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Mcems formulary 1.
| Question | Answer |
|---|---|
| Acetaminophen class and indications? | Non opioid analgesic : pain and fever. |
| Acetaminophen actions? | Activation of descending serotonergic inhibitory pathways in the cns causes analgesia, antipyresis from inhibition of the hypothalamic heat regulation center. |
| Acetaminophen dose adult and pediatrics > 50 kg ? | 640 mg ( 20ml , 4 unit doses ) q 4 hours. > 75 years old 320 mg ( 10 ml or 2 unit dose ) |
| Acetaminophen pediatrics < 50 kg ? | Dosing chart. Call for orders under 24 lbs. 11 kg. |
| Acetaminophen contraindications ? | Severe hepatic impairment or acute liver disease , and hypersensitivity. |
| Adenosine class and indications ? | Anti arrhythmic and endogenous nucleoside present in all cells. Indicated in symptomatic psvt. Adults > 160 bpm, pediatrics > 220 bpm. |
| Adenosine actions ? | Slows or interrupts conduction through the AV node. |
| Adenosine dose adults and pediatrics ? | 6 mg, 12 mg, 12 mg rivp. 0.1 mg /Kg, 0.2 mg/ kg, 0.2mg/kg. |
| Adenosine contraindications ? | Hypersensitivity, atrial ventricular blocks. |
| Albuterol class and indications. | Sympathomimetic, beta 2 agonist. Indicated for asthma, copd, allergic reactions, bronchoconstriction caused by other etiologies. Also indicated for hyperkalemia and crush injury's. |
| Albuterol actions ? | Relaxes smooth muscle of the bronchioles and reverses bronchospasm, and inhibits release of histamine from mast cells. |
| Albuterol dose adult and pediatric ? | 2.5 mg in 3ml normal saline nebulized. |
| Albuterol side effects? | Stimulation of the sympathetic nervous system. Palpitations, tachycardia, increased B/P |
| Albuterol contraindications ? | Known hypersensitivity. |
| Amiodarone class and indications? | Predominately a class 3 antiarrhythmic, but exhibits properties of all 4 antiarrhythmic classes. |
| Amiodarone actions ? | Delays repolarization by prolonging the action potential during refractory period as well as blocking myocardial potassium channels and prolonging internodal conduction and av node refractoriness. Inhibits alpha and beta activity. Vasodilates < afterload |
| Amiodarone adult dose v fib, pulseless v tach ? | 300 mg bolus, repeated at 150 mg in 5 min. |
| Adult post rosc maintenance infusion Amiodarone ? | 1 mg/min for first 6 hours. |
| Adult post resuscitation Amiodarone ? | 150 mg in 10 min if no antiarrhythmic has been given. |
| Adult sustained v tach with a pulse and svt Amiodarone dose? | 150 mg over 10 min. |
| Amiodarone admixture? | 150 mg in 50 ml over 10 min. 3 mg/ml at 5 ml a minute: 300 drops per minute or 5 drops a second 60 gtts set. |
| Amiodarone v fib, pulseless v tach, and svt dose for pediatric ? | 5 mg/kg max 300 mg ,repeat at 5mg/kg max 15 mg/kg. Do not exceed 300 mg in 24 hours. |
| Amiodarone contraindications? | Hypersensitivity, 2nd or 3rd degree heart block, cardiogenic shock, bradycardia, or pt on another antidysrhythmic. |
| Aspirin class and actions? | Platelet aggregate inhibitor. Blocks the formation of substances that cause platelets to aggregate and arteries to constrict. |
| Aspirin indications and contraindications? | Patients with suspected acute coronary syndrome . Bleeding esp gastric ulcers,acute trauma,cva or brain surgery, allergies. |
| Atropine class and action ? | Parasympatholytic, .anticholenergic. inhibits acetycholine at post ganglionic parasympathetic neuroeffector sites. Blocks vagal inhibition of the heart,increases sa node automaticity and increases a chronotropic effect. Increases av node conduction |
| Atropine dose adult and pediatric symptomatic bradycardia? | 0.5 mg rivp max 3 mg iv, 0.02mg/kg rivp min0.1mg, max 0.5 |
| Atropine indications and contraindications ? | Unstable bradycardia with rate < 50, symptomatic organophosphate and cholinergic poisoning , symptomatic nerve agent poisoning. Angle -closure Glaucoma relative contraindication. |
| Atropine side effects ? | Dry mouth, blurred vision, mydriasis, urinary retention, cns excitation, tachycardia , palpitations. |
| Atropine adult and pediatric organophosphate/cholinergic/nerve agent poisoning? | 1-2 mg rivp, repeat in 3 minutes with 2-4 mg rivp until symptoms done. Pediatric 0.02 mg/kg rivp min single dose 0.1 mg q 3 min until signs resolve. |
| Calcium gluconate class and action? | Electrolyte, used to treat negative calcium balance, allows for normal function. |
| Calcium gluconate indications? | Calcium channel blocker overdose, hypocalcemia, hyperkalemia, hypermagnesemia, hydroflouric acid exposure. |
| Calcium gluconate adult and pediatric dose? | Adult: 500mg -1 gram iv/io sivp, Pediatric 60-100 mg/kg ( 0.6 - 1 ml / kg) iv.io sivp |
| Calcium gluconate side effects and contraindications ? | Decreased heart rate, decreased blood pressure, v-fib, arterial spasm, infiltration necrosis. Digitalis toxicity, hypercalcemia . |
| Diphenhdramine (benadryl) class and actions ? | Antihistamine, Competitive antagonist for histamine binding sites on the capillary bed. Inhibition of MAST cell damage preventing histamine release. Anticholinergic effect, drying up secretions, mild anti-emetic, relieves itching. |
| Benadryl indications ? | Dypsnea and other symptoms of systemic/mild allergic reaction. |
| Benadryl adult and pediatric dose? | Adult 25-50 mg iv/im slow push. Pediatric 1mg/kg iv/im slow push max 50 mg. |
| Benadryl side effects? | CNS: sedation, drowsiness, dizziness. CV: hypo tension, tachycardia, palpitations. GI: dry mouth , nausea vomiting. Respiratory: thickening of bronchial secretions, tightness of chest and wheezing. |
| Benadryl contraindications? | Acute asthma, do not administer if the pt has taken (Maoi) such as isocarboxazid(mar-plan), phenelzine (nardil), or tranylcypromine ( parnate) |
| Cardizem class and actions ? | Calcium Channel Blocker, Slows conduction through av node, causes vasodilation, slows ventricle rate in afib and aflutter, negative inotrope,chronotrope, and dromotrope. Decreases myocardial oxygen demand. |
| Cardizem indications ? | To control rapid ventricular response associated with A-fib/ A-flutter. Paroxysmal SVT refractory to adenosine. |
| Cardizem dosage atrial fib/a flutter, psvt? | 0.25 mg/kg typically 20 mg over 2 minutes, repeat 0.35 mg/kg. Maintenance infusion of 10 mg an hour. |
| Cardizem contraindications? | Hypotension, cardiogenic shock, wide complex tachycardia, wpw. Pt taking beta-blockers. |
| Cardizem side effects? | Bradycardia, heart block, hypo tension, asystole. dizziness, nausea, vomiting. |
| Dextrose class, actions, indications? | Carbohydrate. Restores blood sugar, transient osmotic diuretic. Hypoglycemia in pt's < 60 mg symptomatic. |
| Dextrose adult dose? | BLS /als insta glucose 25 gram orally, 25 gram ( d50) iv,io. |
| Dextrose pediatric dose? | Bls/als 25 gram orally. < 6 year old dextrose 25% 0.5 g/kg, > 6 year old dextrose 25% 1 gm/kg all max 25 g. |
| Dextrose Neonate/newborn dose? | 0.5 gm/kg dextrose 10% or 12.5% repeat once prn. |
| Epinephrine class and actions ? | Endogenous catecholamine. Inotrope, chronotrope (sa node ), dromotrope. Lowers fibrillation threshold, alpha 1 effects, beta 2 effects. Inhibits histamine release and inhibits histamine effect on end organs. |
| Epinephrine indications ? | Cardiac arrest all ages, unstable anaphylaxis, unstable bradycardia, shock after fluid replacement. Asthma unresponsive to albuterol. |
| Epinephrine adult dose cardiac arrest, unstable bradycardia dose and admixture? | 1mg iv/io, infusion 2-10 mcg/min. Admixture 1mg in 250cc= 4mcg per ml. |
| Epinephrine anaphylactic severe dose adult ? | Bls assist with epi, 0.3mg (1:1000) IM, Epinephrine infusion 2 -10 mcg/min. |
| Epinephrine anaphylactic dose mild adult ? | 0.3mg im repeat x 3 prn. |
| Epinephrine asthma adult ? | 0.3mg (1,1000) im. |
| Epinephrine cardiac arrest, newborn resuscitation, unstable bradycardia and anaphylactic reactions pediatric dose ? | 0.1 ml/kg iv/io q 3-5 min (1;10,000), 0.01 ml/kg et tube. |
| Epinephrine pediatric dose for anaphylaxis ? | 0.01ml/kg max 0.3ml (1;1000) q 5 min prn max 3 doses. |
| Epinephrine side effects and precautions ? | Nervousness, euphoria, tremors, headache, hypertension, tachycardia. Be cautious for adults in non anaphylactic shock, pt's above 50 years old, pregnant pt's ,asthma pt's with history of hypertension. |
| Etomidate class and actions ? | Sedative / Hypnotic. Produces rapid induction of anesthesia with minimal respiratory/ cardiovascular effects and no histamine release. |
| Etomidate indications and side effects ? | Induction agent for RSI. Hypertension, hypo-tension, tachycardia, bradycardia, myoclonic skeletal muscle movement, hypo ventilation, hyperventilation, laryngospasm, nausea, vomiting. |
| Etomidate dosage for adults and pediatrics >1 year old. | 0.3mg/kg limited to initial dose do not repeat. |
| Etomidate precautions? | Hypo tension, severe asthma, severe cardiovascular disease, known adrenal insufficiency, shock from any cause. |
| Fentanyl class, and actions | Opiate analgesic, inhibits ascending pain pathways in cns, inhibits pain threshold and perception by binding opiate receptors. |
| Fentanyl indications and side effects ? | Musculoskeletal or soft tissue pain, or other etiologies of pain. Dizziness, delirium, euphoria, bradycardia, hypotension, respiratory depression, nausea, vomiting, muscle rigidity with rapid push. |
| Fentanyl dosage adult ? | 1 to 2 mcg/kg Iv/io/im/in. Max single dose of 200 mcg. Orders for dosage beyond 200 mcg. |
| Fentanyl dosage pediatric > 6 months old. | 1 mcg/ kg max single dose 100 mcg, or titrate up to 200 mcg. Orders beyond 200 mcg. |
| Fentanyl contraindications ? | Hypersensitivity to opiates, pt using MAOI inhibitors within 14 days, pregnancy or nursing women. |
| Fentanyl precautions ? | Respiratory disease or respiratory depression, pronounced effects with cns depressants, alcohol,sedatives, anti psychotics, and skeletal muscle relaxants. Increased icp, pt's with seizure disorders, Monitor ecg, pulse oximetry and respiratory status. |
| Lasix class and indications ? | Loop of Henle diuretic, cardiogenic pulmonary edema (chf) with systolic bp above 100 mmhg. |
| Lasix actions ? | Inhibits re absorption of electrolyte in the ascending Loop Of Henle. Decreases the re absorption of sodium and chloride and increases potassium excretion in distal renal tubule. Rapid diuresis. Decreases peripheral vascular resistance. |
| Lasix side effects and contraindications ? | Orthostatic hypotension, electrolyte imbalance, vertigo, blurred vision, dizziness, transient hearing loss with rapid injection. Hypersensitivity, anuria, hypotension. |
| Lasix dosage adult ? | Low dose 20- 40 mg ivsp, 0.5- 1mg/kg ivsp or 2 times the pt's oral dose to a max of 100 mg. |
| Lasix precautions ? | Do not mix with other drugs, use with caution in pt's with hepatic cirrhosis. In pt's receiving cardiac glycosides, may cause hypomagnesemia or hypokalemia and subsequent fatal arrhythmia's. |
| Glucagon class and actions ? | hormone secreted by the pancreas. Increases blood glucose concentration by stimulating hepatic glycogenolysis. Positive inotrope and chronotrope effect. |
| Glucagon indications ? | Hypoglycemia when iv access is difficult. Adults with blood glucose less than 60mg/ dl, pediatrics less than 40 mg/dl. Beta blocker overdose. Esophageal obstruction. |
| Glucagon dosage adults and pediatric hypoglycemia ? | Adults 1mg IM/IN. Pediatric < 20 kg 0.5 mg IM, > 20 kg 1mg IM/IN. |
| Glucagon adult or pediatric Beta Blocker overdose ? | 50 mcg/kg IV/IO repeat dose given in 3-5 min. |
| Glucagon side effects, contraindications ? | Occasional nausea and vomiting. Known hypersensitivity. |
| Glucagon precautions ? | Provide additional carbohydrates to prevent secondary hypoglycemia. Use with caution with pt that have a history of pheochromocytoma with catecholamine release causing increased blood pressure. |
| Haldol class and actions ? | Anti psychotic, depresses cerebral cortex,hypothalamus, and limbic system, which controls activity and aggression, Blocks neurotransmission produced by dopamine at synapse. |
| Haldol indications and dosage ? | Situations where chemical restraint is needed to care for patients or protect responders . Block neurotransmitter produced by dopamine at synapse. Adult 5- 10 mg iv/io/im, depending on the degree of agitation, children 6-12 yrs old , 1- 3 mg . |
| Haldol side effects ? | Laryngospasm, broncho spasm, respiratory depression, seizures, trismus, nausea, vomiting, torsades, hypotension, angina. |
| Haldol contraindications? | Hypersensitivity, children under 3, cns depression, pregnancy. |
| Atrovent class and actions ? | Anticholinergic, parasympatholytic, brochodilator chemically related to atropine. |
| Atrovent indications and dosage ? | Asthma,copd,or other etiologies of bronchoconstriction. 0.5 mg unit dose. |
| Atrovent side effects and contraindications. | Tachycardia, palpitations, eye pain, head ache. Hypersensitivity to atropine or it's derivatives. |
| Ketamine class and actions ? | Anesthetic dissociative, class three controlled substance. Profound analgesia and sedation. Normal pharyngeal-laryngeal reflexes. Mild cardiac stimulation and respiratory depression, bronchodilation. |
| Ketamine indications and side effects ? | Induction, sedation, analgesia. Elevated heart rate and blood pressure, bradycardia( rare), hyper salivation, laryngospasm (rare), Potential for emergent reaction ( consider small amount of benzo). |
| Ketamine analgesia dose ? | 0.1 to 0.3 mg/kg. |
| Ketamine induction dose for adult with hypotension ? | 0.5 mg/kg iv/io/in, repeat half dose every 10-20 min as needed. |
| Ketamine induction and sedation dose for normotensive adult ? | 1 - 2 mg/kg iv/io/in and repeat half dose 10-20 minutes as needed. |
| Ketamine for combative patient? | 2-5 mg/ kg im. Consider higher dose for violent pt or pt with exited delirium. |
| Ketamine dose for pediatric pt's needing induction, sedation or analgesia ? | 1 mg/kg, iv/io/in, 2-5 mg/kg im . |
| Ketamine contraindications ? | Hypersensitivity, Pt's in whom an significant elevation of blood pressure or heart rate would constitute a serious hazard such as increased icp or a pt suffering from cad. |
| Ketamine special considerations ? | Respiratory depression may occur during rapid push or high dose ketamine. Bronchodilation makes this drug favored for rsi for status asthma. |
| Toradol Class and action ? | Nsaid, may inhibit prostaglandin synthesis, to produce anti-inflamatory, analgesic, and antipyretic effects. |
| Toradol indications ? | Muscle cramps, migraine headaches, pain related to kidney stones. |
| Toradol Adult dose ? | < 65 years old 30 mg ivsp , 60 mg deep im . > 65 years old or renal impairment 15 mg ivsp or 30 mg deep im. |
| Toradol pediatric dose ? | 0.5 mg/kg sivp 15 mg max, 1 mg/kg 30 mg max deep im. |
| Toradol side effects ? | Headache, dizziness, drowsiness, sedation, arrhythmia, edema, hypertension, palpitations, gi pain, nausea, constipation, diarrhea, vomiting, diaphoresis. |
| Lactated Ringers class and action? | Crystalloid salt solution, isotonic solution that supplements intravascular volume. |
| Lactated Ringers indications and contraindications ? | Maintain vascular access, fluid challenge for burns, trauma, and Shock states. Hyperkalemia contraindications like with crush injuries. |
| Lactated Ringers adult fluid challenge dose ? | 200-500 ml, reassess and repeat as needed. |
| Lactated Ringers fluid challenge > 1 month old? | 20 ml/kg, re-assess and repeat. |
| Lactated Ringers fluid challenge < 1 month old ? | 10 ml/kg, re- assess and repeat. |
| Keppra class and actions ? | Anticonvulsant, Broad spectrum anti seizure medication that binds to synaptic vesicle protein sv2a to modulate synaptic transmission and indirectly modulates gamma- aminobutyric acid ( gaba). |
| Keppra indications ? | Status epilepticus, subarachnoid hemorrhage, traumatic brain injury. |
| Keppra dosage adults ? | 10 mg/kg over 15 min to a max dose of 1000 mg. |
| Keppra dosage pediatrics ? | 5 mg/kg over 15 minutes to a max dose of 500 mg. |
| Keppra side effects and contraindications ? | Increased blood pressure, aggression, anger, or anxiety, nausea and vomiting. Hypersensitivity . |
| Keppra precautions ? | Cns depression, severe dermatologic reactions, may cause a decrease in hematocrit, hemoglobin, and white blood cells. |
| Lidocaine class and actions ? | Class 1 b anti arrhythmic. In creases v- fib threshold, shortens phase 2 of normal tissue to match ischemic tissue, termination of ventricular ectopy by depressing automaticity of purkinje, and ventricular ectopic pacer cells. |
| Lidocaine indications? | Vf/ V tach cardiac arrest refractory to epinephrine and defibrillation and sustained v tach with a pulse. |
| Lidocaine dosage for adult cardiac arrest v fib, v tach ? | 1.5 mg/kg iv/io push repeated once in 5 minutes to a max of 3mg/kg. |
| Lidocaine dosage for adult v tach with a pulse ? | 1.0 mg/kg , iv/io push repeat at 0.5 - 0.75 every 5 min to a maximum dose of 3mg/kg. |
| Lidocaine adult infusion following conversion ? | 2 to 4 mg/min . |
| Lidocaine pediatric infusion following conversion or elimination of ventricular ectopy ? | 20- 50 mcg /kg/min. |
| Lidocaine pediatric vf pulseless v tach ? | 1.0 mg/kg iv. io repeat once in 5 minutes. |
| Lidocaine pediatric stable/ unstable v tach with a pulse ? | 1.0 mg/kg iv, io repeat once in 5 minutes . |
| Lidocaine infusion following conversion or elimination of ventricular ectopy ? | 20-50 mcg/kg/min. |
| Lidocaine contraindications ? | Hypersensitivity, wpw, stokes adams syndrome, high degree heart blocks, idioventricular rhythm, and accelerated idioventricular rhythms. |
| Ativan class and actions ? | Benzodiazepine, sedative, hypnotic. Raises seizure threshold and stops active seizures by hyperpolarizing neural membranes via enhancement of GABA ( an inhibitory neurotransmitter ) activated chloride channels. |
| Ativan indications ? | Initial control of status elipticus, sedation. |
| Ativan special administration precautions ? | Prior to administration by IV must be diluted with equal amount of ns. When giving IM does not need dilution. |
| Ativan adult iv/io dosage ? | Dilute first ,anxiety and sedation 1-4 mg iv q 5-15 min. Sedation 4 mg iv Q 5-15 min. |
| Ativan pediatric iv/io/im dosage ? | Dilute first, 0.05 mg/kg to 0.15 mg/kg sivp, Max dose 0.2mg/kg. |
| Ativan rectal dose ? | 0.1 to 0.2 mg/kg. |
| Ativan side effects ? | Cv collapse, respiratory depression, drowsiness, nausea, vomiting, delirium. |
| Ativan contraindications ? | Impaired liver/ renal functions, acute narrow angle glaucoma. |
| Ativan precautions ? | Monitor respiratory rate and BP during administration, have suction and intubation equipment, be prepared to ventilate, be careful when administering with barbiturates, alcohol, narcotics, or tranquilizers. |
| Magnesium Sulfate class and actions ? | Electrolyte. Corrects hypomagnesemia induced cardiac arrhythmias and symptoms of cardiac insufficiency. Depresses the CNS and blocks peripheral neuromuscular transmission, producing anticonvulsant effects in pre eclampsia or eclampsia. |
| Magnesium sulfate indications ? | Refractory pulseless vtach or v fib, sustained vtach, pvc.s, torsade's, asthma and status asthma, pre eclampsia and eclampsia. |
| Magnesium sulfate adult dosage refractory vf/vt ? | 2 grams iv/io push . |
| Magnesium sulfate adult torsade's de pointes ? | 2 grams iv or io in cardiac arrest sivp dilute to 25 percent. |
| Magnesium sulfate sustained v tach unstable adult ? | 2 grams of a 25 % concentration sivp. |
| Magnesium sulfate asthma and status asthmaticus adult ? | 1-2 grams in 50 ml of 0.9% normal saline infused over 10 minutes. |
| Magnesium sulfate pre- eclampsia and eclampsia adult ? | 1 gram a minute of a 25% concentration iv slow push up to 4 grams. |
| Magnesium sulfate pediatric dose refractory vf/vt ? | 25-50 mg/kg iv/io slow push max dose 2 grams. |
| Magnesium sulfate pediatric dose torsade's de pointes ? | 25-50 mg/kg iv/io over 10-20 minutes to max dose of 2 grams. |
| Magnesium sulfate pediatric asthma and status asthmaticus ? | 1 gram in 50 ml of 0.9% ns infused over 10 minutes. |
| Magnesium sulfate side effects ? | Flushing, sweating, hypotension, depression of reflexes, hypothermia, cardiac and CNS depression, respiratory depression and paralysis . |
| Magnesium sulfate contraindications ? | Heart block. |
| Mannitol class and actions ? | Osmotic diuretic, produces osmotic diuresis by inhibiting sodium and water absorption in the kidneys, increasing urinary output. Promotes the movement of fluid from intracellular space to extracellular space. Reduces cerebral edema and ICP . |
| Mannitol indications ? | Cerebral edema, increased intracranial pressure. |
| Mannitol dosage/ administration adult ? | For ICP, 0.25- 2 grams/kg/ iv,io infusion of 20% solution over 30-60 minutes. |
| Mannitol pediatrics dosage/administration? | For ICP , 1 gram/kg iv/io infusion of a 20% over 30-60 minutes (see dosing chart). |
| Mannitol side effects ? | Hypotension, tachycardia, dehydration, hypovolemia, nausea, vomiting, headache, dizziness, lethargy, chest pain. |
| Mannitol contraindications ? | Hypersensitivity to mannitol or any component of the formulation, intracranial bleeding, severe renal disease, dehydration,hypotension, profound hypovolemia, severe CHF with pulmonary edema. |
| Mannitol precautions ? | Can cause transitory increase in intravascular volume (like bolus) causing problems with CHF pt's. Do not give in pt's systolic bp less than 100 systolic. Insure no extravasation. |
| Solu-Medrol class ? | Synthetic steroid similar to the glucocorticoids cortisol and corticosterone, which are released from the zona fasciculata of the adrenal cortex. |
| Solu-Medrol actions ? | Anti- inflamatory agent stabilizes cell membranes, and lysosomal membranes preventing the release of histamine, bradykinin, myocardial depressant factor . Prevents excess lactic acid build up. |
| Solu-Medrol indications ? | Treatment of ARDS, bronchial asthma, other bronchospastic states. Life threatening cardiogenic, anaphylactic, and septic shock, to inhibit the body's inflammatory response. |
| Solu-Medrol dosage and administration adults ? | Respiratory distress:125 -250 mg iv, io, im sivp. Anaphylaxis 125 mg iv,io,im sivp. Adrenal insufficiency: 125 mg iv,io,im, sivp. |
| Solu -Medrol Pediatric dose ? | 1-2 mg/kg iv,io,im sivp. |
| Solu-Medrol side effects, contraindications, precautions ? | No toxic side effects, no contraindications pre-hospital. Be cautious in diabetes, and do not mix with any other drug. |
Created by:
rglossip
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