Drug Cards:

SUFFIELD AMBULANCE AEMT MEDICATION REFERENCE BOOK

• Last Updated: 6/6/2025

ACETAMINOPHEN

• Generic Name: Acetaminophen

• Trade Name: Tylenol

• Class: Analgesic, Antipyretic

• Mechanism of Action: Reduces the production of prostaglandins in the brain.

• Indications:

  • Mild to moderate pain

  • Fever

• Contraindications:

  • Hypersensitivity

  • Severe hepatic impairment or liver disease

• Side Effects & Adverse Reactions:

  • Nausea

  • Vomiting

  • Constipation

  • Headache

• Adult Dose:

  • 325-1000 mg PO/IV/IO

• Pediatric Dose:

  • 10-15 mg/kg PO/IV/IO

• Drug Interactions:

  • None

• Duration of Action:

  • Onset: 30-60 minutes

  • Peak Effects: 1-3 hours

  • Duration: 3-8 hours

• Special Considerations:

  • Use with caution in nursing women

  • Do not exceed 4 grams/day

• How Supplied:

  • Liquid, tablets, suppositories, IV solution

ACTIVATED CHARCOAL

• Generic Name: Activated charcoal

• Trade Name: EZ-Char, Actidose, Liqui-Char

• Class: Adsorbent

• Mechanism of Action: Adsorbs toxic substances in the gastrointestinal (GI) tract to inhibit absorption into the bloodstream.

• Indications:

  • Most oral poisonings and medication overdoses

• Contraindications:

  • Comatose patients/altered mental status

  • Ingestion of corrosives, caustics, and petroleum products

  • Bowel obstruction

• Side Effects & Adverse Reactions:

  • Nausea

  • Vomiting

  • Black stools

  • Diarrhea

  • Severe pneumonia if aspirated

• Adult Dose:

  • 1-2 g/kg PO/NG/OG

• Pediatric Dose:

  • 1-2 g/kg PO/NG/OG

• Drug Interactions:

  • None

• Duration of Action:

  • Onset: Immediate

  • Peak Effects: Variable

  • Duration: Until excreted (variable)

• Special Considerations:

  • Does not adsorb cyanide, lithium, iron, lead, or arsenic.

• How Supplied:

  • 25-50 g in 125-250 mL bottles

ALBUTEROL

• Generic Name: Albuterol Sulfate

• Trade Name: Proair, Proventil, Ventolin

• Class: Sympathomimetic

• Mechanism of Action: Selectively binds to β-2 adrenergic receptors to cause smooth muscle relaxation in bronchioles, resulting in bronchodilation.

• Indications:

  • Bronchospasm

• Contraindications:

  • Hypersensitivity

  • Relatively contraindicated in extreme tachycardia and hypertension

• Side Effects & Adverse Reactions:

  • Headache

  • Tachycardia

  • Hypertension

  • Nausea/vomiting

  • Chest pain

  • Cough

  • Palpitations

  • Tremors

  • Increased myocardial oxygen demand

  • Anxiety

• Adult Dose:

  • 2.5 mg in 2.5 mL NS (total 3 mL) via nebulizer with 6-8 L/min oxygen

• Pediatric Dose:

  • 2.5 mg in 2.5 mL NS (total 3 mL) via nebulizer with 6-8 L/min oxygen

• Drug Interactions:

  • Synergistic effect with other sympathomimetics

  • β-blockers may blunt effects

• Duration of Action:

  • Onset: 5-15 minutes

  • Peak Effects: 30-120 minutes

  • Duration: 3-4 hours

• Special Considerations:

  • Can be combined with ipratropium bromide to create a DuoNeb.

• How Supplied:

  • 0.5%: 5 mg/mL (eye dropper bottle)

  • 0.083%: 2.5 mg/3 mL (bullet)

ASPIRIN

• Generic Name: Aspirin

• Trade Name: Bayer, Ecotrin, St. Joseph

• Class: Anti-platelet aggregator

• Mechanism of Action: Inhibits platelets from forming thromboxane A2, which causes platelets to aggregate and arteries to constrict.

• Indications:

  • Acute coronary syndromes (ACS)

• Contraindications:

  • Hypersensitivity

  • Relatively contraindicated in patients with active peptic ulcers/GI bleeding

  • Bronchospasm

  • Abdominal pain

• Side Effects & Adverse Reactions:

  • Prolonged bleeding

  • Nausea

  • GI bleeding

  • Heartburn

• Adult Dose:

  • 160-325 mg PO

• Pediatric Dose:

  • Not recommended

• Drug Interactions:

  • May cause excessive bleeding in patients taking other anticoagulants

• Duration of Action:

  • Onset: 30-45 minutes

  • Peak Effects: Variable

  • Duration: Variable

• Special Considerations:

  • Not recommended for use in pediatric patients due to Reye's Syndrome.

  • Total dose should not exceed 325 mg/day.

• How Supplied:

  • 81 mg chewable tablets

DEXTROSE

• Generic Name: Dextrose

• Trade Name: N/A

• Class: Carbohydrate

• Mechanism of Action: Supplies supplemental glucose in cases of hypoglycemia and provides short-term osmotic diuresis.

• Indications:

  • Hypoglycemia

• Contraindications:

  • Intracranial hemorrhage (relative)

  • Extravasation causes tissue necrosis

  • Pulmonary edema

• Side Effects & Adverse Reactions:

  • Hyperglycemia

  • Cerebral ischemia

• Adult Dose:

  • 12.5-25 g repeated as necessary

• Pediatric Dose:

  • 0.5-1.0 g/kg

• Drug Interactions:

  • None

• Duration of Action:

  • Onset: 1 minute

  • Peak: Variable

  • Duration: Variable

• Special Considerations:

  • Typically administered as 10% (D10W) solution.

  • Titrate to BGL greater than 80 mg/dL.

• How Supplied:

  • D10W: 100 mg/mL (1 g/10 mL)

  • D25W: 250 mg/mL (2.5 g/10 mL)

  • D50W: 500 mg/mL (5 g/10 mL)

DIPHENHYDRAMINE

• Generic Name: Diphenhydramine

• Trade Name: Benadryl

• Class: Antihistamine

• Mechanism of Action: Binds to H-1 receptors to block actions of histamine.

• Indications:

  • Allergy/Anaphylaxis

• Contraindications:

  • Dystonia

  • None in emergency setting

• Side Effects & Adverse Reactions:

  • Dizziness

  • Drowsiness

  • Hypotension

  • Nausea/vomiting

• Adult Dose:

  • 25-50 mg IV/IO/IM/PO

• Pediatric Dose:

  • 1 mg/kg IV/IO/IM/PO

• Drug Interactions:

  • Potentiates effects of anticholinergics

• Duration of Action:

  • Onset: Route dependent

  • Peak: Route dependent

  • Duration: Route dependent

• Special Considerations:

  • Used in conjunction with epinephrine and corticosteroids for treatment of anaphylaxis.

• How Supplied:

  • 10 mg/mL and 50 mg/mL vials; 25 mg and 50 mg tablets

EPINEPHRINE

• Generic Name: Epinephrine

• Trade Name: Adrenalin

• Class: Sympathomimetic

• Mechanism of Action: Non-selectively binds to α1, β₁, and β₂ adrenergic receptors, increasing inotropy, chronotropy, dromotropy, automaticity, peripheral vasoconstriction, and bronchodilation.

• Indications:

  • Cardiac arrest

  • Anaphylaxis

  • Severe bronchospasm

  • Symptomatic bradycardia

  • Non-hypovolemic shock

• Contraindications:

  • None in cardiac arrest

  • Hypovolemia

  • Tachydysrhythmia

  • Relative: heart disease, tachycardia, hypertension

• Side Effects & Adverse Reactions:

  • Hypertension

  • Headache

  • Increased myocardial oxygen demand

  • Nausea/vomiting

  • Syncope

• Adult Dose:

  • Cardiac arrest: 1 mg 1:10,000 IV/IO every 3-5 minutes

  • Anaphylaxis/severe bronchospasm: 0.3-0.5 mg 1:1,000 IM

  • Shock/bradycardia: 2-10 mcg/min IV/IO infusion

• Pediatric Dose:

  • Cardiac arrest: 0.01 mg/kg (0.1 mL/kg) 1:10,000 IV/IO every 3-5 minutes

  • Anaphylaxis/severe bronchospasm: 0.01 mg/kg 1:1,000 IM

  • Shock/bradycardia: 0.1-1.0 mcg/kg/min IV/IO infusion

• Drug Interactions:

  • Incompatible with sodium bicarbonate and furosemide

  • β-blockers may blunt effects

• Duration of Action:

  • Onset: Immediate

  • Peak: Minutes

  • Duration: Several minutes

• Special Considerations:

  • Monitor blood pressure closely

  • May increase infarct size in patients having AMI

  • Correct hypovolemia before administering

• How Supplied:

  • 1 mg/mL vials and ampules (1:1,000)

  • 1 mg/10 mL prefilled syringes (1:10,000)

FAMOTIDINE

• Generic Name: Famotidine

• Trade Name: Pepcid

• Class: Antihistamine

• Mechanism of Action: Binds to H2 receptors to block actions of histamine.

• Indications:

  • Allergy/Anaphylaxis

• Contraindications:

  • Hypersensitivity

  • AV Block

  • Dysrhythmia

• Side Effects & Adverse Reactions:

  • Fever

  • Nausea/vomiting

  • Muscle cramps

  • Palpitations

• Adult Dose:

  • 10-20 mg IV/IO; 20-40 mg PO

• Pediatric Dose:

  • Not recommended

• Drug Interactions:

  • None

• Duration of Action:

  • Onset: Within 1 hour

  • Peak: 1-3 hours IV; 1-4 hours PO

  • Duration: 8-15 hours IV; 6-12 hours PO

• Special Considerations:

  • Typically used in conjunction with diphenhydramine to treat allergy/anaphylaxis.

• How Supplied:

  • 20 mg vials and tablets

GLUCAGON

• Generic Name: Glucagon

• Trade Name: Glucagen

• Class: Pancreatic hormone

• Mechanism of Action: Causes breakdown of glycogen stored in liver and skeletal muscles into glucose to increase blood glucose levels; small positive inotropic and chronotropic action on the heart; decreases renal vascular resistance; smooth muscle relaxation.

• Indications:

  • Hypoglycemia where IV access cannot be obtained

  • Beta-blocker overdose

  • Calcium channel blocker overdose

  • Esophageal obstruction

• Contraindications:

  • Hypersensitivity

  • Hyperglycemia

  • Dizziness

• Side Effects & Adverse Reactions:

  • Headache

  • Tachycardia

  • Hypertension

  • Nausea/vomiting

• Adult Dose:

  • Hypoglycemia: 0.5-1.0 mg IM, repeat in 5-10 minutes

  • Beta-blocker, calcium channel blocker toxicity: 3-10 mg IV/IO push followed by 3-5 mg/hr infusion

• Pediatric Dose:

  • Hypoglycemia: 0.03-0.1 mg/kg IM, maximum 1 mg

  • Beta-blocker, calcium channel blocker toxicity: 0.05-0.15 mg/kg IV/IO push followed by 0.05-0.10 mg/kg/hr infusion

• Drug Interactions:

  • None

• Duration of Action:

  • Onset: 1 minute

  • Peak Effects: 5-20 minutes

  • Duration: 60-90 minutes

• Special Considerations:

  • Ineffective if glycogen stores are depleted (hepatic failure, cirrhosis, hepatitis, etc.)

• How Supplied:

  • 1 mg powder with diluent included for reconstitution

IPRATROPIUM BROMIDE

• Generic Name: Ipratropium bromide

• Trade Name: Atrovent

• Class: Parasympatholytic, anticholinergic

• Mechanism of Action: Inhibits acetylcholine at the receptor sites of bronchial smooth muscle to cause slight bronchodilation and dry respiratory tract secretions.

• Indications:

  • Bronchospasm associated with asthma and COPD

• Contraindications:

  • Hypersensitivity

• Side Effects & Adverse Reactions:

  • Headache

  • Cough

  • Nausea/vomiting

  • Dry mouth

  • Tachycardia

  • Gastrointestinal distress

  • Palpitations

• Adult Dose:

  • 0.5 mg nebulized at 6-8 L/min

• Pediatric Dose:

  • 0.5 mg nebulized at 6-8 L/min

• Drug Interactions:

  • None

• Duration of Action:

  • Onset: 1-3 minutes

  • Peak: 90-120 minutes

  • Duration: 4-6 hours

• Special Considerations:

  • Only given in conjunction with albuterol in a Duo Neb. It is never administered alone.

• How Supplied:

  • 0.5 mg/2.5 mL "bullets"

LEVALBUTEROL

• Generic Name: Levalbuterol

• Trade Name: Xopenex

• Class: Sympathomimetic

• Mechanism of Action: Selectively binds to β-2 adrenergic receptors to cause smooth muscle relaxation in bronchioles, resulting in bronchodilation.

• Indications:

  • Bronchospasm

• Contraindications:

  • Hypersensitivity

  • Relatively contraindicated in extreme tachycardia and hypertension

• Side Effects & Adverse Reactions:

  • Headache

  • Tachycardia

  • Hypertension

  • Palpitations

  • Nausea/vomiting

  • Chest pain

  • Cough

  • Tremors

  • Dry mouth

  • Anxiety

  • Increased myocardial oxygen demand

• Adult Dose:

  • 0.63 mg in 3 mL NS via nebulizer at 6-8 L/min oxygen

• Pediatric Dose:

  • 0.31 mg in 3 mL NS via nebulizer at 6-8 L/min oxygen

• Drug Interactions:

  • Synergistic effect with other sympathomimetics

  • β-blockers may blunt effects

• Duration of Action:

  • Onset: 5-15 minutes

  • Peak Effects: 60-90 minutes

  • Duration: 6-8 hours

• Special Considerations:

  • Chemical variant of albuterol with higher affinity for β-2 adrenergic receptors.

• How Supplied:

  • 0.63 mg/3 mL "bullets"

LIDOCAINE

• Generic Name: Lidocaine

• Trade Name: Xylocaine

• Class: Class I antidysrhythmic; sodium channel blocker; local anesthetic

• Mechanism of Action: Blocks sodium channels to prolong Phase 0 of the action potential, thus decreasing ventricular automaticity. Little effect on atrial tissue.

• Indications:

  • Ventricular fibrillation (VF) or ventricular tachycardia (VT) cardiac arrest refractory to defibrillation

  • Hemodynamically stable regular wide-complex tachycardia (VT)

  • Malignant PVCs

  • Local anesthetic for IO placement

• Contraindications:

  • Bradycardia

  • High degree heart block

  • Hypersensitivity

  • Hypotension (except in cardiac arrest)

  • Cardiogenic shock

• Side Effects & Adverse Reactions:

  • Confusion

  • Bradycardia

  • Heart block

  • Hypotension

  • CHF/pulmonary edema

  • Cough

  • Shortness of breath

  • Nausea

  • Dizziness

  • Seizures

• Adult Dose:

  • 1.0-1.5 mg/kg IV/IO followed by 0.5-0.75 mg/kg IV/IO in 5-10 minutes; max 3 mg/kg

  • Maintenance infusion: 2-4 mg/min

  • 10 anesthesia: 40-100 mg titrated to pain slow push

  • VF/VT arrest: 1 mg/kg IV/IO (max 100 mg) every 3-5 minutes; maximum 300 mg total

  • Maintenance infusion: 20-50 mcg/kg/min

• Pediatric Dose:

  • 10 anesthesia: 40-100 mg titrated to pain slow push

• Drug Interactions:

  • Metabolic clearance is reduced in patients taking beta-blockers and those with liver disease.

• Duration of Action:

  • Onset: 1-5 minutes

  • Peak Effects: 5-10 minutes

  • Duration: 15-120 minutes

• Special Considerations:

  • Reduce dose by 50% in elderly patients or in those with liver/renal disease.

• How Supplied:

  • 150 mg/mL vials or prefilled syringes

NALOXONE

• Generic Name: Naloxone

• Trade Name: Narcan

• Class: Opioid antagonist

• Mechanism of Action: Competitively binds to opiate receptors in the brain, displacing opiates and reversing their effects.

• Indications:

  • Respiratory depression associated with opioid overdose

• Contraindications:

  • None in emergency setting

• Side Effects & Adverse Reactions:

  • Seizures

  • Nausea/vomiting

  • Pulmonary edema

  • Diaphoresis

  • Tachycardia

  • Dysrhythmia

  • Hypertension

  • Cardiac arrest

• Adult Dose:

  • 0.4-2.0 mg IV/IO/IM/IN; repeat at 5-minute intervals to a max of 10 mg

• Pediatric Dose:

  • 0.1 mg/kg IV/IO/IM/IN (max 2 mg/dose); repeat at 5-minute intervals as needed

• Drug Interactions:

  • Increased respiratory depression when used with other CNS depressants

• Duration of Action:

  • Onset: 2 minutes

  • Peak Effects: Variable

  • Duration: 30-60 minutes

• Special Considerations:

  • Should be titrated to respiratory drive

  • Caution when administering to patients with opiate dependency (risk of withdrawal, violent behavior)

• How Supplied:

  • 0.4 mg/mL and 1 mg/mL vials, ampules, and prefilled syringes

NITROGLYCERIN

• Generic Name: Nitroglycerin

• Trade Name: Nitrostat, Nitro-Bid

• Class: Nitrate

• Mechanism of Action: Rapid smooth muscle relaxation causing a decrease in vascular resistance and preload, thereby lowering cardiac workload and to a lesser extent, causing coronary vasodilation.

• Indications:

  • Acute coronary syndromes (ACS)

  • Congestive heart failure (CHF) / Pulmonary edema

• Contraindications:

  • Hypotension

  • Hypovolemia

  • Erectile dysfunction medications (Cialis, Levitra, Viagra) taken in past 24-48 hours

• Side Effects & Adverse Reactions:

  • Reflex tachycardia

  • Syncope

  • Burning at the absorption site

  • Dry mouth

• Adult Dose:

  • ACS: 0.4 mg SL every 3-5 minutes; max 3 doses

  • CHF: 0.4-0.8 mg SL every 3-5 minutes

  • 0.5-2.0 inches of transdermal NTG paste can be administered if SL NTG is effective

  • IV infusion: Begin at 10 mcg/min; increase by 10 mcg/min every 3-5 minutes until desired effect; max 200 mcg/min

• Pediatric Dose:

  • Not recommended

• Drug Interactions:

  • Additive effects with other vasodilators

• Duration of Action:

  • Onset: 1-3 minutes

  • Peak Effects: 5-10 minutes

  • Duration:

  • SL: 20-30 minutes; IV: 1-10 minutes

• Special Considerations:

  • Ensure no RV infarction by conducting right sided EKG for all inferior wall STEMIs.

  • Shield from heat and light

  • IV NTG should be administered with a vented IV set by IV pump only

• How Supplied:

  • 0.4 mg sprays and tablets; transdermal paste; 200 mcg/mL glass vials for IV infusion

ONDANSETRON

• Generic Name: Ondansetron

• Trade Name: Zofran

• Class: Antiemetic

• Mechanism of Action: Blocks serotonin receptors in the chemoreceptor trigger zone (CTZ) to reduce nausea.

• Indications:

  • Prevention and control of nausea and vomiting

• Contraindications:

  • Hypersensitivity

  • Prolonged QT interval

  • Heart block

• Side Effects & Adverse Reactions:

  • Headache

  • Constipation

  • Diarrhea

  • Dry mouth

• Adult Dose:

  • 4 mg IV/IO/IM/PO

• Pediatric Dose:

  • 0.15 mg/kg (max 4 mg) IV/IO/IM/PO

• Drug Interactions:

  • None

• Duration of Action:

  • Onset: 1-30 minutes

  • Peak: 2 hours

  • Duration: 3-6 hours

• Special Considerations:

  • May be given prophylactically prior to the administration of opioids.

• How Supplied:

  • 4 mg/2 mL vials, 4 mg tablets

RACEMIC EPINEPHRINE

• Generic Name: Racemic epinephrine

• Trade Name: Vaponefrin

• Class: Sympathomimetic

• Mechanism of Action: A chemical isomer of epinephrine that stimulates both α and β receptors with a slight preference for β₂ to cause bronchodilation.

• Indications:

  • Relieves subglottic edema associated with croup

• Contraindications:

  • Croup

  • Laryngeal edema

  • Epiglottitis

  • Significant cardiovascular disease

• Side Effects & Adverse Reactions:

  • Hypertension

  • Tachycardia

  • Dysrhythmia

  • Headache

  • Increased myocardial oxygen demand

  • Nausea/vomiting

  • Syncope

• Adult Dose:

  • N/A

• Pediatric Dose:

  • 0.25-0.75 mL of 2.25% solution in total of 3 mL via small volume nebulizer

• Drug Interactions:

  • β-blockers may blunt effects

• Duration of Action:

  • Onset: 5 minutes

  • Peak: 5-15 minutes

  • Duration: 1-3 hours

  • 5 mg epinephrine 1:1,000 may be nebulized if racemic epinephrine is not available

• How Supplied:

  • 2.25% solution

LACTATED RINGERS

• Generic Name: Lactated Ringers

• Trade Name: LR, Lactated Ringers

• Class: Isotonic crystalloid solution

• Mechanism of Action: Replaces water and electrolytes. Lactated Ringers contains sodium, potassium, calcium, chloride, and lactate, which acts as a buffer changed to bicarbonate in the liver, helping correct metabolic acidosis while restoring circulating volume.

• Indications:

  • Hypovolemia

  • Fluid resuscitation in shock (burns, trauma, dehydration)

  • Maintenance of fluid balance during surgery

• Contraindications:

  • Hypertension

  • Congestive heart failure (CHF)

  • Pulmonary edema

  • Renal failure

  • Hyperkalemia (relative contraindications).

• Side Effects & Adverse Reactions:

  • Fluid overload

  • Pulmonary edema

  • Electrolyte imbalance

• Adult Dose:

  • 30 mL/kg max dose, generally given in 250-500 mL boluses. Lung sounds should be assessed every 250 mL.

• Pediatric Dose:

  • 10-20 mL/kg max dose, be cautious of fluid overload.

NORMAL SALINE (0.9% Sodium Chloride Solution)

• Generic Name: Normal Saline

• Trade Name: NS

• Class: Isotonic crystalloid solution

• Mechanism of Action: Increases circulating plasma volume by replacing water and electrolytes, does not carry oxygen or expand intracellular fluid; remains primarily in the intravascular and interstitial spaces.

• Indications:

  • Hypovolemia

  • Dehydration

  • Heat-related emergencies

  • Used as a medication diluent and IV maintenance fluid

• Contraindications:

  • Congestive heart failure (use caution)

  • Pulmonary edema

  • Severe hypertension

  • Renal failure (use caution)

• Side Effects & Adverse Reactions:

  • Fluid overload

  • Pulmonary edema

  • Dilutional effects on electrolytes

• Adult Dose:

  • 30 mL/kg max dose; generally given in 250-500 mL boluses. Lung sounds should be assessed every 250 mL.

• Pediatric Dose:

  • 30 mL/kg max dose; generally given in 250-500 mL boluses. Lung sounds should be assessed every 250 mL.