-
Albuterol (Proventil, Ventolin) Class
Sympathomimetic Bronchodilator
-
Albuterol (Proventil, Ventolin)description
Bronchodilator causing reduced mucus secretion, pulmonary capillary leaking & edema in lungs
-
Albuterol (Proventil, Ventolin)indications (2)
- Bronchospasm
- Asthma in COPD
-
Contraindications for Albuterol (Proventil, Ventolin)
none
-
Precautions for Albuterol (Proventil, Ventolin) (6)
- Tachycardia
- Anxiety
- Nausea
- Cough
- Wheezing
- Dizziness
-
Albuterol (Proventil, Ventolin)dosage
2.5-3 mg in 2.5 mL NS via Neb
-
Fentanyl (Sublimaze)Class
Narcotic Analgesic
-
Fentanyl (Sublimaze)Description
- Synthetic Narcotic Analgesic
- Rapid onset, short acting
-
Fentanyl (Sublimaze) Indication (1)
Sedation for intubation
-
Fentanyl (Sublimaze) Contraindication (2)
- MAO inhibitors
- Myasthenia Gravis
-
Fentanyl (Sublimaze) Precautions (6)
- ^ ICP
- Elderly
- Debilitated pts
- COPD
- Resp Probs
- Hepatic & Renal Insufficiency
-
Fentanyl (Sublimaze) Dosages
25-100 mcg over 2-3 mins IV
-
Ipratropium (Atrovent)Class
Anticholinergic
-
Ipratropium (Atrovent)Description
Bronchodilator that dries resp tract secretions by blocking ACH receptors
-
Ipratropium (Atrovent) Indications (3)
- Asthma
- COPD
- Inhaled Irritants
-
Ipratropium (Atrovent) Contraindications (2)
- Hypersensativity to atropine or its derivatives
- As primary treatment
-
Ipratropium (Atrovent) Precautions (3)
- Elderly
- Cardiovascular Disease
- HTN
-
Ipratropium (Atrovent) Dosages
500 mcg in 2.5-3 mL NS via Neb
-
Morphine Class
Narcotic Analgesic, PROTOTYPE OPIATE
-
Morphine Description
Analgesic & sedative causing some vasodilation, reducing venous return, reduced myocardial O2 demand
-
Morphine Indications (3)
- Pain
- MI
- Reduce venous return in pulmonary edema
-
Morphine Contraindications (6)
- Head or Abd inj
- Hypotension/volume depletion
- Acute Bronchial Asthma
- COPD
- Resp Depression
- Pulmonary edema fr chem inhal
-
Morphine precautions (4)
- Elderly
- Children
- Debilitated
- Keep Narcan available
-
Morphine Dosage
- Pain 2.5-15 mg IV: 5-20 mg IM/Sub Q
- AMI or PE 1-2 mg/ 6-10 mins to response
-
Nalaxone (narcan)Class
Narcotic Antagonist
-
Nalaxone (narcan) Description
- Narcotic antagonist
- Blocks Natl & Syn Narcotics
- May reverse resp depression
-
Nalaxone(narcan) Indications (2)
- Narcotic OD
- Resp depression of unknown origin
-
Nalaxone(narcan) Contraindications (1)
Non Narc induced resp depression
-
Nalaxone(narcan) Precautions (2)
- Dependancy
- Short half life so OD state may return
-
Nalaxone(narcan) Dosage
0.4-2 mg IV/IM repeated 2-3 mins as needed up to 10mg
-
Diazepam (Valium) Class
Benzodiazepine
-
Diazepam (Valium)Description
Sedative, skeletal muscle relaxant
-
Diazepam (Valium)Indications (5)
- Motor Seizures
- Status Epilepticus
- Premed for painful procedures
- Muscle tremors from injury
- Acute anxiety
-
Diazepam (Valium)Contraindications (6)
- Shock
- Coma
- Acute Alcoholism
- Depressed vital signs
- Obstretic pts
- Neonates
-
Diazepam (Valium)Precautions (4)
- Psychosis
- Depression
- Myasthenia Gravis
- Short Half life causing seizure to return
-
Diazepam (Valium) Dosages
- Seizure-- 5-10 mg IV/IM
- Anxiety-- 2-5 mg IV/IM
- Premed-- 5-15 mg IV
-
Etomidate (Amidate)Class
Hypnotic
-
Etomidate (Amidate)Description
Ultra short acting nonbarbituate hypnotic
-
Etomidate(Amidate) Indications (1)
Sedation for RSI
-
Etomidate(Amidate) Contraindications
None
-
Etomidate(Amidate) Precautions (3)
- Hypotension
- Asthma
- Cardiovascular Disease
-
Etomidate(Amidate) Dosage
0.1-0.3 mg/kg IV over 15-30 secs
-
Flumazenil(Romazicon) Class
Benzo Antagonist
-
Flumazenil(Romazicon) Description
Reverses sedative, recall & psychomotor effects of benzos
-
Flumazenil (Romazicon)Indications
Resp Depress secondary to benzos
-
Flumazenil(Romazicon) Contraindications (3)
- Pts currently taking for seizures or status epilepticus
- Seizure prone pts during labor & delivery
- Tricyclic antidepressant OD
-
Flumazenil(Romazicon) Precautions (7)
- Hepatic Impairment
- Elderly
- Pregnancy
- Nursing Mothers
- Head inj
- Alcohol/drug dependancy
- Phys Dependancy on Benzos
-
Flumazenil(Romazicon) Dosage
0.2mg IV over 30-60 secs to 1 mg
-
Midazolam (Versed) Class
Benzodiazepine/ sedative
-
Midazolam (Versed) Description
Short-acting benzo w/ CNS depressant, muscle relaxant, anticonvulsant, anterograde amnestic effects
-
Midazolam (Versed)Indications
Sedation before cardioversion or intubation
-
Midazolam (Versed) Contraindications (4)
- Narrow angle glaucoma
- Shock
- Coma
- Alcohol Intoxication
-
Midazolam (Versed) Precautions (4)
- COPD
- Renal Impairment
- CHF
- Elderly
-
Midazolam (Versed)Dosages
- 1-2mg slow IV
- 0.07-0.08 mg/kg IM
-
Succinylcholine (Anectine) Class
Depolarizing Neuromuscular Blocker
-
Succinylcholine (Anectine) Description
Short acting depolarizing muscular blocker
-
Succinylcholine(Anectine) Indications
ET intubation
-
Succinylcholine(Anectine) Contraindications (3)
- Hx of malignant hyperthermia
- Penetrating eye inj
- Narrow angle glaucoma
-
Succinylcholine(Anectine) Precautions (2)
- Burn or Crush inj
- Spinal cord inj
-
Succinylcholine(Anectine) Dosage
1-1.5 mg/kg IV/IM
-
Adenosine (Adenocard)Class
-
Adenosine(Adenocard) Description
- Chemical cardioverter PSVT --> Normal Sinus
- Half life of 10 sec
- Doesnt cause hypotension
-
Adenosine (Adenocard)Indications
SVT refractory to vagal maneuvers
-
Adenosine (Adenocard)Contraindications (3)
- 2nd & 3rd degree heart block
- Sinus node disease
- Asthma
-
Adenosine (Adenocard)Precautions (2)
- May cause transient dysrhythmias especially in asystole
- COPD
-
Adenosine(Adenocard) Dosage
- 1. 6 mg rapidly IV w/ NS flush
- 2. 12 mg in 1-2 min, may be repeated
-
Atropine Class
Parasympatholytic
-
Atropine Description
- Blocks vagal effects on HR
- ^ myocardial O2 demand
- Decrease airway secretions
-
Atropine Indications
- Hemodynamically significant Bradycardia
- Bradyasystolic Arrest
- Organophosphate Poisoning
-
Atropine Contraindications
None in EMS setting
-
-
Atropine Dosages
- Symptomatic Bradycardia--0.5mg IV/1mg ET 3-5 mins to 3 mg
- Asystole--1mg IV/ 2mg ET 3-5 min to 3 mg
- Poisoning--2-5 mg IV/IM/IO to 15 min
-
Epinephrine (Adrenalin) Class
Sympathomimetic
-
Epinephrine(Adrenalin) Description
- Catecholamine
- ^ tropic properties, systemic vascular resistance, systolic BP, vital capacity, tidal vol
- May reduce pulmonary congestion
- Decreases airway resistance & automaticity
-
Epi (Adrenalin) Indications (2)
- Cardiac arrest
- Severe allergic reactions
-
Epi (Adrenalin)contraindications (3)
- Narrow Angle Glaucoma
- Hemmoragic, Traumatic or Cardiac shock
- Labor
-
Epi (Adrenalin)Precautions
none
-
Epi (Adrenalin)Dosages
- Arrest-- 1mg 1:10 IV 3-5 mins (ET 2-2.5 1:1) NO MAX
- Allergy-- 0.3-0.5 mg 1:1 sub q 5-15 min as needed 0.5-1 1:10 IV if sub q ineffective
-
Vasopressin (Pitressin) Class
Hormone/Vasopressor
-
Vasopressin (Pitressin)Description
Hormone w/ strong vasopressive & antidiuretic properties but that may precipitate angina or AMI
-
Indications for vasopressin(Pitressin) (2)
- ^ peripheral resistance in arrest
- Esophageal Varices
-
Contraindications for Vasopressin(Pitressin)
-
Vasopressin(Pitressin) precautions (8)
- Epilepsy
- Migraine
- Heart failure
- Angina
- Vascular Disease
- Hepatic impairment
- Elderly
- Children
-
Vasopressin (Pitressin)Dosage
- Arrest-- 40 units IV
- Varices-- 0.2-0.4 units/min drip
-
Aspirin Class & Trade
- Acetylsalicylic Acid-- analgesic, antipyretic, Platelet Inhibitor, Antiinflammatory
- Alka-saltzer, Bayer, Empirin, St Joseph's Childrens
-
Aspirin Description
- Inhibits agents that cause inflammation, pain & fever
- Relieves pain by acting on the PNS
- Lowers body Temp
- Powerfully inhibits platelet aggregation
-
Aspirin Indications
Chest pain suggestive of MI
-
Aspirin Contraindications (2)
- Active Ulcer Disease
- Asthma
-
Aspirin Precautions (1)
Bleeding disorders
-
Aspirin Dosages
160-325 mg PO
-
Dextrose 50% in H20 C & T
-
Dextrose description
Simple sugar body can rapidly metabolize
-
Dextrose Indication
Hypoglycemia
-
Dextrose Contraindication
None in hypoglycemia
-
Dextrose precautions (3)
- ^ ICP
- Chk sugar b/f administering
- Ensure good IV
-
Dextrose Dosage
25g in 50mL IV
-
Furosemide (Lasix) Class
Diuretic
-
Furosemide(Lasix) Description
- Rapid acting potent diuretic & antihypertensive
- Inhibits Na reabsorption by kidneys
- Reduces venous return & cardiac workload
-
Furosemide(Lasix) Indications (2)
-
Furosemide (Lasix)Contraindications (3)
- Fluid & electrolyte depleted states
- Hepatic coma
- Pregnancy
-
Furosemide(Lasix) Precautions (8)
- Infants
- Elderly
- Hepatic Impairment
- Nephrotic Syndrome
- Cardiogenic Shock assoc w/ MI
- Gout
- Pts receiving digitalis
- K depleting steroids
-
Furosemide (Lasix)Dosage
40-120 mg slow IV
-
Nitroglycerin (Nitrostat) Class
Nitrate
-
Nitro (Nitrostat)Description
- Rapid smooth muscle relaxant
- Reduces peripheral vascular resistance, BP, Venous Return, Cardiac Workload
-
Nitro (Nitrostat)Indications (2)
- Chest Pain assoc w/ angina or AMI
- Acute pulmonary edema
-
Nitro (Nitrostat)Contraindications (8)
- Tolerance to nitrates
- Severe Anemia
- Head trauma
- Hypotension
- ^ ICP
- Pts taking sildenafil
- Glaucoma
- Shock
-
Nitro (Nitrostat)Precautions (2)
- May cause headache
- Light sensitive losing potency
-
Nitro (Nitrostat)Dosage
- 0.4mg SL 3-5 mins up to 3
- 1/2" topical ointment
- 0.4 mg spray SL
-
Dobutamine (Dobutrex)Class
Sympathomimetic
-
Dobutamine (Dobutrex)description
Catecholamine / Beta agent that ^ inotropy w/o affecting chronotropy
-
Dobutamine (Dobutrex)Indications
^ cardiac output in CHF/cardiogenic shock
-
Dobutamine (Dobutrex)Contraindications (2)
- V-Tach
- Hypovolemia w/o fluid resuscitation
-
Dobutamine(Dobutrex) Precautions (2)
-
Dobutamine(Dobutrex) Dosages
2-20 mcg/kg/min IV
-
Dopamine (Inotropin)Class
Sympathomimetic
-
Dopamine(Inotropin) Description
- Natl catecholamine ^ cardiac output w/o ^ myocardial O2 consumption
- Maintains renal & mesenteric blood flow while inducing vasoconstriction & ^ systolic BP
-
Dopamine(Inotropin) Indications (2)
- Nonhypovolemic hypotension
- Cardiogenic shock
-
Dopamine(Inotropin) Contraindications (3)
- Tachydysrhythmias
- V-Fib
- Pheochromocytoma
-
Dopamine (Inotropin)Precautions
Ensure adequate fluid resuscitation of the hypovolemic pt
-
Dopamine (Inotropin)dosages
2-5 mcg/kg/min up to 20 mcg/kg/min, titrated to effect
-
Isoproterenol (Isuprel)Class
Sympathomimetic
-
Isoproterenol (Isuprel)Description
Synthetic sympathomimetic resulting in ^ cardiac output by increasing inotropy & chronotropy
-
Isoproterenol(Isuprel) Indications
Bradycardia refractory to atropine when pacing is not available
-
Isoproterenol(Isuprel) Contraindications
Cardiogenic Shock
-
Isoproterenol (Isuprel)Precautions
Tachydysrhythmias & those associated w/digitalis & AMI
-
Isoproterenol(Isuprel) Dosages
Bradycardia-- 2-10 mcg/min titrated to cardiac rate
-
Amiodarone (Cordarone, Pacerone)Class
Antidysrhythmic
-
Amiodarone (Cordarone, Pacerone)Description
- Prolongs duration or action potential & refractory periods
- Relaxes smooth muscles
- Reduces peripheral vascular resistence
- Increases coronary blood flow
-
Amiodarone (Cordarone, Pacerone)Indications
- Life threatening ventricular & superventricular dysrhythmias
- Frequently A-Fib
-
Amiodarone (Cordarone, Pacerone)Contraindications (3)
- Cardiogenic Shock
- Severe sinus bradycardia
- Advanced heart block
-
Amiodarone (Cordarone, Pacerone)Precautions
None
-
Amiodarone(Cordarone, Pacerone) Dosage
150-300 mg IV over 10 mins then 1 mg/min for 6 hrs
-
Bretylium (Bretylol) Class
Antidysrhythmic
-
Bretylium (Bretylol)Description
Supresses V-tach dysrhythmias including V-Fib w/ reentry mechanisms
-
Bretylium (Bretylol)Indications
V-Fib & V-Tach refractory to Lidocaine
-
Bretylium (Bretylol)Contraindications
None
-
Bretylium (Bretylol)Precautions (2)
- Digitalized Pts
- Digitalis-induced dysrhythmias
-
Bretylium (Bretylol)Dosages
5 mg/kg IV then 10 mg/kg / 15-30 mins to max of 30 mg/kg
-
Lidocaine (Xylocaine)Class
Antidysrhythmic
-
Lidocaine(Xylocaine) Description
- Antidysrhythmic that suppresses automaticity & raises stimulation threshold of ventricles
- Causes sedation, anticonvulsant & analgesic effects
-
Lidocaine (Xylocaine)Indication (3)
- Pulseless V-Tach
- V-Fib
- V-Tach w/pulse
-
Lidocaine (Xylocaine)Contraindications (4)
- Supraventricular Dysrhythmias
- Stokes-Adams Syndrome
- 2nd & 3rd degree heart block
- Bradycardias
-
Lidocaine(Xylocaine) Precautions (8)
- Hepatic or renal Impairment
- CHF
- Hypoxia
- Resp Depression
- Hypovolemia
- Myasthenia Gravis
- Shock
- Elderly
-
Lidocaine (Xylocaine)Dosages
- Cardiac Arrest-- 1-1.5 mg/kg IV repeated 3-5 mins up to 3 mg/kg. Follow w/ drip of 2-4 mg/min
- V-Tach w/pulse-- 1-1.5mg/kg slow IV-> 1/2 dose 5-10 mins up to 3mg/kg till conversion -> infusion of 2-4 mg/min
-
Procainamide (Pronestyl)Class
Antiarrhythmic
-
Procainamide (Pronestyl)Description
- Prolongs ventricular repolarization
- Slows Dromotropy
- Decreases myocardial excitability
-
Procainamide(Pronestyl) Indications (2)
- V-Fib
- Pulseless V-Tach refractory to Lidocaine
-
Procainamide (Pronestyl)Contraindications (2)
- Myasthenia Gravis
- 2nd or 3rd degree heart block
-
Procainamide(Pronestyl) Precautions (7)
- Hypotension
- Cardiac Enlargement
- CHF
- AMI
- Ventricular dysrhythmias fr digitalis
- Hepatic or renal impairment
- Bronchial Asthma
-
Procainamide(Pronestyl) Dosage
- 20-30 mg/min IV drip
- Stop points-- (1) up to 17 mg/kg to effect -> 1-4 mg/min (2) Ectopy Resolves (3) QRS complex widens more than 50% then original (4) Hypotension ensues
-
Diltiazem (cardizem)Class
calcium channel blocker CCB
-
Diltiazem (cardizem)Description
- Dilates coronary & peripheral arteries & arterioles ^ circulation to the heart & reducing peripheral vascular resistance
- CCB similar to Verapamil
-
Diltiazem (cardizem)Indications (4)
- A-fib
- Atrial flutter
- PSVT refrac to adenosine
- ^ coronary artery perfusion in Angina
-
Diltiazem(cardizem) Contraindications (5)
- Sick Sinus Syndrome
- 2nd & 3rd degree heart block
- Systolic BP < 90
- Diastolic BP < 60
- Wide complex tachycardia
-
Diltiazem (cardizem)Dosage
0.25 mg/kg IV over 2 mins, repeat as needed w/0.35 mg/kg followed by drip of 5-10 mg/hr not exceeding 15 mg/hr over 24 hrs
-
Diltiazem (cardizem)Precautions
CHF w/ Beta blockers
-
Tridil (Nitro Inj) Class
Vasodilator/Nitrate
-
Tridil (Nitro Inj)Description
Relaxes blood vessels ^ blood & O2 supply to heart
-
Tridil (Nitro Inj)Indications (3)
- Pain Associated w/ angina that doesnt respond to oral treatment
- Ctrl BP
- Help treat CHF
-
Tridil(Nitro Inj) Contraindications (5)
- Hypotension
- Uncorrected Hypovolemia
- ^ ICP
- Constrictive Pericarditis
- Pericardial Tamponade
-
Tridil (Nitro Inj)Precautions (3)
- Headache
- Severe Hypotension
- Reflex Tachycardia
-
Tridil(Nitro Inj) Dosage
0.2-1.5 mcg/kg/min
-
Verapamil (Calan, Isoptin) Class
Calcium Channel Blocker CCB
-
Verapamil (Calan, Isoptin)description
- CCB slowing AV conduction
- Supresses reentry dysrhythmias
- Slows ventricular responses to atrial tachydysrhythmias
- Dilates coronary arteries & reduces myocardial O2
-
Verapamil(Calan, Isoptin) Indications (3)
- PSVT refrac to adenosine
- Atrial Flutter
- A-Fib w/ rapid ventricular response
-
Verapamil(Calan, Isoptin) Contraindications (8)
- Severe Hypotension
- Cardiogenic Shock
- 2nd & 3rd Degree Heart Block
- CHF
- Sinus Node Disease
- WPW Disease
- Should not be given to those on Beta Blockers
-
Verapamil (Calan, Isoptin)Precautions
None
-
Verapamil(Calan, Isoptin) Dosages
2.5-5mg IV bolus over 2-3 mins then 5-10mg aft 15-30 min max
-
Calcium Chloride Class
Electrolyte
-
Calcium Chloride Description
Increases myocardial contractile force & automaticity
-
Calcium Chloride Indications (4)
- Hypercalemia
- Hypercalcemia
- Hypermagnesemia
- CCB toxicity
-
Calcium Chloride contraindications (3)
- V-Fib
- Hypercalcemia
- Digitalis toxicity
-
Calcium Chloride precautions
- May precipitate toxicity in pts taking digoxin
- Ensure IV is in lg vein & flushed b/f using & aft calcium
-
Calcium Chloride Dosages
2-4 mg/kg IV / 10 mins as needed
-
Methylprednisolone (Solu-Medrol) Class
Corticosteroid/ Antiiflammatory
-
Methylprednisolone (Solu-Medrol)Description
- Synthetic adrenal corticosteroid used for inflammation, mgmt of allergic reactions & in some cases shock
- Sometimes used for treatment of spinal cord inj
-
Methylprednisolone (Solu-Medrol)Indications (4)
- Spinal Cord Inj
- Asthma
- Severe Anaphylaxis
- COPD
-
Methylprednisolone (Solu-Medrol)Contraindications
None in emergency setting
-
Methylprednisolone (Solu-Medrol)Precautions
Only a single dose should be given in prehospital setting
-
Methylprednisolone (Solu-Medrol)Dosages
- Asthma/COPD/Anaphylaxis -- 125-250 mg IV/IM
- Spinal Cord Inj -- 30 mg/kg IV over 15 min, aft 45min an infusion of 5.4 mg/kg/hr
-
Magnesium Sulfate Class
Electrolyte
-
Magnesium Sulfate Description
- Electrolyte acts as CCB, CNS depressant & anticonvulsant
- Depresses function of smooth, skeletal & cardiac muscles
-
Magnesium Sulfate Indications (3)
- Refractory V-Fib & pulseless V-Tach
- AMI
- Eclamptic Seizures
-
Magnesium Sulfate Contraindications (5)
- Heartblock
- Myocardial Damage
- Shock
- Persistent Hypertension
- Hypocalcemia
-
Magnesium Sulfate Precautions (2)
- Other CNS depressants
- Neuromuscular blocking agents
-
Magnesium Sulfate Dosages
- V-Fib/Tach -- 1-2 g IV over 2 mins
- Torsade de pointes -- 1-2 g IV followed by infusion of 0.5-1 g/hr IV
- AMI -- 1-2 g IV over 5-30 mins
- Eclampsia -- 2-4g IV/IM
- Asthma -- 1-2 g IV drip
-
Phenytoin (Dilantin) Class
Anticonvulsant
-
Phenytoin(Dilantin) Description
- Related to phenobarbital that reduces spread of elec discharges in motor cortex & inhibits seizures
- Antidysrhythmic props counter effects of digitalis
-
Phenytoin (Dilantin)Indications (3)
- Seizures
- Status Epilepticus
- Cardiac dysrhythmias secondary to digitalis toxicity
-
Phenytoin (Dilantin)Contraindications (3)
- Sinus Bradycardia
- Heart Block
- Adams-Stokes syndrome
-
Phenytoin (Dilantin)Precautions
None
-
Phenytoin (Dilantin)Dosages
- Seizure/Status Epilepticus -- 10-15 mg/kg slow IV
- Dysrhythmia -- 100 mg slow IV (over 5 min) to a max of 1000 mg
-
-
Sodium Bicarbonate Description
- Provides vascular bicarbonate to assist buffer sys in reducing effects of metabolic acidosis
- Treatment of some ODs
-
Sodium Bicarbonate Indications (3)
- Tricyclic Antidepressant & Barbituate OD
- Refractory Acidosis
- Hypercalemia
-
Sodium Bicarbonate Contraindications
None when used in severe hypoxia or late cardiac arrest
-
Sodium Bicarbonate Precautions
May precipitate w/ calcium chloride
-
Sodium Bicarbonate Dosages
1 mEq/kg IV, then 0.5 mEq/kg/10 min
-
Diphenhydramine (Benadryl) Class
Antihistamine
-
Diphenhydramine (Benadryl) Description
Blocks histamine release reducing bronchoconstriction, vasodilation & edema
-
Diphenhydramine (Benadryl) Indications (3)
- Anaphylaxis
- Allergic Reactions
- Dystonic Reactions
-
Diphenhydramine (Benadryl) Contraindications (2)
- Asthma
- Lower resp disease
-
Diphenhydramine (Benadryl) Precautions (7)
- Hypotension
- Headache
- Palpitations
- Tachycardia
- Sedation
- Drowsiness
- Disturbed Coordination
-
Diphenhydramine (Benadryl) Dosage
25-50 mg IV/IM
-
-
Activated Charcoal Description
Prepared charcoal that activates & binds toxin fr GI tract
-
Activated Charcoal Indications
Acute Ingested Poisoning
-
Activated Charcoal Contraindications (8)
- Compromised airway
- cyanide ingestion
- Mineral Acids
- Caustic Alkalis
- Organic Solvents
- Iron
- Ethanol
- Methanol
-
Activated Charcoal Precautions (5)
- Hepatic Disease
- Children under 12 w/ arthritic conds.
- Alcoholism
- Malnutrition
- Thrombocytopenia
-
Activated Charcoal Dosage
- 325-650 mg PO/ 4-6 hrs
- 650mg PR/4-6 hrs
-
Lorazapam (Ativan) Class
Sedative/ Benzodiazepam
-
Lorazapam (Ativan)Description
- MOST POTENT BENZO AVAIL.
- Strong antianxiety, sedative, hypnotic & skeletal muscle relaxant props
- Relatively short half life
-
Lorazapam (Ativan)Indications (2)
- Sedation for cardioversion
- Status Epilepticus
-
Lorazapam (Ativan)Contraindications
Sensitivity to benzos
-
Lorazapam (Ativan)Precautions (12)
- Narrow angle glaucoma
- Depression or psychosis
- Coma
- Shock
- Acute Alcohol Intox
- Renal or Hepatic Impairment
- Organic brain syndrome
- Myasthenia Gravis
- GI disorders
- Elderly
- Debilitated
- Limited Pulmonary reserve
-
Lorazapam (Ativan) Dosages
- Sedation -- 2-4 mg IM, 0.5-2mg IV
- Status Epilepticus -- 2 mg slow IV/PR (2 mg/min)
-
Metoclopromide (Reglan) Class
Antiemetic
-
Metoclopromide (Reglan) Description
- Dopamine antagonist similar to procainamide but w/ few antidysrhythmic or anesthetic props
- Antiemetic props fr gastric emptying & desensitization of vomiting reflex
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Metoclopromide (Reglan) Indications (2)
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Metoclopromide (Reglan) Contraindications (6)
- Allergy to sulfite agents
- Seizure Disorders
- Pheochromocytoma
- Mechanical GI obstruction
- Breast Cancer
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Metoclopromide (Reglan) Precautions (5)
- CHF
- Hypokalemia
- Renel Impairment
- GI hemorrhage
- Intermittent porphyria
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Metoclopromide (Reglan) Dosage
10-20 mg IM; 10 mg slow IV (over 1-2 mins)
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Zofran (Ondansetron) Class
Antiemetic
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Zofran (Ondansetron) Description
Selective blocking agent of serotonin 5-HT3 receptor type
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Zofran (Ondansetron) Indication
Nausea & intractible vomiting
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Zofran (Ondansetron)Contraindication
None
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Zofran (Ondansetron) Precautions
May mask progressive ileus &/or gastric distension
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Zofran (Ondansetron) Dosage
Single 24 mg tab ODT, 4 mg undiluted over @ least 30 secs
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Chlordiazepoxide (Librium)Class
Sedative/ Hypnotic
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Chlordiazepoxide (Librium) Description
BENZO DERIVATIVE producing mild sedation & anticonvulsant, skeletal muscle relaxant, prolonged hypnotic effects
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Chlordiazepoxide (Librium)Indications (2)
- Severe anxiety & tension
- Acute alcohol WD symptoms (DTs)
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Chlordiazepoxide (Librium)Contraindications (2)
- Pregnant & nursing Mothers
- Children under 6
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Chlordiazepoxide (Librium) Precautions
- Primary depressive disorders or pyschosis
- Acute alcohol intox
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Chlordiazepoxide (Librium) Dosage
50-100 mg IV/IM
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Butorphanol (Stadol) Class
Synthetic Narcotic Analgesic
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Butorphanol (Stadol)Description
- Centrally acting synthetic narcotic analgesic
- 5x more potent than morphine
- Schedule IV Narc
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Butorphanol (Stadol)Indications
Pain
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Butorphanol(Stadol) Contraindications (2)
- Head Inj
- Undiagnosed Abd pain
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Butorphanol (Stadol)Precautions
none
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Butorphanol (Stadol)Dosage
1 mg IV or 3-4 mg IM
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Meperidine (Demerol) Class
Narcotic Analgesic
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Meperidine(Demerol) Description
Synthetic Narcotic w/ sedative & analgesic props comparable to morphine but w/o hemodynamic side effects
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Meperidine (Demerol)Indications
Pain
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Meperidine (Demerol)Contraindications (2)
- Seizure Disorders
- Acute abd prior to diagnosis
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Meperidine (Demerol)Precautions (10)
- ^ ICP
- Asthma or resp conds
- Superventricular Tachycardias
- Prostatic Hypertrophy
- Urethral Stricture
- Glaucoma
- Elderly or Debilitated pts
- Renal or Hepatic Impairment
- Hyperthyroidism
- Addisons Disease
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Meperidine(Demerol) Dosages
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Nalbuphine (Nubain)
Narcotic Analgesic
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Nalbuphine (Nubain) Description
Equivalent to morphine w/o ^ resp depression w/ higher doses
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Nalbuphine(Nubain) Indications
Pain
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Nalbuphine(Nubain) Contraindications
Undiagnosed Head or abd inj
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Nalbuphine(Nubain) Precautions
none
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Nalbuphine (Nubain)Dosages
5 mg IV/IM/sub q repeat 2mg dose as needed to 20 mg
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Pancuronium (Pavulon)Class
Nondepolarizing Neuromuscular Blocker
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Pancuronium (Pavulon) Description
Nondepolarizing neuromuscular blocker causing paralysis w/o bronchospasm or hypotension
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Pancuronium (Pavulon)Indications
ET intubation
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Pancuronium (Pavulon)Contraindications
Tachycardia
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Pancuronium (Pavulon)Precautions
none
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Pancuronium (Pavulon)Dosages
0.04-0.1 mg/kg IV
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Vecuronium (Norcuron) Class
Nondepolarizing Skeletal Muscle Relaxant
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Vecuronium (Norcuron)Description
Nondepolarizing Neuromuscular blocker w/ minimal cardiovascular effects
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Vecuronium(Norcuron) Indications
ET intubation
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Vecuronium(Norcuron) Contraindications
none
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Vecuronium (Norcuron)Precautions (2)
- Severe obesity
- Myasthenia Gravis
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Vecuronium(Norcuron) Dosages
0.08-0.1 mg/kg IV
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Chlorpromazine (Thorazine)Class
Tranquilizer/Antipsychotic
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Chlorpromazine (Thorazine)Indications (3)
- Acute Psychotic Episode
- Intractable hiccups
- Nausea/Vomiting
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Haloperidol (Haldol) Class
Antipsychotic
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Haloperidol(Haldol) Indications
Acute Psychotic Episodes
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Haloperidol(Haldol) Contraindications (6)
- Parkinson's
- Seizure Disorders
- Coma
- Alcohol Depression
- CNS depression
- Thyrotoxicosis
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Haloperidol(Haldol) Precautions
Anticonvulsant, Anticoagulant or Lithium Therapy
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Haloperidol(Haldol) Dosages
2-5 mg IM
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Promethazine (Phenergan) Class
Antiemetic
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Promethazine (Phenergan)Indications (4)
- Nausea & Vomiting
- Motion Sickness
- Enhance effects of analgesics
- Induce Sedation
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Aminophyline (Somophyllin)Class
Methylxanthine Bronchodilator
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Aminophyline (Somophyllin)Indications (3)
- Bronchospasm in asthma
- COPD refractory to sympathomimetics
- CHF
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Aminophyline (Somophyllin)Contraindications
Uncontrolled cardiac dysrhythmias
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Terbutaline (Brethine/Bricanyl)Class
Sympathetic agonist
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Terbutaline (Brethine/Bricanyl)Description
Synthetic sympathomimetic causing bronchodilation w/ less cardiac effect than epi
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Terbutaline(Brethine/Bricanyl) Indications (2)
- Bronchial asthma
- Bronchospasm in COPD
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ALTEPLASE RECOMBINANT/tPA (Activase) Class
Thrombolytic
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Alteplase Recombinant/tPA (Activase) Indications (3)
- AMI
- Acute Ischemic Stroke
- Pulmonary Embolism
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Alteplase Recombinant/tPA (Activase) Contraindications
- Internal Bleeding
- Suspected Aortic Disection
- Traumatic CPR
- Hemmorhagic Stroke
- Intercranial/Intraspinal Trauma
- Pregnancy
- Uncontrolled Hypertension
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Alteplase Recombinant/tPA (Activase) Precautions
- Recent Major Surgery
- Cerebral Vascular Disease
- Recent GI/GU Bleed
- Recent Trauma
- HTN
- Pt >75
- Hemmorhagic Opthalmic Cond
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Alteplase Recombinant/tPA (Activase) Dosages
- MI/Stroke--15 mg/IV ->0.75 mg/kg (up to 50) over 30 mins -> 0.5 mg/kg (up to 35 mg) over 60 mins
- Pulmonary Embolism--100 mg IV over 2 hrs
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What is the class and trade of Heparin?
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What are indications for Heparin?
Prevent thrombus formation in AMI
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Describe Heparin. . . . .
- Rapid onset anticoagulant.
- Enhances effects of Antithrombin III
- Blocks conversion of Prothrombin -> Thrombin & Fibrinogen -> Fibrin
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What is the class of Timoptic?
Beta Blocker
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Describe Timoptic. . .
Non selective beta adrenergic receptor blocking agent
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What are the indications for Timoptic (3)?
- HTN
- MI
- Elevated Ocular Pressure
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What are contraindications for Timoptic (5)?
- Asthma
- Severe COPD
- Sinus Brady
- 2nd & 3rd degree AV block
- Cardiogenic Shock
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Timoptic Precautions
Readily Absorbed
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Timoptic Dosages
One drop/eye BID
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Norepinephrine (Levophed)Class
Sympathomimetic Agent
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Norepinephrine (Levophed)Description
- Naturally occurring catecholamine
- Causes vasoconstriction, cardiac stimulation, ^ BP, ^ myocardial O2 demand, ^ coronary blood flow
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Norepinephrine (Levophed)Indications are (2)?
- Refractory Hypotension
- Neurogenic Shock
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Norepinephrine(Levophed) Contraindications are?
Hypotension due to uncorrected Hypovolemia
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Norepinephrine(Levophed) Precautions
May cause Necrosis
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