Medication Guide Questions test 2

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Medication Guide Questions test 2
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Protocol Questions
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  1. 1. Place 150 mg Amiodarone in a 100cc bag of NS and mix well.
    • 2. Piggy back bag into IV line using a10 gtt (Macro) tubing.
    • 3. Run at 1.5 gtts per second. This will = approx. a 10 minute drip.
    • Classification (Charcoal)
    • Chemical absorbent
  2. Action (Charcoal)
    Inhibits gastrointestinal absorption of drugs or chemicals
  3. Indications (Charcoal)
    Suspected overdose or accidental ingestion of drugs or chemicals
  4. Contraindications (Charcoal)
    • Altered level of consciousness
    • No gag reflex
    • Ingestion of caustics, corrosives, or petroleum distillates
  5. Adverse effects (Charcoal)
    • Vomiting
    • Aspiration
  6. Adult dosage (Charcoal)
    50 gm PO
  7. Pediatric dosage (Charcoal)
    25 gm PO
  8. Onset (Charcoal)
    Immediate
  9. Pregnancy Safety (Charcoal)
    Not established
  10. Comments for (Charcoal)
    • Milk products ingested prior to activated charcoal can reduce its effectiveness.
    • Most effective if administered within 30 minutes of ingestion.
    • Do not administer orally to patients with altered LOC or potential for decrease in LOC.
  11. Classification Adenosine (Adenocard)
    Antidysrhythmic agent
  12. Action Adenosine (Adenocard)
    Slows conduction through the A-V node, can interrupt the re-entry pathways through the A-V node, and can restore normal sinus rhythm in patients with PSVT
  13. Indications Adenosine (Adenocard)
    Supra-ventricular tachycardia (stable) Monomorphic wide-complex tachycardia (stable)
  14. Contraindications Adenosine (Adenocard)
    • 2nd or 3rd degree heart block
    • Sick sinus syndrome
    • Hypersensitivity to adenosine
  15. Adverse effects Adenosine (Adenocard)
    • Facial flushing
    • Headache
    • Dizziness
    • Dyspnea
    • Nausea/vomiting
    • Chest pressure
    • Transient asystole
    • Bronchoconstriction in some asthma patients
  16. Adult dosage Adenosine (Adenocard)
    6 mg Rapid IVP followed with 20mL NS flush. Repeat 12 mg followed with 20 mL NS flush if needed. May repeat X1. (Total dose 30 mg)
  17. Pediatric dosage Adenosine (Adenocard)
    • 0.1 mg/kg rapid IVP followed with 10 mL NS flush
    • (Max. dose 6 mg).
    • MR in 3 minutes at 0.2 mg/kg followed with 10 mL NS flush (Max.
    • dose 12 mg.)
  18. Onset Adenosine (Adenocard)
    Immediate
  19. Pregnancy Safety Adenosine (Adenocard)
    Category C
  20. Comments for Adenosine (Adenocard)
    • 1/2 life is “10 seconds.”
    • A brief period of asystole (up to 15 seconds) following conversion, followed by resumption of NSR is common after rapid administration.
    • Draw up adenosine and saline flush in separate syringes to allow for a more rapid bolus.
    • Not indicated for patients with a known history of atrial fibrillation/atrial flutter.
  21. Classification Albuterol Sulfate (Proventil, Ventolin)
    Bronchodilator
  22. Action Albuterol Sulfate (Proventil, Ventolin)
    Relaxes bronchial smooth muscle by stimulating beta2 receptors resulting in bronchodilation
  23. Indications Albuterol Sulfate (Proventil, Ventolin)
    • Acute asthma
    • Allergic reaction
    • COPD/bronchitis
    • Bronchospasm
  24. Contraindications Albuterol Sulfate (Proventil, Ventolin)
    • Prior hypersensitivity reaction to Albuterol
    • Symptomatic tachycardia
    • Chest pressure
  25. Adverse effects Albuterol Sulfate (Proventil, Ventolin)
    • Tachycardia
    • Hypertension
    • Palpitations
    • Dizziness
    • Dysrhythmias
    • Restlessness
    • Nausea
  26. Adult dosage Albuterol Sulfate (Proventil, Ventolin)
    • Bronchospasm:
    • 2.5 mg/3 mL NS via nebulizer. If severe distress persists, initiate continuous Albuterol via nebulizer. May also be administered via facemask, BVM, or ETT
  27. Pediatric dosage Albuterol Sulfate (Proventil, Ventolin)
    • Bronchospasm:
    • 2.5 mg in 3 mL NS via nebulizer. If severe distress persists repeat at
    • 0.5 mg/kg hr to a maximum of 15 mg/hr.
  28. Onset Albuterol Sulfate (Proventil, Ventolin)
    Within 5 minutes
  29. Pregnancy Safety Albuterol Sulfate (Proventil, Ventolin)
    Category C
  30. Comments for Albuterol Sulfate (Proventil, Ventolin)
    • Use with caution in patients with:
    • Heart disease
    • Hypertension
    • Tachydysrhymias
    • Patients being treated with MAO inhibitors
    • Patients that are hypersensitive to sympathomimetics
  31. Classification Amiodarone (Cordarone, Pacerone)
    Antiarrhythmic agent
  32. Action Amiodarone (Cordarone, Pacerone)
    • Delays repolarization
    • Prolongs action potential
    • Slows conduction
    • Delays impulses from SA and AV nodes
    • Slows conduction through accessory pathways
    • Vasodilatation
  33. Indications Amiodarone (Cordarone, Pacerone)
    • Ventricular fibrillation
    • Wide-complex tachycardia
  34. Contraindications Amiodarone (Cordarone, Pacerone)
    • Cardiogenic shock
    • Bradycardia/Heartblocks
    • Iodine allergies
  35. Adverse effects Amiodarone (Cordarone, Pacerone)
    • Hypotension
    • Bradycardia
    • AV block
    • Asystole
    • PEA
    • Hepatoxicity
  36. Adult dosage VF/VT Pulseless Amiodarone (Cordarone, Pacerone)
    • VF/VT (pulseless):
    • 300 mg slow IV/IO push (over 1-2 Min.)
    • followed in 5 minutes by 150 mg IV/IO push
  37. Adult dosage VT Pulses Amiodarone (Cordarone, Pacerone)
    • VT (with pulses):
    • IV /IO – Slowly infuse 150 mg over 10 min.
    • Max dose 450mg
  38. Adult dosage PVC’s Amiodarone (Cordarone, Pacerone)
    • Premature Ventricular Contractions:
    • 150 mg over 10 min, repeat in 5 with 150 mg over 10 min max 450 mg
  39. Pediatric dosage VF/VT (pulseless) Amiodarone (Cordarone, Pacerone)
    • VF/VT (pulseless):
    • 5 mg/kg slow IV/IO push (over 1-2 Min.)
    • followed by 5 mg/kg slow IV/IO q 5 Min. to Max. of 15 mg/kg
  40. Pediatric dosage VT (pulses) Amiodarone (Cordarone, Pacerone)
    • VT (with pulses):
    • 5 mg/kg over 20-60 minutes
    • Max dose 300mg
  41. Pediatric dosage PVC’s Amiodarone (Cordarone, Pacerone)
    • Premature Ventricular Contractions:
    • 5 mg/kg slow IV over 10 min, may repeat with 5 mg/kg over 10 min to a max dose of 15 mg/kg
  42. Onset Amiodarone (Cordarone, Pacerone)
    2-3 minutes
  43. Pregnancy Safety Amiodarone (Cordarone, Pacerone)
    Category D
  44. Comments for Amiodarone (Cordarone, Pacerone)
    In patients with a pulse Amiodarone must be administered very slowly (Adults: Over 10 minutes / Pediatrics: Over 30 minutes) Contact base for ROSC patients
  45. To set up a drip for Amiodarone (Cordarone, Pacerone)
    • 1. Place 150 mg Amiodarone in a 100cc bag of NS and mix well.
    • 2. Piggy back bag into IV line using a10 gtt (Macro) tubing.
    • 3. Run at 1.5 gtts per second. This will = approx. a 10 minute drip.
  46. Classification Aspirin (ASA, Acetylsalicylic Acid)
    • Antiplatelet
    • Analgesic
    • Antipyretic
    • Anti- inflammatory
  47. Action Aspirin (ASA, Acetylsalicylic Acid)
    • Inhibition of platelet aggregation and platelet synthesis
    • Reduction of risk of death in patients with a history of myocardial infarction or unstable angina
  48. Indications Aspirin (ASA, Acetylsalicylic Acid)
    Chest pain with suspected myocardial ischemia
  49. Contraindications Aspirin (ASA, Acetylsalicylic Acid)
    • Allergy to ASA
    • Peptic ulcer disease
    • Hypersensitivity to salicylates
  50. Adverse effects Aspirin (ASA, Acetylsalicylic Acid)
    • Nausea-GI upset
    • Hepatotoxicity
    • Occult blood loss
    • Anaphylaxis
  51. Adult dosage Aspirin (ASA, Acetylsalicylic Acid)
    325 mg PO
  52. Pediatric dosage Aspirin (ASA, Acetylsalicylic Acid)
    Not recommended for prehospital use
  53. Onset Aspirin (ASA, Acetylsalicylic Acid)
    30-60 minutes
  54. Pregnancy Safety Aspirin (ASA, Acetylsalicylic Acid)
    Pregnancy safety: Consult M.D., not recommended in third trimester
  55. Comments for Aspirin (ASA, Acetylsalicylic Acid)
    Salicylism signs and symptoms: dizziness, tinnitus, difficulty hearing, nausea, vomiting, and mental confusion.
  56. Classification Atropine Sulfate
    Parasympathetic blocker (Anticholinergic), Antidysrhythmic agent
  57. Action Atropine Sulfate
    • Inhibits parasympathetic stimulation by blocking acetylcholine receptors
    • Decreases vagal tone resulting in increased heart rate and AV conduction
    • Dilates bronchioles and decreases respiratory tract secretions
    • Decreases gastrointestinal secretions and motility
  58. Indications Atropine Sulfate
    • Symptomatic bradycardia
    • Organophosphate poisoning
  59. Contraindications Atropine Sulfate
    Neonates (bradycardia and asystole/PEA in neonates is usually caused by hypoventilation; also the vagus nerve in neonates is underdeveloped and atropine will usually have no effect upon it.
  60. Adverse effects Atropine Sulfate
    • Tachycardia
    • Increased myocardial 02 demand
    • Headache
    • Dizziness
    • Palpitations
    • Dries mucous membranes
    • Nausea/vomiting
    • Flushed skins
    • Dilated pupils
    • Increased intraocular pressure
  61. Precautions Atropine Sulfate
    • Use with caution in patients with suspected acute myocardial infarction (AMI) and glaucoma patients
    • Will not be effective for Type II AV Block and new Third Degree Block with wide QRS complexes (In these patients may cause paradoxical slowing. Be prepared to pace)
  62. Adult dosage Bradycardia Atropine Sulfate
    IVP/IO 0.5mg- q 3-5 min to Max. of 3 mg
  63. Adult dosage Organophosphate poisoning Atropine Sulfate
    administer 2 mg. May be repeated every 5 minutes until symptoms clear.
  64. Pediatric dosage Bradycardia Atropine Sulfate
    IVP/IO: 0.02 mg/kg. Minimum dose of 0.1 mg. This dose may be repeated after 5 minutes for a Max. total dose of 1.0 mg for a child and 2.0 mg for an adolescent
  65. Pediatric dosage Organophosphate poisoning Atropine Sulfate
    Administer per Poison Control guidelines
  66. Onset Atropine Sulfate
    2 – 5 minutes
  67. Pregnancy Safety Atropine Sulfate
    Category C
  68. Comments for Atropine Sulfate
    • Bradycardia in pediatrics is usually due to hypoxia.
    • Antihistamines, phenothiazines, and tricyclic antidepressants enhance the effects of atropine.
    • Atropine is not recommended in asymptomatic bradycardia.
    • The increase in myocardial O2 demand may cause/extend an AMI.
    • Atropine is not recommended in neonates.
    • Neonatal bradycardia often resolves itself quickly without corrective treatment.
  69. Classification Atrovent
    Parasympathetic blocker (Anticholinergic), Bronchodilator
  70. Action Atrovent
    • Inhibits parasympathetic stimulation by blocking acetylcholine receptors
    • Anticholinergics prevent the increase of cyclic guanosine monophosphate which is caused by interaction of acytecholine with the muscarinic receptor on bronchial smooth muscle
    • Dilates bronchioles and decreases respiratory tract secretions
  71. Indications Atrovent
    • Asthma
    • COPD
    • Allergic reaction
    • Bronchospasm
  72. Contraindications Atrovent
    Patients with a history of hypersensitivity to peanuts, soy products, or atropine.
  73. Adverse effects Atrovent
    • Tachycardia
    • Blurred vision
    • Headache
    • Dizziness
    • Back or Chest Pain
    • Constipation
    • Urinary Retention
    • Nausea/vomiting
    • Cough
    • Increased intraocular pressure
    • Insomnia
    • Nervousness/Tremors
    • Hypertension
    • Flu-like Symptoms
  74. Adult dosage Atrovent
    500 mcg premixed with 2.5 mg albuterol (3 mL total solution) via nebulizer. Single dose only.
  75. Pediatric dosage Atrovent
    500 mcg premixed with 2.5 mg albuterol (3 mL total solution) via nebulizer. Single dose only.
  76. Onset Atrovent
    15– 30 minutes
  77. Pregnancy Safety Atrovent
    Category B
  78. Comments for Atrovent
    • Atrovent is given as a single dose only.
    • Temporary blurring of vision or eye pain may result if the solution comes into direct contact with the eyes. Use of a nebulizer with a mouthpiece rather than a face mask may be preferable.
    • Drug should be protected from light
    • Once mixed with albuterol, the mixture should be used within one (1) hour.
  79. Classification Calcium Chloride
    Inotropic Agent (electrolyte)
  80. Action Calcium Chloride
    • Couples electrical and mechanical events of the myocardium
    • Increases myocardial contractility
    • Increases ventricular irritability
  81. Indications Calcium Chloride
    • Hyperkalemia
    • Overdose of calcium channel blockers
  82. Contraindications Calcium Chloride
    Patients taking digitalis based medications
  83. Adverse effects Calcium Chloride
    • Bradycardia
    • Hypotension
    • Syncope
  84. Adult dosage Calcium Chloride
    • 1 gram IV/IO push over 2 min
    • (Flush line with NS before and after administration)
  85. Pediatric dosage Calcium Chloride
    Administer 20 mg/kg slow IV push over 2 min. May repeat once
  86. Onset Calcium Chloride
    5 – 15 minutes
  87. Pregnancy Safety Calcium Chloride
    Category C
  88. Comments for Calcium Chloride
    • Hyperkalemia may be caused by potassium retention in dialysis patients or overdose of potassium supplements.
    • Causes tissue necrosis if injected into interstitial space. Flush the IV line if sodium bicarbonate is used.
  89. Classification Dextrose 50% in water D50W, Glucose
    Hyperglycemic agent, hypertonic solution
  90. Action Dextrose 50% in water D50W, Glucose
    • Provides immediate source of glucose which is rapidly utilized for
    • cellular metabolism
  91. Indications Dextrose 50% in water D50W, Glucose
    Altered level of consciousness due to suspected hypoglycemia
  92. Contraindications Dextrose 50% in water D50W, Glucose
    Hyperglycemia
  93. Adverse effects Dextrose 50% in water D50W, Glucose
    • CVA
    • Intra-cranial hemorrhage
    • Thrombophlebitis
    • Rhabdomyolsis
    • May worsen Wernicke’s encephalopathy
  94. Adult dosage Dextrose 50% in water D50W, Glucose
    12-25 gm IVP
  95. Pediatric dosage Dextrose 50% in water D50W, Glucose
    0.5 grams/kg IV push
  96. Onset Dextrose 50% in water D50W, Glucose
    30 - 60 seconds
  97. Pregnancy Safety Dextrose 50% in water D50W, Glucose
    Category A
  98. Comments for Dextrose 50% in water D50W, Glucose
    • Causes tissue necrosis if injected into interstitial space.
    • Dilute 50:50 with sterile water to make a 25% solution. Dilute
    • 5:1 with sterile water to make a 10% solution.
    • Use caution in patients with suspected intracranial hemorrhage. May
    • increase cerebral ischemia in CVA.
    • Use as large a vein as possible
  99. Blood sugar levels for Dextrose 50% in water D50W, Glucose
    • Neonate < 1 month (b.s. < 50 mg/dL)
    • Infant/child >1 month (b.s. < 60 mg/dL)
    • Adult (b.s. <60 mg/dL)
  100. Classification Diazepam (Valium)
    Benzodiazepine
  101. Action Diazepam (Valium)
    exerts anxiolytic, sedative, muscle-relaxant, anticonvulsant, and amnestic effects. Facilitates GABA, an inhibitory neurotransmitter in the CNS
  102. Indications Diazepam (Valium)
    Therapy for convulsive disorders. Management of selected, refractory, patients with epilepsy
  103. Contraindications Diazepam (Valium)
    • Hypersensitivity
    • Myasthenia Gravis
    • Respiratory Insufficiency
  104. Adverse effects Diazepam (Valium)
    • Drowsiness
    • Fatigue
    • Confusion
    • Respiratory Depression
    • Hypotension
  105. Adult dosage Diazepam (Valium)
    • 5 mg increments IV/IO. May repeat every 10 minutes
    • Max of 30 mg
  106. Pediatric dosage Diazepam (Valium)
    • 0.3 mg/kg IV/IO may repeat every 25 min
    • Max dose of 10 mg
  107. Onset Diazepam (Valium)
    Immediate if given IV
  108. Pregnancy Safety Diazepam (Valium)
    Category D
  109. Comments for Diazepam (Valium)
    Diazepam is subject to Schedule IV control under the Controlled Substances Act of 1970. Abuse and dependence of benzodiazepines have been reported. Addiction-prone individuals (such as drug addicts or alcoholics) should be under careful surveillance when receiving diazepam or other psychotropic agents because of the predisposition of such patients to habituation and dependence
  110. Classification Diphenhydramine (Benadryl)
    Antihistamine
  111. Action Diphenhydramine (Benadryl)
    • Competes with histamines at receptor sites
    • Reverses muscle spasms associated with dystonic reactions (phenothiazine)
  112. Indications Diphenhydramine (Benadryl)
    • Allergic reactions
    • Muscle spasms associated with dystonic reactions
  113. Contraindications Diphenhydramine (Benadryl)
    • Glaucoma
    • Acute asthma
    • COPD
  114. Adverse effects Diphenhydramine (Benadryl)
    • Hypotension
    • Drowsiness
    • Tachycardia
    • Bradycardia
    • Dry mouth
  115. Adult dosage Allergic Reaction Diphenhydramine (Benadryl)
    50-100 mg IM, 25-50 mg IV/IO Push over 2-3 min
  116. Adult dosage Dystonic Reaction Diphenhydramine (Benadryl)
    50 mg IV Push, IM
  117. Pediatric dosage Allergic Reaction Diphenhydramine (Benadryl)
    12.5 mg/kg IM only
  118. Onset Diphenhydramine (Benadryl)
    • 1-5 minutes if given IV/IO Push
    • 15 minutes if given IM/PO
  119. Pregnancy Safety Diphenhydramine (Benadryl)
    Category B
  120. Comments for Diphenhydramine (Benadryl)
    • May cause depressed level of consciousness in elderly patients.
    • Overdoses may result in seizures, coma, and death
  121. Classification Dopamine (Intropin)
    Sympathomimetic agent (Catecholamine)
  122. Action Low Dose Dopamine (Intropin)
    • (1-2 ?g/kg/min)
    • Dilates renal and mesenteric arteries by stimulating dopaminergic receptors
    • May decrease BP due to vasodilation
  123. Action Moderate Dose Dopamine (Intropin)
    • (2-10 ?g/kg/min)
    • Increases inotropy (force) without increasing chronotropy (heart rate)
    • Increases BP by stimulating beta1 receptors
  124. Action High Dose Dopamine (Intropin)
    • (over 10 ?g/kg/min)
    • Causes vasoconstriction. Increases inotropy and chronotropy
    • Increases BP by stimulating alpha and beta1 receptors
  125. Indications Dopamine (Intropin)
    • Cardiogenic shock
    • Distributive shock
  126. Contraindications Dopamine (Intropin)
    Hypovolemia
  127. Adverse effects Dopamine (Intropin)
    • Hypertension (High doses)
    • Hypotension (Low doses)
    • Tachycardia
    • Dyspnea
  128. Adult dosage Dopamine (Intropin)
    2-10 ?g/kg/min. IV infusion
  129. Pediatric dosage Dopamine (Intropin)
    2 -10 ?g/kg/min. via micro drip
  130. Onset Dopamine (Intropin)
    5 minutes
  131. Pregnancy Safety Dopamine (Intropin)
    Not well established
  132. Comments for Dopamine (Intropin)
    • Not for use in hypovolemia
    • Causes tissue necrosis if injected into interstitial
    • space. MAO inhibitors may increase its effects.
  133. Recommended method for mixing Dopamine (Intropin)
    • Recommended method for mixing infusion is to mix 400 mg in a 500 mL bag of NS and infuse via microdrip at a rate of 2-10mcg/kg/min.
    • 200 mcg/min. =15 gtts/min.
    • 400 mcg/min. =30 gtts/min.
    • 600 mcg/min. =45 gtts/min.
    • 800 mcg/min. =60 gtts/min
  134. Classification Epinephrine (Adrenalin)
    Sympathomimetic agent (Catecholamine)
  135. Action Epinephrine (Adrenalin)
    • Acts directly on Alpha & Beta receptors of the SNS. Beta effect is more
    • profound than Alpha effects. Effects include:
    • Increased HR (chronotropy)
    • Increased cardiac contractile force (inotropy)
    • Increased electrical activity with in myocardium (dromotropy)
    • Increased systemic vascular resistance
    • Increased blood pressure
    • Increased automaticity
    • Increased bronchial smooth muscle dilation
    • Increases coronary perfusion during CPR by increasing aortic diastolic pressure
  136. Indications Epinephrine (Adrenalin)
    • Cardiopulmonary arrest:
    • -Ventricular fibrillation/Pulseless VT
    • -Asystole
    • -Pulseless electrical activity (PEA)
    • Allergic reaction/anaphylaxis
    • Asthma
    • Refractory pediatric bradycardia, unresponsive to O2 and ventilation
  137. Contraindications Epinephrine (Adrenalin)
    Hypertension
  138. Adverse effects Epinephrine (Adrenalin)
    • Hypertension-tachycardia
    • Increases myocardial oxygen demand and potentially increases myocardial ischemia
  139. Adult dosage Cardiac Arrest Epinephrine (Adrenalin)
    IV/IO: 1 mg 1:10,000. If rhythm persists repeat every 3 to 5 minutes
  140. Adult dosage Asthma Epinephrine (Adrenalin)
    0.3 mg of 1:1,000 IM, may repeat in 20-minute intervals*
  141. Adult dosage Allergic Reaction Epinephrine (Adrenalin)
    • Bronchospasm: 0.3 mg of 1:1,000 IM, may repeat in 10-20 minutes for a
    • total of two doses.
  142. Adult dosage Bradycardia Epinephrine (Adrenalin)
    • Bradycardia: Drip 2-8 Mcg/min while awaiting pacer, or if pacing
    • Ineffective
  143. Pediatric dosage Cardiac Arrest Epinephrine (Adrenalin)
    • Initial dose: IV/IO*: 0.01 mg/kg
    • Repeat doses: IV/IO: 0.01 mg/kg If rhythm persists repeat every 3 to 5 minutes.
  144. Pediatric dosage Asthma Epinephrine (Adrenalin)
    • 0.01 mg/kg (max. 0.3 mg) of 1:1,000 IM, may repeat in 10-20 minutes
    • for a total of 2 doses.*
  145. Pediatric dosage Refractive Bradycardia Epinephrine (Adrenalin)
    • IV/IO: 0.01 mg/kg (1:10,000, 0.1 ml/kg) repeat dose is same as
    • initial every 3-5 minutes
  146. Pediatric dosage Allergic Reaction: Epinephrine (Adrenalin)
    • Bronchospasm: 0.01 mg/kg of 1:1,000 IM q 15 minutes if there is
    • no clinical improvement.
  147. Pediatric dosage Severe Croup: Epinephrine (Adrenalin)
    Nebulized 1:10,000 0.5mg
  148. Pediatric dosage Hypotension /Airway Compromise Epinephrine (Adrenalin)
    • 0.01 mg (Max. 0.3 mg) IM, q
    • 15 minutes if there is no clinical improvement
  149. Onset Epinephrine (Adrenalin)
    • Immediate if given IVP
    • 5-10 minutes if given SQ/IM
  150. Pregnancy Safety Epinephrine (Adrenalin)
    Category C
  151. Comments for Epinephrine (Adrenalin)
    • High dose epinephrine is no longer recommended (except in
    • adult patients in anaphylaxis related cardiac arrest). High doses
    • do not improve survival or neurologic outcome and may
    • contribute to post resuscitation myocardial dysfunction.
  152. Method for mixing Epinephrine (Adrenalin)
    • Recommended method for mixing infusion is to mix 2 mg in a 250 mL
    • bag of NS or 4 mg in a 500 bag of NS and infuse via microdrip at a rate
    • of 15-60 gtts/min. for a rate of
  153. Drip rate conversion for Epinephrine (Adrenalin)
    • 2 mcg/min.=15 gtts/min.
    • 4 mcg/min.=30 gtts/min.
    • 6 mcg/min.=45 gtts/min.
    • 8 mcg/min.=60 gtts/min
  154. Classification Fentanyl (Fentanil)
    Narcotic analgesic
  155. Action Fentanyl (Fentanil)
    • Produces analgesia by inhibiting the ascending pain pathways
    • Depresses the central nervous system by interacting with receptors in the brain
  156. Indications Fentanyl (Fentanil)
    Moderate to severe pain
  157. Contraindications Fentanyl (Fentanil)
    • Use with caution in hypertension or hypotension
    • Use with caution in patients with increased ICP
    • Use with caution in elderly patients
    • Hypersensitivity to drug
  158. Adverse effects Fentanyl (Fentanil)
    • Severe respiratory difficulty as a result of thoracic rigidity (if given too fast IV or IO)
    • Respiratory depression
    • Hypotension/ Bradycardia
    • Altered mental status
    • Nausea/vomiting
  159. Adult dosage Fentanyl (Fentanil)
    • 50 mcg SLOW IV/IO given over 2 minutes, IN*, or IM. Titrate to relief of
    • pain. May repeat every 5 minutes to a Max. total dose of 200 mcg.
    • (If Systolic BP drops below < 90 mm Hg Fentanyl shall be
    • withheld/discontinued.)
    • *Intranasal dose = 25 mcg (0.5mL) per nostril no repeat
    • Consider lower dose (25 mcg) for smaller or elderly patients.
  160. Pediatric dosage Fentanyl (Fentanil)
    • 1 mcg/kg SLOW IV/IO given over 2 minutes, IN*, or IM (Max.
    • individual dose of 50 mcg). Titrate to relief of pain. May repeat
    • every 5 minutes to a Max. total dose of 3 mcg/kg.
    • *Intranasal dosing = give ½ of dose per nostril no repeat.
  161. Onset Fentanyl (Fentanil)
    Immediate if given SLOW IV/IO/IN, 7-8 minutes if given IM
  162. Pregnancy Safety Fentanyl (Fentanil)
    Category C
  163. Comments for Fentanyl (Fentanil)
    • Monitor vital signs closely before and after administration.
    • Have Narcan/Atropine and respiratory assistance readily available.
    • Check for Fentanyl patch before administration.
    • Fentanyl is 100 times more potent than morphine (100 mcg of Fentanyl = 10 mg of MS).
  164. Classification Glucagon
    Hyperglycemic agent (pancreatic hormone)
  165. Action Glucagon
    • Elevates blood glucose by converting liver glycogen into glucose
    • Increases cardiac output by increasing inotropy and chronotropy
    • Stimulates the release of catecholamines
    • Relaxes smooth muscle of the gastrointestinal tract, bronchioles, and blood vessels
  166. Indications Glucagon
    • Hypoglycemia
    • Beta blocker OD
  167. Contraindications Glucagon
    Not significant in the above indications.
  168. Adverse effects Glucagon
    Not significant in the above indications.
  169. Adult dosage Hypoglycemia: Glucagon
    1 mg IM
  170. Adult dosage Beta blocker OD: Glucagon
    2 mg IV push or IM
  171. Pediatric Hypoglycemia: dosage Glucagon
    If less than 8 years old - 0.5 mg/kg IM
  172. Pediatric Beta blocker OD dosage Glucagon
    If less than 8 years old - 0.1 mg/kg IV push or IM
  173. Onset Glucagon
    • 1 - 3 minutes if given IVP
    • 5 - 20 minutes if given IM
  174. Pregnancy Safety Glucagon
    Category B
  175. Comments for Glucagon
    Use with caution in patients with cardiovascular disease.
  176. Classification Glucose (Oral Glucose)
    Monosaccharide carbohydrate
  177. Action Glucose (Oral Glucose)
    • After absorption from GI tract, glucose is distributed in the tissues and
    • provides a rapid increase in circulating blood sugar
  178. Indications Glucose (Oral Glucose)
    Suspected or known Hypoglycemia
  179. Contraindications Glucose (Oral Glucose)
    Patient not able to follow commands
  180. Adverse effects Glucose (Oral Glucose)
    • Nausea/vomiting
    • Aspiration
    • Hyperglycemia
  181. Adult dosage Glucose (Oral Glucose)
    • 15 Grams PO may repeat if no response and IV dextrose is not
    • available
  182. Pediatric dosage Glucose (Oral Glucose)
    • 15 Grams PO may repeat if no response and IV dextrose is not
    • available
  183. Onset Glucose (Oral Glucose)
    5-10 minutes
  184. Pregnancy Safety Glucose (Oral Glucose)
    Category A
  185. Comments for Glucose (Oral Glucose)
    Not a substitute for IV dextrose in extreme cases of hypoglycemia (i.e., BS < 40) unless IV access is unobtainable.
  186. Classification Lidocaine (Xylocaine)
    Antidysrhythmic
  187. Action Lidocaine (Xylocaine)
    • Suppresses ventricular dysrhythmias by decreasing ventricular irritability
    • Increases fibrillatory threshold by elevating the electrical stimulation of the ventricles
  188. Indications Lidocaine (Xylocaine)
    • - Ventricular dysrhythmias*:
    • - Ventricular tachycardia (VT)
    • - Ventricular fibrillation (VF)
    • Post cardioversion or defibrillation of ventricular rhythms*
    • * May be used if patient is allergic to amiodarone
  189. Contraindications Lidocaine (Xylocaine)
    • Second-degree heart block, Mobitz II
    • Third degree (complete) heart block
    • Junctional bradycardia
    • Ventricular ectopy associated with bradycardia
    • Idioventricular or escape rhythms
    • Hypersensitivity
  190. Adverse effects Lidocaine (Xylocaine)
    • Lightheadedness
    • Bradycardia
    • Confusion
    • Hypotension
    • Seizures
    • May be pro-arrhythmic
  191. Adult dosage VF/VT no pulses Lidocaine (Xylocaine)
    • 1.0 - 1.5 mg/kg IV/IO push Use higher end of dosing range, may
    • repeat every 3-5 min. to a max dose of 3 mg/kg
  192. Adult dosage VT with pulses*: Lidocaine (Xylocaine)
    • 1.0 – 1.5 mg/kg slow IV/IO push*. Use lower end of dosing range,
    • repeat
    • *IVP is the preferred route of administration
  193. Adult dosage Drip Lidocaine (Xylocaine)
    • 1-4 mg/min
    • Used for ventricular ectopy suppressed with Lidocaine bolus. Once ectopy is suppressed a maintenance infusion should be run between 1-4 mg/min, titrated to the continued suppression of the ectopy
  194. Adult dosage Mix Rate Lidocaine (Xylocaine)
    • method for mixing infusion is to mix 2 grams in a 500
    • bag of NS and infuse via microdrip at a rate of 15-60 gtts/min. for a
    • rate of:
    • 1mg/min = 15 gtts/min
    • 2mg/min = 30 gtts/min
    • 3mg/min = 45 gtts/min
    • 4mg/min = 60 gtts/min
  195. Pediatric dosage VF/VT no pulses*: Lidocaine (Xylocaine)
    • IV/IO: 1 mg/kg. If rhythm persists, repeat dose in 10 minutes (Max.
    • dose 3 mg/kg.). Only bolus therapy shall be used in pediatric
    • patients
  196. Pediatric dosage VT with pulses*: Lidocaine (Xylocaine)
    • IV/IO*: 1 mg/kg. If rhythm persists, repeat dose in 10 minutes
    • IVP/IO is the preferred route of administration
  197. Onset Lidocaine (Xylocaine)
    45-90 seconds
  198. Pregnancy Safety Lidocaine (Xylocaine)
    Category B
  199. Comments for Lidocaine (Xylocaine)
    For patients who are 70 years or older, have CHF, chronic liver disease or are in impaired circulatory states, the repeat doses of Lidocaine should be half of the initial dose.
  200. Classification
    • Action
    • Indications
    • Contraindications
    • Adverse effects
    • Adult dosage
    • Pediatric dosage
    • Onset
    • Pregnancy Safety
    • Comments for
  201. Classification
    • Action
    • Indications
    • Contraindications
    • Adverse effects
    • Adult dosage
    • Pediatric dosage
    • Onset
    • Pregnancy Safety
    • Comments for
  202. Classification
    • Action
    • Indications
    • Contraindications
    • Adverse effects
    • Adult dosage
    • Pediatric dosage
    • Onset
    • Pregnancy Safety
    • Comments for
  203. Classification
    • Action
    • Indications
    • Contraindications
    • Adverse effects
    • Adult dosage
    • Pediatric dosage
    • Onset
    • Pregnancy Safety
    • Comments for
  204. Classification
    • Action
    • Indications
    • Contraindications
    • Adverse effects
    • Adult dosage
    • Pediatric dosage
    • Onset
    • Pregnancy Safety
    • Comments for

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