Meds F-K

Narcotic analgesic

• 1. Pain
• 2. Sedation, induce or maintain

Binds to opiod receptors in CNS altering pain perception and response

• 1. Respiratory depression/apnea
• 2. Hypotension
• 3. N/V
• 4. Constipation
• 5. Dizziness/euphoria

• 1. BP <80
• 2. Myasthenia Gravis
• 3. Hypersensitivity
• 4. MAIOs within 14 days

• ADULT:
• Pain: 1mcg/kg max 100mcg q3 max 250mcg
• Maintenance dose: 250/hr in 50mcg increments.
• BP 80-90: 0.5mcg/kg max 25mcg q5 max 250mcg. No maintenance.

Sedation: 1mcg/kg max 100mcg

Maintenance of sedation: 50mcg q10min

Pacing: 50mcg q3 max 250

H/A: OLMC 1mcg/kg

• PEDS:
• Pain: 1mcg/kg IV max 25mcg q5 max 100
• 2mcg/kg IN max 100mcg. Repeat 0.5-1mcg/kg q15 x1.
• Maintenance: 1mcg/kg/hr in 25mcg increments

Maintenance of sedation: 1mcg/kg max 25mcg q 10min

Benzodiazepine antagonist

1. Reversal of benzodiazepine OD or sedation

1. Competitively binds to GABA receptors in CNS.

• 1. Seizure
• 2. Anxiety, Agitation
• 3. H/A
• 4. Arrhythmias
• 5. HTN

• 1. Hypersensitivity
• 2. TCA OD/polypharm - toxicity of TCA can be masked by protective benzo effect
• 3. Increased ICP/head injury

0.3mg IV over 60sec q1min prn, max 3mg

• PEDS:
• 0.01-0.02mg/kg IV over 30sec q1, max 1mg

Loop Diuretic

• 1. CHF/Pulmonary edema
• 2. HTN crisis
• 3. Edema due to renal or hepatic impairment

• 1. Hypersensitivity to sulfonamides
• 2. Electrolyte imbalances (hypokalemia/calcemia/natremia)
• 3. Hypovolemia
• 4. Hypotension
• 5. Hepatic coma

• 1. Inhibits reabsorption on Na, Cl and water from Loop of Henle (and distal tubules).
• 2. Promotes excretion of water, Na, Cl, Mg, Ca, K.
• 3. Diuretic effect is exerted even with a markedly impaired GFR.

• 1. Hypotension/dehydration
• 2. Electrolyte and fluid imbalances
• 3. Vertigo/dizziness
• 4. Tinnitus
• 5. Arrhythmias (K depletion)
• 6. N/V/D

20-40mg IV/IM q1-2hrs increasing by 20mg each time until response is observed.

Peds: 2mg/kg

5min, 30min, 2hrs

rapid acting diuretic

Antihypertensives, digoxin

Pancreatic Hormone

• 1. Hypoglycemia
• 2. B blocker OD
• 3. CCB OD
• 4. Anaphylaxis where pt is refractory hypotensive and on BBs.

• 1. Promotes glycogenolysis in liver and glyconeogensis elsewhere.
• 2. Relaxes smooth musculature in GI tract inhibiting movement.
• 3. Positive chronotropic and inotropic effects via non-α and non-β receptors.

• 1. N/V
• 2. Hypetension
• 3. Tachycardia

• 1. Pheochromocytoma
• 2. Hypersensitivity to beef/pork

10-15min, 30, 30

• Adults:
• Hypoglycemia: 1mg IM q 15min max 2mg
• BB/CCB OD: 2mg IV/IM/IO q 5min max 4mg
• Anaphylaxis: 1mg IV q 5min max 5mg.

• Peds:
• <20kg: 0.5mg IM q 15min max 1mg
• >20kg: 1mg IM q 15min max 1mg

BB/CCB OD: 0.1mg/kg max 1mg q 5min max 4mg.

• Neuroleptic - Butyrophenone Family
• Antiemetic

• Acute Psychosis
• Aggressive and combative behavior
• Excited Delerium
• N/V

• 1. High affinity for dopamine D2 reeptors producting antipsychotic effects and EPS.
• 2. Lowers seizure threshold.
• 3. α adrenergic blocking and anticholinergic activity.
• 4. Dopamine blocked in CTZ resulting in strong antiemetic effects.

• 1. Seizures/Tremors/EPS
• 2. Sedation/resp depression
• 3. Postural Hypotension
• 4. QT prolongation
• 5. Anticholinergic effects

• 1. Hypersensitivity
• 2. Parkinson's
• 3. Spastic Disease
• 4. Seizure history
• 5. QT prolongation meds/syndrome
• 6. Comatose/CNS depression

• 5mg IM/SIVP q15min max 10mg
• 2.5mg single dose if >65y/o

Anticoagulant

Thromboembolic disorder; MI, DVT, PE, a-fib with embolization etc

• 1. Potentiates the inhibitory effect of antithrombin on factor Xa and thrombin, preventing the conversion of fibrinogen to fibrin.
• 2. Acts in intrinsic pathway
• 3. Can be reversed by protamine sulfate.

• 1. Hemorrhage
• 2. HIT - heparin induced thrombocytopenia
• 3. Anemia

• 1. Bleeding, recent surgery/bleeds
• 2. Head trauma
• 3. Hypersensitivity
• 4. Severe Thrombocytopenia

• Adluts: IV 10000U followed by 5000-10000U q4-6hrs
• SC 10000-20000U followed by 8000-10000U tid
• Infusion: 20000-40000U/day

• Peds:
• 50-75U/kg followed by 20U/kg/hr

60-85sec

• Antihypertensive
• Vasodilator

• 1. HTN crisis
• 2. Preeclampsia/eclampsia

• 1. Direct-acting peripheral arterial vasodilator (similar to nitroprusside, but nitroprusside acts on both arterial and venous)
• 2. Reduction in PVR results in increased HR, SV and CO

• 1. H/A, dizziness
• 2. Tachycardia/palps
• 3. Angina
• 4. Edema
• 5. Drug induces lupus syndrome
• 6. N/V/D
• 7. Postural and regular hypotension
• 8. Na retention

• 1. Hypersensitivity
• 2. Mitral valve disease
• 3. Cerebral edema/head injury
• 4. MI/CAD
• 5. Acute dissecting aortic aneurysm

• Adult: 5-40mg IV prn until desired BP
• PO: 10mg qid increasing after 2-4days

• Peds: 0.1-0.2mg/kg max 20mg q4-6hrs prn
• PO: 0.75-1mg/kg/day in 2-4 doses max 25mg/day.

Short Acting corticosteroid

1. Management of adrenocortical insufficiency

• 1. Replaces endogenous cortisone, acting as a strong mineralcorticoid promoting Na and water retention.
• 2. Inhibits inflammatory and immune response by preventing accumulation on inflammatory cells (macrophages and leuks) and inhibiting lysosome release (inflammatory)
• 3. Promotes hlycogenolysis in liver

• BROAD RANGE MANY SIDE EFFECTS
• 1. Convulsions
• 2. Psychosis
• 3. Vertigo
• 4. HTN
• 5. electrolyte impalances
• 6. Increased IOC/glaucoma
• 7. Edema
• 8. N/V
• 9. Peptic ulceration
• 10. Decreased wound healing, fragile skin, ecchymosis
• 11. Muscle wasting
• 12. Hyperglycemia

• 1. Untreated infections
• 2. Hypersensitivity to alcohol, bisulfites, tartrazine

Adult: 100-500mg SIVP q2-6hrs prn

Peds: 1.5mg/kg SIVP/IM bid

• 1. Non-potassium sparring diuretics can cause ++ hypokalemia/hypocalcemia
• 2. NSAIDS can increase chance of ulcers (Side Effect)

• 1. Antipyretic
• 2. NSAID
• 3. Antirheumatic

• 1. Mild-moderate pain
• 2. Fever
• 3. Inflammation

• 1. Inhibits activity of COX, resulting in inhibition of prostaglandin formation.
• 2. Peripheral acting analgesic

• 1. H/A, dizziness
• 2. Drowsiness
• 3. Tinnitus
• 4. Edema/HTN - water retention
• 5. N/V
• 6. GI bleeding
• 7. Hepatitis
• 8. Abd pain

• 1. Hypersensitivity to NSAIDS/Salicylates
• 2. Active GI bleed
• 3. Pregnancy >30wks

• Adult:
• Anti-inflammatory: 400-800mg PO q6-8hrs max 3200mg/day
• Antipyretic/pain: 200-400mg PO q4-6hrs max 1200mg/day

• Peds:
• Anti-inflammatroy: 50mg/kg/day divided into 3-4doses/day
• Pain/fever: 10mg/kg q4-6hrs max 40mg/day

Long acting hormone

Control of hyperglycemia in diabetes mellitus

• 1. Stimulates glucose uptake my skeletal muscles and fat.
• 2. Inhibits lypolysis by promoting triglyceride production
• 3. Stimulate protein synthesis
• 4. Promotes glucose conversion into glycogen.
• 5. Stimulates intracellular shift of potassium

• 1. Anaphylaxis
• 2. Hypoglycemia

• 1. Hypersensitivity
• 2. Hyoglycemia

• DKA
• Adults: 0.1u/kg/hr IV
• Peds: 0.1u/kg IV then 0.05-0.2u/kg/hr IV

SC: 0.5-1u/kg/day divided into doses

• Hyperkalemia:
• 0.5-1g/kg dextrose with 1u q4-5g dextrose admin.

Always dilute IV admin

Anticholinergic Bronchodilator

Bronchospasm

1. Inhibits cholinergic receptors in bronchial smooth muscle

1. Anticholinergic effects

Hypersensitivity to or to soy lecithin or peanut with combivent.

Avoid eyes - narrow angle glaucoma

Adult: 250-500mcg mixed with Ventolin

• Peds:
• <10kg: 125mcg
• 10-20kg: 250mcg
• >20kg: 500mcg

β1 and β2 adrenergic agonist.

• 1. Bradycardia in heart transplants, refractory to atropine, pacing, dopamine and epi, and in BB OD (refractory to other Tx)
• 2. No α effects, therefore not a pressor and not used in hypotension from reasons other than bradycardia.

• 1. Stimulates β1 and β2 receptors with posistive ino, chrono and dromotropic effects.
• 2. No α effects, therefore not a pressor and not used in hypotension from reasons other

• 1. Tachycardia
• 2. Palpitation and arrhythmias
• 3. HTN
• 4. Angina
• 5. H/A

• 1. Hypersensitivity
• 2. Hypotension from other sources other than bradycardia
• 3. Tachyarrhythmias

• Adult: 2-10mcg/min titrating to HR
• Mix 1mg in 250ml D5W or NS = 4mcg/ml

Ped: 0.5mcg/min titrating to BP increasing in 0.1mcg/kg/min increments. Max 1mcg/kg/min

• 1. Analgesic
• 2. Hypnotic
• 3. Amnestic
• 4. Induction Agent

• 1. Sedation and maintenance of for RSI/RSS
• 2. Procedural sedation
• 3. Pain

• 1. Thought to cause dissociation between cortical and limbic systems resulting in dissociated state from environement.
• 2. Powerful analgesic, amnestic and sedative effects.

• 1. Transient HTN
• 2. Hallucinations
• 3. N/V
• 4. Increased skeletal muscle tone
• 5. Increased bronchial secretions

• 1. Hypersensitivity
• 2. Cases where increase in BP in detrimental

• RSI: 1.5mg/kg
• Maintenance: 0.5mg/kg q 10min
• Procedural: 0.5mg/kg
• Pain: 0.2mg/kg OLMC

Peds = same

• 1. NSAID
• 2. Non opiod analgesic

• 1. Pain refractory to Morphine/fent or for renal colic
• 2. Non vascular H/A or vascular H/A refractory to metoclopramide

• 1. Inhibits COX activity which prevents prostaglandin formation.
• 2. Small antiinflammatory and antipyretic effects
• 3. Acts in the peripheral system.

• 1. CVA
• 2. H/A, drowsiness
• 3. Bronchospasm
• 4. GI bleed

• 1. Sub-arachnoid hemorrhage
• 2. GI bleed
• 3. Hypersensitivity to NSAIDs
• 4. Renal failure
• 5. Bronchospastic Hx (Asthma)

30mg IM/IV

No ped dose