Generic Name:

AdenosineIV

Trade Name:

AdenocardIV

Classification:

Antiarrhythmics

Action/Kinetics:

A naturally occurring nucleoside that acts on the AV node to slow conduction and inhibit reentry pathways. Useful in PSVT.  For A fib, atrial or V tach may produce transient AV or retrograde block that may clarify diagnosis. Rapidly metabolized--Half-life is <5 seconds.

Indications:

To convert acute PSVT to normal sinus rhythm. Includes PSVT associated with accessory bypass tracts (Wolff-Parkinson-White syndrome).

Contraindications:

Patients with hypersensitivity to the drug. Those in second or third degree heart block, sick sinus syndrome, or symptomatic bradycardia.

Adverse Effects:

Chest pain, dizziness, dyspnea and or shortness of breath, facial flushing, headache, lightheadedness, blurred vision, nausea, metallic taste, and numbness. More serious symptoms are persistent arrhythmias, and bronchospasm.

How supplied:

6 mg/2 ml with flip top vials that require to be drawn up in a syringe. Also 6mg/2ml and 12mg/2ml in disposable syringes ready to be administered.

Dosage:

The initial dose is 6-mg. rapid bolus over 1-3 seconds. The dose should be followed quickly by a 20-ml saline flush. Then elevate the extremity. Repeat 12mg. in 1-2 minutes if needed. Third dose of 12mg. Maybe given in 1-2 minutes.

Precautions:

Could produce bronchoconstriction in-patients with asthma. Patients who develop high level heart block after a single dose should not receive additional doses. Use with caution in-patients receiving digoxin and verapamil in combination. Therapeutic levels of theophylline and methylxanthines affect the response of adenosineDipyridamole potentiates its effect.

Generic Name:

AlbuterolSulfate Inhalation Solution, 0.083%

Trade Name:

Ventolin

Classification:

Bronchodilators

Action/Kinetics:

Relaxes bronchial, uterine, and vascular smooth muscle by stimulating beta2-adrenergic receptors.

Indications:

Indicated for the relief of bronchospasm in patients two years of age and older with reversible obstructive airway disease and acute attacks of bronchospasm.

Contraindications:

Hypersensitivity to the drug.

Adverse Effects:

Tachycardia, hypertension, bronchospasm, bronchitis, nasal congestion, tremors, dizziness, nervousness, headache, and sleeplessness.

How Supplied:

Unit dose plastic vial containing albuterolsulfate inhalation solution 0.083%, 2.5mg/3ml.

Usual dose for adults and children weighing at least 15 kg is one vial 2.5 mg of albuterol(with Atrovent.5mg. added) administered by nebulization. Inhalation solution will be delivered over approximately 5 to 15 minutes.

Precautions:

Used with caution in patients with cardiovascular disorders, especially coronary insufficiency, cardiac arrhythmia’s and hypertension. MAO inhibitors, tricyclic antidepressants, may potentiate action on CV system. Propranolol, and other beta blockers inhibit the effect of albuterol

Generic Name:

Acetylsalicylic acid

Trade Name:

AspirinASA, Ecotrin,

Classification:

Antiplatelet effect, nonnarcotic analgesic, antipyretic

Action/Kinetics:

To reduce risk of death and/or nonfatal MI in patients with a previous MI or unstable angina pectoris. Impedes clotting by blocking prostaglandin synthesis, which prevents formation of the platelet-aggregating substance thromboxane A2.

Indications:

Dose for cardiac patients fitting criteria, even if absence of chest pains, is a 160-325mg. Aspirin given orally if patient has no history of allergy.

Contraindications:

Hypersensitivity to drug. Patients with active ulcer disease

Adverse Effects:

Bleeding gums, signs of GI bleeding, and petechiae. Aspirinwill increase bleeding time.

How Supplied:

160 mg, 325mg tablets. (May also use 4 baby aspirinchewable 81 mg ea., for a total of 324 mg)

Dosage:

Give one aspirin 325mg. or 4 baby aspirin chewable (chewing is preferable to swallowing) give within minutes of arrival.

Precautions:

Use with caution in patients with GI lesions, impaired renal function, hypoprothrombinemia, vitamin K deficiency, thrombocytopenia, or severe hepatic impairment.

Generic Name:

Lorazepam

Trade Name:

Ativan

Classification:

Antianxiety agent, benzodiazepine

Action/Kinetics:

Absorbed and eliminated faster than other benzodiazepines. Onset- IV 5 minutes, IM 15-30 minutes. Peak plasma levels: IV or IM, 1-1.5 hr. t1/2: 10-20 hr. Metabolized to inactive compounds, which are excreted through the kidneys

Indications:

Amnesic agent, anticonvulsant, antitremor drug, adjunct to skeletal muscle relaxants, preanesthetic medication, used as sedative for behavioral emergencies, adjunct prior to endoscopic procedures, treatment of status epilepticus, relief of acute alcohol withdrawal symptoms. Investigational: Antiemetic in cancer chemotherapy.

Contraindications:

Contraindicated in patients hypersensitive to drug, other benzodiazepines, or the vehicle used in parenteral dosage form. Also contraindicated in those with acute angle-closure glaucoma.

Adverse Effects:

CNS:    Drowsiness, amnesia, insomnia, agitation, sedation, dizziness,

            weakness, unsteadiness, disorientation, depression, headache.

CV:      Hypotension

EENT:             Visual disturbances

GI:       Abdominal discomfort, nausea, change in appetite.

Other: Elevated liver function test results

How Supplied:

Injection: 2mg/ml vial

Dosage:

2mg IV or IM

Precautions:

Greater CNS effects may be noted if other drugs such as phenothiazines, narcotic analgesics, barbiturates, antidepressants, scopolamine, and monoamin-oxidase inhibitors are used in conjunction with Ativan.Extreme caution must be used when administering Ativan to elderly patients, very ill patients or to patients with limited pulmonary reserve because of the possibility that hypoventilation and/or hypoxic cardiac arrest may occur.

Generic Name:

AtropineSulfate IV

Trade Name:

AtropineIV     

Classification:

Antiarrhythmic, anticholinergic, antidote

Action/Kinetics:

Anticholinergic that inhibits acetylcholine at the parasympathetic neuroeffector junction, blocking vagal effects on the SA and AV nodes; this enhances conduction through the AV node and speeds heart rate.

Indications:

Treatment of symptomatic sinus bradycardia, atrioventricular block at the nodal level, or ventricular asystole. Usually not effective when infranodal block suspected. Second drug for asystole or PEA.

Contraindications:

Hypersensitivity to the drug, unstable cardiovascular status, myocardial ischemia, glaucoma, and obstructive disease of the GI or GU tracts.

Adverse Effects:

Postural hypotension, Blurred vision, dryness of the mouth, GI reflux, nausea, vomiting, paralytic ileus,  tachyarrhythmias, and urinary retention.

How Supplied:

0.1mg/ml total of 10ml to equal 1mg of atropine.

Dosage:

Adult: For bradycardia, 0.5mg to 1mg. IV every three to five minutes as needed, up to a total of 3mg. In asystole give 1mg. IV, repeat every 3 to 5 minutes up to a total of 0.04 mg/kg. Peds: Give 0.02 mg/kg or 0.2 cc/kg IV/IO/ET up to 5cc for child or 10cc for adolescent (minimum dose 0.1mg or 1cc). May be repeated once in 5 minutes.

Precautions:

Use with caution in presence of myocardial ischemia and hypoxia. Avoid in hypothermic bradycardia. Usually not effective in second degree block type II and third degree blocks with wide QRS complexes. Antacids decrease absorption of med.

Generic Name:

Ipratropiumbromide

Trade Name:

Atrovent

Classification:

Bronchodilator

Action/Kinetics:

Inhibits vagally mediated reflexes by antagonizing acetylcholine at muscarinic receptors on bronchial smooth muscle.

Indications:

Either alone or with other bronchodilators, especially beta andrenergics, is used for treatment of bronchospasm associated with chronic obstructive pulmonary disease, including asthma chronic bronchitis and emphysema.

Contraindications:

Hypersensitivity to the drug, atropineand its derivatives, and those with a history of hypersensitivity to soy lecithin or related food products such as soybeans and peanuts.

Adverse Effects:

Dizziness, headache, nervousness, palpitations, hypertension, cough, blurred vision, rhinitis, epistaxis, GI distress, Chest pain, flu-like symptoms.

Dosage:

How Supplied: In a unit dose vial containing 2.5 ml (0.5 mg.)

One unit dose vial added to the nebulized albuterolMay repeat neb of albuterol 2.5 mg. with Atrovent0.5mg. x1.

Precautions:

Used cautiously in patients with angle-closure glaucoma, prostatic hyperplasia, and bladder-neck obstruction. Avoid leakage around the face mask, temporary blurring of vision or eye pain may occur.

Generic Name:

Diphenhydraminehydrochloride

Trade Name:

BenadrylIV

Classification:

Antihistamine, antidyskinetic, antiemetic, antivertigo agent, sedative-hypnotic

Action/Kinetics:

Competes with histamine for H1-receptor sites on effector cells. Prevents, but does not reverse, histamine-mediated responses. It also has anticholinergic (antispasmodic), antiemetic, and sedative effects. It has a rapid onset and is widely distributed throughout the body.

Indications:

Supplemental therapy to epinephrinein anaphylaxis and other uncomplicated allergic reactionsrequiring prompt treatment.

Contraindications:

Hypersensitivity to the drug, during acute asthmatic attacks, in newborns, premature neonates, or breast feeding women. Avoid use in patients taking MAO inhibitors. Also patients with narrow angle glaucoma, stenosing peptic ulcer, and symptomatic prostatic hypertrophy

Adverse Effects:

Palpitations, hypotension, tachycardia, confusion, insomnia, headache, vertigo, restlessness, tremor, seizures, blurred vision, nausea and vomiting, and anaphylactic shock.

How Supplied:

Vial 50mg/ml for injection IV or IM

Dosage:

25mg. IV or 50mg IM (See protocol)

Precautions:

Use with extreme caution in patients with prostatic hyperplasia, asthma or COPD, increased intraocular pressure, hyperthyroidism, CV disease, hypertension, Avoid SC or perivascular injection. Drug to drug and alcohol use causes increased CNS depression.

Generic Name:

Calcium Chloride

Trade Name:

Calcijex

Classification:

Antihyperkalemic, antihypermagnesemic, Cardiotonic, antihypocalcemic

Action/Kinetics:

Calciumis a basic element prevalent in the human body. It affects bones, nerves, muscles, glands, cardiac and vascular tone, and normal coagulation of the blood. It is excreted in the urine and feces.

Indications:

Known or suspected hyperkalemia(e.g., renal failure), Hypocalcemia (e.g., after multiple blood transfusion, and as an antidote for toxic effects (hypotension and arrhythmias) from calciumchannel blocker overdose or B-Adrenergic blocker overdose.

Contraindications:

Hypersensitivity to the drug, digitalized patients, hypercalcemia, ventricular fibrillation

Adverse Effects:

May cause bradycardia, cardiac arrest, metallic, calciumor chalky taste, prolonged state of cardiac contraction, sense of oppression, or tingling sensation, especially with a too-rapid rate of administration. (Overdose) nausea and vomiting, coma, and sudden death.

How Supplied:

100mg/ml in 10 ml vial (total =1 GM in a 10% solution)

Dosage:

Usually 10 ml (100mg/ml) (1 Gm) IV

Precautions:

Do not use routinely in cardiac arrest, do not mix with sodium bicarbonate. Three times more potent then calciumluconate. For IV use only

Generic Name:

Prochlorperazine

Trade Name:

Compazine

Classification

Anti-Emetic

Actions/Kinetics

Acts on chemoreceptor trigger zone to inhibit nausea and vomiting

Indications:

Severe nausea and vomiting

Contraindications:

Hypersensitivity to phenothiazines, CNS depression in patients younger than 2-years old.

Adverse Effects

Orthostatic htn, blurred vision, dry mouth, constipation, extrapyramidol reactions

How Supplied:

5 mg/ml 2 ml/vial

Dosage:

10 mg IV or IM

Precautions:

Generic Name:

D-glucoseor glucose

Trade Name:

DextroseIV

Classification:

Nutritional (carbohydrate)

Action/Kinetics:

A monosaccharide that provides glucosecalories for metabolic needs. Oxidation provides water to sustain volume and may help lower excess ketone production and prevent protein loss. Hypertonic solutions (20%-50%) act as diuretics and reduce CNS edema.

Indications:

Diabetics who are unable to take oral fluids due to altered level of consciousness and low blood glucose.

Contraindications:

Delirium tremens with hydration, diabetic coma while blood sugar is excessive, hepatic coma intracranial or intraspinal hemorrhage, glucose-galactose malabsorption syndrome.

Adverse Effects:

Pulmonary edema, exacerbated hypertension, heart failure, (fluid overload-congested states), Hyperglycemia, (during infusion), hyperosmolar syndrome (mental confusion, loss of consciousness),hypokalemia, reactive hypoglycemia (after infusion).

How Supplied:

50 ml prefilled syringe of D₅₀W IV

Dosage:

Adult dose: one prefilled syringe of 50ml D50W IV—may repeat as appropriate. Pediatric dose: Give D₅₀W, 1cc/kg up to 50 cc to patients four years and older with a blood glucose<60 mg/dl. For patients three years and younger, use D₂₅W, 2cc/kg IV.

Precautions:

Use with caution in patients with cardiac or pulmonary disease, hypertension, renal insufficiency, urinary obstruction, or hypovolemia.  Avoid extravasation may cause tissue sloughing, necrosis, and phlebitis.

Generic Name:

Valium

Trade Name:

Diazepam

Classification

Benzodiazepine

Actions/Kinetics

Binds to benzodiazepine receptors; enhances GABA effects

Indications:

Status epiliepticus,

Contraindications:

Hypersensitivity to drug, acute angle glaucoma. Alcohol intoxication, Age less then 2 years

Adverse Effects

CNS depression

How Supplied:

10 mg/2 ml (carpuject syringe with Luer lok)

Dosage:

Rectal Valium (Diazepam) per age: 2-5 y.o., 0.5 mg/kg; 6-11 y.o., 0.3 mg/kg; >11 y.o., 0.2 mg/kg

Precautions:

Caution if psychosis, caution if impaired pulmonary function, caution if impaired renal  and liver function.

Generic Name:

Hydromorphone Hydrochloride

Trade Name:

Dilaudid

Classification:

Narcotic analgesic, morphine type

Action/Kinetics:

Binds with opiate receptors in the CNS, altering both perception of and emotional response to pain through an unknown mechanism.  Is metabolized in the liver and excreted in urine.

Dilaudidis 7-10 times more analgesic than morphine, with a short duration of action.  There is less sedation, vomiting and nausea than with morphine, it can induce pronounced respiratory depression.  The onset is 10-15 min. with peak effect in 15-20 minutes and duration of 2-5 hours.

Indications:

Analgesia for pain.

Contraindications:

Do not use in pediatric patients, during labor,respiratory depression or when ventilatory function is depressed such as in status asthmatics, COPD, emphysema.  Patients who are hypersensitive to drugs, those with intracranial lesions associated with increased intracranial pressure.

Adverse Effects:

CNS:   Sedation, somnolence, clouded sensorium, dizziness

CV:      Hypotension, bradycardia

GI:       Nausea, vomiting

Resp:  Respiratory depression, bronchospasm

How Supplied:

1 ml vial containing 2 mg/1 ml

Dosage:

Adults: 0.5 – 2 mg. IV titrated for pain relief 1-2 mg IM

Precautions:

IV administration should be done over 2-5 min.

Generic Name:

EpinephrineHydrochloride

Trade Name:

Adrenalin

Classification:

Cardiac stimulant, bronchodilator, antiallergic, and vasopressor

Action/Kinetics:

Stimulates alpha and beta-adrenergic receptors within the sympathetic nervous system. A potent cardiac stimulant, it strengthens the myocardial contraction (positive inotropic effect) and increases cardiac rate (positive chronotropic effect). Increases myocardial and cerebral blood flow during CPR.

Indications:

Cardiac arrest: VF, pulseless VT, asystole, pulseless electrical activity. Anaphylaxis, severe allergic reactions, and profound bradycardia or hypotension after other drugs tried maybe used as a gtt.

Contraindications:

Patients with angle-closure glaucoma, shock(other than anaphylactic shock), organic brain damage, cardiac dilation, coronary insufficiency, cerebral arteriosclerosis or laborand delivery. Do not use to treat overdose of adrenergic blocking agents.

Adverse Effects

Nervousness, tremor, headache, agitation, dizziness, weakness, cerebral hemorrhage, palpitations, hypertension, tachycardia, anginal pain, nausea and vomiting, and dyspnea.

How Supplied:

Prefilled syringe  0.1mg/ml (1:10,000), total of 10cc = 1 mg.-vial 1 mg/ml (1:1,000) total of 1 cc

Dosage:

Adult-cardiac arrest: 1 mg (10 ml of 1:10,000 solution) administered every 3-5 minutes during resuscitation. Tracheal route: 2 mg. diluted in saline.

Anaphylaxis: 0.3 mg (1,1000) SC Peds. Cardiac arrest: (1:10,000) Give 0.1mg/kg or 0.1 cc/kg up to 10cc. Tracheal route: (1:1000) Give 0.1 mg/kg or 0.1 cc/kg up to 10cc. Anaphylaxis: (1:1000) 0.01 mg/kg (0.01 cc/kg) SC or IM up to 0.3 cc if patient was exposed to commonly recognized allergen and has respiratory distress or hypotension.

Croup and Epiglottitis: 5 mg. nebulized epinephrine  1:1000. If unable to neb, may give epi 1:1000--- 0.01 mg/kg SC.

Precautions:

High doses do not improve survival or neurologic outcome and may contribute to postresuscitation myocardial dysfunction. Raising blood pressure and increasing heart rate may cause myocardial ischemia, angina and increased myocardial oxygen demand. Higher doses maybe required to treat poison/drug-induced shock.Do not use concurrently with Brevibloc. The effects of the drug maybe potentiated by tricyclic antidepressants.

Generic Name:

Furosemide

Trade Name:

Lasix

Classification:

Diuretic, antihypertensive, and antihypercalcemic

Action/Kinetics:

A sulfonamide-type diuretic, related to the thiazides. Extremely potent and has a rapid onset of action of 5 minutes and may last for 2 hours. Acts on the proximal and distal tubules and ascending loop of Henle. Highly protein bound. Metabolized and excreted in the urine

Indications:

Acute pulmonary edema,in patients with systolic blood pressure >90 (without signs and symptoms of shock), edema associated with congestive heart failure, hypertensive emergencies, and post-cardiac arrest cerebral edema (increased intracranial pressure).

Contraindications:

Anuria, severe progressive renal disease with increasing azotemia and oliguria; hypersensitivity to the drug, rarely used in children, pregnancy, and breast-feeding mothers.

Adverse Effects

Vertigo, headache, dizziness, paresthesia, restlessness, dehydration, orthostatic hypotension, transient deafness (with too-rapid IV infusion), blurred or yellow vision. Abdominal pain, nausea and vomiting, muscle spasm, and electrolyte imbalance.

How Supplied:

Vials of 10 ml (10 mg/ml =total 100 mg. per vial

Dosage:

Dose of 40 mg IV (4cc) for pulmonary edema(per protocol) or amount designated by medical control MD.

Precautions:

Use cautiously in patients with hepatic cirrhosis. If patient is taking antihypertensives, increased risk of hypotension, risk of ototoxicity with higher doses. Use with caution in known sulfonamide sensitivity.

Generic Name:

Glucagon

Trade Name:

GlucaGen

Classification:

Antihypoglycemic, antidote, and diagnostic agent

Action/Kinetics:

Raises blood glucoselevel by promoting catalytic depolymerization of hepatic glycogen to glucose. Induces liver glycogen breakdown, releasing glucose from the liver. Blood glucose is raised within 10 minutes. Has a half-life of 8 to 18 minutes.

Indications:

Treatment of severe hypoglycemia,Helpful in reversing adverse beta-blockade of beta-adrenergic blocking agents and calcium  channel blockers, diagnostic aid in radiologic exam of abdomen

Contraindications:

known hypersensitivity to drug, and in patients with pheochromocytoma or with insulinoma (tumor of pancreas).

Adverse Effects

Hyperglycemia (excessive dosage), nausea and vomiting hypersensitivity reactions (anaphylaxis, dyspnea, hypotension, rash), increased blood pressure, and pulse; this maybe greater in patients taking beta-blockers.

How Supplied:

One vial containing 1 mg. (1 IU) powder and one vial containing 1/ml of sterile water to be reconstituted.

Dosage:

Give 1 mg. IM, after reconstituting powder and sterile water, for symptomatic diabetic patient whose IV access has been difficult. For beta-blocker overdose also give 1 mg. IV.

Precautions:

Give with caution to patients that have low levels of releasable glucose(e.g., adrenal insufficiency, chronic hypoglycemia,  and prolonged fasting). Potentiates oral anticoagulants. Depletes glycogen stores especially in children and adolescents.

Generic Name:

LidocaineHydrochloride IV

Trade Name:

Xylocaine IV

Classification:

Antiarrhythmic

Action/Kinetics:

Decreases ventricular excitability without depressing the force of ventricular contractions by increasing the stimulation threshold of the ventricle during diastole. Onset of action should occur within 2 minutes and last approximately 10 to 20 minutes. Metabolized in the liver and excreted in the urine.

Indications:

Cardiac arrest from VF/VT (class II B) Stable VT, wide-complex tachycardias of uncertain type, wide-complex PSVT (class IIB).

Contraindications:

Hypersensivity to the drug. Stokes-Adams syndrome, Wolff-Parkinson-White syndrome, severe degrees of SA, AV, or intraventricular block (when no pacemaker is present.).

Adverse Effects

Anaphylaxis, bradycardia, hypotension, cardiovascular collapse, seizures, malignant hyperthermia,respiratory depression, tremors, lightheadedness, confusion, tinnitus, blurred or double vision, and vomiting

How Supplied:

Abboject 5 ml prefilled syringe (100 mg. total)

Dosage:

Adult: V tach Lidocaine100 mg. (1.0-1.5 mg/kg) IV over two minutes. Use ½ dose, i.e., 50 mg. if patient is over age 70 or if CHF or hepatic failure present. Repeat 0,5 to 0.75 mg/kg every 5 to 10 minutes; maximum total dose: 3 mg/kg. Cardiac arrest from VF/VT Lidocaine 100 mg. (1.5 mg/kg) may repeat lidocaine 100mg. IV or 200 mg. ET followed by defib. Peds: Cardiac arrest (1:10,000) Give 0.1 mg/kg or 0.1 cc/kg IV/IO/ET followed by defib.

Precautions:

Prophylactic use in AMI patients is not recommended. Discontinue infusion immediately if signs of toxicity develop. Elderly clients who have hepatic or renal disease or who weigh less then 45.5 kg. Should be watched closely for adverse side effects. Do not add lidocaineto blood transfusion assembly. Potentiates amiodarone,beta-adrenergic blockers (Inderal) and Tagamet. Toxicity can occur due to reduced metabolism of lidocaine.

Generic Name:

MagnesiumSulfate

Trade Name:

MagnesiumSulfate

Classification:

Antiarrhythmic, electrolyte replenisher, and anticonvulsant

Action/Kinetics:

A CNS depressant and a depressant of smooth, skeletal and cardiac muscle. It possesses a mild diuretic and vasodilating effect Reverses refractory VF caused by hypomagnesemia and aids in replenishment of intracellular potassium. Onset of action is immediate and effective for about 30 minutes. Excreted in the urine.

Indications:

Refractory VF (after lidocaine), torsades de pointes with a pulse, life threatening ventricular arrhythmias due to digitalis toxicity, adjunctive to alleviate bronchospasm in acute asthma, control of seizures in pregnancy, and control of hypertension in acute nephritis in children.

Contraindications:

In the presence of heart block or myocardial damage, hypersensitivity to drug, and within 2 hours preceding delivery of PIH patient.

Adverse Effects

CNS depression, hypotension, circulatory collapse, depression of myocardium. Sweating, hypothermia, muscle paralysis, respiratory paralysis, suppression of knee jerk reflex, and changes in ECG, (increased PR interval, increased QRS complex, and prolonged QT interval).

How Supplied:

50% solution 1 Gm in 2/ml to be diluted to 10 ml with N.S. or sterile water for injection.

Dosage:

50% solution 1 Gm (2 ml) diluted to 10 ml with N.S. or sterile water for injection. Give IV push over one minute.

Precautions:

Should be administered cautiously in the presence of impaired renal failure. Morphineand Valium potentiate respiratory depression when given to patient receiving MgSO₄. Calciumgluconate should always be available to treat possible respiratory depression due to MgSO4. Toxic level is >10 mg/dl.

Generic Name:

MidazolamHydrochloride

Trade Name:

Versed

Classification:

Sedative-hypnotic, benzodiazepine, amnestic, anesthetic adjunct

Action/Kinetics:

A short acting benzodiazepine, CNS depressant 3 to 4 times as potent as diazepam. Depressant effects are dependent on dose, route of administration and the presence of other medications. Can depress the ventilatory response to CO₂ stimulation. Mechanics of respiration are not adversely affected with usual doses. Diminishes patient recall. Onset of action within 3 -5 minutes. Half-life ranges from 1.8 to 6.4 hours

Indications:

To produce sedation, relieve anxiety, and impair memory of procedural events. Used with or without narcotic for conscious sedation before short procedures. Also as a component in the induction of anesthesia before administration of other anesthetic agents, and for patients in status seizures.

Contraindications:

Hypersensitivity to the drug, and acute narrow-angle glaucoma. Not recommended in pregnancy, childbirth, breast-feeding, shock, coma, acute alcohol intoxication with depression of vital signs.

Adverse Effects

Serious cardiorespiratory events (airway obstruction, apnea, hypotension, oxygen desaturation, respiratory and or cardiac arrest, paradoxical behavior or excitement. Other common side effects are coughing, headache, hiccups, nausea and vomiting, and nystagmus (especially in children).

How Supplied:

Vial 2ml (total 10 mg) = 5 mg per ml.

Dosage:

Status seizures: Adult, if >5 minutes and IV established, VersedIV titrated 1 mg at a time up to a max dose of 10 mg. Peds: if >5 minutes and IV established Versed IV 0.1 mg/kg over two minutes. (Maximum dose = 5 mg.) If no IV is established adult: Give 10 mg. IM. Peds: Give 0.2 mg/kg IM.

Agitation: (intubated patient, behavior emergencies) Versed1-2 mg IV/IM.

Cardioversion: If patient alert and IV access established may give up to 3 mg IV for sedation.

Precautions:

Use cautiously in patients with uncompensated acute illness and in elderly or debilitated patients. Administer slowly over at least 2 minutes. Use with caution in neonates. Verseddoes not protect against the intracranial pressure or against the pulse and blood pressure rise associated with intubation. Erythromycin may alter the metabolism of versed. Oral contraceptives prolong the half-life. Sedative effects may be antagonized by theophylline.

Generic Name:

MorphineSulfate

Trade Name:

MorphineSulfate    (names may vary if preservative free)

Classification

Narcotic analgesic, adjunct, pulmonary edema

Actions/Kinetics:

An opium-derivative, narcotic analgesic, which is a CNS depressant. Induces sleep and inhibits perception of pain by binding to opiate receptors, decreasing sodium permeability, and inhibiting transmission of pain pulses. Relieves pulmonary congestion, and lowers myocardial oxygen need. Detoxified in the liver and excreted in the urine. Onset 2-3 minutes, peak 30 minutes, and duration is 3-6 hours.

Indications:

Analgesic of choice in pain associated with myocardial infarction that is unresponsive to nitrates. Treatment of acute pulmonary edemaassociated with left ventricular failure, (if blood pressure is adequate). Used for sedation, to decrease anxiety and facilitate induction of anesthesia.

Contraindications:

Hypersensitivity to opiates, acute bronchial asthma, heart failure secondary to lung disease, upper airway obstruction, acute alcoholism, convulsive states, and paralytic ileus.

Adverse Effects

Seizures (with large doses), hypotension, bradycardia, cardiac arrest, or may see tachycardia, and hypertension. Nausea and vomiting, ileus, urine retention, respiratory depression and arrest, hypothermia,and increased intracranial pressure may also been seen.

How Supplied:

Vial 10 mg/ml =1ml

Dosage:

For persistent pain, give morphinesulfate 2-10 mg. IV titrated to obtain pain relief. (Use caution in presence of COPD).

Precautions:

Causes hypotension in volume-depleted patients. Administer slowly and titrate to effect. May cause apnea in asthmatic patients. May also cause increase ventricular response rate in presence of supraventricular tachycardias. Use with caution in the elderly, head injuries with increased intracranial pressure, COPD, severe hepatic or renal disease,

Generic Name:

NaloxoneHydrochloride

Trade Name:  

Narcan

Classification

Narcotic (opioid) antagonist, Antidote

Actions/Kinetics

Overcomes effects of narcotic overdose including respiratory depression, sedation, and hypotension. It does not have any narcotic effect itself. It exhibits essentially no pharmacologic activity. Onset of action is within 2 minutes. Duration of action is dependent on dose and route of administration

Indications:

Indicated for complete or partial reversal of known or suspected narcotic-induced respiratory depression and overdose. Antidote for natural and synthetic narcotics. Also indicated for the diagnosis of suspected opioid tolerance.

Contraindications:

Hypersensitivity to the drug. The naloxonechallenge test should not be performed in patients showing S/S of withdrawal or whose urine contains opioids.

Adverse Effects

May see VF, tachycardia, hypertension, nausea, vomiting, and diaphoresis, in higher doses. Tremors and withdrawal symptoms in narcotic-dependent patients.

How Supplied:

Vial 1.0 mg/ml—10 ml multiple dose vials

Dosage:

If suspected narcotic overdose consider up to 2 mg NarcanIV/IM. For physical findings consistent with narcotics overdose, may give up to 2 mg Narcan IV/IM. Case specific consider additional Narcan up to 10 mg.

Precautions:

May precipitate acute withdrawal symptoms in narcotic addicts. Effects of drug may not outlast effects of narcotics. Use with caution in patients with cardiac disease or those receiving cardiotoxic drugs. It is ineffective against respiratory depression caused by barbiturates, anesthetics, other nonnarcotic agents, or pathologic conditions.

Generic Name:

Nitroglycerin IV

Trade Name:  

Tridil or NitroBid IV or Nitrostat IV      

Classification:

Antianginal agent, coronary vasodilator, antihypertensive

Action/Kinetics:

Relaxation of the vascular smooth muscle and dilatation of peripheral arteries and veins. Dilatation of the veins promotes peripheral pooling and decreases venous return to the heart (preload). Arteriolar relaxation reduces systemic vascular resistance, systolic arterial pressure, and mean arterial pressure (afterload).

Onset: 1-2 minutes

Duration: 3-5 minutes (dose-dependent)             

Indications:

Initial 24 to 48 hours in patients with AMI and CHF, large anterior wall infarction, persistent or recurrent ischemia, or hypertension. Angina unresponsive to usual doses of organic nitrate or beta-adrenergic blocking agents. Produce controlled hypotension during surgical procedures.

Contraindications:

Patients who are hypersensitive to drug.

Hypotensive patients     

Severe bradycardia or tachycardia

RV infarction   

Viagra within 24 hours

Patients with pericardial tamponade or constrictive pericarditis

Head trauma with increased intracranial pressure                       

Adverse Reactions:

Headache, transient episodes of light-headedness related to

Blood pressure changes, hypotension, syncope, crescendo

Angina, rebound hypertension, anaphylactoid reactions.

Abd pain and vomiting, may also be seen.

How Supplied:

Available premixed in 250ml D%W with 50mg.Nitroglycerin. All other preparations must be diluted and administered as an infusion.

Dosage:

Dependent on patient response and effective dose. Initial dose  10 mcg/min delivered by infusion pump. Maybe increased by 5-10 mcg/min q 5-10 minutes until desired hemodynamic or clinical response. If no response seen may increase by 20mcg/min until response achieved. Monitor titration continuously until client reaches desired level of response. Monitor blood pressure and pulse closely maintaining systolic pressure>100.                                 

Precautions:

Pregnancy category C: safety for use in pregnancy and in children not established.

Use nonabsorbent polyvinyl chloride IV tubing from the manufacturer.

Do not administer with any other medications in the IV system.

Use with caution in patients with hepatic or renal disease or with postural hypotension.                

Generic Name:

Nitrolingual (spray)---Nitrostat (tabs)

Trade Name:

Nitroglycerinspray---Nitroglycerin tabs

Classification

Antianginal, coronary vasodilator, antihypertensive

Actions/Kinetics

Primary action is relaxation of the vascular smooth muscle and dilatation of peripheral arteries and veins. Although venous effects predominate, nitroproduces dilation of both arterial and venous beds. Promotes peripheral pooling of blood and decreases venous return to the heart, reducing left ventricular pressure (preload). Arteriolar relaxation reduces systemic vascular resistance and arterial pressure (afterload). Also increases blood flow through the collateral coronary vessels. Onset: 1-2 minutes Duration: 3-5 minutes.

Indications:

Initial antianginal for suspected ischemic pain. Drug of choice in unstable angina or CHF associated with acute myocardial infarction, and suspected pulmonary edemawhen systolic blood pressure is greater than 140.

Contraindications:

Hypersensitivity to nitrates, head trauma with increased intracranial pressure, hypotensive patients, severe bradycardia or tachycardia, RV infarction, Viagra within 24 hours, and severe anemia.

Adverse Effects

Headache, transient episodes of light-headedness related to blood pressure changes, hypotension, syncope, crescendo angina, rebound hypertension, and anaphylactoid reactions. Abd pain and vomiting may also be seen.

How Supplied:

Pumpspray 400 mcg per spray, (200 metered sprays). Tablets 0.4mg S.L. (1/150).

Dosage:

One tablet S.L. 0.4 mg (gr. 1/150) or one metered spray (400mcg) may repeat same dosage for chest pain patient every 5 minutes x3 if SBP remains 110 or greater. For pulmonary edemapatients give one tablet S.L. or one metered spray if SBP is 140 or greater. (Two) minutes after initial dose may repeat tablet or spray if patient continues to have symptoms and SBP remains 140 or greater. (Five) minutes after second dose may repeat tablet or spray if symptoms continue and SBP is 140 or greater.

Precautions:

Do not shake aerosol spray container because this affects metered dose. Patient should sit or lie down when taking this drug. Concomitant use of nitrates and alcohol may cause hypotension. Marked symptomatic orthostatic hypotension may occur when calcium  channel blockers and oral controlled-release nitroglycerin are used in combination.

Generic Name:

Flumazenil

Trade Name:

Romazicon

Classification

BZD- Sedation Reversal Toxicology

Actions/Kinetics:

Antagonizes benzodiazepine receptors

Indications:

Benzodiazepine Sedation Reversal

Contraindications:

Hypersensitivity to the drug, TCA overdose, mixed overdose

Adverse Effects

Seizures, Withdrawal Syndrome, Arrhythmias, Resedation

How Supplied:

.1 MG / ML 5ML Vial  (.5 MG / 5ML)

Dosage:

BZD Sedation Reversal

0.2 MG IV qmin x 1-5 doses Max: 1 mg total dose over 15 seconds

BZD Overdose

Precautions:

Caution if seizure risk, caution if alcoholism, caution if chronic BZD use for seizures

Generic Name:

Sodium bicarbonate

Trade Name:

Sodium bicarbonate

Classification

Electrolyte replenisher, alkalizing agent

Actions/Kinetics

An alkalizing agent and sodium salt. Helps to maintain osmotic pressure and ion balance. It is the buffering agent in blood. Bicarbonate ion elevates blood pH promptly. 99% reabsorbed with normal kidney function. 1% is excreted in the urine.

Indications:

Metabolic acidosis caused by circulatory insufficiency resulting from shock or severe dehydration, severe renal disease, cardiac arrest, primary lactic acidosis, tricyclic overdoses, and hyperkalemia.

Contraindications:

Patients with metabolic or respiratory alkalosis, patients losing chlorides by vomiting or GI suction, patients receiving diuretics known to produce hypochloremic alkalosis, and patients with hypocalcemia in which alkalosis may produce tetany, hypertension, seizures, or heart failure.

Adverse Effects

Gastric distention, belching, flatulence, hypokalemia, metabolic alkalosis, hypernatremia, hyperosmolarity, hyperirritability or tetany. Extravasation of IV sodium bicarbonatemay cause chemical cellulitis with tissue necrosis.

How Supplied:

Prefilled syringe 8.4% sodium bicarbonatesolution (50-mEq/50 ml)

Dosage:

Adult: Drug overdose Consider Na Bicarb 50 mEq IV in tricyclic ingestions.

Symptomatic renal patient Consider Na Bicarb 50 mEq IV. Cardiac arrest-asystole-PEA Consider Na Bicarb 50 mEq (1 amp) or 1 mEq/kg if arrest interval long or return of circulation after prolonged resuscitation. Peds: Cardiac arrest asystole-PEA Consider (1 mEq/cc) if arrest interval long or upon spontaneous circulation. Give 1 mEq/kg or 1cc/kg IV/IO up to 50 cc.

Precautions:

Not recommended for routine use in cardiac arrest patients. Sodium bicarbonate inactivates norepinephrine, and dopamine, and forms a precipitate with calcium.Use with caution in the elderly with renal or cardiovascular insufficiency with or without CHF.

Generic Name:

Terbutalinesulfate

Trade Name:

Brethine, Bricanyl

Classification

Sympathomimetic, (bronchodilator), Uterine relaxant

Actions/Kinetics

A beta-adrenergic stimulator. Primary actions are bronchodilation by relaxation of the smooth muscles. and inhibition of uterine smooth muscle contractility. Increases pulse rate and widens pulse pressure moderately. Onset of action is prompt and lasts 2 hours. Metabolized in the liver.

Indications:

Used for prevention and reversal of bronchospasm in patients with bronchial asthma and reversible bronchospasm associated with bronchitis and emphysema.

Contraindications:

Patients with hypersensitivity to drug or sympathomimetic amines, cardiac arrhythmias with tachycardia or digitalis toxicity, uncontrolled hypertension, and any preexisting maternal medical conditions adversely affected by beta-mimetic drugs.

Adverse Effects

Paradoxical bronchospasm with prolonged usage, nervousness, tremor, drowsiness, headache, weakness, palpitations, tachycardia, heartburn, nausea, vomiting, and hypokalemia (with high doses).

How Supplied:

Injection 1 mg/ml (each ampule contains 1 mg. of Terbutalineper 1 ml of solution).

Dosage:

Adult If patient is in respiratory arrest may administer Terbutaline0.25 mg. SC while awaiting medical control contact. Peds May administer Terbutaline 0.01 mg/kg (0.01 cc/kg) SC—Max dose = 0.25 mg. while awaiting medical control contact.

Precautions:

Use cautiously in patients with CV disorders, hyperthyroidism, diabetes, or seizure disorders. Drug is not recommended for children under 12 years of age because of insufficient clinical data. Protect ampule from light. Do not use if discolored. Significant changes in systolic and diastolic blood pressure may occur in some patients.