Meds F-K

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  1. Fentanyl Classifcation
    Narcotic analgesic
  2. Fentanyl Indications
    • 1. Pain
    • 2. Sedation, induce or maintain
  3. Fentanyl Mechanisms of action
    Binds to opiod receptors in CNS altering pain perception and response
  4. Fentanyl Side Effects
    • 1. Respiratory depression/apnea
    • 2. Hypotension
    • 3. N/V
    • 4. Constipation
    • 5. Dizziness/euphoria
  5. Fentanyl Contraindications
    • 1. BP <80
    • 2. Myasthenia Gravis
    • 3. Hypersensitivity
    • 4. MAIOs within 14 days
  6. 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
  7. Flumazenil Classification
    Benzodiazepine antagonist
  8. Flumazenil Indications
    1. Reversal of benzodiazepine OD or sedation
  9. Flumazenil Mechanisms of action
    1. Competitively binds to GABA receptors in CNS.
  10. Flumazenil Side Effects
    • 1. Seizure
    • 2. Anxiety, Agitation
    • 3. H/A
    • 4. Arrhythmias
    • 5. HTN
  11. Flumazenil Contraindication
    • 1. Hypersensitivity
    • 2. TCA OD/polypharm - toxicity of TCA can be masked by protective benzo effect
    • 3. Increased ICP/head injury
  12. Flumazenil Dosing
    0.3mg IV over 60sec q1min prn, max 3mg

    • PEDS:
    • 0.01-0.02mg/kg IV over 30sec q1, max 1mg
  13. Furosemide Classification
    Loop Diuretic
  14. Furosemide Indications
    • 1. CHF/Pulmonary edema
    • 2. HTN crisis
    • 3. Edema due to renal or hepatic impairment
  15. Furosemide Contraindications
    • 1. Hypersensitivity to sulfonamides
    • 2. Electrolyte imbalances (hypokalemia/calcemia/natremia)
    • 3. Hypovolemia
    • 4. Hypotension
    • 5. Hepatic coma
  16. 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.
  17. Furosemide Side Effects
    • 1. Hypotension/dehydration
    • 2. Electrolyte and fluid imbalances
    • 3. Vertigo/dizziness
    • 4. Tinnitus
    • 5. Arrhythmias (K depletion)
    • 6. N/V/D
  18. Furosemide Dosing

    Adults:

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

    Peds: 2mg/kg
  19. Furosemide Onset, Peak, Duration
    5min, 30min, 2hrs

    rapid acting diuretic
  20. Furosemide Interactions
    Antihypertensives, digoxin
  21. Glucagon Classifcation
    Pancreatic Hormone
  22. Glucagon Indications
    • 1. Hypoglycemia
    • 2. B blocker OD
    • 3. CCB OD
    • 4. Anaphylaxis where pt is refractory hypotensive and on BBs.
  23. 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.
  24. Glucagon Side Effects
    • 1. N/V
    • 2. Hypetension
    • 3. Tachycardia
  25. Glucagon Contraindications
    • 1. Pheochromocytoma
    • 2. Hypersensitivity to beef/pork
  26. Glucagon Onset, Peak, Duration
    10-15min, 30, 30
  27. 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.
  28. Haloperidol Classifications
    • Neuroleptic - Butyrophenone Family
    • Antiemetic
  29. Haloperidol Indications
    • Acute Psychosis
    • Aggressive and combative behavior
    • Excited Delerium
    • N/V
  30. 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.
  31. Haloperidol Side Effects
    • 1. Seizures/Tremors/EPS
    • 2. Sedation/resp depression
    • 3. Postural Hypotension
    • 4. QT prolongation
    • 5. Anticholinergic effects
  32. Haloperidol Contraindications
    • 1. Hypersensitivity
    • 2. Parkinson's
    • 3. Spastic Disease
    • 4. Seizure history
    • 5. QT prolongation meds/syndrome
    • 6. Comatose/CNS depression
  33. Haloperidol Dosing
    • 5mg IM/SIVP q15min max 10mg
    • 2.5mg single dose if >65y/o
  34. Heparin Classification
    Anticoagulant
  35. Heparin Indications
    Thromboembolic disorder; MI, DVT, PE, a-fib with embolization etc
  36. 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.
  37. Heparin Side Effects
    • 1. Hemorrhage
    • 2. HIT - heparin induced thrombocytopenia
    • 3. Anemia
  38. Heparin Contraindications
    • 1. Bleeding, recent surgery/bleeds
    • 2. Head trauma
    • 3. Hypersensitivity
    • 4. Severe Thrombocytopenia
  39. 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
  40. Heparin target PTT
    60-85sec
  41. Hydralazine (Apresoline) Classification
    • Antihypertensive
    • Vasodilator
  42. Hydralazine (Apresoline) Indications
    • 1. HTN crisis
    • 2. Preeclampsia/eclampsia
  43. 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
  44. 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
  45. Hydralazine (Apresoline) Contraindications
    • 1. Hypersensitivity
    • 2. Mitral valve disease
    • 3. Cerebral edema/head injury
    • 4. MI/CAD
    • 5. Acute dissecting aortic aneurysm
  46. 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.
  47. Hydrocortisone (Solu-Cortef) Classification
    Short Acting corticosteroid
  48. Hydrocortisone (Solu-Cortef) Indications
  49. Hydrocortisone (Solu-Cortef) Indications
    1. Management of adrenocortical insufficiency
  50. 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
  51. 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
  52. Hydrocortisone (Solu-Cortef) Contraindications
    • 1. Untreated infections
    • 2. Hypersensitivity to alcohol, bisulfites, tartrazine
  53. Hydrocortisone (Solu-Cortef) Dosing

    Adult:

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

    Peds: 1.5mg/kg SIVP/IM bid
  54. Hydrocortisone (Solu-Cortef) Major Interations:
    • 1. Non-potassium sparring diuretics can cause ++ hypokalemia/hypocalcemia
    • 2. NSAIDS can increase chance of ulcers (Side Effect)
  55. Ibuprofen Classifications
    • 1. Antipyretic
    • 2. NSAID
    • 3. Antirheumatic
  56. Ibuprofen Indications
    • 1. Mild-moderate pain
    • 2. Fever
    • 3. Inflammation
  57. Ibuprofen Mechanisms of Action
    • 1. Inhibits activity of COX, resulting in inhibition of prostaglandin formation.
    • 2. Peripheral acting analgesic
  58. 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
  59. Ibuprofen Contraindications
    • 1. Hypersensitivity to NSAIDS/Salicylates
    • 2. Active GI bleed
    • 3. Pregnancy >30wks
  60. 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
  61. Regular Insulin (Toronto) Classification
    Long acting hormone
  62. Regular Insulin (Toronto) Indications
    Control of hyperglycemia in diabetes mellitus
  63. 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
  64. Regular Insulin (Toronto) Side Effects
    • 1. Anaphylaxis
    • 2. Hypoglycemia
  65. Regular Insulin (Toronto) Contraindications
    • 1. Hypersensitivity
    • 2. Hyoglycemia
  66. 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
  67. Ipratropium Bromide Classification
    Anticholinergic Bronchodilator
  68. Ipratropium Bromide Indication
    Bronchospasm
  69. Ipratropium Bromide Mechanisms of Action
    1. Inhibits cholinergic receptors in bronchial smooth muscle
  70. Ipratropium Bromide Side Effects
    1. Anticholinergic effects
  71. Ipratropium Bromide Contraindication
    Hypersensitivity to or to soy lecithin or peanut with combivent.

    Avoid eyes - narrow angle glaucoma
  72. Ipratropium Bromide Dosing

    Adult:

    Ped:
    Adult: 250-500mcg mixed with Ventolin

    • Peds:
    • <10kg: 125mcg
    • 10-20kg: 250mcg
    • >20kg: 500mcg
  73. Isoproterenol Classification
    β1 and β2 adrenergic agonist.
  74. 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.
  75. 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
  76. Isoproterenol Side Effects
    • 1. Tachycardia
    • 2. Palpitation and arrhythmias
    • 3. HTN
    • 4. Angina
    • 5. H/A
  77. Isoproterenol Contraindications
    • 1. Hypersensitivity
    • 2. Hypotension from other sources other than bradycardia
    • 3. Tachyarrhythmias
  78. 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
  79. Ketamine Classifications
    • 1. Analgesic
    • 2. Hypnotic
    • 3. Amnestic
    • 4. Induction Agent
  80. Ketamine Indications
    • 1. Sedation and maintenance of for RSI/RSS
    • 2. Procedural sedation
    • 3. Pain
  81. 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.
  82. Ketamine Side Effects
    • 1. Transient HTN
    • 2. Hallucinations
    • 3. N/V
    • 4. Increased skeletal muscle tone
    • 5. Increased bronchial secretions
  83. Ketamine Contraindications
    • 1. Hypersensitivity
    • 2. Cases where increase in BP in detrimental
  84. 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
  85. Ketorolac Classifications
    • 1. NSAID
    • 2. Non opiod analgesic
  86. Ketorolac Indications
    • 1. Pain refractory to Morphine/fent or for renal colic
    • 2. Non vascular H/A or vascular H/A refractory to metoclopramide
  87. Ketorolac Mechanisms of Action
    • 1. Inhibits COX activity which prevents prostaglandin formation.
    • 2. Small antiinflammatory and antipyretic effects
    • 3. Acts in the peripheral system.
  88. Ketorolac Side Effects
    • 1. CVA
    • 2. H/A, drowsiness
    • 3. Bronchospasm
    • 4. GI bleed
  89. Ketorolac Contraindications
    • 1. Sub-arachnoid hemorrhage
    • 2. GI bleed
    • 3. Hypersensitivity to NSAIDs
    • 4. Renal failure
    • 5. Bronchospastic Hx (Asthma)
  90. Ketorolac Dosing
    30mg IM/IV

    No ped dose
Author
ID
318770
Card Set
Meds F-K
Description
ACP meds F-K
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