Brand: Adrenalin, EpiPen, Auvi-Q
Class: Vasopressor, anaphylaxis treatment; alpha and beta adrenergic agonist
Indications: Cardiac arrest, anaphylaxis, symptomatic bradycardia, septic shock
Action: Alpha-1 vasoconstriction, beta-1 rate and contractility, beta-2 bronchodilation
Typical Adult Dose: Arrest: 1 mg IV/IO every 3-5 min; Anaphylaxis: 0.3-0.5 mg IM (1 mg/mL) in lateral thigh, repeat every 5-10 min
Onset: IV: immediate; IM: within minutes
Adverse Effects: Dysrhythmias, myocardial ischemia, severe hypertension, extravasation necrosis, tremor, hyperglycemia
Contraindications: None in a life-threatening emergency
Interactions: MAOIs and tricyclics (severe hypertension), beta blockers (blunted response)
Nursing Considerations: Confirm concentration (1 mg/mL IM, 0.1 mg/mL IV push in arrest); IM in thigh, never buttock, hands or feet; cardiac monitor with IV use; watch for biphasic anaphylaxis
Patient Teaching: Carry two auto-injectors and use one at the first sign of anaphylaxis; call 911 after use
Doses are typical adult doses for the listed indication; always follow the provider's order and your facility protocol.
Card 2
norepinephrine
Answer
Brand: Levophed
Class: Vasopressor; alpha-1 and beta-1 adrenergic agonist (catecholamine)
Indications: Acute hypotension and shock, first-line vasopressor in septic shock
Action: Strong alpha-1 vasoconstriction raises SVR and MAP, with modest beta-1 inotropy
Typical Adult Dose: Severe acute hypotension (label): 8-12 mcg/min IV initially, titrate to BP; typical maintenance 2-4 mcg/min
Onset: IV: rapid; pressor effect ends within 1-2 min of stopping
Adverse Effects: Extravasation necrosis, dysrhythmias, reflex bradycardia, digital and gut ischemia, hypertension
Contraindications: None listed in current labeling
Interactions: MAOIs and tricyclic antidepressants (severe hypertension), halogenated anesthetics (dysrhythmias)
Antidote: Extravasation: phentolamine 5-10 mg in 10-15 mL NS infiltrated locally
Nursing Considerations: Central line or large vein, check site often; frequent or arterial BP during titration; correct hypovolemia; wean gradually, never stop abruptly
Patient Teaching: Report pain, burning or coolness at the IV site
Doses are typical adult doses for the listed indication; always follow the provider's order and your facility protocol.
Card 3
vasopressin
Answer
Brand: Vasostrict
Class: Vasopressor; antidiuretic hormone (V1 and V2 receptor agonist)
Indications: Vasodilatory shock (septic or post-cardiotomy) that persists despite fluids and catecholamines
Action: V1 vasoconstriction independent of adrenergic receptors; V2 water reabsorption
Typical Adult Dose: Septic shock: 0.01 units/min IV, titrate by 0.005 units/min every 10-15 min; little data above 0.07 units/min
Adverse Effects: Digital, mesenteric and myocardial ischemia, worsening cardiac function, dysrhythmias, hyponatremia, reversible diabetes insipidus
Contraindications: Hypersensitivity to vasopressin (or chlorobutanol in the multiple-dose vial)
Interactions: Other vasopressors (additive); drugs causing SIADH or diabetes insipidus alter its effect
Nursing Considerations: Usually added to norepinephrine, not used alone; monitor sodium and urine output; check fingers, toes and abdomen for ischemia; taper when weaning
Patient Teaching: Report chest pain, belly pain, or cold or numb fingers
Doses are typical adult doses for the listed indication; always follow the provider's order and your facility protocol.
Card 4
dopamine
Answer
Brand: None (generic only)
Class: Vasopressor and inotrope; dose-dependent dopaminergic, beta-1 and alpha-1 agonist
Indications: Symptomatic bradycardia unresponsive to atropine, hypotension and shock
Action: Dose-dependent: moderate doses raise contractility and rate; high doses cause alpha vasoconstriction
Typical Adult Dose: Bradycardia: 5-20 mcg/kg/min IV infusion, titrate to response
Adverse Effects: Tachydysrhythmias, ectopy, extravasation necrosis, hypertension, angina
Contraindications: Pheochromocytoma, uncorrected tachydysrhythmias or ventricular fibrillation
Interactions: MAOIs (greatly prolonged and intensified effect), halogenated anesthetics (dysrhythmias)
Antidote: Extravasation: phentolamine infiltrated into the site
Nursing Considerations: Central line or large vein, check site often; continuous ECG and frequent BP; correct hypovolemia first; taper rather than stop abruptly
Patient Teaching: Report chest pain, a racing heartbeat, or pain at the IV site
Doses are typical adult doses for the listed indication; always follow the provider's order and your facility protocol.
Card 5
dobutamine
Answer
Brand: None (generic only)
Class: Inotrope; beta-1 adrenergic agonist
Indications: Short-term support for cardiac decompensation from depressed contractility (cardiogenic shock, acute heart failure)
Action: Beta-1 stimulation increases contractility and cardiac output with mild vasodilation
Typical Adult Dose: Start 0.5-1 mcg/kg/min IV, titrate every few minutes; usual range 2-20 mcg/kg/min
Adverse Effects: Tachycardia, ventricular ectopy, rapid ventricular rate in A-fib, BP swings, angina, hypokalemia
Contraindications: Idiopathic hypertrophic subaortic stenosis, hypersensitivity (contains sulfite)
Interactions: Beta blockers (blunted effect)
Nursing Considerations: Correct hypovolemia first; continuous ECG and BP during titration; it is not a vasopressor, so hypotension may need a second agent; monitor potassium
Patient Teaching: Report chest pain, palpitations or worsening shortness of breath
Doses are typical adult doses for the listed indication; always follow the provider's order and your facility protocol.
Card 6
phenylephrine
Answer
Brand: Biorphen, Vazculep
Class: Vasopressor; selective alpha-1 adrenergic agonist
Indications: Hypotension from vasodilation, such as during anesthesia
Action: Pure alpha-1 vasoconstriction raises SVR and BP with no direct cardiac stimulation
Typical Adult Dose: Hypotension: 40-100 mcg IV bolus, then up to 200 mcg every 1-2 min; infusion 10-35 mcg/min (max 200)
Adverse Effects: Reflex bradycardia, decreased cardiac output, hypertension, ischemia, extravasation necrosis
Contraindications: None listed in current labeling
Interactions: MAOIs, tricyclic antidepressants and oxytocic drugs (enhanced pressor effect)
Nursing Considerations: Dilute the 10 mg/mL vial before bolus use and double-check the mcg dose; watch HR for reflex bradycardia; caution in low cardiac output; check IV site
Patient Teaching: Report headache, chest pain or pain at the IV site
Doses are typical adult doses for the listed indication; always follow the provider's order and your facility protocol.
Card 7
amiodarone
Answer
Brand: Nexterone, Pacerone (oral)
Class: Antidysrhythmic; class III potassium channel blocker
Indications: Shock-refractory VF or pulseless VT, stable VT, atrial fibrillation
Action: Prolongs repolarization and refractory period; also blocks sodium, calcium and beta receptors
Typical Adult Dose: Cardiac arrest: 300 mg IV/IO, then 150 mg; VT with pulse: 150 mg IV over 10 min, then 1 mg/min for 6 h
Adverse Effects: Hypotension, bradycardia, AV block, QT prolongation, phlebitis; long term: lung, liver, thyroid toxicity
Contraindications: Cardiogenic shock, marked bradycardia, 2nd or 3rd degree AV block without pacemaker, iodine allergy
Interactions: Raises warfarin and digoxin levels; QT-prolonging drugs; beta and calcium channel blockers (bradycardia)
Nursing Considerations: Continuous ECG and BP; infuse through an in-line filter; central line for concentrations above 2 mg/mL; watch QT and HR
Patient Teaching: Long-term use needs lung, liver, thyroid and eye checks; use sunscreen
Doses are typical adult doses for the listed indication; always follow the provider's order and your facility protocol.
Card 8
adenosine
Answer
Brand: Adenocard
Class: Antidysrhythmic; endogenous purine nucleoside (AV nodal blocker)
Indications: Conversion of PSVT to sinus rhythm, including PSVT using an accessory pathway
Action: Briefly blocks conduction through the AV node, interrupting reentry circuits
Typical Adult Dose: 6 mg rapid IV push followed by NS flush; 12 mg if needed
Onset: Seconds; half-life under 10 seconds
Adverse Effects: Transient asystole or bradycardia, flushing, chest pressure, dyspnea, bronchospasm, sense of doom, A-fib
Contraindications: 2nd or 3rd degree AV block or sick sinus syndrome without a pacemaker; use caution in asthma
Interactions: Dipyridamole and carbamazepine increase effect; theophylline and caffeine decrease effect
Nursing Considerations: Use a large proximal IV (antecubital) and push as fast as possible with an immediate flush; run a rhythm strip during the push; keep the defibrillator ready
Patient Teaching: Expect a few seconds of flushing, chest tightness and a feeling of doom; it passes quickly
Doses are typical adult doses for the listed indication; always follow the provider's order and your facility protocol.
Card 9
atropine
Answer
Brand: AtroPen (auto-injector)
Class: Anticholinergic; antimuscarinic (parasympatholytic)
Indications: Symptomatic bradycardia, organophosphate or nerve agent poisoning, reduction of secretions
Action: Blocks acetylcholine at muscarinic receptors, speeding the SA node and AV conduction
Typical Adult Dose: Bradycardia: 1 mg IV every 3-5 min, max total 3 mg
Adverse Effects: Tachycardia, dry mouth, urinary retention, blurred vision, flushing, delirium, hyperthermia
Contraindications: None absolute in an emergency; caution with angle-closure glaucoma and urinary obstruction
Interactions: Other anticholinergics such as antihistamines and tricyclic antidepressants (additive effects)
Nursing Considerations: Prepare to pace or start a drip if no response; often fails in high-grade AV block or a transplanted heart; continuous ECG; watch elderly for confusion
Patient Teaching: Expect dry mouth and blurred vision; report trouble urinating
Doses are typical adult doses for the listed indication; always follow the provider's order and your facility protocol.
Card 10
diltiazem
Answer
Brand: Cardizem
Class: Antidysrhythmic and antihypertensive; nondihydropyridine calcium channel blocker (class IV)
Indications: Rate control in atrial fibrillation or flutter, conversion of PSVT
Action: Blocks calcium entry in the AV node and myocardium, slowing conduction and heart rate
Typical Adult Dose: 0.25 mg/kg IV over 2 min; 0.35 mg/kg after 15 min if needed; infusion 10 mg/h (range 5-15 mg/h)
Adverse Effects: Hypotension, bradycardia, AV block, heart failure exacerbation, flushing
Contraindications: Severe hypotension or cardiogenic shock, sick sinus or 2nd or 3rd degree AV block without pacemaker, A-fib with WPW, VT
Interactions: IV beta blockers (do not give together or close in time), digoxin, CYP3A4 substrates
Nursing Considerations: Confirm a narrow-complex rhythm before giving; BP and ECG during bolus and infusion; hold for low BP or HR per order; store vials refrigerated
Patient Teaching: Rise slowly; report dizziness, fainting or swelling
Doses are typical adult doses for the listed indication; always follow the provider's order and your facility protocol.
Card 11
metoprolol
Answer
Brand: Lopressor, Toprol-XL
Class: Antihypertensive and antidysrhythmic; cardioselective beta-1 blocker
Indications: Acute MI, atrial fibrillation rate control, hypertension, angina
Action: Blocks beta-1 receptors, slowing heart rate and AV conduction and lowering myocardial oxygen demand
Typical Adult Dose: Acute MI (hemodynamically stable): 5 mg IV every 2 min for 3 doses
Adverse Effects: Bradycardia, hypotension, heart block, heart failure, bronchospasm, fatigue, masked hypoglycemia
Contraindications: HR under 45, 2nd or 3rd degree heart block, SBP under 100 mmHg, decompensated heart failure
Interactions: IV diltiazem or verapamil (heart block), clonidine (rebound hypertension), CYP2D6 inhibitors
Nursing Considerations: Check apical pulse and BP before each dose; monitor ECG during IV doses; avoid IV doses with signs of heart failure or shock; use caution in asthma or COPD
Patient Teaching: Do not stop suddenly; check your pulse; it can hide signs of low blood sugar
Doses are typical adult doses for the listed indication; always follow the provider's order and your facility protocol.
Card 12
lidocaine
Answer
Brand: Xylocaine
Class: Antidysrhythmic and local anesthetic; class IB sodium channel blocker
Indications: VF or pulseless VT (alternative to amiodarone), ventricular dysrhythmias, local anesthesia
Action: Blocks fast sodium channels, decreasing ventricular automaticity
Typical Adult Dose: Cardiac arrest: 1-1.5 mg/kg IV/IO, then 0.5-0.75 mg/kg
Adverse Effects: CNS toxicity (perioral numbness, tinnitus, confusion, seizures), bradycardia, hypotension, heart block
Contraindications: Amide anesthetic allergy, severe SA, AV or intraventricular block without pacemaker, WPW
Interactions: Amiodarone, beta blockers and cimetidine raise levels
Antidote: Lipid emulsion 20% for local anesthetic systemic toxicity
Nursing Considerations: Use only preservative-free, epinephrine-free product for IV; watch for CNS toxicity, especially in elderly, liver disease or heart failure; continuous ECG; seizure precautions
Patient Teaching: Report numbness around the mouth, ringing in the ears or confusion
Doses are typical adult doses for the listed indication; always follow the provider's order and your facility protocol.
Card 13
nitroglycerin
Answer
Brand: Nitrostat, Nitrolingual, Nitro-Dur
Class: Antianginal; organic nitrate (vasodilator)
Indications: Acute angina, ACS chest pain, acute heart failure with pulmonary edema, perioperative hypertension
Action: Releases nitric oxide, dilating veins (lowers preload) and coronary arteries
Typical Adult Dose: Angina/ACS: 0.4 mg SL every 5 min, max 3 in 15 min; IV: 5 mcg/min, up by 5 mcg/min every 3-5 min
Onset: SL: 1-3 min; IV: immediate
Adverse Effects: Hypotension, headache, reflex tachycardia, syncope, flushing
Contraindications: PDE-5 inhibitor or riociguat use, increased intracranial pressure, severe anemia, shock, nitrate allergy
Interactions: Sildenafil, tadalafil and other PDE-5 inhibitors (profound hypotension), alcohol, antihypertensives
Nursing Considerations: Check BP before each dose; ask about PDE-5 inhibitor use; caution in right ventricular infarction; non-PVC tubing for IV; get a 12-lead ECG
Patient Teaching: Call 911 if pain is not better 5 min after the first dose; keep tablets capped in the original glass bottle; sit before taking
Doses are typical adult doses for the listed indication; always follow the provider's order and your facility protocol.
Card 14
aspirin
Answer
Brand: Bayer, Ecotrin
Class: Antiplatelet; salicylate (irreversible COX inhibitor)
Indications: Suspected ACS, secondary prevention of MI and stroke, pain and fever
Action: Irreversibly blocks platelet cyclooxygenase, stopping thromboxane A2 for the life of the platelet
Typical Adult Dose: Suspected ACS: 162-325 mg PO non-enteric-coated, chewed as soon as possible
Adverse Effects: GI bleeding, other bleeding, bronchospasm in aspirin-sensitive asthma, tinnitus in toxicity
Contraindications: True aspirin allergy, active GI bleeding, bleeding disorders, children or teens with viral illness (Reye syndrome)
Interactions: Anticoagulants and other antiplatelets (bleeding), ibuprofen (blocks antiplatelet effect), SSRIs (bleeding)
Nursing Considerations: Give early in suspected ACS unless true allergy; have the patient chew it; ask whether EMS or the patient already gave a dose; monitor for bleeding
Patient Teaching: For chest pain, chew it when told to; report black or bloody stools
Doses are typical adult doses for the listed indication; always follow the provider's order and your facility protocol.
Card 15
heparin
Answer
Brand: None (generic only)
Class: Anticoagulant; indirect thrombin inhibitor (unfractionated heparin)
Indications: ACS, pulmonary embolism, DVT, atrial fibrillation with embolization, anticoagulation for procedures
Action: Binds antithrombin, inactivating thrombin and factor Xa to stop clot extension
Adverse Effects: Bleeding, heparin-induced thrombocytopenia (HIT), hyperkalemia, injection site hematoma
Contraindications: Active major bleeding, history of HIT, severe thrombocytopenia
Interactions: Antiplatelets, thrombolytics, NSAIDs and warfarin (bleeding)
Antidote: Protamine sulfate
Nursing Considerations: Dose by weight per the facility nomogram with an independent double check; monitor aPTT or anti-Xa per protocol; watch platelets for HIT; bleeding precautions
Patient Teaching: Report bleeding gums, blood in urine or stool, or new bruising; use a soft toothbrush
Heparin is a high-alert drug: confirm units, concentration and weight before every bolus or rate change.
Card 16
alteplase
Answer
Brand: Activase, Cathflo Activase
Class: Thrombolytic; tissue plasminogen activator (tPA)
Indications: Acute ischemic stroke, STEMI, acute massive pulmonary embolism, occluded central venous catheter (low-dose product)
Action: Converts fibrin-bound plasminogen to plasmin, dissolving clot
Typical Adult Dose: Stroke: 0.9 mg/kg IV (max 90 mg), 10% bolus over 1 min, rest over 60 min; Massive PE: 100 mg IV over 2 h
Adverse Effects: Intracranial hemorrhage, other major bleeding, orolingual angioedema, reperfusion dysrhythmias
Contraindications: Active bleeding or ICH, intracranial surgery or major head trauma within 3 months, bleeding diathesis, severe uncontrolled HTN
Interactions: Anticoagulants and antiplatelets (bleeding), ACE inhibitors (angioedema)
Nursing Considerations: Remove excess drug so only the calculated dose is given; frequent neuro checks and BP; avoid IM and arterial sticks; stop and call for neuro decline or angioedema
Patient Teaching: Report headache, bleeding, or new weakness or numbness right away
Doses are typical adult doses for the listed indication; always follow the provider's order and your facility protocol.
Card 17
tenecteplase
Answer
Brand: TNKase
Class: Thrombolytic; modified tissue plasminogen activator
Indications: Acute ischemic stroke, STEMI (to reduce mortality)
Action: Fibrin-specific plasminogen activator that lyses clot; long half-life allows a single bolus
Typical Adult Dose: Stroke: 15-25 mg by weight tier, IV bolus over 5 sec (max 25 mg); STEMI: 30-50 mg by weight tier
Adverse Effects: Intracranial hemorrhage, other major bleeding, reperfusion dysrhythmias, hypersensitivity
Contraindications: Active bleeding, intracranial or spinal surgery or trauma within 2 months, bleeding diathesis, severe uncontrolled HTN
Interactions: Anticoagulants and antiplatelets (bleeding)
Nursing Considerations: Stroke and STEMI doses differ: confirm indication and weight tier; flush dextrose lines with NS first; neuro and bleeding checks; avoid invasive procedures
Patient Teaching: Report headache, bleeding, or new neuro symptoms right away
Doses are typical adult doses for the listed indication; always follow the provider's order and your facility protocol.
Card 18
labetalol
Answer
Brand: None (generic only)
Class: Antihypertensive; combined alpha-1 and nonselective beta blocker
Indications: Severe hypertension and hypertensive emergency, including in pregnancy and acute stroke
Action: Blocks alpha-1 (vasodilation) and beta receptors, lowering BP without reflex tachycardia
Typical Adult Dose: 20 mg IV over 2 min, then 40-80 mg every 10 min to a total of 300 mg; or infusion at 2 mg/min
Onset: IV: peak effect within 5 min of each dose
Adverse Effects: Orthostatic hypotension, bradycardia, heart block, bronchospasm, dizziness, scalp tingling
Contraindications: Asthma, overt heart failure, cardiogenic shock, 2nd or 3rd degree heart block, severe bradycardia
Interactions: Other antihypertensives, verapamil or diltiazem (heart block), beta agonists (blunted bronchodilation)
Nursing Considerations: Keep the patient supine during IV dosing and check tolerance before getting up; BP and HR before each dose; assess lung sounds for wheezing
Patient Teaching: Rise slowly; report wheezing or dizziness
Doses are typical adult doses for the listed indication; always follow the provider's order and your facility protocol.
Card 19
nicardipine
Answer
Brand: Cardene IV
Class: Antihypertensive; dihydropyridine calcium channel blocker
Indications: Short-term BP control when oral therapy is not possible (hypertensive emergency, stroke)
Action: Blocks calcium entry into arterial smooth muscle, lowering SVR with little effect on AV conduction
Typical Adult Dose: Start 5 mg/h IV, increase by 2.5 mg/h every 5-15 min, max 15 mg/h
Adverse Effects: Hypotension, reflex tachycardia, headache, flushing, phlebitis, angina
Contraindications: Advanced aortic stenosis
Interactions: CYP3A4 inhibitors (higher levels), beta blockers (additive), raises cyclosporine levels
Nursing Considerations: Change the peripheral IV site every 12 h; frequent BP and HR during titration; titrate to the ordered BP target, avoiding sudden large drops
Patient Teaching: Report headache, palpitations, or pain at the IV site
Doses are typical adult doses for the listed indication; always follow the provider's order and your facility protocol.
Card 20
hydralazine
Answer
Brand: None (generic only)
Class: Antihypertensive; direct arteriolar vasodilator
Indications: Severe hypertension when oral therapy is not possible, hypertension in pregnancy
Action: Directly relaxes arteriolar smooth muscle, lowering afterload
Typical Adult Dose: Severe hypertension (label): 20-40 mg IV or IM, repeat as needed; Pregnancy (ACOG): 5-10 mg IV over 2 min, 10 mg if BP still high at 20 min
Onset: IV: within minutes; peak drop 10-80 min
Adverse Effects: Reflex tachycardia, hypotension, headache, angina, flushing; drug-induced lupus with long-term use
Contraindications: Coronary artery disease, mitral valvular rheumatic heart disease
Interactions: Other antihypertensives and diazoxide (profound hypotension), MAOIs
Nursing Considerations: Check BP and HR often; the response is delayed and variable, so avoid stacking doses too quickly; watch for angina; give promptly after drawing up
Patient Teaching: Report chest pain or a racing heartbeat; with long-term use, report joint pain or fever
Doses are typical adult doses for the listed indication; always follow the provider's order and your facility protocol.
Card 21
magnesium sulfate
Answer
Brand: None (generic only)
Class: Anticonvulsant and electrolyte replacement; magnesium salt
Indications: Seizure prevention and control in pre-eclampsia and eclampsia, hypomagnesemia, torsades de pointes with long QT (AHA)
Action: Depresses the CNS and blocks neuromuscular transmission; stabilizes myocardial membranes
Typical Adult Dose: Pre-eclampsia/eclampsia: 4 g IV load, then 1-2 g/h IV; max 30-40 g per 24 h
Adverse Effects: Respiratory depression, lost deep tendon reflexes, hypotension, heart block, flushing; arrest in toxicity
Contraindications: Heart block or myocardial damage; per label, IV use in toxemia within 2 h before delivery; caution in renal impairment
Interactions: CNS depressants (additive), neuromuscular blockers (prolonged blockade)
Antidote: Calcium gluconate IV
Nursing Considerations: Check patellar reflexes, RR and urine output; keep IV calcium at bedside; max 150 mg/min except in eclamptic seizure; follow serum magnesium
Patient Teaching: Expect warmth and flushing during the infusion; report trouble breathing
Doses are typical adult doses for the listed indication; always follow the provider's order and your facility protocol.
Card 22
calcium chloride
Answer
Brand: None (generic only)
Class: Electrolyte replacement; calcium salt (about 3 times the elemental calcium of gluconate)
Indications: Hypocalcemia needing prompt correction, hyperkalemia with ECG changes, calcium channel blocker toxicity
Action: Restores ionized calcium and stabilizes cardiac cell membranes against hyperkalemia
Typical Adult Dose: Hypocalcemia: 200-1,000 mg slow IV, max 100 mg/min (1 mL/min of 10%); CCB poisoning, commonly used (AHA 2023): 2 g IV initial, titrate to BP
Adverse Effects: Severe tissue necrosis with extravasation, bradycardia, hypotension, dysrhythmias, hypercalcemia
Contraindications: Label lists VF, asystole, PEA; AHA: reasonable in CCB poisoning, may be considered in hyperkalemic arrest; neonates on ceftriaxone
Interactions: Digoxin (dysrhythmias), ceftriaxone and sodium bicarbonate (precipitate in the line)
Nursing Considerations: Central or large deep vein, check the site often; never give as a rapid bolus outside a code; continuous ECG; flush between calcium and bicarbonate
Patient Teaching: Report burning at the IV site or tingling
Doses are typical adult doses for the listed indication; always follow the provider's order and your facility protocol.
Card 23
calcium gluconate
Answer
Brand: None (generic only)
Class: Electrolyte replacement; calcium salt
Indications: Acute symptomatic hypocalcemia; used for hyperkalemia with ECG changes and magnesium toxicity
Action: Replaces ionized calcium and antagonizes potassium and magnesium effects on cardiac and muscle membranes
Typical Adult Dose: Hypocalcemia: 1,000-2,000 mg IV, may repeat every 6 h; do not exceed 200 mg/min
Adverse Effects: Bradycardia, hypotension, dysrhythmias, vasodilation, hypercalcemia, injection site reaction
Contraindications: Hypercalcemia; neonates receiving ceftriaxone
Interactions: Digoxin (avoid; dysrhythmias), ceftriaxone (precipitate)
Nursing Considerations: Less irritating to veins than calcium chloride, so preferred for peripheral IVs; continuous ECG during IV doses; follow serum calcium; check the IV site
Patient Teaching: Report tingling, chest discomfort or pain at the IV site
Doses are typical adult doses for the listed indication; always follow the provider's order and your facility protocol.
Card 24
sodium bicarbonate
Answer
Brand: None (generic only)
Class: Alkalinizing agent; buffer (electrolyte)
Indications: Metabolic acidosis, hyperkalemia, tricyclic antidepressant overdose, urine alkalinization
Action: Buffers hydrogen ions, raising blood pH and shifting potassium into cells
Typical Adult Dose: Sodium channel blocker (TCA) poisoning: 50-150 mEq IV initial dose (AHA 2023); not routine in cardiac arrest (AHA 2025)
Adverse Effects: Hypernatremia, fluid overload, metabolic alkalosis, hypokalemia, hypocalcemia, extravasation injury
Contraindications: Alkalosis, chloride loss from vomiting or GI suction, hypocalcemia with risk of tetany
Interactions: Calcium salts and catecholamines (precipitate or inactivate in the same line)
Nursing Considerations: Not routine in arrest (AHA 2025); benefit in hyperkalemic arrest is unproven; flush line before and after; follow ABG, Na and K; ensure ventilation
Patient Teaching: Report swelling, muscle twitching or pain at the IV site
Doses are typical adult doses for the listed indication; always follow the provider's order and your facility protocol.
Card 25
tranexamic acid
Answer
Brand: Cyklokapron, Lysteda (oral)
Class: Hemostatic; antifibrinolytic (lysine analog)
Indications: Hemophilia tooth extraction (IV label), heavy menstrual bleeding (oral); off-label in trauma and postpartum hemorrhage
Action: Blocks lysine binding sites on plasminogen, preventing breakdown of fibrin clot
Adverse Effects: Thromboembolism, seizures, visual disturbances, hypotension with rapid infusion, GI upset
Contraindications: Neuraxial (intrathecal or epidural) use, subarachnoid hemorrhage, active intravascular clotting
Interactions: Factor IX complex concentrates and hormonal contraceptives (thrombosis)
Nursing Considerations: IV only: confirm drug and route, since intrathecal mix-ups have been fatal; infuse no faster than 1 mL/min (100 mg/min); in trauma it works best given early per protocol
Patient Teaching: Report vision changes, leg swelling, chest pain or shortness of breath
TXA is time-sensitive in trauma: benefit is greatest when given early, and given after 3 hours from injury it may increase bleeding deaths.
Card 26
potassium chloride
Answer
Brand: Klor-Con, K-Tab (oral)
Class: Electrolyte replacement; potassium salt
Indications: Treatment and prevention of hypokalemia, hypokalemia with digoxin toxicity
Action: Replaces potassium needed for nerve conduction and cardiac and muscle function
Typical Adult Dose: IV (K above 2.5): max 10 mEq/h, 40 mEq/L and 200 mEq per 24 h; always diluted
Adverse Effects: Hyperkalemia with dysrhythmias, phlebitis and burning, extravasation injury, GI irritation (oral)
Contraindications: Hyperkalemia; caution in renal impairment
Interactions: ACE inhibitors, ARBs and potassium-sparing diuretics (hyperkalemia)
Nursing Considerations: Never IV push; diluted, on a pump; check urine output and renal function; ECG for faster rates; check magnesium, since low Mg keeps K low
Patient Teaching: Take oral tablets with food and a full glass of water; report palpitations or muscle weakness
Doses are typical adult doses for the listed indication; always follow the provider's order and your facility protocol.