CCT_Drugs.txt

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wdzracer
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8027
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CCT_Drugs.txt
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2010-03-21 09:00:21
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Drugs
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CCT Drugs
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  1. Fentanyl
    • • Class- Opioid agonist
    • • Indication- Analgesia and Anesthesia
    • • Dose- 1-2 mcg/kg Slow IVP; Infusion: 1mcg/kg/hr and may titrate
    • • Onset- less than 30 seconds Duration- 30-60 minutes
    • • Side Effects- Dizziness, blurred vision, depressed respiratory function, N/V, muscle rigidity
    • • Special Notes: Crosses placental barrier, reversed with Narcan
  2. Morphine Sulphate
    • • Class- Opioid Agonist
    • • Indication- Analgesia
    • • Dose- 0.05-0.1 mg/kg IVP
    • • Onset- 30-60 seconds; Duration- 30-60 minutes
    • • Side Effects- Dizziness, N/V, depressed respiratory function
    • • Special Notes: Reversed with Narcan
  3. Meperidine (Demerol)
    • • Class- opioid
    • • Indication- Analgesia
    • • Dose- 50-100 mg slow IVP or IM
    • • Onset- 2-10 minutes; Duration- 60 minutes
    • • Side Effects- respiratory depression,seizures, confusion, N/V
    • • Special Notes- can be given IM to follow an IV
  4. Ketamine (Ketalar)
    • • Class- Anesthetic/Analgesic
    • • Indication- Anesthesia/Analgesia for pediatric Asthma Pt.
    • • Dose- 1-2 mg/kg IV q 10-20 minutes
    • • Onset- Immediate; Duration- 10-20 minutes
    • • Side Effects- HTN, Respiratory Depression, Tachycardia, Hallucination
    • • Special Notes- Do not use if pt is HTN, or has increased ICP
  5. Atenolol (Tenormin)
    • • Class- Beta Blocker, anti-anginal
    • • Indication- Angina, refractory CP, Acute MI
    • Dose- 5 mg slow IVP over 5 minutes, then an additional 5 mg in 10 minutes
    • • Onset- 1-2 minutes; Duration- 1-2 hours
    • • Side Effects- Hypotension, CHF, bronchospasm, dizziness, N/V
    • • Special Notes- Use of calcium channel blockers may increase side-effects
  6. Nitroglycerin IV
    • • Class- Peripheral vasodilator; Nitrate; Antihypertensive
    • • Indication- ACS, Hypertensive Emergency, CHF
    • Dose; 10-20 mcg/min, titrate by 5-10mcg every 5-10 minutes
    • • Onset- 1-2 minutes; Duration- 30 minutes
    • • Side Effects- Headache, hypotension, syncope, tachycardia
    • • Special Notes: Caution with hypotension, hypovolemia, nonabsorbent tubing should be used when giving ntg via infusion
  7. Amiodarone
    • • Class- Class 3 Anti-Arrhythmic
    • • Indication- Recurrent VF/Pulseless VT, perfusing SVT
    • • Dose- “living pt” gets 150 mg, “dead pt” gets 300 mg; Infusion- Rapid infusion of 150 mg, then 360mg over 6 hours, then 540 mg over 18 hours
    • • Side Effects- vasodilation, hypotension, bradycardia, AV blocks, prolonged QT interval, hepatotoxicity
    • • Special Notes: Contraindicated in cardiogenic shock, 2nd or 3rd degree heart blocks, 40 day half life
  8. Lidocaine
    • • Class- Anti-Arrhythmic
    • • Indication- VF, VT, ventricular arrhythmias
    • • Dose- 1-1.5 mg/kg
    • • Onset- 30-90 seconds; Duration- 2-4 hours
    • • Side Effects- seizures, slurred speech, altered mental status
    • • Special Notes- use 50% dosage in ederly patients
  9. Procainamide
    • • Class- Anti-Arrhytmic
    • • Indication- cardiac arrest, VF/VT, PSVT
    • • Dose- 100 mg IVP every 5 minutes to a max of 17 mg/kg; Infusion- 50 mg/minute
    • • Onset- 10-30 minutes; Duration- 3-6 hours
    • • Side Effects- PR, QRS, and QT widening, AV Block, hypotension, N/V
    • • Special Notes- contraindicated for Digitalis toxicity, 2nd and 3rd degree AV blocks, myasthenia gravis
  10. Cardizem
    • • Class- Calcium Channel Blocker; Anti-Arrhythmic; Anti-Hypertensive
    • • Indication- Rate control in A-Fib/A-Flutter; Second line treatment for SVT
    • • Dose- 15-20 mg (0.25 mg/kg) IV over 2 minutes, then repeat 20-25 mg (0.35 mg/kg) in 15 minutes if needed; Infusion- should follow at 5-15 mg/min
    • • Onset- 2 Minutes; Duration- 1-2 Hours
    • • Side Effects- hypotension, bradycardia, N/V, CHF, dizziness
    • • Special Notes- May increase Dig levels, contraindicated in WPW, Do not give in same line as lasix due to incompatibility, usually requires refrigeration
    • Incompatible with Lasix
  11. Cefazolin (Ancef)
    • • Class- cephalosporin generation 1
    • • Indication- systemic infection
    • • Dose- 250-1000 mg IM or IV every 6-8 hours
    • • Onset- rapid; Duration- 6-12 hours
    • • Side Effects- phlebitis, diarrhea, rash, urticaria, pruritis, pain, induration
    • • Special Notes- must be reconstituted with NS, dilute in 50-100 ml NS and infuse over 15-30 minutes, caution in patients with PCN
    • allergy
    • 1g/ 2g for open fracture
  12. Furosemide (Lasix)
    • • Class- Loop Diuretic
    • • Indication- Diuresis, CHF with Pulmonary edema, hypertensive crisis
    • • Dose- 0.5-1 mg/kg Slow IVP to a max of 2 mg/kg
    • • Onset- 5 minutes; Duration- 5-6 hours
    • • Side Effects- Hypokalemia, hypotension, dehydration
    • • Special Notes- Use caution in patients with hepatic coma and hypokalemia
    • If pushed too fast, causes deafness
  13. Bumetanide (Bumex)
    • • Class- Loop Diuretic
    • • Indication- edema, HTN, pulmonary edema
    • • Dose- 0.5-1 mg IV over 1-2 minutes, may repeat every 2-3 hours up to 10 mg in 24 hour period
    • • Onset- 10-20 minutes; Duration 2-3 hours
    • • Side Effects- electrolyte imbalance, dizziness, headache, N/V
    • • Special Notes: 40 times stronger than lasix, usually given to pt who dont respond ti thiazide diuretics or rapid diuresis is needed, will increase the effects of non-depolarizing medications
    • K+ Sparing Diuretic, Increases effects of Verconium
  14. Nesiritide (Natrecor)
    • • Class- human B type natriuretic peptide
    • • Indication- acutely decompensated CHF
    • • Dose- 2 mcg/kg IV followed by infusion of 0.01 mcg/kg/min
    • • Onset- 15-60 minutes; Duration- 1-2 hours after d/c of infusion
    • • Side Effects- Hypotension, azotemia, headache, anxiety, N/V
    • • Special Notes: d/c or decrease dose if hypotension develops
  15. Digoxin (Lanoxin)
    • • Class- Anti- Arhythmic, Anti- CHF
    • • Indication- A-Fib, A-Flutter, PSVT, CHF
    • • Dose- 0.5-1 mg IV over 5 minutes
    • • Onset- 5-10 minutes; Duration- 12 hours
    • • Side Effects- Toxicity, N/V, fatigue, Headache, diarrhea, seizures
    • • Special Notes- Use caution in Renal Failure, do not use if HR less than 60
    • Peaked "T" waves
  16. Inamrinone (Inocor)
    • • Class- Inotropic Dilator
    • • Indication- Acute Severe CHF
    • • Dose- 0.75 mg/kg Slow IVP, may repeat in 30 minutes; Infusion; 2-15 mcg/kg/min
    • • Onset- 2-5 minutes; Duration- 30-50 minutes
    • • Side Effects- hypotension, Idiopathic Hypertrophic Subaortic Stenosis, hypovolemia, chest pain
    • • Special Notes- Do not mix with dextrose solutions or lasix
  17. Clopidogrel (Plavix)
    • • Class- anti-platelet
    • • Indication- NSTEMI, anti-platelet therapy
    • • Dose- 300 mg PO followed by 75 mg PO daily
    • • Onset- within 24 hours; Duration 24 hours
    • • Side Effects- rash, flu-like symptoms
    • • Special Notes- do not use with active bleeding disorders or hepatic impairment, do not use if CABG is planned within 5 days
  18. Heparin
    • • Class- anti-coagulant
    • • Indication- anti-coagulation therapy in Acute MI, DVT, and PE
    • • Dose- 60 units/kg IVP up 5000 units and 12 units/kg/hour infusion (5000 Unit bolus, 1000 u/hr Maintenance)
    • • Onset- 5-20 minutes; Duration- 24 hours
    • • Side Effects- bleeding, allergic reaction, thrombocytopenia, itching
    • • Special Notes- Do not give if platelet count is less than 100, heparin toxicity can be reversed with protamine sulphate
    • Protomine Sulfate used as Antidote
  19. Enoxaparin (Lovenox)
    • • Class- low molecular weight heparin, anti-coagulant, inhibits factors 2A and XA
    • • Indication- Acute Coronary Syndromes, DVT, PE
    • • Dose- 1 mg/kg BID
    • • Onset- 20-30 minutes; Duration- 8-12 hours
    • • Side Effects- bleeding, allergic reaction, thrombocytopenia, itching
    • • Special Notes- Should be given with ASA concurrently
  20. Eptifibatide (Integrilin)
    • • Class- Glycoprotein 2B/3A inhibitor, anti-coagulant
    • • Indication- Acute Coronary Syndromes, NSTEMI
    • • Dose- ACS: 180 mcg/kg Bolus over 1-2 minutes, then 2 mcg/kg/hour for 72-96 hours
    • • Onset- Rapid; Duration- 36 hours
    • • Side Effects- bleeding, allergic reaction, arrythmias, thrombocytopenia
    • • Special Notes- use caution or withhold if platelet count is less than 150 or patient has any other bleeding risks
  21. Abciximab (Reopro)
    • • Class- Anti-Platelet
    • • Indication- Acute coronary syndromes, unstable angina
    • • Dose- 0.25 mg/kg IV then 0.125 mcg/kg/min infusion
    • • Onset- 2-3 minutes; Duration- 4 hours
    • • Side Effects- Bleeding, allergic reaction
    • • Special Notes- Use in conjunction with heaprin
  22. Lorazepam (Ativan)
    • • Class- Benzodiazepine, anti-anxiety, hypnotic sedative
    • • Indication- Sedation, Amnesia, Seizures (Best for Active Siezures)
    • • Dose- 0.05 mg/kg IVP up to 4 mg (2mg Normal Dose)
    • • Onset- 1-5 minutes; Duration- 6-24 hours
    • • Side Effects- N/V, drowsiness, restlessness, delirium
    • • Special Notes- decrease dosing in elderly, may be given rectally if no IV or IO access readily available, reversible with romazicon
  23. Phenobarbital
    • • Class- Anti- Convulsant
    • • Indication- Seizures, Status Epilepsy
    • • Dose- 100-250 mg Slow IVP or IM
    • • Onset- 3-30 minutes; Duration- 4-6 hours
    • • Side Effects- Respiratory depression, hypotension, coma, N/V
    • • Special Notes- use caution in pulmonary or hepatic dysfunction
  24. Phenytoin (Dilantin)
    • • Class- Anti-Convulsant, class 1B Anti-dysrhythmic
    • • Indication- seizures, digoxin toxicity
    • • Dose- 15-20 mg/kg; Digoxin Toxicity- 1.25 mg/kg IV every 5 minutes to a total of 15 mg/kg
    • • Onset- 5-15 minutes; Duration- Up to 24 hours
    • • Side Effects- lethargy, headache, irritability, restlessness, vertigo, hypotension, bradycardia, anorexia
    • • Special Notes- Caustic to veins, use larger veins, dilute in NS only
    • For Digoxin Toxicity- 1.25 mg/kg
  25. Fosphenytoin (Cerebyx)
    • • Class- anticonvulsant
    • • Indication- seizures (Seizure Preventative)
    • • Dose- 15-20 mg/kg
    • • Onset- 1-5 minutes; Duration- 6 hours
    • • Side Effects- tinnitus, dizziness, somnolence, headache, parathesia, pruritis
    • • Special Notes- causes increased risk of hypotension with
    • rapid administration, less irritable to veins than phenytoin
  26. Diazepam (Valium)
    • • Class- Benzodiazepine, Anti-Convulsant, Sedative
    • • Indication- Epilepsy, Status Epilepsy, Sedation
    • • Dose- Epilepsy: 5-10 mg Slow IVP; Sedation: 5-15 mg Slow IVP
    • • Onset- 1-5 minutes; Duration- 6-10 hours
    • • Side Effects- respiratory depression, hypotension, drowsiness, venous irritation
    • • Special Notes- reversed with romazicon, can be given rectally
  27. Ondanesetron (Zofran)
    • • Class- Anti-Emetic
    • • Indication- Nausea & Vomiting
    • • Dose- 4 mg Slow IVP or IM
    • • Onset- 30-60 seconds; Duration- 4-6 hours
    • • Side Effects- headache, dizziness, pain at injection site
    • • Special Notes- may precipitate with bicarb administration
  28. Prochlorperazine (Compazine)
    • • Class- Anti-Emetic
    • • Indication- Nausea & Vomiting, Psychosis
    • • Dose- 2.5-10 mg Slow IVP or IM every 4 hours (5mg Normal Dose)
    • • Onset- 2-5 minutes; Duration- 4-6 hours
    • • Side Effects- headache, dizziness, amenorrhea, neuroleptic malignant syndrome, jaundice
    • • Special Notes- contraindicated in dehydrated pediatric patients
  29. Promethazine (Phenergan)
    • • Class- Anti-Emetic, Anti-Histmine
    • • Indication- Nausea & Vomiting
    • • Dose- 12.5-25 mg Slow IVP diluted in 10 ml of NS
    • • Onset- 2-5 minutes; Duration- 4-6 hours
    • • Side Effects- Dizziness, drowsiness, respiratory depression
    • • Special Notes- Never administer without diluting in NS
  30. Captopril (Capoten)
    • • Class- Anti-Hypertensive, ACE inhibitor
    • • Indication- HTN, heart failure, LV Dysfunction
    • • Dose- 50 mg PO
    • • Onset- 50-60 minutes; Duration- 24 hours
    • • Side Effects- proteinuria, thrombocytopenia, photosensitivity, chest pain
    • • Special notes- max dose is 450 mg daily
  31. Clonidine (Catapres)
    • • Class- alpha agonist hypotensive agent
    • • Indication- HTN
    • • Dose- 0.1 mg PO Twice Daily
    • • Onset- 50-60 minutes; Duration- 24 hours
    • • Side Effects- fatigue, fever, headache, N/V, bradycardia, anxiety, delirium
    • • Special Notes- most patients develop leg cramps shortly after admnistration
  32. Nitroprusside (Nipride)
    • • Class- peripheral vasodilator, anti-hypertensive
    • • Indication- HTN crisis, after-load reduction in heart failure, MV or AV regurgitation
    • • Dose- 0.1-10 mcg/kg/min and titrate every 3-5 minutes (2.5 mcg/kg/min)
    • • Onset- 30-60 seconds; Duration- 1-10 minutes
    • • Side Effects- reflex tachycardia, cyanide toxicity, CO2 retention
    • • Special Notes- Nipride is made with fractionated cyanide, toxicity is treated with amyl nitrate
    • Decreases Afterload
  33. Metoprolol (Lopressor)
    • • Class- Beta1 Blocker
    • • Indication- Acute MI, HTN, atrial tachydysrhythmias
    • • Dose- 5 mg slow IVP at 5 minute intervals to a max of 15 mg
    • • Onset- 5 minutes; Duration- 5-8 hours
    • • Side Effects- hyptension, CHF, bronchospasm, bradycardias, dizziness, chest pain, headache, N/V
    • • Special Notes- do not give if Systolic BP is less than 90 or Heart Rate is less than 60, use caution in CHF, bronchospasm, or asthma
  34. Nicardipine (Cardene)
    • • Class- Anti-Hypertensive, Calcium Channel Blocker
    • • Indication- HTN
    • • Dose- 5-20 mg over 1 hour mixed 50 mg in 230 ml D5W
    • • Onset- 1-2 minutes; Duration 12-24 hours
    • • Side Effects- edema, hypotension, aortic stenosis, N/V, flusing
    • • Special Notes- Do not mix with LR, change IV site every 12 hours due to irritation
    • Calcium Gluconate or Calcium Chloride used as antidote.
  35. Labetalol (Normodyne)
    • • Class- Beta1 and Alpha adrenergic antagonist
    • • Indication- HTN
    • • Dose- 10 mg IVP over 1-2 minutes, may repeat or double every 10 minutes to a max of 150 mg
    • • Onset- 5 minutes; Duration- 3-6 hours
    • • Side Effects- hypotension, N/V, dizziness, sweating
    • • Special Notes- keep patient supine during administration, avoid use in bronchial asthma, 2nd or 3rd degree blocks, and hepatic failure
  36. Esmolol (Breviblov)
    • • Class- Anti-Hypertensive, Anti-Arrhythmic (Beta Blocker)
    • • Indication- HTN, A-Fib
    • • Dose- 250-500 mcg/kg over 1 minute then infusion at 25-50 mcg/kg/min
    • • Onset- 1-2 minutes; Duration- 2-3 hours
    • • Side Effects- hypotension, bradycardia, dizziness, chest pain, headache
    • • Special Notes- Calcium Channel Blockers exacerbate side effects
  37. Hydralazine (Apresoline)
    • • Class- Anti-Hypertensive
    • • Indication- HTN
    • • Dose- 10-50 mg IV or IM (20 mg Standard dose)
    • • Onset- 15-30 minutes; Duration- 3-8 hours
    • • Side Effects- dyspnea, headache, N/V, palpitations, angina
    • • Special Notes- Avoid use in patients taking MAO Inhibitors
  38. Albuterol
    • • Class- Bronchodilator
    • • Indication- Bronchospasm, COPD, Asthma
    • • Dose- 1.25-2.5 mg via Nebulizer
    • • Onset- 5-15 minutes; Duration- 3-4 hours
    • • Side Effects- Tachydysrhythmias, anxiety, N/V
    • • Special Notes- avoid use in patients with tachycardia
  39. Metaproterenol (Alupent)
    • • Class- Bronchodilator
    • • Indication- Bronchospasm, COPD, Asthma
    • • Dose- 10-15 mg in 3ml NS via Nebulizer
    • • Onset- 5-15 minutes; Duration- 2-3 hours
    • • Side Effects- tachydysrhythmias, anxiety, N/V
    • • Special Notes- avoid use in patients with tachycardia
  40. Ipratropium (Atrovent)
    • • Class- Bronchodilator
    • • Indication- Bronchospasm, COPD, Asthma
    • • Dose- 0.5 mg in 2.5 ml of NS via Neb
    • • Onset- 3-5 minutes; Duration- 2-5 hours
    • • Side Effects- Dry mouth, Headache, cough
    • • Special note- does not cause tachycardia like albuterol
  41. Theophylline
    • • Class- Bronchodilator
    • • Indication- Bronchospasm, COPD, Asthma
    • • Dose- Varies by Serum Theophylline
    • • Onset- Rapid; Duration- 2-5 hours (depending on serum levels)
    • • Side Effects- N/V, headache, muscle tremors, hypercalcemia
    • • Special Notes- in patients with Cor Pulmonale, infusion rate should not exceed 17 mg/hr
  42. Racemic Epinephrine
    • • Class- sympathomimetic agent
    • • Indication- Croup
    • • Dose- 0.05 ml/kg/dose up to 5 ml diluted with 2.5 ml NS over 15 minutes via Neb
    • • Onset- within 5 minutes; Duration- 2-4 hours
    • • Side Effects- tachydysrhythmias, headache, N/V, palpitations
    • • Special Notes- rebound airway edema may occur, be prepared to control airway
  43. Levalbuterol (Xopenex)
    • • Class- Beta2 adrenergic agonist
    • • Indication- Asthma, bronchoconstriction
    • • Dose- 0.63-1.25 mg every 6-8 hours
    • • Onset- rapid; Duration- 6-8 hours
    • • Side Effects- tachycardia, palpitations, tremors, insomnia, nervousness, N/V, headache
    • • Special Notes- Doesn’t increase HR as much as albuterol
  44. Cimetidine (Tagamet)
    • • Class- Histamine (H2) antagonist
    • • Indication- GERD, ulcers, peptic ulcer disease
    • • Dose- 300 mg IVPB or IM
    • • Onset- 10-20 min; Duration- 6 hours
    • • Side Effects- diarrhea, rash, myalgias, confusion, neutropenia, gynecomastia
    • • Special Notes- use smaller dose in renal diseases, rapid administration will cause hypotension and bradycardia, prolongs half-life of: valium, versed, lopressor, lidocaine
  45. Famotidine (Pepcid)
    • • Class- Histamine Blocker
    • • Indication- GERD, GI ulcers
    • • Dose- 20 mg IV every 12 hours
    • • Onset- 5-10 minutes; Duration- 10-12 hours
    • • Side Effects- Headache, dizziness, N/V, fever, fatigue
    • • Special Notes- frequent dosage usually causes tinnitus
  46. Ranitidine (Zantac)
    • • Class- Histamine blocker
    • • Indication- duodenal ulcers, patients who are NPO
    • • Dose- 50 mg IVP or IM every 6-8 hours
    • • Onset- 3-5 minutes; Duration- 6-8 hours
    • • Side Effects- itching, pain at injection site, dizziness, insomnia, bradycardia
    • • Special Notes- continuous zantac administration increases risk for pneumonia
  47. Magnesium Sulphate
    • • Class- replacement agent, anticonvulsant
    • • Indication- Torsades, status asthmaticus, tocolysis
    • • Dose- Torsades: 1-2 gm/kg IVP or IVPB; Asthma: 25-75 mg/kg IVPB up to 2 gm over 20 minutes; tocolysis- 6 gm IV load, then 2-3 gm/hr infusion
    • • Onset- Immediately; Duration- 3-4 hours
    • • Side Effects- hypotension, respiratory/CNS depression, flushing, sweating
    • • Special Notes- Max rate is 150 mg/min, assess DTR, rapid infusion causes feeling “hot”
  48. Oxytocin (Pitocin)
    • • Class- oxytocic, lactation stimulant
    • • Indication- postpartum hemmorrhage
    • • Dose- 10 units IM after placental delivery or 10-40 units in 1000ml NS or LR infused at 20-100 mu/min
    • • Onset- Immediate; Duration- 20 minutes
    • • Side Effects- HTN, dysrhythmias
    • • Special Notes- Rule out multiple fetuses prior to administration
  49. Terbutaline (Brethine)
    • • Class- Beta2 adrenergic agonist, bronchodilator
    • • Indication- Asthma, Tocolysis
    • • Dose- 0.25 mg SC, repeat one time in 15-30 minutes
    • • Onset- 15-30 minutes; Duration 1-4 hours
    • • Side Effects- tachydysrhythmias, headache, anxiety, N/V
    • • Special Notes- may be given via nebulizer is patient is under 2y/o, tolerance develops with repeated dosing
  50. Vecuronium (Norcuron)
    • • Class- Non-Depolarizing skeletal muscle relaxant
    • • Indication- RSI, facilitation of mechanical ventilation
    • • Dose- Paralytic: 0.1 mg/kg IVP; defasciculation: 0.01 mg/kg IVP: Infusion- 0.05-0.07 mg/kg/hr
    • • Onset- 1-3 minutes; Duration- 30-60 minutes
    • • Side Effects- hepatic disease and long-term corticosteroid use causes longer than usual paralysis
    • • Special Notes- ages 1-10 may require higher doses and shorter intervals than adults
  51. Succinylcholine (Anectine)
    • • Class- depolarizing skeletal muscle relaxant
    • • Indication- RSI
    • • Dose- 1-1.5 mg/kg IVP
    • • Onset- Immediate; Duration- 5-10 minutes
    • • Side Effects- Hyperkalemia, vomiting, intracoular pressure, cardiac dysrhythmias
    • • Special Notes- contraindicated for: hx of malignant hyperthermia (Treated with Dantrolene), MD, crush injury greater than 24 hour old, hyperkalemia, severe sepsis,burns more than 8 hours old, valium decreases the neuromuscular block effects
  52. Rocuronium (Zemuron)
    • • Class- Non-Depolarizing Muscular Blocker
    • • Indication- RSI, Paralysis for mechanical ventilator usage
    • • Dose- 0.6-1.2 mg/kg IVP
    • • Onset- 1-3 minutes; Duration- 20-30 minutes
    • • Side Effects- Bronchospasm, hypotension
    • • Special Notes- avoid use if patient is hepatic impaired or severe
    • obesity
  53. Midazolam (Versed)
    • • Class- Benzodiazepine, Hypnotic sedative
    • • Indication- sedation, induction of anesthesia, RSI, seizures
    • • Dose- 0.05 mg/kg IVP; Infusion- 1-2 mcg/kg/min
    • • Onset- 1-5 minutes; Duration- 2-6 hours
    • • Side Effects- respiratory depression, hypotension, bradycardia, N/V
    • • Special Notes- hypotension and respiratory depression likely to occur with use of opioids, may be less effective of patient is on theophylline, may be reversed with romazicon
  54. Propofol (Diprivan)
    • • Class- Anesthesia induction agent
    • • Indication- anesthesia induction and maintenance, sedation of
    • mechanically ventilated patient
    • • Dose- 5-50 mcg/kg/min infusion
    • • Onset- Immediate; Duration 5-20 minutes
    • • Side Effects- hypotension, bradycardia, vivid dreams
    • • Special Notes- Use caution in hemodynamically unstable patients, not a good drug for use in noisy or excessive stimulation situations such as transport, IV tubing should be changed every 12 hours, Green Urine
  55. Etomidate (Amidate)
    • • Class- CNS Agent, Non-Barbituate hypnotic without analgesic activity
    • • Indication- Induction of anesthesia, RSI
    • • Dose- 0.2-0.6 mg/kg IVP
    • • Onset- Less than 1 minute; Duration 3-10 minutes
    • • Side Effects- myoclonus, tonic movements, hiccups, vomiting
    • • Special Notes- Do not use in gravid and lactating females, myoclonus is reduced with premedication utilizing benzo or opiate
  56. Alteplase (Activase)
    • • Class- Fibrinolytic
    • • Indication- Acute MI less than 12 hours old, Acute Ischemic
    • Stroke, Acute pulmonary embolism
    • • Dose- 15 mg IVP over 2 minutes, then 0.75 mg/kg over 30minutes followed by 0.5 mg/kg over 1 hour
    • • Onset- 3-5 minutes; Duration- 2-3 hours
    • • Side Effects- bleeding, shock, reperfusion dysrhythmias
    • • Special Notes- Avoid use in recent trauma, aneurysm, recent surgery, bleeding disorders
  57. Anistreplase (Eminase)
    • • Class- Fibrinolytic
    • • Indication- Acute MI less than 12 hours old
    • • Dose- 30 units IV over 2-5 minutes
    • • Onset- rapid; Duration- 12 hours
    • • Side Effects- reperfusion dysrhythmias, bleeding, shock, allergic reaction
    • • Special Notes- Avoid use in recent trauma, aneurysm, recent surgery, bleeding disorders
  58. Streptokinase (Streptase)
    • • Class- Fibrinolytic
    • • Indication- Acute MI less than 12 hours old
    • • Dose- 1,500,000 units over 30 minutes followed by infusion of 100,000 units/hour
    • • Onset- 5-15 minutes; Duration- 12 hours
    • • Side Effects- reperfusion dysrhythmias, bleeding, shock, allergic reaction
    • • Special Notes- Avoid use in recent trauma, aneurysm, recent
    • surgery, bleeding disorders
  59. Reteplase (Retavase)
    • • Class- Fibrinolytic
    • • Indication- Acute MI less than 12 hours old
    • • Dose- 10 units over 2 minutes with a repeat dose in 30 minutes
    • • Onset- 10-15 minutes; Duration- 12 hours
    • • Side Effects- dysrhythmias, bleeding, hypotension, shoch, fever, allergic reaction
    • • Special Notes- Avoid use in recent trauma, aneurysm, recent surgery, bleeding disorders
  60. Tenecteplase (TNKase)
    • • Class- Fibrinolytic
    • • Indication- Acute MI less than 12 hours old
    • • Dose- 30-50 mg IVP
    • • Onset- Rapid; Duration- 10-15 hours
    • • Side Effects- dysrhythmias, bleeding, hypotension, shock, CHF
    • • Special Notes- do not use in patient with hx of CVA within 1 year, or bleeding disorders, aortic dissections
  61. Dopamine
    • • Class- inotropic vasopressor
    • • Indication- Hypotension, Bradycardia
    • • Dose- 2-20 mcg/kg/min
    • • Onset- 1-3 minutes; Duration- 1-2 hours
    • • Side Effects- tachydysrhythmias, HTN, N/V, headache, Ischemia
    • • Special Notes- patients taking MAO inhibitors should receive 1/10 of normal dose
  62. Dobutamine (Dobutrex)
    • • Class- Beta 1 adrenergic agonist, sypmpathomimetic
    • • Indication- positive inotrope, cardiac decompensation
    • • Dose- 2-20 mcg/kg/min titrate so Heart Rate does not increase by 10% above baseline
    • • Onset- 1-2 min; Duration- 10-15 min
    • • Side effects- Tachydysrhythmias, VT, HTN, N/V, headache
    • • Special Notes- contraindicated in Idiopathic Hypertrophic Subaortic Stenosis,Hemodynamic monitoring is highly recommended
  63. Norepinephrine
    • • Class- vasopressor, catecholamine, alpha and beta 1 stimulant
    • • Indication- shock, hypotension (Severe)
    • • Dose- 0.5-30 mcg/min
    • • Onset- 1-3 minutes; Duration- 5-10 minutes
    • • Side effects- VT, HTN, N/V, ischemia, decreased renal perfusion, decreases urinary output
    • • Special Notes- Norepi causes tissue necrosis, if this occurs it should be treated with phentolamine
  64. Epinephrine 1:1,000 SQ
    • • Class- Sympathomimetic
    • • Indication- allergic reaction, asthma
    • • Dose- 0.3-0.5 mg SQ
    • • Onset- Rapid; Duration- 1-3 hours
    • • Side Effects- tachydysrhythmias, VT, VF, angina, HTM
    • • Special Notes- contraindicated in patients with CAD
  65. Epinephrine 1:10,000 IV Bolus
    • • Class- Sympathomimetic
    • • Indication- Anaphylaxis, bradycardia, hypotension
    • • Dose- 0.3-0.5 mg IVP
    • • Onset- immediate; Duration- 1-3 hours
    • • Side Effects- tachydysrhythmias, VT, VF, angina, HTN
    • • Special Notes- Avoid use in patients with CAD
  66. Epinephrine Drip
    • • Class- Sympathomimetic
    • • Indication- Bradycardia, Hypotension
    • • Dose- 2-10 mcg/min IV infusion
    • • Onset- immediate; Duration- 1-3 hours
    • • Side Effects- tachydysrhythmias, VT, VF, angina, HTN
    • • Special Notes- Avoid use in patients with CAD
  67. Phenylephrine (Neo-Synephrine)
    • • Class- Vasopressor, Alpha Agonist
    • • Indication- Hypotension
    • • Dose- 0.1-0.5 mg slow IVP over 10-15 minutes
    • • Onset- Rapid; Duration 1-2 hours
    • • Side Effects- Headache, CVA, chest pain, bradycardia, HTN, respiratory distress
    • • Special Notes- potentiated by atropine, antagonized by diuretics and beta-blockers, Gives a purely Alpha effect
  68. Milrinone (Primacor)
    • • Class- Inotropic Dilator
    • • Indication- CHF
    • • Dose- 50 mcg/kg over 10 minutes then follow with infusion at 0.375-0.75 mcg/kg/min every 15-30 minutes
    • • Onset- Rapid; Duration- 2-3 hours
    • • Side Effects- Hypotension, headache, angina, arrythmias
    • • Special Notes- reduce maintenance infusion if renal or hepatic impaired, contraindicated in aortic or pulmonary valve disease
  69. Vasopressin
    • • Class- Antidiuretic hormone, vasopressor
    • • Indication- Esophageal varices, shock, cardiac arrest
    • • Dose- Cardiac Arrest: 40 units IV/IO for one dose only; Varices: 0.1-0.4 units/min; Shock: 0.04 units/min
    • • Onset- 1-3 min; Duration- 20-30 min
    • • Side Effects- Pain at IV site, N/V, angina, trembling
    • • Special Notes- not used in pediatric cardiac arrest
  70. Hetastarch (Hespan)
    • • Class- Plasma Expander
    • • Indication- shock, hypovolemia
    • • Dose- 500-1000 ml not to exceed 1500 ml/day
    • • Onset- 15-30 minutes; Duration- 24-48 hours
    • • Side Effects- headache, N/V, submaxillary and parotid glandular enlargement, prolongation of PT/PTT, flu-like symptoms
    • • Special Notes- contraindicated with bleeding disorders, renal failure with oliguria or anuria, check coagulation factors after administering
  71. Plasmanate
    • • Class- Human plasma protein fraction
    • • Indication- severe hypovolemia, shock, crush injuries
    • • Dose- 250-500 ml initial IV bolus
    • • Onset- 3-5 minutes; Duration 36 hours
    • • Side Effects- flushing, urticaria, back pain, N/V
    • • Special Notes- should be given with 16 gauge catheter minimum
  72. Blood Products
    • • Whole Blood
    • • PRBC
    • • FFP
    • • Albumin
    • • Special Notes- 20 gauge minimum for administration, check patient for fever, use only NS, citrate reactions and hypercalcemia common with multiple units
  73. Pantoprazole (Protonix)
    • • Class- PPI
    • • Indication- GERD associated with Erosive esophagitis
    • • Dose- 40 mg IVP once daily
    • • Onset- 20-30 minutes; Duration 20-30 hours
    • • Side Effects- Abdominal pain, headache, imsomnia, rhinitis, back pain, flatulence
    • • Special Notes- Should not be given for more than 7-10 day
  74. Esomeprazole (Nexium)
    • • Class PPI
    • • Indication- GERD associated with Erosive Esophagitis
    • • Dose- 20-40 mg IVP
    • • Onset- 10-20 minutes; Duration- 24 hours
    • • Side Effects- pruritis, dizziness, flatulence, N/V, dyspepsia, sinusitis
    • • Special Notes- should be given in IV with no other medications and flushed thoroughly afterwards with NS
  75. Lansoprazole (Prevacid)
    • • Class- PPI
    • • Indication- GERD associated with Erosive Esohagitis
    • • Dose- 30 mg IV mixed with 5 ml of sterile water over 30 minutes
    • • Onset- 30-60 minutes; Duration- 16-20 hours
    • • Side Effects- pruritis, dizziness, flatulence, N/V, dyspepsia, sinusitis
    • • Special Notes- should be given with an IV filter to remove impurities from re-constitution
  76. Mannitol
    • • Class- Osmotic Diuretic
    • • Indication- Increased ICP, cerebral edema
    • Dose- 1-2 g/kg over 30-60 minutes
    • • Onset- 30-60 minutes; Duration 3-8 hours
    • • Side Effects- fluid imbalance, electrolyte loss
    • • Special Notes- disrupts the blood-brain barrier, allows other medications to penetrate into the CNS, use a filter to administer, often given with lasix to maximize effects
  77. Insulin (Humulin R, Novolin R)
    • • Class- pancreatic Hormone
    • • Indication- DM, Hyperkalemia
    • • Dose- DKA: 0.1 units/kg, then 0.1 units/kg/hr; Hyperkalemia: 10 units IV diluted with 50 ml D50w
    • Insulin Drip- 10 units/1000 ml D5W (Always run on Pump)
    • • Onset- 30-60 minutes; Duration- 6-8 hours but peaks in 2-4 hours
    • • Side Effects- dry mouth, increased cough, lipoatrophy, lipohypertrophy
    • • Special Notes- mix in NS 1:1 ratio and run at 1 ml/kg/hr
  78. Methylprednisolone (SoluMedrol)
    • • Class- Corticosteroid
    • • Indication- inflammatory and allergic disorders, spinal cord injury
    • • Dose- 40-125 ml IVP, spinal cord injury- 30 mg/kg IV over 15 min and follow with 5.4 mg/kg/hr for 23-47 hours
    • • Onset- 1-2 hours; Duration- 8-24 hours
    • • Side Effects- vertigo, headache, sodium/fluid retention, increases appetite, weight gain, immunosuppression
    • • Special Notes- steroids cause htn, acne, cushings syndrome, increased blood glucose
  79. Potassium Chloride
    • • Class- Electrolyte
    • • Indication- hypokalemia
    • • Dose- Doses vary depending on serum Potassium levels
    • • Onset- 15 minutes; Duration- 1-2 hours
    • • Side Effects- N/V, diarrhea, abdominal pain, IV site pain
    • • Special Notes- Peripheral IV rate max of 10 meq/hr, Central IV rate max of 20 meq/hr, NEVER GIVE IV PUSH! Always run on Pump
    • Normal Potasium is 3.5 - 5
  80. Fumazenil (Romazicon)
    • • Class- Benzodiazepine receptor agent
    • • Indication- antidote for benzo overdose or toxicity
    • • Dose- 0.2-0.5 mg IV not to exceed 3 mg/hr
    • • Onset- immediate; Duration 4-6 hours
    • • Side Effects- seizures, N/V, agitation, withdrawal
    • • Special Notes- contraindicated in status epilepticus and Incresed ICP
  81. Calcium Chloride
    • • Class- Calcium Supplement
    • • Indication- hypocalcemia, hyperkalemia, Calcium Channel Blocker Overdose or Toxicity
    • • Dose- 5-10 ml Slow IVP
    • • Onset- 5-15 min; Duration- 4 hours
    • • Side effects- Bradycardia, asystole, hypotension
    • • Special Notes- 3 times more potent than calcium gluconate, IVP max rate of 1 ml/min; Precipitates with Sodium Bicarb
  82. Calcium Gluconate
    • • Class- Calcium Supplement
    • • Indication- hypocalcemia, hyperkalemia, hypermagnesemia, Calcium Channel Blocker Overdose or Toxicity
    • • Dose- 500-1000 mg
    • • Onset- Rapid; Duration- 30 minutes
    • • Side Effects- bradycardia, hypotension, arterial spasm
    • • Special Notes- 1/3 strength of Calcium Chloride, IVP max rate of 1.5 ml/min, precipitates with sodium bicarb
  83. Glucagon
    • • Class- Hypoglycemia Drug
    • • Indication- Hypoglycemia, Beta-Blocker OD
    • • Dose- Hypoglycemia: 1 mg IM; Beta-Blocker OD: 3-5 mg IVP
    • • Onset- 6-20 minutes; Duration- 4-8 hours
    • • Side Effects- N/V, Hypotension with IV doses
    • • Special Notes- Can also be used to remove debris from esophagus, smooth muscle relaxant
  84. Naloxone (Narcan)
    • • Opiate Antagonist
    • • Indication- Opiate OD or Toxicity
    • • Dose- 2 mg IV, IM, SQ
    • • Onset- Rapid; Duration- 6-8 hours
    • • Side Effects- withdrawal symptoms
    • • Special Notes- can be repeated for max of 10 mg
  85. Dextrose (D50, D25)
    • • Class- Nutrient, replacement
    • • Indication- hypoglycemia
    • • Dose- 25 gm IV
    • • Onset- Rapid; Duration- 2-4 hours
    • • Side Effects- tissue necrosis if extravasion occurs
    • • Special Notes- Contraindicated for patients with intracerebral bleeding
  86. Thiamine (Vitamin B1)
    • • Class- Nutrient
    • • Indication- Malnutrition or Thiamine deficiency
    • • Dose- 100 mg Slow IVP or IM
    • • Onset 15-30 minutes; Duration 12-16 hours
    • • Side Effects- N/V, Hypotension
    • • Special Notes- Certain patients are hypersensitive to Thiamine

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