Paramedic school

  1. Nitroglycerin
    Class: Antianginal

    Actions: Smooth Muscle relaxant, Reduces cardiac work, Dilates arteries, dilates systemic arteries

    Inducations: Angina pectoris, Chest pain associated with myocardial infarction.

    Contrainducations: Children younger than 12 years of age. Hypotension.

    Precautions: Constantly monitor blood pressure, Syncope, Medication must be protected from light.

    Side effects: Headache, dizziness, Hypotension.

    Dosage: (Nitrostat) one tablet repeated 3-5 minute intervals up to 3 times

    Paste(Nitro-bid) 1/2 to 1 inch topical

    Spray(Nitrolingual spray)- one spray administered under the tounge, may be repeated in 3-5 minutes, no more that 3 sprays in 15 minute period, should not be inhalded. route- Under the tongue
  2. Asprin
    Class: Platelet inhibitor and anti-inflammatory

    Actions: Inhibits platelet aggregation

    Indications: New chest pain suggestive of acute myocardial infatction, S/S suggestive of recent stroke

    Contrinducations: Hypersensitivity

    Precautions: Gastrointestinal bleeding, and upset stomach.

    Side effects: Heartburn, Nausea and vomiting, Wheezing

    Dosage: 160 or 325mg by mouth chewed

    Route: Oral

    Pediatric dose: 10-15mg/kg/dose every 4-6 hours
  3. Amiodarone / Cordarone
    Class: Antiarrhytmic (class 3)

    Action: Prolongs action of potential and refactory period. Slows the sinus rate, increases PR and QT intervals, Decreases peripheral vascular resistance (a and b adrenergic blockade)

    Inducations: Life threating cardiac arrhythmias such as V-tac and V-fib

    contrainducations: Severe sinus node dysfunction, Sinus bradycardia, Second and thrid-degree atrioventricular block, Hemodynamically significant bradycardia

    Precautions: Heart failure

    Side effects: Hypotension, nausea, Anorexia, Malaise(fatigue), Tremors, Pulmonary toxicity, ventricular ectopic beats.

    • Dosage: v-Fib or Pulseless V-Tach Adults 300mg may be repeated @ 150mg for recurrent or refactory arrhythmias.
    • Narrow-complex tachycardias- dosed @ 150mg IV/IO over 10 minute and repeated as necessary. this can be followed by a 1mg/min infustion over 6 hours, followed by a .5mg/min infustion as needed. total 24 hour dose should not exceed 2.2gm

    Route: IV

    Pediatric dosage: 5mg/kg IV/IO over 30 minutes. May be repeated twice up to 15/kg max single dose 300mg 
  4. Lidocaine / Xylocaine
    Class Antiarrhythmic (Class IB)

    Actions: Suppresses ventricular ectopic activity, Increases ventricular fibrillation threshold, reduces velocity of electrical impulsee through conductive system.

    Inducations: ventricular Tachycardia/Fibrillation refactory of amiodarone

    Contraindications: High degree heart blocks, PVC's in conjuction with bradycardia

    • Precautions: Dosage should not exceed 300mg/hr, Monitor for CNS toxicity, dosage should be reduced by 50% in patients older than 70 Y/O or who have liver disease.
    • In Cardiac arrest, use only bolus therapy.

    Side effects: Anxiety, Drowsiness, Dizziness, confusion, nausea and vomiting, convulsions, widening QRS complex.

    • Dosage: Bolus: initial bolus of 1.0-1.5mg/kg additinonal bolus of .5-.75mg/kg can be repeated 5-10 mintue intervals untill arrhythmia has been suppressed or 3.0 mg/kg has been administered. reduce dosge by 50% in pt's older than 70.
    • Drip after arrhythmia been suppressed a 2-4mg/min infustion my be started to maintain adquate blood levels

    Routs IV bolus/Iv infustion

    Pediatric 1mg/kg
  5. Calcium chlordie
    Class: Electrolyte

    Action: increases cardiac contractility

    Inducations: Acute hyperkalemia(elevated potassium) Acute hypocalcemia(decreased calcium level), Calcium channel blocker overdose, abdominal muscle spasm accociated with spider bites and Portuguese man of war stings, antidote for magnesium sulfate.

    Contrinducations: pt's receiving digitalis

    Precations: IV line should be flushed between calcium choride and sodium bicarbonate admin.

    Side effects: Arryhmias(Bradycardia and asytole), Hypotension

    dosage: 2-4mg/kg of 10% solution, may be repeated @ 10 minute intervals.

    Route: IV

    Pediatric dosage: 5-7mg/kg of a 10% solution. 
  6. Magnesium
    Class: Anticonvulsant and antiarrhythmic

    Actions: Central nervous system depressent, Anticonvulsant, Antiarrhythmic.

    • Indiactions: Obstetrical- Eclampsia
    • Cardiovascular-Torsade de pointes (irregular, polymorphic ventricular tachycardia.

    Containducations: Shock, heart block

    Precautions: Caution should be used in Pt's receiving digitalis, Hypotension, Calcium choride should be readily available as an antidote if respiratory depression ensues. Use caution in Pt's with renal failure

    Side effects: flushing, respiratory depression, drowsiness

    Dosage- 1-4g

    Route IV/IM

    Pediatric dosage- not indicated
  7. Adenosine / Adenocard
    Class Antiarrythmic

    Actions: Slows atrioventricular conduction

    Inducations: Regular tachyarrhythmias(narrow and wide complex)

    Contraindications: Torsades, atrial fibrillations, second or thrid degree heart block, hypersenstivity

    Precautions: Arrhythmias, including blocks, are common at the time of cardioversion.

    side effects: Facial flushing, headache, shortness of breath, dizziness nausea.

    Dosage: 6mg given as rapid IV bolus over 1-2 seconds, if after 1-2 min cardioversion does not happen, administer a 12mg dose over 1-2 seconds

    route: IV, closet port to the pt.

    Pediatric dosage Less than 50kg 0.05-.1mg/kg max dose .3 mg/kg/dose up to 12mg. Greater than 50 kg same as adult.
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Paramedic school