Drugs Flashcards
Oxygen
Class:
Naturally occurring atmospheric gas.
Description:
Oxygen is an orderless, tasteless, colorless gas that is present in room air at a concentration approx. 21%. It is an important emergency drug that is used to reverse hypoxemia; in doing so, it helps oxidize glucose to produce ATP and helps reduce the size of infracted tissue during an AMI.
Indications:
Confirmed or suspected hypoxia, Ishemic chest pain, respiratory insufficiency, Prophylactically during air transport, confirmed or suspected carbon monoxide poisoning and other causes of decreased tissue oxygenation (cardiac arrest)
Contraindications:
Oxygen should never be withheld in any critical patient.
Adverse Reactions:
High concentration oxygen may cause decrease LOC and respiratory depression in patients with chronic dioxide retention.
Dosage:
Adult - High concentration 10-15 L/min via non-rebreather mask or high-flow oxygen delivery device. Low concentration 1-4 L/min via nasal cannula; Venturi mask concentrations 24%, 28%, 32%, 36%
Peds - same as adult
Nitropaste (Nitro-Bid Ointment)
Class: Vasodilator
Description: Nitro paste contains a 2% solution of nitroglycerin in an absorbent paste.
Indications: Angina pectoris, Chest pain associated with AMI (less easily titrated than IV nitroglycerin)
Contraindications: Hypersensitivity, Hypotension, Head Injury, Cerebral hemorrhage
Adverse Reactions: Transient headache, Postural syncope, Reflex tachycardia, Hypotension, Nausea/Vomiting, Allergic reactions
Dosage:
Adult: Apply 1-2 inches over 2-4 inch area of skin that is free of hair; cover with transparent wrap and secure with tape.
Peds: Not recommended
How Supplied: 20 to 60 gm tubes of 2% nitroglycerine paste.
Naloxone (Narcan)
Class:
Opioid antagonist
Description:
Naloxone is a competitive antagonist that is used in the management of known or overdose caused by narcotics. Naloxone antagonizes all actions of morphine.
Indications:
For complete or partial reversal of CNS and respiratory depression induced by Opioids including the following - Narcotics agonist: Morphine sulfate, Heroin, Hydromorphone, Methadone, Meperidine, Paregoric, Fentanyl citrate, Oxycodone, Codeine, Propoxyphene, Narcotic agonist/antagonist; Pentazocine, Nalbuphine, Decreased level of consciousness, Coma of unknown origin, Circulatory support in refractory shock (investigational), PCP and alcohol ingestion (investigational).
Contraindication:
Hypersensitivity, use with caution in narcotic-dependent patients who may experience withdrawal syndrome (including neonates of narcotic-dependent mothers)
Adverse Reactions:
Tachycardia, Hypertension, Dysrhyhmias, Nausea and vomiting, Diaphoresis, Blurred vision, Withdrawal (opiate)
Dosage:
Adult - Begin with 0.4 - 2 mg IV/IM/SQ or ET diluted. May be repeated in 5 minute intervals to max of 10mg
Infusion:
Mix 8 mg in 1000ml of D5W; infuse at 2/3 of initial reversal dose titrated to desired effect
PEDS - 1mg IV/IO/SQ/ET diluted
How Supplied:
0.4mg/ml (1ml, 10ml) 1 mg/ml (2ml) vials
Nitroglycerin (Nitrostat and others)
Class:
Vasodilator
Description:
Nitrates and nitrites dilate arterioles and veins in the periphery. The resultant reduction in preload, and to a lesser extent in afterload, decreases the workload of the heart and lowers myocardial oxygen demand. Nitroglycerin is a very lipid soluble and is thought to enter the body from the GI tract through the lymphatic, rather than the portal blood.
Indications:
Ischemic chest pain, Pulmonary hypertension, CHF, Hypertensive emergencies
Contraindications:
Hypersensitivity, Hypotension, Head injury, Cerebral hemorrhage
Adverse Reaction:
Transient headache, Reflex tachycardia, Hypotension, Nausea/Vomiting, Postural syncope, Diaphoresis
Dosage:
Adult:
Tablet: (0.15-0.6 mg SL; may be repeated in 5 min two times)
Metered Spray: Spray onto oral mucosa (0.4 mg/spray) may be repeated two times
Infusion: 200-400 mcg/ml @ rate of 10-20 mcg/ml increase by 5-10 mcg/min every 5-10 min until desired effect is achieved
How Supplied:
0.15 mg (1/400 gr) 0.3 (1/200 gr) tablets
Oxytocin (Pitocin)
Class:
Pituitary Hormone
Description:
Oxytocin means “rapid birth” and is a synthetic hormone named for the natural posterior pituitary hormone. It stimulates uterine smooth muscle contractions, and helps expedite the normal contractions of a spontaneous labor. As with all significant uterine contractions, there is a transient reduction in uterine blood flow. Oxytocin also stimulates the mammary glands to increase lactation, without increasing the production of milk. The drug is administered in the prehospital setting to control post-partum bleeding.
Indications:
Postpartum hemorrhage after infant and placental delivery.
Contraindications:
Hypertonic or hyperactive uterus, Presence of a second fetus, Fetal distress
Adverse Reactions:
Hypotension, Tachycardia, Hypertension, Dysrhythmias, Angina pectoris, Anxiety, Seizures, Nausea and vomiting, Allergic reaction, Uterine rupture
Dosage:
IM 3-10 units IM following delivery of placenta, Bleeding following incomplete or elective abortion
IV mix10 units (1 ml) in 1000ml NS or LR; infuse @ rate 20-30 drops/min via microdrip, titrate to severity of bleeding and uterine response.
How Supplied:
10 USP units/1 ampule (10 U/ml) prefilled syringe
5 USP units/1 ml ampule (5 U/ml) and prefilled syringe
Reteplase (Retavase)
Class:
Thrombolytic
Description:
Reteplase is recombinant Plasminogen activator. Thrombolytic action occurs by generating plasmin from Plasminogen that degrades the fibrin matrix of thrombus. The drug is used in the management of AMI in adults, for the improvement of function following AMI, and for a reduction in the incidence of CHF. Treatment with Reteplase should be initiated as soon as possible after the onset of AMI symptoms.
Indications:
Management of AMI in adults (must be confirmed with 12-lead ECG)
Contraindications:
Active internal bleeding, History of stroke, Recent intracranial or intraspinal surgery or trauma, Intracranial neoplasm, AV malformation, Aneurysm, Bleeding disorder, Severe uncontrolled hypertension
Adverse Reaction:
Hypotension, Bleeding (internal and at superficial sites), Reperfusion dysrhythmias, Allergic Reaction, Nausea/Vomiting
Dosage
Adult: Administer as 10+10 U double-bolus injection. Each bolus administered over 2 min. (Second bolus given 30 min after the first bolus). Heparin and aspirin should be administered concomitantly.
Peds: Safety not established
How Supplied:
Supplied in a kit single use vials 10.8 units each.
Procainamide
Class:
Antidysrhthmic (Class I-A)
Description:
Procainamide suppresses Phase 4 depolarization in normal ventricular muscle and Purkinje fibers, reducing the automaticity of ectopic pacemakers. It also suppresses reentry dysrhythmias by slowing intraventricular conduction. Procainamide may be effective in treating PVCs and recurrent ventricular tachycardia that cannot be controlled with Lidocaine.
Indications:
Suppressing PVCs refactory to Lidocaine, Suppressing VT (w/pulse) refractory to Lidocaine, Suppressing VF refactory to Lidocaine, PSVTs with wide complex tachycardia of unknown origin
Contraindications:
Second and third degree AV block (w/o functioning artificial pacemaker), Digitalis toxicity, Torsades de pointes, Complex heart block, Tricyclic antidepressant toxicity.
Adverse Reaction:
Hypotension, Bradycardia, Reflex tachycardia, AV block, Widened QRS, Prolonged P-R or Q-T interval, PVCs, VT, VF, Asystole, CNS depression, Confusion, Seizure.
Dosage:
Adult: 20mg/min (30 mg/min refractory ventricular fibrillation) slow IV infusion (max total 17mg/kg; max dose usually 1 g) Maintenance Infusion (after resuscitation from cardiac arrest) Mix 1 gm in 250 mL solution (4 gm/mL), infuse @ 1-4 gm/min
PEDS: Not recommended in the prehospital setting
How Supplied:
1 gm in 10 mL vial; 1 gm in 2 ML vial for infusion
Phenytoin (Dilantin)
Class:
Anticonvulsant
Description:
Phenytoin is a drug of choice in controlling grand mal and focal motor seizure activity. It was developed as an alternative anticonvulsant that would cause less sedation than barbiturates. Phenytoin appears to inhibit the spread of seizure activity by promoting sodium efflux from neurons, thereby stabilizing the neuron’s threshold against excitability caused by excess stimulation. Phenytoin has also been used to treat digitalis induced atrial and ventricular dysthymias by stabilizing the sodium influx in the Purkinje fibers of the heart, decreasing abnormal ventricular automaticity, and increasing AV node conduction.
Indications:
Major motor seizures (generalized grand mal, simple partial and complex partial seizures), Adams-Stokes syndrome.
Contraindications:
Hypersensitivity, Sinus bradycardia, Second and third degree heart block, Sinoatrial block
Adverse Reactions:
Hypotension with rapid IV push, Cardiovascular collapse (w/rapid IV push), Dysrhythmias, Bradycardia, Respiratory depression, CNs depression, Ataxia, Nystagmus, Thrombophlebitis, Nausea/vomiting, Pain from injection site.
Dosage:
Seizures:
Adults: 100mg or 15-20 mg/kg (usually loading dose) slow IV; not to exceed 1 g or rate of 50 mg/min; following by 100-150 mg/dose at 30 min intervals
Peds: 10-20 mg
How Supplied:
50 mg/mL in 2 and 5 mL ampules, 2 mL Prefilled syringes
Paneuronium (Pavulon)
Class: Neuromuscular Blocker (non-depolarizing)
Description:
It produces complete muscular relaxation by binding to the receptor for acetylcholine at the neuromuscular junction, without initiating depolarization for the muscle membrane. As the concentration of acetylcholine rises in the neuromuscular junction, Pancuronium is displaced and muscle tone is regained. Neuromuscular blocking agents are used to provide muscle relaxation during surgery without general anesthesia, and to prevent convulsive muscle spasms during electroconvulsive therapy. In emergency care, it is used to optimize conditions for endotracheal intubation and assisted ventilations.
Indications:
Induction or maintenance of paralysis after intubation to assist ventilations
Contraindications:
Known hypersensitivity to the drug. Inability to control airway and/or support ventilations with oxygen and positive pressure. Neuromuscular disease (e.g. myasthenia)
Adverse Reactions:
Transient hypotension, Tachycardia, Dysrhythmias, Hypotension, Excessive salivation, Pain, Burning at IV injection site.
Dosage:
Adult:
0.04-0.1 mg/kg slow IV; repeat every 30-60 min prn
Peds:
0.04-0.1 mg/kg slow IV (newborn 0.02mg/kg/dose)
How Supplied:
1,2 mg/mL, 4mg/2mL
Propranolol (Inderal)
Class:
Beta adrenergic blocker, Antidysrhythmic (Class II)
Description:
Propranolol is a nonselective beta adrenergic blocker that inhibits chronotropic, inotropic, and vasodilator response to beta adrenerfic stimulation. It slows the sinus rate, depresses AV conduction, decreases cardiac output, and reduces blood pressure. In addition, propranolol decreases myocardial oxygen demand, and reduces the risk of sudden death inpatients with AMI.
Indications:
Hypertension, Angina pectoris, VT, VF, and rapid supraventricular dysrhythmias refractory to other therapies.
Contraindications:
Sinus bradycardia, Second- or Third-degree AV block, Asthma, Cardiogenic shock, Pulmonary edema, Uncompensated CHF, COPD (relative)
Adverse Reactions:
Bradycardia, Heart blocks, Bronchospasm (in susceptible person), Dyspnea, Dizziness, Weakness, Nausea/Vomiting, Visual disturbance
Dosage: Adult: 1-3mg IV over 2-5 min (not to exceed 1 mg/min); can be repeated after 2 min (total dose of 0.1 mg/kg) Peds: Not recommended
How Supplied:
1mg/mL vials
Promethazine (Phenergan)
Class:
Phenothiazine, Antihistamine
Description:
Promethazine is an H1 receptor antagonist that blocks the actions of histamine by competitive antagonism at the H1 receptor. In addition to antihistamine effects, it also possesses sedative, anti-motion, anti-emetic, and considerable anti-cholinergic activity. It is often administered with analgesics, particularly narcotics, to potentiate their effects, though the occurrence of potentiation is controversial.
Indications:
Nausea, vomiting, motion sickness, Pre and Post operative, obstetric sedation, to potentiate the effects of analgesics.
Contraindications:
Hypersensitivity, comatose states, CNS depression from alcohol, barbiturates, or narcotic, signs associated with Reye’s syndrome
Adverse Reactions:
Sedation, Dizziness, May impair mental and physical ability, allergic reactions, dysrhythmias, Nausea/vomiting, hyperexitability, dystonias, Use in children may cause hallucinations, convulsions, and sudden death
Dosage: Adult: 12.5-25 mg IV or deep IM Peds: Not indicated in the prehospital setting
How supplied:
25, 50 mg/mL in 1 mL ampules and Tubex syringes
Nalmefene (Revex)
Class:
Opioid antagonist
Description:
Nalmefene is a competitive opioid antagonist used in the management of known or suspected opioid overdose, including respiratory depression included by either natural or synthetic opioids.
Indications:
For the complete or partial reversal of CNS and respiratory depression induced by opioids
Contraindications:
Hypersensitivity, use with caution in narcotic dependent patients
Adverse Reactions:
Tachycardia, hypertension, dysrhythmias, nausea/vomiting. diaphoresis, blurred vision, withdrawl (opiate)
Dosage: Adult: 0.5-1.0 mg/70kg may be repeated once in 2-5 minutes Peds safety not established
How Supplied:
100 mcg/mL or 1 mg/mL
Nalbuphine (Nubain)
Class:
Opioid analgesic
Description:
Nalbuphine is a synthetic analgesic with a potency equivalent to morphine sulfate on a milligram-to-milligram basis, It has both agonist and antagonist properties. Nalbuphine may be used for treating chest pain associated with MI as it reduces oxygen needs of the heart without reducing blood pressure. Nalbuphine is not presently regulated under the Controlled Substance Act.
Indications:
Chest pain associated with myocardial infarction, Moderate to severe acute pain, Pulmonary edema; with or without associated pain (morphine is first-line medication in this class)
Contraindications:
Hypersensitivity to narcotics, Hypovolemia, Hypotension, Head injury or undiagnosed abdominal pain
Adverse Reactions:
Sedation (most common), Hypotension, Bradycardia, Facial flushing, Respiratory depression, CNS depression, Euphoria, Paradoxical CNS stimulation, Blurred vision
Dosage: Adult: 2-5 mg Slow IV (may be augmented with 2 mg doses prn; every 3-6 hr) Peds: Not recommended
How Supplied:
10 mg in 1 mL ampule; 20 mg in 1 mL ampule
Morphine Sulfate (Astramorph/ PF and others)
Class:
Opioid analgesic
Description:
MS is a natural opium alkaloid that has a primary effect of analgesia. It also increases peripheral venous capacities and decreses venous return. MS causes euphoria and respiratory and CNS depression. Secondary pharmacologic effects of MS include depressed responsiveness of alpha adrenergic receptors and baroreceptor inhibition. In addition, because MS decreases both preload and afterload, it may decrease myocardial oxygen demand. The properties of this medication make it extremely useful in emergency care. MS is a schedule II drug.
Indications:
Chest pain associated with myocardial infarction, Pulmonary edema w/ or w/o associated pain, Moderate to severe acute and chronic pain.
Contraindications:
Hypersensitivity to narcotics, Hypovolemia, Hypotension, Head injury or undiagnosed abdominal pain, Increased ICP, Severe respiratory depression, Patients who have taken MAO inhibitors within 14 days
Adverse Reactions:
Hypotension, Tachycardia, Bradycardia, Palpitations, Syncope, Facial flushing, Respiratory depression, Euphoria, Bronchospasms, Dry mouth, Allergic reaction
Dosage
Adult:
1-3 slow IV over 1-5 min; titrated to effect
Peds
0.1-0.2 mg/kg/dose IV (max 15 mg total dose)
How Supplied:
10 mg of solution in ampules and Tubex syringes
Midazolam Hydrochloride (versed)
Class:
Short-acting benzodiazepine
Description:
Midazolam HCL is a water-soluble benzodiazepine that may be administered for conscious sedation to relieve apprehension or impair memory prior to tracheal intubation or cardioversion
Indications:
Premedication for tracheal intubation or cardioversion
Contraindications:
Hypersensitivity to Midazolam, Glaucoma (relative), Shock, Coma, Alcohol intoxication (relative; may be used for alcohol withdrawal), Depressed vital signs, Concomitant use of barbiturates/alcohol/narcotics/or other CNS depressants
Adverse Reactions:
Respiratory depression, Hiccough, Over-sedation, Pain at the injection site, Nausea/vomiting, Headache, Blurred vision, Fluctuations in vital signs, Hypotension, Respiratory arrest.
Dosage:
Adult:
1-2.5 mg slow IV (over 2-3 min) may be repeated if necessary in small increments (total max dose not to exceed 0.1 mg/kg)
Peds:
Loading dose 0.05-0.2 mg/kg; then continue infusion 1-2mcg/kg/min
Elderly:
0.5 mg slow IV (max 1.5 mg in a 2 min period)
How Supplied:
2, 5, 10, mL vials (1mg/mL) 1, 2, 5, and 10 mL vials (5 mg/mL)
Methylprednisolone (Solu-Medrol)
Class:
Glucocorticoid
Description:
Methylprenisolone is a sympathetic steroid that suppresses acute and chronic inflammation. In addition, it potentiates vascular smooth muscle relaxation by beta adrenergic agonists, and may alter airway hyperactivity. A newer usage is for reduction of post-traumatic spinal cord edema.
Indications:
Anaphylaxis, Bronchodilator-unresponsive asthma, Shock (controversial), Acute Spinal Cord Injury.
Contraindications:
Use with caution in patients with GI bleeding, diabetes mellitus, severe infection
Adverse Reactions:
Headache, hypertension, sodium and water retention, Hypokalemia, Alkalosis
Dosage: Adult: Variable; usually within the range of 40-125 mg IV, except for spinal cord injury where the initial dose is 30 mg/kg IV bolus followed by an IV infusion of 5.4 mg/kg/hr Peds: 1-2 mg/kg/dose IV
How Supplied:
20, 40, 80 mg/mL
Metaproterenol (Alupent)
Class:
Sympathomimetic, Bronchodilator
Description:
Metaproterenol relaxes the smooth muscles of the bronchial tree and peripheral vasculature by stimulating the Beta2 adrenergic receptors of the sympathetic nervous system.
Indications:
Bronchial asthma, Reversible bronchospasms (bronchitis, emphysema)
Contraindications:
Hypersensitivity, Cardiac dysrhythmias, Tachycardia caused by digitalis toxicity
Adverse Reactions:
Restlessness, Apprehension, Palpitations, Tachycardia, Dysrhythmias, Decreases blood pressure, Coughing, Tremor, Facial flushing, Diaphoresis
Dosage: MDI Adult: 2-3 inhalations every 3-4 hours (2 min between inhalations) max dose of 12 inhalations/day Peds: Same as adult
How Supplied:
MDI 0.65/mg/spray (15 mL inhaler); Solutions: 0.4%, 0.6%, and 5% Syrup; (10mg/mL)
Meperidine (Demerol)
Class:
Opioid analgesic
Description:
Meperidine is a synthetic opioid agonist that works at opioid receptors to produce analgesia and euphoria. Excessive doses can cause respiratory and CNS depression. It has a potential for physical dependence and abuse and is classified as a Schedule II drug.
Indications:
Moderate to severe pain, Preoperative medication, OB analgesia
Contraindications:
Hypersensitivity to narcotics, Patients taking MAO inhibitors or selective reuptake inhibitors, During labor or delivery of a premature infant, Head injury.
Adverse Reactions:
Respiratory depression, Nausea and vomiting, Euphoria Delirium, Agitation, Hallucination, Seizures, Headache, Hypotension, Visual disturbances, Coma, Facial Flushing, Circulatory collapse, Dysrhythmias, Allergic reaction
Dosage:
Adult:
500-1000 mg IM every 3-4 hour as needed; 15-35 mg IV per hour (dosage should be individualized)
Elderly:
25 mg IM every 4 hours as needed
Peds:
1-2 mg/kg/dose IM every 3-4 hour as needed
How Supplied:
25, 50, 100 mg/mL in 1 and 5 mL prefilled syringes and Tubex
Mannitol (Osmitrol)
Class:
Osmotic diuretic
Description:
Because of Mannitol’s osmotic properties, it promotes the movement of fluid from the intracellular into the extracellular space. In emergency care, Mannitol is used in the treatment of head injury to decrease cerebral edema and intracranial pressure.
Indications:
Cerebral edema, other causes of ICP, Rhabdomyolysis, (myoglobinuria), Blood transfusion reaction, Promoting urinary excretion of toxic substances
Contraindications:
Severe hypotension, profound hypovolemia, active intracranial bleeding, dehydration, hyponatremia, severe pulmonary edema or congestion, profound hypovolemia, severe renal disease (Anuria)
Adverse Reactions:
Transient volume overload, Pulmonary edema, Renal failure, CHF, Hypotension (from excessive diuresis), Sodium depletion
Dosage:
Adult:
0.5 g/kg in a 20% solution over 20 min; usual adult dose is 20-200 g/24 hour
Peds:
0.2-0.5 g/kg/dose IV infusion over 30-60 min (max 1 g/kg dose) every 4-6 hours
How Supplied:
250 and 500 mL of 20% solution for IV infusion
Magnesium Sulfate
Class:
Electrolyte, Anticonvulsant
Description:
Magnesium sulfate reduces strained muscle contractions and blocks peripheral neuromuscular transmission by reducing the release of acetylcholine at the myonueural junction. In Emergency care Magnesium sulfate is used in the management of seizures associated with toxemia of pregnancy. Other uses of Magnesium include uterine relaxation, as a bronchodilator after beta agonist and Anticholinergic agents have been used, replaced therapy for magnesium deficiency. Magnesium sulfate is gaining popularity as an initial treatment in the management to TCA or overdose or digitalis toxicity. The drug also is considered as a Class II agent (AHA guidelines) for refractory VF/VT after administration of Lidocaine or bertylium doses.
Indications:
Seizurees of eclampsia (toxemia or pregnancy), Torsades de pointes, Suspected hypomagnesaemia, Refratory ventricular fibrillation
Contraindications:
Heart block or myocardial damage
Adverse Reactions:
Diaphoresis, Facial flushing, Hypotension, Depressed reflexes, hypothermia, Reduced heart rate, Circulatory collapse, respiratory depression, Diarrhea
Dosage: Adult: 1-4g (8-32mEq) IV; maximum dose 1.5 mL/min (max 30-40 g/day) Peds: 20-40 mg/kg IM in 20% solution
SUSPECTED HYPOMAGNESEMIC STATE, OR REFACTORY VF/VT
Adult:
1-2 g (2-4 mL of a 50% solution in 10 mL of D5W over 1-2 min IV, Administer IV push in ventricular fibrillation
Peds:
25-50 mg/kg/dose every 8-12 hour (2-3 doses)
How Supplied:
10%, 12.5%, 50% solution in 40mg, 80mg, 100mg, and 125 mg/mL
Ipratropium (Atrovent)
Class:
Anticholinergic, Bronchodilator
Description:
Ipratropium inhibits interaction of acetylcholine at receptor sites on bronchial smooth muscle, resulting in decreased cGMP and bronchodilation
Indications:
Persistent bronchospasms
Contraindications:
Hypersensitivity to ipratropium, Atropine, Alkaloid, Soybean protein, peanuts
Adverse Reactions:
Nausea/vomiting Coughing, Headache, Tachycardia, Dry mouth, Blurred vision
Dosage: Adult: 1-2 inhalations Peds: Same as adult
How Supplied:
Aerosol 18 mcg/ actuation
Amiodarone (Cordarone)
Class:
Class III Antidysrhythmic
Description:
Amiodarone is a unique Antidysrhthmic agent with multiple mechanisms of action. The drug prolongs duration of the action potential and effective refactory period, and when given short term IV, probable include noncompetitive B-adrenoreceptor and calcium channel blockers.
Indications:
Initial treatment and prophylaxis of frequent recurring VF and hemodynamically unstable VT in patients refactory to other therapy.
Contraindications:
Pulmonary congestion, Cardiogenic shock, hypotension, sensitivity to Amiodarone
Adverse Reactions:
Hypotension, headache, dizziness, bradycardia, AV conduction, abnormalities, flushing, abnormal salivation
Dosage:
Adult:
Loading dose for cardiac arrest 300 mg (6ml) IVP; flush with 10 mL of D5W or NS. Supplemental bolus dose for cardiac arrest 150 mg (3mL) IVP followed by flush. Loading infusion after reestablishment of spontaneous circulation: 360 mg (diluted) over 6 hours. Maintenance infusion: 540 mg (diluted) over 18 hours
Peds:
Safety has not been established
How Supplied:
50 mg/mL vials
Amyl Nitrate
Class:
Coronary vasodilator
Description:
Amyl nitrate is chemically related to nitroglycerin and has been used for many years to treat angina pectoris. It is also effective in the emergency management of cyanide poisoning by causing the oxidation of hemoglobin to the compound methemoglobin. Cyanide preferentially binds methemoglobin, thus freeing hemoglobin to react with oxygen.
Indications: Cyanide poisoning (only until sodium nitrate can be given intravenously)
Contraindications:
None when used for cyanide poisoning, Severe anemia, Hypersensitivity to nitrates
Adverse Reactions:
Hypotension, Tachycardia, Palpitations, Syncope, Headache, Nausea
Dosage
Adult:
Glass ampule should be broken and help under patient’s nostrils and inhaled for 30-60 seconds. 1-6 inhalations from one ampule usually is sufficient
Peds:
Same as adult
How Supplied:
0.3 mL/glass ampule (capsule covered with woven gauze)
Bretylium Tosylate (Bretylol)
Class: Antidysrhythmic (class III)
Description:
Bretylium is an adrenergic neuronal blocking agent that has both adrenergic direct myocardial effects. Although the antidysrhythmic action of Bretylium is poorly understood, like Lidocaine, it has been found to be effective in the treatment of VF and VT. Bretylium prolongs the effective refractory period and therefore produces an increase in ventricular fibrillation threshold, perhaps through post-ganglionic adrenergic blockage. It also causes a transient release of norepinephrine, followed by blocked release and reuptake. At present, its use is reversed for those patients who fail to respond to Lidocaine or other first-line antidysrhythmic.
Indications:
Treatment of VF and VT refractory to Lidocaine
Contraindications:
Digitalis intoxications-induced dysrhythmias
Adverse Reactions:
Vertigo, Vomiting, Dizziness, Syncope, Hypotension, Bradycardia, Increase in PVC’s, Angina pectoralis, Transient Hypertension and tachycardia, lasting approx. 20 minutes.
Dosage
Adult:
5mg/kg rapid IV bolus repeat in 5 minutes at 10mg/kg (max dose 30-35 mg/kg)
Peds:
5mg/kg rapid IV maybe increased to 10 mg/kg (rarely used)
How Supplied:
Parenteral :50 mg/mL in 10 mL vials
Atropine Sulfate (Atropine and others)
Class:
Anticholinergic agent
Description:
Atropine inhibits actions of acetylcholine at post ganglionic parasympathetic receptor sites. Small doses inhibit salivary and bronchial secretions; moderate doses dilate pupils and increases heart rate. Large doses decrease GI motility, inhibit gastric acid secretion, and may block nicotinic receptor sites at the autonomic ganglia and at the neuromuscular junction. Block vagal effects result in increased heart rate and enhanced AV conduction with limited or no inotropic effect. In emergency care, it is primary used to increase the heart rate in life-threatening or symptomatic bradycardia, and to antagonized excess muscarinic receptor stimulation caused by organophosphate insecticides or chemical nerve agents (sarin, soman, etc.)
Indications:
Hemodyamically significant bradycardia, asystole, PEA, Organophosphate or nerve gas poisoning, Bronchospastic pulmonary disorder (exercised-induced).
Contraindications:
Tachycardia, Hypersensitivity to Atropine, Obstructive disease of Gi tract, Obstructive uropathy, Unstable cardiovascular status in acute hemorrhage with myocardial ischemia, Narrow-angle glaucoma, Throtoxicosis.
Adverse Reactions:
Tachycardia, Paradoxical bradycardia when pushed too slowly or when used at doses less than 0.5 mg, Palpitations, Dysrhythmias, Headache, Dizziness, Anticholinergic effects, Nausea/Vomiting, Flushed hot, dry skin, Allergic Reaction.
Dosage: Bradydysrhythmias
Adult:
0.5-1mg, repeated at 5 minute intervals for desired response. (max 0.03-0.04mg/kg)
Peds:
0.02mg/kg Iv, IO, ET (diluted to 3-5mL); min dose 0.1mg; max single dose of 0.5mg for a child and 1.0mg for an adolescent may be repeated in 5 min for a max total dose of 1.0mg for child and 2.0mg for adolescent
Dosage: ASYSTOLE Adult: 1 mg IV, ET (1-2 mg diluted to a total of 10mL) may repeated every 3-5 minutes Peds: Same as for bradydysrhythmias
Dosage: PEA Adult: 1.0mg repeat every 3-5 minutes Peds: Safety and efficiency not established
Dosage: ANTICHOLINERIGIC
Adult:
2mg IV push every 5-15 minutes to dry secretions, repeat as needed, then every 1-4 hours for at least 24 hours
How Supplied:
In emergency care Atropine is supplied in pre-filled syringes containing 1.0mg in 10 mL of solution.
Aspirin (Bayer, ASA, Ecotrin, St. Joseph)
Class:
Analgesic, anti-inflammatory, antipyretic, antiplatelet
Description:
Aspirin blocks pain impulses in the CNS, dilutes peripheral vessels, and decreases platelet aggregation. The use of Aspirin is strongly recommended for all acute MI patients.
Indications:
Mild to moderate pain or fever, prevention of platelet aggregation in ischemia and thromboembolism, unstable angina, prevention of myocardial infarction or rein fraction
Contraindications:
Hypersensitivity, GI Bleed, Active ulcer disease, Hemorrhagic Stroke, Bleeding disorder, children with Flu like symptoms
Adverse Reactions:
Stomach irritation, Heart burn/indigestion, Nausea or vomiting, Allergic reaction
.
Dosage:
Adult:
Mild pain and fever 325-650 mg PO every 4 hours
Myocardial Infarction: 160-325 mg PO (Patients should chew the first one)
Peds:
Mild pain and fever: 40-100 mg/kg/day in divided dosaes
How Supplied: Tablets (65, 81, 325, 500, 650, 975 mg) Capsules ( 325, 500 mg) Controlled Release tablets (800mg) Suppositories (varies from 60 mg to 1.2 gm)
Calcium Chloride
Class:
Electrolyte
Description:
Calcium is an essential component for functional integrity of the nervous and muscular systems, for normal cardiac contractility; and the coagulation of blood. Calcium chloride contains 27.7% element calcium. Calcium chloride is a hypertonic solution and should only be administered intravenously (slowly)
Indications:
Hyperkalemia (except when associated with digitalis toxicity), Hypocalcemia, Calcium channel blocker toxicity, Hypermagesemia, to prevent hypotensive effects of calcium channel blocking agents.
Containdications:
VF during cardiac resuscitation, in patients with digitalis toxicity, Hypercalcemia, Renal or cardiac disease
Adverse Reactions:
Bradycardia, (May cause asystole), Hypotension, Metallic taste, Severe local necrosis and sloughing following IM use or IV infiltration
Dosage:
Adult:
2-4mg/kg (usually 1-2) or 10% solution slow IV; repeat every 10 minutes if necessary
Peds:
20-25%mg/kg of 10% solution slow IV (no faster than 100mg/min) may repeat in 10 min if necessary
How Supplied:
10% solution in 10mL (100mg/mL) ampule, vitals, and pre-filled syringes.
Dexamethasone (Decadron, Hexadrol, and others)
Class:
Glucocorticoid
Description:
Dexamethasone is a synthetic steroid that is chemically related to the natural hormones secreted by the adrenal cortex. The drug suppresses acute and chronic inflammation, potentiates the relaxation of the vascular and bronchial smooth muscle by beta adrenergic agonists, and possibly alters airway hyper-activity. In emergency care, Dexamethasone is generally used in the treatment of allergic reactions, and asthma.
Indications:
Endocrine, rheumatic, hematologic disorders, Allergic states, septic shock, chronic inflammation
Contraindications:
Hypersensitivity, Active untreated infections (relative)
Adverse Reactions:
Hypertension, GI bleeding
Dosage: Adult: This in considerable variance in recommended doses. The usual range in emergency care is 4-24mg IVP. Some physicians may prefer significantly higher doses up to 100 mg, for usual indications. Peds: 0.25-0.5mg/kg/dose IVP or IO
How Supplied:
4 mg/mL in 1, 5, 10, 25, 30 mL vials; 10mg/mL in 10 vials, 1 mL syringe, 1 mL ampule
Digoxin (lanoxin)
Class:
Cardiac Glucoside, Miscellaneous Antidysrhythmic
Description:
Digoxin is a cardiac glucoside derived primarily from the foxglove plant. Its primary action involves alteration of ion transport across cardiac cell membranes. Increased intracellular calcium improves myocardial contractility. Digoxin increases vagal tone and therefore indirectly decreases sinus node rate, reduces sympathetic tone and decreases AV node conduction velocity (with an increases in AV node refractory period). Sodium pumped out of cells may cause increased automaticity.
Indications:
SVTs especially A-Fib and A-flutter, CHF, and Cardiogenic shock
Contraindications:
VF, VT, AV block, Digitalis toxicity, hypersensitivity to digoxin, Second or third degree HB in the absence of artificial pacing
Adverse Reactions:
Headache, weakness, visual disturbances, confusion, seizures, dysrhythmia, nausea/vomiting, skin rash
Dosage
Adult:
0.5 mg slow IV (usually administered in 2-3 doses over 6-12 hours)
Peds:
Older than 2 years old: 0.015-0.035 mg/kg slow IV in divided doses; consult medical direction for dose recommendations in children > 5 years
How Supplied:
In emergency care 2mL ampules containing 0.5mg of the drug (0.25mg/mL)
Pediatric: 0.1 mg/mL
Diazepam (Valium and others)
Class:
Benzodiazepine
Description:
Diazepam is a frequently prescribed medication to treat anxiety and stress. In emergency care, it is used to treat alcohol withdrawal and grand mal seizure activity. Diazepam acts on the limbic, thalamic, and hypothalamic regions of the CNS to potentiate the effects of inhibitory neuromuscular transmitters, raising the seizure threshold in the motor cortex. It may also be used in conscious patients during cardioversion and TCP to induce amnesia and sedation. Its use as an anticonvulsant may be short-lived due to rapid redistribution and excessive sedation, particularly in elderly patients.
Indications:
Acute anxiety, acute alcohol withdrawal, skeletal muscle relaxation, Seizure activity, Premedication prior to countershock ot TCP
Contraindications:
Hypersensitivity to the drug, substance abuse (use with caution), Coma (unless PT has seizures or severe muscle rigidity or myoclonus), Shock, CNS depression as a result of head injury, Respiratory depression
Adverse Reactions:
Hypotension, Reflex tachycardia (rare), Respiratory depression, Ataxia, Psychomotor impairment, Confusion, Nausea
Dosage:
SEIZURE ACTIVITY:
Adult:
5mg over 2 min (up to 10mg for most adults) IV every 10-15 min as needed (maximum dose 30 mg)
Peds:
Dose for infants > 30 days to 5 years is 0.2mg to 0.5mg slow IV every 2-5 min to max 5mg.
How Supplied:
5mg/mL vials, ampules, Tubex
Dextrose 50%
Class:
Carbohydrate, Hypertonic solution
Description:
The term “Dextrose” is used to describe the six carbon sugar d-glucose, the principal form of carbonhydrate utilized by the body. 50% dextrose solution (D50) is used in emergency care to treat hypoglycemia, and in the management of coma of unknown origin.
Indications:
Hyperglycemia, Altered level of consciousness, Coma of unknown etiology, seizure of unknown etiology.
Contraindications:
Intracranial hemorrhage, ICP, Known or suspected CVA in the absence of hypoglycemia
Adverse Reactions:
Warmth, pain, burning from medication infusion, hyperglycemia, thrombophlebitis
Dosage: Adult: 12.5-25 g slow IV; may be repeated once Peds: Dilute 1:1 with sterile water for a concentration of 25% dextrose in water, administer 0.5-1.0 g/kg/dose slow IV; may be repeated once
How Supplied:
25g /50mL prefilled syringe (500mg/mL)
Diltiazem (Cardizem) Injectable
Class:
Slow calcium blocker or calcium channel antagonist
Description:
Diltiazem is a calcium channel blocking agent that slows conduction, increases refractoriness in AV node, and causes coronary and peripheral vasodilation. The drug is used to control ventricular response rate in patients with A-fib or flutter, multifocal atrial tachycardias and PSVT
Indications:
Atrial Fib, Atrial Flutter, PSVTs, and multifocal atrial tachycardias
Containdications:
Sick sinus syndrome, Second or Third degree AV block, hypotension (less than 90 mmHg), Cardiogenic shock, hypersensitivity to Diltiazem, A-fib or A-flutter associated with WPW syndrome or a short PR syndrome, Concomitant use of IV beta blockers, VT, Wide-complex tachycardia of unknown origin, AMI
Adverse Reactions:
A-flutter, first and second degree HB, Bradycardia, hypotension, chest pain, CHF, Peripheral edema, sweating, nausea/vomiting, Dizziness, Dry mouth, Dyspnea, headache
Dosage:
Adult:
Bolus injection: 0.25mg/kg (20 mg for th average PT) IVP over 2 min, every 15 min (0.35 mg/kg; 25 mg for the average patient) IVP over 2-5 min.
Maintenance Infusion: dilute 125 mg(25mL) in 100mL of solution; infuse 5-15 mg/hr titrate to heart rate
Peds:
Similar mg/kg doses as adults (rarely required in Ped Patients)
How Supplied:
25 mg and 50 mg vials
Diphenhydramine (Benadryl)
Class:
Antihistamine
Description:
Antihistamines prevent the physiologic actions of histamine by blocking H1 and H2 receptor sites. The effects of antihistamines are short lived and provide only symptomatic relief. Antihistamines are indicated for conditions in which histamine excess is present, but also are used as adjunct therapy (with Epinephrine) in the treatment of anaphylactic shock. Antihistamines also are effective in the treatment of extrapyramidal reactions and for relief of upper respiratory and sinus symptoms associated with allergic reactions.
Indications:
Moderate to severe allergic reactions (after epinephrine), anaphylaxis, Acute extrapyramidal reactions
Contraindications:
Patients taking monoamine oxidase (MAO) inhibitors, hypersensitivity, narrow angle glaucoma (relative), newborns and nursing mothers
Adverse Reactions:
Dose-related drowsiness, sedation, disturbed coordination, Hypotension, Palpitations, Tachycardia, Bradycardia, Thickening or bronchial secretions
Dosage:
Adult:
25-50 mg IM, IV every 6-8 hours (max 300 mg/day)
Peds:
5 mg/kg/day in divided doses (max 300 mg/day)
How Supplied:
Parenteral: 10, 50 mg/mL vials and prefilled syringes
Dobutamine (Dobutrex)
Class:
Sympathomimetic
Description:
Dobutamine is a synthetic catecholamine that primarily stimulates beta1 adrenergic receptors, and has much less significant effects on beta 2 and Alpha adrenergic receptors. The clinical effects of this drug include positive Inotropic effects with minimal changes in chronotropic activity or systemic vascular resistance. For these reasons, this drug is useful in the management of CHF when an increase in heart rate is not desired.
Indications:
Inotropic support for patients with left ventricular dysfunction
Contraindications:
Tachydysrhythmias, (atrial fibrillation, atrial flutter), severe hypotension
Adverse Reactions:
Headache, Dose-related tachydysrythmias, hypertension, Ventricular ectopy
Dose:
Adult:
2.5-10 mcg/kg/min IV based on inotropic effect; max rate; 40 mcg/kg/min
Peds:
2-20 mcg/kg/min IV/IO, titrated to desired effect
How Supplied:
12.5 mg/mL Injectable
Dopamine (Intropin)
Class:
Sympathomimetic (increases myocardial contraction)
Description:
Dopamine is chemically related to epinephrine and norepinephrine. It acts primarily on alpha1 and beta1 adrenergic receptors in dose dependent fashion. At low doses (renal doses), dopamine acts on dopaminergic receptors causing renal, mesenteric and cerebral vascular dilation. At moderate doses, dopamine stimulates beta adrenergic receptors increasing cardiac contractility, increased cardiac output, and a rise in blood pressure. At high doses, dopamine has alpha adrenergic effect, producing peripheral arterial and venous constriction. Dopamine is commonly used in the treatment of hypotension associated with cardiogenic shock.
Indications:
Hemodynamically significant hypotension in the absence of hypovolemia
Contraindications:
Tachydysrhythmias, Ventricular fibrillation, Patients with pheochromocytoma
Adverse Reactions:
Dose related tachydysrhythmias, Hypotension, Increased myocardial oxygen demand
Dosage: Adult: 1-5 mcg/kg/min IV (titrated to patient responses) Final dose range 5-20 mcg/kg/min is recommended. Dopaminergic response: 1-5 mcg/mg/min Beta Adrenergic response: 5-15 mcg/kg/min. Alpha Adrenergic response: >15 mcg/kg/min Peds: 10 mcg/kg/min IV/IO, titrated to patient response (not to exceed 20 mcg/kg/min)
How Supplied:
200 mg, 400 mg, 800 mg in 5 mL prefilled syringe and ampule
Epinephrine (Adrenalin)
Class:
Sympathomimetic
Description:
Epinephrine is an endogenous catecholamine that directly stimulates Alpha, beta1, and beta2 adrenergic receptors in dose-related fashion. It is the initial drug of choice for treating Bronchoconstriction and hypotension resulting from anaphylaxis as well as all forms of cardiac arrest. It is useful in the management of relative airway disease, but beta adrenergic agents are usually considered the drugs of choice since they are inhaled and have fewer side effects. Rapid injection produces a rapid increase in blood pressure, ventricular contractility, and heart rate. In addition, epinephrine causes vasoconstriction of the skin, mucosa, and spanchnic areas, and antagonizes the effects of histamine.
Indications:
Bronchial asthma, Acute allergic reaction (anaphylaxis), Cardiac arrest; asystole, PEA, VF, and pulseless ventricular tachycardia unresponsive to initial defibrillation, Profound symptomatic bradycardia
Contraindications:
Hypersensitivity, (not an issue especially in emergencies- the dose should be lowered or given slowly in non cardiac arrest patients with heart disease), Hypovolemic shock (as with other catecholamine, correct hypovolemia), Coronary insufficiency (use with caution)
Adverse Reactions:
Headache, Nausea, Restlessness, Weakness, Dysrhythmias (including ventricular tachycardia and ventricular fibrillation) Hypertension, Precipitation of angina pectoris, Tachycardia
Dosage:
ASYSTOLE, PEA, VF, PVT
Adult:
1mg IV push or ET (2-2.5 times the IV dose) repeated every 3-5 min
Peds:
IV/IO 0.1 mL/kg (1:10,000); doses as high as 0.2 mL/kg may be effective ET dose is 0.1 mL/kg (1:1,000) dilutes to 3-5 mL
SUBSEQUENT DOSES:
IV/IO/ET 0.1 mL/kg (1:1,000) every 3-5 min; doses as high as 0.2 mL/kg may be effective
ANAPHYLACTIC REACTIONS OR BRONCHOCONSTRICTION:
Adult:
Mild 0.3-0.5mL (1:1,000) SQ Moderate to Severe 1-2 mL (1:10,000) Slow IV
Peds:
Mild 0.01 mL/kg SQ (1:1,000) Max 0.3 mL Moderate to Severe 0.05-0.15 mcg/kg/min IV infusion
How Supplied:
1mg/mL (1;1,000), 0.1mg/mL (1:10,000) ampule and prefilled syringe. Auto injector Pen (0.5mg/mL (1:2,000))
Epinephrine Racemic (microNEFRIN)
Class:
Sympathomimetic
Description:
As with other forms of Epinephrine, racemic epinephrine acts as a bronchodilator that stimulates beta2 receptors in the lungs, resulting in relaxation of bronchial smooth muscle. This alleviates bronchospasms, increases vital capacity, and reduces airway resistance. It is also useful in treating laryngeal edema, Racemic epinephrine also inhibits the release of histamine.
Indications:
Bronchial asthma, Treatment of bronchospasms, Croup, Laryngeal edema
Contraindications:
Hypertension, underlying cardiovascular disease, epiglottitis
Adverse Reactions:
Tachycardia, dysrhythmias
Dosage: MDI 2-3 inhalations, repeat once in 5 min as needed
Adult:
Dilute 5 mL (1%) in 5 mL saline, administer over 15 minutes
Peds:
Dilute 0.25 mL (0.1%) in 2.5 mL saline (if less than 20 kg); 0.5 mL in 2.5 mL saline (if 20-40 kg); 0.75 mL in 2.5 mL of saline (if greater than 40 kg) administered by aerosolization
How Supplied:
MDI: 0.16-0.25 mg/spray
Solution: 7.5, 15, 30 mL in 1%, 2.25% solution
Glucagon
Class:
Pancreatic hormone, insulin antagonist
Description:
Glucagon is a protein secreted by the alpha cells of the pancreas. When released, it results in blood glucose elevation by increasing the breakdown of glycogen to glucose (glycogenolysis) and stimulating glucose synthesis. The drug is only effective in treating hypoglycemia if live glycogen is available, and may therefore be ineffective in chronic states of hypoglycemia, starvation, and adrenal insufficiency. In addition, glucagon exerts positive inotropic action on the heart and decreases renal vasculature resistance. For this reason it is also used in managing patients with beta-blocker and calcium channel blocker cardiotoxicity who do not respond to saline infusions or other conventional therapy.
Indications:
Persistent hypoglycemia despite glucose supplementation
Contraindications:
Hypersensitivity (allergy to proteins)
Adverse Reactions:
Tachycardia, Hypotension, Nausea/Vomiting
Dosage: Adult: 0.5-1 mg IM; may repeat in 7-10 min Peds: 0.025-1 mg IM; may repeat in 7-10 min
How Supplied:
Dilute 1 unit into 1 mL diluting solution
Furosemide (Lasix)
Class:
Loop diuretic
Description:
Furosemide is a potent diuretic that inhibits the reabsorption of sodium and chloride in the proximal tubule and loop of Henle. Intravenous doses can also reduce cardiac reload by increasing venous capacitance.
Indications:
Pulmonary edema associated with CHF, hepatic or renal disease
Contraindications:
Anuria (though loop diuretics can be used in patients with reduced creatinine clearance), Hypersensitivity, Hypovolemia/dehydration, Hypersensitivities to sulfonamides, Severe electrolyte depletion (hypokalemia)
Adverse Reactions:
Hypotension, ECG changes associated with electrolyte disturbances, Dry Mouth, Hypokalemia, Hyponatremia, Hyperglycemia, Hearing loss can rarely occur after too rapid infusion of large doses especially in patients with renal impairment.
Dosage Adult: 20-40 mg (0.5-1 mg/kg) slow IV over 1-2 min; (not to exceed 20 mg/min); may repeat in 1-2 hours Peds: 1 mg/kg/dose (max 6 mg/kg total dose)
How Supplies:
10 mg/mL in 2, 4, 8 mL ampule, 10 mg/mL in 10 mL vial
Flumazenil (Romanzicon)
Class:
Benzodiazepine receptor antagonist, Antidote
Description:
Flumazenil antagonizes the actions of benzodiazepines in the central nervous system. It has been shown to reverse sedation, impairment of recall, and psychomotor impairment produced by benzodiazepines, Flumazenil is not, however, as effective in reversing hypoventilation. Flumazenil does not antagonize CNS effects of ethanol, barbiturates, or opioids.
Indications:
Reversal of excessive or prolonged benzodiazepine sedation
Contraindications:
Hypersensitivity, Cyclic antidepressant overdose, Cocaine or other stimulant intoxication.
Adverse Reactions:
Nausea, Vomiting, Dizziness, Headache, Agitation, Injection-site Pain, Cutaneous vasodilation, Abnormal vision, Seizures
Dosage Adult: 0.2 mg IV over 30 seconds; an additional dose of 0.3 mg (3 mL) may be given in 30 seconds, followed by 0.5 mg (5 mL) at 1 min intervals (max dose 3 mg) Peds: Not recommended
How Supplied:
5 and 10 mL vials (0.1 mg/mL)
Etomidate (Amidate)
Class:
Non-barbiturate hypnotic, Anesthetic
Description:
Etomidate is a short acting drug that acts at the levels of the reticular activation system to produce anesthesia. Etomidate may be administered for conscious sedation to relieve apprehension or impaired memory prior to tracheal intubation or cardioversion.
Indications:
Premedication for tracheal intubation or cardioversion
Contraindications:
Hypersensitivity to Etomidate, Labor/delivery
Adverse Reactions:
Nausea/vomiting, dysrhythmias, breathing difficulties, hypotension, hypertension, involuntary muscle movement, pain at injection site
Dosage Adult: 0.2-0.6 mg/kg IVP over 30-60 sec Peds: Same as adult (over 10 years of age)
How Supplied:
2 mg/mL vial
Hydralazine (Apresoline)
Class:
Antihypertensive, Vasodilator
Description:
Hydralazine is an arteriolar vasodilating agent that is used in the management of hypertensive crisis. The effects of the drug include a decrease in arterial pressure, a decrease in peripheral resistance, and increase in cardiac output (as result of reflex tachycardia)
Indications:
Hypertensive crisis, Hypertension associated with renal failure, preeclampsia, and eclampsia, Primary pulmonary HTN.
Contraindications:
Compensatory hypertension, Coronary artery disease, Dissecting aneurysm, Hypersensitivity, Mitral Valve/rheumatic heart disease
Adverse Reactions:
Reflex tachycardia, Palpitations, Hypotension, Facial flushing, Headache, Diaphoresis, Anxiety, Nausea/vomiting, Diarrhea
Dosage:
Adult:
10-40 mg IM or IV may be repeated in 10 min prn
Infusion: 20 mg in 250 cc NS or LR at 5-20 mg/hr
Peds:
0.1-0.2 mg/kg/dose every 4-6 hours IM or IV; may be repeated prn
Infusion: 0.75-3 mg/kg every 6-12 hours
How Supplied:
20 mg in 1 mL ampule (20 mg/mL)
Heparin Sodium
Class:
Anticoagulant
Description:
Heparin inhibits the clotting cascade by activating plasma proteins. The drug is used in the prevention and treatment of all types of thrombosis and emboli, DIC, arterial occlusion and thrombophlebitis, and prophylactically to prevent clotting before and after surgery. Heparin is also considered part of the “Thrombolytic package” administered to patients with acute myocardial infarction (along with aspirin and Thrombolytic agents) and acute coronary syndromes including unstable angina and non Q wave myocardial infarction.
Indications:
Acute myocardial infarction, Prophylaxis and treatment of Thrombolytic disorders.
Contraindications:
Hypersensitivity, Active bleeding, Recent intracranial, intraspinal, or eye surgery, severe hypertension, bleeding tendencies, severe thrombocytopenia
Adverse Reactions:
Allergic reaction, Thrombocytopenia, Hemorrhage, Bruising
Dosage:
Always obtain a blood sample for control of partial thromboplastin time before heparin administration. Heparin doses range from 100-500 Units (follow medical direction and local protocol)
How Supplied:
10, 100, and 100-400 U/mL
Hydroxyzine (Atarax, Vistaril)
Class:
Antihistamine
Description:
Hydroxzine is a H1 receptor antagonist that is used to treat allergy-induced pruritus, and is used preoperatively for its antiemetic and sedative properties. It is also effective for treatment of anxiety and tension associated with neuroses and alcohol withdrawal. Concomitant use with analgesics may potentiate their effects.
Indications:
To potentiate the effects of analgesics, Nausea and vomiting, Anxiety reactions, Motion sickness, Alcohol withdrawal, Pruritus
Adverse Reactions:
Dry mouth, Drowsiness
Dosage Adult: 25-100 mg deep IM Peds: 1.0 mg/kg/dose deep IM
How Supplied:
25 and 50 mg/mL in 1 mL vials
Insulin (Regular, NPH, Ultralente, and Others)
Class:
Antidiabetic agent
Description:
Insulin is secreted by the beta cells (islets of Langerhans) of the pancreas and is required for proper glucose utilization by the body. If insulin secretion is diminished (diabetes mellitus) supplemental insulin must be obtained by injection. Insulin preparations are classified as rapid acting (regular) intermediate (NPH) and long acting (Ultralente). Insulin is seldom is administered in the prehospital setting, and then only when ketoacidosis is confirmed.
Indications:
Type I, Type II, Diabetic ketoacidosis, Nonketotic hypermolar coma, Insulin and D50 are given together to lower K levels in hyperkalemia
Contraindications:
Hypoglycemia
Adverse Reactions:
Hypoglycemia, fatigue, weakness, confusion, headache, tachycardia, rapid shallow breathing
Dosage Adult: 10-20 units Peds: 0.1-0.2 units/kg/hr IM
How Supplied:
100 units/mL in 10 mL vials
