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Glossary of AZ Drugs

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CALCIUM CHLORIDE BRAND NAME
BRAND NAME: Calcium Chloride
DEXTROSE 50% BRAND NAME
BRAND NAME: Dextrose 50%, D50
BUMETANIDE BRAND NAME
BRAND NAME: Bumex
BRETYLIUM TOSYLATE BRAND NAME
BRAND NAME: Bretylol
ATROPINE SULFATE BRAND NAME
BRAND NAME: Atropine
ACETYLSALICYLIC ACID, ASA BRAND NAME
BRAND NAME: Bufferin, Anacin, APC
AMIODARONE BRAND NAME
Brand Name: Cordarone
ALBUTEROL SULFATE BRAND NAME
BRAND NAME: Proventil, Ventolin
ADENOSINE BRAND NAME
BRAND NAME: Adenocard
CHARCOAL, ACTIVATED (without sorbitol) BRAND NAME
BRAND NAME: Charcola, Actidose-aqua
VERAPAMIL HCl BRAND NAME
BRAND NAME: Isoptin, Calan, Verelan
THIAMINE HCl (vitamin B1) BRAND NAME
BRAND NAME: Betalin
SODIUM BICARBONATE 8.4% BRAND NAME
BRAND NAME: Sodium Bicarbonate 8.4%
PHENYLEPHRINE NASAL SPRAY 0.5% BRAND NAME
BRAND NAME: Neo-synephrine Nasal Spray 0.5%
OXYTOCIN BRAND NAME
BRAND NAME: Pitocin, Syntocin
NITROUS OXIDE 50% BRAND NAME
BRAND NAME: Nitronox
NITROGLYCERIN BRAND NAME
BRAND NAME: Nitrostat, Tridil
NALOXONE HCl BRAND NAME
BRAND NAME: Narcan
MORPHINE SULFATE BRAND NAME
BRAND NAME: Morphine Sulfate
DIPHENHYDRAMINE HCl BRAND NAME
BRAND NAME: Benadryl
MIDAZOLAM HYDROCHLORIDE BRAND NAME
BRAND NAME: Versed
METHYLPREDNISOLONE SODIUM SUCCINATE BRAND NAME
BRAND NAME: Solu-Medrol
MAGNESIUM SULFATE BRAND NAME
BRAND NAME: Magnesium Sulfate
LIDOCAINE HCl BRAND NAME
BRAND NAME: Xylocaine
GLUCAGON BRAND NAME
BRAND NAME: Glucagon
FUROSEMIDE BRAND NAME
BRAND NAME: Lasix
EPINEPHRINE HCl BRAND NAME
BRAND NAME: Adrenalin
DOPAMINE BRAND NAME
BRAND NAME: Intropin
DIAZEPAM BRAND NAME
BRAND NAME: Valium
DEXAMETHASONE SODIUM PHOSPHATE BRAND NAME
BRAND NAME: Decadron
CALCIUM CHLORIDE CLASS
CLASS: electrolyte
DEXTROSE 50% CLASS
CLASS: carbohydrate, hyperglycemic
BUMETANIDE CLASS
CLASS: Loop diuretic
BRETYLIUM TOSYLATE CLASS
CLASS: antiarrhythmic
ATROPINE SULFATE CLASS
CLASS: parasympatholytic, antimuscarinic, anticholinergic, parasympathetic antagonist, parasympathetic blocker
ACETYLSALICYLIC ACID, ASA CLASS
CLASS: analgesic; antipyretic; antiinflammatory
AMIODARONE CLASS
Class: Antiarrhythmic agent
ALBUTEROL SULFATE CLASS
CLASS: sympathomimetic, bronchodilator
ADENOSINE CLASS
CLASS: antiarrhythmic, endogenous nucleoside
CHARCOAL, ACTIVATED (without sorbitol) CLASS
CLASS: adsorbent
VERAPAMIL HCl CLASS
CLASS: calcium channel blocker
THIAMINE HCl (vitamin B1) CLASS
CLASS: vitamin
SODIUM BICARBONATE 8.4% CLASS
CLASS: buffer
PHENYLEPHRINE NASAL SPRAY 0.5% CLASS
CLASS: topical vasoconstrictor
OXYTOCIN CLASS
CLASS: pituitary hormone, polypeptide, uterine stimulant
NITROUS OXIDE 50% CLASS
CLASS: analgesic, inhalation
NITROGLYCERIN CLASS
CLASS: vasodilator, organic nitrate, antianginal
NALOXONE HCl CLASS
CLASS: narcotic (opioid) antagonist
MORPHINE SULFATE CLASS
CLASS: narcotic agonist
DIPHENHYDRAMINE HCl CLASS
CLASS: antihistamine; anticholinergic
MIDAZOLAM HYDROCHLORIDE CLASS
CLASS: Central nervous system depressant, benzodiazepine
METHYLPREDNISOLONE SODIUM SUCCINATE CLASS
CLASS: corticosteroid, glucocorticoid, steroid, anti-inflammatory
MAGNESIUM SULFATE CLASS
CLASS: electrolyte, tocolytic
LIDOCAINE HCl CLASS
CLASS: antiarrhythmic, local anesthetic
GLUCAGON CLASS
CLASS: pancreatic hormone, polypeptide, hyperglycemic agent
FUROSEMIDE CLASS
CLASS: loop diuretic
EPINEPHRINE HCl CLASS
CLASS: sympathomimetic
DOPAMINE CLASS
CLASS: sympathomimetic
DIAZEPAM CLASS
CLASS: benzodiazepine
DEXAMETHASONE SODIUM PHOSPHATE CLASS
CLASS: synthetic adrenocorticoid/ glucocorticoid with a predominance of glucocorticoid action, antiinflammatory
CALCIUM CHLORIDE Mechanism of Action
Mechanism of Action: Increases extracellular and intracellular calcium levels Stimulates release of catecholamines Increases cardiac contractile state (positive inotropic effect) May enhance ventricular automaticity Inhibits the effects of adenosine on mast cells
DEXTROSE 50% Mechanism of Action
Mechanism of Action: Provides short-term osmotic diuresis. Pharmacological: Aerobic metabolic substrate (ATP production). Clinical effects: Reverses CNS effects of hypoglycemia by rapidly increasing serum glucose levels.
BUMETANIDE Mechanism of Action
Mechanism of Action: Inhibits electrolyte reabsorption in the ascending loop of Henle leading to diuresis
BRETYLIUM TOSYLATE Mechanism of Action
Mechanism of Action: Elevates ventricular fibrillation threshold. Biphasic autonomic response: transient (15-20 minutes) adrenergic response (and possibly ventricular ectopy); followed by a decrease in arterial pressure from vasodilation (due to norepinephrine depletion and reuptake blockade). Decreases re-entry by decreasing refractory time imbalance between normal and infarcted tissue. Prolongs action potential and refractory period. Suppresses PVC's and ventricular arrhythmias 20 minutes to 2 hours after dosing.
ATROPINE SULFATE Mechanism of Action
Mechanism of Action: Pharmacological: Competitive antagonist of acetylcholine at muscarinic receptor sites (smooth muscle and glands, blocking parasympathetic response and allowing sympathetic response to take over). Clinical: CV: Increased heart rate (positive chronotropic effect); increased conduction velocity; increased force of contraction (slight). Resp: Decreased mucous production; increased bronchial smooth muscle relaxation (bronchodilation). GI: Decreased GI secretion and motility. GU: Decreased urinary bladder tone. Misc: Mydriasis (pupillary dilation); decreased sweat production.
ACETYLSALICYLIC ACID, ASA Mechanism of Action
Mechanism of Action: In small doses aspirin blocks thromboxane A2, a potent platelet aggregant and vasoconstrictor. This property has lead to its use in the acute phase of management of the myocardial infarction. Decreased platelet aggregation.
AMIODARONE Mechanism of Action
Mechanism of Action: Multiple effects on sodium, potassium and calcium channels. Prolongs action potential, refractory period, and ventricular automaticity (potassium blocker). Slows membrane depolarization and impulse conduction (sodium blocker). Coronary artery dilation and Negative chronotropic activity in nodal tissue, rate reduction, and antisympathetic activity (calcium channel and a-blocker
ALBUTEROL SULFATE Mechanism of Action
Mechanism of Action: ß agonist (primarily ß2); relaxes bronchial smooth muscle, resulting in bronchodilation; also relaxes vascular and uterine smooth muscle; decreases airway resistance
ADENOSINE Mechanism of Action
Mechanism of Action: Slows conduction time through AV node; can interrupt re-entrant pathways through the AV node. Slows sinus rate. Larger doses decrease BP by decreasing peripheral resistance.
CHARCOAL, ACTIVATED (without sorbitol) Mechanism of Action
Mechanism of Action: Pharmacological: Physical binding (adsorption) of toxins from GI tract. Clinical effects: Prevents/reduces systemic absorption of toxins.
VERAPAMIL HCl Mechanism of Action
Mechanism of Action: Blocks calcium ion influx into cardiac and smooth muscle cells causing a depressant effect on the contractile mechanism resulting in negative inotropy. Reduces contractile tone in vascular smooth muscle resulting in coronary and peripheral vasodilation. Slows conduction and prolongs refractory period in the AV node due to calcium channel blocking. Slows SA node discharge. In summary, decreases myocardial contractile force and slows AV conduction.
THIAMINE HCl (vitamin B1) Mechanism of Action
Mechanism of Action: Required for carbohydrate metabolism. Deficiency leads to anemia, polyneuritis, Wernicke's encephalopathy, cardiomyopathy. Administration may reverse symptoms of deficiency, but effects are dependent upon duration of illness and severity of disease.
SODIUM BICARBONATE 8.4% Mechanism of Action
Mechanism of Action: Buffers H+ and increases pH
PHENYLEPHRINE NASAL SPRAY 0.5% Mechanism of Action
Mechanism of Action: Stimulates a receptors in the blood vessels of the nasal mucosa which causes their constriction and thereby decreases the risk of nasal bleeding.
OXYTOCIN Mechanism of Action
Mechanism of Action: Binds to oxytocin receptor sites on surface of uterine smooth muscles: increases force and frequency of uterine contractions
NITROUS OXIDE 50% Mechanism of Action
Mechanism of Action: Centrally acting agent that produces CNS depression and elevation of the pain threshold
NITROGLYCERIN Mechanism of Action
Mechanism of Action: Smooth muscle relaxant acting on vascular, uterine, bronchial, and intestinal smooth muscle. Reduces workload on the heart by causing blood pooling (decreased preload). Arteriolar vasodilation (decreased afterload). Coronary artery vasodilation Increases blood flow to myocardium. Decreases myocardial O2 demand.
NALOXONE HCl Mechanism of Action
Mechanism of Action: Competitive inhibition at narcotic receptor sites. Reverses respiratory depression secondary to narcotics
MORPHINE SULFATE Mechanism of Action
Mechanism of Action: Alleviates pain by acting on the pain receptors in the brain; elevates pain threshold. Depresses central nervous system; depresses brainstem respiratory centers; decreases responsiveness to changes in PaC02. Increases venous capacitance (venous pooling), vasodilates arterioles, reducing preload and afterload. Histamine release.
DIPHENHYDRAMINE HCl Mechanism of Action
Mechanism of Action: Blocks cellular histamine receptors, but does not prevent histamine release; results in decreased capillary permeability and decreased vasodilation, as well as prevention of bronchospasm. Has some anticholinergic effects.
MIDAZOLAM HYDROCHLORIDE Mechanism of Action
Mechanism of Action: CNS effects are mediated through the inhibitory neurotransmitter gamma-aminobutyric acid (GABA). Acts at the limbic, thalamic, and hypothalamic levels of the CNS, producing anxiolytic, sedative, hypnotic, and anticonvulsant effects. Capable of producing all levels of CNS depression, from mild sedation to coma.
METHYLPREDNISOLONE SODIUM SUCCINATE Mechanism of Action
Mechanism of Action: Enters target cells and causes many complex reactions that are responsible for its antiinflammatory and immunosuppressive effects; thought to stabilize cellular and intracellular membranes.
MAGNESIUM SULFATE Mechanism of Action
Mechanism of Action: Pharmacology: Second most plentiful intracellular cation; essential to enhance intracellular potassium replenishment and activity of many enzymes; important role in neurochemical transmission and muscular excitability (may decrease acetylcholine released by nerve impulses); decreases myocardial irritability and neuromuscular irritability. Clinical: Cardiac-reduces ventricular irritability, especially when associated with hypomagnesemia; inhibition of muscular excitability.
LIDOCAINE HCl Mechanism of Action
Mechanism of Action: Decreases automaticity by slowing the rate of spontaneous phase 4 depolarization. Terminates re-entry by decreasing conduction in re-entrant pathways (by slowing conduction in ischemic tissue, equalizes conduction speed among fibers). Increases ventricular fibrillation threshold.
GLUCAGON Mechanism of Action
Mechanism of Action: Pharmacologic: Acts only on liver glycogen, converting it to glucose. Counteracts the effect of insulin. Relaxes GI smooth muscle causing dilation and decreased motility. Cardiac inotrope. Clinical effects: May reverse hypoglycemia (if patient has glycogen stored in liver) within 4-8 minutes (could be as long as 15 or more).
FUROSEMIDE Mechanism of Action
Mechanism of Action: Pharmacologic: Inhibits electrolyte reabsorption in the ascending Loop of Henle. Promotes excretion of sodium, potassium, chloride. Vasodilation increases venous capacitance and decreases afterload. Clinical: Diuresis
EPINEPHRINE HCl Mechanism of Action
Mechanism of Action: Pharmacological Effects: Direct acting a and ß agonist; a-bronchial, cutaneous, renal, and visceral arterial constriction (increased systemic vascular resistance); ß1-positive inotropic and chronotropic actions (increases myocardial workload and oxygen requirements), increases automaticity and irritability; ß2 bronchial smooth muscle relaxation and dilation of skeletal vasculature. Other: blocks histamine release. Clinical Effects: Cardiac Arrest- increases cerebral and myocardial perfusion pressure; increases systolic and diastolic blood pressures; increases electrical activity in the myocardium; can stimulate spontaneous contractions in asystole. Bradycardia- increases heart rate, increases BP; Bronchospasm/Anaphylaxis-reverse signs/symptoms
DOPAMINE Mechanism of Action
Mechanism of Action: Immediate metabolic precursor to norepinephrine. Effects are dose-dependent: 1-2 Mg/kg/min Acts on dopaminergic receptors to stimulate cerebral, renal and mesenteric vasculature to dilate; HR and B/P are usually unchanged; may increase urine output. 2-10 Mg/kg/min ß1 stimulant action is primary effect (increases cardiac output and partially antagonizes the a-adrenergic-mediated vasoconstriction. Overall effect is increased cardiac output and only modest increase in systemic vascular resistance (SVR). 10-20 Mg/kg/min a-adrenergic effects predominate resulting in renal, mesenteric and peripheral arterial and venous vasoconstriction with marked increase in SVR, pulmonary vascular resistance and further increased preload. 10-20 Mg/kg/min a-adrenergic effects predominate resulting in renal, mesenteric and peripheral arterial and venous vasoconstriction with marked increase in SVR, pulmonary vascular resistance and further increased preload
DIAZEPAM Mechanism of Action
Mechanism of Action: Acts on parts of the limbic system, the thalamus, and hypothalamus producing calming effects; decreases seizures by increasing the seizure threshold; transient analgesia; amnesic; sedative.
DEXAMETHASONE SODIUM PHOSPHATE Mechanism of Action
Mechanism of Action: Improves lung function and myocardial performance: stabilization of lysosomal and cell membranes, inhibition of compliment-induced granulocyte aggregation, rightward shift in oxygen-hemoglobin dissociation curve, inhibition of prostaglandin and leukotriene production, increase in surfactant production, decrease in pulmonary edema, relaxation of bronchospasm.
CALCIUM CHLORIDE Indications/field use
Indications and Field Use: Acute hypocalcemia Calcium channel blocker OD Acute hyperkalemia (known or suspected) Hypermagnesemia. Pre-treatment for IV verapamil administration
DEXTROSE 50% Indications/field use
Indications and Field Use: Known hypoglycemia. Altered level of consciousness of unknown etiology. Seizures of unknown etiology. Hyperkalemia
BUMETANIDE Indications/field use
Indications and Field Use: Pulmonary edema, Congestive heart failure
BRETYLIUM TOSYLATE Indications/field use
Indications and Field Use: Refractory VF/Pulseless VT, VT with pulses, wide complex tachycardia of unknown origin after other pharmacologic therapy. Lidocaine allergy.
ATROPINE SULFATE Indications/field use
Indications and Field Use: Symptomatic bradycardia (sinus, junctional, and AV blocks causing significant hypotension, ventricular ectopy, chest pain, altered level of consciousness, etc.), monitored patient only. Asystole (after epinephrine), monitored patient only. PEA with actual or relative bradycardia (after epinephrine), monitored patient only. Acetylcholinesterase inhibitor poisoning (organophosphate, cholinergic poisoning). Bronchospasm, refractory (second or third line), in conjunction with albuterol or isoetherine.
ACETYLSALICYLIC ACID, ASA Indications/field use
Indications and Field Use: Chest pain or other signs/symptoms, ECG changes suggestive of acute myocardial infarction, unstable angina. Pain, discomfort, fever in adult patient only
AMIODARONE Indications/field use
Indications for use: Treatment of: shock-refractory VF/pulseless VT, polymorphic VT, and wide complex tachycardia of uncertain origin. Control hemodynamically stable ventricular tachycardia when cardioversion unsuccessful. Adjunct to cardioversion of SVT and PSVT. Rate control in atrial fibrillation or flutter.
ALBUTEROL SULFATE Indications/field use
Indications and Field Use: Treatment of bronchospasm
ADENOSINE Indications/field use
Indications and Field Use: Conversion of supraventricular tachycardias with no known atrial fibrillation or atrial flutter. Wide complex tachycardia of uncertain origin unresponsive to lidocaine.
CHARCOAL, ACTIVATED (without sorbitol) Indications/field use
Indications and Field Use: Sole prehospital therapy of oral ingestion of toxic substances. Pre-lavage of oral ingestions of toxic substances.
VERAPAMIL HCl Indications/field use
Indications and Field Use: Supraventricular tachycardia Atrial fibrillation and atrial flutter with rapid ventricular response
THIAMINE HCl (vitamin B1) Indications/field use
Indications and Field Use: Alcoholism, delirium tremens. Coma of unknown origin, especially if alcohol or malnourishment may be involved. Suspect Wernicke or Korsakoff Syndrome. Other thiamine deficiency syndromes. Severe congestive heart failure
SODIUM BICARBONATE 8.4% Indications/field use
Indications and Field Use: Pre-existing metabolic acidosis. Overdose of aspirin, cyclic antidepressants (alkalinization of blood). Cardiac arrest after other interventions and ventilation is adequate
PHENYLEPHRINE NASAL SPRAY 0.5% Indications/field use
Indications and Field Use: Facilitation of nasotracheal intubation
OXYTOCIN Indications/field use
Indications and Field Use: Postpartum hemorrhage due to uterine atony
NITROUS OXIDE 50% Indications/field use
Indications for Field Use: Moderate to severe pain from musculoskeletal trauma, burns, AMI
NITROGLYCERIN Indications/field use
Indications and Field Use: Angina, Myocardial infarction, Congestive heart failure with pulmonary edema
NALOXONE HCl Indications/field use
Indications and Field Use: Antidote for: Opioid overdoses; May differentiate opioid-induced coma from other causes
MORPHINE SULFATE Indications/field use
Indications and Field Use: Analgesia, especially in patients with burns, myocardial infarction, or renal colic. Pulmonary edema (cardiogenic).
DIPHENHYDRAMINE HCl Indications/field use
Indications and Field Use: Anaphylaxis (2nd line). Phenothiazine reactions (extrapyramidal symptoms). Antiemetic
MIDAZOLAM HYDROCHLORIDE Indications/field use
Indications and Field Use: Anti-convulsant Sedation Management of acute agitation/treat cause first Induction for intubation
METHYLPREDNISOLONE SODIUM SUCCINATE Indications/field use
Indications and Field Use: Reactive airway disease: Acute exacerbation of emphysema, chronic bronchitis, asthma. Anaphylaxis. Burns potentially involving the airway. Acute spinal cord trauma (large loading and maintenance doses)
MAGNESIUM SULFATE Indications/field use
Indications and Field Use: Torsades de pointes, drug of choice; VF/Pulseless VT refractory to lidocaine and/or bretylium; Hypomagnesemia > Pre-term labor (PTL) > Pregnancy-induced hypertension (PIH, toxemia of pregnancy, pre-eclampsia and/or eclampsia).
LIDOCAINE HCl Indications/field use
Indications and Field Use: Suppression of ventricular arrhythmias (ventricular tachycardia, ventricular fibrillation, PVC's). Prophylaxis against recurrence after conversion from ventricular tachycardia or ventricular fibrillation. Frequent PVC's (>than 6 per minute; 2 or more in a row; multiform PVC's; or R-on-T phenomenon). Pre-intubation for head trauma or suspected Intra cranial hemorrhage (hypertension and focal neurologic S/S).
GLUCAGON Indications/field use
Indications and Field Use: Symptomatic hypoglycemia when IV access is delayed.
FUROSEMIDE Indications/field use
Indications and Field Use: Pulmonary edema; congestive heart failure
EPINEPHRINE HCl Indications/field use
Indications and Field Use: Cardiac arrest - VF/Pulseless VT; asystole; PEA (First line pharmacologic agent for any pulseless dysrhythmia in cardiopulmonary arrest). Severe bronchospasm, i.e., bronchiolitis, asthma. Anaphylaxis. Bradycardia, refractory with profound hypotension, monitored patient only. Hypotension unresponsive to other therapy, monitored patient only.
DOPAMINE Indications/field use
Indications and Field Use: Symptomatic bradycardias. Hemodynamically significant hypotension in the absence of hypovolemia (Cardiogenic or septic shock only after fluid administration; assess breath sounds first).
DIAZEPAM Indications/field use
Indications and Field Use: Grand mal seizures, especially status epilepticus. Transient analgesia/amnesia for medical procedures (e.g., fracture reduction, cardioversion, Transient analgesia/amnesia for medical procedures (e.g., fracture reduction, cardioversion, pacing). Delirium tremens. Treat the cause first.
DEXAMETHASONE SODIUM PHOSPHATE Indications/field use
Indications and Field Use: Reactive airway disease: Acute exacerbation of bronchial asthma. Anaphylaxis. Cerebral edema (non-traumatic). Acute spinal cord trauma
CALCIUM CHLORIDE Contraindications
Contraindications: Hypercalcemia Concurrent digoxin therapy (relative)
DEXTROSE 50% Contraindications
Contraindications: Known thiamine deficiency (relative, if suspected give thiamine close to same time). Delirium tremens; use with caution in patients with acute alcoholism, may be ineffective without thiamine. Head injury (unless documented hypoglycemia). Intra cranial hemorrhage (relative). Severe pain (paradoxical excitement may occur).
BUMETANIDE Contraindications
Contraindications: hypersensitivity, anuria, electrolyte deficiencies, hepatic coma. Cautious use: hepatic cirrhosis, ascites, history of gout, hypersensitivity to furosemide
BRETYLIUM TOSYLATE Contraindications
Contraindications: None, when used to treat life-threatening arrhythmias.
ATROPINE SULFATE Contraindications
Contraindications: Glaucoma, acute narrow angle (painful) (relative contraindication for patient with symptomatic bradycardia)
ACETYLSALICYLIC ACID, ASA Contraindications
Contraindications: Bleeding ulcer, hemorrhagic states, hemophilia, Known hypersensitivity to salicylates or other non-steroidal antiinflammatories that has lead to hypotension and/or Bronchospasm, Children and adolescents
AMIODARONE Contraindications
Contraindications: Bradycardia Second or third degree heart block cardiogenic shock Hypotension pulmonary congestion
ALBUTEROL SULFATE Contraindications
Contraindications: Synergistic with other sympathomimetics Use caution in patients with diabetes, hyperthyroidism, and cerebrovascular disease
ADENOSINE Contraindications
Contraindications: Sick sinus syndrome, 2nd or 3rd degree AV blocks; except in patients with a functioning ventricular pacemaker. Use cautiously in patients with known asthma (has precipitated acute bronchospasm). Patients on theophylline and related methylxanthines. Patients on dipyridamole (Persantine) or arbamazepine (Tegretol). Cardiac transplant patients are more sensitive to adenosine and require only a small dose (relative). Known atrial fibrillation or atrial flutter Pregnancy (no controlled studies)
CHARCOAL, ACTIVATED (without sorbitol) Contraindications
Contraindications: Ingestion of caustics, Ingestion of hydrocarbons (relative), Oral administration to comatose patient, Simultaneous administration of other oral drugs
VERAPAMIL HCl Contraindications
Contraindications: AV block, Sick sinus syndrome, any wide QRS complex tachycardia, Shock, severe CHF
THIAMINE HCl (vitamin B1) Contraindications
Contraindications: Do not give intra-arterial
SODIUM BICARBONATE 8.4% Contraindications
Contraindications: Alkalosis
PHENYLEPHRINE NASAL SPRAY 0.5% Contraindications
Contraindications: Known allergy to medication
OXYTOCIN Contraindications
Contraindications: Hypersensitivity
NITROUS OXIDE 50% Contraindications
Contraindications: Unconscious patient. Poor respiratory drive, compromise of respiratory status (i.e. pneumothorax) Abdominal pain unless intestinal obstruction has been completely ruled out. Severe head injury
NITROGLYCERIN Contraindications
Contraindications: Hypovolemia, Increased Intra cranial pressure
NALOXONE HCl Contraindications
Contraindications: Hypersensitivity
MORPHINE SULFATE Contraindications
Contraindications: Respiratory depression, Head injuries, Elevated Intra cranial pressure, Asthma, relative, Abdominal pain, relative
DIPHENHYDRAMINE HCl Contraindications
Contraindications: Known hypersensitivity to diphenhydramine or drugs of similar chemical structure. Newborn or premature infants; nursing mothers. Considerable caution in patients with glaucoma, acute narrow angle; stenosing or obstructive diseases of the GI tract; bronchial asthma; hyperthyroidism; cardiovascular disease or hypertension; age greater than 60 years (all relative benefit vs. risk).
MIDAZOLAM HYDROCHLORIDE Contraindications
Contraindications: Hypersensitivity to midazolam Relative contraindication in: Myasthenia gravis or other neuromuscular disorders; acute alcohol intoxication; severe, chronic obstructive pulmonary disease; and acute pulmonary insufficiency
METHYLPREDNISOLONE SODIUM SUCCINATE Contraindications
Contraindications: Preterm infants
MAGNESIUM SULFATE Contraindications
Contraindications: Hypermagnesemia, Use cautiously in patients with impaired renal function and pre-existing heart blocks (relative).
LIDOCAINE HCl Contraindications
Contraindications: Known hypersensitivity/allergy. Use extreme caution in patients with conduction disturbance (second or third degree block). > Do not treat ectopic beats if heart rate is < 60. They are probably compensating for the bradycardia; instead, treat the bradycardia!
GLUCAGON Contraindications
Contraindications: Known hypersensitivity, Pheochromocytoma, Insulinoma, Should not be routinely used to replace dextrose when IV access has been obtained
FUROSEMIDE Contraindications
Contraindications: Anuria (relative), Hypovolemia, Hypotension
EPINEPHRINE HCl Contraindications
Contraindications: None known for cardiac arrest. Hypothermia, relative contraindication
DOPAMINE Contraindications
Contraindications: Hypovolemic shock (relative). Pheochromocytoma. Pheochromocytoma
DIAZEPAM Contraindications
Contraindications: Hypersensitivity (allergy). Glaucoma, acute narrow angle (relative)
DEXAMETHASONE SODIUM PHOSPHATE Contraindications
Contraindications: Systemic fungal infections. Hypersensitivity to any component of dexamethasone, including sulfites. Preterm infants
CALCIUM CHLORIDE Adverse Reactions
Adverse Reactions: Brady-asystolic arrest. Severe tissue necrosis if solution extravasates Use cautiously in patients on digitalis; may cause serious arrhythmias
DEXTROSE 50% Adverse Reactions
Adverse Reactions: Cerebral edema in children when given IV undiluted. Worsening elevated ICP or cerebral edema from trauma or cerebral vascular accident. Extravasation leads to severe tissue necrosis. Sclerosing effect on peripheral veins.
BUMETANIDE Adverse Reactions
Adverse Reactions: Dizziness (most common), headache, muscle cramps, Hypotension,EKG changes associated with hypokalemia, hyponatremia, hypocalcemia, hypomagnesemia,Nausea, vomiting, diarrhea, dry mouth, ringing in ears, High doses or frequent administration, particularly in the elderly, can cause profound diuresis, hypovolemia, and resulting circulating collapse with development of thrombi and emboli. May precipitate hypokalemic-induced digoxin toxicity.
BRETYLIUM TOSYLATE Adverse Reactions
Adverse Reactions: CV: Hypertension may occur initially due to catecholamine release; hypotension 15-20 minutes after administration (can usually be controlled); increased sensitivity to catecholamines; angina or bradydysrhythmias. GI: Nausea/vomiting after rapid IV administration.
ATROPINE SULFATE Adverse Reactions
Adverse Reactions: Major: Tachydysrhythmias; ventricular irritability; exacerbation/initiation of angina; acute narrow angle glaucoma; agitation to delirium. Minor: Dry mouth/mucous membranes; urinary retention; decreased sweating/increased body temperature.
ACETYLSALICYLIC ACID, ASA Adverse Reactions
Adverse Reactions: Use with caution in the patient with history of asthma. Anaphylactic reactions in sensitive patients have occurred; skin eruptions; other side effects rare with single dose
AMIODARONE Adverse Reactions
Adverse Reactions: Cardiovascular: bradycardia, hypotension, asystole/cardiac arrest, AV block, Torsades de Pointes, congestive heart failure; GI & Hepatic: nausea, vomiting, abnormal liver function tests Skin: slate-blue pigmentation. Other: fever, headache, dizziness, flushing, abnormal salivation, photophobia.
ALBUTEROL SULFATE Adverse Reactions
Adverse Reactions: CV: Dysrhythmias, tachycardia (with excessive use), peripheral vasodilation; Resp: Bronchospasm (rare paradoxical with excessive use); CNS: Tremors, nervousness; GI: Nausea, vomiting; Endocrine: Hyperglycemia
ADENOSINE Adverse Reactions
Adverse Reactions: CV: Transient dysrhythmias (systole, bradycardia, PVC's) occur in 55% of patients (none reported as irreversible). Palpitations, chest pressure, chest pain, hypotension, transient hypertension; facial flushing, sweating. Resp: Dyspnea, hyperventilation, tightness in throat, bronchospasm. CNS: lightheadedness, headache, dizziness, paresthesias, apprehension, blurred vision, neck-back pain. GI: Nausea, metallic taste.
CHARCOAL, ACTIVATED (without sorbitol) Adverse Reactions
Adverse Reactions: May provoke vomiting, May worsen overdosed induced Ileus
VERAPAMIL HCl Adverse Reactions
Adverse Reactions: Extreme bradycardia, Asystole, AV block, Hypotension, Congestive heart failure
THIAMINE HCl (vitamin B1) Adverse Reactions
Adverse Reactions: Hypotension (rare)
SODIUM BICARBONATE 8.4% Adverse Reactions
Adverse Reactions: CV: Congestive heart failure, edema secondary to sodium overload. Metabolic: Hyperosmolarity, metabolic alkalosis, hypernatremia, in cardiac arrest may cause extracellular alkalosis and intracellular acidosis.
PHENYLEPHRINE NASAL SPRAY 0.5% Adverse Reactions
Adverse Reactions: (rare with single dose, rarely absorbed systemically from nasal instillation). CV: Hypertension, palpitations. CNS: Tremors.
OXYTOCIN Adverse Reactions
Adverse Reactions: CV: Shock, tachycardia, dysrhythmias. Resp: Anaphylaxis. GI: Nausea and vomiting. GU: If used prior to delivery, can cause uterine rupture, uterine spasm, lacerations, and fetal damage. Other: Clotting disorders, electrolyte disturbances
NITROUS OXIDE 50% Adverse Reactions
Adverse Reactions: Resp: Worsening of pre-existing pneumothorax; may cause hypercarbia in oxygen sensitive patients (CO2 retainers). GI: Nausea and vomiting, may lead to rupture of intestine if administered to patient with intestinal obstruction.
NITROGLYCERIN Adverse Reactions
Adverse Reactions: CV: Hypotension, reflex tachycardia, bradycardia, decreased coronary perfusion at high doses (secondary to hypotension), headache secondary to dilation of meningeal vessels.
NALOXONE HCl Adverse Reactions
Adverse Reactions: Withdrawal symptoms, especially in neonates (nausea, vomiting, diaphoresis, increased heart rate falling blood pressure, tremors). > Be prepared for combative patient after administration.
MORPHINE SULFATE Adverse Reactions
Adverse Reactions: CV: Brady or tachydysrhythmias, orthostatic hypotension. Resp: Respiratory depression or arrest. CNS: Excess sedation, seizures to coma and arrest, pupillary constriction. GI: Nausea and vomiting, GI spasm. Derm: Histamine release may cause local urticaria.
DIPHENHYDRAMINE HCl Adverse Reactions
Adverse Reactions: CV: Hypotension; palpitations; arrhythmias; hemolytic anemia. Resp: Anaphylaxis; thickening of bronchial secretions, tightness in chest; wheezing; nasal stuffiness. CNS: Sedation; visual disturbances; seizures. GU/GI: Urinary frequency or retention; vomiting. Children: In children, may cause paradoxical CNS excitation, seizures, palpitations, thickening of bronchial secretions.
MIDAZOLAM HYDROCHLORIDE Adverse Reactions
Adverse Reactions: CV: Hypotension (especially in patients premedicated with narcotic); cardiac arrest; irregular or fast heartbeat. Respiratory: Apnea; respiratory depression, respiratory arrest; hyperventilation; wheezing or difficulty in breathing; hiccups; coughing. CNS: Emergence delirium; muscle tremor; uncontrolled or jerky movements of body; unusual excitement, irritability, or restlessness; dizziness, light-headedness, or feeling faint; prolonged drowsiness; headache. GI: nausea and/or vomiting. Midazolam administered intravenously has been associated with respiratory depression and respiratory arrest, especially when used concomitantly with opioid analgesics for conscious sedation or when rapidly administered. Midazolam may cause phlebitis. May need to adjust midazolam dose down for patients on erythromycin.
METHYLPREDNISOLONE SODIUM SUCCINATE Adverse Reactions
Adverse Reactions: None from single dose
MAGNESIUM SULFATE Adverse Reactions
Adverse Reactions: Cardiovascular: hypotension (may be transient), flushing circulatory collapse, depressed cardiac function, heart block, asystole, smooth muscle relaxant (antihypertensive effects). Respiratory: respiratory depression and/or paralysis may occur in both mother and/or infant during or up to 24 hours after the administration of MgSO4. CNS: sweating, drowsiness, hypothermia, depressed reflexes progressing to flaccidity and paralysis which may occur in both mother and/or infant during the administration of or up to 24 hours after the administration of MgSO4. GI: nausea GU: mild diuretic. Metabolic: hypocalcemia, hypermagnesemia
LIDOCAINE HCl Adverse Reactions
Adverse Reactions: CV: May also cause SA nodal depression or conduction problems and hypotension in large doses, or if given too rapidly. Excessive doses in pediatric patient may produce myocardial and circulatory depression. CNS: In large doses drowsiness, disorientation, paresthesias, decreased hearing acuity, muscle twitching, agitation, focal or generalized seizures.
GLUCAGON Adverse Reactions
Adverse Reactions: Rare side effects, Nausea and vomiting,Generalized allergic reactions including urticaria, respiratory distress and hypotension (made from beef/pork pancreas) Palpitations, hypertension, tachycardia
FUROSEMIDE Adverse Reactions
Adverse Reactions: May exacerbate hypovolemia; Hyperglycemia (due to hemoconcentration); Hypokalemia; May decrease the response to pressors
EPINEPHRINE HCl Adverse Reactions
Adverse Reactions: CV: Hypertension, ventricular dysrhythmias; tachycardia; angina.CNS: Anxiety, agitation. GI: Nausea/vomiting.
DOPAMINE Adverse Reactions
Adverse Reactions: CV: Cardiac arrhythmias may occur due to increased myocardial oxygen demand (usually tachydysrhythmias), hypertension, and hypotension at low doses. GI: Nausea and vomiting. GU: Renal shutdown (at higher doses). Other: Extravasation may cause tissue necrosis
DIAZEPAM Adverse Reactions
Adverse Reactions: CV: Bradycardia, hypotension, cardiovascular collapse; venous thrombosis; phlebitis; vascular spasm; Resp: Respiratory arrest; may be prolonged in neonate; CNS: Somnolence, confusion, coma, diminished reflexes; s/s may be prolonged in neonate; Other: Burning proximal to IV injection site; local irritation; swelling; extravasation will cause tissue necrosis
DEXAMETHASONE SODIUM PHOSPHATE Adverse Reactions
Adverse Reactions: Sodium retention, fluid retention, potassium loss, hypokalemic alkalosis, hypertension, convulsions, hyperglycemia, myocardial rupture following recent myocardial infarction
CALCIUM CHLORIDE Incompatibilities/Drug Interactions
Incompatibilities/Drug Interactions: All drugs -- flush line before and after administration
DEXTROSE 50% Incompatibilities/Drug Interactions
Incompatibilities/Drug Interactions: Sodium bicarbonate, Diazepam will precipitate if given concurrently without flushing
BUMETANIDE Incompatibilities/Drug Interactions
Incompatibilities/Drug Interactions: NSAIDs reduce diuretic effect, May increase blood levels of lithium increasing risk of lithium poisoning,Potentiates effects of various antihypertensive drugs
BRETYLIUM TOSYLATE Incompatibilities/Drug Interactions
Incompatibilities/Drug Interactions: Pressor effects of dopamine and epinephrine are variable.
ATROPINE SULFATE Incompatibilities/Drug Interactions
Incompatibilities/Drug Interactions: Sodium bicarbonate (relative)
ACETYLSALICYLIC ACID, ASA Incompatibilities/Drug Interactions
Incompatibilities/Drug Interactions: Not applicable with single dose therapy
AMIODARONE Incompatibilities/Drug Interactions
Incompatibilities/Drug Interactions: Beta blockers, calcium channel blockers, and other antiarrhythmics are additive and can be proarrhythmic when given in combination with amiodarone due to similar mechanisms of action. Amiodarone precipitates at certain concentrations when mixed at a Y-site with sodium bicarbonate or furosemide.
ALBUTEROL SULFATE Incompatibilities/Drug Interactions
Incompatibilities/Drug Interactions: Tricyclic antidepressants (TCA's) and monoamine oxidase (MAO) inhibitors, other sympathomimetics (relative)
ADENOSINE Incompatibilities/Drug Interactions
Incompatibilities/Drug Interactions: Adenosine is not blocked by Atropine. Theophylline and related methylxanthines (caffeine & theobromine-xanthine) in therapeutic concentrations decrease effectiveness. Dipyridamole (Persantine) & carbamazepine (Tegretol, Atretol) block uptake and potentiate effects.
CHARCOAL, ACTIVATED (without sorbitol) Incompatibilities/Drug Interactions
Incompatibilities/Drug Interactions: Ineffective for iron, lithium, heavy metals, and other ions. May reduce the effectiveness of other treatments (Mucomyst) in pure acetaminophen OD's. Since charcoal bonds with whatever it is mixed with, flavoring with drinks reduces effectiveness.
VERAPAMIL HCl Incompatibilities/Drug Interactions
Incompatibilities/Drug Interactions: IV Beta-blockers
THIAMINE HCl (vitamin B1) Incompatibilities/Drug Interactions
Incompatibilities/Drug Interactions: None
SODIUM BICARBONATE 8.4% Incompatibilities/Drug Interactions
Incompatibilities/Drug Interactions: Incompatible with other drug infusions
PHENYLEPHRINE NASAL SPRAY 0.5% Incompatibilities/Drug Interactions
Incompatibilities/Drug Interactions: None
OXYTOCIN Incompatibilities/Drug Interactions
Incompatibilities/Drug Interactions: None in prehospital arena
NITROUS OXIDE 50% Incompatibilities/Drug Interactions
Incompatibilities/Drug Interactions: Analgesic effect of nitrous oxide is potentiated by parenteral analgesics and sedatives (i.e. morphine, diazepam).
NITROGLYCERIN Incompatibilities/Drug Interactions
Incompatibilities/Drug Interactions: Other vasodilators, Viagra
NALOXONE HCl Incompatibilities/Drug Interactions
Incompatibilities/Drug Interactions: Should not be mixed with other drugs
MORPHINE SULFATE Incompatibilities/Drug Interactions
Incompatibilities/Drug Interactions: CNS side effects (including respiratory depression) can be reversed by naloxone.
DIPHENHYDRAMINE HCl Incompatibilities/Drug Interactions
Incompatibilities/Drug Interactions: Additive effects with alcohol and other CNS depressants (hypnotics, sedatives, tranquilizers, etc.). MAO inhibitors prolong and intensify anticholinergic (drying) effects.
MIDAZOLAM HYDROCHLORIDE Incompatibilities/Drug Interactions
Incompatibilities/Drug Interactions: Midazolam may potentiate the action of other CNS depressants, including opiate agonists or other analgesics, barbiturates or other sedatives, anesthetics, or alcohol. Erythromycin may double the half-life of midazolam.
METHYLPREDNISOLONE SODIUM SUCCINATE Incompatibilities/Drug Interactions
Incompatibilities/Drug Interactions: None
MAGNESIUM SULFATE Incompatibilities/Drug Interactions
Incompatibilities/Drug Interactions: Concurrent digilization increases danger of dysrhythmias
LIDOCAINE HCl Incompatibilities/Drug Interactions
Incompatibilities/Drug Interactions: None known
GLUCAGON Incompatibilities/Drug Interactions
Incompatibilities/Drug Interactions: Unknown
FUROSEMIDE Incompatibilities/Drug Interactions
Incompatibilities/Drug Interactions: Increased effects with other antihypertensives
EPINEPHRINE HCl Incompatibilities/Drug Interactions
Incompatibilities/Drug Interactions: Potentiates other sympathomimetics. Reacts with alkaline solutions, such as sodium bicarbonate, should not be mixed with alkaline agents.
DOPAMINE Incompatibilities/Drug Interactions
Incompatibilities/Drug Interactions: Incompatible in any alkaline solution. On-board MAO inhibitors will cause hypertensive crisis
DIAZEPAM Incompatibilities/Drug Interactions
Incompatibilities/Drug Interactions: Do not mix or dilute diazepam with other solutions or drugs in syringe, tubing or IV container.
DEXAMETHASONE SODIUM PHOSPHATE Incompatibilities/Drug Interactions
Incompatibilities/Drug Interactions: Dexamethasone is not compatible with Benadryl or Versed in IV tubing.
CALCIUM CHLORIDE Adult Dosage
Adult Dosage: Hypocalcemia, calcium channel blocker OD, hyperkalemia and hypermagnesemia: 5-10 ml (0.5-1 Gm) of 10% calcium chloride. May repeat in 10 minutes. Pre-treatment for IV verapamil administration: 3 ml of 10% calcium chloride. May be repeated once.
DEXTROSE 50% Adult Dosage
Adult Dosage: Hypoglycemia, altered level of consciousness or seizures of unknown etiology: 25-100 ml of D50 (12.5-50 Gm, 2 to 2 amps) IV. Hyperkalemia: 50 Gm of Dextrose IV total may be given over 1 hour. This is a part of a combination drug therapy. See: profiles for calcium chloride and sodium bicarbonate. Insulin may be given upon arrival to ED.
BUMETANIDE Adult Dosage
Adult Dosage: 0.5 to 1.0 mg IV slowly over 1 to 2 minutes, or IM
BRETYLIUM TOSYLATE Adult Dosage
Adult Dosage: VF/Pulseless VT, refractory to defibrillation/lidocaine: 5 mg/kg rapid IVP initial bolus followed by a flush with 20 ml NS; if needed may repeat at 10 mg/kg rapid IVP; thereafter repeat at 5-30 minute intervals until total dose of 35 mg/kg/day. If VF/ Pulseless VT converts with bretylium, a constant infusion of 2 mg/min should be initiated. Refractory VT in conscious patient with pulses: Initial dose 5 mg/kg diluted in 50-100 ml of NS given over 8-10 minutes. If VT remains refractory, a second bolus may be given at 5-10 mg/kg or a continuous infusion may be established at 2 mg/min. If bretylium converts VT, complete the loading dose and begin a continuous infusion at 1-2 mg/min.
ATROPINE SULFATE Adult Dosage
Adult Dosage: Symptomatic Bradycardia: 0.5-1.0 mg rapid IV push or via ET every 3-5 minutes to a total dose of 3 mg if symptoms profound (0.03-0.04 mg/kg). Asystole or PEA with bradycardia: 1.0 mg rapid IV push or via ET every 3-5 minutes to a total dose of 3 mg. Cholinergic or organophosphate poisoning: 2.0-5.0 mg IV, may repeat in 5 minutes. Max dose is unlimited. Bronchospasm: 1.0 mg SVN prepared by using 2.5 ml of 0.4 mg/ml solution out of 8 mg/20 ml vial (may add 0.5 ml NS to make 3 ml inhalation treatment, 2.5 ml is adequate) administered with a mouth piece, O2 mask, or in-line with a ventilatory device; may repeat in 30 minutes or according to medical control preference.
ACETYLSALICYLIC ACID, ASA Adult Dosage
Adult Dosage: Cardiac: 160- 325 mg (2-4 pediatric chewable tabs), chew or swallow, Pain/discomfort/fever: 325 mg po (4 pediatric chewable tablets), chew or swallow
AMIODARONE Adult Dosage
Adult Dosage: For maintenance infusion post resuscitation: After successful defibrillation, follow with up to 1mg/min IV infusion for 6 hours, then up to 0.50 mg/min IV infusion for 18 hours. For maintenance infusion: Rates range from 0.50mg/min to 1mg/min. Maximum daily dose is 2.0 g
ALBUTEROL SULFATE Adult Dosage
Adult Dosage: Give 2.5 mg of premixed solution for inhalation (0.083%) via SVN with a mouth piece, or inline with a ventilatory device. Repeated according to medical control preference
ADENOSINE Adult Dosage
Adult Dosage: Initial: 6 mg rapid IV bolus over 1-3 seconds Special administration procedure: Follow immediately with 20 ml normal saline flush. IV site recommended is antecubital fossa (close to central circulation); use injection port nearest hub of IV catheter; arm elevated during procedure; constant ECG monitoring. Repeat: If no response in 1-2 minutes (of each dose, respectively) may repeat 12 mg, twice, utilizing the same procedure for repeat dose.
CHARCOAL, ACTIVATED (without sorbitol) Adult Dosage
Adult Dosage: 30-60 Gm (1-2 Gm/kg); if not in pre-mixed slurry, mix one part charcoal with four parts water.
VERAPAMIL HCl Adult Dosage
Adult Dosage: 2.5 - 5.0 mg IV PUSH over 2-3 minutes. May rebolus in 15-30 minutes with 5-10 mg IV PUSH until a maximum dose of 20 mg
THIAMINE HCl (vitamin B1) Adult Dosage
Adult Dosage: 100 mg
SODIUM BICARBONATE 8.4% Adult Dosage
Adult Dosage: Pre-existing Metabolic Acidosis or Alkalinization of Blood: 50-100 mEq IV per medical control authority. Infusion: 50 mEq of sodium bicarbonate/250 ml of NS or as determined by medical control. Cardiac arrest: First dose usually 1 mEq/kg (or as determined by blood gas analysis), with subsequent doses of 0.5 mEq/kg every 10 minutes in cardiac arrest after other standard treatment (defibrillation, CPR, intubation, ventilation and more than one trial of epinephrine) has been used.
PHENYLEPHRINE NASAL SPRAY 0.5% Adult Dosage
Adult Dosage: 2-4 sprays in each nostril before attempting tube insertion
OXYTOCIN Adult Dosage
Adult Dosage: Postpartum hemorrhage: 10-20 USP units added to 1000 cc NS or LR and run at a rate necessary to control uterine atony or 10 USP units may be given IM after delivery of placenta.
NITROUS OXIDE 50% Adult Dosage
Adult Dosage: Self-administer and self-regulated by the patient, who must hold the mask to face to create an airtight seal until the pain is significantly relieved or the patient drops the mask.
NITROGLYCERIN Adult Dosage
Adult Dosage: SL for Chest pain: 1/150 gr (0.4 mg) tablet or one full spray, may repeat x 3. SL for Pulmonary edema: 1-2 of the 1/150 gr (0.4 mg) tablets may be given SL every 5-10 minutes as long as the systolic BP is greater 90-100 systolic. ** IV infusion during interfacility transport must be given via infusion pump: Start at low range of 5 µg/min and increase in increments of 5 µg, monitoring pain and blood pressure until desired hemodynamic or clinical response is achieved (fall in SVR, relief of chest pain); most patients respond to 50-200 µg/min
NALOXONE HCl Adult Dosage
Adult Dosage: IV, IM, inject SL, SC, ET: 2.0 mg initial bolus IV or ET, may repeat every 2 minutes as necessary; titrate to effect. Intra-nasal: 1.0 mg each nostril using a Mucosal Atomizer Device for a total of 2 mg. May repeat every 2 minutes as necessary. Titrate to effect. ** Continuous IV Infusion: 2/3 of the initial bolus/hr (bolus that it took to reverse) administered as a continuous infusion; i.e., if 2 mg Narcan resulted in opioid reversal initially, then it can be maintained by continuous infusion of 1.4 mg/hr. Put 1.4 mg Narcan in 250 ml NS and run at 250 ml/hr. A repeat IV bolus of 2 the initial bolus administered 15 minutes after the initial bolus is recommended.
MORPHINE SULFATE Adult Dosage
Adult Dosage: IV Dose: Administer 1-3 mg increments slow IV PUSH (over 1-5 minutes) until desired effect.
DIPHENHYDRAMINE HCl Adult Dosage
Adult Dosage: Anaphylaxis: 25-50 mg slow IV push or deep IM. Extrapyramidal symptoms and antiemetic: 10-50 mg IV or deep IM, dose should be individualized according to the needs and patient response.
MIDAZOLAM HYDROCHLORIDE Adult Dosage
Adult Dosage: Patients 14 to 60 years of age: 2 to 5 mg IM /1 to 5 mg IV, titrate to effect, administer slowly in small increments of no more than 2.5 mg over at least 2 minutes. Patients over 60 years of age: 1 to 3 mg IM /1 to 3.5 mg IV, titrate to effect, administer slowly in small increments of no more than 1.5 mg over at least 2 minutes. Total dose: Should not exceed 20 mg. For emergency intubation: 0.1 mg/kg up to 0.3 mg/kg with dosage limit of 20 mg. Seizures: 0.2 mg/kg IM for status seizures if no IV access
METHYLPREDNISOLONE SODIUM SUCCINATE Adult Dosage
Adult Dosage: Reactive Airway Disease, Anaphylaxis, Burns Potentially Involving the Airway: Usual dose 125 mg slow IV bolus (much larger doses can be used). Acute Spinal Cord Trauma: Should be within 6 hours of insult and patient meeting criteria, initial bolus dose of 30 mg/kg IV administered over 15 minutes; bolus followed by a 45 minute rest period, then a 23-hour continuous infusion of 5.4 mg/kg/hr. See: Special Notes.
MAGNESIUM SULFATE Adult Dosage
Adult Dosage: VF/Pulseless VT: 1-2 Gms IV in 1-2 minutes or dilute 1-2 Gms in 100 ml NS administered over 1-2 minutes. Torsades de pointes: 1-2 Gms over 1-2 minutes or dilute 1-2 Gms in 100 ml NS administered over 1-2 minutes followed by the same amount infused over 1 hour. Hypomagnesemia: Dilute 1-2 Gms in 50-100 ml NS administered IV push over 5-60 minutes. Pre-term labor (PTL): Initial bolus (Field and Interfacility): 4-6 Gm over 15-20 minutes (Suggested method is the addition of 4 Gms to 100 ml D5W, LR or NS. Resultant concentration is 40 mg/ml) Maintenance Infusion (Interfacility only): 1-4 Gms/hour infusion rate. Suggested method for treatment of premature labor is to follow initial bolus with infusion of 2 Gms/hr which may be continued until uterine contractions are reduced to < 1 every 10 minutes. Then, infusion is decreased to 1 Gm/hr and continued for 24-72 hrs. One method for mixing infusion is the addition of 40 Gms to 1000 ml LR. Resultant concentration equals 40 mg/ml. If this concentration is run at 50 ml/hr, MgSO4 delivered equals 2 Gms/hr). Pregnancy induced hypertension, preeclampsia/eclampsia, (PIH): Initial bolus (Field and Interfacility): 3-6 Gm over 10-15 minutes (Suggested method is the addition of 4 Gms to 100 ml D5W, LR or NS. Resultant concentration is 40 mg/ml). Maintenance Infusion (Interfacility only): Follow bolus with 1-3 Gms/hour infusion rate. (Same mixture as for PTL). Rebolus: In an eclamptic emergency may rebolus with MgSO4, 2-4 Gms depending on patient size (mixed as in initial bolus) over 10-15 minutes if DTRs 2+ or higher, respirations >12/minute and urine output >30 ml/hr.
LIDOCAINE HCl Adult Dosage
Adult Dosage: Pulseless VF/VT: Initial bolus of 1.0-1.5 mg/kg IV PUSH every 3-5 minutes to a total of 3 mg/kg. An initial bolus of 1.5 mg/kg should be given for cardiac arrest situations. Following the return of a spontaneous rhythm, initiate a drip at 2-4 mg/min. Antidysrhythmic or rhythms with a pulse: Initial boluses can be given as 1.0-1.5 mg/kg IV PUSH and additional boluses can be given as 0.5-0.75 mg/kg every 5-10 minutes to a total dose of 3 mg/kg. Following the return of a spontaneous rhythm, initiate a drip at 2-4 mg/min; see below. Maintenance Infusion: Started after return of spontaneous rhythm for either indication above. Add 1 gm - 2 g to a 250 ml NS or 5 % dextrose solution or use premixed solution (2 gm in 500 ml) and initiate a drip at 2-4 mg/min according to concentration. Patients > 70 years or with hepatic, renal disease or poor perfusion state, reduce maintenance infusion by half. Pre-intubation for head trauma or suspected Intra cranial hemorrhage (hypertension and focal neurologic S/S). Consider administration of 1 mg/kg IV bolus 1-2 minutes prior to intubation.
GLUCAGON Adult Dosage
Adult Dosage: (children and adults greater than 20 kg or 44 lbs) Hypoglycemia: 1 mg IM, may repeat in 7-10 minutes
FUROSEMIDE Adult Dosage
Adult Dosage: On oral furosemide therapy: Consider initial dose of 2 times daily oral dose, if no effect in 20 minutes may double initial dose. Not on oral furosemide therapy: 0.5-1 mg/kg to a maximum of 2 mg/kg (usually 20-40 mg) IV slowly.
EPINEPHRINE HCl Adult Dosage
Adult Dosage: IV for Cardiac Arrest - VF/Pulseless VT, asystole, PEA: Use 1:10,000 solution and give 1.0 mg every 3-5 minutes flushing each with 20 ml of IV fluid, or, ET for Cardiac Arrest - VF/Pulseless VT, asystole, PEA: Give 2.0 - 2.5 mg via the ET tube. May use 1:10,000 or dilute 1:1000 to equal 10 ml via ET tube for adult. (i.e., 2 mg of 1:1000 epinephrine diluted with 8 ml NS in a 10 ml syringe) Continuous Infusion during Cardiac Arrest or profound Bradycardia: 1 mg every 3-5 minutes. Add 30 mg epinephrine to 250 ml NS to run at 100 ml/hr (same as 1 mg every 3 minutes) or titrated to desired hemodynamic end point. Central line preferred, patency of line must be assured. Continuous Infusion for Hypotension or Symptomatic Bradycardia: 1 mg added to 500 ml of NS administered at 1 mg/min titrated to desired hemodynamic response (range 2-10 Mg/min); not first-line therapy. Anaphylaxis and asthma: Give 0.1- 0.3 mg of 1:1000 solution SC, IM or inject SL; or in extreme cases only, may be asked to use 1:10,000 solution and give 0.1 mg, q 30-60 sec. IV, titrated to effect in patients without cardiovascular collapse, or give 0.3 - 0.5 mg ET or IV if cardiovascular collapse is present.
DOPAMINE Adult Dosage
Adult Dosage: (dosage range 2-20 Mcg/kg/min). Preparation: (If premixed not carried) Add 400 mg/ 250 ml NS or Dextrose = 1600 Mcg/ml. Bradycardia: Start at 5 Mcg/kg/min. Shock: cardiogenic or septic (non-hypovolemic): BP < 70 systolic: Start drip at 5 Mcg/kg/min. BP > 70 systolic: Start drip at 2.5 Mcg/kg/min
DIAZEPAM Adult Dosage
Adult Dosage: 2 mg increments slow IV push. Administer no faster than 2 mg/minute.
DEXAMETHASONE SODIUM PHOSPHATE Adult Dosage
Adult Dosage: Reactive Airway Disease, Anaphylaxis 8 - 24 mg. Cerebral edema: 1-5mg/kg
CALCIUM CHLORIDE Pediatric Dosage
Pediatric Dosage: Hypocalcemia, calcium channel blocker OD hyperkalemia and hypermagnesemia: 0.2 - 0.25 ml/kg of a 10% solution infused slowly. Should not be repeated without documented calcium deficiency.
DEXTROSE 50% Pediatric Dosage
Pediatric Dosage: (14 yrs and below includes infant) Administer 0.5 - 1 Gm/kg of a dextrose 10% solution; recommended to give slowly over a 20 minute period. Dilute D50 (dextrose 50% containing 25 Gm of dextrose) to a 1:4 solution. To prepare, obtain a 250 ml container of normal saline for IV use; waste 50 ml and add 50 ml of dextrose 50%. The resulting solution is dextrose 10% in normal saline or 10 grams/100ml.
BUMETANIDE Pediatric Dosage
Pediatric dosage: none
BRETYLIUM TOSYLATE Pediatric Dosage
Pediatric Dosage: Same as adult (rarely given)
ATROPINE SULFATE Pediatric Dosage
Pediatric Dosage: Symptomatic Bradycardia only: 0.02 mg/kg (minimum of 0.1 mg) IV push (after epinephrine). May repeat only one time. Maximum single doses: Child 0.5 mg; Adolescent 1 mg. Bronchospasm: 0.5 mg SVN prepared by using 1.25 ml of 0.4 mg/ml solution out of 8 mg/20 ml vial, may add 1.25-1.75 ml NS to make 2.5-3 ml inhalation treatment (2.5 ml is adequate). Administer with a mouth piece, O2 mask or in-line with a ventilatory device. May repeat in 30 minutes or according to medical control preference.
ACETYLSALICYLIC ACID, ASA Pediatric Dosage
Pediatric Dosage: Not recommended for children
AMIODARONE Pediatric Dosage
Pediatric Dosage: none
ALBUTEROL SULFATE Pediatric Dosage
Pediatric Dosage: For children < 40 lbs., administer half of 0.083% premixed solution; add 1-1.5 ml NS to make 2.5-3 cc inhalation treatment administered via SVN with a mouth piece, O2 mask or in-line with a ventilatory device. May be repeated according to medical control preference
ADENOSINE Pediatric Dosage
Pediatric Dosage: (Drug of choice for treating SVT in symptomatic infants and children) Initial: 0.1 mg/kg as a rapid IV bolus. Special administration procedure: Follow immediately with 2-3 ml normal saline flush. Use injection port nearest the hub of IV catheter for procedure; constant ECG monitoring. Repeat: If no response, dose may be doubled 1 time (0.2 mg/kg) using same administration procedure. Maximum singe dose: Should not exceed 12 mg. Infants with SVT associated with shock: Adenosine may precede cardioversion if vascular access is available, but cardioversion should not be delayed while IV access is achieved.
CHARCOAL, ACTIVATED (without sorbitol) Pediatric Dosage
Pediatric Dosage: 0.5 -1.0 Gm/kg; if not in pre-mixed slurry, mix one part charcoal with four parts water.

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