Cumulative Drug - Summary Form

Epinephrine

Adrenalin

• Sympathomimetic
• Adrenergic

Alpha and Beta agonist     

• Alpha -1 agonist         
• Peripheral vasoconstriction increasing systemic vascular resistance     

• Beta-1 agonist         
• Positive inotrope                   
• Positive chronotrope         
• Postivive dromotrope         
• Reduces defribrillation threshhold         
• Renin release from kidneys     

• Beta -2 agonist         
• Bronchial smooth muscle relaxation         
• Skeletal vasculature dilation         
• Block histamine release

• Cardiac arrest, all rythms (1st drug for dead people)     
• Increases SVR increasing cerebral & myocardial perfusion pressure during CPR     
• Positive dromotrope can increase success rate of defibrillation     
• Positive dromotrope can increase electrical activity in heart in asytole

• Refractory bronchospasm not relieved with other medication
• Bronchial smooth muscle relaxation increases bronchial airway diameter

• Anaphylaxis     
• Increased SVR increases blood pressure     
• Peripheral vasoconstriction reduces edema     
• Bronchial smooth muscle relaxation increases bronchial airway diameter     
• Histamine release from mast cells inhibited
• Hypotension not relieved by other therapy     
• Increased SVR increases blood pressure     
• Positive chronotropic and inotropic effects increases cardiac output

• Croup     
• Peripheral vasoconstrition reduces edema

Dosage via IV/IO, IM, Sub-Q, SVN, or ETT

• Cardiac arrest, all rhythms (for dead people)
• Epi 1mg of 1:10,000 IV push with 20cc NS flush q 3-5 minutes, no limit         
• ETT route Epi 2mg of 1:1,000 diluted in syringe with 8cc

• Anaphylaxis, Refractory bronchospasm
• Epi 0.3mg of 1:1,000 IM

• Infusion for hypotension     
• Epi 1, 2, or 4mg 1:1,000 added to 250cc NS at 2-10mcg/min     
• Use after other treatment

• None for normal cardiac arrest     
• Hyperthermia arrest (relative)
• Adult with pulse, age <35 (relative, patch)

Verapamil HCL

• Calan
• Isoptin

Calcium channel blocker

• Blocks calcium channels in myocardial cell slowing influx of calcium ions     
•   Reduces force of contraction     
•   Slows heart rate     
•   Slows AV node conduction     
•   Slows ventricular response from atrial fibrillation/atrial flutter     
•   Interrupts reentry in SVT

• Rapid ventricular response from A-Fib/A-Flutter     
•    Slows influx of calcium ions reducing ventricular response

• SVT refractory to Adenosine (no WPW)     
•    Slows influx of calcium ions reducing heart rate and interrupts reentry pathways

All doses are VERY slow IV push over 2-5 minutes with the patient supine

Verapamil 2.5-5.0mg VERY slow IV push over 2-5 minutes.  May repeat in 15-30 minutes with 5-10mg

• Wolf-Parkinson-White (WPW)
• Any wide QRS tachycardia
• Hypotension
• Cardiogenic shock
• Concurrent IV beta-blocker use

Acetylsalicylic Acid, Aspirin

Aspirin, Bayer, Bufferin, Anacin, Children's flavored chewable aspirin

Analgesic
Anti-Thrombotic
Anti-Pyretic
Anti-Inflamatory

Blocks Thromoxane 2
Decreased platelet aggregation and thrombus formation
Use in management of MI

Chest pain
Signs/Symptoms or MI
ECG suggestive of MI
Unstable angina

Bleeding ulcer
Hemorrhagic state
Hemophilia
Known allergies to salicylates
Childern or adolescents

Cardiac: 325 (4 x 81mg pediatric chewable tabs), chew or swallow

• Peds
• Not indicated for prehospital

Adenosine

Adenocard

Antiarrhthmic

Slows Sinus rate
Slows conduction through the AV node
     Interrupts reentrant pathways

SVT refractory to vagal maneuvers (including WPW syndrome)
Why?
     Interrupts reentry pathways

Wide QRS tachycardia of unknown origin refractory to lidocaine/amiodarone
Why?
     Interrupts reentry pathways

All dosage VERY rapid IV push over 1-3 seconds followed by 20cc NS flush with patient supine.  
     16 or 18 guage in the AC
     Use injection port closest to hub
     Have ECG printing during administration

Adult
6mg rapid IV push with 20cc NS flush.  May repeat twice every two minutes wtih 12 mg

Known allergy/hypersensitivity
Sick sinus syndrom or 2nd/3rd degree block
Asthma
Carbamazepine (Tegretol) use
Known A-Fib/A-Flutter
Pregnancy (patch)
Heart transplants (reduce dose)

Lidocaine HCL

Xylocaine

Sodium channel blocker
Antiarrythmic

Blocks sodium channels decreasing automaticity
     Prolongs phase 4 depolarization 
     Terminates re-entry
     Increases v-fib threshhold

Cardiac arrest
     Ventricular fibrillation/pulsless Ventricular Tachycardia only

     Why?
          Blocks sodium channels decreasing depolarization

Supression of ventricular arrythmias
     Ventricular techycardia with pulse
     Wide QRS tachycardia of unknown origin
     Prevent recurrance of VFib/VTach
     Frequent PVCs
          >6/min
          R on T
          Couplets
          Multiform
          Why?
               Blocks sodium channels decreasing depolarization

IV push, ETT, or infusion
Adult - 
1.0 - 1.5mg/kg IV push
Every 5-10 minutes at 1/2 original dose up to 3mg/kg max

If successful - infusion at 2-4mg/min by adding 1gm to 250cc NS

Cardiac arrest - 20cc NS flush after giving
ETT dose - double IV dose

Known allergy / hypersensitivity
3rd degree heart block
Extreme caution in 2nd degree heart block
Idoventricular rythym
Ventricular arrythmias with pulse <60

Atropine Sulfate

Atropine

Parasympatholytic
Anticholinergic

Competitive antagonist to ACh at muscarinic receptor site
     Blocks parasypathetic response & allows sysmpathetic response to take over
         Heart
               Atrial effects
                    Positive chronotrope
                    Postive dromotrope                    
                    Positive inotrope
                         Slight effect
          Lungs
               Decreased mucous production
               Increased bronchial smooth muscle relaxation
          GI
               Decreased secretions
               Decreased motility
          Urinary
               Decreased bladder tone
          Other  
               Pupil dilation
               Decreased sweat production

Symptomatic Bradycardia
     Atrial mechanisms only
          Why?
                 Blocks parasympathetic response increasing heart rate
Acetylcholinesterase inhibitor poisoning
     Organophosphate poisoning
     Nerve agent poisoning
Cholinergic posoning
     Why?
          Blocks the muscarinic receptors reducing the effects of ACh

All Dosages are IV Push or ETT - FAST

Adult

Symptomatic Bradycardia
     Atrial mechanisms only
          Atropine 0.5mg IV Push - q 5 min - max 0.04mg/kg

Acetylcholinestrase inhibitor poisoning
Cholinergic poisoning
     Atropine 2.0 - 5.0 mg IV Push - q 5 min - until symptoms resolved

Allergy
Wide complex 2nd Degree type II heart block
3rd degree heart block
Acute narrow angle glaucoma
     Painful glaucoma probably narrow type

Dopamine

Intropin

Dopamine agonist
Sympathomimetic

MOA depends upon dosage

Dopamine dose 1-2mcg/kg/min
     Activates dopamine receptors causing cerebral, renal, mesenteric vasodilation
          May increase urine output
          May drop BP

Beta-1 Dose 2-10mcg/kg/min
     Activates Beta-1 receptors stimulates heart increasing cardiac output & BP
          Postive inotrope
          Positive chronotrope
          Postivite dropmotrope

Alpha-1 dose 10-20mcg/kg/min
     Activates Alpha-1 receptors causing renal, mesenteric, & peripheral vasoconstriction
          Increases PVR increases BP
          Increased Preload
          >20mcg/kg/min similar to norepi with massive vasoconstriction

Hypotension without fluid loss
     Symptomatic bradycardia with hypotension
     Cardiogenic shock
     Septic shock
     Neurogenic shock

All doses via IV infusion

Add 400mcg to 250cc NS bag giving 1600mcg/cc
     Symptomatic bradycardia with hypostension &/or non-hypovolemic shock
          Dopamine 5mcg/kg/min initial infusion, increase if no repsonse

Hypovolemic shock
Pheochromocytoma (tumor of the adrenal gland)
MAOI's

Glucagon

Glucagon

Pancreatic hormone

• Converts liver glycogen to glucose raising serum glucose levels
•      Reverses effects of hypoglycemia
• Smooth muscle relaxant
• Cardiac inatrope

• Hypoglycemia if IV unattainable
• Why?
• Raises blood sugar levels by converting glycogen to glucose

• Trapped food bolus in esophagus
• Why?
• Smooth muscle relaxant may allow food to pass to stomach

• Beta-Blocker OD
• Why?
• Positive cardiac inotrope

All hytpoglycemic doses are IM.  Other indications may be given IV.  

• Adult:
• Hypoglycemia
•      Glucagon 1mg IM
• Smooth muscle relaxant/Beta-blocker OD
•      Per agency or patch with medical control

• Known hypersensitivity / allergy
• Pheocromocytoma
• Insulinoma

Oxytocin

• Pitocin
• Syntocin

Pituitary hormone

• Oxytocin receptor agonist
•      Increases force & frequency of urinary contractions

• Postpartem hemorrhage AFTER delivery of placenta and twins/triplets if any
• Why
• Stimulates uterus to contract which slows bleeding

All dosages via IV infusion or IM

• Adult
• Infusion
•      Pitocin 10 units added to 10000cc LR infused at rate necessary to control bleeding

• IM
•      10 units IM

• Known hypersensitivity/allergy
• Baby/Babies have not yet delivered
• Placenta has not yet delivered