Pharmacology

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j65gonzalez
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110835
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Pharmacology
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2015-05-10 12:56:48
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Pharmacology
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Drug Classifications
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  1. Alkalinizing Agent
    Combines with hydrogen ions to increase blood pH or make it more alkaline (Sodium BIcarbonate)
  2. Alpha1
    Receptors that cause peripheral vasoconstriction, mild bronchoconstriction, and stimulation of metabolism
  3. Alpha2
    Receptors serve to prevent over-release of norepinephrine in the synapse to stop synapse stimulation
  4. Analgesic
    Relieves pain by altering perception of pain without producing anesthesia or loss of consciousness (ASA, MS, Nitrous Oxide)
  5. Amnesic Agent
    Drugs used for pre-procedure sedation - patient will have less actual pain perception during the event and may not remember the magnitude of the procedure in the hours following the procedure
  6. Anesthetic
    Partial or complete loss of sensation with or without loss of consiousness
  7. Antianginal
    Drug use in the treatment of angina pectoris
  8. Antianxiety
    Drug used to reduce the level of anxiety
  9. Anticholinergic Agent (Parasympatholytic)
    An agent that blocks parasympathetic nerve impulses
  10. Anticoagulant
    Delays blood clotting.
  11. Anticonvulsant
    Stops or prevents seizure activity
  12. Antidote
    A substance that neutralizes poisons or their efects
  13. Antidyskinetic
    Drug used to treat dyskinesias, which is the involuntary movement of the lips, tongue, face, trunk and extremities from long ther use of antipsychotics
  14. Antidysrhythmic
    Controls or prevents cardiac rhythm disturbances
  15. Antiemetic Agent
    Drug that prevents vomiting
  16. Antihistamine
    Counteracts allergic responses by blocking histamine receptors
  17. Antihypertensive
    Drug used to prevent or control high blood pressure
  18. Anti-Inflammatory
    Drug use to counteract inflammation
  19. Barbiturates
    A group of organic compounds derived from barbituric acid. All derivatives depress the CNS, respirations, heart rate, blood pressure and temperature.
  20. Benzodiazepine
    A chemically similar group of psychotropic drugs with potent hypnotic and sedative actions, used primarily as antianxiety and sleep-inducing drugs
  21. Benzodiazepine Agonist
    Drug used to counteract the actions of Benzodiazepines
  22. Beta1
    Recptors that increase heart rate, cardiac contractile force, and cardiac automaticity and conduction
  23. Beta2
    Receptors that cause vasodilation and bronchodilation
  24. Beta Blocker
    Drug work by affecting the response to some nerve impulses in some parts of the body. They reduce the need for blood and oxygen by reducing the workload of the heart
  25. Bronchodilator
    Dilates the bronchoiles and relaxes the smooth muscles of the respiratory tract
  26. Calcium Channel Blocker
    Blocks the influx of calcium into the muscle cells, inhibiting contractility of cardiac and vascular smooth muscles.
  27. Cardiac Glycoside
    Drug that increases the amount of Calcium ions available for contraction of the heart muscle, improves cardiac output and reduces distention of the heart.
  28. Catacholamine
    Acts as a neurotransmitter
  29. CNS Depressant
    Drug that depresses the normal functions of the central nervous system, including the brain, spinal cord, nerves and end organs that control the voluntary and involuntary acts.
  30. Chemical Absorbent
    Absorbs chemicals in the entire gastrointestinal tract
  31. Chronotropic Agent
    Increases or decreases heart rate
  32. Corticosteroid
    Hormonal steroid substances obtained from the cortex of the adrenal glan. They allow many biochemical reactions to proceed at optimal rates
  33. Dipolarizing Neuromuscular Blocking Agent
    Druig that blocks the firing of cells within the neuromuscular system
  34. Diuretic
    Increases urinary output, thus aiding in the removal of sodium and water
  35. Electrolyte
    A serum ion that, in solution, concucts an electric current and is decoposed by the passage of an electric current
  36. Emetic Agent
    An agent that produces vomiting
  37. Hormone
    A substance that originates in an organ, gland, or part, and is conveyed through the blood to another part of the body. It then stimulates it by chemical action to increase functional activity or the increase secretion of another hormone.
  38. Hyperglycemic Agent
    Elevates blood glucose levels
  39. Inotropic Agent
    Increases or decreases mycoardial contractility
  40. Loop diuretic
    Drugs that encourage the kidneys to remove more water from the blood by filtering out more sodium and potassium, thereby producing more urine. This process reduces the volume of circulation blood, which decreases the workload on the heart. It will aslo draw out fluid from any tissues that are overloaded.
  41. MAO Inhibitor
    Monoamine Oxidase Inhibitor- a group of drugs that are effective in treating atypical depression by inhibiting the activity of monoamine oxidase, thereby priventing the breakdown of the monoamine neurotransmiters.
  42. Narcotic Analgesic
    Relieves pain through the suppression of the CNS by binding with opiate receptors
  43. Narcotic Antagonist
    Reverses the effects of narcotics by blocking the opiate receptors
  44. Nitrate
    Dilates systemic and coronary arteries, increases the amount of blood and oxygen to the mycocardium and reduces the workload on the heart
  45. Opioid narcotic
    Drug that is chemically related to Oium, which is extracted from the poppy plant
  46. Osmotic Diuretic
    Diuresis achieved by moving water across a cellular membrane, therby equalizing the concentration of solutes on either side of the membrane without moving the solute. this type of diuretic is designed to move extravascular fluid out of edematous tissues and into the blood stream by increasing urine output
  47. Paralytic
    Drug used to stop the neuromuscular nerve signals to achieve relaxation of the muscles
  48. Parasympatholytic / anticholinergic
    Blocks the effects of stimulation to the parasympathetic nervous system
  49. Phenothiazines
    Originally manufactured as a pesticide, this class of drugs is the larest of the 5 antipsychotic medications available. this drug can induce dystonic reactions early in the treatment regime
  50. Sedative / hypnotic
    Drug that exerts a soothing or tranquilizing effect. Effect can be general, local nervous or vasular
  51. Sympathomimetic
    Causes effects that mimic a sympathetic nervous system reaction
  52. Thrombolytic
    Drug used to cause the breaking up of a thrombus
  53. Tocolytic
    Drug used to inhibit uterine contractions
  54. Tranquilizer
    Drug used to reduce mantal tension and anxiety without interfering with normal mental activity, though this state is difficult to attain
  55. Tricyclic Antidepressants
    Drug that is generally thought to inhibit the re-uptake of nerurotransmitters norepinephrine, dopamine or serotonin by the nerve cells.
  56. Vasodilator
    Dilates the blood vessels
  57. Vasopressor
    Constricts the blood vessels
  58. ASA
    Class
    Analgesic, antipyretic, NSAID, platelet aggregate inhibitor
  59. ASA
    Mech of action
    • 1. Inhibits aggregation of platelets by blocking the formation of the substance thromboxane A2 Prolonging bleeding time
    • 2. Provoides analgesia by ingibiting prostaglandins and other substances that sensitize pain receptors
    • 3 relieves fever by acting upon the hypothalamic heat regulating center.
  60. ASA
    Indication
    • MI
    • CVA
    • Afib Aflut
  61. ASA
    Contra
    • GI bleed
    • Asthma nasal polyps
  62. ASA
    Side effects
    • bleeding
    • GI pain
    • dizziness
    • tinnitus
    • impair renal functions
  63. ASA precautions
    • hx of bleeding or liver disorders
    • do not give to children with chickenpox
  64. ASA
    dose
    • adult 162-325 mg PO
    • peds no
  65. Charcoal
    class
    chemical absorbent
  66. char
    mech of action
    binds toxic substances inhibiting GI absorption leaving less toxic substance in body circulation

    increases fecal elimination of drug/charlcoal complex
  67. Char
    incications
    Suspected ingestion of drugs or chemicals
  68. Char
    contra
    pt with a compromised airway

    ingestion of iron or multi-vitamin
  69. char
    dosages
    • adult 1g/kg PO
    • peds 1g/kg PO
  70. Adenosine
    class
    • antidysrhythmic
    • endogenous nucleoside
  71. adenosine
    mech of action
    • slows AV and Sinus conduction
    • block pathway of reentry of AV and SA node
  72. Adenosine
    contra
    • Hx of sick sinus syndrome
    • 2nd or 3rd degree block
    • hypovolemia give fluids a
  73. Adenosine
    interactions
    Theophylline or caffeine may render drug ineffective

    Tegretol or Persantine will intensify effects.
  74. Adenosine
    dose
    • adult 6mg rapid IV
    • Repeat 2x 12mg p 1-2min

    • ped 0.1mg IVP
    • repeat 0.2mg 2x p 1-2min
  75. Albuterol
    mech of action
    relaxes the smooth muscles of the respiratory tract dilating the bronchioles to decrease airway resistance

    reduces ucus secretion and inhibits histamine release from mast cells thus lessening the respiratory effects of an allergic reaction
  76. albuterol
    class
    sympathomimetic bronchodilator
  77. albuterol
    precautions
    may not be appropriate for pulmonary edema caused by CHF due to the aggresive cardiovascular side effects adding aditional stress to a heart that is already failing

    must monitor ECG rhythm throughout treatment due to cardiovasculsr side effects

    provide pt with oxygen a during and p admin
  78. albuterol
    indications
    • bronchospasms/bronchodialtion caused by
    • asthma
    • toxic gas
    • allergic reaction
    • copd
    • near drowning
    • Pulmonary Edema
  79. albuterol
    interactions
    • use caution with pt taking MAO inhibitors or tricyclic antidepressants as the cardiovascular effects may be potentiated
    • Beta blocker medications and albuterol inhibit each other
  80. albuterol
    dosages
    • adult 5 mg  
    • may repeat PRN
    • peds 2.5 - 5.0 mg
    • Sine Wave hyperkalemia
    • Crush injuries,
    • Sevre burns
    • Continous Nabulized Albuterol
  81. AMYL NITRITE
    NAME
    VAPOROLE
  82. AMYL NITRITE
    CLASS
    nitrie vasodilator, antidote
  83. AMYL NITRITE
    MOA
    • relaxes vascular smooth muscle, decreasing vascular resistance decreases preload and afterload
    • convers hemoglobin to methemoglobin, which then binds with cyanide to form non toxic cyanomethemoglobin that can be excreted
  84. AMYL NITRITE
    INDICATIONS
    • angina
    • hypertension
    • cyanide poisoning
  85. AMYL NITRITE
    CONTRA
    • hypotension
    • ED meds within the last 36hrs
    • no contra with cyanide poisoning
  86. AMYL NITRITE
    DOSE
    ADULT: 1-2 ampules 0.3ml, crushed and inhaled over 30 seconds may repeat q 1-2 min

    PEDS: 1 ampule crushed and inhaled for 15-30 sec may repeat q1-2 min
  87. ATROPINE SULFATE
    CLASS
    PARASYMPATHOLYTIC ANTICHOLINERGIC
  88. ATROPINE
    MOA
    • inhibits parasympathetic stimulation by blocking acetylcholine receptors
    • decreases vagal tone which may increase heart rate and AV conduction
    • dilates bronchioles and decreases respiratory tract secretions Anti-secretory action suppressses sweating, lacrimation, and salivation
  89. ATROPINE
    PRECAUTIONS
    • may cause paradoxical slowing of the hear rate if less than the therapeutic dose is given or dose given too slowly
    • not recommended in asymptomatic bradycardias due to the possibility of inducing or increasing a myocardial infarction
    • can worsen AV blocks
  90. ATROPINE
    DOSES
    • ADULT:
    • BRADY: 0.5-1.0 MG IVP/IO may repeat q 3-5min to max of 3mg
    • PESTICIDES:  Mild:2MG IVP  or 1 2PAM Moderate SOB: 4mg IV or 2 2PAM Severe: Seizures 6mg IV or 3 2PAM q 10 min.
    • Peds Mild-Moderate 0.02-0.05mg/kg IV IM IO max of 4mg. Repeat 0.02 mg/kg IV, IM, IO in 5min to max of 2mg/kg
    • Severe: 0.02mg/kg IV or IO max of 6mg

    • Brady
    • 0.5mg IVP Repeat q 5 min to max of 0.04mg/kg or 3mg 
    • Peds: 0.02mg/kg IV (min single dose 0.1mg, max of 0.5 for child and 1mg for adolescent
    • repeat 0.02 to max of 0.04mg/kg

    Peds Type II or 3rd degree rate <60bpm  0.02mg/kg IO or IV  (min single dose 0.1mg, max of 0.5 for child and 1mg for adolescent
  91. ATROPINE
    SIGNS OF ATROPINIZATION
    • blind as a bat
    • mad as a hatter
    • red as a beet
    • dry as a bone
    • hot as hell
  92. CALCIUM CHLORIDE
    CLASS
    electrolyte
  93. CaCl2
    MOA
    • neccessary for the proper function of the nervous, muscular, skeletal, digestive and endocrine systems
    • positive inotropic activity increases the strength of the myocardial contractions
    • increases ventricular automaticity
  94. CaCl2
    Indications
    • calcium channel blocker or beta blocker oerdose
    • acute hyperkalemia or cardiac arrest when hyperkalemia is suspected
    • hypocalcemia
    • suspected hypermagnesemia with respiratior depression
    • crush injury greater than 4hrs
  95. CaCl2
    contra
    • digitalis toxicity
    • hypercalcemia
    • vetricular fibrillation
  96. CaCl2
    precautions
    • use with caution in pt with renal insufficience or hx of cardiac disease
    • may cause cerebral or coronary vasospasm
    • can cause bradycardia if administration is too rapid
    • safe use in children, pregnant mothers or nursing mothers has not be established
  97. CaCl2
    interactions
    • do not mix with Sodium bicarb makes chalk
    • potentiates the effects of digitalis
    • antagonizes the effectss of calcium channel blockers
  98. CaCl2
    doses
    • Adult: known or suspected hyperkalemia or beta blocker od, cardiac arrest 1 gm over 2 min may repeat 1gm in  10 min prn
    • calcium channel blocker OD 

    • PEDS: 20mg/kg (0.2ml/kg) over 2 min max 1gram repeat in 10 min rhythm remains wide complex
    • 2nd degree or 3rd degree block hemodynamic instability and pt on calcium channel blockers 
    • Adult 10% CaCl2 1gm IV over 2 min 
    • CaCl2 OD Adult 1gm over 2 min 
    • Peds 20mg/kg IV over 2 min (0.2ml/kg) IV over 2 min.
  99. Calcium Gluconate
    Trade Name
    Kalcinate
  100. Calcium Gluconate
    Class
    Electrolyte
  101. Calcium Gluconate
    Actions
    Increases cardiac muscle tone and positive inotropic effect
  102. Calcium Gluconate
    Dose
    • Wide complex brady Prolonged QT sine wave due to hypokalemia
    • Adult 1gm IO or IV over 2 min repeat 1 gram immediately if rhythm remains

    Brady with symptomatic 2nd type II or 3rd degree and pt on calcium channel blockers 1gm IV over 2 min

    • Calcium channel blocker OD 1gm 10ml over 2min
    • peds 60mg/kg (0.6 ml/kg of 10%) IV over 2 min
  103. Calcium Gluconate
    Contraiindications
    • V fib
    • hypercalcemia
    • digitalis toxicity
    • caution in pt taking digoxin as it may precicitate toxity
  104. Calcium Gluconate
    Side Effects
    • Tingling sensation
    • fainting
    • heat waves
    • hypotension
    • bradycardia
    • dysrhythmias
  105. Calcium Gluconate
    Prehospital Considerations
    • cautious of extravasation
    • IV administrations cause burning, and peripheral vsodilation with moderate fall in BP
    • Monitor BP, IV site, and ECG
    • Flush line especially before infusion of Sodium Bicarb
  106. Cefazolin
    Brand name Trade name
    Ancef, Kefzol
  107. Cefazolin
    Class
    First generation cephalosporin antibiotic
  108. Cefazolin
    Actions
    Functions as a bactericidal which inhibits cell wall mucopeptide synthesis. This gives cefazolini the capacity to inhibit the growth of or kill sensitive microorganisms.
  109. Cefazolin
    Dose
    Adult greater than or equal to 70 kg -2gm IV over 10 min Less than 70kg- 1gm IV over 10 min. Pediatric not given
  110. Cefazolin
    Contra
    Allergies to Cefazolin or to Penicillin
  111. Cefazolin
    Side effects
    • Nausea
    • vomiting
    • diarrhea
    • rash
    • abdominal pain
  112. Cefazolin
    considerations
    • cautions with pt with known renal impairment or seizure disorder
    • pt with allergy with any antibiotic monitor closely
    • admin IV drip over 10 min
  113. D50W
    class
    Carbohydrate
  114. D50W
    MOA
    provides immediate source of glucose for cellular metabolism
  115. D50W
    Indications
    ALOC due to or suspected hypoglycemia
  116. D50W
    Contra
    • there are no absolute contra to the IV admvinistration of dextrose
    • relative contra use with caution in pt with increasing ICP as the added glucose may worsen the cerebral edema
  117. D50W
    Considerations
    • INsure IV line patency
    • IO route D50 must be diluted to half concetration with normal saline prior to administration.
  118. D50W
    dose
    • ADULT: 25gm may repeat 1x in 5min
    • BGL less than 60mg/dL
    • Intact gag: 1tube- 15gm
    • PEDS:
    • 8 or greater: D50 1gm/kg IV or IO
    • 31 days - 8 years D25 1gm/kg IV or IO
    • Neonates 30 days D12.5 1gm/kg IV, IO
  119. Diltiazem Hydrochloride
    name
    cardizem
  120. diltiazem
    class
    Calcium channel blocker, antidysrhythmic, antihypertensive
  121. diltiazem
    MOA
    • inhibits calcium influx across cellular membranes
    • coronary artery dilation increasing mycocardial O2 delivery
    • smooth muscle relaxation decreases peripheral vascular resistance
    • slows SA/AV node conduction
  122. Diltiazem
    indications
    symptomatic AFIB with RVR
  123. DILTIAZEM
    CONTRA
    • < 90 systolic
    • 2nd and 3rd heart block
    • sick sinus syndrome Unless with funtioning pacemaker
    • AMI
    • WPW
  124. DILTIAZEM
    INTERACTIONS
    ensure pt is not taking beta blockers or received IV calcium channel blockers because of the increased risk of CHF, bradycardia and asystole
  125. Diltiazem
    dose
    • ADULT: 15mg over 2 min IVP/IO
    • if no response in 15min repeat 20mg over 2 min if no response contact Med control
    • PEDS: NO
  126. DIPHENHYDRAMINE
    other name
    Benadryl
  127. Diphenhydramine
    class
    Antihistamine, antidyskinetic(anticholinergic), sedative/hypnotic
  128. Diphenhydramine
    MOA
    • competes c histamine receptor sites
    • CNS depressant and anticholinergic
  129. Diphenhydramine
    indications
    • allergic symptoms
    • dystonic reactions or extrapyramidal symptoms
  130. Diphenhydramine
    contra
    • acute asthma(relative contraindication)
    • nursing mothers
    • glaucoma
    • Hx of sleep apnea
    • use caution in new borns or premature infants
  131. Diphenhydramine
    precautions
    • may precipitate an acute asthma attack due to thickening of the mucosal secretions. however it should not be withheld from a pt having an allergic reaction simply due to a hx of asthma
    • may increase intra ocular pressure
  132. Diphenhydramine
    routes
    IV, IO, IM, PO
  133. Diphenhydramine
    dose
    ADULT: 25mg IM or IV

    PEDS: >9 months 1mg/kg IVP/IM max of 25mg

    • Dystonic reaction antipsychotic medication
    • adults 25mg IM or IV
    • Peds 1mg/kg IM or IV max of 25 mg
  134. Dopamine
    name
    inotropin
  135. Dopamine
    Class
    sympathomimetic, catecholamine, vasopressor
  136. Dopamine
    MOA
    Low dose
    • Renal/Mesenteric dose (1-5mcg/kg/min)
    • 1.dilates renal and mesenteric arteries by stimulating dopaminergic receptors
    • 2.increases urinary output
  137. Dopamine
    MOA
    Moderate dose
    • inotropic dose (5-10 mcg/kg/min)
    • 1. increases inotropy s increasing chronotropy
    • 2. increases blood pressure by stimulating the beta1 receptors
  138. Dopamine
    MOA
    High Dose
    • VASOPRESSOR DOSE (10-20mcg/kg/min)
    • 1. causes vasoconstriction (alpha); increasing blood pressure
    • 2. increase inotropy and chronotropy (beta1); increasing blood pressure
  139. dopamine
    indications
    • Anaphylaxis allergic reaction
    • cardiac arrest: PEA, Post ROSC hemodynamic instability, ROSC 2 2 block 3rd degree, 
    • Cadiogenic shock
    • Hemorrhage Medical, Sick person
    • Unconscious hypotnesive
    • 5-20mcg/kg/min

    • Peds
    • Haz Mat
    • Anaphylaxis and allergic reaction
    • Cardiac arrest PEA, asystole
    • Cardiac arrest traumatic with vtach or v fib or aystole
    • Post ROSC  2 2 block 3rd degree, Cadiogenic shock Hemorrhage Medical, Sick personUnconscious hypotnesive5-20mcg/kg/min IV
    • Med control contact
  140. Dopamine
    contra
    • hypovolemia
    • tachydysrhythmias
    • hyperthermia
    • V Fib
  141. Dopamine
    precautions
    • cannulate largest vein possible and ensure IV patency
    • start a second IV line if additional medications are needed (dopamine infusion should not be interrupted, to ensure adequate therapeutic blood levels)
  142. Dopamine
    interactions
    • flush tubing a and p administration of HCO3 as dopamine will be inactivated by the change in pH
    • actions may be intensified if pt is also taking antidepressants
    • may cause hypotension if pt taking phenytoin(dilantin)
  143. Dopamine
    dose
    Anaphylaxis allergic reactioncardiac arrest: PEA, Post ROSC hemodynamic instability, ROSC 2 2 block 3rd degree, Cadiogenic shockHemorrhage Medical, Sick personUnconscious hypotnesive5-20mcg/kg/minPedsHaz MatAnaphylaxis and allergic reactionCardiac arrest PEA, asystoleCardiac arrest traumatic with vtach or v fib or aystolePost ROSC  2 2 block 3rd degree, Cadiogenic shock Hemorrhage Medical, Sick personUnconscious hypotnesive5-20mcg/kg/min IVMed control contact
  144. EPINEPHRINE HYDROCHLORIDE
    NAME
    Adrenalin
  145. Epi
    Class
    Sympathomimetic, catecholamine, vasopressor
  146. Epi
    MOA
    • increases cardiac output and BP by increasing inotropy, chronotropy, and AV conduction(beta1 effect)
    • vasoconstriction; increases systolic blood pressure(alpha)
    • relaxes the smooth muscles in the respiratory tract (beta2 effect
    • dilates the bronchioles (beta2 effect)
    • increases coronary perfusion during CPR by increaseing aortic diastolic pressure
  147. Epi
    indications
    • cardiac arrest
    • asthma
    • allergic reaction and anaphylactic shock
    • symptomatic bradycardia (PEDS)
    • beta blocke OD (PEDS)
  148. Epi
    contra
    • Caution with hypovolemia
    • hypertension
    • Caution with glaucoma
    • Med control with pt >55 y/o unless a life threat condition.
  149. Epi
    precautions
    • give slow IVP in conscious pt as it may cause permanent hearing loss
    • monitor blood pressure and ECG frequently after administration due to the high incidence of cardiovascular side effects in pt above the age of 40
  150. Epi
    interactions
    flush tubing a and p adminstration of HCO3 as epi will be inactivated by the change in pH
  151. Epi
    dose
    adult
    • ADULT:
    • cardiac arrest: 1mg (1:10,000) IVP/IO may repeat q 3-5min
    • asthma/ allergic reaction: 0.3mg -0.5mg (1:1,00) IM 
    • Profound shock: 1ml (1:10,000) diluted in 10ml NS over 1-2min IV
    • Persistent shock: 1-4 mcg/min IV (2mg 1:1,000 in 500ml NS)
  152. Epi
    Dose
    Peds
    Peds Cardiac arrest: 0.01mg/kg 1:10,000 IV, IOAnaphylaxis: 0.01mg/kg 1:1,000 IM (max-0.3mg)Hypotension 0.01-0.1 mg/kg/min (1:100,000) IVProfound shock 0.05-1mcg/kg,min (2mg 1:1,000 in 500ml NS)Croup 0.5 ml/kg (max 5ml) (1:1,000) in normal saline for total volume of 5ml
  153. Epi
    Notes
    • Pt must be perfusing to effectively administer SQ injections
    • most bradycardias in infants and children are due to hypoxia-consider aggressive ventilatory support prior to medication administration
  154. FENTANYL
    NAME
    sublimaze
  155. Fentanyl
    class
    narcotic analgesic
  156. Fentanyl
    MOA
    Provides analgesia and sedation by acting on the opiate receptors in the brain, blocking sensation of pain.
  157. Fentanyl
    Indications
    • sedation during rapid sequence intubation
    • severe pain
  158. Fentanyl
    contra
    • pt who have recieved MAO inhibitors in the last 14 days
    • myasthenia gavis
    • safe use in pregnancy and in children<2y/o not established
  159. Fentanyl
    precautions
    use with caution in head injuries, suspected or known increased interacranial pressure: the elderly, debilitated or immuno-compromised pt; COPD or other respiratiory problems and those with kidney or liver dysfunction
  160. Fentanyl
    Interactions
    alcohol and other CNS depressants potentiate effects of fentanyl: MAO inhibitors may precipitate hypertensive crisis
  161. Fentanyl
    dose
    • adult:
    • Initial dose IN 2mcg/kg max of 200mcg/dose
    • IV/IO/IM 1mcg/kg max of 100mcg
    • Subsequent dose 1mcg/kg max of 100mcg any route
    • Peds
    • 1mcg/kg slow IV/IO/IN max 100mcg
  162. Glucagon
    class
    hormone
  163. Glucagon
    MOA
    • elevates blood glucose level by converting stored liver glycogen into glucose
    • increases heart rate and myocardial contractility and improves AV conduction in a manner similar to that produced by catecholamines.
  164. Glucagon
    indications
    • ALOC c hypoglycemia when no IV can be established
    • beta blocker OD
  165. Glucagon
    Precautions
    • only effective if liver glycogen is available, may be ineffective in chronic hypoglycemia or starvation pt
    • use with caution in pt c cardiovascular disease or renal insufficiency/disease
  166. Glucagon
    dose
    • Adult:
    • Hypoglycemia: 1mg IM; 
    • Beta Blocker OD: 3mg IV/IO 
    • Allergic reaction:(contact medical control) 1mg IV/IM

    • Peds:  greater than 30 days old 0.05mg/kg IM; Max dose 1mg
    • Allergic reaction:(contact medical control) <20kg-0.05mg/kg IM; Max dose 1mg
    • Beta blocker OD=0.05mg/kg IM; Max dose 1mg
  167. Labetalol Hydrochloride
    Name
    normodyne, trandate
  168. Labetalol
    class
    Alpha and beta adregergic blocking agent
  169. Labetalol
    MOA
    • combines selective alpgh and non selective beta adregergic blocking actions. both activities serve to reduce blood pressure.
    • 1. alpha blockade leads to : vasodilation, decreased peripheral resistance, and orthostatic hypotension.
    • 2. beta blockade leads to : effects on SA, AV nodes, and ventricular muscle that leads to bradycardia, delay in AV conduction and depression of cardiac contractility.
  170. Labetalol
    indications
    • alone or in combination c other drugs to control hypertension
    • hypertensive emergencies
  171. Labetalol
    contra
    • cardiogenic shock
    • cardiac failure
    • bradycardia
    • bronchial asthma
    • 2nd or 3rd degree heart block
  172. labetalol
    precautions
    use with caution during laction, in impaired renal or hepatic function, in chronic bronchitis and emphysema, and in diabetes (may block signs of hypoglycemia), efficacy and safty in children has not been established
  173. labetalol
    interactions
    • beta adrenergic bronchodilators (i.e. Albuterol) labetalol decreases the bronchodilator effect of these drugs
    • cimetidine (i.e. Tagamet): increases circulating labetalol levels
    • tricyclic antidepressants (i.e. Elavil, tofranil) increased risk of tremors
    • do not use with IV calcium channel blockers
  174. lavetalol
    ROA
    IVPB, IV, IO, PO HOME MEDS
  175. LABETALOL
    DOSE
    • Adult: 20mg slow IV push may repeat q 5min if pt remains hypertensive and symptomatic In presence of possible CVA with SBP >185 and or DBP >110
    • Contact Med control for 10-20mg slow IVP
    • Pt has hx of preeclampsia or is hypertensive 140/90. administer 20mg slow IV may repeat in 5min with persistent HTN
    • Uncontrolled epistaxis with HTN contact med control
  176. Lidocaine Hydrochloride
    name
    xylocaine, xylocard
  177. Lidocaine
    class
    antidysrhythmic agent, local anesthetic
  178. lidocaine
    MOA
    • suppresses ventricular ectopy and increases VFIB threshold; blocks Na influx through fast Na channels and alters activity of some K channels
    • decreases depolarization, automaticity, and excitability in the ventricles during the diastolic phase by direct action on the purkinje network
  179. lidocaine
    indications
    • ventricular dysrhythmias: symptomatic PVCs and monomorphic VTAC
    • cardiac arrest: VFIB/ pulseless VTAC
    • post conversion from a ventricular dysrhythmia (with pulses or pulseless) into a perfusing rhythm
  180. lidocaine
    contra
    • second degree block, Mobitz II
    • third degree block
    • junctional bradycardia
    • ventricular ectopy associated c bradycardia
    • idioventricular rhythm
    • Stokes adams syndrome
  181. lidocaine
    precautions
    due to reduced ability to excrete the drug and the resulting accumulation of the drug in the body, reduce dose in : suspected liver disease, suspected kidney disease, cardiogenic shock, pulmonary edema and elderly
  182. lidocaine
    dose
    • ADULT
    • VFIB/ PulselessVtac: 1.5mg/kg  may repeat 0.5mg/kg IVP/IO  Max dose of 3mg/kg
    • Head trauma Adult Peds for intubation
    • 1.5mg/kg IV/IO 2-3 min prior to intubation
    • IO 
    • Adult 20-40mg (1-2ml) of lidocaine2%
    • Peds 0.5mg/Kg IO max of 40mg
  183. Lidocaine notes
    signs of lidocaine toxicity: vision disturbances (blurred or double vision), tinnitus, trembling, dyspnea, dizziness/ syncope, seizures, chest pain, palpations and bradycardic dysrhythmias.
  184. Magnesium sulfate
    class
    Electrolyte, antidysrhythmic, anticonvulsant, cns depressant
  185. Mag sulfate
    MOA
    • decreases acetylcholine in motor nerve terminals
    • produces neuromuscular blockade in the CNS
    • physiological calcium channel blocker
  186. Mag sulfate
    Indications
    • Refractory vfib/pulsesless vtac(acls)
    • treatment for torsades de pointes (polymorphic vtac)
    • seizures associated c eclampsia and alcohol withdrawal
    • dysrhythmias associated c digitalis toxicity
    • bronchospasms refractory to traditional medications
  187. Mag sul
    contra
    • cardiogenic shock
    • heart blocks
    • renal insufficiency
    • dialysis except in torsades
  188. mag sulfate
    precautions
    pt c renal insufficiency/disease (excreted through the kidneys)
  189. Mag sulf
    routes
    IVP, IO, IM, IVPB
  190. Mag sulfate
    dose
    • Reactive airway respiratory distress
    • Adult: 1-2 gm IV over 5-10min IV/IO
    • Peds: 25mg/kg IV over 5-10min IV/IO
    • Refactory Vfib
    • adult 2gm over 1-2min IV IO
    • Peds 50mg/kg IV/IO max 2g may repeat 5-10min if torsades is present
    • Stable or untable v-tach
    • Adult 2 grams over 1-2min
    • PT >20weeks gestation or <1month post partum and had seizure 4g IV over 15min.
    • May dilute in 150ml NS
  191. Mag sulfate
    note
    calcium chloride can be used as an antidote should respiratory depression occur. in clinical trials as a neuro-protective drug for CVA pt
  192. Labetalol Hydrochloride
    Name
    amnesic agent, sediative/hypnotic, anticonvulsant, benzodiazepine, tranquilizer, anti anxiety
  193. Methylprednisolone
    trade Name
    Solu Medrol
  194. Methylprednisolone
    Class
    Steroid
  195. Methylprednisolone
    Actions
    A potent Anti-inflammatory steroid.
  196. Methylprednisolone
    Dose
    • Adult 125mg IV
    • Peds 2mg/kg max 125mg
  197. Methylprednisolone
    contra
    Allergic reaction
  198. Midazolam
    Name
    Versed
  199. Midazolam
    class
    Benzodiazepine, Seditive
  200. midazolam
    MOA
    • binds to benzodiazepine receptors
    • increases the inhibitory neurotransmitter GABA leading to decreased agitation, relaxation of skeletal uscles, and in high doses sleep
  201. midazolam
    indications
    • seizures
    • prededication for synchronized cardioversion/TCP
    • one of the premedications for RSI
  202. midazolam
    contra
    • acute narrow-angle glaucoma
    • shock (from hypovolemia)
    • hypotension (from hypovolemia)
    • alcohol or drug intoxication
  203. midazolam
    precautions
    • elderly pt c impaired respiratory function
    • pt c renal failure, liver failure or COPD Lower doses should be used
  204. midazolam
    ROA
    IV,IO,IM,IN
  205. midazolam
    dose
    • adult: 5.0-10mg IN or 5mg IM
    • Peds: 0.15mg/kg IM or 0.2mg/kg IN (max 10mg IN max 5mg IM
  206. Morphine sulfate
    class
    opioid narcotic, cns depressant
  207. M.S.
    MOA
    • alters pain perception and produces euphoria
    • decreases mycocardial o2 demand by decreasing preload (venous pooling due to peripheral vasodilation) and decreasing afterload (decreased systemic vascular resistance due to peripheral vasodilation)
    • depresses the cns by interacting c opiate receptors in the brain
  208. MS
    indications
    • moderate to severe pain
    • chest pain of suspected myocardial origin
    • pulmonary edema from CHF c or without chest pain
    • burns
  209. MS
    contra
    • ALOC
    • abdominal pain of unknown etiology
    • pt at risk of repiratory depression
    • head injury
    • hypovolemia
  210. MS
    precautions
    morphine sulfate is an opiate derivative - naloxone should be available to reverse any severe respiratory side effects
  211. MS
    dose
    • Adult
    • Pain: 1.0-10.0mg IV titrated to pain relief or 5.0-10.0 mg IM as a single dose only
    • Pulmonay edema: 5.0-10mg slow IV push (2.0mg/min)

    Peds: 0.1-0.2mg/kg slow IV push (1.0mg/min) titrated to pain relief or 0.1mg/kg IM
  212. Naloxone
    name
    narcan
  213. Naloxone
    class
    Narcotic Opiate antagonist
  214. naloxone
    MOA
    reverses the respiratory depression and cns sedation of narcotics by competing for opiate receptor sites in the brain
  215. naloxone
    indications
    known or suspected narcotic overdoses c inadequate respiratory functions
  216. naloxone
    contra
    not to be used if pt has adequate respiratory status
  217. naloxone
    precautions
    • give drug prior to intubation
    • prepare to protect pt and ems personnel due to aggressive/combative personality following rapid reversal of a narotic OD
    • does not reverse narcotic induced hypotension
    • use c caution in narcotic addicts or chronic pain pt, as narcan will rapidly reverse the cns depresant effects of opiods.
  218. naloxone
    dose
    • Adult 1.0-2.0mg IV/IM/IN titrate IV dose to adequate respiratory rate and tidal volume, May repeat dose q 5 min as needed to 10mg
    • Peds:0.01mg- 0.1mg/kg IV/IM/IN max 2mg titrate IV doe to adequate respiratiory rate and tidal volme. may repeat dose q 5min to 10mg
  219. NTG
    name
    Nitrolingual, nitrostat, nitrobid, tridil
  220. NTG
    class
    vasodilator, nitrate, antianginal
  221. NTG
    MOA
    • relaxes smooth muscles causing venous dilation
    • reduces preload and afterload to the heart
    • dilates the coronary arteries resulting in increased perfusion of the myocardium
  222. NTG
    indications
    • CP of cardiac origin
    • acute pulmonary edema
  223. NTG
    contra
    • BP less than 90 systolic
    • pt who have taken ED meds in the last 24-48 hrs
    • signs and symptoms of head trauma or cerebral hemorrhage
    • poor system perfusion
  224. NTG
    ROA
    SL, TM
  225. NTG
    dose
    • Adult: 0.4mg SL single tablet. May repeat q 5min Until pain resolves
    • nitropaste is 15mg per one inch, 
    • BP >200 2"
    • BP>150 and <200 1.5"
    • BP >100 and <150 1"
    • BP < 100 remove paste
  226. Nitrous oxide
    name
    nitronox
  227. nitrous
    class
    analgesic gas mixture(50% nitrous oxide and 50%oxygen)
  228. Nitrous
    MOA
    • provides rapid relief from pain by depressing the CNS
    • vasodilator
  229. Nitrous
    indications
    pain relief
  230. Nitrous
    contra
    • ALOC
    • head injury
    • abdominal nausea or pain
    • COPD
    • chest injury c posible pneumothorax
    • plmonary edema
    • pulmonay embolism
    • alcohol or drug intoxication
    • moderate to severe shock
    • Pregnant Pts
  231. Nitrous
    precautions
    need to monitor level of consciousness and airway closely
  232. Nitrous
    dose
    • Adult: self administered by pt c hand held mask until pt is relieved or pt drops mask
    • Peds: same
  233. Nitrous
    notes
    ensure ambulance is well vented to avoid inhalation by paramedic. pt should be placed immediately onto high flow o2 following administration. may not operate properly at low temperatures. common drug of misuse and abuse.
  234. ondansetron hydrochloride
    name
    zofran
  235. ondansetron Hydro
    class
    selective serotonin (5-HT3) receptor antagonist, antiemitic
  236. ondansetron hydro
    MOA
    selective antagonist of the neurotransmitter serotonin in the cns at the chemoreceptor trigger zone and in the peripheral nervous system on nerve terminals of the vagus nerve blocking nausea and emesis
  237. ondansetron
    indicatins
    NV
  238. ondansetron
    contra
    use cautiously in pt c hepatic impairment
  239. ondansetron
    interactions
    • drugs such as tagamet that alter hepatic drug metabolizing enzymes, phenobarbital and rifampin may change onset and duration of action of zofran
    • cannot be given through same IV as furosemide, lorazepam, or sodium bicarb.
  240. ondansetron ROA
    IV, IO, PR, PO
  241. ondansetron
    dose
    • Adult: 4-8mg IVP, IM PO
    • Peds 0.15mg/kg max of 4mg
  242. Oxygen
    Class
    Gas
  243. Oxygen
    MOA
    increases percentage of O2 in inspired air (FIO2)
  244. O2
    Indications
    • increased O2 demand
    • hypoxemia or hypoxia
    • respiratory insufficiency
    • hypoperfusion state or trauma
  245. O2
    precautions
    • closely monitor pt c COPD
    • pt c respiratory insufficiency should be monitored closely to ensure adequate ventilation
    • non humidified O2 may cause drying of the mucous membranes
    • neonates should not recieve high concentrations for long periods of time
  246. O2
    dose
    • NC: 2-6L
    • simple mask: 6-10L
    • non rebreather: 10-16L
    • HHN/neb mask: 6-8L
    • BVM: 15L
  247. Sodium Bicarbonate
    name
    NaHCO3
  248. sodium bicarb
    class
    alkalinizing agent, Electrolyte
  249. sodium bicarb
    MOA
    • increases blood pH by neutralizing excess buildup of acids
    • decreases precipitation of myoglobin in renal tubules
  250. sodium bicarb
    indications
    • cardiopulmonary arrest c:
    • unsuccessful drug therapy and defibrillation
    • suspected hyperkalemia (elevated K in dialysis pt)
    • crush syndrome or crush injury greater than 4 hrs
    • suspected tricyclic OD c cardiac dysrhythmias
  251. sodium bicarbonate
    precautions
    • use c caution in pt c CHF
    • administer for crush syndrome prior to removal of entrapped pt, May cause arrhythmias.
  252. sodium bicarb
    interactions
    fluch IV a and p administration as it will precipitate c calcium chloride and inactivates catecholamines
  253. sodium bicarb
    dose
    • ADULT: 1mEq/kg IV/IO (1amp)
    • Peds: same
  254. Hydroxocobalamin
    Indications
    Potential cyanide poisoning
  255. Hydroxocobalamin
    Contra
    Allergies to drug
  256. Hydroxocobalamin
    Dose
    • Adult: 70mg/kg IV max 5gm
    • Peds : same
  257. Verapamil
    name
    isoptin, calan, verelan
  258. verapamil
    class
    calcium channel blocker, antihypertensive, antidysrhythmic
  259. verapamil
    MOA
    • inhibits alcium influx across cell membranes
    • relaxes smooth muscles in vascular wall
    • decreases SA and AV node conduction
    • decreases PVR
  260. verapamil
    indications
    • SVT/PSVT refractory to adenosine
    • AFIB/ AFLU
    • HTN
    • angina
  261. verapamil
    contra
    • severe CHF
    • hx of sick sinus syndrome
    • 2nd and 3rd degree blocks
    • BP less than 90
  262. verapamil
    precations
    • hepatic and renal disease
    • pregnancy
    • WPW
    • hypotension
  263. verapamil
    interactions
    ensure pt s not taking beta blockers as a home medication
  264. verapamil
    dose
    Adult: 2.5mg IV/IO c a 2nd dose of 5.0-10.0m IV/IO in 15-30 min to a max dose of 30.0mg

    • Peds
    • Infant: 0.1-0.2mg/kg c a max of 2.0mg
    • child: 0.1-0.3mg/kg c a max of 5.0mg

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