Drugs Flashcards

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0
Q

Oxygen

A

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

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1
Q

Nitropaste (Nitro-Bid Ointment)

A

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.

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2
Q

Naloxone (Narcan)

A

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

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3
Q

Nitroglycerin (Nitrostat and others)

A

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

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4
Q

Oxytocin (Pitocin)

A

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

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5
Q

Reteplase (Retavase)

A

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.

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6
Q

Procainamide

A

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

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7
Q

Phenytoin (Dilantin)

A

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

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8
Q

Paneuronium (Pavulon)

A
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

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9
Q

Propranolol (Inderal)

A

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

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10
Q

Promethazine (Phenergan)

A

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

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11
Q

Nalmefene (Revex)

A

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

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12
Q

Nalbuphine (Nubain)

A

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

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13
Q

Morphine Sulfate (Astramorph/ PF and others)

A

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

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14
Q

Midazolam Hydrochloride (versed)

A

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)

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15
Q

Methylprednisolone (Solu-Medrol)

A

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

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16
Q

Metaproterenol (Alupent)

A

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)

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17
Q

Meperidine (Demerol)

A

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

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18
Q

Mannitol (Osmitrol)

A

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

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19
Q

Magnesium Sulfate

A

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

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20
Q

Ipratropium (Atrovent)

A

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

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21
Q

Amiodarone (Cordarone)

A

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

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23
Q

Amyl Nitrate

A

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)

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24
Q

Bretylium Tosylate (Bretylol)

A
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

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25
Q

Atropine Sulfate (Atropine and others)

A

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.

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26
Q

Aspirin (Bayer, ASA, Ecotrin, St. Joseph)

A

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)
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27
Q

Calcium Chloride

A

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.

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28
Q

Dexamethasone (Decadron, Hexadrol, and others)

A

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

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29
Q

Digoxin (lanoxin)

A

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

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30
Q

Diazepam (Valium and others)

A

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

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31
Q

Dextrose 50%

A

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)

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32
Q

Diltiazem (Cardizem) Injectable

A

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

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33
Q

Diphenhydramine (Benadryl)

A

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

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34
Q

Dobutamine (Dobutrex)

A

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

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35
Q

Dopamine (Intropin)

A

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

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36
Q

Epinephrine (Adrenalin)

A

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))

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37
Q

Epinephrine Racemic (microNEFRIN)

A

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

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38
Q

Glucagon

A

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

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39
Q

Furosemide (Lasix)

A

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

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40
Q

Flumazenil (Romanzicon)

A

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)

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41
Q

Etomidate (Amidate)

A

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

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42
Q

Hydralazine (Apresoline)

A

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)

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43
Q

Heparin Sodium

A

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

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44
Q

Hydroxyzine (Atarax, Vistaril)

A

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

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45
Q

Insulin (Regular, NPH, Ultralente, and Others)

A

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

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46
Q

Isoproterenol (Isuprel)

A

Class:
Sympathomimetic

Description:
Isoproterenol is a sympathetic catecholamine that stimulates both beta1 and beta2 adrenergic receptors (no alpha receptor stimulation). The drug affects the heart by increasing inotropic and chronotropic activity. In addition, Isoproterenol causes arterial and bronchial dilation, and is sometimes administered via aerolizaion as a bronchodilator to treat bronchial asthma and bronchospasms.

Indications:
Hemodynamically significant bradycardias unresponsive to atropine, TCP, Dopamine, and Epinephrine, Management of torsades de pointes

Contraindications:
Ventricular tachycardia, Ventricular fibrillation, Hypotension (relative), Pulseless idioventricular rhythm, Ischemic heart disease/angina (relative), Cardiac arrest

Adverse Reactions:
Dysrhythmias, Hypotension, Precipitation of angina pectoris, Facial flushing, Restlessness, Dry throat, Discoloration of saliva (pinkish-red)

Dosage
Adult:
Dilute 1 mg in 250 mL D5W (4mg/mL); infuse at 2-20 mcg/min or until the desired heart rate is obtained

Peds:
Dilute 0.6 mg/kg to create solution of 100mL; begin infusion at 5 mL/hr (0.5 mcg/kg/min), titrate to patient response

How Supplied:
5 mL (0.2 mg/mL) vial; 0.02 mg/mL in 1 and 10 mL vials
47
Q

Lorazepam (Ativan)

A

Class:
Benzodiazepine

Description:
Lorazepam is a benzodiazepine with antianxiety and anticonvulsant, skeletal muscle relaxant, anxiety reducing, amnesic and sedative effects. When given by injection, it appears to suppress the propagation of seizure activity produced by foci in the cortex, thalamus, and limbic areas.

Indications:
Seizure, Sedation for painful procedures or injuries or combative patients. Post RSI sedation.
Agitation requiring sedation, Initial control of status epilepticus or severe recurrent seizures (investigation).

Contraindications:
Hypersensitivity to the drug, Substance abuse (relative), Coma (unless seizing), Severe hypotension, Shock, Pre-existing CNS Depression

Adverse Reactions:
Respiratory depression, Tachycardia/Bradycardia, Hypotension, Sedation, Ataxia, Psychomotor impairment, Confusion, Paradoxical excitement or agitation may occur. Use with caution in the presence of other sedating agents; alcohol, barbiturates, benzodiazepines, or opiates.

Dosage
Prior to IV administration, Lorazepam must be diluted with an equal volume of sterile water or sterile saline. When given IM, Lorazepam is not to be diluted.

Adult:
1-4 mg slow IM/IV over 1-2 min; may be repeated in 15-20 min to max dose of 8 mg

Peds:
(Not FDA approved) 0.05-0.15 mg/kg slow IV/IO/IM over 2 min; may be repeated once in 5-10 min, max dose 4 mg

How Supplied:
2 and 4 mg/mL concentrations in 1 mL vials

48
Q

Labetalol (Normodyne, Trandate)

A

Class:
Alpha and Beta Adrenergic blocker

Description:
Labetalol is a competitive alpha1 receptor block as well as a nonselective beta receptor blocker that is used for lowering blood pressure in hypertensive crisis. Because of alpha and beta blocking properties, blood pressure is reduced without reflex tachycardia, and total peripheral resistance is decreased without a significant alteration in cardiac output. In emergency care, Labetalol is administered intravenously.

Indications:
Hypersensitive emergencies

Contraindications:
Bronchial asthma (relative), Uncompensated CHF, Second and third degree heart block, Cardiogenic shock, Bradycardia, Pulmonary edema

Adverse Reactions:
Headache, dizziness, edema, fatigue, vertigo, ventricular dysrhythmias, dyspnea, allergic reaction, facial flushing, diaphoresis, dose related orthostatic hypotension (most common)

Dosage
Adult:
10-20 mg IV over 1-2 min. May repeat or double every 20 min to max dose of 150 mg
Infusion:
Mix 200 mg in 250 D5W (0.8mg/mL); infuse at rate of 2 mg/min, titrated to supine blood pressure
Peds:
Safety not established

How Supplied:
5 mg/mL in 4, 8, 20 and 40 vitals

49
Q

Lidocaine (Xylocaine)

A

Class:
Antidysrhythmic (Class I-B) Local anesthetic

Description:
Lidocaine decreases Phase 4 diastolic depolarization, and has been shown to be effective is suppressing PVCs. In addition, it is used to treat ventricular tachycardia and some cases of ventricular fibrillation. Lidocaine also raises the ventricular fibrillation threshold.

Indications:
Ventricular tachycardia, Ventricular fibrillation, Wide-complex tachycardia of uncertain origin, Significant ventricular ectopy in the setting of myocardial ischemia/infarction.

Contraindications:
Hypersensitivity, Adams-Stokes syndrome, Second- or Third-degree heart block in the absence of an artificial pacemaker

Adverse Reactions:
Lightheadedness, Confusion, Blurred Vision, Hypotension, Cardiovascular collapse, Bradycardia, ALOC, Irritability, Muscle Twitching, Seizures with high doses

Dosage CARDIAC ARREST:
Adult:
1.0 - 1.5 mg/kg IV bolus or ET (2 - 2.5 times IV dose) Repeat 3-5 min (max total dose 3 mg/kg); a single dose of 1.5mg/kg is acceptable
Peds:
1 mg/kg IV/IO or ET (diluted to 3 -5 mL)

MAINTENANCE INFUSION : AFTER RESUSCITATION FROM CARDIAC ARREST

Adult:
2 mg in 500 mL D5W; infuse at 2-4 mg/min (4:1 concentration)
Ped:
Dilute 120 mg in 100 mL D5W; infuse at 20-50 mcg/kg/min (1-2.5 mL/kg/hr)

WIDE-COMPLEX PSVT/WIDE COMPLEX TACHYCARDIA OR UNCERTAIN ORIGIN TYPE/STABLE VT

Adult:
Initial dose 1-1.5 mg/kg IV; if needed, give 0.5-0.75 mg/kg in 5-10 min (max total dose 3 mg/kg); after conversion start a drip 2-4 mg/min
Ped:
Initial loading dose 1 mg/kg IV/IO followed by an infusion of 20-50 mcg/kg/min

How Supplied
Prefilled 100 mg in 5 mL of solution, 1 and 2 gm additive syringes, 100 mg in 5 mL of solution vials, 1 and 2 gm vials in 30 mL of solution

50
Q

Activated Charcoal

A

Class:
Adsorbent

Actions:
Adsorbs toxins by chemical binding and prevents gastrointestinal adsorption

Indications:
Poisoning following emesis or when emesis is contraindicated.

Contraindications:
None in severe poisoning

Precautions:
Should only be administered following emesis, in cases in which it is so indicated. Use with caution in patients with altered mental status. May adsorb Ipecac before emesis. If Ipecac is administered, wait at least 10 minutes to administer activated charcoal.

Side Effects:
Nausea, vomiting, and constipation

Dosage:
1 g/kg (typically 50-75 grams) mixed with a glass of water to form a slurry

Pediatric:
1 g/kg mixed with a glass of water to form a slurry

Route:
Oral

51
Q

Adenosine (Adenocard)

A

Class:
antiarrhythmic

Actions:
Slows AV conduction

Indications:
Symptomatic PSVT

Contraindications:
Sencond- or third-degree heart block, sick-sinus syndrome, known hypersensitivity to the drug.

Precautions:
Arrhythmias, including blocks, are common at the time of cardioversion. Use with caution in patients with asthma.

Side Effects:
Facial flushing, headache, shortness of breath, dizziness, and nausea

Dosage:
6 mg given as a rapid IV bolus over a 1-2 second period; if, after 1-2 minutes, cardioversion does not occur, administer a 12 mg dose over 1-2 seconds

Pediatric Dose:
Safety in children has not been established

Routes:
IV; should be administered directly into a vein or into the medication administration port closest to the patient and followed by flushing of the line with IV fluid

52
Q

Albuterol (Proventil) (Ventolin)

A

Class:
Sympathomimetic (B2 selective)

Actions:
Bronochodilation

Indications:
Asthma reversible bronchospasm associated with COPD

Contraindications:
Know hypersensitivity to the drug, symptomatic tachycardia

Precautions:
Blood pressure, pulse, and EKG should be monitored use caution In patients with known heart disease

Side Effects:
Palpitations, anxiety, headache, dizziness, and sweating

Dosage:
Metered Dose Inhaler:
1-2 sprays (90 micrograms per spray)
Small-Volume Nebulizer:
0.5 mL (2.5 mg) in 2.5 mL normal saline over 5-15 minutes
Rotohaler:
one 200-microgram rotocap should be placed in the inhaler and breathed by the patient

Pediatric Dosage:
0.15 mg (0.03mL)/kg in 2.5 mL normal saline by small volume nebulizer

Routes:
Inhalation

53
Q

Alcohol, Ethyl (Ethanol) (etOH)

A

Class:
Solvent, depressant

Description:
A colorless, volatile, flammable liquid of the formula C2H5OH. Acts as a depressant on the CNS when taken in excessive amounts. Used IV to stop premature labor. The other “common” Alcohols are Isopropyl (C3H7OH, Isopropanol, IPA), and Methyl (CH3OH, Methanol, MeOH)

54
Q

Aminophylime

A

Class:
Xanthine bronchodilator

Actions:
Smooth muscle relaxant, causes bronchodilation, has mild diuretic properties, increases heart rate

Indications:
Bronchial asthma, reversible bronchospasm associated with chronic, bronchitis and emphysema, congestive heart failure, pulmonary edema

Contraindications:
Patients with history of hypersensitivity to the drug, hypotension, patients with peptic ulcer disease.

Precautions:
Monitor for arrhythmias. Monitor blood pressure. Do not administer to patients on chronic theophylline. Preparations until the theophylline blood level has been determined.

Side Effects:
Convulsions, tremor, anxiety, and dizziness vomiting palpitations, PVCs, and tachycardia

Dosages:
Method 1:
250-500 mg in 90 or 80 mL of D5W, respectively, infused over 20-30 minutes (approximately 5-10 mg/kg/hour)

Method 2:
250-500 mg (5-7 mg/kg) in 20 mL of D5W infused over 20-30 minutes

Pediatric:
6 mg/kg loading dose to be infused over 20-30 minutes; maximum does not to exceed 12 mg/kg per 24 hours

Routes:
Slow IV infusion

55
Q

Amrinone (Inocor)

A

Class:
Cardiac inotrope

Actions:
Increases cardiac contractility, vasodilator

Indications:
Short-term management of severe CHF

Contraindications:
Patients with history of hypersensitivity to the drug

Precautions:
May increase myocardial ischemia. Blood pressure, pulse, and EKG should be constantly monitored. Amrinone should only be diluted with normal saline or 1/2 normal saline; no dextrose solutions should be used. FUROSEMIDE (LASIX) should not be administered into an IV line delivering Amrinone.

Side Effects:
Reduction in platelets, nausea and vomiting cardiac arrhythmias.

Dosage:
0.75 mg/kg bolus given slowly over 2-3 minutes interval followed by maintenance infusion of 2-15 ug/kg/minute

Pediatric Dosage:
Safety in children has not been established

Routes:
IV bolus and infusion as described earlier.

56
Q

Aspirin (Bufferin)

A

Class:
Platelet inhibitor/anit-flammatory

Actions:
Blocks platelet aggregation

Indications:
New-onset chest pain suggestive of MI signs and symptoms suggestive or recent CVA

Contraindications:
Patients with history of hypersensitivity to the drug.

Precautions:
GI bleeding and upset

Side Effects:
Heartburn, nausea and vomiting, wheezing

Dosage:
150-325 mg PO or chewed

Pediatric:
NOT RECOMMENDED

routes:
PO

57
Q

Atropine

A

Class:
Parasympatholytic (anticholinergic)

Actions:
Blocks acetylcholine receptors, increases heart rate, decreases gastrointestinal secretions.

Indications:
Hemodynamically-significant bradycardia, hypotension secondary to bradycardia, asystole, organophosphate poisoning

Contraindications:
None when used in emergency situations

Precautions:
Dose of 0.04 mg/kg should not be exceeded except in cases of organophosphate poisoning, tachycardia, hypertension.

Side Effects:
Palpitations and tachycardia, headache, dizziness, and anxiety, dry mouth, pupillary dilation, and blurred vision, urinary retention (especially older males).

Dosage:
Bradycardia:
0.5 mg every 5 minutes to maximum of 0.04 mg/kg
Asystole:
1 mg
Organophosphate poisoning:
2-5 mg

Pediatric Dosage:
Bradycardia:
0.02 mg/kg
Maximum single dose (child 0.5 mg) (adolescent 1.0mg)
Maximum total dose (child 1.0 mg) (adolescent 2.0 mg)

Routes:
IV, ET, (ET dose is 2-2.5 times IV dose)

58
Q

Bretalylium (bretlylol)

A

Class:
Antiarrhythmic

Actions:
Increases ventricular fibrillation threshold, blocks the release of Norepinephrine from peripheral, sympathetic nerves

Indications:
Ventricular fibrillation refactory to LIDOCAINE, ventricular tachycardia refactory to LIDOCAINE, PCVs refactory to first-line medications.

Contraindications:
None when used in the management of life-threatening arrhythmias

Precautions:
Postural hypotension occurs in almost 50% of patients receiving Bretylium. Patient must be kept supine decrease dosage in patients being treated with catecholamine sympathomimetics.

Side Effects:
Hypotension, syncope, and bradycardia. Increased frequency of arrhythmias, dizziness, and vertigo.

Dosage:
5mg/kg may be repeated at dose of 10mg/kg up to total dose of 30 mg/kg

Pediatric Dosage:
5 mg/kg

Routes:
Rapid IV bolus

59
Q

Calcium Chloride (CaCl)

A

Class:
Electrolyte

Actions:
Increases cardiac contractility

Indications:
Acute hyperkalemia (elevated potassium), acute hypocalcemia (decreased calcium), calcium channel blocker (Nifedipine, Verapamil, etc.), overdose, abdominal muscle spasm associated with spider bite and Portuguese man-o-war stings, antidote for MAGNESIUM SULFATE

Contraindications:
Patients receiving digitalis

Precautions:
IV line should be flushed between calcium chloride and SODIUM BICARBONATE administration. Extravasation may cause tissue necrosis.

Side Effects:
Arrhythmias (bradycardia and asystole), hypotension.

Dosage:
2-4 mg/kg of a 10% solution; may be repeated at 10 minute intervals

Pediatric:
5-7 mg/kg of a 10% solution

Route:
IV

60
Q

Dexamethasone (Decadron, Hexadrol)

A

Class:
Steroid

Actions:
Possibly decreases cerebral edema, anti-inflammatory, suppresses immune response (especially in allergic reactions).

Indications:
Cerebral edema, anaphylaxis (after Epinephrine and diphenhydramine), asthma, COPD

Contraindications:
None in the emergency setting

Precautions:
Should be protected from heat, onset of action may be 2-6 hours and thus should not be considered to be of use in the critical first hour following an anaphylactic reaction.

Side Effects:
Gastrointestinal bleeding, prolonged wound healing

Dosage:
4-24 mg

Pediatric:
0.2-0.5 mg/kg

Routes:
IV

61
Q

Dextrose 50%

A

Class:
Carbohydrate

Actions:
Elevates blood glucose level rapidly

Indications:
Hypoglycemia

Contraindications:
None in the emergency setting

Precautions:
A blood sample should be drawn before administering 50% dextrose

Side Effects:
Local venous irritation

Dosage:
25 grams (50mL)

Pediatric:
0.5 g/kg slow IV; should be diluted 1:1 with sterile water to form a 25% solution.

Routes:
IV

62
Q

Diazepam (Valium)

A

Class:
Tranquilizer (Benzodiazepine)

Actions:
Anticonvulsant, skeletal muscle relaxant, sedative

Indications:
Generalized seizures, status epilepticus, premedication before cardioversion, skeletal muscle relaxant, acute anxiety states.

Contraindications:
Patients with a history of hypersensitivity to the drug.

Precautions:
Can cause local venous irritation. Has short duration of effect. Do not mix with other drugs because of possible precipitation problems.

Side Effects:
Drowsiness, hypotension, respiratory depression, apnea

Dosage:
Status epilepticus: 5-10 mg IV
Acute anxiety: 2-5 mg IM or IV
Premedication before cardioversion: 5-15 mg IV

Pediatric Dosage:
Status epilepticus: 0.1 - 0.2 mg/kg

Routes:
IV (care must be taken not to administer faster than 1 mL/min)

63
Q

Digoxin (Lanoxin)

A

Class:
Cardiac glycoside

Actions:
Increases cardiac contractile force, increases cardiac output, reduces edema associated with congestive heart failure, slow AV conduction.

Indications:
Congestive heart failure, rapid atrial arrhythmias, especially atrial flutter and atrial fibrillation.

Contraindications:
Any patient with signs or symptoms of digitalis, toxicity, ventricular fibrillation.

Precautions:
Monitor for signs of digitalis toxicity, Patients who have recently suffered a myocardial infarction have greater sensitivity to the effects of digitalis. Calcium should not be administered o patients receiving digitalis.

Side Effects:
Nausea, vomiting, arrhythmias, yellow vision

Dosage:
0.25-0.50 mg

Pediatric:
25-40 ug/kg

Route:
IV

64
Q

Diltiazem (Cardizem)

A

Class:
Calcium channel blocker

Actions:
Slows conduction through the AV node, causes vasodilation, decreases rate of ventricular response, decreases myocardial oxygen demand

Indications:
To control rapid ventricular response associated with atrial fibrillation and flutter

Contraindications:
Hypotension, wide complex tachycardia, conduction system disturbances

Precautions:
Should not be used in patients receiving intravenous b blockers. Hypotension. Must be kept refrigerated or discarded one month after removal from refrigeration.

Side Effects:
Nausea, vomiting, hypotension, and dizziness

Dosage:
0.25 mg/kg bolus (typically 20 mg) IV over 2 minutes. This should be followed by a maintenance infusion of 5-15 mg/hour

Pediatric:
Rarely used

Route:
IV, IV drip

65
Q

Dimenhydrinate (Dramamine)

A

Class:
Antihistamine

Actions:
Blocks histamine receptors, antiemetic

Indications:
Nausea and vomiting, motion sickness to potentiate the effects of analgesics

Contraindications:
Comatose states, patients who have received large amounts of depressants (including alcohol)

Precautions:
Use with caution inpatients with seizure disorders, asthma

Side Effects:
May impair mental and physical ability, drowsiness, bronchial secretions.

Dosage:
25-50 mg slow IVP (over 2 minute) 50-100 IM

Pediatric:
Not recommended

Routes:
IV, IM

66
Q

Diphenhydramine (Benadryl)

A

Class:
Antihistamine

Actions:
Blocks histamine receptors, has some sedative effects

Indications:
Anaphylaxis, allergic reactions, dystonic reactions due to phenothiazines

Contraindications:
Asthma, nursing mothers

Side Effects:
Sedation, dries bronchial secretions, blurred vision, headache, palpitations

Dosage:
25-50 mg

Pediatric:
2-5 mg/kg

Routes:
Slow IV push deep IM

67
Q

Dobutamine (Dobutrex)

A

Class:
Sympathomimetic

Actions:
Increases cardiac contractility, little chronotropic activity

Indications:
Short-term management of congestive heart failure

Precautions:
Ventricular irritability. Use with caution following myocardial infarction. Can be deactivated by alkaline solutions.

Side Effects:
Increased heart rate, palpitations

Dosage:
2.5-20 ug/kg/minute

Pediatric:
2-20 ug/kg/minute

Routes:
IV drip

68
Q

Dopamine (Intropin)

A

Class:
Sympathomimetic

Actions:
Increases cardiac contractility, causes peripheral vasoconstriction.

Indications:
Hemodyamically significant hypotension (systolic BP of 70-100 mmhg) not resulting hypovolemia; cardiogenic shock

Contraindications:
Hypovolemic shock where complete fluid resuscitation has not occurred

Precautions:
Should not be administered in the presence of severe tachyarrhythmias. Should not be administered in the presence of ventricular fibrillation, ventricular irritability. Beneficial effects lost when dose exceeds 20 ug/kg/minutes

Side Effects:
Ventricular tachyarrhythmias, hypertension, palpitations

Dosage:
2-20 ug/kg/minute. Start low and increase as needed
Method:
800 mg should be placed in 500 mL of D5W giving a concentration of 1600 ug/mL

Pediatric:
2-20 ug/kg/minute

Route:
IV drip only

69
Q

Epinephrine (Adrenalin)

A

Description:
A hormone produces by the adrenal gland (attached to the kidneys) and synthesized commercially. It is employed therapeutically as a vasoconstrictor, as a cardiac stimulant, and to relax bronchioles. It is also used to treat asthmatic attacks and treat anaphylactic shock.

70
Q

Epinephrine 1:1,000

A

Class:
Sympathomimetic

Actions:
Bronchodilation

Indications:
Bronchial asthma, exacerbation of COPD, allergic reactions

Contraindications:
Patients with underlying cardiovascular disease, hypertension, pregnancy, patients with tachyarrhythmias

Precautions:
Should be protected from light. Blood pressure, pulse, and EKG must be constantly monitored.

Side Effects:
Palpitations and tachycardia, anziousness, headache, tremor

Dosage:
0.3-0.5 mg

Pediatric:
0.01 mg/kg up to 0.3 mg

Routes:
Subcutaneous (IV and ET for pediatric cardiac arrest)

71
Q

Epinephrine 1:10,000

A

Class:
Sympathomimetic

Actions:
Increases heart rate and automaticity
Increases cardiac contractile force
Increases myocardial electrical activity
Increases systemic vascular resistance
Increases blood pressure
Causes bronchodilation

Indications:
Cardiac arrest, anaphylactic shock severe reactive airway disease

Contraindications:
Epinephrine 1;10,000 is for intravenous or endotracheal use; it should not be used in patients who do not require extensive resuscitative efforts

Precautions: Should be protected form light. Can be deactivated by alkaline solutions.

Side Effects:
Palpitations, anxiety, tremulousness, nausea and vomiting

Dosage:
cardiac arrest:
0.5-1.0 mg repeated every 3-5 minutes
Severe Anaphylaxis:
0.3-0.5 mg (3-5 mL); occasionally and Epinephrine drip is required

Pediatric:
0.01 mg/kg initially with subsequent doses, Epinephrine 1:1,000 should be used at a dose of 0.1 mg/kg

Route:
IV, IV drip, ET

72
Q

Epinephrine (Adrenalin)

A

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

Contraindication:
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:
1 mg IV push or ET (2-2.5 times the IV dose) repeated every 3-5 min
Peds:
IV/IO 0.1mL/kg (1:10,000); doses as high as 0.2mL/kg may be effective ET dose is 0.1mL/kg (1:1,000) dilutes to 3-5mL

SUBSEQUENT DOSES:
IV/IO/ET 0.1mL/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 1-2mL (1:10,000) Slow IV
Peds:
Mild 0.01mL/kg SQ(1:1,000) Max 0.3mL Moderate to Severe 0.05-0.15mcg/kg/min IV infustion

How Supplied
1mg/mL (1:1,000), 0.1mg/mL (1:10,000) ampule and pre-filled syringe. Auto injector Pen (0.5mg/mL (1:2,000))

73
Q

Albuterol (Proventil, Ventolin)

A

Class:
Sympathomimetic, Bronchodilator, Beta 2 agonist

Description:
Albuterol is a Sympathomimetic that is selective for beta2 adrenergic receptors. It relaxes smooth muscles of the bronchial tree and peripheral vasculature by stimulating adrenergic receptors of the sympathetic nervous system.

Indications:
Relief of bronchospasms in patients with reversible obstructive airway disease. Prevention of exercise-induced bronchospasms

Contraindications:
Prior hypersensitivity reaction to Albuterol, cardiac dysrhythmias associated with tachycardia

Adverse Reactions:
Dose related, restlessness, apprehension, dizziness, palpitations, tachycardia, dysrhythmias

Dosage:
Adult MDI
1-2 inhalations (90-180 mcg) wait five minutes between inhalations, max 12 inhalations per day
Solution:
2.5mg diluted to 3mL with 0.9% NS; administer over 5-15 minutes

Peds MDI
Same as adult
Solution:
0.01-0.03mL/kg dose to maximum of 0.50mL/dose diluted in 2mL of 0.9% NS may be repeated every 20 minutes three times

How Supplied;
MDI: 90 mcg/metered spray (17g canister with 200 inhalations). Solution for aerosoliztion 0.5% (5mg/mL); 0.083% (2.5mg) in 3mL unit dose/nebulizer

74
Q

Diphenhydramine (Benadryl)

A

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 sever 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 of bronchial secretions

Dosage:
Adult:
25-50mg IM, IV every 6-8 hours (max 300mg/day)
Peds:
5mg/kg/day in divided doses (max 300mg/day)

How Supplied:
Parenteral: 10, 50 mg/mL vials and pre-filled syringes

75
Q

Methylprednisolone (Solu-Medrol)

A

Class:
Glucocorticoid

Description:
Methylprednisolone 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 Reaction:
Headache, hypertension, sodium and water retension, Hypokalemia, Alkalosis

Dosage:
Adult:
Variable; usually within the range of 40-125mg 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/hour 
Peds:
1-2 mg/kg/dose IV

How Supplied
20, 40, 80 mg/mL

76
Q

Oxygen

A

Class:
Naturally occurring atmospheric gas

Description:
Oxygen is an odorless, 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, Ischemic 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 decreased LOC and respiratory depression in patients with chronic carbon 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 concentration: 24%, 28%, 32%, 36%

Peds:
Same as adult

77
Q

Flumazenil (Romazicon)

A

Class:
Benzodiazepine antagonist

Actions:
Reverses effects of benzodiazepines

Indications:
To reverse CNS, respiratory depression associated with Benzodiazepines.

Contraindications:
Flumazenil should not be used as a diagnostic agent for Benzodiazepine overdose in the same manner NALOXONE is used for narcotic overdose. Known hypersensitivity to the drug.

Precautions:
Administer with caution to patients dependent upon Benzodiazepines as it may induce life-threatening Benzodiazepine withdrawal.

Side Effects:
Fatigue, headache, nervousness, dizzimess

Dosage:
0.2 - 0.3mg IV over 30 seconds; repeat as needed to a maximum dose of 1.0mg

Routes:
IV

Pediatric Dosage:
Pediatric data unavailable

78
Q

Furosemide (Lasix)

A

Class:
Potent diuretic

Actions:
Inhibits reabsorption of sodium chloride, promotes prompt diuresis, vasodilation.

Indications:
Congestive heart failure, pulmonary edema

Contraindications:
Pregnancy, dehydration

Precautions:
Should be protected from light, dehydration

Side Effects:
Few in emergency usage.

Dosage:
40-80 mg

Routes:
IV

Pediatric Dosage:
1 mg/kg

79
Q

Glucagon

A

Class:
Hormone (antihypoglycemic agent)

Actions:
Causes breakdown of glycogen to glucose.  
Inhibits glycogen synthesis
Elevates blood glucose level
Increases cardiac contractile force
Increases heart rate.

Indications:
Hypoglycemia

Contraindications:
Hypersensitivity to the drug.

Precautions:
Only effective if there are sufficient stores of Glycogen within the liver. Use with caution in patients with cardiovascular disease. Draw blood glucose before administration.

Side Effects: Few in emergency situations

Dosage:
0,25 - 0.50 mg (unit) IV
1.0 mg, IM

Routes:
IV, IM

Pediatric Dosage:
0.03 mg/kg

80
Q

Haloperidol (Haldol)

A

Class:
Major tranquilizer

Actions:
Blocks dopamine receptors in brain responsible for mood and behavior has antiemetic properties.

Indications:
Acute psychotic episodes.

Contraindications:
Should not be administered in the presence of other sedatives. should not be used in the management of dysphoria caused by Talwin.

Precautions:
Orthostatic hypotension.

Side Effects:
Physical and mental impairment, Parkinson-like reactions have been known to occur, especially in children.

Dosage:
2 - 5 mg

Routes:
IM

Pediatric Dosage:
Rarely used

81
Q

Heparin

A

Class:
Anticoagulant

Actions:
Functions as an anticoagulant by accelerating neutralization of activated clotting factors.

Indications:
Situations where a hypocoaguable state is required (i.e. post MI, post-CVA, pulmonary embolism)

Contraindications:
Should not be used unless there is a medical reason to anticoagulate the patient.

Precautions:
Sever, urticarial, and anaphylaxis have been reported following heparin administration skin necrosis can develop at site of subQ injections.

Side Effects:
Fever, bruising, oozing of blood

Dosage:
Loading dose: 5,000 iu IV is a typical loading dose although large patients and patients with heparin resistance may receive larger doses.
Maintenance dose: Infusion therapy is typically started at 800 - 1,000 iu/hr, the dosage is modified based upon the patient’s prothrombin (pt) time.

Routes:
IV subQ (prophylaxis)

Pediatric Dosage:
Rarely used

82
Q

Hydrocodone (Vicodin, Lortab)

A

Class:
Narcotic analgesic

Actions:
CNS depressant, decreases sensitivity to pain

Indications:
Relief of cough and moderate to severe pain

Contraindications:
Patients with a history of hypersensitivity to the drug or acetaminophen (Tylenol).

Precautions:
May exaggerate the effects of other CNS depressants. May cause respiratory depression at high dosages. May elevate intracranial and cerebrospinal fluid pressure in the presence of a head injury or a pre-existing increase in intracranial pressure.

Side Effects:
Lightheadedness, dizziness, drowsiness, nausea, and vomiting

Dosage:
2.5 / 5.0 / 7.5 tablets; 1-2 every 4-6 hours

Routes:
Oral

Pediatric Dosage:
NOT RECOMMENDED

83
Q

Hydroxzine (Vistaril)

A

Class:
Antihistamine

Actions:
Antiemetic, antihistamine, antianxiety, potentiates analgesic effects of narcotics and related agents.

Indications:
To potentiate the effects of narcotics and synthetic narcotics, nausea and vomiting, anxiety reactions.

Contraindications:
Patients with a history of hypersensitivity to the drug.

Precautions:
Orthostatic hypotension, analgesic dosages should be reduced when used with Hydroxyzine, urinary retention.

Side Effect:
Drowsiness

Dosage:
50 - 100 mg

Route:
Deep IM

Pediatric Dosage:
1 mg/kg

84
Q

Insulin (Humulin)

A

Class:
Hormone (hypoglycemic agent)

Actions:
Causes uptake of glucose by the cells, decreases blood glucose level, promotes glucose storage.

Indications:
Elevated blood glucose, diabetic ketoacidosis

Contraindications:
Avoid overcompensation of blood glucose level; if possible, administration should wait until the patient is in the emergency department

Precautions:
Administration of excessive doe may induce hypoglycemia. Glucose should be available.

Side Effects:
Few in the emergency situations.

Dosage:
10 - 25 units regular insulin IV followed by an infusion at 1.0 units/kg/hr

Routes:
IV subQ

Pediatric Dosage:
Dosage is based on blood glucose level

85
Q

Ipatropium (Atrovent)

A

Class:
Anticholinergic

Actions:
Causes bronchodilation, dries respiratory tract secretions.

Indications:
Bronchial asthma, reversible bronchospasm associated with chronic bronchitis and emphysema

Contraindications:
Patients with history of hypersensitivity to the drug, should not be used as primary agent in acute treatment of bronchospasm

Precautions:
Blood pressure, pulse, and EKG must be constantly monitored.

Side Effects:
Palpitations, dizziness, anxiety, tremors, headache, nervousness, dry mouth.

Dosage:
small-volume nebulizer: 500 ug should be placed in small volume nebulizer (typically administered with a B agonist).

Routes:
Inhalation only

Pediatric Dosage:
Safety in children has not been established

86
Q

Isoetharine (Bronkosol)

A

Class:
Sympathomimetic (B2 selective)

Actions:
Bronchodilation, increases heart rate

Indications:
Asthma, reversible bronchospasm associated with chronic bronchitis and emphysema

Contraindications:
Patients with history of hypersensitivity of the drug

Precautions:
Blood pressure, pulse and EKG must be constantly monitored.

Side Effects:
Palpitations, tachycardia, anxiety and tremors, headache

Dosage:
Hand nebulizer: four inhalations
Small-volume nebulizer: 0.5 ml (1:3 with saline)

Routes:
Inhalation only

Pediatric Dosage:
0.25 - 0.5 ml diluted with 4 ml normal saline

87
Q

Ketorolac (Toradol)

A

Class:
Non-steroidal anti-inflammatory agent

Actions:
Anti-inflammatory, analgesic (peripherally-acting)

Indications:
Mild to moderate pain

Contraindications:
Patients with a history of hypersensitivity to the drug, patients allergic to ASPRIN.

Precautions:
GI irritation or hemorrhage can occur

Side Effects:
Edema, rash, heartburn

Dosage:
IV 15 - 30 mg
IM 30 - 60 mg

Routes:
IV, IM

Pediatric Dosage:
Safety in children has not been established

88
Q

Labetalol (Trandate) (Normadyne)

A

Class:
Sympathetic blocker

Actions:
Selectively blocks y1 receptors an nonselectively blocks B receptors.

Indications:
Hypertensive crisis

Contraindications:
Bronchial asthma, congestive heart failure, heart block, bradycardia, cardiogenic shock

Precautions:
Blood pressure, pulse, and EKG must be constantly monitored. Atropine and transcutaneous pacing should be available

Side Effects:
Bradycardia, heart block, congestive heart failure, bronchospasm, postural hypertension

Dosage:
Method 1:
20 mg by slow IV infusion over 2 minutes: doses of 40 mg can be repeated in 10 minutes until desired supine blood pressure is obtained or until 300 mg of the drug has been given
Method 2:
200 mg placed in 500 ml D5W to deliver 2 mg/min

Routes:
IV infusion or slow IV bolus as described earlier

Pediatric Dosage:
Safety in children had not been established

89
Q

Lidocaine (Xylocaine)

A

Class:
Antiarrhythmic

Actions:
Suppresses ventricular ectopic activity, increases ventricular fibrillation threshold, reduces velocity of electrical impulse through conductive system

Indications:
Malignant PVC’s, ventricular tachycardia, ventricular fibrillation, prophylaxis of arrhythmias associated with acute myocardial infarction and thrombolytic therapy, premedication prior to rapid sequence induction.

Contraindications:
High-degree heart blocks, PVC’s in conjunction with bradycardia

Precautions:
Dosage should not exceed 300mg/hr. Monitor for CNS toxicity. Dosage should be reduced by 50% inpatients older than 70 years of age or who have liver disease in cardiac arrest, use only bolus therapy

Side Effects:
Anxiety, drowsiness, dizziness, and confusion, nausea and vomiting, convulsions, widening of QRS.

Dosage:
Bolus:
Initial bolus of 1.5 mg/kg;
additional boluses of 0.5 - 0.75 mg/kg can be repeated at 8 - 10 minute intervals until the arrhythmia has been suppressed or until 3 mg/kg of the drug has been administered; reduce dosage by 50% in patients older than 70 years of age.
Drip:
After the arrhythmia has been suppressed a 2 - 4 mg/min infusion may be started to maintain adequate blood levels.

Routes:
IV bolus
IV infusion

Pediatric Dosage:
1 mg/kg

90
Q

Magnesium Sulfate

A

Class:
Anticonvulsant/Antiarrhythmic

Actions:
CNS depressant, anticonvulsant, antiarrhythmic

Indications:
Obstetrical eclampsia (toxemia of pregnancy), pre-eclampsia/PIH, cardiovascular severe refractory ventricular fibrillation, pulseless ventricular tachycardia, post-MI as prophylaxis for arrhythmias, torsades de pointes (multi-axial ventricular tachycardia).

Contraindications:
Shock, heart block

Precautions:
Caution should be used in patients receiving digitalis. Hypotension. Calcium Chloride should be readily available as an antidote if respiratory depression ensues. Use with caution in patients in renal failure.

Side Effects:
Respiratory depression, drowsiness.

Dosage:
1 - 4 g

Routes:
IV, IM

Pediatric Dosage:
Not indicated

91
Q

Mannitol (Osmotrol)

A

Class:
Osmotic diuretic

Actions:
Decreases cellular edema, increases urinary output

Indications:
Acute cerebral edema, blood transfusion reactions

Contraindications:
Pulmonary edema, patients who are dehydrated, hypersensitivity to the drug.

Precautions:
Rapid administration can cause circulatory overload crystallization of the drug can occur at lower temperatures. An in-line filter should be used.

Side Effects:
Pulmonary congestion, sodium depletion, transient volume overload

Dosage:
1.5 - 2.0 g/kg

Routes:
IV

Pediatric Dosage:
0.25 - 0.5 g/kg IV over 60 minutes

92
Q

Methylprednisolone (Solu-Medrol)

A

Class:
Steroid

Actions:
Anti-inflammatory, suppresses immune response (especially in allergic reactions).

Indications:
Severe anaphylaxis, asthma/COPD, possibly effective as an adjunctive agent in the management of spinal cord injury

Contraindications:
None in the emergency setting

Precautions:
Must be reconstituted and used promptly. Onset of action may be 2- 6 hours and thus should not be expected to be of use in the critical first hour following an anaphylactic reaction

Side Effects:
GI bleeding, prolonged wound healing, suppression of natural steroids

Dosage:
General usage:
125 - 250 mg
Spinal cord injury:
Initial bolus of 30 mg/kg administered over 15 minutes, followed by a maintenance infusion of 5.4 mg/kg/hr

Routes:
IV, IM

Pediatric Dosage:
30 ug/kg

93
Q

Midazolam (Versed)

A

Class:
Benzodiazepine tranquilizer

Actions:
Hypnotic, sedative

Indications:
Premedication prior to cardioversion/RSI, acute anxiety states.

Contraindications:
Patients with known hypersensitivity to the drug, narrow-angle glaucoma, shock

Precautions:
Emergency resuscitation equipment should be available. Flumazenil (Romazicon) should be available. Dilute with normal saline or D5W prior to intravenous administration. Respiratory depression more common with Midazolam than with other Benzodiazepines.

Side Effects:
Drowsiness, hypotension, amnesia, respiratory depression, apnea

Dosage:
1.0 - 2.5 mg IV

Routes:
IV, IM intranasal

Pediatric Dosage:
0.03 mg/kg

94
Q

Morphine

A

Class:
Narcotic

Actions:
CNS depressant, causes peripheral vasodilation, decreases sensitivity to pain,

Indications:
Severe pain, pulmonary edema

Contraindications:
Head injury, volume depletion undiagnosed abdominal pain, patients with history of hypersensitivity to the drug.

Precautions:
Respiratory depression (narcan should be available), hypotension, nausea.

Side Effects:
Dizziness, altered level of consciousness

Dosage:
IV:
2 - 5 mg followed by 2 mg every few minutes until the pain is relieved or until respiratory depression ensues.N
IM:
5 - 15 mg based on patient weight

Routes:
IV, IM

Pediatric Dosage:
0.1 - 0.2 mg/kg IV

95
Q

Nalbuphine (Nubain)

A

Class:
Synthetic analgesic

Actions:
CNS depressant, decreases sensitivity to pain

Indications:
Moderate to severe pain

Contraindications:
Patients with a history of hypersensitivity to the drug

Precautions:
Use with caution in patients with impaired respiratory function, respiratory depression (Naloxone should be available). Patients dependent on narcotics may experience symptoms of withdrawal, nausea.

Side Effects:
Dizziness, altered level of consciousness

Dosage:
5 - 10 mg

Routes:
IV, IM

Pediatric Dosage:
Rarely used

96
Q

Naloxone (Narcan)

A

Class:
Narcotic antagonist

Actions:
Reverses effects of narcotics

Indications:
Narcotic overdose including the following: codeine, Demerol, Dilaudid, Fentanyl, Herion, Lortabs, Methadone, Morphine, Paregoric, Percodan, Tylox, Viccodin, synthetic analgesics.
Overdoses including the following: Darvon, Nubain, Stadol, Talwin, alcoholic coma,
To rule out narcotics in coma of unknown origin

Contraindications:
Patients with a history of hypersensitivity to the drug.

Precautions:
Should be administered with caution to patients dependent on narcotics as it may cause withdrawal effects. Short-acting, should be augmented every 5 minutes.

Side Effects:
none

Dosage:
1 -2 mg

Routes:
IV, IM
ET(ET dose is 2.0 2.5 times IV dose)

Pediatric Dosage:
0.1 mg/kg max 2.0 mg

97
Q

Notroglycerin Spray (Nitrolingual Spray)

A

Class:
Antianginal

Actions:
Smooth-muscle relaxant, decreases cardiac work, dilates coronary arteries, dilates systemic arteries.

Indications:
Angina pectoris, chest pain associated with myocardial infarction.

Contraindications:
Hypotension

Precautions
Constantly monitor vital signs. Syncope can occur

Side Effects:
Dizziness, hypotension, headache.

Dosage:
One spray administered under the tongue; may be repeated in 10-15 minutes; no more than three sprays in a 15-minutes period. spray should not be inhaled.

Routes:
Sprayed under the tongue on mucous membrane

Pediatric Dosage:
NOT INDICATED

98
Q

Nitropaste (Nitro-Bid)

A

Class:
Antianginal

Actions:
Smooth-muscle relaxant, decreases cardiac work, dilates coronary arteries dilates systemic arteries.

Indications:
Angina pectoris, chest pain associated with myocardial infarction

Contraindications:
Children younger than 12 years of age, hypotension

Precautions:
Constantly monitor blood pressure, syncope, drug must be protected from the light, expires quickly once the bottle is opened.

Side Effects:
Dizziness, hypotension

Dosage:
1/2 to 3/4 inches

Routes:
Topical

Pediatric Dosage:
NOT INDICATED

99
Q

Norepinephrine (Levophed)

A

Class:
Sympathomimetic

Actions:
Causes peripheral vasoconstriction

Indications:
Hypotension refractory to other sympathomimetics, neurogenic shock.

Contraindications:
Hypotensive state due to hypovolemia

Precautions:
Can be deactivated by alkaline solutions. Constant monitoring of blood pressure is essential. Extravasation can cause tissue necrosis

Side Effects:
Anxiety, palpitations, hypertension

Dosage:
0.5 - 30 ug/min.

Method:
8 mg should be placed in 500 ml of D5W, giving a concentration of 16 ug/ml

Routes:
IV drip only

Pediatric Dosage:
0.01 - 0.5 ug/kg/minute (RARELY USED)

100
Q

Oxygen (O2)

A

Class:
gas

Actions:
Necessary for cellular metabolism

Indications:
Hypoxia

Contraindication:
NONE

Precautions:
Use cautiously in patients with COPD, humidify when providing high-flow rates.

Side Effects:
Drying of mucous membranes

Dosage:
Cardiac arrest: 100%
Other critical patients: 100%
COPD: 35%

Routes:
Inhalation

Pediatric Dosage:
24 - 100% as required

101
Q

Phenytoin (Dilantin)

A

Class:
Anticonvulsant/antiarrhythmic

Actions:
Inhibits spread of seizure activity through motor cortex, antiarrythmic

Indications:
Status epilepticus, arrhythmias due to digitalis toxicity

Contraindications:
Any arrhythmia except those due to digitalis toxicity, patients with history of hypersensitivity to the drug.

Precautions:
Should not be administered with glucose solutions. Hypotension. EKG monitoring during administration is essential

Side Effects:
Local venous irritation, central nervous system depression.

Dosage:
Status epilepticus; 150 - 250 mg (10 - 15 mg/kg) not to exceed 50 mg/minute. Digitalis toxicity: 100 mg over 5 minutes until the arrhythmia is suppressed or until symptoms of central nervous system depression occur.

Routes:
IV (dilute with saline)

Pediatric Dosage:
Status epilepticus: 8 - 10 mg/kg IV
Digitalis toxicity: 3 - 5 mg/kg IV over 10 minutes

102
Q

Procainamide (Pronestyl)

A

Class:
Antiarrhythmic

Actions:
Slows conduction through myocardium, elevates ventricular fibrillation threshold, suppresses ventricular ectopic activity.

Indications:
Persistent cardiac arrest due to ventricular fibrillation and refractory to Lidocaine, PVCs refractory to Lidocaine, ventricular tachycardia refractory to Lidocaine.

Contraindications:
High-degree heart blocks, PVCs in conjunction with bradycardia.

Precautions:
Dosage should not exceed 17 mg/kg. Monitor for central nervous system toxicity.

Side Effects:
Anxiety, nausea, convulsions, widening of QRS

Dosage:
Initial: 20 mg/minute until arrhythmia abolished, hypotension ensues, QRS widened by 50% of original width total of 17 mg/kg has been given
MAINTENANCE:
1 - 4 mg/minute

Routes:
slow IV bolus, IV drip

Pediatric Dosage:
Rarely used

103
Q

Prochlorperazine (Compazine)

A

Class:
Phenothiazine antiemetic

Actions:
Antiemetic

Indications:
Nausea and vomiting, acute psychosis

Contraindication:
Comatose states, patients who have received a large amount of depressants (including alcohol), patients with a history of hypersensitivity to the drug.

Precautions:
EPS (extra-pyramidal seizure) (dystonic) reactions have been reported

Side Effects:
May impair mental and physical ability, drowsiness

Dosage:
5 -10 mg slow IV or IM

Routes:
IV, IM

Pediatric Dosage:
NOT Recommended

104
Q

Promethazine (Phenergan)

M

A

Class:
Antihistamine (h1 antagonist)

Actions:
Mild anticholinergic activity, potentiates actions of analgesics

Indications:
Nausea and vomiting, motion sickness, to potentiate the effects of analgesics, sedation

Contraindications:
Comatose states, patients who have received a large amount of depressants (including alcohol)

Precautions:
Avoid accidental intra-arterial injection

Side Effects:
May impair mental and physical ability, drowsiness

Dosage:
25 mg

Routes:
IV

Pediatric Dosage:
0.5 mg/kg

105
Q

Racemic Epinephrine (Micronefrin) (VapoNefrin)

A

Class:
Sympathomimetic

Actions:
Bronchodilation, increases heart rate, increases cardiac contractile force

Indications:
Croup (laryngotracheobronchitis)

Contraindications:
Epiglottitis, hypersensitivity to the drug.

Precautions:
Vital signs should be constantly monitored. Should be used only once in the prehospital setting.

Side Effects:
Palpitations, anxiety, headache

Dosage:
0.5 - 0.75ml of a 2.25% solution in 2.0 ml normal saline

Routes:
Inhalation only (small-volume nebulizer)

Pediatric Dosage:
0.25 - 0.75 ml of a 2.25% solution in 2.0 ml normal saline

106
Q

Rifabutin

A

Description:
A sterile solution of specified amounts of calcium, potassium chloride, sodium chloride, and sodium lactate in water for injection. It is used intravenously to treat dehydration and replace electrolytes.

107
Q

Sodium Bicarbonate

A

Class:
Alkalinizing agent

Actions:
Combines with excessive acids to form a weak volatile acid, increases ph

Indications:
Late in the management of cardiac arrest, if at all, tricyclic antidepressant overdose, severe acidosis refractory to hyperventilation.

Contraindications:
Alkalotic states

Precautions:
Correct dosage is essential to avoid overcompensation of ph. Can deactivate catecholamines. Can precipitate with calcium preparations. Delivers large sodium load.

Side Effects:
Alkalosis

Dosage:
1 mEq/kg initially followed by 0.5 mEq/kg every 10 minutes as indicated by blood gas studies

Routes:
IV

Pediatric Dosage:
1 mEq/kg initially followed by 0.5 mEq/kg every 10 minutes

108
Q

Succinylcholine (Anectine)

A

Class:
Neuromuscular blocking agent (depolarizing)

Actions:
Skeletal muscle relaxant, paralyzes skeletal muscles including respiratory muscles.

Indications:
To achieve paralysis to facilitate endotracheal intubation

Contraindications:
Patients with known hypersensitivity to the drug

Precautions:
Should not be administered unless persons skilled in endotracheal intubation are present. Endotracheal intubation equipment must be available. Oxygen equipment and emergency resuscitative drugs must be available Paralysis occurs within 1 minutes and lasts for approximately 8 minutes.

Side Effects:
Prolonged paralysis, hypotension, bradycardia

Dosage:
1 - 1.5 mg/kg (40 - 100mg in an adult)

Routes:
IV

Pediatric Doage:
1 mg/kg

109
Q

Terbutaline (Brethine)

A

Class:
Sympathomimetic

Actions:
Bronchodilator, increases heart rate

Indications:
Bronchial asthma, reversible bronchospasm associated with COPD, preterm labor

Contraindications:
Patients with known hypersensitivity to the drug

Precautions:
Blood pressure, pulse, and EKG must be constantly monitored

Side Effects:
Palpitations, tachycardia, and PVCs, anxiety, tremor, and headache

Dosage:
Metered-dose inhaler: Two inhalations, 1 minutes apart
Subcutaneous injection: 0.25 mg; may be repeated in 15 - 30 minutes
Preterm labor: 0.25 mg IM or IV may be repeated in 15 - 30 minutes as needed

Routes:
Inhalation, subcutaneous injection, IV (preterm labor only)

Pediatric Dosage:
0.01 mg/kg subcutaneously

110
Q

Thiamine (Vitamin B1)

A

Class:
Vitamin

Actions:
Allows normal breakdown of glucose

Indications:
Coma of unknown origin, alcoholism, delirium tremens

Contraindications:
None in the emergency setting

Side Effects:
Rare, if any

Dosage:
100 mg

Routes:
IV, IM

Pediatric Dosage:
Rarely indicated

111
Q

Torsemide (Demadex)

A

Class:
Potent diuretic

Actions:
Inhibits reabsorption of sodium chloride, promotes prompt diuresis.

Indications:
Congestive heart failure, pulmonary edema

Contraindications:
Patients with known hypersensitivity to the drug, anuria

Precautions:
Should be used with caution in patients taking NSAIDS, dehydration

Side Effects:
Dizziness, headache, nausea

Dosage:
10 - 20 mg

Routes:
IV

Pediatric Dosage:
Safety not established

112
Q

Vecuronium (Norcuron)

A

Class:
Neuromuscular blocking agent (non-depolarizing)

Actions:
Skeletal muscle relaxant, paralyzes skeletal muscles including respiratory muscles

Indications:
To achieve paralysis to facilitate endotracheal intubation

Contraindications:
Patients with known hypersensitivity to the drug.

Precautions:
Should not be administered unless persons skilled in endotracheal intubation are present. Endotracheal intubation equipment must be available. Oxygen equipment and emergency resuscitative drugs must be available. Paralysis occurs within 1 minute and lasts for approximately 30 minutes.

Side Effects:
Prolonged paralysis, hypotension, bradycardia

Dosage:
0.08 - 0.10 mg/kg

Routes
IV

Pediatric Dosage:
0.1 mg/kg

113
Q

Verapamil (Isoptin) (Calan)

A

Class:
Calcium channel blocker

Actions:
Slows conduction through the AV node, inhibits reentry during PSVT, decreases rate of ventricular response, decreases myocardial oxygen demand

Indications:
PSVT

Contraindications:
Heart block, conduction system disturbances

Precautions:
Should not be used in patients receiving intravenous b blockers, hypotension.

Side Effects:
Nausea, vomiting, hypotension, and dizziness

Dosage:
2.5 - 5.0 mg repeat dose of 5 - 10 mg can be administered after 15 - 30 minutes if PSVT does not convert. Maximum dose id 30 mg in 30 minutes

Routes:
IV

Pediatric Dosage:
0 - 1 year: 0.1 - 0.2 mg/kg (Maximum of 2.0 mg) administered slowly

1 - 15 years: 0.1 - 0.3 mg/kg (maximum of 5.0 mg) administered slowly