PCP medication

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Last updated 2:54 AM on 9/8/26
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22 Terms

1
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Acetaminophen (PCP Directive)

  1. Indications: Pain.

  2. Clinical Parameters: Age ≥12 years; unaltered LOA.

  3. Contraindications: Acetaminophen within previous 4 hours; allergy/sensitivity; active vomiting; history of liver disease; suspected ischemic chest pain; unable to tolerate PO medication.

  4. Medication / Procedure: Acetaminophen PO.

  5. Dosing: ≥18 yr: 960–1000 mg PO, max 1000 mg, 1 dose. Age 12 to <18 yr: 500–650 mg PO, max 650 mg, 1 dose. <12 yr: not indicated under this directive.

  6. Patch Requirements: No routine patch requirement listed.

  7. Clinical Notes / Decision Tips: Think pain + age ≥12 + awake enough for PO. Do not use for suspected ischemic chest pain.


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Ibuprofen (PCP Directive)

  1. Indications: Pain.

  2. Clinical Parameters: Age ≥12 years; unaltered LOA.

  3. Contraindications: NSAID use within previous 6 hours; allergy/sensitivity to ASA or NSAIDs; current active bleeding; anticoagulation therapy; history of peptic ulcer disease or GI bleed; asthmatic with no prior ASA/NSAID use; active vomiting; known renal impairment; CVA or TBI in previous 24 hours; unable to tolerate PO; suspected ischemic chest pain; pregnancy.

  4. Medication / Procedure: Ibuprofen PO.

  5. Dosing: ≥12 yr: 400 mg PO; max single dose 400 mg; 1 dose.

  6. Patch Requirements: No routine patch requirement listed.

  7. Clinical Notes / Decision Tips: NSAID. Check bleeding, kidney, GI, anticoagulant, asthma, and pregnancy history before giving.


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Ketorolac (PCP Directive)

  1. Indications: Pain.

  2. Clinical Parameters: Age ≥12 years; unaltered LOA.

  3. Contraindications: NSAID use within previous 6 hours; allergy/sensitivity to ASA or NSAIDs; current active bleeding; anticoagulation therapy; history of peptic ulcer disease or GI bleed; asthmatic with no prior ASA/NSAID use; active vomiting; known renal impairment; CVA or TBI in previous 24 hours; unable to tolerate PO; suspected ischemic chest pain; pregnancy.

  4. Medication / Procedure: Ketorolac IM/IV.

  5. Dosing: ≥12 yr: 10–15 mg IM/IV; max single dose 15 mg; 1 dose.

  6. Patch Requirements: No routine patch requirement listed.

  7. Clinical Notes / Decision Tips: Same major NSAID cautions as ibuprofen; route is IM/IV.


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ASA (PCP Directive)

  1. Indications: Suspected cardiac ischemia.

  2. Clinical Parameters: Age ≥18 years; unaltered LOA; able to chew and swallow.

  3. Contraindications: No prior ASA use if asthmatic; allergy to ASA or NSAIDs; current active bleeding; CVA or TBI in past 24 hours.

  4. Medication / Procedure: ASA PO, chewed.

  5. Dosing: Adult ≥18: 160–162 mg PO, 1 dose. Pediatric: not indicated.

  6. Patch Requirements: No routine patch requirement listed.

  7. Clinical Notes / Decision Tips: ASA is the antiplatelet medication for suspected cardiac ischemia. STEMI is not required.


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Nitroglycerin – Cardiac Ischemia (PCP Directive)

  1. Indications: Suspected cardiac ischemia.

  2. Clinical Parameters: Prior nitroglycerin use and/or IV established; HR 60–159 bpm; SBP ≥100 mmHg; stop if SBP drops >1/3 from initial; no PDE inhibitor use in past 48 hours; no right ventricular MI.

  3. Contraindications: SBP <100; HR <60 or ≥160; PDE inhibitor in past 48 hours; right ventricular MI; SBP drop >1/3 from initial; allergy/sensitivity.

  4. Medication / Procedure: Nitroglycerin SL.

  5. Dosing: Non-STEMI: 0.4 mg SL q5 min, max 6 doses. STEMI: 0.4 mg SL q5 min, max 3 doses. Pediatric: not indicated.

  6. Patch Requirements: No routine patch requirement listed when directive conditions are met.

  7. Clinical Notes / Decision Tips: Inferior STEMI? Check right-sided lead V4R before nitro.


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Nitroglycerin – Acute Cardiogenic Pulmonary Edema (PCP Directive)

  1. Indications: Moderate to severe respiratory distress AND suspected acute cardiogenic pulmonary edema.

  2. Clinical Parameters: HR 60–159 bpm; SBP ≥100 mmHg; no PDE inhibitor use in past 48 hours; if SBP <140, patient must have prior nitro use or an IV; SBP must not drop >1/3 from initial.

  3. Contraindications: SBP <100; HR outside 60–159; PDE inhibitor in past 48 hours; allergy/sensitivity; BP drop >1/3.

  4. Medication / Procedure: Nitroglycerin SL.

  5. Dosing: SBP 100–139 WITH IV/history: 0.4 mg q5 min. SBP ≥140 with NO history/IV: 0.4 mg q5 min. SBP ≥140 WITH history/IV: 0.8 mg q5 min. Max 6 doses.

  6. Patch Requirements: No routine patch requirement listed.

  7. Clinical Notes / Decision Tips: Reassess BP after every dose. If STEMI is identified, follow the cardiac ischemia nitro limits.


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Salbutamol (PCP Directive)

  1. Indications: Respiratory distress AND suspected bronchoconstriction.

  2. Clinical Parameters: No allergy/sensitivity to medication.

  3. Contraindications: Allergy/sensitivity.

  4. Medication / Procedure: Salbutamol MDI or NEB.

  5. Dosing: <25 kg MDI 600 mcg; <25 kg NEB 2.5 mg; ≥25 kg MDI 800 mcg; ≥25 kg NEB 5 mg. Repeat q5–15 min; max 3 doses.

  6. Patch Requirements: No routine patch requirement listed.

  7. Clinical Notes / Decision Tips: Bronchodilator. Reassess work of breathing, air entry, SpO2, and response between doses.


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Dexamethasone – Bronchoconstriction (PCP Directive)

  1. Indications: Respiratory distress AND suspected bronchoconstriction.

  2. Clinical Parameters: Not currently on PO or parenteral steroids; history of asthma OR COPD OR 20 pack-year smoking history.

  3. Contraindications: Allergy/sensitivity; currently on PO/parenteral steroids.

  4. Medication / Procedure: Dexamethasone PO/IM/IV; PO preferred, IM/IV for patients who cannot tolerate PO.

  5. Dosing: 0.5 mg/kg; max 8 mg; 1 dose.

  6. Patch Requirements: No routine patch requirement listed.

  7. Clinical Notes / Decision Tips: Steroid for inflammation; not the immediate rescue medication.


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Epinephrine – Severe Bronchoconstriction (PCP Directive)

  1. Indications: Respiratory distress AND suspected bronchoconstriction when BVM ventilation is required.

  2. Clinical Parameters: Must have a history of asthma; BVM ventilation required.

  3. Contraindications: Allergy/sensitivity.

  4. Medication / Procedure: Epinephrine 1:1000 (1 mg/mL) IM.

  5. Dosing: 0.01 mg/kg IM; max 0.5 mg; 1 dose; may round to nearest 0.05 mg.

  6. Patch Requirements: No routine patch requirement listed.

  7. Clinical Notes / Decision Tips: This is for a very sick asthma patient requiring BVM, not routine asthma.


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Epinephrine – Anaphylaxis (PCP Directive)

  1. Indications: Exposure to a probable allergen AND signs/symptoms of a moderate to severe allergic reaction, including anaphylaxis.

  2. Clinical Parameters: No allergy/sensitivity to medication; consider epinephrine for anaphylaxis.

  3. Contraindications: Allergy/sensitivity listed in the directive.

  4. Medication / Procedure: Epinephrine 1:1000 (1 mg/mL) IM ONLY.

  5. Dosing: Adult and pediatric: 0.01 mg/kg IM; max 0.5 mg; repeat no sooner than 5 min; max 2 doses.

  6. Patch Requirements: No routine patch requirement listed.

  7. Clinical Notes / Decision Tips: Epinephrine is the priority medication in anaphylaxis. Diphenhydramine is adjunctive.


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Diphenhydramine (PCP Directive)

  1. Indications: Exposure to a probable allergen AND signs/symptoms of a moderate to severe allergic reaction.

  2. Clinical Parameters: Weight ≥25 kg.

  3. Contraindications: Allergy/sensitivity; weight <25 kg.

  4. Medication / Procedure: Diphenhydramine IV/IM.

  5. Dosing: 25–49 kg: 25 mg IV/IM, 1 dose. ≥50 kg: 50 mg IV/IM, 1 dose.

  6. Patch Requirements: No routine patch requirement listed.

  7. Clinical Notes / Decision Tips: Adjunct in allergic reactions. Do not co-administer with dimenhydrinate.


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Epinephrine – Croup (PCP Directive)

  1. Indications: Current URI AND barking cough/recent barking cough; epinephrine requires stridor at rest.

  2. Clinical Parameters: Age ≥6 months to <8 years; stridor at rest; HR <200 bpm.

  3. Contraindications: Allergy/sensitivity to epinephrine; HR ≥200; outside age range.

  4. Medication / Procedure: Epinephrine 1:1000 (1 mg/mL) NEB.

  5. Dosing: <10 kg: 2.5 mg (2.5 mL) NEB, 1 dose. ≥10 kg: 5 mg (5 mL) NEB, 1 dose.

  6. Patch Requirements: No routine patch requirement listed.

  7. Clinical Notes / Decision Tips: Epinephrine is for croup with stridor at rest.


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Dexamethasone – Croup (PCP Directive)

  1. Indications: Current URI AND barking cough/recent barking cough; may be used in mild, moderate, or severe croup.

  2. Clinical Parameters: Age ≥6 months to <8 years; unaltered LOA; able to tolerate oral medication; no steroids in last 48 hours.

  3. Contraindications: Allergy/sensitivity; steroids within 48 hours; altered LOA; unable to tolerate PO.

  4. Medication / Procedure: Dexamethasone PO.

  5. Dosing: 0.5 mg/kg PO; max 8 mg; 1 dose.

  6. Patch Requirements: No routine patch requirement listed.

  7. Clinical Notes / Decision Tips: Can be used even when nebulized epinephrine is not indicated.


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Dextrose (PCP Directive)

  1. Indications: Suspected hypoglycemia with altered LOA.

  2. Clinical Parameters: ≥2 yr: BGL <4.0 mmol/L. <2 yr: BGL <3.0 mmol/L.

  3. Contraindications: Allergy/sensitivity to dextrose.

  4. Medication / Procedure: D10W IV or D50W IV.

  5. Dosing: Age ≥2 yr. D10W: 0.2 g/kg (2 mL/kg), max 25 g/250 mL, repeat q10 min, max 2 doses. D50W: 0.5 g/kg (1 mL/kg), max 25 g/50 mL, repeat q10 min, max 2 doses.

  6. Patch Requirements: No routine medication patch listed; treat-and-discharge has separate authorization/criteria.

  7. Clinical Notes / Decision Tips: Titrate to a level of awareness where the patient can safely consume complex carbohydrates. Two dextrose doses means transport rather than treat-and-discharge.


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Glucagon (PCP Directive)

  1. Indications: Suspected hypoglycemia with altered LOA.

  2. Clinical Parameters: Hypoglycemia threshold: ≥2 yr <4.0 mmol/L; <2 yr <3.0 mmol/L. IN glucagon requires age ≥4 years.

  3. Contraindications: Pheochromocytoma; allergy/sensitivity to glucagon.

  4. Medication / Procedure: Glucagon IM or IN.

  5. Dosing: IM <25 kg: 0.5 mg q20 min, max 2 doses. IM ≥25 kg: 1 mg q20 min, max 2 doses. IN: 3 mg q20 min, max 2 doses.

  6. Patch Requirements: No routine treatment patch listed; treat-and-discharge requires authorization and BHP consultation if criteria are unclear.

  7. Clinical Notes / Decision Tips: Once awake enough, give complex carbohydrates when safe. Two doses means transport.


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Naloxone (PCP Directive)

  1. Indications: Altered LOC AND respiratory depression AND inability to adequately ventilate OR persistent need to ventilate AND suspected opioid overdose.

  2. Clinical Parameters: RR <10 breaths/min; altered LOA; age ≥24 hours.

  3. Contraindications: Allergy/sensitivity.

  4. Medication / Procedure: Naloxone IV/IM/SC/IN.

  5. Dosing: IV up to 0.4 mg q5 min, max 3 doses. IM 0.4 mg q5 min, max 3. SC 0.8 mg q5 min, max 3. IN 2–4 mg q5 min, max 3.

  6. Patch Requirements: No routine patch requirement listed.

  7. Clinical Notes / Decision Tips: Ventilation comes first. Goal is adequate ventilation, not necessarily full wakefulness.


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Ondansetron (PCP Directive)

  1. Indications: Nausea and/or vomiting.

  2. Clinical Parameters: Unaltered LOA.

  3. Contraindications: Allergy/sensitivity to ondansetron; known prolonged QT syndrome; apomorphine (Apokyn) use.

  4. Medication / Procedure: Ondansetron PO/IV/IM.

  5. Dosing: ≥25 kg: 4 mg PO/IV/IM; 1 dose.

  6. Patch Requirements: No routine patch requirement listed.

  7. Clinical Notes / Decision Tips: If symptoms persist after 30 minutes, the alternate antiemetic may be considered when appropriate.


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Dimenhydrinate (PCP Directive)

  1. Indications: Nausea and/or vomiting.

  2. Clinical Parameters: Unaltered LOA.

  3. Contraindications: Allergy/sensitivity to dimenhydrinate or other antihistamines; overdose on antihistamines, anticholinergics, or TCAs; cannot be co-administered with diphenhydramine.

  4. Medication / Procedure: Dimenhydrinate IV/IM.

  5. Dosing: 25–49 kg: 25 mg, max 1 dose. ≥50 kg: 25 or 50 mg; max cumulative 50 mg; max 2 doses.

  6. Patch Requirements: No routine patch requirement listed.

  7. Clinical Notes / Decision Tips: In patients ≥65, if ondansetron is unavailable, consider risks/benefits and a reduced 25 mg initial dose. IV 50 mg/mL should be diluted 1:9 with NS or D5W; IM is not diluted.


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Hydrocortisone (PCP Directive)

  1. Indications: Primary adrenal failure with signs of adrenal crisis.

  2. Clinical Parameters: Paramedics are presented with a vial of hydrocortisone for the identified patient; no allergy/sensitivity; plus any of: age-related hypoglycemia, GI symptoms, syncope, temperature ≥38°C or suspected/history of fever, altered LOA, age-related hypotension, or age-related tachycardia.

  3. Contraindications: Allergy/sensitivity; appropriate patient-specific medication not available.

  4. Medication / Procedure: Hydrocortisone IM/IV.

  5. Dosing: 2 mg/kg; max 100 mg; may round to nearest 10 mg; 1 dose.

  6. Patch Requirements: No routine patch requirement listed.

  7. Clinical Notes / Decision Tips: Key clue is known adrenal insufficiency + their medication is available + signs of crisis.


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Oxytocin (PCP Directive)

  1. Indications: Postpartum patient following delivery.

  2. Clinical Parameters: Postpartum delivery; all fetuses delivered; SBP <160 mmHg; no suspected/known preeclampsia; no eclamptic seizures in current pregnancy; ≤4 hours after placental delivery.

  3. Contraindications: Allergy/sensitivity; fetus/fetuses not all delivered; SBP ≥160; suspected/known preeclampsia; eclamptic seizures in current pregnancy.

  4. Medication / Procedure: Oxytocin IM.

  5. Dosing: Adult: 10 units IM; 1 dose. No pediatric dose.

  6. Patch Requirements: No routine patch requirement listed.

  7. Clinical Notes / Decision Tips: Placenta may be in or out. Continue appropriate postpartum hemorrhage management.


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0.9% Sodium Chloride (PCP Directive)

  1. Indications: Actual or potential need for IV medication OR fluid therapy.

  2. Clinical Parameters: Cannulation age ≥2 years and no fracture proximal to access site. Bolus: adult SBP <90; pediatric SBP <70 + (2 × age in years); chest clear; no fluid overload/ACPE.

  3. Contraindications: For bolus, signs of fluid overload/ACPE or not meeting hypotension criteria.

  4. Medication / Procedure: 0.9% NaCl IV, TKVO or bolus.

  5. Dosing: ≥12 yr: TKVO 30–60 mL/hr; bolus 20 mL/kg, reassess every 250 mL, max 2000 mL. Age 2 to <12: TKVO 15 mL/hr; bolus 20 mL/kg, reassess every 100 mL, max 2000 mL.

  6. Patch Requirements: Mandatory BHP patch for 0.9% NaCl bolus to hypotensive patients age ≥2 to <12 with suspected DKA.

  7. Clinical Notes / Decision Tips: Reassess lungs and BP frequently; stop if fluid overload develops.


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Tranexamic Acid (TXA) – Auxiliary (PCP Directive)

  1. Indications: Suspected external or internal hemorrhage due to trauma AND hemodynamic instability.

  2. Clinical Parameters: Age ≥16 years; HR ≥110 bpm OR hypotensive.

  3. Contraindications: Known hypersensitivity to TXA; >3 hours from injury; unknown time of injury; isolated head injury.

  4. Medication / Procedure: Tranexamic acid IV/IM under auxiliary directive.

  5. Dosing: ≥16 yr: 1000 mg IV/IM; IV over 5 minutes; max 1000 mg; 1 dose.

  6. Patch Requirements: Auxiliary directive must be authorized; no additional medication-specific patch listed in the pocketbook section.

  7. Clinical Notes / Decision Tips: Think trauma + major bleeding + instability + within 3 hours.