Drug File

• Sympathomimetic Bronchodilator
• Proventil, Ventolin

Bronchodilator causing reduced mucus secretion, pulmonary capillary leaking & edema in lungs

• Bronchospasm
• Asthma in COPD

none

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

2.5-3 mg in 2.5 mL NS via Neb

• Narcotic Analgesic
• Sublimaze

• Synthetic Narcotic Analgesic
• Rapid onset, short acting

Sedation for intubation

• MAO inhibitors
• Myasthenia Gravis

• ^ ICP
• Elderly
• Debilitated pts
• COPD
• Resp Probs
• Hepatic & Renal Insufficiency

25-100 mcg over 2-3 mins IV

• Anticholinergic
• Atrovent

Bronchodilator that dries resp tract secretions by blocking ACH receptors

• Asthma
• COPD
• Inhaled Irritants

• Hypersensativity to atropine or its derivatives
• As primary treatment

• Elderly
• Cardiovascular Disease
• HTN

500 mcg in 2.5-3 mL NS via Neb

• Narcotic Analgesic, PROTOTYPE OPIATE
• Morphine

Analgesic & sedative causing some vasodilation, reducing venous return, reduced myocardial O2 demand

• Pain
• MI
• Reduce venous return in pulmonary edema

• Head or Abd inj
• Hypotension/volume depletion
• Acute Bronchial Asthma
• COPD
• Resp Depression
• Pulmonary edema fr chem inhal

• Elderly
• Children
• Debilitated
• Keep Narcan available

• Pain 2.5-15 mg IV: 5-20 mg IM/Sub Q
• AMI or PE 1-2 mg/ 6-10 mins to response

• Narcotic Antagonist
• Narcan

• Narcotic antagonist
• Blocks Natl & Syn Narcotics
• May reverse resp depression

• Narcotic OD
• Resp depression of unknown origin

Non Narc induced resp depression

• Dependancy
• Short half life so OD state may return

0.4-2 mg IV/IM repeated 2-3 mins as needed up to 10mg

• Banzodiazapine
• Valium

Sedative, skeletal muscle relaxant

• Motor Seizures
• Status Epilepticus
• Premed for painful procedures
• Muscle tremors fr inj
• Acute anxiety

• Shock
• Coma
• Acute Alcoholism
• Depressed vital signs
• OB pts
• Neonates

• Psychosis
• Depression
• Myasthenia Gravis
• Short Half life causing seizure to return

• Seizure-- 5-10 mg IV/IM
• Anxiety-- 2-5 mg IV/IM
• Premed-- 5-15 mg IV

• Hypnotic
• Amidate

Ultra short acting nonbarbituate hypnotic

Sedation for RSI

None

• Hypotension
• Asthma
• Cardiovascular Disease

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

• Benzo Antagonist
• Romazicon

Reverses sedative, recall & psychomotor effects of benzos

Resp Depress secondary to benzos

• Pts currently taking for seizures or status epilepticus
• Seizure prone pts during labor & delivery
• Tricyclic antidepressant OD

• Hepatic Impairment
• Elderly
• Pregnancy
• Nursing Mothers
• Head inj
• Alcohol/drug dependancy
• Phys Dependancy on Benzos

0.2mg IV over 30-60 secs to 1 mg

• Benzodiazepine/ sedative
• Versed

Short-acting benzo w/ CNS depressant, muscle relaxant, anticonvulsant, anterograde amnestic effects

Sedation b/f cardioversion or intubation

• Narrow angle glaucoma
• Shock
• Coma
• Alcohol Intoxication

• COPD
• Renal Impairment
• CHF
• Elderly

• 1-2mg slow IV
• 0.07-0.08 mg/kg IM

• Depolarizing Neuromuscular Blocker
• Anectine

Short acting depolarizing muscular blocker

ET intubation

• Hx of malignant hyperthermia
• Penetrating eye inj
• Narrow angle glaucoma

• Burn or Crush inj
• Spinal cord inj

1-1.5 mg/kg IV/IM

• Antidysrhythmic
• Adenocard

• Chemical cardioverter PSVT --> Normal Sinus
• Half life of 10 sec
• Doesnt cause hypotension

SVT refractory to vagal maneuvers

• 2nd & 3rd degree heart block
• Sinus node disease
• Asthma

• May cause transient dysrhythmias especially in asystole
• COPD

• 1. 6 mg rapidly IV w/ NS flush
• 2. 12 mg in 1-2 min, may be repeated

• Parasympatholytic
• Atropine

• Blocks vagal effects on HR
• ^ myocardial O2 demand
• Decrease airway secretions

• Hemodynamically significant Bradycardia
• Bradyasystolic Arrest
• Organophosphate Poisoning

None in EMS setting

• AMI
• Glaucoma

• Symptomatic Bradycardia--0.5mg IV/1mg ET 3-5 mins to 3 mg
• Asystole--1mg IV/ 2mg ET 3-5 min to 3 mg
• Poisoning--2-5 mg IV/IM/IO to 15 min

• Sympathomimetic
• Adrenalin

• Catecholamine
• ^ tropic properties, systemic vascular resistance, systolic BP, vital capacity, tidal vol
• May reduce pulmonary congestion
• Decreases airway resistance & automaticity

• Cardiac arrest
• Severe allergic reactions

• Narrow Angle Glaucoma
• Hemmoragic, Traumatic or Cardiac shock
• Labor

none

• Arrest-- 1mg 1:10 IV 3-5 mins (ET 2-2.5 1:1) NO MAX
• Allergy-- 0.3-0.5 mg 1:1 sub q 5-15 min as needed 0.5-1 1:10 IV if sub q ineffective

• Hormone/Vasopressor
• Pitressin

Hormone w/ strong vasopressive & antidiuretic properties but that may precipitate angina or AMI

• ^ peripheral resistance in arrest
• Esophageal Varices

• PVCs
• 1st stage of labor

• Epilepsy
• Migraine
• Heart failure
• Angina
• Vascular Disease
• Hepatic impairment
• Elderly
• Children

• Arrest-- 40 units IV
• Varices-- 0.2-0.4 units/min drip

• Acetylsalicylic Acid-- analgesic, antipyretic, Platelet Inhibitor, Antiinflammatory
• Alka-saltzer, Bayer, Empirin, St Joseph's Childrens

• Inhibits agents that cause inflammation, pain & fever
• Relieves pain by acting on the PNS
• Lowers body Temp
• Powerfully inhibits platelet aggregation

Chest pain suggestive of MI

• Active Ulcer Disease
• Asthma

Bleeding disorders

160-325 mg PO

• Carbohydrate
• D50W

Simple sugar body can rapidly metabolize

Hypoglycemia

None in hypoglycemia

• ^ ICP
• Chk sugar b/f administering
• Ensure good IV

25g in 50mL IV

• Diuretic
• Lasix

• Rapid acting potent diuretic & antihypertensive
• Inhibits Na reabsorption by kidneys
• Reduces venous return & cardiac workload

• CHF
• Pulmonary Edema

• Fluid & electrolyte depleted states
• Hepatic coma
• Pregnancy

• Infants
• Elderly
• Hepatic Impairment
• Nephrotic Syndrome
• Cardiogenic Shock assoc w/ MI
• Gout
• Pts receiving digitalis
• K depleting steroids

40-120 mg slow IV

• Nitrate
• Nitrostat

• Rapid smooth muscle relaxant
• Reduces peripheral vascular resistance, BP, Venous Return, Cardiac Workload

• Chest Pain assoc w/ angina or AMI
• Acute pulmonary edema

• Tolerance to nitrates
• Severe Anemia
• Head trauma
• Hypotension
• ^ ICP
• Pts taking sildenafil
• Glaucoma
• Shock

• May cause headache
• Light sensitive losing potency

• 0.4mg SL 3-5 mins up to 3
• 1/2" topical ointment
• 0.4 mg spray SL

• Sympathomimetic
• Dobutrex

Catecholamine / Beta agent that ^ inotropy w/o affecting chronotropy

^ cardiac output in CHF/cardiogenic shock

• V-Tach
• Hypovolemia w/o fluid resuscitation

• A-Fib
• Preexisting HTN

2-20 mcg/kg/min IV

• Sympathomimetic
• Inotropin

• Natl catecholamine ^ cardiac output w/o ^ myocardial O2 consumption
• Maintains renal & mesenteric blood flow while inducing vasoconstriction & ^ systolic BP

• Nonhypovolemic hypotension
• Cardiogenic shock

• Tachydysrhythmias
• V-Fib
• Pheochromocytoma

Ensure adequate fluid resuscitation of the hypovolemic pt

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

• Sympathomimetic
• Isuprel

Synthetic sympathomimetic resulting in ^ cardiac output by increasing inotropy & chronotropy

Bradycardia refractory to atropine when pacing is not available

Cardiogenic Shock

Tachydysrhythmias & those associated w/digitalis & AMI

Bradycardia-- 2-10 mcg/min titrated to cardiac rate

• Antidysrhythmic
• Cordarone, Pacerone

• Prolongs duration or action potential & refractory periods
• Relaxes smooth muscles
• Reduces peripheral vascular resistence
• Increases coronary blood flow

• Life threatening ventricular & superventricular dysrhythmias
• Frequently A-Fib

• Cardiogenic Shock
• Severe sinus bradycardia
• Advanced heart block

None

150-300 mg IV over 10 mins then 1 mg/min for 6 hrs

• Antidysrhythmic
• Bretylol

Supresses V-tach dysrhythmias including V-Fib w/ reentry mechanisms

V-Fib & V-Tach refractory to Lidocaine

None

• Digitalized Pts
• Digitalis-induced dysrhythmias

5 mg/kg IV then 10 mg/kg / 15-30 mins to max of 30 mg/kg

• Antidysrhythmic
• Xylocaine

• Antidysrhythmic that suppresses automaticity & raises stimulation threshold of ventricles
• Causes sedation, anticonvulsant & analgesic effects

• Pulseless V-Tach
• V-Fib
• V-Tach w/pulse

• Supraventricular Dysrhythmias
• Stokes-Adams Syndrome
• 2nd & 3rd degree heart block
• Bradycardias

• Hepatic or renal Impairment
• CHF
• Hypoxia
• Resp Depression
• Hypovolemia
• Myasthenia Gravis
• Shock
• Elderly

• Cardiac Arrest-- 1-1.5 mg/kg IV repeated 3-5 mins up to 3 mg/kg. Follow w/ drip of 2-4 mg/min
• V-Tach w/pulse-- 1-1.5mg/kg slow IV-> 1/2 dose 5-10 mins up to 3mg/kg till conversion -> infusion of 2-4 mg/min

• Antiarrhythmic
• Pronestyl

• Prolongs ventricular repolarization
• Slows Dromotropy
• Decreases myocardial excitability

• V-Fib
• Pulseless V-Tach refractory to Lidocaine

• Myasthenia Gravis
• 2nd or 3rd degree heart block

• Hypotension
• Cardiac Enlargement
• CHF
• AMI
• Ventricular dysrhythmias fr digitalis
• Hepatic or renal impairment
• Bronchial Asthma

• 20-30 mg/min IV drip
• Stop points-- (1) up to 17 mg/kg to effect -> 1-4 mg/min (2) Ectopy Resolves (3) QRS complex widens more than 50% then original (4) Hypotension ensues

• CCB
• Cardizem

• Dilates coronary & peripheral arteries & arterioles ^ circulation to the heart & reducing peripheral vascular resistance
• CCB similar to Verapamil

• A-fib
• Atrial flutter
• PSVT refrac to adenosine
• ^ coronary artery perfusion in Angina

• Sick Sinus Syndrome
• 2nd & 3rd degree heart block
• Systolic BP < 90
• Diastolic BP < 60
• Wide complex tachycardia

0.25 mg/kg IV over 2 mins, repeat as needed w/0.35 mg/kg followed by drip of 5-10 mg/hr not exceeding 15 mg/hr over 24 hrs

CHF w/ Beta blockers

• Vasodilator/Nitrate
• Nitroglycerin Injection

Relaxes blood vessels ^ blood & O2 supply to heart

• Pain Associated w/ angina that doesnt respond to oral treatment
• Ctrl BP
• Help treat CHF

• Hypotension
• Uncorrected Hypovolemia
• ^ ICP
• Constrictive Pericarditis
• Pericardial Tamponade

• Headache
• Severe Hypotension
• Reflex Tachycardia

0.2-1.5 mcg/kg/min

• CCB
• Isoptin, Calan

• CCB slowing AV conduction
• Supresses reentry dysrhythmias
• Slows ventricular responses to atrial tachydysrhythmias
• Dilates coronary arteries & reduces myocardial O2

• PSVT refrac to adenosine
• Atrial Flutter
• A-Fib w/ rapid ventricular response

• Severe Hypotension
• Cardiogenic Shock
• 2nd & 3rd Degree Heart Block
• CHF
• Sinus Node Disease
• WPW Disease
• Should not be given to those on Beta Blockers

None

2.5-5mg IV bolus over 2-3 mins then 5-10mg aft 15-30 min max

• Electrolyte
• Calcium Chloride

Increases myocardial contractile force & automaticity

• Hypercalemia
• Hypercalcemia
• Hypermagnesemia
• CCB toxicity

• V-Fib
• Hypercalcemia
• Digitalis toxicity

• May precipitate toxicity in pts taking digoxin
• Ensure IV is in lg vein & flushed b/f using & aft calcium

2-4 mg/kg IV / 10 mins as needed

• Corticosteroid/ Antiiflammatory
• Solu-medrol

• Synthetic adrenal corticosteroid used for inflammation, mgmt of allergic reactions & in some cases shock
• Sometimes used for treatment of spinal cord inj

• Spinal Cord Inj
• Asthma
• Severe Anaphylaxis
• COPD

None in emergency setting

Only a single dose should be given in prehospital setting

• Asthma/COPD/Anaphylaxis -- 125-250 mg IV/IM
• Spinal Cord Inj -- 30 mg/kg IV over 15 min, aft 45min an infusion of 5.4 mg/kg/hr

• Electrolyte
• Magnesium

• Electrolyte acts as CCB, CNS depressant & anticonvulsant
• Depresses function of smooth, skeletal & cardiac muscles

• Refractory V-Fib & pulseless V-Tach
• AMI
• Eclamptic Seizures

• Heartblock
• Myocardial Damage
• Shock
• Persistent Hypertension
• Hypocalcemia

• Other CNS depressants
• Neuromuscular blocking agents

• V-Fib/Tach -- 1-2 g IV over 2 mins
• Torsade de pointes -- 1-2 g IV followed by infusion of 0.5-1 g/hr IV
• AMI -- 1-2 g IV over 5-30 mins
• Eclampsia -- 2-4g IV/IM
• Asthma -- 1-2 g IV drip

• Anticonvulsant
• Dilantin

• Related to phenobarbital that reduces spread of elec discharges in motor cortex & inhibits seizures
• Antidysrhythmic props counter effects of digitalis

• Seizures
• Status Epilepticus
• Cardiac dysrhythmias secondary to digitalis toxicity

• Sinus Bradycardia
• Heart Block
• Adams-Stokes syndrome

None

• Seizure/Status Epilepticus -- 10-15 mg/kg slow IV
• Dysrhythmia -- 100 mg slow IV (over 5 min) to a max of 1000 mg

• Alkalizing Agent
• NaHCO3

• Provides vascular bicarbonate to assist buffer sys in reducing effects of metabolic acidosis
• Treatment of some ODs

• Tricyclic Antidepressant & Barbituate OD
• Refractory Acidosis
• Hypercalemia

None when used in severe hypoxia or late cardiac arrest

May precipitate w/ calcium chloride

1 mEq/kg IV, then 0.5 mEq/kg/10 min

• Antihistamine
• Benadryl

Blocks histamine release reducing bronchoconstriction, vasodilation & edema

• Anaphylaxis
• Allergic Reactions
• Dystonic Reactions

• Asthma
• Lower resp disease

• Hypotension
• Headache
• Palpitations
• Tachycardia
• Sedation
• Drowsiness
• Disturbed Coordination

25-50 mg IV/IM

• Adsorbent
• Actidose

Prepared charcoal that activates & binds toxin fr GI tract

Acute Ingested Poisoning

• Compromised airway
• cyanide ingestion
• Mineral Acids
• Caustic Alkalis
• Organic Solvents
• Iron
• Ethanol
• Methanol

• Hepatic Disease
• Children under 12 w/ arthritic conds.
• Alcoholism
• Malnutrition
• Thrombocytopenia

• 325-650 mg PO/ 4-6 hrs
• 650mg PR/4-6 hrs

• Sedative
• Ativan

• MOST POTENT BENZO AVAIL.
• Strong antianxiety, sedative, hypnotic & skeletal muscle relaxant props
• Relatively short half life

• Sedation for cardioversion
• Status Epilepticus

Sensitivity to benzos

• Narrow angle glaucoma
• Depression or psychosis
• Coma
• Shock
• Acute Alcohol Intox
• Renal or Hepatic Impairment
• Organic brain syndrome
• Myasthenia Gravis
• GI disorders
• Elderly
• Debilitated
• Limited Pulmonary reserve

• Sedation -- 2-4 mg IM, 0.5-2mg IV
• Status Epilepticus -- 2 mg slow IV/PR (2 mg/min)

• Antiemetic
• Reglan

• Dopamine antagonist similar to procainamide but w/ few antidysrhythmic or anesthetic props
• Antiemetic props fr gastric emptying & desensitization of vomiting reflex

• Nausea
• Vomiting

• Allergy to sulfite agents
• Seizure Disorders
• Pheochromocytoma
• Mechanical GI obstruction
• Breast Cancer

• CHF
• Hypokalemia
• Renel Impairment
• GI hemorrhage
• Intermittent porphyria

10-20 mg IM; 10 mg slow IV (over 1-2 mins)

• Antiemetic
• Ondansetron

Selective blocking agent of serotonin 5-HT3 receptor type

Nausea & intractible vomiting

None

May mask progressive ileus &/or gastric distension

Single 24 mg tab ODT, 4 mg undiluted over @ least 30 secs

• Sedative/ Hypnotic
• Librium

BENZO DERIVATIVE producing mild sedation & anticonvulsant, skeletal muscle relaxant, prolonged hypnotic effects

• Severe anxiety & tension
• Acute alcohol WD symptoms (DTs)

• Pregnant & nursing Mothers
• Children under 6

• Primary depressive disorders or pyschosis
• Acute alcohol intox

50-100 mg IV/IM

• Snythetic Narcotic Analgesic
• Stadol

• Centrally acting synthetic narcotic analgesic
• 5x more potent than morphine
• Schedule IV Narc

Pain

• Head Inj
• Undiagnosed Abd pain

none

1 mg IV or 3-4 mg IM

• Narcotic Analgesic
• Demerol

Synthetic Narcotic w/ sedative & analgesic props comparable to morphine but w/o hemodynamic side effects

Pain

• Seizure Disorders
• Acute abd prior to diagnosis

• ^ ICP
• Asthma or resp conds
• Superventricular Tachycardias
• Prostatic Hypertrophy
• Urethral Stricture
• Glaucoma
• Elderly or Debilitated pts
• Renal or Hepatic Impairment
• Hyperthyroidism
• Addisons Disease

• 25-50mg IV
• 50-100 mg IM

• Narcotic Analgesic
• Nubain

Equivalent to morphine w/o ^ resp depression w/ higher doses

Pain

Undiagnosed Head or abd inj

none

5 mg IV/IM/sub q repeat 2mg dose as needed to 20 mg

• Nondepolarizing Neuromuscular Blocker
• Pavulon

Nondepolarizing neuromuscular blocker causing paralysis w/o bronchospasm or hypotension

ET intubation

Tachycardia

none

0.04-0.1 mg/kg IV

• Nondepolarizing Skeletal Muscle Relaxant
• Norcuron

Nondepolarizing Neuromuscular blocker w/ minimal cardiovascular effects

ET intubation

none

• Severe obesity
• Myasthenia Gravis

0.08-0.1 mg/kg IV

• Tranquilizer/Antipsychotic
• Thorazine

• Acute Psychotic Episode
• Intractable hiccups
• Nausea/Vomiting

• Antipsychotic
• Haldol

Acute Psychotic Episodes

• Parkinson's
• Seizure Disorders
• Coma
• Alcohol Depression
• CNS depression
• Thyrotoxicosis

Anticonvulsant, Anticoagulant or Lithium Therapy

2-5 mg IM

• Antiemetic
• Phenergan

• Nausea & Vomiting
• Motion Sickness
• Enhance effects of analgesics
• Induce Sedation

• Methylxanthine Bronchodilator
• Aminophyline/Somophyllin

• Bronchospasm in asthma
• COPD refractory to sympathomimetics
• CHF

Uncontrolled cardiac dysrhythmias

• Sympathetic agonist
• Brethine/ Bricanyl

Synthetic sympathomimetic causing bronchodilation w/ less cardiac effect than epi

• Bronchial asthma
• Bronchospasm in COPD

• Thrombolytic
• Activase

• AMI
• Acute Ischemic Stroke
• Pulmonary Embolism

• Internal Bleeding
• Suspected Aortic Disection
• Traumatic CPR
• Hemmorhagic Stroke
• Intercranial/Intraspinal Trauma
• Pregnancy
• Uncontrolled Hypertension

• Recent Major Surgery
• Cerebral Vascular Disease
• Recent GI/GU Bleed
• Recent Trauma
• HTN
• Pt >75
• Hemmorhagic Opthalmic Cond

• MI/Stroke--15 mg/IV ->0.75 mg/kg (up to 50) over 30 mins -> 0.5 mg/kg (up to 35 mg) over 60 mins
• Pulmonary Embolism--100 mg IV over 2 hrs

• Anticoagulant
• Heparin

Prevent thrombus formation in AMI

• Rapid onset anticoagulant.
• Enhances effects of Antithrombin III
• Blocks conversion of Prothrombin -> Thrombin & Fibrinogen -> Fibrin

Beta Blocker

Non selective beta adrenergic receptor blocking agent

• HTN
• MI
• Elevated Ocular Pressure

• Asthma
• Severe COPD
• Sinus Brady
• 2nd & 3rd degree AV block
• Cardiogenic Shock

Readily Absorbed

One drop/eye BID

• Sympathomimetic Agent
• Levophed

• Naturally occurring catecholamine
• Causes vasoconstriction, cardiac stimulation, ^ BP, ^ myocardial O2 demand, ^ coronary blood flow

• Refractory Hypotension
• Neurogenic Shock

Hypotension due to uncorrected Hypovolemia

May cause Necrosis

• Steroid
• Decadron

Long-acting adrenocorticoid w/intense anti-inflammatory activity

• Anaphylaxis
• Asthma
• COPD
• Spinal Cord Edema

None in emergency setting

• Nonsteroidal Anti-inflammatory (NSAID)
• Torado

Injectable NSAID that exhibits analgesic, anti-inflammatory, & antipyretic properties w/o sedative effects

Mild or moderate pain

• Osmotic Diuretic
• Osmitrol

Osmotic diuretic that draws water into the intravascular space through its hypertonic effects, then causes diuresis

Cerebral edema

• Hormone, Antihypoglycemic
• GlucaGen

Protein secreted by pancreatic cells that causes a breakdown of stored glycogen into glucose

• Hypoglycemia w/o IV access
• Reverse beta blocker OD

Only effective if there is sufficient stores of glycogen in the liver

• Hypoglycemia = 1 mg IM/SC repeat 5-20 mins
• Beta Blocker OD = 50-150 mcg/kg IV over 1 min