Aspirin (Acetylsalicylic acid)(Alka-seltzer, Bayer, Empirin, St. Joseph's Children's)
Analgesic, Antipyretic, Platelet inhibitor, Anti-Inflammatory
- Description: Aspirin inhibits agents that cause the production of inflammation, pain, and fever. It relieves mild to moderate pain by acting on the peripheral nervous system, lowers body temperature in fever, and powerfully inhibits platelet aggregation.
- Indications: Chest pain suggestive of an MI
- Contraindications: Hypersensitivity to salicylates, active ulcer disease, asthma
- Precautions: Bleeding disorders,
- Dosage/Route: 160 to 324 mg PO (chewable)
Atropine blocks the parasympathetic nervous system, specifically the vagal effects on heart rate. May increase myocardial oxygen demand. Decreases airway secretions.
Hemodynamically significant bradycardia, bradyasystolic arrest, and organophosphate poisoning.
None in the emergency setting. 2nd degree type 2 and above heart blocks are class 2B (not recommended)
- - Dosage/Route:
- - Symptomatic Bradycardia: 0.5 to 1.0mg IV/IO. Repeat 3 to 5 mins to 3 mg.
- - Pedi: 0.02 mg/kg IV, 0.04 mg/kg ET, may repeat in 5 mins up to 1 mg.
- - Organophosphate poisoning: 2 to 5 mg IV/IM/IO/10 to 15 mins.
- - Pedi:: 0.05 mg/kg IV/IM/IO/10 to 15 mins
Dobutamine is a synthetic catecholamine and beta agent that increases the strength of cardiac contraction without appreciably increasing rate.
To increase cardiac output in congestive heart failure/cardiogenic shock.
Hypersensitivity to sympathomimetic amines, ventricular tachycardia, and hypovolemia without fluid resuscitation.
Atrial fibrillation or preexisting hypertension.
- - Dosage/Route: 2 to 20 mcg/kg/min IV
- - Pedi: same as adult
- Description: Dopamine is a naturally occuring catecholamie that increases cardiac output without appreciably increasing myocardial oxygen consumption. It maintains renal and mesentaric blood flow while inducing vasoconstriction and increasing systolic blood pressure.
- Indications: Non-hypovolemic hypotension (70-100 mmHg) and cardiogenic shock
- Contraindications: Hypovolemic hypotension without aggressive fluid resuscitation, tachydisrhythmias, ventricular fibrillation, and pheochromocytoma
- Precautions: Ensure adequate fluid resuscitation in hypovolemic patients
- Dosage/Route: 2 to 5 mcg/kg/min up to 20 mcg/kg/min, titrated to effect.
- Pedi: same as adult
Calcium Channel Blocker
- Description: Diltiazem is a slow calcium channel blocker similar to verapamil. It dilates coronary and peripheral arteries and arteriols, thus increasing circulation to the heart and decreasing peripheral vascular resisitance.
- Indications: Supraventricular tachydisrhythmias (atrial fibrillation, atrial flutter, and PSVT refractory to adenosine) and to increase coronary artery perfusion in angina.
- Contraindications: Hypersensitivity, sick sinus syndrome, 2nd or 3rd degree heart block, systolic BP < 90, Diastolic BP < 60, wide complex tachycardia, and WPW.
- Precautions: CHF (especially with beta blockers), conduction abnormalities.
- Dosage/Route: 0.25 mg/kg IV over 2 min, may repeat as needed with 0.35 mg/kg followed by a drip of 5 to 10 mg/hr, not to exceed 15 mg/hour over 24 hours.
Epinephrine is a naturally occuring catecholamine that increases heart rate, cardiac contractile force, myocardial electrical activity, systemic vascular resistance and systolic blood pressure, and decreases overall airway resistanse and automaticity. It also, through bronchial artery constriction, may reduce pulmonary congestion and increase tidal volume and tidal capacity.
Asthma/COPD, to restore rhythm in cardiac arrest, and severe allergic reactions.
Narrow angle glaucoma, traumatic, hemorrhagic, and cardiac shock.
- - Dosage/Route:
- Arrest: 1 mg of 1:10,000 IV/3 to 5 mins (ET 2 to 2.5 mg of 1:1,000)
- Pedi: 0.01 mg/kg 1:10,000 IV/IO (ET: 0.1 mg/kg 1:1,000). All subsequent doses 0.1 mg/kg IV/IO. No max.
- Adult Bradycardia: 2-5 mcg/min IV drip
- Allergic reactions: 0.3 to 0.5 mg of 1:1,000 subcutaneously/5 to 15 min as needed or 0.5 to 1 mg of 1:10,000 IV if subcutaneous dose ineffective or severe reaction
- Pedi: 0.01 mg/kg (Max 0.5) of 1:1,000 SQ/10 to 15 min or 0.01 mg/kg of 1:10,000 IV if subcutaneous dose ineffective or severe.
- Asthma/COPD 0.3mg 1-1,000 SQ
Isoproterenol is a synthetic sympathomimetic that results in increased cardiac output by increasing the strength of cardiac contraction and somewhat increasing the rate.
Bradycardia refractory to atropine when pacing is not available
Tachydysrhythmias and those associated with digitalis and acute MI
- - Dosage/Route:
- Bradycardia: 2 to 10 mcg/min titrated to cardiac rate
- Pedi: 0.1 mcg/kg/min titrated to cardiac rate
- Description: Metoprolol is a beta-adrenergic blocking agent that decreases heart rate, cardiac output and BP
- Indications: AMI
- Contraindications: Cardiogenic shock, sinus bradycardia < 60, 2nd and 3rd degree HB, PR interval > 0.24, asthma/COPD, or inferior wall AMI.
- Precautions: Hypersensitivity, hepatic and renal impairment, CHF controlled by digitalis and diuretics, AV conduction defects, diabetics, or peripheral vascular disease.
- Dosage/Route: 5 mg slow IVP q 5 mins up to 3 doses while watching HR and BP
Cardiac Inotrope, Vasodilator
Milrinone is related to amrinone and increases the strenght of cardiac contraction without increasing rate, increasing cardiac output without increasing oxygen demand.
CHF, or pediatric septic shock
Elderly, pregnancy, and nursing mothers
- - Dosage/Route:
- CHF: 50 mcg/kg IV over 10 mins, then drip of 0.375 to 0.75 mcg/kg/min
- Pedi: 50 to 70 mcg/kg IV
- Description: Nitroglycerine is a rapid smooth muscle relaxant that reduces peripheral vascular resistance, blood pressure, venous return, and cardiac workload.
- Indications: Chest pain associated with angina and acute MI, and acute pulmonary edema.
- Contraindications: Hypersensitivity, tolerance to nitrates, severe anemia, head trauma, hypotension, increased ICP, patients taking ED drugs, glaucoma and shock
- Precautions: May induce headache that is sometimes severe. Nitroglycerine is light sensitive and will lose potency when exposed to air.
- Dosage/Route: 1 tablet (0.4mg) SL. May be repeated/3 to 5 mins up to 3 tablets, or 1/2 inch topical ointment, or 0.4mg (one spray) SL up to 3 sprays/25 min