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Abciximab, Eptifibatide, Tirofiban
- Name/Class: Abciximab (ReoPro), Eptifibatide
- (Integrilin), Tirofiban (Aggrastat)/Glycoprotien IIb/IIa Inhibitors
- Decription: These drugs inhibit glycoprotein
- receptors on the platelet membrane inhibiting their aggregation.
- Indications: Unstable angina and NSTEMI
- Contraindications:Active bleeding w/in 30 days or
- bledding disorder, intracranial hemorrhage
- Precautions: Current glycoprotein IIb/IIa inhibitor
- Doseage/Route: Abciximab 0.25mg/kg IV; Eptifibatide
- 180mcg/kg IV over 1 to 2 minutes; Tirofiban 0.4 mcg/kg per minute for 30 minutes
- Name/Class: ACE Inhibitors (Enalapril, Captopril, Lisinopril, Ramipril)/Angiotensin-converting enzyme inhibitors.
- Description: ACE inhibitors interfere with the development of angiotension, reducing perpheral vascular resistance, blood pressure, and cardiac afterload.
- Indications; AMI or Heart failure w/out hypotension, hypertension
- Contraindications: Pregnancy, hypersesitivity to the drug, elevated serum potassium, hypotension (less than 100 SBP), hypovolemia, IV form is contraindicated in STEMI.
- Precautions: Renal failure
- Dosage/Route: Enalapril & Ramipril 2.5mg PO; Catopril 6.25mg PO; Lisinopril 5mg PO. Enalapril 1.25 to 5mg IV over 5 min.
- Name/Class: Acetaminophen (Tylenol, Anacin-3)/Analgesic, Antipyretic
- Description: Acetaminophen is a clinically proven analgesic/antipyretic w/little effect on platelet function.
- Indications: For mild to moderate pain and fever when aspirin is otherwise not tolerated.
- Contraindications: Hypersensitivity, children under 3 years
- Precautions: Patients w/hepatic disease; children under 12 years w/arthritic condition; alcoholism; malnutrition; and thrombocytopenia.
- Dosage/Route: 325 to 650mg PO/4-6 hours. 650mg PR/4-6 hours.
- Name/Class: Activated Charcoal (Actidose)/Adsorbent
- Description: Activated charcoal is a specially prepared charcoal that will adsorb & bind toxins from the gastrointestinal tract.
- Indications: Acute ingested poisoning.
- Contraindications: An airway that cannot be controlled; ingestion of cyanide, mineral acids, caustic alkalis, organic solvents, iron, ethanol, methanol.
- Precautions: Adminster only after emesis or in those cases where emesis is contraindicated.
- Dosag/Route: 1g/kg mixed w/at least 6-8 oz of water, then PO or via an NG tube.
- Name/Class: Adenosine (Adenocard)/Antidysrhythmic
- Description: Adenosine is a naturally occuring agent that can "chemically cardiovert" PSVT to a normal sinus rhythm. It has a half-life of 10 seconds & does not cause hypotension.
- Indications: Narrow, complex supraventricular tachycardia refractory to vagal maneuvers.
- Contraindications: Hypersensitivity, 2nd & 3rd degree heart block, sinus node disease, or asthma.
- Precautions: It may cause transient dysrthymias. COPD.
- Dosage/Route: 6mg rapidly (over1-3 sec) IV, then flush the line rapidly w/saline. If ineffective, 12mg in 1-2 min. may be repeated. Ped: 0.1mg/kg to a max of 6mg (rapidly) IV followed by rapid saline flush, then 0.2mg/kg in 1-2 min to max 2nd dose of 12mg.
- Name/Class: Albuterol (Proventil, Ventolin)/Sympathomimetic Broncholdilator
- Description: Albuterol is a synthetic sympathomimetic that causes bronchodilation w/less cardiac effect than epinephrine & reduces mucus secretion, pulmonary capillary leaking, and edema in the lungs during allergic reactions.
- Indications: Bronchospasm & 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 w/elderly, cardiac, or hypertensive patients.
- Dosage/Route: Two inhalations (90mcg) via metered-dose inhaler (2 sprays) or 2.5mg in 2.5 to 3mL NS via nebulizer, repeat as needed. The duration of effect is 3-6 hours. Ped: 0.15mg/kg in 2.5 to 3 mL NS via nebulizer, repeat as needed.
- Name/Class: (tPA) (Activase)/Thrombolytic
- Description: Recombinant DNA-derived form of human tPA promotes thrombolysis by forming plasmin. Plasmin, in turn, degrades fibrin & fibrinogen and, ultimately the clot.
- Indications: To thrombolyse in acute myocardial infarction, acute ischemic stroke, & 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 greater than 75 years, current oral anticoagulants, or hemmorrhagic ophthalmic conditions.
- Dosage/Route: MI: 15mg IV, then 0.75mg/kg (up to 50mg) over 30 min, then 0.5mg/kg (up to 35mg) over 60 min up to 100mg. Stroke: 0.09 mg/kg over 1 min. then 0.91mg/kg (up to 90mg) over next 60 min. Pulmonary Embolism: 100mg IV infusion over 2 hours.
- Name/Class: Aminophylline (Somophyllin)/Methylxanthine Bronchodilator
- Description: Aminophylline is a methylxanthine that prolongs bronchodilation & decreased mucus production & has mild cardiac & CNS stimulating effects.
- Indications: Bronchospasm in asthma & COPD refractory to sympathomimetics & other bronchodilators & in CHF.
- Contraindications: Hypersensitivity to methylxanthines or uncontrolled cardiac dysrhtymias.
- Precautions: Cardiovascular disease, hypertension, or taking theophylline, hepatic impairment, diabetes, hyperthyroidism, young children, glaucoma, peptic ulcers, acute influena or influenza immunization, and the elderly. Watch for PVCs or tachycardia. May cause hypotension.
- Dosage/Route: 250 to 500mg over 20-30 min. Ped: 6mg/kg over 20-30 min. Max 12mg/kg/day.
- Name/Class: Amiodarone (Cordarone, Pacerone)/Antidysrythmic
- Description: Amiodarone is an antidysrythmic that prolongs the duration of the action potential & refractory period & relaxes smooth muscles, reducing peripheral vascular resistance & increasing coronary blood flow.
- Indications: Life threatening recurrent ventricular and supraventricular dysrhythmias that have not responded to other antidysrhytmic agents.
- Contraindications: Hypersensitivity, cardiogenic shock, severe sinus bradycardia, or advanced heart block.
- Precautions: Hepatic impairment, pregnancy, nursing mothers, children.
- Dosage/Route: 150 to 300mg IV over 10 min, then 1mg/min over next 6 hours. Ped: 5mg/kg IV/IO, then repeat up to 15mg/kg.
- Name/Class: Amyl Nitrite (Amyl Nitrite)/Vasodilator
- Description: Amyl Nitrite is a short acting vasodilator similar to nitroglycerin. Binds with hemoglobin to help biodegrade cyanide.
- Indications: Acute cyanide poisoning.
- Contraindications: None for acute cyanide poisoning.
- Precautions: None.
- Dosage/Route: 0.3mL ampule/min (crushed) until sodium nitrate infusion is ready. Ped: same as adult.
- Name/Class: Anistreplase (APSAC)/Thrombolytic
- Description: Anistreplase causes thrombolysis by converting plasminogen into plasmin, which then dissolves the fibrin and fibrinogen of the clot.
- Indications: To reduce infarct size in acute MI.
- Contraindications: Active internal bleeding, suspected aortic dissection, traumatic CPR, recent hemorrhagic stroke, intracranial or intraspinal surgery or trauma, tumors, pregnancy, hypertension, hypersensitivity to anisterplase or streptokinase.
- Precautions: Recent major surgery, cerebral vascular disease, recent GI or GU bleeding, recent trauma, hypertension, patients over 75 years, oral anticoagulants, or hemorrhagic ophthalmic conditions.
- Dosage/Route: 30 units IV over 2 to 5 min.
- Name/Class: Asprin (Acetylsalicylic Acid) (Alka-Seltzer, Bayer, Empirin, St. Joseph Children's)/Analgesic, Antipyretic, Platelet Inhibitor, Antiinflammatory
- Description: Asprin inhibits agents that cause the production of inflammation, pain, and fever. It relieves mild to moderate pain by acting on the peripheral nervouse system, lowers body temp 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 w/varicella or influenza-like symptoms.
- Dosage/Route: 160 to 325mg PO (chewable)
- Name/Class: Atenolol (Tenormin)/Antidysrhythmic, Antihypertensive
- Description: Atenolol is a selective beta-blocker that reduces the rate & force of cardiac contraction & lowers cardiac output & blood pressure.
- Indications: Non-Q wave MI and unstable angina.
- Contraindications: Sinus bradycardia, 2nd or 3rd degree heart block, CHF, cardiogenic failure or shock.
- Precautions: Asthma, COPD, or CHF controlled by digitalis and diuretics.
- Dosage/Route: 5mg slow IV every 5min. to 15mg. Ped: 0.8 to 1.5mg/kg/day PO (max 2mg/kg/day).
- Name/Class: Atracurium (Tracrium)/Nondepolarizing Neuromuscular Blocker
- Description: Atracurium is a synthetic skeletal muscle relaxant that produces a short-duration neuromuscular blockade.
- Indications: To produce skeletal muscle relaxation to facilitate endotracheal intubation and IPPV.
- Contraindications: Myasthenia gravis
- Precautions: Asthma, anaphylaxis, cardiovascular or neuromuscular disease, electrolyte or acid/base imbalance, dehydration, or pulmonary impairment.
- Dosage/Route: 0.4 to 0.5mg/kg IV. Ped: less 2 years 0.3 to 0.4mg/kg, otherwise same as adult.
- Name/Class: Atropine/Parasympatholytic
- Description: Atropine blocks the parasympathetic nervous system, specifically the vagal effects on heart rate. It does not increase contractility but may increase myocardial oxygen demand. Decreases airway secretions.
- Indications: Hemodynamically significant bradycardia, bradyasystolic arrest, and organphosphate poisoning.
- Contraindications: None in the emergency setting.
- Precautions: AMI, glaucoma
- Dosage/Route: Asystole/PEA: 1mg IV/IO every 3-5 min (max. 3 doses). Symptomatic bradycardia: 0.5mg IV. Repeat 3-5 min to 3mg. Ped: 0.02mg/kg IV, 0.03mg/kg ET, may double and repeat IV dose in 5 min up to 1mg. Adolescent: 1mg x 2 Organophosphate poisoning: 2-5mg IV/IM/IO10-15 min. Ped: 0.05mg/kg IV/IM/IO 10-15 min. Organophosphate poisoning: 2-5mg IV/IM/IO 10-15 min. Ped: 0.05mg/kg IV/IM/IO 10-15 min.
- Name/Class: Bumetanide (Bumex)/Loop Diuretic
- Description: Bumetanide is related to furosemide, though it has a faster rate of onset, a greater diuretic potency (40 times), shorter duration, and produces only mild hypotension.
- Indications: To promote diuresis in CHF and pulmonary edema.
- Contraindications: Hypersensitivity to bumetanide and other sulfonamides.
- Precautions: Pregnancy (use only for life threatening conditions).
- Dosage/Route: 0.5 to 1mg IM/IV over 1 to 2 min, repeat in 2-3 hours as needed.
- 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: 1mg IV or 3-4mg IM/3-4 hours.
- 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: 2-4mg/kg IV (10% solution)/10 min, as needed. Ped: 60-100 mg/kg IV/IO repeat at 10 min, as needed.
- Name/Class: Calcium Gluconate (Kalcinate)/Electrolyte
- Description: Calcium Gluconate increases myocardial contractile force and increases ventricular automaticity. It is more potent than calcium chloride.
- Indications: Hyperkalemia, hypermagnesemia, and calcium channel blocker toxicity.
- Contraindications: Ventricular fibrillation.
- Precautions: It may precipitate toxicity in patients digitalis, with renal or cardiac insufficiency, and immobilized patients.
- Dosage/Route: 5 to 10mL of 10% solution, repeated as necessary at 10 min intervals.
- Name/Class: Clopidogrel (Plavix)/Anti-platelet agent
- Description: Clopidogrel inhibits platelet aggregation and prolongs clotting time.
- Indications: ST segment depression MI (Non-STEMI) and dynamic T wave inversion and for MI and stroke patients who cannot tolerate aspirin.
- Contraindications: Hypersensitvity to the drug, pathologic bleeding or bleeding risk.
- Precautions: Liver disease, pregnancy
- Dosage/Route: 300mg PO
- 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, pregnancy and nursing mothers, children under 6.
- Precautions: Primary depressive disorders or psychoses, acute alcohol intoxication.
- Dosage/Route: 50 to 100mg IV/IM
- Name/Class: Chlorpromazine (Thorazine)/Tranquilizer, Antipsychotic
- Description: Chlorpromazine is a phenothiazine derivative used to manage psychotic epidsodes by providing strong sedation and moderate extrapyramidal symptoms. Produces reduced initiative, interest, and affect.
- Indications: Acute psychotic episode, intractable hiccups, nausea/vomiting.
- Contraindications: Hypersensitvity to phenothiazines, coma, sedative overdose, acute alcohol withdrawal, and children under 6 months.
- Precautions: Agitated states w/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: 25-50mg IM. Ped: 0.5mg/kg IM or 1mg/kg PR.
- Name/Class: Dexamethasone (Decadron)/Steroid
- Description: Dexamethasone is a long-acting synthetic adrenocorticoid w/intense antiinflammatory activity. It prevents the accumalation of inflammation generating cells at the sites of infection or injury.
- Indications: Anaphlaxis, 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 24mg IV/IM Ped: 0.5 to 1mg/kg.
Dextrose 50% in Water (D50W)
- 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 (50mL) IV. Ped: 2 to 4mL/kg of a 25% solution IV.
- Name/Class: Diazepam (Valium)/Antianxiety, Hypnotic, Anitconvulsant, 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 durg, 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: 2 to 5mg IV/IM. Ped: 0.5 to 2mg IV/IM. Acute anxiety: 2 to 5mg IV/IM. Ped: 0.5 to 2mg IV/IM. Premedication: 5 to15mg IV. Ped: 0.2 to 0.5mg/kg IV.
- Name/Class: Diazoxide (Hyperstat)/Antihypertensive
- Description: Diazoxide is a rapid-acting thiazide nondiuretic hypotensive and hyperglycemia agent that reduces BP and peripheral vascular resistance.
- Indications: Rapidly decreases BP in hypertensive crisis.
- Contraindications: Hypersensitivity to thiazides, cerebral bleeding, eclampsia, significant, coronary artery disease.
- Precautions: Diabetes, impaired cerebral or cardiac circulation, renal impairment, corticosteroid or progesterone therapy, gout, or uremia.
- Dosage/Route: 1 to 3mg/kg IV up to 150mg, repeated/5 to 15 min, as needed. ped: same as adult.
- Name/Class: Digoxin (Digoxin, Lanoxin)/Cardiac Glycoside
- Description: Digoxin is a rapid-acting cardiac glycoside used in the treatment of CHF and rapid atrial dysrhthmias. It increases the force and velocity of myocardial contraction and cardiac output. It also decreases conduction through the AV node, thus decreasing heart rate.
- Indications: Increase cardiac output in CHF and to stablize supraventricular tachydysrhythmias.
- Contraindications: Hypersensitivity, ventricular fibrillation, or ventricular tachycardia except due to CHF.
- Precautions: Reduce dosage if digitoxin taken w/in 2 weeks. Toxicity potentiated by an MI and w/hypokalemia, hypocalcemia, advanced heart disease, incomplete heart block, corpulmonale, hyperthyroidism, respiratory impairment, children, elderly or debilitated patients, and hypomagnesemia.
- Dosage/Route: 0.25 to 0.5mg slowly IV. Ped: 10 to 50mcg/kg IV.
Digoxin Immune FAB
- Name/Class: Digoxin Immune FAB (Digibind)/Antidote
- Description: Digoxin immue FAB is comprized of fragments of antibodies specific for digoxin (and effective for digitoxin) and prevents the drug from binding to receptor sites.
- Indications: Life-threatening digoxin or digitoxin toxicity.
- Contraindications: Hypersensitvity to sheep products and renal or cardiac failure.
- Precautions: Patients w/prior sheep or bovine antibody fragments, renal impairment, and allergies.
- Dosage/Route: Dose dependent upon patient digoxin or digitoxin levels.
- 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 (atril fibrillation, atrial flutter, and PSVT refractory to adenosine) and to increase coronary artery perfusion in agina.
- Contraindications: Hypersensitivity, sick sinus syndrome, 2nd or 3rd degree heart block, systolic BP less than 90, diastolic BP less than 60, wide-complex tachycardia and WPW.
- Precautions: CHF (especially w/beta blockers), conduction abnormalities, renal or hepatic impairment, the elderly, and nursing mothers.
- Dosage/Route: 0.25mg/kg IV over 2 min., may repeat in 15 min with 0.35mg/kg followed by a drip of 5 to 10mg/hr not to exceed 15mg/hr over 24 hours.
- Name/Class: Dimenhydrinate (Dramamine)/Antihistamine
- Description: Dimenhydrinate is related to diphenhydramine though it is most frequently used for the prevention and treatment of motion sickness and vertigo rather than any antihistamine properties.
- Indications: To relieve nausea/vomiting associated w/motion sickness and narcotic use.
- Contraindications: None in the emergency setting.
- Precautions: Seizure disorders and asthma.
- Dosage/Route: 12.5 to 25mg IV; 50mg IM/4 hours as needed. Ped: 1.25mg/kg/4 hours up to 300mg/day.
- Name/Class: Dimercaprol (BAL in Oil)/Antidote
- Description: Dimercaprol is a dithiol compound that combines w/the ions of various heavy metals to form nontoxic compounds that can be excreted.
- Indications: Antidote for acute arsenic, mercury, lead, and gold poisoning.
- Contraindications: Hepatic and severe renal impairment and poisonings due to cadmium, iron, selenium, and uranium.
- Precautions: Hypertensive patients.
- Dosage/Route: Gold and arsenic: 2.5 to 3mg/kg IM. Ped: same as adult. Mercury: 5mg/kg IM. Ped: same as adult. Lead: 4mg/kg IM. Ped: same as adult.
- Name/Class: Diphenhydramine (Benadryl)/Antihistamine
- Description: Diphenhydramine blocks histamine release, thereby reducing bronchoconstriction, vasodilation, and edema.
- Indications: Anaphylaxis, allergic reaction, and dsytonic reactions.
- Contraindications: Asthma and other lower respiratory rates.
- Precautions: May induce hypotension, headach, palpitations, tachycardia, sedation, drowsiness, and/or disturbed coordination.
- Dosage/Route: 25 to 50mg IV/IM.
- Name/Class: Dobutamine (Dobutrex)/Sypathomimetic
- Description: Dobutamine is a synthetic catecholamine and beta agent that increases the strength of cardiac contraction w/out appreciably increasing rate.
- Indications: To increase cardiac output in CHF/cardiogenic shock.
- Contraindications: Hypersensitivity to sympathomimetic amines, ventricular tachycardia, and hypovolemia w/out fluid resuscitation.
- Precautions: Atrial fibrillation or preexisting hypertension.
- Dosage/Route: 2 to 20mcg/kg/min IV. Ped: same as adult.
- Name/Class: Dopamine (Intropin)/Sympathomimetic
- Description: Dopamine is a naturally occuring catecholamine that increases cardiac output w/out appreciably increasing myocardial oxygen consumption. It maintains renal and mesenteric blood flow while inducing vasoconstriction and increasing systolic blood pressure.
- Indications: Nonhypovolemic hypotension (70-100mmHg) and cardiogenic shock.
- Contraindications: Hypovolemic hypotension w/out aggresive 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: 2 to 20mcg/kg/min, titrated to effect. Ped: same as adult.
- Name/Class: Droperidol (Inapsine)/Antiemetic
- Description: Droperidol is related to haloperidol and antagonizes the emetric properties of morphine-like analgesics. It may also producehypotension and mild sedation.
- Indications: Nausea and vomiting (second line), to produce a tranquilizing effect, and in some cases as an anitpsychotic.
- Contraindications: Intolerance.
- Precautions: Elderly, debilitated, hypotension, and hepatic, renal, or cardiac impairment and Parkinson's disease.
- Dosage/Route: 2.5 to 10mg IV. Ped: 0.088 to 0.165 mg/kg IV.
- Name/Class: Enoxaparin (Lovenox)/Anticoagulant
- Description: Enoxaparin is a heparin derivative that prevents the conversion of fibrinogen to fibrin.
- Indications: To inhibit clot formation to unstable angina and non-Q wave myocardial infarction.
- Contraindications: Hypersensitivity to the drug, pork products or heparin, major active bleeding, or thrombocytopenia.
- Precautions: (none listed on card)
- Dosage/Route: Unstable angina and non-Q wave MI: 1mg/kg subcutaneously. Pulmonary embolism: 0.5mg/kg IV.
- Name/Class: Epinephrine (Adrenalin)/Sympathomimetic
- Description: Epinephrine is a naturally occuring 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 less than 6 years.
- Dosage/Route: Arrest: 1mg of 1:10,000 IV/ 3 to 5 min. (ET: 2 to 2.5mg 1:1,000). Ped: 0.01mg/kg 1:10,000 IV/IO/ 3 to 5 min. (ET: 0.1mg/kg 1:1,000). All subsequent doses 0.1mg/kg IV/IO.
- Allergic reactions: 0.3 to 0.5mg of 1:1,000 SQ/IM/ 5 to 15 min. as needed or 0.5 to 1mg of 1:10,000 IV if subcutaneous dose ineffective or severe reaction. Ped: 0.01mg/kg of 1:1,00 subcutaneously/ 10 to 15 min. or 0.01mg/kg of 1:1,000 IV if subcutaneous does ineffective or severe.
- Name/Class: Esmolol (Brevibloc)/Beta Blocker
- Description: Esmolol is an ultra-short acting cardioselective beta blocker that inhibits the actions of the catecholamines.
- Indications: Supraventricular tachycardias w/rapid ventricular responses.
- Contraindications: Cardiac failure, 2nd and 3rd degree block, sunus bradycardia, and cardiogenic shock.
- Precautions: Allergies or bronchial asthma, emphysema, CHF, diabetes, and renal impairment.
- Dosage/Route: 500mcg/kg/min IV for 1 min, loading dose, then 50mcg/kg/min over 4 min. If unsuccessful, repeat loading dose over 4 min, then 100mcg/kg/min over 4 min.
- Name/Class: Etomidate (Amidate)/Hypnotic
- Description: Etomidate is an ultra-short-acting nonbarbiturate hypnotic w/no analgesic effects and limited cardiovascular and respiratory effects.
- Indications: Induce sedation for rapid squence intubation.
- Contraindications: Hypersensitivity.
- Precautions: Marked hypotension, severe asthma, or severe cardiovascular disease.
- Dosage/Route: 0.1 to 0.3mg/kg IV over 15 to 30 sec. Ped: 0.2 to 0.4mg/kg IV/IO over 30 to 60 sec. Max 20mg.
- 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/moderate to severe pain.
- Contraindications: MAO inhibitors w/in 14 days, myasthenia gravis.
- Precautions: Increased intracranial pressure, elderly, debilitated, COPD, respiratory problems, hepatic and renal insufficiency.
- Dosage/Route: 25 to 100mcg slowly IV (2 to3 min.) Ped: 2mcg/kg slow IV/IM.
- Name/Class: Flecainide (Tambocor)/Antidysrhythmic
- Description: Flecainide is a local anesthetic and antidysrhythmic that slows myocardial conduction and effectively suppresses PVC's and a variety of atrial and ventricular dysrhythmias.
- Indications: Atrial flutter, atrial fibrillation, AV reentrant tachycardia, or SVT associated with WPW syndrome.
- Contraindications: Hypersenitivity, 2nd or 3rd degree heart block, right bundle branch block with left hemiblock, cardiogenic shock, or significant hepatic impairment.
- Precautions: CHF, sick sinus syndrome, or renal impairment.
- Dosage/Route: 100mg PO/ 12 hour or 2mg/kg IV at 10mg/min. Ped: 1 to 3mg/kg/day PO in three equal doses (max 8mg/kg/day).
- 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; 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: 0.2mg IV over 15 sec/min repeated at 0.3mg over 30 sec. then 0.5mg over 30 sec. every minute to affect or 3mg.
- Name/Class: Fosphenytoin (Cerebyx)/Anticonvulsant
- Description: Fosphenytoin is a drug that, once administered, is converted to phenytoin and causes the anticonvulsant properties associated with that drug.
- Indications: Seizure control and status epilepticus.
- Contraindications: Hypersensitvity, seizures due to hypoglycemia, sinus bradycardia, heart block, Stokes-Adams syndrome, late pregnancy, and lactating mothers.
- Precautions: Hepatic or renal impairment, alcoholism, hypotension, bradycardia, heart block, severe CAD, diabetes, hyperglycemia, or respiratory depression.
- Dosage/Route: 15 to 20mg PE/kg IV given at 100 to 150mg PE/min (PE=phenytoin equivalent).
- Name/Class: Furosemide (Lasix)/Diuretic
- Description: Furosemide is a rapid-acting, potent diuretic and anthihypertensive that inhibits sodium reasbsorption by the kidney. Its vasodilating effects reduce venous return and cardiac workload.
- Indications: CHF 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 w/acute MI, gout, or patients receiving digitalis or protassium-depleting steroids.
- Dosage/Route: 40 to 120mg slow IV. Ped: 1mg/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 w/out 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: 1mg IM/SC repeat/ 5 to 20 min. Ped: 0.1mg/kg 1m/SC/IV for child less than 10kg; 1mg/kg 1m/SC/IV for child greater than 10kg. Beta-blocker overdose: 3mg IV over 1 min. Ped: 50 to 150mg/kg IV over 1 min.
- Name/Class: Haloperidol (Haldol)/Antipsychotic
- Description: Haloperidol is believed to block dopamine receptors in the brain associated w/mood and behavior, is a potent antimetic, and impairs temperature regulation.
- Indications: Acute psychotic episodes
- Contraindications: Parkinson's disease, seizure disorders, coma, alcohol depression, CNS depression, and thyrotoxicosis, and w/other sedatives.
- Precautions: Elderly, debilitated patients, urinary retention, glaucoma, severe cardiovascular disease, or anticonvulsant, anticoagulant, or lithium therapy.
- Dosage/Route: 2 to 5mg IM. Ped: Children less three years, 0.015 to 0.15mg/kg/day PO in 2 or 3 divided doses.
- 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 in 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: STEMI: 60 IU/kg to 4, 000 IU NSTEMI: 60 to 70 IU/kg to 5,000.
- Name/Class: Hydralazine (Apresoline)/Antihypertensive
- Description: Hydralazine reduces blood pressure by arterial vasodilation, increasing cardiac output and renal cerebral blood flow.
- Indications: Hypersensitive crisis and preeclampsia
- Contraindications: Hypersensitivity, coronary artery or mitral valve disease, AMI, tachydysrhythmias.
- Precautions: CVA, renal impairment, and MAO inhibitor use.
- Dosage/Route: 20 to 40mg IV/IM repeated in 4 to 6 hours. Ped: 0.1 to 0.5mg/kg/day IV/IM.
- Name/Class: Hydrocortisone (Solu-Cortef)/Steroid
- Description: Hydrocortisone is a short-acting synthetic steroid that inhibits histamine formation, storage, and relase from mast cells, reducing allergic response.
- Indications: Inflammation during allergic reactions, severe anaphlyaxis, asthma, and COPD.
- Contraindications: Hypersensitvity to glucocorticoids.
- Precautions: Limited precautions in acute care.
- Dosage/Route: 40 to 250mg IV/IM. Ped: 4 to 8mg/kg/day IV/IM.
- Name/Class: Hydroxyzine (Vistaril)/Antihistamine
- Description: Hydroxyzine is an antihistamine w/depressive, sedative, antiemetic, and bronchodilator properties.
- Indications: Acute anxiety, nausea/vomiting.
- Contraindications: Hypersensitivity
- Precautions: Elderly
- Dosage/Route: Anxiety: 50 to 100mg deep IM. Ped: 1mg/kg deep IM. Nausea/Vomiting: 25 to 50mg deep IM. Ped: 1mg/kg deep IM.
- Name/Class: Ibuprofen (Advil, Motrin, Nuprin, Excedrin IB)/Nonsteriodal Antiinflammatory Drug (NSAID)
- Description: Ibuprofen is the prototype NSAID w/significant analgesic and antipyretic properties. It also inhibits platelet aggregation and increases bleeding time.
- Indications: Reduce fever and relieve minor to moderate pain.
- Contraindications: Sensitivity to aspirin, or other NSAIDs, active peptic ulcer, and bleeding abnormalities.
- Precautions: Hypertension, GI ulceration, hepatic or renal impairment, cardiac decompensation.
- Dosage/Route: 200 to 400mg PO/ 4 to 6 hours up to 1,200mg/day. Ped: 5 to 10mg/kg PO/ 4 to 6 hours up to 40mg/kg/day.
- Name/Class: Ibutilide (Corvert)/Antidysrhythmic
- Description: Ibutilide is a short-acting antidysrhythmic that may convert atrial flutter and fibrilliation or may assist w/electrical cardioversion.
- Indications: Recent onset atrial flutter and fibrillation.
- Contraindications: Hypersensitivity, hypkalemia, or hypomagnesmia.
- Precautions: CHF, low ejection fraction, recent MI, prolonged QT intervals, hepatic impairment, cardiovascular disorder other than dysrhythmias, or drugs that prolong the QT interval, lactation.
- Dosage/Route: 1mg over 10 min IV. Patients less than 60kg, 0.01mg/kg IV may repeat in 10 min as needed.
- Name/Class: Inamrinone (Inocor)/Cardiac Inotrope
- Description: Inamrinone enhances myocardial contractility, increasing output, and reduces systemic vascular resistance.
- Indications: To increase cardiac output in CHF or children in septic shock or myocardial dysfunction.
- Contraindications: Hypersensitivity to amrinone or bisulfites.
- Precautions: CHF immediately after MI (may cause ischemia).
- Dosage/Route: CHF: 0.75mg/kg IV over 2 to 3 min, then drip at 5 to 15mcg/kg/min titrated to hemodynamic response (may repeat bolus at 30 min.) Septic shock or CHF in peds: 0.75 to 1mg/kg IV over 5 min, repeated up to 2 times to 3mg/kg.
- Name/Class: Insulin (Regular Insulin, Humulin)/Hormone
- Description: Insulin is a naturally occuring protein that promotes the uptake of glucose by the cells.
- Indications: Hyperglycemia and diabetic coma.
- Contraindications: Hypersensitivity and hypoglycemia.
- Precautions: None listed on card.
- Dosage/Route: 5 to 10 units IV/IM/SC. Ped: 2 to 4 units IV/IM/SC.
- Name/Class: Ipecac Syrup/Emetic
- Description: Ipecac syrup is a gastric irritant and acts on the emetic centers of the medulla to induce vomiting. Emesis usually occurs w/in 5 to 10 minutes.
- Indications: Poisoning and overdose.
- Contraindications: Reduced level of consciousness, corrosive ingestion, petroleum distillate ingestion, alkali ingestion, or antiemetic ingestion (especially phenothiazine).
- Precautions: Monitor the airway and have suction ready. Administer activated charcoal only after emesis. Caution w/heart disease patients.
- Dosage/Route: 30mL PO, followed by 1 to 2 glasses of water, repeat in 20 min as needed. Ped: 15mL PO followed by 1 to 2 glasses of water, repeat in 20 min as needed.
- 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 acetlycholine receptors.
- Indications: Bronchospasm associated w/asthma, COPD, and inhaled irritants.
- Contraindications: Hypersensitivity to atropine or its derivavtives, or primary treatment for acute bronchospasm.
- Precautions: Elderly, cardiovascular disease, or hypertension.
- Dosage/Route: 500mcg in 2.5 to 3mL NS via nebulizer or 2 sprays from a metered dose inhaler. Ped: 125 to 250mcg in 2.5 to 3mL NS via nebulizer, or 1 to 2 sprays of a metered dose inhaler.
- Name/Class: Isoetharine (Bronkosol)/Sympathomimetic Bronchodilator
- Description: Isoetheraine is a synthetic sympathomimetic w/rapid onset and prolonged duration that relaxes the bronchial smooth muscles, decreasing airway resistance and helping clear secretions.
- Indications: Bronchospasm in asthma and COPD.
- Contraindications: Hypersensitivity to or use of sympathomimetic amines, preexisting tachydysrhythmias, allergy to sodium bisulfite agents.
- Precautions: Elderly, hypertension, acute coronary artery disease, CHF, hyperthyroidism, diabetes, tuberculosis, or seizures.
- Dosage/Route: 1 to 2 sprays via metered dose inhaler, 0.5mL in 2 to 3mL saline via nebulizer. Ped: 0.01mL/kg of 1% solution (max 0.5mL) diluted in 2 to 3mL saline by nebulizer.
- Name/Class: Ketorolac (Toradol)/Nonsteroidal Antiinflammatory Drug (NSAID)
- Description: Ketorolac is an injectible NSAID that exhibits analgesic, antiinflammatory, and antipyretic properties w/out sedative effects.
- Indications: Mild or moderate pain.
- Contraindications: Hypersensitivity to ketorolac, asprin, or other NSAIDs, and asthma.
- Precautions: Peptic ulcers, renal or hepatic impairment, or elderly.
- Dosage/Route: 30mg IV/IM (15mg greater than 65 years of weight less than 50kg)
- Name/Class: Labetalol (Trandate, Normodyne)/Beta Blocker
- Description: Labetalol is a beta blocker w/some alpha blocker characteristics. It induces vasodilation, reduces peripheral vascular resistance, and lowers blood pressure.
- Indications: Acute hypertensive crisis.
- Contraindications: Asthma, CHF, 2nd and 3rd degree heart block, severe bradycardia, or cardiogenic shock.
- Precautions: COPD, heart failure, hepatic impairment, diabetes, peripheral vascular disease.
- Dosage/Route: 10mg slow IV, then 20 to 40mg/ 10 min as needed, up to 150mg OR a bolus of 10mg, then continuous drip of 2-8mg/min.
- Name/Class: Lidocaine (Xylocaine)/Antidysrythmic
- Description: Lidocaine is an antidysrythmic 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-Adams syndrome, 2nd and 3rd degree blcoks, and bradycardias.
- 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 1.5mg/kg IV/IO repeated at 0.5 to 0.75 every 5 to 10 min up to 3mg/kg, follow conversion w/a drip of 1 to 4mg/min. Ped: 1mg/kg rapid IV/IO, to 100mg, follow conversion w/a drip of 20 to 50mcg/kg/min. Ventricular Tachycardia (w/pulse)0.5 to 1.5mg/kg slow IV. May repeat at one-half dose every 5 to 10 min until conversion up to 3mg/kg. Follow conversion w/an infusion of 1 to 4mg/min. Ped: 1mg/kg, followed by a drip at 20 to 50 mcg/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 4mg IM, 0.5 to 2mg IV. Ped: 0.03 to 0.5mg/kg IV/IM/PR up to 4mg. Status Epilepticus: 2mg slow IV/PR (2mg/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: Torsade de Pointes, eclamptic seizures. In children for status asthmaticus non-responsive to beta agents.
- Contraindications: Heart block, myocardial damage, shock, persistent hypertension, and hypocalcemia.
- Precautions: Renal impairment, digitalized patients, other CNS depressants, or neuromuscular blocking agents.
- Dosage/Route: Diluted in 100mL, over 1 to 2 min (in adults only) Peds: 25 to 50mg/kg over 5 to 20 min. Max dose 2g. Asthma: same as for Torsades. Eclampsia: 2 to 4g 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 renal failure, or severe dehydration.
- Dosage/Route:0.5 to 1g/kg over 5 to 10 min IV. Ped: 0.25 to 0.5g/kg over 60 min.
- Name/Class: Meperidine (Demerol)/Narcotic Analgesic
- Description: Meperidine is a synthetic narcotic w/sedative and analgesic properties comparable to morphine but w/out 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 50mg IV, 50 to 100mg IM. Ped: 1mg/kg IV/IM.
- Name/Class: Metaproterenol (Alupent)/Sympathomimetic Bronchodilator
- Description: Metaproterenol is a synthetic sympathomimetic amine, similar to isoproterenol that causes smooth muscle relaxation of the bronchial tree, decreasing airway resistance, facilitating mucus drainage, and increasing vital capacity.
- Indications: Bronchospasm, as in asthma and COPD.
- Contraindications: Hypersensitivity to sympathomimetic agents, tachydysrhythmias, and hyperthyroidism.
- Precautions: Elderly, hypertension, coronary artery disease, and diabetes.
- Dosage/Route: 0.65mg via metered dose inhaler (2 sprays); 0.2 to 0.3mL in 2.5 to 3mL NS via nebulizer. Ped: 0.1 to 0.2mL/kg (5% solution) in 2.5 to 3mL NS via nebulizer.
- Name/Class: Metaraminol (Aramine)/Sympathomimetic
- Description: Metaraminol is a sympathomimetic similar to norepinephrine but less potent, w/gradual onset and longer duration. It causes systemic, vasoconstriction and increased cardiac contraction strength, increasing blood pressure and reducing flow to the kidneys.
- Indications: Hypotension to a normovolemic patient.
- Contraindications: Hypovolemia; MAO inhibitor therapy; peripheral or mesenteric thrombosis; pulmonary edema; cardiac arrest; untreated hypoxia, hypercapnia, and acidosis.
- Precautions: Digitalized patients, hypertension, thyroid disease, diabetes, hepatic impairment, malaria.
- Dosage/Route: 100mg/500mL D5W or NS, titrated to blood pressure: 5 to 10mg IM.
- Name/Class: Methylprednisolone (Solu-Medrol)/Corticosteroid, Antiinflammatory
- 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 250mg IV/IM. Ped: 1 to 2mg/kg/dose IV/IM. Spinal cord injury: 30mg/kg IV over 15 min, after 45 min an infusion of 5.4mg/kg/hr.
- Name/Class: Metoclorpramide (Reglan)/Antiemetic
- Description: Metoclopromide is a dopamine antagonist similar to procainamide but w/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 sulfits 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 20mg IM; 10mg slow IV (over 1 to 2 min). Ped: 1 to 2mg/kg/dose.
- Name/Class: Metoprolol (Lopressor)/Beta Blocker
- Description: Metoprolol is a beta-adrenergic blocking agent that reduces heart rate, cardiac output, and blood pressure.
- Indications: AMI
- Contraindications: Cardiogenic shock, sinus bradycardia less than 45, 2nd or 3rd degree heart block, PR interval greater than 0.24, cor pulmonale, asthma, or COPD.
- Precautions: Hypersensitivity, hepatic or renal impairment, cardiomegaly, CHF controlled by digitalis and diuretics, AV conduction defects, thyrotoxicosis, diabetes, or peripheral vascular disease.
- Dosage/Route: 5mg slow IV/ 5 min up to 3 times.
- Name/Class: Midazolam (Versed)/Sedative
- Description: Midazolam is a short-acting benzodiazepine w/CNS depressant, muscle relaxant, anticonvulsant, and anterograde amenestic 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 2.5mg slow IV; 0.07 to 0.08mg/kg IM (usually 5mg). Ped: 0.05 to 0.2mg/kg IV: 0.1 to 0.15mg/kg IM; 3mg intranasal.
- Name/Class: Milrinone (Primacor)/Cardiac Inotrope, Vasodilator
- Description: Milrinone is related to amrinone and increases the strength of cardiac contraction without increasing heart rate, increasing cardiac output without increasing oxygen demand.
- Indications: CHF or pediatric septic shock
- Contraindications: Hypersensitvity
- Precautions: Elderly, pregnancy, and nursing mothers.
- Dosage/Route: CHF: 50mcg/kg IV over 10 min, then a drip of 0.375 to 0.75mcg/kg/min IV. Ped: (septic shock) 50 to 75mcg/kg IV, then a drip of 0.5 to 0.75mcg/kg/min.
- 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: MI: 2 to 4mg IV over 1 to 5 min. every 5 to 15 min. Pain: 2.5 to 15mg IV; 5 to 20mg IM/subcutaneous. Ped: 0.05 to 0.1mg/kg IV; 0.1 to 0.2mg/kg IM/subcutaneous. AMI or PE: 1 to 2mg/ 6 to 10 min to response.
- 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: Hypersensitvity, undiagnosed head or abdominal injury.
- Precautions: Impaired respirations, narcotic dependency.
- Dosage/Route: 0.4 to 2mg IV/IO/IM (2 to 2.5 times the dose ET), repeated/ 2 to 3 min as needed up to 10mg. Ped: 0.1mg/kg up to 2mg IV/IM
- 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 2mg IV/IM (2 to 2.5 times the dose ET), repeated/ 2 to 3 min as needed up to 10mg Ped: 0.01mg IV/IM (2 to 2.5 times the dose ET) repeated/ 2 to 3 min as needed up to 10mg.
- Name/Class: Nifedipine (Procardia, Adalat)/Calcium Channel Blocker
- Description: Nifedipine is a calcium channel blocker that reduces coronary artery spasm in angina. It also decreases peripheral vascular resistance, blood pressure, and cardiac workload.
- Indications: Severe hypertension and angina.
- Contraindications: Hypersensitivity or hypotension
- Precautions: Monitor blood pressure carefully, since it can drop significantly with nifedipine use.
- Dosage/Route: One 10 to 20mg capsule SL/PO.
- 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 mycardial 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 (0.4mg) SL. May be repeated/ 3 to 5 min up to 3 tablets, or 1/2 to 1 inch of topical ointment, or 0.4mg (one spray) SL up to 3 sprays/ 25min.
- Name/Class: Nitrous Oxide (Nitronox)/Analgesic (gas)
- Description: Nitrous oxide is a self-administered analgesic gas composed of 50% oxygen and 50% nitrous oxide. Its effects last only 2 to 5 minutes after administration ceases.
- Indications: Musculoskeletal, burn, and ischemic chest pain and severe anxiety (including hyperventilation).
- Contraindications: Possible bowel obstruction, pneumothorax or tension pneumothorax, COPD, head injury, impaired mental status, or drug intoxication.
- Precautions: Use in well-ventilated area. It may cause nausea and vomiting.
- Dosage/Route: It is self-administered inhalation until the pain is relieved or the patient drops the mask.
- Name/Class: Norepinephrine (Levophed)/Sympathomimitec Agent
- Description: Norepinephrine is a naturally occuring 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 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 30mg/min IV, titrated to BP Ped: 0.1 to 2mcg/kg/min titrated to BP (rarely used).
- Name/Class: Ondansetron (Zofran)/Antimetic
- Description: Ondansetron is a selective serotonin receptor antagonist preventing nausea and vomiting.
- Indications: Nausea and vomiting
- Contraindications: Hypersensitivity to the drug
- Precautions: Pregnancy, nursing mothers and children under 3 years.
- Dosage/Route: 4mg/ over 1 to 5 min IV
- Name/Class: Oxygen/Oxidizing Agent (Gas)
- Description: Oxygen is an odorless, colorless, tasteless gas, essential for life. It is one of the most important emergency drugs.
- Indications: Hypoxia or anticipated hypoxia, or in any medical or trauma patient to improve respiratory efficiency.
- Contraindications: There are no contraindications to oxygen therapy.
- Precautions: Chronic obstructive pulmonary disease and very prolonged administration of high concentrations in the newborn.
- Dosage/Route: Hypoxia: 100% by inhalation or IPPV.
- Name/Class: Oxytocin (Pitocin)/Hormone
- Description: Oxytocin is a naturally occuring 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 1,000mL 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 0.1mg/kg IV Ped: same as adult.
- Name/Class: Phenobarbital (Luminal)/Anticonvulsant
- Description: Phenobarbital is a long-acting barbiturate anticonvulsant with sedative and hynotic effects that limits the spread of seizure activity.
- Indications: Seizures, status epileticus, and acute anxiety.
- Contraindications: Hypersensitivity to barbiturates.
- Precautions: Hepatic, renal, cardiac, or respiratory impairment, allergies, elderly, debilitated patients, fever, hyperthyroidism, diabetes, severe anemia, hypoadrenal function, and during labor, delivery, and lactation.
- Dosage/Route: 100 to 300mg slow IV/IM Ped: 6 to 10mg slow IV/IM.
- 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 epilpeticus, or cardiac dysrthythmias secondary to digitalis toxicity.
- Contraindications: Hypersensitivity to hydantoin products, seizures due to hypoglycemia, sinus bradycardia, heart blcok, and Adams-Stokes syndrome.
- Precautions: Hepatic or renal impairment, alcoholism, cardiogenic shock, elderly, debilitated patients, diabetes, hyperglycemia, bradycardia, heart blcok, or respiratory depression.
- Dosage/Route: Seizures, status epilepticus: 10 to 15mg/kg slow IV. Ped: 8 to 10mg/kg slow IV. Dysrhythmias: 100mg slow IV (over 5 min) to a maximum 1,000mg. Ped: 3 to 5mg/kg slow IV.
- Name/Class: Physostigmine (Antilirium)/Parasympathomimetic
- Description: Physostigmine inhibits the breakdown of acetylcholine, resulting in prolonged parasympathtic effects. It is sometimes used as an antidote for anticholinergic (e.g., atropine) and tricyclic antidepressant overdoses.
- Indications: Tricyclic antidepressant (CNS and cardiac effects) and anticholinergic overdose.
- Contraindications: Asthma, diabetes, gangrene, cardiovascular disease, or narrow-angle glaucoma.
- Precautions: Reduce dose (or administer atropine) if increased salivation, emesis, or bradycardia develop.
- Dosage/Route:.0.5 to 3mg IV (not faster than 1mg min), repeat as needed. Ped: 0.01 to 0.03mg/kg/ 15 to 20 min to max 2mg.
- Name/Class: Pralidoxime (2-PAM)/Cholinesterase Reactivator
- Description: Pralidoxime reactivates cholinesterase and reinstitutes the defrading of acetlycholine and restores normal neuromuscular transmission. It is used to reverse severe organophosphate poisoning.
- Indications: Organophosphate poisoning.
- Contraindications: Carbamate insecticides (Sevin), inorganic phosphates, and organophosphates having no anticholinesterase activity, asthma, peptic ulcer disease, severe cardiac disease, or patients receiving aminophylline, theophylline, morphine, succinylcholine, reserpine, or phenothiazines.
- Precautions: Rapid adminstration may result in tachycardia, laryngospasm, and muscle rigidity. Excited or manic behavior may be noted after regaining consciousness.
- Dosage/Route: 1 to 2g in 250 to 500mL NS infused over 15 to 30 minutes; or 1 to 2g IM/subcutaneous if IV not feasible. Ped: 20 to 40mg/kg IV/IM subcutaneous
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