PC: phycoses, depression, myasthenia gravis, short half life
Dose: 5 to 10mg IV (seizures), 2.5 to 5mg IV/IM (anxiety), 5 to 15mg IV (premed for cardioversion)
Class: Nonbarbiturate hypnotic
Des: Ultra short acting, no analgesic effects, limited cardiovascular and respiratory effects
Ind: Induce sedation for rapid sequence intubation
PC: Marked hypotension, severe asthma, severe cardiovascular disease
Dose: 0.1 to 0.3 mg/kg IV over 15 to 30 sec
(Romazicon) Benzodiazepine Antagonist
Des: Used to reverse the sedative, recall, and psychomotor effects of diazepam, midazolam, and benzodiazepines
Ind: Respiratory depression secondary to benzodiazepines
CI: Pts who take benzos for status epilepticus or seizures, seizure-prone pts during labor and delivery, tricyclic antidepressant overdose
PC: Hepatic impairment, elderly, pregnancy, nursing mothers, head injury, alcohol and drug dependency and physical dependence on benzodiazepines.
Dose: 0.2mg IV over 30 sec/min up to 1mg.
Des: short-acting with CNS depressant, muscle relaxant, anticonvulsant, and anterograde amnestic effects
Ind: to induce sedation before cardioversion or intubation
CI: Narrow-angle glaucoma, shock, coma, or acute alcohol intoxication
PC: COPD, renal impairment, CHF, elderly
Dose: 1 to 2.5mg slow IV; 0.07 to 0.08mg/kg IM (usually 5mg)
(Anectine) Depolarizing Neuromuscular Blocker
Des: ultra short acting depolarizing neuromuscular blocker
Ind: facilitated endotracheal intubation
CI: family hx of malignant hyperthermia, penetrating eye injury, narrow-angle glaucoma
PC: Severe burn or crush injury, spinal cord injury
Dose: 1 to 1.5mg/kg IV/IM
Des: can chemically cardiovert PSVT to a normal sinus rythym. It has a halflife of 10 seconds and does not cause hypotension.
Ind: Narrow, complex paroxysmal supraventricular tachycardia refractory to vagal maneuvers
CI: 2nd and 3rd degree heart block, sinus node disease, or asthma
PC: COPD, May cause transient dysrythmias (especially asystole)
Dose: 6mg rapidly IV (over 1 to 2 sec), then flush the line rapidly with saline. If ineffective, 12mg in 1 to 2 min, may be repeated.
Des: Blocks the parasympathetic nervous system, specifically the vagal effects on the heart rate. May increase myocardial oxygen demand. Decreases airway secretions
Ind: Hemodynamically signifcant bradycardia, bradysystolic arrest, and organophosphate poisoning
CI: None in emergency setting. 2nd degree type 2 and above heartblocks are class 2B (not recommended)
PC: AMI, glaucoma
Dose: 0.5mg IV/ 1mg ET. Repeat every 3 to 5 min up to 3mg.(Symptomatic bradycardia) 1mg IV or 2mg ET. May repeat every 3 to 5 min up to 3mg. (Asystole) 2 to 5mg IV/IM/IO/ 10 to 15 min (Organophospate poisoning)
Des: Naturally occuring catecholamine that increases heart rate, cardiac contractile force, myocardial electrical activity, systemic vascular resistance, and systolic blood pressure, and decreases overall airway resistance and automaticity. It also, through bronchial artery constriction may reduce pulmonary congestion and increase tidal volume and vital capacity.
Ind: Cardiac arrest and severe allergic reactions
CI: Narrow angle glaucoma, hemorrhagic, traumatic, or cardiac shock
Dose: 1mg of 1:10,000 IV/ 3 to 5 min, 2 to 2.5mg ET 1:1,000 (Cardiac arrest) 0.3 to 0.5mg of 1:1,000 SQ/ 5 to 15 min as needed or 0.5 to 1mg of 1:10,000 IV if SQ dose ineffective or severe reaction (allergic reaction)
(Pitressin) Hormone, Vasorepressor
Des: A hormone with strong vasorepressive and anitdiuretic properties, but that may precipitate angina and/or AMI
Ind: To increase peripheral vascular resistance in arrest (CPR) or to control bleeding from esophageal
CI: PVCs or 1st stage of labor
PC: Epilepsy, migraine, heart failure, angina, vascular disease, hepatic impairment, elderly, and children
Dose: 40 units IV (arrest), 0.2 to 0.4 units/min IV drip (esophageal varices)
(Acetylsalicylic Acid)[Alka-Seltzer; Bayer; Empirin; St. Joseph Children's] Analgesic, Antipyretic, Platelet Inhibitor, Antiinflammatory
Des: Inhibits agents that cause the production of inflammation, pain, and fever. Relieves mild to moderate pain by acting on the peripheral nervous system, lowers body temperature in fever, and powerfully inhibits platelet aggregation.
Ind: Chest pain suggestive of an MI.
CI: Active ulcer disease, asthma
PC: Bleeding disorders
Dose: 160 to 325mg PO (chewable)
Dextrose 50% In Water
Des: A simple sugar that the body can rapidly metabolize to create energy.
CI: None in hypoglycemia
PC: Increased ICP. Determine blood glucose level before administration. Ensure good venous access.
Dose: 25g D50W (50mL) IV
Des: rapid-acting, potent diruetic and antihypertensive that inhibits sodium reabsorption by the kidney. It's vasodilating effects reduce venous return and cardiac workload.
Ind: Congestive heart failure and pulmonary edema
CI: Fluid and electrolyte depletion states, hepatic coma, pregnancy (except in life-threatening circumstances)
PC: Infants, elderly, hepatic impairment, nephrotic syndrome, cardiogenic shock associated with MI, gout, patients receiving digitalis, or potassium-depleting steroids.
Dose: 40 to 120mg slow IV
Des: rapid smooth muscle relaxant that reduces peripheral vascular resistance, blood pressure, venous return, and cardiac workload.
Ind: Chest pain associated with angina and acute myocardial infarction, and acute pulomany edema
CI: Tolerance to nitrates, severe anemia, head trauma, hypotension, increased ICP, patients taking sildenafil, glaucoma, and shock.
PC: May induce headache that is sometimes severe, Nitro is light-sensitive and will lose potency when exposed to the air.
Dose: 1 tablet (0.4mg) SL (sublingually). May be repeated every 3 to 5 minutes up to 3 tablets. 1/2 inch of topical ointment or 1 spray (0.4mg) SL up to 3 sprays/ 25 min.
Des: Synthetic catecholamine and beta agent that increase the rate of cardiac contraction without appreciably increase rate.
Ind: To increase cardiac output in CHF/ cardiogenic shock
CI: Ventricular Tachycardia, hypovolemia without fluid resuscitation
PC: Atrial fibrillation or preexisting hypertension
Dose: 2 to 20mcg/kg/min IV
Des: A catecholamine that increases cardiac output without appreciably increasing myocardial oxygen consumption. Maintains renal and mesenteric blood flow while inducing vasoconstriction and increasing systolic blood pressure.
Ind: Nonhypovolemic hypotension (70 to 100 mmHg) and cardiogenic shock
CI: Tachydysrhythmias, ventricular fibrillation, and increasing systolic blood pressure.
PC: Ensure adequate fluid resuscitation of the hypovolemic patient
Dose: 2 to 5 mcg/kg/min up to 20mcg/kg/min titrated to effect
Des: A sympathomimetic that results in increased cardiac output by increasing the strength of cardiac contraction and somewhat increasing rate.
Ind: Bradycardia refractory to atropine when pacing is not available
CI: Cardiogenic shock
PC: Tachydysrhythmias, and those associated with digitalis and acute MI.
Dose: 2 to 10mcg/min titrated to cardiac rate
(Cordarone, Pacerone) Antidysrhythmic
Des: Prolongs the duration of the action potential and refractory period and relaxes smooth muscles, reducing peripheral vascular resistance and increasing coronary blood flow.
Ind: Life-threatening ventricular and supraventricular dysrhythmias, frequently atrial fibrillation
CI: Cardiogenic shock, severe sinus bradycardia, or advanced heart block
Dose: 150 to 300mg IV over 10 min, then 1mg/min over the next 6 hours
Des: Surpresses ventricular tachydysrhythmias including ventricular fibrillation with reentry mechanisms
Ind: Ventricular fibrillation and ventricular tachycardia refractory to lidocaine
Dose: 1 to 1.5mg/kg IV repeated every 3 to 5 min up to 3mg/kg, follow conversion with a drip of 2 to 4mg/min (Cardiac Arrest); 1 to 1.5mg/kg slow IV. May repeat at 1/2 dose every 5 to 10 min until conversion. Floow conversion with an infusion of 2 to 4mg/min (Ventricular tachycardia w/ pulse)
Des: Prolongs ventricular repolarization, slows conduction, and decreases myocardial excitability
Ind: Ventricular fibrillation and pulseless ventricular tachycardia refractory to lidocaine
CI: Myasthenia gravis amd 2nd or 3rd degree heart block
PC: Hypotension, cardiac enlargement, CHF, AMI, ventricular dysrhythmias from digitalis, hepatic or renal impairment, or bronchial asthma
Dose: 20 to 30mg/min IV drip
(1) up to 17mg/kg to effect, then 1 to 4mg/min
(2) ectopy resolves
(3) QRS complex widens more than 50% from original
(4) hypotension ensues
(Cardizem) Calcium Channel Blocker
Des: Similar to Verapamil. Dilates coronary and peripheral arteries, increasing circulation to the heart and reducing peripheral vascular resistance.
Ind: Supraventricular tachycardias (atrial fibrillation, atrial flutter, and PSVT refractory to adenosine) and to increase coronary artery perfusion in angina.
CI: Sick sinus syndrome, 2nd or 3rd degree heart block, systolic BP<90, diastolic BP<60, wide-complex tachycardia, and WPW
Dose: 0.25mg/kg IV over 2 min, may repeat as needed with 0.35mg/kg followed by a drip of 5 to 10mg/hr, not to exceed 15mg/hr over 24 hours
(Nitroglycerin Injection) Vasodilator, Nitrate
Des: relaxes blood vessels, increasing blood and oxygen supply to the heart.
Ind: Relieve pain associated with angina that does not respond to oral treatment; to control blood pressure, and to help treat CHF
Dose: 10 to 15mg/kg slow IV (Seizures); 100mg slow IV (over 5 min) to a maximum of 1000mg (Dysrythmias)
(NaHCO3) Alkalizing Agent
Des: Provides vascular bicarbonate to assist the buffer system in reducing the effects of metabolic acidosis and in the treatment of some overdoses
Ind: Tricyclic antidepressant and barbituate overdose, refractory acidosis, or hyperkalemia
PC: May precipitate calcium chloride
Dose: 1mEq/kg IV, then 0.5 mEq/kg/10 min
Des: Vitamin B1, which is required to covert glucose into energy, it is not manufactured in the body and must be constantly provided from diet
Ind: Coma of unknown origin, chronic alcoholism with associated coma, and delirium tremens
Dose: 50 to 100mg IV/IM
Des: blocks histamine release, thereby reducing bronchoconstriction, vasodilation, and edema
Ind: Anaphylaxis, allergic reactions, and dystonic reactions
CI: Asthma and other lower respiratory diseases
Dose: 25 to 50mg IV/IM
Des: the most potent benzodiazepine available. It has strong antianxiety, sedative, hypnotic, and skeletal muscle relaxant properties, and a relatively short half-life
Ind: Sedation for cardioversion and status epilepticus
PC: Narrow-angle glaucoma, depression or psychosis, coma, shock, acute alcohol intoxication, renal or hepatic impairment, organic brain syndrome, myasthenia gravis, GI disorders, elderly, debilitated, limited pulmonary reserve
Dose: 2 to 4mg IM, 0.5 to 2 mg IV (sedation); 2mg slow IV/PR (2 mg/min) (status epilepticus)
Des: a dopamine antagonist similar to procainamide but with few antidysrhythmic or anesthetic properties. Its antiemetic properties stem from rapid gastric emptying and desensitization of the vomiting reflex
Ind: Nausea and vomiting
CI: allergy to sulfite agents, seizure disorders, pheochromocytoma, mechanical GI obstruction or perforation, and breast cancer
PC: CHF, hypokalemia, renal impairment, GI hemorrhage, intermittent porphyria
Dose: 10 to 20mg IM; 10mg slow IV (over 1 to 2 min)
Des: selective blocking agent of the serotonin receptor type
Ind: Nausea and intractible vomiting
PC: may mask a progressive ileus and/or gastric distension
Dose: single 24mg tablet ODT; 4mg IV undiluted over at least 30 seconds, preferably
(Librium) Sedative/ Hyponotic
Des: a benzodiazepine derivative that produces mild sedation and anticonvulsant, skeletal muscle relaxant, and prolonged hypnotic effects
Ind: Severe anxiety and tension, acute alcohol withdrawal symptoms (DTs)
CI: pregnant and nursing mothers, children under 6
PC: Primary depressive disorders or psychoses, acute alcohol intoxication
Dose: 50 to 100mg IV/IM
(Pavulon) Nondepolarizing Neuromuscular Blocker
Des: causes paralysis without bronchospasm or hypotension