Drug Generic (Trade) adenosine (Adenocard)

Class antidysrhythmic

Indications stable PSVT, monomorphic VT, SVT

Adult Dosage/Route initial dose: 6 mg rapid IV push give over 1-2 seconds (may repeat 2 more times) repeat dose: 12 mg rapid IV push give over 1-2 seconds, repeat dose: 12 mg rapid IV push give over 1-2 seconds,

Pediatric Dose initial dose: 0.1 mg/kg rapid IV push (max 6mg) give over 1-2 seconds (may repeat 2 more times) repeat dose: 0.2 mg/kg IV push (max 12mg) give over 1-2 seconds, repeat dose: 0.2 mg/kg IV push (max 12mg) give over 12 seconds

albuterol 0.5% (Proventil, beta 2 adrenergic, Ventolin) bronchodilator

bronchospasm, asthma, reactive airway disease

2.5 mg/3cc saline via nebulizer

amiodarone (Cordarone) antiarrhythmic

cardiac arrest VF/ pulseless VT, VT with a pulse

0.15 mg/kg/3cc saline, up to 2.5 mg (2b protocol states for patients <1 year old 1.5 mg/3cc NS, for patients >1 year old 2.5 mg/3cc NS VF/VT arrest: 300 mg IV, may repeat 150 mg VF/VT arrest: 5 mg/kg IV once, IV after 3-5 minutes (max 2.2 grams in 24), VT max single dose 300 mg w/ pulse: 150mg slowly over 10 minutes administer vapors from crushed ampule for 30 administer vapors from crushed seconds, then administer oxygen 30 seconds, ampule for 30 seconds, then repeat continuously administer oxygen 30 seconds, repeat continuously

amyl nitrite

antidote

cyanide poisoning

aspirin (ASA)

NSAID analgesic, platelet inhibitor anticholinergic, parasympatholytic, antidote

chest pain suggestive of AMI

160 - 325 mg PO chewed

not indicated

atropine

symptomatic bradycardia, organophosphate or bradycardia 0.5 mg IV every 3 - 5 minutes, carbamate insecticide poisoning, premedication for(max 0.04 mg/kg or 3 mg), organophosphate RSI in children <10 years of age poisoning 2 - 5 mg IV until resolution of symptoms coma, hypoglycemia 1 gm/kg IV up to 25 grams, may repeat if glucose is <60 mg/dl (25 - 50 grams)

pediatric RSI dose: 0.02 mg/kg IV, minimum of 0.1 mg IV

dextrose 50%

carbohydrate

dextrose 25%

carbohydrate

coma, hypoglycemia

D50: 1-2 cc/kg , D25: 2-4cc/kg, D10: 5-10cc/kg

diazepam (Valium)

benzodiazepine, status epilepticus, sedation anticonvulsant, sedative

Status epilepticus 5 - 10 mg slow IV, Sedation 0.1 mg/kg IV up to 5mg every 25 - 15 mg slow IV 5 minutes, 0.2 mg/kg IN up to 10 mg every 2-5 minutes, 0.5 mg per rectum

diltiazem (Cardizem)

calcium channel blocker PSVT, rapid atrial fibrillation, atrial flutter (for rate 0.25 mg/kg IV slowly over 2 minutes (max 20 0.25 mg/kg IV slowly over 2 control) mg), if no affect in 15 mins., 0.35 mg/kg IV minutes (max 20 mg), if no slowly over 2 minutes (max 25 mg) affect in 15 mins., 0.35 mg/kg IV slowly over 2 minutes (max 25 mg), contact medical control prior to administration antihistamine, antidote allergies, anaphylaxis, acute dystonic reactions/ extrapyramidal symptoms - EPS shock, hypotension, bradycardia 25 - 50 mg IV, deep IM 1-2 mg/kg IV, up to 25 mg, deep IM

diphenhydramine (Benadryl) dopamine (Intropin)

sympathomimetic

2 - 20 mcg/kg/min titrate to effect, Renal dose 5-15 mcg/kg/min IV 2 - 5mcg/kg, Cardiac dose 5 - 10mcg/kg, Pressor dose 10 - 20mcg/kg

epineprine 1:10,000 (Adrenalin)

sympathomimetic

cardiac arrest, allergic reaction, anaphylaxis, severe asthma

1 mg IV every 3 - 5 minutes - arrest; 0.3-0.5 mg for allergic reaction, anaphylaxis, severe asthma 0.3 - 0.5 mg (0.3 - 0.5 mL 1:1,000) IM or SQ

0.01 mg/kg IV

epinephrine 1:1,000 (Adrenalin)

sympathomimetic

allergic reactions, anaphylaxis, severe asthma

0.01 mg/kg (max 0.5 mg) IV

epinephrine drip

sympathomimetic

bradycardia after atropine and (TCP) pacing are ineffective, hypotension after fluid bolus

2-10 mcg/min, Mix 4 mg/500 mL for 8 mcg/mL 0.1-0.2 mcg/kg/min IV concentration

etomidate (Amidate)

sedative, hypnotic

sedation for RSI

0.3 mg/kg IV

0.3 mg/kg IV

fentanyl (Sublimaze)

narcotic analgesic

analgesia, chest pain

0.5-1.0 mcg/kg (50 - 100 mcg) IV, IM slow push, RSI: 2-5 mcg/kg

1-2 mcg/kg IV

furosemide (Lasix)

loop diuretic

CHF, pulmonary edema, edema

0.5-1 mg/kg (20-80 mg) IV slow push

0.5-1 mg/kg IV, IM, usual max: 20 mg

glucagon

hormone

hypoglycemia, beta-blocker overdose

hypoglycemia: 0.05-1 mg IM, calcium channel hypoglycemia: 0.5-0.1mg/kg IM or beta-blocker OD 3-10 mg IV up to 1 mg, Not recommended for calcium channel or betablocker overdose 1-1.5 mg/kg IV (max 3 mg/kg) 1-1.5 mg/kg IVP (max 3 mg/kg)

lidocane (Xylocaine)

antidysrythmic

cardiac arrest, VT w/ pulse, PVC's

lidocane (Xylocaine) Drip antidysrythmic

ROSC if lidocaine used during arrest, PVC's

1-4 mg/min ( 2 grams in 500 mL NS)

contact medical control

lorazepam (Ativan)

benzodiazepine, status epilepticus, anxiety, sedation anticonvulsant, sedative electrolyte cardiac arrest, torsades des pointes, eclampsia, hypomagnesemia analgesia

magnesium Sulfate

2-4 mg slow IV, IM, may repeat in 15 minutes to max dose of 8 mg, for sedation 0.05 mg/kg up to 4 mg IM 1 - 2 gm IV for Torsades, 2 - 4 grams Eclampsia 50 - 100 mg slow IV, IM, SQ

0.05-0.1 mg/kg IV up to 5 mg IV, IM, max dose 0.2 mg/kg 25-50 mg/kg IV, one time, over 10-20 minutes (max 2 gm) 1mg/kg IV, IM, SQ

meperidine (Demerol)

analgesic

midazolam (Versed)

sedative

seizures, sedation

0.1 mg/kg IV up to 5 mg, 0.2 mg/kg IN up to 10 mg

seizure activity: 0.1 mg/kg IV, 0.2 mg/kg IN, max dose 5 mg

morphine

narcotic analgesic

analgesia, pulmonary edema, chest pain

naloxone (Narcan)

competetive opioid antagonist

opiate overdose, coma

2-10 mg IV, IM, SQ (maximum dose is patient 0.1-0.2 mg/kg IV, IM, SQ, specific based on ability to protect airway, maintain respiratory drive and maintain blood pressure) 0.4-2 mg IN, IV, IM every 2-3 minutues 0.01 mg/kg IN, IV, IM, ETT dose: 0.1 mg/kg, max IV 2 mg/dose 0.3-0.4 mg/spray, 0.3-0.4 mg/tablet not indicated

nitroglycerin spray nitroglycerin tablets

vasodialator

angina, CHF, myocardial infarction, pulmonary edema, hypertension

ondansetron (Zofran) oxygen

antinauseant elemental gas

nausea/vomiting

4 mg slow IV, IM

0.1 mg/kg slow IVP, IM same as adult

hypoxia, ischemic chest pain, respiratory distress, Low concentration - 1 - 4 LPM via cannula, suspected carbon monoxide poisoning, traumatic High Concentration - 10 - 15 LPM via injuries, shock nonrereather mask

oxytocin (Pitocin)

hormone

postpartum hemorrhage

10 units IM after placenta delivers

not indicated

promethazine (Phenergan) rocuronium (Zemuron)

antiemetic, phenothiazine

nausea, vomiting, sedation

12.5-50 mg IV, deep IM every 4 hours

non-depolarizing paralytic sodim bicarbonate 8.4% electrolyte, alkalinizer succinylcholine (Anectine) vasopressin (Pitressin) depolarizing neuromuscular blocker vasopressor, hormone

paralysis to facilitate intubation tricyclic antidepressant overdose (TCA), hyperkalemia paralysis to facilitate intubation

0.6 - 1.2 mg/kg IV 1 mEq/kg 1 - 2 mg/kg IV

<2 years old - not indicated, 2 years old 6.25-12.5 mg IV, deep IM 1 mg/kg IV 0.5-1 mEq/kg IV 2 mg/kg IV

VF/VT cardiac arrest, (use in place of 1st or 2nd dose dose of epinephrine 1:10,000) paralysis to facilitate intubation

40 units IV (replaces 1st or 2nd dose of epinephrine in cardiac arrest) 0.1 mg/kg IV (up to 10 mg)

not indicated

vecuronium (Norcuron)

non-depolarizing paralytic

0.1 mg/kg IV

Contraindications (applies to all - sensitivity to drug) 2 or 3 AV block, sinus node disease, i.e. sicksinus syndrome, polymorphic ventricular tachycardia

Side effects CNS: headache, lightheadedness, dizziness, tingling in arms, numbness, apprehension, and blurred vision CV: brief asystole, facial flushing, bradycardia palpitations, chest pressure, hypotension Resp: dyspnea, hyperventilation, shortness of breath, bronchospasm GI: nausea, metallic taste, throat tighness, inform patient of feeling they will feel when adenosine is administered

Notes/Onset/Duration onset immediate, half-life 10-12 seconds, administer into the medication port closest to the IV site followed by rapid flush of 20 mL saline, theophyllines and caffiene may block effects, dipyridamole and carbamazepine may potentiate effects.

tachydysrythmias

CNS: tremors, headache, nervousness, anxiety onset immediate, half-life unknown, effect may CV: palpitations Resp: bronchospasm GI: be decreased in patients on beta blockers. nausea/vomiting

none in prehospital cardiac arrest, cardiogenic shock, bradycardia, 2 or 3 AV block, idioventricular rhythm, sinus node dysfunction, none prehospital

CV: bradycardia, hypotension, vasodilation, AV block, increases. QTc, hepatotoxicity

onset 1-3 minutes, duration/half-life up to 40 days, do not administer with other QT prolonging drugs such as procainamide

CV: hypotension, headache, methemoglobinemia administer as soon as possible after exposure GI: nausea

allergy to ASA, patients with "factor" deficiencies, use caution with asthma, ulcers or other bleeding disorders presence of acute MI, narrow angle glaucoma

intracranial hemorrhage

CV: prolonged bleeding time Resp: onset 35-40 minutes, duration and peak effect bronchospasm, angioedema GI: nausea, vary by patient vomiting, CNS: dilated pupils, headache CV: , tachycardia, use as premedication for RSI in children <10 dry mouth, flushed hot dry skin, years, or before second dose of Succinylcholine tachydysrhythmias, usually does not work in the in adults presence of beta-blocker or calcium channel blocker overdose CNS: hyperglycemia CV: possible hypokalemia, onset immediate, duration is dependent on leve tissue necrosis if extravasation occurs, venous of hypoglycemia, best if given through central irritation at insertion point line or large venous catheter

intracranial hemorrhage

CNS: hyperglycemia CV: possible hypokalemia, onset immediate, duration is dependent on leve tissue necrosis if extravasation occurs, venous of hypoglycemia, may cause hypokalemia irritation at insertion point onset 1-5 min, duration 20-60 minutes

head Injury, decreased BP, acute narrow angle CNS: drowsiness CV: hypotension, venous glaucoma, renal failure - lorazepam, midazolam, irritation Resp: decreased respirations hepatic failure - lorazepam

2 or 3 AV block, hypotension, sick sinus CNS: headache, dizziness, weaknes CV: syndrome, WPW or short PR syndrome with atrial hypotension, bradycardia, flushing, diaphoresis fibrillation or atrial flutter, do not give with oral GI: nausea, vomiting, diltiazem will increase beta blockers, do not give with IV furosemide in serum digoxin levels the same line

onset 2-3 min, duration 1-3 hours, use

use with caution in elderly patients, use caution with asthma patients, acute narrow angle glaucoma hypovolemic shock, pheochromocytoma, tachyarrhythmias, decrease dose for patient's on MAOIs

CNS: dizziness, sedation, blurred vision, onset 15-30 min, peak affect 1 hour, duration anticholinergic affects Resp: thickens bronchial 12 hours secretions CNS: headache CV: tachydysrhythmia, VT, VF, onset 1-4 minutes, peak afffect 5-10 minutes, hypertension, cardiac ishemia/infarct, incresed mix 800 mg/500 mL for 1600 mcg/mL, ensure myocardial oxygen demand, extravasation causes patient is on supplemental oxygen during tissue necrosis GI: nausea, vomiting administration

none in cardiac arrest, tachydysrhtmias

CNS: anxiety CV: peripheral vasoconstriction, onset immediate, duration 5-10 minutes, do not hypertension, tachycardia, arrhythmias, increasedmix with sodium bicarbonate myocardial oxygen consumption

tachydysrhythmias

CNS: anxiety CV:peripheral vasoconstriction, onset immediate, duration 5-10 minutes, do not hypertension, tachycardia, arrhythmias, increasedmix with sodium bicarbonate myocardial oxygen consumption

tachydysrhythmias, hypovolemia

CNS: anxiety CV: peripheral vasoconstriction, onset immediate, duration 5-10 minutes, using hypertension, tachycardia, arrhythmias, increaseda 60 gtts set - 15 gtts/min = 2 mcg/min, 30 myocardial oxygen consumption gtts/min = 4 mcg/min, 45 gtts/min = 6 mcg/min, 60 gtts/min = 8 mcg/min, 75 gtts/min = 10 mcg/min adrenal insufficiency, use caution in septic shock CNS: transient suppression of corticosteroid onset 30-60 seconds, peak 1-3 minutes, production (after repeated doses), sedation CV: duration 4-10 minutes bradycardia, hypotension Resp: apnea GI: nausea, vomiting MAOI use, asthma, myasthenia gravis CNS: confusion, sedation, headache CV: onset 1-2 minutes, peak 3-5 minutes, duration hypotension, bradycardia Resp: apnea, GI: 20-60 minutes, decrease doses with elderly nausea, vomiting Side effects in pediatrics: chest patients wall rigidity CNS: tinnitus, dizziness CV: hypokalemia, onset 5 minutes, peak effect 20-60 minutes, hypovolemia, hepatic coma duration 2 hours IV, administer through separate IV line than other medications if possible GI: nausea, vomiting onset 5-10 minutes IM, peak effect within 30 minutes, duration 1-2 hours, depletes storage of glycogen patient may become hypoglycemic again if patient does not eat or receive glucose CNS: slurred speech, altered mental status CV: onset 30-90 seconds IV, 10-20 minutes bradycardia duration

hypokalemia, hypovolemia, hepatic coma, hypersensitivity to sulfonamides, anuria

pheocromocytoma

2nd or 3rd degree AV block, wide complex ventricular escape beats with bradycardia, use caution in patients with liver disease or renal disease 2nd or 3rd degree AV block, wide complex ventricular escape beats with bradycardia, use caution in patients with liver disease or renal disease

CNS: slurred speech, altered mental status CV: RSI premedication dose 1.0-1.5mg/kg to help bradycardia control ICP

acute narrow-angle glaucoma, use caution in renal CNS: dizziness, sedation, vertigo failure

onset 1-5 minutes IV, 15-30 minutes IM, duration 12-24 hours, note: overdose may be reversed by flumazenil none in cardiac arrest, renal disease, heart block CNS: CNS depression muscle hyporeflexia CV: antidote is calcium chloride hypotension, asystole, cardiac arrest Resp: repiratory paralysis patients receiving MAOI CNS: sedation, increased ICP CV: apnea, onset 1 minute, peak effect 5-7 minutes, hypotension, tachycardia Resp: nausea, vomiting duration 2-4 hours acute narrow angle glaucoma, shock, renal failureCNS: decreased level of consciousness CV: hypotension, bradycardia Resp: respiratory depression, apnea GI: nausea, vomiting, may be reversed with flumazenil head injury, COPD, hypotension, LOC CNS: dizziness, decreased level of consciousness CV: hypotension, syncope Resp: respiratory depression, apnea GI: nausea,vomiting use caution using with newborns of heroin CNS: withdrawal effects CV: hyper/hypotension, addicted mothers, may be better to use BVM, use arrhythmias/VF caution in chronic opiod user hypotension (systolic below 90), hypovolemia, intracranial bleeding, aortic stenosis, right ventricle infarction, severe bradycardia, or tachycardia, tamponade, recent use of Viagra, Cialis, or Levitra hypersensitivity

onset 1-5 min, durration dose related usually <2 hours

onset 1-3 minutes, peak 20 minutes, 4-5 hours, use caution in elderly, ALOC, patients in renal failure, and inferior MI

onset 1-2 min, duration 1-4 minutes, depending on overdose, will outlast heroin overdose, may not outlast longer acting narcotics

CNS: dizziness, headache CV: syncope, onset 1-2 minutes IV, 2-5 minutes SL, duration hypotension, tachycardia, rebound hypertension 3-5 minutes IV, duration 30-60 minutes SL, decreases preload - use caution in inferior MI, ask patient if using ED medications CNS: headache dizziness

effect is greater if patient has not vomited prior to administration known paraquat poisoning (paraquat is a commonCNS: high concetrations may cause a decreased onset immediate herbicide) level of consciousness and respiratory depression in patients with chronic carbon dioxide retention or chronic lung disease rule out multiple fetuses before administration CV: hypertension, dysrhythmias vasoconstrictors can cause major complications, onset - 3-5 minutes, duration up to 1 hour onset IV 5 minutes, duration is 2-8 hours, sedation effect may be potentiated by alcohol/CNS depressent use onset 30-60 seconds IV, duration 30-60 minutes, use with caution in children <2 onset is immediate, duration is 1-2 hours onset 30-60 seconds, duration 3-5 minutes, give sedation agent prior to administration of paralytic use in caution with patients with epilepsy

asthma, allergy to antihistamines, allergy to CNS: CNS depression, dizziness, drowsiness, phenothiazines, lactating females, MAOI use, sedation Resp: thickens bronchial secretions pregnancy, COPD, HTN caution if impaired hepatic or respiratory function, CV: dysrhythmias, hypotension Resp: or if severe obesity bronchospasm, apnea for 30-60 minutes alkalosis CV: metabolic alkalosis, hypokalemia, fluid overload glaucoma, eye injury, burns 24-48 hours old, CNS: hyperthermia CV: dysrhythmias, crush injury, muscular distrophy bradycardia, hypotension, hyperkalemia Resp:apnea for 3-5 minutes chronic nephritis, migraine, epilepsy, CHF, PG CNS: confusion CV: angina, IV pain GI: stomach cramps, nausea, vomiting, diarrhea, do not use on newborn, myasthenia gravis CV: dysrhythmias, hypotension Resp: bronchospasm, apnea for 20-45 minutes

onset <1min, duration 20-45 minutes, give sedation agent prior to administration of paralytic