Sect 4 Chpt 14 Indications and Contraindications

Indication and Contraindications for Medication Administration

Acetaminophen (Tylenol)

Indication: Pain control, fever control

Contraindication: Known hypersensitivity, severe active liver disease

AcetaZOLAMIDE (Diamox, Diamox Sequels)

Indication: AMS (treatment and prophylaxis), prevention of HACE

Contraindication: Hypersensitivity to acetaZOLAMIDE of sulfa, known hypokalemia, known hyponatremia, renal dysfunction, liver dysfunction. Should not be used for the treatment of HAPE

Acetic Acid (vinegar)

Indication: Otitis externa, pain control for envenomation by jellyfish from outside the United States

Contraindication: Hypersensitivity, perforated tympanic membranes, may increase nematocyst discharge for US jellyfish and should be used only outside the United States

Acetylcysteine (Mucomyst, Acetadote)

Indication: Acetaminophen overdose

Contraindication: Known hypersensitivity, acute asthma

Activated Charcoal (Insta-Char, Actidose-Aqua, Liqui-Char)

Indication: Most oral poisonings and medication overdoses in the alert patient; can be used after evacuation of poisons

Contraindication: Known hypersensitivity, unprotected airway (beware of aspiration), absence of a gag reflex, ileus, intestinal obstruction; do not use after ingestion of petroleum distillates, hydrocarbons, heavy metals, acids or alkalis (corrosives), alcohols, iron, lithium, solvents. Use caution inpatients experiencing abdominal pain of unknown origin or a known GI obstruction

Adenosine (Adenocard)

Indication: First-line drug for most forms of stable, regular, narrow-complex SVT, including those involving AV nodal reentry. May be considered for unstable narrow-complex reentry tachycardia while preparing for cardioversion. Can be used diagnostically for stable, regular, monomorphic wide-complex tachycardia

Contraindication: Known hypersensitivity. Second- or third- degree AV block or sick sinus syndrome or other sinus node disease unless a functioning artificial pacemaker is present; poison- or drug-induced tachycardia. Use with caution in patients with a history of seizure disorder. May induce bronchospasm in a patient with bronchoconstrictive or bronchospastic lung disease (asthma, COPD)

Albuterol (Proventil, Ventolin, Proair, Accuneb)

Indication: Treatment and prevention of bronchospasm in patients with reversible obstructive airway disease, treatment of inhaled airway/respiratory irritant agents, and hyperkalemia treatment

Contraindication: Known hypersensitivity; dysrhythmias, especially those caused by digitalis. Synergistic with other sympathomimetics

Alprazolam (Xanax)

Indication: Anxiety, panic disorder, depression

Contraindication: Known hypersensitivity, respiratory depression, acute alcohol intoxication, psychotic reactions, recent use of respiratory depressants, acute narrow-angle glaucoma

Amiodarone (Cordarone, Pacerone)

Indication: Cardiac arrest resulting from VF or pulseless VT after CPR, defibrillation, and epinephrine; stable, regular narrow-complex tachycardia if the rhythm persists despite vagal maneuvers or adenosine or the tachycardia is recurrent; to control the ventricular rate in AF with a rapid ventricular response without preexcitation; stable wide-complex tachycardia; stable monomorphic VT; polymorphic VT with a normal QT interval

Contraindication: Known hypersensitivity, iodine hypersensitivity (iodine is incorporated in amiodarone’s chemical structure), cardiogenic shock, second- or third-degree AV block, or sick sinus syndrome or other sinus node disease unless a functioning artificial pacemaker is present

Antidepressant Agents

Indications: Prescribed to treat clinical depression, obsessive-compulsive disorder, generalized anxiety disorder, and posttraumatic stress syndrome

Contraindications: Vary depending on the specific medication

Aspirin (Acetylsalicylic Acid)

Indications: New-onset chest discomfort suggestive of ACS

Contraindications: Hypersensitivity to ASA or NSAIDs (ASA-associated hypersensitivity reactions include ASA-induced urticaria or ASA-intolerant asthma); bleeding disorders including ulcers, hemophilia, hemorrhagic diathesis, hemorrhoids, thrombocytopenia, and ulcerative colitis; hemolytic anemia from pyruvate kinase (PK) and glucose-6-phosphate dehydrogenase (G6PD) deficiency; lactating mothers

Atropine Sulfate

Indications: Hemodynamically unstable bradycardia, acetylcholinesterase inhibitor poisoning (carbamates, nerve agents, organophosphates), RSI in pediatrics, beta blocker or calcium channel blocker overdose

Contraindications:Known hypersensitivity, relative contraindications include narrow-angle glaucoma, GI obstruction, severe ulcerative colitis, toxic megacolon, bladder outlet obstruction, myasthenia gravis, hemorrhage with cardiovascular instability, thyrotoxicosis

Benzocaine Spray (Hurricane)

Indications: Used as a topical anesthetic (eg, larynx, mouth, trachea, nasal cavity) to facilitate passage of diagnostic and treatment devices. Suppresses the pharyngeal and tracheal gag reflex

Contraindications: Hypersensitivity to benzocaine or other “caine” anesthetics

Beta Blocking Agents

Indications: used to treat cardiovascular conditions like high blood pressure (hypertension), chest pain (angina), abnormal heart rhythms(arrhythmias), and congestive heart failure—Effective in managing conditions like migraines, glaucoma, and certain vascular tumors. Play a role in reducing the risk of future heart attacks and managing the after-effects of a heart attack

Contraindications: Severe bradycardia, certain heart blocks, cardiogenic shock, and severe asthma of COPD

Bumetanide (Bumex)

Indications: Pulmonary edema, heart failure

Contraindications: Hypersensitivity to bumetanide, furosemide, or sulfonamides; hypovolemia, anuria, acid-base imbalance, electrolyte imbalance, hepatic coma. Use with caution in patients with hepatic cirrhosis, ascites, or diabetes

Calcium Chloride

Indications: Hypocalcemia, hyperkalemia, beta blocker and calcium channel blocker toxicity, antidote for magnesium sulfate overdose

Contraindications: Known hypersensitivity, digoxin toxicity, hypercalcemia, suspected severe hypokalemia

Calcium Gluconate

Indications: Topical use in hydrofluoric acid burn management, hypocalcemia, hyperkalemia, beta blocker and calcium channel blocker toxicity

Contraindications: Known hypersensitivity, digoxin toxicity, hypercalcemia, suspected severe hypokalemia

Cimetidine (Tagamet)

Indications: Gastric or duodenal ulcers, GERD, as an adjunct in treating hives and/or itching in patients experiencing an allergic reaction that does not respond to an H1 blocker alone (eg, diphenhydrAMINE)

Contraindications: Known hypersensitivity to cimetidine or other H2 blocker

Dexamethasone Sodium Phosphate (Decadron)

Indications: Anaphylaxis, acute exacerbation of bronchial asthma, AMS, HACE, spinal cord injury, croup, elevated ICP (prevention and treatment), as an adjunct in the treatment of shock, COVID-19 with severe respiratory symptoms

Contraindications: Documented hypersensitivity, systemic fungal infection, preterm infants

Dextrose

Indications: Hypoglycemia, acutely altered mental status, coma of unknown origin, seizure of unknown origin, status epilepticus

Contraindications: Documented hypersensitivity, hyperglycemia, severe dehydration, anuria, diabetic coma, intracranial or intraspinal hemorrhage, glucose-galactose malabsorption syndrome

Diazepam (Valium, Diastat AcuDial)

Indications: Uncontrolled shivering associated with hyperthermia/heat exposure, active seizures, chemical restraint, acetylcholinesterase inhibitor poisoning (Carbamates, nerve agents, organophosphates)

Contraindications: Documented hypersensitivity, neurologic or respiratory depression, narrow-angle glaucoma, myasthenia gravis, head injury

Digoxin (Lanoxin)

Indications: Heart failure, alternative drug for reentry SVT, ventricular rate control in atrial flutter and AF

Contraindications: Known hypersensitivity, VF, VT, digitalis toxicity. Hypokalemia, hypomagnesemia, and hypercalcemia potentiate digitalis toxicity

Diltiazem (Cardizem, DIlacor, Diltiaz)

Indications: Stable narrow-QRS tachycardia if the rhythm persists despite vagal maneuvers or administration of adenosine, or if the tachycardia is recurrent; to control the ventricular rate in patients with AF or atrial flutter without preexcitation

Contraindications: Known hypersensitivity, hypotension, cardiogenic shock, wide-complex tachycardia (may lead to hemodynamic deterioration and VF), second- or third- degree AV block or sick sinu syndrome or other sinus node disease unless a functioning artificial pacemaker is present, poison- or drug-induced tachycardia, af or atrial flutter when associated with an accessory bypass tract (eg, Wolff-Parkinson- White syndrome or Lown-Ganong-Levine syndrome). Avoid use in patients with left ventricular systolic dysfunction or decompensated heart failure. Use with extreme caution in patients taking oral beta blockers

DiphenhydrAMINE (Benadryl)

Indications: Symptomatic allergic reactions, symptomatic dystonia, extrapyramidal signs or symptoms caused by phenothiazines, antiemetic, chemical restraint

Contraindications:Known hypersensitivity, newborns and premature infants, breastfeeding. use with caution in patients with severe vomiting, asthma, narrow-angle glaucoma, benign prostatic hypertrophy, or alcohol intoxication. Use is controversial in patients with lower respiratory tract disease (eg, acute asthma)

DOBUTamine Hydrochloride (Dobutrex)

Indications: Heart failure with a SBP of 70 to 100mm HG and no signs of shock

Contraindications: Known hypersensitivity, suspected or known poison/drug-induced shock, SBP less than 100mm HG and signs of shock, idiopathic hypertrophic subaortic stenosis

DOPamine Hydrochloride (Inotropin)

Indications: Refractory cardiogenic or distributive shock, hypotension with low cardiac output states, second-line drug for symptomatic bradycardia

Contraindications: Known hypersensitivity, hypovolemia, pheochromocytoma, uncorrected tachydysrhythmias, VF

Droperidol (inapsine)

Indications: Chemical restraint, acute delirium or psychosis

Contraindications: Known hypersensitivity; known or suspected prolonged QT interval, including patients with congenital long QT syndrome. Use with extreme caution in patients with bradycardia, cardiac disease, concurrent MAOI therapy, or use of Class I and Class III antidysrhythmics or other drugs that prolong the QT interval and cause electrolyte disturbances because of its adverse cardiovascular effects (ie, QT prolongation, hypotension, tachycardia, and TdP)

Epinephrine (Adrenalin, EpiPen, AsthmaNefrin)

Indications: Cardia arrest, bradycardia, shock, anaphylaxis, severe refractory wheezing (IM), croup/bronchiolitis (nebulized)

Contraindications: Known hypersensitivity, coronary insufficiency, cardiac dilation. Relative contraindications include uncontrolled hypertension, hypothermia, pulmonary edema, myocardial ischemia, hypovolemic shock

Etomidate (Amidate)

Indications: Premedication for medication-facilitated intubation or procedural sedation

Contraindications: Known hypersensitivity, labor/delivery, or septic shock (particularly in children)

Famotidine (Pepcid)

Indications: GI ulcer, suspected upper GI bleeding, GERD, as an adjunct in the treatment of urticaria and/or pruritus in patients experiencing an allergic reaction that does not respond to an H1 blocker alone (eg, diphenhydrAMINE)

Contraindications: Known hypersensitivity to famotidine or other h2 blockers

Fentanyl Citrate (Sublimaze)

Indications: Pain management, anesthesia adjunct, severe respiratory distress (palliative care)

Contraindications: Known hypersensitivity; patients who have taken an MAOI during the previous 14 days. Administer with caution to patients with a Glascow Coma Scale (GCS) score less than 15, hypotension, hypoxia after maximal supplemental oxygen therapy, or signs of hypoventilation

Fibrinolytic Agents

Indications: Acute myocardial infarction (STEMI), Acute Ischemic stroke, acute pulmonary embolism, Deep vein thrombosis, certain cased of loculated pleural effusions

Contraindications: Increased risk of bleeding—Prior intracranial hemorrhage (ICH), known structural cerebral vascular lesion, known malignant neoplasm, ischemic stroke within 3 months, suspected aortic dissection, active bleeding or bleeding diathesis, significant closed head or facial trauma within 3 months

Furosemide (Lasix)

Indications: Heart failure, hypertension

Contraindications: Hypersensitivity to furosemide or sulfonamide medications, hypovolemia, anuria, hepatic coma, suspected electrolyte imbalances

Glucagon (GlucaGen)

Indications: Altered mental status when hypoglycemia is suspected. Antidote for symptomatic bradycardia caused by beta blocker or calcium channel blocker overdoses

Contraindications: Known hypersensitivity, pheochromocytoma, hyperglycemia, insulinoma

Glucose , Oral (Insta-Glucose)

Indications: Conscious patients with suspected hypoglycemia

Contraindications: Known hypersensitivity, decreased level of consciousness, nausea, vomiting

Glycoprotein IIb/IIIa Inhibitors

Indications: GPIs are used as adjunctive therapy during PCI to reduce the risk of stent thrombosis, myocardial infarction, and major adverse cardiac events. ACS (Unstable Angina/STEMI), Adjunctive Therapy

Contraindications: active major bleeding, history of hemorrhagic stroke, severe thrombocytopenia, known hypersensitivity, recent major surgery or trauma

Haloperidol (Haldol)

Indications: Acute psychotic episodes or agitated/violent behavior refractory to nonpharmacologic interventions, anxiety (palliative care)

Contraindications: Documented hypersensitivity, severe CNS depression (including coma), neuroleptic malignant syndrome, poorly controlled seizure disorder, Parkinson disease, agitation secondary to shock and hypoxia

Helium Gas Mixture (Heliox)

Indications: Persistent or severe bronchospasm in non-intubated patients with obstructive airway disease or pediatric patients with croup unresponsive to all other evidence-based medial interventions

Contraindications: None

HydrALAZINE (Apresoline)

Indications: Pregnancy-induced hypertension (SBP greater than 160mm Hg or DBP greater than 110 mm Hg) lasting more than 15 minutes, with associated preeclampsia symptoms

Contraindications: Known hypersensitivity, CAD, mitral valve rheumatic heart disease. Use with caution in patients with stroke, known renal disease, or hypotension

Hydrocortisone Sodium Succinate (Solu-Cortef)

Indications: Shock with history of adrenal insufficiency or long-term steroid dependence; anaphylaxis, asthma, and COPD

Contraindications: Known hypersensitivity, systemic fungal infections, premature infants (contains benzyl alcohol, which is associated with “fatal gasping syndrome”, characterized by CNS depression, metabolic acidosis, and gasping respirations)

HYDROmorphone (Dilaudid)

Indications: Management of acute moderate to severe pain

Contraindications: Known hypersensitivity, MAOI use during the previous 14 days, GI obstruction. Administer with caution in older adults; in patients with a GCS score less than 15; and in patients with hypotension, hypoxia after maximal supplemental oxygen therapy, signs of hypoventilation, head injury, or concomitant use of CNS depressants

Hydroxocobalamin (Cyanokit)

Indications: Known or suspected cyanide poisoning

Contraindications: Documented hypersensitivity

Ibuprofen (Advil, Motrin)

Indications: Acute pain management, antipyretic

Contraindications: Known ASA/NSAID hypersensitivity, ASA-sensitive asthma, significant renal function impairment, pregnancy, known peptic ulcer disease, active intracranial hemorrhage of GI bleeding, thrombocytopenia, coagulation defects, proven or suspected necrotizing enterocolitis, perioperative pain in the settling of coronary artery bypass graft surgery

Insulin

Indications: Diabetic ketoacidosis or other hyperglycemic state, hyperkalemia (insulin and D50 are used together to hyperkalemia), nonketotic hyperosmolar coma

Contraindications: Hypersensitivity, hypoglycemia, hypokalemia

Ipratropium Bromide (Atrovent)

Indications: Persistent bronchospasm, COPD exacerbation, toxic inhalation (in conjunction with albuterol)

Contraindications: Hypersensitivity or ipratropium, atropine, alkaloids, or peanuts. Use with caution in patients with urinary retention, narrow-angle glaucoma, cardiovascular disease, or hypertension

Isopropyl Alcohol

Indications: Nausea and vomiting

Contraindications: None

Ketamine (Ketalar)

Indications: Procedural sedation, management of agitated or violent behavior, pain control

Contraindications: Known hypersensitivity, infants younger than 3 months of age, pregnancy, angina, heart failure, symptomatic hyperthyroidism, known or suspected schizophrenia, conditions where hypertension would be hazardous to the patient’s care. use with caution in any patient with the potential for increased ICP, including those with head trauma, intracranial mass lesions, intracranial bleeding, or hydrocephalus

Ketorolac Tromethamine (Toradol)

Indications: Acute management of moderate to sever pain

Contraindications: NSAID or ASA allergy; ASA-sensitive asthma; renal insufficiency; pregnancy; known peptic ulcer disease, hypotension (due to renal toxicity); women who are in active labor or breastfeeding; significant renal impairment, particularly when associated with volume depletion; previous or current GI bleeding; intracranial bleeding; coagulation defects; patients at high risk of bleeding. Use with caution in older patients due to a higher risk of renal and fatal GI adverse reactions

Levalbuterol (Xopenex)

Indications: Treatment of acute bronchospasm in patients with reversible obstructive airway disease (COPD/asthma). Bronchospasm prophylaxis in patients with asthma

Contraindications: Known hypersensitivity to the drug, other sympathomimetics, or peanuts; MAOI use within 14 days. Angioedema, tachydysrhythmias, and severe cardiac disease. Avoid administration with other drugs that prolong the QT interval (eg, amiodarone, chlorproMAZINE, droperidol, haloperidol, sotalol. macrolides, fluoroquinolones, procainamide, promethazine). Use with caution in patients with cardiac dysrhythmias and cardiovascular disorders

Lidocaine Hydrochloride (Xylocaine)

Indications: Alternative to amiodarone in patients with cardiac arrest from VT, VF; stable monomorphic VT; or stable polymorphic VT with normal baseline QT interval when ischemia is treated and electrolyte balance is corrected. Can be used for stable polymorphic VT with baseline QT interval prolongation if TdP is suspected. Also used as a local anesthetic for various procedures, including intubation and IO infusion

Contraindications: Hypersensitivity to lidocaine or amide-type local anesthetics, second- or third- degree AV block in the absence of an artificial pacemaker. Stokes-Adams syndrome, wide-complex ventricular escape beats with bradycardia, Wolff-Parkinson-White syndrome. Prophylactic use in AMI is contraindicated

Lorazepam (Ativan)

Indications: uncontrolled shivering associated with hyperthermia/heat exposure, active seizures, anxiety/sedation, chemical restraint

Contraindications: Documented hypersensitivity, neurologic or respiratory depression, acute narrow-angle glaucoma, sleep apnea, shock, suspected drug abuse

Magnesium Sulfate

Indications: Management of TdP, severe bronchoconstriction with impending respiratory failure, seizure during the third trimester of pregnancy or in the postpartum patient

Contraindications: Known hypersensitivity, heart block, myocardial damage, diabetic coma, hypermagnesemia, hypercalcemia. Use with caution in patient with known renal insufficiency

Mannitol (Osmitrol)

Indications: Reduction of ICP in managing neurologic emergencies; promotes diuresis for excretion of toxic substances and metabolites

Contraindications: Known hypersensitivity, hypotension, pulmonary edema or severe pulmonary congestion, electrolyte abnormalities, severe dehydration, intracranial bleeding, heart failure. Use with caution in patients with impaired renal function (fluid overload can result)

Meperidine Hydrochloride (Demerol)

Indications: Analgesia for moderate to sever pain

Contraindications: Known hypersensitivity, diarrhea caused by poisoning, patients who have taken an MAOI during the previous 14 days, during labor or delivery of a premature infant. Administer with caution to patients with a GCS score less than 15, hypotension, hypoxia after maximal supplemental oxygen therapy, or signs of hypoventilation. Decrease the dose for patients with hepatic or renal insufficiency

MethylPREDNISolone Sodium Succinate (Solu-Medrol)

Indications: Allergic reaction, anaphylaxis, acute bronchospastic disease management, shock with a history of adrenal insufficiency or long-term steroid dependence

Contraindications: Known hypersensitivity, serious untreated infections, premature infants. use with caution in patients with GI bleeding, heart failure, hypertension, recent AMI, renal disease, seizure disorder, Cushing disease

Metoclopramide (Reglan)

Indications: Nausea, vomiting

Contraindications: Known hypersensitivity to metoclopramide or procainamide; GI hemorrhage, mechanical obstruction, or perforation; history of seizures, tardive dyskinesia, or a dystonic reaction; pheochromocytoma; Parkinson disease; administration with other drugs that can cause extrapyramidal symptoms *eg, phenothiazines, butyrophenones)

Midazolam Hydrochloride (Versed)

Indications: Uncontrolled shivering associated with hyperthermia/heat exposure, active seizures, chemical restraint, severe respiratory distress (palliative care), sedation for medical procedures (eg, intubation, ventilated patients, cardioversion), poisoning/overdose care

Contraindications: Documented hypersensitivity, neurologic or respiratory depression, acute narrow-angle glaucoma, sleep apnea, shock, alcohol intoxication, overdose, depressed vital signs. Concomitant use with barbiturates, alcohol, opioids, or other CNS depressants

Milrinone (Primacor)

Indications: Heart failure in postoperative cardiovascular surgical patients, shock with high systemic vascular resistance

Contraindications: Known hypersensitivity. Reduce the dose in patients with renal dysfunction

Morphine Sulfate (Roxanol, MS Contin)

Indications: Management of acute pain

Contraindications: Known hypersensitivity, patients who have taken an MAOI during the previous 14 days, paralytic ileus, toxin-mediated diarrhea, heart failure due to chronic lung disease, head injuries, brain tumors, delirium tremens, seizure disorders, during labor when premature birth is anticipated, acute of severe bronchial asthma, upper airway obstruction. Administer with caution to patients with a GCS score less than 15, hypotension, hypoxia after maximal supplemental oxygen therapy, or signs of hypoventilation

Naloxone Hydrochloride (Narcan, EVZIO)

Indications: Complete or partial reversal of CNS and respiratory depression induced by opioids or synthetic opiods

Contraindications: Known hypersensitivity or allergy. Use with caution in opioid-dependent patients. Use with caution in neonates of opioid-addicted mothers

NIFEdipine (Procardia, Adalat, Nifedical)

Indications: HAPE prevention and treatment, pregnancy-induced hypertension (SBP greater than 160mm Hg or DBG greater than 100mm Hg) lasting longer than 15 minutes with associated preeclampsia symptoms

Contraindications: Known hypersensitivity to NIFEdipine or other calcium channel blockers; cardiogenic shock; immediate-release preparation (sublingually or orally) for urgent or emergent hypertension

Nitroglycerin (Nitrostat, Nitrolingual Pumpspray, NitroQuick, Nitro-Bid, Tridil)

Indications: Ischemic-type chest pain, acute and symptomatic hypertension, heart failure, pulmonary edema

Contraindications: Known hypersensitivity, hypotension (SBG less than 90 mm Hg or 30 mm Hg below baseline), hypovolemia, intracranial bleeding or head injury, pericardial tamponade, severe bradycardia or tachycardia, TV infarction, previous administration of sildenafil (Viagra) or vardenafil (Levitra) within 24 hours or tadalafil (Cialis) within 48 hours. Use with caution in patients with hepatic disease, anemia, diabetes mellitus, pregnancy, or breastfeeding

Nitroprusside (Nitropress)

Indications: Heart failure, acute and symptomatic hypertension

Contraindications: Known hypersensitivity, hypotension, decreased cerebral perfusion, heart failure with reduced peripheral vascular resistance

Nitrous Oxide 50:50 (Nitronox)

Indications: Analgesia in the patient who is capable of self-administering this medication

Contraindications: Known hypersensitivity, impaired level of consciousness, head injury, inability to follow or comply with instructions, decompression illness (nitrogen narcosis, air embolism), significant respiratory compromise, suspected abnormal air-filled cavities (eg, pneumothorax, bowel obstruction, air embolism), maxillofacial trauma or facial burns (can interfere with self-administration). Relative contraindications include stoke history, hypotension, pregnancy, known cardiac conditions, and known vitamin B12 deficiency.

Norepinephrine Bitartrate (Levophed, Levarterenol0

Indications: First-line vasopressor in neurogenic shock, hypotension unresponsive to IV/IO fluid resuscitation

Contraindications: Known hypersensitivity; hypotension caused by hypovolemia; pregnancy (relative)

Octreotide (Sandostatin)

Indications: Treatment of active GI bleeding during transport

Contraindications: Known hypersensitivity

Olanzapine (Zyprexa)

Indications: Agitated or violent patients experiencing a behavioral emergency; chemical restraint

Contraindications: Documented hypersensitivity. Use of caution in patients who have engaged in strenuous exercise, have dehydration or heat exposure, or are taking medications with anticholinergic effects; impaired core body temperature regulation may occur. Use with caution in patients with a history of seizures or urinary retention

Ondansetron Hydrochloride (Zofran, Zofran ODT, Zuplenz)

Indications: Prevention and control of nausea or vomiting

Contraindications: Known hypersensitivity to ondansetron or other 5-HT3 receptor antagonists, known or suspected long QT-syndrome, coadministration with apomorphine (the combination is reported to cause profound hypotension and loss of consciousness)

Oral Antidiabetic (Hypoglycemic) Drugs

Indications: Patients with type 2 diabetes when diet and exercise alone are insufficient to control blood glucose levels

Contraindications: type 1 diabetes, diabetic ketoacidosis, and certain conditions like severe renal or hepatic impairment

Oxygen

Indications: Any suspected cardiopulmonary emergency (eg. shock, sepsis, major trauma, respiratory arrest, cardiac arrest and postresuscitation, anaphylaxis, carbon monoxide and cyanide poisonings), complaints of shortness of breath and ischemic chest discomfort, all other causes of decreased tissue oxygenation

Contraindications: Observe closely when using with patients who have pulmonary conditions that are known to be dependent on hypoxic respiratory drive (very rare)

Oxymetazoline (Afrin, Dristan 12-Hour, Vicks Sinus-12 Hour)

Indications: Epistaxis in a patient experiencing facial trauma

Contraindications: Known hypersensitivity, severe hypertension

Oxytocin (Pitocin)

Indications: Postpartum hemorrhage due to uterine atony after infant and placental delivery

Contraindications: Known hypersensitivity, presence of a remaining fetus, unfavorable fetal position, anticipated nonvaginal delivery, fetal distress when delivery is not imminent, prolonged use in severe toxemia

Pancuronium Bromide (Pavulon)

Indications: Adjunct to provide skeletal muscle relaxation and facilitate tracheal intubation and ventilation

Contraindications: Known hypersensitivity to pancuronium or a bromide hypersensitivity, inability to control the airway and/or support ventilation with oxygen and positive pressure, neuromuscular disease (eg. myasthenia gravis), hepatic or renal failure. Use with extreme caution in patients with pulmonary disease, such as COPD.

Phenylephrine (Neo-Synephrine)

Indications: Epistaxis; to reduce bleeding during nasotracheal intubation

Contraindications: Known hypersensitivity. Use with extreme caution in geriatric patients with preexisting cardiovascular disease

Phenytoin (Dilantin)

Indications: Prophylaxis and treatment of major motor seizures

Contraindications: Known hypersensitivity, pregnancy, breastfeeding, sinus bradycardia, second- and third- degree heart block, Stokes- Adams syndrome. Should be used with caution in any patient with cardiac disease (eg. Cardiac dysrhythmias, heart failure, CAD) because symptoms may be potentiated or exacerbated

Potassium Iodide (Pima Syrup, SSKI, ThyroSafe, ThyroShield)

Indications: Environmental radiation emergency to block uptake of radioactive iodine isotopes in the thyroid and reduce thyroid cancer risk

Contraindications: Known iodine hypersensitivity (although an allergy to radiocontrast media, contact dermatitis from iodine-containing antibacterial agents, or allergy to seafood should not be considered evidence of KI allergy), hyperthyroidism, respiratory failure

Pralidoxime (2-PAM, Protopam)

Indications: Antidote in treating poisoning by organophosphate pesticides and related nerve gases (eg. tabun, sarin, soman)

Contraindications: Known hypersensitivity; reduce the dose in patients with impaired renal function, older adults with hypertension, and patients with myasthenia gravis

PredniSONE (Rayos)

Indications: Asthma, COPD

Contraindications: Known hypersensitivity, systemic fungal infections

Procainamide hydrochloride (Pronestyl)

Indications: Stable monomorphic VT with normal QT interval, reentry SVT uncontrolled by vagal maneuvers and adenosine if BP is stable, stable wide-complex tachycardia of unknown origin, AF with a rapid ventricular rate in patients with Wolff-Parkinson-White syndrome

Contraindications: Known hypersensitivity to procainamide or other ingredients, TdP, second- and third- degree AV block (without functioning artificial pacemaker), systemic lupus erythematosus, preexisting QT prolongation, digitalis toxicity, TCA overdose. Administer with caution to patients with asthma or digitalis-induced dysrhythmias, myasthenia gravis, or cardiac, hepatic, or renal insufficiency

Prochlorperazine (Compazine)

Indications: Nausea and vomiting

Contraindications: Documented hypersensitivity to phenothiazines, concurrent use of large amounts of CNS depressants leading to sedation, concomitant use of anticholinergic medications, preexisting cardiac conduction abnormalities, poorly controlled seizure disorder, narrow-angle glaucoma, prostatic hypertrophy, past or current history of tardive dyskinesia, subcortical brain damage, pediatric surgery, children younger than 2 years of age

Promethazine Hydrochloride (Phenergan)

Indications: Nausea and vomiting

Contraindications: Known hypersensitivity to promethazine or other phenothiazines, concurrent use of large amounts of CNS depressants, Reye syndrome, lower respiratory symptoms (eg. asthma), children younger than 2 years (risk of developing potentially fatal respiratory depression). Use with caution, if at all, in patients with a history of sleep apnea, acute or chronic respiratory impairment, or seizure disorders

Proparacaine Ophthalmic (Alcaine, Ophthaine)

Indications: Induction of topical anesthesia before eye irrigation in the management of a chemical injury to the eye

Contraindications: Known hypersensitivity, known or suspected trauma that may have resulted in intraocular injury. Use with caution in patients with cardiac disease or hyperthyroidism

Propofol (Diprivan)

Indications: Maintenance of sedation in mechanically ventilated patients

Contraindications: Hypovolemia; known sensitivities, including to soybean oil, peanuts, and eggs

Rocuronium Bromide (Zemuron)

Indications: Adjunct to provide skeletal muscle relaxation and facilitate tracheal intubation and ventilation

Contraindications: Known hypersensitivity to rocuronium or a bromide hypersensitivity, inability to control the airway or support ventilation with oxygen and positive pressure, neuromuscular disease (eg. myasthenia gravis). Use with caution in patients with heart and liver disease

Sildenafil (Revatio, Viagra)

Indications: HAPE prevention

Contraindications: Known hypersensitivity, coadministration with nitrates, significant cardiovascular disease

Sodium Bicarbonate

Indications: Management of cardiac arrest in which either hyperkalemia or TCA overdose is suspected, QRS prolongation in known or suspected TCA overdose, crush syndrome

Contraindications:Documented hypersensitivity, known metabolic or respiratory alkalosis, hypokalemia, hypernatremia, hypocalcemia. Use with caution in patients with heart failure and renal disease due to high sodium concentration it produces

Sodium Thiosulfate (Nithiodote)

Indications: Known or suspected cyanide poisoning

Contraindications: Documented hypersensitivity

Succinylcholine Chloride (Anectine)

Indications: Adjunct to provide skeletal muscle relaxation and facilitate tracheal intubation and ventilation

Contraindications: Known hypersensitivity, inability to control the airway or support ventilation with oxygen and positive pressure, renal failure, muscular dystrophy and other neuromuscular diseases, paraplegia/quadriplegia, penetrating eye injuries (increases intraocular pressure), prolonged immobilization, stroke with residual motor dysfunction, history of malignant hyperthermia. Acute injury after multisystem trauma, major burns, known or suspected hyperkalemia, or extensive muscle injury that may result in hyperkalemia. Use with caution if a difficult airway is anticipated

Tadalafil (Cialis, Adcirca)

Indications: HAPE prevention

Contraindications: Known hypersensitivity, coadministration with nitrates, Stevens-johnson syndrome, exfoliative dermatitis

Tetracaine Ophthalmic Solution (Pontocaine)

Indications: Induction of topical anesthesia before eye irrigation in the management of a chemical injury to the eye

Contraindications: Known hypersensitivity, known or suspected trauma that may have resulted in intraocular injury

Thiamine Hydrochloride (Vitamin B1)

Indications: Adjunctive therapy that should precede the administration of dextrose 50% or glucagon in an adult patient if alcoholism or malnourishment is suspected

Contraindications: Known hypersensitivity

Tranexamic Acid (Cyklokapron, Lysteda)

Indications: Blunt or penetrating trauma less than 3 hours from onset with hemodynamic compromise, bleeding

Contraindications: Known hypersensitivity; mechanism of injury more than 3 hours prior to EMS care; subarachnoid hemorrhage; history of PE, DVT, or other thromboembolic disorder. Reduce the dose in patients with renal insufficiency

Vecuronium Bromide (Norcuron)

Indications: Adjunct to provide skeletal muscle relaxation and facilitate tracheal intubation and ventilation

Contraindications: Known hypersensitivity to vecuronium or a bromide hypersensitivity, inability to control the airway or support ventilation with oxygen and positive pressure, neuromuscular disease (eg. myasthenia gravis), acute narrow-angle glaucoma, penetrating eye injuries, newborns, hepatic or renal failure

Verapamil Hydrochloride (Isoptin, Calan)

Indications: Stable narrow-QRS tachycardia if the rhythm persists despite vagal maneuvers or adenosine or if the tachycardia is recurrent; to control the ventricular rate in patients with AF or atrial flutter without preexcitation

Contraindications: Known hypersensitivity; Wolff-Parkinson-White syndrome, Lown-Ganong-Levine syndrome; second- or third-degree AV block, sick sinus syndrome, or other sinus node disease unless a functioning artificial pacemaker is present; hypotension, cardiogenic shock, severe left ventricular dysfunction, wide-complex tachycardias; children younger than age 12 months. Use with extreme caution in patients receiving oral beta blockers

Ziprasidone (Geodon)

Indications: For the management of agitated or violent patients experiencing a behavioral emergency, anxiety (palliative care)

Contraindications: Known hypersensitivity, history of QT prolongation, use of any drugs that prolong the QT interval, recent AMI, uncompensated heart failure. Use with caution in patients with impaired renal function

Albumin (Albumarc, Albutein, Flexbumin)

Indications: Hypovolemia

Contraindications: Hypersensitivity, patients at risk of hypervolemia. Use with caution in patients with renal insufficiency or anemia

Bacteriostatic Water

Indications: Used for diluting or dissolving drugs for IV, IM, or subcutaneous injections based on the drug manufacturer’s recommendations

Contraindications: Hypersensitivity to benzyl alcohol due to use as a preservative

Dextran

Indications: Hypovolemic shock

Contraindications: Known hypersensitivity to the drug; heart failure, renal failure, or known bleeding disorders

Hetastarch (Hespan)

Indications: Hypovolemic shock, especially burn shock; septic shock

Contraindications: No significant contraindications when used in the management of life-threatening hypovolemic states

Lactated Ringers (Hartmann) Solution

Indications: Hypovolemic shock; keep open IV, hypoperfusion

Contraindications: Heart failure or renal failure. Avoid use in patients with crush injuries/compartment syndrome because lactated Ringer solution contains potassium