EMT-Intermediate (Oregon) Drug Cards

What is the purpose of amiodarone?

Antiarrhythmic

What is the trade name for Amiodarone?

Cordarone

What are some mechanisms of action on Amiodarone?

Slows automaticity and conduction of the SA and AV nodes, increases refractory period and prolongs the QT interval

What is the onset of Amiodarone?

Less than 1 minute

When does the peak effects of Amiodarone occur?

30-45 minutes

What is the half-life of Amiodarone?

May last up to 120 days

What are the indications of Amiodarone?

Ventricular Fibrillation and Ventricular Tachycardia (with or without a pulse)

What are some precautions of Amiodarone?

Rapid infusion may cause hypotension, extreme care if patient is taking medication which prolongs QT interval

What is the dose of Amiodarone in an adult patient in V-Fib/Pulseless V-Tach?

300mg mixed in 10-30mL normal saline, 150mg given as a second dose or if rhythm converts.

What is the dose of Amiodarone in an adult patient in V-Tack with a pulse?

150mg in 100mL over 10 minutes

What is the maximum does of Amiodarone in an adult patient?

450mg

What is the dose of Amiodarone in a pediatric patient?

5mg/kg, may repeat up to 2 times

What is the maximum single dose of Amiodarone in a pediatric patient?

300mg

What is the class od Atropine?

Anticholinergic or Parasympatholytic

What is the trade name for Atropine Sulphate?

Atropine

What are the actions of Atropine?

Works against the parasympathetic nervous system by blocking receptor sites specific to acetylcholine, increases electrical conduction through the SA and AV node and inhibits secretions by decreasing parasympatholituc activity on bronchial, salivary, sweat and GI glands

What is the onset of Atropine?

2-4 minutes

When does the peak effects of Atropine occur?

20-60 minutes

What is the duration of Atropine?

2-6 hours

What are the indications of Atrpoine?

Symptomatic Bradycardia and Organophosphate poisoning

What are the side effects of Atropine?

Palpitations, dry mouth, nausea, vomiting, pupil dilation, blurred vision, and flushed, hot, dry skin

What are some precautions with Atropine?

Do not treat the rhythm unless the patient shows signs of poor perfusion such as dizziness, weakness, low blood pressure, mental confusion or other orthostatic symptoms, slow administration or lower doses can cause slowing of the heart rate, and not likely to be effective in a second or third-degree block

What is the adult dose of Atropine?

0.5mg with a maximum or 3mg overall

What is the pediatric dose of Atropine?

0.02mg/kg every 3-5 minutes, minimum single dose is 0.1mg, maximum single dose is 0.5mg, with a maximum overall of 1mg

What is the class of Diphenhydramine?

Anti-histamine

What is the trade name for Diphenhydramine?

Benadryl

What are the mechanisms of action of Diphenhydramine?

Competes for histamine binding throughout the body and anticholinergic effects: dry mouth and blurred vision

What are the indications of Diphenhydramine?

Mild to moderate allergic reaction that do not involve wheezing, airway swelling or hypotension and may be used as a second line drug to epinephrine of anaphylaxis

What is a contraindication to diphenhydramine?

Known sensitivity

What are side effects and precautions with Diphenhydramine?

Possible sedation, respiratory depression, occasionally hyperexcitability and Anticholinergic side effects including tachycardia and palpitations

What is the adult dose of Diphenhydramine?

25-50mg

What is the pediatric (weight based) dose of Diphenhydramine?

1-2mg/kg

What is the class of Epinephrine 1:10,000?

Sympathetic Agonist

What is the trade name for Epinephrine 1:10,000?

Adrenaline

What are the mechanism of actions of Epinephrine 1:10,000?

Alpha, Beta 1 and Beta 2 effects

What are indications of Epinephrine 1:10,000?

V-Fib, Pulseless V-Tach, Asystole, PEA and Symptomatic Bradycardia

What are the indications of Epinephrine at the Intermediate level?

Anaphylaxis, Symptomatic Bradycardia, Asthma and Croup, V-Fib, Pulseless V-Tach, Asystole, PEA and Symptomatic Bradycardia

What are some side effects and precautions with Epinephrine?

Can precipitate angina, MI, or major dysrhythmias in an individual with ischemia heart disease; other side effects include anxiety, muscle tremors, tachycardia and palpitations.

What is the dose of Epinephrine in an adult patient in anaphylaxis?

0.3-0.5mg, repeat every 3-5 minutes until severe symptoms are relieved

What is the dose of Epinephrine in a pediatric patient in anaphylaxis?

0.1mg/kg with a maximum single dose of 0.5mg, repeat every 3-5 minutes until severe symptoms are relieved

What is the dose of Epinephrine in an adult patient with asthma?

0.1-0.5 mg

What is the dose of Epinephrine in a pediatric patient with asthma?

0.01mg/kg with a maximum single dose of 0.5mg, repeat every 3-5 minutes until severe symptoms are relieved

What is the dose of Epinephrine in an adult patient in V-Fib, Asystole or PEA? 1mg IV every 3-5 minutes

What is the dose of Epinephrine in an pediatric patient in V-Fib, Asystole, or PEA? 0.01mg/kg

What is the dose of Epinephrine in an adult patient with symptomatic bradycardia?

0.01mg/kg every 3-5 minutes

What is the dose of Epinephrine in a pediatric patient with symptomatic bradycardia?

0.01mg/kg every 3-5 minutes

What is the dose of Epinephrine in an adult patient with croup, severe anaphylaxis or severe asthmas?

1ml of 1mg/mL in 2mL of saline via nebulizer

What is the class of Fentanyl?

Narcotic Analgesic

What is the trade name of Fentanyl?

Sublimaze

What are the mechanisms of action of Fentanyl?

Relieves pain by binding to opiate receptors in the brain and spinal cord, blocking the transmission of pain to the brain

What are the indications of Fentanyl?

Extremity fractures, crush or amputation injuries, pain from severe burns, cardiac chest pain unresponsive to nitroglycerin

What are contraindications to Fentanyl?

BP under 100, Trauma or pain to the head or abdomen, Respiratory depression

What is a major side effect in regards to administering Fentanyl?

"Frozen Chest" syndrome occurs when you rapidly administer it

What are side effects to Fentanyl?

Nausea and vomiting, check and document pain levels.

What is the dose of Fentanyl in an adult?

0.5-1 Micrograms/kg (maximum dose of 100mcg), over 30-60 seconds

What is the dose of Fentanyl in a pediatric?

1 Microgram/kg given over 30-60 seconds. Repeat dose at 0.5-1.0micrograms/kg

What is the class of Furosemide?

Loop Diuretic

What is the trade name for Furosemide?

Lasix

What are the mechanisms of action of Furosemide?

Potent diuretic, action targets early in the filtering process of the kidneys, Potassium is also pulled out of circulation.

What are the indications of Furosemide?

Acute pulmonary edema due to CHF, consider only after nitroglycerin and CPAP

What are the contraindications of Furosemide?

BP under 90, Pneumonia, COPD, and shouldn't be used in pregnant women

What are the side effects and precautions of Furosemide?

Hypovolemia and hypotension may occur. Sodium and potassium depletion may also occur.

What is the dose of Furosemide in an adult?

0.5-1.0mg/kg over 1-2 minutes, if no response, double the dose. Single dose typically 20-40mg

What is the class of Ketorolac?

Non steroidal anti-inflammatory (NSAID); non narcotic analgesic

What is the trade name for Ketorolac?

Toradol

What are the mechanisms of action with Ketorolac?

Blocks the works of prostaglandin, reduces pain and inflammation at the site, does not cause CNS depression as commonly seen with narcotic analgesics

What are the indications of Ketorolac?

Mild to moderate pain due to fractures, dislocations; highly effective in managing the pain associated with kidney stones

What are the contraindications of Ketorolac?

Allergy to NSAIDs, History of asthma, severe liver or kidney disease, peptic ulcers

What are some side effects and precuations of Ketorolac?

Dizziness, headache, dry mouth, or sweating; May stimulate bronchospasm in COPD or asthma patients, use caution in elderly and patients taking aspirin

What is your dose for Ketorolac?

Single dose of 15-30mg IV or 30-60mg IM

What is the class of Lidocaine?

Antidysrhythmic agent

What is the trade name of Lidocaine?

Xylocaine

What are the mechanisms of action of Lidocaine?

Depresses automaticity of ventricular electrical fibers; has very little effect on atrial muscle.

What are the indications of Lidocaine?

PVCs in the presence of cardiac ischemia such as angina or MI, Stable V-Tach or recurrent V-Tach, recurrent V-Fib, pulseless V-Tach; drug of choice for polymorphic V-Tach (Torsades), successful defibbrilation or cardioversion from V-Tach

What are the contraindications of Lidocaine?

Ventricular rythms with a rate less than 1t50 beats per minute; ventricular complexes seen in slow rythms (sinus brady, AV block)

What are some side effects of Lidocaine?

Dizziness, lethargy, may stimulate areas of brain, may cause CNS depression, and may slow the heart rate

What is your dose for Lidocaine in an adult with V-Fib or pulseless V-Tach?

1-1.5mg/kg, after 5-10 minutes, give second dose of 0.5-0.75mg/kg.

What is your maximum total dose of Lidocaine?

3mg/kg

What is your dose for Lidocaine in a pediatric with V-Fib or pulsless V-Tach?

1mg/kg

What is your dose for Lidocaine in an adult patient in V-Tach or PVC's with a Pulse?

0.5-0.75mg/kg

What is your dose for Lidocaine in a pediatric patient in V-Tach or PVC's with a Pulse?

1mg/kg

What is the class of Morphine?

Narcotic Analgesic

What is the trade name for Morphine Sulfate?

Morphine

What are the actions of Morphine?

Relieves pain by binding to opiate receptors in the brain and spinal cord, vasodilation effects that reduce the workload of the heart

What are the indications of Morphine?

Extremity fracture, crush or amputation injuries; severe burns; cardiac chest pain unresponsive to nitroglycerin

What are some contraindications of Morphine?

Known allergy, BP under 90, Trauma or pain of the head or abdomen, Respiratory depression

What are some side effects and precautions of Morphine?

Nausea and Vomiting are common, Drop in BP, Respiratory depression reversible with naloxone, check and document pain levels.

What is the adult dose of Morphine?

0.05-0.1 mg/kg every 5 minutes to a total dose of 20mg

What is a usual adult dose of Morphine?

3-7mg

What is the pediatric dose of Morphine?

Less than 20kg: 0.1mg/kg -OR- If greater than 20kg: follow adult dosing

What is the class of Nitroglycerin? Vasodilator/Anti-Anginal

What are the indications of Nitroglycerin at the Intermediate level?

First line treatment of rcardiac chest pain and acute pulmonary edema, followed by Lasix

What are the contraindications for Nitroglycerin?

BP below 90, Viagara, Levitra, Cialis or Adempas

What are some side effects to Nitroglycerin?

Throbbing headache, burning under tongue or dizziness. May cause hypotension

What is the dose of Nitroglycerin?

0.4mg sublingually

How many times and how often may you repeat Nitro in a patient with cardiac chest pain?

Repeat twice every 3-5 minutes

How many times and how often may you repeat Nitro in a patient with acute pulmonary edema?

May repeat 4 doses every 3-5 minutes

What is the class of Vasopressin?

Vasopressor, Anti-Diuretic

What are the mechanisms of action of Vasopressin?

Horomone normally found in the posterior pituitary gland, water regulation with secondary role of vasoconstriction with no effects on the heart.

What are the indications of Vasopressin?

Used as an alternative vasoconstrictor agent to epinephrine in cardiac arrest; Asystole, PEA, pVFib or V-Tach