Drug Cards

• Benzo sedative and skeletal muscle relaxant
• Reduces tremors
• Induces amnesia
• Reduces incidence and reoccurance of seizures
• -Relaxes muscle spasm in ortho inj
• -Produces amnesia for painful procedures

• -Major motor seizures
• -status epilepticus
• -Premed before cardioversion
• -Muscle tremors due to inj
• -Accute anxiety

• -shock
• -coma
• -Accute alcoholism
• -depressed vital signs
• -OB pts.
• -neonates

• -psychosis
• -depression
• -myasthenia gravis
• -short half so seizure may return

• seizures ------------ 5 - 10 mg IV/IM
• accute anxiety --- 2 - 5 mg IV/IM
• premed------------- 5 -15 mg IV

• -potent synthetic narcotic analgesic
• -rapid and less prolonged action

Induce sedation for intubation

• -MAO inhibitors
• -myasthenia gravis

• -increased intercranial pressure
• -elderly
• -debilitated
• -COPD
• -respiratory problems
• -hepatic and renal insufficiency

25 - 100 mcg slowly IV (2-3 mins)

• -class - carbohydrate
• -trade - D50

Simple sugar that the body can rapidly metabolize

Hypoglecemia

None in Hypoglycemia

• - ^ ICP
• -chk sugar bf administering
• -ensure good IV access

25 mg D50 w/ 50 ml IV

• Nitrate
• Nitrostat

• -Rapid smooth muscle
• -Reduces peripheral vascular resistence
• -Decreases BP, venous return, cardiac workload

• Chest pain assoc w/ angina or AMI
• Acute PE

• Tolerance to nitrates
• Severe Anemia
• Head Trauma
• Hypotension
• ^ ICP
• Pts taking Sildenafil
• Glaucoma
• Shock

• Could induce headache
• Light sensative and may lose potency in air

• 1 tablet SL 3 - 5 mins up to 3
• 1/2" topical ointment
• .4 mg SL spray up to 3/25 mins

• Diuretic
• Lasix

• Rapid acting, potent diuretic
• Antihypertensive that inhibits Na reabsorption by kidneys
• Vasodialator reduces venous return and cardiac workload

• CHF
• Pulmonary Edema

• Fluid electrolyte depleated states
• Hepatic Coma
• Pregnancy except if life threatening

• Infants
• Elderly
• Hepatic Impairment
• Nephrotic Syndrome
• Cardiogenic shock assoc w/ AMI
• Gout
• Pts receiving digitalis or K depleating steroids

40 - 120 mg slow IV

• Bronchodialator
• Atrovent

• Bronchodialator for resp emergencies
• Dries up resp tract secreations by blocking ACh receptors

Broncho spams assoc w/ asthma, COPD, or inhaled irritants

• Hypersensativity to atropine or its derivatives
• Primary treatment for acute bronchospasm

• Elderly
• Cardiovascular disease
• Hypertension

• 500 mcg in 2.5 to 3 mL NS via neb
• 2 sprays from metered dose inhaler

• Synthetic sympathomimetic that causes bronchodilation w/ less cardiac effect than epi
• Reduces Mucus secreations
• Pulmonary capillary leaking
• Edema in lungs during allergic reactions

Bronchospasm and asthma in COPD

Hypersensitivity

Pt may experience tachycardia, nausea, anxiety, cough, wheezing and/or dizziness

2.5mg in 2.5 to 3ml NS VIA nebulizer. Repeat as needed. Duration is 3 to 6 hrs.

Narcan

Pure narcotic antagonist that blocks effects of both natural and synthetic narcotics & may reverse resp. depression

• Narcotic and Synthetic narcotic OD
• Coma of unknown origin

Non narcotic induced resp. depression

• Possible dependancy
• Has half live shorter than most narcs so OD state may return

.4 - 2 mg IV/IM (2 - 2.5 times for ET) repeated 2-3 minutes as needed to 10 mg

• Potent analgesic and sedative that causes some vasodilation
• Reduces venous return
• Reduces myocardial O2 demand

• Moderate to severe pain
• MI
• Reduce venous return in pulmonary edema

• Head or abdominal inj
• Hypotension or volume depleation
• Acute bronchial asthma
• COPD
• Resp depression
• Pulmonary edema

• Elderly
• Children
• Debilitated pts
• Keep Narcan available to counteract effects if necessary

• Pain --------- 2.5-15 mg IV, 5-20 mg IM/ sub q
• AMI or PE -1-2 mg/6-10 mins to response

• Benzodiazapine antagonist
• Romazican

Benzo antagonist used to reverse the sedative, recall and psychomotor effects of diazapam, midazolam and other benzos

Resp depression secondary to benzos

• Seizure prone pts during labor and delivery
• Tricyclic antidepressant OD

• Hepatic impairment
• Elderly
• Pregnancy
• Nursing mothers
• Head inj
• Alcohol or drug dependancy
• physical dependance on benzos

.2 mg IV over 30 sec to minute up to 1 mg

• Sedative
• Versed

Short acting benzo w/ CNS depressant, muscle relaxant, anticonvulsant and anterograde amnestic effects

Induce sedation before cardioversion or intubation

• Narrow angle glaucoma
• Acute alcohol intoxication
• Shock
• Coma

• COPD
• Renal impairment
• CHF
• Elderly

• 1 - 2.5 mg slow IV
• .07 - .08 mg/kg IM

• Depolarizing neuromuscular blocker
• SUX
• Anectine

Ultra short acting depolarizing neuromuscular blocker

Facilitated ET intubation

• Family Hx of malignant hyperthermia
• Penetrating eye inj
• Narrow angle glaucoma

• Severe burn or crush inj
• Spinal cord inj

1 - 1.5 mg/kg IV/IM

• Hypnotic
• Amidate

Ultra short acting nonbarbituate hypnotic w/ no analgesic effects and limited cardiovascular and resp effects

Induce sedation for RSI

None

• Marked hypotension
• Severe asthma
• Severe cardiovascular disease

.1 - .3 mg/kg IV over 15 - 20 secs

• Sympathomimetic
• Adrenalin

• Natural catecholamine that increases HR, cardiac contractile force, myocardial elec. activity,
• systemic vascular resistance and systolic BP
• Decreases airway resistance and automaticity
• May also reduce pulmonary congestion and increase tidal volume and vital capacity

• Cardiac arrest
• Severe allergic reaction

• Narrow angle glaucoma
• Hemmoragic, traumatic and cardiac shock
• Labor

None

• Arrest -- 1mg of 1:10000 IV/ 3-5 minutes
• 2-2.5mg of 1:1,000 ET
• Allergy -- .3 - .5 mg of 1:1000 sub q/ 5-15 mins as needed
• .5 - 1mg of 1:10000 IV if sub q inefective

Parasympatholytic

• Blocks PNS specifically vagal effects on HR
• May increase myocardial O2 demand
• Decreases airway secreations

• Symptomatic bradycardia
• Bradystolic arrest
• Organophosphate poisoning

• None in the EMS setting
• 2nd degree type 2 heart block

• AMI
• Glaucoma

• Symptomatic Bradycardia --- .5 mg IV / 1 mg ET 3 - 5 mins to 3 mg
• Asystole ------------------------- 1 mg IV / 2 mg ET 3 - 5 mins to 3 mg
• Organophosphate Poisoning- 2 - 5 mg IV/IO/IM 10 - 15 mins

• Hormone, Vasopressor
• Pitressin

Hormone w/ strong vasopressive and antidiuretic properties but that may precipitate angina &/or AMI

• Increase peripheral vascular resistance in arrest
• Ctrl bleeding from esophageal varices

• PVCs
• 1st stage of labor

• Epilepsy
• Migraine
• Heart failure
• Angina
• Vascular disease
• hepatic impairment
• elderly
• children

• Arrest ------ 40 units IV
• Esophageal Varices----- .2 - .4 units/min IV drip

• Acetylsalycylic Acid - analgesic, antipyreic, platelet inhibitor, anti-inflamatory
• Alka-Seltzer, Bayer, Empirin, St Josephs Childrens

• Inhibits agents causing pain, inflammation and feaver
• Relieves mild to moderate pain by acting on the PNS
• Lowers body temp in feaver
• Inhibits platelet aggrigation

Chest pain suggestive of MI

• Active ulcer disease
• Asthma

Bleeding disorders

160 - 325 mg PO

• Antidysrhythmic
• Adenocard

• Used to chemically cardiovert PSVT to NSR
• 10 sec half life
• Doesnt cause hypotension

Narrow complex PSVT refractory to vagal maneuvers

• 2nd and 3rd degree heart block
• Sinus node disease
• Asthma

• May cause transient dysrhymathias especially in asysole
• COPD

• 6mg rapid IV w/ rapid saline flush
• If that doesnt work 12 mg over 1 - 2 mins -- repeat as needed

• Sympathomimetic
• Dobutrex

Synthitic catecholamine and beta agent that increases the strength of cardiac contraction w/o appreciably increasing rate

To increase cardiac output in CHF/cardiogenic shock

• Ventricular Tachycardia
• Hypovolemia w/o fluid resusitation

• Atrial fibrillation
• Preexisting hypertension

2-20 mcg/kg/min IV

• Sympathomimetic
• Intropin

• Naturally occuring catecholamine that increases cardiac output w/o myocardial O2 consumption
• Maintains renal and mesenteric blood flow while inducing vasoconstriction and increasing systolic BP

• Nonhypovolemic hypotension (70-100 mmHg)
• Cardiogenic shock

• Tachydysrhythmias
• Ventricular fibrillation
• Pheochromocytoma

Ensure adequate fluid resusitation of the hypovolemic pt

2-5 mcg/kg/min up to 20 mcg/kg/min, titrated to effect

• Sympathomimetic
• Isuprel

Synthetic sympathomimetic that results in increasedcardiac output by increasing the strength of cardiac contraction and somewhat increasing rate

Bradycardia refractory to Atropine when pacing is not available

Cardiogenic shock

Tachydysrhythmias and those assoc w/ digitalis and acute myocardial infarction

Bradycardia -- 2-10mcg/min tatrated to cardiac rate

Fastin

Appetite Depressant

HTN, CCB

Metoprolol

HTN, Beta Blocker

Darvon

Narcotic Analgesic

GERD

Synthetic Opiod Analgesic

Synthetic Opiod Analgesic

Opiod Analgesic

Opiod Analgesic

Ultram

Analgesic

Alprazolam

Anxiety Disorder

Antidepressant

Antidepressant SSRI

Antidepressant SSRNI

Sertaline-Hydrochloride

Antidepressant

Antidepressant

Antidepressant

Prinivil

HTN, ACE Inhibitor

Tenormin

HTN Beta blocker

Lipid Lowering Agent

Glucophage

Antihyperglycemic

Seizure

Hypnotic

Deltasone

Steroid

NSAID

• Antidysrhythmic
• Cordarone, Pacerone

Antodysrhythmic that prolongs the durationof the action potential and refractory period and relaxes smooth muscles reducing peripheral vascular resistance and increasing coronary blood flow

Life threatening ventricular and superventricular dysrhythemias, frequently atrial fibrillation

none

!50-300 mg/IV over 10 mins then 1 mg/min for 6 hrs

• Antidysrhythmic
• Bretylol

Supresses ventricular tachydysrhythmias including vfib w/ reentry mechanisms

V Fib and V Tach refractory to lidocaine

• Digitalized pts
• Digitalis induced dysrhythmias

5 mg/kg IV then 10 mg/kg 15 to 30 mins to max of 30 mg/kg

• Antidysrhythmic
• Xylocaine

Antidysrhythmic the supresses automaticity and raises stimulation threshold of ventricles. It causes sedation, anticonvulsant & analgesic effects

• Pulseless V Tach
• V Fib
• V Tach w/pulse

• Superventricular dysrhythmias
• Stokes-Adams Syndrome
• 2nd & 3rd degree heart blocks
• Bradycardias

• Hepatic or renal impairment
• CHF
• Hypoxia
• Resp. Depression
• Hypovolemia
• Myasthenia gravis
• Shock
• Elderly

• Cardiac Arrest 1-1.5 mg/kg IV repeated 3-5 mins to 3 mg/kg Follow conversion w drip of 2-4 mg/min
• V Tach w pusle 1-1.5mg/kg slow IV. May repeat 1/2 dose every 5-10 mins until conversion up to 3mg. Follow conversion w/ infusion of 2-4 mg/min

• Antiarrhythmic
• Pronestyl

Prolongs ventricular repolarization, slows conduction and decreases myocardial excitability

• V Fib
• Pulseless V Tach refractory to Lidocaine

• Myasthenia Gravis
• 2nd or 3rd degree heart block

• Hypotension
• Cardiac enlargement
• CHF
• AMI
• Ventricular dysrhythmias fr digitalis
• Hepatic or Renal impairment
• Bronchial Asthma

• 20-30 mg/min IV drip
• Stop Points: 1. Up to 17 mg/kg to effect, then 1-4 mg/min
• 2. Ectopy Resolves
• 3. QRS complex widens more than 50% fr original
• 4. Hypotension Ensues

Skeletal Muscle relaxant

• HTN Angiotensin Antagonist
• Valsartan

Psychotropic

• Beta 2 Bronchodialator
• Proventil

• Epileptic
• Gabapentin

CCB

Cardizem

• -slow CCB (similiar to Verapamil)
• -dilates coronary and peripheral arteries and arterioles, increasing circulation to Heart and reducing Peripheral Vascular Resistance

• -Supraventricular Dysrhythmias (A-Fib, A-Flutter, PSVT refractory to Adenosine)
• -increase Coronary Artery Perfusion in Angina

• -Hypersensitivity
• -sick Sinus Syndrome
• -2nd or 3rd degree Heart Block
• -systolic BP <90, diastolic <60
• -wide-complex Tachycardia and WPW

• -CHF (especially w/ Beta Blockers)
• -conduction

0.25 mg/kg IV over 2 min., may repeat as needed w/ 0.35mg/kg followed by a drip of 5 to 10 mg/hr not to exceed 15 mg/hr over 24 hrs

Vasodilator/Nitrate

ntg injection

• -relaxes Blood Vessels
• -increases ICP

• -ntg Infusions used to relieve pain assoc. w/ Angina that doesn't respond to Oral treatment
• -controls BP
• -treats CHF

• -Hypotension
• -uncorrected Hypovolemia
• -increased ICP
• -constrictive Pericarditis
• -Pericardial Tamponade

• -headache
• -severe Hypotension
• -reflex Tachycardia

0.2-1.5 mcg/kg/min.

CCB

Isptin, Calan

• -CCB
• -slows AV conduction
• -suppresses reentry Dysrhythmias (such as PSVT)
• -slows Ventricular responses to Atrial Tachydysrhythmias
• -dilates Coronary Arteries
• -reduces Myocardial O2 demand

• -PSVT refractory to Adenosine
• -Atrial flutter
• -A-Fib w/ rapid Ventricular response

• -severe Hypotension
• -Cardiogenic shock
• -2nd or 3rd degree Heart Block
• -CHF
• -Sinus Node Disease
• -Accessory AV pathways
• -WPW syndrome
• -shouldn't be administered to persons taking Beta Blockers

None

2.5 to 5 mg IV Bolus over 2 to 3 min. then 5 to 10 mg after 15 to 30 min. to a max of 30 mg in 30 min.

ADHD Amphetamine

GERD PPI

Lipid Lowering Agent

Simvastatin

Anti-Bacterial Agent

ED Agent

• Electrolyte
• Calcium Chloride

• Increases contractile force
• Increases ventricular automaticity

• Hyperkalemia
• Hypocalcemia
• Hypermagnesemenia
• CCB Toxicity

• V Fib
• Hypercalcemia
• Possible digitalis toxicity

• May precipitate toxictiy in pts taking digoxin
• Ensure lg vein access & flush b/f & aft pushing

2-4 mg/kg IV(10% solution) / 10 mins, as needed

• Corticosteroid / Antiinflammatory
• Solu-medrol

• Spinal Cord Inj
• Asthma
• Severe Anaphylaxis
• COPD

None in the emergency setting

• Asthma/COPD/Anaphylaxis = 125 - 250 mg/kg IV/IM
• Spinal Cord Inj = 30 mg/kg/ 15 mins. Aft 45 mins infusion of 5.4 mg/kg/hr

Psychotropic

Antimicrobial Agent

• Opiad Analgesic
• Oxycodone

• Seizure
• Klonapin

Antidepressant

• Absorbent
• Actidose

Prepared charcoal to absorb & bind toxins fr GI tract

Acute Ingested Poisoning

• Uncontrolled airway
• Ingestion of Cyanide
• Mineral Acids
• Caustic Alkalis
• Organic Solvents
• Iron
• Ethanol
• Methanol

Give only after emesis or where emesis in Contraindicated

1g/kg w/ 6-8 oz H2O PO or via NG tube

(Magnesium)/Electrolyte

• electrolyte that acts as a calcium channel blocker
• CNS depressant and anticonvulsant
• depresses the function of smooth, skeletal, and cardiac muscles.

• Refractory v-fib
• pulseless v-tach (especially torsade depointes)
• AMI
• eclamptic seizures

• Heart block
• myocardial damage
• shock
• persistent hypertension
• hypocalcemia

• other CNS depressants
• neuromuscular blocking agents

• V-fib or tachycardia: 1 to 2 g IV over 2 min.
• Torsade de pointes: 1 to 2 g IV followed by infusion of 0.5 to 1 g/hr IV.
• AMI: 1 to 2 g IV over 5 to 30 min.
• Eclampsia: 2 to 4 g IV/IM.

(Dilantin)/Anticonvulsant

• derivative related to phenobarbital
• reduces spread of electrical discharges in the motor cortex inhibits seizures
• antidysrhythmic properties that counteract the effects of digitalis

• Seizures
• status epilepticus
• cardiac dysrhythmias secondary to digitalis toxicity

• sinus bradycardia
• heart block
• Adams-Stokes syndrome

None

• Seizures, status epilepticus: 10 to 15 mg/kg slow IV
• Dysrhythmias: 100 mg slow IV (over 5 min) to a maximum 1,000 mg

(NaHCO3)/Alkalizing Agent

• -provides vascular bicarbonate to assist the buffer system in reducing the effects of metabolic acidosis
• -treatment of some overdoses

• Tricyclic antidepressant
• barbiturate overdose
• refractory acidosis
• hyperkalemia

None when used in severe hypoxia or late cardiac arrest

may precipitate with calcium chloride

1 mEq/kg IV, then 0.5 mEq/kg/10 min

THIAMINE/Vitamin

• vitamin B1, which is required to convert glucose into energy. not manufactured by the body
• must be constantly provided from ingested foods

• Coma of unknown origin
• chronic alcoholism with associated coma
• delirium tremens

None

hypersensitivity

50 to 100 mg IV/IM

thyroid agent

atherothromic reducing agent

Flexeril

skeletal muscle relaxant

GERD

NSAID COX-2 inhibitor

augmentin

antibiotic pcn

desyrel

antidepressant

antihistamine

anti-psychotic, epileptic agent

catapres

HTN alpha agonist