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Parameds_complete

P53 med list

General(Trade)MOA or PCOLOnset/durationIndicationsContraindicationsAdverse EffectsDoseNotes
Adenosine (Adenocard) Atypical AntiArrythmic/edogenous nucleoside/prevents or term reentry/dec. automaticity imm 10-30sec PSVT/WPW/WCTach KnownVtach/hypersens/Afib/Aflut/av blocks flush/metalic tst/hypotens/asystole/dizzi/cp rapid 6mg q2 repeat 12mg q2 12mg PED: 0.1-0.2mg/kg repeat double Methylxanthines antagonize actions of adenosine
Lidocaine (Xylocaine) Class1 antiarry/k+ channel block/neg dromo/dec auto/prev or term reentry/local anesthetic 30-90s/10-20m PVCs/Vfib/plvtach/vent_tach/wctach/prophyl Hypersens/adv_av_blk/brady/wpw Myocard depress/cns depres (seizure/tinni/drowsi) IV-vfib 1.5mg/kg q3 repeat half/other 1-1.5mg/kg repeat half q5-10 max 3mg/kg inf: 1g in 250cc at 2-4mg/min PED:1mg/kg inf:20-50mcg/kg/mn Beta blck increase effect/flush between drug lido changes pH
Procainamide (Pronestyl/Procard) Na+ channel block/works to depress excitability/neg dromo/ dec automaticity/inc fibrill thres 30-90s PVC/Vtach/Vfib/plvtach all refract lido/WPW/Afib/wctach hypersens/torsades/adv_av_blk/brady myocard depress/av blk/ekg change IVP 20-30mg/min until 17m or arryth gone or hypotension or widened qrs/ inf 1g in 250ml @1-4mg/min PED: IV 3-6mg/kg inf: 20-80 mcg/kg/min add to lido
Bretylium Tosylate (Bretylol) Class 3 antiarryth/inc fibr thres/ slight bp increase at first/prev or term reentry 2-3m for Anit Fib/20min for anti-arryth/last 6-24hr Vfib/plvtach/wctach refract to classI adv_av_blk/brady/digoxin toxicity/ hypotens/brady/bp & hr increase/N/volatile vomiting IVP 5mg/kg (very slow IVP 8 min) repeat 10mg/kg q5-15 MAX 30 infuse: 1-2mg/mn 1g in 100ml
Amiodarone (Cordarone) K+channelblock/antidisrythmic/relax vascular smooth muscle/alpha β blockade 5-15min/var Vfib/plvtach/Afib/unstableVtach Adv_av_blk/brady/hypotens/torsades/iodine or shellfish allergy/TCA use PEA/Hypotens/Brady/CHG/Naus/Abnormal Liver/Fever/Thrombocytopenia Vfib 300mg/Vtach 150-300mg over 5-10min/max 2.2g in 24hr/INF: 300mg in 250ml D5W @1mg/min for 6min Nabicarb precipitate/increase digoxin/enhance other antiarryth
Verapamil (Isoptin/Calan) Class 4 antiarry/Ca+channelblk/neg dromo/prev & end rentry/dec automat/decreas02/dilate coronary art/inhibit vasospasm 5-10m Stable PSVT/decrease ventricular rate n Afib or Aflutter CHF/Adv_av_blk/Hypotens/wctach/vtach/WPW/Brady Hypotens/brady/av_blk/dizzi/headach/OD:Ca+ 2.5-5mg (slow IV 2min)/repeat 5-10mg q15-30 MAX 20mg PED: 0.1-0.3mg/kg beta blck increase effect lower dose
Diltiazem (Cardizem/Lyoject) Ca+channelblk/prev vasospasm/dilate cor art/dec automat/neg dromo/dec O2 2-5m for 1-3hr PSVT/Afib/Aflut Hypersens/Adv_av_blk/Brady/Hypo/CHF/wctach Brady/Hypotens/CHF/AV_blk/dizzi/PVC OD:Ca+ 0.25mg/kg over 2m repeat 0.35mg/kg over 15min/ Inf: 125mg in 100ml @ 5-15mg/hr supplied 25or 50mg bottle Beta blockers increas effect
Nifedipine (Procardia/Adalat) Ca+channelblk/prev vasospasm/decr after and preload/decr platelet aggr/dec O2/no effect on conduction 15-30m fro 6-8h Hypotensive Emerg/Angina Hypersens/Hypotension Hypotens/Flush/dizzi/Hedache OD:Ca+ 10-20mg capsule puncture and squeeze under tng/bite capsule swallow NOPEDI Beta blockers increas effect/ CNS depress increas eff
Calcium Chloride (CaCl) Electrolyte/pos inotropic/import blood and nerve and muscle funct 5-15min/var Hyperkalemia/Hypocalcemia/Ca+channelblk OD/MagSulf OD Vfig/suspect digoxin toxicity (bradycardia/halo effect vision) metal tst/hypotension/tissue necrosis on infiltration 2-4mg/kg q10 PED: 20mg/kg Sodium Bicarb precipit
Atropine Sulfate (Atropine) Anticholergenic (comp blk of Ach)/+ chrono/+drom/+ automat/+ elect act/+afterload/inc O2 demand Immidiate for 3-5min Symptomatic Brady/some AV_blk/Asystole/PEA/Organophosphate poison none in cardiac arrest/tachycardia decrease bodily fluid/inc O2 demand/tachycardia/blurred vision/OD: Cholergenic (physostigmine) dead 1mg q3 MAX 3mg/Brady: 0.5-1mg q3 titrate to HR>60/Organic: 2-5mg IV or IM or both q5-15 PEDI 0.02mg/kg q3 Max 0.5mg none
Magnesium Sulfate Electrolyte/cofactor of enzyme/cns depressant/block neuromuscular/periph & coron dilation/bronchodilation/dec plate agr/dec fatal MI Immediate Eclamptic toxemia/Refract Vfib/plvtach/torsades/mi/asthma AV Block OD: can kill due to Hypovol Brady/Hypotens/flush/cns depress/sweating/ OD:Ca+ Toxemia 1-4mg over 3min (watch BP)/Other: 1-2mg in 10-100mls over 1to2 min CNS Depress increas effect
Isoproterenol (Isuprel) Synth catecholamine/sympathomimetic/beta agonist (b1 most)/inc chrono ino dromo/bronchodil/periph dilation/significant O2 increase Immediate Symptomatic Brady/some AV_blk/Torsades refract other Hypersens/tachycardia/cardiac arrest/vtach rapid massive incr O2 demand/sweats/flush/tachycardia OD: beta blockers Infusion only 1mg in 250ml @2-10mcg/min titrate to HR>60 or PVC occur Beta blockers decrease effect/ Bretylium inc effect/TCA incr effect
Epinephrine (Adrenaline) Alpha & Beta catecholamine/beta1 +inotropic and beta2 bronchodilation/alpha makes vasoconstriction afterload inc/inc elect act Immediate (1-2min CPR)/5-10min SC lasts 3-10min Vfib/plvtach/asystole/pea/anaphalaxys or severe allergenic/asthma or severe croup/symptomatic bradycardia none in cardiac arrest or anaphylaxis/hypersens to sulfite/unresolved hypovolemia/angina/hypertension/CHF Increase O2 dem/Hypertension/Tremors/ OD: alpha and beta blok/sulfites Standard 1mg q3/Intermediate 2-5mg q3/Escalating 1-3-5mg q3/Severe Croup 5mg 1:1000 in 5ml NS via nebulizer every 30min/Other 0.1-0.5mg 1:1000 SC or 0.1-1mg (1:10000)IVP/Inf: 1mg of 1:1000 in 250ml Bretylium and TCA increase/Beta block decrease
Dopamine (Intropin) Sympathomimetic/catecholamine/vassopressor/stimulates release of NE/Alpha beta dopaminergic effects/ mod dose: most beta +inotropic some alpha/high dose 10-20mcg/kg more alpha +vasoconstr <5m for 5-10min Cardiogenic shock/neurogenic shock/hemodynamic signifi hypotension w/o hypovolemia Hypersens/tachycardia/unresolved hypovolemia/phenochromocytoma (adrenal gland tumor) Tachycardia/Palpation/Hypertension/Increase O2/Tissue necrosis Infusion only 400mg in 250ml @2-20mcg/min titrate to HR>90 PEDI 2-20mcg/kg/min titrate to bp90 Beta blockers decrease effect/Bretylium increases
Dobutamine (Dobutrex) Sympathomimetic/synth catecholamine/vassopressor/Alpha beta effects/ inotropic/some renal dilation/minimal impact on HR/increase cardiac output coronary blood flow 1-2m 2-10m peak cardiogenic shock/hypotension after return of spontaneous circulation/hemodynamic signifi hypotension w/o hypovolemia/left heart failure Hypersens/unresolved hypovolemia/tachydisrythmia Hypotens/Tachycardia (dose related) Infusion only 250mg in 250cc @2-20mcg/kg/min titrate to 90bpm PEDI: 2-20mcg/kg/min titrate to BP Beta blockers decrease effect
Norepinephrine (Levophed) Sympathomimetic/Catecholamine/vassopressor/mostly Alpha with beta effects/vaso renal constriction/increase O2/ +chrono +ino immediate Cardiogenic shock/neurogenic shock/hemodynamic signifi hypotension w/o hypovolemia Hypersens/unresolved hypovolemia Hypertension/reflex brady/inc 02/tissue necrosis Infusion only 4mg in 250cc @0.5-30mcg titrate to BP 90 Beta blockers decrease effect/ Bretylium inc effect
Nitroglycerin (nitrostat/nitroliqual spray) vasodilator/relax smooth muscle(vaso)/inc coron blood flow/stop vasospam/dec pulm vasc res/dec pre & afterload/decrease O2 dem/inhibit platelet aggr/decrease bp SL-1-3m/TD 15-30m/IV immed lasts SL-30/TD 2-12h Ischemic Hrt Fail/Left Hrt Fail/MI/?hypertens? Hypersens/Hypotension/Head trauma (ICP increase) hedach/flush/hypotens/dizzi/reflex tachycardia/postural syncope SL:0.3mg /0.4mg/0.6mg q5 x 3/ TD 1/2 to 2in (15mg/in)/Infusion: 5mcg/min and increas 5-10mcg q5 titrate for effect CNS Depress increas effect
Amyl Nitrate Same as Nitro/causes oxidation of hemoglobin for methemoglobin/Methemoglobin reacts with cyanide and creates a molecule with less affinity than oxygen lowering toxicity 30s for 3-20m Cyanide poisoning none hedach/hypertension/dizzi crush 3ml ampule breath in for 30sec of each minute/ repeat as needed none
Aspirin (Acetacylic Acid ACA) Platelet inhibitor/decrease inflamation/inhibit prostaglandins 30-45m lasts 4hr New onset CP or AMI no signs or symptons of CVA GI Bleeding/Hypersensitive to Aspirin not coating GI Bleed/nausea/Increase PT & PTT Oral only chew 2-4 (81mg each) tablets 324mg/ use 2 if patient already on anticoagualants Increased effects with other anti-coagualants
Heparin Sodium anti-coagulant/prevents conversion of fibrogen into clot/affect active clotting process IX/XI/XII immediate Acute Myocardial infarction (Integrillin the super aspirin) Hypersens/Active bleed/recent surgery bleeding/chills/fever/backpain due to allergic reaction IV: loading 70u/kg ma 14-17u/kg/hr/ PEDI: 50u/kg then 7.5u/kg/hr can be used IV/Infursion/SC Beta blockers increas effect
Morphine Sulfate Schedule 2 narcotic opiod/analgesic/decrease pulmon edema via pooling/vasodilation/decr pre & afterload/anti-anxiety/decr O2/depress resp center immediate for 10-60m ischemic Chest Pain/Lft Hrt fail/?maybe single system trauma (anxiety) Hypersens/hypotens/resp depr/alter LOC/asthma/COPD/abd pain/head inj/hypovolemia resp Depr/NV/Altered LOC/CNS Depr/Flushin/Hypotens/OD: Naloxone IVP/IM/SC/IO/ 1-3mg q5 (give over 2min) PEDI: 0.1mg/kg increased effect wih other CNS depress
Naxolone (Narcan/Vitamin N) Narcotic antagonist/comp inhibition of opiod rec/prevents some opiod effect/no effect if opiod not present 1-2m IVP/3-5m IM or SC last 30-60m IV or 3-6hrs IM/SC Narcotics OD/coma of unknown origin/?use in alcohol coma? Hypersensitive NV/Acute Abstinence Syndrome/sweats/arrythmia IVP/IM/SC/ET/IO 0.4 - 2mg q5 titrated to response/ Pedi <5yr 0.1mg/kg q5 titrate Beta blockers increas effect
Furosemide (Lasix) Loop Diuretic/inhibits reabsorb of fluid in loop of Henley/peripheral vasodilation 5m vaso 10-20 diuretic for 2-4hrs Lft Hrt Fail/Cerebral Edema/?hypertensive crisis? Hypersens/Hypovolemia/Dehydration/Hypotensive NVD/Tinnitus/Hypotension/ loss of electrolytes OD: Fluids IVP/IM/IO 20-100mg over 2m/ PEDI : 1mg/kg increased effect wih other CNS depress
Diazepam (Valium) Sched 4 controlled/CNSdepressant/anticonvulsant(block spread)/sedative effects/muscle relax/induce retrograde amnesia/anti-anxiety imm(IV)/ 5-15(IM) for 15-60m Status Epilectipus/seizure/pre-cardiovert/pre-transcutaneous pacing/induction agents Hypersensitive/Hypotension/Respiratory Depress/Altered LOC CNS Depression/Hypotension OD: Romazicon (awaken RSI patient) /IV IM IO ET Rectal/2-10mg q 5-10m MAX 30mg PEDI: 0.25mg/kg (IV) 0.5mg/kg (PR) CNS Depress increas effect
Lorazepam (Ativan) Sched 4 controlled/CNSdepressant/anticonvulsant(block spread)/sedative effects/muscle relax/induce retrograde amnesia/anti-anxiety 1-5m Status Epilectipus/seizure/pre-cardiovert/pre-transcutaneous pacing/induction agents Hypersensitive/Hypotension/Respiratory Depress/Altered LOC CNS Depression/Hypotension OD: Romazicon (awaken RSI patient) IVB IM IO Rectal/2-4mg q15 to MAX 8mg PEDI: 0.05mg/kg - 0.2mg/kg q15m MAX 0.2mg/kg CNS Depress increas effect
Midazolam (Versed) Sched 4 controlled/CNSdepressant/anticonvulsant(block spread)/sedative effects/muscle relax/induce retrograde amnesia/anti-anxiety 1-3m for 2-6hr Status Epilectipus/seizure/pre-cardiovert/pre-transcutaneous pacing/induction agents Hypersensitive/Hypotension/Respiratory Depress/Altered LOC CNS Depression/Hypotension OD: Romazicon (awaken RSI patient) 2-2.5mg slowly may repeat to MAX 0.1mg/kg (IV only) CNS Depress increas effect
Diphenhydramine (Benadryl) Antihistamine/comp antagaonist fo hist/ block rec not release/prevent initiation and tranof sensory nerve impulse/sedative/antichlinergic/antiemetic immediate(IV) 5-10m(IM) for 1-2hrs Allergic reaction/anaphylaxis/phentothiazine OD Hypersens/Asthma/Alterd LOC/Cardiac History Drowsi/Dizzi/Hedache/Excitable(child)/wheez/thick secretion bronchial/chest tight/palpation/hypotens/blurred vision/dry mout/NVD IVP IO IM/ 10-100mg or 1mg/kg PEDI(2-12) 1-1.25mg/kg Beta blockers increas effect
Dexamethasone Sodium Phosphate (Decadron) Adrenal Corticosteroid (glucocoticoid type)/ Decreases Inflammation by decreasing leukocyte concetration (leukocyte fight infect) 4-8hrs Allergic Reaction/Anaphylaxis/Asthma (inc. status)/ Spinal cord inj/cerebral edema/?use in shock? Hypertension/ None in single dose Hypertension IVP/IM/IO 10-100mg or 1mg/kg PEDI: 0.25 - 1 mg/kg not
Sodium BiCarb Electrolyte/ Increase free buffer to decrease acidosis/Increase pH/ Reverses metabolic acidosis onset : 5-10m durat: 30-60m metabolic acidosis/ Barbituate OD(helps eliminate drup faster in urine)/TCA OD/Hyperkalemia Alkalosis/Hypocalcemia/Hypokalemia Alkalosis/Hypokalemia/Hypoxemia/Tissue Necr/Tetany - cramps/conv/muscle twitch/joint flexion IVP IO 1meq/kg repeat 0.5meq/kg q10 PEDI: 1meq/kg
Thiamine Vitamin B1/water soluble vitamin/needed for conversion of glucose to energy/ required for metabolism coma of unk etiology/delerium tremens/beriberi- B1 vitamin def/wernicke's encephalopathy/korsakoff's syndrome Hypersensitivity Hypotension IVP IM 50-100mg PEDI: none none
Dextrose 50% Nutrient/Carbohydrate/Increases circulating available glucose Hypoglycemia/coma of unk etiology/status epilepticus/diabetic code relative in CVA/hyperglycemia Tissue Necrosis IVP 25-50g PEDI: <2yr: D25 125-250mg/kg
Glucagon HCL Hormone prodcd by alpha cells of pancreas/ insulin antagonist/inc liver glycogenolysis/Increase brkdwn of glycogen to glucose/inhbt glycogen synthetase/rlx smoth muscle of gi tract/may incr cardiac contratility onset : 5m Hypoglycemia/Beta Blocker OD Hypersense N/V OD: support IVP IM SC IO 0.5-1mg q15m PEDI same INT none
Activated Charcoal Absorbent/binds & adsorbs toxins present in gi tract/once bound toxin excreted thru bowel Ingested Poison Hypersensitivity N/V Abdominal cramping/Constipation ORAL NG tube: bottles of 25g & 50g INT Don't administer w/ Syrup of Ipecac / Don't adminster to Pt with Alt LOC (use NG tube inst)
Oxygen Facilitates cellular energy metabolism Hypoxia/Ischemic Chest Pain/Respiratory Dist/Suspect CO poison/Trauma/Shock Known paraquat Poisoning non but CO2 1- 6L low/15L high
Bronchodilators (broad for all bronchodilator) Beta2 Agonist/ Sympathomimetic/Bronchodilation/smooth muscle relax of bronchiole/inhibit histamine release/mild vasodilation on 5-15m dur: 3-4hr Asthma/COPD/Pulmonary Edema Hypersens/relative in tachycard or MI Tachycardia/Palpation/Tremors/N/V/Arrythmia OD: Beta Blockers/Supportive dependent on specific Increased effect wih TCA/ Decrease effect with Beta blocker
Albuterol Sulfate (Proventil/Ventulin) Beta2 Agonist/ Sympathomimetic/Bronchodilation/smooth muscle relax of bronchiole/inhibit histamine release/mild vasodilation on 5-15m dur: 3-4hr Asthma/COPD/Pulmonary Edema Hypersens/relative in tachycard or MI Tachycardia/Palpation/Tremors/N/V/Arrythmia OD: Beta Blockers/Supportive 2.5-5mg PEDI: 1.25-2.5mg
Metaproterenol Sulfate (Alupent) Beta2 Agonist/ Sympathomimetic/Bronchodilation/smooth muscle relax of bronchiole/inhibit histamine release/mild vasodilation on 5-15m dur: 3-4hr Asthma/COPD/Pulmonary Edema Hypersens/relative in tachycard or MI Tachycardia/Palpation/Tremors/N/V/Arrythmia OD: Beta Blockers/Supportive 15mg PEDI: 7.5mg
Terbutaline Sulfate (Brethine/Brethaire) Beta2 Agonist/ Sympathomimetic/Bronchodilation/smooth muscle relax of bronchiole/inhibit histamine release/mild vasodilation on 5m dur: 1-4hr Asthma/COPD/Pulmonary Edema Hypersense/relative in Tachy/ MI Tachycardia/Tremors/N/V/Palpitations/Arrythmia SC 0.25mg q15-30/Inhaler 0.2-0.4mg (1-2 sprays) Increased effects TCA/Decreased effect Beta Blocker
Methylpredisolone Sodium Succinate (Solu-Medrol) Corticosteroid-type Glucocorticoid/Decrease inflammation/Alters airway hyperactivity on 1-2hrs Anaphylaxis/Severe Allergic Reaction/Asthma/Spinal Cord Trauma/Cerebral Edema/?use in shock? NONE Hypertens/CHF OD: supportive 40-125mg Asthma: 1-2mg/kg Spinal Cord Inj: 30mg/kg over 30min PEDI: same Furosimide could increase K loss/
Ipratropium Bromide (Atrovent) Anticholergenic/Parasympatholytic/Dries respiratory tract secretions/Block Acetylcholine Receptors (inhibit parasympathetic) peak 1.5-2hr / duration: 4-6hrs Asthma/COPD Hypersense Palpitation/Anxiety/Dizzi/N/V/Headache 500mcg in 2.5ml saline usually deliver w/ Beta agonist
Hydrocortisone Short acting synth steroid/inhibits formation of histamine/increases response to circulating catecholamines on immediat/ peak 4-8hr dur 1-1.5 days Reduce Inflamation due to allergic reaction/severe anaphylaxis/asthma/COPD Cushings Synd/ Benzyl Alcohol sensitive Leukocytosis/hyperglycemia/incrased infection/decreased wound healing/Increase rat of death in sepsis Anaph shk: IV IO IM 100-500mg PEDI: 2-4mg/kg/day (MAX: 500mg)/Adrenal Insuff: same PEDI: 1-2mg/kg/ Asthma: same PEDI 1mg/kg
Fentanyl Citrate (Sublimaze) Narcotic analgesic/chemically unrelated to morphin but similar reaction/50 to 100 times more potent than Morphine/ less emetic effect/duration of action Immediate(IV) Peak 5-15m(IV) Duration: 30-60m halflife 6-8hr Pain Mgmt/RSI Adjunct/Maintenace of Analgesia Severe Hemorrhage/Shock/Hypersense CNS: sedation/euphoria/dizzi/diaphoresis/delirium CV: hypotension/bradycardia/circulatory depression/ Eyes: Miosis/blurrred 1mcg/kg MAX 150mcg slow IV 1m (2-3 better)/ same can be used nasaly can dilute with NS for easy administration PEDI: 1.7 - 3.3 mcg/kg 2-12yr
Ondansetron (Zofran) Antiememtic ON 30m for 3-6hr adult 2-3hr child Use to prevent nausea & vomiting (typically given to help with pain med) Hypersensitive >10% cardiovasc (malaise/ fatigue)/CNS: Headache Adult: 4mg IV/Child: <30kg 1mg/>30kg 2mg
Vassopressin (Pitressin) Hormone Vassopressor/polypeptide hormone extracted from posterior pituitary glands of animals/ Possess Pressor and anitdiuretic properties Onset: variable/peak: variable/duration: 30-60min/half: 10-20 Need for increase in peripheral vascular resistance during cpr non during CPR/chronic nephritis/ischemic Hrt dis/PVCs skin blanch/abdominal cramps/nausea/hypertension/bradycardia/minor disrythmia 40 units IV (replaces EPI during CPR 2nd) PEDI: same None in ACLS
METOPROLOL (Lopressor) Selective Beta Antagonist/Block both B1 and B2 but mostly B1 Onset Immediate - Peak 20m- Duration 13-19hr halflife 3-4hr Used in patients with MI/ or suspect MI that are hemodynamically stable HR<45bpm/SysBP<100/CHF/early or late signs of shock/advanced av block/ 1st block PR wave >0.24s Bradycardia/Hypotens/lethargy/CHF/Dyspnea/wheezing/weakness 5mg IVP slow if stable vitals still can give 5mg/ total 15mg MAX NOT to be given to a patient that has received Verapamil
Created by: rdslack