Epinephrine

Class: Sympathomimetic

Action: Direct acting alpha & beta agonist

Indications: Cardiac Arrest - vtach,vfib,PEA,asystole

sympathetic bradycardia - in peds or as alternative to dopamine

Severe hypotension 2ary to brady not hypovolemia

allergic rxn, anaphylaxis, asthma

Contras: HTN, hypothermia, pulmonary edema, myocardial ischemia, hypovolemic shock

Adverse Rxns: HTN, tachycardia, arrythmias, pulmonary edema, anxiety, restlessness, agitation

*potentiates other sympathomimetics, 

*deactivated by alkaline solutions (bicarb)

Dosage:

allergic rxn / asthma: 0.3-0.5 mg 1:1000 IM

anaphylaxis: 0.3-0.5 mg 1:10,000 IV

cardiac arrest: 1mg 1:10,000 IV rpt q3-5 min no max

Class: anticholinergic

Action: parasympatholytic, inhibits action of acetylcholine

Indications: hemodynamically unstable bradycardia, asystole, organophosphate poisoning, bronchospastic pulmonary disorders

Contras: tachycardia, hypersensitivity, unstable cardiovascular status in acute hemorrhage and myocardial ischemia, narrow angle glaucoma

Adverse Rxns: headache, dizziness, palpitations, n/v, tachycardia, arrhythmias, blurred vision, dry mouth, paradoxical brady if pushed slowly or at a low dose

Dosage: 

Asystole: 1mg IV/IO push; may rpt q3-5min to max of 3mg

Bradycardia: 0.5mg IV/IO push; may rpt q3-5 min to max of 3mg (0.5 if they're alive)

Organophosphate Poisoning: start at 3mg and go up from there until relief of symptoms

Class: carbohydrate, hypertonic solution

Action: rapid ↑ serum glucose levels, short term osmotic diuresis

Indications: hypoglycemia, ALOC, coma of unknown origin*, seizure of unknown etiology*, status epilepticus

Contras: intracranial hemorrhage

Adverse Rxns: extravasation leads to tissue necrosis; hyperglycemia

Dosage: 12.5 - 25 g slow IV, may rpt as necessary

*administer thiamine prior to D50 in known alcoholic pts

Class: opiod / narcotic analgesic

Action: - suppresses pain through CNS action

- suppresses fear & anxiety centers in the brain

- depresses brain stem respiratory centers

- vasodilates

- ↓ preload & afterload which ↓ O2 demand

Indications:- *severe CHF, pulmonary edema* (controversial)

- chest pain associated with AMI

- anagelsic for mod → severe acute / chronic pain

Contras: head injury, exacerbated COPD, ↓ resp drive, hypotension, undiagnosed abdo pain, ↓LOC, suspected hypovolemia

Adverse Rxns: resp depression, hypotension, ↓LOC, n/v, bradycardia, tachycardia, syncope, euphoria, bronchospasm

Dosage: 2-20mg IV/IO, titrate to effect

Class: hypercycelmic agent, pancreatic hormone, insulin antagonist

Action: -↑ blood glucose level by stimulating glycogenolysis

- unknown mechanism in stabilizing cardiac rhthym in beta blocker OD

- minimal (+) inotropic (BP) & chronotropic (HR) effects

Indications: - ALOC when hypoglycemia is suspected

- beta blocker OD

Contras: hyperglycemia, hypersensitivity

Adverse Rxns: n/v, tachycardia, HTN

Dosage: hypoglycemia - 0.5 - 1.0 mg/iu IM, may rpt in 7-10min

(note: can take 5-15 min or more to activate)

- Calcium Channel / Beta Blocker OD: 3mg/iu IV/IO initially followed by 3mg/hr as needed

Naloxone Hydrochloride

(Narcan)

Class: narcotic antagonist

Action: - competative inhibition @ narcotic receptor sites

- reverses resp depression

- completely inhibits action of morphine

Indications: - opiate OD

- coma of unknown origin

- ↓LOC

Contras: use with caution in narcotic addicted pts

use with cation in neonates of narcotic addicted mothers

Adverse Rxns: withdrawl symptoms in the addicted pt

- tachycardia, HTN, arrythmias, n/v, diaphoresis, pulmonary edema

Dosage: 0.4 - 2mg IV/IM/SQ/IO/IN min recommended is 2mg, rpt @5min intervals to max of 10mg

or infusion: 2mg in 500mL D5W infuse at 0.4mg/hr (100ml/hr)

Class: short action benzodiazepine, CNS depressant

Action: sedative, hypnotic, anxiolytic, induces amnesia, anti-convulsant, muscle relaxer

*keeps  pts relaxed / sedated but conscious to be able to communicate but they won't remember it.

Indications: sedation, anxiolytic prior to intubation, administer for conscious sedation & reducing fxs / dislocations

Contras: glaucoma, shock, alcohol intoxication, OD, depressed vital signs, concommitant ise w/ other CNS depressants, barbituates, alcohol or narcotics

Adverse Rxns: cough, hiccups, oversedation, n/v, blurred vision, resp depression, resp arrest, hypotension

Dosage: 2-2.5 mg slow IV/IO over 2-3 min, may rpt to max of 0.1mg/kg

Class: sympathomimetic

Action: beta2 specific agonist, relaxes smooth muscles of the bronchioles

Indications: acute bronchial asthma, bronchospasm (especially in COPD pts)

Contras: - use caution in pts w/diabetes

- hypothyroidism

- cadriovascular & cerebrovascular disease

Adverse Rxns: dose related tachycardia, palpitations, tremors, nausia, anxiety, multiple doses can cause paradoxical bronchoconstriction

*additive effects if given w/ other b2 agonists

Dosage: 2.5 - 5 mg in 3mL NS nebulized

Class: platelet inhibitor, anti-inflammatory

Action: prostagladin inhibition

Indications: - chest pain suggestive of AMI

- signs & symptoms suggestive of recent CVA

Contras: - hypersensitivity

- relatively contraindicated in pts w/ ulcer disease or asthma

Adverse Rxns: heartburn, GI bleeding, prolonged bleeding, n/v, wheezing in allergic pts

Dosage: 160 - 325mg PO - chew if possible

Nitroglycerin

(nitropaste, nitrospray, nitrostat, tridil)

NTG

Class: nitrate vasodilator

Action: - smooth muscle relaxer acting on bronchial, uterine & intestine smooth muscle

- dilation of arteries & veins in the periphery

- ↓ preload & ↓ afterload

- ↓ workload of the heart thereby ↓ myocardial O2 demand

Indications: - acute angina

- ischemic chest pain (S&S indicitive of AMI)

- HTN

- CHF

- pulmonary edema

Contras: hypotension, hypovolemia, IC bleed or head injury, previous administration of viagra, cialis, lentra, revatio or similar agents within past 24 hours

Adverse Rxns: headache, hypotension, syncope, reflex tachycardia, diaphoresis, n/v, muscle twitching, flushing

*additive effects w/ other vasodilators

*incompatible w/other drugs IV

Dosage: tablets/spray - 0.4mg (1tab or 1spray) SL every 3-5min until pain relief or hypotension

tridil: begin @ 10-20 mcg/min, increase 5mcg/min every 5min until desired effects

Class: beta2 specific sympathomimetic, bronchodilator

Action: b2 agonist that stimulates adrenergic receptors resulting in smooth muscle relaxation of bronchial tree

Indications: - tx of bronchospasm in pts w/ reversible obstructive airway disease (COPD/asthma)

- prevention of exercise induced bronchospasm

Contras: hypersensitivity, tachyarrhythmias (primarily those caused by digitalis) *synergistic w/ other sympathomimetics

Adverse Rxns: often dose related:

-restlessness, tremors, anxiety, palpitations, dizziness, tachycardia, periperal vasodilation, n/v, hyperglycemia, increase BP, paradoxical bronchospasm

Dosage: 2.5mg in 3mL NS nebulized, may rpt

Diazepam

(Valium)

Class: benzodiazepine, sedative, hypnotic, anxiolytic, anti-convulsant, may produce amnesia

Action: potentiates effects of inhibitory neurotransmitters of CNS, ↑ seizure threshold, induces sedation/amnesia

Indications: - acute anxiety

- acute alcohol withdrawl (delirium tremens)

- muscle relaxant

- seizures

- analgesia for medical procedures

Contras: hypersensitivity, glaucoma, shock, substance abuse, head injury

Adverse Rxns: drowsiness, ataxia, nausea, resp depression, hypotension, reflex tachycardia, confusion

Dosage: - seizure 5-10mg IV q5-10 min prn - max 30mg

sedation 5-15mg IV over 5-10min prior to precedure

anxiety 5mg IV

Atrovent

(Ipratropium)

Class: local acting anti-cholinergic

Action: parasympatholytic, inhibits action of acetylcholine on bronchial tissues

Indication: bronchospastic pulmonary disorders

Contraindications: hypersensitivity

use caution w/ tachcardia, acute hemorrhage, myocardial ischemia, glaucoma

Adverse Rxns: anticholinergic effects - blurred vision, dry mouth, urinary retention, palpitations

Dosage: 500mcg (0.5mg) nebulized. May need to add NS to fill nebulizer to 3mL

Diphenhydramine

(Benadryl)

Class: antihistamine, anticholinergic

Action: - blocks cellular histamine receptors

- ↓ vasodilation

- ↓ motion sickness

- reverses extrapyradmidal rxns

Indications: symptomatic relief of allergies, allergic rxns, anaphylaxis, dystonic / extrapyramidal rxns, blood administration rxns

Contras: asthma, glaucoma, pregnancy, HTN, pts taking MAOIs

Adverse Rxns: sedation, hypotension, seizure, vomitting, urinary retention, visual disturbances, palpitations, arrhythmias, dry mouth

* may cause paradoxical CNS excitation in children

*potentiates alcohol

Dose: 25-50mg IV, IM, PO

Class: adsorbant

Action: adsorbs toxic substances from the GI tract. Action is immediate

Indications: most poisonings / ODs, can also be used after evacuation of poisonings

Contras: oral admin to a comatose pt, after ingestions of corrosives, caustics, or petrolium distallates

Adverse Rxns: may induce n/v, may cause constipation, *bonds w/ and generally inactivates whatever it is mixed with

Dosage: 1-2g/kg PO or via NGT

(if premixed, dilute 4:1, H20:charcoal)

Class: anti-arrhythmic, sodium channel blocker

Action: ↓ automaticity by slowing depolarization

Indications: - alternate to amiodarone in vfib/vtach cardiac arrest

- stable monomorphic or polymorphic vtach w/normal QT interval

Contras: hypersensitivity, 2° or 3° AV blocks in pts w/out an artificial pacemaker, wide complex escape beats w/bradycardia

Adverse Rxns: slurred speech, confusion, seizure, death @ high doses, ALOC, bradycardia, coma

Dosage: - cardiac arrest: 1-1.5 mg/kg IV/IO rpt dose 0.5-0.75mg/kg to max of 3mg/kg

-stable vtach / ectopy: 0.5-0.75mg/kg IV/IO q5-10min, max of 3mg/kg

-maintenance drip: 1-4mg/min (4:1 drip)

Lasix

(Furosemide)

Class: loop diuretic

Action: inhibits electrolyte reabsorption in the loop of Henle & promotes excretion of sodium, potassium & chloride

Indications: CHF, Pulmonary Edema, hyptertensive crisis

Contraidications: hypovolemia, anuria, hypotension (relative contra), hypersensitivity, hepatic coma

Adverse Rxns: may exacerbate hypovolemia, hypokalemia, EKG changes, dry mouth, hyponatremia, hyperglycemia

Dosage: 0.5-1mg/kg IV/IO slow push over 1-2mins 

-if no response then double the dose

*consider doubling the pts regularily prescribed dose if pt is in crisis

Dopamine

(Inotropin)

Class: sympathomimetic, inotropic agent

Action: - ↑ systemic vascular resistance

- ↑ myocardial contractility & stroke volume

- ↑ renal blood flow

Indications: - cardiogenic, septic, or spinal shock

- distributive shock

- hypotension w/ low cardiac output states

Contras: hypovolemic shock (relative)

- vfib, tachyarrhythmias

Adverse Rxns: cardiac arrhythmias, HTN, ↑ myocardial O2 demand

*beta blockers may antagonize dopamine

Dosage: 2-20mcg/kg/min IV/IO titrate to effect

mix 400mg drug in 250mL fluid

800mg drug in 500mL fluid

1600mg drug in 1000mL fluid

Note: for easy starting dose math take pt's weight in lbs and drop off last digit

Suucinylcholine

(Anectine)

Class: depolarizing neuromuscular blocker; paralytic

Action: binds to acetylcholine receptors

Indications: - to facilitate intubation

- to terminate laryngospasm

- to promoste muscle relaxation

- to facilitate ECT (shock therapy)

Contras: - acute narrow angle glaucoma

- penetrating eye injury

- inability to control airway / support ventilations w/O2 & positive pressure

Adverse Rxns: bradycardia, exacerbation of hypokalemia in trauma pts, apnea, cardiac arrest, hypo/hypertension, hyperkalemia, arrhythmias, malignant hyperthermia, ↑ intraoccular pressure, fasciculations

Dosage: 1-2mg/kg rapid IV/IO may rpt once if needed

Class: - sedative / hypnotic

- induction agent for general anesthesia 

*no analgesic properties

Action: induces neocorticol sleep producing general anesthesia has no long lasting cardiovascular or respiratory effects may cause brief period of apnea

Indications: sedation, as an adjunct to intubation

Contras: hypersensitivity

Adverse Rxns: - short period of apnea

- hypo / hypertension

- changes in heart (slow, fast, ireegular)

- n/v

Dosage: 0.2-0.6 mg/kg IV/IO slow push given over 60-90 secs

Class: electrolyte

Action: - can cause bronchodilation after b2 agonist & anti-cholinergic have been used

- relaxes striated muscle contractions & block peripheral neuromuscular transmission by ↓ ACH release at the myoneural junction

- induces uterine relaxation

- manages seizures in toxemia of pregnancy

Indications: - vfib/vtach that is refractory to lidocaine

- asthma

-torsades de pointe

- seizures of eclampsia

- hypomagnesemia

Contras: heart blocks

Adverse Rxns: CNS depression, circulatory collapse, depressed reflexes, diaphoresis, facial flushing, hypotension

Dosage: -seizures: 1-4g IV/IO over 3mins - max 30g/day

-asthma: 1-2g IV/IO over 3mins *may mix w/50-100mL NS & infuse over 5-20min

-cardiac arrest: 1-2g IV/IO

Amiodarone

(Pacerone, Cardarone)

Class: Na+ & K+ channel blocker, anti-arrhythmic

Action: blocks Na+ & myocardial K+ channels

Indications: vfib, pulseless vtach, unstable vtach refractory to other therapy

Contras: sinus brady, cardiogenic shock, hypersensitivity, 2° or 3° AV block

Adverse Rxns: - prolonged PR, QRS, QT intervals

- use w/digitalis may cause toxicity

- bradycardia

- hypotension

Dose: vfib/pulseness vtach - 300mg IV/IO push, may rpt once at 3-5 min at 150mg IV/IO push

life threatening ventricular arrhythmias - 150mg in 50-100mL over 10mins IV/IO

Adenosine

(Adenocard)

Class: endogenous nucleotide

Action: - slows condction time through AV node

- is drug of choice for re-entry SVT

- can interrupt re-entrant pathways

- slows heart rate

- acts directly on sinus pacemaker cells

- can be used diagnostically for stable wide complex tachycardia

Indications: - may convert re-entry SVT due to Wolff-Parkinson-White Syndrome

- is not effective on afib / aflutter or vtach

- conversion of PSVT to sinus rhythm

Contras: vtach, afib, poison induced tachycardia, aflutter, sick sinus syndrome, 2° or 3° AV block

Adverse Rxns: CP, diaphoresis, facial flushing, headache, hypotension, nasuea, metallic taste, palpitations, paresthesia, SOB

Dosage: 6mg IV RAPID push over 1-3 secs followed by a 10-20mL bolus NS given through 16# or larger IV preferably AC w/arm elevated. Rpt dose @12mg - total max 30mg

Methylprednisone

(Solumedrol)

Class: anti-inflammatory glucocorticoid

Action: synthetic corticosteroid that supresses acute & chronic inflammation 

potentiates bronchial smooth muscle relaxation by b2 agonists

Indications: acute spinal cord trauma, anaphlaxis, bronchodilator for unresponsive asthma

Contras: systemic fungal infections, use caution in pts w/ GI bleed, premature infants

Adverse Rxns: headache, HTN, hypokalemia, PUD, n/v, Na+ and H20 retention, alkalosis, CHF

Dosage: acute spinal cord trauma- 30mg/kg IV over 30mins followed by 5.4mg/kg/hr

asthma/COPD/anaphylaxis - 1-2mg/kg IV

Fentanyl

(Duragesic)

Class: opioid / narcotic analgesic

Action: synthetic opioid agonist

Indications: analgesia for mod→severe pain

breakthrough CA pain

Contras: pts taking MAOIs, undiagnosed abdo pain, diarrhea caused by poisoning, head injury, hypersensitivity

Adverse Rxns: apnea, resp depression, arrhythmias, circulatory depression, headache, n/v, delirium, sedation, euphoria, agitation, seizure, constipation, coma

Dosage: 50-100mcg slow IV or IM

Class: hyperglycemic

Action: provides quickly absorbed glucose to ↑ blood glucose levels

Indications: conscious pts w/ suspected hypoglycemia

Contras: n/v, ↓LOC

Adverse Rxns: n/v

Dosage: should be sipped or sucked slowly until clinical improvement noted

Zofran

(Odansetron)

Class: selective serotonin receptor antagonist, anti-emetic

Action: blocks serotonin which may cause n/v

Indications: prevention of n/v assoc w/chemo, radiation, surgery, phamacological interventions etc

- other situations where pts may be experiencing n/v

Contras: hypersensitivity

Adverse Rxns: chest pain, headache, hypotension, dizziness

Dosage: 4mg slow IV or IM, may rpt once if needed