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:
CALCIUM CHLORIDE (Calcium Chloride)/Electrolyte
Description:
Calcium chloride increases myocardial contractile force and
increases ventricular automaticity.
Indications:
Hyperkalemia,
hypocalcemia, hypermagnesemia,
and calcium channel blocker toxicity.
Contraindications:
Ventricular fibrillation, hypercalcemia,
and possible digitalis toxicity.
Precautions:
It may precipitate toxicity in patients taking digoxin.
Ensure the IV line is in a large vein and
flushed before using and after calcium.
Dosage/Route:
2 to 4 mg/kg IV (10% solution)/10 min, as needed. Ped: 20 mg/kg IV (10% solution) repeat at
10
min, as needed.
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:
DEXAMETHASONE (Decadron)/Steroid
Description:
Dexamethasone
is a long-acting synthetic adrenocorticoid with
intense antiinflammatory activity.
It
prevents the accumulation of inflammation generating cells at the sites of
infection or injury.
Indications:
Anaphylaxis, asthma, COPD, spinal cord edema.
Contraindications:
No absolute contraindications in the emergency setting. Relative
contraindications: systemic
fungal
infections, acute infections, tuberculosis, varicella,
or vaccinia or live virus vaccinations.
Precautions:
Herpes simplex, keratitis,
myasthenia gravis, hepatic or renal impairment, diabetes, CHF,
seizures,
psychic disorders, hypothyroidism, and GI ulceration.
Dosage/Route:
4 to 24 mg IV/IM Ped:
0.5 to 1 mg/kg.
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:
HEPARIN (Heparin)/Anticoagulant
Description:
Heparin is a rapid-onset anticoagulant, enhancing the effects of antithrombin III and blocking
the conversion of prothrombin
to thrombin and fibrinogen to fibrin.
Indications:
To prevent thrombus formation in acute MI.
Contraindications:
Hypersensitivity; active bleeding or bleeding tendencies; recent
eye, brain, or spinal surgery;
shock.
Precautions:
Alcoholism, elderly, allergies, indwelling
catheters, elderly, menstruation, pregnancy, or cerebral
embolism.
Dosage/Route:
5,000 units IV, then 20,000 to 40,000 units
over 24 hours.
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:
MANNITOL (Osmitrol)/Osmotic Diuretic
Description:
Mannitol is an osmotic
diuretic that draws water into the intravascular space through its hypertonic
effects,
then causes diuresis.
Indications:
Cerebral edema.
Contraindications:
Hypersensitivity, pulmonary edema, CHF, organic CNS disease,
intracranial bleeding,
shock,
or severe dehydration.
Precautions:
Dosage/Route:
1.5 to 2 g/kg slow IV. Ped:
0.25 to 0.5 g/kg over 60 min.
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:
NALBUPHINE (Nubain)/Narcotic Analgesic
Description:
Nalbuphine
is a synthetic narcotic analgesic equivalent to morphine, though its respiratory depression
does
not increase with higher doses.
Indications:
Moderate to severe pain.
Contraindications:
Hypersensitivity, undiagnosed head or abdominal injury.
Precautions:
Impaired respirations, narcotic dependency.
Dosage/Route:
5 mg IV/IM/subcutaneous, repeat as 2 mg doses
as needed up to 20 mg. Ped: 0.1 to 0.15
mg/kg
IV/IM/subcutaneous (rarely used)
Name/Class:
OXYTOCIN (Pitocin)/Hormone
Description:
Oxytocin is a naturally
occurring hormone that causes the uterus to contract, thereby inducing
labor, encouraging delivery of the placenta, and
controlling postpartum hemorrhage.
Indications:
Severe postpartum hemorrhage.
Contraindications:
Hypersensitivity, prehospital
administration before delivery of the infant or infants.
Precautions:
Before delivery may induce uterine rupture
and fetal dysrhythmias, hypertension, intracranial
bleeding, or asphyxia.
Uterine tone, ECG, and vital signs should be monitored during administration.
Dosage/Route:
3 to 10 units IM after delivery of the placenta.
10 to 20 units in 1,000 mL of D5W
or NS IV
titrated
to effect.
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:
PROCHLORPERAZINE (Compazine)/Antiemetic
Description:
Prochlorperazine
is a phenothiazine derivative similar to chlorpromazine
with potent antiemetic
properties
and fewer sedative, hypotensive, and anticholinergic effects.
Indications:
Severe nausea and vomiting or acute psychosis.
Contraindications:
Hypersensitivity to phenothiazines coma
or depression.
Precautions:
Breast cancer, children with acute illness or
dehydration.
Dosage/Route:
5 to 10 mg IV/IM. Ped: 0.13 mg/kg
IV/IM/PR if > 10 kg or > 2 years.
Name/Class:
PROMETHAZINE (Phenergan)/Antiemetic
Description:
Promethazine
is an anticholinergic agent that enhances the effects
of analgesics and is a potent
antiemetic.
Indications:
Nausea and vomiting, motion sickness, to enhance the effects of
analgesics, and to induce sedation.
Contraindications:
Hypersensitivity to phenothiazines.
Precautions:
Hepatic, respiratory, or cardiac impairment, asthma,
hypertension, elderly, or debilitated patients.
Dosage/Route:
12.5 to 25 mg IV/IM/PR. Ped: 0.5 mg/kg
IV/IM/PR.
©
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:
TERBUTALINE (Brethine, Bricanyl)/Sympathetic
Agonist
Description:
Terbutaline
is a synthetic sympathomimetic that causes bronchodilatation with less cardiac effect
than epinephrine.
Indications:
Bronchial asthma and bronchospasm in COPD.
Contraindications:
Hypersensitivity to the drug.
Precautions:
The patient may experience palpitations, anxiety, nausea, and/or
dizziness. Vital signs and
breath sounds must be
monitored; use caution with cardiac or hypertensive patients.
Dosage/Route:
Two inhalations with a metered dose inhaler, repeated once in 1
min or 0.25 mg SQ repeated
in
15 to 30 mins.
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:
THIAMINE/Vitamin
Description:
Thiamine is vitamin B1,
which is required to convert glucose into energy. It is not manufactured
by the body and must be constantly provided
from ingested foods.
Indications:
Coma of unknown origin, chronic alcoholism with associated coma,
and delirium tremens.
Contraindications:
None.
Precautions:
Known hypersensitivity to the drug.
Dosage/Route:
50 to 100 mg IV/IM. Ped: 10 to 25 mg
IV/IM.
©
Name/Class: TIMOPTIC Beta Blocker
Description:
Timoptic is a non-selective beta-adrenergic receptor
blocking agent
Indications:
Contraindications: asthma, severe COPD, sinus brady, 2nd or 3rd degree AV block, cardiogenic shock
Precautions: Readily absorbed
Dosage/Route:
ophthalmic: one drop per eye BID
Name/Class:
ALTEPLASE RECOMBINANT (tPA)
(Activase)/Thrombolytic
Description:
Recombinant DNA–derived form of human tPA promotes thrombolysis
by forming plasmin.
Plasmin, in turn, degrades fibrin and
fibrinogen and, ultimately, the clot.
Indications:
To thrombolyse in acute myocardial
infarction, acute ischemic stroke, and pulmonary embolism.
Contraindications:
Active internal bleeding, suspected aortic dissection, traumatic
CPR, recent hemmorhagic
stroke (6 mo), intracranial or intraspinal
surgery or trauma (2 mo), pregnancy, uncontrolled hypertension,
or hypersensitivity to thrombolytics.
Precautions:
Recent major surgery, cerebral vascular disease, recent GI or GU
bleeding, recent trauma, hypertension,
patient > 75 years, current oral
anticoagulants, or hemorrhagic ophthalmic conditions.
Dosage/Route:
MI and stroke: 15 mg IV, then 0.75 mg/kg
(up to 50 mg) over 30 min, then 0.5 mg/kg (up to
35 mg) over 60 min.
Pulmonary
embolism: 100 mg IV infusion over 2 hours.
©
Name/Class:
VASOPRESSIN (Pitressin)/Hormone, Vasopressor
Description:
Vasopressin is a hormone with strong vasopressive
and antidiuretic properties but that may
precipitate
angina and/or AMI.
Indications:
To increase peripheral vascular resistance in arrest (CPR) or to
control bleeding from esophageal
varices.
Contraindications:
Chronic nephritis with nitrogen retention, ischemic heart disease,
PVCs, advanced
arteriosclerosis,
or 1st stage of labor.
Precautions:
Epilepsy, migraine, heart failure, angina, vascular disease,
hepatic impairment, elderly, and children.
Dosage/Route:
Arrest: 40 units IV.
Esophageal
varices: 0.2 to 0.4 units/min
IV drip.
Name/Class:
ALTEPLASE RECOMBINANT (tPA)
(Activase)/Thrombolytic
Description:
Recombinant DNA–derived form of human tPA promotes thrombolysis
by forming plasmin.
Plasmin, in turn, degrades fibrin and
fibrinogen and, ultimately, the clot.
Indications:
To thrombolyse in acute myocardial
infarction, acute ischemic stroke, and pulmonary embolism.
Contraindications:
Active internal bleeding, suspected aortic dissection, traumatic
CPR, recent hemmorhagic
stroke (6 mo), intracranial or intraspinal
surgery or trauma (2 mo), pregnancy, uncontrolled hypertension,
or hypersensitivity to thrombolytics.
Precautions:
Recent major surgery, cerebral vascular disease, recent GI or GU
bleeding, recent trauma, hypertension,
patient > 75 years, current oral anticoagulants,
or hemorrhagic ophthalmic conditions.
Dosage/Route:
MI and stroke: 15 mg IV, then 0.75
mg/kg (up to 50 mg) over 30 min, then 0.5 mg/kg (up to
35 mg) over 60 min.
Pulmonary
embolism: 100 mg IV infusion over 2 hours.
©
Name/Class: VECURONIUM
(Norcuron)/Nondepolarizing
Skeletal Muscle Relaxant
Description: Vecuronium is a nondepolarizing skeletal muscle relaxant similar to pancuronium with minimal cardiovascular effects.
Indications: Facilitated endotracheal intubation.
Contraindications: Hypersensitivity.
Precautions: Hepatic or renal
impairment, impaired fluid and electrolyte or acid/base balance, severe obesity,
myasthenia gravis, elderly, debilitated patients, or malignant
hyperthermia.
Dosage/Route: 0.08 to 0.1 mg/kg IV. Ped: same as adult.
Name/Class:
VERAPAMIL (Isoptin, Calan)/Calcium
Channel Blocker
Description:
Verapamil is a calcium channel blocker that slows AV conduction,
suppresses reentry dysrhythmias
such
as PSVT, and slows ventricular responses to atrial tachydysrhythmias. Verapamil also dilates
coronary
arteries and reduces myocardial oxygen demand.
Indications:
PSVT refractory to adenosine, atrial
flutter, and atrial fibrillation with rapid
ventricular response.
Contraindications:
Severe hypotension, cardiogenic shock,
2nd- or 3rd-degree heart block, CHF, sinus node
disease,
and accessory AV pathways, WPW syndrome. It should not be administered to
persons taking
beta
blockers.
Precautions:
Hepatic and renal impairment, MI with coronary artery occlusion,
or myocardial stenosis.
Dosage/Route:
2.5 to 5 mg IV bolus over 2 to 3 min, then 5 to 10 mg after 15 to
30 min to a max of 30 mg
in
30 min. Ped: newborn—0.1 to 0.2 mg/kg (not to
exceed 2 mg), age 1 to 15—0.1 to 0.3 mg/kg (not to
exceed
5 mg).
©
Name/Class: Zofran /Antiemetic
Description:: selective blocking agent of the serotonin 5-HT3
receptor type
Indications: Prevention of nausea and intractible vomiting .
Contraindications: None
Precautions: may mask a progressive ileus and/or gastric distension
Dosage/Route: single 24-mg tablet ODT,, IV, 4 mg
undiluted over at least 30 seconds, preferably
No repeat
of Zofran is indicated