Maryland Medical Protocols 2005 (Pharmacology)
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- What is a contraindication for Activated Charcoal?
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1. Altered mental status.
2. Has taken an emetic. - What is the ADULT dosage for Activated Charcoal?
- 1 gm/kg
- What is the PEDIATRIC dosage for Activated Charcoal?
- 1 gm/kg
- What is Adenosine used to treat?
- Narrow complex Tachachardia, PSVT with WPW, PSVT, SVT.
- What does Adenosine do?
- Slows conduction through the AV Node.
- What is the contraindication for Adenosine?
- Known Hypersensitivity.
- What is the adult dosage for Adenosine?
- 6 mg, 12 mg, 12 mg
- What is the pediatric dosage of Adenosine?
- .1 mg/kg to .2 mg/kg max initial dose 6mg max secondary and tirtiary dosages 12 mg.
- Is Medical Consult needed for Adenosine for a CRT-I?
- Yes
- What is the dosages for albuterol (adult and pediatric)?
- Adult 2.5 mg nebulized 2 y/o and up 1.25 mg nebulized 2 and below. May repeat once.
- Is Medical consult needed for albuterol Sulfate?
- Medical consult is needed for pregnant Cardiac history patients.
- What is the indication for asprin?
- Chest pain when acute Myocardial infarction is suspected.
- What is the contraindication for asprin?
- Known hypersensitivity.
- When should you be careful giving asprin
- GI Bleeding and upsent.
- What is the adult dosage for Asprin?
- 325 mg
- What is the Pediatric dosage for Asprin?
- Not indicated.
- What are the indications for using Atropine Sulfate?
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Symptomatic Bradycardia
Organophosphate poisoning
Asystole
Nerve Agents. - What are the contraindications for using Atropine?
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Known Hypersensitivity,
2nd degree type two, third degree AV Block, suspected AMI,Ischemia, Glaucoma - What are the adult dosages for Atropine (Asystole and Bradycardia)?
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Asystole - 1mg/kg 3-5 mins
Bradycardia - .5 - 1mg/kg 3-5 mins
MAX dose .04 mg/kg - What is the pediatric dosage for Atropine?
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.02 mg/kg min dose .1 mg
Max SINGLE Dosage
(10-25kg) .5mg
(25-40kg) 1mg
May repeat one time - What is the atropine dosage for Organophosphate poisoining? (adult & Ped)
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Adult
2-4 mg every 5-10 min
.02 mg/kg every 5-10 min - Is Medical consult needed for Atropine?
- Consult is needed in the case of Organophosphate poisoning.
- What is another name for Atrovent?
- Ipratroprium.
- What are the indications for Atrovent?
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Anaphalaxis/ allergic reaction
Bhroncial Asthma
Bhroncospasms due to chronic bhronchitis or emphysema. - What are the contraindications for atrovent?
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Known Hypersensitivity
Known Hypersensitivity to Atropine
Under 1 y/o - What are the precautions for Atrovent?
- Use caution with CHF, Heart disease, hypertension, glaucoma. May worsen glaucoma if gotten in the eyes. Must be used with a beta agonist (albuterol)
- What is the adult and pediatric dosages for Atrovent?
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Adult > 2/yo 2.5 ml
Pediatric < 2y/o 1.25 ml - What are the indications for Calcium Chloride?
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Hyperkalemia
Hypocalcemia
Calcium Channel Blocker OD
Hypotension due to Diltiazem admin - What are the cotraindications for Calcium Chloride?
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Not indicated in cardiac arrest unless patient has Hypocalcemia, Hyperkalemia, Calcium Channel Blocker toxicity
Patient taking Digoxin with Calcium Channel Toxicity - What is the adult dosage for Calcium Chloride?
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.5 mg - 1mg every 10 minuites
250ug for hypotension due to Diltiazem. - What is the pediatric dosage for Calcium Chloride?
- 20 mg/kg max dose 1 gm or 10ml.
- What is the dosage for Dextrose 50%?
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Adult 25 mg
Pediatric
Less then 2mos 5-10ml/kg D10W
2 mos - 2 yrs 2-4ml/kg D25W
1-2 ml/kg D50W Max 25ml - What are the contraindications for Diazepan?
- Head injury, Altered mental status, hypotension, Narrow angle glaucoma.
- Is Medical Consult needed fore Dextrose 50%?
- No
- Is Medical consult needed for Diazepam?
- Yes
- What are the dosages for Diazepam? (Adult and Ped)
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Adult 2.5-10 mg in 2.5 mg increments
Ped - .1mg/kg IV/IO/IM
Max dose 5 mg
Rectal - .2mg/kg Max 10 mg - When may Diazepam be used without medical consult?
- Severe Nerve Agent exposure.
- What class is Diltiazem?
- Calcium Channel Blocker
- What is Diltiazem used for?
- Symptomatic A-fib & A-flutter
- What is the contraindications for Diltiazem?
- BP below 90 mm Hg, Second or third Degree heart block, hypersensitivity, patients less then 12 y/o
- What are the precautions for diltiazem?
- Use with caution in patients with renal failure or congestive heart failure.
- What is the dosage for diltiazem? (adult & pedi)
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.25 mg/kg Max does 20mg slow IVP over 2 min repeat in 15 minutes .35 mg/kg max dose 25 mg slow ivp over 2 min
Patients over 50 5-10mg slow ivp over 2 min
Under 12 - contraindicated - What do you do if diltiazem admin causes Hypotension?
- Calcium Chloride 250 mg slow IVP with medical consult, IV LR, Elevate legs.
- What is the course of action if diltiazem admin causes bradycardia?
- Consider atropine .5 to 1 mg; if neccesary consider pacing.
- What are the indications for Diphenhydramine?
- Allergic reaction, Anaphalaxis, Dystonic reactions.
- What are the contraindications for Diphenhydramine?
- Known hypersensitivity.
- Is Medical consultation required for Diphenhydramine?
- For Asthmatics and Nursing mothers. Caution with severe vomiting and intoxication.
- What is the adult dosage for Diphenhydramine?
- 25 - 50 mg slow IVP or IM
- What is the pediatric dosage for Diphenhydramine?
- 1 mg/kg slow IV/IO or IM Max single dose 25 mg.
- What are the indications for Dopamine (Intropin)?
- Shock
- What are the contraindications for Dopamine?
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Pheochromocytoma (adrenal tumor)
Pre-existing Tachydysrhythmias
Uncorrected Hypovolemia. - What is the dosage for dopamine?
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2-20ug/kg/min IV titrate to BP of 100Systolic or med consult selected BP, initial infusion rate of 2-5 ug/kg/min
Peds same but inital rate of 2 ug/kg/min. - What are the indications for Epinepherine?
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Cardiac arrest
Moderate to Severe allergic reaction
Asthma
Respiratory Stridor (Croup) - What are the contraindications for epinepherine?
- Hypertension, pre-existing tachydysrhythmias with a pulse, Use with pregnant women should be avoided when ever possible.
- What are the precautions for epinepherine?
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Sodium Bicarb deactivates epi
Epi causes dramatic increas in myocardial oxygen consumption
Its use in teh setting of an acut MI should be restriceted to cardiac arrest, IVP Epi (1:1,000) should not be administred to any patient with a pulse. - What is the Adult cardiac arrest dosage for epinepherine?
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1 mg (1:10,000) IVP every 3-5 mins
If this fails consider 2-5 mg IVP every 3-5 with medical consult. ET does 2 -2.5 times teh IV dose if using 1:1000 dilute in 10ml of lactated ringers. - What is the pediatric cardiac arrest dosage for epinepherine?
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.01 mg/kg (1:10,000) IVP/IO
ET .1mg/kg 1:1000 diluted with 3-5ml lr every 3-5 min - What is the neonate cardiac arrest dosage for epinephrine?
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.01 mg/kg 1:10,000 IVP/IO
ET .01 mg/kg 1:1000 with 1 ml LR. - What is the adult Bradycardia dosage of epinephrine?
- Bzzzzzzzt! Not given.
- What is the pediatric bradycardia dosage of epinephrine?
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.01 mg/kg 1:10,000 every 3-5 min
ET .1 mg/kg 1:1000 diluted in 3-5 ml LR every 3-5 min - What is the neonate bradycardia dosage of epinphrine?
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.01 mg/kg 1:10,000 every 3-5 mins
ET .01 mg/kg 1:1000 with 1ml of LR - What is the adult dosage or Epi in anaphylactic shock/asthma?
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.1 mg/kg 1:10,000 for anaphylactic shock Only
Adult .3 mg SC
Pedi .01 mg/kg SC max .3 mg - How is Epinephrine administered with croup?
- 2.5 ml 1:1000 via nebulizer if no improvement admin an additional dose.
- In what situations would you need to consult with medical control for Epinephrine?
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If initial 1mg epi in cardiac arrest fails can consult for 2-5 mg IVP every 3-5 min
Anaphylactic shock
Croup - What are the indications for Furosemide (Lasix)?
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Acute pulmonary edema
CHF
Edema related to kidney or liver disease - What are the contraindications for Furosemide?
- Known hypersensitivity, allergic to sulfanamides, dehydrated patients, pregnancy, hypokalemia
- What is the adult and pediatric dosage for Furosemide?
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Adult - .5 - 1 mg/kg slow IVP
Ped- 1 mg/kg slow IVP Max 50 mg - Is medical consult required for Furosemide?
- Yes
- What are the indications for Glucagon?
- Unconsious / combative hypoglycemic's w/ no IV access
- What are the contraindications for Glucagon?
- Known hypersensitivity.
- What is the dosages for Glucagon?
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Adult - 1 mg IVP every 5 mins
Ped - 1 mg IVP (25-40kg) max 3 mg
.5mg IVP (less then 25kg) max total dose 3mg - What are the indications for Lidocaine?
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Prevent V-fib/V-tach recurrence
V-tach
V-Fib
Closely coupled Ventricular ectopy
Decrease ICP during RSI
Nasal Tracheal Intubation - What are the contraindications for Lidocaine?
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AV blocks
Known sensitivity
Idioventricular escape rhythms
Accelerated idioventricular rhythms
Sinus bradycardia, arrest or block
Hypotension
Shock
Ventricular conduction defects - What is the adult dosage for Lidocaine?
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With a pulse
1 - 1.5 mg/kg IVP followed by an additional .5-.75 mg/kg max dose 3 mg/kg
No pulse
1.5 mg/kg initial 1.5 mg/kg secondary max dose 3 mg/kg
ET dose 2 -2.5 time IV dose - What is the Pedi dosage for Lidocaine?
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With Pulse- 1 mg/kg initial .5 mg/kg every 8-10 mins max 3 mg/kg
ET 2 -2.5 IV dose
No pulse 1mg/kg initial then 1 mg/kg every 3-5 min max 3 mg/kg - Do you have to consult for Lidocaine?
- No
- What is the indications for using Morphine?
- AMI, APE, Burns, Isolated injuries requiring pain relief.
- What are the cotraindications for morphine?
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Head injury
Undiagnosed Abdominal pain
Multiple Trauma
COPD with compromised respiratory effort
Hypotension
Sensitivity to Morphine, Codeine, percodan - What is the dosage for morphine in AMI patients?
- 2-5 mg IVP followed by 1 mg every 5 minutes to a max of 10 mg or until pain is relieved.
- What is the dosage of morphine for Pulmonary edema patients?
- 2 - 10 mg slw IVP at 1-2 mg/min to 10 mg or until pain is relieved
- What is the dosage of morphine used prior to pacing?
- 1-2 mg/min IVP
- What is the pediatric dosage for morphine?
- .1mg/kg slow IVP (1-2mg) min max dose 5mg