Medic Drugs

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Medic Drugs
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2014-01-16 23:03:06
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Medic Drugs
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  1. Sympathetic Agonist
    Chemical that causes increased heart rate.
  2. Define parasympathetic antagonist and anticholinergic
    Parasympathetic breaks for heart rate, antagonist is a blocker, takes off break.
  3. Benzodiazepine
    Drugs primarily used for treating anxiety, but can also treat seizures, and insomnia.

    General anesthesia,sedation prior to surgery or diagnostic procedures, muscle relaxation, alcohol withdrawal, nausea and vomiting, depression, and panic attacks.
  4. Chronotrope.
    Chemical that either accelerates (positive) or slows (negative) the rate of a body system, mainly the heart.
  5. Inotrope
    Chemical that either strengthen (positive) or weakens (negative) the rate of a body system, mainly the heart.
  6. Define beta 1 effects.
    Stimulating causes positive inotropic effects, while blocking causes negative inotropic effects.
  7. Define beta 2effects.
    Stimulation causesbronchodilation while blocking causes bronchoconstriction.
  8. Define alpha 1effects.
    Increases vascularsmooth muscle contraction producing increases in blood pressure.
  9. Vasopressin Action
    Vasoconstriction independent of sympathetic system
  10. Vasopressin Indication
    In cardiac arrest to support the effectiveness of CPR
  11. Vasopressin Contraindications
    None in cardiac arrest
  12. Vasopressin Dose
    for adults--- 40 units IVP in place of the first or second dose of epinephrine (not repeated)
  13. Vasopressin Side Effects
    none pertinent in cardiac arrest
  14. Vasopressin Delivery
    rapid IV push (IV or IO) (via ETT if no other alternative and at same dose but diluted in 5-10cc NS or sterile water)
  15. Vasopressin Typically Supplied
    multi-dose vial of 20 units in 1cc
  16. Vasopressin Other Uses
    use in cardiac arrest is per ACLS but “off-label”; typically used for control of diabetes insipidus; other off-label uses include as a vasopressor in vasodilatory shock
  17. Lidocaine Action
    slows cardiac conduction
  18. Lidocaine Indications
    in VF / Pulseless VT cardiac arrest to avoid “re-fib”
  19. Lidocaine Contraindications
    none in cardiac arrest
  20. Lidocaine Dose
    for adults---1 to 1.5mg/kg IVP repeated at half the initial dose every 5-10 minutes up to a maximum of 3mg/lg then followed by a drip after ROSC at 1-4 mg/min (pre-mixed drips at concentrations of 1g in 250cc or 2g in 250cc or equivalent)
  21. Lidocaine Side Effects
    none pertinent in cardiac arrest
  22. Lidocaine Delivery
    rapid IV push (IV or IO)
  23. Lidocaine Typically Supplied
    preloaded syringes of 100mg in 10cc
  24. Lidocaine Other Uses
    dysrhythmia control (studied separately)
  25. Epinephrine (Push Dose) Action
    Beta-1, Beta-2, Alpha 1 agonist (sympathetic agonist, sympathomimetic)
  26. Epinephrine (Push Dose) Indications
    in cardiac arrest to support the effectiveness of CPR
  27. Epinephrine (Push Dose) Contraindications
    none in cardiac arrest
  28. Epinephrine (Push Dose) Dose
    for adults--- 1mg IVP every 3-5 minutes every 4 minutes for our class)
  29. Epinephrine (Push Dose) Side Effects
    none pertinent in cardiac arrest
  30. Epinephrine (Push Dose) Delivery
    rapid IV push (IV or IO) (via ETT if no other alternative but at dose of 2mg)
  31. Epinephrine (Push Dose) Typically Supplied
    preloaded syringe with 1mg in 10cc
  32. Epinephrine (Push Dose) Other uses
    we will separately study epinephrine for IV drip infusion (for chronotropic support or as a vasopressor) and for IM / SQ (in anaphylaxis)
  33. Epinephrine Drip Action
    beta and alpha agonist
  34. Epinephrine Drip Indication
    Positive chronotrope for symptomatic bradycardia; positive inotrope and vasoconstrictor
  35. Epinephrine Drip Contraindication
    none pertinent
  36. Epinephrine Drip Caution
    higher doses increases likelihood of ventricular tachycardia or fibrillation
  37. Epinephrine Drip Dose
    2-10 mcg / minute (30gtts / min to start)
  38. Epinephrine Drip Side Effects
    increased myocardial oxygen demand
  39. Epinephrine Drip Delivery
    IV drip infusion (pump desirable)
  40. Epinephrine Drip Typically Supplied
    mixed on scene using 1mg in 250cc D5W or NS to yield 4mcg / cc
  41. Epinephrine Drip Notes
    More effects come from higher doses.
  42. Dopamine Action
    beta and alpha agonist depending on dose
  43. Dopamine Indications
    positive chronotrope for symptomatic bradycardia; positive inotrope
  44. Dopamine Contraindication
    none pertinent
  45. Dopamine Caution
    higher doses increases likelihood of ventricular tachycardia or fibrillation
  46. Dopamine Dose
    5-10 mcg / kg / minute for beta effects; higher doses yield maximum beta 1 effects plus increasing alpha 1 effects
  47. Dopamine Side Effects
    increased myocardial oxygen demand
  48. Dopamine Delivery
    IV drip infusion (pump desirable)
  49. Dopamine Typically Supplied
    pre-mixed 400mg in 250cc D5W or NS (some other concentrations)
  50. Dopamine Other
    vasopressor at higher doses
  51. Amiodarone (Push Dose-Cardiac Arrest) Action
    slows cardiac conduction via multiple mechanisms.
  52. Amiodarone (Push Dose-Cardiac Arrest) Indications
    in VF / Pulseless VT cardiac arrest to avoid “re-fib”
  53. Amiodarone (Push Dose-Cardiac Arrest) Contraindications
    none in cardiac arrest
  54. Amiodarone (Push Dose-Cardiac Arrest) Dose
    For adults---300mg IVP with one repeat dose at 150mg; when ROSC is attained, start infusion of 1mg/min
  55. Amiodarone (Push Dose-Cardiac Arrest) Mix Options
    • 150mg in 100cc at 40gtts / minute with a microdrip set
    • 150mg in 250cc at 100gtts/min with a microdrip set
    • Remove 25cc from 100cc bag of NS then add 150mg; infuse at 30gtts/min with microdrip set
  56. Amiodarone (Push Dose-Cardiac Arrest) Side Effects
    none pertinent in cardiac arrest
  57. Amiodarone (Push Dose-Cardiac Arrest) Delivery
    rapid IV push (IV or IO)
  58. Amiodarone (Push Dose-Cardiac Arrest) Typically Supplied
    vial of 150mg in 3cc
  59. Amiodarone (Push Dose-Cardiac Arrest) Other Uses
    dysrhythmia control (studied separately)
  60. Albuterol Action
    Beta-2 agonist
  61. Albuterol Indications
    Patient requires beta-2 stimulation to relieve the bronchospasm component of bronchiolar obstruction
  62. Albuterol Contraindications
    Ineffective when used with beta blockers; cautious use with marked tachycardia (highly unlikely) as there are beta-2 receptors in the cardiac muscle that may be stimulated by a beta-2 agonist and produce an increase in heart rate - this must be balanced against the relief of hypoxia-induced tachycardia.
  63. Albuterol Dose
    For adults, typically 2.5mg per HFN  although some protocols indicate that 5mg is the correct starting dose
  64. Albuterol Side Effects
    Mostly contained to tremors and agitation (20%) with a few reports of actual tachycardia or palpitations (5%)
  65. Albuterol Delivery
    Patients take prescription albuterol by either MDI or HFN under the trade name ProAir or Ventolin or Proventil; most perhospital services deliver albuterol via HFN.
  66. Albuterol Typically Supplied
    Preloaded vial with twist-off top for easy and rapid distribution into the HFN chamber; some services may carry a multi-dose vial with an eye dropper for mixing with small saline packets in the HFN.
  67. Albuterol Other Uses
    Albuterol forces potassium from the bloodstream into the cells and is therefore, an adjunct in treatment of hyperkalemia however this method is somewhat slow and dosing is quite high (4 x in most protocols) compared with usual albuterol for bronchospasm - some protocols suggest the intubated patient can get albuterol dumped into the ET tube directly rather than nebulized.
  68. Atropine Action
    Parasympathetic antagonist (aka anticholinergic) [parasympathetic breaks for heart rate, antagonist is a blocker, takes off break]. Increase heart rate
  69. Atropine Indications
    Patient requires positive chronotrope due to symptoms related to heart rate in the setting of increased vagal/parasympathetic tone such as sinus bradycardia or 1st degree AV Block or 2nd Degree Type 1 (Mobitz I or Wenkebach)
  70. Atropine Contraindications
    AV Blocks that are not related to increased parasympathetic tone such as 2nd Degree Type II and 3rd Degree and High-Grade AV Block; possible benefit in 2nd Degree with 2:1 conduction (particularly if wide QRS) because those are not clearly either a Type I or Type II. Remember, 2nd Degree Type II and higher grade blocks do not respond to Atropine because the block is not related to parasympathetic tone yet the heart rate may increases from the Atropine and make the block more of a problem.
  71. Atropine Dose
    For adults, typically 0.5mg IVP; use length-based chart for peds patients and beware that there is a minimum dose to avoid a paradoxical Bradycardia effect in peds.
  72. Atropine Delivery
    Slow IV Push over 30-60 seconds; repeat if needed every 3-5 minutes up to a maximum dose of 3.0mg
  73. Atropine  Typically Supplied
    Preloaded syringe of 1mg in 10cc so 0.1mg per cc (purple box) which gives a standard adult dose of 5cc
  74. Atropine Other Uses
    Reversal of cholinergic effects of some nerve gas agents and organophosphate poisoning (insect killers) but these use require very large amount of Atropine (well over 3mg)(SLUDGE Salivation Lacrimation (tears) Urination Defecation Gastrointestinal Emesis)
  75. Ipratropium Action
    Anticholinergic bronchodilator (vagus nerve uses acetylcholine as its neurotransmitter and thus it is called the cholinergic system).
  76. Ipratropium Indications
    Patient requires anticholinergic (parasympathetic antagonist) to relieve the bronchospasm component of bronchiolar obstruction.
  77. Ipratropium Contraindications
    Not a contraindication but ipratropium is not necessarily a fast-acting medication (also, there is NOT an issue with ipratropium via HFN for patients with a soy or peanut allergy -- that was the propellant in the older version of the MDI).
  78. Ipratropium Dose
    For adults, typically 2mg per HFN; frequently given as part of DuoNeb or Combivent (both are albuterol and ipratropium combined).
  79. Ipratropium Side Effects
    Dry mouth
  80. Ipratropium Delivery
    Patients take prescription albuterol be either MDI or HFN under the trade name Atrovent; most prehospital services deliver ipratropium via HFN.
  81. Ipratropium Typically Supplied
    Preloaded vial with twist-off top for easy and rapid distribution into the HFN chamber; some services may carry a multi-dose vial with an eye dropper for mixing with small saline packets in the HFN; again, commonly given prehospital as part of the albuterol-ipratropium combination (Combivent, DuoNeb).
  82. Calcium Chloride Action
    Calcium supplement.
  83. Calcium Chloride Indication
    hypocalcemia, hyperkalemia, hypermagnesemia, calcium channel blocker overdose, beta blockeroverdose
  84. Calcium Chloride Contraindication
    Known or suspected digitalis toxicity—-contact medical control.
  85. Calcium Chloride Dose
    500 to 2000 mg over 5-10 minutes.  Dosing varies by use and by specific service protocol.  Online medical control is ALWAYS a good idea when using this medication.
  86. Calcium Chloride Caution
    Avoid administration in uncertain or fragile veins (hand, foot) and watch closely for infiltration due to severe tissue damage possibility
  87. Calcium Chloride Side Effects
    Hypotension and bradycardia (particularly with rapid administration).
  88. Calcium Chloride Delivery
    IV very slow push.
  89. Calcium Chloride Typically Supplied
    100 mg / ml in a 10 cc preloaded syringe.
  90. Dextrose 50% Action
    Elevate blood glucose.
  91. Dextrose 50% Indication
    Hypoglycemia.
  92. Dextrose 50% Contraindications
    No absolute contraindications although USE CAUTION in cases with uncertain IV quality as D50 is tissue destructive if it infiltrates (if this happens, discontinue any infusion but leave the IV catheter in place for ED management of the extravasation).
  93. Dextrose 50% Dose
    25 grams slow IV over 2-3 minutes  (diluted to Dextrose 25% in infants and children in most cases—-consult Broselow or equivalent)
  94. Dextrose 50% Side Effects
    None (other than hyperglycemia)
  95. Dextrose 50% Delivery
    IV slow push
  96. Dextrose 50% Typically Supplied
    25 gram preloaded (50cc) syringe
  97. Dextrose 50% Other Uses
    When insulin is used to treat hyperkalemia, D50 is given to counteract the hypoglycemic effect of the insulin.
  98. Diazepam Action
    Benzodiazepine
  99. Diazepam Indications
    seizure control, sedation
  100. Diazepam Contraindications
    None in the field setting other than to be aware of the likely respiratory depression in higher doses.
  101. Diazepam Dose
    5 mg IV given over 1 minute; may repeat in 5 minutes or per protocol / online medical control
  102. Diazepam Side Effect
    Respiratory depression
  103. Diazepam Delivery
    IV slow push (5 mg per minute)
  104. Diazepam Typically Supplied
    5 mg / ml in a 2 cc carpule
  105. Diazepam Other Names
    Valium
  106. Flumazenil Action
    benzodiazepine antagonist
  107. Flumazenil Indications
    Reduction in benzodiazepine effects from field sedation
  108. Flumazenil Contraindications
    Seizure patients and patients with benzodiazepine dependence (precipitates withdrawal which can include seizures that could not be treated with benzodiazepines)
  109. Flumazenil Dose
    For reversal of benzodiazepines given for sedation:  0.2 mg IVP over 15-30  seconds;  repeat in 1 minute up to 3.0 mg total  (some protocols, like BHC, allow for increasing the dosage on the 2nd dose to 0.3mg and subsequent doses to 0.5mg).  ANY time this medication is given, online medical control contact is prudent.
  110. Flumazenil Side Effect
    May precipitate benzodiazepine withdrawal and cause seizures.
  111. Flumazenil Delivery
    IV slow push
  112. Flumazenil Typically Supplied
    0.5 mg in a 5ml  multi-dose vial.
  113. Flumazenil Other Names
    Romazicon
  114. Glucagon Action
    Elevate blood glucose.
  115. Glucagon Indications
    Hypoglycemia.
  116. Glucagon Contraindications
    Pheochromocytoma (adrenal tumor that secretes catecholamines such as adrenaline).
  117. Glucagon Dose
    1mg IM
  118. Glucagon Side Effect
    None for IM use.
  119. Glucagon Delivery
    IM
  120. Glucagon Typically Supplied
    2-part vial system for reconstituting or "emergency kit” containing a pre-filled syringe with sterile water.
  121. Glucagon Other Uses
    For calcium-channel blocker and beta blocker overdose to mediate the myocardial depression (negative inotropic effects) of the beta blockers because glucagon causes an increase in calcium availability for myocardial contraction and thereby increases contractility by a mechanism other than beta 1 stimulation (the doses for this treatment are much higher and most EMS services won’t carry enough glucagon for this therapy…..also, beware of vomiting with high doses of IV glucagon and pretreat with ondansetron).
  122. Lorazepam Action
    Benzodiazepine.
  123. Lorazepam Indications
    Seizure control, sedation.
  124. Lorazepam Contraindications
    None for the field use although caution in respiratory depression.
  125. Lorazepam Dose
    1-4 mg (varies by protocol and physician).
  126. Lorazepam Side Effect
    Respiratory depression.
  127. Lorazepam Delivery
    IV slow push 2 mg / minute (maximum rate).
  128. Lorazepam Typically Supplied
    2 mg / ml or 4 mg / ml carpules or multi-dose vials.
  129. Lorazepam Other Names
    Ativan
  130. Midazolam Action
    Benzodiazepine.
  131. Midazolam Indications
    Seizure control, sedation
  132. Midazolam Contraindications
    None for its intended use although caution with respiratory depression
  133. Midazolam Dose
    For IV dosing, use 2.5 mg given over 2 minutes repeated once after a 2-minute waiting period for a total of 5 mg—-however, online medical control contact is advisable when using this drug and orders may vary.
  134. Midazolam Side Effect
    Respiratory depression.
  135. Midazolam Delivery
    IV slow push (2.5 mg over 2 minutes)
  136. Midazolam Typically Supplied
    Both 1 mg / ml in a 2 cc multi-dose vial and 5 mg / ml in a 2 cc multi-dose vial are commonly found in the field setting.
  137. Midazolam Other Names
    Versed
  138. Naloxone Action
    Opiate antagonist.
  139. Naloxone Indications
    Reduction of effects of opiates / opioids such as heroin, morphine etc.
  140. Naloxone Contraindications
    Relatively few in the field setting.
  141. Naloxone Dose
    Titrated to improve respiratory effort (as opposed to full reversal of all effects) which usually is best achieved with small incremental doses such as 0.4 or 0.5 mg repeated as needed every 2-3 minutes  (be aware that some sources suggest 0.05 mg increments).
  142. Naloxone Side Effect
    None pertinent.
  143. Naloxone Delivery
    IV slow push.
  144. Naloxone Typically Supplied
    2 mg / 2 cc preload.
  145. Naloxone Other Names
    Narcan
  146. Oral Glucose Paste Action
    Elevate blood glucose.
  147. Oral Glucose Paste Indications
    Hypoglycemia in patients who can swallow and who can maintain their airway.
  148. Oral Glucose Paste Contraindications
    None.
  149. Oral Glucose Paste Dose
    1 tube with repeated doses as needed after 15-20 minutes.
  150. Oral Glucose Paste Side Effect
    None (other than hyperglycemia).
  151. Oral Glucose Paste Delivery
    Buccally (between cheek and gum)
  152. Oral Glucose Paste Typically Supplied
    30-112 gram tube (various flavors and various vendors)
  153. Thiamine Action
    Vitamin B1
  154. Thiamine Indications
    Correct thiamine deficiency (malnourished, chronic alcohol use) to prevent Korsakoff syndrome or to prevent / partially treat Wernicke’s encephalopathy
  155. Thiamine Contraindications
    None.
  156. Thiamine Dose
    100 mg IV (or IM)
  157. Thiamine Side Effect
    None.
  158. Thiamine Delivery
    IV slow push.
  159. Thiamine Typically Supplied
    100 mg / ml multi-dose vial.
  160. Labetalol Action
    Beta blocker and alpha blocker.
  161. Labetalol Indications
    Reduction in blood pressure via reduced chronotropy and inotropy and blockade of alpha receptor induced vasoconstriction.
  162. Labetalol Contraindications
    Asthma / COPD (bronchial constriction) and bradycardia / AV Block as well as hypertension from amphetamine ingestion.
  163. Labetalol Dose
    20 mg IV over 1-2 minutes in 5 mg increments.
  164. Labetalol Side Effect
    Bronchospasm, bradycardia.
  165. Labetalol Delivery
    IV slow push.
  166. Labetalol Typically Supplied
    5 mg / ml multi-dose vial.
  167. Labetalol Other Uses
    Could be an adjunct in tachycardia although other beta blockers are more cardioselective.
  168. Labetalol Other Names
    Normodyne, Trandate

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