Paramedic 2 Drugs

  1. Actions
    Potassium channel blocker: increased refractory period effecting mainly phase 3 -- prolonged QT interval. Inhibits Alpha and Beta actions
    Amiodarone (Cordarone)
  2. Indication
    1) V-Fib or V-Tach w/o a pulse   2) Stable narrow complexes uncontrolled by Adenosine  3) A-Fib/A-flutter (can be uses w/WPW)  4) Stable wide complex tachycardias
    Amiodarone (Cordarone)
  3. Dosage
    1) 300mg IV/IO. If not effective can follow with one dose of 150mg.
    2)3)4) 150mg IV/IO over 10 minutes followed by 1mg/min infusion. Maximum daily dose of 2.2g.
    Amiodarone (Cordarone)
  4. Actions
    Slow calcium into cardiac cells = decreased SA/AV node conduction, vasodilation
    Diltiazem (Cardizem) Calcium Channel Blocker
  5. Indication
    Stable SVT not corrected by adenosine. Stable Junctional Tach. Stable A-fib/A-flutter. The purpose of this drug is to control RATE not correct rhythm.
    Diltiazem (Cardizem) Calcium Channel Blocker
  6. Dosage
    0.25 mg/kg IV/IO push over 2 min., repeat at 0.35 mg/kg 15 min after initial bolus. Maintenance dose 5-15 mg/hr.

    5 mg/ml
    Diltiazem (Cardizem) Calcium Channel Blocker
  7. Actions
    Sodium channel blockers: Changes the slope of phase 1. Shortens the refractory period, suppresses ectopy, increased V-fib threshold
    Lidocaine (Xylocaine)
  8. Indication
    Alternative therapy in V-fib / V-tach w/o a pulse.  Alternative therapy in stable V-tach.
    Lidocaine (Xylocaine)
  9. Dosage
    1.0-1.5 mg/kg IVP/IO. Repeat doses at 0.5-0.75 mg/kg every 5-10 minutes to a max of 3 mg/kg.  Maintenance dose: 2-4 mg/min

    20 mg/ml.  Premixed bag = 1 gr/250 cc
    Lidocaine (Xylocaine)
  10. Actions
    Prolongation of refractory period of the atria and ventricles by blocking sodium and potassium channels
    Procainamide (Pronestyl) Actions
  11. Indications
    Primary: Stable V-tach (monomorphic)
    Secondary: Atrial fib / Atrial flutter to control rate. Atrial fib / Atrial flutter with WPW.  SVT uncontrolled by adenosine
    Procainamide (Pronestyl) Indications
  12. Dosage
    20-30 mg/min IV/IO piggyback drip.
    Continue administration until: max 17 mg/kg, ectopy resolved, hypotension ensues, QRS complex widens by 50%
    Maintenance Dose: Mixed 1 gm / 250 cc.  Run at 1-4 mg/min
    Concentration: 100 mg/ml
    Procainamide (Pronestyl) Dosage
  13. Actions
    Slow calcium into cardiac cells = decreases SA / AV node conduction, vasodilation
    Verapamil (Calan, Isoptin) Calcium Channel Blocker Actions
  14. Indications
    Stable SVT not corrected by adenosine. Stable Junctional Tach. Stable A-Fib/A-Flutter. The purpose of this drug is to control RATE not correct rhythm
    Verapamil (Calan, Isoptin) Calcium Channel Blocker Indications
  15. Dosage
    2.5-5.0 mg SLOW IVP

    2.5 mg/ml
    Verapamil (Calan, Isoptin) Calcium Channel Blocker Dosage
  16. Actions
    Increased Alpha and Beta stimulation. Increased HR, force of contraction and vasoconstriction. Vasoconstriction is the most beneficial in cardiac arrest.
    Epinephrine (Adrenalin) Actions
  17. Indications
    1) Cardiac Arrest (Asystole, PEA, V-fib, V-tach w/o a pulse)
    2) Bradycardia
    3) Anaphylaxis
    Epinephrine (Adrenalin) Indications
  18. Dosage
    Cardiac Arrest: 1.0 mg IVP/IO every 3-5 min
    Bradycardia: Mix 1 mg in 250 or 500 cc NSS and run at 2-10 mcg/min until HR >60
    Anaphylaxis: 0.3 mg SQ (1:1000 strength)

    1:1000  = 1.0 mg/ml
    1:10000 = 0.1 mg/ml
    Epinephrine (Adrenalin) Dosages
  19. Actions
    Non-adrenergic vasoconstrictor.
    Anti-diuretic hormone (ADH) causes coronary and renal vasoconstriction.
    Vasopressin (Pitressin) Actions
  20. Indication
    Cardiac arrest with any rhythm -- V-fib, V-tach, asystole, or the condition of PEA.
    Vasopressin (Pitressin) Indication
  21. Dosage
    40 U IVP/IO given ONCE.

    20 units/ml
    Vasopressin (Pitressin) Dosage
  22. Actions
    Prevents platelets from clumping.
    Acetylsalicylic Acid (Aspirin/ASA) Actions
  23. Indication
    CP, suspected ACS (Acute Coronary Syndrome)
    Acetylsalicylic Acid (Aspirin/ASA) Indication
  24. Dosage
    160 to 325 mg PO (chewed). Chewable tablets are more rapidly absorbed than swallowed tablets.
    81 mg chewable tablets
    Acetylsalicylic Acid (Aspirin/ASA) Dosage
  25. Actions
    Increased Alpha and Beta stimulation. Increased HR, force of contraction and vasoconstriction. Increased renal / mesenteric blood flow.
    Dopamine (Intropin) Actions
  26. Indication
    Cardiogenic shock, hemodynamically significant bradycardia, non-hypovolemic shock
    Dopamine (Intropin) Indications
  27. Dosage
    Give IV/IO drip
    2-10 mcg/kg/min = Beta (usual dose)
    10-20 mcg/kg/min = Alpha and Beta
    40 mg/ml (vials)
    Premix bag 400mg/250cc
    Dopamine (Intropin) Dosage
  28. Actions
    Relaxes vascular smooth muscle (arteries and veins), vasodilation -- decreased myocardial oxygen demand (easier for the heart to work)
    Nitroglycerin (Nitro-Bid, Tridil) (NTG) Actions
  29. Indication
    CP: ACS, Angina Pectoris, MI, CHF, hypertension.
    Not indicated for right ventricular MI
    Nitroglycerin (Nitro-Bid, Tridil) (NTG) Indication
  30. Dosage
    SL Dose = 0.3 or 0.4 mg tablet every 5 minutes. Typically 3 tablets.
    Paste = 1-2 inches every 8 hours
    IV/IO dose = 10-20 mcg/min (titrate to effect)
    0.3 mg or 0.4 mg SL tabs
    15 mg per inch paste (approx.)
    25 mg / 250 cc drip
    Nitroglycerin (Nitro-Bid, Tridil) (NTG) Dosage
  31. Actions
    CNS depression, opiate actions, vasodilation (easier for the heart to work)
    Morphine Sulfate (Duramorph) Actions
  32. Indication
    Acute myocardial infarction, left heart failure with pulmonary edema
    Morphine Sulfate (Duramorph) Indication
  33. Dosage
    2-4 mg IV/IO push slowly.
    Additional doses of 2-8 mg IV/IO at 5-15 minute intervals until desired effects are achieved. Max 15 mg.
    Various: 1 mg/ml, 2 mg/ml
    Morphine Sulfate (Duramorph) Dosage
  34. Actions
    Decreased SA and AV node conduction.
    Half life of 6-8 seconds
    Adenocard (Adenosine) Actions
  35. Indication
    Stable Supraventricular tachycardia
    Can be used as diagnostic test -- is the rhythm atrial or ventricular. If adenosine has some effect, the rhythm is atrial.
    Adenocard (Adenosine) Indication
  36. Dosage
    6 mg IV/IO push rapidly 1-3 seconds c 20 ml flush. AHA dosages as 6, 12 (typically SVT) or 6, 12, 12 (typically VT [diagnostic])
    3 mg/ml
    Adenocard (Adenosine) Dosage
  37. Actions
    Blocks the actions of the parasympathetic system in the SA and AV nodes.
    Effective in SB, 1st degree block. Not effective in 2nd degree type II, 3rd degree block or idioventricular.
    Atropine Sulfate Actions
  38. Indications
    Hemodynamically significant bradycardia (typically rate <50) with signs and symptoms of poor perfusion.
    No longer administered in routine cardiac arrest settings.
    Atropine Sulfate Indications
  39. Dosage
    Bradycardia=0.5 mg rapid IV/IO push. Max dose of 3.0 mg (0.04 mg/kg)
    Atropine Sulfate Dosage
  40. Actions
    Beta blockade and potassium channel blocker
    Sotolol (betapace) Actions
  41. Indications
    Ventricular Tachycardia, ventricular arrhythmias (PVC's)
    Sotolol (betapace) Indications
  42. Dosage
    100 mg (1.5 mg/kg) over 5 minutes

    150 mg / 10 ml
    Sotolol (betapace) Dosage
  43. Actions
    Combines with narcotic receptors and blocks or reverses the actions of narcotics
    Naloxone (Narcan) Actions
  44. Indication
    Narcotic overdose
    Unconscious, unknown
    Naloxone (Narcan) Indication
  45. Dosage
    0.4-2.0 mg IV/IO slowing
    May repeat q 2-3 mins to max of 10 mg

    1 mg / 1 ml
    Naloxone (Narcan) Dosage
  46. Actions
    CNS depression, antianxiety, sedation, hypnotic, antiseizure activites
    Diazepam (Valium) Benzodiazepine Actions
  47. Indications
    Sedation for cardioversion or pacing
    Seizure patients, status Epilepticus
    Diazepam (Valium) Benzodiazepine Indications
  48. Dosage
    5-10 mg IV/IO push slowly (5mg/min) until desired effect is achieved. (max 30mg)
    Diazepam (Valium) Benzodiazepine Dosage
  49. Actions
    It increases circulating blood sugar levels
    Dextrose (D50) Actions
  50. Indications
    Hypoglycemia, unconscious unknown patients.
    Dextrose (D50) Indications
  51. Dosage
    25 grams IV/IO push. May repeat in severe cases.
    0.5 gr/ml 50 ml syringe
    Dextrose (D50) Dosages
  52. Actions
    Electrolytes required for conduction of nerve impulses in cardiac cells.
    Calcium Chloride Actions
  53. Indications
    Hyperkalemia and calcium channel blocker overdose.
    Magnesium administration issues (given too fast)
    Calcium Chloride Indications
  54. Dosage
    8-16 mg/kg SLOW IV/IO push
    100 mg/ml
    Calcium Chloride Dosage
  55. Actions
    Blocks actions of Beta receptors = decreased HR, blood pressure, contractility
    Beta Blocker (Metaprolol, Atenolol, Inderol, Propanalol) Actions
  56. Indications
    ACS: MI, angina, hypertension, control rate in A-fib / A-flutter, SVT's
    Beta Blocker (Metaprolol [selective B1 blocker], Atenolol [selective B1 blocker], Inderol [non-selective blocker], Propanalol) Indications
  57. Dosage
    5 mg SLOW IVP over 2 minutes. Wait 2 minutes until next dose
    1 mg/ml
    Beta Blocker (Metaprolol [selective B1 blocker], Atenolol [selective B1 blocker], Inderol [non-selective blocker], Propanalol) Dosage
  58. Actions
    Increased Beta 1 stimulation. Increased HR and force of contraction, mild vasodilation
    Dobutamine (Dobutrex) Actions
  59. Indications
    Pulmonary congestion and low cardiac output
    Dobutamine (Dobutrex) Indications
  60. Dosage
    Given IV/IO drip 2-20 mcg/kg/min
    Prepare infusion of 500 mg / 250 ml
    2 mg/ml
    Dobutamine (Dobutrex) Dosage
  61. Actions
    Decreased reabsorption in kidneys = increased urine output, vasodilation, Loop diuretic
    Furosemide (Lasix) Actions
  62. Indications
    Left heart failure with pulmonary edema, hypertension
    Increasing evidence questioning its use in CHF
    Furosemide (Lasix) Indications
  63. Dosage
    0.5 - 1.0 mg/kg IV/IO push slowly over 1-2 minutes
    10 mg/ml
    Furosemide (Lasix) Dosage
  64. Actions
    Breaks down glycogen within the liver, liberating glucose. Causes relaxation of smooth muscles. Positive inotropic and chronotropic effects
    Glucagon Actions
  65. Indications
    Hypoglycemia where IV access is not possible
    Esophageal obstruction
    Calcium channel blocker overdose
    Beta Blocker overdose
    Glucagon Indications
  66. Dosage
    In all cases ... 0.5-1.0 mg IM/SQ/IV/IO. If no response repeat dose in 20 minutes. Can repeat one more time.
    Glucagon Dosage
  67. Actions
    Interferes with thrombin formation = prevents clot formation
    Heparin Actions
  68. Indications
    MI, Unstable Angina, PE, embolism, DVT (deep vein thrombosis)
    Heparin Indications
  69. Dosage
    Bolus 60 U/kg IV/IO
    i.e. 10,000 units/ml, 5,000 units/ml
    Heparin Dosage
  70. Actions
    Increased Beta (KING Beta)
    Isoproterenol (Isuprel) Actions
  71. Indications
    Adjunct therapy for stable torsades de pointes (polymorphic V-Tach, Long QT)
    Hemodynamically significant bradycardia
    Isoproterenol (Isuprel) Indications
  72. Dosage
    Given IV/IO drip
    Add 1 mg to 250 ml D5W. Initial infusion rate of 2-10 mcg/min
    20 mcg/ml
    Isoproterenol (Isuprel) Dosage
  73. Actions
    Electrolyte essential for nerve transmission and muscle contraction
    Magnesium Sulfate Actions
  74. Indications
    Torsades de pointes (polymorphic V-Tach, long QT)
    V-Fib, V-Tach w/o a pulse thought to be caused by torsades de pointes
    Magnesium Sulfate Indications
  75. Dosage
    1-2 gm in 10 ml IV/IO bolus
    Maintenance dose = 0.5-1.0 gm/hr
    100 mg/ml
    Magnesium Sulfate Dosage
  76. Actions
    Sedative effects, vasodilator, depresses CNS
    Midazolam (Versed) Benzodiazepine Actions
  77. Indications
    Sedation prior to cardioversion / pacing
    Midazolam (Versed) Benzodiazepine Indications
  78. Dosage
    1-2.5 mg SLOW IVP/IO
    5 mg/ml
    Midazolam (Versed) Benzodiazepine Dosage
  79. Actions
    Neutralizes acids in blood stream
    Sodium Bicarbonate Actions
  80. Indications
    Metabolic Acidosis
    Good for some overdoses = Tricyclic Antidepressant Overdose, ASA. Good for crush syndrome.
    Sodium Bicarbonate Indications
  81. Dosage
    0.5 - 1 mEq/kg IV push
    1 mEq/ml
    Sodium Bicarbonate Dosage
  82. Actions
    Attacks existing clots and breaks them down. Opens clotted arteries.
    Thrombolytics (Streptase, Retavase, Eminase, Activase) Actions
  83. Indications
    MI, PE, CVA
    Thrombolytics (Streptase, Retavase, Eminase, Activase) Indications
  84. Dosage
    Thrombolytics (Streptase, Retavase, Eminase, Activase) Dosage
Card Set
Paramedic 2 Drugs
Drug Actions, Indications, and Dosages