Paramedic Drug Profile

Question 0

ALBUTEROL SULFATE

Answer 0

BRAND: proventil, ventolin
CLASS: sympathomimetic, bronchodilator
MOA: B2 agonist, relaxes smooth muscles, bronchodilator
INDICATION: bronchospasm(asthma, emphysema, bronchitis), hyperkalemia
CONTRAINDICATION: diabetes, hyperthyroidism, cerebrovascular disease
DOSAGE: Adult: 2.5mg in 3cc (SVN)
Peds: <40lbs 1.25-2.5mg in 2cc

Question 1

ADENOSINE

Answer 1

BRAND: Adenocard
CLASS: Antiarrhythmic
MOA: Slows AV conduction, slows sinus rate
INDICATION: SVT, wide complex tachycardia unknown origin, unresponsive to Lidocaine
CONTRAINDICATION: 2’ or 3’ block, caution with asthma pt., a-fib or a- flutter
DOSAGE: Adult: 6mg(20cc flush rapid IVP) repeat 12mg x2 total q 1-2minutes
Peds: .1mg/kg(5cc NS flush) repeat .2mg/kg x1

Question 2

ACETYLSALICYLIC ACID(aspirin, ASA)

Answer 2

BRAND: bufferin,anacin
CLASS: anti-thrombotic, analgesic, antipyretic, anti inflammatory
MOA: ⬇️ platelet aggregation and thrombus formation
INDICATION: c/p of cardiac origin, acute MI, unstable angina
CONTRAINDICATION: bleeding ulcer, hemophilia, hemorrhagic state, children
DOSAGE: Adult: 81mg x 4 = 324mg PO
Peds: None

Question 3

ATROPINE SULFATE

Answer 3

BRAND: atropine
CLASS: parasympatholytic, anticholinergic
MOA: blocks parasympathetic response, ⬆️HR, conduction velocity and contraction, bronchodilation
INDICATION: symptomatic bradycardia(sinus, junctional, AV blocks(narrow QRS), asystole, PEA), acetylcholinesterase inhibitor poisoning(organophosphate)
CONTRAINDICATION: wide QRS, 2nd Type 2 and 3rd AV blocks, glaucoma
DOSAGE: Adult: Brady- 0.5-1.0mg rapid IVP max 3mg(IV/ET)
Asystole-1mg x3 q 3-5minutes
Peds: .02mg/of x1 IV max
Child: .5mg
Adolescent: 1mg

Question 4

CALCIUM CHLORIDE

Answer 4

BRAND: calcium chloride
CLASS: electrolyte
MOA: ⬆️myocardial contraction and impulse conduction
INDICATION: hypocalcemia, calcium channel blocker OD, pretreat for IV Verapamil admin.
CONTRAINDICATION: hypercalcemia, digoxin therapy
DOSAGE: Adult: 5-10ml(0.5-1Gm)
Peds: .2-.25ml/kg IV

Question 5

DEXTROSE 50%

Answer 5

BRAND: dextrose, D50
CLASS: carbohydrate
MOA: raises blood sugar, ⬆️glucose levels
INDICATION: hypoglycemia, ALOC, seizure unknown origin
CONTRAINDICATION: stroke, intracranial, bleed, head injury(caution tissue necrosis)
DOSAGE: Adult: 25gm in 50ml rapid IVP
Peds: 5-10ml/kg(.5-1gm/kg)250cc waste 50cc(20min) mix Dex. w/200cc bag=D10

Question 6

DIPHENHYDRAMINE HCL

Answer 6

BRAND: Benadryl
CLASS: antihistamine, anticholinergic
MOA: blocks histamine receptors, ⬇️vasodilation, bronchospasm prevention
INDICATION: allergic reaction, anaphylaxis(2nd line)
CONTRAINDICATION: hypersensitivity, newborns, hypertension, cardiovascular disease
DOSAGE: Adult: 25-50mg slow IV/deep IM
Peds: 1-1.25mg/kg slow IV/IM

Question 7

DOPAMINE

Answer 7

BRAND: Intropin
CLASS: Sympathomimetic
MOA: Stimulates Alpha and Beta 1, precursor to norepinephrine
2-10mcg/kg/min(more beta) = B1 stim., ⬆️CO, ⬆️preload, vasoconstriction, inotropic, chromotropic, dromotropic
10-20mcg/kg/min(more alpha) = adrenergic effects, vasoconstriction a/SVR, pulmonary vascular resistance, ⬆️preload
INDICATION: symptomatic bradycardia, hemodynamic significant hypotension(fluids 1st-assess breath sounds)
CONTRAINDICATION: hypovolemic shock
DOSAGE: Adult >70 systolic = 5mcg/kg/min
<70 systolic = 10mcg/kg/min
Peds 2-20mcg/kg/min
PREPARATION:
Adult: Add 400mg/250cc NS in microdrip tubing
CALCULATE: 10% of pt. wt. in lbs. = 5mcg/kg/min
x 2 = 10mcg/kg/min
Peds: 6x body wt. in kg=mg added to NS to make100ml(1ml/hr delivers 1mcg/kg/min)

Question 8

EPINEPHRINE

Answer 8

BRAND: adrenaline
CLASS: sympathomimetic
MOA: stimulates alpha and beta 1 and 2, ⬆️inotropic/dromotropic/chromotropic, peripheral vasoconstriction, bronchodilation, blocks histamine release, ⬆️RVR, ⬆️O2 demand
INDICATION: cardiac arrest(VF/pulseless VT, asystole, PEA), severe bronchospasm, anaphylaxis, hypotension(not 1st option)
CONTRAINDICATION: none for cardiac arrest, hypothermia, relative
DOSAGE: IV: 1mg(1:10,000) q 3-5min
ET: 2-2.5mg(1:10,000)
INF.: 1mg added to 250ml NS(range 2-10mcg/min)
ANAPHYLAXIS/ASTHMA:
Adult: IM: .3mg(.03mg/kg of 1:1,000)
Peds: IV .1ml/kg(.01mg/kg of 1:10,000 q 3-5min)
ET: .1mg/kg(1:1,000 w/5cc)
IM: .01mg/kg(1:1,000 max of .3mg/dose)
STRIDOR/CROUP(SVN):
<4yrs 2.5mg(1:1,000) w/3cc
>4yrs 5mg(1:1,000) w/3cc
IV Infus. .1mcg/kg/min
6 x wt.(kg) = mg w/NS = 1ml/hr
EPI CLOCK(prepare 2mg in 250ml bag)(2mcg/ml)
START 6-8mcg/min(45-60gtts/min)
8mcg/min = 60gtts/min

6mcg/min=45gtts/min. 2mcg/min=15gtts/min

                  4mcg/min=30gtts/min CAUTION: hypertension, tachycardia,  Vent. dysthymias, N/V, incompatible w/sodium bicarb

Question 9

FUROSEMIDE

Answer 9

BRAND: lasix
CLASS: loop diuretic
MOA: blocks sodium reabsorption(Loop of Henie), vasodilation, ⬇️preload/afterload, ⬆️diuresis
INDICATION: pulmonary edema, CHF
CONTRAINDICATION: anuria, hypovolemia, hypotension, pregnancy
DOSAGE: Adult: double pt. daily dose
IV .5-1mg/kg max of 2mg/kg usually 20-40 mg slow IVP
Peds: 1mg/kg slow IVP
CAUTION: hypovolemia, sulphur drugs

Question 10

GLUCAGON

Answer 10

BRAND: glucagon
CLASS: pancreatic hormone
MOA: converts glycogen to glucose, relaxes smooth muscles of GI, cardiac inotrope
INDICATION: symptomatic hypoglycemia(when IV is delayed)
CONTRAINDICATION: hypersensitivity
DOSAGE: Adult: 1mg IM, may repeat 7-10min
Peds: <20kg .5mg IM, 8-10min
>20kg 1mg IM, 8-10min
CAUTION: administer thiamine in known alcoholics

Question 11

IPRATROPIUM BROMIDE

Answer 11

BRAND: atrovent
CLASS: anticholinergic, bronchodilator
MOA: promotes bronchodilation w/albuterol, blocks parasympathetic, dilation of central airways
INDICATION: bronchospasm, COPD, emphysema, bronchitis
CONTRAINDICATION: glaucoma
DOSAGE: Adult: .5mg in 2.5ml NS(SVN)
Peds: .5mg in 2.5ml NS

Question 12

NALOXONE

Answer 12

BRAND: narcan
CLASS: narcotic antagonist
MOA: competitive inhibitor @ narcotic receptor site(blocks), reverses resp. depression secondary to narcotics
INDICATION: opioids/narcotic overdose, unresponsiveness unknown
CONTRAINDICATION: none
DOSAGE: Adult: 2mg IV/IM repeat q 2min(titrate to effect)
Peds: <5yrs or 20kg = .1mg/kg IV/SC/ET
>5yrs or >20kg = .2mg/kg

CAUTION: prepare for combative pt. and N/V

Question 13

NITROGLYCERIN

Answer 13

BRAND: nitrostat, nitro-bid, tridil
CLASS: vasodilator, antianginal
MOA: arterial/coronary vasodilation, ⬇️preload/afterload, ⬆️bloodflow to myocardium, smooth muscle relaxant
INDICATION: angina, MI, L side CHF w/pulmonary edema
CONTRAINDICATION: hypotension, ⬆️ICP, max 3 doses already given, hypovolemia
DOSAGE: Adult: .4mg spray SL 3max(BP >100systolic)
Peds: None

Question 14

ODANSETRON

Answer 14

BRAND: zofran
CLASS: antiemetic agent
MOA: blocks serotonin 5-HT3 receptors in the CNS
INDICATION: nausea and vomiting
CONTRAINDICATION: hypersensitivity
DOSAGE: Adult: 4-8mg slow IVP over 2-5min
Peds: 1month-12yrs
>40kg-4mg over 2-5min
<40kg-.01mg/kg over 2-5min

Question 15

OXYGEN

Answer 15

BRAND: oxygen 
CLASS: natural gas 
MOA: binds to hemoglobin In RBC reverses hypoxemia on heart, brain and other tissues, ⬆️hemoglobin saturation
INDICATION: condition of hypoxemia, dyspnea, resp. arrest, C/P, shock, unconsciousness, stroke, etc
CONTRAINDICATION: none
DOSAGE: Cannula: 1-6L 24-44%
                 NRB: 15L 95%
                 BVM: 15L 95-100%

Question 16

PHENYLEPHRINE N. SPRAY

Answer 16

BRAND: neo-synephrine nasal spray
CLASS: vasoconstrictor
MOA: stimulates alpha receptors in nasal blood vessels, ⬇️nasal bleeding
INDICATION: nasotracheal intubation
CONTRAINDICATION: allergy
DOSAGE: Adult: 2-4 sprays in each nostril
Peds: none

Question 17

SODIUM BICARB.

Answer 17

BRAND: sodium bicarbonate
CLASS: buffer
MOA: buffers H+ and ⬆️pH level in blood and urine
INDICATION: aspirin OD, cardiac arrest after intervention, consider 10min after cardiac arrest, TCA OD(anti-depressant)
CONTRAINDICATION: alkalosis
DOSAGE: Adult: 50-100mEq/kg IV per Med. Control
Peds: 1mEq/kg IV
CAUTION: other drug infusions

Question 18

THIAMINE

Answer 18

BRAND: betalin
CLASS: electrolyte
MOA: required for carbohydrate metabolism
INDICATION: alcoholism, coma unknown, Wernicke or Korsakoff Syndrome
CONTRAINDICATION: none
DOSAGE: Adult: 100mg IM/IV
Peds: none

Question 19

DILTIAZEM

Answer 19

BRAND: cardizem
CLASS: calcium channel blocker
MOA: negative inotrope(force of contractility), slows SA and AV conduction
INDICATION: A-fib & A-flutter with rapid ventricular rate, SVT refractory to adenosine
CONTRAINDICATION: known allergy, hypotension, AMI or cardiogenic shock, V-tach, 2’ or 3’ AV block, WPW and sick sinus syndrome, beta blockers(olol)
DOSAGE: Adult: Initial dose= .25mg/kg slow IVP over 2minutes
If no response= repeat in 15 minutes at .35mg/kg
SPECIAL CONSIDERATIONS: consider pretreatment with calcium chloride to reduce hypotension

Question 20

LIDOCAINE

Answer 20

BRAND: xylocaine
CLASS: antiarrhythmic
MOA: sodium channel blocker, equalizes conduction rate, ⬇️automaticity, slows depolarization, ⬆️Vfib threshold S
INDICATION: V-Fib, V-Tach, drip after post resuscitation, frequent PVC’s(>6/min, >2 in a row, multiform PVC’s, R on T), wide complex tachycardia(uncertain)
CONTRAINDICATION: ventricular escape rythym, bradycardia
DOSAGE: Adult: Pulseless VT/VF-initial 1-1.5mg/kg IVP, may give additional bolus @.5-.75mg/kg q 5-10 minutes to a total of 3 mg/kg.
ROSC=initiate drip @ 2-4mg/kg(see maintenance infusion)
ETT=2-4mg In NS
Peds: 1mg/kg
CAUTION: treat the rate, 2nd/3rd degree AVblocks, hypotension, pt. >70yrs or w/hepatic, renal disease, poor perfusion state, reduce maintenance infusion by half.

                LIDOCAINE CLOCK(microdrip)
(1gm into 250ml NS/5% dextrose solution OT use premixed solution 2gm in 500ml)

                     4mg=60gtts/min
                    (1drop q 1sec)

3mg=45gtts/min. 1mg=15gtts/min
(1drop q 1.5sec) (1drop q 4sec)

                     2mg=30gtts/min
                    (1drop q 2sec)

Question 21

MAGNESIUM SULFATE

Answer 21

BRAND: magnesium sulfate
CLASS: electrolyte
MOA: depresses muscle contraction, alters calcium on myocardial conduction, smooth muscle dilation, ⬇️myocardial/neuromuscular irritability
INDICATION: torsades de pointes, eclampsia, bronchospasm, VF/pulseless VT after lidocaine, hypomagnesemia
CONTRAINDICATION: hypermagnesemia, impaired renal function
DOSAGE: Adult: TDP=1-2g in 10ml slow IV
VF/pulseless VT=1-2g IV
Hypomagnesemia=dilute 2g in 100cc slow 60min.
Preg.=4-6g in 50ml NS infuse over 10-15min(2-3gtts/sec)
Bronchospasm=2g in 50ml NS infuse 10min.
Peds: VF/VT after Lido/TDP=25mg/kg(max 2g)IV over 10-20minuted
Severe Bronchospasm=25mg/kg(max 2g) in 50ml NS piggyback over 10min.
CAUTION:hypotension, respiratory depression(pregnancy), kept Ca Chloride (10ml) available to reverse magnesium toxicity

Question 22

METHYLPREDNISOLONE SODIUM SUCCINATE

Answer 22

BRAND: soul-medrol
CLASS: corticosteroid, anti-inflammatory
MOA: anti-inflammatory and immunoresponsive effects
INDICATION: reactive airway disease(emphysema, asthma, chronic bronchitis, anaphylaxis)
CONTRAINDICATION: preterm infants
DOSAGE: Adults: 125mg slow IV
Peds: 1-2mg/kg slow IV

Question 23

MIDAZOLAM HYDROLCHLORIDE

Answer 23

BRAND: versed
CLASS: benzodiazepine
MOA: sedative, anticonvulsant, CNS depressant
INDICATION: anti-convulsant, sedation, induction for intubation
CONTRAINDICATION: hypersensitivity, caution: COPD, alcohol, intoxication
DOSAGE: Adult: 1-5mg slow IV
2-5mg IM
Administer slow IV max 2.5mg over 2minutes(titrated to effect). >60yrs max 1.5mg over 2minutes TOTAL DOSE 20mg
Seizure= .2mg/kg IM
Peds: .1mg/kg slow IV
.2mg/kg IM
CAUTION: respiratory depression/bradycardia/hypotension/alcoholics

Question 24

MORPHINE SULFATE

Answer 24

BRAND: morphine sulfate
CLASS: narcotic agonist
MOA: acts on pain receptors and elevates pain threshold, depresses CNS, respiratory center vasodilator arteries, ⬇️preload/afterload
INDICATION: analgesia(painkiller), MI, burns, kidney stones, pulmonary edema, trauma
CONTRAINDICATION: hypersensitivity, respiratory depression, head injuries, ⬆️ICP, hypotension
DOSAGE: Adult: 2-4mg increments slow IVP over 1-5 minutes(reversed by narcan)
Peds: .1mg/kg slow IVP
CAUTION: CNS side effects

Question 25

LORAZEPAM

Answer 25

BRAND: ativan
CLASS: benzodiazepines
MOA:CNS depressant, anticonvulsant
INDICATION: seizures, status epilepticcus, agitated(excited) delirium
CONTRAINDICATION: known allergy, acute narrow angle glaucoma, myasthenia gravis, pregnancy(relative)
DOSAGE: Adult: 2-5mg IV/IO/IM slowly over 2-5minutes may repeat in 10-15 minutes to a max dose of 10mg
Peds: .05-.1mg/kg IV/IO/IM slowly over 2-5 minutes may repeat in 10-15 minutes to a max dose of 4mg

Question 26

AMIODARONE

Answer 26

BRAND: cordarone
CLASS: anti arrhythmic
MOA: negative chronotrope(⬇️HR), dilates coronary arteries
INDICATION: VF/pulseless VT unresponsive to defib & epinephrine, wide complex tachycardia of unknown origin, stable (VT, SVT, A-fib, A-flutter), polymorphic V-tach
CONTRAINDICATION: known allergy, bradycardia, 2’ or 3’ AV Block, carcinogenic shock, hypotension, pulmonary edema, CHF
DOSAGE: Adult: Cardiac Arrest=300mg IV/IO first dose, may repeat in 3-5 minutes if no response at 150mg.
Tachy-dysrhythmias=150mg in 50ml D5W infused over 10 minutes
Maintenance Infusion=1mg/min

Question 27

ETOMIDATE

Answer 27

BRAND: amidate
CLASS: general anesthetic
MOA: short term sedation/CNS depression
INDICATION: short term sedation during rapid sequence intubation
CONTRAINDICATION: known allergy
DOSAGE: Adult: .3mg/kg slow IVP over 30 seconds to 1 minute
SPECIAL CONSIDERATIONS: half the dose = ml needed. Ex. 20mg = 10ml also the dose is roughly 1/3 the pt. wt. in kg. Ex. 66kg=20mg

Question 28

SUCCINYLCHOLINE

Answer 28

BRAND: anectine, quelicin
CLASS: short acting neuromuscular blocker
MOA: paralytic
INDICATION: facilitation of rapid sequence intubation
CONTRAINDICATION: known allergy, hyperkalemia, hx of malignant hyperthermia, airway obstruction, neuromuscular disorder, penetrating eye injury, epiglottis, burns or crush injury within last 21 days
DOSAGE: 1.5mg/kg IV
SPECIAL CONSIDERATIONS: to quickly determine mL for bolus: cut total dose in half and move decimal to left. Ex. 80kg x 1.5 = 120mg = 6mL