Medication Formulary

ContentsReference for Medication Listings

Activated Charcoal (Liqui-Char)

Albuterol (Proventil, Ventolin)

Aspirin

Epinephrine (Adrenalin)

Levalbuterol (Xopenex)

Metaproterenol 5% (Alupent)

Nitroglycerin (Nitrostat, Tridil, and others)

Oral Glucose (Insta-Glucose)

Oxygen

MARK 1 or NAAK Kit

•AtropineSulfate

•PralidoximeChloride(2-PAMChloride,Protopam)

Title Goes Here and I need the longest title

2 Medication Formulary

Reference for Medication ListingsName of Medication (Other Common Names)

Activated Charcoal (Liqui-Char)Class Adsorbent.Mechanism of action Adsorbs toxic substances from the gastrointesti-

nal tract; onset of action is immediate.Indications Most oral poisonings and medication overdoses; can be

used after evacuation of poisons.Contraindications Oral administration to comatose patient; after inges-

tion of corrosives, caustics, or petroleum distillates (ineffective and may induce vomiting); simultaneous administration with other oral drugs.

Adverse reactions May induce nausea and vomiting; may cause consti-pation; may cause black stools.

Drug interactions Bonds with and generally inactivates whatever it is mixed with, eg, syrup of ipecac.

How supplied 25 g (black powder)/125-mL bottle (200 mg/mL); 50 g (black powder)/250-mL bottle (200 mg/mL)

Dosage and administration Note: if not in premixed slurry, dilute with 1 part charcoal/4 parts water. Adult: 1–2 g/kg PO or via NGT. Pediat-ric: 1–2 g/kg PO or via NGT

Duration of action Depends on gastrointestinal function; will act until excreted.

Special considerations Often used in conjunction with magnesium ci-trate. Must be stored in a closed container. Does not adsorb cyanide, lithium, iron, lead, or arsenic.

Albuterol (Proventil, Ventolin)Class Sympathomimetic, bronchodilator.Mechanism of action Elective beta-2 agonist that stimulates adrenergic

receptors of the sympathomimetic nervous system resulting in smooth muscle relaxation in the bronchial tree and peripheral vasculature.

Indications Treatment of bronchospasm in patients with reversible obstructive airway disease (COPD/asthma). Prevention of exercise-induced bronchospasm.

Contraindications Known prior hypersensitivity reactions to albuterol. Tachycardia arrhythmias, especially those caused by digitalis. Syner-gistic with other sympathomimetics.

Adverse reactions Often dose-related and include restlessness, tremors, dizziness, palpitations, tachycardia, nervousness, peripheral vasodilatation, nausea, vomiting, hyperglycemia, increased blood pressure, and paradoxical bronchospasm.

Drug interactions Tricyclic antidepressants may potentiate vasculature effects. Beta-blockers are antagonistic. May potentiate hypokalemia caused by diuretics.

How supplied Solution for aerosolization: 0.5% (5 mg/mL). Metered dose inhaler: 90 µg/metered spray (17-g canister with 200 inhala-tions). Syrup: 2 mg/5 mL.

Dosage and administration Adult: Administer 2.5 mg (0.5 mL of 0.5% solution) added to 2 mL normal saline for inhalation by nebulizer treatment and administer over 10–15 minutes. MDI: 1–2 inhalations (90–180 µg). Five minutes between inhalations. Pediatric: (between the ages of 2 and 12) Administer 2.5 mg (0.5 mL of 0.083% solution) added to 2 mL normal saline for inhalation by nebulizer treatment and administer over 10–15 minutes. May repeat every 20 minutes, up to three times.

Duration of action Onset in 5–15 minutes with peak effect in 30 min-utes to 2 hours and duration of 3–4 hours.

Special considerations Pregnancy safety: Category C. Antagonized by beta-blockers (eg, Inderal, Lopressor). May precipitate angina pectoris and arrhythmias. Should only be administered by inhalation methodology in prehospital management.

Class How the medication is categorized as compared to other medications. This is usually done by grouping those medications with similar characteristics, traits, or primary components.

Mechanism of action The manner of combination of parts, processes, etc., which form a common function.Indications A circumstance that points to or shows the cause, pathology, treatment, or issue of an attack of disease; that which points out; that

which serves as a guide or warning.Contraindications Any condition, especially any condition of disease, which renders some particular line of treatment improper or undesirable.Adverse reactions This is an abnormal or harmful effect to an organism caused by exposure to a chemical. It is indicated by some result such as

death, a change in food or water consumption, altered body and organ weights, altered enzyme levels, or visible illness. An effect may be classed as adverse if it causes functional or anatomic damage, causes irreversible change in the homeostasis of the organism, or increases the suscep-tibility of the organism to other chemical or biologic stress. A nonadverse effect will usually be reversed when the organism is no longer being exposed to the chemical.

Drug interactions This refers to any potential effects that a medication may have when administered in conjunction or in the presence of another medication already in the patient’s system, a medication delivery device, or fluid.

How supplied This is how the manufacturer packages the medication for distribution and sale. Typical methods of packaging are prefilled sy-ringes, vials, or ampules.

Dosage and administration This is the typical or average volume of the medication that is to be administered to the patient and the route of intro-duction of the medication to the patient.

Duration of action Three values are given; (1) Onset: the estimated amount of time it will take for the medication to enter the body/system and begin to take effect, (2) Peak effect: the estimated amount of time it will take for the medication to have its greatest effect on the patient/system and (3) Duration: the estimated amount of time that the medication will have any effect on the patient/system.

Special considerations Additional pertinent information concerning a medication.

secTIon

XX

26 Respiratory Emergencies

27 Cardiovascular Emergencies

28 Neurologic Emergencies

29 Endocrine Emergencies

30 Allergic Reactions

31 Gastrointestinal Emergencies

32 Renal and Urologic Emergencies

33 Toxicology: Substance Abuse and Poisoning

34 Hematologic Emergencies

35 Environmental Emergencies

36 Infectious and Communicable Diseases

37 Behavioral Emergencies

38 Gynecologic Emergencies

39 Obstetrics

Medication Formulary 3

AspirinClass Platelet inhibitor, anti-inflammatory agent.Mechanism of action Prostaglandin inhibition.Indications New onset chest pain suggestive of acute myocardial

infarction. Signs and symptoms suggestive of recent cerebrovascular accident.

Contraindications Hypersensitivity. Relatively contraindicated in pa-tients with active ulcer disease or asthma.

Adverse reactions Heartburn, GI bleeding, prolonged bleeding, nau-sea, and vomiting. Wheezing in allergic patients.

Drug interactions Use with caution in patients allergic to NSAIDs.How supplied 81-mg, 160-mg, or 325-mg tablets (chewable and

standard).Dosage and administration 160 mg to 325 mg PO (chewed if pos-

sible).Duration of action Onset: 30–45 minutes. Peak effect: variable. Dura-

tion: variable.Special considerations Pregnancy safety: Category D. Not recom-

mended in pediatric population.

Epinephrine (Adrenalin)Class Sympathomimetic.Mechanism of action Direct-acting alpha- and beta-agonist. Alpha:

vasoconstriction. Beta-1: positive inotropic, chronotropic, and dromotropic effects. Beta-2: bronchial smooth muscle relaxation and dilation of skeletal vasculature.

Indications Cardiac arrest (V-fib/pulseless V-tach, asystole, PEA), symptomatic bradycardia as an alternative infusion to dopamine, severe hypotension secondary to bradycardia when atropine and transcutaneous pacing are unsuccessful, allergic reactions, anaphy-laxis, asthma.

Contraindications Hypertension, hypothermia, pulmonary edema, myocardial ischemia, hypovolemic shock.

Adverse reactions Hypertension, tachycardia, arrhythmias, pulmo-nary edema, anxiety, restlessness, psychomotor agitation, nausea, headache, angina.

Drug interactions Potentiates other sympathomimetics, deactivated by alkaline solutions (ie, sodium bicarbonate), monamine oxidase inhibitors (MAOIs) may potentiate effects, beta-blockers may blunt effects.

How supplied 1:1,000 solution: ampules and vials containing 1 mg/mL. 1:10,000 solution: prefilled syringes containing 1 mg in 10 mL (0.1 mg/mL). Auto-injector (EpiPen): 0.5 mg/mL (1:2,000).

Dosage and administration Adult: Mild allergic reactions and asthma: 0.3–0.5 mg (0.3–0.5 mL of 1:1,000) SC. Anaphylaxis: 0.1 mg (1 mL

of 1:10,000) IV/IO over 5 minutes. Cardiac arrest: IV/IO dose: 1 mg (10 mL of 1:10,000 solution) every 3–5 minutes during resuscita-tion. Follow each dose with 20 mL flush and elevate arm for 10 to 20 seconds after dose. Higher dose: Higher doses (up to 0.2 mg/kg) may be used for specific indications (beta-blocker or calcium channel blocker overdose). Continuous infusion: Add 1 mg (1 mL of 1:1,000 solution) to 500 mL normal saline or D

5W. Initial infusion rate of 1

µg/min titrated to effect (typical dose: 2–10 µg/min). Endotracheal (ET) dose: 2–2.5 mg diluted in 10 mL normal saline. Profound bradycardia or hypotension: 2–10 µg/min; titrate to patient response. Pediatric: Mild allergic reactions and asthma: 0.01 mg/kg (0.01 mL/kg) of 1:1,000 solution SC (maximum of 0.3 mL). Cardiac arrest: IV/IO dose: 0.01 mg/kg (0.1 mL/kg) of 1:10,000 solution every 3–5 minutes during arrest. All endotracheal (ET) doses: 0.1 mg/kg (0.1 mL/kg) of 1:1,000 solution. Symptomatic bradycardia: IV/IO dose: 0.01 mg/kg (0.1 mL/kg) of 1:10,000 solution. Continuous IV/IO infusion: Begin with rapid infusion, then titrate to response. Typical initial infusion: 0.1–1 µg/min. Higher doses may be effective.

Duration of action Onset: immediate. Peak effect: minutes. Duration: several minutes.

Special considerations Pregnancy safety: Category C. May cause syn-cope in asthmatic children. May increase myocardial oxygen demand.

Levalbuterol (Xopenex)Class Bronchodilator, adrenergic beta-2 agonist.Mechanism of Action Causes bronchodilation by action on the beta-2

pulmonary receptors to relax smooth muscle as well as produce CNS and cardiac stimulation.

Indications Used to treat or prevent bronchospasm in patients 6 years or older. Relaxes the smooth muscles of the lower airways.

Contraindications Known sensitivity to the drug. Hypersensitivity to sympathomimetics, tachyarrhythmias, and severe cardiac disease.

Adverse reactions Tremors, anxiety, insomnia, headache, dizziness, restlessness, hallucinations, flushing, irritability, vomiting, nausea, palpitations, tachycardia, hypertension, angina, hypotension, and arrhythmias.

Drug interactions Increased actions of aerosol bronchodilators, tricy-clic antidepressants, MAOIs, and other adrenergics.

How supplied Solution for inhalation 0.63 mg, 1.25 mg/3 mL.Dosage and administration For adults and pediatrics over 6 years old:

1.25 mg in 3 mL administered by the nebulizer route. For adults only: 2 puffs by MDI.

Duration of action Onset: 5-15 minutes, peak effect: 60–90 minutes, duration: 6-8 hours. Metabolized in the liver.

Special considerations Crosses the placenta, breast milk, blood-brain barrier. Precautions should be taken with lactation, pregnancy (Class C), cardiac disorders, hyperthyroidism, diabetes mellitus, hyperten-sion, prostatic hypertrophy, narrow-angle glaucoma, and seizures.

Metaproterenol 5% (Alupent)Class Sympathomimetic bronchodilator.Mechanism of action Beta-2 agonist acts directly on bronchial smooth

muscle causing relaxation of the bronchial tree and peripheral vascu-lature.

Indications Bronchial asthma, reversible bronchospasm secondary to bronchitis, COPD.

Contraindications Tachyarrhythmias, hypersensitivity, tachycardias due to digitalis toxicity.

Title Goes Here and I need the longest title

4 Medication Formulary

Adverse reactions Tachyarrhythmias, anxiety, nausea, vomiting, rest-lessness, apprehension, palpitations, hypotension, coughing, facial flushing, diaphoresis.

Drug interactions Other sympathomimetics may exacerbate cardiovas-cular effects. MAOIs may potentiate hypotensive effects. Beta-block-ers may antagonize metaproterenol.

How supplied MDI: 0.65 mg/dose/spray (15-mL inhaler). Solution: 5% solution in bottles of 10 and 30 mL with calibrated dropper; Alupent inhalation solution unit-dose vial, 0.4% or 0.6%.

Dosage and administration Adult: MDI: 2–3 inhalations every 3–4 hours (2 minutes between inhalations). Inhalation solution 5%: via

hand-held nebulizer 0.2–0.3 mL diluted in 2.5 mL saline. Inhalation solution unit-dose 0.4% or 0.6% vials: intermittent positive-pressure breathing device only: one vial/treatment. Pediatric: MDI: not recom-mended. Inhalation solution 5%: age 6–12 years: 0.1–0.2 mL diluted in 3 mL saline.

Duration of action Onset: 1 minute after inhalation. Peak effect: 45 minutes. Duration: 3–6 hours.

Special considerations Pregnancy safety: Category C. Monitor for hy-potension or tachycardia. Use with caution in patients with diabetes mellitus and coronary artery disease.

Nitroglycerin (Nitrostat, Tridil, and others)Class Vasodilator.Mechanism of action Smooth muscle relaxant acting on vascular, bron-

chial, uterine, and intestinal smooth muscle; dilation of arterioles and veins in the periphery; reduces preload and afterload; decreases the work load of the heart and, thereby, myocardial oxygen demand.

Indications Acute angina pectoris, ischemic chest pain, hypertension, CHF, pulmonary edema.

Contraindications Hypotension, hypovolemia; intracranial bleeding or head injury; previous administration of Viagra, Revatio, Levitra, Cialis, or similar agents within past 24 hours.

Adverse reactions Headache, hypotension, syncope, reflex tachycar-dia, flushing, nausea, vomiting, diaphoresis, muscle twitching.

Drug interactions Additive effects with other vasodilators; incompat-ible with other drugs IV.

How supplied Tablets: 0.15 mg (1/400 grain); 0.3 mg (1/200 grain);

0.4 mg (1/150 grain); 0.6 mg (1/100 grain). NTG spray: 0.4 mg–0.8 mg under the tongue. NTG IV (Tridil).

Dosage and administration Adult: Tablets: 0.3–0.4 mg SL; may repeat in 3–5 minutes to maximum of 3 doses. NTG spray: 0.4 mg under the tongue; 1–2 sprays. NTG IV infusion: begin at 10 to 20 µg/min; increase by 5–10 µg/min every 5 minutes until desired effect. Pediat-ric: Not recommended.

Duration of action Onset: 1–3 minutes. Peak effect: 5–10 minutes. Duration: 20–30 minutes or if IV, 1–10 minutes after discontinuation of infusion.

Special considerations Pregnancy safety: Category C. Hypotension more common in geriatric population. NTG decomposes if exposed to light or heat. Must be kept in airtight containers. Active ingredient may have a stinging effect when administered.

Oral Glucose (Insta-Glucose)Class Hyperglycemic.Mechanism of action Provides quickly absorbed glucose to increase

blood glucose levels.Indications Conscious patients with suspected hypoglycemia.Contraindications Decreased level of consciousness, nausea, vomiting.Adverse reactions Nausea, vomiting.Drug interactions None.

How supplied Glucola: 300-mL bottles. Glucose pastes and gels in various forms.

Dosage and administration Adult: Should be sipped slowly by patient until clinical improvement noted. Pediatric: Same as adult.

Duration of action Onset: immediate. Peak effect: variable. Duration: variable.

Special considerations As noted in indications section.

OxygenClass Naturally occurring atmospheric gas.Mechanism of action Reverses hypoxemia.Indications Confirmed or expected hypoxemia, ischemic chest pain,

respiratory insufficiency, prophylactically during air transport, con-firmed or suspected carbon monoxide poisoning, all other causes of decreased tissue oxygenation, decreased level of consciousness.

Contraindications Certain patients with COPD or emphysema who will not tolerate oxygen concentrations over 35%, hyperventilation. Oxygen should never be withheld from a patient who needs it how-ever. Be prepared to assist with ventilations in a patient with COPD who requires high concentration, as apnea may result.

Adverse reactions Decreased level of consciousness and respiratory depression in patients with chronic carbon dioxide retention. Retro-lental fibroplasia if giving high concentrations to premature infants (maintain 30%-40% oxygen).

Drug interactions None.How supplied Oxygen cylinders (usually green and white) of 100%

compressed oxygen gas.Dosage and administration Adult: Cardiac arrest and carbon monox-

ide poisoning: 100%. Hypoxemia: 10–15 L/min via nonrebreathing mask. COPD: 1–6 L/min via nasal cannula or 28%–35% Venturi mask. Be prepared to provide ventilatory support if higher concentra-tions of oxygen needed. Pediatric: Same as for adult with exception of premature infant.

Duration of action Onset: immediate. Peak effect: not applicable. Du-ration: Less than 2 minutes.

Special considerations Be familiar with liter flow and each type of delivery device used. Supports possibility of combustion.

secTIon

XX

26 Respiratory Emergencies

27 Cardiovascular Emergencies

28 Neurologic Emergencies

29 Endocrine Emergencies

30 Allergic Reactions

31 Gastrointestinal Emergencies

32 Renal and Urologic Emergencies

33 Toxicology: Substance Abuse and Poisoning

34 Hematologic Emergencies

35 Environmental Emergencies

36 Infectious and Communicable Diseases

37 Behavioral Emergencies

38 Gynecologic Emergencies

39 Obstetrics

Medication Formulary 5

MARK 1 or NAAK KitA Mark 1 or NAAK , Nerve Agent Antidote Kit, may be provided by the service you work or volunteer with. This kit is to be utilized only in the event of a chemical exposure to nerve agent event. Prior to the utilization of the Kit the EMT must be knowledgeable concerning local protocol. The kit contains two medications, Atropine and 2-PAM Chloride. Atropine should be administered first. The EMT should first recognize the primary signs and symptoms of nerve agent exposure. A common mnemonic to assist you in remembering these is SLUD-GEM: Salivation, Lacrimation, Urination, Defecation, GI disturbances, Emesis, Miosis, and muscle twitching. Nerve agent exposure results in a buildup of excess acetylcholine at nerve receptor sites.

AtropineSulfateClass Anticholinergic agent.Mechanism of action Parasympatholytic: inhibits action of acetylcho-

line at postganglionic parasympathetic neuroeffector sites.Indications Although there are cardiac indications for atropine the

indication for the MARK I/ NAAK kit is nerve agent exposure. Contraindications None in the event of a nerve agent exposure event. Adverse reactions Headache; dizziness; palpitations; nausea and

vomiting; tachycardia; arrhythmias; anticholinergic effects (blurred vision, dry mouth, urinary retention); paradoxical bradycardia when pushed slowly or at low doses; flushed, hot, dry skin.

Drug interactions Potential adverse effects when administered with digoxin, cholinergics, physostigmine. Effects enhanced by antihis-tamines, procainamide, quinidine, antipsychotics, benzodiazepines, and antidepressants.

How supplied Emergency Single Dose Kit containing: 2 mg in 0.7 mL autoinjector.

Dosage and administration Adult: Nerve agent poisoning: Extremely large doses (2–4 mg or higher) may be needed. The dose of 2 mg should be repeated if symptoms remain after 10 minutes.

Duration of action Onset: immediate. Peak effect: 1–2 minutes. Dura-tion: 2–6 hours.

Special considerations Pregnancy safety: Category C. Moderate doses may cause pupillary dilation.

PralidoximeChloride(2-PAMChloride, Protopam)

Class Oxime Cholinesterase reactivator.Mechanism of action Reactivation of cholinesterase to effectively act

as an antidote to nerve or organophosphate poisoning. This action breaks the bond between the nerve agent and the aceytlcholinester-ase and allows for destruction of accumulated acetylcholine at the neuromuscular junction.

Indications As an antidote in the treatment of poisoning by nerve agents.

Contraindications None in the event of a nerve agent exposure event.Adverse reactions Dizziness, blurred vision, diplopia, headache,

drowsiness, nausea, tachycardia, hyperventilation, muscular weak-ness, excitement, and manic behavior.

Drug interactions No direct drug interactions; however, patients with organophosphate poisoning should not be given barbiturates, mor-phine, theophylline, aminophylline, succinylcholine, reserpine, and phenothiazines.

How supplied Emergency Single Dose Kit containing: One 600 mg in 2 mL autoinjector.

Dosage and administration Should be administered immediately after atropine.

Duration of action Onset: minutes. Peak effects: variable. Duration: variable.

Special considerations Pregnancy safety: unknown. Treatment will be most effective if given within a few hours after poisoning.