Paramedic Medication (Know this)

Medication Study Guide Summary

Acetaminophen

  • Class: Antipyretic, Non-opioid Analgesic

  • Indications: Mild to moderate pain, fever in patients >3 months with temp > 100.4°F

  • Mechanism: Inhibits prostaglandin E2, elevates pain threshold, readjusts hypothalamus regulatory center

  • Dose: Pediatric 15mg/kg; Adult 15mg/kg (max 1000mg) 650 PO/ 1000mg (max 650mg <65kg)

  • Side Effects: Nausea, vomiting, constipation, SJS

  • Contraindications: Hypersensitivity, liver disease, last dose <4 hours

  • Associated Protocols: 1000, 6003, 7003, 7007

Activated Charcoal

  • Class: Absorbent, Antidote

  • Indications: Most oral poisonings in alert patients

  • Mechanism: Absorbs toxins from GI tract

  • Dose: Adults 25-50g orally or NG tube; Peds 1g/kg orally (12.5 - 25g)

  • Side Effects: Nausea, vomiting, intestinal obstruction

  • Contraindications: Known Hypersensitivity. Patient with altered mental status without a protected Airway, Seizures

  • Associated Protocols: 8031

Adenosine

  • Class: Antiarrhythmic

  • Indications: Regular SVT refractory to vagal maneuvers

  • Mechanism: Slows conduction through AV node, interrupts re-entrant pathways

  • Dose: Adult 6mg rapidly IV over 1-3 seconds; may repeat 12mg one more time after 2min. 3rd dose of 12mg needs med command; Peds: 0.1mg/kg after 2 minutes: 0.2mg/kg (max 12mg)

  • Side Effects: Asystole, bronchospasm, hypotension, nausea, bronchospasm

  • Contraindications: sick sinus syndrome, second degree or third degree heart block, hypersensitivity,

    poison-drug induced tachycardia, asthma, or bronchospasm; V tach

  • Associated Protocols: 5022A & P, 5023A & P

Albuterol

  • Class: Bronchodilator

  • Indications: Bronchospasm due to COPD, asthma

  • Mechanism: Selective B2 agonist; relaxation of bronchial smooth muscle

  • Dose: >20kg: 2.5-5mg nebulized (if mixed with Ipratroium bromide); < 1 year old or <20kg: 1.25mg in 1.5mL NS @ 3lpm

  • Side Effects: Tachydysrhythmias, anxiety, nausea and vomiting

  • Contraindications: Angioedema, sensitivity to albuterol, or levalbuterol. Use with caution in lactating

    patients, cardiovascular disorders, cardiac arrhythmias. Hypersensitivity.

  • Associated Protocols: BLS 421, 3000A/P, 4011, 4022, 4023P, 6004

Amiodarone

  • Class: Antiarrhythmic

  • Indications: Cardiac arrest (V-fib/V-tach)

  • Mechanism: Prolongs action potential duration

  • Dose: 300mg IV for VF/VT (Pulseless) repeat 150mg in 10 min; Stable irregular narrow complex tachycardia or stable VT/ Wide complex w/ a pulse: 150mg in 50-100mL NS over 20 minutes; Recurrent VT or Runs of VT post ROSC: 1mg/min infusion (max 2.2 gm in 24 hours); PEDS: VT (pulsed) and SVT: 5mg/kg in 50mL NS 20-60 min

  • Side Effects: Vasodilation, low BP/HR, Torsades, CHF, AV block, Hepatoxicity

  • Contraindications: Known hypersensitivity, Iodine hypersensitivity, Bradycardia, AV block >1

    degree in the absence of a pacemaker, Hypotension

  • Associated Protocols: 3031A/P, 3080, 5022P, 5023A & P

Associated Protocols: (Cefazolin)

  • Class: Cephalosporin antibiotic

  • Indications: Open fractures, amputations

  • Mechanism: Inhibits bacterial cell walls, rendering them unstable leading to cell death

  • Dose: 2g IV for adults >50kg; PEDS ages 9- <14 years old (30-50kg) 1g IV/IO

  • Side Effects: Nausea, vomiting, Diarrhea, Headaches

  • Contraindications: Hypersensitivity, Allergic to Cephalosporins or Penicillin

  • Associated protocols: 6093

Aspirin

  • Class: Antiplatelet/NSAID

  • Indications: Chest pain, acute MI, mild to moderate pain in adults

  • Mechanism: Blocks thromboxane A2 formation, limiting platelet aggregation and arterial constriction; also decreases levels of PGE2, decreasing pain and inflammation

  • Dose: 324mg (4 pills) PO, 650mg PO (>14 years)

  • Side Effects: GI bleeding

  • Contraindications: Gastrointestinal (GI) bleeding, active ulcer disease, hemorrhagic stroke, bleeding disorders, children with chickenpox or flu-like symptoms, known hypersensitivity.

  • Associated Protocols: 5001, 6003, 7003

Atropine Sulfate

  • Class: Antiarrhythmic, antimuscarinic, Parasympatholytic; Antivagolytic

  • Indications: Hemodynamically significant Bradycardia, organophosphate poisoning

  • Mechanism: Competes with acetylcholine at muscarinic receptors

  • Dose: Adult: Symptomatic Bradycardia: 1 mg IVP every 3-5minutes up to 3mg total dose; organophosphate poisoning: 2-6mg IV every 15-30 minutes, until vitals improve; PEDS; Symptomatic Bradycardia (with increased vagal tone)- 0.02 mg/kg (minimum 0.1mg; max dose

0.5mg) repeat to a total of 1mg (May be given endotracheally (Not preferred) dose is 0.03mg/kg with 5ml NSS)

  • Side Effects: Dilated pupils, dry mouth, increased HR, VT; VF, Headache, Dry mouth

  • Contraindications: AMI, myasthenia gravis, GI obstruction; closed-angle glaucoma; known sensitivity to atropine, belladonna alkaloids, or sulfites, Will not be effective for intranodal (type II) AV block and new third- degree block with wide QRS complex; Tachycardia

  • Associated Protocols: 5021A & P, 8083

Calcium Chloride

  • Class: Electrolyte

  • Indications: Hyperkalemia, beta blocker overdose situations, Hypermagnesium, Hypocalcemia with tetany, Calcium channel blocker toxicity, Crush syndrome

  • Mechanism: Increases cardiac contractility by initiating myofibril shortening.

  • Dose: Adult; 1g or 10mL IV/IO (100mg/mL) may repeat as necessary; 0.2mg/kg IV/IO over 5-10 min; PEDS; 0.2 mL/kg IV/IO. repeat as necessary

  • Side Effects: Low HR, low BP, Asystole, Vfib, coronary and cerebral artery spasm, Extravasation causes necrosis

  • Contraindication: digitalis toxicity, hypercalcemia

  • Associated Protocols: 3031A/P, 5021, 5023, 6004, 8031

Captopril

  • Class: ACE inhibitor, Antihypertension

  • Indications: Acute Pulmonary Edema, CHF

  • Mechanism: Blocks angiotensin I conversion to angiotensin II, decreasing systemic vascular resistance preload and afterload

  • Dose: 25mg SL

  • Contraindication: Known hypersensitivity or allergy to ACE inhibitors

  • Side Effects: Hypotension, rash

  • Associated Protocols: 5002

Dexamethasone Sodium Phosphate

  • Class: Corticosteroid

  • Indications: Anaphylaxis, asthma exacerbation

  • Mechanism: Inhibits inflammatory responses

  • Dose: acute mountain sickness - 4mg IM/IV, 8mg for HACE IM/IV/PO max dose 16mg, Asthma 0.6 mg/kg IM, IV or IO every 24hrs (Max dose 16mg)

  • Contraindications: Documented hypersensitivity, systemic fungal infection, preterm infants

  • Side Effects: Headache, hyperglycemia, Nervousness, Sodium and water retention, nausea / vomiting

  • Contraindications: Documented hypersensitivity, systemic fungal infection, preterm infants

  • Associated Protocols: 4011

Dextrose

  • Class: Nutrient

  • Indications: Hypoglycemia, coma of unknown origin

  • Mechanism: Increases blood glucose level

  • Dose: 25g of 10% Dextrose IV (250mL) / PEDS- 10% dextrose: 5mL/kg; 25% dextrose 2mL/kg, 12.5% dextrose 4mL/kg

  • Side Effects: Tissue necrosis with extravasation

  • Contraindications: Intracranial and intraspinal hemorrhage, delirium tremens, solution is not clear, seals are no intact, known or suspected stroke in the absence of hypoglycemia

  • Associated Protocols: 3080, 6081, 7002, 7006, 7007

Diazepam (Valium)

  • Class: Benzodiazepine

  • Indications: Major seizures, anxiety

  • Mechanism: Enhances GABA effect

  • Dose: SEIZURES 0.2mg/kg (max 10mg) IV/IO may repeat every 5 min until max of 0.6mg/kg - PEDS 0.3mg/kg IV/IM/IO max 5mg (0.5mg/kg max of 10mg) every 5 min until max of 0.6mg/kg. SEDATION - 5-10mg IV/IO may repeat every 5min until max of 0.6mg/kg - BEHAVIORAL; (IMCRASS 2) 0.05mg/kg IM max 5mg (IMCRASS 3-4) 0.1mg/kg to max of 5mg PERSISTENT DIZZINESS; (Adults Only) 5mg IV/IO slow push

  • Contraindications: Children <6 years of age, acute angle glaucoma, CNS depression, alcohol intox, known hypersensitivity

  • Side Effects: Respiratory depression, drowsiness

  • Associated Protocols: 3080, 4002, 4091, 5012A & P, 5023P, 7007, 7010, 8001, 8083

Diltiazem (Cardizem)

  • Class: Antiarrhythmic

  • Indications: Irregular SVT, AFib

  • Mechanism: Blocks calcium into heart muscle

  • Dose: 0.25mg/kg IV over 2min. 2nd dose 0.35mg/kg IV/IO

  • Contraindications: Hypotension, 2nd or 3rd degree heart block, heart failure, sick sinus syndrome rhythm, WPW

  • Side Effects: Dizziness, bradycardia, Dyspnea

  • Associated Protocols: 5022A

Diphenhydramine (Benadryl)

  • Class: Antihistamine

  • Indications: Allergic reactions

  • Mechanism: Blocks histamine receptors

  • Dose: 50mg IV/IM/IO/PO, 1mg/kg IV/IM/IO/PO in Peds

  • Contraindications: Acute Asthma, patients with cardiac Hx, known sensitivity, pt is taking MAO inhibitors(antidepressants)

  • Side Effects: Drowsiness, seizures

  • Associated Protocols: 4011

Dobutamine

  • Class: Adrenergic Inotropic Agent

  • Indications: CHF with cardiogenic shock

  • Mechanism: Stimulates beta-1 adrenergic receptors

  • Dose: 5-20 mcg/kg/min; start at 5mcg/kg/min and increase q10 by 5mcg/kg/min until SBP> 100mmHg

  • Side Effects: Angina, PVCs

  • Associated Protocols: 5002

Dopamine

  • Class: Inotropic, Vasopressor

  • Indications: Cardiogenic shock

  • Mechanism: Stimulates adrenergic receptors

  • Dose: start 5mcg/kg/min increase every 10min by 5mcg/kg/min until SBP >100mmHG (>120mmHG in ROSC or (70+(age x 2) in children) Do not exceed 20mcg/kg/min Unless ordered by medical command

  • Side Effects: Headache, dyspnea

  • Associated Protocol: 3000A, 3080, 5002, 5021A&P, 6002, 7005j

Droperidol

  • Class: Antiemetic

  • Indications: Nausea, psychosis

  • Mechanism: Reduces motor activity, anxiety

  • Dose: 1.25mg IV/IM

  • Side Effects: Hypotension, QT prolongation

Duoneb

  • Class: Bronchodilator

  • Indications: COPD, asthma

  • Mechanism: Combines albuterol and ipratropium effects

  • Dose: 0.5 mg Ipratropium / 3mg Albuterol nebulized

  • Side Effects: Dizziness, hypertension

Enalapril

  • Class: ACE inhibitor

  • Indications: Acute pulmonary edema

  • Mechanism: Blocks angiotensin conversion

  • Dose: 0.625-1.25mg IV

  • Side Effects: Hypotension, rash

Epinephrine 1mg/ml

  • Class: Non-Selective Beta Agonist

  • Indications: Anaphylaxis

  • Mechanism: Vasoconstriction, bronchial dilation

  • Dose: 0.3ml IM every 5-15 min

  • Side Effects: Tachycardia, V-Tach

Epinephrine 0.1mg/ml

  • Class: Vasopressor

  • Indications: Cardiac arrest

  • Mechanism: Increases cardiac activity

  • Dose: 1mg IV every 3-5 min

  • Side Effects: Dysrhythmias, tachycardia

Etomidate

  • Class: Hypnotic

  • Indications: Sedation-assist intubation

  • Mechanism: GABA-like effects

  • Dose: 0.3mg/kg over 30s

  • Side Effects: Apnea, vasodilation

Fentanyl

  • Class: Opioid analgesic

  • Indications: Pain management

  • Mechanism: Binds to opiate receptors

  • Dose: 50-100mcg IV/IO

  • Side Effects: Respiratory depression, hypotension

Furosemide (Lasix)

  • Class: Non-Potassium Sparing Diuretic

  • Indications: Congestive heart failure

  • Mechanism: Inhibits sodium and chloride absorption

  • Dose: IV equivalent to daily PO dose

  • Side Effects: Hypokalemia, dehydration

Glucagon

  • Class: Hormone

  • Indications: Hypoglycemia, beta-blocker overdose

  • Mechanism: Converts glycogen to glucose

  • Dose: 1mg IM or intranasal

  • Side Effects: None

Hydrocortisone (Solu-Cortef)

  • Class: Corticosteroid

  • Indications: Shock, anaphylaxis

  • Mechanism: Anti-inflammatory

  • Dose: 25-100mg IV

  • Side Effects: Fluid retention, headache

Hydroxocobalamin

  • Class: Antidote

  • Indications: Cyanide toxicity

  • Mechanism: Binds cyanide for excretion

  • Dose: 70mg/kg IV, max 5g

  • Side Effects: Hypertension, headache

Ibuprofen

  • Class: NSAID

  • Indications: Minor to moderate pain

  • Mechanism: COX inhibitor

  • Dose: 10mg/kg up to 600mg

  • Side Effects: GI bleeding

  • Contraindications: Abdominal pain, allergy

Ketamine

  • Class: Anesthetic

  • Indications: Excited delirium, pain management

  • Mechanism: NMDA receptor interaction

  • Dose: 4mg/kg IM, up to 400mg max

  • Side Effects: Dizziness, hallucinations

Levalbuterol

  • Class: Bronchodilator

  • Indications: Acute bronchospasm

  • Mechanism: Stimulates beta-2 receptors

  • Dose: 1.25mg nebulized

  • Side Effects: Headache, anxiety

Levophed (Norepinephrine)

  • Class: Adrenergic agonist

  • Indications: Non-hypovolemic shock

  • Mechanism: Stimulates alpha and beta receptors

  • Dose: 0.05-0.5 mcg/kg/min

  • Side Effects: Hypertension

Lactated Ringers

  • Class: Isotonic Crystalloid

  • Indications: Hypovolemic shock, dehydration

  • Mechanism: Replaces water/electrolytes

  • Dose: IV/IO per situation

  • Side Effects: Rare

Lidocaine

  • Class: Antiarrhythmic

  • Indications: V-Fib, wide complex tachycardia

  • Mechanism: Decrease automaticity

  • Dose: 1.5mg/kg IV, repeated

  • Side Effects: Seizures, altered mental status

Lorazepam (Ativan)

  • Class: Benzodiazepine

  • Indications: Anxiety, seizures

  • Mechanism: Enhances GABA effects

  • Dose: 1-2mg IV; 0.1mg/kg for max 4mg

  • Side Effects: Respiratory depression

Magnesium Sulfate

  • Class: Electrolyte

  • Indications: Cardiac arrest, seizures

  • Mechanism: Reduces muscle contraction

  • Dose: IV 2g for cardiac arrest

  • Side Effects: Hypotension, flushing

Methylprednisolone (Solu-Medrol)

  • Class: Corticosteroid

  • Indications: Anaphylaxis, asthma

  • Mechanism: Suppresses inflammation

  • Dose: 40-125mg IV

  • Side Effects: Euphoria, hypertension

Midazolam (Versed)

  • Class: Sedative

  • Indications: Sedation in intubations

  • Mechanism: Enhances GABA effects

  • Dose: 1-5mg IV/IO, titrated as needed

  • Side Effects: Excessive sedation, respiratory arrest

Morphine Sulfate

  • Class: Opioid analgesic

  • Indications: Pain, MI

  • Mechanism: Alleviates pain through CNS

  • Dose: 0.1mg/kg IV, repeat until max 20mg

  • Side Effects: Respiratory depression

Naloxone (Narcan)

  • Class: Narcotic antagonist

  • Indications: Narcotic overdose

  • Mechanism: Reverses respiratory depression

  • Dose: 0.4mg IV, titrate to effect

  • Side Effects: Withdrawal symptoms

Nitroglycerin

  • Class: Nitrate

  • Indications: CHF, chest pain

  • Mechanism: Smooth muscle relaxant

  • Dose: 1 tablet SL every 5 min

  • Side Effects: Headache, hypotension

Nitrous Oxide

  • Class: Anesthetic

  • Indications: Pain relief in trauma

  • Mechanism: Mild CNS intoxicant

  • Dose: 50% O2 and 50% nitrous

  • Side Effects: Confusion, lightheadedness

Ondansetron (Zofran)

  • Class: Antiemetic

  • Indications: Nausea/vomiting

  • Mechanism: Blocks serotonin action

  • Dose: 4mg IV/IM

  • Side Effects: Headaches, dizziness

Oxytocin

  • Class: Pituitary hormone

  • Indications: Post-partum hemorrhage

  • Mechanism: Stimulates uterine contractions

  • Dose: 10-20 units IV

  • Side Effects: Nausea, headaches

Pralidoxime Chloride (2PAMCl)

  • Class: Cholinesterase reactivator

  • Indications: Organophosphate poisoning

  • Mechanism: Restores acetylcholinesterase activity

  • Dose: Moderate 600mg IM, Severe varies

  • Side Effects: Tachycardia, blurred vision

Procainamide

  • Class: Antiarrhythmic

  • Indications: Refractory V-Fib/V-Tach

  • Mechanism: Blocks sodium entry during depolarization

  • Dose: 15mg/kg IV over 30-60 min

  • Side Effects: Hypotension, AV block

Racemic Epinephrine

  • Class: Alpha and beta agonist

  • Indications: Severe respiratory distress

  • Mechanism: Vasoconstricts, dilates bronchi

  • Dose: 0.5ml nebulized

  • Side Effects: Tachycardia, headache

Sodium Bicarbonate

  • Class: Alkalinizer

  • Indications: Cardiac arrest with hyperkalemia

  • Mechanism: Buffers acidosis

  • Dose: 1 mEq/kg IV

  • Side Effects: Metabolic alkalosis

Sodium Chloride

  • Class: Isotonic Solution

  • Indications: Hypovolemia, heat exhaustion

  • Mechanism: Replaces electrolytes

  • Dose: Dose dependent on situation

  • Side Effects: Volume overload

Sodium Thiosulfate

  • Class: Antidote

  • Indications: Cyanide toxicity

  • Mechanism: Converts cyanomethhemoglobin to thiocyanate

  • Dose: 12.5g IV

  • Side Effects: Nausea, hypotension

Tetracaine

  • Class: Local anesthetic

  • Indications: Corneal abrasion

  • Mechanism: Blocks sodium channels for anesthesia

  • Dose: 2 drops in affected eye

  • Side Effects: Ocular discomfort

Terbutaline

  • Class: Beta-2 agonist

  • Indications: Bronchospasm

  • Mechanism: Relaxes bronchial smooth muscle

  • Dose: 0.25mg IM

  • Side Effects: Tachycardia, anxiety

Toradol (Ketorolac)

  • Class: NSAID

  • Indications: Moderate to severe pain

  • Mechanism: Blocks COX enzymes

  • Dose: 15mg IV/30mg IM

  • Side Effects: GI bleeding

Tranexamic Acid

  • Class: Coagulation modifier

  • Indications: Traumatic bleeding

  • Mechanism: Inhibits fibrinolysis

  • Dose: 1g over 10 minutes

  • Side Effects: Hypotension, NV

Verapamil

  • Class: Calcium channel blocker

  • Indications: PSVT, AFib

  • Mechanism: Slows conduction through AV node

  • Dose: 5mg IV over 2-3 mins

  • Side Effects: Hypotension, bradycardia