Medic12Drugs

Actidose / Absorbent

Is a specially prepared charcoal that will adsorb and bind toxins from the gastrointestinal tract.

Acute ingested poisoning

Administer only after emesis or in those cases where emsis is contraindicated

1G/Kg mixed with at least 6 to 8 oz of water, then PO or via an NG tube.

Adenocard / Antidysrhythmic

Adenosine is a naturally occurring agent that can “chemically cardiovert” PSVT to a normal sinus rhythm. It has a half-life of 10 seconds and does not cause hypotension.

Narrow, complex paroxysmal supraventricular tachycardia refractory to vagal maneuvers.

Hypersensitivity, 2nd- and 3rd-degree heart block, sinus node disease, or asthma.

It may cause transient dysrhythmias especially asystole, COPD

6 mg rapidly (over 1 to 2 sec) IV, then flush the line rapidly with saline. If ineffective, 12 mg in 1 to 2 min, may be repeated. Ped: 0.1 mg/kg (over 1 to 2 sec) IV followed by rapid saline flush, then 0.2 mg/kg in 1 to 2 min to max 12mg.

Proventil, Ventolin / Sympathomimetic Bronchodilator

Albuterol is a synthetic Sympathomimetic that causes bronchodilatation with less cardiac effect than epinephrine and reduces mucus secretion, pulmonary capillary leaking, and edema in the lungs during allergic reactions.

Bronchospasm and asthma in COPD.

Hypersensitivity to the drug.

The patient may experience tachycardia, anxiety, nausea, cough, wheezing, and/or dizziness. Vital signs and breath sounds must be monitored; use caution with elderly, cardiac, or hypertensive patients.

2.5 mg in 2.5 to 3 mL NS via nebulizer, repeat as needed. The duration of effect is 3 to 6 hours. Ped: 0.15 mg/kg in 2.5 to 3mL NS via nebulizer, repeat as needed.

Activase / Thrombolytic

Recombinant DNA–derived form of human tPA promotes thrombolysis by forming plasmin. Plasmin,in turn, degrades fibrin and fibrinogen and, ultimately, the clot.

To thrombolyse in acute myocardial infarction, acute ischemic stroke, and pulmonary embolism.

Active internal bleeding, suspected aortic dissection, traumatic CPR, recent hemmorhagic stroke (6 mo), intracranial or intraspinal surgery or trauma (2mo), pregnancy, uncontrolled hypertension, or hypersensitivity to thrombolytics.

Recent major surgery, cerebral vascular disease, recent GI or GU bleeding, recent trauma, hypertension, patient > 75 years, current oral anticoagulants, or hemorrhagic ophthalmic conditions.

Aminophylline, Somophyllin / Methylxanthine Bronchodilator

Aminophylline is a methylxanthine that prolongs bronchodilation and decreased mucus productionand has mild cardiac and CNS stimulating effects.

Bronchospasm in asthma and COPD refractory to sympathomimetics and other bronchodilators andin CHF.

uncontrolled cardiac dysrhythmias

Cardiovascular disease, hypertension, or taking theophylline, hepatic impairment, diabetes, hyperthyroidism, young children, glaucoma, peptic ulcers, acute influenza or influenzaimmunization, and the elderly. Watch for PVCs or tachycardia. May cause hypotension.

250 to 500 mg IV over 20 to 30 min. Ped: 6 mg/kg over 20 to 30 min. Max 12 mg/kg/day.

Cordarone, Pacerone / Antidysrhythmic

Amiodarone is an Antidysrhythmic that prolongs the duration of the action potential and refractory period and relaxes smooth muscles, reducing peripheral vascular resistance and increasing coronary blood flow.

Life-threatening ventricular and supraventricular dysrhythmias, frequently atrial fibrillation.

cardiogenic shock, severe sinus bradycardia, or advanced heart block.

150 to 300 mg IV over 10 min, then 1 mg/min over next 6 hours. Ped: 5 mg/kg IV/IO, then 1.5 mg/kg/day.

Alka-Seltzer, Bayer, Empirin, St. Joseph Children's /Analgesic, Antipyretic, Platelet Inhibitor, Antiinflammatory

• Aspirin inhibits agents that cause the production of
• inflammation, pain, and fever. It relieves mild to moderate pain by acting on the peripheral nervous system, lowers body temperature in fever, and powerfully inhibits platelet aggregation.

Chest pain suggestive of an MI.

Hypersensitivity to salicylates, active ulcer disease, asthma.

Bleeding disorders

160 to 325 mg PO (chewable).

Parasympatholytic

Atropine blocks the parasympathetic nervous system, specifically the vagal effects on heart rate. May increase myocardial oxygen demand. Decreases airway secretions.

Hemodynamically significant bradycardia, bradyasystolic arrest, and organophosphate poisoning.

None in the emergency setting. 2nd degree type 2 and above heart blocks are class 2B (not recommended)

AMI, glaucoma

• Symptomatic bradycardia: 0.5 mg IV/1 mg ET. Repeat 3 to 5 min to 3 mg. Ped: 0.02 mg/kg IV, 0.04 mg/kg ET, may repeat in 5 min up to 1 mg. Asystole: 1 mg IV or 2 mg ET, may repeat 3
• to 5 min up to 3 mg
• Organophosphate poisoning: 2 to 5 mg IV/IM/IO/10 to 15 min. Ped: 0.05 mg/kg IV/IM/IO/ 10 to 15 min.

Atrovent / Anticholinergic

Ipratropium is a bronchodilator used in the treatment of respiratory emergencies that causes bronchial dilation and dries respiratory tract secretions by blocking acetylcholine receptors.

Bronchospasm associated with asthma, COPD, and inhaled irritants.

Hypersensitivity to atropine or its derivatives, or as a primary treatment for acute bronchospasm. Nut Allergy

Elderly, cardiovascular disease, or hypertension.

500 mcg in 2.5 to 3 mL NS via nebulizer or 2 sprays from a metered dose inhaler. Ped: 125 to 250 mcg in 2.5 to 3 mL NS via nebulizer, or 1 or 2 sprays of a metered dose inhaler.

Bretylol / Antidysrhythmic

Bretylium suppresses ventricular tachydysrhythmias including vfib with reentry mechanisms.

Ventricular fibrillation and ventricular tachycardia refractory to lidocaine

Digitalized patients, digitalis-induced dysrhythmias

5 mg/kg IV, then 10 mg/kg/15 to 30 min, to a max 30 mg/kg

Stadol / Synthetic Narcotic Analgesic

Butorphanol is a centrally acting synthetic narcotic analgesic about 5 times more potent than morphine. A schedule IV narcotic.

Moderate to severe pain

Hypersensitivity, head injury, or undiagnosed abdominal pain

Calcium Chloride / Electrolyte

Calcium chloride increases myocardial contractile force and increases ventricular automaticity.

Hyperkalemia, hypocalcemia, hypermagnesemia, and calcium channel blocker toxicity.

Ventricular fibrillation, hypercalcemia, and possible digitalis toxicity.

It may precipitate toxicity in patients taking digoxin. Ensure the IV line is in a large vein and flushed before using and after calcium.

5-10cc of (10% solution / 1Gram –10cc)/10 min, as needed or 2-4mg/Kg . Ped: 20 mg/kg IV (10% solution) repeat at 10 min, as needed.

Librium / Sedative, Hypotic

Chlordiazepoxide is a benzodiazepine derivative that produces mild sedation and anticonvulsant, skeletal muscle relaxant, and prolonged hypnotic effects.

Severe anxiety and tension, acute alcohol withdrawal symptoms (DTs).

Hypersen to benzodiazepines, pregnant and nursing mothers, children under 6.

Primary depressive disorders or psychoses, acute alcohol intoxication.

50 to 100 mg IV/IM

Dexamethasone is a long-acting synthetic adrenocorticoid with intense anti-inflammatoryactivity. It prevents the accumulation of inflammation generating cells at the sites of infection or injury.

Anaphylaxis, asthma, COPD, spinal cord edema.

systemic fungal infections, acute infections, tuberculosis, varicella, or vaccinia or live virus vaccinations.

Herpes simplex, keratitis, myasthenia gravis, hepatic or renal impairment, diabetes, CHF, seizures, psychic disorders, hypothyroidism, and GI ulceration

4 to 24 mg IV/IM Ped: 0.5 to 1 mg/kg.

Benadryl / Anyihistamine

blocks histamine release, thereby reducing bronchoconstriction, vasodilatation,and edema.

Anaphylaxis, allergic reactions, and dystonic reactions.

Asthma and other lower respiratory diseases.

May induce hypotension, headache, palpitations, tachycardia, sedation, drowsiness, and/or disturbed coordination.

25 to 50 mg IV/IM

Dobutrex / Sympathomimetic

Dobutamine is a synthetic catecholamine and beta agent that increases the strength of cardiac contraction without appreciably increasing rate.

To increase cardiac output in congestive heart failure/cardiogenic shock

Hypersensitivity to Sympathomimetic amines, ventricular tachycardia, and hypovolemia withoutfluid resuscitation

Atrial fibrillation or preexisting hypertension.

2 to 20 mcg/kg/min IV. Ped: same

D50W / Carbohydrate

Dextrose is a simple sugar that the body can rapidly metabolize to create energy.

Hypoglycemia

Increased ICP. Determine blood glucose level beforeadministration. Ensure good venous access.

25g D50W (50 mL) IV. Ped: 2 mL/kg of a 25% solution IV.

Intropin / Sympathomimetic

Dopamine is a naturally occurring catecholamine that increases cardiac output without appreciably increasing myocardial oxygen consumption. It maintains renal and mesenteric blood flow while inducing vasoconstriction and increasing systolic blood pressure

Nonhypovolemic hypotension (70 to 100 mmHg) and cardiogenic shock.

Hypovolemic hypotension without aggressive fluid resuscitation, tachydysrhythmias, ventricular fibrillation, and pheochromocytoma.

Ensure adequate fluid resuscitation of the hypovolemic patient.

2 to 5 mcg/kg/min up to 20 mcg/kg/min, titrated to effect. Ped: same as adult.

Cardizem / Calcium Channel Blocker

Diltiazem is a slow calcium channel blocker similar to verapamil. It dilates coronary and peripheral arteries and arterioles, thus increasing circulation to the heart and reducing peripheral vascular resistance.

Supraventricular tachydysrhythmias (atrial fibrillation, atrial flutter, and PSVT refractory to adenosine) and to increase coronary artery perfusion in angina.

Hypersensitivity, sick sinus syndrome, 2nd- or 3rd-degree heart block, systolic BP < 90, diastolic BP < 60, wide-complex tachycardia and WPW.

CHF (especially with beta blockers)

0.25 mg/kg IV over 2 min, may repeat as needed with 0.35 mg/kg followed by a drip of 5 to 10 mg/hr not to exceed 15 mg/hr over 24 hours.

Valium / Antianxiety, Hypnotic, Anticonvulsant, Sedative

Diazepam is a benzodiazepine sedative and skeletal muscle relaxant that reduces tremors,induces amnesia, and reduces the incidence and recurrence of seizures. It relaxes muscle spasms in orthopedic injuries and produces amnesia for painful procedures (cardioversion).

Major motor seizures, status epilepticus, premedication before cardioversion, muscletremors due to injury, and acute anxiety.

coma, acute alcoholism, depressed vital signs, obstetric patients, neonates.

Psychoses, depression, myasthenia gravis. Dueto a short half-life of the drug, seizure activity may recur.

Seizures: 5 to 10 mg IV/IM. Ped: 0.5 to 2 mg IV/IM.

Acute anxiety: 2 to 5 mg IV/IM. Ped: 0.5 to 2 mgIM.

Premedication: 5 to 15 mg IV. Ped: 0.2 to 0.5 mg/kgIV.

Adrenaline / Sympathomimetic

Epinephrine is a naturally occurring catecholamine that increases heart rate, cardiac contractile force myocardial electrical activity, systemic vascular resistance, and systolic blood pressure and decreases overall airway resistance and automaticity. It also, through bronchial artery constriction, may reduce pulmonary congestion and increase tidal volumeand vital capacity.

cardiac arrest and severe allergic reactions.

narrow angle glaucoma; hemorrhagic, traumatic, or cardiac shock

• Arrest: 1 mg of 1:10,000 IV/3 to 5 min (ET: 2 to 2.5 mg 1:1,000). Ped: 0.01 mg/kg 1:10,000 IV/IO (ET: 0.1 mg/kg 1:1,000). All subsequent doses
• 0.1 mg/kg IV/IO. No max.

• Allergic reactions: 0.3 to 0.5 mg of 1:1,000
• subcutaneously/5 to 15 min as needed or 0.5 to 1 mg of 1:10,000 IV if subcutaneous dose ineffective or severe reaction. Ped: 0.01 mg/kg of 1:1,000 subcutaneously/10 to 15 min or 0.01 mg/kg of 1:10,000 IV if subcutaneous dose
• ineffective or severe.

Amidate / Hypnotic

Etomidate is an ultra–short-acting nonbarbiturate hypnotic with no analgesic effects and limited cardiovascular and respiratory effects..

Induce sedation for rapid sequence intubation.

Marked hypotension, severe asthma, or severe cardiovascular disease.

Dosage/Route: 0.1 to 0.3 mg/kg IV over 15 to 30 sec. Ped: children > 10 years, same as for adults

Sublimaze / Narcotic Analgesic

Fentanyl is a potent synthetic narcotic analgesic similar to morphine and meperidine but with a more rapid and less-prolonged action.

Induce sedation for endotracheal intubation.

MAO inhibitors within 14 days, myasthenia gravis.

Increased intracranial pressure, elderly, debilitated, COPD, respiratory problems, hepatic and renal insufficiency.

25 to 100 mcg slowly IV (2 to 3 min). Ped: 2 mcg/kg slow IV/IM.

Romazicon / Benzodiazepine Antagonist

Flumazenil is a benzodiazepine antagonist used to reverse the sedative, recall, and psychomotor effects of diazepam, midazolam, and the other benzodiazepines.

Respiratory depression secondary to the benzodiazepines.

Hypersensitivity to flumazenil or benzodiazepines; those patients who take medication for status epilepticus or seizures; seizure-prone patients during labor and delivery; tricyclic antidepressant overdose.

Hepatic impairment, elderly, pregnancy, nursing mothers, head injury, alcohol and drug dependency and physical dependence on benzodiazepines.

0.2 mg IV over 30 sec/min, up to 1 mg.

Lasix / Diuretic

Furosemide is a rapid-acting, potent diuretic and antihypertensive that inhibits sodium reabsorption by the kidney. Its vasodilating effects reduce venous return and cardiac workload.

Congestive heart failure and pulmonary edema.

Hypotension

hepatic impairment, nephrotic syndrome, cardiogenic shock associated with acute MI, gout, or patients receiving digitalis or potassium-depleting steroids.

40 to 120 mg slow IV. Ped: 1 mg/kg slow IV.

GlucaGen / Hormone, Anti-hypoglycemic

Glucagon is a protein secreted by pancreatic cells that causes a breakdown of stored glycogen into glucose

Hypoglycemia without IV access and to reverse beta-blocker overdose.

Effective only if there are sufficient stores of glycogen in the liver.

Hypoglycemia: 1 mg IM/SC repeat/5 to 20 min. Ped: 0.1 mg/kg 1 m/SC/IV for child < 10 kg; 1 mg/kg 1 m/SC/IV for child > 10 kg.

• Beta-blocker overdose / Calcium Channel
• Blocker OD: 3mg IV over 1 min. Ped: 50 to 150 mcg/kg IV over 1 min.

Haldol / Antipsychotic

Haloperidol is believed to block dopamine receptors in the brain associated with mood and behavior,is a potent antiemetic, and impairs temperature regulation.

Acute psychotic episodes.

Parkinson's disease, seizure disorders, coma, alcohol depression, CNS depression, and thyrotoxicosis, and with other sedatives.

anticonvulsants, anticoagulants, or lithium therapy.

2 to 5 mg IM. Ped: Children > 3 years, 0.015 to 0.15 mg/kg/day PO in 2 or 3 divided doses.

Heparin / Anticoagulant

Heparin is a rapid-onset anticoagulant, enhancing the effects of antithrombin III and blocking the conversion of prothrombin to thrombin and fibrinogen to fibrin.

To prevent thrombus formation in acute MI.

Hypersensitivity; active bleeding or bleeding tendencies; recent eye, brain, or spinal surgery; shock.

Alcoholism, elderly, allergies, indwelling catheters, elderly, menstruation, pregnancy, or cerebral embolism.

5,000 units IV, then 20,000 to 40,000 units over 24 hours.

Isuprel / Sympathomimetic

Bradycardia refractory to atropine when pacing is not available

Cardiogenic shock.

Tachydysrhythmias and those associated with digitalis and acute myocardial infarction.

Bradycardia: 2 to 10 mcg/min titrated to cardiac rate. Ped: 0.1 mcg/kg/min titrated to cardiac rate.

Toradol / Nonsteroidal Antiinflammatory Drug (NSAID)

Ketorolac is an injectable NSAID that exhibits analgesic, antiinflammatory, and antipyretic properties without sedative effects.

Mild or moderate pain.

Xylocaine / Antidysrhythmic

Lidocaine is an antidysrhythmic that suppresses automaticity and raises stimulation threshold of the ventricles. It also causes sedation, anticonvulsant, and analgesic effects.

Pulseless ventricular tachycardia, ventricular fibrillation, ventricular tachycardia (w/pulse).

Hypersensitivity to amide-type local anesthetics, supraventricular dysrhythmias, Stokes-Adams syndrome, 2nd- and 3rd-degree heart blocks, and bradycardias.

Hepatic or renal impairment, CHF, hypoxia, respiratory depression, hypovolemia, myasthenia gravis, shock, elderly

Cardiac arrest: 1 to 1.5 mg/kg IV repeated every 3 to 5 min up to 3 mg/kg, follow conversion with a drip of 2 to 4 mg/min. Ped: 1 mg/kg IV, repeat/3 to 5 min up to 3 mg/kg, follow conversion with a drip of 20 to 50 mcg/kg/min.

Ventricular tachycardia (w/pulse): 1 to 1.5 mg/kg slow IV. Consider lower dose for elderly. May repeat at one-half dose every 5 to 10 min until conversion up to 3 mg/kg. Follow conversion with an infusion of 2 to 4 mg/min. Ped: 1 mg/kg, followed by a drip at 20 to 50 mg/kg/min.

Ativan / Sedative

Lorazepam is the most potent benzodiazepine available. It has strong antianxiety, sedative, hypnotic, and skeletal muscle relaxant properties, and a relatively short half-life.

Sedation for cardioversion and status epilepticus.

Sensitivity to benzodiazepines.

Narrow-angle glaucoma, depression or psychosis, coma, shock, acute alcohol intoxication, renal or hepatic impairment, organic brain syndrome, myasthenia gravis, GI disorders, elderly, debilitated, limited pulmonary reserve.

Sedation: 2 to 4 mg IM, 0.5 to 2 mg IV. Ped: 0.03 to 0.5 mg/kg IV/IM/PR up to 4 mg.

Status epilepticus: 2 mg slow IV/PR (2 mg/min). Ped: 0.1 mg/kg slow IV/PR (2 to 5 min).

Magnesium / Electrolyte

Magnesium sulfate is an electrolyte that acts as a calcium channel blocker, acting as a CNS depressant and anticonvulsant. It also depresses the function of smooth, skeletal, and cardiac muscles.

Refractory ventricular fibrillation and pulseless ventricular tachycardia (especially torsade depointes), AMI, eclamptic seizures.

Heart block, myocardial damage, shock, persistent hypertension, and hypocalcemia.

CNS depressants, or neuromuscular blocking agents.

Ventricular fibrillation or tachycardia: 1 to 2 g IV over 2 min.

Torsade de pointes: 1 to 2 g IV followed by infusion of 0.5 to 1 g/hr IV.

Asthma /COPD: 1-2 Grams over 10 minutes

Eclampsia: 2 to 6 g IV/IM over 15-30 mins

Osmitrol / Osmotic Diuretic

Mannitol is an osmotic diuretic that draws water into the intravascular space through its hypertonic effects, then causes diuresis.

Cerebral edema.

1.5 to 2 g/kg slow IV. Ped: 0.25 to 0.5 g/kg over 60 min.

Demerol / Narcotic Analgesic

Meperidine is a synthetic narcotic with sedative and analgesic properties comparable to morphine but without hemodynamic side effects.

Moderate to severe pain.

seizure disorders, or acute abdomen prior to diagnosis.

Increased intracranial pressure, asthma or other respiratory conditions, supraventricular tachycardias, prostatic hypertrophy, urethral stricture, glaucoma, elderly or debilitated patients, renal or hepatic impairment, hypothyroidism, or Addison's disease.

25 to 50 mg IV, 50 to 100 mg IM. Ped: 1 mg/kg IV/IM.

Solu-Medrol / Corticosteroid, Anti-inflammatory

Methylprednisolone is a synthetic adrenal corticosteroid, effective as an anti-inflammatory and used in the management of allergic reactions and in some cases of shock. It is sometimes used in the treatment of spinal cord injury.

Spinal cord injury, asthma, severe anaphylaxis, COPD.

Only a single dose should be given in the prehospital setting.

Asthma/COPD/anaphylaxis: 125 to 250 mg IV/IM. Ped: 1 to 2 mg/kg/dose IV/IM.

Spinal cord injury: 30 mg/kg IV over 15 min, after 45 min an infusion of 5.4 mg/kg/hr.

Reglan / Antiemetic

Metoclopramide is a dopamine antagonist similar to procainamide but with few antidysrhythmic or anesthetic properties. Its antiemetic properties stem from rapid gastric emptying and desensitization of the vomiting reflex.

Nausea and vomiting.

Hypersensitivity, allergy to sulfite agents, seizure disorders, pheochromocytoma, mechanical GI obstruction or perforation, and breast cancer.

CHF, hypokalemia, renal impairment, GI hemorrhage, intermittent porphyria.

10 to 20 mg IM; 10 mg slow IV (over 1 to 2 min). Ped: 1 to 2 mg/kg/dose.

Lopressor / Beta Blocker

Metoprolol is a beta-adrenergic blocking agent that reduces heart rate, cardiac output, and BP

AMI

Cardiogenic shock, sinus bradycardia <45, 2nd-3rd degree HB, PR interval >0.24, asthma or COPD

Hypersensitivity, hepatic or renal impairment, cardiomegaly, CHF controlled by digitalis and diuretics, AV conduction defects, thyrotoxicosis, diabetics, or Peripheral vascular disease.

5mg slow IVP q 5min up to 3 doses while watching HR and BP.

Versed / Sedative

Midazolam is a short-acting benzodiazepine with CNS depressant, muscle relaxant, anticonvulsant, and anterograde amnestic effects.

To induce sedation before cardioversion or intubation.

Hypersensitivity to benzodiazepines, narrow-angle glaucoma, shock, coma, or acute alcohol intoxication.

COPD, renal impairment, CHF, elderly.

1 to 2.5 mg slow IV; 0.07 to 0.08 mg/kg IM (usually 5 mg). Ped: 0.05 to 0.2 mg/kg IV: 0.1 to 0.15 mg/kg IM; 3 mg intranasal.

Primacor / Cardiac Inotrope, Vasodilator

Milrinone is related to amrinone and increases the strength of cardiac contraction without increasing rate, increasing cardiac output without increasing oxygen demand.

CHF, or pediatric septic shock.

Hypersensitivity

Elderly, pregnancy, and nursing mothers

Morphine / Narcotic Analgesic

Morphine sulfate is a potent analgesic and sedative that causes some vasodilation, reducing venous return, and reduced myocardial oxygen demand.

Moderate to severe pain and in MI and to reduce venous return in pulmonary edema.

Hypersensitivity to opiates, undiagnosed head or abdominal injury, hypotension, or volume depletion, acute bronchial asthma, COPD, severe respiratory depression, or pulmonary edema due to chemical inhalation.

Elderly, children, or debilitated patients. Naloxone should be readily available to counteract the effects of morphine

Pain: 2.5 to 15 mg IV; 5 to 20 mg IM/subcutaneous. Ped: 0.05 to 0.1 mg/kg IV; 0.1 to 0.2 mg/kg IM/subcutaneous

AMI or PE: 1 to 2 mg 6 to 10 min to response.

Narcan / Narcotic Antagonist

Naloxone is a pure narcotic antagonist that blocks the effects of both natural and synthetic narcotics and may reverse respiratory depression.

Narcotic and synthetic narcotic overdose, coma of unknown origin.

Hypersensitivity to the drug, non–narcotic-induced respiratory depression.

Possible dependency (including newborns). It also has a half-life that is shorter than that of most narcotics; hence the patient may return to the overdose state.

0.4 to 2 mg IV/IM/IN (2 to 2.5 times the dose ET), repeated/2 to 3 min as needed up to 10 mg. Ped: 0.01 mg IV/IM (2 to 2.5 times the dose ET) repeated/2 to 3 min as needed up to 10 mg.

Nitrostat / Nitrate

Nitroglycerin is a rapid smooth muscle relaxant that reduces peripheral vascular resistance,blood pressure, venous return, and cardiac workload.

Chest pain associated with angina and acute myocardial infarction, and acute pulmonary edema.

Hypersensitivity, tolerance to nitrates, severe anemia, head trauma, hypotension, increased ICP, patients taking sildenafil, glaucoma, and shock.

May induce headache that is sometimes severe. Nitroglycerin is light sensitive and will lose potency when exposed to the air.

1 tablet (0.4 mg) SL. May be repeated/3 to 5 min up to 3 tablets, or 1⁄2 inch of topical ointment, or 0.4 mg (one spray)SL up to 3 sprays/25 min.

Nubain / Narcotic Analgesic

Nalbuphine is a synthetic narcotic analgesic equivalent to morphine, though its respiratory depression does not increase with higher doses.

Moderate to severe pain.

Hypersensitivity, undiagnosed head or abdominal injury.

Impaired respirations, narcotic dependency.

5 mg IV/IM/subcutaneous, repeat as 2 mg doses as needed up to 20 mg. Ped: 0.1 to 0.15 mg/kg IV/IM/subcutaneous (rarely used)