drug cards.docx

Paramedic Pharmacology - Drug Cards

Abciximab

Class: Platelet aggregation inhibitor

Actions: binds to glycoprotein IIb/IIIa receptor sites on the surface of activated platelets preventing normal binding of fibrinogen and other factors, thus preventing platelet aggregation.

Indication: to prevent acute myocardial ischemic complications after percutaneous transluminal coronary angioplasty (PTCA) in patients at high risk for abrupt closure of treated coronary artery.

Contraindications: active internal bleeding, arteriovenous malformation or aneurysm, bleeding disorders, stroke in past 2 yrs, hypersensitivity, GI Bleed in past 6 wks, HTN, oral anticoagulant therapy in past 7 days

Precautions: watch for GI bleed, monitor for hypersensitivity

Side effects: confusion, dizziness, A-fib, bradycardia, dysphagia, N/V, hematuria, anemia, embolism, pneumonia, pulmonary edema, urticarial, bronchospasm

Dosage & Route: 250 mcg/kg bolus, then 10 mcg/min by continuous infusion over 18 - 24 hrs

Acetaminophen (Tylenol)

Class: Non-opioid analgesic; Antipyretic

Actions: Inhibits the synthesis of prostaglandins that may serve as mediators of pain and fever, primarily in the CNS

Indication: Pain, Fever

Contraindications: Hypersensitivity; Impaired hepatic function; Pregnancy

Precautions: Hepatic Failure; Hepatotoxicity

Side effects: Abd pn; N/V; Liver tenderness; Oliguria

Dosage & Route: 325 – 650mg PO/PR every 4-6 hrs, or 1000mg t.i.d/q.i.d

Activated Charcoal

Class: Adsorbent

Actions: Adsorbs toxins by chemical binding and prevents GI adsorption

Indication: Poisoning following emesis or when emesis is contraindicated

Contraindications: None in severe poisoning

Precautions: Should only be admin following emesis in cases in which it is so indicated; Use w/ caution in pt with AMS; May adsorb ipecac before emesis

Side effects: N/V; Constipation

Dosage & Route: 1 g/kg (typically 50 – 75 g) mixed with a glass of water to form a slurry

Adenosine (Adenocard)

Class: Class V Antidysrhythmic (Chemical Cardioverter); Nucleoside

Actions: Slows atrioventricular conduction

Indication: Symptomatic Paroxysmal Supra-Ventricular Tachycardia (PSVT)

Contraindications: Second or third degree heart block

Side effects: Facial Flushing; Headache; Shortness of breath; CP; dizziness, N/V

Dosage & Route: 6 mg rapid IV bolus over 1-2 sec; if no cardioversion, 12 mg over 1-2 sec

Albuterol (Proventil)

Class: Sympathomimetic (Beta 2 selective)

Actions: Bronchodilation

Indication: Asthma; Reversible bronchospasm associated with COPD

Contraindications: Known hypersensitivity; Symptomatic tachycardia

Precautions: B/P, P, ECG monitored; pt w/ known heart disease

Side effects: Palpitation; Anxiety; Headache; Dizziness; Sweating

Dosage & Route: Small-volume Nebulizer: 0.5 mL (2.5 mg) in 2.5 mL NS over 5-15 min; Metered-dose inhaler: 1 -2 sprays (90 micrograms/spray)

Alteplase (Activase)

Class: Glycoprotein; Tissue plasminogen activator, recombinant; thrombolytic

Actions: binds to fibrin in a thrombus and converts trapped plasminogen to plasmin, which breaks down fibrin, and other clotting factors, dissolving thrombi

Indication: To treat acute MI or stroke caused by thrombus induced ischemia

Contraindications: active internal bleeding, aneurysm, HTN

Precautions: bleeding, drugs that alter platelet function, head trauma

Side effects: cerebral edema, seizure, dysrhythmias, GI Bleed, N/V, pulmonary edema, anaphylaxis, cardiac arrest

Dosage & Route: 15 mg bolus followed by 50 mg IV over 30 min, followed by 35 mg over 60 min

Aminophylline

Class: Xanthine bronchodilator

Actions: smooth muscle relaxant; bronchodilation; mild diuretic properties; increases HR

Indication: Bronchial asthma; reversible bronchospasm associated w/ COPD; CHF; Pulmonary edema

Contraindications: Hx of hypersensitivity; hypotension; Pt w/ peptic ulcer disease

Precautions: Monitor for dysrhythmia; monitor blood pressure;

Side effects: Convulsions; Tremor; Anxiety; Dizziness; Vomiting; Palpitations; PVC's Tachycardia

Dosage & Route: 1) 250 – 500 mg in 90 or 80 mL of D5W infused over 20 – 30 min (approximately 5 – 10 mg/kg/hr) 2) 250 – 500 mg (5 -7 mg/kg) in 20 mL of D2W infused over 20 – 30 min

Amiodarone HCL (Cordarone)

Class: Class III Antidysrhythmic

Actions: Prolongs action potential and refractory period; slow the sinus rate; increases PR and QT intervals; Decreases peripheral vascular resistance

Indication: Life-threatening cardiac dysrhythmias such as pulseless V-Tach and V-Fib

Contraindications: Severe sinus node dysfunction; 2nd and 3rd degree AV block; Hemodynamically significant bradycardia

Precautions: Heart failure

Side effects: Hypotension; Nausea; Anorexia; Malaise, fatigue; Tremors; Pulmonary toxicity; Ventricular ectopic beats

Dosage & Route: Adults: Loading dose of 150 mg over 10 min (15mg/min); Maintenance dose: 1 mg/min for 6 hr, then 0.5 mg/min until dysrhythmia is controlled or oral therapy begins

Amrinone (Inocor)

Class: Cardiac inotrope

Actions: Increases cardiac contractility; Vasodilator

Indication: Short-term management of severe CHF

Contraindications: Pt w/ Hx of hypersensitivity

Precautions: Increase Myocardial ischemia; B/P, P, and ECG constantly monitored; amrinone should only be diluted with NS or ½ NS; no dextrose solution should be used

Side effects: Reduction in platelets; N/V; Cardiac dysrhythmias

Dosage & Route: 0.75 mg/kg bolus given slowly over 2- to 5- min interval followed by maintenance infusion of 2 – 15 mg/kg/min

Amyl Nitrite

Class: Nitrate

Actions: Causes coronary vasodilation; removes cyanide ion via complex mechanism

Indication: cyanide poisoning (bitter almond smell to breath)

Contraindications: None when used in the management of cyanide poisoning

Precautions: Has tendency for abuse

Side effects: Headache; Hypotension; Reflex tachycardia; Nausea

Dosage & Route: Inhalant should be broken and inhaled; repeated as needed until pt is delivered to ED; effect diminish after 20 min

Aspirin

Class: Nonopioid Analgesic; Antiplatelet; Antipyretic; Salicylate; NSAID

Actions: Inhibits the synthesis of prostaglandins that may serve as mediators of pain and fever, primarily in the CNS; Inhibits platelet synthesis

Indication: Pain, Fever, Inflammatory conditions; Reduce risk of CVA and MI

Contraindications: Hypersensitivity; MAOIs; Ulcers; Hemophilia; Influenza (risk of Reye’s Syndrome in children/teens); Pregnancy; Bronchospasm

Precautions: Vitamin K deficiency (increases bleeding); Possible teratogen

Side effects: GI Bleeding; Renal Failure; N/V

Dosage & Route: 325 – 650mg PO every 4 hrs, or 500mg every 3 hrs, or 1000mg every 6 hrs.

Atenolol (Tenormin)

Class: Beta adrenergic blocker; antianginal; antihypertensive

Actions: inhibits stimulation of Beta1 receptor sites, decreasing cardiac excitability/output/oxygen demand; decrease release of renin to lower BP

Indication: To treat angina pectoris or acute MI; treat HTN

Contraindications: cardiogenic shock, 2nd/3rd ° heart block, bradycardia

Precautions: digoxin use, diabetics, must be tapered

Side effects: CNS depression, arrhythmias, laryngospasm, N/V/D, anaphylaxis

Dosage & Route: PO 50 mg daily increased to 100 mg daily after 1 - 2 wks; IV 5 mg over 5 min followed by 5 mg after 10 min, 50 mg after 10 min

Atropine

Class: Parasympatholytic (anticholinergic)

Actions: blocks acetylcholine receptors; Increases HR; Decreases GI secretions

Indication: Hemodynamically significant bradycardia; Hypotension secondary to bradycardia; Asystole; Organophosphate poisonings

Contraindications: None in emergency

Side effects: Palpitation; tachycardia; Headache; dizziness; Anxiety; Dry mouth; Pupillary dilation; Blurred vision; Urinary retention

Dosage & Route: Bradycardia: 0.5 mg / 3 -5 min to max of 0.04 mg/kg IV; Asystole: 1 mg IV; Organophosphate Poisoning: 2 -5 mg IV; ETT dose is 2 - 2.5 time the IV dose

Bumetanide (Bumex)

Class: Potent diuretic

Actions: Inhibits reabsorption of sodium chloride; Promotes prompt diuresis; slight vasodilation

Indication: CHF; Pulmonary edema

Contraindications: Dehydration; Pregnancy

Precautions: should be protected from light

Side effects: Few

Dosage & Route: IV/IM 0.5 – 1.0 mg

Calcium Chloride

Class: Electrolyte

Actions: Increases cardiac contractility

Indication: Acute hyperkalemia; Acute hypocalcemia; Calcium channel blocker (e.g. nifedipine, verapamil) OD; Abd muscle spasm associated w/ spider bite and Portuguese man-of-war stings; antidote for magnesium sulfate

Contraindications: Pt receiving digitalis

Precautions: IV line should be flushed between calcium chloride and sodium bicarbonate admin; extravasation may cause tissue necrosis

Side effects: Dysrhythmias (bradycardia and asystole); hypotension

Dosage & Route: 2 – 4 mg/kg of a 10% solution; may be repeated at 10 min intervals IV

Calcium Gluconate

Class: Elemental cation; antacid

Actions: increases levels of intracellular and extracellular calcium; neutralizes stomach acid

Indication: adjunct in exchange transfusion; treat hypocalcemia; treat hyperacidity

Contraindications: hypercalcemia, hypophosphatemia, renal calculi

Precautions: don’t give through same line as bicarbonates, phosphates, or sulfates

Side effects: hypotension, dysrhythmia, N/V, diaphoresis, flushing

Dosage & Route: PO 800-1000 mg daily; IV 500 - 1000 mg slowly

Captopril (Capoten)

Class: ACE Inhibitor; antihypertensive

Actions: prevent conversion of Angiotensin I to angiotensin II, inhibiting aldosterone release, reducing BP

Indication: To control hypertension; treat left-sided heart failure; treat diabetic nephropathy

Contraindications: hypersensitivity, other ACE inhibitor use

Precautions: allopurinol use increases hypersensitivity, antacids prevent absorption; monitor BP, renal function, WBCs

Side effects: fever, CP, orthostatic hypotension, tachycardia, impotence, oliguria, eosinophilia, cough, photosensitivity, angioedema, hyponatremia, hyperkalemia

Dosage & Route: PO 25 – 50 mg bid increased as directed by physician, max. 450 mg daily

Chlordiazepoxide (Librium)

Class: Benzodiazepine; antianxiety

Actions: may potentiate effects of GABA by binding to benzo receptors

Indication: short term management of mild to severe anxiety; treat withdrawal

Contraindications: digoxin use, hypersensitivity

Precautions: may decrease effectiveness of levodopa, CNS depression

Side effects: ataxia, confusion, CNS depression, suicidal ideations, hypotension, tachycardia, jaundice, hepatic dysfunction

Dosage & Route: PO 5 – 10 mg q.i.d., IV/IM 50 – 100 mg, Max. 300 mg daily

Chlorpromazine (Thorazine, Largactil)

Class: Major tranquilizer (Phenothiazine)

Actions: Blocks dopamine receptors in brain associated w/ mood and behavior; Has antiemetic properties

Indication: Acute psychotic episodes; Mild alcohol withdrawal; Intractable hiccoughs; N/V

Contraindications: Comatose states; Presence of sedatives; Presence of hallucinogens or phencyclidine-like compounds

Precautions: Orthostatic hypotension; May cause extrapyramidal reactions (Parkinsonian), especially in children

Side effects: Physical and mental impairment; Drowsiness

Dosage & Route: 25 – 100 mg IM

Cimetidine (Tagamet)

Class: Imidazole derivative; antiulcer agent; antacid

Actions: blocks histamine action at H2 receptors in stomach reducing gastric acid

Indication: treat ulcers, manage GERD, treat heartburn

Contraindications: hypersensitivity

Precautions: antacid use decreases absorption

Side effects: confusion, dizziness, hallucinations, headache, diarrhea, impotence

Dosage & Route: PO 800 mg daily; IV/IM 300 mg every 6-8 hrs, max. 2,400 mg daily

Clopidogrel Bisulfate (Plavix)

Class: Platelet aggregation inhibitor

Actions: binds to adenosine diphosphate (ADP) receptors on the surface of activated platelets, deactivating glycoprotein IIb/IIIa receptors and prevents fibrinogen from attaching, keeping platelets from aggregating.

Indication: to reduce risk of stroke or MI in pts w/ atherosclerosis

Contraindications: active bleeding, hypersensitivity

Precautions: ulcer, intracranial hemorrhage

Side effects: confusion, depression, dizziness, fatigue, hallucinations, headache, CP, edema, HTN, hypotension, bleeding, abd pn, diarrhea, N/V, cough, pancreatitis

Dosage & Route: PO Loading dose 300 mg, 75 mg daily

Dexamethason (Decadron, Hexadrol)

Class: Steroid

Actions: Decreases cerebral edema; Anti-inflammatory; Suppresses immune response

Indication: Anaphylaxis (after epinephrine and diphenhydramine); Asthma; COPD

Contraindications: None in emergency setting

Precautions: Protect from light; Onset of action may be 2 – 6 hr and thus should not be considered to be of sue in the critical first hr

Side effects: GI bleeding; Prolonged wound healing

Dosage & Route: 4 – 24 mg IV, IM

Dextrose (50 Percent)

Class: Carbohydrate

Actions: Elevates Blood Glucose level rapidly

Indication: Hypoglycemia


Precautions: blood glucose should be taken before admin

Side effects: Local venous irritation

Dosage & Route: 25g (50mL) IV

Diazepam (Valium)

Class: Tranquilizer (benzodiazepine)

Actions: Anticonvulsant; Skeletal muscle relaxant; Sedative

Indications: Major motor seizures; Status epilepticus; Premedication before cardioversion; skeletal muscle relaxant; Acute anxiety states

Contraindications: Hypersensitivity

Precautions: Can cause local venous irritation; short duration of effect; Do not mix w/ other drugs; Flumazenil (Romazicon) be available

Side effects: Drowsiness; Hypotension; Respiratory depression and apnea

Dosage & Route: Status epilepticus: 5 – 10 mg IV; Acute anxiety: 2 – 5 mg IM, IV; Premedication for cardioversion: 5 – 15 mg IV; not administer faster than 1mL/min IV

Digoxin Immune Fab (Digibind)

Class: Digoxin-specific antigen-binding fragments; Digitalis glycoside antidote

Actions: binds with digoxin or digitoxin molecules and excretes compound through kidneys

Indication: treat acute digoxin toxicity


Precautions: test for allergic reaction by admin of diluted fab 0.1 ml in 9.9 ml saline intradermally

Side effects: increased ventricular rate in A-Fib, worsening of heart failure or low cardiac output

Dosage & Route: individualized dosage based on amt ingested

Digoxin (Lanoxin)

Class: Cardiac glycoside (Class V Antidysrhythmic)

Actions: Increases cardiac contractile force and cardiac output; Reduces edema associated w/ CHF; Decreases automaticity

Indication: CHF; Rapid atrial dysrhythmias, atrial flutter and atrial fibrillation

Contraindications: pt w/ S/S of digitalis toxicity; V-fib

Precautions: monitor for signs of digitalis toxicity (> 2.0); pt who have recently suffered a MI; calcium should not be admin to pt receiving digitalis

Side effects: N/V anorexia; dysrhythmias; yellowish, blurry vision; fatigue

Dosage & Route: 0.25 – 0.50 mg IV

Diltiazem (Cardizem)

Class: Class IV Antidysrhythmic; Calcium channel blocker

Actions: Slows conduction through the AV node; Causes vasodilation; Decreases rate of ventricular response; Decreases myocardial oxygen demand

Indication: To control Rapid Ventricular rates associated with A-Fib and flutter; Angina pectoris

Contraindications: Hypotension; Wide-complex tachycardia; Conduction system disturbances

Precautions: Should not be used in pt receiving beta blockers; hypotension; kept refrigerated

Side effects: N/V; hypotension; dizziness

Dosage & Route: 0.25 mg/kg bolus (typically 15 - 20 mg) IV over 2 min, following by a maintenance infusion of 5 – 15 mg/hr

Other: antidote = Calcium Chloride

Diphenhydramine (Benadryl)

Class: Antihistamine

Actions: Blocks histamine receptors; Sedative effects

Indication: Anaphylaxis; Allergic reactions; Dystonic reactions due to phenothiazines

Contraindications: Asthma; Nursing mothers

Precautions: Hypotension

Side effects: Sedation; Dries bronchial secretions; blurred vision; Headache; Palpitations

Dosage & Route: 25 – 50 mg slow IV push/deep IM

Other: Pediatric: 2 -5 mg/kg

Dobutamine (Doburex)

Class: Sympathomimetic

Actions: Increases cardiac contractility; little chronotropic activity

Indication: Short-term management of CHF

Contraindications: Should only be used in pt w/ adequate heart rate

Precautions: Ventricular irritability; caution following MI; deactivated by alkaline solution

Side effects: Headache; HTN; palpitations

Dosage & Route: 2.5 – 20 micrograms/kg/min Method: 250mg should be placed in 500 mL of D5W, which give a concentration of 0.5 mg/mL

Dopamine (Intropin)


Actions: Increases cardiac contractility; Causes peripheral vasoconstriction

Indication: Hemodynamically significant hypotension (systolic blood pressure of 70 – 100 mmHg) not resulting from hypovolemia; Cardiogenic shock

Contraindications: Hypovolemic shock in which complete fluid resuscitation has not occurred; pheochromocytoma

Precautions: Presence of severe tachydysrhythmias; presence of V-Fib; Ventricular irritability; Beneficial effects lost when dose exceeds 20 micrograms/kg/min

Side effects: Ventricular tachydysrhythmias; HTN; Palpitation

Dosage & Route: Initial dose: 2 -5 micrograms/kg/min; increases PRN; Method: 800 mg should be placed in 500 mL of D5W giving a concentration of 1600 mg/mL

Droperidol (Inapsine)

Class: Butyophenone anti-psychotic / anti-emetic

Actions: Antagonizes the effect of drugs that act on the chemoreceptor trigger zone (CTZ); Reduces anxiety and produces sedation

Indication: Acute psychosis; N/V

Contraindications: Pt w/ known hypersensitivity

Precautions: “BLACK BOX” warning regarding QT interval prolongation; Use w/ caution in the elderly, debilitated or poor-risk pt; Monitor vital signs and ECG

Side effects: Drowsiness; EPS symptoms (dystonia); Dizziness; Restlessness; Hypotension; Tachycardia


Enalapril (Vasotec)

Class: ACE Inhibitor; antihypertensive

Actions: reduces blood pressure by affecting RAAS.

Indication: To treat hypertension; to treat heart failure

Contraindications: Hx of angioedema from previous ACE Inhibitor; hypersensitivity

Precautions: many drug interaction risks

Side effects: ataxia, confusion, depression, dizziness, dream disturbances, fatigue, headache, insomnia, nervousness, peripheral neuropathy, somnolence, stroke, syncope, vertigo, weakness, angina, arrhythmias, cardiac arrest, hypotension, embolism, abd pn, constipation, hepatitis, renal failure, dry eyes/mouth, photosensitivity, N/V, anaphylaxis, muscle spasms, bronchospasm, impotence

Dosage & Route: IV 1.25 mg every 6 hrs; PO 2.5-5 mg daily, max. 40 mg daily.

Enoxapain (Lovenox)

Class: Anti-coagulant (low molecular-weight heparin)

Actions: Acts as effective anti-coagulant

Indication: Unstable angina; Non-Q-wave MI; Pulmonary embolism; Deep venous thrombosis

Contraindications: Pt w/ known hypersensitivity to the drug or heparin

Precautions: do not use in patients w/ major bleeding or at increased risk of bleeding

Side effects: Confusion; Dizziness; Edema; Bleeding complications

Dosage & Route: MI / angina: 1 mg/kg SC/IV; Pulmonary embolism: 0.5 mg/kg SC/IV

Epinephrine 1:10,000


Actions: Increase in HR, automaticity, cardiac contractile force, myocardial electrical activity, systemic vascular resistance, B/P; bronchodilation

Indication: Cardiac arrest, Anaphylactic shock, Severe reactive airway disease

Contraindications: should not be used in pt who do not require extensive resuscitative efforts

Precautions: Protect from light; deactivated by alkaline solutions

Side effects: Palpitation; Anxiety; Tremulousness; N/V

Dosage & Route: Cardiac arrest: 0.5 – 1.0mg repeated every 3 – 5min; Severe Anaphylaxis: 0.3 – 0.5mg (3 – 5 mL), occasionally an drip is required; ETT dose 2 to 2.5 times IV dose

Other: Pediatric: 0.01mg/kg initially; with subsequent doses, Epinephrine 1:1000 should be used at a dose of 0.1mg/kg

Epinephrine 1:1,000


Actions: Bronchodilation

Indication: Bronchial asthma; Exacerbation of COPD; Allergic reaction; Pediatric cardiac arrest

Contraindications: Pt w/ underlying cardiovascular disease; HTN; Pregnancy; pt w/ tachdysrhythmias

Precautions: Protect from light; B/P, P, ECG monitored closely

Side effects: Palpitations and tachycardia

Dosage & Route: 0.3 – 0.5 mg SC

Other: Pediatric Dose: 0.01 mg/kg up to 0.3 mg

Eptifibatide (Integrilin)

Class: Platelet Aggregation Inhibitor

Actions: reversibly inhibits platelet aggregation by preventing fibrinogen and other factors from binding to glycoprotein IIb/IIIa receptors on activated platelets.

Indication: To treat unstable angina; to treat thrombosis related to PTCA

Contraindications: active bleeding or stroke during prior 30 days; dialysis; hypersensitivity; recent major surgery

Precautions: avoid punctures during therapy

Side effects: intracranial hemorrhage, hypotension, hematemesis, hematuria, thrombocytopenia, anaphylaxis

Dosage & Route: IV 135-180 mcg/kg slow

Esmolol (Brevibloc)

Class: Beta-blocker (beta1 selective)

Actions: Decreases HR; Decreases atrioventricular conduction

Indication: symptomatic SVT (including A-Fib and atrial flutter) as evidenced by Chest pn, palpitation, or dizziness

Contraindications: Sinus bradycardia; Heart block greater than 1 degree; Cardiogenic shock; Overt CHF; Pt w/ bronchospastic diseases (asthma)

Precautions: Hypotension is common and is usually dose related; Pt w/ CHF may worsening of S/S; May worsen bronchospastic disease

Side effects: Dizziness; Diaphoresis; Hypotension; Nausea

Dosage & Route: Prep: place two 2.5 g ampules in 500 mL of D5W, yielding a concentration of 10 mg/mL; Loading: 500 mL/kg/min for 1 min, then reduce to maintenance dose; Maintenance: 50 mg/kg/min; if ineffective after 4 min, repeat loading dose and increase PRN until a total maintenance dose of 200 mg/kg/min has been achieved; IV infusion only.

Etomidate (Amidate)

Class: Hypnotic

Actions: Non-barbiturate hypnotic with no analgesic effects and limited cardiovascular and respiratory effects

Indication: Induce sedation for rapid sequence intubation


Precautions: Hypotension, Severe asthma, Cardiovascular disease

Side effects: Adrenal suppression, opsoclonus, skeletal muscle movements, mainly myoclonic, transient injection site pain

Dosage & Route: 0.1to 0.3 mg/kg IV over 15 to 30 sec. Ped: 0.2 to 0.4 mg/kg IV/IO over 30 to 60 sec. Max 20 mg.

Fentanyl Citrate (Sublimaze)

Class: Narcotic (Synthetic Opioid) *50 – 100x MORE potent than Morphine

Actions: CNS depressant; Decreases sensitivity to pn

Indication: Severe pn; Adjunct to rapid-sequence induction; Adjunct to rapid-sequence sedation; Maintenance of analgesia

Contraindications: Shock; Undiagnosed abd pn; Pt w/ Hx of hypersensitivity; Myasthenia Gravis; Head Injury; COPD

Precautions: Respiratory depression; Hypotension; Chest wall rigidity

Side effects: Dizziness; AMS; Bradycardia; Nausea/Vomiting; Cramps

Dosage & Route: 25 – 100 mcg IV; 2 -12 yr: 1.7 – 3.3 microgram/kg

Other: Naloxone is antagonist

Flecainide (Tambocor)

Class: Class 1C antiarrhythmic

Actions: Inhibits fast sodium channels of myocardial cell membranes, which increase myocardial recovery after repolarization, and by depressing the upstroke of the action potential. Slows conduction; Inhibits calcium influx

Indication: to prevent and suppress VTach; To prevent Paroxysmal AFib or PSVT

Contraindications: cardiogenic shock, hypersensitivity, recent MI, R BBB associated with 2nd or 3rd degree AV block unless pacemaker is present.

Precautions: Risky interactions with amiodarone and digoxin

Side effects: anxiety, depression, dizziness, fatigue, headache, tremors, weakness, arrhythmias, angina, hypotension, heart failure, blurred vision, constipation, N/V, dyspnea, rash

Dosage & Route: PO 50-100 mg every 8-12 hrs

Flumazenil (Romazicon)

Class: Benzodiazepine antagonist

Actions: Reverses the effects of benzodiazepines

Indication: To reverse ENS respiratory depression associated w/ benzodiazepines

Contraindications: Flumazenil should not be used as a diagnostic agent for benzodiazepine OD in the same manner naloxone is used for narcotic OD; Known hypersensitivity to drug

Precautions: Admin w/ caution to pt dependent on benzodiazepines because it may induce life-threatening benzodiazepine withdrawal; Should not be used as part of a “coma cocktail”

Side effects: Fatigue; Headache; Nervousness; Dizziness

Dosage & Route: 0.2 mg IV over 30 sec, repeated as needed to a max dose of 1.0 mg

Fosphenytoin (Cerebyx)

Class: Anticonvulsant

Actions: Converts to phenytoin; Suppresses SZ activity

Indication: Major motor SZ; antidysrhythmic

Contraindications: Hypersen to Rx or phenytoin (hydantoin class of drugs)

Precautions: Pt w/ impaired renal function; Alcoholism; Hypotension; Heart block

Side effects: Dizziness; Somnolence; Hypotension; Heart Block

Dosage & Route: 15 – 20 mg phenytoin equivalent/kg IV/IM

Furosemide (Lasix)

Class: Diuretic

Actions: Inhibits reabsorption of sodium chloride; Promotes prompt diuresis; Vasodilation

Indication: Pulmonary edema 2nd to CHF; Pulmonary edema

Contraindications: Pregnancy; Dehydration

Precautions: Protect from light; Dehydration

Side effects: hypotension; dry mouth

Dosage & Route: 40 – 80 mg IV

Other: Pediatric: 1 mg/kg (max 6 mg/kg total dose) IV

Glucagon

Class: Hormone (antihypoglycemic agent)

Actions: Causes breakdown of glycogen to glucose; Inhibits glycogen synthesis; Elevates blood glucose level; Increases cardiac contractile force

Indication: Hypoglycemia; Beta-blocker overdose


Precautions: Only effective if there are sufficient stores of glycogen with in th liver; Use w/ caution in pt w/ cardiovascular or renal disease; Draw blood for glucose test before admin

Side effects: Few in emergency situation

Dosage & Route: 0.25 – 0.5 unit IV; 1.0 IM

Haloperidol (Haldol)

Class: Major tranquilizer (betrophenone)

Actions: Block dopamine receptors in brain responsible for mood and behavior

Indication: Acute psychotic episodes

Contraindications: Not to be admin in the presence of other sedatives

Precautions: Orthostatic hypotension

Side effects: Physical and mental impairment; Parkinson-like reactions have been known to occur, especially in children

Dosage & Route: 2 – 5 mg IM

Heparin

Class: Anticoagulant

Actions: Inhibits anti-thrombin III – thrombin complex

Indication: Unstable angina; Non-Q-Wave MI; Pulmonary embolism; Deep venous thrombosis

Contraindications: Pt w/ known hypersen to Rx or pork products

Precautions: Do not use in pt w/ major bleeding or thrombocytopenia

Side effects: Confusion, Dizziness, Edema, Bleeding complications

Dosage & Route: 5000 units IV followed by maintenance infusion; IV, SQ

Hydralazine (Apresoline)

Class: Anti-hypertensive (potent vasodilator)

Actions: Relaxes vascular smooth muscle; Decreases arterial pressure (diastolic greater than systolic); Increases cardiac output

Indication: HTN emergency in which a prompt reduction in BP is required; HTN accompanying pregnancy

Contraindications: Pt w/ known Hx of coronary artery disease; Rheumatic heart disease involving the mitral valve; Hx of hypersensitivity

Precautions: May induce angina; May cause ECG changes and cardiac ischemia; BP, P, and ECG results constantly monitored

Side effects: Headache; N/V/D; Tachycardia; Palpitations

Dosage & Route: 20 40 mg given by slow IV bolus; may be repeated if required

Hydrocortisone (Soul-Cortef)

Class: Steroid

Actions: Anti-inflammatory; Suppresses immune response (especially in allergic and anaphylactic reactions)

Indication: Severe anaphylaxis; Asthma and COPD; Urticaria (hives)

Contraindications: None in the emergency setting

Precautions: Must be reconstituted and used promptly; Onset of action may be 2 – 6 hr, and thus the drug should not be expected to be of use in the critical 1st hr following an acute anaphylactic reaction

Side effects: GI bleeding; Prolonged wound healing; suppression of natural steroids


Hydromorphone (Dilaudid)

Class: Narcotic (Opioid)

Actions: CNS depressant; Decrease sensitivity to pn

Indication: Relief of moderate to severe pain.

Contraindications: History of chronic respiratory illness

Precautions: Excessive sedation, respiratory depression, circulatory depression and collapse

Side effects: Nausea/Vomiting, Cramps

Dosage & Route: 0.5 – 2mg; Adults= 1mg slow IV repeat in 5min if B/P >90.


Hydroxocobalamin

Class: Vitamin

Actions: Binds to plasma proteins to be used for growth, cell reproduction, hematopoiesis, nucleoprotein and myelin synthesis.

Indication: Pernicious anemia, both uncomplicated and accompanied by nervous system involvement; Dietary deficiency of Vitamin B12; Malabsorption of vitamin B12; Inadequate secretion of intrinsic factor, resulting from lesions that destroy the gastric mucosa (ingestion of corrosives, extensive neoplasia), and a number of conditions associated with a variable degree of gastric atrophy (such as multiple sclerosis, certain endocrine disorders, iron deficiency, and subtotal gastrectomy).


Precautions: May mask certain conditions

Side effects: Mild transient diarrhea, itching, transitory exanthema, feeling of swelling of entire body, and anaphylaxis.

Dosage & Route: IM 30 mcg daily for 5 - 10 days followed by 100 - 200 mcg monthly

Hydroxyzine (Vistaril)

Class: Anti-histamine

Actions: Anti-emetic; Anti-histamine; Anti-anxiety; Potentiates analgesic effect of narcotics and related agents

Indication: To potentiate the effects of narcotics and synthetic narcotics; N/V; Anxiety reactions


Precautions: Orthostatic hypotension; Analgesic dosages should be reduced when used with hydroxyzine; Urinary retention

Side effects: Drowsiness

Dosage & Route: 50 – 100 mg Deep IM

Ibuprofen (Advil, Motrin)

Class: Propionic acid derivative; analgesic; NSAID, antipyretic

Actions: Blocks activity of cyclooxygenase, the enzyme needed to synthesize prostaglandins, which mediate inflammation and cause pain signal; Vasodilates to reduce temperature.

Indication: To relieve pain caused by arthritis, migraine, muscle ache; To reduce fever

Contraindications: angioedema, asthma, bronchospasm, rhinitis, nasal polyps, hypersensitivity

Precautions: long term use may have damaging effects on renal and hepatic function; Use caution in pt with Hx of ulcers

Side effects: Aseptic meningitis, dizziness, headache, nervousness, stroke, fluid retention, heart failure, hypertension, MI, tachycardia, epistaxis, tinnitus, abd pn, constipation, hepatitis, N/V, renal failure, anemia, anaphylaxis, angioedema, weight gain, bronchospasm, dyspnea

Dosage & Route: PO 200-800 mg 2-6 times daily; IV 400-800 mg over 6 hrs

Insulin (Humilin, Novolin, Iletin)

Class: Hormone (hypoglycemic agent)

Actions: Causes uptake of glucose by the cells; Decreases blood glucose level; Promotes glucose storage

Indication: Elevated blood glucose; Diabetic ketoacidosis

Contraindications: Avoid overcompensation of blood glucose level, if possible, admin should wait until the pt is in the ED

Precautions: Administration of excessive dose may induce hypoglycemia; glucose should be available

Side effects: few in emergency situation

Dosage & Route: 10 – 25 units regular insulin IV followed by an infusion @ 0.1 units/kg/hr; IV, SQ

Ipratropium (Atrovent)

Class: Anticholinergic

Actions: Causes bronchodilation; dries respiratory tract secretions

Indication: Bronchial asthma; Reversible bronchospasm associated w/ chronic bronchitis and emphysema

Contraindications: Should not be used in patients w/ Hx of hypersensitivity; should not be used as primary acute treatment of bronchospasm

Precautions: Monitor vital signs

Side effects: Palpitation; Dizziness; Anxiety; headache; Nervousness

Dosage & Route: 500 mcg placed in small-volume nebulizer (typically admin w/ a beta-agonist)

Isoetharine (Bronkosol)

Class: Sympathomimetic (Beta2 selective)

Actions: Bronchodilation; Increases HR

Indication: Asthma; Reversible bronchospam associated with chronic bronchitis and emphysema


Precautions: BP, P, ECG constantly monitored

Side effects: Palpitation; Tachycardia; Anxiety; Tremors; Headache

Dosage & Route: small-volume nebulizer: 0.5 mL (1:3 w/ NS)

Other: Pediatric: 0.25 – 0.5 mL diluted w/ 4 mL NS

Isoproterenol (Isuprel)


Actions: Increases HR; Increases Cardiac contractile force; Causes bronchodilation

Indication: Bradycardias refractory to atropine (when transcutaneous pacing is unavailable); severe status asthmaticus

Contraindications: Should not be used to increase blood pressure in cardiogenic shock

Precautions: Can cause ventricular irritability; can be deactivated by alkaline solutions; Should be used with caution for recent MI; External pacing, if available, should be used instead of isoproterenol

Side effects: Tachydysrhythmias; Tremors; Palpitation; Headache

Dosage & Route: 1 mg should be placed in 500 mL of D5W and then slowly infused at 2 – 10 micrograms/min and titrated until the desired rate is obtained or until PVCs occur; Iv Drip Only

Ketamine (Ketalar)

Class: Sedative / hypnotic and analgesic

Actions: Causes dissociative state

Indication: Induction agent for rapid-sequence induction

Contraindications: Hypersensitivity; significantly elevated BP

Precautions: hallucination can occur w/ emergency, particularly on emergence; Emergency airway and resuscitative equipment and drugs must be available

Side effects: Hallucination; Increased skeletal muscle tone

Dosage & Route: 0.5 – 1.0 mg/kg IV; 2.0 – 4.0 mg/kg IM

Ketorolac Tromethamine (Toradol)

Class: NSAID; Antipyretic

Actions: Anti-Inflammatory; Analgesic (peripherally acting); Inhibits prostaglandins that cause fever/pain.

Indication: Mild to moderate pn

Contraindications: Pt w/ history of hypersensitivity; Pt allergic to aspirin

Precautions: GI irritation or hemorrhage can occur

Side effects: Edema; Rash; Heartburn

Dosage & Route: 15 – 30 mg IV; 30 – 60 mg IM

Other: Works well with kidney stones

Labetalol (Trandate, Normodyne)

Class: Class II Antidysrhythmic; Beta blocker

Actions: Selectively block Alpha1 receptors and non-selectively blocks Beta receptors

Indication: Hypertensive crisis

Contraindications: Bronchial asthma; CHF; Heart block; Bradycardia; Cardiogenic shock

Precautions: BP, ECG constantly monitored; Atropine should be available

Side effects: Bradycardia; Heart block; CHF; Bronchospasm; Postural hypotension

Dosage & Route: 20 mg by slow IV infusion over 2min; doses of 40 mg can be repeated in 10 min until desired supine BP is obtained or until 300 mg has be given; 200 mg placed in 500 mL D5W to deliver 2 mg/min

Levalbuterol (Xopenex)

Class: Sympathomimetic amine; Bronchodilator

Actions: Attaches to Beta2 receptors on bronchial cell membranes to relax bronchial smooth muscle; Inhibits histamine release

Indication: To prevent or treat bronchospasm

Contraindications: hypersensitivity, use of beta blockers, TCAs, or MAOIs

Precautions: Decreases blood digoxin level, increases risk of hypokalemia

Side effects: Anxiety, chills, dizziness, hypertonia, insomnia, migraine, nervousness, syncope, tremors, angina, HTN, hypotension, tachycardia, N/V, myalgia, cough

Dosage & Route: Inhalation Aerosol 45-90 mcg every 4-6 hrs

Other: may cause paradoxical bronchospasm

Lidocaine (Xylocaine)

Class: Class IB Antidysrhythmic; Local anesthetic

Actions: Suppresses ventricular ectopic activity; Increases V-Fib threshold; Reduces velocity of electrical impulse through conductive system

Indication: Malignant PVCs; V-Tach refractory to Amiodarone; V-Fib; Prophylaxis of dysrhythmias associated w/ fibrinolytic therapy

Contraindications: High-degree heart block; PVCs in conjunction w/ bradycardia

Precautions: dosage should not exceed 300 mg/hr; Monitor for central nervous system toxicity; Dosage should be reduced by 50 in pt older than 70yo or have liver disease

Side effects: Anxiety; Drowsiness; Dizziness; Confusion; N/V; Convulsions; Widening QRS complex

Dosage & Route: Bolus: 1.0-1.5 mg/kg; additional of 0.5-0.75 mg/kg repeated 3-5 min intervals until the dysrhythmia suppressed or until 3.0 mg/kg has been given; reduce by 50% in pt older than 70 yo.

Lisinopril ( Prinivil, Zestril)

Class: Antihypertensive; Vasodilator

Actions: Reduce blood pressure by affecting RAAS

Indication: Manage HTN, Treat heart failure


Precautions: Drug interactions

Side effects: Ataxia, confusion, depression, dizziness, fatigue, headache, mood swings, stroke, syncope, TIA, vertigo, arrhythmias, angina, hypotension, MI, hyperglycemia, abd pn, diarrhea, hepatitis, N/V, renal failure, impotence, spasms, myalgia, bronchospasm, dyspnea, cough, rash

Dosage & Route: PO Initial 5-10 mg daily, maintenance 20-40 mg, max. 80 mg daily

Lorazepam (Ativan)

Actions: Anti-convulsant; Sedative

Indication: Major motor SZ; Status epilepticus; Pre-medication before cardioversion; acute anxiety states


Precautions: has short duration of effect; Do not mix w/ other drugs because of possible precipitation problems; Flumazenil (Romazicon) should be available; Dilute w/ NS of D5W prior to IV admin

Side effects: Drowsiness; Hypotension; Respiratory depression and apnea

Dosage & Route: 0.5 – 2.0 mg IV; May be increased to 1.0 – 4.0 mg IV; IV, IM, Rectal routes

Other: Pediatric: 0.05 – 0.10 mg/kg (max dose of 4 mg)

Magnesium Sulfate

Class: Anticonvulsant and Antidysrhythmic (Electrolyte Stabilizer)

Actions: CNS depressant; Anticonvulsant; Antidysrhythmic

Indication: Obstetrical: Eclampsia; Cardiovascular: Severe refractory V-Fib or Pulseless V-Tach, Post MI as prophylaxis for dysrhythmias, and Torsade de Pointes (“TdP” multiaxial (polymorphic) V-Tach)

Contraindications: Shock; Heart block;

Precautions: Caution in pt receiving digitalis; hypotension; Calcium Chloride should be readily available as an antidote if respiratory depression ensues; caution in pt w/ renal failure

Side effects: Flushing; Respiratory depression; Drowsiness

Dosage & Route: 1 – 4 g IV, IM

Other: antidote = Calcium Chloride

Mannitol (Osmotrol)

Class: Osmotic diuretic

Actions: decreases cellular edema; Increases urinary output

Indication: Acute cerebral edema; Blood transfusion reaction

Contraindications: Pulmonary edema; Pt who are dehydrated

Precautions: Rapid admin can cause circulatory overload; Crystallization of the drug can occur at lower temp; An in-line filter should be used

Side effects: Pulmonary congestion; Sodium depletion; Transient volume overload

Dosage & Route: 1.5 – 2.0 g/kg IV slow bolus or infusion

Meperidine (Demerol)



Indication: Moderate to severe pn

Contraindications: Pt receiving monoamine oxidase inhibitor; Undiagnosed abd pn; pt w/ Hx of hypersensitivity to drug

Precautions: Respiratory depression; Hypotension

Side effects: Dizziness; AMS; Nausea/Vomiting; Euphoria/Dysphoria

Dosage & Route: 25 – 50 mg IV; 50 – 100 mg IM; Pediatric: 1 mg/kg

Other: Naloxone is antagonist; Used with antiemetic Promethazine

Metaproterenol (Alupent)

Class: Sympathominmetic (Beta2 selective)

Actions: Bronchodilation; Increases heart rate

Indication: Bronchial asthma; Reversible bronchospasm associated w/ chronic bronchitis and emphysema

Contraindications: Pt w/ cardiac dysrhythmias or significant tachycardia

Precautions: BP, P, ECG constantly monitored; Occasional N/V reported

Side effects: palpitations; Anxiety; Headache; N/V Dizziness; Tremor

Dosage & Route: Small-volume nebulizer: 0.2 – 0.3 mL diluted in 2 – 3 mL NS admin over 5 – 15 min

Metaraminol (Aramine)

Class: Sympathomimetic (indirect acting)

Actions: Causes release of endogenous stores of norepinephrine; Increases cardiac contractile force; Increases cardiac rate; Causes peripheral vasoconstriction

Indication: Hemodynamically significant hypotension not due to hypovolemia

Contraindications: Hypotensive states due to hypovolemia

Precautions: Constant monitoring of BP is essential; Not effective in catecholamine-depleted pt

Side effects: Palpitations; Tachycardia; PVCs; HTN; Tremor; Dizziness

Dosage & Route: 200 mg should be placed in 500 mL of D5W; this gives a concentration of 0.4 mg/mL, which should be slowly infused and titrated to BP response; 5 – 10 mg can be admin IM when an IV cannot be placed

Methylprednisone (Solu – Medrol)

Class: Steroid

Actions: Anti-inflammatory; Suppresses immune response

Indication: Severe anaphylaxis; Asthma and COPD


Precautions: Must be reconstituted and used promptly; Onset of action may be 2 – 6 hr

Side effects: GI bleeding; Prolonged wound healing; Suppression of natural steroids


Metoclopramide (Reglan)

Class: Phenothiazine antiemetic

Actions: Antiemetic; Reduces gastroesophageal reflux

Indication: N/V; Gastroesophageal reflux

Contraindications: GI hemorrhage; Bowel obstruction or perforation; Pt w/ Hx of hypersensitivity to Rx

Precautions: Extrapyramidal (dystonic) symptoms have been reported

Side effects: May impair mental and physical ability; Drowsiness

Dosage & Route: 10 – 20 mg IM; 10 mg by slow IV push over 1 – 2 min

Metoprolol (Lopressor)

Class: Sympathetic blocker (beta 2 selective)

Actions: selectively blocks beta 2 adrenergic receptors (cardioprotective)

Indication: suspected or definite acute MI in pt who are hemodynamically stable

Contraindications: HR less than 45; Systolic blood pressure <100 mmHg; Heart block; shock; Hx of asthma

Precautions: BP, P, ECG constantly monitored; Atropine and transcutaneous pacing should be available

Side effects: bradycardia; Heart block; CHF; depression; Bronchospasm

Dosage & Route: Initial bolus of 5 mg slow IV; May repeat 5 mg bolus in 5 min if vitals are stable; May repeat 5 mg bolus in 10 min if vitals are stable

Midazolam (Versed)

Class: Tranquilizer (benzodiazepine)

Actions: Hypnotic; Sedative

Indication: Premedication before cardioversion; acute anxiety states

Contraindications: Pt w/ hypersensitivity; Narrow-angle glaucoma; Shock

Precautions: Resuscitative equip at hand; Flumazenil (Romazicon) available; Dilute w/ D5W prior to IV; Respiratory depression more common with midazolam than other benzodiazepines

Side effects: Drowsiness; Hypotension; Amnesia; Respiratory depression and apnea

Dosage & Route: 1.0 – 2.5 mg IV; IV, Oral, Intranasal

Other: Pediatric: 0.03 mg/kg

Milrinone (Primacor)

Class: Bipyridine derivative; Inotropic; Vasodilator

Actions: Increases force of contraction and cardiac output by blocking the enzyme phosphodiesterase.

Indication: To provide short-term Tx of acute heart failure


Precautions: Drug Interactions; Do not administer through same line as Furosemide to prevent precipitation

Side effects: Headache, tremors, angina, hypotension, SVT, TdP, bronchospasm, rash, anaphylaxis, rash

Dosage & Route: IV Loading: 50 mcg/kg over 10 min, dosage adjusted to clinical response

Morphine Sulfate (Duramorph)


Actions: CNS depressant, Peripheral vasodilation; Decrease sensitivity to pn

Indication: Severe pn; Pulmonary edema

Contraindications: Head injury; Volume depletion; Undiagnosed abd pn; Hypersensitivity

Precautions: Apnea (or Respiratory depression); Hypotension; Nausea

Side effects: Dizziness; Tachycardia (or Bradycardia), Altered LOC

Dosage & Route: 2 – 10 mg IV, 2 mg every few min until pn relieved or respiratory depression; 5 – 15 mg IM based on pt weight.


Nalbuphine (Nubain)

Class: Synthetic analgesic


Indication: Moderate to severe pn


Precautions: pt w/ impaired respiratory function; Respiratory depression; Pt dependent on narcotics may experience S/S of withdrawal; Nausea

Side effects: Dizziness; AMS


Nalmefene (Revex)

Class: Synthetic opiate antagonist

Actions: reverses the effects of opioid medications, also called narcotics.

Indication: Treatment for narcotic overdose


Precautions: use in patients physically dependent on opioids can result in precipitated withdrawal reactions that may result in symptoms that require medical attention.

Side effects: dysphoria, headache, HTN, hypotension, tachycardia, vasodilation,abdominal cramps, nausea, joint pain, myalgia, chills, fever, postoperative pain.

Dosage & Route: IV 0.25 mcg/kg followed by incremental doses of 0.25 mcg/kg q 2–5 min (up to a total dose of 1 mcg/kg)

Naloxone Hydrochloride (Narcan)

Class: Opiate antagonist

Actions: Reverses effects of narcotics (opiates)

Indication: Narcotic OD: morphine, Dilaudid, fentanyl, Demerol, paregoric, methadone, heroin, Percodan, Tylox; Synthetic analgesic OD: Nubain, Stadol, Talwin, Darvon, alcoholic coma


Precautions: May cause withdrawal effects in pt dependent on narcotics

Side effects: N/V; Chills

Dosage & Route: 0.4 – 2 mg IV, IM, ETT (2 – 2.5 times IV dose)

Nifedipine (Procardia)

Class: Calcium channel blocker

Actions: Relaxes smooth muscle, causing arteriolar vasodilation; decreases peripheral vascular resistance

Indication: severe HTN; angina pectoris

Contraindications: Pt w/ known hypersensitivity; hypotension

Precautions: B/P should be monitored; may worsen CHF; Nifedipine should not be admin to pt receiving IV Beta blockers

Side effects: Dizziness; Flushing; Nausea; Headache; Weakness

Dosage & Route: 10 mg PO

Nitroglycerin Paste

Class: Nitrate; antianginal; antihypertensive; vasodilator

Actions: Interacts with nitrate receptors in vascular smooth-muscle cell membranes, reducing nitroglycerin to Nitric Oxide, which activates the enzyme guanylate cyclase, increasing intracellular formation of cGMP, relaxing vascular smooth-muscle, causing vasodilation.

Indication: To prevent or treat angina; Manage HTN or heart failure

Contraindications: Erectile dysfunction drugs; Acute MI, glaucoma, cerebral hemorrhage, head trauma, hypersensitivity to nitrates

Precautions: Drug interactions

Side effects: Agitation, anxiety, dizziness, headache, syncope, insomnia, weakness, arrhythmias, hypotension, blurred vision, abd pn, diarrhea, N/V, impotence, bronchitis.

Dosage & Route: 15-30 mg every 8 hrs. , max. 75 mg.

Nitroglycerin (Nitrostat)

Class: Anti-anginal

Actions: Smooth muscle relaxant; Reduces cardiac work; Dilates coronary and systemic arteries

Indication: Angina pectoris; Chest pn associated with MI

Contraindications: children younger than 12 yo; Hypotension; Pt on erectile dysfunction Rx

Precautions: Constantly monitor B/P; Syncope; protect from light; expires quickly

Side effects: Headache; Dizziness; Hypotension

Dosage & Route: One tablet repeated @ 3 - 5 min intervals up to 3 times sublingual

Other: Have IV fluid ready

Nitrous Oxide (Nitronox, Entonox)

Class: Gas

Actions: CNS depressant

Indication: Pn of musculoskeletal origin, particularly fx; Burns; suspected ischemic chest pn; States of severe anxiety including hyperventilation

Contraindications: Alt LOC; Intoxication; Head-injury; COPD; increased oxy concentration my cause respiratory depression; thoracic injury suspicious of pneumothorax; Abd pn and distension suggestive of bowel obstruction

Precautions: Use only in well-ventilated area; gas scavenging system is recommended; May not operate properly at low temps

Side effects: headache; dizziness; giddiness; N/V

Dosage & Route: Self-admin only using fixed 50% Nitrous oxide and 50% Oxy blender by inhalation only

Other: Pediatric: Self-administered only

Norepineprine (Levophed)

Class: sympathomimetic

Actions: Causes peripheral vasoconstriction

Indication: hypotension (systolic blood pressure < 70 mmHg refractory to other sympathomimetics); Neurogenic shock

Contraindications: Hypotensive states due to hypovolemia

Precautions: can be deactivated by alkaline solution; Constant monitoring of BP essential; Extravasation can cause tissue necrosis

Side effects: Anxiety; Palpitation; Headache; HTN

Dosage & Route: 0.5 – 30 mcg/min; Method: 8 mg should be placed in 500 mL of D5W, giving concentration of 16 mcg/mL; IV drip only

Ondansetron (Zofran)

Class: Antiemetic

Actions: Blocks serotonin receptors at vagal nerve terminals in the intestine to prevent nausea/vomiting

Indication: To prevent nausea/vomiting


Precautions: Do not use with alcohol

Side effects: agitation, anxiety, ataxia, dizziness, drowsiness, fever, headache, hypotension, restlessness, seizures, syncope, somnolence, weakness, arrhythmias, CP, hypotension, embolism, shock, tachycardia, blurred vision, dry mouth, abd pn, constipation/diarrhea, bronchospasm, rash, anaphylaxis

Dosage & Route: PO 4-8 mg every 8-12 hrs.; IV/IM 4mg

Oral Glucose (Insta-glucose)

Class: Saccharide

Actions: Absorbed into blood stream to deliver vital sugars needed for cellular metabolism

Indication: hypoglycemia; conscious pt w/ altered mental status & hx of diabetes

Contraindications: unconscious pt; no gag reflex

Precautions: None

Side effects: None

Dosage & Route: PO 24 g per tube.

Oxygen

Class: Gas

Actions: Necessary for cellular metabolism

Indication: Hypoxia

Contraindications: None

Precautions: Use cautiously in pt w/ COPD; Humidify when providing high-flow rates

Side effects: Drying of mucous membranes

Dosage & Route: Cardiac Arrest: 100%; Other critical pt: 100%; COPD: 35%

Other: Pediatric: 24 – 100 % PRN

Oxymetazoline nasal (Afrin)

Class: decongestant

Actions: constricts blood vessels in nasal tissues leading to sinus drainage

Indication: used to treat congestion associated with allergies, hay fever, and cold

Contraindications: MAOI use, dysrhythmia, glaucoma, diabetes, thyroid problems

Precautions: unknown teratogenic effects, do not use if liver or kidney disease

Side effects: anaphylaxis, seizures, hallucinations, dysrhythmia, Fatigue, coma

Dosage & Route: intranasal as directed by label or physician

Oxytocin (Pitocin)

Class: Hormone (oxytocic)

Actions: Causes uterine contraction; Causes lactation; Slows postpartum vaginal bleeding

Indication: Postpartum vaginal bleeding

Contraindications: Any condition other than postpartum bleeding; Cesarean section

Precautions: essential to ensure that the placenta has delivered and that there is not another fetus before administering oxytocin; HTN

Side effects: Anaphylaxis; Cardiac dysrhythmia

Dosage & Route: 10 – 20 units in 500 mL of D5W admin according to uterine response IV; 3 – 10 units IM

Pancuronium Bromide (Pavulon)

Class: Neuromuscular-blocking agent (nondepolarizing)

Actions: Skeletal muscle relaxant; Paralyzes skeletal muscles including respiratory muscles

Indication: To achieve paralysis to facilitate endotracheal intubation

Contraindications: Pt w/ known hypersensitivity

Precautions: Should not be admin unless person skilled in ETT intubation are present; ETT intubation equipment must have available; Oxygen equipment and emergency resuscitative drugs must be available; Paralysis occurs within 3 – 5 min and last for approximately 60 min

Side effects: prolonged paralysis; Hypotension; Bradycardia

Dosage & Route: 0.04 – 0.1 mg/kg; repeat doses of 0.01 – 0.02 mg/kg intravenously as required every 20 – 40 min IV

Phenobarbitol (Luminal)

Class: Barbiturate

Actions: Suppresses spread of seizure activity through the motor cortex; CNS depressant

Indication: Major motor SZ; Status epilepticus; Acute anxiety states

Contraindications: Hx of hypersensitivity

Precautions: Respiratory depression; Hypotension; Can cause hyperactivity in children; Extravasation may cause tissue necrosis

Side effects: Drowsiness; Children my become hyperactive

Dosage & Route: 100 – 250 mg slow IV / IM

Phenylephrine (Neo-Synephrine)

Class: alpha adrenergic agonist; vasopressor

Actions: shrinks blood vessels in the nasal passages to relieve congestion

Indication: treat nasal and sinus congestion, or congestion of the tubes that drain fluid from your inner ears, called the eustachian tubes

Contraindications: Hypersensitivity; MAOI use

Precautions: heart disease, high blood pressure, diabetes, or thyroid disorder.

Side effects: anaphylaxis, arrhythmias, dizziness, anxiety, loss of appetite; warmth, tingling, or redness under your skin; feeling restless or excited (especially in children); sleep problems (insomnia); skin rash

Dosage & Route: IM or subcutaneous: 2 to 5 mg every 1 to 2 hours as needed. IV bolus: 0.2 mg/dose (range: 0.1 to 0.5 mg/dose) every 10 to 15 minutes as needed (initial dose should not exceed 0.5 mg) IV infusion: 100 to 180 mcg/min initially. The usual maintenance dose is 40 to 60 mcg/min

Phenytoin (Dilantin)

Class: Anticonvulsant and antidysrhythmic

Actions: Inhibits spread of SZ activity through motor cortex; Antidysrhythmic

Indication: Status epilepticus; dysrhythmias due to digitalis toxicity

Contraindications: any dysrhythmia except those due to digitalis toxicity; High-grade heart blocks; Pt w/ Hx of hypersensitivity

Precautions: Should not be admin w/ glucose solutions; Hypotension; ECG monitory during admin

Side effects: Local venous irritation; Itching; CNS depression

Dosage & Route: Status epilepticus: 150 – 250 mg (10 – 15 mg/kg) not to exceed 50 mg/min; digitalis toxicity: 100 mg over 5 min until the dysrhythmia is suppressed or until a max dose of 1000mg has been admin or symptoms of CNS depression occur; IV (dilute w/ NS)

Other: Pediatric: Status epilepticus: 8 – 10 mg/kg IV; digitalis toxicity 3 – 5 mg/kg IV over 100 min

Physotigmine (Antilirium)

Class: Cholinesterase inhibitor

Actions: Inhibits cholinesterase; Potentiates acetylcholine

Indication: Tricyclic antidepressant overdoses (Elavil, Tofranil, Triavil, Norpramin); Atropine (belladonna) overdose

Contraindications: Asthma and COPD; Gangrene; Diabetes; Cardiovascular disease

Precautions: Monitor for bronchospasm and laryngospasm; SZ

Side effects: Excessive salivation; Bradycardia; Emesis


Pralidoxime (2-Pam, Protopam)

Class: Cholinesterase reactivator

Actions: Reactivates cholinesterase in cases of organophosphate poisoning; Deactivates certain organophosphates by direct chemical reaction

Indication: severe organophosphate poisoning as characterized by muscle twitching, respiratory depression, and paralysis

Contraindications: Poisonings due to inorganic phosphates; Poisoning other than organophosphates

Precautions: Always ensure safety and protection of rescue personnel; Laryngospasm, tachycardia, and muscle rigidity have occurred following rapid admin; should only follow atropinization

Side effects: Excitement; Manic behavior

Dosage & Route: 1 – 2 g in 250 – 500 mL of NS infused over 30 min

Prednisone

Class: Glucocorticoid; anti-inflammatory; immunosuppresant

Actions: Binds to intracellular glucocorticoid receptors and suppresses inflammatory and immune responses by inhibiting neutrophil and monocyte accumulation

Indication: To treat adrenal insufficiency and immunosuppressive disorders

Contraindications: Hypersensitivity; systemic fungal infection

Precautions: Drug Interactions

Side effects: Euphoria, headache, insomnia, nervousness, psychosis, restlessness, seizures, vertigo, edema, heart failure, HTN, cataracts, glaucoma, adrenal insufficiency, growth suppression, hyperglycemia, anorexia, GI Bleeding, increased appetite, indigestion, N/V, joint necrosis, bone fractures, myalgia, weakness, acne, thin skin, delayed wound healing

Dosage & Route: PO 5-250 mg daily

Procainamide (Pronestyl)

Class: Class IA Antidysrhythmic

Actions: slow conduction through myocardium; Elevates ventricular fibrillation threshold; suppresses ventricular ectopic activity

Indication: Persistent cardiac arrest due to V Fib and V Tach refractory to Lidocaine.

Contraindications: High-degree heart block; PVCs in conjunction w/ bradycardia

Precautions: Dosage should not exceed 17 mg/kg; Monitor for CNS toxicity

Side effects: Anxiety; Nausea; Convulsion; Widening of QRS complex

Dosage & Route: Initial 20 mg/min until dysrhythmia is abolished, hypotension ensues, QRS complex is widened by 50% of original width, or total of 1.7 mg/kg has been given; Maintenance: 1 – 4 mg/min

Prochlorperazine (Compazine)

Class: Phenothiazine; antianxiety; antiemetic; antipsychotic

Actions: Alleviates psychotic symptoms by blocking dopamine receptors, depressing release of selected hormones, and blocking alpha-adrenergic signals in the brain.

Indication: To control N/V; To manage psychotic disorders; To treat anxiety

Contraindications: < 2 yrs old, CAD, hepatic dysfunction, hypersensitivity, HTN, CNS depression, subcortical brain damage

Precautions: Drug Interactions; Not for Tx of dementia (Increases mortality)

Side effects: Akathisia, altered temperature regulation, dizziness, drowsiness, EPS, hypotension, tachycardia, blurred vision, dry mouth, gynecomastia, constipation, N/V, dysuria, photosensitivity, rash, weight gain

Dosage & Route: IV/IM 5-10 mg every 4 hrs, max. 40 mg daily; PO 5-40 mg daily

Promethazine (Phenergan)

Class: Phenothiazine antihistamine (H1 antagonist)

Actions: Mild anticholinergic activity; antiemetic; Potentiates actions of analgesics

Indication: N/V; Motion sickness; to potentiate the effects of analgesics; Sedation

Contraindications: Comatose states; Pt who have received a lg amount of depressants (including alcohol)

Precautions: Avoid accidental intra-arterial injection


Dosage & Route: 12.5 – 25.0 mg IV, IM

Propranolol (Inderal)

Class: Sympathetic blocker

Actions: Nonselectively block beta adrenergic receptors

Indication: Ventricular tachydysrhythmias refractory to lidocaine and bretylium; Recurrent ventricular fibrillation refractory to lidocaine and bretylium; Tachydysrhythmias due to digitalis toxicity

Contraindications: Comatose states; Patients who have received a large amount of depressants (including alcohol)

Precautions: Avoid accidental intra-arterial injection


Dosage & Route: 12.5 – 25.0 mg IV,IM

Racemic Epinephrine (MicroNEFRIN)


Actions: Bronchodilation; Increases heart rate; Increases cardiac contractile force

Indication: Croup (laryngotracheobronchitis)

Contraindications: Epiglottitis; Hypersensitivity to drug

Precautions: Vital signs should be constantly monitored; Should be used only once in the prehospital setting

Side effects: Palpitation; Anxiety; Headache

Dosage & Route: 0.25 – 0.75 mL of a 2.25 percent solution in 2.0 Ml NS; Inhalation only (small-volume nebulizer)

Reteplase, Recombinant (Retevase)

Class: Tissue Plasminogen Activator

Actions: Aids in dissolution of blood clots.

Indication: Management of acute MI, to reduce incidence of CHF and mortality associated with an acute MI.

Contraindications: Active internal bleeding; history of cerebrovascular accident; recent intracranial or intraspinal surgery or trauma; intracranial neoplasm, arteriovenous malformation or aneurysm; bleeding diathesis or severe uncontrolled hypertension

Precautions: Drug interactions: Abciximab, aspirin, dipyridamole, heparin, vitamin K antagonists

Side effects: Bleeding

Dosage & Route: IV 10 + 10 unit double-bolus injection, each bolus given over 2 min. Second bolus given 30 min after.

Rocuronium (Zemuron)

Class: Neuromuscular blocking (paralyzing) agent

Actions: produces neuromuscular blockade by competing with acetylcholine for cholinergic receptors at the motor end plate

Indication: an adjunct to general anesthesia to facilitate rapid-sequence or routine tracheal intubation and to induce skeletal muscle relaxation during surgery or mechanical ventilation

Contraindications: Hypersensitivity; Neuromuscular diseases, such as myasthenia gravis or myasthenic syndrome; Burns; Pulmonary hypertension or valvular heart disease

Side effects: HTN, hypotension, arrhythmia, bronchospasm, pruritus, rhonchi, skin rash, swelling at injection site, tachycardia, wheezing

Dosage & Route: IV 0.6–1.2 mg per kg of body weight

Sodium Bicarbonate

Class: Alkalinizing agent

Actions: Combines w/ excessive acids to form a weak volatile acid; Increases pH

Indication: Late in the management of cardiac arrest, if at all; Tricyclic antidepressant overdose; Severe acidosis refractory to hyperventilation

Contraindications: Alkalotic states

Precautions: Correct dosage is essential o avoid overcompensation of pH; Can deactivate catecholamines; Can precipitate with calcium; delivers large sodium load

Side effects: Alkalosis

Dosage & Route: 1 mEq/kq IV initially followed by 0.5 mEq/kg every 10 min as indicated by blood gas studies

Other: 1 mEq/kg initially followed by 0.5 mEq/kg every 10 min

Sodium Nitroprusside (Nipride, Nitropress)

Class: Potent vasodilator

Actions: Peripheral arterial and venous vasodilator; decreases blood pressure; Increases cardiac output in CHF

Indication: Hypertensive emergency

Contraindications: None when used in the management of life-threatening emergencies

Precautions: Bottle must be wrapped in foil to protect from light; Should not be admin to children or pregnant women in the prehospital setting; Reduce the dosage in elderly patients; BP, P, ECG diligently monitored

Side effects: N/V; Retching; Palpitation; Diaphoresis; Tachycardia; Dizziness: Side effects often diminish as dosage is reduced

Dosage & Route: 0.5 mg/kg/min IV infusion only

Succinylcholine (Anectine)

Class: Neuromuscular blocking agent (depolarizing)

Actions: Skeletal muscle relaxant; Paralyzes skeletal muscles, including respiratory muscles


Contraindications: Patients w/ known hypersensitivity to drug

Precautions: Should not be administered unless persons skilled in endotracheal intubation are present; Oxygen equipment and emergency resuscitative drugs must be available

Side effects: Prolonged paralysis; Hypotension; Bradycardia

Dosage & Route: 1 1.5 mg/kg (40 -100 mg in an adult) IV

Tenecteplase (TNKase)

Class: Purified glycoprotein; Thrombolytic

Actions: Binds fibrin and converts plasminogen to plasmin, which breaks down fibrin, resulting in dissolution of coronary artery thrombus

Indication: Acute MI secondary to thrombus

Contraindications: Active internal bleeding, aneurysm, brain tumor, CVA, hypersensitivity, severe HTN


Side effects: Intracranial hemorrhage, epistaxis, GI Bleed, Hematoma

Dosage & Route: IV 30-50 mg, based on weight

Terbutaline (Brethine)


Actions: Bronchodilator; Increases heart rate

Indication: Bronchial asthma; Reversible bronchospasm associated w/ COPD; Preterm labor

Contraindications: Patients w/ known hypersensitivity to the drug

Precautions: BP, P, ECG results must be constantly monitored

Side effects: Palpitations; Tachycardia; PVC; Anxiety; Tremors; Headache

Dosage & Route: Metered-dose inhaler: two inhalation, 1 min apart; Subcutaneous injection: 0.25 mg; may be repeated in 15 – 30 min; Inhalation, subcutaneous injection, IV drip (in preterm labor)

Tetracaine (Pontocaine, Viractin, Dermocaine)

Class: anesthetic

Actions: works by blocking nerve signals in your body.

Indication: to numb the skin or surfaces inside the mouth, nose, and throat to lessen the pain of inserting a medical instrument such as a tube or scope.


Precautions: overdose of numbing medications can cause fatal side effects if too much of the medicine is absorbed through your skin and into your blood

Side effects: anaphylaxis, arrhythmias, dizziness

Dosage & Route: Topically: as directed on the label, or as it has been prescribed by your doctor.

Thiamine (Vitamin B1)

Class: Vitamin

Actions: Allows normal breakdown of glucose

Indication: Coma of unknown origin; Alcoholism; Delirium tremens

Contraindications: None in the emergency setting

Precautions: Rare anaphylactic reactions have been reported; Should not be used as part of a “coma cocktail”

Side effects: Rare, if any

Dosage & Route: 100 mg IV, IM

Tirofiban (Aggrastat)

Class: Tyrosine derivative; Platelet aggregation inhibitor

Actions: Binds to glycoprotein IIb/IIIa receptor sites on the surface of activated platelets, preventing the normal binding of fibrinogen, inhibiting platelet aggregation.

Indication: Treat acute coronary syndrome

Contraindications: Acute pericarditis, recent stroke, GI bleed, hypersensitivity, aneurysm


Side effects: Chills, dizziness, fever, headache, CVA, edema, bradycardia, hematuria, N/V, pulmonary hemorrhage, rash, anaphylaxis

Dosage & Route: IV 0.4 mcg/kg/min for 30 min., followed by 0.1 mcg/kg/min

Vasopressin

Class: Hormone, vasoconstrictor

Actions: Antidiuretic hormone; Potent vasoconstrictor

Indication: Cardiac arrest


Precautions: Few in emergency setting

Side effects: Blanching of skin; HTN; Bradycardia

Dosage & Route: 40 units IV (single dose only)

Vecuronium (Norcuron)

Class: Neuromuscular-blocking agent (nondepolarizing)

Actions: Skeletal muscle relaxant; Paralyzes skeletal muscles including respiratory muscles


Contraindications: Pt w/ known Hypersensitivity

Precautions: Should not be administered unless persons skilled in endotracheal intubation are present; Endotracheal intubation equipment must be available; Oxygen equipment and emergency resuscitative drugs must be available; Paralysis occurs within 1 min and lasts for approximately 30 min

Side effects: Prolonged paralysis; Hypotension; Bradycardia

Dosage & Route: 0.08 – 0.1 mg/kg IV

Other: Pediatric: 0.1 mg/kg

Verapamil (Isoptin, Calan)

Class: [Prototype] Calcium channel blocker (Class IV Antidysrhythmic)

Actions: Slows conduction through the atrioventricular node; Inhibits reentry during paroxysmal supraventricular tachycardia (PSVT); Decreases rate of ventricular response; Decreases myocardial oxygen demand

Indication: PSVT

Contraindications: Heart block; Conduction system disturbances

Precautions: NOT for patient receiving intravenous beta blockers; hypotension

Side effects: N/V; hypotension; Dizziness

Dosage & Route: 2.5 – 5 mg; a repeat dose of 5 -10 mg can admin after 15 – 30 min if PSVT does not convert; max dose is 30 mg in 30 min; IV

Other: Pediatric: 0 – 1 yr: 0.1 – 0.2 mg/kg (max of 2.0 mg) administered slowly; 1 – 15 yo: 0.1 – 0.3 mg/kg (max of 5.0 mg) administered slowly

Ziprasidone (Geodon)

Class: Antipsychotic

Actions: Selectively blocks serotonin and dopamine receptors in the mesocortical tract of the CNS, suppressing psychotic symptoms

Indication: Treat schizophrenia or bipolar disorder

Contraindications: hypersensitivity, recent acute MI


Side effects: agitation, akathisia, amnesia, anxiety, asthenia, CVA, depression, dizziness, EPS, headache, insomnia, mania, speech disorders, syncope, suicidal ideation, tremors, bradycardia, CP, HTN, prolonged QT interval, tachycardia, hypotension, blurred vision, N/V, abd pn, priapism, incontinence, back pn, cough, embolism, rash, angioedema

Dosage & Route: PO 20-100 mg daily

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