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  1. Activated Charcoal Class?
    Absorbant
  2. Activated Charcoal Mechanism of Action
    Absorbs toxic substances from the gastrointestinal tract; onset of action is immediate.
  3. Activated Charcoal indications
    most oral poisonings and medication overdoses. Can be used after evacuation of poisonings.
  4. Activated Charcoal contraindications
    • oral administration to a comatose patient
    • after ingestion of corrosives, caustics, or petroleum distillates (ineffective and may induce vomitting)
    • simultaneous administration with other oral drugs
  5. Activated Charcoal adverse reactions
    • May induce nausea / vomitting
    • may cause constipation
    • may cause black stool (dark dookie)
  6. Activated Charcoal Drug interactions
    Bonds with and generally inactivates anything it mixes with (ex syrup of ipecac)
  7. Activated Charcoal how supplied
    25 or 50 gram black powder
  8. Activated Charcoal dosage and administration
    Note: if not in premixed slurry dilute and mix with 4 parts water (1:4 ratio)
  9. Activated Charcoal Adult Dosage
    1 to 2 grams per kilogram PO (oral) or via Nasal gastrointestinal tube
  10. Activated Charcoal Pediatric Dosage
    1 to 2 grams per kilogram PO (oral) or via Nasal gastrointestinal tube
  11. Activated Charcoal Duration of action
    Depends on the gastrointestinal function. Will act until excreted.
  12. Activated Charcoal Special Considerations
    • Often used in conjunction with magnesium citrate.
    • Must be stored in a close container
    • Does not absorb cyanide, lithium, iron, lead, or arsenic
  13. Albuterol (proventil / Ventolin) Class
    Sympathomimetic, Bronchiodilator
  14. Albuterol (proventil / Ventolin) Mechanism of Action
    Selective Beta-2 agonist that stimulates adrenergic receptors of the sympathomimetic nervous system resulting in smooth muscle relaxation in the bronchial tree and peripheral vasulature
  15. Albuterol (proventil / Ventolin) Indications
    • Treatment of bronchospasm in patient's with reversable obstructive airway disease (COPD / Asthma).
    • Prevention of excersise induced bronchospasm
  16. Albuterol (proventil / Ventolin) contraindications
    • Known prior hypersensitivity to albuterol
    • Tachicardia Arrhymmias, especially those caused by digitalis
    • Synergistic with other sympathominetics
  17. Albuterol (proventil / Ventolin) Adverse reactions
    Often dose related and include: restlessness, tremors, dizziness, palpitations, tachicardia, nervousness, peripheral vasodilation, nausea, vomitting, hyperglycemia, increase blood pressure, paradoxial bronchospasms.
  18. Albuterol (proventil / Ventolin) Drug Interactions
    Trycyllic Antidepressant may potentiate vasculature effects.Beta Blockers are antagonistic. May potentiate hypokalemia caused by diruetics.
  19. Albuterol (proventil / Ventolin) How supplied
    • Solution of aerosolization; .05% (5mg per mL.)
    • Metered dose inhaler: 90ug per metered spray (17g canister with 200 inhalations)
    • Syrup 2 mg per 5mL
  20. Albuterol (proventil / Ventolin) Adult dosage and administation
    Adult: Administer 2.5mg. Dilute .5mL of .5% solution with 2.5mL normal saline in nebulizer and administer over 10 to 15 minutes.

    Metered dose inhaler: 1 to 2 inhalations (90 to 180ug.) 5 minutes between inhalations
  21. Albuterol (proventil / Ventolin) Pediatric dosage and administration
    Administer solution of .01 to .03mL (.05 to .15mg per Kg per dose) diluted in 2mL of 0.9% normal saline. May repeat every 20 minutes 3 times.
  22. Albuterol (proventil / Ventolin) Duration of action
    Onset in 5 to 15 minutes with peak effect in 30 minutes to 2 hours and duration of 3 to 4 hours.
  23. Albuterol (proventil / Ventolin) Special Considerations
    • Pregnancy Safety: Category C antagonized by beta blockers (examples inderal, lopressor)
    • May precipitate angina pectoris and arrhythmias.
    • Should only be administered by inhalation methodogy in prehospital management
  24. Aspirin Class
    Platelet inhibitor / Anti inflamatory agent.
  25. Aspirin Mechanism of Action
    Prostaglandin inhibition
  26. Aspirin Indications
    New onset chest pain suggestive of acute myocardial infarction. Signs and symptoms suggestive of recent CVA
  27. Aspirin Contraindications
    Hypersensitivity and relatively contraindicated with active ulcer disease or asthma
  28. Aspirin Adverse Reactions
    • Heartburn, GI Bleeding, Prolonged bleeding, nausea / vomitting.
    • Wheezing in allergic patients
  29. Aspirin Interactions
    Use caution in patient's allergic to NSAIDs
  30. Aspirin How supplied
    81mg, 160mg or 325mg tablets. Chewable and standard
  31. Aspirin Duration of Action
    • Onset: 30 to 45 Minutes
    • Peak effect: variable
    • Duration: variable
  32. Aspirin special considerations
    • Pregnancy Safety: Category D
    • Not recommended in pediatric population
  33. Epinephrine (Adrenalin) Epi 1:1 Class
    Sympathometic
  34. Epinephrine (Adrenalin) Epi 1:1 Mechanism of Action
    • Direct acting alpha and beta agonist.
    • Alpha: Vasoconstriction.
    • Beta-1: Positive inotropic, chronotropic and dromotropic effects.
    • Beta-2: Bronchial Smooth muscle relaxation and dilation of skeletal vasculature.
  35. Epinephrine (Adrenalin) Epi 1:1 Indications
    • Cardiac Arrest (V-Fib / Pulseless V-Tac, Asystole, Pulseless electical activity)
    • Symtomatic Bradicardia: As an alternative infusion to dopamine
    • Severe Hypotension secondary to bradicardia when atropine and transcutaneous pacing are unsuccessful
    • Allergic Reactions: anaphalaxis
    • Asthma
  36. Epinephrine (Adrenalin) Epi 1:1 Contraindications
    • Hypertension
    • Hypothermia
    • Pulmonary edema
    • Myocardial Ischemia
    • Hypovolemic Shock
  37. Epinephrine (Adrenalin) Epi 1:1 Adverse Reactions
    • Hypertension
    • Tachicardia
    • Arrhymmias
    • Pulmonary Edema
    • Anxiety
    • Restlessness
    • Psychomotor agitation
    • Nausea
    • Headache
    • Angina
  38. Epinephrine (Adrenalin) Epi 1:1 Drug Interactions
    Potentiates Other symphathomimetics deactivated by alkaline solutions (ex: sodium bicarbonate), Monomine oxidase inhibitors (MAOIs) may potentiate effects, beta blockers may blunt effects.
  39. Epinephrine (Adrenalin) Epi 1:1 how supplied
    • 1 to 1000 solution: ampules and vials containing 1mg per mL
    • 1 to 10,000 solution: prefilled syringes containing 1mg in 10mL
    • Autoinjector (epipen) .05mg per mL (1 to 2000)
  40. Epinephrine (Adrenalin) Epi 1:1 Dosage and Administration (adult mild allergic reactions and asthma)
    .3 to .5mg of 1:1000 SC
  41. Epinephrine (Adrenalin) Epi 1:1 Dosage and Administration (adult anaphalaxis)
    .1mg (1mL of 1:10,000) IV/IO over 5 minutes
  42. Epinephrine (Adrenalin) Epi 1:1 Dosage and Administration (adult cardiac arrest)
    • IV/IO Dose: 1mg (10mL of 1:10,000 solution) every 3 to 5 minutes during resusitation. Follow each dose with 20mL flush and elevate arm for 10 to 20 seconds after dose.
    • Higher Dose: (up to .2mg per Kg) may be used for specific indiacations (beta blocker or calcium channel overdose).
    • Continuous infusion: Add 1mg(1mL of 1:1000 solution) to 500mL normal saline or d5w. Initial infusion rate of 1ug per minute titrated to effect. (typical dose: 2 to 10ug per minute).
    • Endotrachial Dose: 2 to 2.5mg diluted in 10mL normal saline.
  43. Epinephrine (Adrenalin) Epi 1:1 Dosage and Administration (adult profound bradicardia or hypotension)
    2 to 10ug per minute: titrate to patient response
  44. Epinephrine (Adrenalin) Epi 1:1 Dosage and Administration (pediatrics mild allergic reactions and asthma)
    0.01mg per kg (0.01mL per kg) of 1:1000 solution SC (maximum of .3mL)
  45. Epinephrine (Adrenalin) Epi 1:1 Dosage and Administration (pediatrics cardiac arrest)
    • IV/IO Dose: .01mg per kg (.1mL per kg) of 1:10,000 solution every 3 to 5 minutes during arrest
    • All endotracial doses .1mg per kg (.1mL per kg) of 1:1000 solution
  46. Epinephrine (Adrenalin) Epi 1:1 Dosage and Administration (pediatrics symptomatic bradicardia)
    • IV/IO Dose: .01mg per kg (.1mL per kg) of 1:10,000 solution
    • All endotrachial doses: .1mg per kg (.1mL per kg) of 1:1000 solution
  47. Epinephrine (Adrenalin) Epi 1:1 Dosage and Administration (pediatrics coninutious IV/IO infusion)
    Begin with rapid infusion then titrate to response. Typical initial infusion .1 to 1ug per minute. Higher doses may be effective.
  48. Epinephrine (Adrenalin) Epi 1:1 Duration of Action
    • Onset: Immediate
    • Peak effect: Minutes
    • Duration: Several Minutes
  49. Epinephrine (Adrenalin) Epi 1:1 Special Considerations
    • Pregnancy Safety: Category C
    • May cause syncope in asthmatic children
    • May increase myocardial oxygen demand
  50. Nitroglycerin Class
    Vasodilator
  51. Nitroglycerine Mechanism of Action
    • Smooth muscle relaxant acting on vascular, bronchial, uterine, and intestinal smooth muscle
    • Dilation of arterioles and veins in the periphery
    • Reduces preload and afterload
    • Decreases the workload of the heart and thereby myocardial oxygen demand
  52. Nitroglycerine Indications
    • Acute angina pectoris
    • Ischemic Chest Pain
    • Hypertension
    • CHF
    • Pulmonary Edema
  53. Nitroglycerine Contraindications
    • Hypotension
    • Hypovolemia
    • Intercranial bleeding or head injury
    • Previous administration of viagra, revatio, levitra, cialis, or similar agents within past 24 hours
  54. Nitroglycerine Adverse Reactions
    Headache, hypotension, syncope, relex tachicardia, flushing, nausea, vomitting, diaphoresis, muscle twitching
  55. Nitroglycerine Drug interactions
    • Additive effects with other vasodialators
    • incapadible with other drugs IV
  56. Nitroglycerine How Supplied
    • Tablets: .15mg, .3mg, .4mg, .6mg
    • NTG Spray: .4mg to .8mg under the tounge
    • NTG IV (tridil)
  57. Nitroglycerine Dosage and administration
    • Adult
    • Tablets: .3 to .4mg sublingually. May repeat every 3 to 5 minutes with a maximum dose of 3 doses
    • NTG Spray: .4mg under the tounge. 1 to 2 sprays.
    • NTG IV Infusion: Begin at 10 to 20ug per minute. Increase by 5 to 10 drips per minute until desired effect
    • Pediatrics: Not recommended
  58. Nitroglycerine Duration of Action
    • Onset: 1 to 3 minutes
    • Peak Effect: 5 to 10 minutes
    • Duration: 20 to 30 minutes or if IV 5 to 10 minutes after discontinuation of infusion
  59. Nitroglycerine Special Considerations
    • Pregnancy Safety: Category C
    • Hypotension more common in geriatric population
    • NTG decomposes if exposed to light or heat. Must be kept airtight
    • Active ingredient may have a stinging effect when administered.
  60. Oral Glucose (insta glucose) Class
    Hyperglycemic
  61. Oral Glucose (insta glucose) Mechanism of Action
    Provides quickly absorbed glucose to increase blood glucose levels
  62. Oral Glucose (insta glucose) indications
    Conscious patient's with suspected hypoglycemia
  63. Oral Glucose (insta glucose) Contraindications
    • Decreased level of consciousnes
    • Nausea / vomitting
  64. Oral Glucose (insta glucose) Advserse reactions
    Nausea / Vomitting
  65. Oral Glucose (insta glucose) Drug interactions
    None
  66. Oral Glucose (insta glucose) How supplied
    • Glucola 300mL bottles
    • Glucose Pastes and Gels in various forms
  67. Oral Glucose (insta glucose) Dosage and administration (Pedi and Adult)
    Sipped slowly by patient until clinical improvement noted
  68. Oral Glucose (insta glucose) Duration of interaction
    • ONset: Immediate
    • Peak Effect: Variable
    • Duration: Variable
  69. Oxygen Class
    Naturally occuring atmospheric gas
  70. Oxygen Mechanism of action
    reverses hypoxia
  71. Oxygen Indications
    • Confirmed or expected hypoxia
    • Ischemic Chest pain
    • respiratory insufficiency
    • Prophylactically during air transport
    • Confirmed or suspected carbon monoxide poisoning
    • All other causes of tissue oxygenation
    • decreased level of consciousness
  72. Oxygen Contraindications
    • Certain patient's with COPD or emphysema who will not tolerate oxygen concentrations over 35%
    • Hyperventilation
  73. Oxygen Adverse Reactions
    • Decreased level of consciousness and respiratory depression in patients with chronic carbon monoxide retention
    • Retrolental fibroplasia if given high concentrations to premature infants. Maintain 30 to 40% oxygen
  74. Oxygen Drug interactions
    None
  75. Oxygen How Supplied
    Oxygen cylinders usually green and white of 100% compressed oxygen gas
  76. Oxygen Dosage and Administration
    • Adult: Cardiac Arrest and Carbon Monoxide Poisoning: 100%
    • Hypoxemia: 10 to 15L per minute via NRB
    • COPD: 1 to 6L per minute via NC or 28-35% via Venturi Mask
    • Be prepared to supply ventilatory support if higher concentrations of oxygen are needed
    • Pediatrics: Same as adult with exception of premature infant
  77. Oxygen Duration of Action
    • Onset: Immediate
    • Peak Effect: N/A
    • Duration: Less than 2 minutes
  78. Adenosine (Adenocard) Class
    Endogenious Nucleotide
  79. Adenosine (Adenocard) Mechanism of Action
    • Slows conduction time through the AV node
    • Can interupt reentry pathways
    • Slows heartrate
    • Actions directly on the sinus pacemaker cells
    • Is drug of choice or reentry SVT
    • Can be used diagnosticly for stable, wide complex, tachicardias of unknown type after two doses of lidocaine
  80. Adenosine (Adenocard) Indications
    • Conversion of PSVT to sinus rhythm
    • May convert reentry SVT due to wolff-parkinson-white syndrome
    • Not effective in converting atrial fibrilation / flutter or Ventricular tachicardia
  81. Adenosine (Adenocard) Contraindications
    • Second or third degree block or sick sinus syndrome
    • atrial flutter / fibrilation
    • ventricular tachicardia
    • hypersensitivity to adenosine
    • Poison induced tachicardia
  82. Adenosine (Adenocard) Adverse Reactions
    • Facial Flushing
    • Shortness of breath
    • Chest Pain
    • Headache
    • Paresthesia
    • Diaphoresis
    • Palpitations
    • Hypotension
    • Nausea
    • Metallic Taste
  83. Adenosine (Adenocard) Drug interactions
    • Methylxanthines (theophylline-like drugs) antagonize the effects of adenosine
    • Dipyridamole (persantine) potensiates the effects of adenosine
    • Carbamazepine (tegretal) may potensiate the AV node blocking the effects of adenosine
    • May cause bronchoconstriction in asthmatic patients
  84. Adenosine (Adenocard) How Supplied
    3mg per mL in 2 mL flip top vials for IV injection
  85. Adenosine (Adenocard) Dosage and administration (adult)
    Adults: 6mg over 1 to 3 seconds followed by a 20mL saline flush and elevate extremity; If no response after one to two minutes administer 12mg over 1 to 3 seconds. Maximum total dose of 30 mg.
  86. Adenosine (Adenocard) Dosage and administration (pediatric)
    .1 to .2mg per kg rapid IV; maximum single dose 12mg
  87. Adenosine (Adenocard) Duration of Action
    • Onset and peak effects in seconds
    • Duration is 12 seconds
  88. Adenosine (Adenocard) Special Considerations
    • Short half life limits side effects in most patients
    • Pregnancy Safety: Category C
  89. Amiodarone (Cordarone, Pacerone) Class
    Antiarrhythmic
  90. Amiodarone (Cordarone, Pacerone) Mechanism of Action
    Blocks sodium channels and myocardial potasium channels
  91. Amiodarone (Cordarone, Pacerone) Indications
    V-Fib / Pulseless V-Tac and unstable V-Tac in patient's refractory to other therapy
  92. Amiodarone (Cordarone, Pacerone) Contraindications
    • Known hypersensitivity
    • Cardiogenic Shock
    • Sinus Bradicardia
    • Second or third degree AV Block (unless a functional pacemaker is available)
  93. Amiodarone (Cordarone, Pacerone) Adverse Reactions
    • Hypotension
    • Bradicardia
    • Prolongation of the P-R, QRS, and QT intervals
  94. Amiodarone (Cordarone, Pacerone) Drug interactions
    • Use with digoxin may cause the digitalis toxicity
    • Antiarrhymtics may cause increased serum levels
    • Beta Blockers and calcium channel blockers may potensiate bradicardia, sinus arrest, and AV heartblocks.
  95. Amiodarone (Cordarone, Pacerone) How supplied
    Ampules containing 150mg per 3mL and prefilled syringes containing 150mg per 3mL
  96. Amiodarone (Cordarone, Pacerone) Dosage and Administration (adult)
    • V-Fib / Pulseless V-Tac (unresponsive to CPR, defibrilation, or vasopressors): 300mg IV/IO Push (recommended dilution in 20 to 30mL of D5W). INitial dose can be followed 1 time in 3 to 5 minutes at 150mg IV/IO push.
    • Recurrent Life threatening ventricular arrhythmias: Maxium cumulative dose is 2.2g per 24 hours and administered as follows: Rapid Infusion: 150mg IV/IO over 10 minutes (15mg per minute). May repeat rapid infusion every 10 minutes as needed. Slow infusion: 360mg IV/IO over 6 hours which is 1mg per minute. Maintainence infusion: 540mg IV/IO over 18 hours at .5mg per minute
  97. Amiodarone (Cordarone, Pacerone) Dosage and Administration (pediatrics)
    • Refractory V-Fib/ pulseless V-Tac: 5mg per kg IV/IO bolus. Can repeat the same dosage up to a total dose of 15mg per kg per 24 hour. Maximum single dose 300mg.
    • Perfusing supraventricular and ventricular tachicardias: Loading Dose of 5mg per kg IV/IO over 20 to 60 minutes (maximum single dose of 300mg) Can repeat to a maximum of 15mg/kg per day
  98. Amiodarone (Cordarone, Pacerone) Duration of Action
    • Onset: Immediate with peak effect in 10 to 15 minutes
    • Duration of Action: 30 to 45 minutes
  99. Amiodarone (Cordarone, Pacerone) Special Considerations
    • Pregnancy Safety- Category D
    • Monitor patient for hypotension
    • May worsen arrhythmias or precipitate new arrthymias.
  100. Atropine Sulfate Class
    Anticholinergic Agent
  101. Atropine Sulfate Mechanism of Action
    • Parasympatholytic: Inhibits action of acetycholine at postganglionic parasympathetic neuro effector sites
    • Increases heartrate in life threatening brady arrhythmias
  102. Atropine Sulfate Indications
    • Hemodynamicly unstable bradicardia
    • Asytole
    • Bradicardia (Less than 60bpm)
    • Pulseless Electrical Activity
    • Organophosphate poisoning
    • Bronchospastic pulmonary disorders
  103. Atropine Sulfate Contraindications
    • Tachicardia
    • Hypersensitivity
    • Unstable cardiovascular status in acute hemorrage
    • Myocardial Ischemia
    • Narrow angle glaucoma
  104. Atropine Sulfate Adverse Reactions
    • Headache
    • Dizziness
    • Palpitations
    • Nausea / Vomitting
    • Tachycardia
    • Arrhythmias
    • Anticolonergic Effects (blurred vision, dry mouth, urinary retention)
    • Paradoxical bradicardial when pushed slowly or at low doses
    • Flushed hot dry skin
  105. Atropine Sulfate Drug interactions
    • Potensial adverse effects when administered with digoxin, cholinergics, physostigmine.
    • Effects enhanced by antihistimines, procainamide, quinidine, antipsychotics, benzodiazapines, and antidepressants
  106. Atropine Sulfate How supplied
    • Prefillled syringes: 1mg in 10mL (.1mg per mL)
    • Nebulizer: .2% (1mg in .5mL) .5% (2.5mg in .5mL)
  107. Atropine Sulfate Dosage and administration (adult)
    • Asystole, bradicardic PEA: 1mg IV/IO push. May repeat every 3 to 5 minutes if asystole or PEA persists to a maximum of 3 doses (3mg)
    • Endotrachial Administration: 2-3mg diluted in 10mL of water or normal saline
    • Unstable Bradicardia: .5mg IV/IO every 3 to 5 minutes as needed not to exceed total dose of 3mg. Use shorter dosing intervals (3 minutes) and higher doses in severe clincal condtions
    • Organophosphate poisoning: Extremely large doses (2-3mg or higher) may be needed
  108. Atropine Sulfate Dosage and administration (pediatric)
    • .02mg/kg via IV/IO push; may double this dose for second IV/IO dose
    • minimum single dose .1mg
    • maximum doses: (child single dose: .5mg) (child total dose: 1mg) (adolescent single dose: 1mg) (adolescent total dose 2mg)
    • endotrachial administration: .3mg / kg. Absorbtion may be unreliable
  109. Atropine Sulfate Duration of Action
    • Onset: Immediate
    • Peak Effect: Rapid (1 to 2 minutes)
    • Duration: 2 to 6 hours
  110. Atropine Sulfate Special Considerations
    • Pregnancy Safety-C
    • Moderate doses may cause pupilary dilation
  111. Diltazam (Cardizem, Lyo-ject) Class
    Calcium Channel Blocker
  112. Diltazam (Cardizem, Lyo-ject) Mechanism of Action
    • Block influx of calcium ions into cardiac muscle
    • Prevent spasm of corronary arteries
    • Arteriol and Venous vasodilator
    • Reduces preload and afterload
    • Reduces myocardial oxygen demand
  113. Diltazam (Cardizem, Lyo-ject) Indications
    Control of rapid ventricular rates due to atrial flutter / A-Fib / Reentry SVT / Angina Pectoris
  114. Diltazam (Cardizem, Lyo-ject) Contraindications
    • Hypotension
    • Sick Sinus Syndrome
    • Second or Third degree AV Block
    • Cardiogenic shock
    • Wide Complex tachicardias
    • Poison / Drug induced Tachicardia
  115. Diltazam (Cardizem, Lyo-ject) Adverse Reactions
    • Bradicardia
    • Second or Third Degree AV Block
    • Chest Pain
    • CHF
    • Syncope
    • V-FIb
    • V-Tac
    • Nausea
    • Vomitting
    • Dizziness
    • Dry Mouth
    • Dyspnea (difficulty breathing)
    • Headache
  116. Diltazam (Cardizem, Lyo-ject) Drug interactions
    Caution in patient's using medications that affect cardiac contractility. In general should not be used on patient's taking beta blockers.
  117. Diltazam (Cardizem, Lyo-ject) How Supplied
    • 25mg per 5mL vial
    • 50mg per 10mL vial
    • Non refrigerated; lyo-ject syringe
  118. Diltazam (Cardizem, Lyo-ject) Dosage and administration
    • Initial Bolus: .25mg per kg. (average dose 15-20mg) IV over 2 minutes
    • If inadequate response may rebolus in 15 minutes: .35mg per kg (average dose 20 to 25mg) IV over 2 minutes
    • Maintainance Infusion of 5 to 15mg per hour
    • Not recommended for pediatrics
  119. Diltazam (Cardizem, Lyo-ject) Duration of Action
    • Onset: 2-5 minutes
    • Peak Effect: Variable
    • Duration: 2-3 hours
  120. Diltazam (Cardizem, Lyo-ject) Special Considerations
    • Pregnancy Safety Category C.
    • Use with caution in patient's with renal or hepatic disfunction
    • PVC's may be noted at time of converstion of PSVT to sinus rhythm
  121. Dopamine (Intropin) Class
    • Sympthomimetic
    • Inotropic Agent
  122. Dopamine (Intropin) Mechanism of Action
    Immediate metabolic precursor to norepinephrine. Increases systemic vascular reisistance, dialates renal and splanchnic vasculature. Increases myocardial contractility and stroke volume
  123. Dopamine (Intropin) Indications
    • Cardiogenic, septic, or spinal shock
    • Hypotension with low cardiac output states
    • Distributive shock
  124. Dopamine (Intropin) Contraindications
    • Hypovolemic Shock
    • Pheochromocytoma
    • Tachyarrhythmias
    • V-Fib
  125. Dopamine (Intropin) Adverse Reactions
    • Cardiac Arrthymias
    • Hypertension
    • Increased Myocardial oxygen demand; extravasation may cause necrosis
  126. Dopamine (Intropin) Drug interactions
    • Incapatible in alkaline solutions. MAOI's will enhance effects of dopamine
    • Pretylium may potentiate the effect of dopamine.
    • Beta Blockers may antagonize effects of dopamine
    • When administered with phenytoin; may cause hypertension, bradicardia, seizures
  127. Dopamine (Intropin) How supplied
    • 250mg per 5mL to 400mg per 500mL prefilled syringes,
    • ampules for IV infusion 400mg in 250mL D5W premixed solutions
  128. Dopamine (Intropin) Dosage and administratio(Adult & Pediatric)
    • Adult: 2 to 20 drips per kg per minute titrated to patient response
    • Pediatric is the same
  129. Dopamine (Intropin) Duration of Action
    • Onset- 1 to 4 minutes
    • Peak Effect- 5 to 10 minutes
    • Duration- Effects cease almost immediately after infusion is shut off
  130. Dopamine (Intropin) Special considerations
    • Pregnancy Safety not established
    • Effects are dose dependant
    • Dopaminergic response: 2-4 drips per kg per minute: dialates vessels in kidneys; increased urine output
    • Beta-adregergic response: 4 to 10 drips per kg per minute: positive chronotropic and inotropic adregergic response: 10 to 20 drips per kg per minute: primary alpha stimulant / vasocontriction
    • Greater than 20 drips per kg per minute: Reversal of renal effects / override alpha effects
    • Always monitor drip rate
    • Avoid extravasation injury
  131. Lidocaine (Xylocaine) Class
    Antiarrhythmic
  132. Lidocaine (Xylocaine) Mechanism of Action
    Decreases automaticity by slowing the rate of phase 4 depolariztion
  133. Lidocaine (Xylocaine) Indications
    Alternative to amiodarone in cardiac arrest from V-Fib to pulseless V-Tac, stable monomorphic V-Tac, Stable polymorphic V-Tac with normal baseline QT interval
  134. Lidocaine (Xylocaine) Contraindications
    • Hypersensitivity
    • Second and Third degree AV blocks in the absense of artificial pacemaker
    • Stokes Adams Syndrome
    • Profalactic use in AMI
    • Wide Complex Ventricular escape beats with bradicardia
  135. Lidocaine (Xylocaine) Adverse Reactions
    • Slurred Speech
    • Seizures with high doses
    • Altered Mental Status
    • Confusion
    • Lightheadedness
    • Blurred Vision
    • Bradicardia
  136. Lidocaine (Xylocaine) Drug interactions
    • Apnea induced with succinylcholine may be prolonged with high doses of lidocaine. Cardiac Depression may occur in conjunction with IV Phenytoin (Dilatin)
    • Procainamide may exaserbate central nervous system effects
    • Metabolic clearance is decreased in patient's with liver disease or patient's taking beta blockers
  137. Lidocaine (Xylocaine) How Supplied
    • 100mg in 5mL prefilled syringes and ampules (20mg per mL)
    • 1g and 2g additive syringes, 1 and 2 gram vials in 30mL of solution
  138. Lidocaine (Xylocaine) Dosage and administration (adult)
    • Cardiac Arrest (V-FIb/Pulseless V-Tac): Initial Dose: 1-1.5mg per kg IV/IO. Repeat dose .5-.75mg per kg, repeated in 5 to 10 minutes to maximum dose of 3mg per kg.
    • Endotrachial Dose: 2-4mg per kg
    • Stable V-Tac, Wide Complex Tachicardia of uncertain type, Signifigant ectopy: Doses ranging from .5-.75mg per kg and up to 1-1.5mg per kg may be used. Repeat .5 to .75mg per kg every 5 to 10 minutes. Max total dose is 3mg per kg
    • Maintainence infusion: 1 to 4mg per minute (30 to 50 drops per kg per minute); can dilute in D5W or Normal Saline
  139. Lidocaine (Xylocaine) Dosage and administration (pediatric)
    • IV/IO Dose: 1mg per kg rapid IV/IO Push. Max Dose 100mg. Continuous IV/IO infusion: 20to50 drops per kg per minute. Administer bolus dose (1mg per kg) when infusion is initiated if bolus has not been given within previous 15 minutes.
    • Endotrachial dose: 2-3mg per kg
  140. Lidocaine (Xylocaine) Duration of Action
    • Onset: 1-3 minutes
    • Peak Effect: 5 to 10 minutes
    • Duration: Variable (15 minutes to 2 hours)
  141. Lidocaine (Xylocaine) Special Considerations
    • Pregnancy Safety Category B
    • Reduce Maintanence infusions by 50% if patient is over 70 years of age, has liver or renal disease, or is in CHF or shock.
    • A 75 to 100mg bolus maintains blood levels for only 20 minutes if not in shock.
    • Exceedingly high doses of lidocaine can result in coma or death.
    • Avoid lidocaine for reprofusion arrhythmias after fibrinolytic therepy.
    • Cross / Reactivity with other forms of local anethesics.
  142. Magnesium Sulfate Class
    Electrolyte
  143. Magnesium Sulfate Mechanism of Action
    Reduces striated muscle contractions and blocks peripheral nuero muscular transmission by reducing Acetylcholine release at the myonueral junction, manages seizures in toxemia of pregnancy, induces uterine relaxation, cause bronchodilations after betagnists and anticolonerigcs have been used.
  144. Magnesium Sulfate Indications
    • Seizures of ecclampsia (toxemia of pregnancy)
    • Torsade de Pointes
    • Hypomagnesia
    • Class 2A agent for V-Fib/pulseless V-Tac that is refractory to lidocaine
  145. Magnesium Sulfate Contraindications
    Heart blocks and myocardial damage
  146. Magnesium Sulfate Adverse Reactions
    • CNS Depression
    • Facial Flushing
    • Diaphoresis
    • Depressed reflexes
    • Circulatory Collapse
    • Hypotension
  147. Magnesium Sulfate Drug interactions
    • May enhance effects of other CNS depressants
    • serious changes in overall cardiac function may occur with cardiac glycosides
  148. Magnesium Sulfate How supplied
    10%, 12.5%, 50% solution in 40, 80, 100, 250mg per mL
  149. Magnesium Sulfate Dosage and Administration (adult)
    • Seizure activity associated with pregnancy: 1 to 4g IV/IO over 3 minutes; maximum dose of 30 to 40 grams per day
    • Cardiac Arrest due to hypomagnesemia or Torsade de Pointes: 1 to 2 grams (2 to 4mL of a 50% solution) diluted in 10mL of D5W IV/IO over 15 to 20 minutes
    • Torsade de Pointes with a pulse or acute myocardial infarction with hypomagnesemia: Loading dose of 1 to 2 grams mixed in 50 to 100mL D5W over 5 to 6 minutes IV. Follow with .5 to 1g per hour IV (titrate to control Torsade de pointes)
  150. Magnesium Sulfate Dosage and Administration (pediatric)
    • IV/IO infusion 25 to 50mg per kg (maximum dose 2g) over 10 to 20 minutes; faster for Torsade de Pointes
    • For asthma: 25 to 50mg per kg (maximum dose 2g) over 10 to 20 minutes
  151. Magnesium Sulfate Duration of action
    • Onset: IV/IO: Immediate
    • IM: 3 to 4 hours
    • Duration: IV/IO: 30 minutes
    • IM: 3 to 4 hours
  152. Magnesium Sulfate Special Considerations
    • Pregnancy Safety Category B
    • Recommended that the drug not be given in the 2 hours before delivery if possible
    • IV calcium chloride or calcium gluconate should be available as a magnesium antagonist if needed.
    • Use with caution in patient's with renal failure
  153. Norepinephrine (Levophed / Levarterenol) class
    Sympathomimetic
  154. Norepinephrine (Levophed / Levarterenol) Mechanism of Action
    • Potenent alpha agonist resulting in intense vaso contriction
    • Positive chronotropic and increased inotropic effects (from 10% beta effects) with increased cardiac output
  155. Norepinephrine (Levophed / Levarterenol) Indications
    Cardiogenic Shock and Significant hypotensive states (less than 70mmHg)
  156. Norepinephrine (Levophed / Levarterenol) Contraindications
    • Hypotensive patient's with hypovolemia
    • Pregnancy (which is a relative contraindication)
  157. Norepinephrine (Levophed / Levarterenol) Adverse Reactions
    • Headache
    • Arrythmias
    • Tachicardia
    • Reflex Bradicardia
    • Angina Pectoris
    • Hypertension
    • Decreased blood flow to gastro intestinal tract, kidneys, skeletal muscles, skin
  158. Norepinephrine (Levophed / Levarterenol) Drug interactions
    • Can be deactivated by alkaline solutions, sympathomimetics, and phosphodiesterase inhibitors may exaserbate arrhythmias
    • Bretylium may potensiate the effects catachomines
  159. Norepinephrine (Levophed / Levarterenol) How Supplied
    1mg per mL, 4mL ampules
  160. Norepinephrine (Levophed / Levarterenol) Dosage and Administration for Adult
    • Dilute 8mg in 500mL of D5W or 4mg in 250mL of d5W (16mg per mL)
    • Infuse by IV piggyback at .5 to 1 drips per minute titrated to improved blood pressure (up to 30 drips per minute
  161. Norepinephrine (Levophed / Levarterenol) Dosage and Administration (Pediatric)
    .1 to 1 drop per minute IV infusion, titrated to patient response.
  162. Norepinephrine (Levophed / Levarterenol) Duration of Action
    • Onset: 1 to 3 minutes
    • Peak Effect: Variable
    • Duration: 1 to 10 minutes (lasts only 1 minute after infusion is discontinued)
  163. Norepinephrine (Levophed / Levarterenol) Special Considerations
    • Pregnancy Class: Not established
    • May cause fetal anoxia when used in pregnancy. Must be infused through a large stable vein to avoid tissue necrosis (antidote: local phentolamine injection)
    • Often used with low dose dopamine to spare renal and mesenteric blood flow
  164. Vasopressin (Pitressin synthetic) Class
    Antidiuretic hormone
  165. Vasopressin (Pitressin synthetic) Mechanism of Action
    • Stimulation of the V1 smooth muscle receptors.
    • Potent vasocontrictor when given in high doses
  166. Vasopressin (Pitressin synthetic) Indications
    Alternate vasopressor to the first or second dose of epinephrine in cardiac arrest, may be useful in cases of vasodialatory shock (example: septic shock)
  167. Vasopressin (Pitressin synthetic) Contraindications
    Responsive patient's with coronary artery disease
  168. Vasopressin (Pitressin synthetic) Adverse REactions
    Bronchoconstriction, Ischemic Chest Pain, Nausea/vomitting, abdominal pain
  169. Vasopressin (Pitressin synthetic) Drug interactions
    None
  170. Vasopressin (Pitressin synthetic) How supplied
    1mL vials containing 20 units (20 u per mL)
  171. Vasopressin (Pitressin synthetic) Dosage and Administration
    • Adult: 40 unit 1 time dose IV/IO to replace the first or second dose of epinephrine in cardiac arrest
    • Pedi: Not recommended
  172. Vasopressin (Pitressin synthetic) Duration of Action
    • Onset: Immediate
    • Duration: Variable
  173. Vasopressin (Pitressin synthetic) Special considerations
    • Pregnancy Safety: Category C
    • May increase peripheral vascular resistance and provoke cardiac ischemia and angina
  174. 5% Dextrose in Water (D5W) Class
    Hypotonic dextrose-containing solution
  175. 5% Dextrose in Water (D5W) Mechanism of Action
    D5W provides nutrients in the form of dextrose as well as free water
  176. 5% Dextrose in Water (D5W) Indications
    IV Access for emergency drugs; for dilution of concentrated drugs for intravenous infusion
  177. 5% Dextrose in Water (D5W) Contraindications
    D5W should not be used as a fluid replacement for hypovolemic state
  178. 5% Dextrose in Water (D5W) Adverse Reactions
    Rare in therapeutic doses
  179. 5% Dextrose in Water (D5W) Drug interactions
    D5W should not be used with phenytoin (dilantin) or ammrinon (Incor)
  180. 5% Dextrose in Water (D5W) How supplied
    D5W is supplied in bags of 50, 100, 150, 250, 500, 1000mL
  181. 5% Dextrose in Water (D5W) Dosage and Administration
    D5W is usually administered through a mini drip (60 drops per mL) at a rate of TKO (To keep vein open)
  182. 5% Dextrose in Water (D5W) Duration of Action
    Short term therapy
  183. 5% Dextrose in Water (D5W) Special Considerations
    None
  184. Lactated Ringers (Hartman's Solution) Class
    Isotonic Crystaloid Solution
  185. Lactated Ringers (Hartman's Solution) Mechanism of Action
    Lactated Ringers replaces water and electrolytes
  186. Lactated Ringers (Hartman's Solution) Indications
    Hypovolemic Shock and TKO IV
  187. Lactated Ringers (Hartman's Solution) Contraindications
    CHF or Renal Failure Patient's
  188. Lactated Ringers (Hartman's Solution) Adverse Reactions
    Rare in therapeutic Doses
  189. Lactated Ringers (Hartman's Solution) Drug interactions
    Few in the emergency setting
  190. Lactated Ringers (Hartman's Solution) How Supplied
    LR is supplied in 250, 500, 100mL bags for IV infusion
  191. Lactated Ringers (Hartman's Solution) Dosage and Administration
    For hypovolemic shock: titrated according to patient's physiological response
  192. Lactated Ringers (Hartman's Solution) Duration of Action
    Short Term Therapy
  193. Lactated Ringers (Hartman's Solution) Special Considerations
    None
  194. Normal Saline (NS, .9% Sodium Chloride) Class
    Isotonic Crystaloid Solution
  195. Normal Saline (NS, .9% Sodium Chloride) Mechanism of Action
    Normal saline replaces water and electolytes
  196. Normal Saline (NS, .9% Sodium Chloride) Indications
    • Heat related problems (heat exhaustion, head stroke)
    • Fresh Water drowning
    • Hypovolemia
    • Diabetic Ketoacidosis
    • TKO
  197. Normal Saline (NS, .9% Sodium Chloride) Contraindications
    Use of NS should not be considered in patient's with CHF as circulatory overload can be easily induced.
  198. Normal Saline (NS, .9% Sodium Chloride) Adverse Reactions
    Rare in therapeutic doses
  199. Normal Saline (NS, .9% Sodium Chloride) Drug interactions
    Few in Emergency setting
  200. Normal Saline (NS, .9% Sodium Chloride) How Supplied
    • NS is supplieed in 250, 500, 1000mL bags.
    • Sterile normal saline for irrigation should not be confused with that designed for IV administration
  201. Normal Saline (NS, .9% Sodium Chloride) Dosage and Administration
    • The specific situation being treated will dictate the rate in which NS will be administered.
    • In severe heat stroke, diabetic ketoacidosis, and fresh water drowning it is likely that you will be called on to administer the fluid quite rapidly. In other cases it is advisable to administer the fluid at a moderate rate (for example 100mL per hour)
  202. Normal Saline (NS, .9% Sodium Chloride) Duration of Action
    Short term therapy
  203. Normal Saline (NS, .9% Sodium Chloride) Special Considerations
    None
  204. Calcium Chloride Class
    Electrolyte
  205. Calcium Chloride Mechanism of Action
    Increases cardiac contractile state (positive inotropic effect). May enhance ventricular automaticity
  206. Calcium Chloride Indications
    Hypocalcemia, Hypercalemia, Magnesium Sulfate Overdose, Calcium Channel Blocker Overdose, Adjunctive therapy of insects bits and stings
  207. Calcium Chloride Contraindications
    Hypercalcemia, V Fib, digitalis toxicity
  208. Calcium Chloride Adverse Reactions
    Bradicardia, Asystole, Hypotension, peripheral vasodilation, metallic taste, local necrosis, choronary and cerbral artery spasm, nausea, vomitting
  209. Calcium Chloride Drug interactions
    • May worsen arrythmias secondary to digitalis toxicity.
    • May antagonize the effects of verapamil
    • Do not mix or infuse immediately before or after sodium bicarbonate without intervening flush
  210. Calcium Chloride How supplied
    Prefilled syringes containing a 10% solution in 10mL (100mg per mL)
  211. Calcium Chloride Dosage and Administration (Adult)
    500mg to 1000mg (5 to 10mL of a 10% solution) IV/IO Push for hyperkalemia and calcium channel blocker overdose. May be repeated as needed
  212. Calcium Chloride Dosage and Administration (pediatric)
    20mg per kg (.2mL per kg) slow IV/IO push. Maximum 1g dose. May repeat in 10 minutes
  213. Calcium Chloride Duration of Action
    • Onset: 5 to 15 minutes
    • Peak Effect: 3 to 5 minutes
    • Duration : 15 to 30 minutes but may persist to 4 hours (dose dependant)
  214. Calcium Chloride Special Considerations
    • Pregnancy Safety Category C
    • Do not use routinely in cardiac arrest
  215. Dextrose (D50) Class
    Carbohydrate, hypertonic solution
  216. Dextrose (D50) Mechanism of Action
    Rapidly increases serum glucose levels. Short term osmotic diuresis.
  217. Dextrose (D50) Indications
    Hypoglycemia, Altered levels of consciousness, Coma of unknown etiology, Seizure of unknown etiology. Staus epilepticus.
  218. Dextrose (D50) Contraindications
    Intracranial hemmorhage
  219. Dextrose (D50) Adverse Reactions
    • Extravasation leads to tissue necrosis
    • Warmth
    • Pain
    • Burning
    • thrombophlebitis
    • Rhabdomyolysis
    • Hyperglycemia
  220. Dextrose (D50) Drug interactions
    • Sodium Bicarbonate
    • Coumadin
  221. Dextrose (D50) How Supplied
    25g per 50mL prefilled syringes (500mg per mL)
  222. Dextrose (D50) Dosage and Administration (Adult)
    • 12.5 to 25 grams slow IV .
    • May be repeated as nessicary
  223. Dextrose (D50) Dosage and Administration (Pediatric)
    .5 to 1g per kg per dose slow IV. May be repeated as nessicary
  224. Dextrose (D50) Duration of Action
    • Onset: Less than 1 minute
    • Peak Effect: Variable
    • Duration: variable
  225. Dextrose (D50) Special Considerations
    • Administer thiamine prior to D50 in known alcoholic patient's.
    • Draw blood to determine glucose level before administering
    • Do not administer to patient's with known CVA unless hypoglycemia documented.
  226. Diphenhydramine (Benadryl) Class
    Antihistamine, Anticholinergic
  227. Diphenhydramine (Benadryl) Mechanism of Action
    Blocks cellular histamine receptors. Decreases vasodialation. Decreases motion sickness, and reverses extrapyramidal reactions.
  228. Diphenhydramine (Benadryl) Indications
    Symptomatic Relief of allergies, allergic reactions, anaphalaxis, Acute distonic reactions (phenothiazines), Blood administration reactions; used for motion sickness, hay fever
  229. Diphenhydramine (Benadryl) Contraindications
    Asthma, Glaucoma, Pregnancy, Hypertension, Narrow angle glaucoma, infants, patient's taking MAOI's
  230. Diphenhydramine (Benadryl) Adverse Reactions
    Sedation, hypotension, Seizures, Visual disturbances, vomitting, urinary retention, palpitations, arrhythmias, dry mouth and throat, paradoxial CNS excitation in children
  231. Diphenhydramine (Benadryl) Drug Interactions
    Potentiates effects of alcohol and other anticholonergics, May inhibit corticosteroid activity; MAOI prolong anticholonergic effect of diphenhydramine
  232. Diphenhydramine (Benadryl) How supplied
    • tablets; 25 and 50mg
    • capsules: 25 and 50mg
    • Prefilled syringes: 50 or 100mg
    • Vials: IV or IM; elixir: 12.5mg per 5mL
  233. Diphenhydramine (Benadryl) Dosage and Administration (Adult and Pediatric)
    • Adult: 25 to 50 mg IM/IV/PO
    • Pediatric: 1 to 2mg per kg IV/IO(slowly)/ IM
    • If given PO 5mg per kg for 24 hours
  234. Diphenhydramine (Benadryl) Duration of Action
    • Onset: 15 to 30 minutes
    • Peak Effect: 1 hour
    • Duration: 3 to 12 hours
  235. Diphenhydramine (Benadryl) Special Considerations
    • Not used in infants or pregnancy (Category B)
    • If used in anaphylasis will be in conjunct with epinephrine, coritcosteroids
  236. Furosemide (Lasix) Class
    Loop Diruetic
  237. Furosemide (Lasix) Mechanism of Action
    Inhibits electrolyte reabsorbtion and promotes excretion of sodium, potasium, and chloride
  238. Furosemide (Lasix) Indications
    CHF, Pulmonary Edema, Hypertensive Crisis,
  239. Furosemide (Lasix) Contraindications
    • Hypovolemia
    • Anuria
    • Hypotension (relative contraindication)
    • Hypersensitivity
    • Hepatic Coma
  240. Furosemide (Lasix) Adverse Reactions
    • Exacerbate hypovolemia
    • hypokalemia
    • ecg changes
    • dry mouth
    • hypochloremia
    • hyponatremia
    • hyperglycemia (due to hemoconcentration)
  241. Furosemide (Lasix) Drug interactions
    • Lithium toxicity may be potentiated by sodium depletion
    • Digitalis toxicity may be potentiated by potassium depletion
  242. Furosemide (Lasix) How supplied
    100mg per 5mL, 20mg per 2mL, 40mg per 4mL vials
  243. Furosemide (Lasix) Dosage and Administration (adult and pediatric)
    Adult: .5 to 1mg per kg injected IV over 1 to 2 minutes. If no response double the dose to 2mg per kg over 1 to 2 minutes.

    Pediatrics: 1mg per kg per dose IV/IO
  244. Furosemide (Lasix) Duration of Action
    • Onset: 5 minutes
    • Peak Effects: 20 to 60 minutes
    • Duration: 4 to 6 hours
  245. Furosemide (Lasix) Special Considerations
    • Pregnancy Safety: Category C
    • Ototoxicity and deafness can occur with rapid administration. Should be protected from light.
  246. Glucagon Class
    • Hyperglycemic Agent
    • Pancreatic Hormone
    • Insulin antagonist
  247. Glucagon Mechanism of Action
    Increases blood glucose level by stimulating glycogenolysis. Unknown mechanism of stabilizing cardiac rhythm in beta blocker overdose. Minimal positive inotropic and chronotropic response. Decreases gastrointestinal motility and secretion
  248. Glucagon Indications
    • Alerted levels of consciousness when hypoglycemia is suspected
    • May be used as a inotropic agent in beta blocker overdose.
  249. Glucagon Contraindications
    • Hyperglycemia
    • Hypersensitivity
  250. Glucagon Adverse Reactions
    Nausea, vomitting, tachycardia, hypertension
  251. Glucagon Drug interactions
    • Incompatible in solution with most other substances.
    • No signifigant drug interactions with other emergency medications
  252. Glucagon How supplied
    1mg ampules (requires reconstitution with diluent provided)
  253. Glucagon Dosage and Administration (Adult)
    • Hypoglycemia: .5 to 1mg IM: may repeat in 7 to 10 minutes
    • Calcium Channel Blocker / Beta Blocker Overdose: 3mg initially followed by infusion at 3mg per hour as nessicary
  254. Glucagon Dosage and Administration (Pediatric)
    • For Hypoglycemia: .5 to 1mg IM for children less than 20kg.
    • Calcium Channel Blocker / Beta Blocker Overdose: Not recommended
  255. Glucagon Duration of Action
    • Onset: 1 Minute
    • Peak Effect: 30 minutes
    • Duration: Variable (generally 9 to 17 minutes)
  256. Glucagon Special Considerations
    • Pregnancy Category C
    • Ineffective if glycogen stores is depleted
    • Should always be used in conjunction with 50% dextrose whenever possible
    • If patient does not respond to second dose of Glucagon, 50% dextrose must be administered
  257. Naloxone (Narcan) Class
    Narcotic Antagonist
  258. Naloxone (Narcan) Mechanism of Action
    Competive inhibition at narcotic receptor sites. Reverse respiratory depression secondary to opiate drugs. Completely inhibits the effects of morphine
  259. Naloxone (Narcan) Indications
    • Opiate Overdose, Coma
    • Complete or partial reversal of CNS or respiratory depression induced by opioids
    • decreased level of consciousness
    • coma of unknown origin
    • Narcotic Agonist for the following: Morphine, Heroin, Hydomorphone (Dilaudid), Methodone, Meperidine (Demerol), Paregoric, Fentanyl (sublimase), oxycodone (percodan), Codeine, Propoxyphene (Darvon),
    • Narcotic Agonist and Antagonist for the following: Butorphanol (stadol), Pentazocine (talowin), Nalbuphine (nubain).
  260. Naloxone (Narcan) Contraindications
    Use caution with narcotic dependent patient's. Use with caution with neonates with narcotic addicted mothers
  261. Naloxone (Narcan) Adverse Reactions
    • Withdrawl symptoms in the addicted patient
    • hypertension
    • tachycardia
    • arrhythmias
    • nausea
    • vomitting
    • diaphoresis
  262. Naloxone (Narcan) Drug Interactions
    Incompatible with bisulfite and alkaline solutions
  263. Naloxone (Narcan) How supplied
    • .2mg per mL (neonate) ampules
    • .4mg per mL ampules
    • 1mg per mL ampules
    • 2mg per 5mL ampules
    • 2mg per 5mL prefilled syringe
  264. Naloxone (Narcan) Dosage and Administration (adult)
    • .4 to 2mg IV/IM/SC/ET (diluated)
    • Minimum recommended dose 2mg
    • repeat at 5 minute intervals to a maximum dose of 10mg
    • Medical control may request higher amounts,.

    • Infusion: 2mg in 500mL of D5W at (4 drips per mL)
    • Infuse at .4mg per house (100mL per hour)
  265. Naloxone (Narcan) Dosage and Administration (Pediatric)
    • .1mg per kg per dose IV/IM/SC/ET (diluted for ET)
    • Maximum dose of .8mg if no response in 10 minutes administer an additional .1mg per kg per dose.
  266. Naloxone (Narcan) Duration of Action
    • Onset: within 2 minutes
    • Peak Effect: Variable
    • Duration: 30 to 60 minutes
  267. Naloxone (Narcan) Special Considerations
    • Pregnancy Safety: B
    • Seizures without casual relationship have been reported
    • May not reverse Hypotension
    • Use caution when administering to narcotic addicts (potential violent behavior)
  268. Vecuronium (Norcuron) Class
    Paralytic Agent
  269. Vecuronium (Norcuron) Mechanism of Action
    Nondepolarizing nueromuscular blocking agent.
  270. Vecuronium (Norcuron) Indication
    • To facilitate intubation,
    • to terminate laryngospasm
    • To promote muscle relaxation
    • To facilitate electroconvulsive shock therepy
  271. Vecuronium (Norcuron) Contraindications
    • Acute Narrow angle glaucoma
    • Penetrating eye injuries
    • Inability to ventilate or support airway with oxygen and positive pressure
    • Newborns: Myasthenia gravis, hepatic or renal failure
  272. Vecuronium (Norcuron) Adverse Reactions
    • Apnea
    • Weakness
    • Salivation
    • Premature ventricular contractions
    • tachycardia
    • Increased blood pressure
  273. Vecuronium (Norcuron) Drug interactions
    Use of inhalation anestetics will enhance nueromuscular blockade
  274. Vecuronium (Norcuron) How supplied
    • 10mg per 10mL vercuronium bromide vials with diluent.
    • 20mL vials (20mg vercuronium) without diluent
  275. Vecuronium (Norcuron) Dosage and Administration (Adult)
    • .1mg per kg IV push
    • Maintainence Dose within 25 to 40 minutes: .01-.05mg per kg IV push
  276. Vecuronium (Norcuron) Dosage and Administration (Pediatric)
    .1mg per kg IV/IO; maintainence dose with in 20-35 minutes (.01 to .05mg per kg IV push)
  277. Vecuronium (Norcuron) Duration of Action
    • Onset: 30 seconds
    • Peak Effects: 2.5 to 3 minutes
    • Duration: 25 to 30 minutes
  278. Vecuronium (Norcuron) Special Considerations
    • Pregnancy Safety Category C
    • If patient is conscious explain the effect of the medication before administering.
    • Always sedate the patient before using this medication

    • Intubation: Involuntary support must be readily available.
    • Vecuronium has no effect on consciousness or pain.
    • Will not stop nueral seizure acitivity.
    • Pulse rate / cardiac output are increased
    • Decreased doses with patient's with renal disease.
  279. Methylprednisolone (Solu-Medrol) Class
    Anti-inflammatory glucocorticoid
  280. Methylprednisolone (Solu-Medrol) Mechanism of Action
    • Synthetic corticosteriod that suppresses acute and chronic inflammation.
    • Potentiates vasular smooth muscle relaxation by beta adrenergic agonists
  281. Methylprednisolone (Solu-Medrol) Indications
    • Acute Spinal Cord trauma
    • Anaphalaxis
    • Broncho-dialator for unresponsive asthma
  282. Methylprednisolone (Solu-Medrol) Contraindications
    • Premature infants
    • systemic fungal infections
    • use with caution in patient's with gastro intestinal bleeding
  283. Methylprednisolone (Solu-Medrol) Adverse Reactions
    • Heachache
    • Hypertension
    • Sodium and Water Retention
    • CHF
    • Hypokalemia
    • alkolosis
    • peptic ulcer disease
    • nausea
    • vomitting
  284. Methylprednisolone (Solu-Medrol) Drug interactions
    • Hypoglycemic reponses to insulin and hypoglycemic agents may be blunted
    • Potassium depleting agents may exasserbate hypokalemic effects
  285. Methylprednisolone (Solu-Medrol) How supplied
    40, 125, 500, 1000mg vials
  286. Methylprednisolone (Solu-Medrol) Dosage and Administration (Adult)
    • Acute spinal cord injury: 30mg per kg IV over 30 minutes followed by infusion: 5.4mg per kg per hour.
    • Asthma/COPD: 1-2mg per kg IV
  287. Methylprednisolone (Solu-Medrol) Dosage and Administration (Pediatrics)
    • Acute Spinal Cord Trauma: 30mg per kg IV over 30 minutes (infusion 5.4mg per kg per hour)
    • Asthma: 1 to 2mg per hour per dose IV
  288. Methylprednisolone (Solu-Medrol) Duration of Action
    • Onset of Action: 1 to 2 hours
    • Peak Effect: Variable
    • Duration of Action: 8-24 hours
  289. Methylprednisolone (Solu-Medrol) Special Considerations
    • Pregnancy Safety Not established
    • Not effective with spinal cord injuries over 8 hours
    • Crosses the placenta and may cause fetal harm
  290. Thiamine Class
    Vitamin B-1
  291. Thiamine Mechanism of Action
    Combines with ATP to form thiamine protophosphate coenzyme, a nessecary component for carbohydrate metabolism. The brain is extremely sensitive to thiamine deficieincy
  292. Thiamine Indications
    • Coma of unknown origen
    • Delirium Tremens
    • Beriberi
    • Wernicke's Encephalopathy
  293. Thiamine Contraindications
    None
  294. Thiamine Adverse Reactions
    • Hypotension from too rapid of an injection or too high of a dose
    • Anxiety
    • Diaphoresis
    • Nausea
    • Vomitting
    • Allergy (rare)
  295. Thiamine Drug interactions
    Give thiamine before glucose under all circumstances
  296. Thiamine how supplied
    1000mg in 10mL vial (100mg per mL)
  297. Thiamine Dosage and Administration (adult and child)
    • Adult: 100mg slow IV/IM
    • Pediatric: 10-25 slow IV/IM
  298. Thiamine Duration of Action
    • Onset: Rapid
    • Peak Effects: Variable
    • Duration: Dependent upon the degreee of deficiency
  299. Thiamine Special Considerations
    • Pregnancy Safety Category A
    • Large IV doses may cause respiratory difficulties and anaphalaxis reactions reported
  300. Diazepam (Valium) Class
    Benzodiazepine / Sedative-hypnotic / anti-convulsant
  301. Diazepam (Valium) Mechanism of Action
    • Potentiates effects of inhibitory nuerotransmitters
    • Raises seizure threshold
    • Induces amnesia and sedation
  302. Diazepam (Valium) Indications
    • Acute anxiety states
    • Acute alcohol withdrawl (delerium tremens)
    • Muscle Relaxant
    • Seizure Activity
    • Agitation
    • Analgesia
    • For medical procedures (fracture reduction / cardioversion)
  303. Diazepam (Valium) Contraindications
    • Hypersensitivity
    • Glaucoma
    • Coma
    • Shock
    • Substance Abuse
    • Head injury
  304. Diazepam (Valium) Adverse Reactions
    • Respiratory Depression
    • Hypotension
    • Drowziness
    • Ataxia
    • Reflex tachycardia
    • nausea
    • confusion
    • thrombosis
    • phlebitis
  305. Diazepam (Valium) Drug interactions
    Incompatible with most drugs, fluids
  306. Diazepam (Valium) how supplied
    10mg per 5mL prefilled syringes, ampules, vials, Tubex
  307. Diazepam (Valium) Dosage and Administration (adult and pediatric)
    • Adult: Seizure Activity: 5-10mg IV q 10-15minutes PRN (5mg over 5 minutes)(Max dose 30mg)
    • Pediatric Seizure Activity: .2-.5mg slowly q 2-5 minutes up to 5mg (max dose 10mg per kg)

    Rectal diazepam: .5mg per kg via 2" rectal cathether and flush with 2-3mL air after administration

    Sedation for cardioversion: 5-15mg IV over 5 to 10 minutes prior to cardioversion
  308. Diazepam (Valium) Duration of Action
    • Onset: 1-5 minutes
    • Peak Effect: Minutes
    • Duration: 20-50 minutes
  309. Diazepam (Valium) Special Considerations
    • Pregnancy Safety: Category D
    • Short duration of anticonvulsant effect. Reduce dose by 50% in elderly patient
  310. Midazolam (Versed) Class
    Short Acting Benzodiazepine / CNS depressant
  311. Midazolam (Versed) Mechanism of Action
    Anxiolytic and sedative properties similar to other benzodiazepines, memory impairment
  312. Midazolam (Versed) Indications
    • Sedation
    • Anxiolytic Prior to endotrachial or nasotracheal intubation; Administer for conscious sedation
  313. Midazolam (Versed) Contraindications
    • Glaucoma
    • Shock
    • Coma
    • Alcohol intoxication
    • Overdose
    • Depressed Vital Signs
    • Concomitant use with other CNS depressants
    • Barbituates
    • Alcohol
    • Narcotics
  314. Midazolam (Versed) Adverse Reactions
    Hiccough, cough, oversedation, nausea, vomitting, injection site pain, headache, blurred vision, hypotension, respiratory depression, arrest
  315. Midazolam (Versed) Drug interactions
    Should not be used in patient's who have taken a CNS depressant
  316. Midazolam (Versed) How Supplied
    2, 5, 10mL vials (1mg per mL) and 1, 2, 5, 10mL vials (5mg per mL)
  317. Midazolam (Versed) Dosage and Administration (Adult and Pediatric)
    Adult: 2-2.5mg slow IV over 2-3 minutes; may be repeated to a total maximum of .1mg per kg

    Pediatric: Not recommended
  318. Midazolam (Versed) Duration of Action
    • Onset: 1-3 minutes IV and dose dependent
    • Peak Effect: Variable
    • Duration: 2-6 hours, dose dependent
  319. Midazolam (Versed) Special Considerations
    • Pregnancy Safety Category D
    • Administer immediately after intubation procedure
    • Requires continuous monitoring of respiratory and cardiac function
    • Never administer as IV bolus
  320. Morphine SulfateAstamorph / PF/ Others) Class
    Opioid / analgesic (schedule II narcotic)
  321. Morphine SulfateAstamorph / PF/ Others) Mechanism of Action
    • Alleviates pain through CNS action
    • Suppresses fear and anxiety centers in brain
    • Depresses brain stem respiratory centers
    • Increases periperal venous capacitanec and decreases venous return
    • Decreases preload and afterload which decreases myocardial oxygen demand
  322. Morphine SulfateAstamorph / PF/ Others) Indications
    • Severe CHF
    • Pulmonary edema
    • Chest Pain associated with acute MI
    • Analgesia for moderate to severe acute and chronic pain (use with caution)
  323. Morphine SulfateAstamorph / PF/ Others) Contraindications
    • Head injury
    • Exaserbated COPD
    • Depressed respiratory drive
    • hypotension
    • undiagnosed abdominal pain
    • decreased level of consciusness
    • suspected hypovolemia
    • patients who have taken MAOI's in the past 14 days
  324. Morphine SulfateAstamorph / PF/ Others) Adverse Reactions
    • Respiratory Depression
    • Hypotension
    • Decreased level of consciousness
    • Nausea
    • Vomitting
    • Bradicardia
    • Tachycardia
    • Syncope
    • Facial Flushing
    • Euphoria
    • Bronchospasm
    • Dry Mouth
  325. Morphine SulfateAstamorph / PF/ Others) Drug interactions
    • Potentiates sedative effects of phenothiazines
    • CNS depressant
    • may potentiate effects of morphine
    • MAOI's may cause paradoxical excitation
  326. Morphine SulfateAstamorph / PF/ Others) How supplied
    10mg in 1mL of solution, ampules, and Tubex syringes
  327. Morphine SulfateAstamorph / PF/ Others) Dosage and Administration (Adult)
    INitial Dose: 2-4mg IV over 1 to 5 minutes every 5 to 30 minutes. Repeat dose 2-8mg at 5 to 10 minute intervals
  328. Morphine SulfateAstamorph / PF/ Others) Dosage and Administration (pediatric)
    • .1 to .2mg per kg per dose via IV/IO/IM/SC
    • Max dose of 5mg
  329. Morphine SulfateAstamorph / PF/ Others) Duration of Action
    • Onset: Immediate
    • Peak Effect: 20 minutes
    • Duration: 2-7 hours
  330. Morphine SulfateAstamorph / PF/ Others) Special Considerations
    • Prenancy Safety: Category C
    • Morphine rapidly crosses the placenta
    • Safety in neonate not established
    • Use with caution in geriatric population and those with COPD, Asthma,
    • vagotonic effect in patient wtih acute inferior MI (bradycardia, heart block)
    • Naloxone should be readily available as an antidote
  331. Succinylcholine (Anectine) Class
    Depolarizing nueromuscular blocker, paralyzing agent
  332. Succinylcholine (Anectine) Mechanism of Action
    Bind to the receptors for Acetylcholine
  333. Succinylcholine (Anectine) indications
    • To faciliate intubation, to terminate laryngospasm
    • To promote muscle relaxation
    • To faciliate convulsive shock therapy
  334. Succinylcholine (Anectine) Contraindications
    • Acute narrow angle glaucoma
    • Penetrating eye injuries
    • Inability to control airway or support ventilations with oxygen and positive pressure
  335. Succinylcholine (Anectine) Adverse Reactions
    • Apnea
    • Malignant Hyperthermia
    • Arrhythmias
    • Bradycardia
    • Hypertension
    • Hypotension
    • Cardiac Arrest
    • Hyperkalemia
    • Increased intraoccular pressure
    • Fasciculations
    • Exacerbation of Hyperkalemia in trauma patient's
  336. Succinylcholine (Anectine) Drug interactions
    • Effects potentiated by oxytosin, beta blockers, and organophosphates.
    • Diazepam may reduce duration of action
  337. Succinylcholine (Anectine) How supplied
    • 40mg in 2mL ampules (20mg per mL)
    • 100mg in 5mL ampules (20mg per mL)
    • Multidose vial
  338. Succinylcholine (Anectine) Dosage and Administration (Adult and Pediatric)
    Adult: 1-2mg per kg rapid IV, repeat once if needed

    Pediatric: 1-1.5mg per kg dose rapid IV/IO; repeat once if neede
  339. Succinylcholine (Anectine) Duration of Action
    • Onset: 1 minute
    • Peak Effect: 1 to 3 minutes
    • Duration: 5 minutes
  340. Succinylcholine (Anectine) Special Considerations
    • Pregnancy Safety Category C
    • EMS use primarily to facilitate endocrachial intubation
    • If the patient is conscious explain the effects of the drug prior to administration
    • Consider premedication with atropine especially with pediatric age group
    • Premedication with lidocaine may blunt any increase in intracranial pressure during intubation
    • Diazepam or midazolam should be used in any conscious patient undergoing nuero muscular blockade.
  341. Etomidate Class
    Hypnatic
  342. Etomidate Mechanism of Action
  343. Etomidate Indications
  344. Etomidate Contraindications
  345. Etomidate Adverse Reactions
  346. Etomidate Drug interactions
  347. Etomidate How Supplied
  348. Etomidate Dosage and Administration
  349. Etomidate Duration of Action
  350. Etomidate Special Considerations

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