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Noncardiac drugs 119

Non-Cardiac drugs 119

QuestionAnswer
Dextrose Class Carbohydrate Hypertonic Solution
Dextrose Route and Dose Adult: 12.5-25 gm slow IV Pediatric: 12 and up: D50 25 gm may repeat x1 1 month - 12 years: D25 2ml/kg. May repeat x1 <1 month: D10 5ml/kg
Dextrose Actions 6-carbon sugar that is principle form of carbohydrate in the body.
Dextrose Indications Hypoclycemia Altered LOC Coma or seizure of unknown origin
Dextrose Precautions Obtain accucheck (blood glucose) if possible. Extravasation may cause tissue necrosis. May precipitate Wernicke’s encephalopathy in thiamine deficient patients.
Dextrose Contraindications Intracranial hemorrhage Increased intracranial pressure CVA in absence of hypoglycemia
Glucagon Class Pancreatic Hormone Insulin antagonist
Glucagon Route and Dose IM, IV, IO, IN Adult hypoglycemia: 0.5mg-1.0mg IM. May q 7-10 minutes. Adult b blocker or CC Blocker Tox: 1-5mg (average 3mg) IV/IO or 1mg IM if no access. Ped: Hypoglycemia: 1-12 yo 1mg IM. <1 yo 0.5mg IM BB/CC Blocker tox: 1-12 yo 1mg (consult med
Glucagon Action When administered or released by pancreas, increases breakdown of glycogen to glucose. May be ineffective in chronic states of hypoglycemia. Also has positive inotropic effect on heart. Onset within 1 minute Duration 60-90 minutes.
Glucagon Precautions Use caution with patients with cardiovascular disease. Patients with kidney or liver dysfunction.
Glucagon Adverse Reactions Hypotension Nausea/Vomiting Tachycardia
Glucagon Contraindication Hypersensitivity to proteins
Activated Charcoal Actions Binds and removes ingested toxins
Activated Charcoal Duration Continuous duration, as long as it remains in the GI tract and has not become saturated with toxin.
Activated Charcoal How supplied 2 types, Actidose Aqua and Actidose with sorbitol. Actidose w/sorbitol is charcoal mixed with a sugar alcohol which creates defecation through osmosis. It also sweetens the taste.
Activated Charcoal Indications Ingestion of pills, capsules, and tablets.
Activated Charcoal Contraindications NOT used for ingestion of liquids, corrosives, caustics, or petroleum products. Patients with ALOC or the possibility of becoming altered.
Activated Charcoal Time Best if administered within 30 minutes of ingestion.
Activated Charcoal Dose 1-2 Grams/kg PO/NG/OG Usually supplied in 125mL with 25G or 250mL with 50G
Narcan (Naloxone) Class Opioid Antagonist
Narcan (Naloxone) Action Competes for and replaces narcotic molecules in the brain.
Narcan (Naloxone) Onset and Duration Works within 1-2 minutes and lasts for about 30-60 minutes.
Narcan (Naloxone) Indications Used for respiratory depression due to narcotic overdose. Also, may be used in idiopathic coma.
Narcan (Naloxone) Contraindications Will NOT work in barbituate, GHB, Rohypnol or benzodiazepine overdoses.
Narcan (Naloxone) Precautions Use caution in narcotic dependent patients who may experience withdrawal. May cause projectile vomiting and/or VT if given too rapidly.
Narcan (Naloxone) Dose .4mg-2mg IV/IM/IN/SQ Normally .4mg titrated to respiratory rate
Diazepam (Valium) Class Benzodiazepine: sedative/hypnotic anticonvulsant anxiolytic amnesic muscle relaxant
Diazepam (Valium) Dose and Route Adult: SLOW IV/IM/Rectal Push (1 minute for each 5mg) 2.5mg increments titrated to achieve effect (usually up to 10mg) Sedation: 2.5mg - 5.0mg (max 10mg) Seizure: up to 10mg Pediatric: 0.5mg/kg rectal up to 10mg
Diazepam (Valium) Action Central nervous system depressant Amnesia Sedation Muscle relaxation
Diazepam (Valium) Onset and duration 1-5 minutes Duration 2-4 hours
Diazepam (Valium) Indications Active seizure/status epilepticus Sedation for cardioversion Chest pain or tachycardia following O.D. or ingestion of stimulant or hallucinogen (cocaine, meth, extacy, LSD, PCP, ketamine)
Diazepam (Valium) Precautions Monitor respiratory status closely. Administer at site closest to IV catheter, flush well before and after, utilize large veins (scorches veins). IM is absorbed erratically and has a long onset. Can cause cleft palate in 1st trimester of pregnancy.
Diazepam (Valium) Side effects CNS/Respiratory depression Hypotension Confusion Stupor Vein irritation, phlebitis, and sclerosis
Diazepam (Valium) Contraindications Alcohol or sedative use Head injury
Diazepam (Valium) Antidote: Romazicon (flumazenil) - Benzodiazepine antagonist Duration of action 30-60 minutes
Benadryl Class Antihistamine
Benadryl Action Blocks the effects of histamine in the body related to allergic reactions. Used in adjunctive therapy in anaphylaxis with epinephrine. Used in the treatment of extrapyramidal (dystonic) reactions.
Benadryl Dose Adult: 25-50mg IM or IV 1-2mg/kg IM or IV
Benadryl Onset and Duration Max effects in 1-3 hours Duration is up to 6-12 hours after administration.
Benadryl Indications moderate to severe allergic reactions (after epi) Anaphylaxis Acute extrapyramidal (dystonic) reactions
Benadryl Drug interactions CNS depressant that may increase depressant effects, ie: alcohol or valium. MAO inhibitors may prolong and intensify anticholinergic effects of antihistamines.
Benadryl Adverse reactions Drowsiness Hypotension Palpitations Tachycardia or bradycardia overexcitement in children disturbed coordination
Benadryl Contraindications Patients taking MAOI's Hypersensitivity Narrow-angle glaucoma Newborns and nursing mothers
Promethazine HCL (Phenergan) Class Phenothiazine and antihistamine with antiemetic, antimotion, and sedative effects.
Promethazine HCL (Phenergan) Route SIVP over 1 minute IM - deep into muscle
Promethazine HCL (Phenergan) Dose Adult: Titrated doses of 12.5-25mg, to achieve desired effect. Pediatric: Not used in the prehospital setting.
Promethazine HCL (Phenergan) Action Potent antiemetic with sedative effects.
Promethazine HCL (Phenergan) Indications Persistent vomiting due to gastrointestinal problems
Promethazine HCL (Phenergan) Precautions Monitor LOC Avoid antra-arterial or subcutaneous administration. Give slowly in small boluses and flush well, can cause vein irritation, phlebitis, and sclerosis. Watch for signs/symptoms of excessive sedation and dystonic reaction.
Promethazine HCL (Phenergan) Side effects Marked drowsiness/sedation Dystonic reaction Tissue necrosis if IV infiltrates, or if not given deep IM Dysrhythmias In children can cause hallucinations, convulsions, and sudden death.
Promethazine HCL (Phenergan) Contraindications Hypersensitivity Comatose states CNS depression from alcohol, barbituates, or narcotics Signs associated with Reye's syndrome
Promethazine HCL (Phenergan) Antidote For dystonic reactions, administer diphenhydramine (Benadryl)
Ondansetron HCL (Zofran) Class Antiemetic
Ondansetron HCL (Zofran) Route Slow IV Push (over 1 minute) IM IN
Ondansetron HCL (Zofran) Dose Adult: For nausea and or vomiting: 2mg IV Push given slowly (over 1 minute) with 10mL saline Do not exceed 4mg cumulative Pediatric: for nausea and/or vomiting: 0.1mg/Kg given slowly (over 1 minute) Do not exceed 4mg cumulative
Ondansetron HCL (Zofran) Action selectively blocks serotonin receptor (those that produce nausea/vomiting)
Ondansetron HCL (Zofran) Indications prevention of nausea and vomiting
Ondansetron HCL (Zofran) Precautions Ondansetron does not work effectively in every patient. Patients who fail to respond to a single IV dose often do not respond to additional doses. If valium is used, do not use Zofran.
Ondansetron HCL (Zofran) Side effects Headache, Dizziness, Musculoskeletal pain, Drowsiness/Sedation, burning sensation at injection site, hypersensitivity
Ondansetron HCL (Zofran) Contraindications Hypersensitivity Children under the age of 2 years
Methylprednisolone Sodium Succinate (Solu-Medrol) Class Synthetic steroid
Methylprednisolone Sodium Succinate (Solu-Medrol) Route SIVP (over 5 minutes)
Methylprednisolone Sodium Succinate (Solu-Medrol) Dose Adult: 60-125mg IV push for anaphylaxis or airway emergencies; 30mg/kg IV over 15 minutes followed by a maintenance infusion for 23 hours. Pediatric: 1-2 mg/kg/IV
Methylprednisolone Sodium Succinate (Solu-Medrol) Action Strengthens and stabilizes cell membranes, leading to: decreases in capillary permeability - prevents leakage and edema. Blockage of the release of histamine, bradykinin and other substances that cause vasodilation, tissue permeability, and irritation.
Methylprednisolone Sodium Succinate (Solu-Medrol) Action Controls symptoms, suppresses acute and chronic inflammation for asthma, COPD, allergies, but does not cure the underlying disease. In asthma, increases the number of beta receptors and increases responsiveness to beta bronchodilators.
Methylprednisolone Sodium Succinate (Solu-Medrol) Indications An adjunct to, but not a substitute for bronchodilators during: wheezing associated with refractory asthma and status asthmaticus. Wheezing associated with COPD Allergic reactions/anaphylaxis
Methylprednisolone Sodium Succinate (Solu-Medrol) Precautions Consult Med Control for patients who are diabetic (hypoglycemic responses to insulin and oral hypoglycemia), have severe infections, and active gastrointestinal bleeding.
Methylprednisolone Sodium Succinate (Solu-Medrol) Side Effects Hypertension Sodium and water retention Headache Hypokalemia Alkalosis
Methylprednisolone Sodium Succinate (Solu-Medrol) Contraindications Hypersensitivity
Proparacaine HCL (Alcaine) Class Topical anesthetic
Proparacaine HCL (Alcaine) Route Dropped into the affected eye or eyes
Proparacaine HCL (Alcaine) Dose Adult: 1-2 drops in the affected eye or eyes repeat dose (if indicated) every 5 minutes. No max dose. Pediatric: same as adult
Proparacaine HCL (Alcaine) Action Topical anesthetic for eyes that blocks nerve impulses from sensory nerves.
Proparacaine HCL (Alcaine) Indications Burns to the eyes or corneal abrasions. Patient comfort prior to irrigation of eyes exposed to chemicals such as pepper spray or mace.
Proparacaine HCL (Alcaine) Precautions Caution patient not to rub eye.
Proparacaine HCL (Alcaine) Side effects Initial burning or stinging sensation.
Proparacaine HCL (Alcaine) Contraindications Trauma/lacerations to the eyes. Foreign bodies in the eyes. Allergies to the "caine" drugs.
Nitrous Oxide:Oxygen (50:50) (Nitronox) Class Gaseous Analgesic/Anesthetic
Nitrous Oxide:Oxygen (50:50) (Nitronox) Route Inhalation: self-administered.
Nitrous Oxide:Oxygen (50:50) (Nitronox) Dose Adult: Instruct patients to inhale deeply as they hold the mask. Pediatric: Same as above.
Nitrous Oxide:Oxygen (50:50) (Nitronox) Action CNS Analgesic/Anesthetic whose actions are short lived
Nitrous Oxide:Oxygen (50:50) (Nitronox) Indications Patients who are alert and complaining of pain caused by the following: Musculoskeletal injuries/fractures Kidney stones Suspected AMI (if NTG or Morphine are ineffective or contraindicated) Active labor during an uncomplicated delivery. Thermal burn
Nitrous Oxide:Oxygen (50:50) (Nitronox) Precautions Must be self administered Check machine gauges daily for proper concentrations. Monitor blood pressure and pulse oximetry values.
Nitrous Oxide:Oxygen (50:50) (Nitronox) Side effects Hypotension Dizziness
Nitrous Oxide:Oxygen (50:50) (Nitronox) Contraindications Acutely psychotic patients Decompression sickness Patients who cannot self-administer Any altered LOC or head injury Abdominal distension Major facial trauma Chest trauma or actual/suspected pneumothorax Chronic obstructive pulmonary disease
Furosemide (Lasix) Class Loop Diuretic
Furosemide (Lasix) Action Affects sodium and chloride re-absorption at the Loop of Henle Decreased osmotic gradient
Furosemide (Lasix) Onset and Duration Onset 15-20 minutes. Duration 2-6 hours.
Furosemide (Lasix) Indications Pulmonary edema Renal disease Hyperkalemia
Furosemide (Lasix) Contraindications Dehydration Hypovolemia Pregnancy
Furosemide (Lasix) Adverse Reactions Hypotension Electrolyte imbalance Ototoxicity
Furosemide (Lasix) Drug interactions Digitalis toxicity Increased ototoxicity when used with some antibiotics
Furosemide (Lasix) How supplied 10mg/mL 2,4,8,10mL
Furosemide (Lasix) Dose/Route 20-40mg SIVP (20mg/min) Double the usual daily single dose
Ipratropium Bromide (Atrovent) Class Topical Anticholinergic
Ipratropium Bromide (Atrovent) Route Inhalation (nebulized) ETT (alternate route)
Ipratropium Bromide (Atrovent) Dose All doses are combined with 2.5mg of Albuterol. Adult: Nebulizer: 0.5mg in 2.5mL NS Pediatric: Nebulizer: <1yr old - 0.25mg in 2.5mL NS >1yr or older - 0.5mg in 2.5mL NS
Ipratropium Bromide (Atrovent) Action Bronchodilator Dries respiratory tract secretions
Ipratropium Bromide (Atrovent) Indications Bronchospasm associated with asthma or COPD that does not respond to the first dose of Albuterol. Bronchospasm from chemical toxins: nerve agents, cyanide, blistering agents, choking agents.
Ipratropium Bromide (Atrovent) Precautions Use caution if patients have a history of glaucoma, prostatic hypertrophy, or bladder neck obstruction.
Ipratropium Bromide (Atrovent) Side effects Dry mouth Cough, worsening of symptoms skin rash
Ipratropium Bromide (Atrovent) Contraindications Sensitivity to soy lecithin products (soybeans, peanuts) Sensitivity to Atropine Bronchoconstriction that is caused by allergic reaction.
Albuterol (Ventolin, Proventil) Class Sympathomimetic
Albuterol (Ventolin, Proventil) Route Inhalation (nebulized) ETT (alternate route) May be administered via either lumen of the Combitube
Albuterol (Ventolin, Proventil) Supplied Liquid
Albuterol (Ventolin, Proventil) Dose Nebulizer: 2.5mg over 5-15minutes 2-15 Liters per minute - preferably 8 lpm. Pediatric: same as adult
Albuterol (Ventolin, Proventil) Action Bronchodilation (beta2)
Albuterol (Ventolin, Proventil) Indications Bronchospasm associated with asthma and COPD Bronchospasm from chemical toxins: nerve agents, cyanide, blistering agents, choking agents, allergic reactions unresponsive to Epinephrine or Diphenhydramine (Benadryl)
Albuterol (Ventolin, Proventil) Precautions Known heart disease
Albuterol (Ventolin, Proventil) Side effects Restlessness Hypertension Tachycardia - palpations
Albuterol (Ventolin, Proventil) Contraindications Pregnancy, except in life-threatening situations
Midazolam (Versed) Class Schedule IV, short-acting benzo. Benzodiazepine
Midazolam (Versed) Midazolam (Versed) Actions Enhances the affect of the neurotransmitter gamma-aminobutyric acid (GABA)
Midazolam (Versed) Indications Active seizure/status epilepticus Procedural sedation Chest pain or tachy following an overdose or ingestion of a stimulant or hallucinogen (cocaine, amphetamine, extacy, LSD, PCP, ketamine) Sedation in struggling patients when med restraints applied.
Midazolam (Versed) Dose and Route Adult: Sedation, combative pts, CP from SNS. Seizures: 1-2.5mg titrated up to 10mg SLOW IV/IO/IN push. PAI: 0.1mg/kg IV/IO to achieve effect with max dose 5.0mg. Pediatric: 0.5mg/mg rectal up to 10mg or 0.1mg/kg IN up to 10mg or 0.1mg/kg IV
Midazolam (Versed) Action CNS depressant Amnesia Sedation Muscle relaxation
Midazolam (Versed) Onset and duration Onset: 1-3 minutes Duration: 15 minutes to 6 hours (dose dependent)
Midazolam (Versed) Precautions Titrate in small doses to avoid side effects Monitor respiratory status closely Monitor B/P closely Administer at site closest to IV catheter, flush well before and after. Do not mix with other drugs or solutions.
Midazolam (Versed) Side effects Hypotension Respiratory depression Confusion Stupor Vein irritation, phlebitis, and sclerosis
Midazolam (Versed) Contraindications Alcohol or sedative use Head injury Acute narrow angle glaucoma
Midazolam (Versed) Antidote Romazicon (flumazenil) benzodiazepine antagonist
Created by: 23905196