Paramedic Drugs

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Paramedic Drugs
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  1. MIDAZOLAM (Versed)
    1. Drug Class
    2. Indications
    1. Benzodiazepine

    2. Conscious sedation, RSI, seizure, chemical restraint.
  2. MIDAZOLAM (Versed)
    1. Adult Dose
    • 1. Conscious sedation 2.5-10 mg IV over 2 min.
    •    RSI 5 - 10 mg IV over 2 min 
    •    Chemical restraint 2.5 - 10 mg IV/IM
    •    Seizure 2.5 - 10 mg IM; may also be given intranasal
  3. MIDAZOLAM (Versed)
    1. Mechanism of Action
    1. CNS depressant via facilitation of inhibitory GABA at benzodiazepine receptor sites (BZ1-associated with sleep; BZ2 associated with memory, motor, sensory and cognitivefunction); effects include muscle relaxation, anticonvulsant,ataxia, emotional behavior and anxiolytic effect.
  4. MIDAZOLAM (Versed)
    1. Contraindications
    2. Side Effects
    1. Hypersensitivity, Acute narrow glaucoma, shock.

    2. Respiratory depression, hypotension, bradycardia.
  5. MORPHINE SULFATE
    1. Drug Class
    2. Indications
    1. Narcotic analgesic-Opioid agonist

    2. Analgesia, pulmonary edema, cardiac chest pain.
  6. MORPHINE SULFATE
    1. Adult Dose
    • 1. Analgesia 2 - 4 mg IV q 2-5 min up to 20.0 mg
    •    Pulmonary edema 2 - 4 mg IV
    •    Cardiac 4 mg titrate by 2 mg up to 10 mg
  7. MORPHINE SULFATE
    1. Mechanism of Action
    1. Narcotic agonist with activity at u-receptors (supraspinalanalgesia, euphoria, respiratory and physical depression), kreceptors(sedation and miosis), and delta-receptors(dysphonia, hallucinations, respiratory and vasomotor stimulation)
  8. MORPHINE SULFATE
    1. Contraindications
    2. Side Effects
    1. Hypersensitivity, Head injury, exacerbated COPD, depressedrespiratory drive (unless being used in RSI), hypotension,Altered LOC.

    2. Respiratory depression, hypotension, ALOC, nausea & vomiting.
  9. NALOXONE (Narcan)
    1. Drug Class
    2. Indications
    1. Narcotic antagonist

    2. Respiratory depression 2o to opiate overdose, ALOC ofunknown etiology.
  10. NALOXONE (Narcan)
    1. Adult Dose
    1. 0.5-2 mg IV/IM/ET; may also be given intranasal
  11. NALOXONE (Narcan)
    1. Mechanism of Action
    1. Prevents or reverses the effects of opioids, including respiratory depression.
  12. NALOXONE (Narcan)
    1. Contraindications
    2. Side Effects
    1. Hypersensitivity

    2. Withdrawal syndrome in addicted patients, agitation, vomiting.
  13. NITROGLYCERINE (Nitrostat)
    1. Drug Class
    2. Indications
    1. Nitrate

    2. Acute angina, AMI, CHF with pulmonary edema.
  14. NITROGLYCERINE (Nitrostat)
    1. Adult Dose
    • 1. 0.4 mg SL q 3-5 min
    • *Systolic BP of at least 90mmHg
  15. NITROGLYCERINE (Nitrostat)
    1. Mechanism of Action
    1. Relaxes vascular smooth muscle of both the venous and arterial beds, resulting in a net decrease in myocardial oxygen consumption leading to redistribution of blood flow to ischemic tissue. Peripheral capacitance vessel dilation decreases venousreturn to heart (preload) while arterial vasodilation decreases arterial impedance (afterload), decreasing left ventricular work and aiding the failing heart.
  16. NITROGLYCERINE (Nitrostat)
    1. Contraindications
    2. Side Effects
    1. Hypersensitivity, Hypotension, hypovolemia, intracranialbleeding, aortic stenosis, recent use of Erectile dysfunction medications.

    2. Hypotension, HA, syncope, tachycardia, flushing.
  17. NITROUS OXIDE
    1. Drug Class
    2. Indications
    1. Analgesic and anesthetic gas

    2. Moderate to severe pain, childbirth, renal colic.
  18. NITROUS OXIDE
    1. Adult Dose
    1. Less than 30 minute episodes with at least 50% oxygen mixture.

    *20% of population has no response.
  19. NITROUS OXIDE
    1. Mechanism of Action
    1. Exact mechanism is unknown, affects phospholipids in CNS,CNS depressant
  20. NITROUS OXIDE
    1. Contraindications
    2. Side Effects
    1. Hypersensitivity, Patient who is unable to self administer,Nitrogen narcosis, Pnuemothorax, Perforated viscus, Otitus,Air embolism, or Decompression sickness, as the pockets ofair expand and may exacerbate these problems.

    2. Administration of greater than 50% may cause hypoxia,dyspnea, dizziness, and drowsiness
  21. OXYGEN
    1. Drug Class
    2. Indications
    1. Oxygen is an odorless, tasteless, colorless gas necessary for life.

    2. Possible hypoxemia or respiratory distress from any cause,acute chest pain suggestive of cardiac ischemia, shock,decreased oxygenation of tissue from any cause, major trauma, all cases of cardiopulmonary arrest, carbon monoxide poisoning.
  22. OXYGEN
    1. Adult Dose
    • 1. 24 – 100% depending on patient condition
    •     2 – 4 liters per minute (LOW FLOW)
    •     4 – 6 liters per minute (MODERATE FLOW)
    •     6 – 15 liters per minute (HIGH FLOW)
  23. OXYGEN
    1. Mechanism of Action
    1. Supplemental oxygen administration increases the oxygen available for transport to the tissues. Oxygen is essential for the break down of glucose into energy.
  24. OXYGEN
    1. Contraindications
    2. Side Effects
    1. No absolute contraindications. Use in caution with COPD patients.

    2. Can knock out the respiratory drive of patient with COPD, but do not withhold oxygen because of this possibility.
  25. OXYTOCIN (Pitocin)
    1. Drug Class
    2. Indications
    1. Horomone-Pituitary hormone, Uterine stimulant, Polypeptide.

    2. Postpartum hemorrhage
  26. OXYTOCIN (Pitocin)
    1. Adult Dose
    1. Mix 20 units of Oxytocin in 1000ml of Normal Saline; run at 30– 40gtt/min, and titrate to response or may administer 10 units IM if unable to establish an IV.
  27. OXYTOCIN (Pitocin)
    1. Mechanism of Action
    1. Increases amplitude and frequency of uterine contractions,Dilation of vascular smooth muscle (increases renal, coronary,and cerebral blood flow)
  28. OXYTOCIN (Pitocin)
    1. Contraindications
    2. Side Effects
    1. Hypersensitivity, Possibility of additional fetus.

    2. Alterations in blood pressure, Severe cramping, tachycardia,arrhythmias, anaphylaxis, clotting disorders, electrolyte disturbances, and if used prior to delivery it can cause uterinerupture, uterine spasm, uterine lacerations, and fetal damage.
  29. PHENERGAN (Promethazine)
    1. Drug Class
    2. Indications
    1. Phenothiazine antihistamine H1 agonist. Antiemetic

    2. Treatment of motion sickness, nausea and vomiting, pain management adjunct.
  30. PHENERGAN (Promethazine)
    1. Adult Dose
    1. 6.25 – 12.5 IV, 12.5 - 25 mg IM
  31. PHENERGAN (Promethazine)
    1. Mechanism of Action
    1. Acts as antihistamine by blocking H1 receptors; produces sedation, anti-vertigo.
  32. PHENERGAN (Promethazine)
    1. Contraindications
    2. Side Effects
    1. Hypersensitivity, Narrow angle glaucoma

    2. Hypotension, anxiety, dystonic reactions
  33. RACEMIC EPINEPHRINE
    1. Drug Class
    2. Indications
    1. Sympathomimetic

    2. Croup, Post extubation edema, Laryngeal angioneurotic edema, Bronchospasm (as a second-line drug)
  34. RACEMIC EPINEPHRINE
    1. Adult Dose
    1. 0.5 – 0.8ml in 3ml normal saline UDN
  35. RACEMIC EPINEPHRINE
    1. Mechanism of Action
    1. Alpha and Beta agonist, arteriole constriction, positive inotropic,positive chronotropic, bronchial smooth muscle relaxer(bronchodilator). Also blocks histamine release, inhibits insulin release, and relaxes GI smooth muscle.
  36. RACEMIC EPINEPHRINE
    1. Contraindications
    2. Side Effects
    1. Hypersensitivity

    • 2. Palpitations, Anxiety, Headache, Hypertension, Nausea,Vomiting, Arrhythmias, and Rebound edema 15 – 30 minutes post administration.
    • *Can lead to hyperglycemia, Should not be mixed with otherdrugs
  37. SODIUM BICARBONATE
    1. Drug Class
    2. Indications
    1. Alkalizing agent

    2. Hypersensitivity, Metabolic acidosis 2o cardiac arrest, cyclic antidepressant OD, hyperkalemia.
  38. SODIUM BICARBONATE
    1. Adult Dose
    1. 1 mEq/kg IV
  39. SODIUM BICARBONATE
    1. Mechanism of Action
    1. Sodium bicarbonate is an alkalizing agent that dissociates toprovide bicarbonate ion to buffer hydrogen ions in order to raise the pH level to reverse acidosis. It has also been found to beneficial in the event of drug overdose in order to force urine alkalinization/diuresis, membrane stabilization of cardiac cells as well and electrolyte balance restoration.
  40. SODIUM BICARBONATE
    1. Contraindications
    2. Side Effects
    1. None in the emergency setting

    2. Metabolic alkalosis, electrolyte imbalance, fluid overload.
  41. SUCCINYLCHOLINE (Anectine)
    1. Drug Class
    2. Indications
    1. Depolarizing Neuromuscular blocking agent

    2. Paralysis to facilitate intubation.
  42. SUCCINYLCHOLINE (Anectine)
    1. Adult Dose
    1. 1 - 1.5 mg/kg IV (40-100mg in adult)
  43. SUCCINYLCHOLINE (Anectine)
    1. Mechanism of Action
    1. Similar to the acetylcholine molecular structure, succinylcholine has an affinity for Ach receptor sites and acts by prolonging depolarization at the motor end plate.
  44. SUCCINYLCHOLINE (Anectine)
    1. Contraindications
    2. Side Effects
    1. Hypersensitivity, Acute narrow angle glaucoma, penetrating eye injury, burns/crush injuries greater than 12 hours old.

    2. Apnea, malignant hyperthermia, dysrhythmias, bradycardia,hypertension, hypotension, hyperkalemia, increased intraocular pressure, cardiac arrest.
  45. THIAMINE (Vitamin B1)
    1. Drug Class
    2. Indications
    1. Vitamin

    2. Co-administration with D50W in patients with suspected malnutrition or thiamine deficiency.
  46. THIAMINE (Vitamin B1)
    1. Adult Dose
    1. 100 mg IV/IM
  47. THIAMINE (Vitamin B1)
    1. Mechanism of Action
    1. Thiamine is required for carbohydrate metabolism. It combines with adenosine triophosphate to form thiamine pyrophosphate,a coenzyme in carbohydrate metabolism and transketolation reactions.
  48. THIAMINE (Vitamin B1)
    1. Contraindications
    2. Side Effects
    1. Hypersensitivity

    2. Nausea & vomiting, hypotension, restlessness.
  49. VASOPRESSIN (Pitressin)
    1. Drug Class
    2. Indications
    1. Hormone, vasoconstrictor-Posterior pituitary antidiuretic hormone

    2. VT/VF/Asystole/PEA arrested states

    *Vasopressin during CPR increases coronary perfusion pressure,vital organ blood flow, VF median frequency and cerebral oxygen delivery.
  50. VASOPRESSIN (Pitressin)
    1. Adult Dose
    1. 40 units IV
  51. VASOPRESSIN (Pitressin)
    1. Mechanism of Action
    1. Acting primarily at the renal tubular level, vasopressin increases cyclic 3’5’-adenosine monophosphate, which increases water permeability at the renal tubule and collecting duct, resulting inincreased urine osmolality and decreased urinary flow rate as well as vascular smooth muscle contraction.
  52. VASOPRESSIN (Pitressin)
    1. Contraindications
    2. Side Effects
    1. Hypersensitivity, Chronic nephritis

    2. Moderate to severe skeletal weakness, which may require artificial respiration. Malignant hyperthermia.
  53. VECURONIUM BROMIDE (Norcuron)
    1. Drug Class
    2. Indications
    1. Nondepolarizing neuromuscular blocking agent.

    2. Paralysis to facilitate intubation
  54. VECURONIUM BROMIDE (Norcuron)
    1. Adult Dose
    1. 0.1 mg/kg IV
  55. VECURONIUM BROMIDE (Norcuron)
    1. Mechanism of Action
    1. Prevents acetylcholine from binding to receptors on the motorend plate, thus blocking depolarization. Vecuronium exhibits minimal cardiovascular effect and does not appear to effect heart rate, rhythm, systolic or diastolic blood pressure, cardiac output, systemic vascular resistance or mean arterial pressure.It has little to no histamine releasing properties.
  56. VECURONIUM BROMIDE (Norcuron)
    1. Contraindications
    2. Side Effects
    1. Hypersensitivity, Newborn infants, myasthenia gravis.

    2. Apnea, profound weakness
  57. Zofran (Ondansetron)
    1. Drug Class
    2. Indications
    1. Antiemetic

    2. Prevention and control of nausea and vomiting in adults.
  58. Zofran (Ondansetron)
    1. Adult Dose
    1. 4-8 mg IV/IM/IO. If given IV or IO give slowly over 2 min.
  59. Zofran (Ondansetron)
    1. Mechanism of Action
    1. Zofran is a 5HT3 type serotonin antagonist that has both central and peripheral effects.
  60. Zofran (Ondansetron)
    1. Contraindications
    2. Side Effects
    • 1. Allergy to Zofran or other serotonin antagonists.
    • *Hypersensitivity reactions have been reported in patients whohave exhibited hypersensitivity to other 5HT3 receptor antagonists (Dolasetron (Ansemet) and Granisetron (Kytril))

    2. None noted at this time
  61. ACETAMINOPHINE (Tylenol)
    1. Drug Class
    2. Indications
    1. Para-aminophenol derivative; antipyretic; analgesic.

    2. Fever
  62. ACETAMINOPHINE (Tylenol)
    1. Adult Dose
    1. 500 - 1,000 mg PO
  63. ACETAMINOPHINE (Tylenol)
    1. Mechanism of Action
    1. The mechanism of action is unclear and may be related to inhibition of prostaglandin synthesis in the CNS. It is believed to exert its antipyretic effect by direct action on the hypothalamic heat-regulating center to block the effects of endogenouspyrogens. This results in increased heat dissipation through sweating and vasodilatation. Its analgesic effect may be related to an elevation of the pain threshold.
  64. ACETAMINOPHINE (Tylenol)
    1. Contraindications
    2. Side Effects
    1. Hypersensitivity, hepatic disease

    2. Allergic reaction, decreased renal and hepatic function.
  65. ACETYLSALICYLIC ACID (Aspirin)
    1. Drug Class
    2. Indications
    1. Antiplatelet agent

    2. Acute coronary syndrome
  66. ACETYLSALICYLIC ACID (Aspirin)
    1. Adult Dose
    1. 324 mg PO
  67. ACETYLSALICYLIC ACID (Aspirin)
    1. Mechanism of Action
    1. Blocks prostaglandin synthetase action, which prevents formation of the platelet-aggregating substance thromboxane A2
  68. ACETYLSALICYLIC ACID (Aspirin)
    1. Contraindications
    2. Side Effects
    1. Hypersensitivity to non-steroidal anti-inflammatory, GI bleeding,ulcers, other bleeding disorders.

    2. Gastric irritation, GI bleeding
  69. ACTIVATED CHARCOAL
    1. Drug Class
    2. Indications
    1. Absorbent

    2. Emergency treatment of most orally ingested poisonings.
  70. ACTIVATED CHARCOAL
    1. Adult Dose
    • 1. 50gm PO, NG
    • *Most effetive when given w/in 30min of ingestion.
  71. ACTIVATED CHARCOAL
    1. Mechanism of Action
    1. Binds poisons, toxins and irritants in GI tract. Bound toxins are inactive until excreted.
  72. ACTIVATED CHARCOAL
    1. Contraindications
    2. Side Effects
    1.Hypersensitivity, Altered mental status with depressed gag reflex; Cyanide, mineral acids, alkali’s, iron and carbon based products.

    2. Constipation, nausea and vomiting
  73. ADENOSINE (Adenocard)
    1. Drug Class
    2. Indications
    1. Antiarrhythmic-Endogenous nucleoside

    2. PSVT, PSVT and wide complex tachycardia of unknown etiology.
  74. ADENOSINE (Adenocard)
    1. Adult Dose
    1. 6 mg IVP; May repeat 12 mg IVP twice at 2 minute intervals
  75. ADENOSINE (Adenocard)
    1. Mechanism of Action
    1. Slows the conduction through AV node; interrupts reentrypathways through AV node.
  76. ADENOSINE (Adenocard)
    1. Contraindications
    2. Side Effects
    1. Hypersensitivity, 2o or 3o AV block, VT, sick sinus syndrome.

    2. Transient dysrhythmias, dyspnea, chest pressure, hypotension,bronchospasm, facial flushing, headache.
  77. ALBUTEROL (Ventolin, Proventil)
    1. Drug Class
    2. Indications
    1. β2 Selective, β2 bronchodilator, Sympathomimetic.

    2. Bronchospasms and reactive airway disease, Pulmonary edema.
  78. ALBUTEROL (Ventolin, Proventil)
    1. Adult Dose
    1. 2.5 mg via UDN, may repeat PRN
  79. ALBUTEROL (Ventolin, Proventil)
    1. Mechanism of Action
    1. Causes bronchodilation by β2-stimulation, resulting in relaxation of bronchial smooth muscles; inhibits mast cell degranulation;stimulates cilia to remove secretions
  80. ALBUTEROL (Ventolin, Proventil)
    1. Contraindications
    2. Side Effects
    1. Hypersensitivity, Cardiac ischemia, or Cardiac insufficiency.

    2. Tachydysrhythmias
  81. AMIODARONE (Cordarone)
    1. Drug Class
    2. Indications
    1. Alpha and Beta noncompetitive receptor blocking agent, aswell as calcium, potassium, and sodium channel blocker.

    2. Pulseless VT/VF, Stable wide complex tachycardia, SVT,PSVT, Atrial fibrillation/flutter, Ventricular ectopy
  82. AMIODARONE (Cordarone)
    1. Adult Dose
    • 1. VT/VF: 300mg IVP may repeat 150mg IVP q 3 – 5min X 1. If defibrillation successful administer slow infusion 1mg/min infusion over next 6 hours
    • All other arrhythmias refer to the following dosing regimen:Loading: 150mg in 100ml D5W and infuse over 10 minutes Followed by slow infusion: 450mg in 250ml D5W and infuse1mg/min (30 gtt/min using a 60 gtt set)
    • Max Dose:2gm IV per 24 hours
  83. AMIODARONE (Cordarone)
    1. Mechanism of Action
    1. Prolongs action potential duration and effective refractory period; noncompetitive alpha and beta adrenergic inhibition.
  84. AMIODARONE (Cordarone)
    1. Contraindications
    2. Side Effects
    1. Hypersensitivity, Cardiogenic shock, bradycardia, 2nd or 3rd degree heart block in absence of a functional pacemaker, Do not use with drugs that prolong QT interval.

    2. Vasodilatation, Hypotension, Bradycardia, AV block,Hepatotoxicity, Increased QT interval, VF, VT
  85. ATROPINE SULFATE
    1. Drug Class
    2. Indicaitons
    1. Anticholinergic

    2. Symptomatic bradycardia, asystole, cholinergic poisoning,pediatric RSI.
  86. ATROPINE SULFATE
    1. Adult Dose
    • 1. Symptomatic bradycardia:0.5 - 1 mg IV q 3-5 min; up to 0.04 mg/kg
    • Asystole:1.0 mg IVP q 3-5 min; Up to 0.04 mg/kg
    • Cholinergic poisoning:2 - 5 mg IV q 15-30 min
  87. ATROPINE SULFATE
    1. Mechanism of Action
    1. Competitively blocks acetylcholine at muscarinic sites, therebyincreasing SA and AV node conduction velocity. It also increases sinus node discharge rate and decreases the AVnode’s effective refractory period.
  88. ATROPINE SULFATE
    1. Contraindiations
    2. Side Effects
    1. Hypersensitivity,A-Fib/A-Flutter, Tachycardias, Glaucoma.

    2. Tachycardia, myocardial ischemia VT/VF, dilated pupils, HA,dry mouth
  89. CALCIUM CHLORIDE
    1. Drug Class
    2. Indications
    1. Electrolyte

    2. Calcium blocker toxicity and hyperkalemia.
  90. CALCIUM CHLORIDE
    1. Adult Dose
    • 1. 5 - 10 mg/kg IV
    • *Bradycardia may be caused by rapid administration.
  91. CALCIUM CHLORIDE
    1. Mechanism of Action
    1. Calcium ions are rapidly transferred to the sites of interaction between actin and myosin filaments of the sarcromere initiating myofibril shortening resulting in increased force of myocardial contraction. Calcium’s positive inotropic and vasoconstriction effects produce a predictable rise in systemic arterial pressure.
  92. CALCIUM CHLORIDE
    1. Contraindications
    2. Side Effects
    1. Hypersensitivity, VF, digitalis toxicity, hypercalcemia.

    2. Bradycardia, asystole, hypotension, VF, extravasation causesnecrosis, coronary and cerebral artery spasm.
  93. DEXTROSE
    1. Drug Class
    2. Indications
    1. Carbohydrate

    2. Hypoglycemia, hyperkalemia, ALOC of unknown etiology.
  94. DEXTROSE
    1. Adult Dose
    1. 25 Gm IV
  95. DEXTROSE
    1. Mechanism of Action
    1. Dextrose is a rapidly metabolized source of calories and fluid inpatients with inadequate oral intake.
  96. DEXTROSE
    1. Contraindications
    2. Side Effects
    1. Hypersensitivity, CVA, ICP, intracranial hemorrhage.

    2. Tissue necrosis
  97. DILTIAZEM (Cardizem)
    1. Drug Class
    2. Indications
    1. Calcium Channel Blocker

    2. PSVT, A-Fib/A-Flutter
  98. DILTIAZEM (Cardizem)
    1. Adult Dose
    1. 20 mg IV over 2 minutes

    *Consider administration of 200mg of Calcium as a pretreatment in elderly dehydrated patients or in the case of drug induced hypotension.
  99. DILTIAZEM (Cardizem)
    1. Mechanism of Action
    1. Inhibits calcium ion influx across cell membranes during cardiac depolarization; produces relaxation of coronary vascular smoothmuscle; slows SA/AV node conduction times; decreases myocardial contractility and peripheral vascular resistance.
  100. DILTIAZEM (Cardizem)
    1. Contraindications
    2. Side Effects
    1. Sick sinus syndrome, high degree heart blocks, concomitantuse of IV beta blockers, wide complex tachycardia of unknown etiology, CHF, hypotension
  101. DIPHENHYDRAMINE (Benadryl)
    1. Drug Class
    2. Indications
    1. Antihistamine

    2. Allergic reactions, extra pyramidal symptoms (dystonicreaction), migraine headaches, may be used as an antiemetic if allergy to promethazine.
  102. DIPHENHYDRAMINE (Benadryl)
    1. Adult Dose
    1. 25 - 50 mg IV/IM   25 mg PO
  103. DIPHENHYDRAMINE (Benadryl)
    1. Mechanism of Action
    1. Antihistamines compete for histamine H1-receptor sites on thesmooth muscle of the bronchi, GI tract, uterus and large vessels. By binding to cellular receptors, they prevent accessof histamine and suppress histamine induced allergic symptoms, even though they do not prevent its release. Antihistamines are also effective in the treatment of extrapyramidal reactions.
  104. DIPHENHYDRAMINE (Benadryl)
    1. Contraindications
    2. Side Effects
    1. Hypersensitivity, Active asthma attacks, pregnancy or lactating females.

    2. Sedation, hypotension, Anticholinergic effects.
  105. DOPAMINE (Intropin)
    1. Drug Class
    2. Indications
    1. Sympathomimetic

    2. Cardiogenic shock and vasogenic shock
  106. DOPAMINE (Intropin)
    1. Adult Dose
    1. 5 – 20 mcg/kg/min IVD, start at 5 mcg and titrate to effect.
  107. DOPAMINE (Intropin)
    1. Mechanism of Action
    1. An immediate precursor of norepinephrine, dopamine stimulates dopaminergic and beta-adrenergic receptors of the sympathetic nervous system. Low to moderate dosages resultin renal/mesenteric vasodilatation and increased chronotropic and inotropic properties of the heart. High doses result in vasoconstriction.
  108. DOPAMINE (Intropin)
    1. Contraindications
    2. Side Effects
    1. Hypersensitivity, Relative ventricular ectopy, Ectopy secondary to shock may resolve as cardiac perfusion is improved.

    2. Tachydysrhythmias, VT/VF, increased myocardial ischemia,AMI, hypertension.
  109. EPINEPHRINE (Adrenalin)
    1. Drug Class
    2. Indications
    1. Adrenergic Sympathomimetic

    2. Cardiac arrest, anaphylactic shock, bronchospastic conditions,croup, pediatric shock.
  110. EPINEPHRINE (Adrenalin)
    1. Adult Dose
    • 1. Cardiac arrest 1 mg 1:10,000 IV q 3-5 min 2.5 mg 1:10,000 ETT q 3-5 min
    •     Anaphylaxis 0.3 - 0.5 mg 1:1,000 SQ q 20 min for a total of 3doses
    •    Anaphylactic shock 0.3 - 0.5 mg 1:1,000 SQ q 20 min for a total of 3 doses
    •    Bronchospasm 0.3 - 0.5 mg 1:1,000 SQ q 20 min for a total of 3 doses
  111. EPINEPHRINE (Adrenalin)
    1. Mechanism of Action
    1. Acts directly by stimulating alpha and beta adrenergic receptors in the sympathetic nervous system. Epinephrine relaxes bronchial smooth muscles and constricts bronchial arterioles,resulting in relief of bronchospasm, reduces congestion and edema. Vasodilatation results form its effect on beta2 receptors. As a vasopressor, epinephrine produces a positive chronotropic and inotropic effect by action on beta1 receptors ofthe heart, increasing cardiac output, myocardial oxygen consumption and force of contraction; vasoconstriction results from beta adrenergic effect.
  112. EPINEPHRINE (Adrenalin)
    1. Contraindications
    2. Side Effects
    1. Hypersensitivity

    2. Hypertension, VT/VF, Tachydysrhythmias, angina.
  113. ETOMIDATE (Amidate)
    1. Drug Class
    2. Indications
    1. Hypnotic/Sedative

    2. Induce sedation to facilitate intubation
  114. ETOMIDATE (Amidate)
    1. Adult Dose
    1. 0.1 – 0.3 mg/kg IV over 15 – 30 seconds. May repeat X 1
  115. ETOMIDATE (Amidate)
    1. Contraindications
    2. Side Effects
    1. Hypersensitivity, Do not use in children under 10 years old.

    2. Myoclonic skeletal muscle movement, apnea, hyperventilation,laryngospasm, dysrhythmias, nausea (common), vomiting, eyemovement (common), hiccups, snoring, and seizures.

    *Concurrent use with Verapamil may cause prolongedrespiratory depression & apnea.
  116. FENTANYL CITRATE (Sublimaze)
    1. Drug Class
    2. Indications
    1. Opioid agonist/Narcotic

    2. Analgesia for pain relief
  117. FENTANYL CITRATE (Sublimaze)
    1. Adult Dose
    • 1. Start at 50mcg and titrate by 50mcg increments up to max dose of 5mcg/kg.
    • *To exceed maximum dose contact medicalcontrol
  118. FENTANYL CITRATE (Sublimaze)
    1. Mechanism of Action
    1. Narcotic agonist with activity at u – receptors (supraspinalanalgesia, euphoria, respiratory and physical depression), k –receptors (sedation and miosis), and delta – receptors(dysphonia, hallucinations, respiratory and vasomotorstimulation)
  119. FENTANYL CITRATE (Sublimaze)
    1. Contraindications
    2. Side Effects
    1. Hypersensitivity to opiates, Myesthesia Gravis, Head injury,exacerbated COPD, depressed respiratory drive, hypotension,Altered LOC, and pediatric patients under 2 years old.

    2. Respiratory depression, hypotension, Altered LOC, nauseaand vomiting.
  120. FUROSEMIDE (Lasix)
    1. Drug Class
    2. Indications
    1. Loop Diuretic

    2. Pulmonary edema
  121. FUROSEMIDE (Lasix)
    1. Adult Dose
    1. 0.5 - 1 mg/kg IV (not to exceed 20.0 mg/min)

    *Double the patient’s single oral daily dose up to 160 mg IV
  122. FUROSEMIDE (Lasix)
    1. Mechanism of Action
    1. Loop diuretics inhibit sodium and chloride reabsorption in the proximal part of the ascending loop of Henle, promoting the excretion of sodium, water, chloride and potassium. Intravenous doses can also reduce cardiac preload by increasing venous capacitance.
  123. FUROSEMIDE (Lasix)
    1. Contraindications
    2. Side Effects
    1. Hypersensitivity, Dehydration/hypovolemia, hypokalemia,hepatic coma, transient hearing loss.

    2. Hypotension, electrolyte imbalance
  124. GLUCAGON
    1. Drug Class
    2. Indications
    1. Polypeptide hormone- antihypoglycemic agent

    2. Hypoglycemia, β blocker overdoses, Second line for Calcium channel blocker overdose, Esophageal spasm.
  125. GLUCAGON
    1. Adult Dose
    • 1. Hypoglycemia 1 mg IM
    •     β & Ca++ channel blocker overdose 3 - 10 mg IV
  126. GLUCAGON
    1. Mechanism of Action
    1. Accelerates liver glycogenolysis and inhibits glycogensynthetase resulting in blood glucose elevation; stimulates hepatic gluconeogenesis and causes an inotropic myocardial effect because of the stimulation of adenylate cyclase to produce cyclic 3’5’-AMP
  127. GLUCAGON
    1. Contraindications
    2. Side Effects
    1. Hypersensitivity

    2. Nausea and vomiting
  128. ORAL GLUCOSE
    1. Drug Class
    2. Indications
    1. Hyperglycemic

    2. Conscious patients with known or suspected hypoglycemia.
  129. ORAL GLUCOSE
    1. Adult Dose
    1. 1 tube; May repeat as needed
  130. ORAL GLUCOSE
    1. Mechanism of Action
    1. Provides a quickly absorbed form of glucose to increase blood glucose levels
  131. ORAL GLUCOSE
    1. Contraindications
    2. Side Effects
    1. Hypersensitivity, Decreased level of consciousness, Nauseaand vomiting.

    2. Nausea and vomiting
  132. IPRATROPIUM BROMIDE (Atrovent)
    1. Drug Class
    2. Indications
    1. Anticholinergic bronchodilator

    2. Bronchospasms secondary to COPD and reactive airway disease.
  133. IPRATROPIUM BROMIDE (Atrovent)
    1. Adult Dose
    1. 0.5 mg UDN
  134. IPRATROPIUM BROMIDE (Atrovent)
    1. Mechanism of Action
    1. Inhibits vagally mediated reflexes by antagonizing the action of acetylcholine. Anticholinergic prevent the increase in intracellular concentration of cyclic guanosine monophosphate(CGMP) that results from the interaction of acetylcholine with the muscarinic receptor on bronchial smooth muscle.
  135. IPRATROPIUM BROMIDE (Atrovent)
    1. Contraindications
    2. Side Effects
    1. Hypersensitivity

    2. Dry mouth, HA, cough
  136. KETOROLAC (Toradol)
    1. Drug Class
    2. Indications
    1. Nonsteroidal anti-inflammatory agent

    2. Flank pain associated with renal colic, Muscle skeletal pain.
  137. KETOROLAC (Toradol)
    1. Adult Dose
    1. 30 mg IV cut dose in half if over 65 years old or under 100lbs.
  138. KETOROLAC (Toradol)
    1. Mechanism of Action
    1. Acts by inhibiting the synthesis of prostaglandins.
  139. KETOROLAC (Toradol)
    1. Contraindications
    2. Side Effects
    1. Hypersensitivity, ASA allergies, bleeding disorders, renal failure,active peptic ulcer.

    2. Increased bleeding time, anaphylaxis, headache
  140. LIDOCAINE (Xylocaine)
    1. Drug Class
    2. Indications
    1. Amide derivative/Antiarrhythmic Class IB

    2. VT/VF, VT with a pulse, symptomatic PVCs, RSI with suspected closed head injuries and broncho-spasms.
  141. LIDOCAINE (Xylocaine)
    1. Adult Dose
    • 1. VT/VF 1.5 mg/kg IV q 5-10 min, Max 3 mg/kg After conversion to NSR, start drip at 2 - 4 mg/min
    • VT with pulse 1 - 1.5 mg/kg IV; then 0.5 - 0.75 mg/kg q 5-10 min up to 3mg/kg. Start drip ASAP
    • PVC 0.5 - 1.5 mg/kg IV then 0.5 - 0.75 mg/kg q 5-10 min up to 3mg/kg. Start drip ASAP
    • RSI: 1 - 1.5 mg/kg IV
    • DRIP: 2 - 4 mg/min
    • 2 mg/min p 1 mg/kg bolus
    • 3 mg/min p 1 - 2 mg/kg bolus
    • 4 mg/min p 2 - 3 mg/kg bolus

    *Reduce maintenance infusion by 50% if pt is > 70 y/o., has liver disease, or is in CHF or shock.
  142. LIDOCAINE (Xylocaine)
    1. Mechanism of Action
    1. As an antiarhythmic, it suppresses automaticity and shortens the effective refractory period and action potential duration of His-Purkinje fibers and suppresses spontaneous ventricular depolarization during diastole by altering sodium permeability through cellular fast channels membranes. The drug act preferentially on diseased or ischemic myocardial tissue,exerting its effects on the conduction system, by inhibits reentry mechanisms and halts ventricular arrhythmias.
  143. LIDOCAINE (Xylocaine)
    1. Contraindications
    2. Side Effects
    1. Hypersensitivity, High degree heart blocks, Stokes-Adams syndrome, hypotension.

    2. Seizures, slurred speech, altered mental status.
  144. MAGNESIUM SULFATE
    1. Drug Class
    2. Indications
    1. Anticonvulsant/antiarrhythmic/Electrolyte
  145. MAGNESIUM SULFATE
    1. Adult Dose
    • 1. Torsades de Pointes 1 - 2 Gm/100ml IV over 2 min
    • VT/VF 1 - 2 Gm/20ml IV
    • Seizures 2o eclampsia 4 Gm/100ml IV over 2 min
    • Maintenance drip 1 – 2 gm/hr
    • Asthma 1 - 2 Gm IV over 5-10 min
  146. MAGNESIUM SULFATE
    1. Mechanism of Action
    1. Reduces striated muscle contractions and blocks peripheral neuromuscular transmission by reducing acetylcholine release at the myoneural junction; slows the rate of SA node impulse formation, prolongs conduction time.
  147. MAGNESIUM SULFATE
    1. Contraindications
    2. Side Effects
    1. Hypersensitivity, Renal disease, heart block, hypermagnesemia.

    • 2. Hypotension, respiratory depression, cardiac arrest, CNS depression, flushing, sweating.
    • *Caution should be used in patients receiving digitalis-Calcium chloride should be readily available as an antidote if respiratory depression ensues.
  148. METHYLPREDNISOLONE (Solu-Medrol)
    1. Drug Class
    2. Indications
    1. Synthetic glucocorticoid/Steroid

    2. COPD, reactive airway disease, allergic reaction.
  149. METHYLPREDNISOLONE (Solu-Medrol)
    1. Adult Dose
    1. COPD & Asthma, Allergic Reaction 62.5 mg IV
  150. METHYLPREDNISOLONE (Solu-Medrol)
    1. Mechanism of Action
    1. Decreases inflammation by depressing migration of polymorphonuclear leukocytes and activity of endogenous mediators of inflammation.
  151. METHYLPREDNISOLONE (Solu-Medrol)
    1. Contraindications
    2. Side Effects
    1. Hypersensitivity, Premature infants, systemic fungal infections.

    2. CHF, HTN, seizures, headache, nausea & vomiting.
  152. METOPROLOL (Lopressor)
    1. Drug Class
    2. Indications
    1. Beta-adrenergic blocking agent

    2. Myocardial salvage in acute myocardial infarction,Tachydysrhythmias, Hypertension without evidence of CVA.
  153. METOPROLOL (Lopressor)
    1. Adult Dose
    1. 5 mg IV over 5 min, repeat q 5 min to max 15 mg
  154. METOPROLOL (Lopressor)
    1. Mechanism of Action
    1. As a competitive β-adrenergic antagonist, negative inotropic and chronotropic responses are demonstrated by slowing of AVnodal conduction and decreased heart rate. Decreased myocardial oxygen consumption, antiarhythmic effect,suppression of renin release and inhibition of central nervous system outflow is observed.
  155. METOPROLOL (Lopressor)
    1. Contraindications
    2. Side Effects
    1. Hypersensitivity, CHF, pulmonary edema, bronchospasm, heartblock, bradycardia, hypotension, history of asthma.

    2. Hypotension, CHF, bronchospasm, bradycardia, dizziness,chest pain, headache.

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