Drug Index Cards
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Transcript of Drug Index Cards
Activated Charcoal-Class: * AbsorbentActions: * Absorbs poisons in the stomach, prevents absorption by the body and enhances their elimination from the BodyIndications: * Utilized for patients who have ingested poisons or overdosed medications by mouthContraindications:
* Altered mental status* Patients that have ingested acids of alkalis.* Patients unable to swallow.
Precautions: * Do not give the patient milk, ice cream or sherbet as they decrease the effectiveness of the charcoal.Adverse Reactions:
* Blackening of the stools.* Vomiting
Adult dose: Administer 1-2 g/kg (25-50)Pediatric dose:
Administer 1-2 g/kg (12.5-25 grams)
Adenosine/Adenocard- Class: antidysrhythmic.Action: *natural nucleoside that slows conduction through the AV node without negative inotropic effects. *Decreases chronotroic effect from direct activity of sinus pacemaker cells and vagal nerve terminals.Indication: *Superventricular tachycardia, except for atrial fibrillation and flutter.Contraindications: * Adenosine hypersensitivity
*Bradycardia * Second-or third –degree block *Sick sinus syndrome
Side effects/Precaution: *Transient dysrhythmias including second or third degree AV Blocks, asystole, sinus Bradycardia, premature atrial contractions, or premature ventricular contractions.
*facial flushing*Headache*Shortness of breath*Dizziness*Nausea*Chest Discomfort*Bronchoconstriction*Methylxanthines may decrease effectiveness, may require larger
dose.*Dipyridamole may potentiate effect, may need to reduce dose.
Dosage: 6mg rapid IV push followed by a 20 ml saline flush, repeated in 1 to 2 minutes at 12 mg to a total cumulative dose of 30 mg.
Albuterol (Proventil, Ventolin, Salbutaol)-
Class: * beta 2 specific sympathomimetic.Action: * Primarily a beta 2 agonist that dilates bronchial smooth muscle
* Relaxes vascular smooth muscle.Indications:
* Reverse Bronchoconstriction associated with asthma, emphysema, chronic bronchitis, and other conditions that cause bronchospasm.Contraindications:
* Hypersensitivity to drug* Symptomatic tachycardia* Hypertension* Tachycardia greater than 150 BPM* Acute myocardial infarction
Side Effects/Precautions:*Tachycardia* Hypertension*Chest pain*Anxiety* Headache
Side Effects/Precautions:* Dizziness* Sweating * Nausea and Vomiting*Tremors* Dysrhythmias* Antidepressants may potentiate vasodilation
Dosage:* 2.5 mg to 5.0 mg in 2.5 to 3 ml of normal saline via nebulizer over 5 to 10 minutes* Repeat if severe bronchospasm persists.
Amyl Nitrate- Class: * Antidote for cyanide PoisoningActions: Forms methemoglobin, which combines with the cyanide forming a nontoxic compound (cyanmethemoglobin) which is excreted when sodium thiosulfate is administered.
Indications: Used initially in the management of cyanide poisoning.
Contraindications: Non when used for cyanide poisoning.
Precautions: * stop administration once sodium nitrate infusion is started * Do not administer to patients improving on their own * Oxygenation is critical in these patients
Adverse Reactions: * Headache
* Hypotension * Tachycardia
* Nausea/VomitingAdult dose: Vapor inhaled every 10-20 minutes until sodium nitrate iv solution is available. Crush capsule inside oxygen mask and patient inhales vapor.
Pediatric dose: Same as adult.
Aspirin-
Class: * Platelet aggregation inhibitor* Anti-inflammatory agent
Action: * Inhibits platelet aggregation and reduces clot formation
Indications: * Acute Myocardial infarction * Acute ischemic stroke
Contraindications: *Hypersensitivity* Hemorrhagic stroke* Bleeding disorder* GI Bleed
Side Effects/ Precautions:* GI Bleeding* Nausea and vomiting* May cause wheezing* Heartburn
Dosage: * 160 or 325 mg tablet chewed or swallowed.
Atropine Sulfate-
Class: * Parasympatholytic (Anticholinergic, Vagolytic)Action: * Anticholinergic agent that blocks acetylcholine receptors blocking the parasympathetic nervous system influence on the heart, smooth muscle, and glands.
Indications: * Hemodynamically significant Bradycardia * Asystole * Organophosphate poisoning or nerve gas exposure * PEA with slow complex rate
Contraindications: * Asymptomatic Bradycardia * Tachycardia * Hypersensitivity * Thyrotoxicosis
Side Effects/Precautions:* Tachycardia* Palpitations* Seizures* Hypertension* Respiratory Distress* Dizziness*Anxiety
Side Effects/ Precautions:* Dry mouth* Pupillary Dilation* Blurred Vision* Urinary Retention
Dosage: * Symptomatic Bradycardia: 0.5 to 1.0 mg IV repeated in 3 to 5 minutes at dose of 0.5 to 1.0 mg to a total maximum cumulative dose of 0.04 mg/kg.
Calcium Chloride-
Class: Calcium Salt (electrolyte)Action: * Increases calcium levels (calcium is necessary for normal function of nerves, muscles, skeletal system, and for cell membrane and capillary permeability.
* Has a role in the release of neurotransmitters and hormones* Increases cardiac contractile state* May increase ventricular automaticity
Indications: * Acute hypocalcemia * Acute hyperkalemia * Calcium channel blocker overdose * Hypermagnesemia
Contraindications: * Hypercalcemia * Digitalis toxicity * Renal or cardiac disease
Side Effects/Precautions:* Extravasation may cause tissue damage and necrosis* Will precipitate of mixed with sodium bicarbonate* Rapid injection may cause vasodilation, Hypotension, Bradycardia, cardiac
dysrhythmias, syncope, and cardiac arrest.Dosage: * 2-4 mg/kg of a 10% solution repeated at 10 minute intervals
Dextrose 50 %-
Class: * Carbohydrate
Action: * Increases blood glucose level
Indications: * Hypoglycemia
Contraindications: * Do not use for altered mental status due to stroke, head injury, or other intracranial pathology unless hypoglycemia is documented.
Side Effects/Precautions:* Local venous irritation* Infiltration may cause tissue necrosis* Collect a blood sample before administration* Consider thiamine administration in suspected thiamine-deficient patients
Dosage: 25 g (50 ml) intravenous injection
Diazepam (Valium)-
Class: * BenzodiazepineAction: * CNS depressant * Anticonvulsant * Anxiolytic
* Sedative* Skeletal Muscle relaxant
Indications: * Status epilepticus or actively seizing patient * Skeletal muscle relaxant * Sedation prior to cardioversion * Reduction of extreme anxiety
Contraindications: *HypersensitivitySide Effects/Precautions:
* Local venous irritation and burning at the intravenous injection site* CNS depression* Respiratory depression* Hypotension when injected too rapidly* Use with caution in patients with narrow angle glaucoma and those with
increased intraocular pressure.Dosage: * Seizures: 5-10 mg over a three minute period repeat every 5 minutes to a total of 20 mg.
* Acute anxiety: 2-5 mg IV or IM * Premedication prior to cardioversion: 5-15 mg
Diphenhydramine (Benadryl)-
Class: * Antihistamines (H1 histamine blocker)
Action: * Blocks histamine 1 receptor sites* Anticholinergic effects* Reduces vasodilation, Hypotension, Tachycardia associated with histamine release in
anaphylaxis.
Indications: * Severe allergic reaction * Anaphylaxis * Dystonic (extrapyramidal) reaction as a result of phenothiazines and
antipsychotic drug.
Contraindications: * Hypersensitivity * Asthma * Narrow-angle glaucoma
Side Effects/Precautions:* Hypotension* Drowsiness * Wheezing* Nausea and vomiting * Thickened bronchial secretions* Disturbed coordination* Epigastric distress* Dry mouth * Dry nose
* Tachycardia* Urinary retention
Dosage: * 25-50 mg IV or Deep IM
Dobutamine (Dobutrex)
Class: * Synthetic catecholamine (sympathomimetic) with primary beta adrenergic reception stimulation.
Action: * Positive inotrope (increases myocardial contractility)* Increases stroke volume and cardiac output* Minimal chronotrope (increased heart rate)
Indications: * Cardiogenic shock from left ventricular dysfunction * Acute congestive heart failure
Contraindications: *Atrial fibrillation, atrial flutter * Bradycardia-induced hypotension
Side effects/Precautions: * May increase myocardial infarction size* May cause ventricular* May be deactivated by alkaline solutions* Headache* Hypertension
Side Effects/Precautions- cont.* Palpitations
Dosage: 2-20 ug/kg/minute intravenous infusion
Dopamine (Intropin)-
Class: * sympathomimetic
Action: * Precursor to noreinehrine* Dose-dependent action may include increased renal and mesentery blood flow, beta
adrenergic effects including increased heart rate in myocardial contractility, and increased systemic vascular resistance from vasoconstriction
* Acts on alpha, beta and dopaminergic adrenergic receptors
Indications: * Cardiogenic shock with hemodynamically significant hypotension (systolic BP of 70 to 100 mmHg)
Contraindications: * Hypotension due to hypovolemia prior to fluid resuscitation efforts * Pheochromocytoma (tumor of adrenal gland)
Side Effect/Precautions:* Tachydysrhythmias* Hypertension* Palpitations* Nausea and vomiting* Chest pain* Nervousness* Headache* Dyspnea
Side Effects/Precaustions cont:
* May be deactivated by alkaline solution* Reduce the dose of patient is taking MAO inhibitor (antidepressant)* May cause hypotension if administered concomitantly with phenytoin
(dilantin)
Dosage: * 2 to 5 ug/kg/minute will increase renal and mesentery blood flow * 2 to 10 ug/kg/minute for predominant beta adrenergic effects for increasing heart rate
and myocardial contractility * 10 to 20 ug/kg/minute for predominant alpha adrenergic effects for vasoconstriction and an increase in systemic vascular resistance
Epinephrine (Adrenalin)-
Class: * Sympathomimetic
Action: *Alpha and beta agonist* Alpha effects are vasoconstriction and an increase in peripheral vascular resistance
(PVR)* Beta 1 is a positive inotrope that increases myocardial contractility and a positive
chronotrope that increases heart rate* Beta 2 dilates bronchial smooth muscle and skeletal vasculature* Increases myocardial automaticity* Increases myocardial electrical activity* Vasoconstriction of arterioles in the skin, muscle, and splanchic (visceral) areas
Indications: * Cardiac arrest * Anaphylaxis * Status asthmaticus * Reactive airway disease
Contraindications:* None in cardiac arrest* Hypertension* Pregnant Patient* Cardiovascular or hyperthyroid disease
Side Effects/Precautions:* Protect drug from light* Tachycardia* Palpitations* Hypertension* Dysrhythmia due to myocardial irritability* Increased myocardial oxygen demand* Headache* Tremors* Anxiety* Nausea and vomiting* Use with caution in males > 40 years of age or females> 50 years of age
Dosage:* Cardiac arrest: 1 mg of 1:10,000 IV every 3 to 5 minutes* Anaphylaxis: 0.3 to 0.5 mg 1:1,000 SQ or 0.3 to 0.5 mg IV (1:10,000) if hypotension
and poor perfusion* Asthma with severe bronchochonstriction: 0.3 to 0.5 mg 1:1,000 SQ* Infusion: 1 mg in 500 ml D5W --- infuse at 1 to 2 ug/min and titrate to desired
response to 10 ug/min* Endotracheal dose: 2.0 to 2.5 mg
Flumazenil (Romazicon)
Class: * Benzodiazepine Antagonist
Action: * Reverses the effects of benzodiazepines
Indications: * Reversal of respiratory depression associated with administration of BenzodiazepinesContraindications:
* Hypersensitivity to drug* Cocaine or other stimulant intoxication* Should not be used to rule out benzodiazepine overdose in the same manner
as naloxone
Side Effect/Precautions:* Headache* Nervousness and agitation* Dizziness* Fatigue* Cutaneous vasodilation
*Careful administration in patients with known benzodiazepine dependencyDosage:
* 0.2 mg IV over 30 seconds with additional doses of 0.3 to 0.5 mg to a maximum dose of 3.0 mg
Furosemide (Lasix)-
Class: * Loop diuretic
Action: * Inhibits reabsorption of sodium and chloride in loop of Henle, promoting diuresis* Vasodilation increases venous capacitance and decreases preload
Indications: * Congestive heart failure * Pulmonary edema associated with left ventricular failure
Contraindications:* Anuria* Hypovolemia* Dehydration* Pregnancy* Hypersensitivity
Side Effects/Precautions:* Protect drug from light* Dehydration* Hypokalemia
Side Effects/Precautions: cont.* Hyperglycemia* Hypercalcemia* Hyponatremia* Hypochloremia
Dosage:
* 40 mg (0.5 to 1.0 mg/kg) slow IV push over 1-2 minutes not exceed 20 mg/min.
Glucagon-
Class: * Antihypoglycemic counter-regulatory hormone * Beta blocker overdose antidote
Action: * Causes glycogenolysis ( conversion of glycogen to glucose* Increases blood glucose level (only if liver glycogen is available)* Positive inotrope (increased myocardial contractility) and positive chronotrope
(increased heart rate)* Increases AV Conduction* Inhibits glycogenesis (syntheses of glycogen from glucose)
Indication: * Hypoglycemia * Beta-blocker overdose
Contraindications: * Hypersensitivity* Hyperglycemia
Side Effects/Precaution:
* Nausea* Vomiting* Headache* Tachycardia* Hypotension* Use with caution in patients with cardiovascular or renal disease
Dosage:
* Hypoglycemia: 0.5 to 1 mg IM or IV* Beta-blocker overdose: 3 to 10 mg IV Bolus followed by a 2 to 5 mg/hr infusion
Glucose (Oral)-
Class: Carbohydrate
Action: Increases blood Glucose Level
Indications: Altered mental statues secondary to hypoglycemia
Contraindications: *Patients unable to protect their own airway,*Patients unable to swallow.
Precautions: Assure that the patient has a gage reflex.
Adverse reaction: AspirationNausea and vomiting
Adult dose: 25-50 gm PO or one single dose tube, and may repeat once
Pediatric dose:0.5 gm/kg PO if the child is < 8 years of age (ALS ONLY)
Haloperidol (Haldol)-
Class: Tranquilizer Anti-psychotic
Actions: Strong anti-emetic effect and impairs central thermoregulation. Produces weak central anticholinergic effects and transient orthostatic hypotension due to blockade of dopamine activity.
Indications: Management of the manifestations of the psychotic disorders and for treatment of agitated states in acute and chronic psychoses.
Contraindications: Patients wit known hypersensitivityComaParkinson’s diseaseAlcoholismCNS depressionCocaine Overdose
Precaution: *Severe cardiovascular disorders (may cause transient hypotension or precipitate angina pectoris). * Receiving anticonvulsant medication (may lower convulsive threshold.
Adverse Reactions: Extra-pyramidal syndrome (EPS) Headache
Lethargy Tachycardia Hypotension
Adult dose: 5 mg IM> Patients over the age of 655 y/o, 2.5 mg IM
Pediatric:5 mg IM (>12 yrs) and 2 mg IM (6-12yrs) MEDICAL DIRECTION REQUIRED.
HYDROXYCOBALAMIN (CYANOKIT)-
Class: AntidotePrecursor of vitamin B12
Actins: Binds with cyanide ions to form cyanocobalamin, which is excreted in the urine.
Indications: Treatment of cyanide poisoning with significant signs and symptoms of circulatory compromise.
Contraindications: Patients with known anaphylactic reactions to hydroxocobalamin or cyanocobalamin.
Precautions: Administer slowly over 15 minutes Transient hypertension
Adverse reactions: Hypertension Headache Red-colored urine Nausea
Adult dose:Initial dose is 5 g administered over 15 minutes slow IV. (Each 2.5 g vial of hydroxocobalamin for injections is
to be reconstituted with 100 mL of N.S. and administered at 10-15 mL/Min) An additional 5 g dose may be administered with medical control order.
Pediatric dose:70 mg/kg (reconstitute concentration is 25 mg/mL) Each 2.5 g vial of hydroxocobalamin for injection is to be
reconstituted with 100 mL/Minute. Maximum single dose 5 grams.
Ipratropium Bromide (Atrovent)-
Class: Anticholinergic Bronchodilator
Actions: Bronchodilation Dries respirator tract secretions. Is most effective in combination with a beta-adrenergic bronchodilator.
Indications: Bronchospasm related to asthma, chronic bronchitis and emphysema.
Contraindications: Sensitivity to soybeans or peanuts Sensitivity to Atropine
Tachydysrhythmias
Precautions: Administer Cautiously to patients with narrow-angle glaucoma.
Adverse Reactions: Tachycardia Palpitations
Dizziness Headache Dry Mouth
Adult dose:2.5 mL (500 mcg) mixed with 2.5 mg albuterol via nebulizer
Pediatric dose:< 2 y/o 1.25 mL (250 mcg) mixed with 2.5 mg Albuterol via nebulizer> 2 y/o 2.5 ml (500 mcg) mixed with 2.5 mg Albuterol via nebulizer.
Lidocaine (Xylocine)-
Class: * Antidysrhythmic
Action: * Decreases automaticity by slowing rate of phase for depolarization* Reduces re-entry by converting unidirectional block to bidirectional block in ischemic
tissue* Increases the ventricular fibrillation threshold
Indications: * Prevents a rise in intracranial pressure associated with administration of succinylcholine and the intubation procedure
* Suppression of ventricular dysrhythmia
Contraindications: * Hypersensitivity * Second- or third-degree block
* PVC’s with a heart rate less than 60 bmp
Side Effects/Precautions:* Hypotension* Drowsiness* Confusion* Anxiety* Seizures at high doses* Muscle twitching* Agitation* Blurred vision* Lightheadedness* Reduced conduction velocity at large doses
Dosage:* 1 to 1.5 mg/kg IV repeat at 0.5 to 0.75 mg/kg every 3-5 minutes to a total cumulative
dose of 3 g/kg* 2 to 2.5 mg/kg ET* After suppression of ectopy or dysrhthmia, initiate an infusion at 2 to 4 mg/minute
Magnesium Sulfate-
Class: * Anticonvulsant* Electrolyte* Antidysrhythmic
Action:* Magnesium depresses central nervous system and blocks neuromuscular transmission
Indications: * Seizures associated with eclampsia * Hypomagnesemia * Tosades de pointes * Severe asthma * Refractory ventricular fibrillation * Refractory pulseless ventricular tachycardia
Side Effects/Precautions:* CNS depression* Flushing* Hypotension* Myocardial depression* Diaphoresis* Respiratory depression* Hypothermia* Decreased heart rate* Use with caution in patient with renal failure or taking digitalis
Adult Dosage:Torsades de pointes (Pulseless)
2 gm slow IV/IO. Mix 2 gm in 10 mL of N.S. and administer over 2 minutes.With Pulses-
2 gm slow infusion. Mix 2 gm in 100 mL of N.S. Utilize a 10 gtts set and run at 50 gtts/min.Eclampsia-
4 gm slow infusion. Mix 4 gm in 100 mL of N.S. Utilize a 10 gtts set and run at 50 gtts/minAsthma=
2 gm slow infusion. Mix 2 gm in 100 mL of N.S. Utilize a 10 gtts set and run at 50 gtts/min.
Pediatric dosage:Tosades de pointes (Pulseless)
25-50 mg/kg IV over 20 minutes, up to maximum single dose of 2 gm.Torsades de pointes with pulse:
25-50 mg/kg IV over 20 minutes up to a maximum single dose of 2 gmAsthma-
25-50 mg/kg IV over 20 minutes up to a maximum single dose of 2 gm
Methylprednisolone ( Solu-Medrol)-
Class: * Corticosteroid
Action: * Anti-inflammatory* Immunosuppression
Indications: * Anaphylaxis * Asthma * Chronic obstructive pulmonary disease * Spinal cord injury
Contraindications: * None in the emergency setting
Side Effects/Precautions:* Headache* Hypertension* Hyperglycemia* Hypocalcemia* Nausea and vomiting* Use with caution in patients with renal disease, CHF and diabetes mellitus
Adult Dosage:
* 125 mg IV/IM
Pediatric dose:
* 2 mg/kg IV/IM up to a maximum single dose of 125.
Midazolam HCL (Versed)-
Class: Benzodiazepine
Actions: A short acting central nervous system depressant that causes amnesia, sedation and muscle relaxation,
Indications: Active seizures/status epilepticus. A sedation prior to cardioversion or Transcutaneous pacing in conscious patients. Chest pain or tachycardia due to overdose on ingestion of cocaine, amphetamine, ecstasy, LSD, PCP, or ketamine.
Contraindications: Known Hypersensitivity Hypotension
Precautions: Monitor respirations Avoid mixing with other medications, flush IV line after administration Titrate in small doses.
Adverse reactions: respiratory depression Apnea Hypotension
Amnesia Nausea
Adult Dose:2-5 mg IN/IN, up to a maximum dose of 5 mg. For combative patients the dosages is 5 mg IN/IM.
2-5 mg IV/IN, up to a maximum dose of 10 mg for patients requiring drug-assisted intubation.
Pediatric dose:0,1 mg/kg IV/IN, up to a maximum single dose of 5 mg
Morphine Sulfate-
Class: Narcotic AnalgesicActions: Potent analgesic
Decreases peripheral vascular resistance-vasodilatation. Decreases cardiac workload and oxygen demand on the heart.
Indications: Chest pain not relived by nitroglycerin Pain management
Contraindications: Known hypersensitivity. Head injury Hypotension Respiratory depression.
Precautions: Monitor respirator status and blood pressure. Have naloxone readily available.
Adverse reactions: Hypotension Respiratory Depression Syncope Bronchospasm
Adult dose: Pain management:
2 mg IV until pain is relieved or maximum of 10 mg is reached.
CHF:2 mg IV, up to a maximum of 10 mg as long as the patients systolic BP is > 140 mmHg.
Cardiac Chest Pain:2 mg IV, up to a maximum of 6 mg.
Pediatric dose:Pain management:
0.1 mg/kg IV, until pain is relieved or a maximum of 5 mg is reached.CHF:
0.1 mg/kg IV up to a maximum of 5 mg.
Naloxone (Narcan)-
Class: * Narcotic antagonist
Action: * Competes for narcotic receptor sites
Indications: * Known or suspected narcotic overdose
Contraindications: * Hypersensitivity
Side Effects/Precautions:* Hypertension* Nausea and vomiting* Dysrhythmia* Use with caution in patients who are depending on narcotics since it may
cause withdrawal
Dosage: * 0.4 mg to 2.0 mg IV, IM, or SQ* Endotracheal dose: 2 to 2.5 times IV dose
Nitroglycerin (Nitostat)-
Class: * Vasodilator* Antianginal analgesic
Action: * Vascular smooth muscle dilation* Reduction in myocardial workload* Coronary artery dilation* Reduction of systemic vascular resistance
Indications: * Angina pectoris * Chest pain associated with myocardial infarction * Hypertensive emergency * Congestive heart failure * Cerebral hemorrhage
Contraindications: * Hypersensitivity * Hypotension * Increased intracranial pressure
Side Effects/Precaution:* Hypotension* Reflex tachycardia* Headache* Syncope* Burning sensation in mouth* Dizziness* Nausea and vomiting
Dosage:* 1/150 g (0.4 mg) sublingual repeated every 3-5 minutes up to 3 doses* 1 to 2 metered dose sprays (0.4 mg/spray) repeat every 3 to 5 minutes up to 3 doses* 10 to 100 ug/min for IV infusion
Ondansetron (Zofran)-
Class: Anti-emetic.
Action: Potent anti-emetic
Indications: Persistent vomiting due to gastrointestinal
Contraindications: History of allergic reaction Pregnancy – MEDICAL CONTROL OPTION ONLY
Precautions: Avoid intra-arterial or subcutaneous administration.
Adverse reactions: Allergic reaction.
Adult dose: 4 mg IV.
Pediatric dose:Rarely used. 2-4 mg IV MEDICAL DIRECTION REQUIRED.
OXYGEN
Class: Gas
Action: Odorless, colorless, tasteless gas that is essential for life.
Indications: Cardiopulmonary arrest Trauma Dyspnea Suspected hypoxemia Cardiac related chest pain.
Contraindications: None
Precautions: Utilize the prescribed dose of the COPD patient unless the patient is in severe respiratory distress then 100 % is required.
Adverse reactions: May induce respiratory drive in some COPD patients.
Adult dose:> 15 lpm via BVM, 12-15b lpm via NRB, or 2-6 lpm via nasal cannula.
Pediatric dose:>15 lpm via BVM, 12-15 lpm vial NRB mask or blow by, 2-6 lpm via nasal cannula
Pralidoxime Chloride / 2-Pam CL (WMD)
Class: Cholinesterase Reactivator
Actions: * Reactivates cholinesterase which has been deactivated by chemical nerve agents and organophosphate poisons.
* Relieves paralysis of the respiratory muscles following chemical nerve agent or organophosphate exposure.Indications: *Second drug given for the treatment of poisoning due to organophosphate pesticides and chemical nerve agents. (First drug of choice is atropine).
* Primary indication for Pralidoxime administration is muscle weakness or respiratory depression in these patients.
Contraindications: Known hypersensitivity
Precautions: not indicated for poisonings with carbonate pesticides. Effects during pregnancy are unknown. Safety and efficacy in children is unknown. Do not administer more than 3 Auto-injectors due to its hypertensive effects.
Adverse Reactions: Tachycardia, laryngospasm, muscle rigidity if IV and infused to quickly Mild to moderate pain at the injection site. Blurred or double vision, dizziness, loss of coordination, headache drowsiness, hypertension,
tachycardia.
Adult dose:600 mg IM, uup to 1800 mg or 3 auto-injectors.
Pediatric dose:Not indicated.
Sodium Bicarbonate-
Class: * Alkalinizing agent, electrolyte
Action: * Sodium bicarbonate combines with hydrogen ions to for water and carbon dioxide* buffers metabolic acidosis* Forces and intracellular shift of excess potassium in hyperkalemia* Increases pH
Indications: * Severe metabolic acidosis in cardiac arrest refractory to ventilation * Tricyclic antidepressant overdose
* Hyperkalemia * Alkalinization agent for specific toxins
Contraindications:* Metabolic or respiratory alkalosis* Hypocalcemia* Hypokalemia* Hypernatremia
Side Effect/Precautions:* Metabolic alkalosis may occur* Precipitates when mixed with calcium chloride* May increase intracellular acidosis* May cause electrolyte imbalance* May deactivate catecholamine* Large solute load may lead to fluid overload
Dosage:* 1 mEq/kg IV Repeated at 0.5 mEg/kg every 10 minutes
Sodium Thiosulfate-
Class: Antidote for cyanide poisoning.
Actions: converts cyanide to less toxic thiocyanate which is excreted in the urine
Indications: Acute cyanide toxicity.
Contraindications: None in acute cyanide toxicity
Precautions: Not useful in hydrogen sulfide toxicity. Should be used after administration of nitrates.
Adverse reactions: No significant side effects in the setting of acute cyanide toxicity following the administration of nitrates.
Adult dose:12.5 grams (50 mL of 25 % solution) Slow IV push over 10 minutes.
Pediatric dose:MEDICAL CONTROL!!!
TETRACAINE HCL-
Class: Local anesthetic for the eye
Actions: Blocks the initiation and conduction of nerve impulse.
Indications: Topically applied local anesthetic for eye examination.
Contraindications: Hypersensitivity to ester anesthetics. Not to be applied in large amounts or to infants less than 1 year of age.
Do not use in the presence of penetrating trauma
Precautions: Advise patient that the drops may burn for a few seconds.
Adverse reactions: Stinging in affected eye.
Adult dose:1-2 drops per eye
Pediatric dose: 1-2 drops per eye.
Thiamine (bendizine)
Class: * Vitamin B1
Action: * Combines with ATP to form a co-enzyme in glucose metabolism
Indications: * Known or suspected thiamine deficiency * Alcoholism * Coma of unknown origin * Wernicke’s encephalopathy * Korsakoff’s syndrome
Contraindications: * None in emergency settings
Side Effects/Precautions:* May cause allergic reaction* Hypotension in rapid push* Nausea and vomiting
Dosage:* 100 mg slow IV or IM* Ideally, 50 mg IV and 50 mg IM