Transcript File - 911 Target & Medical Concepts LLC

DIAZEPAM (VALIUM)
Class: CNS agent – benzodiazepine; anticonvulsant; anxiolytic
Action: Anticonvulsant and antianxiety psychotherapeutic drug
with actionat both limbic and subcortical levels of CNS
Dose:
Adults:
Status Epilepticus: 5-10 mg slow IV push, repeat in 3-4h
Sedation: 5-15 mg slow IV push
Pediatrics:
1month- 5yrs: 0.25mg/kg every 5 min IV, max dose 5.0 mg
6yrs and older: 0.25 mg/kg every 5min IV, max dose 10.0 mg.
Indications: For anxiety, seizures, skeletal muscle spasm relief;
also used as an amnesic, for treatment of restless leg syndrome,
acute alcohol withdrawal, and is the drug of choice for status
epilepticus
Contraindications: Shock, coma, alcohol intoxication,
depressed vital signs; acute narrow-angle glaucoma, untreated
open-angle glaucoma; MAOIs; pregnancy category D
Adverse Effects: Throat and chest pain; drowsiness, fatigue,
ataxia, confusion, paradoxic rage, dizziness, vertigo, amnesia,
vivid dreams, headache, slurred speech, tremor; EEG changes,
tardive dyskinesia; hypotension, tachycardia, edema,
cardiovascular collapse; blurred vision, diplopia, nystagmus;
xerostomia, nausea, constipation, hepatic dysfunction;
incontinence, urinary retention, gynecomastia (prolonged use);
hiccups, coughing, laryngospasm; venous thrombosis, phlebitis
Interactions: Alcohol, CNS depressants, anticonvulsants, and
herbals (kava kava, valerian) potentiate CNS depression;
cimetidine increases levels and toxicity; may decrease effects of
levodopa; may increase phenytoin levels; smoking decreases
sedative and antianxiety effects
DIPHENHYDRAMINE (BENADRYL)
Class: H1-blocker; antihistamine
Action: H1-receptor antagonist and antihistamine as it competes
for H1-receptor sites on effector cells; significant central
anticholinergic activity as it prolongs action of dopamine by
inhibiting its reuptake and storage, thus decreasing parkinsonism
and drug-induced extrapyramidal symptoms
Dose:
Adults: 25-50 mg IVP or IM every 4-6 hrs.
Pediatrics: 1.0 mg/kg IV, IO or IM every 4-6 hrs.
Indications: For allergic conditions, treatment or prevention of
motion sickness, vertigo, blood or plasma reactions, treatment of
Parkinsonism and drug-induced extrapyramidal reactions; also
used with epinephrine for anaphylaxis, as a cough suppressant,
a sedative-hypnotic, and for intractable insomnia
Contraindications: Antihistamine hypersensitivity; lower
respiratory tract symptoms, asthma; narrow-angle glaucoma;
prostatic hypertrophy, bladder neck obstruction; GI obstruction;
pregnancy category C
Adverse Effects: Drowsiness, dizziness, headache, fatigue,
disturbed coordination, tingling, heaviness and weakness of
hands, tremors, euphoria, nervousness, restlessness, insomnia;
confusion; excitement, fever, palpitation, tachycardia, hypo- or
hypertension, cardiovascular collapse, tinnitus, vertigo, dry nose,
throat, nasal stuffiness; blurred vision, diplopia, photosensitivity,
dry eyes, dry mouth, nausea, epigastric distress, anorexia,
vomiting, constipation, diarrhea; urinary frequency or retention,
dysuria; thickened bronchial secretions, wheezing, chest
tightness
Interactions: Alcohol, other CNS depressants, and MAOIs
compound CNS depression
EPINEPHRINE
Class: Autonomic nervous system agent – natural and synthetic
catecholamine; alpha- and beta-adrenergic agonist; bronchodilator
Action: Sympathomimetic that acts directly on both alpha and beta receptors;
the most potent activator of alpha receptors; strengthens myocardial
contraction; increases systolic but may decrease diastolic blood pressure;
increases cardiac rate and output; constricts bronchial arterioles and inhibits
histamine release, thus reducing congestion and edema and increasing tidal
volume and vital capacity
Dose: All should be rapid infused, titrate to effect, flush after every dose.
Adults: 0.1–0.5 mL SC/IM q10–15min (1:1000 soln = 1mg/1ml)
Pulseless arrest: 1mg (10mL of 1:10000) given every 3-5 min
Symptomatic bradycardia: 2-10ug/min (add 1mg of 1:1000 to 500mL normal
saline; infuse at 1-5mL/min)
Pediatrics:
Pulseless arrest: 0.01 mg/kg (of 1:10000) every 3-5 minutes
Symptomatic bradycardia: 0.01 mg/kg (1:10000)
Indications: For hypersensitivity and anaphylactic reactions, acute asthma
attack, bronchospasm, mucosal congestion, syncope due to heart block or
carotid sinus hypersensitivity, and to restore cardiac rhythm in cardiac arrest;
prolong action and delay absorption of anesthetics; control superficial bleeding
Contraindications: Sympathomimetic amine hypersensitivity; narrow-angle
glaucoma; hemorrhagic, traumatic, or cardiogenic shock; cardiac dilatation,
cerebral arteriosclerosis, coronary insufficiency, arrhythmias, organic heart or
brain disease; do NOT use with local anesthesia of fingers, toes, ears, nose,
genitalia; pregnancy category C
Adverse Effects: Nervousness, restlessness, sleeplessness, fear, anxiety,
tremors, headache, CVA, weakness, dizziness, syncope, pallor, sweating,
dyspnea; nausea, vomiting; precordial pain, palpitations, hypertension, MI,
tachyarrhythmias; bronchial and pulmonary edema; urinary retention; tissue
necrosis; metabolic acidoses; altered state of perception and thought,
psychosis
Interactions: May increase hypotension in circulatory collapse; additive
toxicities with other medications
FENTANYL
Class: CNS agent - potent narcotic (opiate) agonist
Action: Action similar to morphine with more rapid and less
prolonged analgesia and sedation, but less emetic effect
Dose:
Adults: 400-800 mcg oral-tranmucosally, titrate to pain up to
max 1600 mcg/d; lozenge on a stick to be placed in mouth
between cheek and lower gum and sucked, not chewed (have
opioid antagonist [naloxone/ narcan] immediately available!)
Pediatrics: DO NOT USE-NOT EVALUATED FOR PEDS
Indications: For moderate to severe pain management
Contraindications: MAOIs; myasthenia gravis; pregnancy
category C
Side Effects: Sedation, euphoria, dizziness, diaphoresis,
delirium, convulsions; bradycardia, hypotension, circulatory
depression, cardiac arrest; miosis, blurred vision; nausea,
vomiting, constipation, ileus; muscle and thoracic muscle rigidity;
urinary retention, rash; laryngospasm, bronchoconstriction,
respiratory depression or arrest have
Interactions: Alcohol and other CNS depressants potentiate
effects; MAOIs may precipitate hypertensive crisis
MORPHINE SULFATE (MSO4)
Class: CNS agent – narcotic (opiate) agonist; analgesic
Action: Natural opium alkaloid with agonist activity as it binds
with 3 types of the same receptors as endogenous opioid
peptides; analgesia at supraspinal level, euphoria, respiratory
depression and physical dependence; sedation and miosis;
dysphoric, hallucinogenic, and cardiac stimulant effects
Dose: Contact Med Control prior to giving ANY dose.
Adults: 2mg slow IV push, titrate to pain, max dosage 10mg.
Pediatrics: 0.1 mg/kg IV, Contact Med Control for max dosage.
Indications: For severe acute and chronic pain management, MI
pain relief, preanesthesia and as adjunct to anesthesia, and for
relief of dyspnea from acute left ventricular failure and pulmonary
edema
Contraindications: Opiate hypersensitivity; increased ICP;
seizures; acute alcoholism; acute bronchial asthma, chronic
pulmonary disease, severe respiratory depression; chemicalirritant induced pulmonary edema; BPH; diarrhea due to
poisoning untiltoxic material has been eliminated; undiagnosed
acute abdominal conditions; following biliary tract surgery and
surgical anastomosis; pancreatitis; acute ulcerative colitis;
severe liver or renal insufficiency; hypothyroidism; pregnancy
category B
Adverse Effects: Pruritus, rash, urticaria, edema, anaphylactoid
reaction; sweating, euphoria, insomnia, visual disturbances,
dysphoria, paradoxic CNS stimulation (restlessness, tremor,
delirium, insomnia), convulsions; decreased cough reflex,
drowsiness, dizziness, deep sleep, miosis; bradycardia,
palpitations, syncope; orthostatic hypotension, constipation,
anorexia, dry mouth, biliary colic, nausea, vomiting, urinary
retention or urgency, dysuria, oliguria, severe respiratory
depression or arrest; pulmonary edema
Interactions: CNS depressants, sedatives, barbiturates, alcohol,
benzodiazepines, and TCAs potentiate CNS depressant effects;
MAOIs may precipitate hypertensive crisis; phenothiazines may
antagonize analgesia; herbals (Kava-kava, valerian, St. John's
wort) may increase sedation
NALOXONE (NARCAN)
Class: CNS agent – narcotic (opiate) antagonist
Action: A "pure" narcotic antagonist, essentially free of agonistic
(morphine-like) properties; thus, produces no significant
analgesia, respiratory depression, psychotomimetic effects, or
miosis when administered in the absence of narcotics and
possesses more potent narcotic antagonist action
Dose:
Adults: 2.0 mg IV or IM, repeat every 2–3min up to 10 mg or
until narcotic effects are reversed.
Pediatrics:
Less than 5 yrs- 0.1 mg/kg IV, IO, SQ, ET
5yrs and older- 2.0 mg IV, IO, SQ, ET
Indications: For narcotic opiate overdose and reversal of effects
of natural and synthetic narctotics (opiates), including respiratory
depression, sedation, and hypotension; drug of choice when
depressant drug is unknown and for diagnosis of suspected
acute opioid overdose
Contraindications: Non-opioid drug respiratory depression;
pregnancy category B
Adverse Effects: Analgesia reversal, tremors, hyperventilation,
drowsiness, sweating; increased BP, tachycardia; nausea,
vomiting; elevated PTT
Interactions: Reverses analgesic effects of narcotic (opiate)
agonists and agonist-antagonists
PROMETHAZINE (PHENERGAN)
Class: GI agent – phenothiazine; antiemetic, antivertigo
Action: Long-acting phenothiazine derivative with prominent
sedative, amnesic, antiemetic, and anti-motion-sickness actions
and marked antihistamine activity; antiemetic action due to
depression of CTZ in medulla; as with other antihistamines, it
exerts antiserotonin, anticholinergic, and local anesthetic action
Dose: 12.5-25 mg PO/IM/IV q4-6h prn
Indications: For symptomatic relief from nausea, vomiting,
motion sickness, and allergic conditions; also used for pre- and
postoperative sedation, and as adjunct to analgesics for control
of pain
Contraindications: Phenothiazine hypersensitivity; narrowangle glaucoma; stenosing peptic ulcer, pyloroduodenal
obstruction; BPH; bladder neck obstruction; epilepsy; bone
marrow depression; comatose or severe depressed states;
Reye's syndrome, encephalopathy, hepatic diseases; pregnancy
category C
Adverse Effects: Deep sleep, coma, convulsions,
cardiorespiratory symptoms, extrapyramidal reactions,
nightmares, CNS stimulation, abnormal movements; irregular
respirations, respiratory depression; sedation drowsiness,
confusion, dizziness, disturbed coordination, restlessness,
tremors; transient mild hypo- or hypertension; anorexia, nausea,
vomiting, constipation; leukopenia, agranulocytosis; blurred
vision, dry mouth, nose, or throat; photosensitivity; urinary
retention
Interactions: Alcohol and other CNS depressants add to CNS
depression and anticholinergic effects
ONDANSETRON (ZOFRAN)
Class: GI agent – 5-HT3 antagonist, antiemetic
Action: Selective serotonin (5-HT3) receptor antagonist, acting
centrally in the chemoreceptor trigger zone (CTZ) and
peripherally on the vagal nerve terminals; serotonin is released
from the wall of the small intestine, stimulates the vagal efferents
through the serotonin receptors, and initiates the vomiting reflex
Dose: 8-16 mg PO q8h prn; 4mg slow IVP or IM q8h prn
Indications: Prevention of nausea and vomiting associated with
anesthesia, postoperative state, and chemotherapy
Contraindications: Hypersensitivity to ondansetron; pregnancy
category B
Adverse Effects: Dizziness, light-headedness, headache,
sedation; diarrhea, constipation, dry mouth
Interactions: Rifampin may decrease ondansetron levels
LORAZEPAM (ATIVAN)
Class: Anticonvulsant / sedative
Action: Status Epilepticus, Anti-anxiety, Sedativehypnotic, skeletal muscle relaxant
Dose:
Adults:
Status Epilepticus: 2-4mg slow IV or IM
Anxiety, Sedation: 0.05mg/kg up to 4mg IM
For IV or IO use: dilute 1:1 in NS, D5W.
Pediatrics: 0.05mg- 0.2mg/kg IV, IO, IM slow.
Indications: RSI
Contraindications: hypersensitivity, acute narrow-angle
glaucoma, pregnancy/breastfeeding
Adverse Effects: confusion, depressed mood, thoughts
of suicide or hurting yourself; hyperactivity, agitation,
hostility; hallucinations; or feeling light-headed, fainting.
Interactions: Barbiturates, MAO inhibitors or medicines
to treat psychiatric disorders, narcotic medications such
as Stadol, Codeine, Hydrocodone, Loratab, Vicodine,
Demerol, Methadone, Morphine, Narcan, Oxycodone
Darvocet or antidepressants such as Elavil, Celexa,
Prozac, Paxil or Zoloft should not take this medication.
Other medical problems- The presence of other
medical problems may affect the use of
benzodiazepines. Make sure you tell your doctor if you
have any other medical problems, especially:
History of alcohol abuse may make effects of alcohol
worse while taking this medication. Epilepsy or history of
seizures should not take these medications.
ETOMIDATE (AMIDATE)
Class: Sedative/Hypnotic
Action: is a hypnotic drug without analgesic activity. It produces
hypnosis characterized by rapid onset of action, usually within 1
minute.
Dose:
Adults: (10 and older) 0.3mg/kg (max dose: 20mg) IV
Infused over 30 to 60 seconds will produce rapid sedation that
lasts 10 to 15 minutes.
Pediatrics: DO NOT USE-NOT EVALUATED FOR PEDS
Indications: RSI
Contraindications: Patients under 10 should not be used on, do
not use with ketamine, use with caution in the elderly (especially
those with high blood pressure), pregnancy/breastfeeding
Adverse Effects: More common effects are shivering or
trembling, blurred or double vision or other vision problems;
dizziness, lightheadedness, or feeling faint; drowsiness;
headache; mood or mental changes; nausea (mild) or vomiting;
nightmares or unusual dreams.
Adverse Effects: Brief pain in the veins; coughing; drowsiness;
hiccups; nausea; temporary uncontrollable muscle movements;
vomiting.
Interactions: Amiodarone because the risk of side effects, such
as slowed heart rate or heart block may be increased; Do not give
with Droxidopa because its actions and side effects may be
increased.
Other medical problems: Do not use with CNS depressants or
antihistamines, medications for hay fever, other allergies, or colds,
sedatives, tranquilizers, sleeping medicine or prescription pain
medicine such as narcotics or other barbiturates; patients should
not be given if patient is on medicine for seizures or muscle
relaxants.
NITROGLYCERIN (NITRO)
Class: Potent Vasodilator
Action: Vascular smooth muscle relaxation, which leads to
venous coronary and arterial vasodilatation. This causes a
decrease in preload and myocardial oxygen demand, it also
dilates pulmonary capillaries.
Dose:
Adults: Sublingual: 0.4mg (1 tablet) SL, repeat every 5 minutes
if no relief for a total of 3 doses. DO NOT ADMINISTER UNTIL
IV ACCESS IS ESTABLISHED; DO NOT ADMINISTER IF
SYSTOLIC BP IS LESS THAN 90mm Hg.
If the Patient has a Topical Patch: REMOVE for Defibrillation.
Pediatrics: DO NOT USE.
Indications: AMI, Congestive Heart Failure, Acute Angina,
Presumed cardiac chest pain.
Contraindications: Allergy or hypersensitivity, hypotension,
head trauma, pregnant/breastfeeding
Adverse Effects: May cause dizziness, lightheadedness, or
fainting or blurred vision. Burning or tingling in the mouth
flushing, headache, heavy sweating, nausea, pale skin, vomiting
may also occur.
Interactions: Beta-blockers (propranolol), calcium channel
blockers (diltiazem), phenothiazines (thioridazine), or
phosphodiesterase type 5 inhibitors (sildenafil) because side
effects such as severely low blood pressure may occur; Alteplase
or heparin because the effectiveness of these medicines may be
decreased; Salicylates (aspirin) because the effectiveness of
nitroglycerin may be altered.
Other medical problems- Alcohol, hot weather, exercise, and
fever can increase these effects.
VECURONIUM (NORCURON)
Class: Non-depolarizing neuromuscular blocking agent.
Action: Paralyzes respiratory and skeletal muscles, blocks acetylcholine
from binding to receptors on motor endplates inhibiting depolarization
Dose:
Adults: 0.1mg/kg IV.
Pediatrics: 0.1mg/kg IV
WARNING: DO NOT USE THIS AGENT UNLESS;
PREPARED WITH SUCTION, A BVM APPARATUS AND SURGICAL
CRICOTHYROIDOTOMY SET IN THE EVENT OF INTUBATION FAILURE
OR BAG THE PATIENT UNTIL THE EFFECT SUBSIDES IN THE
PATIENT.
THIS MEDICATION DOES NOT PROVIDE SEDATION OR ANALGESIA;
DO NOT USE THIS MEDICATION IN A PATIENT THAT HAS NOT ALSO
RECEIVED SOME FORM OF SEDATION.
Indications: To maintain paralysis during long transport times. May be
used initially to facilitate endotracheal intubation if Succinylcholine is
contraindicated.
Contraindications: Suspected heart attack, ICP,
severe anemia, currently taking a phosphodiesterase type 5 inhibitor
(sildenafil) or other medications used frequently for sexual dysfunction,
children less than 31 days old, obesity, and hypersensitivity.
Adverse Effects: Prolonged paralysis, hypotension, bradycardia,
malignant hyperthermia.
Interactions: Aminoglycosides (gentamicin), clindamycin, cyclosporine,
inhalation anesthetics (eg, enflurane), lincomycin, magnesium salts,
polypeptide antibiotics (bacitracin), quinidine, quinine, trimethaphan, or
verapamil because the side effects of Vecuronium may be increased.
Carbamazepine, hydantoins, other nondepolarizing neuromuscular blockers
(pancuronium), tetracyclines (doxycycline), theophyllines, or thiopurines
because the effectiveness of Vecuronium may be decreased.
Other medical problems- Pregnant/breast-feeding. If you are taking any
prescription or nonprescription medicine, herbal preparation or dietary
supplements; history of asthma, an enlarged prostate, trouble urinating,
circulation problems, electrolyte problems, a blockage of your bladder,
irregular heartbeat or other heart problems, liver or kidney problems,
adrenal gland problems, underactive thyroid, lung problems (COPD),
myasthenia gravis or Eaton-Lambert syndrome, mood, mental problems,
suicidal thoughts or behaviors, serious head injury, ICP, unusual growths in
the brain, seizures, or severe inflammatory bowel disease; history of
substance abuse or you are having stomach or intestinal surgery.
Norepinephrine bitartrate (Levophed)
Class: Sympathomimetic amine
Action:.Functions as a peripheral vasoconstrictor and as an
inotropic stimulator of the heart and dilator of coronary arteries.
Dose:
Adults: Add a 4 mL ampul (4 mg) of Levophed to 1,000 mL of a
5 percent dextrose containing solution. After observing the
response to an initial dose of 2 mL to 3 mL (from 8 mcg to 12
mcg of base) per minute, adjust the rate of flow to establish and
maintain a low normal blood pressure (usually 80 mm Hg to 100
mm Hg systolic) sufficient to maintain the circulation to vital
organs.
Pediatrics:
Indications: For blood pressure control in certain acute
hypotensive states (pheochromocytomectomy, sympathectomy,
poliomyelitis, spinal anesthesia, myocardial infarction,
septicemia, blood transfusion, and drug reactions).
As an adjunct in the treatment of cardiac arrest and hypotension.
Contraindications: allergy to Sulfites; should not be given to
patients who are hypotensive from blood volume deficits except
as an emergency measure to maintain coronary and cerebral
artery perfusion until blood volume replacement therapy can be
completed; avoid with patients with mesenteric or peripheral
vascular thrombosis.
Adverse Effects: Use with caution in patients with profound
hypoxia or hypercarbia as V-Tach or V-Fib may occur.
Interactions: cyclopropane and halothane anesthesia is
generally considered contraindicated because of the risk of
producing V-Tach or V-Fib; should be used with extreme caution
in patients receiving MAOI or antidepressants drugs;
Other medical problems: use in a large vein due to possible
necrosis in smaller veins; Ischemic injury due to potent
vasoconstrictor action and tissue hypoxia. bradycardia, probably
as a reflex result of a rise in blood pressure, arrhythmias. anxiety,
headache, dyspnea, necrosis at injection site.
prolonged administration may result in plasma volume depletion
which should be continuously corrected by electrolyte IV.
Midazolam (Versed)
Class: Anesthetic, adjunct sedative-hypnotic, anticonvulsant
Action: Is a short-acting benzodiazepine CNS depressant.
Dose:
Adults: To rapidly initiate sedation, 0.02 to 0.05 mg/kg IV (may
be given slowly or infused over several minutes.
Pediatrics:
0-6 months- DO NOT USE-NOT EVALUATED FOR PEDS
6 months to 12 years of age- Initial dose 0.03mg/kg IV.
WARNING- MEDICATION HAS BEEN ASSOCIATED WITH
RESPIRATORY DEPRESSION AND RESPIRATORY ARREST,
HAVE AGE/SIZE APPROPRIATE EQUIPMENT FOR
BAG/VALVE/MASK VENTILATION AND INTUBATION READY.
Indications: Is used to produce loss of consciousness
sleepiness or drowsiness and to relieve anxiety before certain
procedures or for preoperative sedation/anxiolysis/amnesia.
Contraindications: Do not give if patient has ever had an
allergic reaction to midazolam or other benzodiazepines (such as
Xanax ,Lectopam, Librium, Klonopin, Tranxen, Valium, ProSom,
Dalmane, Paxipam, Loftran, Ativan, Mogadon, Serax, Centrax,
Doral, Restoril or Halcion.) Avoid giving to pregnant/
breastfeeding mothers, newborn infants or elderly.
Adverse Effects: Do not give in patients with history of heart,
kidney, lung or liver, nerve or muscle disease (esp myasthenia
gravis)-medication may make the condition worse.
Interactions: Central nervous system (CNS) depressants
(medicines that cause drowsiness) or alcohol- effects may be
increased and may last longer. Avoid if patient is taking
Saquinavir drugs (Fortovase, Invirase)—combination may
interfere with the removal of midazolam from the body, which
could lead to serious side effects.
Other medical problems: Effects of medication may be
prolonged in obese pts.
Succinylcholine
Class: neuromuscular blocking agent.
Action: Relaxing muscles during surgery or when using a
ventilator. Used to induce anesthesia or when intubating. It is
depolarizing muscle relaxant and causes paralysis of the
muscles in the face and those used to breathe.
Dose:
Adults: 1.0-1.5 mg/ kg IV, max dose 150 mg.
Pediatrics: 1 mg/kg IV
Indications: indicated as an adjunct to general anesthesia to
facilitate tracheal intubation by providing skeletal muscle
relaxation during surgery or mechanical ventilation.
Contraindications: Recent severe burn, trauma, nerve damage,
or upper body movement injury of family history of muscle
disease or malignant hyperthermia (high body temp); if you are
pregnant/planning/breast-feeding, herbal preparation or dietary
supplement; glaucoma, electrolyte imbalance, liver problems,
plasma cholinesterase deficiency, bone fracture, muscle spasms,
high levels of potassium or low levels of calcium or potassium in
the blood, dehydrated or recent eye surgery/injury, history of
stomach infections or bleeding the brain.
Adverse Effects: Increased saliva; muscle pain following
surgery; muscle twitching; chest pain; fast breathing; fast or slow
heartbeat; high temp; increased pressure in the eye;
slowed/pauses in breathing; pounding in the chest; tightening of
jaw or other muscles.
Interactions: Digoxin due to risk of arrhythmias may be
increased; Aminoglycosides (gentamicin), beta-adrenergic
blockers (propranolol), chloroquine, clindamycin,
cyclophosphamide, glucocorticoids (prednisone), lithium,
magnesium salts, metoclopramide, oxytocin, oral contraceptives,
procainamide, quinidine, quinine, terbutaline, or trimethaphan
because effects may decrease.
Cefazolin (ANCEF)
Class: Antibiotic (cephalosporins)
Action: Fights bacteria in the body used to treat bacterial
infections for respiratory, skin, genital, urinary, bone & joint.
Dose:
Adults: 250 milligrams (mg) to 1.5 grams 6-12 hours, IM or IV
Pediatrics:
Infants and children 1 month of age and older—6.25 to 25 mg
per kilogram (kg) (2.84 to 11.36 mg per pound) of body weight
every 6 hours, or 8.3 to 33.3 mg per kg (3.77 to 15.13 mg per
pound) of body weight every 8 hours, IM or IV
Newborns—20 mg per kg (9.09 mg per pound) of body weight
every 8-12 hours, IV only.
Indications: Are used in the treatment of infections caused by
bacteria. They work by killing bacteria or preventing their growth.
Given by injection are also used to prevent infections before,
during, and after surgery.
Contraindications: Allergic reaction to another cephalosporin or
PCN; kidney, GI or liver disease or diabetes or patients with
phenylketonuria (PKU)
Adverse Effects: Severe nausea, vomiting, or diarrhea with
mucous or blood in the stool, chest pain, SOB, unusual bleeding
or bruising.
Interactions: probenecid (Benemid); diuretics (water pillfurosemide, bumex, demadex, edecrin, coumadin or another
antibiotic.
Other medical problems: difficult urination/ decreased output;
sores, ulcers, or white spots on lips or in mouth; seizures; side
effects also may occur up to several weeks after you stop taking
this medicine.
Sodium Bicarbonate
Class: Systemic alkalizer, urinary antacid, electrolyte replenisher
Action: Treats metabolic acidosis (too much acid in the body)
and certain drug intoxications, It is an electrolyte. It works by
neutralizing excess acid in the blood.
Dose: Follow medication with adequate ventilation
Adults: 1mEq/kg IV bolus with a 15-20 cc flush of NS
Pediatrics: 1mEq/kg per dose; administer as slow bolus with a
15-20 cc flush of NS
Contraindications: Vomiting, CHF, heart disease or
hypertension, liver or kidney problems, a decreased urine or no
urine, peripheral edema, or rectal bleeding of unknown cause.
Adverse Effects: Frequent urge to urinate; headache, loss of
appetite, mood or mental changes; muscle pain or twitching;
nausea or vomiting, nervousness or restlessness; slow
breathing; swelling of feet or lower legs; unusual tiredness or
weakness.
Interactions: Sympathomimetics (pseudoephedrine) because
side effects may be increased by this medicine
Anorexiants (phentermine), azole antifungals (itraconazole),
cephalosporins (cephalexin), corticosteroids (prednisone),
corticotropin, lithium, or tetracyclines (doxycycline) because
effectiveness may be decreased by Sodium bicarbonate
Other medical problems: Toxemia of pregnancy-causes
retention of water, which may precipitate condition. Alkalosis (too
little acid in the body), low blood levels of calcium or chloride,
Metoprolol (Lopressor)
Class: Beta-adrenergic blocking agent
Action: Works by reducing the amount of work the heart has to
do (reduces angina) and the amount of blood the heart pumps
out (lowers HBP). Also used to stabilize the heart rhythm in
conditions in which the heart is beating too fast or at an irregular
rhythm.
Adults: 5 mg every two minutes for three doses.
Pediatrics: DO NOT USE- NOT EVALUATED FOR PEDS
Indications: Treats hypertension, long-term treatment of angina;
reduces risk of death in MI patients
Contraindications: Bradycardia or suspected AV block; heart
failure controlled by diuretics (furosemide or digoxin); low systolic
blood pressure (<100 mm Hg); taking mibefradil; history of liver,
heart, or blood circulation problems, diabetes mellitus, COPD
dyspnea or asthma
Adverse Effects: Blurred vision; confusion; dizziness; itching;
lightheadedness; muscle aches; nausea; nightmares; memory
loss; stomach pain; unusual tiredness or weakness, chest pain;
fainting; pounding in the chest; peripheral edema or wheezing
Interactions: Barbiturates (phenobarbital), indomethacin, or
phenylpropanolamine because they may decrease effectiveness;
Amiodarone, cimetidine, disopyramide, flecainide, hydralazine,
ketanserin, mefloquine, mibefradil, quinazolines (imatinib),
quinidine, birth control pills, thioamines (propylthiouracil) or
verapamil because serious side effects, bradycardia and very
LBP may occur. Bupivacaine, disopyramide, flecainide,
hydralazine, ketanserin, or lidocaine because the risk of their
side effects may be increased by medication or Clonidine
because stopping either of these medicines suddenly can lead to
a rapid increase in BP.
Other medical problems: tumors on your adrenal gland, have
an overactive thyroid, or are scheduled to have surgery
Lidocaine 1%
Class: Antiarrhythmic agent
Action: Attenuates phase 4 diastolic depolarization, decreases
automaticity, decreases action potential duration, and raises
ventricular fibrillation threshold; inhibits conduction of nerve
impulses from sensory nerves.
Dose:
Adults: IV bolus 50 to 100 mg at rate of 25 to 50 mg/min; may
repeat, but do not exceed 200 to 300 mg/h. Continuous infusion
1 to 4 mg/min.
Pediatrics: IV bolus/ intratracheal 1 mg/kg/dose every 5 to 10
min (max dose, 5 mg/kg). Maintenance dose is 20 to 50
mcg/kg/min.
Indications: Acute management of ventricular arrhythmias
Contraindications: Stokes-Adams syndrome; Wolff-ParkinsonWhite syndrome; severe degrees of sinoatrial, AV or
intraventricular block in absence of pacemaker;
Adverse Effects: Hypotension; bradycardia; CV collapse;
cardiac arrest, CNS, dizziness; lightheadedness; nervousness;
drowsiness; apprehension; confusion; mood changes;
hallucinations; tremors, visual disturbances; diplopia; nausea;
vomiting, respiratory depression or arrest, difficulty in speaking,
breathing and swallowing, numbness of lips or tongue and
paresthesias.
Interactions: Beta-adrenergic blockers increased lidocaine
levels; Cimetidine decreases lidocaine levels; antiarrhythmic
agents (tocainide, mexiletine) produce toxic effects are additive
and potentially synergistic; Procainamide additive to neurological
and cardiac effects; Succinylcholine prolongs neuromuscular
blockade; Do not use with Amphotericin B, parenteral
cephalosporins, doxycycline, epinephrine, isoproterenol,
methohexital, nitroprusside, norepinephrine, phenytoin, sodium
bicarbonate, sulfadiazine.
Other medical problems: Use with caution in patients with
CHF, reduced cardiac output, digitalis toxicity, may result in
excessive depression of cardiac conductivity.
Atropine
Class: Antiarrhythmic; anticholinergics; antispasmodic
Action: Anticholinergics/antispasmodics are used emergency
procedures to help relax and decrease secretions; used to help
keep the heartbeat normal.
Dose: DO NOT give to patients under 1 year old.
Adults:
Asystole/PEA: 1mg IVP every 3-5 min, max dose 0.04 mg/kg
Symptomatic bradycardia: 0.5-1.0 mg IVP every 3-5 min, max
dose 0.04 mg/kg
Pediatrics: 0.02 mg/kg, minimum dose will be at least 0.1 mg.
Indications: Temporarily increase heart rate or decrease AVblock until definitive intervention can take place.
Contraindications: kidney disease; severe ulcerative colitis,
glaucoma, GI, liver or lung disease or myasthenia gravis, severe
bleeding, hypertension, toxemia of pregnancy or overactive
thyroid.
Adverse Effects: Blurred vision; difficulty in swallowing;
drowsiness, headache; increased sensitivity of eyes to light; loss
of memory; nausea, vomiting; unusual tiredness, irregular or fast
heart rate; flushing and eye pain; dizziness, lightheadedness,
weakness or nervousness; large pupils, may increase heart rate
Interactions: amantadine (Symmetrel);
quinidine (Quinaglute, Cardioquin, Quinora, Quinidex);
antihistamines such as diphenhydramine (Benadryl),
brompheniramine (Dimetapp, Bromphen), triprolidine (Actifed)
and chlorpheniramine (Chlor-Trimeton).phenylpropanolamine
(Dexatrim), phenylephrine (Neo-Synephrine), and
pseudoephedrine (Sudafed), phenothiazines such as
chlorpromazine (Thorazine) and prochlorperazine (Compazine);
fluphenazine (Prolixin), mesoridazine (Serentil), perphenazine
(Trilafon), thioridazine (Mellaril), trifluoperazine (Stelazine), and
promazine (Sparine); tricyclic antidepressants such as
amitriptyline (Elavil, Endep), doxepin (Sinequan), nortriptyline
(Pamelor), amoxapine (Asendin), clomipramine (Anafranil),
desipramine (Norpramin), imipramine (Tofranil), protriptyline
(Vivactil), and trimipramine (Surmontil).
Mannitol 20%
Class: Osmotic diuretic.
Action: Works by increasing the amount of fluid excreted by the
kidneys and helps the body to decrease pressure in the brain
and eyes.
Dose:
Adults: In adults a dose of 0.25 to 2 g/kg body weight as a 15%
to 25% solution administered over a period of 30 to 60 minutes;
Pediatrics: pediatric patients 1 to 2 g/kg body weight or 30 to 60
g/m2 body surface area over a period of 30 to 60 minutes
Indications: Reduction of intracranial pressure and brain mass.
Contraindications: renal disease or damage, severe pulmonary
congestion or pulmonary edema, intracranial bleeding, severe
dehydration.
Adverse Effects: Pulmonary congestion, fluid and electrolyte
imbalance, acidosis, electrolyte loss, edema, headache, blurred
vision, convulsions, nausea, vomiting, skin necrosis,
thrombophlebitis, chills, dizziness, dehydration, hypotension,
tachycardia, fever and angina.
Interactions: None recorded at this time.
Calcium chloride
Class: Antihyperkalemic; antihypermagnesemic;
antihypocalcemic, cardiotonic, electrolyte replenisher
Action: Necessary for the restoration of normal cardiac function
and aids in the coagulation of blood.
Dose:
Adults: The usual adult dosage in hypocalcemic disorders
ranges from 200 mg to 1 g (2−10 mL) at intervals of 1 to 3 days.
Pediatrics: The pediatric dosage in hypocalcemic disorders
ranges from 2.7 to 5.0 mg/kg hydrated Calcium Chloride
Indications: indicated for the treatment of hypocalcemia in those
conditions requiring a prompt increase in plasma calcium levels.
Contraindications: contraindicated for cardiac resuscitation in
the presence of ventricular fibrillation or in patients with the risk
of existing digitalis toxicity. Is not recommended in the treatment
of asystole and electromechanical dissociation, Heart disease
Hypercalcemia (blood) or Hypercalciuria (urine) Hyper/ or hypo
parathyroidism, kidney disease or stones
Adverse Effects: moderate fall in BP, dizziness; irregular
heartbeat; nausea or vomiting; burning at injection site; sweating,
weakness
Interactions: Cellulose sodium phosphate (Calcibind), digitalis
glycosides (heart med), Etidronate (Didronel), Gallium nitrate
(Ganite) Magnesium sulfate (for injection), Phenytoin (Dilantin)
phenytoin tetracyclines (antibiotics)
Other medical problems: Patient may complain of tingling
sensations, a calcium taste, a sense of “heat wave” or hot
flashes.
Adenosine
Class: Antiarrhythmic.
Action: Slows conduction time through the A-V node, can
interrupt the reentry pathways through the A-V node, and can
restore NSR in patients with paroxysmal supraventricular
tachycardia (PSVT); used primarily to treat SVT.
Dose:
Adults: Initial dose is 6 mg given as rapid IV bolus over 1- 2
seconds; repeat administration if the first dose does not result in
elimination of SVT within 1-2 minutes, 12 mg should be given as
a rapid IV bolus and may be repeated a second time if required.
Pediatrics: (Body Weight < 50 kg) initial dose is given 0.05-0.1
mg/kg as a rapid IV bolus followed by saline flush; repeat
administration if conversion of PSVT does not occur within 1-2
minutes, additional bolus injections of Adenosine can be
administered at incrementally higher doses, increasing the
amount given by 0.05 to 0.1 mg/kg. Follow each with saline flush,
continue process until sinus rhythm is established or max single
dose of 0.3 mg/kg is used. Peds with body weight ≥ 50 kg should
be given adult dose.
Indications: Conversion to SR of paroxysmal supraventricular
tachycardia (PSVT), including that associated with accessory
bypass tracts (Wolff-Parkinson-White Syndrome). Med DOES
NOT convert atrial flutter, A-FIB, or V-TACH to NSR. In the
presence of atrial flutter or A-FIB, a transient modest slowing of
ventricular response may occur immediately.
Contraindications: Second- or third-degree A-V block (except in
patients with a functioning artificial pacemaker).
Sinus node disease, such as sick sinus syndrome or
symptomatic bradycardia (except in patients with a functioning
artificial pacemaker).
Adverse Effects: Chest pressure/discomfort; dizziness; flushing
of the face; headache; HBP; lightheadedness; nausea; SOB;
throat, neck, or jaw discomfort; tingling in the arms.
Interactions: Digoxin or verapamil, carbamazepine or
dipyridamole or methylxanthines (caffeine, theophylline)
Other medical problems:. None noted.
Dopamine
Class: Alpha and beta-adrenergic agent (sympathomimetic,
cardiac inotrope and vasoconstrictor)
Action: Treats shock and LBP due to MI, trauma, infections,
surgery, other causes. Helps improve heart function when it is
unable to pump enough blood, increasing the pumping strength
of the heart and the kidney blood supply.
Dose: DO NOT mix with Sodium Bicarbonate
Adults: Mix 400-800mg in 250ml NS, LR or D5W, titrate to
patient response.
Pediatrics: Mix from 40mg/mL in 5 or 10 mL vial, initial dose
often 5-10 ug/kg per minute.; typical is 2-20 ug/kg per min.
Indications: Cardiogenic and/or septic shock.
Contraindications: you are taking droxidopa or have taken
furazolidone or MAOI (phenelzine) within the past 21 days,
adrenal gland tumors or irregular heartbeat diabetes, history of
HBP, MI, or blood vessel disease (arteriosclerosis, Raynaud
disease, Buerger disease), or a decreased amount of blood in
the body (hypovolemia)
Adverse Effects: Tachycardia; headache; nausea; vomiting.
Interactions: Catechol-O-methyltransferase (COMT) inhibitors
(tolcapone) Cyclopropene, droxidopa, ergot derivatives
(methylergonovine), furazolidone, halogenated hydrocarbon
anesthetics (halothane), or MAO inhibitors (phenelzine), Alphablockers (prazosin), beta-blockers (propranolol), butyrophenones
(haloperidol), hydantoins (phenytoin) or phenothiazines.
Bromocriptine or tricyclic antidepressants (amitriptyline)
Guanadrel or guanethidine.
Other medical problems: None noted.
Amiodarone
Class: Antiarrhythmic.
Action: Treating life-threatening recurrent heart rhythm by stabilizing the heart
rhythm in conditions in which the heart is beating too fast or in an irregular
rhythm. Produces its helpful effects by slowing nerve impulses in the heart and
acting directly on the heart tissues correcting abnormal heart rhythms.
Dose:
Adults:
Cardiac Arrest- 300 mg IV push, consider additional 150mg push in 3-5 min.
Wide-Complex Tachycardia- First dose is rapid infusion 150 mg injected into a
vein for ten minutes, followed by a dose of 360 mg slow in fusion for six hours,
subsequent should be managed in the hospital.
Pediatrics:
For refractory pulseless VT,VF - 5mg/kg rapid IV/IO bolus
Supraventricular and ventricular arrhythmias- loading dose is 5mg/kg IV/IO
over 20-60 mintues (repeat to max of 15 mg/kg per day IV)
Indications: Used in a wide variety of atrial and ventricular tachyarrhythmias
Contraindications: allergy to iodine, complete/second/third or severe
sinoatrial heart block; bradycardia; or shock due to serious heart problems; or
fainting due to bradycardia (except if patient has a pacemaker) history of
liver/heart/thyroid or eye problems, lung disease, LBP, electrolyte problems
(low blood potassium or magnesium), post-operation.
Adverse Effects: Cough; painful breathing; SOB, dizziness, lightheadedness
or fainting; fever (slight); numbness or tingling in fingers or toes; trembling or
shaking of hands; trouble walking; unusual and uncontrolled movements of the
body; weakness of arms/legs
Interactions: Cholestyramine, hydantoins (phenytoin), rifampin, St. John's
wort, Antiarrhythmics (flecainide), arsenic, azole antifungals (ketoconazole),
cimetidine, cisapride, diuretics (furosemide, hydrochlorothiazide), dofetilide,
droperidol, H1 antagonists (astemizole, loratadine, terfenadine), HIV protease
inhibitors (ritonavir), ketolides (telithromycin), macrolide antibiotics
(erythromycin), phenothiazines (thioridazine), phosphodiesterase type 5
inhibitors (vardenafil), pimozide, quinolones (ciprofloxacin), serotonin receptor
antagonists (dolasetron), streptogramins (dalfopristin, quinupristin), trazodone,
ziprasidone, narcotic pain relievers (fentanyl) Anticoagulants (warfarin), betablockers (propranolol), calcium channel blockers (verapamil, diltiazem),
cyclosporine, dextromethorphan, digoxin, HMG-CoA reductase inhibitors
(simvastatin), lidocaine, methotrexate, thyroid hormones (levothyroxine) or
Clopidogrel.
Other medical problems:. None noted.