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Phenergan (Promethazine)

  • Method: IV/IM/PR
  • Dose: 12.5-25 mg
  • Contraindications: narrow angled glaucoma, under the age of 2, allergy
  • Indications: N/V, motion sickness
  • Given with morphine to help with nausea

Ibuprofen

  • Method: PO
  • Dose: 400-800 mg every 6-8 hours. Max dose in 24 Hours is 3200 mg
  • Contraindications: third trimester pregnancy, severe hepatic impairment, allergy, use with other NSAID'S, UGI bleed, ulcers
  • Indications: arthritis, Px, Fever
  • Why are NSAID's not given in a combat environment?

Fentanyl (Lollipop)

Morphine

Naloxone (Narcan)

  • Method: Transbuccal, tape the lozenge stick to Pt finger
  • Dosage: 800 micrograms
  • Reassess every 15 minutes
  • Contraindications: Paralytic ileus, increased ICP, respiratory distress, severe renal/hepatic impairment
  • Indications: temporary Px relief

Antifungal

  • Method: IV
  • Dose: 0.4 mg - 2.0 mg slow IVP over 1-2 minutes, may need to repeat 3-4 times.
  • Contraindications: drug hypersensitivity
  • Indications: opioid overdose, complete or partial reversal of CNS and respiratory depression induced by opioids
  • Should be adjusted to casualty's respiratory rate not LOC
  • Always reassess Pt, why?
  • Lamisil (Terbinae HCL): Topical 7 days, 4 weeks max
  • Preferred Method: IV (intravenious)
  • Dose: 5 mg slow IV push over 1-2 minutes. Dilute morphine with 5 mL of Sterile water or Normal Saline, repeat dose every 5 minutes.
  • Contraindications: Respiratory depressions, severe asthma, GI obstruction
  • Indications: Relief of severe Px, acute Px relief of AMI
  • After Administration: monitor respiratory rate, document every dose and time

Ketamine

Five R's

  • Right Patient
  • Right Drug
  • Right Dose
  • Right Route
  • Right Time
  • Route: IM, IN, IV, IO
  • Dose: 50 mg IM/IN repeat 30 minutes as needed, 20 mg IV/IO repeat after 20 minutes
  • Contraindications: Penetrating eye injury, has the potential to worsen TBI
  • Indications: moderate to severe Px, hemorrhagic shock, respiratory distress
  • Can be given with Morphine and Fentanyl

Classifications of Medications

Acetaminophen (Tylenol)

Epinephrine

  • Method: PO (By mouth)
  • Dose: Two 650 mg bi-layered caplets every 8 hours
  • Used for mild/moderate Px in soldiers still able to fight
  • Contraindications: G6PD deficiency
  • Indications: mild to moderate Px, headache, and fever
  • Given with Mobic to bridge the gap until the Mobic kicks in
  • Analgesics- pain reliever
  • Antibiotics- inhibits growth of microorganisms
  • NSAID's- Nonsteroidal anti-inflammatory drug, used to treat inflammation
  • Antihistamines- inhibits the effects of histamine
  • Antifungals: inhibits fungal growth
  • Anesthetics: creates loss of sensation, contrast with analgesics

Diphenhydramine (Benadryl)

  • Method: SC (subcutaneous)
  • Dose: 0.1-0.5 cc every 15 minutes as needed to treat acute symptoms
  • Contraindications: cardiac arrhythmia
  • Indications: cardiac arrest, anaphylaxis, open angled glaucoma
  • Closely monitor vitals after administration, why?
  • Method: PO
  • Dose: 25 to 50 mg t.i.d (three times a day) maximum dose in 24 hours is 300 mg
  • Contraindications: asthma, glaucoma, HTN, seizures, liver disease
  • Indications: allergic reactions, motion sickness, nausea, sedation, coughing
  • Used alongside epinephrine during anaphylaxis
  • Causes drowsiness, dry mouth, palpitations

Resources

Antibiotics:

  • http://www.operationalmedicine.org/TextbookFiles/FMST_20008/FMST_2_A.htm
  • http://www.slideshare.net/larrylentino/general-pharmacology-and-pharmacology-for-the-soldier-medic-10720717
  • http://www.medtrng.com/blackboard/pharmacology_for_the_soldier_med.htm
  • Avelox (Moxifloxacin): given 400 mg PO o.i.d
  • Cefotan (cefotetan): given 2 g IV/IO over 3-5 minutes or 2 g IM if the Pt cannot take medications PO.
  • Ivanz (ertapenum): 1 g IV/IO/IM
  • Do not give oral ABX to Pt who are going into hypovolemic shock.

Meloxicam (Mobic)

  • Method: PO (By mouth)
  • Dosage: One 15 mg tablet
  • Used for mild/moderate Px in soldiers still able to fight
  • Contraindications: allergies to Mobic
  • Indications: Arthritis, Px relief for soldiers still able to fight
  • NSAID

Pharmacology for Combat Medics

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