Paramedic Pharmacology - Drug Cards

Abciximab Class: Platelet aggregation inhibitor Actions: binds to glycoprotein IIb/IIIa receptor sites on the surface of activated platelets preventing normal binding of fibrinogen and other factors, thus preventing platelet aggregation. Indication: to prevent acute myocardial ischemic complications after percutaneous transluminal coronary angioplasty (PTCA) in patients at high risk for abrupt closure of treated coronary artery. Contraindications: active internal bleeding, arteriovenous malformation or aneurysm, bleeding disorders, stroke in past 2 yrs, hypersensitivity, GI Bleed in past 6 wks, HTN, oral anticoagulant therapy in past 7 days Precautions: watch for GI bleed, monitor for hypersensitivity Side effects: confusion, dizziness, A-fib, bradycardia, dysphagia, N/V, hematuria, anemia, embolism, pneumonia, pulmonary edema, urticarial, bronchospasm Dosage & Route: 250 mcg/kg bolus, then 10 mcg/min by continuous infusion over 18 - 24 hrs

Acetaminophen (Tylenol) Class: Non-opioid analgesic; Antipyretic Actions: Inhibits the synthesis of prostaglandins that may serve as mediators of pain and fever, primarily in the CNS Indication: Pain, Fever Contraindications: Hypersensitivity; Impaired hepatic function; Pregnancy Precautions: Hepatic Failure; Hepatotoxicity Side effects: Abd pn; N/V; Liver tenderness; Oliguria Dosage & Route: 325 650mg PO/PR every 4-6 hrs, or 1000mg t.i.d/q.i.d

Activated Charcoal Class: Adsorbent Actions: Adsorbs toxins by chemical binding and prevents GI adsorption Indication: Poisoning following emesis or when emesis is contraindicated Contraindications: None in severe poisoning Precautions: Should only be admin following emesis in cases in which it is so indicated; Use w/ caution in pt with AMS; May adsorb ipecac before emesis Side effects: N/V; Constipation Dosage & Route: 1 g/kg (typically 50 75 g) mixed with a glass of water to form a slurry

Adenosine (Adenocard) Class: Class V Antidysrhythmic (Chemical Cardioverter); Nucleoside Actions: Slows atrioventricular conduction Indication: Symptomatic Paroxysmal Supra-Ventricular Tachycardia (PSVT) Contraindications: Second or third degree heart block Side effects: Facial Flushing; Headache; Shortness of breath; CP; dizziness, N/V Dosage & Route: 6 mg rapid IV bolus over 1-2 sec; if no cardioversion, 12 mg over 1-2 sec

Albuterol (Proventil) Class: Sympathomimetic (Beta 2 selective) Actions: Bronchodilation Indication: Asthma; Reversible bronchospasm associated with COPD Contraindications: Known hypersensitivity; Symptomatic tachycardia Precautions: B/P, P, ECG monitored; pt w/ known heart disease Side effects: Palpitation; Anxiety; Headache; Dizziness; Sweating Dosage & Route: Small-volume Nebulizer: 0.5 mL (2.5 mg) in 2.5 mL NS over 5-15 min; Metered-dose inhaler: 1 -2 sprays (90 micrograms/spray)

Alteplase (Activase) Class: Glycoprotein; Tissue plasminogen activator, recombinant; thrombolytic Actions: binds to fibrin in a thrombus and converts trapped plasminogen to plasmin, which breaks down fibrin, and other clotting factors, dissolving thrombi Indication: To treat acute MI or stroke caused by thrombus induced ischemia Contraindications: active internal bleeding, aneurysm, HTN Precautions: bleeding, drugs that alter platelet function, head trauma Side effects: cerebral edema, seizure, dysrhythmias, GI Bleed, N/V, pulmonary edema, anaphylaxis, cardiac arrest Dosage & Route: 15 mg bolus followed by 50 mg IV over 30 min, followed by 35 mg over 60 min

Aminophylline Class: Xanthine bronchodilator Actions: smooth muscle relaxant; bronchodilation; mild diuretic properties; increases HR Indication: Bronchial asthma; reversible bronchospasm associated w/ COPD; CHF; Pulmonary edema Contraindications: Hx of hypersensitivity; hypotension; Pt w/ peptic ulcer disease Precautions: Monitor for dysrhythmia; monitor blood pressure; Side effects: Convulsions; Tremor; Anxiety; Dizziness; Vomiting; Palpitations; PVC's Tachycardia Dosage & Route: 1) 250 500 mg in 90 or 80 mL of D5W infused over 20 30 min (approximately 5 10 mg/kg/hr) 2) 250 500 mg (5 -7 mg/kg) in 20 mL of D2W infused over 20 30 min

Amiodarone HCL (Cordarone) Class: Class III Antidysrhythmic Actions: Prolongs action potential and refractory period; slow the sinus rate; increases PR and QT intervals; Decreases peripheral vascular resistance Indication: Life-threatening cardiac dysrhythmias such as pulseless V-Tach and V-Fib Contraindications: Severe sinus node dysfunction; 2 bradycardia Precautions: Heart failure Side effects: Hypotension; Nausea; Anorexia; Malaise, fatigue; Tremors; Pulmonary toxicity; Ventricular ectopic beats Dosage & Route: Adults: Loading dose of 150 mg over 10 min (15mg/min); Maintenance dose: 1 mg/min for 6 hr, then 0.5 mg/min until dysrhythmia is controlled or oral therapy begins
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and 3 degree AV block; Hemodynamically significant

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Amrinone (Inocor) Class: Cardiac inotrope Actions: Increases cardiac contractility; Vasodilator Indication: Short-term management of severe CHF Contraindications: Pt w/ Hx of hypersensitivity Precautions: Increase Myocardial ischemia; B/P, P, and ECG constantly monitored; amrinone should only be diluted with NS or NS; no dextrose solution should be used Side effects: Reduction in platelets; N/V; Cardiac dysrhythmias Dosage & Route: 0.75 mg/kg bolus given slowly over 2- to 5- min interval followed by maintenance infusion of 2 15 mg/kg/min

Amyl Nitrite Class: Nitrate Actions: Causes coronary vasodilation; removes cyanide ion via complex mechanism Indication: cyanide poisoning (bitter almond smell to breath) Contraindications: None when used in the management of cyanide poisoning Precautions: Has tendency for abuse Side effects: Headache; Hypotension; Reflex tachycardia; Nausea Dosage & Route: Inhalant should be broken and inhaled; repeated as needed until pt is delivered to ED; effect diminish after 20 min

Aspirin Class: Nonopioid Analgesic; Antiplatelet; Antipyretic; Salicylate; NSAID Actions: Inhibits the synthesis of prostaglandins that may serve as mediators of pain and fever, primarily in the CNS; Inhibits platelet synthesis Indication: Pain, Fever, Inflammatory conditions; Reduce risk of CVA and MI Contraindications: Hypersensitivity; MAOIs; Ulcers; Hemophilia; Influenza (risk of Reyes Syndrome in children/teens); Pregnancy; Bronchospasm Precautions: Vitamin K deficiency (increases bleeding); Possible teratogen Side effects: GI Bleeding; Renal Failure; N/V Dosage & Route: 325 650mg PO every 4 hrs, or 500mg every 3 hrs, or 1000mg every 6 hrs.

Atenolol (Tenormin) Class: Beta adrenergic blocker; antianginal; antihypertensive Actions: inhibits stimulation of Beta1 receptor sites, decreasing cardiac excitability/output/oxygen demand; decrease release of renin to lower BP Indication: To treat angina pectoris or acute MI; treat HTN Contraindications: cardiogenic shock, 2 /3 heart block, bradycardia Precautions: digoxin use, diabetics, must be tapered Side effects: CNS depression, arrhythmias, laryngospasm, N/V/D, anaphylaxis Dosage & Route: PO 50 mg daily increased to 100 mg daily after 1 - 2 wks; IV 5 mg over 5 min followed by 5 mg after 10 min, 50 mg after 10 min
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Atropine Class: Parasympatholytic (anticholinergic) Actions: blocks acetylcholine receptors; Increases HR; Decreases GI secretions Indication: Hemodynamically significant bradycardia; Hypotension secondary to bradycardia; Asystole; Organophosphate poisonings Contraindications: None in emergency Side effects: Palpitation; tachycardia; Headache; dizziness; Anxiety; Dry mouth; Pupillary dilation; Blurred vision; Urinary retention Dosage & Route: Bradycardia: 0.5 mg / 3 -5 min to max of 0.04 mg/kg IV; Asystole: 1 mg IV; Organophosphate Poisoning: 2 -5 mg IV; ETT dose is 2 - 2.5 time the IV dose

Bumetanide (Bumex) Class: Potent diuretic Actions: Inhibits reabsorption of sodium chloride; Promotes prompt diuresis; slight vasodilation Indication: CHF; Pulmonary edema Contraindications: Dehydration; Pregnancy Precautions: should be protected from light Side effects: Few Dosage & Route: IV/IM 0.5 1.0 mg

Calcium Chloride Class: Electrolyte Actions: Increases cardiac contractility Indication: Acute hyperkalemia; Acute hypocalcemia; Calcium channel blocker (e.g. nifedipine, verapamil) OD; Abd muscle spasm associated w/ spider bite and Portuguese man-of-war stings; antidote for magnesium sulfate Contraindications: Pt receiving digitalis Precautions: IV line should be flushed between calcium chloride and sodium bicarbonate admin; extravasation may cause tissue necrosis Side effects: Dysrhythmias (bradycardia and asystole); hypotension Dosage & Route: 2 4 mg/kg of a 10% solution; may be repeated at 10 min intervals IV

Calcium Gluconate Class: Elemental cation; antacid Actions: increases levels of intracellular and extracellular calcium; neutralizes stomach acid Indication: adjunct in exchange transfusion; treat hypocalcemia; treat hyperacidity Contraindications: hypercalcemia, hypophosphatemia, renal calculi Precautions: dont give through same line as bicarbonates, phosphates, or sulfates Side effects: hypotension, dysrhythmia, N/V, diaphoresis, flushing Dosage & Route: PO 800-1000 mg daily; IV 500 - 1000 mg slowly

Captopril (Capoten) Class: ACE Inhibitor; antihypertensive Actions: prevent conversion of Angiotensin I to angiotensin II, inhibiting aldosterone release, reducing BP Indication: To control hypertension; treat left-sided heart failure; treat diabetic nephropathy Contraindications: hypersensitivity, other ACE inhibitor use Precautions: allopurinol use increases hypersensitivity, antacids prevent absorption; monitor BP, renal function, WBCs Side effects: fever, CP, orthostatic hypotension, tachycardia, impotence, oliguria, eosinophilia, cough, photosensitivity, angioedema, hyponatremia, hyperkalemia Dosage & Route: PO 25 50 mg bid increased as directed by physician, max. 450 mg daily

Chlordiazepoxide (Librium) Class: Benzodiazepine; antianxiety Actions: may potentiate effects of GABA by binding to benzo receptors Indication: short term management of mild to severe anxiety; treat withdrawal Contraindications: digoxin use, hypersensitivity Precautions: may decrease effectiveness of levodopa, CNS depression Side effects: ataxia, confusion, CNS depression, suicidal ideations, hypotension, tachycardia, jaundice, hepatic dysfunction Dosage & Route: PO 5 10 mg q.i.d., IV/IM 50 100 mg, Max. 300 mg daily

Chlorpromazine (Thorazine, Largactil) Class: Major tranquilizer (Phenothiazine) Actions: Blocks dopamine receptors in brain associated w/ mood and behavior; Has antiemetic properties Indication: Acute psychotic episodes; Mild alcohol withdrawal; Intractable hiccoughs; N/V Contraindications: Comatose states; Presence of sedatives; Presence of hallucinogens or phencyclidine-like compounds Precautions: Orthostatic hypotension; May cause extrapyramidal reactions (Parkinsonian), especially in children Side effects: Physical and mental impairment; Drowsiness Dosage & Route: 25 100 mg IM

Cimetidine (Tagamet) Class: Imidazole derivative; antiulcer agent; antacid Actions: blocks histamine action at H2 receptors in stomach reducing gastric acid Indication: treat ulcers, manage GERD, treat heartburn Contraindications: hypersensitivity Precautions: antacid use decreases absorption Side effects: confusion, dizziness, hallucinations, headache, diarrhea, impotence Dosage & Route: PO 800 mg daily; IV/IM 300 mg every 6-8 hrs, max. 2,400 mg daily

Clopidogrel Bisulfate (Plavix) Class: Platelet aggregation inhibitor Actions: binds to adenosine diphosphate (ADP) receptors on the surface of activated platelets, deactivating glycoprotein IIb/IIIa receptors and prevents fibrinogen from attaching, keeping platelets from aggregating. Indication: to reduce risk of stroke or MI in pts w/ atherosclerosis Contraindications: active bleeding, hypersensitivity Precautions: ulcer, intracranial hemorrhage Side effects: confusion, depression, dizziness, fatigue, hallucinations, headache, CP, edema, HTN, hypotension, bleeding, abd pn, diarrhea, N/V, cough, pancreatitis Dosage & Route: PO Loading dose 300 mg, 75 mg daily

Dexamethason (Decadron, Hexadrol) Class: Steroid Actions: Decreases cerebral edema; Anti-inflammatory; Suppresses immune response Indication: Anaphylaxis (after epinephrine and diphenhydramine); Asthma; COPD Contraindications: None in emergency setting Precautions: Protect from light; Onset of action may be 2 6 hr and thus should not be considered to be of sue in the critical first hr Side effects: GI bleeding; Prolonged wound healing Dosage & Route: 4 24 mg IV, IM

Dextrose (50 Percent) Class: Carbohydrate Actions: Elevates Blood Glucose level rapidly Indication: Hypoglycemia Contraindications: None in emergency setting Precautions: blood glucose should be taken before admin Side effects: Local venous irritation Dosage & Route: 25g (50mL) IV

Diazepam (Valium) Class: Tranquilizer (benzodiazepine) Actions: Anticonvulsant; Skeletal muscle relaxant; Sedative Indications: Major motor seizures; Status epilepticus; Premedication before cardioversion; skeletal muscle relaxant; Acute anxiety states Contraindications: Hypersensitivity Precautions: Can cause local venous irritation; short duration of effect; Do not mix w/ other drugs; Flumazenil (Romazicon) be available Side effects: Drowsiness; Hypotension; Respiratory depression and apnea Dosage & Route: Status epilepticus: 5 10 mg IV; Acute anxiety: 2 5 mg IM, IV; Premedication for cardioversion: 5 15 mg IV; not administer faster than 1mL/min IV

Digoxin Immune Fab (Digibind) Class: Digoxin-specific antigen-binding fragments; Digitalis glycoside antidote Actions: binds with digoxin or digitoxin molecules and excretes compound through kidneys Indication: treat acute digoxin toxicity Contraindications: hypersensitivity Precautions: test for allergic reaction by admin of diluted fab 0.1 ml in 9.9 ml saline intradermally Side effects: increased ventricular rate in A-Fib, worsening of heart failure or low cardiac output Dosage & Route: individualized dosage based on amt ingested

Digoxin (Lanoxin) Class: Cardiac glycoside (Class V Antidysrhythmic) Actions: Increases cardiac contractile force and cardiac output; Reduces edema associated w/ CHF; Decreases automaticity Indication: CHF; Rapid atrial dysrhythmias, atrial flutter and atrial fibrillation Contraindications: pt w/ S/S of digitalis toxicity; V-fib Precautions: monitor for signs of digitalis toxicity (> 2.0); pt who have recently suffered a MI; calcium should not be admin to pt receiving digitalis Side effects: N/V anorexia; dysrhythmias; yellowish, blurry vision; fatigue Dosage & Route: 0.25 0.50 mg IV

Diltiazem (Cardizem) Class: Class IV Antidysrhythmic; Calcium channel blocker Actions: Slows conduction through the AV node; Causes vasodilation; Decreases rate of ventricular response; Decreases myocardial oxygen demand Indication: To control Rapid Ventricular rates associated with A-Fib and flutter; Angina pectoris Contraindications: Hypotension; Wide-complex tachycardia; Conduction system disturbances Precautions: Should not be used in pt receiving beta blockers; hypotension; kept refrigerated Side effects: N/V; hypotension; dizziness Dosage & Route: 0.25 mg/kg bolus (typically 15 - 20 mg) IV over 2 min, following by a maintenance infusion of 5 15 mg/hr Other: antidote = Calcium Chloride

Diphenhydramine (Benadryl) Class: Antihistamine Actions: Blocks histamine receptors; Sedative effects Indication: Anaphylaxis; Allergic reactions; Dystonic reactions due to phenothiazines Contraindications: Asthma; Nursing mothers Precautions: Hypotension Side effects: Sedation; Dries bronchial secretions; blurred vision; Headache; Palpitations Dosage & Route: 25 50 mg slow IV push/deep IM Other: Pediatric: 2 -5 mg/kg

Dobutamine (Doburex) Class: Sympathomimetic Actions: Increases cardiac contractility; little chronotropic activity Indication: Short-term management of CHF Contraindications: Should only be used in pt w/ adequate heart rate Precautions: Ventricular irritability; caution following MI; deactivated by alkaline solution Side effects: Headache; HTN; palpitations Dosage & Route: 2.5 20 micrograms/kg/min Method: 250mg should be placed in 500 mL of D5W, which give a concentration of 0.5 mg/mL

Dopamine (Intropin) Class: Sympathomimetic Actions: Increases cardiac contractility; Causes peripheral vasoconstriction Indication: Hemodynamically significant hypotension (systolic blood pressure of 70 100 mmHg) not resulting from hypovolemia; Cardiogenic shock Contraindications: Hypovolemic shock in which complete fluid resuscitation has not occurred; pheochromocytoma Precautions: Presence of severe tachydysrhythmias; presence of V-Fib; Ventricular irritability; Beneficial effects lost when dose exceeds 20 micrograms/kg/min Side effects: Ventricular tachydysrhythmias; HTN; Palpitation Dosage & Route: Initial dose: 2 -5 micrograms/kg/min; increases PRN; Method: 800 mg should be placed in 500 mL of D5W giving a concentration of 1600 mg/mL

Droperidol (Inapsine) Class: Butyophenone anti-psychotic / anti-emetic Actions: Antagonizes the effect of drugs that act on the chemoreceptor trigger zone (CTZ); Reduces anxiety and produces sedation Indication: Acute psychosis; N/V Contraindications: Pt w/ known hypersensitivity Precautions: BLACK BOX warning regarding QT interval prolongation; Use w/ caution in the elderly, debilitated or poor-risk pt; Monitor vital signs and ECG Side effects: Drowsiness; EPS symptoms (dystonia); Dizziness; Restlessness; Hypotension; Tachycardia Dosage & Route: 2.5 10.0 mg IV

Enalapril (Vasotec) Class: ACE Inhibitor; antihypertensive Actions: reduces blood pressure by affecting RAAS. Indication: To treat hypertension; to treat heart failure Contraindications: Hx of angioedema from previous ACE Inhibitor; hypersensitivity Precautions: many drug interaction risks Side effects: ataxia, confusion, depression, dizziness, dream disturbances, fatigue, headache, insomnia, nervousness, peripheral neuropathy, somnolence, stroke, syncope, vertigo, weakness, angina, arrhythmias, cardiac arrest, hypotension, embolism, abd pn, constipation, hepatitis, renal failure, dry eyes/mouth, photosensitivity, N/V, anaphylaxis, muscle spasms, bronchospasm, impotence Dosage & Route: IV 1.25 mg every 6 hrs; PO 2.5-5 mg daily, max. 40 mg daily.

Enoxapain (Lovenox) Class: Anti-coagulant (low molecular-weight heparin) Actions: Acts as effective anti-coagulant Indication: Unstable angina; Non-Q-wave MI; Pulmonary embolism; Deep venous thrombosis Contraindications: Pt w/ known hypersensitivity to the drug or heparin Precautions: do not use in patients w/ major bleeding or at increased risk of bleeding Side effects: Confusion; Dizziness; Edema; Bleeding complications Dosage & Route: MI / angina: 1 mg/kg SC/IV; Pulmonary embolism: 0.5 mg/kg SC/IV

Epinephrine 1:10,000 Class: Sympathomimetic Actions: Increase in HR, automaticity, cardiac contractile force, myocardial electrical activity, systemic vascular resistance, B/P; bronchodilation Indication: Cardiac arrest, Anaphylactic shock, Severe reactive airway disease Contraindications: should not be used in pt who do not require extensive resuscitative efforts Precautions: Protect from light; deactivated by alkaline solutions Side effects: Palpitation; Anxiety; Tremulousness; N/V Dosage & Route: Cardiac arrest: 0.5 1.0mg repeated every 3 5min; Severe Anaphylaxis: 0.3 0.5mg (3 5 mL), occasionally an drip is required; ETT dose 2 to 2.5 times IV dose Other: Pediatric: 0.01mg/kg initially; with subsequent doses, Epinephrine 1:1000 should be used at a dose of 0.1mg/kg

Epinephrine 1:1,000 Class: Sympathomimetic Actions: Bronchodilation Indication: Bronchial asthma; Exacerbation of COPD; Allergic reaction; Pediatric cardiac arrest Contraindications: Pt w/ underlying cardiovascular disease; HTN; Pregnancy; pt w/ tachdysrhythmias Precautions: Protect from light; B/P, P, ECG monitored closely Side effects: Palpitations and tachycardia Dosage & Route: 0.3 0.5 mg SC Other: Pediatric Dose: 0.01 mg/kg up to 0.3 mg

Eptifibatide (Integrilin) Class: Platelet Aggregation Inhibitor Actions: reversibly inhibits platelet aggregation by preventing fibrinogen and other factors from binding to glycoprotein IIb/IIIa receptors on activated platelets. Indication: To treat unstable angina; to treat thrombosis related to PTCA Contraindications: active bleeding or stroke during prior 30 days; dialysis; hypersensitivity; recent major surgery Precautions: avoid punctures during therapy Side effects: intracranial hemorrhage, hypotension, hematemesis, hematuria, thrombocytopenia, anaphylaxis Dosage & Route: IV 135-180 mcg/kg slow

Esmolol (Brevibloc) Class: Beta-blocker (beta1 selective) Actions: Decreases HR; Decreases atrioventricular conduction Indication: symptomatic SVT (including A-Fib and atrial flutter) as evidenced by Chest pn, palpitation, or dizziness Contraindications: Sinus bradycardia; Heart block greater than 1 degree; Cardiogenic shock; Overt CHF; Pt w/ bronchospastic diseases (asthma) Precautions: Hypotension is common and is usually dose related; Pt w/ CHF may worsening of S/S; May worsen bronchospastic disease Side effects: Dizziness; Diaphoresis; Hypotension; Nausea Dosage & Route: Prep: place two 2.5 g ampules in 500 mL of D5W, yielding a concentration of 10 mg/mL; Loading: 500 mL/kg/min for 1 min, then reduce to maintenance dose; Maintenance: 50 mg/kg/min; if ineffective after 4 min, repeat loading dose and increase PRN until a total maintenance dose of 200 mg/kg/min has been achieved; IV infusion only.

Etomidate (Amidate) Class: Hypnotic Actions: Non-barbiturate hypnotic with no analgesic effects and limited cardiovascular and respiratory effects Indication: Induce sedation for rapid sequence intubation Contraindications: Hypersensitivity Precautions: Hypotension, Severe asthma, Cardiovascular disease Side effects: Adrenal suppression, opsoclonus, skeletal muscle movements, mainly myoclonic, transient injection site pain Dosage & Route: 0.1to 0.3 mg/kg IV over 15 to 30 sec. Ped: 0.2 to 0.4 mg/kg IV/IO over 30 to 60 sec. Max 20 mg.

Fentanyl Citrate (Sublimaze) Class: Narcotic (Synthetic Opioid) *50 100x MORE potent than Morphine Actions: CNS depressant; Decreases sensitivity to pn Indication: Severe pn; Adjunct to rapid-sequence induction; Adjunct to rapid-sequence sedation; Maintenance of analgesia Contraindications: Shock; Undiagnosed abd pn; Pt w/ Hx of hypersensitivity; Myasthenia Gravis; Head Injury; COPD Precautions: Respiratory depression; Hypotension; Chest wall rigidity Side effects: Dizziness; AMS; Bradycardia; Nausea/Vomiting; Cramps Dosage & Route: 25 100 mcg IV; 2 -12 yr: 1.7 3.3 microgram/kg Other: Naloxone is antagonist

Flecainide (Tambocor) Class: Class 1C antiarrhythmic Actions: Inhibits fast sodium channels of myocardial cell membranes, which increase myocardial recovery after repolarization, and by depressing the upstroke of the action potential. Slows conduction; Inhibits calcium influx Indication: to prevent and suppress VTach; To prevent Paroxysmal AFib or PSVT Contraindications: cardiogenic shock, hypersensitivity, recent MI, R BBB associated with 2 unless pacemaker is present. Precautions: Risky interactions with amiodarone and digoxin Side effects: anxiety, depression, dizziness, fatigue, headache, tremors, weakness, arrhythmias, angina, hypotension, heart failure, blurred vision, constipation, N/V, dyspnea, rash Dosage & Route: PO 50-100 mg every 8-12 hrs
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or 3 degree AV block

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Flumazenil (Romazicon) Class: Benzodiazepine antagonist Actions: Reverses the effects of benzodiazepines Indication: To reverse ENS respiratory depression associated w/ benzodiazepines Contraindications: Flumazenil should not be used as a diagnostic agent for benzodiazepine OD in the same manner naloxone is used for narcotic OD; Known hypersensitivity to drug Precautions: Admin w/ caution to pt dependent on benzodiazepines because it may induce life-threatening benzodiazepine withdrawal; Should not be used as part of a coma cocktail Side effects: Fatigue; Headache; Nervousness; Dizziness Dosage & Route: 0.2 mg IV over 30 sec, repeated as needed to a max dose of 1.0 mg

Fosphenytoin (Cerebyx) Class: Anticonvulsant Actions: Converts to phenytoin; Suppresses SZ activity Indication: Major motor SZ; antidysrhythmic Contraindications: Hypersen to Rx or phenytoin (hydantoin class of drugs) Precautions: Pt w/ impaired renal function; Alcoholism; Hypotension; Heart block Side effects: Dizziness; Somnolence; Hypotension; Heart Block Dosage & Route: 15 20 mg phenytoin equivalent/kg IV/IM

Furosemide (Lasix) Class: Diuretic Actions: Inhibits reabsorption of sodium chloride; Promotes prompt diuresis; Vasodilation Indication: Pulmonary edema 2
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to CHF; Pulmonary edema

Contraindications: Pregnancy; Dehydration Precautions: Protect from light; Dehydration Side effects: hypotension; dry mouth Dosage & Route: 40 80 mg IV Other: Pediatric: 1 mg/kg (max 6 mg/kg total dose) IV

Glucagon Class: Hormone (antihypoglycemic agent) Actions: Causes breakdown of glycogen to glucose; Inhibits glycogen synthesis; Elevates blood glucose level; Increases cardiac contractile force Indication: Hypoglycemia; Beta-blocker overdose Contraindications: Hypersensitivity Precautions: Only effective if there are sufficient stores of glycogen with in th liver; Use w/ caution in pt w/ cardiovascular or renal disease; Draw blood for glucose test before admin Side effects: Few in emergency situation Dosage & Route: 0.25 0.5 unit IV; 1.0 IM

Haloperidol (Haldol) Class: Major tranquilizer (betrophenone) Actions: Block dopamine receptors in brain responsible for mood and behavior Indication: Acute psychotic episodes Contraindications: Not to be admin in the presence of other sedatives Precautions: Orthostatic hypotension Side effects: Physical and mental impairment; Parkinson-like reactions have been known to occur, especially in children Dosage & Route: 2 5 mg IM

Heparin Class: Anticoagulant Actions: Inhibits anti-thrombin III thrombin complex Indication: Unstable angina; Non-Q-Wave MI; Pulmonary embolism; Deep venous thrombosis Contraindications: Pt w/ known hypersen to Rx or pork products Precautions: Do not use in pt w/ major bleeding or thrombocytopenia Side effects: Confusion, Dizziness, Edema, Bleeding complications Dosage & Route: 5000 units IV followed by maintenance infusion; IV, SQ

Hydralazine (Apresoline) Class: Anti-hypertensive (potent vasodilator) Actions: Relaxes vascular smooth muscle; Decreases arterial pressure (diastolic greater than systolic); Increases cardiac output Indication: HTN emergency in which a prompt reduction in BP is required; HTN accompanying pregnancy Contraindications: Pt w/ known Hx of coronary artery disease; Rheumatic heart disease involving the mitral valve; Hx of hypersensitivity Precautions: May induce angina; May cause ECG changes and cardiac ischemia; BP, P, and ECG results constantly monitored Side effects: Headache; N/V/D; Tachycardia; Palpitations Dosage & Route: 20 40 mg given by slow IV bolus; may be repeated if required

Hydrocortisone (Soul-Cortef) Class: Steroid Actions: Anti-inflammatory; Suppresses immune response (especially in allergic and anaphylactic reactions) Indication: Severe anaphylaxis; Asthma and COPD; Urticaria (hives) Contraindications: None in the emergency setting Precautions: Must be reconstituted and used promptly; Onset of action may be 2 6 hr, and thus the drug should not st be expected to be of use in the critical 1 hr following an acute anaphylactic reaction Side effects: GI bleeding; Prolonged wound healing; suppression of natural steroids Dosage & Route: 100 250 mg IV, IM

Hydromorphone (Dilaudid) Class: Narcotic (Opioid) Actions: CNS depressant; Decrease sensitivity to pn Indication: Relief of moderate to severe pain. Contraindications: History of chronic respiratory illness Precautions: Excessive sedation, respiratory depression, circulatory depression and collapse Side effects: Nausea/Vomiting, Cramps Dosage & Route: 0.5 2mg; Adults= 1mg slow IV repeat in 5min if B/P >90. Other: Naloxone is antagonist

Hydroxocobalamin Class: Vitamin Actions: Binds to plasma proteins to be used for growth, cell reproduction, hematopoiesis, nucleoprotein and myelin synthesis. Indication: Pernicious anemia, both uncomplicated and accompanied by nervous system involvement; Dietary deficiency of Vitamin B12; Malabsorption of vitamin B12; Inadequate secretion of intrinsic factor, resulting from lesions that destroy the gastric mucosa (ingestion of corrosives, extensive neoplasia), and a number of conditions associated with a variable degree of gastric atrophy (such as multiple sclerosis, certain endocrine disorders, iron deficiency, and subtotal gastrectomy). Contraindications: Hypersensitivity Precautions: May mask certain conditions Side effects: Mild transient diarrhea, itching, transitory exanthema, feeling of swelling of entire body, and anaphylaxis. Dosage & Route: IM 30 mcg daily for 5 - 10 days followed by 100 - 200 mcg monthly

Hydroxyzine (Vistaril) Class: Anti-histamine Actions: Anti-emetic; Anti-histamine; Anti-anxiety; Potentiates analgesic effect of narcotics and related agents Indication: To potentiate the effects of narcotics and synthetic narcotics; N/V; Anxiety reactions Contraindications: Pt w/ Hx of hypersensitivity Precautions: Orthostatic hypotension; Analgesic dosages should be reduced when used with hydroxyzine; Urinary retention Side effects: Drowsiness Dosage & Route: 50 100 mg Deep IM

Ibuprofen (Advil, Motrin) Class: Propionic acid derivative; analgesic; NSAID, antipyretic Actions: Blocks activity of cyclooxygenase, the enzyme needed to synthesize prostaglandins, which mediate inflammation and cause pain signal; Vasodilates to reduce temperature. Indication: To relieve pain caused by arthritis, migraine, muscle ache; To reduce fever Contraindications: angioedema, asthma, bronchospasm, rhinitis, nasal polyps, hypersensitivity Precautions: long term use may have damaging effects on renal and hepatic function; Use caution in pt with Hx of ulcers Side effects: Aseptic meningitis, dizziness, headache, nervousness, stroke, fluid retention, heart failure, hypertension, MI, tachycardia, epistaxis, tinnitus, abd pn, constipation, hepatitis, N/V, renal failure, anemia, anaphylaxis, angioedema, weight gain, bronchospasm, dyspnea Dosage & Route: PO 200-800 mg 2-6 times daily; IV 400-800 mg over 6 hrs

Insulin (Humilin, Novolin, Iletin) Class: Hormone (hypoglycemic agent) Actions: Causes uptake of glucose by the cells; Decreases blood glucose level; Promotes glucose storage Indication: Elevated blood glucose; Diabetic ketoacidosis Contraindications: Avoid overcompensation of blood glucose level, if possible, admin should wait until the pt is in the ED Precautions: Administration of excessive dose may induce hypoglycemia; glucose should be available Side effects: few in emergency situation Dosage & Route: 10 25 units regular insulin IV followed by an infusion @ 0.1 units/kg/hr; IV, SQ

Ipratropium (Atrovent) Class: Anticholinergic Actions: Causes bronchodilation; dries respiratory tract secretions Indication: Bronchial asthma; Reversible bronchospasm associated w/ chronic bronchitis and emphysema Contraindications: Should not be used in patients w/ Hx of hypersensitivity; should not be used as primary acute treatment of bronchospasm Precautions: Monitor vital signs Side effects: Palpitation; Dizziness; Anxiety; headache; Nervousness Dosage & Route: 500 mcg placed in small-volume nebulizer (typically admin w/ a beta-agonist)

Isoetharine (Bronkosol) Class: Sympathomimetic (Beta2 selective) Actions: Bronchodilation; Increases HR Indication: Asthma; Reversible bronchospam associated with chronic bronchitis and emphysema Contraindications: Pt w/ Hx of hypersensitivity Precautions: BP, P, ECG constantly monitored Side effects: Palpitation; Tachycardia; Anxiety; Tremors; Headache Dosage & Route: small-volume nebulizer: 0.5 mL (1:3 w/ NS) Other: Pediatric: 0.25 0.5 mL diluted w/ 4 mL NS

Isoproterenol (Isuprel) Class: Sympathomimetic Actions: Increases HR; Increases Cardiac contractile force; Causes bronchodilation Indication: Bradycardias refractory to atropine (when transcutaneous pacing is unavailable); severe status asthmaticus Contraindications: Should not be used to increase blood pressure in cardiogenic shock Precautions: Can cause ventricular irritability; can be deactivated by alkaline solutions; Should be used with caution for recent MI; External pacing, if available, should be used instead of isoproterenol Side effects: Tachydysrhythmias; Tremors; Palpitation; Headache Dosage & Route: 1 mg should be placed in 500 mL of D5W and then slowly infused at 2 10 micrograms/min and titrated until the desired rate is obtained or until PVCs occur; Iv Drip Only

Ketamine (Ketalar) Class: Sedative / hypnotic and analgesic Actions: Causes dissociative state Indication: Induction agent for rapid-sequence induction Contraindications: Hypersensitivity; significantly elevated BP Precautions: hallucination can occur w/ emergency, particularly on emergence; Emergency airway and resuscitative equipment and drugs must be available Side effects: Hallucination; Increased skeletal muscle tone Dosage & Route: 0.5 1.0 mg/kg IV; 2.0 4.0 mg/kg IM

Ketorolac Tromethamine (Toradol) Class: NSAID; Antipyretic Actions: Anti-Inflammatory; Analgesic (peripherally acting); Inhibits prostaglandins that cause fever/pain. Indication: Mild to moderate pn Contraindications: Pt w/ history of hypersensitivity; Pt allergic to aspirin Precautions: GI irritation or hemorrhage can occur Side effects: Edema; Rash; Heartburn Dosage & Route: 15 30 mg IV; 30 60 mg IM Other: Works well with kidney stones

Labetalol (Trandate, Normodyne) Class: Class II Antidysrhythmic; Beta blocker Actions: Selectively block Alpha1 receptors and non-selectively blocks Beta receptors Indication: Hypertensive crisis Contraindications: Bronchial asthma; CHF; Heart block; Bradycardia; Cardiogenic shock Precautions: BP, ECG constantly monitored; Atropine should be available Side effects: Bradycardia; Heart block; CHF; Bronchospasm; Postural hypotension Dosage & Route: 20 mg by slow IV infusion over 2min; doses of 40 mg can be repeated in 10 min until desired supine BP is obtained or until 300 mg has be given; 200 mg placed in 500 mL D5W to deliver 2 mg/min

Levalbuterol (Xopenex) Class: Sympathomimetic amine; Bronchodilator Actions: Attaches to Beta2 receptors on bronchial cell membranes to relax bronchial smooth muscle; Inhibits histamine release Indication: To prevent or treat bronchospasm Contraindications: hypersensitivity, use of beta blockers, TCAs, or MAOIs Precautions: Decreases blood digoxin level, increases risk of hypokalemia Side effects: Anxiety, chills, dizziness, hypertonia, insomnia, migraine, nervousness, syncope, tremors, angina, HTN, hypotension, tachycardia, N/V, myalgia, cough Dosage & Route: Inhalation Aerosol 45-90 mcg every 4-6 hrs Other: may cause paradoxical bronchospasm

Lidocaine (Xylocaine) Class: Class IB Antidysrhythmic; Local anesthetic Actions: Suppresses ventricular ectopic activity; Increases V-Fib threshold; Reduces velocity of electrical impulse through conductive system Indication: Malignant PVCs; V-Tach refractory to Amiodarone; V-Fib; Prophylaxis of dysrhythmias associated w/ fibrinolytic therapy Contraindications: High-degree heart block; PVCs in conjunction w/ bradycardia Precautions: dosage should not exceed 300 mg/hr; Monitor for central nervous system toxicity; Dosage should be reduced by 50 in pt older than 70yo or have liver disease Side effects: Anxiety; Drowsiness; Dizziness; Confusion; N/V; Convulsions; Widening QRS complex Dosage & Route: Bolus: 1.0-1.5 mg/kg; additional of 0.5-0.75 mg/kg repeated 3-5 min intervals until the dysrhythmia suppressed or until 3.0 mg/kg has been given; reduce by 50% in pt older than 70 yo.

Lisinopril ( Prinivil, Zestril) Class: Antihypertensive; Vasodilator Actions: Reduce blood pressure by affecting RAAS Indication: Manage HTN, Treat heart failure Contraindications: hypersensitivity Precautions: Drug interactions Side effects: Ataxia, confusion, depression, dizziness, fatigue, headache, mood swings, stroke, syncope, TIA, vertigo, arrhythmias, angina, hypotension, MI, hyperglycemia, abd pn, diarrhea, hepatitis, N/V, renal failure, impotence, spasms, myalgia, bronchospasm, dyspnea, cough, rash Dosage & Route: PO Initial 5-10 mg daily, maintenance 20-40 mg, max. 80 mg daily

Lorazepam (Ativan) Actions: Anti-convulsant; Sedative Indication: Major motor SZ; Status epilepticus; Pre-medication before cardioversion; acute anxiety states Contraindications: Hypersensitivity Precautions: has short duration of effect; Do not mix w/ other drugs because of possible precipitation problems; Flumazenil (Romazicon) should be available; Dilute w/ NS of D5W prior to IV admin Side effects: Drowsiness; Hypotension; Respiratory depression and apnea Dosage & Route: 0.5 2.0 mg IV; May be increased to 1.0 4.0 mg IV; IV, IM, Rectal routes Other: Pediatric: 0.05 0.10 mg/kg (max dose of 4 mg)

Magnesium Sulfate Class: Anticonvulsant and Antidysrhythmic (Electrolyte Stabilizer) Actions: CNS depressant; Anticonvulsant; Antidysrhythmic Indication: Obstetrical: Eclampsia; Cardiovascular: Severe refractory V-Fib or Pulseless V-Tach, Post MI as prophylaxis for dysrhythmias, and Torsade de Pointes (TdP multiaxial (polymorphic) V-Tach) Contraindications: Shock; Heart block; Precautions: Caution in pt receiving digitalis; hypotension; Calcium Chloride should be readily available as an antidote if respiratory depression ensues; caution in pt w/ renal failure Side effects: Flushing; Respiratory depression; Drowsiness Dosage & Route: 1 4 g IV, IM Other: antidote = Calcium Chloride

Mannitol (Osmotrol) Class: Osmotic diuretic Actions: decreases cellular edema; Increases urinary output Indication: Acute cerebral edema; Blood transfusion reaction Contraindications: Pulmonary edema; Pt who are dehydrated Precautions: Rapid admin can cause circulatory overload; Crystallization of the drug can occur at lower temp; An inline filter should be used Side effects: Pulmonary congestion; Sodium depletion; Transient volume overload Dosage & Route: 1.5 2.0 g/kg IV slow bolus or infusion

Meperidine (Demerol) Class: Narcotic (Opioid) Actions: CNS depressant; Decreases sensitivity to pn Indication: Moderate to severe pn Contraindications: Pt receiving monoamine oxidase inhibitor; Undiagnosed abd pn; pt w/ Hx of hypersensitivity to drug Precautions: Respiratory depression; Hypotension Side effects: Dizziness; AMS; Nausea/Vomiting; Euphoria/Dysphoria Dosage & Route: 25 50 mg IV; 50 100 mg IM; Pediatric: 1 mg/kg Other: Naloxone is antagonist; Used with antiemetic Promethazine

Metaproterenol (Alupent) Class: Sympathominmetic (Beta2 selective) Actions: Bronchodilation; Increases heart rate Indication: Bronchial asthma; Reversible bronchospasm associated w/ chronic bronchitis and emphysema Contraindications: Pt w/ cardiac dysrhythmias or significant tachycardia Precautions: BP, P, ECG constantly monitored; Occasional N/V reported Side effects: palpitations; Anxiety; Headache; N/V Dizziness; Tremor Dosage & Route: Small-volume nebulizer: 0.2 0.3 mL diluted in 2 3 mL NS admin over 5 15 min

Metaraminol (Aramine) Class: Sympathomimetic (indirect acting) Actions: Causes release of endogenous stores of norepinephrine; Increases cardiac contractile force; Increases cardiac rate; Causes peripheral vasoconstriction Indication: Hemodynamically significant hypotension not due to hypovolemia Contraindications: Hypotensive states due to hypovolemia Precautions: Constant monitoring of BP is essential; Not effective in catecholamine-depleted pt Side effects: Palpitations; Tachycardia; PVCs; HTN; Tremor; Dizziness Dosage & Route: 200 mg should be placed in 500 mL of D5W; this gives a concentration of 0.4 mg/mL, which should be slowly infused and titrated to BP response; 5 10 mg can be admin IM when an IV cannot be placed

Methylprednisone (Solu Medrol) Class: Steroid Actions: Anti-inflammatory; Suppresses immune response Indication: Severe anaphylaxis; Asthma and COPD Contraindications: None in emergency setting Precautions: Must be reconstituted and used promptly; Onset of action may be 2 6 hr Side effects: GI bleeding; Prolonged wound healing; Suppression of natural steroids Dosage & Route: 125 250 mg IV, IM

Metoclopramide (Reglan) Class: Phenothiazine antiemetic Actions: Antiemetic; Reduces gastroesophageal reflux Indication: N/V; Gastroesophageal reflux Contraindications: GI hemorrhage; Bowel obstruction or perforation; Pt w/ Hx of hypersensitivity to Rx Precautions: Extrapyramidal (dystonic) symptoms have been reported Side effects: May impair mental and physical ability; Drowsiness Dosage & Route: 10 20 mg IM; 10 mg by slow IV push over 1 2 min

Metoprolol (Lopressor) Class: Sympathetic blocker (beta 2 selective) Actions: selectively blocks beta 2 adrenergic receptors (cardioprotective) Indication: suspected or definite acute MI in pt who are hemodynamically stable Contraindications: HR less than 45; Systolic blood pressure <100 mmHg; Heart block; shock; Hx of asthma Precautions: BP, P, ECG constantly monitored; Atropine and transcutaneous pacing should be available Side effects: bradycardia; Heart block; CHF; depression; Bronchospasm Dosage & Route: Initial bolus of 5 mg slow IV; May repeat 5 mg bolus in 5 min if vitals are stable; May repeat 5 mg bolus in 10 min if vitals are stable

Midazolam (Versed) Class: Tranquilizer (benzodiazepine) Actions: Hypnotic; Sedative Indication: Premedication before cardioversion; acute anxiety states Contraindications: Pt w/ hypersensitivity; Narrow-angle glaucoma; Shock Precautions: Resuscitative equip at hand; Flumazenil (Romazicon) available; Dilute w/ D5W prior to IV; Respiratory depression more common with midazolam than other benzodiazepines Side effects: Drowsiness; Hypotension; Amnesia; Respiratory depression and apnea Dosage & Route: 1.0 2.5 mg IV; IV, Oral, Intranasal Other: Pediatric: 0.03 mg/kg

Milrinone (Primacor) Class: Bipyridine derivative; Inotropic; Vasodilator Actions: Increases force of contraction and cardiac output by blocking the enzyme phosphodiesterase. Indication: To provide short-term Tx of acute heart failure Contraindications: Hypersensitivity Precautions: Drug Interactions; Do not administer through same line as Furosemide to prevent precipitation Side effects: Headache, tremors, angina, hypotension, SVT, TdP, bronchospasm, rash, anaphylaxis, rash Dosage & Route: IV Loading: 50 mcg/kg over 10 min, dosage adjusted to clinical response

Morphine Sulfate (Duramorph) Class: Narcotic (Opioid) Actions: CNS depressant, Peripheral vasodilation; Decrease sensitivity to pn Indication: Severe pn; Pulmonary edema Contraindications: Head injury; Volume depletion; Undiagnosed abd pn; Hypersensitivity Precautions: Apnea (or Respiratory depression); Hypotension; Nausea Side effects: Dizziness; Tachycardia (or Bradycardia), Altered LOC Dosage & Route: 2 10 mg IV, 2 mg every few min until pn relieved or respiratory depression; 5 15 mg IM based on pt weight. Other: Naloxone is antagonist

Nalbuphine (Nubain) Class: Synthetic analgesic Actions: CNS depressant; Decreases sensitivity to pn Indication: Moderate to severe pn Contraindications: Hypersensitivity Precautions: pt w/ impaired respiratory function; Respiratory depression; Pt dependent on narcotics may experience S/S of withdrawal; Nausea Side effects: Dizziness; AMS Dosage & Route: 5 10 mg IV, IM

Nalmefene (Revex) Class: Synthetic opiate antagonist Actions: reverses the effects of opioid medications, also called narcotics. Indication: Treatment for narcotic overdose Contraindications: Hypersensitivity Precautions: use in patients physically dependent on opioids can result in precipitated withdrawal reactions that may result in symptoms that require medical attention. Side effects: dysphoria, headache, HTN, hypotension, tachycardia, vasodilation, abdominal cramps, nausea, joint pain, myalgia, chills, fever, postoperative pain. Dosage & Route: IV 0.25 mcg/kg followed by incremental doses of 0.25 mcg/kg q 25 min (up to a total dose of 1 mcg/kg)

Naloxone Hydrochloride (Narcan) Class: Opiate antagonist Actions: Reverses effects of narcotics (opiates) Indication: Narcotic OD: morphine, Dilaudid, fentanyl, Demerol, paregoric, methadone, heroin, Percodan, Tylox; Synthetic analgesic OD: Nubain, Stadol, Talwin, Darvon, alcoholic coma Contraindications: Hypersensitivity Precautions: May cause withdrawal effects in pt dependent on narcotics Side effects: N/V; Chills Dosage & Route: 0.4 2 mg IV, IM, ETT (2 2.5 times IV dose)

Nifedipine (Procardia) Class: Calcium channel blocker Actions: Relaxes smooth muscle, causing arteriolar vasodilation; decreases peripheral vascular resistance Indication: severe HTN; angina pectoris Contraindications: Pt w/ known hypersensitivity; hypotension Precautions: B/P should be monitored; may worsen CHF; Nifedipine should not be admin to pt receiving IV Beta blockers Side effects: Dizziness; Flushing; Nausea; Headache; Weakness Dosage & Route: 10 mg PO

Nitroglycerin Paste Class: Nitrate; antianginal; antihypertensive; vasodilator Actions: Interacts with nitrate receptors in vascular smooth-muscle cell membranes, reducing nitroglycerin to Nitric Oxide, which activates the enzyme guanylate cyclase, increasing intracellular formation of cGMP, relaxing vascular smooth-muscle, causing vasodilation. Indication: To prevent or treat angina; Manage HTN or heart failure Contraindications: Erectile dysfunction drugs; Acute MI, glaucoma, cerebral hemorrhage, head trauma, hypersensitivity to nitrates Precautions: Drug interactions Side effects: Agitation, anxiety, dizziness, headache, syncope, insomnia, weakness, arrhythmias, hypotension, blurred vision, abd pn, diarrhea, N/V, impotence, bronchitis. Dosage & Route: 15-30 mg every 8 hrs. , max. 75 mg.

Nitroglycerin (Nitrostat) Class: Anti-anginal Actions: Smooth muscle relaxant; Reduces cardiac work; Dilates coronary and systemic arteries Indication: Angina pectoris; Chest pn associated with MI Contraindications: children younger than 12 yo; Hypotension; Pt on erectile dysfunction Rx Precautions: Constantly monitor B/P; Syncope; protect from light; expires quickly Side effects: Headache; Dizziness; Hypotension Dosage & Route: One tablet repeated @ 3 - 5 min intervals up to 3 times sublingual Other: Have IV fluid ready

Nitrous Oxide (Nitronox, Entonox) Class: Gas Actions: CNS depressant Indication: Pn of musculoskeletal origin, particularly fx; Burns; suspected ischemic chest pn; States of severe anxiety including hyperventilation Contraindications: Alt LOC; Intoxication; Head-injury; COPD; increased oxy concentration my cause respiratory depression; thoracic injury suspicious of pneumothorax; Abd pn and distension suggestive of bowel obstruction Precautions: Use only in well-ventilated area; gas scavenging system is recommended; May not operate properly at low temps Side effects: headache; dizziness; giddiness; N/V Dosage & Route: Self-admin only using fixed 50% Nitrous oxide and 50% Oxy blender by inhalation only Other: Pediatric: Self-administered only

Norepineprine (Levophed) Class: sympathomimetic Actions: Causes peripheral vasoconstriction Indication: hypotension (systolic blood pressure < 70 mmHg refractory to other sympathomimetics); Neurogenic shock Contraindications: Hypotensive states due to hypovolemia Precautions: can be deactivated by alkaline solution; Constant monitoring of BP essential; Extravasation can cause tissue necrosis Side effects: Anxiety; Palpitation; Headache; HTN Dosage & Route: 0.5 30 mcg/min; Method: 8 mg should be placed in 500 mL of D5W, giving concentration of 16 mcg/mL; IV drip only

Ondansetron (Zofran) Class: Antiemetic Actions: Blocks serotonin receptors at vagal nerve terminals in the intestine to prevent nausea/vomiting Indication: To prevent nausea/vomiting Contraindications: Hypersensitivity Precautions: Do not use with alcohol Side effects: agitation, anxiety, ataxia, dizziness, drowsiness, fever, headache, hypotension, restlessness, seizures, syncope, somnolence, weakness, arrhythmias, CP, hypotension, embolism, shock, tachycardia, blurred vision, dry mouth, abd pn, constipation/diarrhea, bronchospasm, rash, anaphylaxis Dosage & Route: PO 4-8 mg every 8-12 hrs.; IV/IM 4mg

Oral Glucose (Insta-glucose) Class: Saccharide Actions: Absorbed into blood stream to deliver vital sugars needed for cellular metabolism Indication: hypoglycemia; conscious pt w/ altered mental status & hx of diabetes Contraindications: unconscious pt; no gag reflex Precautions: None Side effects: None Dosage & Route: PO 24 g per tube.

Oxygen Class: Gas Actions: Necessary for cellular metabolism Indication: Hypoxia Contraindications: None Precautions: Use cautiously in pt w/ COPD; Humidify when providing high-flow rates Side effects: Drying of mucous membranes Dosage & Route: Cardiac Arrest: 100%; Other critical pt: 100%; COPD: 35% Other: Pediatric: 24 100 % PRN

Oxymetazoline nasal (Afrin) Class: decongestant Actions: constricts blood vessels in nasal tissues leading to sinus drainage Indication: used to treat congestion associated with allergies, hay fever, and cold Contraindications: MAOI use, dysrhythmia, glaucoma, diabetes, thyroid problems Precautions: unknown teratogenic effects, do not use if liver or kidney disease Side effects: anaphylaxis, seizures, hallucinations, dysrhythmia, Fatigue, coma Dosage & Route: intranasal as directed by label or physician

Oxytocin (Pitocin) Class: Hormone (oxytocic) Actions: Causes uterine contraction; Causes lactation; Slows postpartum vaginal bleeding Indication: Postpartum vaginal bleeding Contraindications: Any condition other than postpartum bleeding; Cesarean section Precautions: essential to ensure that the placenta has delivered and that there is not another fetus before administering oxytocin; HTN Side effects: Anaphylaxis; Cardiac dysrhythmia Dosage & Route: 10 20 units in 500 mL of D5W admin according to uterine response IV; 3 10 units IM

Pancuronium Bromide (Pavulon) Class: Neuromuscular-blocking agent (nondepolarizing) Actions: Skeletal muscle relaxant; Paralyzes skeletal muscles including respiratory muscles Indication: To achieve paralysis to facilitate endotracheal intubation Contraindications: Pt w/ known hypersensitivity Precautions: Should not be admin unless person skilled in ETT intubation are present; ETT intubation equipment must have available; Oxygen equipment and emergency resuscitative drugs must be available; Paralysis occurs within 3 5 min and last for approximately 60 min Side effects: prolonged paralysis; Hypotension; Bradycardia Dosage & Route: 0.04 0.1 mg/kg; repeat doses of 0.01 0.02 mg/kg intravenously as required every 20 40 min IV

Phenobarbitol (Luminal) Class: Barbiturate Actions: Suppresses spread of seizure activity through the motor cortex; CNS depressant Indication: Major motor SZ; Status epilepticus; Acute anxiety states Contraindications: Hx of hypersensitivity Precautions: Respiratory depression; Hypotension; Can cause hyperactivity in children; Extravasation may cause tissue necrosis Side effects: Drowsiness; Children my become hyperactive Dosage & Route: 100 250 mg slow IV / IM

Phenylephrine (Neo-Synephrine) Class: alpha adrenergic agonist; vasopressor Actions: shrinks blood vessels in the nasal passages to relieve congestion Indication: treat nasal and sinus congestion, or congestion of the tubes that drain fluid from your inner ears, called the eustachian tubes Contraindications: Hypersensitivity; MAOI use Precautions: heart disease, high blood pressure, diabetes, or thyroid disorder. Side effects: anaphylaxis, arrhythmias, dizziness, anxiety, loss of appetite; warmth, tingling, or redness under your skin; feeling restless or excited (especially in children); sleep problems (insomnia); skin rash Dosage & Route: IM or subcutaneous: 2 to 5 mg every 1 to 2 hours as needed. IV bolus: 0.2 mg/dose (range: 0.1 to 0.5 mg/dose) every 10 to 15 minutes as needed (initial dose should not exceed 0.5 mg) IV infusion: 100 to 180 mcg/min initially. The usual maintenance dose is 40 to 60 mcg/min

Phenytoin (Dilantin) Class: Anticonvulsant and antidysrhythmic Actions: Inhibits spread of SZ activity through motor cortex; Antidysrhythmic Indication: Status epilepticus; dysrhythmias due to digitalis toxicity Contraindications: any dysrhythmia except those due to digitalis toxicity; High-grade heart blocks; Pt w/ Hx of hypersensitivity Precautions: Should not be admin w/ glucose solutions; Hypotension; ECG monitory during admin Side effects: Local venous irritation; Itching; CNS depression Dosage & Route: Status epilepticus: 150 250 mg (10 15 mg/kg) not to exceed 50 mg/min; digitalis toxicity: 100 mg over 5 min until the dysrhythmia is suppressed or until a max dose of 1000mg has been admin or symptoms of CNS depression occur; IV (dilute w/ NS) Other: Pediatric: Status epilepticus: 8 10 mg/kg IV; digitalis toxicity 3 5 mg/kg IV over 100 min

Physotigmine (Antilirium) Class: Cholinesterase inhibitor Actions: Inhibits cholinesterase; Potentiates acetylcholine Indication: Tricyclic antidepressant overdoses (Elavil, Tofranil, Triavil, Norpramin); Atropine (belladonna) overdose Contraindications: Asthma and COPD; Gangrene; Diabetes; Cardiovascular disease Precautions: Monitor for bronchospasm and laryngospasm; SZ Side effects: Excessive salivation; Bradycardia; Emesis Dosage & Route: 0.5 2.0 mg IV

Pralidoxime (2-Pam, Protopam) Class: Cholinesterase reactivator Actions: Reactivates cholinesterase in cases of organophosphate poisoning; Deactivates certain organophosphates by direct chemical reaction Indication: severe organophosphate poisoning as characterized by muscle twitching, respiratory depression, and paralysis Contraindications: Poisonings due to inorganic phosphates; Poisoning other than organophosphates Precautions: Always ensure safety and protection of rescue personnel; Laryngospasm, tachycardia, and muscle rigidity have occurred following rapid admin; should only follow atropinization Side effects: Excitement; Manic behavior Dosage & Route: 1 2 g in 250 500 mL of NS infused over 30 min

Prednisone Class: Glucocorticoid; anti-inflammatory; immunosuppresant Actions: Binds to intracellular glucocorticoid receptors and suppresses inflammatory and immune responses by inhibiting neutrophil and monocyte accumulation Indication: To treat adrenal insufficiency and immunosuppressive disorders Contraindications: Hypersensitivity; systemic fungal infection Precautions: Drug Interactions Side effects: Euphoria, headache, insomnia, nervousness, psychosis, restlessness, seizures, vertigo, edema, heart failure, HTN, cataracts, glaucoma, adrenal insufficiency, growth suppression, hyperglycemia, anorexia, GI Bleeding, increased appetite, indigestion, N/V, joint necrosis, bone fractures, myalgia, weakness, acne, thin skin, delayed wound healing Dosage & Route: PO 5-250 mg daily

Procainamide (Pronestyl) Class: Class IA Antidysrhythmic Actions: slow conduction through myocardium; Elevates ventricular fibrillation threshold; suppresses ventricular ectopic activity Indication: Persistent cardiac arrest due to V Fib and V Tach refractory to Lidocaine. Contraindications: High-degree heart block; PVCs in conjunction w/ bradycardia Precautions: Dosage should not exceed 17 mg/kg; Monitor for CNS toxicity Side effects: Anxiety; Nausea; Convulsion; Widening of QRS complex Dosage & Route: Initial 20 mg/min until dysrhythmia is abolished, hypotension ensues, QRS complex is widened by 50% of original width, or total of 1.7 mg/kg has been given; Maintenance: 1 4 mg/min

Prochlorperazine (Compazine) Class: Phenothiazine; antianxiety; antiemetic; antipsychotic Actions: Alleviates psychotic symptoms by blocking dopamine receptors, depressing release of selected hormones, and blocking alpha-adrenergic signals in the brain. Indication: To control N/V; To manage psychotic disorders; To treat anxiety Contraindications: < 2 yrs old, CAD, hepatic dysfunction, hypersensitivity, HTN, CNS depression, subcortical brain damage Precautions: Drug Interactions; Not for Tx of dementia (Increases mortality) Side effects: Akathisia, altered temperature regulation, dizziness, drowsiness, EPS, hypotension, tachycardia, blurred vision, dry mouth, gynecomastia, constipation, N/V, dysuria, photosensitivity, rash, weight gain Dosage & Route: IV/IM 5-10 mg every 4 hrs, max. 40 mg daily; PO 5-40 mg daily

Promethazine (Phenergan) Class: Phenothiazine antihistamine (H1 antagonist) Actions: Mild anticholinergic activity; antiemetic; Potentiates actions of analgesics Indication: N/V; Motion sickness; to potentiate the effects of analgesics; Sedation Contraindications: Comatose states; Pt who have received a lg amount of depressants (including alcohol) Precautions: Avoid accidental intra-arterial injection Side effects: May impair mental and physical ability; Drowsiness Dosage & Route: 12.5 25.0 mg IV, IM

Propranolol (Inderal) Class: Sympathetic blocker Actions: Nonselectively block beta adrenergic receptors Indication: Ventricular tachydysrhythmias refractory to lidocaine and bretylium; Recurrent ventricular fibrillation refractory to lidocaine and bretylium; Tachydysrhythmias due to digitalis toxicity Contraindications: Comatose states; Patients who have received a large amount of depressants (including alcohol) Precautions: Avoid accidental intra-arterial injection Side effects: May impair mental and physical ability; Drowsiness Dosage & Route: 12.5 25.0 mg IV,IM

Racemic Epinephrine (MicroNEFRIN) Class: Sympathomimetic Actions: Bronchodilation; Increases heart rate; Increases cardiac contractile force Indication: Croup (laryngotracheobronchitis) Contraindications: Epiglottitis; Hypersensitivity to drug Precautions: Vital signs should be constantly monitored; Should be used only once in the prehospital setting Side effects: Palpitation; Anxiety; Headache Dosage & Route: 0.25 0.75 mL of a 2.25 percent solution in 2.0 Ml NS; Inhalation only (small-volume nebulizer)

Reteplase, Recombinant (Retevase) Class: Tissue Plasminogen Activator Actions: Aids in dissolution of blood clots. Indication: Management of acute MI, to reduce incidence of CHF and mortality associated with an acute MI. Contraindications: Active internal bleeding; history of cerebrovascular accident; recent intracranial or intraspinal surgery or trauma; intracranial neoplasm, arteriovenous malformation or aneurysm; bleeding diathesis or severe uncontrolled hypertension Precautions: Drug interactions: Abciximab, aspirin, dipyridamole, heparin, vitamin K antagonists Side effects: Bleeding Dosage & Route: IV 10 + 10 unit double-bolus injection, each bolus given over 2 min. Second bolus given 30min after.

Rocuronium (Zemuron) Class: Neuromuscular blocking (paralyzing) agent Actions: produces neuromuscular blockade by competing with acetylcholine for cholinergic receptors at the motor end plate Indication: an adjunct to general anesthesia to facilitate rapid-sequence or routine tracheal intubation and to induce skeletal muscle relaxation during surgery or mechanical ventilation Contraindications: Hypersensitivity; Neuromuscular diseases, such as myasthenia gravis or myasthenic syndrome; Burns; Pulmonary hypertension or valvular heart disease Side effects: HTN, hypotension, arrhythmia, bronchospasm, pruritus, rhonchi, skin rash, swelling at injection site, tachycardia, wheezing Dosage & Route: IV 0.61.2 mg per kg of body weight

Sodium Bicarbonate Class: Alkalinizing agent Actions: Combines w/ excessive acids to form a weak volatile acid; Increases pH Indication: Late in the management of cardiac arrest, if at all; Tricyclic antidepressant overdose; Severe acidosis refractory to hyperventilation Contraindications: Alkalotic states Precautions: Correct dosage is essential o avoid overcompensation of pH; Can deactivate catecholamines; Can precipitate with calcium; delivers large sodium load Side effects: Alkalosis Dosage & Route: 1 mEq/kq IV initially followed by 0.5 mEq/kg every 10 min as indicated by blood gas studies Other: 1 mEq/kg initially followed by 0.5 mEq/kg every 10 min

Sodium Nitroprusside (Nipride, Nitropress) Class: Potent vasodilator Actions: Peripheral arterial and venous vasodilator; decreases blood pressure; Increases cardiac output in CHF Indication: Hypertensive emergency Contraindications: None when used in the management of life-threatening emergencies Precautions: Bottle must be wrapped in foil to protect from light; Should not be admin to children or pregnant women in the prehospital setting; Reduce the dosage in elderly patients; BP, P, ECG diligently monitored Side effects: N/V; Retching; Palpitation; Diaphoresis; Tachycardia; Dizziness: Side effects often diminish as dosage is reduced Dosage & Route: 0.5 mg/kg/min IV infusion only

Succinylcholine (Anectine) Class: Neuromuscular blocking agent (depolarizing) Actions: Skeletal muscle relaxant; Paralyzes skeletal muscles, including respiratory muscles Indication: To achieve paralysis to facilitate endotracheal intubation Contraindications: Patients w/ known hypersensitivity to drug Precautions: Should not be administered unless persons skilled in endotracheal intubation are present; Oxygen equipment and emergency resuscitative drugs must be available Side effects: Prolonged paralysis; Hypotension; Bradycardia Dosage & Route: 1 1.5 mg/kg (40 -100 mg in an adult) IV

Tenecteplase (TNKase) Class: Purified glycoprotein; Thrombolytic Actions: Binds fibrin and converts plasminogen to plasmin, which breaks down fibrin, resulting in dissolution of coronary artery thrombus Indication: Acute MI secondary to thrombus Contraindications: Active internal bleeding, aneurysm, brain tumor, CVA, hypersensitivity, severe HTN Precautions: Drug Interactions Side effects: Intracranial hemorrhage, epistaxis, GI Bleed, Hematoma Dosage & Route: IV 30-50 mg, based on weight

Terbutaline (Brethine) Class: Sympathomimetic Actions: Bronchodilator; Increases heart rate Indication: Bronchial asthma; Reversible bronchospasm associated w/ COPD; Preterm labor Contraindications: Patients w/ known hypersensitivity to the drug Precautions: BP, P, ECG results must be constantly monitored Side effects: Palpitations; Tachycardia; PVC; Anxiety; Tremors; Headache Dosage & Route: Metered-dose inhaler: two inhalation, 1 min apart; Subcutaneous injection: 0.25 mg; may be repeated in 15 30 min; Inhalation, subcutaneous injection, IV drip (in preterm labor)

Tetracaine (Pontocaine, Viractin, Dermocaine) Class: anesthetic Actions: works by blocking nerve signals in your body. Indication: to numb the skin or surfaces inside the mouth, nose, and throat to lessen the pain of inserting a medical instrument such as a tube or scope. Contraindications: Hypersensitivity Precautions: overdose of numbing medications can cause fatal side effects if too much of the medicine is absorbed through your skin and into your blood Side effects: anaphylaxis, arrhythmias, dizziness Dosage & Route: Topically: as directed on the label, or as it has been prescribed by your doctor.

Thiamine (Vitamin B1) Class: Vitamin Actions: Allows normal breakdown of glucose Indication: Coma of unknown origin; Alcoholism; Delirium tremens Contraindications: None in the emergency setting Precautions: Rare anaphylactic reactions have been reported; Should not be used as part of a coma cocktail Side effects: Rare, if any Dosage & Route: 100 mg IV, IM

Tirofiban (Aggrastat) Class: Tyrosine derivative; Platelet aggregation inhibitor Actions: Binds to glycoprotein IIb/IIIa receptor sites on the surface of activated platelets, preventing the normal binding of fibrinogen, inhibiting platelet aggregation. Indication: Treat acute coronary syndrome Contraindications: Acute pericarditis, recent stroke, GI bleed, hypersensitivity, aneurysm Precautions: Drug Interactions Side effects: Chills, dizziness, fever, headache, CVA, edema, bradycardia, hematuria, N/V, pulmonary hemorrhage, rash, anaphylaxis Dosage & Route: IV 0.4 mcg/kg/min for 30 min., followed by 0.1 mcg/kg/min

Vasopressin Class: Hormone, vasoconstrictor Actions: Antidiuretic hormone; Potent vasoconstrictor Indication: Cardiac arrest Contraindications: None in emergency setting Precautions: Few in emergency setting Side effects: Blanching of skin; HTN; Bradycardia Dosage & Route: 40 units IV (single dose only)

Vecuronium (Norcuron) Class: Neuromuscular-blocking agent (nondepolarizing) Actions: Skeletal muscle relaxant; Paralyzes skeletal muscles including respiratory muscles Indication: To achieve paralysis to facilitate endotracheal intubation Contraindications: Pt w/ known Hypersensitivity Precautions: Should not be administered unless persons skilled in endotracheal intubation are present; Endotracheal intubation equipment must be available; Oxygen equipment and emergency resuscitative drugs must be available; Paralysis occurs within 1 min and lasts for approximately 30 min Side effects: Prolonged paralysis; Hypotension; Bradycardia Dosage & Route: 0.08 0.1 mg/kg IV Other: Pediatric: 0.1 mg/kg

Verapamil (Isoptin, Calan) Class: [Prototype] Calcium channel blocker (Class IV Antidysrhythmic) Actions: Slows conduction through the atrioventricular node; Inhibits reentry during paroxysmal supraventricular tachycardia (PSVT); Decreases rate of ventricular response; Decreases myocardial oxygen demand Indication: PSVT Contraindications: Heart block; Conduction system disturbances Precautions: NOT for patient receiving intravenous beta blockers; hypotension Side effects: N/V; hypotension; Dizziness Dosage & Route: 2.5 5 mg; a repeat dose of 5 -10 mg can admin after 15 30 min if PSVT does not convert; max dose is 30 mg in 30 min; IV Other: Pediatric: 0 1 yr: 0.1 0.2 mg/kg (max of 2.0 mg) administered slowly; 1 15 yo: 0.1 0.3 mg/kg (max of 5.0 mg) administered slowly

Ziprasidone (Geodon) Class: Antipsychotic Actions: Selectively blocks serotonin and dopamine receptors in the mesocortical tract of the CNS, suppressing psychotic symptoms Indication: Treat schizophrenia or bipolar disorder Contraindications: hypersensitivity, recent acute MI Precautions: Drug Interactions Side effects: agitation, akathisia, amnesia, anxiety, asthenia, CVA, depression, dizziness, EPS, headache, insomnia, mania, speech disorders, syncope, suicidal ideation, tremors, bradycardia, CP, HTN, prolonged QT interval, tachycardia, hypotension, blurred vision, N/V, abd pn, priapism, incontinence, back pn, cough, embolism, rash, angioedema Dosage & Route: PO 20-100 mg daily