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Paramedic Drug Cards

Michael Egan

Formazione Scolastica, Scienza e Medicina

Readings of weekly drug cards based on the NREMT curriculum.

87 - Ketorolac

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87 - Ketorolac
Trade:Toradol Class:NSAIDMOA:inhibits the production or prostaglandins in inflamed tissue, which decreases the responsiveness of pain receptors. Indications:Moderately severe acute painContraindications: Patients with a hx of peptic ulcer disease or GI bleed, patients with renal insufficiency, hypovolemic patients, 3rd trimester pregnancy, nursing mothers, allergy to other nsaids, stroke or head trauma, having surgery within the next 7 days. Side effects: headache, drowsiness, dizziness, abdominal pain, dyspepsia, N/V, Diarrhea.Dosing:
Adult
IV 30mg
IM 60mg
Senior (65 and older)/ Pediatric < 50kgs
IV 15mg
IM 30mg

Thu, 22 Dec 2022
86 - Morphine
Trade: MorphineClass: Opiate agonist/Narcotic Analgesic MOA:Binds to the opiate receptors. Reduces stimulation of the sympathetic nervous system caused by pain and anxiety. Reduction of sympathetic stimulation reduces heart rate, cardiac work, and myocardial O2 consumptionIndications: moderate to severe pain including chest pain associated with ACS, CHF, and pulmonary edema.Contraindications: Respiratory depression, shock.Side effects: Respiratory depression, hypotension, N/V, dizziness, lightheadedness, sedation, diaphoresis, euphoria, seizures, cardiac arrest, anaphylactoid reaction.Dosage:
Adult
2-10mg IV/IO/IM
Pediatric
< 110 lbs 0.025 – 0.2mg/kg IV/IO/IM

Thu, 22 Dec 2022
85 - Fentanyl
Trade:SublimazeClass:Narcotic Analgesic MOA:Binds to opiate receptors producing analgesia and euphoriaIndication:PainContraindication: Use caution in traumatic brain injury, Respiratory depression Side effects: Respiratory depression, apnea, hypotension, N/V, dizziness, sedation euphoria, Sinus bradycardia, sinus tachycardia, palpitations, HTN, diaphoresis, syncopeDosing
Adult
50-100mcg IM/IV

Pedi
1-2mcg/kg IM/IV

Thu, 22 Dec 2022
84 - Diazepam
Trade:Valium Class:BenzodiazepineMOA:Binds to the benzodiazepine receptor and enhances the effects of GABAIndications: Anxiety, Skeletal muscle relaxation, anticonvulsant Contraindications: Children younger then 6 months, acute angle glaucoma, CNS depression, alcohol intoxication. Side effects: Respiratory depression, drowsiness, fatigue, headache, pain at the injection site, confusion, nausea, hypotension, cardiac arrest at high doses•Dosing:
Adult:
Anxiety: 2-10mg IV/IM
Seizure: 5-10mg IV/IO
Pediatric:
Anxiety: 0.2 – 0.3mg/kg IV/IM
Seizure: Older then 5 years: 1mg IV/IO
Older then 30 days less then 5 years:0.2 to 0.5mg IV/IO
Neonate: 0.1-0.3mg/kg IV/IO

Thu, 22 Dec 2022
83 - Carbamazepine
Trade:Tegretol Class: Anticonvulsant MOA:Binds preferably to voltage gated Sodium channels in their inactive conformation, which prevents repetitive and sustained firing of an action potential.Indications:Partial and generalized tonic – clonic seizures Contraindications: AV Block, bundle branch block, agranulocytosis, bone marrow supression, monoamine oxidase inhibitor therapySide effects: Dizziness, drowsiness, ataxia, N/V, blurred vision, confusion, headache, transient diplopia, visual hallucinations, life threatening rashes.Dosing:
Adult:
200mg PO
Pediatric:
6-12 years old: 100mg PO
Less then 6: 10mg/kg PO

Thu, 22 Dec 2022
82 - PHYSICAL DRUG CARDS AVAILABLE
First and foremost, THANK YOU to everyone who was listened to this Podcast over the past year. In just under 12 months we have risen to one of the top listened to and searched paramedic pod casts on spotify and apple podcasts. Again, thank you so much!

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Exclusive DISCOUNT CODE for my listeners: MEDIC22
Thu, 08 Dec 2022
81 - Nicardipine
Trade –Cardene
Class –Calcium Channel blocker
MOA –Blocks calcium movement into the smooth muscle of the blood vessel walls, causing vasodilation.
Indication– Angina, HTN
Contraindication – Aortic stenosis, hypotension, use caution in heart failure, cardiac conduction abnormalities, Cerebrovascular disease, depressed AV node conduction.
Side effects– Edema, headaches, flushing, sinus tachycardia, hypotension

Dosages :
Adult: 5mg/hr IV/IO
Pedi: 0.5 – 5 mcg/kg/min
Wed, 07 Dec 2022
80 - Hydroxocobalamin
Trade– CyanokitMOA: Antidote, cyanide poisoning adjunct Binds with cyanide to form nontoxic cyanocobalamin, preventing its toxic effects; excreted renallyIndications:Treatment of known or suspected cyanide poisioning.Contraindications: None is the emergency settingSide Effects: Hypertension, allergic reactions, GI bleeding, nausea, vomiting, dyspepsia, dyspnea, dizziness, headache, injection site reactions.Dosage:
Adult: 5 g IV infusion over 15 minutes at a rate of 15 mL/min.
Pedi: 70 mg/kg IV one time, may be repeated one time at the same dose.

Wed, 07 Dec 2022
79 - Verapamil
Trade – IsoptinClass– Calcium Channel blockerMOA– Blocks calcium from moving into the heart muscle cell, which prolongs conduction of the electrical impulses through the AV node.Indications – AF, HTN, paroxysmal SVT, Paroxysmal SVT prohylaxisContraindications– 2nd or 3rd degree AV block, Hypotension, cardiogenic shock, Sick sinus syndrome, WPW.Side effects – Sinus bradycardia, 1st, 2nd, or 3rd degree AV blocks, CHF, reflex tachycardia, transient asystole, hypotension.Dosing
Adult
2.5-10mg IV/IO over 2 minutes. May repeat at 5-10mg every 15-30 mins to a maximum dose of 30mg

Pedi
1-16 years old: 0.1mg/kg IV/IO max single dose 5mg over 2mins may repeat in 30 mins to a max dose of 10mg

Wed, 07 Dec 2022
78 - Clopidogrel
Trade – PlavixClass– Antiplatelet MOA– Blocks platelet aggregation by antagonizing the IIb/IIIa receptors Indications– ACS, chronic coronary and vascular disease, ischemic stroke.Contraindications – Hx of intracranial hemorrhage, GI bleed or trauma.Side effects – Nausea, Abdominal pain, hemorrhage. Dosing :
Unstable angina pectoris or non Q wave AMI.
Adult – Loading dose 300-600mg PO
Pedi– Not recommended for pedi patients

Wed, 07 Dec 2022
77 - Promethazine
Trade – PhenerganClass –Antiemetic MOA - Decreases nausea and vomiting by antagonizing H1 receptors Indications – Nausea/Vomiting Contraindication – Altered level of consciousness, jaundice, bone marrow suppression, Use caution in seizure disorder.Side effects– Paradoxic excitation in children and older adults. Dosing:
Adult - 12.5 - 25mg IV, IO, IM
Pedi - 2years and older 0.25 – 1 mg/kg IV, IO, IM

Wed, 07 Dec 2022
76 - Hydrocortisone
Trade – CortefClass – Corticosteroid MOA– Reduces inflammation by multiple mechanisms. As a steroid it replaces the steroids that are lacking in adrenal insufficiency.Indications– Adrenal insufficiency, allergic reactions, anaphylaxis, asthma, COPDContraindications– Cushing Syndrome, known sensitivity to benzyl alcohol, Use with caution in diabetes, HTN, CHF, known systemic fungal infection, renal disease, idiopathic thrombocytopenia, psychosis, seizure disorder, GI disease, glaucoma. Side effects– Leukocytosis, hyperglycemia, increased infection, decreased wound healing, increased rate of death from sepsis. Dosing
Anaphylactic shock
Adult100-500mg IV,IO, or IM
Pedi 2-10 mg/kg per day IV,IO, or IM max 500mg

Wed, 07 Dec 2022
75 - Sodium Nitroprusside
Trade – Nipride Class– Antihypertensive agentMOA– Causes direct relaxation of both arteries and veins Indication– HTN emergencies Contraindications– Hypotension, increased ICP, cerebrovascular disease, coronary artery disease, hepatic disease, renal disease, pulmonary disease.Side effects – Cyanide or thiocyanate toxicity, N/V, dizziness, headache, restlessness, abdominal pain, methemoglobinemia.Dosing
Adult 0.3-10mcg/kg/min
Pedi 0.5 – 10mcg/kg/min

Wed, 07 Dec 2022
74 - Hydrazaline
Trade– ApresolineClass– Vasodilator MOA– Directly dilates peripheral blood vesselsIndication – HTN associated with preeclampsia and eclampsia, HTN crisis Contraindication – Patients taking diazoxide or MAOI’s, coronary artery disease, stroke, angina, dissecting aortic aneurism, mitral valve and rheumatic heart disease. Side effects – Headache, angina, flushing, palpitations, reflex tachycardia, anorexia, N/V, diarrhea, hypotension, syncope, peripheral vasodilation, peripheral edema, fluid retention, pareshesias. Dosing
Preeclampsia and eclampsia:
Adult : 5-10mg IV repeat every 20-30mins until Systolic pressure of 90-105mmhg
Acute HTN ( not associated with preeclampsia )
Adult :10-20mg IV/IM
Pedi : 1mo – 12yr 0.1-0.2 mg/kg IV/IM max 20mg per dose

Wed, 07 Dec 2022
73 - Haloperidol
Trade – HaldolClass – Antipsychotic agent MOA– Selectively blocks postsynaptic dopamine receptorsIndications– Psychotic disorders, agitation Contraindications– Depressed mental status, Parkinson diseaseSide effects– extrapyramidal symptoms, drowsiness, tardive dyskinesia, hypotension, hypertension, VT, sinus tachycardia, QT prolongation, torsades de pointes. Dosing
Adult:
Mild agitation : 0.5-2mg PO/IM
Moderate agitation : 5-10mg PO/IM
Severe agitation : 10mg PO/IM
Pedi:
1-5mg IM/PO

Wed, 07 Dec 2022
72 - Tetracaine
Trade: TetraViscClass:Anesthetic MOA:Short acting pain suppressantIndication: Topical anesthetic for eye injuriesContraindication:allergySide Effects:numbness, blurred vision in treated eye, mild short burning sensationDose:
Adult: 1-2 drops every 5 minutes, repeat as needed
Pediatric1-2 drops every 5 minutes, repeat as needed

Wed, 07 Dec 2022
71 - Propofol
Trade – Diprivan Class– Anesthetic MOA – Produces rapid and brief state of general anesthesia. Indication – Anesthesia inductionContraindication– HypovolemiaSide effects – Apnea, Cardiac arrhythmias, asystole, hypotension, hypertension.Dosing
Initial induction:
1.5-3mg/kg IV/IO followed by a maintenance infusion.
Adult maintenance infusion
25-75 mcg/kg/min IV/IO

Pedi maintenance infusion
30-300 mcg/kg/min IV/IO

Thu, 13 Oct 2022
70 - Phenytoin
Trade – Dilantin Class– AnticonvulsantMOA– Depresses seizures by affecting the movement of sodium and calcium into neural tissue. Indication – Generalized tonic – clonic seizures.Contraindication – sinus bradycardia, sinoatrial block, second and third degree heart block, adam stokes syndrome, known sensitivity to hydantoins. Side effects – N/V, depression of cardiac conduction, sedation, nystagmus, tremors, ataxia, dysarthria, gingival hypertrophy, hirsutism, facial coarsening Dosing:
Adult: 15-20mg/kg IV/IO ( not to exceed a push rate of 50mg/min)

Pedi: 15-20mg/kg IV/IO ( at a rate of 1-3 mg/kg/min)

Thu, 13 Oct 2022
69 - Fibrinolytic
Trade– ALTEPLASE RECOMBINANT-TPAClass– Thrombolytic Agent MOA– Dissolves thrombi plugs in the coronary arteries and reestablishes blood flow.Indication – ST segment elevation greater then 1mm in 2 or more contiguous leads, New or presumed new left bundle branch block. Contraindications – ST segment depression, Cardiogenic shock, Recent major surgery, cerebrovascular disease, recent (within 10 days) GI bleeding, recent trauma, severe HTN Systolic greater then 180 diastolic greater then 110. High likely hood of left heart thrombus, acute pericarditis, severe renal or liver failure with bleeding complications, significant liver dysfunction, diabetic hemorrhagic retinopathy, septic thrombophlebitis, Patients older then 75, patients already taking Coumadin. Side effects – Bleeding, intracranial hemorrhage, stroke, cardiac arrhythmias, hypotension, bruisingDosing
Adult
Per medical direction.

Pedi
Not recommended

Thu, 13 Oct 2022
68 - Heparin
Trade – Unfractionated Heparin Class – Anticoagulant MOA– Acts on antithrombin III to reduce the ability of the blood to form clots, thus preventing clot deposition in the coronary arteries. Indication – ACS, acute pulmonary embolism, DVTContraindication – Predisposed to bleeding, aortic aneurism, peptic ulcer. Dosing:
Adult
Cardiac indications– 60 units/kg
Pulmonary embolism/ DVT – 80 units/kg

Pedi
Cardiac indications – 75 units/kg
Pulmonary embolism/DVT 75 units/kg

Thu, 13 Oct 2022
67 - Propranolol
Trade:Inderal Class:Beta Blocker MOA:Nonselective Beta antagonist that binds with both the beta1 and beta 2 receptors. Inhibits the strength of the hearts contractions, as well as decreases heart rate resulting in decreased cardiac O2 consumptionIndication:Angina, reentry SVT, Atrial Fibrillation, Atrial Flutter. Contraindication: Cardiogenic shock, Heart failure, AV block, bradycardia, pulmonary edema, sick sinus syndrome.Side effects: Bradycardia, AV block, Bronchospasm, hypotension. Dosing:
Adult:
1-3mg IV/IO Slow IVP
Pediatric:
0.01 to 0.1mg/kg slow IVP

Mon, 11 Jul 2022
66 - Labetalol
Trade:NormodyneClass:Beta blocker MOA: Binds with beta1, beta2 and Alpha1 receptors. Inhibits the strength of the hearts contractions, as well as heart rate. This results in decrease in cardiac Oxygen consumption. Indication:ACS, SVT, severe HTNContraindications:Hypotension, Cardiogenic shock, acute pulmonary edema, heart failure, severe bradycardia, Sick sinus syndrome, second or third degree heart block, bronchospasm. Side effects:Usually mild, Hypotensive symptoms, N/V, Bronchospasm, arrhythmia, bradycardia, AV blockDosing:
Adult
10mg IV/IO Over 1-2mins may repeat every 10 mins to a max dose of 150mg

Pedi
0.4-1mg/kg per hour to a max dose of 3mg/kg per hour

Mon, 11 Jul 2022
65 - Warfarin, glipizide, clopidogrel
Warfarin
Trade: Coumadin
Use:Anticoagulant

Glipizide
Trade: Glucotrol
Use: Diabetes

Clopidogrel bisulfate
Trade: Plavix
Use: Platelet inhibitor
Sun, 03 Jul 2022
64 - Oxytocin
Trade: Pitocin Class: HormoneMOA:Increases Uterine Contractions Indications: Postpartum hemorrhage after infant and placental deliveryContraindications: Presence of a second fetus, unfavorable fetal position.Side effects: Hypotension, Hypertension, tachycardia, arrhythmias, angina, seizures, N/V, uterine rupture, anaphylaxis.Dosing:
IM: 3-10 units after delivery of placenta IV: 20-40 milliunits/min titrate to severity of bleeding.

Sun, 03 Jul 2022
63 - Atenolol
Trade:Tenormin Class:Beta BlockerMOA: Inhibits the strength of the hearts contractions and heart rate, resulting in a decrease in cardiac oxygen consumption. Also saturates the beta receptors and inhibits dilation of bronchial smooth muscle. Indications: ACS, HTN, SVT, A-flutter, A-FibContraindications:Cardiogenic shock, AV block, bradycardia, use caution in hypotension, chronic lung disease ( asthma and COPD)Side effects: Bradycardia, bronchospasm, hypotension Dosing
Adult: Oral dosing only
Pediatric: Not recommended

Sun, 03 Jul 2022
62 - Norepinephrine
Trade:LevophedClass: Adrenergic agonist, inotropic, vasopressor MOA: alpha 1, alpha 2, Beta 1 agonist. Primarily results in peripheral vasoconstriction resulting in increasing BP, and coronary blood flow. Beta adrenergic action produces inotropic stimulation of the heart and dilates coronary arteries.Indications:Cardiogenic Shock, septic shock, severe hypotension Contraindications:Patients taking MAOIs, use caution in hypovolemia Side Effects: Dizziness, anxiety, cardiac arrhythmias, dyspnea, asthma exacerbation

Dosing
Adult:2-4mcg/min IV/IO titrate to effect ( systolic BP greater then 80) Max dose is 30mcg/min
Pedi: 0.05 to 2mcg/kg/min IV/IO

Sun, 03 Jul 2022
61 - Dobutamine
Trade: DobutrexClass:Adrenergic agent, InotropicMOA: Increases myocardial contractility and stroke volume with minor chronotropic effects, resulting in increased cardiac outputIndication:CHF, Cardiogenic shockContraindications: Drug induced shock, Systolic pressure greater then 100, use caution in HTN, recent MI, Arrhythmias, hypovolemia Side effects: Tachycardia, PVC’s, HTN, Hypotension, palpitations, arrhythmiasDosing:
Adult: 2-20 mcg/kg/min IV/IO
Pedi: SAA

Thu, 23 Jun 2022
60 - Milrinone
Trade:PrimacorClass:Inotropic / VasodilatorMOA: Positive inotropic drug and vasodilator with minimal chronotropic effects. Inhibits enzyme cAMP phosphodiesterase which results in an increased concentration of calcium inside the cardiac cell and results in better diastolic function and myocardial contractility. Indication:Cardiogenic shock, Heart failureContraindication: Valvular heart disease.Side effects: Cardiac arrhythmias, N/V, Hypotension

Dosing:
Adult:50 Mcg/kg IV/IO over 10 mins
Pedi:SAA

Thu, 23 Jun 2022
59 - Dopamine
Trade: IntropinClass: Vasopressor /Sympathomimetic MOA: Stimulates alpha and beta adrenergic receptors resulting in inotropy and increased cardiac output while maintaining dopaminergic induced vasodilatory effects.Indications: Hypotension and decreased cardiac output associated with cardiogenic shock and septic shock. Hypotension after ROSC. Symptomatic Bradycardia that doesn’t respond to atropineContraindications: VF, VT, or other ventricular arrhythmiasSide effects: Tachycardia, arrhythmias, skin and soft tissue necrosis, severe HTN, angina, dyspnea, headache, N/VDosing
Adults:2-20 mcg/kg/min IV/IO
Pedi: SAA

Thu, 23 Jun 2022
58 - Meloxicam, ibuprofen, insulin
meloxicam
Trade: Mobic
Use:NSAID

ibuprofen
Trade: Advil
Use:Pain, fever, arthritis

insulin glargine
Trade: Lantus
Use:Diabetes Mellitus
Fri, 17 Jun 2022
57 - Sodium Bicarb
Class:Electrolyte replacement /Alkalizing AgentMOA:Counteracts existing acidosisIndications: Acidosis, Drug intoxications (barbiturates, salicylates, methyl alcohol)Contraindications: Metabolic alkalosis, hypocalcemiaSide effects: metabolic alkalosis, hypernatremia, injection site reaction, sodium and fluid retention, peripheral edema.

Dosing
Metabolic acidosis during cardiac arrest
Adult:1 mEq/kg slow IV/IO may repeat at 0.5 mEq/kg in 10 mins
Pedi:SAA

Fri, 17 Jun 2022
56 - Lidocaine
Trade-XylocaineClass – Antiarrhythmic / NA+ blockerMOA– blocks sodium channels increasing the recovery period after repolarization. Suppresses automaticity in the His-Purkinje system and depolarization in the ventricles.Indication – Ventricular arrhythmiasContraindications- AV block, Bleeding, thrombocytopenia, Use caution in bradycardia, hypovolemia, cardiogenic shock, adams stokes syndrome, WPWSide effects– Toxicity ( signs may include anxiety, apprehension, euphoria, nervousness, disorientation, dizziness, blurred vision, facial paresthesias, tremors, hearing disturbances, slurred speech, seizures, sinus bradycardia.) Seizures without warning, cardiac arrhythmias, hypotension, cardiac arrest, pain at injection site. Dosing
Pulseless v- tach and v-fib
Adult: – 1-1.5mg/kg IV/IO may repeat at half the original dose (0.5 to 0.75mg/kg) every 5-10 mins to a max dose of 3mg/kg.
Maintenance drip 1-4mg/min
Pedi: 1mg/kg IV/IO (max 100mg)
Maintenance
20-50 mcg/kg/min
Perfusing ventricular rhythms
Adult: 0.5-0.75mg/kg IV/IO repeat every 5-10mins to a max dose of 3mg/kg
Pedi:1mg/kg IV/IO may repeat every 5-10 mins to a max of 3mg/kg

Fri, 17 Jun 2022
55 - Amiodarone
•Trade – Cordarone•Class – Antiarrhythmic•MOA - Acts directly on the myocardium to delay repolarization and increase the duration of action potential •Indications – Ventricular arrhythmias, second line for atrial rhythms.•Contraindications – Sick sinus syndrome, second and third degree heart block, cardiogenic shock, when episodes of bradycardia have cause syncope, sensitivity to benzyl alcohol and iodine.•Side effects – Burning at the IV site, hypotension, bradycardia. •Dosing
Ventricular Fibrillation, and Pulseless Ventricular Tachycardia
Adult:300mg IV/IO followed by 150mg in 3-5 mins
1mg/min maintenance infusion after ROSC
Pedi:5mg/kg max dose 300mg may repeat 5mg/kg up to 15mg/kg
Stable Wide Complex Tachycardia
Adult:150mg over 10 mins.
Pedi: 5mg/kg IV/IO over 20-60 mins

Fri, 17 Jun 2022
54 - Calcium Chloride
Class-Antidote Description-Calcium chloride increases myocardial contractile force and increases ventricular automaticity.Indications-Hyperkalemia, hypocalcemia, hypermagnesemia, and calcium channel blocker toxicity.Contraindications-Ventricular fibrillation, hypercalcemia, and possible digitalis toxicity.Precautions-It may precipitate toxicity in patients taking digoxin. Ensure the IV line is in a large vein and flushed before using and after calciumDosing Adult
Bradycardia of Suspected Hyperkalemia
Adult: 1G IV, IO over 5-10mins
Cardiac Arrest of Suspected Hyperkalemia
Adult:1G IV IO
Hyperkalemia
Adult: 1G IV/IO may repeat after 5 mins

Fri, 10 Jun 2022
53 - Adenosine
Trade– Adenocard Classification – Antiarrhythmic MOA– Slows the conduction of electrical impulses at the AV nodeIndication – SVTContraindications – Sick sinus syndrome, second or 3rd degree heart block, Poison/drug induced tachycardia, asthma, or bronchospasm Side Effects– Sense of impending doom, complaints of flushing, chest pressure, throat tightness, numbness, brief period of asystole after administration. Dosing
Adult: 6mg rapid IV/IO followed by a rapid saline flush; If rhythm doesn’t break in 1-2 minutes 2nd dose of 12mg RAPID IV/IO followed by saline flush
Pediatric:
Greater than 110 pounds SAA
Less than 110 pounds initial dose 0.1mg/kg IV/IO (max 6mg) Followed by a rapid saline flush second dose if rhythm persists or reoccurs 0.2mg/kg (max 12mg) followed by a rapid saline flush.

Fri, 10 Jun 2022
52 - Calcium Gluconate
Trade– Calcium Gluconate Class – Electrolyte solution MOA– Counteracts the toxicity of hyperkalemia by stabilizing the membrane of the cardiac cells, reducing the likelihood of fibrillation Indication– Hyperkalemia, hypocalcemia, hypermagnesemia Contraindications- VF, Dig toxicity, hypercalcemia Side effects – soft tissue necrosis, hypotension, bradycardia ( if administered rapidly)Dosing
Adult: 500 to 1000mg IV/IO (packaged as 100mg/ml) administer 1-1.5 ml/min max dose 3G IV/IO

Pedi: 60-100ml/kg IV/IO slowly over a 5-10 minute period maximum dose 3G IV/IO

Fri, 10 Jun 2022
51 - Montelukast, tramadol, pantoprazole
Sun, 05 Jun 2022
50 - Metoprolol
Trade– Lopressor, Toprol XLClass– Beta Blocker ( Class II antiarrhythmic) MOA– Inhibits the strength of the hearts contraction as well as the heart rateIndication– ACS, HTN, SVT, atrial flutter, Afib, thyrotoxicosis Contraindications– Cardiogenic Shock, AV Block, BradycardiaSide effects – Tiredness, dizziness, diarrhea, heart block, bradycardia, bronchospasm, drop in blood pressure.Dosing
Adult: 5mg slow IV/IO over 2 minute period, Repeat at 5 minute intervals as necessary up to 15mg
Pediatric: Not Recommended

Sun, 05 Jun 2022
49 - Diltiazem
Trade – Cardizem Class – Calcium channel Blocker ( class IV antiarrhythmic) MOA– Blocks Calcium from moving into the heart muscle cell, which prolongs the conduction of electrical impulses through the AV node Indication– Rapid atrial fibrillation Contraindications– Hypotension, Heart block, heart failure Side effects– Flushing, headache, bradycardia, hypotension, heart block, myocardial depression, severe AV block, at high doses cardiac arrest Dosing
Adult: 0.25mg/kg IV/IO 2nd dose of 0.35mg/kg IV/IO

Pediatric: Not recommended

Sun, 05 Jun 2022
48 - Atropine
Class – Anticholinergic MOA – Competes reversibly with ACH at the site of the muscarinic receptor. Indication – Symptomatic Bradycardia, asystole or PEA, Nerve agent exposure or organophosphate poisoning.Contraindications – Acute MI, Myasthenia Gravis, GI obstruction, closed angle glaucoma, known sensitivity to atropine, belladonna alkaloids, or sulfites. Atropine may not be effective on second degree type 2 and 3rd degree heart blocks.Side effects – decreased secretions resulting in dry mouth and hot skin, intense facial flushing, blurred vision or dilation of the pupils with photophobia, tachycardia and restlessness. Atropine may cause paradoxical bradycardia if the dose administered is too low or if it is administered too slowly. Dosing
Symptomatic Bradycardia
Adult: 0.5mg IV/IO every 3-5 minutes to a maximum dose of 3mg
Pediatric:0.02mg/kg IV/IO up to a total dose of 2mg
Nerve Agent or Organophosphate Poisoning
Adult:1-6mg IV/IM repeat every 5 minutes until symptoms dissipate
Pediatric: 0.05mg/kg IV/IM every 10 – 30 minutes until symptoms dissipate

Sun, 05 Jun 2022
47 - Mannitol
Trade – OsmitrolClass– Osmotic DiureticMOA– Facilitates the flow of fluid out of tissues including the brain and into interstitial fluid and blood, this causes dehydration of the brain which results in decreased swelling. Reabsorption by the kidneys is limited so increased urine output takes placeIndications – increased ICPContraindications- Active intracranial bleeding, heart failure, pulmonary edema, severe dehydration, use caution with hypovolemia and renal failure.Side effects – Pulmonary edema, headache, blurred vision, dizziness, seizures, hypovolemia, nausea/vomiting, diarrhea, electrolyte imbalance, hypotension/HTN, sinus tachycardia, PVCs, angina, phlebitis Dosage
Adult:0.25-1g/kg
Pediatric:SAA

Thu, 02 Jun 2022
46 - Dexamethasone
Trade– DecadronClass – Corticosteroid MOA – Reduces inflammation by multiple mechanismsIndication – Asthma, airway edema, acute mountain sickness, cerebral edema and multiple medical conditions requiring anti-inflammatory Contraindications– Fungal infection, use caution in active infections, renal disease, penetrating spinal cord injury.Side effects – Depression, euphoria, headache, restlessness, HTN, Bradycardia, Nausea/vomiting, swelling, diarrhea, weakness, fluid retention, paresthesias Dose
Adult: 10mg IV/PO

Thu, 02 Jun 2022
45 - Dextrose
Trade– Dextrose (D50, D25, D10)Class– Antihypoglycemic MOA– Increases blood glucose concentrationsIndications – Hypoglycemia Contraindications – Intracranial and instraspinal hemorrhage, delirium tremens. Side effects – Hyperglycemia, warmth, burning from IV infusion. Concentrated solutions may cause pain and thrombosis of peripheral veins. Dosing –
Hyperkalemia:
Adult: 25G of dextrose 50% IV,IO
Pedi:0.5 – 1G/kg IV/IO
Hypoglycemia:
Adult:10-25g dextrose 50% IV
Pedi: Older then 2 years 2ml/kg of Dextrose 50%
Pedi under years old: 2-4 ml/kg of Dextrose 10%

Thu, 02 Jun 2022
44 - Bupropion, Potassium, Carvedilol
Bupropion
Trade: Wellbutrin
Use:Antidepressant

Potassium
Trade: K-Dur
Use:Hypokalemia

Carvedilol
Trade: Coreg
Use:HTN
Thu, 02 Jun 2022
43 - Fluticasone, Alprazolam, Trazadone
Fluticasone
Trade: Flonase
Use: Allergies

Alprazolam
Trade:Xanax
Use:Anxiety, Panic disorder

Trazodone hydrochloride
Trade:Desyrel
Use:Depression
Sat, 21 May 2022
42 - Esmolol
Trade – BreviblocClass– Beta BlockerMOA– Inhibits the strength of the hearts contractions, as well as heart rate. Indication – ACS, MI, acute HTN, Supraventricular tachyarrhythmiasContraindications – COPD, Acute Bronchospasm, Bradycardia, Advanced Heart blocks, cardiogenic shock, Pulmonary Edema, Side Effects – Hypotension, sinus bradycardia, AV block, Cardiac arrest, nausea/vomiting, hypoglycemia, injection site reactionDosage
Adult: 500mcg/kg IV/IO over 1 minute

Pedi: 500mcg/kg IV/IO over 1 minute

Sat, 21 May 2022
41 - Glucagon
Trade – GlucagonClass – HormoneMOA– Converts glycogen to glucoseIndication– hypoglycemia, beta blocker overdoseContraindications – Pheochromocytoma, Insulinoma Side effects– Nausea/vomiting, rebound hyperglycemia, hypotension, sinus tachycardiaDosages
Hypoglycemia
Adult: 1mg IM, IV, IO, SQ
Pedi: Less than 44 lbs – 0.5mg IM, IV, IO, Sq

Beta Blocker/CCB Overdose
Adult:3-10mg IV, IO

Sat, 21 May 2022
40 - Terbutaline
Trade – BrethineClass– Adrenergic agent MOA – Stimulates B2 receptor producing relaxation of bronchial smooth muscle and bronchodilation. Indication – prevention and reversal of bronchospasm Contraindications– known sensitivity to sympathomimeticsSide Effects – Cardiac arrhythmias, arrhythmia exacerbation, angina, anxiety, headache, tremor, palpitations, dizzinessDosages
Adult: 0.25mg SQ every 20 minutes for up to 3 doses
Pedi: 0.005 to 0.01 mg/kg SQ every 20 mins for up to 3 doses

Sat, 21 May 2022
39 - Amoxicillin, Citalopram, Fluoxetine Hydrochloride
Sun, 15 May 2022
38 - Ondansetron
Trade– ZofranClass– Antiemetic MOA – Binds and blocks a receptor for the brain chemical serotonin Indication – Prevention and treatment of nausea and vomitingContraindication – Use caution in hypokalemia, hypomagnesemia, cardiac arrhythmias Side Effects – headache, fatigue, diarrhea, dizziness, hypotension/HTN, Prolonged PR and QT intervals, Widened QRS, Bradycardia, tachycardia, syncope. Dosage
Adult: 4– 8mg IV, IO, PO
Pedi:(2-16 years) 0.15 mg/kg IV,IO ( max dose 16mg)

Sun, 15 May 2022
37 - Methyprednisolone
Trade – Solu MedrolClass – CorticosteroidMOA– Reduces inflammation by multiple mechanismsIndications– Anaphylaxis, Asthma, COPDContraindications – Cushing Syndrome, Fungal infection, HTN, seizures, CHF, Penetrating spinal cord injuries, Renal diseaseSide effects– depression, euphoria, headache, restlessness, HTN, Bradycardia, nausea/vomiting, swelling, diarrhea, weakness, fluid retention, paresthesiaDosage:
Asthma and COPD
Adult: 40-80mg/day IV
Pedi:1mg/kg (up to 60) IV/IO per day
Anaphylactic Shock
Adult:0.5 – 1mg/kg IV
Pedi:SAA

Sun, 15 May 2022
36 - Acetaminophen, Atenolol, Pravastatin Sodium
Generic Acetaminophen
Trade: Tylenol
Use:Pain/Fever

Generic Atenolol
Trade: Tenormin
Use: HTN

Generic Pravastatin Sodium
Trade: Pravachol
Use: High cholesterol
Sat, 07 May 2022
35 - Magnesium Sulfate
Trade – Magnesium SulfateClass – Electrolyte, Tocolytic, MineralAction – Controls seizures by blocking peripheral neuromuscular transmission. Magnesium is also a peripheral vasodilator, and an inhibitor of platelet function. Indication – Torsades de Pointes, cardiac arrhythmias associated with hypomagnesemia, eclampsia and seizure prophylaxis in preeclampsia, status asthmaticus. Contraindications – AV Block, GI obstruction, use caution in renal impairment. Side effects – Mag Toxicity
Signs of Mag Toxicity would include flushing, diaphoresis, hypotension, muscle paralysis, weakness, hypothermia, and cardiac, CNS, or respiratory depression
Dosages
Pulseless V-fib/ V-tach with Torsades de Pointes or Hypomagnesemia
Adult:1 – 2 G in 10ml D5W IV,IO, over 15 mins or faster if cardiac arrest
Pediatric: 25 – 50mg/kg IV/IO over 10 – 20 mins or faster for Torsades- max single dose: 2G
Eclampsia and Seizure Prophylaxis in preeclampsia
Adult:4-6G IV/O over 20-30 mins followed by 1-2G/Hr
Status Asthmaticus
Adult: 1.2-2G IV/IO over 20 mins
Pediatric:25/50mg/kg slow IV/IO over 10-20 mins

Sat, 07 May 2022
34 - Aspirin
Trade– ASA(Acetylsalicylic Acid)Class – Antiplatelet, nonnarcotic analgesic, antipyretic. MOA – prevents the formation of a chemical known as thromboxane A2, which causes platelets to clump together, or aggregate, and form plugs that cause obstruction or constriction of small coronary arteries. Indication – Fever, inflammation, angina, AMI, and patients complaining of pain, pressure, squeezing, or crushing in the chest that may be cardiac in origin.Contraindication – GI bleeding, active ulcer disease, hemorrhagic stroke, bleeding disorders, children with chickenpox or flulike symptoms. Use caution in Reye SyndromeSide Effects:NoneDosing
Myocardial Infarction
Adult: 160-325mg PO
Pedi:3-5mg/kg per day
Pain or fever
Adult: 325-600mg PO every 4-6 hours
Pedi: 60-90mg/kg per day divided into doses every 4-6 hours

Sat, 07 May 2022
33 - Furosemide
Trade – LasixClass– Loop Diuretic MOA– Inhibits the absorption of the sodium and chloride ions and water in the loop of Henle, as well as the convoluted tubule of the nephron. This results in decreased absorption of water and increased urination Indication – Pulmonary edema, CHF, HTN emergencyContraindications – Known Sensitivity to sulfonamides or furosemideSide Effects - Vertigo, dizziness, weakness, orthostatic hypotension, hypokalemia, thrombophlebitisDosage:
Congestive Heart Failure and Pulmonary Edema
Adult: 20 – 40mg IV,IO slow push over 1-2 mins
Pedi:1mg/kg IV, IO, IM
Pedi 2nd Dose:2mg/kg IV, IO, IM
Hypertensive Emergency
Adult: 40mg IV, IO
Pedi: 1mg/kg IV,IM

Sat, 07 May 2022
32 - Methylphenidate, Estradiol, Losartan Potassium
Methylphenidate Trade – Concerta Use – ADHDEstradiol Trade – Climara Use – Menopaus Losartan Potasium Trade – CozaarUse – High cholesterol

Fri, 18 Feb 2022
31 - Metoclopramide
Trade – Reglan Class – Antiemetic MOA – promotes gastric emptyingIndication – Nausea/vomiting, Migraine with historyContraindication – GI obstruction or perforation, pregnancy, under 6 yo.Side effects – constipation, diarrhea, dry mouth, HTN

Dosing

Adult 10-15mg IV,IO

Pediatric 0.4-0.8mg/kg IV/IO

Fri, 18 Feb 2022
30 - Procainamide
Trade – Pronestyl

Class – Antiarrhythmic – NA+ blocker

MOA – Blocks influx of sodium through membrane pores, consequently suppresses atrial and ventricular arrhythmias by slowing conduction in myocardial tissue.

Indication – Alternative to amiodarone for stable monomorphic VT with normal QT interval. Reentry SVT if uncontrolled by adenosine and vagal maneuvers if BP is stable. Rapid Afib in WPW

Contraindications – AV block, QT prolongation, torsades de pointes,

Side effects – Asystole, VF, flushing, hypotension, PR prolongation, QRS widening, QT prolongation.

Dosing
Adult – 500-600mg over 25-30 mins or 20-50mg/min ( max dose of 17mg/kg until one of the following occurs; arrhythmia resolves, hypotension, QRS widens > 50% of original width. )

Pedi 10 to 15 mg/kg slow IV,IO over 30-60 mins.
Fri, 18 Feb 2022
29 - Levalbuterol
Trade –XopenexDescription: Sympathomimetic, bronchodilator-Stimulates beta-2 receptors resulting in smooth muscle relaxation of bronchial tree and peripheral vasculature.Indications: Treatment of acute bronchospasm in patients with reversible obstructive airway disease (COPD/asthma). Bronchospasm prophylaxis in asthma patients.Contraindications: Angioedema, tachydysrhythmias, and sever cardiac disease. Avoid use in patients taking phenothiazines; may cause prolonged QT interval and dysrthythmias. Dosage/Route: 1.25 mg in 3 mL

Sat, 12 Feb 2022
28 - Pancuronium
Description: Pancuronium is a non-depolarizing neuromuscular blocker that causes paralysis without bronchospasm or hypotension, it does not cause the fasciculation's associated with polarizing agents.Indications: To facilitate endotracheal intubation.Contraindications: Tachycardia.Dosage/Route: 0.04 to 0.1 mg/kg IV. Pedi: same as adult.

Sat, 12 Feb 2022
27 - Famotidine
Name/Class: Pepcid) Anti-Ucler Agent / H2-Receptor Antagonist
Description: Famotidine is a histamine-2 blocker. It works by decreasing the amount of acid the stomach produces.
Indications: Upper GI Bleed, Anaphylaxis.
Contraindications: Hypersensitivity, Long QT syndrome.
Precautions: Asthma, COPD.
Dosage/Route: 20mg IV
Sat, 12 Feb 2022
26 - Gabapentin, Furosemide, Sertraline
Gabapentin Trade - Neurontin Use – Epilepsy Furosemide Trade – LasixUse – CHF/HTN/EdemaSertraline HCL
Trade – Zoloft Use - Antidepressant

Mon, 07 Feb 2022
25 - Racemic Epinephrine
Description: Sympathomimetic Agonist is a variation of epinephrine used only for inhalation to induce bronchodilation and to reduce laryngeal edema and mucus secretion.Indications: Croup (laryngotracheobronchitis).Contraindications: Hypersensitivity, hypertension, or epiglottitis.Precautions be monitored. : May result in tachycardia and other dysrhythmias. Patient vital signs and ECG shouldDosage/Route: 0.25-0.75ml of a 2.25% solution in 2.0ml NS Pedi: same as adult.

Mon, 07 Feb 2022
24 - ::UPDATE::
Just wanted to give you all a heads up that from this point on, I will be copying and pasting each drug slide into the episode description incase anyone wants to follow along with the reading. I tend to also be a visual learner so I need to read along every once in awhile to really help get these memorized.

I will do my best to go back and update all the previous episodes over the next week or so to make everything consistent across the board.

As always, if you have any feedback or recommendations, please do not hesitate to let me know.

Thank You!
Fri, 04 Feb 2022
23 - Diphenhydramine
Trade – Benadryl Class – Antihistamine MOA – Antagonizes h1 histamine receptors Indication – Anaphylactic reaction Contraindication – Acute asthma as Benadryl thickens secretions.Side effects – Drowsiness, Dizziness, headache, excitable state, wheezing, thickening bronchial secretions, chest tightness, palpitations, hypotension, blurred vision, dry mouth, N/V, Diarrhea. Dosing Adult 25-50mg IV/IO/IMPedi 2-12 years – 1-1.25 mg/kg IV/IO/IM

Fri, 04 Feb 2022
22 - Nitroglycerin
Trade – Nitroquick
Class – Antianginal agent
MOA – Relaxes vascular smooth muscle, thereby dilating peripheral arteries and veins. This causes pooling of venous blood and decreased venous return to the heart, which decreases preload. Nitroglycerin also reduces left ventricular systolic wall tension, which decreases afterload.
Indication – Angina, ongoing ischemic chest discomfort, HTN, Myocardial Ischemia associated with cocaine intoxication.
Contraindication – Hypotension, severe bradycardia or tachycardia, right sided MI, increased ICP, intracranial bleeding, patients taking any medications for erectile dysfunction, known sensitivity to nitrites.
Side effects – Headache, hypotension, bradycardia, lightheadedness, flushing, cardiovascular collapse, methemoglobinemia
Dosing Adult
Sublingual tablets/translingual spray 0.4mg at 5 min intervals for a max of 3 doses
Ointment 2% topical apply 1-2 inches of paste over the chest wall
IV infusion 5mcg/min may increase rate by 5-10mcg/min every 5 – 10 mins as needed
Pedi
IV infusion – 0.25-0.5 mcg/kg/min titrate up to max dose of 5 mcg/kg/min
Fri, 04 Feb 2022
21 - Albuterol, Losartan Potassium, Hydrochlorothiazide
Sun, 30 Jan 2022
20 - Albuterol
Sun, 30 Jan 2022
19 - Ipatropium Bromide
Sun, 30 Jan 2022
18 - Thiamine
Sat, 29 Jan 2022
17 - Benzocaine Spray
Sat, 29 Jan 2022
16 - DuoNeb
Sat, 29 Jan 2022
15 - Vecuronium
Sat, 29 Jan 2022
14 - Metoprolol, Amlodipine, Hydrocodone
Fri, 21 Jan 2022
13 - Nitrous Oxide
Fri, 21 Jan 2022
12 - Etomidate
Fri, 21 Jan 2022
11 - Rocuronium
Fri, 21 Jan 2022
10 - Succinylcholine
Fri, 21 Jan 2022
9 - Metformin, Omeprazole, Simvastatin.
Fri, 14 Jan 2022
8 - Ketamine
Fri, 14 Jan 2022
7 - Midazolam
Thu, 13 Jan 2022
6 - Epinephrine 2/2
Thu, 13 Jan 2022
5 - Epinephrine 1/2
Thu, 13 Jan 2022
4 - Activated Charcoal
Thu, 13 Jan 2022
3 - Oxygen
Thu, 13 Jan 2022
2 - Prescription Meds- Atorvastatin, Levothyroxine, Lisinopril
Thu, 13 Jan 2022
1 - Naloxone
Thu, 13 Jan 2022

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