Paramedic Meds A-C

The flashcards below were created by user cgazzard on FreezingBlue Flashcards.

  1. Acetaminophen Classifications
    • Non-narcotic analgesic
    • Antipyretic
  2. Acetaminophen Indications
    • Tx of mild pain
    • Reduce fever >38°C (AHS)
  3. Acetaminophen Mechanisms of Action
    • 1. Acts of hypothalamic centre to produce vasodilation and block prostaglandin synthesis in CNS with minimal effects on peripheral prostaglansin, explaining it's lack of anti-inflammatory effects compared to ASA.
    • 2. Nonsalicylate analgesic-antipyretic
    • 3. 90-95% metabolized in liver with glucuronic acis, sulfuric acid and cystein.
    • 4. Inhibits cyclooxygenase which is responsible for formation of prostaglandin.
  4. Acetaminophen Adverse Effects
    Virtually free of severe toxicity or side effects when used as directed.
  5. Acetaminophen Precautions
    • 1. Chronic alcohol impairs liver function - Acetaminophen hepatotoxicity
    • 2. Barbiturates enhance metabolism
    • 3. Caution in pts <3y/o
    • 4. Crosses placenta, safe for short term use.
  6. Acetaminophen Contraindications
    • Hypersensitivity
    • Acetaminophen-induced liver disease or acute liver disease.
  7. Acetaminophen doses
    Adult:
    Ped:
    • Adult 975mg PO (AHS)
    • 500-1000mg q4-6hrs, not to exceed 4g/24hrs.

    • Pediatric 15mg/kg PO (AHS)
    • 10-15mg/kg q4-6hrs, max 75mg/kg/24hrs or 5 doses
  8. Acetaminophen Drug Interactions
    • Warfarin: Potentiates anticoagulant effect.
    • Cholestyramine: Reduces absorption of acetaminophen
    • Barbiturates: Enhances metabolism of acetaminophen - can increase clearance, diminish therapeutic effect and increase hepatotoxicity.
  9. Acetaminophen Toxic Levels and S/S seen in (time frame)
    > or equal to 150mg/kg in both peds and adults or >7.5g in adults.

    Effects seen in 24-36hrs - severe hepatic damage
  10. Acetylcysteine Classifications:
    • Antidote
    • Mysolytic Agent
  11. Acetylcysteine Indication
    Prevent hepatotoxicity in acetaminophen OD
  12. Acetylcysteine Mechanism of Action
    • 1. Since hepatotoxicity occurs when glutathione (binds of toxic metabolites of acetaminophen until excreted) stores are depleted in acetaminophen OD, acetylcysteine is thought to provide cysteine for glutathione synthesis and acts as an alternate substrate to conjugate with toxic metabolites of acetaminophen.
    • 2. Lowers mucous viscosity (cystic fibrosis, COPD, pneumonia...) and increases pH.
  13. Acetylcysteine Contraindications
    None
  14. Acetylcysteine Precautions
    • 1. May induce bronchospasm in asthmatics
    • 2. Pts must be able to cough to clear secretions.
  15. Acetylcysteine Side Effects
    • 1. Bronchospasm
    • 2. Chest tightness
    • 3. Rhinorrhea
    • 4. Fever
    • 5. Clammy skin
    • 6. N/V
    • 7. Fatigue
    • 8. Tachycardia
    • 9. Hypo/hypertension
    • 10. Stomatitis
  16. Acetylcysteine dosing
    Administer 3 doses, same for peds and adults:

    • 1. 150mg/kg in 25ml NS or D5W over 15min.
    • 2. 50mg/kg in 500ml over 4hrs.
    • 3. 100mg/kg in 1000ml over 16hrs.

    or PO: 140mg/kg loading dose followed by 70mg/kg q4hrs for 17 doses.
  17. Acetylcysteine Trade names
    Musomyst, Musolysion, Parvolex, Bronkyl, fluimuscil, Mucosil
  18. Acetylcysteine Supplied Forms
    • 20% solution - 200mg/ml
    • 10% solution - 100mg/ml
  19. Acetylcysteine Notes
    • 1. Most effective when used 4-8hrs post exposure, but can be used up to 24hrs post exposure.
    • 2. Does not reverse hepatotoxicity, only prevents  it.
    • 3. Can interfere with lab testing, draw blood first.
  20. Acetylcysteine Drug Interactions
    Nitrates: Potentiates vasodilation effects.
  21. Acetylsalicylic Acid Classifications
    • 1. Analgesic
    • 2. Anti-inflammatory
    • 3. Antipyretic
    • 4. Platelet Aggregation Inhibitor
  22. Acetylsalicylic Acid Mechanisms of Action
    • 1. Interferes with the production of prostaglandin by inactivating cyclooxygenase (COX) which is an enzyme involved in early stages of inflammatory cascade. It mostly acts in the peripheral body, with similar minimal activity in the CNS, which is why it is a better anti-inflammatory agent than acetaminophen.
    • 2.Lowers body temperature mainly by inhibiting prostaglandin E1 synthesis in the brain. Heat production is not affected, however dissipation is enhanced via increased blood flow through the skin and sweating.
    • 3. Prevents thrombaxane A2 synthesis by acetylating COX which prevents platelets froms adhering together.
  23. Acetylsalicylic Acid Indications
    • 1. ACS
    • 2. Relief of mild pain, fever, and inflammation
  24. Acetylsalicylic Acid Contraindications
    • 1. Hypersensitivity
    • 2. Active GI Bleed
    • 3. Asthma (w/ PmHx of bronchospasm with ASA)
    • 4. Bleeding Disorders
  25. Acetylsalicylic Acid Side Effects
    • Heartburn
    • GI bleed/upset
    • N/V
    • Bronchospasm
  26. Acetylsalicylic Acid Dosing
    ACS:
    Analgesia and fever:
    Inflammation:
    • ACS: 160-325mg PO
    •          300mg PR
    • Analgesia and fever: 325-650mg q4-6hrs
    • Inflammation: 2.4 - 3.6g/day divided up. 60-90mg/kg in peds.
  27. Acetylsalicylic Acid Drug Interactions
    • Anticoagulants: Increases chances of GI bleed and has synergistic effect.Lithium: Increases serum levels of lithium.
    • Digoxin: Increases serum levels of digoxin.
    • Antacids: May reduce serum levels of ASA by decreasing absorption.
    • Anti-inflammatories: Increases both drugs serum levels and side effects.
  28. Acetylsalicylic Acid Toxicity levels/OD signs and symptoms
    Mild/Mederate:

    Severe:
    Mild-moderate: 150-300mg/kg - tinnitus, tachypnea*, hyperpyrexia, diaphoresis, lethargy, confusion.

    Severe: 300mg/kg - increased vascular permeability resulting in pulmonary and cerebral edema. Seizures, coma.

    Antidote therapy is not available, Tx is aimed at enhancing elimination.

    Tachypnea* in early stages can result in respiratory alkalosis, forcing kidneys to try and compensate with HCO3 elimination and H+ retention, causing a more profound metabolic acidosis later.

    Hyperglycemia followed by hypoglycaemia - multiple BGLs required. Cerebral glucose levels can decrease before peripheral levels.

    Renal excretion is enhanced by alkaline diuresis - sodium bicarb with D5W solution. Potassium supplementation is often requires.
  29. Acetylsalicylic Acid Notes
    • 1. Can cause Reye's syndrome in pediatrics with chicken pox.
    • 2. Mostly absorbed in stomach.
  30. Activated Charcoal Classification
    Adsorbent
  31. Activated Charcoal Mechanism of Action
    • 1. Adsorbs certain chemicals and prevents their absorption from the GI tract.
    • 2. SDAC: Forms effective barrier betweens GI mucosa and any remaining particulate material.
    • 3. MDAC: Creates and maintains a concentration gradient across the GI wall and facilitates passive diffusion of toxic substances from blood stream into the GI tract where it is then adsorbed and excreted.
    • 4. Especially effective in binding to ASA, amphetamines, strychnine, phenytoin, phenobarbital.
    • 5. Alcohols, strong acids and alkalis, lithium, magnesium, potassium, heavy metals, and petroleum distillates do not adsorb well to charcoal.
  32. Activated Charcoal Indications
    Adsorption of ingested poisons when vomiting is contraindicated and/or following gastric lavage.
  33. Activated Charcoal Contraindications
    • 1. Unprotected Airways
    • 2. Corrosive ingestion as it could affect visualization of endoscopiy.
    • 3. GI hemorrhage or perforation
  34. Activated Charcoal Side Effects
    • Tarry Stool
    • Vomiting
    • Diarrhea
    • Constipation
  35. Activated Charcoal Dosing

    Solution:

    Adults:

    Peds:
    Should be suspended in water, not sorbitol.

    • Adults: SDAC (single dose) 25-100g    
    •            MDAC (multiple dose) following SDAC and then at least 12.6g qhr until pt recovers

    Pediatrics: SDAC 0.5-1g/kg, max 50g          MDAC following SDAC and then 1-2g q2-6hrs
  36. Activated Charcoal Drug Interactions
    Leflunomide: Charcoal will decrease serum levels of the active metabolites.
  37. Activated Charcoal Notes
    • 1. Not absorbed by the body.
    • 2. Effectiveness is highest immediately after ingestion, but can be effective for up to 2 hrs depending if drug absorption is delayed.
  38. Adenosine Classification
    Miscellaneous Antiarrhythmic
  39. Adenosine Mechanisms of Action
    • 1. Slows AV nodal conduction
    • 2. Interrupts reentry pathways through AV node restoring NSR in pts with PSVT.
    • 3. Not effective in A-flutter/fib, VT although transient AV nodal block helps Dx atrial activity.
    • 4. Potent vasodilator, but since half life is <10sec, hemodynamic changes are not usually seen
    • 5. Metabolized via erythrocytes so renal or hepatic insufficiency does not affect activity.
  40. Adenosine Indications
    • 1. PSVT
    • 2. Orthodromic WPW (AVRT)
    • 3. AVNRT
    • 4. Wide complex Tachycardias in pediatrics.
  41. Adenosine Contraindications
    • 1. Torsades/ polymorphic VT
    • 2. Antidromic WPW
    • 3. 2nd or 3rd degree heart block
    • 4. Sick Sinus Syndrome
    • 5. Hypersensitivity
    • 6. Symptomatic Bradycardia
    • 7. A-fib/flutter
    • 8. Bronchospasm/severe asmtha - AHS
    • 9. Pt taking carbamazepine or dipyridamole - AHS (reduce dose)
  42. Adenosine Side Effects
    • 1. Severe Bronchospasm
    • 2. Facial Flushing (vasodilation effects)
    • 3. H/A
    • 4. Dizziness
    • 5. SOB
    • 6. Nausea
    • 7. CP
    • 8. Arrhythmias
  43. Adenosine dosing

    Adults:

    Peds:
    • Adults: 1st dose 6mg. (20ml rapid flush)
    •            2nd dose 12mg if rhythm does not convert.
    • AHS - 12mg as first dose

    • Peds: 0.1mg/kg max 6mg first dose.
    •         Second dose 0.2mg/kg max 12mg. Each with 10ml rapid flush.
  44. Adenosine Precautions
    • 1. Asthma, COPD
    • 2. Dysrhythmias may be seen during conversion.
  45. Adenosine Drug Interactions
    • Dipyridamole: Can potentiate effects of adenosine, therefore lower doses are given.
    • Carbamazepine: Increases degree and chances of heart block.
    • Methylxanthines: Anagonize effects of adenosine, so higher doses are needed.
    • Digoxin, verapamil: May be associated with VF.
  46. Alteplase Classifications
    • 1. Fibrinolytic
    • 2. Thombolytic
  47. Alteplase Mechanisms of Action
    • 1. Binds to fibrin in a thrombus and converts the entrapped plasminogen to plasmin, initiating local fibrinolysis with minimal systemic effects.
    • 2. 20-30% decrease in circulating fibrinogen.
  48. Alteplase Indications
    • 1. Acute Ischemic Stroke
    • 2. Acute MI
  49. Alteplase Contraindications
    • 1. Symptom onset greater than 4hrs.
    • 2. Evidence of intracranial hemorrhage.
    • 3. Recent intracranial or intraspinal surgery, serious head trauma or previous stroke within 3 months.
    • 4. Hx of intracranial hemorrhage.
    • 5. Uncontrolled HTN at time of Tx.
    • 6. Aggressive Tx required to reduce BP to specified limits.
    • 7. Seizure at onset of stroke.
    • 8. Active internal bleeding.
    • 9. Intracranial neoplasm, arteriovenous malformation, or aneurysm.
    • 10. Major surgery within 14 days.
    • 11. GI or urinary tract hemorrhage within 21 days.
    • 12. Arterial puncture at a non-compressible site within 7 days.
    • 13. BGL <3 or >22mmol/LMI within 3 months and/or clinical presentation associated with post MI pericarditis.
    • 14. Currently on anticoagulants with INR > 1.7 or a prothrombin time (PT) > 15sec
    • 15. Heparin administration within 48hrs and elevated aPTT at presentation.
    • 16. Platelet count < 100 000mm3
    • 17. Hypersensitivity
  50. Alteplase Side Effects
    • 1. Bleeding
    • 2. Allergic/anaphylactoid reaction
    • 3. Fever
    • 4. N/V
    • 5. Reperfusion arrhythmias
  51. Alteplase dosing
    0.9mg/kg max 90mg. 10% of dose as bolus and then the remaining over 60min.
  52. Aminophylline Classifications
    • 1. Bronchodilator unrelated to beta agonists.
    • 2. Methylxanthine
    • 3. Xanthine
  53. Aminophylline Mechanisms of Action
    • 1. Exact Mech unknown
    • 2.Relaxes smooth muscles without acting on adrenergic receptors
    • 3. Stimulates resp. center in medulla.
    • 4. Mild diuretic properties, increases CO and HR
    • 5. Increases diaphragmatic contractility.
    • 6. Complex of theophylline and dissociates into theophylline.
  54. Aminophylline Indications
    • 1. Bronchospasm with asthma, COPD - can be useful in situations where sympathomimetics are not effective.
    • 2. CHF, pulmonary edema due to positive chrono/inotropic effects.
  55. Aminophylline Contraindications
    • 1. Hypersensitivity
    • 2. Uncontrolled arrythmias
    • 3. Symptomatic CAD
    • 4. Hypotension
  56. Aminophylline Side Effects
    • Tachycardia
    • Arrythmias
    • CP
    • Nervousness
    • H/A
    • Seizures
    • N/V
  57. Aminophylline Dosing
    • 6mg/kg in 100ml over 20-30min.
    • Slow infusion decreased risk of arrythmias
  58. Aminophylline Drug Interactions
    • Adenosine: Antagonizes adenosine effects.
    • Benzodiazepines: Causes decreased sedative effects of benzos.
    • Theophylline: Pt on chronic theophylline therapy should not receive until serum levels have been tested.
    • Zafirlukast: Xanthines decrease serum levels of zafirlukast.
  59. Aminophylline Precautions
    • 1. Narrow Therapeutic Index
    • 2. Pediatrics are sensitive to xanthines
    • 3. Absorption unpredictable
    • 4. Rapid IV injections in pts with pronounced myocardial injury can result in sever hypotension or cardiac arrest.
  60. Aminophylline OD Sign/Symptoms and Tx
    Especially common in pediatrics.

    Seizures, death, hyperreflexia, hallucinations, arrhythmias, marked hypotension.

    Seizures may be difficult to control and IV benzos are used. May need to progress to barbiturates or propofol. Avoid phenytoin.
  61. amiodarone Classifications
    Class III antiarrythmic (Potassium channel blocker)
  62. amiodarone mechanisms of action
    • 1. considered class III but has characteristics of all 4 class.
    • 2. Prolongs action potential duration and refractory period by blocking K channels.
    • 3. Also was alpha blocking effects resulting in vasodilation.
  63. amiodarone indications
    • 1. Pulseless VT
    • 2. V-Fib
    • 3. VT with a pulse - re-entry pathways
    • 4. A-fib (or A-flutter) with RVR for rate control
  64. Amiodarone Contraindications
    • 1. Severe sinus node dysfunction resulting in marked sinus brad.
    • 2. 2nd or 3rd degree AV blocks unless pacemaker present
    • 3. Symptomatic bradycardia
    • 4. Hypersensitivity to iodine or amiodarone.
    • 5. Cardiogenic shock/ cardiovascular colllapse (due to alpha blocking properties)
    • 6. Thyroid dysfunction
    • 7. Acute hepatitis
    • 8. Interstitial pulmonary disease
    • 9. Pt's predisposed to intracranial HTN
  65. Amiodarone Side Effects
    • 1. Hypotension
    • 2. Bradycardia
    • 3. Prolonged QTc, PR and QT intervals.
    • 4. AV block
    • 5. Increased ventricular beats
    • 6. Pulmonary toxicity - cough, dyspnea, pleuritic pain.
    • 7. Tremors
    • 8. N/V
  66. Amiodarone dosing.

    Peds:

    Adults:
    Peds: 5mg/kg, may repeat twice.

    • Adults: VF/pulselss VT: initial dose of 00mg, floowed by 150mg in needed.
    • VT with a pulse: 150mg in 250 D5W over 10min. Can be followed by 1mg/min for 6hrs, decreased to 0.5mg/min for 18hrs. Max 2.2g/24hrs.
  67. Amiodarone Drug Interations
    • Warfarin: Warfarin can be potentiated, increased PT by 100% after 3-4 days.
    • Digoxin: Can cause digoxin toxicity.
    • procainamide: Increases procainamide plasma concentrations. (reduce p. dose by 1/3)
    • quinidine: Increases quinidine serum concentrations. (reduce q. dose by 1/3)
    • phenytoin: Increases phenytoin serum concentrations and phenytoin decreases amiodarone levels.
    • B-Blocker and Ca+ Channel blockers: Increases risk of blocks, bradys and sinus arrest.
  68. Amiodarone Notes:
    • 1. Very long half life - up to 10 days IV and 100 days PO.
    • 2. Distributed and stored extensively in adipose tissue before therapeutic effects occur.
    • 3. Can cause pulmonary fibrosis, neuropathy, hepatotoxicity, corneal deposits, optic neuritis, blue-grey skin discolouration, and hypo/hyperthyroidism.
  69. Atenolol Classifications:
    • 1. Selective Beta Blocker
    • 2. Class II antiarrhythmic
  70. Atenolol Mechanisms of Action
    1. Cardioselective drug that blocks B1 receptors causing negative chrono and inotropic effects, lowers BP and myocardial O2 demand.
  71. Atenolol Indications
    • 1. Stable, narrow tachys if not converted with adenosine.
    • 2. Control V rate in A-fib/flutter
    • 3. Certain forms of polymorphic VT
  72. Atenolol Contraindications
    • 1. Bradycardia, 2-3rd° block, Sick sinus syndrome
    • 2. Decompensated CHF
    • 3. RV failure due to pulmonary HTN
    • 4. Hyoptension
    • 5. Hypersensitivity.
  73. Atenolol Side Effects
    • 1. Bradycardia
    • 2. Heart Blocks
    • 3. Hypotension
    • 4. CHF
    • 5. Bronchospasm (more with non-selective)
    • 6. Lethargy and weakness.
  74. Atenolol Dosing
    5mg IV over 5min q 10min prn, may repeat once
  75. Atenolol Drug Interactions
    CCB: may result in severe hypotension, bradycardia and cardiac failure.
  76. Atropine Classifications
    • Anticholinergic
    • Vagal Blocker
    • Parasympatholytic
  77. Atropine Mechanisms of Action
    • 1. Binds to and blocks muscarinic receptors preventing acetylcholine from binding to those sites.
    • 2. Great inhibitory effects on bronchial tissue and secretion of saliva and sweat.
  78. Atropine Indications
    • 1. Symptomatic bradycardia
    • 2. AV blocks at nodal level
    • 3. Preintubation, especially in pediatrics
    • 4. Organophosphate poisoning
  79. Atropine Contraindications:
    • 1. Hypothermic bradycardia
    • 2. Hypersensitivity.
  80. Atropine Side Effects
    • 1. Tachycardia
    • 2. Blurred Vision
    • 3. Dry mouth
    • 4. Dilated pupils
    • 5. Confusion
    • 6. Use in caution in pt with CAD due to increased myocardial demand.
  81. Atropine dosing
    Bradycardia
    Peds:
    Adults:

    Organophosphate Poinsoning:
    Peds:
    Adults
    • Bradycardia
    • Pediatric: 0.02mg/kg min 0.1mg max 0.5mg, q3-5min prn may repeat once to max of 0.04mg/kg or 1mg, whichever is less.

    Adult: 0.5mg q3-5min, max 3mg or 0.04mg/kg (3mg=75kg)

    • Organophosphate Poisoning:
    • Pediatrics: 0.05mg/kg q5min until reversal of SLUDGEM

    Adults: 2mg q5min until reversal of SLUDGEM
  82. Atropine Notes
    1. Transplanted hearts will not respond due to denervation.
  83. benztropine (Cogentin) Classifications
    • AntiParkinson's
    • Anticholingergic (antimuscarinic)
    • Antidyskinetic
  84. benztropine (Cogentin) Mechanisms or Action
    1. Blocks cholinergic transmission, thus helping to correct the imbalance or dopamine/acetylcholine ratio (Parkinson's has low levels of dopamine). Therefore it acts similarly to augmentation of dopaminergic transmission.
  85. benztropine (Cogentin) Indications
    • 1. Acute dystonic reactions
    • 2. All forms of Parkinson's
  86. benztropine (Cogentin) Contraindications
    • 1. Glaucoma
    • 2. Hypersensitivity
    • 3. Prostatic hyperplasia
    • 4. Pyloric Stenosis
    • 5. Myasthenia Gravis
  87. benztropine (Cogentin) Side effects
    • 1. Dry mouth
    • 2. Tachycardia
    • 3. Blurred vision
    • 4. Confusion
    • 5. Mydriasis
  88. benztropine (Cogentin) dosing
    Adults: 1-4mg IV/IM max 6mg/day. 2mg generally relieves symptoms
  89. Calcium Chloride Classification
    Electrolyte
  90. Calcium Chloride Mechanisms of Action
    • 1. Positive inotropic effects
    • 2. Enhances ventricular automaticity
    • 3. Stabilizes myocardial contractility in hyperkalemia (>6mEq/L) by reducing the threshold potential of cardiac myocytes, thereby restoring the normal gradient with the resting membrane potential, and reverses ECG changes without changing serum K levels.
  91. Calcium Chloride Indications
    • 1. CCB OD
    • 2. Cardiac arrest suspicious of electrolyte imbalances/prolonged arrest
    • 3. Hyperkalemia
    • 4. Mag Sulfate OD/Hypermagnesia
    • 5. Hypocalcemia
    • 6. BB OD refractory to glucagon, atropine, pacing and dopamine.
  92. Calcium Chloride Contraindications
    • 1. Digitalis Toxicity (increases arrhythmia risk)
    • 2. Hypercalcemia
  93. Calcium Chloride Side Effects
    • 1. Bradycardia
    • 2. Syncope
    • 3. Arrhythmias
    • 4. N/V
    • 5. Cardiac arrest
  94. Calcium Chloride Notes
    • 1. Extravasation causes tissue necrosis
    • 2. Can cause arterial vasospasm - caution with CAD and CVD.
    • 3. Forms precipitate when in contact with sodium bicarb.
  95. Calcium Chloride Dosing

    Cardiac Arrest:

    Hyperkalemia:

    CCB OD:
    Adult:
    Ped:
    • Cardiac Arrest:
    • Adult: 1g SIVP/IO

    • Hyperkalemia:
    • Adult/Ped: 20mg/kg max 1g over 5 min q 5min, max 40mg/kg or 2g.

    • CCB OD:
    • Adult: 500mg in 50ml NS over 10min q 10min max 1g.
    • Peds: 20mg/kg in 50ml NS over 30min
  96. cefazolin (Ancef) Classification
    • Antibiotic
    • Cephalosporin
  97. Cefazolin (Ancef) Mechanisms of Action
    Inhibits bacterial cell wall synthesis, causing cell death.
  98. Cefazolin (Ancef) Indications
    • 1. Open Fractures
    • 2. Wide variety of bacterial infections.
  99. Cefazolin (Ancef) Contraindications
    1. Hypersensitivity to cephalosporin antibiotics
  100. Cefazolin (Ancef) Precautions
    • 1. Pregnancy
    • 2. Hepatic Insufficiency
    • 3. Renal Insufficiency
    • 4. Allergy to Penicillin
    • 5. GI disease
  101. Cefazolin (Ancef) Side Effects
    • 1. GI upset
    • 2. Anaphylaxis
    • 3. Seizures in OD situations
  102. Cefazolin (Ancef) Dosing

    Adult:

    Ped:
    Adult: 1g over 5-15min q6-8hrs, max 12g/day

    Ped: 25mg/kg over 5-15min q 6-8hrs. max 6g/day
  103. Chlorpromazine classifications
    First-generation Antipsychotic.
  104. Chlorpromazine Mechanisms of Action
    • 1. Moderate-weakly binds to dopamine D2 receptors in mesolimbic system of brain
    • 2. Blocks alpha adrenergic receptors and histamine receptors.
  105. Chlorpromazine Indications
    • 1. Acute psychosis
    • 2. Aggresive/agitated behaviour
    • 3. Prevent or treat N/V
  106. Chlorpromazine Contraindications
    • 1. Comatose
    • 2. Presence of sedatives
    • 3. Presence of hallucinogens of PCP-like compounds
  107. Chlorpromazine Precautions
    • 1. Parkinsons
    • 2. Seizure disorders
    • 3. Elderly
  108. Chlorpromazine Side Effects
    • 1. EPS
    • 2. Seizures
    • 3. Hypotension
    • 4. Physical and mental impairment
    • 5. Drowsiness
    • 6. Anticholinergic Effects
  109. Chlorpromazine Dosing

    Adult:

    Ped:
    Adult: 25-100mg IM

    Ped: 0.5mg/kg IM

    q4-6hrs
  110. Chlorpromazine Trade Names
    • Largactil
    • Thorazine
  111. Cimetidine Classification
    Histamine H2 antagonist
  112. Cimetidine Mechanisms of Action
    • 1. Competitively blocks/binds to H2 receptors in gastric parietal cells (responsible to HCl production) reducing the secretion of gastric acid. (Gastric acid is secretion is stimulated by Aceylcholine, histamine and gastrin.)       
    • 2. Fully reversible
  113. Cimetidine Indications
    • 1. Treating peptic ulcers - duodenal or gastric.       
    • 2. Treating acute stress ulcers.       
    • 3. GERD       
    • 4. Management of upper GI hemorrhage where inhibition of gastric acid secretion is beneficial
  114. Cimetidine Contraindications
    Hypersensitivity
  115. Cimetidine Side Effects
    • Mostly well tolerated.       
    • Rare side effects include        cardiovascular effects, interstitial nephritis, erectile dysfunction, dermatologic reactions and confusion.
  116. Cimetidine Side Effects
    Impairs metabolism of warfarin, phenytoin diazepame, quinidine, carbamazepine, theophylline, imipramine.
  117. Cimetidine dosing

    Adult:   

    Ped:
    Adult: 300mg in 50-100ml NS or D5W over 15min q6hrs, max 2400mg/day.   

    Ped: 20-40mg/kg/day
  118. Clopidogrel Classification
    Platelet aggregate inhibitor
  119. Clopidogrel Mechanisms of Action
    • 1. Inhibits platelet aggregation by binding to ADP receptors on the surface of platelets (which blocks activation of GP IIb/IIIa receptors required for platelets to bind to fibrinogen and to each other).       
    • 2. Binds irreversibly, therefore platelets are affected for their lifespan.
  120. Clopidogrel Indications
    • 1. ACS       
    • 2. CVA       
    • 3. PVD
  121. Clopidogrel Contraindications
    • 1. Hypersensitivity       
    • 2. Bleeding disorder       
    • 3. Ulcer
  122. Clopidogrel Side Effects
    • 1. Bleeding (no antidote)       
    • 2. Fever       
    • 3. Allergic reaction       
    • 4. Myalgias (muscle pain)       
    • 5. Rash
  123. Clopidogrel Dosing   

    ACS/NSTEMI:   
    STEMI:   
    Recent MI, CVA, or PVD:
    ACS: 300mg PO followed by 75mg once a day, usually in combo with ASA.   

    STEMi: 75mg once a day in combo with ASA. Can be given with or without the 300mg loading dose.   

    Recent MI, CVA or PVD: 75mg every day
  124. Codeine Classification
    Narcotic/Opiate/Opioid Analgesic
  125. Codeine Mechanisms of Action
    1. Metabolized (by CYP450 2D6 enzyme) into morphine and binds to various opioid receptors in CNS, spinal cord and GI tract to produce analgesia.       

    2. Acts as an anti-tussive
  126. Codeine Indications
    Mild - moderate pain
  127. Codeine Contraindications:
    • 1. Hypersensitivity       
    • 2. Resp depression       
    • 3. Hypotension       
    • 4. Acute exacerbation of COPD or Asthma       
    • 5. MAOIs within 14 days       
    • 6. Caution in pt with renal dysfunction
  128. Codeine Side Effects
    • 1. Hypotension       
    • 2. Sedation       
    • 3. Constipation       
    • 4. Urinary retention       
    • 5. N/V       
    • 6. Myosis       
    • 7. Resp depression
  129. Codeine Dosing   

    Adult:   
    Ped:
    Adult: 15-60mg PO/IM/SC q 4hrs   

    Ped: 0.5-1mg/kg PO/IM q 4-6hrs, max 60mg dose.
Author:
cgazzard
ID:
313249
Card Set:
Paramedic Meds A-C
Updated:
2016-02-07 16:17:16
Tags:
Meds SAIT EMTP
Folders:

Description:
ACP Prep
Show Answers: