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- Class: Hypnotic
- Description: Etomidate is an ultra–short-acting nonbarbiturate hypnotic with no analgesic effects and limited cardiovascular and respiratory effects.
- Indications: Induce sedation for rapid sequence intubation.
- Contraindications: None
- Precautions: Head Injury if no paralytics used, marked hypotension, severe asthma, or severe cardiovascular disease.
- Dosage/Route: 0.1 to 0.3 mg/kg IV over 15 to 30 sec.
- Pedi: children > 10 years, same as for adults
- Class: Antipsychotic
- Description: Haloperidol is believed to block dopamine receptors in the brain associated with mood and behavior,is a potent antiemetic, and impairs temperature regulation.
- Indications: Acute psychotic episodes.
- Contraindications: Parkinson's disease, seizure disorders, coma, alcohol depression, CNS depression, and thyrotoxicosis, and with other sedatives.
- Precautions: Orthostatic Hypotension
- Dosage/Route: 2 to 5 mg IM.
- Class: Nondepolarizing Neuromuscular Blocker
- Description: Pancuronium is a nondepolarizing neuromuscular blocker that causes paralysis without bronchospasm or hypotension, it does not cause the fasciculations associated with polarizing agents.
- Indications: To facilitate endotracheal intubation.
- Contraindications: Tachycardia.
- Dosage/Route: 0.04 to 0.1 mg/kg IV.
- Pedi: same as adult.
- Class: Depolarizing Neuromuscular Blocker
- Description: Succinylcholine is an ultra–short-acting depolarizing neuromuscular blocker.
- Indications: Facilitated endotracheal intubation.
- Contraindications: Family history of malignant hyperthermia, penetrating eye injury,narrow-angle glaucoma. Hyperkalemia.
- Precautions: Severe burn or crush injury; HyperKalemia; spinal cord injury;
- Dosage/Route: 1 to 1.5 mg/kg IV/IM.
- Pedi: 1 to 2 mg/kg IV/IM.
- Class: Nondepolarizing Skeletal Muscle Relaxant
- Description: Vecuronium is a nondepolarizing skeletal muscle relaxant similar to pancuronium with minimal cardiovascular effects.
- Indications: Facilitated endotracheal intubation.
- Contraindications: None.
- Precautions: Hepatic or renal impairment, impaired fluid and electrolyte or acid/base balance, severe obesity, myasthenia gravis, elderly, debilitated patients, or malignant hyperthermia.
- Dosage/Route: 0.08 to 0.1 mg/kg IV.
- Class: Antianxiety, Hypnotic, Anticonvulsant, Sedative
- Description: Diazepam is a benzodiazepine sedative and skeletal muscle relaxant that reduces tremors, induces amnesia, and reduces the incidence and recurrence of seizures. It relaxes muscle spasms in orthopedic injuries and produces amnesia for painful procedures (cardioversion).
- Indications: Major motor seizures, status epilepticus, premedication before cardioversion, muscle tremors due to injury, and acute anxiety.
- Contraindications: Hypersensitivity to the drug, shock, coma, acute alcoholism, depressed vital signs, obstetric patients, neonates.
- Precautions: Psychosis, depression, myasthenia gravis, Due to a short half-life of the drug, seizure activity may recur.
- Seizures: 5 to 10 mg IV/IM.
- Acute anxiety: 2 to 5 mg IV/IM. Pedi: 0.5 to 2 mg IM.
- Premedication: 5 to 15 mg IV. Pedi: 0.2 to 0.5 mg/kg IV.
- Class: Sedative
- Description: Midazolam is a short-acting benzodiazepine with CNS depressant, muscle relaxant, anticonvulsant, and anterograde amnestic effects.
- Indications: To induce sedation before cardioversion or intubation, Seizures
- Contraindications: Hypersensitivity to benzodiazepines, narrow-angle glaucoma, shock, coma, or acute alcohol intoxication.
- Precautions: COPD, renal impairment, CHF, elderly.
- Dosage/Route: 1 to 2.5 mg slow IV; 0.07 to 0.08 mg/kg IM (usually 5 mg).
- Ped: 0.05 to 0.2 mg/kg IV: 0.1 to 0.15 mg/kg IM; 3 mg intranasal.
- Class: Sedative
- Description: Lorazepam is the most potent benzodiazepine available. It has strong antianxiety, sedative, hypnotic, and skeletal muscle relaxant properties, and a relatively short half-life.
- Indications: Sedation for cardioversion and status epilepticus.
- Contraindications: Sensitivity to benzodiazepines.
- Precautions: Narrow-angle glaucoma, depression or psychosis, coma, shock, acute alcohol intoxication, renal or hepatic impairment, organic brain syndrome, myasthenia gravis, GI disorders, elderly, debilitated, limited pulmonary reserve.
- Sedation: 2 to 4 mg IM, 0.5 to 2 mg IV.
- Pedi: 0.03 to 0.5 mg/kg IV/IM/PR up to 4 mg.
- Status epilepticus: 2 mg slow IV/PR (2 mg/min).
- Pedi: 0.1 mg/kg slow IV/PR (2 to 5 min).
- Class: Sedative, Hypnotic
- Description: Chlordiazepoxide is a benzodiazepine derivative that produces mild sedation and anticonvulsant, skeletal muscle relaxant, and prolonged hypnotic effects.
- Indications: Severe anxiety and tension, acute alcohol withdrawal symptoms (DTs).
- Contraindications: Hypersen to benzodiazepines, pregnant and nursing mothers, children under 6.
- Precautions: Primary depressive disorders or psychoses, acute alcohol intoxication.
- Dosage/Route: 50 to 100 mg IV/IM.
ACTIVATED CHARCOAL (Actidose)
- Class: Absorbent
- Description: Is a specially prepared charcoal that will adsorb and bind toxins from the gastrointestinal tract.
- Indications: Acute ingested poisoning
- Precautions: Administer only after emesis or in those cases where emesis is contraindicated.
- Dosage/Route: 1G/Kg mixed with at least 6 to 8 oz of water, then PO or via an NG tube
- Class: Narcotic Antagonist
- Description: Naloxone is a pure narcotic antagonist that blocks the effects of both natural and synthetic narcotics and may reverse respiratory depression.
- Indications: Narcotic and synthetic narcotic overdose, coma of unknown origin.
- Contraindications: Hypersensitivity to the drug, non–narcotic-induced respiratory depression.
- Precautions: Possible dependency (including newborns). It also has a half-life that is shorter than that of most narcotics; hence the patient may return to the overdose state.
- Dosage/Route: 0.4 to 2 mg IV/IM/IN repeated/2 to 3 min as needed up to 10 mg.
- Pedi: 0.01 mg IV/IM repeated/2 to 3 min as needed up to 10 mg.
- Class: Benzodiazepine Antagonist
- Description: Flumazenil is a benzodiazepine antagonist used to reverse the sedative, recall, and psychomotor effects of diazepam, midazolam, and the other benzodiazepines.
- Indications: Respiratory depression secondary to the benzodiazepines.
- Contraindications: Hypersensitivity to flumazenil or benzodiazepines; those patients who take medication for status epilepticus or seizures; seizure-prone patients during labor and delivery; tricyclic antidepressant overdose.
- Precautions: Hepatic impairment, elderly, pregnancy, nursing mothers, head injury, alcohol and drug dependency and physical dependence on benzodiazepines.
- Dosage/Route: 0.2 mg IV over 30 sec/min, up to 1 mg.