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30 Cards in this Set

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ACTIVATED CHARCOAL
ACTION:
Adsorbs or binds toxin preventing it from being absorbed during its transit through the gastrointestinal tract.

INDICATIONS:
• Overdose
• Poisonings

CONTRAINDICATIONS:
• Should not be given to unconscious patients

PRECAUTIONS:
• See below

ADVERSE REACTIONS:
• May induce nausea and vomiting

DOSE:
• 15 to 30 grams (3 to 6 tablespoons)

ROUTE:
• Oral or via Nasogastric Tube

HOW SUPPLIED:
• Bottle containing 25 grams
ADENOCARD: (Adenosine)
ACTIONS:
An endogenous nucleotide from human body cells, it slows conduction time through the AV-node restoring patients to a normal sinus rhythm.

INDICATIONS:
• Paroxysmal supraventricular tachycardia
• Narrow complex tachycardia

CONTRAINDICATIONS:
• 2nd or 3rd degree AV block
• Known sick sinus syndrome unless an artificial pacemaker is in place
• Known hypersensitivity to adenosine

PRECAUTIONS:
• Wide Complex Tachycardia
• Atrial Fibrillation and Atrial Flutter with a rapid ventricular response
• Patients with ASTHMA, or COPD
• Patients known or suspected of taking Theodur, Persantine or any product containing Dipyradamole

ADVERSE REACTIONS:
• Transient high grade AV block, chest pain, palpitations, and shortness of breath.

DOSAGE:
• 6mg given rapidly (1-2 seconds) IV push, followed by a 20cc flush. If the first dose fails to convert the rhythm within 2 minutes, a second dose of 12mg rapid IV push, followed by a 20 cc flush, may be administered. The half-life of adenocard is 10 seconds. After drug administration flush the IV for 30 seconds.

ROUTE:
• IV. Should not be administered through veins distal to antecubital vein

HOW SUPPLIED:
• 6 mg in a 2 ml pre-filled syringe. 12 mg in a 4 ml pre-filled syringe.
• 6 mg in a 2 ml vial
ASPIRIN
ACTIONS:
Aspirin blocks pain impulses in the CNS, dialates peripheral vessels, and inhibits platelet aggregation.

INDICATIONS:
• Prevention of platelet aggreagation in ischemia and thromboembolism
• Unstable angina
• Prevention of myocardial infarction or reinfarction

CONTRAINDICATIONS:
• Hypersensitivity to salicylates
• GI bleeding
• Active ulcer disease
• Hemorrhagic stroke
• Bleeding disorders

PRECAUTIONS:
• None

ADVERSE REACTIONS:
• Stomach irritation
• Indigestion
• Nausea or vomiting
• Allergic reaction

DOSAGE:
• 162 mg

ROUTE:
• Chewed and swallowed

HOW SUPPLIED:
• 81 mg chewable tablets
ATROPINE: (Atropine Sulfate)
ACTIONS:
Parasympathetic blocker, reducing vagal tone. Atropine is a Parasympatholytic (Anticholinergic) that acts to block acetylcholine receptors, thus inhibiting parasympathetic stimulation.

INDICATIONS:
• Hemodynamically symptomatic bradycardias
• Heart blocks
• Asystole
• Organic phosphate poisoning

CONTRAINDICATIONS:
• Tachycardias
• Second Degree Type II and Third Degree heart blocks

PRECAUTIONS:
• If given in too small a dose, or if given too slowly, bradycardia may worsen.

ADVERSE REACTIONS:
• Dryness of the mouth and nose, blurred vision, dilated pupils, tachycardia, headache and restlessness

DOSAGE :
ADULT:
• Brady-Dysrhythmias: 0.5mg every 5 minutes to 0.03 - 0.04mgs/kg
• Asystole: 1mg IV push to be repeated every three minutes to a maximum of 0.03 - 0.04 mgs / kg
• Organic Phosphate Poisoning: 0.5-1 mg boluses, titrating until signs / symptoms
resolve

PEDIATRIC:
• Brady and Asystole: 0.01 - 0.03 mg / kg.

ROUTE:
• IV, IM, or ET

HOW SUPPLIED:
• 1 mg in a 10 ml pre-filled syringe
• 0.5 mg in a 5 ml pre-filled syringe
BENADRYL: (Diphenhydramine Hydrochloride)
ACTION:
Benadryl is an antihistamine with anticholinergic (drying) and sedative side effects. Antihistamines compete with histamine for cell receptor sites during allergic reactions.

INDICATIONS:
• Anaphylaxis (administered after epinephrine)
• Allergic Reactions

PRECAUTIONS:
• Use with caution in patients with a history of asthma, cardiovascular disease, and hypertension
• Sedative effects are more pronounced when patient has ingested alcohol or other CNS depressants (barbiturates, phenothiazine, antidepressants, or narcotics)

ADVERSE REACTION:
• Tachycardia
• Hypotension
• Central Nervous System depression
• Nausea and vomiting

DOSAGE:
ADULT:
• 25 mg to 50 mg

PEDIATRIC:
• 10 to 25mg, usually 1 mg / kg

ROUTE:
• IV, IM

HOW SUPPLIED:
• 50 mg in a 1ml vial
• 50 mg in a 1 ml pre-filled syringe
CARDIZEM
ACTION:
Cardizem is a benzothiazepine calcium channel blocker,. Cardizem inhibits the influx of extracellular calcium across both the myocardial and vascular smooth muscle cell membranes. The end result decreases the contractility of the myocardial smooth muscle, dilation of the coronary and systemic arteries.

INDICATIONS:
• Atrial Fibrillation
• Atrial Flutter
• Angina
• Hypertension
• Paroxysmal supraventricular tachycardia (PSVT) refractory to adenosine


CONTRAINDICATIONS:
• Patients with cardiogenic shock, or patients with a systolic B/P <90mmHg.
• Patients with known accessory pathway conditions ( WPW )

PRECAUTIONS:
• Use with caution in patients with ventricular dysfunction, severe bradycardia or with previous conduction abnormalities
• It should not be used in obstetric patients


ADVERSE REACTION:
• Systemic hypotension
• Nausea/Vomiting
• Bradycardias
• Heart blocks
• Asystole.

DOSAGE:
• .25 mgs /kg IV over 2-3 minutes, not to exceed 20 mgs
• If necessary a second dosage of .35 mgs /kg IV may be given over 2-3 minutes, not to exceed 25mgs.
* NOTE: There is to be a 15-minute interval between 1st and 2nd dosage.

ROUTE:
• IV

HOW SUPPLIED:
• 25 mg in a 5 ml pre-filled syringe.
CORDARONE (Amiodarone)
ACTIONS:
Antiarrhythmic drug with sodium channel blocking, and anti-sympathetic nervous system properties, resulting in negative dromotropic effect on the heart. Prolonged administration results in a lengthening of the cardiac action potential. Amiodarone possesses negative chronotropic effects slowing conduction and prolonging the refractory period. Amiodarone administration prolongs intranodal conduction and refractoriness of the atrioventricular node, but has no effect on the sinus node. Used in a wide variety of atrial and ventricular tachyarrhythmias and for rate control of rapid atrial arrhythmias in patients with impaired LV function.

INDICATIONS: Ventricular Fibrillation and Pulseless Ventricular Tachycardia.
• Treatment of Polymorphic Ventricular Tachycardia and Wide Complex Tachycardia of uncertain etiology
• Control of hemodynamically stable Ventricular Tachycardia when cardioversion is unsuccessful
• Used as adjunct to cardioversion of SVT and PSVT
• May be used for rate control in atrial fib and flutter when other therapies are ineffective or contraindicated
• Acceptable for termination of ectopic or multifocal atrial tachycardia with Left Ventricular dysfunction

CONTRAINDICATIONS:
• Torsade de Pointes
• Cardiogenic Shock
• Hypotension

PRECAUTIONS:
• May produce vasodilatation and hypotension, and negative inotropic effects
• May prolong QT interval, DO NOT USE WITH OTHER DRUGS THAT PROLONG THE QT INTERVAL
• Use with caution in renal failure, half-life can last up to 40 days

ADVERSE REACTIONS:
• Hypotension
• Headache
• Bradycardia
• AV conduction abnormalities
• Flushing

DOSAGE:
• Cardiac Arrest: 300 mg IV push, repeated in 3-5 minutes at 150 mgs if required.
• Wide Complex Tachycardia (stable): 150mg in 100 ml D5W over 10 minutes
• Pediatric dose in VF/pulseless VT is 5 mg / kg
• Pediatric dose in perfusing supraventricular and ventricular arrhythmias is 5mg / kg over 20-60 minutes ( max of 15 mg /kg / day ).
ROUTE:
• IV
HOW SUPPLIED: 150 mg in a 3 ml vial
D5W: (5% dextrose in water)
ACTION:
D5W is a hypotonic glucose solution, used to keep a vein open and to supply calories necessary for cell metabolism. While it will have an initial effect of increasing the circulatory volume, glucose molecules rapidly diffuse across the vascular membrane with a resultant free water increase. It has a Ph of 4.3 and contains 5g of dextrose per 100ml.

INDICATIONS:
• Infusion of Cordarone or Magnesium Sulfate

CONTRAINDICATIONS:
• None for its intended use

PRECAUTIONS:
• N/A

ADVERSE REACTIONS:
• N/A

DOSAGE:
• 100 ml

ROUTE:
• IV infusion

HOW SUPPLIED:
• 100 ml bags
DOPAMINE: (Intropin)
ACTION:
Vasopressor – dose dependent alpha, beta, and dopaminergic agonist.
• Low dose (0.5-2mcg/kg/min.) causes vasodilatation in renal, mesenteric, cerebral, and coronary arteries, via activation of the dopamine receptor sites.
• Intermediate doses (2-10 mcg/kg/min.) produce a step-wise increase in contractility, automaticity, and conductivity via beta-receptor effects.
• High doses (10-20mcg/kg/min.) the alpha receptor effects predominate producing peripheral vasoconstriction.
• Extremely dose (>20mcg/kg) renal and mesenteric vessels constrict resulting in decreased blood flow.

INDICATIONS:
• Hypoperfusion due to myocardial infarction, sepsis, severe congestive heart failure, and pulmonary edema
• Cardiogenic shock

CONTRAINDICATIONS:
• Tachydysrhythmias
• VF

PRECAUTIONS:
• Correct any volume deficit before instituting dopamine therapy, unless otherwise directed.
• Do not mix with Sodium Bicarbonate; this deactivates Dopamine

ADVERSE REACTIONS:
• Ectopy, local tissue narcosis if line infiltrates, tachycardia, palpitations, dysrhythmias, hypotension, nausea and vomiting

DOSAGE:
• 400mg/250cc premixed bag yields 1600mcg/ml
• Initiate therapy at rate of 5mcg/kg/min and titrate to a blood pressure of 100 systolic in adults and 80-90 in pediatric patients

ROUTE:
• IV

HOW SUPPLIED:
• 400 mg in a 10 ml pre-filled syringe
• 400 mg in a 250 ml premix bag
GLUCAGON
ACTION:
Pancreatic hormone, Insulin antagagonist. Increases the breakdown of glycogen to glucose and stimulates glucose synthesis, resulting in blood glucose elevation.

INDICATIONS:
• Persistent symptomatic hypoglycemia
• Unable to gain IV access

CONTRAINDICATIONS:
• Hypersensitivity
• Only effective if liver glycogen is available
• May be ineffective in chronic states of hypoglycemia, starvation, and adrenal insufficiency
• Do not mix with saline

PRECAUTIONS:
• None

ADVERSE REACTIONS:
• Tachycardia
• Hypotension
• Nausea and vomiting
• Urticaria

DOSAGE:
ADULT:
• 0.5 – 1 mg IM

PEDIATRIC:
• 0.025 – 1 mg IM

ROUTE:
• IM

HOW SUPPLIED:
• Glucagon must be reconstituted (with provided diluent) before administration
• Dilute 1 unit (1 mg) white powder in 1 ml of diluting solution (1 mg / ml)
EPINEPHRINE
ACTION:
Alpha and beta adrenergic agonist that stimulates all the effects of the sympathetic nervous system except those affecting the arteries of the face and sweat glands; major sympathetic effects include: Positive chronotropic effect, positive inotropic effect, increased systemic vascular resistance, bronchodilation, assist in the conversion of ventricular fibrillation, and Increased cerebral blood flow in cardiac arrest

INDICATIONS:
• Asystole
• Pulseless electrical activity
• Heart blocks, bronchospasms, and anaphylaxis.
• Hemodynamically unstable bradycardias
• Ventricular fibrillation (in the absence of Vasopressin)
• Pulseless ventricular tachycardia

CONTRAINDICATIONS:
• Hypovolemic Shock

PRECAUTIONS:
• Give cautiously in patients with hypertension, tachycardia, or who are pregnant.
• Do not mix with Sodium Bicarbonate. This results in a deactivation of the Epinephrine.

ADVERSE REACTIONS:
• Tachycardia, palpitations, anxiety and headache
• Increased myocardial oxygen demand

DOSAGE:
• Ventricular Fibrillation, Pulseless Ventricular Tachycardia, Pulseless Electrical Activity and Asystole – 1 mg of 1:10,000 repeated every three to five minutes.
• Endotracheal Dose is 2 times the IV dose (give one time only)
• Asthma and Anaphylactoid reactions 0.3ml of 1:1,000 is given sq.
• Anaphylactic shock (life threatening) 2 mg of 1:1,000 in 250 NS started at 1 mcg / min and titrate to effect.
• Epinephrine Drip – Bradycardias and blocks 2 mg/250cc run at 2-4 mcg / min
• See Broslow Tape for correct pediatric dose

ROUTE:
• IV,IM,ET,SQ.

HOW SUPPLIED:
• 1:1000 - 1 mg in a 1 ml Tubex syringe, 30mg in 30cc multi-dose vial
• 1:10,000 – 1 mg in a 10ml pre-filled syringe.
IPECAC SYRUP
ACTION:
Ipecac is an Emetic class of drug that causes gastric irritation and stimulates the chemoreceptor trigger zone of the medulla.

INDICATIONS:
• Syrup of Ipecac is a potent and effective emetic used in the management of poisonings where the induction of vomiting is indicated

CONTRAINDICATIONS:
• Semiconscious patients
• Ingestion of caustic agents, hydrocarbons, acids and alkali
• Patients with no gag reflex
• Also not indicated when the ingested agent was an anti-emetic, especially phenothiazine

PRECAUTIONS:
• Be attentive to airway management

ADVERSE REACTIONS:
• Arrhythmias
• Hypotension
• Diarrhea
• Depression

DOSAGE:
ADULT: 30 ml
PEDIATRIC: 15 ml
INFANT: 10 ml
• In all three age groups the Ipecac should be followed by two or three glasses of water. The Ipecac may be repeated in 20 minutes.

ROUTE:
• Orally

HOW SUPPLIED:
• 30 ml per bottle
LACTATED RINGERS
ACTION:
Lactated Ringers is an isotonic crystalloid solution, used for fluid and electrolyte replacement. Lactated Ringers remains in the vascular for 30-60 minutes.

INDICATIONS:
• Hypovolemic Shock
• Any condition causing body fluid loss

CONTRAINDICATIONS:
• Congestive Heart Failure
• Pulmonary Edema

PRECAUTIONS:
• Use with caution in patients with renal disease
• Monitor patients for signs and symptoms of circulatory overload

ADVERSE REACTIONS:
• Phlebitis
• Venous thrombosis
• Fluid overload

DOSAGE:
• Titrate to effect
• Pediatric patients start at 20 ml / kg

ROUTE:
• IV

HOW SUPPLIED:
• 1000 ml bags
LASIX: (Furosemide)
ACTION:
Potent vasodilator and diuretic. Blocks the reabsorbtion of the sodium in the Loop of Henle as well as the distal and proximal tubules.

INDICATIONS:
• Congestive heart failure
• Pulmonary Edema
• Hypertension
• Cerebral Edema

CONTRAINDICATIONS:
• Dehydrated patients
• Blood Pressure <90 systolic

PRECAUTIONS:
• Patients with hypersensitivity to sulfa may experience reactions to furosemide
• May need higher doses in patients with renal failure

ADVERSE REACTIONS:
• Hypotension
• Hypokalemia electrolyte abnormalities, muscle cramps, weakness, thirst, light headiness, dizziness, nausea and vomiting

DOSAGE:
ADULT:
• 40 mg IV may be repeated X2

PEDIATRIC:
• 1 mg / kg

ROUTE:
• IV, IM

HOW SUPPLIED:
• 80 mg in 8 ml pre-filled syringe
LIDOCAINE: (Xylocaine)
ACTIONS:
Antiarrhythmic – decreases phase 4 depolarization inhibits impulse transmission in the myocardial nervous system.

INDICATIONS:
• Ventricular Fibrillation (in the absence of Amiodarone) (Class IIb)
• Pulseless Ventricular Tachycardia (in the absence of Amiodarone) (Class IIb)
• Significant ventricular ectopy in the seting of myocardial ischemia / infarction
• Stable Ventricular Tachycardia
• Wide Complex Tachycardia of unclear etiology

CONTRAINDICATIONS:
• Bradycardia with PVC’s

PRECAUTIONS:
• Prophylactic use in MI’s is not indicated
• Reduce dose (maintenance, not loading) with liver impairment or LV dysfunction
• Discontinue infusion at first sign of toxicity

ADVERSE REACTIONS:
• Lidocaine Toxicity (Light headiness, dizziness, blurred vision, nausea, vomiting, seizures, hypotension, bradycardia and central nervous system depression)

DOSAGE:
ADULT:
• Cardiac arrest from VF/VT, 1.5mg/kg
• Refractory VF, give an additional 1.5 mg/kg dose in 5-10 minutes, achieving the maximum of 3 mg/kg
• Tracheal administration is 3 mg/kg ( used for initial dose )
• Stable VT, WCT, significant ectopy, 1-1.5mg/kg IV push, repeat .5 to .75mg/kg every 5-10 minutes to a max of 3mg/kg
• Maintenance infusion 1-4mg/min

PEDIATRIC (up to 38kgs):
• Loading dose: 1 mg/kg
• Infusion: Utilize Broselow tape for appropriate concentration and infusion rates

HOW SUPPLIED:
• 100 mg in a 5 ml pre-filled
• 1 Gram in a 250 ml premix bag
MAGNESIUM SULFATE
ACTIONS:
Magnesium is an intracellular electrolyte that is vital to many body functions. It acts as a physiological calcium channel blocker and blocks neuromuscular transmission. Hypomagnesemia will greatly affect the neuromuscular, gastrointestinal and cardiovascular systems. Hypomagnesemia is associated with cardiac arrhythmias, symptoms of cardiac insufficiency, and sudden death. Hypomagnesemia can cause refractory ventricular fibrillation. Administration of magnesium sulfate in the emergency setting appears to reduce the incidence of ventricular arrhythmias that follow an acute myocardial infarction.

Magnesium sulfate is a central nervous system depressant effective in the management of seizures associated with eclampsia. It is used for the initial therapy of convulsions associated with pregnancy. If Magnesium fails to control seizures, procede with other anticonvulsant agents.

INDICATIONS:
• Cardiac arrest if torsade or suspected hypomagnesemia suspected
• Ventricular Fibrillation refractory to Amiodarone
• Torsade de Pointe with a pulse
• Life threatening arrhythmias with digitalis toxicity
• Eclampsia

CONTRAINDICATIONS:
• Heart Block or AMI

PRECAUTIONS:
• Magnesium should be administered slowly to minimize side effects
• Maintain continuous cardiac monitoring
• Use with caution in renal failure

ADVERSE REACTIONS:
• Flushing of the skin, sweating
• Central Nervous System depression
• Respiratory depression
• Hypotension
• Bradycardias and cardiac arrhythmias

DOSAGE:
• VF/VT or torsade de pointe: 1 gram IV
• Eclampsia: 4 grams IV over 5 minutes

HOW SUPPLIED:
• 1 Gram in 2 ml vial
MORPHINE
ACTION:
Morphine is central nervous system depressant and potent analgesic.
As such morphine provides both analgesia and sedative properties. It increases peripheral venous capacity and decreases venous return while providing mild arterial dilatation; central nervous system depression; decreases myocardial oxygen demand; decreases preload and after load. Increases venous capacity equaling to decrease in venous return, which in turn causes decrease in the systemic vascular resistance.

INDICATIONS:
• Pain relief due to myocardial ischemia
• Pain relief per the “Pain Management Protocol”
• Acute pulmonary edema
• Chronic heart failure

CONTRAINDICATIONS:
• Hypotension
• Shock due to volume depletion
• Cerebral insult (traumatic or medical)
• Abdominal pain

PRECAUTIONS:
• Hypotension

ADVERSE REACTIONS:
• Hypotension
• Central Nervous System depression
• Respiratory depression

DOSAGE:
ADULT:
• Pain Management - 2mg increments, up to a maximum of 6mg.
• Congestive Heart Failure/Pulmonary Edema – 2mg increments, up to a maximum of 6mg
If more than 6mg of Morphine Sulfate is required call Emergency Department Physician for orders.

PEDIATRIC:
• 0.1 mg /kg slowly

ROUTE:
• IV , IM

HOW SUPPLIED:
• 10mg in 1ml vial
NARCAN: (Naloxone
ACTION:
Narcotic antagonist reverses the central nervous system and respiratory depression effects of narcotics; reverses the cardiovascular effects to a lesser extent. Naloxone competes for narcotic receptor sites in the brain, and displaces narcotic molecules from the opiate receptors.

INDICATIONS:
• Known or suspected narcotic overdoses involving the following:
• morphine Demerol heroin
• paregoric Dilaudid codeine
• Percodan Fentanyl methadone
• Known or suspected overdoses of the following synthetic narcotics:
• Nubian Talwin Stadol Darvon
• Coma of unknown origin
• Unwitnessed cardiac arrests

CONTRAINDICATIONS:
• Hypersensitivity reaction

PRECAUTIONS:
• Narcan should be administered cautiously to patients who are known or suspected to be physically dependent on narcotics. Abrupt and complete reversal of narcotic effects by Naloxone can cause withdrawal-type effects.

ADVERSE REACTIONS:
• Aspiration
• Hypotension/hypertension
• Ventricular arrhythmias
• Nausea/Vomiting
• Acute narcotic withdrawal syndrome (nausea, vomiting, sweating, tachycardia, hypertension, tremor, agitation, diarrhea, abdominal cramps, seizures, and cardiac arrest)

DOSAGE:
ADULT:
• 2 mg (higher doses 2-5mg may be required in Darvon OD)

PEDIATRIC:
• 0.1mg/kg

ROUTE:
• IV, IM, SQ, ET

HOW SUPPLIED:
• 2 mg in a 2 ml pre-filled syringe
NITROGLYCERIN DRIP: (Tridal
ACTION:
Antianginal Agent: Nitroglycerin is a rapid smooth-muscle relaxant that reduces cardiac work and, to a lesser degree, dilates the coronary arteries. This results in increased coronary blood flow and improved perfusion of the ischemic myocardium. Relief of ischemia causes reduction and alleviation of chest pain. Pain relief following nitroglycerine administration usually occurs within 1-2 minutes, and the therapeutic effects can be observed up to 30 minutes later.

As a rapid-acting smooth-muscle relaxant, nitroglycerine causes vasodilation, which reduces preload. Decreased preload leads to decreased cardiac work and relaxation of the vascular smooth muscle and consequent dilation of the peripheral arteries and veins. Arteriolar relaxation reduces systemic vascular resistance and systolic arterial pressure, thereby reducing afterload, further reducing the workload of the myocardium.

INDICATIONS:
• Angina pectoris
• Myocardial infarction
• Congestive heart failure
• Hypertension

CONTRAINDICATIONS:
• Hypotension
• Increased intracranial pressure
• VIAGRA taken within 24 hours

PRECAUTIONS:
• Volume-depleted patients may experience exaggerated hypotensive response
• Postural hypotension
• Right Inferior Infarct

ADVERSE REACTIONS:
• Headache
• Nausea/Vomiting
• Tachycardia
• Dizziness
• Palpitations
• Apprehension

DOSAGE:
• 25 mg in 250cc of D5W (100ug/cc). Starting at 5ug/min and titrate to effect.

ROUTE:
• IV infusion

HOW SUPPLIED:
• 25 mg in 250 ml of D5W
NITROGLYCERIN SPRAY
ACTION:
Antianginal Agent: Nitroglycerin is a rapid smooth-muscle relaxant that reduces cardiac work and, to a lesser degree, dilates the coronary arteries. This results in increased coronary blood flow and improved perfusion of the ischemic myocardium. Relief of ischemia causes reduction and alleviation of chest pain. Pain relief following nitroglycerine administration usually occurs within 1-2 minutes, and the therapeutic effects can be observed up to 30 minutes later.

As a rapid-acting smooth-muscle relaxant, nitroglycerine causes vasodilation, which reduces preload. Decreased preload leads to decreased cardiac work and relaxation of the vascular smooth muscle and consequent dilation of the peripheral arteries and veins. Arteriolar relaxation reduces systemic vascular resistance and systolic arterial pressure, thereby reducing afterload, further reducing the workload of the myocardium.

INDICATIONS:
• Angina pectoris
• Myocardial infarction
• Congestive heart failure
• Hypertension

CONTRAINDICATIONS:
• Hypotension
• Increased intracranial pressure
• VIAGRA taken within 24 hours

PRECAUTIONS:
• Volume-depleted patients may experience exaggerated hypotensive response
• Postural hypotension
• Right Inferior Infarct

ADVERSE REACTIONS:
• Headache
• Nausea/Vomiting
• Tachycardia
• Dizziness
• Palpitations
• Apprehension

DOSAGE:
• 0.4 mg that may be repeated one or two more times depending on the patient’s blood pressure

ROUTE:
• Sublingual

HOW SUPPLIED:
• Each aerosol contains 200-metered doses of 0.4mg
NORMAL SALINE: (0.9% Sodium Chloride)
ACTION:
Normal saline is an isotonic crystalloid solution, used for fluid and electrolyte replacement. 0.9% normal saline contains 154 Milliequivalents of sodium ions (Na+) and 154 Milliequivalents of chloride (Cl-) ions per liter of thus making it isotonic with the extracellular fluid. It has a Ph of 5.0 and contains 900mg of sodium per 100ml.

INDICATIONS:
• Diabetic ketoacidosis
• Heat related emergencies
• Freshwater drowning
• Keep vein open

CONTRAINDICATIONS:
• Congestive Heart Failure
• Pulmonary Edema

PRECAUTIONS:
• Circulatory overload
• Renal disease
• Large volume infusion may dilute other electrolytes; Lactated Ringers may be a more prudent choice for large volume infusion

ADVERSE REACTIONS:
• Febrile response
• Infection at the injection site
• Venous thrombosis

DOSAGE:
• Titrate to effect; larger volumes may be required in patients suffering DKA

ROUTE:
• IV

HOW SUPPLIED:
• 100ml bags, 250 ml bags, 1000 ml bags
OXYGEN
ACTION:
Increased concentrations of oxygen increase the saturation level in the hemoglobin in the red blood cell. This results in an increased oxygenation level at the tissue. Oxygen is required for the efficient breakdown of glucose into a usable energy form.

INDICATIONS:
• Hypoxia
• Oxygen should be used in any type of patient that has or may have a condition in which an increased oxygen level will decrease tissue hypoxia
• Chest pain
• Abdominal pain
• Trauma patients
• Respiratory distress

CONTRAINDICATIONS:
• None

PRECAUTIONS:
• Possible oxygen toxicity in COPD patients
• Never deprive the hypoxic patient of oxygen for fear of respiratory depression

ADVERSE REACTIONS:
• None

DOSAGE:
• Patients in mild distress should receive 4 to 6 liters via a nasal cannula
• Patients in moderate to severe distress from should receive 100% oxygen via a 100% non-rebreather
• Severe multiple trauma patients, cardiac arrest patients, severe pulmonary edema, etc., should be orally or nasally intubated

ROUTE:
• Self-Explanatory

HOW SUPPLIED:
• Self-Explanatory
PROVENTIL: (Albuterol Sulfate)
ACTIONS:
A selective beta-2 adrenergic receptor agonist, thereby decreasing bronchospasms.

INDICATIONS:
• Asthma
• Chronic bronchitis
• Emphysema
• Anaphylaxes
• Chronic Obstructive Pulmonary Disease (COPD)
• Pulmonary edema

CONTRAINDICATIONS:
• Cardiac dysrhythmias associated with tachycardias

PRECAUTIONS:
• Concern should be given in patients with a history of cardiovascular disease due to the beta-2 effect Albuterol has on the heart.
• Hypertension
• Sensitivity to the drug

ADVERSE REACTIONS:
• Tachycardia
• Palpitations
• Paradoxical bronchospasms
• Exacerbation of angina
• Anxiety
• Hypertension
• Palpitations

DOSAGE:
ADULT:
• One dose vial (2.5mg in 3 ml NS) nebulized

PEDIATRIC:
• Remove 1.5 ml of solution, replace with 1.5 ml of NS to half concentration

ROUTE:
• Nebulizer at 6 liters per minute

HOW SUPPLIED:
• 2.5 mg in a 3 ml vial
SODIUM BICARBONATE
ACTION:
Alkalinizing agent used in the treatment of metabolic acidosis.

INDICATIONS:
• Any life – threatening acidosis
• Cardiac Arrest (after defibrillation, airway management, and other pharmaceutical interventions) Rarely administered in the first 10 minutes of resuscitation
• Tricyclic antidepressant overdose
• Known hyperkalemia
• Phenobarbital overdose

CONTRAINDICATIONS:
• Respiratory acidosis

PRECAUTIONS:
• Possible fluid overload in patients with a history of heart failure
• Precipitates calcium chloride
• Inactivates catecholamines

ADVERSE REACTIONS:
• Metabolic alkalosis
• Tissue necrosis if the IV infiltrates.

DOSAGE:
ADULT/PEDIATRIC:
• 1Meq/kg of 8.4% repeated in 10-15 minutes if necessary at 0.5Meq/kg

INFANT:
• 2Meq/kg of 4.2% repeated in 10-15 minutes if necessary at 1Meq/kg

ROUTE:
• Intravenously and Intraosseous.

HOW SUPPLIED:
• 8.4% - ADULT: 50 Meq in 50 ml, in a pre-filled syringe.
• 4.2% - INFANT: 5 Meq in 10 ml, in a pre-filled syringe.
SUCCINYLCHOLINE: (Anectine / Quelicin)
ACTION:
A short acting, depolarizing skeletal muscle relaxant. Combines with the cholinergic receptors in the motor nerves to cause depolarization. Neuromuscular transmission is thus inhibited, which renders the muscles unable to be stimulated by acetylcholine. Following IV injection, complete paralysis is obtained within 1 minute and persists for approximately 4-6 minutes. Effects then begin to fade, and a return to normal is seen within 6 minutes. Muscle relaxation begins in the eyelids and jaw. It progresses to the limbs, the abdomen, and finally the diaphragm and intercostals. Succinycholine has no effect on consciousness.

INDICATIONS:
• To achieve temporary paralysis where endotracheal intubation is indicated and where muscle tone or seizure activity prevents it.
• Used in conjunction with Versed in the Rapid Sequence Induction protocol.

CONTRAINDICATIONS:
• Known hypersensitivity to the drug
• Individuals with a history of malignant hyperthermia
• Skeletal muscle myopathies
• Penetrating eye injuries
• Narrow angle glaucoma
• Pediatric patients under the age of 1
• Burns/crush injury post 24 hr

PRECAUTIONS:
• Fractures have been reported in children due to the strong and sustained muscle fasciculation

ADVERSE EFECTS:
• Hypotension
• Bradycardia
• Dysrhythmias
• Initial muscle fasiculations
• Malignant hyperthermia

DOSAGE:
• 1 mg / kg Adult
• 2 mg/kg Peds

ROUTE:
• IV

HOW SUPPLIED:
• 200 mgs in a 10ml vial
THIAMINE: (Vitamin B1)
ACTION:
Thiamin is a necessary component for carbohydrate metabolism. Certain states such as alcoholism and malnourishment may affect the intake, absorption, and utilization of glucose.

INDICATIONS:
• Coma of unknown origin, especially if alcohol may be involved, with Thiamine given prior to glucose administration
• Delirium tremors, with Thiamine given prior to glucose administration

CONTRAINDICATIONS:
• Hypersensitive reaction to Thiamine

PRECAUTIONS:
• Thiamine should be administered prior to the administration of glucose

ADVERSE REACTIONS:
• Allergic reaction

DOSAGE:
• 100 mg

ROUTE:
• IV, IM

HOW SUPPLIED:
• 100 mg in a 1 ml vial
• 200 mg in a 2 ml vial
VALIUM: (Diazepam
ACTION: (Benzodiazepine)
Valium is a central nervous system depressant, anticonvulsant, sedative and hypnotic medication. Valium is the principal anticonvulsant used in the prehospital setting. It suppresses the spread of seizure activity through the motor cortex of the brain. It does not appear to abolish the abnormal discharge focus.
Peek effects of Valium are seen 5 to 10 minutes after administration.

INDICATIONS:
• Major motor seizures
• Status epilepticus
• Conscious sedation prior to cardioversion
• Muscle spasms
• Delirium tremors associated with acute alcohol withdrawal
• Acute anxiety states

CONTRAINDICATIONS:
• History of hypersensitivity to Valium

PRECAUTIONS:
• Respiratory depressant effects are more pronounced when patient has ingested alcohol or other CNS depressant agents
• Because Valium is a relativity short acting drug, seizure activity may recur
• Administer slowly until desired effects are obtained (1ml per minute)

ADVERSE REACTIONS:
• Respiratory depression
• Hypotension
• Bradycardia

DOSAGE:
ADULT:
• Sedation, seizures and muscle spasms - 5 to 10mg, at a rate of 5mg/minute, if more is required contact ED Physician

PEDIATRIC:
• 0.2mg/kg at a rate of 1mg/min

ROUTE:
• IV, IM, rectal

HOW SUPPLIED:
• 10 mg in a 2 ml vial
VASOPRESSIN
ACTION: (Hormone)
The mechanism of action of Vasopressin during cardiac arrest is poorly understood. Hemodynamic measurements suggest it causes profound shunting of blood to the myocardium and brain and away from the muscles and skin. This may be mediated by the release of nitric oxide. In the brain Vasopressin provides significantly more perfusion during cardiopulmonary resuscitation than epinephrine, perhaps secondary to nitric acid release.

Unlike epinephrine, Vasopressin continues to cause intense vasoconstriction in the presence of the severe acidosis that accompanies cardiopulmonary arrest. Vasopressin possesses a longer duration of action than epinephrine. Unlike epinephrine, which significantly increases myocardial oxygen consumption via ß1-adrenergic receptor activation, Vasopressin enhances myocardial oxygen delivery and may increase cardiac contractility, without the marked increased in oxygen consumption observed with catecholamines."

INDICATION:
• Refractory Ventricular Fibrillation
• Pulseless Ventricular Tachycardia
• May be useful for hemodynamic support in vasodilatory shock (septic or anaphylactic shock)

CONTRAINDICATIONS:
• Known hypersensitivity to the drug
• Responsive patients with known coronary artery disease

PRECAUTIONS:
• Potent peripheral vasoconstrictor.
• Increased peripheral vascular resistance may provoke cardiac ischemia and angina

ADVERSE REACTIONS:
• Local or systemic allergic reactions

DOSAGE:
• Ventricular Fibrillation: 40 units, administered one time only
• Pulseless Ventricular Tachycardia: 40 units, administered one time only
• The half-life of Vasopressin is 10-20 minutes.

ROUTE:
• IV

HOW SUPPLIED:
• 20 units in a 2ml vial
VERSED: (Midazolam)
ACTION:
Versed is a potent, but short-acting benzodiazepine with strong hypnotic and amnestic properties. It is widely used as a sedative prior to cardioversion and intubation. Versed is 3-4 times more potent than Valium, with a 1.5 minute onset of action when administered intravenously and 15 minutes when administered intramuscularly. Versed has impressive amnestic properties making it the drug of choice for conscious sedation. Like all benzodiazepine class drugs, Versed is a central nervous system depressant.

INDICATIONS:
• General anesthesia
• Conscious sedation of patients prior to short-term invasive procedures (intubation, cardioversion, etc.)
• Versed may be used as a 2nd line drug in seizures, where Valium does not work (in adults only)

CONTRAINDICATIONS:
• Not to be used in pediatrics for seizure control
• Hypersensitivity to the drug
• Narrow-angle glaucoma
• Obstetrical patients in the last few weeks of pregnancy

PRECAUTIONS:
• A slight to moderate decrease in mean arterial pressure, cardiac output, systemic vascular resistance and heart rate may be seen
• Lower dosages should be considered in patients that are debilitated or chronically ill

ADVERSE REACTIONS:
• Respiratory depression
• Laryngospasm
• Bronchospasm
• Respiratory depressant effects are more pronounced when patient has ingested alcohol or other CNS depressant agents

DOSAGE:
• Conscious Sedation: 2 mg slow IV push, repeat as necessary in boluses of 0.5–2mgs, titrated to the desired level of sedation, do not exceed a total dosage of 10mgs IV.
• Seizures 2-5 mgs IV (in adults only).
• Additional dosages may be titrated to achieve the desired level of sedation.
NOTE: You may dilute 5mg of Versed in 9cc of saline to result in a 0.5mg/cc concentrated.

ROUTE:
• IV, IM

HOW SUPPLIED: 5 mgs in a 1ml vial
DEXTROSE: (D50/D25)
ACTION:
Dextrose in water supplies supplemental glucose in cases of hypoglycemia. D-50% is a hypertonic solution primarily used to elevate the blood sugar. It may be used to initially decrease intracranial pressure.

INDICATIONS:
• Hypoglycemia
• Coma of unknown origin
• Cardiac arrest
• And in rare instances cerebral edema

CONTRAINDICATIONS:
• Patients with increased ICP or intracranial hemorrhage

PRECAUTIONS:
• Perform a glucometer check and draw a blood tubes prior to administration, if possible
• Localized venous irritation and tissue necrosis may result from infiltrated line

ADVERSE REACTIONS:
• Hyperglycemia
• Thrombophlebitis

DOSAGE:
ADULT:
• 25 grams of D50

PEDIATRIC:
• 0.25 - 0.5 gm / kg of D25

ROUTE:
• IV

HOW SUPPLIED:
• D-50 - 25 grams glucose in a 50 ml pre-filled syringe.
• D-25 - 2.5 grams of glucose in a 10 ml pre-filled syringe.