Paramedic Drugs

Name: Ventolin, Proventil

Class: Sympathomimetic Bronchodilator

Bronchodilation with less cardiac effect than epinephrine

Reduces mucus secretions, pulmonary leaking and edema in the lungs during allergic reactions

• Bronchospasms
• Asthma in COPD

Hypersensitivity

• Tachycardia
• Anxiety
• Nausea
• Cough
• Wheezing
• Dizziness

2.5mg in 2.5 - 3ml NS via nebulizer

Name: Sublimaze

Class: Narcotic Analgesic

Potent synthetic narcotic analgesic

Rapid & less prolonged than morphine

Induce sedation for ETI

MAO inhibitors within 14 days

Myasthenia Gravis

• Increased ICP
• Elderly/debilitated
• COPD
• Respiratory problems
• Liver/kidney insufficiency

25 - 100mcg slow IV

Name: Atrovent

Class: Anticholinergic

• Bronchodilator
• Dries respiratory tract secretions by blocking acetylcholine receptors

Bronchospasms due to asthma, COPD & inhaled irritants

• Hypersensitivity to Atropine
• Primary treatment for bronchospasms

• Elderly
• Cardiovascular disease
• HTN

500mcg in 2.5 - 3ml NS via nebulizer or 2 sprays from metered dose inhaler

Name: Morphine

Class: Narcotic Analgesic

• Potent analgesic & sedative
• Causes vasodilation
• Reduces venous return
• Reduces myocardial 0₂ demand

• Severe pain
• MI

• Hypersensitivity to opiates
• Undiagnosed head or abdominal injury
• Hypotension/volume depletion
• Asthma
• COPD
• Severe respiratory depression
• Pulmonary edema due to chemical inhalation

• Elderly/debilitated
• Children
• Narcan should be available

Pain: 2.5 - 15mg IV; 5 - 20mg IM/Subcutaneous

AMI or PE: 1 - 2mg (6 - 10 min. response)

Name: Narcan

Class: Narcotic Antagonist

• Blocks effects of natrual and synthetic narcotics
• May reverse respiratory depression

• Narcotic overdose
• Coma of unknown origin

Non-narcotic induced respiratory depression

• Possible dependency
• Short half life

.4 - 2mg IV/IM repeated 2 - 3 min. up to 10mg

Name: Valium

Class: Antianxiety, Hypnotic, Anticonvulsant, Sedative

• Benzodiazepine sedative
• Skeletal muscle relaxant
• Reduces tremors
• Reduces seizure reoccurance
• Induces amnesia (cardioversion)
• Relaxes muscle spasms due to orthopedic injuries

• Major motor seizures
• Status epilepticus
• Premedication before cardioversion
• Muscle tremors from injury
• Acute anxiety

• Shock
• Coma
• ETOH
• Depressed vitals
• Pregnancy
• Neonates

• Psychosis
• Depression
• Myasthenia Gravis
• Hepatic/renal insufficiency
• Addiction
• Elderly/very ill
• COPD
• Short half life

Seizures: 5 - 10mg IV/IM

Anxiety: 2 - 5mg IV/IM

PreMedication: 5 - 15mg IV

Name: Amidate

Class: Hypnotic

• Short acting hypnotic
• No analgesic effects
• Limited cardiovascular and respiratory effects

Sedation for RSI

Hypersensitivity

• Hypotension
• Asthma
• Cardiovascular disease

.1 - .3mg/kg IV 15 to 30 sec.

Name: Romazicon

Class: Benzodiazepine Antagonist

Reverses sedative, recall and psychomotor effects of benzodiazepines

Respiratory depression due to benzodiazepines

• Seizure prone patients during labor/delivery
• Tricyclic antidepressant overdose

• Hepatic impairment
• Elderly
• Pregnancy/Nursing mothers
• Head injury
• Alcohol/Drug dependency
• Physical dependency on benzodiazepines

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

Name: Versed

Class: Sedative

• Short-acting benzodiazepine with CNS depressant
• Muslce relaxant
• Anticonvulsant
• Amterograde amnesic effects

Induce sedation for cardioversion or intubation

• Narrow-angle glaucoma
• Shock
• Coma
• Acute ETOH

• COPD
• Renal impairment
• CHF
• Elderly

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

Name: Anectine

Class: Depolarizing Neuromuscular Blocker

Ultra-short-acting depolarizing neuromuscular blocker

Facilitated ETI

• Family hx of malignant hyperthermia
• Penetrating eye injury
• Narrow-angle glaucoma

• Severe burn or crash
• Electrolyte imbalances
• Hepatic/renal impairment
• Cardiac/pulmonary impairment
• Fractures
• Spinal cord injury
• Severe anemia
• Porphyria

1 - 1.5mg/kg IV/IM

Name: Adenocard

Class: Antidysrhythmic

• Chemically cardiovert PSVT to NSR
• 10 sec. half life

Narrow & complex supraventricular tachycardia refractory to vagal maneuvers

• 2^nd & 3^rd degree heart blocks
• Sinus Node disease
• Asthma

• Transient dysrhythmias
• COPD

6mg rapid IV, then flush. If ineffective, 12mg, in 1 - 2 min. repeat

Name: Atropine

Class: Parasympatholytic

• Blocks parasympathetic nervous system, vagal effects on heart rate
• Decreases airway secretions
• May increase myocardial O₂ demand

• Bradycardia
• Bradysystolic arrest
• Organophosphate poisoning

None

• AMI
• Glaucoma

Asystole/PEA: 1mg IV/IO every 3 - 5 min, 3 dose max

Symptomatic Bradycardia: .5mg IV; 1mg ET. Repeat 3 - 5 min. to 3mg

Organophosphate Poisoning: 2 - 5mg IV/IM/IO 10 - 15 min.

Name: Adrenaline

Class: Sympathomimetic

Naturally occuring catecholamine

• Increases:
• Heart rate
• Cardiac contractile force
• Myocardial electrical activity
• Systemic vascular resistance
• Systolic BP

• Decreases:
• Airway resistance
• Automaticity

May reduce pulmonary congestion and increase tidal volume and vital capacity through bronchial artery constriction

• Cardiac arrest
• Severe allergic reactions

• Narrow-angle glaucoma
• Hemorrhagic shock
• Traumatic shock
• Cardiac shock
• Labor

• Elderly
• HTN
• Diabetes
• Hyperthyroidism
• Parkinsons
• Asthma

Arrest: 1mg of 1:10000 IV 3 - 5 min.; 2 - 2.5mg 1:1000 ET

Allergic Reactions: .3 - .5mg of 1:1000 subcutaneously 5 - 15 min. as needed; .5 - 1mg of 1:10000 IV if subcutaneous ineffective or severe reaction

Name: Pitressin

Class: Hormone, Vasopressor

• Strong vasopressive & antidiuretic properties
• May prescipitate angina or AMI

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

• PVCs
• 1^st 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

Name: Acetylsalicylic Acid

Class: Acetylsalicylic Acid

Acts on PNS and inhibits agents causing inflammation, pain & fever

Chest pain suggestive of an MI

• Active ulcer disease
• Asthma

Bleeding disorders

160 - 325mg PO (chewable)

Name: D₅₀W

Class: Carbohydrate

Simple sugar the body can rapidly metabolize and create energy

Hypoglycemia

None in hypoglycemia

• Increased ICP
• Determine blood glucose before administration
• Good venous access

25g (50ml) IV

Name: Lasix

Class: Diuretic

• Potent diuretic
• Antihypertensive
• Inhibits sodium reabsorption by kidneys
• Vasodilating effects reduce venous return & cardiac workload

• CHF
• Pulmonary Edema

• Fluid/electrolyte depletion
• Hepatic coma
• Pregnancy (except in life threatening circumstances)

• Infants
• Elderly
• Liver impairment
• Nephrotic syndrome
• Cardiogenic shock during acute MI
• Gout
• Patients receiving digitalis or potassium depleting steroids

40 - 120mg slow IV

Name: Nitrostat

Class: Nitrate

• Rapid smooth muscle relaxant
• Reduces peripheral vascular resistance
• Reduces BP
• Reduces Venous return
• Reduces cardiac workload

Chest pain due to angina, AMI, Acute pulmonary edema

• Tolerance to nitrates
• Severe anemia
• Head trauma
• Hypotension
• Increased ICP
• Pts taking sildenafil
• Glaucoma
• Shock

• Headache
• Nitro is light sensitive, loses potency when exposed to air

.4mg (1 table) SL repeated 3 - 5 min. up to 3 tablets; 1/2" ointment; .4mg (1 spray) SL up to 3 sprays over 25 mins.

Name: Dobutrex

Class: Sympathomimetic

• Synthetic catecholamine and beta agent
• Increases strength of cardiac contraction without increasing rate

Increase cardiac output in CHF & cardiogenic shock

• Vtach
• Hypovolemia w/o fluid resuscitation

• Afib
• Pre-existing HTN

2 - 20mcg/kg/min IV

Name: Intropin

Class: Sympathomimetic

• Catecholamine
• Increases cardiac output without increasing myocardial O₂ consumption
• Maintains renal and mesenteric blood flow
• Induces vasoconstriction
• Increases systolic BP

• Nonhypovolemic hypotension
• Cardiogenic shock

• Tachydysrhythmias
• Vfib
• Pheochromocytoma

Adequate fluid resuscitation of the hypovolemic Pt

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

Name: Isuprel

Class: Sympathomimetic

Increases cardiac output by increasing strength and rate of contraction

Bradycardia refractory to Atropine when pacing is not available

Cardiogenic shock

• Tachydysrhythmias
• Digitalis dysrhythmias
• AMI

2 - 10mcg/min titrated to cardiac rate

Name: Cordarone, Pacerone

Class: Antidysrhythmic

• Prolongs the duration of the action potential and refractory period
• Relaxes smooth muscle
• Reduces peripheral vascular resistance
• Increases coronary blood flow

• Ventricular and supraventricular dysrhythmias
• Afib

• Cariogenic shock
• Sever sinus bradycardia
• Advanced heart block

Hepatic impairment

150 - 300mg IV over 10 mins., then 1mg/min over next 6 hrs.

Name: Bretylol

Class: Antidysrhythmic

Suppresses ventricular dysrhythmias including vfib with re-entry mechanisms

Vtach & Vfib refractory to lidocaine

None

• Digitalized Pts
• Digitalis induced dysrhythmias

5mg/kg IV then 10mg/kg 15 - 30 mins., max 30mg/kg

Name: Xylocaine

Class: Antidysrhythmic

• Raises automaticity
• Supresses stimulation threshold of ventricles
• Sedation
• Anticonvulsant
• Analgesic effects

• Vtach
• Vfib

• Supraventricular dysrhythmias
• Stokes-Adams Syndrome
• 2nd & 3rd degree heart blocks
• Bradycardia

• Hepatic/Renal impairment
• CHF
• Hypoxia
• Respiratory depression
• Hypovolemia
• Myasthenia Gravis
• Shock
• Elderly

Cardiac Arrest: 1 - 1.5mg/kg IV repeated every 3 - 5 mins. up to 3mg/kg, follow conversion with drip of 2 - 4mg/min.

Vtach: 1 - 1.5mg/kg slow IV; repeat at 1/2 dose every 5 - 10 mins. until conversion up to 3mg/kg; follow conversion with infusion of 2 - 4mg/min.

Name: Pronesty

Class: Antiarrhythmic

• Prolongs ventricular repolarization
• Slows conduction
• Decreases myocardial excitability

• Vfib
• Pulseless Vtach refractory to lidocaine

• Hypersensitivity to procaine
• Myasthenia Gravis
• 2nd & 3rd degree heart blocks

• Hypotension
• Cardiac enlargement
• CHF
• AMI
• Ventricular dysrhythmias from digitalis
• Hepatic/renal impairment
• Asthma

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

Name: Cardizem

Class: Calcium channel blocker

Dilates coronary and peripheral arteries & arterioles, which increases circulation to the heart and decreases peripheral vascular resistance.

• Supraventricular tachydysrhythmias (Afib, Aflutter, PSVT)
• Increase coronary artery perfusion in angina

• Sick sinus syndrome
• 2nd or 3rd degree heart block
• Systolic BP <90
• Diastolic BP <60
• Wide complex tachycardia
• WPW

CHF

.25mg/kg IV over 2 mins., repeat as need with .35mg/kg followed by drip of 5 - 10mg/hr. Do not exceed 15mg/hr over 24hrs.

Name: Isoptin, Calan

Class: Calcium channel blocker

• Slows AV conduction
• Suppresses re-entry dysrhythmias
• Slows ventricular responses to atrial tachydysrhythmias
• Dilates coronary arteries
• Reduces myocardial O₂ demand

• PSVT refractory to adenosine
• Aflutter
• Afib with rapid ventricular response

• Hypotension
• Cardiogenic shock
• 2nd & 3rd degree heart block
• CHF
• Sinus Node Disease
• Accessory AV pathways
• WPW syndrome
• Beta blockers

Hepatic/renal impairment

2.5 - 5mg IV bolus over 2 - 3 mins., then 5 - 10mg after 15 to 30 mins. to a max of 30mg in 30 mins.

Name: Nitroglycerin Injection

Class: Vasodilator, Nitrate

• Relaxes blood vessels
• Increases blood and O₂ supply to heart

• Relieve pain associated with angina that does not respond to oral tx
• Control BP
• CHF

• Hypotension
• Uncorrected hypovolemia
• ICP
• Contrictive pericarditis
• Pericardial tamponade

• Headache
• Hypotension
• Tachycardia

.2 - 1.5mcg/kg/min

Name: Calcium Chloride

Class: Electrolyte

• Increases myocardial contractile force
• Increases ventricular automaticity

• Hyperkalemia
• Hypocalcemia
• Hypermagnesemia
• Calcium channel blocker toxicity

• Vfib
• Hypercalcemia
• Digitalis toxicity

• May precipitate toxicity in Pts taking digoxin
• IV in large vein
• Flush before & after use

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

Name: Solu-Medrol

Class: Corticosteriod, Antiinflammatory

• Aniinflammatory
• Allergic reactions
• Shock
• Spinal cord injuries

• Spinal cord injury
• Anaphylaxis
• COPD
• Asthma

None

Only 1 dose should be given

Asthma/COPD/Anaphylaxis: 125 - 250mg IV/IM

Spinal cord injury: 30mg/kg IV over 15 mins., after 45 mins. an infusion of 5.4mg/kg/hr