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Flashcards in Paramedic Drugs Deck (33):
1

Adenosine

Trade Name: Adenocard

Classification: Antiarrhythmic

Action/Effects: Slows supraventricular tachycardia, decreasing the electrical activity by interrupting the reentry pathways through the AV node.

Indication: PSVT Rhythm (after vagal maneuvers)

Contraindication: Hypersensitivity 2nd & 3rd degree AV heart block, Sick Sinus Syndrome, A-Fib

Side Effects: Syncope, Chest Pain, facial flushing, SOB, dizziness, hypotension

Adult Dose: 6mg IV push with 20cc NS fluid bolus, a repeat dose of 12mg in 1-2 minutes up to 2X may be given if not converted.

Pediatric Dose: 0.1mg/kg rapid IV push followed by 5cc bolus, repeat 0.2mg/kg x 1

Cautions: Half life is 5 seconds. Pediatric doses don't exceed adult doses

2

Albuterol

Trade Name: Proventil, Ventolin

Classification: Bronchodilator, Sympathomimetic

Action/Effects: A beta2-adrenergic agonist which helps relax the bronchial smooth muscles

Indication: Asthma, Relief of bronchospasm with reversible obstructive airway disease.

Contraindications: These are relative to pt. symptoms: Cardiac dysrhythmias, Tachyarrhythmia's, Angina, HTN, diabetes

Side Effects: Tremors, Dizziness, Anxiety, Palpitations, Tachycardia

Adult Dose: 2.5mg/3ml of NS

Pediatric Dose: 2.5mg in 3cc NS > 1 year old, 1.5mg in 3cc NS < 1 year old

Cautions: Be aware of prior doses/ can interact with diuretics, digoxin, betablockers, & MAO inhibitors/ can have toxicity effects on vascular system if used with tricyclic antidepressants

3

Amiodarone

Trade Name: Cordarone

Classification: Antiarrhythmic

Action/Effects: Prolongs phase 3 of the cardiac action potential. Amiodarone increases the refractory period of sodium and potassium channels. This intern slows the cardiac action potential.

Indication: V-Fib/V-Tach Pulseless

Contraindication: Hypersensitivity

Side Effects: Lung problems, Liver Problems, Epididymis in long term use

Adult Dose: 150-300 mg IV (Expected 300mg IV loading dose) Check your protocols. (Expected 150mg 2nd dose if needed)

Pediatric Dose: 5mg/kg IV/IO (Check your protocols for additional doses)

4

Amyl Nitrate

Trade Name: Vaporole

Classification: Vasodilator, Cyanide Antidote

Action/Effects: Causes oxidation of hemoglobin to the compound of methemoglobin. Vasodilatation, including coronary artery dilation. Smooth muscle relaxant
Indication: Cyanide poisoning

Contraindication: None when given for cyanide poisoning

Side Effects: Hypotension with syncope, Headache, Nausea & Vomiting

Adult Dose: 0.3ml or an Amyl Nitrate glass pearl (similar to ammonia) Break ampule & inhale for 30 seconds, then 100% O2 for 50-100 seconds, monitor blood pressure

5

Aspirin

Trade Name: ASA, Baby Aspirin, Bayer

Classification: Anti-platelet, Antipyretic, NSAID

Action/Effects: Decreases platelet aggregation, prolongs clotting time. Antipyretic Activity

Indication: MI, Coronary Artery Disease, Pericarditis

Contraindication: Hypersensitivity, Pt. already on anticoagulants, Bleeding Disorders

Side Effects: Heart Burn, Nausea, Wheezing, Tinnitus

Adult Dose: 160-325mg PO chewable (2-4 tablets 81mg per tablet) Expected Dose: 324mg

Cautions: Pediatrics, GI bleeds

6

Atropine Sulfate

Atropine Sulfate Trade Name: Atropine

Classification: Parasympatholytic, Anticholinergic agent

Action/Effects: Increases HR, Contractility, Automaticity, Conduction, & Dilation of the peripheral vessels. Works mainly on the Atrium

Indication: Symptomatic Bradycardia; Organophosphate Poisoning

Contraindication: Hypersensitivity, Tachycardia,
Relative or not functional uses:2nd & 3rd degree AV heart block

Side Effects: Increased Cardiac consumption, Dryness in mouth, Headache, Dizziness, Nausea & Vomiting

Adult Dose: Brady 0.5mg q 3-5 min IV,ET
2-5mg for Organophosphate Poisoning (Vary w/Pt. symptoms)

Pediatric Dose: 0.02mg/kg IV, ET Minimum dose 0.1mg

Cautions: A-Fib, A-Flutter, Glaucoma, & COPD

7

Diazepam

Trade Name: Valium

Classification: Benzodiazepine, Anticonvulsant

Action/Effects: Antianxiety & anticonvulsant activity. Acts on the CNS to relax the nervous system

Indication: Status Epilepticus, Severe Anxiety, Pacing

Contraindication: Hypersensitivity, Depressed Vital Signs, CNS depressions due to head trauma

Side Effects: Respiratory Depression, Hypotension, Slurred Speech, Confusion, Nausea, Ataxia

Adult Dose: 5-20mg IV/ET/IO

Expected Dose: 5 mg IV increasing to desired effects, smaller doses for elderly patients are needed (2-5mg)

Pediatric Dose: Pediatric 0.1mg/kg IV/ET/IO 0.5mg/kg PR

Cautions: EMT's carry nothing to reverse a benzodiazepine over dose.

8

Diphenhydramine

Trade Name: Benadryl

Classification: Antihistamine

Action/Effects: Blocks histamine receptors. This is at the H1 sites. High doses may cause Anticholinergic activity.

Indication: Anaphylaxis, Allergic reaction

Contraindication: Asthma, Hypersensitivity, Pregnancy, nursing mothers

Side Effects: Thicken bronchial secretions, Hypotension, Drowsiness, Dizziness, Tremors

Adult Dose: 25-50mg IM/IV, 15-30 min onset

Expected Dose: 50mg IM

Pediatric Dose: 1-2mg/kg IM/IV

Note: Deliver IM injections into deep muscle mass & alternate sites

9

Dopamine

Trade Name: Intropin

Classification: Sympathomimetic, Inotrope and chronotropic effects

Action/Effects: Naturally occurring neurotransmitter. Stimulates dopaminergic, beta1/alpha1 adrenergic receptors in a dose dependant amount.

Indication: Cardiogenic shock & hypotension not resulting from
hypovolemia

Contraindication: Hypersensitivity, V-Fib, tachydysrhythmias

Side Effects: Ventricular irritability, Hypertension, Headache, Infiltration causes necrosis, Nausea, Vomiting

Adult/Pediatric Dose: 800mg in a 500cc D5W or NS

Expected Dose: 5-20mcg/kg/min titrating to increase systolic to 100; 2-5 mcg/kg/min are renal effects for lowering BP

Cautions: If possible correct hypovolemia before Dopamine treatment with a fluid bolus. 500-1000cc

DO NOT MIX with NaHCO3

10

Dextrose 5%

Classification: Hypotonic Solution

Action/Effects: N/A

Indication: Mixing medications (Lidocaine, Dopamine)

Contraindication:N/A

Side Effects:N/A

Adult Dose: Medication Dependent

Expected Dose: N/A

Pediatric Dose: N/A

Cautions: Use caution if used for main IV solution

11

Epinephrine 1-1,000

Trade Name: Adrenalin 1-1,000

Classification: Bronchodilator, Cardiac Stimulant, Sympathomimetic

Action/Effects: SQ = Bronchodilator & relief of bronchial edema, Beta 1&2 IV = Increases HR, Vasoconstricts, Alpha 1 & Beta 1

Indication: Anaphylaxis, Acute Allergic Reactions, Asthma, Shock

Side Effects: Tremors, Dizziness, Anxiety, Palpitations, Tachycardia, Acute Hypertension

Adult Dose: Anaphylaxis: 0.3-0.5mg SQ.
-Upper Airway Stridor: 2mg of 1:1,000 in 3ml of NS
-Shock treatment= Infusion: as inotrope/pressor.
4 mg in 500ml NS = 8 mcg/ml titrated to effect: Usual range 2-10 mcg/minute (0.01 - 0.1 mcg/kg/minute). (Raise BP S 70-100)

Pediatric Dose: 0.01mg/kg with a max dose of 0.3mg for anaphylaxis - 0.1mg/kg ET (1-1,000) q 3-5 min w/3-5cc flush for cardiac

Cautions: Use caution with pregnancy & preexisting heart disease

Note: Be sure you are using the correct Epinephrine. Both
Epinephrines' can have the same uses depending route.

12

Epinephrine 1-10,000

Trade Name: Adrenalin 1-10,000

Classification: Sympathomimetic, Cardiac Stimulant, Bronchodilator

Action/Effects: Increases cardiac resistance, BP, Electrical activity, O2 Needs, contractility, & myocardial activity. Alpha 1 & Beta 1

Indication: Cardiac Arrest V-Fib, V-Tach, Asystole, PEA, & profound Bradycardia

Side Effects: Hypertension, Peripheral constriction

Adult Dose: 0.5-1mg IV every 3-5 minutes
(ET is 2-2 ½ time the dose w/20cc flush)

Expected Dose: 1mg IV Max: None in a life threatening emergency

Pediatric Dose: 0.01mg/kg IV/IO with a max dose of 1mg IV
0.1mg/kg ET (1-1,000) q 3-5 min w/3-5cc flush

Cautions: DO NOT mix with NaHCO3, Heat destroys this drug

13

Fentanyl

Trade Name: Sublimaze

Classification: Opioid Analgesic

Action/Effects: Combines with receptors sites in brain to produce potent analgesic effects.

Indication: Pain Control, 2nd drug choice for chest pain if morphine allergy. Possible sedation with approved protocol. (RSI)

Contraindication: Respiratory Depression, Hypotension, Head injury, Dysrhythmias, Myasthenia gravis (Muscles tires easy),
Hypersensitivity.

Side Effects: Respiratory depression, Bradycardia, Hypotension or Hypertension, ICP, Nausea

Adult Dose: 25-50mcg IV, IM Max: 100mcg

Ped Dose: Over 2 y/o 0.5-1mcg/kg IV/IM Slow Push (Rarely used in Prehospital)

Cautions: Use Caution with elderly, Schedule II drug (addictive)

14

Furosemide

Trade Name: Lasix

Classification: Loop Diuretic

Action/Effects: Inhibits the reabsorption of sodium & chloride in the kidney tubule & promotes increased urine formation & excretion

Indication: Pulmonary Edema, CHF

Contraindication: Pregnancy, Hypovolemic, & Hypokalemia

Side Effects: Dehydration, hypotension, Tinnitus/hearing impairment with long term affects

Adult Dose: 20-80mg IV SLOW push to prevent tinnitus

Pediatric Dose: 1mg/kg

Cautions: PUSH slowly & lower doses to avoid Tinnitus.

15

Glucagon

Trade Name: GlucaGen

Classification: Pancreatic Hormone, Insulin Antagonist

Action/Effects: Raises glucose level by using the glycogen in the liver for glucose. Stimulating glucose synthesis

Indication: Hypoglycemia

Contraindication: Hypersensitivity

Side Effects: Hypotension, Nausea, Hypokalemia

Adult Dose: 1mg IM/IV but usually given IM

Pediatric Dose: 0.02-0.03mg/kg IM/IV with max of 1mg

Cautions: Pt. may have home emergency glucagon kit
May be used w/calcium channel blocker&beta-blocker toxicity

16

D50

Trade Name: D 50, 50% Dextrose

Classification: Carbohydrate

Action/Effects: Raises BSL, using electrolytes

Indication: Hypoglycemia

Contraindication: Intracranial Hemorrhage, & possible CVA. Consider D25

Side Effects: Tissue necrosis if infiltration occurs with IV

Adult Dose: 25-50gms IV/IO only (lower doses may be given)

Expected Dose: 25gm/50ml given slowly

Pediatric Dose: 0.5-1gm/kg IV/IO with a max of 25gms (D25 for Under 1y/o) (D10 for Under 1 month old)

Cautions: Tissue necrosis if infiltration occurs with IV

17

Haloperidol

Trade Name: Haldol

Classification: Antipsychotic

Action/Effects: Blocks the stimulation of dopamine receptors in the brain, altering mood & behavior

Indication: Acute psychotic episodes

Contraindication: Severe toxic CNS depression, Coma, Parkinson's disease, Head injury, Hypersensitivity

Side Effects: Orthostatic Hypotension, Parkinson like symptoms, N & V, blurred vision, headache, drowsiness, diaphoresis

Adult Dose: 5-10mg IM / IV

Expected Dose: 5mg IM

Cautions: Use cautions with patients that have cardiovascular disorders, receiving anticonvulsants, and anticoagulants.
Not recommended for pediatrics.

18

Hydroxocobalamin

Trade Name: Cyanokit

Classification: Cyanide Antidote

Action/Effects: Hydroxocobalamin combines with cyanide to form cyanocobalamin which is excreted through the kidneys

Indication: Known or suspected cyanide exposure

Contraindication: None prehospital

Side Effects: Turns the patient bright red, transient hypertension.

Adult Dose: 5.0 g (in two vials of 2.5 g) each reconstituted with 100 mL of NS infused over 15 minutes

Pediatric Dose: Contact medical control. 70 mg/kg up to 5 g.

Cautions: None prehospital. Suspect cyanide intoxication in victims of smoke inhalation from closed space with altered mental status, unstable vital signs, or cardiorespiratory arrest.

19

Lactated Ringers

Trade Name: LR

Classification: Isotonic fluid but is slightly more hypertonic than NS

Action/Effects: Assist in fluid replacement for dehydration or blood loss

Indication: IV fluid for IV maintenance or Electrolyte replacement

Precautions: CVA, Diabetics, Mixing with blood sets.

Adult Dose: 200-500cc

Pediatric Dose: 20cc/kg for fluid replacement

Max: 60cc/kg for pediatrics or 2-3 liters of fluid for adults

20

Lidocaine HCL

Trade Name: Xylocaine, Xylocard

Classification: Antiarrhythmic Agent

Action/Effects: Decreases the depolarization, automaticity, & excitability in the in the ventricles during the diastolic phase by the direct action on the tissue, especially the Purkinje network.

Indication: V-fib/ V-Tach, Post V-fib/ V-Tach (after conversion), possible symptomatic PVC's

Contraindication: Bradycardia, AV Heart Blocks

Side Effects: Seizures, Coma, Respiratory depression may occur if given rapidly or in high doses, Sinus Brady, Hypotension

Adult & Pediatric Dose:
0.75-1.5mg/kg IV/ET/IO q 3-5 min followed by a drip of
1-4mg/minute depending on prior boluses

Expected Dose: Initial dose: 1mg/kg IV/IO or 2 ½ times the dose for ET 2nd doses: ½ initial dose for 2nd and subsequent dosing

Max: 3mg/kg

Cautions: ½ doses for over 70 years old, ½ dose for liver disease pt

21

Lorazepam

Trade Name: Ativan

Classification: Benzodiazepine

Action/Effects: Anti-seizure, anti-convulsant, sedative, muscle relaxant

Indication: Seizures, Conscious sedation, Chemical restraint

Contraindication: Hypersensitivity, depressed CNS, hypotension

Caution: Pregnancy Category D, Should not be used in patients who have taken other CNS depressants

Side Effects: Respiratory depression, decreased CNS, N/V, blurred vision, headache, bradycardia

Adult Dose: 4mg IV/IO/IM (Slow IV push)

Pediatric Dose: 0.1-0.2mg/kg IV/IO/IM (Slow IV Push)

Other information: Supplied 2mg/ml or 4mg/ml in many departments

22

Meperidine HCL

Trade Name: Demerol

Classification: Narcotic Analgesic, Opioid Analgesic

Action/Effects: Addictive narcotic that depresses the CNS & may relieve pain

Indication: Relief of moderate to severe pain

Contraindication: Hypersensitivity, MAO inhibitors, Head injury

Side Effects: Depressed respirations & BP, Tremor, Nausea, Vomiting

Adult Dose: 50-100mg IM/IV

Expected Dose 50mg followed by an anti-emetic slow IVP

Pediatric Dose: 1-2mg/kg

Cautions: May mix with promethazine for increase & potentiate analgesics

23

Midazolam

Trade Name: Versed

Classification: Short acting benzodiazepine, CNS depressant, Anti-seizure

Action/Effects: Anti-seizure, anti-convulsant, sedative, muscle relaxant

Indication: Seizures, Conscious sedation, Chemical restraint

Contraindication: Hypersensitivity, depressed CNS, shock

Cautions: Pregnancy Category D, Should not be used in patients who have taken other CNS depressants

Side Effects: Depressed CNS, N/V, blurred vision, headache, retrograde amnesia

Adult & Pediatric Dose: IV 0.1mg/kg up to 5mg [1-5min onset]
IN 0.2mg/kg up to 10mg dose [3-7min onset] 1cc per nostril
IM 0.1mg/kg up to 10mg dose[15-30min]

Expected Dose ADULT IV 2-5mg, IN/IM 5-10mg
2nd doses may be given

24

Morphine Sulfate

Trade Name: MS

Classification: Narcotic analgesic, Opioid analgesic

Action/Effects: Acts on opiate receptors in the brain providing analgesia & sedation. Vasodilator, reducing venous return & myocardial oxygen demand.

Indication: Moderate to severe pain with trauma. Chest pain associated with MI

Contraindication: Hypersensitivity, Head injury, CVA, Hypotension, and respiratory depression

Side Effects: Depressed CNS, constipation, dry mouth

Adult Dose: IV 2-4mg titrated to max of 20mg max. [immediate onset] IM/SC 5-20mg [10-30min onset]

Pediatric Dose: IV 0.1mg/kg. IM/SC 0.1 - 0.2mg/kg

Expected Dose: IV 2-4mg titrated to max of 20 or medical control dose

Caution: Have Narcan ready in case of severe adverse reaction.

25

Naloxone

Trade Name: Narcan

Classification: Narcotic Antagonist, Opioid Antagonist

Action/Effects: Displace narcotics at the receptor sites in the CNS. Attaches to the receptors & inhibits the narcotics action

Indication: Narcotic overdose, Respiratory depression,
Coma of unknown origin, man down, coma of unknown origin

Contraindication: Hypersensitivity

Side Effects: N/V, Seizures, tachycardia, HTN, diaphoresis, blurred vision, withdrawal

Adult Dose: 2-4mg IV/IM/IN/ET/IO.

Possible Dose: 0.5-1mg IV, 2mg IM/IN
(Titrate to respirations to prevent narcotic withdrawals.)

Pediatric Dose: 0.1mg/kg IV/IM with max of 2mg

Cautions: It can cause seizure from withdrawal in chronic opiate users

26

Nitroglycerin

Trade Name: Nitrostat

Classification: Coronary Vasodilator

Action/Effects: Decreases cardiac work, increases circulation to the heart, dilates coronary & systemic arteries.

Indication: AMI, Pulmonary Edema, Hypertension emergencies, CHF

Contraindication: EMT-P Systolic <100, CVA, head injury, recent use of ED drugs (Cialis, Levitra, Viagra)

Side Effects: Severe Hypotension, Weakness, Headache, Syncope, dizziness, N/V

Adult Dose: 0.3-0.4mg Sublingual q 5min up to 3x
(May come in spray or tablet) (Most doses are 0.4mg)

Cautions: If the pt. is wearing a nitroglycerin patch or paste, additional administration may not be effective.

27

0.9% Sodium Chloride Injection USP

Trade Name: Normal Saline, NS

Classification: Isotonic Fluid IV

Action/Effects: Assists in the re-hydration of fluid & electrolytes in the vascular system

Indication: IV maintenance, Fluid Bolus, Combination with blood sets on trauma patients, volume replacement, dehydration, hypotension

Contraindication: Hypersensitivity, pulmonary Edema

Side Effects: 3rd spacing of fluid is possible on bolus dosing, Pulmonary Edema

Dose: 200-500cc bolus or TKO, after listening to lung sounds

Pediatric Dose: 20cc/kg with a max of 60cc/kg

Max: 3 L max for Trauma pt's may be suggested. Heat Exhaustion or Dehydrated pt's you may exceed the 3L max.

Cautions: Overloading pediatrics/geriatrics/ & Pulmonary Edema

28

Ondansetron

Trade Name: Zofran

Classification: Anti-emetic

Action/Effects: Prevention & control of severe nausea. Calms vomiting reflex through vagal afferent nerves.

Indication: Non-sedating anti-emetic is desirable for preventing nausea

Contraindication: Hypersensitivity

Side Effects: Headache, Dizziness, Diarrhea

Adult Dose: 4mg IV Slow push 2-5 minutes, 4mg IM Max: 8mg
Also available in the pill form.(Dissolve in mouth same dose)

Ped Dose: Over 2 y/o 0.1mg/kg IV, IM Max: 4mg

Caution: Use caution in patients with impaired liver function. Rate of administration should not be less than 30 sec.

Note: Zofran has no effect on motion sickness

29

Oxytocin

Trade Name: Pitocin

Classification: Pituitary Hormone

Action/Effects: Stimulates uterine smooth muscle contraction, & helps expedite constricting uterine blood vessels & controlling excessive hemorrhage.

Indication: Post partum hemorrhage, AFTER infant and placenta delivery

Contraindication: Hypertonic & hyperactive uterus, 2nd fetus, maternal bradycardia

Side Effects: Hypo/hypertension, N/V, seizures, anxiety, dysrhythmias, Fetal Bradycardia. Stimulates lactation

Dose: 3-10 units IM, AFTER infant and placenta

Expected Dose:
10 units IM

30

Promethazine

Trade Name: Phenergan

Classification: CNS depressant, Antihistamine, antiemetic.

Action/Effects: Produces an antihistamine & antiemetic response, It also potentiates narcotics & increases the effectiveness

Indication: Nausea & vomiting, potentiates sedative effects of analgesics (Meperidine)

Contraindication: Hypersensitivity

Side Effects: Pronounced sedation, confusion, & Tissue irritation

Adult Dose Range: 12.5-50mg IV/IM (may dilute with 10cc with given to lesson tissue damage in IV) Expected 12.5-25mg with 10cc NS.

Pediatric Dose: 0.5mg/kg

Cautions: Tissue irritation is possible on IV infiltration or SQ area injection. Use caution with pediatrics.

31

Procainamide

Trade Name: Pronestyl

Classification: Antiarrthythmic, Sodium Channel Blocker

Action/Effects: Blocks open sodium channels and prolongs cardiac action potential. (may also block K+) reduces ectopic pacemakers

Indication: Monomorphic VT with normal QT, stable wide complex tachycardia of unknown origin, A-Fib with WPW

Contraindication: AMI, hypokalemia

Side Effects: Hypotension, may prolong QT interval

Adult Dose: 20mg per minute IV Infusion(Max dose 17mg/kg)

Cautions: Urgent situations may require 50 mg per minute
Use in Cardiac arrest is limited

Extra Info: Give until one or more of the following occurs:
Arrhythmia suppression, hypotension, QRS widens by 50%, total 17mg/kg given

32

Sodium Bicarbonate

Trade Name: NaHCO3

Classification: Alkalinizing Agent

Action/Effects: Neutralizes acids, returning blood & body fluid to a more normal ph instead of an acidosis state. (Increases pH)

Indication: Metabolic acidosis, Prolonged CPR or down time (more than 5-10 minutes), Tricyclic overdoses. (Tricyclic meds = Amitriptyline, Desipramine, Endep, Janimine, Norpramin, Nortriptyline, Pamelor, Surmontil, Tofranil, Triavil, Trimpramine)

Contraindication: Hypersensitivity, Alkalosis patient.

Side Effects: Pushing a ph to an alkalosis state instead of neutralizing the ph.

Adult & Pediatric Dose: 1mEq/kg followed ½ the initial dose q 10 minutes. Use 4.2% solution for pediatrics

Cautions: Avoid mixing with Epinephrine or Calcium.

33

Verapamil

Trade Name: NaHCO3

Classification: Antiarrhythmic, Calcium Channel Blocker

Action/Effects: Dilates the coronary arteries. This increases the blood flow to the heart. Prolongs AV nodes refractory period.

Indication: 2nd line med for SVT. A-fib, A-Flutter, Multifocal Atrial Tachycardia (Only for narrow complex QRS)

Contraindication: Wide QRS Complex, WPW, Sick Sinus Syndrome, AV Heart Blocks

Side Effects: Constipation, nausea, heartburn, headache

Adult Dose: 1st dose: 2.5 - 5mg IV bolus over 2 minutes
2nd dose: 5-10mg IV bolus over 4 minutes

Pediatric Dose: None

Cautions: Max dose: 20mg (Supplied 5mg/2ml)