Drug Cards

PHARMACOLOGY AND ACTIONS

• Acetaminophen is a synthetic
• non-opiate derivative of p-aminophenol which produces analgesia and
• antipyresis. Acetaminophen is rapidly
• and almost completely absorbed from the GI tract. Following administration of acetaminophen,
• peak plasma concentrations are attained within 10-60 minutes.

• Therapeutic doses of
• acetaminophen appear to have little effect on cardiovascular and respiratory
• systems. Toxic doses may cause
• circulatory failure and rapid, shallow breathing.

INDICATIONS

• Acetaminophen is used
• frequently to lower body temperature in pediatric febrile patients in whom
• fever may be deleterious or in whom considerable relief is obtained when fever
• is lowered.

PRECAUTIONS

• A. Acetaminophen is relatively nontoxic in
• therapeutic does.

• B. Acetaminophen should be used with caution in
• patients with preexisting anemia.

• C.
• Repeated administration of acetaminophen is contraindicated in patients
• with anemia or cardiac, pulmonary, renal, or hepatic disease.

ADMINISTRATION

• General dose is 10 mg/kg. Pediatric patients over the age of 1yrs may
• receive 120 mg rectal suppository.

PHARMACOLOGY AND ACTIONS

• Adsorbs toxic substances
• ingested, and inhibits gastrointestinal absorption by forming an effective barrier
• between remaining particulate material and the gastrointestinal mucosa.

INDICATIONS

• Effective in
• the management of poisoning or overdose of many substances.

PRECAUTIONS

• A. May not be given to patients
• who are unconscious or with diminishing level of consciousness.

• B. May be ineffective in
• ingestion such as mineral acids, alkalis, petroleum products or cyanide.

• C. Never give simultaneously
• with Ipecac - may prevent emesis.

• D.
• May result in aspiration or
• significant particulate obstruction of the airway.

ADMINISTRATION

• A. 1gm/kg. of Activated
• Charcoal. If administered, an
• aqueous-based solution must be used. Dosage may be higher as directed by a
• physician.

• B.
• Consider administration per
• nasogastric tube if patient refuses oral ingestion.

PHARMACOLOGY AND ACTIONS

• 1. Adenosine is a naturally occurring
• nucleoside.

• 2. Acts on AV node to slow
• conduction and inhibit reentry pathways.
• Half life of 10 seconds. Onset
• immediate.

INDICATIONS

• To convert paroxysmal supraventricular
• tachycardia into sinus rhythm.

CONTRAINDICATIONS

1. 2nd and 3rd degree heart block

2. Sick Sinus Syndrome

3. Ventricular tachycardia

4. Known Atrial Fib./Flutter

• 5. Patients taking Tegretol
• (carbamazepine)

• 6. Denervated heart (heart
• transplant)

PRECAUTIONS

• 1. Patients may develop a transient heart block, other transient
• dysrythmias, or asystole.

• 2. Chest pain, dizziness, blurred vision; low BP, backache, headache,
• heaviness in arms, etc. are all possible side effects.

ADMINISTRATION

• 1. IV
• should be started in AC region of arm or higher. Fluid should be Normal Saline for rapid bolus
• after administration.

• 2. 6mg
• very rapid I.V. push, if not effective in 1-2 minutes, give 12 mg very rapid
• I.V. push ASAP. May repeat 12mg dose
• once if first two doses (18mgs) is unsuccessful. When 12mg used, both unit doses (6mg) must be
• mixed together, then flushed.

PHARMACOLOGY AND ACTIONS:

• Aqueous solution
• administered by oral inhalation with the aid of hand-held nebulizer
• system. It is a very selective Beta-2
• agonist with very little Beta-1 stimulation.
• Onset of action is 5-15 minutes.
• Duration of action is 4-6 hrs.
• Primary effect is to relax bronchial smooth muscles with resultant
• relief of bronchospasm.

INDICATIONS:

1. Acute asthma.

• 2. Reversible
• bronchospasm associated with obstructive airway disease, bronchitis or mild
• CHF.

PRECAUTIONS:

• 1. As with
• other adrenergic aerosols, the potential for paradoxical bronchospasm exists.

• 2. Use with
• caution for patients being treated with monoamine oxidase inhibitors (i.e.
• Elavil, Sinequan) since the action of albuterol may be potentiated on the
• vascular system.

• 3. Use with
• caution for patients with history of HTN, coronary artery disease, CHF or MI.

• 4. Do not use
• in patients exhibiting signs of acute CHF, MI or cardiac arrythmia without
• consult from medical control.

• 5. Use with
• caution in Pregnancy.

DOSAGE:

• 1. Use one 3cc
• ampule containing 2.5mg of albuterol.
• Administer by nebulizer. If
• patient is intubated, double the dose and give ET (non nebulized).

• 2. Use this dosage for adults
• and children over age of 12.

• 3. For under age 12 dosage per
• medical control.

WEIGHT ALBUTEROL DOSE SALINE DILUTION

• <15 kg 1cc
• (.83 mg) 2
• cc

• 15-25 kg 2cc
• (1.66 mg) 1
• cc

• >25 kg 3cc
• (2.5 mg) 0
• cc

• * Total solution in nebulizer should be 3.0
• cc.

ADMINISTRATION:

• 1. Via nebulization with mouthpiece or aerosol
• mask.

2. Oxygen source at 8 liters per min.

• 3. Have patient inhale slowly
• and exhale passively through the nose.

• 4. On every 4th breath, inhale
• deeply and pause 1-2 seconds before exhaling (may improve the anxious dyspneic
• patient and drug absorption).

ADVERSE REACTIONS:

Tremor is most common. Also palpitations, tachycardia, nervousness,

• dizziness, hypertension, nausea, vomiting, angina,
• headache, and

drying of the oropharynx.

PHARMACOLOGY AND ACTIONS:

• 1. Prolongation of myocardial
• cell action potential.

• 2. Alpha and beta sympathetic
• blocking effect.

• 3. Reduction of Sinoatrial Node
• automaticity.

• 4. Exhibits Calcium Channel
• blocking effect.

INDICATIONS:

• 1. Ventricular Fibrillation/
• Pulseless Ventricular Tachycardia

2. Wide Complex Tachycardia

3. Narrow Complex Tachycardia



CONTRAINDICATIONS:

1. Bradycardia

• 2. Second or Third degree Heart
• Block

3. Hypotension

4. Known Hypersensitivity



PRECAUTIONS:

• 1. Observe for hypotension and
• bradycardia. Treatment should include
• fluid bolus and consider pressor agents.

• 2. Administer cautiously in
• patients with congestive heart failure or known low ejection fraction.

• 3. Do not administer with Sodium
• Bicarbonate; a precipitate will form in the IV line.

• ADMINISTRATION:
• 1.
• Ventricular Fibrillation/Pulseless Ventricular Tachycardia:

• 300mg IVP, may
• repeat in 3-5 minutes with 150mg IVP.
• Do not administer over 2.2grams IV in 24 hours.
• PEDIATRIC – 5mg/kg
• IVP/IO

• 2.
• Narrow and Wide Complex Tachycardia:

• 150mg slow IVP
• over 10 minutes. May repeat
• 150mg slow IVP once or for maintenance if rhythm converts.

• Supplied
• in 150mg pre-loaded syringe; add 150-300mg of amiodarone to 100ml NaCl bag
• and run wide-open through a macrodrip.
• Ensure all air/foam remains at top of fluid bag.

PHARMACOLOGY AND ACTIONS

• Cefazolin is a first generation semi-synthetic
• cephalosporin antibiotic. It works well
• against many gram positive cocci but has limited activity against gram-negative
• bacteria.

INDICATIONS



For infection prophylaxis.



CONTRAINDICATIONS

• 1. Allergies
• to cephalosporins.

• 2. Use with
• caution with known allergies to penicillin.

ADMINISTRATION



1. Adult:1gm may be given IV over 3-5 minutes.

• 2. For IV dilute powder with 2.5cc of saline and
• shake or roll vial until completely dissolved.
• Then withdraw the contents of the vial into a 10cc syringe and dilute
• further with saline to a total volume of 10cc.
• Concentration shall be 100 mg/ml. Slowly push over 3-5 minutes.

• 1. Cefazolin may be diluted, as
• above, with 2-5cc of normal saline for deep IM administration.

• 2. Pediatric: 15mg/kg given IV
• over 3-5 minutes. IM administration may
• have to be divided and given in two sites because of volume.

PHARMACOLOGY AND ACTIONS:

• 1. Aspirin exhibits analgesic,
• anti-inflammatory, and antipyretic activity.
• It also increases bleeding time.

INDICATIONS

• 1. Aspirin
• may be used to reduce the risk of death and/or nonfatal myocardial infarction in
• patients with unstable angina.

• 2. Aspirin
• should be given when a high suspicion exists for chest pain related to a
• myocardial event.

CONTRAINDICATIONS

• 1. Patients with bleeding
• disorders such as hemophilia, von Willebrand's disease, or telangiectasia.

• 2. Active GI lesions (e.g.,
• erosive gastritis, peptic ulcers).

3. GI bleeding.

4. Epistaxis





PRECAUTIONS

1. Impaired renal function.

• 2. Patients should be informed
• that alcohol has a synergistic effect with aspirin in causing GI bleeding.

3. Cerebrovascular Disease.





ADMINISTRATION

Give four 81.0 mg.(total dose 324mg)chewable tablets.

PHARMACOLOGY AND ACTIONS:

• Atropine Sulfate is a
• muscarinic-cholinergic blocking agent.
• As such, it has the following effects:

• 1. Increases the heart rate by blocking vagal
• influences.

2. Increases conduction through AV node.

• 3. Reduces motility and tone of gastrointestinal
• tract.

4. Reduces action and tone of urinary bladder.

5. Dilates pupils





INDICATIONS:

• 1. To
• increase the heart rate in bradycardias.

• 2. To improve
• conduction in 2nd and 3rd degree heart block.

• 3. As an
• antidote for some insecticide exposures (anticholinesterases, i.e.,
• organophosphates) and nerve gas.

• 4. To
• counteract excessive vagal influences responsible for some bradysystolic and
• asystolic arrests.

PRECAUTIONS:

• 1. Use with
• caution in atrial fibrillation and atrial flutter because increased conduction
• will speed ventricular rate
• excessively.

• 2. Use with
• caution in the Myocardial infarcted patient.

ADMINISTRATION:

• 1. Adult: 0.5-1.0 mg IV/IO, repeated if needed at 3-5
• min. intervals to a total dose of 2-3 mg

• (0.04 mg/kg) or when
• ventricular rate is 60 or better/min.

2. Pediatric: 0.02 mg/kg IV/IO/ET. Minimum dose is 0.1mg.

• 3.
• Organophosphate Overdose: 1.0-2.0 mg IV/IO every 5 minutes until
• secretions have substantially decreased.

PHARMACOLOGY AND ACTIONS:

• Atrovent (ipratropium
• bromide), a quaternary ammonium derivative of atropine, produces a local,
• site-specific effect and is relatively free of the systemic side effects
• associated with earlier anticholinergic compounds. Pulmonary vagal tone is the major determinant
• of resting airway caliber and resistance.
• Parasympathetic or cholinergic receptors are found on bronchial smooth
• muscle. This anatgonizes the action
• of acetylcholine and thus decreases the
• formation of active cyclic GMP. Thus
• Atrovent improves impaired pulmonary function by decreasing resting bronchial
• smooth muscle tone and blocking reflex bronchospasm. Atrovent acts differently from
• sympathomimetic agents in that it directly inhibits bronchial smooth muscle
• contractility by cholinergic blockade.
• Sympathomimetics, on the other hand, stimulate adrenergic receptor
• sites, which results in a series of chemical events that serve to decrease
• bronchoconstriction.

INDICATIONS:

• Atrovent Inhalation solution
• administered either alone or with other bronchodilators, especially beta
• adrenergics, is indicated as a bronchodilator for maintenance treatment of
• bronchospasm associated with chronic obstructive pulmonary disease (COPD)
• including chronic bronchitis and emphysema.

PRECAUTIONS:

• Atrovent is contraindicated
• in known or suspected cases of hypersensitivity to ipratropium bromide, or to
• atropine and its derivatives.

• The use of Atrovent inhalation solution as a single
• agent for the relief of bronchospasm in acute COPD exacerbation has not been
• adequately studied. Drugs with faster
• onset of action may be preferable as initial therapy in this situation.

ADMINISTRATION:

• Supplied unit dose vial with
• 0.5mg per 2.5cc’s. May be given one time
• only.

• Atrovent shall be mixed with
• 2.5mg Albuterol (Proventil) and given by nebulizer.

• MECHANISM OF
• ACTION

• Calcium ions increase the
• force of myocardial contraction. In
• response to electrical stimulation of muscle, calcium ions enter the sarcoplasm
• from the extracellular space. Calcium
• may either increase or decrease systemic vascular resistance. In normal myocardium calcium’s positive
• inotropic and vasoconstricting effects produce a predictable rise in systemic
• arterial pressure.

INDICATIONS

• 1. Calcium channel blocker
• toxicity

• 2. Known or suspected
• hypocalcemia

• 3. Known or suspected
• hyperkalemia

4. Known or suspected hypermagnesemia



PRECAUTIONS

• Calcium can, especially when
• given rapidly, produce slowing of the cardiac rate. Calcium must be used
• cautiously in the patient receiving digitalis because calcium increases
• ventricular irritability and may precipitate digitalis toxicity. In the presence of sodium bicarbonate,
• calcium salts will precipitate as carbonates, thus these drugs cannot be
• administered together. Calcium may
• produce vasospasm in coronary and cerebral arteries.

DOSAGE

• A 10ml prefilled syringe or
• ampule of 10% solution of calcium chloride (1ml=100mg) contains 13.6 mEq of
• calcium. Usual adult dose is 5 to 10mls
• and repeated as necessary at 10-minute intervals.

PHARMACOLOGY AND ACTIONS:

• The therapeutic value of
• Diltiazem is due to its slow channel blocking properties, especially on cardiac
• and vascular smooth muscle. It also
• blocks the slow inward current of both calcium and sodium flux and causes
• coronary vasodilation. Diltiazem
• produces fewer hemodynamic effects than Verapamil. Intravenous diltiazem is highly effective in
• controlling the ventricular response rate in patients with atrial fibrillation.

INDICATIONS:

• 1. Symptomatic atrial
• fibrillation or atrial flutter with a rapid ventricular response

• 2. Paroxsymal supraventricular
• tachycardia

• 3. Ventricular rate control in
• patients with atrial fibrillation or flutter and when the ventricular rate over
• rides the underlying rhythm on the ECG monitor.
• IV diltiazem, like verapamil, appears to be effective in terminating and
• preventing PSVT.

PRECAUTIONS:

• A transient decrease in
• arterial pressure due to peripheral vasodilation should be expected in response
• to diltazem. Intravenous calcium
• injection will restore arterial pressure and has been recommended as a pretreatment. Should be used with caution with patients in
• CHF, acute MI or hypotension. Should
• also be used with caution in patients having impaired hepatic or renal systems.

• Contraindications include
• second or third degree heart block, sick sinus syndrome, severe hypotension,
• cardiogenic shock, and WPW or accessory pathway conduction.

ADMINISTRATION:

• An initial bolus dose of
• 0.25mg/kg (20mg for the average patient) is administered IV over 2
• minutes. A second dose of 0.35mg/kg
• (25mg for the average patient) has been used to convert to a sinus rhythm after
• the initial bolus was given. The second dose requires a physician consult.

PHARMACOLOGY AND ACTIONS:

• Glucose is the body's basic
• fuel. It produces most of the body's
• quick energy. Its use is regulated by
• insulin, which stimulates storage of excess glucose from the bloodstream and
• glucagon which mobilizes stored glucose into the bloodstream.

INDICATIONS:

• 1.
• Hypoglycemia states usually associated with insulin shock in diabetes.

• 2. The
• unconscious, when a history is unobtainable.

• 3. In
• patients with any focal or partial neurological deficit or altered state of
• consciousness.

• 4.
• Generalized hypothermia

• 5.
• In the stressed pediatric
• patient (i.e. respiratory distress).

PRECAUTIONS:

• 1. Attempt a
• CBG prior to administration.

• 2. Extravasation
• of 50% Dextrose will cause necrosis of tissue.
• IV should be secure and have free return of blood into syringe or
• tubing. The IV should be checked 2-3
• times during administration. If
• extravasation should occur, immediately stop administration of D50. Report extravasation of the drug to the
• receiving hospital personnel and document.

ADMINISTRATION:

• 1. Give thiamine, 100 mg IV,
• slow push, if dextrose is to be administered to a patient suspected of
• alcoholism or chronic malnutrition.

• 2. Give D50, 50 ml in secure
• vein, if patient unable to take sugar orally.

• 3. Saline plug is not to be
• utilized.

• 4. Dilute dextrose to D25 in newborns, give 2
• ml/kg.

SIDE EFFECTS AND SPECIAL NOTES

• 1. Do not
• draw blood for glucose determination from site proximal to an IV containing
• Glucose or Dextrose.

• 2. If glucose
• level is less than 80 mg/dl, reversal of hypoglycemia is indicated.

PHARMACOLOGY AND ACTIONS:

• Diazepam acts as a
• tranquilizer, anticonvulsant, and a skeletal muscle relaxant.

INDICATIONS:

• 1. Status seizures. In the field, this is any seizure which has lasted
• longer than 2 minutes or two consecutive seizures without regaining
• consciousness. Do not give unless
• patient is actively seizing.

• 2.
• May be given prior to
• cardioversion.

• 3.
• May be given for patient
• sedation.

• 4.
• To provide a safe restraint
• for violent patients who are a threat to themselves and others.

• 5.
• To be used as a light
• anesthesia and anterograde amnesia for invasive procedures.

PRECAUTIONS:

• 1. Since
• Diazepam can cause respiratory depression and/or hypotension, the patient
• should be monitored closely. Very
• rarely, cardiac arrest may occur.

• 2. For the
• above reasons, Diazepam should not be given without a good IV line in place and
• a bag valve mask ready.

ADMINISTRATION:

• 1. Adult: 5-10 mg slow IV push (each 5 mg over at least
• one minute). Do not exceed 0.3 mg/kg.

• 2. Pediatric: 2-5 mg slow IV push (0.25 mg/kg). Do not
• exceed 5 mg in Peds under the age of 5 years and 10mg if under the age of 10
• years.

• 3. Rectal administration 0.5
• mg/kg (if unable to administer IV) in seizing patients.

• SIDE EFFECTS
• AND SPECIAL NOTES:

• 1. Common
• side effects include: drowsiness, dizziness, fatigue and ataxia. Paradoxical excitement or stimulation sometimes
• occurs.

• 2. Should not
• be mixed with other agents or diluted with IV solutions. Turn off IV flow while administering and give
• through the nearest port of the IV tubing to the entry site.

• 3. Most
• likely to produce respiratory depression in patients who have taken other
• depressant drugs, especially alcohol and barbituates, or when given rapidly.

PHARMACOLOGY AND ACTIONS:

• 1. An
• antihistamine which blocks action of histamines released from the cells during
• an allergic reaction.

• 2. Direct CNS
• effects, which may be stimulant, or more commonly, depressant, depending on the
• individual variation.

• 3
• Anticholinergic, antiparkinsonism effect, which is used to treat acute
• dystonic reactions to antipsychotic drugs (e.g., Haldol, Thorizine,
• Compazine). These reactions
• include: oculogyric crisis, acute
• torticollis and facial grimacing.

INDICATIONS:

• 1. The
• second-line drug in anaphylaxis and severe allergic reactions after
• Epinephrine.

• 2. To
• counteract acute dystonic reactions from antipsychotic (phenothiazine) drugs.

PRECAUTIONS:

• 1. May have
• additive effect with alcohol or other CNS depressants.

• 2. Although
• useful in acute dystonic reactions, it is not an antidote to Phenothiazine
• toxicity or overdoses.

• 3. May cause
• hypotension when given IV.

• 4. Relative
• contraindicated with Narrow angle (acute) glaucoma and prostate enlargement.

ADMINISTRATION:

• A.Adult: 25 to 50 mg deep IM or
• slow IV push.

• B.Pediatric: 1 mg/kg mg deep IM
• or slow IV push, maximum dose of 50mg.

SIDE EFFECTS AND SPECIAL NOTES:

• There is a relative
• contraindication in patients with asthma due to the thickening of bronchial
• secretions when Diphenyhdramine is administrated. May cause blurring of vision.

PHARMACOLOGY AND ACTIONS:

• Chemical precursor of
• Norepinephrine which occurs naturally in man and which has both Alpha and Beta
• receptor stimulating actions. Its
• actions differ with dosage given.

• 1. 1-2
• mcg/kg/min: Dilates renal and mesenteric blood vessels (no effect on the heart
• and blood pressure).

• 2. 2-10
• mcg/kg/min: Beta effects on heart which usually increase cardiac output without
• increasing heart rate or blood pressure.

• 3. 10-20
• mcg/kg/min: Alpha peripheral effects cause peripheral vasoconstriction and increased
• blood pressure.

• 4. 20-40
• mcg/kg/min: Alpha effects reverse dilation of renal and mesenteric vessels with
• resultant decreased flow.

INDICATIONS:

• 1. Primary
• indication is cardiogenic shock.

• 2. May be
• useful for other forms of shock, except hypovolemia.

• 3. Useful in
• the treatment of profound bradycardia.

PRECAUTIONS:

• 1. May induce
• tachyarrythmias, in which case infusion should be decreased or stopped.

• 2. High doses
• may cause extreme peripheral vasoconstriction.
• Conversely, low doses may cause a decreased blood pressure due to
• peripheral dilation.

• 3. Certain
• antidepressants potentiate the effects of this drug. Check for medications and call Medical
• Control if other drugs are being used.

• 4. Should not
• be added to Sodium Bicarbonate or other alkaline solutions since Dopamine will
• be inactivated in alkaline solutions.

ADMINISTRATION:

• A. Adult: IV infusion only: Mix 400 mg in 250 ml NaCl
• to produce a concentration of 1600 mcg/ml.
• Infusion rate should start at 5 mcg/kg/min.

• Gradual increase from 5-20 mcg/kg/min
• usually achieves desired effect.

• B. Pediatric: Mix 400 mg in 250 ml NaCl to produce a
• solution of 1600 mcg/ml. Rate starts at
• 5-20 mcg/kg/min. Titrate to effect.

• SIDE EFFECTS
• AND SPECIAL NOTES:

• 1. The most
• common side effects include ectopic beats, nausea and vomiting. Angina has been reported following treatment
• (tachycardia and dysrhythmias are less likely than with other catecholamines.)

• 2. Can
• precipitate hypertensive crisis in susceptible individuals (i.e. patients on
• MAO inhibitors: Parnate, Nardil,
• Marplan).

• 3. Consider
• hypovolemia and treat this with appropriate fluids before administration of
• Dopamine. Dopamine is contraindicated in
• hypovolemic shock.

• 4. Dopamine
• is best administered by an infusion pump to accurately regulate rate. For this reason, it is hazardous when used in
• the field. Monitor closely.

PHARMACOLOGY AND ACTIONS:

• 1.
• Catecholamine with alpha and beta effects.

• 2. In
• general, the following cardiovascular responses can be expected:

A. Increased heart rate.

B. Increased myocardial contractile force.

C. Increased systemic vascular resistance.

• D.
• Increased arterial blood pressure.

• E. Increased myocardial O2
• consumption.

F. Increased automaticity.

• 3. Potent
• bronchodilator

INDICATIONS:

• 1.
• Ventricular fibrillation/ventricular tachycardia without a pulse.

1. Asystole.

• 2. Pulseless electrical
• activity.

1. Systemic allergic reactions.

2. Asthma in patients under 50.

• 3. Sinus Bradycardia
• unresponsive to Dopamine, Bradycardia secondary to calcium channel blocker or
• beta-blocker overdose.

PRECAUTIONS:

• 1. Should not
• be added directly to bicarbonate infusion, since catecholamines may be
• partially inactivated by alkaline solution.

• 2. When used
• for allergic reactions, increased cardiac work can precipitate angina and/or MI
• in susceptible individuals. Epinephrine
• may also induce major arrhythmias.

• 3. Due to
• peripheral vasoconstriction, epinephrine should be used with caution in
• patients with peripheral vascular insufficiency.

• 4. Wheezing
• in an elderly person is pulmonary edema or pulmonary embolus until proven
• otherwise.

ADMINISTRATION:

1. Adult:

• A. Cardiac
• arrest:

• 1. 1:10,000
• administration. 1 mg (10ml 1:10,000
• solution) every 3-5 minutes during arrest.

2.

• 1:1000 administration. May be used in cardiac arrest. The dose is 1mg (1cc) for the initial dose
• every 3-5 minutes. It must be
• administered through a rapidly running IV (Marco drip). Epinephrine given through the

• E.T. tube must be either
• 1:10,000 or 1:1000 diluted with saline.

• B. Allergic reaction (anaphylactic shock,
• laryngeal edema, severe asthma): 0.3 mg -0.5mg
• (0.3-0.5 ml of 1:1000 solution), SQ or IM, or if in profound shock,

• 0.5-1.0mg
• of 1:10,000 solution IV. May be repeated
• x 2.

• C.
• Bradycardia: Epinephrine 2 to
• 10ug/min (1mg/250cc equals 4ug/ml)

2. Pediatric:

• A. Cardiac arrest: 0.01 mg/kg (1:10,000 =
• 0.1ml/kg) IV/IO

• May
• also be given via endotracheal tube:
• 0.1mg/kg (1:1,000=0.1ml/kg).

Repeat every 3-5 minutes.

• B.
• Allergic reaction
• (anaphylactic shock, laryngeal edema, severe asthma) 0.01 mg/kg (0.01 ml/kg of
• 1:1,000 solution), SQ, IM, or if in profound shock, 0.01mg/kg 1:10,000 solution
• IV.

• C. Severe Bradycardia with shock (patients close
• to the state of PEA, Asystole). IV/IO 0.01mg/kg (0.1ml/kg of 1:10,000) may
• repeat every 3-5 min if necessary.

SIDE EFFECTS AND SPECIAL NOTES:

1. Anxiety, tremor, headache.

2. Tachycardia, palpitations, PVC's

3. Angina, hypertension.

PHARMACOLOGY AND ACTIONS:

• Hypnotic drug, without
• analgesic activity, intended for induction of general anesthesia. Intravenous injection produces hypnosis
• characterized by a rapid onset of action, usually within one minute. The hypnotic effect usually lasts three to
• five minutes, but is dose dependant.
• Etomidate has little to no effect on myocardial metabolism, cardiac
• output, peripheral or pulmonary circulation.
• Administration has been associated with a transient 20-30% decrease in
• cerebral blood flow, which will result in roughly a proportional decrease in
• cerebral oxygen utilization. Etomidate
• induction is usually followed by a moderate lowering of intracranial pressure,
• lasting several minutes. The drug is
• rapidly metabolized in the liver.
• Limited data in patients with cirrhosis and esophageal varices suggest
• that the distribution and half-life are approximately double of those seen in
• healthy subjects.

INDICATIONS:

• 1.
• To produce rapid hypnosis in the process of rapid
• sequence intubation for direct airway control.

• To produce a short acting rapid hypnosis and
• deep sedation in the awake patient needing invasive procedures (e.g.
• cardioversion).

CONTRAINDICATIONS:

• 1.
• Known hypersensitivity to Etomidate.

PRECAUTIONS:

• 1.
• Not indicated for pediatric patients under 10 years
• old.

• Benefit to the pregnant mother must outweigh
• the potential risk to fetus.

SIDE EFFECTS:

• 1.
• Transient venous pain following administration about
• 20% of the time. More pronounced in
• small, distal veins.

• Transient skeletal muscle movements following
• administration 32% of the time, predominately myoclonic in nature.

• ADMINISTRATION:
• 0.3mg/kg
• slow (30-60 seconds) IV push. Effect
• is dose and weight dependant!

• Supplied in 10ml single-dose vial containing 2mg/ml
• (20mg).

PHARMACOLOGY AND ACTIONS:

• Binds to the opiate
• receptors in the central nervous system, altering the response to and
• perception of pain. Fentanyl has a rapid
• onset, peaks in 3-5 minutes, with a short duration of 30-60 minutes. It has less cardiovascular and hemodynamic
• effects than Morphine, but can still cause respiratory depression through its
• central nervous system actions. Fentanyl
• is a Class II scheduled drug.

INDICATIONS:

• Use
• to control moderate through severe pain.

CONTRAINDICATIONS:

• 1.
• Known allergy or hypersenitivity to narcotic
• analgesics.

PRECAUTIONS:

• 1.
• Patients with respiratory depression or
• hypoventilation.

• 2.
• Bradydysrhythmias.

ADMINISTRATION:

• 50-200
• mcg initial dose given IM or IV.
• Titrate fentanyl to effect up to a total dose of 500 mcg.
• Intranasal
• route dose is at total of 100 mcg and limited to 1ml of fluid per
• nostril.

• Pediatric (2-12yrs, >15kg weight) dosing:
• 1.0-2.0
• micrograms/kg slow IV or IM, may repeat once
• 1.0-2.0
• micrograms/kg IN if no IV
• access, once only

SIDE EFFECTS:

• 1. Skeletal and muscle
• rigidity, especially post IV administration.

2. Bradycardia

• 3. May cause nausea and
• vomiting.

PHARMACOLOGY AND ACTIONS:

• Flumazenil is a
• benzodiazepine antagonist that competitively inhibits the actions of the
• benzodiazepine on the gamma aminobutyric acidbenzodiazepine receptor complex.

INDICATIONS:

• 1. Complete or partial reversal
• of the sedative effects of benzodiazepines after sedation or overdose,
• particularly respiratory depression.

• 2. Diagnostically in coma of
• unknown etiology to rule out or reverse benzodiazepine depression.

CONTRAINDICATIONS:

• 1.
• Hypersensitivity

• 2.
• Patients taking
• benzodiazepine for seizure control.

• 3.
• Patient with a serious
• tricyclic sedation overdose.

PRECAUTIONS:

• 1.
• May experience seizure
• activity with the withdrawal of the benzodiazepine.

• 2.
• Be prepared to restrain the
• patient prior to administration.

ADMINISTRATION:

• Management of overdose
• or sedation reversal, for IV/IO
• 1st dose: 0.2mg over 15 seconds.
• If unable to obtain
• desired effects
• 2nd dose: 0.3mg over 30 seconds.
• If unable to obtain
• desired effects
• 3rd dose: 0.5mg over 30 seconds

PHARMACOLOGY AND ACTIONS:

• Potent diuretic with a rapid
• onset of action and short duration of effect.
• It acts primarily by inhibiting sodium reabsorption throughout the
• kidney. Increase in potassium excretion
• occurs along with sodium excretion. As
• an IV bolus furosemide causes immediate (3-4 min) increase in venous
• capacitance. This decreases venous
• backup and probably accounts for its immediate effect in pulmonary edema. Peak effect: 1/2-1 hour after IV
• administration: duration about 2 hours (duration 6-8 hours if given orally,
• with peak in 1 - 2 hours).

INDICATIONS:

• 1. Acute pulmonary edema: to
• decrease extracellular volume and reduce venous pressure on the lung in
• congestive heart failure.

PRECAUTIONS:

• A.
• Contraindicated in hypovolemia and hypotension.

• B. Can lead
• to profound diuresis with resultant shock and electrolyte depletion. Therefore, do not use in hypovolemic states
• and monitor closely, particularly after IV administration.

• C. Have
• urinal or bed pan available. Effect may
• be seen within 10-15 min.

ADMINISTRATION:

• 1 mg/kg slowly IV bolus over
• 2 minutes to a maximum of 80mg. May also
• be given IM. Physician consult required for doses greater than 80mg.

• SIDE EFFECTS
• AND SPECIAL EFFECTS:

• 1.
• Hypovolemia, hypotension, hyponatremia and hypokalemia are the main
• toxic effects. Because of the potency
• and the need for close monitoring, should only be given with specific
• indications.

• 2. Other
• toxicity is not related to single dose use.

• 3. The side
• effect of hypokalemia (where potassium is an integral part of the
• sodium/potassium adenosine triphosphatase pump in myocardial contractility) is
• of concern in digitalized patients and particularly those who have digitalis
• toxicity.

4. May cause acute and profound diarrhea.

• 5. Patients
• with compromised respirations and poor lung sounds may be in pulmonary edema
• without wet lung sounds.

PHARMACOLOGY AND ACTIONS:

• Glucagon is a hormone which
• causes glucose mobilization in the body.

• It works opposite to
• insulin, which causes glucose storage, and is present normally in the
• body. It is released at times of injury
• or insult when glucose in needed and mobilizes glucose from body glycogen
• stores. Return to consciousness should
• be within 20 min of IM dose if patient is hypoglycemic.

INDICATIONS:

• 1. Known insulin shock when
• patient is stuporous or comatose, and D50 is not available and an IV cannot be
• started.

• 2. Used for suspected beta
• blocker overdose/reaction

PRECAUTIONS:

• D50 is the treatment of
• choice for insulin shock. Use of
• Glucagon is restricted to patients who are seizing, combative, or with
• collapsed veins and when an IV cannot be started. In these rare situations, it may be
• invaluable.

ADMINISTRATION:

Adult: 1.0 mg IM or IV.

Pediatric: 0.1 mg/kg up to 1 mg.



Beta-blocker overdose: 1-5 mg IV.



SIDE EFFECTS AND SPECIAL EFFECTS:

• 1. Nausea and
• vomiting

• 2. Persons
• with no liver glycogen stores (malnutrition, alcoholism) may not be able to
• mobilize glucose in response to Glucagon.

• 3. May be
• useful in treating life threatening beta-blocker overdoses, although effective
• dose range is high.

PHARMACOLOGY AND ACTIONS:

• The
• precise mechanism of action has not been clearly established, but it is
• suspected that Haloperidol alters the effects of dopamine in the CNS. It also has anticholinergic activity.

INDICATIONS:

• As an adjunct to
• control and restrain violent patients who are a threat to themselves
• and/or others

CONTRAINDICATIONS:

• Severe toxic CNS
• depression
• Coma
• Parkinson’s disease
• Known hypersensitivity
• to haloperidol

PRECAUTIONS:

• Severe cardiovascular
• disease may cause transient hypotension
• Seizure history with
• prescribed anticonvulsants. This
• may decrease the seizure threshold
• Unknown safety in
• pregnancy and lactation

• ADMINISTRATION:
• 5mg
• IM, may be repeated twice at 5 minute intervals to a total of 15mg.
• If possible use 2-5mg IVP

• SIDE EFFECTS AND SPECIAL
• NOTES:

• CNS depression and
• sedation, extrapyramidal reactions, tardive dyskinesia
• Anticholinergic
• effects: dry mouth and eyes, blurred vision, constipation
• May cause hypotension
• and tachycardia

PHARMACOLOGY AND ACTIONS:

• A relatively short acting
• alpha 1 and beta 1-2 blocking agent.
• Reduces blood pressure, systemic vascular resistance and heart
• rate. Onset is within 5-15 minutes.

INDICATIONS

• 1. Severe hypertension with
• associated signs and symptoms. Systolic
• BP greater than 220mmHg and/or diastolic 120mmHg.

2. Acute myocardial infarction

• 3. Rate control in narrow
• complex tachycardia

PRECAUTIONS

• 1.
• May cause profound
• hypotension, especially orthostatic hyptotension

• 2.
• May exacerbate CHF

• 3.
• Asthma

CONTRAINDICATIONS

• 1.
• Severe bradycardia

• 2.
• 2nd and 3rd
• degree heart blocks

• 3.
• History of severe CHF

ADMINISTRATION

• 10mg (0.25mg/kg) IV over 2
• minutes. May repeat with 20mg slow IV
• until the desired supine BP is achieved or a total of 30mg has been given.

• In AMI: may give up to 150mg total.
• Because Labetalol is short acting, continued bolus’ may be needed to
• reach the theraputic effect in AMI. Keep
• patient supine and monitor BP closely before and after administration.

PHARMACOLOGY AND ACTIONS:

• 1. Depresses
• automaticity of purkinje fibers; therefore, raises stimulation threshold in the
• ventricular muscle fibers (makes ventricles less likely to fibrillate).

• 2. Little
• antiarrhythmic effect at subtoxic levels on atrial muscle.

• 3. CNS
• stimulation: Tremor, restlessness and clonic convulsions followed by depression
• and respiratory failure at higher doses.

• 4.
• Cardiovascular effect: Decreased conduction rate and force of
• contraction, mainly at toxic levels.

• 5. The effect
• of a single bolus on the heart disappears in 10-20 minutes due to
• redistribution in the body. Metabolic
• half-life is about 2 hours and therefore toxicity develops with repeated doses.

• 6. There is limited case study evidence that may
• correlate a blunting to the effect of ICP created by endotracheal intubation if
• Lidocaine is administered prior to the procedure in head-injured patients.

• INDICATIONS
• (Second line drug for cardiac dysrhythmias, Amiodarone is preferred):

• 1. Ventricular tachycardia or
• suspected ventricular tachycardia if clinical condition is not rapidly
• deteriorating.

• 2.
• Recurrent ventricular
• fibrillation.

• 3. Following successful
• defibrillation.

• 4. As a means to blunt ICP in
• head-injured patients during induced intubation.

• 5. As an anesthetic after
• successful placement of an intraosseous needle.

PRECAUTIONS:

• 1. Do not use in the presence of advanced AV block
• unless artificial pacemaker is in place.

• 2. In atrial fibrillation or flutter, quinidine-like
• effect may cause alarming ventricular acceleration.

• 3. Lidocaine is not recommended for treatment of
• supraventricular arrhythmias.

• 4. Do not administer with heart rate less than 50;
• you may suppress the heart completely.

ADMINISTRATION:

• A.
• CARDIAC ARREST: VENTRICULAR FIBRILLATION OR
• PULSELESSVENTRICULAR TACHYCARDIA:

• 1. Lidocaine bolus 1-1.5 mg/kg load then 0.5
• mg/kg every 5 minutes to a total dose of 3 mg/kg.

• 2. Begin continuous infusion if successful
• resuscitation has occurred. Infusion
• should be initiated at 2-4 mg/min.

• B.
• PARALYTIC THERAPY

• 1. Lidocaine 1.0mg/kg one
• time dose.

E.T.T. ADMINISTRATION:

• Lidocaine may be
• administered through the ET tube 2 mg/kg not to exceed a total

volume of 10 cc.



C. IO ANESTHETIC

• 1. 20-40mg of 2% Lidocaine
• flushed through IO site.

• 2. Pediatric: 0.5mg/kg 2% Lidocaine flushed through IO
• site.

I.V. INFUSION:

• How supplied: Premixed IV Drip solution, 1 gm of Lidocaine Hydrochloride in 250 ml D5W, which
• yields a 0.4% solution or 4 mg/ml.

SIDE EFFECTS AND SPECIAL NOTES:

A. Side effects:

• 1. CNS disturbances: sleepiness, dizziness,
• disorientation, confusion, and convulsions.

• 2. Hypotension: decreased myocardial contractility
• and increased AV block at toxic levels only.

• 3. Rare instance of sudden cardiovascular collapse
• and death.

• B. Lidocaine is metabolized in the liver and
• therefore patients with hepatic disease, shock or CHF will have impaired
• metabolism. All doses, except the
• initial loading dose, must be decreased by 50% in patients over 70 and those
• referred to above.

• C.
• Toxicity is more likely in
• elderly patients.

PHARMACOLOGY AND ACTIONS:

• Is
• essential for the activity of many enzymes.
• It also plays an important role in neurotransmission and muscular
• excitability. Hypomagnesemia can lead to
• cardiac dysrhythmias as well as sudden cardiac death.

INDICATIONS:

• 1.
• Known or suspected torsades de pointes dysrhythmia,
• with or without a pulse.

• 2.
• Refractory ventricular fibrillation after Amiodarone
• and Lidocaine use.

• 3.
• Cardiac arrest with known or suspected hypomagnesemia.

• 4.
• Seizure activity associated with Pre-Eclampsia or
• Eclampsia

PRECAUTIONS:

• 1.
• In the non-arrest patient, may cause hypotension and/or
• bradycardia.

• 2.
• May depress the CNS and neurotransmission; therefore
• deep tendon reflexes should be assessed in the conscious patient.

ADMINISTRATION:

• Cardiac dysrhythmias or arrest: 1-2 grams slow IV. If the patient has a pulse administer
• much slower, over 10-15 minutes.

• Seizures:
• 4mg slow IV, followed by 4mg deep IM.

• Magnesium Sulfate is supplied as a 50% solution
• (1gram/2ml). For IV administration
• Magnesium Sulfate MUST BE DILUTED to a 20% solution. Draw up the 1gram/2ml and add 3mls of
• NaCl solution to make 1gram/5ml.

• Magnesium
• Sulfate 50% may be administered IM.

May be infused at 0.5-1.0gms/hour. Add 2 grams to 250ml NaCl and run at 62-124gtts/min

PHARMACOLOGY AND INDICATIONS

• Midazolam shares the actions
• of other benzodiazepines. Although
• initial data indicated that the sedative potency of midazolam was about 1.5-2.5
• times that of diazepam, clinical experience with the drug suggests that potency
• may be 3-4 times that of diazepam.
• Midazolam hydrochloride injection should be stored at 15-30C and
• protected from light.

INDICATIONS:

• 1. Adult and pediatric patients
• with continuous seizures.

2. Sedation for cardiac pacing

• 3. Premedication for
• cardioversion

• 4. Premedication for rapid
• sequence intubation

PRECAUTIONS:

• 1. Continuously monitor the
• patient’s respiratory and cardiac function.

• 2. Never administer as a rapid
• IV bolus.

• 3. Since this procedure will be
• performed in the presence of seizure activity, some assistance in restraining
• the patient may be required to maintain proper patient position during
• administration.

• 4. Should be given with caution
• to patients in shock or with depressed vital signs.

5. Can induce respiratory depression.

• ADMINISTRATION:
• Cardiac pacing and cardioversion
• Adult:
• IV 1-2mg slow IV push
• IM
• or IN 2mg single dose
• Pediatric: IV 0.1mg/kg not to exceed 5mg
• IM
• or IN 0.1 mg/kg single injection to a maximum dose of 7mg.
• Seizure control
• Adult:
• 2-5mg IM or IN if IV cannot be established for Diazepam
• administration.
• Peds: IM or IN Dose 0.2mg/kg up to a
• maximum dose of 7.0mg
• IV Dose 0.1mg/kg up to an initial dose of
• 1-2.5mg, not to exceed a total of 5mg.
• Rapid sequence intubation
• Adult: 2-5mg IV/IM
• Peds: 0.1mg/kg IV to maximum dose of
• 5.0mg

0.2mg/kg IM to a maximum dose of 7.0mg.











































SIDE EFFECTS – WARNINGS

• 1. Respiratory depression
• and/or respiratory arrest.

2. Oversedation

3. Hypotension

• Care will be exercised to assure that the
• patient retains a patent airway and is protected from the occurrence of injury
• secondary to the seizure while this procedure is being performed.

PHARMACOLOGY AND ACTIONS:

• Morphine sulfate is a
• narcotic with potent analgesic and hemodynamic properties. It exerts its analgesic effects on the
• central nervous system, simultaneously inducing drowsiness, mental clouding and
• mood changes. Morphine has several
• hemodynamic actions of considerable importance.

• 1. It increases venous capacitance and thereby
• pools blood peripherally and decreases its return (reduced preload). This assists in relieving pulmonary
• congestion, reduces left ventricular and diastolic dimensions, and myocardial
• wall stress. These all result in
• decreased myocardial oxygen requirement.

• 2. Reduces systemic vascular resistance at the
• arteriolar level (reduced after load).
• This reduction in afterload also tends to decrease myocardial oxygen
• requirement. Central sedative effects of
• morphine also will reduce myocardial oxygen requirements and the chance of
• malignant arrhythmias due to reduction of apprehension and fear in
• patients. The hemodynamic effects of
• Morphine are probably mediated through the central nervous system by a
• sympatholytic mechanism. Given
• intravenously, the onset of action is prompt (2-3 minutes), peaks at 7 - 10
• minutes, and last 3 - 5 hours.

INDICATIONS:

• 1. Severe chest pain unaffected by respirations
• or body movements with suspected ischemic cardiac pain unresponsive to
• nitroglycerin.

2. Pulmonary edema.

• 3. Severe pain associated with burn or extremity
• injuries not affecting respiratory or hemodynamic status.

CONTRAINDICATIONS:

1. Known allergy to morphine.

2. Volume depletion.

3. Hypotension.

4. Undiagnosed head trauma.

5. CNS Trauma, such as paralysis.

















MORPHINE SULFATE CONTINUE



PRECAUTIONS:

• Morphine sulfate causes predictable
• respiratory depression. This is
• quickly reversible with naloxone (Narcan).
• Respiratory depression is much more likely to occur in patients
• with pre-existing respiratory insufficiency (COPD).
• Use with caution in undiagnosed
• abdominal pain or potential surgical emergencies, e.g. appendicitis or
• acute abdomen.
• Naloxone (Narcan) and
• respiratory support must be at hand when administering morphine.

ADMINISTRATION:

• 1. Morphine
• should be given by titration of small intravenous doses at frequent intervals
• until the desired response is achieved.
• There is considerable variation from patient to patient in the amount of
• drug required to acquire the given effect.

• 2. A dose of
• 2-5 mg IV is given and repeated at 5-30 minute intervals until the desired effect
• has been achieved. Total dose of 20mg
• with Physician Consult required exceeding 20mg.

• 3. Pediatric
• Dose: Pediatrics less than 50 kg,
• 0.1mg/kg IV.

• 4. Vital
• signs should be taken with particular attention to blood pressure and
• respiratory rate after every incremental dose is administered. The end points of administration should be:

A. Achievement of desired effects.

B. Blood pressure less than 90 mmHg systolic

C. Respiratory rate less than 12.





SIDE EFFECTS AND SPECIAL NOTES:

1. Respiratory depression, nausea and vomiting.

• 2. The analgesic effect of morphine should not
• be gauged solely by the total elimination of pain. More importantly, morphine reduces the
• perception of pain.

• 3. Hypotension may develop as a consequence of
• the hemodynamic effect of morphine, especially in older patients, volume
• depleted patients, or patients who have required elevated systemic vascular
• resistance for the maintenance of their blood pressure. Hypotension is usually responsive to naloxone
• administration and the Trendelenburg position.
• If not, contact medical control, prepare for cautious fluid challenge
• with 100 cc of Normal Saline.

• 4. Morphine has a high tendency for
• addiction/abuse and is classified as a schedule II drug under the Controlled
• Substances Act of 1970.

PHARMACOLOGY AND ACTIONS:

• Narcan is a narcotic
• antagonist which competitively binds to narcotic sites but which exhibits
• almost no pharmacologic activity of its own.
• Duration of action: 1-4 hours.

INDICATIONS:

• 1. Reversal of narcotic effects, particularly
• respiratory depression, due to narcotic drugs ingested, injected or
• administered in the course of treatment.
• Narcotic drugs include morphine, Fentanyl, Demerol, heroin, Dilaudid, Percodan,
• Codeine, Lomotil, propoxphene (Darvon), pentazocine (Talwin).

• 2. Diagnostically in coma of unknown etiology to
• rule out (or reverse) narcotic depression.

PRECAUTIONS:

• 1. In patients physically dependent on
• narcotics, frank and occasionally violent withdrawal symptoms may be precipitated.

ADMINISTRATION:

• 1. Slowly
• inject up to 1-2mg IV, IM, SQ, IN, or by ET tube. If no, or inadequate,
• respiratory response is observed, this dose maybe repeated at 3-5 minute
• intervals up to 8 mg. in the patient suspected of having narcotic overdose.

• 2. IV
• administration is preferred.

• 3. Pediatric
• Dose: 0.1mg/kg IV, ET, IM, SQ, or IN.

SIDE EFFECTS AND SPECIAL NOTES:

• 1. This drug is remarkably safe and free from
• side effects. Do not hesitate to use it
• if indicated.

• 2. The duration of some narcotics is longer than
• Narcan and the patient must be monitored closely. Repeated doses of Narcan may be
• required. Patients who have received
• this drug should be transported to the hospital because coma may reoccur when
• Narcan wears off.

• 3. May need large doses (8-10 ml) to reverse
• propoxphene (Darvon) overdose.

PHARMACOLOGY AND ACTIONS:

• 1.Cardiovascular effects
• include:

• A. Reduced venous tone
• causes pooling of blood in peripheral veins and decreased return of blood to
• the heart.

• B. Decreased peripheral
• resistance.

• C. Dilation of coronary
• arteries (if not already at maximum).

• 2.General smooth muscle
• relaxation.

INDICATIONS:

1. Angina

• 2. Chest, arm, or neck pain thought to be
• related to coronary ischemia; may be used diagnostically as well as
• therapeutically.

• 3. Control of hypertension in angina or acute
• MI.

• 4. Pulmonary edema: to increase venous pooling; lowering cardiac
• preload and afterload.

PRECAUTIONS:

• 1. Generalized vasodilation may cause profound
• hypotension and reflex tachycardia.

• 2. Nitroglycerin loses potency easily, should be
• stored in dark glass container with tight lid and not exposed to heat.

3. Use with caution in hypotensive patients.

• 1. Hypotension and bradycardia
• following nitroglycerin are usually responsive to atropine.

• 2. Contraindicated within 24
• hours post PDE-5 selective inhibitors, e.g. Viagra, Cialis, Levitra

ADMINISTRATION:

• 1. Nitroglycerin (NTG): 0.4 mg
• sublingual if systolic pressure is greater than 90, when initially treating
• patients, q. 5 minutes if:

A. No sign of hypotension are present.

• B. Patient did not show signs of
• hypersensitivity to initial dose of NTG.

• 2.
• Blood pressure must be taken
• prior to and after all NTG doses.

• 3.
• Nitroglycerin drip may be
• started if initial SL administration failed to completely control chest pain or
• blood pressure.

• Nitroglycerin Drip Chart for
• 50mg/250cc
• 200mcg/ml

3mls/hr


6mls/hr


9mls/hr


12mls/hr


15mls/hr


18mls/hr


21mls/hr


24mls/hr




10mcg/min


20mcg/min


30mcg/min


40mcg/min


50mcg/min


60mcg/min


70mcg/min


80mcg/min
























SIDE EFFECTS AND SPECIAL NOTES:

• 1. Common
• side effects include throbbing headache, flushing, dizziness, and burning under
• the tongue (if these side effects are noted, the pills may be assumed potent,
• not outdated).

• 2. Less
• common effects: marked hypotension; particularly orthostatic.

• 3. NOTE: Therapeutic effect is enhanced but adverse
• effects are increased when patient is upright.

• 4. Because
• nitroglycerin causes generalized smooth muscle relaxation, it may be effective
• in relieving chest pain caused by esophageal spasm.

PHARMACOLOGY AND ACTIONS:

• Glucose is the body's basic
• fuel. It produces most of the body's
• quick energy. Its use is regulated by
• insulin, which stimulates storage of excess glucose from the bloodstream and
• glucagon that mobilizes stored glucose into the bloodstream.

INDICATIONS:

• 1.
• Hypoglycemic states usually associated with insulin shock in diabetes.

PRECAUTIONS:

• 1. Attempt a CBG prior to
• administration.

• 2. Give only to patients that
• have control of their airway and are able to chew or swallow food/liquids.

ADMINISTRATION:

1. Give entire tube of 15 grams glucose orally.











SIDE EFFECTS AND SPECIAL NOTES

• 1. Discontinue use if patient
• becomes unresponsive or cannot swallow.

PHARMACOLOGY AND ACTIONS:

• 1. Hormone
• which increases electrical and contractile activity in the uterine smooth
• muscle. Oxytocin can initiate or enhance
• rhythmic contractions at any time during pregnancy, but the uterus is most
• sensitive at term.

• 2. Exhibits
• rapid onset (minutes), very short half-life, rapid inactivation and excretion.

INDICATIONS:

Control of post partum hemorrhage.





PRECAUTIONS:

• 1. Prior to its administration, the presence
• of a second fetus must be considered.
• Administration with fetus in uterus can cause rupture of the uterus
• and/or death of the fetus.

• 2.
• Administration should follow delivery of placenta whenever possible.

ADMINISTRATION:

• 1. Dose: 20 units in 1000ml Normal Saline with
• maxi-drip IV set. Utilize IV pump, as
• feasible, and start at a flow rate of 1.0-2.0 ml/min titrated to severity
• of hemorrhage and uterine response.

• 2. If unable to establish an IV,
• 10 units may be given IM.

SIDE EFFECTS AND SPECIAL NOTES:

• 1. In large
• amounts, Oxytocin exhibits a transient but marked vasodilating effect and
• reflex tachycardia.

• 2. Cardiac
• dysrhythmias may be precipitated or aggravated by Oxytocin.

PHARMACOLOGY AND ACTIONS:

1. Antiemetic

2. Sedative

• 3.
• As an antihistamine, it acts
• by competitive antagonism but does not block the release of histamine. In
• varying degrees it antagonizes most, but not all of, the pharmacological
• effects of histamine. It also possesses
• sedative antimotion, antiemetic and anticholinergic effects with a duration of
• action lasting 4-6 hours.

INDICATIONS:

• 1. Active
• treatment for motion sickness.

• 2. Prevention
• and control of nausea and vomiting.

CONTRAINDICATIONS:

1. Comatose patients.

2. Asthmatic patients.

3. Narrow-angle glaucoma.

• 4. Prostatic hypertrophy and other urinary tract
• obstructions.

• 5. Patients
• receiving monoamine oxidase inhibitors (antidepressants).

PRECAUTIONS:

• Lowers the seizure threshold
• Do not use in patients less than 2 years
• of age
• Chronic alcohol use or abuse
• History of dystonic reactions

ADMINISTRATION:

• Adult: 0.25-0.5mg/kg IM (25-50mg
• average). May be given IV at half
• of the IM dose (12.5-25mg average), but IV dose must be diluted
• with at least 10cc NaCl.
• Preferred method is to dilute syringe and then give in flowing
• IV line.
• Pediatrics (2-12
• years): 0.125-0.25 mg/kg IM
• (12.5-25mg average). May be
• given IV at half the IM dose (6.25-12.5mg), but IV dose must
• be diluted with at least 10cc NaCl.

PHARMACOLOGY AND ACTIONS:

• Acids are increased when
• body tissues become hypoxic due to cardiac or respiratory arrest. Sodium bicarbonate is an alkalotic solution
• which neutralizes acids found in the blood.

INDICATIONS:

• 1. To correct
• acidosis found during cardiac arrest, asystole, or electromechanical
• dissociation by normalizing the ph.

• 2. To
• control arrhythmias in tricyclic antidepressant overdose.

PRECAUTIONS:

• 1. There is
• little evidence to support the use of bicarbonate in the cardiac arrest setting
• to improve outcome. There is evidence to prove that bicarbonate
• has several negative effects.

• A. Sodium bicarbonate does not improve the
• ability to defibrillate.

• B Sodium bicarbonate inhibits the release of
• oxygen by shifting the oxyhemoglobin curve.

• C Sodium bicarbonate induces hyperosmolarity
• and hypernatremia.

• D. Sodium bicarbonate produces paradoxical
• acidosis due to production of CO2, which particularly effects
• myocardium and brain cells.

• E. Sodium bicarbonate induces extracellular
• alkalosis.

• F. Sodium bicarbonate makes central venous
• acidosis worse.

• G Sodium bicarbonate inactivates
• catecholamines. Therefore, the mainstay
• of acid-base balance should be adequate ventilation in the routine arrest
• situation.

• 2. The use of
• sodium bicarbonate is not recommended for use by the AHA except in certain
• circumstances such as preexisting acidosis, or hyperkalemia.

ADMINISTRATION:

• Bicarbonate should not be
• considered for use before other therapies have been tried. When it is used, the dose is:

• A. Adult: 1
• mEq/kg initially; 0.5 mEq to follow given every 10 minutes.

• Children: 1 mEq/kg initially; 0.5 mEq given every 10 minutes during
• arrest. Dilute 1 to 1 with normal
• saline.

• B. For
• tricyclic antidepressant overdose with life threatening arrhythmias, 1mEq/kg
• IV.

SIDE EFFECTS AND SPECIAL NOTES:

• 1. Each amp.
• of bicarbonate contains 50 mEq of NA+.
• In persons with cardiac disease, this will increase intravascular volume
• and further stress the heart.

• 2.
• Hyperosmolarity of the blood can occur because the NaHCO3 is
• concentrated. This results in cerebral
• impairment.

• 3. These
• dosages are a very rough guide. Blood
• gases should be obtained as soon as possible to direct further therapy.

• 4. In the
• presence of a respiratory arrest without cardiac arrest, the treatment of
• choice is ventilation to correct the respiratory acidosis. No NaHCO3 should be given unless cardiac
• arrest has also occurred.

PHARMACOLOGY AND ACTIONS:

• Methylprednisolone is a
• synthetic glucocorticoid that is used as an anti-inflammatory and
• immunosuppressant drug.

INDICATIONS

1. Asthma

2. Allergic reaction/anaphylaxis





PRECAUTIONS

1. Administer slowly

2. History of allergy to methylprednisolone





ADMINISTRATION

• 1.
• Reconstitute according to product packaging. Withdraw the desired dose and administer over
• at least 1 minute. IV route is the
• preferred method for emergency use, but IM is acceptable.

• 2. Dosage
• Adult: 125 mg. IV
• Pediatric: 1.0 mg/kg IV

PHARMACOLOGY AND ACTIONS:

• Succinylcholine is used
• principally to produce skeletal muscle relaxation during procedures of short
• duration such as endotracheal intubation.
• Because of its short duration of action, succinylcholine is generally considered
• the neuromuscular blocking agent of choice for procedures lasting less than 3
• minutes. Repeated administration may
• lead to tachyphylaxis and therefore, multiple fractional doses of
• succinylcholine should generally not be used.

• Succinylcholine causes a
• slight, transient increase in intraocular pressure immediately after injection
• and during the fasciculation phase.

INDICATIONS:

• 1. Required emergent intubation for airway
• protection with active gag reflex.

CONTRAINDICATIONS:

• Succinylcholine is
• contraindicated in patients with known hypersensitivity to the drug,
• genetically determined disorders of plasmapseudocholinesterase, personal or
• familial history of malignant hyperthermia, myopathies associated with elevated
• serum creatine kinase (CK, creatine phosphokinase, CPK) values, angle-closure
• glaucoma, or penetrating eye injuries.

ADMINISTRATION:

• Consider Valium 0.1mg/kg
• (5-10mg) IV or Versed 2-5mg IV or IM prior to giving Succinylcholine.

• Consider Lidocaine to blunt
• ICP in the head-injured patient.

Adult:

• 1.5 mg/kg IV with the onset
• of action taking approximately 30 secounds to 1 minute. Can be given I.M. if
• unable to obtain an IV at 2mg/kg with the onset of action taking 3-5 minutes.

• For Bradycardias treat with
• Atropine (0.5mg IV push >6 years old).

Pediatric:

• For children <6 years
• old, pre medicate with atropine 0.02mg/kg IV (minimum dose of 0.1mg). Succinylcholine is then given at 2mg/kg IV.

• Succinylcholine should be used during pregnancy only when clearly
• needed for airway management.

PHARMACOLOGY AND ACTIONS:

• 1. Terbutaline sulfate is used as a
• bronchodilator in the symptomatic treatment of bronchial asthma and reversible
• bronchospasm which may occur in association with bronchitis and emphysema. Subcutaneous terbutaline is about as effective
• as an equal subcutaneous dose of epinephrine in improving pulmonary function.

• 2. Subcutaneous or IV terbutaline has been used
• to inhibit spontaneous uterine activity during preterm labor.

INDICATIONS:

1. Bronchial asthma or bronchospasm.

• 2. Anaphylaxis Reaction without signs or
• symptoms of cardiovascular shock.

PRECAUTIONS:

• 1. Not recommended or dosed
• for children younger than 12 years of age.

• 2. Used with caution in
• patients with diabetes mellitus, hypertension, or hyperthyroidism.

3. History of seizures.

• 4. It's use is
• contraindicated in patients who are known to be hypersensitive to
• sympathomimetic agents.

ADMINISTRATION:

• 1.
• Adult: Dose is 0.25mg.
• subcutaneous. May be repeated in 15-30
• minutes if no clinical improvement is evident. No more than 0.5mg should be
• given within a 4-hour period.

• 2. Pediatric:
• 12 years or older, same as adult.

• PHARMACOLOGY AND
• ACTIONS:

• Ketorolac Tromethamine is a non-steroidal
• anti-inflammatory drug. Although the exact
• mechanism is unknown, it is thought to act through inhibition of prostaglandin
• synthesis. Ketorolac Tromethamine
• exhibits anti-inflammatory, analgesic, and antipyretic effects.

INDICATIONS:

• Management
• of moderately severe, acute
• pain in:

1. Trauma to an extremity.

2. Suspected renal colic.

• 3. Visceral pain associated
• with cancer.

• 4. Patients with know allergies
• to narcotic analgesics or as a non-narcotic analgesic alternative.

PRECAUTIONS:

• 1.
• Monitor patients with liver disease closely.

• 2. Reduce dose in elderly patients
• and those with renal insufficiency.

• 3. DO NOT mix with meperedine
• HCL, morphine sulfate, promethazine HCL or hydroxyzine HCL as a precipitate
• will form.

4. Do not use prior to surgery.

• ADMINISTRATION:
• 1. Adult:
• 60mg IM or 30mg IV. Adults over 70
• and/or those with renal insufficiency reduce dose by 50% - 30mg IM or 15mg
• IV.
• 2. Not
• recommended for pediatric patients less than two years old.

CONTRAINDICATIONS:

• 1.
• History of ASA/NSAID induced asthma or allergic
• reactions.

• 2.
• Active GI lesions (e.g. erosive gastritis, peptic
• ulcers.)

• 3.
• GI bleeding.

• 4.
• Suspected or confirmed CVA.

• 5.
• Renal insufficiency.

• 6.
• Current ASA/NSAID/anticoagulant therapy.

• 7.
• Pregnancy.

SIDE EFFECTS:

• 1.
• Drowsiness, sedation.

• 2.
• Dyspepsia, nausea.

• 3.
• GI pain.

• 4.
• Renal failure.

• 5. Prolonged
• bleeding time.

PHARMACOLOGY AND ACTIONS:

• Vecuronium bromide is a synthetic, nondepolarizing
• neuromuscular blocking agent that produces pharmacologic effects similar to
• those of other nondepolarizing neuromuscular blocking agents. The manufacturer states that following IV
• administration of a vecuronium bromide dose of 0.1 mg/kg, neuromuscular
• blockade begins within 1 minute and is maximal at 3-5 minutes. Following intubation with succinylcholine,
• the duration of clinically sufficient neuromuscular blockade of initial
• vecuronium bromide doses is 20-30 minutes.

• The manufacturer states that the recovery time
• following administration of vecuronium is about 15-20 minutes to achieve 75% of
• the control response.

INDICATIONS:

• After successful intubation or placement of the
• Combitube, and the patient begins to recover from Succinylcholine, vecuronium
• may be given as an intermediate paralytic every 20 minutes to maintain
• paralysis.

PRECAUTIONS:

• Since the onset of neuromuscular blockade and
• maximum effect of vecuronium bromide may be delayed secondary to impaired
• circulation or an increased volume of distribution of the drug, larger than
• usual doses of the drug are not recommended in patients with these conditions. Vecuronium bromide should be administered
• with caution in patients with hepatic dysfunction since the drug appears to be
• eliminated principally via bile and recovery from neuromuscular blockade may be
• prolonged in these patients.
• Neuromuscular blocking agents should be used with extreme caution, if at
• all in patients with myasthenia gravis.

ADMINISTRATION:

• Vecuronium requires that 10mls normal saline be used in order to
• reconstitute at 1 mg/1 ml.

• The usual initial (intubation) adult dose of vecuronium bromide is 0.1
• mg/kg.. Procedures can be performed
• within 2.5-3.0 minutes in most patients and maximum neuromuscular blockade
• generally occurs within dose usually within 3-5 minutes.

Initial Dosage after succinylcholine.

Adult 0.1 mg/kg

Ped. 0.1 mg/kg



Second Dose every 20 minutes as needed.

Adult 0.05 mg/kg

Ped. 0.05mg/kg

PHARMACOLOGY AND ACTIONS;

• Ondansetron is a selective 5-HT3 antagonist. Ondansetron’s mechanism of action has not
• been fully characterized and it is not certain whether its antiemetic action in
• chemotherapy –induced nausea and vomiting is mediated centrally, peripherally,
• or both. Cytotoxic chemotherapy releases
• serotonin from cells in the small intestine.
• This released serotonin may stimulate the vagal afferents through the
• 5-HT3 receptors and initiate the vomiting reflex.

INDICATIONS:

• 1. The prevention and /or
• cessation of acute nausea and vomiting.

CONTRAINDICATIONS:

• 1. Known hypersensitivity to
• Ondansetron hydrochloride.

PRECATIONS:

• 1. May not be effective in
• preventing motion-induced nausea and vomiting.

• 2. Should be avoided in
• pregnant or nursing mothers.

• 3. Do not use in patients less
• than 4 years old.

• 4. Half-life is two-fold in
• patients over 75 years old (>5 hours).

SIDE EFFECTS:

The most common side effects are:

1. Headache

2. Diarrhea

3. Dizziness

4. Musculoskeletal pain

• ADMINISTRATION:
• Supplied in 4mg/2ml Single Dose Vials and 4mg dissolving tablets for
• oral use.

• ADULT: 4-8mg IV push over 2-5
• minutes or 4-8mg IM, or 4-8mg PO.
• Repeat doses (giving more than 8mg total) are not recommended. If nausea/vomiting continues after 15-20
• minutes post-administration, administer Promethazine.

• PEDIATRIC: 0.1mg/kg IV push over 2-5 minutes in
• patients <40kg. For patients
• >40kg administer 4mg IV or 4mg PO.