Samc Pharm Quiz 1

Front 1

Adenosine
(Adenocard)

Back 1

CLASSIFICATION: Antiarrythmic

ACTIONS:
Slows conduction of electrical impulses at the AV node

INDICATIONS:
• SVT. NOTE: Does not convert atrial flutter, ventricular tach, or atrial fib

ADVERSE REACTIONS:
• Flushing, chest pressure, throat tightness, numbness. PT will have a brief episode of asystole after administration.

CONTRAINDICATIONS:
• 2nd or 3rd degree AV block
• Sick sinus syndrome
• Poison-/drug- induced tachycardia

PRECAUTIONS:
• -Use caution in PT with pre-existing bronchospasm and those with a history of AF
- Elderly PT with no history of PSVT should be carefully evaluated for dehydration and rapid sinus tachycardia requiring volume fluid replacement rather than simply treated with adenosine

DOSAGE:
ADULT:
• 6 mg given rapidly (1-3 seconds) IV,IO push, immediately followed by a 20-mL saline flush. If the first dose fails to convert the rhythm within to 2 minutes, a second dose of 12mg rapid IV, IO push, followed by a 20 mL flush, may be administered.

PEDIATRIC:
>50 kg: same as adult dosing
<50 kg: initial dose 0.1 mg/kg IV, IO (max dose: 6 mg) Immediately followed by 5-mL rapid saline flush. May repeat at 0.2 mg/kg (max dose: 12 mg).

HOW SUPPLIED:
• 6 mg in a 2 ml pre-filled syringe. 12 mg in a 4 ml pre-filled syringe.
• 6 mg in a 2 ml vial

Front 2

Asprin
(ASA)

Back 2

CLASSIFICATION: Anti-platelet, non-narcotic analgesic, antipyretic

ACTIONS:
Prevents the formation of a chemical known as thromboxane A2, which causes platelets to clump together, or aggregate, and to form plugs that cause obstruction or construction of small coronary arteries.

INDICATIONS:
Fever, inflammation, angina, acute MI, and PT C/O of pain, pressure, squeezing, or crushing in the chest that may be cardiac in origin.
•
ADVERSE REACTIONS:
Anaphylaxis, angioedema, bronchospasm, bleeding, stomach irritation, nausea/ vomiting.

CONTRAINDICATIONS:
• GI bleeding, active ulcer disease, hemorrhagic stroke, bleeding disorders, children w/ chicken pox or flu like symptoms, known sensitivity.

PRECAUTIONS:
Pregnancy class C except the last 3 months of pregnancy, when aspirin is considered pregnancy class D.

DOSAGE: Note: "Baby aspirin" 81 mg, standard adult dose 325 mg.
Myocardial Infarction:
ADULT: 160 to 325 mg PO (4 baby aspirin) , 300 mg rectal suppository.
PEDIATRIC: 3 to 5 mg/kg/day to 5 to 10 mg/kg/day given as a single dose
Pain of fever:
ADULT: 325 to 650 mg PO (1 to 2 Adult tablets) every 4 to 6 hours
PEDIATRIC: 60 to 90 mg/kg/day in divided doses every 4 to 6 hours

Front 3

Morphine

Back 3

CLASSIFICATION: opiate agonist, schedule C-11

ACTIONS:
Binds with opiod receptors. Morphine is capable of inducing hypotension by depression of the vasomotor centers of the brain, as well as release of histamine. In the management of angina, morphine reduces stimulation of the sympathetic nervous system caused by pain and anxiety. reduction of the sympathetic stimulation reduces heart rate, cardiac work, myocardial oxygen consumption.

INDICATIONS:
•Moderate to severe pain, including chest pain associated with ACS, CHF, pulmonary edema.

ADVERSE REACTIONS:
•Respiratory depression, hypotension, nausea/vomiting, dizziness, light headedness, sedation, MI, seizures, cardiac arrest, anaphylactoid reaction.

CONTRAINDICATIONS:
• Respiratory depression, shock, known sensitivity. Use with caution in hypotension, acute bronchial asthma, respiratory insufficiency, head trauma.

PRECAUTIONS:
•-Monitor vital signs and pulse OX. Be prepared to support patients airway and ventilations.
-overdose should be treated with naloxone.
-Pregnancy class C

DOSAGE:
PAIN:
-ADULT: 2.5 to 15 mg IV, IO, IM, Sub- Q administered slowly over a period of several minutes. The dose is the same whether administered IV, IO, IM, or Sub- Q.
•-PEDIATRIC:
- 6 months to 12 years 0.05 to 0.2 mg/kg IV, IO, IM, or Sub- Q.
- Younger that 6 months: 0.03 to 0.05 mg/kg IV, IO, IM, or Sub- Q.
CHEST PAIN: Associated with acute coronary syndrome, CHF, and Pulmonary edema.
Administer small doses and re evaluate the patient. Large doses may lead to respiratory depression and worsen the patient's hypoxia.

-ADULT: 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.
-PEDIATRIC: 0.1 to 0.2 mg/kg/doses IV,IO

Front 4

Nitroglycerine
(Nitrolingual, NitroQuick, NitroStat, Nitro- Dur)

Back 4

CLASSIFICATION: Antianginal agent

ACTIONS:
Relaxes vascular smooth muscle, thereby dilating peripheral arteries and veins. This causes pooling of venous blood and decreased venous return to the heart, which decreases pre-load. Nitroglycerin also reduces left ventricular systolic wall tension, which decreases after-load.

INDICATIONS:
•Angina, ongoing ischemic chest discomfort, hypertension, myocardial ischemia associated with cocaine intoxication.

ADVERSE REACTIONS:
•Headache, hypotension, bradycardia, light headedness, flushing, cardiovascular collapse, methemoglobinemia.

CONTRAINDICATIONS:
•Hypotension, severe bradycardia or tachycardia, increased ICP, Intercranial bleeding, PT taking any medications for erectile disfunction. Known sensitivity to nitrates. Use with caution in anemia, closed- angle glaucoma, hypotension, postural hypotension, uncorrected hypovolemia.

PRECAUTIONS:
•-Administration of nitroglycerin to a PT with right ventricular MI can result in hypovolemia.

DOSAGE:
ADULT:
•- Sublingual tablets: 1 tablets (0.3-0.4 mg) at 5 minute intervals to a maximum of 3 doses.
- Transligual spray: 1 (0.4 mg) spray at 5 minute intervals to a maximum of 3 sprays.
-Ointment: 2% topical (nitro-bid ointment): Apply 1 to 2 inches over the chest wall, cover with transparent wrap, and secure with tape.
-IV:
- Bolus: 12.5 to 25 mcg
- Infusion: 5 mcg/min; may increase rate by 5 to 10 mcg/min every 5 to 10 minutes as needed. End points of dose titration for nitroglycerin include a drop in the blood pressure of 10%, relief of chest pain, and return of ST- segment to normal on a 12 lead EKG.

PEDIATRIC IV infusion: The initial pediatric infusion is 0.25 to 0.5 mcg/kg/min IV, IO titrated by 0.5 to 1 mcg/kg/min. Usual required dose is 1 to 3 mcg/kg/min to a maximum dose of 5 mcg/kg/min.

Front 5

Lorazepam
(Ativan)

Back 5

CLASSIFICATION: Benzodiazepine; schedule c-IV

ACTIONS:
Binds to the benzodiazepine receptor and enhances the effects of the brain chemical GABA, an inhibitory transmitter, and may result in a state of sedation, hypnosis, skeletal muscle relaxation, anticonvulsant activity, coma.

INDICATIONS:
•Pre-procedure sedation induction, anxiety, status epilepticus.

ADVERSE REACTIONS:
•Headache, drowsiness, ataxia, dizziness, amnesia, depression, dysarthria, euphoria, syncope, fatigue, tremor, vertigo, respiratory depression, paradoxical CNS stimulation.

CONTRAINDICATIONS:
•Known sensitivity to lorazepam, benzodiazepines, poloyethylene glycol, propylene, glycol, or benzyl alcohol; COPD; sleep apnea (except while being mechanically ventilated); shock; coma; acute closed- angle glaucoma.

DOSAGE:
Analgesia and Sedation:
ADULT:
•- 2 mg or 0.44 mg/kg/ IV, IO, whichever is smaller. This dose will provide adequate sedation in most PT and should not be exceeded in patients older than 50 years.
PEDIATRIC:
- 0.05 mg/kg IV, IO. Each dose should not exceed 2 mg IV, IO

Seizures:
ADULT:
- 4 mg IV, IO given over 2 to 5 min; may repeat in 10 to 15 minutes (max single dose: 8 mg in a 12- hour period)
PEDIATRIC:
-Adolescents: 0.07 mg/kg/ slow IV, IO given over 2 to 5 minutes (max single dose: 4 mg). May repeat in 10- 15 minutes (max dose: 8 mg in a 12 hour period)

-Children and infants: 0.1 mg/kg slow IV, IO given over 2 to 5 minutes (max single dose: 4 mg). May repeat at half the original dose in 10 to 15 minutes if seizure activity resumes.

-Neonates: 0.05 mg/kg slow IV, IO given over 2 to 5 minutes. May repeat in 10 to 15 minutes.

Front 6

Dexamethasone
(Decadron)

Back 6

CLASSIFICATION: Corticosteroid

ACTIONS:
Reduces inflammation and immune responses

INDICATIONS:
• Various inflammatory conditions, adrenal insufficiency, non- responsive forms of shock.

ADVERSE REACTIONS:
• Nausea, abdominal pain, and haemorrhage.

CONTRAINDICATIONS:
• Fungal infections, known sensitivity.

PRECAUTIONS:
•Pregnancy class C

DOSAGE:
ADULT:
• - 1 to 6 mg/kg IV to a maximum dose of 40 mg.

PEDIATRIC:
- 0.03 to 0.3 mg/kg IV, IO divided into doses every 6 hours.

Front 7

Flumazenil
(Romazicon)

Back 7

CLASSIFICATION: Benzodiazepine receptor antagonist, antidote

ACTIONS:
Competes with benzodiazepines for binding for binding at the benzodiazepine receptor, reverses the sedative effects of benzodiazepine

INDICATIONS:
• Benzodiazepine over sedation.

ADVERSE REACTIONS:
• Resedation, seizures, dizziness, pain at injection site, nausea/vomiting, diaphoreses, headache, visual impairment.

CONTRAINDICATIONS:
• Cyclic anti-depressant overdose; life threatening conditions that require treatment with benzodiazepines, such as status epilepticus and intercranial hypertension; known sensitivity to flumazenil or benzodiazepines. use with caution where there is the possibility of unrecognised benzodiazepine dependence and in patients who have a history of substance abuse or who are known substance abusers.

PRECAUTIONS:
•- Monitor for signs of hypoventilation and hypoxia for approximately 2 hours.
- If the half- life of the benzodiazepine is longer that flumazenil, an additional dose may be needed
- May precipitate withdrawal symptoms in patients dependent on benzodiazepines.
- Flumazenil has not been shown to benefit patients patients who have overdosed on multiple drugs.

DOSAGE:
ADULT:
• initial dose is 0.2 mg IV/ IO over a 15 second period. if the desired effect is not observed after 45 seconds, administer a second 0.2 - mg dose, again over a 15 second period. Doses can be repeated a total of four times until a total dose of 1 mg has been administered.

PEDIATRIC:
Children older than 1 year, 0.01 mg/kg IV, IO given over a 15 second period. May repeat in 45 seconds and then every minute to a maximum cumulative dose of 0.05 mg/kg or 1 mg, whichever is the lower dose.

Front 8

Ketorolac
(Toradol)

Back 8

CLASSIFICATION: NSAID

ACTIONS:
Inhibits the production of prostaglandins in inflamed tissue, which decreases the responsiveness of pain receptors.

INDICATIONS:
• Moderately severe acute pain.

ADVERSE REACTIONS:
• Headache, drowsiness, dizziness, abdominal pain, dyspepsia, nausea/vomiting, diarrhea.

CONTRAINDICATIONS:
• Patients with a history of peptic ulcer disease or GI bleed, patients with renal insufficiency, hypovolemic patients, pregnancy (third trimester), nursing mothers , allergy to aspirin
or other NSAID's stroke, suspected stroke, or head trauma, need for major surgery in the immediate or near future (7 days)

PRECAUTIONS:
Pregnancy class C and D or in the third trimester.•

DOSAGE:

ADULT:
• - Younger than 65 years: 30 mg IV, IO or 60 mg IM
- Older than 65 years: 15 mg IV, IO or 30 mg IM
PEDIATRIC:
- 0.5 mg/kg IV, IO to a maximum dose of 15 mg, or 1 mg/kg IM to a maximum dose of 30 mg.