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20 Cards in this Set

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Bumetanide
Trade Name: Bumex
Class: loop diuretic; anti hypertensive
Rx: Pulmonary Edema
Contra: non when clinically indicated
Adverse Reactions: Hypotension and hypokalemia
Dose: 0.5-2.0mg IV push given over 2 min. q. 2-3 hrs
Note: 1mg Bumex = 40mg Lasix
Action Mechanism: Primarily inhibts sodium reabsorbtion in the proximal tubule
Interactions: Bumetanide administered with other antihypertensives or diuretics may cause additive hypotension and fluid depletion
Note: No Pediatric Dose
Diazepam
Trade Name: Valium
Class: Benzodiazepine; Anticonvulsant; tranquilizer
Rx: Seizures; Cocaine OD
Contra: CNS depression and respiratory depression. Use caution in elderly pt's
Adverse Reactions: Cardiovascular collapse, respiratory depression, withdrawal syndrome
Dose: Adult
Seizures-2-5mg IV Push SLOWLY
Cocaine OD-5-15mg IV Push SLOWLY
Sedation post RSI-0.1mg/kg IV Push SLOWLY
Pediatric
Seizures 0.1mg/kg IV Push
0.5 mg/kg PR
Action Mechanism: 1/2 life is 10-15 min.
Interactions: Flumazenil can reverse Valium in 1-2 minutes
Will precipitate in NS or D5W
Albuterol
Trade Name: Proventil
Class: B2 selective sympathomimetic; Beta Agonist
Rx: Any disorder with associated bronch-constriction/wheezing; Hyperkalemia
Contra:None when clinically indicated
Adverse Reactions: Tachyarrhythmias, palpitations, restlessness
Dose:
Adult
Broncho-constriction/wheezing/hyperkalemia
-2.5 mg in 3cc's NSS
-Administered nebulized with 5-8LPM of O2
Pediatric
Broncho-constriction/wheezing/hyperkalemia
-2.5 mg in 3cc's NSS
-Administered nebulized with 5-8LPM of O2
Action Mechanism: Acts primarily on bronchial smooth musculature by stimulating beta 2 receptors
Interactions: Efficacy may be severely reduced if taking beta blockers. Efficacy may increased if combined with other beta agonists
Atropine
Trade Name: Atropine
Class: Anticholinergic; Parasympatholytic
Rx: Hemodynamically compromised symptomatic bradycardia (non-AMI); Symptomatic Sinus Arrest or block; AV block at the Junctional level; Slow PEA; Asystole; Organophosphate poisoning, cholinesterase inhibiting pesticides, sarin, parathion and gas poisons
Contra: Heart transplant as there are no parasympathetic connection to the heart due to the vagus nerve being severed
Adverese Reactions: Serious-if given too slowly will cause rebound bradycardia
Common-Mydriasis, Arrhythmia, Xerostoma, Ileus, Malignant HTN, Urine reduction output, Malignant hyperthermia (MAXIMUM)
Dose:Adult:All cardiac indications
-0.5-1.0mg IVP q 3-5 min up to max 3mg or (0.04mg/kg), Rapidly
-Alternatively can be given ETT at 2.0-2.5X IV dose
Organophosphate Poisoning
-1mg q 2 min
Pediatric:All Cardiac indications - max 0.04mg/kg min dose=0.1mg
-0.02mg/kg IV to max of 0.5mg for child and 1mg for adolescents
-Repeat 0.5mg-1mg for child and 1mg-2mg for adolescents
-Alternatively can be given ETT at 2.0-2.5X IV dose
Organophosphate Poisoning
-0.05mg/kg IV q 10-20min
Action Mechanism:
-antagonizes acetylcholine receptors - blocks effect of acetylcholione
-Increases myocardial O2 demand
-Increases rate of discharge at SA and AV nodes
-Relaxes smooth muscle in GI tract - inhibits secretions of the duct glands(sweat/saliva)
-Causes relaxation of smooth muscle in bronchial tree
Hot as a Hare-Dry as a Bone-Mad as a Hatter-Red as a Beet-Blind as a Bat
Interactions:None
Furosemide
Trade Name: Lasix
Class: Loop Diuretic
Rx: Pulmonary Edema (acute); Hypertension
Contra: Allergy to sulfa drugs, hypotension with pulmonary edema and dehydration
Caution with sever renal disease, acute MI, and pancreatitis
Adverse Reactions: Severe-Hypotension
Common-Frequent Urniation, dizziness, N/V, muscle cramps, hypokalemia, hypomagnesemia, hypotension, abdominal cramps, hyperglycemia, hypocalcemia, tinnitus, photosensitivity
Dose: Adult
Acute Pulmonary Edema (BP > 120 Systolic) 1.0mg/kg IV Push SLOWLY
Pediatric
1mg/kg IV Push q. 6-12 hr
Action Mechanism: Blocks sodium at the proximal loop of Henle; Onset of action in 5 min with max effect in 30 min; Direct vasodialating effect in pulmonary edema
Interactions: None
Ipratropium Bromide
Trade Name: Atrovent
Class: Anti-Cholinergic/Bronchodilator
Rx: Adult
Reasons 1-9 COPD
Reason 10 Asthma
Pediatrics
Asthma
Contra: none if clincally indicated
Adverse Reactions: Almost none - Dry mouth
Dose: 0.5mg in 2.5cc NSS = 0.02% solution
Action Mechanism: Bronchiole smooth muscle relaxer
Inhibits vagal mediated antagonists by blocking Acetylchonline
Interactions: None
Notes: Onset of action - 2 hrs. Studies have shown decrease hospital admission secondary to increase lung function.
If severe respiratory distress - use albuterol as primary bronchodilator
Use first in Mild - Moderate distress
Some physicians mix Albuterol and Atrovent together in nebulizer
Some physicians will alternate Atrovent 1st and 3rd nebulizer with Albuterol between until relief of SOB
Diphenhydramine
Trade Name: Benadryl
Class: Antihistamine
Rx: Relief of symptoms from allergic reactions;Anticholinergic-used to treat acute dystonic response (Stiff gait, cog wheel rigidity) extrapyramidal reactions to antipsychotic drugs (Haldol, Thorazine, Compazine)
Contra: None when clincally indicated
Adverse Reactions:
Rare-Convulsions and death may result from OD, wheezing, and hypotension
Common-Drowsiness and confusion, blurred vision, diplopia, Diffculty urinating in males, dry mouth
Dose:
Adult
Allergic Reaction/Dystonic response-50-100mg IV Push or Deep IM
Pediatric
All Indication-1mg/kg IV Push or IM
Action Mechanism: Blocks histamine effects in allergic reactions by preventing histamines from reaching H1 receptor sites;Sedative effects due to CNS depression;Antiemetic-inhibits motion sickness;Onset 1-3hrs; Duration 6-12hrs
Interactions:combined with benzodiazepines, other sedatives, ethanol, and opiates may exacerbate CNS depression resulting in respiratory depression
Note: Not recommended for newborn or premature infants
Levalbuterol
Trade Name: Xopenex
Class: B2 selective sympathomimtic; Beta Antagonist
Rx: Any disorder with associated broncho-constriction/wheezing<p>Bronchiolitis in infants
Contra: None when clinically indicated
Adverse Reactions: Tachyarrhythmias, palpitations, restlessness
Dose: Adult
Broncho-constriction/wheezing/hyperkalemia
1.25mg in 3CC NSS for more sever wheezing (acute setting
Administered nebulized with 5 - 8LPM of O2
Other Doses
0.63mg in 3cc Nss for moderate wheezing (home therapy)
Peditrics
1.25 mg in 3cc NSS for more severe wheezing (acute setting)
0.31mg in 3cc NSS for pediatric patients (home therapy)
Action Mechanism: Acts primarily on bronchial smooth musculature by antagonizing beta 2 receptors
Interactions: Efficacy may be severely reduced if taking beta blockers
Efficacy may increase if combined with other beta agonists
Dexamethasone Sodium Phosphate
Trade Name: Decadron
Class: Synthetic Steroid; Corticosteroid
Rx: Asthma/Croup;Near drowning in fresh water;Anaphylaxis or allergic state;Brain tumor with edema;Alternative to Solu-medrol
Contra: Systemic fungal infection
Adverse Reactions: Serious - steroid psychosis
Common - None in the pre-hospital setting
Dose:
Adult
All Indications-10mg IV Push
Pediatric
Croup-0.6mg/kg IM or IV
Inflammation-0.08-0.3mg/kg IM or IV
Action Mechanism: A potent rapid acting, short duration, anti-inflammatory steroid(stabilizes the cell wall of MAST cells, thus preventing release of histamine, etc.);Onset of action is 4-8hrs
Interactions: None
Epinephrine
Trade Name: Adrenalin
Class: Vasopressor, Catecholamine
Rx: Bradycardia;Cardiac Arrest;Anaphylaxis;Asthma
Contra:If pt is awake, administer cautiously in presence of old age, debilitation, hyperthyroidism, hypertension, and diabetes;Use caution in patients with angina, hypertension, CAD;May cause severe hypertension and reflex Bradycardia in those taking beta blockers
Adverse Reactions: Serious-V-fib, V-tach, cerebral hemorrhage
Common-Tachycardia, palpitations, hypertension, tremors, nervousness
Dose:
Adult
Anaphylaxis-0.3-0.5mg SC (1:1000 Concentration)
Asthma-0.3-0.5mg SC (1:1000 Concentration)
Cardiac Arrest-1mg IV Push(1:10,000 Concentration) 1. 3-5min
2.0X-2.5X IV dose for ETT Administration (mix 2.0-2.5mg of 1:1000 in 10cc's of NSS)
Bradycardia-1-10mcg/min IV Drip;1mg to 500cc
Pediatric
Cardiac Arrest-0.01mg/kg IV Push(1:10,000 Concentration) q. 3-5min
Anaphylaxis-0.01mg/kg IV Push(1:10,000 Concentration);0.01mg/kg SC (1:1000 Concentration)
Bradycardia-0.01mg/kg IV Push x1 dose only(1:10,000 Concentration);Max dose of 1mg
Action Mechanism:Stimulates alpha and beta-adrenergic receptors;Alpha-constrics peripheral blood vessels raise systolic blood pressure; dilate pupils, makes V-fib more susceptible to DC shock. Lowers threshold for defib;Beta-positive inotropic and chronotropic effects;Dilates bronchial smooth muscle, inhibits bronchial secretions, increases myocardial O2 demand
Interactions:None
Lorazepam
Trade Name: Ativan
Class: Benzodiazepine;anti-convulsants;sedative
CNS depressant
Rx: Control seisure disorders emergent and non-emergent (not listed in PDR)
Relieve anxiety
Contra: Known Hypersensitivity to benodiazepines
Caution in eldery patients, very ill patients or patients with reduced pulmonary reserve as hypoventilation, hypoxia
Adverse Reactions: Serious-respiratory depression, withdrawl syndrome, abude/dependency
Common-Amnesia, sedation, dissiness
Dose: Adult
Seizure/sedation/relieve anxiety
IV injection-1.0 to 2.0 mg
IM injection (If no Versed Available)-2.0mg up to 4.0mg injected
Pediatrics
Seizures
0.05-0.1mg.kg IV Push
Action Mechanism:binds to benzodiazepine receptors
Interactions: Additive effect with other narcotics, barbiturates, analgesics, antidepressants, and MAO inhibitors
Magnesium Sulfate
Trade Name: Magnesium Sulfate
Class: Antiarrhythmic;Smooth muscle relaxant
Rx: Torsades de Pointes; Pulseless VT/VF (refractory)(after Lidocaine);Seizures due to toxemia of pregnancy(eclampsia);Asthma
Contra: None when clinically indicated
Adverse Reactions: Serious-loss of Deep Tendon Reflexes, respiratory depression, bradycardia
Common-depressed relfexes, hypotension, reduced cardiac output
Dose: V-Tach w/ Pulse/Ventricular Ectopy
-1-2 grams in 50-100cc's
-IV Drip over 15 min
Recurrent or refractory v-fib/pulseless v-tach/Torsades
-1-2 grams IV in 2-4cc's
-given over 1-2 min
Asthma
-2 grams IV Drip in 100cc's
-given over 20 min
Eclampsia
-2-4 grams IV
-given over 3 min
Action Mechanism: Effects energy transfer & electric stability in the myocardium; Stabilizes cardiac cells;Regulates potassium(K);Blocks Calcium Channels;Depletion of Mg
-Cardiac cells unable to maintain intracellular K(Na pump fails)
-loss of K as Mg and K required for action of Na pump
Interactions:None
Note: Pediatric dosages are currently not available
Nalmefene
Trade Name: Revex
Class: Opioid Antagonist
Rx: Complete or partial reversal of CNS and respiratory depression induced by opioids including propoxyphene, nalbuphine, pentazocine, and butorphanol
Contra: Caution with CAD disease, opiate aadiction as it may precipitate withdrawl
Adverse Reactions: Serious-arrythmias
Common-N/V, tachycardis, hypertension, diaphoresis, bradycardia, headache, chills, dizziness
Dose: Opioid OD
0.5-1.0mg.70kg IV Push
May be repeated once q. 2-5 min
Action Mechanism: Antagonizes various opiod receptors
Interactions: None
Note: No Pediatric Dose
Methylprednisolone
Trade Name: Solu-Medrol
Class: Glucocoticoid Steroid
Rx: Asthma;Neurogenic shock(controversial);Acute spine core injury
Contra: Caution with GI bleeding, diabetes mellitus
Adverse Reactions: Serious-Steroid psychosis, CHF, peptic ulcer, anaphylaxis, osteoporosis
Dose:
Adult
Anaphylaxis, Asthma-125mg IV Push
Spinal Cord Injury-30mg/kg IV Push;Followed by infusion of 5.4mg/kg/hr
Pediatric
Anaphylaxis, Asthma-2mg/kg/dose IV Push
Action Mechanism: Methylprednisolone is a synthetic steroid that supresses acute and chronic inflammation. In addition, it potentiates vascular smooth muscle relaxation by beta adrengic agonists, and may alter airway hyperactivity. A newer usage is for the reduction of post-traumatic spinal edema;Onset 2-4hrs
Interactions:None
Naloxone
Trade Name: Narcan
Class: Opiod Antagonist
Rx: Reverse pre-operative opiate induced sedation
Odioid/Opiate OD
Contra: Use caution when given to an OD patient who may be intubated, be cautious of destructive self extubation
Use caution when administering to patients. Too much Narcan can induce withdrawl, only administer enough to maintain respiratory drive a good cardiac output
Adverse Reactions: Tachycardia, hypertension, N/V, tremors,minor withdrawl symptoms, diaphoresis
Dose: Adult
Opiate OD
0.4-2.0mg IM/IV/SC/Inter-nasal
Post-op opioid reversal
0.1-0.2mg q. 2-3 min PRN
Pediatrics
Opiate reversal (0-5 years old or < 20kg)
0.1mg/kg IV/SC/ETT q. 3 min until response
Action Mechanism: Antagonizes various opiate receptors
Half life is 30-100 min
Interactions: None
Midazolame Hydrochloride
Trade Name: Versed
Class: Benzodiazepine
Rx: Pre-medication before cardioversion;Sedation;Seizures
Contra: Use caution with decreased respiratory drive;Liver disease/cirrhosis
Adverse Reactions: Serious-hypoventilation
Common-N/V, sedation, hypotension, euphoria, hallucinations, confusion, dizziness
Dose:
Adult
Pre-intubation/Sedation-0.1mg/kg IV Push;typical dose 5mg IV Push
Seizures (When no IV access is avail)-2-5mg IM
Induction agent-0.2mg/kg IV Push~7-10mg avg. adult
Pediatric
Seizures w/o IV access-0.1mg/kg IM
Action Mechanism:Binds to benzodiazepine receptors enhancing GABA effects;Conscious sedation or to relieve apprehension or impair memory before intubationor endoscopy, etc;Antegrade amnesia/retrograde;Onset 1-5min;Peaks 5-7min;Duration 2 hours;Half life of 2-4hrs
Interactions: Reversed with Romazicon
Note: 2mg versed = 5mg valium
Terbutaline
Trade Name: Brethine
Class: Synthetic sympathomimetic amine
Beta-adrenergic
Bronchodilator;smooth muscle relexant
Rx: Asthma and bronchospasms
Premature labor
Contra: Caution with hypertension and ventricular arrhythmias
Adverse Reactions: Rare-arrythmia, hypotension, angina
Common- nervousness, headache, tachycardia, palpitations, N/V, sweating, muscle cramps
Dose: Adult:Asthma/Bronchospasms/premature labor - 0.25mg SC to start, wait 15 min, repeat if necessary
Pediatrics:Not recommended for pediatrics in the pre-hospital setting
Action Mechanism:Stimulates beta-2 adrenergic receptors
Interactions: None
Morphine Sulfate
Trade Name: Morphine
Class: Narcotic;Named after Morphous, Greek god for dreams
Rx: Pain (burns, MI, and others);Cardiac chest pain
Contra: Existing respiratory depression;Allergy to sulfate drugs
Adverse Reactions: Serious-respiratory, apnea, severe hypotension
Common-decreased LOC, N/V, dizziness, hypotension, euphoria, diaphoresis, miosis, constipation, dry mouth
Dose:
Adult
Pain(MI, sickle cenn, and other)-2-5mg IV Push q. 5min until desired effects
Pain(burns)-5-10mg IV Push q. 5 min until desired effect;Often high dose morphine is required for pain relief
Pediatric
Pain(all indications)-0.1mg/kg IV Push
Action Mechanism: binds to various receptors producing analgesia and sedation;Dilates venous system therefore reducing preload and afterload and intern decreasing myocardial O2 demand;Vagotonic effect on heart
Interactions: None
Note: Have respiratory equipment readily available;Narcan reverses effects of morphine;may be ordered in pulmonary edema
Nitroglycerin
Trade Name: Nitrostat, Nitrospan, Nitrodisc, Nitrodur, Tridil
Class: Nitrate, Vasodilator
Rx: MI(not right ventricular);Angina Pain;Pulmonary Edema from CHF
Contra: None when clinically indicated
Adverse Reactions: Serious-hypotension, bradycardia, developed tolerance
Common-headache, lightheadedness, dizziness, flushing, reflex tachycardia, burning or tingling during SL administration
Dose: All Indications
-0.4mg(2% solution) SL spray;administeron mucus membranes of mouth (under tounge)
-0.4mg(1/150grains) SL tablet q. 3-5min;store in brown glass or opaque container as sunlight will inactivate
-1-2 inches as on ointment;Apply to skin w/o hair;Avoid self exposure during administration
-10-20mcg/min IV Drip
-Increased by 5-10mcg/min q 5-10min until desired response
-Mixed 50-100mg in 250cc's
Action Mechanism: Stimulates cGMP production resulting in vascular smooth muscle relaxation;Decreases preload(venous dilation) therefore reducing myocardial O2 demand;Dilate coronary arteries(effect may be limited by atherosclerosis);Increases subendocardial blood flow;Onset 1-2min
Interactions:None
Note:No prehospital administration suggested in pediatrics. DO NOT attempt to defibrillate a pt through a nitroglycerin patch.
Oxygen
Trade Name: Oxygen
Class: Naturally occuring gas
Rx: Confirmed or suspected hypoxia;Ischemic chest pain;Respiratory insufficiency;Confirmed or suspected carbon monoxide poisoning and other causes of decreased issue oxygenation(cardiac arrest)
Contra: None
Adverse Reactions: Serious-respiratory depression within hours with patients who have hypoxic drive after long periods of exposure to high concentration oxygen
Dose: All indications-High concentration 10-15 lpm via NRB;Low concentration 1-4 lpm via nasal cannula
Action Mechanism: Oxygen is an odorless, tasteless, colorless gas that is present in room air at a concentration of approximately 21%. It is an important emergency drug that is used to reverse hypoxemia; in doing so, it helps oxidize glucose to produce ATP(aerobic metabolism)
Interactions: None