Hydromorphone (Dilaudid) 10mg (2mL q4min) Epidural
Reason: To control severe pain r/t rib fracture, etc.
Classification: Opiate agonist
Actions: Structurally similar to morphine but with 8-10 times more potent analgesic effect.
Side Effects: Hypotension, bradycardia, respiratory depression, blurred vision.
Morphine 2mg Q4h IV
Administration: Dilute 2–10 mg in at least 5 mL of sterile water for injection. Give a single dose over 4–5 min. Avoid rapid administration.
Reason: To control severe pain r/t rib fracture, etc.
Classification: Opiate agonist
Actions: Natural opium alkaloid with agonist activity by binding with the same receptors as endogenous opioid peptides
Side effects: Respiratory depression, flush of face, neck, and upper thorax, oliguria, pulmonary edema
**Narcan is antidote for overdose!
Naloxone (Narcan) 40mL/h PRN IV
Administration: Dilute 2 mg in 500 mL of D5W or NS to yield 4 mcg/mL (0.004 mg/mL). Give 0.4 mg or fraction thereof over 10–15 sec.
Reason: Opiate overdose antidote
Classification: Opiate antagonist
Actions: Reverses the effects of opiates, including respiratory depression, sedation, and hypotension.
Side effects: Reversal of analgesia, increased BP, HR, and tachycardia.
Oxycodone (Oxycontin) 5-10mg BID PO
Reason: Treatment of moderate to severe pain (dislocation, simple fractures)
Classification: Opiate analgesic
Actions: Binds with stereo-specific receptors in various sites of CNS to alter both the perception of pain and emotional response to pain.
Side effects: Respiratory depression, pruritus, bradycardia, urinary retnetion or urinary frequency
Cyclobenzaprine (Flexeril) 10mg TID PO
Reason: Relief of muscle spasm associated with acute musculoskeletal conditions
Classification: Skeletal muscle relaxant
Actions: Acts primarily within CNS at brain stem; some action at spinal cord level is also probable. Depresses tonic somatic motor activity.
Side effects: Edema of tongue and face, tachycardia, postural hypotension, flatulence, tremor, impotence.
Levofloxacin (Levaquin) 750mg Q24h x 5 days IV
Administration: Normal (750mg Q24 hours X 5 days). Diluted with D5W, NS, D5/NS, D5/RL from 500mg (25mg/mL) to produce 5mg/mL. Intermittent- adm over >60min, do not bolus or infuse too rapidly
Reason: Community-acquired pneumonia
Classification: Broad-spectrum fluoroquinolone antibiotic
Actions: Inhibits bacterial DNA replication, transcription, repair, and recombination.
Side effects: Decreased vision, foreign body sensation, transient ocular burning, ocular pain, photophobia, chest or back pain, phlebitis.
Levalbuterol (Xopenex) 1.25mg TID IH
Administration: Nebulizer treatment
Reason: Reversal of bronchospasm with reversible obstructive airway disease. Increases vital capacity.
Actions: Acts on the beta2 receptors of the smooth muscles of the bronchial tree, thus resulting in bronchodilation.
Classification: Beta-adrenergic agonist
Side effects: Migraine, tachycardia, increased serum glucose, dyspepsia, increased HR, insomnia.
Diltiazem (Cardizem) 240mg Daily PO
Administration: Do NOT crush, withhold if SBP <90, class="blsp-spelling-error" id="SPELLING_ERROR_14">subthreshold levels insufficient to stimulate cell excitation and contraction. Side effects: Syncope, arrhythmias, flushing, hypotension, weight increase. Liothyronine (Cytomel) 25mcg Daily PO
Administration: In morning, after breakfast
Reason: Hypothyroidism treatment (replace decreased amounts of T4)
Classification: Thyroid hormone substitute, with more rapid action and disappearance.
Actions: Replacement therapy for diminished/absent thyroid function resulting from primary or secondary atrophy of gland. Increase in the metabolic rate of all body tissues.
Side effects: Irritability, nervousness, HA, tremor, sweating, weight loss