Paramedic Pharmacology

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Paramedic Pharmacology
2013-12-25 20:08:50
Paramedic pharmacology drugs ACLS PALS BLS

Paramedic Pharmacology Oregon Standards.
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  1. Adenosine (adenocard)-Class Endogenous-Antiarrhythmic
    Dose-6mg Rapid IV, repeat dose after 1-2 mins if no response at 12 mg, 3rd dose 12 mg if required, 30mg max. (I)- conversion of PSVT to NSR, may convert WPW syndrome. (CI)- 2nd/3rd AV block, A-Fib/A-flut, V-Tach, poison induced Vtach. (MOA)-Slows conduction through AV node(negative dromotropic effect), Slows HR(negative chronotropic effect), acts directly on sinus pacemaker cells, *drug of choice for re-entry SVT
  2. Amiodarone (cordarone)-class antiarrhythmic
    Dose-300mg IV, followed by repeat dose 5-10 mins 150mg, max does of 450mg. (I)-V-Fib, pulsless V-Tach, Unstable-V-tach. (CI)- Cardiogenic shock, sinus bradycardias, 2nd/3rd degree AV block (unless a functional pacemaker is available. (MOA)- Blocks Sodium channels and potassium channels resulting in prolongation of myocardial cell action potential duration and refractory period
  3. Aspirin-Class Platelet inhibitor
    Dose- 160mg-325mg GI, 81mg baby aspirin X4. (I)-CP, AMI, S&S of Cerebrovascular accident. (CI)-Acute ulcer disease or asthma. (MOA)- prostaglandin inhibition.
  4. Atropine-Class Anticholinergic
    Dose- 0.5-1.0mg IV?IO bolus, Max of 3mg. (I)-unstable bradycardia less then 60 BPM, asystole, PEA. (CI) Tachycardia, A-Fib, A-Flut, Glaucoma. (MOA)-Parasympatholytic, increases the HR in life threatning bradyarrhythmias
  5. Calcium Chloride
    Dose-2-4mg/kg of 10%(100mg/cc) solution IV. (I)- hypoocalcemia, hyperkalemia known or suspected calcium channel blocker overdoses, magnesium sulfate over dose. (CI)-hypercalcemia, cannot be administered with sodium bicarbonate. (MOA)- increases the force of myocardial contraction by initiation of myofibril shortening.
  6. Dextrose 50%
    Dose-12.5-25g Slow IV. (I) Hypoglycemic, alter LOC, Coma of unknown etiology. (CI) Intracranial hemorrhage. (MOA)- Rapidly increases serum glucose levels, short term.
  7. Diltiazem (Cardizem/lyo-ject)-class-Calcium channel blocker
    Dose-0.25mg/KG slow IV, if no response repeat at 0.35mg/KG after 15min of first dose. (I) Rapid A-Fib/A-Flut. (CI)- systolic BP less then 90, Sick sinus syndrome, 2nd/3rd degree AV block in the absence of an artificial pacemaker, patients with V-Tach or WPW syndrome. (MOA) Blocks calcium channels across cardiac and smooth muscle cells, decreasing myocardium contractility and O2 demand.
  8. Dopamine (intropin)-sympathomimetic
    Dose-IV infusion of 400mg dopamine in 250ml NS rates= 1-2 mcg/kg-dilates renal mesenteric vessels, 2-10mcg/kg-beta effects on heart which usually increases cardiac output w/o increasing HR or BP, 10-20mcg/kg-alpha peripheral effects vasoconstriction & increases BP, 20-40mcg/kg-alpha effects reverse dilation of renal & mesenteric vessels resulting in decreased flow-boost BP. (I) Primary indication is cardiogenic shock, septic shock, neurogenic shock. (CI)-infusion should be stopped if tachyarrhythmias or HTN occurs, Hypovolemic shock. (MOA)-same as dose.
  9. Epinephrine
    Dose-Cardiac-(1.0mg(1:10,000) IV every 3-5 mins during arrest. (0.1mg/kg (1:1000) diluted in 10ml NS) every 3-5min, Allergic reaction & anaphylaxis-.3mg (1:1000) SQ/IM. (I)-V-FIB, Asystole, PEA, Systemic allergic reactions, asthma in patients under age 50. (CI) caution in patients with peripheral vascular insufficiency. (MOA) catecholamine with alpha effects, increased HR, BP, systemic vascular resistance, myocardial contractile force, potent bronchodilator.
  10. Etomidate (amidate)-Class-Sedative hypnotic
    Dose- .3mg/kg IV over 30-60 sec. (I)-RSI in the hypotensive patient. (CI)-hypersensitivity to drug. (MOA)-exact MOA unknown believed to have GABA-like effects-depresses brain stem reticular formation activity and produces hypnosis.
  11. Furosemide (lasix)-Class-Loop diuretic
    Dose-0.5-1.0mg/kg over 1-2 min. (I) CHF, Pulmonary edema. (CI) Dehydration, hypovolemia, pregnancy, hypokalemia. (MOA) Potent Diuretic with rapid onset and short duration, inhibits sodium reabsorption through kidneys, increases in potassium excretion along with sodium excretion, as IV bolus causes immediate increase in venous capacitance and decreases in venous back-up.
  12. Lebetal (normodyne)- Class selective alpha and non selective beta-adrenergic blocker
    Dose-5-20mg slow IV over 2mins. addition repeat at 10-40 mg can be given at 10 min intervals. (I) moderate to sever hypertension. (CI) CHF, Cardiogenic shock, 2nd/3rd degree heart block, bradycardia. (MOA) reduces BP w/o reflex tachycardia, total peripheral resistance reduced.
  13. Lidocaine (xylocaine)-Class- Antiarrhythmic
    Dose-1-1.5mg/kg IV, repeat dose at 0.5-0.75mg/kg, Max 3mg/kg. maintenance dose drip set 1-4mg/min microdrip set only. (I) V-Tach, recurrent V-Fib, Preparalytic RSI, start drip following successful defibrillation. (CI) supra ventricular dysrrhythmias. (CI) supra ventricular dysrrhythmia, A-Fib.A-flut, 2nd/3rd degree AV block, Hypotension. (MOA) depresses automaticity of purkinje fibers thus increasing ventricular fibrillation threshold, decrease in conduction rate and force of contraction.
  14. Magnesium Sulfate
    Dose- 1-4g IV?IO. Adult typically 1g, pregnant eclampsia 4g. (I) sever refractory V-Fib, Torsades, Eclampsia. (CI) renal disease, heart block. (MOA) CNS depressant, stabilizes muscle cell membranes by interacting w/ sodium/ potassium exchange, SM relaxant, vaso dilator, bronchodilator.
  15. Midazolam (versed)- Class-short acting benzodiazepine CNS depressent
    Dose- 0.1 mg/kg slow IV over 2-3 min. (I) sedation & amnesia during RSI. (CI) glaucoma, shock, coma, alcohol intoxication, overdose, depressed vital signs. (MOA) generalized CNS depression, therapeutic effects postoperative amnesia.
  16. Morphine Sulfate (astramorph)-Class- Analgesic
    Dose- 2-4mg IV over 1-5 min, every 5-30 mins. repeat dose of 2-8 mg at 5-15 min intervals. (I) sever CHF, Pulmonary Edema, CP, MI, Analgesia for moderate-chronic pain. (CI) head injuries or abdominal injuries, hypotension, patients with respiratory difficulties except for pulmonary edema, hypovolemia, decreased LOC. (MOA) analgesic alleviates pain through CNS action supress fear, peripheral vasodilator, myocardial O2 consumption decreases, BP will drop.
  17. Nitroglycerin (nitrostat) - Class Vasodilator
    Dose- 0.3-0.4mg SL, repeat 3-5 mins to a max of 3 doses. (I) acute angina, ischemic CP, Hypertension, CHF, pulmonary edema. (CI) hypotension systolic less then 90, ED drugs, hypovolemia, intracranial hemorrhage, head inury. (MOA) smooth muscle relaxant, acts on bronchial, intestinal SM, reduces preload/afterload on heart thus decreases myocardial O2 demand.
  18. Norepinephrine (levophed)-class-Sympathomimetic.
    Dose-8mg in 500ml D5W. (I) cardiogenic shock, significant hypotensive less then 70. (CI) hypotensive patients with hypovolemia, pregnancy. (MOA) potent alpha agonist resulting in intense vasoconstriction, positive chrono and inotropic effect=increased cardiac output.
  19. Sodium bicarbonate
    Dose-Cardiac arrest-1mEq/KG initially followed by 0.5 mEq/KG every 10min. (I) to reverse acidosis found during cardiac arrest or near drowning victims. makes heart more receptive to conversion from V-Fib, asystole, or PEA by normalizing Ph. (CI) none. (MOA) alkalotic solution that neutralizes acids found in the blood. if body is acidotic it depresses cardiac contractility and makes the heart more likely to fibrillate.
  20. Vasopressin- Class-antidiureetic hormone
    Dose-40 units IV one time no response in 10-20 min acceptable to return to epinephrine 1 mg every 3-5 min. (I) V-Fib, Pulseless V-Tach. (CI) none in cardiac arrest. (MOA) Vasopressor that stimulates SM V1 receptors, peripheral vasoconstrictor, provides some cerebral and cardiac dilation.
  21. Albuterol (proventil, ventolin)-Class- Sympathomimetic, broncodilator
    Dose-(A)-2.5mg dilute in 2.5ml NS nebulizer 90 mq per inhalation, (P) 0.05-0.15mg/kg/dose dilute in 2ml NS. (I) treatment for bronchospasm with COPD/Asthma. (CI) hypersensitivity to drug, tachycardia arrythmias, synergistic with other sympathomimetics. (MOA)- selective beta 2 agonist stimulates adrenergic receptors in Smooth muscle resulting in relaxation of bronchials.
  22. Aminophylline-class- bronchodilator, asthma.
    Dose-6-7mg/kg IV/PO: infuse IV over 20 min. (I) bronchospasms due to asthma, chronic bronchitis, emphysema. (CI) hypersensitivity, active peptic ulcer, underlying uncontrolled seizure disorder.
  23. Amyl Nitrite (sodium nitraite, cyanide antidote kit) class-Antidote
    Dose- breathe 30 sec out every min, directions on kit. (I) cyanide or hydrocyanic acid poisoning. (CI)-Not applicable. (MOA) amul nitrite has an affinty for cyanide ions reacts with hemoglobin to form methemoglobin.
  24. Calcium gluconate-class-mineral/antidote
    Dose-hypocalcemia 2-15g/24 hour IV as continous infusion, magnesium intoxication or cardiac arrest 500-800mg IV over 10 min, hypcalcemic tetany 1-3g/dose IV until therapeutic response. (I) hypocalcemia, hyperkalemia, hyperphosphatemia, ekg changes, cardiac resucitation, hypermagnesemia, calcium channel blocker OD. (CI) hypersensitivity, IM/SQ administration, ventricular fibrillation, hypercalcemia, digoxin poisoning sarcoidosis.
  25. Dexamethasone (decadron, hexadrol)-Class-Corticosteroid.
    Dose-(A)-10-100mg IV (1mg/KG Slow IV bolus) (P)- 0.25mg-1mg/kg/dose IV, IO, IM. (I) anphylaxis, asthma, spinal cord injury, croup, elevated intracranial pressure. (CI) hypersensitivity to product. (MOA) supresses acute and chronic inflammation; immunosuppressive effects.
  26. Diazepam-(valium)-Class-Benzodiazepine, sedative hypnotic anticonvulsant
    Dose- Seizure activity (A)-5-10mg IV over 5 min, Max dose of 30 mg. (P) 0.2-0.5mg over 2-5 min max of 5 mg. (I)-Acute anxiety, acute alcohol withdrawal (delirium tremens) muscle relaxant, seizure activity, agitation, analgesia for medical procedures. (CI)- hypersensitivity, glaucoma, coma, shock, substance abuse, head injury. (MOA) potentiates effects on inhibitory neurotransmitters, raises seizure threshold, induces amnesia and sedation.
  27. Digoxin (ianoxin)- Class-Inotropic agent
    Dose-(A) loading dose of 10-15 mq/kg (P)-not recommended for prehospital. (I) CHF, Re-entry SVT, A-fib, A-Flut. (CI) V-Fib, V-Tach, Digitalis toxicity, hypersensitivity to digoxin. (MOA)- Rapid acting cardiac glycoside with direct and indirect effects that increase force myocardial contraction, increase refractory period of AV node and increases total peripheral resistance.
  28. Dimenhydrinate-class-antiemetic agent.
    Dose-IV 50mg in 10ml NS over 2 min. (I) nausea, motion sickness. (CI) hypersensitivity, lower respiratory disease nursing women. (MOA) Anticholinergic, antiemetic, antihistamine, local anesthetic effects.
  29. Diphenhydramine (benadryl)-Class- Antihistamine; anticholinergic
    Dose-(A) 25-50mg IM or IV or PO. (P)-1-2mg/kg slow IV, IM, PO=5mg/kg/24hours max. (I) symptomatic relief of allergies, allergic reactions, anaphylaxism acute dystonic reactions (phenothiazines), Blood administration reaction used for motion sickness,hay fever. (CI) asthma, glaucoma, pregnancy, hypertension, infants, patients taking monoamine oxidase inhibitors. (MAOIS). (MOA) blocks cellular histamine receptors; decreases vasodilation; decreases motion sickness reverses extrapyramidal reaction.
  30. Dobutamine (dobutrex)-Class-sympathomimetic inotropic agent.
    Dose-(A) iv infusion 2-20mq/kg/min titrated to desired effect. (P) same as adult. (I) cardiogenic shock, CHF, left ventricular dysfunction, often used in conjuction with other drugs. (CI) tachyarrhythmias, IHSS, severe hypotension due to hypovolemia. (MOA) synthetic catecholamine, increased myocardial contractility and stroke volume. minimal chronotropic activity increases renal blood flow.
  31. Droperidol(inapsine)-class-Antiemetic
    • Dose-2.5mg IV/IM, addition doses of 1.25mg may be given if no response. (I) prevention of vomiting. (CI)-hypersensitivity, a prolonged QT interval of > 450ms.
    • Should not be used in the presence of narcotics or barbiturates which may result in respiratory depression or apnea.
    • Renal failure or hepatic disease,
    • Pregnancy. (MOA) antiemesis, dopamine receptor blockade in brain.
    • Produces mild alphaadrenergic
    • blockade, peripheral vascular dilatation and reduction of the pressor effect of epinephrine, resulting in hypotension and decreased peripheral
    • vascular resistance.
  32. Enoxaparin-Class-Anticoagulant.
    Dose- Mainly for hospital use but IV bolus of 30mg may be given fro a STEMI. (I) to thin the blood. (CI) active bleeding, thrombocytopenia with antiplatelet antibody in presence of enoxaparin or heparin. (MOA) low molecular wt heparin; antithrombolytic inhib factor
  33. Fentanyl-opioid analgesic
    Dose-1-2mcg/kg IV/IM Adult dose usually 40 mcg given slowly IV usually comes in injection solution of 0.05mg/ml. (I) analgesic/sedation. (CI) hypersensitivity, if they have taken MAO inhibitors within 2wk. non opioid tolerant pts. (MOA) narcotic agonist analgesic.
  34. Flumanzenil-Class-Antidote
    Dose- comes in 0.1mg/ml injectable solution, for a benzodiazepine reversal 0.2 mg IV inj over 15-30 sec. (I) indicated for reversal of benzodiazepine use during procedure. (CI) hypersensitivity, epileptic drugs. (MOA) competitive benzodiazepine receptor antagonist.
  35. Fosphenytoin-class seizure
    Dose- 15-20mg/kg IV infuse at 100-150mg/min. (I) prevention and treatment of seizures occuring during neurosurger. (CI) hypersensitvitiy, sinus bradycardia, SA node Block, 2nd or 3rd degree block. (MOA) converted to phenytoin after injection
  36. Glucagon-class-hyperglycemic agent pancreatic hormone
    Dose-(A) hypoglycemia-0.5-1mg IM, calcium channel blocker or beta blocker overdose 3mg, followed by infusion at 3mg/hr. (P) 0.5-1mg less then 20kg. (I) altered level of consciousness when hypoglycemia is suspected. (CI) hyperglycemia, hypersensitivity. (MOA) increases blood glucose level by stimulating glycogenolysis.
  37. Haloperidol (haldol)-Class-antipsychotic
    Dose- (A)-2-5mg IM every 30-60 mins, 1-5 mg IV every 4-8 hrs until sedation achieved. (I) acute psychotic episode, sedation. (CI) agitation secondary to shock or hypoxia, hypersensitivity. (MOA) inhibits CNS catecholamine receptors. strong antidopaminergic. weak anticholinergic.
  38. Hydromorphone-Class-Opioid analgesic
    Dose-0.2-0.6 mg given slowly over 2-3 mins. (I) for pain. (CI) respiratory depression, acute/severe asthma, upper airway obstruction. (MOA) narcotic agonist analgesic.
  39. Ibuprofen-Class-NSAIDS
    Dose-300-800 mg PO for pain, fever 200mg PO. (I) arthritis, cystic fibrosis, vascular headache. (CI) allergies, bleeding disorder, duodenal/gastric/peptic ulcer, stomatitis, upper GI disease. (MOA)-inhibits synthesis of prostaglandins in body tissues by inhibiting cycloxygenase; at least 2 isoenzymes.
  40. ipecac-antidote
    Dose-15-30ml PO once, may repeat once with 15ml if vomiting does not occue within 20 mins. give with 3-4 glasses of water. (I) to induce vomiting. (CI) lethargy, absent gag reflex, coma, short time between ingestion of poison and charcoal adminstration, ingestion of caustics, volatile liquids, or sharp objects. (MOA) gastric irritant and stimulates chemoreceptor trigger zone in CNS to produce vomiting.
  41. Ipratropium- asthma/copd decongestant
    Dose- nebulizer 500mcg/ 0.5mg, inhaler maintenance for bronchospasm associated with copd. chronic bronchitis emphysema, Cystic fibrosis or exercise induced. (CI) hypersensitivity, contact with eye can cause burning, renal/ hepatic impairment. (MOA) anticholinergic bronchodilator, inhibits vagally mediated relfexes by antagonizing effects of acetycholine.
  42. Ketorolac (toradol)-Class-(NSAID)-analgesic
    Dose- (A) 30-60mg IM. (I) short term management of moderate tos ever pain. (CI) allergy to salicylates or other NSAIDs, patients with history of asthma; bleeding disorders especially GI, renal failure. (MOA)-NSAID that also exhibits peripherally acting nonnarcotic analgesic activity by inhibiting prostaglandin synthesis
  43. Labetol-Class-Beta blocker
    Dose- 20mg IV over 2 min then 40-80mg IV, max of 300mg. (I) for high blood pressure. (CI) asthma, copd, severe brady cardia, 2nd/3rd degree HB, Cardiogenic shock, hypersensitivity, sick sinus syndrome without a permanent pacemaker.
  44. Lorazepam (ativan)- class-Benzodiazepine, sedative, anticonvulsant.
    Dose- IV/IO must dilute with equal volume of sterile saline, IM do not dilute. (A) 2-4mg slow IV at 2mg/min or IM; may repeat dose in 15-20mins to a max of 8mg, for sedation 0.05mg/kg up to 4mg IM. (P) 0.05-0.20 mg/kg slowly over 2 mins-Max of 0.2mg/kg. (I) initial control of status epilepticus or severe recurrent, seizures, anxiety, sedation. (CI) acute narrow angle glaucoma, coma, shock or suspected drug abuse. (MOA) anxiolytic, anticonvulsant supresses propagation or seizure activity produced by foci in cortex.
  45. Mannitol
    Dose- 10.5-2.0g/kg IV over 30-60 mins. (I) reduction of intracranial pressure in treatment of cerebral edema. (CI)- hypersensitivity, anuria, severe pulmonary edema or heart failure, severe dehydration, active intracranial bleeding except during cranitomy. (MOA) osmotic diuretic.
  46. Meperidine (demerol) class- opioid analgesic
    Dose- (A) 50-100mg IM, SC or 25-50 mg slowly IV, (P) 1-2mg/kg dose IV, IO,IM,SC. (I) analgesia for moderate tos evere pain. (CI) hypersensitive to narcotic agents, diarrhea, patients taking MAOIs, during labor or delivery of premature infant, undiagnosed abdominal pain or head injury. (MOA) synthetic opioid agonist that acts on opioid receptors to produce analgesia, euphoria, respirtory and physical depression. schedule 2 drug with potential for physical dependence
  47. Metaproterenol 5% (alupent)-Class-Sympathomimetic bronchodilator
    Dose- 2-3 inhalations every 3-4 hours. 2 mins between inhalations. 5% solution via nebulizer 0.2-0.3 ml diluted in 2.5 ml saline. (I) bronchial asthma, reversable broncho spasm secondary to bronchitis, COPD. (CI) tachyarrhythmias, hypersensitivity, tachycardias due to digitalis toxicity. (MOA) beta 2 agonist acts directly on bronchilal smooth muscle causing relaxation of the bronchial tree.
  48. methylprenisolone sodium succinate (solu-medrol) class anti inflammatory glucocorticoid.
    Dose- (A) acute spinal cord injury; 30mg/kg iv over 30 mins folowed by infusion, 5.4 mg/kh/hr. asthma/copd 125mg slow iv push 1-2 mg/kg IV. (P) same. (I) acute spinal cord trauma, anaphylaxis bronchodilator for unresponsive asthma. (CI) premature infants, systemic fungal infections, use caution in pt. with Gi bleeds, sepsis, local infection. (MOA) synthetic corticosteroid that suppresses acute and chronic inflammation; potentiates vascular smooth muscle relaxation by beta adrenergic agonist.
  49. Metoprolol (lopressor) class beta adrenergic receptor blocking agent.
    dose (A) 5mg slow IV bolus may repeat every 2 mins up to a max of 15mg. (P) not rec. (I) suspected ACS provided heart is greater then 80 bpm and systolic BP is great then 120 mm hg. pt. may be taking the tablet form for hypertension or angina. (CI) in context of MI a HR less then 45 is contraindicated, 2nd and 3rd degree HB, significant 1st degree (p-R interval greater then 0.24 sec, BP less then 100 of moderate to sever cardiac failure. (MOA) exerts mostly beta 1 adrenergic blocking activity
  50. Nalbuphrine (nubaine)-class opioid analgesic
    Dose (A) 2-5 mg slow IV may repeat 2mg doses as necessary to max of 10mg. (P) not recc. (I) chest pain associated with acute MI, severe acute pain; pulmonary edema with or without associated Cx pain. (morphine remains first line) (CI) head injury or undiagnosed abdominal pain, diarrhea caused by poisoning, hypovolemia, hypotension. (MOA) activates opiate receptors in the limbic system of CNS, analgesic similar to morphine, may be prefered for chest pain in the setting of MI as it reduces the myocardial oxygen demand without reducing the blood pressure.
  51. Nifedipine (procardia)- class calcium channel blocker
    Dose- (A) 10mg SL, (I) hypertensive crisis, angina pectoris, pulmonary edema. (CI) compensatory hypertension, hypotension, hypersensitivity. (MOA)inhibits movement of calcium ions across cell membranes, arterial and venous vasodilator, reduces preload and afterload; prevents cornary artery spasm and decreases total peripheral resistance reduces myocardial O2 demand; does not prolong av nodal conduction.
  52. Norepinephrine Class-sympathomimetic
    Dose- (A) dilute 8mg in 500ml of D5w or 4mg in 250 D5W (16mg/ml) infuse by IV piggyback at 0.5-1.0 mcg/min, titrate to effect up to 30 mcg/min. (P)- 0.1-1.0 mcg/min IV infusion titrate toe ffect. (I) cardiogenic shock, significant hypotensive (less then 70mm hg). (CI) hypotensive patients with hypovolemia. prenancy- (MOA) potent alpha-agonist resulting in intense vasoconstriction, positive, chronotropic and increased inotropic.
  53. Oxytocin (pitocin)- class hormone
    Dose- IM administration 3-10 units after delivery of placenta, IV adminstration; mix 10-40 units in 1000ml of nonhydrating diluent infused at 20-40 miliunits/min titrated to severity of bleeding. (I) postpartum hemorrhage after infant and placental delivery. (CI) presence of second baby, unfavorable fetal position, hypersensitivity. (MOA) increases uterine contractions.
  54. phenobarbital (luminal) class barbiturate, anticonvulsant.
    Dose- (A) 100-250mg slow IV or IM; may repeat as needed in 20-30 mins. (P) 10-20mg/kg IV/IO less than 1mg kg/min or IM. (I) prevention and treatment of seizure activity; prophylaxis of febrile seizures. anxiety, apprehension; status epilepticus. (CI) patients with porphyria, hypersensitivity, severe liver or respiratory diseases. (MOA) generally unknown but believed to reduce neuronal excitability by increasing the motor cortex threshold to electrical stimulation.
  55. phenytoin (dilantin) Class Anticonvulsant
    Dose- (A) seizures- 10-20mg/kg slow IV, not to exceed 1g or rate of 50mg/min, arrhythmias-50-100mg diluted slow IV every 5-15mins max of 1g. (P) seizures- 10-20mg/kg slow IV 1-3mg/min. arrhythmias 5mg/kg slow IV max of 1g. (I) prophylaxis and treatment of major motor seizures digitalis-induced arrhythmias. (CI) hypersensitivty, bradycardia, second and third degree heart blocks. (MOA) promotes sodium efflux from nerons thereby stablizing the neurons threshold against excitability caused by excess stimulation in similar fasion, decreases abnormal ventricular automaticity and decreases the refractory period in teh myocardial conduction system
  56. Procainamide (pronesty) class-antiarrhythmic
    Dose- (A) recurrent V-fib/Pulesless V-Tach, 20mg/min IV infusion (max dose of 17mg/kg maintenance infusion at 1-4mg/min (dilute in D5W or normal saline) (P) loading dose of 15mg/kg IV or IO over 30-60 min (I) stable monomorphic V-tach with normal QT interval, reentry SVT uncontrolled by vagal maneuvers and adenosine, A-Fib with rapid ventricular rate in patients with WPW. (CI) torsade de pointes, second and third degree AV block, digitalis toxicity, tricylic antidepressent overdose. (MOA) supresses phase 4 depolarization in normal ventricular muscle and purkinje fibers, reducing ectopic pacemaker automaticity, supresses intraventricular conduction.
  57. Promethazine (phenergan) class- Antihistamine
    • Dose- (A) 12.5-25mg IV, Deep IM, PO, Rectally. (P) greater than 2 y/o 0.25- 0.5mg/kg dose IM. (I) nausea, vomitting, motion sickness, sedation for patients in labor, potentiation of analgesic effects of narcotics. (CI)- Intestinal or bladder obstruction, Seizure disorder, Coma, CNS depression, Newborns, premature neonates, breastfeeding
    • women(MOA)-antiemitic-
    • Antagonizes central and peripheral H1 receptors (nonselective
    • antihistamine).
  58. Racemic Epinephrine
    Dose- 0.25-0.5ml (8-15 gtt) of 22.25% racemic ephinephrine diluted in 3ml NS nebulized. (I) croup, acute bronchospasm, postintubation, bronchiolittis, epiglottitis . (MOA) alpha, beta 1 and beta 2 receptor agonist
  59. Rocuronium (Zemuron)-paralytic.
    • (Dose) 0.1mg/kg IV push for RSI. Maintenance Dose 1mg/kg every 12-15 mins. (I) to facilitate intubation in RSI. (CI) any patient not needing intubation.
    • Use caution in patients with impaired hepatic or respiratory function or severe obesity
    • ∙ Arrhythmia, tachycardia, N/V, bronchospasm, hypotension, HTN, rash, or edema. (MOA)- Non-depolorizing neuromuscular blocking agent.
  60. Succinylcholine (anectine)- class-depolarizing neuromuscular blocker, paralytic
    Dose (A) 1-2mg/kg rapid IV; repeat once if needed. Max of 150mg (P) 1-1.5 mg/kg rapid IV, IO repeat once if needed. (I) to facilitate intubation, to terminate laryngospasm, to promote muscle relaxation, to facilitate electro cardio-version shock therapy. (CI) acute narrow angle glaucoma, penetrating eye injuries, recent burns up to a week old, dialysis pt. para/ quadraplegic inability to control airway or support ventilation with oxygen and positive pressure. (MOA) bind to the receptors for acetycholine.
  61. Thiamine-Class-Vitamin B1
    Dose- (A) 100mg slow IV/IM. (P) 10-25mg slow IV/IM. (I) coma of unknown origin, delirium remens, wernickes encephalopathy, (CI) none. (MOA) combines with ATP to form thiamine pyrophosphate coenzyme, a necessary component for carbohydrate metabolism the brain is extremely sensitive to thiamine deficiency
  62. Vecuronium (norcuron)- class-paralytic agent
    • 0.01mg/kg IV push, maintenance dose within 25-40mins. 0.01-0.05mg/kg IV push. (P) Same. (I) to facilitate intubation, to terminate laryngospasm, to promote muscle relaxation. (CI) acute narrow angle glaucoma, penetrating eye injuries, inability to control airway or support ventilation with O2, myasthenia gravics, hepatic or renal failure. (MOA)-
    • Vecuronium competes with acetylcholine at cholinergic receptor sites. Its
    • maximal neuromuscular blockade occurs in five minutes
  63. Verapamil (isoptin) class- Antiarrhythmic
    Dose- (A) 2.5-5.0 mg IV bolus over 2 mins over 3 mins for geriatrics repeat dose at 5-10mg may be given every 15-30 mins to a max of 20mg. (P) 0.1-0.2 mg/kg/dose IV/IO push over 2 mins not to be used in infants less then 12 months. (I) PSVT, PAT, A-Fib, A-flut with rapid Ventricular response. (CI) WPW, 2nd/3rd degree AV block, Sick Sinus syndrome unless functioning pacemaker is present, hypotension, cardiogenic shock, severe CHF, Pulmonary edema, patients IV beta blockers, Wide-complex Tachycardias. (MOA) calcium channel blocker, prolongs AV nodal refact period, dilates coronary arteries and arterioles.
  64. Zofran
    • Dose- 2-4mg IV/IM immediatly before anesthesia. (I) antiemetic. (CI) co-adminstration with a po morphine; combination reported to cause profound hypotension.
    • Headache, malaise, fatigue, dizziness, fever, sedation, Extrapyramidal symptoms have Benadryl available, Pregnancy risk category B