NEEMSI Paramedic Pharmacology Flashcards

Terms Definitions
What is the functional class of oxygen?
Oxidizer
What is the functional class of oxygen?
Other oxidizing agents include ozone, chlorine, nitric acid, hydrogen peroxide and household bleach (NaClO).
By what mechanism does oxygen act?
A colorless, odorless, tasteless gas necessary for the breakdown of glucose into a usable energy form.
By what mechanism does oxygen act?
Gaseous oxygen is actually a very pale blue
What are the indications for oxygen?
Presence or suspicion of hypoxemia.
What are the indications for oxygen?
Hypoxemia is the decreased partial pressure of oxygen in the blood. Hypoxemia is different from hypoxia, which is an low oxygen availability to tissue, but hypoxemia can cause hypoxia.
What are the listed contraindications for oxygen?
None.
What are the listed contraindications for oxygen?
Never withhold oxygen from a patient for whom it is indicated.
What are the listed precautions for oxygen?
- Use cautiously with COPD patients
- Monitor long-term high concentrations in neonate as retrolental fibroplasia may develop
- Open flame
What are the listed precautions for oxygen?
Retrolental fibroplasia (now known as "retinopathy of prematurity") is an eye disease that affects premature infants. Both oxygen toxicity and hypoxia can contribute to its development.
What is the dosage for oxygen?
25-100%
What is the dosage for oxygen?
High-flow oxygen systems include venturi masks, air-entrainment nebulizers and high-flow blender systems.
What is the route for oxygen?
BLS and/or ALS airway adjuncts as appropriate.
What is the route for oxygen?
Or no adjunct, if indicated... (e.g. nasal cannula)
What is the relationship between liters per minute of oxygen and oxygen concentration?
Every 1 L/minute (LPM) increase in oxygen is equal to a 4% increase in concentration.

Examples:
- 1 L/minute = 25%
- 2 L/minute = 29%
What is the relationship between liters per minute of oxygen and oxygen concentration?
Oxygen gas constitutes 20.9% of the volume of dry air. Other gases present are nitrogen (78.1%), argon (0.9%) and carbon dioxide (<0.1%).
What is the best-known trade name for diazepam?
Valium
What is the best-known trade name for diazepam?
There are hundreds of trade names for diazepam around the world. In the US, Valium, Diastat and Valrelease are the most common.
What is the functional class of diazepam?
Benzodiazepine
What is the functional class of diazepam?
Other prehospital benzodiazepines are lorazepam (Ativan) and midazolam (Versed).
What is the mechanism of action of diazepam?
By intensifying the activity of GABA, it suppresses the spread of seizure activity through the motor cortex of the brain.

It is effective in the management of stress, anxiety, and alcohol withdrawal due to its sedative properties.

Additionally, it is effective as a premedication for minor orthopedic procedures due to its skeletal muscle relaxant properties, and as a premedication for cardioversion because it produces amnesia.
What is the mechanism of action of diazepam?
γ-aminobutyric acid is the chief inhibitory neurotransmitter in the CNS. As diazepam (and other benzodiazepines) requires GABA to act, it is safer than the barbiturates which were once used.
What are the listed indications for diazepam?
- Seizures (status epilepticus)
- To induce sedation prior to painful procedures
- Acute anxiety
What are the listed indications for diazepam?
California offers diazepam to condemned inmates as a pre-execution sedative...
What are the listed contraindications for diazepam?
- Known hypersensitivity
- Shock
- Coma
- Acute alcohol intoxication
What are the listed contraindications for diazepam?
Contraindications not in the NEEMSI documentation include pregnancy, breastfeeding, sleep apnea and porphyria.
What are the listed precautions for diazepam?
- Can cause local irritation, therefore, use large vein when possible
- Seizure activity may reoccur due to its lipid solubility
- Use with caution in patients with myasthenia gravis, impaired renal or hepatic function, obstetrical patients, and the elderly.
What are the listed precautions for diazepam?
Myasthenia gravis (MG) is a disorder characterized by muscle weakness caused by circulating antibodies that block acetylcholine receptors at the postsynaptic neuromuscular junction.
What are the listed side effects of diazepam?
- Hypotension
- Drowsiness
- Tachycardia
- Ataxia
- Amnesia
- Slurred speech
- Edema
- Headache
- Dizziness
- N/V
- Blurred vision
- Respiratory depression
What are the listed side effects of diazepam?
Ataxia (for the Greek for "lack of order") is a loss of muscle coordination that can affect balance, movement and speech.
What are the listed interactions of diazepam?
- Effects are enhanced when used in conjunction with other CNS depressants and alcohol
- Cimetidine (Tagamet) may increase diazepam plasma levels
What are the listed interactions of diazepam?
Cimetidine is a histamine H2-receptor antagonist that inhibits the production of stomach acid and is used in the treatment of heartburn and peptic ulcers.
What is the dosage and route of diazepam?
Adult:
- 5mg IVP, may repeat at 2.5mg q 5 minutes prn, max 10mg

Pedi:
- 0.1 - 0.25mg/kg IV/IO, maximum single dose 5mg
- 0.5mg/kg PR, maximum single dose 10mg
- may repeat either pedi dose once after 5 minutes
What is the dosage and route of diazepam?
Diazepam (unlike lorazepam and midazolam) may not be administered IM.
What are the pharmacokinetics of diazepam?
Onset: 1 - 5 minutes IV
Half-life: 20 - 50 hours
What are the pharmacokinetics of diazepam?
Diazepam has the longest half-life of the prehospital benzodiazepines.
What medication is an antagonist to diazepam?
Flumazenil
What medication is an antagonist to diazepam?
Flumazenil has trade names including Anexate, Lanexat, Mazicon & Romazicon.
What is the best-known trade name for lorazepam?
Ativan
What is the best-known trade name for lorazepam?
There are dozens of trade names for lorazepam around the world. When lorazepam was introduced in the US in 1971 it was known as Ativan and Temesta.
What is the functional class of lorazepam?
Benzodiazepine
What is the functional class of lorazepam?
The first benzodiazepine, chlordiazepoxide (Librium), was discovered in 1955 and first marketed in 1960.
What is the mechanism of action of lorazepam?
Lorazepam is the most potent of the benzodiazepines.

It acts as an anxiolytic, sedative, hypnotic, and skeletal muscle relaxant.

It intensifies the effects of GABA.

Because of its short half-life it is the preferred benzodiazepine for the treatment of pediatric seizures.
What is the mechanism of action of lorazepam?
1mg of lorazepam is equivalent to 10mg diazepam.
What are the listed indications for lorazepam?
- Seizures (status epilepticus)
- To induce sedation prior to painful procedures
- Acute anxiety
What are the listed indications for lorazepam?
Status epilepticus can be defined as defined as one continuous unremitting seizure lasting longer than 30 minutes, or recurrent seizures for greater than 30 minutes with no intervening consciousness.
What are the listed contraindications for lorazepam?
- Hypersensivity to benzodiazepines
- Acute narrow-angle glaucoma
- Coma
- Shock
- Acute alcohol intoxication
What are the listed contraindications for lorazepam?
Glaucoma is an eye disorder in which the optic nerve is permanently and progressively damaged, resulting in complete blindness if untreated. It is often, but not always, associated with increased intraocular pressure (IOP).
What are the listed precautions for lorazepam?
- Renal or hepatic impairment
- Myasthenia gravis
- COPD
What are the listed precautions for lorazepam?
Lorazepam may be safer than most benzodiazepines in patients with impaired liver function as it does not require hepatic oxidation, but only hepatic glucuronidation.
What are the listed side effects for lorazepam?
- Anterograde amnesia
- Sedation
- Hypertension
- Hypotension
- Blurred vision
- N/V
- Confusion
What are the listed side effects for lorazepam?
Anterograde amnesia is a loss of the ability to create new memories after the event that caused the amnesia.
What are the listed interactions for lorazepam?
Effects of lorazepam will be increased when used in conjunction with other CNS depressants, alcohol, or cimetidine.
What are the listed interactions for lorazepam?
Other CNS depressants include barbiturates, opioids, disassociatives and antipsychotics.
What is the dosage and route of lorazepam?
Adult:
- 1 - 2mg slow IVP or IM q 5 minutes, max 8mg

Pedi:
- 0.1mg/kg slow IVP or IM, max single dose 2mg, may repeat once after 5 minutes
What is the dosage and route of lorazepam?
Lorazepam can be quantitated in blood and plasma to confirm a diagnosis of poisoning.
What are the pharmacokinetics of lorazepam?
Onset: 1 - 5 minutes IV, 5 - 10 minutes IM
Half-Life: 10 - 20hrs
What are the pharmacokinetics of lorazepam?
Despite its higher potency, the half-life of lorazepam is much shorter than that of diazepam.
What medication is an antagonist to lorazepam?
Flumazenil
What medication is an antagonist to lorazepam?
Flumazenil reverses the effects of benzodiazepines by competitive inhibition at the benzodiazepine binding site on the GABA receptor.
What is the best-known trade name for midazolam?
Versed
What is the best-known trade name for midazolam?
Other trade names include Dormicum and Hypnovel.
What is the functional class of midazolam?
Benzodiazepine
What is the functional class of midazolam?
There are about 35 benzodiazepines that have been formulated and are used medically, several are not approved for use in the US.
What is the mechanism of action of midazolam?
This short-acting benzodiazepine intensifies activity of GABA.

It also has CNS depressant, anticonvulsant and anterograde amnestic properties.

It also relaxes skeletal muscles and induces sleep.
What is the mechanism of action of midazolam?
An amnestic is a drug that induces amnesia.
What are the listed indications for midazolam?
- Seizures (status epilepticus)
- To induce sedation prior to painful procedures
What are the listed indications for midazolam?
Unlike diazepam and lorazepam, midazolam is not indicated for acute anxiety.
What are the listed contraindications for midazolam?
- Hypersensivity to benzodiazepines
- Acute narrow-angle glaucoma
- Coma
- Shock
- Acute alcohol intoxication
What are the listed contraindications for midazolam?
These are the same as the contraindications for lorazepam.
What are the listed precautions for midazolam?
Use with caution in patients with COPD, CHF and/or renal failure.
What are the listed precautions for midazolam?
Many sources include hypotension as a precaution or relative contraindication.
What are the listed side effects of midazolam?
- N/V
- Burred vision
- Retrograde amnesia
- Excessive amnesia
- Apnea
- Hypotension
- PVCs
What are the listed side effects of midazolam?
PVCs (premature ventricular contractions/complexes) occur when the heartbeat is initiated by the heart ventricles rather than by the sinoatrial node.
What are the listed interactions of midazolam?
- Prolonged respiratory depression when given in conjunction with other CNS depressants such as alcohol
- Cimetidine (Tagamet) increases plasma levels of midazolam.
What are the listed interactions of midazolam?
The interactions of all three prehospital benzodiazepines are very similar.
What is the dosage and route of midazolam?
Adult:
- 1.0 - 2.5mg slow IVP or IM q 5 min until seizure abolished

Pedi:
- 0.1mg/kg slow IVP or IM, maximum single dose 6mg, may repeat once after 5 minutes
What is the dosage and route of midazolam?
There is evidence that buccal and intranasal midazolam are easier to administer and more effective than rectally administered diazepam for the control of seizures.
What are the pharmacokinetics of midazolam?
Onset: 3 - 5 minutes IV
Duration: <2 hours IV
Half-Life: 1 - 4 hours
What are the pharmacokinetics of midazolam?
The duration of apparent action is considerably less than the half-life. Noticeable effects wear off within a few hours but as long as the drug is present it will exert subtle effects. These effects may become apparent during continued use or may appear as withdrawal symptoms when dosage is reduced or the drug is stopped.
What medication is an antagonist to midazolam?
Flumazenil
What medication is an antagonist to midazolam?
Flumazenil has also been found to be effective in overdoses of non-benzodiazepine sleep enhancers, such as zolpidem (Ambien) and zaleplon (Sonata).
What is the best-known trade name for succinylcholine?
Anectine
What is the best-known trade name for succinylcholine?
Suxamethonium chloride, also known as suxamethonium or succinylcholine, is also sold under the trade names Quelicin and Scoline.
What is the functional class of succinylcholine?
Depolarizing neuromuscular blocker
What is the functional class of succinylcholine?
The only other depolarizing neuromuscular blocker used in medicine -- and very rarely -- is decamethonium (Syncurine).
What is the mechanism of action of succinylcholine?
Synthetic, ultra short-acting neuromuscular blocking agent. Succinylcholine is composed of two adjacent acetylcholine molecules and has a high affinity for acetylcholine receptors. It causes transient muscle contractions called fasciculations followed by skeletal muscle paralysis. There is no effect on level of
consciousness.
What is the mechanism of action of succinylcholine?
Succinylcholine was originally known as diacetylcholine because of its structure.
What are the listed indications for succinylcholine?
To facilitate endotracheal intubation.
What are the listed indications for succinylcholine?
Neuromuscular blocks are also in surgery, especially during intra-abdominal and intra-thoracic surgeries, to allow them to be conducted with fewer complications.
What are the listed contraindications for succinylcholine?
- Acute narrow angle glaucoma
- Penetrating eye injuries
- Family history of malignant hyperthermia
- Hyperkalemia
- 24 - 48 hours post severe trauma including burns
- Disorder of pseudocholinesterase
- Neuromuscular disorders such as myasthenia gravis or ALS
What are the listed contraindications for succinylcholine?
ALS is amyotrophic lateral sclerosis, also referred to as Lou Gehrig's disease
What are the listed precautions for succinylcholine?
Never paralyze without adequate sedation.
What are the listed precautions for succinylcholine?
Patients are still aware of pain even after full conduction block has occurred hence general anesthetics and/or analgesics must also be given to prevent the condition known as "anesthesia awareness".
What are the listed side effects for succinylcholine?
- Apnea
- Malignant hyperthermia
- Dysrhythmias
- Bradycardia
- Tachycardia
- Hypertension
- Hypotension
- Cardiac arrest
- Increased intraocular pressure
- Fasciculations
- Exacerbation of hyperkalemia in trauma
patients
What are the listed side effects for succinylcholine?
Fasciculations are muscle twitches: small, local, involuntary muscle contractions and relaxations visible under the skin.
What are the listed interactions for succinylcholine?
- Effects potentiated by oxytocin, beta-blockers, and organophosphates
- Diazepam may reduce duration of action
What are the listed interactions for succinylcholine?
Organophosphates include many pesticides and nerve agents.
What is the dosage and route of succinylcholine?
Adult:
- 1 - 1.5mg/kg rapid IV, repeat once if needed

Pedi:
- 1 - 2mg/kg rapid IV/IO, repeat once if needed
What is the dosage and route of succinylcholine?
Succinylcholine has occasionally been used as a paralyzing agent for executions and as a means of murder and assassination.
What are the pharmacokinetics of succinylcholine?
Onset: 1 minute
Peak effect: 1 - 3 minutes
Duration: 5 minutes
What are the pharmacokinetics of succinylcholine?
Non-depolarizing blockers (e.g vecuronium, rocuronium) have a much longer duration but can be reversed.
What is the best-known trade name for epinephrine?
Adrenalin
What is the best-known trade name for epinephrine?
Epinephrine is known as "adrenaline" in most of the world but the term is not used in the US due to its similarity to the trademarked "Adrenalin".
What is the functional class of epinephrine?
Sympathomimetic
What is the functional class of epinephrine?
In the human body, the most abundant catecholamines (which all have sympathomimetic effects) are epinephrine, norepinephrine and dopamine.
What is the mechanism of action of epinephrine?
A naturally-occurring catecholamine that acts directly on the alpha- and beta- (more profound) adrenergic receptors. This causes positive inotropic, dromotropic, and chronotropic effects as well as increased systemic vascular resistance and BP.
What is the mechanism of action of epinephrine?
- Inotropic - increased contractility
- Dromotropic - increased conduction velocity
- Chronotropic - increased rate
What are the listed indications for epinephrine?
- Cardiac arrest: asystole, VF, pulseless VT, PEA
- Symptomatic bradycardia
- Anaphylaxis
- Severe reactive airway disease
What are the listed indications for epinephrine?
Epinephrine is also used as a local vasoconstrictor in local anesthetics and in ointments to stop bleeding in contact sports such as boxing.
What are the listed contraindications for epinephrine?
Hypersensitivity to sympathomimetic amines
What are the listed contraindications for epinephrine?
Some sources state that epinephrine is contraindicated for patients on nonselective β-blockers because severe hypertension may result as only the α-adrenergic effects will be produced.
What are the listed precautions for epinephrine?
- Protect from light
- Can be deactivated by sodium bicarbonate, therefore flush IV line between administration of epinephrine and sodium bicarbonate.
- Effects can be intensified by antidepressants
What are the listed precautions for epinephrine?
Furosemide (Lasix) can also block the effects of epinephrine.
What are the listed side effects for epinephrine?
- Increases myocardial oxygen demand
- Can cause palpitations, anxiety, headache, CVA, syncope, HTN, tachydysrhythmias
- Tissue necrosis with repeated injections or extravasation of IV
What are the listed side effects for epinephrine?
Some sources add acute pulmonary edema as a side effect of epinephrine.
What are the listed interactions for epinephrine?
- May increase hypotension caused by phenothiazines, alpha and beta blockers
- Can be deactivated in alkaline solutions or sodium bicarbonate
What are the listed interactions for epinephrine?
Tricyclic antidepressants can potentiate epinephrine by inhibition of norepinephrine reuptake.
What is the dosage and route of epinephrine for cardiac arrest?
Adult:
- 1.0mg of 1:10,000 IVP q 3 - 5 minutes or
2.0 - 2.5mg of 1:1,000 ET q 3 - 5 minutes (diluted to 10mL)

Pedi:
- 0.01mg/kg of 1:10,000 IV/IO or
0.1mg/kg of 1:1,000 ET q 3 - 5 minutes (diluted to 3 - 5mL)
What is the dosage and route of epinephrine for cardiac arrest?
Note that the differing routes use differing concentrations. High-dose epinephrine is ET (as it is being diluted), low-dose is IV/IO.
What is the dosage and route of epinephrine for severe anaphylaxis/asthma?
Adult:
- 0.3 - 0.5mg of 1:1,000 SQ q 5 - 15 minutes,
- If ineffective give 0.1 - 0.5mg of 1:10,000 IVP q 5 - 15 minutes

Pedi:
- 0.01mg/kg of 1:1,000 SQ
- If ineffective give 0.01mg/kg of 1:10,000 IVP q 5 - 15 minutes
What is the dosage and route of epinephrine for severe anaphylaxis/asthma?
First dose is high-dose SQ, second dose is low-dose IVP.
What is the dosage and route of epinephrine for symptomatic bradycardia (as an infusion)?
Preparation: 1 mg of 1:1,000 in 250mL NS

Adult:
- 2 - 10mcg/min

Pedi:
- 0.1 - 1mcg/kg/min
What is the dosage and route of epinephrine for symptomatic bradycardia (as an infusion)?
This is high-dose epinephrine as it is being diluted for infusion.

NH EMS protocols do not include epinephrine infusion for pediatric patients.
What are the pharmacokinetics of epinephrine?
None listed.
What are the pharmacokinetics of epinephrine?
One source states:

Onset: 5 - 10 min SQ, 1 - 2 min IV
Duration: 5 - 10 min
What is the best-known trade name for vasopressin?
Pitressin
What is the best-known trade name for vasopressin?
Vasopressin is also known as argipressin, arginine vasopressin (AVP) and antidiuretic hormone (ADH).
What is the functional class of vasopressin?
Hormone (ADH), vasopressor
What is the functional class of vasopressin?
Vasopressin is mainly produced in the paraventricular nucleus (PVN) and supraoptic nucleus (SON) of the hypothalamus. It is very similar in structure to oxytocin.
What is the mechanism of action of vasopressin?
Vasopressin possesses pressor and antidiuretic properties:
- It increases nephron distal tube reabsorption of water.
- In unnaturally high doses, it acts as a non-adrenergic vasoconstrictor by stimulation of smooth muscle receptors.
- It is used as an alternative to epinephrine during CPR.
What is the mechanism of action of vasopressin?
Vasopressin has also been identified in memory formation and the regulation of social bonding and behavior.
What are the listed indications for vasopressin?
Cardiac arrest
What are the listed indications for vasopressin?
Vasopressin is also used in the hospital treatment of septic shock.
What are the listed contraindications for vasopressin?
- Chronic nephritis
- Ischemic heart disease
- PVCs
- First stage of labor
What are the listed contraindications for vasopressin?
And, of course, known hypersensitivity.
What are the listed precautions for vasopressin?
Use with caution in patients with:
- Epilepsy
- Migraine
- Asthma
- Heart failure
- Angina pectoris
What are the listed precautions for vasopressin?
Some sources also list renal insufficiency as a precaution.
What are the listed side effects for vasopressin?
- N/V
- Abdominal cramps
- HTN
- Bradycardia
- PACs
- MI
What are the listed side effects for vasopressin?
PACs (premature atrial contractions) are a benign arrhythmia that occurs in the atria. They are not as serious as premature ventricular contractions (PVCs) and usually require no medical care.
What are the listed interactions for vasopressin?
- Epinephrine
- Heparin
- Alcohol
- Phenytoin
- Thiazide diuretics
- Carbamazepine
- Neostigmine
What are the listed interactions for vasopressin?
May decrease antidiuretic effects:
- Epinephrine
- Heparin
- Alcohol
- Phenytoin

May increase antidiuretic effects:
- Thiazide diuretics
- Carbamazepine

May increase vasoconstriction:
- Neostigmine
What is the dosage and route of vasopressin?
40 units IVP/IO (single dose only)
What is the dosage and route of vasopressin?
Vasopressin international units are defined by comparing the pressor effects to that of the USP Posterior-pituitary Reference Standard. 1mg of vasopressin is 600 units.
When should vasopressin be used in a cardiac arrest situation?
May replace first or second dose of epinephrine in cardiac arrest.
When should vasopressin be used in a cardiac arrest situation?
This is for adult arrest only (AHA).
What is the best-known trade name for atropine?
None.
What is the best-known trade name for atropine?
Atropine derives its name from Atropos, one of the three Fates who, according to Greek mythology, chose how a person was to die.
What is the functional class of atropine?
Parasympatholytic
What is the functional class of atropine?
Atropine is one of only two prehospital parasympatholytics - the other is Atrovent (ipratropium bromide).
What is the mechanism of action of atropine?
Blocks muscarinic acetylcholine receptors thus inhibiting parasympathetic stimulation. By blocking vagal impulses to the heart it accelerates SA node discharge, enhances conduction through the AV junction, and increases cardiac output. It is also a potent bronchodilator when bronchoconstriction is caused by increased parasympathetic tone.
What is the mechanism of action of atropine?
One of the main actions of the parasympathetic nervous system is to stimulate the M2 muscarinic receptor in the heart, but atropine inhibits this action.
What are the listed indications for atropine?
- Symptomatic bradycardia
- Asystole (brady-asystolic arrest)
- Organophosphate/nerve agent poisoning
- Bradycardic PEA
What are the listed indications for atropine?
Atropine has many opthalmic uses including as a cyclopegic and mydriatic.
What are the listed contraindications for atropine?
None in the emergency setting.
What are the listed contraindications for atropine?
In non-emergency situations, atropine is contraindicated in patients pre-disposed to narrow angle glaucoma.
What are the listed precautions for atropine?
- May worsen bradycardia associated with 2nd Degree Mobitz II and 3rd Degree AV blocks thus consider TCP first.
- Use with caution in patients with signs and symptoms of acute myocardial ischemia,
myocardial infarction & glaucoma.
What are the listed precautions for atropine?
Atropine increases oxygen demand of the AV nodal tissue, thereby aggravating ischemia and any resulting heart block.
What are the listed side effects for atropine?
- Blurred vision
- Dilated pupils
- Dry mouth
- Tachycardia
- Drowsiness
- Convulsions
- HTN or hypotension
- Palpitations
- Paradoxical bradycardia (if given too slowly)
- AV dissociation
- Urinary retention
What are the listed side effects for atropine?
In medieval Europe women used the juice of the berries of Atropa belladonna (a source of atropine) to enlarge the pupils of their eyes for cosmetic reasons; "bella donna" is Italian for "beautiful lady".
What are the listed interactions for atropine?
Antihistamines, tricyclic antidepressants & procainamide can lead to the anticholinergic effects of atropine.
What are the listed interactions for atropine?
Procainamide is a cardiac medication and used to treat supraventricular and ventricular arrhythmias.
What is the dosage and route of atropine in asystole/bradycardic PEA?
Adult:
- 1mg IVP q 3 - 5 minutes max total 0.04mg/kg
- 2 - 2.5mg ET q 3 - 5 minutes

Pedi:
- 0.02mg/kg IVP or IO (min single dose is 0.1mg and max single dose is 1mg) q 5 minutes max total 0.04mg/kg
What is the dosage and route of atropine in asystole/bradycardic PEA?
There is no listed ET dosage for pediatric patients. The pediatric dose is the same as that for symptomatic bradycardia.
What is the dosage and route of atropine in symptomatic bradycardia?
Adult:
- 0.5mg IVP q 3 - 5 minutes max total 0.04mg/kg

Pedi:
- 0.02mg/kg IVP or IO (min single dose is 0.1mg and max single dose is 1mg) q 5 minutes max total 0.04mg/kg
What is the dosage and route of atropine in symptomatic bradycardia?
The pediatric dose is the same as that for asystole/bradycardic PEA.
What is the dosage and route of atropine in organophosphate poisoning?
Adult:
2 mg IVP q 5 minutes prn

Pedi:
0.05 – 0.1mg/kg IV/IM (min dose of 0.1mg and max single dose 5mg), repeat q 2 – 5 minutes prn
What is the dosage and route of atropine in organophosphate poisoning?
Atropine is included in the US military's Mark 1 NAAK ("Nerve Agent Antidote Kit") and ATNAA ("Antidote Treatment Nerve Agent Auto-Injector").
What are the pharmacokinetics of atropine?
Absorption: 2 - 4 minutes IV
Half-Life: 2 - 3 hours
What are the pharmacokinetics of atropine?
As a therapeutic mydriatic, atropine's effects can last for 1-2 weeks.
What is the best-known trade name for lidocaine?
Xylocaine
What is the best-known trade name for lidocaine?
Lidocaine was first marketed in 1949. it has also been called "lignocaine".
What is the functional class of lidocaine?
Class Ib antidysrhythmic (sodium channel blocker)
What is the functional class of lidocaine?
Other Ib antidysrhythmics include phenytoin (Dilantin) and Mexiletine (Mexitil).
What is the mechanism of action of lidocaine?
Suppresses depolarization and automaticity in the His-Purkinje system. Also suppresses ventricular ectopy and increases the ventricular threshold for dysrhythmias; however it decreases the ventricular threshold for defibrillation.
What is the mechanism of action of lidocaine?
Lidocaine blocks the fast voltage gated sodium (Na+) channels.
What are the listed indications for lidocaine?
- VF
- Pulseless VT
- VT with a pulse
- Malignant PVCs:
-- More than six unifocal PVCs a minute
-- Multifocal PVCs
-- Couplets
-- R-on-T phenomena
What are the listed indications for lidocaine?
Lidocaine also has significant use as a local anesthetic, including during IO insertion. It is also used as an inhaled antitussive.
What are the listed contraindications for lidocaine?
- Hypersensitivity
- Supraventricular dysrhythmias
- Untreated sinus bradycardia
- 2nd Degree Mobitz II AV Block
- 3rd Degree AV Block
- Stokes-Adams syndrome
What are the listed contraindications for lidocaine?
Some sources also include AIVR, the presence of an artificial pacemaker and the use of class I antidysrhythmics.
What are the listed precautions for lidocaine?
CNS depression may occur in doses greater than 300 mg/hour
- Liver or renal disease
- CHF
- Hypovolemia
- Shock
- Myasthenia gravis.
What are the listed precautions for lidocaine?
Some sources state that lidocaine should not be used in patients with congenital or idiopathic methemoglobinemia or with pseudocholinesterase deficiency.
What are the listed side effects for lidocaine?
- Altered mental status including confusion
- Bradycardias,
- Hypotension
- Seizures
What are the listed side effects for lidocaine?
Prolonged use may produce permanent corneal opacification and ulceration with accompanying loss of vision.
What are the listed interactions for lidocaine?
Use caution when administered with beta blockers or procainamide as drug toxicity may result.
What are the listed interactions for lidocaine?
Cimetidine may increase serum levels of lidocaine due to reduced hepatic circulation.
What is the dosage and route of lidocaine for cardiac arrest?
Adult:
- 1 - 1.5mg/kg IVP, repeat at half the initial dose (0.5 - 0.75mg/kg IVP) q 5 minutes up to a maximum of 3mg/kg

Note: a single dose of 1.5 mg/kg IVP in cardiac arrest is acceptable if moving on to amiodarone

- 2 - 4mg/kg ETT q 3 - 5 minutes

Pedi:
- 1 mg/kg IVP/IO/ETT
What is the dosage and route of lidocaine for cardiac arrest?
Interestingly, lidocaine has no proven short-term or long-term efficacy in cardiac arrest.
What is the dosage and route of lidocaine for a patient with a pulse?
Adult:
- 1 - 1.5mg/kg IVP, repeat at half the initial dose (0.5 - 0.75mg/kg IVP) q 5 - 10 minutes up to a maximum of 3mg/kg

- Infusion: 1 - 4 mg/minute using the "+1 Rule"
What is the dosage and route of lidocaine for a patient with a pulse?
The infusion and bolus should be administered together so no lag occurs.
What are the pharmacokinetics of lidocaine?
Absorption = 3 minutes
Duration = 10 - 20 minutes
Half-Life = 1.5 - 2 hours
What are the pharmacokinetics of lidocaine?
The elimination half-life of lidocaine is approximately 90-120 minutes in most patients. This may be prolonged in patients with hepatic impairment (average 343 minutes) or congestive heart failure (average 136 minutes). - Ann. Intern. Med. 1973 Apr; 78(4):499-508.
What is the best-known trade name for amiodarone?
Cordarone
What is the best-known trade name for amiodarone?
Another trade name in the US is Pacerone.
What is the functional class of amiodarone?
Class III antidysrhythmic (potassium channel blocker)
What is the functional class of amiodarone?
Other class III antidysrythmics are Sotalol, Ibutilide, Dofetilide, Dronedarone and the experimental E-4031
What is the mechanism of action of amiodarone?
Amiodarone is a unique Class III antidysrhythmic that acts directly on all cardiac tissues. It prolongs the duration of the action potential and refractory period (by blocking potassium channels) without significantly affecting the resting membrane potential. It also blocks sodium channels. The IV form relaxes vascular smooth muscle, decreases peripheral vascular resistance and increases coronary blood flow. Additionally, it blocks the effects of sympathetic stimulation.
What is the mechanism of action of amiodarone?
Amiodarone also resembles thyroid hormones and its binding to the nuclear thyroid receptors might contribute to some of its
What are the listed indications for amiodarone?
Life-threatening ventricular and supraventricular dysrhythmias
(VF, VT, A-Fib, A-Flutter, SVT, WPW)
What are the listed indications for amiodarone?
Amiodarone should not be used for hemodynamically unstable ventricular tachycardia.
What are the listed contraindications for amiodarone?
- Hypersensitivity
- Cardiogenic shock
- Severe sinus bradycardia,
- AV block
What are the listed contraindications for amiodarone?
Some sources also caution against use with 2nd or 3rd degree heart block in the absence of an artificial pacemaker.
What are the listed precautions for amiodarone?
Use with caution in:
- severe liver disease
- pregnancy
- nursing mothers
What are the listed precautions for amiodarone?
The injectable forms of amiodarone containing benzyl alcohol should be avoided with neonates or infants because the
What are the listed side effects for amiodarone?
- CHF
- Angioedema
- Hypotension
- AV block
- Hepatotoxicity
- Cardiogenic shock
- Fatigue
- Bradycardia
- Sinus arrest
- Permanent blindness
- N/V
- Prolonged QT interval
What are the listed side effects for amiodarone?
Long-term administration of amiodarone is associated with a blue-gray discoloration of the skin that may fade once therapy is discontinued.
What are the listed interactions for amiodarone?
- Increases digoxin levels
- Enhances pharmacological effects of:
-- Procainamide
-- Lidocaine
-- Quinidine
-- Oral anticoagulants
- Concurrent use of calcium channel blockers, beta blockers, fentanyl, or cimetidine may potentiate sinus bradycardia
What are the listed interactions for amiodarone?
Amiodarone inhibits the action of the cytochrome P450 isozyme family.
What is the dosage and route of amiodarone?
Adult:
With pulse: 150mg (in 50 - 100ml of NS) IV infusion over 10 minutes. May repeat dose once after 10 minutes

Pulseless: 300mg IVP, repeat in 3 - 5 minutes at 150mg IVP

Maintenance infusion: 1mg/min over the next 6 hours

Pedi:
5mg/kg IV/IO
What is the best-known trade name for adenosine?
Adenocard
What is the best-known trade name for adenosine?
A formulation of adenosine used as a pharmacologic stress agent is called Adenoscan. Adenosine is often abbreviated "Ado".
What is the functional class of adenosine?
Antidysrhythmic
What is the functional class of adenosine?
Adenosine is a class V antidysrythmic (direct nodal inhibition). Adenosine also has topical anti-inflammatory properties
What is the mechanism of action of adenosine?
A naturally occurring nucleoside that decreases conduction through the AV node and interrupts AV and SA re-entry pathways thus restoring normal sinus rhythm in patients with SVT.
What is the mechanism of action of adenosine?
Adenosine also indirectly causes a shortening of the refractory period in atrial tissue and can precipitate A Fib if administered via a central lumen catheter.
What are the listed indications for adenosine?
SVT refractory to vagal maneuvers including Wolff-Parkinson-White (WPW)
What are the listed indications for adenosine?
WPW features ventricular preexcitation due to an accessory pathway from the atria to the ventricles known as the bundle of Kent.
What are the listed contraindications for adenosine?
- 2nd and 3rd Degree AV heart blocks
- Symptomatic bradycardia
- Sick sinus syndrome
- Hypersensitivity
What are the listed contraindications for adenosine?
2nd and 3rd degree AV heart blocks and sick sinus syndrome may be permitted if a cardiac pacemaker is present.
What are the listed precautions for adenosine?
- Place patient in semi-Fowler position as patients will typically develop arrhythmias at the time of conversion
- Use cautiously in patients with asthma
What are the listed precautions for adenosine?
This can be expanded to include patients with acute bronchospasm and other obstructive lung diseases.
What are the listed side effects for adenosine?
- Syncope
- Dizziness
- Dyspnea
- N/V
- Headaches
- Palpitations
- Chest pain
- Hypotension
- Dysrhythmias

Side effects are usually self-limiting due to short half-life.
What are the listed side effects for adenosine?
A metallic taste in the mouth is a hallmark side effect of adenosine.
What are the listed interactions for adenosine?
- Patients taking caffeine or xanthines (aminophylline or theophylline) may require larger doses as these drugs antagonize adenosine

- Patients on dipyridamole (Persantine) and carbamazepine (Tegretol) may need smaller doses of adenosine as these drugs potentiate adenosine’s effects
What are the listed interactions for adenosine?
Some sources state that verapamil (and related medications) may increase the risk of V Fib.
What is the dosage and route of adenosine?
Adult:
- 6mg rapid IVP followed by a 10-20mL NS flush
- If no conversion after 1-2 minutes administer 12mg rapid IVP followed by a 10-20mL NS flush
- If no conversion after 1-2 minutes administer repeat 12mg rapid IVP followed by a 10-20mL NS flush

Pedi:
- 0.1mg/kg IVP/IO (maximum single dose is 6mg)
- May repeat only once in 1-2 minutes at 0.2mg/kg (maximum second dose is 12mg)
What is the dosage and route of adenosine?
Because of the very short half-life, administer adenosine as close to the heart as possible.
What are the pharmacokinetics of adenosine?
Onset = rapid
Half-Life = approximately 10 seconds
What are the pharmacokinetics of adenosine?
Adenosine is broken down by adenosine deaminase, which is present in RBCs and vessel walls.
What is the best-known trade name for diltiazem?
Cardizem
What is the best-known trade name for diltiazem?
There are over twenty brand names for diltiazem including Angizem, Cartia, Diltalen & Tiazac.
What is the functional class of diltiazem?
Class IV antidysrhythmic (calcium channel blocker)
What is the functional class of diltiazem?
Like verapamil, diltiazem is a non-dihydropyridine calcium channel blocker. Dihydropyridine calcium channel blockers have only vasodilatory rather than negative inotropic effects.
What is the mechanism of action of diltiazem?
Inhibits calcium ion influx through slow channels into cells of myocardial and arterial smooth muscle. This causes intracellular calcium to remain at sub-threshold levels that are insufficient to stimulate cell excitation and contraction. It reduces peripheral vascular resistance by inhibiting the contractility of vascular smooth muscle which causes dilation of the coronary arteries. It also inhibits coronary artery spasm. Diltiazem also slows SA and AV node conduction without affecting atrial action potential.
What is the mechanism of action of diltiazem?
Diltiazem also affects dopaminergic and glutamatergic signalling in the brain and this may explain why it can be used to reduce cocaine cravings.
What are the listed indications for diltiazem?
- SVT refractory to adenosine
- Rapid A-Fib or A-Flutter
What are the listed indications for diltiazem?
Diltiazem and other calcium channel blockers are also being investigated in the treatment and prophylaxis of migraine.a
What are the listed contraindications for diltiazem?
- Hypersensitivity
- Sick sinus syndrome
- 2nd and 3rd Degree AV block,
- Hypotension
- WPW
- Wide complex tachycardia
What are the listed contraindications for diltiazem?
Hypotension may be a symptom of tachydysrhythmia caused by decreased ventricular filling and administration of diltiazem may still be considered. NH protocols allow diltiazem for tachycardic patients who are symptomatic but hemodynamically stable.
What are the listed precautions for diltiazem?
- Avoid in patients receiving oral beta-blockers
- Monitor for hypotension resulting from peripheral vasodilation.
- Use with caution in CHF
What are the listed precautions for diltiazem?
Some sources list PAOD and COPD as relative contraindications.
What are the listed side effects for diltiazem?
- Chest pain
- Bradycardia
- Hypotension
- Syncope
- CHF
- Dysrhythmias
- N/V
- Headache
- Sweating
- Dizziness
- Dyspnea
- 2nd and 3rd Degree AV block
- Palpitations
What are the listed side effects for diltiazem?
Some sources include blurred vision and confusion.
What are the listed interactions for diltiazem?
Beta-blockers may increase digoxin (sic) levels
What are the listed interactions for diltiazem?
Beta blockers and quinidine may interact with diltiazem to increase the likelihood of dysrhythmias and AV node block.
What is the dosage and route of diltiazem?
Bolus
0.25mg/kg slow IVP, may repeat in 15 minutes at 0.35mg/kg slow IVP

IV Infusion:
5-15mg/hr, titrate to heart rate
What is the dosage and route of diltiazem?
NH protocols state that a diltiazem bolus should be administered over two minutes.
What are the pharmacokinetics of diltiazem?
None listed.
What are the pharmacokinetics of diltiazem?
The half-life of diltiazem is approximately seven hours. There is a strong relation between plasma diltiazem concentration and percent heart rate reduction.
What are the best-known trade names for nitroglycerin?
Nitrostat, Nitro-Bid, Tridil
What are the best-known trade names for nitroglycerin?
Other trade names include Nitrospan, Nitrol, Trinipatch, Nitro-Dur, Natispray and NitroMist.
What is the functional class of nitroglycerin?
Nitrate
What is the functional class of nitroglycerin?
Other nitrates include isosorbide mononitrate (Imdur), isosorbide dinitrate (Isordil) and pentaerythritol tetranitrate (Lentonitrat).
What is the mechanism of action of nitroglycerin?
Rapid vascular smooth muscle relaxant that increases coronary blood flow and improves perfusion of the ischemic myocardium. This results in decreased venous return to the heart, alleviation of chest pain, and a decrease in preload and afterload in the left ventricle.
What is the mechanism of action of nitroglycerin?
The effects of NTG (and other nitrovasodilators) is achieved by denitration to produce nitric oxide (NO) which is a potent vasodilator.
What are the listed indications for nitroglycerin?
- Chest pain associated with angina pectoris or AMI
- Acute pulmonary edema
- Congestive heart failure
What are the listed indications for nitroglycerin?
NTG is also used to treat hypertension, coronary artery spasms due to cocaine and topically for anal fissures.
What are the listed contraindications for nitroglycerin?
- Hypersensitivity
- Head trauma
- Patients in shock (systolic BP < 90 mmHg)
- Patients with increased ICP (head trauma)
What are the listed contraindications for nitroglycerin?
Some sources also list anemia.
What are the listed precautions for nitroglycerin?
- Protect from light and air.
- Monitor vitals closely as it may cause orthostatic hypotension
- Phosphodiesterase-type 5 (PDE-5) inhibitors:
-- Viagra (sildenafil) use within the past 24 hours
-- Cialis (tadalafil) use within the past 48 hours
-- Levitra (vardenafil) use within the past 48 hours
What are the listed precautions for nitroglycerin?
There is no evidence that defibrillation across a transdermal NTG patch can cause explosion or fire.
What are the listed side effects for nitroglycerin?
- Hypotension
- Palpitations
- Tachycardia
- Syncope
- Dry mouth
- N/V
- Headache
- Dizziness
- Skin rash
What are the listed side effects for nitroglycerin?
Prolonged, repeated use of NTG can lead to tolerance. The severe headaches associated with NTG may necessitate analgesia in some patients and are a significant cause of lack of compliance.
What are the listed interactions for nitroglycerin?
May cause hypotension when used in conjunction with alcohol and antihypertensives (beta-blockers)
What are the listed interactions for nitroglycerin?
Orthostatic hypotension has been reported when calcium channel blockers and nitrates were used concomitantly.
What is the dosage and route of nitroglycerin?
- 0.4mg SL (or 1/150gr) tablet or spray q 5 minutes prn with BP>100mmHg.
- 1-2 inches of TD paste

Infusion:
10mcg/min via IV infusion pump increasing by 5-10mcg/minute q 5 minutes to relieve CP or pulmonary edema (if systolic BP>100mmHg)
What is the dosage and route of nitroglycerin?
NH protocols require an IV be established before SL NTG can be administered (with the exception of assisting a pt with their own medication).
What are the pharmacokinetics of nitroglycerin?
Onset: 1-3 minutes SL, 30 minutes TD
Half-Life: 1-4 minutes
What are the pharmacokinetics of nitroglycerin?
Effect reaches a maximum 5 minutes after SL administration and persists for at least 25 minutes.
What should be performed before a nitroglycerin infusion is started?
Recommend two IVs or a TwinCath in place to administer infusion.
What should be performed before a nitroglycerin infusion is started?
This is a requirement in NH protocols, as is the use of an infusion pump.
How should nitroglycerin spray be handled?
Do not shake aerosol spray as it may affect metered dose.
How should nitroglycerin spray be handled?
However, medicinal NTG is not explosive...
What is the chemical name for aspirin?
Acetylsalicylic acid (ASA)
What is the chemical name for aspirin?
Aspirin, with a capital "A", remains a registered trademark of Bayer in Germany, Canada, Mexico, and in over 80 other countries.
What are the functional classes of aspirin?
- Salicylate
- Analgesic
- Antiplatelet
- Antipyretic
What are the functional classes of aspirin?
Salicylic acid is found in willow bark and is the source of the name, from the Latin "salix" meaning "willow".
What is the mechanism of action of aspirin?
- Aspirin blocks the production of cyclooxygenase (COX), the precurser to thromboxane A2 (which is the physiological inducer of platelet aggregation).
- As an anti-inflammatory agent it appears to be involved in the inhibition of prostaglandin synthesis. Its anti-inflammatory actions also contribute to its analgesic effects.
- Aspirin also acts to reduce fever by causing centrally-mediated peripheral vasodilation and sweating.
What is the mechanism of action of aspirin?
Asprin has other modes of action which are less well-understood, including affecting mitochondria and reducing inflammation by at least two other mechanisms.
What are the listed indications for aspirin?
Suspected AMI, chest pain, or ACS
What are the listed indications for aspirin?
In non-prehospital arenas, aspirin has been used as a prophylactic for DVT in air travellers, to treat Kawasaki disease in children and investigated as an anti-cancer drug.
What are the listed contraindications for aspirin?
Hypersensitivity
What are the listed contraindications for aspirin?
Hypersensitivity to ibuprofen or naproxen may indicate hypersensitivity to aspirin.
What are the listed precautions for aspirin?
Peptic ulcer disease, asthma
What are the listed precautions for aspirin?
Some sources include hemophilia and other disorders likely to result in excessive bleeding (such as Dengue fever).
What are the listed side effects for aspirin?
Overdose may result in considerable toxicity with dizziness, N/V, abdominal pain, thrombocytopenia, easy bruising, and/or metabolic acidosis.
What are the listed side effects for aspirin?
Use of aspirin in children and teenagers can increase the likelihood of them devloping Reye's syndrome.

Large doses of aspirin can cause tinnitus.
What are the listed interactions for aspirin?
- Incompatible with uricosuric agents
- Anticoagulants increase the risk of bleeding
What are the listed interactions for aspirin?
Ibuprofen can negate the antiplatelet effect of aspirin used for cardioprotection and stroke prevention.
What is the dosage and route of aspirin?
160 - 325mg PO (chewable) tablets
What is the dosage and route of aspirin?
"Baby aspirin" are typically 81mg
What is the best-known trade names for metoprolol?
Lopressor and Toprol-XL
What is the best-known trade names for metoprolol?
Lopressor is metoprolol tartrate which is immediate-release whereas Toprol-XL is metoprolol succinate which is an extended-release formulation.
What is the functional class of metoprolol?
Class II antidysrhythmic (beta blocker).
What is the functional class of metoprolol?
Other beta blockers include carvedilol (Coreg), labetalol (Normodyne, Trandate) and propranolol (Inderal). Most have generic names ending in "-lol".
What is the mechanism of action of metoprolol?
Selective inhibitor of beta-1 adrenergic receptors located on cardiac muscle. Completely blocks beta-1 receptors, with little or no effect on beta-2 receptors at doses less than 100mg. Reduces heart rate, cardiac output at rest and during exercise, and lowers BP.
What is the mechanism of action of metoprolol?
Lopressor can mask tachycardia associated with hypoglycemia.
What are the listed indications for metoprolol?
- Chest pain associated with AMI, ACS
- Angina pectoris
- SVT
What are the listed indications for metoprolol?
Metoprolol is frequently prescribed for off-label use in anxiety disorders.
What are the listed contraindications for metoprolol?
- Hypersensitivity
- Sinus bradycardia
- Heart block greater than 1st degree (except in patients with a functioning artificial pacemaker)
- Cardiogenic shock (BP < 100mmHg)
- Uncompensated cardiac failure
- Pregnancy (2nd and 3rd trimesters)
- Asthma
- COPD
What are the listed contraindications for metoprolol?
Metoprolol is pregnancy category C in the US: "Risk can not be ruled out- Adequate, well-controlled human studies are lacking, and animal studies have shown a risk to the fetus or are lacking as well.
There is a chance of fetal harm if the drug is administered during pregnancy; but the potential benefits may outweigh the potential risk."
What are the listed precautions for metoprolol?
- Impaired hepatic or renal function
- CHF controlled by digitalis or diuretics
- Do not mix with IV calcium channel blockers
What are the listed precautions for metoprolol?
AstraZeneca, the manufacturer of Toprol-XL, also lists hyperthyroidism and arteriosclerosis.
What are the listed side effects for metoprolol?
- Bronchospasm
- Bradycardia
- Palpitations
- Edema
- CHF
- Reduced peripheral circulation
- Drowsiness
- Insomnia
What are the listed side effects for metoprolol?
Abrupt cessation of metoprolol therapy (or other beta blockers) may cause a thyroid storm
What are the listed interactions for metoprolol?
- Drugs which slow AV conduction such as digoxin as the effects may be cumulative with beta-blockers
- Glucagon: metoprolol may blunt the hyperglycemic action of glucagon
- Verapamil or diltiazem may have synergistic pharmacological effects when taken concurrently with beta-blockers
What are the listed interactions for metoprolol?
Drugs that inhibit CYP2D6 such as quinidine and fluoxetine may increase metoprolol plasma concentration, which can decrease its beta-1 selectivity.
What is the dosage and route of metoprolol?
5mg slow IVP (over 2-5 minutes) q5 minutes x3 (max of 15mg)

Acute MI:
Maintain systolic BP>100 and heart rate >60/minute

SVT:
Maintain heart rate 90-100/minute
What is the dosage and route of metoprolol?
Home PO dosages of metoprolol are in the range of 100-450mg/day
What is the chemical formula for sodium bicarbonate?
NaHCO₃
What is the chemical formula for sodium bicarbonate?
The "bi-" prefix means that the anion is the result of one hydrogen ion (H⁺) being added to the carbonate ion (CO₃²⁺)
What is the functional class of sodium bicarbonate?
- Electrolyte
- Alkalinizing Agent
What is the functional class of sodium bicarbonate?
Sodium bicarbonate can also be used as an exfoliant or mouthwash.
What is the mechanism of action of sodium bicarbonate?
Given IV, it immediately raises the pH of blood plasma by buffering excess H⁺ cations. Excess bicarbonate ions are excreted in the urine, thus rendering the urine less acidic.
What is the mechanism of action of sodium bicarbonate?
Sodium bicarbonate is integral to the body's acid-base homeostasis.
What are the listed indications for sodium bicarbonate?
- Severe acidosis (refractory to hyperventilation)
- Tricyclic antidepressant (TCA) overdose
- Barbiturate overdose
- Known hyperkalemia
What are the listed indications for sodium bicarbonate?
Sodium bicarbonate has occasionally been used to treat ASA overdoses.
What are the listed contraindications for sodium bicarbonate?
None in the emergency setting
What are the listed contraindications for sodium bicarbonate?
Some sources list as contraindications patients with metabolic and respiratory alkalosis and in patients with hypocalcemia in which alkalosis may produce tetany. These are the exact opposites of the indications for the drug!
What are the listed precautions for sodium bicarbonate?
- Not recommended for routine use in cardiac arrest
- Dosage must be specific to prevent metabolic alkalosis and is thus weight-based
What are the listed precautions for sodium bicarbonate?
In patients with diminished renal function, administration of solutions containing sodium ions may result in sodium retention.
What are the listed side effects for sodium bicarbonate?
- Severe tissue damage if extravasation occurs
- May produce paradoxical acidosis that can depress cerebral and cardiac function
- May cause extracellular alkalosis, which may reduce the concentration of ionized calcium, decrease plasma potassium, and induce a left shift of the oxyhemoglobin curve which may inhibit oxygen release to the tissues and induce malignant arrhythmias
What are the listed side effects for sodium bicarbonate?
The tissue acidosis in cardiac arrest is caused by CO₂ accumulation and that is what bicarbonate administration increases when it combines with H⁺ ions.
What are the listed interactions for sodium bicarbonate?
- Will deactivate most catecholamines and vasopressors
- Sodium bicarbonate will precipitate when used in conjunction with calcium chloride
What are the listed interactions for sodium bicarbonate?
Sodium bicarbonate can react with sodium polystyrene sulfonate, a different treatment for hyperkalemia, and grossly interferes with it.s function.
What is the dosage and route of sodium bicarbonate?
1mEq/kg IVP/IO push, repeat at 0.5mEq/kg q10 minutes prn
What is the dosage and route of sodium bicarbonate?
The (molar) equivalent, abbreviated Eq, is the amount of a substance that will react with or supply one mole of hydrogen ions (H+) in an acid–base reaction. The prefix "m" is the SI "milli".
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Term:
Definition:
Definition:

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