Notes on Administration (if any specific) & Incompatibilities/Drug Interactions (if any)

Question 1

ABIXIMAB

notes of administration & incompatibilities/drug Interactions

Answer 1

• Weight-based dosing of both abciximab and concomitant heparin is essential to decrease the incidence of major and minor bleeding episodes. Patients should be managed following an accepted, literature-based standard of practice.
• Abciximab infusions must be administered through a low protein binding 0.2 or 0.22 micron in line filter.
• Infusion pump is required in management of abciximab infusions.

Incompatibilities/Drug Interactions:
- Other medications that effect hemostasis: thrombolytics, oral anticoagulants, nonsteroidal anti-inflammatory agents, dipyridamole, ticlopidine, clopidogrel.
- IV dextran in combination with abciximab results a high incidence of bleeding.

Question 2

ACETYLSALICYLIC ACID, ASPIRIN, ASA

notes of administration & incompatibilities/drug Interactions

Answer 2

Incompatibilities/Drug Interactions:
Not applicable with single dose therapy

Question 3

ACETYLSALICYLIC ACID, ASPIRIN, ASA (EMT Administration)

notes of administration & incompatibilities/drug Interactions

Answer 3

Incompatibilities/Drug Interactions:
Not applicable with single dose therapy

Question 4

ADENOSINE

notes of administration & incompatibilities/drug interactions

Answer 4

Incompatibilities/Drug Interactions:
- Adenosine is not blocked by Atropine.
- Theophylline and related methylxanthines (caffeine & theobromine-xanthine) in
therapeutic concentrations decrease effectiveness. See: CONTRAINDICATIONS Dipyridamole (Persantine) & carbamazepine (Tegretol, Atretol) block uptake and potentiate effects. See: CONTRAINDICATIONS.

Question 5

ALBUMIN, normal serum 5% / 25%

notes of administration & incompatibilities/drug interactions

Answer 5

Notes on Administration:
Needs to be administered IV slowly to prevent fluid overload; dilute with NS for injection or D5W; 5% may be given undiluted; 25% may be given diluted or undiluted, give over 4 hr, use infusion pump.

Question 6

ALUTEROL SULFATE

notes of administration & incompatibilities/drug interactions

Answer 6

Incompatibilities/Drug Interactions:
Tricyclic antidepressants (TCA’s) and monoamine oxidase (MAO) inhibitors Other sympathomimetics (relative)

Question 7

AMIODARONE

notes of administration & incompatibilities/drug interactions

Answer 7

Incompatibilities/Drug Interactions:
- Beta blockers, calcium channel blockers, and other antiarrhythmics are additive and can be proarrhythmic when given in combination with Amiodarone due to similar mechanisms of action.
- Amiodarone precipitates at certain concentrations when mixed at a Y-site with sodium bicarbonate, furosemide, and heparin.

Question 8

ATROPINE SULFATE

notes of administration & incompatibilities/drug interactions

Answer 8

Incompatibilities/Drug Interactions:
Incompatibilities:
- Y-site incompatible with thiopental
- Syringe incompatible with cimetidine, pentobarbital (variable)
- Admixture incompatible with floxacillin, metaraminol, methohexital, norepinephrine
- Sodium bicarbonate (relative)
Drug Interactions
- Atropine may increase the levels/effects of: anticholinergics, cannabinoids, and
potassium chloride
- Atropine may decrease the levels/effects of: phenothiazines, acetylcholinesterase
inhibitors (central), and secretin
- Concurrent use of atropine with psychotropics may result in additive anticholiergic side
effects (dry mouth, blurred vision, constipation)
- Pramlintide may increase the levels/effects of atropine
- Acetylcholinesterase inhibitors (central) may decrease the levels/effects of atropine

Question 9

BUMETANIDE

notes of administration & incompatibilities/drug interactions

Answer 9

NOTES ON ADMINISTRATION
High doses or frequent administration, particularly in the elderly, can cause profound diuresis, hypovolemia, and resulting circulating collapse with development of thrombi and emboli.. May precipitate hypokalemic-induced digoxin toxicity.

Incompatibilities/Drug Interactions:
- NSAIDs reduce diuretic effect
- May increase blood levels of lithium increasing risk of lithium poisoning
- Potentiates effects of various antihypertensive drugs

Question 10

CALCIUM CHLORIDE

notes of administration & incompatibilities/drug interactions

Answer 10

Incompatibilities/Drug Interactions:
All drugs – flush line before and after administration

Question 11

CALCIUM GLUCONATE GEL, 2.5%

notes of administration & incompatibilities/drug interactions

Answer 11

NOTES ON ADMINISTRATION
- Personnel should wear appropriate HF-protective gloves (neoprene) and other safety equipment before assisting patient with application of gel.
- If possible, the patient should wash area and apply the gel themselves.
- Consider placing surgical glove over gel when applied to distal upper extremities.

Question 12

CHARCOAL, ACTIVATED (without sorbitol)

notes of administration & incompatibilities/drug interactions

Answer 12

Incompatibilities/Drug Interactions:
- Ineffective for iron, lithium, heavy metals, and other ions.
- May reduce the effectiveness of other treatments (Mucomyst) in pure acetaminophen
OD’s.
- Since charcoal bonds with whatever it is mixed with, flavoring with drinks reduces
effectiveness.

Question 13

CIMETIDINE

notes of administration & incompatibilities/drug interactions

Answer 13

Incompatibilities/Drug Interactions:
- Fosphenytoin, lidocaine, phenytoin, propanolol, some benzodiazepines, theophylline, warfarin: Inhibits hepatic microsomal enzyme metabolism of these drugs.
- Digoxin, fluconazole, indomethacin, iron salts, ketoconazole, tetracycline: Decreases drug absorption.

Question 14

DEXAMETHASONE SODIUM PHOSPHATE

notes of administration & incompatibilities/drug interactions

Answer 14

Incompatibilities/Drug Interactions:
Dexamethasone is not compatible with benadryl or versed in IV tubing.

Question 15

DEXTROSE 50%

notes of administration & incompatibilities/drug interactions

Answer 15

Incompatibilities/Drug Interactions:
- Sodium bicarbonate
- Diazepam will precipitate if given concurrently without flushing

Question 16

DIAZEPAM

notes of administration & incompatibilities/drug interactions

Answer 16

Incompatibilities/Drug Interactions:
Do not mix or dilute diazepam with other solutions or drugs in syringe, tubing or IV container.

Question 17

DILTIAZEM

notes of administration & incompatibilities/drug interactions

Answer 17

Incompatibilities/Drug Interactions:
- Avoid use in patients with poison- or drug-induced tachycardia.
- Calcium chloride can be used to prevent the hypotensive effects of this drug and treat
patients with a calcium channel blocker poisoning.
- Beta blocker use

Question 18

DIPHENHYDRAMINE HCL

notes of administration & incompatibilities/drug interactions

Answer 18

Incompatibilities/Drug Interactions:
- Additive effects with alcohol and other CNS depressants (hypnotics, sedatives, tranquilizers, etc.).
- MAO inhibitors prolong and intensify anticholinergic (drying) effects.

Question 19

DOPAMINE

notes of administration & incompatibilities/drug interactions

Answer 19

Incompatibilities/Drug Interactions:
Incompatible in any alkaline solution
On-board MAO inhibitors will cause hypertensive crisis

Question 20

EPINEPHRINE AUTO-INJECTOR

notes of administration & incompatibilities/drug interactions

Answer 20

Incompatibilities/Drug Interactions:
Potentiates other sympathomimetics.

Question 21

EPINEPHRINE HCL

notes of administration & incompatibilities/drug interactions

Answer 21

Incompatibilities/Drug Interactions:
Potentiates other sympathomimetics.
Reacts with alkaline solutions, such as sodium bicarbonate, should not be mixed with alkaline agents.

Question 22

EPTIFIBATIDE

notes of administration & incompatibilities/drug interactions

Answer 22

Notes on Administration:
Weight-based dosing of both eptifibatide and concomitant heparin is essential to decrease the incidence of major and minor bleeding episodes. Patients should be managed following an accepted, literature-based standard of practice.
Infusion pump is required in management of eptifibatide infusions.

Incompatibilities/Drug Interactions:
- Other medications that effect hemostasis: thrombolytics, oral anticoagulants, aspirin and other nonsteroidal anti-inflammatory agents, dipyridamole, ticlopidine, clopidogrel.
- Not compatible in the same IV line with furosemide
- Compatible in the same IV line with: alteplase, atropine dobutamine, heparin, potassium
chloride, lidocaine, meperidine, metoprodol, midazolam, morphine, nitroglycerin and verapamil

Question 23

FAMOTIDINE

notes of administration & incompatibilities/drug interactions

Answer 23

Incompatibilities/Drug Interactions:
None significant

Question 24

FENTANYL CITRATE

notes of administration & incompatibilities/drug interactions

Answer 24

NOTES ON ADMINISTRATION:
RESUSCITATIVE AND INTUBATION EQUIPMENT AND OXYGEN SHOULD BE READILY AVAILABLE.
CNS, Respiratory and to a certain extent CV side effects can be reversed by naloxone. This does not preclude the aggressive support of airway, ventilation and circulation prior to the administration of naloxone if the clinical situation dictates.

Question 25

FUROSEMIDE

notes of administration & incompatibilities/drug interactions

Answer 25

Incompatibilities/Drug Interactions:
Increased effects with other antihypertensives

Question 26

GLUCAGON

notes of administration & incompatibilities/drug interactions

Answer 26

Incompatibilities/Drug Interactions:
Unknown

Question 27

HEMOSTATIC AGENTS

notes of administration & incompatibilities/drug interactions

Answer 27

Incompatibilities/Drug Interactions:
None

Question 28

HYDROXOCOBALAMIN

notes of administration & incompatibilities/drug interactions

Answer 28

Incompatibilities/Drug Interactions:
The 5 g vial of hydroxocobalamin for injection is to be reconstituted with 200 mL of diluent using the supplied sterile transfer spike. The recommended diluent is 0.9% NaCl. Lactated Ringers and 5% dextrose are also compatible. Following the addition of diluent, the vial should be repeatedly inverted or rocked, not shaken, for at least 60 seconds prior to infusion. Chemically incompatible with sodium thiosulfate and sodium nitrate. Physical incompatibility (particle formation) and chemical incompatibility were observed with the mixture of hydroxocobalamin in solution with select drugs that are frequently used in resuscitation efforts. (Do not administer via same IV line.)

Question 29

INSULIN

notes of administration & incompatibilities/drug interactions

Answer 29

Incompatibilities/Drug Interactions:
Drug-drug. Acetazolamide, albuterol, antiretrovirals, asparaginase, calcitonin, corticosteroids, cyclophosphamide, danazol, dextrothyroxine, diazoxide, diltiazem, diuretics, dobutamine, epinephrine, estrogens, hormonal contraceptives, isoniazid, morphine, niacin, phenothiazines, phenytoin, somatropin, terbutaline, thyroid hormones: decreased hypoglycemic effect
Anabolic steroids, angiotensin-converting enzyme inhibitors, calcium, chloroquine, clofibrate, clonidine, disopyramide, fluoxetine, guanethidine, mebendazole, MAO inhibitors, octreotide, oral hypoglycemics, phenylbutazone, propoxyphene, pyridoxine, salicylates, sulfinpyrazone, sulfonamides, tetracyclines: increased hypoglycemic effect Beta-adrenergic blockers (nonselective): masking of some hypoglycemia symptoms, delayed recovery from hypoglycemia Lithium carbonate: decreased or increased hypoglycemic effect
Pentamidine: increased hypoglycemic effect, possibly followed by hyperglycemia

Question 30

IPRATROPIUM BROMIDE

notes of administration & incompatibilities/drug interactions

Answer 30

Incompatibilities/Drug Interactions:
None. Ipratropium bromide has been shown to be safe and effective bronchodilator when used in conjunction with beta adrenergic bronchodilators (albuterol).

Question 31

KETAMINE HYDROCHLORIC INJECTION

notes of administration & incompatibilities/drug interactions

Answer 31

Notes of Administration:
IV/IO: May re-medicate with half-dose after 10 minutes.
Incompatibilities/Drug Interactions:
Diazepam

Question 32

LIDOCAINE HCL

notes of administration & incompatibilities/drug interactions

Answer 32

Incompatibilities/Drug Interactions:
None known

Question 33

LORAZEPAM

notes of administration & incompatibilities/drug interactions

Answer 33

Incompatibilities/Drug Interactions:
Concomitant use of CNS sedatives such as phenothiazines, narcotic analgesics, barbiturates, antidepressants, and alcohol should be assessed prior to administration of IV Lorazepam.

Question 34

MAGNESIUM SULFATE

notes of administration & incompatibilities/drug interactions

Answer 34

Incompatibilities/Drug Interactions:
Concurrent digitalization increases danger of dysrhythmias

Question 35

METHYLPREDNISOLONE SODIUM SUCCINATE

notes of administration & incompatibilities/drug interactions

Answer 35

Incompatibilities/Drug Interactions:
None

Question 36

MIDAZOLAM HYDROCHLORIDE

notes of administration & incompatibilities/drug interactions

Answer 36

Notes on Administration:
Midazolam administered intravenously has been associated with respiratory depression and respiratory arrest, especially when used concomitantly with opioid analgesics for conscious sedation or when rapidly administered. Midazolam may cause phlebitis. May need to adjust midazolam dose down for patients on erythromycin.

Incompatibilities/Drug Interactions:
Midazolam may potentiate the action of other CNS depressants, including opiate agonists or other analgesics, barbiturates or other sedatives, anesthetics, or alcohol.

Question 37

MORPHINE SULFATE

notes of administration & incompatibilities/drug interactions

Answer 37

Incompatibilities/Drug Interactions:
CNS side effects (including respiratory depression) can be reversed by naloxone.

Question 38

NALMEFENE HCL

notes of administration & incompatibilities/drug interactions

Answer 38

Incompatibilities/Drug Interactions:
Should not be mixed with other drugs

Question 39

NALOXONE HCL

notes of administration & incompatibilities/drug interactions

Answer 39

Incompatibilities/Drug Interactions:
Should not be mixed with other drugs

Question 40

NITROGLYCERIN

notes of administration & incompatibilities/drug interactions

Answer 40

Incompatibilities/Drug Interactions:
Other vasodilators
Phosphodiesterase-5 inhibitors such as: Erectile dysfunction: Viagra, Cialis, Levitra Pulmonary hypertension: Revatio (Sildenafil), Adcirca (Tadalafil), Staxyn ODT (Vardenafil).

Question 41

NOREPINEPHRINE

notes of administration & incompatibilities/drug interactions

Answer 41

Incompatibilities/Drug Interactions:
- Alpha-adrenergic blockers: antagonism of norepinephrine effects
- Antihistamines, ergot alkaloids, guanethidine, MAO inhibitors, oxytocin, tricyclic
antidepressants: severe hypertension
- Bretylium, inhalation anesthetics: increased risk of arrhythmias

Question 42

ONDANSETRON

notes of administration & incompatibilities/drug interactions

Answer 42

Incompatibilities/Drug Interactions:
Inducers or inhibitors of P450 drug metabolizing enzymes may alter the clearance of Ondansetron. No dosage adjustment is recommended.

Question 43

OXYTOCIN

notes of administration & incompatibilities/drug interactions

Answer 43

Incompatibilities/Drug Interactions:
None in prehospital arena

Question 44

PHENYLEPHRINE NASAL SPRAY 0.5%

notes of administration & incompatibilities/drug interactions

Answer 44

Incompatibilities/Drug Interactions:
None

Question 45

PROPARACAINE HYDROCHLORIDE OPTHALMIC

notes of administration & incompatibilities/drug interactions

Answer 45

Incompatibilities/Drug Interactions/Precautions:
- Should be used cautiously in patients with cardiac disease or hyperthyroidism.
- Protection of eye from irritating chemicals, foreign bodies and rubbing during the
period of anesthesia is very important.
- Do not touch dropper tip to any surface as this may contaminate the solution.
- Must be kept cooled to 2-8 degrees C (36-46 degrees F).
- Pregnancy Category C.
- Nursing Mothers: Unknown transmission in breast milk. Use caution.
- Single patient use appropriate for EMS.

Question 46

PROPOFOL

notes of administration & incompatibilities/drug interactions

Answer 46

Incompatibilities/Drug Interactions:
Increased effects with narcotics (eg., morphine, meperidine, fentanyl), combinations of opioids and sedatives (e.g., benzodiazepines, barbiturates, chloral hydrate, droperidol) and potent inhalational agents (e.g., isoflurane, enflurane, halothane). Concomitant fentanyl may cause bradycardia in pediatrics. Increased risk of propofol infusion syndrome with vasoconstrictors, steroids, and inotropes

Question 47

RACEMIC EPINEPHRINE

notes of administration & incompatibilities/drug interactions

Answer 47

Incompatibilities/Drug Interactions:
- May potentiate other sympathomimetics
- MAO inhibitors – may cause hypertensive crisis
- Alpha-adrenergic blockers – may cause hypotension

Question 48

RANITIDINE

notes of administration & incompatibilities/drug interactions

Answer 48

Incompatibilities/Drug Interactions:
- Diazepam: Decreases absorption of diazepam. Monitor patient closely.
- Glipizide: May increase hypoglycemic effect.
- Procainamide: May decrease renal clearance of procainamide. Monitor patient closely
for toxicity.
- Warfarin: May interfere with warfarin clearance. Monitor patient closely.

Question 49

SODIUM BICARBONATE 8.4%

notes of administration & incompatibilities/drug interactions

Answer 49

Incompatibilities/Drug Interactions: Incompatible with other drug infusions

Question 50

SUCCINYLCHOLINE

notes of administration & incompatibilities/drug interactions

Answer 50

Incompatibilities/Drug Interactions:
Beta-blockers, procainamide, lithium, and quinidine prolong the effects.

Question 51

THIAMINE HCL (VITAMIN B1)
notes of administration & incompatibilities/drug interactions

Answer 51

Incompatibilities/Drug Interactions:
None

Question 52

TIROFIBAN

notes of administration & incompatibilities/drug interactions

Answer 52

Notes on Administration:
- Weight-based dosing of both tirofiban and concomitant heparin is essential to decrease the incidence of major and minor bleeding episodes. Patients should be managed following an accepted, literature-based standard of practice.
- Infusion pump is required in management of tirofiban infusions. Incompatibilities/Drug Interactions:

Other medication that effects hemostasis: thrombolytics, oral anticoagulants, aspirin and other nonsteroidal anti-inflammatory agents, dipyridamole, ticlopidine, clopidogrel.

Question 53

TOTAL PARENTERAL NUTRUITION

notes of administration & incompatibilities/drug interactions

Answer 53

Notes on Administration:
- Total parenteral nutrition (TPN) is an individualized mixture of dextrose (15% to 35%), crystalline amino acids (2.5% to 5.0%), electrolytes, water, vitamins, trace elements, and may include insulin, heparin, an H2 antagonist (cimetidine or ranitidine), antibiotics or fat emulsions (lipids).
- TPN may be administered with a separate fat emulsion (looks like milk) flowing on a Y- site distal to the infusion pump, or on a peripheral line. Prior to paramedic transport, the separate fat emulsion infusion should be turned off with the tubing roller clamp, but not removed from the tubing Y-site attachment.
- Paramedics may transport patients receiving other medications contained within the TPN solution that are usual and normal components of TPN and are in usual and normal concentrations in the solution.
- Strict aseptic precautions are observed in preparing TPN mixtures using a filtered-air, laminar flow hood to avoid bacterial contamination–the high sugar content of these products supports prolific bacterial growth. Sepsis is a potentially severe patient problem.
- When patients are removed from an infusion pump in the transferring facility and placed on the transport infusion pump, the procedure is accomplished quickly to avoid buildup of potentially harmful organisms at the IV-tubing connection site. All tubing connections should be taped to avoid separation and consequent contamination. Dressing changes at the catheter insertion site require sterile technique, and are best done at the transferring agency prior to transport.
- No TPN solution should be abruptly discontinued, but should the solution be entirely consumed or need to be removed during transport, dextrose 10% should be administrated in place of the TPN to avoid rebound hypoglycemia.
- Never exceed the prescribed rate of infusion. Do not attempt to “catch up” if the infusion falls behind schedule.
- Particulate matter in clear TPN solutions or visible separation of oil droplets in lipid- containing solutions indicate the solution should be immediately replaced.

Question 54

VASOPRESSIN

notes of administration & incompatibilities/drug interactions

Answer 54

Incompatibilities/Drug Interactions:
None in the emergency setting

Question 55

VERAPAMIL HCL

notes of administration & incompatibilities/drug interactions

Answer 55

Incompatibilities/Drug Interactions:
IV Beta-blockers