Racemic Epinephrine Class: Bronchodilator, adrenergic agent Action: Stimulates both alpha and beta receptors, causing vasoconstrictin,

reduced mucosal edema, and bronchodilation. Interactions: Bronchial astha, croup Adverse: Anxiety, dizziness, h/a, tremor, palpitations, tachycardia, n/v, htn Contra: Glaucoma, elderly, cardiac disease, htn, thyroid, diabetes Dosage: adults- add 0.5ml to nebulizer; for hand bulb nebulizer, admin. 1To 3inhalations Special: Monitor blood pressure, hr, caridac rhythm for changes. Class C Furosemide (Lasix) Class: Loop diuretic Action: Inhibits the reabsorbtion of the sodium and CL ions and water in the loop of Henle, as well as the convoluted tubule of the nephron. Indictions: Pulmonary edema, CHF, htn, Adverse: vertigo, dizziness, weakness, orthostatic hypotension, hypokalemia, thrombophlebitis, electrolyte depletion. Contra: know sensitivity Dosage: CHF/ PE: adult- 40mg slow IV/IO over 2min. Ped: 1mg/km. For HTN: adult- 4080mg IV/IO Ped: 1mg/kg Special Considerations: Peak will be in 30min, onset 5min. Be prepared to help pt void. Class C. Nitroglycerin (Nitrolingual, Nitroquick) Class: Antianginal agent Action: relaxes vascular smooth muscle, thereby dilating peripheral arteries and veins. Indications: Agina, ongoing ischemia chest pain, chest discomfort, htn. Adverse Effects: H/A, hypotension, bradycardia or tachycardia flushing, cardio collapse. Contra: Hypotension, severe bradycardia or tachycardia, increased ICP, intracranial bleed, pt that have taken erectile dysfunction drugs recently. Dosage: Adults- 1 spray sublingual (0.4mg) at 5min intervals to a max of 3 sprays. Special: administration of nitro to a pt with rt sided MI can cause hypotension. Preg. Class C. Digoxin (Lanoxin) Class: Caridac Glycoside Action: Inhibits sodium potassium adenosine tri mem. Pump, resulting in a increase in calcium inside the heart muscle cell, which causes an increase in the force of contration of the heart. Indications: CHF, to control the vent. Rate in chronic AF and atrial Flutter, narrow complex PSVT. Adverse: H/A, weakness, GI disturbances, arrhythmias, NV, diarrhea, vision disturbances. Contra: Digitalis allergies, VT and VF, heart block, sick sinus, tachycardia without heart failure, pulse lower than 50, MI, pts with Afib or Aflutter with abberance. Dosage: individualized. Special considerations: Low levels of serum potassium can lead to digoxin toxicity and bradycardia. Preg class C.

Captopril (Capoten) Class: ACE inhibitors Action: used to treat high BP and heart Failure. It decreases certain chemicals that tighten blood vessels so blood flow flows more smoothly and the heart can pump more efficiently. Indications: HTN Adverse: Hypotension, dizziness, lightheadedness, couch, sore throat, fever, tachycardia, excessive tiredness. Contra: chest pain, swelling of the face, fainting, rash, difficulty breathing. Dosage: Individualized Special Considerations: do not take if pregnant. Enalapril (Renitec) Class: ACE inhibitors Action: used alone or in combo with other meds to treat HTN. It is also used in combo with other meds for heart failure. Indications: It works by decreasing certain chemicals that tighten the blood vessels so that blood flows smoothly and the heart can pump blood more efficiently. Contra: pregant, hypotension, bradycardia, heart block, hemodynamically unstable. Dosage: individualized Special Considerations: Do not take if pregnant. Lisinopril (Prinivil) Class: ACE inhibitors Action: used alone or in combo with other meds to treat HTN. It is also used in combo with other meds for heart failure. Indications: It works by decreasing certain chemicals that tighten the blood vessels so that blood flows smoothly and the heart can pump blood more efficiently. Contra: pregant, hypotension, bradycardia, heart block, hemodynamically unstable. Dosage: individualized Special Considerations: Do not take if pregnant. Ramipril (Altace) Class: ACE inhibitors Action: used alone or in combo with other meds to treat HTN. It is also used in combo with other meds for heart failure. Indications: It works by decreasing certain chemicals that tighten the blood vessels so that blood flows smoothly and the heart can pump blood more efficiently. Contra: pregant, hypotension, bradycardia, heart block, hemodynamically unstable. Dosage: individualized Special Considerations: Do not take if pregnant. Metoprolol (Lopressor) Class: Beta adrenergic antagonist, antiaginal, antiHTN, class 2 antiarrhythmic Action: Inhibits the strength of the heart's contractions, as well as the heart rate. Indications: ACS, HTN, SVT, Atrial Flutter, heart block, bradycardia Adverse: Tiredness, dizziness, diarrhea, heart block, bradycardia Contra: Cardiogenic shock, AV block, Bradycardia, sensitivity. Dose: Adults- 5mg slow IV over 5min period up to max of 15mg Special Considerations: Monitor carefully, caution with asthma pts, preg class C.

Propranolol (Inderal) Class: Beta adrenergic antagonist, antiaginal, antiHTN, class 2 antiarrhythmic. Actions: Nonselective beta antagonist that binds with both beta1 and beta 2. inhibits the strength of the hearts contractions, as well as HR. Indications: Angina, narrow complex tachycardia that originate from either a reentry mechanism or an automatic focus. Adverse: Bradycardia, AV Block, Bronchospasm, Hypotension. Contra: Cardiogenic shock, heart failure, AV block, bradycardia, pulmonary edema. Dose: adult- 1 to 3mg IV/IO at a rate of 1mg/min. Peds- 0.01 to 0.1mg/kg slow IV/IO over 10 min. Special Considerations: Monitor closely, preg class C. Procainamide (Pronestyl) Class:Antiarrhythmic Class IA Actions: Blocks influx of Sodium through membrane pores. Indicactions: Alternative to amiodarone for stable monomorphic VT and normal QT interval and perserved function, reentry SVT if uncontrolled by adenosine and vagal manu. Adverse: Asystole, VF, Flushing, AF with rapid rate in WPW syn. Contra: AV Block, QT prolongations, Torsades, heart failure, Hypotension. Dosage: Adult- 20mg/ min slow IV/IO max dose of 17mg/kg until one of the following occures, resolves, hypotensions, QRS widens. Special Considerations: Preg class C. Esmolol (Brevibloc) Class: Beta Adrenergic antagonist Actions: inhibits the strengths of the heart contrations, as well as the heart rate. Indications: ACS, MI, Acute hypertension, SVT. Adverse: Hypotension, sinus brady, AV block, cardiac arrest, n/v, hypoglycemic. Contra: Acute bronchospasm, COPD, heart blocks, bradycardia, cardiogenic shock, PE. Dose: adults- 500mcg/kg over 1min followed by 50mcg/kg/min infusion over 4 min period max of 200mcg/kg. Special Considerations: half life 5-9min, resolution of effects within 10-20min, preg class C. Diazepam (Valium) Class: Benzodiazepine Action: Binds to the Benzo receptor and enhances the effects of Gaba. Indications: Anxiety, sketetal muscle relaxation, alcohol withdraw, Sz. Adverse: Respiratory depression, drowsiness, fatigue, HA, nausea. Contra: Children younger than 6months, acute angle glaucoma, CNS Depression. Dosage: Adult- 2-10mg Slow IV/IO Rectal: 0.2mg/kg Special Considerations: causes tissue necrosis if exvasiation. Push slowly to prevent burning Preg Class C. Lorazepam (Ativan) Class: Benzodiazepines; Schedule C4 Actions: Binds to the Benzo receptor and enhances the effects of Gaba. Indication: Preprocedure sedation induction, anxiety, status epilepticus. Adverse: HA, Drowsiness, ataxia, dizziness, anmesia, depression, euphoria, syncope. Contra: Know sensitivity, sleep apnea, shock, coma.

Dosage: Adult Analgesia/Sedation: 2mg or 0.44mg/kg. Sz: 4mg IV/IO over 2min max total 8mg. Special Considerations: Be prepared to support airway. Preg class D. Felbamate (Felbatol) Class: Anticonvulsant Action: Although the mechanism of the action is not known, it is believed that felbamate antagonizes the effects of glycine, increases the sz threshold in the absense of tremors. Indications: Partial Sz with and without generalization in epileptic adults. Adverse: NV, suicidal ideation and behavior. Contra: Blood dyscrasias, hepatic disease, know sensitivity to carbomates. Dosage: should be individualized based on the condition. Special Considerations: Pregnancy Class C Phenytoin (Dilantin) Class: Anticonvulsant Action: Depresses Sz by affecting the movement of Sodium and Calcium into neural tissue. Indications: Generalized tonic-clonic Sz Adverse: NV, depression of cardiac conduction, sedation, nystagums ataxia, dysarthria. Contra: Sinus Brady, sinoatrial block, second and third degree block, know sensitivity. Dosage: adult 15-20mg/kg not to exceed 50mg/kg. Special Considerations: Continuously monitor the ECG and blood pressure during drug administration. Fosphenytoin (Cerebyx) Class: anticonvulsant Action: alters the movement of Sodium and calcium into the nervous system and prevents the spread of Sz activity. Indications: Partial and generalization Sz, status epilepticus, Sz prophylaxis. Adverse: Phenytoin can cause several adverse effects often related to drug overdose, seation, nystagmus, tremors, ataxia. Contra: Bradycardia, bundle branch block, agranulocytosis, adams-stokes-syn, hydantoin hypotension. Dosage: adult- the usual dose is 15-20mg PE/kg Iv not to exceed3 mg PE/kg/min. Special Considerations: preg class D, compatible with breast feeding. Carbamazepine (Tegretol) Class: Anticonvulsant Action: Decreases the spread of Sz. Indications: Partial and generalized tonic-clonic Sz. Adverse: Dizziness, drowsiness, ataxia, NV, blurred vision, confusion, HA, visual hallucinations. Contra: AV block, bundle branch block, agranulocytosis, bone marrow suppression, MAOI therapy, hypersentitivity, liver disease, history of alcoholism. Dosage: adult-200mg PO every 12hrs. Special Considerations: Preg class D. Phenobarbital (Luminal) Class: anticonvulsant, Barbiturate

Action: Depresses Sz activity in the cortex, thalamus, and limbic system; increase threshold for electrical stimulation of motor cortex; produces state of sedation. Indication: Sz Adverse: depression, agitation, respiratory arrest, acceleration of metabolism of several meds. Contra: Liver dysfunction, porphyria, agranulocytosis, known sensititivy. Dosage: Adult- 15 to 18 mg/kg IV/IO infuse at a rate not faster than 60mg/min. Special Considerations: Be prepared to manage pts airway. Preg Class D. Gabapentin (Neurotin) Class: Anticonvulsant Action: the exact mechanism of action has not been determined Indications: Sz, neuropathic pain Syndromes Adverse: Dizziness, ataxia, sleepiness, gait disturbances, upset stomach. Contra: know sensitivity, use cause in elderly. Dosage: 300 to 1800mg PO daily Special Considerations: Preg Class C Lamotrigine (Lamictal) Class: Anticonvulsant, Antimanic agent. Action: the exact mechanism of action has not been determined. Indicactions: Sz, bipolar disorders. Adverse: HA, dizziness, n/v, ataxia, diplopia. Dosage: Adult- individualized. Special considerations: Preg. Class C. Glucagon Class: hormone Action: Converts glycogen to glucose Indications: hypoglycemic, beta blocker, overdose. Adverse: NV, rebound hyperglycemic, hypotension, sinus tachycardia. Contra: Pheochromocytoma, insulinoma, sensitivity. Dose: Hypoglycemic- 1mg IM/IV/IO/SQ Betablocker: 2-5mg over 1min followed with 10mg IV is bradycardia and hypotension does not resolve. Special Considerations: Preg. Class B Thiamine (Vitamin B1) Class: Vitamin B1 Actions: Thiamine combines with adenosine tri. To produce thiamine diphos. Which acts as a coenzyme in carb. Metabolism. Indications: wernicke-korsakoff syn, beriberi, supplementation Adverse: itching, rash, pain at injection. Dose: 100mg for WKS. Special Considerations: Preg Class A Nicardipine (Cardene) Class: Calcium channel Blocker Action: blocks Calcium movement into the smooth muscle of the blood vessel walls, causing vasodialation.

Indications: hypertension Adverse: Edema, ha, flushing, sinus tachycardia, hypotension. Contra: Aortic stenosis, hypotension, known sensitivity. Dosage: Adult- 5mg/hr may increase by 2.5mg/hr every 5-15min max 15mg/hr. Special Considerations: Preg Class C Sodium Nitroprusside (Nipride) Class:Antihypertensive Agent Action: Causes direct relaxation of both arteries and veins. Indications: Hypertension emergencies Adverse: Cynaide or thiocyanate toxicity, nv, dizziness, ha, abd pain. Contra: hypotension, increased ICP, cerebrovascular disease, CAD, renal disease. Dose: adult- 0.3-10mcg/kg/min. Special Considerations: will break down when exposed to light. Preg Class C. Labetalol (Normodyne) Class: Beta adrenergic antagonist, antianginal, antihypertensive Action: Binds with both the beta1 and beta 2 receptorsin vascular smooth muscle relaxation. Indications: ACS, SVT, severe hypertension. Adverse: Usually mild and transient, hypotension symptoms, nv, bradycardia. Contra: Hypotension, cardiogenic shock, acute pulmonary edema, heart failure, severe bradycardia, sick sinus syndrome, second and third degree block. Dosage: adult- Cardiac indications: 10mg Iv over 1-2min. Repeat every 10min if necessary. Max 150mg. For Severe Hypertension: adult- 20mg initial dose slow infusion over 2min. Special Considerations: Preg class C. Hydralazine (Apresoline) Class: Antihypertensive Action: Directly dialates the peripheral blood vessels. Indications: Hypertension associated with preeclampsia, hypertension crisis. Adverse: Ha, angina, flushing, palpitations, reflex tachycardia, nv, syncope, peripheral edema. Contra: Pts taking diaoxide or MAIOs and rheumatic heart disease. Dosage: 5-10mg for adults with preeclampsia. For acute hypertension 10-20mg for adults. Special Considerations: Preg. Class C Phentolamine (Regitine) Class: Alpha antagonist, antihypertensive Action: Blocks alpha adrenergic receptors, causing vasodilation Indications: Hypertension emergencies and hypertension caused by pheochromocytoma, cocaine induced vasospasm. Adverse: sinus tachycardia, angina, dizziness, orthostatic hypotension, prolonged hypotension, nv, diarrhea, weakness, flushing. Contra: know sensitivity, use caution in acute MI, angina, coronary insufficiency, evidence of suggestive of coronary artery disease, peptic ulcer. Dose: Hypertension crisis- adult: 5-15mg IV Cocaine induced Vasospasm adult-5mg IV. Special Considerations: Preg Class C Activated Charcoal Class: Antidote, Absorbent

Action: when certain chemicals and toxins are in proximity to the activated charcoal, the chemical will attach. Indications: toxic ingestion Adverse: nv, constipation, diarrhea. Contra: Ingestions of acids, ethanol, methanol, cyanide, ferrous sulfate, iron, salts. Dose: adults: 50-100g dose Ped 1-2g/kg. Special Considerations: Preg Class C Terbutaline (Brethine) Class: Adrenergic Agonist Action: stimulates the beta2 to produce vasodilation of the smooth muscle in the bronchials. Adverse: Cardiac Arrhythmias, angina, anxiety, ha, tremor, palpitations, dizziness. Indications: Prevention and reversal of bronchospasm Contra: sensitivity, cardiac disease, cardiac arrhythmias, diabetes, elderly, MAOI's, Sz disorders. Dosage: Adult- 0.25 mg SubQ every 20min for 3 doses. Special Considerations: Preg Class B Prednisone Class: Corticosteriod Action: Reduces inflammation Indications: inflammation conditions, such as asthma with bronchospasms. Adverse: Many adverse effects of steriod use are not relate to short-term but typically are seen with long-term and during withdrawal. Contra: Cushing's syn, fungal infections, measles, varcella, know sensitivity. Dosage: adult: dosage must be individualized. Special Considerations: Preg Class C Ipratropium Bromide (Atrovent) Class: Bronchodilator, anticholinergic Action: antagonizes, the acetylcholine receptor on Bronchial smooth muscle, producing bronchodilation. Indictions: Asthma, Brochospasm, associated with COPD. Adverse: paradoxical acute bronchospasm, cough, throat irritations, ha, dizziness, dry mouth, palpitations. Contra: closed angle glaucoma, bladder neck, obstruction, prostatic, hypertrophy, known sensitity. Dosage: 4inhalations every 10min with no more 24 inhalations per day or closer. Special Considerations: not typically used as a sole medication in the treat of the acute, exacerbations of asthma. Preg Class B. Naloxone (Narcan) Class: Opioid Antagonist Action: Binds the opioid receptor and blocks the effect of narcotics. Indications: narcotic overdoses, reversal of narcotics used for procedure-related anesthesia. Adverse: NV, restlessness, diaphoretic, tachycardia, hypertension, tremulousness, Sz, cardiac arrest, narcotic withdrawal. Contra: Know sensitivity to naloxone, nalmefene or naltrexone. Use with caution in patients with superavent. Arrhythmia or other cardiac disease, head trauma, brain tumor.

Dosage: adult 0.4 to 2mg IV/IO/ET/IM/SubQ. Special Considerations: Preg Class C Haloperidol (Haldol) Class: Antipsychotic agent Action: Selectively blocks postsynaptic dopamine receptors. Indications: Psychotic disorders, agitation Adverse: Extrapyramidal sym, drowsiness, tardive dyskinesia, hypotension, hypertension, VT, Sinus tachycardia, QT prolongations, torsades de pointes. Dose: Adult- 0.5-10mg PO/IM Special Considerations: Preg. Class C. Epinephrine Class: Adrenergic agent, inotropic Action: binds strongly with alpha and beta receptors, producing increasing, blood pressure, increased hr, bronchodilation. Indications: Bronchospasm, allergic and anaphylactic reactions, restoration of cardiac activity in cardiac arrest. Adverse: Anxiety, ha, cardiac arrhythmia, hypertension, nervousness, tremors, chest pain, nv. Contra: arrhythmia other than VF, asystole, PEA; cardiovascular disease; hypertension, cerebrovascular disease; hypertension, cerebrovascular disease. Dosage: Cardiac Arrest- adult: 1mg (1:10000) every 3-5min. Symptomatic Bradycardia: 1mcg/min. Asthma: 0.3-0.5mg (1:1000). Special Considerations: Half-Life 1min. Preg Class C.