Drug Box 1-5

carcoal, activated (without sorbitol)

Charcola, Actidose-aqua

Adsorbent

• * Sole prehospital therapy of oral ingestion of toxic substances.
• * Pre-lavage of oral ingestions of toxic substances.

30-60 Gm (1-2 GM/kg) PO or OG/NG Tube, if not in pre-mix slurry, mix one part charcoal with four parts water.

• * Give it!
• * Charcoal mixture should not contain sorbitol; carefully read label of exchange supply.

Dextrose 50%

• * Dextrose 50%
• * D50

• * Carbohydrate
• * Hyperglycemic

• * Known hypoglycemia
• * Altered level of consciousness of unknown etiology
• * Seizures of unknown etiology
• * Hyperkalemia`

• * Hpyoglycemia, ALOC or seizures of unknownetiology: 25-100 ml of D50 ( 12.5-50 Gm, 1 to 2 amps) IV/IO
• * Hyperkalemia: 50 Gm of Dextrose IV total may be given over 1 hour. This is a part of a combination drug therapy. See CaCl and NaHCO3.

• * Determine a blood glucose level before initiating administration of dextrose.
• * Inducing an unneccessary hyperosmolar state during certain illness/injury states (i.e. head injuries, cerebal edema, Intra-cranial bleeds, etc.) may worsen neurological outcome.
• * Additionally dextrose is very necrosing to the vascular system, will cause necrosis if infiltrated and should not be administered through small veins.

glucagon

Glucagon

• * pancreatic hormone
• * polypeptide
• * hyperglycemic agent

Symptomatic hypoglycemia when IV access is delayed

Hypoglycemia: 1 mg IM, May repeat in 7-10 mins

• * Blood sugar should be measured rapidly before deciding upon the administration of D50 or glucagon, especially in the non-diabetic Pt.
• * Documented hypoglycemia is a true medical emergency, IM glucagon should be administered rapidly if IV access delayed.
• * In known alcoholics, administer thiamine in addtion to glucagon to prevent inducing an encephalopathy in a thiamine-deficient Pt.
• * Pt with Type 1 diabetes do not have as great a response in blood glucose levels as Type 2 stable Pt.
• * For all Pt having hypoglycemic episode, supplementary comples carbohydrates should be eaten within 2 hour, especially in a child or adolescent.

naloxone HCl

Narcan

Narotic (opioid) antagonist

• * Antidote for: Opioid overdose
• * May differentiate opioid-induced coma from other causes

• IV, IM, injject SL, SC, ET: 2.0 mg initial, may repeat x2 every 2 mins if no response. Max dose of 6 mg.
• Intra-nasal: 2.0 mg each nostril using a Mucosal Atomizer Device for a total of 4 mg. May repeat every 2 mins as necessary. Titrate to effect.

• * Opioid drugs include heroin, Dilaudid, morphine, meperidine, codeine, methadone, Lomotil, Darvocent, Talwin and others.
• * Large amounts of the drug may be needed for Darvon, Darvocet, and Methadone.
• * For adult intra-nasal administration, 1mg/1ml is the preferred solution.
• * 0.4mg/1ml may be used as an alternative.

ondansetron

Zofran

Antiemetic agent

Nausea and vomiting

• * 4-8 mg IV or IM, If given IV, slow over 2-5 mins
• * 8mg PO ODT or tablet
• * PO dose may be given by breaking up ODT Tablet or Giving IV solution PO

• * Do not attempt to puch Zofran ODT Tablets through the foil backing.
• * Bottles: Store between 2*C and 30*C (36*F and 86*F). Protect from light. Dispense in tight, Light-resistant container as defined in the USP.
• * Unit Dose Packs: Store between 2*C and 30*C n(36* and 86*F). Protect from light. Store blisters in cartons.

oxytocin

• * Pitocin
• * Syntocin

• * pituitary hormone
• * polypeptide
• * uterine stimulant

Postpartum hemorrhage due to uterine atony

Postpartum hemorrhage: 10-20 USP units added to 1000cc NS or LR and run at a rate necessary to control uterine atony or 10 USP units my be given IM after delivery of placenta.

• * IV infusion, IM
• * IV infusion on interfacility transfers requires infusion pump.

• * Post partum hemorrhage is defined as blood loss in excess off 500ml at delivery and during the first 24 hours after delivery.
• * It should be remembered that all blood seen at delivery is the mother's, unless there is a spill or cord blood, or trauma to the placenta.
• * Do not use if solution is discolored or contains a precipitate.
• * In addition to oxytocin, fundal massage is also indicated to remove clot formation and stimulate uterine contraction.
• * IV fluids are necessary to correct hypovolemia; if post partum hemorrhage is due to other causes such as baginal or cerical lacerations or retained placental fragments, oxytocin and fundal massage will not be effective.

Thiamine HCl (vitamin B1)

Betalin

Vitamin

• * Alcoholism, delirium tremens
• * Coma of unknown origin, especially if alcohol or malnourishment my be involved.
• * Suspect Wernicke or Korsakoff Syndrome
• * Other thiamine deficiency syndromes
• * Sever congestive heart failure

100mg IV slow puch or DEEP IM

• * In the known alcoholic Pt, dextrose should not be administered without thiamine.
• * Thiamine has been shown to be useful in severe congestive heart failure