Paramedic Drugs

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Paramedic Drugs
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2011-04-08 19:14:43
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Paramedic Drugs
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  1. Asprin

    Acetylsalicylic Acid
    • Brand Names: ASA, Bayer, Ecotrin, St. Joseph
    • Class: Antiplatelet, analgesic, anit-inflammatory, antopyretic
    • Indications: Cardiac Chest Pain, prevention of MI, prevention of platelet aggregation in ischemia and thromboembolism, mild to moderate pain or fever
    • Contraindications: hypersencitivity to salicylates, GI bleeding, active ulcer disease, hemorrhagic stroke, bleeding disorders, children with flu-like symptoms
    • Adult Dose: 163-324mg (2-4 tabs, 81mg/tab, chewable baby asprin)
    • Ped Dose: not recommended in pre-hospital use
    • Route: PO
    • Onset: 15-30 mins, Peak: 1-2 hrs
    • Expected Effects: Decreases platelet aggregation, dilates peripheral vessels, blocks pain impulses in CNS
    • Adverse Reactions: Stomach irritation, heartburn, n/v, allergic reactions
  2. Albuterol Sulfate
    • Brand Names: Proventil, Ventolin
    • Class: Sympathomimetic
    • Indications: Bronchospasm from emphysema or asthma (wheezing)
    • Contraindications: Synergistic with other sympathomimetics; use with caution in pts with diabetes, hypertension, hyperthyroidism, cerebrovascular disease
    • Adult/Ped Dose: 2.5mg diluted in 3cc or normal saline
    • Dosage form: Aerosol inhaler
    • Routes of administration: HHN, metered-dose inhaler
    • Onset of action: 5-15 mins
    • Mechanism of Action: Sympathomimetic
    • Adverse reactions: excessive use may cause - arrhythmias, tachycardia, tremors, nervousness, n/v
  3. Activated Charcoal
    • Brand Names: Aqua, Actidose, Liqui-Char
    • Class: Absorbent, Antidote
    • Indications: Many oral poisonings and medication overdose
    • Contraindications: Corrosives, caustics, petroleum distillates, GI bleeding
    • Adult/Ped Dose: 1-2 g/kg (30-100g)
    • Preparation/Dosage form: as a slurry - 25g/15ml bottle(200 mg/ml)
    • Route of Administration: PO, NG, OG
    • Onset of Effect: Immediate
    • Expected effects: Binds and absorbs ingested toxins, extreted among feces
    • Adverse Effects: May indirectly induce n/v, may cause constipation or mild diarrhea
  4. Dextrose 50% Solution (D50)
    • Brand Names: none
    • Class: Hyperglycemic
    • Indications: Hypoglycemia, unknown coma/no glucometry, ALOC/no glucometry, seizure/no glucometry
    • Contraindications: none
    • Adult Dose: 25-50g (50-100ml of a 50% solution
    • Ped Dose: 1mos-2yrs D25W 2-4cc/kg
    • 0-30days D10W 2-4cc/kg
    • Preparation/Dosage: 50%- prefilled syringe, 25g in 50ml; 25%-add 12.5g(25ml) of D50 and 25 ml of NS to a 50ml syringe; 10%-add 5g(10ml) of D50 and 40ml of NS to a 50ml syringe
    • Route: IV, IO
    • Onset of Effect: Immediate
    • Expected Effects: Increases blood glucose levels
    • Adverse Effects: If IV not properly in vein, necrosis of tissue surrounding IV site could occur
  5. Diphenhydramine Hydrochloride
    • Brand Names: Benadryl
    • Class: Antihistamine
    • Indications: Moderate to severe allergic reactions (after Epi), anaphylaxis, acute extrapyramidal reations
    • Contraindications: Pts taking monoamine oxidase inhibitors, hypersensitivity, narrow-angle glaucoma, newborns, nursing mothers
    • Adult Dose: 25-50mg
    • Ped Dose: 1mg/kg
    • Dosage: Vial-50mg(25mg/ml), pre-filled syringes: 50mg/ml
    • Route: IV or IM
    • Onset of Effect: Immediate
    • Expected Effects: Prevent the physiologic actions of histamine by blocking H1 and H2 receptor sites
    • Adverse Effects: Drowsiness, sedation, disturbed coordination, hypotention, palpitations, tachycardia, bradycardia, thickening of bronchial secreations, dry mouth and throat
  6. Epinephrine
    • Brand Names: Adrenalin
    • Class: Sympathomimetic
    • Indications: Acute bronchospasm: anaphylaxis, bronchiolitis, asthma, COPD
    • Contraindications: Pulmonary edema, hypothermia, hypertension
    • Adult/Ped Dose: 0.01mg/kg of 1:1000 to a max of 0.3mg-0.5mg
    • Dosage forms: Ampule: 1mg/ml 1:1000, multi-dose vial: 30ml, 1mg/ml
    • Route: IM
    • Onset of Effect: Immediate
    • Expected Effects: direct acting alpha and beta agonist
    • Adverse Effects: Ventricular arrhythmias, precipitation of angina or MI, tachycardias, anxiety, hypertenstion, headache
  7. Glucagon
    • Brand Names: Glucagon
    • Class: Pancreatic hormone, insulin antagonist
    • Indications: Hypoglycemia, persistent hypoglycemia despite glucose supplementation
    • Contraindications: Hypersensitivity
    • Adult Dose: 0.5-1mg
    • Dosage forms: Must be reconstituted with the provided diluent before administation. Dilute 1 unit (1mg) white powder in 1ml of diluting solution for 1mg/ml
    • Route: IM
    • Onset of Effect: 60-90mins
    • Expected Effects: blood glucose elevation by increasing the breakdown of glycogen to glucose and stimulating the glucose synthesis
    • Adverse Effects: tachycardia, hypotension, n/v, uticaria
  8. Ipratropium Bromide
    • Brand Names: Atrovent
    • Class: Anticholinergic. bronchodilator
    • Indications: Persistent bronchospasm (wheezing), COPD exacerbation
    • Contraindications: Hypersensitivity to atrovent, atropine, alkaloid, soybean protein, peanuts
    • Dose: 0.5mg in 3cc NS, used in combination with albuterol 5 minutes after albuterol-only nembulizer. albuterol/atrovent HHN may be given first when patient is in severe distress or has not responded to home therapy.
    • Route: HHN
    • Onset of Effect: 5-15 mins
    • Expected Effects: Inhibits interatction of acetylcholine at receptor sites on bronchial smooth muscle, resulting in decreased cyclic guanosine monophosphate and bronchodiation.
    • Adverse Effects: N/V, coughing, headache, tachycardia, dry mouth.
  9. Methylprednisolone
    • Brand Names: Solu-medrol
    • Class: Glucocorticoid
    • Indications: Anaphylaxis, bronchodilator for asthma
    • Contraindications: Use caution w/diabetic pts and pts with severe infection
    • Adult Dose: 125mg
    • Ped Dose: Loading dose 102mg/kg
    • Route: IV
    • Onset of Effect: 1-2 hours
    • Expected Effects: a synthetic steroid that suppresses inflammation, potentiates vascular smooth muscle relaxation by beta-adrenergic agonist
    • Adverse Effects: headache, hypertension, sodium and water retention, hypokalemia
  10. Naloxone
    • Brand Names: Narcan
    • Class: Narcotic antagonist
    • Indications: Narcotic/Opiate OD
    • Contraindications: none
    • Adult Dose: 2mg: titrate to resp. effect. may be repeated once
    • Ped Dose: 0.1 mg/kg up to 2mg
    • Dosage: pre0filled syringe: 2mg(1mg/ml)
    • Route: IV, IM
    • Onset of Effect: within 2 mins
    • Expected Effects: competitive inhibition at narcotic receptor sites. reverses respiratory depression secondary to depressant drugs
    • Adverse Effects: withdrawal symptoms, especially in neonates, combative pt after administration
  11. Nitroglycerin
    • Names: Nitrostat, Tridil, Nitroquick
    • Class: vasodilator
    • Indications: cardica chest pain, MI, angina pectoris, CHF
    • Contraindications: Hypotension (<100mmHg Systolic BP), Increased UCP, severe hepatic or renal disease
    • Dose: 0.4mg, repeat every 5mins up to 3 times if chest pain persists
    • Dosage: 0.4mg Tabs
    • Route: SL, topical or transdermal, aerosol
    • Onset of Effect: 1-3 mins
    • Expected Effects: Coronary artery vasodilation, reduces workload on the heart by causing blood pooling and peripheral vasodilation, smooth muscle relaxant acting on vascular, uterine, bronchial, and intestinal smooth muscle
    • Adverse Effects: hypotension, headache, bradycardia, sexually enhancing medications up to 72hrs prior to nitro admin.
  12. Thiamine
    • Names: Betaxin
    • Class: Vitamin B1
    • Indications: Given with and prior to D50 in cases of hypogylcemia w/suspected malnutrition or alcoholism, DTs, wernicke's encephalopathy
    • Contraindications: none
    • Adult Dose: 100mg
    • Ped Dose: Not recommended in prehospital
    • Route: Slow IV push, IM
    • Onset of Effect: Rapid
    • Expected Effects: combines w/ATP to form a coenzyme to necessitate carbohydrate metabolism
    • Adverse Effects: Hypotension, anxiety, diaphoresis, n/v, allergic reation (from IV/rare), angioedema
  13. Oxygen
    • Used to treat hypoxia and hypoxemia.
    • Delivered by tanks through
    • Nasal Canulas (1-6L/M) giving 24-44% O2,
    • NRB Mask (10-15L/M) giving 80-95%
  14. Oral Glucose
    Names: Glutose, Insta-Glucose
  15. ADENOSINE
    • Names: Adeonocard
    • Class: Endogenous nucleoside, misc. antidystrhythmic
    • Indications: To slow SVT, PSVT
    • Onset: Immediate
    • Duration: 10 seconds
    • Contra: 2nd or 3rd av block, sick sinus syndrome, hypersensitivity, Aflutter, Afib, VT
    • Adverse Reactions: Light-headedness, Parasthesia, Headache, Diaphoreses, Palpitations, CP, Flushing, Hypotenstion, SOB, N, Metallic taste
    • How Supplied: 3mg/mL in 2mL & 5mL flip top vials
    • Dosage/Admin: Adult- 6mg rapid IV over 1/3 secs., 20mL saline flush; repeat if no response 12mg, 12mg. PED - 0.1mg/kg, may be doubled once up to 6mg, rapid IV with 5mL saline flush

  16. AMIODARONE
    • Names: Cordarone
    • Class: Class III Antidysthythmic
    • Indications: VFib, unstable VT
    • Onset: Within minutes
    • Duration: Variable
    • Contra: Pulmonary congestion, cariogenic shock, hypotension, sensitivity, bradycardia
    • Adverse Reactions: Hypotension, headache, dizziness, bradycardia, AV abnormalities, flushing, salivation
    • How Supplied: 50mg/mL vials
    • Dosage/Admin: Adult- Pulseless: 300mg/IV,150mg. Wide-complex T: 150mg/IV over 10 mins, repeated every 10 mins PED- Pulseless: 5mg/kg rapid IV, perfusing T: 5mg/kg IV over 20-60 mins, max 15mg/kg/day IV
  17. ATENOLOL
    • Class: Beta-blocking agent
    • Indications: SVT, Aflutter, Afib, reduce Ischemia, and damage in acute MIs
    • Onset: Within 10 mins
    • Duration: 2-4hrs
    • Contra: Heart failure, cardigenic shock, brady, lung disease, hypersensitivity, hypotension, second or third degree HB
    • Adverse Reactions: Bradycardia, AV conduction delays, hypotension
    • How Supplied: 5mg in 10mL amules
    • Dosage/Admin: Adult- 5mg slow IV, wait 10 mins, 5mg slow IV PED- not recommended
  18. ATROPINE SULFATE
    • Class: Anticholinergic agent
    • Indications: Hemodynamically significant Bradycardia, asystole, PEA w/bradycardia, organophosphate or nerve gas poisoning
    • Onset: Rapid
    • Duration: 2-6hrs
    • Contra: Tachycardia, hypersensitivity Obstructive disease of gastro. tract, obstructive uropathy, unstable cardiovascular status in acute hemorrhage with myocardial ischemia, narrow angle glaucoma, thyrotoxicosis
    • Adverse Reactions: thchycardia, paradoxical brady when pushed too slowly, palpitations, dysrhythmias, headache, dizziness, anticholinergic effects, n/v, flushed, hot/dry skin, allergic reactions
    • How Supplied: prefilled syringes 1mg in 10mL
    • Dosage/Admin: Bradydysrhythmias/Adult - 0.5mg every 3-5 mins, max 3mg PED- 0.02mg/kg IV, max 0.5mg-1mg, 2mg adolescent
    • Asystole or PEA/Adult - 1mg IV, 3-5mins
    • Anticholinesterase poisoning/Adult - 1-2mg IV every 5-15 mins PED- 0.02-0.05mg/kg every 10-20 mins
  19. CALCIUM CHLORIDE
    • Class: Electrolyte
    • Indications:Hyperkalemia (except dig tox, hypocalcemia, calcium channel blocker tox, hypermagnesemia, to prevent hypotensive effects of calcium channel blocking agents
    • Onset: 5-15mins
    • Duration:dose dependent (effects may persist for 4hrs after IV admin)
    • Contra: VFeb during cardiac resuscitation, dig tox, hypercalcemia, renal or cardiac disease
    • Adverse Reactions:brady, hypotension, metallic taste, necrosis
    • How Supplied:10% solution in 10mL (100mg/mL) ampules, vials, and prefilled syringes
    • Dosage/Admin: Adult- 8-16mg/kg slo IV, may repeat 10mins PED- 20mg/kg slow IV, may repeat 10mins
  20. DIGOXIN
    • Class: Cardiac glycoside, misc. antidysrhythmic
    • Indications:SVT (esp. Aflutter and Afib), CHF, Cardiogenic shock
    • Onset:5-30mins
    • Duration:3-4 days
    • Contra:VFib, VT, AV block, Dig Tox, hypersensitivity, secon or third degree HB in absence of artificial pacing
    • Adverse Reactions: headache, weakness, vision disturbances, confusion, seizures, dysrhythmias, n/v, skin rash
    • How Supplied:2mL ampules w 0.5mg (0.25mg/mL)
    • Dosage/Admin: Adult- 10-15mcg/kg
  21. DILTIAMZEM (cardizem)
    • Class:Slow calcium channel blocker or calcuim channel antagonist
    • Indications:AFIB, AFlutter, multifocal ATach, PSVT
    • Onset:2-5min
    • Duration:1-3hrs
    • Contra:Sick sinus syndrome, second or third degree AB block, hypotension, cardiogenic shock, hypersensitivity, Afib or Aflutter w/WPW, concomitant use of IV beta blockers, VT, WC TC, acute MI
    • Adverse:AFlutter, first and second degree AV block, brady, hypotension, CP, CHG, peripheral edema, syncope, n/v, dizziness, dry mouth, dyspnea, headache
    • How Supplied:25mg (5mL vial)
    • Dosage/Admin:0.25mg/kg IV over 3 min, repeated in 15mins
  22. DOBUTAMINE
    • Class: Sympathomimetic
    • Indications:AFIB, AFlutter, Multifocal ATach, PSVT
    • Onset: 1-2mins; peak after 10mins
    • Duration: 10-15mins
    • Contra:Afib, Aflutter, hypotension w/shock, idiopathic hypertrophic subaortic stenosis, drug-induced shock
    • Adverse Reactions: headache, dose related tachydysrythmias, hypertension, ventricular ectopy
    • How Supplied:12.5mg/mL injectable
    • Dosage/Admin: 2-20mcg/kg/min IV
  23. DOPAMINE (intropin)
    • Class:Sympathomimetic
    • Indications:Hemodynamically significant hypotension in the absence of hypovolemia
    • Onset:2-4mins
    • Duration:10-15mins
    • Contra:tachydysrhythmias, VFib, pheochromocytoma
    • Adverse:tachydysrhythmias, hypertension, increased myocardial oxygen demand
    • Supplied:200mg, 400mg, 800mg in 5mL prefilled syringe and ampule for IV
    • Dosage:Adult Cardiac- 5-10mcg/kg/min, PED- 2-20mcg/kg/min
  24. EPINEPHRINE (adrenalin)
    • Class: Sympathomimetic
    • Indications: Acute allergic reactions, cardiac arrest, asytole, PEA, VFib, profound symptomactic bradycardia, bronchial asthma
    • Onset:5-10min (SQ), 1-2min (IV/ETT)
    • Duration:5-10min
    • Contra:hypersensitivity, hypovolemic shock, coronary insufficiency (caution)
    • Adverse:headache, N, restlessness, weakness, dysrhythmias, hypertension, precipitation of angina pectoris, tachycardia
    • Supplied: 0.1mg/mL (1:10,000) prefilled syringe
    • Dosage:1mg IV
  25. FUROSEMIDE (lasix)
    • Class: Loop Diuretic
    • Indications: Pulmonary edema associated with CHF, hepatic or renal disease, hyperkalemia
    • Onset: IV 15-20mins
    • Duration:2hrs
    • Contra:Anuria, hypersensitivity, hypovolema/hehydration, kypokalemia
    • Adverse: hypotension, ECG changes, dry mouth, hypochloremia, hypokalemia, hyponatreamia, hypercalcemia, hyperglycemia, hearing loss if IV admin too fast
    • Supplied:10mg/mL in 2, 4, 8mL ampule, 10mg/mL in 10mL vial
    • Dosage:CHF Adult- 20-40mg slow IV, may repeat 1-2hr PED- 1mg/kg/dose Hyperkalemia Adult- 40-80mg IV
  26. IBUTILIDE (corvert)
    • Class: Short-acting antidysrhythmic
    • Indications: SVT dysrhythmias, conversion of AFib and AFlutter of brief duration
    • Onset:1/2-1&1/2hr
    • Duration:10-12hr
    • Contra:Hx of heart failure or VT, sensitivity
    • Adverse: V dysrhythmias, hyper/hypotension
    • Supplied:1mg in 10mL ampules
    • Dosage:1mg IV over 10mins
  27. ISOPROTERENOL (isuprel)
    • Class: Sympathomimetic
    • Indications:hemodynamically significant bradycardias secondary to beta blocker overdose, management of torsades de pointes
    • Onset: 1-5mins
    • Duration:15-30mins
    • Contra:VT, VFib, hypotension, pulseless IVR, Ischemic heart disease/angina, cardiac arrest, acetylcholinesterase-indused bradycardias
    • Adverse:dysrhythmias, hypotension, precipitation of angina pectoris, facial flushing, restlessness, dry throat, pinkish saliva
    • Supplied:5mL vial
    • Dosage: Adult- dilute 1mg in 250mL of D5W; infuse at 2-10mcg/min or until desired HR is obtained. in torsades, titrate to increase heart rate until VT is suppressed
  28. LIDOCAINE (xylocaine)
    • Class: Antidysrhythmic (class I-B), local anesthetic
    • Indications: VT, VFib, WC T, Significant ventricular ectopy in MI
    • Onset:30-90 secs
    • Duration:10-20 mins
    • Contra:hypersensitivity, Adams-Stokes syndrome, second or thrid degree HBin absence of artificial pacemaker
    • Adverse: light headedness, confusion, blurred vision, hypotension, cardiovascular collapse, bradycardia, ALOC
    • Supplied: Prefilled syringes: 100mg in 5mL Ampules: 100mg in 5mL
    • Dosage:1-1.5mg/kg IV, repeat in 3-5 mins. PED - 1mg/kg
  29. MAGNESIUM SULFATE
    • Class:Electrolyte, anticonvulsant
    • Indications:seizures of eclampsia, Torsades de pointes, hypomagnesemia, refractory VFiB, status asthmaticus not responsive to beta-adrenergic drugs
    • Onset:IV- immediate, IM- 3-4hrs
    • Duration:IV- 30mins, IM- 3-4hrs
    • Contra:HB or Myocardial damage
    • Adverse:diaphoresis, facial flushing, hypotension, depressed reflexes, hypothermia, reduced HR, circularoty collapse, respiratory depression, diarrhea
    • Supplied:10%, 12.5%, 50% solution in 40, 80, 100, and 125mg/mL
    • Dosage:PEA- Adult- 1-2g diluted in 10mL of D5W IV PED- 25-50mg/kg over 10-20mins Torsades de Pointes- Adult- 1-2g in 50-100mL of D5W over 5-60mins IV, follow with 0.5g/hr/IV
  30. METOPROLOL (lopressor)
    • Class: Beat-blocking agent
    • Indications:PSVT, Aflutter, Afib, to reduce myocardial ischemia and damage in patients with acute myocardial infarction
    • Onset:1-2mins
    • Duration:3-4hrs
    • Contra:heart failure, second or third degree HB, cardiogenic shock, hypotension, bradycardia, lung disease w/bronchospasm, hypersensitivity
    • Adverse:bradycardia, AV conduction delays, hypotension
    • Supplied:1mg/mL ampules
    • Dosage:Adult- 5mg slow IV at 5min intervals to total of 15mg
  31. MORPHINE SULFATE (astramorph/pf and others)
    • Class: Opioid analgesic
    • Indications:CP w/MI
    • Onset:1-2mins
    • Duration:2-7hrs
    • Contra:hypersensitivity, hypovolemia, hypotension, head injury, abdominal pain, ICP, severe respiratory depression, MAO inhibitors w14 days
    • Adverse:hypotension, tachycardia, bradycardia, palpitations, syncope, facial flushing, diaphoreses, itching, resp. depression, euphoria, bronchospasm, dry mouth, allergic reaction
    • Supplied:IV, 10mg in 1mL of solution, ampules and Tubex syringes
    • Dosage:Adult- 2-4mg slow IV titrated to effect PED- 0.1-0.2mg/kg/dose IV max 15mg
  32. NITROPASTE (nitro-bid ointment)
    • Class: Vasodilator
    • Indications:Angina pectoris, MI CP
    • Onset: 15-60mins
    • Duration: 2-12hrs
    • Contra: hypersensitivity, hypotension, head injury, cerebral hemorrhage
    • Adverse:headache, syncope, tachycardia, hypotension, n/v, allergic reaction
    • Supplied: 20, 60g tubes of 2% ntg paste
    • Dosage: 1-2inches over 2-4 inch area of skin free of hair, cover w/transparent wrap and secure w/tape
  33. NOREPINEPHRINE (levophed)
    • Class: Sympathomimetic
    • Indications: cardiogenic shock, neurogenic shock, inotroic support, hemodynamically significant hypotension refractory to other sympathomimetic amines
    • Onset:1-3mins
    • Duration: 5-10mins
    • Contra: hypotensive w/hypovolemia
    • Adverse: headache, dysrhythmias, tachycardia, reflex bradycardia, angina pectoris, hypertension
    • Supplied: 1mg/mL, 4mL ampule
    • Dosage: adult- dilute 4mg in 250mL of D5W at 0.5-1mcg/min titrated PED- 0.1-2mcg/kg/min IV/IO
  34. PROCAINAMIDE (pronestyl)
    • Class: Antidysrhythmic (class IA)
    • Indications: stable monomorphic VT w/normal QT interval, PSVT uncontrolled by adenosine and vagal maneuvers, stable wide-complex T, Afib w/rapid rate in WPW syndrome
    • Onset:10-30mins
    • Duration:3-6hrs
    • Contra:second and third degree HB, dig tox, torsades de pointes, tricyclic antidepressant tox
    • Adverse:hypotension, bradycardia, reflex tachycardia, AV block, widened QRS, prolonged PR or QT, PVC, VT, Ffib, asystole, CNS depression, confusion, seizure
    • Supplied:1g in 10mL vial (100mg/mL), 1g in 2mL vials (500mg/mL) for infusion
    • Dosage:Adult- 20mg/min slow IV infusion in recurrent VFIB/pulseless VT
  35. PROPRANOLOL (inderal)
    • Class: Beta-adrenergic blocker, antidysrhythmic (class II)
    • Indications: hypertension, angina pectoris, VT, VFib, rapid SV dysrhythmias refractory to other therapies
    • Onset: Within 1-2hrs
    • Duration: 6-12hrs
    • Contra: sinus brady, second or third degree HB, asthma, cardiogenis shock, pulmonary edema, uncompensated CHF, COPD, cocaine intoxication
    • Adverse:brady, HB, bronchospasm, syspnea, dizziness, weakness, n/v, visual disturbances
    • Supplied: 1mg/mL vials
    • Dosage:adult- 1-3mg IV over 2-5mins, repeat after 2 mins
  36. RETEPLASE (retavase)
    • Class: Fibrinolytic
    • Indications:Management of acute MI in adults confirmed in 12 lead
    • Onset: Causes reperfusion within 90 mins for most
    • Duration: variable
    • Contra:active internal bleeding, stroke history, recent intracranial or intraspinal surgery or trauma, intracranial neoplasm, AV malformation, aneurysm, bleeding disorders, severe uncontrolled hypertension
    • Adverse: bleeding, reperfusion dysrhythmias, allergic reaction, n/v, hypotension
    • Supplied:reconstitution kit vials
    • Dosage:adult- 10 + 10 U double bolus injection IV over 2 mins, second bolus after 30mins
  37. SODIUM BICARBONATE
    • Class: Buffer, alkalinizing agent, electrolyte supplement
    • Indications: Intuated with continued long arrest interval, PEA, upon return of spontaneous circulation after long arrest interval
    • Onset: 2-10mins
    • Duration: 30-60mins
    • Contra: chloride loss, alkalosis, sever pulmonary edema, abdominal pain, hypocalcemia, hypokalemia, hypernatermia
    • Adverse: metabolic alkalosis, hypoxia, electrolyte imbalance, seizures, tussue sloughing at injection site
    • Supplied: 50mEq in 50mL, and 0.5, 0.6 mEq/mL
    • Dosage: Adult: 1mEq/kg IV, repeat 0.5 mEq/kq q 20 mins. PED- same as adult infuse slowly
  38. STREPTOKINASE (streptase)
    • Class:Fibrinolytic agent
    • Indications:acute MI, massive PE, arterial thrombosis and embolism, to clear arteriovenous cannulas, deep venous thrombosis
    • Onset: 10-20mins
    • Duration:3-4hr
    • Contra:hypersensitivity, active bleeding, recent surgery, cva, prolonged cardiopulmonary resuscitation, intracranial or intraspinal surgery, head trauma, hypertension
    • Adverse: bleeding, allergic reactions, hypotension, CP, reperfusion dysrhythias, abdominal pain
    • Supplied: 250,000-750,000 1.5 million IU vials
    • Dosage: 1.5million U diluted to 45 mL IV over 1hr
  39. VASOPRESSIN
    • Class: Naturally occuring antidiuretic hormone
    • Indications: as an alternative pressor to epi in adult shock-refractory ventricular fibrillation, vasodilatory shock
    • Onset:immediate
    • Duration:variable
    • Contra:responsive patients with coronary arter disease
    • Adverse: ischemic CP, abdominal distress, sweating, n/v, tremors, bronchial constriction, uterine contraction
    • Supplied:5 U/mL
    • Dosage: adult- VFib/Cardiac Arrest:40 U IV one time
  40. VERAPAMIL (isoptin)
    • Class: Calcium channel blocker (Class IV antidysrhythmic)
    • Indications: PSVT, AFlutter or AFIB w/rapid ventricular response, vasospastic and unstable angina, chronic stable angina
    • Onset: 2-5min
    • Duration:30-40mins
    • Contra: hypersensitivity, sick sinus syndrome, second or third degree HB, bradycardia, hypotension, cardiogenic shock, sever CHF, WPW w/AFIB or FLutter, IB beta blockers, wide complex tachycardias
    • Adverse:dizziness, headache, n/v, hypotension, brady, complete av block, peripheral edema
    • Supplied: 5mg/2mL in 2,4,5mL vials or 2,4mL ampules
    • Dosage:adult- 2.5-5mg slow IV bolus over 2 mins

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