P meds for final.txt

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Plewis831
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280912
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P meds for final.txt
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2014-08-19 20:07:18
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Paramedic meds final
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P meds for final
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    • Adenosine Class
    • Antidysrhythmic
  1. Adenosine action
    Slows conduction through AV node. Inhibits re-entry pathways through SA and AV node
  2. Adenosine indication
    SVT, PSVT
  3. Adenosine dose/route
    6 mg RIVP followed by 10 ml NS flush. MR 12 mg RIVP followed by 10 ml NS flush q 2 min and no change
  4. Adenosine peds dose
    1st dose: 0.1mg/kg RIVP to max 6mg followed by 10 ml NS flush MR 2nd dose at 0.2mg/kg RIVP to max 12mg followed by 10ml NS flush
  5. Adenosine onset
    20-30 second, half life 10 sec
  6. Adenosine contra (3)
    Atrial fib/flutter, v-tach, 2nd & 3rd degree AV block
  7. Adenosine adverse (CNS: 5, CV: 5)
    • CNS: blurred vision, burning sensation, dizziness, neck pain, tingling in arms
    • CV: CP, facial flushing, hypotension, transient bradycardia/asystole, arrhythmias
  8. Adenosine precautions (5)
    • -Use large proximal vein to establish IV
    • -Monitor EKG, heart rate and blood pressure q 15-30 sec for several minutes post administration
    • -Use supplemental O2
    • -The solution must be clear at time of use, discard if discolored
    • -may cause bronchoconstriction in PTs with asthma
  9. Adenosine supplied
    • 6mg/2ml vial or preload
    • 12mg/4ml preload
  10. Albuterol class
    Bronchodilator (beta 2 adrenergic)
  11. Albuterol action
    Bronchial smooth muscle dilation by stimulation of beta 2 receptors
  12. Albuterol indication
    • -Bronchospasms of any etiology
    • -asthma
    • -COPD
    • -Pulmonary edema
  13. Albuterol dose/route
    5.0 mg via nebulizer
  14. Albuterol peds dose
    1.25mg in 3ml NS (<6 YO)
  15. Albuterol contra (2)
    Allergies to Albuterol, hypertension
  16. Albuterol adverse (CNS: 3, CV: 3, GI: 1)
    • CNS: tremor, insomnia, h/a
    • CV: tachycardia, HTN, palpitations
    • GI: n/v
  17. Albuterol precautions (7)
    • -Monitor VS & EKG
    • -Use supplemental O2 in addition to HHN
    • -Monitor for toxicity if used with other sympathomimetics
    • -Beta-blockers may act antagonistically
    • -TCAs and MAO inhibitors increase CV effects
    • -Produces less cardiac stimulation than other sympathomimetics, but should still be used with caution
    • -Check lung sounds pre and post administration
  18. Albuterol supplied
    2.5 mg in 3cc NS
  19. Dextrose 50% class
    Hyperglycemic agent
  20. Dextrose 50% action
    Rapidly raises blood glucose levels
  21. Dextrose 50% indication
    • -Unconscious diabetic pt
    • -Coma of unknown etiology
    • -Seizures w/ suspected hypoglycemia
    • -<60 blood glucose level (SCCO protocol)
  22. Dextrose 50% dose/route
    25gm (50ml) IVP, MR x1
  23. Dextrose 50% peds dose
    • -1ml/kg of D50 given IV, IO, 2yr and older
    • -1mg/kg of D50, dilute w/ equal amount of NS to create D25, <2yr
  24. Dextrose 50% onset
    Less than 1 minute
  25. Dextrose 50% contra
    None in emergency setting
  26. Dextrose 50% precautions (6)
    • -Record BG level pre and post administration
    • -Use large bore catheter to establish IV
    • -Aspirate occasionally during administration
    • -Infiltration may cause local tissue necrosis
    • -May precipitate psychosis in alcoholics with thiamine deficiency
    • -Use cautiously if suspected CVA or intracranial hemorrhage
  27. Dextrose 50% supplied
    25gm/50ml preload
  28. Dopamine class
    Sympathomimetic
  29. Dopamine action
    • -Stimulates dopaminergic, alpha & beta receptors of sympathetic NS
    • -Low dose stimulates dopaminergic receptors (=renal and mesenteric)
    • -Mid dose stimulates beta receptors (=+inotrope effects)
    • -High dose stimulates alpha receptors (=peripheral renal & mesenteric vasoconstriction)
  30. Dopamine indication
    DOC for cardiogenic shock, bradycardia w/ hypotension, other shock states after fluid resuscitation
  31. Dopamine dose/route
    • 5-20 mcg/kg/min IV infusion, dosage ranges:
    • -5-10 mcg/kg/min dosage=beta stimulation
    • -over 10 mcg/kg/min dosage= alpha stimulation
  32. Dopamine peds dose
    2-15 mcg/kg/min IV infusion
  33. Dopamine contra (2)
    Hypovolemic shock, tachydysrhythmias
  34. Dopamine adverse (CNS: 1, CV: 4, GI: 1)
    • CNS: h/a
    • CV: ventricular irritability, dysrhythmias, HTN (high dose), hypotension
    • GI: n/v
  35. Dopamine precautions (5)
    • -Monitor VS & EKG continuously!
    • -Use supplemental O2
    • -If unwanted rise in diastolic pressure is seen, STOP infusion
    • -Tissue necrosis occurs on extravasion
    • -incompatible w bicarb
  36. Dopamine supplied
    400mg in 250ml D5W (1600mcg/ml) premix bag
  37. Lidocaine class
    Antiarrhythmic
  38. Lidocaine action
    • -Increases fibrillatory threshold
    • -Decreases ventricular irritability
    • -Supresses ventricular ectopy
  39. Lidocaine indication
    V-fib, V-tach, malignant PVCs
  40. Lidocaine dose/route
    • -Ventricular ectopy: 1mg/kg SLOW IVP/IO, MR 0.5mg/kg q 5-10 min to max 3mg/kg
    • -V-tach: 1mg/kg SLOW IVP/IO, MR 0.5mg/kg q 5-10 min to max 3mg/kg
    • -V-fib: 1-1.5mg/kg SLOW IVP/IO, MR 1-1.5mg/kg q 5-10 min to max 3mg/kg
    • -IV infusion: 2gm in 250cc D5W run @ 2-4mg/min
    • 2mg/min=15 gtts, 4mg/min= 30 gtts
  41. Lidocaine peds dose
    1mg/kg SLOW IV/IO
  42. Lidocaine onset
    2 min IV & duration=10-20 min
  43. Lidocaine contra (4)
    PVCs w/ bradycardia, 2nd or 3rd degree AV block, Idioventricular rhythm, allergy to amide type local anesthetics
  44. Lidocaine S/S toxicity (early: 7, late: 6)
    • -Early S/S: restlessness, anxiety, disorientation, combativeness, twitching, numbness, euphoria
    • -Late S/S: convulsions, coma, hypotension, widening QRS complex, prolonged PRI, cardiac arrest
  45. Lidocaine precautions (4)
    • -Monitor VS & EKG, ectopy, CNS toxicity
    • -Use supplemental O2
    • -STOP infusion @ first sign of toxicity
    • -Use cautiously and 1/2 dose if pt is >65 YO or has Hx or CHF or liver disease
  46. Lidocaine supplied
    100mg/ml preload, 100mg/5ml preload, 2gm/250cc premix
  47. Versed (Midazolam) class
    Benzodiazepine (short acting)
  48. Versed (Midazolam) action
    • -Anticonvulsant/CNS depressant
    • -Sedative (w/ amnesic effect)
    • -Skeletal muscle relaxant
  49. Versed (Midazolam) indication
    • -Seizures
    • -Adjunct to intubation
    • -Sedation prior to Cardioversion
    • -Chemical restraint
  50. Versed (Midazolam) dose/route
    • IV=0.1mg/kg SLOW IVP (max 5mg)
    • IM= 0.2mg/kg IM (max 10mg)
  51. Versed (Midazolam) peds dose
    0.1mg/kg IM (max 3mg)
  52. Versed (Midazolam) onset
    IV = 3-5 min, IM= 5-15
  53. Versed (Midazolam) contra (8)
    • -Hypersensitivity to versed
    • -Hypovolemia, hypotension, shock, coma
    • -Acute narrow angle glaucoma
    • -Depressed vital signs
    • -Pregnancy
  54. Versed (Midazolam) adverse (CNS: 4, CV: 1, RESP: 2)
    • CNS: sedation, ataxia, coma, drowsiness
    • CV: Hypotension
    • RESP: Respiratory depression, apnea
  55. Versed (Midazolam) precautions (5)
    • -Keep airway equipment ready (airway management)
    • -Monitor VS & assess respirations continuously
    • -IM injection= give in large muscle mass (no deltoid)
    • -Possible respiratory depression w rapid IV push
    • -Potentiates effects of ETOH & CNS depressants
  56. Narcan class
    Narcotic antagonist
  57. Narcan action
    Displaces narcotics from opiate receptor sights
  58. Narcan indication
    • -Overdose of narcotics or their derivatives: Heroin, Morphine, Methadone, Paregoric, Codeine, Oxycodone, Demerol, Darvon, Fentanyl, Dilaudid, Talwin, Lomotil
    • -Coma of unknown etiology
  59. Narcan dose/route
    2mg IVP, use IN, IM, SL, if IV cannot be started (titrate for respiratory effect) MR q 3-5 min
  60. Narcan peds dose
    0.1mg/kg IVP, IO, IM, IN; MR q 3-5 min 0-5 YO or <20kg
  61. Narcan onset
    1-2 min IV, IO, IN; slightly longer IM
  62. Narcan contra (1)
    Hypersensitivity to Narcan
  63. Narcan adverse (6)
    Withdrawal S/S with rapid reversal; N/V, tachycardia, tachypnea, combative behavior, MI, return of chronic pain
  64. Narcan precautions (4)
    • -Rapid reversal of narcotic OD may cause withdrawal S/S, titrate for adequate respirations
    • -Monitor EKG & VS
    • -High potential for rapid relapse if duration of narcotic exceeds Narcan (monitor for re-administration)
    • -Use w caution in newborns w suspected drug hx exposure
  65. Narcan supplied
    2mg/ml preload or ampule
  66. Zofran class
    Antiemetic (Serotonin 5-HT3 receptor antagonist)
  67. Zofran action (2)
    • -Reduces vagus nerve activity, diminishing activation of the vomiting center in the medulla oblongata
    • -Blocks serotonin receptors in the chemoreceptor trigger zone
  68. Zofran indication
    • -Severe nausea
    • -Intractable vomiting
  69. Zofran dose/route
    4mg slow IVP/IO (over 30 seconds), IM, ODT
  70. Zofran peds dose
    4mg slow IVP/IO (over 30 seconds), IM, ODT (over 4 years of age)
  71. Zofran onset
    3-5 minutes IM/IVP
  72. Zofran contra (2)
    • -Patients under 4 years of age
    • -Known sensitivity to ondansetron or other 5-HT3 antagonists: Granisetron, Dolasetron, Palonosetron
  73. Zofran adverse (3)
    • -Hypotension
    • -Tachycardia
    • -Rapid IV push may cause syncope
  74. Zofran precautions (3)
    • -Unlikely to have a response on patients with nausea D/T ETOH abuse
    • -Consider other treatable causes
    • -Typically does not cause sedation
  75. Zofran supplied
    • -2mg/ml in 2ml vial (4mg total)
    • -4mg sublingual wafer

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