Medications
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| Diphenhydramine also known as | Benadryl
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| Diphenhydramine Class | Antihistamine
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| Diphenhydramine Action | Binds and blocks H1 histmine receptors.
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| Diphenhydramine Indications | Anaphylactic reactions, dystonic reactions.
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| Diphenhydramine Adverse Effects | Drowsiness, dizziness, headache, excitable state (children), wheezing, thickening of bronchial secretions, chest tightness, palpitations, hypotension, blurred vision, dry mouth, nausea/vomiting, diarrhea.
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| Diphenhydramine Contraindications | Acute asthma, which thickens secretions, patients with cardiac histories; known sensitivity.
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| Diphenhydramine Dosage: Adult: | 25-50-mg IV, IO, IM.
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| Diphenhydramine Dosage: Pedi: | 2-12 yrs: 1-1.25mg/kg IV, IO, IM.
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| Diphenhydramine Special Considerations | Pregnancy class B.
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| Vasopressin Class | Nonadrenergic vasoconstrictor
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| Vasopressin Action | Causes vasoconstriction independent of adrenergic receptors, or neural innervation.
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| Vasopressin Indications | Adult shock-refractory VF or pulseless VT, asystole, PEA, vasodilatory shock.
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| Vasopressin Adverse Effects | Cardiac ischemia, angina.
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| Vasopressin Contraindications | Responsive patients with cardiac disease.
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| Vasopressin Dosage: Adult | 40U IV/IO may replace either the first or second dose of epinephrine. -May be given ET but the optimal dose is not known
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| Vasopressin Special Considerations | Pregnancy class C.
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| Verapamil, also known as | Isoptin
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| Verapamil class | Calcium channel blocker; class IV antniarrhythmic
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| Verapamil Action | Blocks calcium from moving into the heart muscle cell, which prolongs the conduction of electrical impulses through the AV node. Also dilates arteries.
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| Verapamil Indications | Atrial fibrillation, hypertension, PSVT, PSVT prophylaxis.
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| Verapamil Adverse Effects | Sinus bradcardia; first-, second-, or third-degree AV block; congestive heart failure; reflex sinus tachycardia; transient asystole; AV block; hypotension.
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| Verapamil Contraindications | 2nd or 3rd degree AV block (except in patents w/ a functioning artificial pacemaker; hypotension (systolic pressure <90mm Hg) or cardiogenic shock; sick sinus syndrome; Lown-Ganong_Levine syndrome; severe left ventricular dysfunction.
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| Verapamil Dosage: Adult: | 2.5-5mg IV, IO over 2 minutes (3 minutes in elderly patients). May repeat at 5-10mg every 15-30 minutes to a max dose of 30mg.
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| Verapamil: Pedi: Children 1-16 yrs | 0.1mg/kg IV, IO (max 5mg/dose) over 2 minutes. May repeat in 30 minutes to a max dose of 10mg.
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| Verapamil Dosage: Pedi: Infants <1 yr | Not recommended.
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| Verapamil Special Considerations | Pregnancy class C.
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| Amiodarone, also known as | Cordarone
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| Amiodarone Class | Antiarrhythmic, Class III.
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| Amiodarone Action | Acts directly on the myocardium to delay repolarization and increase the duration of the action potential.
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| Amiodarone Indications | Ventricular arrhythmias; second-line agent for atrial arrhythmias.
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| Amiodarone Adverse Effects | Burning at the IV site, hypotensiosn, bradycardia.
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| Amiodarone Contraindications | Sick sinus syndrome, second- and third-degree heart block, cardiogenic shock when episodes of bradycardia have caused syncope, sensitivity to benzyl alcohol and iodine.
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| Amiodarone Dosage: Ventricular Fibrillation and Pulseless Ventricular Tachycardia: Adult | 300mg IV/IO. May be followed by one dose of 150mg in 3-5 minutes. After conversion, follow with 1-mg/min infusion for 6 hours, then 0.5mg/min maintenance infusion over 18 hours.
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| Amiodarone Dosage: Pedi: Ventricular fibrillation and Pulseless Ventricular Tachycardia: Pedi: | 5mg/kg (max dosoe: 300mg); may repeat 5mg/kg IV, IO up to 15mg/kg.
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| Amiodarone Dosage: Relatively Stable Patients with Arrhythmias such as Premature Ventricular Contractioins or Wide Complex Tachycardias with a Strong Pulse: Adult: | 150mg in 100ml,D5W IV, IO over a 10 minute period; may repeat in 10 minutes up to a max dose of 2.2g over 24 hrs.
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| Amiodarone Dosage: Relatively Stable Patients with Arrhythmias such as Premature Ventricular Contractiosn or Wide Complex Tachycardias with a Strong Pulse: Pedi: | 5mg/kg very slow IV, IO (over 20-60 minutes); may repeat in 5mg/kg doses up to 15mg/kg (max dose: 300mg).
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| Amiodarone Special Considerations | Pretnancy class D.
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| Atropine Sulfate Class | Anticholinergic (antimuscarinic)
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| Atropine Sulfate Action | Competes reversibly w/ acetylcholine at the site of the muscarinic receptor. Receptors affected, in order from the most sensitive to the least sensitive, inculde salivary, bronchial, sweat glands, eye, heart, and GI tract.
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| Atropien Sulfate Indications | Symptomatic bradycardia, asystole or PEA, nerve agent exposure, organophosphate poisoning.
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| Atropine Sulfate Adverse Effects | Decreased secretions resulting in dry mouth and hot skin temp, intense facial flushing, blurred vision or dilation of the pupils with subsequent photophobia, tachycardia, restlessness. May cause paradoxical bradycardia if dose admin'd too low or slowly.
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| Atropine Sulfate Contraindications | Acute MI; myasthenia gravis; GI obstruction; closed-angle glaucoma; known sensitivity to Atropine, belladonna alkaloids; or sulfites. Won't be effective for infranodal (type II) AV block and new 3rd-degree block w/ wide QRS complex.
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| Atropine Sulfate Dosage: Symptomatic Bradycardia: Adult: | 0.5mg IV, IO every 3-5 mins to a max dose of 3mg
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| Atropine Sulfate Dosage: Symptomatic Bradycardia: Adolescent: | 0.02mg/kg (minimum 0.1mg/dose; max 1mg/dose) IV, IO up to a total dose of 2mg.
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| Atropine Sulfate Dosage: Symptomatic Bradycardia: Pedi: | 0.02mg/kg (minimum 0.1mg/dose; max 0.5mg/dose) IV, IO, to a total dose of 1mg.
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| Atropine Sulfate Dosage: Asystole/Pulseless Electrical Activity: | 1mg IV, IO every 3-5 m inutes, to a max dose of 3mg. May be administered via ET tube at 2-2.5mg diluted in 5-10ml of water or normal saline.
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| Atropine Sulfate: Nerve Agent or Organophosphate Poisoning: Adult: | 2-4mg IV, IM; repeat if needed every 20-30 minutes until symptoms dissipate. In severe cases, the initial dose can be as large as 2-6mg admin'd IV. Repeat doses of 2-6mg can be admin'd IV, IM every 5-60 m inutes.
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| Atropine Sulfate Dosage: Nerve Agent or Organophosphate Poisoning: Pedi: | 0.05mg/kg IV, IM every 10-30 minutes as needed until symptoms dissipate.
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| Atropine Sulfate Dosage: Nerve Agent or Organophosphate Poisoning: Infants <15lb: | 0.05mg/kg IV, IM every 5-20 inutes as needed until symptoms dissipate.
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| Atropine Sulfate Special Considerations | Pregnancy class C; possible unsafe lactating mothers.
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| Epinephrine Class | Adrenergic agent, inotrope.
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| Epinephrine Action | Binds strongly with both alpha and beta receptors, producing increased blood pressure, incrased heart rate, bronchodilation.
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| Epinephrine Indications | Bronchospasm, alleric and anaphylactic reactions, cardiac arrest.
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| Epinephrine Adverse Effects | Anxiety, headache, cardiac arrhythmias, hypertension, nervousness, tremors, chest pain, nausea/vomiting.
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| Epinephrine Containdications | Arrhythmias other than pulseless VT/VF, Asystole, PEA; Cardiovascular disease; hypertesion; cerebrovascular diasase; shock secondary to causes other than anaphylactic shock; closed-angle glauoma; diabetes;
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| Epinephrine Dosage: Cardiac Arrest: Adult: | Initial dose 1mg (1:10,000 solution)IV,IO; repeat every 3-5 inutes.
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| Epinephrine Dosage: Cardiac Arrest: Pedi: | Initial dose 0.01mg/kg (1:10,000solution) IV, IO; repeat every 3-5 minutes as needed (max dose 1mg).
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| Epinephrine Dosage: Symptomatic Bradycardia: Adult: | 1mcg/min (1:10,000 solution) as a continuous IV infusion; usual dosage range: 2-20mcg/min IV, titrate to effect.
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| Epinephrine Dosage: Symptomatic Bradycardia: Pedi: | 0.01mg/kg (1:10,000 solution) IV, IO; may repeat every 3-5 minutes (max dose: 1mg). If giving epinephrine by ET tube, administer 0.1 mg/kg.
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| Epinephrine Dosage: Asthma Attacks and Certain Allergic Reactions: Adult: | 0.3-0.5mg (1:1000 solution) IM or subQ. Mayrepeat every 10-15 minutes (max dose 1mg).
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| Epinephrine Dosage: Asthma Attacks and Certain Allergic Reactions: Pedi: | 0.01mg/kg (1:1000) solution) IM or subQ (max dose: 0.5mg).
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| Epinephrine Dosage: Anaphylactic Shock: Adult: | 0.1mg (1:10,000 solution) IV slowly over 5 minutes, or IV infusion of 1-4mcg/min, titrated to effect.
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| Epinephrine Dosage: Anaphylactic Shock: Pedi: | Continuous IV infusion rate of 0.1-1mcg/kg/min (1:10,000 solution); titrate to response.
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| Epinephrine Special Considerations | Half-life 1 minute. Pregnancy class C.
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| Lidocaine, also known as | Xylocaine
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| Lidocaine Class | Antiarrhythmic, class IB
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| Lidocaine Action | Blocks sodium channels, increasing the recovery period after repolarization; suppresses automaticity in the His-Purkinje system and depolarization in the ventricles.
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| Lidocaine Indications | Ventricular arrythmias, when amiodarone is not a vailable; cardiac arrest from VF/VT, stable monomorphic VT with preserved Ventricular function, stable polymorphic VT with Normal baseline QT interval and preserved left ventricular function (when ischemia
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| Lidocaine Adverse Effects | Toxicity-may include anxiety, apprehension, euphoria, nervousness, disorientation, dizziness, blurred vision, facial paresthesias, tremors, hearing disturbanceas, slurred speech, seizures, sinus bradycardia; seizures without warning, cardiac arrhythm
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| Lidocaine Contraindications | AV block; bleeding; thrombocytopenia,; known sensitivity to lidocaine, sulfite, or paraben. Use with caution in bradycardia, hypovolemia, cardiogenic shock, Adams-Stokes syndrome, Wolff-Parkinson-White syndrome.
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| Lidocaine Dosage: Pulseless Ventricular Tachycardia and Ventricular Fibrillation: Adult IV, IO: | 1-1.5mg/kg IV, IO; may repeat at half the original dose every 5-10 minutes to a max dose of 3mg/kg. If a maintenance infusion is warranted, the rate is 1-4mg/min.
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| Lidocaine Dosage: Pulselesws Ventricular Tachycardia and Ventricular Fibrillation: Adult ET tube: | 2-10mg/kg ET tube, diluted in 10ml normal saline or sterile distilled water.
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| Lidocaine Dosage: Pulseless Ventricular Tachycardia and Ventricular Fibrillation: Pedi IV, IO: | 1mg/kg IV, IO (max 100mg). If a maintenance infusion is warranted, the rate is 20-50mcg/kg/min.
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| Lidocaine Dosage: Pulseless Ventricular Tachycardia and Ventricular Fibrillation: Pedi ET tube: | 2-3mg/kg ET tube, followed by a 5ml flush of normal saline.
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| Lidocaine Dosage: Perfusing Ventricular Rhythms: Adult: | 0.5-0.75mg/kg IV, IO *up to 1-1.5mg/kg may be used). Repeat 0.5-0.75mg/kg every 5-10 m inutes to a max total dose of 3mg/kg. A maintenance infusion of 1-4mg/min (30-50mcg/kg/min) is acceptable.
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| Lidocaine Dosage: Perfusing Ventricular Rhythms: Pedi: | 1mg/kg IV, IO. May repeat every 5-10 minutes to a max dose of 3mg/kg. Maintenance infusion rate is 20-50mcg/kg/min.
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| Lidocaine Special Considerations | Half-life approximately 90 minutes. Pregnancy class B.
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| Diltiazem, also known as | Cardizem
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| Diltiazem Class | Calcium channel blocker, class IV antiarrhythmic.
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| Diltiazem Action | Blocks calcium from moving into the heart muscle cell, which prolongs the conduction of electrical impulses throu the AV node.
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| Diltiazem Indications | Stable narrow-QRS tachycaardida caused by reentry, stable narrow-QRS tachycardia cauased by automaticity, to control the ventricular rate in patients with A-Fib or atrial flutter (Should not be given w/A-fib or atrial flutter assoc w/know preexitation.
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| Diltiazem Adverse Effects | Flushing; headache; bradycardia; hypotension; heart block; myocardial depression; severe AV block; and, at high doses, cardiac arrest.
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| Diltiazem Containdications | Hypotension, heart block, heart failure.
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| Diltiazem Dosage: Adult: | Optimum dose 0.25mg/kg IV, IO over 2 min period; 20mg reasonable dose for the avg adult. A 2nd, higher dose of 0.35mg/kg IV, IO (25mg typical 2nd dose) may be admin'd over 2 min period if rate control isn't obtained w/ 1st. Continued heart rate redu
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| Diltiazem Pedi: | Not recommended.
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| Diltiazem Special Considerations | Use with extreme caution in patients who are taking beta blockers because these two drug classes potentiate each other's effects and toxicities. Patients with a history of heart failure and heart block are at a higher risk for tox. Pregnancy class C.
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| Promethazine, also kown as | Phenergan
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| Promethazine Class | Antiemetic, antihistamine
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| Promethazine Action | Decreases nausea and vomiting by antagonizing H1 receptors.
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| Promethazine Indications | Nausea/vomiting.
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| Promethazine Adverse Effects | Paradoxic excitation in children and elderly patients.
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| Promethazine Contraindications | Altered level of consciousness, jaundice, bone marrow suppression, known sensitivity. Use with caution in seizure disorder.
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| Promethazine Dosage: Adult | 12.5-25mg IV, IO, or Im.
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| Promethazine Dosage: Pedi: 2 yrs and older | 0.25-1mg/kg IV, IO, IM (max rate of IV, IO adminstration is 25mg/min).
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| Promethazine Special considerations | Pregnancy class C.
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| Thiamine, also know as | Vitamin B1.
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| Thiamine Class | Vitamin B1.
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| Thiamine Action | combines with adenosine triphosphate to produce thiamine diphosphate, which acts as a coenzyme in carbohydrate metabolism.
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| Thiamine Indication | Wernicke Korsakoff syndrome, berberi, nutritional supplementation.
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| Thiamine Adverse Effects | Itching, rash, pain at injection site.
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| Thiamine Contraindications | Known sensitivity.
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| Thiamine Dosage: Wernicke-Korsakoff Syndrome: Adult | 100mg IV, IO.
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| Thiamine Dosage: Wernicke-Korsakoff Syndrome: Pedi: | Not recommended.
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| Thiamine Special Considerations | Pregnancy class A.
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| Epinephrine Autoinjectors, also known as | Epi-Pen, Epi-pen Jr
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| Epinephrine Autoinjectors Class | Adrenergic agonist, inotrope
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| Epinephrine Autoinjectors Action | Binds strongly with both alpha and beta receptors, producing increased blood pressure, increased heart rate, bronchodialation.
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| Epinephrine Autoinjectors Indications | Anaphylactic shock, certain allergic reactions, asthma attacks.
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| Epinephrine Autoinjectors Adverse Effects | Headaches, nervousness, tremors, arrhythmias, hypertension, chest pain, nausea/avomiting.
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| Epinephrine Autoinjectors Contraindications | Arrhythmias other than VF, asystole, PEA; cardiovascular disease; hypertension; cerebrovascular disease; shock secondary to cuases other than anaphylactic shock, closed-angle glaucoma; diabetes; preg women in active labor.
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| Epinephrine Autoinjectors Dosage: Adult: | Contains 0.3mg to be admin'd IM into the anterolateral thigh.
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| Epinephrine Autoinjectors Dosage: Pedi: | For children weighing <30kg, an IpiPen Jr delivers 0.15mg IM.
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| Epinephrine Autoinjectors Special Considerations | Half-life 1 minute. Pregnancy class C.
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| Zofran, also known as | Ondansetron
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| Zofran Class | Antiemetic
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| Zofran Actions | Is a unique antiemetic that acts central as a serotonin (5-HT3) receptor anagonist. Its major advantage is that it is non-sedating and is better tolerated by the pedi population. It may also be used safely in pregnancy.
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| Zofran Indications | Nausea and vomiting associated with a variety of medical conditions.
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| Zofran Adverse Effects | Headache and dizziness.
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| Zofran Contraindications | Hypersensitivity. Age less than 6 months.
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| Zofran Dosage: Adults: | 4mg IV push every 4 hours.
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| Zofran Dosage: Pedi: | 0.15mg/kg IV every 4 hours; max dose of 4mg.
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| Zofran Special Considerations | None.
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