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.
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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