Paramedic Pharmacology

What class of medication is adenosine/ Adenocard?

• Misc. antidysrhythmic

• Potassium channel agonist/ calcium channel antagonist

What are the indications for adenosine?

• Atrial tachycardia

• Monomorphic wide beat tachycardia

Adenosine dosages:

• Adult

  • 6 mg rapid IVP

  • may repeat 12mg rapid IVP

• Pediatric

  • 0.1 mg/kg rapid IVP

  • may repeat 0.2 mg/kg rapid IVP

Albuterol trade name:

Proventil/ Ventolin

What class of medication is albuterol?

sympathomimetic (bronchodilator). 

What are the indications for albuterol?

• reactive bronchoconstriction

• hyperkalemia

For reactive bronchoconstriction, what is the dosage for albuterol?

For both adult and pediatrics, 2.5 mg nebulized

For hyperkalemia, what are the dosages for albuterol?

• Adult

  • 10 mg nebulized

• Pediatric

  • Not recommended

What class of medication is amiodarone?

Class III antidysrhythmic (Potassium channel antagonist).

Diazepam trade name

How does amiodarone work?

It works by prolonging the action potential and refractory period in myocardial tissue, stabilizing heart rhythm.

How does adenosine work?

By slowing conduction through the AV node, effectively interrupting reentrant pathways and restoring normal sinus rhythm.

What are the indications for amiodarone?

• Pulseless VT/ VF

• VT with pulses 

For pulseless VT/ VF, what are the dosages for amiodarone?

• Adult

  • 300 mg IVP

  • May repeat 150 mg IVP

• Pediatric

  • 5mg/kg IVP not to exceed 300 mg 

For VT with pulses, what are the dosages for amiodarone?

• Adult

  • 150 mg IV over 10 minutes

• Pediatric

  • 5 mg/kg IV over 10 minutes not to exceed 150mg

What are the indications for etomidate?

RSI

What are the dosages for etomidate?

• Adult 

  • 0.3 mg/kg IVP

• Pediatric 

  • Not recommended 

Etomidate trade name

Amidate

Fentanyl trade names:

Duragesic, sublimaze

What are the dosages for Fentanyl?

• Adult and pediatric

  • 1mcg/kg - 2mcg/kg slow IVP

What are the indications for furosemide?

• CHF with a pulmonary event 

Why would you use furosemide on a patient with CHF with a pulmonary event?

It will reduce fluid overload and decrease pulmonary congestion by promoting diuresis.

What are the dosages for furosemide?

• Adult 

  • 40 mg slow IVP

• Pediatric 

  • not recommended 

What class of drugs is glucagon/glucagen?

Hormone

What are the indications for glucagon/glucagen?

• Hypoglycemia

• Beta blocker OD

• Calcium channel blocker OD

For treating hypoglycemia, what is the dosage for glucagon?

• Adult

  • 1 mg IM

• Pediatric

  • 0.5 mg IM

For treating a beta blocker OD, what is the dosage for glucagon?

• Adult

  • 2mg - 5mg IVP

• Pediatric

  • Not recommended

What is the dosage for hydromorphone?

• Adult

  • 1mg - 2mg slow IVP

  • Pediatric - not recommended

What’s class of medications is ipratropium/ atrovent?

Parasympathetic bronchodilator

What are the indications for ipratroprium/atrovent?

• reactive bronchoconstriction

What is the dosage for ipratropium?

• Adult & peds

  • 0.5 mg along with 2.5 mg of albuterol sulfate nebulized

What class of medication is diltiazem/ Cardizem?

Class IV antidysrhythmic (Calcium channel antagonist)

What are the indications for diltiazem/ Cardizem?

• SVT = atrial fibrillation, atrial flutter

What is the dosage for diltiazem?

• Adult

  • 0.25 mg/kg - 0.35 mg/kg slow IVP

• Pediatric

  • Not recommended

What are the dosages for diphenhydramine?

• Adult

  • 25 mg- 50 mg slow IVP

• Pediatric

  • 1mg/kg - 2mg/kg slow IVP not to exceed 25mg

What class of medication is dopamine/ Intropin?

Sympathomimetic

What are the indications for dopamine?

• Symptomatic bradycardia

• Cardiogenic shock

What is the dosage for dopamine?

• Adult and pediatric

  • 2 mcg/kg/min - 20 mcg/kg/min IV infusion

What class of medications is epinephrine/ Adrenalin?

Sympathomimetic

What are the indications for epinephrine?

• Cardiac arrest

• Symptomatic bradycardia

• Cardiogenic shock

• Mild to moderate allergic reaction

• Anaphylaxis

• Reactive bronchoconstriction

When treating cardiac arrest with epinephrine, what is the dosage?

• Adult

  • 1mg IVP may repeat every 3-5 minutes

• Pediatric

  • 0.01 mg/kg not to exceed 1.0 mg, may repeat every 3-5 mins

When treating symptomatic bradycardia with epinephrine, what is the dosage?

• Adult

  • 2 mcg/min- 10mcg/min IV infusion

• Pediatric

  • 0.01 mg/kg not to exceed 0.5 mg

When treating Cardiogenic shock with epinephrine, what is the dosage?

• Adult

IV infusion or push dose

• IV infusion: 2mcg/min-10mcg/min

• Pediatric

  • Not recommended

When using epinephrine to treat mild to moderate allergic reaction, what is the dosage?

• Adult

  • 0.3 mg 1,000 SQ/ IM

• Pediatric

  • 0.01 mg/kg not to exceed 0.3 mg

When using epinephrine to treat anaphylaxis, what is the dosage?

• Adult

  • 0.3 mg 1:10,000 IV

• Pediatric

  • 0.01 mg/kg 1:10,000 IV not to exceed 0.3mg

When using epinephrine to treat reactive bronchoconstriction, what is the dosage?

• Adult

  • 0.3 mg 1:1,000 SQ/ IM

• Pediatric

  • 0.1 mg/kg 1:1,000 SQ/ IM not to exceed 0.3 mg

What class of medication is rocuronium bromide/ Esmeron/ Zemeron?

Non- depolarizing Neuromuscular Blocking Agent

What is the dosage for rocuronium?

• Adult and pediatric

  • 1mg/kg slow IVP

What class of medications is sodium bicarbonate?

Electrolyte (buffer)

What are the indications for sodium bicarbonate?

• metabolic acidosis

• Tricyclic antidepressant overdose

What class of medication is succinycholine/ Anectine?

Depolarizing Neuromuscular Blocking Agent

What is the dosage for succinylcholine?

• Adult and pediatric 1mg

  • 1.0 mg/kg - 1.5 mg/kg slow IVP

What class of medication is thiamine/ Thiamilate?

Vitamin B1

What are the indications for thiamine?

• PT who has been administered IV dextrose with a history of ETOH(ethanol, aka alcohol abuse) or an eating disorder

What are the dosages for thiamine?

• Adult

  • 100 mg in 1000ml bag of normal saline

• Pediatric

  • Not recommended

What class of medication is tranexamic acid/ Cyklokapron?

Hemostatic agent

What are the indications for tranexamic acid(TXA)?

• Adults in traumatic hemorrhagic shock with suspected need for massive blood transfusion.

What are the dosages for TXA?

• Adult

  • 1 G in 100 ml normal saline infusion over 10 minutes

  • Maintenance dose 1g in 500 ml normal saline infusing 60ml/hr for a total of 8 hours

• Pediatric

  • Not recommended

What class of medications is vecuronium bromide/ Norcuron/ Vecuron?

Non-depolarizing neuromuscular blocking agent

What are the dosages for vecuronium?

• Adult

  • 0.1 mg/kg slow IVP

• Pediatric >20 kg

  • 0.1 mg/kg slow IVP

What are the brand names for morphine?

Astromorph, Duramorph, MS Cotin, Roxanol

What are the dosages for morphine?

• Adult

  • 5-10 mg slow IVP

• Pediatric

  • Not recommended

What are the dosages for naloxone?

• Adult

  • 0.4 mg-2.0 mg slow IVP

• Pediatric

  • 0.1 mg/kg slow IVp not to exceed 2.0 mg

What class of medications is nitroglycerin/ Nitro-big, Nitro-stat?

Vasodilator

What are the dosages for nitroglycerin?

• Adult

  • 0.4 mg SL

  • May repeat 0.4 mg 2 doses

What class of medications is norepinephrine? Levophed?

Sympathomimetic

What are the indications for norepinephrine?

Cardiogenic shock

What are the dosages for norepinephrine

• Adult

  • Initial 2cg/min- 10 mcg/min IV infusion,m titrate to a maximum dose of 30 mcg/min

• Pediatric

  • Not recommended

What class of medications is ondansetron/ Zofran?

Antiemetic

What are the indications for ondansetron?

Nausea and vomiting

What are the dosages for ondansetron?

• Adult

  • 4mg slow IVP

• Pediatric

  • 2mg slow IVP

What class of medications is promethazine/ Phenergan?

Antihistamine

What are the indications for promethazine?

Nausea and vomiting

What are the dosages for promethazine?

• Adult

  • 12.5 mg- 25 mg slow IVP

• Pediatric 2mg

  • .25 mg/kg - 0.5 mg/kg slow IVP not to exceed 12.5 mg

What class of medications is atropine sulfate?

Parasympatholytic (Anticholinergic)

What are the indications for atropine sulfate?

• Symptomatic bradycardia

• Acetylcholinesterase inhibition

When using atropine sulfate to treat symptomatic bradycardia, what is the dosage?

• Adult

  • 1 mg rapid IVP, may repeats every 3-5 minutes to a max dose of 3mg

• Pediatric

  • 0.02 mg/kig, minimum dose 0.1 mg not to exceed 0.5 mg

When using atropine sulfate to treat acetylcholinesterase inhibition, what is the dosage?

• Adult

  • 2-4 mg may repeat every 5-15 minutes to dry secretions

• Pediatric

  • 0.05 mg/kg, may require multiple doses

What are the indications for bumetanide?

CHF with pulmonary edema

What are the dosages for bumetanide?

• Adult

  • Less than 70kg =1 mg slow IV

  • Greater than 70kg = 2mg slow IV

• Pediatric

  • 20 mg/kg not to exceed 500mg

What class of medications is calcium chloride?

Electrolyte

What are the indications for calcium chloride?

• Calcium channel blocker OD

• Hyperkalemia

What are the dosages for calcium chloride when treating a calcium channel blocker OD?

• Adult

  • 500 mg-1g slow IVP

• Pediatric 2mg

  • 20 mg/kg not to exceed 500 mg

When using calcium chloride to treat hyperkalemia, what are the dosages?

• Adult

  • 500 mg-1g slow IVP

• Pediatric

  • 20 mg /kg not to exceed 500mg

What class of medications is dextrose?

carbohydrate

What are the indications for dextrose?

Hypoglycemia

What are the dosages for dextrose?

• Adult

  • 25gm IVP or IV infusion

• Pediatric

  • 0.3 mg/kg IVP not to exceed 5mg or 

  • 0.5 mg/kg rectal not to exceed 5mg

What class of medications is diazepam/ Valium?

Benzodiazepine

What are the indications for benzodiazepines?

• Status epilepticus

• Sedation of the severely agitated and/or combative patient  

• Sedation for cardioversion or transcutaneous pacing

What are the dosages for diazepam?

• Adult

  • 5-10 mg IVP

• Pediatric 

  • 0.3 mg/kg IVP not to exceed 5mg 

  • 0.5 mg/kg rectal not to exceed 5mg Adult: 5-10 mg IVP; Pediatric: 0.3 mg/kg IVP (max 5 mg) or 0.5 mg/kg rectal (max 5 mg)

What class of medications is lorazepam/ Ativan?

Benzodiazepine

What are the indications for lorazepam?

• Status epilepticus

• Sedation of the severely agitated and/or combative patient

• Sedation for cardioversion or transcutaneous pacing

What are the dosages for lorazepam?

• Adult

  • 1-2 mg IVP

• Pediatric

  • 0.01 mg/kg IVP not to exceed 1mg 

What class of medications is magnesium sulfate?

Electrolyte

What are the indications for magnesium sulfate?

• Torsades de Pointes

• Eclampsia

• Reactive bronchoconstriction

When using magnesium sulfate to treat Torsdaes de Pointes, what are the dosages?

• Adult

  • 1-4 gm slow IVP

• Pediatric 

  • 50 mg/kg not to exceed 1 gm

When using magnesium sulfate to treat eclampsia, what are the dosages?

• Adult

  • 2-4 gm slow IVP

When using magnesium sulfate to treat reactive bronchoconstriction, what are the dosages?

• Adult

  • 1-4gm slow IVP

• Pediatric

  • 50 mg/kg not to exceed 1 gm

What are the indications for methylprednisone/ Solu-medrol?

• Reactive bronchoconstriction 

• Anaphylactic reactions 

What are the dosages for Solu-medrol?

• Adult 

  • 125 mg slow IVP

• Pediatric 

  • 2 mg/kg slow IVP not to exceed 125 mg