Maryland Medical Protocols 2005 (Pharmacology)

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What is a contraindication for Activated Charcoal?: 1. Altered mental status.
2. Has taken an emetic.
What is the ADULT dosage for Activated Charcoal?: 1 gm/kg
What is the PEDIATRIC dosage for Activated Charcoal?: 1 gm/kg
What is Adenosine used to treat?: Narrow complex Tachachardia, PSVT with WPW, PSVT, SVT.
What does Adenosine do?: Slows conduction through the AV Node.
What is the contraindication for Adenosine?: Known Hypersensitivity.
What is the adult dosage for Adenosine?: 6 mg, 12 mg, 12 mg
What is the pediatric dosage of Adenosine?: .1 mg/kg to .2 mg/kg max initial dose 6mg max secondary and tirtiary dosages 12 mg.
Is Medical Consult needed for Adenosine for a CRT-I?: Yes
What is the dosages for albuterol (adult and pediatric)?: Adult 2.5 mg nebulized 2 y/o and up 1.25 mg nebulized 2 and below. May repeat once.
Is Medical consult needed for albuterol Sulfate?: Medical consult is needed for pregnant Cardiac history patients.
What is the indication for asprin?: Chest pain when acute Myocardial infarction is suspected.
What is the contraindication for asprin?: Known hypersensitivity.
When should you be careful giving asprin: GI Bleeding and upsent.
What is the adult dosage for Asprin?: 325 mg
What is the Pediatric dosage for Asprin?: Not indicated.
What are the indications for using Atropine Sulfate?: Symptomatic Bradycardia
Organophosphate poisoning
Asystole
Nerve Agents.
What are the contraindications for using Atropine?: Known Hypersensitivity,
2nd degree type two, third degree AV Block, suspected AMI,Ischemia, Glaucoma
What are the adult dosages for Atropine (Asystole and Bradycardia)?: Asystole - 1mg/kg 3-5 mins
Bradycardia - .5 - 1mg/kg 3-5 mins
MAX dose .04 mg/kg
What is the pediatric dosage for Atropine?: .02 mg/kg min dose .1 mg
Max SINGLE Dosage
(10-25kg) .5mg
(25-40kg) 1mg
May repeat one time
What is the atropine dosage for Organophosphate poisoining? (adult & Ped): Adult
2-4 mg every 5-10 min
.02 mg/kg every 5-10 min
Is Medical consult needed for Atropine?: Consult is needed in the case of Organophosphate poisoning.
What is another name for Atrovent?: Ipratroprium.
What are the indications for Atrovent?: Anaphalaxis/ allergic reaction
Bhroncial Asthma
Bhroncospasms due to chronic bhronchitis or emphysema.
What are the contraindications for atrovent?: Known Hypersensitivity
Known Hypersensitivity to Atropine
Under 1 y/o
What are the precautions for Atrovent?: Use caution with CHF, Heart disease, hypertension, glaucoma. May worsen glaucoma if gotten in the eyes. Must be used with a beta agonist (albuterol)
What is the adult and pediatric dosages for Atrovent?: Adult > 2/yo 2.5 ml
Pediatric < 2y/o 1.25 ml
What are the indications for Calcium Chloride?: Hyperkalemia
Hypocalcemia
Calcium Channel Blocker OD
Hypotension due to Diltiazem admin
What are the cotraindications for Calcium Chloride?: Not indicated in cardiac arrest unless patient has Hypocalcemia, Hyperkalemia, Calcium Channel Blocker toxicity
Patient taking Digoxin with Calcium Channel Toxicity
What is the adult dosage for Calcium Chloride?: .5 mg - 1mg every 10 minuites
250ug for hypotension due to Diltiazem.
What is the pediatric dosage for Calcium Chloride?: 20 mg/kg max dose 1 gm or 10ml.
What is the dosage for Dextrose 50%?: Adult 25 mg
Pediatric
Less then 2mos 5-10ml/kg D10W
2 mos - 2 yrs 2-4ml/kg D25W
1-2 ml/kg D50W Max 25ml
What are the contraindications for Diazepan?: Head injury, Altered mental status, hypotension, Narrow angle glaucoma.
Is Medical Consult needed fore Dextrose 50%?: No
Is Medical consult needed for Diazepam?: Yes
What are the dosages for Diazepam? (Adult and Ped): Adult 2.5-10 mg in 2.5 mg increments
Ped - .1mg/kg IV/IO/IM
Max dose 5 mg
Rectal - .2mg/kg Max 10 mg
When may Diazepam be used without medical consult?: Severe Nerve Agent exposure.
What class is Diltiazem?: Calcium Channel Blocker
What is Diltiazem used for?: Symptomatic A-fib & A-flutter
What is the contraindications for Diltiazem?: BP below 90 mm Hg, Second or third Degree heart block, hypersensitivity, patients less then 12 y/o
What are the precautions for diltiazem?: Use with caution in patients with renal failure or congestive heart failure.
What is the dosage for diltiazem? (adult & pedi): .25 mg/kg Max does 20mg slow IVP over 2 min repeat in 15 minutes .35 mg/kg max dose 25 mg slow ivp over 2 min

Patients over 50 5-10mg slow ivp over 2 min

Under 12 - contraindicated
What do you do if diltiazem admin causes Hypotension?: Calcium Chloride 250 mg slow IVP with medical consult, IV LR, Elevate legs.
What is the course of action if diltiazem admin causes bradycardia?: Consider atropine .5 to 1 mg; if neccesary consider pacing.
What are the indications for Diphenhydramine?: Allergic reaction, Anaphalaxis, Dystonic reactions.
What are the contraindications for Diphenhydramine?: Known hypersensitivity.
Is Medical consultation required for Diphenhydramine?: For Asthmatics and Nursing mothers. Caution with severe vomiting and intoxication.
What is the adult dosage for Diphenhydramine?: 25 - 50 mg slow IVP or IM
What is the pediatric dosage for Diphenhydramine?: 1 mg/kg slow IV/IO or IM Max single dose 25 mg.
What are the indications for Dopamine (Intropin)?: Shock
What are the contraindications for Dopamine?: Pheochromocytoma (adrenal tumor)
Pre-existing Tachydysrhythmias
Uncorrected Hypovolemia.
What is the dosage for dopamine?: 2-20ug/kg/min IV titrate to BP of 100Systolic or med consult selected BP, initial infusion rate of 2-5 ug/kg/min
Peds same but inital rate of 2 ug/kg/min.
What are the indications for Epinepherine?: Cardiac arrest
Moderate to Severe allergic reaction
Asthma
Respiratory Stridor (Croup)
What are the contraindications for epinepherine?: Hypertension, pre-existing tachydysrhythmias with a pulse, Use with pregnant women should be avoided when ever possible.
What are the precautions for epinepherine?: Sodium Bicarb deactivates epi
Epi causes dramatic increas in myocardial oxygen consumption
Its use in teh setting of an acut MI should be restriceted to cardiac arrest, IVP Epi (1:1,000) should not be administred to any patient with a pulse.
What is the Adult cardiac arrest dosage for epinepherine?: 1 mg (1:10,000) IVP every 3-5 mins
If this fails consider 2-5 mg IVP every 3-5 with medical consult. ET does 2 -2.5 times teh IV dose if using 1:1000 dilute in 10ml of lactated ringers.
What is the pediatric cardiac arrest dosage for epinepherine?: .01 mg/kg (1:10,000) IVP/IO
ET .1mg/kg 1:1000 diluted with 3-5ml lr every 3-5 min
What is the neonate cardiac arrest dosage for epinephrine?: .01 mg/kg 1:10,000 IVP/IO
ET .01 mg/kg 1:1000 with 1 ml LR.
What is the adult Bradycardia dosage of epinephrine?: Bzzzzzzzt! Not given.
What is the pediatric bradycardia dosage of epinephrine?: .01 mg/kg 1:10,000 every 3-5 min
ET .1 mg/kg 1:1000 diluted in 3-5 ml LR every 3-5 min
What is the neonate bradycardia dosage of epinphrine?: .01 mg/kg 1:10,000 every 3-5 mins
ET .01 mg/kg 1:1000 with 1ml of LR
What is the adult dosage or Epi in anaphylactic shock/asthma?: .1 mg/kg 1:10,000 for anaphylactic shock Only

Adult .3 mg SC
Pedi .01 mg/kg SC max .3 mg
How is Epinephrine administered with croup?: 2.5 ml 1:1000 via nebulizer if no improvement admin an additional dose.
In what situations would you need to consult with medical control for Epinephrine?: If initial 1mg epi in cardiac arrest fails can consult for 2-5 mg IVP every 3-5 min
Anaphylactic shock
Croup
What are the indications for Furosemide (Lasix)?: Acute pulmonary edema
CHF
Edema related to kidney or liver disease
What are the contraindications for Furosemide?: Known hypersensitivity, allergic to sulfanamides, dehydrated patients, pregnancy, hypokalemia
What is the adult and pediatric dosage for Furosemide?: Adult - .5 - 1 mg/kg slow IVP
Ped- 1 mg/kg slow IVP Max 50 mg
Is medical consult required for Furosemide?: Yes
What are the indications for Glucagon?: Unconsious / combative hypoglycemic's w/ no IV access
What are the contraindications for Glucagon?: Known hypersensitivity.
What is the dosages for Glucagon?: Adult - 1 mg IVP every 5 mins
Ped - 1 mg IVP (25-40kg) max 3 mg
.5mg IVP (less then 25kg) max total dose 3mg
What are the indications for Lidocaine?: Prevent V-fib/V-tach recurrence
V-tach
V-Fib
Closely coupled Ventricular ectopy
Decrease ICP during RSI
Nasal Tracheal Intubation
What are the contraindications for Lidocaine?: AV blocks
Known sensitivity
Idioventricular escape rhythms
Accelerated idioventricular rhythms
Sinus bradycardia, arrest or block
Hypotension
Shock
Ventricular conduction defects
What is the adult dosage for Lidocaine?: With a pulse
1 - 1.5 mg/kg IVP followed by an additional .5-.75 mg/kg max dose 3 mg/kg
No pulse
1.5 mg/kg initial 1.5 mg/kg secondary max dose 3 mg/kg
ET dose 2 -2.5 time IV dose
What is the Pedi dosage for Lidocaine?: With Pulse- 1 mg/kg initial .5 mg/kg every 8-10 mins max 3 mg/kg
ET 2 -2.5 IV dose
No pulse 1mg/kg initial then 1 mg/kg every 3-5 min max 3 mg/kg
Do you have to consult for Lidocaine?: No
What is the indications for using Morphine?: AMI, APE, Burns, Isolated injuries requiring pain relief.
What are the cotraindications for morphine?: Head injury
Undiagnosed Abdominal pain
Multiple Trauma
COPD with compromised respiratory effort
Hypotension
Sensitivity to Morphine, Codeine, percodan
What is the dosage for morphine in AMI patients?: 2-5 mg IVP followed by 1 mg every 5 minutes to a max of 10 mg or until pain is relieved.
What is the dosage of morphine for Pulmonary edema patients?: 2 - 10 mg slw IVP at 1-2 mg/min to 10 mg or until pain is relieved
What is the dosage of morphine used prior to pacing?: 1-2 mg/min IVP
What is the pediatric dosage for morphine?: .1mg/kg slow IVP (1-2mg) min max dose 5mg

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