CLASS: Sympathomimetic Agonist (Selective B2 adrenergic receptors)
INDIC: Asthma; Bronchospasm; COPD; Hyperkalemia
CONTRA: Caution to elderley, CVD, HTN
SIDE EFFECTS: Palpatations, anxiety, dizziness, headache, nervousness, tremor, hypertension, arrhythmias, chest pain, nausea/vomiting
DOSE: 2.5mg nebulized
MOA: Parasympatholytic, causes bronchodilation, drying of respiratory secretions, blocks acetylcholine receptors thus inhibiting parasympathetic stimulation.
INDIC: Symptomatic Bradycardia, organophosphate poisoning, nerve agent
CONTRA: Known Hypersensitivity
SIDE EFFECTS: Palpitations, anxiety, dizziness, headache, nervousness, rash, nausea, vomiting
DOSAGES: Adult- Symptomatic Bradycardia/PEA, Asystole: 0.5-1.0mg IV, IO, ET. Max Dose- 3mg or 0.04mg/kg.
Adult Organophosphate Poisioning: 2-5mg until symptoms dissipate.
Pediatric PEA; Asystole: 0.02mg/kg 1.0mg max
50% Dextrose in Water
MOA: Elevates blood glucose levels rapidly
INDIC: Hypoglycemia, BGL< 60
CONTRA: IV with signs of infiltration
SIDE EFFECTS: Local venous irritation, necrosis if given through an infiltrated IV
DOSAGES: Adult: 25mg (50ml)
Pediatrics: D25 0.5-1ml/kg (may be premixed or eject out 25ml and draw 25ml of NS)
CLASS: Platelet inhibitor and anti-inflammatory
INDIC: New chest pain suggestive of acute myocardial infarction. Signs and symptoms suggestive or a recent stroke (CVA)
CONTRA: Patients with known hypersensitivity to the drug.
SIDE EFFECTS: Heartburn, nausea, wheezing
DOSE: 160mg or 325mg by mouth (primarily by four 81mg chewable tablets)
CLASS: Benzodiazepine antagonist
MOA: Reverse the effects of benzodiazepines
INDIC: To reverse central nervous system respiratory depression associated with benzodiazepines
CONTRA: Do not administer as a diagnostic agent for Benzo OD; hypersensitivity. DO NOT ADMIN WITH MIXED OD OR IF PT HAS TRICYCLIC ANTIDEPRESSENT
SIDE: Fatigue, Headache, Nervouseness, Dizziness
DOSE: 0.2mg IV over 30 seconds. Max dose 1mg
CLASS: Phenothiazine antihistamine
MOA: Mild anticholinergic activity, anit-emetic, potentiates actions of analgesics, sedation.
INDIC: Nausea/Vomiting, motion sickness, potentiate the effects of analgesics, sedation.
CONTRA: Comatose states, patients with large amounts of depressants (including alcohol)
Side: Impair mental and physical ability. May cause severe venous irritation and phlebitis. If given intra-arterial may cause sever damage including the need for amputation. May also cause distonic reaction.
DOSE: 12.5mg-25mg IV (a lower dose for geriatrics 6.25mg)
NOTE: HAS BEEN KNOWN TO CAUSE RESPIRATORY DEPRESSION IN PEDIATRICS
MOA: Selective blocking agent of serotonin 5-HT3 receptor type.
SIDE: Diarrhea, headache
DOSE: 4mg IV (Adult) 0.2mg/kg IV (Pediatric)
CLASS: Hormone (oxytocic)
MOA: Caues uterine contraction, lactation, slows postpartum vaginal bleeding
INDIC: Postpartum vaginal bleeding
CONTRA: Any condition other than postpartum bleeding; C-Section
SIDE: Anaphlyaxis, cardiac dysrhythmias
DOSE: IV 10-20units in 500ml until desired effect; 3-10units IM
MOA: Anticonvulsant, skeletal muscle relanxant.
INDIC: Major motor seizures, status epilepticus, premedication of cardioversion, acute anxiety states
SIDE: Drowsiness, hypotension, respiratory depression
DOSE: (Adult) 0.5-2mg IV, IM
(Pediatric) 0.05-0.1mg/kg IV, IM, Rectal
CLASS: Antidysrhthymic Group III
MOA: Prolongs action potential and refractory period, slows sinus rate, increases PR and QT interval, decreases PVR
INDIC: V-Fib, V-Tach, (Prmary success is with wide complex tachycardias with pulse)
CONTRA: Severe sinus node dysfunction, sinus bradycardia, high degree AV blocks
SIDE: Hypotension, nausea, anorexia, malaise, tremors, ventricular ectopic beats
DOSE: Adult V-Fib/V-Tach w/o Pulse: 300mg followed by 150mg. Wide Complex Tachycardia: 150mg over 10 minutes. (Pediatrcis) 5mg/kg
CLASS: Potent Diuretic
MOA: Inhibits reabsorption of sodium chloride, promotes prompt dieresis, vasodilation (very small amount) potassium wasting
INDIC: CHF, Pulmonary Edema
CONTRA: Pregnancy, dehydration
SIDE: If kidneys are working; Electrolyte depletion. If kidneys are not working; little to no use.
DOSAGE: 20-40mg (double if already on lasix)
CLASS: Hormone, vasoconstrictor
MOA: Potent vasoconstrictor
INDIC: Cardiac Arrest
SIDE: Blanching of skin, hypertension, bradycardia
DOSAGE: 40 Units IV Single dose
MOA: Suppresses ventricular ectopy, increases ventricular fib threshold, reduces velocity of electrical impulse.
INDIC: V-fib, V-Tach, Malignant PVC’s, Pretreatment for intubation in head injury
CONTRA: High degree heart blocks, PVC’s in conjunction with bradycardia
SIDE EFFECTS: Anxiety, drowsiness, confusion, convulsions, widening QRS
DOSE: Adult: Bolus 1-1.5mg/kg followed by ½ initial dose. Drip Rate: 4:1 concentration 1-4mg/min.
CLASS: Calcium Channel Blocker
MOA: Slows conduction through the atrioventricular node; Causes vasodilation; Decreases rate of ventricular response; Decreases myocardial oxygen demand.
INDIC: To control rapid ventricular rates associated with atrial fibrillation and flutter; Angina pectoris
CONTRA: Hypotension; wide complex tachycardia; Conduction system disturbances. Should not be used in patients receiving IV beta blockers or with severe hypotension.
SIDE EFFECTS: Nausea and vomiting; hypotension; Dizziness
DOSAGE: Adult: 1st dose is 0.25mg/kg bolus (typically 20mg) IV over 10 minutes, Followed by a second dose of 0.35 mg/kg IV slow IV push or IV drip over 10 minutes.
Do a 12 Lead, make sure QRS is no wider than .12
MOA: Slows atrioventricular conduction
INDIC: Symptomatic SVT
CONTRA: Second or third degree heart block; sick sinus syndrome; known hypersensitivity to the drug.
SIDE EFFECTS: Facial Flushing; Headache; Shortness of Breath; Dizziness; Nausea.
DOSAGE: 1st dose 6mg RIVP, 2nd dose 12mg RIVP, 3rd dose 12mg RIVP
Note: 60% of those who will respond to adenosine will respond to the a 6mg dose. 90% of patients will respond to a 12mg RIVP dose. Most EMS services will skip the 6mg dose and jump straight to the 12mg dose.
MOA: Increases Cardiac contractility; Causes peripheral vasoconstriction
INDIC: Hemodynamically significant hypotension (systolic of 70-100mmHg) not resulting from hypovolemia; cardiogenic shock.
CONTRA: Hypovolemia in which pre-load has not been restored.
SIDE EFFECTS: Ventricular tachydysrhtymias; Hypertension; Palpitations
DOSAGE: 1-2mcg/kg/min Dopaminergic effects (renal)
2-10 mcg/kg/min stimulates beta adrenergic receptors (causing enhanced contractility, increased cardiac output, rise in BP)
10-20 mcg/kg/min stimulates alpha adrenergic receptors (causing peripheral and venous constriction)
MOA: Anti-inflammatory; suppresses immune response, especially in allergic reactions
INDIC: Severe anaphylaxis, Asthma, COPD
CONTRA: none in the emergency setting
SIDE EFFECTS: GI bleeding; prolonged wound healing; suppression of natural steroids
DOSAGE: General usage: 125mg IV, IM (Adult)
CLASS: Sympathetic Agonist
MOA: Acts on the alpha and beta adrenergic receptors. Much more beta effects than alpha. Increase heart rate, cardiac contractile force, SVR, and increase BP
INDIC: Bronchial Asthma; anaphylaxis; Cardiac Arrest
CONTRA: Caution in patients with known cardiovascular disease; None in life threatening situations
SIDE: Palpitations, anxiety, headache, dizziness, nausea, vomiting, possible myocardial ischemia
DOSE: Adult Anaphylaxis: 0.3-0.5mg SC 1:1000.
Cardiac Arrest: 1mg IV 1:10,000
Pediatric Anaphyaxis: 0.01mg/kg SC 1:1000
Pediatric Cardiac Arrest: 0.01 mg/kg IV/IO 0.1mg ET
CLASS: Antihistamine, H1 Histamine
MOA: Blocks histamine receptors, has some sedative effects.
INDIC: Anaphylaxis, Allergic Reactions, Dystonic Reactions due to phenothiazines
CONTRA: Asthma; Nursing Mothers, Hypotension
SIDE: Sedation; dries bronchial secretions; blurred vision; headache; palpitations.
DOSE: Adult: 25-50 mg IV, IM
Pediatric 2-5 mg/kg
MOA: Smooth muscle relaxant, reduces cardiac work, dilates coronary arteries, dilates systemic arteries
INDIC: Angina; Chest pain associated with MI, CHF
CONTRA: Children under 12 years of age, Viagra/Levitra within 24 hours, Cialis within 36 hours. Caution with right side MI involvement.
SIDE: Headache, hypotension
DOSE: Nitro Tab: 0.4mg = 1 tab (usually up to 3 tabs)
Nitro Spray: 0.4mg = 1 spray (usually up to 3 sprays)
Nitro Paste: 1inch transdermal = 15mg
CLASS: Hormone (anti-hypoglycemic agent)
MOA: Breakdown of glycogen to glucose (liver), inhibits glycogen synthesis; Elevates blood glucose level, increase heart rate.
INDIC: Hypoglycemia, beta-blocker overdose
CONTRA: Hypersensitivity to the drug
SIDE: Few in emergency situation
DOSE: Adult: 1mg IV, IM
Pediatric 0.03 mg/kg
MOA: Dries respiratory tract secretions
INDIC: Bronchial Asthma, Reversible bronchospasm associated with COPD
CONTRA: Hypersensitivity to the drug
SIDE: Palpitations, dizziness, anxiety, headache, nervousness
DOSAGE: 500mcg placed in neb with beta agonist
(Safety in children has not been established)
CLASS: Nonsteroidal anti-inflammatory (NSAID)
MOA: Anti-inflammatory, analgesic
INDIC: Mild to moderate pain (Kidney Stones)
CONTRA: Hypersensitivity, allergy to ASA, bleeding disorders, probability or surgery
SIDE: Edema, rash, heartburn, continued bleeding
DOSE: 30-60mg IV,IM Adult only
MOA: Allows normal breakdown of glucose
INDIC: Coma of unknown origin, alcoholism, delirium tremors, malnutrition
DOSE: 100mg IV,IM
CLASS: Cholinesterase reactivator
MOA: Reactivates cholinesterase in cases of organophosphate poisoning and nerve agents
INDIC: Severe organophosphate poisoning/nerve agent characterized by muscle twitching, respiratory depression and paralysis
CONTRA: Poisoning due to inorganic phosphates
SIDE: Excitement, Manic Behavior
DOSE: 600mg Auto Injector
MOA: Slows conduction through myocardium; Elevates ventricular fibrillation threshold; Suppresses ventricular ectopic activity.
INDIC: Persistent cardiac arrest due to ventricular fibrillation and refractory to lidocaine; PVC’s refractory to lidocaine; Ventricular tachycardia refractory to lidocaine.
CONTRA: High Degree Heart Blocks; PVC’s in conjunction with bradycardia.
SIDE: Anxiety; Nausea; Convulsions; Widening of QRS complex
DOSE: Adults Intial: 20mg/min IV drip until dysrhtymia is abolishised, or hypotension ensues, or RS complex is widened by 50% of its original width, or total of 17mg/kg has been given. Given by Slow IV bolus, IV Drip
Adult Mainanence: 1-4mg/min
MOA: Magnesium is a physiological Ca Channel blocker as well as a smooth muscle relaxant.
INDIC: OB: Eclampsia
Cardiovascular: Severe refractory V-fib or Pulseless V-Tach; post-myocardia infarction as prophylaxis for dysrhthmias, and torsade de pointes (multifocal V-Tach
Respiratory: Severe bronchoconstriction
CONTRA: High degree AV blocks, dialysis patients.
SIDE: Flushing; sweating; bradycardia; decreased deep tendon reflexes, drowsiness, RESPIRATORY DEPRESSION, HYPOTENSION, hypothermia, itching.
DOSAGE:Eclampsia – 4g over 10min; V-Fib/V-Tach 2g IVP
Severe Bronchoconstriction: 2g over 10min
MOA: Increases cardiac
INDIC: Acute hyperkalemia (elevated KI level); Acute Hypocalcemia (decreased Ca) level; Ca Channel blocker OD; Abdominal muscle spasm associated with spider bites and Portuguese man of War stings; antidote for Mag Sulfate.
CONTRA: Patients on digitalis
SIDE: Dysrhthymias (bradycardia and asystole)
DOSE: Adult: 1 Gram
Pediatric: 5-7mg/kg of a 10% solution.
CLASS: Cyanide Antidote
MOA: Converts cyanide to thiocyanate where it can be eliminated by the body.
INDIC: Cyanide poisoning
CONTRA: none in the emergency setting of Cyanide Poisoning
SIDE: Nausea; Vomiting; Psychosis.
DOSE: Adult: 12.5g IV; half original dose repeated as needed
Pediatric: 400mg/kg IV; half original dose repeated as needed.
CLASS: Analgesic, Antipyretic
MOA: Elevated pain threshold and antipyresis through action on the hypothalamic heat-regulating center
INDIC: Minor headache, muscle pains, bursitis, sprains, fever due to colds and “Flu”
CONTRA: Use caution if patient has hepatic problems
SIDE: In overdose situations may cause hepatic toxicity. Fatality rare in overdoses less than 15grams. Toxicity amount greater than 150mg/kg
DOSE: Adults and Children 12Y/O 1-2 tablets or capsules 3-4 times a day. Usual package is 325mg
MOA: Adsorbs toxins by chemical binding and preventing GI adsorption.
INDIC: Poisoning following emesis or when emesis is contraindicated.
CONTRA: None in Severe poisoning
SIDE: Nausea, vomiting, constipation.
DOSE: 1g/kg (typically 50-78g) mixed with a glass of water to form a slurry.
MOA: Causes coronary vasodilation, removes cyanide ion via complex mechanism
INDIC: Cyanide Poisoning (bitter
almond smell of breath)
CONTRA: None in cyanide poisoning
SIDE: Headache, hypotension, reflex tachycardia, nausea
DOSE: Adult-Inhalant broken and inhaled as needed
Pediatric-Same as Adult
CLASS: Narcotic agonist
MOA: Reverses effects of Narcotics
INDIC: Narcotic overdoses with respiratory depression (opiates: morphine, dilauded, fentanyl, Demerol, heroin, percodan, methadone)
CONTRA: Hypersensitivity to the drug
DOSE: Adult: 1-2mg IV,ET,IM,IN (as much as 4-6mg may be required)
Pediatric: 0.1mg/kg IV,ET,IM,IN
CLASS: ACE Inhibitory (Angiotensin-Converting Enzyme Inhibitor)
MOA: Inhibiting the conversion of Angiotensin I to angiotensin II, the angioensin/aldosterone sysem is suppressed and BP is lowered.
INDIC: Uncontrolled hypertension, CHF
DOSE: Adult: 1.25mg IV
CLASS: Neuromuscular blocking agent (depolarizing)
MOA: Skeletal muscle relaxants; paralytic
INDIC: To paralyze a pt for RSI to achieve intubation
CONTRA: Hypersensitivity to the drug, burns in the first 24 hrs, open globe injuries, hyperkalemia, rhabdomyolisis, crush injury
PRECAUTION: Not to be adminstered unless skilled personnel are present
SIDE: Hypotension; Bradycardia
DOSE:1-1.5mg/kg (40-100mg) in an adult IV
Pediatric: 1mg/kg IV
CLASS: Paralytic (non-depolarizing)
MOA: Skeletal muscle relaxant including respiratory
INDIC: Paralysis to achieve RSI for ETI
CONTRA: Known hypersensitivity
PRECAUTION: Should not be administered unless skilled personnel are present
SIDE: Prolonged paralysis; hypotension; bradycardia
DOSE: (adult) 0.1mg/kg IV
Pediatric: 0.1mg/kg IV
MOA: Creates ultra short acting sed/hypnotic effect
INDIC: Induction agent for RSI; Sedative for other sedating measures.
CONTRA: Known hypersensitivity
SIDE: Myoclonic skeletal muscle movement; laryngospasm
DOSE: 0.1-0.3mg/kg IV over 15-30 seconds.
Pediatrics over 10: Same as adult
Not indicated in pt under 10 years old.
MOA: Increase cardiac contractility, little chronotropic activity
INDIC: Short term management of CHF
CONTRA: Should onlybe used in patients with an adequate heart rate
SIDE: Headache; Hypertension; Palpitations
DOSE: 2.5-20 mcg/kg/min. Mix 250mg in 500mL to get a concentration of 500mcg/mL
CLASS: Alkalinizing agent
MOA: Combines with excessive acids to form a weak volatile acid, increases pH
INDIC: Late management of cardiac arrest, tricyclic antidepressant OD, First line for cardiac arrest due to hyperkalemia (dialysis pt), crush injury
CONTRA: Alkalotic states
DOSE: 1 mEq/kg follewd by 0.5mEq/kg every 10min usually one syringe contains (50mEq)
MOA: Anticonvulsant, skeletal muscle relaxant.
INDIC: Major motor seizures, status epilepticus, premedication for cardioversion, acute anxiety states
SIDE: Drowsiness, hypotension, respiratory depression
DOSE: (Adult) 4 mg IV, IM repeat 2mg q 3-5 max 10mg
(Pediatric) 0.1 –0.3 mg/kg IV,IM,Rectal
CLASS: Tranquilizer, antipsychotic
MOA: Blocks Dopamine receptors in brain responsible for mood and behavior, antiemetic properties
INDIC: Acute psychotic episodes
CONTRA: Should not administered in the presence of other sedatives, not used in management of dysphoria caused by Talwin
SIDE: Physical and mental impairment
DOSE: 5-10mg IM
FDA JUST ISSUED A BLACK BOX WARNING FOR IV USE MAY PROLONG QT SEGMENT
MOA: Bronchodilator, increases heart rate
INDIC: Bronchial asthma, COPD, pre-term labor
SIDE: Palpitations, tachycardia, PVC, anxiety, tremors, headache
DOSE: Adult –0.25 mg SQ
Pediatric –0.01 mg/kg SQ
MOA: Central nervous system depressant, peripheral vasodilation, decreases sensitivity to pain (causes dilatation through histamine release)
INDIC: Severe pain, Pulmonary Edema, MI chest pain
CONTRA: Head injury, volume depletion, undiagnosed abdominal pain, hypersensitivity
SIDE: Dizziness, altered LOC
DOSE: (Adult) 4 mg; repeat 2mg q 5-10; max 10mg or until relief of symptoms (burns require much more)
(Pediatric) 0.1 mg/kg max 5mg
MOA: Binds to opiate receptors in the CNS, altering the response and perception of pain
INDIC: Narcotic pain relief, anti-anxiety
CONTRA: known hypersensitivity and BP<110 systolic
DOSE: (Adult) 50-75 mcg IM, IV, IO; Subsequent dose of 25 mcg q20-30 minutes to max of 200 mcg
MOA: Central nervous system depressant
INDIC: Pain of musculoskeletal origin, particularly fx, burns, ischemic chest pain
CONTRA: Patients who cannot comprehend verbal instructions, intoxicated, Head injury with altered LOC, COPD, pneumothorax, abd pain
SIDE: Headache, dizziness, giddiness, nausea, vomiting
DOSE: Self admin. Fixed 50% nitrous and 50% O2blender