special considerations Flashcards
acetaminophen
Pregnancy Safety: Category B
activated charcoal
● Shake vigorously before use.
● Contact medical control before administering in cases of acetaminophen OD.
● Charcoal aspiration can produce an unmanageable airway.
● Aspiration of emesis containing charcoal can induce fatal pneumonitis.
● Use caution in patients with abdominal pain of unknown origin.
● Do not use charcoal with sorbitol additive in pediatrics
adenosine
● Record a rhythm strip to capture the rhythm before and after administration.
● Reduce the dose by 50% in patients with heart transplants, patients taking
dipyridamole or carbamazepine, or if administered via central line
albuterol
● No benefit shown in bronchiolitis
amiodorone
● Monitor for hypotension and increasing PR and QT intervals
aspirin
Not recommended for children due to risk of reye syndrome
atropine sulfate
● Paradoxical bradycardia can occur with doses less than 0.1mg
● Ineffective in hypothermic bradycardia and patients with AV blocks or heart
transplants.
● Use with caution in myocardial ischemia
calcium chloride
● Infiltration can cause severe tissue necrosis. Do not administer IM/SQ.
● Calcium gluconate is preferred in pediatric calcium channel blocker OD
calcium gluconate
● Infiltration can cause severe tissue necrosis. Do not administer IM/SQ.
● Calcium gluconate is preferred in pediatric calcium channel blocker OD due to
increased risk of tissue damage with calcium chloride
dexamethasone
Can increase BGL in diabetic patients
dextrose
● For children younger than 8 years, do not use concentrations higher than D25.
● Co-administer thiamine to alcoholic or malnourished patients to prevent
Wernicke’s encephalopathy.
● Do not administer to known stroke unless hypoglycemia is documented.
● Extravasation may lead to severe tissue necrosis - aspirate the syringe during
administration to ensure IV patency and use a large vein
diazepam
● Consider decreasing the dose by 50% in patients older than 60 years.
● CANA contains 10mg of diazepam for use in ACH poisoning
diltiazem
none
diphenydramine hydrochloride
● Pregnancy Safety: Category B
● Increases effectiveness of epinephrine
● Can be given with any H2-blocking antihistamine
dopamine hydrochloride
● Extravasation may cause necrosis and sloughing of surrounding tissue.
● Utilize infusion pump to ensure accurate dosing.
● Slow or stop the infusion if tachydysrhythmias or increased ventricular ectopy is
observed.
● Sudden cessation of infusion can result in significant hypotension
epinephrine
none
etomidate
● No analgesic properties
● Avoid administration into small veins because it is highly irritating
● Consider decreasing the dose in older patients and cardiac patients
● Etomidate can suppress adrenal gland production of steroid hormones and
cortisol, temporarily causing adrenal gland failure
fentanyl citrate
● 50 to 100 times more potent than morphine
flumazenil
● Use in drug overdoses that are not from benzodiazepines may result in death.
● Be prepared to manage seizures in benzodiazepine-dependent patients.
● If treating status epilepticus with benzodiazepines, do not use flumazenil to
reverse accidental overdose.
● Do not use as a diagnostic medication for differential diagnosis
furosemide
● Rapid administration can cause ototoxicity and projectile vomiting
● Furosemide is being phased out due to nephrotoxic side effects. Use with caution
in patients with renal dysfunction
glucagon
● Pregnancy Safety: Category B
● Ineffective if glycogen stores are depleted
● Not recommended for use in lactating mothers
glucose, oral
none
haloperidol
none
hydromorphone
● 5-7 times more potent than morphine, with a shorter duration of analgesia
hydroxycobalamin
Pulse oximetry values may be inaccurate because Cyanokit darkens skin
ibuprofen
none
ipratropium bromide
● Pregnancy Safety: Category B
● Should not be given to children with bronchiolitis
ketamine
● Pregnancy Safety: Category B
● Should not be given to children with bronchiolitis
ketamine
● Pregnancy Safety: not classified
● Some patients may experience an emergence reaction lasting for several hours
after the full duration of the medication’s effect.
ketorolac tromethamine
none
labetolol
● Consider the source of hypertension prior to giving antihypertensives.
● Patients should be supine before receiving labetalol
lidocaine hydrochloride
● Pregnancy Safety: Category B
● Reduce maintenance infusion in patients with impaired liver function or left
ventricular dysfunction.
● Metabolic clearance is decreased in patients with liver disease and patients taking
beta blockers.
lorazepam
● Consider decreasing the dose by 50% in patients older than 60 years
● Use caution in patients concurrently using opioids
magnesium sulfate
● Magnesium toxicity presents with delayed deep tendon reflexes, somnolence,
slurred speech, and respiratory paralysis leading to cardiac arrest. To treat
toxicity, stop the magnesium infusion and administer 1g calcium gluconate IV
mannitol
● May crystallize at low temperatures
methylprednisolone sodium succinate
none
midazolam hydrochloride
none
morphine sulfate
● Safety in neonates has not been established
naloxone hydrochloride
● Generally not beneficial in cardiac arrest
nitroglycerin
● Hypotension is more common in older patients.
● IV NTG must be administered with an infusion pump direct from the bottle.
● If a 12-lead EKG shows an inferior wall infarct, rule out RV infarction with a right-sided 12-lead before administering NTG
norepinephrine bitartrate
● Drug- and poison-induced hypotension may require high doses
● Lower mortality rate for cardiogenic/septic shock than dopamine
● Administer through a large vein to avoid tissue necrosis
ondansetron hydrochloride
● Pregnancy Safety: Category B
● Can be sedating in very young children
oxygen
Patients with carbon monoxide poisoning may be hypoxemic with severe
respiratory distress despite SpO2 of 100% due to carbon monoxide’s much higher
affinity for hemoglobin and subsequent displacement of O2.
● Use with caution on neonates as oxygen toxicity may occur.
● High-flow O2 may decrease respiratory drive in COPD patients (rare)
oxytocin
● Always consider the presence of additional fetuses before administering.
● Administering during active labor can rupture the uterus and cause fetal death.
● DO NOT USE TO INDUCE OR ACCELERATE LABOR IN THE FIELD.
VIII. Drug Interactions
● Can cause severe, persistent hypertension if administered with vasopressors
phenylephrine
none
pralidoxime
● Geriatrics may have visual impairment and severe increases in hypertension with
excessive doses.
● Overdose of 2-PAM may cause profound neuromuscular weakness and
respiratory depression in children
procainamide hydrochloride
● Reduce maximum total dose to 12mg/kg and maintenance infusion to 1-2 mg/min
for patients with cardiac, hepatic or renal dysfunction
promethazine hydrochloride
Convulsions and sudden death have been reported with pediatric
rocuronium bromide
● Reduce the dose in patients with renal failure
sodium bicarbonate
● Extravasation may cause tissue sloughing, cellulitis and necrosis.
● 4.2% concentration recommended for infants younger than 1 month.
succinylcholine chloride
● Must use a non-depolarizing paralytic for repeat dosing
terbutaline sulfate
● Pregnancy Safety: Category B
● Use with caution in patients with cardiovascular disease, hypertension, diabetes, and seizures
thiamine hydrochloride
Pregnancy Safety: Category A
tranexamic acid
● Pregnancy Safety: Category B
● Reduce the dose in patients with renal insufficiency.
vecuronium bromide
none
verapamil hydrochloride
none
