Medications - Classifications, Indications, Contraindications

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JeremyChrist
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89548
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Medications - Classifications, Indications, Contraindications
Updated:
2011-09-16 21:18:08
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Medications
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Medications
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  1. Albuterol Sulfate (Proventil)
    • Classifications:
    • -B2 selective sympathomimetic
    • -beta agonist

    • Indications:
    • -Asthma
    • -COPD
    • -Wheezing
    • -Reactive Airway Disease
    • -Hyperkalemia

    • Contraindications:
    • - Not indicated in cardiac wheeze
    • Adult:
    • - Broncho-constriction/wheezing/hyperkalemia
    • 2.5mg in 3mL NSS
    • Administered nebulized with 5-8LPM of 02

    • Pediatric:
    • - Broncho-constriction/wheezing/hyperkalemia
    • 2.5mg in 3mL NSS
    • Administered nebulized with 5-8LPM of 02
  2. Atropine (Atropine)


    • Classifications:
    • - Anticholinergic
    • - Parasympatholytic

    • Indications:
    • - Hemodynamically compromised symptomatic bradycardia (non-ami)
    • - Symptomatic Sinus Arrest or Block
    • - AV block at the Junctional Level
    • - Slow PEA
    • - Asystole
    • - Organophosphate poisoning, cholinesterase inhibiting pesticides, sarin, Parathion and certain chemical weapons (SLUDGEM symptoms)

    • Contraindications:
    • - Contraindicated with heart transplant as there is no parasympathetic connection to the heart due to the vagus nerve being severed
    • Adult:
    • - All cardiac indications
    • 0.5 to 1.0mg IVP q 3-5 min up to max 3mg or 0.04 mg/kg rapidly
    • Alternatively it can be given via ETT at 2.0 to 2.5x IV dosage

    • - Organophosphate poisoning
    • 1-2mg q 5min

    • Pediatric:
    • - All cardiac indications
    • Max 0.04mg/kg - min dose 0.1mg
    • 0.02 mg/kg IVP
    • Alternatively can be given ETT at 2.0 to 2.5X IV dose

    • - Organophosphate poisoning
    • 0.05mg/kg IV q. 10-20 min
  3. Bumetanide (Bumex)
    • Classifications:
    • - Loop diuretic

    • Indications:
    • - Pulmonary edema
    • - Fluid overloaded patient

    • Contraindications:
    • - None when clinically indicated
    • Adult:
    • - Diuretic
    • 0.5 - 2.0mg IV Push given over 2 minutes q 2-3 hours
    • Note - 1mg of Bumex = 40mg of Lasix
    • Max dose 10mg per day

    • Pediatric:
    • - Not recommended for pediatric patients
  4. Diazepam (Valium)
    • Classifications:
    • - Benzodiazepine
    • - Anticonvulsant; Sedative-hypnotic

    • Indications:
    • - Seizures
    • - Acute Agitation
    • - Cocaine Overdose

    • Contraindications:
    • - Contraindicated with CNS depression and respiratory depression
    • - Use caution in elderly patients
    • Adult:
    • - Seizures
    • 5mg IV push SLOWLY
    • - Cocaine overdose/Acute agitation
    • 5-10mg IVpush SLOWLY

    • Pediatric:
    • - Seizures
    • 0.1mg/kg IV push
    • 0.5mg/kg PR
  5. Diphenhydramine (Benadryl)
    • Classifications:
    • - Antihistamine
    • - Anticholinergic (Antimuscarinic)

    • Indications:
    • - Relief of symptoms from allergic reactions
    • - Anticholinergic - used to treat acute dystonic response (stiff gait, cog wheel rigidity), extrapyramidal reactions to antipsychotic drugs (Haldol, Thorazine, Compazine)

    • Contraindications:
    • - None when clinically indicated
    • Adult:
    • - Allergic reaction/Dystonic response
    • 25-50mg IV push or deep IM

    • Pediatric:
    • - All indications
    • 1mg/kg IV push or IM
  6. Dexamethasone Sodium Phosphate (Decadron)
    • Classifications:
    • - Synthetic Steroid (long-lasting glucocorticoid)

    • Indications:
    • - Asthma / Croup
    • - Anaphylaxis or allergic state
    • - Brain tumor with edema
    • - Alternative to Solu-Medrol

    • Contraindications:
    • - Contraindicated with systemic fungal infection
    • Adult:
    • - All indications
    • 10mg IV push or IM

    • Pediatric:
    • - Croup
    • 0.6mg/kg IM or IV
  7. Epinephrine (Adrenalin)
    • Classifications:
    • - Vasopressor
    • - Catecholamine

    • Indications:
    • - Bradycardia
    • - Cardiac Arrest
    • - Anaphylaxis
    • - Asthma

    • Contraindications:
    • - Outside of cardiac arrest, administer cautiously in presence of older age, debilitation, hyperthyroidism, hypertension
    • - Use with caution in patients with angina, hypertension, CAD
    • - May cause severe hypertension in those taking beta blockers
    • Adult:
    • - Anaphylaxis
    • 0.3 - 0.5mg SC (1:1000 Concentration)
    • - Asthma
    • 0.3 - 0.5mg SC (1:1000 Concentration)
    • - Cardiac Arrest
    • 1mg IV push (1:10,000 Concentration) q 3-5 min
    • 2.0X to 2.5X IV dose for ETT administration (mix 2.0-2.5mg in 10ml of NSS)
    • - Bradycardia
    • 1-10mcg/min IV Drip; 1mg to 500mL

    • Pediatric:
    • - Cardiac Arrest
    • 0.01mg/kg IV Push (1:10,000 concentration) q. 3-5min
    • - Anaphylaxis
    • 0.01 mg/kg IV Push (1:10,000 concentration)
    • 0.01 mg/kg SC (1:1,000 concentration)
    • - Bradycardia
    • 0.01 mg/kg IV push x1 dose only (1:10,000 concentration)
    • Max dose of 1mg
  8. Furosemide (Lasix)
    • Classifications:
    • - Loop Diuretic

    • Indications:
    • - Pulmonary edema (acute)
    • - Hyperkalemia (not acute treatment)
    • - Acute renal failure

    • Contraindications:
    • - Relative contraindicated with allergy to sulfa drugs, hypotension with pulmonary edema, and dehydration
    • - Caution with severe renal disease, acute MI
    • Adult:
    • - Acute pulmonary edema (BP > 120 systolic)
    • 20mg IVP - standing orders
    • 1.0mg/kg IV push slowly

    • Pediatric:
    • - Pulmonary edema/Hypertension
    • 1mg/kg IV push q 6-12 hrs
  9. Ipratropium Bromide (Atrovent)
    • Classifications:
    • - Anti-Cholinergic
    • - Bronchodilator

    • Indications:
    • - COPD
    • - Asthma

    • Contraindications:
    • - None if clinically indicated
    • Adult/Pediatric:
    • 0.5mg in 2.5ml NSS - 0.02% solution
    • Nebulized with 6-8 liters of 02
  10. Levalbuterol (Xopenex)
    • Classifications:
    • - B2 selective sympathomimetic
    • - Beta agonist

    • Indications:
    • - Asthma
    • - COPD
    • - Wheezing
    • - Reactive airway disease

    • Contraindications:
    • - None when clinically indicated
    • Adult:
    • - Broncho-constriction/wheezing
    • 1.25mg in 3ml NSS for more severe wheezing (acute setting)
    • Administered nebulized with 5-8 LPM of 02
    • - Other doses
    • 0.63mg in 3ml NSS for moderate wheezing (home therapy)

    • Pediatric:
    • 1.25mg in 3ml NSS for more severe wheezing (acute setting)
    • 0.31mg in 3ml NSS for pediatric patients (home therapy)
  11. Lorazepam (Ativan)
    • Classifications:
    • - Benzodiazepine
    • - Anti-convulsant
    • - Sedative-hypnotic
    • - CNS depressant

    • Indications:
    • - Control seizure disorders emergent and non-emergent
    • - Relieve anxiety

    • Contraindications:
    • - Contraindicated with known hypersensitivity to benzodiazepines
    • - Caution in elderly patients, very ill patients or patients with reduced pulmonary reserve as hypoventilation, hypoxia
    • Adult:
    • - Seizure/sedation/relieve anxiety
    • IV injection - 1.0mg to 2.0mg
    • IM injection - 2.0mg up to 4.0mg

    • Pediatric:
    • - Seizures
    • 0.05 - 0.1mg/kg IV push
  12. Magnesium Sulfate (Magnesium Sulfate)
    • Classifications:
    • - Antiarrhythmic
    • - Smooth muscle relaxant

    • Indications:
    • - Torsades de Pointes
    • - Pulseless VT/VF (refractory) after Amiodarone or Lidocaine
    • - Eclampsia-seizures due to toxemia of pregnancy
    • - Asthma

    • Contraindications:
    • - None when clinically indicated
    • Adult:
    • - Alive Dose - Torsades de Pointes - VTach
    • 1-2g IV drip over 5-15 minutes (BP dependant)
    • - Dead Dose - Recurrent or refractory v-fib / pulseless VTach / Torsades
    • 1-2g IVP
    • -Asthma
    • 2g IV drip given over 20 minutes
    • -Pre-eclampsia/eclampsia
    • 2-4g IV given over 3-5 minutes

    • Pediatric:
    • None available
  13. Methylprednisolone (Solu-Medrol)
    • Classifications:
    • - Glucocorticoid steroid (medium-acting)

    • Indications:
    • - Asthma
    • - Neurogenic Shock (controversial)
    • - Acute spine cord injury

    • Contraindications:
    • - Caution with GI bleeding, diabetes mellitus
    • Adult:
    • - Anaphylaxis, Asthma
    • 125mg IV Push

    • Pediatric:
    • - Anaphylaxis, Asthma
    • 2mg/kg dose IV Push
  14. Midazolam Hydrochloride (Versed)
    • Classifications:
    • - Benzodiazepine
    • - Sedative-hypnotic (rapid onset, short acting)

    • Indications:
    • - Pre-medication before cardioversion
    • - Sedation
    • - Seizures

    • Contraindications:
    • - Use caution with decreased respiratory drive; AMS
    • - Liver disease / cirrhosis
    • Adult:
    • - Pre-intubation/Sedation
    • 0.1mg/kg IV Push
    • Typical dose 5mg-10mg IV Push
    • - Seizures when no IV access is avail
    • 2-5mg IM
    • -Induction Agent
    • 0.2mg/kg IV push - 7-10mg avg. adult

    • Pediatric:
    • - Seizures without IV access
    • 0.1mg/kg IM
  15. Morphine Sulfate (Morphine)
    • Classifications:
    • - Narcotic
    • - Analgesic

    • Indications:
    • - Pain (burns, MI, and others)
    • - Cardiac chest pain (refractory to nitrates)

    • Contraindications:
    • - Contraindicated with existing respiratory depression
    • - Caution with COPD, CNS depression, hypotension
    • Adult:
    • - Pain (MI, sickle cell and other)
    • 2-5mg IV Push q. 5 minutes until desired effects
    • - Pain (Burns)
    • 5-10mg IV Push q. 5 minutes until desired effects
    • Often high dose morphine is required for pain relief

    • Pediatric:
    • - Pain (all indications)
    • 0.1mg/kg IV Push
  16. Naloxone (Narcan)
    • Classifications:
    • - Opioid Antagonist (shorter acting)

    • Indications:
    • - Reverse pre-operative opiate induced sedation
    • - Opioid/Opiate overdose

    • Contraindications:
    • - In apneic, narcotized patients, apply BVM resuscitation prior to administration of Narcan.
    • - Too much Narcan can induce withdrawal, only administer enough to maintain respiratory drive and oxygenate patient
    • Adult:
    • - Opiate overdose
    • 0.4 - 2.0mg IM/IV/SC/Inter-Nasal

    • Pediatric:
    • - Opiate reversal (0-5 years old or <20kg)
    • 0.1 mg/kg IV/SC/ETT q. 3 minutes until response
  17. Nitroglycerin (Nitrostat, Nitrospan, Nitrodisc, Nitrodur, Tridil)
    • Classifications:
    • - Nitrate
    • - Vasodilator

    • Indications:
    • - MI (without right ventricular involvement)
    • - Angina pain
    • - First line agent for pulmonary edema from CHF

    • Contraindication:
    • - Hypotension
    • - Bradycardia (relative)
    • Adult:
    • - All indications:
    • 0.4mg (2% solution) SL spray administer on mucus membranes of mouth (under toungue)
    • 0.4mg (1/150grains) SL tablet q. 3-5 minutes
    • 1-2 inches as on ointment/paste - apply to skin without hair - avoid self exposure
    • 10-20mcg/min IV drip mixed 50-100 mg in 250mL
    • Increase by 5-10mcg/min q. 5-10 minutes until desired response

    • Pediatric:
    • No prehospital administration recommended
  18. Oxygen (Oxygen)
    • Classifications:
    • - Naturally occurring gas

    • Indications:
    • - Confirmed or suspected hypoxia
    • - Ischemic chest pain
    • - Respiratory insufficiency
    • - Confirmed or suspected carbon monoxide poisoning and other causes of decreased tissue oxygenation (cardiac arrest, shock)
  19. Terbutaline (Brethine)
    • Classifications:
    • - B2 agonist
    • - Bronchodilator; smooth muscle relaxant

    • Indications:
    • - Asthma
    • - Bronchospasms
    • - Premature labor

    • Contraindications:
    • - Caution with hypertension and ventricular arrhythmias
    • Adult:
    • - Asthma/Bronchospasm/Premature labor
    • 0.25mg SQ to start, wait 15 min repeat if necessary

    • Pediatric:
    • Not recommended for pediatrics in pre-hospital setting.

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