Drugs For Paramdeic

Adenosine (Adenocard)

SVT | MOA: Decreases electrical conduction through the AV node | Contraindications: Hypersensitivity, drug-induced tachycardia, bradycardia | Dose: 1st 6 mg; 2nd 12 mg; 3rd 12 mg fast IV followed by flush | Side effects: Lightheadedness, hypotension, nausea

Albuterol (Proventil/Ventolin)

Bronchospasm from asthma or COPD | MOA: Bronchodilation via beta-2 receptors | Contraindication: Pregnancy except in life-threatening situation | Dose: 2.5 mg in 3 mL; may repeat x2; if no improvement after first, combine with Atrovent | Side effects: Tachycardia, hypertension, restlessness

Alcaine (Proparacaine)

Burns to eyes or corneal abrasion | MOA: Blocks impulses from sensory nerves | Contraindications: Trauma/laceration to eye, foreign body, allergy to "-caine" drugs | Dose: 1–2 drops every 5 min, maximum 3 doses | Side effect: Initial burning/stinging sensation

Amiodarone (Cordarone)

VFib and VTach | MOA: Blocks calcium, sodium, and potassium channels | Contraindications: Cardiogenic shock, bradycardia | Adult VF/VT without pulse: 300 mg IV/IO, then 150 mg IV/IO; VT with pulse: 150 mg over 10 min | Pediatric VF/VT without pulse: 5 mg/kg, max 150 mg; VT with pulse: 5 mg/kg over 30 min | Side effects: Hypotension if infused rapidly, bradycardia, CHF

Amyl Nitrite

Acute cyanide poisoning with severe symptoms such as altered mental status, dyspnea, cyanosis, vomiting, seizures | MOA: Converts hemoglobin to methemoglobin as part of cyanide treatment | Do not administer if IV is established and sodium nitrite can be given | Dose: Adult/pediatric 1 ampule crushed and inhaled | Side effect: Hypotension due to vasodilation

Atrovent (Ipratropium Bromide)

Bronchospasm not improved with first albuterol treatment | MOA: Causes bronchodilation and dries secretions | Contraindications: Sensitivity to atropine, bronchospasm due to allergic reaction | Adult: 0.5 mg in 2.5 mL; pediatric

Aspirin (Acetylsalicylic Acid)

Cardiac chest pain | MOA: Reduces platelet stickiness | Contraindications: Aspirin allergy, GI bleed, hemorrhagic stroke | Adult dose: 324 mg | Pediatric: Not given | Side effects: None listed in emergency setting

Ativan (Lorazepam)

Active seizure/status epilepticus; sedation for airway device placement, painful procedures, stimulant/hallucinogen-induced chest pain or tachycardia, and excited delirium | MOA: CNS depressant causing muscle relaxation, sedation, and amnesia | Contraindications: Hypotension, head injury, pregnancy except eclamptic seizure | Adult: 2–10 mg IV/IM/IN; pediatric: 0.05–0.1 mg/kg, max 10 mg | Side effects: Hypotension, respiratory depression, confusion/stupor, nausea, vein irritation/phlebitis/sclerosis

Atropine

Symptomatic bradycardia; organophosphate poisoning | MOA: Reverses vagal tone and blocks acetylcholine in organophosphate poisoning | Contraindication: Hypothermic bradycardia | Adult symptomatic bradycardia: 0.5 mg IV every 3–5 min, max 3 mg; poisoning: 2–5 mg every 15 min until secretions stop | Pediatric symptomatic bradycardia: 0.02 mg/kg; poisoning: 0.05 mg/kg | Side effects: Tachycardia, blurred vision, dry mouth

Calcium Chloride

Hyperkalemia, hypocalcemia, magnesium overdose, calcium-channel-blocker overdose | MOA: Helps conduct electrical current in heart and assists normal cardiac contraction | Contraindications: Cardiac arrest, hypercalcemia, digitalis | Adult/pediatric: 10–15 mg/kg | Side effect: Bradycardia and hypotension if pushed too rapidly

Calcium Gluconate

Hyperkalemia, magnesium overdose, calcium-channel-blocker overdose | MOA: Calcium replacement/support | Contraindications: Cardiac arrest, hypercalcemia | Adult: 15–30 mL of 10% solution; pediatric: 60–100 mg/kg slow IV push | Side effects: Bradycardia, hypercalcemia

Cardizem (Diltiazem)

AFib/AFlutter with RVR; PSVT unresponsive to adenosine | MOA: Calcium-channel blocker that blocks calcium movement into muscle and slows ventricular response | Contraindications: Systolic BP <90, diastolic BP <60, wide-complex tachycardia | Adult: 0.25 mg/kg first; 0.35 mg/kg second, IV push over 2 min | Pediatric: Not used prehospital | Side effects: Bradycardia, hypotension

Decadron (Dexamethasone)

Refractory bronchospasm in status asthmaticus/COPD; allergic reactions/anaphylactic shock; sometimes spinal cord injury swelling | MOA: Synthetic corticosteroid; suppresses immune response, restores capillary permeability, inhibits histamine release, anti-inflammatory | Contraindication: Known hypersensitivity | Adult: 4–24 mg IVP; pediatric: 0.2–0.5 mg/kg IV/IM, not exceeding adult dose | Side effects: Possible hypertension, rare anaphylactic reactions, CHF exacerbation, seizures

Dextrose 10%

Hypoglycemia | MOA: Increases blood glucose | Contraindication: None in hypoglycemia; use caution with head injuries | Adult: 250 mL D10 IV; pediatric: 5 mL/kg D10 | Side effect: Tissue necrosis with infiltration

Diazepam (Valium)

Active seizure/status epilepticus; premedication | MOA: CNS depressant causing amnesia, sedation, muscle relaxation | Contraindications: Alcohol/sedative drug use, head injury | Adult: 5–10 mg, max 10 mg IV/IM; pediatric: 0.5 mg/kg max 5 mg rectal or 0.2 mg/kg max 5 mg IV | Side effects: Respiratory depression, hypotension

Diphenhydramine (Benadryl)

Anaphylaxis; moderate/severe allergic reactions after epinephrine | MOA: Blocks effects of histamine | Contraindications: MAOIs, newborns, nursing mothers | Adult: 25–50 mg; pediatric: 1–2 mg/kg | Side effects: Drowsiness, dizziness, sedation

Dopamine (Inotropin)

Nonhypovolemic hypotension; symptomatic bradycardia if atropine ineffective | MOA: Low dose increases organ perfusion; moderate dose increases ventricular rate/force; high dose causes peripheral vasoconstriction | Contraindications: Hypovolemic shock, tachydysrhythmias, VFib | Dose: 2–20 mcg/kg/min; effects start at 5–10 mcg/kg/min | Side effects: Hypertension, headache, nausea/vomiting

Epinephrine 1:1000 (Adrenalin)

Asthmatic bronchoconstriction, allergic/anaphylactic reactions, profound bradycardia after atropine/shock/dopamine fail | MOA: Alpha effects cause vasoconstriction; beta-1 increases rate/force/contractility; beta-2 causes bronchodilation | Contraindications: Hypersensitivity, hypovolemic shock, coronary insufficiency | Adult asthma/allergy: 0.3 mg SQ/IM; bradycardia: 2–10 mcg/min; pediatric: 0.15 mg SQ/IM | Side effects: Tachycardia, hypertension, worsened cardiac ischemia

Epinephrine 1:10,000 (Adrenalin)

Cardiac arrest; anaphylaxis | MOA: Alpha vasoconstriction increases coronary/cerebral perfusion; beta-1 increases rate/force/contractility; beta-2 causes bronchodilation | Contraindications: Hypersensitivity, hypovolemic shock, coronary insufficiency | Adult cardiac arrest: 1 mg IV every 3–5 min; anaphylaxis: 0.3 mg, may repeat once; pediatric cardiac arrest: 0.01 mg/kg; anaphylaxis: 0.15 mg | Side effects: Palpitations, anxiety, tremulousness, headache, dizziness, hypertension, worsened cardiac ischemia

Etomidate

Induction agent before neuromuscular blockade | MOA: Suppresses CNS activity | Contraindications: Known hypersensitivity, labor/delivery | Dose: 0.3 mg/kg, max 40 mg | Side effects: Nausea/vomiting, dysrhythmias, SOB, hypotension, muscle twitch

Fentanyl

Pain control; sedation for RSI and PAI | MOA: Binds receptors in brain to produce effects | Contraindications: Respiratory depression, hypotension | Dose: 1–2 mcg/kg, max 200 mcg | Side effects: Respiratory depression, bradycardia, hypo/hypertension, nausea/vomiting

Oral Glucose

Altered LOC caused by hypoglycemia | MOA: Provides glucose to bloodstream for cellular metabolism | Contraindications: No gag reflex, unable to protect airway | Dose: 25–50 g (full tube) | Side effect: Aspiration

Glucagon

Hypoglycemia; beta-blocker overdose; calcium-channel-blocker toxicity | MOA: Converts stored liver glycogen to glucose; improves cardiac contractility and heart rate | Contraindication: Hypersensitivity to proteins | Hypoglycemia: 1 mg IM/IN; CCB/beta-blocker OD: 1 mg IV/IO up to 3 mg; <1 year: 0.5 mg | Side effects: Nausea/vomiting, tachycardia

Haldol (Haloperidol)

Sedation for comfort/safety during transport; acute psychosis, severe anxiety/tension, acute alcohol withdrawal/DTs | MOA: Butyrophenone that blocks dopaminergic receptors in brain | Contraindications: Preexisting coma, intoxication, known cardiovascular disease | Adult 18+: 5–10 mg IM, max 100 mg/24 hr; pediatric doses vary by age | Side effects: Extrapyramidal/dystonic reactions, tardive dyskinesia, potentially fatal NMS

Heparin

Prevention of thrombus formation in acute MI | MOA: Binds antithrombin III, inactivating thrombin and impairing fibrin formation | Contraindications: Active bleeding, bleeding tendencies, recent major surgery/trauma | Adult: 5,000 units IV followed by 20,000–40,000 units over 24 hr; pediatric: 100–150 units/kg IV followed by 28 units/kg/hr | Side effects: Potentially life-threatening bleeding, hematologic disorder

Hydroxocobalamin (Cyanokit)

Cyanide toxicity | MOA: Cyanide displaces cobalt from vitamin B12 molecule, forming cyanocobalamin removed by renal excretion | Absolute contraindication: None; relative: history of anaphylactic reaction to hydroxocobalamin/cyanocobalamin | Dose: 5 g (2 vials) over 15 min | Side effects: Flushing, urticaria, itching/rash, chest tightness, dyspnea, transient BP elevation, anaphylaxis, red skin/tears/sweat/urine

Ketamine (Ketalar)

Anesthesia prior to RSI; chemical sedation for psychiatric/behavioral issues | MOA: Affects catecholaminergic transmission | Contraindication: Hypersensitivity | RSI: 1 mg/kg IV, may repeat every 5–10 min; sedation: 1 mg/kg IV or 4 mg/kg IM | Side effects: Hypertension, tachycardia, sedation, vomiting, involuntary muscle movement

Labetalol (Trandate/Normodyne)

Acute hypertensive crisis with end-organ dysfunction; unstable angina; non-Q-wave MI; AAA; SVT with RVR; refractory VT | MOA: Competitively blocks beta-adrenergic receptors; lowers HR, cardiac output and BP; causes vasodilation; decreases AV conduction | Contraindications: Cocaine/amphetamine overdose, CHF | Adult crisis: 5–10 mg IV, may repeat to total 20 mg | Antidote: Glucagon | Side effects: Bronchospasm, hypotension

Lasix (Furosemide)

Acute pulmonary edema | MOA: Diuretic; osmotic gradient | Contraindications: Hypersensitivity, hypovolemia/dehydration | Dose: 1 mg/kg over 2 min; if already taking Lasix, give twice daily dose | Side effects: Hypotension, dry mouth, electrolyte imbalance, hearing loss if given too quickly

Levophed (Norepinephrine)

Neurogenic, cardiogenic, and septic shock; hemodynamically significant hypotension with BP <70 | MOA: Vasoconstrictor/adrenergic agonist | Contraindication: Hypovolemia | Dose: 8–12 mcg/min | Side effects: Hypertension, dysrhythmias, angina, reflex bradycardia, tissue necrosis

Lidocaine

Cardiac arrest from VT/VF; maintenance infusion after ROSC associated with VT/VF | MOA: Slows diastolic depolarization, suppresses PVCs, increases VF threshold | Contraindications: 2nd/3rd heart block, Stokes-Adams syndrome, prophylactic use in AMI | Cardiac arrest: 1–1.5 mg/kg every 5–10 min, max 3 mg/kg; ROSC: 1–4 mg/min | Side effects: Lightheadedness, confusion, blurred vision, hypotension, bradycardia, altered LOC, seizures

Magnesium Sulfate

Eclamptic seizures, ventricular dysrhythmias, torsades, digitoxin toxicity, asthma | MOA: CNS depressant and physiologic calcium-channel blocker | Contraindications: Heart block, myocardial damage | Eclampsia/torsades/asthma: 1–2 g over 10 min; cardiac arrest: 1–2 g IV push | Side effects: Diaphoresis, hypothermia, respiratory depression, facial flushing, bradycardia, hypotension, nausea/vomiting

Methylprednisolone (Solu-Medrol)

Wheezing refractory to inhaled bronchodilators; status asthmaticus; severe anaphylaxis with epinephrine/diphenhydramine | MOA: Potent anti-inflammatory steroid | Contraindication: Known hypersensitivity | Dose: 60–125 mg IV/IO; IM in asthma; pediatric 2 mg/kg | Side effects: Hypertension, rare anaphylaxis, CHF exacerbation, seizures

Midazolam (Versed)

Active seizure/status epilepticus; sedation prior to cardioversion/pacing | MOA: CNS depressant causing amnesia, sedation, relaxation | Contraindications: Hypersensitivity, acute narrow-angle glaucoma | Dose: 2.5–5 mg IV/IN, may repeat once | Side effects: Respiratory depression, confusion, hypotension, nausea

Morphine

Pain and anxiety; chest pain unrelieved by nitroglycerin | MOA: Alleviates pain, decreases anxiety, vasodilator | Contraindications: BP <90, traumatic brain injury | Dose: 2–4 mg every 3–5 min until hypotension or respiratory depression | Side effects: Respiratory depression, dizziness, nausea/vomiting, hypotension, bradycardia

Narcan (Naloxone)

Opiate overdose | MOA: Narcotic antagonist | Contraindication: Hypersensitivity | Dose: 0.4 mg to max 2 mg | Side effects: Dysrhythmias, nausea/vomiting, hypertension, tachycardia, violent behavior

Nitroglycerin (Nitrostat)

Chest pain of cardiac origin; pulmonary edema associated with CHF | MOA: Vasodilator | Contraindications: Systolic BP <90, increased intracranial pressure, ED drugs, extreme brady/tachycardias | Dose: 1 spray 0.4 mg or 1 SL tablet 0.4 mg | Side effects: Hypotension, headache, reflex tachycardia, nausea/vomiting, diaphoresis

Nitrous Oxide (Nitronox)

Analgesia for alert/oriented patients with pain such as kidney stones, thermal burns, AMI, labor, fractures | MOA: Short-term CNS analgesic/anesthetic | Contraindications: Decompression sickness, COPD, chest trauma, abdominal distention, altered LOC | Dose: Self-dose | Side effects: Hypotension, dizziness

Norcuron (Vecuronium)

Long-term muscle paralysis to facilitate endotracheal intubation | MOA: Competitive antagonist to acetylcholine at postsynaptic NMJ receptors; prevents stimulation without depolarization | Contraindication: Hypersensitivity; caution with neuromuscular disease and hepatic/renal impairment | Dose: 0.1 mg/kg IV/IO; onset 30 sec; duration 30–40 min | Side effects: Hypotension/hypertension, tachycardia/bradycardia

Pavulon (Pancuronium)

Long-term muscle paralysis to facilitate endotracheal intubation | MOA: Competitive antagonist to acetylcholine at postsynaptic NMJ receptors | Contraindication: Hypersensitivity; caution with neuromuscular disease and hepatic/renal impairment | Adult/pediatric: 0.04–0.1 mg/kg IV/IO; onset 30 sec; duration 180 min | Side effects: Hypotension/hypertension, tachycardia/bradycardia

Phenergan (Promethazine)

Persistent vomiting, GI problems, allergic reactions; noted as better than Zofran if patient is already vomiting | MOA: Potent antiemetic with sedative effects | Contraindications: Hypersensitivity, comatose states, altered LOC | Dose: 12.5 mg to max 25 mg | Side effects: Drowsiness/sedation, dystonic reaction, necrosis

Pralidoxime Chloride (2-PAM)

Second drug for organophosphate pesticide/chemical nerve-agent poisoning; especially muscle weakness or respiratory depression | MOA: Reactivates cholinesterase deactivated by organophosphates/nerve agents | Contraindications: No absolute contraindications | Dose: 600 mg (1 autoinjector) to 1800 mg (3 autoinjectors) standing order | Side effects: Tachycardia, laryngospasm, muscle rigidity if infused too quickly, injection-site pain, blurred/double vision, dizziness, loss of coordination, headache, drowsiness, hypertension

Pronestyl (Procainamide)

Refractory/recurrent VF, pulseless VT, stable monomorphic/polymorphic VT with pulse, wide-complex tachydysrhythmias, malignant refractory PVCs; also certain atrial dysrhythmias | MOA: Slows myocardial conduction by stabilizing myocardial membranes and reduces automaticity | Contraindications: TCA overdose, previous amiodarone, 2nd/3rd degree heart block | IV infusion: 20–30 mg/min titrated to effect; max 17 mg/kg | Side effects: Hypotension, 2nd/3rd degree AV block, widened QRS

Racemic Epinephrine (Vaponefrin)

Acute bronchospasm in asthma/COPD; allergic reaction unresponsive to other treatment; croup | MOA: Activates beta-2 receptors causing smooth-muscle relaxation and bronchodilation | Contraindications: Hypersensitivity, pregnancy except life-threatening situation; racemic epi contraindicated in epiglottitis | Dose: 0.5 mL of 2.25% solution in 2.5 mL NS nebulized every 4 hr PRN | Side effects: Tachycardia, restlessness/nervousness/tremors, hypertension

Sodium Bicarbonate

TCA overdose, hyperkalemia/acidosis, prolonged CPR, DKA, rhabdomyolysis, compartment syndrome | MOA: Buffers metabolic acidosis | Contraindications: Alkalosis, PE, abdominal pain of unknown origin, hypocalcemia | Dose: 1 mEq/kg | Side effects: Acidosis, hypoxia, tissue sloughing, seizures, hypernatremia, increased PCO2

Succinylcholine

Facilitate intubation | MOA: Depolarizing neuromuscular blocker | Contraindications: Burn injuries within 12 hr, inability to control airway, acute rhabdomyolysis | Relaxation: 0.3–1.1 mg/kg; RSI: 1–1.5 mg/kg | Side effects: Respiratory depression, bradycardia, dysrhythmias, allergic reaction

Terbutaline

Acute bronchospasm in asthma/COPD; allergic reaction unresponsive to other treatment | MOA: Activates beta-2 receptors causing smooth-muscle relaxation and bronchodilation | Contraindications: Hypersensitivity, pregnancy except life-threatening situation | Adult: 0.25 mg SC, may repeat once in 15 min; pediatric: 0.01 mg/kg, not exceeding adult dose | Side effects: Tachycardia, restlessness/nervousness/tremors, hypertension

Thiamine

Vitamin required to convert glucose to energy; must be ingested because body does not manufacture it | MOA: Required for conversion of glucose to energy | Contraindication: History of sensitivity to thiamine or any ingredient | Adult: 50 mg IV/IM, may repeat to total 100 mg | Side effects: Not listed in packet

Verapamil (Calan)

SVT, Aflutter with RVR, AFib, atrial tachycardia, unstable angina | MOA: Inhibits movement of calcium ions across cell membranes | Contraindications: Hypersensitivity, bradycardia | Dose: Initial 2.5–5 mg; repeat 5–10 mg bolus every 15 min | Side effects: Dizziness, headache, nausea/vomiting, hypotension, bradycardia

Zemuron (Rocuronium)

Long-term muscle paralysis to facilitate endotracheal intubation | MOA: Competitive antagonist to acetylcholine at postsynaptic NMJ receptors; blocks stimulation without depolarizing muscle | Contraindication: Hypersensitivity; caution with neuromuscular disease and hepatic/renal impairment | Adult/pediatric: 1 mg/kg IV/IO; onset 60–90 sec; duration 45–70 min | Side effects: Hypotension/hypertension, tachycardia/bradycardia

Zofran (Ondansetron)

Prevention of nausea and vomiting | MOA: Blocks serotonin receptor | Contraindications: Hypersensitivity, pediatric patients <2 years; do not administer Phenergan and Zofran to same patient | Dose: 2 mg to max 4 mg | Side effects: Dizziness, burning at injection site, drowsiness