RICHARDSON PROTOCOL DRUGS

Adenosine Class:
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Terms in this set (98)
Adenosine Class:
endogenous nucleoside present in all cells of the body
Adenosine Action:
slows conduction through AV node
Adenosine Contraindications:
1. History of 'Sick Sinus Syndrome'

2. 2nd or 3rd degree heart block
Adenosine Drug Interactions:
Methylxanthines (caffeine), (theophylline-like drugs) antagonize the effects of adenosine

Dipyridamole (Persantine) potentiates the effect of adenosine

Carbamazepine (Tegretol) may produce higher degree of AV block
Adenosine Dose: (IV in AC or proximal to AC)
Adult: 12mg repeat 1x

Pedi: 0.1mg/kg, then 0.2mg/kg
Albuterol Side Effects:
Nervous: Tremors, Headache, Hyperactivity
Cardiac: Tachycardia, Palpitations, Hypokalemia
GI: N/V
Respiratory: Bronchospasm, increased sputum
Albuterol Precautions:
Patients with CVD, and cardiac arrhythmias
Albuterol Dose:
Adult: 2.5mg/3mL
Pedi 2.5mg/3mL
Amiodarone Class:
Potassium channel blocker (Class III antiarrhythmic) that exhibits properties of each of the four anti-arrhythmic classes
Amiodarone Action:
blockade of potassium chloride leading to prolongation of action potential duration
Amiodarone Contraindications:(1) Second or third degree AV blocks, Sick Sinus, Symptomatic Bradycardia (2) Cardiogenic ShockAmiodarone Precautions:QT prolongation may be exaggerated in patients with hypokalemia or hypomagnesaemia, increasing potential for torsades de pointesAmiodarone Drug Interactions:- Use with beta blockers and Ca+ channel blockers may increase risk of hypotension and bradycardia - Potentiate antihypertensivesAmiodarone Indications:V-tach Vfib Rate control in Afib with RVRAtropine Contraindications1) Myocardial ischemia 2) Asthma 3) Myasthenia Gravis 4) angle closure glaucoma 5) tachycardia 6) down syndrome (may be sensitive to effects)Atropine DoseAdult: OP poisoning- 2mg q 3 min as needed Ca+ channel blocker or Beta Blocker OD- 0.5 mg 1x then pace Brady: 1mg q 3-5 min up to 3x Pedi: OP poisoning- 0.02mg/kg (minimum 0.1mg) q 3 min as needed Brady: 0.02mg/kg (minimum 0.1mg) repeat 1x as neededCaCl Indications:Hypocalcemia, Mg ODCaCl Contraindications:- Cancer Patients with bone metastases - hypercalcemia - renal calculiCaCl Precautions:- patients taking digitalis - Use cautiously in pregnancyDiltiazem Action:Partial blockade of AV node conductionDiltiazem Side Effects:- May induce VF if pt in wide complex tachycardia due to WPW - hypotensionDiltiazem Contraindications: (IV slowly over 2 min)1) Hypotension 2) Wide Complex Tachycardia 3) WPW 4) 2nd or 3rd degree blockDiltiazem Dose:Adult: 20mg IV/IO repeat 1x in 15 minutes if rhythm persistsDiphenhydramine Dose:Adult: 50mg IV/IO/IM Pedi: 1mg/kg (max 25mg) IV/IO/IMEpinephrine Dose:Adult: AR- 0.5mg IM repeat as needed, 0.5mg IV/IO with 500ml NS bolus for hypotension, 0.5mg nebulized repeat as needed for laryngeal edema Pedi: .01mg/kg IV/IO/IM, repeat IM or nebulized as needed. Nebulized is 0.5mgFentanyl Dose:Adult: 2mcg/kg (max 300mcg) Pedi: 2mcg/kg (max 150mcg)Hydroxocobalamin (Cyanokit) Dose:Adult: 5g (two vials) over 15 minutes Pedi: 100mg/kg (4mL/kg) over 15 minutesIpratropium Bromide Action:Inhibits vagally mediated reflexes by antagonizing acetylcholine at muscarinic receptors on bronchial smooth muscleIpratropium Bromide Contraindications:sensitivity to atropine or its derivativesIpratropium Bromide Dose:0.5mg nebulized alwaysKetamine Hydrochloride Class:Sedative, Analgesic, General AnestheticKetamine Hydrochloride Action:NMDA receptor antagonist - lower dose potent analgesia and mild sedation - high dose dissociative anesthesia and moderate to deep sedationKetamine Hydrochloride Precautions:- use with amiodarone can cause arrhythmias - may be used with anticholinergics to decrease salivation - 12% patients will experience vivid hallucinations, emergence delirium (when this happens give midazolam: adult- 5mg/pedi- 0.1mg/kg)Ketamine Hydrochloride Dose:Pain: Adult- 25mg may repeat 1x/ Pedi- 10mg (if pt at least 10kg)may repeat 1x RSI: 2mg/kg both adult and pedi IV dose should be administered over 60 seconds (too fast can cause respiratory depression or apneaLidocaine Hydrochloride Class:Aminoacyl AmideLidocaine Hydrochloride Action:Class 1B antiarrhythmic that decreases the depolarization, automaticity, and excitability in the ventricles during the diastolic phase by direct action on the tissues, especially the Purkinje network. Also a local anestheticLidocaine Indications:Anesthetic for wound closure, dental pain, or regional anesthesiaLidocaine Indicators for Toxicity:drowsiness, altered LOC, agitation, slurred speech, tinnitus, paresthesias, visual disturbances, hallucinations, muscle twitching, and seizuresMagnesium Sulfate Class:ElectrolyteMagnesium Sulfate Actions:Replaces magnesium and maintains magnesium level, Interferes with release of ACh at myoneural junctionMagnesium Sulfate Dose:Torsades de pointes: 2 grams Asthma or COPD: 2 grams Eclamptic Seizure: 4-5 grams in up to 500ml NS over 5 minutesMagnesium Sulfate Side Effects:Depressed reflexes hypotension, flushing, bradycardia resp paralysisMidazolam Class:BenzodiazepineMidazolam Actions:Potentiates effects of GABA to hyperpolarize cells by opening Cl- ion channels for influx. Reduces seizure activity and depresses CNS.Midazolam Side Effects:Sedation, Respiratory Depression/apnea, NauseaMidazolam Dose:Adult: Anxiety- 2.5mg Sedation for Sync Cardioversion- 5-10mg RSI- 5mg Seizure: 5mg IV/IO/IM/IN Pedi: Use LBRTNaloxone Hydrochloride (Narcan) Class:Opiate Receptor AntagonistNaloxone Hydrochloride (Narcan) Side Effects:Seizures, VFNaloxone Hydrochloride (Narcan) Dose:Cardiac Arrest: 2mg IV/IO OD: 0.5mg IV/IO : 1mg IM/INOndansetron Hydrochloride (Zofran) Class:AntiemeticOndansetron Hydrochloride (Zofran) Actions:Selective antagonist of 5-HT3 receptors located in the CNS at the chemoreceptor trigger zone in the peripheral nervous system on the nerve terminals of the Vagus nerveOndansetron Hydrochloride (Zofran) Dose:4mg PO/IV/IO/IMMetoprolol(Lopressor, Toprol XL) beta blockerCarvedilol(Coreg) beta blockerBisoprolol(bisoprolol) beta blockerpropranolol(Inderal) beta blockerAtenolol(Tenormin, Tenoretic) beta blockerDiltiazem(Cardizem) Ca+ Channel BlockerAmlodipine(Norvasc) Ca+ Channel BlockerNifedipine(Procardia) Ca+ Channel BlockerVerapamil(Calan, Isoptin) Ca+ Channel BlockerFelodipine(Plendil) Ca+ Channel BlockerAmitriptyline(Elavil, Amitril, Amitid) Tricyclic AntidepressantDesipramine(Norpramin, Pertofrane) Tricyclic AntidepressantTrazodone(Desyrel) Tricyclic AntidepressantNortriptyline(Pamelor, Aventyl) Tricyclic AntidepressantImipramine(Imipril, Tofranil, Janimine) Tricyclic AntidepressantDoxepin(Adapin, Sinequan) Tricyclic AntidepressantCodeine(Tylenol #3) OpioidHydromorphone(Dilaudid) OpioidMorphine(MS-Contin) OpioidTramadol(Ultram) OpioidHydrocodone(Vicodin, Lortab, Norco) OpioidMeperidine(Demerol) OpioidOxycodone(Oxycontin, Percocet, Percodan) OpioidFentanyl(Duragesic, Sublimaze) OpioidMethadone(Methadose) OpioidPropoxyphene-N(Darvocet) OpioidPrednisone Class:Corticosteroid (Systemic)Prednisone Actions:Inhibits multiple inflammatory cytokines; produces multiple glucocorticoid and mineralocorticoid effectsPrednisone Side Effects:Psychosis, Edema, UrticariaPrednisone Dose:12-16 years: 40mg PO >16 years: 60mg POWhat four drugs can be given IN?1. Naloxone (Narcan) 2. Ketamine 3. Midazolam (Versed) 4. FentanylSodium Bicarbonate Class:ElectrolyteSodium Bicarbonate Actions:Restores buffering capacity of the body and neutralizes excess acidSodium Bicarbonate Dose:1meq/kg (1mL/kg)Sodium Bicarbonate Precautions:Bicarb administration without hyperventilation increases intracellular acidosis. The excess CO2 produced crosses cell membranes into the cells quickly if it is not excreted through the lungs.Tetracaine 0.5% Ophthalmic Solution Class:Topical anesthetic for eyesTetracaine 0.5% Ophthalmic Solution Actions:Local anesthetic (ester); inhibits sodium ion channels - inhibits nerve impulse initiation and conductionTetracaine 0.5% Ophthalmic Solution Dose:1-2 drops in affected eye may be used in conjunction with fluorescein dyeTranexamic Acid (TXA) (Cyklokapron) Class:IV hemostatic medicationTranexamic Acid (TXA) (Cyklokapron) Actions:Inhibits plasminogen binding sites, decreasing plasma formation and fibrinolysis (prevents breakdown of clot formation)Tranexamic Acid (TXA) (Cyklokapron) Dose:1 gram in up to 500mL NS over 10 minutes IVVecuronium (Norcuron) Class:Non-depolarizing neuromuscular blocking agentVecuronium (Norcuron) Actions:Prevents ACh from binding to receptors on the neuromuscular junction, blocking depolarization and causing complete paralysis. (DOES NOT PRODUCE SEDATION)Vecuronium (Norcuron) Contraindications:PregnancyVecuronium (Norcuron) Dose:10mg OR use LBRT for pediVecuronium (Norcuron) Precautions:Undersedation (tachycardia, HTN, tears)