Class: Adsorbent

MOI: Absorbs toxic substances from the GI tract.

Indications: Oral poisonings and drug OD.

Contraindications: Comatose pt's. Pt's who have ingested caustic substances. When simultaneously administering other oral medications, use with caution in pt's experiencing abdominal pain of unknown origin or know GI obstruction.

Side effects: Aspiration can cause induce pneumontitis, constipation, diarrhea, vomiting and bowel obstruction.

Drug Interactions: Bonds with and generally inactivates whatever it is mixed with.

How Supplied: 25g/125ml bottle (200mg/ml); 50g/250ml bottle (200mg/ml)

Dose and administration: Adult: 1-2g/kg PO or NG tube. Ped: 1-2 g/kg PO or NG tube.

Duration of Action: Onset:Immediately Peak:Depends on GI function Duration: Will act until excreted. 

Special considerations: Pregnancy safety: Category C. Often used in conjunction with Mag. Citrate. Must be stored in a closed container. Mix well before administering. Cannot absorb cyanide, lithium, iron, lead or arsenic. 

Class: Antidysrhytimic

MOI: Slow conduction through the AV Node, can interrupt re-entrant pathways; slows HR by acting directly on sinus pacemaker cells by slowing impulse formation. Drug of choice for re-entry SVT. Can be used diagnostically for stable, wide complex tachycardia of unknown origin after two doses of Lidocaine.

Indications: PSVT, WPW syndrome. Stable narrow complex SVT.

Contraindication: 2nd or 3rd degree AV block, asthma or COPD, poison or drug induced tachycardia.

Side effects: Generally short and mild. Includes HA, dizziness, dyspnea, bronchospasm, dysrhythmia, palpitations, hypotension, CP, facial flushing, cardiac arrest, nausea, metallic taste, head & neck pain, parestheia and diaphoresis.

Drug Interactions: Methylxanthines (Theophylline-like drugs) antagonize th effects of Adenosine. Dipyridamole (Persantine) potentiates the effect of Adensosine. Carbamazepine (Tegretol) may potentiate the AV Node blocking effect of Adenosine.

How Supplied: 3mg/ml in 2 ml and 5 ml vials.

Dosage and administration: Adult: 6mg rapid IV push followed by 20ml saline flush and elevate extremity. No response after 1-2 minutes? 12mg IV push. Peds: 0.1 mg/kg IV/IO followed by 5-10ml saline flush. (Max 1st dose is 6mg), Second dose is 0.2mg/kg IV/IO (Max 2nd dose is 12mg)

Duration of Action: Onset:Seconds Peak:Seconds, Duration:12 seconds

Special considerations: Pregnancy safety: Category C. May cause broncoconstriction in Asthma patients. Evaluate elderly for signs of dehydration requiring fluid replacement prior to giving Adenosine. Short 1/2 life limits side effects in most patients.

Class: Sympathomimetic, bronchodilator

MOI: Selective Beta-2 agonist stimulates adrenergic receptors of the sympathomimetic nervous system. Results Bronchial relaxation and peripheral vascular relaxation. Indications: Bronchospasm in patients with reversible obstructive airway disease (COPD/Asthma). Prevention of exercise induced bronchospasm.

Contraindications: Known hypersensitivity, tachycarda, dysrhythmias, especially those caused by digitalis. Synergistic with other sympathomimetics.

Side effects: Often dose related. Include: HA, fatigue, lightheadedness, irritability, restlessness, aggressiveness, pulmonary edema, hoarseness, nasal congestion, increased sputum, hypertension, tachycardia, dysrhythmias, CP, palpitations, N&V, dry mouth, epigastric pain, and tremors.

Drug Interactions: Tricylic antidepressants may potentiate vasculature effects. Beta Blockers are antagonist and may block pulmonary effects. May potentiate hypokalemia caused by diuretics.

How supplied: MDI: 90 ug/spray; 0.5% (5mg/ml in 2.5ml NS by HHN.

Dosage and administration: Adult:2.5mg. Dulute in 0.5ml of 0.5% solution by HHN over 10 - 15 minutes. MDI: 1-2 inhalations (90-180ug) 5 minutes between inhalations. Peds:20kg: 2.5mg/dose by HHN or mask over 20 minutes. Repeat once in 20 minutes. Duration of Action: Onset: 5-15 minutes, Peak: 30-120 minutes, Duration: 3-4 hours. Special considerations: Pregnancy Safety: Category C. May precipate angina and dysrhythmias. Prehospital emergency? Administer only by inhalation.

Class: Fibrinolytic

MOI: The enzyme binds to the fibrin-bound plasmiogen at the clot site, converting plasminogen to plasmin. Plasmin digest the fibrin strands of the clot, restoring perfusion. Indications: AMI, STEMI, massive pulmonary emboli, acute ischemic CVA. Contraindications: Active internal bleeding, previous surgery (2-3 weeks), previous CVA or seizure at onset, prolonged CPR, intracranial or intraspinal surgery (within 3 months), intracranial neoplasm, arteriovenous malformation, or aneurysm; recent significant trauma. Uncontrolled hypertension (sys > 185 mm Hg or dia > 110 mm Hg).

Side effects: Intracranial bleeding, HA, reperfusion dysrhythmia, CP, Hypotension, GI bleeding, N&V, abdominal pain.

Drug Interactions: Acetylsalicylic acid (aspirin) may increase bleeding. Heparin or other anticoagulants may increase hemorrhage.

How supplied:  50 & 100mg powder (reconsitute in 1mL sterile water)

Dosage and Administration: Adult: 15mg IV bolus over 2 minutes; followed by infusion of 0.75mg/kg over 30 minutes (not to exceed 50mg); then 0.50mg/kg over 60 minutes; maximum total dose not to exceed 100mg. Other doses may be prescribed by medical direction. Acute Ischemic Stoke: 0.9mg 1kg infused over 60 minutes; administer 10% of total dose in 1 minute and the rest over 60 minutes. Peds: Safety not established. Duration of Action: Onset: Clot lysis most often within 60-90 minutes, Peak: Variable, Duration: 30 minutes with 80% cleared within 10 minutes.

Special considerations: Pregnancy Safety: Category C. Closely monitor VS. Observe for bleeding. Do not give IM injections to patients receiving TPA. Only administer with an IV pump. Due to severe risk of bleeding, invasive procedure such as IV sticks, injections, NG tubes should be avoided.

Class: Antidysrhythmic

MOI: Blocks sodium channels and myocardial potassium channels, delaying repolarization and increasing the duration of action potential.

Indication: V-Fib, pulseless V-Tach, unstable V-Tach in patients refractory to other therapy.

Contraindications: Known hypersensitivity t Amiodarone or iodine, cardiogenic shock, sinus bradycardia, 2nd or 3rd degree AV block (If can't TCP), severe sinus node dysfunction.

Side effects: Dizziness, fatigue, malaise, tremor, ataxia, lack of coordination, adult respiratory distress syndrome, pulmonary edema, cough, progressive dyspnea, CHF, bradycardia, hypotension, worsening of dysrhythmia, prolonged QT interval, N&V, burning at IV site, Stevens-Johnson syndrome.

Drug Interactions: Use with Digoxin may cause Digitalis toxicity. Antidysrhythmics may cause increased serum levels. Beta blocker and calcium channel blockers may potentiate bradycardia, sinus arrest, and AV heart blocks.

How Supplied: 50mg/ml vials and prefilled syringes. For rapid infusion, add 150mg/3ml to a 10ml D5W (1.5mg/ml) run at 600mL/h on IV pump.

Dosage and administration: 300 mg IV/IO push. Initial dose can be followed q 3-5 minutes at 150mg IV/IO push. Recurrent life threatening ventricular dysrhythmias: Max cumulative dose: 2.2g IV/24 hours. Administered as follows. Rapid infusion: 150mg IV/IO over 10 minutes (15mg/min). May repeat rapid infusion (150mg IV/IO) q 10 minutes. Peds: Refractory V-Fib/pulseless V-Tach: 5mg/kg IV/IO bolus. Can repeat the 5mg/kg bolus up to a total dose of 15mg/kg per 24 hours. Max single dose: 300mg. Perfusing supraventricular and ventricular tachycardias: loading dose 5mg/kg IV/IO over 20-60 minutes (max single dose of 300mg) Can repeat to max dose of 15mg/kg/day (2.2g in adolescents). Max single dose: 300mg

Duration of action: Onset: Immediate, Peak: 10-15 minutes, Duration: 30-45 minutes. Special considerations: Pregnancy safety: Category D. Monitor pts for hypotension. May worsen or precipitate new dysrhythmias.

Class: Antidote, cyanide poisoning adjunct.

MOI: Converts hemoglobin to methemoglobin, which reacts with cyanide and chemically bind with it, preventing any toxic effects.

Indications: Cyanide poisoning.

Contraindication: None in emergency setting.

Side effects: HA, dizziness, weakness, increased ICP, SOB, orthostatic Hypotension, tachycardia, syncope, cyanosis of the lips, fingernails or palms.

Drug interactions: Increased hypotensive effects of antyhypertensives, alcohol ingestion, phenothiazines, or beta blockers.

How supplied: 0.3ml ampules for inhalation.

Dosage and administration: Adult: 1-2 ampules crushed and inhaled for 30 seconds of each minute until sodium nitrite is prepared or administered for 30-60 seconds every 5 minutes until the pt is conscious. Peds: 1 ampule crushed and inhaled for 30 seconds of each minute until sodium nitrite is prepared or administered for 30-60 seconds every 5 minutes until pt is conscious.

Duration of Action: Onset: 30 seconds to 5 minutes, Peak: effect varies, Duration: 3-5 minutes.

Special considerations: Pregnancy Safety: Category X. Highly inflammable: avoid exposure to heat or flame. Patient should remain seated or lying after administration due to hypotensive effect. Use with caution in pts with cerebral hemorrhage, increased ICP or hypotension. This is the 1st step in a 3 step process of cyanide poisoning followed by Sodium Nitrite and then sodium thiosulfate.

Class: Platelet inhibitor, anti-inflammatory agen.

MOI: Prevents platelets from clumping together, or aggregating, and forming emboli. Indications: New onset CP suggestive of AMI.

Contraindications: Hypersensitivity

Side effects: Bronchospasm, anaphylaxis, wheezing in allergic patients, prolonged bleeding, GI bleeding, epigastric distress, nausea, vomiting, heartburn, Reye syndrome.

Drug interactions: Use with caution in pts allergic to NSAIDs.

How supplied: 81mg, 160mg and 325mg tablets.

Dosage and administration: Adult: 160mg to 325mg PO. Peds: Not recommended

Duration of action: Onset: 30-45 minutes, Peak: Variable, Duration: Variable.

Special considerations: Pregnancy safety: Category D. Not recommended in Peds.

Class: Beta blocker (Beta 1 selective), antidysrhythmic.

MOI: Decreases HR, myocardial contractility, and caridac output. Inhibits dilation of bronchial smooth muscle.

Indications: To reduce myocardial ischemia and damage in AMI patients, paroxysmal SVT, A fib/flutter and hypertension.

Contraindications: Heart failure, cardiogenic shock, bradycardia, lung disease, hypotension 2nd & 3rd degree HB.

Side effects: Dizziness, bronchospasm, bradycardia, AV conduction delays, hypotension, MI, heart failure.

Drug interactions: May potentiate antihypertensive effects when given to patients taking calcium channel blockers or MAOIs. Catecholamine-depleting drugs may potentiate hypotension. Sympathomimetic drugs may be antagonized. Signs of hypoglycemia may be masked.

How supplied: 5mg in 10ml ampules

Dosage and administration: Adult: 5mg slow IV (over 5 mins). Wait 10 minutes. Give second dose of 5mg over 5 minutes. Peds: Not recommended.

Duration of action: Onset: Within 5 minutes, Peak: 10 minutes, Duration: 2-4 hours. Special considerations: Pregnancy safety: Category D. Atenolol must be given slowly IV over 5 minutes. Concurrent administration with IV calcium channel blockers may cause hypotension. Should be used with caution in pts with liver or renal dysfunction or COPD.

Class: Anticholinergic agent

MOI: Inhibits the action of acetycholine at postganglionic parasympathetic neuroeffector sites. Increases HR in life threatening bradycardias.

Indications: Hemodynamically unstable bradycardia, organophosphate poisoning, nerve agent exposure, RSI in peds, beta blocker or calcium channel blocker OD. Contraindications: Tachycardia, hypersensitivity, unstable cardiovascular status in acute hemorrhage with myocardial ischemia, narrow-angle glaucoma, hypothermic bradycardia.

Side effects: Drowsiness, confusion, HA, tachycardia, palpitations, dysrhythmias, N&V, dilated pupils, dry mouth/nose/skin, blurred vision, urinary retention, constipation, flushed, hot, dry skin; paradoxical bradycardia when pushed too slowly or when given in low doses.

Drug interactions: Potential adverse effects when administered with digitalis, cholinergics, physotigmine. Effects enhanced by antihistamines, procainamide, quinidine, antipsychotics, benzodiazepines, and antidepressants.

How supplied:Prefilled syringes 1mg/10ml (0.1mg/ml). Nebulizer: 0.2% (1mg in 0.5ml) and 0.5% (2.5mg in 0.5ml).

Dosage and administration: Adult: Unstable bradycardia: 0.5mg IV/IO q 3-5 minutes as needed. Not to exceed total dose of 0.04mg/kg (max 3mg total) Organophosphate poisoning may require large doses (2-4mg or higher). Peds: Unstable bradycardia: 0.02mg/kg IV/IO (max dose 0.1mg), may repeat once. Max single dose: child: 1mg, adolescent: 3mg. ET dose: 0.04-0.06mg/kg. RSI: 0.01-0.02mg/kg IV/IO (min: 0.1mg, max: 0.5mg)

Duration of action: Onset: Immediate, Peak: 1-2 minutes, Duration: 2-6 hours.

Special consideration: Pregnancy safety: Category C. Moderate doses may cause pupillary dilation. Paradoxical bradycardia can occur with doses lower than 0.1mg.

Class: Topical anesthetic

MOI: Stabilizes neuronal membrane, which blocks the initiation and conduction nerve impulses.

Indications: Used as lubricant and topical anesthetic to facilitate passage of diagnostic and treatment devices. Suppresses the pharyngeal and tracheal gag reflex.

Contraindications: Known hypersensitivity.

Side effects: Methmoblobinemia in rare occasions.

Drug interactions: No significant interactions found or known.

How supplied: Multi-dose aerosol can of 20% Benzocaine.

Dosage and administration: Adult: 0.5-1 second spray, repeat as needed. Peds: 0.25-0.5 second spray, repeat as needed.

Duration of action: Onset: Immediate, Peak: 30 seconds, Duration: 15 minutes.

Special considerations: Pregnancy safety: Category C. Topical use only; not or ocular use or injection.

Class: Loop diuretic.

MOI: A potent loop diuretic with rapid onset and short duration of action. Inhibits the reabsorption of sodium and chloride in the ascending limb of the loop of Henle.

Indications: Pulmonary edema, CHF.

Contraindications: Know hypersensitivity. hypovolemia, anuria, electrolyte deficiencies, hepatic coma. Use with caution: hepatic cirrhosis, ascites, diabetes, hypersensitivity to furosemide.

Side effects: Dizziness, HA, orthostatic hypotension, ECG changes due to electrolyte depletion, N&V, diarrhea, muscle cramps, metabolic alkalosis, hypovolemia, dehydration.

Drug interactions: NSAIDs reduce diuretic effect. May increase blood levels of lithium, increasing risk of lithium poisoning. Antihypertensives and diuretics can cause further hypotension and fluid depletion.

How supplied: 0.25mg/ml vials

Dosage and administration: Adults: 0.5-1mg IV slowly over 1-2 minutes, or IM. Peds: Safety and effectiveness in pediatric patients is not established.

Duration of action: Onset: Immediate, Peak: 15-30 minutes, Duration: 2-4 hours. Special considerations: Pregnancy safety: Category C. Bumetanide does not have the vasodilatory effects of Furosemide. 1.0mg Bumetanide = 40mg Furosemide. May precipitate hypokalemic induced digoxin toxicity.

Class: Electrolyte (anion)

MOI: Increases cardiac contractile state (positive inotropic effect). May enhance ventricular automaticity.

Indications: Hypocalcemia, hyperkalemia, hypermagnesemia, beta blocker and calcium channel blocker toxicity.

Contraindications: Hypercalcemia, V-Fib, Digitalis toxicity.

Side effects: Syncope, cardiac arrest, dysrhythmias, bradycardia, hypotension, asystole, peripheral vasodilation, N&V, metallic taste, tissue necrosis at the injection site, coronary and cerebral artery spasm.

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 flushing.

How supplied: 10% solution in 10ml (100mg/ml) ampules, vials and prefilled syringes. Dosage and administration: Adult: Calcium channel blocker overdose & hyperkalemia: 500-1000mg (5-10ml of 10% solution) IV push. May repeat as needed. Peds: Calcium channel blocker overdose and hyperkalemia: 20mg/kg (0.2 mL/kg) slow IV push. Maximum 1g dose; may repeat in 10 minutes.

Duration of action: Onset: 1-3 minutes, Peak: Variable, Duration: 20-30 minutes but may persist for 4 hours.

Special considerations: Pregnancy safety: Category C. Do not use routinely in cardiac arrest. Comparable dose of 10% calcium gluconate is 15-30ml. Central venous administration is the preferred route in peds.

Class: Electrolyte

MOI: Counteracts the toxicity of hyperkalemia by stabilizing the membranes of the cardiac cells, reducing the likelihood of fibrillation.

Indications: Hyperkalemia, hypocalcemia, hypermagnesemia, beta blocker and calcium channel blocker overdose.

Contraindications: V-Fib, digitalis toxicity, hypercalcemia.

Side effects: Syncope, cardiac arrest, dysrhythmia, bradycardia, hypotension, asystole, peripheral vasodilation, N&V, metallic taste, tissue necrosis at the injection site, coronary and cerebral artery spasm.

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.

How supplied: 100mg/ml of 10% solution.

Dosage and administration: Adult: Hyperkalemia: 500-1000mg slow IV/IO push (1-1.5 minutes) to maximum of 3 grams. Beta blocker and calcium channel blocker overdose: 3-6 grams (30-60 ml) IV/IO followed by continuous hourly infusion of the same dose. Peds: Hyperkalemia: 60-100mg/kg IV/IO slowly over 5-10 minutes to a max of 3 grams. Beta blocker and calcium channel blocker overdose: 60mg/kg (0.06mL/kg) IV/IO followed by continuous hourly infusion of the same dose.

Duration of action: Onset: Immediate, Peak: Immediate, Duration: 30 minutes to 2 hours.

Special considerations: Pregnancy safety: Category C. Do not administer by IM or SQ; causes tissue necrosis.

Class: Thienopyridine antiplatelet

MOI: Inhibits platelet aggregation by blocking activation of the glycoprotein IIb/IIa complex.

Indications: STEMI, moderate to high risk non-ST elevation NI (NSTEMI),acute coronary syndrome, substitute for aspirins for patients unable to take aspirin.

Contraindications: Active GI bleeding, intracranial hemorrhage, know hypersensitivity.

Side effects: Severe neutropenia, thrombotic thrombocytopenic purpura (TTP), GI hemorrhage, cerebral hemorrhage, angioedema, Stevens-Johnson syndrome, rash, flu-like symptoms.

Drug interactions: Shold not be taken with proton pump inhibitors (nexium, etc), use with caution with other anticoagulants (Warfarin, enoxaparin, streptokinase, aspirin)

How supplied: 75mg and 300mg tablets

Dosage and administration: Adult: Loading dose of 300-600mg PO. Peds: Not recommended

Duration of action: Onset: Rapid, Peak: 1 hour, Duration: 7-10 days.

Special considerations: Pregnancy safety: Category B. Often given with other anticoagulants in ACS or MI.

Class: Corticosteroid, adrenal glucocorticoid.

MOI: Suppresses acute and chronic inflammation, immunosuppressive effects.

Indications: Anaphylaxis, asthma, spinal cord injury, croup, elevated ICP (prevention and treatment), as an adjunct in the treatment of shock.

Contraindications: Hypersensitivity, use with caution in suspected systemic sepsis.

Side effects: HA, restlessness, euphoria, psychoses, pulmonary tuberculosis, hypertension, peptic ulcer, N&V, GI bleeding, edema, hyperglycemia, immunosuppression, sodium and water retention. None from single dose.

Drug interactions: Calcium, metaraminol.

How supplied: 100mg/5ml vials or 20mg/1ml vials.

Dosage and administration: Adults: 10-100mg IV (1mg/kg slow IV bolus) Peds: 0.25-1.0mg/kg IV/IO/IM. Given one time with max dose of 16mg.

Duration of action: Onset: Hours. Peak: 8-12 hours. Duration: 24-72 hours.

Special considerations: Pregnancy safety: Category C. Protect medication from heat. Toxicity and side effects with long term use.

Class: Carbohydrate, antihypoglycemic.

MOI: Rapidly increases serum glucose levels. Short-term osmotic diuresis.

Indications: Hypoglycemia, altered LOC, coma of unknown origin, seizure of unknown origin, status epilepticus.

Contraindications: Intracranial hemorrhage.

Side effects: Extravasation leads to tissue necrosis. Cerebral hemorrhage, cerebral ischemia, pulmonary edema, warmth, pain, burning from IV infusion. Hyperglycemia. Drug interactions: Sodium bicarbonate, warfarin (Coumadin).

How supplied: 500mg/ml or 25g/50ml (50%), 250mg/ml or 12.5g/50ml(25%), 100mg/ml (10%) prefilled syringes and vials.

Dosage and administration: Adult: 12.5-25 grams of D50 slow IV push. May repeat as necessary. Peds: 1 y/o and above; 0.5-1g/kgof D25 slow IV/IO push. May repeat as necessary; Noonates and infants: 200-500mg/kg of 10%-25% solution slow IV push. May repeat as necessary.

Duration of action: Onset: Less than 1 minute. Peak: Variable. Duration: Variable. Special considerations: Pregnancy safety: Category C. Administer thiamine prior to D50 in known alcoholics. Draw blood to chick BGL before administering. Do not administer to know CVA patient unless hypoglycemia is documented.

Class: Benzodiazepine, long-acting sedative-hypnotic; anticonvulsant; schedule IV drug. MOI: Potentiates effects of inhimitory neurotransmitters. Raises the seizure threshold. Induces amnesia and sedation.

Indications: Acute anxiety and agitation. acute alcohol withdrawal, muscle relaxant, seizure activity, sedation for medical procedures (intubation, cardioversion), may be helpful in acute symptomatic cocaine OD.

Contraindications: Hypersensitivity, narrow-angle glaucoma, myasthenia gravis, respiratory insufficiency, coma, head injury.

Side effects: Dizziness, drowsiness, confusion, HA, respiratory depression, hypotension, reflex tachycardia, N&V, muscle weakness, tissue necrosis, ataxia, thrombosis, phlebitis. Drug interactions: Incompatible with most drugs, fluids.

How supplied: 5mg/ml prefilled syringes, ampules, vials and Tubex syringes.

Dosage and administration: Adults: Seizure activity: 5-10mg IV q 10-15 minutes PRN (5mg over 5 minutes)(max dose: 30mg). Premedication for cardioversion: 5-15mg IV over 5-10 minutes prior to cardioversion. Peds: Seizures: 0.2-0.5mg/kg slow IV q 2-5 minutes up to 5mg.(max dose 10mg/kg). Rectally: 0.5mg/kg via 2" rectal catheter and flush with 2-3ml air after administration.

Duration of action: Onset: 1-5 minutes. Peak: 15 minutes. Duration: 20-50 minutes. Special considerations: Pregnancy safety: Category D. Short duration for anticonvulsant effect. Reduce by 50% in elderly.

Class: Inotropic agent, cardiac glycoside.

MOI: Rapid acting cardiac glycoside with direct and indirect effects: Increases force of myocardial contractions, increases refractory period of AV Node, and increases total peripheral resistance.

Indications: CHF, re-entry SVTs, ventricular rate control in AFib/flutter. Contraindications: V-Fib, V-Tach, digitalis toxicity, hypersensitivity.

Side effects: Fatigue, HA, blurred yellow/green vision, seizures, confusion, bradycardia, dysrhythmia, N&V, anorexia, skin rash.

Drug interactions: Amiodarone, verapamil, and quinidine may increase serum digoxin concentrations by 50-70%. Concurrent use of Digoxin and verapamil may lead to severe heart block. Diuretics may potentiate cardiac toxicity.

How supplied: 0.25mg/ml vials.

Dosage and administration: Adult: Loading dose 4-6ug/kg over 5 minutes. Second & third boluses of 2-3ug/kg to follow at 4-8 hour intervals. Peds: Not recommended Duration of action: Onset: 5-30 minutes. Peak: 30-120 minutes. Duration: Several days.

Special considerations: Pregnancy safety: Category C. Patients receiving IV digoxin must be on a monitor. Patients with known renal failure are prone to digitalis toxicity. Hypokalemia, hypomagnesemia, and hypercalcemia potentiate digitalis toxicity. Use carefully in patients with WPW syndrome.

Class: Calcium channel blocker, antidysrhythmic.

MOI: Slow calcium channel blocker that blocks calcium ion influx during depolarization of the cardiac and vascular smooth muscle. Decreases peripheral vascular resistance and causes relaxation of the vascular smooth muscle, resulting in a decrease of both systolic and diastolic B/P. Reduces preload and afterload. Reduces myocardial oxygen demand. Indications: Control rapid ventricular rates in Afib/flutter and re-entry SVTs. Contraindications: Hypotension, SSN, 2nd or 3rd HB, cardiogenic shock, wide complex tachycardia, poison or drug induced tachycardia.

Side effects: Dizziness, weakness, HA, dyspnea, cough, dysrhythmmia, CHF, peripheral edema, bradycardia, hypotension, AV Blocks, syncope, V-Fib, V-Tach, cardiac arrest, CP, N&V, dry mouth.

Drug interactions: Caution in patients using medication that affect cardiac contractility. In general, should not be used on patients on beta blockers.

How supplied: 5mg/ml vials(requires refrigeration), 100mg powder for infusion. (125mg/25ml into a 100ml bag of D5W for 1mg/ml)

Dosage and administration: Adult: Initial dose: 0.25mg/kg (15-20mg for the average patient) IV over 2 minutes. May re-bolus in 15 minutes. Secondary dose: 0.35mg/kg (20-25mg for the average patient) IV over 2 minutes. Maintenance infusion of 5-15mg/hour titrated to physiologically appropriate HR. Peds: Not recommended

Duration of action: Onset: 2-5 minutes. Peak: Variable. Duration: 1-3 hours.

Special considerations: Pregnancy safety: Category C. Use with caution in patients with renal or hepatic dysfunction. PVCs may be present on conversion of PSVT to sinus rhythm. 500mg dose of calcium chloride 5 minutes prior to administering diltiazem can help block the hypotensive effects of borderline hypotensive patients.

Class: Antihistamine, anticholinergic.

MOI: Block cellular histamine receptors, decreases vasodilation, decreases motion sickness. Reverses extrapyramidal reactions.

Indications: Symptomatic relief of allergies, allergic reactions, and anaphylaxis. Hemolytic reactions, motion sickness, allergies such as hay fever, relief of acute dystonic reactions caused by phenothiazines, may be used in phenothiazine OD.

Contraindications: Asthma, glaucoma, pregnancy, hypertension, narrow-angle glaucoma, infants, patients taking MAOIs.

Side effects: Drowsiness, sedation, seizures, dizziness, HA, blurred vision, paradoxical CNS excitement in children, wheezing, thickening of bronchial secretions, palpitations, hypotension, dysrhythimias, dry mouth, diarrhea, N&V.

Drug interactions: Potentiates effects of alcohol and other anticholinergics. May inhibit corticosteriod activity. MAOIs prolong anticholinergic effects of diphenhydramine.

How supplied: 25 & 50mg tablets and capsules. 10mg/ml & 50mg/ml vials.

Dosage and administration: Adult: 25-50mg IM/IV/PO. Peds: 1-2mg/kg IV/IO slowly or IM. If PO: 5mg/kg/24hours.

Duration of action: Onset: 15-30 minutes. Peak: 1 hour. Duration: 3-12 hours.

Special considerations: Pregnancy safety: Category B. Not used in infants. If used in anaphylaxis, must use in conjunction with epinephrine and corticosteriods.

Class: Sympathomimetic, inotropic agent.

MOI: Synthetic catecholamine. Increased myocardial contractility, stroke volume, and increased cardiac output. Minimal chronotropic activity. Increases renal blood flow. Indications: Cardiogenic shock, CHF, Left ventricular dysfunction, often used in conjunction with other drugs.

Contraindications: Tachydysrhythmias, severe hypotension, idiopathic hypertrophic subaortic stenosis (IHSS), suspected or known poison/drug related shock.

Side effect: HA, dyspnea, tachycardia, hypertension, CP, dysrhythmias, PVCs, N&V.

Drug interactions: Incompatible with sodium bicarbonate and furosemide. Beta blockers may blunt inotropic effects.

How supplied: 12.5mg/ml vials. 250mg/250ml D5W (1000ug/ml)

Dosage and administration: Adults: IV infusion at 2-20ug/kg/min titrated to desired effect. Max dose 40ug/kg/min. Peds: IV infusion at 2-20ug/kg/min titrated to desired effect. (Not recommended)

Duration of action: Onset: 2 minutes. Peak: 10 minutes. Duration: 1-2 minutes after d/c infusion.

Special considerations: Pregnancy safety: Category B. Monitor B/P closely. Titrate to maintain HR increase no greater than 10% of baseline. May increase infarct size in patients with MI. Elderly may have a significantly decreased response.

Class: Serotonin receptor antagonist, antiemetic.

MOI: Selectively blocks the action of serotonin, a natural substance that causes N&V. Indications: For the prevention and control of N&V. In-hospital on patients undergoing chemotherapy and surgical procedures.

Contraindications: Known hypersensitivity. Use with caution in patients with dysrhythmias or electrolyte abnormalities.

Side effects: ECG changes(prolonged PR intergal & QT interval, widened QRS), dysrhythmias, anaphylactic reaction, HA, hypotension, dyspepsia, fever, dizziness, constipation.

Drug interactions: Use with phenothiazines, verapamil, haloperidol, dilitiazem, digoxin, beta blockers, and class III antidysrhthimics can have increased cardiac side effects.

How supplied: 20mg/ml vials and 50mg & 100mg tablets.

Dosage and administration: Adult: 12.5mg IV one time, 100mg PO one time. Peds: 2-16 y/o - 0.35mg/kg IV one time to a max of 12.5mg/dose, 1.2mg/kg PO one time to a max of 100mg/dose. Safety in children under 2 not established.

Duration of action: Onset: 30 minutes. Peak: 60 minutes. Duration: 4-9 hours.

Special considerations: Pregnancy safety: Category B. Injectable form should no longer be used in any patient with chemotherapy induced N&V. NO effect when symptoms are due to motion sickness.

Class: Sympathomimetic, vasopressor, inotropic agent.

MOI: Immediate metabolic precursor to norepinephrine. Produces positive inotropic and chronotropic effects. Dilates renal and splanchnic vasculature, increasing B/P and preload. Increases myocardial contractility and stroke volume.

Indications: Cardiogenic and septic shock, hypotension with low cardiac output states, distributive shock, second-line drug for symptomatic bradycardia.

Contraindications: Hypovolemic shock, pheochromocytoma, tachydysrhythmias, V-Fib. Side effects: Extravasation may cause tissue necrosis. HA, anxiety, dyspnea, dysrhythmias, hypotension, hypertension, palpitations, CP, increased myocardial O2 demand, PVCs, N&V.

Drug interactions: Incompatible with alkaline solutions (sodium Bicarbonate). MAOIs will enhance the effect of dopamine. Beta blockers may antagonize the effects of dopamine. When administered with phenytoin, may cause hypotension, bradycardia, and seizures. How supplied: 40mg/ml and 80mg/ml prefilled syringes and vials for infusion. 400mg/250ml D5W premixed solutions (1600ug/ml)

Dosage and administration: Adults: IV/IO infusion at 2-20ug/kg/min, slowly titrated to patient response. Peds: IV/IO infusion at 2-20ug/kg/min, slowly titrated to patient response.

Duration of action: Onset: 3-4 minutes. Peak: 5-10 minutes. Duration: 5-10 minutes. Effects cease almost immediately when infusion is d/c.

Special considerations: Pregnancy safety: Category C. Effects are dose dependent. Dopaminergic response: 2-4ug/kg/min dilates vessels in kidnesy; increasing urine output. Beta-adrenergic response: 4-10ug/kg/min - positive chronotropic and inotropic effects. Adrenergic response: 10-20ug/kg/min - primary alpha stimulant/vasoconstriction. Greater than 20ug/kg/min: reversal of renal effects/ override alpha effect, consider other agents such as epinephrine or norepinephrine infusions. Should be administered with an IV pump.

Class: Sympathomimetic

MOI: Direct acting alpha and beta agonist. Alpha: vasoconstriction. Beta1: positive inotropic, chronotropic, and dromotropic effects. Beta2: bronchial smooth muscle relaxation and dilation of skeletal vasculature. Blocks histamine receptors.

Indications: Cardiac arrest (asystole, PEA, V-Fib & pulseless V-Tach),symptomatic bradycardia as an alternative to dopamine, severe hypotension secondary to bradycardia when atropine and TCP are unsuccessful, allergic reactions, anaphylaxis, and asthma. Contraindications: Hypertension, hypothermia, pulmonary edema, myocardial ischemia, hypovolemic shock.

Side effects: Nervousness, restlessness, HA, tremor, pulmonary edema, dysrhythmias, CP, hypertension, tachycardia, N&V.

Drug interactions: Potentiates other sympathomimetics. Deactivated by alkaline solutions. MAOIs may potentiate effect. Beta blocker may blunt effect.

How supplied: 1:1000 solution: ampules and vials containing 1mg/ml. 1/10,000 solution: prefilled syringes containing 0.1mg/ml. Auto-injector 0.5mg/ml (1:2,000)

Dosage and administration: Adult: Mild allergic reaction and asthama: 0.3-.05mg 1:1,000 SQ. Anaphylaxis: 0.1mg (10ml 1:10,000) IV. Cardiac arrest: IV/IO dose: 1mg (10mL, 1:10,000) q 3-5 minutes during resuscitation. Follow each dose with a 20ml flush of NS and elevate the arem for 10-20 seconds. Continuous infusion: Add 1mg (1ml 1:10,000) to 250ml NS or D5W (4ug/mL). Initial infusion rate of 1ug/min titrated to desired effect (typical dose: 2-10ug/min). ET dose: 2-2.5mg diluted in 10ml of NS. Profound bradycardia or hypotension: 2-10ug/min, titrate to patient's response. Higher doses may be used for beta blocker or calcium channel blocker OD: (up to 0.2mg/kg) Peds: Mild allergic reaction or asthama: 0.01mg/kg (0.01mL/kg of 1:1,000 SQ) max dose of 0.3mL. Anaphylaxis/sever status asthmaticus: 0.01mg/kg (0.01mL/kg 1:10,000 IM) max single dose is 0.3mg/kg. Cardiac arrest: IV/IO dose: 0.01mg/kg (0.1mL/kg of 1:10,000) q 3-5 minutes during arrest. All ET doses: 0.01mg/kg (0.01mL/kg) of 1:10,000 mixed in 3-5mL of NS until IV/IO access. Max single dose is 1mg. Symptomatic bradycardia: IV/IO dose: 0.01mg/kg 1:10,000. Continuous infusion: IV/IO. Begin with rapid infusion, then titrate to response. Typical initial infusion: 0.1-1ug/min. 

Duration of action: Onset: Immediate. Peak: Minutes. Duration: Severel minutes.

Special considerations: Pregnancy safety: Category C. May cause syncope in asthmatic children. May increase myocardial O2 demand. To mix for infusion: 1mg of 1:10,000/500mL D5W, yields 2mcg/mL. Many states are pulling away from IV/IO/IM administration of 1:10,000 and replacing with auto-injectors due to the vascular side effects of solo epi. 1:10,000 injections. 

Class: Sympathomimetic.

MOI: Stimulates Beta2 receptors in the lungs causing bronchodilation with relaxation of bronchial smooth muscles. Reduces airway resistance. Useful in tx laryngeal edema; inhibits histamine release.

Indications: Bronchial asthma, prevention of bronchospamsm, croup, laryngotracheobronchitis, laryngeal edema.

Contraindications: Hypertension, underlying cardiovascular disease, epiglottis.

Side effects: HA, anxiety, fear, nervousness, respiratory weakness, palpitations, tachycardia, dysrhythmias, N&V.

Drug interactions: MAOIs and bretylium may potentiate effect. Beta blockers may blunt effect.

How supplied: MDI: 0.16-0.25mg/spray. Solution: 7.5, 15, 30 mL in 1%, 2.25% solution.

Dosage and administration: Adult: MDI 2-3 inhalations, repeated q 5 minutes PRN. Solution: dilute 5mL (1%) in 5mL NS, administer over 15 minutes. Peds: Solution: dilute 0.25mL (1%) in 2.5mL NS if < 20kg; dilute 0.5mL in 2.5mL NS if 20-40kg; dilute 0.75mL in 2.5mL NS if > 40kg. Administer by HHN.

Duration of action: Onset: Within 5 minutes. Peak: 5-15 minutes. Duration: 1-3 hours. Special considerations: May cause tachycardia and other dysrhythmias. Monitor VS. Excessive use may cause bronchospasm. May have a strong rebound effect after drug wears off.

Class: Glycoprotein IIb/IIa inhibitor, platelet aggregation inhibitor.

MOI: Prevents the aggregation of platelets by binding to the glycoprotein IIb/IIa receptor, preventing the binding of fibrogen and von Willebrand factors.

Indications: Unstable angina and NSTEMI (ACS) being managed medically. Patients undergoing percutaneous coronary intervention.

Contraindications: Any prior intracranial hemorrhage, known malignant intracranial neoplasm, suspected aortic dissection, significant closed head or facial trauma within 3 months. Ischemic CVA within 3 months except if acute within 3 hours. Active internal bleeding in past 30 days, surgical procedure or trauma within preceding 6 weeks, platelet count < 150,000x10/3/uL, hypersensitivity to and concomitant use of another glycoprotein IIb/IIa inhibitor, severe uncontrolled hypertension (sys > 220 or dia > 110)

Side effects: Cerebral hemorrhage, pulmonary hemorrhage, hypotension, GI bleeding, internal bleeding, anaphylactic shock.

Drug interactions: Thrombolytics, oral anticoagulants, aspirin, NSAIDs, dipyridamole, ticlopidine, and clopidogrel increase effect. Incompatible in the same IV line with furosemide.

How supplied: 2mg/mL vials and 0.75mg/mL bottles requires refrigeration.

Dosage and administraton: Adult: Medical management: 180ug/kg IV bolus over 1-2 minutes, followed by a 2ug/kg infusion for 72-96 hours. Percutaneous coronary inverveninfusion/percutaneous transluminal coronary angioplasty: 180ug/kg IV bolus over 1-2 minutes followed by a 2ug/kg infusion, then repeat bolus in 10 minutes. Max dose: (based on a 121kg patient) PCI: 22.6mg bolus, 15mg/hour infusion, infusion duration 18-24 hours after procedure. Peds: Not recommended.

Duration of action: Onset: A few minutes: Peak: 30 minutes to 4 hours. Duration: Platlet function recovers within 4-8 hours after d/c.

Special considerations: Pregnancy safety: Category B. Must be administered only with an IV pump direct from the bottle with a vented set. Due to severe spontaneous bleeding risk invasive procedures should be avoided.

Class: Opioid analgesic, schedule II narcotic.

MOI: Binds to opiate receptors, producing analgesia and euphoria.

Indication: Pain management, anesthesia adjunct.

Contraindications: Known hypersensitivity. Use with caution in traumatic brain injury.

Side effects: Confusion, paradoxical excitation, delirium drowsiness, CNS depression, sedation, respiratory depression, apnea, dyspnea, dysrhythmias, bradycardia, tachycardia, hypotension, synope, N&V, abdominal pain, dehydration, fatigue.

Drug interactions: Increased respiratory effects when given with other CNS depressants. How supplied: 50ug/mL ampules and Tubex syringes.

Dosage and administration: Adult: 50-100ug (1ug/kg) IM/IV/IO slow push (over 1-2 minutes) to max of 150ug. Peds: 1-2ug/kg IM/IV/IO slow push (over 1-2) minutes). The safety and efficacy in children younger than 2 years has not been establish.

Duration of action: Onset: 1-3 minutes. Peak: 3-5 minutes. Duration: 30-60 minutes. Special considerations: Pregnancy safety: Category C. Chest wall rigidity possible with a high dose rapid infusion. A dose of 100ug of fentanyl citrate is equivalent to 10mg of morphine or 75mg Demerol.

Class: Benzodiazepine antagonist, antidote.

MOI: Antagonizes the action of benzodiazepines on the CNS, reversing the sedative effect.

Indications: Reversal of respiration depression and sedative effects from pure benzodiazepine OD.

Contraindications: Hypersensitivity, tricyclic antidepressant OD, seizure prone patients, coma of unknown origin.

Side effects: Seizures, dizziness, agitation, confusion, HA, visual disturbances, dysrhythmias, CP, hypertension, N&V, hiccups, rigors, shivering, pain at injection site. Drug interactions: Toxic effects of mixed drug OD (especially trycyclics)

How supplied: 0.1mg/mL vials.

Dosage and administration: Adult: First dose is 0.2mg IV/IO over 15 seconds. Second dose is 0.3mg may be given over 30 seconds; if no response, give third dose. Third dose is 0.5mg IV/IO over 30 seconds; if no response, repeat once every minute until adequate response or total of 3mg is given. Peds: Not recommended.

Duration of action: Onset: 1-2 minutes. Peak: Related to plasma concentration of benzodiazepines. Duration: Related to plasma concentration of benzodiazepines.

Special considerations: Pregnancy safety: Category C. Be prepared to manage seizures in patients addicted to benzodiazepines. Flumazenil my precipitate withdrawel symptoms in patients addicted to benzodiazepines. Monitor patients for re-sedation and respiratory depression; be prepared to assist ventilations. Not recommended with combined drug OD's, especially with tricyclic antidepressants; may result in death. Controversial use in ploysubstance OD or unknown OD.

Class: Hydantoin anticonvulsant.

MOI: Modulates voltage dependent sodium and calcium channels of neurons, inhibits calcium flux across neuronal membranes. Also selectively elevates the excitibility threshold of the cell, reducing it's response to stimuli.

Indications: Status epilepticus; seizure disorder.

Contraindications: Bradycardia, Adams-Stokes syndrome, 2nd or 3rd AV blocks, sinoatrial blocks, known hypersensitivity to fosphenytoin, phenytoin, or other hydantoins. Side effects: Severe hypotension, bradycardia, dysrhythmias, Stevens-Johnson syndrome, cardiovascular collapse, nystagmus, dizziness, HA, nausea, somnolence, rash and tremor.

Drug interactions: Dopamine may cause severe hypotension. Reacts with many medications, decreasing their effect and increasing the risk of fosphenytoin toxicity. Additive effect with other CNS depressants.

How supplied: 75mg/mL vials.

Dosage and administration: Adult: loading dose of 10-20mg PE/kg IM, IV one time to a max of 150mg PE/min IV. Peds: loading dose of 10-20mg PE/kg IM, IV one time to a max of 3mg PE/kg/min up to 150mg PE/min IV.

Duration of action: Onset: 10 minutes. Peak: 30 minutes. Duration: 12-28 hours. Special considerations: Pregnancy safety: Category D. Use with caution in patients with hepatic and renal impairment and diabetic, elderly, and debilitated patients. Fosphenytoin dosing is expressed as phenytoin equivalents (PE) to avoid the need for dose conversion between products. Each vial contains 75mg/mL, which is equivalent to 50mg/mL of phenytoin.

Class: Loop diuretic.

MOI: Blocks the absorption of sodium and chloride at the distal and proximal tubules and the loop of the Henle, causing increased urine output.

Indications: CHF, pulmonary edema, hypertensive crisis.

Contraindications: Hypovolemia, anuria, hypotension (relative contraindications), hypersensitivity, hepatic coma, suspected electrolyte imbalances.

Side effects: Dizziness, HA, ECG changes, weakness, orthostatic hypotension, dysrhythmias, N&V, diarrhea, dry mouth, may exacerbate hypovolemia and hypokalemia, hyperglycemia.

Drug interactions: Lithium toxicity may be potentiated because of sodium depletion. Digitalis toxicity may be potentiated by potassium depletion.

How supplied: 10mg/ml vials.

Dosage and administration: Adult: 0.5-1mg/kg IV over 1-2 minutes. If no response, double the dose to 2mg/kg slowly over 1-2 minutes. Peds: 1mg/kg IV/IO.

Duration of action: Onset: 5 minutes. Peak: 30-60 minutes. Durations: 4-6 hours. Special considerations: Pregnancy safety: Category C. Ototoxicity, dedafness and projectile vomiting can occur with rapid administration. Should be protected from light. Vasodilatory effects within 5 minutes, diuretic effects withing 30 minutes. Expect a 10-12 mm Hg systolic and 5-7 mm Hg diastolic drop in B/P. Being phased out due to nephrotoxic side effects and greater success rates with CPAP.

Class: Hyperglycemia agent, pancreatic hormone, insulin antagonist.

MOI: Increases BGL by stimulating glycogenolysis. Unknown mechanism of stabilizing cardiac rhythm in beta blocker OD. Minimal positive inotopic and chronotropic response. Decreases GI motility and secretions.

Indications: Altered LOC when hypoglycemia is suspected. May be used as a reversal agent in beta blocker and calcium channel blocker ODs.

Contraindications: Hyperglycemia, hypersensitivity.

Side effects: Dizziness, HA, hypertension, tachycardia, N&V, rebound hypoglycemia. Drug interactions: Incompatible in solutions with most other substances. No significant drug interactions with other emergency medications.

How supplied: 1mg powder in vials

Dosage and administration: Adult: Hypoglycemia: 0.5-1mg IM; may repeat in 7-10 minutes. Calcium channel or beta blocker OD: 3-10mg IV slowly over 3-5 minutes initially, followed by a 3-5mg/hour infusion as necessary. Peds: Hypoglycemia: 0.03-0.1mg/kg IM/IM/SQ, slow IV may repeat in 20 minutes. Max dose 1mg. Calcium channel and beta blocker toxicity: 0.05-0.15mg/kg IV/IO over 3-5 minutes initially, followed by a 0.05-0.10mg/kg/h infusion as necessary.

Duration of action: Onset: 1 minute. Peak: 5-20 minutes. Duration: 60-90 minutes. Special considerations: Pregnancy safety: Category B. Ineffective in glycogen stores depleted. Should always be used in conjunction with D50 whenever possible. If patient does not respond to a second dose of Glucagon, D50 must be administered.

Class: Tranquilizer, antipsychotic.

MOI: Inhibits CNS catecholamine receptors: strong antidopaminergic and weak anticholinergic. Acts on CNS to depress subcortical areas, mid-brain, and ascending reticular activating system in the brain.

Indications: Acute psychotic episodes.

Contraindications: Parkinsons disease, depressed mental status, secondary to shock and hypoxia, hypersensitivity.

Side effects: Seizures, sedation, confusion, restlessness, extrapyramidial reactions, dystonia, respiratory depression, hypotension, tachycardia, orthostatic hypotension, QT prolongation, sudden cardiac death, constipation, dry mouth, N&V, drooling, blurred vision. Drug interactions: Enhanced CNS depression and hypotension in combination with alcohol. Antagonized amphetamines and epinephrine. Other CNS depressants may potentiate effect.

How supplied: 5mg/mL ampules and vials.

Dosage and administration: Adult: 2-5mg IM only q 30-60 minutes until sedation is achieved. Peds: Not recommended.

Duration of action: Onset: 10 minutes. Peak: 30-45 minutes. Duration: Variable (generally 12-24 hours).

Special consideration: Pregnancy safety: Category C. Treat hypotension secondary to halopericol with fluids and norepinephrine, not epinephrine. Patients may also be taking benztropine mesylate (Cogentin) if on long term therapy with haloperidol.

Class: Anticoagulant.

MOI: Prevents conversion of fibrogen to fibrin. Affects clotting factors IX, XI, XII, plasmin. Does not lyse existing clots.

Indications: AMI, prophylaxis and treatment for thromboembolic disorders (eg, pulmonary emboli and DVT).

Contraindications: Hypersensitivity, active bleeding, recent intracranial, intraspinal, or eye surgery, severe hypertension, bleeding tendencies, severe thrombocytopenia.

Side effects: Pain, anaphylaxis, shock, hematuria, GI bleeding, hemorrhage, thrombocytopenia, bruising.

Drug interactions: Salicylates, ibuprofen, dipyridamole and hydroxchloroquine may increase bleeding.

How supplied: Common mix: 25,000U/500mL (yeild 50U/mL).

Dosage and administration: Adult: If used with fibrinolytic therapy, always obtain a blood sample for control of PTT before heparin administration. Heparin is given as an IV bolus of 60U/kg max 4,000 IU (weight adjusted). A continuous infusion is given following the bolus at a rate of 12IU/kg/h rounded to the nearest 50(max: 4,000IU or 1,000U/h). Follow medical control or local protocols. Peds: Not recommended.

Duration of action: Onset: IV immediate, SQ 20-60 minutes. Peak: Variable. Duration: 4-8 hours.

Special considerations: Pregnancy safety: Category C. Heparin dose not lyse existing clots. Heparin along with aspirin is part of the antithrombotic package.

Class: Adrenal glucocoticoid.

MOI: Anti-inflammatory, immunosupressive with salt-retaining actions.

Indications: Shock due to acute adrenocortical insufficiency, anaphylaxis, asthma, and COPD.

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.

Side effects: HA, vertigo, pulmonary TB, CHF, hypertension, fluid retention, nausea.

Drug interactions: Incompatible with heparin and metaraminol.

How supplied: 100mg, 250mg, or 500mg powder in vials. (reconstitue with solution provided)

Dosage and administration: Adult: 4mg/kg slow IV bolus. Peds: 2mg/kg slow IV bolus. Max dose: 100mg.

Duration of action: Onset: 1 hour. Peak: Variable. Duration: 8-12 hours.

Special considerations: Pregnancy safety: Category C. May be used in status asthmaticus as second line drug.

Class: Antidote, cyanide poisoning adjunct.

MOI: Binds with cyanide to form nontoxic cyanocobalamin, preventing its toxic effects; excreted renally.

Indications: Tx of known or suspected cyanide poisoning.

Contraindications: None in emergency setting.

Side effects: Hypertension, allergic reactions, GI bleeding, N&V, dyspepsia, dyspnea, dizziness, HA, injection site reactions.

Drug interactions: Do not administer in the same IV line with diazepam, dobutamine, dopamine, fentanyl, nitroglycerin, propofol, sodium nitrite, and sodium thiosulfate.

How supplied: 2.5g/250mL glass vials.

Dosage and administration: Adult: 5g IV infusion over 15 minutes at a rate of 15mL/min, one time, may be repeated one time at the same rate to a max of 10g. Peds: 70mg/kg IV one time, may repeat same dose.

Duration of action: Onset: Rapid. Peak: 8-10 minutes. Duration: Varies.

Special considerations: Pregnancy safety: Category C. Make sure to reassess the patients airway, oxygenation, and hydration during administration. The patient may become hypertensive during treatment (>180 sys and >110 dia) and will return to baseline in 4 hours.

Class: Antihistamine, antiemetic, antianxiety agent, anxiolytic.

MOI: Potentiates effects of analgesics. Calming effect without impairing mental alertness. Rapid acting true ataraxic with probable action of suppressing activity in key locations of the CNS's subcortical area. Exerts bronchodilating, antispasmodic, antihistaminic, analgesic, and antiemetic effects.

Indications: Potentiates the effects of anagelsics. Controls N&V in anxiety reactions and motion sickness; preoperative and postoperative sedation.

Contraindications: Hypersensitivity, early pregnancy.

Side effects: Drowsiness, agitation, ataxia, dizziness, HA, weakness, wheezing, chest tightness, urinary retention, dry mouth, constipation, pain at injection site.

Drug interactions: Potentiates the effects of CNS depressants such as narcotics, barbiturates, and alcohol.

How supplied: 25, 50mg/mL vials.

Dosage and administration: Adult: 20-100mg IM ONLY. Peds: 0.5-1mg/kg IM ONLY. Duration of action: Onset: 15-30 minutes. Peak: 45-90 minutes. Duration: 4-6 hours. Special considerations: Pregnancy safety: Category C. Should be administered by IM only. Localized burning at injection site.

Class: Antidiabetic, hormone.

MOI: Allows glucose transport into cells of all tissues; converts glycogen to fat; produces intracellular shift of potassium and magnesium to reduce elevated serum levels of these electrolytes.

Indications: Not used in emergency prehospital setting. DKA or other hyperglycemic state, hyperkalemia (insulin and D50 used together to lower hyperkalemia state), nonketotic hypersomolar coma.

Contraindications: Hypoglycemia, hypokalemia.

Side effects: Weakness, fatigue, confusion, HA, seizure, coma, tachycardia, nausea, hypokalemia, hypoglycemia, diaphoresis, itching, swelling, redness.

Drug interactions: Incompatible in solution with all other drugs. Corticosteriod, dobutamine, epinephrine, and thiazide diuretics decrease the hypoglycemic effects of insulin. Alcohol and salicylates may potentiate the effects of insulin.

How supplied: 30-70U/mL vials.

Dosage and administration: Dosage is adjusted relative to BGL. Standard dose for diabetic coma Adult: 10-25U SQ/IM/IV followed by infusion of 0.1U/kg/h. Peds: 0.1-0.2U/kg/h SQ/IM or IV followed by infusion of 50U/250mL (0.2U/mL), at a rate of 0.1-0.2U/kg/h.

Duration of action: Onset: Minutes. Peak: Approx. 1 hour (short acting), 3-6 hours (intermediate acting), 5-8 hours (long acting). Duration: Approx. 6-8 hours (short acting), 24 hours (intermediate acting), 36 hours (long acting).

Special considerations: Pregnancy safety: Category B. Insulin is the drug of choice for control of diabetes in pregnancy. Usually requires refrigeration. Most rapid absorption if injected into abdominal wall; next most rapid (arm), slowest absorption if injected into the thigh.

Class: Anticholinergic, bronchodilator.

MOI: Inhibits interaction of acetylcholine at receptor sites of bronchial smooth muscle, resulting in decreased cyclic guanosine monophosphate and bronchodilation.

Indications: Persistent bronchospasm, COPD exacerbation.

Contraindications: Hypersensitivity to ipratropium, atropine, alkaloids, peanuts.

Side effects: HA, dizziness, nervousness, fatigue, tremor, blurred vision, cough, dyspnea, worsening COPD symptoms, tachycardia, palpitations, flushing, MI, dry mouth, N&V, GI distress.

Drug interactions: None reported.

How supplied: Aerosol 18ug/actuation. 500ug/mL of a 0.025 solution for HHN.

Dosage and administration: Adult: 250-500ug/HHN q 20 minutes up to 3 times. Peds: Same.

Duration of action: Onset: 1-3 minutes. Peak: 90-120 minutes. Duration: 4-6 hours. Special considerations: Pregnancy safety: Category B. Note: when used in combination with beta-agonist (eg, metaproterenol and albuterol), the beta-agonist is always administered first with a 5 minute wait before administering Ipratropium. Shake well. Use with caution in patients with urinary retention.

Class: Sympathomimetic.

MOI: Beta2 agonist; relaxes smooth muscle of the bronchioles.

Indications: Acute bronchial asthma, bronchospasms (esp. in COPD patients). Contraindications: Use with caution in patients with diabetes, hyperthyroidism, cardiovasular disease, and cerebrovascular disease.

Side effects: Nervousness, dose-related tachycardia, palpitations, nausea, tremors. Multiple doses can cause paradoxical bronchoconstriction.

Drug interactions: Additive adverse effects if given with other Beta-2 agonist drugs.

How supplied: Multi dose inhalers and 2mL unit dose of 1% solution.

Dosage and administration: Adult: 1-2 inhalations with MDI: COPD - 2.5-5mg (2.5-0.5mL) diluted in 3mL NS and nebulized. Peds: 0.01mg/kg; max dose: 0.5mL in 3ml NS by HHN.

Duration of action: Onset: Immediate. Peak: 5-15 minutes. Duration: 1-4 hours.

Special considerations: None

Class: NSAID analgesic.

MOI: Potent analgesic that does not possess any sedative or anxiolytic activities by inhibiting prostaglandin synthesis.

Indications: Short term management of moderate to severe pain.

Contraindications: Allergy to salicylates or other NSAIDs. Patients with Hx of asthma, bleeding disorders (esp. GI related), renal failure.

Side effects: Drowsiness, dizziness, HA, sedation, bronchospasm, dyspnea, edema, vasodilation, hypotension, hypertension, GI bleeding, diarrhea, dyspepsia, nausea.

Drug interactions: May increase bleeding time in patients taking anticoagulants.

How supplied: 15mg/mL and 30mg/mL vials.

Dosage and administration: Adult: 30-60mg IM. Peds: Not recommended.

Duration of action: Onset: 10 minutes. Peak: 1-2 hours. Duration: 2-6 hours.

Special considerations: Pregnancy safety: Category C. Use with caution in elderly patients due to higher risk of renal and fatal GI adverse reactions.

Class: Selective alpha and nonselective beta-adrenergic blocker. antihypertensive.

MOI: B/P reduction without reflex tachycardia; total peripheral resistance reduced without significant alteration of cardiac output.

Indications: Moderate to severe hypertension.

Contraindications: Bronchial asthma, CHF, cardiogenic shock, 2nd & 3rd degree HB, bradycardia.

Side effects: Fatigue, weakness, depression, HA, dizziness, bronchospasm, wheezing, dyspnea, bradycardia, CHF, pulmonary edema, orthostatic hypotension, ventricular dysrhythmias, N&V, diarrhea.

Drug interactions: may block bronchodilator effects of beta-adrenergic agonist. Nitroglycerin may augment hypotensive effects.

How supplied: 5mg/mL vials.

Dosage and administration: Adult: 10mg IV push over 1-2 minutes. May repeat or double q 10 minutes to a max dose of 150mg. Infusion: 2-8mg/min, titrated to supine B/P. Peds: Not recommended.

Duration of action: Onset: >5 minutes. Peak: Variable. Duration: 3-6 hour.

Special considerations: Pregnancy safety: Category C. B/P, pulse rate, and ECG should be monitored continuously. Observe for signs of CHF, bradycardia, and bronchospasm. Only administer to patients in supine position.

Class: Sympathomimetic, bronchodilator.

MOI: Stimulates beta2 receptors resulting in smooth muscle relaxation of bronchial tree and peripheral vasculature.

Indications: Treatment of acute bronchospasm in patients with reversible obstructive airway disease (COPD/asthma). Bronchospasm prophylaxis in asthma patients. Contraindications: Known hypersensitivity to this or other sympathomimetic drugs. Angioedema, tachydysrhythmias, and severe cardiac disease. Avoid use in patients taking phenothiazines; may cause prolonged QT interval and dysrhythmias. Avoid use in patients on sotalol; may decrease bronchodilating effects and cause bronchospasm, prolonged QT interval, and dysrhythmias.

Side effects: HA, anxiety, dizziness, restlessness, hallucinations, throat irritation, tachycardia, hypertension, hypotension, dysrhythmias, angina, N&V, dyspepsia, tremors, hypokalemia, hyperglycemia.

Drug interactions: Increased actions of bronchodilators, tricyclic antidepressants, MAOIs, and other adrenergic drugs.

How supplied: 0.63mg, 1.25mg/3mL solutions.

Dosage and administration: Adult: 1.25mg to 2.5mg in 3ml administered by HHN q 20 minutes to a max of 3 doses. Peds: 0.075mg/kg (minimum of 1.25mg) administered by HHN q 20 minutes for a max of 3 doses.

Duration of action: Onset: 5-15 minutes. Peak: 60-90 minutes. Duration: 6-8 hours. Special considerations: Pregnancy safety: Category C. Use with caution in patients with cardiac dysrhythmias and cardiovascular disorders.

Class: Antidysrhythmic.

MOI: Decreases automaticity by slowing the rate of spontaneous phase 4 depolarization. Indications: Alternative to amiodarone in cardiac arrest from V-Tach, V-Fib, stable wide-complex tachycardia (poly or mono) with normal baseline QT interval, stable monomorphic V-Tach with preserved ventricular function.

Contraindications: Hypersensitivity. 2nd & 3rd AV block, Stokes-Adams syndrome, prophylactic use in AMI, wide complex ventricular escape beats with bradycardia.

Side effects: Anxiety, drowsiness, confusion, seizures, slurred speech, respiratory arrest, hypotension, bradycardia, dysrhythmias, cardiac arrest, AV blocks, N&V.

Drug interactions: Apnea induced with succinylcholine may be prolonged with high doses of lidocaine. Cardiac depression may occur in conjunction with IV phenytoin. Procainamide may exacerbate CNS effect. Metabolic clearance is decreased in patients with liver disease or in patients taking beta blockers.

How supplied: 20mg/mL of 2% solution prefilled syringe. 4mg/mL in D5w fro infusion (1g/250mL D5W)

Dosage and administration: Adult: Cardiac arrest/pulseless V-Tach/V-Fib: Initial dose: 1-1.5mg/kg IV/IO. Repeat dose: 0.5-0.75mg/kg repeated in 5-10 minutes. Max total dose: 3mg/kg. Stable V-Tach, wide complex tacycardia of unknown origin, significant ectopy: dose range 0.5-0.75mg/kg and up to 1-1.5mg/kg. Repeat 0.5-0.75mg/kg q 5-10 minutes. Max dose 3mg/kg. ET dose: 2-4mg/kg. Maintenance infusion: 1-4mg/min (30-50 ug/kg/min); can dilute in D5W or NS. Peds: IV/IO dose: 1mg/kg rapid push. Max dose 100mg. Continuous IV/IO infusion: 20-50ug/kg/min. Repeat bolus dose (1mg/kg) when infusion is initiated if bolus has not been given within previous 15 minutes. ET dose: 2-3mg/kg. RSI: 1-2mg/kg IV/IO one time only.

Duration of action: Onset: 1-5 minutes. Peak: 5-10 minutes. Duration: Variable (15 minutes to 2 hours).

Special considerations: Pregnancy safety: Category B. Reduce maintenance infusion by 50% if patient is older than 70, has liver or renal disease, in CHF, or in shock. A 75-100mg bolus maintains blood levels fro only 20 minutes (if not in shock). Exceedingly high doses can result in death or coma. Avoid lidocaine fro reperfusion dysrhythmias after fibrinolytic therapy. Cross-reactivity with other forms of local anesthetics.

Class: Benzodiazepine, short/immediate acting; sedative, anticonvulsant, schedule IV drug.

MOI: Anxiolytic, anticonvulsant, and sedative effect; suppresses propagation of seizure activity produced by foci in cortex, thalamus, and limbic areas.

Indications: Initial control of status epilepticus or severe recurrent seizures, severe anxiety, sedation.

Contraindications: Acute narrow-angle glaucoma, coma, shock, suspected drug abuse. Side effects: Dizziness, drowsiness, CNS depression, HA, sedation, respiratory depression, apnea, hypotension, bradycardia.

Drug interactions: May precipitate CNS system depression in already taking CNS depressant medications.

How supplied: 2 and 4mg/mL vials and Tubex syringes.

Dosage and administration: Note: When given IV/IO, must be diluted with equal volume of NS. When given IM, not diluted. Adult: 2-4mg slow IM/IV at 2mg/min; may repeat in 15-20 minutes. Max dose 8mg. For sedation: 0.05mg/kg up to 4mg IM. Peds: 0.05-0.20mg/kg slow IV/IO/IM over 2 minutes. May be repeated once in 15-20 minutes. Max dose of 0.2mg/kg.

Duration of action: Onset: 1-5 minutes. Peak: Variable. Duration: 6-8 hours.

Special considerations: Pregnancy safety: Category D. Monitor respiratory rate and B/P during administration. Have advance airway equipment readily available. Inadvertent arterial injection may result in vasospasm and gangrene. Lorazepam expires in 6 weeks when not refrigerated.

Class: Electrolyte, anti-inflammatory.

MOI: Reduces striated muscle contractions and blocks peripheral neuromuscular transmission by reducing acetylcholine release at the myoneural junction. Manages seizures in toxemia of pregnancy. Induces uterine relaxation. Can cause bronchodilation after beta-agonist and anti-cholinergics have been administered.

Indications: Seizures of eclampsia, torsades, hypomagnesaemia, V-Fib/pulseless V-Tach that is refractory to amiodarone, life threatening dysrhythmias due to digitalis toxicity. Contraindications: Heart block, myocardial damage.

Side effects: Drowsiness, CNS depression, respiratory depression, respiratory tract paralysis, abnormal ECG, AV block, hypotension, vasodilation, hyporeflexia.

Drug interactions: May enhance effect of CNS depressants. Serious changes in overall cardiac function may occur with cardiac glycosides.

How supplied: 50% solution (500mg/mL) vials. Must be diluted to a 10% solution before administered.

Dosage and administration: Adult: Seizure activity associate with pregnancy: 1-4g of 10% solution IV/IO over 3 minutes; max dose 30-40g/day. Cardiac arrest to hypomagnesaemia or torsades: 1-5g of 10% solution IV/IO over 5-20 minutes. Torsades w/pulse: loading dose of 1-2g in 50-100mL of D5W over 5-60 minutes IV. Follow with 0.5-1g/h IV (titrate). Peds: Pulseless V-Tach w/Torsades: 25-50mg/kg IV/IO bolus of 10% solution over 10-20 minutes to a max dose of 2g. Torsades w/pulse or hypomagneasemia: 25-50mg/kg IV/IO of 10% solution over 10-20 minutes to a max dose of 2g. Status asthmaticus: 25-50mg/kg IV/IO of 10% solution over 15-30 minutes to a max dose of 2g.

Duration of action: Onset:IV/IO Immediate. Peak: Variable. Duration:IV/IO 30 minutes. Special considerations: Pregnancy safety: Category A. Recommended that the drug be administered in the 2 hours before delivery, if possible. IV calcium gluconate or calcium chloride should be available as an antagonist to Mag sulfate if needed. Use with caution in patients with renal failure.

Class: Osmotic diuretic.

MOI: Promotes the movement of fluid from intracellular space to the extracellular space. Decreases cerebral edema and ICP. Promotes urinary excretion of toxins.

Indications: Cerebral edema, reduce ICP for certain cause (space occupying lesions), rhabdomyolysis (myglobinuria), blood transfusion reactions.

Contraindications: Hypotension, pulmonary edema, severe dehydration, intracranial bleeding, CHF.

Side effects: HA, confusion, seizures, pulmonary edema, tachycardia, CP, CHF, hypotension, hypertension, edema, N&V, dehydration.

Drug interactions: May precipitate digitalis toxicity when given concurrently.

How supplied: 250mL and 500mL of 20% solution for IV infusion (200mg/mL). 25% solution in 50mL for slow IV push.

Dosage and administration: Adult: 0.5-1g/kg IV infusion over 5-10 minutes. Additional doses of 0.25-2g/kg can be given every 4-6 hours as needed. Peds: 0.5-1g/kg/dose IV, IO infusion over 30-60 minutes; may repeat after 30 minutes if no effect.

Duration of action: Onset: 1-3 hours for diuretic effect; 15 minutes for reduction of ICP. Peak: Variable. Duration: 4-6 hours for diuretic effect; 3-8 hours for reduction of ICP. Special considerations: Pregnancy safety: Category C. May crystallize at low temps; store at room temp. In-line filter should always be used. Effectiveness depends on large doses and an intact blood brain barrier. Usage and dosage in emergency care are controversial. Be sure to have ventilatory support available.

Class: Opioid analgesic, schedule II drug.

MOI: Synthetic opioid analgesic whose effects on the CNS and smooth muscle organs are similar to morphine, primarily acting as an analgesic and sedative.

Indications: Moderate to severe pain.

Contraindications: Hypersensitivity to narcotics, diarrhea caused by poisoning, patients taking MAIOs, during L&D of a premature infant, undiagnosed abdominal pain or head injury.

Side effects: Seizures, confusion, sedation, dysphoria, HA, hallucinations, increased ICP, respiratory depression, apnea, hypotension, or orthstatic hypotension, syncope, bradycardia, dysrhythmias, N&V, constipation, sweating.

Drug interactions: Do not give concurrently with MAOIs (even within the last 14 days). Exacerbates CNS depression when given with other CNS depressants.

How supplied: 50mg/mL and 100mg/mL prefilled syringes and Tubex syringes.

Dosage and administration: Adult: 50-100mg IM, SQ. 25-50mg slow IV. Peds: 1-2mg/kg/dose IV/IO/IM/SQ.

Duration of action: Onset: IM: 10-45 minutes; IV: immediate. Peak: 30-60 minutes. Duration: 2-4 hours.

Special considerations: Pregnancy safety: Category C. Use with caution in patients with asthma & COPD. May aggravate seizures in patients with know convulsive disorders. Narcan should be readily available.

Metaproterenol Sulfate (Alupent)

Class: Beta-2 adrenergic agonist, bronchodilator.

MOI: Acts directly on bronchial smooth muscle causing relaxation of the bronchial tree and peripheral vasculature.

Indications: Bronchial asthma, reversible bronchospam secondary to bronchitis, COPD.

Contraindications: Tachydysrhthmias, hypersensitivity, tachycardia caused by Digitalis.

Side effects: Nervousness, tremor, HA, anxiety, cough, paradoxical bronchospasm, hypertension, CP, tachydysrhythmias, palpitations, cardiac arrest, diarrhea, N&V, backache, skin reactions, sweating.

Drug interactions: Other sympathomimetics may exacerbate cardiovascular effects. MAOIs may potentiate hypotensive effects. Beta blockers may antagonize metaproternol. How supplied: MDI 0.65/mg/spray (15mL inhaler). Solution: 5% solution in bottles of 10 & 30mL with calibrated dropper. Alupent inhalation solution unit-dose vial 0.4% or 0.65. Dosage and administration: Adult: MDI: 2-3 inhalations q 3-4 hours (2 mins between each inhale). Inhalation solution 5%: Via HHN 0.2-0.3mL of 5% solution diluted in 2.5mL NS. Peds: MDI: Not recommended. Inhaled solution 5%: Age 6-12: 0.1-02mL in 3mL NS by HHN.

Duration of action: Onset: 1 minute. Peak: 45 minutes. Duration: 3-6 hours.

Special considerations: Pregnancy safety: Category C. Monitor for hypotension and tachycardia. Use with caution in patients with coronary artery disease, seizures, hypertension, and diabetes.

Class: Corticosteroid.

MOI: Highly potent synthetic glucocorticoid that suppresses acute and chronic inflammation; potentiates vascular muscle relaxation by beta-adrenergic agonist.

Indications: Acute spinal cord trauma, anaphylaxis, bronchodilator for unresponsive asthma.

Contraindications: Premature infants, systemic fungal infections, use with caution in patients with GI bleeding.

Side effects: Depression, euphoria, HA, hypertension, CHF, N&V, peptic ulcer, fluid retention, hypernatremia, hyperkalemia.

Drug interaction: Hypoglycemic reponses to insulin and hypoglycemic agents may be blunted.

How supplied: 40,125,500,1,000mg powder.

Dosage and administration: Adult: Acute spinal cord injury: 30mg/kg IV over 30 minutes followed by infusion: 5.4mg/kg/h. Asthma, COPD, anaphylaxis: 1-2mg/kg IV. Peds: Acute spinal cord tauma: Same as adult. Status asthmaticus/anaphylaxis: 2mg/kg/dose IV/IO/IM to a max dose of 60mg.

Duration of action: Onset: 1-2 hours. Peak: Variable. Duration: 8-24 hours.

Special considerations: Pregnancy safety: Category C. Not effective if time of spinal cord injury >8 hours. Crosses the placenta and can cause fetal harm.

Class: Benzodiazepine, short/intermediate acting; schedule IV drug.

MOI: Reversibly interacts with gamma-amino butyric acid (GABA) receptors in the CNS causing sedative, anxiolytic, amnesic, and hypnotic effects.

Indications: Sedation for medical procedures (eg. Intubation, pts on vents, cardioversion).

Contraindications: Acute narrow angle glaucoma, shock, coma, alcohol intoxication, OD, depressed VS. Concomitant use of barbiturates, alcohol, narcotis, or other CNS depressants.

Side effects: HA, somnolence, respiratory depression, respiratory arrest, apnea, hypotension, cardiac arrest, N&V, pain at injection site.

Drug interactions: Should not be used in patients who have taken CNS depressants. How supplied: 1mg/mL & 5mg/mL vials and Tubex syringes.

Dosage and administration: Adult: 2-2.5mg slow IV push (over 2-3 mins). May be repeated to total max dose of 0.1mg/kg. Peds: 0.1-0.3mg/kg IV/IO (max single dose: 10mg).

Duration of action: Onset: 1-3 minutes IV and dose dependant. Peak: Variable. Duration: 2-6 hours, dose dependant.

Special considerations: Pregnancy safety: Category D. Administer immediately prior to intubation procedure. Requires continuous monitoring of respiratory & cardiac function. Decrease dose by 50% in patients with hepatic and renal dysfunction.

Class: Beta blocker, beta-1 selective; antihypertensive, antidysrhythmic.

MOI: Decreases HR, conduction velocity, myocardial contractility, and cardiac output. Used to control ventricular response in SVT (PSVT, A-Fib/Flutter). Considered second line agent after adenosine, diltiazem, or digitalis derivative.

Indications: PSVT, A-Fib/Flutter, reduces myocardial ischemia and damage in patients with AMI.

Contraindications: Heart failure, 2nd & 3rd degree AV block, 1st degree block (if PR-interval >0.24 seconds), SSN, cardiogenic shock, bradycardia.

Side effects: Weakness, dizziness, depression, bronchospasm, wheezing, dyspnea, bradycardia, pulmonary edema, CHF, AV blocks, hypotention, heart failure, nausea, indigestion.

Drug interactions: Metoprolol may potentiate antihypertensive effects when given to patients taking calcium channel blockers or MAOIs. Catecholamine-depleting drugs may potentiate hypotension. Sympathomimetic effects may be antagonized. Signs of hypoclycemia may be masked.

How supplied: 1mg/mL ampules and vials.

Dosage and administration: Adult: 5mg slow IV push at 5 minute intervals to a total dose of 15mg. Peds: Safety not established.

Duration of action: Onset: 1-2 minutes. Peak: 5-10 minutes. Duration: 3-4 hours. Special considerations: Pregnancy safety: Category C. Must be given slowly over 5 minutes. Concurrent IV administration with IV calcium channel blocker (verapamil or diltiazem) can cause severe hypotension. Should be used with caution in patients with liver or renal dysfunction, hypotension, and COPD.

Class: Opioid analgesic. (Schedule II)

MOI: 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 O2 demand.

Indications: Severe CHF, acute cardiogenic pulmonary edema, CP associated with AMI, analgesia for moderate to severe pain. (acute and chronic)

Contraindications: Head injury, exacerbated COPD, depressed respiratory drive, hypotension, undiagnosed abdominal pain, decreased LOC, suspected hypovolemia, patients taken MAOIs in past 14 days.

Side effects: Confusion, sedation, HA, CNS depression, respiratory depression, apnea, bronchospasm, dyspnea, hypotension, orthostatic hypotension, syncope, bradycardia, tachycardia, N&V, dry mouth.

Drug interactions: Potentiates sedative effects of phenothiazines. CNS depressants may potentiate effect of morphine. MAOIs may cause paradoxical excitation.

How supplied: 2mg/mL, 4mg/mL, 8mg/mL, 10mg/mL ampules, vials and Tubex syringes.

Dosage and administration: Adult: STEMI: Initial dose: 2-4mg slow IV (over 1-5 minutes). Repeat dose: 2-8mg at 5-15 minute intervals. NSTEMI/Unstable angina: 1-5mg IV push if symptoms not relieved by nitrates. Peds: 0.1-0.2mg/kg/dose IV/IO/IM/SQ. Max dose: 5mg.

Duration of action: Onset: Immediate. Peak: 20 minutes. Duration: 2-7 hours.

Special considerations: Pregnancy safety: Category C. Morphine rapidly crosses the placenta. Safety in neonates has not been established. Use with caution in elderly, asthma patients, and those susceptible to CNS depression. Vagotonic effect in patients with acute inferior MI (bradycardia, HB). Narcan should be readily available.

Class: Synthetic opioid agonist/antagonist.

MOI: Activates opiate receptor in limbic system of CNS. Anagelsic similar to morphine on mg for mg basis. Agonist and antagonist properties. May be preferred for CP in setting of AMI because it reduces the myocardial O2 demand without reducing the B/P.

Indications: CP associated with AMI. Moderate to severe acute pain.

Contraindications: Head injury, undiagnosed abdominal pain, diarrhea caused by poisoning, hypovolemia, hypotension.

Side effects: HA, dizziness, vertigo, seizure, CNS depression, paradoxical CNS stimulation, respiratory depression, pulmonary edema, hypotension, hypertension, palpitations, bradycardia, N&V, dry mouth.

Drug interactions: CNS depressants may potentiate effects.

How supplied: 10mg/mL and 20mg/mL ampules and vials.

Dosage and administration: Adult: 2-5mg slow IV. May repeat 2mg doses PRN to a max dose of 10mg. Peds: Not recommended.

Duration of action: Onset: 2-3 minutes. Peak: Variable. Duration: 3-6 hours.

Special considerations: Pregnancy safety: Category B. Use with caution in patients with impaired respiratory function. May precipitate withdrawal syndromes in narcotic dependent patients. Narcan should be readily available.

Class: Calcium channel blocker.

MOI: Inhibits movement of calcium ions across cell membranes; calcium channel blocker; arterial and venous vasodilator; reduces preload and afterload; prevents coronary artery spasm and decreases total peripheral resistance; reduces myocardial O2 demand; does not prolong AV nodal conduction.

Indications: Hypertensive crisis, angina.

Contraindications: Compensatory hypertension, hypotension, cardiogenic shock.

Side effects: HA, dizziness, nervousness, weakness, mood changes, dyspnea, cough, wheezing. CHF, MI, ventricular dysrhythmias, hypotension, syncope, nausea, abdominal discomfort, diarrhea.

Drug interactions: Beta blocker may potentiate effects. Effects of theophylline may be increased. Antihypertensives may potentiate hypotensive effects.

How supplied: 10 & 20mg liquid filled capsules.

Dosage and administration: Adult: 10mg SL or buccal. May repeat in 30 minutes. Peds: Not recommended.

Duration of action: Onset: 15- 30 minutes. Peak: 1-3 hours. Duration: 6-8 hours. Special considerations: Pregnancy safety: Category C. Does not slow AV nodal activity. Have beta blocker available for control of reflex tachycardia. Use with caution in geriatric population. Hypotension and angina may occur.

Class: Vasodilator

MOI: Smooth muscle relaxant acting on vasculature, bronchial, uterine, intestinal smooth muscle. Dilation of arterioles and veins in the periphery. Reduces preload and afterload, decreasing workload of the heart and thereby O2 demand.

Indications: Acute angina, ischemic CP, hypertension, CHF, pulmonary edema. Contraindications: Hypotension, hypovolemia, intracranial bleeding or head injury, pericardial tamponade, severe bradycardia or tachycardia, RV infarction, previous administration in last 24/h of tadalafil(Cialis) (48hours), vardenafil(Levitra), sildenafil(Viagra).

Side effects: HA, dizziness, weakness, reflex tachycardia, syncope, hypotension, N&V, dry mouth, muscle twitching, diaphoresis.

Drug interactions: Additive effects with other vasodilators. Incompatible with other drugs intravenously.

How supplied: Tablets: 0.3mg (1/200gr). 0.4mg (1/150gr). 0.6mg (1/100gr). NTG spray: 0.4mg/actuation. NTG IV(Tradil). 200ug/mL in D5W glass vials.

Dosage and administration: Adult: Tablet: 0.3-0.4mg SL; may repeat q 5 minutes to a max of 3 doses. NTG spray: 1-2 sprays for 0.5-1 second q 5 minutes to a max of 3 sprays in 15 minutes. NTG IV infusion: Begin at 10ug/min; increase by 10ug/min q 3-5 minutes until desired effect. Max of 200ug/min. Peds: Not recommended. IV infusion: 0.25-0.5ug/kg/min IV/IO titrated by 1ug/kg/min (max dose of 5ug/kg/min).

Duration of action: Onset: 1-3 minutes. Peak: 5-10 minutes. Duration: SL-20-30 minutes. IV-1-10 minutes after d/c infusion.

Special considerations: Pregnancy safety: Category C. Hypotension more common in the elderly. If 12 lead ECG shows inferior wall infarct, R/O right ventricular infarct via right sided 12 lead ECG prior to administering NTG. NTG decomposes when exposed to light or heat, must be kept in airtight containers. Must be administered only with an IV pump direct from the bottle with vented IV set and non PVC tubing. Active ingredient may have stinging effect when administered.

Class: Vasodilator.

MOI: Smooth muscle relaxant acting on vasculature, bronchial, uterine, intestinal smooth muscle. Dilation of arterioles and veins in the periphery. Reduces preload and afterload, decreasing workload of the heart and thereby O2 demand.

Indications: Acute angina, CP associated wtih AMI, hypertension, CHF, pulmonary edema.

Contraindications: Hypotension, hypovolemia, intracranial bleeding or head injury, previous administration in last 24/h of tadalafil(Cialis) (48hours), vardenafil(Levitra), sildenafil(Viagra).

Side effects: HA, dizziness, weakness, reflex tachycardia, syncope, hypotension, N&V, dry mouth, muscle twitching, diaphoresis.

Drug interactions: Additive effects with other vasodilators.

How supplied: 20-60gram tubes of 2% NTG paste with measuring applicator.

Dosage and administration: Adult: Paste: apply 1/2"-34" (1-2cm), 15-30mg, cover with wrap and secure with tape. Max 5" (75mg) per application. Apply transdermally usually to chest wall. Peds: Not recommended.

Duration of action: Onset: 30 minutes. Peak: Variable. Duration: 18-24 hours.

Special considerations: Pregnancy safety: Category C. Not a great value in prehospital arena. Wear gloves when applying paste. Store in a cool place with cap tightly secured. Erratic absorption rates quite common.

Class: Gaseous analgesic and anesthetic.

MOI: Exact mechanism unknown; affects CNS phospholipids.

Indications: Moderate to severe pain, anxiety, apprehension.

Contraindications: Impaired LOC, head injury, inability to follow or comply with instructions, decompression sickness (nitrogen narcosis, air embolism, and air transport), undiagnosed abdominal pain or marked distention, bowel obstruction, hypotension, shock, COPD, cyanosis, chest trauma with pneumothorax.

Side effects: Lightheadedness, drowsiness, respiratory depression, apnea, N&V, malignant hyperthermia.

Drug interaction: None of significance. How supplied: D & E cylinders (Blue & green) of a 50% nitrous & 50% O2 compressed gas.

Dosage and administration: Adult: Instruct the person to inhale deeply through demand valve and mask or mouthpiece. Peds: Same.

Duration of action: Onset: 2-5 minutes. Peak: Variable. Duration: 2-5 minutes.

Special considerations: Pregnancy safety: Category C. Increases the incidence of spontaneous abortion. Ventilate patient care area during use. Nonflammable and nonexplosive. Ineffective in 20% of the population.

Class: Serotonin receptor antagonist, antiemetic.

MOI: Blocks action of serotonin, which is a natural substance that causes N&V.

Indications: For the prevention and control of N&V. Used in hospital for patients undergoing chemo. or surgical procedures.

Contraindications: Known allergy to ondansetron or other 5-HT3, receptor agonist.

Side effects: HA, malaise, wheezing, bronchospasm, A-Fib, abnormal ECG, prolonged QT interval, ST segment depression, 2nd degree AV block, constipation, diarrhea, hives, skin rash.

Drug interactions: Not recommended in the patient is taking apomorphine, mesoridazine, pimozide, or thioridazine.

How supplied: 2mg/mL vials.

Dosage and administration: Adult: 4mg IV/IM may repeat in 10 minutes. Peds: 0.1mg/kg IV/IM.

Duration of action: Onset: 30 minutes. Peak: 2 hours. Duration: 3-6 hours.

Special considerations: Pregnancy safety: Category B.

Class: Hypoglycemic, carbohydrate.

MOI: After absorption in the GI tract, glucose is distributed to the tissues providing an increase in circulating BGL.

Indications: Conscious patient w/suspected hypoglycemia.

Contraindications: Decreased LOC, N&V.

Side effects: Nausea, vomiting.

Drug interactions: None.

How supplied: Paste and gel.

Dosage and administration: Adult: 15-45g PO. Peds: 5-45g PO.

Duration of action: Onset: 10 minutes. Peak: Variable. Duration: Variable.

Special considerations: Must be swallowed. Glucose is not absorbed SL or buccally. Check BGL before administering and repeat 10 minutes following.

Class: Pituitary hormone.

MOI: Increase uterine contractions.

Indications: Postpartum hemorrhage after infant and placenta delivery.

Contraindications: Presence of second fetus, unfavorable fetal position.

Side effects: Coma, seizure, anxiety, subarachnoid hemorrhage, hypotension, tachycardia, dysrhythmias, CP, N&V, painful uterine contractions, uterine rupture.

Drug interactions: Other vasopressors may potentiate hypotension.

How supplied: 10units/mL solution.

Dosage and administration: Adult: IM: 10units following placenta delivery. IV: Mix 10-40units in 1,000ml nonhydrating solution. Infuse at 20-40milliunits/min. Titrated to severity of bleeding and uterine response. Peds: N/A.

Duration of action: Onset: IM: 3-5 minutes, IV: immediate. Peak: Variable. Duration: IM: 30-60 minutes, IV: 20 minutes after infusion is stopped.

Special considerations: Pregnancy safety: Category C. Monitor VS including fetal HR and uterine tone closely.

Class: Nondepolarizing neuromuscular blocker/paralytic.

MOI: Binds to receptor for acetylcholine at the neuromuscular junction.

Indications: Induction or maintenance of paralysis after intubation to assist ventilations. Contraindications: Hypersensitivity, inability to control airway and provide ventilatory support with O2/positive pressure, neuromuscular disease (myasthenia gravis), hepatic or renal failure.

Side effect: Weakness, prolonged neuromuscular block, bronchospasm, apnea, respiratory failure, tachydysrhythmias, transient hypotension, hypertension, PVCs, salivation.

Drug interactions: Positive chronotropic drugs may potentiate tachycardia.

How supplied: 1mg/mL and 2mg/mL ampules and vials.

Dosage and administration: Adult: 0.06-0.1/mg/kg slow IV. Repeat every 30-60 minutes as needed. Peds: 0.04-0.1mg/kg slow IV/IO.

Duration of action: Onset: 30 seconds. Peak: Paralysis in 3-5 minutes. Duration: 45-60 minutes.

Special considerations: Pregnancy safety: Category C. If patient is conscious, always explain the effects before administering and always sedate prior to administering. Intubation/ventilatory support must always be available; monitor the patient carefully. Has no effect over consciousness or pain. Will not stop neuronal seizure activity. HR and cardiac output will be increased. Decrease dose for patients with renal impairment or myasthenia gravis.

Class: Barbiturate, long lasting anticonvulsant; schedule IV drug.

MOI: Generally unknown but believed to reduce neuronal excitibility by increasing the motor cortex threshold to electrical stimulation.

Indications: Prevention and treatment of seizure activity; status epilepticus. Contraindications: Patients with porphyria, history of hypnotic addiction, severe liver or respiratory disease.

Side effects: Coma, drowsiness, HA, vertigo, paradoxical excitation, CNS depression, ataxia, bronchospasm, laryngospasm, respiratory depression, hypotension, bradycardia, syncope, N&V.

Drug interactions: Effects potentiated by other CNS depressants, anticonvulsants, and MAOIs. Incompatible with all other drugs. Flush line before and after use.

How supplied: 30mg/mL, 60mg/mL, 65mg/mL, 130mg/mL ampules, vials, and Tubex syringes.

Dosage and administration: Adult: 100-250mg slow IV or IM. May repeat as needed in 20-30 minutes. Peds: 10-20mg/kg slow IV/IO/IM. Repeat as needed in 20-30 minutes. Duration of action: Onset: 3-30 minutes. Peak: 30 minutes. Duration: 4-6 hours. Special considerations: Pregnancy safety: Category D. Potential for abuse. Carefully monitor VS. Use with caution in patients with pulmonary, cardiovascular, hepatic, or renal insufficiency. Elderly more likely to experience side effects; consider decreasing dose to 75% usual dose. Use large, stable vein for injection.

Class: Anticonvulsant.

MOI: Promotes sodium efflux from neurons, thereby stabilizing the neuron's threshold against excitability caused by excess stimulation. In similar fashion, decreases abnormal ventricular automaticity and decreases the refractory period in the myocardial conduction system.

Indications: Prophylaxis and treatment of major motor seizures, digitalis induced dysrhythmias.

Contraindications: Hypersensitivity, bradycardia, 2nd & 3rd degree HB.

Side effects: Ataxia, agitation, dizziness, HA, drowsiness, CNS depression, respiratory depression, hypotension, tachycardia, vasodilation, HB's, dysrhythmias, N&V, hepatitis, altered taste, rash, Stevens-Johnson syndrome, pain at the injection site.

Drug interactions: Serum phenytoin levels increased by anticoagulants, Tagamet, sulfonamides, and salicylates. Metabolism increased by chronic alcohol use. Cardiac depressants effects increased by lidocaine, propranolol, and other beta blockers. Precipitation may occur when mixed with D5W. Incompatible with many solutions and medications.

How supplied: 50mg/mL vials, prefilled and Tubex syringes. May be diluted with NS (1-10mg/mL). Must use inline filter on administration set. IV line should be flushed with 0.9% NS before and after drug is administered.

Dosage and administration: Adult: Seizures: 10-20mg/kg slow IV; not to exceed 1g or rate of 50mg/minute. Dysrhythmias: 50-100mg (diluted) slow IV q 5-15 minutes PRN; max dose of 1g. Peds: Seizues: 10-20mg/kg slow IV (1-3mg/kg/min). Dysrhythmias: 5mg/kg slow IV; max 1g loading dose.

Duration of action: Onset: 20-30 minutes. Peak: 1-3 hours. Duration: 18-24 hours but as long as 15 days.

Special considerations: Pregnancy safety: Category D. Carefully monitor VS. Venous irritation may occur. Use large, stable vein.

Class: Cholinesterase reactivator, antidote.

MOI: Reactivates cholinesterase to effectively act as an antidote to organophosphate and pesticide poisonings. This action allows for destruction of accumulated acetylcholine at the neuromuscular junction resulting in reversal of respiratory paralysis and paralysis of skeletal muscle.

Indications: As an antidote in the treatment of poisoning by organophosphate pesticides and chemicals. Anticholinesterase ODs.

Contraindications: Reduce dose in patients with impaired function, patients with myasthenia gravis, inorganic phosphates poisoning.

Side effects: Dizzines, drowsiness, HA, neuromuscular blockade, seizure, laryngospasm, hyperventilation, apnea, tachycardia, cardiac arrest, nausea, muscle rigidity, muscle weakness, rash, pain at injection site.

Drug interactions: Avoid use concurrently with succinylcholine, morphine, aminophylline, theophylline, and other respiratory depressants to include barbiturates, narcotic analgesics, and sedative hypnotics.

How supplied: 1g powder to solution for infusion. 600mg/2mL auto-injector.

Dosage and administration: Adult: Organophosphate poisoning: Initial dose is 1-2g as an IV infusion over 30-60 minutes after atropine administration. Dose can be repeated in 1/h if muscle paralysis is still present. 600mg IM repeat twice more at 15 minute intervals as needed. Anticholinesterase OD: 1-2g as an IV infusion over 30-60 minutes. Repeat at 250mg q 5 minutes PRN. Peds: 20-40mg/kg as IV infusion over 15-30 minutes. Dose may be repeated in 1/h if muscle paralysis is still present. If IV administration is not feasible, IM or SQ injection may be used.

Duration of action: Onset: Minutes. Peak: Variable. Duration: Variable.

Special considerations: Pregnancy safety: Category C. Slow IV infusion prevents tachycardia, laryngospasm, muscle rigidity. Consider drawing a blood sample prior to administration for hospital to run pretreatment levels.Treatment is most effective if given within a few hours after poisoning. Cardiac monitoring should be considered in all cases of severe organophosphate poisoning.

Class: Antidysrhythmic.

MOI: Suppresses phase 4 depolarization in normal ventricular muscle and Purkinje fibers, reducing ectopic pacemaker's automaticity; suppresses intraventricular conduction.

Indications: Stable monomorphic V-Tach with normal QT-Interval, reentry SVT uncontrolled by vagal maneuvers and adenosine, stable wide complex tachycardia of unknown origin, A-Fib with rapid ventricular rate in patients with WPW syndrome.

Contraindications: Torsades, 2nd & 3rd degree heart AV block, preexisting QT prolongation, digitalis toxicity, trycyclic antidepressant OD.

Side: effects: Confusion, seizures, hypotension, bradycardia, reflex tachycardia, ventricular dysrhythmias, AV blocks, asystole, widening PR, QRS, and QT intervals, N&V.

Drug interactions: Increases plasma levels of amiodarone and quinidine. 

How supplied: 100mg and 500mg vials. 

Dosage and administration: Adult: Recurrent V-Fib/pulseless V-Tach: 20mg/min slow IV infusion (max dose of 17mg/Kg). In urgent situation, up to 50mg/mm may be adminsitered (max dose of 17mg/kg). Other Indications: 20mg/min slow IV infusion until anyone of the following occurs: Dysrththmia suppression, hypotension, QRS widens by >50% of it's pretreatment width, or total dose of 17mg/kg has been given. Maintenance infusion: 1-4mg/min (diluted in D5W or NS) Reduce dose in presence of renal insufficiency. Peds: Loading dose 15mg/kg IV/IO over 30-60 minutes.

Duration of action: Onset: 10-30 minutes. Peak: Variable. Duration: 3-6 hours. 

Special considerations: Pregnancy safety: Category C. Potent vasodilation and negative inotropic effects. Hypotension may occur with rapid infusion. Administer cautiously to patients with cardiac, hepatic, or renal insufficiency. Administer cautiously to patients with asthma or digitalis-induced dysrhythmias. 

Class: Phenothiazine, antiemetic, antihistamine.

MOI: H-1 receptor antagonist; blocks action of histamine; possesses sedative, anti-motion, antiemetic, and anticholiergic activity; potentiates the effects of narcotics to induce analgesia.

Indications: N&V, motion sickness, sedation for patients in labor, potentiates the analgesic effects of narcotics.

Contraindications: Coma, CNS depression from alcohol, barbiturates, or narcotics, Reye syndrome, lower respiratory symptoms (asthma).

Side effects: HA, dizziness, drowsiness, confusion, restlessness, wheezing, chest tightness, thickening of bronchial secretions, palpitations, bradycardia, reflex tachycardia, QT prolongation, postural hypotension, diarrhea, N&V.

Drug interactions: Additive with other CNS depressants. Increased extrapyramidal effects with MAOIs.

How supplied: 25mg/mL, 50mg/mO ampules and Tubex syringes. Dosage and administration: Adult: 12.5-25mg IV/IM/PO/PR. Peds: >2 y/o: 0.25-0.5mg/kg dose deep IM.

Duration of action: Onset: IV-Immediate. Peak: 30-60 minutes. Duration: 4-6 hours. Special considerations: Pregnancy safety: Category C. Convulsions and sudden death when used with children. Use with caution in patients with asthma, peptic ulcer and bone marrow suppression. Do not use in children with vomiting of unknown etiology. Avoid intra-arterial injection. Deep IM injection preferred administration route.

Class: Beta-adrenergic blocker.

MOI: Nonselective beta-adrenergic blocker that reduces chronotropic, inotropic, and vasodilator response to beta-adrenergic stimulation.

Indications: Hypertension, angina, V-Tach, V-Fib refractory to lidocaine, selected SVT. Contraindications: Bradycardia, 2nd & 3rd degree HB, bronchial asthma, SSN, cardiogenic shock, CHF, acute pulmonary edema.

Side effects: Weakness, depression, fatigue, anxiety, dizziness, bronchospasm, wheezing, hypotension, bradycardia, CHF, AV blocks, N&V, diarrhea, hypoglycemia, hyperglycemia.

Drug interactions: Verapamil may worsen atrioventricular conduction abnormalities. Succincylcholine effects may be enhanced. Effects may be reversed by isoproterenol, norepinephrine, dopamine (Intropin).

How supplied: 1mg/mL vials.

Dosage and administration: Adult: dilute 1-3mg in 10-30ml of D5W. Administer slowly IV at a rate of 1mg/min. Max dose of 5mg. Peds: 0.01-0.05mg/kg/dose slow IV over 10 minutes for a max dose of 3mg.

Duration of action: Onset: 15-60 minutes. Peak: Variable. Duration: 6-12 hours.

Special considerations: Pregnancy safety: Category C. Closely monitor patients during administration. Use with caution in elderly patients. Atropine should be readily available.

Class: Nondepolarizing neuromuscular blocker.

MOI: Antagonizes acetylcholine at the motor end plate producing skeletal muscle paralysis.

Indications: RSI

Contraindications: Known hypersensitivity to bromides. Use with caution in patients with heart and liver disease.

Side effects: Bronchospasm, wheezing, ronchi, respiratory depression, apnea, dysrhythmias, tachycardia, transient hypotention & hypertension, N&V.

Drug interactions: Use of inhalation anesthetics will enhance neuromuscular blockade. How supplied: 10mg/mL vials.

Dosage and administration: Adult: 0.6-1.2mg/kg IV/IO. Peds: >3 months: 0.6-1.2mg/kg IV/IO.

Duration of action: Onset: 1-2 minutes. Peak: Varies. Duration: 45-120 minutes. Special considerations: Pregnancy safety: Category B. If patient is conscious explain the effects and always sedate prior to administering. Monitor the patient carefully. Has no effect on consciousness or pain. Will not stop neuronal seizure activity. Pulse rate and cardiac output are increased. Decrease dose for patients with renal disease.

Class: Systemic hydrogen ion buffer, alkalizing agent.

MOI: Buffers metabolic and lactic acid buildup in the body caused by anaerobic metabolism secondary to sever hypoxia by reacting with hydrogen ions to form water and CO2.

Indications: Metabolic acidosis during cardiac arrest, tricyclic antidepressants, aspirin, and phenobarbital ODs, hyperkalemia, crush patients.

Contraindications: Metabolic and respiratory alkalosis, hypokalemia, electrolyte imbalances due to severe diarrhea or vomiting.

Side effects: Hypernatremia, metabolic alkalosis, tissue sloughing, cellulitis, or necrosis at the injection site. Seizures, fluid retention, hypokalemia, electrolyte imbalance, tetany, sodium retention, peripheral edema.

Drug interactions: Increases the effects of amphetamines. Decreases the effect of benzodiazepines, tricyclic antidepressants. May deactivate sympathomimetics (dopamine, epinephrine, and norepinephrine).

How supplied: 1mEq/ml of 8.4% solution in 10 & 50mL vials and prefilled syringes. 0.5mEq/mL of 4.2% solution in 2.5, 5, 10mL prefilled syringes.

Dosage and administration: Adult: 1mEq/kg slow IV/IO push may repeat at 0.5mEq/kg q 10 minutes. Peds: 1mEq/kg slow IV/IO push. (dilute to 4.2% solution in small children).

Duration of action: Onset: Seconds. Peak: 1-2 minutes. Duration: 10 minutes.

Special considerations: Pregnancy safety: Category C. Repeat as needed in tricyclic antidepressant OD until QRS narrows. Must be used in conjunction with effective ventilation and chest compression 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 CHF and renal disease patients due to high sodium concentration. Monitor closely for signs and symptoms of fluid overload.

Class: Antidote cyanide poisoning adjunct.

MOI: Reacts with hemoglobin to form methemoglobin, which reacts with cyanide and chemically binds with it to prevent toxic effects.

Indications: Cyanide poisoning.

Contraindications: None in emergency.

Side effects: Hypotension, tachycardia, fainting, N&V.

Drug interactions: None in emergency.

How supplied: 3% solution (30mg/mL) vials.

Dosage and administration: Adult: 300mg (10mL of 3% solution) slow IV push over 5 minutes or dilute 300mg in 100mL of NS and infuse slowly. Peds: 10mg/kg (0.33mL/kg of 10% solution) IV/IO over 3-5 minutes.

Duration of action: Onset: 2-10 minutes. Peak: Varies. Duration: 30 minutes to 2 hours. Special considerations: Pregnancy safety: Category C. Potent vasodilator causes significant hypotension if given too rapidly. Monitor B/P closely. Look for signs of methemoglobinemia (eg, cyanosis, vomiting, shock, and coma).

Class: Cyanide antidote.

MOI: Converts cyanide to the less toxic thiocyanate, which is secreted in the urine. Indications: Cyanide poisoning.

Contraindications: None in emergency.

Side effects: Diarrhea.

Drug interactions: None

How supplied: 12.5g/50mL of 25% solution ampules, vials.

Dosage and administration: Adult: 12.5g(50mL of 25% solution) IV/IO slow push over 10 minutes. Peds: 400mg/kg(1.65mL/kg of 25% solution) IV/IO push at a rate of 0.625-1.25g/min over 10 minutes.

Duration of action: Onset: 2-10 minutes. Peak: Varies. Duration: 30 minutes to 2 hours. Special considerations: Pregnancy safety: Category C. If response to treatment is inadequate, repeat sodium nitrate and sodium thiosulfate; administer a second dose of each at half the original dose. This is the 3rd step in a 3 step treatment proceeded by amyl nitrate and sodium nitrate.

Class: Thrombolytic.

MOI: Combines with plasminogen to produce an activator complex that converts free plasminogen to the proteolytic enzyme, plasmin. Plasmin degrades fibrin threads and fibrinogen, causing clot lysis.

Indications: Acute evolving MI, massive pulmonary emboli, arterial thrombosis and embolism, to clear intraventricular cannula.

Contraindications: Hypersensitivity, active bleeding, recent CVA, prolonged CPR, intracranial or intraspinal neoplasm, arteriovenous malformation, recent surgery or significant trauma (particularly head truma), severe uncontrolled hypertension.

Side effects: Intracranial hemorrhage, bronchospastic hemoptysis, ARDS, reperfusion dysrhythmias, hypotension, MI, GI bleeding, hematuria, abdominal pain, bleeding from other sites, allergic reactions.

Drug interactions: Aspirin, heparin, and other anticoagulants may increase risk of bleeding as well as improve outcome.

How supplied: 250,000, 750,000, and 1.5 million unit powder.

Dosage and administration: Note: Reconstitute by slowly adding 5mL of NS or D5W, directing stream to the side of the vial instead of directly into the powder. Gently roll and tilt vial to reconstitute; dilute slowly to 45mL total. Adult: 500,000-1.5 million IU diluted to 45mL IV over 1/h. Peds: Safety not established.

Duration of action: Onset: 10-20 minutes (fibrnolysis, 10-20 mins, clot lysis, 60-90 mins). Peak: Variable. Duration: 3-4 hours (prolonged bleeding time up to 24/h).

Special considerations: Pregnancy safety: Category C. Thin transparent fibers may occur after reconstituton; they do not interfere with safe use. Do not administer IM injections to patients receiving fibrinolytics. Obtain blood sample prior to administering for coagulation studies. Carefully monitor VS and observe for bleeding.

Class: Neuromuscular blocker, depolarizing; skeletal muscle relaxant.

MOI: Ultra-short acting depolarizing skeletal muscle relaxant that mimics acetylcholine as it binds with the cholinergic receptors on the motor end plate, producing a phase 1 block as manifested by fasciculations.

Indications: RSI

Contraindications: Acute narrow-angle glaucoma, penetrating eye injuries, malignant hyperthermia. Acute injury after multi-system trauma, major burns, or extensive muscle injury. Inability to control airway or support ventilations with O2 and positive pressure. Side effects: Apnea, respiratory depression, bradydysrhythmias, tachydysrhythmias, dysrhythmias, cardiac arrest, salivation, prolonged muscle rigidity, rhabdomyolysis, malignant hyperthermia, increased intraocular pressure, hyperkalemia (trauma patients). Drug interactions: Oxytocin, beta blockers, and organophosphate my potentiate effects. Diazepam may reduce duration of action.

How supplied: 20mg/mL vials.

Dosage and administration: Adult: 1-1.5mg/kg rapid IV. Repeat once if needed. Peds: 1-1.5mg/kg rapid IV/IO. Repeat once if needed. 2mg/kg in infants.

Duration of action: Onset: 1 minute. Peak: 1-3 minutes. Duration: 5-10 minutes. Special considerations: Pregnancy safety: Category C. If the patient is conscious, explain the effects of the drug before administering. Consider premedication with Atropine especially in pediatric age group. Premedication with lidocaine my blunt any increase of ICP during intubation. Etomidate, diazepam, or didazolam should be used in any conscious patient before undergoing neuromuscular blockade.

Class: Vitamin B.

MOI: Combines with ATP to form thiamine pyophosphate coenzyme, which is a necessary component for carbohydrate metabolism. The brain is extremely sensitive to thiamine deficiency.

Indications: Coma of unknown origin, delirium tremens, beriberi, Wernicke encephalopathy.

Contraindications: None.

Side effects: Anxiety, dyspnea, respiratory failure, vasodilation, hypotension, N&V.

Drug interactions: Give thiamine before glucose under all circumstances.

How supplied: 100mg/mL vials.

Dosage and administration: Adult: 100mg slow IV/IM. Peds: 10-25mg slow IV/IM. Duration of action: Onset: Rapid. Peak: Variable. Duration: Depends on degree of deficiency.

Special considerations: Pregnancy safety: Category A. Rapid or large IV doses may cause respiratory difficulties, hypotension and vasodilation. Anaphylaxis reactions reported.

Class: Glycoprotein IIb/IIa inhibitor, platelet aggregation inhibitor.

MOI: Inhibits aggregation of platelets by reversibly antagonizing fibrinogen binding to the glycoprotein IIb/IIa receptor.

Indications: Acute coronary syndrome, patients undergoing percutaneous transluminal coronary angioplasty (PTCA) or atherectomy.

Contraindications: Trauma or major surgery within the past 30 days, hemorrhage stroke, intracranial neoplasm. Arteriovenous malformation, aneurysm or evidence of aortic dissection. Severe uncontrolled hypertension (sys >180, dia >110), concomitant use of another glycoprotein IIb/IIa inhibitor, acute percarditis.

Side effects: Dizziness, pain, sweating, intracranial bleeding, CVA, bradydysrhythmmias, dissecting coronary artery aneurysm, GI bleeding, sever bleeding.

Drug interactions: Other medications that affect hemostasis: Thrombolytics, oral anticogaulants, aspirin, NSAIDs, dipyridamole, ticlopidine, and clopidogrel.

How supplied: 50ug/mL solution for infusion.

Dosage and administration: Adult: Loading dose: 0.4ug/kg/min IV for 30 minutes. Infusion: 0.1ug/kg/min for 18-24 hours post angioplasty. Peds: Not recommended. Duration of action: Onset: A few minutes. Peak: Early peak < 30 minutes, infusion at a steady rate will peak in 6 hours. Duration: Platelet function restores 4-8 hours after infusion is d/c.

Special considerations: Pregnancy safety: Category B. Must be administered only with an IV pump from the bottle with a vented IV set. Avoid invasive procedures due to spontaneous bleeding risk.

Class: Vasopressor

MOI: Stimulation of smooth muscle receptors. Potent vasoconstrictor when given in high doses.

Indications: Alternative vasopressor to the first and second dose of epinephrine in cardiac arrest, alternative to epinephrine in asystole, PEA.

Contraindications: Use with caution in patients with CAD, epilepsy, or heart failure.

Side effects: Dizziness, HA, bronchial constriction, MI, CP, angina, dysrhythmias, decreased cardiac output, abdominal cramps, diarrhea, N&V, paleness, sweating.

Drug interactions: None

How supplied: 20units/mL vials.

Dosage and administration: Adult: 40U one time dose IV/IO to replace the 1st or 2nd dose of epinephrine in cardiac arrest. 0.02-0.04U/min continuous. Peds: 0.4-1U/kg IV/IO to a max of 40U to replace the 1st or 2nd dose of epinephrine in cardiac arrest.

Duration of action: Onset: Immediate. Peak: Variable. Duration: Variable.

Special considerations: Pregnancy safety: Category C. May increase peripheral vascular resistance and provoke cardiac ischemia and angina.

Class: Neuromuscular blocker, nondepolarizing.

MOI: Neuromuscular agent with intermediate duration of action that competes with acetylcholine for receptors at the end motor plate, resulting in neuromuscular blockade. Indications: RSI.

Contraindications: Acute narrow-angle glaucoma, penetrating eye injuries, inability to control airway or support ventilations with O2 and positive pressure, newborns, myasthenia gravis, hepatic or renal failure.

Side effects: Weakness, prolonged neuromuscular block, bronchospasm, apnea, dysrhythmias, bradycardia, tachycardia, PVCs, transient hypotension, cardiac arrest, excessive salivation.

Drug interactions: Use of inhalation anesthetics will enhance neuromuscular blockade. How supplied: 10 and 20mg powder.

Dosage and administration: Adult: 0.1-0.2mg/kg IV push. Maintenance dose withing 45-60 minutes: 0.8-1.2mg/kg IV push. Peds: 0.1-0.3mg/kg IV/IO. Maintenance dose within 20-40 minutes: 0.01-0.015g/kg IV push.

Duration of action: Onset: 1-3 minutes. Peak: Varies. Duration: 45-90 minutes.

Special considerations: Pregnancy safety: Category C. If patient is conscious, explain the effect of the medication before administration and always sedate first. Intubation and ventilatory support must be readily available. Monitor the patient carefully. Has on effect on consciousness or pain. Will not stop neuronal seizure activity. Pulse rate and cardiac output are increased. Decrease dose in patients with renal disease.

IV Solutions

Plasma Protein Fraction (Plasmanate)

Class: Natural colloid.

MOI: Plasmanate is a protein-containing colloid that remains in the intravascular compartment. It increases intravascular volume by attracting water from other fluid compartments by virtue of it's colloid osmotic pressure.

Indications: Hypovolemic shock (especially in burns); hypoproteinemia (low protein states).

Contraindications: No major contraindications.

Side effects: Chills, fever, urticaria(hives), N&V have all been reported.

Drug interactions: Solutions should not be mixed with or administered through the same administration set as other IV fluids.

How supplied: 250 and 500mL bottles of 5% solution.

Dosage and administration: The plasma protein fraction infusion rate should be titrated according to the patient's hemodynamic response. In the management of shock secondary to burns, the physicians orders regarding the rate of administration must be closely followed. Standard formulas for IV fluid administration have been developed. Med. control will use these in judging the correct rate of IV administration.

Duration of action: 24-36 hours

Special considerations: Do not use if the solution is cloudy or if you see sedimentation.

IV Solutions

Dextran

Class: Artificial colloid.

MOI: A sugar containing colloid used as an intravascular volume expander. It remains in the intravascular compartment for approximately 12 hours. It increases intravascular volume by attracting water from other fluid compartments by virtue of it's colloid osmotic pressure. Indications: Hypovolemic shock.

Contraindications: Should not be administered to patients with known hypersensitivity. Should not be administered to patients with CHF, renal failure, or known bleeding disorders. Side effects: Rash, itching, dyspnea, chest tightness, and mild hypotension.

Drug interactions: Should not be administered to patients who are receiving anticoagulants because it significantly retards blood clotting.

How supplied: Dextran 40 and Dextran 70 are supplied in 250 and 500mg bottles.

Dosage and administration: Titrated according to patients physiologic response.

Duration of action: 8-12 hours.

Special considerations: In the management of burn shock, it is especially important to follow standard fluid resuscitation regiments to prevent possible circulatory overload.

IV Solution

Hetastarch (Hespan)

Class: Artificial colloid.

MOI: Hetastarch is a starch-containing colloid used as an intravascular volume expander. Following administration, the plasma volume is expanded slightly in excess of the volume of hetastarch administered. This effect is observed for up to 24-36 hours. Hetastarch increases intravascular volume by virtue of it's colloid osmotic pressure.

Indications: Hypovolemic shock(esp burns), septic shock.

Contraindications: No major contraindications.

Side effects: N&V, mild febrile reactions, chills, itching, and urticaria (hives) have been reported. Severe anaphylactic reactions have been rarely reported.

Drug interactions: Should not be administered to patients taking anticoagulants.

How supplied: Sterile 6% hetastarch in 0.9% NS supplied in 500mL bottle.

Dosage and administration: Titrated according to patient's physiologic response.

Duration of action: 24-36 hours.

Special considerations: Pregnancy safety: Category C. Patients allergic to corn may be allergic to hetastarch.

IV Solution

Lactated Ringers

Class: Isotonic crystalloid solution.

MOI: Replaces water and electrolytes.

Indications: Hypovolemic shock, KVO.

Contraindications: Should not be used in patients with CHF or renal failure.

Side effects: Rare in therapeutic dosages.

Drug interactions: Few in emergency setting.

How supplied: 250,500, and 1,000mL bags.

Dosage and administration: Titrate according to patient's physiologic response.

Duration of action: Short term therapy.

Special considerations: None.

IV Solutions

Dextrose 5% Solution (D5W)

Class: Hypotonic dextrose containing solution.

MOI: Provides nutrients in the form of dextrose as well as free water.

Indications: IV access for emergency drugs; for dilution of concentrated drugs for IV infusion.

Contraindications: Should not be used as fluid replacement for hypovolemic states.

Side effects: Rare in therapeutic doses.

Drug interactions: Should not be used with phenytoin(Dilantin) or amrinone(Inocor).

How supplied: 50,100,150,250,500, & 1,000mL bags.

Dosage and administration: Usually administered through a minidrip (60gtt) set to KVO. Duration of action: Short term therapy.

Special considerations: None

IV Solutions

Dextrose 10% Solution (D10W)

Class: Hypertonic dextrose-containing solution.

MOI: Provides nutrients in the form of dextrose as well as free water.

Indications: Neonatal resuscitation, hypoglycemia.

Contraindications: Should not be used as fluid replacement in hypovolemic states.

Side effects: Rare in therapeutic doses.

Drug interactions: Should not be used with phenytoin(Dilantin) or amrinone(Inocor).

How supplied: 50,100,150,250,500, & 1,000mL bags.

Dosage and administration: Dependent on patient's condition.

Duration of action: Short term therapy.

Special considerations: None

IV Solution

0.9% Sodium Chloride (NS)

Class: Isotonic crystalloid solution.

MOI: Replaces water and electrolytes.

Indications: Heat-related problems (heat exhaustion, heat stroke), fresh water drowning, hypovolemia, DKA, and to KVO.

Contraindications: Should not be considered in patients in CHF because circulatory overload can be easily induced.

Side effects: Rare in therapeutic doses.

Drug interactions: Few in emergency setting.

How supplied: 250,500, & 1,000mL bags. Sterile saline used for irrigation is not the same as IV solution.

Dosage and administration: Rate of administration is dependent of specific situation. Severe heatstroke, DKA and freshwater drowning, will likely be administered quite rapidly. In other cases, it is advisable to administer NS at a moderate rate (100mL/h).

Duration of action: Short term therapy.

Special considerations: None

IV Solution

0.45% Sodium Chloride (1/2 NS)

Class: Hypotonic crystalloid solution.

MOI: 1/2NS replaces free water and electrolytes.

Indications: Patients with diminished renal or cardiovascular function for which rapid rehydration is not indicated.

Contraindications: Cases where rapid rehydration is not indicated.

Side effects: Rare in therapeutic doses.

Drug interactions: Few in the emergency setting.

How supplied: 250,500, & 1,000mL bags.

Dosage and administration: The specific situation and patients condition will dictate the rate at which 1/2NS will be administered.

Duration of action: Short term therapy.

Special considerations: None.

IV Solution

5% Dextrose in 0.45% Sodium Chloride (D5 1/2NS)

Class: Hypertonic dextrose-containing crystalloid solution.

MOI: Replaces free water and electrolytes and provides nutrients in the form of dextrose. Indications: Heat exhaustion, diabetic disorders, patients with impaired renal or cardiovascular function.

Contraindications: Should not be used when rapid fluid resuscitation is indicated.

Side effects: Rare in therapeutic doses.

Drug interactions: Should not be used with phenytoin(Dilantin) or amrinone(Inocor).

How supplied: 250,500, & 1,000mL bags.

Dosage and administration: The specific situation and patient condition will dictate the rate at which D5 1/2NS will be administered.

Duration of action: Short term therapy.

Special considerations: None

IV Solution

5% Dextrose in 0.9% Sodium Chloride (D5NS)

Class: Hypertonic dextrose-containing crystalloid solution.

MOI: Replaces free water and electrolytes and provides nutrients in the form of dextrose. Indications: Heat-related disorders, freshwater drownings, hypovolemia, peritonitis. Contraindications: Should not be administered to patients with impaired renal or cardiac function.

Side effects: Rare in therapeutic doses.

Drug interactions: Should not be used with phenytoin(Dilantin) and amrinone(Inocor).

How supplied: 250,500, & 1,000mL bags.

Dosage and administration: The specific situation and patients condition will dictate the rate of administration.

Duration of action: Short term therapy.

Special considerations: None.

IV Solution

5% Dextrose in Lactated Ringer's (D5LR)

Class: Hypertonic dextrose-containing crystalloid solution.

MOI: Replaces water and electrolytes and provides nutrients in the form of dextrose. Indications: Hypovolemic shock, hemorrhage shock, certain cases of acidosis. Contraindications: Should not be administered to patients with decreased renal or cardiovascular function.

Side effects: Rare in therapeutic doses.

Drug interactions: Should not be used with phenytoin(Dilantin) and amrinone(Inocor).

How supplied: 250,500, & 1,000mL bags.

Dosage and administration: In severe hypovolemic shock, should be administered through a large bore catheter and rate should be "wide open" until B/P of 100mm Hg is achieved. When the B/P is attained, the infusion should be reduced to 100mL/h. In other cases, the specific situation and patient's condition will dictate the rate of administration.

Duration of action: Short term therapy.

Special considerations: None

Class: Nonbarbiturate hypnotic, anesthesia induction agent. 

MOI: Short acting hypnotic that acts at the level of the reticular activating system. 

Indications: Premedication for tracheal intubation or cardioversion. 

Contraindications: Hypersitivity, labor and delivery. 

Side effects: Apnea of short duration, respiratory depression, hypoventilation, hyperventilation, dysrhythmias, hypotension, hypertension, N&V, involuntary muscle movement, pain at injection site. 

Drug interactions: Effects may be enhanced when given with other CNS depressants.

How supplied: 2mg/mL vials.

Dosage and administration: Adult: 0.2-0.6mg/kg IV over 30-60 seconds (typical adult dose is 20mg). Peds: 0.2-0.4mg/kg IV/IO over 30-60 seconds for RSI (older than 10 years), 1 time only. Max dose: 20mg.

Duration of action: Onset: <1 minute. Peak: 1 minute. Duration: 5-10 minutes.

Special considerations: Pregnancy safety: Category C. Carefully monitor VS. Etomidate can suppress adrenal gland production of steroid hormones, which can temporary cause gland failure. Considering decreasing dose in elderly and patients with cardiac conditions.

Class: Opioid antagonist, antidote.

MOI: Competitive inhibition at narcotic receptor sites. Reverses respiratory depression secondary to opiate drugs. Completely inhibits the effect of morphine. 

Indications: Opiate OD, complete and partial reversal of CNS and respiratory depression caused by opiates, coma of unknown origin. Agonist against: morphine, heroin, Dilaudid(hydromorphine), methadone, Demerol, paregoric, Sublimaze(fentanyl), Percodan, codeine, Darvon(propoxyphene). Narcotic agonist and antagonist for Stadol(butorphanol), Talwin(pentazocine), Nubain(nalbuphine).

Contraindications: Use with caution in narcotic dependent patients. Use with caution in neonates with narcotic dependent mothers. 

Side effects: Restlessness, seizures, dyspnea, pulmonary edema, tachycardia, hypertension, dysrhythmias, cardiac arrest, N&V, withdrawal symptoms in opioid addicted patients, diaphoresis. 

Drug interactions: Incompatible with bisulfite and alkaline solutions. 

How supplied: 0.4mg/mL and 1mg/mL ampules and vials.

Dosage and administration: Adult: 0.4-2mg IM/IO/IV/SQ/ET/Intranasal; minimum single dose recommended: 2mg. Repeat at 5 minute intervals to a max dose of 10mg. Peds: 0.1mg/kg/dose IV/IO/IM/SQ every 2 minutes as needed. Max dose of 2mg. If no response in 10 minutes, administer an additional 0.1mg/kg/dose. 

Duration of action: Onset: <2 minutes. Peak: Variable. Duration: 30-60 minutes. 

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 Narcan is often shorter than the half life of the narcotic; repeat dosing may be required.

Class: Sympathomimetic, vasopressor.

MOI: Potent alpha-agonist resulting in intense peripheral vasoconstriction, positive chronotropic and increased inotropic effect (from 10% beta effect) with increased cardiac output. Alpha-adrenergic activity resulting in peripheral vasoconstriion and beta-adrenergic activity leading to inotropic stimulation of the heart and coronary artery vasodilation. 

Indications: Cardiogenic shock, unresponsive to fluid resuscitation, significant hypontensive (<70mmhg) states. 

Contraindications: Hypotensive patients with hypovolemia, pregnancy (relative CI).

Side effects: HA, anxiety, dizziness, restlessness, dyspnea, bradycardia, hypertension, dysrhythmias, CP, peripheral cyanosis, cardiac arrest, N&V, urinary retention, renal failure, decreased blood flow to the GI tract, kidneys, skeletal muscle, and skin, tissue necrosis from extravasation. 

Drug interations: Can be deactivated by alkaline solutions. Sympathomimetic and phosphodiesterase inhibitors may exacerbate dysrhythmias. Bretylium may potentiate the effects of catecholamines.

How supplied: 1mg/mL vials.

Dosage and administration: Adult: Dilute 8mg in 500mL or 4mg in 250mL D5W (16ug/mL). Infuse by IV piggyback at 0.1-0.5ug/kg/min titrated to response (average dose for a 70kg patient is 7-35ug/min). Peds: Begin at 0.1-2ug/kg/min IV infusion, adjust rate to achieve desired in change in B/P and systemic perfusion. Titrated to patient response. 

Duration of action: Onset: 1-3 minutes. Peak: Variable. Duration: 5-10 minutes and last only 1 minute after infusion d/c.

Special considerations: Pregnancy safety: Category C. May cause fetal anoxia when used in pregnancy. Infuse norepinephrine through a large, stable vein to avoid extravasation and tissue necrosis. Often used with low-dose dopamine to spare decreased renal and mesenteric blood flow. Drug or poison induced hypotension may require higher doses to achieve adequate perfusion.

Class: Naturally occurring atmospheric gas.

MOI: Reverses hypoxemia.

Indications: Confirmed or expected hypoxemia, ischemic CP, respiratory insufficiency, prophylactically during transport, Carbon monoxide poisoning, all other causes of decreased tissue oxygenation, decreased LOC.

Contraindications: Certain patients with COPD cannot tolerate concentrations over 35%, hyperventilation.

Side effects: Decreased LOC (COPD pt), decreased respiratory drive (COPD pt), dry mucous membranes. 

Drug interactions: None.

How supplied: O2 cylinders of 100% compressed gas.

Dosage and administration: Adult: Cardiac arrest and CO poisoning: 100%. Hypoxemia: 10-15 Lpm via NRB. COPD: 0-2 Lpm via nasal cannula or 28-35% by Venturi mask. Be prepared to provide ventilatory support if higher concentrations of O2 are needed. Peds: Same as adult except with premature infants.

Duration of action: Onset: Immediate. Peak: N/A. Duration: <2 minutes.

Special considerations: Be familiar with liter flow and each type of delivery device used. Supports combustion.

Class: Calcium channel blocker.

MOI: Slow calcium channel blocker that selectively blocks the transmembrane influx of calcium ions into arterial smooth muscles and myocardial cells. Prolongs AV nodal refractory period. Reduces systemic vascular resistance and selective vasodilation of peripheral arteries. Dilates coronary arteries and arterioles. 

Indications: PSVT, A-Fib/Flutter with rapid ventricular response, re-entry SVT.

Contraindications: WPW syndrome, Lown-Ganong-Levine syndrome, 2nd & 3rd degree AV block, SSN, hypotension, cardiogenic shock, severe left ventricular dysfunction (ejection fraction ration <30%), wide-complex tachycardia, children <12 months old, A-Fib.

Side effects: Dizziness, HA, pulmonary edema, sinus arrest, asystole, AV blockes, bradycardia, hypotension, N&V, constipation. 

Drug interactions: Increases the serum concentration of digoxin. Beta-adrenergic blockers may have additive negative inotropic and chronotropic effects. Antihypertensives may potentiate hypotensive effects.

How supplied: 2.5mg/mL vials.

Dosage and administration: Adult: 2.5-5mg IV bolus over 2 minutes (3 in elderly). Repeat dose of 5-10mg may be given every 15-30 minutes to a max dose of 20mg. Peds: 0.01-0.02mg/kg/dose IV/IO push over 2 minutes. Repeat dose in 30 minutes if not effective. DO NOT USE IN CHILDREN <12 MONTHS OLD.

Duration of action: Onset: 2-5 minutes. Peak: Variable. Duration: 30-60 minutes. 

Special considerations: Pregnancy safety: Category C. Closely monitor patients VS. Be prepared to resuscitate. AV block or asystole may occur because of slowed AV conduction.

Class: Sedative hypnotic, short acting. 

MOI: Produces rapid and brief state of general anesthesia.

Indications: Anesthesia induction, anesthesia maintenance, sedation for mechanically ventilated patients. 

Contraindications: Hypovolemia, known hypersensitivity including soybean oil, peanuts and eggs. 

Side effects: Seizure, apnea, dysrhythmias, asystole, hypotension, hypertension, N&V, involuntary muscle movement, acute renal failure.

Drug interactions: No known drug interactions in adults. In peds when used with Fentanyl, can cause profound bradycardia. 

How supplied: 10mg/mL IV emulsion.

Dosage and administration: Adult: Induction dose: 1.5-3mg/kg IV/IO. Maintenance infusion: 25-75ug/kg/min IV/IO. Peds: Induction dose: 2.5-3.5mg/kg IV/IO. Maintenance infusion: 125-300ug/kg/min IV/IO.

Duration of action: Onset: <1 minute. Peak: 1 minute. Duration: As long as infusion is running. 

Special considerations: Pregnancy safety: Category B. Avoid rapid administration in elderly patients to avoid hypotension and airway obstruction. Continue to monitor VS and O2 levels. Use large, stable vein to avoid injection site pain. Avoid in pregnancy due to neonatal depression.

Class: Beta-2 adrenergic agonist, bronchodilator. 

MOI: Selective Beta-2 adrenergic receptor activity resulting in relaxation of smooth muscle of the bronchial tree and peripheral vasculature with minimal cardiac effects.

Indications: Bronchial asthma, reversible bronchospasm associated with exercise, COPD. 

Contraindications: Hypersensitivity, tachydysrhythmias.

Side effects: CNS stimulation, HA, seizure, restlessness, apprehension, wheezing, coughing, bronchospasm, bradycardia, tachycardia, ST wave changes, PVCs, PACs, CP. 

Drug interactions: Cardiovascular effects exacerbated by other sympathomimetics. MAOIs may potentiate dysrhythmias. Beta blockers may antagonize terbutaline.

How supplied: 1mg/mL vials.

Dosage and administration: Adult: 0.25mg SQ may repeat in 15-30 minutes to a max dose of 0.5mg in a 4 hour period. Peds: Not recommended in children <12 y/o. 0.25mg SQ may repeat in 15-30 minutes to max dose of 0.5mg in a 4 hour period. 

Duration of action: Onset: 5-10 minutes. Peak: Variable. Duration: 1.5-4 hours.

Special considerations: Pregnancy safety: Category B. Carefully monitor VS. Use with caution in patients with cardiovascular disease, seizure disorder, hypertension and diabetes. Patients should receive O2 before and during administration.