Drugs Cards Flashcards
Succinylcholine*
Brand Name: Anectine
Classification: Depolarizing neuromuscular blocker
Action: Binds to ACh receptors at the neuromuscular junction, causing depolarization and subsequent paralysis.
Indications: Rapid Sequence Intubation (RSI)
Contraindications: Hyperkalemia, Neuromuscular
disease, Crush Injuries, Burns, Increased ICP, Severe Trauma
Dose: 1-2 mg/kg
Routes: IV, IO
Adverse Effects: Hyperkalemia, Bradycardia, Prolonged Paralysis, Malignant hyperthermia, Increased ICP, Muscle fasciculations, Trismus
Other: Should only be used by a skilled provider
Ipratropium*
Brand Name: Atrovent
Classification: Muscarinic anticholinergic (parasympathetic stimulation)
Action: Selectively blocks muscarinic receptors inhibiting parasympathetic stimulation
Indications: Bronchospasms associated with obstructive lung disease
Contraindications: Hypersensitivity
Dose: 500 mcg
Routes: Inhaled
Adverse Effects: Blurred Vision, Dry Mouth, Dilated Pupils, Cough, Confusion
Other: Typically administered with a beta agonist (although not as frequently)
Rocuronium*
Brand Name: Zemuron
Classification: Nondepolarizing neuromuscular blocker
Action: Binds to ACh receptors at the neuromuscular junction, causing paralysis
Indications: Rapid Sequence Intubation (RSI)
Contraindications: Hypersensitivity
Dose: 1 mg/kg
Routes: IV, IO
Adverse Effects: Hypertension, Hypotension, Skeletal muscle weakness, Malignant Hyperthermia, Apnea
Other: Should only be used by a skilled provider
Vecuronium*
Brand Name: Norcuron
Classification: Nondepolarizing neuromuscular junction, causing paralysis
Action: Binds to ACh receptors at the neuromuscular junction, causing paralysis
Indications: Rapid Sequence Intubation (RSI)
Contraindications: Hypersensitivity
Dose: 0.1-0.15 mg/kg
Routes: IV, IO
Adverse Effects: Skeletal Muscle Weakness, Malignant Hyperthermia, Apnea
Other: Should only be used by a skilled provider
Midazolam*
Brand Name: Versed
Classification: Benzodiazepine (Class IV)
Action: Binds to Type A GAGA receptors, causing sedations
Indications: Anxiety, Sedation, Seizures
Contraindications: History of Hypersensitivity
Dose: 1-5 mg
Routes: IV, IM, IO
Adverse Effects: Hypotension, Sedation, Amnesia, Amnesia, Respiratory Depression, Nausea, Vomiting
Other: Flumazenil is an antagonist
Etomidate*
Brand Name: Amidate
Classification: Nonbarbiturate, nonbenzodiazepine sedative
Action: Appears to modulate GABA receptors
Indications: Sedation
Contraindications: History of Hypersensitivity
Dose: 0.1-0.3 mg/kg
Routes: IV
Adverse Effects: Myoclonic jerks, Respiratory Depression, Laryngospasm
Other: Does not have analgesic properties. Calcium-channel blockers can prolong respiratory depression. Can cause increased cortisol levels. All monitors should be in place. Resuscitative equipment should be immediately available.
Ketamine*
Brand Name: Ketalar
Classification: Dissociative Anesthetic (Schedule III)
Action: Causes Dissociation between the cortical and limbic system
Indications: Sedation and Analgesia
Contraindications: History of Hypersensitivity and Hypertension
Dose: 0.5-2 mg/kg(IV) 2-4 mg/kg(IM)
Routes: IV and IM
Adverse Effects: Hallucinations
Other: All monitors should be in place. Resuscitative Equipment should be immediate available.
Morphine*
Brand Name: Duramorph
Classification: Narcotic (opioid) (Schedule II)
Action: Analgesia and sedation through binding to opiate receptors
Indications: Moderate-severe pain
Contraindications: Hypotension and Hypersensitivity
Dose: 2-10 mg
Routes: IV, IO, IM, SQ, PO
Adverse Effects: Hypotension, Syncope, Tachycardia, Bradycardia, Apnea, Nausea, Vomiting, Respiratory depression
Other: Use appropriate monitors, Naloxone is an antagonist
Hydromorphone*
Brand Name: Dilaudid
Classification: Narcotic (opioid) (Schedule II)
Action: Analgesia and sedation through binding to opiate receptors
Indications: Moderate-Severe Pain
Contraindications: Hypersensitivity
Dose: 0.5-2.0 mg
Routes: IV, IO, IM, SQ, PO
Adverse Effects: Nausea, Vomiting, Cramps, Respiratory Depression
Other: Use appropriate monitors. Naloxone is an antagonist
Fentanyl*
Brand Name: Sublimaze
Classification: Narcotic (opioid) (Schedule II)
Action: Analgesia through binding to opiate receptors
Indications: Moderate-Severe Pain and Anesthetic
Contraindications: Hypersensitivity
Dose: 50-100 mcg
Routes: IV, IO, IM, SQ, IN
Adverse Effects: Nausea, Vomiting, Cramps, Chest wall rigidity, Respiratory Depression
Other: Use Appropriate monitors. Naloxone is an antagonist
Aspirin*
Brand Name: Aspirin
Classification: NSAID
Action: Anti-inflammatory and antipyretic through inhibition of thromboxane A2
Indications: Mild-Moderate pain, Fever, Platelet Aggregation inhibitor
Contraindications: Hypersensitivity, Bronchospasm, Angioedema, Patient receiving monoamine oxidase inhibitor (MAOIs)
Dose: 350-650 mg
Routes: PO
Adverse Effects: Nausea, Vomiting, GI bleeding, Allergic reactions
Other: Commonly causes gastric upset. Avoid enteric-coated aspirin in chest pain
Naloxone*
Brand Name: Narcan
Classification: Opiate Antagonist
Action: Opioid antagonist without opiate agonist properties (it has not activity when given in the absence of an opiate agonist
Indications: Partial reversal of opiate drug effects, Opiate overdose
Contraindications: Hypersensitivity
Dose: 0.4-2.0 mg
Routes: IV, IO, SQ, IN, Nebulizer
Adverse Effects: Fever, Chills, Nausea, Vomiting, Diarrhea, Opiate withdrawal
Other: Administer enough to reverse respiratory depression and avoid full narcotic withdrawal syndrome
Nalmefene*
Brand Name: Revex
Classification: Opiate antagonist
Action: Opioid Antagonist without opiate agonist properties (if no activity when given in the absence of an opiate agonist)
Indications: Partial reversal of opiate drug effects, Opiate overdose
Contraindications: Hypersensitivity
Dose: 0.4-2.0 mg
Routes: IV, IM, SQ, IO, nebulizer
Adverse Effects: Fever, Chills, Nausea, Vomiting, Diarrhea, Opiate withdrawal
Other: Duration of effect much longer than naloxone
Nalbuphine*
Brand Name: Nubain
Classification: Opiate agonist-antagonist
Action: Analgesia and sedation through binding to opiate receptors. It also has some opiate receptor antagonistic properties
Indications: Moderate-Severe Pain
Contraindications: Hypersensitivity, Opiate dependence, Respiratory depression
Dose: 10-20 mg
Routes: IV, IO, SQ
Adverse Effects: Sedation, Dizziness, Nausea, Vomiting, Opiate withdrawal
Other: Use with caution in patients with liver and renal disease
Diazepam*
Brand Name: Valium
Classification: Benzodiazepine (Schedule IV)
Action: Binds to Type A GABA receptors, causing sedation
Indications: Anxiety, Seizures, Sedation, Muscle relaxation
Contraindications: Hypersensitivity
Dose: 2-10 mg
Routes: IV, IM, IO, PO, rectal
Adverse Effects: Hypotension, Sedation, Amnesia, Respiratory depression, nausea, vomiting
Other: Incompatible with other medication because it is not water soluble. Can cause irritation with injection. Flumazenil is an antagonist
Lorazepam*
Brand Name: Ativan
Classification: Benzodiazepine (Schedule IV)
Action: Binds to Type A GABA receptors, causing sedation
Indications: Anxiety, Sedation, Seizures
Contraindications: Hypersensitivity
Dose: 1-4 mg
Routes: IV, IM, IO, PO, rectal
Adverse Effects: Hypotension, Sedation, Amnesia, Respiratory depression, Nausea, Vomiting
Other: Flumazenil is an antagonist
Nitrous Oxide*
Brand Name: Nitrous Oxide
Classification: Sedative/anesthetic gas
Action: CNS depressant
Indications: Pain and Sedation
Contraindications: COPD, Pneumothorax, Bowel obstruction
Dose: Self-Administered
Routes: Inhalation
Adverse Effects: Dizziness, Hallucinations, Nausea, Vomiting, Altered Mental Status
Other: Should not be used in any patient who cannot comprehend verbal instructions or who is intoxicated with alcohol or other medications
Haloperidol*
Brand Name: Haldol
Classification: Butyrophenone
Action: Blocks dopamine receptors associated with mood and behavior
Indications: Psychosis
Contraindications: Hypotension and Hypersensitivity
Dose: 2-10 mg
Routes: IM, PO
Adverse Effects: Extrapyramidal reactions, insomnia, restlessness, dry mouth, hypotension, tachycardia
Other: Hypotension more common in patients taking antihypertensive
Epinephrine*
Brand Name: Epinephrine
Classification: Sympathetic agonist
Action: α and β adrenergic agonist (β effects more pronounced although dose-related)
Indications: Cardiac arrest, symptomatic bradycardia, Normovolemic hypotension, Allergies/anaphylaxis, Severe bronchospasm
Contraindications: Few in the emergency setting
Dose: 0.3-1.0 mg
Routes: IV, IO, IM, SQ, ET, inhaled
Adverse Effects: Palpitations, anxiety, tremulousness, headache, dizziness, hypertension, Can worsen cardiac ischemia
Other: Two preparations are commonly available 1:1,000 (1mg/mL) 1:10,000 (1mg/10mL)
Norepinephrine*
Brand Name: Levophed
Classification: Sympathetic agonist
Action: α and β adrenergic agonist (α effects more pronounced)
Indications: Normovolemic hypotension, Septic Shock, Cardiogenic shock
Contraindications: Should not be used in hypovolemia until volume replacement has occurred
Dose: 0.1-0.5 mcg/kg/min (titrate to effect)
Routes: IV
Adverse Effects: Palpitations, Anxiety, Tremulousness, Headache, Dizziness, Hypertension, Can worsen cardiac ischemia, reflex bradycardia
Other: Extravasation can cause localized tissue damage. Best administered through a central line
Dopamine (not found in book or OK Protocol)
Brand Name: Intropin
Classification: Sympathetic agonist
Action: α and β adrenergic agonist
Indications: Normovolemic hypotension, Symptomatic bradycardia, Septic shock, Cardiogenic Shock
Contraindications: Should not be used in hypovolemia until volume replacement has occured
Dose: 2-20 mcg/kg/min (titrated to effect)
Routes: IV
Adverse Effects: Palpitations, Anxiety, Tremulousness, Headache, Dizziness, Hypertension, Can worsen cardiac ischemia, Reflex bradycardia
Other: Extravasation can cause localized tissue damage. Best administered through central line. Proposed renal benefit has been disproven
Phenylephrine*
Brand Name: Neo-Synephrine
Classification: Sympathetic agonist
Action: Almost a pure α agonist causing vasoconstriction
Indications: Normovolemic hypotension, Septic Shock, Spinal Shock
Contraindications: Avoid in cardiogenic shock
Dose: 100-180 mcg/min (0.5-2.0 mcg/kg/min and titrate to effect)
Routes: IV
Adverse Effects: Palpitations, Anxiety, Tremulousness, Headache, Dizziness, Can worsen cardiac ischemia, Reflex bradycardia
Other: can be applied to nasal mucosa to shrink tissues prior to nasal procedures
Albuterol*
Brand Name: Ventolin, Proventil
Classification: β agonist
Action: β agonist with preference for β2 adrenergic receptors.
Indications: Bronchospasm, Allergies/anaphylaxis, Hyperkalemia
Contraindications: Hypersensitivity
Dose: 2.5 mg (SVN) 90 mcg (MDI)
Routes: Inhalation
Adverse Effects: Palpitations, Anxiety, Tremulousness, Headache, Dizziness, Tachycardia
Other: Patient’s heart rate and SpO2 should be monitored during treatment
Amiodarone*
Brand Name: Cordarone
Classification: Class III antiarrhythmic
Action: Prolongs action potential and duration in cardiac tissues through sodium, potassium, and calcium channels; block α and β adrenergic receptors
Indications: Maybe consider for V-Tach, V-fib that is unresponsive to CPR defib, and vasopressor therapy
Contraindications: Breastfeeding, Bradycardia, High-grade heart block, Hypersensitivity
Dose: 150-300 mg
Routes: IV
Adverse Effects: Hypotension, Bradycardia, Prolonged PR, QRS, and QT
Other: Constant ECG monitoring, Now first-line agent in V-fib and tachycardia
Lidocaine*
Brand Name: Xylocaine
Classification: Class 1B antiarrhythmic, local anesthetic
Action: Amide-type local anesthetic; slows depolarization and automaticity
Indications: May be considered for: V-Tach, V-fib what is unresponsive to CPR, Defib, and vasopressor therapy, or Local Anesthetic
Contraindications: Should not be administer to patients receiving IV calcium channel blockers
Dose: 1.0-1.5 mg/kg
Routes: IV
Adverse Effects: Drowsiness, Slurred Speech, Confusion, Seizures, Hypotension
Other: Use with caution when administered with other antiarrhythmics
Adenosine*
Brand Name: Adenocard
Classification: Nucleoside
Action: Slows AV conduction; short half-life
Indications: Supraventricular Tachyarrhythmias (SVT)
Contraindications: A-Fib, Torsades de pointe
Dose: 6 mg
Routes: IV
Adverse Effects: Facial flushing, Headache, Chest Pain, Nausea
Other: Should be given by rapid IV push followed by saline bolus, Arrhythmias common following administration
Diltiazem*
Brand Name: Cardizem
Classification: Class IV antiarrhythmic; calcium channel blocker
Action: Lowers BP by relaxing vascular smooth muscle; slows AV conduction
Indications: A-fib w/ Rapid Ventricular Rate (RTR) and Stable narrow-complex Tachyarrhythmias
Contraindications: Hypotension, CHF, Cardiogenic shock, Wide-complex V-Tach
Dose: 15-20 mg
Routes: IV
Adverse Effects: Nausea, Vomiting, Dizziness, Headache, Hypotension
Other: Can be given IV bolus or IV infusion. Calcium chloride can reverse some of the untoward effects
Magnesium Sulfate*
Brand Name: Magnesium Sulfate
Classification: Mineral/electrolyte
Action: Physiologic calcium-channel blocker; bronchodilator
Indications: Torsades des pointes, Asthma, Hypertensive disorders of pregnancy
Contraindications: High-Degree Heart block, Shock, Dialysis, Hypocalcemia, V-fib/pulseless V-Tach in adults
Dose: 1-2 g
Routes: IV
Adverse Effects: Flushing, Sweating, Bradycardia, Respiratory Depression, Hypothermia
Other: Can cause cardiac conduction problems in conjunction with digitalis
Nitroglycerin*
Brand Name: Nitrostat
Classification: Nitrate
Action: Relaxes vascular smooth muscle causing vasodilation, decreased cardiac work, and improved coronary blood flow.
Indications: Chest Pain and CHF
Contraindications: Hypotension and Increased ICP
Dose: 0.4 mg
Routes: SL (tablet or spray)
Adverse Effects: Headache, Dizziness, Weakness, Tachycardia, Hypotension
Other: Tablets will lose effectiveness after exposure to air. Monitor BP closely
Nitroglycerin Paste*
Brand Name: Nitroglycerin Paste
Classification: Nitrate
Action: Relaxes vascular smooth muscle causing vasodilation, decreased cardiac work, and improved coronary blood flow
Indications: Chest pain and CHF
Contraindications: Hypotension and Increased ICP
Dose: 0.5-1.0 inch
Routes: Transdermal
Adverse Effects: Headache, Dizziness, Weakness, Tachycardia, Hypotension
Other: Do not get paste on your finger, as this may cause a headache. Monitor BP closely
Diphenhydramine*
Brand Name: Benadryl
Classification: antihistamine
Action: Nonselectively blocks H1 and H2 histamine receptors
Indications: Allergies, Extrapyramidal reactions, Parkinson’s disease, Sedation, Anaphylaxis
Contraindications: Hypersensitivity, Glaucoma, Pregnancy
Dose: 25-50 mg
Routes: IV, IM, IO, PO
Adverse Effects: Drowsiness, Dizziness, Sedation, Dry Mouth
Other: If given IM give deep in muscle
Ondansetron*
Brand Name: Zofran
Classification: Serotonin antagonist
Action: Selectively blocks 5-HT3 serotonin receptors, including those in the CTZ and vagus nerve terminals
Indications: Nausea and Vomiting
Contraindications: Hypersensitivity
Dose: 4-8 mg
Routes: IV, IM, PO, SL
Adverse Effects: Dizziness and Lightheaded
Other: Commonly used in emergency medicine because of good safety profile
Oxytocin*
Brand Name: Pitocin
Classification: Hormone (oxytocin)
Action: Oxytocic; caused uterine contractions and lactations
Indications: Postpartum vaginal bleeding,
Induction/augmentation of labor
Contraindications: Anything other than postpartum bleeding (in the prehospital setting)
Dose: 10-20 units in 500 mL IV; 3-10 units IM
Routes: IV, IM
Adverse Effects: Anaphylaxis and Arrhythmias
Other: Ensure placenta (and possible additional baby) has delivered before administering
Glucagon*
Brand Name: Glucagon
Classification: Hormone (glucagon)
Action: Elevates blood glucose levels through conversion of glycogen to glucose and other factors
Indications: Hypoglycemia and Beta-blocker overdose
Contraindications: Hypersensitivity
Dose: 0.25-0.5 units (IV); 1.0 mg (IM)
Routes: IV, IM, IO
Adverse Effects: Few in the emergency setting
Other: Less effective in patients with decreased glycogen stores (e.g., alcoholics)
Dextrose, 50%*
Brand Name: Dextrose, 50%
Classification: Carbohydrate
Action: Substrate for carbohydrate metabolism
Indications: Hypoglycemia
Contraindications: None in the emergency setting
Dose: 12.5-25.0 g
Routes: IV, PO
Adverse Effects: Local venous irritation common, Tissue injury
Other: Less concentrated solutions (e.g., 10%) equally effective with fewer side effects
Dextrose, 10%*
Brand Name: Dextrose, 10%
Classification: Carbohydrate
Action: Substrate for carbohydrate metabolism
Indications: Hypoglycemia
Contraindications: None in the emergency setting
Dose: 100 mL
Routes: IV, IO
Adverse Effects: Local venous irritation common, Tissue injury
Other: Preferred over D50W due to improved safety profile and cost
Amyl nitrite*
Brand Name: Amyl nitrite
Classification: Cyanide antidote
Action: Vasodilator; oxidizes hemoglobin to methemoglobin which reacts with cyanide ion to form cyanmethemoglobin, that is enzymatically degraded
Indications: Cyanide poisoning
Contraindications: None in the emergency setting
Dose: 1-2 inhalants
Routes: Inhaled
Adverse Effects: Headache, Weakness, Dizziness, Flushing, Tachycardia, Orthostatic hypotension
Other: Headache and hypotension common, can worsen hypoxia in the setting of CO poisoning
Activated Charcoal
Brand Name: Activated Charcoal
Classification: Absorbent
Action: Absorbs toxic substances from the GI tract
Indications: Most oral poisonings and medication overdoses
Contraindications: Comatose patient, ingestion of corrosives, caustics, or petroleum distillates
Dose: 1-2 mg/kg
Routes: PO
Adverse Effects: Nausea, Vomiting, Constipations, Black stool
Other
Atropine
Brand Name: NA
Classification: Anticholinergic
Action: Antagonizes acetylcholine receptors
Indications: Treat Symptomatic Bradycardias especially those arising in the Atria
Contraindications: None in emergency settings
Dose: 0.5mg repeat every 3-5 mins (max 3.0mg)
Routes: IV or IO
Adverse Effects: blurred vision, dilated pupils, dry mouth, tachycardia, drowsiness
Other: Organophosphate poisonings may require a significantly higher dose
Insta-Glucose
Brand Name: Oral Glucose
Classification: Hyperglycemic
Action: Increases Blood Glucose levels
Indications: Conscious patient with suspected hypoglycemia
Contraindications: Decreased LOC, Nausea, Vomiting
Dose:
Routes: Oral
Adverse Effects: Nausea and Vomiting
Dextrose 5% in Water
Brand Name: D5W
Classification: Hypotonic Dextrose-containing solution
Action: provides nutrients in the form of dextrose as well as free water
Indications: Dilution of concentrated drugs, IV access for emergency drugs
Contraindications: Hypovolemic state
Dose: TKO via microdrip (60 gtt/mL)
Routes: IV
Adverse Effects: Rare in Therapeutic Doses
Normal Saline
Brand Name: Normal Saline
Classification: Isotonic Crystalloid Solution
Action: Replaces Water and Electrolytes
Indications: Heat related problems, freshwater
drowning, hypovolemia, DKA, Keep IV open
Contraindications: use caution with CHF and Renal Failure
Dose: titrate to effect, 250 ml at a time, TKO
Routes: IV
Adverse Effects: Rare in Therapeutic doses.
Hartman’s Solution
Brand Name: Lactated Ringer’s
Classification: Isotonic Crystalloid Solution
Action: replaced water and electrolytes
Indications: Hypovolemic shock and to keep IV open
Contraindications: CHF or renal failure
Dose: Titrate to effect, 250 mL at a time
Routes: IV
Adverse Effects: Rare in Therapeutic Doses
Oxygen
Brand Name: Oxygen
Classification: Natural Atmospheric Gas
Action: Reverses Hypoxemia
Indications: Hypoxemia, Ischemic Chest Pain, Carbon Monoxide Poisoning, Decreased LOC, Respiratory Insufficiency
Contraindications: COPD or Emphysema use caution,
Dose: 1-15 lpm
Routes: Inhaled
Adverse Effects: Possible Decreased Respiratory drive in COPD or Emphysema patients
Other: Be familiar with the bottles and delivery devices
Promethazine*
Brand Name: Phenergan
Classification: Phenothiazine
Action: Suppresses the CTZ; has antihistaminic effects
Indications: Nausea, Vomiting
Contraindications: Hypersensitivity to the drug
Dose: 12.5-25 mg
Routes: IV, IM, PO
Adverse Effects: Drowsiness, Dizziness, Sedation, Dry Mouth, Extrapyramidal symptoms
Other: Can potentiate CNS depressants (e.g., alcohol), Extravasation can cause local tissue injury, rarely used
Betalin
Brand Name: Thiamine
Classification: Vitamin
Action: carbohydrate metabolism
Indications: Alcoholism, delirium tremens, coma of unknown etiology, Wernicke, Korsakoff syndrome
Contraindications: Hypersensitivity to drug, use caution with pregnancy and renal impairment
Dose: 100 mg
Routes: IV or IM
Adverse Effects: Hypotension(rare)
Sodium Bicarbonate
Brand Name: Sodium Bicarbonate
Classification: Alkalinizing Agent
Action: Buffers excess acid to assist returning the blood to a normal pH balance.
Indications: Metabolic acidosis
Contraindications: Hypersensitivity, alkalosis, hypocalcemia, excessive chloride loss
Dose: 1 mEq/kg SIVP may be repeated at 0.5 mEq in 10 mins
Routes: IV
Adverse Effects: Edema, Irritation at IV site
Other: Use Caution in patients with CHF and Kidney insufficiency or with corticosteroid therapy. Monitor for fluid overload.
Flumazenil*
Brand Name: Romazicon
Classification: benzodiazepine antagonist
Action: Competitively blocks benzodiazepines at the GABA/benzodiazepine receptor complex
Indications: Overdose of Benzodiazepines
Contraindications: Hypersensitivity, Patient taking Benzodiazepine for a life-threatening illness
Dose: 0.2 mg Additional 0.3 mg may be given 30 sec later. Later doses of 0.5 mg may be given at 1 min intervals max dose of 3 mg
Routes: IV
Adverse Effects: fatigue, headache, nervousness, dizziness
Other: Admin with caution in pts dependent on benzodiazepines as life-threatening withdrawal (including seizures) can occur
Meperidine*
Brand Name: Demerol
Classification: Narcotic (opioid class II)
Action: Analgesia through binding to opiate receptors
Indications: Moderate-severe pain
Contraindications: Hypersensitivity, Pt on monamine oxidase inhibitors (MAOIs)
Dose: 25-100mg
Routes: IV, IO, IM, SQ, PO
Adverse Effects: Nausea, vomiting, euphoria, dysphoria, respiratory depression
Other: use appropriate monitors, naloxone is an antagonist
Acetaminophen*
Brand Name: Tylenol
Classification: Nonnarcotic analgesic, antipyretic
Action: unknown but approximated to be inhibiting cyclooxygenase
Indications: mild-moderate pain, fever
Contraindications: hypersensitivity, alcoholism, chronic liver disease
Dose: 325-650mg
Routes: PO, IV
Adverse Effects: Rare
Other: can be liver toxic, use minimal dosage necessary
Ibuprofen*
Brand Name: Motrin, Advil
Classification: NSAID
Action: Anti-inflammatory, antipyretic through inhibition of prostaglandins
Indications: mild-moderate pain, fever, inflammation
Contraindications: hypersensitivity, bronchospasms, angioedema
Dose: 200-800mg
Routes: PO
Adverse Effects: nausea, vomiting, GI bleed, allergic reactions
Other: commonly causes gastric distress
Ketorolac*
Brand Name: Toradol
Classification: NSAID
Action: Anti-inflammatory and antipyretic through inhibition of prostaglandins
Indications: Mild-moderate pain, fever, inflammation, renal colic
Contraindications: hypersensitivity, bronchospasm, angioedema
Dose: 30mg (IV and elderly 60mg IM)
Routes: IV, IM
Adverse Effects: Nausea, vomiting, GI bleeding, allergic reactions
Other: commonly causes gastric upset, avoid entericcoated aspirin in chest pain
Butorphanol*
Brand Name: Stadol
Classification: Opiate agonist-antagonist (class IV)
Action: Analgesia and sedation through binding with opiate receptors, it also has some opiate receptor antagonistic properties
Indications: Moderate-Severe pain
Contraindications: Hypersensitivity, opiate dependence, respiratory depression
Dose: 1-4mg
Routes: IV, IM, SQ, IO, IN
Adverse: Sedation, dizziness, nausea, vomiting, opiate withdrawal
Other: use with caution in pts with liver and renal disease
Propofol*
Brand Name: Diprivan
Classification: Nonbarbiturate, nonbenzodiazepine sedative
Action: Uncertain, Appears to potentiate GABA receptors
Indications: Sedation
Contraindications: Hypersensitivity to drug or egg/soy products
Dose: 25-75 mcg/kg/min
Routes: IV
Adverse: pain on induction, nausea, vomiting, respiratory depression
Other: all monitors in place, resuscitation equipment should be immediately available
Chlorpromazine*
Brand Name: Thorazine
Classification: Phenothiazine
Action: Blocks dopamine receptors associated with mood and behavior
Indications: Psychosis, intractable hiccups
Contraindications: hypotension and hypersensitivity
Dose: 25-50mg
Routes: IM, PO
Adverse: Extrapyramidal reactions, insomnia, restlessness, dry mouth, hypotension, tachycardia
Other: hypotension more common in pts taking antihypertensive
Ziprasidone*
Brand Name: Geodon
Classification: Unclassified antipsychotic
Action: inhibits uptake of serotonin and dopamine
Indications: psychosis, Tourette’s syndrome
Contraindications: Hypersensitivity
Dose: 50-100mcg
Routes: IM, PO
Adverse: Extrapyramidal reactions, insomnia, restlessness, dry mouth, hypotension, tachycardia
Other: Carbamazepine (Tegretol) can decrease ziprasidone levels
Dobutamine*
Brand Name: Dobutrex
Classification: Synthetic sympathetic agonist
Action: A and B adrenergic agonist (inotropic properties more pronounced that chronotropic properties)
Indications: Congestive Heart Failure (CHF)
Contraindications: Hypovolemia
Dose: 2-20mcg/kg/min (titrate to effect)
Routes: IV
Adverse: Palpatations, anxiety, tremulousness, headache, dizziness, hypertension, can worsen cardiac ischemia, reflex bradycardia
Other: Extravasation can cause localized tissue damage, best administered through central line, other agents preferred in cardiogenic shock
Levalbuterol*
Brand Name: Xopenex
Classification: B agonist
Action: B agonist with preference for B2 adrenergic receptors. It is a racemic isomer of albuterol
Indications: Bronchospasms, allergies/anaphylaxis, hyperkalemia
Contraindications: Hypersensitivity
Dose: 0.63mc (SVN)
Routes: Inhalation
Adverse: Palpitations, anxiety, tremulousness, headache, dizziness, tachycardia
Other: The pts heart rate and SpO2 should be monitored during treatment
Metaproterenol*
Brand Name: Alupent
Classification: B Agonist
Action: B Agonist with preference for B2 adrenergic receptors
Indications: Bronchospasm, allergies/anaphylaxis, hyperkalemia
Contraindications: Hypersensitivity
Dose: 0.2-0.3ml of solution containing 15mg/ml (SVN); 0.65mg (MDI)
Routes: Inhalation
Adverse: Palpitations, anxiety, tremulousness, headache, dizziness, tachycardia
Other: The pts heart rate and SpO2 should be monitored during treatment
Terbutaline*
Brand Name: Brethine
Classification: B Agonist
Action: Relatively nonselective B agonist
Indications: Bronchospasm, allergies/anaphylaxis, hyperkalemia, preterm labor
Contraindications: hypersensitivity
Dose: 0.25mg
Routes: Inhalation, SQ
Adverse: Palpitations, anxiety, tremulousness, headache, dizziness, tachycardia
Other: The pts heart rate and SpO2 should be monitored during treatment
Racemic Epinephrine*
Brand Name: S2
Classification: Sympathetic Agonist
Action: Relatively nonselective B agonist. It is a mix of both racemic isomers of epinephrine
Indications: Croup
Contraindications: Hypersensitivity
Dose: 0.25-0.75ml of a 2.5% solution
Routes: Inhalation
Adverse: Palpitations, anxiety, tremulousness, headache, dizziness, tachycardia
Other: The pts heart rate and SpO2 should be monitored during treatment
Procainamide*
Brand Name: Pronestyl
Classification: Class Ia antiarrhythmic; local anesthetic
Action: Ester-type local anesthetic; reduces automaticity and AV conduction
Indications: V-Tach w/ pulse, pre-excited A-Fib
Contraindications: Do not administer to pts receiving IV calcium channel blockers
Dose: 20-50mg/min
Routes: IV
Adverse: Drowsiness, slurred speech, confusion, seizures, hypotension
Other: Carefully monitor ECG (QRS duration) during administration
Phenytoin*
Brand Name: Dilantin
Classification: Class Ib antiarrhythmic; anticonvulsant
Action: Depresses automaticity and AV conduction; reduces voltage and spread of electrical discharges in motor cortex
Indications: Life-threatening arrhythmias from digitalis toxicity; & seizures
Contraindications: bradycardia, high-grade heart block, hypersensitivity
Dose: 15-18mg/kg
Routes: IV
Adverse: Drowsiness, dizziness, headache, hypotension, arrhythmias, nausea, vomiting
Other: Fosphenytoin is preferred for seizure management
Esmolol*
Brand Name: Brevibloc
Classification: Class II antiarrhythmic; beta blocker
Action: slows heart rate through selective blockage of B1 receptors; short half life
Indications: Tachycardia
Contraindications: Asthma, heart block, bradycardia, cardiogenic shock
Dose: 50-100 mcg/kg/min
Routes: IV
Adverse: Bradycardia, hypotension, CHF, lethargy
Other: Hypotension is common but dose related; should not be administered to pts receiving calcium channel blockers
Labetalol*
Brand Name: Trandate, Normodyne
Classification: Class II antiarrhythmic; beta blocker
Action: lowers BP through nonselective blockage of B receptors (and limit blockage of A2 receptors)
Indications: Hypertensive emergency
Contraindications: Asthma, heart block, bradycardia, cardiogenic shock
Dose: 10-20mg
Routes: IV, PO
Adverse: Bradycardia, hypotension, CHF, lethargy
Other: Should not be administered to pts receiving calcium channel blockers
Cimetidine*
Brand Name: Tagamet
Classification: Antihistamine
Action: Selectively blocks H2 histamine receptors
Indications: Duodenal/ peptic ulcer, anaphylaxis
Contraindications: Hypersensitivity
Dose: 300mg
Routes: IV, IM, PO
Adverse: Diarrhea, drowsiness, dizziness
Other: Can be used as an adjunct for severe allergic reactions and anaphylaxis
Prochlorperazine*
Brand Name: Compazine
Classification: Phenothiazine
Action: Suppresses the CTZ; has antihistaminic effects
Indications: Nausea, vomiting, anxiety, psychosis
Contraindications: Hypersensitivity, small children, or pregnancy
Dose: 5-10mg
Routes: IV, IM, IO, PO
Adverse: Drowsiness, dizziness, sedation, dry mouth, extrapyramidal symptoms
Other: Can potentiate CNS depressants (e.g. alcohol)
Droperidol*
Brand Name: Inapsine
Classification: Antidopaminergic
Action: Blocks dopamine receptors (D2)
Indications: Nausea, vomiting, psychosis
Contraindications: Hypersensitivity, prolonged QTc on ECG
Dose: 1.25-2.50mg
Routes: IV, IM
Adverse: QTc prolongation, hypotension, tachycardia
Other: Has “Black Box” warning due to possible QT prolongation
Vasopressin*
Brand Name: Pitressin
Classification: Hormone (analog of antidiuretic hormone)
Action: Non-adrenergic vasoconstrictor; promotes fluid retention in the kidney
Indications: Normovolemic hypotension
Contraindications: Few in the emergency setting
Dose: 40 units
Routes: IV
Adverse: Blanching of the skin, abdominal cramping, nausea, hypertension
Other: Benefits in cardiac arrest are questionable
Insulin*
Brand Name: Humulin, NovoLog, Novolin
Classification: Hormone (insulin)
Action: causes glucose uptake by the cells thus lowering blood glucose levels
Indications: Diabetes, hyperglycemia, diabetic ketoacidosis
Contraindications: Hypoglycemia, normoglycemia
Dose: Varies
Routes: IV, SQ
Adverse: Few in the emergency setting
Other: Dosage of the various insulin types vary significantly
Methylprednisolone*
Brand Name: Methylprednisolone
Classification: Hormone (analog of corticosteroid)
Action: anti-inflammatory; suppresses immune response
Indications: asthma, COPD, anaphylaxis
Contraindications: hypersensitivity
Dose: 125-250mg
Routes: IV, IO
Adverse: GI bleeding, increases blood glucose levels
Other: effects are delayed and not typically seen in the prehospital setting
Hydroxocobalamin*
Brand Name: Cyanokit
Classification: cyanide antidote
Action: chelates cyanide from cytochrome oxidase forming cyanocobalamin (Vitamin B12)
Indications: cyanide or suspected cyanide poisoning
Contraindications: none in the emergency setting
Dose: 5-10mg
Routes: IV
Adverse: Chromaturia, red skin, rash, hypertension, nausea, headache
Other: Be prepared to continue full resuscitative measures following administration
Sodium Nitrite*
Brand Name: Sodium Nitrite
Classification: Cyanide Antidote
Action: Vasodilator; oxidizes to hemoglobin to methemoglobin which reacts to cyanide ion to form cyanomethemoglobin, which is enzymatically degraded
Indications: cyanide poisoning
Contraindications: should not be administered to asymptomatic pts
Dose: 150-300 mg
Routes: IV
Adverse: Headache, weakness, dizziness, flushing, tachycardia, orthostatic hypotension
Other: Headache and hypotension common; can worsen hypoxia in the setting of carbon monoxide poisoning
Sodium Thiosulfate*
Brand Name: Sodium Thiosulfate
Classification: Cyanide antidote
Action: converts cyanide to thiocyanate, which is removed by the kidneys
Indications: cyanide poisoning
Contraindications: none in the emergency setting
Dose: 12.5g
Routes: IV
Adverse: Nausea, vomiting, joint pain, psychosis
Other: should be administered as part of the standard (Pasadena) cyanide kit
Pralidoxime*
Brand Name: 2-PAM, Protpam
Classification: Organophosphate antidote
Action: Reactivates cholinesterase; deactivates certain organophosphates
Indications: organophosphate poisoning
Contraindications: poisoning other than organophosphates
Dose: 1-2g over 30 min
Routes: IV
Adverse: Excitement, manic behavior, laryngospasm, tachycardia
Other: Always protect rescue personnel from the poison; 2-PAM administration should always follow atropinization
