NCTI- Pharmacology- Drug List B

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RunNickMarini
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18457
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NCTI- Pharmacology- Drug List B
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2010-05-09 13:17:15
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NCTI Pharmacology Drug List
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NCTI- Pharmacology- Drug List B
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  1. Diazepam
    trade name
    Valium
  2. Diazepam
    class
    • Anticonvulsant
    • Benzodiazepine
    • sedative-hypnotic
    • anti-anxiety (anxiolytic)
  3. Diazepam
    mechanism of action
    • Suppresses the spread of seizure activity and raises the seizure threshold in the motor cortex
    • Sedative effects depress the CNS and reduce anxiety
    • Skeletal muscle relaxant
    • Induces amnesia
  4. Diazepam
    indications
    • Generalized seizure activity and status epilepticus
    • Sedation prior to cardioversion or pacing of a conscious patient
    • Acute anxiety
    • Muscle relaxer
    • Chemical restraint
  5. Diazepam
    contraindications
    • Head injury/CNS Depression
    • Respiratory depression
    • Hypotension / depressed vital signs
    • Shock
    • Infants < 30 days old
  6. Diazepam
    side effects
    • Cardiovascular: bradycardia, hypotension, rebound tachycardia
    • Neurological: dizziness, drowsiness, headache
    • Respiratory: respiratory depression/arrest
    • Gastrointestinal: nausea/vomiting
  7. Diazepam
    precautions
    Use with caution in the elderly and very ill patients due to paradoxical effects
  8. Diazepam
    interactions
    Use with caution when patient is taking antihistamines, antidepressants, alcohol, narcotics, barbiturates, sedatives and hypnotics as these drug classifications may potentiate the effects
  9. Diazepam
    routes
    IV, IO, IM, PR
  10. Diazepam
    onset and duration
    Onset in 5 minutes with an unknown duration
  11. Diazepam
    dosages
    • Adult:
    • Seizures: 5-10 mg IV/IM. May repeat every 5-15 minutes prn to maximum dose of 20 mg
    • Anxiety: 5-10 mg IV/IMCardioversion: 5-10 mg IV titrated to effect

    Pediatric: 0.1 mg/kg IV/PR. May repeat every 5-15 minutes prn to maximum dose of 20 mg
  12. Diazepam
    notes
    not in riverside
  13. Midazolam
    trade name
    Versed
  14. Midazolam
    class
    • Amnesic Agent
    • Sedative/hypnotic
    • Anticonvulsant
    • Benzodiazepine
    • Tranquilizer
    • Anti-anxiety (anxiolytic)
  15. Midazolam
    mechanism of action
    • Reduces anxiety
    • Relaxes skeletal muscles
    • Produces short term CNS depression and amnesia
  16. Midazolam
    indications
    • Seizures
    • Premedication for synchronized cardioversion/TCP
    • One of the premeditations for RSI
  17. Midazolam
    contraindications
    • Acute narrow-angle glaucoma
    • Shock (from hypovolemia)
    • Hypotension (from hypovolemia)
    • Alcohol or drug intoxication
    • Allergies to cherries
  18. Midazolam
    side effects
    • Cardiovascular: bradycardia, rebound tachycardia, hypotension
    • Neurological: amnesia, drowsiness, agitation, ALOC
    • Respiratory: respiratory depression or arrestG
    • astrointestinal: nausea/vomiting
  19. Midazolam
    precautions
    • Elderly patients with impaired respiratory function
    • Patients with renal failure, liver failure or COPD
  20. Midazolam
    interactions
    Other CNS depressants or benzodiazepines
  21. Midazolam
    routes
    IV, IO, IM, IN
  22. Midazolam
    onset and duration
    Onset in 1-5 minutes (IV/IO/IN) or 5-15 (IM) and may last 2-6 hours
  23. Midazolam
    dosages
    • Adult:
    • Pre-cardioversion or transcutaneous pacing: – 2.5 mg slow IV/IO
    • Seizure: 0.1 mg/kg slow IV/IO/IN or 0.2 mg/kg IM to a maximum of 5.0 mg

    Pediatric: Seizure: 0.1 mg/kg slow IV/IO/IN or 0.2 mg/kg IM to a maximum of 5.0 mg
  24. Midazolam
    notes
    none
  25. Naloxone
    trade name
    Narcan
  26. Naloxone
    class
    Narcotic (Opiate) Antagonist
  27. Naloxone
    mechanism of action
    Reverses the respiratory depression and CNS sedation of narcotics by competing for opiate receptor sites in the brain
  28. Naloxone
    indications
    Known or suspected narcotic overdoses with inadequate respiratory function
  29. Naloxone
    contraindications
    none
  30. Naloxone
    side effects
    • Cardiovascular: tachycardia, hypertension, dysrhythmias
    • Neurological: tremors/seizures, aggressive/combative
    • Gastrointestinal: nausea/vomiting
  31. Naloxone
    precautions
    • Give drug prior to intubation
    • Prepare to protect patient and EMS personnel due to aggressive/combative personality following rapid reversal of a narcotic overdose
    • Does not reverse narcotic-induced hypotension
    • Use with caution in narcotic addicts or chronic pain patients, as Narcan will rapidly reverse the CNS depressant effects of opiods.
  32. Naloxone
    interactions
    none
  33. Naloxone
    routes
    IV, IO, IM, IN, ET
  34. Naloxone
    onset and durations
    Immediate onset when administered IV/IO/IN/ET and 5-10 minutes if administered IM. Either may last 20-30 minutes
  35. Naloxone
    dosages
    Adult: 1.0 – 2.0 mg IV/IM or 2.0 – 4.0 mg ET. Titrate IV dose toadequate respiratory rate and tidal volume. May repeat dose every 5 minutes as needed

    Pediatric: 0.1 mg/kg IV/IM or 0.2 mg/kg ET. Titrate IV dose toadequate respiratory rate and tidal volume. May repeat dose every 5 minutes as needed
  36. Naloxone
    notes
    Darvon and other synthetic narcotics may require larger dosages to reverse the effects
  37. Glucagon
    trade name
    none
  38. Glucagon
    class
    hormone
  39. Glucagon
    mechanism of action
    • 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
  40. Glucagon
    indications
    • ALOC with hypoglycemia when no IV can be established
    • Beta-Blocker OD
  41. Glucagon
    contraindications
    Not significant
  42. Glucagon
    side effects
    • Cardiovascular: tachycardia, hypertension
    • CNS: dizziness, headache
  43. Glucagon
    precautions
    • Only effective if liver glycogen is available, may be ineffective in chronic hypoglycemia or starvation patients
    • Use with caution in patients with cardiovascular disease or renal insufficiency/disease
  44. Glucagon
    interactions
    none
  45. Glucagon
    routes
    IM, IVP, IO
  46. Glucagon
    onset and duration
    Onset in 5-20 minutes and may last 15-30 minutes
  47. Glucagon
    dosages
    • Adult:
    • Hypoglycemia: 1 mg IM; May repeat in 20 minutes
    • Beta Blocker OD: 1 mg IV

    Pediatric: 0.03 – 0.1 mg/kg IM; Max dose 1 mg (must have documented hypoglycemia)
  48. Glucagon
    notes
    Place patient into recovery position to prevent aspiration should vomiting occur prior to patient becoming fully conscious
  49. Dextrose 50% in water (D50W)
    trade name
    25 gm of Dextrose in a 50 ml solution
  50. Dextrose 50% in water (D50W)
    class
    carbohydrate
  51. Dextrose 50% in water (D50W)
    mechanism of action
    Provides immediate source of glucose for cellular metabolism
  52. Dextrose 50% in water (D50W)
    indications
    ALOC due to documented or suspected hypoglycemia
  53. Dextrose 50% in water (D50W)
    contraindications
    • There are no absolute contraindications to the IV administration of dextrose in the emergency setting
    • Relative contraindication: Use with caution in patients with increasing Intracranial pressure as the added glucose may worsen the cerebral edema.
  54. Dextrose 50% in water (D50W)
    side effects
    • Patients may complain of warmth, pain or burning at the injection site.
    • Dextrose can cause severe neurologic symptoms (Wernicke’s encephalopathy or Korsakoff’s psychosis) if patient is thiamine deficient.
  55. Dextrose 50% in water (D50W)
    precautions
    • Aspirate prior to administration and after every 10-15 ml to ensure IV patency (medication will cause necrosis)
    • Cannulate largest vein possible and run IV wide open prior to and after administration
    • Relative contraindication: Use with caution in patients with increasing intracranial pressure as the added glucose may worsen the cerebral edema or potentiate cellular necrosis in hemorrhagic stroke
  56. Dextrose 50% in water (D50W)
    interactions
    none
  57. Dextrose 50% in water (D50W)
    routes
    IVP, IO
  58. Dextrose 50% in water (D50W)
    onset and duration
    Onset will be 30-60 seconds but duration depends upon degree and cause of hypoglycemia
  59. Dextrose 50% in water (D50W)
    dosages
    Adult: 25 gm (50 ml solution preload) IVP/IOMay repeat once in 5 minutes

    Pediatric: Birth – 1 month: 0.5g-1gm/kg (5-10 ml/kg) slow IVP of a 10% solution. May repeat once in 10 minutes.

    1 month+-2 years: 0.5g-1gm/kg (2-4 ml/kg) slow IVP/IO of a 25% solutionMay repeat once in 5 minutes

    Over 2 years: 0.5g-1gm/kg (1-2 ml/kg) slow IVP/IO of a 50% solution (same solution as for the adult)May repeat once in 5 minutes
  60. Dextrose 50% in water (D50W)
    notes
    Do not exceed a 12.5% concentration in neonates.
  61. Thiamine
    trade name
    • vitamin B1
    • Biamine
  62. Thiamine
    class
    water soluble vitamin
  63. Thiamine
    mechanism of action
    Coenzyme necessary for carbohydrate metabolism of glucose
  64. Thiamine
    indications
    • Coma associated with delirium tremens (DTs) or alcohol withdrawal prior to Dextrose
    • Alcoholism or malnutrition
    • Coma of unknown origin
  65. Thiamine
    contraindications
    none
  66. Thiamine
    side effects
    • Cardiovascular: mild hypotension
    • Respiratory: pulmonary edema
    • Gastrointestinal: nausea/vomiting
  67. Thiamine
    precautions
    none
  68. Thiamine
    interactions
    none
  69. Thiamine
    routes
    IV, IO, IM
  70. Thiamine
    onset and duration
    Onset is immediate with an unknown duration
  71. Thiamine
    dosages
    • Adult: 10-100 mg
    • Pediatric: 10-25 mg
  72. Thiamine
    notes
    Medication should be administered prior to Dextrose 50%

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