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NREMT Paramedic Drugs

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ACETAMINOPHEN
Class: Anti-pyretic
Indications: Fever
Contraindications: Liver failure; hypersensitivity; exceed max dose
Side effects: Liver toxicity
Adult Dose: 1 g q 6 hours; max 4 g in 24 hours
Pediatric Dose: 15 mg/kg q 6 hours
Special info: Tylenol
ADENOSINE
TRADE NAME: Adenocard
CLASS: Antiarrhythmic
ACTIONS: Slows (decreases) AV conduction
INDICATIONS: Symptomatic PSVT, including Wolff-Parkinson-White Syndrome (WPW)
PHARMACOKINETICS:

Onset: 20 - 35 seconds
Peak Effect: 20 - 35 seconds
Duration: 30 - 120 seconds
Half Life: 10 seconds
CONTRAINDICATIONS: Second or third degree heart block, sick-sinus syndrome, known
hypersensitivity to the drug, dysrhythmias other than PSVT, reactive airway diseases like asthmea.
PRECAUTIONS: Arrhythmias, including blocks, are common at the time of cardioversion.
Use with caution in patients with asthma.
SIDE EFFECTS:
CNS: Dizziness, near syncope, syncope
CV: PVCs, PACs, sinus tachycardia, sinus bradycardia, AV blocks, chest pain, facial flushing,
headache
Resp: SOB, bronchoconstriction
GI/GU: Nausea
DOSAGE:
ADULT: 6 mg rapid IV bolus over 1-2s; after 1-2 minutes, 12-mg dose over 1-2 seconds.
PEDIATRIC: Initial dose: 0.1mg/kg; max 1st does = 6mg; Rapid IV bolus w/5cc flush
ROUTES: IV with 20cc flush
ALBUTEROL
TRADE NAME: Proventil, Ventolin
CLASS: Sympathetic Agonist
DESCRIPTION: Sympathomimetic bronchodilator selective for β2 adrenergic receptors
ACTIONS: Selective direct acting β2 agonist
INDICATIONS: Bronchial asthma, emphysema, chronic bronchitis, allergic bronchospasm,
or other reversible bronchospasm
PHARMACOKINETICS:

Onset: 5 - 15 minutes
Peak Effect: 1 - 1.5 hours
Duration: 3 - 6 hours
Half Life: < 3 hours
CONTRAINDICATIONS: Know hypersensitivity to Albuterol.
SIDE EFFECTS:
CNS: Tremor, anxiety, dizziness, seizure
CV: Headache, palpations, HTN, tachycardia, chest pain
Resp: Bronchospasm (paradoxical effect)
GI/GU: Nausea, vomiting, dry mouth
DOSAGE For patients in emergency setting:
ADULT: Nebulizer: 2.5mg in 3cc normal saline or 5mg in 6cc normal saline via HHN over 5 - 15 min.
Repeat 10-20 min. prn, maximum 10mg/hr (4 treatments) MDI- 1-2 inhalations (90mcg each)
many repeat every 15 minutes prn.
PEDIATRIC: 0.15 mg/kg in 2.5-3.0 ml NS via HHN. Repeat prn.
ROUTES: Nebulizer, metered-dose inhaler (MDI)
PACKAGED: Premixed unit dose of 2.5mg in 2.5ml NS.
AMIODARONE
TRADE NAME: Cordarone, Pacerone
CLASS: Antiarrhythmic
ACTIONS: Prolongs action potential and refractory period. Slows the sinus rate; Increases PR
and QT intervals. Decreases Peripheral vascular resistance.
INDICATIONS: Life-threatening cardiac arrhythmias such as ventriculartachycardia
and ventricular fibrillation.
PHARMACOKINETICS:
Onset: 2 minutes IV. Oral: 2-3 days
Peak Effect: 6 - 20 minutes
Duration: Varies
Half Life: Varies, 30 - 100 days post oral administration
CONTRAINDICATIONS: Hypersensitivity to Amiodarone, heart failure, severe sinus node dysfunction
(sinus bradycardia, 2nd Π3rd degree blocks), cardiogenic shock
SIDE EFFECTS:
CNS: dizziness
CV: Headache, bradycardia, hypotension, sinus arrest, prolonged PR, QRS, QT intervals, CHF,
AV block, cardiogenic shock, palpations, chest pain
Resp: Dyspnea, pulmonary fibrosis
GI/GU: Nausea, vomiting
DOSAGE:
ADULT: V-Fib / V-Tach without pulses: 300 mg IV (max is 2.2g IV/24 hrs)
Ventricular arrhythmias with a pulse: 150 mg over 10 minute. rpt every 10 min.
Maintenance Infusion: 540mg IV over 18 hours (0.5mg/min)
PEDIATRIC: Pulseless arrest: 5mg/kg rapid IV bolus,
Perfusing tachycardia: 5mg/kg IV over 20-60 min.
ROUTE: IV
ASPRIN
TRADE NAME: ASA, Bufferin, Ecotrin, Empirin, etc.
CLASS: Platelet aggregate inhibitor, analgesic, non-steroidal anti-inflammatory (NSAID), antipyretic
Description: Anti-inflammatory, inhibits platelet function
ACTIONS: Blocks platelet aggregation.
INDICATIONS: New-onset chest pain suggestive of MI signs and symptoms suggestive or recent CVA.
PHARMACOKINETICS:
Onset: 5 - 30 minutes
Peak Effect: 15 - 120 minutes
Duration: 1 - 4 hours
Half Life: 15 - 20 minutes
CONTRAINDICATIONS: GI bleed, ulcer, hemorrhagic stroke, bleeding disorders, kids with flu symptoms. Hypersensitivity to salicylates, relatively contraindicated in active ulcer disease & asthma.
May cause GI upset/bleeding. Administer cautiously to patients with bleeding disorders and those who report allergies to non-steroidal anti-inflammatory (NSAID) drugs. Contraindicated in children 16 - 19 years of age with flu or chickenpox symptoms due to incidence of Reye's syndrome.

SIDE EFFECTS:
CV: Prolonged bleeding
Resp: Wheezing, bronchspasm
GI/GU: Nausea, vomiting, heartburn, GI bleeding
DOSAGE:
ADULT:324 mg PO (4 x 81 mg chewable preferred) as soon as possible after onset of chest pain.
PEDIATRIC: Not recommended for use in the field with children.
ROUTE: PO
ATROPINE
TRADE NAME: Atropine, Atropa
CLASS: Anticholingeric
Description: Anticholingeric, antimuscarinic, parasympatholytic
ACTIONS: Decreases vagal tone resulting in positive chronotropic effect & increases AV conduction. Competitive antagonist for acetylcholine at muscarinic receptors. Atropine bronchodilates via parasympatholytic mechanism.
INDICATIONS: Hemodynamically significant bradycardia and asystole. Cholinergic poisoning by certain mushrooms (Amanita spp.), insecticides (carbamates, acetycholinesterase inhibitors), and nerve gas.
PHARMACOKINETICS:
Onset: < 2 minutes
Peak Effect: 2 - 4 min. IV (20 - 60 min. IM)
Duration: 4 hours
Half Life: 2 - 3 hours
CONTRAINDICATIONS: No significant contraindications, however, may worsen bradycardia associated with Mobitz-Type 2 and complete heart block. Use transcutaneous pacing if available. Use with extra caution in patients with symptoms of myocardial ischemia.
SIDE EFFECTS:
CNS: Pupillary dilation, confusion, restlessness, drowsiness, seizure
CV: Tachycardia, paradoxical bradycardia
Resp: Can cause mucus plugs due to drying of secretions
GI/GU: Dry Mouth
INTERACTIONS: Additive anticholinergic effects with antihistamines, phenothiazines, antipsychotics, tricyclic antidepressants, procainamide, other anticholinergics drugs. Caution with SSRIs.
DOSAGE:
ADULT: Symptomatic Bradycardias 0.5 - 1.0mg IV push; may be repeated q 3-5 minutes to a maximum of 0.04mg/kg; (2.5 - 3mg adults) results in full vagal blockage. Doses of less than 0.5mg may cause further slowing of the heart rate.
Asystole & PEA initially 1.0mg IV; may be repeated q 3-5 minutes for total of 3mg. ETT-2.0mg
Poisoning initially 1mg rapid IV, 2nd 1mg slow IV; larger doses may be required. Dosage exceeding 4mg by physician order only.
PEDIATRIC: 0.05mg/kg IV, IM, IO every 10-15 min.
ROUTE: IV, IO, ET (May be administered via *ABT in some cases of bronchospasm. Smaller doses of atropine are indicated for the elderly.)
NOTES: Monitor vital signs carefully.
BENADRYL
Packaged: 1cc (50mg/1ml) Ampoule or Vial.
Dose: 25-50mg IV or 50mg IM max is 400mg per day
Actions: An antihistamine with anticholinergic (drying) and sedative side effects. Prevents but does not reverse histamine mediated responses, particularly on the smooth muscles of the airway, GI tract, uterus, and blood vessels.
CALCIUM CHLORIDE
Packaged: 10 grams in 10ML
Dose: 4mg/kg IV slow
Actions: Increases the force of myocardial contraction; calcium may either increase or decrease systemic vascular resistance
CARDIZEM
Packaged: 25mg in 5cc
Dose: .25mg/kg for first dose, .35mg/kg in second dose
Actions: Calcium channel blocker that slows AV nodal conduction time and prolong AV refractoriness.
DOPAMINE
Packaged: 400mg in 250 cc's making for a 1600mcg/ml
Dose: 400mg in 250cc for a 1600mcg/cc concentration
Actions: It exerts an inotropic effect on the myocardium resulting in increased cardiac output, peripheral vasoconstriction and a marked increase in pulmonary occlusive pressure
EPINEPHRINE
Packaged: 1mg in 10cc for 1:10,000 concentration
Dose: 1mg in 10cc IV 1:10,000 or for anaphylaxis .3mg sub Q 1:1,000
Actions: Sympathomimetic, which stimulates both alpha and beta adrenergic receptors causing immediate bronchodilation, increase in heart rate and increase in the force of cardiac contraction as well as increasing vascular resistance which may enhance defibrillation
FUROSEMIDE
TRADE NAME: Lasix
CLASS: Diuretic
DESCRIPTION: Potent diuretic. Causes venous dilation
ACTIONS: Causes venous dilation and therefore decreases preload and cardiac workload.
Blocks reabsorption of chloride and sodium primarily in the Loop of Henle thereby increasing urine volume/decreasing blood volume.
INDICATIONS: Congestive heart failure, acute pulmonary edema, hypertensive crisis
PHARMACOKINETICS:

Onset: 5 - 10 minutes, diuresis in 5 - 30 minutes
Peak Effect: 30 minutes. (IV) 1 - 2 hr (PO)
Duration: 2 hours, Diuresis duration approx. 6 hours
Half Life: 30 minutes
CONTRAINDICATIONS: Hypersensitivity to furosemide or other sulfonamides. Renal failure.
Use with caution in cases of known urinary retention. May cause birth defects, safety has not been established in pregnancy. Extreme caution in cases of pneumonia - creates mucus plugs.
SIDE EFFECTS:
CNS: Dizziness
CV: Hypotension, hypokalemia, dehydration, dysrhythmias, headache
GI/GU: Nausea, vomiting, diarrhea
INTERACTIONS: Possible additive or synergistic effects with antihypertensives,
nitrates, and other diuretics. Do not mix with amrinone (Inocor) - will precipitate.
DOSAGE:
ADULT: 40 - 80 mg slow IV push at 10-20mg/minute (4 mg/min. recommended).
Titrate to maintain uterine tone
PEDIATRIC: 1 mg/kg
ROUTES: IV preferred, slow - moderate push.
May be given IM if IV route is not available.
NOTES: Protect from light, heat.
Observe patient carefully during administration, especially elderly, during diuresis is essential. Currently, furosemide is rarely administered in the field,
unless the patient is already taking furosemide.
LIDOCAINE
Packaged: 5ml Preload syringes (100mg/5ml)
250ml NS with IGM Lidocaine premixed.
Dose: 1 - 1.5mg/kg max dose is 3mg/kg (Adult use 2% Peds. use 1% solution) or make a drip 1g in 250ml
MAGNESIUM SULFATE
TRADE NAME: Magnesium
CLASS: Electrolyte, Anticonvulsant, Antidysrhythmic
DESCRIPTION: Electrolyte, cation, Physiologic calcium channel blocker, CNS depressant and anticonvulsant. Acts as neuromuscular blocker.
ACTIONS: Raising magnesium level inhibits calcium flux across cell membranes, corrects hypomagnesemia, depresses CNS and inhibits muscle cell activity.
INDICATIONS: Convulsive states associated with severe preeclampsia and eclampsia, Torsades de Pointes, refractory/recurrent VF or pulseless VT, refractory bronchospasm
PHARMACOKINETICS:

Onset: Immediate in IV , IM: 1 hour
Peak Effect: Varies
Duration: 1 hour
CONTRAINDICATIONS: Contraindicated in: High degree heart block, shock, patients on digitalis or who are on dialysis or who are hypocalcemic,
or persistent hypertension.
Use with caution in patients with other CNS depressants on board.
Patients with impaired renal function may not be able to eliminate excess Mg++
Use with caution in patients with asthma.
SIDE EFFECTS:
CNS: Sedation, confusion, muscle weakness, paralysis
CV: Hypotension, bradycardia, heart block
Resp: Depression, arrest
Other: Flushing, sweating, hypotension, hypocalcemia
INTERACTIONS: Incompatible with many drugs. Those present in the prehospital arena include:
digitalis, alcohol, salicylates, and sodium bicarbonate.
DOSAGE:
ADULT: VF/VT/Torsade: 1 - 2 grams. Maintenance infusion is indicated following initial IV dose at a rate of 0.5 - 1.0 g/hr. IV for control of Torsade.
PEDIATRIC: VFVT/Torsade: 25 - 50 mg/kg IV/IM
Eclampsia: 1 - 4 grams of 10% solution. Smallest effective dose should be used. Dose rate should not exceed 1.5 ml (150mg)/min.
Bronchospasm: Adults 1 - 2 grams, Pediatric: 25 - 50 mg/kg
ROUTES: IV over 1-20 minutes depending upon illness and seriousness.
It is preferred to use a more dilute solution (10%) when administering IV.
NOTES: Calcium is antidote if respiratory depression occurs. Continuous cardiac monitoring is essential.
General signs of toxicity include: sedation, thirst, diarrhea, muscle weakness.
MORPHINE SULFATE
Packaged: 1ml Ampule (10mg/ml).
Dose: 2-10mg IV Slowly every 5:00 until desired response max is 10mg
Action: Narcotic analgesic, which depresses the CNS and sensitivity to pain. Increases venous capacitance, decreases venous return and produces mild peripheral vasodilatation. Also decreases myocardial oxygen demand.
NALOXONE
Packaged: 2cc Ampule (1mg/1ml.) 10ml Vial (4mg/10ml.) 1ml Ampule/Vial (0.4mg/1ml).
Dose: 2mg IV, IM, ET, SC may repeat every 2-3:00
Action: antagonizes the effects of opiates by competing at the same receptor sites. When given IV the action is apparent within 2:00. IM or SC administration is slightly slower
NITROGLYCERIN
Packaged: Spray 0.4mg metered dose. Bottle 1/150gr = 0.4mg per tablet.
Dose: .4mg (1 tablet or 1 spray) max is 3 doses
Action: direct vasodilator which acts principally on the venous system although it also produces direct coronary artery vasodilatation as a result. There is a decrease in venous return which decreases the workload on the heart and thus decreases myocardial oxygen demand.
OXYTOCIN
TRADE NAME: Pitocin, Syntocinon
CLASS: Uterotonic, pituitary hormone
DESCRIPTION: Synthetic oxytocic hormone released from the posterior pituitary gland
ACTIONS: Stimulates frequency and force of uterine contraction,
decreasing bleeding from uterine vessels
Stimulates lactation
INDICATIONS: Postpartum hemorrhage not controlled by fundal massage
PHARMACOKINETICS:

Onset: 1 minute by IV
Peak Effect: 5 minutes by IV
Duration: 30 minutes post infusion end
Half Life: 3 - 5 minutes
CONTRAINDICATIONS: No contraindications in controlling excessive postpartum hemorrhage.
Essential to assure the placenta has delivered and that no other fetus is present prior to administering oxytocin.
Overdosage can cause uterine rupture
Check fundus q 5 mins and message
SIDE EFFECTS:
CV: Hypo/hypertension, - rare, fluid retention, cardiac dysrhythmias, anaphylaxis
Gi/GU: Nausea, vomiting, pelvic hematoma, uterine spasm/rupture
INTERACTIONS: Additive or other synergistic effects possible with other uterotonics
such as methyl ergonovine (Methergine)
DOSAGE:
ADULT: 10 - 40 units in 1,000 ml NS to be infused 250 ml then 200 ml/Hr.
Titrate to maintain uterine tone
PEDIATRIC: Not Used
ROUTES: Continuous IV, infusion, can be given IM
NOTES: Consider multiple large bore IV lines for fluid replacement.
SODIUM BICARBINATE
Packaged: 50ml syringe (1mEq/1ml).
Dose: 1meq/kg
Action: an alkalizing agent used to buffer acids present in the body during and after severe hypoxia. It combines with excess acids present in the body to form a weak volatile acid which is broken down into CO2 and H2O. Only effective with adequate ventilation
VALIUM
Packaged:
Dose: 5-20mg IV 20mg is max
Action: Benzodiazepine which depresses the limbic system, thalamus, and hypothalamus resulting in calming effects. Also a muscle relaxant
VASOPRESSIN
Packaged:
Dose: 40 units in 2cc's
Action: normally and anti diuretic hormone. In unnaturally high doses (more than needed for diuretic) vasopressin acts as a non adrenergic peripheral vasoconstrictor. Acts by direct stimulation of smooth muscle V1 receptors. During CPR increases coronary perfusion pressure, vital organ blood flow, ventricular fibrillation median frequency, and cerebral oxygen delivery.
VERSED
Packaged: 2mg/2ml, 10mg/2ml and 5mg/5ml vials
Dose: 2mg IV slowly
Action: Short-acting benzodiazepine CNS depressant that produces sedation and lack of recall.
ACTIVATED CHARCOAL
Class: Chemical adsorbent
Indications: Oral poisonings/medication overdoses; can be used after evacuation of poisons
Contraindications: Comatose pt; ingestion of caustic, corrosive, or petroleum distillates; simultaneous administration of other oral medications
Side effects: may induce nausea/vomiting, constipation, black stool
Adult Dose: 1-2 g/kg PO or via NGT
Pediatric Dose: 1-2 g/kg PO or via NGT
Special info: Doesn't adsorb cyanide, lithium, iron, lead, or arsenic
ALBUTEROL
Class: Sympathomimetic bronchodilator; relatively selective beta 2 adrenergic
Indications: Treatment of bronchospasm in patients with reversible obsructive airway disease; also an adjunct to treat hyperkalemia
Contraindications: Known hypersensitivity to albuterol or levalbuterol
Side Effects: Restlessness, tremors, dizziness, palpitations, tachycardia, nervousness, peripheral vasodilation, nausea, vomiting, hyperglycemia, HBP, paradoxical bronchospasm
Adult dose: 2.5-5.0 mg Neb
Pediatric Dose: 2.5 mg Neb (0.15 mg/kg)
Special Info: May precipitate angina pectoris and arrhythmias; beta blockers are antagonistic; may potentiate hypokalemia caused by diuretics
AMYL NITRATE
Drug Class: amyl and sodium nitrite = affinity for cyanide ions, reacts with hemoglobin to form methemoglobin. Sodium Thiosulfate combines with Cyanide to produce thiocyanate, which is then excreted.
Indications: Cyanide Poisoning
Contraindications: none
Side Effects: excessive doses of the nitrites can cause life-threatening methemoglobinemia
Adult Dose: Amyl nitrite pearl - crush and have pt inhale 30 seconds out of every minute; Sodium Thiosulfate and Sodium Nitrite, give IV dose based on antidote kit guidelines
Pediatric Dose: Same as adult
Special Info: must be used in conjuction with oxygen
Brand Name: Lily Kit
ASPRIN
Drug Class:Platelet inhibitor, anti-inflammatory agent.; Prostaglandin inhibition.
Indications: New onset chest pain suggestive of acute myocardial infarction
Contraindications: Hypersensitivity. Relatively contraindicated in patients with active ulcer disease or asthma.
Side Effects: Heartburn, GI bleeding, prolonged bleeding, nausea, and vomiting. Wheezing in allergic patients.
Adult Dose: 162 (2 x 81mg) or 324 (4 x 81mg) or 325 (enteric coated - 1 x 325)mg PO (chew if not enteric coated)
Pediatric Dose: Not given
Special Info: Bayer; Overdose may need multiple doses of charcoal.
COMPAZINE
Drug Class: Antiemetic; phenothiazine
Indications: To relieve severe nausea and vomiting; to manage acute psychosis
Contraindications: patients with hypersensitivity to phenothiazines
Side Effects: extrapyramidal reactions (akathisia, dystonia, or parkinsonism), persistent tardive dyskinesia, acute catatonia, sedation
Special Info: Treat EPS with diphenhydramine
Generic name: Prochlorperazine
DEXAMETHASONE
Drug Class: Corticosteroid; Suppresses acute and chronic inflammation; immunosuppressive effects.
Indications: Anaphylaxis, asthma, spinal cord injury, croup, elevated intracranial pressure
Contraindications: Hypersensitivity to product.
Side Effects: Immunosupression; hyperglycemia
Adult Dose: 4-24 mg IV/IM
Pediatric Dose: 0.5-1.0 mg/kg
Special Info: Brand Name: Decadron
DEXTROSE
Drug Class: Carbohydrate, hypertonic solution.
Indications: Hypoglycemia; with insulin can be used to treat hypekalemia
Contraindications: Intracranial hemorrhage (unless low BG)
Side Effects: Extravasation leads to tissue necrosis.
Adult Dose: usual 12.5 - 25g of D50
Adult Dose (oral glucose): 15 - 25g (must be able to swallow)
Precautions (oral glucose): must be able to swallow and protect airway
Pediatric Dose: 0.5-1 g/kg/dose slow IV; Newborn = D10 (5-10 mL/kg); children = D25 (2-4 mL/kg)
Special Info: Administer thiamine prior to D50 in known alcoholic patients. Do not administer to patients with known CVA unless
hypoglycemia documented.
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