Paramedic Drugs For Saems

Front 1

GENERIC NAME: CHARCOAL, ACTIVATED

BRAND NAME: Charcoal, Actidose-Aqua

Back 1

GENERIC NAME: CHARCOAL, ACTIVATED

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

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

Contraindications:
Ingestion of caustics (risk of gastrointestinal hemorrhage)
Ingestion of hydrocarbons (relative)
Oral administration to comatose patient
Simultaneous administration of other oral drugs
Absence of bowel sounds
Gastrointestinal perforation
Intestinal obstruction
Recent surgery

Adverse Reactions:
May provoke vomiting, diarrhea and constipation
May worsen overdosed induced Ileus
Pulmonary aspiration
Fecal discoloration (black)
Acute pancreatitis

Adult Dosage:
50-100 Gm (1-2 Gm/kg) as a single initial dose; if not in pre-mixed slurry, mix one part charcoal with four parts water.

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

Onset of Action:
Immediate

Front 2

GENERIC NAME: ADENOSINE

BRAND NAME: Adenocard

Back 2

GENERIC NAME: ADENOSINE
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.

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.

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 carbamazepine (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)

Adverse Reactions:
CV: Transient dysrhythmias (systole, bardycardia, 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.

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.

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.

Routes of Administration:
Rapid IV push

Onset of Action:
Seconds

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

Front 3

GENERIC NAME: ALBUTEROL SULFATE

BRAND NAME: Proventil, Ventolin

Back 3

GENERIC NAME: ALBUTEROL SULFATE
CLASS: sympathomimetic, bronchodilator

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

Indications and Field Use:
Treatment of bronchospasm

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

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

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

Pediatric Dosage: (children <40 lbs)
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

Onset of Action:
5-15 minutes

Duration of Action:
3-4 hours

Front 4

Generic Name: AMIODARONE

Class: Antiarrhythmic Agent

Back 4

Generic Name: AMIODARONE

Mechanism of Action:
Multiple effects on sodium, potassium and calcium channels.
Prolongs action potential, refractory period.
Ventricular automaticity (potassium channel blockade).
Slows membrane depolarization and impulse conduction (sodium channel blockade).
Negative chronotropic activity in nodal tissue, rate reduction, and antisympathetic activity (calcium channel and β-blockade).
Dilates coronary arteries due to calcium channel and alpha-adrenergic blocking action.

Indications for use:
Treatment of: defibrillation-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.

Contraindications:
Bradycardia
Second or third degree heart block unless a functioning pacemaker is present
Cardiogenic shock
Hypotension
Pulmonary congestion

Adverse Reactions:
Cardiovascular: bradycardia, hypotension, asystole/cardiac arrest, atrio-ventricular block
Torsades de Pointes (prolongs QTc interval), congestive heart failure
GI & Hepatic: nausea, vomiting, abnormal liver function tests
Skin: slate-blue pigmentation
Other: fever, headache, dizziness, flushing, abnormal salivation, photophobia

Adult Dosage:
VF/Pulseless VT
300 mg IV push over 30 – 60 seconds, may repeat in 3-5 minutes with 150 mg IV push
Wide-Complex Tachycardias, Atrial Flutter, Atrial Fibrillation, SVT with cardioversion
150 mg IV over 10 minutes (mix in 50 mL bag of D5W) may repeat every 10 minutes
Maintenance Infusion Post Resuscitation/Conversion
After successful defibrillation, follow with up to 1mg/min IV infusion for 6 hours, then up to 0.5 mg/min IV infusion for up to 18 hours, maximum daily dose is 2.2 grams
Mix 450 mg in 250 mL of D5W (special polyolefin bag), concentration 1.8 mg/mL, and run at 33.3 mL/hr for 1 mg/min or 16.7 mL/hr for 0.5 mg/min
For Other Maintenance infusion
Rates range from 0.5 mg/min to 1mg/min. Maximum daily dose is 2.2 grams

Pediatric Dosage:
VF/Pulseless VT
5 mg/kg IV push (max 300 mg single dose), may repeat every 5 minutes two times to a total maximum of 15 mg/kg/day
Probable VT with pulse
5 mg/kg IV administered over 20 minutes may repeat two more times to a total of 15 mg/kg/day

Front 5

GENERIC NAME: ACETYLSALICYLIC ACID, ASPIRIN, ASA

BRAND NAME: Bufferin, Anacin, APC, among others

Back 5

GENERIC NAME: ACETYLSALICYLIC ACID, ASPIRIN, ASA

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.

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

Contraindications:
Bleeding ulcer, hemorrhagic states, hemophilia
Known hypersensitivity to salicylates or other non-steroidal anti-inflammatories that has lead to hypotension and/or bronchospasm
Children and adolescents (prehospital personnel should not administer ASA to this age group)

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

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

Pediatric Dosage:
Not recommended for prehospital use in children

Onset of Action:
20-30 minutes

Front 6

GENERIC NAME: ATROPINE SULFATE

CLASS: Anticholinergic agent, antidote, antispasmodic agent, antiarrhythmic, antimuscarinic

Back 6

GENERIC NAME: ATROPINE SULFATE

Mechanism of Action:
CV: Increased heart rate (positive chronotropic effect); increased conduction velocity; increased force of contraction (slight), increase cardiac output.
Resp: Decreased mucus 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.

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, carbamate cholinergic poisoning).

Contraindications:
 Hypersensitivity to atropine or any component of the formulation – Belladonna alkaloid allergy
 Glaucoma, acute narrow angle (relative contraindication for patient with symptomatic bradycardia), adhesions between the iris and lens
 Tachycardia
 Obstructive GI disease, paralytic ileus, intestinal atony of the elderly or debilitated patient, severe ulcerative colitis, or toxic megacolon complicating ulcerative colitis
 Hepatic disease
 Renal disease, obstructive uropathy
 Myasthenia gravis (unless used to treat side effects of acetylcholinesterase inhibitor
 Asthma
 Thyrotoxicosis
 Mobitz type II block
 3rd degree heart block

Adverse Reactions:
Major: Tachydysrhythmias; flushing; ventricular irritability; exacerbation/initiation of angina; acute narrow angle glaucoma; blurred vision; mydriasis; agitation to delirium; bloating; constipation; decreased gastric emptying
Minor: Dry mouth/mucous membranes; loss of taste; nausea; vomiting; urinary retention; neuromuscular weakness; decreased sweating/increased body temperature.

Adult Dosage:
Symptomatic Bradycardia:
IV – 0.5 mg every 5 minutes. Do NOT exceed a total dose of 3 mg or 0.04mg/kg if symptoms profound.
Organophosphate or carbamate poisoning:
IV – Initially: 1-5 mg. Doses should be doubled every 5 minutes until signs of muscarinic excess abate (clearing of bronchial secretions, bronchospasm, and adequate oxygenation)

Pediatric Dosage:
Symptomatic Bradycardia:
IV – 0.02 mg/kg (minimum of 0.1 mg), may repeat at 5 minute intervals to a maximum total dose of 1 mg in children and 2 mg in adolescents
Maximum single doses: Child 0.5 mg; Adolescent 1 mg.

Organophosphate or carbamate cholinergic poisoning:
IV – 0.03-0.05 mg/kg every 10 to 20 minutes until cholinergic symptoms minimize, then every 1 to 4 hours for at least 24 hours

Front 7

GENERIC NAME: CALCIUM CHLORIDE

CLASS: electrolyte

Back 7

GENERIC NAME: CALCIUM CHLORIDE

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

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

Contraindications:
Hypercalcemia
Concurrent digoxin therapy (relative)

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

Adult Dosage:
Hypocalcemia, calcium channel blocker OD, hyperkalemia and hypermagnesemia: 5-10 ml (0.5-1 Gm) of 10% calcium chloride. May repeat in 10-20 minutes.
Pre-treatment for IV verapamil administration: 3 ml of 10% calcium chloride. May be repeated once.

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 8

GENERIC NAME: DEXTROSE 50%

CLASS: carbohydrate, hyperglycemic

Back 8

GENERIC NAME: DEXTROSE 50%

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

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

Contraindications:
Hypersensitivity
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).
Diabetic coma with hyperglycemia
Glucose-galactose malabsorption symdrome
Anuria and hepatic coma

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.
Tachypnea
Pulmonary edema

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

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.

Onset of Action:
Seconds

Front 9

GENERIC NAME: DIAZEPAM
BRAND NAME: Valium
CLASS: Benzodiazepine

Back 9

GENERIC NAME: DIAZEPAM

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.

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

Contraindications:
Hypersensitivity (allergy)
Glaucoma, acute narrow angle (relative)
Allergy to soy protein (Diazepam rectal gel only)

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

Adult Dosage:
2 mg increments slow IV push. Administer no faster than 5 mg/minute.
Status epilepticus: 5-10 mg IV push. May repeat at intervals of 10-15 min., to a total of 30 mg.

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.
Status epilepticus:
Neonates: 0.15-0.5 mg/kg IV
Infants (>30 days old) 0.2-0.5 mg IV every 2-5 minutes to a max of 5 mg
Children (>5 yrs old) 1 mg every 2-5 minutes, to a max of 10 mg

Onset of Action:
Minutes

Front 10

GENERIC NAME: DIPHENHYDRAMINE HCl
BRAND NAME: Benadryl
CLASS: Antihistamine; anticholinergic

Back 10

GENERIC NAME: DIPHENHYDRAMINE HCl

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.

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

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).

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.

Adult Dosage:
Allergic Reaction: 25-50 mg slow IV push or deep IM
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.

Pediatric Dosage:
Allergic Reaction: 1.0-1.25 mg/kg slow IV push or deep IM
Anaphylaxis or Phenothiazine Overdose: 1-2 mg/kg slow IV push

Routes of Administration:
IV, Deep IM

Onset of Action:
IV 5 - 10 minutes

Front 11

GENERIC NAME: DILTIAZEM
BRAND NAME: Cardizem
CLASS: Calcium Channel Blocker
Calcium antagonist

Back 11

GENERIC NAME: DILTIAZEM

Mechanism of Action:
Pharmacological: Inhibits calcium ion influx across cell membranes during cardiac depolarization, decreases SA and AV conduction and dilates coronary and peripheral arteries and arterioles.
Clinical effects: Slows the rapid ventricular rate associated with atrial fibrillation and atrial flutter, and reduces coronary and peripheral vascular resistance.

Indications and Field Use:
Rapid ventricular rates associated with atrial fibrillation and atrial flutter, and for PSVT refractory to adenosine.

Contraindications:
Severe Hypotension
Hypotension (less than 90 mmHg systolic)
Acute Myocardial infarction
Cardiogenic shock
Ventricular tachycardia or wide-complex VT of unknown origin
Second or third-degree AV block
Wolff-Parkinson-White (WPW) syndrome
Sick Sinus syndrome
Concomitant IV Beta Blocker use within a few hours
Hypersensitivity

Adverse Reactions:
CV: hypotension, bradycardia, heart block, chest pain, and asystole
GI: nausea and vomiting
CNS: headache, fatigue, drowsiness

Adult Dosage:
Initial: 0.25 mg/kg IVP (usually 20 mg) administered over 2 minutes
If response is inadequate, repeat in 15 minutes: 0.35 mg/kg IVP administered over 2 minutes
Maintenance infusion: 5.0 to 15 mg/hr

Pediatric Dosage:
The safety and efficacy of this drug for use in children has not been established.

Onset of Action:
IV - immediately

Front 12

GENERIC NAME: DOPAMINE
BRAND NAME: Intropin
CLASS: Sympathomimetic

Back 12

GENERIC NAME: DOPAMINE

Mechanism of Action:
Immediate metabolic precursor to norepinephrine
Effects are dose-dependent:
1-2 μg/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 μg/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 μg/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
> 20 μg/kg/min Produces hemodynamic effects similar to norepinephrine; may increase HR and O2 demand to undesirable limits

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

Contraindications:
Hypersensitivity
Hypovolemic shock (relative)
Pheochromocytoma
MAO inhibitors, such as Marplan, Nardil, or Parnate
Tachyarrythmias / Ventricular Fibrillation

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

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

Pediatric Dosage:
2-20 μg/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 μ/kg/min; titrate to effect.

Onset of Action:
Almost immediate, upon presentation to central circulation

Front 13

GENERIC NAME: EPINEPHRINE HCl
CLASS: sympathomimetic

Back 13

GENERIC NAME: EPINEPHRINE HCl

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

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.
Croup

Contraindications:
None known for cardiac arrest
Hypothermia, relative contraindication

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

Adult Dosage:
Pulseless Arrest –
IV/IO: 1 mg of 1:10,000 solution repeat every 3 - 5 minutes or,
ET: Give 2 - 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 1:1,000 epinephrine diluted with 8 mL NS in a 10 mL syringe)
Continuous Infusion for Hypotension or Symptomatic Bradycardia: 1 mg added to 500 mL of NS administered at 1 mcg/min titrated to desired hemodynamic response (range 2-10 mcg/min); not first-line therapy.
Anaphylaxis and asthma: Give 0.3 - 0.5 mg of 1:1,000 solution IM (preferred), SC, or inject SL, may repeat every 15 to 20 minutes; or in extreme cases only.
Pediatric Dosage:
Pulseless Arrest or Refractory Bradycardia:
IV/IO: 0.01 mg/kg of 1:10,000 repeat every 3 - 5 minutes, maximum single dose 1 mg.
ET: 0.1 mg/kg of 1:1,000; 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 repeat every 3 - 5 minutes, maximum single dose 10 mg.
Asthma/anaphylaxis: Use 1:1,000 solution; give 0.01 mg/kg IM (preferred), SC (maximum single dose of 0.5 mg/dose).
IV Infusion: 0.1 – 1 mcg/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 mcg/kg/min.
Croup: 3 mg 1:1,000 mixed in 3 mL NS via SVN.

Front 14

GENERIC NAME: ETOMIDATE
CLASS: sedative/hypnotic agent

Back 14

GENERIC NAME: ETOMIDATE

Mechanism of Action:
Produces hypnosis rapidly causing CNS depression and anesthesia
No analgesic effect

Indications and Field Use:
Induction of anesthesia for rapid sequence intubation (RSI)

Contraindications:
Hypersensitivity

Adverse Reactions:
Transient muscle movements
Apnea
Causes minimal but not clinically significant suppression of cortisol levels
May cause myoclonus and tremors that can resemble seizure activity

Adult Dosage:
0.3 mg/kg IV over 30-60 seconds

Onset of Action:
1 minute

Front 15

GENERIC NAME: FUROSEMIDE
CLASS: Loop diuretic

Back 15

GENERIC NAME: FUROSEMIDE

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

Indications and Field Use:
Pulmonary edema; congestive heart failure

Contraindications:
Anuria (relative)
Hypovolemia (relative)
Hypotension (relative)
Hypersensitivity

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

Adult Dosage:
0.5 to 1.0 mg/kg IVP to maximum dose of 40 mg
CHF/Pulmonary Edema: 20-40 mg IV over 1-2 minutes

Pediatric Dosage:
1 mg/kg IV over 1-2 minutes

Onset of Action:
5 minutes (vasodilation)

Front 16

GENERIC NAME: GLUCAGON
BRAND NAME: Glucagon
CLASS: Pancreatic hormone, polypeptide, hyperglycemic agent

Back 16

GENERIC NAME: GLUCAGON

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).

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

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

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

Adult Dosage: (children and adults greater than 20 kg or 44 lbs)
Hypoglycemia: 1 mg IM, may repeat in 20 minutes. IM preferred, but may give IM, IV or SC)

Pediatric Dosage: (for children under 20 kg or 44 lbs)
Hypoglycemia: 0.5 mg IM or a dose equivalent to 20-30 μg/kg, may repeat in 20 minutes. IM preferred, but may give IM, IV or SC.

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

Front 17

GENERIC NAME: IPRATROPIUM BROMIDE
BRAND NAME: Atrovent
CLASS: anticholinergic, bronchodilator

Back 17

GENERIC NAME: IPRATROPIUM BROMIDE

Mechanism of Action:
Anticholinergic (parasympatholytic) agent appears to inhibit vagally-mediated reflexes by antagonizing the action of acetylcholine, the transmitter released from the vagal nerve.

Indications and Field use:
Treatment of bronchospasm associated with chronic obstructive pulmonary disease (emphysema and chronic bronchitis). To be used either alone or in combination with other bronchodilators especially beta adrenergics (i.e., albuterol).

Contraindications:
Ipratropium bromide is contraindicated in known or suspected cases of hypersensitivity to ipratropium bromide or to atropine and its derivatives. Precaution: should be used with caution in patients with narrow angle glaucoma.

Adverse Reactions:
Resp: Coughing. Sputum increased
CNS: Dizziness. Insomnia. Tremor. Nervousness
GI: Nausea

Adult Dosage:
Give 500 mcg in 2.5 ml normal saline (1 unit dose vial) via SVN with a mouth piece or in-line with a ventilatory device. Repeat according to medical control preference. May mix one unit dose vial of ipratropium with one unit dose vial of albuterol.

Onset of Action:
5-15 minutes

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GENERIC NAME: LIDOCAINE HCl
BRAND NAME: Xylocaine
CLASS: antiarrhythmic, local anesthetic

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GENERIC NAME: LIDOCAINE HCl

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.

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).

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!

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.

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. See: Maintenance Infusion below.
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 gms 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.

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 μg/kg/min; prepared by adding 120 mg (3cc) of 1 Gm/25 ml (40 mg/ml) solution to 97 ml of NS, yielding 1200 μg/ml.
1 ml/kg/hr delivers 20 μg/kg/min. 2.5 ml/kg/hr delivers 50 μg/kg/min. Reduce to < 20 μg/kg/min for children with low cardiac output, severe CHF or compromised hepatic blood flow. Infusion should be avoided unless infusion pump available.

Onset of Action:
1-5 minutes

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GENERIC NAME: MAGNESIUM SULFATE
BRAND NAME: Magnesium Sulfate
CLASS: Electrolyte, tocolytic

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GENERIC NAME: MAGNESIUM SULFATE

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.

Indications and Field Use:
• Torsade de pointes, drug of choice
• VF/Pulseless VT refractory to lidocaine and/or amiodarone
• Hypomagnesemia
• Pre-term labor (PTL)
• Pregnancy-induced hypertension (PIH, toxemia of pregnancy, pre-eclampsia and/or eclampsia).
• Hyperreactive Airway - Severe Asthma

Contraindications:
• Hypermagnesemia
• Use cautiously in patients with impaired renal function and pre-existing heart blocks (relative).
• Precautions: Caution when used with barbituates, narcotics, or other hypnotics (or system anesthetics) in conjunction with Magnesium Sulfate due to the additive central depressive effects of magnesium.

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. This adverse reaction may occur in both mother and/or infant during or up to 24 hours after the administration of Magnesium Sulfate.
CNS: sweating, drowsiness, hypothermia, depressed reflexes progressing to flaccidity and paralysis. This adverse reaction may occur in both mother and/or infant during the administration of or up to 24 hours after the administration of Magnesium Sulfate.

Adult Dosage:
Cardiac:
• VF/Pulseless VT: 1-2 Gm IV diluted in 50-100 ml NS or D5W, administered over 1-2 minutes.
• Torsade de pointes: 1-2 Gm IV diluted in 50-100 ml NS or D5W administered over 1-2 minutes, followed by the same amount infused over 1 hour.
• Hypomagnesemia: Dilute 1-2 Gm in 50-100 ml NS or D5W administered IV push over 5-60 minutes.
• Respiratory/Severe Asthma: Initial Infusion (field) 2 Gm Magnesium Sulfate mixed in 50 ml NS or D5W to be infused IV using microdrip tubing over 5 to 10 minutes. Stop infusion if hypotension, respiratory depression or bradycardia develop.

Pregnancy:
Pre-term labor (PTL): Initial bolus (Field and Interfacility): 4-6 Gm over 15-20 minutes (Suggested method is the addition of 4 Gm to 100 ml D5W, LR or NS. Resultant concentration is 40 mg/ml.) Maintenance Infusion (Interfacility only): 1-4 Gm/hour infusion rate. (Suggested method for treatment of premature labor is to follow initial bolus with infusion of 2 Gm/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 Gm to 1000 ml LR. Resultant concentration equals 40 mg/ml. If this concentration is run at 50 ml/hr, Magnesium Sulfate delivered equals 2 Gm/hr).
Pregnancy induced hypertension, pre-eclampsia/eclampsia, (PIH): Initial bolus (Field and Interfacility): 3-6 Gm over 10-15 minutes (Suggested method is the addition of 4 Gm to 100 ml D5W, LR or NS. Resultant concentration is 40 mg/ml). Maintenance Infusion (Interfacility only): Follow bolus with 1-3 Gm/hour infusion rate. (Same mixture as for PTL). Rebolus: In an eclamptic emergency may rebolus with Magnesium Sulfate, 2-4 Gm depending on patient size (mixed as an initial bolus) over 10-15 minutes if respirations >12/minute and urine output >30 ml/hr.

Onset of Action:
Seconds
20 minutes for IV Infusion (respiratory)

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GENERIC NAME: METHYLPREDNISOLONE SODIUM SUCCINATE

BRAND NAME: Solu-Medrol
CLASS: corticosteroid, glucocorticoid, steroid, anti-inflammatory

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GENERIC NAME: METHYLPREDNISOLONE SODIUM SUCCINATE

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

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)

Contraindications:
Preterm infants

Adverse Reactions:
None from single dose

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.

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

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

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GENERIC NAME: MIDAZOLAM HYDROCHLORIDE
BRAND NAME: Versed
CLASS: Central nervous system depressant, benzodiazepine

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GENERIC NAME: MIDAZOLAM HYDROCHLORIDE

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.

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

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

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

Adult Dosage:
Patients14 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
0.3 IN (intranasal) Adults over 50 kg: 10 mg (2ml) Total volume (5mg/ml concentration) = (Total mg dose divided in each nostril).

Pediatric Dosage:
Pediatric patients: 0.05 to 0.1 mg/kg slow IV PUSH
0.2 mg/kg IM for status seizures if no IV Access
Calculate appropriate dose of IN (intranasal midazolam) using the following formula:
Children: Total kg wt X 0.2 mg = total mg maximum of 10mg

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

Duration of Action:
2 to 6 hours

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GENERIC NAME: MORPHINE SULFATE
BRAND NAME: Morphine Sulfate
CLASS: narcotic agonist

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GENERIC NAME: MORPHINE SULFATE

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.

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

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

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

Adult Dosage:
IV Dose: Administer 1-3 mg increments slow IV PUSH (over 1-5 minutes) until desired effect. Up to 20mg max

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

Onset of Action:
Seconds
Peak Effects:
20 minutes
Duration of Action:
2-4 hours

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Generic Name: Ondansetron
Brand Name: Zofran
Class: Antiemetic agent

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Generic Name: Ondansetron

Mechanism of Action:
Selectively blocks serotonin 5-HT3 receptors located in the CNS at the chemoreceptor trigger zone and in the peripheral nervous system on nerve-terminals of the vagus nerve

Indications for use:
Nausea and vomiting

Contraindications:
Hypersensitivity
Use with caution in patients with hepatic impairment

Adverse Reactions:
CNS: Headache, malaise, fatigue, dizziness, fever, sedation, extrapyramidal syndrome
Cardiovascular: Chest pain, arrhythmias
Respiratory: Hypoxia
GI & Hepatic: Diarrhea, constipation, abdominal pain, xerostomia, decreased appetite
Skin: Rash

Adult Dosage:
4 – 8 mg IV slow push over 2 – 5 minutes
8 mg PO ODT or tablet

Pediatric Dosage: (1 month to 12 years old)
Greater than 40 kg- 4 mg IV slow push over 2 – 5 minutes
Less than 40 kg- 0.1 mg/kg IV slow push over 2 – 5 minutes

Onset of Action:
Unknown but probably 10 to 30 minutes
Peak effects:
Unknown
Duration of Action:
Half life is approximately 4 hours. Exact duration unknown but appears to be prolonged compared to half-life

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GENERIC NAME: SODIUM BICARBONATE 8.4%
BRAND NAME: Sodium Bicarbonate 8.4%
CLASS: buffer

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GENERIC NAME: SODIUM BICARBONATE 8.4%

Mechanism of Action:
Buffers H+ and increases pH

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

Contraindications:
Alkalosis

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.

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 D5W NS or as determined by medical control.
Cardiac arrest: First dose usually 0.5 - 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.

Pediatric Dosage:
0.5 - 1 mEq/kg IV or IO slowly, if ventilation is adequate according to medical control authority. Can contribute to acidosis and cause fluid overload.

Onset of Action:
Seconds
Peak Effects:
1-2 minutes
Duration of Action:
10 minutes

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GENERIC NAME: SUCCINYLCHOLINE
CLASS: ultra-short-acting depolarizing-type skeletal muscle relaxant

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GENERIC NAME: SUCCINYLCHOLINE

Mechanism of Action:
Combines with cholinergic receptors of the motor end plate to produce depolarization
Hydrolyzed by acetylcholinesterase

Indications and Field Use:
Endotracheal intubation requiring paralysis (RSI) by a qualified EMT-P with authorization from the EMT-P’s administrative medical director

Contraindications:
Muscle disorders
Personal or family history of malignant hyperthermia
History of hyperkalemia
Burn injured patients*
Ocular injuries
Patients in whom successful endotracheal intubation is doubtful

Adverse Reactions:
Vagal stimulation leading to bradycardia or asystole
Hyperkalemia
Rhabdomyolysis
Hypersalivation
Elevated intraocular pressure
Release of histamine

Route of Administration:
IV
Onset of Action:
<1 minute
Duration of Action:
Muscle paralysis lasting 4-6 minutes

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GENERIC NAME: THIAMINE HCl (vitamin B1)
BRAND NAME: Betalin
CLASS: vitamin

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GENERIC NAME: THIAMINE HCl (vitamin B1)

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.

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

Contraindications:
Do not give intra-arterial

Adverse Reactions:
Hypotension (rare)

Adult Dosage:
100 mg

Pediatric Dosage:
Rarely used

Routes of Administration:
IM
IV over several minutes

Onset of Action:
Hours
Peak Effects:
3-5 days
Duration of Action:
Unavailable

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GENERIC NAME: VERAPAMIL HCl
BRAND NAME: Isoptin, Calan, Verelan
CLASS: calcium channel blocker

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GENERIC NAME: VERAPAMIL HCl

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.

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

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

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

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

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

Routes of Administration:
IV slow push (See: Special Notes)
Onset of Action:
1-3 minutes
Peak Effects:
3-5 minutes
Duration of Action:
2-5 hours