Medic Drugs

Chemical that causes increased heart rate.

Parasympathetic breaks for heart rate, antagonist is a blocker, takes off break.

Drugs primarily used for treating anxiety, but can also treat seizures, and insomnia.

General anesthesia,sedation prior to surgery or diagnostic procedures, muscle relaxation, alcohol withdrawal, nausea and vomiting, depression, and panic attacks.

Chemical that either accelerates (positive) or slows (negative) the rate of a body system, mainly the heart.

Chemical that either strengthen (positive) or weakens (negative) the rate of a body system, mainly the heart.

Stimulating causes positive inotropic effects, while blocking causes negative inotropic effects.

Stimulation causesbronchodilation while blocking causes bronchoconstriction.

Increases vascularsmooth muscle contraction producing increases in blood pressure.

Vasoconstriction independent of sympathetic system

In cardiac arrest to support the effectiveness of CPR

None in cardiac arrest

for adults--- 40 units IVP in place of the first or second dose of epinephrine (not repeated)

none pertinent in cardiac arrest

rapid IV push (IV or IO) (via ETT if no other alternative and at same dose but diluted in 5-10cc NS or sterile water)

multi-dose vial of 20 units in 1cc

use in cardiac arrest is per ACLS but “off-label”; typically used for control of diabetes insipidus; other off-label uses include as a vasopressor in vasodilatory shock

slows cardiac conduction

in VF / Pulseless VT cardiac arrest to avoid “re-fib”

none in cardiac arrest

for adults---1 to 1.5mg/kg IVP repeated at half the initial dose every 5-10 minutes up to a maximum of 3mg/lg then followed by a drip after ROSC at 1-4 mg/min (pre-mixed drips at concentrations of 1g in 250cc or 2g in 250cc or equivalent)

none pertinent in cardiac arrest

rapid IV push (IV or IO)

preloaded syringes of 100mg in 10cc

dysrhythmia control (studied separately)

Beta-1, Beta-2, Alpha 1 agonist (sympathetic agonist, sympathomimetic)

in cardiac arrest to support the effectiveness of CPR

none in cardiac arrest

for adults--- 1mg IVP every 3-5 minutes every 4 minutes for our class)

none pertinent in cardiac arrest

rapid IV push (IV or IO) (via ETT if no other alternative but at dose of 2mg)

preloaded syringe with 1mg in 10cc

we will separately study epinephrine for IV drip infusion (for chronotropic support or as a vasopressor) and for IM / SQ (in anaphylaxis)

beta and alpha agonist

Positive chronotrope for symptomatic bradycardia; positive inotrope and vasoconstrictor

none pertinent

higher doses increases likelihood of ventricular tachycardia or fibrillation

2-10 mcg / minute (30gtts / min to start)

increased myocardial oxygen demand

IV drip infusion (pump desirable)

mixed on scene using 1mg in 250cc D5W or NS to yield 4mcg / cc

More effects come from higher doses.

beta and alpha agonist depending on dose

positive chronotrope for symptomatic bradycardia; positive inotrope

none pertinent

higher doses increases likelihood of ventricular tachycardia or fibrillation

5-10 mcg / kg / minute for beta effects; higher doses yield maximum beta 1 effects plus increasing alpha 1 effects

increased myocardial oxygen demand

IV drip infusion (pump desirable)

pre-mixed 400mg in 250cc D5W or NS (some other concentrations)

vasopressor at higher doses

slows cardiac conduction via multiple mechanisms.

in VF / Pulseless VT cardiac arrest to avoid “re-fib”

none in cardiac arrest

For adults---300mg IVP with one repeat dose at 150mg; when ROSC is attained, start infusion of 1mg/min

• 150mg in 100cc at 40gtts / minute with a microdrip set
• 150mg in 250cc at 100gtts/min with a microdrip set
• Remove 25cc from 100cc bag of NS then add 150mg; infuse at 30gtts/min with microdrip set

none pertinent in cardiac arrest

rapid IV push (IV or IO)

vial of 150mg in 3cc

dysrhythmia control (studied separately)

Beta-2 agonist

Patient requires beta-2 stimulation to relieve the bronchospasm component of bronchiolar obstruction

Ineffective when used with beta blockers; cautious use with marked tachycardia (highly unlikely) as there are beta-2 receptors in the cardiac muscle that may be stimulated by a beta-2 agonist and produce an increase in heart rate - this must be balanced against the relief of hypoxia-induced tachycardia.

For adults, typically 2.5mg per HFN  although some protocols indicate that 5mg is the correct starting dose

Mostly contained to tremors and agitation (20%) with a few reports of actual tachycardia or palpitations (5%)

Patients take prescription albuterol by either MDI or HFN under the trade name ProAir or Ventolin or Proventil; most perhospital services deliver albuterol via HFN.

Preloaded vial with twist-off top for easy and rapid distribution into the HFN chamber; some services may carry a multi-dose vial with an eye dropper for mixing with small saline packets in the HFN.

Albuterol forces potassium from the bloodstream into the cells and is therefore, an adjunct in treatment of hyperkalemia however this method is somewhat slow and dosing is quite high (4 x in most protocols) compared with usual albuterol for bronchospasm - some protocols suggest the intubated patient can get albuterol dumped into the ET tube directly rather than nebulized.

Parasympathetic antagonist (aka anticholinergic) [parasympathetic breaks for heart rate, antagonist is a blocker, takes off break]. Increase heart rate

Patient requires positive chronotrope due to symptoms related to heart rate in the setting of increased vagal/parasympathetic tone such as sinus bradycardia or 1st degree AV Block or 2nd Degree Type 1 (Mobitz I or Wenkebach)

AV Blocks that are not related to increased parasympathetic tone such as 2nd Degree Type II and 3rd Degree and High-Grade AV Block; possible benefit in 2nd Degree with 2:1 conduction (particularly if wide QRS) because those are not clearly either a Type I or Type II. Remember, 2nd Degree Type II and higher grade blocks do not respond to Atropine because the block is not related to parasympathetic tone yet the heart rate may increases from the Atropine and make the block more of a problem.

For adults, typically 0.5mg IVP; use length-based chart for peds patients and beware that there is a minimum dose to avoid a paradoxical Bradycardia effect in peds.

Slow IV Push over 30-60 seconds; repeat if needed every 3-5 minutes up to a maximum dose of 3.0mg

Preloaded syringe of 1mg in 10cc so 0.1mg per cc (purple box) which gives a standard adult dose of 5cc

Reversal of cholinergic effects of some nerve gas agents and organophosphate poisoning (insect killers) but these use require very large amount of Atropine (well over 3mg)(SLUDGE Salivation Lacrimation (tears) Urination Defecation Gastrointestinal Emesis)

Anticholinergic bronchodilator (vagus nerve uses acetylcholine as its neurotransmitter and thus it is called the cholinergic system).

Patient requires anticholinergic (parasympathetic antagonist) to relieve the bronchospasm component of bronchiolar obstruction.

Not a contraindication but ipratropium is not necessarily a fast-acting medication (also, there is NOT an issue with ipratropium via HFN for patients with a soy or peanut allergy -- that was the propellant in the older version of the MDI).

For adults, typically 2mg per HFN; frequently given as part of DuoNeb or Combivent (both are albuterol and ipratropium combined).

Dry mouth

Patients take prescription albuterol be either MDI or HFN under the trade name Atrovent; most prehospital services deliver ipratropium via HFN.

Preloaded vial with twist-off top for easy and rapid distribution into the HFN chamber; some services may carry a multi-dose vial with an eye dropper for mixing with small saline packets in the HFN; again, commonly given prehospital as part of the albuterol-ipratropium combination (Combivent, DuoNeb).

Calcium supplement.

hypocalcemia, hyperkalemia, hypermagnesemia, calcium channel blocker overdose, beta blockeroverdose

Known or suspected digitalis toxicity—-contact medical control.

500 to 2000 mg over 5-10 minutes.  Dosing varies by use and by specific service protocol.  Online medical control is ALWAYS a good idea when using this medication.

Avoid administration in uncertain or fragile veins (hand, foot) and watch closely for infiltration due to severe tissue damage possibility

Hypotension and bradycardia (particularly with rapid administration).

IV very slow push.

100 mg / ml in a 10 cc preloaded syringe.

Elevate blood glucose.

Hypoglycemia.

No absolute contraindications although USE CAUTION in cases with uncertain IV quality as D50 is tissue destructive if it infiltrates (if this happens, discontinue any infusion but leave the IV catheter in place for ED management of the extravasation).

25 grams slow IV over 2-3 minutes  (diluted to Dextrose 25% in infants and children in most cases—-consult Broselow or equivalent)

None (other than hyperglycemia)

IV slow push

25 gram preloaded (50cc) syringe

When insulin is used to treat hyperkalemia, D50 is given to counteract the hypoglycemic effect of the insulin.

Benzodiazepine

seizure control, sedation

None in the field setting other than to be aware of the likely respiratory depression in higher doses.

5 mg IV given over 1 minute; may repeat in 5 minutes or per protocol / online medical control

Respiratory depression

IV slow push (5 mg per minute)

5 mg / ml in a 2 cc carpule

Valium

benzodiazepine antagonist

Reduction in benzodiazepine effects from field sedation

Seizure patients and patients with benzodiazepine dependence (precipitates withdrawal which can include seizures that could not be treated with benzodiazepines)

For reversal of benzodiazepines given for sedation:  0.2 mg IVP over 15-30  seconds;  repeat in 1 minute up to 3.0 mg total  (some protocols, like BHC, allow for increasing the dosage on the 2nd dose to 0.3mg and subsequent doses to 0.5mg).  ANY time this medication is given, online medical control contact is prudent.

May precipitate benzodiazepine withdrawal and cause seizures.

IV slow push

0.5 mg in a 5ml  multi-dose vial.

Romazicon

Elevate blood glucose.

Hypoglycemia.

Pheochromocytoma (adrenal tumor that secretes catecholamines such as adrenaline).

1mg IM

None for IM use.

IM

2-part vial system for reconstituting or "emergency kit” containing a pre-filled syringe with sterile water.

For calcium-channel blocker and beta blocker overdose to mediate the myocardial depression (negative inotropic effects) of the beta blockers because glucagon causes an increase in calcium availability for myocardial contraction and thereby increases contractility by a mechanism other than beta 1 stimulation (the doses for this treatment are much higher and most EMS services won’t carry enough glucagon for this therapy…..also, beware of vomiting with high doses of IV glucagon and pretreat with ondansetron).

Benzodiazepine.

Seizure control, sedation.

None for the field use although caution in respiratory depression.

1-4 mg (varies by protocol and physician).

Respiratory depression.

IV slow push 2 mg / minute (maximum rate).

2 mg / ml or 4 mg / ml carpules or multi-dose vials.

Ativan

Benzodiazepine.

Seizure control, sedation

None for its intended use although caution with respiratory depression

For IV dosing, use 2.5 mg given over 2 minutes repeated once after a 2-minute waiting period for a total of 5 mg—-however, online medical control contact is advisable when using this drug and orders may vary.

Respiratory depression.

IV slow push (2.5 mg over 2 minutes)

Both 1 mg / ml in a 2 cc multi-dose vial and 5 mg / ml in a 2 cc multi-dose vial are commonly found in the field setting.

Versed

Opiate antagonist.

Reduction of effects of opiates / opioids such as heroin, morphine etc.

Relatively few in the field setting.

Titrated to improve respiratory effort (as opposed to full reversal of all effects) which usually is best achieved with small incremental doses such as 0.4 or 0.5 mg repeated as needed every 2-3 minutes  (be aware that some sources suggest 0.05 mg increments).

None pertinent.

IV slow push.

2 mg / 2 cc preload.

Narcan

Elevate blood glucose.

Hypoglycemia in patients who can swallow and who can maintain their airway.

None.

1 tube with repeated doses as needed after 15-20 minutes.

None (other than hyperglycemia).

Buccally (between cheek and gum)

30-112 gram tube (various flavors and various vendors)

Vitamin B1

Correct thiamine deficiency (malnourished, chronic alcohol use) to prevent Korsakoff syndrome or to prevent / partially treat Wernicke’s encephalopathy

None.

100 mg IV (or IM)

None.

IV slow push.

100 mg / ml multi-dose vial.

Beta blocker and alpha blocker.

Reduction in blood pressure via reduced chronotropy and inotropy and blockade of alpha receptor induced vasoconstriction.

Asthma / COPD (bronchial constriction) and bradycardia / AV Block as well as hypertension from amphetamine ingestion.

20 mg IV over 1-2 minutes in 5 mg increments.

Bronchospasm, bradycardia.

IV slow push.

5 mg / ml multi-dose vial.

Could be an adjunct in tachycardia although other beta blockers are more cardioselective.

Normodyne, Trandate