By Henry Feldman, ?2001(Edited by Lewis Nelson, MD)Routes of administrationIVIntravenous administration is when the drug is given in liquid form directly into a vein. This is oftendone by placing a venous catheter to allow easy administration.
IMDirect injection into the muscle. Often a painful mode of administration, and provides a slow routeof absorption. POBy mouth (Per Orum). Typically intermediate between IM and IV in speed of absorption. (is thistrue?)PRRectal administration (Per Rectum). The rectum is actually a very quick method of drugadministration as the rectum is highly vascular.
This route is often used in children. ETCertain drugs can be given down an endotracheal tube. The drugs are given at 2-2. 5 times normalIV dose.
Drugs are followed with a saline bolus of ~10ml. The acronym for drugs that can go downan ET tube is ALONE:? A ? Atropine? L ? Lidocaine? O ? Oxygen? N ? Naloxone (Narcan)? E ? EpinephrineDrug ListLidocaineLidocaine has 2 uses: It is a local anesthetic when injected subcutaneously (and it can be usedfor a nerve block). It is also an antidysrhythmic drug when injected IV (used to treat cardiacdysrhythmias). Anesthetic preparations come in 2 forms: with and without epinephrine. Theepinephrine is added to reduce absorption and prolong the effect. A classic question by theresident/attending is: What is the toxic dose when used as a local anesthetic (Answer: 5mg/kg forlidocaine without epi, and 7mg/kg with epi.
)EpinephrineEpinephrine is a natural substance produced by the adrenal gland (a. k. a. adrenaline).
Epinephrine is used in emergencies to stimulate the heart or to dilate the bronchial tree. Its use islimited by cardiac side effects. It is also mixed with lidocaine to prolong lidocaine?s effect and tocontrol bleeding. Furosemide (Lasix)Lasix is a diuretic, which is given IV or PO, which causes the patient to produce more urine. Thisis often given to reduce the fluid overload in patients with congestive heart failure (a.
k. a. CHF) orhypertension. Diazepam (Valium)Diazepam is a benzodiazepine that is used both as a powerful sedative and as an anticonvulsantfor patients with seizures.
You will see it used for alcohol withdrawal, cocaine toxicity,and status epilepticus (i. e. uncontrolled seizures). Diazepam may produce respiratory depression. Midazolam (Versed)Versed is a very powerful short acting benzodiazepine type of sedative and is used to sedatepatients for painful procedures. Excessive dosing may produce respiration depression (whengiven i.
v. ) or coma. Haloperidol (Haldol)Haldol is a antipsychotic with powerful sedative properties. It is often used for patients who areacting in a psychotic manner.
It should not be used to treat alcohol withdrawal or cocaince toxicity. In sufficient quantities it will render the patient unconscious. SuccinylcholineOften called ?sux? (pronounced sucks), it is a paralytic, resulting in total muscular paralysis. It willmost often be used for ?rapid-sequence-intubation? to make tracheal intubation easier and toallow the patient to be mechanically ventilated. It has no analgesic properities and paralyzedpatients see, hear and feel everything – like a zombie! – thus it is never used without sedation.
AtropineAtropine is used for several purposes, including inducing the heart to beat faster (i. e. chronotropy) as well as an antidote for certain organophosphate poisonings. It is sometimesused as a drug for patients with severe asthma.
It can also be dripped into the eyes to producedilation of the pupil (although this is a different formulation). Can also be used to dry up respiratorysecretions during procedures. HeparinHeparin is an anticoagulant used to prevent blood from clotting. It is used in patients suspectedof having a myocardial infarction and to prep the syringe for an arterial-blood-gas for the samereason. Valproic AcidValproic Acid is used as an anticonvulsant medication.
It is not typically used in the emergencytreatment of seizures, but toxicity can often be seen with seizure patients who have taken toomuch. PhenobarbitalPhenobarbital is a barbiturate which is used either as a sedative and/or anticonvulsantmedication. PentobarbitalSimilar to phenobarbital but much faster acting and with a duration of effect. It is used as ananticonvulsant medication and to treat severe alcohol withdrawal.
Often used in a continuousdrip for patients who continue to seize. Methylprednisolone (Solumedrol)Solu-medrol is a long acting corticosteroid. It is often used to prevent the recurrence ofanaphylaxis after the epinephrine has worn off and for patients with asthma. It has a half-life ofaround 6 hours. Albuterol (Proventil)Albuterol is a bronchodilator, used in a nebulizer for asthma patients. Typically a drop (0.
5 mg)of albuterol is suspended in saline and nebulized with oxygen. Often referred to as ?how manynebs the patient got?. Ampicillin/Sulbactam (Unasyn)This is an antibiotic (ampicillin) with the second compound added to prevent bacterial ?lactamasesfrom working (which interfere with penicillins). This overcomes the antibiotic resistanceacquired by many bacteria. FlourosceinThis is a fluorescent dye used to stain the cornea to look for scratches or ulcers. Scratches andulcers will selectively retain the dye, making them glow under the cobalt-blue light of anopthalmoscope.
Ketorolac (Toradol)Ketorolac is a powerful NSAID, used for severe headaches, musculo-skeletal pain, kidneystones and inflammation. Morphine SulfateMorphine is a powerful opiate (derived from opium and similar to heroin) that is used as a pain killer(i. e. analgesic). However, as a side effect it can suppress respirations. Naloxone (Narcan)Narcan is the antidote to opioids such as heroin or morphine.
It is very rapidly acting andcompetes with the opioid for the opioid receptor. Be careful when administering this drug, as itmay cause withdrawal in opioid tolerant patients. PrednisonePrednisone is a corticosteroid that is given for asthma and as an anti-inflammatory. A side effectof prolonged use is Cushing?s syndrome and often you may see tremors. RocuroniumOften called ?rock?, it is a paralytic. Administration produces total muscular paralysis.
It is mostoften used for ?rapid-sequence-intubation? to make tracheal intubation easier and to allow thepatient to be mechanically ventilated. It has no analgesic properities and paralyzed patients see,hear and feel everything and should never used without sedation. PilocarpinePilocarpine is dripped into the eyes to produce constriction of the pupil in patients with glaucoma. DopamineDopamine is a mild pressor agent, which is administered IV to produce vasoconstriction and raise apatient?s blood presure. Phenytoin (Dilantin)Dilantin is an anticonvulsant. As a side effect, when administered too fast, it can inducehypotension.
N-Acetylcysteine (Mucomyst)Mucomyst is given in cases of acetaminophen toxicity (e. g. Tylenol). tPATissue plasminogen activator is a thrombolytic agent, used to lyse blood clots in patients withmyocardial infarction (a. k. a.
heart attacks), non-hemorrhagic CVA?s (a. k. a. strokes) and PE?s (a.
k. a. pulmonary emboli). Thrombolytics can cause hemorrhage and should be used with care. StreptokinaseStreptokinase is a thrombolytic (note: discovered here at NYU) made by Streptococcus bacteriawhich dissolves clots, similar to tPA (although through a different mechanism)Diltiazem(Cardizem)Diltiazem is a calcium channel blocker used to slow the heart down in patients with certaintypes of tachycardias such as atrial fibrillation.
MetoprololMetoprolol is a beta-blocker which is used to slow down the heart and lower blood-pressure. These drugs are not typically used in asthmatics, as they can induce bronchoconstriction. AtenololAtenolol is a beta-blocker similar to metoprolol. AdenosineAdenosine (the A of ATP fame) is used as an antidysrhythmic to break certain cardiacdysrhythmias; it is often used in patients with supraventricular tachycardia.
The half life of the drugis only a few seconds, and can often induce non-pathologic asystole (flat line on an EKG) for a fewseconds. DigoxinDigoxin (a derivative of the Foxglove plant) is a cardiac drug used to slow conduction throughthe heart, especially in cases of atrial-fibrillation. As a side effect it can produce variousdysrhythmias including ventricular fibrillation and aystole. Metronidazole (Flagyl)Flagyl is an antibiotic used against anaerobic bacteria and certain parasites.
As a side effectpatients can become violently ill to their stomachs from consuming alcohol with Flagyl (similar toAntabuse)VancomycinVancomycin is the ?last ditch? antibiotic, used for highly resistant bacteria. It is fairly toxic to thepatient, and often is a hobson?s choice to administer to a septic, shocky patient. Trimethoprim/sulfamethoxazole (Bactrim)Bactrim is a ?sulfa? class antibiotic and is often used in urinary tract infections. KetamineA sedative often used in conjuction with other sedatives (such as midazolam or diazepam). PepcidPepcid is a systemic antacid (H2 blocker) which takes 30-45 minutes to take effect, but lasts forseveral hours. Similar to ranitidine (Zantac) and cimetidine (Tagamet).
NSNS stands for Normal Saline, which is 0. 9% Sodium Chloride, and is the usual fluid given to apatient who needs fluid due to dehydration. It is approximately isotonic. LRLR stands for Lactated Ringers, which is Normal Saline with other electrolytes.
Due to thepresence of the other electrolytes, there is a limit to how much can be administered within aspecific period of time. D5, D10, D25 and D50The D stands for Dextrose, which is a stable form of glucose. This solution is given IV to givethe patient glucose. This is never given IM, as high concentrations of glucose cause tissue deathoutside the vasculature.Other useful termsQDOnce per DayBIDTwice per dayTIDThree times per dayQIDFour times per dayQHSAt the hour of sleepNPONothing by mouth
