Aspirin (ASA, Bayer, Ecotrin, St. Joseph)

CLASS:

Antiplatelet/Antithrombotic

Aspirin also falls under many other functional classifications

Aspirin (ASA, Bayer, Ecotrin, St. Joseph)

Indications:

Aspirin (ASA, Bayer, Ecotrin, St. Joseph)

 Mechanism of Action:

Aspirin (ASA, Bayer, Ecotrin, St. Joseph)

Adult Dosage/Administration:

160 mg to 325 mg PO

Chewing is preferable to swallowing

Aspirin (ASA, Bayer, Ecotrin, St. Joseph)

Pedi Dosage/Administration:

Aspirin (ASA, Bayer, Ecotrin, St. Joseph)

How Supplied:

Aspirin (ASA, Bayer, Ecotrin, St. Joseph)

Contraindications:

Hypersensitivity

Relatively contraindicated in patients with active ulcer disease or asthma

Aspirin (ASA, Bayer, Ecotrin, St. Joseph)

Adverse reactions/Side effects:

Bronchospasm

Anaphylaxis

wheezing in allergic patients

prolonged bleeding

GI bleeding

epigastric distress

nausea/vomiting

heartburn

Reye syndrome

Aspirin (ASA, Bayer, Ecotrin, St. Joseph)

Drug Interactions:

Aspirin (ASA, Bayer, Ecotrin, St. Joseph)

Duration of Action:

Onset: 30–45 minutes

Peak effect: Variable

Duration: Variable

Aspirin (ASA, Bayer, Ecotrin, St. Joseph)

Special Considerations:

Pregnancy safety: Category D

Not recommended in pediatric population

Atropine Sulfate

  CLASS:

Atropine Sulfate

  Indications:

Hemodynamically unstable bradycardia, organophosphate poisoning, nerve agent exposure, rapid sequence intubation in pediatrics, beta blocker or calcium channel blocker overdose.

Atropine Sulfate

Mechanism of Action:

Inhibits the action of acetylcholine at postganglionic parasympathetic neuroeffector sites

Increases heart rate in life-threatning bradydysrhythmias

Atropine Sulfate

Adult Dosage/Administration:

Unstable bradycardia: 0.5 mg IV/IO every 3–5 minutes as needed. Not to exceed total dose of 0.04 mg/kg (maximum 3 mg total)

Use shorter dosing interval (3 minutes) and higher doses in severe clinical conditions.

Organophosphate poisoning: Extremely large doses (2–4 mg or higher) may be needed.

Atropine Sulfate 

Adolescent Dosage/Administration:

1 mg. Maximum total dose:

Child: 1 mg

Adolescent: 3 mg.

ET dose: 0.04–0.06 mg/kg

Rapid sequence intubation: 0.01–0.02 mg/kg IV/IO (minimum: 0.1 mg, maximum: 0.5 mg)

Atropine Sulfate

 Pedi Dosage/Administration:

Unstable bradycardia: 0.02 mg/kg IV/IO (minimum dose: 0.1 mg). May repeat once

Maximum single dose: Child: 0.5 mg.

Atropine Sulfate

How Supplied:

1 mg in 10 mL (0.1 mg/mL) Prefilled syringes

0.2% (1 mg in 0.5 mL) and 0.5% (2.5 mg in 0.5 mL) Nebulizer

Atropine Sulfate

 Contraindications:

Tachycardia

Hypersensitivity

Unstable cardiovascular status in acute hemorrhage with myocardial ischemia

Narrow-angle glaucoma

Hypothermic bradycardia

Atropine Sulfate 

Adverse Reactions/Side effects:

Drowsiness

Confusion

Headache

Tachycardia

Palpitations

Dysrhythmias

Nausea/Vomiting

Pupil dilation

Dry mouth/nose/skin

Blurred vision

Urinary retention

Constipation

Flushed, hot, dry skin

Paradoxical bradycardia when pushed too slowly or when given at low doses.

Atropine Sulfate

 Drug Interactions: 

Potential adverse effects when administered with digitalis, cholinergics, physostigmine

Effects enhanced by antihistamines, procainamide, quinidine, antipsychotics, benzodiazepines, and antidepressants.

Atropine Sulfate

Duration of Action:

Onset: Immediate

Peak effect: Rapid to 1–2 minutes

Duration: 2–6 hours

Atropine Sulfate

Special Considerations:

Pregnancy safety: Category C

Moderate doses may cause pupillary dilation.

Paradoxical bradycardia can occur with doses lower than 0.1 mg

Morphine Sulfate (Roxanol, MS Contin)

CLASS:

Opioid analgesic

(Schedule II Narcotic)

Morphine Sulfate (Roxanol, MS Contin)

Indications:

Severe CHF

acute cardiogenic pulmonary edema

chest pain associated with acute myocardial infarction

analgesia for moderate to severe acute and chronic pain

Morphine Sulfate (Roxanol, MS Contin)

Mechanism of Action:

Alleviates pain through CNS action

Suppresses fear and anxiety centers in the brain

Depresses brainstem respiratory centers

Increases peripheral venous capacitance and decreases venous return

Decreases preload and afterload, which decreases myocardial oxygen demand

Morphine Sulfate (Roxanol, MS Contin)

Adult Dosage/Administration:

STEMI: Initial dose: 2–4 mg slow IV (over 1–5 minutes)

Repeat dose: 2–8 mg at 5–15 minute intervals

NSTEMI/Unstable angina: 1–5 mg IV push if symptoms not relieved by nitrates, use with caution

Morphine Sulfate (Roxanol, MS Contin)

Pedi Dosage/Administration:

0.1–0.2 mg/kg/dose IV, IO, IM, SC

Maximum dose: 5 mg

Morphine Sulfate (Roxanol, MS Contin)

How Supplied:

Morphine Sulfate (Roxanol, MS Contin)

Contraindications:

Head injury

exacerbated COPD

depressed respiratory drive

hypotension

undiagnosed abdominal pain

decreased level of consciousness

suspected hypovolemia, patients who have taken MAOIs within 14 days

Morphine Sulfate (Roxanol, MS Contin)

Adverse Reactions/Side effects:

Confusion

Sedation

Headache

CNS depression

respiratory depression

apnea

bronchospasm

dyspnea

hypotension

orthostatic hypotension

syncope

bradycardia

tachycardia

nausea/vomiting

dry mouth

Morphine Sulfate (Roxanol, MS Contin)

Drug Interactions:

Potentiates sedative effects of phenothiazines

CNS depressants may potentiate effects of morphine

MAOIs may cause paradoxical excitation

Morphine Sulfate (Roxanol, MS Contin)

Duration of Action:

Onset: Immediate

Peak effect: 20 minutes

Duration: 2–7 hours

Morphine Sulfate (Roxanol, MS Contin)

Special Considerations:

Pregnancy safety: Category C

Morphine rapidly crosses the placenta Safety in neonates has not been established

Use with caution in the elderly, those with asthma, and in those susceptible to central nervous system depression

Vagotonic effect in patients with acute inferior MI (bradycardia, heart block)

Naloxone hydrochloride (Narcan) should be readily available as an antidote

Naloxone Hydrochloride (Narcan)

CLASS:

Naloxone Hydrochloride (Narcan)

Indications:

Opiate overdose

complete or partial reversal of central nervous system and respiratory depression induced by opioids

decreased level of consciousness

coma of unknown origin

Narcotic agonist for the following: morphine sulfate, heroin, hydromorphone (Dilaudid), methadone, meperidine (Demerol), paregoric, fentanyl (Sublimaze), oxycodone (Percodan), codeine, propoxyphene (Darvon)

Narcotic agonist and antagonist for the following: butorphanol (Stadol), pentazocine (Talwin), nalbuphine (Nubain)

Naloxone Hydrochloride (Narcan)

Mechanism of Action:

Competitive inhibition at narcotic receptor sites

Reverses respiratory depression secondary to opiate drugs

Completely inhibits the effect of morphine

Naloxone Hydrochloride (Narcan)

Adult Dosage/Administration:

0.4–2 mg IM/IV/IO/SQ/ET/Intranasal (diluted)

Minimum single dose recommended: 2 mg

Repeat at 5-minute intervals to a maximum total dose of 10 mg (medical control may request higher amounts)

Naloxone Hydrochloride (Narcan)

Pedi Dosage/Administration:

0.1 mg/kg/dose IV/IO/IM/SQ every 2 minutes as needed

Maximum total dose of 2 mg

If no response in 10 minutes, administer an additional 0.1 mg/kg/dose

Naloxone Hydrochloride (Narcan)

How Supplied:

Adult: 0.4 – 2.0 mg IV, IO, ET, IM,SC or IN q 5 minutes as needed to reverse the effects of the narcotics OD to a maximum of 10.0 mg

Pediatric: 0.1 mg/kg every 2 minutes to maximum of 2 mg. If no response in 10 minutes administer another 0.1 mg/kg dose

Naloxone Hydrochloride (Narcan)

Contraindications:

Use with caution in narcotic-dependent patients

Use with caution in neonates of narcotic-addicted mothers.

Naloxone Hydrochloride (Narcan)

Adverse Reactions/Side effects:

Restlessness

Seizures

Dyspnea

pulmonary edema

tachycardia

hypertension

dysrhythmias

cardiac arrest

nausea/vomiting

withdrawal symptoms in opioid-addicted patients

diaphoresis

Naloxone Hydrochloride (Narcan)

Drug Interactions:

Naloxone Hydrochloride (Narcan)

Duration of Action:

Onset: <2 minutes

Peak effect: Variable

Duration: 30–60 minutes

Naloxone Hydrochloride (Narcan)

Special Considerations:

Pregnancy safety: Category C

Assist ventilations prior to administration to avoid sympathetic stimulation

Seizures without causal relationship have been reported

May not reverse hypotension

Use caution when administering to narcotic addicts (potential violent behavior)

Half-life of naloxone is often shorter than the half-life of narcotics; repeat dosing may be required

Dextrose

CLASS:

Dextrose

Indications:

Hypoglycemia

altered level of consciousness

coma of unknown origin

seizure of unknown origin

status epilepticus

Dextrose

Mechanism of Action:

Rapidly increases serum glucose levels

Short-term osmotic diuresis

Dextrose

Adult Dosage/Administration:

12.5–25 grams of a 50% solution slow IV push

May be repeated as necessary.

Dextrose

Pedi Dosage/Administration:

1 year and older; 0.5–1 g/kg of a 25% solution slow IV/IO push May be repeated as necessary

Neonates and infants: 200–500 mg/kg of a 10%–25% solution slow IV push (see below) May be repeated as necessary. Maximum concentration of 12.5% (vasculature extremely sensitive to high concentrations)

Dextrose

How Supplied:

500 mg/mL (50%)/ 250 mg/mL (25%)

and 100 mg/mL (10%) prefilled syringes and vials

Dextrose

Contraindications:

Dextrose

Adverse reactions/Side effects:

Extravasation leads to tissue necrosis

Cerebral hemorrhage

cerebral ischemia

pulmonary edema

warmth, pain, burning from IV infusion

hyperglycemia

Dextrose

Drug Interactions:

Sodium Bicarbonate

Warfarin (Coumadin)

Dextrose

Duration of Action:

Onset: Less than 1 minute

Peak effect: Variable

Duration: Variable

Dextrose

Special Considerations:

Pregnancy safety: Category C

Administer thiamine prior to D50 in known alcoholic patients

Draw blood to determine glucose level before administering

Do not administer to patients with known CVA unless hypoglycemia documented

How to prepare D10, D12.5, and D25 from D50 : To make a 10% solution:– Take 5 mL (2.5 grams) of a 50-mL stock solution of D50 and dilute with 20 mL of injectable sterile water:2.5 g/25 mL = 2,500 mg/25 mL = 100 mg/1 mL = 10% = D10To make a 12.5% solution:– Take 2.5 mL (1.25 grams) of a 50-mL stock solution of D50 and dilute with 7.5 mL of injectable sterile water:1.25 g/10 mL = 1,250 mg/10 mL = 125 mg/1 mL = 12.5% = D12.5To make a 25% solution:– Take 25 mL (12.5 grams) of a 50-mL stock solution of D50 and dilute with 25 mL of injectable sterile water:12.5 g/50 mL = 12,500 mg/50 mL= 250 mg/1 mL = 25% = D25

Glucagon

CLASS:

Glucagon

Indications:

Altered level of consciousness when hypoglycemia is suspected

May be used as a reversal agent in beta blocker and calcium channel blocker overdoses.

Glucagon

Mechanism of Action:

Increases blood glucose level by stimulating glycogenesis

Unknown mechanism of tabilizing cardiac rhythm in beta blocker overdose

Minimal positive inotropic and chronotropic response

Decreases gastrointestinal motility and secretions

Glucagon

Adult Dosage/Administration:

Hypoglycemia: 0.5–1 mg IM; may repeat in 7–10 minutes

Calcium channel blocker or beta blocker overdose: 3–10 mg IV slowly over 3–5 minutes initially, followed by a 3–5 mg/h infusion as necessary

Glucagon

Pedi Dosage/Administration:

Hypoglycemia: 0.03–0.1 mg/kg IM, IO, SQ, slow IV may repeat in 20 minutes

 Maximum dose: 1 mg

Calcium channel blocker or beta blocker toxicity: 0.05–0.15 mg/kg IV/IO over 3–5 minutes initially, followed by a 0.05–0.10 mg/kg/h infusion as necessary

Glucagon

How Supplied:

Glucagon

Contraindications:

Hypovolemia

Anuria

hypotension (relative contraindication)

hypersensitivity

hepatic coma

suspected electrolyte imbalances

Glucagon

Adverse Reactions/Side effects:

Dizziness

Headache

Hypertension

Tachycardia

Nausea/vomiting

rebound hypoglycemia

Glucagon

Drug Interactions:

Incompatible in solution with most other substances

No significant drug interactions with other emergency medications

Glucagon

Duration of Action:

Onset: 1 minute

Peak effect: 5–20 minutes

Duration: 60–90 minutes

Glucagon Special

Considerations:

Pregnancy safety: Category B

Ineffective if glycogen stores depleted

Should always be used in conjunction with 50% dextrose whenever possible

If patient does not respond to second dose of glucagon, 50% dextrose must be administered

Thiamine (Betaxin)

CLASS:

Thiamine (Betaxin)

Indications:

Thiamine (Betaxin)

Mechanism of Action:

Thiamine (Betaxin)

Adult Dosage/Administration:

Thiamine (Betaxin)

Pedi Dosage/Administration:

Thiamine (Betaxin)

How Supplied:

Thiamine (Betaxin)

Contraindications:

Thiamine (Betaxin)

Adverse Reactions/Side effects:

Thiamine (Betaxin)

Drug Interactions:

Thiamine (Betaxin)

Duration of Action:

Onset: Rapid

Peak effect: Variable

Duration: Depends on degree of deficiency

Thiamine (Betaxin)

Special Considerations:

Hydroxocobalamin (Cyanokit)

CLASS:

Hydroxocobalamin (Cyanokit)

Indications:

Hydroxocobalamin (Cyanokit)

Mechanism of Action:

Hydroxocobalamin (Cyanokit)

Adult Dosage/Administration:

5g IV infusion over 15 minutes at a rate of 15 ml/min - one time

May be repeated one time at the same dose to a maximum of 10 g

Hydroxocobalamin (Cyanokit)

Pedi Dosage/Administration:

70 mg/kg IV - one time

May be repeated one time at the same dose

Hydroxocobalamin (Cyanokit)

How Supplied:

Hydroxocobalamin (Cyanokit)

Contraindications:

Hydroxocobalamin (Cyanokit)

Adverse Reactions/Side effects:

Hypertension

allergic reactions

GI bleeding

Nausea/Vomiting

Dyspepsia

Dyspnea

Dizziness

Headache

injection site reactions

Hydroxocobalamin (Cyanokit)

Drug Interactions:

Hydroxocobalamin (Cyanokit)

Duration of Action:

Onset : Rapid

Peak effect: 8–10 min

Duration: Varies

Hydroxocobalamin (Cyanokit)

Special Considerations:

Pregnancy safety: Category C

Make sure to reassess the patient’s airway, oxygenation, and hydration during administration

The patient may become hypertensive during treatment (greater than 180 mm Hg systolic and 110 mm Hg diastolic are not uncommon) and will return to baseline within 4 hours

Albuterol (Proventil, Ventolin)

CLASS:

Bronchodilator /

Sympathomimetic

Albuterol (Proventil, Ventolin)

Indications:

COPD

Asthma

Prevention of exercise-induced bronchospasm

Treatment of bronchospasm in patients with reversible obstructive airway disease 

Albuterol (Proventil, Ventolin)

Mechanism of Action:

Albuterol (Proventil, Ventolin)

Adult Dosage/Administration:

2.5 mg – 3mg  in 2.5ml of NS in nebulizer.

   Administer over 10 minutes @ 5 L per minute in Non-humidified oxygen

Metereddose inhaler: 1–2 inhalations wait 5 minutes between inhalations

Albuterol (Proventil, Ventolin)

Pedi Dosage/Administration:

1.25 mg via nebulizer if less than 2 yrs of age. (< 20 kg) over 20 mins Via hand held nebulizer

1.25-2.5 mg via nebulizer if greater than 2 yrs. of age (>20 kg) over 20 mins Via hand held nebulizer

Albuterol (Proventil, Ventolin)

How Supplied:

Metered-dose inhaler: 90 μg/metered spray/ Solution for aerosolization: 0.5%

(5 mg/mL)/

0.083% (2.5 mg) in 3-mL unit dose nebulizer

Albuterol (Proventil, Ventolin)

Contraindications:

Known hypersensitivity to Albuterol

Tachydysrhythmias (especially digitalis induced)

Synergism with other Sympathomimetics

Albuterol (Proventil, Ventolin)

Adverse reactions/Side effects:

Tremulousness

Dizziness

Insomnia

Tachycardia

Headache ~ HTN

Increased Sputum production

Albuterol (Proventil, Ventolin)

Considerations:

Use with caution in cardiovascular

disorders

May cause paradoxical bronchospasm

It is a bit more Beta 2 selective therefore it may cause less stimulation of other sympathomimetics

May be mixed with Ipratropium Bromide

Albuterol (Proventil, Ventolin)

Duration of Action:

Onset: 5–15 minutes

Peak effect: 30 minutes to 2 hours

Duration: 3–4 hours

Albuterol (Proventil, Ventolin)

Special Considerations:

Ipratropium (Atrovent)

CLASS:

Ipratropium (Atrovent)

Indications:

Persistent Bronchospasm

COPD Exacerbation

Ipratropium (Atrovent)

Mechanism of Action:

Ipratropium (Atrovent)

Adult Dosage/Administration:

Ipratropium (Atrovent)

Pedi Dosage/Administration:

Ipratropium (Atrovent)

How Supplied:

Aerosol 18 μg/actuation

500 μg/mL of a 0.02% solution for nebulized inhalation

Ipratropium (Atrovent)

Contraindications:

Ipratropium (Atrovent)

Adverse Reactions/Side effects:

Headache

Dizziness

Nervousness

Fatigue

Tremor

blurred vision

cough

dyspnea

worsening COPD symptoms

tachycardia

palpitations

flushing

MI

dry mouth

nausea/vomiting

GI distress

Ipratropium (Atrovent)

Drug Interactions:

Ipratropium (Atrovent)

Duration of Action:

Onset: 1–3 minutes

Peak effect: 90–120 minutes

Duration: 4–6 hours

Ipratropium (Atrovent)

Special Considerations:

Pregnancy safety: Category B

Note: When used in combination with beta-agonists (eg, metaproterenol and albuterol), the beta-agonist is always administered first with a 5-minute wait before administering ipratropium

Shake well before use

Use with caution in patients with urinary retention

Terbutaline Sulfate (Brethine)

CLASS:

Terbutaline Sulfate (Brethine)

Indications:

Bronchial asthma

reversible bronchospasm associated with exercise chronic bronchitis

emphysema

Terbutaline Sulfate (Brethine)

Mechanism of Action:

Terbutaline Sulfate (Brethine)

Adult Dosage/Administration:

Terbutaline Sulfate (Brethine)

Pedi Dosage/Administration:

Not recommended for children younger than 12 years of age

0.25 mg SC may repeat in 15–30 minutes to Maximum dose of 0.5 mg in a 4-hour period

Terbutaline Sulfate (Brethine)

How Supplied:

Terbutaline Sulfate (Brethine)

Contraindications:

Hypersensitivity

Tachydysrhythmias

Terbutaline Sulfate (Brethine)

Adverse Reactions/Side effects:

CNS stimulation

Headache

Seizure

Restlessness

Apprehension

Wheezing

Coughing

Bronchospasm

Bradycardia

Tachycardia

ST wave changes,

PVCs

PACs

chest pain

Terbutaline Sulfate (Brethine)

Drug Interactions:

Cardiovascular effects exacerbated by other sympathomimetics

MAOIs may potentiate dysrhythmias

Beta blockers may antagonize terbutaline

Terbutaline Sulfate (Brethine)

Duration of Action:

Onset: 5–10 minutes

Peak effect: Variable

Duration: 1.5–4 hours

Terbutaline Sulfate (Brethine)

Special Considerations:

Pregnancy safety: Category B

Carefully monitor vital signs

Use with caution in patients with cardiovascular disease, seizure disorder, hypertension, and diabetes

Patient should receive oxygen before and during administration

Diphenhydramine (Benadryl)

CLASS:

Diphenhydramine (Benadryl)

Indications:

Symptomatic relief of allergies

Allergic reactions

Anaphylaxis

Blood administration reactions

Motion sickness

Hay fever

Relief of acute dystonic reactions caused by phenothiazines

May be useful in phenothiazine overdoses

Diphenhydramine (Benadryl)

Mechanism of Action:

Blocks cellular histamine receptors

Decreases vasodilation

Decreases motion sickness

Reverses extrapyramidal reactions

Diphenhydramine (Benadryl

Adult Dosage/Administration:

Diphenhydramine (Benadryl)

Pedi Dosage/Administration:

1–2 mg/kg IV/IO slowly/or IM.

If PO: 5 mg/kg/24h.

Diphenhydramine (Benadryl)

How Supplied:

25- and 50-mg tablets and capsules

10 mg/mL and 50 mg/mL vials

Diphenhydramine (Benadryl)

Contraindications:

Asthma

Glaucoma

Pregnancy

Hypertension

narrow-angle glaucoma

infants

patients taking MAOIs

Diphenhydramine (Benadryl)

Adverse reactions/Side effects:

Drowsiness

Sedation

Seizures

Dizziness

Headache

blurred vision

paradoxical CNS excitement in children

wheezing

thickening of bronchial secretions

palpitations

hypotension

dysrhythmias

dry mouth

diarrhea

nausea/vomiting

Diphenhydramine (Benadryl)

Drug Interactions:

Potentiates effects of alcohol and other anticholinergics

May inhibit corticosteroid activity

MAOIs prolong anticholinergic effects of diphenhydramine.

Diphenhydramine (Benadryl)

Duration of Action:

Onset: 15–30 minutes

Peak effect: 1 hour

Duration: 3–12 hours

Diphenhydramine (Benadryl)

Special Considerations:

Pregnancy safety: Category B

Not used in infants.

If used in anaphylaxis, must be in conjunction with Epinephrine and Corticosteroids.

Diazepam (Valium and others)

CLASS:

Benzodiazepine/Long-acting Sedative-Hypnotic/Anticonvulsant

Schedule IV drug

Diazepam (Valium and others)

Indications:

Acute anxiety states and agitation

acute alcohol withdrawal

muscle relaxant

seizure activity

sedation for medical procedures (eg, intubation, ventilated patients, cardioversion)

may be helpful in acute symptomatic cocaine overdose

Diazepam (Valium and others)

Mechanism of Action:

Potentiates effects of inhibitory neurotransmitters

Raises the seizure threshold

Induces Amnesia and Sedation

Diazepam (Valium and others)

Adult Dosage/Administration:

Seizure activity: 5–10 mg IV q 10–15 minutes PRN (5 mg over 5 minutes) (maximum dose: 30 mg)

Premedication for cardioversion: 5–15 mg IV over 5–10 minutes prior to cardioversion.

Diazepam (Valium and others)

Pedi Dosage/Administration:

Seizure activity: 0.2 mg/kg to 0.5 mg/kg slow IV q 2–5 minutes up to 5 mg (maximum dose 10 mg/kg)

Rectal diazepam: 0.5 mg/kg via 2" rectal catheter and flush with 2–3 mL air after administration

Diazepam (Valium and others)

How Supplied:

Diazepam (Valium and others)

Contraindications:

Hypersensitivity

narrow-angle glaucoma

myasthenia gravis

respiratory insufficiency

coma

head injury

Diazepam (Valium and others)

Adverse reactions/Side effects:

Dizziness

Drowsiness

Confusion

Headache

respiratory depression

hypotension

reflex tachycardia

nausea/vomiting

muscle weakness

tissue necrosis

ataxia

thrombosis

phlebitis

Diazepam (Valium and others)

Drug Interactions:

Diazepam (Valium and others)

Duration of Action:

Onset: 1–5 minutes

Peak effect: 15 minutes

Duration: 20–50 minutes

Diazepam (Valium and others)

Special Considerations:

Pregnancy safety: Category D

Short duration for anticonvulsant effect

Reduce dose by 50% in elderly patients

Lorazepam (Ativan)

CLASS:

Benzodiazepine

Short/Intermediate acting sedative Anticonvulsant

Schedule IV drug

Lorazepam (Ativan)

Indications:

Lorazepam (Ativan)

Mechanism of Action:

Anxiolytic/Anticonvulsant/Sedative effect

Suppresses propagation of seizure activity produced by foci in cortex, thalamus, and limbic area

Lorazepam (Ativan)

Adult Dosage/Administration:

Note: When given IV/IO, must be diluted with equal volume of sterile water or sterile saline

When given IM: Lorazepam is not diluted

Adult: 2–4 mg slow IM/IV at 2 mg/min; may be repeated in 15–20 minutes

Maximum dose of 8 mg

For sedation: 0.05 mg/kg up to 4 mg IM

Lorazepam (Ativan)

Pedi Dosage/Administration:

0.05–0.20 mg/kg slow IV/IO/IM over 2 minutes

May be repeated once in 5–20 minutes Maximum dose of 0.2 mg/kg

Lorazepam (Ativan)

How Supplied:

Lorazepam (Ativan)

Contraindications:

Acute narrow-angle glaucoma

Coma

Shock

suspected drug abuse

Lorazepam (Ativan)

Adverse Reactions/Side effects:

Dizziness

Drowsiness

CNS depression

Headache

Sedation

respiratory depression

apnea

hypotension

bradycardia

Lorazepam (Ativan)

Drug Interactions:

Lorazepam (Ativan)

Duration of Action:

Onset: 1–5 minutes

Peak effect: Variable

Duration: 6–8 hours

Lorazepam (Ativan)

Special Considerations:

Pregnancy safety: Category D

Monitor respiratory rate and blood pressure during administration

Have advanced airway equipment readily available

Inadvertent arterial injection may result in vasospasm and gangrene

Lorazepam expires in 6 weeks when not refrigerated

Midazolam Hydrochloride (Versed)

CLASS:

Benzodiazepine-short/intermediate acting

schedule IV drug

Midazolam Hydrochloride (Versed)

Indications:

Midazolam Hydrochloride (Versed)

Mechanism of Action:

Midazolam Hydrochloride (Versed)

Adult Dosage/Administration:

2–2.5 mg slow IV (over 2–3 minutes)

May be repeated to total maximum: 0.1 mg/kg.

Midazolam Hydrochloride (Versed)

Pedi Dosage/Administration:

0.1–0.3 mg/kg IV/IO

Maximum single dose: 10 mg

Midazolam Hydrochloride (Versed)

How Supplied:

Midazolam Hydrochloride (Versed)

Contraindications:

Acute narrow-angle glaucoma

Shock

Coma

alcohol intoxication

overdose

depressed vital signs

Concomitant use with barbiturates

Alcohol

Narcotics

or other central nervous system depressants

Midazolam Hydrochloride (Versed)

Adverse Reactions/Side effects:

Headache

Somnolence

respiratory depression

respiratory arrest

apnea

hypotension

cardiac arrest

nausea/vomiting

pain at the injection site

Midazolam Hydrochloride (Versed)

Drug Interactions:

Midazolam Hydrochloride (Versed)

Duration of Action:

Onset: 1–3 minutes, IV and dose dependent

Peak effect: Variable

Duration: 2–6 hours, dose dependent

Midazolam Hydrochloride (Versed)

Special Considerations:

Pregnancy safety: Category D

Administer immediately prior to intubation procedure

Requires continuous monitoring of respiratory and cardiac function

Decrease dose by 50% in patients with hepatic and renal dysfunction

Haloperidol Lactate (Haldol)

CLASS:

Haloperidol Lactate (Haldol)

Indications:

Haloperidol Lactate (Haldol)

Mechanism of Action:

Inhibits central nervous system catecholamine receptors:

Strong Antidopaminergic and weak anticholinergic

Acts on CNS to depress subcortical areas, mid-brain, and ascending reticular activating system in the brain

Haloperidol Lactate (Haldol)

Adult Dosage/Administration:

Haloperidol Lactate (Haldol)

Pedi Dosage/Administration:

Haloperidol Lactate (Haldol)

How Supplied:

Haloperidol Lactate (Haldol)

Contraindications:

Parkinsons disease

depressed mental status

agitation secondary to shock and hypoxia

hypersensitivity

Haloperidol Lactate (Haldol)

Adverse Reactions/Side effects:

Seizures

Sedation

Confusion

Restlessness

extrapyramidal reactions

dystonia

respiratory depression

hypotension

tachycardia

orthostatic hypotension

QT prolongation

sudden cardiac death

constipation

dry mouth

nausea/vomiting

drooling

blurred vision

Haloperidol Lactate (Haldol)

Drug Interactions:

Enhanced central nervous system depression and hypotension in combination with alcohol

Antagonized amphetamines and epinephrine

Other CNS depressants may potentiate effects

Haloperidol Lactate (Haldol)

Duration of Action:

Onset: 10 minutes

Peak effect: 30–45 minutes

Duration: Variable (generally 12–24 hours)

Haloperidol Lactate (Haldol)

Special Considerations:

Pregnancy safety: Category C

Treat hypotension secondary to haloperidol with fluids and norepinephrine, not epinephrine

Patient may also be taking benztropine mesylate (Cogentin) if on long-term therapy with haloperidol

Ondansetron Hydrochloride (Zofran)

CLASS:

Ondansetron Hydrochloride (Zofran)

Indications:

For the prevention and control of nausea or vomiting

Used in hospital for patients undergoing chemotherapy or surgical procedures

Ondansetron Hydrochloride (Zofran)

Mechanism of Action:

Ondansetron Hydrochloride (Zofran)

Adult Dosage/Administration:

Ondansetron Hydrochloride (Zofran)

Pedi Dosage/Administration:

Ondansetron Hydrochloride (Zofran)

How Supplied:

Ondansetron Hydrochloride (Zofran)

Contraindications:

Ondansetron Hydrochloride (Zofran)

Adverse Reactions/Side effects:

Headache

Malaise

Wheezing

Bronchospasm

atrial fibrillation

abnormal ECG

prolonged QT interval

ST segment depression

second-degree AV block

constipation

diarrhea

hives

skin rash

Ondansetron Hydrochloride (Zofran)

Drug Interactions:

Ondansetron Hydrochloride (Zofran)

Duration of Action:

Onset: 30 minutes

Peak effect: 2 hours

Duration: 3–6 hours

Ondansetron Hydrochloride (Zofran)

Special Considerations:

Hydrocortisone Sodium Succinate (Solu-Cortef)

CLASS:

Hydrocortisone Sodium Succinate (Solu-Cortef)

Indications:

Hydrocortisone Sodium Succinate (Solu-Cortef)

Mechanism of Action:

Hydrocortisone Sodium Succinate (Solu-Cortef)

Adult Dosage/Administration:

Hydrocortisone Sodium Succinate (Solu-Cortef)

Pedi Dosage/Administration:

2 mg/kg slow IV bolus

Maximum dose: 100 mg

Hydrocortisone Sodium Succinate (Solu-Cortef)

How Supplied:

Hydrocortisone Sodium Succinate (Solu-Cortef)

Contraindications:

Systemic fungal infections

premature infants (contains benzyl alcohol, which is associated with “fatal gasping syndrome,” characterized by CNS depression, metabolic acidosis, and gasping respirations)

known hypersensitivity

Hydrocortisone Sodium Succinate (Solu-Cortef)

Adverse Reactions/Side effects:

Headache

Vertigo

pulmonary tuberculosis

CHF

Hypertension

fluid retention

nausea

Hydrocortisone Sodium Succinate (Solu-Cortef)

Drug Interactions:

Hydrocortisone Sodium Succinate (Solu-Cortef)

Duration of Action:

Onset: 1 hour

Peak effect: Variable

Duration: 8–12 hours

Hydrocortisone Sodium Succinate (Solu-Cortef)

Special Considerations:

Pregnancy safety: Category C

May be used in status asthmaticus as a second-line drug

Sodium Bicarbonate

CLASS:

Sodium Bicarbonate

Indications:

Sodium Bicarbonate

Mechanism of Action:

Sodium Bicarbonate

Adult Dosage/Administration:

Sodium Bicarbonate

Pedi Dosage/Administration:

Sodium Bicarbonate

How Supplied:

1 mEq/mL of an 8.4% solution in 10- and 50-mL vials and prefilled syringe

0.5 mEq/mL of a 4.2% solution in 2.5-, 5-, and 10-mL prefilled syringe

Sodium Bicarbonate

Contraindications:

Sodium Bicarbonate

Adverse Reactions/Side effects:

Hypernatremia

metabolic alkalosis

tissue sloughing

cellulitis

or necrosis at injection site

Seizures

fluid retention

hypokalemia

electrolyte imbalance

tetany

sodium retention

peripheral edema

Sodium Bicarbonate

Drug Interactions:

Increases the effects of amphetamines Decreases the effects of benzodiazepines, tricyclic antidepressants

May deactivate sympathomimetics (dopamine, epinephrine, (norepinephrine)

Sodium Bicarbonate

Duration of Action:

Onset: Seconds

Peak effect: 1–2 minutes

Duration: 10 minutes

Sodium Bicarbonate

Special Considerations:

Pregnancy safety: Category C

Repeat as needed in tricyclic antidepressant overdose until QRS narrows

Must be used in conjunction with effective ventilation and chest compressions in cardiac arrest

Avoid contact with other medications; may precipitate or inactivate them. Always flush IV line well before and after injecting

Use with caution in patients with CHF and renal disease due to high sodium concentration

Monitor patient closely for signs and symptoms of fluid overload

Calcium Chloride

CLASS:

Calcium Chloride

Indications:

Hypocalcemia

Hyperkalemia

Hypermagnesemia

beta blocker toxicity

calcium channel blocker toxicity

Calcium Chloride

Mechanism of Action:

Increases cardiac contractile state (positive inotropic effect)

May enhance ventricular automaticity

Calcium Chloride

Adult Dosage/Administration:

Calcium channel blocker overdose and hyperkalemia: 500 mg to 1,000 mg (5–10 mL of 10% solution)IV push

May repeat as needed

Calcium Chloride

Pedi Dosage/Administration:

Calcium channel blocker overdose and hyperkalemia: 20 mg/kg (0.2 mL/kg) slow IV/IO push

Maximum 1-g dose

May repeat in 10 minutes.

Calcium Chloride

How Supplied:

Calcium Chloride

Contraindications:

Hypercalcemia

Vfib

Digitalis toxicity.

Calcium Chloride

Adverse reactions/Side effects:

Syncope

cardiac arrest

dysrhythmia

bradycardia

hypotension

asystole

peripheral vasodilation

nausea/vomiting

metallic taste

tissue necrosis at injection site

coronary and cerebral artery spasm

Calcium Chloride

Drug Interactions:

May worsen dysrhythmias secondary to digitalis toxicity.

May antagonize the effects of calcium channel blockers.

Do not mix or infuse immediately before or after sodium bicarbonate without intervening flush

Calcium Chloride

Duration of Action:

Onset: 1–3 minutes

Peak effect: Variable

Duration: 20–30 minutes, but may persist for 4 hours (dose dependent)

Calcium Chloride

Special Considerations:

Pregnancy safety: Category C

Do not use routinely in cardiac arrest

Comparable dose of 10% calcium gluconate is 15–30 mL

Central venous administration is the preferred route in pediatrics if available

Furosemide (Lasix)

CLASS:

Furosemide (Lasix)

Indications:

CHF

pulmonary edema

hypertensive crisis

Furosemide (Lasix)

Mechanism of Action:

Furosemide (Lasix)

Adult Dosage/Administration:

0.5–1 mg/kg IV over 1–2 minutes

If no response, double the dose to 2 mg/kg slowly over 1–2 minutes

Furosemide (Lasix)

Pedi Dosage/Administration:

Furosemide (Lasix)

How Supplied:

Furosemide (Lasix)

Contraindications:

Hypovolemia

Anuria

hypotension (relative contraindication)

hypersensitivity

hepatic coma

suspected electrolyte imbalances

Furosemide (Lasix)

Adverse Reactions/Side effects:

Dizziness

Headache

ECG changes

Weakness

orthostatic hypotension

dysrhythmias

nausea/vomiting

diarrhea

dry mouth

may exacerbate hypovolemia and hypokalemia hyperglycemia (due to hemoconcentration)

Furosemide (Lasix)

Drug Interactions: