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.
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
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
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].
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
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.
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
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
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.
Des: 1)rapid-acting 2)potent diuretic 3)antihypertensive 4)inhibits sodium reabsorption by the kidney 5)vasodilating effects reduce venous return & cardiac workload.
Dose: bradycardia: 2-10 mcg/min titrated to cardiac rate. Ped: 0.1 mcg/kg/min titrated to
(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
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.
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
PC: headache, severe hypotension, reflex tachycardia
(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