paramedic drug flash cards

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paramedic drug flash cards
2014-10-10 20:31:10
drug cards


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  1. Acetaminophen:
    • Trade name: Tylenol
    • Classification: analgesic, antipyretic
    • Actions: analgesic, antipyretic with little effect on platelet function
    • Indications: fever, mild to moderate pain
    • Contraindications: liver disease
    • Side effects: decreased liver function
    • Dose/Route: 15mg/kg PO q 4-6 hrs
  2. Aspirin:
    • Trade name:Acetylsalicylic acid
    • Classification: anti-platelet aggregate
    • Actions: inhibits platelet aggregation
    • Indications: new chest pain suggestive of acute MI, S/S suggestive of recent stroke
    • Contraindications: known bleeding disorder
    • Side effects: heartburn, nausea, vomiting, wheezing
    • Dose/Route: 160-325mg PO. Peds: consult physician
  3. Activated Charcoal:
    • Trade name: Actidose, InstaChar
    • Classification: adsorbant
    • Actions: adsorbs toxins by chemical binding and prevents GI adsorption
    • Indications: poisoning by select drugs and chemicals
    • Contraindications: poisoning by cyanide, mineral acids, caustic alkalis, organic solvents, iron, ethanol, methanol
    • Side effects: vomiting following rapid ingestion
    • Dose/Route: 1g/kg with 6-8oz water PO/NG.
  4. Adenosine:
    • Trade name: Adenocard
    • Classification: antidysrhythmic
    • Actions: slows atrioventricular conduction
    • Indications: symptomatic PSVT, paroxysmal supraventricular tachycardia
    • Contraindications: 2nd or 3rd heart block, sick-sinus syndrome
    • Side effects: facial flushing, headache, sob, dizziness, nausea
    • Dose/Route: Initial 6mg rapid IV push over 1-2 sec followed by 20 cc flush, if no action administer 12mg. maximum single dose is 12mg.
  5. Afrin:
    • Trade name: Genasal
    • Classification: decongestant
    • Actions: stimulates smooth muscle, alpha-adrenergic receptors
    • Indications: pt requiring nasal intubation or nasal airway
    • Contraindications: hypersensitivity to Rx
    • Side effects: nasal irritation, sneezing, nasal dryness, hypertension, cardiovascular collapse
    • Dose/Route: 2-3 sprays intranasal.
  6. Albuterol:
    • Trade name: Proventil, Ventolin
    • Classification: sympathomimetic bronchodilator
    • Actions: selective beta2 adrenergic, bronchodilation
    • Indications: asthma, bronchospasm associated w/ COPD, Anaphylaxis
    • Contraindications: symptomatic tachycardia, others relative to patient
    • Side effects: palpitations, anxiety, headache, dizziness, sweating
    • Dose/Route: 2.5-5 mg nebulizer / Peds 2.5 mg in 2cc of NS, MDI : 90mcg
  7. Alteplase Recombinant (TPA):
    • Trade name: Activase
    • Classification: Thrombolytic
    • Actions: thrombolytic agent
    • Indications: thrombolysis in acute MI and acute ischemic stroke
    • Contraindications: active internal bleeding, suspected aortic dissection, traumatic CPR, history of hemorrhagic stroke, hypertension
    • Side effects: internal and superficial bleeding
    • Dose/Route: 15mg IV, then 0.75mg/kg (up to 50mg) over 30 min, and then 0.5mg/kg (up to 35mg) over 60 min. Not indicated for Pedi Use
  8. Aminophylline:
    • Trade name: Phyllocontin, Somophyllin, Truphyllin
    • Classification: Xanthine bronchodilator
    • Actions: Direct smooth muscle relaxant, bronchodilation, increase vital capacity
    • Indications: bronchial asthma, CHF, pulmonary edema
    • Contraindications: hypotension, peptic ulcer disease (PUD)
    • Side effects: PVC's, tachycardia, convulsions, anxiety, dizzy, vomiting, narrow TI
    • Dose/Route: 5mg/kg IV bolus over 20-30min, followed by an 0.5-0.8mg/kg/hr continuous infusion
  9. Amiodarone:
    • Trade name: Cordarone
    • Classification: antidysrhythmic
    • Actions: prolongs action potential, slows sinus rate, increase PR&QT interval, decrease PVR peripheral vascular resistance
    • Indications: pulseless VTach, VFib, stable wide complex tachycardia, SVT, PSVT, AFib, ventricular ectopy
    • Contraindications: 2nd & 3rd degree heart blocks
    • Side effects: hypotension, ventricular ectopic beats, pulmonary toxicity, nausea, tremors
    • Dose/Route: Arrest: 1st 300mg IVP, Then: 150mg IVP q 3-5 min up to 2 grams. Drip: 150 mg in 100 ml over 10 minutes.
  10. Amyl Nitrate:
    • Trade name: Amyl Nitrate
    • Classification: nitrate vasodilator, cyanide antidote
    • Actions: coronary vasodilation, removes cyanide ion via complex mechanism
    • Indications: cyanide poisoning (bitter almond smell to breath)
    • Contraindications: none when used in treatment of cyanide poisoning
    • Side effects: hypotension, headache, reflex tachycardia, nausea
    • Dose/Route: inhalant should be broken and inhaled. Repeat PRN
  11. Atenolol:
    • Trade name: Tenormin
    • Classification: antidysrhythmic
    • Actions: selective B1 adrenergic antagonist
    • Indications: ventricular fibrillation, acute coronary syndromes including non-Q-wave MI & unstable angina
    • Contraindications: sinus bradycardia, greater than first degree heart block, CHF, cardio shock
    • Side effects: dizziness, hypotension, bradycardia. dysrhythmias, pulmonary edema, bronchospasm
    • Dose/Route: 2.5 - 5.0 mg over 2-5 minutes, if dose tolerated, then 2.5 - 5.0 mg every 2 - 10 minutes to a total of 10 mg over 10 - 15 minutes IV/IO
  12. Atropine:
    • Trade name: Atropine
    • Classification: parasympatholytic or anticholinergic
    • Actions: blocks acetylcholine receptors, increase HR, decrease GI secretions
    • Indications: hemodynamically significant bradycardia, hypotension secondary to bradycardia, asystole, organophosphate poisoning
    • Contraindications: Hypersensitivity to Belladonna Alkaloids, AMI, Tachycardia, COPD, Glaucoma, A-Fib, A-Flutter
    • Side effects: palpitations, tachycardia, headache, pupil dilation, blurred vision, dry mouth
    • Dose/Route: bradycardia 0.5mg every 3-5min to a maximum of 0.4mg/kg IV, organophosphate poisoning 2-5mg IV every 10-15 min. Peds bradycardia 0.02mg/kg(min dose 0.1mg), 0.5mg/kg for organophosphate poisoning.
  13. Bumex:
    • Trade name: Bumetanide
    • Classification: Class: Potent Loop Diuretic, Electrolyte and water balance agent
    • Actions: inhibits reabsorption of sodium chloride, promotes prompt diuresis, slight vasodilation
    • Indications: Treatment of Edema associated with CHF, Renal and Hepatic disease, including nephritic syndrome
    • Contraindications: dehydration, pregnancy
    • Side effects: Dizziness, Headache, Weakness, Tinnitus, Hypotension, EKG changes, Angina, Leukopenia, Anemia, Hypokalemia
    • Dose/Route: 0.5-1mg IV, IM. Not for Pedi Use
  14. Calcium Chloride:
    • Trade name: Calcium Chloride
    • Classification: electrolyte
    • Actions: increases cardiac contractility
    • Indications: acute hyperkalemia (elevated potassium), acute hypocalcemia (decreased calcium), calcium channel blocker overdose, antidote for magnesium sulfate
    • Contraindications: pt receiving digitalis, ventricular fibrillation
    • Side effects: dysrhythmias (bradycardia and asystole), hypotension
    • Dose/Route: 2-4mg/kg IV of a 10% solution may be repeated at 10min intervals. Peds 5-7mg/kg of a 10% solution
  15. Calcium Gluconate:
    • Trade name: Kalcinate
    • Classification: electrolyte
    • Actions: positive inotropic effect making it useful in pt with sympathetic blockade
    • Indications: cardiac toxicity of hyperkalemia, antidote for magnesium sulfate, calcium channel blocker overdose
    • Contraindications: ventricular fibrillation, renal or cardiac insufficiency
    • Side effects: hypotension, bradycardia, dysrhythmias
    • Dose/Route: 5-8ml IV of a 10% solution. May repeat every 10min as needed
  16. Captopril:
    • Trade Name: Capoten
    • Classification: Anti-hypertensive, ACE Inhibitor
    • Actions: Blocks transformation of Angiotensin 1 to Angiotensin 2
    • Indications: HTN, Some Cardiac events, CHF, Some Diabetic issues, Rx by PCP
    • Contraindications: Capoten has demonstrated fetal toxicity
    • Side effects: Coughing, angioedema, proteinuria, taste changes, Hypotension, pregnancy complications, rash, increased renin levels
    • Dose: Varies on condition, 12.5 mg- 150 mg PO q8hrs
  17. cimetidine:
    • Trade Name: Tagamet
    • Classification: H2 receptor agonist used in treatment of stomach ulcers, heartburn, sour stomach, GERD
    • Actions: Blocks production of acid in stomach
    • Indications: Home med use directed by physician
    • Contraindication:
    • Side Effects: constipation, diarrhea, fatigue, headache, insomnia, muscle pain, nausea, and vomiting.
    • Dose/Route: 200-1600 mg PO dependent on condition, IV and IM preparation available for hospital use.
  18. D50:
    • Trade name: D50W
    • Classification: carbohydrate, hypertonic glucose solution
    • Actions: elevates blood glucose level rapidly
    • Indications: hypoglycemia
    • Contraindications: hyperglycemia, diabetic coma, intracranial and spinal hemorrhage
    • Side effects: hyperglycemia, local venous irritation
    • Dose/Route: 25g (50ml) IV ONLY. Peds 1mg/kg, young children dilute 50/50 with NS
  19. Dexamethasone:
    • Trade name: Decadron, Hexadrol
    • Classification: corticosteroid, glucocorticoid
    • Actions: anti-inflammatory, suppresses immune response (especially in anaphylaxis), decreases cerebral edema
    • Indications: Control of severe allergic reactions, asthma attacks, and bronchospasm associated with COPD
    • Contraindications: Known Allergy
    • Side effects: Prolonged healing, GI Bleeding
    • Dose/Route: 4-24mg IV, IO, IM. Peds 0.2-0.5mg/kg
  20. Diazepam
    • Trade name: Valium
    • Classification: benzodiazepine
    • Actions: anticonvulsant, skeletal muscle relaxant, sedative,
    • Indications: major motor seizure, status epilepticus, premedication before cardioversion,
    • Contraindications: precaution- short duration of effect, Flumazenil (romazicon) should be available
    • Side effects: hypotension, respiratory depression and apnea
    • Dose/Route: status epilepticus 5-10mg IV, acute anxiety 2-5mg IM or IV, premed for cardioversion 5-15mg IV. Peds status epilepticus 0.1-0.2mg/kg
  21. Digoxin
    • Trade name: Digoxin, Lanoxin, Novodigoxin
    • Classification: cardiac glycoside
    • Actions: Increases the force and velocity of myocardial contraction and cardiac output
    • Indications: CHF, rapid atrial dysrhythmias especially atrial flutter and atrial fibrillation
    • Contraindications: any sign of digitalis toxicity, ventricular fibrillation
    • Side effects: dysrhythmias, various degree of heart block, n/v, yellow vision, cardiac arrest, h/a, sweating, rash
    • Dose/Route: 0.25-0.5mg slow IV. Peds 10-50 mcg/kg
  22. Diltiazem
    • Trade name: Cardizem
    • Classification: calcium channel blocker
    • Actions: slows conduction through atrioventricular node, vasodilation, decrease rate of ventricular response, decrease myocardial oxygen demand
    • Indications: to control rapid ventricular rates associated with atrial fibrillation
    • Contraindications: hypotension, wide complex tachycardia, conduction system disturbances
    • Side effects: hypotension, n/v, dizziness
    • Dose/Route: Initial dose: 0.25mg/kg slow IV (average dose 20mg in adult male) May repeat with 0.35 mg/kg (25 mg average) in 10-15 minutes if no or diminishing effect. Decrease by 5 mg per bolus for elderly (>70 yr/old).
  23. Dyphenhydramine
    • Trade name: Benadryl
    • Classification: antihistamine
    • Actions: blocks histamine receptors, has some sedative effects
    • Indications: anaphylaxis, allergic reaction and or EPS
    • Contraindications: asthma
    • Side effects: sedation dries bronchial secretion, palpitations
    • Dose/Route: 20-50mg deep IM, IV. Peds 1mg/kg
  24. Dobutamine
    • Trade name: Dobutrex
    • Classification: sympathomimetic
    • Actions: synthetic catecholamine and beta agent that increase the strength of cardiac contraction without appreciably increasing rate
    • Indications: to increase cardiac output in CHF and cardiogenic shock
    • Contraindications: v-tach, hypovolemia without fluid resuscitation
    • Side effects: h/a, hypertension, palpitations
    • Dose/Route: 2-20 mcg/kg/min IV drip placed in 500 ml of d5w giving a concentration of 0.5 mg/ml
  25. Dopamine
    • Trade name: Intropin
    • Classification: sympathomimetic
    • Actions: increase cardiac contractility, causes peripheral vasoconstriction
    • Indications: hemodynamically significant hypotension, cardiogenic shock
    • Contraindications: hypovolemic shock, pheochromocytoma
    • Side effects: ventricular tachycardia, hypertension, palpitations
    • Dose/Route: 2-5 mcg/kg/min IV drip. Pedi dose same as adult
  26. Enalapril
    • Trade name: Vasotec
    • Classification: ACE inhibitor, antihypertensive
    • Actions: blocks conversion of angiotensin I to angiotensin II, vasoconstriction
    • Indications: hypertension
    • Contraindications:
    • Side effects:
    • Dose/Route: 2.5-20mg PO, 1.25mg/ml IM
  27. Epinephrine
    • Trade name: Adrenalin, Epinephrine
    • Classification: sympathomimetic
    • Actions: increases heart rate, contractility, conductivity, systemic vascular resistance, and systolic BP, decreases overall airway resistance and automaticity.
    • Indications: cardiac arrest, anaphylactic shock, severe reactive airway disease
    • Contraindications: narrow angle glaucoma, hemorrhagic, traumatic or cardiogenic shock, coronary insufficiency, dysrhythmias, organic brain or heart disease, labor
    • Side effects: palpitations, tachycardia, anxiety, h/a, n/v, tremors
    • Dose/Route:
    • Arrest: 1mg of 1:10,000 IV q.3-5 min.
    • Allergic reactions: 0.3-0.5 mg of 1:1,000 IM/SQ 5-15 min as needed or 0.5-1 mg of 1:10,000 IV if IM dose is ineffective or severe reaction.
  28. Intergrilin
    • Trade name: Eptifibatide
    • Classification: antiplatelet
    • Actions: inhibits platelet aggregation
    • Indications: acute coronary syndrome,
    • Contraindications: recent history of CVA,
    • Side effects: headache, bleeding, N/V, hypotension
    • Dose/Route: 0.75-2mg/ml IV
  29. Esmolol
    • Trade name: Brevibloc
    • Classification: beta blocker (B1 selective)
    • Actions: inhibits the actions of catecholamines, decreases HR. decreases AV conduction
    • Indications: symptomatic supraventricular tachycardia (including A-fib, A-flutter) as evidenced by chest pain, palpitations or dizziness
    • Contraindications: sinus bradycardia, 2nd and 3rd degree heart blocks, cardiogenic shock, CHF, asthma
    • Side effects: dizziness, diaphoresis, hypotension, n/v, dyspnea, wheezing, weakness
    • Dose/Route: Preparation: 2.5g ampules in 500 ml of d5w/ concentration of 10mg/ml IV. Loading dose: 500 mg/kg for 1 min. Maintenance dose: 50 mg/kg/min
  30. Fentanyl
    • Trade name: Sublimaze
    • Classification: narcotic analgesic
    • Actions: potent synthetic narcotic analgesic similar to morphine and meperidine but with a more rapid and less prolonged action. CNS depressant
    • Indications: severe pain, adjunct to RSI, maintenance of analgesia
    • Contraindications: MOAI within 14 days, myasthenia gravis, shock, severe hemorrhage, undiagnosed abdominal pain
    • Side effects: dizziness, LOC/AMS, bradycardia
    • Dose/Route: 25-100 mcg slow IV (2-3 min) Peds: 2.0 mcg/kg slow IV
  31. Tambocor
    • Trade name: Flecainide
    • Classification: antidysrthmic
    • Actions: slows myocardial conduction and effectively suppresses PVC's and a variety of atrial and ventricular dysrhythmias
    • Indications: A-flutter, A-fib, AV re-entrant tachycardia, SVT associated with WPW syndrome
    • Contraindications: 2nd or 3rd degree heart block, right bundle branch with left hemiblock, cardiogenic shock or significant hepatic impairment
    • Side effects: dizziness, h/a, chest pain, n/v, dyspnea, fever, blurred vision
    • Dose/Route: 100 mg PO/12 hrs or 2 mg/kg IV at 10 mg/min. Peds 1-3mg/kg/day PO in 3 equal doses
  32. Flumazenil
    • Trade name: Romazicon
    • Classification: benzodiazepine antagonist
    • Actions: reverses the sedative, recall and psychomotor effects of diazepam, midazolam, and other benzodiazepines
    • Indications: to reverse CNS respiratory depression associated with benzodiazepines
    • Contraindications: hypersensitivity
    • Side effects: fatigue, h/a, nervousness, dizziness
    • Dose: 0.2 mg IV over 30 sec- max dose of 1.0 mg
  33. Furosemide
    • Trade name: Lasix
    • Classification: diuretic
    • Actions: inhibits sodium reabsorption by the kidneys. Its vasodilation effects reduce venous return and cardiac workload
    • Indications: CHF and pulmonary edema
    • Contraindications: pregnancy, dehydration, hepatic coma
    • Side effects: few in emergency setting
    • Dose/Route: 40-120 mg slow IV. Pedi 1 mg/kg slow IV
  34. Glucagon
    • Trade name: Glucagen
    • Classification: antihypoglycemic, hormone
    • Actions: elevates blood glucose levels, increases cardiac contractile force and HR
    • Indications: hypoglycemia, beta blocker overdose
    • Contraindications: precaution-only effective if there are sufficient stores of glycogen in the liver
    • Side effects: dizziness, h/a, n/v, hypotension, hyperglycemia, hypokalemia
    • Dose/Route:
    • Hypoglycemia: 1mg IM, SC repeat every 5-10 min.
    • Beta blocker overdose: 50-150 mg/kg IV over 1 min
  35. Haldol
    • Trade name: Haloperodol
    • Classification: antipsychotic
    • Actions: blocks dopamine receptors in the brain associated with mood and behavior, is a potent antiemetic, and impairs temperature regulation
    • Indications: acute psychotic episodes
    • Contraindications: parkinsons disease, seizure disorders, coma, alcohol depression, CNS depression, use of other sedatives and thyrotoxicosis
    • Side effects: insomnia, restlessness, anxiety, euphoria, agitation, drowsiness, mental depression, lethargy, fatigue, weakness, tremors, ataxia, h/a, confusion
    • Dose/Rote: 2-5 mg IM. Peds children >3 yo 0.015-0.15 mg/kg/day PO in 2-3 equal doses
  36. Heparin
    • Trade name: Heparin
    • Classification: anticoagulant
    • Actions: rapid onset anticoagulant, enhancing effect of antithrombin III and blocking the conversion of prothrombin to thrombin and fibrinogen to fibrin
    • Indications: to prevent thrombus formation in non-Q-wave MI, unstable angina, PE and DVT
    • Contraindications: active bleeding, recent eye, brain, spinal surgery, and shock
    • Side effects: confusion, dizziness, edema, bleeding complications
    • Dose/Route: 5000 units IV, maintenance dose of 20,000-40,000 units over 24hrs
  37. Insulin
    • Trade name: Humilin, Novolin, Iletin, Actrapid, Hypurin
    • Classification: hormone
    • Actions: causes uptake of glucose by the cells, decreases blood glucose levels, promotes glucose storage
    • Indications: hyperglycemia, diabetic coma, diabetic ketoacidosis
    • Contraindications: hypoglycemia
    • Side effects: few in the emergency setting
    • Dose/Route: 5-10 units IV, IM, SC. Peds 2-4 units IV, IM, SC
  38. Ipratropium
    • Trade name: Atrovent
    • Classification: anticholinergic (parasympatholytic bronchodilator)
    • Actions: bronchodilator used in the treatment of respiratory emergencies that causes bronchial dilation and dries respiratory tract secretions by blocking acetylcholine receptors
    • Indications: bronchospasm associated with asthma, COPD and inhaled irritants
    • Contraindications: hypersensitivity to atropine or its derivatives, or as a primary treatment for acute bronchospasm
    • Side effects: palpitations, dizziness, anxiety, h/a, nervousness
    • Dose/Route: 500 mcg in 2.5-3 ml NS via nebulizer or 2 sprays from an MDI. Peds 125-250 mcg in 2.5-3 ml NS via nebulizer or 1-2 sprays from an MDI
  39. Isoproterenol
    • Trade name: Isuprel
    • Classification: sympathomimetic
    • Actions: increase in cardiac output by increasing the strength of cardiac contraction and increasing rate. Reduces PVR and venous return and causes bronchodilation
    • Indications: bradycardia refractory to atropine when pacing is not available and for severe status asthmaticus
    • Contraindications: cardiogenic shock
    • Side effects: tachydysrhythmias, tremors, palpitations, h/a
    • Dose/Route: bradycardia: 2-10 mcg/min titrated to cardiac rate. Peds 0.1 mcg/kg/min titrated to cardiac rate. Status asthmaticus: 1-2 sprays MDI. Peds same as adult
  40. Ketorolac
    • Trade name: Toradol
    • Classification: NSAID
    • Actions: exhibits analgesic, anti-inflammatory and antipyretic properties without sedative effects
    • Indications: mild to moderate pain, renal colic
    • Contraindications: hypersensitivity to ketorlac, aspirin, or other nsaids, asthma
    • Side effects:
    • Dose/Route: 30 mg IV (15 mg >65 yo or weighs <50 kg), 30-60 mg IM
  41. Labetalol
    • Trade name: Trandate, Normodyne, Presolol
    • Classification: beta blocker
    • Actions: induces vasodilation, reduces PVR and lowers BP
    • Indications: acute hypertensive crisis
    • Contraindications: asthma, CHF, 2nd 3rd degree heart block, severe bradycardia, cardiogenic shock
    • Side effects: bradycardia, heart block, CHF, bronchospasm, postural hypotension
    • Dose/Route: 20 mg slow IV, then 40-80 mg/10 min as needed up to 300 mg or IV infusion of 2 mg/min up to 300 mg
  42. Lidocaine
    • Trade name: Xylocaine, Xylocard
    • Classification: antiarrhythmic
    • Actions: suppresses automaticity and raises stimulation threshold of the ventricles. Also causes sedation, anticonvulsant, and analgesic effects
    • Indications: pulseless ventricular tachycardia, VFib, VTach (with pulse)
    • Contraindications: hypersensitivity to amide-type local anesthetics, SVT dysrhythmias, stokes-adams syndrome, 2nd 3rd degree heart blocks, bradycardia
    • Side effects: anxiety, convulsions, n/v, dizziness, drowsiness, confusion
    • Dose/Route: cardiac arrest: 1-1.5 mg/kg IV repeated every 3-5 min up to 3mg/kg, follow conversion with drip of 2-4 mg/min. Peds 1 mg/kg IV repeat 3-5 min up to 3 mg/kg, follow conversion with drip of 20-50 mcg/kg/min. VTach (with pulse) : 1-1.5 mg/kg slow IV, may repeat at ½ dose every 5-10 min until conversion, follow conversion with drip rate 0f 2-4 mg/min. Peds 1 mg/kg followed by drip rate of 20-50 mcg/kg/min
  43. Lorazepam
    • Trade name: Ativan, Novo-Lorazepam, Nu-loraz
    • Classification: sedative
    • Actions: 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, pregnancy
    • Side effects: respiratory depression, apnea, n/v, drowsiness, hypotension
    • Dose/Route: Sedation: 2-4 mg IM, 0.5-2 mg IV. Peds 0.03-0.5 mg/kg IV,IM up to 4mg. Status Epilepticus: 2 mg slow IV. Peds 0.1 mg/kg slow IV
  44. Magnesium Sulfate
    • Trade name: Magnesium
    • Classification: electrolyte
    • Actions: acts as a calcium channel blocker, acting as a CNS depressant and anticonvulsant. Depresses the function of smooth, skeletal, and cardiac muscles
    • Indications: refractory VFib and pulseless VTach, AMI, eclamptic seizures
    • Contraindications: heart block, myocardial damage, shock, HTN, hypocalcemia
    • Side effects: flushing, sweating, respiratory depression, hypotension, muscle weakness, drowsiness
    • Dose/Route: VTach/VFib: 1-2 g IV over 2 min. Torsade de pointes: 1-2 g IV followed by drip of 0.5-1 g/hr IV. AMI: 1-2 g IV over 5-30 min. Eclampsia: 2-4 g IV/IM
  45. Mannitol
    • Trade name: Osmitrol
    • Classification: osmotic diuretic
    • Actions: draws water into the intravascular space through its hypertonic effects, then causes diuresis
    • Indications: cerebral edema
    • Contraindications: hypersensitivity, pulmonary edema, CHF, organic CNS disease, intracranial bleeding, shock, severe dehydration
    • Side effects: pulmonary congestion, sodium depletion, transient volume overload
    • Dose/Route: 1.5-2 g/kg slow IV. Peds 0.25-0.5 g/kg over 60 min
  46. Meperidine
    • Trade name: Demerol
    • Classification: narcotic analgesic
    • Actions: synthetic narcotic with sedative and analgesic properties comparable to morphine but w/o hemodynamic effects
    • Indications: moderate to severe pain
    • Contraindications: hypersensitivity, seizure disorder, acute abdomen pain prior to diagnosis
    • Side effects: dizziness, altered LOC
    • Dose/Route: 25-50 mg IV, 50-100 mg IM. Peds 1 mg/kg IV,IM
  47. Metaproterenol
    • Trade name: Alupent, Metaprel
    • Classification: sympathomimetic bronchodilator
    • Actions: synthetic sympathomimetic amine that causes smooth muscle relaxation of the bronchial tree, decreasing air way resistance, facilitating mucus drainage and increasing vital capacity
    • Indications: bronchial asthma, reversible bronchospasm associated with COPD
    • Contraindications: hypersensitivity to sympathomimetic agents, tachydysrhythmias, hyperthyroidism
    • Side effects: palpitations, anxiety, h/a, n/v, tremors, dizziness
    • Dose/Route: 0.65 mg MDI (2 sprays) or 0.2-0.3 ml in 2.5-3 ml NS via nebulizer. Peds 0.1-0.2 ml/kg (5% solution) in 2.5-3 ml NS via nebulizer
  48. Methylprednisolone
    • Trade name: Solu-Medrol
    • Classification: corticosteroid, anti-inflammatory
    • Actions: synthetic adrenal corticosteroid effective as an anti-inflammatory and used in the management of allergic reactions and in some cases of shock and spinal cord injury
    • Indications: severe anaphylaxis, asthma, COPD, spinal cord injury
    • Contraindications: none in emergency setting
    • Side effects: GI bleeding, prolonged wound healing
    • Dose/Route: Asthma/COPD/Anaphylaxis: 125-250 mg IV, IM. Peds 1-2 mg/kg/dose IV, IM. Spinal cord injury: 30 mg/kg IV over 15 min
  49. Lopressor
    • Trade name: Metoprolol
    • Classification: beta blocker (B2 selective)
    • Actions: beta adrenergic blocking agent that reduces HR, cardiac output and BP
    • Indications: AMI
    • Contraindications: cardiogenic shock, systolic BP <100mmHg, sinus bradycardia <45 bpm, 2nd 3rd degree block, PR interval >0.24, cor pulmonale, asthma, COPD
    • Side effects: bradycardia, heart block, CHF, depression, bronchospasm
    • Dose/Route: 5 mg slow IV/5 min up to 15 mg
  50. Midazolam
    • Trade name: Versed
    • Classification: sedative
    • Actions: short acting benzodiazepine with CNS depressant, muscle relaxant, anticonvulsant, and anterograde amnestic effects
    • Indications: induce sedation for cardioversion or intubation, acute anxiety states
    • Contraindications: hypersensitivity, narrow angle glaucoma, shock, coma, acute alcohol intoxication
    • Side effects: drowsiness, hypotension, amnesia
    • Dose/Route: 1-2.5 mg slow IV, 0.07-0.08 mg/kg IM (usually 5 mg). Peds 0.05-0.2 mg/kg IV, 0.1-0.15 mg/kg IM, 3 mg intranasal
  51. Milrinone
    • Trade name: Primacor
    • Classification: vasodilator, cardiac inotrope
    • Actions: increases the strength of cardiac contraction w/o increasing rate, increases cardiac output w/o O2 demand
    • Indications: CHF, pediatric septic shock
    • Contraindications: hypersensitivity
    • Side effects: increased ectopic activity, PVC's, VTach, VFib, supraventricular dysrhythmias, increase in angina symptoms, hypotension
    • Dose/Route: CHF: 50 mcg/kg IV over 10 min, then drip at 0.375-0.75 mcg/kg/min IV. Pediatric septic shock: 50-75 mcg/kg IV then drip at 0.5-0.75 mcg/kg/min
  52. Morphine Sulfate
    • Trade name: Morphine
    • Classification: narcotic analgesic
    • Actions: potent analgesic and sedative that causes some vasodilation reducing venous return and reduced myocardial O2 demand
    • Indications: moderate to severe pain, MI, pulmonary edema
    • Contraindications: hypersensitivity to opiates, undiagnosed head or abdominal injury, hypotension, volume depletion, acute bronchial asthma, COPD, severe respiratory depression, pulmonary edema due to chemical inhalation
    • Side effects: altered LOC, respiratory depression, dizziness
    • Dose/Route: Pain: 2.5-15 mg IV, 5-20 mg IM/SC. Peds 0.05-0.1 mg/kg IV, 0.1-0.2 mg/kg IM/SC. AMI/Pulmonary edema: 1-2 mg/ 6 to 10 min to response
  53. Nubain
    • Trade name: Nalbuphine
    • Classification: narcotic analgesic
    • Actions: synthetic narcotic analgesic equivalent to morphine, though its respiratory depression does not increase with higher doses
    • Indications: moderate to severe pain
    • Contraindications: hypersensitivity, undiagnosed head or abdominal injury
    • Side effects: altered LOC, dizziness
    • Dose/Route: 5 mg IV, IM, SC may repeat at 2 mg doses as needed up to 20 mg. Peds 0.1-0.15 mg/kg IV, IM, SC (rarely used)
  54. Naloxone
    • Trade name: Narcan
    • Classification: narcotic antagonist
    • Actions: blocks the effects of both natural and synthetic narcotics and may reverse respiratory depression
    • Indications: narcotics overdose: morphine, dilaudid, Fentanyl, Demerol, paregoric, methadone, heroin, percodan, tylox. Synthetic narcotic overdose: nubain, Stadol, talwin, darvon. Coma of unknown origin
    • Contraindications: hypersensitivity, non-narcotic induced respiratory depression
    • Side effects: rare
    • Dose/Route: 0.4-2 mg IV, IM (2-2.5 times the dose ET), repeated in 2-3 min as needed up to 10 mg. Peds 0.01 mg IV, IM ( 2-2.5 times the dose ET), repeated in 2-3 min as needed up to 10mg
  55. Nitroglycerin
    • Trade name: Nitrostat
    • Classification: nitrate
    • Actions: rapid smooth muscle relaxant that reduces PVR, BP, venous return and cardiac workload
    • Indications: chest pain associated with angina and AMI, acute pulmonary edema
    • Contraindications: hypersensitivity, tolerance to nitrates, severe anemia, head trauma, hypotension, increased ICP, pts taking sildenafil, glaucoma and shock
    • Side effects: severe h/a
    • Dose/Route: 1 tablet (0.4 mg) SL, may repeat every 3-5 min up to 3 tablets, or 0.4 mg ( 1 spray) SL up to 3 sprays/25 min
  56. Nitrous Oxide
    • Trade name: Nitronox, Entonox
    • Classification: analgesic gas
    • Actions: self administered analgesic gas composed of 50% O2 and 50% nitrous oxide. Effects last only 2-5 min
    • Indications: musculoskeletal pain, burns, ischemic chest pain, severe anxiety
    • Contraindications: bowel obstruction, pneumothorax or tension pneumothorax, COPD, head injury, impaired mental status, drug intoxication
    • Side effects: h/a, dizziness, giddiness, n/v
    • Dose/Route: self administered inhalation until pain is relieved or pt drops mask
  57. Norepinephrine
    • Trade name: Levophed
    • Classification: sympathomimetic agent
    • Actions: naturally occurring catecholamine that causes vasoconstriction, cardiac stimulation and increased BP, myocardial O2 demand and coronary blood flow
    • Indications: refractory hypotension, neurogenic shock
    • Contraindications: hypotension due to hypovolemia
    • Side effects: anxiety, palpitations, h/a, HTN
    • Dose/Route: 0.5-30 mcg/min IV titrated to BP (8 mg in 500 ml D5W, giving a concentration of 16 mcg/ml). Peds 0.01 mcg/kg/min (rarely used)
  58. Oxytocin
    • Trade name: Pitocin
    • Classification: hormone
    • Actions: naturally occurring hormone that causes the uterus to contract, there by inducing labor, encouraging delivery of the placenta and controlling postpartum hemorrhage
    • Indications: severe postpartum hemorrhage
    • Contraindications: hypersensitivity, prehospital administration prior to delivery, C-section
    • Side effects: anaphylaxis, cardiac dysrhythmias
    • Dose/Route: 3-10 units IM after delivery of placenta. 10-20 units in 1000 ml of D5W or NS IV titrated to effect
  59. Zofran
    • Trade name: Ondansetron
    • Classification: antiemetic
    • Actions: blocks receptor sites associated with N/V
    • Indications: nausea and vomiting
    • Contraindications: hypersensitivity
    • Side effects: chest pain, hypotension, headache, dizziness
    • Dose/Route: 2-4mg IV, IM
  60. Pancuronium
    • Trade name: Pavulon
    • Classification: neuromuscular blocker (non-depolarizing)
    • Actions: causes paralysis without bronchospasm or hypotension, doesn't cause fasciculations associated with polarizing agents
    • Indications: facilitate endotrachial intubation
    • Contraindications: hypersensitivity, tachycardia
    • Side effects: prolonged paralysis, hypotension, bradycardia
    • Dose/Route: 0.04-0.1 mg/kg IV may repeat at doses of 0.01-0.02 mg/kg as needed every 20-40 min. Peds same as adult
  61. Phenobarbital
    • Trade name: Lumial
    • Classification: anticonvulsant
    • Actions: long acting barbiturate anticonvulsant with sedative and hypnotic effects that limit the spread of seizure activity
    • Indications: seizure, status epilepticus, acute anxiety
    • Contraindications: hypersensitivity to barbiturates
    • Side effects: drowsiness, hyperactivity in children
    • Dose/Route: 100-300 mg slow IV, IM. Peds 6-10 mg/kg slow IV, IM
  62. Phenytoin
    • Trade name: Dilantin
    • Classification: anticonvulsant
    • Actions: reduces the spread of electrical discharges in the motor cortex and inhibits seizures. Also has antidysrhythmic properties that counteract the effects of digitalis
    • Indications: seizures, status epilepticus, or cardiac dysrhythmias secondary to digitalis toxicity
    • Contraindications: hypersensitivity to hydantoin products, seizures due to hypoglycemia, sinus bradycardia, heart block and adams-stokes syndrome
    • Side effects: local venous irritation, itching, CNS depression
    • Dose/Route: Seizures/Status Epilepticus: 10-15 mg/kg slow IV. Peds 8-10 mg/kg slow IV.
    • Dysrhythmias/Digitalis toxicity: 100 mg slow IV to maximum 1000 mg. Peds 3-5 mg/kg slow IV
  63. Pralidoxime
    • Trade name: 2-Pam
    • Classification: cholinesterase reactivator
    • Actions: reactivates cholinesterase and reinstitutes the degrading of acetylcholine and restores normal neuromuscular transmission. Deactivates certain organophosphates by direct chemical reaction
    • Indications: organophosphate poisoning
    • Contraindications: carbamate insecticides (sevin), inorganic phosphates, asthma, peptic ulser disease, severe cardiac disease, pts receiving aminophylline, theophylline, morphine, Succinylcholine, reserpine or phenothiazines
    • Side effects: excitement, manic behavior
    • Dose/Route: 1-2 g in 250-500 ml in NS infused over 15-30 min; or 1-2 g IM, SC if IV not feasible. Peds 20-40 mg/kg IV, IM, SC
  64. Procainamide
    • Trade name: Pronestyl
    • Classification: antidysrhythmic
    • Actions: prolongs ventricular repolarization, slows conduction and decreases myocardial excitability
    • Indications: vfib, pulseless vtach refractory to lidocaine
    • Contraindications: hypersensitivity to Procainamide or procaine, myasthenia gravis, 2nd 3rd degree heart blocks
    • Side effects: anxiety, n/v, convulsions, widening of QRS complex
    • Dose/Route: 20-30 mg/min IV drip up to 17 mg/kg to effect, then 1-4 mg/min. Peds 15 mg/kg IV, IO over 30-60 min
  65. Promethazine
    • Trade name: Phenergan
    • Classification: antiemetic
    • Actions: anticholinergic agent that enhances the effects of analgesics and is a potent antiemetic
    • Indications: n/v, motion sickness, to enhance effects of analgesics, and to induce sedation
    • Contraindications: comatose states, hypersensitivity
    • Side effects: drowsiness, may impair mental and physical ability
    • Dose/Route: 12.5-20 mg IV, IM. Peds 0.5 mg/kg IV, IM
  66. Sodium Bicarbonate
    • Trade name: NaHCO3
    • Classification: alkalizing agent
    • Actions: provides vascular bicarbonate to assist the buffer system in reducing the effects of metabolic acidosis and in the treatment of some overdoses
    • Indications: tricyclic antidepressant and barbiturate overdose, refractory acidosis, hyperkalemia
    • Contraindications: none when using in severe hypoxia or late cardiac arrest
    • Side effects: alkalosis
    • Dose/Route: 1 mEq/kg IV, then 0.5 mEq/kg/10 min. Peds same as adult.
  67. Succinylcholine
    • Trade name: Anectine
    • Classification: depolarizing neuromuscular blocker
    • Actions: ultra short acting depolarizing neuromuscular blocker that paralyzes skeletal muscles
    • Indications: to achieve paralysis to facilitate endotrachial intubation
    • Contraindications: hypersensitivity, hx of malignant hyperthermia, penetrating eye injury, narrow angle glaucoma
    • Side effects: prolonged paralysis, hypotension, bradycardia
    • Dose/Route: 1-1.5 mg/kg IV, IM. Peds 1 mg/kg IV, IM
  68. Terbutaline
    • Trade name: Brethine
    • Classification: sympathomimetic
    • Actions: causes bronchodilation with less cardiac effect than epinephrine
    • Indications: bronchial asthma, bronchospasm in COPD, pre term labor
    • Contraindications: hypersensitivity
    • Side effects: palpitations, anxiety, tachycardia, n/v, dizziness, PVC. tremors, h/a
    • Dose/Route: MDI: 2 inhalations 1 min apart. SQ injection: 0.25 mg/ 15 min up to 3 times
  69. Thiamine
    • Trade name: Vitamin B1
    • Classification: vitamin
    • Actions: vitamin required to convert glucose into energy. It is not manufactured by the body and must constantly be provided from ingested foods
    • Indications: coma of unknown origin, chronic alcoholism with associated coma, DT's, given before D50 to unconscious hypoglycemic pts with history of liver impairment
    • Contraindications: none
    • Side effects: rare
    • Dose/Route: 50-100 mg IV, IM. Peds 10-25 mg IV, IM
  70. Vasopressin
    • Trade name: Pitressin
    • Classification: hormone, vasoconstrictor
    • Actions: strong vasopressive and antidiuretic properties
    • Indications: cardiac arrest
    • Contraindications: none when used in emergency setting
    • Side effects: bradycardia, hypertension, blanching of skin
    • Dose/Route: 40 units IV (single dose only)
  71. Vecuronium
    • Trade name: Norcuron
    • Classification: nondepolarizing neuromuscular blocking agent
    • Actions: paralyzes skeletal muscles with minimal cardiovascular effects
    • Indications: to achieve paralysis to facilitate ET intubation
    • Contraindications: hypersensitivity
    • Side effects: prolonged paralysis, hypotension, bradycardia
    • Dose/Route: 0.08-0.1 mg/kg IV. Peds same as adult
  72. Verapamil
    • Trade name: Isoptin, Calan
    • Classification: calcium channel blocker
    • Actions: slows AV conduction, suppresses re-entry dysrhythmias such as PSVT, and slows ventricular responses to atrial tachydysrhythmias. Also dilates coronary arteries and reduces myocardial O2 demand
    • Indications: PSVT refractory to adenosine, A-flutter, afib with rapid ventricular response
    • Contraindications: severe hypotension, cardiogenic shock, 2nd 3rd degree block, CHF, sinus node disease, and accessory AV pathways, WPW syndrome, pts taking beta blockers
    • Side effects: n/v, hypotension, dizziness
    • Dose/Route: 2.5-5 mg IV bolus over 2-3 min, then 5-10 mg after 15-20 min to max of 30 mg in 30 min
  73. Clonidine
    • Trade name: Catapres
    • Classification: Adrenergic agonist
    • Action: Stimulates A2 receptor in the brain
    • indications: high blood pressure, attention-deficit/hyperactivity disorder, anxiety disorders, withdrawal (from either alcohol, opioids, or smoking), migraine, menopausal flushing, diarrhoea, and certain pain conditions
    • Contraindication:
    • Side effects: Rash, Puritits, dysgeusia, insomnia, dizziness, fatigue, paresthesia, malaise, N, diarrhea, constipation, dry mouth, tachycardia
    • Dose/Route: