Acetaminophen (Tylenol) 

(Indications and Dosing)

Indications: Fever in pediatric patients

Dosing: 10-15 mg/kg orally

*Don't exceed 50 mg/kg/24 hours

Acetaminophen (Tylenol)

(Cautions, Contraindications, Drugs Interactions)

Contraindications: Hypersensitivity and Hepatic failure/impairment

Interactions: Phenothiazines (may cause hypothermia)

Phenobarbital (increases hepatic toxicity)

Acetaminophen (Tylenol)

(Class, MOA, Pharmacokinetics, Side Effects)

Class: Antipyretic, Analgesic

Adenosine

(Indications and dosing)

Adults: used for PSVT (HR>150) with sxs of CP or severe SOB

 6mg RIVP followed by 30 cc flush, 12mg RIVP, 12mg RIVP Max of 30mg

Peds: used for SVT (Infant HR>220, Child HR>180)

Peds: 0.1mg/kg (max 6mg), 0.2mg/kg (max 12mg), 0.2mg/kg (max 12mg)

Adenosine

(Cautions, Contraindications, Drugs Interactions)

• Don't administer to pts with known WPW disorder, wide complex tachycardia (QRS >0.10 sec), A-Flutter, A-Fib, 2nd/3rd degree blocks or any dysrhythmia with irregular rate.
• Caution in patients with a history of reactive airway disease, especially in patients who are actively wheezing-may cause bronchospasm. In this situation, contact MCEP prior to use.
• Caution in heart transplant pts-effects are prolonged (if 2nd dose needed, decrease to 6mg)
• Drug interactions and conditions: Tegretol (Carbamazepine), Aggrenox and Dipyradomole (Persantine) enhance the effects of Adenosine and may increase the duration of AV blocks and periods of asystole.
• Aminophylline (Xanthines) may decrease effects 
• Nicotine- may increase tachycardia

Adenosine

(Class, MOA, Pharmacokinetics, Side Effects)

Class: Antidysrhythmic

MOA: Slows AV conduction through the AV node and interrupts AV re-entry pathways in PSVT

Onset: 20-30 seconds

Duration: 30 seconds

Half-Life: 10 seconds

Side effects: facial flushing, headache, sob, dizziness, nausea

Albuterol

(Indications and dosing)

Anaphylaxis, Ashtma, COPD, Bronchitis, Bronchiolitis (RSV)

Adults: 5.0mg in 3cc 0.9% NS; Repeat as needed

Peds < 2yrs: 1.25-2.5mg in 3cc 0.9% NS; Repeat as needed

Albuterol

(Class, MOA, Pharmacokinetics, Side Effects)

Class: Sympathetic Agonist

MOA: Sympathomimetic selective for Beta 2 adrenergic receptos; prompt bronchodilator

Onset: 5-15min

Duration: 3-6hrs

Half Life: < 3hrs

Side effects: palpitations, htn, headache, anxiety, chest pain, n/v

Albuterol

(Cautions, Contraindications, Drug Interactions)

Caution: Place pt on monitor, beta adrenergic effects

Contraindications: Hypersensitivity

Drug Interactions: Beta adrenergics- potentiates effect

MAOIs- may lead to htn crisis

Beta blockers- decreases the effectiveness

Acetylsalicyclic Acid (Aspirin)

(Indications and Dosing)

Cardiac Chest Pain

162-325mg tablets PO

Acetylsalicyclic Acid (Aspirin)

(Cautions, contraindications, drug interactions)

Caution in pts with a tendency for GI irritation and bleeding

Caution in pts with NSAID allergies

Relative contraindication in pts with active ulcer disease and asthma

May decrease absorption when combined with antacids

Increased side effects with other anti-inflammatories

Acetylsalicyclic Acid (Aspirin)

(Class, MOA, Pharmacokinetics, Side Effects)

Class: Platelet aggregator inhibitor

MOA: inhibits platelet function by blocking the formation of the substance "thromboxane A2"

Onset: 5-30min

Duration: 1-4hrs

Half Life: 15-20min

Side effects: Heartburn, GI bleeding, n/v, wheezing, prolonged bleeding

Atropine

(Indications and Dosing)

Adults: Organophosphate poisoning; Mushrooms; Nerve Gases; Symptomatic Bradycardia- hypoperfusion (decreased/altered LOC, CP, SOB, acute heart failure or other SxS of shock)

0.5mg IV/IO/ET; max 3mg

Peds > 6mon: Symptomatic Bradycardia- decreased LOC, hypotension, cyanosis/mottling/pallor, prolonged cap refill, weak/absent peripheral 

pulses

0.02mg/kg IV/IO (0.1mg min dose, 0.5mg max single dose) q 5min. May repeat once.

0.04mg/kg ET (0.1mg min dose, 0.5mg max single dose) q 5min. May repeat once

Atropine

(Cautions and Contraindications)

Atropine

(Class, MOA, Pharmacokinetics, Side Effects)

Class: Anticholinergic/Parasympatholytic

MOA: acts by binding to acetylcholine receptors thus inhibiting parasympathetic stimulation; positive chrontropic, negative inotropic

Onset: Immediate

Duration: 4hrs

Half Life: 2-3hrs

Side effects: blurred vision, dilated pupils, dries secretion (mouth, lungs digestive tract), bronchodilator, tachycardia, drowsiness, confusion

Calcium Gluconate 

(Indications and Dosing)

Indications: Antidote for Ca++ Channel blocker OD

Magnesium Sulfate OD

Black Widow spider bite

Dosing: Adults- 5-10ml SIVP (don't exceed 2ml/min). Repeat prn after 5-10min

Peds- 0.6ml/kg SIVP of a 10% solution

Calcium Gluconate

(Cautions, Contraindications, Drugs Interactions)

Cautions: May produce bradycardia and hypotension if administered fast

May increase cardiac irritability (PVCs)

Local infiltration will cause tissue necrosis

Contraindications: Hyperkalemia

Drug Interactions: Increase toxicity of cardiac glycoside

Calcium Gluconate

(Class, MOA, Pharmacokinetics, Side Effects)

Class: Electrolyte

Side Effects: May cause PVCs

Dextrose

(Indications and Dosing)

Hypoglycemia < 60mg/dl with AMS

Adults-D50W 25-50gm SIVP; titrate to effect

12.5-25gm Orally

*Can be given rectally

Peds-D25W 0.5gm/kg (2ml/kg) SIVP (dilute D50W 1 to 1 w/ NS to make D25W)

*Can be given rectally

Neonate: Hypoglycemia < 45mg/dl; Cardiac Arrest

D10W 0.5gm/kg (5ml/kg) SIVP (dilute 50 cc D50W in 500 ml bag NS to make D10W OR dilute 25 cc D50W in 250 ml bag NS)

Dextrose

(Class, MOA, Pharmacokinetics, Side Effects)

Class: Carbohydrate

MOA: a six-carbon sugar d-glucose which is the main form of carbohydrate used by the body

Onset: Immediate

Duration: Varies

Half Life: N/A

Side effects: Tissue necrosis if infiltrated, phlebitis at the injection site

Dextrose

(Cautions, Contraindications, Drug Interactions)

Cautions: Re-check that line is patent during administration

Contraindications: Intra-cranial bleeds, CVAs, Delirium tremens, admin through the same set as blood

No drug interactions

Diazepam

(Indications and Dosing)

Post-Intubation Sedation: Adult-titrate to total of 0.2mg/kg (don't exceed 5 mg/min) (Peds > 5y/o titrate to a total of 0.2 mg/kg not to exceed 1 mg/min)

*Versed preferred

TCP: Adult- 2.5-5.0mg increments SIVP q 3-5min; max 0.2mg/kg (10mg)

Sync Cardio: Adult 2.5–5.0mg increments SIVP; max 0.2mg/kg

(Peds- 0.1–0.2mg/kg IV/IO) *Versed preferred for Peds

Convulsive Seizures/Status Epilepticus: Adult-0.2mg/kg IV/IO; max 10mg (don't exceed 5mg/min)

Peds < 5y/o 0.2mg/kg IV/IO; max 5mg (don't exceed 1mg/min); 0.5mg/kg rectal via 3cc lubed syringe; max 10mg

Infant-0.2mg/kg IV/IO over 2-3min; max 2.5mg

Eclampsia (if given Mag and pt still seizing): Adult 0.2mg/kg IV/IO; max 0.2mg/kg (don't exceed 5mg/min)

Diazepam

(Cautions, contraindications, and drug interactions)

Cautions: drug is short-acting so seizure activity may resume

Local venous irritation may occur

Apnea in children may occur

Drug Interactions: Effects may be additive with other CNS depressants, alcohol, narcotics

Contraindications: CNS Depression

Diazepam

(Class, MOA, Pharmacokinetics, Side Effects)

Class: Anticonvulsant and Sedative

MOA: Binds to GABA receptors in the brain which potentiates GABA which causes sedation

*Good for procedural sedation due to it's amnesic properties which diminshes pt's memory

Onset: 1-5min IV

Duration: 15-60min

Half Life: 20-50hrs

Side effects: hypotension, drowsiness, headache, amnesia, respiratory depression, blurred vision, n/v

Diphenhydramine

(Indications and Dosing)

Allergic Reactions, Anaphylaxis, Dystonic Rxns to phenothiazines (intermittent spasmodic or sustained involuntary contractions of muscles in the face, neck, trunk, pelvis, extremities, and even the larynx) Motion Sickness

Adults:25-50mg SIVP/IO/Deep IM; max 50mg

Pediatrics: 1mg/kg SIVP/IO/Deep IM; max 50mg

Diphenhydramine

(Cautions and Contraindications)

May cause hypotension

Contraindicated in asthma pts and nursing mothers

Diphenhydramine

(Class, MOA, Pharmacokinetics, Side Effects)

Class: Antihistamine

MOA: Blocks histamine receptors

Onset: N/A

Duration: N/A

Half Life: N/A

Side effects: Sedatiom, blurred vision, dries bronchial secretions, palpitations

Dopamine (Dopastat, Inotropin)

(Indications and Dosing)

Septic shock- 4-12mcg/kg/min (titrated to increase BP >90) 

Symtomatic Brady (unresponsive to pacing/Atropine)- 4-12mcg/kg/min (titrated to increase BP >90)

Cardiogenic Shock (unresponsive to fluid bolus or if fluid contraindicated)-

4-12mcg/kg/min

Anaphylaxis where pt continues to decompensate

*Needs MCEP

*Mix 400 mg in 250 cc D5W or NS (Concentration of 1600 mcg/ml)

OR 800 mg in 500 cc OR 1600 mg in 1000 cc

Dopamine

(Class, MOA, Pharmacokinetics, Side Effects)

Class: Naturally occuring catecholamine

MOA: increase bp by acting on alpha (peripheral vasoconstriction) and beta 1 (positive inotropic but doesn't increase myocardial O2 demand) adrenergic receptors

*maintains renal and mesenteric blood flow

Onset: < 5min

Duration: < 10min

Half Life: 2min

Side effects: nervousness, headache, palpitations, dysrhythmias, cp, dyspnea, n/v

Dopamine

(Cautions, Contraindications, Drug Interactions)

Contraindications: Pheochromocytomas, Tachydysrhythmias

Drug Interactions: Hypotension/Bradycardia with Phenytoin

Reduced effects with Beta Adrenergic blocker

Cautions: High doses can lead to central vasoconstriction and limit renal blood flow

Epinephrine 1:1,000 

(Indications and Dosing)

Bradycardia: 1mg (1:1000) in 250 cc NS at 2-10mcg/min

Peds- 0.1-0.2mcg/kg/min (0.6 x kg = mg to add to NS to create total volume of 100 ml) Run at 1ml/hr

Bronchospasm/Anaphylaxis: 0.3mg (1:1000) SQ/IM

Peds- 0.01mg/kg (1:1000) SQ, max of 0.3mg/dose

Epinephrine 1:10,000

(Indications and Dosing)

Cardiac Arrest: 1mg (1:10,000) q 3-5min IV/IO

2mg (1:10,000) ET

Peds- 0.01mg/kg (1:10,000) IV/IO (Subsequent doses: 0.1mg/kg (1:1000) IV/IO/ET)

0.1mg/kg (1:1000) ET

Bronchospasm/Anaphylaxis: 0.3mg (1:10,000) IV/IO

Epinephrine

(Cautions, Contraindications, Drugs Interactions)

Caution in anaphylaxis- increased cardiac workload can precipitate angina

Caution in pt's with peripheral vascular insufficiency

No contraindications

Drug Interactions: Reduced effects with beta adrenergic blockers

Epinephrine

(Class, MOA, Pharmacokinetics, Side Effects)

Class: Sympathomimetic

MOA:

Onset:

Duration:

Half-Life:

Side effects:

Fentanyl

(Indications and Dosing)

Sedation for TCP

Analgesia for pt's in moderate to severe pain

Adults: 1-4 mcg/kg IVP

Peds- <15 kg IN only 2-12 y/o 1 mcg/kg

Fentanyl

(Cautions, Contraindications, Drug Interactions)

Caution in bradycardic pts

Caution in elderly, diabetics, head trauma, increased ICP, undiagnosed abdominal pain

Caution in pts with liver and kidney disease 

Contraindicated in severe hemorrhage,shock, pregnancy and myasthenia gravis

Potentiating effect when combined with other CNS depressants (barbiturates, narcotics, anesthetics, tranquillizers)

Not recommended with MAOIs

Fentanyl

(Class, MOA, Pharmacokinetics, Side Effects)

Class: Narcotic analgesic

MOA: similar to Morphine but 50-100 x more powerful (100mcg Fent=10mg Morph) ; analgesic and sedative

Onset: Immediately

Duration: 30-60min

Half-Life: 6-8hrs

Side effects: Respiratory depression, apnea, muscle rigidity, bradycardia

Furosemide (Lasix)

(Indications and Dosing)

Pulmonary Edema

Hypertensive emergencies (AMI, APE, Encephalopathy)

Adults: 20-40mg SIVP or 0.5-1.0mg/kg *if pt is not already taking Lasix

*if pt already taking Lasix- double their PO dose

Can repeat once

Peds: 1.0mg/kg SIVP; may repeat in 6-8 hours

Furosemide (Lasix)

(Cautions, Contraindications, Drugs Interactions)

Caution: can lead to electrolyte depletion and shock- don't use in hypovolemic pts

Use in children and pregnant women with caution

Contraindications: Hypovolemia, Hyperkalemia, Hypotension

Drug Interactions: Hypotension with antihypertensives and nitrates

Furosemide (Lasix)

(Class, MOA, Pharmacokinetics, Side Effects)

Class: Loop Diuretic

Moa:

Onset:

Half-life:

Duration:

Side effects:

Glucagon

(Indications and Dosing)

Symtpomatic hypoglycemia when IV can't be initiated

Adults: 0.5-1mg IM/SQ/IVP; may repeat in 10-20min if no response

Peds:0.1mg/kg IM/SQ/IVP; may repeat in 10-20min if no response

Beta blocker OD

Adults: 3-10mg IVP over 1min

Peds: 0.1mg/kg IVP over 1 min; may repeat in 5min

Anaphylaxis: refractory to Epi

Adults: 1-2mg SIVP q 5-10min

Peds: 0.1mg/kg max of 1mg

*1mg= 1 unit

Glucagon

(Cautions, Contraindications, Drugs Interactions)

*mix 1ml of NS for every 1mg of Glucagon

Cautions: Pt must be given supplemental Glucose ASAP either PO, rectal, IV

Caution in pt's with Pheochromocytomas

Contraindications: Pt's who won't be able to receive supplemental glucose after

Hypersensitivity to pork or beef

Drug Interactions: Will precipitate with Calcium preperation

Hyperglycemia effects intensified by Epi

Glucagon

(Class, MOA, Pharmacokinetics, Side Effects)

Ipratropium

(Indications and Dosing)

Bronchospasm due to Asthma, COPD, Bronchitis, Emphysema

*Administer with Albuterol

Adults: 250-500mcg OR 0.25-0.5mg via neb

Ipratropium

(Cautions, Contraindications, Drugs Interactions)

Caution in administering to elderly and those with Cardiovascular disease and HTN

Contraindications: Hypersensitivity to the drug

Tx of bronchospam when a rapid response is required

No drug interactions

Ipratropium

(Class, MOA, Pharmacokinetics, Side Effects)

Lidocaine

(Indications and Dosing)

VF/Pulseless VT: 1.0mg/kg IV/IO (max of 3.0mg/kg); repeat at 0.5-0.75mg/kg (Same for peds)

2.0mg/kg ET diluted in 0.9% NS to 10ml (Peds: 2.0mg/kg; repeat 1mg/kg q 3-5min (max 6mg/kg)

Given after 3rd defibrillation

Unstable VT (hypotensive, AMS, SOB, CP): 1.0-1.5mg/kg SIVP/IO (Repeat 0.5-0.75mg/kg SIVP/IO q 5min until arrhythmia resolves or 3mg/kg has been given)

Alternate Lidocaine with continued synchronized cardioversion at max joule setting until VT is terminated

*If VT is terminated, start Lido drip*

If pt goes into stable VT post-ROSC:

If no Lidocaine was administered during the arrest, administer 1.0–1.5mg/kg SIVP. If the dysrhythmia persists, (repeat 0.5-0.75mg/kg may be admin SIVP q 5-10min (max of 3mg/kg)

If Lidocaine was administered during arrest, consider amount already given as well as time of last administration when administering additional doses post-ROSC

Lido Drip:

Adults: Mix 1gm in 250 NS for a concentration of 4mg/ml

up to 2mg/kg-drip at 2mg/min; if 2mg/kg-drip at 3mg/min; if 3mg/kg-drip at 4mg/min

Peds: Mix 120mg of Lido in 100 ml D5W

set drip at 20-50 mcg/kg/min OR 1-2.5 cc/kg/hr

Lidocaine

(Cautions and Contraindications)

Benefits of Lido probably limited to VT caused by cardiac ischemia

Cautions: Pt's over 70 or with hepatic/renal failure-maintenance infusion if run at 1/2 the normal dose

Contraindicated in 2nd and 3rd degree heart blocks- slows conduction from the atria to the ventricles

Don't administer Lido if you suspect hyperkalemia (e.g., renal failure patients on dialysis) or if the underlying rhythm is believed secondary to an overdose by an agent that blocks sodium channels {e.g., TCAs, phenothiazines, B-blockers, antihistamines, cocaine or Class 1 anti-arrhythmic agents-procainamide, amiodarone [weak Class 1 effects], quinidine, disopyramide, flecainide or phenytoin}- drug toxicity may result

Lidocaine

(Class, MOA, Pharmacokinetics, Side Effects)

Class: Antidysrhythmic

MOA: depresses depolarization and automaticity in the ventricles *pt's successfully defibrillated should be treated with Lido

Onset: <3min

Duration:10-20min

Half-Life: 1.5-2.0hrs

*75-100mg bolus will maintain therapeutic levels for only 20 min, so follow the bolus with a 2-4mg/min infusion to maintain levels

Side effects: drowsiness, seizures, confusion, hypotension, bradycardia, n/v, heart blocks

Magnesium

(Indications and Dosing)

Reactive airway disease refractory to albuterol and epi: 2gm IV/IO over 5-10min (Peds <50kg: 20-25mg/kg)

Control contractions in pre-term labor: 2gm SIVP followed by maintenance of 1gm/hr

Eclampsia (seizure): 2-4gm over 12min

Pre-eclampsia(increasing HTN, HA, clonus, visual disturbances, RUQ pain, edema of the lower extremities): 2gm over 12min *Needs MCEP

VFib/VTach refractory to Lidocaine: 2gm IVP

VTach unresponsive to Lido- 2gm SIVP

Torsades de Pointes: stable - 2gm over 12min; unstable - 2gm over 3-6min; 30mg/min infusion if indicated; pulseless - 2gm over 1-2min

(Peds: stable and unstable - 25mg/kg IV/IO over 6min and initiate 0.5mg/kg/min infusion; pulseless - 50mg/kg)

Magnesium

(Cautions, Contraindications, Drug Interactions)

If admin too rapidly (i.e., faster than parameters listed) severe hypotension, dysrhythmia, respiratory depression, or cardiac arrest

 Monitor deep tendon reflexes often

Contraindicated in pts with renal failure (kidney's are the major exit for Magnesium from the body)

Contraindicated in pts with heart block, in shock, severe HTN, routine dialysis, hypocalcemia, hypermagnesemia

Can cause cardiac conduction abnormalities if given with digitalis

*Calcium chloride is the antidote

Magnesium

(Class, MOA, Pharmacokinetics, Side Effects)

Class: Antidysrhythmic/electrolyte; essential element in numerous biochemical rxns that occur in the body

MOA: Physiological Ca++ Channel Blocker; appears to recude the incidence of ventricular dysrhythmias; CNS depressant (used for ecclampsia)

*Hypomagnesemia can cause dysrhythmias

Onset: Immediate (IV) 1hr (IM)

Duration: 1hr

Half-Life: N/A

Side effects: Flushing, sweating, bradycardia, decreased deep tendon reflexes, drowsiness, hypotension, itching and rash

Midazolam

(Indications and dosing)

Chemical sedation for violently agitated patient: 5mg IM or 1-2mg IV (max 2.5mg)

Status epilepticus (consider if IV access not readily available): 0.1mg/kg IM (max 5mg) (Peds- 0.1mg/kg IN (via MAD nasal atomizer) or IM (max 5mg))

Eclamptic seizures (if unable to establish IV/IO): 0.1mg/kg IM (max 5mg)

Synchronized cardio: 1-2mg increments IV (max 5mg) (Peds: 0.025–0.05mg/kg IV/IO)

Post-Intubation Sedation: 1-2mg increments SIVP q 3-5min (max 5.0mg) (Peds:Titrate in 0.05mg/kg increments up to 0.2mg/kg (Absolute max of 5.0mg)

TCP: 1-2mg increments SIVP q 3-5min (max 5.0mg)

*Only if narcotic analgesia is contraindicated (ie: allergy)

Midazolam

(Cautions, Contraindications, and Drug Interactions)

Elderly pts >65, pts with known COPD, and pts on meds that enhance Midazolam’s effects should receive ½ of the normal adult dose (2.5 mg IM)

Contraindicated in narrow-angle glaucoma, shock, or pts in alcoholic coma

Midazolam is a potent respiratory depressant, especially when given intravenously and is also a cardiovascular depressant. May cause hypotension. Noted to cause mild to moderate drops in blood pressure, especially in patients who are volume depleted

Drug interactions that prolong the respiratory depressant effects of midazolam include: Antifungals (e.g., ketoconazole and fluconazole), HIV Antivirals (protease inhibitors and reverse transcriptase inhibitors), Macrolides antibiotics (e.g., erythromycin) and certain anti-depressants (SSRI inhibitors).

Midazolam

(Class, MOA, Pharmacokinetics, Side Effects)

Class: Sedative/hypnotic

MOA: binds to GABA receptor sites in the brain which potentiates GABA-increased GABA causes sedation; 3-4x more potent then Valium-no effect on pain

Onset: 3-5min (IV) 15min (IM)

Duration: < 2hrs (IV) 1-6hrs (IM)

Half-Life: 1-4hrs

Side effects: laryngospasm, bronchospasm, dyspnea, respiratory depression, amnesia, bradycardia, PVCs

Morphine

(Indications and Dosing)

Isolated extremity trauma and burns: 2-6mg increments (max 20mg);

(Peds <12y/o: 0.1mg/kg increments (max 0.15mg/kg) 

Cardiac chest pain: 2-6mg increments (max 10mg)

*Chest pain, give if NTG hasn't releived pain or if contra.

 (Peds <12y/o: 0.1mg/kg increments q 3-5min (max 0.15mg/kg)

*Peds <18 y/o needs MCEP order

TCP: 2mg increments (max 10mg); (Peds <12y/o: 0.05–0.1mg/kg increments (max 0.15 mg/kg); *Fentanyl is preferred

Right ventricular AMI: 1-2mg increments (max 10mg) *MCEP order required

Acute Pulmonary Edema

Morphine

(Cautions, Contraindications, Drug Interactions)

Contraindications: hypotensive pts (systolic <100), pts with a Morphine allergy, or pts with suspected head, chest, or abdominal injuries

 Don't use in pt's with respiratory difficulties-resp drive may be depressed

Enhanced effects when given with barbiturates, antihisamines, antiemetics, sedatives, hypnotics, alcohol

Drug Interactions: additive effects with CNS depressants

MAOIs-reduce dose to 25% of usual dose

Morphine

(Class, MOA, Pharmacokinetics, Side Effects)

Class: Narcotic analgesic

MOA: CNS depressant that acts on opiate receptors in the brain causing sedation and analgesia; decreases venous return and systemic vascular resistance, decreases myocardial O2 demand,

Onset: Immediate (IV) 15-30min (IM)

Duration: 2-7hrs

Half-Life: 1-7hrs

Side effects: N/V, headache, abdominal cramps, constricted pupils. respiratory depression

Naloxone (Narcan)

(Indications and Dosing)

Suspected narcotic OD: unconscious or depressed mentation and either apneic or bradypneic. Opiate ingestion will be suspected based on history or circumstances found at scene. Pupils will be small to pinpoint.

(Morphine, Demerol, Heroin, Dilaudid, Percodan, Codeine, Darvon, Fent)

 0.4-2.0mg IM/IV/IO/ET (max 2.0mg); 2mg IN with repeat dose 1mg (max 3.0mg)

Peds: <5y/o OR <20kg 0.01mg/kg IM/IV/IO/IN/SQ/ET, max 2.0mg

>5y/o OR >20kg 2mg IM/IV/IO/ET/SQ/IN

*May repeat 0.1mg/kg

Neonate: 0.1mg/kg SIVP/ET/IM/SQ/IO; repeat in 2-3 min if needed

mix 1ml (0.4mg) in 9ml of D5W

Naloxone

(Class, MOA, Pharmacokinetics, Side Effects)

Class: Narcotic antagonist

MOA: Competes for opiod receptors and can displace narcotic molecules from the receptors

Onset: < 2min (IV), 2-10min (IM, ET)

Duration: 2-120min

Half-Life: 60-90min

Side effects: Rare but N/V, hypotension, HTN and ventricular dysrhythmias have been reported

Nitroglycerine

(Indications and dosing)

Cardiac Chest Pain: 0.4mg SL (max 1.2mg)

Hypertensive Emergencies (APE, AMI, Encephalopathy)

Pulmonary Edema/CHF: SOB and rales, pink frothy sputum (classic sign but usually absent) pt will be anxious, pale, clammy and acutely dyspneic/tachypneic, will avoid recumbency, and attempt to sit upright

0.4mg SL q 5min (max 1.2mg) until SOB relieved

Nitroglycerine

(Cautions, Contraindications, Drug Interactions)

Contraindicated in: Hypotensive pts (systolic <100)

Pt's with ICP

Suspected right sided AMI

Pt's who have taken sexual performance enhancing drugs (SPED) w/in the last 48hrs

Pericardial Tamponade

Caution: may cause orthostatic hypotension when given with beta-blockers

Drug Interactions: Added hypotension with Beta Blockers, Ca++ Ch. Blockers, and Phenothiazines

TCAs and Antihistamines may interfere w/ absorption

Nitroglycerine

(Class, MOA, Pharmacokinetics, Side Effects)

Class: Nitrate

MOA: smooth muscle relaxer that reduces the work load of the heart, dilates coronary arteries, and vasodilates- this increases coronary blood flow, decreases preload and improves cardiac perfusion

Onset: 1-3min

Duration: 20-30min

Half Life: 1-4min

Side Effects: headache (from dilation of cerebral vessels), dizziness, tachycardia, hypotension, skin rash, orthostasis

Oxytocin (Pitocin)

(Indications and Dosing)

Control of post-partum hemorrhage

*10 USP units or 20mg/ml

IV: 10-20USP units in 500 ml NS; run at 10-15 gtts/min titrated to severity of hemorrhage and uterine response

IM: 10 USP units IM

Oxytocin (Pitocin)

(Cautions, Contraindications, Drugs Interactions)

Cautions: None

Containdications: Potential of a remaining fetus

Drug Interactions: HTN with vasopressors (Dopamine, Epi, Levophed, Vasopressin)

Oxytocin (Pitocin)

(Class, MOA, Pharmacokinetics, Side Effects)

Class: Pituitary Hormone

MOA:

Onset:

Duration:

Half-Life:

Side Effects: None

Phenylepherine (Neo-Synephrine)

(Indications and Dosing)

Reduces bleeding during nasal intubation

2 "squirts" in the selected nare prior to intubation

Phenylepherine (Neo-Synephrine)

(Cautions, Contraindications, Drugs Interactions)

Caution in elderly pts, sever arteriosclerosis, bradycardia, partial heart block, pregnancy and lactation

Contraindicated in VTach, HTN, and known hypersensitivity

Drug Interactions: may decrease the effectiveness of Insulin

Use with Beta Blockers may result in HTN followed by bradycardia

MAOIs- causes HTN

Phenylepherine

(Class, MOA, Pharmacokinetics, Side Effects)

Class: Alpha Adrenergic Agent

Nasal Vasoconstrictor

MOA:

Onset:

Duration:

Half Life:

Side Effects:

Promethazine (Phenergan)

(Indications and Dosing)

Treatment and Prevention of Nausea/Vomiting

Adults: 12.5-25 mg PO/IM/IV or rectally q 4 hours

Peds > 2y/o: 0.25-0.5 mg/kg PO/IM/Rectal q 4 hours

Promethazine (Phenergan)

(Cautions, Contraindications, Drugs Interactions)

Caution: in Children-use with prolonged vomiting of known etiology

May cause marked drowsiness

Caution in HTN, epilepsy, sleep apnea, cardiovascular disease, liver impairement, pregnancy

Contraindicated in Lactation, Children <2y/o, CNS Depression, Comatose pts, Hypersensitivity to phenothiazines

Drug Interactions: Caution with anticholinergics, MAOIs, and CNS depressants

Promethazine

(Class, MOA, Pharmacokinetics, Side Effects)

Class: Antiemetic

MOA:
Onset:

Duration:

Half-Life:

Side Effects:  

Sodium Bicarbonate

(Indications and dosing)

 Suspected hyperkalemia (dialysis pt with ‘sine wave’ pattern or sino-ventricular rhythm)  or TCA OD or if Na+ channel blocking agent OD/ingestion is suspected (ie:TCA, phenothiazines, beta blockers, antihistamines, cocaine, or Class 1 anti-arrhythmic agents such as procainamide, amiodarone [weak Class 1 effects], quinidine, disopyramide, lidocaine, flecainide or phenytoin) in

Cardiac arrest and stable/unstable VT: 1mEq/kg IV (may repeat once after 5min at 0.5mEq/kg)

Adult and Peds Dosing

*Should proceed Lidocaine in this circumstance

Sodium Bicarbonate

(Class, MOA, Pharmacokinetics, Side Effects)

Class: Alkalinizing agent

MOA: a salt that provides bicarbonate to buffer metabolic acidosis- used in TCA overdose because TCA excretion is enhanced by making the urine more alkaline (raising the pH)

Onset: Immediate

Duration: 1-2hrs

Half Life: N/A

Side Effects: Very few

Sodium Bicarb

(Cautions, Contraindications, Drug Interactions)

Cautions: Will stress the heart in Cardiovascular disease by increasing intravascular volume

Contraindications: Suspected metabolic/respiratory alkalosis

Drug Interactions:Inactivates most drugs, don't give in the same IV at the same time

Causes calcium preparations to precipitate