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Citizen Hospital
Protocols for Drug Administration
Terms
Indications: Any reason required to administer the drug
Contraindications: Any reason to prevent you from administering the drug.
Onset: Time it takes for the drug to start working
Peak Effectiveness: Time it takes for drug to work at full effect
Duration: How long the drug will last
Acetaminophen (aka Tylenol or Paracetamol)
Mild painkiller. Fever control.
Indications: Mild to moderate pain, fever
Contraindications: None
Side Effects: None
Dose and Administration: 650mg Orally every 4 hours.
Duration of Action:
-onset: 30 minutes
-peak effectiveness: variable
-duration: 4 hours
Acetylsalicyclic Acid (aka ASA or Aspirin)
Anti-inflammatory, Prevents clotting
Indications: chest pain suggestive of MI
Contraindications: Internal bleeding
Side Effects: heartburn, nausea & vomiting, wheezing in allergic patients, prolonged bleeding
Dose and Administration: 160mg chewed orally once
Duration of Action:
-onset: 30-45 minutes
-peak effectiveness: variable
-duration: 7-10 days
Amiodarone (aka Cordarone)
Reverses abnormal heart rhythms such as v-fib
Indications: patient with no vital signs and either v-fib or v-tach
Contraindications: Hypothermic cardiac arrest, renal failure, 2nd or 3rd degree heart block, hypotension, bradycardia
Side Effects: hypotension, bradycardia, nausea, fever
Dose and Administration: 300mg initial slow IV push, 150mg second slow IV dose after 10 minutes if indicated
Duration of Action:
-onset: 5-15 minutes
-peak effectiveness: variable
-duration: variable
Atropine
Increases slow heart rate
Indications: asystole, pulseless electrical activity, shocky bradycardia, nerve gas exposure
Contraindications: trauma or hypothermic cardiac arrest, tachycardia
Side Effects: headache, dizziness, nausea & vomiting, tachycardia, flushed hot dry skin
Dose and Administration: 1mg IV push every 3-5 minutes up to a max of 3mg
Duration of Action:
-onset: immediate
-peak effectiveness: 1-2 minutes
-duration: 2-6 hours
D50W (Dextrose)
Brings up blood sugars
Indications: Blood sugar below 4 mmol/L
Contraindications: Hyperglycemia
Side Effects: warmth, pain, burning, tissue death if leaked out of the vein
Dose and Administration: 25g slow IV push, may be repeated once after 5 minutes if BGL >4mmol/L
Duration of Action:
-onset: <1 minute
-peak effectiveness: variable
-duration: variable
Dimenhydrinate (aka Gravol)
Decreases nausea and vomiting
Indications: symptomatic relief of nausea and vomiting
Contraindications: Hypertension
Side Effects: sedation, hypotension, seizures, hallucinations, vomiting, dry mouth and throat
Dose and Administration: 25-50mg IM, IV, or Orally
Duration of Action:
-onset: 15-30 minutes
-peak effectiveness: 1 hour
-duration: 3-12 hours
Diphenhydramine (aka Benadryl)
Blocks allergic reactions
Indications: relief of allergies, anaphylaxis, motion sickness
Contraindications: hypertension
Side Effects: sedation, hypotension, seizures, hallucinations, vomiting, dry mouth and throat
Dose and Administration: 25-50mg IM, IV, or Orally
Duration of Action:
-onset: 15-30 minutes
-peak effectiveness: 1 hour
-duration: 3-12 hours
Epinephrine (aka Adrenaline or EpiPen)
Opens up airways, increases heart rate and blood pressure
Indications: absent vitals with v-fib or v-tach, asystole without death determination, PEA, severe bronchospasm, anaphylaxis
Contraindications: hypothermic cardiac arrest, hypertension, pulmonary edema, hypovolemic shock,
Side Effects: hypertension, pulmonary edema, anxiety, nausea, chest pain, headache
Dose and Administration: Cardiac Arrest: 1mg IV push every 3-5 minutes. Anaphylaxis: 0.3mg IM
Duration of Action:
-onset: immediate
-peak effectiveness: within minutes
-duration: several minutes
Furosemide (aka Lasix)
Reverses fluid buildup in the lungs caused by heart failure
Indications: shortness of breath with crackles in both lungs, pulmonary edema
Contraindications: hypotension, hypovolemia
Side Effects: dry mouth, may make hypovolemia or hyperglycemia worse
Dose and Administration: 40mg IV Bolus
Duration of Action:
-onset: 5 minutes
-peak effectiveness: 30 minutes
-duration: 4-6 hours
Glucagon
Helps raise blood sugars
Indications: hypoglycemia
Contraindications: hyperglycemia, known adrenal tumor
Side Effects: tachycardia, hypertension
Dose and Administration: 1mg IM
Duration of Action:
-onset: 1 minute
-peak effectiveness: 30 minutes
-duration: 60-90 minutes
Oral Glucose
Tube of pure glucose to raise blood sugars
Indications: hypoglycemia
Contraindications: decreased LOC, no gag reflex, nausea, vomiting, hyperglycemia
Side Effects: nausea and vomiting
Dose and Administration: 50 grams bucally
Duration of Action:
-onset: immediate
-peak effectiveness: variable
-duration: variable
Heparin
Clot busting drug.
Indications: blood clot occluding a blood vessel
Contraindications: Hemorrhaging
Side Effects: bleeding, inability to clot
Dose and Administration: 60-80 units/kg IV loading dose, 14-18 units/kg IV infused per hour
Duration of Action:
-onset: immediate
-peak effectiveness: variable
-duration: 4 hours after last dose
Lorazepam (aka Ativan)
Sedative
Indications: seizure lasting longer then 5 minutes, severe anxiety, other sedation needs
Contraindications: hypersensitivity, coma, shock, suspected drug abuse
Side Effects: respiratory depression, drowsiness, sedation, confusion, restlessness, hypotension, bradycardia
Dose and Administration: 2mg IM. Repeat after 15 minutes if symptoms persist
Duration of Action:
-onset: 1-5 minutes
-peak effectiveness: variable
-duration: 6-8 hours
Morphene
Analgesic
Indications: pain control
Contraindications: undiagnosed head injury, shock, respiratory depression, hypotension, hypovolemia, decreased LOC
Side Effects: respiratory depression, hypotension, decreased LOC, nausea, vomiting, bradycardia, tachycardia, euphoria, bronchospasm, dry mouth
Dose and Administration: 2mg slow IV every 5 minutes as needed up to 10mg
Duration of Action:
-onset: immediate
-peak effectiveness: 20 minutes
-duration: 2-7 hours
Naloxone (aka Narcan)
Reverses effects of opiates such as morphine, codeine, and heroin
Indications: opiate overdose, unconsciousness of unknown origin
Contraindications: None
Side Effects: withdrawal symptoms ina ddicts, tachycardia, hypertension, nausea, vomiting, diaphoresis
Dose and Administration: 0.4mg IV, IM, or SC every 3-5 minutes as necessary up to 2mg
Duration of Action:
-onset: 2 minutes or less
-peak effectiveness: variable
-duration: 30-81 minutes
Nitroglycerine (aka Nitro)
Dilates blood vessels
Indications: chest pain indicative of ischemia, hypertension, congestive heart failure
Contraindications: hypotension, use of viagra within 24 hours or cialis within 72 hours, intracranial bleed, head injury
Side Effects: headache, hypotension, fainting, tachycardia, nausea, vomiting, diaphoresis
Dose and Administration: 0.3mg Sublingually every 5 minutes as necessary up to 0.9mg
Duration of Action:
-onset: 1-3 minutes
-peak effectiveness: 5-10 minutes
-duration: 20-30 minutes
Salbutamol (aka Ventolin)
Relaxes airways
Indications: bronchospasm (wheezing, respiratory distress, and feeling of "can't breathe")
Contraindications: None
Side Effects: Dizziness, tachycardia, nervousness, nausea, vomiting, increased blood pressure, synergistic with epinephrine
Dose and Administration: 2.5mg via Nebulizer every 15 minutes as necessary
Duration of Action:
-onset: 5-15 minutes
-peak effectiveness: 60-90 minutes
-duration: 3-6 hours