NREMT ALS Meds Flashcards
Enalapril, Captopril, Lisinopril, Ramipril, et al
Trade Name(s): Vasotec®, Lotensin®, Accupril®, Altace®, Zestril®, et al
Class: Angiotensin-converting enzyme (ACE) inhibitor, antihypertensive
Description: ACE inhibitors interfere with the development of angiotensin II, reducing peripheral vascular resistance, blood pressure and cardiac afterload.
Indication(s): Hypertension, AMI or heart failure without hypotension.
Contraindication(s): Pregnancy, elevated serum potassium, hypotension (SBP<100), hypovolemia, Hx of angioedema, or hypersensitivity to the drug.
Precautions: Renal failure.
Dosage/Administration: Enalapril-2.5mg PO, 1.25 mg IV over 5 minutes (IV form can be contraindicated in STEMI); Captoril-6.25 to 25 mg PO; Lisinopril-2.5 to 10 mg PO; Ramipril-2.5 mg PO.
Special Considerations: Watch for ACE inhibitor induced angioedema and chronic cough (from increased bradykinin levels).
Captopril is on NJ Formulary.
Adenosine
Trade Name(s): Adenocard®
Class: Antiarrhythmic
Description: Adenosine is a naturally occurring agent (endogenous nucleoside) that can “chemically cardiovert” SVT to a normal sinus rhythm
Indication(s): Narrow complex, supraventricular tachycardia refractory to vagal maneuvers or to facilitate diagnosing tachycardia of unknown origin.
Contraindication(s): Hypersensitivity, 2° and 3° AV block and sick sinus syndrome (without a pacemaker), severe hypotension. Relative in asthma.
Precautions: May cause transient dysrhythmias
Dosage/Administration: 6 mg rapid IV push, immediately followed by a rapid flush of saline. If ineffective after 1-2 minutes, give 12 mg. If still ineffective, 12 mg may be repeated once. Ped: 0.1mg/kg to a maximum dose of 6 mg rapid IV push, immediately followed by a rapid saline flush. If ineffective after 1-2 minutes give 0.2mg/kg to a maximum dose of 12 mg rapid IV push. If still ineffective 0.2mg/kg dose may repeated once.
Special Considerations: Adenosine has a half life of less then 10 seconds. It, therefore, must be pushed rapidly. An IV site which is most proximal to the heart should be utilized. Also, use the largest gauge angio that the vein can accommodate. Brief asystole is common after injection and does not persist to cardiac arrest.. Less effective in patients taking theophylline or caffeine. Reduce initial dose in patients receiving dipyridamole, carbamazepine, heart transplants, or via central line.
Albuterol
Trade Name(s): Proventil®, Ventolin®, Proair®
Class: Sympathomimetic, Bronchodilator, Beta-2 Agonist
Description: Albuterol is a synthetic sympathomimetic that causes bronchodilation with less cardiac effect than epinephrine. It also reduces mucus secretion, pulmonary capillary leakage and edema in the lungs during allergic reactions.
Indication(s): Prevention and treatment of reversible bronchospasm associated with asthma and other obstructive pulmonary diseases. Commonly used to treat Hyperkalemia. Shifts potassium intracellularly due to Beta-2 specific adrenergic stimulation, therefore reducing overall serum potassium levels.
Contraindication(s): Hypersensitivity to the drug or any of its components.
Precautions: 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.
Dosage/Administration: Two inhalations (90 mcg) via metered dose inhaler or
2.5 mg in 2.5-3 ml NS via nebulizer, repeat as needed. The duration of the effect is
3-6 hours. Ped: 0.15 mg/kg in 2.5 to 3 ml NS via nebulizer, repeat as necessary.
Special Considerations: Beta-blockers are Antagonistic; May potentiate hypokalemia.
Onset: approximately 15 mins.
Aminophylline
Trade Name(s): Truphylline®, Somohyllin®
Class: Methylxanthine bronchodilator
Description: Aminophylline is a methylxanthine that prolongs bronchodilation and decreases mucus production and has mild cardiac and CNS stimulating effects.
Indication(s): Bronchospasm in asthma and COPD refractory to sympathomimetics and other bronchodilators.
Contraindication(s): Hypersensitivity to methylxanthines or uncontrolled cardiac
dysrhythmias
Precautions: Cardiovascular disease, hypertension, hepatic impairment, diabetes, hyperthyroidism, glaucoma, peptic ulcers, acute influenza, recent influenza immunization, young children, the elderly, and those taking theophylline.
Dosage/Administration: 250-500 mg IV over 20-30 mins. Ped: 6mg/kg over 20-
30 mins to a maximum of 12/kg/day
Special Considerations: Seldom used due to narrow therapeutic index before
toxicity
Amiodarone
Trade Name(s): Cordarone®, Nexterone®, Pacerone®
Class: Antiarrhytmic
Description: Amiodarone is an antiarrhythmic that prolongs the duration of the
action potential and refractory period through sodium, potassium, and calcium
channels; blocks alpha and beta adrenergic receotors; relaxes smooth muscles,
reducing peripheral vascular resistance and increasing coronary flow.
Indication(s): Life-threatening and refractory VF, VT, and supraventricular
tachydysrhythmias.
Contraindication(s): Hypersensity to the drug, cardiogenic shock, severe sinus
bradycardia and advanced heart block.
Precautions: Hepatic impariment, pregnancy, breastfeeding
Dosage/Administration: Refractory VF/pVT: 300 mg IV push, second dose of
150 mg IV push. Perfusing VT/ rapid infusion: 150mg IV over 10 minutes.
Maintenance/slow infusion 360mg over next 6 hours (1mg/min) then infusion
540mg over 18 hours (0.5mg/min). Max dose 2.2g/24 hours. Ped: Refractory
Pulseless Ventricular Tachycardia and Ventricular Fibrillation 5 mg/kg, then repeat
to a total dose of 15 mg/kg. Ped: 5 mg/kg IV/IO over 20-60 minutes, can be
repeated up to a total dose of 15 mg/kg.
Special Considerations: May drop blood pressure when administered; give
slowly (IV drip) when patient has a pulse, push only when pulseless/cardiac arrest.
Amiodarone itself can be thyrotoxic and delivers a large iodine load which can
effect patients with hypo- or hyperthyroid. In pregnancy, exposure may cause fetal
harm
Amyl Nitrite
Trade Name(s): Amyl nitrite
Class: Cyanide poisoning adjunct, antidote, vasodilator
Description: Amyl nitrite is a short-acting vasodilator similar to nitroglycerin. It
binds with hemoglobin to form methemoglobin which preferentially binds cyanide,
releasing it from the cytochrome.
Indication(s): Acute cyanide poisoning
Contraindication(s): None in the case of acute cyanide poisoning.
Precautions: None
Dosage/Administration: 0.3 mL ampule crushed and contents poured onto a
gauze and placed in front of patient’s mouth or endotracheal tube, if patient
intubated, to be inhaled over 15-30 sec; repeat q 1 min. until IV sodium nitrite
available. Each ampule lasts approximately 3 min; separate administration by at
least 30 sec to allow patient to adequate oxygenate.
Special Considerations: Part of cyanide antidote kit which also includes sodium
nitrate and sodium thiosulfate.
Aspirin, Acetylsalicylic Acid (ASA)
Trade Name(s): Empirin®, Ecotrin®, Halfprin®, Zorprin®
Class: Antipyretic, analgesic, platelet inhibitor, anti-inflammatory
Description: Aspirin inhibits agents that cause the production of inflammation,
pain and fever. It also powerfully inhibits platelet aggregation.
Indication(s): Cardiogenic chest discomfort
Contraindication(s): Hypersensitivity to salicylates, active ulcer disease
Precautions: Allergies to other NSAIDs, bleeding disorders, children or teenagers
with varicella or influenza-like symptoms, asthma
Dosage/Administration: 160-325 mg PO (chewable, non-enteric coated).
Special Considerations: Platelet aggregation effects take place in 15 minutes and
last approximately 4 days
Atropine sulfate
Trade Name(s): Sal-Tropine®
Class: Parasympatholytic, anticholinergic
Description: Atropine blocks the parasympathetic nervous system, specifically
the vagal effects on the heart rate. It does not increase contractility but may
increase myocardial oxygen demand. It also decreases airway secretions.
Indication(s): Hemodynamically significant bradycardia and organophosphate
poisoning.
Contraindication(s): None in the emergency setting.
Precautions: AMI, Glaucoma, hypothermic bradycardia.
Dosage/Administration: Symptomatic Bradycardia: 0.5-1 mg rapid IV push,
repeat q 3-5 min to a max of 3 mg. Pediatric dose: 0.02mg/kg rapid IV push, may
be repeated once up to 1 mg for a child or 3 mg for an adolescent. Can be given
via ETT 0.04-0.06 mg/kg. Organophosphate Poisoning: 2-4 mg IV/IO repeated
until symptomatic improvement. Pediatric dose: <12 years old 0.02-0.05 mg/kg
IV/IO q 20-30 min, as needed.
Special Considerations: If pushed too slowly or if less than the recommended
dosage is given the result will be paradoxical bradycardia
Bumetanide
Trade Name(s): Bumex®
Class: Loop Diuretic
Description: Bumetanide is related to furosemide, however it has a faster rate of
onset, greater diuretic potency (40 times), shorter duration and produces only mild
hypotension.
Indication(s): Diuresis in CHF and pulmonary edema.
Contraindication(s): Hypersensitivity to bumetanide or other sulfonamides.
Precautions: Pregnancy-it should only be used in life-threatening conditions.
Dosage/Administration: 0.5-1 mg IM/IV over 1-2 minutes, repeat in 2-3 hours as
needed
Special Considerations: Usually used if furosemide shortage.
Calcium Chloride
Trade Name(s): Calcium Chloride
Class: Electrolyte
Description: Calcium chloride increases myocardial contractile force and
increases ventricular automaticity.
Indication(s): Hyperkalemia, hypocalemia, hypermagnesemia, calcium channel
blocker toxicity
Contraindication(s): Ventricular fibrillation, hypercalcemia, possible digitalis
toxicity.
Precautions: May precipitate toxicity in patients taking digoxin. .
Dosage/Administration: 500-1000 mg IV (5-10 ml of 10% solution) as needed.
Ped: 20mg/kg IV/IO, as needed.
Special Considerations: Ensure the IV line is in a large vein and flushed before
and after using calcium. Painful, burning sensation when administered rapidly or
in a small vein. Can cause vein sclerosis. Precipitates when mixed with Sodium
Bicarbonate.
Calcium Gluconate
Trade Name(s): Kalcinate®
Class: Electrolyte
Description: Counteracts the toxicity of hyperkalemia by stabilizing the
membranes of the cardiac cells, reducing the likelihood of fibrillation; increases
myocardial contractile force & ventricular automaticity.
Indication(s): Hyperkalemia, hypocalemia, hypermagnesemia, calcium channel
blocker toxicity
Contraindication(s): Ventricular fibrillation, hypercalcemia, possible digitalis
toxicity.
Precautions: May precipitate toxicity in patients taking digitalis, with renal and
cardiac insufficiency, and immobilized patients.
Dosage/Administration: Hyperkalemia 500-1,000mg slow IV/IO push,
maximum of 3 grams. Beta blocker and calcium channel blocker overdose 3-6
grams IV/IO; followed by a continuous hourly infusion of the same dose.
Pediatric: Hyperkalemia 60-100mg/hour IV/IO slowly over a 5-10 minutes to a
maximum of 3 grams. Beta blocker and calcium channel blocker overdose:
60mg/kg IV/IO followed by a continuous hourly infusion of the same dose.
Special Considerations: Do not administer by IM or Sq; causes significant tissue
necrosis. Less potent than calcium chloride (calcium chloride has 3 times as much
calcium)
Dexamethasone Sodium Phosphate
Trade Name(s): Decadron®
Class: Corticosteroid, Adrenal Glucocorticoid
Description: Long-acting adrenocorticoid with intense anti-inflammatory activity.
It prevents the accumulation of inflammation generating cells at the sites of
infection or injury.
Indication(s): Anapylaxis, asthma and COPD, Moderate to severe Croup
Contraindication(s): There are no absolute contraindications in the emergency
setting. Relative contraindications include, systemic fungal infections, actue
infections, tuberculosis, vaccine or live virus vaccinations.
Precautions: Herpes simplex, keratitis, myasthenia gravis, hepatic or renal
impairment, diabetes, CHF, seizures, psychiatric disorders, hypothyroidism and GI
ulceration.
Dosage/Administration: 2-100mg IV/IM Peds: 0.5-1 mg/kg
Special Considerations: Immunosuppressive effects.
Dextrose, (D50W, D25W, D10W, D5W)
Trade Name(s): Dextrose
Class: Carbohydrate
Description: Dextrose is a simple sugar that the body can rapidly metablozie to
create energy.Short term osmotic diuresis.
Indication(s): Hypoglycemia, Hyperkalemia
Contraindication(s): None in the presence of hypoglycemia.
Precautions: Increased ICP or intracranial hemmorhage. Determine blood
glucose level prior to administration.
Dosage/Administration:
Adult:25g D50W (50ml) IV push. Peds: >1 month 0.5-
1.0 g/kg of a 25% solution IV/IO, 0.5 g/kg of a 10% dextrose solution IV/IO for <1
month old.
Special Considerations: When establishing an IV to administer D50W, utilize the
largest vein available and use the largest catheter the vein can
accomadate.Extravasation leads to tissue necrosis.
Diazepam
Trade Name(s): Valium®
Class: Antianxiety/Hypnotic/Anticonvulsant/Sedative.
Description: 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 in
painful procedures (e.g., synchronized cardioversion)
Indication(s): Seizures, status epilepticus, premedication before cardioversion,
muscle tremors due to injury, muscle spasm and acute anxiety.
Contraindication(s): Hypersensity to drug, shock, coma, acute alchoholism,
depressed vital signs, obstetric patients and neonates.
Precautions: Psychosis, hypotension, mental status depression, respiratory
depression.
Dosage/Administration: Seizures: 5-10 mg IV/IM, Peds: 0.5-2mg IV/IM.
Acute Anxiety: 2-5 mg IV/IM, Peds: 0.5-2mg IM Premedication:5-15 mg IV
Peds: 0.2-0.5mg/kg IV. Available as rectal gel for pediatrics.
Special Considerations: Has a longer half life than other benzodiazepines but is redistributed to fat so serum concentrations decrease faster. Parents may
administer to children with epilepsy who are seizing prior to EMS arrival. As with
all opiates, push slowly
Diltiazem
Trade Name(s): Cardizem®
Class: Calcium Channel Blocker
Description: Diltiazem is a slow calcium channel blocker similar to verapamil. It
dilates coronary and periphreal arteries and arterioles, thus increasing circulation to
the heart and reducing peripheral vascular resistance.
Indication(s): Supraventricular tachydysrhythmias (ie atrial fibrillation, atrial
flutter and PSVT refractory to adenosine) and to increase coronary artery perfusion
in angina.
Contraindication(s): 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, the elderly and nursing mother.
Dosage/Administration: 0.25 mg/kg (15-20 mg) slow IV push over 2 minutes,
may repeat in 15 minutes with 0.35 mg/kg (20-25 mg) slow IV push over 2
minutes.
Special Considerations: Continuous EKG monitoring and frequent measurement
of blood pressure.
Comparing Calcium Channel Blockers: Verapamil is mostly
cardiac effects, nicardipine/nifedipine/amlodipine are mostly peripheral effects
and diltiazem is somewhere in the middle.
Diphenhydramine
Trade Name(s):Benadryl®
Class: Antihistamine, Anticholinergic
Description: Diphenhydramine blocks histamine release, thereby reducing
histamine-induced bronchoconstriction, vasodilation and edema.
Indication(s): Anaphylaxis, allergic reactions, motion sickness and acute dystonic
extrapyramidal reactions to antipsychotic drugs.
Contraindication(s): Hypersensitivity; narrow-angle glaucoma
Precautions: May induce hypotention, headache, palpitations, tachycardia,
sedation, drowsiness and/or disturbed coordination; Asthma and other lower
respiratory disease.
Dosage/Administration: 25-50 mg IV/IM Peds:2-5 mg/kg
Special Considerations: Will potentiate actions and side effects of narcotics and
other CNS depressants; cannot be given SQ; give either IV or deep IM injection
Dobutamine Hydrochloride
Trade Name(s): Dobutrex®
Class: Sympathomimetic
Description: Dobutamine is a synthetic catecholamine and beta agent that
increases the strength of cardiac contraction without appreciably increasing rate.
Indication(s): To Increase cardiac output in congestive heart failure and
cardiogenic shock.
Contraindication(s): Hypersensitivity to sympathomimetic amines, ventricular
tachycardia and hypovolemia without fluid rescucitation.
Precautions: Atrial fibrillation or preexisting hypertention.
Dosage/Administration: 2-20 mcg/kg/min IV titrated to effect. Peds: same as
adult.
Special Considerations:
During the administration of dobutamine EKG and
blood pressure should be continuously monitored. Hypovolemia should be
corrected with suit-able volume expanders before treatment with dobutamine is
instituted. Dobutamine can worsen hypotension
Dopamine Hydrochloride
Trade Name(s): Intropin®
Class: Sympathomimetic, Vasopressor, Inotropic Agent
Description: Dopamine is a naturally occuring catecholamine that increases
cardiac output without appreciably increasing mycardial oxygen consumption. It
maintains renal and mesenteric blood flow while inducing vasoconstriction and
increasing systolic blood pressure.
Indication(s): Used in the treatment of hypotension, low cardiac output, poor
perfusion of vital organs; used to increase mean arterial pressure in septic shock
patients who remain hypotensive after adequate volume expansion.
Contraindication(s): Hypovolemic hypotension without aggressive fluid
resuscitation, tachydysrhythmias, ventricular fibrillation and pheochromocytoma
(a rare adrenal gland cancer).
Precautions: Occlusive vascular disease, cold injury, arterial embolism.
Dosage/Administration: 5-20 mcg/kg/min titrate to desired SBP/MAP.
Theoretically doses less that 5 mcg/kg/min have predominately renal effects
Special Considerations: Use caution in patients taking MAO inhibitors. Ensure
adequate fluid resuscitation of the hypovolemic patient prior to use.
Epinephrine
Generic Name: Epinephrine
Trade Name(s): Adrenalin®, EpiPen®, Adrenaclick®
Class: Sympathomimetic
Description: Epinephrine is a naturally occurring catecholamine that increases
heart rate, cardiac contractile force, myocardial electrical activity and automaticity.
It also, through bronchial artery constriction, may reduce pulmonary congestion
and increase tidal volume.
Indication(s): Cardiac arrest, anaphylaxis, hypotension, symptomatic bradycardia,
bronchospasm, upper airway edema
Contraindication(s): Hypersensitivity to sympathomimetic amines, narrow-angle
glaucoma; hemorrhagic, tramatic or cardiac shock; coronary insufficiency;
dysrhythmias; organic brain or heart disease; during labor.
Precautions: Elderly or debilitated patients, hypertension, diabetes,
hyperthyroidism, Parkinson’s disease, tuberculosis, asthma, emphysema.
Dosage/Administration: Cardiac arrest: 1 mg IV/IO q 3-5 min. (ET:2-2.5 mg
diluted in 10 ml NS) Peds: 0.01 mg/kg (0.1 ml/kg sol’n) IV/IO every 3-5 minutes
(ET: 0.1 mg/kg of 0.1 ml/kg sol’n) Allergic reactions: 0.3-0.5 mg SQ/IM q 5-15
min.prn or 0.5 mg IV if subcutaneous dose ineffective or severe reaction. Ped:
0.01 mg/kg SQ q 10-15 min. or 0.01 mg/kg IV/IO if SQ dose ineffective or
reaction severe. Symptomatic bradycardia or profound hypotension: 2-10
mcg/min IV infusion, titrate to response. Post-ROSC hypotemsion refractory to
crystalloid bolus 0.1-0.5 mcg/kg/min. Typical autoinjector doses are 0.15 mg and
0.3 mg IM.
Special Considerations: Use with extreme caution in ischemic heart disease.
May nebulize 3mg 1:1000 epinephrine or racemic epinephrine. As of May 1,
2016, ratio expressions of epinephrine concentrations are prohibited on drug labels,
but are still residually used by providers. 1:1,000 1 mg/mL and 1:10,000 0.1
mg/mL
Etomidate
Trade Name(s): Amidate®
Class: Hypnotic
Description: Etomidate is an ultra-short-acting nonbarbiturate hypnotic with no
analgesic effects and limited cardiovascular and respiratory effects.
Indication(s): Induce sedation for intubation or as part of a medication “cocktail”
for sedation in rapid sequence intubation.
Contraindication(s): Hypersensitivity
Precautions: Marked hypotension, severe asthma, severe cardiovascular disease
and septic shock.
Dosage/Administration: 0.1-0.6 mg/kg IV over 15-30 seconds with a maximum
dose of 100 mg.Peds: 0.2-0.4 mg/kg over 30-60 seconds with a maximum dose of
20 mg.
Special Considerations: Has an onset of < 1 minute and has a duration of 5-10
minutes; no analgesic properties; masseter muscle spasm if given rapidly
Fentanyl Citrate
Trade Name(s): Sublimaze®
Class: Synthetic Opioid Analgesic
Description: Fentanyl is a potent synthetic narcotic/analgesic similar to morphine
and meperidine but with a more rapid and less-prolonged action.
Indication(s): Anesthesia adjunct for endotracheal intubation and to control
moderate to severe pain.
Contraindication(s): MAO inhibitors with 14 days, myasthenia gravis.
Precautions: Increased ICP, elderly, debilitated, COPD, respiratory problems and
hepatic and/or renal insufficiency.
Dosage/Administration: 25-100 mcg slow IV push over 2-3 mins or 3mcg/kg for
use in RSI. Peds: 2mcg/kg slow IV push or IM.
Special Considerations: Rapid injection will result in increased incidence of side
effects up to and including respiratory arrest. 100 times more potent than
Morphine
Flumazenil
Trade Name(s): Romazicon®
Class: Benzodiazepine Antagonist
Description: Flumazenil is a benzodiazepine antogonist used to reverse the
sedative, recall and psychomotor effects of diazepam, midazolam and other
bezodiazepines.
Indication(s): Respiratory depression secondary to benzodiazepine overdose
Contraindication(s): Contraindicated in patients hypersensitive to drug or
benzodiazepines, patients who show evidence of serious tricyclic antidepressant
overdose, and patients who received a benzodiazepine to treat a potentially lifethreatening condition such as status epilepticus.
Precautions: Hepatic or renal impairment, alcoholism, hypotension, bradycardia,
heart block, severe CAD, diabetes, hyperglycemia and respiratory depression.
Dosage/Administration:1st dose: 0.2 mg IV over 15 seconds 2nd dose:0.3 mg IV
over 30 seconds, if no adequate response 3rd dose 0.5 mg over 30 seconds. If no
adequate response, repeat once every minute until adequate response or a total of 3
mg is given.
Special Considerations: May induce seizures by reversing benzodiazepine
effects.
Furosemide
Trade Name(s): Lasix®
Class: Loop Diuretic
Description: Potent diuretic and antihypertensive that inhibits reabsorption of
sodium and chloride at the distal and proximal tubules and the loop of Henle.
Causes increased urine output. Vasodilatory effects.
Indication(s): Congestive heart failure and pulmonary edema.
Contraindication(s): Hypersensitivity to furosemide or the sulfonamides, fluid
and electrolyte depletion states, hepatic coma, pregnancy (except in lifethreatening circumstances).
Precautions: Infants, elderly, hepatic impairment, nephrotic syndrome,
cardiogenic shock associated with acute MI, gout, patients receiving digitalis or
potassium-depleting steroids.
Dosage/Administration: 0.5-1 mg/kg slow IV push over 1-2 minutes. Standard
Dose 20mg.
Special Considerations: When medication is pushed too quickly patients can
experience tinnitis or transient deafness. It is packaged in amber glass to protect it
from light.Vasodilatory effect within five minutes and diuretic effects within 30 minutes.
Glucagon
Trade Name(s): Gluca-Gen®
Class: Hormone/HyperglycemicAgent
Description: Glucagon is a protein secreted by pancreatic cells that causes a
breakdown of glycogen stores into glucose and inhibits the synthesis of glycogen
from glucose.
Indication(s): Hypoglycemia without IV access, reversal of beta-blocker and
calcium channel blocker overdose and management of esophageal food bolus
obstruction.
Contraindication(s): Hypersensitivity to glucagon or protein compounds.
Precautions: Cardiovascular or renal impairment.
Dosage/Administration: Hypoglycemia:1 mg IM/SQ repeat every 5-20 minutes
Peds: 0.03 mg/kg IM/SQ Beta-blocker/Calcium channel blocker overdose:3-10
mg slow IV push over 3-5 minutes. Food bolus: 1-2 mg IV push
Special Considerations: Effective only if there are sufficient stores of glycogen
in the liver
Haloperidol Lactate
Trade Name(s): Haldol®
Class: Antipsychotic
Description: Haloperidol is believed to block dopamine receptors in the brain
associated with mood and behavior, it is also a potent antiemetic.
Indication(s): Acute psychosis
Contraindication(s): Parkinson’s disease, seizure disorders, coma, alcohol
depression, CNS depression, thyrotoxicosis and use with other sedatives.
Precautions: Elderly or debilitated patients, urinary retention, glaucoma, severe
cardiovascular disease and anticonvulsant, anticoagulant or lithium therapy, prior
dystonic reactions.
Dosage/Administration: 2-10 mgIM Peds: <3 years 0.015-0.15 mg/kg/day PO or
in 2-3 divided doses.
Special Considerations: It impairs temperature regulation. May cause akathesia,
dystonia, and neuroleptic malignant syndrome (NMS)
Heparin Sodium
Trade Name(s): Heparin
Class:Anticoagulant
Description: Heparin is a rapid-onset anticoagulant, enhancing the effects of
antithrombin III and blocking the conversin of prothrombin and fibrinogen to
fibrin.
Indication(s): Prevention of thrombus formation in hypercoaguable conditions (ie
AMI, DVT, PE)
Contraindication(s): Hypersensitivity, active bleeding or bleeding tendencies,
recent eye, brain or spinal surgery and shock.
Precautions: Bleeding
Dosage/Administration: 60 IU/kg maximum bolus of 4,000 IU.
Special Considerations: Should be used with caution with any clinical state in
which there is an increase risk of bleeding (i.e. gi bleed, post-op). Also used in
hospital for initial treatment of new onset atrial fibrillation, deep vein thrombus
and pulmonary embolism.
Hydrocortisone sodium succinate
Trade Name(s): Solu-Cortef®
Class: Glucocorticoid
Description: Short-acting synthetic steroid used for its anti-inflammatory action
and as a replacement therapy in adrenocortical insufficiency.
Indication(s): Emergent allergic conditions in asthma, anaphylaxis, transfusion
reactions; adrenocortical insufficiency; cerebral edema; and others.
Contraindication(s): Systemic fungal infections and patients with known
hypersensitivity to the product. IM corticosteroid preparations are contraindicated
for idiopathic thrombocytopenic purpura.
Precautions: There may be decreased resistance and inability to localize infection
associated with use alone or in combination with other immunosuppressive agents.
Dosage/Administration: Given IV or IM. First, reconstitute for injection from
powder with bacteriostatic water or saline (up to 2 mL/250 mg). For IV infusion,
this reconstituted solution can be added to a bag of D5W or NS for a solution
concentration up to 1 mg/mL. Initial dose is 100-500 mg over 30 seconds to 10
minutes.
Special Considerations: Because of possible physical incompatibilities, should
not be diluted or mixed with other solutions.
Ipatropium Bromide
Trade Name(s): Atrovent®
Class: Anticholinergic, Bronchodilator
Description: Ipratropium Bromide is a bronchodilator used in the treatment of
respiratory emergencies that causes bronchial dilatition and dries respiratory tract
secretions by blocking acetylcholine receptors.
Indication(s): Bronchospasm associated with asthma, COPD and inhaled irritants.
Contraindication(s): Hypersensitivity to atropine or its derivatives or a as a
primary treatment for acute bronchospasm.
Precautions: Elderly, patients with cardiovascular disease or hypertension and
those with peanut allergy.
Dosage/Administration: 500 mcg in 2.5-3 ml NS via nebulizer or 2 sprays from a
metered dose inhaler. Peds: 125-250 mcg in 2.5-3 mL NS via nebulizer, or 1-2
sprays of a metered dose inhaler.
Special Considerations: Some providers have concerns to hypersensitivity to
peanuts, but with inhalation therapies not a concern.
Hydroxocobalamin
Trade Name(s): Cyanokit®
Class: Vitamin, Antidote
Description: Hydroxocobalamin (vitamin B12a) is a precursor to cyanocobalamin
(vitamin B12). In the presence of cyanide, each hydroxocobalamin molecule can
bind one cyanide ion, forming cyanocobalamin, which is then excreted in the urine.
Indication(s): IV for known or suspected cyanide
poisoning; IM for pernicious anemia or vitamin B12
deficiency.
Contraindication(s): IV – None in setting of cyanide
poisoning. IM – Hypersensitivity to drug or other
ingredients.
Precautions: Hypertension may occur with infusion
which subsides within a few hours.
Dosage/Administration: For cyanide poisoning, 5 g IV
as initial single infusion; may repeat a second 5 g dose
depending on the severity and response. Maximum
cumulative dose: 10 g.
Special Considerations: Fire victims may present with
both cyanide and carbon monoxide poisoning. In this
scenario, hydroxocobalamin is the agent of choice for
cyanide intoxication since the traditional cyanide
antidote that contains sodium nitrite produces
methemoglobinemia and may worsen tissue hypoxia.
Hydroxocobalamin can discolor the skin and exudates,
complicating the assessment of burn severity.
Isoetharine
Trade Name(s): Bronkosol®. Bronkometer®
Class: Sympathomimetic, Bronchodilator, Beta2Agonist
Description: Isoetharine is a synthetic sympathomimetic with rapid onset and
prolonged duration that relaxes the bronchial smooth muscles, decreasing airway
resistance and helping clear secretions.
Indication(s): Bronchospasm associated with asthma and COPD.
Contraindication(s): Hypersensitvity to or use of sympathomimetic amines, preexisting tachydysrhythmias or allergy to sodium disulfite agents.
Precautions: Elderly, hypertension, acute coronary artery disease, CHF,
hyperthyroidism, diabetes, tuberculosis or seizures.
Dosage/Administration: 1-2 sprays via metered dose inhaler or 0.5 mL in 2-3 mL
NS via nebulizer. Peds: 0.01 mL/kg of 1% solution (max 0.5 mL) diluted in 2-3
mL saline via nebulizer.
Special Considerations: Multiple Doses can cause paradoxical
bronchoconstriction
