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257 Cards in this Set

  • Front
  • Back
Amiodarone-Trade name
Codarone
Amiodarone-Class
Class III antiarrhymic
Amiodarone-Mechanism of action
Acts directly on the myocardium to delay repolarization and increase the duration of the action potential
Amiodarone-Indications
Ventricular arrhythmias; second line drug for atrial arrhythmias
Amiodarone-Contraindications
SA node dysfunction, 2nd and 3rd degree AV blocks, cardiogenic shock, syncope caused by bradycardia.
Amiodarone-Routes of administration
IV/IO
Amiodarone-Adult dosage
300mg, 150mg in 3-5 min
Amiodarone-Peds dosage
5mg/kg to a max of 300mg
Amiodarone-Adverse affects
Hypotension, HA, dizziness, bradycardia
Amiodarone-Special considerations
Pregnancy Class D,
Pregnancy class A
No evidence of risk exists.
Pregnancy class B
The risk of human fetal harm is possible but remote.
Pregnancy class C
Human fetal risk cannot be ruled out. Drugs should only be given in the potential benefit justifies the potential risk to the fetus.
Pregnancy class D
Positive evidence of human fetal risk. May be beneficial in life-threatening situations where no other drug can be used
Pregnancy class X
Contraindicated during pregnancy. The use outweights any potential benefit.
Asprin-AKA
ASA, acetylsalicylic acid
Asprin-Mechanism of action
Prevents platelet aggregation by preventing the formation of thromboxane A in the blood.
Asprin-Class
Antiplatelet agent, non narcotic analgesic, antipyretic
Asprin-Indications
Pain, discomforts, CP, Fever
Asprin-Contraindications
Known hypersensitivity, bleeding ulcer, bleeding disorder, hemorrhagic stroke, children, GI bleed.
Asprin-Dosage
Adult: 160mg-325mg (81 mg tablets)
Asprin-Route of administration
PO
Asprin-Adverse affects
GI bleeding, anaphylaxis, angioedema, bleeding, stomach upset, N&V
Asprin-Special considerations
Large doses of salicylates have a hypoglycemic affect, Pregnancy class C, last trimester is class D.
Atropine-AKA
Atropine sulfate
Atropine-Class
Anticholinergic, parasympathetic blocker, parasympatholytic, antimuscarinic
Atropine-Mechanism of action
Competes reversibly with acetylcholine at the site of muscarinic receptors
Atropine-Indications
Symptomatic bradycardia, asytole, PEA, bronchospasm, nerve agent exposure, organophosphate poisoning
Atropine-Contraindications
Tachycardia, acute MI, myasthenia gravis, GI obstruction, glaucoma, 3rd degree heart block
Atropine-Route of administration
IV,IO, IM, Tracheal
Atropine-Adult dosage for symptomatic bradycardia
0.5mg IV/IO every 3-5 minutes to a max dose of 3mg
Atropine-Adolescent doseage for symptomatic bradycardia
0.02 mg/kg (min dose of .10mg, max dose of .5mg/dose) IV/IO up to a max of 2mg
Atropine-Pediatric-dosage for symptomatic bradycardia
0.02 mg/kg (min dose of .10mg, max dose of .5mg/dose) IV/IO up to a max of 1mg
Atropine-Asystole/PEA
1mg IV/IO every 3-5 minutes to a max dose of 3mg *may be give via ET tube a 2-2.5 mg diluted in 5-10ml of H20 or NS
Atropine-Adult dosage for nerve agent/organophosphate poisoning
2-4mg IV/IM every 20-30 minutes till symptoms dissipate *In severe cases, the initial dose can be as large as 2 to 6 mg IV. Repeat doses of 2 to 6 mg can be administered IV, IM every 5 to 60 minutes
Atropine-Pediatric dosage for nerve agent/organophosphate poisoning
0.05 mg/kg IV, IM every 10 to 30 minutes as needed until symptoms dissipate
Atropine-Infant <15 lbs. dosage for nerve agent/organophosphate poisoning
0.05 mg/kg IV, IM every 5 to 20 minutes as needed until symptoms dissipate
Atropine-Adverse effects
Anxiety, dizziness, HA, confusion, delirium, hallucinations, decreased oral secretions , hot skin temp, facial flushing, bradycardia if given in too low a dose or too slowly
Atropine-Special considerations
Pregnancy class C, possibly unsafe for lactating mothers, 2.5 hour half-life
Morphine-AKA
MS Contin, Duramorph
Morphine-Class
Opiate agonist, Class II controlled substance
Morphine-Mechanism of action
Binds with opioid receptors, reduces the stimulation of sympathetic nervous system thereby reducing pain, anxiety, HR, cardiac work, and myocardial oxygen consumption
Morphine-Indications
Analgesia, cardiac CP, cardiac pulmonary edema
Morphine-Contraindications
Hypotension, head trauma, pregnancy, liver, kidney, or endocrine disease, acute asthma
Morphine-Routes of administration
IV/IM/IO/SubQ
Morphine-Dosages for adult pain control
2.5-15mg IV/IM/IO/SubQ given slowly over a period of a few minutes
Morphine-Dosages for pedatric pain control (6 months to 12 years)
.05 - .20 mg/kg IV/IM/IO/SubQ
Morphine-Dosages for pedatric pain control (Newborn to 6 months)
.03 - .05 mg/kg IV/IM/IO/SubQ
Morphine-Dosages for adult cardiac CP, CHF, pulmonary edema
2 to 4 mg slow IV/IO over a 1- to 5-minute period with increments of 2 to 8 mg repeated every 5 to 15 minutes until patient relieved of chest pain
Morphine-Dosages for pediatric cardiac CP, CHF, pulmonary edema
0.1 to 0.2 mg/kg IV/ IO
Morphine-Adverse effects
Hypotension, syncope, tachycardia, bradycardia, euphoria, dry mouth, anaphylaxis, N&V, respiratory depression, seizures
Morphine-Special considerations
Patients who are allergic should receive a opioid agonist from a different subclass like dilaudid, or fentanyl. Monitor vital signs and pulse oximetry closely. Be ready to support respirations. OD should be treated with Narcan. Pregnancy class C
Nitro-AKA
Nitrostat, Nitrobid, Tridil
Nitro-Class
Vasodialator, organic nitrate, antianginal
Nitro-Mechanism of action
Smooth muscle relaxant dilating peripheral arteries and veins decreasing preload and afterload.
Nitro-Indications
CP due to angina or myocardial ischemia, pulmonary edema, hypertensive emergency
Nitro-Contraindications
Viagra or similar in last 48 hours, suspected inferior wall MI, Hypotension, extreme brady, tachycardia, increased ICP, uncorrected hypovolemia, pericarditis, pericardial tamponade, glaucoma
Nitro-Dosage, SL
0.3-0.4mg (translingual 0.4mg) at 5 minute intervals with a max dose of 3 sprays
Nitro-Dosage, ointment
1-2 inches covered by a transparent bandage
Nitro-Dosage, IV Bolus
12.5-25mcg
Nitro-Dosage, infusion
5mcg/min, may increase by 5-10mcg/min every 5-10 minutes till relief of pain, SBP drops 10%, or ST segment returns to baseline
Nitro-Dosage, pediatric infusion
0.25-0.50mcg/kg/min titrated by .25-.50mcg/kg/min to a usual dose of 1-3 mcg/min up to a max dose of 5mcg/kg/min
Nitro-Adverse effects
Hypotension, tachycardia, bradycardia, HA, palpitations, syncope, lightheadedness, methamoglobinemia
Nitro-Special considerations:
R ventricular MI Pt may have significant hypotension after administration of NTG. Hypotention may worsen myocardial ischemia. Hypotension usually responds well to IV fluids. Pregnancy class C.
Lidocaine-AKA
Xylocaine
Lidocaine-Class
Class 1b antiarrhythmic
Lidocaine-Mechanism of action
Blocks sodium channels increasing the recovery period after repolarization. Suppresses the automaticity in the His-Purkinje system and depolarization in the ventricles
Lidocaine-Indications
VT, VF, cardiac arrest, wide complex VT when amiodarone is not available, pre-intubation for head trauma or intracranial bleeding
Lidocaine-Contraindications
Hypersensitivity to amide-type local anesthetics, severe SA, AV, or intraventricular block in the absence of an artificial pacemaker. WPW syndrome. Adams-Stokes syndrome.
Lidocaine-Route of administration
IV, IO, tracheal
Lidocaine-ADULT dose, pulseless VT/VF
1-1.5mg/kg IV/IO. May repeat at 0.5-0.75mg/kg every 5-10 minutes to a max dose of 3mg/kg
Lidocaine-ADULT dose, pulseless VT/VF--Tracheal
2-10mg/kg followed by a 10ml NS/sterile H20 flush
Lidocaine- ADULT dose, perfusing ventricular rhythms
0.5-0.75mg/kg Repeat every 5-10 minutes to a max dose of 3mg/kg
Lidocaine-PEDS dose, pulseless VT/VF
1mg/kg IV/IO to a max dose of 100mg
Lidocaine-Adverse effects
Bradycardia, hypotension, may cause SA node depression or conduction problems if given in large doses or given too rapidly. Toxicity with symptoms including anxiety, euphoria, blurred vision, dizziness, seizures.
Lidocaine-PEDS dose, pulseless VT/VF--Tracheal
2-3mg/kg ET, followed by a 5ml NS/sterile H20 flush
Lidocaine-Special considerations
Half-life may be prolonged in patients with liver dysfunction. MAY BE LETHAL in a bradycardia with a ventricular escape rhythm.
Epi: AKA
Adrenalin, EpiPen
Epi: Class
Adrenergic agent, Inotrope, natural catecholamine, sympathomemetic
Epi: Mechanism of action
Binds strongly with both alpha and beta receptors increasing BP, HR, and bronchodilation.
Epi: Indications
Cardiac arrest, profound bradycardia, severe bronchospasm, anaphylaxis
Epi: Contraindications
None in cardiac arrest, hypovolemic shock, coronary insufficiency, glaucoma, diabetes, pregnant women, arrhythmias other than VF, asystole, PEA
Epi: Route of administration
IV/IO/IM/SubQ/Tracheal
Epi: Dosage-ADULT Cardiac Arrest
1mg (1:10,000) IV/IO every 3 to 5 minutes
Epi: Dosage-ADULT Symptomatic Bradycardia
1mcg/min (1:10,000) as a continuous IV infusion. Usual dosage 2-10mcg/min
Epi: Dosage-PEDS Cardiac Arrest
0.01mg/kg (1:10,000) IV/IO every 3 to 5 minutes with a max dose of 1mg
Epi: Dosage- PEDS Symptomatic Bradycardia
0.01mg/kg (1:10,000) every 3-5 min to a max dose of 1mg
Epi: Dosage-ADULT Asthma
0.3-0.5mg (1:1000) IM or SubQ every 10 min to a max dose of 1mg
Epi: Dosage-PEDS Asthma
0.01mg/kg (1:1000) IM or SubQ every 10 min to a max dose of 0.5mg
Epi: Dosage-ADULT Anaphylaxis
0.1mg (1:10,000) IV slowly over 5 minutes OR 1-4mcg/min titrated to effect
Epi: Dosage-PEDS Anaphylaxis
0.1-1mcg/kg/min (1:10,000) continuous IV infusion titrated to effect
Epi: Adverse Effects
Palpitations, tachycardia, hypertension, dysrhythmias, angina, myocardial ischemia, tremors, anxiety, HA, dizziness, N&V
Epi: Special Considerations
Deteriorates rapidly on exposure to light or air. Solutions that show signs of discoloration should be replaced. Half-life is 1 minute. Pregnancy class C.
Vasopressin-AKA
N/A
Vasopressin-Class
Nonadrenergic vasoconstrictor
Vasopressin-Mechanism of Action
Causes vasoconstriction independent of adrenergic receptors or neural invervation.
Vasopressin-Indications
Adult shock refractory of VF, pulseless VT, Asystole, PEA, vasodilatory shock
Vasopressin-Contraindications
Responsive patients with cardiac disease
Vasopressin-Dosage, ADULT
40U IV/IO may replace either the 1st or 2nd dose of Epi.
Vasopressin-Adverse Effects
Cardiac ischemia, angina
Vasopressin-Special Considerations
Pregnancy class C. May be given ET but the dosage is not known.
Vasopressin-Route of administration
IV/IO/Tracheal
Oxygen-AKA
O2, O's
Oxygen-Class
Elemental gas
Oxygen-Mechanism of Action
Facilitates cellular energy metabolism
Oxygen-Indications
Hypoxia, CP, Shock, Respiratory distress, CO poisoning, cardiac arrest, trauma
Oxygen-Contraindications
Known paraquat poisoning
Oxygen-Route of administration
Inhalation
Oxygen-Doseage
High concentration=15LPM via mask. Low concentration=6LPM via nasal canula
Oxygen-Adverse Effects
High concentrations can cause decreased LOC in patients with increased CO2 retention and COPD.
Oxygen-Special Considerations
Pregnancy class A
Metoprolol-AKA:
AKA: Lopressor, Toprol XL
Metoprolol-Class:
Class: Beta Blocker, antihypertensive, antianginal
Metoprolol-Mechanism of Action:
Mechanism of action: Inhibits the strength of the hearts contraction as well as heart rate causing a decrease in the hearts O2 consumption.
Metoprolol-Indications:
Indications: ACS, SVT, A-flutter, A-fib, HTN
Metoprolol-Contraindications:
Contraindications: Heart failure, 2nd or 3rd degree blocks, hypotension (SBP<100), bradycardia (HR<45), cardiogenic shock.
Metoprolol-Route of Administration:
Route of administration: IV, IO, oral
Metoprolol-Dosage
Dosages: 5mg IV slow IV push over 5 minutes. May be repeated at 5 minute intervals to a max dose of 15mg.
Metoprolol-Special Considerations
Special Considerations: Pregnancy class C
Metoprolol-Adverse Effects
Adverse effects: Bradycardia, AV blocks, hypotension, dizziness, diarrhea, N&V
Sodium Bicarbonate-AKA
AKA: Sodium Bicarb
Sodium Bicarbonate-Class
Class: Electrolyte Replacement
Sodium Bicarbonate-Mechanism of Action
Mechanism of action: Counteracts existing acidosis, short acting strong antacid
Sodium Bicarbonate-Indications
Indications: TCA OD, prolonged cardiac arrest, hyperkalemia, metabolic acidosis, crush syndrome
Sodium Bicarbonate-Contraindications
Contraindications: Alkalosis, hypocalcemia
Sodium Bicarbonate-Routes of Administration
Route of administration: IV/IO
Sodium Bicarbonate-Dosage
Dosages: 1 mEq/kg IV/IO. May repeat at .5mEq/kg if needed in 10 minutes.
Sodium Bicarbonate-Adverse Effects
Adverse effects: Hypernatremia, Alkalosis, peripheral and pulmonary edema, hypokalemia, intracranial bleeding
Sodium Bicarbonate-Special Considerations
Special Considerations: Use with caution in pt with CHF or renal disease, Do not mix with other meds in the same IV line, pregnancy class C
Mag Sulfate-AKA:
Magnesium Sulfate
Mag Sulfate-Class:
Class: Electrolyte, tocolytic
Mag Sulfate-Mechanism of Action:
Mechanism of action: CNS depressant, smooth muscle relaxant, laxative if taken PO
Mag Sulfate-Indications:
Indications: Torsades de pointes, eclampsia, SZ prophylaxis in eclampsia, status asthmaticus
Mag Sulfate-Contraindications:
Contraindications: AV Block, GI obstruction, use with caution in renal impairment
Mag Sulfate-Route of Administration:
Route of administration: IV/IO
Mag Sulfate-Dosages: Adult Cardiac
Cardiac: 1-2g in 10ml D5W IV/IO over 5-10 minutes
Mag Sulfate-Dosages: Eclampsia
Eclampsia: 4-6g IV/IO over 20-30 minutes followed by 1-2g/hour
Mag Sulfate-Dosages: Status Asthmaticus
Status Asthmaticus: 1.2-2g SLOW IV/IO over 20 minutes
Mag Sulfate-Adverse Effects:
Adverse effects: Magnesium toxicity, Hypotension, depressed cardiac function
Mag Sulfate-Special Considerations
Special Considerations: Pregnancy Class A
Calcium Gluconate-AKA
AKA: Kalcinate
Calcium Gluconate-Class
Class: Electrolyte
Calcium Gluconate-Mechanism of Action:
Mechanism of action: Counteracts the toxicity of hyperkalemia by stabilizing the membranes of the cardiac cells, reducing the likelihood of fibrillation.
Calcium Gluconate-Indications:
Indications: Hyperkalemia, Hypocalcemia, hypermagnesmia, antidote for mag sulfate
Calcium Gluconate-Contraindications:
Contraindications: VF, digitalis toxicity, hypercalcemia, DO NOT mix with sodium bicarb
Calcium Gluconate-Route of Administration
Route of administration: IV/IO NOT IM
Calcium Gluconate-Dosage
Dosages: 500-1000mg IV/IO SLOW IVP (1-1.5ml/min) to a max dose of 3g
Calcium Gluconate-Adverse Effects:
Adverse effects: Soft tissue necrosis, hypotension, bradycardia (if administered too rapidly)
Calcium Gluconate-Special Considerations:
Special Considerations: NO IM, do NOT administer too rapidly, do NOT mix with sodium bicarb, Pregnancy class C
Hypertonic Saline-AKA
3% Saline
Hypertonic Saline-Class
Class: Electrolyte solution, volume expander
Hypertonic Saline-Mechanism of action:
Mechanism of action: Pulls extravascular fluid in to the vascular space to act as a volume expander. Also used to reduce ICP.
Hypertonic Saline-Indications
Indications: ICP, hypovolemic shock
Hypertonic Saline-Contraindications:
Pulmonary edema, NOT to be administered IO
Hypertonic Saline-Route of administration:
IV ONLY
Hypertonic Saline-Dosages
Dosages: 250ml IV over 1 hour
Hypertonic Saline-Adverse Effects:
Adverse effects: Increased rate of bleeding, alteration of blood clotting ability
Hypertonic Saline-Special considerations:
Special Considerations: NOT to be administered IO, can cause damage to vein administered in, Pregnancy class C
Lorazepam-AKA:
Lorazepam-AKA: Ativan
Lorazepam-Class:
Lorazepam-Class: Benzodiazepine, anticonvulsant, anxiolytic, schedule 4 narcotic
Lorazepam-Mechanism of action:
Lorazepam-Mechanism of action: Binds to the benzo receptors and enhances the GABA receptors in the brain.
Lorazepam-Indications:
Lorazepam-Indications: Anxiety, status epilepticus, sedation
Lorazepam-Contraindications:
Lorazepam-Contraindications: Known sensitivity, coma, hypotension, COPD, sleep apnea, glaucoma
Lorazepam-Routes of Administration:
Lorazepam-Routes of Administration: IV/IO/IN/IM/PO
Lorazepam-Dosages:
Lorazepam-Dosages: Analgesia/Sedation-2 mg or 0.44 mh/kg (whichever is smaller) Status Seizures: 4 mg over 2-5 minutes. May repeat in 10-15 minutes. Max dose of 8 mg in 24 hours.
Lorazepam-Adverse Effects:
Lorazepam-Adverse Effects: Respiratory depression, hypotension, HA, drowsiness, dizziness, amnesia, euphoria, vertigo, ataxia
Lorazepam-Special Considerations:
Lorazepam-Special Considerations: Be prepared to support respirations
Diazepam-AKA:
Diazepam-AKA: Valium
Diazepam-Class:
Diazepam-Class: Benzodiazepine, anticonvulsant, sedative, anxiolytic, schedule 4 narcotic
Diazepam-Mechanism of Actions:
Diazepam-Mechanism of action: Binds to the benzodiazepine receptors and enhances the effects of the GABA receptors in the brain.
Diazepam-Indications:
Diazepam-Indications: Status epilepticus, analgesia/amnesia for procedures, ETOH withdrawal (DT’s), anxiety
Diazepam-Contraindications
Diazepam-Contraindications: Hypersensivity, children <6 months, coma, glaucoma, respiratory depression
Diazepam-Routes of Administration:
Diazepam-Route of administration: IV/IO/IN/IM/PO
Diazepam- Dosages:
Diazepam-Dosages: Adult:
Severe: 5-10 mg slow IVP (no faster than 5 mg/min)
Moderate: 2-5 mg slow IVP
Low: Low dosages are often required for the elderly
DT’s: 10mg slow IVP (no faster than 5 mg/min)
Seizure: 5-10 mg slow IV/IO/IN/IM every 10 minutes to a max dose of 30 mg
Diazepam-Adverse Effects:
Diazepam-Adverse effects: Respiratory depression, hypotension, tachycardia, HA, drowsiness, ataxia, nausea, fatigue, oversedation.
Diazepam-Special Considerations:
Diazepam-Special Considerations: Use with caution with other respiratory depressants of board, ensure patent IV as tissue necrosis can occur if fluid leaks into the extravascular space.
Midazolam-AKA:
Midazolam-AKA: Versed
Midazolam-Class:
Midazolam-Class: Benzodiazepine, Schedule 4 narcotic, amnesiac
Midazolam-Mechanism of Action:
Midazolam-Mechanism of action: Binds to the benzodiazepine receptors and enhances the effects of the GABA receptors in the brain.
Midazolam-Indications:
Midazolam-Indications: Sedation, anxiety, skeletal muscle relaxation
Midazolam-Contraindications:
Midazolam-Contraindications: Pregnancy, glaucoma, known sensitivity
Midazolam-Route of Administration:
Midazolam-Route of administration: IV/IO/IM/IN
Midazolam-Dosages:
Midazolam-Dosages: Each dose should be individualized, some require only 1 mg. If other narcotics on board, 30% less than may be effective. Max dose of 5 mg. Use caution in elderly or chronically ill. If continuous infusion is required for intubated or critically ill, 0.02-0.10 mg/kg/hr
Midazolam-Adverse Effects:
Midazolam-Adverse effects: Respiratory depression, respiratory arrest, cardiac arrest, hypotension, N&V, HA
Midazolam-Special Considerations:
Midazolam-Special Considerations: Must monitor vitals closely, be prepared to support respirations, Pregnancy class D
Fentanyl-AKA:
Fentanyl-AKA Sublimaze
Fentanyl-Class:
Fentanyl-Class: Narcotic analgesic, general anesthetic, schedule 2 narcotic
Fentanyl-Mechanism of Action:
Fentanyl-Mechanism of Action: Binds to opiate receptors
Fentanyl-Indications:
Fentanyl-Indications: Pain, sedation for RSI or prolonged intubation
Fentanyl-Contraindications:
Fentanyl-Contraindications: Known sensitivity, use caution in TBI, respiratory depression
Fentanyl-Route of Administration:
Fentanyl: Route of Administration: IV, IM, IO
Fentanyl-Dose:
Fentanyl-Dose: 50-100 mcg
Fentanyl-Adverse Effects
Fentanyl-Adverse effects: Respiratory depression, apnea, hypotension, brady/tachy, HTN, N&V, dizziness
Fentanyl-Special Considerations
Fentanyl-Special Considerations: Pregnancy class B, O2 and resuscitative equipment should be nearby
Haldol-AKA:
Haldol-AKA: Haloperidol
Haldol-Class:
Haldol-Class: Antipsychotic agent
Haldol-:Mechanism of Action:
Haldol-Mechanism of action: Selectively blocks postsynaptic dopamine receptors
Haldol-Indications:
Haldol-Indications: Psychotic disorders, agitation
Haldol-Contraindications:
Haldol-Contraindications: Depressed mental status, Parkinson’s disease
Haldol-Routes of Administration:
Haldol-Route of administration: IV, IM, PO
Haldol-Dosages:
Haldol-Dosages:
Mild agitation: 0.5-2.0 mg
Moderate agitation: 5-10 mg
Severe agitation: 10 mg
Haldol-Adverse Effects:
Haldol-Adverse effects: VT, Hypotension, HTN, Tachy, Torsades, extrapyramidal symptoms, drowsiness, tardive dyskinesia,
Haldol-Special Considerations:
Haldol-Special Considerations: Pregnancy class C
Ketamine-AKA:
Ketamine-AKA: Ketalar
Ketamine-Class:
Ketamine-Class: General anesthetic
Ketamine-Mechanism of Action:
Ketamine-Mechanism of action: Produces a state of anesthesia while maintaining airway reflexes, HR, BP
Ketamine-Indications:
Ketamine-Indications: Pain and as anesthesia for procedures of short duration
Ketamine-Contraindications:
Ketamine-Contraindications: HTN, CVA, ICP, head trauma, bleeding, MI, glaucoma, hypovolemia, dehydration
Ketamine-Route of Administration:
Ketamine-Route of administration: IV, IO, IM
Ketamine-Dosages
Ketamine-Dosages:
Adult:
IV: 1-4.5 mg/kg
IM: 6.5-13 mg/kg
Ketamine-Adverse Effects:
Ketamine-Adverse effects: Emergence phenomena, HTN, Tachycardia, Hypotension, bradycardia, respiratory depression, apnea, laryngospasams, tonic/clonic movements, vomiting.
Ketamine-Special Considerations
Ketamine-Special Considerations: Concomitant administration of a benzodiazepine reduces the chances of an emergence reaction. Pregnancy class C
Toradol-AKA:
Toradol-AKA: Ketorolac
Toradol-Class:
Toradol-Class: NSAID
Toradol-Mechanism of Actions:
Toradol-Mechanism of action: Inhibits production of prostiglandins in inflamed tissue which decreases the responsiveness of pain receptors.
Toradol-Indications:
Toradol-Indications: Moderate pain
Toradol-Contraindications:
Toradol-Contraindications: Hx of ulcers, GI bleed, renal disease, hypovolemia, 3rd trimester pregnancy, nursing mothers, allergy to ASA or other NSAIDS, CVA or head trauma, need for immediate surgery
Toradol-Route of Administration:
Toradol-Route of administration: IV, IO, IM
Toradol-Dosages:
Toradol-Dosages:
Adult <65: 30mg IV or 60mg IM
Adult >65: 15mg IV or 30mg IM
Toradol-Adverse Effects:
Toradol-Adverse effects: HA, drowsiness, dizziness, Abd pain, N&V, diarrhea, dyspepsia
Toradol-Special Considerations:
Toradol-Special Considerations: Pregnancy class C, class D in 3rd trimester.
Demerol-AKA:
Demerol-AKA: Meperidine
Demerol-Class:
Demerol-Class: Analgesic, Schedule 2 narcotic
Demerol-Mechanism of Action
Demerol-Mechanism of action: Binds to opiate receptors producing analgesia and euphoria
Demerol-Indications:
Demerol-Indications: Moderate to severe pain
Demerol-Contraindications:
Demerol-Contraindications: Use of a MAOI in past 2 weeks, use of other CNS depressants or ETOH, Use with caution with chronic respiratory conditions, pregnant or nursing women, A-flutter.
Demerol-Route of Administration:
Demerol-Route of administration: IV, IO, IM
Demerol-Doseages
Demerol-Dosages: 50-150mg IV,IO,IM,Sub-Q
Demerol-Adverse Effects:
Demerol-Adverse effects: Respiratory depression, cardiac arrest, bradycardia, tachycardia, HTN, hypertension, N&V, syncope, shock
Demerol-Special Considerations:
Demerol-Special Considerations: Half life approx 4 hours, but may last 30 hours in the bloodstream. Pregnancy class C, class D near term.
Verapamil-AKA
Verapamil-AKA: Isoptin
Verapamil-Mechanism of Action:
Verapamil-Mechanism of action: Blocks calcium from moving into the heart muscle cell which prolongs the conductions of electrical impulses through the AV node.
Verapamil-Indications:
Verapamil-Indications: A-Fib, HTN, PSVT, PSVT prophylaxis
Verapamil-Contraindications:
Verapamil-Contraindications: 2nd, 3rd degree blocks (except with patients that have a pacemaker), SBP<90, WPW
Verapamil-Route of Administration:
Verapamil-Route of administration: IV/IO
Verapamil-Dosages
Verapamil-Dosages: 2.5-5.0 mg IV/IO over 2 minutes (3 min in elderly). May repeat at 5-10mg every 15-30 minutes to a max dose of 30mg.
Verapamil-Adverse Effects:
Verapamil-Adverse effects: Bradycardia, Hypotension, AV block (1,2,3), asystole
Verapamil-Special Considerations:
Verapamil-Special Considerations: Pregnancy class C
Verapamil-Class:
Verapamil-Class: Calcium channel blocker, Class 4 antiarrhythmic
Dopamine-AKA:
Dopamine-AKA: Intropin
Dopamine-Class:
Dopamine-Class: Inotrope vasopressor, adrenergic agonist.
Dopamine-Mechanism of Action:
Dopamine-Mechanism of action: Stimulates alpha and beta adrenergic receptors. At low doses (2-10mcg) dopamine stimulates beta 1 receptors resulting in increased cardiac inotropy and increased cardiac output while maintaining vasodilatory effects. At higher doses (>10mcg/kg/min), alpha agonism predominates and increased peripheral vascular resistance and vasoconstriction result
Dopamine-Indications:
Dopamine-Indications: Hypotension and decreased cardiac output associated with cardiogenic shock and septic shock. Hypotension after ROSC, symptomatic bradycardia unresponsive to atropine.
Dopamine-Contraindications:
Dopamine-Contraindications: VF/VT or other ventricular arrhythmias. Correct hypovolemia before administering dopamine. Pheochromacytoma (rare tumor of the adrenal gland causing production of too much epinephrine and norepinephrine).
Dopamine-Route of Administration:
Dopamine-Route of administration: IV/IO
Dopamine-Dosages:
Dopamine-Dosages: Starting dose is 5mg/kg/min; may gradually increase by 5-10 mcg/kg/min to desired effect. Cardiac dose is usually 5-10 mcg/kg/min; vasopressor dose is usually 10-20 mcg/kg/min. Little benefit is gained beyond 20 mcg/kg/min.
Dopamine-Adverse Effects:
Dopamine-Adverse effects: Tachycardia, arrhythmias, severe HTN from excessive vasoconstriction, angina, dyspnea, HA, N&V. Skin and soft tissue necrosis if IV infiltration.
Dopamine-Special Considerations:
Dopamine-Special Considerations: Half life= 2min. Pregnancy class C.
Adenosine-AKA:
Adenosine-AKA: Adenocard
Adenosine-Class:
Adenosine-Class: Antiarrhythmic
Adenosine-Mechanism of Action:
Adenosine-Mechanism of action: Slows the conduction of electrical impulses at the AV node
Adenosine-Indications:
Adenosine-Indications: Stable reentry SVT, does not convert AFib, Aflutter, or VT.
Adenosine-Contraindications:
Adenosine-Contraindications: Sick sinus syndrome, 2nd or 3rd AVB or poison/drug induced tachycardia.
Adenosine-Route of Administration:
Adenosine-IV/IO
Adenosine-Dosages:
Adenosine-Dosages: 6 mg rapid IV/IO push immediately followed by a 20 ml flush. May repeat at 6 mg and then 12 mg if rhythm does not convert after 1-2 minutes.
Adenosine-Adverse Effects:
Adenosine-Adverse effects: Will have a brief period of asystole after administration. Common adverse reactions are short lived: flushing of skin, throat tightness, numbness, chest pressure.
Adenosine-Special Considerations:
Adenosine-Special Considerations: Use caution with preexisting bronchospasm and those with a hx of AFib. Elderly with no hx of PSVT should be carefully evaluated for dehydration and rapid sinus tachycardia requiring fluid replacement rather than simply treating with adenosine. Pregnancy class C.