ALS Pharmacology Flashcards

Vocabulary practice flashcards covering indications, contraindications, pharmacology, and key properties of ALS medications according to MIEMSS protocols.

Acetaminophen Indications

Patients 3 months of age and older with: (1) Mild to moderate discomfort (e.g., 1–5 on FACES scale) or (2) Fever (EMS-documented temperature greater than or equal to $100.4^\text{o}\text{F}$ / $38^\text{o}\text{C}$).

Acetaminophen Contraindications

(1) Head Injury (2) Hypotension (3) Administration of acetaminophen or medications containing acetaminophen within the previous 4 hours (4) Inability to swallow or take medications by mouth (5) Respiratory distress (6) Persistent vomiting (7) Known or suspected liver disease (including patients suspected of current alcohol ingestion) (8) Allergy to acetaminophen (9) Patients less than 3 months of age.

Acetaminophen Dosages

Activated Charcoal Indications

Poisoning by mouth.

Activated Charcoal Contraindications

(1) Altered mental status (2) Patients who have received an emetic.

Activated Charcoal Dosages

(1) Adult: Administer 1 gram/kg PO

(2) Pediatric: Administer 1 gram/kg PO

Adenosine Indications

To slow the rate of narrow complex tachycardia (SVT/PSVT)

Adenosine Contraindications

(1) Known hypersensitivity (2) History of moderate to severe asthma or active bronchospasm (3) Polymorphic or irregular wide complex tachycardia

Adenosine Dosages

Adult: 6 mg rapid IVP bolus followed by a rapid flush Give 12 mg if no response within 2 minutes. Give 12 mg more if no response within another 1–2 minutes

Pediatric: 0.1 mg/kg rapid IVP/IO; maximum initial dose 6 mg Second and third doses: 0.2 mg/kg rapid IVP/IO; maximum single additional dose 12 mg

Albuterol Indications

(1) Signs and symptoms of respiratory distress (2) Bronchospasm/wheezing associated with: (a) Asthma (b) COPD/emphysema (c) Allergic reaction (anaphylaxis) (3) Hyperkalemia/Crush Syndrome.

Albuterol Dosages

Bronchospasm

(i) Age 2 or older: 2.5 mg by nebulized aerosol (ii) Age less than 2 years: 1.25 mg by nebulized aerosol

Hyperkalemia

(a) Adult: 20 mg by nebulized aerosol connected to 6–8 lpm of oxygen (b) Pediatric (i) Age 2 or older: 2.5 mg by nebulized aerosol (ii) Age less than 2 years: 1.25 mg by nebulized aerosol

Amiodarone Indications

(1) Prevent recurrence of ventricular fibrillation/tachycardia after defibrillation and conversion to supraventricular rhythm (2) Ventricular tachycardia (VT) (3) Ventricular fibrillation (VF) (4) Atrial fibrillation/Atrial Flutter with aberrancy (Wide QRS), for HR greater than 130 and SBP greater than 100.

Amiodarone Contraindications

(1) Second or third degree AV blocks (2) Sensitivity to amiodarone (3) Idioventricular escape rhythms (4) Accelerated idioventricular rhythm (5) Sinus bradycardia or arrest or block (6) Hypotension (7) Cardiogenic shock (8) Ventricular conduction defects (9) Iodine hypersensitivity

Amiodarone Dosages

(1) Adult with pulse (including Afib/Aflutter with aberrancy): 150 mg IV/IO over 10 minutes (mixed in 50 - 100 mL of approved diluent). May repeat once.

(2) Adult without pulse VF/VT/(torsades after magnesium sulfate): 300 mg IV/IO. May repeat one time at 150 mg IV/IO

(3) Pediatric with pulse: 5 mg/kg IV/IO over 20 minutes (mixed in 50 - 100 mL of approved diluent)

(4) Pediatric without pulse: 5 mg/kg IV/IO; max single dose 300 mg. May repeat twice to a maximum of 15 mg/kg

Aspirin Indications

(1) Suspected Acute Coronary Syndrome and/or (2) ST Elevation MI (STEMI).

Aspirin Dosages

(1) Adult: 324 mg or 325 mg chewed (2) Pediatric: Not indicated

Atropine Indications

(1) Symptomatic bradycardia, if pacing is unavailable or ineffective (2) Organophosphate poisoning (3) Nerve agents.

Atropine Contraindications

(1) Known hypersensitivity (2) Dysrhythmias in which enhancement of conduction may accelerate the ventricular rate and cause decreased cardiac output (e.g., atrial fibrillation, atrial flutter, or PAT with block) (3) Relative Contraindications (weigh risk/benefits): (a) AV block at His-Purkinje level (second-degree Type II AV Block and third-degree AV Block) (b) Suspected acute myocardial infarction or ischemia (c) Glaucoma

Atropine Dosages

(1) Adult: Bradycardia: Administer 0.5–1 mg IVP repeated every 3–5 minutes to a total dose of 0.04 mg/kg

(2) Pediatric: Bradycardia: Administer 0.02 mg/kg IV/IO; maximum single dose 0.5 mg; ET 0.04– 0.06 mg/kg, dilute 5 mL; repeat once

(3) Organophosphate poisoning: (a) Adult: Administer 2–4 mg IVP or IM every 5–10 minutes. (b) Pediatric: Administer 0.02 mg/kg IVP/IO or IM every 5–10 minutes.

Calcium Chloride (10% Solution) Indications

(1) Hyperkalemia/Crush Syndrome (2) Hypocalcemia (3) To treat adverse effects caused by calcium channel blocker overdose (4) Hypotension secondary to diltiazem or verapamil (5) Respiratory depression, decreased reflexes, flaccid paralysis, and apnea following magnesium sulfate administration.

Calcium Chloride (10% Solution) Contraindications

Patient currently taking digoxin with suspected calcium channel blocker overdose

Calcium Chloride Dosages

(1) Adult: (a) Hyperkalemia/Crush Syndrome, Hypocalcemia, Calcium Channel Blocker Overdose: administer 0.5-1 gram SLOW IVP/IO over 3–5 minutes. Maximum dose 1 gram. (b) For hypotension following diltiazem administration OR respiratory depression, flaccid paralysis, decreased reflexes and apnea after magnesium sulfate administration: administer 500 mg SLOW IVP/IO over 3–5 minutes.

(2) Pediatric: Administer 20 mg/kg (0.2 mL/kg) SLOW IVP/IO over 3–5 minutes. Maximum dose 1 gram or 10 mL.

Cefazolin Indications

(1) Suspected open fracture (2) Amputations (3) Mangled or degloved extremity.

Cefazolin Contraindications

Known allergy or hypersensitivity to a medication in the penicillin or cephalosporin class of antibiotics

Cefazolin Dosages

(1) For patients 13 years of age and older: Administer 2 grams in 100 mL of approved diluent IV/IO over 10 minutes

(2) For patients 5 through 12 years of age: Administer 1 gram in 100 mL of approved diluent IV/IO over 10 minutes

(3) For patients 1 through 4 years of age: Administer 500 mg in 100 mL of approved diluent IV/IO over 10 minutes

(4) For patients less than 1 year of age: a medical consultation is required

Dexamethasone Indications

(1) Moderate to severe asthma/COPD exacerbation (2) Croup (3) Anaphylaxis (4) Adrenocortical insufficiency.

Dexamethasone Contraindications

(1) Hypersensitivity to drug (2) Known systemic fungal infection (3) Premature infants

Dexamethasone Dosages

(1) Adult: 15 mg IV/IM/PO/IO with no repeat doses.

(2) Pediatric: 0.5 mg/kg PO (preferred), IM or IV to a maximum of 15 mg. No repeat doses.

Dextrose Indications

Correction of altered mental status due to low blood sugar (hypoglycemia) seizures and cardiac arrest.

Dextrose Dosages

(1) Adult: (a) If blood glucose is less than 70 mg/dL, administer 10% dextrose in 50 mL (5 grams) boluses, one minute apart, to a maximum of 250 mL OR 25 grams of 50% dextrose IVP/IO, until: (i) the patient has a return to normal mental status, and (ii) the patient’s blood glucose is at least 90 mg/dL.

(2) Pediatric: (a) Patient less than 28 days — if blood glucose is less than 40 mg/dL administer 2 mL/kg of 10% dextrose IV/IO. D10W is prepared by mixing one part of D50W with four parts LR. Recheck glucose after first dose. If blood glucose is less than 40 mg/dL, obtain medical consultation to administer second dose of D10W.

Diphenhydramine Hydrochloride Indications

(1) Allergic reaction (2) Anaphylaxis (3) Dystonic reactions.

Diphenhydramine Hydrochloride Dosages

(1) Adult: Administer 25–50 mg SLOW IVP or IM

(2) Pediatric (for patients greater than 6 months old): Administer 1 mg/kg SLOW IV or IM

Droperidol Indications

(1) Moderate agitation due to suspected psychiatric emergency or medical delirium (2) Nausea and vomiting secondary to migraines, cannabinoid hyperemesis syndrome, cyclic vomiting syndrome, or persistent symptoms after ondansetron.

Droperidol Dosages

(1) Moderate Agitation (a) Adult (i) Patient 18–68 years of age: 2.5 mg IM/IV (ii) Patient 69 years and older: 1.25 mg IM/IV (iii) Medical consultation required for additional dose (b) Pediatric (i) Patient 13–18 years of age: 2.5 mg IM/IV. Medical consultation required for additional dose

(2) Nausea and Vomiting (a) Adult and Pediatric 13 years of age and older (i) For nausea/vomiting secondary to migraines, cannabinoid hyperemesis or patient stated history of cyclic vomiting syndrome, administer droperidol 1.25 mg IM or IV over 2-5 minutes; no repeat dosage. If continued symptoms after droperidol, may administer ondansetron 8 mg IV/4-8mg IM/8 mg ODT. (ii) For nonspecific nausea/vomiting, for persistent symptoms after ondansetron 8 mg IV/IM/ODT, administer droperidol 1.25 mg IM or IV over 2-5 minutes; no repeat dosage.

Epinephrine Indications

(1) Medical cardiac arrest and pediatric traumatic arrest (2) Moderate to severe allergic reaction/anaphylaxis (3) Epinephrine infusion for shock refractory to fluid bolus or anaphylactic shock (4) Severe asthma (5) Respiratory stridor (suspected croup).

Epinephrine Contraindications

(1) Hypertension (2) Preexisting tachydysrhythmias with a pulse (ventricular and supraventricular) (3) IV push epinephrine should not be administered to any patient with a pulse

Esmolol Indications

Persistent VF or pulseless VT after the second dose of amiodarone.

Esmolol Dosages

(1) Adult (age 13 and older): 0.5 mg/kg IV/IO over 1-2 minutes. No repeat dosing.

Fentanyl Indications

(1) The patient reports moderate to severe pain. (2) In the clinician’s judgment the patient will benefit from treatment with an opioid analgesic, including patients who are MOLST and/or EMS/DNR patients

Glucagon Pharmacology

(1) Hormone synthesized by the pancreas (2) Increases blood glucose concentration (3) Inhibits gastric and pancreatic secretions (4) May increase heart rate and cardiac output (5) May decrease blood pressure (6) Increases metabolic rate.

Glucagon Indications

(1) Patients with altered mental status who are suspected of being hypoglycemic where IV access is not obtainable (2) Beta blocker overdose.

Ipratropium Pharmacology

(1) Anticholinergic (parasympatholytic) bronchodilator (2) Site-specific, not systemic (3) Dries respiratory tract secretions (4) Most effective in combination with a beta-adrenergic bronchodilator.

Ketamine Pharmacology

Sedative-hypnotic; analgesic. A rapid-acting, non-barbiturate agent characterized by normal pharyngeal-laryngeal reflexes, normal or enhanced skeletal muscle tone, and possible cardiovascular and respiratory stimulation.

Ketamine Indications

(1) Moderate to severe pain (2) Severe agitation (3) Ventilatory difficulty secondary to bucking or combativeness in intubated patients (4) CPR-induced awareness (5) Pain management for synchronized cardioversion and transcutaneous pacing (6) Seizures that have not resolved or recur after max dose of midazolam.

Ketorolac Pharmacology

(1) Inhibits synthesis of prostaglandin, which reduces pain and inflammation (2) Antipyretic agent (3) Peripherally acting analgesic that does not possess sedative properties of a narcotic.

Ketorolac Indications

(1) Management of moderate to severe acute pain (2) First line medication for renal stones/colic (3) Mild to moderate burns (4) Non-traumatic neuromuscular pain.

Labetalol Hydrochloride Indications

(1) Pregnant patients from 21 weeks gestation to 6 weeks postpartum with SBP $\ge 160\text{ mmHg}$ or DBP $\ge 110\text{ mmHg}$. (2) Stroke with SBP $\ge 220\text{ mmHg}$ AND DBP $\ge 120\text{ mmHg}$ AND focal neurological deficit or positive stroke assessment. (3) Chest Pain with SBP $\ge 220\text{ mmHg}$ AND DBP $\ge 120\text{ mmHg}$ with strong suspicion/diagnosis of acute aortic aneurysm or dissection WITH CONSULTATION.

Magnesium Sulfate Pharmacology

Physiologic calcium channel blocker and neuromuscular transmission blocker. CNS depressant effective in managing pregnancy seizures by decreasing acetylcholine release from motor nerve terminals.

Magnesium Sulfate Indications

(1) Torsades de pointes or polymorphic ventricular tachycardia (2) Pregnant patients greater than 20 weeks gestation OR up to 6 weeks postpartum with hypertensive disorders of pregnancy or eclampsia (3) Moderate to severe asthma/bronchospasm exacerbation.

Metoprolol Tartrate Indications

Symptomatic atrial fibrillation and atrial flutter with a ventricular rate greater than or equal to 130 bpm. (May be used only when diltiazem is unavailable).

Midazolam Pharmacology

A short-acting benzodiazepine with strong hypnotic, anticonvulsant activity, and amnestic properties. It is five times as potent per milligram as diazepam.

Naloxone Pharmacology

Reverses all central and peripheral nervous system effects and respiratory depression caused by opioid (morphine-like) agents.

Nitroglycerin Pharmacology

(1) Vasodilator-effect on veins more than arteries (2) Decreases right heart return (preload) by venous pooling, thereby decreasing myocardial workload and oxygen consumption.

Ondansetron Pharmacology

A selective blocking agent of the serotonin $5\text{-HT}_3$ receptor type.

Oxygen Indications

(1) If evidence of hypoxia (Less than $94\%\text{ SpO}_2$) (2) Respiratory distress (3) Cardiopulmonary arrest (4) Trauma (5) Suspected CO exposure (6) Dyspnea.

Sodium Bicarbonate Pharmacology

Sodium bicarbonate corrects acidosis; raises blood pH.

Tranexamic Acid (TXA) Pharmacology

(1) Anti-fibrinolytic: prevents conversion of plasminogen to plasmin, promoting blood clot stability (2) Interruption of bradykinin-induced angioedema: decreases bradykinin levels.