Paramedic Drug Cards

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Category A Drugs

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Safe for fetus. unable to cause problems in first trimester and is safe for 2nd and 3rd trimesters. Risk very remote.

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Category B drugs

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animal reproductive studies showed no risk to fetus but there are no controlled studies done on women OR animal control studies showed an adverse affect that was not confirmed in women in 1st trimester and is safe in later trimesters.

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Catergory C drugs

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studies in animals reveal harmful effect or there is no data on this effect in women. These drugs should only be given when thier effects are greater than the risks.

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Category D drugs

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positive evidence of human fetal risk however the benefits may be acceptable despite the risk as in life-threatening events in which safer drugs arent an option.

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Category X drugs

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studies shown human fetal abnormalities. The use of this drug clearly outweighs any possible benefit. Contraindicated in Pregnacy.

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Atropine Sulfate

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Class:
Anticholinergic Agent
Category: C
Action:
Parasympatholytic
blocks acetylcholine
increases SA node automaticity and AV conduction. Small doses inhibit salivary and bronchial secretions, moderate doses dilate pupils and increase heart rate. Large doses decrease GI motility, inhibit gastric acid secretion. Blocked vagal effects result in positive chronotropy and positive dromotropy (limited or no inotropic effect).
Onset: Rapid
Duration: 2-4 hrs
Indications: Hemodynamically significant bradycardia
Asystole
PEA
Organophosphate poisoning (drug of choice)
Pretreatment in pediatric patients receiving RSI.
Dose: Adult
0.5 - 1.0 mg for bradycardia every 3 - 5 min to total dose of 0.04 mg/kg. endotracheal route - 1-2 mg diluted in 10 mL sterile water or normal saline.
Pedi: asystole- 0.02 mg/kg Min dose 0.1mg; max single dose of 0.5 mg for a child and 1.0 mg for an adolescent
PEA- 1 mg IV (if bradycardic), repeat every 3-5 minutes, max 0.03 – 0.04mg/kg.
Anticholinesterase Poisoning
Adult-2 mg IV push every 5-15 minutes to dry secretions. No max dose.
Pedi-0.05 mg/kg/dose (usual dose 1-5 mg) IV, may be repeated in 15 minutes
Contraindications:
Tachycardia
Hypersensitivity
Unstable cardiovascular status in acute hemorrhage with myocardial ischemia
Adverse Reactions:
Tachycardia
Possible paradoxical bradycardia when pushed slowly or when used at doses less than 0.5mg
Palpitations, dysrhythmias, headache, dizziness, nausea/vomiting, flushed and dry skin, allergic reactions.
Anticholinergic effects (dry mouth/nose, photophobia, blurred vision, urine retention)..think anti-SLUDGE.

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Adenosine

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Adenocard
Class:
endogenous nucleotide
Cat: C
Action:Adenosine is primarily formed from the breakdown product of adenosine triphosphate (ATP). Both compounds are found in every cell of the human body, and have a wide range of metabolic roles. Its actions in the AV node are thought to act through stimulation of specific adenosine receptors. Adenosine slows those tachycardias associated with the AV node (i.e. AV Node Re-entry Tachycardias) by decreasing conductivity through the node. Specifically, activation of A1 receptors in the AV node activate an inward potassium channel and inactivation of inward slow calcium channels that result in membrane hyperpolarization. This decreases the speed of AV node conduction and increases the AV node refractory period.
Onset: within 3 seconds
Duration: 10 seconds
Indications:
PSVT including WPW
Contraindications:
Second or third degree AV block, or sick sinus syndrome or hypersensitivity.
Adverse reactions:
Lightheadedness, hypotension, paresthesia, shortness of breath, headache, transient periods of sinus bradycardia and ventricular ectopy, palpitations, chest pain, nauseua
Drug interactions:
Methylxanthines (ie caffeine and theophylline) antagonize the action of adenosine.
Dipyridmole potentiates the effect of adenosine; you may need to reduce dose of adenosine
Carbamazepine may potentiate the AV-nodal blocking effect of adenosine, therefore the adenosine dose may need to be decreased.
Dose:
6mg, 12, 12
Pedi- .1, .2, .2, max 12mg

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Albuterol

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Ventolin, proventil
Class:
Sympathomimetic, bronchodilator
Action:
Primarily beta 2 -selective sympathomimetic. Relaxes smooth muscle of the bronchial tree and peripheral vascula
Onset: 5-15 min after inhalation
Duration: 3-4 hrs
Indications:
Relief of bronchospasm
Beta-blocker overdose
Hyperkalemia
Contraindications:
Prior hypersensitivity reaction to albuterol
Cardiac dyshythmias associated with tachycardia
Adverse Reactions:
restlessness, apprehension, dizziness, palpitations, increase in BP, dysrhythmia
Drug Interactions:
As with all sympathomimetics, may exacerbate adverse cardiovascular effects.
Antidepressants may potentiate the effects on the vasculature.
Beta-blockers may antagonize albuterol.
Albuterol may potentiate diuretic-induced hypokalemia.
Dose:
2.5 mg neb
Pedi-0.01 - 0.03 ml maximum of 0.50 ml/dose

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Aminophylline

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Amoline, Somopphyllin, Aminophyllin
Class:
Xanthine Bronchodilator (theophylline derivative)
Onset:
less than 15 min IV
Duration:
4 1/2 hrs
Indications:
Severe bronchospasm (associated with asthma, chronic bronchitis, emphysema).
Severe bronchospasm associated with pulmonary edema
May be effective when sympathomimetics have been ineffective
Congestive heart failure.
Contraindications:
Allergy to xanthine compounds (for example, caffeine).
Currently taking theophylline containing medication
Hypersensitivity to the drug
Cardiac dysrhythmia
Adverse Reactions;
Tachycardia, palpitations, PVCs, angina pectoris, dizziness, anxiety, headache, seizure, nausea and vomiting, adbominal cramps.
Drug Interactions;
Beta blockers may oppose effects.
Barbiturates, phenytoin and smoking may decrease theophylline levels.
Dose:
5 mg/kg (if wheezing) in 50-100 ml of diluent over 10 – 20 min, followed by 0.5 – 0.7 mg/kg/hr (max 200 mg/min)
Pedi dose:
0.01 - 0.03 ml (0.05 - 0.15 mg)/kg/dose to maximum of 0.50 ml/dose diluted in 2 ml of 0.9% saline solution adminstered by nebulizer. May be repeated q 20 minutes X 3

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Amiodorone

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Cordarone
Class:
Antiarrhythmic (Class III)
Action:
Prolongs duration of action potential and effective refractory period, also provides noncompetitive a- and b- adrenergic inhibition. Decreases AV conduction velocity and sinus node function.
Onset:
Within minutes IV
Duration:
days
Indications:
VF, unstable VT and SVT refractory to other therapy. Trials underway or recently completed indicated amiodarone is an effective first line medication for VT/VF in cardiac arrest.
Contraindications:
None in cardiac arrest with VF or VT. High degree AV blocks, sinus node dysfunction and marked bradycardia.
Adverse Reactions:
Hypotension, bradycardia
Drug Interactions:
Enhanced bradycardia and hypotension when given with other b-blockers or calcium channel blockers.
Dose:
IV: 300 mg bolus in cardiac arrest.
Pedi-5mg/kg then 15mg/kg/day

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Amyl Nitrate

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Class:
Vasodilator
Action:
Amyl nitrate is chemically related to nitroglycerin and has been used for many years to treat angina pectoris. It is also effective in the emergency management of cyanide poisoning by causing the oxidation of hemoglobin to the compound methemoglobin. Methemoglogbin reacts with the cyanide ion to form cyanomethemoglogin, which has less affinity for oxygen, thus freeing hemoglogin to react with oxygen.
Onset: 3 sec inhaled
Duration: 3-20 min
Indications:
Cyanide poisoning, angina
Contraindications:
none for cyanide poisoning, use caution with cyanide and CO poisoning.
Adverse Reactions:
Hypotension, tachycardia, palpitations, syncope, headache, nausea
Dose:
ampule broken and inhaled for 30-60 seconds. Repeat PRN.
Cat: C

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anisoylated plasminogen streptokinase activator (APSAC®, Anistreplase®)

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Class:
fibrinolytic (thrombolytic)
Action;
Anisoylated plasminogen streptokinase activator is a complex that converts plasminogen to the proteolytic enzyme plasmin. Plasmin degrades fibrin clots as well as fibrinogen and certain other plasma proteins. Following administration, plasma fibrinogen levels are decreased for 24-36 hours, and thrombin time may remain prolonged for 24 hours.
Onset:
10-20 min
Duration:
12-24 hrs
Indications:
Acute evolving transmural myocardial infarction.
Contraindications:
Active bleeding, recent CVA, intracranial or intraspinal surgery
Uncontrolled hypertension, severe allergy to the product.
Prolonged CPR, trauma, recent surgery (within 2-3 weeks), peptic ulcer disease, other bleeding disorder.
Adverse Reactions:
Bleeding
Dysrhythmias (IVR, Sinus Bradycardia, 2nd and 3rd degree AV Block
Allergic reactions
Dose:
30 units over 5 min

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Aspirin

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Class:
salicylate, antipyretic, NSAID
NOT an anticoagulant
Action:
Powerfully inhibits platelet aggregation by inhibiting thrombonxane A2 production. Major actions appear to be associated primarily with inhibiting the formation of prostaglandins involved in the production of inflammation, pain and fever. Lowers body temperature by indirectly causing centrally mediated peripheral vosodilation and sweating.
Onset:
15 min
Duration:
2-4 hrs
Indications:
Acute myocardial injury/infarction
Relieve pain of low to moderate intensity.
Inflammatory conditions
Reduce fever
Prevent recurrence of MI and TIA
Contraindications:
Hypersensitivity to salicylates (such as Rye syndrome)
History of GI ulceration
Hemophilia or other bleeding disorders
Pregnancy or children under 2 years
Adverse Reactions;
dizziness, confusion, tinnitus, hearing loss, nausea, heartburn, stomach pains
Dose:
325 mg PO
Cat: D

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Burophanol Tartrate

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Stadol
Class:
Opiod agonist-antagonist analgesic
Action:
Butorphanol is a synthetic analgesic that has effects similar to those of morphine (2mg of butorphanol is equivalent to 10 mg of morphine or 80 mg of meperidine). It has both narcotic agonist and antagonist properties, and should be used with caution in patients who are narcotic dependent. At present butorphanol is not restricted under the Controlled Substances Act.
Onset:
10 min IM, 1-5 min IV
Duration:
3-4 hrs
Indications:
Relief of moderate to severe pain.
Pre-operative or pre-anesthetic medication
Used to relieve pre-partum pain
Contraindications:
Hypersensitivity
Head injury
Use with caution in patients with respiratory depression
Adverse Reactions:
Sedation, headache, vertigo, hallucinations, palpitations
Increase or decrease in BP
Respiratory depression (naloxone should be available)
Patient may experience symptoms of withdrawl.
Dose:
2mg every 3-4 hrs IM
1mg every 3-4 hrs IV