Pharm - Electrolytes, Vitamins, & Misc

Front 1

BRAND NAME

charcoal, activated (without sorbitol)

Back 1

Charcola, Actidose-aqua

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CLASS

charcoal, activated (without sorbitol)

Back 2

adsorbent

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MECHANISM OF ACTION

charcoal, activated (without sorbitol)

Back 3

PHARMACOLOGICAL: Physical binding (adsorption) of toxins from GI tract.

CLINICAL EFFECTS: Prevents/reduces systemic absorption of toxins.

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INDICATIONS

charcoal, activated (without sorbitol)

Back 4

Sole prehospital therapy of oral ingestion of toxic substances.

Pre-lavage of oral ingestions of toxic substances.

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CONTRAINDICATIONS

charcoal, activated (without sorbitol)

Back 5

Ingestion of caustics

Ingestion of hydrocarbons (relative)

Oral administration to comatose patient

Simultaneous administration of other oral drugs

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ADVERSE REACTIONS

charcoal, activated (without sorbitol)

Back 6

May provoke vomiting

May worsen overdosed induced Ileus

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INCOMPATIBILITES/DRUG INTERACTIONS (you have to add this one)

charcoal, activated (without sorbitol)

Back 7

Ineffective for iron, lithium, heavy metals, and other ions.

May reduce the effectiveness of other treatments (Mucomyst) in pure acetaminophen OD's.

Since charcoal bonds with whatever it is mixed with, flavoring with drinks reduces effectiveness.

Front 8

ADULT DOSAGE

charcoal, activated (without sorbitol)

Back 8

30 - 60 gm (1-2 gm/kg) PO or OG/NG tube; if not in pre-mixed slurry, mix one part charcoal with four parts water.

Front 9

PEDIATRIC DOSAGE

charcoal, activated (without sorbitol)

Back 9

0.5-1.0 gm/kg PO or OG/NG tube; if not in pre-mixed slurry, mix one part charcoal with four parts water.

Front 10

BONUS

charcoal, activated (without sorbitol)

Back 10

Give it!

Charcoal mixture SHOULD NOT contain sorbitol; CAREFULLY read label of exchange supply.

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BRAND NAME

dextrose 50%

Back 11

Dextrose 50%, D50

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CLASS

dextrose 50%

Back 12

carbohydrate, hyperglycemic

Front 13

MECHANISM OF ACTION

dextrose 50%

Back 13

PHARMACOLOGICAL: Aerobic metabolic substrate (ATP production).

CLINICAL EFFECTS: Reverses CNS effects of hypoglycemia by rapidly increasing serum glucose levels. Provides short-term osmotic diuresis.

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INDICATIONS

dextrose 50%

Back 14

Known hypoglycemia

ALOC of unknown etiology

Seizures of unknown etiology

Hyperkalemia

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CONTRAINDICATIONS

dextrose 50%

Back 15

Known thiamine deficiency (relative, if suspected give thiamine close to the same time).

Delirium tremens; use with caution in patients with acute alcoholism, may be ineffective without thiamine.

Head injury (unless documented hypoglycemia).

Intracranial hemorrhage (relative).

Severe pain (paradoxical excitement may occur).

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ADVERSE REACTIONS

dextrose 50%

Back 16

Cerebral edema in children when given IV undiluted.

Worsening elevated ICP or cerebral edema from trauma or cerebral vascular accident.

Extravasation leads to severe tissue necrosis.

Slerosing effect on peripheral veins.

Front 17

ADULT DOSAGE

dextrose 50%

Back 17

HYPOGLYCEMIA, ALOC OR SEIZURES OF UNKNOWN ETIOLOGY: 25-100 mL of D50 (12.5-50 gm, 1 to 2 amps) IV/IO.

HYPERKALEMIA: 50 gm of Dextrose 50% IV total may be given over 1 hour. This is part of a comination drug therapy. See: CaCl and NaHCO3

Front 18

PEDIATRIC DOSAGE

dextrose 50%

Back 18

(14 years and below includes infant)

Administer 05.-1 gm/kg of a dextrose 10% solution; recommended to give slowly over a 20 minute period.

Dilute D50 (dextrose 50% containing 25 gm of dextrose) to a 1:4 solution. To prepare, take 50 mL out of a 250 mL NS IV bag, then add 50 mL (1 amp) of dextrose 50% into the IV bag. The resultion solution is 10% in NS or 10 gm/100 mL.

Front 19

BONUS

dextrose 50%

Back 19

Determine a blood glucose level before initiating administration of dextrose.

Inducing an unnecessary hyperosmolar state during certain illness/injury states (ie head injuries, cerebral edema, intracranial bleeds, etc) may worsen neurological outcome.

Additionally dextrose is very necrosing to the vascular system, will cause necrosis if infiltrated and should not be administered through small veins.

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BRAND NAME

glucagon

Back 20

Glucagon

Front 21

CLASS

glucagon

Back 21

pancreatic hormone, polypeptide, hyperglycemic agent

Front 22

MECHANISM OF ACTIONS

glucagon

Back 22

PHARMACOLOGIC: Acts only on liver glycogen, converting it to glucose. Counteracts the effect of insulin. Relaxes GI smooth muscle causing dilation and decreased motility. Cardiac inotrope.

CLINICAL EFFECT: May reverse hypoglycemia (if patient has glycogen stored in liver) within 4-8 minutes (could be as long as 15 or more).

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INDICATIONS

glucagon

Back 23

Symptomatic hypoglycemia when IV access is delayed.

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CONTRAINDICATIONS

glucagon

Back 24

Known hypersensitivity

Pheochromocytoma ( a rare tumor of the adrenal gland that cause too much release of epi and norepi).

Insulinoma

Should not be routinely used to replace dextrose when IV access has been obtained.

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ADVERSE REACTIONS

glucagon

Back 25

N/V

Generalized allergic reactions including urticaria, respiratory distress, and hypotension (made from beef/pork pancreas)

Palpitations, HTN, tachycardia

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ADULT DOSAGE

glucagon

Back 26

(children and adults greater than 20 kg or 44 lbs)

HYPOGLYCEMIA: 1 mg IM, may repeat in 7-10 min

Front 27

PEDIATRIC DOSAGE

glucagon

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(for children under 20 kg or 44 lbs)

HYPOGLYCEMIA: 0.5 mg IM or a dose equivalent to 20-30 mcg/kg, may repeat in 7-10 minutes.

Front 28

BONUS

glucagon

Back 28

Blood sugar should be measured rapidly before deciding upon the administration of D50 or glucagon, especially in the non-diabetic patient.

Documented hypoglycemia is a true medical emergency, IM glucagon, should be administered rapidly if IV access is delayed.

In known alcoholics, administer thiamine in addition to glucagon to prevent inducing an encephalopathy in a thiamine-deficient patient.

Patients with Type I diabetes do not have as great a response in blood glucose levels as Type II stable patients.

For all patients having hypoglycemic episode, supplementary complex carbohydrates should be eaten within 2 hours, especially in a child or adolescent.

Front 29

BRAND NAME

ondansetron

Back 29

Zofran

Front 30

CLASS

ondansetron

Back 30

antiemetic agent

Front 31

MECHANISM OF ACTION

ondansetron

Back 31

Selectively blocks serotonin 5-HT3 receptors located in the CNS at the chemoreceptor trigger zone and in the peripheral nervous system on nerve-terminals of the vagus nerve

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INDICATIONS

ondansetron

Back 32

N/V

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CONTRAINDICATIONS

ondansetron

Back 33

Hypersensitivity

Use with caution in patients with hepatic impairment

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ADVERSE REACTIONS

ondansetron

Back 34

CNS: HA, malaise, fatigue, dizziness, fever, sedation, extrapyramidal syndrome

CV: CP, arrhythmias

RESP: Hypoxia

GI & HEPATIC: Diarrhea, constipation, abdominal pain, xerostomia, decreased appetite

SKIN: Rash

Front 35

ADULT DOSAGE

ondansetron

Back 35

4-8 mg IV slow push over 2-5 min

8mg PO ODT or tablet

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PEDIATRIC DOSAGE

ondansetron

Back 36

(1 month to 12 years old)

Greater than 40 kg - 4 mg IV slow push over 2-5 min

Less than 40 kg - 0.1 mg/kg IV slow push over 2-5 min

4-12 years old 4 mg PO ODT or Tablet

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BONUS

ondansetron

Back 37

Do not attempt to push Zofran ODT tablets through the foil backing. With dry hands, PEEL BACK the foil backing of 1 blister and GENTLY remove the tablet. IMMEDIATELY place the Zofran ODT tablet on top of the tongue where it will dissolve in seconds, then swallow with saliva. Administration with liquid is not necessary.

Bottles: Store between 2 degrees C and 30 degrees C (36F-86F). Protect from light. Dispense in tight, light-resistant container as defined in the USP.

Unit dose packs: store between 2C-30C (36F-86F) Protect from light. Store blisters in cartons.

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BRAND NAME

naloxone HCl

Back 38

Narcan

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CLASS

naloxone HCl

Back 39

narcotic (opioid) antagonist

Front 40

MECHANISM OF ACTION

naloxone HCl

Back 40

Competitive inhibition at narcotic receptor sites.

Reverses respiratory depression secondary to narcotics.

Front 41

INDICATIONS

naloxone HCl

Back 41

ANTIDOTE FOR: Opioid overdoses.

May differentiate opioid-induced coma from other causes.

Front 42

CONTRAINDICATIONS

naloxone HCl

Back 42

Hypersensitivity

Front 43

ADVERSE REACTIONS

naloxone HCl

Back 43

Withdrawal symptoms, especially in neonates (N/V, diaphoresis, increased HR, falling BP, tremors).

BE PREPARED FOR COMBATIVE PT AFTER ADMINISTRATION.

Front 44

ADULT DOSAGE

naloxone HCl

Back 44

IV, IM, SC, Inject SL, ET: 2.0 mg initial bolus IV or ET, may repeat every 2 minutes as necessary; titrate to effect.

INTRA-NASAL: 1.0 mg each nostril using a Mucosal Atomizer Device for a total of 2 mg. May repeat every 2 minutes as necessary. Titrate to effect.

Front 45

PEDIATRIC DOSAGE

naloxone HCl

Back 45

< 5 years or < 20 kg: 0.1 mg/kg IV, ET, inject SL, SC, IO (includes neonate)

> 5 years or > 20 kg: 2 mg IV, ET, inject SL, SC, or IO

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BONUS

naloxone HCl

Back 46

Opioid drugs include heroin, Dilaudid, morphine, meperidine, codeine, methadone, Lomotil, Darvon, Darvocet, Talwin and others.

Front 47

BRAND NAME

thiamine HCl (vitamin B1)

Back 47

Betalin

Front 48

CLASS

thiamine HCl (vitamin B1)

Back 48

vitamin

Front 49

MECHANISM OF ACTION

thiamine HCl (vitamin B1)

Back 49

Required for carbohydrate metabolism.

Deficiency leads to anemia, polyneuritis, Wernicke's encephalopathy, cardiomyopathy.

Administration may reverse symptoms of deficiency, but effects are dependent upon duration of illness and severity of disease.

Front 50

INDICATIONS

thiamine HCl

Back 50

Alcoholism, delirium tremens.

Coma of unknown origin, especially if alcohol or malnourishment may be involved.

Suspect Wernicke or Korsakoff Syndrome

Other thiamine deficiency syndromes

Severe CHF

Front 51

CONTRAINDICATIONS

thiamine HCl

Back 51

Do not give intra-arterial

Front 52

ADVERSE REACTIONS

thiamine HCl

Back 52

Hypotension (rare)

Front 53

ADULT DOSAGE

thiamine HCl (vitamin B1)

Back 53

100 mg SIVP or Deep IM

Front 54

PEDIATRIC DOSAGE

thiamine HCl (vitamin B1)

Back 54

Rarely used.

Front 55

BONUS

thiamine HCl (vitamin B1)

Back 55

In the known alcoholic patient, dextrose should not be administered without thiamine.

Thiamine has been shown to be useful in severe CHF.

Front 56

BRAND NAME

oxytocin

Back 56

Pitocin, Syntocin

Front 57

CLASS

oxytocin

Back 57

pituitary hormone, polypeptide, uterine stimulant

Front 58

MECHANISM OF ACTION

oxytocin

Back 58

Binds to oxytocin receptor sites on the surface of uterine smooth muscles: increases force and frequency of uterine contractions.

Front 59

INDICATIONS

oxytocin

Back 59

Postpartum hemorrhage due to uterine atony

Front 60

CONTRAINDICATIONS

oxytocin

Back 60

Hypersensitivity

Front 61

ADVERSE REACTIONS

oxytocin

Back 61

CV: Shock, tachycardia, dysrhythmias

RESP: Anaphylaxis

GI: N/V

GU: If used prior to deliver, can cause uterine rupture, uterine spasm, lacerations, and fetal damage.

OTHER: Clotting disorders, electrolyte disturbances.

Front 62

ADULT DOSAGE

oxytocin

Back 62

POSTPARTUM HEMORRHAGE: 10-20 USP units added to 1000 mL NS or LR and run at a rate necessary to control uterine atony or 10 USP units may be given IM after delivery of the placenta.

Front 63

PEDIATRIC DOSAGE

oxytocin

Back 63

Not applicable.

Front 64

BONUS

oxytocin

Back 64

Post partum hemorrhage is defined as blood loss in excess of 500 mL at delivery and during the first 24 hours after delivery.