Class: Sympathomimic, Bronchodialator

Indications: Treatment of bronchospasm in pts with reversable COPD/ asthma

Contraindications: Hypersensitivity, tachycardia arrhythmias

Adverse reactions: Often dose related restlesness, tremors, dizziness, palpitations, tachycardia, perpheral vasodialation, nausea, vomiing

Dose: 2.5mg in 0.5mL of .05% solution for inhaliation administer over 5-10 min MDI 1-2 inhaliations 90-180 mcg 5 min between inhalations

Max dose: 5mg

Isoetharine (Bronchosol Bronkometer)

Class: Sympathomimetic

Indications: acute bronchial asthma, bronchospasm especially in COPD

Contraindications: use caution in pts with diabetes, hyperthyroidims, cardiovascular and cerebralvascular disease

Adverse Reaction: Dose related tachycardia, palpitations, tremors, nausea. Multiple doses can cause paradoxical bronchoconstriction

Dose: Adult 1-2 inhaliations with MDI. COPD 2.5-5mg diluted in 3mL of normal saline. Peds 0.01mL/kg max dose 0.5mL diluted in 3mL of NS nebulized

Metaproterenol 5% (Alupent)

Class: Sympathomimetic, Bronchodialator

Indications: Bronchial asthma, rev bronchospasm secondary to bronchitis, COPD

Contraindications: Tachyarrhythmias, hypersensitivity, tachycardias due to digitalis toxicity

Adverse Reactions: Tachyarrhythmias, anxiety, nausea, vomiting, restlessness, apprehention, palpitations, hypotension, coughing, facial flushing, diaphoresis

Dose: 2-3 inhalations every 3-4 hours ( 2 min between  inhalations)  Inhalation solution 5% via hand held nebulizer 0.2-0.3 mL diluted in 2.5mL saline. Inhalation solution unit dose 0.4-0.6% Vials  Peds MDI not recommended. Inhalation solution 5% age 6-12 yrs 0.1-0.2mL diluted in 3mL saline

Methylprednisolone ( Solu-Medrol)

Class: Anti-inflammatory glucocorticoid

Indications: Acute spinal cord trauma, anaphylaxis, bronchodialator for unresponsive asthma

Conrtaindications: Premature infants, systemic fungal infection, use with caution with gastrointestional bleeding

Adverse Reactions: Headache, hypertension, sodium and water retention, CHF, hypokalemia, alkalosis, peptic ulcer disease, nausea, vomiting

Dose: Adult and Peds: acute spinal cord injury 30mg/kg over 30min followed by infusion: 5.4mg/kg/hr. Asthma-COPD 1-2mg/kg IV

Terbutaline (Brethine)

Class: Sympathomimetic bronchodialator

Indications: Bronchial asthma, reversable bronchospasm associated with exercise, chronic bronchitis, emphysemia

Contraindications: hypersensitivity, tachyarrhythmias

Adverse Reactions: usuallu transient and dose-related restlesness apprehention, palpitations, tachycardia, chest pain, coughing, bronchospasm facial flushing

Dose: Adult 0.25mg SC may repeat in 15-30min to a max of 0.5mg in 4hr period 400mcg (2 inhalattions MDI) every 4-6hr (1-2min between) not recommended for children under 12, 0.01mg/kg SC every 15-20min 0.25mg/kg max

Thiamine (B1)

Class: Vitamin B1

Indications: Coma of unknown origin, delerium trements

Contraindications: NONE

Adverse Reactions: Hypotension from rapid injection or high dose, anxiety, diaphoresis, nausea, vomiting, allergy

Dose: Adult 100mg slow IV or IM Pediatric: 10-25mg slow IV or IM MAX 100mg

Naloxone (Narcan)

Class: Narcotic Antagonist

Indications: Opiate overdose, coma, complete or partial of CNS and respiratory induced by opioids, decreased level of consciousness, coma of unknown origin

Contraindications: Use caution with narcotic dependant pts and neonates of narcotic dependant mothers

Adverse Reaction: Withdrawl symptoms in addicted pts, tachycardia, hypertension, arrhythmias, nausea, vomiting, diaphoresis

Dose: Adult:0.4-2mg IV IM SC or ET repeat at 5 min intervals to max 10mg Infusion 2mg in 500mL D5W (4mcg/mL)infuse at 0.4mg/hr Peds: 0.1mg/kg/dose IV IM SC MAX dose 0.8mg if no response additional 0.1mg/kg/dose

Glucagon

Class: hyperglycemic agent, pancreatic hormone, insulin antagonist

Indications: Altered level of consciousness when hypoglycemia is suspected

Contraindications: Hyperglycemia, hypersensitivity

Adverse Reactions: Nausea,  vomiting, tachycardia, hypertension

Dose: Adult hypoglycemia 0.5-1mg may repeat in 7-10min calcium channel blocker or beta blocker 3mg initially then 3mg/hr as necessary Peds: Hypoglycemia 0.5-1mg IM ( for kids under 20kg)

Dextrose (D50)

Class: Carbohydrate, hypertonic solution

Indications: Hypoglycemia, altered level of consciousness, coma of unknown etiology, status epilipticus, seizure of unknown origin

Contraindications: Intracranial hemmorhage

Adverse Reactions: Extravasation leads to tissue necrosis, warmth, pain, burning, thrombophlebitis, rhabdomilosis, hyperglycemia

Dose: Adult: 12.5-25g slow IV may be repeated as necessary. Peds 0.5-1g/kg/dose slow IV repeated as necessary MAX 50g

Ipratropium (Atrovent)

Class: Parasympathetic bronchodialator

Indications: Relieve bronchspasms in pts with obstructive airway disease (chronic bronchitis, emphysemia, asthma)and acute attacks of bronchospasms

Contraindications: hypersensitivity to atropine

Adverse Reactions: blurred vision,nausea, constipation, cough,

Dose: Adult 500mcg in 2.5-3mL nebulized or 2 inhalations from MDI Peds: 125-250mcg in 2.5-3mL nebulized or 1-2 inhalations of MDI MAX 500mcg