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Fentanyl Classifcation
Narcotic analgesic
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Fentanyl Indications
- 1. Pain
- 2. Sedation, induce or maintain
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Fentanyl Mechanisms of action
Binds to opiod receptors in CNS altering pain perception and response
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Fentanyl Side Effects
- 1. Respiratory depression/apnea
- 2. Hypotension
- 3. N/V
- 4. Constipation
- 5. Dizziness/euphoria
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Fentanyl Contraindications
- 1. BP <80
- 2. Myasthenia Gravis
- 3. Hypersensitivity
- 4. MAIOs within 14 days
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Fentanyl Dosing
Adult:
Pain:
Sedation:
Maintenance of sedation:
Pacing:
H/A:
Peds: Pain/Maintenance
- 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
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Flumazenil Classification
Benzodiazepine antagonist
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Flumazenil Indications
1. Reversal of benzodiazepine OD or sedation
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Flumazenil Mechanisms of action
1. Competitively binds to GABA receptors in CNS.
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Flumazenil Side Effects
- 1. Seizure
- 2. Anxiety, Agitation
- 3. H/A
- 4. Arrhythmias
- 5. HTN
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Flumazenil Contraindication
- 1. Hypersensitivity
- 2. TCA OD/polypharm - toxicity of TCA can be masked by protective benzo effect
- 3. Increased ICP/head injury
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Flumazenil Dosing
0.3mg IV over 60sec q1min prn, max 3mg
- PEDS:
- 0.01-0.02mg/kg IV over 30sec q1, max 1mg
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Furosemide Classification
Loop Diuretic
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Furosemide Indications
- 1. CHF/Pulmonary edema
- 2. HTN crisis
- 3. Edema due to renal or hepatic impairment
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Furosemide Contraindications
- 1. Hypersensitivity to sulfonamides
- 2. Electrolyte imbalances (hypokalemia/calcemia/natremia)
- 3. Hypovolemia
- 4. Hypotension
- 5. Hepatic coma
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Furosemide Mechanisms of Action
- 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.
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Furosemide Side Effects
- 1. Hypotension/dehydration
- 2. Electrolyte and fluid imbalances
- 3. Vertigo/dizziness
- 4. Tinnitus
- 5. Arrhythmias (K depletion)
- 6. N/V/D
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Furosemide Dosing
Adults:
Peds:
20-40mg IV/IM q1-2hrs increasing by 20mg each time until response is observed.
Peds: 2mg/kg
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Furosemide Onset, Peak, Duration
5min, 30min, 2hrs
rapid acting diuretic
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Furosemide Interactions
Antihypertensives, digoxin
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Glucagon Classifcation
Pancreatic Hormone
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Glucagon Indications
- 1. Hypoglycemia
- 2. B blocker OD
- 3. CCB OD
- 4. Anaphylaxis where pt is refractory hypotensive and on BBs.
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Glucagon Mechanisms of Action
- 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.
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Glucagon Side Effects
- 1. N/V
- 2. Hypetension
- 3. Tachycardia
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Glucagon Contraindications
- 1. Pheochromocytoma
- 2. Hypersensitivity to beef/pork
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Glucagon Onset, Peak, Duration
10-15min, 30, 30
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Glucagon dosing
Adult
Hypoglycemia
ODs
Anaphylaxis
Peds:
- 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.
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Haloperidol Classifications
- Neuroleptic - Butyrophenone Family
- Antiemetic
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Haloperidol Indications
- Acute Psychosis
- Aggressive and combative behavior
- Excited Delerium
- N/V
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Haloperidol Mechnisms of Action
- 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.
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Haloperidol Side Effects
- 1. Seizures/Tremors/EPS
- 2. Sedation/resp depression
- 3. Postural Hypotension
- 4. QT prolongation
- 5. Anticholinergic effects
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Haloperidol Contraindications
- 1. Hypersensitivity
- 2. Parkinson's
- 3. Spastic Disease
- 4. Seizure history
- 5. QT prolongation meds/syndrome
- 6. Comatose/CNS depression
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Haloperidol Dosing
- 5mg IM/SIVP q15min max 10mg
- 2.5mg single dose if >65y/o
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Heparin Classification
Anticoagulant
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Heparin Indications
Thromboembolic disorder; MI, DVT, PE, a-fib with embolization etc
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Heparin Mechanisms of Action
- 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.
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Heparin Side Effects
- 1. Hemorrhage
- 2. HIT - heparin induced thrombocytopenia
- 3. Anemia
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Heparin Contraindications
- 1. Bleeding, recent surgery/bleeds
- 2. Head trauma
- 3. Hypersensitivity
- 4. Severe Thrombocytopenia
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Heparin Dosing
Adults:
Peds:
- 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
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Heparin target PTT
60-85sec
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Hydralazine (Apresoline) Classification
- Antihypertensive
- Vasodilator
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Hydralazine (Apresoline) Indications
- 1. HTN crisis
- 2. Preeclampsia/eclampsia
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Hydralazine (Apresoline) Mechanisms of Action
- 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
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Hydralazine (Apresoline) Side Effects
- 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
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Hydralazine (Apresoline) Contraindications
- 1. Hypersensitivity
- 2. Mitral valve disease
- 3. Cerebral edema/head injury
- 4. MI/CAD
- 5. Acute dissecting aortic aneurysm
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Hydralazine (Apresoline) Dosing
Adult:
Peds:
- 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.
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Hydrocortisone (Solu-Cortef) Classification
Short Acting corticosteroid
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Hydrocortisone (Solu-Cortef) Indications
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Hydrocortisone (Solu-Cortef) Indications
1. Management of adrenocortical insufficiency
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Hydrocortisone (Solu-Cortef) Mehcanisms of Action
- 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
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Hydrocortisone (Solu-Cortef) Side Effects
- 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
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Hydrocortisone (Solu-Cortef) Contraindications
- 1. Untreated infections
- 2. Hypersensitivity to alcohol, bisulfites, tartrazine
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Hydrocortisone (Solu-Cortef) Dosing
Adult:
Ped:
Adult: 100-500mg SIVP q2-6hrs prn
Peds: 1.5mg/kg SIVP/IM bid
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Hydrocortisone (Solu-Cortef) Major Interations:
- 1. Non-potassium sparring diuretics can cause ++ hypokalemia/hypocalcemia
- 2. NSAIDS can increase chance of ulcers (Side Effect)
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Ibuprofen Classifications
- 1. Antipyretic
- 2. NSAID
- 3. Antirheumatic
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Ibuprofen Indications
- 1. Mild-moderate pain
- 2. Fever
- 3. Inflammation
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Ibuprofen Mechanisms of Action
- 1. Inhibits activity of COX, resulting in inhibition of prostaglandin formation.
- 2. Peripheral acting analgesic
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Ibuprofen Side Effects
- 1. H/A, dizziness
- 2. Drowsiness
- 3. Tinnitus
- 4. Edema/HTN - water retention
- 5. N/V
- 6. GI bleeding
- 7. Hepatitis
- 8. Abd pain
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Ibuprofen Contraindications
- 1. Hypersensitivity to NSAIDS/Salicylates
- 2. Active GI bleed
- 3. Pregnancy >30wks
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Ibuprofen Dosing
Anti-inflammatory:
Anti-pyretic/pain:
Adult:
Peds:
- 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
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Regular Insulin (Toronto) Classification
Long acting hormone
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Regular Insulin (Toronto) Indications
Control of hyperglycemia in diabetes mellitus
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Regular Insulin (Toronto) Mechanisms of Action
- 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
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Regular Insulin (Toronto) Side Effects
- 1. Anaphylaxis
- 2. Hypoglycemia
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Regular Insulin (Toronto) Contraindications
- 1. Hypersensitivity
- 2. Hyoglycemia
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Regular Insulin (Toronto) Dosing
DKA: Adult/Peds
Hyperkalemia
- 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
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Ipratropium Bromide Classification
Anticholinergic Bronchodilator
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Ipratropium Bromide Indication
Bronchospasm
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Ipratropium Bromide Mechanisms of Action
1. Inhibits cholinergic receptors in bronchial smooth muscle
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Ipratropium Bromide Side Effects
1. Anticholinergic effects
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Ipratropium Bromide Contraindication
Hypersensitivity to or to soy lecithin or peanut with combivent.
Avoid eyes - narrow angle glaucoma
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Ipratropium Bromide Dosing
Adult:
Ped:
Adult: 250-500mcg mixed with Ventolin
- Peds:
- <10kg: 125mcg
- 10-20kg: 250mcg
- >20kg: 500mcg
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Isoproterenol Classification
β1 and β2 adrenergic agonist.
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Isoproterenol Indications
- 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.
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Isoproterenol Mechanisms of Action
- 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
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Isoproterenol Side Effects
- 1. Tachycardia
- 2. Palpitation and arrhythmias
- 3. HTN
- 4. Angina
- 5. H/A
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Isoproterenol Contraindications
- 1. Hypersensitivity
- 2. Hypotension from other sources other than bradycardia
- 3. Tachyarrhythmias
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Isoproterenol Dosing
Adult:
Ped:
- 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
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Ketamine Classifications
- 1. Analgesic
- 2. Hypnotic
- 3. Amnestic
- 4. Induction Agent
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Ketamine Indications
- 1. Sedation and maintenance of for RSI/RSS
- 2. Procedural sedation
- 3. Pain
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Ketamine Mechanisms of Action
- 1. Thought to cause dissociation between cortical and limbic systems resulting in dissociated state from environement.
- 2. Powerful analgesic, amnestic and sedative effects.
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Ketamine Side Effects
- 1. Transient HTN
- 2. Hallucinations
- 3. N/V
- 4. Increased skeletal muscle tone
- 5. Increased bronchial secretions
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Ketamine Contraindications
- 1. Hypersensitivity
- 2. Cases where increase in BP in detrimental
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Ketamine Dosing
RSI:
Maintenance:
Procedural:
Pain:
- RSI: 1.5mg/kg
- Maintenance: 0.5mg/kg q 10min
- Procedural: 0.5mg/kg
- Pain: 0.2mg/kg OLMC
Peds = same
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Ketorolac Classifications
- 1. NSAID
- 2. Non opiod analgesic
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Ketorolac Indications
- 1. Pain refractory to Morphine/fent or for renal colic
- 2. Non vascular H/A or vascular H/A refractory to metoclopramide
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Ketorolac Mechanisms of Action
- 1. Inhibits COX activity which prevents prostaglandin formation.
- 2. Small antiinflammatory and antipyretic effects
- 3. Acts in the peripheral system.
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Ketorolac Side Effects
- 1. CVA
- 2. H/A, drowsiness
- 3. Bronchospasm
- 4. GI bleed
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Ketorolac Contraindications
- 1. Sub-arachnoid hemorrhage
- 2. GI bleed
- 3. Hypersensitivity to NSAIDs
- 4. Renal failure
- 5. Bronchospastic Hx (Asthma)
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Ketorolac Dosing
30mg IM/IV
No ped dose
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