EMT-PARAMEDIC Drug Cards

EMT-PARAMEDIC –Drug Cards

Pharmacology

Please note

·  Many drugs have nausea, vomiting, dizziness as side effects

·  All drugs are metabolized/eliminated by the liver and kidneys and should be given cautiously to patients with diseases in these body systems

·  You should never give any drug to a patient with a known hypersensitivity to that drug

Cardiac Drugs / Vasopressors /

*Epinephrine, 1:10,000, 1:1,000

w  Type of drug; B-1 and B-2 agonist.
w  Mechanism of Action; Stimulates alpha and beta adrenergic receptors causing bronchodilation, cardiac and CNS stimulation.
w  Indications; Acute asthma attacks, severe allergic reactions, cardiac arrest, sinus bradycardia causing severe hypotension.
w  Contraindications; None in cardiac arrest.
w  Precautions; Cardiac disorders, hypertension, elderly.
w  Route and Dosage; onset usually ~ 90 seconds
Bronchodilator; Adult SQ/IM 0.1 – 0.5 mg (1:1,000 soln) q 10 – 15 min., max. dose 1 mg; for Adult neb 0.5 ml (1:1000 soln) in 2.5 ml NS
Anaphylactic reaction/asthma; Adult SQ/IM 0.1 – 0.5 mg (1:1,000 soln) q 10-15 min., max. dose 1 mg; Peds 0.01 mg/kg.
Cardiac Arrest; Adult 1 mg q 3 – 5 min. (1:10,000 soln); Peds 0.01 mg/kg.
w  Adverse reactions and side effects; cerebral hemorrhage, palpitations, tachycardia, dysrhythmias

*Vasopressin

w  Type of drug; Pituitary hormone
w  Mechanism of Action; Promotes reabsorption of water by action on renal tubular epithelium; potent peripheral vasoconstrictor.
w  Indications; Cardiac arrest; Vf/Pulseless VT
w  Contraindications; none in cardiac arrest
w  Precautions; none in cardiac arrest
w  Route and Dosage; IV 40 U, one time only
w  Adverse reactions and side effects

*Dopamine

w  Type of drug; Sympathomimetic, vasopressor, inotropic agent
w  Mechanism of Action; Causes increased cardiac output; acts on B-1 and Alpha receptors, causing vasoconstriction to blood vessels; B-1 stimulation produces inotropic effects with increased cardiac output.
w  Indications; Hypotension (not related to hypovolemia)
w  Contraindications; vf, tachydysrhythmias
w  Precautions; Treat hypovolemia with fluid before administering dopamine.
w  Route and Dosage; IV, 2 – 20 mcg/kg/min., titrated to effect
w  Adverse reactions and side effects; tachyarrhythmias

Cardiac Drugs / Vasopressors

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*Atropine

·  Type of drug; antidysrhythmic, anticholinergic, parasympatholytic

w  Mechanism of Action; blocks acetylcholine at parasympathetic neuroeffector sites on AV and SA nodes; increases cardiac output, heart rate by blocking vagal stimulation
w  Indications; Symptomatic bradycardia < 60 bpm
w  Contraindications;
w  Precautions; Increases myocardia oxygen demand, CHF, HTN. May be harmful if used to treat AV block (Mobitz II and 3rd degree block; doses less than the minimum may slow the heart rate.
w  Route and Dosage; Bradycardia Adult IV 0.5 mg q 3-5 min., max 0.03-0.04 mg/kg; Peds 0.02 mg/kg (min. dose 0.1mg, max dose 0.5 mg)
Asystole or PEA Adult IV 1 mg q 3-5 min., max 0.03-0.04 mg/kg (3 mg)
w  Adverse reactions and side effects; tachycardia, paradoxical slowing in 3rd degree block, dry mouth, dilated pupils.

*Lidocaine

w  Type of drug; Antidysrhythmic
w  Mechanism of Action; Increases electrical stimulation threshold of ventricle, His-Purkinje system by affecting sodium channels, which stabilizes cardiac membrane, decreases automaticity
w  Indications; Ventricular tachycardia, ventricular fibrillation, malignant PVC’s
w  Contraindications; hypersensitivity, heart blocks, supraventricular dysrhythmias, bradycardia with PVCs, systolic < 90 mmHg systolic
w  Precautions; hepatic disease, CHF, respiratory depression, elderly
w  Route and Dosage; IV, 1-1.5 mg/kg q 5-8 min, max dose 3 mg/kg; Peds 1mg/kg;
w  NOTE bolus dose of lidocaine lasts approx. 20 min. administer lidocaine gtt to maintain desired levels once arrhythmia is corrected or spontaneous circulation returns. Add 1 gm lidocaine to 250 cc of NS (concentration of 4 mg/ml); gtt at 1-4 mg/min.
w  Adverse reactions and side effects; heart block, respiratory depression, seizures, hypotension
*Amiodarone w  Type of drug; Antidysrhythmic
w  Mechanism of Action; prolongs duration of action potential and effective refractory period; non-competitive a and b-adrenergic inhibitions; increases PR and QT intervals; decreases sinus rate, decreases peripheral vascular resistance.
w  Indications; Ventricular tachycardia, ventricular fibrillation, cardiac arrest
w  Contraindications; 2nd and 3rd degree blocks, bradycardia, neonates, infants
w  Precautions; CHF, severe hepatic, respiratory diseases, children; half-life 40 days
w  Route and Dosage; IV
Ventricular dysrhythmias; 150 mg over 10 minutes. May repeat 150 mg over 10 min.
Cardiac arrest; 300 mg IV push; may repeat once 150 mg in 3-5 min.
w  Adverse reactions and side effects; sinus arrest, CHF, dysrhythmias, SA node dysfunction; hepatotoxicity; ARDS

Cardiac Stimulator/Vasoconstrictor (cont.)

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*Adenosinew  Type of drug; Antidysrhythmic
w  Mechanism of Action; Slows conduction through AV node; inhibits reentry pathways through AV node.
w  Indications; to convert SVT to sinus rhythm
w  Contraindications; 2nd or 3rd degree heart block; prolonged asystole in patients taking Dipyridamole (Persantine, an antiplatelet agent) or Tegretol (an antiseizure drug)
w  Precautions; Pt may transiently develop asystole, PVCs, PACs, sinus bradycardia, and sinus tachycardia after administration; asthma
w  Route and Dosage; IV; 6 mg rapid IV bolus, followed in 1-2 min. with 12 mg if no response. May admin. an additional 12 mg. Peds 0.05 mg/kg, may increase by 0.05 mg/kg every 2 minutes to a max of .25 mg/kg. Note: rapid bolus is crucial – half-live is ~ 30 seconds;
follow rapid IV bolus (in proximal IV site) with rapid IV flush of NS.
w  Adverse reactions and side effects; prolonged asystole, dyspnea, chest pressure
*Diltiazem (Cardizem)w  Type of drug; Calcium channel blocker
w  Mechanism of Action; Inhibits calcium ion influx across cell membrane during cardiac depolarization; decreases conduction velocity and ventricular rate; produces relaxation of coronary vascular smooth muscle.
w  Indications; Atrial fibrillation, atrial flutter
w  Contraindications; 2nd or 3rd degree block, hypotension (SBP 90), AMI.
w  Precautions; CHF, hypotension.
w  Route and Dosage; 0.25 mg/kg bolus over 2 min.; may repeat at 0.35 mg/kg after 15 min. (avg initial dose 25 mg)
w  Adverse reactions and side effects; heart block, hypotension, bradycardia, CHF.
*Magnesium Sulfatew  Type of drug; Electrolyte, antiarrhythmic, anticonvulsant
w  Mechanism of Action; essential for muscle contraction; causes CNS depression and controls seizures by blocking release of acetylcholine at the myoneural junction; decreases sensitivity of motor end plate to acetylcholine and decreases excitability of motor membrane.
w  Indications; correct hypomagnesemia in Torsade de pointes; management of eclampsia of pregnancy
w  Contraindications; hypocalcemia, heart block; do not administer in toxemia during the 2-hour period before delivery.
w  Precautions; rapid IV administration. May cause respiratory or cardiac arrest
w  Route and Dosage; Cardiac arrest: 1-2 gm in 10 ml IVP; Torsade de pointes; 1-2 gm in 50-100 ml of NS IV over 5-20 min.; Eclampsia: 4 – 5 g IV infusion over 5-10 min
w  Adverse reactions and side effects; resp. depression and arrest, arrhythmias, hypotension; to reverse these effects, hyperventilate pt. and admin. IV bolus of 10% calcium gluconate 10-20 ml.
Vasodilator
*Nitroglycerine·  Type of drug; coronary vasodilator, antianginalw  Mechanism of Action; relaxes vascular smooth muschle, causes vasodilation which results in increased coronary blood flow; dec. preload.
w  Indications; prophylaxis of angina pain, CHF associated with acute MI
w  Contraindications; Cerebral hemorrhage; use of Viagra or other EDD drugs within 24-36 hrs, SBP<90.
w  Precautions; postural hypotension, severe hepatic disease
w  Route and Dosage; SL or Spray, 0.4 mg q 5 min. max dose 3 tabs/sprays, Transdermal 1-2 inches on skin
w  Adverse reactions and side effects; headache, hypotension, tachycardia
Antidote
Narcan (naloxone)
w  Type of drug; Opioid antagonist, antidote
w  Mechanism of Action; competes with opioids at opiate receptor sites
w  Indications; respiratory depression induced by opioids, coma of unknown origin (to rule out narcotic OD)
w  Contraindications; none in the emergency setting
w  Precautions; pregnancy, cardiovascular disease, opioid dependency, seizure disorder. NOTE: repeat doses of narcan may be necessary due to shorter half life than narcotics
w  Route and Dosage; IV/SQ/IM; 0.4-2 mg q 2-3 min.(slow IV bolus); Peds 0.01 mg/kg
w  Adverse reactions and side effects; recurrent respiratory depression
Activated Charcoal
w  Type of drug; antidote
w  Mechanism of Action; binds poisons, toxins, irritants; increases adsorption in the GI tract; inactivates toxins and binds until excreted
w  Indications; poisoning
w  Contraindications; unconsciousness (unless with NG tube), poisoning of cyanide, mineral acids, caustic acids and alkalines, absent gag reflex, ethanol intoxication
w  Precautions;
w  Route and Dosage; PO/NG; Adult and child; 30-100 g or 1 g/kg NOTE: most effective if given within 30 minutes of ingestion
w  Adverse reactions and side effects; vomiting, black stools
Antihistamine
Benadryl (diphenhydramine)
w  Type of drug; antihistamine
w  Mechanism of Action; decreases allergic response by blocking histamine
w  Indications; allergic reaction
w  Contraindications; acute asthma attack, COPD
w  Precautions; cardiac disease, hypertension, glaucoma, elderly
w  Route and Dosage: IV 10-50 mg; Peds 2-5 mg/kg IV/IM
w  Adverse reactions and side effects; seizures, CNS depression
Bronchodilator /
*Albuterol (Proventil, Ventolin)
w  Type of drug; Adrenergic b-2 agonist, sympathomimetic, bronchodilator
w  Mechanism of Action; Dilates bronchial smooth muscle, selectively stimulates B-2 adreneric receptors of bronchial smooth muscle and lungs.
w  Indications; asthma, acute bronchospasm assoc. with COPD, bronchiectasis or other reversible airway obstruction.
w  Contraindications; hypersensitivity to this drug and peanuts, tachydysrhythmias
w  Precautions; cardiac disorders, hypertension
w  Route and Dosage; nebulized inhaler; 2.5 mg tid-qid (in 2.5 ml NS ‘fish’)
w  Adverse reactions and side effects; bronchospasm, tremors, anxiety, palpitations, tachycardia, hypertension
*Atrovent (ipratropium)
w  Type of drug; Anticholinergic, bronchodilator
w  Mechanism of Action; inhibits interaction of acetylcholine at receptor sites on the bronchial smooth muscle resulting in bronchodilation
w  Indications; COPD, asthma
w  Contraindications; hypersensitivity to this drug, atropine, soya lecithin, peanuts
w  Precautions;
w  Route and Dosage; Nebulized, 0.5 mg in 2.5 mL saline ‘fish’
w  Adverse reactions and side effects; bronchospasms, dizziness, headache, N/V, cramps
Diuretic
Lasix (furosemide)
w  Type of drug; loop diuretic
w  Mechanism of Action; inhibits reabsorption of sodium and chloride at proximal and distal tubule and in the loop of Henle causing an increase in urine output and decreased venous return to right atria.
w  Indications; pulmonary edema, edema in CHF
w  Contraindications; hypersensitivity to sulfonamides(glucose lowering oral medications), hypovolemia, pneumonia
w  Precautions; severe renal disease
w  Route and Dosage; IV 20-40 mg increased by 20 mg q 2 h until desired results, give slowly; Peds 1 mg/kg
w  Adverse reactions and side effects; hypotension, arrhythmias
Antiplatelet

Aspirin (acetylsalicylic acid, ASA)

·  Type of drug; non-opioid analgesic; non-steroidal anti-inflammatory (NSAID); antipyretic; antiplatelet

w  Mechanism of Action; blocks pain impulses in CNS, reduces inflammation by inhibition of prostaglandin synthesis; decreases platelet aggregation
w  Indications; mild to moderate pain or fever, TIA, ischemic stroke, prophylaxis of MI, angina
w  Contraindications; bleeding disorders, taking Coumadin, pediatric pts.
w  Precautions; recent history of gastrointestinal bleeding or ulcers.
w  Route and Dosage; MI, angina: PO 160-325 mg (Chewable tabs 81 mg, 325 mg tablets)
w  Adverse reactions and side effects; GI bleeding, laryngeal edema, bronchospasm
Analgesic /
*Morphine (Morphine sulfate) Controlled substance, schedule II
w  Type of drug; Opioid analgesic
w  Mechanism of Action; depresses pain impulse transmission at the spinal cord level by interacting with opioid receptors; produces generalized CNS depression; dec. systemic vascular resistance, relieving pulmonary congestion.
w  Indications; severe pain, Pulmonary edema
w  Contraindications; COPD, hypotension
w  Precautions; head trauma/increased ICP, patients who regularly intake alcohol
w  Route and Dosage; IV, SQ, IM; 2-10 mg, titrated to relief; Peds 0.1-0.2 mg/kg
w  Adverse reactions and side effects; respiratory depression, hypotension
Fentanyl (Sublimaze) Controlled substance, schedule II
w  Type of drug; Opioid analgesic
w  Mechanism of Action; Binds to opiate receptors in the CNS, altering the perception of and response to painful stimuli; produces CNS depression.
w  Indications; Severe pain
w  Contraindications; myasthenia gravis
w  Precautions; pt. with head trauma/increased ICP, severe respiratory disease, elderly.
w  Route and Dosage; Sedation; IM or IV; 0.5-1 mcg/kg; Peds age 2-12: 2-3 mcg/kg
w  Adverse reactions and side effects; respiratory depression, bradycardia
Tylenol (Acetaminophen)
w  Type of drug; Nonopioid analgesic; antipyretic
w  Mechanism of Action; May block pain impulses peripherally; does not possess anti-inflammatory properties; antipyretic action due to inhibition of prostaglandins in the CNS
w  Indications; mild to moderate pain, fever
w  Contraindications; hepatic disease
w  Precautions; hepatic disease
w  Route and Dosage; Adult; PO & Rectal, 650 mg; Child, Rectal & PO Child <12: 10-15 mg/kg
w  Adverse reactions and side effects; hepatotoxicity, renal failure
Antihypoglycemic
*D50 (50% Dextrose)
w  Type of drug; Carbohydrate, Antihypoglycemic
w  Mechanism of Action; rapidly increases blood glucose which is needed for adequate utilization of amino acids; decreases protein, nitrogen loss; prevents ketosis
w  Indications; acute hypoglycemia
w  Contraindications; hyperglycemia, CVA, delirium tremens
w  Precautions; renal, hepatic, cardiac disease, diabetes mellitus
w  Route and Dosage; IV, 25-50 Gm slow IVP; Peds 0.5-1 Gm/kg
w  Adverse reactions and side effects; CHF, pulmonary edema, venous irritation
Glucagon
w  Type of drug; Hormone
w  Mechanism of Action; acts on hepatocytes to stimulate release of glucose; promotes breakdown of glycogen to glucose in liver to increase blood glucose
w  Indications; severe hypoglycemia
w  Contraindications;
w  Precautions; may increase anticoagulant effect of warfarin
w  Route and Dosage; IM or SQ, 1 mg (supplied 1 mg of glucagon and 1 ml of glycerin; must be mixed just prior to administration)
w  Adverse reactions and side effects; hypotension
Benzodiazepine /
*Versed (Midazolam) Schedule IV
w  Type of drug; short-acting benzodiazepine; sedative, anxiolytic
w  Mechanism of Action; CNS depressant causing sedative, anxiolytic, amnesic and hypnotic activity.
w  Indications; sedation for RSI or cardioversion, generalized seizures, anxiety
w  Contraindications; shock
w  Precautions; COPD, renal failure, geriatric
w  Route and Dosage; Sedation for RSI: IV; 0.1 mg/kg; max single dose 5 mg; Anxiolytic; IV 2.5-5 mg., give slowly Note: may be given deep IM. Onset ~ 2 min.; Not recommended for peds <12
w  Adverse reactions and side effects; respiratory depression and arrest, hypotension
Neuromuscular Blocker
*Succinylcholine (Anectine)
w  Type of drug; Depolarizing neuromuscular blocking drug
w  Mechanism of Action; prevents muscles from contracting by prolonging time during which the receptors at the neuromuscular junction cannot respond to acetylcholine
w  Indications; to facilitate ET intubation
w  Contraindications; Hx of malignant hyperthermia; penetrating eye injuries
w  Precautions; severe burns, myasthenia gravis
w  Route and Dosage; IV: 1-1.5 mg/kg. May be given IM; up to 3-4 mg/kg, max dosage 150 mg total. NOTE: Onset IV admin. 1-2 min., recovery 4-6 min; IM onset 2-3 min., recovery 4-6 min.; Peds 1-1.5 mg/kg
w  Adverse reactions and side effects; apnea, prolonged respiratory depression, arrhythmias, bronchial spasms, hypotension, inc. ocular pressure
*Vecuronium (Norcuron)
w  Type of drug; Nondepolarizing neuromuscular blocking drug
w  Mechanism of Action; a competitive nondepolarizing drug that competes with acetylcholine for receptor sites in the muscle cells, preventing the muscles from contracting
w  Indications; to facilitate ET intubation
w  Contraindications; Myasthenia gravis
w  Precautions; use with caution in elderly patients
w  Route and Dosage; IV: 0.1 mg/kg (onset 1 min. recovery; 45 min.); not recommended in children under age 10
w  Adverse reactions and side effects; apnea, profound weakness, bronchospasms, NOTE; monitor vitals and ECG; Vecuronium can cause vagal stimulation resulting in bradycardia, hypotension and arrhythmias
Vitamin
Thiamine
w  Type of drug; B-complex vitamin (vitamin B-1)
w  Mechanism of Action; required for metabolism of carbohydrates.
w  Indications; Coma of unknown origin, alcohol abuse, and DTs
w  Contraindications: none
w  Precautions; Thiamine deficiency can cause Wernicke’s encophalopathy and Korsakoff’s syndrome(irreversible psychosis) in the alcohol dependent patient.
w  Route and Dosage; IV: 100 mg mixed in 1 liter of fluid; IM 50 mg
w  Adverse reactions and side effects; hypotension if administered too rapidly

Hypnotic

Etomidate

w  Type of drug; Short acting hypnotic
w  Mechanism of Action; Depresses the activity and reactivity of the brain stem reticular formation; does not cause significant cardiovascular or respiratory depression may cause brief apnea, slightly decreases intracranial pressure
w  Indications; Rapid sequence intubation, induction of anesthesia.
w  Contraindications;
w  Precautions; marked hypotension, severe asthma, severe cardiovascular disease
w  Route and Dosage: 15-.3 mg/kg IV; not recommended in children under age 10
w  Adverse reactions and side effects; hypotension, myoclonus (transient skeletal muscle movements)
Alkalinizer
Sodium Bicarbonate
w  Type of drug; Systemic hydrogen ion buffer
w  Mechanism of Action; Buffers acid buildup in the body to correct metabolic acidosis and assist returning the blood to a physiologic pH.
w  Indications; TCA overdose, after prolonged cardiac arrest
w  Contraindications;
w  Precautions; Sodium bicarbonate administ. can result in metabolic alkalosis or sodium overload. Use with caution in patients with CHF and renal failure.
w  Route and Dosage; Adult/Peds IV bolus, 1 mEq/kg
w  Adverse reactions and side effects; CHF, metabolic alkalosis, tissue necrosis at IV site.

Anti-Nausea

Phenergan (Promethazine)

w  Type of drug; Antihistamine, anticholinergic, anti-emetic
w  Mechanism of Action; Competes with histamine
w  Indications; treatment and prevention of nausea
w  Contraindications; should not be used in children <2, asthma
w  Precautions; use caution in geriatric patients; they are more likely to experience confusion, dizziness and hypotension. Use cautiously with a history of seizures.
w  Route and Dosage; IV: 12.5-25 mg; IM 25 mg , Peds 0.25-0.5 mg/kg
w  Adverse reactions and side effects; Thickened bronchial secretions, wheezing, palpitations

Ondansetron (Zofran)

w  Type of drug; serotonin receptor antagonistc
w  Mechanism of Action; prevents nausea/vomiting by blocking serotonin peripherally, centrally and in small intestine.
w  Indications; prevention of nausea and vomiting
w  Contraindications;
w  Precautions; pregnancy, pediatric, geriatric
w  Route and Dosage; IV (or IM) 4 mg undiluted >30 seconds
w  Adverse reactions and side effects; drowsiness, bronchospasm, shivering

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