Pharmacology Guide: Cardiac Medications and Doses, Exams of Study of Commodities

Download Pharmacology Guide: Cardiac Medications and Doses and more Exams Study of Commodities in PDF only on Docsity! Paramedic Drug Cards Exam Study Guide Questions & Answers. Activated Charcoal - Trade Name: Act dose, Super Char, Charcodate, Liquid-Char, Aqua-Char Classification: Antidote, Adsorbent Action/Effects: A fine black powder with liquid that adsorbs poisonous compounds to its surface, reducing the absorption. Indication: Oral poisonings Over dose of a non-caustic or other burning poison Contraindication: Do NOT use in caustic acids, alkalis, irons tablets & lithium. There is NO value for the ETOH OD pt. Side Effects: Constipation is possible, vomiting due to pt. intolerance Adult & Pediatric Dose: 1gm/kg PO or slow Nasogastric or gastric tubes Cautions: Not suggested in most local protocols or by national Guidelines. Some people like to spit it out at YOU! Adenosine - Trade Name: Aden card Classification: Antiarrhythmic Action/Effects: Slows supraventricular tachycardia, decreasing the electrical activity by interrupting the reentry pathways through the AV node. Indication: PSVT Rhythm (after vagal maneuvers) Contraindication: Hypersensitivity 2nd & 3rd degree AV heart block, Sick Sinus Syndrome, A-Fib Side Effects: Syncope, Chest Pain, facial flushing, SOB, dizziness, hypotension Adult Dose: 6mg IV push with 20cc NS fluid bolus, a repeat dose of 12mg in 1-2 minutes up to 2X may be given if not converted. Pediatric Dose: 0.1mg/kg rapid IV push followed by 5cc bolus, repeat 0.2mg/kg x 1 Cautions: Half-life is 5 seconds. Pediatric doses don't exceed adult doses Albuterol - Trade Name: Proventil, Vent Olin Classification: Bronchodilator, Sympathomimetic P a g e 1 | 16 Action/Effects: A beta2-adrenergic agonist which helps relax the bronchial smooth muscles Indication: Asthma, Relief of bronchospasm with reversible obstructive airway disease. Contraindications: These are relative to pt. symptoms: Cardiac dysrhythmias, Tachyarrhythmia's, Angina, HTN, diabetes Side Effects: Tremors, Dizziness, Anxiety, Palpitations, Tachycardia Adult Dose: 2.5mg/3ml of NS Pediatric Dose: 2.5mg in 3cc NS > 1 year old, 1.5mg in 3cc NS < 1 year old Cautions: Be aware of prior doses/ can interact with diuretics, digoxin, beta blockers, & MAO inhibitors/ can have toxicity effects on vascular system if used with tricyclic antidepressants Amiodarone - Trade Name: Cordarone Classification: Antiarrhythmic Action/Effects: Prolongs phase 3 of the cardiac action potential. Amiodarone increases the refractory period of sodium and potassium channels. This intern slows the cardiac action potential. Indication: V-Fib/V-Teach Pulseless Contraindication: Hypersensitivity Side Effects: Lung problems, Liver Problems, Epididymis in long term use Adult Dose: 150-300 mg IV (Expected 300mg IV loading dose) Check your protocols. (Expected 150mg 2nd dose if needed) Pediatric Dose: 5mg/kg IV/IO (Check your protocols for additional doses) Amyl Nitrate - Trade Name: Vapor olé Classification: Vasodilator, Cyanide Antidote Action/Effects: Causes oxidation of hemoglobin to the compound of met hemoglobin. Vasodilatation, including coronary artery dilation. Smooth muscle relaxant Indication: Cyanide poisoning Contraindication: None when given for cyanide poisoning Side Effects: Hypotension with syncope, Headache, Nausea & Vomiting P a g e 2 | 16 Side Effects: Ventricular irritability, Hypertension, Headache, Infiltration causes necrosis, Nausea, Vomiting Adult/Pediatric Dose: 800mg in a 500cc D5W or NS Expected Dose: 5-20mcg/kg/min titrating to increase systolic to 100; 2-5 mcg/kg/min are renal effects for lowering BP Cautions: If possible correct hypovolemia before Dopamine treatment with a fluid bolus. 500-1000cc DO NOT MIX with NaHCO3 Dextrose 5% - Classification: Hypotonic Solution Action/Effects: N/A Indication: Mixing medications (Lidocaine, Dopamine) Contraindication/A Side Effects’/A Adult Dose: Medication Dependent Expected Dose: N/A Pediatric Dose: N/A Cautions: Use caution if used for main IV solution Epinephrine 1-1,000 - Trade Name: Adrenalin 1-1,000 Classification: Bronchodilator, Cardiac Stimulant, Sympathomimetic Action/Effects: SQ = Bronchodilator & relief of bronchial edema, Beta 1&2 IV = Increases HR, Vasoconstricts, Alpha 1 & Beta 1 Indication: Anaphylaxis, Acute Allergic Reactions, Asthma, Shock Side Effects: Tremors, Dizziness, Anxiety, Palpitations, Tachycardia, Acute Hypertension Adult Dose: Anaphylaxis: 0.3-0.5mg SQ. -Upper Airway Stridor: 2mg of 1:1,000 in 3ml of NS -Shock treatment= Infusion: as inotrope/presser. 4 mg in 500ml NS = 8 mcg/ml titrated to effect: Usual range 2-10 mcg/minute (0.01 - 0.1 mcg/kg/minute). (Raise BP S 70-100) P a g e 5 | 16 Pediatric Dose: 0.01mg/kg with a max dose of 0.3mg for anaphylaxis - 0.1mg/kg ET (1-1,000) q 3-5 min w/3-5cc flush for cardiac Cautions: Use caution with pregnancy & preexisting heart disease Note: Be sure you are using the correct Epinephrine. Both Epinephrine’s' can have the same uses depending route. Epinephrine 1-10,000 - Trade Name: Adrenalin 1-10,000 Classification: Sympathomimetic, Cardiac Stimulant, Bronchodilator Action/Effects: Increases cardiac resistance, BP, Electrical activity, O2 Needs, contractility, & myocardial activity. Alpha 1 & Beta 1 Indication: Cardiac Arrest V-Fib, V-Teach, Systole, PEA, & profound Bradycardia Side Effects: Hypertension, Peripheral constriction Adult Dose: 0.5-1mg IV every 3-5 minutes (ET is 2-2 ½ time the dose w/20cc flush) Expected Dose: 1mg IV Max: None in a life threatening emergency Pediatric Dose: 0.01mg/kg IV/IO with a max dose of 1mg IV 0.1mg/kg ET (1-1,000) q 3-5 min w/3-5cc flush Cautions: DO NOT mix with NaHCO3, Heat destroys this drug Fentanyl - Trade Name: Sublimate Classification: Opioid Analgesic Action/Effects: Combines with receptors sites in brain to produce potent analgesic effects. Indication: Pain Control, 2nd drug choice for chest pain if morphine allergy. Possible sedation with approved protocol. (RSI) Contraindication: Respiratory Depression, Hypotension, Head injury, Dysrhythmias, Myasthenia gravis (Muscles tires easy), Hypersensitivity. Side Effects: Respiratory depression, Bradycardia, Hypotension or Hypertension, ICP, Nausea Adult Dose: 25-50mcg IV, IM Max: 100mcg Pad Dose: Over 2 y/o 0.5-1mcg/kg IV/IM Slow Push (Rarely used in Prehospital) P a g e 6 | 16 Cautions: Use Caution with elderly, Schedule II drug (addictive) Furosemide - Trade Name: Lasix Classification: Loop Diuretic Action/Effects: Inhibits the reabsorption of sodium & chloride in the kidney tubule & promotes increased urine formation & excretion Indication: Pulmonary Edema, CHF Contraindication: Pregnancy, Hypovolemic, & Hypokalemia Side Effects: Dehydration, hypotension, Tinnitus/hearing impairment with long term affects Adult Dose: 20-80mg IV SLOW push to prevent tinnitus Pediatric Dose: 1mg/kg Cautions: PUSH slowly & lower doses to avoid Tinnitus. Glucagon - Trade Name: Glucagon Classification: Pancreatic Hormone, Insulin Antagonist Action/Effects: Raises glucose level by using the glycogen in the liver for glucose. Stimulating glucose synthesis Indication: Hypoglycemia Contraindication: Hypersensitivity Side Effects: Hypotension, Nausea, Hypokalemia Adult Dose: 1mg IM/IV but usually given IM Pediatric Dose: 0.02-0.03mg/kg IM/IV with max of 1mg Cautions: Pt. may have home emergency glucagon kit May be used w/calcium channel blocker&beta-blocker toxicity Glucose or Dextrose - Trade Name: D 50, 50% Dextrose Classification: Carbohydrate Action/Effects: Raises BSL, using electrolytes Indication: Hypoglycemia P a g e 7 | 16 Action/Effects: Decreases the depolarization, automaticity, & excitability in the in the ventricles during the diastolic phase by the direct action on the tissue, especially the Purkinje network. Indication: V-fib/ V-Teach, Post V-fib/ V-Teach (after conversion), possible symptomatic PVC's Contraindication: Bradycardia, AV Heart Blocks Side Effects: Seizures, Coma, Respiratory depression may occur if given rapidly or in high doses, Sinus Brady, Hypotension Adult & Pediatric Dose: 0.75-1.5mg/kg IV/ET/IO q 3-5 min followed by a drip of 1-4mg/minute depending on prior boluses Expected Dose: Initial dose: 1mg/kg IV/IO or 2 ½ times the dose for ET 2nd doses: ½ initial dose for 2nd and subsequent dosing Max: 3mg/kg Cautions: ½ doses for over 70 years old, ½ dose for liver disease pt. Clonazepam - Trade Name: Ativan Classification: Benzodiazepine Action/Effects: Anti-seizure, anti-convulsing, sedative, muscle relaxant Indication: Seizures, Conscious sedation, Chemical restraint Contraindication: Hypersensitivity, depressed CNS, hypotension Caution: Pregnancy Category D, Should not be used in patients who have taken other CNS depressants Side Effects: Respiratory depression, decreased CNS, N/V, blurred vision, headache, bradycardia Adult Dose: 4mg IV/IO/IM (Slow IV push) Pediatric Dose: 0.1-0.2mg/kg IV/IO/IM (Slow IV Push) Other information: Supplied 2mg/ml or 4mg/ml in many departments Meperidine HCL - Trade Name: Demerol Classification: Narcotic Analgesic, Opioid Analgesic Action/Effects: Addictive narcotic that depresses the CNS & may relieve pain P a g e 10 | 16 Indication: Relief of moderate to severe pain Contraindication: Hypersensitivity, MAO inhibitors, Head injury Side Effects: Depressed respirations & BP, Tremor, Nausea, Vomiting Adult Dose: 50-100mg IM/IV Expected Dose 50mg followed by an anti-emetic slow IVP Pediatric Dose: 1-2mg/kg Cautions: May mix with promethazine for increase & potentiate analgesics Midazolam - Trade Name: Versed Classification: Short acting benzodiazepine, CNS depressant, Anti-seizure Action/Effects: Anti-seizure, anti-convulsing, sedative, muscle relaxant Indication: Seizures, Conscious sedation, Chemical restraint Contraindication: Hypersensitivity, depressed CNS, shock Cautions: Pregnancy Category D, Should not be used in patients who have taken other CNS depressants Side Effects: Depressed CNS, N/V, blurred vision, headache, retrograde amnesia Adult & Pediatric Dose: IV 0.1mg/kg up to 5mg [1-5min onset] IN 0.2mg/kg up to 10mg dose [3-7min onset] 1cc per nostril IM 0.1mg/kg up to 10mg dose [15-30min] Expected Dose ADULT IV 2-5mg, IN/IM 5-10mg 2nd doses may be given Morphine Sulfate - Trade Name: MS Classification: Narcotic analgesic, Opioid analgesic Action/Effects: Acts on opiate receptors in the brain providing analgesia & sedation. Vasodilator, reducing venous return & myocardial oxygen demand. Indication: Moderate to severe pain with trauma. Chest pain associated with MI Contraindication: Hypersensitivity, Head injury, CVA, Hypotension, and respiratory depression Side Effects: Depressed CNS, constipation, dry mouth P a g e 11 | 16 Adult Dose: IV 2-4mg titrated to max of 20mg max. [Immediate onset] IM/SC 5-20mg [10-30min onset] Pediatric Dose: IV 0.1mg/kg. IM/SC 0.1 - 0.2mg/kg Expected Dose: IV 2-4mg titrated to max of 20 or medical control dose Caution: Have Narran ready in case of severe adverse reaction. Naloxone - Trade Name: Narran Classification: Narcotic Antagonist, Opioid Antagonist Action/Effects: Displace narcotics at the receptor sites in the CNS. Attaches to the receptors & inhibits the narcotics action Indication: Narcotic overdose, Respiratory depression, Coma of unknown origin, man down, coma of unknown origin Contraindication: Hypersensitivity Side Effects: N/V, Seizures, tachycardia, HTN, diaphoresis, blurred vision, withdrawal Adult Dose: 2-4mg IV/IM/IN/ET/IO. Possible Dose: 0.5-1mg IV, 2mg IM/IN (Titrate to respirations to prevent narcotic withdrawals.) Pediatric Dose: 0.1mg/kg IV/IM with max of 2mg Cautions: It can cause seizure from withdrawal in chronic opiate users Nitroglycerin - Trade Name: Nitro stat Classification: Coronary Vasodilator Action/Effects: Decreases cardiac work, increases circulation to the heart, dilates coronary & systemic arteries. Indication: AMI, Pulmonary Edema, Hypertension emergencies, CHF Contraindication: EMT-P Systolic <90, EMT-I Systolic <100, CVA, head injury, recent use of ED drugs (Cialis, Levitra, Viagra) Side Effects: Severe Hypotension, Weakness, Headache, Syncope, dizziness, N/V Adult Dose: 0.3-0.4mg Sublingual q 5min up to 3x (May come in spray or tablet) (Most doses are 0.4mg) P a g e 12 | 16 Contraindication: AMI, hypokalemia Side Effects: Hypotension, may prolong QT interval Adult Dose: 20mg per minute IV Infusion (Max dose 17mg/kg) Cautions: Urgent situations may require 50 mg per minute Use in Cardiac arrest is limited Extra Info: Give until one or more of the following occurs: Arrhythmia suppression, hypotension, QRS widens by 50%, total 17mg/kg given Sodium Bicarbonate - Trade Name: NaHCO3 Classification: Alkalinizing Agent Action/Effects: Neutralizes acids, returning blood & body fluid to a more normal ph. instead of an acidosis state. (Increases pH) Indication: Metabolic acidosis, Prolonged CPR or down time (more than 5-10 minutes), Tricyclic overdoses. (Tricyclic meds = Amitriptyline, Desipramine, Ended, Jaimie, Norpramin, Nortriptyline, Pamela, Surmounted, Tofranil, Trivial, Imipramine) Contraindication: Hypersensitivity, Alkalosis patient. Side Effects: Pushing a ph. to an alkalosis state instead of neutralizing the ph. Adult & Pediatric Dose: 1mEq/kg followed ½ the initial dose q 10 minutes. Use 4.2% solution for pediatrics Cautions: Avoid mixing with Epinephrine or Calcium. Verapamil - Trade Name: NaHCO3 Classification: Antiarrhythmic, Calcium Channel Blocker Action/Effects: Dilates the coronary arteries. This increases the blood flow to the heart. Prolongs AV nodes refractory period. Indication: 2nd line med for SVT. A-fib, A-Flutter, Multifocal Atrial Tachycardia (Only for narrow complex QRS) Contraindication: Wide QRS Complex, WPW, Sick Sinus Syndrome, AV Heart Blocks Side Effects: Constipation, nausea, heartburn, headache Adult Dose: 1st dose: 2.5 - 5mg IV bolus over 2 minutes 2nd dose: 5-10mg IV bolus over 4 minutes P a g e 15 | 16 Pediatric Dose: None Cautions: Max dose: 20mg (Supplied 5mg/2ml) P a g e 16 | 16