Term
|
Definition
Class Inotropic agent, cardiac glycoside, antidysrhythmic.
Mechanism of action Rapid-acting cardiac glycoside with direct and indirect effects: Increases force of myocardial contraction, increases refractory period of AV node, and increases total peripheral resistance. Indications Heart failure, reentry SVTs, ventricular rate control in atrial flutter and AF.
Contraindications VF, VT, digitalis toxicity, hypersensitivity to digoxin. Hypokalemia, hypomagnesemia, and hypercalcemia potentiate digitalis toxicity.
Adverse reactions/side effects Fatigue, headache, blurred yellow or green vision, seizures, confusion, bradycardia, dysrhythmia, nausea, vomiting, anorexia, skin rash.
Drug interactions Amiodarone, verapamil, and quinidine may increase serum digoxin concentrations. Concurrent use of digoxin and verapamil may lead to severe AV block. Diuretics may potentiate cardiac toxicity.
Dosage and administration Adult: Loading dose: 4 to 6 mcg/kg over 5 minutes. Second and third: boluses of 2 to 3 mcg/kg to follow at 4 to 8 |
|
|
Term
Fentanyl citrate (Sublimaze) |
|
Definition
Class Opioid analgesic; schedule II drug. Mechanism of action Binds to opiate receptors, producing analgesia and euphoria. Indications Pain management, anesthesia adjunct. Contraindications Known hypersensitivity. Use with caution in traumatic brain injury. Adverse reactions/side effects Confusion, paradoxical excitation, delirium, drowsiness, CNS depression, sedation, respiratory depression, apnea, dyspnea, dysrhythmias, bradycardia, tachycardia, hypotension, syncope, nausea, vomiting, abdominal pain, dehydration, fatigue. Drug interactions Increased respiratory effects when given with other CNS depressants. Dosage and administration Adult: 50 to 100 mcg (1 mcg/kg) IM and IV slow push (over 1 to 2 minutes) to maximum of 150 mcg. IN is rapid push. Pediatric: 1 to 2 mcg/kg IM, IV, or IN slow push (over 1 to 2 minutes). The safety and efficacy in children younger than age 2 years has not been established. Duration of action Onset: 1 to 3 minutes. Peak effect: 3 to 5 minutes. Duration: 30 to 60 minutes. Special considerations Pregnancy safety: Category C. Chest wall rigidity possible with a high-dose rapid infusion. A dose of 100 mcg of fentaNYL citrate is equivalent to 10 mg of morphine or 75 mg of meperidine. |
|
|
Term
|
Definition
Class Loop diuretic. Mechanism of action Blocks the absorption of sodium and chloride at the distal and proximal tubules and the loop of Henle, causing increased urine output. Indications Heart failure, pulmonary edema, hypertensive crisis. Contraindications Hypovolemia, anuria, hypotension (relative contraindication), hypersensitivity, hepatic coma, suspected electrolyte imbalances. Adverse reactions/side effects Dizziness, headache, ECG changes, weakness, orthostatic hypotension, dysrhythmias, nausea, vomiting, diarrhea, dry mouth, may exacerbate hypovolemia and hypokalemia, hyperglycemia (due to hemoconcentration). Drug interactions Lithium toxicity may be potentiated because of sodium depletion. Digitalis toxicity may be potentiated by potassium depletion. Dosage and administration Adult: 0.5 to 1 mg/kg IV over 1 to 2 minutes. If no response, double the dose to 2 mg/kg slowly over 1 to 2 minutes. Pediatric: 1 mg/kg IV/IO. Duration of action Onset: 5 minutes. Peak effect: 20 to 60 minutes. Duration: 4 to 6 hours. Special considerations Pregnancy safety: Category C. Should only be used during pregnancy if maternal benefit outweighs fetal risk. Ototoxicity, deafness, and projectile |
|
|
Term
|
Definition
| Class Hyperglycemic agent, pancreatic hormone, insulin antagonist. Mechanism of action Increases blood glucose level by stimulating glycogenolysis. Unknown mechanism of stabilizing cardiac rhythm in beta-blocker overdose. Minimal positive inotropic and chronotropic response. Decreases GI motility and secretions. Indications Altered level of consciousness when hypoglycemia is suspected. May be used as a reversal agent in beta-blocker and calcium channel blocker overdoses. Contraindications Hyperglycemia, hypersensitivity. Adverse reactions/side effects Dizziness, headache, hypertension, tachycardia, nausea, vomiting, rebound hypoglycemia. Drug interactions Incompatible in solution with most other substances. No significant drug interactions with other emergency medications. Dosage and administration Adult: Hypoglycemia: 1 mg IM/IN, may repeat in 7 to 10 minutes. Calcium channel blocker or beta-blocker overdose: 3 to 10 mg IV slowly over 3 to 5 minutes initially, followed by a 3 to 5 mg/h infusion as necessary. Pediatric: Hypoglycemia: 1 mg IM/IN if 20 kg or greater (or 5 years or more); 0.5 mg IM/IN if less than 20 kg or younger than 5 years. Calcium channel blocker or beta-blocker toxicity: 0.15 mg/kg IV/IO over 3 to 5 minutes initially, followed by a 0.05- to 0.10-mg/kg per hour infusion as necessary. Duration of action Onset: 1 minute. Peak effect: 5 to 20 minutes. Duration: 60 to 90 minutes. Special considerations Pregnancy safety: Category B. Use in pregnancy only if clearly indicated. Not recommended for use in lactating women. Ineffective if glycogen stores depleted. Should always be used in conjunction with D whenever possible. If patient does not respond to second dose of glucagon, D must be administered. Requires reconstitution with the supplied solution. |
|
|
Term
|
Definition
| Class Tranquilizer, antipsychotic. Mechanism of action Inhibits CNS catecholamine receptors: strong antidopaminergic and weak anticholinergic. Acts on CNS to depress subcortical areas, midbrain, and ascending reticular activating system in the brain. Indications Acute psychotic episodes. Contraindications Parkinson disease, depressed mental status, agitation secondary to shock and hypoxia, hypersensitivity. Adverse reactions/side effects Seizures, sedation, confusion, restlessness, extrapyramidal reactions, dystonia, respiratory depression, hypotension, tachycardia, orthostatic hypotension, QT prolongation, sudden cardiac death, constipation, dry mouth, nausea, vomiting, drooling, blurred vision. Drug interactions Enhanced CNS depression and hypotension in combination with alcohol. Antagonized amphetamines and EPINEPHrine. Other CNS depressants may potentiate effects. Dosage and administration Adult: 2 to 5 mg IM only every 30 to 60 minutes until sedation is achieved. Pediatric: Not recommended. Duration of action Onset: 10 minutes. Peak effect: 30 to 45 minutes. Duration: Variable (generally 12 to 24 hours). Special considerations Pregnancy safety: Category C. Use during pregnancy only if maternal benefit outweighs fetal risk, especially during the third trimester. Treat hypotension secondary to haloperidol with fluids and norepinephrine, not EPINEPHrine. Patient may also be taking benztropine mesylate (Cogentin) if on long-term therapy with haloperidol. |
|
|
Term
|
Definition
| Class Anticoagulant. Mechanism of action Prevents conversion of fibrogen to fibrin. Affects clotting factors IX, XI, XII, plasmin. Does not lyse existing clots. Indications AMI, prophylaxis and treatment of thromboembolic disorders (eg, PE and DVT). Contraindications Hypersensitivity, active bleeding, recent intracranial, intraspinal, or eye surgery, severe hypertension, bleeding tendencies, severe thrombocytopenia. Adverse reactions/side effects Pain, anaphylaxis, shock, hematuria, GI bleeding, hemorrhage, thrombocytopenia, bruising. Drug interactions Salicylates, ibuprofen, dipyridamole, and hydroxychloroquine may increase risk of bleeding. Dosage and administration Adult: If used with fibrinolytic therapy, always obtain a blood sample for control of partial thromboplastin time before heparin administration. Heparin is given as an IV bolus of 60 units/kg. Maximum dose 4,000 units (weight adjusted). A continuous infusion is given following the bolus at a rate of 12 units/kg per hour rounded to the nearest 50 (maximum: 4,000 units or 1,000 units/h). Follow medical direction and local protocol. Pediatric: Not recommended. Duration of action Onset: IV: immediate; subcutaneous: 20 to 60 minutes. Peak effect: Variable. Duration: 4 to 8 hours. Special considerations Pregnancy safety: Category C. Use cautiously in pregnant women with threatened abortion and avoid using heparin vials containing benzyl alcohol. Heparin does not lyse existing clots. Heparin along with aspirin is part of the antithrombotic package. If the patient experiences uncontrollable bleeding, the reversal agent is protamine. |
|
|
Term
|
Definition
| Class Antidote, cyanide poisoning adjunct. Mechanism of action Binds with cyanide to form nontoxic cyanocobalamin, preventing its toxic effects; excreted renally. Indications Treatment of known or suspected cyanide poisoning. Contraindications None in the emergency setting. Adverse reactions/side effects Hypertension, allergic reactions, GI bleeding, nausea, vomiting, dyspepsia, dyspnea, dizziness, headache, injection site reactions. Drug interactions Do not administer in the same IV line with diazePAM, DOBUTamine, DOPamine, fentaNYL, NTG, propofol, sodium nitrite, and sodium thiosulfate. 29 1512 8/6/2020 Nancy Careoline‛s: Emergency Care in the Streets https://openpage-ebooks.jblearning.com/wr/viewer.html?skipLastRead=true&oneTimePasscode=ST-ec7e96cc-7014-463e-b4d5-92b884059450&lang… 6/8 Dosage and administration Adult: 5 g IV infusion over 15 minutes at a rate of 15 mL/min, one time, may be repeated one time at the same dose. Maximum of 10 g. Pediatric: 70 mg/kg IV one time, may be repeated one time at the same dose. Duration of action Onset: Rapid. Peak effect: 8 to 10 minutes. Duration: Varies. Special considerations Pregnancy safety: Category C. May cause fetal harm although risk from cyanide poisoning may outweigh fetal risk. Breastfeeding should be ceased following medication administration. Make sure to reassess the patient’s airway, oxygenation, and hydration during administration. The patient may become hypertensive during treatment (BP greater than 180 mm Hg systolic and 110 mm Hg diastolic are not uncommon) and will return to baseline within 4 hours. |
|
|
Term
|
Definition
| Class Anticholinergic, bronchodilator. Mechanism of action Inhibits interaction of acetylcholine at receptor sites of bronchial smooth muscle, resulting in decreased cyclic guanosine monophosphate and bronchodilation. Indications Persistent bronchospasm, COPD exacerbation. Contraindications Hypersensitivity to ipratropium, atropine, alkaloids, peanuts. Adverse reactions/side effects Headache, dizziness, nervousness, fatigue, tremor, blurred vision, cough, dyspnea, worsening COPD symptoms, tachycardia, palpitations, flushing, MI, dry mouth, nausea, vomiting, GI distress. Drug interactions None reported. Dosage and administration Adult and pediatric: 250 to 500 mcg via inhalation with handheld nebulizer every 20 minutes up to 3 times. Duration of action Onset: 1 to 3 minutes. Peak effect: 90 to 120 minutes. Duration: 4 to 6 hours. Special considerations Pregnancy safety: Category B. Note: When used in combination with beta-agonists (eg, metaproterenol and albuterol), the beta-agonist is always administered first with a 5-minute wait before administering ipratropium. Shake well before use. Use with caution in patients with urinary retention. |
|
|
Term
|
Definition
| Class Sedative, analgesic dissociative anesthetic. Mechanism of action Blocks pain receptors and minimizes spinal cord activity, affecting the association pathways of the brain between the thalamus and limbic system. Indications Excited delirium, pain management, procedural sedation. Contraindications Hypersensitivity, conditions where hypertension would be hazardous to the patient’s care. Adverse reactions/side effects Hypertension, dysrhythmia, bronchodilation, respiratory depression. Drug interactions Ketamine increases the effects of opiates, barbiturates, and nondepolarizing neuromuscular blockers. Dosage and administration Adult and pediatric: 1 to 2 mg/kg IV push over 1 to 2 minutes. Duration of action Onset: 30 seconds. Peak effect: Unknown. Duration: 5 to 10 minutes. Special considerations Pregnancy safety: Category is not assigned by the FDA for ketamine. Contraindicated for use during pregnancy or by breastfeeding women. Patients may experience excessive drooling. 4 Some patients may experience an emergence reaction after the full duration of the medication’s effect. |
|
|
Term
|
Definition
| Class NSAID analgesic. Mechanism of action Potent analgesic that does not possess any sedative or anxiolytic activities by inhibiting prostaglandin synthesis. Indications Short-term management of moderate to severe pain. Contraindications Allergy to salicylates or other NSAIDs. Patients with history of asthma, bleeding disorders (especially GI related, such as peptic ulcer disease), renal failure. Adverse reactions/side effects Drowsiness, dizziness, headache, sedation, bronchospasm, dyspnea, edema, vasodilation, hypotension, hypertension, GI bleeding, diarrhea, dyspepsia, nausea. Drug interactions May increase bleeding time in patients taking anticoagulants. Dosage and administration Adult: 30 to 60 mg IM, 15 to 30 mg IV. Pediatric: Not recommended. Duration of action Onset: 10 minutes. Peak effect: 1 to 2 hours. Duration: 2 to 6 hours. Special considerations Pregnancy safety: Category C. Contraindicated for use during pregnancy. Use with caution in older patients due to higher risk of renal and fatal GI adverse reactions. Because it is a salicylate derivative, it is important to use caution if pain is possibly from a traumatic source. |
|
|
Term
|
Definition
| Class Selective alpha and nonselective beta-adrenergic blocker, antihypertensive. Mechanism of action BP reduction without reflex tachycardia; total peripheral resistance reduced without significant alteration in cardiac output. Indications Moderate to severe hypertension. Contraindications Bronchial asthma, heart failure, cardiogenic shock, second- and third-degree heart block, bradycardia. Adverse reactions/side effects Fatigue, weakness, depression, headache, dizziness, bronchospasm, wheezing, dyspnea, bradycardia, heart failure, pulmonary edema, orthostatic hypotension, ventricular dysrhythmias, nausea, vomiting, diarrhea. Drug interactions Labetalol may block bronchodilator effects of betaadrenergic agonists. NTG may augment hypotensive effects. Dosage and administration Adult: 10 mg IV push over 1 to 2 minutes. May repeat or double every 10 minutes to a maximum dose of 150 mg. Infusion: 2 to 8 mg/min, titrated to supine BP. Pediatric: Not recommended. Duration of action Onset: Less than 5 minutes. Peak effect: Variable. Duration: 3 to 6 hours. |
|
|
Term
|
Definition
| Class Antidysrhythmic (Class Ib), anesthetic. Mechanism of action Cardiac: Decreases automaticity by slowing the rate of spontaneous phase 4 depolarization. Local anesthetic: Inhibits transport of ions across the neuronal membrane, blocking conduction of normal nerve impulses. Indications Alternative to amiodarone in cardiac arrest from VT, VF, stable wide-complex tachycardia (poly- or monomorphic) with normal baseline QT interval. Also used as a local anesthetic for various procedures, including intubation and IO infusions. Contraindications Hypersensitivity, second- or third-degree AV block in the absence of an artificial pacemaker, Stokes-Adams syndrome, prophylactic use in AMI, wide-complex ventricular escape beats with bradycardia. 8/6/2020 Nancy Careoline‛s: Emergency Care in the Streets https://openpage-ebooks.jblearning.com/wr/viewer.html?skipLastRead=true&oneTimePasscode=ST-ec7e96cc-7014-463e-b4d5-92b884059450&lang… 4/8 Adverse reactions/side effects Anxiety, drowsiness, confusion, seizures, slurred speech, respiratory arrest, hypotension, bradycardia, dysrhythmias, cardiac arrest, AV block, nausea, vomiting. Drug interactions Apnea induced with succinylcholine may be prolonged with high doses of lidocaine. Cardiac depression may occur in conjunction with IV phenytoin. Procainamide may exacerbate CNS effect. Metabolic clearance is decreased in patients with liver disease or in patients taking beta-blockers. Dosage and administration Adult: Cardiac arrest/pulseless VT/VF: Initial dose: 1 to 1.5 mg/kg IV/IO. Repeat dose: 0.5 to 0.75 mg/kg IV/IO repeated in 5 to 10 minutes. Maximum total dose: 3 mg/kg. Stable VT, and wide-complex tachycardia of unknown etiology: Maintenance infusion: 1 to 4 mg/min (30 to 50 mcg/kg per minute); can dilute in D W or normal saline. Local anesthetic dose varies depending on procedure and location. Pediatric: IV/IO dose: 1 mg/kg rapid IV/IO push. Maximum dose 100 mg. Continuous IV/IO infusion: 20 to 50 mcg/kg per minute. Repeat bolus dose (1 mg/kg) when infusion is initiated if bolus has not been given within previous 15 minutes. Local anesthetic dose varies depending on procedure and location. Duration of action Onset: 1 to 5 minutes. Peak effect: 5 to 10 minutes. Duration: Variable (15 minutes to 2 hours). Special considerations Pregnancy safety: Category B. Reduce maintenance infusion by 50% if patient is older than age 70 years, has liver or renal disease, is in heart failure, or is in shock. A 75- to 100-mg bolus maintains blood levels for only 20 minutes (if not in shock). Exceedingly high doses of lidocaine can result in death and coma. Crossreactivity with other forms of local anesthetics. |
|
|
