Special Pops Drugs Flashcards
Dexamethasone (Decadron, Hexadrol) Class
Steroid
Dexamethasone (Decadron, Hexadrol) Actions
decreases cerebral edema
anti-inflammatory
suppresses immune response (especially in allergic reactions)
Dexamethasone (Decadron, Hexadrol) Indications
Anaphylaxis (after epinephrine and diphenhydramine)
Asthma
COPD
Dexamethasone (Decadron, Hexadrol) Contraindications
None in an emergency setting
Dexamethasone (Decadron, Hexadrol) Precautions / SE
Prec: protect from heat / onset of action may be 2-6hrs thus should not be of use in critical first hour following anaphylaxis
SE: GI bleeding / prolonged wound healing
Dexamethasone (Decadron, Hexadrol) Dose
Adult: 4-24mg IV/IM
Peds: 0.2 - 0.5 mg/kg IV/IM
Etomidate (Amidate) Class
Sedative / Hypnotic
Etomidate (Amidate) Action
ultra short acting sedative/hypnotic effect
Etomidate (Amidate) Indication
Induction for RSI
Etomidate (Amidate) Contraindication
Hypersensitivity
Etomidate (Amidate) Precautions / SE
Prec: marked hypotension severe asthma severe cardiovascular disease adrenal suppression
SE: myoclonic skeletal muscle movement / apnea / laryngospasm
Etomidate (Amidate) Dose
Adult: 0.1 - 0.3 mg/kg IV over 15-30secs
Ped: >10yrs = same as adult
<10yrs = not indicated
Ketamine (Ketalar) Class
Sedative / Hypnotic / Analgesic
Ketamine (Ketalar) Action
causes dissociative state
Ketamine (Ketalar) Indication
Induction for RSI
Ketamine (Ketalar) Contraindications
significantly elevated BP
Ketamine (Ketalar) Precautions / SE
Prec: hallucinations / emergency airway and resuscitative equipment/meds must be available
SE: hallucinations / increased skeletal muscle tone
Ketamine (Ketalar) Dose
Adult: 1-4.5 mg/kg IV / 3-8 mg/kg IM
Peds: 0.5-3 mg/kg IV/IM
Midazolam (Versed) Class
Benzodiazepine / Tranquilizer
Midazolam (Versed) Actions
Hypnotic / Sedative
Midazolam (Versed) Indications
Premedication for cardioversion
Acute anxiety states
Midazolam (Versed) Contraindications
narrow angle glaucoma
shock
Midazolam (Versed) Precautions / SE
Prec: emergency resucitative equipment must be available
Flumazenil (romazicon) should be available
Dilute with NS or D5W prior to IV admin
Respiratory depression very common
SE: drowsiness / hypotension / amnesia / respiratory depression / apnea
Midazolam (Versed) Dose
Adult: 1-2.5 mg IV / 1-5mg IM
Peds: 0.03 mg/kg
Can also be given PO/IN
Oxytocin (Pitocin) Class
Hormone
Oxytocin (Pitocin) Actions
causes uterine contraction
causes lactation
slows postpartum vaginal bleeding
Oxytocin (Pitocin) Indication
postpartum vaginal bleeding
Oxytocin (Pitocin) Contraindications
any condition other than postpartum bleeding
Cesarean section
Oxytocin (Pitocin) Precautions / SE
Prec: ensure placenta has delivered and there is not another fetus before giving / OD can cause uterine rupture / hypertension
SE: anaphylaxis / cardiac arrhythmias
Oxytocin (Pitocin) Dose
IV 10-20units in 500mL of D5W administered according to uterine response
3-10units IM
Terbutaline (Brethine) Class
sympathomimetic
Terbutaline (Brethine) Actions
bronchodilator / increases heart rate
Terbutaline (Brethine) Indications
bronchial asthma / reversible bronchospasm associated with COPD / preterm labor
Terbutaline (Brethine) Contraindications
hypersensitivity
Terbutaline (Brethine) Precautions / SE
Prec: BP, HR and ECG must be constantly monitored
SE: palpitations / tachycardia / PVCs / anxiety / tremors / headache
Terbutaline (Brethine) Dose
MDI: 2 inhalations, 1min apart
SubQ: 0.25mg, may repeat in 15-30min
Pedi: 0.01mg/kg SubQ
Pralidoximine (Protopam) Class
Cholinesterase reactivator
Pralidoximine (Protopam) Actions
Reactivates cholinesterase in cases of organophosphate poisoning
Deactivates certain organophosphates by direct chemical reaction
Pralidoximine (Protopam) Indications
Severe organophosphate poisoning characterized by muscle twitching, respiratory depression, and paralysis
Pralidoximine (Protopam) Contraindications
poisoning due to inorganic phosphates
poisoning other htan organophosphates
Pralidoximine (Protopam) Precautions / Side Effects
Prec: laryngospasm, tachycardia, muscle rigidity, should only follow atrpinization
SE: excitement, manic behavior
Pralidoximine (Protopam) Dose
Adult: 1-2g in 250-500mL of NS over 30min
Ped: 20-40mg/kg in 250-500mL of NS over 30min
Hydromorphone (Dilaudid) Class
Narcotic
Hydromorphone (Dilaudid) Action
central nervous system depressant
decreases sensitivity to pain
Hydromorphone (Dilaudid) Indications
severe pain
Hydromorphone (Dilaudid) Contraindications
shock
severe hemorrhage
hypersensitivity
Hydromorphone (Dilaudid) Precautions / Side Effects
Prec: respiratory depression / hypotension / nausea
SE: dizziness / AMS / bradycardia
Hydromorphone (Dilaudid) Dose
Adult: 1-4mg/IV, IO, PO
Pedi: 0.015 mg/kg/IV
Racemic Epinephrine Class
Sympathomimetic
Racemic Epinephrine Action
bronchodilation / increase HR / increased cardiac contractile force
Racemic Epinephrine Indications
Croup (laryngotacheobronchitis)
Racemic Epinephrine Contraindications
Epiglottitis / hypersensitivity
Racemic Epinephrine Precautions / Side Effects
Prec: monitor vitals / use only once in prehospital setting
SE: palpitations / anxiety / headache
Racemic Epinephrine Dose
0.25-0.75mL of a 2.25% solution in 2mL normal saline / by nebulizer
Mannitol Class
osmotic diuretic
Mannitol Actions
decreases cellular edema
increases urinary output
Mannitol Indications
acute cerebral edema
blood transfusion reactions
Mannitol Contraindications
pulmonary edema / dehydration / hypersensitivity
Mannitol Precautions / Side Effects
Prec: rapid administration can cause circulatory overload / crystallization occurs at lower temperatures / in-line filter should be used
SE: pulmonary congestion / sodium depletion / transient volume overload
Mannitol Dose
Adult: 1.5-2.0g/kg/IV slow bolus or infusion
Peds: 0.25-0.5g/kg IV over 60min
