Paramedic Drugs Flashcards
Adenosine
Trade Name: Adenocard
Classification: Antiarrhythmic
Action/Effects: Slows supraventricular tachycardia, decreasing the electrical activity by interrupting the reentry pathways through the AV node.
Indication: PSVT Rhythm (after vagal maneuvers)
Contraindication: Hypersensitivity 2nd & 3rd degree AV heart block, Sick Sinus Syndrome, A-Fib
Side Effects: Syncope, Chest Pain, facial flushing, SOB, dizziness, hypotension
Adult Dose: 6mg IV push with 20cc NS fluid bolus, a repeat dose of 12mg in 1-2 minutes up to 2X may be given if not converted.
Pediatric Dose: 0.1mg/kg rapid IV push followed by 5cc bolus, repeat 0.2mg/kg x 1
Cautions: Half life is 5 seconds. Pediatric doses don’t exceed adult doses
Albuterol
Trade Name: Proventil, Ventolin
Classification: Bronchodilator, Sympathomimetic
Action/Effects: A beta2-adrenergic agonist which helps relax the bronchial smooth muscles
Indication: Asthma, Relief of bronchospasm with reversible obstructive airway disease.
Contraindications: These are relative to pt. symptoms: Cardiac dysrhythmias, Tachyarrhythmia’s, Angina, HTN, diabetes
Side Effects: Tremors, Dizziness, Anxiety, Palpitations, Tachycardia
Adult Dose: 2.5mg/3ml of NS
Pediatric Dose: 2.5mg in 3cc NS > 1 year old, 1.5mg in 3cc NS < 1 year old
Cautions: Be aware of prior doses/ can interact with diuretics, digoxin, betablockers, & MAO inhibitors/ can have toxicity effects on vascular system if used with tricyclic antidepressants
Amiodarone
Trade Name: Cordarone
Classification: Antiarrhythmic
Action/Effects: Prolongs phase 3 of the cardiac action potential. Amiodarone increases the refractory period of sodium and potassium channels. This intern slows the cardiac action potential.
Indication: V-Fib/V-Tach Pulseless
Contraindication: Hypersensitivity
Side Effects: Lung problems, Liver Problems, Epididymis in long term use
Adult Dose: 150-300 mg IV (Expected 300mg IV loading dose) Check your protocols. (Expected 150mg 2nd dose if needed)
Pediatric Dose: 5mg/kg IV/IO (Check your protocols for additional doses)
Amyl Nitrate
Trade Name: Vaporole
Classification: Vasodilator, Cyanide Antidote
Action/Effects: Causes oxidation of hemoglobin to the compound of methemoglobin. Vasodilatation, including coronary artery dilation. Smooth muscle relaxant
Indication: Cyanide poisoning
Contraindication: None when given for cyanide poisoning
Side Effects: Hypotension with syncope, Headache, Nausea & Vomiting
Adult Dose: 0.3ml or an Amyl Nitrate glass pearl (similar to ammonia) Break ampule & inhale for 30 seconds, then 100% O2 for 50-100 seconds, monitor blood pressure
Aspirin
Trade Name: ASA, Baby Aspirin, Bayer
Classification: Anti-platelet, Antipyretic, NSAID
Action/Effects: Decreases platelet aggregation, prolongs clotting time. Antipyretic Activity
Indication: MI, Coronary Artery Disease, Pericarditis
Contraindication: Hypersensitivity, Pt. already on anticoagulants, Bleeding Disorders
Side Effects: Heart Burn, Nausea, Wheezing, Tinnitus
Adult Dose: 160-325mg PO chewable (2-4 tablets 81mg per tablet) Expected Dose: 324mg
Cautions: Pediatrics, GI bleeds
Atropine Sulfate
Atropine Sulfate Trade Name: Atropine
Classification: Parasympatholytic, Anticholinergic agent
Action/Effects: Increases HR, Contractility, Automaticity, Conduction, & Dilation of the peripheral vessels. Works mainly on the Atrium
Indication: Symptomatic Bradycardia; Organophosphate Poisoning
Contraindication: Hypersensitivity, Tachycardia,
Relative or not functional uses:2nd & 3rd degree AV heart block
Side Effects: Increased Cardiac consumption, Dryness in mouth, Headache, Dizziness, Nausea & Vomiting
Adult Dose: Brady 0.5mg q 3-5 min IV,ET
2-5mg for Organophosphate Poisoning (Vary w/Pt. symptoms)
Pediatric Dose: 0.02mg/kg IV, ET Minimum dose 0.1mg
Cautions: A-Fib, A-Flutter, Glaucoma, & COPD
Diazepam
Trade Name: Valium
Classification: Benzodiazepine, Anticonvulsant
Action/Effects: Antianxiety & anticonvulsant activity. Acts on the CNS to relax the nervous system
Indication: Status Epilepticus, Severe Anxiety, Pacing
Contraindication: Hypersensitivity, Depressed Vital Signs, CNS depressions due to head trauma
Side Effects: Respiratory Depression, Hypotension, Slurred Speech, Confusion, Nausea, Ataxia
Adult Dose: 5-20mg IV/ET/IO
Expected Dose: 5 mg IV increasing to desired effects, smaller doses for elderly patients are needed (2-5mg)
Pediatric Dose: Pediatric 0.1mg/kg IV/ET/IO 0.5mg/kg PR
Cautions: EMT’s carry nothing to reverse a benzodiazepine over dose.
Diphenhydramine
Trade Name: Benadryl
Classification: Antihistamine
Action/Effects: Blocks histamine receptors. This is at the H1 sites. High doses may cause Anticholinergic activity.
Indication: Anaphylaxis, Allergic reaction
Contraindication: Asthma, Hypersensitivity, Pregnancy, nursing mothers
Side Effects: Thicken bronchial secretions, Hypotension, Drowsiness, Dizziness, Tremors
Adult Dose: 25-50mg IM/IV, 15-30 min onset
Expected Dose: 50mg IM
Pediatric Dose: 1-2mg/kg IM/IV
Note: Deliver IM injections into deep muscle mass & alternate sites
Dopamine
Trade Name: Intropin
Classification: Sympathomimetic, Inotrope and chronotropic effects
Action/Effects: Naturally occurring neurotransmitter. Stimulates dopaminergic, beta1/alpha1 adrenergic receptors in a dose dependant amount.
Indication: Cardiogenic shock & hypotension not resulting from
hypovolemia
Contraindication: Hypersensitivity, V-Fib, tachydysrhythmias
Side Effects: Ventricular irritability, Hypertension, Headache, Infiltration causes necrosis, Nausea, Vomiting
Adult/Pediatric Dose: 800mg in a 500cc D5W or NS
Expected Dose: 5-20mcg/kg/min titrating to increase systolic to 100; 2-5 mcg/kg/min are renal effects for lowering BP
Cautions: If possible correct hypovolemia before Dopamine treatment with a fluid bolus. 500-1000cc
DO NOT MIX with NaHCO3
Dextrose 5%
Classification: Hypotonic Solution
Action/Effects: N/A
Indication: Mixing medications (Lidocaine, Dopamine)
Contraindication:N/A
Side Effects:N/A
Adult Dose: Medication Dependent
Expected Dose: N/A
Pediatric Dose: N/A
Cautions: Use caution if used for main IV solution
Epinephrine 1-1,000
Trade Name: Adrenalin 1-1,000
Classification: Bronchodilator, Cardiac Stimulant, Sympathomimetic
Action/Effects: SQ = Bronchodilator & relief of bronchial edema, Beta 1&2 IV = Increases HR, Vasoconstricts, Alpha 1 & Beta 1
Indication: Anaphylaxis, Acute Allergic Reactions, Asthma, Shock
Side Effects: Tremors, Dizziness, Anxiety, Palpitations, Tachycardia, Acute Hypertension
Adult Dose: Anaphylaxis: 0.3-0.5mg SQ.
-Upper Airway Stridor: 2mg of 1:1,000 in 3ml of NS
-Shock treatment= Infusion: as inotrope/pressor.
4 mg in 500ml NS = 8 mcg/ml titrated to effect: Usual range 2-10 mcg/minute (0.01 - 0.1 mcg/kg/minute). (Raise BP S 70-100)
Pediatric Dose: 0.01mg/kg with a max dose of 0.3mg for anaphylaxis - 0.1mg/kg ET (1-1,000) q 3-5 min w/3-5cc flush for cardiac
Cautions: Use caution with pregnancy & preexisting heart disease
Note: Be sure you are using the correct Epinephrine. Both
Epinephrines’ can have the same uses depending route.
Epinephrine 1-10,000
Trade Name: Adrenalin 1-10,000
Classification: Sympathomimetic, Cardiac Stimulant, Bronchodilator
Action/Effects: Increases cardiac resistance, BP, Electrical activity, O2 Needs, contractility, & myocardial activity. Alpha 1 & Beta 1
Indication: Cardiac Arrest V-Fib, V-Tach, Asystole, PEA, & profound Bradycardia
Side Effects: Hypertension, Peripheral constriction
Adult Dose: 0.5-1mg IV every 3-5 minutes
(ET is 2-2 ½ time the dose w/20cc flush)
Expected Dose: 1mg IV Max: None in a life threatening emergency
Pediatric Dose: 0.01mg/kg IV/IO with a max dose of 1mg IV
0.1mg/kg ET (1-1,000) q 3-5 min w/3-5cc flush
Cautions: DO NOT mix with NaHCO3, Heat destroys this drug
Fentanyl
Trade Name: Sublimaze
Classification: Opioid Analgesic
Action/Effects: Combines with receptors sites in brain to produce potent analgesic effects.
Indication: Pain Control, 2nd drug choice for chest pain if morphine allergy. Possible sedation with approved protocol. (RSI)
Contraindication: Respiratory Depression, Hypotension, Head injury, Dysrhythmias, Myasthenia gravis (Muscles tires easy),
Hypersensitivity.
Side Effects: Respiratory depression, Bradycardia, Hypotension or Hypertension, ICP, Nausea
Adult Dose: 25-50mcg IV, IM Max: 100mcg
Ped Dose: Over 2 y/o 0.5-1mcg/kg IV/IM Slow Push (Rarely used in Prehospital)
Cautions: Use Caution with elderly, Schedule II drug (addictive)
Furosemide
Trade Name: Lasix
Classification: Loop Diuretic
Action/Effects: Inhibits the reabsorption of sodium & chloride in the kidney tubule & promotes increased urine formation & excretion
Indication: Pulmonary Edema, CHF
Contraindication: Pregnancy, Hypovolemic, & Hypokalemia
Side Effects: Dehydration, hypotension, Tinnitus/hearing impairment with long term affects
Adult Dose: 20-80mg IV SLOW push to prevent tinnitus
Pediatric Dose: 1mg/kg
Cautions: PUSH slowly & lower doses to avoid Tinnitus.
Glucagon
Trade Name: GlucaGen
Classification: Pancreatic Hormone, Insulin Antagonist
Action/Effects: Raises glucose level by using the glycogen in the liver for glucose. Stimulating glucose synthesis
Indication: Hypoglycemia
Contraindication: Hypersensitivity
Side Effects: Hypotension, Nausea, Hypokalemia
Adult Dose: 1mg IM/IV but usually given IM
Pediatric Dose: 0.02-0.03mg/kg IM/IV with max of 1mg
Cautions: Pt. may have home emergency glucagon kit
May be used w/calcium channel blocker&beta-blocker toxicity
D50
Trade Name: D 50, 50% Dextrose
Classification: Carbohydrate
Action/Effects: Raises BSL, using electrolytes
Indication: Hypoglycemia
Contraindication: Intracranial Hemorrhage, & possible CVA. Consider D25
Side Effects: Tissue necrosis if infiltration occurs with IV
Adult Dose: 25-50gms IV/IO only (lower doses may be given)
Expected Dose: 25gm/50ml given slowly
Pediatric Dose: 0.5-1gm/kg IV/IO with a max of 25gms (D25 for Under 1y/o) (D10 for Under 1 month old)
Cautions: Tissue necrosis if infiltration occurs with IV
Haloperidol
Trade Name: Haldol
Classification: Antipsychotic
Action/Effects: Blocks the stimulation of dopamine receptors in the brain, altering mood & behavior
Indication: Acute psychotic episodes
Contraindication: Severe toxic CNS depression, Coma, Parkinson’s disease, Head injury, Hypersensitivity
Side Effects: Orthostatic Hypotension, Parkinson like symptoms, N & V, blurred vision, headache, drowsiness, diaphoresis
Adult Dose: 5-10mg IM / IV
Expected Dose: 5mg IM
Cautions: Use cautions with patients that have cardiovascular disorders, receiving anticonvulsants, and anticoagulants.
Not recommended for pediatrics.
Hydroxocobalamin
Trade Name: Cyanokit
Classification: Cyanide Antidote
Action/Effects: Hydroxocobalamin combines with cyanide to form cyanocobalamin which is excreted through the kidneys
Indication: Known or suspected cyanide exposure
Contraindication: None prehospital
Side Effects: Turns the patient bright red, transient hypertension.
Adult Dose: 5.0 g (in two vials of 2.5 g) each reconstituted with 100 mL of NS infused over 15 minutes
Pediatric Dose: Contact medical control. 70 mg/kg up to 5 g.
Cautions: None prehospital. Suspect cyanide intoxication in victims of smoke inhalation from closed space with altered mental status, unstable vital signs, or cardiorespiratory arrest.
Lactated Ringers
Trade Name: LR
Classification: Isotonic fluid but is slightly more hypertonic than NS
Action/Effects: Assist in fluid replacement for dehydration or blood loss
Indication: IV fluid for IV maintenance or Electrolyte replacement
Precautions: CVA, Diabetics, Mixing with blood sets.
Adult Dose: 200-500cc
Pediatric Dose: 20cc/kg for fluid replacement
Max: 60cc/kg for pediatrics or 2-3 liters of fluid for adults
Lidocaine HCL
Trade Name: Xylocaine, Xylocard
Classification: Antiarrhythmic Agent
Action/Effects: Decreases the depolarization, automaticity, & excitability in the in the ventricles during the diastolic phase by the direct action on the tissue, especially the Purkinje network.
Indication: V-fib/ V-Tach, Post V-fib/ V-Tach (after conversion), possible symptomatic PVC’s
Contraindication: Bradycardia, AV Heart Blocks
Side Effects: Seizures, Coma, Respiratory depression may occur if given rapidly or in high doses, Sinus Brady, Hypotension
Adult & Pediatric Dose:
0.75-1.5mg/kg IV/ET/IO q 3-5 min followed by a drip of
1-4mg/minute depending on prior boluses
Expected Dose: Initial dose: 1mg/kg IV/IO or 2 ½ times the dose for ET 2nd doses: ½ initial dose for 2nd and subsequent dosing
Max: 3mg/kg
Cautions: ½ doses for over 70 years old, ½ dose for liver disease pt
Lorazepam
Trade Name: Ativan
Classification: Benzodiazepine
Action/Effects: Anti-seizure, anti-convulsant, sedative, muscle relaxant
Indication: Seizures, Conscious sedation, Chemical restraint
Contraindication: Hypersensitivity, depressed CNS, hypotension
Caution: Pregnancy Category D, Should not be used in patients who have taken other CNS depressants
Side Effects: Respiratory depression, decreased CNS, N/V, blurred vision, headache, bradycardia
Adult Dose: 4mg IV/IO/IM (Slow IV push)
Pediatric Dose: 0.1-0.2mg/kg IV/IO/IM (Slow IV Push)
Other information: Supplied 2mg/ml or 4mg/ml in many departments
Meperidine HCL
Trade Name: Demerol
Classification: Narcotic Analgesic, Opioid Analgesic
Action/Effects: Addictive narcotic that depresses the CNS & may relieve pain
Indication: Relief of moderate to severe pain
Contraindication: Hypersensitivity, MAO inhibitors, Head injury
Side Effects: Depressed respirations & BP, Tremor, Nausea, Vomiting
Adult Dose: 50-100mg IM/IV
Expected Dose 50mg followed by an anti-emetic slow IVP
Pediatric Dose: 1-2mg/kg
Cautions: May mix with promethazine for increase & potentiate analgesics
Midazolam
Trade Name: Versed
Classification: Short acting benzodiazepine, CNS depressant, Anti-seizure
Action/Effects: Anti-seizure, anti-convulsant, sedative, muscle relaxant
Indication: Seizures, Conscious sedation, Chemical restraint
Contraindication: Hypersensitivity, depressed CNS, shock
Cautions: Pregnancy Category D, Should not be used in patients who have taken other CNS depressants
Side Effects: Depressed CNS, N/V, blurred vision, headache, retrograde amnesia
Adult & Pediatric Dose: IV 0.1mg/kg up to 5mg [1-5min onset]
IN 0.2mg/kg up to 10mg dose [3-7min onset] 1cc per nostril
IM 0.1mg/kg up to 10mg dose[15-30min]
Expected Dose ADULT IV 2-5mg, IN/IM 5-10mg
2nd doses may be given
Morphine Sulfate
Trade Name: MS
Classification: Narcotic analgesic, Opioid analgesic
Action/Effects: Acts on opiate receptors in the brain providing analgesia & sedation. Vasodilator, reducing venous return & myocardial oxygen demand.
Indication: Moderate to severe pain with trauma. Chest pain associated with MI
Contraindication: Hypersensitivity, Head injury, CVA, Hypotension, and respiratory depression
Side Effects: Depressed CNS, constipation, dry mouth
Adult Dose: IV 2-4mg titrated to max of 20mg max. [immediate onset] IM/SC 5-20mg [10-30min onset]
Pediatric Dose: IV 0.1mg/kg. IM/SC 0.1 - 0.2mg/kg
Expected Dose: IV 2-4mg titrated to max of 20 or medical control dose
Caution: Have Narcan ready in case of severe adverse reaction.
Naloxone
Trade Name: Narcan
Classification: Narcotic Antagonist, Opioid Antagonist
Action/Effects: Displace narcotics at the receptor sites in the CNS. Attaches to the receptors & inhibits the narcotics action
Indication: Narcotic overdose, Respiratory depression,
Coma of unknown origin, man down, coma of unknown origin
Contraindication: Hypersensitivity
Side Effects: N/V, Seizures, tachycardia, HTN, diaphoresis, blurred vision, withdrawal
Adult Dose: 2-4mg IV/IM/IN/ET/IO.
Possible Dose: 0.5-1mg IV, 2mg IM/IN
(Titrate to respirations to prevent narcotic withdrawals.)
Pediatric Dose: 0.1mg/kg IV/IM with max of 2mg
Cautions: It can cause seizure from withdrawal in chronic opiate users
Nitroglycerin
Trade Name: Nitrostat
Classification: Coronary Vasodilator
Action/Effects: Decreases cardiac work, increases circulation to the heart, dilates coronary & systemic arteries.
Indication: AMI, Pulmonary Edema, Hypertension emergencies, CHF
Contraindication: EMT-P Systolic <100, CVA, head injury, recent use of ED drugs (Cialis, Levitra, Viagra)
Side Effects: Severe Hypotension, Weakness, Headache, Syncope, dizziness, N/V
Adult Dose: 0.3-0.4mg Sublingual q 5min up to 3x
(May come in spray or tablet) (Most doses are 0.4mg)
Cautions: If the pt. is wearing a nitroglycerin patch or paste, additional administration may not be effective.
0.9% Sodium Chloride Injection USP
Trade Name: Normal Saline, NS
Classification: Isotonic Fluid IV
Action/Effects: Assists in the re-hydration of fluid & electrolytes in the vascular system
Indication: IV maintenance, Fluid Bolus, Combination with blood sets on trauma patients, volume replacement, dehydration, hypotension
Contraindication: Hypersensitivity, pulmonary Edema
Side Effects: 3rd spacing of fluid is possible on bolus dosing, Pulmonary Edema
Dose: 200-500cc bolus or TKO, after listening to lung sounds
Pediatric Dose: 20cc/kg with a max of 60cc/kg
Max: 3 L max for Trauma pt’s may be suggested. Heat Exhaustion or Dehydrated pt’s you may exceed the 3L max.
Cautions: Overloading pediatrics/geriatrics/ & Pulmonary Edema
Ondansetron
Trade Name: Zofran
Classification: Anti-emetic
Action/Effects: Prevention & control of severe nausea. Calms vomiting reflex through vagal afferent nerves.
Indication: Non-sedating anti-emetic is desirable for preventing nausea
Contraindication: Hypersensitivity
Side Effects: Headache, Dizziness, Diarrhea
Adult Dose: 4mg IV Slow push 2-5 minutes, 4mg IM Max: 8mg
Also available in the pill form.(Dissolve in mouth same dose)
Ped Dose: Over 2 y/o 0.1mg/kg IV, IM Max: 4mg
Caution: Use caution in patients with impaired liver function. Rate of administration should not be less than 30 sec.
Note: Zofran has no effect on motion sickness
Oxytocin
Trade Name: Pitocin
Classification: Pituitary Hormone
Action/Effects: Stimulates uterine smooth muscle contraction, & helps expedite constricting uterine blood vessels & controlling excessive hemorrhage.
Indication: Post partum hemorrhage, AFTER infant and placenta delivery
Contraindication: Hypertonic & hyperactive uterus, 2nd fetus, maternal bradycardia
Side Effects: Hypo/hypertension, N/V, seizures, anxiety, dysrhythmias, Fetal Bradycardia. Stimulates lactation
Dose: 3-10 units IM, AFTER infant and placenta
Expected Dose:
10 units IM
Promethazine
Trade Name: Phenergan
Classification: CNS depressant, Antihistamine, antiemetic.
Action/Effects: Produces an antihistamine & antiemetic response, It also potentiates narcotics & increases the effectiveness
Indication: Nausea & vomiting, potentiates sedative effects of analgesics (Meperidine)
Contraindication: Hypersensitivity
Side Effects: Pronounced sedation, confusion, & Tissue irritation
Adult Dose Range: 12.5-50mg IV/IM (may dilute with 10cc with given to lesson tissue damage in IV) Expected 12.5-25mg with 10cc NS.
Pediatric Dose: 0.5mg/kg
Cautions: Tissue irritation is possible on IV infiltration or SQ area injection. Use caution with pediatrics.
Procainamide
Trade Name: Pronestyl
Classification: Antiarrthythmic, Sodium Channel Blocker
Action/Effects: Blocks open sodium channels and prolongs cardiac action potential. (may also block K+) reduces ectopic pacemakers
Indication: Monomorphic VT with normal QT, stable wide complex tachycardia of unknown origin, A-Fib with WPW
Contraindication: AMI, hypokalemia
Side Effects: Hypotension, may prolong QT interval
Adult Dose: 20mg per minute IV Infusion(Max dose 17mg/kg)
Cautions: Urgent situations may require 50 mg per minute
Use in Cardiac arrest is limited
Extra Info: Give until one or more of the following occurs:
Arrhythmia suppression, hypotension, QRS widens by 50%, total 17mg/kg given
Sodium Bicarbonate
Trade Name: NaHCO3
Classification: Alkalinizing Agent
Action/Effects: Neutralizes acids, returning blood & body fluid to a more normal ph instead of an acidosis state. (Increases pH)
Indication: Metabolic acidosis, Prolonged CPR or down time (more than 5-10 minutes), Tricyclic overdoses. (Tricyclic meds = Amitriptyline, Desipramine, Endep, Janimine, Norpramin, Nortriptyline, Pamelor, Surmontil, Tofranil, Triavil, Trimpramine)
Contraindication: Hypersensitivity, Alkalosis patient.
Side Effects: Pushing a ph to an alkalosis state instead of neutralizing the ph.
Adult & Pediatric Dose: 1mEq/kg followed ½ the initial dose q 10 minutes. Use 4.2% solution for pediatrics
Cautions: Avoid mixing with Epinephrine or Calcium.
Verapamil
Trade Name: NaHCO3
Classification: Antiarrhythmic, Calcium Channel Blocker
Action/Effects: Dilates the coronary arteries. This increases the blood flow to the heart. Prolongs AV nodes refractory period.
Indication: 2nd line med for SVT. A-fib, A-Flutter, Multifocal Atrial Tachycardia (Only for narrow complex QRS)
Contraindication: Wide QRS Complex, WPW, Sick Sinus Syndrome, AV Heart Blocks
Side Effects: Constipation, nausea, heartburn, headache
Adult Dose: 1st dose: 2.5 - 5mg IV bolus over 2 minutes
2nd dose: 5-10mg IV bolus over 4 minutes
Pediatric Dose: None
Cautions: Max dose: 20mg (Supplied 5mg/2ml)
