Az Drugs

Front 1

CALCIUM CHLORIDE BRAND NAME

Back 1

BRAND NAME: Calcium Chloride

Front 2

DEXTROSE 50% BRAND NAME

Back 2

BRAND NAME: Dextrose 50%, D50

Front 3

BUMETANIDE BRAND NAME

Back 3

BRAND NAME: Bumex

Front 4

BRETYLIUM TOSYLATE BRAND NAME

Back 4

BRAND NAME: Bretylol

Front 5

ATROPINE SULFATE BRAND NAME

Back 5

BRAND NAME: Atropine

Front 6

ACETYLSALICYLIC ACID, ASA BRAND NAME

Back 6

BRAND NAME: Bufferin, Anacin, APC

Front 7

AMIODARONE BRAND NAME

Back 7

Brand Name: Cordarone

Front 8

ALBUTEROL SULFATE BRAND NAME

Back 8

BRAND NAME: Proventil, Ventolin

Front 9

ADENOSINE BRAND NAME

Back 9

BRAND NAME: Adenocard

Front 10

CHARCOAL, ACTIVATED (without sorbitol) BRAND NAME

Back 10

BRAND NAME: Charcola, Actidose-aqua

Front 11

VERAPAMIL HCl BRAND NAME

Back 11

BRAND NAME: Isoptin, Calan, Verelan

Front 12

THIAMINE HCl (vitamin B1) BRAND NAME

Back 12

BRAND NAME: Betalin

Front 13

SODIUM BICARBONATE 8.4% BRAND NAME

Back 13

BRAND NAME: Sodium Bicarbonate 8.4%

Front 14

PHENYLEPHRINE NASAL SPRAY 0.5% BRAND NAME

Back 14

BRAND NAME: Neo-synephrine Nasal Spray 0.5%

Front 15

OXYTOCIN BRAND NAME

Back 15

BRAND NAME: Pitocin, Syntocin

Front 16

NITROUS OXIDE 50% BRAND NAME

Back 16

BRAND NAME: Nitronox

Front 17

NITROGLYCERIN BRAND NAME

Back 17

BRAND NAME: Nitrostat, Tridil

Front 18

NALOXONE HCl BRAND NAME

Back 18

BRAND NAME: Narcan

Front 19

MORPHINE SULFATE BRAND NAME

Back 19

BRAND NAME: Morphine Sulfate

Front 20

DIPHENHYDRAMINE HCl BRAND NAME

Back 20

BRAND NAME: Benadryl

Front 21

MIDAZOLAM HYDROCHLORIDE BRAND NAME

Back 21

BRAND NAME: Versed

Front 22

METHYLPREDNISOLONE SODIUM SUCCINATE BRAND NAME

Back 22

BRAND NAME: Solu-Medrol

Front 23

MAGNESIUM SULFATE BRAND NAME

Back 23

BRAND NAME: Magnesium Sulfate

Front 24

LIDOCAINE HCl BRAND NAME

Back 24

BRAND NAME: Xylocaine

Front 25

GLUCAGON BRAND NAME

Back 25

BRAND NAME: Glucagon

Front 26

FUROSEMIDE BRAND NAME

Back 26

BRAND NAME: Lasix

Front 27

EPINEPHRINE HCl BRAND NAME

Back 27

BRAND NAME: Adrenalin

Front 28

DOPAMINE BRAND NAME

Back 28

BRAND NAME: Intropin

Front 29

DIAZEPAM BRAND NAME

Back 29

BRAND NAME: Valium

Front 30

DEXAMETHASONE SODIUM PHOSPHATE BRAND NAME

Back 30

BRAND NAME: Decadron

Front 31

CALCIUM CHLORIDE CLASS

Back 31

CLASS: electrolyte

Front 32

DEXTROSE 50% CLASS

Back 32

CLASS: carbohydrate, hyperglycemic

Front 33

BUMETANIDE CLASS

Back 33

CLASS: Loop diuretic

Front 34

BRETYLIUM TOSYLATE CLASS

Back 34

CLASS: antiarrhythmic

Front 35

ATROPINE SULFATE CLASS

Back 35

CLASS: parasympatholytic, antimuscarinic, anticholinergic, parasympathetic antagonist, parasympathetic blocker

Front 36

ACETYLSALICYLIC ACID, ASA CLASS

Back 36

CLASS: analgesic; antipyretic; antiinflammatory

Front 37

AMIODARONE CLASS

Back 37

Class: Antiarrhythmic agent

Front 38

ALBUTEROL SULFATE CLASS

Back 38

CLASS: sympathomimetic, bronchodilator

Front 39

ADENOSINE CLASS

Back 39

CLASS: antiarrhythmic, endogenous nucleoside

Front 40

CHARCOAL, ACTIVATED (without sorbitol) CLASS

Back 40

CLASS: adsorbent

Front 41

VERAPAMIL HCl CLASS

Back 41

CLASS: calcium channel blocker

Front 42

THIAMINE HCl (vitamin B1) CLASS

Back 42

CLASS: vitamin

Front 43

SODIUM BICARBONATE 8.4% CLASS

Back 43

CLASS: buffer

Front 44

PHENYLEPHRINE NASAL SPRAY 0.5% CLASS

Back 44

CLASS: topical vasoconstrictor

Front 45

OXYTOCIN CLASS

Back 45

CLASS: pituitary hormone, polypeptide, uterine stimulant

Front 46

NITROUS OXIDE 50% CLASS

Back 46

CLASS: analgesic, inhalation

Front 47

NITROGLYCERIN CLASS

Back 47

CLASS: vasodilator, organic nitrate, antianginal

Front 48

NALOXONE HCl CLASS

Back 48

CLASS: narcotic (opioid) antagonist

Front 49

MORPHINE SULFATE CLASS

Back 49

CLASS: narcotic agonist

Front 50

DIPHENHYDRAMINE HCl CLASS

Back 50

CLASS: antihistamine; anticholinergic

Front 51

MIDAZOLAM HYDROCHLORIDE CLASS

Back 51

CLASS: Central nervous system depressant, benzodiazepine

Front 52

METHYLPREDNISOLONE SODIUM SUCCINATE CLASS

Back 52

CLASS: corticosteroid, glucocorticoid, steroid, anti-inflammatory

Front 53

MAGNESIUM SULFATE CLASS

Back 53

CLASS: electrolyte, tocolytic

Front 54

LIDOCAINE HCl CLASS

Back 54

CLASS: antiarrhythmic, local anesthetic

Front 55

GLUCAGON CLASS

Back 55

CLASS: pancreatic hormone, polypeptide, hyperglycemic agent

Front 56

FUROSEMIDE CLASS

Back 56

CLASS: loop diuretic

Front 57

EPINEPHRINE HCl CLASS

Back 57

CLASS: sympathomimetic

Front 58

DOPAMINE CLASS

Back 58

CLASS: sympathomimetic

Front 59

DIAZEPAM CLASS

Back 59

CLASS: benzodiazepine

Front 60

DEXAMETHASONE SODIUM PHOSPHATE CLASS

Back 60

CLASS: synthetic adrenocorticoid/ glucocorticoid with a predominance of glucocorticoid action, antiinflammatory

Front 61

CALCIUM CHLORIDE Mechanism of Action

Back 61

Mechanism of Action: Increases extracellular and intracellular calcium levels Stimulates release of catecholamines Increases cardiac contractile state (positive inotropic effect) May enhance ventricular automaticity Inhibits the effects of adenosine on mast cells

Front 62

DEXTROSE 50% Mechanism of Action

Back 62

Mechanism of Action: Provides short-term osmotic diuresis. Pharmacological: Aerobic metabolic substrate (ATP production). Clinical effects: Reverses CNS effects of hypoglycemia by rapidly increasing serum glucose levels.

Front 63

BUMETANIDE Mechanism of Action

Back 63

Mechanism of Action: Inhibits electrolyte reabsorption in the ascending loop of Henle leading to diuresis

Front 64

BRETYLIUM TOSYLATE Mechanism of Action

Back 64

Mechanism of Action: Elevates ventricular fibrillation threshold. Biphasic autonomic response: transient (15-20 minutes) adrenergic response (and possibly ventricular ectopy); followed by a decrease in arterial pressure from vasodilation (due to norepinephrine depletion and reuptake blockade). Decreases re-entry by decreasing refractory time imbalance between normal and infarcted tissue. Prolongs action potential and refractory period. Suppresses PVC's and ventricular arrhythmias 20 minutes to 2 hours after dosing.

Front 65

ATROPINE SULFATE Mechanism of Action

Back 65

Mechanism of Action: Pharmacological: Competitive antagonist of acetylcholine at muscarinic receptor sites (smooth muscle and glands, blocking parasympathetic response and allowing sympathetic response to take over). Clinical: CV: Increased heart rate (positive chronotropic effect); increased conduction velocity; increased force of contraction (slight). Resp: Decreased mucous production; increased bronchial smooth muscle relaxation (bronchodilation). GI: Decreased GI secretion and motility. GU: Decreased urinary bladder tone. Misc: Mydriasis (pupillary dilation); decreased sweat production.

Front 66

ACETYLSALICYLIC ACID, ASA Mechanism of Action

Back 66

Mechanism of Action: In small doses aspirin blocks thromboxane A2, a potent platelet aggregant and vasoconstrictor. This property has lead to its use in the acute phase of management of the myocardial infarction. Decreased platelet aggregation.

Front 67

AMIODARONE Mechanism of Action

Back 67

Mechanism of Action: Multiple effects on sodium, potassium and calcium channels. Prolongs action potential, refractory period, and ventricular automaticity (potassium blocker). Slows membrane depolarization and impulse conduction (sodium blocker). Coronary artery dilation and Negative chronotropic activity in nodal tissue, rate reduction, and antisympathetic activity (calcium channel and a-blocker

Front 68

ALBUTEROL SULFATE Mechanism of Action

Back 68

Mechanism of Action: ß agonist (primarily ß2); relaxes bronchial smooth muscle, resulting in bronchodilation; also relaxes vascular and uterine smooth muscle; decreases airway resistance

Front 69

ADENOSINE Mechanism of Action

Back 69

Mechanism of Action: Slows conduction time through AV node; can interrupt re-entrant pathways through the AV node. Slows sinus rate. Larger doses decrease BP by decreasing peripheral resistance.

Front 70

CHARCOAL, ACTIVATED (without sorbitol) Mechanism of Action

Back 70

Mechanism of Action: Pharmacological: Physical binding (adsorption) of toxins from GI tract. Clinical effects: Prevents/reduces systemic absorption of toxins.

Front 71

VERAPAMIL HCl Mechanism of Action

Back 71

Mechanism of Action: Blocks calcium ion influx into cardiac and smooth muscle cells causing a depressant effect on the contractile mechanism resulting in negative inotropy. Reduces contractile tone in vascular smooth muscle resulting in coronary and peripheral vasodilation. Slows conduction and prolongs refractory period in the AV node due to calcium channel blocking. Slows SA node discharge. In summary, decreases myocardial contractile force and slows AV conduction.

Front 72

THIAMINE HCl (vitamin B1) Mechanism of Action

Back 72

Mechanism of Action: Required for carbohydrate metabolism. Deficiency leads to anemia, polyneuritis, Wernicke's encephalopathy, cardiomyopathy. Administration may reverse symptoms of deficiency, but effects are dependent upon duration of illness and severity of disease.

Front 73

SODIUM BICARBONATE 8.4% Mechanism of Action

Back 73

Mechanism of Action: Buffers H+ and increases pH

Front 74

PHENYLEPHRINE NASAL SPRAY 0.5% Mechanism of Action

Back 74

Mechanism of Action: Stimulates a receptors in the blood vessels of the nasal mucosa which causes their constriction and thereby decreases the risk of nasal bleeding.

Front 75

OXYTOCIN Mechanism of Action

Back 75

Mechanism of Action: Binds to oxytocin receptor sites on surface of uterine smooth muscles: increases force and frequency of uterine contractions

Front 76

NITROUS OXIDE 50% Mechanism of Action

Back 76

Mechanism of Action: Centrally acting agent that produces CNS depression and elevation of the pain threshold

Front 77

NITROGLYCERIN Mechanism of Action

Back 77

Mechanism of Action: Smooth muscle relaxant acting on vascular, uterine, bronchial, and intestinal smooth muscle. Reduces workload on the heart by causing blood pooling (decreased preload). Arteriolar vasodilation (decreased afterload). Coronary artery vasodilation Increases blood flow to myocardium. Decreases myocardial O2 demand.

Front 78

NALOXONE HCl Mechanism of Action

Back 78

Mechanism of Action: Competitive inhibition at narcotic receptor sites. Reverses respiratory depression secondary to narcotics

Front 79

MORPHINE SULFATE Mechanism of Action

Back 79

Mechanism of Action: Alleviates pain by acting on the pain receptors in the brain; elevates pain threshold. Depresses central nervous system; depresses brainstem respiratory centers; decreases responsiveness to changes in PaC02. Increases venous capacitance (venous pooling), vasodilates arterioles, reducing preload and afterload. Histamine release.

Front 80

DIPHENHYDRAMINE HCl Mechanism of Action

Back 80

Mechanism of Action: Blocks cellular histamine receptors, but does not prevent histamine release; results in decreased capillary permeability and decreased vasodilation, as well as prevention of bronchospasm. Has some anticholinergic effects.

Front 81

MIDAZOLAM HYDROCHLORIDE Mechanism of Action

Back 81

Mechanism of Action: CNS effects are mediated through the inhibitory neurotransmitter gamma-aminobutyric acid (GABA). Acts at the limbic, thalamic, and hypothalamic levels of the CNS, producing anxiolytic, sedative, hypnotic, and anticonvulsant effects. Capable of producing all levels of CNS depression, from mild sedation to coma.

Front 82

METHYLPREDNISOLONE SODIUM SUCCINATE Mechanism of Action

Back 82

Mechanism of Action: Enters target cells and causes many complex reactions that are responsible for its antiinflammatory and immunosuppressive effects; thought to stabilize cellular and intracellular membranes.

Front 83

MAGNESIUM SULFATE Mechanism of Action

Back 83

Mechanism of Action: Pharmacology: Second most plentiful intracellular cation; essential to enhance intracellular potassium replenishment and activity of many enzymes; important role in neurochemical transmission and muscular excitability (may decrease acetylcholine released by nerve impulses); decreases myocardial irritability and neuromuscular irritability. Clinical: Cardiac-reduces ventricular irritability, especially when associated with hypomagnesemia; inhibition of muscular excitability.

Front 84

LIDOCAINE HCl Mechanism of Action

Back 84

Mechanism of Action: Decreases automaticity by slowing the rate of spontaneous phase 4 depolarization. Terminates re-entry by decreasing conduction in re-entrant pathways (by slowing conduction in ischemic tissue, equalizes conduction speed among fibers). Increases ventricular fibrillation threshold.

Front 85

GLUCAGON Mechanism of Action

Back 85

Mechanism of Action: Pharmacologic: Acts only on liver glycogen, converting it to glucose. Counteracts the effect of insulin. Relaxes GI smooth muscle causing dilation and decreased motility. Cardiac inotrope. Clinical effects: May reverse hypoglycemia (if patient has glycogen stored in liver) within 4-8 minutes (could be as long as 15 or more).

Front 86

FUROSEMIDE Mechanism of Action

Back 86

Mechanism of Action: Pharmacologic: Inhibits electrolyte reabsorption in the ascending Loop of Henle. Promotes excretion of sodium, potassium, chloride. Vasodilation increases venous capacitance and decreases afterload. Clinical: Diuresis

Front 87

EPINEPHRINE HCl Mechanism of Action

Back 87

Mechanism of Action: Pharmacological Effects: Direct acting a and ß agonist; a-bronchial, cutaneous, renal, and visceral arterial constriction (increased systemic vascular resistance); ß1-positive inotropic and chronotropic actions (increases myocardial workload and oxygen requirements), increases automaticity and irritability; ß2 bronchial smooth muscle relaxation and dilation of skeletal vasculature. Other: blocks histamine release. Clinical Effects: Cardiac Arrest- increases cerebral and myocardial perfusion pressure; increases systolic and diastolic blood pressures; increases electrical activity in the myocardium; can stimulate spontaneous contractions in asystole. Bradycardia- increases heart rate, increases BP; Bronchospasm/Anaphylaxis-reverse signs/symptoms

Front 88

DOPAMINE Mechanism of Action

Back 88

Mechanism of Action: Immediate metabolic precursor to norepinephrine. Effects are dose-dependent: 1-2 Mg/kg/min Acts on dopaminergic receptors to stimulate cerebral, renal and mesenteric vasculature to dilate; HR and B/P are usually unchanged; may increase urine output. 2-10 Mg/kg/min ß1 stimulant action is primary effect (increases cardiac output and partially antagonizes the a-adrenergic-mediated vasoconstriction. Overall effect is increased cardiac output and only modest increase in systemic vascular resistance (SVR). 10-20 Mg/kg/min a-adrenergic effects predominate resulting in renal, mesenteric and peripheral arterial and venous vasoconstriction with marked increase in SVR, pulmonary vascular resistance and further increased preload. 10-20 Mg/kg/min a-adrenergic effects predominate resulting in renal, mesenteric and peripheral arterial and venous vasoconstriction with marked increase in SVR, pulmonary vascular resistance and further increased preload

Front 89

DIAZEPAM Mechanism of Action

Back 89

Mechanism of Action: Acts on parts of the limbic system, the thalamus, and hypothalamus producing calming effects; decreases seizures by increasing the seizure threshold; transient analgesia; amnesic; sedative.

Front 90

DEXAMETHASONE SODIUM PHOSPHATE Mechanism of Action

Back 90

Mechanism of Action: Improves lung function and myocardial performance: stabilization of lysosomal and cell membranes, inhibition of compliment-induced granulocyte aggregation, rightward shift in oxygen-hemoglobin dissociation curve, inhibition of prostaglandin and leukotriene production, increase in surfactant production, decrease in pulmonary edema, relaxation of bronchospasm.

Front 91

CALCIUM CHLORIDE Indications/field use

Back 91

Indications and Field Use: Acute hypocalcemia Calcium channel blocker OD Acute hyperkalemia (known or suspected) Hypermagnesemia. Pre-treatment for IV verapamil administration

Front 92

DEXTROSE 50% Indications/field use

Back 92

Indications and Field Use: Known hypoglycemia. Altered level of consciousness of unknown etiology. Seizures of unknown etiology. Hyperkalemia

Front 93

BUMETANIDE Indications/field use

Back 93

Indications and Field Use: Pulmonary edema, Congestive heart failure

Front 94

BRETYLIUM TOSYLATE Indications/field use

Back 94

Indications and Field Use: Refractory VF/Pulseless VT, VT with pulses, wide complex tachycardia of unknown origin after other pharmacologic therapy. Lidocaine allergy.

Front 95

ATROPINE SULFATE Indications/field use

Back 95

Indications and Field Use: Symptomatic bradycardia (sinus, junctional, and AV blocks causing significant hypotension, ventricular ectopy, chest pain, altered level of consciousness, etc.), monitored patient only. Asystole (after epinephrine), monitored patient only. PEA with actual or relative bradycardia (after epinephrine), monitored patient only. Acetylcholinesterase inhibitor poisoning (organophosphate, cholinergic poisoning). Bronchospasm, refractory (second or third line), in conjunction with albuterol or isoetherine.

Front 96

ACETYLSALICYLIC ACID, ASA Indications/field use

Back 96

Indications and Field Use: Chest pain or other signs/symptoms, ECG changes suggestive of acute myocardial infarction, unstable angina. Pain, discomfort, fever in adult patient only

Front 97

AMIODARONE Indications/field use

Back 97

Indications for use: Treatment of: shock-refractory VF/pulseless VT, polymorphic VT, and wide complex tachycardia of uncertain origin. Control hemodynamically stable ventricular tachycardia when cardioversion unsuccessful. Adjunct to cardioversion of SVT and PSVT. Rate control in atrial fibrillation or flutter.

Front 98

ALBUTEROL SULFATE Indications/field use

Back 98

Indications and Field Use: Treatment of bronchospasm

Front 99

ADENOSINE Indications/field use

Back 99

Indications and Field Use: Conversion of supraventricular tachycardias with no known atrial fibrillation or atrial flutter. Wide complex tachycardia of uncertain origin unresponsive to lidocaine.

Front 100

CHARCOAL, ACTIVATED (without sorbitol) Indications/field use

Back 100

Indications and Field Use: Sole prehospital therapy of oral ingestion of toxic substances. Pre-lavage of oral ingestions of toxic substances.

Front 101

VERAPAMIL HCl Indications/field use

Back 101

Indications and Field Use: Supraventricular tachycardia Atrial fibrillation and atrial flutter with rapid ventricular response

Front 102

THIAMINE HCl (vitamin B1) Indications/field use

Back 102

Indications and Field Use: Alcoholism, delirium tremens. Coma of unknown origin, especially if alcohol or malnourishment may be involved. Suspect Wernicke or Korsakoff Syndrome. Other thiamine deficiency syndromes. Severe congestive heart failure

Front 103

SODIUM BICARBONATE 8.4% Indications/field use

Back 103

Indications and Field Use: Pre-existing metabolic acidosis. Overdose of aspirin, cyclic antidepressants (alkalinization of blood). Cardiac arrest after other interventions and ventilation is adequate

Front 104

PHENYLEPHRINE NASAL SPRAY 0.5% Indications/field use

Back 104

Indications and Field Use: Facilitation of nasotracheal intubation

Front 105

OXYTOCIN Indications/field use

Back 105

Indications and Field Use: Postpartum hemorrhage due to uterine atony

Front 106

NITROUS OXIDE 50% Indications/field use

Back 106

Indications for Field Use: Moderate to severe pain from musculoskeletal trauma, burns, AMI

Front 107

NITROGLYCERIN Indications/field use

Back 107

Indications and Field Use: Angina, Myocardial infarction, Congestive heart failure with pulmonary edema

Front 108

NALOXONE HCl Indications/field use

Back 108

Indications and Field Use: Antidote for: Opioid overdoses; May differentiate opioid-induced coma from other causes

Front 109

MORPHINE SULFATE Indications/field use

Back 109

Indications and Field Use: Analgesia, especially in patients with burns, myocardial infarction, or renal colic. Pulmonary edema (cardiogenic).

Front 110

DIPHENHYDRAMINE HCl Indications/field use

Back 110

Indications and Field Use: Anaphylaxis (2nd line). Phenothiazine reactions (extrapyramidal symptoms). Antiemetic

Front 111

MIDAZOLAM HYDROCHLORIDE Indications/field use

Back 111

Indications and Field Use: Anti-convulsant Sedation Management of acute agitation/treat cause first Induction for intubation

Front 112

METHYLPREDNISOLONE SODIUM SUCCINATE Indications/field use

Back 112

Indications and Field Use: Reactive airway disease: Acute exacerbation of emphysema, chronic bronchitis, asthma. Anaphylaxis. Burns potentially involving the airway. Acute spinal cord trauma (large loading and maintenance doses)

Front 113

MAGNESIUM SULFATE Indications/field use

Back 113

Indications and Field Use: Torsades de pointes, drug of choice; VF/Pulseless VT refractory to lidocaine and/or bretylium; Hypomagnesemia > Pre-term labor (PTL) > Pregnancy-induced hypertension (PIH, toxemia of pregnancy, pre-eclampsia and/or eclampsia).

Front 114

LIDOCAINE HCl Indications/field use

Back 114

Indications and Field Use: Suppression of ventricular arrhythmias (ventricular tachycardia, ventricular fibrillation, PVC's). Prophylaxis against recurrence after conversion from ventricular tachycardia or ventricular fibrillation. Frequent PVC's (>than 6 per minute; 2 or more in a row; multiform PVC's; or R-on-T phenomenon). Pre-intubation for head trauma or suspected Intra cranial hemorrhage (hypertension and focal neurologic S/S).

Front 115

GLUCAGON Indications/field use

Back 115

Indications and Field Use: Symptomatic hypoglycemia when IV access is delayed.

Front 116

FUROSEMIDE Indications/field use

Back 116

Indications and Field Use: Pulmonary edema; congestive heart failure

Front 117

EPINEPHRINE HCl Indications/field use

Back 117

Indications and Field Use: Cardiac arrest - VF/Pulseless VT; asystole; PEA (First line pharmacologic agent for any pulseless dysrhythmia in cardiopulmonary arrest). Severe bronchospasm, i.e., bronchiolitis, asthma. Anaphylaxis. Bradycardia, refractory with profound hypotension, monitored patient only. Hypotension unresponsive to other therapy, monitored patient only.

Front 118

DOPAMINE Indications/field use

Back 118

Indications and Field Use: Symptomatic bradycardias. Hemodynamically significant hypotension in the absence of hypovolemia (Cardiogenic or septic shock only after fluid administration; assess breath sounds first).

Front 119

DIAZEPAM Indications/field use

Back 119

Indications and Field Use: Grand mal seizures, especially status epilepticus. Transient analgesia/amnesia for medical procedures (e.g., fracture reduction, cardioversion, Transient analgesia/amnesia for medical procedures (e.g., fracture reduction, cardioversion, pacing). Delirium tremens. Treat the cause first.

Front 120

DEXAMETHASONE SODIUM PHOSPHATE Indications/field use

Back 120

Indications and Field Use: Reactive airway disease: Acute exacerbation of bronchial asthma. Anaphylaxis. Cerebral edema (non-traumatic). Acute spinal cord trauma

Front 121

CALCIUM CHLORIDE Contraindications

Back 121

Contraindications: Hypercalcemia Concurrent digoxin therapy (relative)

Front 122

DEXTROSE 50% Contraindications

Back 122

Contraindications: Known thiamine deficiency (relative, if suspected give thiamine close to same time). Delirium tremens; use with caution in patients with acute alcoholism, may be ineffective without thiamine. Head injury (unless documented hypoglycemia). Intra cranial hemorrhage (relative). Severe pain (paradoxical excitement may occur).

Front 123

BUMETANIDE Contraindications

Back 123

Contraindications: hypersensitivity, anuria, electrolyte deficiencies, hepatic coma. Cautious use: hepatic cirrhosis, ascites, history of gout, hypersensitivity to furosemide

Front 124

BRETYLIUM TOSYLATE Contraindications

Back 124

Contraindications: None, when used to treat life-threatening arrhythmias.

Front 125

ATROPINE SULFATE Contraindications

Back 125

Contraindications: Glaucoma, acute narrow angle (painful) (relative contraindication for patient with symptomatic bradycardia)

Front 126

ACETYLSALICYLIC ACID, ASA Contraindications

Back 126

Contraindications: Bleeding ulcer, hemorrhagic states, hemophilia, Known hypersensitivity to salicylates or other non-steroidal antiinflammatories that has lead to hypotension and/or Bronchospasm, Children and adolescents

Front 127

AMIODARONE Contraindications

Back 127

Contraindications: Bradycardia Second or third degree heart block cardiogenic shock Hypotension pulmonary congestion

Front 128

ALBUTEROL SULFATE Contraindications

Back 128

Contraindications: Synergistic with other sympathomimetics Use caution in patients with diabetes, hyperthyroidism, and cerebrovascular disease

Front 129

ADENOSINE Contraindications

Back 129

Contraindications: Sick sinus syndrome, 2nd or 3rd degree AV blocks; except in patients with a functioning ventricular pacemaker. Use cautiously in patients with known asthma (has precipitated acute bronchospasm). Patients on theophylline and related methylxanthines. Patients on dipyridamole (Persantine) or arbamazepine (Tegretol). Cardiac transplant patients are more sensitive to adenosine and require only a small dose (relative). Known atrial fibrillation or atrial flutter Pregnancy (no controlled studies)

Front 130

CHARCOAL, ACTIVATED (without sorbitol) Contraindications

Back 130

Contraindications: Ingestion of caustics, Ingestion of hydrocarbons (relative), Oral administration to comatose patient, Simultaneous administration of other oral drugs

Front 131

VERAPAMIL HCl Contraindications

Back 131

Contraindications: AV block, Sick sinus syndrome, any wide QRS complex tachycardia, Shock, severe CHF

Front 132

THIAMINE HCl (vitamin B1) Contraindications

Back 132

Contraindications: Do not give intra-arterial

Front 133

SODIUM BICARBONATE 8.4% Contraindications

Back 133

Contraindications: Alkalosis

Front 134

PHENYLEPHRINE NASAL SPRAY 0.5% Contraindications

Back 134

Contraindications: Known allergy to medication

Front 135

OXYTOCIN Contraindications

Back 135

Contraindications: Hypersensitivity

Front 136

NITROUS OXIDE 50% Contraindications

Back 136

Contraindications: Unconscious patient. Poor respiratory drive, compromise of respiratory status (i.e. pneumothorax) Abdominal pain unless intestinal obstruction has been completely ruled out. Severe head injury

Front 137

NITROGLYCERIN Contraindications

Back 137

Contraindications: Hypovolemia, Increased Intra cranial pressure

Front 138

NALOXONE HCl Contraindications

Back 138

Contraindications: Hypersensitivity

Front 139

MORPHINE SULFATE Contraindications

Back 139

Contraindications: Respiratory depression, Head injuries, Elevated Intra cranial pressure, Asthma, relative, Abdominal pain, relative

Front 140

DIPHENHYDRAMINE HCl Contraindications

Back 140

Contraindications: Known hypersensitivity to diphenhydramine or drugs of similar chemical structure. Newborn or premature infants; nursing mothers. Considerable caution in patients with glaucoma, acute narrow angle; stenosing or obstructive diseases of the GI tract; bronchial asthma; hyperthyroidism; cardiovascular disease or hypertension; age greater than 60 years (all relative benefit vs. risk).

Front 141

MIDAZOLAM HYDROCHLORIDE Contraindications

Back 141

Contraindications: Hypersensitivity to midazolam Relative contraindication in: Myasthenia gravis or other neuromuscular disorders; acute alcohol intoxication; severe, chronic obstructive pulmonary disease; and acute pulmonary insufficiency

Front 142

METHYLPREDNISOLONE SODIUM SUCCINATE Contraindications

Back 142

Contraindications: Preterm infants

Front 143

MAGNESIUM SULFATE Contraindications

Back 143

Contraindications: Hypermagnesemia, Use cautiously in patients with impaired renal function and pre-existing heart blocks (relative).

Front 144

LIDOCAINE HCl Contraindications

Back 144

Contraindications: Known hypersensitivity/allergy. Use extreme caution in patients with conduction disturbance (second or third degree block). > Do not treat ectopic beats if heart rate is < 60. They are probably compensating for the bradycardia; instead, treat the bradycardia!

Front 145

GLUCAGON Contraindications

Back 145

Contraindications: Known hypersensitivity, Pheochromocytoma, Insulinoma, Should not be routinely used to replace dextrose when IV access has been obtained

Front 146

FUROSEMIDE Contraindications

Back 146

Contraindications: Anuria (relative), Hypovolemia, Hypotension

Front 147

EPINEPHRINE HCl Contraindications

Back 147

Contraindications: None known for cardiac arrest. Hypothermia, relative contraindication

Front 148

DOPAMINE Contraindications

Back 148

Contraindications: Hypovolemic shock (relative). Pheochromocytoma. Pheochromocytoma

Front 149

DIAZEPAM Contraindications

Back 149

Contraindications: Hypersensitivity (allergy). Glaucoma, acute narrow angle (relative)

Front 150

DEXAMETHASONE SODIUM PHOSPHATE Contraindications

Back 150

Contraindications: Systemic fungal infections. Hypersensitivity to any component of dexamethasone, including sulfites. Preterm infants

Front 151

CALCIUM CHLORIDE Adverse Reactions

Back 151

Adverse Reactions: Brady-asystolic arrest. Severe tissue necrosis if solution extravasates Use cautiously in patients on digitalis; may cause serious arrhythmias

Front 152

DEXTROSE 50% Adverse Reactions

Back 152

Adverse Reactions: Cerebral edema in children when given IV undiluted. Worsening elevated ICP or cerebral edema from trauma or cerebral vascular accident. Extravasation leads to severe tissue necrosis. Sclerosing effect on peripheral veins.

Front 153

BUMETANIDE Adverse Reactions

Back 153

Adverse Reactions: Dizziness (most common), headache, muscle cramps, Hypotension,EKG changes associated with hypokalemia, hyponatremia, hypocalcemia, hypomagnesemia,Nausea, vomiting, diarrhea, dry mouth, ringing in ears, High doses or frequent administration, particularly in the elderly, can cause profound diuresis, hypovolemia, and resulting circulating collapse with development of thrombi and emboli. May precipitate hypokalemic-induced digoxin toxicity.

Front 154

BRETYLIUM TOSYLATE Adverse Reactions

Back 154

Adverse Reactions: CV: Hypertension may occur initially due to catecholamine release; hypotension 15-20 minutes after administration (can usually be controlled); increased sensitivity to catecholamines; angina or bradydysrhythmias. GI: Nausea/vomiting after rapid IV administration.

Front 155

ATROPINE SULFATE Adverse Reactions

Back 155

Adverse Reactions: Major: Tachydysrhythmias; ventricular irritability; exacerbation/initiation of angina; acute narrow angle glaucoma; agitation to delirium. Minor: Dry mouth/mucous membranes; urinary retention; decreased sweating/increased body temperature.

Front 156

ACETYLSALICYLIC ACID, ASA Adverse Reactions

Back 156

Adverse Reactions: Use with caution in the patient with history of asthma. Anaphylactic reactions in sensitive patients have occurred; skin eruptions; other side effects rare with single dose

Front 157

AMIODARONE Adverse Reactions

Back 157

Adverse Reactions: Cardiovascular: bradycardia, hypotension, asystole/cardiac arrest, AV block, Torsades de Pointes, congestive heart failure; GI & Hepatic: nausea, vomiting, abnormal liver function tests Skin: slate-blue pigmentation. Other: fever, headache, dizziness, flushing, abnormal salivation, photophobia.

Front 158

ALBUTEROL SULFATE Adverse Reactions

Back 158

Adverse Reactions: CV: Dysrhythmias, tachycardia (with excessive use), peripheral vasodilation; Resp: Bronchospasm (rare paradoxical with excessive use); CNS: Tremors, nervousness; GI: Nausea, vomiting; Endocrine: Hyperglycemia

Front 159

ADENOSINE Adverse Reactions

Back 159

Adverse Reactions: CV: Transient dysrhythmias (systole, bradycardia, PVC's) occur in 55% of patients (none reported as irreversible). Palpitations, chest pressure, chest pain, hypotension, transient hypertension; facial flushing, sweating. Resp: Dyspnea, hyperventilation, tightness in throat, bronchospasm. CNS: lightheadedness, headache, dizziness, paresthesias, apprehension, blurred vision, neck-back pain. GI: Nausea, metallic taste.

Front 160

CHARCOAL, ACTIVATED (without sorbitol) Adverse Reactions

Back 160

Adverse Reactions: May provoke vomiting, May worsen overdosed induced Ileus

Front 161

VERAPAMIL HCl Adverse Reactions

Back 161

Adverse Reactions: Extreme bradycardia, Asystole, AV block, Hypotension, Congestive heart failure

Front 162

THIAMINE HCl (vitamin B1) Adverse Reactions

Back 162

Adverse Reactions: Hypotension (rare)

Front 163

SODIUM BICARBONATE 8.4% Adverse Reactions

Back 163

Adverse Reactions: CV: Congestive heart failure, edema secondary to sodium overload. Metabolic: Hyperosmolarity, metabolic alkalosis, hypernatremia, in cardiac arrest may cause extracellular alkalosis and intracellular acidosis.

Front 164

PHENYLEPHRINE NASAL SPRAY 0.5% Adverse Reactions

Back 164

Adverse Reactions: (rare with single dose, rarely absorbed systemically from nasal instillation). CV: Hypertension, palpitations. CNS: Tremors.

Front 165

OXYTOCIN Adverse Reactions

Back 165

Adverse Reactions: CV: Shock, tachycardia, dysrhythmias. Resp: Anaphylaxis. GI: Nausea and vomiting. GU: If used prior to delivery, can cause uterine rupture, uterine spasm, lacerations, and fetal damage. Other: Clotting disorders, electrolyte disturbances

Front 166

NITROUS OXIDE 50% Adverse Reactions

Back 166

Adverse Reactions: Resp: Worsening of pre-existing pneumothorax; may cause hypercarbia in oxygen sensitive patients (CO2 retainers). GI: Nausea and vomiting, may lead to rupture of intestine if administered to patient with intestinal obstruction.

Front 167

NITROGLYCERIN Adverse Reactions

Back 167

Adverse Reactions: CV: Hypotension, reflex tachycardia, bradycardia, decreased coronary perfusion at high doses (secondary to hypotension), headache secondary to dilation of meningeal vessels.

Front 168

NALOXONE HCl Adverse Reactions

Back 168

Adverse Reactions: Withdrawal symptoms, especially in neonates (nausea, vomiting, diaphoresis, increased heart rate falling blood pressure, tremors). > Be prepared for combative patient after administration.

Front 169

MORPHINE SULFATE Adverse Reactions

Back 169

Adverse Reactions: CV: Brady or tachydysrhythmias, orthostatic hypotension. Resp: Respiratory depression or arrest. CNS: Excess sedation, seizures to coma and arrest, pupillary constriction. GI: Nausea and vomiting, GI spasm. Derm: Histamine release may cause local urticaria.

Front 170

DIPHENHYDRAMINE HCl Adverse Reactions

Back 170

Adverse Reactions: CV: Hypotension; palpitations; arrhythmias; hemolytic anemia. Resp: Anaphylaxis; thickening of bronchial secretions, tightness in chest; wheezing; nasal stuffiness. CNS: Sedation; visual disturbances; seizures. GU/GI: Urinary frequency or retention; vomiting. Children: In children, may cause paradoxical CNS excitation, seizures, palpitations, thickening of bronchial secretions.

Front 171

MIDAZOLAM HYDROCHLORIDE Adverse Reactions

Back 171

Adverse Reactions: CV: Hypotension (especially in patients premedicated with narcotic); cardiac arrest; irregular or fast heartbeat. Respiratory: Apnea; respiratory depression, respiratory arrest; hyperventilation; wheezing or difficulty in breathing; hiccups; coughing. CNS: Emergence delirium; muscle tremor; uncontrolled or jerky movements of body; unusual excitement, irritability, or restlessness; dizziness, light-headedness, or feeling faint; prolonged drowsiness; headache. GI: nausea and/or vomiting. Midazolam administered intravenously has been associated with respiratory depression and respiratory arrest, especially when used concomitantly with opioid analgesics for conscious sedation or when rapidly administered. Midazolam may cause phlebitis. May need to adjust midazolam dose down for patients on erythromycin.

Front 172

METHYLPREDNISOLONE SODIUM SUCCINATE Adverse Reactions

Back 172

Adverse Reactions: None from single dose

Front 173

MAGNESIUM SULFATE Adverse Reactions

Back 173

Adverse Reactions: Cardiovascular: hypotension (may be transient), flushing circulatory collapse, depressed cardiac function, heart block, asystole, smooth muscle relaxant (antihypertensive effects). Respiratory: respiratory depression and/or paralysis may occur in both mother and/or infant during or up to 24 hours after the administration of MgSO4. CNS: sweating, drowsiness, hypothermia, depressed reflexes progressing to flaccidity and paralysis which may occur in both mother and/or infant during the administration of or up to 24 hours after the administration of MgSO4. GI: nausea GU: mild diuretic. Metabolic: hypocalcemia, hypermagnesemia

Front 174

LIDOCAINE HCl Adverse Reactions

Back 174

Adverse Reactions: CV: May also cause SA nodal depression or conduction problems and hypotension in large doses, or if given too rapidly. Excessive doses in pediatric patient may produce myocardial and circulatory depression. CNS: In large doses drowsiness, disorientation, paresthesias, decreased hearing acuity, muscle twitching, agitation, focal or generalized seizures.

Front 175

GLUCAGON Adverse Reactions

Back 175

Adverse Reactions: Rare side effects, Nausea and vomiting,Generalized allergic reactions including urticaria, respiratory distress and hypotension (made from beef/pork pancreas) Palpitations, hypertension, tachycardia

Front 176

FUROSEMIDE Adverse Reactions

Back 176

Adverse Reactions: May exacerbate hypovolemia; Hyperglycemia (due to hemoconcentration); Hypokalemia; May decrease the response to pressors

Front 177

EPINEPHRINE HCl Adverse Reactions

Back 177

Adverse Reactions: CV: Hypertension, ventricular dysrhythmias; tachycardia; angina.CNS: Anxiety, agitation. GI: Nausea/vomiting.

Front 178

DOPAMINE Adverse Reactions

Back 178

Adverse Reactions: CV: Cardiac arrhythmias may occur due to increased myocardial oxygen demand (usually tachydysrhythmias), hypertension, and hypotension at low doses. GI: Nausea and vomiting. GU: Renal shutdown (at higher doses). Other: Extravasation may cause tissue necrosis

Front 179

DIAZEPAM Adverse Reactions

Back 179

Adverse Reactions: CV: Bradycardia, hypotension, cardiovascular collapse; venous thrombosis; phlebitis; vascular spasm; Resp: Respiratory arrest; may be prolonged in neonate; CNS: Somnolence, confusion, coma, diminished reflexes; s/s may be prolonged in neonate; Other: Burning proximal to IV injection site; local irritation; swelling; extravasation will cause tissue necrosis

Front 180

DEXAMETHASONE SODIUM PHOSPHATE Adverse Reactions

Back 180

Adverse Reactions: Sodium retention, fluid retention, potassium loss, hypokalemic alkalosis, hypertension, convulsions, hyperglycemia, myocardial rupture following recent myocardial infarction

Front 181

CALCIUM CHLORIDE Incompatibilities/Drug Interactions

Back 181

Incompatibilities/Drug Interactions: All drugs -- flush line before and after administration

Front 182

DEXTROSE 50% Incompatibilities/Drug Interactions

Back 182

Incompatibilities/Drug Interactions: Sodium bicarbonate, Diazepam will precipitate if given concurrently without flushing

Front 183

BUMETANIDE Incompatibilities/Drug Interactions

Back 183

Incompatibilities/Drug Interactions: NSAIDs reduce diuretic effect, May increase blood levels of lithium increasing risk of lithium poisoning,Potentiates effects of various antihypertensive drugs

Front 184

BRETYLIUM TOSYLATE Incompatibilities/Drug Interactions

Back 184

Incompatibilities/Drug Interactions: Pressor effects of dopamine and epinephrine are variable.

Front 185

ATROPINE SULFATE Incompatibilities/Drug Interactions

Back 185

Incompatibilities/Drug Interactions: Sodium bicarbonate (relative)

Front 186

ACETYLSALICYLIC ACID, ASA Incompatibilities/Drug Interactions

Back 186

Incompatibilities/Drug Interactions: Not applicable with single dose therapy

Front 187

AMIODARONE Incompatibilities/Drug Interactions

Back 187

Incompatibilities/Drug Interactions: Beta blockers, calcium channel blockers, and other antiarrhythmics are additive and can be proarrhythmic when given in combination with amiodarone due to similar mechanisms of action. Amiodarone precipitates at certain concentrations when mixed at a Y-site with sodium bicarbonate or furosemide.

Front 188

ALBUTEROL SULFATE Incompatibilities/Drug Interactions

Back 188

Incompatibilities/Drug Interactions: Tricyclic antidepressants (TCA's) and monoamine oxidase (MAO) inhibitors, other sympathomimetics (relative)

Front 189

ADENOSINE Incompatibilities/Drug Interactions

Back 189

Incompatibilities/Drug Interactions: Adenosine is not blocked by Atropine. Theophylline and related methylxanthines (caffeine & theobromine-xanthine) in therapeutic concentrations decrease effectiveness. Dipyridamole (Persantine) & carbamazepine (Tegretol, Atretol) block uptake and potentiate effects.

Front 190

CHARCOAL, ACTIVATED (without sorbitol) Incompatibilities/Drug Interactions

Back 190

Incompatibilities/Drug Interactions: Ineffective for iron, lithium, heavy metals, and other ions. May reduce the effectiveness of other treatments (Mucomyst) in pure acetaminophen OD's. Since charcoal bonds with whatever it is mixed with, flavoring with drinks reduces effectiveness.

Front 191

VERAPAMIL HCl Incompatibilities/Drug Interactions

Back 191

Incompatibilities/Drug Interactions: IV Beta-blockers

Front 192

THIAMINE HCl (vitamin B1) Incompatibilities/Drug Interactions

Back 192

Incompatibilities/Drug Interactions: None

Front 193

SODIUM BICARBONATE 8.4% Incompatibilities/Drug Interactions

Back 193

Incompatibilities/Drug Interactions: Incompatible with other drug infusions

Front 194

PHENYLEPHRINE NASAL SPRAY 0.5% Incompatibilities/Drug Interactions

Back 194

Incompatibilities/Drug Interactions: None

Front 195

OXYTOCIN Incompatibilities/Drug Interactions

Back 195

Incompatibilities/Drug Interactions: None in prehospital arena

Front 196

NITROUS OXIDE 50% Incompatibilities/Drug Interactions

Back 196

Incompatibilities/Drug Interactions: Analgesic effect of nitrous oxide is potentiated by parenteral analgesics and sedatives (i.e. morphine, diazepam).

Front 197

NITROGLYCERIN Incompatibilities/Drug Interactions

Back 197

Incompatibilities/Drug Interactions: Other vasodilators, Viagra

Front 198

NALOXONE HCl Incompatibilities/Drug Interactions

Back 198

Incompatibilities/Drug Interactions: Should not be mixed with other drugs

Front 199

MORPHINE SULFATE Incompatibilities/Drug Interactions

Back 199

Incompatibilities/Drug Interactions: CNS side effects (including respiratory depression) can be reversed by naloxone.

Front 200

DIPHENHYDRAMINE HCl Incompatibilities/Drug Interactions

Back 200

Incompatibilities/Drug Interactions: Additive effects with alcohol and other CNS depressants (hypnotics, sedatives, tranquilizers, etc.). MAO inhibitors prolong and intensify anticholinergic (drying) effects.

Front 201

MIDAZOLAM HYDROCHLORIDE Incompatibilities/Drug Interactions

Back 201

Incompatibilities/Drug Interactions: Midazolam may potentiate the action of other CNS depressants, including opiate agonists or other analgesics, barbiturates or other sedatives, anesthetics, or alcohol. Erythromycin may double the half-life of midazolam.

Front 202

METHYLPREDNISOLONE SODIUM SUCCINATE Incompatibilities/Drug Interactions

Back 202

Incompatibilities/Drug Interactions: None

Front 203

MAGNESIUM SULFATE Incompatibilities/Drug Interactions

Back 203

Incompatibilities/Drug Interactions: Concurrent digilization increases danger of dysrhythmias

Front 204

LIDOCAINE HCl Incompatibilities/Drug Interactions

Back 204

Incompatibilities/Drug Interactions: None known

Front 205

GLUCAGON Incompatibilities/Drug Interactions

Back 205

Incompatibilities/Drug Interactions: Unknown

Front 206

FUROSEMIDE Incompatibilities/Drug Interactions

Back 206

Incompatibilities/Drug Interactions: Increased effects with other antihypertensives

Front 207

EPINEPHRINE HCl Incompatibilities/Drug Interactions

Back 207

Incompatibilities/Drug Interactions: Potentiates other sympathomimetics. Reacts with alkaline solutions, such as sodium bicarbonate, should not be mixed with alkaline agents.

Front 208

DOPAMINE Incompatibilities/Drug Interactions

Back 208

Incompatibilities/Drug Interactions: Incompatible in any alkaline solution. On-board MAO inhibitors will cause hypertensive crisis

Front 209

DIAZEPAM Incompatibilities/Drug Interactions

Back 209

Incompatibilities/Drug Interactions: Do not mix or dilute diazepam with other solutions or drugs in syringe, tubing or IV container.

Front 210

DEXAMETHASONE SODIUM PHOSPHATE Incompatibilities/Drug Interactions

Back 210

Incompatibilities/Drug Interactions: Dexamethasone is not compatible with Benadryl or Versed in IV tubing.

Front 211

CALCIUM CHLORIDE Adult Dosage

Back 211

Adult Dosage: Hypocalcemia, calcium channel blocker OD, hyperkalemia and hypermagnesemia: 5-10 ml (0.5-1 Gm) of 10% calcium chloride. May repeat in 10 minutes. Pre-treatment for IV verapamil administration: 3 ml of 10% calcium chloride. May be repeated once.

Front 212

DEXTROSE 50% Adult Dosage

Back 212

Adult Dosage: Hypoglycemia, altered level of consciousness or seizures of unknown etiology: 25-100 ml of D50 (12.5-50 Gm, 2 to 2 amps) IV. Hyperkalemia: 50 Gm of Dextrose IV total may be given over 1 hour. This is a part of a combination drug therapy. See: profiles for calcium chloride and sodium bicarbonate. Insulin may be given upon arrival to ED.

Front 213

BUMETANIDE Adult Dosage

Back 213

Adult Dosage: 0.5 to 1.0 mg IV slowly over 1 to 2 minutes, or IM

Front 214

BRETYLIUM TOSYLATE Adult Dosage

Back 214

Adult Dosage: VF/Pulseless VT, refractory to defibrillation/lidocaine: 5 mg/kg rapid IVP initial bolus followed by a flush with 20 ml NS; if needed may repeat at 10 mg/kg rapid IVP; thereafter repeat at 5-30 minute intervals until total dose of 35 mg/kg/day. If VF/ Pulseless VT converts with bretylium, a constant infusion of 2 mg/min should be initiated. Refractory VT in conscious patient with pulses: Initial dose 5 mg/kg diluted in 50-100 ml of NS given over 8-10 minutes. If VT remains refractory, a second bolus may be given at 5-10 mg/kg or a continuous infusion may be established at 2 mg/min. If bretylium converts VT, complete the loading dose and begin a continuous infusion at 1-2 mg/min.

Front 215

ATROPINE SULFATE Adult Dosage

Back 215

Adult Dosage: Symptomatic Bradycardia: 0.5-1.0 mg rapid IV push or via ET every 3-5 minutes to a total dose of 3 mg if symptoms profound (0.03-0.04 mg/kg). Asystole or PEA with bradycardia: 1.0 mg rapid IV push or via ET every 3-5 minutes to a total dose of 3 mg. Cholinergic or organophosphate poisoning: 2.0-5.0 mg IV, may repeat in 5 minutes. Max dose is unlimited. Bronchospasm: 1.0 mg SVN prepared by using 2.5 ml of 0.4 mg/ml solution out of 8 mg/20 ml vial (may add 0.5 ml NS to make 3 ml inhalation treatment, 2.5 ml is adequate) administered with a mouth piece, O2 mask, or in-line with a ventilatory device; may repeat in 30 minutes or according to medical control preference.

Front 216

ACETYLSALICYLIC ACID, ASA Adult Dosage

Back 216

Adult Dosage: Cardiac: 160- 325 mg (2-4 pediatric chewable tabs), chew or swallow, Pain/discomfort/fever: 325 mg po (4 pediatric chewable tablets), chew or swallow

Front 217

AMIODARONE Adult Dosage

Back 217

Adult Dosage: For maintenance infusion post resuscitation: After successful defibrillation, follow with up to 1mg/min IV infusion for 6 hours, then up to 0.50 mg/min IV infusion for 18 hours. For maintenance infusion: Rates range from 0.50mg/min to 1mg/min. Maximum daily dose is 2.0 g

Front 218

ALBUTEROL SULFATE Adult Dosage

Back 218

Adult Dosage: Give 2.5 mg of premixed solution for inhalation (0.083%) via SVN with a mouth piece, or inline with a ventilatory device. Repeated according to medical control preference

Front 219

ADENOSINE Adult Dosage

Back 219

Adult Dosage: Initial: 6 mg rapid IV bolus over 1-3 seconds Special administration procedure: Follow immediately with 20 ml normal saline flush. IV site recommended is antecubital fossa (close to central circulation); use injection port nearest hub of IV catheter; arm elevated during procedure; constant ECG monitoring. Repeat: If no response in 1-2 minutes (of each dose, respectively) may repeat 12 mg, twice, utilizing the same procedure for repeat dose.

Front 220

CHARCOAL, ACTIVATED (without sorbitol) Adult Dosage

Back 220

Adult Dosage: 30-60 Gm (1-2 Gm/kg); if not in pre-mixed slurry, mix one part charcoal with four parts water.

Front 221

VERAPAMIL HCl Adult Dosage

Back 221

Adult Dosage: 2.5 - 5.0 mg IV PUSH over 2-3 minutes. May rebolus in 15-30 minutes with 5-10 mg IV PUSH until a maximum dose of 20 mg

Front 222

THIAMINE HCl (vitamin B1) Adult Dosage

Back 222

Adult Dosage: 100 mg

Front 223

SODIUM BICARBONATE 8.4% Adult Dosage

Back 223

Adult Dosage: Pre-existing Metabolic Acidosis or Alkalinization of Blood: 50-100 mEq IV per medical control authority. Infusion: 50 mEq of sodium bicarbonate/250 ml of NS or as determined by medical control. Cardiac arrest: First dose usually 1 mEq/kg (or as determined by blood gas analysis), with subsequent doses of 0.5 mEq/kg every 10 minutes in cardiac arrest after other standard treatment (defibrillation, CPR, intubation, ventilation and more than one trial of epinephrine) has been used.

Front 224

PHENYLEPHRINE NASAL SPRAY 0.5% Adult Dosage

Back 224

Adult Dosage: 2-4 sprays in each nostril before attempting tube insertion

Front 225

OXYTOCIN Adult Dosage

Back 225

Adult Dosage: Postpartum hemorrhage: 10-20 USP units added to 1000 cc NS or LR and run at a rate necessary to control uterine atony or 10 USP units may be given IM after delivery of placenta.

Front 226

NITROUS OXIDE 50% Adult Dosage

Back 226

Adult Dosage: Self-administer and self-regulated by the patient, who must hold the mask to face to create an airtight seal until the pain is significantly relieved or the patient drops the mask.

Front 227

NITROGLYCERIN Adult Dosage

Back 227

Adult Dosage: SL for Chest pain: 1/150 gr (0.4 mg) tablet or one full spray, may repeat x 3. SL for Pulmonary edema: 1-2 of the 1/150 gr (0.4 mg) tablets may be given SL every 5-10 minutes as long as the systolic BP is greater 90-100 systolic. ** IV infusion during interfacility transport must be given via infusion pump: Start at low range of 5 µg/min and increase in increments of 5 µg, monitoring pain and blood pressure until desired hemodynamic or clinical response is achieved (fall in SVR, relief of chest pain); most patients respond to 50-200 µg/min

Front 228

NALOXONE HCl Adult Dosage

Back 228

Adult Dosage: IV, IM, inject SL, SC, ET: 2.0 mg initial bolus IV or ET, may repeat every 2 minutes as necessary; titrate to effect. Intra-nasal: 1.0 mg each nostril using a Mucosal Atomizer Device for a total of 2 mg. May repeat every 2 minutes as necessary. Titrate to effect. ** Continuous IV Infusion: 2/3 of the initial bolus/hr (bolus that it took to reverse) administered as a continuous infusion; i.e., if 2 mg Narcan resulted in opioid reversal initially, then it can be maintained by continuous infusion of 1.4 mg/hr. Put 1.4 mg Narcan in 250 ml NS and run at 250 ml/hr. A repeat IV bolus of 2 the initial bolus administered 15 minutes after the initial bolus is recommended.

Front 229

MORPHINE SULFATE Adult Dosage

Back 229

Adult Dosage: IV Dose: Administer 1-3 mg increments slow IV PUSH (over 1-5 minutes) until desired effect.

Front 230

DIPHENHYDRAMINE HCl Adult Dosage

Back 230

Adult Dosage: Anaphylaxis: 25-50 mg slow IV push or deep IM. Extrapyramidal symptoms and antiemetic: 10-50 mg IV or deep IM, dose should be individualized according to the needs and patient response.

Front 231

MIDAZOLAM HYDROCHLORIDE Adult Dosage

Back 231

Adult Dosage: Patients 14 to 60 years of age: 2 to 5 mg IM /1 to 5 mg IV, titrate to effect, administer slowly in small increments of no more than 2.5 mg over at least 2 minutes. Patients over 60 years of age: 1 to 3 mg IM /1 to 3.5 mg IV, titrate to effect, administer slowly in small increments of no more than 1.5 mg over at least 2 minutes. Total dose: Should not exceed 20 mg. For emergency intubation: 0.1 mg/kg up to 0.3 mg/kg with dosage limit of 20 mg. Seizures: 0.2 mg/kg IM for status seizures if no IV access

Front 232

METHYLPREDNISOLONE SODIUM SUCCINATE Adult Dosage

Back 232

Adult Dosage: Reactive Airway Disease, Anaphylaxis, Burns Potentially Involving the Airway: Usual dose 125 mg slow IV bolus (much larger doses can be used). Acute Spinal Cord Trauma: Should be within 6 hours of insult and patient meeting criteria, initial bolus dose of 30 mg/kg IV administered over 15 minutes; bolus followed by a 45 minute rest period, then a 23-hour continuous infusion of 5.4 mg/kg/hr. See: Special Notes.

Front 233

MAGNESIUM SULFATE Adult Dosage

Back 233

Adult Dosage: VF/Pulseless VT: 1-2 Gms IV in 1-2 minutes or dilute 1-2 Gms in 100 ml NS administered over 1-2 minutes. Torsades de pointes: 1-2 Gms over 1-2 minutes or dilute 1-2 Gms in 100 ml NS administered over 1-2 minutes followed by the same amount infused over 1 hour. Hypomagnesemia: Dilute 1-2 Gms in 50-100 ml NS administered IV push over 5-60 minutes. Pre-term labor (PTL): Initial bolus (Field and Interfacility): 4-6 Gm over 15-20 minutes (Suggested method is the addition of 4 Gms to 100 ml D5W, LR or NS. Resultant concentration is 40 mg/ml) Maintenance Infusion (Interfacility only): 1-4 Gms/hour infusion rate. Suggested method for treatment of premature labor is to follow initial bolus with infusion of 2 Gms/hr which may be continued until uterine contractions are reduced to < 1 every 10 minutes. Then, infusion is decreased to 1 Gm/hr and continued for 24-72 hrs. One method for mixing infusion is the addition of 40 Gms to 1000 ml LR. Resultant concentration equals 40 mg/ml. If this concentration is run at 50 ml/hr, MgSO4 delivered equals 2 Gms/hr). Pregnancy induced hypertension, preeclampsia/eclampsia, (PIH): Initial bolus (Field and Interfacility): 3-6 Gm over 10-15 minutes (Suggested method is the addition of 4 Gms to 100 ml D5W, LR or NS. Resultant concentration is 40 mg/ml). Maintenance Infusion (Interfacility only): Follow bolus with 1-3 Gms/hour infusion rate. (Same mixture as for PTL). Rebolus: In an eclamptic emergency may rebolus with MgSO4, 2-4 Gms depending on patient size (mixed as in initial bolus) over 10-15 minutes if DTRs 2+ or higher, respirations >12/minute and urine output >30 ml/hr.

Front 234

LIDOCAINE HCl Adult Dosage

Back 234

Adult Dosage: Pulseless VF/VT: Initial bolus of 1.0-1.5 mg/kg IV PUSH every 3-5 minutes to a total of 3 mg/kg. An initial bolus of 1.5 mg/kg should be given for cardiac arrest situations. Following the return of a spontaneous rhythm, initiate a drip at 2-4 mg/min. Antidysrhythmic or rhythms with a pulse: Initial boluses can be given as 1.0-1.5 mg/kg IV PUSH and additional boluses can be given as 0.5-0.75 mg/kg every 5-10 minutes to a total dose of 3 mg/kg. Following the return of a spontaneous rhythm, initiate a drip at 2-4 mg/min; see below. Maintenance Infusion: Started after return of spontaneous rhythm for either indication above. Add 1 gm - 2 g to a 250 ml NS or 5 % dextrose solution or use premixed solution (2 gm in 500 ml) and initiate a drip at 2-4 mg/min according to concentration. Patients > 70 years or with hepatic, renal disease or poor perfusion state, reduce maintenance infusion by half. Pre-intubation for head trauma or suspected Intra cranial hemorrhage (hypertension and focal neurologic S/S). Consider administration of 1 mg/kg IV bolus 1-2 minutes prior to intubation.

Front 235

GLUCAGON Adult Dosage

Back 235

Adult Dosage: (children and adults greater than 20 kg or 44 lbs) Hypoglycemia: 1 mg IM, may repeat in 7-10 minutes

Front 236

FUROSEMIDE Adult Dosage

Back 236

Adult Dosage: On oral furosemide therapy: Consider initial dose of 2 times daily oral dose, if no effect in 20 minutes may double initial dose. Not on oral furosemide therapy: 0.5-1 mg/kg to a maximum of 2 mg/kg (usually 20-40 mg) IV slowly.

Front 237

EPINEPHRINE HCl Adult Dosage

Back 237

Adult Dosage: IV for Cardiac Arrest - VF/Pulseless VT, asystole, PEA: Use 1:10,000 solution and give 1.0 mg every 3-5 minutes flushing each with 20 ml of IV fluid, or, ET for Cardiac Arrest - VF/Pulseless VT, asystole, PEA: Give 2.0 - 2.5 mg via the ET tube. May use 1:10,000 or dilute 1:1000 to equal 10 ml via ET tube for adult. (i.e., 2 mg of 1:1000 epinephrine diluted with 8 ml NS in a 10 ml syringe) Continuous Infusion during Cardiac Arrest or profound Bradycardia: 1 mg every 3-5 minutes. Add 30 mg epinephrine to 250 ml NS to run at 100 ml/hr (same as 1 mg every 3 minutes) or titrated to desired hemodynamic end point. Central line preferred, patency of line must be assured. Continuous Infusion for Hypotension or Symptomatic Bradycardia: 1 mg added to 500 ml of NS administered at 1 mg/min titrated to desired hemodynamic response (range 2-10 Mg/min); not first-line therapy. Anaphylaxis and asthma: Give 0.1- 0.3 mg of 1:1000 solution SC, IM or inject SL; or in extreme cases only, may be asked to use 1:10,000 solution and give 0.1 mg, q 30-60 sec. IV, titrated to effect in patients without cardiovascular collapse, or give 0.3 - 0.5 mg ET or IV if cardiovascular collapse is present.

Front 238

DOPAMINE Adult Dosage

Back 238

Adult Dosage: (dosage range 2-20 Mcg/kg/min). Preparation: (If premixed not carried) Add 400 mg/ 250 ml NS or Dextrose = 1600 Mcg/ml. Bradycardia: Start at 5 Mcg/kg/min. Shock: cardiogenic or septic (non-hypovolemic): BP < 70 systolic: Start drip at 5 Mcg/kg/min. BP > 70 systolic: Start drip at 2.5 Mcg/kg/min

Front 239

DIAZEPAM Adult Dosage

Back 239

Adult Dosage: 2 mg increments slow IV push. Administer no faster than 2 mg/minute.

Front 240

DEXAMETHASONE SODIUM PHOSPHATE Adult Dosage

Back 240

Adult Dosage: Reactive Airway Disease, Anaphylaxis 8 - 24 mg. Cerebral edema: 1-5mg/kg

Front 241

CALCIUM CHLORIDE Pediatric Dosage

Back 241

Pediatric Dosage: Hypocalcemia, calcium channel blocker OD hyperkalemia and hypermagnesemia: 0.2 - 0.25 ml/kg of a 10% solution infused slowly. Should not be repeated without documented calcium deficiency.

Front 242

DEXTROSE 50% Pediatric Dosage

Back 242

Pediatric Dosage: (14 yrs and below includes infant) Administer 0.5 - 1 Gm/kg of a dextrose 10% solution; recommended to give slowly over a 20 minute period. Dilute D50 (dextrose 50% containing 25 Gm of dextrose) to a 1:4 solution. To prepare, obtain a 250 ml container of normal saline for IV use; waste 50 ml and add 50 ml of dextrose 50%. The resulting solution is dextrose 10% in normal saline or 10 grams/100ml.

Front 243

BUMETANIDE Pediatric Dosage

Back 243

Pediatric dosage: none

Front 244

BRETYLIUM TOSYLATE Pediatric Dosage

Back 244

Pediatric Dosage: Same as adult (rarely given)

Front 245

ATROPINE SULFATE Pediatric Dosage

Back 245

Pediatric Dosage: Symptomatic Bradycardia only: 0.02 mg/kg (minimum of 0.1 mg) IV push (after epinephrine). May repeat only one time. Maximum single doses: Child 0.5 mg; Adolescent 1 mg. Bronchospasm: 0.5 mg SVN prepared by using 1.25 ml of 0.4 mg/ml solution out of 8 mg/20 ml vial, may add 1.25-1.75 ml NS to make 2.5-3 ml inhalation treatment (2.5 ml is adequate). Administer with a mouth piece, O2 mask or in-line with a ventilatory device. May repeat in 30 minutes or according to medical control preference.

Front 246

ACETYLSALICYLIC ACID, ASA Pediatric Dosage

Back 246

Pediatric Dosage: Not recommended for children

Front 247

AMIODARONE Pediatric Dosage

Back 247

Pediatric Dosage: none

Front 248

ALBUTEROL SULFATE Pediatric Dosage

Back 248

Pediatric Dosage: For children < 40 lbs., administer half of 0.083% premixed solution; add 1-1.5 ml NS to make 2.5-3 cc inhalation treatment administered via SVN with a mouth piece, O2 mask or in-line with a ventilatory device. May be repeated according to medical control preference

Front 249

ADENOSINE Pediatric Dosage

Back 249

Pediatric Dosage: (Drug of choice for treating SVT in symptomatic infants and children) Initial: 0.1 mg/kg as a rapid IV bolus. Special administration procedure: Follow immediately with 2-3 ml normal saline flush. Use injection port nearest the hub of IV catheter for procedure; constant ECG monitoring. Repeat: If no response, dose may be doubled 1 time (0.2 mg/kg) using same administration procedure. Maximum singe dose: Should not exceed 12 mg. Infants with SVT associated with shock: Adenosine may precede cardioversion if vascular access is available, but cardioversion should not be delayed while IV access is achieved.

Front 250

CHARCOAL, ACTIVATED (without sorbitol) Pediatric Dosage

Back 250

Pediatric Dosage: 0.5 -1.0 Gm/kg; if not in pre-mixed slurry, mix one part charcoal with four parts water.

Front 251

VERAPAMIL HCl Pediatric Dosage

Back 251

Pediatric Dosage: IV form not used in children in the field

Front 252

THIAMINE HCl (vitamin B1) Pediatric Dosage

Back 252

Pediatric Dosage: Rarely used

Front 253

SODIUM BICARBONATE 8.4% Pediatric Dosage

Back 253

Pediatric Dosage: 1 mEq/kg IV or IO slowly, if ventilation is adequate according to medical control authority. Can contribute to acidosis and cause fluid overload. Neonatal Dosage: 1 mEq/kg IV or IO of 4.2% slowly. Waste 25 ml of 8.4% solution and add 25 ml of NS from IV bag, each ml will contain 0.5 mEq of sodium bicarbonate

Front 254

PHENYLEPHRINE NASAL SPRAY 0.5% Pediatric Dosage

Back 254

Pediatric Dosage: None

Front 255

OXYTOCIN Pediatric Dosage

Back 255

Pediatric dose: none

Front 256

NITROUS OXIDE 50% Pediatric Dosage

Back 256

Pediatric Dosage: Must be old enough to follow the instructions for use and large enough that the mask creates an airtight seal.

Front 257

NITROGLYCERIN Pediatric Dosage

Back 257

Pediatric dose: none

Front 258

NALOXONE HCl Pediatric Dosage

Back 258

Pediatric Dosage: < 5 years or < 20 kg: 0.1 mg/kg IV, ET, inject SL, SC, IO (includes neonate). > 5 years or > 20 kg: 2 mg IV, ET, inject SL, SC or IO

Front 259

MORPHINE SULFATE Pediatric Dosage

Back 259

Pediatric Dosage: 100-200 mcg/kg slow IV push

Front 260

DIPHENHYDRAMINE HCl Pediatric Dosage

Back 260

Pediatric Dosage: 1.0 -1.25 mg/kg slow IV push May also be given deep IM

Front 261

MIDAZOLAM HYDROCHLORIDE Pediatric Dosage

Back 261

Pediatric Dosage: 0.05 to 0.1 mg/kg slow IV push / 0.2 mg/kg IM for status seizures if no IV access

Front 262

METHYLPREDNISOLONE SODIUM SUCCINATE Pediatric Dosage

Back 262

Pediatric Dosage: Reactive Airway Disease, Anaphylaxis, Burns Potentially Involving the Airway: 2-4 mg/kg slow IV bolus

Front 263

MAGNESIUM SULFATE Pediatric Dosage

Back 263

Pediatric dosage: none

Front 264

LIDOCAINE HCl Pediatric Dosage

Back 264

Pediatric Dosage: Initial Bolus doses: 1 mg/kg, may repeat 1 time in 3-5 minutes for VF/Pulseless VT or in 15 minutes if used for refractory dysrhythmias with a pulse (VT with pulse, significant ventricular ectopy). Infusion with return of spontaneous rhythm, optional: 20-50 Mg/kg/min; prepared by adding 120 mg (3cc) of 1 Gm/25 ml (40 mg/ml) solution to 97 ml of NS, yielding 1200 Mg/ml. 1 ml/kg/hr delivers 20 Mg/kg/min. 2.5 ml/kg/hr delivers 50 Mg/kg/min. Reduce to < 20 Mg/kg/min for children with low cardiac output, severe CHF or compromised hepatic blood flow. Infusion should be avoided unless infusion pump available.

Front 265

GLUCAGON Pediatric Dosage

Back 265

Pediatric Dosage: (for children under 20 kg or 44 lbs) Hypoglycemia: 0.5 mg IM or a dose equivalent to 20-30 mg/kg, may repeat in 7-10 minutes

Front 266

FUROSEMIDE Pediatric Dosage

Back 266

Pediatric Dosage: 1 mg/kg IV slowly

Front 267

EPINEPHRINE HCl Pediatric Dosage

Back 267

Pediatric Dosage: (Cardiac arrest includes VF/Pulseless VT, Asystole, and PEA) IV/IO Initial Dose for Cardiac Arrest or Refractory Bradycardia: 0.01 mg/kg of 1:10,000. ET Initial Dose for Cardiac Arrest or Refractory Bradycardia: 0.1 mg/kg of 1:1000; diluted with NS to a volume of 3-5 ml prior to instillation or followed with flush of 3-5 ml of NS after instillation. IV/IO/ET Repeat Dose Cardiac Arrest: 0.1 mg/kg of 1:1000; dilute with 3-5 ml of NS. Repeat Dose Refractory Bradycardia: Same dose every 3-5 min. See: Special Notes section. Asthma/anaphylaxis: Use 1:1,000 solution; give 0.01 mg/kg SC (maximum of 0.35 mg/dose). IV Infusion: 0.1 Mg/kg/min; to prepare for small children 0. 6 x body wt. in kg = mg added to NS to make 100 ml. With this mixture, 1 ml/hr delivers 0.1 Mg/kg/min. Neonatal Dose for First 12 hours of life: IV/IO/ET Initial and Repeat Dose for Cardiac Arrest or Refractory Bradycardia: 0.01-0.03 mg/kg of 1:10,000 every 3-5 minutes Repeat Dose Consideration for ET Epinephrine: 0.1 mg/kg of 1:1000 solution if neonate has no vascular access, fails to respond to positive pressure ventilation with 100% O2, and standard epinephrine dose by the ET tube

Front 268

DOPAMINE Pediatric Dosage

Back 268

Pediatric Dosage: 2-20 Mg/kg/min for circulatory shock or shock unresponsive to fluid administration. To prepare infusion for small children: 6 x body wt. in kg = mg added to NS to make 100 ml. With this mixture 1 ml/hr delivers 1 mcg/kg/min; titrate to effect.

Front 269

DIAZEPAM Pediatric Dosage

Back 269

Pediatric Dosage: IV Dose: 0.2-0.3 mg/kg every 15-30 minutes (max. of 1.0 mg/kg); administer IV over at least 3 minutes or until seizure activity subsides. IV Dose after rectal dose: 0.1 mg/kg with same administration instructions. Rectal dose (<6 years): 0.3-0.5 mg/kg rectally at IV push rate; may repeat in 15-30 min at 0.25 mg/kg.

Front 270

DEXAMETHASONE SODIUM PHOSPHATE Pediatric Dosage

Back 270

Pediatric Dosage: Reactive Airway Disease, Anaphylaxis 0.25 - 0.5mg/kg. Cerebral Edema 0.5 -1.5mg/kg

Front 271

CALCIUM CHLORIDE Routes of Administration

Back 271

Routes of Administration: IV bolus

Front 272

DEXTROSE 50% Routes of Administration

Back 272

Routes of Administration: IV bolus (rapid)

Front 273

BUMETANIDE Routes of Administration

Back 273

Routes of administration: IV

Front 274

BRETYLIUM TOSYLATE Routes of Administration

Back 274

Routes of Administration: IV bolus, then IV infusion

Front 275

ATROPINE SULFATE Routes of Administration

Back 275

Routes of Administration: IV, ET, SVN

Front 276

ACETYLSALICYLIC ACID, ASA Routes of Administration

Back 276

Routes of Administration: Oral

Front 277

AMIODARONE Routes of Administration

Back 277

Route of Administration: IV infusion

Front 278

ALBUTEROL SULFATE Routes of Administration

Back 278

Routes of Administration: Nebulized, mouth piece or in-line via mask Inhaler, patients own, ET/NT in-line

Front 279

ADENOSINE Routes of Administration

Back 279

Routes of Administration: Rapid IV push

Front 280

CHARCOAL, ACTIVATED (without sorbitol) Routes of Administration

Back 280

Routes of Administration: Oral (po), nasogastric tube (ng), orogastric (og)

Front 281

VERAPAMIL HCl Routes of Administration

Back 281

Routes of Administration: IV slow push (See: Special Notes)

Front 282

THIAMINE HCl (vitamin B1) Routes of Administration

Back 282

Routes of Administration: IM, IV over several minutes

Front 283

SODIUM BICARBONATE 8.4% Routes of Administration

Back 283

Routes of Administration: IV bolus; IV infusion. For IV infusion to be monitored on interfacility transports, infusion pump is required

Front 284

PHENYLEPHRINE NASAL SPRAY 0.5% Routes of Administration

Back 284

Routes of Administration: Mucosal; spray in each nostril

Front 285

OXYTOCIN Routes of Administration

Back 285

Routes of Administration: IV infusion, IM (IV infusion on interfacility requires infusion pump)

Front 286

NITROUS OXIDE 50% Routes of Administration

Back 286

Routes of Administration: Self-administered via mask

Front 287

NITROGLYCERIN Routes of Administration

Back 287

Routes of Administration: IV or SL. ** IV infusion on interfacility transports; special training and infusion pump required

Front 288

NALOXONE HCl Routes of Administration

Back 288

Routes of Administration: IV, ET, SC, inject SL, IO or constant IV infusion

Front 289

MORPHINE SULFATE Routes of Administration

Back 289

Routes of Administration: Usually given IV in the field, can be given IM or SC.

Front 290

DIPHENHYDRAMINE HCl Routes of Administration

Back 290

Routes of Administration: IV, Deep IM

Front 291

MIDAZOLAM HYDROCHLORIDE Routes of Administration

Back 291

Routes of Administration: For IM administration, inject deep into large muscle mass. For IV bolus and infusion, administer slowly in small increments over at least 2 minutes and allow 2 more minutes between doses to evaluate effect.

Front 292

METHYLPREDNISOLONE SODIUM SUCCINATE Routes of Administration

Back 292

Routes of Administration: IV bolus

Front 293

MAGNESIUM SULFATE Routes of Administration

Back 293

Routes of Administration: IV PUSH, IV infusion bolus and IV infusion

Front 294

LIDOCAINE HCl Routes of Administration

Back 294

Routes of Administration: IV bolus, followed by IV infusion. May be given ET if IV access is delayed

Front 295

GLUCAGON Routes of Administration

Back 295

Routes of Administration: Hypoglycemia: IM or SC administration avoids possibility of inducing encephalopathy in a thiamine-deficient patient

Front 296

FUROSEMIDE Routes of Administration

Back 296

Routes of Administration: Slow IV push

Front 297

EPINEPHRINE HCl Routes of Administration

Back 297

Routes of Administration: Cardiac: IV push, IV infusion, ET, or IO (pediatric patients up to 6 years of age) Asthma/anaphylaxis/bronchiolitis: SC, SL injection, IM, IV, ET, IO Infusion pump required for IV infusions in interfacility transfers

Front 298

DOPAMINE Routes of Administration

Back 298

Routes of Administration: IV infusion. Infusion pump required on interfacility transfers

Front 299

DIAZEPAM Routes of Administration

Back 299

Routes of Administration: Slow IV push Rectally for children < 6 years

Front 300

DEXAMETHASONE SODIUM PHOSPHATE Routes of Administration

Back 300

Route of Administration: IV bolus, IM

Front 301

CALCIUM CHLORIDE Onset of Action

Back 301

Onset of Action: Seconds

Front 302

DEXTROSE 50% Onset of Action

Back 302

Onset of Action: Seconds

Front 303

BUMETANIDE Onset of Action

Back 303

Onset of Action: immediate

Front 304

BRETYLIUM TOSYLATE Onset of Action

Back 304

Onset of Action: 5 minutes

Front 305

ATROPINE SULFATE Onset of Action

Back 305

Onset of Action: 1 minute

Front 306

ACETYLSALICYLIC ACID, ASA Onset of Action

Back 306

Onset of Action: 20-30 minutes

Front 307

AMIODARONE Onset of Action

Back 307

Onset of Action: Variable

Front 308

ALBUTEROL SULFATE Onset of Action

Back 308

Onset of Action: 5-15 minutes

Front 309

ADENOSINE Onset of Action

Back 309

Onset of Action: Seconds

Front 310

CHARCOAL, ACTIVATED (without sorbitol) Onset of Action

Back 310

Onset of Action: Immediate

Front 311

VERAPAMIL HCl Onset of Action

Back 311

Onset of Action: 1-3 minutes

Front 312

THIAMINE HCl (vitamin B1) Onset of Action

Back 312

Onset of Action: Hours

Front 313

SODIUM BICARBONATE 8.4% Onset of Action

Back 313

Onset of Action: Seconds

Front 314

PHENYLEPHRINE NASAL SPRAY 0.5% Onset of Action

Back 314

Onset of Action: Seconds

Front 315

OXYTOCIN Onset of Action

Back 315

Onset of Action: Seconds

Front 316

NITROUS OXIDE 50% Onset of Action

Back 316

Onset of Action: Within a few breaths

Front 317

NITROGLYCERIN Onset of Action

Back 317

Onset of Action: Seconds

Front 318

NALOXONE HCl Onset of Action

Back 318

Onset of Action: IV -- within 2 minutes

Front 319

MORPHINE SULFATE Onset of Action

Back 319

Onset of Action: Seconds

Front 320

DIPHENHYDRAMINE HCl Onset of Action

Back 320

Onset of Action: IV 5 - 10 minutes

Front 321

MIDAZOLAM HYDROCHLORIDE Onset of Action

Back 321

Onset of Action: IM - 15 minutes, IV - immediate

Front 322

METHYLPREDNISOLONE SODIUM SUCCINATE Onset of Action

Back 322

Onset of Action: 1 - 6 hours; dogmatic 6 hour time to onset of benefit has decreased markedly during the last few years

Front 323

MAGNESIUM SULFATE Onset of Action

Back 323

Onset of Action: Seconds

Front 324

LIDOCAINE HCl Onset of Action

Back 324

Onset of Action: 1-5 minutes

Front 325

GLUCAGON Onset of Action

Back 325

Onset of Action: (dose and route dependent) 1 mg IM, 8-10 minutes. IV, 1 minute

Front 326

FUROSEMIDE Onset of Action

Back 326

Onset of Action: 5 minutes (vasodilation)

Front 327

EPINEPHRINE HCl Onset of Action

Back 327

Onset of Action: Seconds

Front 328

DOPAMINE Onset of Action

Back 328

Onset of Action: Almost immediate

Front 329

DIAZEPAM Onset of Action

Back 329

Onset of Action: Minutes

Front 330

DEXAMETHASONE SODIUM PHOSPHATE Onset of Action

Back 330

Onset of Action: 4-8 hours

Front 331

CALCIUM CHLORIDE Peak Effects

Back 331

Peak Effects: 3 - 5 minutes

Front 332

DEXTROSE 50% Peak Effects

Back 332

Peak Effects: Variable

Front 333

BUMETANIDE Peak Effects

Back 333

Peak Effect: IV – 15 to 30 minutes

Front 334

BRETYLIUM TOSYLATE Peak Effects

Back 334

Peak Effects: 45-60 minutes

Front 335

ATROPINE SULFATE Peak Effects

Back 335

Peak Effects: 2-5 minutes

Front 336

ACETYLSALICYLIC ACID, ASA Peak Effects

Back 336

Peak Effects: 2 hours

Front 337

AMIODARONE Peak Effects

Back 337

Peak effects: Variable

Front 338

ALBUTEROL SULFATE Peak Effects

Back 338

Peak Effects: 30 minutes - 2 hours

Front 339

ADENOSINE Peak Effects

Back 339

Peak Effects: Seconds

Front 340

CHARCOAL, ACTIVATED (without sorbitol) Peak Effects

Back 340

Peak Effects: Not applicable

Front 341

VERAPAMIL HCl Peak Effects

Back 341

Peak Effects: 3-5 minutes

Front 342

THIAMINE HCl (vitamin B1) Peak Effects

Back 342

Peak Effects: 3-5 days

Front 343

SODIUM BICARBONATE 8.4% Peak Effects

Back 343

Peak Effects: 1-2 minutes

Front 344

PHENYLEPHRINE NASAL SPRAY 0.5% Peak Effects

Back 344

Peak Effects: 30 minutes

Front 345

OXYTOCIN Peak Effects

Back 345

Peak Effects: Variable

Front 346

NITROUS OXIDE 50% Peak Effects

Back 346

Peak Effects: Not available

Front 347

NITROGLYCERIN Peak Effects

Back 347

Peak Effects: 5-10 minutes

Front 348

NALOXONE HCl Peak Effects

Back 348

Peak Effects: Variable

Front 349

MORPHINE SULFATE Peak Effects

Back 349

Peak Effects: 20 minutes

Front 350

DIPHENHYDRAMINE HCl Peak Effects

Back 350

Peak Effects: 1 hour

Front 351

MIDAZOLAM HYDROCHLORIDE Peak Effects

Back 351

Peak Effects: IM - 15 to 60 minutes, IV - 3 to 5 minutes

Front 352

METHYLPREDNISOLONE SODIUM SUCCINATE Peak Effects

Back 352

Peak Effects:8 hours

Front 353

MAGNESIUM SULFATE Peak Effects

Back 353

Peak Effects: Not known

Front 354

LIDOCAINE HCl Peak Effects

Back 354

Peak Effects: 5-10 minutes

Front 355

GLUCAGON Peak Effects

Back 355

Peak Effects: (does and route dependent)1 mg IM, 12-14 minutes, IV, 3-6 minutes

Front 356

FUROSEMIDE Peak Effects

Back 356

Peak Effects: 20-60 minutes (diuresis)

Front 357

EPINEPHRINE HCl Peak Effects

Back 357

Peak Effects: Minutes

Front 358

DOPAMINE Peak Effects

Back 358

Peak Effects: 5-10 minutes

Front 359

DIAZEPAM Peak Effects

Back 359

Peak Effects: Minutes

Front 360

DEXAMETHASONE SODIUM PHOSPHATE Peak Effects

Back 360

Peak Effects: 6 - 12 hours

Front 361

CALCIUM CHLORIDE Duration of Action

Back 361

Duration of Action: 15-30 minutes

Front 362

DEXTROSE 50% Duration of Action

Back 362

Duration of Action: Variable

Front 363

BUMETANIDE Duration of Action

Back 363

Duration of Action: 2 to 4 hours

Front 364

BRETYLIUM TOSYLATE Duration of Action

Back 364

Duration of Action: 5-10 hours

Front 365

ATROPINE SULFATE Duration of Action

Back 365

Duration of Action: 2 hours

Front 366

ACETYLSALICYLIC ACID, ASA Duration of Action

Back 366

Duration of Action: 4-6 hours

Front 367

AMIODARONE Duration of Action

Back 367

Duration of Action: Half-life may exceed 40 days.

Front 368

ALBUTEROL SULFATE Duration of Action

Back 368

Duration of Action: 3-4 hours

Front 369

ADENOSINE Duration of Action

Back 369

Duration of Action: 10-12 seconds (1/2 life 5 seconds)

Front 370

CHARCOAL, ACTIVATED (without sorbitol) Duration of Action

Back 370

Duration of Action: Dependent upon GI function; acts until excreted

Front 371

VERAPAMIL HCl Duration of Action

Back 371

Duration of Action: 2-5 hours

Front 372

THIAMINE HCl (vitamin B1) Duration of Action

Back 372

Duration of Action: Unavailable

Front 373

SODIUM BICARBONATE 8.4% Duration of Action

Back 373

Duration of Action: 10 minutes

Front 374

PHENYLEPHRINE NASAL SPRAY 0.5% Duration of Action

Back 374

Duration of Action: 30 minutes to 4 hours

Front 375

OXYTOCIN Duration of Action

Back 375

Duration of Action: 1 hour after discontinued

Front 376

NITROUS OXIDE 50% Duration of Action

Back 376

Duration of Action: 1-2 minutes

Front 377

NITROGLYCERIN Duration of Action

Back 377

Duration of Action: 1-10 minutes after IV discontinued

Front 378

NALOXONE HCl Duration of Action

Back 378

Duration of Action: Approximately 45 minutes

Front 379

MORPHINE SULFATE Duration of Action

Back 379

Duration of Action: 2-4 hours

Front 380

DIPHENHYDRAMINE HCl Duration of Action

Back 380

Duration of Action: 3-6 hours

Front 381

MIDAZOLAM HYDROCHLORIDE Duration of Action

Back 381

Duration of Action: 2 to 6 hours

Front 382

METHYLPREDNISOLONE SODIUM SUCCINATE Duration of Action

Back 382

Duration of Action: 18-36 hours

Front 383

MAGNESIUM SULFATE Duration of Action

Back 383

Duration of Action: 24 hours or greater

Front 384

LIDOCAINE HCl Duration of Action

Back 384

Duration of Action: Bolus only - 20 minutes

Front 385

GLUCAGON Duration of Action

Back 385

Duration of Action: (dose and route dependent) 1 mg IM, 12-27 minutes, IV, 20 minutes

Front 386

FUROSEMIDE Duration of Action

Back 386

Duration of Action:Variable

Front 387

EPINEPHRINE HCl Duration of Action

Back 387

Duration of Action: Several minutes

Front 388

DOPAMINE Duration of Action

Back 388

Duration of Action: Effects cease almost immediately when infusion is shut off

Front 389

DIAZEPAM Duration of Action

Back 389

Duration of Action: 20 minutes to 50 minutes

Front 390

DEXAMETHASONE SODIUM PHOSPHATE Duration of Action

Back 390

Duration of Action: 24 - 72 hours

Front 391

CALCIUM CHLORIDE Dosage Forms/Packaging

Back 391

Dosage Forms/Packaging: 1 Gm/10 ml prefilled syringes

Front 392

DEXTROSE 50% Dosage Forms/Packaging

Back 392

Dosage Forms/Packaging: 25 Gms/50 ml prefilled syringe

Front 393

BUMETANIDE Dosage Forms/Packaging

Back 393

Dosage Forms/Packaging: Depends on supply

Front 394

BRETYLIUM TOSYLATE Dosage Forms/Packaging

Back 394

Dosage Forms/Packaging: 500 mg/10 ml ampules

Front 395

ATROPINE SULFATE Dosage Forms/Packaging

Back 395

Dosage Forms/Packaging: 1 mg/10 ml Prefilled syringes and 8 mg/20 ml multi-dose vial

Front 396

ACETYLSALICYLIC ACID, ASA Dosage Forms/Packaging

Back 396

Dosage Forms/Packaging: 81 - 325 mg tablet individually packaged

Front 397

AMIODARONE Dosage Forms/Packaging

Back 397

Dosage Forms/Packaging: 2-3 glass ampules, 150mg/6.0 mL

Front 398

ALBUTEROL SULFATE Dosage Forms/Packaging

Back 398

Dosage Forms/Packaging: 2.5 mg albuterol premixed in 3 ml normal saline (independent dose) sulfite-free

Front 399

ADENOSINE Dosage Forms/Packaging

Back 399

Dosage Forms/Packaging: Flip top vials 6 mg/2 ml (3 mg/ml) Prefilled syringe 6 mg/2 ml (3 mg/ml)

Front 400

CHARCOAL, ACTIVATED (without sorbitol) Dosage Forms/Packaging

Back 400

Dosage Forms/Packaging: Powder, Pre-mixed slurries of 15, 25, and 50 g, Pre-mixed tubes of 25 g

Front 401

VERAPAMIL HCl Dosage Forms/Packaging

Back 401

Dosage Forms/Packaging: 5 mg/2 ml prefilled syringes, ampules and vials (2.5 mg/ml)

Front 402

THIAMINE HCl (vitamin B1) Dosage Forms/Packaging

Back 402

Dosage Forms/Packaging: 100 mg/ml; 1 ml ampule or tubes

Front 403

SODIUM BICARBONATE 8.4% Dosage Forms/Packaging

Back 403

Dosage Forms/Packaging: 50 mEq/50 ml prefilled syringes

Front 404

PHENYLEPHRINE NASAL SPRAY 0.5% Dosage Forms/Packaging

Back 404

Dosage Forms/Packaging: 0.5% solution, 15 ml bottle

Front 405

OXYTOCIN Dosage Forms/Packaging

Back 405

Dosage Forms/Packaging: 10 USP units/1 ml ampule or tubes

Front 406

NITROUS OXIDE 50% Dosage Forms/Packaging

Back 406

Dosage Forms/Packaging: Nitrous oxide machine that delivers a fixed ration of nitrous oxide and oxygen (50:50) utilizing a mixing valve with separate tanks of N2O and O2 with a fail safe device (O2 tank empty, no nitrous flows) and a self-administration mask

Front 407

NITROGLYCERIN Dosage Forms/Packaging

Back 407

Dosage Forms/Packaging: Bottles of 25 1/150 grain/tablets / Spray Bottle with 200 metered doses, each 0.4 mg. IV form not carried on drug box, must use infusion pump for interfacility transfers

Front 408

NALOXONE HCl Dosage Forms/Packaging

Back 408

Dosage Forms/Packaging: 0.4 mg/ml: 1 ml ampule; 1 ml, 10 ml vials, 1 mg/ml: 1 ml, 2 ml ampules; 1ml, 5ml, 10 ml vials

Front 409

MORPHINE SULFATE Dosage Forms/Packaging

Back 409

Dosage Forms/Packaging: 10 mg/ml ampules, only

Front 410

DIPHENHYDRAMINE HCl Dosage Forms/Packaging

Back 410

Dosage Forms/Packaging: 50 mg/1 ml syringes and vials

Front 411

MIDAZOLAM HYDROCHLORIDE Dosage Forms/Packaging

Back 411

Dosage Forms/Packaging: 1 mg midazolam/1 mL: 5 mL vials (5 mg)

Front 412

METHYLPREDNISOLONE SODIUM SUCCINATE Dosage Forms/Packaging

Back 412

Dosage Forms/Packaging: 125 mg/1 ml, 500 mg/4 ml, 1 g/8 ml mix-a-vial 2G vial w/ dilutent

Front 413

MAGNESIUM SULFATE Dosage Forms/Packaging

Back 413

Dosage Forms/Packaging: 1 Gm/2 cc vials (0.5 Gm/cc) 5 Gm/10 cc vials (0.5 Gm/cc)

Front 414

LIDOCAINE HCl Dosage Forms/Packaging

Back 414

Dosage Forms/Packaging: 100 mg/5 ml prefilled syringes (for bolus) 1 Gm in 25 ml vials and prefilled syringes (for infusion) 2 Gm in 500 ml D5W premixed bags (optional)

Front 415

GLUCAGON Dosage Forms/Packaging

Back 415

Dosage Forms/Packaging: 1 mg (1 unit) with 1 mL vial of diluting solution. 1 mg (1 unit) with prefilled syringe of diluting solution (Glucagon Emergency Kit)

Front 416

FUROSEMIDE Dosage Forms/Packaging

Back 416

Dosage Forms/Packaging: 20 mg/2 mL ampule, vial, syringe, 40 mg/4 mL ampule, vial, syringe, 100 mg/10 mL ampule, vial, syringe

Front 417

EPINEPHRINE HCl Dosage Forms/Packaging

Back 417

Dosage Forms/Packaging: 1:10,000 solution 1 mg/10 ml prefilled syringes. 1:1,000 solution 1 mg/1 ml ampule or prefilled syringes; 30 mg/30 ml vial.

Front 418

DOPAMINE Dosage Forms/Packaging

Back 418

Dosage Forms/Packaging: 400 mg/5 ml vials / 400 mg in 250 ml D5W premixed IV solution

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DIAZEPAM Dosage Forms/Packaging

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Dosage Forms/Packaging: 10 mg/2 ml prefilled syringes, ampules and vials. Diazepam Rectal Delivery Gel (optional) - 10 mg twin pack pediatric (total 20 mg)

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DEXAMETHASONE SODIUM PHOSPHATE Dosage Forms/Packaging

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Dosage Forms/Packaging: 20mg /5ml, 100mg/25ml, 120mg/5ml

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CALCIUM CHLORIDE Arizona Drug Box Supply Range

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Arizona Drug Box Supply Range: PARAMEDIC: 1 - 2 prefilled syringes

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DEXTROSE 50% Arizona Drug Box Supply Range

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Arizona Drug Box Supply Range: PARAMEDIC: 2 - 4 prefilled syringes

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BUMETANIDE Arizona Drug Box Supply Range

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Arizona Drug Box Supply Range: If furosemide is not available: 4 – 8 vials of 1 mg/4 mL (0.25 mg/1mL)

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BRETYLIUM TOSYLATE Arizona Drug Box Supply Range

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Arizona Drug Box Supply Range: PARAMEDIC: 1 - 3 ampules

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ATROPINE SULFATE Arizona Drug Box Supply Range

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Arizona Drug Box Supply Range: PARAMEDIC: 3 - 4 (1 mg/10 ml) prefilled syringes, 1 - 2 (8 mg/20 ml, 0.4 mg/ml) multidose vial

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ACETYLSALICYLIC ACID, ASA Arizona Drug Box Supply Range

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Arizona Drug Box Supply Range: PARAMEDIC: 36 - 100 Tablets

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AMIODARONE Arizona Drug Box Supply Range

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Arizona Drug Box Standard Supply: None.

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ALBUTEROL SULFATE Arizona Drug Box Supply Range

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Arizona Drug Box Supply Range: PARAMEDIC: 2 - 6 independent doses

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ADENOSINE Arizona Drug Box Supply Range

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Arizona Drug Box Supply Range: PARAMEDIC: 5 - 6 vials

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CHARCOAL, ACTIVATED (without sorbitol) Arizona Drug Box Supply Range

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Arizona Drug Box Supply Range: PARAMEDIC: 2 - 4 (25 gm. tubes)

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VERAPAMIL HCl Arizona Drug Box Supply Range

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Arizona Drug Box Supply Range: PARAMEDIC: 2 - 3 units

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THIAMINE HCl (vitamin B1) Arizona Drug Box Supply Range

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Arizona Drug Box Supply Range: PARAMEDIC: 1 - 2 units

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SODIUM BICARBONATE 8.4% Arizona Drug Box Supply Range

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Arizona Drug Box Supply Range: PARAMEDIC: 2 - 3 prefilled syringes

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PHENYLEPHRINE NASAL SPRAY 0.5% Arizona Drug Box Supply Range

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Arizona Drug Box Supply Range: PARAMEDIC: 1 - 2 bottles

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OXYTOCIN Arizona Drug Box Supply Range

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Arizona Drug Box Supply Range: PARAMEDIC: 1 - 2 units

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NITROUS OXIDE 50% Arizona Drug Box Supply Range

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Arizona Drug Box Supply Range: Paramedic: Optional item / kept outside of box due to size

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NITROGLYCERIN Arizona Drug Box Supply Range

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Arizona Drug Box Supply: PARAMEDIC: 1 - 2 bottles of tablets or 1 - 2 spray bottles

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NALOXONE HCl Arizona Drug Box Supply Range

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Arizona Drug Box Supply Range: PARAMEDIC: 10 mg total

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MORPHINE SULFATE Arizona Drug Box Supply Range

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Arizona Drug Box Supply Range: PARAMEDIC: 2 (20 mg)

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DIPHENHYDRAMINE HCl Arizona Drug Box Supply Range

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Arizona Drug Box Supply Range: PARAMEDIC: 1 - 2 units

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MIDAZOLAM HYDROCHLORIDE Arizona Drug Box Supply Range

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Arizona Drug Box Supply Range: Paramedic: optional, 2-4 vials of 5 mg/5 mL

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METHYLPREDNISOLONE SODIUM SUCCINATE Arizona Drug Box Supply Range

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Arizona Drug Box Supply Range: PARAMEDIC: 1 - 2 125 mg/2 ml mix-a-vial. Optional: additional training requirement for Spinal Cord Trauma (2 g x 1, 1 g x 1, 500 mg x 1, 125 mg x 1)

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MAGNESIUM SULFATE Arizona Drug Box Supply Range

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Arizona Drug Box Supply Range: PARAMEDIC: 4 - 10 1 gm/2 ml vials

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LIDOCAINE HCl Arizona Drug Box Supply Range

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Arizona Drug Box Supply Range: PARAMEDIC: 100 mg/5 ml prefilled syringes x 3 - 4 , 1 gm/25 ml vial x 1 - 2 2 gm/50 ml vial (premixed in 500 ml D5W optional) x 1 - 2

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GLUCAGON Arizona Drug Box Supply Range

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Arizona Drug Box Supply Range: PARAMEDIC: 1 - 2 units

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FUROSEMIDE Arizona Drug Box Supply Range

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Arizona Drug Box Supply Range: PARAMEDIC: 4 (20 mg/2 mL) or 4 (40mg/4mL) or 2 100mg/10mL)

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EPINEPHRINE HCl Arizona Drug Box Supply Range

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Arizona Drug Box Supply Range: PARAMEDIC: 1:10,000 prefilled syringes x 6 - 8. 1:1000 ampules or prefilled syringes x 1 – 2; 1:1000 multidose vial x 1 – 2

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DOPAMINE Arizona Drug Box Supply Range

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Arizona Drug Box Supply Range: PARAMEDIC: 1 - 2

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DIAZEPAM Arizona Drug Box Supply Range

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Arizona Drug Box Supply Range:PARAMEDIC: 2 prefilled syringes (20 mg) 10 mg twin pack pediatric (20 mg)

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DEXAMETHASONE SODIUM PHOSPHATE Arizona Drug Box Supply Range

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Arizona Drug Box Supply Range: PARAMEDIC: 2 - 4 120mg/5ml and 2 - 4 20mg/5ml

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CALCIUM CHLORIDE Special Notes

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Special Notes: > For pediatrics, calcium chloride may be diluted with 1-2 ml of NS IV fluid per ml calcium chloride. > Concurrent administration of sodium bicarbonate and calcium chloride will produce a precipitate, calcium carbonate (chalk). > Studies have shown no benefit from calcium administration in asystole or PEA. There is increasing evidence that calcium increases damage to cells that have been injured and worsens the neurological outcome. > Calcium chloride is not recommended in patients with suspected digitalis toxicity. > Pediatric patients should not receive IV calcium channel blockers therefore there is no dose for pre-treatment. > Use of calcium chloride in treatment of hyperkalemia is a part of a combination drug therapy. Insulin may be given upon arrival to ED.

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DEXTROSE 50% Special Notes

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Special Notes: > Determine a blood glucose level before initiating administration of dextrose. Inducing an unnecessary hyperosmolar state during certain illness/injury states may worsen neurological outcome. Additionally dextrose is very necrosing to the vascular system. > Emergency treatment of hyperkalemia (clinical presentation, PMH and ECG changes) includes CaCl (or gluconate), sodium bicarbonate, and insulin and dextrose. Insulin may be given upon arrival to ED.

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BUMETANIDE Special Notes

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Special Notes: >Bumetanide does not have the vasodilatory effects of furosemide. >Patients allergic to sulfa drugs may show hypersensitivity. >May cause a reduction of blood supply to developing fetus. >Safety and effectiveness in pediatric patients is not established. >1.0 mg bumetanide = 40 mg furosemide

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BRETYLIUM TOSYLATE Special Notes

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Special Notes: > Bretylium is not considered first-line therapy for VF or VT because it is no more effective than lidocaine and is more likely to produce adverse hemodynamic effects during CPR. > In the non-cardiac arrest patient receiving bretylium transient hypertension may occur due to the initial stimulation of norepinephrine from adrenergic nerve terminals

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ATROPINE SULFATE Special Notes

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Special Notes: > Administering too small doses or administering too slowly may result in paradoxical bradycardia. > Signs and symptoms of cholinergic/organophosphate poisoning: excess salivation, lacrimation, urination, defecation, gastrointestinal cramping, excretion (SLUDGE), bradycardia; coma. > Signs and symptoms of poisoning/overdose of atropine-like drugs: dry mouth; thirst; hot, dry, flushed skin; fever; palpitations, restlessness; excitement; delirium.

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ACETYLSALICYLIC ACID, ASA Special Notes

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Special Notes: > Baby ASA is heat and light sensitive. The odor of acetic acid (vinegar-like smell) indicates degradation of product

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AMIODARONE Special Notes

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Special Notes: > May prolong QT interval. > Use with caution if hepatic failure is present or if administered in combination with other drugs. > Patient must be on a cardiac monitor. > Must be administered on an IV infusion pump. > Amiodarone is an optional drug.

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ALBUTEROL SULFATE Special Notes

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Special Notes: > Must be sulfite-free

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ADENOSINE Special Notes

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Special notes: > Dysrhythmias may recur (short half life). > Dysrhythmias appear in 55% of patients at conversion; lasting for a few seconds, do not usually require intervention. > Second dose must be prepared and available. > Check for crystallization in cold climates.

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CHARCOAL, ACTIVATED (without sorbitol) Special Notes

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Special Notes: > Give it! > Charcoal mixture should not contain sorbitol; carefully read label of exchange supply.

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VERAPAMIL HCl Special Notes

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Special Notes: > May be used in conjunction with cardioversion. > Vagal maneuvers may be tried first (Valsalva maneuver). > Monitor closely for hypotension and AV block during administration. > Slow IV push: Verapamil is generally given over a 1-2 minute period. In middle age or older patients the IV dose should be administered over a 3 minute period. Peak effects occur within 3-5 minutes of bolus injection. > Hypotension may be treated with fluids, supine position, and/or calcium chloride. > Cautious administration is recommended when IV verapamil is given to a patient receiving oral Beta blockers or oral calcium channel blockers (not a contraindication). > The ventricular response to atrial fibrillation in patients with Wolff-Parkinson-White (WPW) syndrome may be accelerated in response to verapamil and VF can occur. Verapamil should be used cautiously, if at all, in patients with WPW syndrome associated with atrial fibrillation and flutter. > Verapamil is not effective for the treatment of most types of VT. It may induce severe hypotension and predispose the patient to the development of VF. Avoid verapamil in patients with wide-QRS tachycardia unless it is known with certainty to be supraventricular in origin. > In patients with acute pump failure (not severe), therapy with verapamil is indicated (used cautiously) if resolution of the tachycardia will remove the cause of the hemodynamic compromise. IV calcium has been recommended as pretreatment therapy against hypotension in patients with marginal blood pressure or with left ventricular dysfunction. > Because of the shorter duration of action, adenosine is preferable in PSVT.

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THIAMINE HCl (vitamin B1) Special Notes

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Special Notes: > In the known alcoholic patient dextrose should not be administered without thiamine. > Thiamine has been shown to be useful in severe congestive heart failure.

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SODIUM BICARBONATE 8.4% Special Notes

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Special Notes: > Flush tubing before and after administration, especially with concurrent use of calcium chloride. > Sodium bicarbonate administration should be considered only for treatment of documented severe acidosis associated with prolonged cardiac arrest or an unstable hemodynamic state, hyperkalemia or certain overdoses (i.e. cyclic antidepressants, ASA, phenobarbital, etc.). > In premature infants hyperosmolarity from undiluted sodium bicarbonate has been correlated with an increased risk for periventricular-intraventricular hemorrhage. > Severe tissue necrosis will occur with extravasation.

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PHENYLEPHRINE NASAL SPRAY 0.5% Special Notes

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Special Notes: > Single patient use only. > Air or strong light causes potency loss; do not use solution if brown in color or precipitate is in bottle. > Nasal intubation tips: examine nares for most patent side; administer topical vasoconstrictor, use ETT 0.5-1.0 mm smaller than for oral intubation; lubricate nostril and tube; tube bevel face nasal septum to avoid abrading Kieselbach's Plexus; advance tube along nasal floor of more patent side.

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OXYTOCIN Special Notes

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Special Notes: > Post partum hemorrhage is defined as blood loss in excess of 500 ml at delivery and during the first 24 hours after delivery. It should be remembered that all blood seen at delivery is the mother's unless there is a spill of cord blood or trauma to the placenta. > Do not use if solution is discolored or contains a precipitate. > In addition to oxytocin, fundal massage is also indicated to remove clot formation and stimulate uterine contraction. > IV fluids are necessary to correct hypovolemia; if post partum hemorrhage is due to other causes such as vaginal or cervical lacerations or retained placental fragments, oxytocin and fundal massage will not be effective. > Oxytocin is an optional drug.

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NITROUS OXIDE 50% Special Notes

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Special Notes: > Does not work well for short periods of intense pain. > Does not mask serious conditions. > Must be self-administered by the patient

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NITROGLYCERIN Special Notes

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Special Notes:> NTG is heat and light sensitive; stock rotation assures fresh supply. > SL: Cautiously administer NTG to a patient who has never received it, consider establishing an IV prior to administration. > Patients with hypotension should be administered this drug with caution. > Closely monitor vital signs, cardiac rhythm. > Bradydysrhythmias and hypotension usually respond to Trendelenburg’s position; atropine and vasopressors may be administered if needed. > Monitoring IV nitroglycerin on patients during interfacility transport requires an infusion pump and is limited to prehospital providers that have completed a special training curriculum in accordance with their medical control authorities. ** Indicates special training requirement

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NALOXONE HCl Special Notes

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Special Notes: > Opioid drugs include heroin, Dilaudid, morphine, meperidine, codeine, methadone, Lomotil, Darvon, Darvocet, Talwin and others. Large amounts of the drug may be needed for Darvon, Darvocet, and Methadone. > If Naloxone HCl is not available, use Nalmefene HCl (2 mg/2mL). > For adult intra-nasal administration, 1 mg/1ml is the preferred solution. 0.4 mg/1 ml may be used as an alternative. ** Indicates special training requirement

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MORPHINE SULFATE Special Notes

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Special Notes: > Schedule II narcotic. > Watch for histamine effects (wheals, urticaria) proximal to IV site; contact medical control. > Correct hypotension before administration. > Maximum respiratory depression 7-10 minutes after administration; can be reversed with naloxone; use caution in patients with emphysema. > Infusions: IV infusions of morphine sulfate may be transported, however an infusion pump is required.

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DIPHENHYDRAMINE HCl Special Notes

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Special Notes: > Not used in newborn or premature infants; used in pregnancy only if clearly needed. > In anaphylaxis, used as a 2nd line treatment after epinephrine and steroids.

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MIDAZOLAM HYDROCHLORIDE Special Notes

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Special Notes: > Flumazenil is the accepted antagonist for midazolam. > Midazolam is an optional drug

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METHYLPREDNISOLONE SODIUM SUCCINATE Special Notes

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Special Notes: > Use for spinal cord trauma is limited to prehospital providers that have completed a special training curriculum in accordance with their medical control authorities. Proper administration of methylprednisolone for spinal cord trauma is imperative.> Infusions: An infusion pump is required for continuous infusions of corticosteroids during interfacility transports; a minimum of microdrip tubing is required for field use if administering loading dose therapy for spinal cord trauma.

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MAGNESIUM SULFATE Special Notes

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Special Notes: > O2 should be administered to patients receiving MgSO4. > For OB emergencies maintenance infusions of MgSO4 should be administered by infusion pump to prevent toxicity. Therefore, loading bolus therapy only, using a minimum of microdrip tubing is recommended for field to hospital intervention for OB indications. Interfacility transfers may include a loading dose followed by a maintenance infusion of MgSO4 which requires an infusion pump. > Transport gravid patients lying or tilted to left side to prevent restricting venous return to heart. > Use cautiously in patients with impaired renal function, pre-existing heart blocks and women in labor. > Keep calcium chloride (10%) 10 ml available to reverse magnesium toxicity. See: CaCl profile > Monitor vital signs every 15 minutes and DTR's hourly in patients receiving MgSO4 infusion. If DTR's are absent or respirations <12/min, discontinue MgSO4 infusion, notify medical control. > Hourly intake and output should be monitored on long transport; urine output should be >30 cc/hr. > When given to toxemic mothers within 24 hours before delivery observe newborn for S/S of MgSO4 toxicity (neuromuscular and/or respiratory depression). > Additional high risk prenatal consultation is available through: Tucson Area 1-800-852-6616 or Phoenix Area 1-800-552-5252. > Interfacility maternal transport teams are recommended and available for the transport of patients requiring continuous IV infusions of MgSO4. > In treatment of seizures associated with PIH it may be necessary to use an anticonvulsant such as diazepam.

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LIDOCAINE HCl Special Notes

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Special Notes: > Decrease maintenance infusion by 50% in cases of congestive heart failure, shock, liver disease. > Cross-allergenicity between local anesthetic "caine" drugs is controversial. > Consider increased dose for ET administration. > Infusions: Infusion pump is required for interfacility transports. A minimum of microdrip tubing is required for field use. Lidocaine drip rates established in field should be monitored carefully.

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GLUCAGON Special Notes

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Special Notes: > Blood sugar should be measured rapidly before deciding upon the administration of D50 or glucagon, especially in the non-diabetic patient. > Documented hypoglycemia is a true medical emergency, IM glucagon should be administered rapidly if IV access is delayed. > In known alcoholics, administer thiamine in addition to glucagon to prevent inducing an encephalopathy in a thiamine-deficient patient. > Patients with Type I diabetes do not have as great a response in blood glucose levels as Type II stable patients. For all patients having hypoglycemic episode, supplementary complex carbohydrates should be eaten within 2 hour, especially in a child or adolescent.

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FUROSEMIDE Special Notes

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Special Notes: > Ototoxicity and resulting deafness can occur. > Since furosemide is a sulfonamide derivative, it may induce allergic reactions in patients with sensitivity to sulfonamides (sulfa drugs).

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EPINEPHRINE HCl Special Notes

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Special Notes: > Total dose for an adult ET (drug plus diluting solution) should equal at least 10 ml to ensure that the drug reaches lung tissue rather than remaining in the tube. Pediatric patient should equal 3 - 5 ml. > Multi-dose Vial: 1 mg/ml (1:1000) in 30 ml bottle. May be used for administering the ACLS doses of epinephrine down the endotracheal tube (2-2.5 times the peripheral route dose, diluted with 8 ml NS to make a 1:10,000 solution) or for mixing an epinephrine infusions such as 30 mg/250 ml NS. > Pediatric: If first dose given ET, then IV established, begin at initial IV dose for next dose. > Data is inadequate to evaluate the safety of high dose epinephrine in newborns; may lead to prolonged hypertension and resultant complications such as Intra cranial hemorrhage in preterm infants. > Infusions: An infusion pump is required for interfacility transports. A minimum of microdrip tubing is required for field use.

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DOPAMINE Special Notes

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Special Notes: > Always monitor drip rate, never run "wide open". > An infusion pump is required for interfacility transports; a minimum of microdrip tubing is required for field use. > It is important to remember that even in low dose ranges dopamine elevates pulmonary artery occlusive pressure and may induce or exacerbate pulmonary congestion despite a rise in cardiac output. > Notify physician if infusion infiltrates for administration of antidote.

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DIAZEPAM Special Notes

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Special Notes:> Valium must be injected slowly and small veins such as those on the dorsum of the hand or wrist should be avoided. Risk of venous thrombosis, phlebitis, local irritation, swelling and vascular spasm is increased. > Extreme care must be taken to avoid intra-arterial injection or extravasation. > Diazepam may cause prolonged CNS depression in the neonate (30 days of age or less).

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DEXAMETHASONE SODIUM PHOSPHATE Special Notes

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Special Notes: > Use for spinal cord trauma is limited to prehospital providers that have completed a special training curriculum in accordance with their medical control authorities. Proper administration of dexamethasone for spinal cord trauma is imperative. >Infusions: An infusion pump is required for continuous infusions of corticosteroids during interfacility transports; a minimum of microdrip tubing is required for field use of administering loading dose therapy for spinal cord trauma.

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SUCCINYLCHOLINE BRAND NAME

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Brand Name: Anectine

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VASOPRESSIN BRAND NAME

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Brand Name: Pitressin

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SUCCINYLCHOLINE CLASS

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Class: Neuromuscular blocker (depolarizing)

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VASOPRESSIN CLASS

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Class: Naturally occurring antidiruetic hormone

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SUCCINYLCHOLINE Mechanism of Action

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Mechanism of Action: The quickest onset & briefest duration or all neuromuscular blocking drugs. Binds to the receptors for acetylcholine. Causes depolarization of muscle membrane & often leads to fascicualtions & some muscular contractions .

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VASOPRESSIN Mechanism of Action

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Mechanism of Action: Acts by direct stimulation of smooth muscle V1 receptors, when given in extremely high doses, it acts as a nonadrenergic peripheral vasoconstrictor.

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SUCCINYLCHOLINE Indications/field use

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Indications & Field Use: To facilitate intubation (RSI), terminating laryngospasm, muscle relaxation

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VASOPRESSIN Indications/field use

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Indications & Field Use: Alternative to epinephrine in adult shock-refractory VF, vasodilatory shock

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SUCCINYLCHOLINE Contraindications

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Contradictions: Acute injuries, hypersensitivity, skeletal muscle myopathies, Paramedic’s inability to control / support pt airway / ventilations, acute rhabdomyolysis.

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VASOPRESSIN Contraindications

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Contradictions: Responsive patents, w/ coronary artery disease

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SUCCINYLCHOLINE Adverse Reactions

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Adverse Reactions: CV: Hypotension, bradycardia, dysrhythmias, RESP: Resp depression. CNS: Initial muscle fascilation, excess salivation, malignant hyperthermia, allergic raction

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VASOPRESSIN Adverse Reactions

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Adverse Reactions: CV: Ischemic chest pain, RESP: Bronchial constriction, CNS: Tremors, sweating, GI: Nausea & vomiting, abdominal distress, uterine contraction

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SUCCINYLCHOLINE Incompatibilities/Drug Interactions

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Incompatabilites/Drug Interactions: Oxytocin, beta-blockers, contraceptives, organophosphates

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VASOPRESSIN Incompatibilities/Drug Interactions

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Incompatabilites/Drug Interactions: None have been reported.

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SUCCINYLCHOLINE Adult Dosage

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Adult Dosage: 0.3 to 1.1mg/kg (25 to 75mg) over 10 to 30secs IV, .04 - .07mg/kg to maintain relaxation.

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VASOPRESSIN Adult Dosage

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Adult Dosage: 40 U IVP, ONE TIME

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SUCCINYLCHOLINE Pediatric Dosage

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Pediatric Dosage: 1 - 2mg/kg

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VASOPRESSIN Pediatric Dosage

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Pediatric Dosage: Not recommended

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SUCCINYLCHOLINE Routes of Administration

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Routes of Administration: RIVP

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VASOPRESSIN Routes of Administration

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Routes of Administration: RIVP

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SUCCINYLCHOLINE Onset of Action

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Onset of Action: Seconds

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VASOPRESSIN Onset of Action

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Onset of Action: Immediate

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SUCCINYLCHOLINE Peak Effects

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Peak Effects: 2 – 3 mins

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VASOPRESSIN Peak Effects

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Peak Effects: 10 – 20mins

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SUCCINYLCHOLINE Duration of Action

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Duration of Action: 5 – 10min

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VASOPRESSIN Duration of Action

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Duration of Action: Variable

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SUCCINYLCHOLINE Dosage Forms/Packaging

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Dosage Forms/Packaging: 20, 50, 100mg/ml; 1G multi-dose vial

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VASOPRESSIN Dosage Forms/Packaging

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Dosage Forms/Packaging: 5 U / ml

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SUCCINYLCHOLINE Arizona Drug Box Supply Range

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AZ Drug Box : None

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VASOPRESSIN Arizona Drug Box Supply Range

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AZ Drug Box : None