School of EMS Paramedic Drug Reference

Flashcards based on the School of EMS Paramedic Drug Reference manual, covering classes, mechanisms, indications, and dosages of common pre-hospital medications.

Acetaminophen (Tylenol, Ofrimev)

An analgesic and anti-pyretic that reduces the production of prostaglandins in the brain and elevates the pain threshold. Typical adult PO dose is $650-1000\,mg$.

Acetylcysteine (Mucomyst, Acetadote)

An anitdote for Acetaminophen overdose that restores glutathione concentrations within the liver to detoxify substances. Loading dose is $150\,mg/kg$ IV mixed in $200\,mL$ of $D5W$.

Activated Charcoal

An adsorbent that binds to and inactivates toxic substances from the GI tract. Dosage is $1-2\,gm/kg$ PO or via NGT. It does not adsorb cyanide, lithium, iron, lead, or arsenic.

Adenosine (Adenocard)

An endogenous nucleotide and drug of choice for PSVT. It slows conduction time through the AV Node and can interrupt re-entrant pathways. Adult dose is $6\,mg$ rapid IV over $1-3$ seconds.

Albuterol (Proventil, Ventolin)

A sympathomimetic and bronchodilator that is a selective $\beta-2$ agonist. It results in smooth muscle relaxation in the bronchial tree and peripheral vasculature. Adult dose is $2.5\,mg$ in $2.5\,ml$ normal saline via nebulizer.

Amiodarone (Cordarone)

An antidysrhythmic used for VF or pulseless VT. It causes prolongation of the action potential and has non-competitive alpha and beta sympathetic blocking effects. Adult cardiac arrest dose is $300\,mg$ IV push.

Amyl Nitrite, Sodium Nitrite, Sodium Thiosulfate

The components of a Cyanide Antidote Kit. Amyl Nitrite reacts with hemoglobin to form methemoglobin, while Sodium Thiosulfate produces thiocyanate for excretion.

Aspirin

A platelet inhibitor and anti-inflammatory agent that inhibits prostaglandins to make platelets less sticky. Used for chest pain suggestive of Myocardial Infarction at a dose of $162\,mg$ to $324\,mg$ PO.

Atropine Sulfate

An anticholinergic agent (parasympatholytic) that increases heart rate in brady dysrhythmias and is the drug of choice for organophosphate poisoning. Adult bradycardia dose is $1\,mg$ IV every $3-5$ minutes.

Bumetanide (Bumex)

A potent loop diuretic with a potency approximately $40$ times greater than furosemide. It inhibits reabsorption of sodium and chloride in the ascending limb of the loop of Henle.

Calcium Chloride

An electrolyte that increases the cardiac contractile state (positive inotropic effect) and stabilizes cell membranes. Indicated for Hyperkalemia, Magnesium sulfate overdose, and Calcium channel blocker toxicity.

Dextrose

A carbohydrate and hypertonic solution used to rapidly increase serum glucose levels in patients with an altered level of consciousness secondary to hypoglycemia. Adult dose is $12.5-25\,grams$ slow IV.

Diazepam (Valium)

A benzodiazepine, anticonvulsant, and sedative-hypnotic that potentiates inhibitory neurotransmitters and raises the seizure threshold. Standard adult seizure dose is $5-10\,mg$ IV.

Diltiazem HCL (Cardizem)

A calcium channel blocker used for Atrial flutter or Atrial fibrillation with rapid ventricular rates. It acts as an arterial and venous vasodilator and reduces myocardial oxygen demand.

Diphenhydramine (Benadryl)

An antihistamine that blocks cellular histamine receptors. It is used for symptomatic relief of allergies, anaphylaxis, and to reverse acute dystonic reactions from phenothiazines.

Dopamine (Inotropin)

A sympathomimetic and inotropic agent that is the metabolic precursor to Norepinephrine. It increases systemic vascular resistance and myocardial contractility in a dose-dependent manner ($5-20\,mcg/kg/min$).

Epinephrine

A sympathomimetic and direct acting alpha and beta agonist. Used in cardiac arrest ($1\,mg$ of $1:10,000$ every $3-5$ minutes) and anaphylaxis ($0.3-0.5\,mg$ of $1:1,000$ IM).

Etomidate (Amidate)

A short-acting nonbarbiturate hypnotic used for anesthesia induction during RSI. It acts at the level of the reticular activating system. Typical adult dose is $0.2-0.6\,mg/kg$ IV.

Fentanyl Citrate (Sublimaze)

A short-duration narcotic analgesic where $100\,mcg$ is approximately equivalent to $10\,mg$ of morphine. Maximum adult dose is $150\,mcg$ slow IV push.

Flumazenil (Romazicon)

An antidote and benzodiazepine receptor antagonist that reverses sedation and respiratory depression from pure benzodiazepine overdose. Max adult dose is $3\,mg$.

Furosemide (Lasix)

A loop diuretic that inhibits electrolyte reabsorption and promotes excretion of sodium, potassium, and chloride. Adult dose is $0.5-1.0\,mg/kg$ slow IV.

Glucagon

A pancreatic hormone and hyperglycemic agent that stimulates glycolysis. It is also used as an inotropic agent in beta-blocker overdose cases. Adult dose is $0.5-1\,mg$ IM, SC, or slow IV.

Haloperidol (Haldol)

A tranquilizer and antipsychotic that inhibits CNS catecholamine receptors. Indicated for acute psychotic episodes. Adult dose is $5\,mg$ IM.

Heparin Sodium

An anticoagulant that prevents the conversion of fibrinogen to fibrin. It does not lyse existing clots. Adult loading dose is $80\,units/kg$ IV.

Hydroxocobalamin (Vitamin B12)

An antidote for cyanide poisoning that binds cyanide ions to form cyanocobalamin, which is then excreted in the urine. Standard adult dose is $5\,g$ administered over $15$ minutes.

Hydromorphone (Dilaudid)

A schedule II semisynthetic analog of morphine used for moderate to severe pain. It works at opioid receptors to produce analgesia and euphoria. Adult dose is $1-2\,mg$ slow IV.

Ibuprofen (Advil, Motrin)

An NSAID and nonopioid analgesic that inhibits prostaglandin synthesis to reduce swelling, pain, and fever. Adult dose is $10\,mg/kg$ to a maximum of $800\,mg$.

Ketamine (Ketalar)

A sedative and dissociative anesthetic that blocks pain receptors and minimizes spinal cord activity. Adult dose for Excited Delirium is $4\,mg/kg$ IM only.

Ketorolac (Toradol)

A nonsteroidal anti-inflammatory drug used for short-term management of moderate to severe pain. Adult IM dose for patients under $65$ is $60\,mg$.

Lidocaine HCL (2%)

An antidysrhythmic that decreases automaticity by slowing Phase 4 depolarization. Used for suppression of ventricular dysrhythmias at an adult dose of $1-1.5\,mg/kg$ IV push.

Lorazepam (Ativan)

A benzodiazepine used for status epilepticus and sedation. When given IV or IO, it must be diluted with an equal volume of sterile water or saline. Adult dose is $2-4\,mg$ slow IV.

Magnesium Sulfate

An electrolyte used for Torsades de Pointes ($1-2\,grams$ IV) and eclampsia seizures ($1-4\,gm$ IV). It reduces muscle contractions by blocking peripheral neuromuscular transmission.

Mannitol 20%

An osmotic diuretic that promotes fluid movement from intracellular to extracellular space to decrease cerebral edema and intracranial pressure. Adult dose is $0.5-2\,g/kg$ IV infusion.

Midazolam (Versed)

A short-acting benzodiazepine and CNS depressant used for status seizures and conscious sedation. Adult dose is $2-6\,mg$ slow IV push.

Morphine Sulfate

An opioid analgesic that alleviates pain through CNS actions and decreases preload and afterload. Adult dose is $0.1\,mg/kg$ to a maximum of $10\,mg$ IV, IM, or SC.

Naloxone (Narcan)

A narcotic antagonist that competitively inhibits narcotic receptor sites to reverse respiratory depression from opiate overdose. Adult dose is $0.4-2.0\,mg$ IV, IM, SC, or Nasal.

Nitroglycerin

A vasodilator and smooth muscle relaxant that reduces preload and afterload. Indicated for acute angina and ischemic chest pain. Adult SL tablet dose is $0.3\,mg$.

Norepinephrine (Levophed)

A potent alpha-agonist vasopressor resulting in peripheral vasoconstriction and increased inotropic effect. Adult dose is $0.1-0.5\,mcg/kg/min$ titrated to a BP of $90$ systolic.

Ondansetron (Zofran)

An antiemetic and selective $5-HT_3$ receptor antagonist. It blocks serotonin peripherally on vagal nerve terminals and centrally in the CNS. Adult dose is $4-8\,mg$ IV or PO.

Oxytocin (Pitocin)

A pituitary hormone and uterine vasoconstrictor used for postpartum hemorrhage due to uterine atony. Adult dose is $10\,units$ IM after delivery of the placenta.

Pancuronium (Pavulon)

A non-depolarizing neuromuscular blocker that produces complete muscular relaxation by binding to acetylcholine receptors. Adult dose is $0.04-0.1\,mg/kg$ slow IV.

Pralidoxime Chloride (2-PAM)

A cholinesterase reactivator used as an antidote for organophosphate poisoning. It allows for the destruction of accumulated acetylcholine at the neuromuscular junction.

Procainamide (Pronestyl)

A Class Ia antidysrhythmic that suppresses Phase IV depolarization to reduce automaticity of ectopic pacemakers. Loading dose is $20-30\,mg/min$ to a max of $17\,mg/kg$.

Promethazine (Phenergan)

A phenothiazine and H1 receptor antagonist with sedative, antiemetic, and anticholinergic activity. Adult IV dose is $6.25-25\,mg$ (must be diluted in $9\,mL$ of $NaCl$).

Propofol (Diprivan)

A short-acting general anesthetic and sedative-hypnotic often used for maintenance of sedation in ventilated patients. It has no analgesic properties.

Rocuronium (Zemuron)

A non-depolarizing neuromuscular blocker used to facilitate intubation. It has an onset of $30$ seconds to $1$ minute and a duration of $25-75$ minutes.

Sodium Bicarbonate 8.4%

A buffer and alkalinizer that reacts with hydrogen ions to form water and $CO_2$ to treat metabolic acidosis, TCA overdose, and hyperkalemia. Adult dose is $1\,mEq/kg$ IV.

Succinylcholine (Anectine)

An ultra-short acting depolarizing skeletal muscle relaxant used for RSI. It mimics acetylcholine to produce a Phase I block manifested by fasciculations. Adult dose is $1-2\,mg/kg$ rapid IV.

Thiamine (Vitamin B1)

A vitamin required for carbohydrate metabolism. It is used in Wernicke’s encephalopathy and delirium tremens. Adult dose is $100\,mg$ slow IV or IM.

Tranexamic Acid (TXA)

A hemostatic agent and antifibrinolytic that reduces plasminogen activation. Indicated for trauma with significant bleeding within $3$ hours of MOI. Adult dose is $1000\,mg$ infused over $10$ minutes.

Vasopressin (Pitressin)

A naturally occurring antidiuretic hormone used as an alternative to epinephrine in adult cardiac arrest. The standard IV/IO push dose is $40\,units$.

Verapamil (Isoptin)

A calcium channel blocker (Class IV antidysrhythmic) that inhibits calcium ion movement across cell membranes, decreasing atrial automaticity and AV conduction velocity. Adult dose is $2.5-5\,mg$ slow IV bolus.