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70 Cards in this Set
- Front
- Back
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Valium is also known as...
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Diazepam
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class of Valium/Diazepam
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Benzodiazepine
Sedative – hypnotic Anticonvulsant |
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What is the theraputic action of Valium/Diazepam
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It suppresses the spread of seizure activity…status epilepticus
Diazepam is a frequently prescribed medication to treat anxiety and stress. In emergency care, it is used to treat alcohol withdrawal and grand mal seizure activity. Diazepam potentiates the effects of inhibitory neurotransmitters (GABA), hyperpolarising the membrane potential and raising the seizure threshold in the motor cortex. It may also be used in conscious patients during cardioversion and TCP to induce amnesia and sedation. Though the drug is still widely used as an anticonvulsant because of its fast action, it is actually a relatively weak anticonvulsant because of its short duration. Rapid IV administration may be followed by respiratory depression and excessive sedation. |
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dose for Valium/Diazepam
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5-10 mg slow IVP, IM, or rectal
Seizure adult...5 mg over 2 min (up to 10 mg for most adults) IV every 10 – 15 min prn. peds...0.2 – 0.3 mg/kg IV/IO (no faster than 1mg/min) every 2-5 min prn; 0.5 mg/kg rectal dose. Max dose 5mg Premedication prior to Cardioversion/TCP adult...5-15mg IV, 5-10 minutes prior to procedure |
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Naloxone is also known as...
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Narcan
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What reverses benzodiazapines
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romazicon
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the class of Narcan/Naloxone is...
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narcotic antagonist
reverses narcotics Synthetic opioid competitive antagonist |
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theraputic action of Narcan/Naloxone
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blocks opiate receptors
Naloxone is a competitive narcotic antagonist that is used in the management and reversal of overdoses caused by narcotics and synthetic narcotic agents. Compared with other narcotic antagonists which do not completely inhibit the analgesic properties of opiates, naloxone antagonizes all actions of morphine |
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side effects of Narcan/Naloxone
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increased HR, abrupt withdrawl effects, hypotension, N&V, pain meds become useless
Tachycardia Hypertension Dysrhythmias Nausea and vomiting Diaphoresis |
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dose of Narcan/Naloxone
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0.4-2 mg
push 1 mg slowly then the other |
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D-50 is...
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50% Dextrose
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class of D-50
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carbohydrate
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theraputic acion of D-50
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puts sugar in the blood stream
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D-50 indications
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hypoglycemia, unknown unresponsiveness or coma
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D-50 contraindications
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known allergy and hyperglycemia
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D-50 precautions
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Extravasation may cause tissue necrosis; use large vein with large gauge needle and aspirate occasionally to ensure route patency. ICP, CVA or suspected CVA in the absence of hypoglycemia, or head injury c possible ICP...check pupils-if blown high suspicion of ICP...if blood sugar is low GIVE IT
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D-50 dose
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adult...12.5-25 g slow IV push, may be repeated once
peds...dilute 1:1 with saline for a concentration of 25% dextrose in water; administer 0.5 – 1.0 g/kg/dose (2-4 cc/kg) slow IV, may be repeated once |
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D-50 is supplied
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25g/50 ml prefilled syring (500 mg/ml)
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Adenosine is also known as...
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Adenocard
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class of Adenosine...
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endogenous nucleotide
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Adenosine dose
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adult...Initial : 6 mg rapid IV bolus over 1-3 second, followed immediately by a 20 ml saline flush.
Repeat if no change after 1-2 minutes at 12 mg in same manner. Repeat again at 12 mg after 1-2 mg peds...Initial dose 0.1mg/kg, may be doubled once if no effect. Max single dose 12 mg. Follow immediately with 2-3ml saline flush |
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albuterol is also known as...
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Ventolin or Proventil
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class of albuterol...
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Sympathomimetic, bronchodilator
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albuterol description...
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Primarily beta 2 -selective sympathomimetic. Relaxes smooth muscle of the bronchial tree and peripheral vasculature.
Activates cAMP via a non-beta receptor mechanism. For this reason, it is sometimes used in beta-blocker overdoses. It also activates the Na-K pump by the same mechanism which is useful in treating hyperkalemia. |
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onset for albuterol
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5-15 minutes after inhalation
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duration of albuterol
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3-4 hours after inhalation
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indications for albuterol
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Relief of bronchospasm
Beta-blocker overdose Hyperkalemia |
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contraindications of albuterol
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Prior hypersensitivity reaction to albuterol
Cardiac dyshythmias associated with tachycardia |
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adverse reactions of albuterol
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Usually dose related, restlessness, apprehension, dizziness, palpitations, increase in BP, dysrhythmia
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albuterol drug interactions
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As with all sympathomimetics, may exacerbate adverse cardiovascular effects.
Antidepressants may potentiate the effects on the vasculature. Beta-blockers may antagonize albuterol. Albuterol may potentiate diuretic-induced hypokalemia |
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how is albuterol supplied
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MDI: 90 mcg/metered spray (17g /200 inhalations)
Solutions for aerosolization: 0.5% (5mg/ml) |
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dose for albuterol
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adult...2.5 mg (0.5 ml of 0.5% solution) diluted to 3 ml with 0.9% saline solution. Administer over 5-15 minutes by nebulizer.
peds...0.01 - 0.03 ml (0.05 - 0.15 mg)/kg/dose to maximum of 0.50 ml/dose diluted in 2 ml of 0.9% saline solution adminstered by nebulizer. May be repeated q 20 minutes x 3 |
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special considerations for albuterol...
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May precipitate angina pectoris and dysthythmias. Should be used with caution in patients with diabetes, hyperthyroidism, prostatic hypertrophy or seizure disorder.
Should be administerd only by nebulizer in the field. |
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class of atropine
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parasympatholytic=blocks effects of vagal nerve, blocks acetylcholine receptors. Helps to increase HR by blocking the parasympathetic nervous system.
Anticholinergic Agent |
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description of atropine...
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Atropine sulfate is a potent parasympatholytic. It inhibits actions of acetylcholine at postganglionic parasympathetic neuroeffector sites, primarily at muscarinic receptors. Small doses inhibit salivary and bronchial secretions, moderate doses dilate pupils and increase heart rate. Large doses decrease GI motility, inhibit gastric acid secretion. Blocked vagal effects result in positive chronotropy and positive dromotropy (limited or no inotropic effect). In emergency care, it is primarily used to increase the heart rate in life-threatening bradycardias. You can think of the effects of atropine as being 'anti-SLUDGE'.
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indications for atropine
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Symptomatic bradycardia: Hemodynamically significant bradycardia
Asystole Bradycardic PEA Organophosphate poisoning (drug of choice) Pretreatment in pediatric patients receiving RSI. |
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contraindications of atropine
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2nd degree type 2 classic and 3rd degree blocks
can give to wenckebach Tachycardia Hypersensitivity Unstable cardiovascular status in acute hemorrhage with myocardial ischemia |
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side effects of atropine
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blurred vision, dilated pupils (be sure to check pupils before giving in full arrest), dry mouth, unwanted tachycardia
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adverse reactions of atropine
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Tachycardia
Possible paradoxical bradycardia when pushed slowly or when used at doses less than 0.5mg Palpitations, dysrhythmias, headache, dizziness, nausea/vomiting, flushed and dry skin, allergic reactions. Anticholinergic effects (dry mouth/nose, photophobia, blurred vision, urine retention)..think anti-SLUDGE. |
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atropine drug interactions
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Use with other anticholinergics may increase vagal blockade.
Potential adverse effects when administered in conjunction with digitalis, cholinergics, neostigmine. The effects of atropine may be enhanced by antihistamines, procainamide, quinidine, antipsychotics, antidepressants, and benzodiazepines |
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atropine dosing
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Bradydysrhythmias
Adult 0.5 – 1.0 mg IV, may be repeated at 5 min intervals until desired rate achieved. (max 0.03-0.04mg/kg) Pediatric 0.02 mg/kg IV, IO, ET(diluted to 3-5ml). Min dose 0.1mg; max single dose fo 0.5 mg for a child and 1.0 mg for an adolescent; may be repeated in 5 minutes for a max total fo 1.0 mg for a child and 2.0 mg for an adolescent. Asystole Adult 1.0 mg IV, ET, (1-2 mg diluted to a total of 10ml); may be repeated every 3-5 minutes (max 0.03 – 0.04mg/kg) Pediatric unknown efficacy PEA Adult 1 mg IV (if bradycardic), repeat every 3-5 minutes, max 0.03 – 0.04mg/kg. Pediatric unknown efficacy Anticholinesterase Poisoning Adult 2 mg IV push every 5-15 minutes to dry secretions. No max dose. Pediatric 0.05 mg/kg/dose (usual dose 1-5 mg) IV, may be repeated in 15 minutes. |
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class of epi
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Sympathomimetic
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MOI of epi
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Epinephrine stimulates alpha, beta 1 and beta 2 adrenergic receptors in dose-related fashion. Rapid injection produces a rapid increase in blood pressure, ventricular contractility, and heart rate. In addition, epinephrine causes vasoconstriction in the arterioles of the skin and mucosa. It antagonizes the effects of histamine by decreasing its release and decreasing membrane permeability.
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how is epi supplied
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1mg/ml (1:1,000)
0.1mg/ml (1:10,000) ampule and prefilled syringes |
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dose of epi
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Cardiac Arrest (all rhythms)
Adult 1mg IV or 2 – 2 ½ times the IV dose via ET, repeat every 3-5 minutes. Pediatric Initial Dose: IV/IO 0.01mg/kg (1:10,000) ET dose is 0.1 ml/kg (1:1,000) diluted to 3-5 ml Repeat Doses: IV/IO/ET 0.1ml/kg (1:1,000) every 3-5 minutes Allergic Reactions/Bronchoconstriction Adult Moderate allergice reaction/bronchoconstriction 0.3-0.5mg (1:1,000) SQ Anaphylaxis (Severe allergic reaction) 1 mg (1:10,000) slow IV Pediatric Moderate allergice reaction/bronchoconstriction 0.01 ml/kg (1:1,000) SQ Anaphylaxis (Severe allergic reaction) 0.05-0.5 mcg/kg/min INFUSION |
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indications for epi
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Bronchoconstriction
Anaphylaxis All forms of cardiac arrest Profound symptomatic bradycardia |
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contraindications for epi
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Hypersensitivity
Hypovolemic shock Coronary insufficiency Hypertension |
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adverse reactions of epi
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Headache, nausea, restlessness
Weakness, dysrhythmias, hypertension Precipitation of angina pectoris |
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epi drug interactions
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MAO inhibitors and bretylium may potentiate the effect of epinephrine
Beta adrenergic antagonists may blunt inotropic response. Sympathomimetics and phosphodiesterase inhibitors may exacerbate dysrhythmia response. May be deactivated by alkaline solutions (sodium bicarbonate, Furosemide) |
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special considerations for epi
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Pregnancy Safety: Category C
Do not use prefilled syringes for epinephrine infusions Syncope has occurred following epinephrine administration to asthmatic children. May increase myocardial oxygen demand |
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class of morphine
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narcotic or opioid analgesic
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MOA of morphine
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alleviates pain, acts on opiate receptors, opens up vessels so they can store more fluid. Smooth muscle relaxor so mostly opens up arteries
Morphine sulfate is a natural opium alkaloid that increases peripheral venous capacitance and decreases venous return ("chemical phlebotomy"). It promotes analgesia, euphoria, and respiratory and physical depression. Secondary pharmacologic effects of mophine include depressed responsiveness of alpha adrenergic receptors (producing peripheral vasodilation) and baroreceptor inhibition. In addition, because morphine decreases both preload and afterload, it may decrease myocardial oxygen demand. The properties of this medication make it extremely useful in emergency care. Morphine is a Schedule II drug. |
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morphine onset
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< 1 minute
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indications for morphine
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Chest pain associated with myocardial infarction/ischemia
Pulmonary edema, with or without associated pain Moderate to severe acute and chronic pain |
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contraindications for morphine
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Hypersensitivity to narcotics
Hypovolemia Hypotension Head injury or undiagnosed abdominal pain Patients who have taken MAO inhibitors within 14 days. |
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adverse reactions of morphine
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Hypotension
Tachycardia or bradycardia Palpitations Syncope Facial flushing Respiratory depression Euphoria Bronchospasm Allergic reaction. |
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morphine drug interactions
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CNS Depressants may potentiate effects of morphine
Chlorpromazine may potentiate analgesia MAO inhibitors may cause paradoxical excitation |
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dose for morphine
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Adult
IV: 1-3 mg slow push over 1-5 minutes. Repeat in 5 - 10 minute intervals, titrated to relief of pain. Pediatric IV: 0.1 – 0.2 mg/kg , max 15 mg dose |
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dose for aspirin
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160-325 mg
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class of aspirin
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antiinflammatory
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contraindications for aspirin
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allergy, recent surgery, active ulcers, bleeding problems
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special considerations for morphine
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Pregnancy Safety: Category
Narcotics rapidly cross the placenta Safety in neonates has not been established Use with caution in the elderly and those with asthma, and in those susceptible to CNS depression. May worsen bradycardia or heart block in inferior MI (vagotonic effect) Naloxone should be readily available |
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class of diphenhydramine (Benadryl®)
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Antihistamine (H1 only)
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dose of diphenhydramine (Benadryl®)
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Adult
25-50 mg IM, IV Pediatric 1-2 mg/kg IV, IM (max 50 mg) |
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MOA for diphenhydramine (Benadryl®)
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An antihistamine with significant anticholinergic effects and a high incidence of drowsiness. Competes for H1 receptors on effector cells thus blocking effects of histamine release. Effects in parkinsonism and drug-induced extrapyramidal symptoms are apparently related to its ability to suppress central cholinergic activity and to prologn action of dopamine by inhibiting its reuptake and storage. Diphenhydramine does not effect H2 receptors and therefore has no effect on gastric acid secretion
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adverse reactions of diphenhydramine (Benadryl®)
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Dose-related drowsiness
Sedation Disturbed coordination Hypotension Palpitations Tachycardia, bradycardia Thickening of bronchial secretions Dry mouth and throat |
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diphenhydramine (Benadryl®)
drug interactions |
CNS depressants may increase depressant effects
MAO inhibitors may prolong and intensify anticholinergic effects of antihistamines |
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contraindications for diphenhydramine (Benadryl®)
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Acute asthma
CNS depression Patients taking monoamine oxidase (MAO) inhibitors Hypersensitivity |
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xopenex class
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bronchodilator
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xopenex dose
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.63-1.25 nebulized with 6-8 L O2 per min
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