Paramedic Pharmacology

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Activated Charcoal
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Terms in this set (33)
Activated Charcoal
CLASS: adsorbent
ACTIONS: adsorbs toxins by chemical binding and prevents GI absorption
INDICATIONS: poisoning following emesis or when emesis is contraindicated
CONTRAINDICATIONS: none in severe poisoning
PRECAUTIONS: should only be administered following emesis in which it is so indicated, use with caution in patients with altered mental status, may absorb ipecac; if ipecac is administered, wait at least 10 mins to administer activated charcoal
SIDE EFFECTS: nausea/vomiting
ROUTE: PO
ADULT DOSAGE: 1 g/kg (typically 50-75 g)mixed with a glass of water to form a slurry
PEDIATRIC DOSAGE: 1 g/kg mixed with a glass of water to form a slurry
Image: Activated Charcoal
Adenosine (Adenocard)
CLASS: antidysrhythmic
ACTIONS: slows atrioventricular conduction
INDICATIONS: symptomatic PSVT
CONTRAINDICATIONS: second or third degree heart block, sick sinus syndrome, known hypersensitivity to drug, Wolf Parkinson White syndrome
PRECAUTIONS: dysrhythmias, including blocks, are common at the time of cardioversion, use with caution in patients with asthma
SIDE EFFECTS: facial flushing, headache, SOB, dizziness, nausea
ROUTE: IV/IO; should be administered directly into a vein or into the medication administration port closest to the patient and followed by flushing of the line with IV fluid
ADULT DOSAGE: 6 mg rapid IV bolus over 1-2 seconds, if after 1-2 minutes, cardioversion doesn't occur, administer a 12 mg dose over 1-2 seconds
PEDIATRIC DOSAGE: safety in children has not been established
Image: Adenosine (Adenocard)
Albuterol (Proventil)
CLASS: sympathomimetic (Beta 2 selective)
ACTIONS: bronchodilation
INDICATIONS: asthma, reversible bronchospasm associated with COPD
CONTRAINDICATIONS: symptomatic tachycardia, known hypersensitivity to drug
PRECAUTIONS: BP, HR, and ECG results should be monitored, use caution in patients with known heart disease
SIDE EFFECTS: palpitations, anxiety, headache, dizziness, sweating
ROUTE: inhalation (via NEB)
ADULT DOSAGE: 0.5 mL (2.5 mg) in 2.5 mL of NaCl over 5-15 mins via NEB
PEDIATRIC DOSAGE: 0.15 mg/kg (0.03 mL/kg) in 2.5 mL normal saline via NEB
Image: Albuterol (Proventil)
Amiodarone (Cordarone)
CLASS: antidysrhythmic
ACTIONS: prolongs action potential and refractory period, slows the sinus rate, prolongs PR and QT intervals, decreased peripheral vascular resistance
INDICATIONS: life threatening cardiac dysrhythmias such as V-Tach and V-Fib
CONTRAINDICATIONS: severe sinus node dysfunction, sinus bradycardia, second and third degree AV block, hemodynamically significant bradycardia
PRECAUTIONS: heart failure
SIDE EFFECTS: hypotension, nausea, anorexia, malaise/fatigue, tremors, pulmonary toxicity, ventricular ectopic beats
ROUTE: IV/IO, PO
ADULT DOSAGE: loading dose of 150 mg over 10 mins (15 mg/min), maintenance dose of 1 mg/min for 6 hrs, then 0.5 mg/min until dysrhythmia is controlled or oral therapy begins
PEDIATRIC DOSAGE: 5 mg/kg IV/IO, maximum dose of 15 mg/kg
Image: Amiodarone (Cordarone)
Aspirin (ASA)
CLASS: platelet inhibitor and anti-inflammatory
ACTIONS: inhibits platelet aggregation
INDICATIONS: acute onset CP which is suggestive of an MI, signs and symptoms suggestive of recent stroke (CVA)
CONTRAINDICATIONS: patients with known hypersensitivity to the drug
PRECAUTIONS: GI bleeding and upset stomach
SIDE EFFECTS: heartburn, nausea/vomiting, wheezing
ROUTE: PO
ADULT DOSAGE: 160-324 mg PO
PEDIATRIC DOSAGE: not recommended
Image: Aspirin (ASA)
Atropine Sulfate
CLASS: parasympatholytic (anticholinergic)
ACTIONS: blocks ACh receptors, increases HR, decreases GI secretions
INDICATIONS: hemodynamically significant bradycardia, hypotension secondary to bradycardia, organophosphate poisoning
CONTRAINDICATIONS: none when used in emergency situations
PRECAUTIONS: dose of 0.04 mg/kg should not be exceeded except in cases of organophosphate poisonings, hypertension, tachycardia
SIDE EFFECTS: palpitations, tachycardia, headache, dizziness, anxiety, dry mouth, pupillary dilation, blurred vision, urinary retention
ROUTE: IV/IO, ETT (2-2.5 x IV dose)
ADULT DOSAGE: Bradycardia - 0.5 mg every 3-5 mins to maximum of 0.04 mg/kg, Organophosphate Poisoning - 2-5 mg
PEDIATRIC DOSAGE: Bradycardia - 0.02 mg/kg (minimum dose of 0.1 mg), child/adolescent maximum single dose - 0.5 mg/1.0 mg, child/adolescent maximum total dose - 1.0 mg/2.0 mg
Image: Atropine Sulfate
Calcium Chloride
CLASS: electrolyte
ACTIONS: increases cardiac contractility
INDICATIONS: acute hyperkalemia, acute hypocalcemia, calcium channel blocker OD, ABD muscle spasm associated with spider bites and Portugese Man-of-War stings, antidote for Magnesium Sulfate
CONTRAINDICATIONS: patients receiving digitalis
PRECAUTIONS: IV line should be flushed between Calcium Chloride and Sodium Bicarbonate administration, extravasation may cause tissue necrosis
SIDE EFFECTS: dysrhythmias (bradycardia and asytole), hypotension
ROUTE: IV/IO
ADULT DOSAGE: 2-4 mg/kg of 10% solution, may be repeated at 10 min intervals
PEDIATRIC DOSAGE: 5-7 mg/kg of 10% solution
Image: Calcium Chloride
Dextrose (50 Percent)
CLASS: carbohydrate
ACTIONS: elevates blood glucose rapidly
INDICATIONS: hypoglycemia
CONTRAINDICATIONS: none in the emergency setting
PRECAUTIONS: a blood sugar should be checked before administration
SIDE EFFECTS: local venous irritation, extravasation may cause tissue necrosis
ROUTE: IV/IO
ADULT DOSAGE: 25 g (50 mL) or 1 D50 ampule
PEDIATRIC DOSAGE: 0.5 g/kg Dextrose 25% (D25) slow IV
Image: Dextrose (50 Percent)
Diazepam (Valium)
CLASS: tranquilizer (benzodiazepine)
ACTIONS: anticonvulsant, skeletal muscle relaxant, sedative
INDICATIONS: major motor seizures, status epilepticus, premedication before cardioversion, skeletal muscle relaxant, acute anxiety states
CONTRAINDICATIONS: known hypersensitivity to the drug
PRECAUTIONS: can cause local venous irritation, short duration of effect, do not mix with other drugs due to precipitation problems, Flumazenil (Romazicon) should be available
SIDE EFFECTS: drowsiness, hypotension, respiratory depression and apnea
ROUTE: IV/IO (do not administer faster than 1 mL/min), IM, PR
ADULT DOSAGE: Status Epilepticus - 5-10 mg IV, Acute Anxiety - 2-5 mg IV or IM, Pre-Cardioversion - 5-15 mg IV
PEDIATRIC DOSAGE: Status Epilepticus - 0.1-0.2 mg/kg
Image: Diazepam (Valium)
Diltiazem (Cardizem)
CLASS: calcium channel blocker
ACTIONS: slows conduction through AV node, causes vasodilation, decreases rate of ventricular response, decreases myocardial oxygen demand
INDICATIONS: to control rapid ventricular rates associated with a-fib and a-flutter, angina pectoris
CONTRAINDICATIONS: hypotension, wide-complex tachycardias, conduction system disturbances
PRECAUTIONS: should not be used in patients recieving venous beta blockers, hypotension, must be kept refrigerated
SIDE EFFECTS: nausea/vomiting, hypotension, dizziness
ROUTE: IV/IO, IV drip
ADULT DOSAGE: 0.25 mg/kg bolus (typically 20 mg) IV over 2 mins, followed by a maintenance infusion of 5-15 mg/hr
PEDIATRIC DOSAGE: rarely used
Image: Diltiazem (Cardizem)
Diphenhydramine (Benadryl)CLASS: antihistamine ACTIONS: blocks histamine receptors and has some sedative effects INDICATIONS: anaphylaxis, allergic reactions, dystonic reactions due phenothiazines CONTRAINDICATIONS: asthma, nursing mothers PRECAUTIONS: hypotension SIDE EFFECTS: sedation, dries bronchial secretions, blurred vision, headache, palpitations ROUTE: slow IV push, deep IM ADULT DOSAGE: 25-50 mg PEDIATRIC DOSAGE: 1-2 mg/kgDopamine (Intropin)CLASS: sympathomimetic ACTIONS: increases cardiac contractility, causes peripheral vasoconstriction INDICATIONS: hemodynamically significant hypotension (systolic of 70-100) not resulting from hypovolemia, cardiogenic shock CONTRAINDICATIONS: hypovolemic shock in which complete fluid resuscitation has not occurred, pheochromocytoma PRECAUTIONS: presence of severe tachydysrhytmias, presence of v-fib, ventricular irritability, beneficial effects lost when dose exceeds (20 ug/kg/min) SIDE EFFECTS: ventricular tachydysrhythmias, hypertension, palpitations ROUTE: IV drip only ADULT DOSAGE: Initial - 2-5 ug/kg/min, increase as needed PEDIATRIC DOSAGE: 2-20 ug/kg/minEpinephrine 1:1000CLASS: sypathomimetic ACTIONS: bronchodilation INDICATIONS: bronchial asthma, COPD exacerbation, allergic reactions, pediatric cardiac arrest (after initial epinephrine dosage) CONTRAINDICATIONS: patients with underlying cardiovascular disease, hypertension, pregnancy, patients with tachydysrhythmias PRECAUTIONS: should be protected from light, BP, HR, and ECG results should be constantly monitored SIDE EFFECTS: palpitations and tachycardia, anxiousness, headache, tremor ROUTE: subcutaneous ADULT DOSAGE: 0.3-0.5 mg PEDIATRIC DOSAGE: 0.01 mg/kg up to 0.3 mgEpinephrine 1:10000CLASS: sympathomimetic ACTIONS: increases HR and automaticity, increases cardiac contractile force, increases myocardial electrical activity, increases systemic vascular resistance, increases BP, causes bronchodilation INDICATIONS: cardiac arrest, anaphylactic shock, severe reactive airway disease CONTRAINDICATIONS: for IV use and shouldn't be used in patients who do not require extensive resuscitation efforts PRECAUTIONS: should be protected from light, can be deactivated by alkaline solutions SIDE EFFECTS: palpitations, anxiety, tremulousness, nausea/vomiting ROUTE: IV, IV drip, ETT (2-2.5 x IV dose) ADULT DOSAGE: Cardiac Arrest - 0.5 mg-1.0 mg every 3-5 mins, Severe Anaphylaxis - 0.3-0.5 mg (3-5 mL), occasionally an epinephrine drip is required PEDIATRIC DOSAGE: 0.01 mg/kg initially, with repeated doses (Epinephrine 1:1000 should be used at 0.1 mg/kg)EpiPen AutoinjectorCLASS: sypathomimetic ACTIONS: bronchodilation INDICATIONS: anaphylaxis CONTRAINDICATIONS: patients with underlying cardiovascular disease, hypertension, pregnancy, patients with tachydysrhythmias PRECAUTIONS: BP, HR, and ECG results should be constantly monitored SIDE EFFECTS: palpitations and tachycardia, anxiousness, headache, tremor ROUTE: IM ADULT DOSAGE: 0.3 mg PEDIATRIC DOSAGE: 0.15 mgFentanyl Citrate (Sublimaze)CLASS: narcotic ACTIONS: CNS depressant, decreases sensitivity to pain INDICATIONS: severe pain, RSI adjunct, maintenance of analgesia CONTRAINDICATIONS: shock, severe hemorrhage, hypersensitivity to the drug PRECAUTIONS: respiratory depression (naloxone should be available), hypotension, nausea SIDE EFFECTS: dizziness, altered LOC, bradycardia ROUTE: IV ADULT DOSAGE: 25-100 ug PEDIATRIC DOSAGE: 2-12 yrs - 1.7-3.3 ug/kgFurosemide (Lasix)CLASS: potent diuretic ACTIONS: inhibits reabsorption of NaCl, promotes prompt diuresis, vasodilation INDICATIONS: CHF, pulmonary edema CONTRAINDICATIONS: pregnancy, dehyrdration PRECAUTIONS: should be protected from light, dehydration SIDE EFFECTS: few in emergency usage ROUTE: IV ADULT DOSAGE: 40-80 mg PEDIATRIC DOSAGE: 1 mg/kgGlucagonCLASS: hormone (antihypoglycemic agent) ACTIONS: causes breakdown of glycogen into glucose, inhibits glycogen synthesis, elevates blood sugar, increases cardiac contractile force, increases HR INDICATIONS: hypoglycemia, beta-blocker OD CONTRAINDICATIONS: hypersensitivity to the drug PRECAUTIONS: only effective if there are sufficient stores of glycogen in the liver, use with caution in patients with cardiovascular or renal disease, check blood sugar before administration SIDE EFFECTS: few in emergency situations ROUTE: IV, IM ADULT DOSAGE: IV - 0.25-0.5 units, IM - 1.0 mg PEDIATRIC DOSAGE: 0.03 mg/kgHydrocortisone (Solu-Cortef)CLASS: steroid ACTIONS: suppresses immune system response (especially in allergic reaction and anaphylaxis) INDICATIONS: severe anaphylaxis, asthma and COPD disease, urticaria CONTRAINDICATIONS: none in the emergency setting PRECAUTIONS: must be reconstituted and used properly, onset of action may be 2-6 hrs, so this drug should not be used for the first hour in the acute anaphylactic reaction SIDE EFFECTS: GI bleeding, prolonged wound healing, suppression of natural steroids ROUTE: IV, IM ADULT DOSAGE: 100-250 mg PEDIATRIC DOSAGE: 30 mg/kgAtrovent (Ipratropium Bromide)CLASS: anticholinergic ACTIONS: bronchodilation, dries respiratory tract secretions INDICATIONS: bronchial asthma, reversible bronchospam associated with COPD and emphysema CONTRAINDICATIONS: hypersensitivity to the drug, should not be used as primary acute treatment of bronchospasm PRECAUTIONS: monitor VS SIDE EFFECTS: palpitations, dizziness, anxiety, headache, nervousness ROUTE: inhalation (via NEB) ADULT DOSAGE: 500 mcg in NEB (usually mixed with a beta antagonist - Combivent) PEDIATRIC DOSAGE: safety in children has not been establishedLidocaineCLASS: antidysrhythmic ACTIONS: suppresses ventricular ectopic activity, increases ventricular fibrillation threshold, reduces velocity of electrical impulse through the conductive system INDICATIONS: malignant PVC's, V-Tach, V-Fib, prophylaxis of dysrhythmias associated with fibrinolytic therapy CONTRAINDICATIONS: high degree heart blocks, PVC's in conjunction with bradycardia PRECAUTIONS: dosage should not exceed 300 mg/hr, monitor for CNS toxicity, dosage should be reduced by 50% in patients older than 70 yrs. or patients with liver disease, in cardiac arrest only use the bolus therapy SIDE EFFECTS: anxiety, drowsiness, dizziness, confusion, nausea/vomiting, convulsions, widening of QRS complex ROUTE: IV/IO bolus, IV infusion ADULT DOSAGE: Initial Bolus - 1.0-1.5 mg/kg, additional boluses of 0.5-0.75 mg/kg can be repeated at 3-5 min intervals until dysrhythmia is suppressed or max dose of 3 mg/kg has been reached, IV Drip - 2-5 mg/min IV infusion to maintain adequate blood levels after dysrhythmia has been suppressed PEDIATRIC DOSAGE: 1 mg/kgLorazepam (Ativan)CLASS: tranquilizer (benzodiazepine) ACTIONS: anticonvulsant, sedative INDICATIONS: major motor seizure, status epilepticus, premedication before cardioversion, acute anxiety CONTRAINDICATIONS: hypersensitivity to the drug PRECAUTIONS: short duration of effect, do not mix with other drugs due to precipitation problems, Flumazenil (Romazicon) should be available, dilute with NaCl of D5W prior to IV administration SIDE EFFECTS: drowsiness, hypotension, respiratory depression and apnea ROUTE: IV, IM, PR ADULT DOSAGE: 0.5-2.0 mg IV, may be increased to 1.0-4.0 mg IV PEDIATRIC DOSAGE: 0.05-0.10 mg/kg (max dose of 4 mg)Magnesium SulfateCLASS: anticonvulsant and antidysrhythmic ACTIONS: CNS depressant, anticonvulsant, antidysrhythmic INDICATIONS: Obstetrical - eclampsia (toxemia of pregnancy), Cardiovascular - severe refractory V-Tach, post myocardial infarction as prophylaxis for dysrhythmias, torsades de pointes (multiaxial V-Tach) CONTRAINDICATIONS: shock, heart block PRECAUTIONS: caution should be used in patients recieving digitalis, hypotension, CaCl2 should be readily available as an antidote if respiratory, use caution in patients with renal failure SIDE EFFECTS: flushing, respiratory depression, drowsiness ROUTE: IV, IM ADULT DOSAGE: 1-4 g PEDIATRIC DOSAGE: not indicatedMetoprolol (Lopressor)CLASS: sympathetic blocker (beta 1 selective) ACTIONS: selectively blocks beta 1 adrenergic receptors (cardioprotective) INDICATIONS: suspected or definite acute myocardial infarction in patients who are hemodynamically stable CONTRAINDICATIONS: HR < 45 BPM, systolic < 100, heart block, shock, history of asthma PRECAUTIONS: BP, HR, and ECG results should be monitored, atropine and transcutaneous pacing should be available SIDE EFFECTS: bradycardia, heart block, CHF, depression, bronchospasm, ROUTE: slow IV bolus ADULT DOSAGE: Initial bolus - 5 mg slow IV injection, may repeat (up to 2 times) 5 mg bolus in 10 mins if vitals are stable PEDIATRIC DOSAGE: safety in children has no been establishedMidazolam (Versed)CLASS: tranquilizer (benzodiazepine) ACTIONS: hypnotic, sedative INDICATIONS: premedication before cardioversion, acute anxiety states CONTRAINDICATIONS: hypersensitivity to the drug, narrow-angle glaucoma, shock PRECAUTIONS: emergency resuscitation equipment must be available, Flumazenil (Romazicon) should be available, dilute with NaCl of D5W prior to IV administration, respiratory depression more common with midazolam than with other benzodiazepines SIDE EFFECTS: drowsiness, hypotension, amnesia, respiratory depression and apnea ROUTE: IV, PO, Nasal Atomizer ADULT DOSAGE: 1.0-2.5 mg IV PEDIATRIC DOSAGE: 0.03 mg/kgMorphine SulfateCLASS: narcotic ACTIONS: CNS depressant, peripheral vasodilation, descreases sensitivity to pain INDICATIONS: severe pain, pulmonary edema CONTRAINDICATIONS: head injury, volume depletion, hypersensitivity to the drug PRECAUTIONS: respiratory depression (naloxone should be available), hypotension, nausea SIDE EFFECTS: dizziness, altered LOC ROUTE: IV, IM ADULT DOSAGE: IV - 2-5 mg followed by 2 mg every few minutes until pain is relieved or respiratory depression ensues, IM - 5-15 mg based on the patient's weight PEDIATRIC DOSAGE: 0.1-0.2 mg/kg IVNarcan (Naloxone)CLASS: narcotic antagonist ACTIONS: reverses effects of narcotics INDICATIONS: narcotic OD including: morphine, Dilaudid, fentanyl, Demerol, paragoric, methadone, heroin, Percodan, and Tylox, Sythetic Analgesic OD including: Nubain, Stadol, Talwin, Darvon, and alcoholic coma, to rule out narcotics in coma of unknown origin CONTRAINDICATIONS: hypersensitivity to the drug PRECAUTIONS: may cause withdrawal effects in narcotic dependent patients, short acting (should be augmented every 5 mins), should never be used as part of a "coma cocktail" SIDE EFFECTS: rare ROUTE: IV, IM, ETT (2-2.5x IV dose), Nasal Atomizer ADULT DOSAGE: 1-2 mg PEDIATRIC DOSAGE: <5 yrs - 0.1 mg/kg, >5 yrs - 2.0 mgNitroglycerin (Nitrostat)CLASS: antianginal ACTIONS: smooth muscle relaxant, reduces cardiac work, dilates coronary arteries, dilates systemic arteries INDICATIONS: angina pectoris, CP associated with mycardial infarction CONTRAINDICATIONS: children < 12 yrs, hypotension (systolic <100) PRECAUTIONS: constantly monitor BP, syncope, drug must be protected from light, expires quickly once bottle is opened SIDE EFFECTS: headache, dizziness, hypotension ROUTE: sublingual ADULT DOSAGE: one tablet (0.4 mg) repeated at 5 minute intervals to a max of 3 doses or until systolic < 100 PEDIATRIC DOSAGE: not indicatedRacemic Epinephrine (MicroNEFRIN)CLASS: sypathomimetic ACTIONS: bronchodilation, increases HR, increases cardiac contractile force INDICATIONS: croup (laryngotracheobronchitis) CONTRAINDICATIONS: epiglottitis, hypersensitivity to the drug PRECAUTIONS: VS should be constantly monitored, should be used only once in the prehospital setting SIDE EFFECTS: palpitations, anxiety, headache ROUTE: inhalation (via NEB) ADULT DOSAGE: 0.25-0.75 mL of 2.25% solution in 2.0 mL NaCl PEDIATRIC DOSAGE: 0.25-0.75 mL of a 2.25% solution in 2.0 mL NaClSodium BicarbonateCLASS: alkalinizing agent ACTIONS: combines with excessive acids to form a weak volatile acid, increases pH (more basic) INDICATIONS: late in the management of cardiac arrest, tricyclic antidepressant OD, severe acidosis refractory to hyperventilation CONTRAINDICATIONS: alkalotic states PRECAUTIONS: correct dosage is essential to avoid overcompensation of pH, can deactivate catecholamines, can precipitate with calcium, delivers large sodium load SIDE EFFECTS: alkalosis ROUTE: IV ADULT DOSAGE: 1 mEq/kg initially followed by 0.5 mEq/kg every 10 mins as indicated by ABG PEDIATRIC DOSAGE: 1 mEq/kg initially followed by 0.5 mEq/kg every 10 minsThiamine (Vitamin B1)CLASS: vitamin ACTIONS: allows normal breakdown of glucose INDICATIONS: coma of unknown origin, alcoholism, delirium tremens CONTRAINDICATIONS: none in the emergency setting PRECAUTIONS: rare anaphylactic reactions have been reported, should not be used as part of a "coma cocktail" SIDE EFFECTS: rare, if any ROUTE: IV, IM ADULT DOSAGE: 100 mg PEDIATRIC DOSAGE: rarely indicatedVasopressinCLASS: hormone, vasoconstrictor ACTIONS: antidiuretic hormon, potent vasoconstrictor INDICATIONS: cardiac arrest CONTRAINDICATIONS: none when used in the emergency setting PRECAUTIONS: few in the emergency setting SIDE EFFECTS: blanching of the skin, hypertension, bradycardia ROUTE: IV ADULT DOSAGE: 40 units IV (single dose only) PEDIATRIC DOSAGE: not indicatedZofran (Ondansetron)CLASS: antiemetic ACTIONS: prevents nausea/vomiting INDICATIONS: nausea/vomiting CONTRAINDICATIONS: hypersensitivity to the drug PRECAUTIONS: none in the emergency setting SIDE EFFECTS: headache, drowsiness, pruritus ROUTE: IV, IM ADULT DOSAGE: 4 mg PEDIATRIC DOSAGE: < 30 kg - 1 mg, > 30 kg - 2 mg