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