AZ Paramedic Cardiac Drugs

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Asprin: T/C:analgesic; antipyretic; anti-inflammatory
MOA:A2 blocker (Small doses), Vasoconstrictor, Decreased platelet aggregation
I:Symptoms indicative of acute MI. Unstable angina. Pain or Fever
C/I:Cronic conditions of bleeding of any type. Know sensativities, asathama.
Dose:160 to 325 Chewable PO
Carried:36-100 tablets
Adenosine: T/C:Antiarrhythmic
MOA:Slows conduction time through AV node, Slows sinus rate Larger doses decrease BP by decreasing peripheral resistance
I:Conversion of SVTs
C/I:Sick Sinus Syndrome, 2nd and 3rd degree AV Blocks, Known atrial fibrillation or atrial flutter
Dose:6 mg rapid IV bolus over 1-3 seconds, Follow immediately with 20 ml normal saline flush. constant ECG monitoring (6,12, 12 total of 30mg)
Carried: Flip top vials 6 mg/2 ml, Prefilled syringe 6 mg/2 ml/5-6 vials in the drug box.
Amiodarone: T/C:Antiarrythmic
MOA:Prolongs action potential, refractory period, and ventricular automaticity (K+ Blocker) Slows impulse conduction (NA) Negative chronotropic activity(Ca++) Dilates coronary arteries.
I:shock-refractory VF/pulseless VT, polymorphic VT, and wide complex tachycardia of uncertain origin. Control hemodynamically stable ventricular tachycardia Adjunct to cardioversion of SVT and PSVT. Rate control in atrial fibrillation or flutter
C/I:Brady, Heart Blocks CG shock, Hypotension, PE
Dose:1mg/min IV infusion for 6 hours, then 0.50 mg/min IV infusion for 18 hours. Maximum daily dose is 2.2 g
Carried:
Atropine: T/C:parasympatholytic, antimuscarinic, anticholinergic, parasympathetic antagonist,
parasympathetic blocker

MOA:smooth muscle and glands, blocking parasympathetic response and allowing sympathetic response to take over
I:Symptomatic bradycardia, sinus, junctional, and AV blocks causing significant hypotension, ventricular ectopy, chest pain, altered level of consciousness, etc,Asystole (after epinephrine),PEA with Brady,organophosphate, cholinergic poisoning
C/I:Glaucoma, acute narrow angle
Dose: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)1.0mg for everything else.
Carried:3 - 4 (1 mg/10 ml) prefilled syringes, 1 - 2 (8 mg/20 ml, 0.4 mg/ml) multidose vial
Calcium Chloride: T/C:electrolyte
MOA:Increases extracellular and intracellular calcium levels, Increases cardiac contractile state (positive inotropic effect) May enhance ventricular automaticity
I:Acute hypocalcemia, Calcium channel blocker OD, Acute hyperkalemia, Hypermagnesemia
C/I:Hypercalcemia, Concurrent digoxin therapy
Dose:5-10 ml (0.5-1 Gm) of 10% calcium chloride
Carried:1 Gm/10 ml prefilled syringes (1-2 vials)
Dopamine: T/C:sympathomimetic
MOA:Dose dependant Low dose D receptors, Middle Beta, High Alpha
I:Symptomatic bradycardias, Hemodynamically significant hypotension in the absence of hypovolemia
C/I:Hypovolemic shock, MAOI's
Dose:dosage range 2-20 µg/kg/min
Carried:400 mg/5 ml vials
400 mg in 250 ml D5W premixed IV solution
Epi: T/C:sympathomimetic
MOA:Direct acting a and ÃŸ agonist ÃŸ1-positive inotropic and chronotropic actions
I:First line pharmacologic agent for any pulseless dysrhythmia in cardiopulmonary arrest Bradycardia, refractory with profound hypotension
C/I: None
Dose:1:10,000 solution and give 1.0 mg every 3-5 minutes flushing each with 20 ml of IV fluid
Carried: 1:10,000 prefilled syringes x 6 - 8
1:1000 ampules or prefilled syringes x 1 - 2
FUROSEMIDE-Lasix: T/C: Loop Diuretic
MOA:Vasodilation increases venous capacitance and decreases afterload, Promotes Urine production in the kindneys.
I:Pulmonary Edema, CHF
C/I:Hypovolemia Hypotension
Dose:0.5-1 mg/kg to a maximum of 2 mg/kg (usually 20-40 mg) IV slowly
Carried:4 (20 mg/2 mL) or
4 (40mg/4mL) or
2 (100mg/10mL)
Mag Suflfate: T/C:electrolyte, tocolytic
MOA:); decreases myocardial irritability and neuromuscular irritability.
I: TdP, VF/Pulseless VT refractory to lidocaine, Pre term labor and Pre Eclampsia.
C/I:None in the field, Digatalis therapy
Dose:1-2 Gms IV in 1-2 minutes
Carried:4 - 10 1 gm/2 ml vials
Lidocane: T/C:antiarrhythmic, local anesthetic
MOA:Decreases automaticity by slowing the rate of spontaneous phase 4 depolarization.
Terminates re-entry by decreasing conduction in re-entrant pathway
I:Suppression of ventricular tachycardia, ventricular fibrillation, PVC's
C/I: hypersenastivities
Dose: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
Carried:100 mg/5 ml prefilled syringes x 3 - 4
1 gm/25 ml vial x 1 - 2
2 gm/50 ml vial (premixed in 500 ml D5W optional) x 1 - 2
Nitro: T/C:vasodilator, organic nitrate, antianginal
MOA:Smooth muscle relaxant acting on vascular, uterine, bronchial, and intestinal smooth muscle, reduces workload.Coronary artery vasodilation
I:Angina Myocardial infarction
Congestive heart failure with pulmonary edema

C/I:hypovolemia, hypotension, VIAGRA
Dose: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 systol
Carried:1 - 2 bottles of tablets, or 1 - 2 spray bottles
Sodium Bicarb: T/C:buffer
MOA:Buffers H+ and increases pH
I:Pre-existing metabolic acidosis
Overdose of aspirin, cyclic antidepressants (alkalinization of blood)
Cardiac arrest after other interventions and ventilation is adequate

C/I:Alkalosis
Dose: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.
Carried:2 - 3 prefilled syringes
Verapamil: T/C:calcium channel blocker
MOA:Blocks calcium ion influx into cardiac and smooth muscle cells causing a depressant effect on the contractile mechanism resulting in negative inotropy.Slows conduction and prolongs refractory period in the AV node due to calcium channel blocking.
Slows SA node discharge

I:Supraventricular tachycardia
Atrial fibrillation and atrial flutter with rapid ventricular response

C/I:AV block, Sick sinus syndrome, any wide QRS complex tachycardia
Dose:2.5 - 5.0 mg SIVP (over 2-3 minutes). May rebolus in 15-30 minutes with 5-10 mg SIVP until a maximum dose of 20 mg
Carried:5 mg/2 ml prefilled syringes, ampules and vials (2.5 mg/ml)
Vasopressin: T/C:Putitary Hormone, antidiuretic
MOA:Causes massive Vasoconstriction, Acts on V1
I: Shock refractory Vfib and Puselses Vtac.
C/I:Hypertension. Consciousness.
Dose: 40u one time only, prior to administartion of Epi.
Carried:40u/1ml
Morphine Suflfate: T/C:narcotic agonist
MOA:Increases venous capacitance (venous pooling), vasodilates arterioles, reducing preload and afterload. Analgesic.
I:Analgesia, especially in patients with burns, myocardial infarction, or renal colic.
Pulmonary edema (cardiogenic).

C/I:Respiratory depression
Head injuries
Elevated Intra cranial pressure

Dose:Administer 1-3 mg increments slow IV PUSH (over 1-5 minutes) until desired effect.
Carried:10 mg/ml ampules x2

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