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