Critical Care Paramedic Drug Cards Exam Study Guide Solutions

Critical Care Paramedic Drug Cards Exam Study Guide Solutions ETOMIDATE (AMIDATE) - ANSWER---Induction agent-- Dissociative Anesthetic RSI: 0.2-0.3 mg/kg Onset: 30-60 seconds Duration: 3-12 minutes MOA: Depresses reticular activating system by stimulating GABA receptors + Minimal hemodynamic effects, ↓ ICP/IOP, preferred for awake sedation (fast onset, short half-life) ©EMILLECT 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED FIRST PUBLISH OCTOBER 2024 Page 2/57 - Adrenal suppression (multiple doses), apnea, N/V, ↑↓ BP, ↑↓ HR, myoclonus (muscle jerks; pretreat with Versed) *May cause adrenal insufficiency* KETAMINE (KETALAR) - ANSWER---Induction agent-- Dissociative Anesthetic RSI: 1-2 mg/kg Maintenance: 0.1-0.5 mg/min Onset: 60 seconds Duration: 10-15 minutes MOA: Interrupts pathways in cortex and limbic system; prompts release of endogenous catecholamines ©EMILLECT 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED FIRST PUBLISH OCTOBER 2024 Page 3/57 + Sedation, analgesia, amnesia, potent bronchodilator (preferred RSI for asthmatics) - HTN, emergence reactions (PCP like reaction)(pretreat with benzo), ↑ ICP, hallucinations, tremors, ↑ HR/BP 2nd catecholamine release, ↑ secretions (treat with 0.01 mg/kg Atropine) PRECEDEX (DEXMEDETOMIDINE) - ANSWER---Sedative-- Dissociative Anesthetic RSI: 1 mcg/kg over 10 minutes Maintenance: 0.2-0.7 mcg/kg/hr Onset: < 5 minutes Reversal: Atipamezole ©EMILLECT 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED FIRST PUBLISH OCTOBER 2024 Page 4/57 MOA: Alpha-2 agonist that provides sedation without any blunting of the respiratory drive or airway reflexes + Respiratory stability, potent sedative/anxiolytic/analgesic properties - Bradycardia/sinus arrest, transient HTN *Use with caution in pts with hepatic impairments* PROPOFOL (DIPROVAN) - ANSWER---Sedative-Hypnotic/Induction agent-- Dissociative Anesthetics RSI: 1.5 mg/kg Maintenance: 10-50 mcg/kg/min ©EMILLECT 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED FIRST PUBLISH OCTOBER 2024 Page 5/57 Onset: 15-45 seconds Duration: 5-10 minutes MOA: Decreases GABA separation from receptors allowing prolonged opening of the chloride channel which results in hyperpolarization of cell membranes + Use in hemodynamically stable pts, reactive airways disease (asthma, COPD, viral URI), status epilepticus - Apnea, ↑↓ BP, ↑↓ HR, arrhythmias, propofol infusion syndrome, ↓ CPP/MAP, pain on injection, egg/soybean allergy *Use lowest dose possible* **Do not use in pts with head injury/hemodynamically unstable** ATRACURIUM (TRACRIUM) - ANSWER---Nondepolarizing neuromuscular blocking agent-- ©EMILLECT 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED FIRST PUBLISH OCTOBER 2024 Page 6/57 Paralytic RSI: 0.4-0.5 mg/kg Maintenance: 0.08-0.1 mg/kg 20-45 mins after, then q 15-25 mins Onset: 2-3 minutes Duration: 60-70 minutes Reversal: Neostigmine - 0.03-0.07 mg/kg MOA: Competes to attach at NII receptor site, causing extended chemical paralysis + Longer duration, defasiculating dose reduces ↑ ICP - Apnea, ↑↓ BP, ↑↓ HR, prolonged paralysis with long term use/concurrent use of corticosteroids, renal/hepatic dysfunction ©EMILLECT 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED FIRST PUBLISH OCTOBER 2024 Page 7/57 *Use caution in pts with nervous system disorder* **Must give pain/sedation meds also** CISATRACURIUM (NIMBEX) - ANSWER---Nondepolarizing neuromuscular blocking agent-- Paralytic RSI: 0.15-0.2 mg/k