Term
|
Definition
-naturally occurring atmospheric gas
-reverses hypoxemia |
|
|
Term
|
Definition
-confirmed or suspected hypoxemia
-ischemic chest pain
-respiratory insufficiency
-confirmed/suspected CO poisoning
-decreased level of consciousness |
|
|
Term
|
Definition
-certain pt's with COPD/emphysema
-hyperventilation syndrome |
|
|
Term
|
Definition
-decreased mental status and respiratory depression in pt's with chronic CO2 retention
-retrolental fibroplasia |
|
|
Term
|
Definition
-Onset - Immediate
-Peak - N/A
-Duration - 2 minutes |
|
|
Term
|
Definition
-Adult
*Cardiac arrest/CO poisoning - 100%
*Hypoxemia - 100% via NRB/BVM
*COPD - 0-2 LPM via NC or 28-35% via venturi system
Pedi
*same as adult, except premature infants |
|
|
Term
|
Definition
-acetylsalicylic acid
-platelet aggregate inhibitor
-decreases inflammation
-inhibits release of prostaglandins - lipids that are derived from fatty acids |
|
|
Term
|
Definition
|
|
Term
|
Definition
-ischemic chest pain suggestive of AMI
-possibly of use with signs/symptoms suggestive of recent thrombotic CVA |
|
|
Term
| Aspirin Contraindications |
|
Definition
|
|
Term
|
Definition
-GI bleed
-Nausea
-Increased PT and PTT (clotting times)
-OD: supportive
*consider bicarb |
|
|
Term
|
Definition
| -increased effects with other anticoagulants |
|
|
Term
|
Definition
|
|
Term
| Aspirin Dose and Supplied |
|
Definition
Adult
-chew 2-4 tablets (81 mg each) = 162-324mg
-if pt is already on anticoagulant, give 2 tablets
Pedi
-none
Supplied
-81 mg tablets |
|
|
Term
| Activated Charcoal Pharmacology |
|
Definition
-absorbent
-binds and absorbs toxins present in the GI tract
-once bound it excretes toxins from body |
|
|
Term
| Activated Charcoal Indications |
|
Definition
|
|
Term
| Activated Charcoal Side Effects |
|
Definition
-N/V
-Abdominal cramping
-Constipation |
|
|
Term
| Activated Charcoal Interactions |
|
Definition
-don't administer with syrup of ipecac
-don't administer to pt with altered LOC |
|
|
Term
|
Definition
|
|
Term
| Activated Charcoal Dose and Packaged |
|
Definition
Adult
-50-75mg PO
Pedi
-1G/kg
Packaged
-bottles containing 25 and 50 grams |
|
|
Term
| Nitroglycerin Pharmacology |
|
Definition
-Nitrostat, Nitrolingual spray
-vasodilator
-relaxes smooth muscle of vasculature
-increases coronary blood flor
-stops vasospasm
-increases collateral blood flow to ischemic area
-decreases pulmonary vascular resistance
-decreases preload, afterload
-decreases O2 demand
-decreases infarct size and expansion
-inhibits platelet aggregation
-overall decrease in BP |
|
|
Term
|
Definition
Onset
*SL 1-3 min
*TD 15-30 min
*IV immediate
Duration
*SL 30 min
*TD 2-12 min
*IV continuous |
|
|
Term
| Nitroglycerin Indications |
|
Definition
-ischemic CP
-left heart failure
-MI
-hypertension |
|
|
Term
| Nitroglycerin Contraindications |
|
Definition
-hypersensitivity
-hypotension
-head trauma / CVA (increases ICP)
-PREG: C
-pt usage of ED medication within 24 hrs
*within 48 hrs call med control |
|
|
Term
| Nitroglycerin Side Effects |
|
Definition
-Hypotension
-headache
-flushing
-dizziness
-postural syncope
-N/V
-reflex tachycardias
-OD: supportive |
|
|
Term
| Nitroglycerin Interactions |
|
Definition
| -CNS depressants increase the hypotension effects |
|
|
Term
|
Definition
|
|
Term
| Nitroglycerin Dose and Supplied |
|
Definition
Adult
*SL: 0.3mg (1/200 grain), 0.4mg (1/150 grain), 0.6mg (1/100 grain) Q5 min x3 doses
*Spray: 1 spray Q5 min
*TD: 1/2 to 2 inches
*Infusion: 5 mcg/min and increased by 5-10 mcg Q5 min titrated to effect
Supplied
*SL - bottles of 25 and 100
*Spray - 200 sprays and delivers 0.4mg per spray
*TD - 30-60 gm tubes of 2% ointment (15mg/inch) w/ application
*Infusion - various |
|
|
Term
| Nitroglycerin Special Considerations |
|
Definition
-have IV established BEFORE administration
-have pt in sitting position
-must be protected from air, heat, light and moisture
-monitor BP every min x3 after administration
-for infusion, use non PVC tubing
-bottles are multi-dose not multi-patient |
|
|
Term
|
Definition
-Albuterol sulfate (Proventil, Ventolin)
-Metaproterenol sulfate (Alupent)
-Terbutaline sulfate (Brethine, Brethaire)
-Ipratropium bromide (Atrovent) |
|
|
Term
| Bronchodilators Pharmacology |
|
Definition
-beta2 agonist
-sympathomimetic
-brochodilator
-smooth muscle relaxation of bronchioles
-inhibits histamine release
-vasodilation (mild) |
|
|
Term
|
Definition
-Onset - 5-15 min
-Duration - 3-4 hours |
|
|
Term
| Bronchodilator Indications |
|
Definition
-Asthma
-COPD
-Pulmonary edema
*after initial treatments have been completed |
|
|
Term
| Bronchodilator Contraindications |
|
Definition
| -relative in tachycardia, MI |
|
|
Term
| Bronchodilator Side Effects |
|
Definition
-Tachycardia
-Tremors
-Palpitations
-N/V
-Arrythmias
-OD: supportive, beta blockers |
|
|
Term
| Bronchodilator Interactions |
|
Definition
-increased effects with TCA's (tricyclic antidepressants)
-decreased effects with beta blockers |
|
|
Term
|
Definition
|
|
Term
| Albuterol Dose and Supplied |
|
Definition
Adult
-2.5mg - 5mg
Pedi
-1.25mg - 2.5mg
*6 months to 5 years
Supplied
-20mL multi dose
-3mL unit dose |
|
|
Term
| Metaproterenol Dose and Supplied |
|
Definition
Adult
-15mg
Pedi
-7.5mg
Supplied
-0.6% (2.5mL) unit dose
-5% (10mL) multi dose vial |
|
|
Term
| Terbutaline sulfate Dose and Supplied |
|
Definition
Adult
-SC: 0.25mg may repeat in 15-30 min
-Inhaler: 0.2mg - 0.4mg (1-2 sprays)
Pedi
-none
Supplied
-SC 1mg/mL in 2mL ampules/vials |
|
|
Term
| Ipratropium bromide Pharmacology |
|
Definition
-anticholinergic
-parasympatholytic
-dries respiratory tract secretions
-blocks acetylcholine receptors
*thereby inhibiting parasympathetic stimulation |
|
|
Term
| Ipratropium bromide Indications |
|
Definition
|
|
Term
|
Definition
-Palpitations
-Anxiety
-Dizziness
-N/V
-Headache |
|
|
Term
|
Definition
Adult
- 500mcg in 2.5mL saline
*usually administered with a beta agonist such as albuterol
Pedi
-none |
|
|
Term
| Ipratropium bromide Considerations |
|
Definition
-atrovent does not produce rapid response
-not a primary front line drug with acute bronchospasm |
|
|
Term
| Diphenhydramine Pharmacology |
|
Definition
-Antihistamine
-competitive antagonist of histamine (H1)
-prevents initiation and transmission of sensory nerve impulses
-sedative
-anticholinergic
-antiemetic
-blocks the receptors, does not block the release |
|
|
Term
|
Definition
-Onset: IV - immediate / IM 5-10 min
-Duration: 1-2 hours |
|
|
Term
| Diphenhydramine Indications |
|
Definition
-allergic reaction
-anaphylaxis
-phenothiazine OD |
|
|
Term
| Diphenhydramine Contraindications |
|
Definition
-hypersensitivity
-asthma
-altered LOC |
|
|
Term
| Diphenhydramine Side Effects |
|
Definition
-CNS depression
-respiratory distress
-dry mouth
-hypotension
-tachycardia
-OD = supportive |
|
|
Term
| Diphenhydramine Interactions |
|
Definition
| -increased effects with other CNS depressants |
|
|
Term
| Diphenhydramine Route, Dose and Supplied |
|
Definition
-IVP, IM, IO
-ADULT: 25-50mg slow IVP, deep IM
-PEDI: 1mg/kg
-Supplied: 10mg/mL or 50mg/mL |
|
|
Term
| Sodium Bicarbonate Pharmacology |
|
Definition
-electrolyte (NaHCO3)
*increases free buffer to decrease acidosis
*by reacting with H+ ions and form water and CO2 buffer
-increases pH (alkalinizer)
-reverses metabolic acidosis |
|
|
Term
| Sodium Bicarbonate Kinetics |
|
Definition
-Onset: 5-10 min
-Duration: 30-60 min |
|
|
Term
| Sodium Bicarbonate Indications |
|
Definition
-metabolic acidosis
-barbituate OD
-tricyclic antidepressant OD
-hyperkalemia |
|
|
Term
| Sodium Bicarbonate Contraindications |
|
Definition
-alkalosis
-hypocalcemia
-hypokalemia |
|
|
Term
| Sodium Bicarbonate Side Effects |
|
Definition
-alkalosis
-kypokalemia
-hypoxemia
-tissue necrosis
-tetany-cramps, convulsions, muscle twitching
-OD: calcium, fluids |
|
|
Term
| Sodium Bicarbonate Interactions |
|
Definition
-DON'T MIX WITH ANYTHING
*drugs packaged with HCl will react with NaCO2
*reaction creates chalk |
|
|
Term
| Sodium Bicarbonate Route, Dose and Supplied |
|
Definition
- IVP, IO
-ADULT: 1 mEq/kg
*repeat with 0.5 mEq/kg q10 min
-PEDI: 1 mEq/kg
-SUPPLIED: 1 mEq/mL in 50 mL's |
|
|
Term
|
Definition
-vitamin B1
-water soluble vitamin
-needed for conversion of glucose to energy
-required for metabolism |
|
|
Term
|
Definition
-coma of unknown etiology
-Delirium Tremens
-Beriberi = B1 deficiency
-Wernicke's encephalopathy
-Korsakoff's syndrome |
|
|
Term
| Thiamine Contraindications |
|
Definition
|
|
Term
|
Definition
-hypotension
-OD: supportive |
|
|
Term
| Thiamine Route, Dose and Supplied |
|
Definition
-IVP, IM
-ADULT: 50-100mg
-PEDI: none
-SUPPLIED: 100mg/mL in 1,2,10 and 30 mLs
-200mg/mL in 30 mL |
|
|
Term
|
Definition
-nutrient
-carbohydrate
-increases circulating and available levels of glucose |
|
|
Term
|
Definition
-hypoglycemia
-coma of unknown etiology
-status epilepticus
-diabetic code |
|
|
Term
| Dextrose Contraindications |
|
Definition
-relative in CVA
-hyperglycemia |
|
|
Term
|
Definition
|
|
Term
| Dextrose Route, Dose and Supplied |
|
Definition
-IVP
-ADULT: >50kg D50% 25-50 grams
-PEDI: <50kg D25% 500-1000 mg/kg
-INFANT/NEONATE: D10% 500 mg/kg
-SUPPLIED: 25 grams in 50 mLs (50%) |
|
|
Term
| Oral Glucose Pharmacology |
|
Definition
-hyperglycemic
-rapidly absorbed glucose increases blood glucose levels |
|
|
Term
|
Definition
-ONSET: Immediate
-PEAK/DURATION: Varies |
|
|
Term
|
Definition
| -conscious patients with suspected hypoglycemia |
|
|
Term
| Oral Glucose Contraindications |
|
Definition
| -decreased LOC, nausea, vomiting |
|
|
Term
| Oral Glucose Dose and Supplied |
|
Definition
-Unit dose tube
-may be repeated
-sipped, eaten until clinical improvement
-various tubes |
|
|
Term
| Oral Glucose Interactions |
|
Definition
|
|
Term
| Oral Glucose Side Effects |
|
Definition
|
|
Term
|
Definition
-hormone produced by alpha cells of pancreas
-insulin antagonist
-increases liver glycogenolysis
-increases breakdown of glycogen to glucose
-inhibits glycogen sythetase
-stimulates hepatic gluconeogenesis by promoting uptake of amino acids
-relaxes smooth muscle of GI tract
-may increase cardiac contractility |
|
|
Term
|
Definition
|
|
Term
|
Definition
-hypoglycemia
-beta blocker OD |
|
|
Term
| Glucagon Contraindications |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Glucagon Route, Dose and Supplied |
|
Definition
-IVP, IM, SC, IO
-ADULT: 0.5-1mg may repeat in 15 min
-PEDI: same
-SUPPLIED: 1mg of powder with 1 ml of diluent for reconstitution |
|
|
Term
| Glucagon Special Considerations |
|
Definition
-give food ASAP
-drug only works if adequate stores of glycogen are available |
|
|
Term
|
Definition
-narcotic antagonist
-competetive inhibition of opiod receptor sites
-prevents SOME effects of opiods
-reverses SOME effects of opiods
-if no opiods taken, drug will have no effect |
|
|
Term
|
Definition
-Onset: 1-2 min IVP / 3-5 min IM/SC
-Duration: 30-60 min IV bolus / 3-6 hrs IM/SC |
|
|
Term
|
Definition
-narcotic OD
-coma of unknown etiology
-questionable use in alcoholic coma |
|
|
Term
| Naloxone Contraindications |
|
Definition
|
|
Term
|
Definition
-N/V
-acute abstinence syndrome
-sweats
-arrythmias
-OD: supportive |
|
|
Term
| Naloxone Route, Dose and Supplied |
|
Definition
-IVP, IM, ET, SC, IO and IN
-ADULT: 0.4-2mg q5 min titrated to respirations
*IN: 1mg in 1mL in each nostril
*PEDI: <5years 0.1mg/kg q5 min titrated to respirations
-SUPPLIED: various |
|
|
Term
| Morphine Sulfate Pharmacology |
|
Definition
-schedule II narcotic (opiod)
-analgesic
-decreases pulmonary edema by peripheral pooling and vasodilation
*decreases preload, afterload
-anxiolytic
-decreases respiratory center in medulla
-decreases O2 demand |
|
|
Term
| Morphine Sulfate Kinetics |
|
Definition
-ONSET: immediate
-DURATION: 10-60 min |
|
|
Term
| Morphine Sulfate Indications |
|
Definition
-ischemic CP
-left heart failure
-pain management in single system trauma |
|
|
Term
| Morphine Sulfate Contraindications |
|
Definition
-hypersensitivity
-hypotension
-respiratory depression
-altered LOC
-asthma/COPD
-abdominal pain
-head injury
-hypovolemia |
|
|
Term
| Morphine Sulfate Side Effects |
|
Definition
-hypotension
-respiratory depression
-N/V
-altered LOC
-CNS depression
-flushing
-OD: Naloxone |
|
|
Term
| Morphine Sulfate Interactions |
|
Definition
| -increased effects with other CNS depressants |
|
|
Term
| Morphine Sulfate Route, Dose and Supplied |
|
Definition
-IVP, IM, SC, IO
-ADULT: 1-3mg (2-4mg) q5 min titrated to effect (give over 1-2 min) for CP
-ADULT: 0.1mg/kg up to 10mg max for single system trauma
*may be repeated one time
-PEDI: 0.1mg/kg
-SUPPLIED: various |
|
|
Term
| Morphine Sulfate Special Considerations |
|
Definition
| -use with caution in extensive burns (shock) |
|
|
Term
| Fentanyl Citrate Pharmacology |
|
Definition
-narcotic analgesic
-approx. 100x more powerful than MS (mg for mg) |
|
|
Term
| Fentanyl Citrate Kinetics |
|
Definition
-ONSET: almost immediate IVP
-DURATION: 30-60 min IVP |
|
|
Term
| Fentanyl Citrate Indications |
|
Definition
-for analgesic action of short duration during the anesthetic periods
-for use as a narcotic analgesic supplement in general or regional anesthesia
-pain management |
|
|
Term
| Fentanyl Citrate Contraindications |
|
Definition
-hypersensitivity
-PREG: Class C |
|
|
Term
| Fentanyl Citrate Side Effects |
|
Definition
-respiratory depression
-muscle paralysis
-respiratory arrest |
|
|
Term
| Fentanyl Citrate Route, Dose and Supplied |
|
Definition
-IV, IM, SQ, IN, IO
-ADULT: 1mcg/kg to max 150mcg IVP
-PEDI: 1mcg/kg
-SUPPLIED: 10, 20 mL vials / 50 mcg/mL |
|
|
Term
|
Definition
-DEMEROL
-opiod analgesic
-synthetic opiod agonist that acts on opiod receptors to produce analgesic, euphoria, respiratory and physical depression
-schedule II drug with potential for physical dependency and abuse |
|
|
Term
|
Definition
| -analgesic for moderate to severe pain |
|
|
Term
| Meperidine Contraindications |
|
Definition
-hypersensitivity
-diarrhea caused by poisoning
-patients taking MAOI's
-during labor or delivery of a premature infant
-undiagnosed abdominal pain or head injury |
|
|
Term
| Meperidine Adverse Reactions |
|
Definition
-respiratory depression, sedation, apnea, circulatory depression, dysrythmias, shock.
-euphoria, delirium, agitation, hallucinations, visual disturbances, coma.
-seizures, headache, facial flushing
-increased ICP, nausea, vomiting. |
|
|
Term
| Meperidine Route and Dose |
|
Definition
-ADULT: 50-100mg IM, SC
-ADULT: 25-50mg slowly IV
-PEDI: 1-2mg/kg IV, IO, IM, SC |
|
|
Term
| Meperidine Special Considerations |
|
Definition
-PREG: Class C
-use with caution in patients with asthma and COPD
-may aggravate seizures in patients with known convulsive disorders
-naloxone should be readily available as antagonist |
|
|
Term
|
Definition
-Diazepam (VALIUM)
-Lorazepam (ATIVAN)
-Midazolam (VERSED) |
|
|
Term
| Benzodiazepine Pharmacology |
|
Definition
-schedule IV controlled substance
*NOT narcotic or opdiod
-CNS depressant
-anticonvulsant
*blocks the spread of seizure activity through the motor cortex and raises the seizure threshold
-sedative
-skeletal muscle relaxant
-induces retrograde amnesia
-antianxiety |
|
|
Term
| Benzodiazepine Indications |
|
Definition
-status epilepticus (except Versed)
-seizures (except Versed)
-pre-sedation for:
*cardioversion
*transcutaneous pacing
-induction agents for RSI |
|
|
Term
| Benzodiazepine Contraindications |
|
Definition
-hypersensitivity
-hypotension
-respiratory depression
-altered LOC |
|
|
Term
| Benzodiazepine Side Effects |
|
Definition
-CNS depression
*especially respiratory depression
-hypotension
-OD: Romazicon (with great caution) |
|
|
Term
| Benzodiazepine Interactions |
|
Definition
| -increased effects with other CNS depressants |
|
|
Term
|
Definition
-ONSET: immediate IV / 5-15 min IM
-DURATION: 15-60 min |
|
|
Term
| Diazepam Dose, Route and Supplied |
|
Definition
-IV, IM, IO, PR
-ADULT: 2-10mg q5-10 min max 30mg
-PEDI: 0.25mg/kg (max single of 5-10mg) IV
-PEDI: 0.5mg/kg (max single of 5-10mg) PR
-SUPPLIED: 5mg/mL in various size vials/amps |
|
|
Term
| Diazepam Special Considerations |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Lorazepam Route, Dose and Supplied |
|
Definition
-IV, IM, IO, PR
-ADULT: 2-4mg, may repeat in 15 min to max of 8mg
-PEDI: 0.05-0.2mg/kg, may repeat in 15 min to a max of 0.2mg/kg
-SUPPLIED: 2, 4mg/mL in 1 mL vials |
|
|
Term
| Lorazepam Special Considerations |
|
Definition
-must dilute with saline for IV/IO/PR use 50/50 (not for IM)
-6 week expiration if not refrigerated |
|
|
Term
|
Definition
-ONSET: 1-3 min
-DURATION: 2-6 hours |
|
|
Term
| Midazolam Route, Dose and Supplied |
|
Definition
-IV
-ADULT: 0.5-2.5mg slowly, may repeat if necessary to max 0.1mg/kg
-PEDI: same
-SUPPLIED: 1, 5mg/mL in various sizes |
|
|
Term
| Midazolam Special Considerations |
|
Definition
| -does not work well for seizures |
|
|
Term
|
Definition
-local anesthetic
-blocks the initiation and conduction of nerve impulses |
|
|
Term
|
Definition
| -topically applied local anesthetic for eye examination |
|
|
Term
| Tetracaine Contraindications |
|
Definition
-hypersensitivity
-not to be applied in large amounts
-infants of less than 1 year old |
|
|
Term
|
Definition
-ADULT: ophthalmic solution: instill 1-2 drops
-PEDI: safety and efficacy have not been established |
|
|
Term
|
Definition
| -ONSET: within 60 seconds |
|
|
Term
| Tetracaine Special Considerations |
|
Definition
-PREG: Class C
-store in light resistant container
-lasts 6 months refrigerated; lasts 4 weeks at room temp
-caution in child <6 years old |
|
|
Term
|
Definition
-calcium channel blocker
*blocks influx of calcium
*reduces afterload and cardiac contractility |
|
|
Term
|
Definition
-ONSET: 15-30 min
-DURATION: 6-8 hrs |
|
|
Term
|
Definition
-Hypertensive emergencies
-Angina |
|
|
Term
| Nifedipine Contraindications |
|
Definition
|
|
Term
|
Definition
-hypotension
-flushing
-headache
-dizziness
-OD: supportive |
|
|
Term
|
Definition
-CNS depressants increase effects
-beta blockers increase effects |
|
|
Term
| Nifedipine Route, Dose and Supplied |
|
Definition
-SL, oral
-ADULT: 10-20mg
*puncture capsule, squeeze contents under tongue
*_bite capsule, then swallow
-PEDI: none
-SUPPLIED: 10 and 20mg capsules |
|
|
Term
| Calcium Chloride Pharmacology |
|
Definition
-electrolyte
-positively iontropic (increases cardiac contractility)
-structure element in bone
-5th most abundant element in the body
-important for muscle, nerve and blood functions |
|
|
Term
| Calcium Chloride Kinetics |
|
Definition
|
|
Term
| Calcium Chloride Indications |
|
Definition
-hypocalcemia
-hyperkalemia
-calcium channel blocker OD
-magnesium sulfate OD |
|
|
Term
| Calcium Chloride Contraindication |
|
Definition
- V-fib
-suspected digoxin toxicity |
|
|
Term
| Calcium Chloride Side Effects |
|
Definition
-metallic taste
-hypotension
-tissue necrosis if infiltrated
-OD: supportive |
|
|
Term
| Calcium Chloride Interactions |
|
Definition
|
|
Term
| Calcium Chloride Route, Dose and Supplied |
|
Definition
-IVP, IO
-ADULT: 2-4mg/kg may repeat in 10 minutes
-PEDI: 20mg/kg
-SUPPLIED: 10% solution (100mg/mL) in 10mL's |
|
|
Term
|
Definition
-LOPRESSOR
-blocks beta 1 receptors (adrenergic)(beta agonist)
-does not usually effect beta 2
-decreases HR and BP
-decreases angina attacks |
|
|
Term
|
Definition
-ONSET: 15 min
-DURATION: 3-7 hrs |
|
|
Term
|
Definition
-hypertension
-angina pectoris
-MI |
|
|
Term
| Metoprolol Contraindications |
|
Definition
-uncompensated CHF
-pulmonary edema
-cardiogenic shock
-bradycardia or heart block
-PREG: C |
|
|
Term
|
Definition
-bradycardia
-CHF
-hypotension
-vasocontriction @ high doses
-dizziness
-bronchospasm |
|
|
Term
|
Definition
-additional cardiac depression with digitalis (digoxin)
-anesthesia may cause additional depression
-alcohol and nitrates cause depression |
|
|
Term
| Metoprolol Route, Dose and Supplied |
|
Definition
-IVP, PO
-ADULT: NEED BP >130 and HR >100
-IVP
*MI 5mg Q5 min x3
-PO
*100mg day
-SUPPLIED: 1mg/mL vial |
|
|
Term
| Magnesium Sulfate Pharmacology |
|
Definition
-electrolyte
-important cofactor for enzymes, neurochemical transmissions, muscular excitability
-blocks neuromuscular transmission-decreases acetylcholine (ACH) release
-CNS depressant
-peripheral vasodilation
-bronchodilation
-coronary vasodilation
-decreases platelet aggregation
-decreases mortality in MI
-deficiency causes arrythmias including refractory v-fib |
|
|
Term
| Magnesium Sulfate Indications |
|
Definition
-toxemia of pregnancy (eclampsia)
-Torsades de Pointes
-Refractory v-fib
-pulseless v-tach
-MI
-asthma |
|
|
Term
| Magnesium Contraindications |
|
Definition
-Heart blocks
-PREG: Class A |
|
|
Term
| Magnesium Sulfate Side Effects |
|
Definition
-flushing
-sweating
-CNS depression
-hypotension
-OD: calcium |
|
|
Term
| Magnesium Sulfate Interactions |
|
Definition
| -CNS depressants increase effects |
|
|
Term
| Magnesium Sulfate Route and Dose |
|
Definition
-IVP, IO
-ADULT: Toxemia: 1-4 Grams over 3 min
-ADULT: Other: 1-2 Grams in 10-100mLs over 1-2 min |
|
|
Term
| Hydroxocobolamine Pharmacology |
|
Definition
-form of Vit B12
-binds to cyanide ions |
|
|
Term
| Hydroxocobolamine Indications |
|
Definition
| -known or suspected cyanide poisonings |
|
|
Term
|
Definition
-ADULT: 5 Grams IV over 15 min
*may repeat 1 time for max of 10 Grams
-PEDI: 70mg/kg IV infusion over 15 min |
|
|
Term
| Hydroxocobolamine Side Effects |
|
Definition
|
|
Term
|
Definition
-class 1B antiarrhythmic
-increases fibrillatory threshold by increasing K+ conductance
-negatively dromotropic
-negatively chronotropic
-local anesthetic
-decreases automaticity
-prevents/terminates reentry (fixes block or makes it 2 way) |
|
|
Term
|
Definition
-ventricular ectopy
-ventricular fibrillation / pulseless v-tach
-ventricular tachycardia (stable)
-PVC's: >6 min, multi-focal, runs, pairs, R on T
-wide complex tachycardias or unknown origin |
|
|
Term
| Lidocaine Contraindications |
|
Definition
-advanced AV blocks
-bradycardia
-Wolff-Parkinson-White syndrome
-PREG: Class B |
|
|
Term
|
Definition
-myocardial depression (hypotension or bradycardia)
-CNS depression (drowsiness, seizures, dizziness, tinnitus)
-OD: supportive |
|
|
Term
|
Definition
-beta blockers increase the effects
-flush between drugs, drug increases pH causing other drugs to unstable |
|
|
Term
|
Definition
-IV, ET, infusion, IO
-ADULT: IVP in cardiac arrest - 1.5mg/kg
-ADULT: Other - 1/1.5 mg/kg
*repeat 0.5/1.5 mg/kg q5-10 min, max 3mg/kg
-ADULT: Infusion (after arrhythmia is resolved) - 1G in 250mL at 2-4 mg/min
*dose should be 1 mg + dose when arrhythmia was resolved
-PEDI: IV bolus 1mg/kg same IO
-PEDI: Infusion - 20-50 mcg/kg/min |
|
|
Term
| Lidocaine Special Considerations |
|
Definition
| -Decrease dose by 50% if pt is >70 y/o, has CHF or Renal failure |
|
|
Term
|
Definition
-antiarrhythmic
-Na+, Ca+ and K+ channel blocker
-prolongs refractory period
*atrial, nodal, ventricular tissue
-inhibits adrenergic stimulation
-sympatholitic
-negatively dromotropic
-alpha and beta blockade |
|
|
Term
|
Definition
-v-fib
-unstable v-tach refractory to lidocaine
-a-fib/flutter with ventricular response |
|
|
Term
| Amiodarone Contraindications |
|
Definition
-advanced AV blocks
-hypotension
-bradycardia
-Torsades de Pointes
-PREG: Class D |
|
|
Term
|
Definition
-PEA (pulseless electrical activity)
-hypotension
-bradycardia
-CHF
-N/V
-OD: supportive ACLS |
|
|
Term
|
Definition
| -precipitate with sodium bicarbonate |
|
|
Term
| Amiodarone Route and Dose |
|
Definition
-IV
-ADULT: 150 mg (alive) to 300 mg (dead), diluted in 10mL slow IVP
-ADULT: Infusion - prep 300mg in 100mL NS, infuse over 10-15 min (MAX 450mg)
-PEDI: 5mg/kg IV/IO (15mg/kg max) |
|
|
Term
| Amiodarone Special Considerations |
|
Definition
-room temp storage
-hypotension response to saline slow
-may be effective to high risk MI patients
-give cautiously to patients with CHF |
|
|
Term
| Procainamide Pharmacology |
|
Definition
-class 1A antiarrhythmic
-depresses excitability of cardiac muscle to electrical stimulation
-negatively dromotropic
-negatively chronotropic
-decreases automaticity
-increases threshold for fibrillation
- ? vagolytic effects
-blocks sodium conduction |
|
|
Term
|
Definition
-patients allergic to lidocaine
-ventricular ectopy refractory to lidocaine
- v-tach (stable) refractory to lidocaine
- v-fib / pulseless v-tach refractory to lidocaine
-wide complex tachycardia of unknown origin
-WPW
- a-fib with rapid ventricular response |
|
|
Term
| Procainamide Contraindications |
|
Definition
-Torsades de Pointes
-advanced AV blocks
-bradycardia
-PREG: Class C |
|
|
Term
| Procainamide Side Effects |
|
Definition
-myocardial depression
-AV blocks
-EKG changes: prolonged QRS, PR, QT intervals
-OD: supportive |
|
|
Term
| Procainamide Interactions |
|
Definition
| -additive effects with lidocaine |
|
|
Term
| Procainamide Route and Dose |
|
Definition
-IV bolus, infusion and IO
-ADULT: IVP - 20-30mg/min until:
1) 17mg/kg given
2) arrhythmia disappears
3) hypotension develops
4) QRS increases by 50% or more
-ADULT: Infusion - prep 1G in 250 mL, give 1-4mg/min |
|
|
Term
| Procainamide Special considerations |
|
Definition
| -decrease by 50% in elderly, renal/hepatic failure, CHF |
|
|
Term
|
Definition
-atypical antiarrhythmic
-endogenous nucleotide - product of ATP breakdown
-acts directly on sinus pacemaker cells and vagus nerve junctions to decrease conduction, heart rate
-negatively dromotropic
-negatively chronotropic
-prevents/terminates reentry
-decreases automaticity
-does not convert a-fib/a-flutter or v-tach |
|
|
Term
|
Definition
-paroxysmal supraventricular tachycardia (PSVT), converts to NSR
-WPW
-wide complex tachycardias of unknown origin following lidocaine |
|
|
Term
| Adenosine Contraindications |
|
Definition
-KNOWN v-tach
-atrial fibrillation
-atrial flutter
-advanced AV blocks |
|
|
Term
|
Definition
-flushing
-metallic taste
-hypotension
-asystole
-dizziness
-chest pain
-OD: supportive |
|
|
Term
|
Definition
| -caffeine and COPD drugs antagonize actions |
|
|
Term
|
Definition
-RAPID IV bolus, IO
-ADULT: Initial - 6mg (60% effective)
*Repeat - 12mg in 1-2 min (92% effective)
*Repeat - 12mg in 1-2 min |
|
|
Term
| Adenosine Special Considerations |
|
Definition
-give in large vein as close to central circulation as possible with large bore IV of NS
-immediately follow administration with a flush of NS
-be sure patient is well oxygenated prior to administration |
|
|
Term
|
Definition
-class 4 antiarrhythmic
-calcium channel blocker in heart and vascular smooth muscle
-blocks movement of all Ca+ ions across cell membranes
-negatively dromotropic
-prevents/terminates reentry in the atria
-decreases automaticity
-dilates coronary arteries
-inhibits coronary artery vasospasm
-decreases preload, afterload
-decreases O2 requirements
-atrial antidysrhythmic |
|
|
Term
|
Definition
-stable PSVT; breaks rhythm
-decreases ventricular rate in a-fib / a-flutter; controls rate only |
|
|
Term
| Verapamil Contraindications |
|
Definition
-CHF
-advanced AV blocks
-hypotension
- v-tach/wide complex tachycardias
-WPW
-bradycardia |
|
|
Term
|
Definition
-hypotension
-bradycardia
-dizziness
-headache
-AV blocks
-OD: calcium chloride |
|
|
Term
|
Definition
| -beta blockers increase effects |
|
|
Term
|
Definition
-IVP, IO
-ADULT: 2.5-5mg SLOW
*repeat 5-10mg in 15-30min to max of 20mg |
|
|
Term
|
Definition
-calcium channel blocker
-blocks influx of calcium into cardiac muscle
-prevents vasospasm of coronary arteries
-atrial/venous vasodilation
-decreases preload/afterload
-dilates coronary arteries
-decreases automaticity
-negatively dromotropic
-decreases oxygen demand |
|
|
Term
|
Definition
-PSVT
- a-fib/a-flutter with rapid ventricular response |
|
|
Term
| Diltiazem Contraindications |
|
Definition
-advanced AV blocks
-bradycardia
-hypotension
-CHF
-wide complex tachycardias |
|
|
Term
|
Definition
-bradycardia
-CHF
-AV blocks
-dizziness
-hypotension
-PVC's (premature ventricular contractions)
-OD: calcium |
|
|
Term
|
Definition
| -beta blockers increase the effects |
|
|
Term
|
Definition
-IV, infusion
-ADULT: IV bolus - initial 0.25mg/kg (approx 20mg) over 2 min
*repeat 0.35mg/kg (approx 25mg) in 15 min
-ADULT: Infusion - prep 125mg in 100 mLs, give 5-15mg/hr |
|
|
Term
| Diltiazem Special Considerations |
|
Definition
-may need to decrease dose in renal/hepatic failure
-vials must be refrigerated, only good for 30 days in not |
|
|
Term
| Atropine Sulfate Pharmacology |
|
Definition
-anticholinergic = competitive block of ACh
-parasympathetic blocker of vagus nerve (parasympatholytic)
*vagus stimulation -> ACh released from nerves -> decreases HR
*blocks the vagus -> increase in HR
-positively chronotropic
-positively dromotropic
-increases automaticity
-increases electrical activity
-increases afterload
-increases O2 demand |
|
|
Term
| Atropine Sulfate Indications |
|
Definition
-symptomatic bradycardia
-LIMITED use in advanced AV blocks
-asystole
-PEA
-organophosphate / nerve agent poisoning |
|
|
Term
| Atropine Sulfate Contraindications |
|
Definition
-none in cardiac arrest
-tachycardias |
|
|
Term
| Atropine Sulfate Side Effects |
|
Definition
-decreases all bodily fluids
*SLUDGE
*Salivation
*Lacrimation
*Urination
*Defecation
*Gastrointestinal
*Emesis
-OD: "red as a beet, blind as a bat, dry as a bone, made as a hatter and hot as hell"
-increased O2 demand
-tachycardia
-blurred vision
-OD: cholinergic agent |
|
|
Term
| Atropine Sulfate Route and Dose |
|
Definition
-IV, ET, IM, SC, IO
-CARDIAC ARREST: 1mg q3 min to max of 0.04mg/kg (3-4mg)
-BRADYCARDIA: 0.5-1 mg q3 min to max of 0.04mg/kg (3-4mg) or titrated to HR 60
-ORGANOPHOSPHATE POISONING: 2-5mg IV/IM or both q5-15 mins until dry |
|
|
Term
| Atropine Sulfate Special Considerations |
|
Definition
-be sure patient is well oxygenated prior to administration
-do not give <0.5 mg to an adult |
|
|
Term
|
Definition
-ADRENALINE
-alpha and beta catecholamine
-beta1 -> + inotropic
-beta2 -> bronchodilation
-alpha -> vasoconstriction (increased afterload)
-increases electrical activity
-positively chronotropic
-histamine antagonist
-increases contractility
-decreases threshold for defibrillation
-decreases renal blood flow (not a good thing)
-increases coronary blood flow
-increases cerebral blood flow
-increases automaticity
-increases O2 demand |
|
|
Term
|
Definition
- v-fib/pulseless v-tach
-asystole
-PEA
-anaphylaxis or severe allergic reaction
-asthma
-symptomatic bradycardia |
|
|
Term
| Epinephrine Contraindications |
|
Definition
-none in cardiac arrest or anaphylaxis
-unresolved hypovolemia
-angina
-hypertension
-CHF |
|
|
Term
|
Definition
-increases O2 demand
-hypertension
-tremors
-OD: supportive, alpha and beta blockers; nitrates |
|
|
Term
|
Definition
-bretylium increase the effects
-TCA's increase effects
-beta blockers decrease effects |
|
|
Term
| Epinephrine Route and Dose |
|
Definition
-IV, ET, IM, SC, IO, infusion
-CARDIAC ARREST: standard; 1mg 1:10,000 IVP/IO q3 min
*for ET admin. give 2-2.5 x the dose in 10mL
-ASTHMA, ALLERGIC REACTION, ANAPHYLAXIS: 0.1-0.5mg 1:1,000 or 0.1-1mg 1:10,000 IVP/IO
-INFUSION: prep 1mg of 1:1,000 in 500mL, give 2-10mcg/min |
|
|
Term
| Norepinephrine Pharmacology |
|
Definition
-LEVOPHED
-sympathomimetic
-catecholamine
-vasopressor
-alpha and beta
*alpha->vasconstriction (90%)
*beta1->inotropic (10%)
-vasoconstriction
-positively inotropic
-some positive chronotropic effects
-increases O2 demand
-renal/mesenteric vasoconstriction |
|
|
Term
| Norepinephrine Indications |
|
Definition
-hemodynamically significant hypotension w/o hypovolemia
-cardiogenic shock
-nuerogenic shock |
|
|
Term
| Norepinephrine Contraindications |
|
Definition
-unresolved hypovolemia
-pheocromocytoma
*tumor of the adrenal gland that causes excess release of epinephrine and norepinephrine |
|
|
Term
| Norepinephrine Route and Dose |
|
Definition
-Infuse only
-prep 4mg in 250mL, give 0.5-30mcg/min titrated to BP 90 |
|
|
Term
| Isoproterenol Pharmacology |
|
Definition
-ISUPREL
-synthetic catecholamine
-sympathomimetic
-pure beta agonist (mostly beta1)
-positively inotropic
-smooth muscle relaxant
*bronchodilation
*peripheral vasodilation
-dramatically increases O2 demand |
|
|
Term
| Isoproterenol Indications |
|
Definition
-symptomatic bradycardia refractory to other therapies
-advanced AV blocks refractory to other therapies
-Torsades de Pointes refractory to other therapies |
|
|
Term
| Isoproterenol Contraindications |
|
Definition
-tachycardia
- v-tach
-cardiac arrest |
|
|
Term
| Isoproterenol Side Effects |
|
Definition
-increases O2 demand (palpitations, ectopy, chest pain)
-tachycardia
-sweats
-flushing
-OD: supportive, beta blockers |
|
|
Term
| Isoproterenol Interactions |
|
Definition
-bretylium increases effects
-beta blockers decrease effects
-TCA's increase effects |
|
|
Term
| Isoproterenol Route and Dose |
|
Definition
-Infuse only
-prep 1mg in 250mL, give 2-10mcg/min titrated to HR 60 or PVC's occur |
|
|
Term
| Isoproterenol Special Considerations |
|
Definition
| -Atropine -> pacer -> dopamine -> epi -> isoproterenol |
|
|
Term
|
Definition
-INTROPIN
-sympathomimetic
-catecholamine
-vasopressor
-stimulates release of NE
-alpha, beta, dopaminergic |
|
|
Term
|
Definition
-LOW: 1-2mcg/kg/min -> beta and dopaminergic
-MEDIUM: 2-10mcg/kg/min -> beta and alpha (B1) -> positively inotropic
-HIGH: 10-20mcg/kg/min -> more alpha than beta
-GREATER than 20mcg/kg/min -> alpha (vasoconstriction)
*once up to 20mcg/kg/min, switch to norepinephrine
*at low doses, BP and HR won't change
-most effects are on systolic BP |
|
|
Term
|
Definition
-cardiogenic shock
-neurogenic shock
-hemodynamically significant hypotension w/o hypovolemia
-hypotension after return of spontaneous circulation
-septic shock |
|
|
Term
| Dopamine Contraindications |
|
Definition
-unresolved hypovolemia
-pheochromocytoma
-tachycardia |
|
|
Term
|
Definition
-tachycardia
-palpitations
-hypertension
-increased O2 demand
-tissue necrosis
-OD: supportive |
|
|
Term
|
Definition
-bretylium increases effects
-beta blockers decrease effects |
|
|
Term
|
Definition
-infuse only
-prep 400mg in 250 mL, give 2-20mcg/kg/min titrated to systolic BP >= 90 |
|
|
Term
|
Definition
-DOBUTREX
-sympathomimetic
-synthetic catecholamine
-vasopressor
-alpha and beta (mostly beta)
-positively inotropic
-increases cardiac output
-increases coronary blood flow
-some renal vasodilation
-does not cause release of NE
-has MINIMAL effect on HR |
|
|
Term
|
Definition
-cardiogenic shock
-hemodynamically significant hypotension w/o hypovolemia
-hypotension after return of spontaneous circulation
-left heart failure |
|
|
Term
| Dobutamine Contraindications |
|
Definition
-unresolved hypovolemia
-tachydysrythmias |
|
|
Term
|
Definition
-hypertension
-tachycardia (dose related) |
|
|
Term
|
Definition
| -beta blockers decrease effects |
|
|
Term
| Dobutamine Route and Dose |
|
Definition
-infuse only
-prep 250mg in 250mL, give 2-20mcg/kg/min titrated to systolic BP >= 90 |
|
|
