
5mg Nebulized
Mild: may repeat x 1 prn. Moderate: may repeat prn. Severe: may repeat prn
Drowning
If fluid is auscultated (i.e. rales) in the lungs
5mg Nebulized, q5min, may repeat x3 prn
Crushing Injury/Syndrome
Signs of hyperkalemia present
20mg Nebulized

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14
Q

Albuterol Dosages Pediatric

A

Asthma/Wheeze > 2 yo
> 4yo = 5mg Nebulized
< 4yo = 2.5mg Nebulized
May repeat x2 while administering other treatments. Continue duonebs prn while en
route

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15
Q

Albuterol Side Effects

A

Tachycardia, palpitations, hypertension, angina, nervousness, tremors

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16
Q

Albuterol Physiological Effects

A

Beta-2 sympathomimetic that produces bronchodilatation by causing smooth muscle
relaxation of the smooth bronchial muscles through the stimulation of the beta-2
receptors in the lung tissue

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17
Q

Amiodarone Additional Names

A

Cordarone, Nexterone

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18
Q

Amiodarone Classification

A

Antiarrhythmic (Class III)

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19
Q

Amiodarone Indications

A

Ventricular Tachycardia, Ventricular Fibrillation

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20
Q

Amiodarone ContraIndications

A

Known hypersensitivity
Cardiogenic Shock
Severe Sinus Bradycardia, AV Block without a functioning pacemaker
Β and Ca2+ Channel Blocker OD, with widened QT segment

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21
Q

Amiodarone Dosages Adult:

A

Cardiac Arrest – VF/pVT
Initial: 300mg IV/IO
2nd: 150mg IV/IO, q 3-5 minutes after 1st dose
Post ROSC
Loading Dose: 150mg IV/IO infusion over 10 minutes if two boluses (300 mg followed by
150 mg) were not already given during resuscitation
Maintenance Infusion: 1mg/min IV/IO infusion
Wide Complex Tachycardia
Regular/Irregular Rhythm:
Loading Dose: 150mg IV/IO infusion over 10 minutes
Maintenance Infusion upon conversion: 1mg/min IV/IO infusion

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22
Q

Amiodarone Dosages Pediatric

A

Cardiac Arrest – VF/pVT
Initial: 5mg/kg IV/IO, max 300mg, may repeat bolus x2 prn, max 450mg total

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23
Q

Amiodarone Infusion Setup

A

Loading Dose Infusion: 150mg over 10min: Add 150mg Amiodarone to 150mL NS/D5W,
using a 10 gtt/ml macrodrip set, administer 2.5gtts/sec (aka 150 gtt/min). If using a 15
gtt/ml macrodrip set, administer 3.75 gtts/sec (aka 225 gtt/min)
Maintenance Infusion: 1mg/min: Add 150mg Amiodarone to 150 mL NS/D5W, using a
60 gtt/ml microdrip set, administer 1gtt/sec (aka 60 gtt/min)

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24
Q

Amiodarone Side Effects

A

May slow heart rate, may cause hypotension with cumulative doses

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25
Q

Amiodarone
Physiological: Effects

A

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.

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26
Q

Amiodarone Additional Info

A

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

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27
Q

Aspirin Additional Names

A

Acetylsalicylic Acid

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28
Q

Aspirin Classification

A

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

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29
Q

Aspirin
Indication

A

Cardiac Chest Pain (ACS), STEMI

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30
Q

Aspirin
Contraindications

A

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

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31
Q

Aspirin
Dosages

A

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

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32
Q

Aspirin
Side Effects

A

May slow heart rate, may cause hypotension with cumulative doses

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33
Q

Aspirin
Physiological Effects

A

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.

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34
Q

Aspirin
Additional Information

A

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.

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35
Q

Atropine
Additional Names

A

Atropisol (ophthalmic), Atreza

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36
Q

Atropine
Classification

A

Anticholinergic, Sympatholytic

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37
Q

Atropine
Indication

A

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

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38
Q

Atropine
Contraindications

A

Known hypersensitivity Tachycardia (relative)

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39
Q

Atropine
Adult Dosages

A

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

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40
Q

Atropine
Pediatric Dosages

A

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

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41
Q

Atropine
Side Effects

A

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

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42
Q

Atropine
Physiological Effects

A

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

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43
Q

Atropine
Additional Information

A

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”

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44
Q

Calcium Chloride
Additional Names

A

Calcium Replacement

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45
Q

Calcium Chloride
Classification

A

Electrolyte, Antidote

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46
Q

Calcium Chloride
Indication

A

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

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47
Q

Calcium Chloride
Contraindications

A

Known hypersensitivity
Digoxin Overdose
Hypercalcemia

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48
Q

Calcium Chloride
Adult Dosages

A

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

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49
Q

Calcium Chloride
Pediatric Dosages

A

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

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50
Q

Calcium Chloride
Side Effects

A

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

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51
Q

Calcium Chloride
Physiological Effects

A

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

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52
Q

Calcium Chloride
Additional Information

A

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.

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53
Q

Calcium Gluconate
Classification

A

Mineral supplement, Antidote

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54
Q

Calcium Gluconate
Indication

A

Ca2+ Channel Blocker Overdose Hydrofluoric Acid Exposure

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55
Q

Calcium Gluconate
Contraindications

A

Ventricular fibrillation Hypercalcemia
Concurrent use of IV Calcium Gluconate

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56
Q

Calcium Gluconate
Dosages

A

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

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57
Q

Calcium Gluconate
Side Effects

A

Nausea, Constipation

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58
Q

Calcium Gluconate
Physiological Effects

A

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.

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59
Q

Calcium Gluconate
Preparation

A

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%

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60
Q

Calcium Gluconate
Additional Information

A

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.

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61
Q

Dexamethasone
Additional Names

A

Decadron, Maxidex, Baycadron, DexPak, Ozurdex

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62
Q

Dexamethasone
Classification

A

Corticosteroid, Glucocorticoid

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63
Q

Dexamethasone
Indications

A

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

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64
Q

Dexamethasone
Contraindications

A

Known hypersensitivity Hyperglycemia (relative)

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65
Q

Dexamethasone
Adult Dosages

A

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

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66
Q

Dexamethasone
Pediatric Dosages

A

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

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67
Q

Dexamethasone
Side Effects

A

Hyperglycemia, Immunosuppression, GI discomfort

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68
Q

Dexamethasone
Physiological Effects

A

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.

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69
Q

Dexamethasone Additional Information

A

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.

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70
Q

Dextrose
Additional Names

A

D10, D25, D50

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71
Q

Dextrose Classification

A

Carbohydrate, Hyperglycemic

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72
Q

Dextrose Indications

A

Carbohydrate, Hyperglycemic

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73
Q

Dextrose
Contraindications

A

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

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74
Q

Dextrose
Adult Dosages

A

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)

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75
Q

Dextrose
Pediatric Dosages

A

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

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76
Q

Dextrose
Side Effects

A

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

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77
Q

Dextrose Physiological Effects

A

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

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78
Q

Dextrose
Additional Information

A

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

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79
Q

Diazepam
Additional Names

A

Valium

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80
Q

Diazepam
Classification

A

Benzodiazepine

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81
Q

Diazepam
Indications

A

Seizure Control
Anxiolytic/Sedation

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82
Q

Diazepam
Contraindications

A

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

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83
Q

Diazepam
Adult Dosages

A

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

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84
Q

Diazepam
Pediatric Dosages

A

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

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85
Q

Diazepam
Side Effects

A

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

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86
Q

Diazepam Physiological Effects

A

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

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87
Q

Diazepam
Additional Information

A

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

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88
Q

Diltiazem Additional Names

A

Cardizem

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89
Q

Diltiazem
Classification

A

Calcium Channel Blocker, Antihypertensive

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90
Q

Diltiazem
Indications

A

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

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91
Q

Diltiazem
Contraindications

A

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

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92
Q

Diltiazem
Adult Dosages

A

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.

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93
Q

Diltiazem
Pediatric Dosages

A

Pediatric:
Probable SVT
- Contraindicated

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94
Q

Diltiazem
Side Effects

A

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

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95
Q

Diltiazem
Physiological Effects

A

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

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96
Q

Diltiazem Additional Information

A

: 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

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97
Q

Diphenhydramine Additional Names

A

Benadryl

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98
Q

Diphenhydramine Classification

A

Antihistamine

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99
Q

Diphenhydramine Indications

A

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

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100
Q

Diphenhydramine
Contraindications

A

Hypersensitivity

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101
Q

Diphenhydramine Adult Dosages

A

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

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102
Q

Diphenhydramine Pediatric Dosages

A

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

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103
Q

Diphenhydramine Side Effects

A

Drowsiness, dry mouth and throat

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104
Q

Diphenhydramine Physiological Effects

A

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

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105
Q

Diphenhyrdramine Additional Information

A

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

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106
Q

Dopamine Additional Names

A

Intropin, Myocard-DX

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107
Q

Dopamine Classification

A

Sympathomimetic, Inotrope, Vasopressor

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108
Q

Dopamine Indication

A

Cardiogenic Shock

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109
Q

Dopamine Contraindication

A

Known hypersensitivity
Hypovolemia secondary to trauma

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110
Q

Dopamine Adult Dosages

A

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

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111
Q

Dopamine Preparation

A

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

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112
Q

Dopamine Side Effects

A

Tachydysrhythmias

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113
Q

Dopamine Physiological Effects

A

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

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114
Q

Dopamine Additional Information

A

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

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115
Q

Epinephrine Additional Names

A

Adrenaline

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116
Q

Epinephrine Classification

A

Sympathomimetic, Catecholamine

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117
Q

Epinephrine Indications

A

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

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118
Q

Epinephrine Contraindications

A

Known hypersensitivity
Hemorrhagic Shock

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119
Q

Epinephrine Adult Anaphylaxis Dose

A

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

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120
Q

Epinephrine Adult Wheezing/Bronchospasm Dose

A

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

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121
Q

Epinephrine Adult CHF/Acute Pulmonary Edema Dose

A

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

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122
Q

Epinephrine Adult Cardiac Arrest Dose

A

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

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123
Q

Epinephrine Adult Post ROSC Dose

A

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

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124
Q

Epinephrine Adult Shock Dose

A

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

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125
Q

Epinephrine Adult Bradycardia Peri-Arrest Dose

A

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

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126
Q

Epinephrine Adult Bradycardia Persistent Hypotension Dose

A

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

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127
Q

Epinephrine Adult Hypothermia Induced Cardiac Arrest Dose

A

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

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128
Q

Epinephrine Pediatric Anaphylaxis Dose

A

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

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129
Q

Epinephrine Pediatric Croup/Stridor Dose

A

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

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130
Q

Epinephrine Pediatric Lower Airway / Bronchiolitis Dose

A

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

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131
Q

Epinephrine Pediatric Asthma/Wheezing Dosage

A

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

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132
Q

Epinephrine Pediatric Cardiac Arrest Dose

A

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

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133
Q

Epinephrine Pediatric Shock Dose

A

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

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134
Q

Epinephrine Pediatric Neonatal Resuscitation Dose

A

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

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135
Q

Epinephrine Adult Push Dose Preparation

A

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.

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136
Q

Epinephrine Pediatric Push Dose Preparation

A

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.

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137
Q

Epinephrine Infusion Preparation

A

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

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138
Q

Epinephrine Side Effects

A

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

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139
Q

Epinephrine Physiological Effects

A

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.

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140
Q

Epinephrine Additional Information

A

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.

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141
Q

Etomidate Additional Names

A

Amidate

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142
Q

Etomidate Classification

A

General Anesthetic
Hypnotic

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143
Q

Etomidate Indications

A

To induce general anesthesia to facilitate intubation

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144
Q

Etomidate Contraindications

A

Known hypersensitivity

145
Q

Etomidate Adult Dosage

A

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

146
Q

Etomidate Side Effects

A

Transient injection site pain, myoclonic muscle events, adrenal suppression

147
Q

Etomidate Physiological Effects

A

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

148
Q

Etomidate Additional Information

A

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

149
Q

Fentanyl Additional Names

A

Sublimaze

150
Q

Fentanyl Classification

A

Opioid Analgesic, Synthetic Opioid

151
Q

Fentanyl Indications

A

Acute Pain
Sedation

152
Q

Fentanyl Contraindications

A

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

153
Q

Fentanyl Adult Dosages

A

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

154
Q

Fentanyl Pediatric Dosages

A

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

155
Q

Fentanyl Side Effects

A

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

156
Q

Fentanyl Physiological Effects

A

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

157
Q

Fentanyl Additional Information

A

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

158
Q

Hydroxycobalamin Additional Names

A

Cyanokit

159
Q

Hydroxycobalamin Classification

A

Cyanide antidote , Vitamin B12 precursor

160
Q

Hydroxycobalamin Indications

A

Cyanide Poisoning (known or suspected)

161
Q

Hydroxycobalamin Contraindications

A

None

162
Q

Hydroxycobalamin Adult Dosage

A

Adult:
Cyanide Poisoning
5g IV/IO

163
Q

Hydroxycobalamin Pediatric Dosage

A

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

164
Q

Hydroxycobalamin Side Effects

A

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

165
Q

Hydroxycobalamin Physiological Effects

A

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.

166
Q

Hydroxycobalamin Additional Information

A

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

167
Q

Ipratropium Bromide Additional Names

A

Atrovent

168
Q

Ipratropium Bromide Classification

A

Anticholinergic (parasympatholytic), Bronchodilator

169
Q

Ipratropium Bromide Indications

A

Relieve bronchospasm associated with asthma, emphysema, and chronic
bronchitis

170
Q

Ipratropium Bromide Contraindications

A

Known Hypersensitivity to Atrovent or Atropine

171
Q

Ipratropium Bromide Adult Dosages

A

Adult:
Wheezing / Bronchospasm
0.5mg Nebulized

172
Q

Ipratropium Bromide Pediatric Dosage

A

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

173
Q

Ipratropium Bromide Side Effects

A

Headache, dry mouth, dizziness, cough, upset stomach

174
Q

Ipratropium Bromide Physiological Effects

A

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

175
Q

Ipratropium Bromide Additional Information

A

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.

176
Q

Ketamine Additional Names

A

Ketalar

177
Q

Ketamine Classification

A

Dissociative Anesthetic

178
Q

Ketamine Indications

A

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

179
Q

Ketamine Contraindications

A

Known hypersensitivity
Hypertensive Crisis

180
Q

Ketamine Adult Dosage Excited Delirium

A

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.

181
Q

Ketamine Adult Post Intubation Sedation Dosage

A

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

182
Q

Ketamine Adult Post ROSC Sedation

A

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

183
Q

Ketamine Adult Transcutaneous Pacing Sedation Dosage

A

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

184
Q

Ketamine Adult Traumatic Pain Management Dosage

A

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

185
Q

Ketamine Side Effects

A

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

186
Q

Ketamine Physiological Effects

A

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

187
Q

Ketamine Additional Information

A

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

188
Q

Lidocaine Additional Names

A

Lidocaine CV, Xylocaine

189
Q

Lidocaine Classification

A

Antidysrhythmic (class Ib), Local Anesthetic

190
Q

Lidocaine Indications

A

Ventricular Arrhythmia
Local Infiltration Anesthesia prior to IO infusion

191
Q

Lidocaine Contraindications

A

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

192
Q

Lidocaine Adult Cardiac Arrest Dosage

A

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

193
Q

Lidocaine Adult IO Access Dosage

A

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

194
Q

Lidocaine Side Effects

A

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

195
Q

Lidocaine Physiological Effects

A

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

196
Q

Lidocaine Additional Information

A

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

197
Q

Lorazepam Additional Names

A

Ativan

198
Q

Lorazepam Classification

A

Benzodiazepam

199
Q

Lorazepam Contraindication

A

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

200
Q

Lorazepam Adult Seizure Dosage

A

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

201
Q

Lorazepam Adult Combative PT Dosage

A

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

202
Q

Lorazepam Adult Excited Delerium Dosage

A

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

203
Q

Lorazepam Adult Post Intubation Sedation

A

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

204
Q

Lorazepam Pediatric Seizure Dosage

A

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

205
Q

Lorazepam Side Effects

A

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

206
Q

Lorazepam Physiological Effects

A

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

207
Q

Lorazepam Additional Information

A

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

208
Q

Magnesium Sulfate Additional Names

A

MgSO4

209
Q

Magnesium Sulfate Classification

A

Antidysrhythmic, Electrolyte, Smooth Muscle Relaxant

210
Q

Magnesium Sulfate Indications

A

Asthma, Reactive Airway Disease
Eclampsia
Torsade de Pointes

211
Q

Magnesium Sulfate Contraindications

A

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

212
Q

Magnesium Sulfate Adult Wheezing/Bronchospasm Dosage

A

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

213
Q

Magnesium Sulfate Adult Ecclampsia Dosage

A

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

214
Q

Magnesium Sulfate Adult Cardiac Arrest Torsades Dosage

A

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

215
Q

Magnesium Sulfate Adult Torsades/Polymorphic VT Dosage

A

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

216
Q

Magnesium Sulfate Pediatric Asthma/Wheezing Dosage

A

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

217
Q

Magnesium Sulfate Pediatric Cardiac Arrest Torsades/Polymorphic VT Dosage

A

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

218
Q

Magnesium Sulfate Pediatric Torsades / Polymorphic VT Dosage

A

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

219
Q

Magnesium Sulfate Infusion Set Up

A

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

220
Q

Magnesium Sulfate Side Effects

A

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

221
Q

Magnesium Sulfate Physiological Effects

A

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

222
Q

Magnesium Sulfate Additional Information

A

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

223
Q

Methylpednisolone Additional Names

A

Solu-Medrol, Medrol

224
Q

Methylprednisolone Classification

A

Steroid-Glucocorticoid, Anti-Inflammatory Agent

225
Q

Methylprednisolone Indications

A

Anaphylaxis, Allergic Reaction
Asthma, COPD
Adrenal Crisis

226
Q

Methylprednisolone Contraindications

A

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

227
Q

Methylprednisolone Adult Wheezing / Bronchospasm Dosage

A

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

228
Q

Methylprednisolone Adult Anaphylaxis Dosage

A

Anaphylaxis
125mg IV/IO/IM

229
Q

Methylprednisolone Adult Shock with Adrenal Sufficiency (Addisons Disease) Dosage

A

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

230
Q

Methylprednisolone Pediatric Asthma / Wheezing Dosage

A

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

231
Q

Methylprednisolone Pediatric Anaphylaxis Dosage

A

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

232
Q

Methylprednisolone Side Effects

A

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

233
Q

Methylprednisolone Physiological Effects

A

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

234
Q

Methylprednisolone Additional Information

A

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

235
Q

Metoprolol Additional Names

A

Lopressor, Toprol

236
Q

Metoprolol Classification

A

Beta-Adrenergic Blocker

237
Q

Metoprolol Indications

A

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

238
Q

Metoprolol Contraindications

A

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

239
Q

Metoprolol Adult Narrow Complex Tachycardia Dosages

A

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)

240
Q

Metoprolol Pediatric Narrow Complex Tachycardia Dosage

A

Contraindicated

241
Q

Metoprolol Side Effects

A

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

242
Q

Metoprolol Physiological Effects

A

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

243
Q

Metoprolol Additional Information

A

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

244
Q

Midazolam Additional Names

A

Versed

245
Q

Midazolam Classification

A

Benzodiazepine, Anxiolytic

246
Q

Midazolam Indications

A

Seizure Control
Anxiolytic, Sedation
Pre-medication before TCP

247
Q

Midazolam Contraindications

A

Known Hypersensitivity
Narrow-Angle Glaucoma
Hypotension

248
Q

Midazolam Adult Seizure Dosage

A

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)

249
Q

Midazolam Adult Combative Patient Dosage

A

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

250
Q

Midazolam Adult Excited Delirium Dosage

A

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

251
Q

Midazolam Adult Post Intubation Sedation Dosage

A

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

252
Q

Midazolam Adult Pre TCP / Cardioversion Dosage

A

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

253
Q

Midazolam Adult Anxiolytic pre CPAP Dosage

A

2.5 mg IV/IO/IM x1 prn

254
Q

Midazolam Pediatric Seizure Dosage

A

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

255
Q

Midazolam Side Effects

A

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

256
Q

Midazolam Physiological Effects

A

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

257
Q

Midazolam Additional Information

A

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

258
Q

Morphine Additional Names

A

MS, Contin

259
Q

Morphine Classification

A

Opioid Analgesic

260
Q

Morphine Indications

A

Chest pain unrelieved by Nitroglycerin
Traumatic Injury
Burn

261
Q

Morphine Contraindications

A

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

262
Q

Morphine Adult Chest Pain Dosage

A

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

263
Q

Morphine Adult Pain Management Dosage

A

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

264
Q

Morphine Pediatric Pain Management Dosage

A

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

265
Q

Morphine Side Effects

A

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

266
Q

Morphine Physiological Effects

A

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

267
Q

Morphine Additional Information

A

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

268
Q

Naloxone Additional Names

A

Narcan

269
Q

Naloxone Classification

A

Opioid Antagonist, Opioid Reversal Agent

270
Q

Naloxone Indications

A

Respiratory and neurologic depression due to opioid intoxication

271
Q

Naloxone Contraindications

A

Known hypersensitivity

272
Q

Naloxone Adult Overdose Dosage

A

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

273
Q

Naloxone Adult Cardiac Arrest Dosage

A

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

274
Q

Naloxone Pediatric Overdose Dosage

A

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

275
Q

Naloxone Pediatric Cardiac Arrest Dosage

A

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

276
Q

Naloxone Side Effects

A

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

277
Q

Naloxone Physiological Effects

A

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

278
Q

Naloxone Additional Information

A

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.

279
Q

Nitroglycerin Additional Names

A

Nitrostat, NitroDur, Transderm Nitro

280
Q

Nitroglycerin Classification

A

Vasodilator, Antianginal Agent

281
Q

Nitroglycerin Indications

A

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

282
Q

Nitroglycerin Contraindications

A

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)

283
Q

Nitroglycerin Adult Chest Pain / ACS Dosage

A

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

284
Q

Nitrolgycerin Adult CHF / Pulmonary Edema Dosage

A

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

285
Q

Nitroglycerin Side Effects

A

Headache, hypotension, palpitations, flushing, nausea/vomiting

286
Q

Nitroglycerin Physiological Effects

A

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

287
Q

Nitroglycerin Additional Information

A

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

288
Q

Norepinephrine Additional Names

A

Levophed

289
Q

Norepinephrine Classification

A

Sympathomimetic, Vasopressor

290
Q

Norepinephrine Indications

A

Shock

291
Q

Norepinephrine Contraindications

A

Hypovolemia

292
Q

Norepinephrine Adult Shock Dosage

A

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

293
Q

Norepinephrine Adult CHF Dosage

A

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

294
Q

Norepinephrine Adult Post ROSC Dosage

A

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

295
Q

Norepinephrine Pediatric Shock Dosage

A

Shock
0.01-0.5mcg/kg/min Infusion

296
Q

Norepinephrine Preparation Instructions

A

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

297
Q

Norepinephrine Side Effects

A

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

298
Q

Norepinephrine Physiological Effects

A

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).

299
Q

Norepinephrine Additional Information

A

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.

300
Q

Ondansetron Additional Names

A

Zofran

301
Q

Ondansetron Classification

A

Antiemetic

302
Q

Ondansetron Indications

A

Nausea and Vomiting

303
Q

Ondansetron Contraindications

A

Congenital Long QT Syndrome

304
Q

Ondansetron Adult Dosage

A

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

305
Q

Ondansetron Side Effects

A

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

306
Q

Ondansetron Physiological Effects

A

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

307
Q

Ondansetron Additional Information

A

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

308
Q

Oral Glucose Additional Names

A

Glucose, Insta-Glucose

309
Q

Oral Glucose Classification

A

Monosaccharide

310
Q

Oral Glucose Indication

A

Hypoglycemia

311
Q

Oral Glucose Contraindication

A

Inability to Protect Airway or Follow Commands

312
Q

Oral Glucose Adult Dosage

A

Hypoglycemia
15g PO

313
Q

Oral Glucose Pediatric Dosage

A

Hypoglycemia
15g PO

314
Q

Oral Glucose Side Effects

A

Negligable

315
Q

Oral Glucose Physiological Effects

A

Increases blood serum glucose level by absorption through mucous membranes

316
Q

Oral Glucose Additional Information

A

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

317
Q

Rocuronium Additional Names

A

Zemuron

318
Q

Rocuronium Classification

A

Neuromuscular Blocking Agent

319
Q

Rocuronium Indications

A

Pharmacologically assisted endotracheal intubation

320
Q

Rocuronium Contraindication

A

Hypersensitivity

321
Q

Rocuronium Adult Dosage

A

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

322
Q

Rocuronium Side Effects

A

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

323
Q

Rocuronium Physiological Effects

A

Nondepolarizing skeletal muscle relaxant; inhibits depolarization

324
Q

Rocuronium Additional Information

A

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

325
Q

Sodium Bicarbonate Classification

A

Electrolyte Buffer

326
Q

Sodium Bicarbonate Indications

A

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

327
Q

Sodium Bicarbonate Contraindications

A

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

328
Q

Sodium Bicarbonate Adult ASA/TCA Overdose Dosage

A

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

329
Q

Sodium Bicarbonate Adult Cardiac Arrest Acidosis Dosage

A

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

330
Q

Sodium Bicarbonate Adult Excited Delirium Cardiac Arrest Dosage

A

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

331
Q

Sodium Bicarbonate Adult Sodium Channel Blocker OD Dosage

A

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

332
Q

Sodium Bicarbonate Adult Crush Injury without Hyperkalemia Dosage

A

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

333
Q

Sodium Bicarbonate Adult Crush Injury with Hyperkalemia Dosage

A

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

334
Q

Sodium Bicarbonate Adult Irritant Gas / Simple Asphyxiant / Chlorine Exposure Dosage

A

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

335
Q

Sodium Bicarbonate Pediatric Cardiac Arrest with Acidosis Dosage

A

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

336
Q

Sodium Bicarbonate Side Effects

A

Metabolic Alkalosis
CHF (edema secondary to sodium overload)
Hypernatremia

337
Q

Sodium Bicarbonate Physiological Effects

A

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

338
Q

Sodium Bicarbonate Additional Information

A

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

339
Q

Succinylcholine Additional Names

A

Suxamethonium, Anectine

340
Q

Succinylcholine Classification

A

Neuromuscular Blocking Agent

341
Q

Succinylcholine Indications

A

Pharmacologically assisted endotracheal intubation

342
Q

Succinylcholine Contraindications

A

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

343
Q

Succinylcholine Adult Dosage

A

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

344
Q

Succinylcholine Side Effects

A

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

345
Q

Succinylcholine Physiological Effects

A

Depolarizing muscle relaxant

346
Q

Succinylcholine Additional Information

A

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

347
Q

Tranexamic Acid Additional Names

A

TXA, Cyklokapron

348
Q

Tranexamic Acid Classification

A

Antifibrinolytic Agent

349
Q

Tranexamic Acid Indication

A

Major Hemorrhage (trauma

350
Q

Tranexamic Acid Contraindications

A

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

351
Q

Tranexamic Acid Adult Dosage

A

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

352
Q

Tranexamic Acid Side Effects

A

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

353
Q

Tranexamic Acid Physiological Effects

A

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.

354
Q

Tranexamic Acid Additional Information

A

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

355
Q

Transcutaneous Pacing Rate

A

70 - 80 bpm

356
Q

Transcutaneous Pacing Starting Strength Adult

A

50mA

357
Q

Synchronized Cardioversion Regular Rhythm Strength

A

100 joules Synchronized

358
Q

Synchronized Cardioversion Irregular Narrow Rhythm Strength

A

200 joules Synchronized

359
Q

Synchronized Cardioversion Wide Irregular Rhythm Strength

A

200 joules Synchronized, max joules defibrillation if unable to capture

ROPE March 2022 (3 decks)

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