ALS Medication Formulary Guide Flashcards

Practice question-and-answer flashcards covering mechanisms of action, indications, contraindications, adverse effects, and adult/pediatric dosages for medications in the ALS Medication Formulary Guide.

What is the mechanism of action of Acetaminophen?

Acetaminophen is a non-opioid analgesic and antipyretic that works primarily within the central nervous system through peroxidase inhibition (COX-2 inhibitor).

What are the adult and pediatric dosages for Acetaminophen?

Adult dosage is $650\,mg\text{ PO}$ and pediatric dosage is $15\,mg/kg\text{ PO or PR}$.

What is the mechanism of action of Activated Charcoal?

Activated charcoal binds many toxins and medications within the gastrointestinal tract due to an extremely large surface area that adsorbs ingested toxins and drugs, preventing further gastrointestinal absorption.

What are the main contraindications for Activated Charcoal?

Decreased level of consciousness and suspected overdose of corrosives, caustics, or petroleum substances.

How does Adenosine work and what is a key requirement for its administration?

Adenosine binds to Adenosine $A_1$ receptors in the SA and AV node, causing an efflux of potassium and inhibiting calcium influx to hyperpolarize cells and stop electrical conduction through the AV node. It has a very short half-life and must be administered rapidly.

What is the adult dosing schedule for Adenosine in SVT?

1st Dose: $6\,mg$ rapid IV/IO push followed by a rapid IV flush. 2nd Dose: $12\,mg$ rapid IV/IO push followed by a rapid IV flush.

What is the pharmacological action of Albuterol?

It is a selective $\beta_2$-adrenergic agonist bronchodilator that relaxes bronchial smooth muscle, causes bronchodilation, decreases airway resistance, improves airflow and oxygenation, and promotes intracellular movement of potassium.

What are the adult dosages of Albuterol for bronchoconstriction versus hyperkalemia?

For bronchoconstriction: $2.5\,mg/3\,mL$ via SVN connected to $6\text{--}8\,lpm$ oxygen (repeat every $15\text{--}20\text{ minutes}$ PRN). For hyperkalemia: $20\,mg$ via LVN connected to $6\text{--}8\,lpm$ oxygen.

What class of antiarrhythmic is Amiodarone and what is its primary effect?

Amiodarone is a Class III antiarrhythmic agent with properties of all four Vaughan-Williams classes. Its primary effect is blockade of potassium channels, which prolongs repolarization and increases the effective refractory period in cardiac tissue.

What are the adult cardiac arrest doses for Amiodarone in VF/Pulseless VT?

1st Dose: $300\,mg$ IV/IO push. 2nd Dose: $150\,mg$ IV/IO push if needed.

What is the mechanism of action of Aspirin?

Aspirin blocks cyclooxygenase (COX), which acts upon Arachidonic Acid to generate Thromboxane A2 (a compound regulating platelet activation to form a clot), thereby preventing further platelet aggregation.

What is the adult dosage of Aspirin for suspected Acute Coronary Syndrome?

$160\text{ to }325\,mg$.

How does Atropine produce positive chronotropic and dromotropic effects?

It is an anticholinergic (parasympatholytic) agent that competitively blocks acetylcholine at muscarinic receptors, inhibiting vagal influences on the sinoatrial (SA) and atrioventricular (AV) nodes.

What is the adult dosing for Atropine in symptomatic bradycardia?

$1\,mg$ IV push every $3\text{--}5\text{ minutes}$ as needed, not to exceed a total dose of $0.04\,mg/kg$ (total $3\,mg$).

What are the main indications for Calcium Chloride?

Hyperkalemia, hypocalcemia, treatment of adverse effects caused by calcium channel blocker overdose, and hypotension secondary to administration of Diltiazem.

What interaction occurs when Calcium Chloride is mixed with Sodium Bicarbonate?

Calcium will precipitate with Sodium Bicarb.

What is the mechanism of action of Captopril?

Captopril is an ACE inhibitor that blocks the conversion of angiotensin I to angiotensin II, opposing the RAAS to cause vasodilation and reduce water retention by the kidneys.

What is the mechanism of action and adult dose for Dexamethasone?

It is a long-acting synthetic corticosteroid that turns down the body's inflammatory response by preventing the release of inflammatory chemicals. Adult dose is $10\,mg$ IM/IV/IO/PO.

What are the blood glucose level indications for Dextrose administration?

Correction of hypoglycemia: $<70\,mg/dL$ in adults; $<70\,mg/dL$ in pediatric patients greater than $2\text{ months}$; $<45\,mg/dL$ in pediatric patients less than $2\text{ months}$.

What is the pediatric dosing for Dextrose by age group?

Birth to $2\text{ months}$: $5\text{--}10\,mL/kg$ of D10. $2\text{ months}$ to $2\text{ years}$: $2\text{--}4\,mL/kg$ of D25. $>2\text{ years}$: $1\text{--}2\,mL/kg$ of D50.

What is the mechanism of action of Diazepam?

It is a benzodiazepine that binds with GABA receptors, causing an influx of chloride and neuronal hyperpolarization, which slows down nerve impulses to produce sedation and anticonvulsant effects.

What class of drug is Diltiazem and what are its primary indications?

It is a Class IV antiarrhythmic (calcium channel blocker). It is 1st line for A-Fib and A-Flutter with RVR (ventricular rates above $150\,bpm$) and 2nd line for SVT refractory to adenosine.

What is the mechanism of action and adult dosage of Diphenhydramine?

It is an antihistamine that competitively blocks histamine $H_1$ receptors. Adult dose is $25\text{--}50\,mg$ slow IV/IO or IM.

How does Dobutamine affect the cardiovascular system?

It is a synthetic catecholamine and inotropic agent that primarily stimulates $\beta_1$ receptors in the heart, increasing contraction strength and cardiac output (pumps stronger, not necessarily faster).

How do the receptor effects of Dopamine change based on infusion rates?

At $5\text{--}10\,mcg/kg/min$ it produces $\beta_1$ stimulation. At $10\text{--}20\,mcg/kg/min$ it produces both $\beta_1$ and $\alpha_1$ stimulation.

What are the primary indications for Droperidol?

Moderate to severe agitation due to psychiatric emergency or delirium, and nausea/vomiting (especially secondary to migraines, cannabinoid hyperemesis, or cyclic vomiting syndrome).

What is the adult dosage and route for Epinephrine 1:1,000 in severe bronchospasm or anaphylaxis?

$0.3\text{--}0.5\,mg$ IM.

What is the adult dosage for Epinephrine 1:10,000 in cardiac arrest?

$1\,mg$ IVP/IOP every $3\text{--}5\text{ minutes}$.

What is the mechanism of action and onset/duration of Etomidate?

Nonbarbiturate sedative-hypnotic that increases GABA-A mediated chloride influx into neurons (no analgesic properties). Onset is within $30\text{ seconds}$ and duration is $5\text{--}10\text{ minutes}$.

How does Fentanyl compare in potency to Morphine?

Fentanyl is significantly more potent: $100\,mcg$ of Fentanyl is equivalent to $10\,mg$ of Morphine.

What is the mechanism of action and adult dosing steps for Flumazenil?

Benzodiazepine antagonist that competitively displaces benzodiazepines at GABA-A receptors. Adult dosing: $0.2\,mg$ IV/IO over $15\text{ s}$ (1st dose), $0.3\,mg$ over $30\text{ s}$ (2nd dose), $0.5\,mg$ over $30\text{ s}$ (3rd dose), up to $3\,mg$ max.

What is the mechanism of action of Furosemide?

Loop diuretic that inhibits the sodium-potassium-chloride ($\text{Na}^+\text{--}\text{K}^+\text{--}2\text{Cl}^-$) cotransporter in the ascending limb of the loop of Henle, preventing reabsorption of sodium, chloride, and water.

What is the adult dose of Glucagon for Beta Blocker or Calcium Channel Blocker overdose?

$3\text{--}10\,mg$ IV slowly over $3\text{--}5\text{ minutes}$, followed by an infusion of $3\text{--}5\,mg\text{ per hour}$.

What is the mechanism of action and unique adverse effect of Hydroxocobalamin?

Form of Vitamin B12 that acts as a cyanide antidote by binding cyanide to form non-toxic cyanocobalamin excreted in urine. Adverse effect includes red colored urine lasting $2\text{ to }5\text{ weeks}$.

What is the mechanism of action of Ipratropium bromide?

Anticholinergic bronchodilator that competitively inhibits muscarinic receptors (primarily $M_3$) in airway smooth muscle, decreasing vagally mediated bronchoconstriction and reducing secretions.

What is the mechanism of action of Ketamine?

Dissociative anesthetic acting as a noncompetitive antagonist of NMDA receptors in the CNS while stimulating the sympathetic nervous system to increase catecholamine release.

Which receptors are blocked by Labetalol?

Combined $\alpha_1$- and nonselective $\beta$-adrenergic receptor antagonist; competitively blocks $\beta_1$, $\beta_2$, and $\alpha_1$ receptors.

What are the adult doses for Magnesium Sulfate in Torsades de Pointes with vs. without a pulse?

TdP with a pulse: $1\text{--}2\,grams$ IV/IO over $5\text{--}60\text{ minutes}$ (infusion). TdP without a pulse (cardiac arrest): $1\text{--}2\,grams$ IV/IO IVP.

What is the mechanism of action and indication for Methylene Blue?

Oxidation-reduction (redox) agent facilitating conversion of methemoglobin ($\text{Fe}^{3+}$) back to functional hemoglobin ($\text{Fe}^{2+}$); indicated for symptomatic methemoglobinemia and suspected nitrate overdose.

What are the adult doses of Midazolam for active seizures versus SFI/RSI induction?

Active seizures: $0.1\,mg/kg$ slow IV/IO or $5\,mg$ IM/IN. Induction agent (SFI/RSI): $0.1\text{--}0.3\,mg/kg$ (max $10\,mg$).

What are the contraindications for Nitroglycerin?

Known hypersensitivity, hypotension (SBP $<90\,mmHg$ or $\ge 30\,mmHg$ below baseline), severe bradycardia ($<50\,bpm$), tachycardia ($>100\,bpm$ without CHF or $>150\,bpm$ with CHF), RVI, PDE inhibitor use within last $48\text{ hours}$, and increased ICP.

What receptor activity accounts for the effects of Norepinephrine (Levophed)?

Acts primarily as an $\alpha_1$-adrenergic receptor agonist (peripheral vasoconstriction, increased SVR, increased BP) with additional $\beta_1$-adrenergic receptor activity (increased contractility and mild heart rate increase).

What is the mechanism of action of Ondansetron?

Selective serotonin ($5\text{-HT}_3$) receptor antagonist that blocks serotonin receptors centrally in the CTZ and peripherally on vagal nerve terminals in the GI tract.

What are the 4 endpoint criteria for stopping a Procainamide infusion?

1. Termination of the rhythm; 2. Hypotension; 3. Widening of the QRS by more than $50\%$; 4. Reaching the max total dose ($17\,mg/kg$).

What are the main indications for Sodium Bicarbonate?

Metabolic Acidosis (Severe Hypoxia), Hyperkalemia, suspected sodium channel blocker overdose, tricyclic antidepressant or Phenobarbital overdose, cocaine overdose, and Crush Syndrome.

How does Succinylcholine differ in mechanism from Rocuronium?

Succinylcholine is a depolarizing neuromuscular blocker that causes sustained end-plate depolarization and muscle fasciculations followed by flaccid paralysis; Rocuronium is a nondepolarizing competitive antagonist at nicotinic acetylcholine receptors.

What is the mechanism of action and critical time constraint for Tranexamic Acid (TXA)?

TXA is an antifibrinolytic agent that binds plasminogen/plasmin to block fibrinolysis and stabilize formed blood clots. It is contraindicated if administered past $3\text{ hours}$ from injury.