paramedic drugs

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Morphine sulfate: Class: Opioid (narcotic) analgesic

Adult Dosage range: 2-10mg IM/IV

Expected Dose: (None); 2-4mg slow IV; titrated to effect (relief of pain)

Maximum Dose: None

Pediatric Dose: 0.1-0.2mg/kg IM/slow IV/IO to a max dose of 15mg.

Physiological Actions: Natural opium alkaloid that has a primary effect of analgesia. Also increases peripheral venous capacitance and decreases venous return. Causes euphoria & respiratory & CNS depression. Because Morphine decreases both preload and after-load it may decrease myocardial oxygen demand. Morphine Sulfate is a Schedule II drug.
ONSET: 1-2 minutes after administration.
DURATION: 2-7 hours

Clinical Use: Chest pain associated with myocardial infarction, pulmonary edema with or without associated pain, moderate to severe acute & chronic pain.

Side Effects: Hypotension, tachycardia, bradycardia, palpitations, syncope, facial flushing, respiratory depression, euphoria, bronchspasm, dry mouth, allergic reaction.

Contraindications: Hypersensitivity to narcotics, hypovolemia, hypotension, head injury or undiagnosed abdominal pain, increased ICP, severe respiratory depression, patients who have taken MAO inhibitors within 14 days.

Notes: Pregnancy Safety: Category B; narcotics rapidly cross the placenta. Safety in neonates has not been established. Use with caution in the elderly, those with asthma, those susceptible to CNS depression, should be used with caution in chronic pain syndromes, may worsen bradycardia or heart blocks in inferior MI. Naloxone should be readily available.
ACTIVATED CHARCOAL (Aqua, Actidose, Liqui-Char, Actidose-Aqua, Actidose with Sorbitol): Class: Adsorbent, Antidote

Adult Dosage Range: 1-2g/kg (30g-100g)

Expected Dose: 1 gram/kg p.o.

Maximum Dose: 2 grams/kg

Pediatric Dose: 1gram/kg (1-12 yrs: 15-30grams;
<1 year: 1 gram/kg).

Physiological Actions: Binds and absorbs ingested toxins and is
excreted among feces.
ONSET: Immediate
DURATION: Continual while in GI tract.

Clinical Use: Many oral poisonings & medication overdoses.

Side Effects: May induce nausea & vomiting, cause constipation or mild diarrhea.

Contraindications: Corrosives, caustics, petroleum distillates (relatively ineffective), GI bleeding.

Notes: Pregnancy Safety: Category C, charcoal is frequently administered to pregnant patients and the potential benefit vs. risk is very high. May blacken feces. Does not absorb all drugs and toxic substances (e.g. Phenobarbital, aspirin, cyanide, lithium, iron, lead, arsenic).
ATROPINE SULFATE (Atropine): Class: Anticholinergic Agent (Cardiac Stimulant)

Adult Dosage Range: 0.5-1mg IV q 5 minutes.

Expected Dose: Cardiac: 1 mg IV/ET q 5 minutes.

Bradycardia: 0.5 mg q 5 minutes IV.

Organophosphate Poisoning: 2-5mg IV q 15 minutes, prn - titrate to improved vitals and dried secretions.

Maximum Dose: 0.04 mg/kg

Pediatric Dose: CARDIAC: 0.02 mg/kg IV/ET/IO (diluted to 3-5 mL); minimum dose of 0.1 mg; maximum dose of 0.04 mg/kg or 0.5mg/dose.

ORGANOPHOSPHATE POISONINGS: 0.05 mg/kg IV/ET/IO (usual dose 1-5 mg) titrated to improved vital signs & dried secretions.

Physiological Actions: Blocked vagal effects result in increased heart rate & enhanced AV conduction with limited or no inotropic effect. Primarily used to increase the heart rate in life threatening or symptomatic bradycardia, and to antagonize excess muscarinic receptor stimulation caused by organophosphate insecticides or chemical nerve agents (sarin, soman, etc.)
ONSET: Rapid
DURATION: 2-6 hours

Clinical Use: Hemodynamically significant bradycardia, asystole, PEA with absolute bradycardia, organophosphate or nerve gas poisoning, brochospastic pulmonary disorders.

Side Effects: Tachycardia, paradoxical bradycardia when pushed too slowly or when used at doses less than 0.5 mg, palpitations, dysrhythmias, headache, dizziness, anticholinergic effects, nausea & vomiting, flushed hot dry skin, allergic reactions.

Contraindications: Tachycardia, Hypersensitivity, obstructive disease of GI tract, obstructive uropathy, unstable cardiovascular status in acute hemorrhage with myocardial ischemia, narrow-angle glaucoma, thyrotoxicosis.

Notes: Pregnancy Safety: Category C, follow ET administration w/several positive-pressure ventilations, Causes pupillary dilation rendering the pupils nonreactive; pupil response may not be useful in monitoring CNS status.
DEXTROSE 50% (D50): Class: Carbohydrate

Adult Dosage Range: 12.5-25grams IV slow push (25-50 cc)

Expected Dose: *Obtain blood specimen before administering. 25g; May repeat once.

Maximum Dose: 50 grams (may increase to 75 grams)

Pediatric Dose: 0.5-1.0 g/kg IV/IO slow push (use D25 for infants)
1-2 mL/kg of D50
2-4 mL/kg of D25
5-10 mL/kg of D10

Physiological Actions: Use to treat hypoglycemia, and in the management of coma of unknown origin.
ONSET: 1 minute
DURATION: Depends on the degree of hypoglycemia.

Clinical Use: Hypoglycemia, altered level of consciousness, coma of unknown etiology, seizure of unknown etiology.

Side Effects: Warmth, pain, burning from medication infusion, hyperglycemia, thrombophlebitis.

Contraindications: Intracranial hemorrhage, increased intracranial pressure, known or suspected CVA in the absence of hypoglycemia.

Notes: Pregnancy Safety: Category C, draw blood sample prior to administration, perform blood glucose analysis prior to administration. May cause tissue necrosis. May sometimes precipitate severe neurological symptoms in thiamine deficient patients e.g. alcoholics (this can be prevented by administering 100 mg thiamine, IV)
DIAZEPAM (Valium): Class: Benzodiazepine (Hypnotic/Sedative)

Adult Dosage Range: 2.5-20mg

Expected Dose: SEIZURE: 5mg IV slow push over 2 minutes q 10-15 minutes. Usual adult dose is 10 mg with a maximum of 20-30mg.

CARDIOVERSION or TCP: 5-15mg IV, 5-10 minutes prior to procedure.

Pediatric Dose: 0.1-0.2mg/kg to a maximum of 4mg slow IV.
0.5 mg/kg rectal. Repeat at 0.25mg/kg q 10 minutes X 3.

Physiological Actions: Prescribed medication to treat anxiety & stress. Used to treat alcohol withdrawal & grand mal seizure activity. Used in conscious patients during cardioversion & TCP to induce amnesia & sedation. Rapid IV administration may be followed by respiratory depression and excessive sedation particularly in elderly patients.
ONSET: IV: 1-5 minutes; IM: 15-30 minutes
DURATION: IV & IM: 15 minutes-1 hour

Clinical Use: Anxiety states, alcohol withdrawals, skeletal muscle relaxation, seizure activity, premedication prior to countershock or TCP.

Side Effects: Hypotension, reflex tachycardia (rare), respiratory depression, ataxia, psychomotor impairment, confusion, nausea.

Contraindications: Hypersensitivity, substance abuse (use with caution), coma (unless the patient has seizures or severe muscle rigidity or myoclonus), shock, CNS depression as result of head injury, respiratory depression.

Notes: Pregnancy Safety: Category D, may cause local venous irritation, has short duration of anticonvulsant effect, reduce dose by 50% in elderly patients, resuscitation equipment should be readily available.
DIPHENHYDRAMINE HCL (Benadryl): Class: Antihistamine

Adult Dosage Range: 25-50mg IM/IV/PO

Expected Dose: 50 mg slow IV or deep IM

Maximum Dose: 100 mg (may increase to 300 mg/day)

Pediatric Dose: 1 mg/kg (1.25mg/kg/dose for children > 10kg)
Slow IV or deep IM

Physiological Actions: Antihistamines prevent the physiologic actions of histamine by blocking H1 & H2. Indicated for conditions in which histamine excess is present. Also used as adjunctive therapy with epinephrine in the treatment of anaphylactic shock. Effective in the treatment of extrapyramidal reactions and for relief of upper respiratory and sinus symptoms associated with allergic reactions.
ONSET: Maximal effects 1-3 hours
DURATION: 6-12 hours

Clinical Use: Moderate to severe allergic reactions, anaphylaxis, acute extrapyramidal reactions.

Side Effects: Dose-related drowsiness, sedation, disturbed coordination, hypotension, palpitations, tachycardia & bradycardia, thickening of bronchial secretions, dry mouth & throat, paradoxical excitement in children.

Contraindications: Patients taking MAO inhibitors, hypersensitivity, narrow-angle glaucoma, newborns & nursing mothers.

Notes: Pregnancy Safety: Category C, use cautiously in patients with CNS depression or lower respiratory diseased such as asthma.
EPINEPHRINE 1:1,000 (Adrenaline): Class: Sympathomimetic (Bronchodilator)

Adult Dosage: Mild reaction: 0.3-0.5 mg (cc) SQ q 20 minutes.

Moderate to Severe reaction: 1-2mL of 1:10,000 IV slow push.

Expected Dose: 0.5 mg SQ q 20 minutes.

Maximum Dose: Usually does not exceed 1.5mg.

Pediatric Dose: Mild reaction: 0.01 mg/kg SQ (0.01 mL/kg SQ) q 20 minutes X 3 to max of 0.3 mg (mL)

Moderate to Severe reaction: 0.05-0.15mg/kg/min IV

Physiological Actions: Initial drug of choice for treating brochoconstriction and hypotension resulting from anaphylaxis as well as all forms of cardiac arrest. Rapid injection produces a rapid increase in blood pressure, ventricular contractility, and heart rate. Also causes vasoconstriction in the arterioles of the skin, mucosa, & splanchnic areas, & antagonizes the effect of histamine.
ONSET: (SQ) 5-10 minutes
(IV)(ET) 1-2 minutes
DURATION: 5-10 minutes.

Clinical Use: Bronchial asthma, acute allergic reaction (anaphylaxis), Cardiac arrest, asystole, PEA, Ventricular fibrillation & pulseless ventricular tachycardia unresponsive to initial defibrillation, profound insufficiency (use with caution)

Side Effects: Headache, nausea, restlessness, weakness, dysrhythmias-including ventricular tachycardia and ventricular fibrillation, hypertension, precipitation on angina pectoris, tachycardia.

Contraindications: Hypersensitivity (not an issue especially in emergencies-the dose should be lowered or given slowly in non-cardiac arrest patients with heart disease), Hypovolemic shock (correct hypovolemia prior to use), Coronary insufficiency (use with caution).

Notes: Pregnancy Safety: Category C; Do not use prefilled syringes for epinephrine infusions, Syncope has occurred following epinephrine administration to asthmatic children, May increase myocardial oxygen demand.
EPINEPHRINE 1:10,000 (Adrenaline): Class: Sympathomimetic (Cardiac Stimulant)

Adult Dosage Range: 0.5-1mg IV push q 5 minutes, prn (ET=2.5 times the IV dose)
Higher doses of 2-2.5mg (0.2+ mg/kg) may be used if the 1mg dose fails. ACLS is leaning to an initial high dose.

Expected Dose: 1mg IV push q 5 minutes, prn.

Pediatric Dose: 0.01 mg/kg IV/IO
ET: 0.1-0.2mg/kg, 1:1,000 q 5 minutes
Note: High doses (0.1 mg/kg, 1:1,000) may be effective and appropriate.

Physiological Actions: Initial drug of choice for treating cardiac arrest. Rapid injection produces a rapid increase in blood pressure, ventricular contractility, and heart rate.
ONSET: (IV)(ET) 1-2 minutes
DURATION: 5-10 minutes.

Clinical Use: Cardiac arrest, asystole, PEA, Ventricular fibrillation & pulseless ventricular tachycardia unresponsive to initial defibrillation, profound insufficiency (use with caution)

Side Effects: Headache, nausea, restlessness, weakness, dysrhythmias-including ventricular tachycardia and ventricular fibrillation, hypertension, precipitation on angina pectoris, tachycardia.

Contraindications: Hypersensitivity (not an issue especially in emergencies-the dose should be lowered or given slowly in non-cardiac arrest patients with heart disease), Hypovolemic shock (correct hypovolemia prior to use), Coronary insufficiency (use with caution).

Notes: Pregnancy Safety: Category C; Do not use prefilled syringes for epinephrine infusions, Syncope has occurred following epinephrine administration to asthmatic children, May increase myocardial oxygen demand.
MEPERIDINE HCL (Demerol): Class: Opioid (narcotic) analgesic

Adult Dosage Range: 25-125mg IM/IV

Expected Dose: 25-100mg IM/IV Elderly dose may be 25mg IM

Maximum Dose: 100mg q 3-4 hours

Pediatric Dose: 1-2mg/kg IM/IV/IO

Physiological Actions: Synthetic opioid agonist that works at opioid receptors to produce analgesia and euphoria. Excessive doses can cause respiratory & CNS depression. Has potential for physical dependence & abuse, and is classified as a Schedule II drug.
ONSET: IM: 10-15 minutes; IV: Within 5 minutes.
DURATION: 2-4 hours.

Clinical Use: Moderate to severe pain, preoperative medication.

Side Effects: Respiratory depression, nausea & vomiting, euphoria, delirium, agitation, hallucinations, seizures, headache, hypotension, visual disturbances, coma, facial flushing, circulatory collapse, dysrhythmias, allergic reactions.

Contraindications: Hypersensitivity to narcotics, patients taking MAO inhibitors or selective serotonin reuptake inhibitors, during labor or delivery of a premature infant, head injury.

Notes: Pregnancy Safety: Category B, use with caution in patients with asthma and COPD, may aggravate seizures in those with convulsive disorders (especially in patients with renal insufficiency), naloxone should be readily available, protect from light and freezing.
NALOXONE HCL (Narcan): Class: Opioid (narcotic) antagonist

Adult Dosage range: 0.4-2mg IM/IV/ET (diluted) repeated q 5 minutes to a maximum of 10mg

Expected Dose: Same as above
2mg IV/IM/ET/SQ repeated prn
Infusion dose: 8mg in 1,000mL NS; titrated to effect (0.04-0.16mg/kg/hr)

Pediatric Dose: Â¡Ãœ5 years or Â¡Ãœ20kg: 0.1mg/kg IM/IV/ET (diluted)/IO/SQ
>5 years or > 20kg: 2mg IM/IV/ET (diluted)/ IO/SQ

Physiological Actions: Naloxone is a competitive narcotic antagonist
that is used in the management of known or suspected overdose caused by narcotics. It antagonizes all actions of Morphine.
ONSET: Within 2 minutes.
DURATION: 30-60 minutes.

Clinical Use: Has a complete or partial reversal of CNS or respiratory depression induced by opioids including the following: Narcotic Agonists; morphine sulfate, heroin, hydromorphone, methadone, meperidine, paregoric, fentanyl citrate, oxycodone, codeine, propoxyphene.
Narcotic Agonists/Antagonists; butorphanol
tartrate, pentazocine, nalbuphine.
Decreased level of consciousness, coma of
unknown origin, circulatory support in refractory
shock (investigational), PCP & alcohol ingestion (investigational).

Side Effects: Tachycardia, hypertension, dysrhythmias, nausea & vomiting, diaphoresis, blurred vision, withdrawal (opiate).

Contraindications: Hypersensitivity, use with caution in narcotic-dependent patients who may experience withdrawal syndrome (including neonates of narcotic-dependent mothers).

Notes: Pregnancy Safety: Category B, seizures have been reported, may not reverse hypotension, caution should be exercised when administering Naloxone to narcotic addicts.
LIDOCAINE (Xylocaine): Class: Antidysrhythmic (cardiac depressant)
(Class 1-B), Local anesthetic

Adult Dosage Range: 1-1.5mg/kg IV bolus (50-100mg). ET administration is 2-2.5 times the IV dose.

Expected Dose: 1-1.5mg/kg IV bolus. ET administration is 2-2.5 times the IV dose; repeat in 3-5 minutes
Maintenance infusion after resuscitation from cardiac arrest: 2-4mg/minute

Maximum Dose: 3mg/kg

Pediatric Dose: 1mg/kg IV/IO/ET
Maintenance infusion after resuscitation from cardiac arrest: 20-50 mcg/kg (0.5-1mg/kg) per minute

Physiological Actions: Decreased phase 4 diastolic depolarization. Effective in suppressing premature ventricular complexes. Used to treat ventricular tachycardia and some cases of ventricular fibrillation. Lidocaine also raised the ventricular fibrillation threshold.
ONSET: 30-90 seconds
DURATION: 10-20 minutes

Clinical Use: Ventricular tachycardia, ventricular fibrillation,
Wide-complex tachycardia of uncertain origin, significant ventricular ectopy in the setting of myocardial ischemia/infarction

Side Effects: Lightheadedness, confusion, blurred vision,
hypotension, cardiovascular collapse, bradycardia, altered level of consciousness, irritability, muscle twitching, seizures with high doses.

Contraindications: Hypersensitivity, Adams-Stokes syndrome, 2nd or 3rd degree heart block in the absence of an artificial pacemaker.

Notes: Pregnancy Safety: Category B, If bradycardia occurs in conjunction with PVCÂ’s, always treat the bradycardia with Atropine. Exceedingly high doses of Lidocaine can result in coma or death. Decrease dose in the elderly. Use extreme caution in patients with hepatic disease, heart failure, marked hypoxia, severe respiratory depression, hypovolemia or shock, incomplete heart block or bradycardia & atrial fibrillation.
NITROGLYCERIN (Nitrostat, Nitrobid, and others): Class: Vasodilator

Adult Dosage Range: 0.4mg (1/150 gr) SL or 0.4mg per spray of
metered spray q 5 minutes. May repeat twice.

Expected Dose: Same as above.

Pediatric Dose: Not used.

Physiological Actions: Nitrates and nitrites dilate arterioles and veins in
the periphery (and coronary arteries in high doses). The resultant reduction in preload, and to a lesser extent in afterload, decreased the work load of the heart and lowers myocardial oxygen demand.
ONSET: 1-3 minutes
DURATION: 30-60 minutes

Clinical Use: Ischemic chest pain, pulminary hypertension, CHF, hypertensive emergencies.

Side Effects: Transient headache, reflex tachycardia, hypotension, nausea and vomiting, postural syncope, diaphoresis.

Contraindications: Hypersensitivity, hypotension, head injury, cerebral hemorrhage, recent Viagra use.

Notes: Pregnancy Safety: Category C. Increased susceptibility to hypotension in the elderly. Decomposes when exposed to light or heat. Must be kept in airtight containers. Use with caution in patients with inferior AMI. PVC tubing may absorb up to 80% of available drug; non-PVC tubing should be used.
OXYTOCIN (Pitocin): Class: Pituitary Hormone

Adult Dosage Range: 3-10 units IM.

Expected Dose: Postpartum: 3-10 units IM; IV=10 units in 1,000
mL NS; infuse at 20-30 gtt/min to effect. (Firm
uterine fundus and control of bleeding). Usual IM dose is 10 units.

Maximum Dose: 40 units

Pediatric Dose: Not used.

Physiological Actions: Stimulates uterine smooth muscle contractions,
and helps expedite the normal contractions of a spontaneous labor. Transient reduction in uterine blood flow. Stimulates the mammary glands to increase lactation, without increasing the production of milk. Administered in the prehospital setting to control postpartum bleeding.
ONSET: IV: Immediate; IM: within 3-5 minutes.
DURATION: IV: 20 minutes after the infusion is stopped; IM: 30-60 minutes.

Clinical Use: Postpartum hemorrhage after infant and placental delivery.

Side Effects: Hypotension, tachycardia, hypertension, dysrhythmias, angina pectoris, anxiety, seizure, nausea and vomiting, allergic reaction, uterine rupture (from excessive administration).

Contraindications: Hypertonic or hyperactive uterus, presence of a 2nd fetus, fetal distress.

Notes: Pregnancy Safety: Category X. Vital signs and uterine tone should be closely monitored. Should only be administered in the prehospital setting after delivery of all fetuses.
PROMETHAZINE (Phenergan): Class: Phenothiazine, Antihistamine

Adult Dosage Range: 12.5-50mg deep IM/IV

Expected Dose: 12.5-50mg deep IM/IV (usually 25mg)

Maximum Dose: 50mg

Pediatric Dose: Not used. (Sometimes used under medical
direction)
0.5 mg/kg deep IM/IV

Physiological Actions: Possesses sedative, antimotion, antiemetic, and
considerable anticholinergic activity. It is often administered with analgesics, particularly narcotics, to potentiate their effect.
ONSET: IV rapid
DURATION: 4-6 hours

Clinical Use: Nausea and vomiting, motion sickness, pre- and postoperative, obstetric (during labor) sedation, to potentiate the effects of analgesics, allergic reactions.

Side Effects: Sedation, dizziness, may impair mental and physical ability, allergic reactions, dysrhythmias, nausea and vomiting, hyperexcitability, dystonias, use in children may cause hallucinations, convulsions and sudden death.

Contraindications: Hypersensitivity, comatose states, CNS depression from alcohol, barbiturates, or narcotics, signs associated with ReyeÂ’s Syndrome.

Notes: Pregnancy Safety: Category C (generally considered safe for use during labor). Use caution in patients with asthma, peptic ulcer, and bone marrow depression. Care must be taken to avoid accidental intra arterial injection. IM injections are the preferred route of administration. Slow IV administration over 1 minute.
SODIUM BICARBONATE (None): Class: Buffer, Electolyte Supplement

Adult Dosage Range: 1 mEq/kg IV; repeat ½ dose q 10 minutes
(average adult dose is usually 2 amps)

Expected Dose: Same as above.

Maximum Dose: Time related.

Pediatric Dose: Same as above.

Physiological Actions: Reacts with hydrogen ions to form water and carbon dioxide and thereby can act to buffer metabolic acidosis. As the plasma hydrogen ion concentration decreases, blood pH rises.
ONSET: 2-10 minutes
DURATION: 30-60 minutes

Clinical Use: Known preexisting bicarbonate responsive acidosis, intubated patient with continued long arrest interval, PEA, upon return of spontaneous circulation after long arrest interval, tricyclic antidepressant overdose, alkalinization for treatment of specific intoxications, management of metabolic acidosis, DKA.

Side Effects: Metabolic alkalosis, hypoxia, rise in intracellular PCO2 and increased tissue acidosis, electrolyte imbalance (hypernatremia), seizures, tissue sloughing, at injection site.

Contraindications: In patients with chloride loss from vomiting and GI suction, metabolic and respiratory alkalosis, severe pulmonary edema, abdominal pain of unknown origin, hypocalcemia, hypokalemia, hypernatremia, when administration of sodium could be detrimental.

Notes: Pregnancy Safety: Category C, bicarbonate administration produces carbon dioxide, which crosses cell membranes more rapidly than bicarbonate (potentially worsening intracellular acidosis), may increase edematous or sodium-retaining states, may worsen CHF, maintain adequate ventilation.
ADENOSINE (Adenocard): Class: Antidysrhythmic

Adult Dosage Range: 6mg IV push over 1-3 seconds, followed by a 20
mL saline flush; elevate extremity. If no response observed after 1-2 minutes, administer 12 mg in the same manner; may repeat dose once in 1-2 minutes.

Expected Dose: Same as above.

Maximum Dose: 12mg

Pediatric Dose: Initial dose of 0.1 mg/kg; may be doubled once
(maximum first dose of 6 mg or 0.3 mg/kg) IV push, followed by 5 mL saline flush.

Physiological Actions: Found in every cell in the human body. Slows supraventrical tachycardias (SVTÂ’s) by decreasing electrical conduction through the AV node without causing negative inotropic effects. Also acts directly on sinus pacemaker cells and vagal nerve terminals to decrease chronotropic (heart rate) activity. Drug of choice for paroxysmal supraventricular tachycardias (PSVTÂ’s) and can be used diagnostically for stable, wide-complex tachycardiaÂ’s of unknown type, following 2 doses of Lidocaine.
ONSET: Immediate
DURATION: 10 Seconds

Clinical Use: 1st drug for most forms of narrow-complex PSVT & dysrhythmias associated w/bypass tracts such as Wolff-Parkinson-White syndrome, in adults and pediatric patients.

Side Effects: Lightheadedness, paresthesis, headache, diaphoresis, palpitations, chest pain, hypotension, SOB, transient periods of sinus bradycardia, sinus pause or brady asystole, ventricular ectopy, nausea, metallic taste.

Contraindications: 2nd or 3rd degree AV block, sick sinus syndrome, hypersensitivity, atrial flutter, atrial fibrillation, ventricular tachycardia (Adenosine isnÂ’t effective in converting these rhythms to sinus rhythm)

Notes: Pregnancy Safety: Category C, place patient in mild reverse trendelenburg position before drug administration. A brief period of asystole (up to 15 seconds) following conversion, followed by resumption of NSR, is common after rapid administration. Patients taking theophylline may require larger doses of Adenosine. Cardiac transplant recipients may require only a small dose. May produce bronchoconstriction in patients with asthma & patients with
ALBUTEROL (Proventil and others): Class: Sympathomimetic, Bronchodilator, Beta2
agonist

Adult Dosage Range: MDI: 1-2 inhalations (90-180 mcg) q 5 minutes
q 4-6 hours
Solution: 2.5mg (0.5 mL of 0.5% solution)
Diluted with 3 mL of 0.9% NS; Administer over 5-15 minutes; 3-4 times per day with nebulizer.

Expected Dose: Same as Solution above.

Maximum Dose: None.

Pediatric Dose: < 15 kg or < 2 years old: 2.5 to 5 mg (0.5 to 1
mL) Diluted to 3 mL with 0.9% NS. Repeat q 20 minutes X 3 doses or use continually in critical patients.

> 15 kg or > 2 years old: 5-10 mg (1-2 mL)
Diluted to 3 mL with 0.9% NS. Repeat q 20 minutes X 3 doses or use continually in critical patients.

Physiological Actions: Relaxes smooth muscles of the bronchial tree
and peripheral vasculature by stimulating adrenergic receptors of the sympathetic nervous system.
ONSET: 5-15 minutes after inhalation
DURATION: 3-4 hours after inhalation

Clinical Use: Relief of bronchospasm in patients with reversible obstructive airway disease, prevention of exercise-induced bronchospasm.

Side Effects: Restlessness, apprehension, dizziness, palpitations, tachycardia, dysrhythmia.

Contraindications: Prior hypersensitivity reaction, cardiac dysrhythmias associated with tachycardia.

Notes: Pregnancy Safety: Category C. May precipitate angina pectoris and dysrhythmias. Should be used with caution in patients with diabetes mellitus, hyperthyroidism, prostatic hypertrophy, seizure disorder or cardiovascular disorder.
AMIODARONE (Cordarone, Pacerone): Class: Antidysrhythmic (Class III)

Adult Dosage Range: Pulseless Arrest: 300mg diluted in 20-30 mL NS
or D5W. Consider repeated 150 mg IV push in 3-5 minutes.

Wide-Complex Tachycardia: Rapid infusion of 150 mg IV in first 10 minutes (15 mg/minute) Repeated every 10 minutes as needed.

Expected Dose: Same as above.

Maximum Dose: 2g IV/24 hours.

Pediatric Dose: Pulseless Arrest: 5mg/kg IV push

Profusing Tachycardias: 5 mg/kg over 20-60 minutes (max dose of 15 mg/kg/24 hours).

Physiological Actions: Antidysrhythmic agent. Prolongs duration of the action potential and effective refractory period, and when given short term IV, probably include noncompetitive ÃŸ-adrenoreceptor and calcium channel blockers.
ONSET: Within minutes
DURATION: Variable

Clinical Use: Initial treatment and prophylaxis of frequently recurring VF & hemodynamically unstable VT in patients refractory to other therapy. Refractory PSVT in conjunction with electrical cardioversion.

Side Effects: Hypotension, headache, dizziness, bradycardia, AV conduction abnormalities, flushing, abnormal salivation.

Contraindications: Pulmonary congestion, cardiogenic shock, hypotension, sensitivity, bradycardia.

Notes: Pregnancy Safety: Category D; continuous ECG monitoring is required, slow infusion or discontinue if bradycardia or AV block occur, maintain at room temperature and protect from excessive heat.
ASPIRIN (ASA, Anacin, Bayer, Ectorin, St. Joseph, and others): Class: Analgesic, Anti-inflammatory, Antipyretic,
Antiplatelet

Adult Dosage Range: For Pain/Fever: 325-650mg po q 4 hours.

For MI: 160-325mg po chewed.

Expected Dose: 325mg po chewed

Pediatric Dose: > 12 years old, pain/fever: 40 mg/kg (normally
not given as a pediatric med)

Physiological Actions: Block pain impulses in the CNS, dilates peripheral vessels, and decreases platelet aggregation. Strongly recommended for all acute MI patients.
ONSET: 15-30 minutes
DURATION: 4-6 hours

Clinical Use: Mild to moderate pain or fever, prevention of platelet aggregation in ischemia and thromboembolism, unstable angina, prevention of myocardial infarction or reinfarction.

Side Effects: Stomach irritation, heartburn or indigestion, nausea or vomiting, allergic reaction.

Contraindications: Hypersensitivity to salicylates, GI bleeding, active ulcer disease, hemorrhagic stroke, bleeding disorders, children with flulike symptoms.

Notes: Pregnancy Safety: Category D; should be given as soon as possible to the patient with AMI.
DOPAMINE HCL (Intropin): Class: Sympathomimetic (Vasopressor)

Adult Dosage Range: Low Dose: 2-4 mcg/kg/minute

Moderate (Cardiac) Dose: 5-10 mcg/kg/minute

High (Vasopressor) Dose: 10-20 mcg/kg/minute. 800mg in 500cc NS. IV drip; titrate to SBP>100 or adequate blood profusion.

Expected Dose: Same as above.

Pediatric Dose: 2-20 mcg/kg/minute IV/IO, titrate to patient
response with max dose of 20 mcg/kg/minute. 200mg in 500 cc NS. Use with caution, normally not given in peds.

Physiological Actions: At low doses, dopamine acts on dopaminergic
receptors causing renal, mesenteric, and cerebral vascular dilation. At moderate doses (Â“cardiac dosesÂ”), dopamine stimulates beta adrenergic receptors causing enhanced myocardial contractility, increased cardiac output, and a rise in blood pressure. At high doses, (Â“vasopressor dosesÂ”), dopamine has an alpha-adrenergic effect, producing peripheral arterial and venous constriction. Commonly used in the treatment of hypotension associated with cardiogenic shock.
ONSET: 2-4 minutes
DURATION: 10-15 minutes

Clinical Use: Hemodynamically significant hypotension in the absence of hypovolemia.

Side Effects: Dose-related tachydysrhythmias, hypertension,
increased myocardial oxygen demand

Contraindications: Tachydysrhythmias, ventricular fibrillation, patients with pheochromocytoma.

Notes: Pregnancy Safety: Category C, Infuse through large, stable vein to avoid the possibility of extravasation injury, use infusion pump to ensure precise flow rates, monitor patient for signs of compromised circulation, correct hypovolemia prior to using dopamine in hypotensive patients.
FUROSEMIDE (Lasix): Class: Loop diuretic

Adult Dosage Range: 20-40 (as high as 40-80) mg IV slow push. If no
effect, double dose to 2 mg/kg slow IV over 1-2 minutes.

Expected Dose: Same as above.

Maximum Dose: 80mg

Pediatric Dose: 1mg/kg/dose (max of 6 mg/kg/dose)

Physiological Actions: A potent diuretic that inhibits the reabsorption of sodium and chloride in the proximal tubule and loop of Henle. Intravenous doses can also reduce cardiac preload by increasing venous capacitance.
ONSET: (IV)diuretic effects within 15-20 minutes; vascular effects within 5 minutes
DURATION: 2 hours

Clinical Use: Pulmonary edema associated with CHF, hepatic or renal disease.

Side Effects: Hypotension, ECG changes associated with electrolyte disturbances, dry mouth, hypochloremia, hypokalemia, hyponatremia, hypercalcemia, hyperglycemia, hearing loss can rarely occur after too rapid infusion of large doses especially in patients with renal impairment.

Contraindications: Anuria, hypersensitivity, hypovolemia/dehydration, known hypersensitivity to sulfonamides, severe electrolyte depletion (hypokalemia).

Notes: Pregnancy Safety: Category C, Furosemide has been known to cause fetal abnormalities, should be protected from light and stored at room temperature; do not use if solution is discolored or yellow.
MAGNESIUM SULFATE (Magnesium Sulfate): Class: Electrolyte; anticonvulsant; laxative

Adult Dosage Range: Seizure activity associated with Pregnancy: 1-4g
(8-32 mEq) IV; max dose of 1.5 mL/minute

Pulseless Arrest or Torsades De Pointes: 1-2g (2-4 mL of a 50% solution) diluted in 10 mL of D5W IV push

Torsades De Pointes (not in cardiac arrest) and AMI (if indicated): Loading dose of 1-2g in 50-100 mL D5W over 5-60 minutes IV; follow with 0.5-1 g/hour IV to control Torsades De Pointes.

Asthma: 1-2g IV. Used after other methods have failed.

Expected Dose: Same as above.

Maximum Dose: 30-40 g/24 hours

Pediatric Dose: Seizure: not used.

Pulseless Arrest or Torsades De Pointes: 25-50 mg/kg to a max of 2g over 10-20 minutes.

Torsades De Pointes (not in cardiac arrest) and AMI (if indicated): Same as Pulseless Arrest.

Physiological Actions: Used in the management of seizures associated
with toxemia of pregnancy. Other uses include uterine relaxation (to inhibit contractions of premature labor), a bronchodilator after beta agonist and anticholinergic agents have been used, replacement therapy for magnesium deficiency. Is gaining popularity as an initial treatment in the management of various dysrhythmias, particularly torsades de pointes, and dysrhythmias secondary to TCA overdose or digitalis toxicity. Also is considered as a Class II agent (AHA guidelines; probably helpful) for refractory ventricular fibrillation/ventricular tachycardia after administration of lidocaine doses.
ONSET: IV: Immediate
IM: 3-4 hours
DURATION: IV: 30 minutes
IM: 3-4 hours

Clinical Use: Seizures of eclampsia, Torsades de pointes, suspected hypomagnesemia, refractory ventricular fibrillation, status asthmaticus not responsive to Ã¢-adrenergic drugs.

Side Effects: Diaphoresis, facial flushing, hypotension,
depressed reflexes, hypothermia, reduced heart rate, circulatory collapse, respiratory depression, diarrhea.

Contraindications: Heart block or myocardial damage

Notes: Pregnancy Safety: Category B, Magnesium sulfate is administered for the treatment of toxemia of pregnancy. It is recommended that the drug not be administered in the 2 hours prior to delivery. IV calcium gluconate or calcium chloride should be available as an antagonist to magnesium if needed. The Â“cureÂ” for toxemia is delivery of the baby. Magnesium must be used with caution in patients with renal failure, since it is cleared by the kidneys and can reach toxic levels easily in those patients.
METHYLPREDNISOLONE (Solu-Medrol, others): Class: Corticosteroid (functional); Glucocorticoid
(chemical)

Adult Dosage Range: 40-125mg IV

Expected Dose: Variable

Spinal Injury: Initial dose of 30 mg/kg IV over first 15 minutes followed in 45 minutes by infusion of 5.4 mg/kg/hour X 23-47 hours.

Asthma: 10-250 mg/dose IM/IV (usually 125mg) every 4-6 hours.

Maximum Dose: None.

Pediatric Dose: Not used in children, 2 y/o; 1-2 mg/kg IM/IV

Asthma: 2 mg/kg X 3 IM/IV; 2 mg/kg/24 hours÷q 6 hours.

Physiological Actions: A synthetic steroid that suppresses acute and
chronic inflammation. It potentiates vascular smooth muscle from relaxation by beta adrenergic agonists, and may alter airway hyperactivity. A newer usage is for reduction of posttraumatic spinal cord edema.
ONSET: 1-2 hours
DURATION: 8-24 hours

Clinical Use: Anaphylaxis, bronchodilator-unresponsive asthma, shock, acute spinal cord injury.

Side Effects: Headache, hypertension, sodium and water retention, hypokalemia, alkalosis.

Contraindications: Use with caution in patients with GI bleeding, diabetes mellitus, severe infection.

Notes: Pregnancy Safety: Category C.
THIAMINE (Betaxin, Vitamin B12): Class: Vitamin

Adult Dosage Range: 100mg slow IV, deep IM

Expected Dose: Same as above.

Maximum Dose: 100mg

Pediatric Dose: Not used.

Physiological Actions: Thiamine combines with adenosine triphosphate (ATP) to form thiamine pyrophosphate coenzyme, a necessary component for carbohydrate metabolism. Certain states such as alcoholism and malnourishment may affect the intake, absorption, and utilization of thiamine. The brain is extremely sensitive to thiamine deficiency.
ONSET: Rapid
DURATION: Depends on the degree of deficiency.

Clinical Use: Coma of unknown origin (with administration of D50 or Naloxone). Delirium tremens, beriberi (rare), WernickeÂ’s encephalopathy.

Side Effects: Hypotension (from rapid injection or large dose), anxiety, diaphoresis, nausea & vomiting, allergic reaction; angioedema.

Contraindications: None Significant

Notes: Pregnancy Safety: Category A, large IV doses may cause respiratory difficulties, anaphylactic reactions have been reported.
Morphine sulfate: Class: Opioid (narcotic) analgesic

Adult Dosage range: 2-10mg IM/IV

Expected Dose: (None); 2-4mg slow IV; titrated to effect (relief of pain)

Maximum Dose: None

Pediatric Dose: 0.1-0.2mg/kg IM/slow IV/IO to a max dose of 15mg.

Physiological Actions: Natural opium alkaloid that has a primary effect of analgesia. Also increases peripheral venous capacitance and decreases venous return. Causes euphoria & respiratory & CNS depression. Because Morphine decreases both preload and after-load it may decrease myocardial oxygen demand. Morphine Sulfate is a Schedule II drug.
ONSET: 1-2 minutes after administration.
DURATION: 2-7 hours

Clinical Use: Chest pain associated with myocardial infarction, pulmonary edema with or without associated pain, moderate to severe acute & chronic pain.

Side Effects: Hypotension, tachycardia, bradycardia, palpitations, syncope, facial flushing, respiratory depression, euphoria, bronchspasm, dry mouth, allergic reaction.

Contraindications: Hypersensitivity to narcotics, hypovolemia, hypotension, head injury or undiagnosed abdominal pain, increased ICP, severe respiratory depression, patients who have taken MAO inhibitors within 14 days.

Notes: Pregnancy Safety: Category B; narcotics rapidly cross the placenta. Safety in neonates has not been established. Use with caution in the elderly, those with asthma, those susceptible to CNS depression, should be used with caution in chronic pain syndromes, may worsen bradycardia or heart blocks in inferior MI. Naloxone should be readily available

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Number of cards 25