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Microsoft word - gh drug protocols 2004 with table of content revised may 5 2005.doc

Grays Harbor & North Pacific Counties TABLE OF CONTENTS
ACETAMINOPHEN. 1 ACETYLSALICYLIC ACID (ASA). 2 ACTIVATED CHARCOAL . 3 ADENOSINE . 4 AFRIN . 5 ALBUTEROL. 6 AMIODARONE (revised May 5, 2005). 7 ATROPINE SULFATE. 8 CALCIUM CHLORIDE . 9 50% DEXTROSE (D50W) . 10 DIAZEPAM. 11 DILTIAZEM (CARDIZEM) . 12 DIPHENHYDRAMINE HCL . 13 DOPAMINE HCL. 14 EPINEPHRINE. 15 FUROSEMIDE . 16 GLUCAGON. 17 HALOPERIDOL. 18 SYRUP OF IPECAC . 19 IPRATROPIUM BROMIDE (ATROVENT). 20 LABETALOL. 21 LIDOCAINE (XYLOCAINE) . 22 MAGNESIUM SULFATE . 23 MEPERIDINE. 24 METHYLPREDNISOLONE . 25 MIDAZOLAM HCL. 26 MORPHINE SULFATE. 27 NALOXONE . 28 NITROGLYCERINE / NITRO PASTE . 29 OXYGEN. 30 OXYTOCIN . 31 PRALIDOXIME CHLORIDE . 32 PROMETHAZINE HYDROCHLORIDE . 33 PROPOFOL . 34 SODIUM BICARBONATE . 35 SUCCINYLCHOLINE . 36 TETRACAINE . 37 THIAMINE . 38 VASOPRESSIN . 39 VECURONIUM. 40 XYLOCAINE JELLY (2%). 41 INDEX -- Drug Listing By Trade Name. 42 ACETAMINOPHEN
Trade Names: Tylenol
Class:

Mechanism of Action:
Elevates the pain threshold in the CNS and acts on the hypothalamic thermoregulatory centers.
Indications:

Contraindications: Hypersensitivity
Adverse/Side Affects:
Dizziness, Lethargy, N/V, Abdominal Pain, Diarrhea Anorexia, Diaphoresis, Chills, Elevated Liver Function.
Drug Interactions:
Alcohol may increase risk of hepatoxicity with chronic co-administration with many other drugs. ACETYLSALICYLIC ACID (ASA)
Trade Name: Aspirin
Class:
Anti-inflammatory
Therapeutic Action:
Prevents blood clot formation (specifically in coronary arteries), Decreases inflammation, Controls pain and decreases fever (antipyretic).
Mechanism of Action:
Prevents platelet clumping and blood clot formation by irreversible changes in platelet shape and function. The pain, anti-inflammatory, and antipyretic effects are due to blocking prostaglandins (Chemical Messengers).
Indications:

Contraindications:

Adverse/Side Effects:
Excessive use may cause GI irritations and bleeding.
Drug Interactions:
Adverse reactions and effects may be increased with use of other NSAID’s. 160-325mg orally, chewed or swallowed with small amount of water after onset of chest pain. Not recommended for children because it has been linked with Reye’s syndrome. ACTIVATED CHARCOAL
Trade Names:
Insta-Char, Sorbitol, Acti-Char, Liqui-Char. Acti-Dose
Class: Absorbent
Therapeutic Action:
Absorbs poisonous compounds, Prevents GI tract absorption
Mechanism of Action:
Binds many poisons and chemicals to its surface while in GI tract.
Indications:
Poisonings at direction of poison control if possible. Overdoses at direction of poison control if possible.
Contraindications: Petroleum

Adverse/Side Effects:
Aspiration, N/V, Diarrhea, and Constipation
Drug Interactions:
Adult: 25-30gms in tap water
Peds: 10-30gm in tap water

Onset: Immediate
Durations:
ADENOSINE

Trade Name: Adenocard
Class: Antidysrhythmic
Therapeutic Action:

Mechanism of Action:
Slows conduction of electrical impulses through the Sinoatrial (SA) and Atroventricular (AV) nodes. Interrupts reentry pathways such as WPW
Indications:

Contraindications:
2nd and 3rd degree heart blocks, Sick Sinus Syndrome, Hypersensitivity to Adenosine
Adverse/Side Effects:

Transient flushing, Dyspnea, Chest pain, Bradycardia, Headache, Hemodynamic instability, Brief period of asystole, Dizziness, N/V
Drug Interactions:
Aminophylline inhibits effects by blocking receptor sites, dose may be increased. Tegretol (Persantine) prolongs effects by blocking the uptake of Adenosine.
Supplied:
Adult: 6mg rapid IVP with 10-20ml NS rapidly followed. If
no change in 2 minutes, give 12mg rapid IVP. If no change
in 2 minutes repeat 12mg dose IVP.
Peds: 0.1mg/kg may repeat with 0.2mg/kg up to 12mg
max single dose.

Onset: Rapid
Duration: 5-10
Safe to use with WPW (Wolf-Parkinson-White), whereas Diltiazem is not. Trade Names: None
Class: Adrenergic

Mechanism of Action:

Unknown. Causes vasoconstrictions of the smaller arterioles in the nasal passages, which lasts up to 12 hours.
Indications:
Preparation for nasotracheal intubations. Control of epitaxis.
Contraindications:

Adverse/Side Effects:
Headache, Drowsiness, Insomnia, Palpitations, and Hypertension. Burning, stinging, or sneezing may occur if recommended dosage is exceeded. The use of the dispenser by more than on patient may spread infection. Rebound nasal congestion or irritation.
Caution:
Not recommended for Children under 6 years old. Adults/Children over 6yo: 2-3 sprays per nostril

Duration:
ALBUTEROL
Trade Name: Proventil,

Class: Bronchodilator
Therapeutic Action:

Mechanism of Action:
Albuterol is a Sympathomimetic agent which primarily the B2 receptors on the bronchial tree.
Indications:
Bronchospasms associated with COPD (Bronchitis, Emphysema) Asthma wheezes associated with toxic inhalations
Contraindications:
Tachydysrhythmias, Known hypersensitivity to Albuterol. Caution with hypertension, angina, and diabetes
Adverse/Side Effects:
Palpitations, Tachycardia, Tremors, Nervousness, Dizziness, Headache, Restlessness, Anxiety, Nausea and Vomiting. Adult: 2.5mg of 0.5% solution in 3ml (1 phishe), may
repeat in 10-20 minutes.
Peds: 0.01 to 0.03 ml/kg of 0.5% solution in 2ml NS

Onset:
5-15

Duration: 3-4
AMIODARONE
(Amiodarone revised May 5, 2005)
Trade Names: Cordarone
Class: Proarrythmic
Indications:
Polymorphic VT/Wide complex tachycardia of uncertain origin. Control of hemodynamically stable VT when cardioversion is unsuccessful. Contraindications:
Patients with hypersensitivity to Cordarone. Patients with cardiogenic shock. Marked Sinus Bradycardia. 2nd & 3rd degree AV blocks unless a pacemaker is available.
Caution:
May produce vasodilatation and hypotension. May have negative inotropic effects and prolong QT interval. Renal failure – Terminal Elimination is Long (Half-Life lasts up to 40 days)
Adverse/Side Effects:

300mg IVP, consider repeating 150mg in 3-5 minutes. Max dose – 2.2g IV in 24hours. Route of Delivery – IV
Use NS or D5W – Run Wide Open – Push 300mg – Flush Line Route of Delivery – Saline Lock
Mix 300mg Amiodarone with 10cc of NS or D5W – Rapid IVP
Onset: Immediate
Duration


(Note: Amiodarone—revised May 5, 2005 in the Grays Harbor and North Pacific County
Protocols. Remove page 7 from August 2004 version and replace with this revision.)
ATROPINE SULFATE
Trade Name: None
Class: Anticholinergic
Therapeutic Action:
Increases rate of SA node discharge and enhances conduction through the AV junction.
Mechanism of Action:
Blocks or antagonizes the effects of acetylcholine in sweat glands, smooth and cardiac muscle. Acetylcholine is a parasympathetic neurotransmitter, which is released into the synapses with stimulation of the Vagus (10th Cranial Nerve). This release of Ach decreases heart rate and velocity through the junction. Atropine blocks the receptors for Ach, thus blocking effects on the cardiac muscle, causing an increase in heart rate. Vagal stimulation can be caused by ischemic damage or parasympathomimetic overdose.
Indications:
Symptomatic Bradycardia, 1st & 2nd Type 1 AV blocks Narrow Complex 2nd and 3rd degree AV blocks Slow PEA rhythms, Asystole, Cholinergic Poisoning (Organophosphate and Carbamate) 0.5mg – 1mg IVP, q 3 – 5 minutes to maximum dose of 0.04mg/kg or 3mg. 1mg Rapid IVP may repeat in 3 – 5 minutes Symptomatic Bradycardia PEA, & Asystole 0.02mg/kg rapid IVP to a maximum single dose of 0.5mg in child/1mg in adolescent. Maximum total dose of 1mg in child/2mg in adolescent.
Onset: Rapid
Duration: 2-6
CALCIUM CHLORIDE
Trade Names: None

Class:


Therapeutic Action:
Facilitates conduction in tissues such as myocardium, muscle and nerves. Increases myocardial contraction strength.
Mechanism of Action:

Increases calcium levels in blood and tissues.
Indications:

Acute Hyperkalemia (renal failure with CV compromise). Calcium Channel Blocker toxicity (hypotension, dysrhythmias)
Contraindications:

Adverse/Side Effects: Cardiac

Drug Interactions:
Precipitates with NaCHO3 and Aminophylline
Dosages:
Adult: 2-4mg/kg of a 10% for black widow bite and
hypocalcemia. If no response after 10 minutes may repeat
the dose.
Peds: 20-25mg/kg of a 10% solution, up to 500mg slow
IVP.

Onset:
5-15

Duration:

Dose dependent up to 4 hours after IV administration. American Heart Association recommends 8-16mg/kg of a 10% solution in Calcium Channel Blocker OD. 50% DEXTROSE (D50W)
Trade Name: None

Class:
Nutrient
Therapeutic Action:

Mechanism of Action:
Adds glucose to circulating blood volume
Indications: Hypoglycemia
Coma or Altered Level of Consciousness of Unknown origin
Contraindication: Intracranial
CVA
Adverse/Side Effects:
Wernecke’s Encephalopathy in alcoholics (thiamine deficiency B1). Tissue necrosis, Korsakoff’s Adult: 50ml of a 50% solution through a flowing IV line. Peds: 0.5mg/kg slow IV. Mix 1:1 for D25W
Onset: <1

Duration:

DIAZEPAM
Trade Name: Valium
Class: Benzodiazepine
Therapeutic Action:
Suppresses seizure activity in motor cortex. CNS depressant and muscle relaxant. Suppresses anxiety and tremors with DT’s, mild amniotic. Sedative effects during cardioversion and TCP.
Mechanism of Action:

Binds to specific benzodiazepine receptors in the CNS, which inhibits neuronal transmissions.
Indications:
Acute Anxiety and tremors in alcoholic delirium tremens. Premedication for cardioversion, TCP and RSI Acute Anxiety states and Cocaine toxicity
Contraindications:
Hypersensitivity to Benzodiazepines, CNS depression secondary to head injuries or mind altering drugs, Pregnancy (mother comes first), Respiratory depressed patients, Shock, and Patients with alcohol and depressant drugs on board.
Adverse/Side Effects:

Hypotension, Respiratory depression or arrest, Confusion, N/V, Coma, Periods of excitement, and Reflex tachycardia.
Drug Interactions:
Potentiates effects of other CNS depressing medications. May react with other medications in IV line. Barbiturates, Alcohol, and other narcotics will increase effects of benzodiazepines. 2 – 5mg IV, IM, or ET as needed. Max dose 10mg 5 – 10mg slowly IV, IM or ET 5 – 10 prior to TCP/Cardioversion or Succinylcholine use. Seizures
0.1 – 0.3mg/kg IV, IO, or ET (no faster than 1mg/min) 0.3 – 0.5mg/kg rectally q 10 – 15min total 3 doses IV: 1 – 5min IM: 15 – 30min, ET rapidly
Duration:
IV: 15min – 1 hour, IM: 15min – 1 hour, ET 15min – 1 hour
** DOSE SHOULD BE REDUCED BY 50% IN THE ELDERLY**
DILTIAZEM (CARDIZEM)
Trade Name: Cardizem
Class:

Therapeutic Action:
Slows conduction through AV node and dilates coronary and peripheral arteries.
Mechanism of Action:

Slows calcium ion influx during myocardial depolarization.
Indications:
Atrial fibrillation/flutter with rapid ventricular response
Contraindications:
Sick Sinus Syndrome, 2nd & 3rd degree AV blocks WPW, Ventricular or Wide Complex Tachycardias
Adverse/Side Effects:
AV Blocks, Bradycardia, Ventricular Dysrhythmias Chest Pain, CHF, Dyspnea, Dizziness, Syncope, Nausea & Vomiting
Drug Interactions:
Increases effects of Beta-blockers, Digoxin, Lithium, Tegretol, Cyclosporine and other Calcium channel blockers. Increased effects by Cimetidine (Tagamet) Adult: 0.25mg/kg IV slowly of 2 minutes. If no effect
0.35mg/kg 15 minutes later given over 2 minutes.

Duration:
DIPHENHYDRAMINE HCL
Trade Names: Benadryl

Class:
Antihistamine
Therapeutic Action:
Prevents responses mediated by histamine such as vasodilatation, bronchospasm, capillary permeability and edema.
Mechanism of Action:
Blocks H1 (bronchial & gastric constrictions) and H2 (peripheral vascular dilation & gastric secretions) receptor sites.
Indications: Acute
Anaphylactic and Allergic Reactions with Epinephrine Extra pyramidal (dystonic) reactions to phenothiazines (thorazine, haldol, compazine, phenergan, raglan, mellaril)
Contraindications:
Anticholinergic symptoms (flushing, dilated pupils, dry mucous membranes)
Adverse/Side Effects:
Hypotension, Headache, Tachycardia, Sleepiness, Palpitations, Blurred Vision, Dizziness
Drug Interactions:
Potentiates other CNS depressants (narcotics & alcohol) and Anticholinergic medications
Dosages:
Adult: 25 – 50mg IV or IM
Peds: 1 -2mg/kg IV or IM to Max 50mg

Duration:
DOPAMINE HCL
Trade Name: Intropin,

Class: Sympathomimetic

Therapeutic Action:
Increased renal and gastric flow; Increases BP; Mild Chronotrope
Mechanism of Action:
Alpha – 1; Beta 1; Dopaminergic receptor stimulation
Indication:
Correct hypo perfusion (BP<90mmHg) after fluid resuscitation and rate problems have been corrected.
Contraindications: Hypovolemic
Hypotensive CHF with Pulmonary Edema (PVR)
Adverse/Side Effects: Chest
Sluffing

Drug Interactions:

Inactivated by alkaline medications (CaCl, NaCHO3) Reduce to 1/10th dose when on MAO inhibitors Adult/Pediatric 2 – 20 mcg/kg/min infusion
2 – 5 mcg/kg/min – Renal/Gastric Effects 10 – 20 mcg/kg/min – Vasopressor Effects
Duration:
EPINEPHRINE
Trade Names: Adrenalin

Class:
Catecholamine
Therapeutic Action:
Vasoconstriction, Bronchial Dilation, Inotropic & Chronotropic Effects
Mechanism of Action:
Sympathomimetic which stimulates the Alpha and Beta receptors
Indications: V-Fib/Pulseless
Asystole/PEA Bronchospasms Anaphylaxis Symptomatic
Contraindications:

Adverse/Side Effects:
Palpitations, Ventricular Ectopy, Tachycardia, and Anxiety. Headache, Nausea & Vomiting
Drug Interactions:

Antagonizes the effects of vasodilators, beta-blockers, and anti-diabetic medications. Inactivated by Aminophylline, CaCl, CaGluconate, NaCHO3, Valium
Dosages:
1mcg/min up to 2-10mcg min by hemodynamics 0.1-0.5mg of 1:1,000 SQ, may repeat in 5 min. If no response or rapidly deteriorating give 0.25-0.5mg of 1:10,000 slow IV. ET Dose 2-2.5 times IV dose. 0.01mg/kg (0.1mg/kg) IV or IO 1:10,000 1st dose; 2nd dose 0.1-1mg/kg IV or IO 1:1,000 q 5 minutes ET Dose 0.1 mg/kg of 1:1,000 diluted 1:1
Duration:
FUROSEMIDE
Trade Name: Lasix
Class: Diuretic
Therapeutic Action:
Increases water excretion and venous dilatation, reduces preload.
Mechanism of Action:
Inhibits sodium and chloride re-absorption in the kidney. Reduces vascular volume, thus removing excess volume from the lungs in CHF and Pulmonary Edema.
Indications: Pulmonary
Hypertension
Contraindications:
Hypotension; Pregnancy; Hx of no urine production; Dehydration; Allergies to Sulfa’s
Adverse/Side Effects:
Volume depletion; Hypotension; Electrolyte disturbances (especially Potassium loss); Rash; Headache; Deafness; Cardiac Dysrhythmias.
Drug Interactions:
Incompatible with Diazepam, Diphenhydramine, and Thiamine Adult: 20 – 40mg slow IVP (0.5 – 1mg/kg) over 1 – 2
minutes
Peds: 1 – 2mg/kg slow IVP. Max 6mg/kg
Patients already taking Lasix, double their dose IV. Also patient should be monitored for cardiac disturbances due to electrolyte imbalances and for hypotension from volume depletion
Duration:

GLUCAGON
Trade Name: None

Class:
Hormone
Therapeutic Action:
Stimulates the release of glucose from the liver, muscles and adipose tissue into the bloodstream.
Mechanism of Action:
Directly binds to target cells in the liver and counteracts the effects of insulin.
Indications:
Hypoglycemic emergencies when IV access cannot be established. Beta-blocker and calcium channel blocker toxicity.
Contraindications: Pregnancy

Adverse/Side Effects
Headache, Nausea & Vomiting, Allergic Reaction Pediatric patients (below 44lbs.) should receive
0.1 – 0.5mg IM or IV
Sites of choice – buttock, thigh, or arm
Beta-blocker 3 – 10mg IV
Procedure:
Withdraw solution from bottle labeled #1. Inject the solution into the bottle labeled #2. Shake bottle gently until contents appear clear and water like.
Other Facts:
May improve cardiac contractility and increase heart rate in beta-adrenergic blocker and calcium channel blocker toxicity.
Duration:

HALOPERIDOL
Trade Name: Haldol
Class: Tranquilizer
Therapeutic Action:
Controls aggression and activity in psychotic patients.
Mechanism of Action:
Exact mechanism in brain is not clear, however, it does block dopamine receptors and suppresses the cerebral cortex, limbic system, and an anti-cholinergic blocking component is present. It also exhibits a strong Alpha-adrenergic effect.
Indications:
Acute psychotic episode, which needs to be, treated for the safety of the patients, public, or response personnel.
Contraindications:
CNS depression or Coma or suspected brain damage
Adverse/Side Effects:
Hypotension (orthostatic), Dystonias, Akathisia, N&V, Blurred vision, Cardiac arrest, Respiratory depression, Seizures.
Drug Interactions:

Increases both drugs: Beta-blockers, Alcohol and Anticholinergic Adult: 2 – 5mg IM, IV use is OK, but IM is preferred
Recommended

Duration:

SYRUP OF IPECAC
Trade Name: Ipecac
Class: Emetic
Therapeutic Action:
Promotes emesis on poisonings and overdoses
Mechanism of Action:

Stimulates the brains emetic centers, irritates gastric mucosa. Contact Poison Control if Possible 1-800-222-1222
Indications:
Acute oral drug or toxin overdose in alert patients.
Contraindications:

Adverse/Side Effects:
Prolonged vomiting, Chest pain, Hypotension, Muscle Ache, Conduction defects.
Drug Interaction:
Activated Charcoal may decrease efficacy Adult: 30ml with 2 – 3 8oz glasses of water
Peds: 15ml with 2 – 3 8oz glasses of water

Duration: 80
IPRATROPIUM BROMIDE (ATROVENT)
Trade Name: Atrovent

Class:
Anticholinergic

Therapeutic Action:
Relaxes bronchial constriction associated with COPD (Chronic bronchitis & Emphysema), Dries bronchial secretions.
Mechanism of Action:
Inhibits acetylcholine and Vagal-mediated reflexes in the bronchial smooth muscles.
Indications:
Bronchial spasm associated with COPD (Chronic Bronchitis & Emphysema) Administration with Albuterol will improve affects and duration of relaxed bronchial tree.
Contraindications:

Known Allergies to Ipratropium Bromide or Atropine. Use caution in patients with Narrow Angle Glaucoma, Prostatic hypertrophy, and bladder neck obstruction.
Adverse/Side Effects:

Temporary blurred vision, Keep away from eyes, Tachycardia, Palpitations, Urinary retention, Bronchospasms, Headache, Dry mouth. Adult: 500mcg (1 unit-dose vial) in a hand-held nebulizer.
Mix with Albuterol in the nebulizer after the 2nd dose of Albuterol has failed to relieve the bronchoconstriction. Use on patients under the age of 12 is not recommended.
Duration:
If the patient has had 2 or more hand held nebulized doses of Albuterol with-in 1 hour of your arrival and marked shortness of breath is present, some literature show mixing Atrovent with Albuterol on initial dose is acceptable. LABETALOL
Trade Name:

Therapeutic Action:
Lowers blood pressure without reflex tachycardia
Mechanism of Action:
Competitive Alpha receptor blocker and a non-selective Beta-blocker. Reduces Renin plasma levels. Vasodilatation and Beta-blocker blockade of heart and lungs are the main effects.
Indications:
Hypertensive

Contraindications: Bradycardia,

Adverse/Side Effects:

Orthostatic hypotension, Bradycardia, AV Blocks, Bronchospasms, Pulmonary Edema, Ventricular dysrhythmias, CHF
Drug Interactions:

Blocks affects of beta-adrenergic bronchodilators in Asthma and COPD patients. Severe Bradycardias if given after Verapamil or other Calcium Channel Blockers. Potentiates hypotension with Nitroglycerine. Adult: 5 – 20mg IV over 2 minutes. If no response in 10
minutes give 40mg slow IV over 2 minutes. If still no
response in 10 minutes give 80mg slow IV over 2 minutes.
Max dose 300mg.
**Consider ½ dose for patients over 65 years old.**
Duration:
LIDOCAINE (XYLOCAINE)
Trade Name: None
Class: Ventricular

Therapeutic Action:
Suppresses ventricular automaticity in ischemic tissue, thus lowering the ventricles ability to produce ectopic beats. Lengthens phase 4’s spontaneous depolarization.
Mechanism of Action:
Raises the Ventricular Fibrillation threshold by altering phase 4 depolarization and ventricular automaticity.
Indications:
V-Fib/V-Tach (Pulseless and with a pulse) PVC’s >6 a minute, couplets, triplets, R-on-T, Multi-Focal Wide Complex Tachycardias of unknown origin.
Contraindications:


Adverse/Side Effects:

Drowsiness & Discoloration, Hypotension, Seizures, Coma, Numbness and Tingling
Drug Interactions:

Caution with Procainamide, Phenytoin, Quinidine, and Beta Blockers
Dosages:
Cardiac Arrest Rhythms
1 – 1.5mg/kg IVP q 5 minutes at 1 – 1.5mg/kg IVP to a total of 3mg/kg 1 – 1.5mg/kg IVP over 2 minutes. Repeat dose if needed in 5 – 10 minutes at 0.5 – 0.75mg/kg over 2 minutes to total of 3mg/kg. 1 – 1.5mg/kg IVP over 2 minutes. Repeat dose if needed in 5 – 10 minutes at 0.5 – 0.75mg/kg IVP over 1 – 2 minutes to a total of 3mg/kg. ET Dose should be 2 – 2.5 times the normal dose. Patients over 70 y/o and hepatic disease – reduce dose by ½.
Duration:
MAGNESIUM SULFATE
Trade Names: None

Class:
Electrolyte
Therapeutic Action:
Stops convulsive seizures associated with pre-eclampsia, CNS depressant.
Mechanism of Action:
Magnesium is integral in the normal functioning of the sodium/potassium pump, which helps maintain cellular wall stability. It is identified as a “physiological” calcium channel blocker and a blocker of normal neuromuscular nerve transmission. It effects the movement of potassium across the cellular wall during cellular depolarization, which increases intracellular potassium and altering calcium effects on conduction. This decreases Chronotropic effects.
Indications:


Contraindications:
Kidney

Adverse/Side Effects:

Hypotension; Respiratory depression or arrest Toxicity – Flaccid muscle paralysis due to blocking neuromuscular transmissions; Depression of deep tendon reflexes; Respiratory paralysis and Circulatory collapse.
Drug Interactions:

May interfere with effects of neuromuscular blocking agents and calcium 1 – 2g in 100ml of D5W over 1 – 2 minutes
Onset: Immediate
Duration:
MEPERIDINE
Trade Name: Demerol
Class: Narcotic

Therapeutic Action:
Produces analgesia, euphoria, and sedation.
Mechanism of Action:
Binds opioid receptors in the CNS, which results in a decrease in, pain transmissions.
Indications:
Severe pain from Fractures; Kidney Stones; Burns; Patients that are allergic to Morphine; OB analgesic
Contraindications

Adverse/Side Effects:
Respiratory depression/arrest; CNS depression; Hypotension; Bronchospasms; N/V
Drug Interactions:
May antagonize Beta-blockers. ETOH, opiates, and other CNS depressants will potentiate effects. Adult: 50 – 100mg IM or 25 – 50mg IV
Peds: 1 – 1.5mg/kg IM or 1mg/kg IV

Duration:
METHYLPREDNISOLONE
Trade Names: Solumedrol
Class: Steroid
Therapeutic Action:
Decreases inflammatory response and reduces edema in tissues
Mechanism of Action:
Has strong anti-inflammatory and cell membrane stabilizing effects.
Indications: Acute

Contraindications: Premature
Known hypersensitivity to methylprednisolone
Adverse/Side Effects:
Exacerbation of CHF (retention of fluid) Arrhythmias
Hyperglycemia

Drug Interactions:

Cyclosporin, Methylprednisolone, Phenobarbital, Phenytoin, Rifampin, Troleandomycin, and Ketoconazole Adult: 125mg slow IV push
Peds: 1 – 2mg/kg (max 125mg) slow IVP
Caution: Incompatible with Diphenhydramine (Benadryl); Flush between drugs.

Duration:
MIDAZOLAM HCL
Trade Name: Versed

Class:
Short-acting

Therapeutic Action:
Relieves apprehension and impairs memory during cardioversion and endotracheal intubation.
Indications:

Contraindications:

Barbiturates; Narcotics; or other CNS depressants on board
Adverse/Side Effects:
Cough; Oversedation; Pain at injection site; Blurred Vision; N/V; Hypotension; Fluctuating Vitals; Respiratory Depression or Arrest
Drug Interactions:
Narcotics, Benzodiazepines, Barbiturates, or other CNS depressants accentuate sedative effects
Dosages:
Adult: 1 – 4mg IV over 2 – 3 minutes. May be repeated in
1mg increments; not to exceed 0.1mg/kg
Peds: 0.1mg per kilogram;

Duration:
MORPHINE SULFATE
Trade Name: None

Therapeutic Action:

Potent pain reliever; venous pooling; reduces preload; reduces systemic vascular resistance; reduces MV02; reduces cardiac workload
Mechanism of Action:
Smooth muscle relaxant (venous & arterial); Binds opiate receptors in the CNS.
Indications:
Chest Pain secondary to Acute Myocardial Infarction
Contraindications: Head

Adverse/Side Effects:

Drug Interactions:

Other CNS depressants, Respiratory depressants and alcohol
Dosages:
Adult: 2mg q 2 – 3 minutes when respiratory drive OK and
BP >90mmHg. 2 – 10mg slow IV push repeated every 5
minutes for pain.
Peds: 0.1 – 0.2mg/kg/dose IV. Max – 15mg

Onset: Immediate
Duration:
NALOXONE
Trade Name: Narcan
Class: Opiate

Therapeutic Action:
Reverses effects of narcotics on the body
Mechanism of Action:

Binds to the opiate receptors in the body to block the effects of narcotics.
Indications:

Respiratory depression of unknown origin
Contraindications:

Adverse/Side Effects:
Tachycardia; Diaphoresis; Hypertension; N/V; Dysrhythmias; Withdrawals
Drug Interactions: Alkaline

Dosage: Adult:
2mg q 2 – 5 minutes to a Max of 10mg IV, IM, SQ,
Peds: 0.1mg/kg for less than 5y/o and/or 20kg IV, IM, SQ,
IO, ET

Duration:

NITROGLYCERINE / NITRO PASTE
Trade Name: Nitro,

Class: Vasodilator
Therapeutic Action:
Systemic arterial and venous dilatation; Reduces preload and after load
Mechanism of Action:


Indications:
Chest pain secondary to decreased myocardial oxygen flow Hypertension
Contraindications:
CAUTION **CONTACT MEDICAL CONTROL PRIOR TO ADMINISTERING IF
PATIENT HAS TAKEN VIAGRA**

Adverse/Side Effects:
Hypotension; Headache; Fainting; Flushing and Nausea
Drug Interactions:
1” of Nitro Paste may be applied to the anterior chest after the 3rd dose in chest pain secondary to decreased myocardial oxygen flow (Angina/AMI) 1” of Nitro Paste may be applied to the anterior chest of patients experiencing pulmonary edema in association with congestive heart failure.
Duration:

Trade Name: O2
Class: Inhaled

Therapeutic Action:
Increases inspired oxygen levels, alveolar oxygen levels, and oxygen within the blood stream.
Mechanism of Action:
Binds up to 100% of unsaturated hemoglobin molecules inside RBC’s
Indications:

Contraindications:

Adverse/Side Effects:
Depression of respiratory drives in COPD patients.
Drug Interactions: None

Dosage:

Adult & Pediatrics: 24 – 100%

Onset: Immediately
Duration:
OXYTOCIN
Trade Name: Pitocin
Class:

Therapeutic Action:
Stimulates contractions of uterine smooth muscle to decrease bleeding from uterine vessels. Squeezes down on uterine smooth muscle myofibrils, producing uterine wall contractions.
Mechanism of Action:
Synthetic hormone similar to the one released by the posterior Pituitary gland, which causes contraction of the uterine smooth muscle myofibrils producing uterine wall contractions.
Indications:
Postpartum hemorrhage after delivery of baby & placenta
Contraindications:
Multiple babies, which have not all delivered
Adverse/Side Effects:
Hypotension; Hypertension; Angina; Anxiety; Uterine Rupture; Tachycardia; Seizure; Allergic Reaction; Dysrhythmias; IC Bleed
Drug Interactions:
Mix 10units (1ml) in 1000cc NS = 10 milliunits/ml
Onset: Immediate

Duration:

PRALIDOXIME CHLORIDE
Trade Name:

Class: Cholinesterase

Indication: Organophosphate

Contraindications:
Do not use Morphine, Theophylline, Aminophylline, or Succinylcholine. Not indicated as an antidote for intoxication by pesticides of the Carbamate class. Not effective in the treatment of poisoning due to phosphorous, inorganic phosphates, or organophosphates not have anticholinesterase
Adverse/Side Effects:
40 – 60 minutes after the IM injection, mild to moderate pain may be experienced at the site of the injection May cause blurred vision, Diplopia, and Impaired Accommodation, Dizziness, Headache, Drowsiness, Nausea, Tachycardia, Increased BP, Hyperventilation, Muscular Weakness
Caution:
Use great caution in treating organophosphate/nerve agent poisoning in cases of Myasthenia Gravis Adult: 1 auto-injector (600mg) IM. May repeat depending
on symptoms

Onset: 15

Duration: 3
PROMETHAZINE HYDROCHLORIDE
Trade Name: Phenergan
Class: Antihistamine,

Mechanism of Action:
Acts on blood vessels, GI respiratory system by competing with histamine for H1 – receptor site; decreases allergic response by blocking histamine
Indications:
Nausea & Vomiting; Motion Sickness; Allergic Reaction; Pre-op Medication
Contraindications:
Children under 2 years; SC or intra-arterial injection; Hypersensitivity to H1 – receptor antagonist; Acute Asthma attack; Narrow Angle Glaucoma; Peptic Ulcer; Prostatic Hypertrophy; Bladder or Pyeloduodenal Obstruction; MAOI therapy
Adverse/Side Effects:
Drowsiness; Xerostornia; Dizziness; Fatigue; Poor Coordination; Anxiety; Euphoria; Increased thick secretion; Wheezing; Chest Tightness; Apnea in Neonates, Infants, and Young Children
Drug Interaction:
Increased Depression; Barbiturates; Narcotics; Hypnotics; Trycyclic Anti-depressants; Alcohol. Decreased effects of anticoagulants, Heparin. Increased Anticholinergic effect; henbane leaf, Benatropine, Cabergolinec, Cisapride, Dofetilide, Gatifloxacin, Grepaflozacin, Halofantrine, Lithium, Meperidine, Metrizamide, Moxifloxin, Orphenadrine, Phenobarbital, Pimozide, Porfimer, Procyclidine, Sparflozacin, Tramadol, Trazadone, Tribexyphenidyl 12.5 – 25mg Q 4 – 6 hours prn (PO, IV, IM, Rectal) 2y/o or older – IV dose is 50% of Adult. Max Dose is 0.5mg/kg/dose. Give over 1 minute.
Durations:

PROPOFOL
Trade Name: Diprivan

Class:
Anesthetic

Administration:
Dilute only with normal saline to a concentration not less than 2mg/ml Maintain strict aseptic technique during handling
Monitoring:
Continuously; Hypotension; Apnea; Airway Obstruction; Oxygen Desaturation
Contraindications:
Hypersensitivity to Propofol, Soy, or Peanuts
Adverse/Side Effects:
Injection Site Pain, Involuntary Muscle movement, Nausea & Vomiting, Anaphylaxis (rare) – soy, peanut allergy, Respiratory Acidosis, Bradycardia, Hypertension, Hypotension, Torsades de Pointes – Responds well to MgSO4
Dose Adjustments:
Geriatrics, Weight, ETOH, etc – titrate 20 – 50mg IV q 10 seconds until onset (1 – 2.5mg/kg) Dose varies Ped (3 – 16yo & Healthy)

Pregnancy Category: B
SODIUM BICARBONATE
Trade Name: None

Class:
Alkalizing

Therapeutic Action:


Mechanism of Action:
Acts as a bicarbonate ion and binds with H ions to from Carbonic acid.
Indications:
Metabolic
Hyperkalemia
Contraindications:
Before Respiratory Alterations have been accomplished
Adverse/Side Effects:
Hypernatremia
Drug Interactions:
May precipitate with CaCl, CaG1, MSO4, Aminophylline, and MgSO4. Inactivates Epinephrine, Isuprel, Dopamine
Dosages:
Adult: 1mEq/kg slow IVP. Repeat in 10 minutes with 0.5mEq/kg Ped: 1mEq/kg of pediatric mixture (8.4%). Repeat in 10 minutes with 0.5mEq/kg slow IVP
Durations:
SUCCINYLCHOLINE
Trade Name: Anectine
Class:
Depolarizing Neuromuscular Blocker (Paralytic)
Therapeutic Action:
Paralysis of Diaphragm and Skeletal muscles throughout the body.
Mechanism of Action:
Binds with receptors at the motor end plate of skeletal and the diaphragm thereby blocking acetylcholine from attaching to the receptors. Because it binds to the receptors instead of blocking them; muscle fasiculations and some muscle contractions occur.
Indications:
To facilitate intubation of patients which have an intact gag reflex
Contraindications:
Penetrating eye injuries (Succ’s ↑ intraocular pressure) Unlikely to have a successful intubation Neuromuscular Disease (Myasthenia Gravis) Narrow Angle Glaucoma (Succ’s ↑ intraocular pressure)
Adverse/Side Effects:

Muscle fasiculations, Hypersalivation (atropine?), Bradycardia (atropine?) Malignant Hyperpyrexia (rare, muscle rigidity, tachycardia, hypertension) Trismus (locking of jaw & teeth clenching) Don’t give more Anectine.
Drug Interactions:
Oxytocin, Beta-blockers, Procainamide, Lidocaine, Magnesium salts and Organophosphates may potentiate effects. Adult/Ped: 1 – 2mg/kg rapid IVP

Premedication:
Head-Injury Patients: 1mg/kg Lidocaine slow IV
Duration:

TETRACAINE
Trade Name:

Class:
Ophthalmic

Therapeutic Action:
Suppresses sensory-input from conjunctiva and eye
Mechanism of Action:
Decreases ion (Na+) permeability by stabilizing neuronal membrane. Inhibits nerve impulses from sensory nerves.
Indications:

Removal of foreign objects (non-impaled) Placement of Morgan lenses during an eye flushing procedure.
Contraindications:
Hypersensitivity to Paraaminobenzoic Acid Caution with Hypothyroidism, Hypertension, CAD, Pregnancy
Adverse/Side Effects:

Blurred Vision, Stinging, Burning, and Lacrimation
Drug Interactions:

Decreases antibacterial action of sulfonamides
Duration:
THIAMINE
Trade Name: Betaxin
Class: Vitamin

Therapeutic Action:
Replenishes Thiamine stores in Malnourished Individuals.
Mechanism of Action:
Converts pyruvic acid to acetyl-coenzyme-A. This allows cells to use the glucose on hand to fuel the body. Prevents Wernicke’s syndrome (acute & reversible encephalopathy) and Korsakoff’s psychosis (mental derangement which may not be reversible). Combines with ATP to form Thiamine pyrophosphate coenzyme (carb metabolism).
Indications:
Coma of unknown origin where alcohol use is possible
Contraindications:
Hypotension, Dyspnea, Respiratory Failure, Nausea, Vomiting and Diaphoresis
Drug Interactions:


Onset:
Rapidly
Duration:
VASOPRESSIN
Trade Names: Pitressin
Class: Vasopressor,

Therapeutic Action:
Smooth muscle constriction results in blood being directed toward the vital organs along with increased return of spontaneous circulation without an increase in oxygen demand.
Mechanism of Action:

Acts by direct stimulation of smooth muscle receptors causing smooth constriction. Minimal beta effects (Inotropy).
Indications: Cardiac

Contraindications:
Chronic Nephritis, Ischemic Heart Disease, and PVC’s
Adverse/Side Effects:
Pallar, Abdominal Cramps, Nausea, Hypertension, Bradycardia, Cardiac Dysrhythmias, Heart Blocks, and AMI
Drug Interactions:
Alcohol, Epinephrine, Lithium, Neostigmine Increases effects. 0.1 – 0.4 units/min. Max 1 – 2units/min IV push Ped: Not Recommended
VECURONIUM
Trade Name: Norcuron
Class:

Therapeutic Action:

Paralysis of diaphragmatic and skeletal muscles throughout the body.
Mechanism of Action:

A non-depolarizing neuromuscular blocker (NMB), blocks the receptor sites for Acetylcholine on the motor end plate (MEP), preventing stimulation of the muscle fibers.
Indications:
Bucking or fighting the endotracheal tube At risk of harming Paramedical Personnel Trismus (locking of jaw and teeth clenching)
Contraindications:
Myasthenia
Patients which require a neuro examination upon arrival to ER
Adverse/Side Effects:

Apnea, Hypoxia, Hypercarbia, Profound Weakness
Drug Interactions:
Increased neuromuscular blockade: Clindamycin, Lincomycin, Quinidine, Polymyxin Antibiotics, Local Anesthetics, Lithium, Narcotics, Thiazides, Adult/Children >9y/o: 0.1mg/kg IV

Premedicate:
Awake patients should receive 3 – 5mg of Valium slow IV
Duration:
XYLOCAINE JELLY (2%)
Trade Name: None
Class: Topical

Indications:


Contraindications:
Known hypersensitivity to local Anesthetics.
Caution:
Wear protective gloves when handling to prevent numbing. Do not apply to stylet or inner lumens of ET or Nasogastric tubes.
Adverse/Side Effects:
Impaired swallowing may lead to aspiration. Numbness of tongue or bucchal mucosa may enhance possibility of unintentional biting trauma. Bradycardia Hypotension Drowsiness Blurred/Double Apply moderate amount to external surfaces of endotracheal / nasogastric tubes prior to placement. 3 – 5 minutes after contact with topical region or mucosa.
Duration:
1.5 – 2.0 hours. Can very with dosage and site of application.
INDEX-- Drug Listing By Trade Name
Acti-Char . `3 Acti-Dose. 3 Adenocard. 4 Adrenalin . 15 Anectine . 36 Aspirin . 2 Atrovent. 20 Benadryl . 13 Betaxin . 38 Cardizem. 12 Cordarone (revised May 5, 2005) . 7 Demerol. 24 Diprivan . 34 Dopastat. 14 Haldol . 18 Insta-Char . 3 Intropin . 14 Ipecac. 19 Lasix. 16 Liqui-Char. 3 Narcan. 28 Nitro. 29 Nitrostat. 29 Norcuron . 40 Normodyne. 21 O2 . 30 Ophthaine. 37 2 – Pam Chloride . 32 Phenergan. 33 Pitocin . 31 Pitressin . 39 Proparacaine. 37 Proventil . 6 Solumedrol . 25 Sorbitol . 3 Tetracaine . 37 Transdate . 21 Tylenol. 1 Valium . 11 Ventolin . 6 Versed. 26 Xylocaine Jelly . 41

Source: http://www.ghfd2.org/GHDrugProtocols.pdf

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