ALBUTEROL (Revised 11/29/04)
MORPHINE (Revised 11/29/04)
SECTION 7
DRUG INFORMATION
| Dextrose | Morphine | Thiamine | |
| Adenosine | Diphenhydramine | Narcan | Valium |
| Albuterol | Dopamine | Nitro | Vecuronium |
| Amiodarone | EPI 1:1,000 | Oxygen | Magnesium Sulfate |
| Aspirin | EPI 1:10,000 | Promethazine | Lidocaine |
| Atropine | Furosemide | Sodium Bicarbonate | |
| Calcium Chloride | Glucagon | Succinylcholine |
CLASS: Absorbent
ACTION:
Absorbs toxins by chemical binding and prevents gastrointestinal absorption.INDICATIONS: Poisoning following emesis or when emesis is contraindicated.
CONTRAINDICATIONS: Altered level of consciousness; hydrocarbon or caustic ingestion.
PRECAUTIONS: Aspiration. Should only be administered following emesis, in cases in which it is so indicated.
Use with caution in patients with an altered mental status.
SIDE EFFECTS: Nausea, vomiting, and constipation.
DOSAGE: 1g/kg (typically 50-75 grams) mixed with a glass of water to form slurry.
ROUTE: Oral.
Pediatric Dosage: 1g/kg mixed with a glass of water to form slurry.
Class:
Endogenous nucleotide
Description:
Adenosine is primarily formed from the breakdown product of adenosine triphosphate (ATP). Both compounds are found in every cell of the human body and have a wide range of metabolic roles. Adenosine slows tachycardias associated with the AV node via modulation of the autonomic nervous system without causing negative inotropic effects. It acts directly on sinus pacemaker cells and vagal nerve terminals to decrease chronotropic and dromotropic activity. Adenosine is the drug of choice for paroxysmal supraventricular tachycardia (PSVT) and can be used diagnostically for stable, wide complex tachycardias of unknown type after two doses of lidocaine.
Onset & Duration:
Onset: 30 seconds
Duration: 10 seconds
Indications:
Conversion of PSVT to sinus rhythm
Contraindications:
Second or third-degree AV block, or sick-sinus syndrome
Atrial flutter
Atrial fibrillation
Ventricular tachycardia
Hypersensitivity to Adenosine
Adverse Reactions:
Facial flushing Lightheadedness
Paresthesia Headache
Diaphoresis Palpitations
Chest pain Hypotension
Nausea Metallic taste
Shortness of breath
Drug Interactions:
Methylxanthines (ex: caffeine and theophylline) antagonize the action of adenosine. Dipyridamole potentiates the effect of adenosine; reduction of adenosine dose may be required. Carbamazepine may potentiate the AV-nodal blocking effect of adenosine.
How supplied:
Parenteral for IV injection 12 mg pre-filled syringe
Dosage and Administration:
Adult:
Initial Dose: 6 mg over 1-3 seconds
Repeat Dose: If no response is observed after 1 to 2 minutes, administer 12 mg over 1 to 3 seconds.
The second 12 mg dose may be repeated once if needed (Maximum 30 mg dose)
Pediatric:
0.1 to 0.2 mg/kg rapid IV
Maximum single dose: 12 mg
Special Considerations:
May produce bronchoconstriction in patients with asthma or bronchopulmonary disease.
Pregnancy safety: Category "C"
ALBUTEROL (PROVENTIL) (VENTOLIN)
Class:
Sympathomimetic, bronchodilatorDescription:
Albuterol is a sympathomimetic that is selective for beta2 adrenergic receptors. It relaxes smooth muscles of the bronchial tree and peripheral vasculature by stimulating adrenergic receptors of the sympathetic nervous system.
Onset & Duration:
Onset: 5 to 15 minutes after inhalation
Duration: 3 to 4 hours after inhalation
Indications:
Relief of bronchospasm in patients with reversible obstructive airway disease
Prevention of exercise-induced bronchospasm
Contraindications:
Prior hypersensitivity reaction to Albuterol
Cardiac dysrhythmias associated with tachycardia
Tachycardia caused by digitalis intoxication
Adverse Reactions:
Usually dose related restlessness, apprehension, dizziness
Palpitations
Increase in blood pressure
Dysrhythmias
Increased hypoxemia
Drug Interactions:
Sympathomimetics may exacerbate adverse cardio-vascular effects. Antidepressants may potentiate the effects on the vasculature. Beta blockers may antagonize Albuterol. Albuterol may potentiate diuretic-induced hypokalemia.
How supplied:
Solution for aerosolization 2.5 mg in a 3 ml solution.
Dosage and Administration:
Adult: 2.5 mg administered via nebulizer over 5 to 15 minutes
Pediatric: 2.5 mg administered via nebulizer over 5 to 15 minutes
Special Considerations:
May precipitate angina pectoris and dysrhythmias
Should be used with caution in patients with diabetes mellitus, hyperthyroidism, prostatic hypertrophy, or seizure disorder
Pregnancy safety: Category "C"
Class:
Antiarrhythmic
Description:
Amiodarone blocks sodium channels at rapid pacing frequencies and it exerts a noncompetitive antisympathetic action. One of its main effects, with prolonged administration, is to lengthen the cardiac action potential and produce negative chronotropic effect in nodal tissues. In addition to blocking sodium channels, amiodarone blocks myocardial potassium channels, which contributes to slowing of conduction and prolongation of refractoriness. The antisympathetic action and the block of calcium and potassium channels are responsible for the negative dromotropic effect on the sinus node and for the slowing of conduction and prolongation of refractoriness in the atrioventricular (AV) node. Its vasodilatory action can decrease cardiac workload and consequently myocardial oxygen consumption.
Onset & Duration:
Onset: 5 to 10 minutes
Duration: Up to 24 hours
Indications:
Treatment of refractory Ventricular Fibrillation and Pulseless Ventricular Tachycardia
Contraindications:
Known hypersensitivity
Cardiogenic Shock
Sinus Bradycardia
Second and Third-degree AV Block
Adverse Reactions:
Bradycardia Congestive Heart Failure
Hypotension Ventricular Arrhythmia
Liver, Lung, and Thyroid abnormalities
Drug Interactions:
Solvent used for bolus and drip must be Dextrose 5% Water only.
How Supplied:
Parenteral 15 mg/ml in 10 ml pre-filled syringe
Dosage and Administration:
Adult: Ventricular Fibrillation or Pulseless Ventricular Tachycardia 300 mg IV
Pediatrics: Contact Medical Control for orders
Special Considerations:
Pregnancy safety: Category "C"
Class:
Platelet inhibitor / anti-inflammatory
Actions:
Blocks platelet aggregation
Indications:
New-onset chest pain suggestive of MI
Contraindications:
Patients with history of hypersensitivity
Recent GI bleed
Anti-coagulation therapy with heparin or warfarin
Adverse reactions:
Heartburn Vomiting
Nausea Wheezing
How supplied:
81 mg chewable tablet
Dosage and administration:
Adult: Chest pain - 162 mg PO
Pediatrics: Not recommended
Adult: Hendersonville ER - 324 mg PO
Class:
Anticholinergic agent
Description:
Atropine sulfate, a potent parasympatholytic, inhibits actions of acetylcholine at post ganglionic parasympathetic neuroeffector sites. Small dosed inhibit salivary and bronchial secretions; moderate doses dilate pupils and increase heart rate. Large doses decrease GI motility, inhibit gastric acid secretion, and may block nicotinic receptor sites at the autonomic ganglia and at the neuromuscular junction. Blocked vagal effects result in positive chronotropy and positive dromotropy (limited or no inotropic effect). In emergency care, it is primarily used to increase the heart rate in life-threatening bradycardias.
Onset and duration:
Onset: Rapid
Duration: 2 - 6 hours
Indications:
Hemodynamically significant bradycardia
Asystole
Organophosphate poisoning (drug of choice)
Bronchospastic pulmonary disorders
Contraindications:
Tachycardia
Hypersensitivity
Unstable cardiovascular status in acute hemorrhage and myocardial ischemia
Narrow-angle glaucoma
Adverse reactions:
Tachycardia Palpitations
Dysrhythmias Headache
Dizziness Nausea & Vomiting
Flushed, hot, dry skin
Paradoxical bradycardia when pushed slowly or when used at doses less then 0.5 mg
Anticholinergic effects (dry mouth or nose, photophobia, blurred vision, urine retention)
Drug interactions:
Anticholinergics may increase vagal blockade
Potential adverse effects when administered in conjunction with digitalis, cholinergics, neostigmine.
The effects of atropine may be enhanced by antihistamines, procanamide, quinidine, antipsychotics, antidepressants, and benzodiazepines.
How supplied:
Parenteral: 1.0 mg in 10 ml prefilled syringe
Dosage and administration:
Bradydsrhythmias
Adult: 0.5-1.0 mg IV every 3-5 minutes as needed
Pediatric: 0.02 mg/kg (minimum dose of 0.1 mg; maximum single dose of 0.5 mg for a child and 1.0 for an adolescent)
Asystole:
Adult: 1.0 mg IV (maximum of 0.04 mg/kg)
Pediatric: Same as for dysrhythmias
Special considerations:
Pregnancy safety: Category "C"
CLASS:
ELECTROLYTE, CALCIUM SALTACTION: BLOCKS HARMFUL EFFECT OF ELEVATED SERUM POTASSIUM ON CARDIAC CELL MENBRANE
INDICATIONS: PULSELESS ELECTRICAL ACTIVITY (PEA)
ASYSTOLE IN A RENAL PATIENT WITH POSSIBLE ELEVATED SERUM POTASSIUM
CONTRAINDICATIONS: ANY OTHER RHYTHMS OR PATIENTS OTHER THAN THOSE DESCRIBED IN THE INDCATIONS WITHOUT CONTACTING MEDICAL CONTROL.
PRECAUTIONS: SHOULD ONLY BE GIVEN IN WIDELY PATENT IV LINE WITHOUT ANY POSSIBILITY OF EXTRAVASATION.
SIDE EFFECTS: BRADYCARDIA, FLUSHING, HYPOTENSION, NAUSEA, VOMITING, LOCAL IRRITATION AND BURNING, SKIN NECROSIS.
DOSAGE: 1 GM (10 CC)
ROUTE: IV ONLY
PEDIATRIC DOSAGE: 0.25 ML/KG, NOT TO EXCEED 10 CC.
CLASS: CARBOHYDRATE
ACTION: ELEVATES BLOOD GLUCOSE LEVELS
INDICATIONS: HYPOGLYCEMIA
CONTRAINDICATIONS: HYPERGLYCEMIA
NORMAL BLOOD SUGAR LEVELS
PRECAUTIONS: CHECK GLUCOSE LEVEL BEFORE ADMINISTRATION.
SIDE EFFECTS: LOCAL VENOUS IRRITATION
DOSAGE: 25 GM’s
ROUTE: IV
PEDIATRIC DOSAGE: 0.5 – 1 MG/KG OF A 25% SOLUTION
CLASS: TRANQUILIZER
ACTION: ANTI CONVULSANT
SKELETAL MUSCLE RELAXANT
SEDATIVE
INDICATIONS: SEIZURES
PREMEDICATION FOR CARDIOVERSION
PREMEDICATION FOR RSI
CONTRAINDICATIONS: HYPERSENSITIVITY
PRECAUTIONS: SHORT DURATION OF EFFECT
DO NOT MIX WITH OTHER DRUGS
LOCAL VENOUS IRRITATION
SIDE EFFECTS: DROWSINESS
HYPOTENSION
RESPIRATORY DEPRESSION
DOSAGE: 5 – 10 MG
ROUTE: ETT, DOUBLE THE DOSE
IV
IM
RECTAL (0.5 MG/KG)
PEDIATRIC DOSAGE: 0.2 MG/KG
CLASS: ANTIHISTAMINE
ACTION: BLOCKS HISTAMINE RECEPTORS
INDICATIONS: ANAPHYLAXIS
CONTRAINDICATIONS: USE WITH CAUTION IN ASTHMATICS
PRECAUTIONS: HYPOTENSION
SIDE EFFECTS: SEDATION, BLURRED VISION, HEADACHE, and PALPITATIONS.
DOSAGE: 25 – 50 MG
ROUTE: SLOW IV
DEEP IM
PEDIATRIC DOSAGE: 2 MG/KG
DOPAMINE (INTROPINE)
CLASS: SYMPATHOMIMETIC
ACTION: INCREASES CARDIAC CONTRACTILITY
PERIPHERAL VASOCONSTRICTION
INDICATIONS: CARDIOGENIC SHOCK
NEUROGENIC SHOCK
SEPTIC SHOCK
SYMPTOMATIC BRADYCARDIA
CONTRAINDICATIONS: HYPOVOLEMIC SHOCK
PRECAUTIONS: SEVERE TACHYCARDIA
VENTRICULAR IRRITABILITY
SIDE EFFECTS: VENTRICULAR ARRHYTHMIAS
HYPERTENSION
DOSAGE: 2 – 20 UG/KG/MIN TITRATED TO EFFECT
ROUTE: IV
PEDIATRIC DOSAGE: SAME AS ADULTS
CLASS: SYMPATHOMIMETIC
ACTION: BRONCHODILATION
POSITIVE CHRONOTROPE AND INOTROPE
INDICATIONS: ALLERGIC REACTIONS
CONTRAINDICATIONS: NONE
PRECAUTIONS: CARDIAC PATIENTS
HYPERTENSION
PREGNANCY
TACHYARRHYTHMIAS
SIDE EFFECTS: PALPITATIONS
HEADACHES
ANXIETY
DOSAGE: 0.01 MG/KG TO A MAXIMUM SINGLE DOSE OF 0.3 MG. REPEAT ONCE IF NEEDED
ROUTE: SUBCUTANEOUSLY
PEDIATRIC DOSAGE: SAME AS ADULTS
CLASS: SYMPATHOMIMETIC
ACTION: INCREASES HEART RATE
INCREASES CARDIAC CONTRACTILITY
CAUSES BRONCHODILATION
INDICATIONS: CARDIAC AREST
CONTRAINDICATIONS: NONE
PRECAUTIONS: DEACTIVATED BY ALKALINE SOLUTIONS
SIDE EFFECTS: TACHYCARDIAS
PALPITATIONS
HTN
DOSAGE: 1 MG EVERY 3 – 5 MINUTES
ROUTE: ETT, DOUBLE THE DOSE
IV
IO
PEDIATRIC DOSAGE: 0.01 MG/KG EVERY 3 – 5 MINUTES
CLASS: DIURETIC
ACTION: INHIBITS THE REABSORPTION OF SODIUM
PROMOTES ROMPT DIURESIS
VASODILATION
INDICATIONS: PULMONARY EDEMA
CONTRAINDICATIONS: PREGNANCY
DEHYDRATION
SULFONAMIDE ALLERGY
PRECAUTIONS: PROTECT FORM LIGHT
SIDE EFFECTS: FEW
DOSAGE: 40 – 80 MG
ROUTE: IV
PEDIATRIC DOSAGE: 1 MG/KG
CLASS: PANCREATIC HORMONE
ACTION: ELEVATES BLOOD GLUCOSE BY CAUSING THE BREAKDOWN OF GLYCOGEN
INDICATIONS: SYMPTOMATIC HYPOGLYCEMIA WHERE IV ACCESS IS UNOBTAINABLE DESPITE THREE ATTEMPTS
CONTRAINDICATIONS: ALLERGY
PRECAUTIONS:
SIDE EFFECTS: NAUSEA AND VOMITING
HYPERTENSION
TACHYCARDIA
DOSAGE: 0.5 – 1.0 MG, MAY REPEAT IN 20 MINUTES IF INADEQUATE RESPONSE
ROUTE: IM
PEDIATRIC DOSAGE: 0.03 TO 0.1 MG/KG/DOSE, NOT TO EXCEED 1.0 MG
LIDOCAINE (XYLOCAINE)
CLASS: ANTIARRHYTHMIC
ACTION: SUPRESSES VENTRICULAR ECTOPY
INCREASES V-FIB THRESHOLD
INDICATIONS: PVC’s
V-TACH
V-FIB
WIDE COMPLEX TACHYCARDIA
CONTRAINDICATIONS: HEART BLOCKS
PVC’s IN BRADYCARDIA
PRECAUTIONS: REDUCE DOSAGE IN PATIENTS OVER 70 YEARS OLD
REDUCE DOSAGE IN PATIENTS WITH LIVER DISEASE
SIDE EFFECTS: ANXIETY, DROWSINESS, DIZZINESS, CONFUSION, NAUSEA, VOMITING, CONVULSIONS, WIDENING OF THE QRS
DOSAGE: BOLUS – 1.5 MG/KG UP TO MAXIMUM OF 3 MG/KG
DRIP – 2 TO 4 MG/MIN
ROUTE: ETT, DOUBLE THE DOSE
IV
IO
PEDIATRIC DOSAGE: 1 MG/KG
CLASS: ANTIARRHYTHMIC
ACTION: COFACTOR IN ENZYMATIC REACTIONS
CNS DEPRESSANT
INDICATIONS: V-FIB REFRACTORY TO LIDOCAINE
CONTRAINDICATIONS: HEART BLOCKS
PRECAUTIONS: INCOMPATIBLE WITH BICARBONATES
SIDE EFFECTS: RESPIRATORY DEPRESSION
HYPOTENSION
SWEATING
DOSAGE: 1 – 2 GM’s OVER 1 TO 2 MINUTES, PUSH IN A PULSELESS PATIENT
ROUTE: IV
PEDIATRIC DOSAGE: NOT RECOMMENDED
CLASS: NARCOTIC
ACTION: CNS DEPRESSANT
VASODILATION
DECREASES PAIN RESPONSE
INDICATIONS: SEVERE PAIN
CHEST PAIN AFTER NITROGLYCERINE
PULMONARY EDEMA
CONTRAINDICATIONS: HYPERSENSITIVITY
HEAD INJURY
ABDOMINAL PAIN
PRECAUTIONS: RESPIRATORY DEPRESSION
HYPOTENSION
SIDE EFFECTS: DIZZINESS
ALTERED LOC
DOSAGE: FOR CHEST PAIN, CHF – 2 MG TITRATED TO DESIRED EFFECT
IN 2 MG INCREMENTS UP TO BUT NOT EXCEEDING 10 MG.
FOR BURNS, AMPUTATIONS, FRACTURES – 0.05 - 0.1 MG/KG IV. REPEAT TIMES ONE IF NEEDED
ROUTE: IV
PEDIATRIC DOSAGE: 0.05 - 0.1 MG/KG IV. REPEAT TIMES ONE IF NEEDED
CLASS: NARCOTIC ANTAGONIST
ACTION: REVERSES THE EFECT OF NARCOTICS
INDICATIONS: NARCOTIC OVERDOSES
COMA OF UNKNOWN ORIGIN
CONTRAINDICATIONS: HYPERSENSITIVITY
PRECAUTIONS: WITHDRAWAL EFFECTS
SHORT ACTING
SIDE EFFECTS: NONE
DOSAGE: 2 MG
ROUTE: IV
IM
ETT, DOUBLE THE DOSE
IO
PEDIATRIC DOSAGE: 0.01 – O.1 MG/KG
NITROGLYCERIN (NITROSTAT)
CLASS: ANTIANGINAL
ACTION: DILATES CORONARY ARTERIES
DILATES SYSTEMIC ARTERIES
INDICATIONS: CHEST PAIN
CONTRAINDICATIONS: CHILDREN <12 YEARS OLD
HYPOTENSION
VIAGRA USE WITHIN 12 HOURS
PRECAUTIONS: MONITOR VITAL SIGNS
PROTECT FROM LIGHT
SIDE EFFECTS: HEADACHES
DIZZINESS
HYPOTENSION
DOSAGE: 1 SPRAY, REPEAT 3 TIMES IF NEEDED Q 5 MINUTES
ROUTE: SUBLINGUAL
PEDIATRIC DOSAGE: NOT INDICATED
CLASS: GAS
ACTION: INCREASES ARTERIAL OXYGEN LEVELS
INDICATIONS: HYPOXIA
CONTRAINDICATIONS: NONE
PRECAUTIONS: COPD
SIDE EFFECTS: ONLY WITH LONG TERM USE
DOSAGE: 24 TO 100% AS INDICATED BY THE PATIENT CONDITION
ROUTE: INHALATION
PEDIATRIC DOSAGE: SAME AS ADULTS
CLASS: ANTIHISTAMINE
ACTION: ANTIEMETIC
INDICATIONS: SEVERE NAUSEA AND VOMITING
CONTRAINDICATIONS: ALTERED LEVEL OF CONSCIOUSNESS
PRECAUTIONS:
SIDE EFFECTS: DROWSINESS
DOSAGE: 12.5 – 25.0 MG
ROUTE: IV
IM
PEDIATRIC DOSAGE: 0.5 MG/KG, MAXIMUM DOSE 12.5 MG
NOT APPROVED FOR CHILREN 2 YEARS OF AGE OR LESS.
CLASS: ALKALINIZING AGENT
ACTION: COMBINES WITH ACIDS TO FORM A WEAKER ACID TO LOWER pH.
INDICATIONS: METABOLIC ACIDOSIS
TRICYCLIC OVERDOSES
CONTRAINDICATIONS: ALKALOTIC STATES
PRECAUTIONS: DEACTIVATES CATECHOLOMINES
SIDE EFFECTS: ALKALOSIS
DOSAGE: 1 MEQ/KG
ROUTE: IV
PEDIATRIC DOSAGE: SAME AS ADULTS
CLASS: PARALYTIC
ACTION: DEPOLARIZING MUSCLE RELAXANT
INDICATIONS: TO FACILITATE ENDOTRACHEAL INTUBATION
CONTRAINDICATIONS: HYPERKALEMIA
RENAL FAILURE
HISTORY OF MALIGNANT HYPERTHERMIA
PENETRATING EYE INJURIES
MASSIVE CRUSH INJURIES
BURNS GREATER THAN 8 HOURS OLD
SPINAL CORD INJURY GREATER THAN 24
HOURS OLD
NEUROMUSCULAR DISEASE
PESTICIDE (ORGANOPHOSPHATE) POISONING
PRECAUTIONS: BE PREPARED TO PLACE AN ALTERNATE AIRWAY IF
ENDOTRACHEAL INTUBATION FAILS
GIVE SEDATION AS SUCCINYLCHOLINE HAS NO
SEDATING PROPERTIES
SIDE EFFECTS: HYPERKALEMIA
CARDIAC ARRHYTHMIAS
INCREASED INTRAOCULAR PRESSURE
DOSAGE: 1 MG/KG
ROUTE: IV PUSH
PEDIATRIC DOSAGE: 1.5 MG/KG
CLASS: SYMPATHOMIMETIC
ACTION: BRONCHODILATION
INDICATIONS: SEVERE BRONCHOSPASMS
CONTRAINDICATIONS: HYPERSENSITIVITY
CORONARY ARTERY DISEASE
CARDIAC ARRHYTHMIAS
PRECAUTIONS: MONITOR VITAL SIGNS
SIDE EFFECTS: PALPITATIONS
ANXIETY
HEADACHE
DOSAGE: 0.25 MG
ROUTE: SUBCUTANEOUS
PEDIATRIC DOSAGE: NOT RECOMMENDED
CLASS: VITAMIN
ACTION: ALLOWS THE BREAKDOWN OF GLUCOSE
INDICATIONS: COMA OF UNKNOWN ORIGIN
ALCOHOLISM
DELIRIUM TREMORS
CONTRAINDICATIONS: NONE
PRECAUTIONS: NONE
SIDE EFFECTS: ANAPHYLAXIS WHEN GIVEN IV, RARE
DOSAGE: 100 MG
ROUTE: IV
IM
PEDIATRIC DOSAGE: NOT INDICATED
CLASS: PARALYTIC
ACTION: NONDEPOLARIZING MUSCLE RELAXANT
INDICATIONS: TO FACILITATE VENTILATIONS IN A PATIENT WITH A
SECURED AIRWAY (ENDOTRACHEAL TUBE WITH
POSITION CONFIRMED)
CONTRAINDICATIONS: HISTORY OF MALIGNANT HYPERTHERMIA
AIRWAY WHICH IS NOT ABSOLUTELY
SECURED
PRECAUTIONS: KEEP AIRWAY SECURED
CONTINUOUSLY MONITOR VENTILATIONW AND
OXYGENATION
BE PREPARED TO REPLACE ENDOTRACHEAL TUBE
IF NECESSARY
SEDATE PATIENT, VECURONIUM HAS NO SEDATING
PROPERTIES
SIDE EFFECTS: HYPOTENSION
TACHYCARDIA
DOSAGE: 0.1 MG/KG
ROUTE: IV PUSH
PEDIATRIC DOSAGE: 0.1 MG/KG