NCTI- Pharmacology- Drug List B

Valium

• Anticonvulsant
• Benzodiazepine
• sedative-hypnotic
• anti-anxiety (anxiolytic)

• Suppresses the spread of seizure activity and raises the seizure threshold in the motor cortex
• Sedative effects depress the CNS and reduce anxiety
• Skeletal muscle relaxant
• Induces amnesia

• Generalized seizure activity and status epilepticus
• Sedation prior to cardioversion or pacing of a conscious patient
• Acute anxiety
• Muscle relaxer
• Chemical restraint

• Head injury/CNS Depression
• Respiratory depression
• Hypotension / depressed vital signs
• Shock
• Infants < 30 days old

• Cardiovascular: bradycardia, hypotension, rebound tachycardia
• Neurological: dizziness, drowsiness, headache
• Respiratory: respiratory depression/arrest
• Gastrointestinal: nausea/vomiting

Use with caution in the elderly and very ill patients due to paradoxical effects

Use with caution when patient is taking antihistamines, antidepressants, alcohol, narcotics, barbiturates, sedatives and hypnotics as these drug classifications may potentiate the effects

IV, IO, IM, PR

Onset in 5 minutes with an unknown duration

• Adult:
• Seizures: 5-10 mg IV/IM. May repeat every 5-15 minutes prn to maximum dose of 20 mg
• Anxiety: 5-10 mg IV/IMCardioversion: 5-10 mg IV titrated to effect

Pediatric: 0.1 mg/kg IV/PR. May repeat every 5-15 minutes prn to maximum dose of 20 mg

not in riverside

Versed

• Amnesic Agent
• Sedative/hypnotic
• Anticonvulsant
• Benzodiazepine
• Tranquilizer
• Anti-anxiety (anxiolytic)

• Reduces anxiety
• Relaxes skeletal muscles
• Produces short term CNS depression and amnesia

• Seizures
• Premedication for synchronized cardioversion/TCP
• One of the premeditations for RSI

• Acute narrow-angle glaucoma
• Shock (from hypovolemia)
• Hypotension (from hypovolemia)
• Alcohol or drug intoxication
• Allergies to cherries

• Cardiovascular: bradycardia, rebound tachycardia, hypotension
• Neurological: amnesia, drowsiness, agitation, ALOC
• Respiratory: respiratory depression or arrestG
• astrointestinal: nausea/vomiting

• Elderly patients with impaired respiratory function
• Patients with renal failure, liver failure or COPD

Other CNS depressants or benzodiazepines

IV, IO, IM, IN

Onset in 1-5 minutes (IV/IO/IN) or 5-15 (IM) and may last 2-6 hours

• Adult:
• Pre-cardioversion or transcutaneous pacing: – 2.5 mg slow IV/IO
• Seizure: 0.1 mg/kg slow IV/IO/IN or 0.2 mg/kg IM to a maximum of 5.0 mg

Pediatric: Seizure: 0.1 mg/kg slow IV/IO/IN or 0.2 mg/kg IM to a maximum of 5.0 mg

none

Narcan

Narcotic (Opiate) Antagonist

Reverses the respiratory depression and CNS sedation of narcotics by competing for opiate receptor sites in the brain

Known or suspected narcotic overdoses with inadequate respiratory function

none

• Cardiovascular: tachycardia, hypertension, dysrhythmias
• Neurological: tremors/seizures, aggressive/combative
• Gastrointestinal: nausea/vomiting

• Give drug prior to intubation
• Prepare to protect patient and EMS personnel due to aggressive/combative personality following rapid reversal of a narcotic overdose
• Does not reverse narcotic-induced hypotension
• Use with caution in narcotic addicts or chronic pain patients, as Narcan will rapidly reverse the CNS depressant effects of opiods.

none

IV, IO, IM, IN, ET

Immediate onset when administered IV/IO/IN/ET and 5-10 minutes if administered IM. Either may last 20-30 minutes

Adult: 1.0 – 2.0 mg IV/IM or 2.0 – 4.0 mg ET. Titrate IV dose toadequate respiratory rate and tidal volume. May repeat dose every 5 minutes as needed

Pediatric: 0.1 mg/kg IV/IM or 0.2 mg/kg ET. Titrate IV dose toadequate respiratory rate and tidal volume. May repeat dose every 5 minutes as needed

Darvon and other synthetic narcotics may require larger dosages to reverse the effects

none

hormone

• Elevates blood glucose level by converting stored liver glycogen into glucose
• Increases heart rate and myocardial contractility and improves AV conduction in a manner similar to that produced by catecholamines

• ALOC with hypoglycemia when no IV can be established
• Beta-Blocker OD

Not significant

• Cardiovascular: tachycardia, hypertension
• CNS: dizziness, headache

• Only effective if liver glycogen is available, may be ineffective in chronic hypoglycemia or starvation patients
• Use with caution in patients with cardiovascular disease or renal insufficiency/disease

none

IM, IVP, IO

Onset in 5-20 minutes and may last 15-30 minutes

• Adult:
• Hypoglycemia: 1 mg IM; May repeat in 20 minutes
• Beta Blocker OD: 1 mg IV

Pediatric: 0.03 – 0.1 mg/kg IM; Max dose 1 mg (must have documented hypoglycemia)

Place patient into recovery position to prevent aspiration should vomiting occur prior to patient becoming fully conscious

25 gm of Dextrose in a 50 ml solution

carbohydrate

Provides immediate source of glucose for cellular metabolism

ALOC due to documented or suspected hypoglycemia

• There are no absolute contraindications to the IV administration of dextrose in the emergency setting
• Relative contraindication: Use with caution in patients with increasing Intracranial pressure as the added glucose may worsen the cerebral edema.

• Patients may complain of warmth, pain or burning at the injection site.
• Dextrose can cause severe neurologic symptoms (Wernicke’s encephalopathy or Korsakoff’s psychosis) if patient is thiamine deficient.

• Aspirate prior to administration and after every 10-15 ml to ensure IV patency (medication will cause necrosis)
• Cannulate largest vein possible and run IV wide open prior to and after administration
• Relative contraindication: Use with caution in patients with increasing intracranial pressure as the added glucose may worsen the cerebral edema or potentiate cellular necrosis in hemorrhagic stroke

none

IVP, IO

Onset will be 30-60 seconds but duration depends upon degree and cause of hypoglycemia

Adult: 25 gm (50 ml solution preload) IVP/IOMay repeat once in 5 minutes

Pediatric: Birth – 1 month: 0.5g-1gm/kg (5-10 ml/kg) slow IVP of a 10% solution. May repeat once in 10 minutes.

1 month+-2 years: 0.5g-1gm/kg (2-4 ml/kg) slow IVP/IO of a 25% solutionMay repeat once in 5 minutes

Over 2 years: 0.5g-1gm/kg (1-2 ml/kg) slow IVP/IO of a 50% solution (same solution as for the adult)May repeat once in 5 minutes

Do not exceed a 12.5% concentration in neonates.

• vitamin B₁
• Biamine

water soluble vitamin

Coenzyme necessary for carbohydrate metabolism of glucose

• Coma associated with delirium tremens (DTs) or alcohol withdrawal prior to Dextrose
• Alcoholism or malnutrition
• Coma of unknown origin

none

• Cardiovascular: mild hypotension
• Respiratory: pulmonary edema
• Gastrointestinal: nausea/vomiting

none

none

IV, IO, IM

Onset is immediate with an unknown duration

• Adult: 10-100 mg
• Pediatric: 10-25 mg

Medication should be administered prior to Dextrose 50%