DRUGS SO FAR
PREHOSPITAL DRUGS
* INDICATES CHANGES TO ORIGINAL DRUG CARDS
strikethrough information
is good to know but is NOT required
Name/Class: ADENOSINE (Adenocard)/Antidysrhythmic
Description: Adenosine is a naturally occurring
agent that can “chemically cardiovert” PSVT to a
normal sinus rhythm. It has a half-life of 10 seconds and does not cause
hypotension.
Indications: Narrow, complex paroxysmal supraventricular tachycardia refractory to vagal maneuvers.
Contraindications: Hypersensitivity, 2nd- and 3rd-degree heart block,
sinus node disease, or asthma.
Precautions: It may cause transient dysrhythmias especially asystole,
COPD.
Dosage/Route: 6 mg rapidly (over 1 to 2 sec) IV,
then flush the line rapidly with saline. If ineffective, 12 mg in 1 to 2 min, may be repeated. Ped: 0.1
mg/kg (over 1 to 2 sec) IV followed by rapid saline flush, then 0.2 mg/kg in 1
to 2 min to max 12 mg.
Name/Class:
ALBUTEROL (Proventil, Ventolin)/Sympathomimetic
Bronchodilator)
Description:
Albuterol
is a synthetic sympathomimetic that causes bronchodilatation with less cardiac effect
than
epinephrine and reduces mucus secretion, pulmonary capillary leaking, and edema
in the lungs during
allergic
reactions.
Indications:
Bronchospasm and asthma in COPD.
Contraindications:
Hypersensitivity to the drug.
Precautions:
The patient may experience tachycardia, anxiety, nausea, cough,
wheezing, and/or dizziness.
Vital
signs and breath sounds must be monitored; use caution with elderly, cardiac,
or hypertensive patients.
Dosage/Route:
Two inhalations (90 mcg) via metered-dose inhaler (2 sprays) or
2.5 mg in 2.5 to 3 mL NS via
nebulizer, repeat as needed.
The duration of effect is 3 to 6 hours. Ped: 0.15
mg/kg in 2.5 to 3 mL NS via
nebulizer, repeat as needed.
Name/Class: AMIODARONE (Cordarone, Pacerone)/Antidysrhythmic
Description: Amiodarone is an antidysrhythmic
that prolongs the duration of the action potential and refractory period and
relaxes smooth muscles, reducing peripheral vascular resistance and increasing
coronary blood flow.
Indications: Life-threatening ventricular and supraventricular dysrythmias,
frequently atrial fibrillation.
Contraindications: Hypersensitivity, cardiogenic
shock, severe sinus bradycardia, or advanced heart
block.
Precautions: Hepatic impairment, pregnancy,
nursing mothers, children.
Dosage/Route: 150 to 300 mg IV over 10 min, then 1
mg/min over next 6 hours. Ped: 5 mg/kg IV/IO, then
1.5 mg/kg/day.
Name/Class: AMINOPHYLLINE (Aminophylline, Somophyllin)/Methylxanthine Bronchodilator
Description: Aminophylline is a methylxanthine
that prolongs bronchodilation and decreased mucus
production and has mild cardiac and CNS stimulating effects.
Indications: Bronchospasm in asthma and COPD
refractory to sympathomimetics and other bronchodilators
and in CHF.
Contraindications: Hypersensitivity to methylxanthines or uncontrolled cardiac dysrhythmias.
Precautions: Cardiovascular disease, hypertension,
or taking theophylline, hepatic impairment, diabetes,
hyperthyroidism, young children, glaucoma, peptic ulcers, acute influenza or
influenza immunization, and the elderly. Watch for PVCs
or tachycardia. May cause hypotension.
Dosage/Route: 250 to 500 mg IV over 20 to 30 min. Ped: 6 mg/kg over 20 to 30 min. Max 12
mg/kg/day.
.
Name/Class: ASPIRIN (Acetylsalicylic
Acid) (Alka-Seltzer, Bayer, Empirin,
Description: Aspirin inhibits agents that cause
the production of inflammation, pain, and fever. It relieves mild to moderate
pain by acting on the peripheral nervous system, lowers body temperature in
fever, and powerfully inhibits platelet aggregation.
Indications: Chest pain suggestive of an MI.
Contraindications: Hypersensitivity to salicylates, active ulcer disease, asthma.
Precautions: Allergies to other NSAIDs, bleeding disorders, children or teenagers with varicella
or influenzalike symptoms.
Dosage/Route: 160 to 325 mg
Name/Class:
ATROPINE/Parasympatholytic
Description:
Atropine blocks the parasympathetic nervous system, specifically
the vagal effects
on
heart rate. May increase myocardial oxygen demand. Decreases airway secretions.
Indications:
Hemodynamically
significant bradycardia, bradyasystolic
arrest, and organophosphate poisoning.
Contraindications:
None in the emergency setting. 2nd degree
type 2 and above heart blocks are class 2B (not recommended)
Precautions:
AMI, glaucoma.
Dosage/Route:
Symptomatic bradycardia: 0.5 mg
IV/1 mg ET. Repeat 3 to 5 min to 3 mg. Ped: 0.02
mg/kg
IV, 0.04 mg/kg ET, may repeat in 5 min up to 1 mg. Asystole:
1 mg IV or 2 mg ET, may repeat 3 to
5 min up to 3
mg
Organophosphate
poisoning: 2 to 5 mg IV/IM/IO/10 to 15 min. Ped: 0.05 mg/kg IV/IM/IO/ 10 to 15 min.
Name/Class:
IPRATROPIUM (Atrovent)/Anticholinergic
Description:
Ipratropium
is a bronchodilator used in the treatment of respiratory emergencies that
causes
bronchial
dilation and dries respiratory tract secretions by blocking acetylcholine
receptors.
Indications:
Bronchospasm associated with asthma, COPD, and inhaled irritants.
Contraindications:
Hypersensitivity to atropine or its derivatives, or as a primary
treatment for acute bronchospasm.
Precautions:
Elderly, cardiovascular disease, or hypertension.
Dosage/Route:
500 mcg in 2.5 to 3 mL NS via nebulizer or 2 sprays from a metered dose inhaler. Ped: 125 to
250
mcg in 2.5 to 3 mL NS via nebulizer,
or 1 or 2 sprays of a metered dose inhaler.
Name/Class: BRETYLIUM (Bretylol)/Antidysrhythmic
Description: Bretylium causes a release of norepinephrine, depresses ventricular fibrillation, and
reduces ectopy. Bretylium suppresses ventricular
tachydysrhythmias including vfib
with reentry mechanisms.
Indications: Ventricular fibrillation and
ventricular tachycardia refractory to lidocaine.
Contraindications: None
Precautions: Digitalized patients,
digitalis-induced dysrhythmias, fixed cardiac
output, angina, or renal impairment. May induce postural
hypotension.
Dosage/Route: 5 mg/kg IV, then 10 mg/kg/15 to 30 min,
to a max 30 mg/kg. Following conversion:
1 to 2 mg/min drip. Ped: 5 mg/kg IV, repeat 10 mg/kg in 15 to 30 min.
Name/Class: BUTORPHANOL
(Stadol)/Synthetic Narcotic Analgesic
Description: Butorphanol is a centrally acting synthetic
narcotic analgesic about 5 times more potent than morphine. A
schedule IV narcotic.
Indications: Moderate to severe pain.
Contraindications: Hypersensitivity, head injury, or
undiagnosed abdominal pain.
Precautions: May cause withdrawal in
narcotic-dependent patients
Dosage/Route: 1 mg IV or 3 to 4 mg IM/3 to 4 hours.
Name/Class: CHLORDIAZEPOXIDE
(Librium)/Sedative, Hypnotic
Description: Chlordiazepoxide is a benzodiazepine derivative
that produces mild sedation and anticonvulsant, skeletal muscle relaxant, and
prolonged hypnotic effects.
Indications: Severe anxiety and tension, acute
alcohol withdrawal symptoms (DTs).
Contraindications: Hypersensitivity to benzodiazepines,
pregnant and nursing mothers, children under 6.
Precautions: Primary depressive disorders or psychoses,
acute alcohol intoxication.
Dosage/Route: 50 to 100 mg IV/IM.
Name/Class: CHLORPROMAZINE
(Thorazine)/Tranquilizer, Antipsychotic
Description: Chlorpromazine is a phenothiazine derivative used to manage psychotic episodes
by providing strong sedation and moderate extrapyramidal
symptoms. Produces reduced initiative, interest, and affect.
Indications: Acute psychotic episode, intractable
hiccups, nausea/vomiting.
Contraindications: Hypersensitivity to phenothiazines, coma, sedative overdose, acute alcohol
withdrawal, and children < 6 months.
Precautions: Agitated states with depression,
seizure disorders, respiratory infection or COPD, glaucoma, diabetes,
hypertension, peptic ulcer, prostatic hypertrophy,
breast cancer, thyroid, cardiovascular, and hepatic impairment, and patients
exposed to extreme heat or organophosphates.
Dosage/Route: 25 to 50 mg IM. Ped:
0.5 mg/kg IM or 1 mg/kg PR.
Name/Class:
DEXTROSE 50% IN WATER (D50W)/Carbohydrate
Description:
Dextrose is a simple sugar that the body can rapidly metabolize to
create energy.
Indications:
Hypoglycemia
Contraindications:
None in hypoglycemia.
Precautions:
Increased ICP. Determine blood glucose level before
administration. Ensure good venous access.
Dosage/Route:
25g D50W (50 mL) IV. Ped: 2 mL/kg of a 25% solution IV.
Name/Class: DOBUTAMINE (Dobutrex)/Sympathomimetic
Description: Dobutamine is a synthetic catecholamine and
beta agent that increases the strength of cardiac contraction without
appreciably increasing rate.
Indications: To increase cardiac output in
congestive heart failure/cardiogenic shock.
Contraindications: Hypersensitivity to sympathomimetic amines, ventricular tachycardia, and hypovolemia without fluid resuscitation.
Precautions: Atrial fibrillation or preexisting
hypertension.
Dosage/Route: 2 to 20 mcg/kg/min
IV. Ped: same as adult.
.
Name/Class: DOPAMINE (Intropin)/Sympathomimetic
Description: Dopamine is a naturally occurring
catecholamine that increases cardiac output without appreciably increasing
myocardial oxygen consumption. It maintains renal and mesenteric blood flow
while inducing vasoconstriction and increasing systolic blood pressure.
Indications: Nonhypovolemic hypotension (70 to 100 mmHg) and cardiogenic shock.
Contraindications: Hypovolemic hypotension without aggressive fluid
resuscitation, tachydysrhythmias, ventricular fibrillation, and pheochromocytoma.
Precautions: Occlusive vascular disease, cold
injury, arterial embolism. Ensure adequate fluid resuscitation of the hypovolemic
patient.
DOSAGE/ROUTE:
Name/Class: DIPENHYDRAMINE
(Benadryl)/Antihistamine
Description: Diphenhydramine blocks histamine release, thereby
reducing bronchoconstriction, vasodilation,
and edema.
Indications: Anaphylaxis, allergic reactions, and dystonic reactions.
Contraindications: Asthma and other lower respiratory
diseases.
Precautions: May induce hypotension, headache,
palpitations, tachycardia, sedation, drowsiness, and/or disturbed coordination.
Dosage/Route: 25 to 50 mg IV/IM.
Name/Class:
DILTIAZEM (Cardizem)/Calcium Channel Blocker
Description:
Diltiazem
is a slow calcium channel blocker similar to verapamil.
It dilates coronary and peripheral
arteries
and arterioles, thus increasing circulation to the heart and reducing
peripheral vascular resistance.
Indications:
Supraventricular
tachydysrhythmias (atrial
fibrillation, atrial flutter, and PSVT refractory to
adenosine)
and to increase coronary artery perfusion in angina.
Contraindications:
Hypersensitivity, sick sinus syndrome, 2nd- or 3rd-degree heart
block, systolic BP < 90, diastolic
BP
< 60, wide-complex tachycardia and WPW.
Precautions:
CHF (especially with beta blockers), conduction abnormalities,
renal or hepatic impairment, the
elderly,
and nursing mothers.
Dosage/Route:
0.25 mg/kg IV over 2 min, may repeat as needed with 0.35 mg/kg
followed by a drip of 5 to
10
mg/hr not to exceed 15 mg/hr over 24 hours.
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Name/Class: DIAZEPAM (Valium)/Antianxiety, Hypnotic, Anticonvulsant, Sedative
Description: Diazepam is a benzodiazepine sedative
and skeletal muscle relaxant that reduces tremors, induces amnesia, and reduces
the incidence and recurrence of seizures. It relaxes muscle spasms in
orthopedic injuries and produces amnesia for painful procedures (cardioversion).
Indications: Major motor seizures, status epilepticus, premedication before
cardioversion, muscle tremors due to injury, and
acute anxiety.
Contraindications: Hypersensitivity to the drug, shock, coma, acute alcoholism,
depressed vital signs, obstetric patients, neonates.
Precautions: Psychoses, depression, myasthenia
gravis, hepatic or renal impairment, addiction, elderly or very ill
patients, or COPD. Due to a short half-life of the drug, seizure activity
may recur.
Dosage/Route: Seizures: 5 to 10 mg IV/IM. Ped:
0.5 to 2 mg IV/IM.
Acute anxiety: 2 to 5 mg IV/IM. Ped:
0.5 to 2 mg IM.
Premedication: 5 to 15 mg IV. Ped: 0.2 to
0.5 mg/kg IV.
Name/Class: EPINEPHRINE
(Adrenalin)/Sympathomimetic
Description: Epinephrine is a naturally occurring catecholamine
that increases heart rate, cardiac contractile force myocardial electrical
activity, systemic vascular resistance, and systolic blood pressure and
decreases overall airway resistance and automaticity.
It also, through bronchial artery constriction, may reduce pulmonary congestion
and increase tidal volume and vital capacity.
Indications: To restore rhythm in cardiac arrest and severe allergic
reactions.
Contraindications: Hypersensitivity to sympathomimetic amines, narrow angle glaucoma; hemorrhagic, traumatic, or
cardiac shock; coronary insufficiency; dysrhythmias;
organic brain or heart disease; or during labor.
Precautions: Elderly, debilitated patients,
hypertension, diabetes, hyperthyroidism, Parkinson's disease, tuberculosis, asthma,
emphysema, and in children < 6 years.
Dosage/Route: Arrest: 1 mg of 1:10,000 IV/3 to 5 min (ET: 2
to 2.5 mg 1:1,000). Ped: 0.01 mg/kg 1:10,000 IV/IO
(ET: 0.1 mg/kg 1:1,000). All subsequent doses 0.1 mg/kg IV/IO. No max.
Allergic reactions: 0.3 to 0.5 mg of 1:1,000
subcutaneously/5 to 15 min as needed or 0.5 to 1 mg of 1:10,000 IV if
subcutaneous dose ineffective or severe reaction. Ped:
0.01 mg/kg of 1:1,000 subcutaneously/10 to 15 min or 0.01 mg/kg of 1:10,000 IV
if subcutaneous dose ineffective or severe.
Name/Class: ETOMIDATE (Amidate)/Hypnotic
Description: Etomidate is an ultra–short-acting
nonbarbiturate hypnotic with no analgesic effects and
limited cardiovascular and respiratory effects.
Indications: Induce sedation for rapid sequence intubation.
Contraindications: Hypersensitivity.
Precautions: Marked hypotension, severe asthma, or
severe cardiovascular disease.
Dosage/Route:
0.1 to 0.3 mg/kg IV
over 15 to 30 sec. Ped: children > 10 years, same
as for adults
Name/Class: FENTANYL (Sublimaze)/Narcotic
Analgesic
Description: Fentanyl is a potent synthetic
narcotic analgesic similar to morphine and meperidine
but with a more rapid and less-prolonged action.
Indications: Induce sedation for endotracheal intubation.
Contraindications: MAO inhibitors within 14 days,
myasthenia gravis.
Precautions: Increased intracranial pressure,
elderly, debilitated, COPD, respiratory problems, hepatic and renal
insufficiency.
Dosage/Route: 25 to 100 mcg slowly IV (2 to 3 min).
Ped: 2 mcg/kg slow IV/IM.
Name/Class: FLUMAZENIL
(Romazicon)/Benzodiazepine Antagonist
Description: Flumazenil is a benzodiazepine
antagonist used to reverse the sedative, recall, and psychomotor effects of
diazepam, midazolam, and the other benzodiazepines.
Indications: Respiratory depression secondary to
the benzodiazepines.
Contraindications: Hypersensitivity to flumazenil or benzodiazepines; those patients who take flumazenil for status epilepticus
or seizures; seizure-prone patients during labor and delivery; tricyclic antidepressant overdose.
Precautions: Hepatic impairment, elderly,
pregnancy, nursing mothers, head injury, alcohol and drug dependency and
physical dependence on benzodiazepines.
Dosage/Route: 0.2 mg IV over 30 sec/min, up to 1
mg.
Name/Class: FUROSEMIDE
(Lasix)/Diuretic
Description: Furosemide is a rapid-acting, potent diuretic
and antihypertensive that inhibits sodium reabsorption
by the kidney. Its vasodilating effects reduce venous
return and cardiac workload.
Indications: Congestive heart failure and
pulmonary edema.
Contraindications: Hypersensitivity to furosemide or the sulfonamides, fluid and electrolyte
depletion states, heptic coma, pregnancy (except in
life-threatening circumstances).
Precautions: Infants, elderly, hepatic impairment,
nephrotic syndrome, cardiogenic shock associated with acute MI, gout, or
patients receiving digitalis or potassium-depleting steroids.
Dosage/Route: 40 to 120 mg slow
IV. Ped: 1 mg/kg slow IV.
Name/Class:
GLUCAGON (GlucaGen)/Hormone, Antihypoglycemic
Description:
Glucagon is a protein
secreted by pancreatic cells that causes a breakdown of stored glycogen
into
glucose and inhibits the synthesis of glycogen from glucose.
Indications:
Hypoglycemia without IV access and to reverse beta-blocker
overdose.
Contraindications:
Hypersensitivity to glucagon or protein
compounds.
Precautions:
Cardiovascular or renal impairment.
Effective only if there are sufficient stores of glycogen in the
liver.
Dosage/Route:
Hypoglycemia: 1 mg IM/SC repeat/5 to 20 min. Ped: 0.1 mg/kg 1 m/SC/IV for child < 10 kg;
1
mg/kg 1 m/SC/IV for child > 10 kg.
Beta-blocker overdose: 50 to 150 mcg/kg IV over 1 min. Ped: 50 to 150 mcg/kg IV over 1 min.
Name/Class: HALOPERIDOL
(Haldol)/Antipsychotic
Description: Haloperidol is believed to block
dopamine receptors in the brain associated with mood and behavior,is a potent antiemetic,
and impairs temperature regulation.
Indications: Acute psychotic episodes.
Contraindications: Parkinson's disease, seizure
disorders, coma, alcohol depression, CNS depression, and thyrotoxicosis,
and with other sedatives.
Precautions: Elderly, debilitated patients,
urinary retention, glaucoma, severe cardiovascular disease, or anticonvulsant, anticoagulant, or
lithium therapy.
Dosage/Route: 2 to 5 mg IM. Ped:
Children > 3 years, 0.015 to 0.15 mg/kg/day
Name/Class: ISOPROTERENOL (Isuprel)/Sympathomimetic
Description: Isoproterenol
is a synthetic sympathomimetic that results in
increased cardiac output by
increasing the strength of cardiac contraction
and somewhat increasing rate.
Indications: Bradycardia
refractory to atropine when pacing is not available
Contraindications: Cardiogenic
shock.
Precautions: Tachydysrhythmias
and those associated with digitalis and acute myocardial infarction.
Dosage/Route: Bradycardia:
cardiac rate.
Name/Class: KETOROLAC (Toradol)/Nonsteroidal Antiinflammatory
Drug (NSAID)
Description: Ketorolac is an injectable
NSAID that exhibits analgesic, antiinflammatory, and
antipyretic properties without sedative effects.
Indications: Mild or moderate pain.
Contraindications: Hypersensitivity to ketorolac, aspirin, or other NSAIDs,
and asthma.
Precautions: Peptic ulcers, renal or hepatic impairment,
or elderly.
Dosage/Route: 30 mg IV/IM (15 mg > 65 years or
weighs < 50 kg)
Name/Class: LIDOCAINE (Xylocaine)/Antidysrhythmic
Description: Lidocaine is an antidysrhythmic
that suppresses automaticity and raises stimulation
threshold of the ventricles. It also causes sedation, anticonvulsant, and
analgesic effects.
Indications: Pulseless ventricular tachycardia, ventricular
fibrillation, ventricular tachycardia (w/ pulse).
Contraindications: Hypersensitivity to amide-type local
anesthetics, supraventricular dysrhythmias,
Stokes-
Precautions: Hepatic or renal impairment, CHF,
hypoxia, respiratory depression, hypovolemia,
myasthenia gravis, shock, debilitated patients, elderly, family
history of malignant hypothermia.
Dosage/Route: Cardiac arrest: 1 to 1.5 mg/kg IV repeated every 3 to
5 min up to 3 mg/kg, follow conversion with a drip of 2 to 4 mg/min. Ped: 1 mg/kg IV, repeat/3 to 5 min up to 3 mg/kg, follow
conversion with a drip of 20 to 50 mcg/kg/min. Ventricular tachycardia (w/
pulse): 1 to 1.5 mg/kg slow IV. May repeat at one-half
dose every 5 to 10 min until conversion up to 3 mg/kg. Follow conversion
with an infusion of 2 to 4 mg/min. Ped: 1 mg/kg,
followed by a drip at 20 to 50 mg/kg/min.
Name/Class: LORAZEPAM
(Ativan)/Sedative
Description: Lorazepam is the most potent benzodiazepine
available. It has strong antianxiety, sedative,
hypnotic, and skeletal muscle relaxant properties, and a relatively short
half-life.
Indications: Sedation for cardioversion
and status epilepticus.
Contraindications: Sensitivity to benzodiazepines.
Precautions: Narrow-angle glaucoma, depression or
psychosis, coma, shock, acute alcohol intoxication, renal or hepatic
impairment, organic brain syndrome, myasthenia gravis, GI disorders, elderly,
debilitated, limited pulmonary reserve.
Dosage/Route: Sedation: 2 to 4 mg IM, 0.5 to 2 mg IV. Ped: 0.03 to 0.5 mg/kg IV/IM/PR up to 4 mg.
Status
epilepticus: 2 mg slow IV/PR (2 mg/min). Ped: 0.1 mg/kg slow IV/PR (2 to 5 min).
Name/Class: MAGNESIUM SULFATE
(Magnesium)/Electrolyte
Description: Magnesium sulfate is an electrolyte
that acts as a calcium channel blocker, acting as a CNS depressant and
anticonvulsant. It also depresses the function of smooth, skeletal, and cardiac
muscles.
Indications: Refractory ventricular fibrillation
and pulseless ventricular tachycardia (especially torsade depointes), AMI, eclamptic seizures.
Contraindications: Heart block, myocardial damage,
shock, persistent hypertension, and hypocalcemia.
Precautions: Renal impairment, digitalized
patients, other CNS
depressants, or neuromuscular blocking agents.
Dosage/Route: Ventricular fibrillation or
tachycardia: 1 to 2
g IV over 2 min.
Torsade de pointes: 1 to 2 g IV followed by infusion
of 0.5 to 1 g/hr IV.
AMI: 1 to 2 g IV over 5 to 30 min.
Eclampsia: 2 to 4 g IV/IM.
Name/Class: MEPERIDINE
(Demerol)/Narcotic Analgesic
Description: Meperidine is a synthetic narcotic with
sedative and analgesic properties comparable to morphine but without hemodynamic side effects.
Indications: Moderate to severe pain.
Contraindications: Hypersensitivity, seizure disorders, or acute abdomen
prior to diagnosis.
Precautions: Increased intracranial pressure,
asthma or other respiratory conditions, supraventricular
tachycardias, prostatic
hypertrophy, urethral stricture, glaucoma, elderly or debilitated patients,
renal or
hepatic impairment, hypothyroidism, or
Addison's disease.
Dosage/Route: 25 to 50 mg IV, 50 to 100 mg IM. Ped: 1 mg/kg IV/IM.
Name/Class: METHYLPREDNISOLONE (Solu-Medrol)/Corticosteroid, Antiinflammatoty
Description: Methylprednisolone is a synthetic adrenal
corticosteroid, effective as an antiinflammatory and
used in the management of allergic reactions and in some cases of shock. It is
sometimes used in the treatment of spinal cord injury.
Indications: Spinal cord injury, asthma, severe
anaphylaxis, COPD.
Contraindications: No major contraindications in the
emergency setting.
Precautions: Only a single dose should be given in
the prehospital setting.
Dosage/Route: Asthma/COPD/anaphylaxis: 125 to 250 mg IV/IM. Ped: 1 to 2 mg/kg/dose IV/IM.
Spinal cord injury: 30 mg/kg IV over 15 min, after 45 min
an infusion of 5.4 mg/kg/hr
Name/Class: METOCLOPRAMIDE (Reglan)/Antiemetic
Description: Metoclopramide is a dopamine antagonist similar to procainamide but with few antidysrhythmic
or anesthetic properties. Its antiemetic properties
stem from rapid gastric emptying and desensitization of the vomiting reflex.
Indications: Nausea and vomiting.
Contraindications: Hypersensitivity, allergy to sulfite
agents, seizure disorders, pheochromocytoma,
mechanical GI obstruction or perforation, and breast cancer.
Precautions: CHF, hypokalemia,
renal impairment, GI hemorrhage, intermittent porphyria.
Dosage/Route: 10 to 20 mg IM; 10 mg slow IV (over 1
to 2 min). Ped: 1 to 2 mg/kg/dose.
Name/Class: MIDAZOLAM
(Versed)/Sedative
Description: Midazolam is a short-acting benzodiazepine
with CNS depressant, muscle relaxant, anticonvulsant, and anterograde
amnestic effects.
Indications: To induce sedation before cardioversion or intubation.
Contraindications: Hypersensitivity to benzodiazepines,
narrow-angle glaucoma, shock, coma, or acute alcohol intoxication.
Precautions: COPD, renal impairment, CHF, elderly.
Dosage/Route: 1 to 2.5 mg slow IV; 0.07 to 0.08
mg/kg IM (usually 5 mg). Ped: 0.05 to 0.2 mg/kg IV:
0.1 to 0.15 mg/kg IM; 3 mg intranasal.
Name/Class: MORPHINE SULFATE
(Morphine)/Narcotic Analgesic
Description: Morphine sulfate is a potent
analgesic and sedative that causes some vasodilation,
reducing venous return, and reduced myocardial oxygen demand.
Indications: Moderate to severe pain and in MI and
to reduce venous return in pulmonary edema.
Contraindications: Hypersensitivity to opiates,
undiagnosed head or abdominal injury, hypotension, or volume depletion, acute
bronchial asthma, COPD, severe respiratory depression, or pulmonary edema due
to chemical inhalation.
Precautions: Elderly, children, or debilitated
patients. Naloxone should be readily available to
counteract the effects of morphine.
Dosage/Route: Pain: 2.5 to 15 mg IV; 5 to 20 mg
IM/subcutaneous. Ped: 0.05 to 0.1 mg/kg IV; 0.1 to
0.2 mg/kg IM/subcutaneous AMI or PE: 1 to 2 mg/
Name/Class: NALOXONE
(Narcan)/Narcotic Antagonist
Description: Naloxone is a pure narcotic antagonist that
blocks the effects of both natural and synthetic narcotics and may reverse
respiratory depression.
Indications: Narcotic and synthetic narcotic
overdose, coma of unknown origin.
Contraindications: Hypersensitivity to the drug,
non–narcotic-induced respiratory depression.
Precautions: Possible dependency (including
newborns). It also has a half-life that is shorter than that of most narcotics;
hence the patient may return to the overdose state.
Dosage/Route: 0.4 to 2 mg IV/IM (2 to 2.5 times the
dose ET), repeated/2 to 3 min as needed up to
10 mg. Ped: 0.01 mg IV/IM (2
to 2.5 times the dose ET) repeated/2 to 3 min as needed up to 10 mg.
Name/Class:
NITROGLYCERIN (Nitrostat)/Nitrate
Description:
Nitroglycerin is a rapid smooth muscle relaxant that reduces
peripheral vascular resistance,
blood
pressure, venous return, and cardiac workload.
Indications:
Chest pain associated with angina and acute myocardial infarction,
and acute pulmonary edema.
Contraindications:
Hypersensitivity, tolerance to nitrates, severe anemia, head
trauma, hypotension, increased
ICP,
patients taking sildenafil, glaucoma, and shock.
Precautions:
May induce headache that is sometimes severe. Nitroglycerin is
light sensitive and will lose potency
when
exposed to the air.
Dosage/Route:
1 tablet (0.4 mg) SL. May be repeated/3 to 5 min up to 3 tablets,
or 1⁄2 inch
of topical ointment,
or
0.4 mg (one spray)SL up to 3 sprays/25 min.
Name/Class: NOREPINEPHRINE (Levophed)/Sympathomimetic Agent
Description: Norepinephrine is a naturally occurring
catecholamine and causes vasoconstriction, cardiac stimulation, and increased
blood pressure ,myocardial oxygen demand, and coronary
blood flow.
Indications: Refractory hypotension and neurogenic shock.
Contraindications: Hypotension due to uncorrected hypovolemia.
Precautions: Hypertension, hyperthyroidism, severe
heart disease, elderly, MAO inhibitor therapy, patients receiving tricyclic antidepressants. Monitor blood pressure
frequently and infuse
the drug through the largest vein available as it may cause tissue necrosis.
Dosage/Route: 0.5 to 30 mcg/min IV,
titrated to BP. Ped: 0.01 mcg/kg/min (rarely used).
Name/Class: PANCURONIUM (Pavulon)/Nondepolarizing Neuromuscular Blocker
Description: Pancuronium is a nondepolarizing
neuromuscular blocker that causes paralysis without bronchospasm or hypotension,
it does not cause the fasciculations associated with
polarizing agents.
Indications: To facilitate endotracheal
intubation.
Contraindications: Hypersensitivity to pancuronium or bromides, or tachycardia.
Precautions: Debilitated patients, myasthenia
gravis, pulmonary, hepatic, or renal disease, or fluid or electrolyte imbalance.
Dosage/Route: 0.04 to 0.1 mg/kg IV. Ped: same as adult.
Name/Class: PHENYTOIN
(Dilantin)/Anticonvulsant
Description: Phenytoin is a derivative related to phenobarbital that reduces the spread of electrical
discharges in the motor cortex and inhibits seizures. It also has antidysrhythmic properties that counteract the effects of
digitalis.
Indications: Seizures, status epilepticus,
or cardiac dysrhythmias secondary to digitalis
toxicity.
Contraindications: Hypersensitivity to hydantoin products, seizures due to hypoglycemia, sinus bradycardia,
heart block, and Adams-Stokes syndrome.
Precautions: Hepatic or renal impairment,
alcoholism, cardiogenic shock, elderly, debilitated
patients, diabetes, hyperglycemia, bradycardia, heart
block, or respiratory depression.
Dosage/Route: Seizures, status epilepticus:
10 to 15 mg/kg slow
IV. Ped: 8 to 10 mg/kg slow IV.
Dysrhythmias: 100 mg slow IV (over 5 min) to a maximum 1,000 mg. Ped: 3 to 5 mg/kg slow IV.
Name/Class: PROCAINAMIDE (Pronestyl)/Antiarrhythmic
Description: Procainamide prolongs ventricular repolarization, slows conduction, and decreases myocardial
excitability.
Indications: Ventricular fibrillation and pulseless ventricular tachycardia refractory to lidocaine.
Contraindications: Hypersensitivity to procainamide or
procaine, myasthenia gravis, and 2nd- or 3rd-degree heart block.
Precautions: Hypotension, cardiac enlargement,
CHF, AMI, ventricular dysrhythmias from digitalis,
hepatic or renal impairment, electrolyte imbalance, or bronchial asthma.
Dosage/Route: 20 to 30 mg/min IV drip .Stop points: (1) up to 17 mg/kg to effect,
then 1 to 4 mg/min (2) ectopy resolves (3) QRS complex widens more than 50%
from original (4) hypotension ensues.
Ped: 15 mg/kg/IV/IO over 30 to 60 min.
Name/Class: RACEMIC EPINEPHRINE (microNefrin, Vaponefrin)/Sympathomimetic
Agonist
Description: Racemic epinephrine is a variation of
epinephrine used only for inhalation to induce bronchodilation
and to reduce laryngeal edema and mucus secretion.
Indications: Croup (laryngotracheobronchitis).
Contraindications: Hypersensitivity, hypertension, or epiglottitis.
Precautions: May result in tachycardia and other dysrhythmias. Patient vital signs and ECG should be
monitored.
Dosage/Route: 0.25 to 0.75 mL
of a 2.25% solution in 2 mL NS once by nebulizer. Ped: same as adult.
Name/Class: Tridil (nitroglycerin injection)
Vasodilator/Nitrate
Description:
relaxes blood vessels, increasing the blood
and oxygen supply to the heart.
Indications: Nitroglycerin infusions are used to help relieve
the pain associated with angina that does not respond to oral (by mouth)
treatment; to control blood pressure; and to help treat congestive heart
failure.
Contraindications: hypotension, uncorrected
hypovolemia, increased intracranial pressure, constrictive
pericarditis and pericardial tamponade
Precautions/side
effects:
headache, severe hypotension, reflex tachycardia
Dosage: 0.2 - 1.5 mcg/kg/minute
Name/Class: SODIUM BICARBONATE (NaHCO3)/Alkalizing Agent
Description: Sodium bicarbonate provides vascular
bicarbonate to assist the buffer system in reducing the effects of metabolic
acidosis and in the treatment of some overdoses.
Indications: Tricyclic antidepressant and barbiturate
overdose, refractory acidosis, or hyperkalemia.
Contraindications: None when used in severe hypoxia or
late cardiac arrest.
Precautions: May cause alkalosis if given in
too large a quantity. It may also deactivate vasopressors
and may precipitate with calcium chloride.
Dosage/Route: 1 mEq/kg
IV, then 0.5 mEq/kg/10 min. Ped: same as adult (may
be given IO).
Name/Class: SUCCINYLCHOLINE (Anectine)/Depolarizing
Neuromuscular Blocker
Description: Succinylcholine is
an ultra–short-acting depolarizing neuromuscular blocker.
Indications: Facilitated endotracheal
intubation.
Contraindications: Hypersensitivity, family history of
malignant hyperthermia, penetrating eye injury,
narrow-angle
glaucoma.
Precautions: Severe burn or crush injury; electrolyte imbalances;
hepatic, renal, cardiac, or pulmonary
impairment; fractures; spinal
cord injury; dehydration;
severe anemia; porphyria.
Dosage/Route: 1 to 1.5 mg/kg IV/IM. Ped:
1 to 2 mg/kg IV/IM.
Name/Class: TIMOPTIC Beta Blocker
Description: Timoptic
is a non-selective beta-adrenergic receptor blocking agent