Mosby's 3Rd Ed. Paramedic Pharmacology

Front 1

Activated Charcoal
(Aqua, Actidose, Liqui-char)

Back 1

Class: Adsorbent, antidote
Desc: fine black powder, binds with toxins, excreted in feces.
Inda: oral poisoning, OD
Contra: corrosives, caustics, petroleum distillates(ineffective, may induce vomiting)
Adverse Rx: nausea, vomiting, diarrhea
Onset: immediate
duration: continual
dose: 1-2g/kg body mass(larger w/food present)
adult:30-100g
ped(1-12): 15-30g
infant(less 1 yr.): 1g/kg
consider: Preg. Cat. C, does not adsorb all drugs

Front 2

Adenosine
(Adenocard)

Back 2

Class: Antidysrhythmic
Desc: slows tachycardia, decreases heart activity.
Inda: narrow complex paroxysmal supraventricular tachycardia, dysrhythmias
Contra: 2nd or 3rd degree Atrioventricular block
Adverse Rx: transient dysrhythmias, facial flushing
dyspnea, chest press. HTN headache nausea
Onset:immediate
duration: 10 sec.
dose: Adult: initial- 6mg rapid IV bolus over 1-3 sec, followed by 20mL saline flush(elevate extremity)
Adult repeat-if no response after 1-2 min, admin. 12mg in same manner(may repeat once in 1-2 min. max sing. dose 12mg)
Ped: initial-0.1mg/kg; may be doubled once(max 1st dose 6mg);rapid IV bolus,followed by 5mL saline flush
Consider:Preg. Cat. C,place pt. in mild trendelenberg pos. before admin. asystole will be present up to 15 sec. following admin. Monitor ECG during admin.

Front 3

Albuterol
(Proventil)

Back 3

Class: Bronchodilator
Desc:relaxes smooth muscles of bronchial tree
Inda:Bronchospasm
Contra:dysrhythmias associated with tachycardia
Adverse Rx:restlessness, dizziness tachycardia, dysrhythmias
Onset:5-15 min.
duration:3-4 hrs.
dose:Bronchial asthma
Adult:MDI:1-2 inhalations(90-180mcg)q4-6 hr.(wait 5min.between inhalations, max 12/day)
Solution:2.5mg(0.5mL of 0.5%sol.)dilute to 3mL w/0.9%NS(0.083%sol.) admin. over 5-15 min. 3-4x/day nebulizer.
Ped:MDI: same as adult
Solution:0.01-0.03mL(0.05-0.15mg)/kg dose to max 0.50mL/dose diluted in 2 mL f 0.9%NS, may repeat q20min 3x
consider:Preg. Cat. C

Front 4

Amiodarone
(Cordarone)

Back 4

Class: Class 3antidysrhythmic
Desc:prolongs duration of action potential & effective refractory period
Inda:initial tx of recurring v-fib &hemodynamically unstable tachycardia, refractory paroxysmal supraventricular tachycardia in conjunctionw/cardioversion
Contra:Pulmonary Congestion, cardiongenic shock, headache,
hypotension,bradycardia, sensitivity to Amiodarone
Adverse Rx:Hypotension, headache, dizziness, bradycardia, Atrioventricular
conduction abnormalities, flushing, abnormal salivation
Onset:minutes
duration:variable
dosage: Adult:
Pulseless arrest: 300mg IVpush(dilute in 20-30mL NS or D5W. Consider repeat 150mg
IVpush in 3-5min.(max total dose 2.2g IV/24hr)
Wide Complex tachycardia: may give as rapid infusion 150mgIV over 1st 10 min.(15mg/min)repeat every 10 min. PRN, or by slow infusion
360mgIV over 6hr. (1mg/min) maintenance infusion 540mgIV over 18hr.(0.5mg/min
pediatric:
pulseless arrest:5mg/kgIV bolus
perfusing tachycardias: loading dose 5mg/kgIV/IO over 20-60min.(max dose 15mg/kg/dayIV
consider: Preg. Cat. D, ECG monitoring req.slow infusion or DC if bradycardia or atrioventricular block occurs.

Front 5

Aspirin
(A.S.A., Bayer, Ecotrin, St. Josephs)

Back 5

Class:analgesic,antipyretic, antiinflammatory, antiplatlet
Desc:decreases inflammation, blocks pain impulses, dilates peripheral vessels,
decreases platlet aggregation
RECCOMENDED IN acute MI
Inda:mild-moderate pain/fever
prevention of platelet aggregation in ischemia & thromboembolism, unstable angina, prevention MI or reinfarction
Contra:GI bleed,ulcer disease
hemmorhagic stroke, bleeding disorders,hypersensitivity to
salicylates, Peds w/flulike syptoms
Adverse Rx:stomach irritation
heartburn/indigestion,nausea vomiting, allerigic rx.
Onset:15-30 min.
duration:4-6 hrs.
dose: Adult:
mild pain/fever:325-650mg/PO q 4hr.
MI:160-325mg/PO(chewble pref)
Ped:(over12)mild pain/fever:40-100mg/kg/day divided doses
Consider:Preg. Cat. D ASAP in poss. MI

Front 6

Atropine Sulfate
(Atropine)

Back 6

class:Antichlinergic agent
Desc:potent parasympatholytic,inhibits actions of acetylcholine at postganglionic parasympathetic neuroeffector sites, primarily at muscarinic receptors,inhibits salivary and bronchial secretions,dilates pupils,increases heart rate,decrease GI motility, inhibit gastric acid secretion,Blocked vagal effects result in positive chronotropy & positive dromotropy (limited or no inotropic effect)
Inda: Hemodynamically significant bradycardia,Asystole,PEA,Organophosphate poisoning,Pretreatment in ped patients receiving RSI
Contra:Tachycardia,Hypersensitivity,Unstable cardiovascular status in acute hemorrhage w/myocardial ischemia
Adverse Rx: Tachycardia,Poss.paradoxical bradycardia when pushed slowly or when used at doses less than 0.5mg,Palpitations,dysrhythmias,headache,dizziness,nausea/vomiting,flushed/dry skin,allergic rx,dry mouth/nose,photophobia,blurred vision,urine retention
Onset:rapid
duration:2-6hrs
dose:Bradydysrhythmias
Adult:0.5–1.0mg/IV,may repeat5min intervals until desired rate.(max0.03-0.04mg/kg)
Pediatric:0.02mg/kgIV,IO,ET(dilute to3-5ml)Min dose0.1mg;max single dose for0.5mg for child;1.0 mg for adolescent;may repeat in 5min for a max total of 1.0mg for child and 2.0mg for adolescent
Asystole
Adult:1.0mg/IV,ET,(1-2mg diluted to total of10ml);may repeat every3-5min(max0.03–0.04mg/kg)
Pediatric:unknown efficacy
PEA
Adult:1mg/IV(if bradycardic),repeat every3-5min,max 0.03–0.04mg/kg
Pediatric:unknown efficacy
Anticholinesterase Poisoning
Adult:2mgIV push every 5-15min to dry secretions No max
Pediatric
0.05mg/kg/dose(usual dose1-5mg)IV,may repeat in 15 min
Consider:Preg. Cat. C Pos. pressure ventilate in ET admin

Front 7

Dextrose 50%
(D50)

Back 7

Class:Carbohydrate,Hypertonicsolution
Desc:term "dextrose" used to describe the six carbon sugar d-glucose,principal form of carbohydrate utilized by body for energy production,D50 used in emergency care to treat hypoglycemia,and in management of coma of unknown origin
Inda:Hypoglycemia,Refractory cardiac arrest(controversial)
Contra:Intracranialhemorrhage
Increased intracranial pressure Known or suspected CVA in absence of hypoglycemia
Adverse Rx: Warmth, pain, burning from medication infusion,thrombophlebitis
Onset:less than 1 min.
duration:depends on degree of hypoglycemia
dose:Adult
12.5-25g slow IV push,may repeat once
Pediatric
dilute 1:1 with saline for concentration of 25%dextrose in water;administer0.5–1.0g/kg/dose(2-4cc/kg)slow IV,may repeat once.
consider:no preg. cat., draw bloodpriorto admin.

Front 8

Diazepam
(Valium)

Back 8

Class:benzodiazepine,sedative,anticonvulsant
Desc:used to treat alcohol withdrawal and grand mal seizure activity,used in conscious patients during cardioversion and TCP to induce amnesia and sedation
Inda:Acute anxiety states,Acute alcohol withdrawal,Sedation,Seizure activity,Premedication prior to countershock or TCP
Contra:Hypersensitivity,Substance abuse,Coma,Shock
Adverse Rx:Hypotension,Reflex tachycardia,Respiratory depression,Ataxia,Psychomotor impairment,Confusion,Nausea
onset:IV-rapid,IM15-30min.ET-rapid
duration:15min-1hr.
dose:Seizure
Adult
5mg over 2min(up to 10mg most adults)IV every10–15min prn
Pediatric
0.2–0.3mg/kgIV/IO(no faster than 1mg/min)every 2-5min prn;0.5mg/kg rectal dose Max dose 5mg
Premedication prior to Cardioversion/TCP
Adult
5-15mg/IV,5-10min prior to procedure
consider:preg. cat. D, may cause venous irritation,reduce dose by 50%in elderly,resuscitative equip. should be ready

Front 9

Diphenhydramine
(Benadryl)

Back 9

Class:Antihistamine
Desc:significant anticholinergic effect,high incidence of drowsiness,Competes for H1 receptors on effector,does not effect H2 receptors,has no effect on gastric acid secretion.
Inda:allergic reactions (after epinephrine)Anaphylaxis (after epinephrine)Acute extrapyramidal reactions
Contra:Acute asthma,CNS depression,MAO inhibitors,hypersensitivity
Adverse Rx:Dose-related drowsiness,Sedation,Disturbed coordination,Hypotension,Palpitations,Tachycardia,bradycardia,Thickening of bronchial secretions,Dry mouth/throat
onset:max effect 1-3hrs
duration:6-12hrs
dose:adult
25-50mgIM/IV
Pediatric
1-2mg/kgIV/IM(max 50mg)
consider:preg. cat. B

Front 10

Dopamine
(Inotropin)

Back 10

class:sympathomimetic
Desc:acts on alpha1,beta1, adernergic receptors,low doses causes renal and vascular dilation,moderate doses causes enhanced myocardialcontractility, increased cardiac output, rise in BP, high dose causeperipheral venous/arterial constriction.
Inda:Hemodynamically significant hypotension in absence of hypovolemia
Contra:VF/VT,hypovolemia, pts.w/pheochromocytoma
Adverse Rx:dose related tachydysrhythmias, HTN, Increased myocardial O2 demand
Onset:2-4min
duration:10-15min after cessation of infusion
dose:Adult
Dopaminergic response:1-5mcg/kg/min
Beta Adrenergic response:5-10mcg/kg/min
Alpha Adrenergic response:10–20mcg/kg/min
Pediatric
dilute 6mg/kg in solution to total of 100mg;begin infusion at 10mcg/kg/min IV/IO,titrate to effect (max 20mcg/kg/min)
consider:no preg. cat. infuse thorough large vein, monitor for decreased circulation

Front 11

Epinephrine
(Adrenalin)

Back 11

Class:sympathomimetic
Desc:stimulates alpha,beta 1,and beta 2 adrenergic receptors in dose-related fashion
Rapid injection produces rapid increase in BP,ventricular contractility,and heart rate.
vasoconstriction in arterioles of skin and mucosa,It antagonizes effects of histamine by decreasing
release and decreasing membrane permeability
Inda:Bronchoconstriction
Anaphylaxis,All forms of cardiac arrest,Profound symptomatic bradycardia
Contra:Hypersensitivity,Hypovolemic shock,Coronary insufficiency,Hypertension
Adverse Rx:Headache,nausea,restlessness,Weakness,dysrhythmias,HTN,Precipitation of angina pectoris
Onset:SQ5-10min,IV/ET 1-2min
duration:5-10min.
Dose:Cardiac Arrest (all rhythms)
Adult
1mg/IV or 2–2½ times the IV dose via ET,repeat every 3-5min
Pediatric
Initial Dose:
IV/IO 0.01mg/kg(1:10,000)
ET dose is 0.1ml/kg(1:1,000)diluted to 3-5ml
Repeat Doses:
IV/IO/ET 0.1ml/kg(1:1,000) every 3-5min
Allergic Reactions/Bronchoconstriction
Adult
Moderate allergice reaction/bronchoconstriction
0.3-0.5mg(1:1,000)SQ
Anaphylaxis (Severe allergic reaction)
1mg(1:10,000)slow IV
Pediatric
Moderate allergice reaction/bronchoconstriction
0.01 ml/kg(1:1,000)SQ
Anaphylaxis(Severe allergic reaction)
0.05-0.5mcg/kg/min INFUSION
Infusion
Adult
2-10mcg/min titrated to increased HR/BP
Suggested concentration: mix 1mg in 500ml solution to get 2mcg/ml concentration
Pediatric
0.1mcg/kg/min titrated to increase HR/BP
Suggested concentration: mix 0.6mg/kg to create a 100ml solution.
consider:Cat. C preg., no prefilled syringes for epi infusions,Syncope can occur in asthmatic children

Front 12

Furosemide
(Lasix)

Back 12

Class:loop diuretic
Desc:inhibits reabsorbtion of sodium & chloridein loop of henle.
Inda:Cardiogenic pulmonary edema,CHF
Contra:Anuria,Hypersensitivity,hypovolemia/dehydration
Adverse Rx:Hypotension,dry mouth,hypochloremia,hypokalemia,hyponatremia,hyperglycemia
Onset:diuretic effects in 15-20min.,vasodilatoryeffects within 5min/IV
Duration:4-6hrs
Dose:Adult
20-40mg(0.5-1.0mg/kg)slow IV over 1-2min(not to exceed 20mg/min)or twice the pts. daily PO dose
Pediatric
1mg/kg/dose
Consider:Preg. Cat. C,known to cause fetal abnormalities,protect from light

Front 13

Glucagon

Back 13

Class:pancreatic hormone, insulin antagonist
Desc:results in Blood glucose elevation by increasing glycogen breakdown
Inda:Hypoglycemia with altered LOC,Beta-blocker overdose
Contra:hypersensitivity
Adverse Rx:tachycardia,nausea/vomiting,HTN
Onset:within 1min
Duration:9-17min.
Dose:Hypoglycemia
Adult
1 mg/IM,may repeat in 10min
Pediatric
0.5mg/IM,may repeat in 10min
Beta-blocker Toxicity
Adult
1-5mg slow IV(over 2-5min)
Pediatric
0.0015-.1mg/kg slow IV
Consider:Preg. Cat. B,not 1st line choice for hypoglycemia,primary use when IV unestablished for50%dextrose,IV glucose will need administered if no rx from pt.