Meds O-R

Antiemetic

N/V with chemotherapy, gastroenteritis, head injury or refractory to other Tx.

Blocks serotonin (5-HT3) receptors in CTZ, GI tract and VC (vomiting centre = medulla)

QT prolongation

Hypersensitivity

8mg IM or in 50ml over 15min

• Peds: <4y/o 2mg PO
•          >y/o 4mg PO

or 0.1mg/kg IV max 4mg in 50ml over 15min

• Onset: 15-30min
• Peak: 1-1.5hr
• Duration: 6-12hrs

Hormone

• 1. Delivery
• 2. Post partum hemorrhage

• 1. Stimulates contraction of uterine smooth muscle.
• 2. Has vasopressor/antiduiretic effects

• 1. Fluid retension ↠ hyponatremia and hypochloremia
• 2. Hypotension
• 3. Uterine rupture

• 1. Hypersensitivity
• 2. Uterine inversion
• 3. Placenta previa
• 4. Placenta abruptio
• 5. If subsequent fetus not yet delivered

• Delivery: 10u IM
• Hemorrhage: 6u/hr = 40u in 1000ml = 150ml/hr

Long acting nondeplolarizing neuromuscular blocking agent.

• RSI
• Surgery

• 1. Blocks ACh from binding to postsynaptic receptors by competitively binding to without stimulating depolarization.
• 2. Selectively blocks Vagus nerve resulting in tachycardia, arrhythmias and HTN

• 1. Bronchospasm
• 2. Tachycardia
• 3. HTN
• (4. ↑ ICP - preferable to use vecuronium in theres pts.)

Hypersensitivity to bomides

• Onset: 30-45sec
• Peak: 3-5min
• Duration: 30-60min

• 0.04-0.1mg/kg
• infusion of 0.1mg/kg/hr

Peds is the same

Plasma Volume Expander

Shock, volume depletion. Situations where volume expansion is needed.

Hypertonic solution that increases osmotic force and pulls fluid into vascular space from interstital space for 18-24hrs.

• 1. Coagulation disorders
• 2. H/A
• 3. Edema
• 4. CP
• 5. Fever

• 1. Hypersensitivity to hydroxyethyl
• 2. Bleeding disorders
• 3. CHF
• 4. Renal failure with anuria/oliguria

500-2000ml bolus

No ped dose

• Long acting Barbiturate
• Anticonvulsant
• Hypnotic
• Sedative

• 1. Tx of status epilepticus refractory to standard Tx - 2nd line agent.
• 2. Febrile seizure

• 1. Prosuces all levels of CNS depression - sensory cortex, motor activity and alters cerebellar function.
• 2. Increases seizure threshold by mimicking GABA effects.
• 3. Speeds up liver enzymes that metabolize drugs and bilirubin.

• 1. Sedation
• 2. Resp Depression
• 3. Hypotension
• 4. Bronchospasm
• 5. N/V
• (6. Neuralgia, myalgia)

• 1. Hypersensitivity
• 2. COPD/Asthma/resp difficulties
• 3. Uncontrolled severe pain
• 4. Severe liver disease

• Adult: 20mg/kg SIVP
• Maintenance 1-3mg/kg/day

• Peds: 20mg/kg SIVP
• Maintenance of 6mg/kg/day

Alpha adrenergic blocker

• 1. HTN Crisis due to primarily pheochromocytoma
• 2. Prevention of dermal necrosis/sloughing following extravasation of catecholamine administration (epi/norepi/dope/dobut)

• 1. Cerebrovascular spasm
• 2. Hypotension
• 3. Tachycardia
• 4. Angina/MI
• 5. Arrhythmias
• 6. N/V/D
• 7. Abd pain

• 1. Hypersensitivity
• 2. PVD
• 3. CAD
• 4. cerebral atherosclerosis

5-10mg IV

• Onset: immediate
• Peak: 2min
• Duration: 15-30min

Sympathetic agonist

BP <70mmHg due to decreased peripheral vascular resistance (distributive shock), not a first line agent

Acts almost exclusively of alpha receptors increasing vascular resistance and BP

• Onset: immediate
• Peak: <1min
• Duartion: 15-20min

1. Cardiogenic shock

• 1. Angina
• 2. HTN
• 3. Nervousness/H/A
• 4. blurred vision
• 5. lacrimation
• 6. urinary retention
• 7. arrhythmias
• 8. N/V

• 100-180mcg/min
• Maintenance of 46-60mcg/min

• 1. Anticonvulsant
• 2. Class 1B Antiarrythmic

• 1. Status epilepticus refractory of other Tx (benzos etc)
• 2. Neuropathic pain
• 3. Ventricular arrhythmias due to digitalis toxicity

• 1. Blocks Na and Ca channels in neurons, stabilizing cell membranes. This increases threshold activity in brain, prevents spread of seizure activity and decreases speed of conduction through a neuron.
• 2. Highly bound to plasma protein so a low serum concentration of albumin (malnourishment or chronic renal failure) there is an increased in free, unbound active phenytoin in blood.
• 3. Antiarrhythmic: normalizes Na and Ca influx in Purkinje fibers and accelerates repolarization period.

• 1. Hypotension
• 2. Arrhythmias
• 3. Ataxia
• 4. Nystagmus
• 5. Slurred speech
• 6. Encephalophathy

Green = OD (narrow therapeutic index)

• 1. Hypersensitivity to hydrantoins, propylene glycol, and ethanol
• 2. Bradycardia/Severe Heart blocks
• 3. TCA ingestion - promotes further seizures.
• 4. Chronic admin

Adult: 15-20mg/kg IV no faster than 50mg/min

Peds: 15-20mg/kg no faster than 1mg/kg/min or 50mg/min.

• Onset 5-30min
• Duration: 12-24hrs
• Half Life: 10-60hrs

Electroly

Hypokalemia

• Potassium is needed for:
• - Metabolic enzymatic reactions
• - conduction of nerve impulses
• - renal function
• - acid-base balance
• - tissue synthesis
• - carbohydrate metabolism

• 1. Arrhythmias/cardiac arrest
• 2. Confusion
• 3. Restlessness
• 4. N/V/D
• 5. Abd pain

• 1. Severe renal impairment
• 2. Hyperkalemia

Adult: 20-40mEq/day depending on severity, not to exceed 10-20mEq/hr.

Peds: 0.5-1mEq/kg, max 30mEq

corticosteriod

• 1. Bronchospasm
• 2. Immunosuppressant purposes

• 1. Prevents accumulation of inflammatory cells, including macrophages and leukocytes.
• 2. Inhibits lysosomal enzyme release and synthesis of chemical mediators of inflammation.

• 1. Increased intraocular pressure
• 2. HF, cardiac edema
• 3. HF
• 4. HTN
• 5. tooo many to list

• 1. Pts already taking prednisone
• 2. Hypersensitivity
• 3. Systemic infections

50mg PO

Class 1A antiarrhythmic

• 1. VT
• 2. WPW
• 3. SVTs/A-fib
• 4. Suppression of PVCs

• 1. Stabilizes cell membranes by blocking Na channels depressing myocardial excitability
• 2. Increases action potential duration
• 3. Prolongs effective refractory period time by decreasing repolarization
• 4. Decreases or eliminates ectopic foci stimulation
• 5. Anticholinergic activity
• 6. Negative inotropic effect

• 1. ++ CNS effects including seizures, confusion
• 2. ++ Arrhythmias - ventricular, QT prolongation
• 3. Blood disorders
• 4. N/V/D
• 5. Fever
• 6.... Lots more

• 1. Hypersensitivity
• 2. 2nd and 3rd degree blocks
• 3. Torsades

• 20-50mg/min until :
• 1. Arrhythmia suppressed
• 2. Hypotension
• 3. QRS widens by 50%
• 4. Max of 17mg/kg

Maintenance of 1-4mg/min

• 1. Antiemetic
• 2. Antipsychotic

• 1. N/V
• 2. Psychosis

• 1. Blocks Dopamine D2 receptors in CTZ.
• 2. Blocks Vagus nerve in GI tract
• 3. Alpha blocking activity

• 1. EPS
• 2. Anticholinergic effects
• 3. Neuroleptic malignant syndrome
• 4. Hypotension

• 1. Hypersensitivity to or to bisulfites or benzyl alcohol
• 2. Seizures
• 3. Encephalopathy
• 4. Parkinson's

• 2.5-10mg IV tid-qid
• 5-10mg IM tid-qid

Non-selective β blocker

• 1. HTN
• 2. MI/Angina
• 3. Rate control with SVTs/Afib
• 4. Tachyarrhythmias with cardiac glycoside ingestion, thyrotoxicosis (excessive thyroid hormones)
• 5. Migraines

• 1. Bronchospasm
• 2. Hypotension
• 3. Bradycardia/Heart Blocks
• 4. CHF/pul edema
• 5. Arrhythmias
• 6. Fatigue/dizziness/weakness

• 1. Hypersensitivity
• 2. Bradycardia/Heart blocks
• 3. Asthma/COPD
• 4. CHF/Cardiogenic shock

Adult: 1-3mg in D5W (10-30ml) over 2min. May repeat x1 in 2min.

Ped: 10-100mcg/kg, max 1mg over 2min q6-8hrs prn

• General Anesthetic
• Ultra short acting hypnotic

• Anesthesia
• Sedation/maintenance of

• 1. Specific mechs are ukn, ultra short acting sedative
• 2. Potent resp and cardiovascular depressant
• 3. No analgesic properties
• 4. Vasodilation

• 1. Severe resp depression/apnea
• 2. Bradycardia
• 3. Hypotension
• 4. Pain/stinging at injection site
• 5. Twithcing extremities

• 1. Hypersensitivity to or to soybean oil, egg lecithin, or glycerol
• 2. Peds <3y/o

• Induction: 1-3mg/kg in D5W only
•              or 40mg prn until sedation

• Maintenance: 100-200mcg/kg/min for first 30min, then reduce dose by 30-50%.
•              or: 25-50mg prn

Degrades plastic

Vents: 5-50mcg/kg/min

Peds = same as adult

• Onset: immediate
• Duration: 3-5min

1. Laryngo/bronchospasm - croup mainly, asthma, bronchitis, bronchiolitis

0.25-5ml 2.25% solution (mixed with 3ml NS if necessary) neb q 5min prn.

Histamine H2 receptor antagonist

• 1. GERD
• 2. Peptic ulcers
• 3. Indigestion
• 4. Zollinger-Ellison Syndrome (excessive HCl secreting)

• Rarely any
• (confusion)

• 1. Copetitively blocks H2 receptors of parietal cells, decreasing responsiveness to histamine, ACh and gastrin. This reduced acid secretion by up to 90%.
• 2. Stomach pH increases
• 3. Increases prolactin secretion from anterior pituitary

Hypersensitivity

Adult: 50mg IV/IM q4-6hrs, max 400mg/day

Peds: 2-4mg/kg/day divided into 3-4 doses/day

Fibrinolytic

AMI

1. Catalyzes conversion of plasminogen into plasmin. Plasmin degrades the fibrin matrix of clots.

• 1. Bleeding
• 2. Reperfusion arrhythmias
• 3. N/V
• 4. Fever
• 5. Anaphylaxis

• 1. Prior intracranial hemorrhage
• 2. CVA lesion
• 3. Malignant intracranial neoplasm
• 4. Ischemic stroke within 3 months except acute within 3 hrs
• 5. Aortic dissection
• 6. Active bleeding
• 7. Significant closed head trauma of facial trauma within 3 months

• Relative:
• 1. Poorly/uncontrolled HTN
• 2. Uncontrolled HTN sys >180 or DBP >110
• 3. Ischemis stroke >3 months
• 4. Traumatic or prolonged CPR or major bleed within 3 weeks
• 5. Recent intracranial bleed (2-4wks)
• 6. Noncompressible vascular punctures
• 7. Strptokinase/anitrplase greater than 5 days
• 8. Pregnancy

10u IV over 2min q30min max 20u.

Intermediate acting Nondepolarizing neuromuscular blocking agent

• RSI
• Surgery
• Maintenance of paralysis

1. Blocks ACh from binding to postsynaptic receptors by competitively binding to without stimulating depolarization.

1. Bronchospasm

Hypersensitivity to or to bromide

1mg/kg repeat 0.5mg/kg q10min prn

Peds = same

• Onset: 1-3min
• Duration 30-60min

Discontinued tocolytic

β2 agonist that relaxes uterine smooth muscle and supression of preterm labour.

50-350mcg/min IV