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Adenosine, also known as Adenocard
Adenosine Class Antiarrhythmic
Adenosine Actions It slows the conduction of electrical impulses at the AV node.
Adenosine Indications Use for Stable re-entry SVT. It does not convert A-Fib, atrial flutter, or V-Tach.
Adenosine Adverse Effects Generally mild and short-lived: Sense of impending doom, flushing, chest pressure, throat tightness, numbness. Patients will have a brief episode of asystole.
Adenosine Contraindications Sick sinus syndrome, second or third degree heart block, or poison/drug-induced tachycardia.
Adenosine Dosage: Adult: 6mg rapid IV, IO followed by 20ml rapid saline flush. If the first dose does not eliminate the rhythm in 1 – 2 minutes, 12mg rapid IV, IO, repeat a second time if required.
Adenosine Dosage: Pedi: >50kg Adult dosing.
Adenosine Dosage: Pedi: < 50kg dose 0.1mg/kg IV, IO (max dose 6mg) followed by >/= 5ml saline flush; may repeat at 0.2mg/kg (max dose 12mg).
Adenosine Special Considerations Cau'n with preexist. bronchospasm and hist. of AF.Elderly patients with no history of PSVT should be evaluated for dehydration and a rapid sinus tachycardia requiring volume fluid replacement rather than simply treated with Adenosine.Pregnancy class C.
Aspirin Class Antiplatelet, nonnarcotic analgesic, antipyretic
Aspirin Actions Aspirin blocks formation of thromboxane A2, which causes platelets to aggregate and coronary arteries to constrict.
Aspirin Indications Fever, inflamation, angina, acute MI, and patients complaining of pain, pressure, squeezing, or crushing in the chest that may be cardiac in origin.
Aspirin Adverse Effects Anaphylaxis, angioedema, bronchospasm, bleeding, stomach irritation, nausea/vomiting.
Aspirin Contraindications GI bleeding, active ulcer, hemorrhagic stroke, bleeding disorder, children witn chicken pox or flu-like symptoms, and known sensitivity.
Aspirin Dosage: Myocardial Infarction: Adult: 160-325mg PO (four 81mg baby aspirin), 300mg rectal suppository.
Aspirin Dosage: Myocardial Infarction: Pedi: 3-5mg/kg/day to 5 -10mg/kg/day given as a single dose.
Aspirin Dosage: Pain or Fever: Adult: 325-650mg PO (1-2 tablets) every 4-6 hours.
Aspirin Dosage: Pain or Fever: Pedi: 60-90mg/kg/day in divided doses every 4-6 hours.
Aspirin Special Considerations Pregnancy class C except the last 3 months of pregnancy, when aspirin is considered pregnancy class D.
Morphine Sulfate Class Opiate agonist, schedule C-II.
Morphine Actions Binds w/ opioid rcptrs, inducing hypotension by dprsn of vasomotor cntrs of brain, and releases histamine. In mgmt of angina, reduces stim'n of the symp'c nervous system caused by pain an anxty, which reduces heart rate, cardiac wk, and myocardial O2
Morphine Indications Moderate to severe pain, including chest pain associated with ACS, CHF, and pulmonary edema.
Morphine Adverse Effects Respiratory dprsn, hypotension, nausea/vomiting, dizziness,sedation, diaphoresis, euphoria, dysphoria, worsening of Bradycardia and heart block in some patients with acute inferior wall MI, seizures, cardiac arrest, anaphylactic reactions.
Morphine Contraindications Respiratory depression, shock, known sensitivity. Use caution in hypotension, acute bronchial asthma, respiratory insufficiency, head trauma.
Morphine Dosage: Pain: Adult: 2.5-15mg IV, IO, IM or sub-Q.
Morphine Dosage: Pain: Pedi: 6months-12 years; 0.05-0.2mg/kg IV, IO, IM, sub-Q. Younger than 6 months: 0.03-0.05mg/kg IV, IO, IM, sug-Q.
Morphine Dosage: Chest pain associated with acute coronary syndrome, CHF, and pulmonary edema (Small doses and reevaluate patient. Large doses may lead to respiratory depression and worsen the patient’s hypoxia): Adult: 2-4mg slow IV, IO over a 1-5 minute period with increments of 2-8mg repeated every 5-15 minutes until patient relieved of chest pain.
Morphine Dosage: Chest pain associated with acute coronary syndrome, CHF, and pulmonary edema (Small doses and reevaluate patient. Large doses may lead to respiratory depression and worsen the patient’s hypoxia): Pedi: 0.1-0.2mg/kg/dose IV, IO.
Morphine Special Considerations *Monitor vital signs and pulse oximetry closely. Be prepared to support patient’s airway and ventilations. *Overdose should be treated with Naloxone (Narcan). *Pregnancy class C.
Nitroglycerine Class Anti-anginal agent.
Nitroglycerine Actions Rlxs vascular smooth muscle, dialating peripheral arteries and veins. This causes cooling of venous blood and decreases venous return to the heart, which decr's preload. Also, reduces left ventricular systolic wall tension, which decreases afterload.
Nitroglycerine Indications Angina, ongoing ischemic chest discomfort, hypertension, myocardial ischemia associated with cocaine intoxication.
Nitroglycerine Adverse Effects Headache, hypotension, brachycardia, light-headedness, flushing, cardiovascular collapse, and methemoglobinemia.
Nitroglycerine Contraindications Hypotension, severe brachy or tachycardia, increased ICP, intracranial bleeding, erectile dysfunction medication, known sensitivity to nitrates. (Use caution in anemia, closed-angle glaucoma, hypotension, postural hypotension, uncorrected hypovolemia).
Nitroglycerine Dosage: Sublingual tablets: Adult: 1 tablet (0.3-0.4mg) at 5 minute intervals to a max of 3 doses.
Nitroglycerine Dosage: IV Bolus: Adult: 12.5-25mcg
Nitroglycerine Dosage: IV infusion: Adult: 5mcg/minute; may increase rate by 5-10mcg per minute every 5-10 minutes as needed. End points of dose titration for nitroglycerin include a drop in the blood pressure of 10%, relief of chest pain, and return of ST-segment to normal on a 12-lead ECG.
Nitroglycerine Dosage: Translingual spray: Adult 1 (0.4mg) spray at 5 minute intervals to a max of 3 sprays.
Nitroglycerine Dosage: Infusion: Pedi: Initial pedi infusion is 0.25-0.5mcg/kg/minute IV, IO titrated by 0.5-1mcg/kg/minute. Usual required dose is 1-3mcg/kg/minute to a max of 5mcg/kg/minute.
Nitroglycerine Special Considerations *Patient with right ventricular MI can result in hypotension. *Pregnancy class C.
Nitroglycerine Dosage: Ointment: Adult: 2% (Nitro-Bid ointment) apply 1-2 inches of paste over chest wall, cover with transparent wrap, and secure with tape.
Lorazapam, also known as Ativan
Lorazapam Class Benzodiazepine; schedule class IV
Lorazapam Actions Binds to benzodiazepine receptor and enhances the effects of the brain chemical GABA, an inhibitory transmitter, and may result in a state of sedation, hypnosis, skeletal muscle relaxation, anticonvulsant activity, coma.
Lorazapam Indications Procedural sedation induction, anxiety, status epilepticus.
Lorazapam Adverse Effects Headache, drowsiness, ataxia, dizziness, amnesia, depression, dysarthria, euphoria, syncope, fatigue, tremor, vertigo, respiratory depression, paradoxical CNS stimulation.
Lorazapam Contraindications Known sensitivity to Lorazapam, benzodiazepines, polyethylene glycol, propylene glycol, or benzyl alcohol; COPD; sleep apnea; shock; coma; acute closed-angle glaucoma.
Lorazapam Dosage: Analgesic and Sedation: Adult: or 0.44mg/kg IV, IO, whichever is smaller.
Lorazapam Dosage: Analgesic and Sedation: Pedi: 0.05mg/kg IV, IO. Each dose should not exceed 2mg IV, IO.
Lorazapam Dosage: Seizures: Adult: 4mg IV, IO given over 2-5 minutes; may repeat in 10=15 minutes (max dose 8mg in a 12 hour period).
Lorazapam Dosage: Seizures: Pedi: Adolescents: 0.07mg/kg slow IV, IO given over 2-5 minutes (max single dose 4mg). May repeat in 10-15 minutes (max dose 8mg in a 12 hour period).
Lorazapam Dosage: Seizures: Pedi: Children and infants: 0.1mg/kg slow IV, IO given over 2-5 minutes (max single dose 4mg). May repeat at half the original dose in 10-15 minutes if seizure activity resumes.
Lorazapam Dosage: Seizures: Pedi: Neonates: 05mg/kg slow IV, IO given over 2-5 minutes. May repeat in 10-15 minutes.
Lorazapam Special Considerations *Be prepared to support the patient’s airway and ventilation. *Pregnancy class D.
Dexamethasone, also known as Decadron
Dexamethasone Class Corticosteroid
Dexamethasone Actions Reduces inflammation and immune response.
Dexamethasone Indications Various inflammatory conditions, adrenal insufficiency, nonresponsive forms of shock.
Dexamethasone Adverse Effects May cause; Nausea/vomiting, edema, hypertension, hyperglycemia, and immunosuppression.
Dexamethasone Contraindications Fungal infections, known sensitivity.
Dexamethasone Dosage: Adult: 1-6mg/kg IV to a max dose of 40mg.
Dexamethasone Dosage: Pedi: 0.03-0.3 mg/kg IV, IO divided into doses every 6 hours.
Dexamethasone Special Considerations Pregnancy class C.
Flumazenil, also known as Romazicon
Flumazenil Class Benzodiazepine receptor antagonist, antidote
Flumazenil Actions Competes with benzodiazepines for binding at the benzodiazepine receptor, reverses the sedation effects of benzodiazepines.
Flumazenil Indications Benzodiazepine over-sedation.
Flumazenil Adverse Effects Re-sedation, seizures, dizziness, pain at injection site, nausea/vomiting, diaphoresis, headache, visual impairment.
Flumazenil Contraindications Cyclic antidepres. overdose; life-threat. cndtns that rqr tx w/ benzo such as status epilepticus and intracranial hypertnsn; known sens. to Flum. or benzo. Use cau whr thr is poss. of unrecgnzd benzo dependence in ppl who hv a hist of sub. abuse who r
Flumazenil Dosage: Adult: Initial dose, 0.2mg IV, IO over a 15 second period. If desired effect is not observed after 45 seconds, administer a second dose. Doses can be repeated until a total dose of 1mg has been administered.
Flumazenil Dosage: Pedi: Older than one 1 year, 0.01mg/kg IV, IO given over a 15 second period. May repeat in 45 seconds, and then every minute to a max cumulative dose of 0.05mg/kg or 1mg, whichever is the lower dose.Special Considerations:
Flumazenil Special Considerations Monitor for signs of hypovent'n and hypoxia for approx 2 hr. If half-life of benzo is longer than Flum, and addt'l may be needed. May precipitate wthd'l symps in ppl dep. on benzo. Flum has not bn shwn to benefit ppl who hv overdos. Pregnancy class C.
Ketolorac, also known as Toradol
Ketolorac Class NSAID (non-steroidal anti-inflammatory drug)
Ketolorac Actions It inhibits the production of prostaglandins in inflamed tissue, which decreases the responsiveness of pain receptors.
Ketolorac Indications Use for Moderately severe acute pain.
Ketolorac Adverse Effects It may cause Headache, drowsiness, dizziness, abdominal pain, dyspepsia, nausea/vomiting, diarrhea.
Ketolorac Contraindications Hist of peptic ulcer disease or GI bleed, ppl with renal insuf, hypovolemic ppl, prgncy (3rd trimester), nursing moms, allergy aspirin or other NSAIDS, stroke or spctd storke or head trau, need for mjr surg in the immed or near future (within 7 days).
Ketolorac Dosage: (Note: The following regime applies to single dose administration ONLY. IV, IO administration should occur over a period of at least 15 seconds). Adult: 65 years: 30mg IV, IO or 60mg IM.> 65 years: 15mg IV, IO or 30mg IM.
Ketolorac Dosage: Pedi: 0.5mg/kg IV, IO to a max dose of 15mg, or 1mg/kg IM to a max dose of 30mg.
Ketolorac Special Considerations Pregnancy class C; class D in 3rd trimester.
Created by: 1300311346