Class: Ventricular antiarrhythmic

Mechanism of action: Blocks sodium channels and myocardium potassium channels

Indications : V-fib, V-tach, PVCs

Contraindications : sinus bradycardia and hypotension

Adverse reactions : hypotension and bradycardia

Dosage and route: 300 mg IV push, can be repeated at 150 mg one time in cardiac arrest. 150 mg over 10 minutes for stable v-tach. Mantinence infusion 150 mg in 100 ccs run at 1mg/minute

Class: Atrial antiarrythmic 

Mechanism of action: slows conduction through the AV node

Indications : SVT

Contraindications : 2nd or 3rd degree AV block

Adverse reactions : Facial flushing, shortness of breath, chest pain

Dosage and route: 6 mg rapid IV push, 12mg rapid IV push if not effective , 12 mg IV push if not effective 

Class: platelet inhibitor

Mechanism of action:Prevents platelets from forming clots

Indications : new onset chest pain suggestive of acute myocardial infarction

Contraindications : Active ulcer disease

Adverse reactions : GI bleeding, nausea and vomiting 

Dosage and route: 324/325 mg oral route

Class: anticholinergic

Mechanism of action: Increases heart rate in unstable bradycardia, parasympathetic blocker

Indications : hemodynamically unstable bradycardia

Contraindications : Tachycardia 

Adverse reactions : Paradoxical bradycardia 

Dosage and route: 0.5 mg IV push, can be repeated up to 3 mg given every 3-5 minutes

Class: electrolyte

Mechanism of action: Increases cardiac contractile state, may enhance ventricular automaticity 

Indications : magnesium sulfate overdose, calcium channel blocker overdose

Contraindications : V-fib

Adverse reactions : Asystole

Dosage and route: 500-1000 mg IV push

Class:  calcium channel blocker 

Mechanism of action: Blocks influx of calcium ions into cardiac muscle 

Indications : atrial flutter, atrial fibrillation w/RVR

Contraindications : Hypotension 

Adverse reactions : Dizziness, dry mouth, headache

Dosage and route: 0.25 mg/kg IV push, can be repeated at 0.35 mg/kg , average dose is 20 mg

Class: sympathomimetic 

Mechanism of action: Increases systemic vascular resistance, increases myocardial contractility and stroke volume

Indications : cardiogenic, septic or spinal shock, hypotension with low cardiac output

Contraindications : Hypovolemic shock

Adverse reactions : Hypertension 

Dosage and route: 2-20 mcg/kg/minute IV

Class: sympathomimetic

Mechanism of action: Direct acting alpha and beta agonist, alpha: vasoconstriction, Beta-1 positive inotropic, chronotropic, and dromotropic effects

Indications : alternative to dopamine for hypotension, cardiac arrest

Contraindications : None

Adverse reactions : None

Dosage and route: 1 mg 1:10000 dose given every 3-5 minutes in cardiac arrest no max dose, 1 mg 1:1000 given in 250 cc bag at 2-10 mcg/minute for hypotension.

Class: narcotic analgesic 

Mechanism of action: Agonist actions at the body's opioid receptors

Indications : severe pain

Contraindications : Children under 2

Adverse reactions : Muscular rigidity 

 Dosage and route: 25-100 mcg IV push

Class: Loop diuretic 

Mechanism of action: Inhibits electrolyte reabsorption and promotes excretion of sodium, potassium and chloride

Indications : CHF, pulmonary edema

Contraindications : Hypovolemia , hypotension 

Adverse reactions : ECG changes, hypovolemia

Dosage and route: 40 mg slow IV push

Class: ventricular antiarrythmic

Mechanism of action: Decreases automaticity by slowing rate of phase 4 depolarization 

Indications : cardiac arrest from V-fib, pulseless V-tach, PVCs

Contraindications : Bradycardia, hypotension 

Adverse reactions : Altered mental status, blurred vision, confusion

Dosage and route: 1-1.5 mg/kg not to exceed 3 mg/kg in cardiac arrest. 0.5 to 0.75 in stable v-tach. Mantinence infusion 1 gram in 250 cc or 2 grams in 500 cc bag 1-4 mg/minute.

Class: electrolyte 

Mechanism of action:  reduces striated muscle contractions and blocks peripheral neuromuscular transmission by reducing acetylcholine release at the myoneural junction 

Indications : torsade de pointes, polymorphic V-tach

Contraindications : Heart blocks

Adverse reactions : CNS depression 

Dosage and route: 1-2 grams in 10 mLs , run for 5-20 minutes

Class: beta blocker

Mechanism of action: Exerts mostly beta-1 adrenergic blocking activity

Indications : suspected acute coronary syndrome provided that the heart rate is greater than 80 beats per minute and systolic blood pressure is greater than 120 mm Hg

Contraindications : Bradycardia, hypotension 

Adverse reactions : headache, dizziness, confusion 

Dosage and route: 5 mg slow IV push, may be repeated every 2 minutes up to 15 mg

Class: benzodiazepine 

Mechanism of action: Anxiolytic and  sedative properties similar to other benzodiazepines, memory impairment 

Indications : given prior to endotracheal or nasotracheal intubation, cardioversion

Contraindications : Alcohol intoxication, overdose 

Adverse reactions : Hypotension, respiratory depression, nausea and vomiting 

Dosage and route: 2-5 mg slow IV push

Class: opioid analgesic 

Mechanism of action:  alleviates pain through central nervous system action, suppresses fear and anxiety centers in the brain, decreases preload and after load, which decreases myocardial oxygen demand 

Indications : severe CHF, pulmonary edema, chest pain associated with acute MI

Contraindications : Head injury, respiratory depression, decreased level of consciousness, hypotension 

Adverse reactions : Hypotension, respiratory depression 

Dosage and route: Max dose 10 mg slow IV push, given in increments of 2 mg

Class: narcotic antagonist

Mechanism of action:  competitive inhibition at narcotic receptor sites 

Indications : opiate overdose, coma of unknown origin

 Contraindications : None

Adverse reactions :  None

Dosage and route: 0.4-0.8 mg packaged in 2 mg containers. Multiple routes available 

Class: vasodilator 

Mechanism of action:  dilation of arterials and veins, reduces preload and after load, decreases the workload of the heart 

Indications : ischemic chest pain

Contraindications : Boner pills, hypotension 

Adverse reactions : Hypotension, headache, flushing 

Dosage and route: 0.4 mg (1/50th of a grain) every 3-5 minutes.

Class: atmospheric gas 

Mechanism of action: Reverses hypoxemia

Indications : confirmed or expected hypoxemia, ischemic chest pain, respiratory insufficiency

Contraindications : None

Adverse reactions : None

Dosage and route: 2-15 LPM via cannula or mask

Class: Antiarrythmic

Mechanism of action: Supresses phase 4 depolarization in normal ventricular muscle and atrial muscle

Indications : stable monomorphic V-tach

Contraindications : Torsade de pointes 

Adverse reactions : widening of the QRS complex, hypotension 

Dosage and route: 30 to 50 mg/minute not to exceed 17 mg/kg. Mantinence drip 1 gram in 250 cc bag 1-4 mg/minute. 3 parameters 1.) 1 gram given 2.) QRS complex widens by 50 percent 3.) pt becomes significantly hypotensive. 

Class: electrolyte 

Mechanism of action: neutralizes hydrochloric acid 

Indications : mild or moderate metabolic acidosis, cardiac arrest

Contraindications : Alkalosis 

Adverse reactions : Tissue sloughing, necrosis of injection site

Dosage and route: 1 meq/kg can be repeated 1 time at half dose after 10 minutes.