Paramedic Meds S-Z

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  1. Sodium Bicarbonate Classification
    Alkalinizing Agent
  2. Sodium Bicarbonate Indications
    • 1. Prolonged downtime with cardiac arrest
    • 2. Cardiac arrest due to ExDS
    • 3. TCA OD with wide QRS or/and seizures
    • 4. BB/CCB OD
    • 5. Sympathomimetic OD
    • 6. Hyperkalemia
    • 7. Any correction of metabolic acidosis.
  3. Sodium Bicarbonate Side Effects
    • 1. Alkalosis
    • 2. Water and Na retention
    • 3. Hypernatremia
    • 4. Hypokalemia
  4. Sodium Bicarbonate Contraindications
    • 1. None in emergent settings
    • 2. Respiratory or metabolic alkalosis
    • 3. Hypocalcemia
    • 4. Excessive chlorine loss (vomiting)
  5. Sodium Bicarbonate Dosing
    • Prolonged downtime: 1mEq/kg
    • TCA OD with wide QRS: 1mEq/kg q5 until QRS is narrow
    • TCA OD with seizures: 1mEq/kg before benzos
    • BB/CCB OD: 1mEq/kg q5 max 2mEq/kg
    • Sympathommimetic OD: 1mEq/kg q5 max 2mEq/kg
    • Cardiac arrest due to ExDS: 2mEq/kg
  6. Steptokinase (Streptase) Classification
    Fibrinolytic
  7. Steptokinase (Streptase) Indications
    • 1. AMI
    • 2. PE
    • 3. DVT
  8. Steptokinase (Streptase) Mechanisms of Action
    • 1. Derived from bacteria β-hemolytic streptococci that converts plasminogen into plasmin. Plasmin digests fibrin.
    • 2. Not clot specific
    • 3. Body develops antibodies after 5 days to it for 6m-1y so cannot re-admin
  9. Steptokinase (Streptase) Side Effects
    • 1. Hypotension
    • 2. Bleeding
    • 3. Fever
    • 4. N/V
    • 5. Anaphylaxis
  10. Steptokinase (Streptase) Contraindications
    • 1. Prior intracranial hemorrhage
    • 2. CVA lesion
    • 3. Malignant intracranial neoplasm
    • 4. Ischemic stroke within 3 months except acute within 3 hrs
    • 5. Aortic dissection
    • 6. Active bleeding
    • 7. Significant closed head trauma of facial trauma within 3 months

    • Relative:
    • 1. Poorly/uncontrolled HTN
    • 2. Uncontrolled HTN sys >180 or DBP >110
    • 3. Ischemis stroke >3 months
    • 4. Traumatic or prolonged CPR or major bleed within 3 weeks
    • 5. Recent intracranial bleed (2-4wks)
    • 6. Noncompressible vascular punctures
    • 7. Streptokinase/aniteplase greater than 5 days.
    • 8. Pregnancy
  11. Steptokinase (Streptase) Dosing
    AMI: 1.5million units over 1hr

    • PE: 250 000 units over 30min
    •       100 000 units over 24hrs
  12. Succinylcholine (Anectine) Classification
    Short acting depolarizing neuromuscular blocking agent
  13. Succinylcholine (Anectine) Indications
    • RSI
    • Surgery
  14. Succinylcholine (Anectine) Mechanisms of Action
    • 1. Binds to post synaptic receptors on motor end-plate.
    • 2. Since it's metabolized slower than ACh it produces an ongoing depolarization on postsynaptic receptors. (can release potassium)
  15. Succinylcholine (Anectine) Side Effects
    • 1. Arrhythmias
    • 2. Intreased intragastric and intraocular pressure
    • 3. Hyperkalemia
    • 4. Malignant hyperthermia
    • 5. Fasciculations
  16. Succinylcholine (Anectine) Contraindications
    • 1. Hyperkalemia
    • 2. Hypersensitivity
    • 3. Hx /FmHx or malignant hyperthermia
    • 4. Penetrating globe injury/acute narrow angle glaucoma
    • 5. Myopathies
    • 6. Spinal cord injuries
  17. Succinylcholine (Anectine) Dosing
    1.5mg/kg max 150mg

    2mg/kg in crash pts

    Peds: 1mg/kg
  18. Malignant Hyperthermia
    Genetically linked metabolic reaction that increased body temp rapidly, produces tachycardia, tachypnea and muscular rigidity.
  19. Tenecteplase (TNKase) Classification
    Fibrinolytic
  20. Tenecteplase (TNKase) Indications
    • 1. CVA
    • 2. AMI
  21. Tenecteplase (TNKase) Mechanisms of Action
    • 1. DNA recombinant human tissue-type plasminogen activator (tPA) that catalyzes cleavage of plasminogen into plasmin.
    • 2. Plasmin breaks down fibrin.
  22. Tenecteplase (TNKase) Side Effects
    • 1. Arrhythmias
    • 2. Bleeding
    • 3. Hypotension
  23. Tenecteplase (TNKase) Contraindications
    • 1. Prior intracranial hemorrhage
    • 2. CVA lesion
    • 3. Malignant intracranial neoplasm
    • 4. Ischemic stroke within 3 months except acute within 3 hrs
    • 5. Aortic dissection
    • 6. Active bleeding
    • 7. Significant closed head trauma of facial trauma within 3 months

    • Relative:
    • 1. Poorly/uncontrolled HTN
    • 2. Uncontrolled HTN sys >180 or DBP >110
    • 3. Ischemis stroke >3 months
    • 4. Traumatic or prolonged CPR or major bleed within 3 weeks
    • 5. Recent intracranial bleed (2-4wks)
    • 6. Noncompressible vascular punctures
    • 7. Pregnancy
  24. Tenecteplase (TNKase) Dosing
    • Weight based:             Max 50mg
    • <60kg           30mg
    • 60-70            35mg
    • 70-80            40mg
    • 80-90            45mg
    • >90kg           50mg
  25. Tetanus Toxoid Classification
    Toxoid
  26. Tetanus Toxoid Indication
    Immunization against tetanus
  27. Tetanus Toxoid Mechanisms of action
    • 1. Toxoids are vaccines that provide active immunization.
    • 2. Antigens are injected that stimulate the humoral immune system to produce anitbodies.
    • 3. Is now only available as DPT - with diptheria and pertussis
  28. Tetanus Toxoid Side Effects
    • 1. Local effects at injection site
    • 2. Severe effects include encephalitis, peripheral neuropathy, anaphylaxis, shock, unresponsiveness, temp >39.
    • 3. Fever
  29. Tetanus Toxoid Contraindications
    1. Hx of systemic hypersensitivity
  30. Tetanus Toxoid Dosage
    0.5ml IM for adult and peds

    Need 3 doses throughout days/weeks
  31. Thiamine (Betaxin) Classification
    Vitamin B1
  32. Thiamine (Betaxin) Indications
    • 1. Thiamine deficiency - malnutrition, chronic alcoholism
    • 2. Prevention of Wernicke's encephalopathy
    • 3. Malnourished pt who requires glucose
  33. Thiamine (Betaxin) Mechanisms of Action
    1. Thiamine is required for carbohydrate metabolism
  34. Thiamine (Betaxin) Side Effects
    Very rare, if any

    • 1. Hypotension
    • 2. Resp failure
    • 3. Dyspnea
  35. Thiamine (Betaxin) Contraindications
    • 1. None in emergent setting
    • 2. Hypersensitivity to or to bisulfites
  36. Thiamine (Betaxin) Dosage
    Adult 100mg IV/IM

    Peds: Rarely indicated ... 10-25mg IV/IM
  37. Wernicke's Encephalopathy:
    Acute and irreversible disorder associated with chronic alcoholism seen with poor voluntary muscle coordination, eye muscle weakness and mental derangement.
  38. Korsakoff's Syndrome:
    Memory disorder as a result of chronic alcoholism. Reversible syndrome characterized by disorientation, hallucination and painful extremities.
  39. Thiamine (Betaxin) Onset/Peak/Duration
    • Onset: 1hr
    • Peak: Days
    • Duration: days-weeks
  40. Thiopental (Pentothal) Classification
    Barbiturate
  41. Thiopental (Pentothal) Indications
    • 1. Seizures/status
    • 2. Sedation
  42. Thiopental (Pentothal) Mechanisms of Action
    • 1. Potentiates GABA inhibiting nerve impulse transmission. This increases seizure threshold
    • 2. Decreases ICP, vasodilator, myocardial depressant.
    • 3. Stimulate hepatic metabolism of drugs
  43. Thiopental (Pentothal) Side Effects
    • 1. Resp depression/apnea/bronchospasm/laryngospasm
    • 2. Hypotension, vasodilation
    • 3. N/V/D
  44. Thiopental (Pentothal) Contraindications
    • 1. Hypersensitivity
    • 2. Dyspnea
    • 3. Pregnancy
    • 4. Severe liver dysfunction
  45. Thiopental (Pentothal) Dosing
    Adults: 50-75mg SIVP repeat at 25-50mg if required

    Peds: 2-4mg/kg
  46. Tetracaine (Pontocaine) Classification
    Local anesthetic
  47. Tetracaine (Pontocaine) Indications
    • Local anesthesic - mainly eyes
    • Spinal anesthesia
  48. Tetracaine (Pontocaine) Mechanisms of Action
    • 1. Interferes with ion channels stabilizing nerve cell membrane and inhibiting transmission.
    • 2. No effects on CNS
  49. Tetracaine (Pontocaine) Side Effects
    1. Allergy
  50. Tetracaine (Pontocaine) Contraindication
    Allergy
  51. Tetracaine (Pontocaine) Dose
    0.5% solution 1-3gtts
  52. Theophylline (Theolair) Classification
    Xanthine
  53. Theophylline (Theolair) Indications
    • 1. Bronchospasm
    • 2. Mostly used as a preventative or in conjunction with rescue meds as it has a slower onset of action
  54. Theophylline (Theolair) Mechanisms of Action
    • 1. Narrow therapeutic index
    • 2. Increases level of cAMP which contributes to smooth muscle relaxation and inhibits IgE (allergy immunoglobin).
    • 3. Metabolized into caffeine and stimulated CNS - positive ino/chrono effects and stimulate resp drive.
    • 4. Promotes renal vasodilation and increases GFR
  55. Theophylline (Theolair) Side Effects:
    • 1. N/V
    • 2. Tachycardia/arrhythmias
    • 3. Hyperglycemia
  56. Theophylline (Theolair) Contraindications
    • 1. Allergy
    • 2. Uncontrolled arrhythmias
    • 3. Seizure disorders
    • 4. Hyperthyroidism
    • 5. Peptic ulcers
  57. Theophylline (Theolair) Dosage
    • 16mg/kg/day divided into 3-4 doses PO
    • Max 400mg/day
  58. Ticagrelor (Brilianta) Classification
    Antiplatelet
  59. Ticagrelor (Brilianta) Indication
    STEMI/ACS
  60. Ticagrelor (Brilianta) Mechanisms of Action
    Prevents platelet aggregation by reversibly interacting with platelet receptors, preventing signal transduction and platelet activation
  61. Ticagrelor (Brilianta) Side Effects
    • 1. Bleeding
    • 2. Dyspnea
    • 3. Bradycardia
  62. Ticagrelor (Brilianta) Contraindications
    • 1. Bleeding
    • 2. Hx on intracranial hemorrhage
    • 3. Severe hepatic impairment
    • 4. Hypersensitivity
  63. Ticagrelor (Brilianta) Dosing
    180mg PO
  64. Tranexemic Acid (TXA) Classification
    Antifibrinolytic
  65. Tranexemic Acid (TXA) Indications
    Traumatic Hemorrhage
  66. Tranexemic Acid (TXA) Mechanisms of Action
    Prevents lysis of fibrin thereby prevent clot breakdown.
  67. Tranexemic Acid (TXA) Contraindications
    • 1. Hypersensitivity
    • 2. Active thromboembolic disease (CVA, PE, DVT...)
    • 3. >3hrs since injury
    • 4. pt <16y/o without OLMC
  68. Tranexemic Acid (TXA) Dosing
    1g in 250ml over 10min
  69. Vasopressin (Pressyn) Classification
    Hormone (Posterior pituitary) (ADH)
  70. Vasopressin (Pressyn) Indications
    • 1. Alternative to epi in CPR to increase vascular resistance
    • 2. Vasodilatory shock
  71. Vasopressin (Pressyn) Mechanisms of Action
    • 1. Non α adrenergic vasoconstricto through direct stimulation of smooth muscle receptors
    • 2. Directly stimulate GI tract musculature
    • 3. Changes permeability of renal collecting ducts to allow water reabsorption
  72. Vasopressin (Pressyn) Side Effects
    • 1. Hypertension
    • 2. Mild arrhythmias/bradycardia
    • 3. Water retention
    • 4. Abd cramps
    • 5. N/V
    • 6. Blanching of skin
    • 7. CP/MI
  73. Vasopressin (Pressyn) Contraindications
    • 1. None in CPR
    • 2. Chronic nephritis/renal failure
    • 3. CAD
    • 4. PVC's
  74. Vasopressin (Pressyn) Dosing
    40u x1 in CPR

    Shock: 0.01-0.1u/min
  75. Vecuronium (Norcuron) Classification
    Intermediate acting nondepolarizing neuromuscular blocking agent
  76. Vecuronium (Norcuron) Indications
    • RSI
    • Surgery
  77. Vecuronium (Norcuron) Mechanisms of Action
    • 1. Derivative of Pancuronium, shorter acting.
    • 2. Competitively binds to postsynaptic receptors blocking ACh from binding and preventing depolarization.
  78. Vecuronium (Norcuron) Side Effects
    • 1. Bronchospasm
    • 2. HTN
    • 3. Arrhythmias
  79. Vecuronium (Norcuron) Contraindications
    1. vec or bromide allergy
  80. Vecuronium (Norcuron) Dosing
    0.1mg/kg

    Defasciculation dose of 0.01mg/kg
  81. Vecuronium (Norcuron) Onset/Peak/Duration
    • Onset: <1min
    • Peak: 3-5min
    • Duration: 25-40min
  82. All paralytic interactions
    Enhanced by Mag sulfate, lidocaine, procainamide, BB, and other paralytics
  83. Verapamil (Isoptin) Classification
    Calcium Channel Blocker
  84. Verapamil (Isoptin) Indications
    • 1. SVTs/afib/flutter = mainly
    • 2. HTN
    • 3. Angina
    • 4. Migraines
  85. Verapamil (Isoptin) Mechanisms of action
    • 1. Inhibits Ca uptake into myocardial and vascular smooth muscle = inhibition of excitation-conduction coupling and vasodilation in coronary and peripheral vessels.
    • 2. Decreases myocardial O2 demand and increases O2 delivery to heart tissue
    • 3. Decreases automaticity and conduction through SA and AV nodes
  86. Verapamil (Isoptin) Side Effects
    • 1. Hypotension
    • 2. Bradycardia/heart blocks
    • 3. HF
    • 4. Peripheral Edema
  87. Verapamil (Isoptin) Contraindications
    • 1. Hypersensitivity
    • 2. AMI
    • 3. 2-3rd degree blocks
    • 4. Hypotension
    • 5. Cardiogenic Shock
    • 6. Wide complex tachycardias
  88. Verapamil (Isoptin) Dosing
    5-10mg IV repeat 10mg @10min x1 prn

    Peds: 0.1-0.3mg/kg max 5mg IV q30min x1 prn
  89. Xylometrazoline Classification
    • Topical nasal decongestant
    • alpha adrenergic agent
  90. Xylometrazoline Indications
    Nasal congestion
  91. Xylometrazoline Mechanisms of Action
    Stimulates α1 and α2 reeptors in nose resulting in vasocontrictions of veins.
  92. Xylometrazoline Contraindications
    HTN and Heart problems

Card Set Information

Author:
cgazzard
ID:
320000
Filename:
Paramedic Meds S-Z
Updated:
2016-05-11 19:00:43
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Paramedic Meds
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Paramedic Meds S-Z
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