Emergency Medical Pharmacology Flashcards

Terms Definitions
Albuterol
CLASS: Sympathomimetic Agonist (Selective B2 adrenergic receptors)

MOA: Bronchodilation

INDIC: Asthma; Bronchospasm; COPD; Hyperkalemia

CONTRA: Caution to elderley, CVD, HTN

SIDE EFFECTS: Palpatations, anxiety, dizziness, headache, nervousness, tremor, hypertension, arrhythmias, chest pain, nausea/vomiting

DOSE: 2.5mg nebulized
Atropine
CLASS: Anticholinergic

MOA: Parasympatholytic, causes bronchodilation, drying of respiratory secretions, blocks acetylcholine receptors thus inhibiting parasympathetic stimulation.

INDIC: Symptomatic Bradycardia, organophosphate poisoning, nerve agent

CONTRA: Known Hypersensitivity

SIDE EFFECTS: Palpitations, anxiety, dizziness, headache, nervousness, rash, nausea, vomiting

DOSAGES: Adult- Symptomatic Bradycardia/PEA, Asystole: 0.5-1.0mg IV, IO, ET. Max Dose- 3mg or 0.04mg/kg.

Adult Organophosphate Poisioning: 2-5mg until symptoms dissipate.

Pediatric PEA; Asystole: 0.02mg/kg 1.0mg max
D50
50% Dextrose in Water

CLASS: Carbohydrate

MOA: Elevates blood glucose levels rapidly

INDIC: Hypoglycemia, BGL< 60

CONTRA: IV with signs of infiltration

SIDE EFFECTS: Local venous irritation, necrosis if given through an infiltrated IV

DOSAGES: Adult: 25mg (50ml)

Pediatrics: D25 0.5-1ml/kg (may be premixed or eject out 25ml and draw 25ml of NS)
ASA
Asprin

CLASS: Platelet inhibitor and anti-inflammatory

INDIC: New chest pain suggestive of acute myocardial infarction. Signs and symptoms suggestive or a recent stroke (CVA)

CONTRA: Patients with known hypersensitivity to the drug.

SIDE EFFECTS: Heartburn, nausea, wheezing

DOSE: 160mg or 325mg by mouth (primarily by four 81mg chewable tablets)
Flumanzenil
Romazicon

CLASS: Benzodiazepine antagonist

MOA: Reverse the effects of benzodiazepines

INDIC: To reverse central nervous system respiratory depression associated with benzodiazepines

CONTRA: Do not administer as a diagnostic agent for Benzo OD; hypersensitivity. DO NOT ADMIN WITH MIXED OD OR IF PT HAS TRICYCLIC ANTIDEPRESSENT

SIDE: Fatigue, Headache, Nervouseness, Dizziness

DOSE: 0.2mg IV over 30 seconds. Max dose 1mg
Phenergan
Promethazine

CLASS: Phenothiazine antihistamine

MOA: Mild anticholinergic activity, anit-emetic, potentiates actions of analgesics, sedation.

INDIC: Nausea/Vomiting, motion sickness, potentiate the effects of analgesics, sedation.

CONTRA: Comatose states, patients with large amounts of depressants (including alcohol)

Side: Impair mental and physical ability. May cause severe venous irritation and phlebitis. If given intra-arterial may cause sever damage including the need for amputation. May also cause distonic reaction.

DOSE: 12.5mg-25mg IV (a lower dose for geriatrics 6.25mg)

NOTE: HAS BEEN KNOWN TO CAUSE RESPIRATORY DEPRESSION IN PEDIATRICS
Zofran
Ondansetron

CLASS: Anti-emetic

MOA: Selective blocking agent of serotonin 5-HT3 receptor type.

INDIC: Nausea/Vomiting

CONTRA: Hypersensitivity

SIDE: Diarrhea, headache

DOSE: 4mg IV (Adult) 0.2mg/kg IV (Pediatric)
Pitocin
Oxytocin

CLASS: Hormone (oxytocic)

MOA: Caues uterine contraction, lactation, slows postpartum vaginal bleeding

INDIC: Postpartum vaginal bleeding

CONTRA: Any condition other than postpartum bleeding; C-Section

SIDE: Anaphlyaxis, cardiac dysrhythmias

DOSE: IV 10-20units in 500ml until desired effect; 3-10units IM
Lorazepam
Ativan

CLASS: Benzodiazepine

MOA: Anticonvulsant, skeletal muscle relanxant.

INDIC: Major motor seizures, status epilepticus, premedication of cardioversion, acute anxiety states

CONTRA: Hypersensitivity

SIDE: Drowsiness, hypotension, respiratory depression

DOSE: (Adult) 0.5-2mg IV, IM
(Pediatric) 0.05-0.1mg/kg IV, IM, Rectal
Amiodarone
Coradarone

CLASS: Antidysrhthymic Group III

MOA: Prolongs action potential and refractory period, slows sinus rate, increases PR and QT interval, decreases PVR

INDIC: V-Fib, V-Tach, (Prmary success is with wide complex tachycardias with pulse)

CONTRA: Severe sinus node dysfunction, sinus bradycardia, high degree AV blocks

SIDE: Hypotension, nausea, anorexia, malaise, tremors, ventricular ectopic beats

DOSE: Adult V-Fib/V-Tach w/o Pulse: 300mg followed by 150mg. Wide Complex Tachycardia: 150mg over 10 minutes. (Pediatrcis) 5mg/kg
Lasix
Furosemide

CLASS: Potent Diuretic

MOA: Inhibits reabsorption of sodium chloride, promotes prompt dieresis, vasodilation (very small amount) potassium wasting

INDIC: CHF, Pulmonary Edema

CONTRA: Pregnancy, dehydration

SIDE: If kidneys are working; Electrolyte depletion. If kidneys are not working; little to no use.

DOSAGE: 20-40mg (double if already on lasix)
Vasopressin
CLASS: Hormone, vasoconstrictor

MOA: Potent vasoconstrictor

INDIC: Cardiac Arrest

CONTRA: None

SIDE: Blanching of skin, hypertension, bradycardia

DOSAGE: 40 Units IV Single dose
Lidocaine
Xylocaine

CLASS: Antidysrhthymic

MOA: Suppresses ventricular ectopy, increases ventricular fib threshold, reduces velocity of electrical impulse.

INDIC: V-fib, V-Tach, Malignant PVC’s, Pretreatment for intubation in head injury

CONTRA: High degree heart blocks, PVC’s in conjunction with bradycardia

SIDE EFFECTS: Anxiety, drowsiness, confusion, convulsions, widening QRS

DOSE: Adult: Bolus 1-1.5mg/kg followed by ½ initial dose. Drip Rate: 4:1 concentration 1-4mg/min.
Pediatric: 1mg/kg
Cardizem
Diltiazem

CLASS: Calcium Channel Blocker

MOA: Slows conduction through the atrioventricular node; Causes vasodilation; Decreases rate of ventricular response; Decreases myocardial oxygen demand.

INDIC: To control rapid ventricular rates associated with atrial fibrillation and flutter; Angina pectoris

CONTRA: Hypotension; wide complex tachycardia; Conduction system disturbances. Should not be used in patients receiving IV beta blockers or with severe hypotension.

SIDE EFFECTS: Nausea and vomiting; hypotension; Dizziness

DOSAGE: Adult: 1st dose is 0.25mg/kg bolus (typically 20mg) IV over 10 minutes, Followed by a second dose of 0.35 mg/kg IV slow IV push or IV drip over 10 minutes.

Do a 12 Lead, make sure QRS is no wider than .12
Adenosine
Adenocard

CLASS: Antidysrhthmyic

MOA: Slows atrioventricular conduction

INDIC: Symptomatic SVT

CONTRA: Second or third degree heart block; sick sinus syndrome; known hypersensitivity to the drug.

SIDE EFFECTS: Facial Flushing; Headache; Shortness of Breath; Dizziness; Nausea.

DOSAGE: 1st dose 6mg RIVP, 2nd dose 12mg RIVP, 3rd dose 12mg RIVP

Note: 60% of those who will respond to adenosine will respond to the a 6mg dose. 90% of patients will respond to a 12mg RIVP dose. Most EMS services will skip the 6mg dose and jump straight to the 12mg dose.
Dopamine
Intropin

CLASS: Sympathomimetic

MOA: Increases Cardiac contractility; Causes peripheral vasoconstriction

INDIC: Hemodynamically significant hypotension (systolic of 70-100mmHg) not resulting from hypovolemia; cardiogenic shock.

CONTRA: Hypovolemia in which pre-load has not been restored.

SIDE EFFECTS: Ventricular tachydysrhtymias; Hypertension; Palpitations

DOSAGE: 1-2mcg/kg/min Dopaminergic effects (renal)

2-10 mcg/kg/min stimulates beta adrenergic receptors (causing enhanced contractility, increased cardiac output, rise in BP)

10-20 mcg/kg/min stimulates alpha adrenergic receptors (causing peripheral and venous constriction)
Solumedrol
Methylprednisone

CLASS: Steroid

MOA: Anti-inflammatory; suppresses immune response, especially in allergic reactions

INDIC: Severe anaphylaxis, Asthma, COPD

CONTRA: none in the emergency setting

SIDE EFFECTS: GI bleeding; prolonged wound healing; suppression of natural steroids

DOSAGE: General usage: 125mg IV, IM (Adult)
Pediatrics: 1-2mg/kg
Epinephrine
CLASS: Sympathetic Agonist

MOA: Acts on the alpha and beta adrenergic receptors. Much more beta effects than alpha. Increase heart rate, cardiac contractile force, SVR, and increase BP

INDIC: Bronchial Asthma; anaphylaxis; Cardiac Arrest

CONTRA: Caution in patients with known cardiovascular disease; None in life threatening situations

SIDE: Palpitations, anxiety, headache, dizziness, nausea, vomiting, possible myocardial ischemia

DOSE: Adult Anaphylaxis: 0.3-0.5mg SC 1:1000.
Cardiac Arrest: 1mg IV 1:10,000
Pediatric Anaphyaxis: 0.01mg/kg SC 1:1000
Pediatric Cardiac Arrest: 0.01 mg/kg IV/IO 0.1mg ET
Benadryl
Diphenhydramine

CLASS: Antihistamine, H1 Histamine

MOA: Blocks histamine receptors, has some sedative effects.

INDIC: Anaphylaxis, Allergic Reactions, Dystonic Reactions due to phenothiazines

CONTRA: Asthma; Nursing Mothers, Hypotension

SIDE: Sedation; dries bronchial secretions; blurred vision; headache; palpitations.

DOSE: Adult: 25-50 mg IV, IM
Pediatric 2-5 mg/kg
Nitroglycerin
CLASS: Anti-anginal

MOA: Smooth muscle relaxant, reduces cardiac work, dilates coronary arteries, dilates systemic arteries

INDIC: Angina; Chest pain associated with MI, CHF

CONTRA: Children under 12 years of age, Viagra/Levitra within 24 hours, Cialis within 36 hours. Caution with right side MI involvement.

SIDE: Headache, hypotension

DOSE: Nitro Tab: 0.4mg = 1 tab (usually up to 3 tabs)
Nitro Spray: 0.4mg = 1 spray (usually up to 3 sprays)
Nitro Paste: 1inch transdermal = 15mg
Glucagon
CLASS: Hormone (anti-hypoglycemic agent)

MOA: Breakdown of glycogen to glucose (liver), inhibits glycogen synthesis; Elevates blood glucose level, increase heart rate.

INDIC: Hypoglycemia, beta-blocker overdose

CONTRA: Hypersensitivity to the drug

SIDE: Few in emergency situation

DOSE: Adult: 1mg IV, IM
Pediatric 0.03 mg/kg
Ipratropium
Atrovent

CLASS: Anticholinergic

MOA: Dries respiratory tract secretions

INDIC: Bronchial Asthma, Reversible bronchospasm associated with COPD

CONTRA: Hypersensitivity to the drug

SIDE: Palpitations, dizziness, anxiety, headache, nervousness

DOSAGE: 500mcg placed in neb with beta agonist
(Safety in children has not been established)
Toradol
Ketorolac

CLASS: Nonsteroidal anti-inflammatory (NSAID)

MOA: Anti-inflammatory, analgesic

INDIC: Mild to moderate pain (Kidney Stones)

CONTRA: Hypersensitivity, allergy to ASA, bleeding disorders, probability or surgery

SIDE: Edema, rash, heartburn, continued bleeding

DOSE: 30-60mg IV,IM Adult only
Thiamine (B1)
CLASS: Vitamin

MOA: Allows normal breakdown of glucose

INDIC: Coma of unknown origin, alcoholism, delirium tremors, malnutrition

CONTRA: None

SIDE: Rare

DOSE: 100mg IV,IM
Pralidoxime
2-pam; Protopam

CLASS: Cholinesterase reactivator

MOA: Reactivates cholinesterase in cases of organophosphate poisoning and nerve agents

INDIC: Severe organophosphate poisoning/nerve agent characterized by muscle twitching, respiratory depression and paralysis

CONTRA: Poisoning due to inorganic phosphates

SIDE: Excitement, Manic Behavior

DOSE: 600mg Auto Injector
Procainamide
Pronestyl

CLASS: Antidysrhtymic

MOA: Slows conduction through myocardium; Elevates ventricular fibrillation threshold; Suppresses ventricular ectopic activity.

INDIC: Persistent cardiac arrest due to ventricular fibrillation and refractory to lidocaine; PVC’s refractory to lidocaine; Ventricular tachycardia refractory to lidocaine.

CONTRA: High Degree Heart Blocks; PVC’s in conjunction with bradycardia.

SIDE: Anxiety; Nausea; Convulsions; Widening of QRS complex

DOSE: Adults Intial: 20mg/min IV drip until dysrhtymia is abolishised, or hypotension ensues, or RS complex is widened by 50% of its original width, or total of 17mg/kg has been given. Given by Slow IV bolus, IV Drip
Adult Mainanence: 1-4mg/min
Mag Sulfate
CLASS: Mineral

MOA: Magnesium is a physiological Ca Channel blocker as well as a smooth muscle relaxant.

INDIC: OB: Eclampsia
Cardiovascular: Severe refractory V-fib or Pulseless V-Tach; post-myocardia infarction as prophylaxis for dysrhthmias, and torsade de pointes (multifocal V-Tach
Respiratory: Severe bronchoconstriction

CONTRA: High degree AV blocks, dialysis patients.

SIDE: Flushing; sweating; bradycardia; decreased deep tendon reflexes, drowsiness, RESPIRATORY DEPRESSION, HYPOTENSION, hypothermia, itching.

DOSAGE:Eclampsia – 4g over 10min; V-Fib/V-Tach 2g IVP
Severe Bronchoconstriction: 2g over 10min
Calcium Cholride
CLASS: Electrolyte

MOA: Increases cardiac
contractility

INDIC: Acute hyperkalemia (elevated KI level); Acute Hypocalcemia (decreased Ca) level; Ca Channel blocker OD; Abdominal muscle spasm associated with spider bites and Portuguese man of War stings; antidote for Mag Sulfate.

CONTRA: Patients on digitalis

SIDE: Dysrhthymias (bradycardia and asystole)

DOSE: Adult: 1 Gram
Pediatric: 5-7mg/kg of a 10% solution.
Sodium Thiosulfate
CLASS: Cyanide Antidote

MOA: Converts cyanide to thiocyanate where it can be eliminated by the body.

INDIC: Cyanide poisoning

CONTRA: none in the emergency setting of Cyanide Poisoning

SIDE: Nausea; Vomiting; Psychosis.

DOSE: Adult: 12.5g IV; half original dose repeated as needed
Pediatric: 400mg/kg IV; half original dose repeated as needed.
Tylenol
Acetaminophen

CLASS: Analgesic, Antipyretic

MOA: Elevated pain threshold and antipyresis through action on the hypothalamic heat-regulating center

INDIC: Minor headache, muscle pains, bursitis, sprains, fever due to colds and “Flu”

CONTRA: Use caution if patient has hepatic problems

SIDE: In overdose situations may cause hepatic toxicity. Fatality rare in overdoses less than 15grams. Toxicity amount greater than 150mg/kg

DOSE: Adults and Children 12Y/O 1-2 tablets or capsules 3-4 times a day. Usual package is 325mg
Activated Charcoal
CLASS: Adsorbent

MOA: Adsorbs toxins by chemical binding and preventing GI adsorption.

INDIC: Poisoning following emesis or when emesis is contraindicated.

CONTRA: None in Severe poisoning

SIDE: Nausea, vomiting, constipation.

DOSE: 1g/kg (typically 50-78g) mixed with a glass of water to form a slurry.
Amyl Nitrate
CLASS: Nitrate

MOA: Causes coronary vasodilation, removes cyanide ion via complex mechanism

INDIC: Cyanide Poisoning (bitter
almond smell of breath)

CONTRA: None in cyanide poisoning

SIDE: Headache, hypotension, reflex tachycardia, nausea

DOSE: Adult-Inhalant broken and inhaled as needed
Pediatric-Same as Adult
Narcan
Naloxone

CLASS: Narcotic agonist

MOA: Reverses effects of Narcotics

INDIC: Narcotic overdoses with respiratory depression (opiates: morphine, dilauded, fentanyl, Demerol, heroin, percodan, methadone)

CONTRA: Hypersensitivity to the drug

SIDE: Rare

DOSE: Adult: 1-2mg IV,ET,IM,IN (as much as 4-6mg may be required)
Pediatric: 0.1mg/kg IV,ET,IM,IN
Vasotech
Enalapril

CLASS: ACE Inhibitory (Angiotensin-Converting Enzyme Inhibitor)

MOA: Inhibiting the conversion of Angiotensin I to angiotensin II, the angioensin/aldosterone sysem is suppressed and BP is lowered.

INDIC: Uncontrolled hypertension, CHF

CONTRA: Hypotension

SIDE: Hypotension

DOSE: Adult: 1.25mg IV
Succinylcholine
Acctine

CLASS: Neuromuscular blocking agent (depolarizing)

MOA: Skeletal muscle relaxants; paralytic

INDIC: To paralyze a pt for RSI to achieve intubation

CONTRA: Hypersensitivity to the drug, burns in the first 24 hrs, open globe injuries, hyperkalemia, rhabdomyolisis, crush injury

PRECAUTION: Not to be adminstered unless skilled personnel are present

SIDE: Hypotension; Bradycardia

DOSE:1-1.5mg/kg (40-100mg) in an adult IV
Pediatric: 1mg/kg IV
Vecuronium
Norcuron

CLASS: Paralytic (non-depolarizing)

MOA: Skeletal muscle relaxant including respiratory

INDIC: Paralysis to achieve RSI for ETI

CONTRA: Known hypersensitivity

PRECAUTION: Should not be administered unless skilled personnel are present

SIDE: Prolonged paralysis; hypotension; bradycardia

DOSE: (adult) 0.1mg/kg IV
Pediatric: 0.1mg/kg IV
Etomidate
Amidate

CLASS: Sedative/Hypnotic

MOA: Creates ultra short acting sed/hypnotic effect

INDIC: Induction agent for RSI; Sedative for other sedating measures.

CONTRA: Known hypersensitivity

SIDE: Myoclonic skeletal muscle movement; laryngospasm

DOSE: 0.1-0.3mg/kg IV over 15-30 seconds.
Pediatrics over 10: Same as adult
Not indicated in pt under 10 years old.
Dobutamine
Dobutrex

CLASS: Sympathomimetic

MOA: Increase cardiac contractility, little chronotropic activity

INDIC: Short term management of CHF

CONTRA: Should onlybe used in patients with an adequate heart rate

SIDE: Headache; Hypertension; Palpitations

DOSE: 2.5-20 mcg/kg/min. Mix 250mg in 500mL to get a concentration of 500mcg/mL
Pediatric: 2-20mcg/kig/min
Sodium Bicarb
CLASS: Alkalinizing agent

MOA: Combines with excessive acids to form a weak volatile acid, increases pH

INDIC: Late management of cardiac arrest, tricyclic antidepressant OD, First line for cardiac arrest due to hyperkalemia (dialysis pt), crush injury

CONTRA: Alkalotic states

SIDE: Alkalosis

DOSE: 1 mEq/kg follewd by 0.5mEq/kg every 10min usually one syringe contains (50mEq)
Diazepam
Valium

Class: Benzodiazepine

MOA: Anticonvulsant, skeletal muscle relaxant.

INDIC: Major motor seizures, status epilepticus, premedication for cardioversion, acute anxiety states

CONTRA: Hypersensitivity

SIDE: Drowsiness, hypotension, respiratory depression

DOSE: (Adult) 4 mg IV, IM repeat 2mg q 3-5 max 10mg
(Pediatric) 0.1 –0.3 mg/kg IV,IM,Rectal
Haloperidol
Haldol

CLASS: Tranquilizer, antipsychotic

MOA: Blocks Dopamine receptors in brain responsible for mood and behavior, antiemetic properties

INDIC: Acute psychotic episodes

CONTRA: Should not administered in the presence of other sedatives, not used in management of dysphoria caused by Talwin

SIDE: Physical and mental impairment

DOSE: 5-10mg IM

FDA JUST ISSUED A BLACK BOX WARNING FOR IV USE MAY PROLONG QT SEGMENT
Terbuataline
Brethine

CLASS: Sympathomimetic

MOA: Bronchodilator, increases heart rate

INDIC: Bronchial asthma, COPD, pre-term labor

CONTRA: Hypersensitivity

SIDE: Palpitations, tachycardia, PVC, anxiety, tremors, headache

DOSE: Adult –0.25 mg SQ
Pediatric –0.01 mg/kg SQ
Morphine
CLASS: Narcotic

MOA: Central nervous system depressant, peripheral vasodilation, decreases sensitivity to pain (causes dilatation through histamine release)

INDIC: Severe pain, Pulmonary Edema, MI chest pain

CONTRA: Head injury, volume depletion, undiagnosed abdominal pain, hypersensitivity

SIDE: Dizziness, altered LOC

DOSE: (Adult) 4 mg; repeat 2mg q 5-10; max 10mg or until relief of symptoms (burns require much more)
(Pediatric) 0.1 mg/kg max 5mg
Fentanyl
Sublimaze

CLASS: Narcotic

MOA: Binds to opiate receptors in the CNS, altering the response and perception of pain

INDIC: Narcotic pain relief, anti-anxiety

CONTRA: known hypersensitivity and BP<110 systolic

DOSE: (Adult) 50-75 mcg IM, IV, IO; Subsequent dose of 25 mcg q20-30 minutes to max of 200 mcg
(Pediatric) 1mcg/kg
Nitrous Oxide
CLASS: Gas

MOA: Central nervous system depressant

INDIC: Pain of musculoskeletal origin, particularly fx, burns, ischemic chest pain

CONTRA: Patients who cannot comprehend verbal instructions, intoxicated, Head injury with altered LOC, COPD, pneumothorax, abd pain

SIDE: Headache, dizziness, giddiness, nausea, vomiting

DOSE: Self admin. Fixed 50% nitrous and 50% O2blender
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