Medications & Indications + Contraindications Flashcards
Acetaminophen
Indications: Pain and fever control
Contraindications: Known hypersensitivity | Severe active liver disease
AcetaZOLAMIDE (Diamox, Diamox Sequels)
Indications: Acute Mountain Sickness (treatment and prophylaxis) | Prevention of HACE (High-altitude cerebral edema)
Contraindications: Hypersensitivity to acetaZOLAMIDE or sulfa | Known hypokalemia or hyponatremia | Renal or liver dysfunction | Should not be used for the treatment of HAPE (high-altitude pulmonary edema)
Acetic Acid (Vinegar)
Indications: Otitis externa | Pain control for envenomation by jellyfish from outside the United States
Contraindications: Hypersensitivity | Perforated tympanic membranes | May increase nematocyst discharge for US jellyfish and should be used only outside the United States
Acetylcysteine (Mucomyst, Acetadote)
Indications: Acetaminophen overdose
Contraindications: Known hypersensitivity | Acute asthma
Activated charcoal
Indications: Most oral poisonings and medication overdoses in the alert patient | Can be used after evacuation of poisons
Contraindications: Known hypersensitivity | Unprotected airway | Absence of a gag reflex | Ileus | Intestinal obstruction | Do not use after ingestion of petroleum distillates, hydrocarbons, heavy metals, acids or alkalis (corrosives), alcohols, iron, lithium, solvents | Use caution in patients experiencing abdominal pain of unknown origin
Adenosine (Adenocard)
Indications: First-line drug for most forms of stable, regular, narrow-complex SVT | Can be considered for marrow-complex reentry tachycardia while preparing for cardioversion | Can be used diagnostically for stable, regular, monomorphic wide-complex tachycardia
Contraindications: Known hypersensitivity | Second- or third-degree AV block or sick sinus syndrome or other sinus node disease | Poison- or drug-induced tachycardia | Use with caution in patients with a history of seizure disorder | May induce bronchospasm in a patient with bronchoconstrictive or bronchospastic lung disease (ex: asthma and COPD)
Albumin (Albumarc, Albutein, Flexbumin)
Indications: Hypovolemia
Contraindications: Hypersensitivity | Patients at risk of hypervolemia | Use with caution in patients with renal insufficiency or anemia
Albuterol
Indications: Treatment and prevention of bronchospasm in patients with reversible obstructive airway disease | Treatment of inhaled airway/respiratory irritant agents and Hyperkalemia
Contraindications: Known hypersensitivity | Dysrhythmias (notably those caused by Digitalis) | Synergistic with other sympathomimetics
Amiodarone (Cordarone, Pacerone)
Indications: Cardiac arrest resulting from VF or pulseless VT after CPR, defibrillation, and epinephrine | Stable, regular narrow-complex tachycardia if the rhythm persists despite vagal maneuvers or adenosine or the tachycardia is recurrent | To control the ventricular rate in AF with a rapid ventricular response without preexcitation | Stable wide-complex tachycardia | Stable monomorphic VT | Polymorphic VT with a normal QT interval
Contraindications: Known hypersensitivity | Iodine hypersensitivity | Cardiogenic shock | Second- of third-degree AV block | Sick sinus syndrome or other sinuse node disease (unless a functioning artificial pacemaker is present)
Aspirin (Acetylsalicylic Acid)
Indications: New-onset chest discomfort suggestive of ACS
Contraindications: Hypersensitivity to ASA or NSAIDs | Bleeding disorders | Hemolytic anemia | Lactating mothers
Atropine sulfate
Indications: Hemodynamically unstable bradycardia | Acetylcholinesterase inhibitor poisoning (carbamates, nerve agents, organophosphates) | RSI in pediatrics | Beta blocker or calcium channel blocker overdose
Contraindications: Known hypersensitivity | Narrow-angle glaucoma | GI obstruction | Severe ulcerative colitis | Toxic megacolon | Bladder outlet obstruction | Myasthenia gravis | Hemorrhage with cardiovascular instability | Thyrotoxicosis
Benzocaine Spray (Hurricane)
Indications: Topical anesthetic (ex at larygnx, mouth, trachea, nasal cavity) to facilitate passage of diagnostic and tx devices | Suppresses the pharyngeal and tracheal gag reflex
Contraindications: Hypersensitivity to benzocaine or other “caine” anesthetics
Bumetanide (Bumex)
Indications: Pulmonary edema, heart failure
Contraindications: Hypersensitivity to bumetanide, furosemide, or sulfonamides | Hypovolemia, anuria, acid-based imbalance, electrolyte imbalance, hepatic coma | Use with caution in patients with hepatic cirrhosis, ascites, or diabetes
Calcium chloride
Indications: Hypocalcemia | Hyperkalemia | Beta blocker and calcium channel blocker toxicity | Antidote for magnesium sulfate overdose
Contraindications: Known hypersensitivity | Digoxin toxicity | Hypercalcemia | Suspected severe hypokalemia
Calcium gluconate
Indications: Topical use in hydrofluoric acid burn management | Hypocalcemia | Hyperkalemia | Beta blocker and calcium channel blocker toxicity
Contraindications: Known hypersensitivity | Digoxin toxicity | Hypercalcemia | Suspected severe hypokalemia
Cimetidine (Tagamet)
Indications: Gastric or duodenal ulcers | GERD | Adjunct in treating hives and/or itching in pts w/ an allergic reaction that’s NOT responding to H1 blockers alone (ex: diphenhydrAMINE)
Contraindications: Known hypersensitivity to cimetidine or other H2 blockers
Hetastarch (Hespan)
Indications: Hypovolemic shock, especially burn shock | Septic shock
Contraindications: No significant contraindications when used in the management of life-threatening hypovolemic states
Plasma Protein Fraction (Plasmanate)
Indications: Hypovolemic shock, especially burn shock | Hypoproteinemia (low-protein states)
Contraindications: No significant contraindications when used to treat life-threatening hypovolemic states
0.9% Sodium Chloride (Normal Saline)
Indications: Heat-related problems (heat exhaustion, heatstroke) | Freshwater drowning | Hypovolemia | Diabetic ketoacidosis | Keep open IV
Contraindications: Avoid in patients with history of heart failure or renal failure because circulatory overload can be easily induced
0.45% Sodium Chloride
Indications: Patients with diminished renal or cardiovascular function for whom rapid rehydration is not indicated
Contraindications: Cases in which rapid rehydration is indicated
Lactated Ringer Solution (Hartmann Solution)
Indications: Hypovolemic shock | Keep open IV, hypoperfusion
Contraindications: Heart failure or renal failure | Avoid use in patients with crush injuries/compartment syndrome
3% Sodium Chloride (Hypertonic Saline)
Indications: Traumatic brain injuries | Fluid resuscitation in severe sepsis | Hyponatremia
Contraindications: Hypotension | Use with caution in pediatric patients because their sodium levels shift rapidly | Rapid increases can cause significant neurologic complications
5% Dextrose in 0.45% Sodium Chloride
Indications: Heat exhaustion, diabetic disorders | KVO solution (keep veins open solution) in patients with impaired renal or cardiovascular function
Contraindications: Should NOT be used when rapid fluid resuscitation is indicated
5% Dextrose in 0.9% Sodium Chloride
Indications: Heat-related disorders | Freshwater drowning | Hypovolemia | Peritonitis
Contraindications: Should NOT be administered to patients with impaired cardiac or renal function
5% Dextrose in Lactated Ringer Solution
Indications: Hypovolemic shock | Hemorrhagic shock | Some instances of acidosis
Contraindications: Should NOT be administered to patients with impaired cardiac or renal function
Total Parenteral Nutrition
Indications: Ordered and customized to each patient based on needs identified from lab work
Contraindications: Vary based on the specific mixture
Dexamethasone sodium phosphate (Decadron)
Indications: Anaphylaxis | Acute exacerbation of bronchial asthma | AMS (Acute Mountain Sickness) | HACE (High-altitude cerbral edema) | Spinal cord injury | Croup | Elevated ICP | Adjunct in treatment of shock | COVID-19 w/ severe respiratory sxs
Contraindications: Documented hypersensitivity | Systemic fungal infection | Preterm infants
Dextran
Indications: Hypovolemic shock
Contraindications: Known hypersensitivity | Heart failure, renal failure, or known bleeding disorders
Bacteriostatic Water
Indications: Used for diluting or dissolving drugs for IV, IM, or subcutaneous injections based on the drug manufacturer’s recommendations
Contraindications: Hypersensitivity to benzyl alcohol due to use as a preservative
5% Dextrose in Water
Indications: IV access for emergency drugs; Dilution of concentrated drugs for IV infusion
Contraindications: Should NOT be used as a fluid replacement for hypovolemic states
10% Dextrose in Water
Indications: Neonatal resuscitation | Hypoglycemia
Contraindications: Should NOT be used as a fluid replacement for hypovolemic states
Dextrose
Indications: Hypoglycemia | Acutely altered mental status | Coma or seizure of unknown origin | Status epilepticus
Contraindications: Documented hypersensitivity | Hyperglycemia | Severe dehydration | Anuria | Diabetic coma | Intracranial or intraspinal hemorrhage | Glucose-galactose malabsorption syndrome
Diazepam (Valium, Diastate, AcuDial)
Indications: Uncontrolled shivering associated w/ hyperthermia/heat-exposure, active seizures, chemical restraint, axetylcholinesterase inhibitor poisoning (carbamate, nerve agents, organophosphate)
Contraindications: Documented hypersensitivity | Neurologic or respiratory depression | Narrow-angle glaucoma | Myasthenia gravis | Head injury
Digoxin (Lanoxin)
Indications: Heart failure | alternative frug for reentry SVT | ventricular rate control in atrial flutter and AF
Contraindications: Known hypersensitivity | VF | VT | digitalis toxicity | Hypokalemia, hypomagnesemia, and hypercalcemia potentiate digitalis toxicity
Diltiazem (Cardizem, Dilacor, Diltiaz)
Indications: Stable narrow-QRS tachycardia; if Rhythm persists despite vagal maneuvers or administration of adenosine, or if the tachycardia is recurrent | To control the ventricular rate in patients with AF or atrial flutter without preexcitation
Contraindications: Known hypersensitivity | Hypotension | Cardiogenic shock | Wide-complex tachycardia (may lead to hemodynamic deterioration and VF) | Second- or third-degree AV block | Sick sinus syndrome or other sinus node disease | Poison- or drug-induced tachycardia | AF or atrial flutter associated with an accessory bypass tract (ex: Wolff-Parkinson-White syndrome or Lown-Ganong-Levine syndrome) | Avoid use in patients with left ventricular systolic dysfunction or decompensated heart failure | Use with extreme caution in patients taking oral beta blockers
DiphenhydrAMINE HCl (Benadryl)
Indications: Symptomatic allergic reactions | Symptomatic dystonia | Extrapyramidal signs or symptoms caused by phenothiazines | Antiemetic | Chemical restraint
Contraindications: Known hypersensitivity, newborns and premature infants, breastfeeding | Use with caution in patients with severe vomiting, asthma, narrow-angle glaucoma, benign prostatic hypertrophy, or alcohol intoxication | Use is controversial in patients with lower respiratory tract disease (including acute asthma)
DOBUTamine Hydrochloride (Dobutrex)
Indications: Heart failure with a SBP of 70 to 100 mm Hg and no signs of shock
Contraindications: Known hypersensitivity | Suspected or known poison/drug-induced shock | SBP less than 100 mm Hg and signs of shock | Idiopathic hypertrophic subaortic stenosis
DOPamine Hydrochloride (Intropin)
Indications: Refractory cardiogenic or distributive shock | Hypotension with low cardiac output states | Second-line drug from symptomatic bradycardia
Contraindications: Known hypersensitivity | Hypovolemia | Pheochromocytoma | Uncorrected tachydysrhythmias | VF
Droperidol (Inaspine)
Indications: Chemical restraint | Acute delirium or psychosis
Contraindications: Known hypersensitivity | Known or suspected prolonged QT interval | Use with extreme caution in patients with bradycardia, cardiac disease, concurrent MAOI therapy, or use of Class I and Class III antidysrhythmics or other drugs that prolong the QT interval and cause electrolyte disturbances because of its adverse cardiovascular effects
EPINEPHrine
Indications: Cardiac arrest | Bradycardia | Shock | Anaphylaxis | Sever refractory wheezing (IM) | Coup/bronchiolitis (nebulized)
Contraindications: Known hypersensitivity, coronary insufficiency, cardiac dilation | Uncontrolled hypertension | Hypothermia | Pulmonary edema | Myocardial ischemia | Hypovolemic shock
Etomidate (Amidate)
Indications: Premedication for medication-facilitated intubation or procedural sedation
Contraindications: Known hypersensitivity | Labor/delivery | Septic shock (particularly in children)
Famotidine (Pepcid)
Indications: GI ulcer | Suspected upper GI bleeding | GERD | As an adjunct in the treatment of urticaria and/or pruritus in pts experiencing an allergic reaction that does not respond to an H1 blocker alone (ex: diphenhydraAMINE)
Contraindications: Known hypersensitivity to famotidine or other H2 blockers
FentanNYL Citrate (Sublimaze)
Indications: Pain management | Anesthesia adjunct | Severe respiratory distress (palliative care)
Contraindications: Known hypersensitivity; Patients who have taken an MAOI in the previous 14 days | Administer with caution to patients with a Glasgow Coma Scale (GCS) score less than 15 | Hypotension | Hypoxia after maximal supplemental oxygen therapy | Signs of hypoventilation
Furosemide (Lasix)
Indications: heart failure | HTN
Contraindications: hypersensitivity to furosemide or sulfonamide medications | hypovolemia | anuria |hepatic coma | suspected electrolyte imbalance
Glucagon (GlucaGen)
Indications: Altered mental status when hypoglycemia is suspected | Antidote for symptomatic bradycardia caused by beta blocker or calcium channel blocker overdoses
Contraindications: Known hypersensitivity, pheochromocytoma, hyperglycemia, insulinoma
Glucose, oral
Indications: Conscious patients with suspected hypoglycemia
Contraindications: Known hypersensitivity | Decreased level of consciousness | N/V
Haloperidol (Haldol)
Indications: Acute psychotic episodes or agitated/violent behavior | Anxiety (Palliative care)
Contraindications: Documented hypersensitivity | Severe CNS depression | Neuroleptic malignant syndrome | Poorly controlled seizure disorder | Parkinson disease | Agitation secondary to shock and hypoxia
Helium Gas Mixture (Heliox)
Indications: Persistent or severe bronchospasm
Contraindications: N/A
HydrALAZINE (Apresoline)
Indications: Pregnancy-induced hypertension (SBP >= 160 mmHg or DBP >= 100 mmHg) lasting more than 15 minutes with associated preeclampsia symptoms
Contraindications: Known hypersensitivity, CAB, mitral valve rheumatic heart disease | Use with caution in patients with stroke, known renal disease, or hypotension
Hydrocortisone sodium succinate (Colu-Cortef)
Indications: Shock with history of adrenal insufficiency or long-term steroid dependence - Anaphylaxis, asthma, and COPD
Contraindications: Known hypersensitivity | Systemic fungal infections | Premature infants (contains benzyl alcohol, which is associated w/ “Fatal Gasping Syndrome” - characterized by CNS depression, metabolic acidosis, and gasping respirations)
HYRDROmorphone (Dilaudid)
Indications: Management of acute moderate to severe pain
Contraindications: Known hypersensitivity | MAOI use during the previous 14 days | GI obstruction | Administer with caution in: Older adults; Patients with a GCS score less than 15; and Patients with hypotension, hypoxia, signs of hypoventilation, head injury, or concomitant use of CNS depressants
Hydroxocobalamin (Cyanokit)
Indications: Known or suspected cyanide poisoning
Contraindications: Documented hypersensitivity
Ibuprofen (Advil, Motrin)
Indications: Acute pain management | Antipyretic
Contraindications: Known ASA/NSAID hypersensitivity | ASA-sensitive asthma | Significant renal function impairment | Pregnancy | Known peptic ulcer disease | Active intracranial hemorrhage or GI bleeding | Thrombocytopenia | Coagulation defects | Proven or suspected necrotizing enterocolitis | Perioperative pain in the setting of coronary artery bypass graft surgery
Insulin
Indications: Diabetic ketoacidosis or other hyperglycemic state | hyperkalemia (insulin and D50 are used together to kyerkalemia) | nonketotic hyperosmolar coma
Contraindications: Hypersensitivity | hypoglycemia | hypokalemia
Ipratropium Bromide (Atrovent)
Indications: Persistent bronchospasm | COPD exacerbation | Toxic inhalation (in conjunction with albuterol)
Contraindications: Hypersensitivity to ipratropium, atropine, alkaloids, or peanuts | Use with caution in patients with urinary retention, narrow-angle glaucoma, cardiovascular disease, or hypertension
Isopropyl Alcohol
Indications: Nausea/Vomitting
Contraindications: N/A
Ketamine (Ketalar)
Indications: Procedural sedation | Management of agitated or violent behavior | pain control
Contraindications: Known hypersensitivity | Infants younger than 3 months of age | Pregnancy | Angina | Heart failure | Symptomatic hyperthyroidism | Known or suspected schizophrenia | Conditions where hypertension would be hazardous to a patient’s care | Use with caution in any patient with the potential for increased ICP
Ketorolac Tromethamine (Toradol)
Indications: Acute management of moderate to severe pain
Contraindications: NSAID or ASA allergy | ASA-sensitive asthma | Renal insufficiency | Pregnancy/Labour/Breastfeeding | Known peptic ulcer disease | Hypotension | Significant renal impairment | Previous or current GI bleeding | Intracranial bleeding | Coagulation defects | Patients at high risk of bleeding | Use with caution in older patients due to a higher risk of renal and fatal GI adverse reactions
Levalbuterol (Xopenex)
Indications: Treatment of acute bronchospasm in patients with reversible obstructive airway disease (COPD/asthma) | Bronchospasm prophylaxis in patients with asthma
Contraindications: Known hypersensitivity to the drug, other sympathomimetics, or peanuts | MAOI use within 14 days | Angioedema, tachydysrhythmias, and severe cardiac disease | Avoid administration with other drugs that prolong the QT interval | Use with caution in patients with cardiac dysrhythmias and cardiovascular disorders
Lidocaine HCl (Xylocaine)
Indications: Alternative to amiodarone in patients with cardiac arrest from: VT, VF ; Stable monomorphic VT ; or Stable polymorphic VT with normal baseline QT interval when ischemia is treated with electrolyte balance is corrected | Can be used for stable polymorphic VT with baseline QT interval prolongation if TdP is suspected | Can be used as a local anesthetic for various procedures
Contraindications: Hypersensitivity to lidocaine or amide-type local anesthetics, second- or third-degree AV block in the absence of artifical pacemaker, Stokes-Adams syndrome, wide-complex ventricular escape beats w/ bradycardia, Wolff-Parkinson-White Syndrome | Prophylactic use in AMI is contraindicated
LORazepam (Ativan)
Indications: Uncontrolled shivering associated with hyperthermia/heat exposure | Active seizures | Anxiety/sedation | Chemical restraint
Contraindications: Documented hypersensitivity | Neurologic or respiratory depression | Acute narrow-angle glaucoma | Sleep apnea | Shock | Suspected drug abuse
Magnesium sulfate
Indications: Management of TdP | Severe bronchoconstriction with impending respiratory failure | Seizure during the third trimester of pregnancy or in the postpartum patient
Contraindications: Known hypersensitivity, heart block, myocardial damage, diabetic coma, hypermagnesemia, hypercalcemia | Use with caution in patients with known renal insufficiency
Mannitol (Osmitrol)
Indications: Reduction of ICP in managing neurologic emergencies; Promotes diuresis for excretion of toxic substances and metabolites
Contraindications: Known hypersensitivity, hypotension, pulmonary edema | Severe pulmonary congestion | Electrolyte abnormalities | Severe dehydration | Intracranial bleeding | Heart failure | Use with caution in patients with impaired renal function (fluid overload can result)
Meperidine Hydrochloride (Demerol)
Indications: Analgesia for moderate to severe pain
Contraindications: Known hypersensitivity | Diarrhea caused by poisoning | Patients who have taken an MAOI during the previous 14 days | During labor or delivery for a premature infant | Administer with caution to patients with: A GCS score less than 15, Hypotension, Hypoxia after maximal supplemental oxygen therapy, Signs of hypoventilation | Decrease the dose for patients with hepatic or renal insufficiency
MethylPREDNISolone Sodium Succinate (Solu-Medrol)
Indications: Allergic reaction | Anaphylaxis | Acute bronchospastic disease management | Shock with a history of adrenal insufficiency or long-term steroid dependence
Contraindications: Known hypersensitivity | Serious untreated infections | Premature infants | Use with caution in patients with: GI bleeding, Heart failure, Hypertension, Recent AMI, Renal disease, Seizure disorder, Cushing disease
Metoclopramide (Reglan)
Indications: Nausea/vomiting
Contraindications: Known hypersensitivity to metoclopramide or procainamide | GI hemorrhage, mechanical obstruction, or perforation | History of seizures, tardive dyskinesia, or a dystonic reaction | Pheochromocytoma (a neuroendocrine tumor) | Parkinson disease | Administration with other drugs that can cause extrapyramidal symptoms
Midazolam Hydrochloride (Versed)
Indications: Uncontrolled shivering associated with hyperthermia/heat exposure | Active seizures | Chemical restraint | Severe respiratory distress (pallative care) | Sedation for medical procedures (ex: intubating, cardioversion, ventilated pts) | Poisoning/overdose care
Contraindications: Documented hypersensitivity | Neurologic or respiratory depression | Acute narrow-angle glaucoma | Sleep apnea | Shock | Alcohol intoxication | Overdose | Depressed vital signs | Concomitant use with barbiturates, alcohol, opioids, or other CNS depressants
Milrinone (Primacor)
Indications: Heart failure in postoperative cardiovascular surgical patients | Shock with high systemic vascular resistance
Contraindications: Known hypersensitivity | Reduce the dose in patients with renal dysfunction
Morphine sulfate (Roxanol, MS Contin)
Indications: Management of acute pain
Contraindications: Known hypersensitivity | Patients who have taken an MAOI during the previous 14 days | Paralytic ileus | Toxin-mediated diarrhea | Heart failure due to chronic lung disease | Head injuries | Brain tumors | Delirium tremens | Seizure disorders | During labor when premature birth is anticipated | Acute or severe bronchial asthma | Upper airway obstruction | Administer with caution to patients with: A GCS score less than 15, Hypotension, Hypoxia after maximal supplemental oxygen therapy, Signs of hypoventilation
Naloxone Hydrochloride (Narcan, EVZIO)
Indications: Complete or partial reversal of CNS and respiratory depression induced by opioids or synthetic opioids
Contraindications: Known hypersensitivity or allergy | Use with caution in opioid-dependent patients | Use with caution in neonates of opioid-addicted mothers
NIFEdipine (Procardia, Adalat, Nifedical)
Indications: HAPE prevention and treatment | Pregnancy-induced hypertension (SBP >= 160 mmHg or DBP >= 110 mmHg) lasting more than 15 minutes with associated preeclampsia symptoms
Contraindications: Known hypersensitivity to calcium channel blockers | Cardiogenic shock | Immediate-release preparation (sublingually or orally) for urgent or emergent hypertension
Nitroglycerin (NGT)
Indications: Ischemic-type chest pain | Acute and symptomatic hypertension | Heart failure | Pulmonary edema
Contraindications: Known hypersensitivity | Hypotension | Hypovolemia | Intracranial bleeding or head injury | Pericardial tamponade | Severe bradycardia or tachycardia | RV infarction | Previous administration of sildenafil or vardenafil within 24 hours or tadalafil within 48 hours | Use with caution in patients with: Hepatic disease, Anemia, Diabetes mellitus, Pregnancy, Breastfeeding
Nitroprusside (Nitropress)
Indications: Heart failure | Acute and symptomatic hypertension
Contraindications: Known hypersensitivity | Hypotension | Decreased cerebral perfusion | Heart failure with reduced peripheral vascular resistance
Nitrous oxide 50:50 (Nitronox)
Indications: Analgesia in the patient who can self-administer this medication
Contraindications: Known hypersensitivity | Impaired level of consciousness | Head injury | Inability to follow or comply with instructions | Decompression illness | Significant respiratory compromise | Suspected abnormal air-filled cavities | Maxillofacial trauma or facial burns | Relative contraindications include: stroke history, hypotension, pregnancy, known cardiac conditions, and known vitamin B12 deficiency
Norepinephrine Bitartrate (Levophed, Levarterenol)
Indications: First-line vasopressor in neurogenic shock | Hypotension unresponsive to IV/IO fluid resuscitation
Contraindications: Known hypersensitivity | Hypotension caused by hypovolemia | Pregnancy (relative)
Ondansetron (Sandostatin)
Indications: Treatment of active GI bleeding during transport
Contraindications: Known hypersensitivity
Olanzapine (Zyprexa)
Indications: Agitated or violent patients experiencing a behavioral emergency | Chemical restraint
Contraindications: Documented hypersensitivity | Use with caution in patients who: Have dehydration or heat exposure, Are taking medications with anticholinergic effects | Impaired core body temperature regulation may occur | Use with caution in patients with a history of seizures or urinary retention
Onansetron Hydrochloride (Zofran, Zuplenz)
Indications: Prevention and control or nausea or vomiting
Contraindications: Known hypersensitivity to ondansetron or other 5-HT3 receptor antagonists | Known or suspected long QT syndrome | Coadministration with apomorphin (the combination is reported to cause profound hypotension and loss of conciousness)
Oxygen
Indications: Any suspected cardiopulmonary emergency | Complaints of shortness of breath and ischemic chest discomfort | All other causes of decreased tissue oxygenation
Contraindications: Observe closely when using with patients who have pulmonary conditions that are known to be dependent on hypoxic respiratory drive (very rare)
Oxymetazoline (Afrin, Dristan 12-hours, Vicks Sinus-12hours)
Indications: Epistaxis in a patient experiencing facial trauma
Contraindications: Known hypersensitivity | Severe hypertension
Oxytocin (Pitocin)
Indications: Postpartum hemorrhage due to uterine atony after infant and placental delivery
Contraindications: Known hypersensitivity | Presence of a remaining fetus | Unfavorable fetal position | Anticipated nonvaginal delivery | Fetal distress when delivery is not imminent | Prolonged use in severe toxemia
Pancuronium Bromide (Pavulon)
Indications: Adjunct to provide skeletal muscle relaxation and facilitate tracheal intubation and ventilation
Contraindications: Known hypersensitivity to pancuronium or a bromide hypersensitivity | Inability to control the airway and/or support ventilation with oxygen and positive pressure | Neuromuscular disease | Hepatic or renal failure | Use with extreme caution in patients with pulmonary disease, such as COPD
Phenylephrine (Neo-Synephrine)
Indications: Epistaxis; To reduce bleeding during nasotracheal intubation
Contraindications: Known hypersensitivity | Use with extreme caution in geriatric patients with preexisting cardiovascular disease
Potassium Iodide (Pima Syrup, SSKI, ThyroSafe, ThyroShield)
Indications: Environmental radiation emergency to block uptake of radioactive iodine isotopes in the thyroid and reduce thyroid cancer risk
Contraindications: Known iodine hypersensitivity | Hyperthyroidism | Respiratory failure
Pralidoxime (2-PAM, Protopam)
Indications: Antidote in treating poisoning by organophosphate pesticides and related nerve gases
Contraindications: Known hypersensitivity | Reduce the dose in: Patients with impaired renal function; Older adults with hypertension; Patients with myasthenia gravis
Procainamide Hydrochloride (Pronestyl)
Indications: Stable monomorphic VT with normal QT interval | Reentry SVT uncontrolled by vagal maneuvers and adenosine if BP is stable | Stable wide-complex tachycardia of unknown origin | AF with a rapid ventricular rate in patients with Wolff-Parkinson-White syndrome
Contraindications: Known hypersensitivity to procainamide or other ingredients | TdP | Second- and third-degree heart AV block | Systemic lupus erythematosus | Preexisting QT prolongation | Digitalis toxicity | TCA overdose | Administer with caution to patients with: Asthma or digitalis-induced dysrhythmias; Myasthenia gravis; Cardiac, hepatic, or renal insufficiency
Prochlorperazine (Compazine)
Indications: Nausea and vomiting
Contraindications: Documented hypersensitivity to phenothiazines | Concurrent use of large amounts of CNS depressants leading to sedation | Concomitant use of anticholinergic medications | Preexisting cardiac conduction abnormalities | Poorly controlled seizure disorder | Narrow-angle glaucoma | Prostatic hypertrophy | Past or current history of tardive dyskinesia | Subcortical brain damage | Pediatric surgery | Children younger than age 2 years
Promethazine Hydrochloride (Phenergan)
Indications: Nausea and vomiting
Contraindications: Known hypersensitivity to any phenothiazines | Concurrent use of large amounts of CNS depressants | Reye syndrome | Lower respiratory symptoms | Children younger than 2 years | Use with caution, if at all, in patients with a history of sleep apnea, acute or chronic respiratory impairment, or seizure disorders
Proparacaine Opthalmic (Alcaine, Ophthaine)
Indications: Induction of topical anesthesia before eye irrigation in the management of a chemical injury to the eye
Contraindications: Known hypersensitivity | Known or suspected trauma that may have results in intraocular injury | Use with caution in patients with cardiac disease or hyperthyroidism
Propofol (Diprivan)
Indications: Maintenance of sedation in mechanically ventilated patients
Contraindications: Hypovolemia | Known sensitivities, including to soybean oil, peanuts, and eggs
Rocuronium Bromide (Zemuron)
Indications: Adjunct to provide skeletal muscle relaxation and facilitate tracheal intubation and ventilation
Contraindications: Known hypersensitivity to rocuronium or bromide | inability to control the airway or support ventilation w/ oxygen and positive pressure | neuromuscular disease | Use w/ caution in pts w/ heart and liver disease
Sildenafil (Revatio, Viagra)
Indications: HAPE prevention
Contraindications: Known hypersensitivity | Coadministration with nitrates | Significant cardiovascular disease
Sodium bicarbonate
Indications: Management of cardiac arrest in which either hyperkalemia or TCA overdose is suspected | QRS prolongation in known or suspected TCA overdose | Crush syndrome
Contraindications: Documented hypersensitivity | Known metabolic or respiratory alkalosis | Hypokalemia | Hypernatremia | Hypocalcemia | Use with caution in patients with heart failure and renal disease due to high sodium concentration it produces
Sodium thiosulfate (Nithiodote)
Indications: Known or suspected cyanide poisoning
Contraindications: Documented hypersensitivity
Succinylcholine Chloride (Anectine)
Indications: Adjunct to provide skeletal muscle relaxation and facilitate tracheal intubation and ventilation
Contraindications: Known hypersensitivity | Inability to control the airway or support ventilation with oxygen and positive pressure | Renal failure | Muscular dystrophy and other neuromuscular diseases | Paraplegia/quadriplegia | Penetrating eye injuries | Prolonged immobilization | Stroke with residual motor dysfunction | History of malignant hyperthermia | Acute injury after multisystem trauma, major burns, known or suspected hyperkalemia, or extensive muscle injury that may result in hyperkalemia | Use with caution if a difficult airway is anticipated
Tadalfil (Cialis, Adcirca)
Indications: HAPE prevention
Contraindications: Known hypersensitivity | Coadministration with nitrates | Stevens-Johnson syndrome | Exfoliative dermatitis
Tetracaine Opthalmic Solution (Pontocaine)
Indications: Induction of topical anesthesia before eye irrigation in the management of a chemical injury to the eye
Contraindications: Known hypersensitivity | Known or suspected trauma that may have resulted in intraocular injury
Thaimine Hydrochloride (Vitamin B1)
Indications: Adjunctive therapy that should precede the administration of dextrose 50% or glucagon in an adult patient if alcoholism or malnourishment is suspected
Contraindications: Known hypersensitivity
Tranexamic Acid (Cyklokapron, Lysteda)
Indications: Blunt or penetrating trauma less than 3 hours from onset with hemodynamic compromise, bleeding
Contraindications: Known hypersensitivity | Mechanism of injury more than 3 hours prior to EMS care | Subarachnoid hemorrhage | History of PE, DVT, or other thromboembolic disorder | Reduce the dose in patients with renal insufficiency
Vecuronium Bromide (Norcuron)
Indications: Adjunct to provide skeletal muscle relaxation and facilitate tracheal intubation and ventilation
Contraindications: Known hypersensitivity to vecuronium or bromide | Inability to control the airway or support ventilation with oxygen and positive pressure | Neuromuscular disease | Acute narrow-angle glaucoma | Penetrating eye injuries | Newborns | Hepatic or renal failure
Verapamil Hydrochloride (Isoptin, Calan)
Indications: Stable narrow-QRS tachycardia if the rhythm persists despite vagal maneuvers or adenosine or if the tachycardia is recurrent | To control the ventricular rate in patients with AF or atrial flutter without preexcitation
Contraindications: Known hypersensitivity | Wolff-Parkinson-White syndrome, Lown-Ganong-Levine syndrome | Second- or third-degree AV block, sick sinus syndrome, or other sinus node disease without an artificial pacemaker present | Hypotension, cardiogenic shock, severe left ventricular dysfunction, wide-complex tachycardias | Children younger than age 12 months | Use with extreme caution in patients receiving oral beta blockers
Ziprasidone (Geodon)
Indications: For the management of agitated or violent patients experiencing a behavioral emergency | Anxiety (palliative care)
Contraindications: Known hypersensitivity | History of QT prolongation | Use of any drugs that prolong the QT interval | Recent AMI | Uncompensated heart failure | Use with caution in patients with impaired renal function
