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- (Proventil, Ventolin) Sympathomimetic Bronchodilator
- Des: 1) causes bronchodilation 2) less cardiac effects than epinephrine 3) reduces mucus secretion 4) reduces pulmonary capillary leaking 5) reduces edema in the lungs during allergic rxns
- Ind: Brochospasm and asthma in COPD
- CI: Hypersensitivity
- PC: 1) tachycardia 2) anxiety 3) nausea 4) cough 5) wheezing 6) dizziness
- Dose: 2.5mg in 2.5 to 3mL NS via nebulizer. repeat as needed. duration of effect 3-6 hrs. PED: .15mg/kg in 2.5-3mL NS via nebulizer, repeat as needed.
- (Sublimaze) Narcotic Analgesic
- Des: potent synthetic narcotic analgesic with more rapid/less prolonged action than morphine & meperidine
- Ind: Induce sedation for endotracheal intubation
- CI: 1) MAO inhibitors within 14 days 2) myasthenia gravis
- PC: 1) increased intracranial pressure 2) elderly 3) debilitated 4) COPD 5) respiratory problems 6) hepatic and renal insufficiency
- Dose: 25 to 100mcg slowly IV (2 to 3 min) PED: 2mcg/kg slow IV/IM
- (Atrovent) Anticholinergic
- Des: bronchodialator used in treatment of respiratory emergencies. causes 1) bronchodilation & 2) dries respiratory tract secretions by blocking acetylcholine receptors
- Ind: 1) bronchospasm associated with asthma 2) COPD 3) inhaled irritants
- CI: 1) hypersensitivity to atropine or its derivatives 2) as a primary treatment for acute bronchospasm 3) nut allergy
- PC: 1) elderly 2) cardiovascular disease 3) hypertension
- Dose: 500mcg in 2.5 to 3mL NS via nebulizer or 2 sprays from metered dose inhaler. PED: 125-250mcg in 2.5-3mL NS via nebulizer or 1 or 2 sprays of a metered dose inhaler.
- (Morhine) Narcotic Analgesic
- Des: potent analgesic & sedative. 1) causes some vasodilation 2) reducing venous return 3) reduced myocardial O2 demand
- Ind: 1) moderate to severe pain & 2) in MI & 3) to reduce venous return in pulmonary edema
- CI: 1) hypersensitivity to opiates 2) undiagnosed head or abdominal injury 3) hypotension or volume depletion 4) acute bronchial asthma 5) COPD 6) severe respiratory depression 7) pulmonary edema due to chemical inhalation
- PC: 1) elderly 2) children 3) debilitated [naloxone available to counteract effects of morphine]
- Dose: (pain) 2.5 to 15mg IV or 5 to 20mg IM/SQ, (AMI or pulmonary edema) 1-2mg per 6-10 minute to response. PED: (pain) .05 to .10mg/kg IV; .10-.20mg/kg IM/SQ
- (Narcan) Narcotic antagonist
- Des: 1) blocks the effects of narcotics 2) may reduce respiratory depression
- Ind: 1) narcotic overdose 2) coma of unknown origin
- CI: 1) hypersensitivity to the drug 2) non-narcotic induced respiratory depression
- PC: 1) possible dependency (including newborn) 2) shorter half-life than narcotics: (pt may relapse)
- Dose: 0.4 to 2mg IV/IM/IN (2 to 2.5 the dose ET) repeated every 2 to 3 min as needed up to 10mg. PED: .01mg IV/IM (2 to 2.5 the dose ET) repeated every 2 to 3 min as needed up to 10mg.
- (Valium) Antianxiety, Hypnotic, Anticonvulsant, Sedative
- Des: benzodiazepine sedative and skeletal muscle relaxant 1) reduces tremors 2) induces amnesia 3) reduces the incidence and recurrence of seizures 4) relaxes muscle spasms in orthopedic injuries 5) produces amnesia for painful procedures (cardioversion).
- Ind: 1) major motor seizures 2) status epilepticus 3) premedication before cardioversion 4) muscle tremors due to injury 5) acute anxiety
- CI: 1) shock 2) coma 3) acute alcoholism 4) depressed vital signs 5) obstetric patients 6) neonates
- PC: 1) psychoses 2) depression 3) myasthenia gravis 4) COPD. (Due to a short half-life of the drug, seizure activity may recur.)
- Dos: (seizures) 5 to 10 mg IV/IM Ped: 0.5 to 2 mg IV/IM.
- (acute anxiety) 2 to 5 mg IV/IM. Ped: 0.5 to 2 mg IM
- (premed for cardioversion) 5 to 15 mg IV Ped: 0.2 to 0.5 mg/kg IV
- (Amidate) Hypnotic
- Des: 1) ultra–short-acting nonbarbiturate hypnotic 2) no analgesic effects 3) limited cardiovascular and respiratory effects.
- Ind: Induce sedation for rapid sequence intubation.
- PC: 1) marked hypotension 2) severe asthma 3) severe cardiovascular disease
- Dos: 0.1 to 0.3 mg/kg IV over 15 to 30 sec. Ped: children > 10 years, same as for adults
- (Romazicon) Benzodiazepine Antagonist
- Des: used to reverse the sedative, recall, and psychomotor effects of diazepam, midazolam, and the other benzodiazepines.
- Ind: respiratory depression secondary to the benzodiazepines.
- CI: 1) hypersensitivity to flumazenil or benzodiazepines 2) patients who take medication for status epilepticus or seizures 3) seizure-prone patients during labor and delivery 4) tricyclic antidepressant overdose
- PI: 1) hepatic impairment 2) elderly 3) pregnancy 4) nursing mothers 5) head injury 6) alcohol and drug dependency 7) physical dependence on benzodiazepines
- Dose: 0.2 mg IV over 30 sec/min, up to 1 mg
- (Versed) Sedative
- Des: short-acting benzodiazepine with CNS depressant 1) muscle relaxant 2) anticonvulsant 3) anterograde amnestic effects
- Ind: to induce sedation before cardioversion or intubation
- CI: 1) hypersensitivity to benzodiazepines 2) narrow-angle glaucoma 3) shock 4) coma 5) acute alcohol intoxication
- PI: 1) COPD 2) renal impairment 3) CHF 4) elderly
- Dose: 1 to 2.5 mg slow IV; 0.07 to 0.08 mg/kg IM (usually 5 mg). Ped: 0.05 to 0.2 mg/kg IV: 0.1 to 0.15 mg/kg IM; 3 mg intranasal.
- (Anectine) Depolarizing Neuromuscular Blocker
- Des: ultra–short-acting depolarizing neuromuscular blocker
- Ind: facilitated endotracheal intubation
- CI: 1) family history of malignant hyperthermia 2) penetrating eye injury 3) narrow-angle glaucoma 4) hyperkalemia
- PI: 1) severe burn 2) crush injury 3) spinal cord injury
- Dose: 1 to 1.5 mg/kg IV/IM. Ped: 1 to 2 mg/kg IV/IM.
- (Adenocard) Antidysrhythmic
- Des: can “chemically cardiovert” PSVT to a normal sinus rhythm. half-life of 10 sec & does not cause hypotension.
- Ind: narrow, complex paroxysmal supraventricular tachycardia refractory tovagal maneuvers.
- CI: 1)2nd & 3rd degree heart block 2)sinus node disease 3)asthma.
- PC: may cause transient dysrhythmias - especially asystole, COPD.
- Dose: 6 mg IV (rapidly - over 1-2 sec), then flush line rapidly w/ NS. If ineffective, 12 mg (over 1-2 min, may be repeated. Ped: 0.1 mg/kg IV (rapidly - over 1-2 sec), then flush line rapidly w/ NS. If ineffective, 0.2 mg/kg (over 1-2 min) [max 12 mg].
- (Adrenalin) Sympathomimetic
- Des: naturally occurring catecholamine that increases 1)heart rate 2)cardiac contractile force 3)myocardial electrical activity 4)systemic vascular resistance 5)systolic BP; decreases 1) airway resistance 2)automaticity. Via bronchial artery constriction, may reduce pulmonary congestion & increase tidal vol. & vital capacity.
- Ind: 1)restore rhythm in cardiac arrest 2)severe allergic reactions
- CI: 1)narrow angle glaucoma 2)hemorrhagic, traumatic, or cardiac shock 3)during labor
- PC: none
- Dose: Arrest: 1.0mg of 1:10,000 IV 3-5 min (ET: 2.0-2.5mg of 1:1,000). Ped: 0.01mg/kg of 1:10,000 IV/IO (ET: 0.1mg/kg of 1:1,000). All subsequent doses 0.1 mg/kg IV/IO [no max). Allergic: 0.3-0.5mg of 1:1,000 SQ 5-15 min as needed or 0.5-1.0mg of 1:10,000 IV if SQ dose ineffective or severe reaction. Ped: 0.01 mg/kg of 1:1,000 SQ 10-15 min or 0.01 mg/kg of 1:10,000 IV if SQ dose ineffective or severe reaction.
- (Pitressin) Hormone, Vasopressor
- Des: hormone w/ strong vasopressive & antidiuretic properties, may precipitate angina &/or AMI.
- Ind: 1)to increase peripheral vascular resistance in arrest (CPR) 2)control bleeding from esophageal varices
- CI: 1)PVCs 2)1st stage of labor.
- PC: 1)epilepsy 2)migraine 3)heart failure 4)angina 5)vascular disease 6)hepatic impairment 7)elderly 8)children
- Dose: Arrest: 40units IV Esophagealvarices: 0.2-0.4 units/min IV drip.
- (Atropine) Parasympatholytic
- Des: 1)blocks the parasympathetic nervous system, specifically the vagal effects on heart rate 2)may increase myocardial oxygen demand 3)decreases airway secretions
- Ind: 1)hemodynamically significant bradycardia 2) brady asystolic arrest 3)organophosphate poisoning
- CI: none in emergency setting. 2nd degree type 2 & above heart blocks are class 2B (not recommended)
- PC: 1) AMI 2)glaucoma
- Dose: Symptomatic Bradycardia: 0.5mg IV (ET 1.0mg) repeat 3-5 min to 3 mg Ped: 0.02 mg/kg IV (ET 0.04mg/kg) may repeat in 5 min up to 1 mg Asystole: 1.0mg IV (ET 2.0mg) may repeat 3-5 min up to 3 mg Organophosphate Poisoning: 2.0-5.0mg IV/IM/IO 10-15 min Ped: 0.05 mg/kg IV/IM/IO 10-15 min
- [1)Acetylsalicylic Acid 2)Alka-Seltzer 3)Bayer 4)Empirin 5)St. Joseph Children's] 1)Analgesic 2)Antipyretic 3)Platelet Inhibitor 4)Antiinflammatory
- Des: 1)inhibits agents that cause production of a)inflammation b)pain c)fever 2)relieves mild to moderate pain by acting on the PNS 3)lowers body temperature in fever 4)powerfully inhibits platelet aggregation.
- Ind: Chest pain suggestive of an MI.
- CI: 1)hypersensitivity to salicylates 2)active ulcer disease 3)asthma.
- PC: bleeding disorders
- Dose: 160 to 325 mg PO (chewable)
Dextrose 50% in Water
- Des: simple sugar body can rapidly metabolize to create energy
- Ind: hypoglycemia
- CI: none in hypoglycemia
- PC: 1)increased ICP 2)determine blood glucose level before administration 3)ensure good venous access
- Dose: 25g D50W (50 mL) IV. Ped: 2mL/kg of a 25% solution IV.
- (Lasix) Diuretic
- Des: 1)rapid-acting 2)potent diuretic 3)antihypertensive 4)inhibits sodium reabsorption by the kidney 5)vasodilating effects reduce venous return & cardiac workload.
- Ind: 1)congestive heart failure 2)pulmonary edema.
- CI: hypotension
- PC: 1)hepatic impairment 2)nephrotic syndrome 3)cardiogenic shock associated w/ acute MI 4)gout 5)PTs receiving digitalis or potassium-depleting steroids.
- Dose: 40-120 mg slow IV. Ped: 1 mg/kg slow IV
- (Nitrostat) Nitrate
- Des: 1)rapid smooth muscle relaxant 2)reduces peripheral vascular resistance, BP, venous return, & cardiac workload
- Ind: 1)chest pain associated w/ angina & acute myocardial infarction, 2)acute pulmonary edema.
- CI: 1)hypersensitivity 2)tolerance to nitrates 3)severe anemia 4)head trauma 5)hypotension 6)increased ICP 7)PTs taking sildenafil 8)glaucoma 9)shock
- PC: 1)may induce servere headache 2)nitroglycerin is light sensitive & will lose potency when exposed to the air.
- Dose: 1 tablet (0.4 mg) SL. May be repeated 3-5 min up to 3 tablets, or 1⁄2 inch of topical ointment, or 0.4 mg (one spray)SL up to 3 sprays/25 min.
- (Dobutrex) Sympathomimetic
- Des: synthetic catecholamine & beta agent that increases strength of cardiac contraction without appreciably increasing rate
- Ind: increase cardiac output in CHF/cardiogenic shock
- CI: 1)hypersensitivity to Sympathomimetic amines 2)ventricular tachycardia 3)hypovolemia without fluid resuscitation
- PC: 1)atrial fibrillation 2)preexisting hypertension
- Dose: 2-20 mcg/kg/min IV Ped: same
- (Intropin) Sympathomimetic
- Des: naturally occurring catecholamine that increases cardiac output without appreciably increasing myocardial oxygen consumption. maintains renal & mesenteric blood flow while inducing vasoconstriction & increasing systolic BP
- Ind: Nonhypovolemic hypotension (70 to 100 mmHg) & cardiogenic shock
- CI: 1)hypovolemic hypotension w/out aggressive fluid resuscitation 2) tachydysrhythmias 3) ventricular fibrillation 4)pheochromocytoma
- PC: 1)occlusive vascular disease 2)cold injury 3)arterial embolism 4)ensure adequate fluid resuscitation of the hypovolemic PT
- Dose: 2-5 mcg/kg/min up to 20 mcg/kg/min, titrated to effect. Ped: same
- (Isuprel) Sympathomimetic
- Des: synthetic sympathomimetic results in increased cardiac output by increasing the strength of cardiac contraction and somewhat increasing rate.
- Ind: bradycardia refractory to atropine when pacing is not available
- CI: cardiogenic shockPC: tachydysrhythmias & those associated w/ digitalis & acute myocardial infarction
- Dose: bradycardia: 2-10 mcg/min titrated to cardiac rate. Ped: 0.1 mcg/kg/min titrated to
- cardiac rate.
- (Tetracaine) Ophthalmic, Anesthetics
- Des: after topical application to the eye, local anesthetics penetrate to sensory nerve endings in the corneal tissue. these medications block both the initiation & conduction of nerve impulses by decreasing the neuronal membrane's permeability to sodium ions. this reversibly stabilizes the membrane and inhibits depolarization, resulting in the failure of a propagated action potential and subsequent conduction blockade
- Ind: eye injuries or foreign body
- CI: hypersensitivity
- PC: 1)be monitored 2)hyperthyroid disease 3)cardiac diseases
- Dose: 1-2 drops in each eye
- (Cordarone, Pacerone) Antidysrhythmic
- Des: Antidysrhythmic that prolongs duration of the action potential & refractory period & relaxes smooth muscles, reducing peripheral vascular resistance & increasing coronary blood flow.
- Ind: 1)life-threatening ventricular & supraventricular dysrhythmias 2)frequently atrial fibrillation.
- CI: 1)cardiogenic shock 2)severe sinus bradycardia 3)advanced heart block.
- PC: none
- Dose: 150-300 mg IV over 10 min, then 1 mg/min over next 6 hours. Ped: 5 mg/kg IV/IO, then 1.5mg/kg/day.
- (Bretylol) Antidysrhythmic
- Des: suppresses ventricular tachydysrhythmias including vfib w/ reentry mechanisms.
- Ind: ventricular fibrillation & ventricular tachycardia refractory to lidocaine
- CI: none
- PC: 1)digitalized patients 2)digitalis-induced dysrhythmias
- Dose: 5 mg/kg IV, then 10 mg/kg/15 to 30 min, to a max 30 mg/kg
- (Xylocaine) Antidysrhythmic
- Des: antidysrhythmic that suppresses automaticity & raises stimulation threshold of the ventricles. also causes sedation, anticonvulsant, & analgesic effects.
- Ind: 1)pulseless ventricular tachycardia 2)ventricular fibrillation 3)ventricular tachycardia (w/ pulse)
- CI: 1)hypersensitivity to amide-type local anesthetics 2)supraventricular dysrhythmias 3)stokes-adams syndrome 4)2nd- & 3rd-degree heart blocks 5)bradycardias
- PC: 1)hepatic or renal impairment 2)CHF 3)hypoxia 4)respiratory depression 5)hypovolemia 6)myasthenia gravis 7)shock 8)elderly
- Dose: cardiac arrest: 1-1.5 mg/kg IV repeated every 3-5 min up to 3 mg/kg, follow conversion with a drip of 2-4 mg/min. Ped: 1 mg/kg IV, repeat/3-5 min up to 3 mg/kg, follow conversion with a drip of 20-50 mcg/kg/min. ventricular tachycardia (w/ pulse): 1 to 1.5 mg/kg slow IV (consider lower dose for elderly). May repeat at one-half dose every 5-10 min until conversion up to 3 mg/kg. Follow conversion with an infusion of 2 to 4 mg/min. Ped: 1 mg/kg, followed by a drip at 20-50 mg/kg/min.
- (Pronestyl) Antiarrhythmic
- Des: prolongs ventricular repolarization, slows conduction, and decreases myocardial excitability
- Ind: ventricular fibrillation and pulseless ventricular tachycardia refractory to lidocaine.
- CI: hypersensitivity to procainamide or procaine, myasthenia gravis, & 2nd- or 3rd-degree heart block.
- PC: hypotension, cardiac enlargement, CHF, AMI, ventricular dysrhythmias from digitalis, hepatic or renal impairment, or bronchial asthma.
- Dose: 20-30 mg/min IV drip. Stop points: (1) up to 17mg/kg to effect, then 1 to 4 mg/min (2) ectopy resolves (3) QRS complex widens more than 50% from original (4) hypotension ensues. Ped: 15 mg/kg/IV/IO over 30-60 min.
- (Cardizem)/Calcium Channel Blocker
- Des: slow calcium channel blocker similar to verapamil. dilates coronary & peripheral arteries & arterioles, thus increasing circulation to the heart & reducing peripheral vascular resistance
- Ind: supraventricular tachydysrhythmias (atrial fibrillation, atrial flutter, & PSVT refractory to adenosine) & to increase coronary artery perfusion in angina.
- CI: 1) hypersensitivity 2)sick sinus syndrome 3)2nd or 3rd degree HB 4)systolic BP < 90, diastolic BP < 60 5)wide-complex tachycardia 6)WPW
- PC: CHF (especially with beta blockers)
- Dose: 0.25mg/kg IV over 2 min, may repeat as needed with 0.35 mg/kg followed by a drip of 5-10mg/hr not to exceed 15mg/hr over 24 hrs
- (nitroglycerin injection) Vasodilator/Nitrate
- Des: relaxes blood vessels, increasing blood & O2 supply to the heart
- Ind: help relieve the pain associated with angina that does not respond to oral (by mouth) treatment; to control blood pressure; & help treat CHF
- CI: hypotension, uncorrected hypovolemia, increased intracranial pressure, constrictive pericarditis & pericardial tamponade
- PC: headache, severe hypotension, reflex tachycardia
- Dose: 0.2-1.5mcg/kg/minute
- (Isoptin, Calan)/Calcium Channel Blocker
- Des: calcium channel blocker that slows AV conduction, suppresses reentry dysrhythmias such as PSVT, & slows ventricular responses to atrial tachydysrhythmias. also dilates coronary arteries & reduces myocardial O2 demand
- Ind: PSVT refractory to adenosine, atrial flutter, & atrial fibrillation w/ rapid ventricular response
- CI: severe hypotension, cardiogenic shock, 2nd or 3rd degree heart block, CHF, sinus node disease, & accessory AV pathways, WPW syndrome. It should not be administered to persons taking beta blockers
- PC: none
- Dose: 2.5-5mg IV bolus over 2-3 min, then 5-10mg after 15-30 min to a max of 30mg in 30 min
- ( Lopressor) / Beta Blocker
- Des: beta-adrenergic blocking agent that reduces heart rate, cardiac output, and BP
- Ind: AMI
- CI: cardiogenic shock, sinus bradycardia <45, 2nd & 3rd degree HB, PR interval >0.24, asthma or COPD
- PC: hypersensitivity, hepatic or renal impairment, cardiomegaly, CHF controlled by digitalis & diuretics, AV conduction defects, thyrotoxicosis, diabetics, or peripheral vascular disease
- Dose: 5mg slow IVP q 5min up to 3 doses while watching HR & BP.
- Des: specially prepared charcoal that will adsorb & bind toxins from the gastrointestinal tract.
- Ind: acute ingested poisoning
- CI: none
- PC: administer only after emesis or in those cases where emesis is CI
- Dose: 1g/Kg mixed w/ at least 6-8 oz of H2O, then PO or via NG tube
- (Calcium Chloride)/Electrolyte
- Des: increases myocardial contractile force & increases ventricular automaticity.
- Ind: hyperkalemia, hypocalcemia, hypermagnesemia, & calcium channel blocker toxicity
- CI: ventricular fibrillation, hypercalcemia, & possible digitalis toxicity
- PC: may precipitate toxicity in PTs taking digoxin. ensure the IV line is in a large vein & flushed before using & after calcium
- Dose: 5-10cc of (10% solution / 1Gram –10cc)/10 min, as needed or 2-4mg/Kg . Ped: 20 mg/kg IV (10% solution) repeat at 10 min, as needed
- (Solu-Medrol)/Corticosteroid, Anti-inflammatory
- Des: synthetic adrenal corticosteroid, effective as an anti-inflammatory & used in mgt of allergic reactions & in some cases of shock. sometimes used in treatment of spinal cord injury.
- Indications: spinal cord injury, asthma, severe anaphylaxis, COPD.
- CI: no major CIs in the emergency setting.
- PC: only a single dose should be given in the prehospital setting.
- Dose: asthma/COPD/anaphylaxis: 125-250 mg IV/IM. Ped: 1-2 mg/kg/dose IV/IM. spinal cord injury: 30mg/kg IV over 15 min, after 45 min an infusion of 5.4 mg/kg/hr.