Paramedic Drug Cards: Recent Episodes
Michael Egan
- Trade: Sublimaze
- Class: Narcotic Analgesic
- MOA: Binds to opiate receptors producing analgesia and euphoria
- Indication: Pain
- Contraindication: Use caution in traumatic brain injury, Respiratory depression
- Side effects: Respiratory depression, apnea, hypotension, N/V, dizziness, sedation euphoria, Sinus bradycardia, sinus tachycardia, palpitations, HTN, diaphoresis, syncope
- Dosing
Adult
50-100mcg IM/IV
Pedi
1-2mcg/kg IM/IV
- Trade: Valium
- Class: Benzodiazepine
- MOA: Binds to the benzodiazepine receptor and enhances the effects of GABA
- Indications: Anxiety, Skeletal muscle relaxation, anticonvulsant
- Contraindications: Children younger then 6 months, acute angle glaucoma, CNS depression, alcohol intoxication.
- Side effects: Respiratory depression, drowsiness, fatigue, headache, pain at the injection site, confusion, nausea, hypotension, cardiac arrest at high doses
- •Dosing:
Adult:
Anxiety: 2-10mg IV/IM
Seizure: 5-10mg IV/IO
Pediatric:
Anxiety: 0.2 – 0.3mg/kg IV/IM
Seizure: Older then 5 years: 1mg IV/IO
Older then 30 days less then 5 years: 0.2 to 0.5mg IV/IO
Neonate: 0.1-0.3mg/kg IV/IO
- Trade: Tegretol
- Class: Anticonvulsant
- MOA: Binds preferably to voltage gated Sodium channels in their inactive conformation, which prevents repetitive and sustained firing of an action potential.
- Indications: Partial and generalized tonic – clonic seizures
- Contraindications: AV Block, bundle branch block, agranulocytosis, bone marrow supression, monoamine oxidase inhibitor therapy
- Side effects: Dizziness, drowsiness, ataxia, N/V, blurred vision, confusion, headache, transient diplopia, visual hallucinations, life threatening rashes.
- Dosing:
Adult:
200mg PO
Pediatric:
6-12 years old: 100mg PO
Less then 6: 10mg/kg PO
- Trade: Toradol
- Class: NSAID
- MOA: inhibits the production or prostaglandins in inflamed tissue, which decreases the responsiveness of pain receptors.
- Indications: Moderately severe acute pain
- Contraindications: Patients with a hx of peptic ulcer disease or GI bleed, patients with renal insufficiency, hypovolemic patients, 3rd trimester pregnancy, nursing mothers, allergy to other nsaids, stroke or head trauma, having surgery within the next 7 days.
- Side effects: headache, drowsiness, dizziness, abdominal pain, dyspepsia, N/V, Diarrhea.
- Dosing:
Adult
IV 30mg
IM 60mg
Senior (65 and older)/ Pediatric < 50kgs
IV 15mg
IM 30mg
- Trade: Morphine
- Class: Opiate agonist/Narcotic Analgesic
- MOA: Binds to the opiate receptors. Reduces stimulation of the sympathetic nervous system caused by pain and anxiety. Reduction of sympathetic stimulation reduces heart rate, cardiac work, and myocardial O2 consumption
- Indications: moderate to severe pain including chest pain associated with ACS, CHF, and pulmonary edema.
- Contraindications: Respiratory depression, shock.
- Side effects: Respiratory depression, hypotension, N/V, dizziness, lightheadedness, sedation, diaphoresis, euphoria, seizures, cardiac arrest, anaphylactoid reaction.
- Dosage:
Adult
2-10mg IV/IO/IM
Pediatric
< 110 lbs 0.025 – 0.2mg/kg IV/IO/IM
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- Trade – Cortef
- Class – Corticosteroid
- MOA – Reduces inflammation by multiple mechanisms. As a steroid it replaces the steroids that are lacking in adrenal insufficiency.
- Indications – Adrenal insufficiency, allergic reactions, anaphylaxis, asthma, COPD
- Contraindications – Cushing Syndrome, known sensitivity to benzyl alcohol, Use with caution in diabetes, HTN, CHF, known systemic fungal infection, renal disease, idiopathic thrombocytopenia, psychosis, seizure disorder, GI disease, glaucoma.
- Side effects – Leukocytosis, hyperglycemia, increased infection, decreased wound healing, increased rate of death from sepsis.
- Dosing
Anaphylactic shock
Adult 100-500mg IV,IO, or IM
Pedi 2-10 mg/kg per day IV,IO, or IM max 500mg
- Trade – Phenergan
- Class – Antiemetic
- MOA - Decreases nausea and vomiting by antagonizing H1 receptors
- Indications – Nausea/Vomiting
- Contraindication – Altered level of consciousness, jaundice, bone marrow suppression, Use caution in seizure disorder.
- Side effects – Paradoxic excitation in children and older adults.
- Dosing:
Adult - 12.5 - 25mg IV, IO, IM
Pedi - 2years and older 0.25 – 1 mg/kg IV, IO, IM
- Trade – Plavix
- Class – Antiplatelet
- MOA – Blocks platelet aggregation by antagonizing the IIb/IIIa receptors
- Indications – ACS, chronic coronary and vascular disease, ischemic stroke.
- Contraindications – Hx of intracranial hemorrhage, GI bleed or trauma.
- Side effects – Nausea, Abdominal pain, hemorrhage.
- Dosing :
Unstable angina pectoris or non Q wave AMI.
Adult – Loading dose 300-600mg PO
Pedi – Not recommended for pedi patients
- Trade – Isoptin
- Class – Calcium Channel blocker
- MOA – Blocks calcium from moving into the heart muscle cell, which prolongs conduction of the electrical impulses through the AV node.
- Indications – AF, HTN, paroxysmal SVT, Paroxysmal SVT prohylaxis
- Contraindications – 2nd or 3rd degree AV block, Hypotension, cardiogenic shock, Sick sinus syndrome, WPW.
- Side effects – Sinus bradycardia, 1st, 2nd, or 3rd degree AV blocks, CHF, reflex tachycardia, transient asystole, hypotension.
- Dosing
Adult
2.5-10mg IV/IO over 2 minutes. May repeat at 5-10mg every 15-30 mins to a maximum dose of 30mg
Pedi
1-16 years old: 0.1mg/kg IV/IO max single dose 5mg over 2mins may repeat in 30 mins to a max dose of 10mg
- Trade – Cyanokit
- MOA: Antidote, cyanide poisoning adjunct Binds with cyanide to form nontoxic cyanocobalamin, preventing its toxic effects; excreted renally
- Indications: Treatment of known or suspected cyanide poisioning.
- Contraindications: None is the emergency setting
- Side Effects: Hypertension, allergic reactions, GI bleeding, nausea, vomiting, dyspepsia, dyspnea, dizziness, headache, injection site reactions.
- Dosage:
Adult: 5 g IV infusion over 15 minutes at a rate of 15 mL/min.
Pedi: 70 mg/kg IV one time, may be repeated one time at the same dose.
Trade – Cardene
Class – Calcium Channel blocker
MOA – Blocks calcium movement into the smooth muscle of the blood vessel walls, causing vasodilation.
Indication – Angina, HTN
Contraindication – Aortic stenosis, hypotension, use caution in heart failure, cardiac conduction abnormalities, Cerebrovascular disease, depressed AV node conduction.
Side effects – Edema, headaches, flushing, sinus tachycardia, hypotension
Dosages :
Adult: 5mg/hr IV/IO
Pedi: 0.5 – 5 mcg/kg/min
- Trade – Apresoline
- Class – Vasodilator
- MOA – Directly dilates peripheral blood vessels
- Indication – HTN associated with preeclampsia and eclampsia, HTN crisis
- Contraindication – Patients taking diazoxide or MAOI’s, coronary artery disease, stroke, angina, dissecting aortic aneurism, mitral valve and rheumatic heart disease.
- Side effects – Headache, angina, flushing, palpitations, reflex tachycardia, anorexia, N/V, diarrhea, hypotension, syncope, peripheral vasodilation, peripheral edema, fluid retention, pareshesias.
- Dosing
Preeclampsia and eclampsia:
Adult : 5-10mg IV repeat every 20-30mins until Systolic pressure of 90-105mmhg
Acute HTN ( not associated with preeclampsia )
Adult :10-20mg IV/IM
Pedi : 1mo – 12yr 0.1-0.2 mg/kg IV/IM max 20mg per dose
- Trade – Haldol
- Class – Antipsychotic agent
- MOA – Selectively blocks postsynaptic dopamine receptors
- Indications – Psychotic disorders, agitation
- Contraindications – Depressed mental status, Parkinson disease
- Side effects – extrapyramidal symptoms, drowsiness, tardive dyskinesia, hypotension, hypertension, VT, sinus tachycardia, QT prolongation, torsades de pointes.
- Dosing
Adult:
Mild agitation : 0.5-2mg PO/IM
Moderate agitation : 5-10mg PO/IM
Severe agitation : 10mg PO/IM
Pedi:
1-5mg IM/PO
- Trade – Nipride
- Class – Antihypertensive agent
- MOA – Causes direct relaxation of both arteries and veins
- Indication – HTN emergencies
- Contraindications – Hypotension, increased ICP, cerebrovascular disease, coronary artery disease, hepatic disease, renal disease, pulmonary disease.
- Side effects – Cyanide or thiocyanate toxicity, N/V, dizziness, headache, restlessness, abdominal pain, methemoglobinemia.
- Dosing
Adult 0.3-10mcg/kg/min
Pedi 0.5 – 10mcg/kg/min
- Trade: TetraVisc
- Class: Anesthetic
- MOA: Short acting pain suppressant
- Indication: Topical anesthetic for eye injuries
- Contraindication: allergy
- Side Effects: numbness, blurred vision in treated eye, mild short burning sensation
- Dose:
Adult: 1-2 drops every 5 minutes, repeat as needed
Pediatric1-2 drops every 5 minutes, repeat as needed
- Trade – Dilantin
- Class – Anticonvulsant
- MOA – Depresses seizures by affecting the movement of sodium and calcium into neural tissue.
- Indication – Generalized tonic – clonic seizures.
- Contraindication – sinus bradycardia, sinoatrial block, second and third degree heart block, adam stokes syndrome, known sensitivity to hydantoins.
- Side effects – N/V, depression of cardiac conduction, sedation, nystagmus, tremors, ataxia, dysarthria, gingival hypertrophy, hirsutism, facial coarsening
- Dosing:
Adult: 15-20mg/kg IV/IO ( not to exceed a push rate of 50mg/min)
Pedi: 15-20mg/kg IV/IO ( at a rate of 1-3 mg/kg/min)
- Trade – Unfractionated Heparin
- Class – Anticoagulant
- MOA – Acts on antithrombin III to reduce the ability of the blood to form clots, thus preventing clot deposition in the coronary arteries.
- Indication – ACS, acute pulmonary embolism, DVT
- Contraindication – Predisposed to bleeding, aortic aneurism, peptic ulcer.
- Dosing:
Adult
Cardiac indications– 60 units/kg
Pulmonary embolism/ DVT – 80 units/kg
Pedi
Cardiac indications – 75 units/kg
Pulmonary embolism/DVT 75 units/kg
- Trade – ALTEPLASE RECOMBINANT-TPA
- Class– Thrombolytic Agent
- MOA – Dissolves thrombi plugs in the coronary arteries and reestablishes blood flow.
- Indication – ST segment elevation greater then 1mm in 2 or more contiguous leads, New or presumed new left bundle branch block.
- Contraindications – ST segment depression, Cardiogenic shock, Recent major surgery, cerebrovascular disease, recent (within 10 days) GI bleeding, recent trauma, severe HTN Systolic greater then 180 diastolic greater then 110. High likely hood of left heart thrombus, acute pericarditis, severe renal or liver failure with bleeding complications, significant liver dysfunction, diabetic hemorrhagic retinopathy, septic thrombophlebitis, Patients older then 75, patients already taking Coumadin.
- Side effects – Bleeding, intracranial hemorrhage, stroke, cardiac arrhythmias, hypotension, bruising
- Dosing
Adult
Per medical direction.
Pedi
Not recommended
- Trade: Inderal
- Class: Beta Blocker
- MOA: Nonselective Beta antagonist that binds with both the beta1 and beta 2 receptors. Inhibits the strength of the hearts contractions, as well as decreases heart rate resulting in decreased cardiac O2 consumption
- Indication: Angina, reentry SVT, Atrial Fibrillation, Atrial Flutter.
- Contraindication: Cardiogenic shock, Heart failure, AV block, bradycardia, pulmonary edema, sick sinus syndrome.
- Side effects: Bradycardia, AV block, Bronchospasm, hypotension.
- Dosing:
Adult:
1-3mg IV/IO Slow IVP
Pediatric:
0.01 to 0.1mg/kg slow IVP
- Trade: Normodyne
- Class: Beta blocker
- MOA: Binds with beta1, beta2 and Alpha1 receptors. Inhibits the strength of the hearts contractions, as well as heart rate. This results in decrease in cardiac Oxygen consumption.
- Indication: ACS, SVT, severe HTN
- Contraindications: Hypotension, Cardiogenic shock, acute pulmonary edema, heart failure, severe bradycardia, Sick sinus syndrome, second or third degree heart block, bronchospasm.
- Side effects: Usually mild, Hypotensive symptoms, N/V, Bronchospasm, arrhythmia, bradycardia, AV block
- Dosing:
Adult
10mg IV/IO Over 1-2mins may repeat every 10 mins to a max dose of 150mg
Pedi
0.4-1mg/kg per hour to a max dose of 3mg/kg per hour
- Trade: Pitocin
- Class: Hormone
- MOA: Increases Uterine Contractions
- Indications: Postpartum hemorrhage after infant and placental delivery
- Contraindications: Presence of a second fetus, unfavorable fetal position.
- Side effects: Hypotension, Hypertension, tachycardia, arrhythmias, angina, seizures, N/V, uterine rupture, anaphylaxis.
-
Dosing:
- IM: 3-10 units after delivery of placenta
- IV: 20-40 milliunits/min titrate to severity of bleeding.
- Trade: Tenormin
- Class: Beta Blocker
- MOA: Inhibits the strength of the hearts contractions and heart rate, resulting in a decrease in cardiac oxygen consumption. Also saturates the beta receptors and inhibits dilation of bronchial smooth muscle.
- Indications: ACS, HTN, SVT, A-flutter, A-Fib
- Contraindications: Cardiogenic shock, AV block, bradycardia, use caution in hypotension, chronic lung disease ( asthma and COPD)
- Side effects: Bradycardia, bronchospasm, hypotension
- Dosing
Adult: Oral dosing only
Pediatric: Not recommended
- Trade: Levophed
- Class: Adrenergic agonist, inotropic, vasopressor
- MOA: alpha 1, alpha 2, Beta 1 agonist. Primarily results in peripheral vasoconstriction resulting in increasing BP, and coronary blood flow. Beta adrenergic action produces inotropic stimulation of the heart and dilates coronary arteries.
- Indications: Cardiogenic Shock, septic shock, severe hypotension
- Contraindications: Patients taking MAOIs, use caution in hypovolemia
-
Side Effects: Dizziness, anxiety, cardiac arrhythmias, dyspnea, asthma exacerbation
-
Dosing
Adult:2-4mcg/min IV/IO titrate to effect ( systolic BP greater then 80) Max dose is 30mcg/min
Pedi: 0.05 to 2mcg/kg/min IV/IO
Warfarin
Trade: Coumadin
Use: Anticoagulant
Glipizide
Trade: Glucotrol
Use: Diabetes
Clopidogrel bisulfate
Trade: Plavix
Use: Platelet inhibitor
- Trade: Dobutrex
- Class: Adrenergic agent, Inotropic
- MOA: Increases myocardial contractility and stroke volume with minor chronotropic effects, resulting in increased cardiac output
- Indication: CHF, Cardiogenic shock
- Contraindications: Drug induced shock, Systolic pressure greater then 100, use caution in HTN, recent MI, Arrhythmias, hypovolemia
- Side effects: Tachycardia, PVC’s, HTN, Hypotension, palpitations, arrhythmias
- Dosing:
Adult: 2-20 mcg/kg/min IV/IO
Pedi: SAA
- Trade: Intropin
- Class: Vasopressor /Sympathomimetic
- MOA: Stimulates alpha and beta adrenergic receptors resulting in inotropy and increased cardiac output while maintaining dopaminergic induced vasodilatory effects.
- Indications: Hypotension and decreased cardiac output associated with cardiogenic shock and septic shock. Hypotension after ROSC. Symptomatic Bradycardia that doesn’t respond to atropine
- Contraindications: VF, VT, or other ventricular arrhythmias
- Side effects : Tachycardia, arrhythmias, skin and soft tissue necrosis, severe HTN, angina, dyspnea, headache, N/V
- Dosing
Adults: 2-20 mcg/kg/min IV/IO
Pedi: SAA
- Trade: Primacor
- Class: Inotropic / Vasodilator
- MOA: Positive inotropic drug and vasodilator with minimal chronotropic effects. Inhibits enzyme cAMP phosphodiesterase which results in an increased concentration of calcium inside the cardiac cell and results in better diastolic function and myocardial contractility.
- Indication: Cardiogenic shock, Heart failure
- Contraindication: Valvular heart disease.
-
Side effects: Cardiac arrhythmias, N/V, Hypotension
-
Dosing:
Adult: 50 Mcg/kg IV/IO over 10 mins
Pedi:SAA
- •Trade – Cordarone
- •Class – Antiarrhythmic
- •MOA - Acts directly on the myocardium to delay repolarization and increase the duration of action potential
- •Indications – Ventricular arrhythmias, second line for atrial rhythms.
- •Contraindications – Sick sinus syndrome, second and third degree heart block, cardiogenic shock, when episodes of bradycardia have cause syncope, sensitivity to benzyl alcohol and iodine.
- •Side effects – Burning at the IV site, hypotension, bradycardia.
- •Dosing
Ventricular Fibrillation, and Pulseless Ventricular Tachycardia
Adult: 300mg IV/IO followed by 150mg in 3-5 mins
1mg/min maintenance infusion after ROSC
Pedi: 5mg/kg max dose 300mg may repeat 5mg/kg up to 15mg/kg
Stable Wide Complex Tachycardia
Adult: 150mg over 10 mins.
Pedi: 5mg/kg IV/IO over 20-60 mins
meloxicam
Trade: Mobic
Use: NSAID
ibuprofen
Trade: Advil
Use: Pain, fever, arthritis
insulin glargine
Trade: Lantus
Use: Diabetes Mellitus
- Class: Electrolyte replacement /Alkalizing Agent
- MOA: Counteracts existing acidosis
- Indications: Acidosis, Drug intoxications (barbiturates, salicylates, methyl alcohol)
- Contraindications: Metabolic alkalosis, hypocalcemia
-
Side effects: metabolic alkalosis, hypernatremia, injection site reaction, sodium and fluid retention, peripheral edema.
-
Dosing
Metabolic acidosis during cardiac arrest
Adult:1 mEq/kg slow IV/IO may repeat at 0.5 mEq/kg in 10 mins
Pedi:SAA
- Trade- Xylocaine
- Class – Antiarrhythmic / NA+ blocker
- MOA – blocks sodium channels increasing the recovery period after repolarization. Suppresses automaticity in the His-Purkinje system and depolarization in the ventricles.
- Indication – Ventricular arrhythmias
- Contraindications - AV block, Bleeding, thrombocytopenia, Use caution in bradycardia, hypovolemia, cardiogenic shock, adams stokes syndrome, WPW
- Side effects – Toxicity ( signs may include anxiety, apprehension, euphoria, nervousness, disorientation, dizziness, blurred vision, facial paresthesias, tremors, hearing disturbances, slurred speech, seizures, sinus bradycardia.) Seizures without warning, cardiac arrhythmias, hypotension, cardiac arrest, pain at injection site.
- Dosing
Pulseless v- tach and v-fib
Adult: – 1-1.5mg/kg IV/IO may repeat at half the original dose (0.5 to 0.75mg/kg) every 5-10 mins to a max dose of 3mg/kg.
Maintenance drip 1-4mg/min
Pedi: 1mg/kg IV/IO (max 100mg)
Maintenance
20-50 mcg/kg/min
Perfusing ventricular rhythms
Adult: 0.5-0.75mg/kg IV/IO repeat every 5-10mins to a max dose of 3mg/kg
Pedi: 1mg/kg IV/IO may repeat every 5-10 mins to a max of 3mg/kg
- Trade – Calcium Gluconate
- Class – Electrolyte solution
- MOA – Counteracts the toxicity of hyperkalemia by stabilizing the membrane of the cardiac cells, reducing the likelihood of fibrillation
- Indication – Hyperkalemia, hypocalcemia, hypermagnesemia
- Contraindications - VF, Dig toxicity, hypercalcemia
- Side effects – soft tissue necrosis, hypotension, bradycardia ( if administered rapidly)
- Dosing
Adult: 500 to 1000mg IV/IO (packaged as 100mg/ml) administer 1-1.5 ml/min max dose 3G IV/IO
Pedi: 60-100ml/kg IV/IO slowly over a 5-10 minute period maximum dose 3G IV/IO
- Class- Antidote
- Description- Calcium chloride increases myocardial contractile force and increases ventricular automaticity.
- Indications-Hyperkalemia, hypocalcemia, hypermagnesemia, and calcium channel blocker toxicity.
- Contraindications-Ventricular fibrillation, hypercalcemia, and possible digitalis toxicity.
- Precautions- It may precipitate toxicity in patients taking digoxin. Ensure the IV line is in a large vein and flushed before using and after calcium
- Dosing Adult
Bradycardia of Suspected Hyperkalemia
Adult: 1G IV, IO over 5-10mins
Cardiac Arrest of Suspected Hyperkalemia
Adult: 1G IV IO
Hyperkalemia
Adult: 1G IV/IO may repeat after 5 mins
- Trade – Adenocard
- Classification – Antiarrhythmic
- MOA– Slows the conduction of electrical impulses at the AV node
- Indication – SVT
- Contraindications – Sick sinus syndrome, second or 3rd degree heart block, Poison/drug induced tachycardia, asthma, or bronchospasm
- Side Effects– Sense of impending doom, complaints of flushing, chest pressure, throat tightness, numbness, brief period of asystole after administration.
- Dosing
Adult: 6mg rapid IV/IO followed by a rapid saline flush; If rhythm doesn’t break in 1-2 minutes 2nd dose of 12mg RAPID IV/IO followed by saline flush
Pediatric:
Greater than 110 pounds SAA
Less than 110 pounds initial dose 0.1mg/kg IV/IO (max 6mg) Followed by a rapid saline flush second dose if rhythm persists or reoccurs 0.2mg/kg (max 12mg) followed by a rapid saline flush.
- Trade– Lopressor, Toprol XL
- Class– Beta Blocker ( Class II antiarrhythmic)
- MOA– Inhibits the strength of the hearts contraction as well as the heart rate
- Indication– ACS, HTN, SVT, atrial flutter, Afib, thyrotoxicosis
- Contraindications– Cardiogenic Shock, AV Block, Bradycardia
- Side effects – Tiredness, dizziness, diarrhea, heart block, bradycardia, bronchospasm, drop in blood pressure.
- Dosing
Adult: 5mg slow IV/IO over 2 minute period, Repeat at 5 minute intervals as necessary up to 15mg
Pediatric: Not Recommended
- Trade – Cardizem
- Class – Calcium channel Blocker ( class IV antiarrhythmic)
- MOA – Blocks Calcium from moving into the heart muscle cell, which prolongs the conduction of electrical impulses through the AV node
- Indication – Rapid atrial fibrillation
- Contraindications – Hypotension, Heart block, heart failure
- Side effects – Flushing, headache, bradycardia, hypotension, heart block, myocardial depression, severe AV block, at high doses cardiac arrest
- Dosing
Adult: 0.25mg/kg IV/IO 2nd dose of 0.35mg/kg IV/IO
Pediatric: Not recommended
- Class – Anticholinergic
- MOA – Competes reversibly with ACH at the site of the muscarinic receptor.
- Indication – Symptomatic Bradycardia, asystole or PEA, Nerve agent exposure or organophosphate poisoning.
- Contraindications – Acute MI, Myasthenia Gravis, GI obstruction, closed angle glaucoma, known sensitivity to atropine, belladonna alkaloids, or sulfites. Atropine may not be effective on second degree type 2 and 3rd degree heart blocks.
- Side effects – decreased secretions resulting in dry mouth and hot skin, intense facial flushing, blurred vision or dilation of the pupils with photophobia, tachycardia and restlessness. Atropine may cause paradoxical bradycardia if the dose administered is too low or if it is administered too slowly.
- Dosing
Symptomatic Bradycardia
Adult: 0.5mg IV/IO every 3-5 minutes to a maximum dose of 3mg
Pediatric: 0.02mg/kg IV/IO up to a total dose of 2mg
Nerve Agent or Organophosphate Poisoning
Adult: 1-6mg IV/IM repeat every 5 minutes until symptoms dissipate
Pediatric: 0.05mg/kg IV/IM every 10 – 30 minutes until symptoms dissipate
- Trade – Osmitrol
- Class – Osmotic Diuretic
- MOA – Facilitates the flow of fluid out of tissues including the brain and into interstitial fluid and blood, this causes dehydration of the brain which results in decreased swelling. Reabsorption by the kidneys is limited so increased urine output takes place
- Indications – increased ICP
- Contraindications- Active intracranial bleeding, heart failure, pulmonary edema, severe dehydration, use caution with hypovolemia and renal failure.
- Side effects – Pulmonary edema, headache, blurred vision, dizziness, seizures, hypovolemia, nausea/vomiting, diarrhea, electrolyte imbalance, hypotension/HTN, sinus tachycardia, PVCs, angina, phlebitis
- Dosage
Adult: 0.25-1g/kg
Pediatric: SAA
- Trade – Decadron
- Class – Corticosteroid
- MOA – Reduces inflammation by multiple mechanisms
- Indication – Asthma, airway edema, acute mountain sickness, cerebral edema and multiple medical conditions requiring anti-inflammatory
- Contraindications – Fungal infection, use caution in active infections, renal disease, penetrating spinal cord injury.
- Side effects – Depression, euphoria, headache, restlessness, HTN, Bradycardia, Nausea/vomiting, swelling, diarrhea, weakness, fluid retention, paresthesias
- Dose
Adult: 10mg IV/PO
- Trade– Dextrose (D50, D25, D10)
- Class – Antihypoglycemic
- MOA – Increases blood glucose concentrations
- Indications – Hypoglycemia
- Contraindications – Intracranial and instraspinal hemorrhage, delirium tremens.
- Side effects – Hyperglycemia, warmth, burning from IV infusion. Concentrated solutions may cause pain and thrombosis of peripheral veins.
- Dosing –
Hyperkalemia:
Adult: 25G of dextrose 50% IV,IO
Pedi: 0.5 – 1G/kg IV/IO
Hypoglycemia:
Adult: 10-25g dextrose 50% IV
Pedi: Older then 2 years 2ml/kg of Dextrose 50%
Pedi under years old: 2-4 ml/kg of Dextrose 10%
Bupropion
Trade: Wellbutrin
Use: Antidepressant
Potassium
Trade: K-Dur
Use: Hypokalemia
Carvedilol
Trade: Coreg
Use: HTN
Fluticasone
Trade: Flonase
Use: Allergies
Alprazolam
Trade: Xanax
Use: Anxiety, Panic disorder
Trazodone hydrochloride
Trade: Desyrel
Use: Depression
- Trade – Brevibloc
- Class– Beta Blocker
- MOA– Inhibits the strength of the hearts contractions, as well as heart rate.
- Indication – ACS, MI, acute HTN, Supraventricular tachyarrhythmias
- Contraindications – COPD, Acute Bronchospasm, Bradycardia, Advanced Heart blocks, cardiogenic shock, Pulmonary Edema,
- Side Effects – Hypotension, sinus bradycardia, AV block, Cardiac arrest, nausea/vomiting, hypoglycemia, injection site reaction
- Dosage
Adult: 500mcg/kg IV/IO over 1 minute
Pedi: 500mcg/kg IV/IO over 1 minute
- Trade – Glucagon
- Class – Hormone
- MOA – Converts glycogen to glucose
- Indication – hypoglycemia, beta blocker overdose
- Contraindications – Pheochromocytoma, Insulinoma
- Side effects – Nausea/vomiting, rebound hyperglycemia, hypotension, sinus tachycardia
- Dosages
Hypoglycemia
Adult: 1mg IM, IV, IO, SQ
Pedi: Less than 44 lbs – 0.5mg IM, IV, IO, Sq
Beta Blocker/CCB Overdose
Adult: 3-10mg IV, IO
- Trade – Brethine
- Class– Adrenergic agent
- MOA – Stimulates B2 receptor producing relaxation of bronchial smooth muscle and bronchodilation.
- Indication – prevention and reversal of bronchospasm
- Contraindications – known sensitivity to sympathomimetics
- Side Effects – Cardiac arrhythmias, arrhythmia exacerbation, angina, anxiety, headache, tremor, palpitations, dizziness
- Dosages
Adult: 0.25mg SQ every 20 minutes for up to 3 doses
Pedi: 0.005 to 0.01 mg/kg SQ every 20 mins for up to 3 doses
- Trade – Solu Medrol
- Class – Corticosteroid
- MOA – Reduces inflammation by multiple mechanisms
- Indications – Anaphylaxis, Asthma, COPD
- Contraindications – Cushing Syndrome, Fungal infection, HTN, seizures, CHF, Penetrating spinal cord injuries, Renal disease
- Side effects – depression, euphoria, headache, restlessness, HTN, Bradycardia, nausea/vomiting, swelling, diarrhea, weakness, fluid retention, paresthesia
- Dosage:
Asthma and COPD
Adult: 40-80mg/day IV
Pedi: 1mg/kg (up to 60) IV/IO per day
Anaphylactic Shock
Adult: 0.5 – 1mg/kg IV
Pedi: SAA
- Trade – Zofran
- Class – Antiemetic
- MOA – Binds and blocks a receptor for the brain chemical serotonin
- Indication – Prevention and treatment of nausea and vomiting
- Contraindication – Use caution in hypokalemia, hypomagnesemia, cardiac arrhythmias
- Side Effects – headache, fatigue, diarrhea, dizziness, hypotension/HTN, Prolonged PR and QT intervals, Widened QRS, Bradycardia, tachycardia, syncope.
- Dosage
Adult: 4– 8mg IV, IO, PO
Pedi: (2-16 years) 0.15 mg/kg IV,IO ( max dose 16mg)
- Trade – Magnesium Sulfate
- Class – Electrolyte, Tocolytic, Mineral
- Action – Controls seizures by blocking peripheral neuromuscular transmission. Magnesium is also a peripheral vasodilator, and an inhibitor of platelet function.
- Indication – Torsades de Pointes, cardiac arrhythmias associated with hypomagnesemia, eclampsia and seizure prophylaxis in preeclampsia, status asthmaticus.
- Contraindications – AV Block, GI obstruction, use caution in renal impairment.
- Side effects – Mag Toxicity
Signs of Mag Toxicity would include flushing, diaphoresis, hypotension, muscle paralysis, weakness, hypothermia, and cardiac, CNS, or respiratory depression
- Dosages
Pulseless V-fib/ V-tach with Torsades de Pointes or Hypomagnesemia
Adult:1 – 2 G in 10ml D5W IV,IO, over 15 mins or faster if cardiac arrest
Pediatric: 25 – 50mg/kg IV/IO over 10 – 20 mins or faster for Torsades- max single dose: 2G
Eclampsia and Seizure Prophylaxis in preeclampsia
Adult:4-6G IV/O over 20-30 mins followed by 1-2G/Hr
Status Asthmaticus
Adult: 1.2-2G IV/IO over 20 mins
Pediatric:25/50mg/kg slow IV/IO over 10-20 mins
Generic Acetaminophen
Trade: Tylenol
Use: Pain/Fever
Generic Atenolol
Trade: Tenormin
Use: HTN
Generic Pravastatin Sodium
Trade: Pravachol
Use: High cholesterol
- Trade – ASA(Acetylsalicylic Acid)
- Class – Antiplatelet, nonnarcotic analgesic, antipyretic.
- MOA – prevents the formation of a chemical known as thromboxane A2, which causes platelets to clump together, or aggregate, and form plugs that cause obstruction or constriction of small coronary arteries.
- Indication – Fever, inflammation, angina, AMI, and patients complaining of pain, pressure, squeezing, or crushing in the chest that may be cardiac in origin.
- Contraindication – GI bleeding, active ulcer disease, hemorrhagic stroke, bleeding disorders, children with chickenpox or flulike symptoms. Use caution in Reye Syndrome
- Side Effects: None
- Dosing
Myocardial Infarction
Adult: 160-325mg PO
Pedi: 3-5mg/kg per day
Pain or fever
Adult: 325-600mg PO every 4-6 hours
Pedi: 60-90mg/kg per day divided into doses every 4-6 hours
- Trade – Lasix
- Class – Loop Diuretic
- MOA – Inhibits the absorption of the sodium and chloride ions and water in the loop of Henle, as well as the convoluted tubule of the nephron. This results in decreased absorption of water and increased urination
- Indication – Pulmonary edema, CHF, HTN emergency
- Contraindications – Known Sensitivity to sulfonamides or furosemide
- Side Effects - Vertigo, dizziness, weakness, orthostatic hypotension, hypokalemia, thrombophlebitis
- Dosage:
Congestive Heart Failure and Pulmonary Edema
Adult: 20 – 40mg IV,IO slow push over 1-2 mins
Pedi: 1mg/kg IV, IO, IM
Pedi 2nd Dose: 2mg/kg IV, IO, IM
Hypertensive Emergency
Adult: 40mg IV, IO
Pedi: 1mg/kg IV,IM
- Methylphenidate
- Trade – Concerta
- Use – ADHD
- Estradiol
- Trade – Climara
- Use – Menopaus
- Losartan Potasium
- Trade – Cozaar
- Use – High cholesterol
- Trade – Reglan
- Class – Antiemetic
- MOA – promotes gastric emptying
- Indication – Nausea/vomiting, Migraine with history
- Contraindication – GI obstruction or perforation, pregnancy, under 6 yo.
- Side effects – constipation, diarrhea, dry mouth, HTN
- Dosing
-
Adult 10-15mg IV,IO
-
Pediatric 0.4-0.8mg/kg IV/IO
Trade – Pronestyl
Class – Antiarrhythmic – NA+ blocker
MOA – Blocks influx of sodium through membrane pores, consequently suppresses atrial and ventricular arrhythmias by slowing conduction in myocardial tissue.
Indication – Alternative to amiodarone for stable monomorphic VT with normal QT interval. Reentry SVT if uncontrolled by adenosine and vagal maneuvers if BP is stable. Rapid Afib in WPW
Contraindications – AV block, QT prolongation, torsades de pointes,
Side effects – Asystole, VF, flushing, hypotension, PR prolongation, QRS widening, QT prolongation.
Dosing
Adult – 500-600mg over 25-30 mins or 20-50mg/min ( max dose of 17mg/kg until one of the following occurs; arrhythmia resolves, hypotension, QRS widens > 50% of original width. )
Pedi 10 to 15 mg/kg slow IV,IO over 30-60 mins.
- Description: Pancuronium is a non-depolarizing neuromuscular blocker that causes paralysis without bronchospasm or hypotension, it does not cause the fasciculation's associated with polarizing agents.
- Indications: To facilitate endotracheal intubation.
- Contraindications: Tachycardia.
- Dosage/Route: 0.04 to 0.1 mg/kg IV.
- Pedi: same as adult.
- Trade –Xopenex
- Description: Sympathomimetic, bronchodilator-Stimulates beta-2 receptors resulting in smooth muscle relaxation of bronchial tree and peripheral vasculature.
- Indications: Treatment of acute bronchospasm in patients with reversible obstructive airway disease (COPD/asthma). Bronchospasm prophylaxis in asthma patients.
- Contraindications: Angioedema, tachydysrhythmias, and sever cardiac disease. Avoid use in patients taking phenothiazines; may cause prolonged QT interval and dysrthythmias.
- Dosage/Route: 1.25 mg in 3 mL
Name/Class: Pepcid) Anti-Ucler Agent / H2-Receptor Antagonist
Description: Famotidine is a histamine-2 blocker. It works by decreasing the amount of acid the stomach produces.
Indications: Upper GI Bleed, Anaphylaxis.
Contraindications: Hypersensitivity, Long QT syndrome.
Precautions: Asthma, COPD.
Dosage/Route: 20mg IV
- Gabapentin
- Trade - Neurontin
- Use – Epilepsy
- Furosemide
- Trade – Lasix
- Use – CHF/HTN/Edema
-
Sertraline HCL
- Trade – Zoloft
- Use - Antidepressant
- Description: Sympathomimetic Agonist is a variation of epinephrine used only for inhalation to induce bronchodilation and to reduce laryngeal edema and mucus secretion.
- Indications: Croup (laryngotracheobronchitis).
- Contraindications: Hypersensitivity, hypertension, or epiglottitis.
- Precautions be monitored. : May result in tachycardia and other dysrhythmias. Patient vital signs and ECG should
- Dosage/Route: 0.25-0.75ml of a 2.25% solution in 2.0ml NS
- Pedi: same as adult.
Just wanted to give you all a heads up that from this point on, I will be copying and pasting each drug slide into the episode description incase anyone wants to follow along with the reading. I tend to also be a visual learner so I need to read along every once in awhile to really help get these memorized.
I will do my best to go back and update all the previous episodes over the next week or so to make everything consistent across the board.
As always, if you have any feedback or recommendations, please do not hesitate to let me know.
Thank You!
Trade – Nitroquick
Class – Antianginal agent
MOA – Relaxes vascular smooth muscle, thereby dilating peripheral arteries and veins. This causes pooling of venous blood and decreased venous return to the heart, which decreases preload. Nitroglycerin also reduces left ventricular systolic wall tension, which decreases afterload.
Indication – Angina, ongoing ischemic chest discomfort, HTN, Myocardial Ischemia associated with cocaine intoxication.
Contraindication – Hypotension, severe bradycardia or tachycardia, right sided MI, increased ICP, intracranial bleeding, patients taking any medications for erectile dysfunction, known sensitivity to nitrites.
Side effects – Headache, hypotension, bradycardia, lightheadedness, flushing, cardiovascular collapse, methemoglobinemia
Dosing Adult
Sublingual tablets/translingual spray 0.4mg at 5 min intervals for a max of 3 doses
Ointment 2% topical apply 1-2 inches of paste over the chest wall
IV infusion 5mcg/min may increase rate by 5-10mcg/min every 5 – 10 mins as needed
Pedi
IV infusion – 0.25-0.5 mcg/kg/min titrate up to max dose of 5 mcg/kg/min
- Trade – Benadryl
- Class – Antihistamine
- MOA – Antagonizes h1 histamine receptors
- Indication – Anaphylactic reaction
- Contraindication – Acute asthma as Benadryl thickens secretions.
- Side effects – Drowsiness, Dizziness, headache, excitable state, wheezing, thickening bronchial secretions, chest tightness, palpitations, hypotension, blurred vision, dry mouth, N/V, Diarrhea.
- Dosing
- Adult 25-50mg IV/IO/IM
- Pedi 2-12 years – 1-1.25 mg/kg IV/IO/IM