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29 terms

Paramedic Drugs

CLASS: Anti-pyretic


CONTRAINDICATIONS: Liver failure; hypersensitivity; exceed max dose

ADULT: 1 g (2 pills) q 6 hours; max 4 g (8 pills) in 24 hours
PEDIATRIC: 15 mg/kg q 6 hours

SIDE EFFECTS: Liver toxicity
TRADE NAME: Adenocard
CLASS: Antiarrhythmic
ACTIONS: Slows (decreases) AV conduction

INDICATIONS: Symptomatic PSVT, including Wolff-Parkinson-White Syndrome (WPW)

CONTRAINDICATIONS: Second or third degree heart block, sick-sinus syndrome, known
hypersensitivity to the drug, dysrhythmias other than PSVT, reactive airway diseases like asthmea.

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

Onset: 20 - 35 seconds
Peak Effect: 20 - 35 seconds
Duration: 30 - 120 seconds
Half Life: 10 seconds

PRECAUTIONS: Arrhythmias, including blocks, are common at the time of cardioversion.
Use with caution in patients with asthma.

CNS: Dizziness, near syncope, syncope
CV: PVCs, PACs, sinus tachycardia, sinus bradycardia, AV blocks, chest pain, facial flushing,
Resp: SOB, bronchoconstriction
GI/GU: Nausea
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

CONTRAINDICATIONS: Known hypersensitivity to albuterol.

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.

Onset: 5 - 15 minutes
Peak Effect: 1 - 1.5 hours
Duration: 3 - 6 hours
Half Life: < 3 hours

CNS: Tremors, anxiety, dizziness, seizure
CV: Headache, palpations, HTN, tachycardia, chest pain
Resp: Bronchospasm (paradoxical effect)
GI/GU: Nausea, vomiting, dry mouth

ROUTES: Nebulizer, metered-dose inhaler (MDI)
PACKAGED: Premixed unit dose of 2.5mg in 2.5ml NS.
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.

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

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

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.
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 of recent CVA.

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, children 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.

CV: Prolonged bleeding
Resp: Wheezing, bronchspasm
GI/GU: Nausea, vomiting, heartburn, GI bleeding

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.
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.

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.

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.

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.
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.
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
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.
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
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

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

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.

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.

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.
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
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

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.

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.

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.
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.
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
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.
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

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 massage.

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)

ADULT: 10 - 40 units in 1,000 ml NS to be infused 250 ml then 200 ml/Hr. Titrate to maintain uterine tone
ROUTES: Continuous IV, infusion, can be given IM
NOTES: Consider multiple large bore IV lines for fluid replacement.
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
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
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.
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.
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

Dose: 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
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
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
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.
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
TRADE NAME: Decadron
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
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.

ADULTS: usual 12.5 - 25g of D50
ADULTS (oral glucose): 15 - 25g (must be able to swallow)
PEDIATRIC: 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.

Precautions (oral glucose): must be able to swallow and
protect airway