Medications for Exams

Anticholinergic (Parasympatholytic)

• Bronchial Asthma
• Reversible bronchospasm assoc with COPD & Emphysema

500 mcg/dose (typically with a B-agonist) via small volume nebulizer

Sympathetic Agonist - B2 selective

• Reversible bronchospasm assoc with COPD
• Bronchial Asthma
• Preterm Labor

Labor: 0.25 mg subcutaneously (initial) may repeat in 30 - 60 minutes as needed

IV drip (labor): 5 mg in 500 mL Lactated Ringers or NS.  30 mL/hr (5 mcg/min).  Slowly increase rate to max of 80 mcg/min as needed.

Sympathomimetic - B2 selective

• Asthma
• Reversible bronchospasm assoc with COPD

2.5 - 5.0 mg in 2.5 mL NS over 5 - 15 minutes via small volume nebulizer

Hormone - Anti-hypoglycemic Agent

• Hypoglycemia
• Beta Blocker OD
• Calcium Channel Blocker OD

• 0.25 - 0.5 mg IV
• OR
• 1.0 mg IM

Vitamin

• Coma of unknown origin - esp is ETOH may be involved
• Delirium Tremens (DT's)

100 mg IV or IM

Carbohydrate

• Hypoglycemia
• Coma of unknown origin

• 25 g (50 mL) IV
• 2nd dose (same) may be given if 1st dose is ineffective

Sedative / Hypnotic

Induction and maintenance of sedation

2 mg/kg IV followed by 25 - 75 mcg/kg/min

Sedative / Hypnotic / Analgesic

Induction agent for rapid sequence intubation

• 0.5 - 1.0 mg/kg IV over 30 - 60 seconds
• OR
• 2 - 4 mg/kg IM

Sedative / Hypnotic

Induction agent for rapid sequence intubation

0.1 - 0.3 mg/kg IV over 15 - 30 seconds

Sodium Channel Blocker / Antiarrhythmic

• V-Tach with a pulse
• Pre-excited A-Fib

20 - 50 mg/minute until arrhythmia suppressed

• D/C if:
• Arrhythmia suppressed
• Hypotension
• QRS widened by 50%
• Max dose of 17 mg/kg administered

• V-Tach
• V-Fib
• A-Fib
• Cardiac Arrest
• Stable narrow-complex tachycardia (to control ventricular rate)

V-Fib / Pulseless V-Tach:  300 mg IV or IO over 10 minutes.  Repeat at 150 mg over 10 minutes.

A-Fib: 150 mg IV or IO over 10 minutes.  Repeat as needed.

Antiarrythmic

Tachyarrhythmias refractory to vagal maneuvers

• 1st Dose: 6 mg rapid IV or IO over 1 - 2 seconds followed by rapid saline flush
• 2nd Dose: 12 mg IV or IO over 1 - 2 seconds followed by rapid saline flush

Fibrinolytic

• Acute coronary syndrome
• Acute MI

• 10 units IV over 2 minutes
• Repeat in 30 minutes (20 units total)

Anticoagulant

• Acute coronary syndrome
• Pulmonary embolism

• Acute STEMI & unstable angina:
• 60 units/kg IV (max 4000 units) followed by 12 units/kg/hour

• NSTEMI & unstable angina:
• 60 - 70 units/kg IV (max 5000 units) followed by 12 - 15 units/kg/hour.

Platelet Aggregation Inhibitor

• Acute coronary syndrome
• Recent MI
• Stroke
• Peripheral vascular disease (PVD)

• Acute coronary syndrome & NSTEMI:
• 300 mg loading dose followed by 75 mg daily

Calcium Channel Blocker

Narrow-complex tachycardias (SVT, PSVT)

• 0.25 mg/kg IV over 2 minutes - initial dose
• 0.35 mg/kg IV over 2 minutes as needed

Calcium Channel Blocker

Narrow-complex tachycardias

• 2.5 - 5 mg IV or IO over 2 minutes
• Repeat dose at 5 - 10 mg in 15 - 30 minutes if needed.

Antipyretic / Platelet Inhibitor / Anti-Inflammatory

• New CP suggestive of acute MI
• Active MI

160 - 325 mg orally - chewed

Parasympatholytic

• Symptomatic bradycardia
• Organophosphate Poisoning

0.5 mg IV every 3 - 5 minutes to max dose of 3.0 mg

Sympathetic Agonist

Short term management of CHF when increased cardiac output without increased HR is desired

2 - 20 mcg/kg/min

• Dilute 250 mg in 500 mL D5W (0.5 mg/mL)
• OR
• 250 mg in 1L D5W (0.25 mg/mL)

Sympathetic Agonist

• Hemodynamically significant hypotension (systolic 70 - 100 mmHg) NOT resulting from hypovolemia.
• Cardiogenic Shock
• Symptomatic bradycardia

2 - 10 mcg/kg/minute.  Increase until BP imporoves or mad dose of 20 mcg/kg/min

Dilute: 400 mg in 250 mL D5W= 1600 mcg/mL

Hypotension NOT due to hypovolemia

0.1 - 0.5 mcg/min per AHA, however higher doses may be needed to maintain BP.

• Dilute: 8 mg in 500 mL D5W = 16 mcg/mL
• OR
• 4 mg in 250 mL D5W = 16 mcg/mL

Sympathetic Agonist

• 1:1000:
• Bronchial Asthma
• COPD exacerbation
• Allergic Reaction

0.3 - 0.5 mg

1:10 000:

• Cardiac Arrest = 1.0 mg every 3 - 5 minutes
• Anaphylaxis = 0.05 - 0.1 mg IV or IO
• Bradycardias refractory to Atropine = 2 - 10 mcg/min

Non selective Beta Blocker

Hypertensive emergency: markedly elevated BP with end-organ failure.  (HA & anxiety with increased BP are NOT indications

20 mg slow IV over 10 minutes.  Monitor BP prior and 5 - 10 minutes after administration.

Additional doses of 40 mg every 10 minutes until desired supine BP is reached

Non-selective Beta-Blocker, Antiarrhythmic

Hemodynamically stable monomorphic V-Tach (Stable V-Tach)

1.5 mg/kg infused over 5 minutes (slower is preferred)

Selective Beta-Blocker, Antiarrhythmic

• Suspected or aute MI who are also hypertensive
• Stable narrow-complex tachycardia if rhythm remains uncontrolled or unconverted by Adenosine or vagal maneuvers, or if SVT is recurrent.

5 mg slow IV every 2 - 5 minutes, to max of 3 doses.  Reassess vitals in between and re-administer only if Pt remains stable.

Nitrate

• CP assoc with MI
• Angina

0.4 mg sublingual spray or tablet every 3 - 5 minutes.

Gas

Hypoxia

Cardiac arrest & critical Pt - 100%.  Other titrate SpO2: 94 - 99%

• NC: 2 - 6 lpm  24 - 44%
• Simple: 8 - 10 lpm  40 - 60%
• Venturi: 4 - 12 lpm  24 - 50%
• Partial:  6 - 10 lpm  35 - 60 %
• NRB: 6 - 10 lpm  60 - 95%
• BVM: 10 - 15 lpm  40 - 90%

Nondepolarizing Neuromuscular Blocking Agent (Paralytic)

To achieve paralysis to facilitate endotracheal intubation when muscle tone or seizure activity prevents it.

0.08 - 0.1 mg/kg IV

Anticonvulsant / Antiarrhythmic

Torsade de pointes:  1 - 2 g (in 10 mL D5W)

Eclampsia: 2 - 4 g (in 10 mL D5W)

Alkalinizing Agent

• Tricyclic antidepressant overdose.
• Severe acidosis refractory to hyperventilation.

1 mEq/kg initial followed by 0.5 mEq/kg every 10 minutes as indicated by blood gas studies

Calcium Supplement

• Hyperkalemia
• Hypocalcemia
• Calcium Channel Blocker Toxicity (Cardizem, Verapamil)

2 - 4 mg/kg IV every 10 minutes as needed

Narcotic  (schedule II)

Severe pain with MI, kidney stones, etc.

• 2 - 10 mg IV - initial dose
• Additional doses of 2 mg every few minutes until pain is relieved or respiratory depression occurs.

Narcotic

• Severe pain
• Adjunct to rapid sequence intubation (RSI)
• Maintenance of analgesia

25 - 100 mcg IV slowly over 1 - 3 minutes

Narcotic Antagonist

Narcotic overdoses including: morphine, hydromorphone (Dilaudid), Fentanyl, Demeral, Methadone, Heroin, Oxy, Percocet, etc.

1 - 2 mg IV or IO

Nondepolarizing Neuromuscular Blocker (Paralytic)

Induction of skeletal muscle paralysis

• 600 mcg/kg initial (0.6 mg/kg)
• followed by: 100 - 200 mcg/kg/min continuously (0.1 - 0.2 mg/kg/min)

Vasopressor

• Cardiac arrest
• Organophosphate Poisoning

40 units IV or IO - may replace 1st or 2nd dose of Epi during cardiac arrest

Depolarizing Neuromuscular Blocking Agent (Paralytic)

To achieve paralysis to facilitate endotracheal intubation when muscle tone or seizure activity prevent it.

1.0 - 1.5 mg/kg IV

Barbituate

• Major motor seizures
• Status epilepticus
• Acute anxiety state

Status epipecticus: 100 - 250 mg slow IV

Osmotic Diuretic

• Acute cerebral edema
• Blood transfusion reactions

1.5 - 2.0 g/kg slow IV bolus or infusion

Non-Steroidal Anti-inflammatory Agent (NSAID)

Mild to moderate pain

• 30 mg IV 
• OR
• 30 - 60 mg IM and then 1/2 original dose after 6 hours

* 1/2 dose in elderly Pts

• Angiotensin-Converting Enzyme
• (ACE Inhibitor)

• HTN
• CHF

12.5 - 25 mg sublingually if BP is between 90 - 110 systolic

• Angio-tensin Converting Enzyme
• ACE Inhibitor

• HTN
• CHF

1.25 - 5 mg (typically 1.25 mg) IV over 5 minutes.  Can be repeated every 6 hours.

Corticosteroid / Anti-Inflammatory

• Anaphylaxis (after Epi & Benadryl)
• Asthma
• COPD

Anaphylaxis: 4 - 10 mg IV - single dose prehospitally

4 - 24 mg IV

Anti-Histamine

• Allergic reactions
• Anaphylaxis
• Extrapyramidal symptoms

25 - 50 mg slow IV push or deep IM

Corticosteroid / Anti-Inflammatory

• Severe anaphylaxis
• Asthma
• COPD

125 - 250 mg IV - single dose prehospitally

Antiemetic

Nausea & Vomiting

4 - 8 mg IV

Phenothiazine Antihistamine (H1 antagonist)

• Nausea & Vomiting
• Motion Sickness
• Sedation
• To potentiate the effects of analgesics

12.5 - 25 mg IV or deep IM

Phenothiazine Antiemetic

• Nausea & Vomiting
• Gastroesophageal reflux

• 10 mg slow IV push over 1 - 2 minutes
• or
• diluted in 50 mL NS over 15 minutes