Drug Cards

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Class: analgesic, antipyretic
Action: relieves pain by elevating the pain threshold and reduces fever through its
action on the heat-regulating center of the brain
Indication: fever reduction, minor pain control
Fever ➞ we only use Tylenol to reduce fevers
Contraindication: liver insufficiency/failure
Adult dose: 650mg PO
Pediatric dose: 10-15mg/kg PO
Adverse reactions: side effects are rare, chronic use can cause liver
dysfunction/failure. Potential for acetaminophen to
harm the liver is increased when it is combined with
alcohol or drugs that also harm the liver.
Chronic use can cause liver dysfunction/failure

Acetaminophen (Tylenol®)


Class: adsorbent
Action: binds and adsorbs ingested toxins that may remain in the GI tract following
ingestion. Once bound, the combined complex is then harmlessly excreted
from the body
Indication: oral poisonings, oral medication overdose
Contraindication: ingestion of corrosives, caustics, and petroleum distillates, pregnancy
Dose: preparations come or are required to be mixed as 25g mixed in 125mL water of
50g mixed in 250mL as slurry.
Adult dose: 1-2g/kg (usually 30-100g)
Pediatric dose: 1-2g/kg (usually 15-30g)
Adverse reactions: may indirectly induce nausea and vomiting, constipation and
blackened feces. Pregnancy safety is not established.
Can cause nausea and vomiting
***Will NOT adsorb all toxins such as cyanide, lithium, iron, lead, or arsenic***

Activated Charcoal (Actidose®, Charcoaide®)


Class: class IV antiarrhythmic
Action: directly acts on sinus pacemaker cells and vagus verve to decrease chronotropic
and dromotropic activity without causing negative inotropic effects
Temporarily stops the heart and allows it to repolarize
Slows down the heart rate and conductivity through the heart without causing
a decrease in contraction strength
Indication: conversion of SVT/atrial tachycardia to a sinus rhythm
***Only time we use adenosine is for SVT***
Contraindication: second or third degree AV blocks, atrial flutter, atrial fibrillation,
ventricular tachycardia, hypersensitivity to adenosine
Any and all cardiac rhythms EXCEPT SVT
Adult dose: 6mg rapid IV/IO; if no effect after 1-2mins, then 12mg rapid IV/IO
Pediatric dose: 0.1mg/kg rapid IV/IO; if no effect after 1-2mins, then 0.2mg/kg rapid IV/IO
Adverse reactions: facial flushing, paresthesia, headache, diaphoresis, hypotension, chest
pain, palpitations, shortness of breath, nausea,
lightheadedness, transient asystole

Adenosine (Adenocard®)


Class: sympathomimetic, bronchodilator
Action: a beta2 specific sympathomimetic. It relaxes the smooth muscles of the
bronchial tree and peripheral vasculature by stimulating adrenergic receptors
of the sympathetic nervous system.
Beta2 specific sympathomimetic that causes bronchodilation
Indication: relief of bronchospasm in patients with reversible obstructive pulmonary
disease. Prevention of exercise induced bronchospasm.
Contraindication: hypersensitivity, tachydysrhythmias over 140 (MDI only)
Adult dose: 2.5mg diluted with 3mL normal saline SVN over 5-15min
Pediatric dose: <20kg: 1.25mg diluted with 3mL normal saline SVN over 5-15min
Adverse reactions: restlessness, apprehension, dizziness, palpitations, increase in
blood pressure, dysrhythmias, increased hypoxemia
***May be antagonized by beta-blockers, may potentiate diuretic induced hypokalemia***
***Anti-depressants may potentiate the effects on the vasculature***

Albuterol (Proventil®, Ventolin®)


Class: xanthine bronchodilator (theophylline derivative)
Action: respiratory stimulant, bronchodilation, mild diuresis, positive inotrope, positive
chronotropy (in large doses).
Causes bronchodilation along with positive inotropic and chronotropic effects
Indication: severe bronchospasm associated with asthma, chronic bronchitis,
emphysema or pulmonary edema, CHF, bronchospasm refractory to
sympathomimetic therapy.
Contraindication: allergy to xanthines (like caffeine), hypersensitivity, dysrhythmias
Adult dose: 5mg/kg loading dose in 50-100mL diluent over 10-20min slow IV infusion
followed by 0.5-0.7mg/kg/hr not to exceed 20mg/min
Pediatric dose: not recommended in pediatrics
Adverse reactions: tachycardia, palpitations, PVC’s, angina, dizziness, headache, seizure,
nausea/vomiting, abdominal cramps

Aminophylline (Amoline®, Somophyllin®, Aminophyllin®)


Class: Class III antidysrhythmic
Action: decreases sinus automaticity, reduces the speed of conduction, increases the refractory
period of the AV node, prolongs the action potential duration in all cardiac tissue
Slows down the conduction in the heart, makes the AV node hold
onto the impulse longer to correct the arrhythmia
Indication: stable VT, VF/pulseless VT
Contraindication: breast-feeding patients in cardiogenic shock, heart blocks, symptomatic bradycardia
Any rhythm other than ventricular tachycardia or ventricular fibrillation
Adult dose: stable VT: mix 150mg/100mL D5W and infuse over 10min, May repeat
this twice ***LIVE DOSE***
VF/pulseless VT: 300mg rapid IV/IO, If remains in VF/VT second dose of 150mg
rapid IV/IO ***DEAD DOSE***
maintenance infusion: mix 450mg/250mL D5W, administer 1mg/min for 6hrs, then
0.5mg/min for the next 18hrs ***Max dose ➞ 2.2g/24hr***
Pediatric dose: stable VT: 5mg/kg over 20min, may repeat twice ***LIVE DOSE***
VF/pulseless VT: 5mg/kg rapid IV/IO ***DEAD DOSE***
Adverse Reactions: hypotension, bradycardia, prolonged PR interval, pulmonary toxicity,
may react with warfarin, quinidine, digoxin, procainamide and phenytoin.
Profound hypotension and bradycardia

Amiodarone (Cordarone®)


Class: cyanide poisoning antidote
Action: chemically binds with cyanide and prevents any toxic effects
Indication: cyanide poisonings
Contraindication: none
Adult dose: 1-2 ampules crushed and inhaled for 30seconds per minute
Pediatric dose: 1 ampule crushed and inhaled for 30seconds per minute
Adverse reactions: headache, dizziness, tachycardia, syncope, shortness of breath

Amyl Nitrite


Class: analgesic, anti-inflammatory, antipyretic, antiplatelet
Action: blocks pain impulses in the CNS; decreases platelet aggregation
We only administer ASA for the antiplatelet properties
Indication: acute coronary syndrome, unstable angina, undiagnosed chest pressure, pain or discomfort
Anyone having chest pain or a cardiac event
Contraindication: ASA induced asthma, bleeding disorders, hemorrhagic stroke, pediatrics
exhibiting flu like symptoms. Always consider risks vs. benefits
Strokes, pediatrics and during pregnancy
Adult dose: 160-325mg PO. Usually administered pre-hospital as four 81mg chewable tablets (324mg)
Pediatric dose: do not give, safety not established
Adverse reactions: stomach irritation, indigestion, nausea/vomiting, increased bleeding time.
Use it in caution in active peptic ulcer disease. Aspirin’s effects may be
decreased in administration with steroids or antacids and increased in the
administration of anticoagulants, insulin, hypoglycemic and fibrinolytics.
Unless it is a true allergic reaction, ASA should always be given in cardiac related events

Aspirin (Bayer®, Bufferin®)


Class: anticholinergic
Action: inhibits the actions of acetylcholine at parasympathetic receptor sites. These blocked
vagal effects result in positive chronotropy and dromotropy without increased inotropy.
Used primarily to treat bradycardias and organophosphate poisonings.
Increases the heart rate by blocking the vagus nerve from stimulation, causing
positive chronotropy and positive dromotropy without increased inotropy
Indication: symptomatic bradycardias, organophosphate poisonings
Contraindication: tachycardia, hypersensitivity, acute hemorrhage, myocardial ischemia/infarction
Adult dose: Bradycardia: 0.5mg fast IV/IO can repeat every 3-5mins (max dose 3mg)
Organophosphate: 2-4mg IV/IO (no max dose)
Pediatric dose: 0.02mg/kg IV/IO minimum dose of 0.1mg with a max does of 0.5mg
Max dose of 0.04mg/kg
Adverse reactions: tachycardia, paradoxical bradycardia when pushed slowly or less than 0.5mg,
dysrhythmias, palpitations, anticholinergic effects, dizziness, headache

Atropine Sulfate


Class: loop diuretic
Action: inhibits the reabsorption of sodium and chloride in the proximal tubule and the Loop
of Henle within the kidneys. Does not have the vasodilatory effects that furosemide
Indication: CHF, pulmonary edema
Contraindication: anuria, hypovolemia, dehydration, hypersensitivity to sulfonamides, severe
electrolyte depletion
Adult dose: 0.5mg – 1.0mg slow IV/IO or IM
Pediatric dose: not recommended
Adverse reactions: dizziness, headache. EKG changes due to electrolyte depletion,
nausea/vomiting, diarrhea, muscle cramps, dehydration

Bumetanide (Bumex®)


Class: hypertonic electrolyte
Action: promotes functional integrity of nervous and muscular systems such as cardiac
contractility and coagulation of blood. Contains 27.2% elemental calcium
Promotes cardiac contractility (+inotropy)
Indication: hyperkalemia, hypocalcemia, calcium channel blocker toxicity, hypermagnesemia,
PEA or asystole rhythms in the known renal failure patient, antidote for calcium
channel blocker-induced hypotension/bradycardia
Most common prehospital reason is for asystole and PEA in known
dialysis patients who have missed treatments
Contraindication: VF cardiac resuscitation, Digoxin toxicity, hypercalcemia
Adult dose: 500mg-1000mg slow IV/IO
Pediatric dose: 20mg/kg slow IV/IO
Adverse reactions: bradycardia, asystole, metallic taste, severe tissue necrosis if infiltrated
***Calcium chloride is the antidote for calcium channel blocker overdoses***
Calcium Chloride

Calcium Chloride


Class: steroid, anti-inflammatory
Action: suppresses acute and chronic inflammation, potentiates relaxation of vascular smooth
muscle by beta-adrenergic agonists, and possibly alters airway hyperactivity
Indication: cerebral edema, allergic states, asthma, spinal cord injury (especially with associated
neurogenic shock)
Anaphylaxis and trouble breathing in hypersensitive airways such as asthma and COPD
Contraindication: hypersensitivity, use cautiously with hypertensive crisis and pulmonary edema
Adult dose: 10mg-100mg IV/IO (1mg/kg)
Pediatric dose: 0.25-1.0mg/kg IV/IO/IM
Adverse reactions: hypertension, sodium and water retention, GI bleeding, suppression of
adrenocortical steroid production.

Dexamethasone (Decadron®, Hexadrol®)


Class: carbohydrate, hypertonic solution
Action: increases circulating blood glucose levels. Due to its hypertonic qualities, it is a very
short acting osmotic diuretic.
Increases blood glucose
Indication: hypoglycemia, altered LOC, coma of unknown origin, seizures of unknown origin
Our only indication is hypoglycemia
Contraindication: intracranial hemorrhage, increased ICP, known or suspected CVA without
Hyperglycemia and CVA
Adult dose: 12.5-25g slow IV push, may repeat once
Pediatric dose: dilute to a 25% concentration and administer 2mL/kg
Infant Dose: dilute to a 12.5% concentration and administer 4mL/kg
Adverse reactions: thrombophlebitis, tissue sloughing and necrosis if IV is not patent, pain at site
***Administration of D50 may cause severe neurological symptoms (Wernicke’s encephalopathy) in thiamine deficient
patients. Prevention of this can be remediated by administering Thiamine 100mg IV/IO prior***

Dextrose 50% (D50)


Class: benzodiazepine, sedative-hypnotic, anticonvulsant
Action: potentiates effects of inhibitory neurotransmitters, raises seizure threshold and induces
amnesia and sedation
Suppresses seizure activity on the brain and induces amnesia and sedation
Indication: acute anxiety states, seizure activity, pre-cardioversion sedative, acute alcohol
Seizure activity and precardioversion sedative for electrical cardioversion
Contraindication: hypersensitivity, coma, shock, substance abuse, may worsen existing
respiratory depression. Don’t administer valium to intoxicated patients,
unless they are seizing.
Adult dose: 5-10mg IV/IO, may repeat every 10-15mins
Pediatric dose: 0.2mg/kg IV/IO or 0.5mg/kg rectal
Adverse reactions: hypotension, respiratory depression, CNS depression,
tachycardia, ataxia and confusion.

Diazepam (Valium®)


Class: inotropic agent, cardiac glycoside
Action: increased force and velocity of myocardial systolic contraction, increased AV nodal
refractory period, increased total peripheral resistance. Indirectly depresses the SA node
and prolongs AV nodal conduction.
Increases inotropic effects and slows down the heart rate indirectly by depressing the SA node
Indication: CHF, SVT, atrial fibrillation/flutter
Contraindication: ventricular fibrillation, ventricular tachycardia, Digoxin toxicity, hypersensitivity
Adult dose: 1st dose: 4-6mcg/kg slow IV/IO
2nd & 3rd dose: 2-3mcg/kg slow IV/IO
Adverse reactions: headache, visual disturbances (blurred yellow/green vision or halo effect),
confusion, seizures, EKG abnormalities, dysrhythmias, skin rash
Dig toxicity ➞ most common S/S will be the patient complaining of visual
disturbances such as blurred vision, seeing everything with a yellow or green tint
or experiencing a halo effect

Digoxin (Lanoxin®)


Class: calcium channel blocker (antagonist)
Action: decreases peripheral vascular resistance and causes relaxation of vascular smooth muscle resulting in a decrease in systolic and diastolic blood pressure. Reduces preload and
afterload and reduces myocardial oxygen demand.
Decreases blood pressure and reduces preload and afterload resulting in a
decrease in myocardial oxygen demand
Indication: atrial fibrillation, atrial flutter, SVT/atrial tachycardia
Contraindication: 2nd or 3rd degree heart blocks, severe hypotension, cardiogenic shock,
hypersensitivity, WPW or short PR syndrome
Adult dose: Initial dose: 0.25mg/kg IV/IO over 2min, may be repeated at 0.35mg/kg after 15mins.
Maintenance infusion: 5mg-15mg/hr
Pediatric dose: not recommended for pediatrics
Adverse reactions: atrial flutter, 1st and 2nd degree heart blocks, bradycardia, angina, CHF,
syncope, ventricular tachydysrhythmias/fibrillation, diaphoresis, dyspnea,
dizziness and headache
***For Cardizem overdoses, calcium chloride is the antidote***

Diltiazem (Cardizem®)


Class: antihistamine, anticholinergic
Action: prevents histamines from reaching the histamine 1 and 2 receptor sites. Short acting and
used for symptomatic relief only in cases of excess histamine release (such as anaphylaxis, urticaria etc.). Also used as adjunctive therapy with epinephrine in the treatment
of anaphylaxis. Effective as an upper respiratory and sinus-drying agent.
Blocks histamines and dries mucous membranes
Indication: moderate to severe allergic reactions, anaphylaxis
Anaphylaxis, urticaria, dystonic reactions
Contraindication: respiratory distress, CNS depression. MAO inhibitors, hypersensitivity, narrow
angle glaucoma
Adult dose: 25-50mg IV/IO/IM
Pediatric dose: 1mg/kg IV/IO/IM
Adverse reactions: dose related drowsiness, sedation, ataxia, hypotension, palpitations,
tachycardia, bradycardia, dry mouth and throat

Diphenhydramine (Benadryl®)


Class: sympathomimetic, inotropic agent
Action: synthetic catecholamine that stimulates alpha1, beta1 and beta2 adrenergic receptors.
Positive inotropic effects are seen with administration with minimal changes in
chronotropic activity or systemic vascular resistance. Dobutamine is useful in the
management of CHF when an increase in heart rate is not desired.
Stimulates alpha, beta1 and beta2 receptors along with stimulating inotropic effects
Indication: inotropic support in left ventricular dysfunction
Congestive heart failure (CHF)
Contraindication: tachydysrhythmias, severe hypotension
Adult dose: mix 250mg in 250mL D5W and run 2-20mcg/kg/min, titrated to inotropic effect
Pediatric dose: not recommended
Adverse reactions: headache, dose-related tachydysrhythmias, hypertension, PVC’s
***Beta-adrenergic antagonists will minimize inotropic effect***
***Incompatible with sodium bicarbonate***

Dobutamine (Dobutrex®)


Class: sympathomimetic, vasopressor, inotropic agent
Action: acts primarily on alpha and beta1 receptors, increasing systemic vascular resistance and
exerting a positive inotropic effect on the heart, dilates large vessels, increases heart
rate and increases blood pressure.
Peripheral vasoconstriction, large vessel dilation, increases heart rate
Indication: bradycardia, septic shock, neurogenic shock, hypotension
Hypotension, bradycardia
Contraindication: tachydysrhythmias, ventricular fibrillation, hypovolemia
Adult dose: 2-20mcg/kg/min low dose: 2-4mcg/kg/min (renal and mesenteric artery dilation)
mid dose: 5-10mcg/kg/min (beta1 adrenergic response)
high dose: 10-20 mcg/kg/min (total alpha effects)
Pediatric dose: 2-20mcg/kg/min (same as adult)
Adverse reactions: tachydysrhythmias, hypertension, increased myocardial oxygen demand

Dopamine Hydrochloride (Intropin®)


Class: sympathomimetic
Action: stimulates alpha, beta1 and beta2 receptors. Increases systolic pressure, heart rate and
cardiac contractility. Stabilizes the cell membrane and decreases the release of histamine.
Indication: bronchial asthma, acute allergic reaction/anaphylaxis , asystole, PEA, ventricular
fibrillation, bradycardia refractory to atropine
Contraindication: hypovolemia, coronary insufficiency, hypertension, CHF
Adult dose: Asthma/Anaphylaxis: 0.3mg-0.5mg 1:1000 IM or 0.1mg IV (1:10,000 severe)
PEA, VF/VT, Asystole: 1 mg (1:10,000) IV/IO every 3-5 minutes
Bradycardia: 2-10mcg/min (mix 1mg/250mL)
Pediatric dose: Asthma/Anaphylaxis: 0.01mg/kg (1:1,000)
Cardiac arrest: 0.01mg/kg (1:10,000)
Adverse reactions: tachydysrhythmias, increased myocardial oxygen demand/workload,

Epinephrine (Adrenalin®)


Class: sympathomimetic
Action: stimulates beta2 receptors in the lungs causing relaxation of bronchial smooth muscles,
Indication: bronchial asthma, prevention of bronchospasm, croup and laryngeal edema
Contraindication: epiglottitis, hypertension, underlying cardiovascular disease
Adult dose: 0.5mg diluted with 3mL normal saline SVN over 5-15 min
Pediatric dose: dilute 0.25mL of epinephrine into 2.5mL saline via SVN
Adverse reactions: headache, anxiety, tachycardia, dysrhythmias, nausea/vomiting
***May have a rebound effect after medication wears off***

Epinephrine Racemic (Micronefrin®)


Class: nonbarbituate hypnotic, anesthesia induction agent
Action: short acting hypnotic
Indication: premedication for RSI or cardioversion
Contraindication: hypersensitivity, labor and delivery
Adult dose: 0.2-0.6mg/kg IV/IO (typical dose 20mg)
Pediatric dose: 0.2-0.4mg/kg IV/IO (>10years old) with max dose of 20mg
Adverse reactions: apnea of short duration, respiratory depression, hypoventilation,
dysrhythmias, hypotension

Etomidate (Amidate®)


Class: narcotic analgesic
Action: sedation and analgesia. Fentanyl is similar to morphine sulfate in pharmacological
actions, but with a more prompt onset and less prolonged action.
Blocks pain and makes the patient feel relaxed
Indication: chest pain, procedural sedition during RSI, patients with severe pain or as an
alternative to morphine sulfate.
Contraindication: MAOI use within 14 days, myasthenia gravis. Use with caution in head
injuries, increased ICP, COPD, bradydysrhythmias and high-risk patients
Adult dose: 1-2mcg/kg slow IV/IO, IM or IN. Max single dose 100mcg
Pediatric dose: 1-2mcg/kg slow IV/IO, IM or IN. Max single dose 100mcg
Adverse reactions: chest wall rigidity in high doses (>15mcg/kg) or with fast loading doses,
respiratory depression/arrest, hypotension (especially in the ETOH patient),
bradycardia and circulatory depression
Chest wall rigidity and respiratory depression

Fentanyl (Duragesic®, Sublimaze®)


Class: benzodiazepine antagonist, antidote
Action: antagonizes the actions of benzodiazepines on the CNS, antagonizes sedation, recall and
psychomotor impairment produced by benzodiazepines.
Indication: reversal of benzodiazepines
Contraindication: hypersensitivity to benzodiazepines or flumazenil, cyclic antidepressant overdose
Adult dose: first dose: 0.2mg slow IV/IO
second dose: 0.3mg slow IV/IO
subsequent doses: 0.5mg slow IV/IO
Pediatric dose: not recommended
Adverse reactions: nausea/vomiting, dizziness, injection site pain, abnormal vision, seizures,
cutaneous vasodilation, withdrawal syndrome
Withdrawal symptoms ➞ seizure, nausea/vomiting, agitation
***Will not antagonize opioid analgesics, barbiturates, or ethanol***
***IV/IO push given over 30 seconds and doses are given at 1 minute intervals***

Flumazenil (Romazicon®)


Class: loop diuretic
Action: inhibits the reabsorption of sodium and chloride in the proximal tubule and the Loop of
Henle of the kidneys. Causes diuresis and pools blood in the venous system. Decreases
preload through vasodilation
Causes diuresis and pools blood in the venous system to decrease preload
which in turn decreases blood pressure
Indication: pulmonary edema, CHF, hypertensive crisis
Contraindication: anuria, hypovolemia, dehydration, hypersensitivity to sulfonamides, severe
electrolyte depletion
Adult dose: 40mg-80mg IV/IO slow over 2 minutes
mild: 40mg IV/IO
moderate: 60mg IV/IO
severe: 80mg IV/IO
Pediatric dose: 1mg/kg IV/IO
Adverse reactions: hypotension, EKG changes, chest pain, dry mouth, hypochloremia, hypokalemia, hyponatremia
Electrolyte depletion, hypotension

Furosemide (Lasix®)


Class: hormone, insulin antagonist
Action: protein released by the pancreas and will cause blood glucose elevation by increasing the
breakdown of glycogen to glucose and inhibiting glycogen synthesis. Also exerts positive
inotropic action of the heart and decreases renal vascular resistance. May be used in
beta-blocker cardiotoxicity refractory to saline infusion therapy.
Converts glycogen to glucose ➞ raises blood glucose
Antidote for beta-blocker medications
Indication: hypoglycemia, beta-blocker cardiotoxicity
Contraindication: hypersensitivity, emaciated patients or patients suffering from
starvation, severe +ETOH
Adult dose: hypoglycemia: 0.5mg-1mg IM; repeat in 7-10minutes if needed
beta blocker overdose: 3-10mg slow IV/IO or IM; repeat in 20minutes if needed
Pediatric dose: hypoglycemia: 0.1mg/kg IM; repeat in 20minutes if needed
beta blocker overdose: 0.15mg/kg slow IV/IO or IM; repeat in 20minutes if needed
Adverse reactions: tachycardia, hypertension, nausea/vomiting

Glucagon (GlucaGen®)


Class: tranquilizer, antipsychotic
Action: strong antidopaminergic and a weak anticholinergic, CNS depression
Indication: acute psychotic episodes
Contraindication: Parkinson’s disease, depressed mental status, agitation from shock and/or
Adult dose: 2-5mg IM every 30-60 minutes until sedation is achieved
Pediatric dose: not recommended
Adverse reactions: seizures, sedation, confusion, restlessness, respiratory depression,
hypotension, dystonia (sustained muscle contractions)
***Benadryl is an antidote for overdose***

Haloperidol (Haldol®)


Class: anti-coagulation
Action: inhibits the clotting cascade by activating specific plasma proteins. Included in the
thrombolytic package with aspirin in the active AMI patient
Slows down the clotting cascade and thins the patients blood
Indication: AMI, also used in the hospital setting to prevent emboli, clots, thrombophlebitis and
arterial occlusion
Acute MI and CVA
Contraindication: active bleeding, recent intracranial, intraspinal or eye surgery, hypertension
and bleeding tendencies/disorders
Adult dose: large variation in dosages, generally orders are between100 - 5000U
Commonly 60U/kg IV/IO followed by 12U/kg/hr IV/IO
Pediatric dose: not recommended
Adverse reactions: allergic reaction (fever, chills, hives, back pain), thrombocytopenia
and hemorrhage

Heparin Sodium


Class: bronchodilator, anticholinergic
Action: causes bronchodilation by competitive inhibition of cholinergic receptors on bronchial
smooth muscle. Reduces bronchospasm induced by smoke, dust or cold air
Indication: used in conjunction or in combination with other bronchodilators. Chronic or
acute exacerbation of acute asthma
Asthma, anaphylaxis, COPD ➞ wheezing
Contraindication: hypersensitivity to atropine, peanuts, soybeans or soy lecithin.
Atrovent is given after or in combination with beta2 agonists to
reduce the risk of rebound bronchoconstriction
Adult dose: 500mcg SVN
Pediatric dose: 500mcg SVN (same as adult dose)
Adverse reactions: uncommon due to there being little systemic absorption of ipratropium.
Transient dry mouth, scratchy throat, and rebound bronchoconstriction

Ipratropium Bromide (Atrovent®)


Class: nonbarbituate anesthetic
Action: produces anesthetic state characterized by profound analgesia, bronchodilation, normal
or slightly enhanced skeletal muscle tone, cardiovascular and respiratory stimulation, and
occasionally a transient and minimal respiratory depression.
Indication: induction, sedation, analgesia and aesthesia. Bronchodilation makes
ketamine a favored induction agent for RSI during status asthmaticus
excited delirium, sedation, pain management
Contraindication: patients in whom signification elevation of BP would constitute a serous hazard
Adult dose: Excited Delirium: 4mg/kg IM
Sedation/Pain Management: 0.5mg/kg IN or 0.2mg/kg IV/IO, max single dose 25mg
repeat every 10-15 minutes to a max dose of 2mg/kg
Pediatric dose: Sedation/Pain Management: 0.5mg/kg IN or 0.2mg/kg IV/IO, max single dose
25mg repeat every 10-15 minutes to a max dose of 2mg/kg
Adverse reactions: hypersalvation, elevation of heart rate and blood pressure, respiratory
depression/apnea may occur with over dosage or too rapid rate of use
***Emergence reactions may occur including hallucinations and combativeness.
Consider using a small amount of benzodiazepines to reduce the risk***

Ketamine Hydrochloride (Ketalar®)


Class: nonsteroidal anti-inflammatory (NSAID) analgesic
Action: potent analgesic that does not possess any sedative or anxiolytic activities
Indication: short-term management of moderate to severe pain
Contraindication: allergy to salicylates or other nonsteroidal anti-inflammatory drugs (NSAID’s),
renal failure, bleeding ulcers or disorders
On blood thinners or have any bleeding disorders, possibility of requiring surgery,
renal failure, hypersensitivity
Adult dose: 15mg IM
Pediatric dose: 1mg/kg IM/IV max single dose 15mg
Adverse reactions: nausea vomiting, sedation, drowsiness, dyspnea, edema, vasodilation,

Ketorolac Tromethamine (Toradol®)


Class: antidysrhythmic
Action: decreases cardiac depolarization and suppresses PVC’s. Raises the ventricular
fibrillatory threshold
Raises fibrillatory threshold and suppresses impulses in the ventricles
Indication: acute ventricular dysrhythmias as an alternative to amiodarone
Ventricular tachycardia and ventricular fibrillation
Contraindication: 2nd or 3rd degree heart blocks in the absence of an artificial pacemaker, idioventricular rhythms, ventricular escape rhythms
Adult dose: VF/VT without a pulse: 1.0-1.5mg/kg IV/IO repeat at 0.5-0.75mg/kg
Ventricular ectopy with a pulse: 1.0-1.5mg IV/IO repeat every 5-10 minutes
***Max dose: 3.0mg/kg***
***If either rhythm converts, hang a maintenance drip at 1-4 mg/min***
Pediatric dose: 1mg/kg IV/IO
Adverse reactions: bradycardia, cardiovascular collapse, confusion, blurred vision, hypotension
Hypotension and bradycardia

Lidocaine (Xylocaine®)


Class: benzodiazepine, sedative, anticonvulsant
Action: suppresses propagation of seizure activity
Indication: initial control of status epilepticus or severe recurrent seizures, severe
anxiety, sedation
Seizure, anxiety, post intubation sedation (RSI)
Contraindication: coma, shock, suspected drug abuse
Adult dose: IV/IO: 2-4mg (must be diluted with equal volume of normal saline)
IM: 2-4mg (does not have to be diluted)
Pediatric dose: IV/IO/IM: 0.05-0.2mg/kg slow administration
Adverse reactions: dizziness, CNS depression, sedation, apnea, hypotension, bradycardia

Lorazepam (Ativan®)


Class: electrolyte, anti-inflammatory
Action: reduces smooth muscle contractions and blocks peripheral neuromuscular transmission
by reducing acetylcholine release. Causes uterine relaxation, is used as replacement
therapy for hypomagnesemia and as initial treatment for Torsades de Pointes.
Considered helpful in treatment for refractory VF/VT
Relaxes smooth muscle, replaces electrolyte
Indication: eclamptic seizures, Torsades de Pointes, hypomagnesemia, refractory asthma and
Contraindication: heart block, hypermagnesemia
Adult dose: Eclampsia: 1-4g IV/IO over 3 minutes
Torsades: 1-2g IV/IO over 5-20 minutes
Respiratory: 1-2g IV/IO over 5-20 minutes
Pediatric dose: not recommended
Adverse reactions: diaphoresis, facial flushing, hypotension, hypothermia, negative chronotropy,
circulatory collapse, respiratory depression, CNS depression
Hypotension, respiratory depression, negative chronotropy (if given too fast)

Magnesium Sulfate


Class: osmotic diuretic
Action: promotes the movement of fluid from the intracellular to the extracellular space. Used
to treat head injuries to decrease intracranial pressure and in the promotion of urinary
exertion of toxic substances.
Indication: increased ICP with closed head injury, diuresis with certain drug overdoses, blood
transfusions, cerebral edema
Contraindication: severe hypotension, profound hypovolemia, dehydration, hyponatremia,
pulmonary edema, CHF
Used only for head injuries
Adult dose: 0.5-1.0g/kg IV in a 20% solution over 5-10minutes
Pediatric dose: 0.5-1.0g/kg IV infusion over 30-60minutes to a max dose of 1g/kg
Adverse reactions: transient volume overload, pulmonary edema, renal failure, CHF, hypotension
from dehydration, sodium depletion
Volume overload, pulmonary edema, CHF

Mannitol (Osmitrol®)


Class: beta-blocker, beta1 selective, antihypertensive, antidysrhythmic
Action: decreases heart rate, conduction velocity, myocardial contractility and cardiac output
Indication: SVT, atrial flutter, atrial fibrillation, junctional tachycardia, MAT and in AMI patients
(to reduce myocardial ischemia, and to reduce the incidence of ventricular fibrillation)
SVT, atrial fibrillation, atrial flutter, in MI patients
Contraindication: heart failure, cardiogenic shock, bradycardia, bronchial asthma, 2nd or 3rd
degree heart blocks, hypersensitivity
Bradycardias, hypotension, asthma patients
Adult dose: 5mg slow IV/IO (over 5minutes); repeat after 5 minutes at 5mg to a max dose of
15mg total
Pediatric dose: not recommended
Adverse reactions: concurrent administration with calcium channel blockers like Cardizem or
verapamil may precipitate profound hypotension and bradycardia
Hypotension, bradycardia
***Antidote for beta-blocker overdose ➞ Glucagon***
***Must be given slow***

Metoprolol (Lopressor®)


Class: corticosteroid
Action: highly potent synthetic glucocorticoid that suppresses acute and chronic inflammation;
potentiates vascular smooth muscle relaxation by beta-adrenergic agonists
Suppresses acute and chronic inflammation
Indication: anaphylaxis, bronchodilator unresponsive asthma, acute spine cord injury
Anaphylaxis, trouble breathing in asthma, COPD patients
Contraindication: GI bleeds, use with caution in Diabetes Mellitus
Adult dose: 125mg IV/IO
Pediatric dose: 1mg/kg IV/IO
Adverse reactions: headache, hypertension, sodium and water retention, hypokalemia, alkalosis
***Will cross the placenta and may cause fetal injury/demise***

Methylprednisolone (Solu-Medrol®)


Class: short-acting benzodiazepine, CNS depressant
Action: relieves apprehension, impairs memory, anxiolytic, sedation
Indication: conscious sedation, premeditation for intubation or cardioversion, seizures
Seizures, RSI, pre-cardioversion
Contraindication: (+) ETOH, overdose, respiratory depression, concurrent use with barbiturates,
narcotics or other CNS depressants
Adult dose: 1-5mg slow IV/IO/IM/IN over 2-3 minutes titrated to effect. May be repeated in
small increments to a total max dose of 0.1mg/kg
5-10mg IM (loading dose for any seizing patient without IV access)
Pediatric dose: 0.1mg/kg IV/IO/IM/IN
Adverse reactions: hiccups (may increase ICP), cough, oversedation, blurred vision, hypotension,
fluctuation of vital signs, respiratory depression, respiratory arrest, chest wall,
rigidity, pain at the injection site
Respiratory depression/arrest
***Never administer by rapid IV push***

Midazolam Hcl (Versed®)


Class: opioid analgesic
Action: increases peripheral capacitance, decreases venous return. Promotes analgesia, euphoria
and respiratory and physical depression. Secondary effects include depressed responsiveness of alpha-adrenergic receptors (causing vasodilation) and baroreceptor inhibition.
Causes decreased pre-load and afterload and will decrease myocardial oxygen demand.
Pain management, dilates coronary arteries, decreases pre-load, decreases myocardial oxygen demand
Indication: chest pain associated with myocardial infarction and pulmonary edema
Chest pain, musculoskeletal pain, cardiac events, hypertensive crisis
Contraindication: hypersensitivity to narcotics, hypovolemia, hypotension SBP<90mm/Hg,
MAOI administration within 14 days, head injury or undiagnosed abdominal
pain. Use caution with inferior wall/right ventricle AMI
Adult dose: 2-4mg IV every 5-15minutes (titrate to effect)
0.1mg/kg standard dosing
Pediatric dose: 0.1mg/kg IV not to exceed max dose of 5mg
Adverse reactions: hypotension, tachycardia, bradycardia, palpitations, facial flushing, syncope,
respiratory depression, dry mouth, bronchospasm, euphoria, allergic reaction
Hypotension, respiratory depression
Nausea (especially when given/pushed too fast) ➞ Zofran
Allergic reaction ➞ facial flushing, low scale histamine release, itch

Morphine Sulfate (MS Contin®, Roxanol®)


Class: opioid antagonist, antidote
Action: binds and blocks all opioid/narcotic receptor sites
Antagonizes narcotics/reverses effects of narcotics
Indication: coma of unknown origin, decreased LOC, reversal of CNS/respiratory depression
induced by opioids, narcotic overdose
Contraindication: hypersensitivity, narcotic-dependency patients (including neonates)
Adult dose: 0.4mg-2.0mg IV/IO/IM/IN, intranasal may repeat every 5min to max of 10mg
Pediatric dose: 0.1mg/kg slow IV/IO/IM/IN
Adverse reactions: tachycardia, hypertension, dysrhythmias, nausea/vomiting
Withdrawal symptoms
Works on/common narcotics ➞ Morphine Sulfate, Fentanyl, heroin, Dilaudid, methadone,
Demerol, Percodan, Percocet, codeine, Stadol, Talwin, Nubain, Darvon, Norco, Vicodin,
Tylenol 3(has codeine)

Naloxone (Narcan®)


Class: nitrate, vasodilator
Action: vasodilation, peripheral vasodilation, decreases cardiac workload, decreases myocardial
oxygen demand
Vasodilation, decreases workload and oxygen demand on the heart, decreases preload
Indication: ischemic chest pain, hypertension, CHF, pulmonary edema
Contraindication: hypotension SBP <90mm/Hg, head injury, cerebral hemorrhage, hypersensitivity. Use caution with inferior wall/right ventricle AMI. Previous administration
of vardenafil(Levitra), sildenafil(Viagra), tadalafil(Cialis) within the prior 48
Adult dose: 0.4mg SL, may repeat 2 more times every 3-5minutes
Pediatric dose: not recommended
Adverse reactions: transient headache, postural syncope, reflex tachycardia, hypotension, diaphoresis, muscle twitching, allergic reaction
Hypotension, rebound hypertension, transient headache

Nitroglycerin (Nitrobid®, Nitrostat®)


Class: gaseous analgesic and anesthetic
Action: CNS depression, increases oxygen tension in the blood (this reduces hypoxia)
CNS depression, reduces/eliminates pain
Indication: moderate to severe pain, anxiety, apprehension
Contraindication: impaired LOC, head injury, chest trauma, decompression sickness,
undiagnosed abdominal pain or distention, bowel obstruction, hypotension,
shock (hypovolemia), COPD
Dose: self-administered, have patient inhale deeply several times
Adverse reactions: expansion of gas filled pockets, dizziness, apnea, cyanosis,
nausea and vomiting

Nitrous Oxide/Oxygen 50/50 (Nitronox®)


Class: sympathomimetic, vasopressor
Action: alpha and beta1 adrenergic agonist. A potent vasoconstrictor what increases myocardial
contractility and peripheral vascular resistance. Because it tends to constrict the renal
and mesenteric blood vessels, it is rarely used in the prehospital setting.
Vasoconstricts raising BP, increases contractile force
Indication: cardiogenic shock, neurogenic shock, inotropic support, hemodynamically significant hypotension refractor to other sympathomimetic amines
When the heart needs to be stimulated when nothing else helps for hypotension
(heart failure, cardiogenic shock, post arrest)
Generally ONLY used when nothing else works due to its potency
Contraindication: hypotensive patients with hypovolemia
Adult dose: mix 4mg in 250mL D5W and run infusion at 0.1-0.5mcg/min and titrate up to desired effect (average adult dose of 12mcg/min)
Pediatric dose: not recommended
Adverse reactions: headache, dysrhythmias, tachycardia, reflex bradycardia, angina pectoris,
Tachycardia, angina, hypertension

Norepinephrine (Levophed®)


Class: antiemetic agent, serotonin receptor antagonist
Action: selectively blocks serotonin receptors located in the CNS and in the peripheral system
on nerve terminals of the vagus nerve that causes nausea
Suppresses nausea
Indication: nausea and vomiting caused by head injury, narcotic administration, GI issues
Contraindication: hypersensitivity, liver insufficiency/failure
Adult dose: 4mg ODT/IV/IO/IM over 2 mins
Pediatric dose: 0.1mg/kg IV/IO/IM over 2 mins (<40 kg)
Adverse reactions: constipation, dizziness, fatigue, sedation, diarrhea

Ondansetron (Zofran®)


Class: naturally occurring atmospheric gas
Action: reverses hypoxia, helps oxidize glucose and reduces area of infarct
Indication: hypoxia, ischemic chest pain, respiratory distress, carbon monoxide poisoning and
any other cause of decreased perfusion
Contraindication: none, oxygen should never be withheld in any critical patient.
Use with caution with high concentration in COPD patients. Use
enough to keep SpO2 between 94%-99% in patients with
uncomplicated chest pain
Dose: nasal cannula: up to 6lpm 24% -44%
non-rebreather mask: 8lpm – 15lpm 85%-100%
BVM: 15lpm 100%
Adverse reactions: high concentrations may cause oxygen toxicity which can include
decreased LOC, carpopedal spasms and vasoconstriction



Class: hormone (synthetic)
Action: stimulates uterine smooth muscle contractions indirectly. Stimulates the mammary
glands to increase lactation without increasing the production of milk. During uterine
contractions, a transient reduction in uterine blood flow is noted.
Stimulates uterine contraction
Indication: post-partum hemorrhage after infant and placental delivery secondary to fundal
Post partum hemorrhage after fundal massage has been performed
Contraindication: presence of second fetus
Adult dose: IM: 10 units following placental delivery
IV: mix 10-40 units in 1000mL normal saline and infuse
Adverse reactions: hypotension, tachycardia, hypertension, seizures, dysrhythmias, angina,
anxiety, nausea/vomiting, allergic reaction, uterine rupture (from excessive
Uterine rupture, tachycardia, hypertension

Oxytocin (Pitocin®)


Class: neuromuscular blockade (non-depolarizing)
Action: produces complete muscular relaxation by binding to the cholinergic receptor at the
neuromuscular junction, without initiating depolarizing of the muscle. Prevents convulsive
muscle spasms, optimizes conditions for intubations and ventilatory support
Blocks nervous control to the cells ➞ relaxes the muscles and causes paralysis
Indication: induction or maintenance of paralysis for intubation (RSI)
Paralysis for RSI
Contraindication: hypersensitivity, neuromuscular disease (Myasthenia Gravis), inability to control airway with positive pressure ventilations
Neuromuscular diseases, inability to control the airway
Adult dose: 0.1mg/kg slow IV, repeat every 45-60min as needed
Adverse reactions: transient hypotension, tachycardia, dysrhythmias, hypertension, excessive
salivation, pain at the injection site

Pancuronium (Pavulon®)


Class: anticonvulsant, antidysrhythmic
Action: inhibits the spread of seizures by promoting sodium efflux from neurons (increases the
convulsant threshold), stabilizes the neurons threshold against excitability caused by
excess stimulation. Also has been used to treat dig induced atrial and ventricular
arrhythmia by stabilizing the sodium influx in the purkinje fibers
Increases the seizure threshold and cardiac cell excitement through sodium movement
Indication: seizures, dig toxicity
Contraindication: bradycardia, 2nd and 3rd degree heart blocks
Adult dose: seizures: 10-20mg/kg slow IV/IO, max single dose 1g
dysrhythmias: 50-100mg diluted over 5-15minutes
Adverse reactions: hypotension with rapid IV/IO infusion, cardiovascular collapse, dysrhythmias,
CNS depression, ataxia, nausea/vomiting
***Must be given with normal saline ONLY! May precipitate with other solutions***

Phenytoin (Dilantin®)


Class: cholinesterase reactivator, antidote
Action: reactivates cholinesterase to effectively act as an antidote to organophosphate
Indication: organophosphate poisonings
Contraindication: reduce dose in patients with impaired renal function, Myasthenia Gravis
Adult dose: 1-2g IV infusion over 30-60mins after Atropine administration
Pediatric dose: 20-40mg/kg IV infusion over 15-30mins after Atropine administration
Adverse reactions: seizure, laryngospasm, hyperventilation, apnea, tachycardia, muscle rigidity,
cardiac arrest

Pralidoxime (2-PAM®, Protopam®)


Class: glucocorticoid, synthetic steroid, anti-inflammator
Action: suppresses acute and chronic inflammation. Potentiates vascular smooth
muscle relaxation by beta-adrenergic agonists and may alter airway
hyperactivity. Also may be used to reduce posttraumatic spinal cord edema
Suppresses acute and chronic inflammation
Indication: anaphylaxis, bronchial asthma, acute spinal cord injury
Anaphylaxis, trouble breathing in asthma, COPD patients
Contraindication: systemic fungal infections, GI bleeds, use with caution in DM
Adult dose: 50mg PO
Pediatric dose: 0.5mg/kg PO
Adverse reactions: headache, hypertension, sodium and water retention,
hypokalemia, alkalosis, hyperglycemia, Cushing’s Syndrome
***Will cross the placenta and may cause fetal injury/demise with long term use***

Prednisone (Deltasone®, Orapred®, Pediapred®)


Class: sedative, hyptonic
Action: produces rapid and brief state of general anesthesia
Indication: sedation for ventilated patients
Contraindication: hypovolemia, known hypersensitivity to soy bean oil, peanuts and eggs
Adult dose: Induction dose: 1.5-3mg/kg IV/IO
Maintenance infusion: 5 - 50mcg/kg/min
Pediatric dose: Induction dose: 2.5-3.5mg/kg IV/IO
Maintenance infusion: 5 - 50mcg/kg/min
Adverse reactions: seizure, apnea, dysrhythmias, asystole, hypotension, rebound hypertension,
acute renal failure

Propofol (Diprivan®)


Class: hydrogen ion buffer, alkalinizing agent
Action: reacts with hydrogen ions to form water and CO2 and thereby acts to buffer metabolic
acidosis. (By increasing the plasma concentration of bicarbonate, blood pH rises)
Neutralizes acids in the body and raises the body’s pH
Indication: known acidosis, cardiac arrest, cardiac arrest with extended down time, hyperkalemia, overdose of TCA’s, Phenobarbital, diphenhydramine, ASA, cocaine
Contraindication: hypokalemia, unknown acidosis
Adult dose: 1 mEq/kg IV/IO and may follow with 0.5mEq/kg IV/IO
Adverse reactions: metabolic alkalosis, hypokalemia, fluid overload
***Must ventilate patient following administration***
***Will react with amines such as Epinephrine and cause precipitation of line in concurrent use.***

Sodium Bicarbonate


Class: neuromuscular blockade (depolarizing)
Action: binds with cholinergic receptors. It is the drug of choice for terminating laryngospasms
and endotracheal intubation. However, because it causes depolarization of the muscle
membrane it causes muscle fasciculation and contraction
Indication: to facility endotracheal intubation, termination of laryngospasm, muscle relaxation
Paralysis for RSI
Contraindication: penetrating eye injury, inability to control airway with positive pressure ventilations
Adult dose: 1.0-1.5mg/kg rapid IV/IO, repeat every 20-30mins as needed
Pediatric dose: 1.0-1.5mg/kg IV/IO, repeat every 20-30mins as needed
Adverse reactions: hypotension, bradycardia, dysrhythmias, muscle fasciculation/contraction,
excess salivation, malignant hyperthermia, exacerbation of hyperkalemia
in trauma patients (usually hours post trauma). Oxytocin, beta blocker and
organophosphates may potentiate, diazepam may reduce duration

Succinylcholine (Anectine®)


Class: vitamin (B1)
Action: combines with ATP to form a thiamine coenzyme, which is a required component for
carbohydrate metabolism. Thiamine prevents severe neurological symptoms, which
may result from D50 administration in the chronic alcoholic states if given prior to D50
Helps metabolize dextrose
Indication: coma of unknown origin, delirium tremens (DT’s) Beriberi (a rare condition caused
by severe vitamin B deficiency), Wernicke’s encephalopathy, Korsakoff’s Psychosis
When administration of D50 is required in vitamin B deficient,
malnourished or chronic alcoholic patients
Contraindication: pediatrics
Adult dose: 100mg slow IV/IO/IM
Adverse reactions: hypotension from rapid injection, anxiety, diaphoresis, nausea/vomiting,
possible allergic reaction from IV injection

Thiamine (Betaxin®)


Class: calcium channel blocker
Action: decreases atrial automaticity, decreases AV conduction velocity, prolongs the AV nodal
refractory period, depresses myocardial contractility, reduces vascular smooth muscle
tone and dilates coronary arteries.
Decreases chronotropic, inotropic and dromotropic effects of the heart
Indication: SVT, atrial flutter/atrial fibrillation with a rapid ventricular response (RVR)
Contraindication: hypersensitivity, 2nd or 3rd degree heart blocks, hypotension, cardiogenic
shock, severe CHF, WPW with afib/flutter, IV beta blockers, wide complex
Anything other than tachycardias, hypotension
Adult dose: 2.5-5.0mg IV/IO over 2mins, repeat 5-10mg every 15-30mins for a max dose of 20mg
Pediatric dose: 0.01-0.02mg/kg IV/IO over 2mins, repeat in 30mins if ineffective
Adverse reactions: dizziness, nausea/vomiting, hypotension, complete AV block, bradycardia,
peripheral edema

Verapamil (Isoptin®, Calan®)