Pharmacology

Combines with hydrogen ions to increase blood pH or make it more alkaline (Sodium BIcarbonate)

Receptors that cause peripheral vasoconstriction, mild bronchoconstriction, and stimulation of metabolism

Receptors serve to prevent over-release of norepinephrine in the synapse to stop synapse stimulation

Relieves pain by altering perception of pain without producing anesthesia or loss of consciousness (ASA, MS, Nitrous Oxide)

Drugs used for pre-procedure sedation - patient will have less actual pain perception during the event and may not remember the magnitude of the procedure in the hours following the procedure

Partial or complete loss of sensation with or without loss of consiousness

Drug use in the treatment of angina pectoris

Drug used to reduce the level of anxiety

An agent that blocks parasympathetic nerve impulses

Delays blood clotting.

Stops or prevents seizure activity

A substance that neutralizes poisons or their efects

Drug used to treat dyskinesias, which is the involuntary movement of the lips, tongue, face, trunk and extremities from long ther use of antipsychotics

Controls or prevents cardiac rhythm disturbances

Drug that prevents vomiting

Counteracts allergic responses by blocking histamine receptors

Drug used to prevent or control high blood pressure

Drug use to counteract inflammation

A group of organic compounds derived from barbituric acid. All derivatives depress the CNS, respirations, heart rate, blood pressure and temperature.

A chemically similar group of psychotropic drugs with potent hypnotic and sedative actions, used primarily as antianxiety and sleep-inducing drugs

Drug used to counteract the actions of Benzodiazepines

Recptors that increase heart rate, cardiac contractile force, and cardiac automaticity and conduction

Receptors that cause vasodilation and bronchodilation

Drug work by affecting the response to some nerve impulses in some parts of the body. They reduce the need for blood and oxygen by reducing the workload of the heart

Dilates the bronchoiles and relaxes the smooth muscles of the respiratory tract

Blocks the influx of calcium into the muscle cells, inhibiting contractility of cardiac and vascular smooth muscles.

Drug that increases the amount of Calcium ions available for contraction of the heart muscle, improves cardiac output and reduces distention of the heart.

Acts as a neurotransmitter

Drug that depresses the normal functions of the central nervous system, including the brain, spinal cord, nerves and end organs that control the voluntary and involuntary acts.

Absorbs chemicals in the entire gastrointestinal tract

Increases or decreases heart rate

Hormonal steroid substances obtained from the cortex of the adrenal glan. They allow many biochemical reactions to proceed at optimal rates

Druig that blocks the firing of cells within the neuromuscular system

Increases urinary output, thus aiding in the removal of sodium and water

A serum ion that, in solution, concucts an electric current and is decoposed by the passage of an electric current

An agent that produces vomiting

A substance that originates in an organ, gland, or part, and is conveyed through the blood to another part of the body. It then stimulates it by chemical action to increase functional activity or the increase secretion of another hormone.

Elevates blood glucose levels

Increases or decreases mycoardial contractility

Drugs that encourage the kidneys to remove more water from the blood by filtering out more sodium and potassium, thereby producing more urine. This process reduces the volume of circulation blood, which decreases the workload on the heart. It will aslo draw out fluid from any tissues that are overloaded.

Monoamine Oxidase Inhibitor- a group of drugs that are effective in treating atypical depression by inhibiting the activity of monoamine oxidase, thereby priventing the breakdown of the monoamine neurotransmiters.

Relieves pain through the suppression of the CNS by binding with opiate receptors

Reverses the effects of narcotics by blocking the opiate receptors

Dilates systemic and coronary arteries, increases the amount of blood and oxygen to the mycocardium and reduces the workload on the heart

Drug that is chemically related to Oium, which is extracted from the poppy plant

Diuresis achieved by moving water across a cellular membrane, therby equalizing the concentration of solutes on either side of the membrane without moving the solute. this type of diuretic is designed to move extravascular fluid out of edematous tissues and into the blood stream by increasing urine output

Drug used to stop the neuromuscular nerve signals to achieve relaxation of the muscles

Blocks the effects of stimulation to the parasympathetic nervous system

Originally manufactured as a pesticide, this class of drugs is the larest of the 5 antipsychotic medications available. this drug can induce dystonic reactions early in the treatment regime

Drug that exerts a soothing or tranquilizing effect. Effect can be general, local nervous or vasular

Causes effects that mimic a sympathetic nervous system reaction

Drug used to cause the breaking up of a thrombus

Drug used to inhibit uterine contractions

Drug used to reduce mantal tension and anxiety without interfering with normal mental activity, though this state is difficult to attain

Drug that is generally thought to inhibit the re-uptake of nerurotransmitters norepinephrine, dopamine or serotonin by the nerve cells.

Dilates the blood vessels

Constricts the blood vessels

Analgesic, antipyretic, NSAID, platelet aggregate inhibitor

• 1. Inhibits aggregation of platelets by blocking the formation of the substance thromboxane A2 Prolonging bleeding time
• 2. Provoides analgesia by ingibiting prostaglandins and other substances that sensitize pain receptors
• 3 relieves fever by acting upon the hypothalamic heat regulating center.

• MI
• CVA
• Afib Aflut

• GI bleed
• Asthma nasal polyps

• bleeding
• GI pain
• dizziness
• tinnitus
• impair renal functions

• hx of bleeding or liver disorders
• do not give to children with chickenpox

• adult 162-325 mg PO
• peds no

chemical absorbent

binds toxic substances inhibiting GI absorption leaving less toxic substance in body circulation

increases fecal elimination of drug/charlcoal complex

Suspected ingestion of drugs or chemicals

pt with a compromised airway

ingestion of iron or multi-vitamin

• adult 1g/kg PO
• peds 1g/kg PO

• antidysrhythmic
• endogenous nucleoside

• slows AV and Sinus conduction
• block pathway of reentry of AV and SA node

• Hx of sick sinus syndrome
• 2nd or 3rd degree block
• hypovolemia give fluids a

Theophylline or caffeine may render drug ineffective

Tegretol or Persantine will intensify effects.

• adult 6mg rapid IV
• Repeat 2x 12mg p 1-2min

• ped 0.1mg IVP
• repeat 0.2mg 2x p 1-2min

relaxes the smooth muscles of the respiratory tract dilating the bronchioles to decrease airway resistance

reduces ucus secretion and inhibits histamine release from mast cells thus lessening the respiratory effects of an allergic reaction

sympathomimetic bronchodilator

may not be appropriate for pulmonary edema caused by CHF due to the aggresive cardiovascular side effects adding aditional stress to a heart that is already failing

must monitor ECG rhythm throughout treatment due to cardiovasculsr side effects

provide pt with oxygen a during and p admin

• bronchospasms/bronchodialtion caused by
• asthma
• toxic gas
• allergic reaction
• copd
• near drowning
• Pulmonary Edema

• use caution with pt taking MAO inhibitors or tricyclic antidepressants as the cardiovascular effects may be potentiated
• Beta blocker medications and albuterol inhibit each other

• adult 5 mg  
• may repeat PRN
• peds 2.5 - 5.0 mg
• Sine Wave hyperkalemia
• Crush injuries,
• Sevre burns
• Continous Nabulized Albuterol

VAPOROLE

nitrie vasodilator, antidote

• relaxes vascular smooth muscle, decreasing vascular resistance decreases preload and afterload
• convers hemoglobin to methemoglobin, which then binds with cyanide to form non toxic cyanomethemoglobin that can be excreted

• angina
• hypertension
• cyanide poisoning

• hypotension
• ED meds within the last 36hrs
• no contra with cyanide poisoning

ADULT: 1-2 ampules 0.3ml, crushed and inhaled over 30 seconds may repeat q 1-2 min

PEDS: 1 ampule crushed and inhaled for 15-30 sec may repeat q1-2 min

PARASYMPATHOLYTIC ANTICHOLINERGIC

• inhibits parasympathetic stimulation by blocking acetylcholine receptors
• decreases vagal tone which may increase heart rate and AV conduction
• dilates bronchioles and decreases respiratory tract secretions Anti-secretory action suppressses sweating, lacrimation, and salivation

• may cause paradoxical slowing of the hear rate if less than the therapeutic dose is given or dose given too slowly
• not recommended in asymptomatic bradycardias due to the possibility of inducing or increasing a myocardial infarction
• can worsen AV blocks

• ADULT:
• BRADY: 0.5-1.0 MG IVP/IO may repeat q 3-5min to max of 3mg
• PESTICIDES:  Mild:2MG IVP  or 1 2PAM Moderate SOB: 4mg IV or 2 2PAM Severe: Seizures 6mg IV or 3 2PAM q 10 min.
• Peds Mild-Moderate 0.02-0.05mg/kg IV IM IO max of 4mg. Repeat 0.02 mg/kg IV, IM, IO in 5min to max of 2mg/kg
• Severe: 0.02mg/kg IV or IO max of 6mg

• Brady
• 0.5mg IVP Repeat q 5 min to max of 0.04mg/kg or 3mg 
• Peds: 0.02mg/kg IV (min single dose 0.1mg, max of 0.5 for child and 1mg for adolescent
• repeat 0.02 to max of 0.04mg/kg

Peds Type II or 3rd degree rate <60bpm  0.02mg/kg IO or IV  (min single dose 0.1mg, max of 0.5 for child and 1mg for adolescent

• blind as a bat
• mad as a hatter
• red as a beet
• dry as a bone
• hot as hell

electrolyte

• neccessary for the proper function of the nervous, muscular, skeletal, digestive and endocrine systems
• positive inotropic activity increases the strength of the myocardial contractions
• increases ventricular automaticity

• calcium channel blocker or beta blocker oerdose
• acute hyperkalemia or cardiac arrest when hyperkalemia is suspected
• hypocalcemia
• suspected hypermagnesemia with respiratior depression
• crush injury greater than 4hrs

• digitalis toxicity
• hypercalcemia
• vetricular fibrillation

• use with caution in pt with renal insufficience or hx of cardiac disease
• may cause cerebral or coronary vasospasm
• can cause bradycardia if administration is too rapid
• safe use in children, pregnant mothers or nursing mothers has not be established

• do not mix with Sodium bicarb makes chalk
• potentiates the effects of digitalis
• antagonizes the effectss of calcium channel blockers

• Adult: known or suspected hyperkalemia or beta blocker od, cardiac arrest 1 gm over 2 min may repeat 1gm in  10 min prn
• calcium channel blocker OD 

• PEDS: 20mg/kg (0.2ml/kg) over 2 min max 1gram repeat in 10 min rhythm remains wide complex
• 2nd degree or 3rd degree block hemodynamic instability and pt on calcium channel blockers 
• Adult 10% CaCl2 1gm IV over 2 min 
• CaCl2 OD Adult 1gm over 2 min 
• Peds 20mg/kg IV over 2 min (0.2ml/kg) IV over 2 min.

Kalcinate

Electrolyte

Increases cardiac muscle tone and positive inotropic effect

• Wide complex brady Prolonged QT sine wave due to hypokalemia
• Adult 1gm IO or IV over 2 min repeat 1 gram immediately if rhythm remains

Brady with symptomatic 2nd type II or 3rd degree and pt on calcium channel blockers 1gm IV over 2 min

• Calcium channel blocker OD 1gm 10ml over 2min
• peds 60mg/kg (0.6 ml/kg of 10%) IV over 2 min

• V fib
• hypercalcemia
• digitalis toxicity
• caution in pt taking digoxin as it may precicitate toxity

• Tingling sensation
• fainting
• heat waves
• hypotension
• bradycardia
• dysrhythmias

• cautious of extravasation
• IV administrations cause burning, and peripheral vsodilation with moderate fall in BP
• Monitor BP, IV site, and ECG
• Flush line especially before infusion of Sodium Bicarb

Ancef, Kefzol

First generation cephalosporin antibiotic

Functions as a bactericidal which inhibits cell wall mucopeptide synthesis. This gives cefazolini the capacity to inhibit the growth of or kill sensitive microorganisms.

Adult greater than or equal to 70 kg -2gm IV over 10 min Less than 70kg- 1gm IV over 10 min. Pediatric not given

Allergies to Cefazolin or to Penicillin

• Nausea
• vomiting
• diarrhea
• rash
• abdominal pain

• cautions with pt with known renal impairment or seizure disorder
• pt with allergy with any antibiotic monitor closely
• admin IV drip over 10 min

Carbohydrate

provides immediate source of glucose for cellular metabolism

ALOC due to or suspected hypoglycemia

• there are no absolute contra to the IV admvinistration of dextrose
• relative contra use with caution in pt with increasing ICP as the added glucose may worsen the cerebral edema

• INsure IV line patency
• IO route D50 must be diluted to half concetration with normal saline prior to administration.

• ADULT: 25gm may repeat 1x in 5min
• BGL less than 60mg/dL
• Intact gag: 1tube- 15gm
• PEDS:
• 8 or greater: D50 1gm/kg IV or IO
• 31 days - 8 years D25 1gm/kg IV or IO
• Neonates 30 days D12.5 1gm/kg IV, IO

cardizem

Calcium channel blocker, antidysrhythmic, antihypertensive

• inhibits calcium influx across cellular membranes
• coronary artery dilation increasing mycocardial O2 delivery
• smooth muscle relaxation decreases peripheral vascular resistance
• slows SA/AV node conduction

symptomatic AFIB with RVR

• < 90 systolic
• 2nd and 3rd heart block
• sick sinus syndrome Unless with funtioning pacemaker
• AMI
• WPW

ensure pt is not taking beta blockers or received IV calcium channel blockers because of the increased risk of CHF, bradycardia and asystole

• ADULT: 15mg over 2 min IVP/IO
• if no response in 15min repeat 20mg over 2 min if no response contact Med control
• PEDS: NO

Benadryl

Antihistamine, antidyskinetic(anticholinergic), sedative/hypnotic

• competes c histamine receptor sites
• CNS depressant and anticholinergic

• allergic symptoms
• dystonic reactions or extrapyramidal symptoms

• acute asthma(relative contraindication)
• nursing mothers
• glaucoma
• Hx of sleep apnea
• use caution in new borns or premature infants

• may precipitate an acute asthma attack due to thickening of the mucosal secretions. however it should not be withheld from a pt having an allergic reaction simply due to a hx of asthma
• may increase intra ocular pressure

IV, IO, IM, PO

ADULT: 25mg IM or IV

PEDS: >9 months 1mg/kg IVP/IM max of 25mg

• Dystonic reaction antipsychotic medication
• adults 25mg IM or IV
• Peds 1mg/kg IM or IV max of 25 mg

inotropin

sympathomimetic, catecholamine, vasopressor

• Renal/Mesenteric dose (1-5mcg/kg/min)
• 1.dilates renal and mesenteric arteries by stimulating dopaminergic receptors
• 2.increases urinary output

• inotropic dose (5-10 mcg/kg/min)
• 1. increases inotropy s increasing chronotropy
• 2. increases blood pressure by stimulating the beta₁ receptors

• VASOPRESSOR DOSE (10-20mcg/kg/min)
• 1. causes vasoconstriction (alpha); increasing blood pressure
• 2. increase inotropy and chronotropy (beta₁); increasing blood pressure

• Anaphylaxis allergic reaction
• cardiac arrest: PEA, Post ROSC hemodynamic instability, ROSC 2 2 block 3rd degree, 
• Cadiogenic shock
• Hemorrhage Medical, Sick person
• Unconscious hypotnesive
• 5-20mcg/kg/min

• Peds
• Haz Mat
• Anaphylaxis and allergic reaction
• Cardiac arrest PEA, asystole
• Cardiac arrest traumatic with vtach or v fib or aystole
• Post ROSC  2 2 block 3rd degree, Cadiogenic shock Hemorrhage Medical, Sick personUnconscious hypotnesive5-20mcg/kg/min IV
• Med control contact

• hypovolemia
• tachydysrhythmias
• hyperthermia
• V Fib

• cannulate largest vein possible and ensure IV patency
• start a second IV line if additional medications are needed (dopamine infusion should not be interrupted, to ensure adequate therapeutic blood levels)

• flush tubing a and p administration of HCO3 as dopamine will be inactivated by the change in pH
• actions may be intensified if pt is also taking antidepressants
• may cause hypotension if pt taking phenytoin(dilantin)

Anaphylaxis allergic reactioncardiac arrest: PEA, Post ROSC hemodynamic instability, ROSC 2 2 block 3rd degree, Cadiogenic shockHemorrhage Medical, Sick personUnconscious hypotnesive5-20mcg/kg/minPedsHaz MatAnaphylaxis and allergic reactionCardiac arrest PEA, asystoleCardiac arrest traumatic with vtach or v fib or aystolePost ROSC  2 2 block 3rd degree, Cadiogenic shock Hemorrhage Medical, Sick personUnconscious hypotnesive5-20mcg/kg/min IVMed control contact

Adrenalin

Sympathomimetic, catecholamine, vasopressor

• increases cardiac output and BP by increasing inotropy, chronotropy, and AV conduction(beta₁ effect)
• vasoconstriction; increases systolic blood pressure(alpha)
• relaxes the smooth muscles in the respiratory tract (beta₂ effect
• dilates the bronchioles (beta₂ effect)
• increases coronary perfusion during CPR by increaseing aortic diastolic pressure

• cardiac arrest
• asthma
• allergic reaction and anaphylactic shock
• symptomatic bradycardia (PEDS)
• beta blocke OD (PEDS)

• Caution with hypovolemia
• hypertension
• Caution with glaucoma
• Med control with pt >55 y/o unless a life threat condition.

• give slow IVP in conscious pt as it may cause permanent hearing loss
• monitor blood pressure and ECG frequently after administration due to the high incidence of cardiovascular side effects in pt above the age of 40

flush tubing a and p adminstration of HCO3 as epi will be inactivated by the change in pH

• ADULT:
• cardiac arrest: 1mg (1:10,000) IVP/IO may repeat q 3-5min
• asthma/ allergic reaction: 0.3mg -0.5mg (1:1,00) IM 
• Profound shock: 1ml (1:10,000) diluted in 10ml NS over 1-2min IV
• Persistent shock: 1-4 mcg/min IV (2mg 1:1,000 in 500ml NS)

Peds Cardiac arrest: 0.01mg/kg 1:10,000 IV, IOAnaphylaxis: 0.01mg/kg 1:1,000 IM (max-0.3mg)Hypotension 0.01-0.1 mg/kg/min (1:100,000) IVProfound shock 0.05-1mcg/kg,min (2mg 1:1,000 in 500ml NS)Croup 0.5 ml/kg (max 5ml) (1:1,000) in normal saline for total volume of 5ml

• Pt must be perfusing to effectively administer SQ injections
• most bradycardias in infants and children are due to hypoxia-consider aggressive ventilatory support prior to medication administration

sublimaze

narcotic analgesic

Provides analgesia and sedation by acting on the opiate receptors in the brain, blocking sensation of pain.

• sedation during rapid sequence intubation
• severe pain

• pt who have recieved MAO inhibitors in the last 14 days
• myasthenia gavis
• safe use in pregnancy and in children<2y/o not established

use with caution in head injuries, suspected or known increased interacranial pressure: the elderly, debilitated or immuno-compromised pt; COPD or other respiratiory problems and those with kidney or liver dysfunction

alcohol and other CNS depressants potentiate effects of fentanyl: MAO inhibitors may precipitate hypertensive crisis

• adult:
• Initial dose IN 2mcg/kg max of 200mcg/dose
• IV/IO/IM 1mcg/kg max of 100mcg
• Subsequent dose 1mcg/kg max of 100mcg any route
• Peds
• 1mcg/kg slow IV/IO/IN max 100mcg

hormone

• elevates blood glucose level by converting stored liver glycogen into glucose
• increases heart rate and myocardial contractility and improves AV conduction in a manner similar to that produced by catecholamines.

• ALOC c hypoglycemia when no IV can be established
• beta blocker OD

• only effective if liver glycogen is available, may be ineffective in chronic hypoglycemia or starvation pt
• use with caution in pt c cardiovascular disease or renal insufficiency/disease

• Adult:
• Hypoglycemia: 1mg IM; 
• Beta Blocker OD: 3mg IV/IO 
• Allergic reaction:(contact medical control) 1mg IV/IM

• Peds:  greater than 30 days old 0.05mg/kg IM; Max dose 1mg
• Allergic reaction:(contact medical control) <20kg-0.05mg/kg IM; Max dose 1mg
• Beta blocker OD=0.05mg/kg IM; Max dose 1mg

normodyne, trandate

Alpha and beta adregergic blocking agent

• combines selective alpgh and non selective beta adregergic blocking actions. both activities serve to reduce blood pressure.
• 1. alpha blockade leads to : vasodilation, decreased peripheral resistance, and orthostatic hypotension.
• 2. beta blockade leads to : effects on SA, AV nodes, and ventricular muscle that leads to bradycardia, delay in AV conduction and depression of cardiac contractility.

• alone or in combination c other drugs to control hypertension
• hypertensive emergencies

• cardiogenic shock
• cardiac failure
• bradycardia
• bronchial asthma
• 2^nd or 3^rd degree heart block

use with caution during laction, in impaired renal or hepatic function, in chronic bronchitis and emphysema, and in diabetes (may block signs of hypoglycemia), efficacy and safty in children has not been established

• beta adrenergic bronchodilators (i.e. Albuterol) labetalol decreases the bronchodilator effect of these drugs
• cimetidine (i.e. Tagamet): increases circulating labetalol levels
• tricyclic antidepressants (i.e. Elavil, tofranil) increased risk of tremors
• do not use with IV calcium channel blockers

IVPB, IV, IO, PO HOME MEDS

• Adult: 20mg slow IV push may repeat q 5min if pt remains hypertensive and symptomatic In presence of possible CVA with SBP >185 and or DBP >110
• Contact Med control for 10-20mg slow IVP
• Pt has hx of preeclampsia or is hypertensive 140/90. administer 20mg slow IV may repeat in 5min with persistent HTN
• Uncontrolled epistaxis with HTN contact med control

xylocaine, xylocard

antidysrhythmic agent, local anesthetic

• suppresses ventricular ectopy and increases VFIB threshold; blocks Na influx through fast Na channels and alters activity of some K channels
• decreases depolarization, automaticity, and excitability in the ventricles during the diastolic phase by direct action on the purkinje network

• ventricular dysrhythmias: symptomatic PVCs and monomorphic VTAC
• cardiac arrest: VFIB/ pulseless VTAC
• post conversion from a ventricular dysrhythmia (with pulses or pulseless) into a perfusing rhythm

• second degree block, Mobitz II
• third degree block
• junctional bradycardia
• ventricular ectopy associated c bradycardia
• idioventricular rhythm
• Stokes adams syndrome

due to reduced ability to excrete the drug and the resulting accumulation of the drug in the body, reduce dose in : suspected liver disease, suspected kidney disease, cardiogenic shock, pulmonary edema and elderly

• ADULT
• VFIB/ PulselessVtac: 1.5mg/kg  may repeat 0.5mg/kg IVP/IO  Max dose of 3mg/kg
• Head trauma Adult Peds for intubation
• 1.5mg/kg IV/IO 2-3 min prior to intubation
• IO 
• Adult 20-40mg (1-2ml) of lidocaine2%
• Peds 0.5mg/Kg IO max of 40mg

signs of lidocaine toxicity: vision disturbances (blurred or double vision), tinnitus, trembling, dyspnea, dizziness/ syncope, seizures, chest pain, palpations and bradycardic dysrhythmias.

Electrolyte, antidysrhythmic, anticonvulsant, cns depressant

• decreases acetylcholine in motor nerve terminals
• produces neuromuscular blockade in the CNS
• physiological calcium channel blocker

• Refractory vfib/pulsesless vtac(acls)
• treatment for torsades de pointes (polymorphic vtac)
• seizures associated c eclampsia and alcohol withdrawal
• dysrhythmias associated c digitalis toxicity
• bronchospasms refractory to traditional medications

• cardiogenic shock
• heart blocks
• renal insufficiency
• dialysis except in torsades

pt c renal insufficiency/disease (excreted through the kidneys)

IVP, IO, IM, IVPB

• Reactive airway respiratory distress
• Adult: 1-2 gm IV over 5-10min IV/IO
• Peds: 25mg/kg IV over 5-10min IV/IO
• Refactory Vfib
• adult 2gm over 1-2min IV IO
• Peds 50mg/kg IV/IO max 2g may repeat 5-10min if torsades is present
• Stable or untable v-tach
• Adult 2 grams over 1-2min
• PT >20weeks gestation or <1month post partum and had seizure 4g IV over 15min.
• May dilute in 150ml NS

calcium chloride can be used as an antidote should respiratory depression occur. in clinical trials as a neuro-protective drug for CVA pt

amnesic agent, sediative/hypnotic, anticonvulsant, benzodiazepine, tranquilizer, anti anxiety

Solu Medrol

Steroid

A potent Anti-inflammatory steroid.

• Adult 125mg IV
• Peds 2mg/kg max 125mg

Allergic reaction

Versed

Benzodiazepine, Seditive

• binds to benzodiazepine receptors
• increases the inhibitory neurotransmitter GABA leading to decreased agitation, relaxation of skeletal uscles, and in high doses sleep

• seizures
• prededication for synchronized cardioversion/TCP
• one of the premedications for RSI

• acute narrow-angle glaucoma
• shock (from hypovolemia)
• hypotension (from hypovolemia)
• alcohol or drug intoxication

• elderly pt c impaired respiratory function
• pt c renal failure, liver failure or COPD Lower doses should be used

IV,IO,IM,IN

• adult: 5.0-10mg IN or 5mg IM
• Peds: 0.15mg/kg IM or 0.2mg/kg IN (max 10mg IN max 5mg IM

opioid narcotic, cns depressant

• alters pain perception and produces euphoria
• decreases mycocardial o2 demand by decreasing preload (venous pooling due to peripheral vasodilation) and decreasing afterload (decreased systemic vascular resistance due to peripheral vasodilation)
• depresses the cns by interacting c opiate receptors in the brain

• moderate to severe pain
• chest pain of suspected myocardial origin
• pulmonary edema from CHF c or without chest pain
• burns

• ALOC
• abdominal pain of unknown etiology
• pt at risk of repiratory depression
• head injury
• hypovolemia

morphine sulfate is an opiate derivative - naloxone should be available to reverse any severe respiratory side effects

• Adult
• Pain: 1.0-10.0mg IV titrated to pain relief or 5.0-10.0 mg IM as a single dose only
• Pulmonay edema: 5.0-10mg slow IV push (2.0mg/min)

Peds: 0.1-0.2mg/kg slow IV push (1.0mg/min) titrated to pain relief or 0.1mg/kg IM

narcan

Narcotic Opiate antagonist

reverses the respiratory depression and cns sedation of narcotics by competing for opiate receptor sites in the brain

known or suspected narcotic overdoses c inadequate respiratory functions

not to be used if pt has adequate respiratory status

• give drug prior to intubation
• prepare to protect pt and ems personnel due to aggressive/combative personality following rapid reversal of a narotic OD
• does not reverse narcotic induced hypotension
• use c caution in narcotic addicts or chronic pain pt, as narcan will rapidly reverse the cns depresant effects of opiods.

• Adult 1.0-2.0mg IV/IM/IN titrate IV dose to adequate respiratory rate and tidal volume, May repeat dose q 5 min as needed to 10mg
• Peds:0.01mg- 0.1mg/kg IV/IM/IN max 2mg titrate IV doe to adequate respiratiory rate and tidal volme. may repeat dose q 5min to 10mg

Nitrolingual, nitrostat, nitrobid, tridil

vasodilator, nitrate, antianginal

• relaxes smooth muscles causing venous dilation
• reduces preload and afterload to the heart
• dilates the coronary arteries resulting in increased perfusion of the myocardium

• CP of cardiac origin
• acute pulmonary edema

• BP less than 90 systolic
• pt who have taken ED meds in the last 24-48 hrs
• signs and symptoms of head trauma or cerebral hemorrhage
• poor system perfusion

SL, TM

• Adult: 0.4mg SL single tablet. May repeat q 5min Until pain resolves
• nitropaste is 15mg per one inch, 
• BP >200 2"
• BP>150 and <200 1.5"
• BP >100 and <150 1"
• BP < 100 remove paste

nitronox

analgesic gas mixture(50% nitrous oxide and 50%oxygen)

• provides rapid relief from pain by depressing the CNS
• vasodilator

pain relief

• ALOC
• head injury
• abdominal nausea or pain
• COPD
• chest injury c posible pneumothorax
• plmonary edema
• pulmonay embolism
• alcohol or drug intoxication
• moderate to severe shock
• Pregnant Pts

need to monitor level of consciousness and airway closely

• Adult: self administered by pt c hand held mask until pt is relieved or pt drops mask
• Peds: same

ensure ambulance is well vented to avoid inhalation by paramedic. pt should be placed immediately onto high flow o2 following administration. may not operate properly at low temperatures. common drug of misuse and abuse.

zofran

selective serotonin (5-HT3) receptor antagonist, antiemitic

selective antagonist of the neurotransmitter serotonin in the cns at the chemoreceptor trigger zone and in the peripheral nervous system on nerve terminals of the vagus nerve blocking nausea and emesis

NV

use cautiously in pt c hepatic impairment

• drugs such as tagamet that alter hepatic drug metabolizing enzymes, phenobarbital and rifampin may change onset and duration of action of zofran
• cannot be given through same IV as furosemide, lorazepam, or sodium bicarb.

IV, IO, PR, PO

• Adult: 4-8mg IVP, IM PO
• Peds 0.15mg/kg max of 4mg

Gas

increases percentage of O2 in inspired air (FIO2)

• increased O2 demand
• hypoxemia or hypoxia
• respiratory insufficiency
• hypoperfusion state or trauma

• closely monitor pt c COPD
• pt c respiratory insufficiency should be monitored closely to ensure adequate ventilation
• non humidified O2 may cause drying of the mucous membranes
• neonates should not recieve high concentrations for long periods of time

• NC: 2-6L
• simple mask: 6-10L
• non rebreather: 10-16L
• HHN/neb mask: 6-8L
• BVM: 15L

NaHCO3

alkalinizing agent, Electrolyte

• increases blood pH by neutralizing excess buildup of acids
• decreases precipitation of myoglobin in renal tubules

• cardiopulmonary arrest c:
• unsuccessful drug therapy and defibrillation
• suspected hyperkalemia (elevated K in dialysis pt)
• crush syndrome or crush injury greater than 4 hrs
• suspected tricyclic OD c cardiac dysrhythmias

• use c caution in pt c CHF
• administer for crush syndrome prior to removal of entrapped pt, May cause arrhythmias.

fluch IV a and p administration as it will precipitate c calcium chloride and inactivates catecholamines

• ADULT: 1mEq/kg IV/IO (1amp)
• Peds: same

Potential cyanide poisoning

Allergies to drug

• Adult: 70mg/kg IV max 5gm
• Peds : same

isoptin, calan, verelan

calcium channel blocker, antihypertensive, antidysrhythmic

• inhibits alcium influx across cell membranes
• relaxes smooth muscles in vascular wall
• decreases SA and AV node conduction
• decreases PVR

• SVT/PSVT refractory to adenosine
• AFIB/ AFLU
• HTN
• angina

• severe CHF
• hx of sick sinus syndrome
• 2nd and 3rd degree blocks
• BP less than 90

• hepatic and renal disease
• pregnancy
• WPW
• hypotension

ensure pt s not taking beta blockers as a home medication

Adult: 2.5mg IV/IO c a 2nd dose of 5.0-10.0m IV/IO in 15-30 min to a max dose of 30.0mg

• Peds
• Infant: 0.1-0.2mg/kg c a max of 2.0mg
• child: 0.1-0.3mg/kg c a max of 5.0mg