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Level 11

Precautions


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Morphine
Cardiac disorders, hypertension, elderly.
Atropine
Increases myocardia oxygen demand, CHF, HTN. May be harmful if used to treat AV block (Mobitz II and 3rd degree block; doses less than the minimum may slow the heart rate
Dextrose
Renal, hepatic, cardiac disease, diabetes mellitus
Diazepam
Psychoses, depression, myasthenia gravis, hepatic or renal impairment, addiction, elderly or very ill patients, or COPD. Due to a short half-life of the drug, seizure activity may recur.
Diphenhydramine
Cardiac disease, hypertension, glaucoma, elderly
Diphenhydramine (NYC REMAC ADVISORY)
Has an atropine - like action and must be used with caution in patients with a history of increased intraocular pressure, hyperthyroidism, cardiovascular disease, and/or hypotension.
Epinephrine
Cardiac disorders, hypertension, elderly.
Naloxone
Pregnancy, cardiovascular disease, opioid dependency, seizure disorder. NOTE: repeat doses of may be necessary due to shorter half life than narcotics
Nitroglycerin
Postural hypotension, severe hepatic disease
Sodium Bicarbonate
Administration can result in metabolic alkalosis or sodium overload. Use with caution in patients with CHF and renal failure.
Adenosine
Patient may transiently develop asystole, PVCs, PACs, sinus bradycardia, and sinus tachycardia after administration; asthma
Albuterol
Cardiac disorders, hypertension
Amiodarone
CHF, severe hepatic, respiratory diseases, children; half-life 40 days
Aspirin
Recent history of gastrointestinal bleeding or ulcers.
Aspirin (NYC REMAC ADVISORY)
Should not be administered to patients with known hypersensitivity. Gastrointestinal complaints are not a contraindication for administration.
Dopamine
Treat hypovolemia with fluid before administering dopamine.
Furosemide
Severe renal disease
Magnesium Sulfate
Rapid IV administration. May cause respiratory or cardiac arrest
Methylprednisolone
Only a single dose should be given in the prehospital setting.
Ondansetron
Pregnancy, pediatric, geriatric
Diltiazem
CHF, hypotension.
Diltiazem (NYC REMAC ADVISORY)
Must be used with caution in patients with liver or kidney disease, CHF, atrioventricular conduction abnormalities, and/or hypotension. Medical Control should be alerted to these conditions, and the dose should be reduced to half the normal dose.
Ondansetron (NYC REMAC ADVISORY)
Has been associated with prolongation of the QT interval, possibly resulting in Torsades de Pointes. Therefore, this drug should be used with caution in patients with a history of cardiac disease and those taking other medications known to prolong the QT interval. This drug should not be administered to patients with a history of familial QT prolongation.
Glucagon
Cardiovascular or renal impairment. Effective only if there are sufficient stores of glycogen in the liver.
Vasopressin
None in cardiac arrest. Epilepsy, migraine, heart failure, angina, vascular disease, hepatic impairment, elderly, and children.
Lorazepam
Narrow-angle glaucoma, depression or psychosis, coma, shock, acute alcohol intoxication, renal or hepatic impairment, organic brain syndrome, myasthenia gravis, GI disorders, elderly, debilitated, limited pulmonary reserve.
Midazolam
COPD, renal failure, geriatric
Fentanyl
Increased intracranial pressure, elderly, debilitated, COPD, respiratory problems, hepatic and renal insufficiency.
Ipratropium
Elderly, cardiovascular disease, or hypertension.
Dexamethasone
Herpes simplex, keratitis, myasthenia gravis, hepatic or renal impairment, diabetes, CHF, seizures, psychic disorders, hypothyroidism, and GI ulceration.
Nitroglycerin (NYC REMAC ADVISORY)
Shall not be administered to patients who have used erectile dysfunction medications within the past 72 hours.
Calcium Chloride
It may precipitate toxicity in patients taking digoxin. Ensure the IV line is in a large vein and flushed before using and after calcium.
Etomidate
marked hypotension, severe asthma, severe cardiovascular disease
Hydroxocobalamin
Transient severe hypertension secondary to infusion