Brand: Sprix (nasal); Toradol (legacy name)
Class: Analgesic; NSAID
Indications: Short-term acute pain, renal colic
Action: Inhibits COX-1 and COX-2, reducing prostaglandins
Typical Adult Dose: Single dose, under 65 y: 30 mg IV (over 15+ sec) or 60 mg IM; 65+ y, renal impairment or under 50 kg: 15 mg IV or 30 mg IM
Onset: About 30 min; peak 1 to 2 h
Adverse Effects: GI bleed or perforation, acute kidney injury, MI and stroke, bleeding, anaphylaxis
Contraindications: GI bleed or ulcer, advanced renal disease, hypovolemia, suspected brain bleed, CABG, labor, NSAID allergy
Interactions: Aspirin or other NSAIDs, anticoagulants, ACE inhibitors, ARBs, diuretics, lithium
Nursing Considerations: Ask about NSAIDs taken today; check creatinine and volume status; assess bleeding risk; total course max 5 days
Patient Teaching: Report black stools; avoid ibuprofen and naproxen; stay hydrated
Doses are typical adult doses for the listed indication; always follow the provider's order and your facility protocol.
Card 2
morphine
Answer
Brand: Duramorph, MS Contin (oral ER)
Class: Opioid analgesic; mu-opioid agonist
Indications: Severe acute pain, palliative dyspnea
Action: Binds CNS mu receptors, altering pain perception
Typical Adult Dose: Opioid-naive: start 2 to 10 mg IV per 70 kg, lowest effective dose, inject slowly; lower in older adults
Onset: IV peak CNS effect may lag about 30 min
Adverse Effects: Respiratory depression, hypotension, sedation, nausea, constipation, itching
Contraindications: Significant respiratory depression, acute severe asthma unmonitored, GI obstruction or ileus
Interactions: Benzodiazepines, alcohol, other CNS depressants, MAO inhibitors
Antidote: naloxone
Nursing Considerations: Check RR, SpO2 and sedation before and after; push slowly (rigid chest risk); reassess before redosing; caution in renal impairment
Patient Teaching: Call for help if very drowsy; get up only with help; no alcohol
Doses are typical adult doses for the listed indication; always follow the provider's order and your facility protocol.
Card 3
fentanyl
Answer
Brand: Sublimaze, Duragesic (patch)
Class: Opioid analgesic; synthetic mu-opioid agonist
Indications: Acute severe pain, procedural analgesia, post-intubation analgesia
Action: Potent mu agonist, about 50 to 100 times morphine; little histamine release
Typical Adult Dose: Postop or acute pain (StatPearls): 50 to 100 mcg IV or IM every 1 to 2 h as needed; IV over 1 to 2 min; lower doses if 65+
Adverse Effects: Respiratory depression, apnea, chest wall rigidity with rapid high doses, bradycardia, sedation
Contraindications: Significant respiratory depression without airway support, hypersensitivity
Interactions: CNS depressants, CYP3A4 inhibitors (raise levels), serotonergic drugs
Antidote: naloxone
Nursing Considerations: SpO2 and capnography with repeat doses; never push rapidly (chest wall rigidity); useful when BP is soft
Patient Teaching: Report slow breathing; never cut, heat or share a patch
Doses are typical adult doses for the listed indication; always follow the provider's order and your facility protocol.
Card 4
hydromorphone
Answer
Brand: Dilaudid
Class: Opioid analgesic; mu-opioid agonist
Indications: Severe acute pain
Action: Mu agonist, roughly 5 to 7 times as potent as morphine per mg
Typical Adult Dose: 0.2 to 1 mg IV every 2 to 3 h as needed, over 2 to 3 min; IM or subcut 1 to 2 mg every 2 to 3 h
Adverse Effects: Respiratory depression, sedation, hypotension, nausea, constipation, itching
Contraindications: Significant respiratory depression, GI obstruction; high-potency form for opioid-tolerant only
Interactions: Benzodiazepines, alcohol, other CNS depressants, MAO inhibitors
Antidote: naloxone
Nursing Considerations: High-alert drug: verify mg vs mL and concentration; check RR, SpO2 and sedation before each dose; start low in opioid-naive and older adults
Patient Teaching: No driving or alcohol; report slow breathing or extreme drowsiness
Doses are typical adult doses for the listed indication; always follow the provider's order and your facility protocol.
Card 5
acetaminophen
Answer
Brand: Tylenol, Ofirmev (IV)
Class: Analgesic and antipyretic; non-opioid
Indications: Mild to moderate pain, fever, opioid-sparing adjunct
Action: Central COX inhibition; little anti-inflammatory or antiplatelet effect
Typical Adult Dose: IV (50 kg+): 1,000 mg every 6 h or 650 mg every 4 h, over 15 min; max 4,000 mg/day from all sources
Adverse Effects: Hepatotoxicity and liver failure with overdose, rare serious skin reactions
Contraindications: Severe hepatic impairment or active liver disease, hypersensitivity
Interactions: Alcohol, other acetaminophen products, warfarin (INR rise)
Antidote: acetylcysteine
Nursing Considerations: Total all acetaminophen in the last 24 h, including home combination products; lower limits with alcohol use or low weight; IV doses 4+ h apart
Patient Teaching: Read labels for hidden acetaminophen; avoid alcohol
Doses are typical adult doses for the listed indication; always follow the provider's order and your facility protocol.
Card 6
naloxone
Answer
Brand: Narcan (nasal), Kloxxado, Zimhi
Class: Opioid antidote; pure opioid antagonist
Indications: Opioid overdose, opioid-induced respiratory depression
Action: Competitively displaces opioids from their receptors
Typical Adult Dose: Overdose: 0.4 to 2 mg IV, IM or subcut, repeat every 2 to 3 min; rethink diagnosis if no response by 10 mg
Onset: IV usually within 2 min
Adverse Effects: Acute withdrawal, vomiting, agitation, tachycardia, hypertension, pulmonary edema
Contraindications: Hypersensitivity
Interactions: Reverses opioid analgesia abruptly
Nursing Considerations: Goal is breathing, not full arousal; ventilate first; titrate 0.1 to 0.2 mg doses if opioid dependent; watch for renarcotization
Patient Teaching: Carry nasal naloxone if at risk; call 911 after giving it
Doses are typical adult doses for the listed indication; always follow the provider's order and your facility protocol.
Card 7
flumazenil
Answer
Brand: None (generic only)
Class: Benzodiazepine antidote; benzodiazepine receptor antagonist
Indications: Reversal of benzodiazepine sedation, selected benzodiazepine overdose
Action: Competitively blocks the benzodiazepine site on GABA-A
Typical Adult Dose: Sedation: 0.2 mg IV over 15 sec, again after 45 sec, then every 60 sec, max 1 mg. Overdose: 0.2, 0.3, then 0.5 mg every 1 min, max 3 mg
Onset: Usually 1 to 2 min
Adverse Effects: Seizures (boxed warning), withdrawal, agitation, arrhythmias, resedation
Contraindications: Benzodiazepine treating a life-threatening condition, serious tricyclic overdose
Interactions: Unmasks seizures in mixed overdoses
Nursing Considerations: Avoid in undifferentiated overdose; have seizure treatment ready; give into a running IV in a large vein; watch 2 h for resedation
Patient Teaching: No driving or major decisions for 24 h after sedation
Doses are typical adult doses for the listed indication; always follow the provider's order and your facility protocol.
Card 8
ondansetron
Answer
Brand: Zofran
Class: Antiemetic; 5-HT3 receptor antagonist
Indications: Nausea and vomiting (postoperative, chemotherapy, ED symptomatic)
Action: Blocks 5-HT3 receptors centrally and on gut vagal afferents
Typical Adult Dose: PONV: 4 mg IV undiluted over 30+ sec (preferably 2 to 5 min), or 4 mg IM
Adverse Effects: QT prolongation and torsades, headache, constipation, serotonin syndrome
Contraindications: Concurrent apomorphine, hypersensitivity; avoid in congenital long QT
Interactions: QT-prolonging drugs, serotonergic drugs (SSRIs, SNRIs, fentanyl)
Nursing Considerations: Correct low potassium and magnesium; ECG if QT risk; push slowly; reassess nausea in 15 to 30 min
Patient Teaching: ODT dissolves on the tongue; report palpitations or fainting
Doses are typical adult doses for the listed indication; always follow the provider's order and your facility protocol.
Card 9
metoclopramide
Answer
Brand: Reglan
Class: Antiemetic and prokinetic; dopamine D2 antagonist
Indications: Nausea and vomiting, diabetic gastroparesis, migraine nausea (off-label)
Action: Blocks D2 in the chemoreceptor trigger zone; speeds gastric emptying
Typical Adult Dose: Gastroparesis: 10 mg IV over 1 to 2 min or IM; PONV: 10 or 20 mg IM near end of surgery; CrCl 60 or less: half dose
Adverse Effects: Tardive dyskinesia (boxed warning), akathisia, dystonia, NMS, drowsiness, depression
Contraindications: GI obstruction, perforation or bleed, pheochromocytoma, seizure disorder
Interactions: Antipsychotics (more EPS), CNS depressants
Nursing Considerations: Rapid push causes intense restlessness; treat akathisia or dystonia with diphenhydramine; avoid use over 12 weeks; not with bowel obstruction
Patient Teaching: Report restlessness, spasms or abnormal movements
Doses are typical adult doses for the listed indication; always follow the provider's order and your facility protocol.
Card 10
prochlorperazine
Answer
Brand: Compro (rectal); Compazine (legacy name)
Class: Antiemetic; phenothiazine D2 antagonist
Indications: Severe nausea and vomiting, migraine (off-label)
Action: Blocks D2 in the chemoreceptor trigger zone
Typical Adult Dose: 5 to 10 mg deep IM every 3 to 4 h, or 2.5 to 10 mg slow IV (max 5 mg/min, no bolus); max 40 mg/day
Adverse Effects: Akathisia, dystonia, hypotension, sedation, QT prolongation, NMS
Contraindications: Coma or severe CNS depression, children under 2 y or 20 lb, pediatric surgery
Interactions: CNS depressants, other antipsychotics and metoclopramide, QT-prolonging drugs
Nursing Considerations: Check BP after IV dose; watch for akathisia (urge to pace), often pretreated with diphenhydramine; boxed warning in dementia-related psychosis
Patient Teaching: Report muscle spasms or restlessness; rise slowly
Doses are typical adult doses for the listed indication; always follow the provider's order and your facility protocol.
Card 11
promethazine
Answer
Brand: Phenergan
Class: Antiemetic and antihistamine; phenothiazine H1 antagonist
Indications: Nausea and vomiting, motion sickness, allergic reactions, sedation
Action: Blocks H1, dopamine and muscarinic receptors
Typical Adult Dose: N/V: 12.5 to 25 mg deep IM (preferred), no more often than every 4 h
Adverse Effects: Severe tissue injury or gangrene (boxed warning), respiratory depression, sedation, confusion
Contraindications: Children under 2 y, subcut or intra-arterial injection, coma
Interactions: Opioids, benzodiazepines, other CNS depressants, anticholinergics
Nursing Considerations: Deep IM preferred; IV: dilute in NS to 1 mg/mL or less, over 20 to 40 min, large vein not hand or wrist, never push; stop if burning
Patient Teaching: No driving or alcohol; report pain or color change at the site
Doses are typical adult doses for the listed indication; always follow the provider's order and your facility protocol.
Card 12
diphenhydramine
Answer
Brand: Benadryl
Class: Antihistamine; first-generation H1 antagonist
Indications: Allergic reactions, anaphylaxis adjunct, acute dystonia, motion sickness
Action: Blocks H1 receptors; anticholinergic and sedating
Typical Adult Dose: 10 to 50 mg IV (max 25 mg/min) or deep IM; up to 100 mg if needed; max 400 mg/day
Adverse Effects: Sedation, delirium in older adults, urinary retention, dry mouth, tachycardia
Contraindications: Neonates and premature infants, breastfeeding, use as a local anesthetic
Interactions: Alcohol, opioids, other CNS depressants and anticholinergics
Nursing Considerations: Never a substitute for epinephrine in anaphylaxis; fall precautions; avoid in older adults (Beers list); watch for urinary retention
Patient Teaching: No driving or alcohol after a dose
Doses are typical adult doses for the listed indication; always follow the provider's order and your facility protocol.
Card 13
famotidine
Answer
Brand: Pepcid
Class: Antiulcer agent; H2 receptor antagonist
Indications: GERD, peptic ulcer, hypersecretory states; allergic reaction adjunct (off-label)
Action: Blocks parietal cell H2 receptors, reducing acid secretion
Typical Adult Dose: 20 mg IV every 12 h, push over 2+ min or infuse over 15 to 30 min; CrCl 30 to 60: 20 mg daily
Adverse Effects: Headache, dizziness, confusion or delirium in older adults and renal impairment
Contraindications: Hypersensitivity to H2 blockers
Interactions: Drugs needing acid for absorption (ketoconazole, atazanavir)
Nursing Considerations: Reduce dose in renal impairment; watch older adults for confusion; in allergy it is add-on only, never instead of epinephrine
Patient Teaching: Report black stools or vomiting blood
Doses are typical adult doses for the listed indication; always follow the provider's order and your facility protocol.
Card 14
albuterol
Answer
Brand: ProAir, Ventolin, Proventil
Class: Bronchodilator; short-acting beta-2 agonist (SABA)
Indications: Acute bronchospasm in asthma and COPD, hyperkalemia adjunct (off-label)
Action: Stimulates beta-2 receptors, relaxing bronchial smooth muscle
Typical Adult Dose: Asthma exacerbation (NHLBI EPR-3): 2.5 to 5 mg neb every 20 min x 3, or MDI 4 to 8 puffs every 20 min x 3
Adverse Effects: Tachycardia, tremor, hypokalemia, nervousness, paradoxical bronchospasm
Contraindications: Hypersensitivity
Interactions: Nonselective beta-blockers, loop diuretics (hypokalemia), MAO inhibitors
Nursing Considerations: Assess breath sounds, work of breathing, SpO2 and peak flow before and after; watch HR and potassium with repeat doses
Patient Teaching: Use a spacer; seek care if needing it more than usual
Doses are typical adult doses for the listed indication; always follow the provider's order and your facility protocol.
Card 15
ipratropium
Answer
Brand: Atrovent; DuoNeb (with albuterol)
Class: Bronchodilator; short-acting muscarinic antagonist
Indications: COPD bronchospasm, add-on in moderate to severe asthma exacerbation
Action: Blocks airway muscarinic receptors, reducing bronchoconstriction
Typical Adult Dose: Asthma exacerbation (NHLBI EPR-3): 0.5 mg neb every 20 min x 3, with albuterol
Adverse Effects: Dry mouth, cough, blurred vision or angle-closure glaucoma if mist hits the eyes, urinary retention
Contraindications: Hypersensitivity to ipratropium or atropine
Interactions: Other anticholinergics
Nursing Considerations: Keep mist out of the eyes; never the sole rescue drug in asthma; caution with glaucoma and BPH
Patient Teaching: Report eye pain or blurred vision
Doses are typical adult doses for the listed indication; always follow the provider's order and your facility protocol.
Card 16
methylprednisolone
Answer
Brand: Solu-Medrol (IV), Medrol (oral)
Class: Anti-inflammatory; systemic glucocorticoid
Indications: Asthma and COPD exacerbations, severe allergic reactions, inflammatory flares
Action: Suppresses inflammatory mediators and immune response
Typical Adult Dose: Asthma exacerbation (NAEPP EPR-3): 40 to 80 mg/day IV in 1 or 2 divided doses, each given over several minutes
Adverse Effects: Hyperglycemia, arrhythmia with rapid large doses, mood changes, infection, GI bleeding
Contraindications: Systemic fungal infection, intrathecal use, cow's milk allergy (40 mg vial contains lactose), IM use in ITP
Interactions: NSAIDs, insulin and oral hypoglycemics, loop diuretics, live vaccines
Nursing Considerations: Check glucose; never give over 0.5 g in under 10 min; effect takes hours, so continue bronchodilators
Patient Teaching: Take oral doses with food; do not stop a long course suddenly
Doses are typical adult doses for the listed indication; always follow the provider's order and your facility protocol.
Card 17
dexamethasone
Answer
Brand: Hemady (oral); Decadron (legacy name)
Class: Anti-inflammatory; long-acting glucocorticoid
Indications: Cerebral edema, croup, asthma exacerbation, severe allergic reactions
Action: Potent glucocorticoid, minimal mineralocorticoid effect
Typical Adult Dose: Cerebral edema (label): 10 mg IV, then 4 mg IM every 6 h until maximum response
Adverse Effects: Hyperglycemia, perineal burning with fast IV push, insomnia, mood changes, infection
Contraindications: Systemic fungal infection, hypersensitivity
Interactions: CYP3A4 inducers, NSAIDs, insulin and oral hypoglycemics, live vaccines
Nursing Considerations: Push slowly or dilute to avoid perineal burning; check glucose; long half-life allows single doses in croup
Patient Teaching: Take with food; report fever or signs of infection
Doses are typical adult doses for the listed indication; always follow the provider's order and your facility protocol.
Card 18
lorazepam
Answer
Brand: Ativan
Class: Anticonvulsant and sedative; benzodiazepine
Indications: Status epilepticus, acute agitation, alcohol withdrawal
Action: Enhances GABA-A activity
Typical Adult Dose: Status epilepticus: 4 mg IV at 2 mg/min or slower; repeat 4 mg once after 10 to 15 min if needed
Adverse Effects: Respiratory depression, hypotension, oversedation, paradoxical agitation
Contraindications: Acute narrow-angle glaucoma, severe respiratory insufficiency unventilated
Interactions: Opioids, alcohol, other CNS depressants
Antidote: flumazenil (seizure risk with chronic benzodiazepine use or tricyclic overdose)
Nursing Considerations: Dilute with equal volume before IV push; airway and suction ready; deep IM if no IV; refrigerate vials
Patient Teaching: No alcohol or driving; do not stop long-term use suddenly
Doses are typical adult doses for the listed indication; always follow the provider's order and your facility protocol.
Card 19
midazolam
Answer
Brand: Seizalam (IM), Nayzilam (nasal)
Class: Sedative and anticonvulsant; short-acting benzodiazepine
Indications: Status epilepticus without IV access, procedural sedation, agitation
Action: Enhances GABA-A activity; sedation and amnesia
Typical Adult Dose: Status epilepticus: 10 mg IM (thigh). Sedation under 60 y: up to 2.5 mg IV over 2+ min, wait 2 min; total usually 5 mg or less
Adverse Effects: Respiratory depression, apnea, hypotension, paradoxical agitation
Contraindications: Acute narrow-angle glaucoma, hypersensitivity
Interactions: CNS depressants, CYP3A4 inhibitors (azoles, macrolides) raise levels
Antidote: flumazenil (seizure risk with chronic benzodiazepine use or tricyclic overdose)
Nursing Considerations: SpO2 and capnography with airway equipment ready; age 60+: max 1.5 mg per 2 min; titrate slowly
Patient Teaching: May not remember the procedure; no driving for 24 h
Doses are typical adult doses for the listed indication; always follow the provider's order and your facility protocol.
Card 20
haloperidol
Answer
Brand: Haldol
Class: Antipsychotic; first-generation D2 antagonist
Indications: Acute agitation and psychosis, schizophrenia, Tourette disorder
Action: Strong blockade of brain D2 receptors
Typical Adult Dose: Agitated schizophrenia (label): 2 to 5 mg IM (lactate), may repeat as often as hourly; IV is not FDA approved
Adverse Effects: QT prolongation and torsades, dystonia, akathisia, NMS, hypotension, tardive dyskinesia
Contraindications: Parkinson disease, severe CNS depression or coma, hypersensitivity
Interactions: QT-prolonging drugs, CNS depressants, levodopa, lithium
Nursing Considerations: ECG and QTc when possible; treat dystonia with diphenhydramine or benztropine; watch for NMS (fever, rigidity); boxed warning in dementia
Patient Teaching: Report stiffness, fever or abnormal movements
Doses are typical adult doses for the listed indication; always follow the provider's order and your facility protocol.
Card 21
levetiracetam
Answer
Brand: Keppra
Class: Anticonvulsant; SV2A modulator
Indications: Status epilepticus second line (off-label), focal and generalized seizures
Action: Binds SV2A, reducing neurotransmitter release
Typical Adult Dose: Status epilepticus (ESETT): 60 mg/kg IV, max 4,500 mg, over 10 min
Adverse Effects: Somnolence, dizziness, irritability, depression, suicidal thoughts
Contraindications: Hypersensitivity
Interactions: Few; additive sedation with alcohol and sedatives
Nursing Considerations: Give after benzodiazepines fail; no levels or cardiac monitoring needed for the load; reduce maintenance dose in renal impairment
Patient Teaching: Do not stop suddenly; report mood changes or self-harm thoughts
Doses are typical adult doses for the listed indication; always follow the provider's order and your facility protocol.
Card 22
ketamine
Answer
Brand: Ketalar
Class: General anesthetic; dissociative NMDA antagonist
Indications: RSI induction, procedural sedation, severe agitation, analgesia (off-label)
Action: Blocks NMDA receptors; dissociation, analgesia and amnesia with airway reflexes kept
Typical Adult Dose: RSI induction (label): 1 to 4.5 mg/kg IV over 60 sec (2 mg/kg typical); label IM 6.5 to 13 mg/kg is anesthesia, not agitation, dosing
Onset: IV within 30 sec; IM 3 to 4 min
Adverse Effects: Emergence reactions (about 12%), hypertension, tachycardia, laryngospasm, salivation, vomiting
Contraindications: Patients harmed by a significant BP rise, hypersensitivity
Interactions: CNS depressants, theophylline (seizures)
Nursing Considerations: Supports BP and bronchodilates, so useful in asthma and shock; low-stimulation recovery; suction ready
Patient Teaching: Vivid dreams can occur; no driving for 24 h
Doses are typical adult doses for the listed indication; always follow the provider's order and your facility protocol.
Card 23
etomidate
Answer
Brand: Amidate
Class: General anesthetic; nonbarbiturate hypnotic
Indications: RSI induction
Action: Enhances GABA-A activity; rapid hypnosis without analgesia
Typical Adult Dose: Induction: 0.2 to 0.6 mg/kg IV over 30 to 60 sec; usual 0.3 mg/kg
Adverse Effects: Adrenal suppression, myoclonus, injection pain, nausea and vomiting
Contraindications: Hypersensitivity
Interactions: Opioids and other CNS depressants
Nursing Considerations: Hemodynamically stable, common in hypotension and trauma; lasts minutes with no analgesia, so start sedation and analgesia after intubation
Patient Teaching: Explain to family that a breathing tube and sedation follow
Doses are typical adult doses for the listed indication; always follow the provider's order and your facility protocol.
Card 24
propofol
Answer
Brand: Diprivan
Class: General anesthetic; sedative-hypnotic
Indications: Anesthesia induction, procedural sedation, ventilated patient sedation
Action: Enhances GABA-A activity; rapid, short-acting hypnosis
Typical Adult Dose: Induction (label), under 65: 2 to 2.5 mg/kg IV titrated to onset; older, debilitated or ASA III-IV: 1 to 1.5 mg/kg
Adverse Effects: Hypotension, apnea, bradycardia, injection pain, high triglycerides, infusion syndrome
Contraindications: Egg or soy allergy (per label), hypersensitivity
Interactions: Opioids, benzodiazepines (more hypotension and apnea)
Nursing Considerations: No analgesia; strict aseptic handling of the lipid emulsion; check triglycerides on infusions; watch BP
Patient Teaching: Wakes quickly; no driving or decisions for 24 h
Doses are typical adult doses for the listed indication; always follow the provider's order and your facility protocol.
Card 25
succinylcholine
Answer
Brand: Anectine, Quelicin
Class: Neuromuscular blocker; depolarizing
Indications: Paralysis for rapid sequence intubation
Action: Depolarizes the motor end plate (fasciculations), then flaccid paralysis
Typical Adult Dose: RSI: 1.5 mg/kg IV (label average for elective intubation is 0.6 mg/kg); IM up to 3 to 4 mg/kg, max 150 mg
Onset: IV within 45 to 60 sec; paralysis about 10 min at RSI dose
Adverse Effects: Hyperkalemia and cardiac arrest, malignant hyperthermia, bradycardia, muscle pain
Contraindications: MH susceptibility, myopathies, burns, trauma or denervation after the acute phase
Interactions: Cholinesterase inhibitors (prolonged block)
Nursing Considerations: Give sedation first, no analgesia or amnesia; screen for hyperkalemia risk; MH signs (rising ETCO2, rigidity, fever) need dantrolene
Patient Teaching: Muscle aches afterward are common
Doses are typical adult doses for the listed indication; always follow the provider's order and your facility protocol.
Card 26
rocuronium
Answer
Brand: None (generic only)
Class: Neuromuscular blocker; nondepolarizing
Indications: Paralysis for RSI and during mechanical ventilation
Action: Competitively blocks acetylcholine at the motor end plate
Typical Adult Dose: RSI: 0.6 to 1.2 mg/kg IV
Onset: Intubating conditions in under 2 min
Adverse Effects: Prolonged paralysis, anaphylaxis, awareness if sedation is inadequate
Contraindications: Hypersensitivity
Interactions: Aminoglycosides, magnesium, inhaled anesthetics (prolong block)
Antidote: sugammadex
Nursing Considerations: Long-acting, so start sedation and analgesia right after intubation; eye care; refrigerate, 60 days at room temperature
Patient Teaching: Family should know the patient is sedated, not just paralyzed
Doses are typical adult doses for the listed indication; always follow the provider's order and your facility protocol.
Card 27
Tdap vaccine
Answer
Brand: Boostrix, Adacel
Class: Vaccine; tetanus, diphtheria and acellular pertussis
Indications: Booster immunization, tetanus prophylaxis in wound care
Action: Induces antibodies to tetanus and diphtheria toxins and pertussis
Typical Adult Dose: 0.5 mL IM (deltoid)
Wound Rule (CDC): Complete series: clean minor wound if 10+ y since last dose, dirty or major if 5+ y; unknown or incomplete series: vaccinate for any wound
Adverse Effects: Injection-site pain, fever, headache, syncope, rare anaphylaxis
Contraindications: Anaphylaxis to a prior dose, encephalopathy within 7 days of a pertussis vaccine
Interactions: Immunosuppressants blunt response
Nursing Considerations: TIG 250 units IM: dirty or major wound and series unknown or incomplete, or HIV or severe immunodeficiency; none for clean minor wounds; observe 15 min
Patient Teaching: Keep a record of the date
Doses are typical adult doses for the listed indication; always follow the provider's order and your facility protocol.
Card 28
ceftriaxone
Answer
Brand: Rocephin
Class: Antibiotic; third-generation cephalosporin
Indications: Pneumonia, pyelonephritis, meningitis, gonorrhea, sepsis, skin infections
Action: Binds penicillin-binding proteins, blocking cell wall synthesis
Typical Adult Dose: Label: 1 to 2 g IV or IM daily, max 4 g/day (meningitis: 2 g IV every 12 h); gonorrhea (CDC): 500 mg IM once, 1 g if 150 kg+
Adverse Effects: Allergy and anaphylaxis, C. difficile diarrhea, biliary sludge, hemolytic anemia
Contraindications: Cephalosporin allergy, neonates needing IV calcium, jaundiced neonates
Interactions: Calcium-containing IV solutions (precipitate), warfarin
Nursing Considerations: Ask about beta-lactam allergy; cultures before first dose when possible; IM often mixed with lidocaine, check lidocaine allergy
Patient Teaching: Finish the course; report watery diarrhea; partners need treatment
Doses are typical adult doses for the listed indication; always follow the provider's order and your facility protocol.
Card 29
dextrose 50%
Answer
Brand: None (generic only)
Class: Antihypoglycemic; hypertonic dextrose solution
Indications: Severe or symptomatic hypoglycemia
Action: Supplies glucose directly to the blood
Typical Adult Dose: 10 to 25 g (20 to 50 mL) slow IV; repeat as needed
Adverse Effects: Phlebitis, tissue necrosis if extravasated, hyperglycemia, rebound hypoglycemia
Contraindications: Intracranial or intraspinal bleed, severe dehydration, alcohol withdrawal, hypersensitivity
Interactions: Insulin and sulfonylureas (recurrent lows)
Nursing Considerations: Use a patent large vein, watch the site; recheck glucose in 15 min and often; give thiamine too if alcohol use, never delaying dextrose
Patient Teaching: Eat a snack and a meal once alert
Doses are typical adult doses for the listed indication; always follow the provider's order and your facility protocol.
Card 30
glucagon
Answer
Brand: GlucaGen, Gvoke, Baqsimi (nasal)
Class: Antihypoglycemic; pancreatic hormone
Indications: Severe hypoglycemia without IV access, beta-blocker overdose (off-label)
Action: Stimulates hepatic glycogenolysis, raising glucose
Typical Adult Dose: Severe hypoglycemia: 1 mg IM or subcut (IV only under medical supervision); repeat 1 mg after 15 min if no response
Onset: Glucose rises within about 10 min of subcut dose
Adverse Effects: Nausea and vomiting, transient hypertension and tachycardia
Contraindications: Pheochromocytoma, insulinoma
Interactions: Beta-blockers, warfarin (more anticoagulant effect)
Nursing Considerations: Fails without liver glycogen (starvation, adrenal insufficiency, alcohol use); side-lying for vomiting; oral carbs once able
Patient Teaching: Teach family to use the kit, then call 911
Doses are typical adult doses for the listed indication; always follow the provider's order and your facility protocol.