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NEW MFD Meds

New MFD MedicationsNew MFD Medications

• ETOMIDATE (AMIDATE)

• FENTANYL (SUBLIMAZE)

• HALOPERIDOL LACTATE (HALDOL)

• HYDROXOCOBALAMIN (CYANOKIT)

• METHYLPREDNISOLONE (SOLU-MEDROL)

• ONDANSETRON (ZEMURON, ZOLFRAN)

• ROCURONIUM (ZEMURON)

• THIAMINE (BETAXIN, B1)

• VECURONIUM (NORCURON)

ETOMIDATE (AMIDATE)ETOMIDATE (AMIDATE)

• CLASS• Nonbarbiturate hypnotic, anesthetic

• DESCRIPTION• Etomidate is a short-acting drug that acts at the level of the

reticular activating system to produce anesthesia. Etomidate may be administered for conscious sedation to relieve apprehension or impair memory before cardioversion. To facilitate Rapid Sequence intubation.

• ONSET AND DURATION• Onset: Within 30 sec• Duration: 3-5 min

• INDICATIONS• Premedication Rapid Sequence intubation• Premedication for cardioversion

• CONTRAINDICATIONS• Hypersensitivity to Etomidate


• ADVERSE REACTIONS• Nausea and vomiting• Dysrhythmias• Breathing difficulties• Hypotension• Involuntary muscle movement (jerking)• Pain at the injection site

• DRUG INTERACTIONS• Effects may be enhanced when given with other central

nervous system depressants.

• HOW SUPPLIED• 2 mg/mL (40 mg) Preloaded Syringe


• DOSAGE AND ADMINISTRATION• RSI

• Adult: 0.3 mg/kg IV over 30-60 sec (max 20mg) - Second dose same as first

• Pediatric: 0.3 mg/kg - Second dose same as first

• Sedation• Adult: 0.1 mg/kg IV over 30-60 sec (max 20mg)• Pediatric: 0.1 mg/kg

• SPECIAL CONSIDERATIONS• Pregnancy safety: Category C• Etomidate can suppress adrenal gland production of

steroid hormones, which can cause temporary gland failure.

FENTANYL (SUBLIMAZE)FENTANYL (SUBLIMAZE)

• CLASS• Opioid analgesic

• DESCRIPTION• Fentanyl (like other opoids) combines with receptor sites in the brain to

produce potent analgesic effects. The drug often is given in combination with benzodiazepines for conscious sedation.

• ONSET AND DURATION• Onset: <1 minute• Duration: ½ - 1 hour

• INDICATIONS• Pain control• Sedation for invasive airway procedures (e.g., rapid-sequence induction)

• CONTRAINDICATIONS• Respiratory depression• Hypotension• Cardiac dysrhythmias• Myasthenia gravis• Hypersensitivity to opiates

FENTANYL (SUBLIMAZE)FENTANYL (SUBLIMAZE)

• ADVERSE REACTIONS• Respiratory depression• Bradycardia• Hypotension or hypertension• Nausea or vomiting

• DRUG INTERACTIONS• Effects may be increased when given with other central nervous system depressants or

skeletal muscle relaxants.• HOW SUPPLIED

• 0.05-mg/mL vial• DOSAGE AND ADMINISTRATION

• Adult: 50 -100 mcg IV Repeat as needed, up to max of 200 mcg• May give 100 mcg if no IV (max of one dose)

• Child: 2 – 4 mcg/kg • SPECIAL CONSIDERATIONS

• Pregnancy safety: Category C• Fentanyl is a schedule II drug with the potential for abuse. • Fentanyl should be used (if at all) with caution in elderly patients and in those with severe

respiratory disorders, seizure disorders, cardiac disorders, or pregnancy. • Naloxone should be available to reverse respiratory depressions.

HALOPERIDOL LACTATE (HALDOL)HALOPERIDOL LACTATE (HALDOL)

• CLASS• Antipsychotic/neuroleptic

• DESCRIPTION• Haloperidol has pharmacological properties similar to those of the

phenothiazines. The drug is thought to block dopamine (type 2) receptors in the brain, altering mood and behavior. In emergency care, haloperidol usually is administered IM but also may be given IV.

• ONSET AND DURATION• Onset: (IM) minutes• Duration: 12-24 hr

• INDICATIONS• Emergency sedation of severely agitated or delirious patients• Acute psychotic episodes

• CONTRAINDICATIONS• Central nervous system depression• Coma• Hypersensitivity• Pregnancy• Severe liver or cardiac disease

HALOPERIDOL LACTATE (HALDOL)HALOPERIDOL LACTATE (HALDOL)

• ADVERSE REACTIONS• Dose-related extrapyramidal reactions:

• Pseudoparkinsonism• Akathisia• Dystonias

• Hypotension• Orthostatic hypotension• Nausea, vomiting• Allergic reactions• Blurred vision • Prolonged QT - rarely• Torsades de points - rarely

• DRUG INTERACTIONS• Other central nervous system depressants may potentiate effects.• Haloperidol may inhibit vasoconstrictor effects of epinephrine.

• HOW SUPPLIED• 5 mg/mL vial

• DOSAGE AND ADMINISTRATION• Adult: 10 mg IM (mixed with 2 mg Lorazepam) • Pediatric: Safety not established

• SPECIAL CONSIDERATIONS• Pregnancy safety: Category C

HYDROXOCOBALAMIN (CYANOKIT)HYDROXOCOBALAMIN (CYANOKIT)

• CLASS• Pancreatic hormone, insulin antagonist

• DESCRIPTION• The active ingredient in Cyanokit, hydroxocobalamin,

is a precursor of vitamin B12. Hydroxocobalamin

works by binding directly to the cyanide ions, creating cyanocobalamin, a natural form of vitamin B12, which is excreted in the urine.

• INDICATIONS• Treatment of known or suspected cyanide poisoning

• CONTRAINDICATIONS• No known contraindications.• Use cautiously in patients with history of anaphylactic reactions to

hydroxocobalamin or cyanocobalamin, hypertension, or disorders that could be exacerbated by elevated blood pressure. Safety and efficacy haven't been established in children.


• ADVERSE REACTIONS• CNS: headache, dizziness, memory impairment, eye disorders,

restlessness.CV: hypertension.GI: nausea, dysphagia, abdominal discomfort, vomiting, diarrhea, dyspepsia. GU: red urine.Respiratory: throat tightness, dry throat, dyspnea.Skin: rash, erythema, urticaria, pruritus.Other: hot flush, injection site reaction, photosensitivity.

• DRUG INTERACTIONS• Physical incompatibility(particle formation) was observed with

the mixture of hydroxocobalamin in solution and the following drugs: diazepam, dobutamine, dopamine, fentanyl, nitroglycerin, pentobarbital, propofol, and thiopental. Consequently, these drugs should not be administered simultaneously through the same IV line as hydroxocobalamin.


• HOW SUPPLIED• Emergency kit: 2 glass vials each containing 2.5 g

hydroxocobalamin, 2 sterile transfer spikes, IV infusion set• PREPARATION OF SOLUTION FOR INFUSION

• Each 2.5 g vial of hydroxocobalamin for injection is to be reconstituted with 100 mL of diluent (not provided with Cyanokit) using the supplied sterile transfer spike. The recommended diluent is 0.9% Sodium Chloride injection (0.9% NaCl). 5% Dextrose injection (D5W) have also been found to be compatible with hydroxocobalamin and may be used if 0.9% NaCl is not readily available. The line on each vial label represents 100 mL volume of diluent. Following the addition of diluent to the lyophilized powder, each vial should be repeatedly inverted or rocked, not shaken, for at least 30 seconds prior to infusion.

• Hydroxocobalamin solutions should be visually inspected for particulate matter and color prior to administration. If the reconstituted solution is not dark red or if particulate matter is seen after the solution has been appropriately mixed, the solution should be discarded.


• DOSAGE AND ADMINISTRATION• Adults: Initially, 5 g (2 vials) hydroxocobalamin

given by IV infusion over 15 minutes; a second dose of 5 g may be given by IV infusion over 15 to 120 minutes, if needed.

• SPECIAL CONSIDERATIONS• Pregnancy safety: Category C• Pediatric: Safety and efficacy have not been

established• Skin and urine redness. Skin redness may last

up to 2 weeks.• Urine redness may last up to 5 weeks.

METHYLPREDNISOLONE (SOLU-MEDROL)METHYLPREDNISOLONE (SOLU-MEDROL)

• CLASS• Glucocorticoid

• DESCRIPTION• Methylprednisolone is a synthetic steroid that suppresses acute and

chronic inflammation. In addition, it potentiates vascular smooth muscle relaxation by beta-adrenergic agonists and will alter airway hyperactivity. It currently is used for reduction of posttraumatic spinal cord edema, but this indication is controversial.

• ONSET AND DURATION• Onset: 1-2 hr• Duration: 8-24 hr

• INDICATIONS• Anaphylaxis• Severe Asthma• Decrease inflammation & potentate other bronchodilators

• CONTRAINDICATIONS• Use with caution in patients with gastrointestinal bleeding, diabetes

mellitus, or severe infection.

METHYLPREDNISOLONE (SOLU-MEDROL)METHYLPREDNISOLONE (SOLU-MEDROL)

• ADVERSE REACTIONS• Headache• Hypertension• Sodium and water retention• Hypokalemia• Alkalosis

• DRUG INTERACTIONS• Hypoglycemic responses to insulin and oral hypoglycemic agents may be

blunted.• Potassium-depleting agents may potentiate hypokalemia induced by

corticosteroids.• HOW SUPPLIED

• 62.5 mg/mL (Dilutant/powder) vial• DOSAGE AND ADMINISTRATION

• Adult (Asthma/COPD/Allergic Reaction): 125 mg IV• Pediatric (Asthma/Allergic Reaction): 1 mg/kg/IV (125 mg max)


ONDANSETRON (ZEMURON, ZOFRAN)ONDANSETRON (ZEMURON, ZOFRAN)

• CLASS• Anti-emetic

• DESCRIPTION• Ondansetron is a competitive, highly selective antagonist of 5-

hydroxytryptamine (serotonin) subtype 3 (5-HT 3) receptors. 5-HT 3 receptors are present peripherally on vagal nerve terminals and centrally in the area postrema of the brain. It is not certain whether Ondansetron’s action is mediated peripherally, centrally, or both. Cytotoxic drugs and radiation appear to damage gastrointestinal mucosa, causing the release of serotonin. Stimulation of 5-HT 3 receptors causes transmission of sensory signals to the vomiting center via vagal afferent fibers to induce vomiting. By binding to 5-HT 3 receptors, Ondansetron blocks vomiting mediated by serotonin release.

• ONSET AND DURATION• Onset: <5 minutes• Duration: 1 – 4 hours

• INDICATIONS• Nausea and vomiting

• CONTRAINDICATIONS• Hypersensitivity

ONDANSETRON (ZEMURON, ZOFRAN)ONDANSETRON (ZEMURON, ZOFRAN)

• ADVERSE REACTIONS• May cause:

• Headache• Abdominal pain• Chest pain• Hypotension

• HOW SUPPLIED• 2mg/ml (2 ml) Vial

• DOSAGE AND ADMINISTRATION• Adult: 4 mg IV

• SPECIAL CONSIDERATIONS• Hepatic Impairment: Maximum dose of 8 mg IV• Use with caution in pregnant or lactating females. It is not

known whether• Zofran is distributed into human breast milk.

ROCURONIUM (ZEMURON)ROCURONIUM (ZEMURON)

• CLASS• Non- Depolarizing Neuromuscular Blocker

• DESCRIPTION• Inhibits transmission of nerve impulses by binding with

cholinergic receptor sites, antagonizing action of acetylcholine.

• ONSET AND DURATION• Onset: 1 minute• Duration: 30 - 60 minutes

• INDICATIONS• Facilitation of endotracheal intubation. To induce

skeletal muscle relaxation during mechanical ventilation.• CONTRAINDICATIONS

• Hypersensitivity

ROCURONIUM (ZEMURON)ROCURONIUM (ZEMURON)

• ADVERSE REACTIONS• Bradycardia, tachycardia, changes in BP, edema

• HOW SUPPLIED• 10 mg/ml (5 ml) vial

• DOSAGE AND ADMINISTRATION

• RSI• Adult: 1 mg/kg IV• Pediatric: 1 mg/kg IV

• Induced Hypothermia – Prevents Shivering• Adult: 0.6 mg/kg IV


THIAMINE (BETAXIN, B1)THIAMINE (BETAXIN, B1)

• CLASS• Vitamin (B1)

• DESCRIPTION• Thiamine combines with adenosine triphosphate to form thiamine

pyrophosphate, a coenzyme necessary for carbohydrate metabolism. Most vitamins required by the body are obtained through diet; however; certain states such as alcoholism and malnourishment may affect the intake, absorption, and utilization thiamine. The brain is extremely sensitive to thiamine deficiency.

• ONSET AND DURATION• Onset: Rapid• Duration: Depends on the degree of deficiency

• INDICATIONS• Hypoglycemia: Administer prior to glucose in setting malnutrition &

chronic alcoholism• Delirium tremens• Wernicke’s encephalopathy

• CONTRAINDICATIONS• None significant

THIAMINE (BETAXIN, B1)THIAMINE (BETAXIN, B1)

• ADVERSE REACTIONS• Hypotension (from rapid injection or large dose)• Anxiety• Diaphoresis• Nausea and vomiting• Allergic reaction (usually from IV injection: rare); angioedema

• DRUG INTERACTIONS• None significant

• HOW SUPPLIED• 2-mL vials (100 mg/mL)

• DOSAGE AND ADMINISTRATION• Adult: 100 mg slow IV or IM• Pediatric: Not recommended in the prehospital setting

• SPECIAL CONSIDERATIONS• Pregnancy safety: Category A (Category C if dose exceeds

recommended daily allowance)• Large IV doses may cause respiratory difficulties.• Anaphylactic reactions have been reported.

VECURONIUM (NORCURON)VECURONIUM (NORCURON)

• CLASS• Non- Depolarizing Neuromuscular Blocker

• DESCRIPTION• Long acting, non-depolarizing skeletal muscle relaxant.

Following IV injection, complete paralysis is obtained within 1-2minutes and persists for approximately 25 – 40 minutes. Vecuronium does not affect level of consciousness.

• ONSET AND DURATION• Onset: 2-3 minutes• Duration: 25 – 40 minutes

• INDICATIONS• To induce skeletal muscle relaxation during mechanical

ventilation.• CONTRAINDICATIONS

• Patients with history of hypersensitivity to the drug• Neonates

VECURONIUM (NORCURON)VECURONIUM (NORCURON)

• ADVERSE REACTIONS• May Cause:

• Malignant Hypothermia• Unresponsive Tachycardia• Skeletal Muscle Weakness

• HOW SUPPLIED• 10mg/5ml vial

• DOSAGE AND ADMINISTRATION• Adult: 0.1 mg / kg• Pediatric: 0.1 mg / kg

• SPECIAL CONSIDERATIONS• Pregnancy safety: Category C• Persons inexperienced in its use should not administer

Vecuronium.• Monitor V/S/ & EKG as Vagal stimulation may cause bradycardia,

hypotension and cardiac arrhythmias.• Requires refrigeration

Acetaminophen (Tylenol)Acetaminophen (Tylenol)

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