Paramedic Meds D-E

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  1. Dexamethasone Classification
    Corticosteroid
  2. Dexamethasone Mechanisms of Action
    • 1. Glucocorticoid receptor agonist that decreases and prevents tissue response to inflammatory process.       
    • 2. Suppresses immune system       
    • 3. Decreased cerebral edema (mech. ukn)       
    • 4. Onset of action is 2-6hrs
  3. Dexamethasone Indications
    • 1. Asthma/COPD
    • 2. Anaphylaxis  
    • 3. Croup
  4. Dexamethasone Contraindications
    • 1. Systemic fungal infection       
    • 2. Hypersensitivity to steriod, benzyl alcohol or sodium sulfite.
  5. Dexamethasone Side Effects
    • GI Bleeding       
    • Prolonged Wound Healing
  6. Dexamethasone Dosing   

    Adult:   

    Ped:
    Adult: 4-24mg   

    Ped: 0.5mg/kg
  7. D50W Classifications
    Carbohydrate
  8. D50W Mechanisms of Action
    • 1. Rapidly increases serum glucose levels
    • 2. Hypertonic solution that promotes osmotic diuresis from interstitial spaces into vascular space
  9. D50W indications
    • 1. Hypoglycemia
    • 2. Coma when BGL unavailable
  10. D50W Contraindications
    1. None in emergent setting
  11. D50W Precautions
    • 1. Can cause tissue necrosis if IV not patent.
    • 2. Viscous, therefore large bore IV needed.
    • 3. May precipitate severe neurological symptoms in alcoholics, therefor it's recommended to give thiamine first.
  12. D50W Dosing

    Adult:

    Ped:

    CVA pts:
    Adults: 25g, may repeat once

    Peds: D25W of 0.5g/kg = 2ml/kg

    Neonate: D10W 0.5g/kg = 5ml/kg

    CVA: 12.5g D50W
  13. Diazepam Classifications
    • Benzodiazepine
    • Anticonvulsant
    • Skeletal muscle relaxant
    • Sedative
  14. Diazepam Mechanisms of Action
    • 1. Bind to γ and α GABA receptors in CNS and cause chloride shift resulting in hyperpolarization of neurons decreasing neurotransmission and inhibiting action potentials. This results in:
    •  a) Reduction of anxiety
    •  b) Sedative/hypnotic effect
    •  c) Anterograde amnesia
    •  d) Anticonvulsant
    •  e) Muscle relaxant
  15. Diazepam Indications
    • 1. Anxiety/Panic Attacks
    • 2. Seizures
    • 3. Premedication before procedures (cardioversion)
    • 4. Skeletal muscle spasms (MS or cerebral palsy)
  16. Diazepam Contraindications
    1. Hypersensitivity
  17. Diazepam Side Effects
    • 1. Drowsiness
    • 2. Confusion
    • 3. Ataxia at higher doses
    • 4. Hypotension
    • 6. Resp depression
  18. Diazepam Dosing

    Seizures:
    - Adults:
    - Peds:

    Anxiety:

    Premedication:
    • Seizures:
    • - Adults: 5-10mg IV q 5-15min, max 20mg
    • - Peds: 0.1-0.2mg/kg

    Anxiety/Behavioural: 2-5mg IM or IV

    Premedication: 5-15mg IV
  19. Diazoxide Classifications
    • Antihypertensive
    • Hyperglycemic agent
  20. Diazoxide Mechanisms of Action
    • 1. Relaxes smooth muscle in peripheral arterioles, decreasing vascular resistance and increasing CO and decreasing BP. Coronary and cerebral blood flow are maintained.
    • 2. Increased BGL by inhibiting pancreatic insulin release (β cells).
    • 3. Decreased sodium and water excretion.
  21. Diazoxide Indications
    • 1. Hypertensive crisis where emergency reduction in diastolic BP is required.
    • 2. Hypoglycemia as a result of hypersecretion of insulin.
  22. Diazoxide Contraindications
    • 1. Compensatory Hypertension
    • 2. Hypersensitivity to diazoxide, thiazides or sulfonamides.
    • 3. Dissecting aneurysm
  23. Diazoxide Side Effects
    • 1. Hypotension
    • 2. Hyperglycemia
    • 3. Edema (Na and H2O retention)
    • 4. SVT/Palps
    • 5. H/A
    • 6. Confusion
    • 7. TIAs
  24. Diazoxide Dosing
    1-3mg/kg IV push decently quickly as slow push will not produce results. Max 300mg dose, q 5-15min titrating to BP.
  25. Diltiazem Classification
    Calcium Channel Blocker
  26. Diltiazem Mechanisms of Action
    • 1. Block influx in Ca into myocytes and smooth muscle of arteriolar vasculature resulting in arteriole dilation and negative inotropic effects. (Verapamil has stronger neg. inotropic effects)
    • 2. Slows conduction through AV node.
    • 3. Decreases ventricular response
  27. Diltiazem Indications
    • 1. SVTs refractory to adenosine and cardioversion.
    • 2. Control ventricular rate in A-fib/flutter
  28. Diltiazem Contraindication
    • 1. Hypotension
    • 2. Wide complex tachycardias
    • 3. Conduction system disturbances.
    • 4. Caution in pts on β blockers - severe hypotension.
  29. Diltiazem Side Effects
    • 1. Hypotension
    • 2. Bradycardia
    • 3. AV blocks
    • 4. N/V
    • 5. Dizziness
  30. Diltiazem Dosing
    • 15-20mg IV over 2min (0.25mg/kg).
    • Additional dosages of 20-25mg over 2min (0.35mg/kg) q 15min if needed.
    • Maintenance dose of 5-15mg/hr for rate control.
  31. Digoxin Classification
    • Cardiac Glycoside
    • Antidysrhythmic
    • Inotrope
  32. Digoxin Mechanisms of Action
    • 1. Inhibits Na/K ATP pump which shortens the refractory period in contractile cells and prolongs effective refractory period while decreasing conduction velocity through AV node.
    • 2. This has negative dromo/chromo effects while having a postivie inotropic effect due to enhancement of Ca influx and augmented Ca release within myocardial cells.
  33. Digoxin Indications
    • 1. A-fib/flutter with RVR
    • 2. CHF
    • 3. Other rapid atrial arrhythmias.
  34. Digoxin Contraindication
    • 1. S/S Digitalis toxicity
    • 2. VF/VT
    • 3. Hypersensitivity
  35. Digoxin Side Effects
    • 1. N/V
    • 2. Arrhythmias
    • 3. Hypotension
    • 4. H/A Dizziness
    • 5. "yellow" vision/ visual changes - blurred, halluciantions
  36. Digoxin Drug Interactions
    • 1. Quinidine and CCB can increase serum digoxin levels.
    • 2. Beta blockers can cause severe bradycardia.
    • 3. Diurectics can cause hypokalemia and can lead to digitalis toxicity.
  37. Digoxin Precautions/Toxicity
    • 1. Pts with MI are prone to toxicity.
    • 2. Calcium should not be admin to pts receiving digoxin.
    • 3. Toxicity presents with cardiac arrhythmias (PVCs, PSVT with 2:1 block ect), N/V, H/A, visual disturbances, drowsiness. Almost any arrhythmia can be associated iwth digitalis toxicity.
    • 4. Watch for ladle scoop in ST seg.
  38. Digoxin Dosing
    0.25-0.5mg SIVP 2hrs max 1.5mg
  39. Dihydroergotamine (DHE) Classification
    • 1. Ergot Alkaloid
    • 2. Alpha Adrenergic Agonist.
  40. Dihydroergotamine (DHE) Mechanisms of Action
    • Aborts vascular headaches by
    • direct vasoconstriction of vascular smooth muscle, particularly the
    • carotid artery bed but also peripheral and cerebral vessels which
    • reduces the amplitude of pulsation in the cranial arteries.
  41. Dihydroergotamine (DHE) Indications
    Vascular H/A that is not resolves by triptans
  42. Dihydroergotamine (DHE) Contraindications
    • 1. PVD
    • 2. Cerebral vascular disease
    • 3. CAD
    • 4. ischemic or vasospastic heart disease
    • 5. Impaired renal or hepatic function
    • 6. Pregnancy/lactation
    • 7. Uncontrolled hypertension
  43. Dihydroergotamine (DHE) Dosing

    Adult:

    Ped:
    • Adult: 0.5-1mg SIVP over 3-5min or IM/SC. q 1hr to a max of 2mg IV or 3mg IM/SC.
    • Max weekly dose of 6mg.

    If IV given too quickly, will cause adverse effects and if given >5min, effects will be reduced.

    Ped: 0.1-0.2mg SIVP or IM q6hrs max 16doses. (6-16y/o)
  44. Dimenhydrinate Classifications
    • Antiemetic
    • Antihistamine
  45. Dimenhydrinate Indications
    1. Relief or prevention of N/V due to motion sickness, Meniere's disease or narcotic admin
  46. Dimenhydrinate Mechanisms of Action
    1. Blocks histamine (H1) (causing sedation) and muscarinic cholinergic (anticholinergic effects) receptors in neuronal pathway connecting inner ear and vomiting center in medulla.
  47. Dimenhydrinate Contraindications
    • 1. Hypersensitivity to dimenhydrinate, dipehnhydramine or propyl glycol.
    • 2. Large amounts of depressants ingested.
    • 3. Acute narrow angle glaucoma
  48. Dimenhydrinate Side Effects
    • 1. Sedation
    • 2. Dry mouth
    • 3. Blurred vision
    • 4. Urinary retention
    • 5. Constipation
  49. Dimenhydrinate Dosing

    Adult:

    Ped:
    • Adult: 50-100mg q4hrs prn
    • 1mg/kg max 50mg IV/IM q 4hrs
    • 25mg in pts >65y/o q15 max 50mg

    Ped: 1mg/kg IV/IM max 25mg
  50. Diphenhydramine Classification
    Antihistamine
  51. Diphenhydramine Mechanisms of Action
    • 1. Blocks H1 receptor sites of effector cells preventing not reversing histamine responses.
    • 2. Central inhibition of acetelycholine muscarinic receptors
  52. Diphenhydramine Indications
    • 1. Anaphylaxis
    • 2. Allergic reaction
    • 3. Extrapyramidal reactions that occur with Maxeran, phenothiazine derivatives and butrophenones (chloropramazine, haloperidol, druperidol)
  53. Diphenhydramine Contraindications
    1. Hypersensitivity to diphenhydramine or dimenhydrinate.
  54. Diphenhydramine Side Effects
    • 1. Sedation
    • 2. Anticholinergic effects
    • 3. Hypotension
  55. Diphenhydramine Dosing

    Adult:

    Ped:
    • Adult: 1mg/kg max 50mg
    • 25mg for EPS

    Ped: 1mg/kg max 50mg
  56. Dobutamine Classifications
    • Sympathomimetic
    • Vasopressor
  57. Dobutamine Indications
    1. Short-term support for cardiogenic shock with refractory hypotension and myocardial dysfunction
  58. Dobutamine Mechanisms of Action
    • 1. Low dose (5-10mcg) primarily beta 1 an 2 effects - ino/chronotropic and vasorelaxation decreasing afterload.
    • 2. Higher doses (10-20mcg) have adrenergic alpha 1 effects.
    • 3. Small decrease in pulmonary resistance.
  59. Dobutamine Side Effects
    • 1. Tachycardia
    • 2. Dysrhythmias
    • 3. CP
    • 4. Nausea
    • 5. H/A
    • 6. HTN
  60. Dobutamine Contraindications
    • 1. Hypersensitivity to dob. or sulfites
    • 2. Uncontrolled hypovolemia (treat with fluids first)
    • 3. Uncorrected tachyarrhythmias
    • 4. Pheochromocytoma
    • 5. Idiopathic hypertrophic subaortic stenosis
  61. Dobutamine Dosing
    5mcg/kg/min titrating up to a max of 20mcg/kg/min
  62. Dopamine Classification
    • Sympathomimetic
    • Vasopressor
  63. Dopamine Indications
    • 1. Symptomatic bradycardia
    • 2. Cardiogenic shock with refractory hyopotension.
    • 3. Shock refractory to fluid resuscitation
    • 4. Pulmonary edema with hyoptension
  64. Dopamine Contraindications
    • 1. Pheochromocytoma
    • 2. Uncorrected tachyarrhythmias
    • 3. Hypovolemic shock where fluid resus has not occured
    • 4. MAOIs withing 14 days
    • 5. Hypersensitivity to sulfites
    • 6. VF
  65. Dopamine Mechanisms of Action
    • 1) 1-2mcg/kg/min - dopaminergic effects - vasodilation in renal, mesenteric, coronary and intracerebral vessels.
    • 2) 2-10mcg/kg/min - B1 effects - ino/chrono.
    • 3) 10-20mcg/kg/min - Alpha 1 effects - vasoconstriction
    • 4) >20mcg/kg/min - potent vasoconstrictor
  66. Droperidol Classifcations
    • Antiemetic
    • Neuroleptic (antipsychotic)
  67. Droperidol Indications
    • 1. Combative and aggressive behaviour
    • 2. Psychosis
    • 3. N/V with Meniere's Disease
  68. Droperidol Mechanisms of Action
    • 1. Blocks dopamine D2 receptors in the CTZ (chemotrigger zone) in brain. This creates antiemetic effect and risk of EPS. Also produces antipsychotic effect
    • 2. May lower seizure threshold
  69. Droperidol Contraindications
    • 1. QT prolongation
    • 2. Hypersensitivity
    • 3. Parkinson's
    • 4. Seizure disorder
    • 5. CNS depression
    • 6. Spastic disease
  70. Droperidol Side Effects
    • 1. Sedation
    • 2. EPS
    • 3. Hypotension
    • 4. QT prolongation
    • 5. Arrhythmias
  71. Droperidol Dosing

    Psych:

    N/V:
    • Psych: 14-60y/o 5mg IM with or without Versed IM. q 15min once.
    • >60y/o 2.5mg IM q 15min x1 with or without Versed

    2.5-10mg IV

    N/V: 1-5mg IV or IM q3-6hrs
  72. Enoxaparin Classification
    • LLMH
    • Anticoagulant
  73. Enoxaparin Indications
    • 1. Unstable Angine/NSTEMI/STEMI
    • 2. DVT
    • 3. PE
  74. Enoxaparin Mechanisms of Action
    • 1. Binds to antithrombin III and accerates activity which inhibits factor Xa thereby decreasing thrombin-mediated events in coagulation including conversion of fibrinogen to fibrin.
    • 2. Affects intrinsic pathway with almost immediate effects.
    • 3. Reversed by protamine sulfate.
  75. Enoxaparin Contraindications
    • 1. Clotting disorders
    • 2. Shock
    • 3. Hypersensitivity to pork products
    • 4. Active bleeding
    • 5. Hx of heparin induced thrombocytopenia (HIT)
  76. Enoxaparin Side Effects
    • 1. Bleeding
    • 2. Neuro injury with pts undergoing spinal puncture/epidural.
  77. Enoxparin Dosing
    STEMI:
    NSTEMI:
    DVT:
    STEMI: 30mg/kg bolus IV plus 1mg/kg SC followed by 1mg/kg SC q12hrs

    NSTEMI: 1mg/kg SC q 12hrs (with ASA) for 2-8 days

    DVT: 1mg/kg SC q12hrs for 7 days.
  78. Epi classification
    sympathomimetic
  79. Epi Indications
    • 1. Anaphylaxis
    • 2. Symptomatic bradycardia
    • 3. Refractory hypotension
    • 4. Cardiac Arrest
    • 5. Severe bronchospasm
    • 6. Stridor
  80. Epi Mechanisms of Action
    α1, β1, β2 agonist
  81. Epi Contraindications
    Anaphylaxis and Cardiac Arrest = none

    All others: uncorrected tachyarrhythmias
  82. Epi Dosing

    Anaphylaxis A/P:
    Bradycardia A/P:
    Refractory hypotension A/P:
    Cardiac arrest A/P:
    Severe bronchospasm
    Stridor
    • Anaphylaxis: 0.3mg IM q5min max 0.9mg
    •                     0.1mg 1:10 000 IV q2min max 1mg.
    •                     0.1mg 1:10 000 IV q3-5min prn
    • P : 0.01mg IM max 0.3mg q5 max 0.9mg

    • Bradycardia: 2mcg/min IV titrating to BP, max 10mcg
    • P: 0.01mg/kg 1:10 000 IV q 3-5min prn
    •     0.1mg/kg 1:1000 q3-5min prn

    Hypotension: Same as bradycardia

    • Cardiac arrest: 1mg 1:10 000 IV q3-5min prn
    • P: 0.01mg/kg 1:10 000 IV max 1mg q 3-5min prn

    • Severe bronchospasm: 0.3mg 1:1000 IM q 20min max 0.9mg
    • P: 0.01mg/kg 1:1000 max 0.3mg IM q20min max 0.9mg.

    Stridor: 5mg 1:1000 neb prn max 10mg
  83. Esmolol Classification
    Beta Blocker
  84. Esmolol Indications
    • 1. SVT/A-fib/flutter rate control
    • 2. HTN emergencies
  85. Esmolol Mechanisms of action
    • 1. Blocks β1 having neg ino/chrono/dromo effects decreasing myocaridal O2 demand.
    • 2. Blocks sympathomimetic neurotransmitters - blocking catecholamine response from hypgoglycemia.
  86. Esmolol Contraindications
    • 1. Hypersensitivity
    • 2. Bradycardia/AV block/CHF/RV failure
    • 3. Bronchospastic disease
    • 4. MI patients
    • 5. Concomitant use of CCB
    • 6. Drug induced HTN
  87. Esmolol Side Effects
    • 1. Hypotension
    • 2. AV blocks
    • 3. Bronchospasm
    • 4. Bradycardia
    • 5. CHF
  88. Esmolol Dosing
    Adult:
    Ped:
    Adult: 0.5mg/kg over 1 min followed by 0.05mg/kg/min infusion, max 0.3mg/kg/min. Titrate to effect.

    Ped: 0.5mg/kg over 2min followed by 0.2mg/kg/min infusion.
  89. Etomidate Classifications
    • Hypnotic
    • Sedative
  90. Etomidate Indications
    • 1. Sedation for RSS/RSI
    • 2. Maintenance of sedation
    • 3. Sedation for procedures
  91. Etomidate Mechanisms of Action
    • 1. Ultra short acting, non-barbiturate hypnotic (imidazole derivative)
    • 2. Minimal cardiovascular and respiratory effects. (best safety profile of sedatives used in RSI) therefore preferred in pts with cardiovascular disease
    • 3. Decreases ICP.
    • 4. Blocks stress response, decreasing cortisol production.
    • 5. No analgesia properties.
    • 6. Lowers seizure threshold.
    • 7. Does not elevate histamine release.
  92. Etomidate Contraindications
    • 1. Seizure disorders
    • 2. Hypersensitivity
  93. Etomidate Side Effects
    • 1. Tonic clonic skeletal movements
    • 2. N/V
    • 3. Transient apnea
    • 4. Vein irritation
  94. Etomidate Dosing

    Adult:

    Ped:
    Adult: 0.3mg/kg over 30-60 seconds

    Ped: 0.2mg/kg over 30-60 seconds.

    Onset is 10-20sec, peak at 1min. Duration of 10-15min
Author:
cgazzard
ID:
313849
Card Set:
Paramedic Meds D-E
Updated:
2016-05-09 17:34:03
Tags:
SAIT EMTP Meds
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Description:
ACP Prep
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