Edison Paramedic Drug Cards

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Activated Charcoal (Actidose/Adsorbant)

-Description
-Indication
-Contraindications
-Precautions
-Dosage/Route
Description:  Specially prepared charcoal that will adsorb and bind toxins from the gastrointestinal tract Indications:  Acute ingested poisoning Contraindications:  An airway that cannot be controlled  Ingestion of cyanide, iron or ethanol  Ingestion of mineral acids or methanol  Ingestion of caustic alkalis or organic solvents Precautions:  Administer only after emesis or in those cases where emesis is contraindicated Dosage/Route:
 1 gram/kg PO or via NG tube

ASPIRIN (Acetylsalicylic Acid) Platelet Inhibitor, Anti-inflammatory

-Description
-Indication
-Contraindications
-Precautions
-Dosage/Route
Description:  Inhibits agents that cause the production of inflammation, pain, and fever  Inhibits platelet aggregation Indications:  Chest pain suggestive of an MI Contraindications:  Hypersensitivity to salicylates  Ulcer disease  Asthma Precautions:  Allergies to other NSAIDs  Bleeding disorders  Children or teenagers with varicella or influenza like symptoms Dosage/Route:
 160 to 325 mg PO (chewable)

ATROPINE/Parasympatholytic

-Description
-Indication
-Contraindications
-Precautions
-Dosage/Route
Description:  Blocks the parasympathetic nervous system, specifically the vagal effects on heart rate  Does not increase contractility but may increase myocardial oxygen demand  Decreases airway secretions. Indications:  Hemodynamically significant bradycardia  Bradyasystolic arrest  Organophosphate poisoning Contraindications:  None in the emergency setting Precautions:  AMI  Glaucoma Dosage/Route:  Asystole/PEA 1 mg IV/IO q. 3 to 5 min (max. 3 doses)  Symptomatic bradycardia: 0.5 mg IV. Q. 3 to 5 min to 3 mg. Ped: 0.02 mg/kg IV, 0.03 mg/kg ET, may double and repeat IV dose in 5 min up to 1 mg. Adolescent: 1 mg x 2  Organophosphate poisoning: 2 to 5 mg IV/IM/IO to 15 min. Ped: 0.05 mglkg IV/IM/IO 10 to 15 min.

ADENOSINE/(Adenocard) Antidysrhythmic

-Description
-Indication
-Contraindications
-Precautions
-Dosage/Route
Description:  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. Indications:  Narrow, supraventricular tachycardia refractory to vagal maneuvers. Contraindications:  Hypersensitivity  2nd and 3rd degree heart blocks  Sinus node disease  Asthma Precautions:  May cause transient asytole Dosage/Route:  6 mg rapid IVP with a 10CC saline flush. May be repeated with 12 mg rapid IVP with a 10CC saline flush  Ped: 0.1 mg/kg to a max of 6mg rapid IVP. May be repeated with 0.2 mg/kg to a max of 12mg rapid IVP.

ALBUTEROL/(Provental) Sympathomimetic Bronchodilator

-Description
-Indication
-Contraindications
-Precautions
-Dosage/Route
Description:  Synthetic sympathomimetic that causes bronchodilation with less cardiac effect then epinephrine that reduces secretions, pulmonary capillary leaking, and edema in the lungs during an allergic reaction. Indications:  Bronchospasm  Asthma in COPD Contraindications:  Hypersensitivity Precautions:  Patient may experience, tachycardia, anxiety, nausea, cough or dizziness Dosage/Route:  2.5 mg in 3 cc of NS via nebulizer, repeat as needed
 Ped: 0.15 mg/kg in 3 cc of NS via nebulizer, repeat as needed

AMIODARONE/(Cordarone) Antidysrhythmic

-Description
-Indication
-Contraindications
-Precautions
-Dosage/Route
Description:  Antidysrhythmic that prolongs the duration of the action potential and refractory period. Indications:  Life threatening recurrent ventricular and supraventricular dyrythmias Contraindications:  Hypersensitivity  Cardiogenic shock  Severe sinus Bradycardia  2nd and 3rd degree heart blocks Precautions:  Hepatic impairment  Nursing mothers  children Dosage/Route:  150 to 300 mg IV over 10 minutes, then 1mg/min over the next 6 hours
 Ped: 5 mg/kg IV/IO

CALCIUM CHLORIDE {Calcium Chloride)/Electrolyte

-Description
-Indication
-Contraindications
-Precautions
-Dosage/Route
Description:  Increases myocardial contractile force and increases ventricular automaticity. Indications:  Hyperkalemia  Hypocalcemia  Hypermagnesemia and calcium channel blocker toxicity Contraindications:  Ventricular fibrillation  Hypercalcemia, and possible digitalis toxicity Precautions:  It may precipitate toxicity in patients taking digoxin  Ensure the IV line is in a large vein and flushed before using and after calcium. Dosage/Route:  2 to 4 mg/kg IV {10% solution) repeat at 10 min, as needed.
 Ped: 60-100 mg/kg IVIIO repeat at 10 min, as needed.

DEXAMETHASONE (Decadron)/Steroid

-Description
-Indication
-Contraindications
-Precautions
-Dosage/Route
Description:  Long-acting synthetic adrenocorticoid with intense anti-inflammatory activity  Prevents the accumulation of inflammation generating cells at the sites of infection or injury Indications:  Anaphylaxis  Asthma  COPD  Spinal cord edema Contraindications:  No absolute contra indications in the emergency setting. Precautions:  Herpes simplex  Myasthenia gravis  Hepatic or renal impairment  Diabetes  CHF  Seizures  Psychic disorders  Hypothyroidism  GI ulceration. Dosage/Route:
 4 to 24 mg IV/IM Ped: 0.5 to 1 mg/kg.

DEXTROSE 50% (D-50)/Carbohydrate

-Description
-Indication
-Contraindications
-Precautions
-Dosage/Route
Description:  Dextrose is a simple sugar that the body can rapidly metabolize to create energy. Indications:  Hypoglycemia Contraindications:  None in hypoglycemia Precautions:  Increased ICP  Ensure good venous access Dosage/Route:
 25g (50 mL) IV. Ped: 2 to 4 mg/kg of a 25% solution IV.

DIAZEPAM (Valium)/Hypnotic, Anticonvulsant, Sedative

-Description
-Indication
-Contraindications
-Precautions
-Dosage/Route
Description:  Benzodiazepine sedative  Skeletal muscle relaxant that reduces tremors Indications:  Major motor seizures  Status epilepticus  Premedication before cardioversion  Acute anxiety Contraindications:  Hypersensitivity to the drug  Shock  Coma  Acute alcoholism, depressed vital signs  Obstetric patients, neonates Precautions:  Psychosis  Depression  Myasthenia gravis  Hepatic or renal impairment  COPD  Due to a short half-life of the drug, seizure activity may recur Dosage/Route: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 mg IM.
Premedication: 5 to 15 mg IV. Ped: 0.2 to 0.5 mg/kg IV.

DIGOXIN (Lanoxin)

-Description
-Indication
-Contraindications
-Precautions
-Dosage/Route
Description:  Rapid-acting cardiac glycoside used in the treatment of CHF and rapid atrial dysrhythmias  Increases the force and velocity of myocardial contraction and cardiac output  Decreases conduction through the AV node, thus decreasing heart rate Indications:  Increase cardiac output in CHF  Stabilize supraventricular tachydysrhythmias Contraindications:  Hypersensitivity  V-fib, or V-tach except due to CHF Precautions:  Toxicity potentiated by an MI and with hypokalemia, hypocalcemia  Advanced heart disease  Incomplete heart block, corpulmonale  Hyperthyroidism, respiratory impairment Dosage/Route:  0.25 to 0.5 mg slowly IV
 Ped: 10 to 50 mcg/kg I Description:  Rapid-acting cardiac glycoside used in the treatment of CHF and rapid atrial dysrhythmias  Increases the force and velocity of myocardial contraction and cardiac output  Decreases conduction through the AV node, thus decreasing heart rate Indications:  Increase cardiac output in CHF  Stabilize supraventricular tachydysrhythmias Contraindications:  Hypersensitivity  V-fib, or V-tach except due to CHF Precautions:  Toxicity potentiated by an MI and with hypokalemia, hypocalcemia  Advanced heart disease  Incomplete heart block, corpulmonale  Hyperthyroidism, respiratory impairment Dosage/Route:  0.25 to 0.5 mg slowly IV
 Ped: 10 to 50 mcg/kg IV

DILTIAZEM (Cardizem)/Calcium Channel Blocker

-Description
-Indication
-Contraindications
-Precautions
-Dosage/Route
Description:  Slow calcium channel blocker  Dilates coronary and peripheral arteries and arterioles  Increases circulation to the heart and reducing peripheral vascular resistance Indications:  SVT  A-fib  A-Flutter Contraindications:  Hypersensitivity  Sick sinus syndrome  2nd- or 3rd-degree heart block  Systolic BP >90, diastolic BP >60  Wide-complex tachycardia and WPW Precautions:  CHF (especially with beta blockers)  Conduction abnormalities  Renal or hepatic impairment Dosage/Route:  0.25 mg/kg IV over 2 min, may repeat in 15 min with 0.35 mg/kg followed by a drip of 5 to 10 mg/hr not to exceed 15 mg/hr over 24 hours.

DIPENHYDRAMINE (Benadryl)/ Antihistamine

-Description
-Indication
-Contraindications
-Precautions
-Dosage/Route
Description:  Blocks histamine release, thereby  Reduces bronchoconstriction, vasodilation, and edema Indications:  Anaphylaxis  Allergic reactions,  Dystonic reactions Contraindications:  Asthma and other lower respiratory diseases Precautions:  Hypotension  Headache  Palpitations  Tachycardia  Sedation  Drowsiness Dosage/Route:
 25 to 50 mg IV/1M.

DOPAMINE (Intropin)/Sympathomimetic

-Description
-Indication
-Contraindications
-Precautions
-Dosage/Route
Description:  Naturally occurring catecholamine that increases cardiac output  Maintains renal and mesenteric blood flow while inducing vasoconstriction and increasing systolic blood pressure. Indications:  Non-hypovolemic hypotension (70 to 100 mmHg)  Cardiogenic shock Contraindications:  Hypovolemic hypotension without aggressive fluid resuscitation  Tachydysrhythmias  V-fib Precautions:  Occlusive vascular disease,  Arterial embolism.  Ensure adequate fluid resuscitation of the  Hypovolemic patient Dosage/Route:  2 to 20 mcg/kg/min. titrated to effect.
 Ped: same as adult.

EPINEPHRINE (Adrenalin)/Sympathomimetic

-Description
-Indication
-Contraindications
-Precautions
-Dosage/Route
Description:  Naturally occurring catecholamine that increases heart rate, cardiac contractile force myocardial electrical activity, systemic vascular resistance, and systolic blood pressure  Decreases overall airway resistance and automaticity  Through bronchial artery constriction, may reduce pulmonary congestion and increase tidal volume and vital capacity Indications:  Restore rhythm in cardiac arrest and severe allergic reactions Contraindications:  Hypersensitivity to sympathomimetic amines  Narrow angle glaucoma  Hemorrhagic, traumatic, or cardiac shock  Coronary insufficiency Precautions:  Elderly, debilitated patients  Hypertension, diabetes  Hyperthyroidism,  Asthma, emphysema Dosage/Route:Arrest: 1 mg of 1:10,000 IV q. 3 to 5 min Ped: 0.01 mg/kg 1:10,000 IV/IO q. 3 to 5 min.  Allergic reactions: 0.3 to 0.5 mg of 1:1,000 SQ q. 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 SQ/IO to 15 min or 0.01 mg/kg of 1:10,000 IV if SQ dose ineffective or severe.

ETOMIDATE (Amidate)/Hypnotic

-Description
-Indication
-Contraindications
-Precautions
-Dosage/Route
Description:  Ultra-shon-acting non barbiturate hypnotic with no analgesic effects and limited Cardiovascular and respiratory effects Indications:  Induce sedation for rapid sequence intubation Contraindications:  Hypersensitivity Precautions:  Hypotension,  Severe asthma  Cardiovascular disease Dosage/Route:
 0.1to 0.3 mg/kg IV over 15 to 30 sec. Ped: 0.2 to 0.4 mg/kg IV/IO over 30 to 60 sec. Max 20 mg.

FENTANYL (Sublimaze)/Narcotic Analgesic

-Description
-Indication
-Contraindications
-Precautions
-Dosage/Route
Description:  Potent synthetic narcotic analgesic similar to morphine and meperidine but with a more rapid and less-prolonged action Indications:  Induce sedation for endotracheal intubation  Moderate to severe pain. Contraindications:  MAO inhibitors within 14 days  Myasthenia gravis Precautions:  Increased intracranial pressure  Elderly  COPD  Respiratory problems  Hepatic and renal insufficiency Dosage/Route:
 25 to 100 mcg slow IV (2 to 3 min) Ped: 2 mcg/kg slow IV/IM.

FLUMAZENIL (Romazicon)/Benzodiazepine Antagonist

-Description
-Indication
-Contraindications
-Precautions
-Dosage/Route
Description:  Benzodiazepine antagonist used to reverse the sedative, recall, and psychomotor effects of diazepam, midazolam, and the other benzodiazepines. Indications:  Respiratory depression secondary to the benzodiazepines Contraindications:  Hypersensitivity to Flumazenil or benzodiazepines; those  Patients who take Flumazenil for status epilepticus or seizures  Seizure-prone patients during labor and delivery  Tricyclic antidepressant overdose Precautions:  Hepatic impairment  Elderly  Pregnancy, nursing mothers  Head injury  Alcohol and drug dependency  Physical dependence on benzodiazepines Dosage/Route:  0.2 mg IV over 15 sec. repeated at 0.3 mg over 30 sec. then 0.5 mg over 30 sec. every minute to desired affect or 3 mg.

Furosemide (Lasix) Diuretic

-Description
-Indication
-Contraindications
-Precautions
-Dosage/Route
Description:  Rapid-acting potent diuretic that inhibits sodium re-absorption by the kidneys Indications:  CHF  Pulmonary Edema Contraindications:  Hypersensitivity to sulfonamides Precautions:  Infants  Elderly  Hepatic impairment  Cardiogenic Shock Dosage/Route:  40 -120 mg slow IVP
 Ped: 1mg/kg slow IVP

HALOPERIDOL (Haldol)/Antipsychotic

-Description
-Indication
-Contraindications
-Precautions
-Dosage/Route
Description:  Blocks dopamine receptors in the brain associated with mood and behavior  Potent antiemetic  Impairs temperature regulation Indications:  Acute psychotic episodes Contraindications:  Parkinson's disease  Seizure disorders  Coma  Alcohol depression Precautions:  Elderly  urinary retention, glaucoma,  Severe cardiovascular disease, or anticonvulsant, anticoagulant, or lithium therapy Dosage/Route:
 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 (Heparin)/ Anticoagulant

-Description
-Indication
-Contraindications
-Precautions
-Dosage/Route
Description:  Rapid-onset anticoagulant,  Enhancing the effects of antithrombin III and blocking the conversion of prothrombin to thrombin and fibrinogen to fibrin. Indications:  Prevent thrombus formation in acute MI. Contraindications:  Hypersensitivity  Active bleeding or bleeding tendencies  Recent eye, brain, or spinal surgery  Shock Precautions:  Alcoholism  Elderly  Allergies  Indwelling catheters, elderly  Menstruation, pregnancy  Cerebral embolism Dosage/Route:
 STEMl: 60 IU/kg to 4,000 IU NSTEMl: 60 to 70 IU/kg to 5,000.

Hydromorphone hydrochloride (Dilaudid)

-Description
-Indication
-Contraindications
-Precautions
-Dosage/Route
Description:  An opiate type narcotic analgesic Indications:  Relief of moderate to severe pain. Contraindications:  History of chronic respiratory illness Precautions:  Excessive sedation  Respiratory depression  Circulatory depression and collapse Dosage/Route:  Adults= 1mg slow IV repeat in 5min if B/P >90.
 Can be given IM

IBUPROFEN (Nonsteroidal Antiinflammatory Drug (NSAID)

-Description
-Indication
-Contraindications
-Precautions
-Dosage/Route
Description: Ibuprofen is the prototype  NSAID with significant analgesic and antipyretic properties It also  Inhibits platelet aggregation and increases bleeding time Indications:  Reduce fever and relieve minor to moderate pain Contraindications:  Sensitivity to aspirin or other NSAIDs  Active peptic ulcer, and bleeding abnormalities Precautions:  Hypertension,  GI ulceration,  Hepatic or renal impairment,  Cardiac decompensation. Dosage/Route:  200 to 400 mg PO q. 4 to 6 hours up to 1,200 mg/day.
 Ped: 5 to 10 mg/kg PO/4 to 6 hours up to 40 mg/kg/day.

IPRATROPIUM (Atrovent)/ Anticholinergic
-Description
-Indication
-Contraindications
-Precautions
-Dosage/Route
Description:  Bronchodilator used in the treatment of respiratory emergencies that causes bronchial dilation and dries respiratory tract secretions by blocking acetylcholine receptors. Indications:  Bronchospasm associated with asthma, COPD, and inhaled irritants. Contraindications:  Hypersensitivity to atropine or its derivatives, or as a primary treatment for acute bronchospasm Precautions:  Elderly,  Cardiovascular disease  Hypertension Dosage/Route:  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.

LIDOCAINE (Xylocaine)/ Antidysrhythmic

-Description
-Indication
-Contraindications
-Precautions
-Dosage/Route
Description:  Antidysrhythmic that suppresses automaticity and raises stimulation threshold of the ventricles  Causes sedation  Anticonvulsant, and analgesic effects Indications:  Pulseless and Pulsatile V-tach  V-fib Contraindications:  Hypersensitivity to amide-type local anesthetics  SVTsupraventricular dysrhythmias  StokesAdams syndrome  2nd- and 3rd-degree heart blocks  Bradycardias. Precautions:  Hepatic or renal impairment  CHF  Hypoxia, respiratory depression  Hypovolemia  Myasthenia gravis  Shock Dosage/Route:Cardiac arrest: 1 to 1.5 mg/kg IV/IO up to 3 mg/kg, follow conversion with a drip of 1 to 4 mg/min. Ped: 1 mg/kg rapid IV/IO, to 100 mg, follow conversion with a drip of 20 to 50 mcg/kg/min.  V-Tach /w)pulse): 0.5 to 1.5 mg/kg slow IV. May repeat at one-half dose every 5 to 10 min until conversion up to 3 mg/kg. Follow conversion with an infusion of 1 to 4 mg/min. Ped: 1 mg/kg, followed by a drip at 20 to 50 mcg/kg/min.

LORAZEPAM (Ativan)/Sedative

-Description
-Indication
-Contraindications
-Precautions
-Dosage/Route
Description:  Potent benzodiazepine  Strong antianxiety, sedative, hypnotic, and skeletal muscle relaxant properties  Relatively short half-life Indications:  Sedation for cardioversion and status epilepticus Contraindications:  Sensitivity to benzodiazepines Precautions:  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. Dosage/Route:  Sedation: 2 to 4 mg 1M, 0.5 to 2 mg IV. Ped: 0.03 to 0.5 mglkg 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 SULFATE (Magnesium)/Electrolyte


-Description
-Indication
-Contraindications
-Precautions
-Dosage/Route
Description:  Electrolyte that acts as a calcium channel blocker  CNS depressant and anticonvulsant  Depresses the function of smooth, skeletal, and cardiac muscle Indications:  Torsade de Pointes  Eclamptic seizures  Children for status asthmaticus non-responsive to beta agents Contraindicarions:  Heart block, myocardial damage  Shock  Persistent hypertension, and hypocalcemia Precautions:  Renal impairment  Digitalized patients Dosage/Route:  Diluted in 100 mL, over 1 to 2 minutes (in adults only) IV/IM  Peds: 25 to 50 mg/kg over 5 to 20 min. Max dose 2 g. IV
 Asthma: same as for Torsades. Eclampsia: 2 to 4 g IV /IM.

MANNITOL (Osmitrol)/Osmotic Diuretic

-Description
-Indication
-Contraindications
-Precautions
-Dosage/Route
Description:  Osmotic diuretic that draws water into the intravascular space through its hypertonic effects, then causes diuresis Indications:  Cerebral edema Contraindications:  Hypersensitivity  Pulmonary edema, CHF  Organic CNS disease  Intracranial bleeding  Shock renal failure, or severe dehydration Precautions:  None Dosage/Route:
 0.5 to 1 g/kg over 5 to 10 min IV. Ped: 0.25 to 0.5 g/kg over 60 min.

MEPERIDINE (Demerol)/Narcotic Analgesic

-Description
-Indication
-Contraindications
-Precautions
-Dosage/Route
Description:  Synthetic narcotic with sedative and analgesic properties comparable to morphine but without hemodynamic side effects. Indications:  Moderate to severe pain Contraindications:  Hypersensitivity  Seizure disorders, or acute abdomen prior to diagnosis Precautions:  Increased intracranial pressure  Asthma or other respiratory conditions  SVT  Prostatic hypertrophy  Urethral stricture  Glaucoma, elderly or debilitated patients  Renal or hepatic impairment  Hypothyroidism  Addison's disease Dosage/Route:
 25 to 50 mg IV, 50 to 100 mg 1M. Ped: 1 mg/kg IV/IM

METHYLPREDNISOLONE (Solu-Medrol)

-Description
-Indication
-Contraindications
-Precautions
-Dosage/Route
Description:  Synthetic adrenal corticosteroid  Anti-inflammatory and used in the management of allergic reactions and in some cases of shock Indications:  Spinal cord injury  Asthma  Severe anaphylaxis  COPD Contraindications:  No major contra indications in the emergency setting Precautions:  Only a single dose should be given in the prehospital setting Dosage/Route:
 Asthma/COPD/anaphylaxis: 125 to 250 mg IV/IM. Ped: 1 to 2 mg/kg/dose IV/IM.

METOPROLOL (Lopressor)/Beta Blocker

-Description
-Indication
-Contraindications
-Precautions
-Dosage/Route
Description:  Beta-adrenergic blocking agent that reduces heart rate, cardiac output, and blood pressure Indications:  AMI Contraindications:  Cardiogenic shock,  Sinus bradycardia >45  2nd- or 3rd-degree heart block, PR interval> 0.24  Cor pulmonale  Asthma  COPD Precautions:  Hypersensitivity  Hepatic or renal impairment  cardiomegaly  CHF controlled by digitalis and diuretics  AV conduction defects  Thyrotoxicosis  Diabetes  Peripheral vascular disease Dosage/Route:
 5 mg slow IV/5 min up to 3 times

MIDAZOLAM (Versed)/Sedative

-Description
-Indication
-Contraindications
-Precautions
-Dosage/Route
Description:  Short-acting benzodiazepine with CNS depressant  Muscle relaxant  Anticonvul-sant  Anterograde amnestic effects Indications:  To induce sedation before cardioversion or intubation Contraindications: 1. Hypersensitivity to benzodiazepines 2. Narrow-angle glaucoma 3. Shock 4. Coma 5. Acute alcohol intoxication Precautions:  COPD  Renal impairment  CHF Dosage/Route:  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 IN

MORPHINE SULFATE (Morphine)/Narcotic Analgesic

-Description
-Indication
-Contraindications
-Precautions
-Dosage/Route
Description: Morphine sulfate is a  Potent narcotic analgesic and sedative that  Causes some vasodilation that reducing venous return  Reduced myocardial oxygen demand Indications:  Moderate to severe pain and in MI and to reduce venous return in pulmonary edema Contraindications:  Hypersensitivity to opiates  Undiagnosed head or abdominal injury, hypotension, or volume depletion  Acute bronchial asthma  COPD  Severe respiratory depression  Pulmonary edema due to chemical inhalation Precautions:  Elderly, children, or debilitated patients  Naloxone should be readily available to counteract the effects of morphine. Dosage/Route:MI: 2 to 4 mg IV over 1 to 5 min. q. 5 to 15 min  Pain: 2.5 to 15 mg IV; 5 to 20 mg IM/SQ.  Ped: 0.05 to 0.1 mg/kg IV; 0.1 to 0.2 mg/kg IM/SQ
AMI or PE: 1 to 2 mg/6 to 10 min to response.

NALOXONE (Narcan)

-Description
-Indication
-Contraindications
-Precautions
-Dosage/Route
Description:  Narcotic antagonist that blocks the effects of both natural and synthetic narcotics and may reverse respiratory depression Indications:  Narcotic and synthetic narcotic overdose  Coma of unknown origin Contraindications:  Hypersensitivity to the drug  Non-narcotic-induced respiratory depression Precautions:  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. Dosage/Route:  0.4 to 2 mg IV/IM (2 to 2.5 times the dose ET), q. 2 to 3 min as needed up to 10 mg.
 Ped: 0.01 mg IV/IM (2 to 2.5 times the dose ET) q. 2 to 3 min as needed up to 10 mg.

NITROGLYCERIN (Nitrostat)

-Description
-Indication
-Contraindications
-Precautions
-Dosage/Route
Description:  Rapid acting smooth muscle relaxant that reduces peripheral vascular resistance, blood pressure, venous return, and cardiac workload Indications:  Chest pain associated with angina, acute MI or pulmonary edema Contraindications:  Severe anemia  Head trauma  Increased ICP  Patient taking erectile dysfunction drugs within 24 hours  Hypotension Precautions:  May cause headache Dosage/Route:
 1 tablet (or spray) 0.4 mg SL q. 3-5 minutes provided systolic BP > 90

-Description
-Indication
-Contraindications
-Precautions
-Dosage/Route
Description:  Oxygen is an odorless, colorless, tasteless gas, essential for life, It is one of the most important emergency drugs Indications:  Hypoxia or anticipated hypoxia, or in any medical or trauma patient to improve respiratory efficiency Contraindications:  There are no contra indications to oxygen therapy. Precautions:  Chronic obstructive pulmonary disease and very prolonged administration of high concentrations in the newborn Dosage/Route:
 Hypoxia: 100% by inhalation or PPV.

OXYTOCIN (Pitocin)

-Description
-Indication
-Contraindications
-Precautions
-Dosage/Route
Description:  Naturally occurring hormone that causes the uterus to contract, thereby inducing labor, encouraging delivery of the placenta, and controlling postpartum hemorrhage Indications:  Severe postpartum hemorrhage Contraindications:  Hypersensitivity,  Prehospital administration before delivery of the infant or infants Precautions:  Before delivery may induce uterine rupture and fetal dysrhythmias  Hypertension  Intracranial bleeding, or asphyxia  Uterine tone  ECG, and vital signs should be monitored during administration Dosage/Route:
 3 to 10 units IM after delivery of the placenta 10 to 20 units in 1,000 mL in NS IV titrated to effect.

PROMETHAZINE (Phenergan)

-Description
-Indication
-Contraindications
-Precautions
-Dosage/Route
Description:  Anticholinergic agent that enhances the effects of analgesics and is a potent antiemetic Indications:  Nausea and vomiting  Motion sickness  Enhance the effects of analgesics, and to induce sedation. Contraindications:  Hypersensitivity to phenothiazines Precautions:  Hepatic, respiratory, or cardiac impairment  Asthma  Hypertension Dosage/Route:
 12.5 to 25 mg IV/IM Ped: 0.5 mg/kg IV/IM

RACEMIC EPINEPHRINE (Vaponefrin)/Sympathomimetic

-Description
-Indication
-Contraindications
-Precautions
-Dosage/Route
Description:  Variation of epinephrine used only for inhalation to induce bronchodilation and to reduce laryngeal edema and mucus secretion. Indications:  Croup (laryngotracheobronchitis) Contraindications:  Hypersensitivity  Hypertension  Epiglottitis Precautions:  May result in tachycardia and other dysrhythmias  Patient vital signs and ECG should be monitored Dosage/Route:
 0.25 to 0.75 mL of a 2.25% solution in 2 mL NS once by nebulizer Ped: same as adult

SODIUM BICARBONATE (NaHC03)/ Alkalizing Agent

-Description
-Indication
-Contraindications
-Precautions
-Dosage/Route
Description:  Provides vascular bicarbonate to assist the buffer system in reducing the effects of metabolic acidosis and in the treatment of some overdoses. Indications:  Tricyclic antidepressant and barbiturate overdose  Refractory acidosis  Hyperkalemia Contraindications:  None when used in severe hypoxia or late cardiac arrest. Precautions:  May cause alkalosis if given in too large a quantity  Deactivate vasopressors  Do not give in the same line as calcium chloride Dosage/Route:
 1 mEqlkg IV/IO Ped: same as adult

SUCCINYLCHOLINE {Anectine)

-Description
-Indication
-Contraindications
-Precautions
-Dosage/Route
Description:  Ultra-short-acting depolarizing neuromuscular blocker Indications:  Facilitated endotracheal intubation Contraindications:  Hypersensitivity  History of malignant hyperthermia  Penetrating eye injury  Narrow -angle glaucoma Precautions:  Severe burn or crush injury  Electrolyte imbalances  Hepatic, renal, cardiac, or pulmonary impairment  Fractures  Spinal cord injury  Dehydration  Severe anemia Dosage/Route:
 1 to 1.5 mg/kg IV/IM. Ped: 1 to 2 mg/kg IV/IM.

TERBUTALINE (Brethine)

-Description
-Indication
-Contraindications
-Precautions
-Dosage/Route
Description:  Synthetic sympathomimetic that causes bronchodilatation with less cardiac effect than epinephrine Indications:  Bronchial asthma and bronchospasm in COPD Contraindications:  Hypersensitivity to the drug. Precautions:  Palpitations  Nausea, and/or dizziness  Vital signs and breath sounds must be monitored  Use caution with cardiac or hypertensive patients Dosage/Route:  Two inhalations with a metered dose inhaler, repeated once in 1 min or
0.25 mg SQ repeated in 15 to 30 mins.

VECURONIUM (Norcuron)/Nondepolarizing Skeletal Muscle Relaxant

-Description
-Indication
-Contraindications
-Precautions
-Dosage/Route
Description:  Nondepolarizing skeletal muscle relaxant similar to pancuronium with minimal cardiovascular effects Indications:  Facilitated endotracheal intubation Contraindications:  Hypersensitivity Precautions:  Hepatic or renal impairment  Impaired fluid and electrolyte or acid/base balance  Severe obesity  Myasthenia gravis  Malignant hyperthermia Dosage/Route:
 0.08 to 0.1 mg/kg IV. Ped: same as adult.

VERAPAMIL (Calan)/Calcium Channel Blocker

-Description
-Indication
-Contraindications
-Precautions
-Dosage/Route
Description:  Calcium channel blocker that slows AV conduction  Suppresses reentry dysrhythmias such as PSVT  Slows ventricular responses to atrial tachydysrhythmias  Dilates coronary arteries and reduces myocardial oxygen demand Indications:  PSVT refractory to adenosine,  A-flutter, and A-fib with rapid ventricular response Contraindications:  Severe hypotension  Cardiogenic shock  2nd- or 3rd-degree heart block  CHF  Sinus node disease, and accessory AV pathways, WPW syndrome  Do not be administered to persons taking beta blockers Precautions:  Hepatic and renal impairment,  MI with coronary artery occlusion  Myocardial stenosis Dosage/Route:  2.5 to 5 mg IV bolus over 2 to 3 min, then 5 to 10 mg after 15 to 30 min to a max of 20 mg.
 Ped: newborn1 to 0.2 mglkg (not to exceed 2 mg)1 to 15-0.1 to 0.3 mglkg (not to exceed 5 mg).