All Drugs

Question 1

Acetaminophen

Answer 1

Class – Analgesic, Antipyretic

Indications – Fever in pediatric patients (long transport)

Contraindications – Hypersensitivity, Hepatic failure or impairment

Drug Interaction – Phenothiazines (may produce hypothermia), phenobarbital (increase hepatic toxicity)

Administration – Pediatric [10-15mg/kg] orally (NTE 50 mg/kg/day)

Notes – Acetaminophen use in the scope of practice is intended for fever control in pediatric patients during long transports to prevent febrile seizure

Question 2

Acetylsalicylic Acid

Answer 2

Names – ASA, Aspirin

Class – Anti-inflammatory, analgesic, anti-pyretic, anti-coagulant

Indications – MI, including suspected AMI

Contraindications – Hypersensitivity, bleeding disorders, asthma (relative)

Administration – Adult [162-324mg] orally for AMI (chewable preferred), Pediatric [DO NOT GIVE]

Notes – All patients with suspected AMI without contraindications should receive aspirin

Question 3

Activated Charcoal

Answer 3

Class – Gastrointestinal Adsorbent

Indications – Activated charcoal is used in the Tx of certain cases of poisoning and over-doses in alert patients. Most commonly given in hospital after gastric lavage, appropriate pre-hospital if long transport anticipated.

Contraindications – Acids or alkali ingestion unless other drugs have ingested, GI obstruction

Interaction – Contact MCEP before giving in Acetaminophen OD, interferes with antidote (N-Acetylcysteine), Milk products decrease effectiveness

Administration – Adult and Pediatric [1gm/kg] PO

Notes – Patients must be capable of protecting their airway over time

Question 4

Albuterol

Answer 4

Names – Proventil, ventolin

Class – Sympathomimetic, Beta-2 selective adrenergic bronchodilator

Indications – Used Tx reversible airway obstruction caused by [wheezing associated with asthma], [COPD (emphysema)], [chronic bronchitis]

Contraindications – Hypersensitivity

Drug Interaction – Beta Adrenergic agents (potentiates effect), MAO inhibitors (potential hypertensive crisis), beta adrenergic blockers (decreases effectiveness)

Administration – Adult [2.5-5.0mg] (up to 10mg), Pediatric [1.25-2.5mg] (up to 5mg) in 3mL of sterile NS given as nebulized inhalation therapy over 5-15 minutes

Notes – Most side effects are dosage related, may decrease arterial O2 tension acutely by causing bronchodilation in areas of lung with poor blood perfusion, care should be taken if patient is already using an inhalant due to possible development of severe paradoxical airway resistance with repeated excessive use

Question 5

Promethazine

Answer 5

Names – Phenergan

Class – Anti-emetic

Indications – Tx of nausea and vomiting

Contraindications – Hypersensitivity to phenothiazines, comatose patients, CNS depression due to drugs, children <2 yo or critically ill/dehydrated, lactation

Drug interaction – CNS depressants (may increase, prolong, or intensify sedative action), Anticholinergics (use caution), MAO inhibitors (use caution)

Administration – Adults [6.25-25mg] PO, IM, IV/IO or rectal Q4hrs, Pediatrics [0.25-0.5mg/kg] PO, IM, or Rectal Q4hrs

Notes – Use cautiously in patients with hypertension, epilepsy, sleep apnea, cardiovascular disease, impairment of the liver, and pregnancy; may cause marked drowsiness

Question 6

Ondansetron

Answer 6

Class – Anti-emetic, selective serotonin blocking agent

Indications – Tx and prevention of nausea and vomiting

Contraindications – Known sensitivity to ondansetron or related agents

Drug interaction – none

Administration – Adult [4mg] IV/IO slow IVP/IM may repeat in 30 minutes, [8mg] ODT; Pediatric [0.1mg/kg] IV/IO slow IVP/IM, [4mg] ODT (12-17 yo)

Notes – Do not use in pts with prolonged QT syndrome, providers may not administer second dose of Zofran ODT

Question 7

Atropine Sulfate

Answer 7

Class – Anticholinergic (parasympatholytic)

Indications – Anticholinesterase poisonings (organophosphates, mushrooms, nerve gasses)

Contraindications – None

Drug interaction – Anti-histamines, tricyclic anti-depressants (additive affect)

Administration – Auto-injector

Question 8

Methylprednisolone

Answer 8

Names – Solu-medrol

Class – Anti-inflammatory, immunosuppressant

Indications – Reactive airway disease with no response to albuterol and other treatments

Contraindications – Hypersensitivity, (Relative) immunocompromised state, serious infections, psychotic disorders

Drug interaction – None

Administration – Adults [125-250mg] IV Q6hrs; Pediatrics [1-2mg/kg] IV Q6hrs

Notes – Adverse effects (hyperglycemia; psychosis), high dose methylprednisolone is no longer given routinely for spinal cord injury

Question 9

Dextrose

Answer 9

Class – Carbohydrate, nutrient, short acting osmotic diuretic

Indications – Symptomatic hypoglycemia, unconsciousness of unknown origin, seizures (associated with decreased BGL) of [ukn etiology], [new onset], or [known diabetic actively seizing], refractory medical cardiac arrest (especially in neonates)

Contraindications – Intra-cranial bleeds, delirium tremens with dehydration, administration through same infusion set as blood, unconscious (for oral), suspected CVA

Drug interaction – none

Administration – Oral [12-25gm] paste on tongue depressor;

IV: Adult [12.5-25gm] slow IV/IOP. Repeat as needed. Be prepared to restrain; Pediatric dilute 1:1 with sterile saline to make 25% solution give [0.5-1.0g/kg] slow IV/IOP; Neonates use 10% Dextrose solution (dilute 50mL D50 in 500mL bag of D5W) at [0.2g/kg)

Notes – Attempts at documenting hypoglycemia via automatic glucometry should be made before administration, must insure patent IV line and recheck patency during administration

Question 10

Diphenhydramine HCL

Answer 10

Names – Benadryl

Class – Anti-histamine, H1 blocker

Indications – Allergic reactions, anaphylaxis, dystonic reaction to phenothiazines

Contraindications – Acute asthma

Drug interactions – Additive CNS depression with ETOH, sedatives, narcotics

Administration – Adults [12.5-50mg] slow IV/IOP @1ml/min or deep IM injection; Pediatric [1mg/kg] slow IV/IOP; deep IM injection w/max dose 50mg

Special notes – May have immediate effect in dystonic reactions, no early benefit in allergic reactions

Question 11

Epinephrine

Answer 11

Names – Adrenaline

Class – Sympathomimetic

Indications – Severe bronchospasm, bronchospasms unresponsive to albuterol, anaphylaxis, cardiac arrest, symptomatic bradycardia after other Tx

Contraindications – None

Drug interaction – Reduced effects with Beta-adrenergic blocker

Administration (Cardiac Arrest) – Adult [1mg] (1:10,000) every 3-5 minutes IV/IO preferred, may be given ET (2-2.5x dose); Pediatric [0.01mg/kg] (1:10,000) every 3-5 minutes. ET 0.1mg/kg (1:1,000)

Administration (Bradycardia) – Adult [1mg] (1:1,000) in 250cc NS or D5W @2-10mcg/min; Pediatric [0.01mcg/kg] IV/IO every 3-5 minutes or [0.1-0.2 mcg/kg/minute] (0.6x body weight = mg to add to D5W to create total volume of 100m) infuse at 1mL/hr

Administration (Bronchospasms/Anaphylaxis) – Adult [0.3mg] (1:1,000) SQ or IM using 0.3mL syringe or pre-filled device. [0.1mg] (1:10,000) IV/IO over 5 minutes infusion of [1-4mcg/min]; Pediatric [0.01mg/kg] (1:1,000) SQ or IM max dose of 0.3mg/dose

Notes – When used for allergic rxns increased cardiac workload can precipitate angina or AMI in susceptible individuals, due to peripheral vasoconstriction it should be used with caution on pts with peripheral vascular insufficiency, consider pulmonary edema or pulmonary embolus inwheezing patients with Hx of RAD, EMT-I/EMT-P not required to use prefilled device or .3cc syringe

Question 12

Glucagon

Answer 12

Class – Hormone (hyperglycemic agent)

Indications – Documented symptomatic hypoglycemia (BGL <60mg/dl) when IV/IO cannot be started, beta blocker overdose with serious signs and sx, anaphylaxis refractory to epinephrine or in pts who have hx of serious coronary arterial disease and cannot receive epinephrine

Contraindications – Pts who will be unable to receive supplemental glucose orally, IV, or rectally, hypersensitivity to pork and/or beef, use with caution on pts with pheochromocytoma

Drug interaction – hyperglycemic effects intensified and prolonged by epinephrine, will precipitate with mixed with calcium preparation

Administration (Hypoglycemia) – Adult [0.5mg-1mg] IM, may repeat in 10-20 minutes if no response; Pediatric [0.1mg/kg] IM may repeat in 10-20 minutes if no response

Administration (Beta Blocker OD) – Adult [3-10mg] IV/IO over 1 minute. May be followed by infusion of 2-5mg/hr.; Pediatric [0.1mg/kg] IV/IO over 1 minute, repeat in 5 minutes if needed

Administration (Anaphylaxis) – Adult [1-2mg] slow IV/IO may be repeated every 5-10 minutes, Pediatric [0.1mg/kg up to 1mg] IV/IO may be repeated every 5-10 minutes (rarely indicated)

Notes – Patient MUST be given supplemental glucose asap; PO, IV, or rectal. If this is not possible pt may be better off w/o glucagon, glucagon is supplied in a powder and must be reconstituted with sterile water or saline, 1mL of normal saline for each 1mg of powder and shaken well

Question 13

Hydroxocobalamin

Answer 13

Class – Antidote

Indications – Tx of cyanide poisoning

Contraindications – rare anaphylactic reactions

Drug interactions – used in combination with sodium thiosulfates to treat methemoglobinemia. No more effective than sodium nitrite

Administration – Adult [5 grams] IV/IO over 30 minutes; Pediatrics (<70kg) [70mg/kg] IV/IO

Notes – Transient hypertension, reddish discoloration of skin and mucous membranes

Question 14

Ipratroprium

Answer 14

Names – Atrovent

Class – Anticholinergic

Indications – Bronchial asthma, reversible bronchospasm associated with bronchitis and emphysema

Contraindications – Hypersensitivity to drug (especially atropine products) soy or peanuts, acute Tx of bronchospasm where rapid response is required

Drug interaction – Oxivent and Spiriva

Administration – Should be administered in conjunction with beta agonist therapy

Adults [1-2 inhalations] via MDI; [250-500mcg] nebulized

Notes – Vital signs must be monitored during therapy, caution should be used when administering to elderly patients and those with cardiovascular disease or hypertension

Question 15

Levalbuterol

Answer 15

Names – Xopenex

Class – Isomer, Beta 2 Agonist

Indications – Xopenex is used to treat reversible airway obstruction caused by [wheezing associated with asthma], [COPD/emphysema], or [Chronic bronchitis]

Contraindications – Hypersensitivity to the drug class, MAO inhibitor used within 14 days, hypersensitivity to peanuts

Drug interactions – Phenothiazines

Administration – Adult [1.25mg] in 3mL of sterile NS over 5-15 minutes, repeat as necessary; Pediatric [0.63-1.25mg] in 3mL of sterile NS over 5-15 minutes, repeat as necessary

Notes – Drug of choice for patients with concern of increased myocardial oxygen demand. However this drug can still cause an increase in HR and BP; it is not recommended that this drug be mixed with atrovent

Question 16

Lidocaine Hydrochloride

Answer 16

Names – Xylocaine

Class – Anti-dysrhythmic, local anesthetic

Indications – Intraosseous space infusion on pain responsive patients prior to receiving intraosseous fluids or medications

Contraindications – Hypersensitivity

Drug interaction – Additive cardiac depression with phenytoin, quinidine, procainamide, propranolol

Administration – 3cc injection into IO site prior to infusion of fluids/medications

Question 17

Naloxone

Answer 17

Names – Narcan

Class – Narcotic antagonist

Indications – Reversal of narcotic effects, particularly respiratory depression due to narcotic drugs whether ingested, injected, or administered in the course of Tx including morphine, Demerol, heroin, dilaudid, Percodan, codeine, lomotil, propoxyphene, pentazocine; for unconsciousness of unknown etiology to rule out/reverse narcotic depression of CNS

Contraindications – Hypersensitivity, absence of indication

Drug interactions – May induce narcotic withdrawal

Administration – Adult [0.4mg-2.0mg] IV/IO/IM/SQ/ET (2.0mg total dose) may be repeated every 2-3 minutes if needed [2mg] IN (1mg per naris); Pediatric [0.1mg/kg] <5yrs or <= 20kg [2mg] >=5yrs or >20kg IV, ET, IM, SQ, IO may be repeated at 0.1mg/kg if no response; Neonate [0.1mg/kg] slow IVP, ET, IM, SQ, IO repeat in 2-3 minutes if needed (mix 1mL of naloxone (.4mg) in 9mL of D5W which gives .04 mg/ml)

Notes – Patient may quickly become conscious and combative, much higher doses should be given to patients with suspected propoxyphene, pentazocine, and fentanyl OD

Question 18

Hydromorphone

Answer 18

Names – Dilaudid

Class – Opiate analgesic

Indications – Analgesia for patients with moderate to severe pain

Contraindications – Hypersensitivity, hypotension is a relative contraindication to use, head/abd injuries contraindicated, do not use with respiratory compromise, do not use in hemodynamically unstable patients

Drug interaction – Additive effects with other CNS depressants, MAO inhibitors can cause unpredictable and severe reactions reduce dose to 25% of usual dose

Administration – Adult [0.5-1.0mg] slow IV/IOP until desired effect achieved; Pediatrics (not recommended)

Notes – Take vitals before and 2 minutes after administration, IV/IO only (unless ordered to administer IM), often causes vomiting, online medical control should be contacted before administering to non-cardiac patient

Question 19

Fentanyl

Answer 19

Names – Sublimaze

Class – Opiate analgesic

Indications – Analgesia for patients with moderate to severe pain

Contraindications – Hypersensitivity/known intolerance, pts particularly sensitive to respiratory depression, myasthenia gravis, pregnancy

Drug interaction – Benzodiazepines Diazepam (increased risk of CV depression), sedatives/hypnotics/other opiods/CNS depressants and ETOH (increased risk of hypotension), avoid use in pts who have received MAO inhibitors within 14 days (may produce unpredictable, potentially fatal reactions)

Administration – Adult [25-50mcg] IV/IO; Pediatric [0.5-1mcg/kg] IV/IO (2-12 yoa)

Notes – Use cautiously in geriatric or debilitated patients, diabetics, patients with pulmonary/hepatic disease, head trauma, increased ICP, undiagnosed abd pain and cardiac disease; abd distension, muscle rigidity, and /or urinary retention may be seen at high doses

Question 20

Morphine Sulfate

Answer 20

Class – Opiate Analgesic

Indications – Analgesia for patients with moderate to severe pain

Contraindications – Hypersensitivity, hypotension is relative contraindication to use, head/abd injuries, do not use in pts respiratory or hemodynamically unstable

Drug interactions – Additive effects with other CNS depressants, MAO inhibitors can cause unpredictable and severe reactions, reduce dose to 25% of usual dose

Administration – Adult [2-10mg] slow IVP until desired effect achieved; Pediatric [0.05-0.1mg/kg] slow IV/IO titrated to effect

Notes – Take vitals before and 2 minutes after administration, IV/IO only (unless ordered to administer IM), often causes vomiting (administer slowly), online medical control should be contacted before administering to the non-cardiac patient

Question 21

Nitroglycerin

Answer 21

Class – Anti-angina agent/vascular dilating agent

Indications – Chest pain/angina pain, congestive heart failure with severe pulmonary edema

Contraindications – Hypersensitivity, severe hypotension, pericardial tamponade, increased intracranial pressure, hypovolemia/severe anemia

Drug interaction – Additive hypotension with beta-adrenergic blockers, anti-hypertensives, Ca-channel blockers, and phenothiazines; tricyclic anti-depressants and anti-histamines may interfere with buccal absorption, can cause a lethal drop in blood pressure in patients taking sildenafil citrate (Viagra) within 48 hours

Administration – Adult [0.3-0.4mg] tablet, repeat at 3-5 minutes as needed for 3 total tabs (or more per MCEP); Lingual spray [0.4mg] metered dose, sprayed directly under the tongue, additional sprays every 3-5 minutes for total of three sprays (or more per MCEP); Pediatric (not recommended for pre-hospital use)

Notes – Common side effects may include: throbbing headache, flushing dizziness, and burning under the tongue (with these sx pills may be assumed potent, not outdated); less common effect, marked hypotension esp. orthostatic; medics should use their supply of nitro (not patients); use with caution for first time users; generalized vasodilation may cause profound hypotension and reflex tachycardia; NTG tabs lose potency easily, NTG spray doesn’t have this problem; use only with med control on patients with systolic BP below 100mmHG

Question 22

Oxygen

Answer 22

Class – Class III Gas, Oxidizer

Indications – Suspected hypoxia/respiratory distress of any cause; acute chest pain with MI suspected; shock from any cause; trauma; carbon monoxide poisoning

Contraindications – None

Drug Interaction – None

Administration (low flow) – Nasal Cannula 1-2L/min (patients with chronic lung disease with unusual dyspnea or other problems

Administration (moderate fow) – NC 4-6L/min (precautionary use for trauma, chest pain, etc.)

Administration (high flow) – NRB 10-15 LPM (severe respiratory distress, either medical or traumatic, shock, or at providers discretion

Notes – If pt is not breathing adequately on their own, tx of choice is supplemental ventilation not just supplemental O2; administration of 02 in certain chronic lung disease pts may cause respiratory depression (be prepared to assist ventilation, do not withhold); Oxygen toxicity is not a hazard from acute administration; nasal prongs work equally well on nose and mouth breathers; giving 100% O2 to all pts is unnecesasry

Question 23

Potassium

Answer 23

Class – Electrolyte

Indications – IV preparations are used for treatment or prophylaxis of hypokalemia

Contraindications – Severe renal impairment, hyperkalemia, untreated Addison’s disease, severe tissue trauma

Drug interaction – None

Administration – Adults Eq/hour] IV/IO; Pediatrics [2-3 mEq/kg/day] IV

Notes – Cardiac monitoring required, EMT-I cannot transport with doses exceeding 20mEq/1000mL

Question 24

Pralidoxime

Answer 24

Names – 2PAM

Class – Cholinesterase re-activator

Indications – Organophosphate pesticide or nerve agent poisoning after atropine has been administered; unknown cholinesterase inhibitor poisoning

Contraindications – (Relative) Myasthenia gravis, renal failure (Absolute) inability to perform endotracheal intubation if neuromuscular blockade were to occur

Drug interaction – None

Administration – Adult [600mg] IM by auto injector, repeat 3-5 minutes after first dose if symptoms not resolved;

Notes – Neuromuscular blockade, laryngospasm, muscular rigidity, and tachycardia have occurred with rapid IV administration, or with doses much higher than those usually administered; will not work for pesticides of the carbamate class; morphine, aminophylline, succinylcholine, and phenothiazine-type tranquilizers should be avoided in patients with organophosphate poisoning; must be given concurrent with atropine

Question 25

Vaccines

Answer 25

Types – DPT, TT, DT, DTP/DTaP, Hep B, Hep A, MMR, OPV, Poliomyelitis, Inactivated, Salk, Pneumoccoccal, Varicella, TB Skin testing