EMT-P Pharmacology Contraindications
Terms
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- adenosine
- 2nd or 3rd degee AV block or sick sinus syndrome, if no pacemaker, bronchoconstrictive or bronchospastic lung disease (asthma, COPD), poison or drug induced tachycardia.
- albuterol
- hypersensitivity, tachycardia, dysrhythmias, especially those caused by digitalis, synergistic with other sympathomimetics
- alteplase
- generals, recent significant trauma - esp. head trauma. uncontrolled hypertension : systolic 185+, diastolic 110+
- amiodarone
- hypersensitivity to amio or iodine, cardiogenic shock, sinus brady, 2nd or 3rd degree AV block with no pacemaker, severe sinus node dysfunction
- amyl nitrite
- none in emergency setting
- aspirin
- hypersensitivity, relative contra. in asthma or active ulcer
- atropine sulfate
- tachycardia, hypersensitivity, unstable CV status in acute hemorrhage with myocardial ischemia, narrow angle glaucoma, hypothermic brady
- atenolol
- heart failure, cardiogenic shock, bradycardia, lung disease, hypotension, 2nd or 3rd degree heart block
- benzocaine spray
- hypersensitivity
- calcium chloride
- hypercalcemia, vfib, digitalis toxicity
- bumetanide
- hypersensitivity to it or sulfonamides, hypovolemia, anuria, electrolyte deficiencies, hepatic coma CAUTIONS: hepatic cirrhosis, ascites, diabetes, hypersensitivity to furosemide
- eptifibatide
- prior intercranial hemorrhage, malignant brain tumor, suspected aortic dissection, ischemic stroke except if in last 3 hrs, 3 months head or facial trauma, 30 days active internal bleed, surgery or trauma in 6 weeks, low platelet count, hypersens to other aggregation inhibitors, uncontrolled hypert. >200syst >110diastolic
- heparin
- generals, bleeding tendencies, severe thrombocytopenia, recent eye surgery
- clopidogrel
- active gi bleed, intercrainial hemorrhage,
- reteplase
- generals
- tenecteplase
- bleeding, cva, recent intercrainial or interspinal surgery, brain tumor, arteriovenous disease, hypertension
- tirofiban
- generals, acute pericarditis,
- general contraindications for use of aggregation inhibitors
- active internal bleed, hx cva, recent intercrainial or interspinal surgery, brain tumor, arteriovenous disease, severe hypertension, recent major trauma or surgery
- acetaminophen
- hepatic failure
- dextrose
- intercrainial hemorrhage
- calcium
- vfib, digitalis toxicity, hypercalcemia
- glucagon
- hyperglycemia
- diphenhydramine
- asthma, glaucoma, pregnancy, hypertension, glaucoma, mao, infants
- epoprostenol
- long term use in chf with severe left ventricle dysfunction, long term use in pts who develop pulmonary edema
- ketorolac
- asthma, bleeding disorders, ulcers, renal failure
- insulin
- hypoglycemia, hypokalemia
- magnesium sulfate
- heart block, myocardial damage
- protamine sulfate
- hypersensitivity
- sodium bicarb
- metabolic and respiratory alkalosis, hypokalemia, electrolyte imbalance due to severe diarrheah and vomiting
- thiamine
- hypersensitivity
- alteplase
- generals, systolic >185 diastolic >110
- standard contras for antidysrhythmics
- hypotension, 2nd or 3rd degree blocks or sick sinus without pacemaker, cardiogenic shock, hypersensitivity.
- diltiazem
- poison or drug induced tachy, wide complex tachy
- dobutamine
- tachydysrhythmias, severe hypotension, idiopathic hypertropic subaortic stenosis, suspected poison or drug induced shock
- epinephrine
- hypertension, hypothermia, pulmonary edema, myocardial ischemia, hypovolemic shock
- furosemide
- hypovolemic shock, anuria, hypotension(relative), hepatic coma
- hydralazine
- coronary artery disease, mitral valve rheumatic heart disease
- labetalol
- bronchial asthma, chf, cardio shock, 2nd-3rd blocks, brady
- lidocaine
- 2-3 blocks wout pacemaker, stokes/adams, prophylactic use in ami, wide complex ventricular escape beats with brady
- metropolol
- hr<45, 2-3 blocks, pr interval over 0.23 secs, syst <100, moderate to severe cardiac failure, signs of shock, use of other beta blkrs
- nesiritide
- should not use as primary therapy for pts with cardio shock, bp <90
- nitro
- bp<100, hypovolemia, icp or head injury, pericardial tamponade, severe brady or tachy, cialis in 24, levitra or viagra in 48
- norepinephrine
- hypotensive with hypovolemia, pregnancy(relative)
- procainamide
- torsades, 2-3 block wout pacemaker, digitalis toxicity, tricyclic od, pre-existing qt prolongation
- sodium nitroprusside
- decreased cerebral perfusion
- vasopressin
- responsive pts with coronary artery disease
- verapamil
- wpw, generals, severe chf, pulmonary edema, pts receiving iv beta blockers, wide complex tachy, child under 1
- aminophylline
- hypersensitivity to theophylline or ethylenediamine
- dexamethasone
- systemic sepsis, bacterial infection
- ipratropium
- hypersensitivity to atropine or any anticholinergics, hypersens to soya lecithin or soy products
- levalbuterol
- hypersens to sympathomimetics, tachyarrythmias, severe cardiac disease
- methylprednisolone
- premature infants, systemic fungal infections, caution with gi bleeds, sepsis, local infection
- prednisone
- systemic fungal infections
- racemic epinephrine
- hypertension, cv disease, epiglottitis
- diazepam. lorazepam
- glaucoma, coma, shock, head injury, addicts
- fentanyl
- myasthenia gravis, pregnancy, sensitivity to respiratory depression, children under 2
- fosphenytoin
- brady, adams/stokes, 2-3 av blocks, sa blocks, hypersens. to phenytoin and hydantoins
- mannitol
- hypotension, pe edema, severe dehydration, ic bleeds, chf
- meperidine
- mao, undiagnoses abd pain, head injury, during delivery of premature infant
- midazolam
- glaucoma, shock, coma, etoh, od, depressed vitals, narcotics, other cns depressants
- morphine
- icp and head injury, exacerbated copd, depressed respiratory drive, hypotension, undiag abd pain, ams or loc, hypovolemia, mao use in 14
- naloxone
- caution in addicted neonates, caution in drug abusers
- phenytoin
- brady, 2-3 blocks
- dopamine
- hypovolemic shock, pheochromocytoma, tachyarrhythmias, vfib
- octreotide
- hypersensitivity
- ondansetron
- hypersens. to other 5ht receptor antagonists
- promethazine
- coma, cns depression from etoh-barbituates-narcs, reye syndrome, lower respiratory symptoms (asthma, copd)
- abciximab
- active internal bleed, gi bleed-major trauma-surgery in 6wks, severe hypertension, cva in 2yrs, cva w/deficit, thrombocytopenia, brain tumor, aneurysm
- aspirin
- hypersens. to nsaids
- enoxaparin
- active major bleed, thrombocytopenia, hypersens. to heparin/ pork prods/ benzl alcohol