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1.Activated Charcoal

Class: Adsorbent

Actions: Adsorbs toxins by chemicalbinding and prevents gastrointestinaladsorption.

Indications: Poisoning following emesis or

when emesis is contraindicated.

Contraindications: None in severepoisoning.

Precautions: Should only be administeredfollowing emesis, in cases in which it is so

indicated. Use with caution in patients withaltered mental status. May adsorb Ipecacbefore emesis; If Ipecac is administered,wait at least 10 minutes to administeractivated charcoal.

Side Effects: Nausea, vomiting, and

constipation.Dosage: 1 g/kg (typically 50-75 grams)mixed with a glass of water to form aslurry.

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Routes: Oral

Pediatric Dosage: 1 g/kg mixed with a

glass of water to form a slurry

2.Adenosine (Adenocard)

Class: @@@Antiarrhythmic

Actions: slows AV conduction

Indications: symptomatic PSVT

Contraindications: second- or third-degree heart block, sick-sinus syndrome,

known hypersensitivity to the drug.Precautions: Arrhythmias, includingblocks, are common at the time ofcardioversion. Use with caution in patientswith asthma.

Side Effects: Facial flushing, headache,shortness of breath, dizziness, and nausea.

Dosage: 6 mg given as a rapid IV bolusover a 1-2 second period; if, after 1-2

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minutes, cardioversion does not occur,administer a 12-mg dose over 1-2 seconds.

Routes: IV; should be administereddirectly into a vein or into the medicationadministration port closest to the patientand followed by flushing of the line with IVfluid.

Pediatric Dosage: Safety in children has

not been established.

3.Albuterol (Proventil) (Ventolin)

Class: Sympathomimetic (2 selective)Actions: Bronchodilation

Indications: Asthma reversiblebronchospasm associated with COPD

Contraindications: Known

hypersensitivity to the drug, symptomatictachycardia

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Precautions: Blood pressure, pulse, andEKG should be monitored use caution inpatients with known heart disease

Side Effects: Palpitations, anxiety,headache, dizziness, and sweating

Dosage:Metered Dose Inhaler: 1-2 sprays(90 micrograms per spray)

Small-Volume Nebulizer: 0.5 ml (2.5 mg) in

2.5 ml normal saline over 5-15 minutes

Rotohaler: one 200-microgram rotocapshould be placed in the inhaler andbreathed by the patient

Routes: Inhalation

Pediatric Dosage: 0.15 mg (0.03 ml)/kgin 2.5 ml normal saline by small volumenebulizer

3.Alcohol, Ethyl (Ethanol) (EtOH)

Class: Solvent, @@depressant

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Description:A colorless, volatile,flammable liquid of the formula C2H5OH.Acts as a depressant on the CNS when

taken in excessive amounts. Used IV tostop premature labor.

The other to "common" Alcohols areIsopropyl (C3H7OH, Isopropanol, IPA), and

Methyl (CH3OH, Methanol, MeOH).4.Aminophylline

Class: Xanthine bronchodilator

Actions: Smooth muscle relaxant,causes bronchodilation, has milddiuretic properties, increases heartrate.

Indications: Bronchial asthma, reversiblebronchospasm associated with chronic,

bronchitis and emphysema, congestiveheart failure, pulmonary edema.

Contraindications: Patients with historyof hypersensitivity to the drug,

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hypotension, patients with peptic ulcerdisease.

Precautions: Monitor for arrhythmias.Monitor blood pressure. Do not administerto patients on chronic theophylline.Preparations until the theophylline bloodlevel has been determined.

Side Effects: Convulsions, tremor,

anxiety, and dizziness vomitingpalpitations, PVCs, and tachycardia.

Dosages: Method 1: 250 - 500 mg in 90 or80 ml of d5w, respectively, infused over20-30 minutes (approximately 5-10mg/kg/hr)

Method 2: 250 - 500 mg (5-7 mg/kg) in 20ml of D5W infused over 20-30 minutes

Routes: Slow IV infusion.

Pediatric Dosage: 6 mg/kg loading doseto be infused over 20-30 minutes;

maximum dose not to exceed 12 mg/kg per24 hours.

5.Amrinone (Inocor)

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Class: Cardiac inotrope.

Actions: Increases cardiaccontractility, vasodilator.

Indications: Short-term management ofsevere CHF.

Contraindications: Patients with history

of hypersensitivity to the drug.

Precautions: May increase myocardialischemia. Blood pressure, pulse, and EKGshould be constantly monitored. Amrinoneshould only be diluted with normal saline or1/2 normal saline; no dextrose solutions

should be used. Furosemide (Lasix) shouldnot be administered into an IV linedelivering Amrinone.

Side Effects: Reduction in platelets,nausea and vomiting cardiac arrhythmias.

Dosage: 0.75 mg/kg bolus given slowlyover 2-3 minute interval followed bymaintenance infusion of 2-15 g/kg/minute.

Routes: IV bolus and infusion as describedearlier.

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Pediatric Dosage: Safety in children hasnot been established.

6.Aspirin (Bufferin)

Class: Platelet inhibitor/anti-inflammatory.

Actions: Blocks platelet aggregation.

Indications: New-onset chest painsuggestive of MI signs and symptomssuggestive or recent CVA.

Contraindications: Patients with history

of hypersensitivity to the drug.

Precautions: GI bleeding and upset.

Side Effects: Heartburn, nausea andvomiting, wheezing.

Dosage: 150-325 mg PO or chewed.

Routes: PO.

Pediatric Dosage: not recommended.

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7.Atropine

Class: Parasympatholytic(anticholinergic).

Actions: Blocks acetylcholinereceptors, increases heart rate,decreases gastrointestinal secretions.

Indications: Hemodynamically-significantbradycardia, hypotension secondary tobradycardia, asystole, organophosphatepoisoning.

Contraindications: None when used inemergency situations.

Precautions: Dose of 0.04 mg/kg shouldnot be exceeded except in cases oforganophosphate poisonings, tachycardia,hypertension.

Side Effects: Palpitations and tachycardia,

headache, dizziness, and anxiety, drymouth, pupillary dilation, and blurredvision, urinary retention (especially oldermales).

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Dosage: Bradycardia: 0.5 mg every 5minutes to maximum of 0.04 mg/kg.

Asystole: 1 mg.Organophosphate poisoning: 2-5 mg.

Routes: IV, ET (ET dose is 2 - 2.5 times IVdose).

Pediatric Dosage: Bradycardia: 0.02

mg/kg

Maximum single dose (child 0.5 mg)(adolescent 1.0 mg)

Maximum total dose (child 1.0 mg)(adolescent 2.0 mg)

8.Bretylium (bretylol)

Class: Antiarrhythmic.

Actions: Increases ventricularfibrillation threshold, blocks therelease of Norepinephrine fromperipheral, sympathetic nerves.

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Indications: Ventricular fibrillationrefractory to Lidocaine, ventriculartachycardia refractory to Lidocaine, PCVs

refractory to first-line medications.

Contraindications: None when used inthe management of life-threateningarrhythmias.

Precautions: Postural hypotension occurs

in almost 50% of patients receivingBretylium. Patient must be kept supinedecrease dosage in patients being treatedwith catecholamine sympathomimetics.

Side Effects: Hypotension, syncope, andbradycardia, Increased frequency of

arrhythmias, dizziness and vertigo.Dosage: 5 mg/kg. may be repeated atdose of 10 mg/kg up to a total dose of 30mg/kg.

Routes: Rapid IV bolus.

Pediatric Dosage: 5 mg/kg

9.Calcium Chloride (CaCl)

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Class: Electrolyte.

Actions: @@@Increases cardiaccontractility.

Indications: Acute hyperkalemia (elevatedpotassium), acute hypocalcemia(decreased calcium), calcium channelblocker (Nifedipine, Verapamil, etc.),

overdose, abdominal muscle spasmassociated with spider bite and portugueseman-o-war stings, antidote for magnesiumsulfate.

Contraindications: Patients receivingdigitalis.

Precautions: IV line should be flushedbetween calcium chloride and sodiumbicarbonate administration. Extravasationmay cause tissue necrosis.

Side Effects: Arrhythmias (bradycardia

and asystole), hypotension.

Dosage: 2-4 mg/kg of a 10% solution; maybe repeated at 10-minute intervals.

Routes: IV.

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Pediatric Dosage: 5-7 mg/kg of a 10%solution.

10.Dexamethasone (Decadron,Hexadrol)

Class: Steroid.

Actions: Possibly@@@ decreasescerebral edema, anti-inflammatory,suppresses immune response(especially in allergic reactions).

Indications: Cerebral edema,

@@@@anaphylaxis (after Epinephrineand diphenhydramine), asthma, COPD.

Contraindications: None in theemergency setting.

Precautions: Should be protected fromheat, onset of action may be 2-6 hours and

thus should not be considered to be of usein the critical first hour following ananaphylactic reaction.

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Side Effects: Gastrointestinal bleeding,prolonged wound healing.

Dosage: 4-24 mg.Routes: IV.

Pediatric Dosage: 0.2-0.5 mg/kg

11.Dextrose 50%

Class: Carbohydrate.

Actions: Elevates blood glucose levelrapidly.

Indications: Hypoglycemia.

Contraindications: None in theemergency setting.

Precautions: A blood sample should bedrawn before administering 50% dextrose.

Side Effects: Local venous irritation.

Dosage: 25 grams (50 ml).

Routes: IV.

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Pediatric Dosage: 0.5 g/kg slow IV;should be diluted 1:1 with sterile water toform a 25% solution.

12.Diazepam (Valium)

Class: Tranquilizer (Benzodiazepine).

Actions: Anticonvulsant, skeletalmuscle relaxant, sedative.

Indications: Generalized seizures, statusepilepticus, premedication beforecardioversion, skeletal muscle relaxant,acute anxiety states.

Contraindications: Patients with a historyof hypersensitivity to the drug.

Precautions: Can cause local venousirritation. Has short duration of effect. Donot mix with other drugs because of

possible precipitation problems.

Side Effects: Drowsiness, hypotension,respiratory depression, apnea.

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Dosage: Status epilepticus: 5-10 mg IV.

Acute anxiety: 2-5 mg IM or IV.

Premedication before cardioversion: 5-15mg IV.

Routes: IV (care must be taken not toadminister faster than 1 ml/min)

IM rectal.

Pediatric Dosage: Status epilepticus: 0.1- 0.2 mg/kg.

13.Digoxin (Lanoxin)

Class: Cardiac glycoside.

Actions: Increases cardiac contractileforce, increases cardiac output,reduces edema associated withcongestive heart failure, slows AVconduction.

Indications: Congestive heart failure,rapid atrial arrhythmias, especially atrialflutter and atrial fibrillation.

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Contraindications: Any patient with signsor symptoms of digitalis, toxicity,ventricular fibrillation.

Precautions: Monitor for signs of digitalistoxicity. Patients who have recentlysuffered a myocardial infarction havegreater sensitivity to the effects of digitalis.Calcium should not be administered topatients receiving digitalis.

Side Effects: Nausea, vomiting,@@@@@@ARRHYTHMIAS, yellow vision.

Dosage: 0.25-0.50 mg.

Routes: IV.

Pediatric Dosage: 25-40 g/kg.

14.Diltiazem (Cardizem)

Class: Calcium channel blocker.Actions: Slows conduction through theAV node, causes vasodilation,decreases rate of ventricular

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response, decreases myocardialoxygen demand.

Indications: To control rapid ventricularresponse associated with atrial fibrillationand flutter.

Contraindications: Hypotension, widecomplex tachycardia, conduction systemdisturbances.

Precautions: Should not be used inpatients receiving intravenous blockers.Hypotension. Must be kept refrigerated ordiscarded one month after removal fromrefrigeration.

Side Effects: Nausea, vomiting,hypotension, and dizziness.

Dosage: 0.25 mg/kg bolus (typically 20mg) IV over 2 minutes. This should befollowed by a maintenance infusion of 5-15mg/hour.

Routes: IV, IV drip.

Pediatric Dosage: Rarely used.

Dimenhydrinate (Dramamine)

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15.Class: Antihistamine.

Actions: Blocks histamine receptors,antiemetic.

Indications: Nausea and vomiting, motionsickness, to potentiate the effects ofanalgesics.

Contraindications: Comatose states,patients who have received large amountsof depressants (including alcohol).

Precautions: Use with caution in patientswith seizure disorders, asthma.

Side Effects:May impair mental and

physical ability, drowsiness, bronchialsecretions.

Dosage: 25-50 mg slow IVP (over 2minutes) 50 - 100 mg IM.

Routes: IV, IM.

Pediatric Dosage: Not recommended.

16 .Diphenhydramine (Benadryl)

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Class: Antihistamine.

Actions: Blocks histamine receptors,has some sedative effects.

Indications: @@@Anaphylaxis, allergicreactions, dystonic reactions due tophenothiazines.

Contraindications: Asthma, nursingmothers.

Precautions: Hypotension.

Side Effects: Sedation, dries bronchialsecretions, blurred vision, headache,palpitations.

Dosage: 25-50 mg.

Routes: Slow IV push deep IM.

Pediatric Dosage: 2-5 mg/kg.

17.Dobutamine (Dobutrex)

Class: Sympathomimetic.

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Actions: Increases cardiaccontractility, little chronotropicactivity.

Indications: Short-term managementof congestive heart failure.

Contraindications: Should only be usedin patients with an adequate heart rate.

Precautions: Ventricular irritability. Use

with caution following myocardialinfarction. Can be deactivated by alkalinesolutions.

Side Effects: Increased heart rate,palpitations.

Dosage: 2.5-20 g/kg/minute.

Method: 250 mg should be placed in 500ml of d5w, which gives a concentration of0.5 mg/ml.

Routes: IV drip.

Pediatric Dosage: 2 - 20 g/kg/min.

18.Dopamine (Intropin)

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Class: Sympathomimetic.

Actions: Increases cardiaccontractility, causes peripheralvasoconstriction.

Indications: Hemodynamically significanthypotension (systolic BP of 70-100 mmhg)not resulting from hypovolemia,

cardiogenic shock.

Contraindications: Hypovolemic shockwhere complete fluid resuscitation has notoccurred.

Precautions: Should not be administered

in the presence of severetachyarrhythmias. Should not beadministered in the presence of ventricularfibrillation, ventricular irritability. Beneficialeffects lost when dose exceeds 20g/kg/min.

Side Effects: Ventriculartachyarrhythmias, hypertension,palpitations.

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Dosage: 2-20 g/kg/minute. Start low andincrease as needed.

Method: 800 mg should be placed in 500ml of D5W giving a concentration of 1600g/ml.

Routes: IV drip only.

Pediatric Dosage: 2-20 g/kg/minute.

19.Epinephrine (Adrenalin):

Description: A hormone produced by theadrenal gland (attached to the kidneys)

and synthesized commercially. It isemployed therapeutically as aVASOCONSTRICTOR, as a cardiacstimulant, and to RELAXBRONCHIOLES. Itis also used to treat ASTHAMATICattacks and treat ANAPHYLACTIC

SHOCK.

20.Epinephrine 1:1,000

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Class: Sympathomimetic.

Actions: Bronchodilation.

Indications: Bronchial asthma,exacerbation of COPD, allergicreactions.

Contraindications: Patients with

underlying cardiovascular disease,hypertension, pregnancy, patients withtachyarrhythmias.

Precautions: Should be protected fromlight. Blood pressure, pulse, and EKG mustbe constantly monitored.

Side Effects: Palpitations and tachycardia,anxiousness, headache, tremor.

Dosage: 0.3-0.5 mg.

Routes: Subcutaneous (IV and ET forpediatric cardiac arrest).

Pediatric Dosage: 0.01 mg/kg up to 0.3mg.

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21.Epinephrine 1:10,000

Class: Sympathomimetic.

Actions: Increases heart rate andautomaticity.

Increases cardiac contractile force.

Increases myocardial electrical activity.

Increases systemic vascular resistance.

Increases blood pressure.

Causes bronchodilation.

Indications: Cardiac arrest, anaphylacticshock severe reactive airway disease.

Contraindications: Epinephrine 1:10,000is for intravenous or endotracheal use; itshould not be used in patients who do notrequire extensive resuscitative efforts.

Precautions: Should be protected fromlight. Can be deactivated by alkalinesolutions.

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Side Effects:Palpitations, anxiety,tremulousness, nausea and vomiting.

Dosage: cardiac arrest: 0.5-1.0 mgrepeated every 3-5 minutes.

severe anaphylaxis: 0.3-0.5 mg (3-5 ml);occasionally and Epinephrine drip isrequired.

Routes: IV, IV drip, ET.

Pediatric Dosage: 0.01 mg/kg initially.with subsequent doses, Epinephrine1:1,000 should be used at a dose of 0.1mg/kg.

22.Flumazenil (Romazicon)

Class: Benzodiazepine antagonist.

Actions: Reverses effects ofbenzodiazepines.

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Indications: To reverse CNS, respiratorydepression associated withBenzodiazepines.

Contraindications: Flumazenil should notbe used as a diagnostic agent forBenzodiazepine overdose in the samemanner Naloxone is used for narcoticoverdose. Known hypersensitivity to thedrug.

Precautions: Administer with caution topatients dependent upon Benzodiazepinesas it may induce life-threateningBenzodiazepine withdrawal.

Side Effects: Fatigue, headache,

nervousness, dizziness.Dosage: 0.2-0.3 mg IV over 30 seconds;repeated as needed to a maximum dose of1.0 mg.

Routes: IV.

Pediatric Dosage: Pediatric dataunavailable.

23.Furosemide (Lasix)

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Class: Potent diuretic.

Actions: Inhibits reabsorption of sodiumchloride, promotes prompt diuresis,vasodilation.

Indications: Congestive heart failure,pulmonary edema.

Contraindications: Pregnancy,dehydration.

Precautions: Should be protected fromlight, dehydration.

Side Effects: Few in emergency usage.

Dosage: 40-80 mg.

Routes: IV.

Pediatric Dosage: 1 mg/kg.

24.Glucagon

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Class: Hormone (antihypoglycemic agent).

Actions: Causes breakdown of glycogen to

glucose.Inhibits glycogen synthesis.

Elevates blood glucose level.

Increases cardiac contractile force.

Increases heart rate.

Indications: Hypoglycemia.

Contraindications: Hypersensitivity tothe drug.

Precautions: Only effective if there are

sufficient stores of Glycogen within theliver. Use with caution in patients withcardiovascular or renal disease. Draw bloodglucose before administration.

Side Effects: Few in emergencysituations.

Dosage: 0.25-0,50 mg (unit) IV 1.0 mg, IM.

Routes: IV, IM.

Pediatric Dosage: 0.03 mg/kg.

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25.Haloperidol (Haldol)

Class: Major tranquilizer.

Actions: Blocks dopamine receptors inbrain responsible for mood and behaviorhas antiemetic properties.

Indications: Acute psychotic episodes.

Contraindications: Should not beadministered in the presence of othersedatives. Should not be used in themanagement of dysphoria caused by

Talwin.

Precautions: Orthostatic hypotension.

Side Effects: Physical and mentalimpairment, Parkinson-like reactions havebeen known to occur, especially in children.

Dosage: 2-5 mg.Routes: IM.

Pediatric Dosage: Rarely used.

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26.Heparin

Class: Anticoagulant.

Actions: Functions as an anticoagulant byaccelerating neutralization of activatedclotting factors.

Indications: Situations where ahypocoaguable state is required (i.e. postMI, post-CVA, pulmonary embolism).

Contraindications: Should not be usedunless there is a medical reason toanticoagulate the patient.

Precautions: Sever, urticaria, andanaphylaxis have been reported followingheparin administration skin necrosis candevelop at site of subQ injections.

Side Effects: Fever, bruising, oozing of

blood.

Dosage: Loading dose: 5,000 iu IV is atypical loading dose although large

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patients and patients with heparinresistance may receive larger doses.

Maintenance dose: Infusion therapy istypically started at 800 - 1,000 iu/hour. thedosage is modified based upon thepatient's prothrombin (pt) time.

Routes: IV subQ (for prophylaxis).

Pediatric Dosage: Rarely used.

27.Hydrocodone (Vicodin, Lortab)

Class: Narcotic analgesic.

Actions: CNS depressant, decreasessensitivity to pain.

Indications: Relief of cough and moderateto severe pain.

Contraindications: Patients with a historyof hypersensitivity to the drug oracetaminophen (Tylenol).

Precautions: May exaggerate the effectsof other CNS depressants. May cause

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repiratory depression at high dosages. Mayelevate intracranial and cerebrospinal fluidpressure in the presence of a head injury or

a pre-existing increase in intracranialpressure.

Side Effects: Lightheadedness, dizziness,drowsiness, nausea, and vomiting.

Dosage: 2.5/5.0/7.5 mg tablets; 1-2 every

4-6 hours.Routes: Oral.

Pediatric Dosage: Not recommended.

28.Hydroxyzine (Vistaril)

Class: Antihistamine.

Actions: Antiemetic, antihistamine,antianxiety, potentiates analgesic effects of

narcotics and related agents.Indications: To potentiate the effects ofnarcotics and synthetic narcotics, nauseaand vomiting, anxiety reactions.

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Contraindications: Patients with a historyof hypersensitivity to the drug.

Precautions: Orthostatic hypotension,analgesic dosages should be reduced whenused with Hydroxyzine, urinary retention.

Side Effects: Drowsiness.

Dosage: 50-100 mg.

Routes: Deep IM.

Pediatric Dosage: 1 mg/kg.

29.Insulin (Humulin)

Class: Hormone (hypoglycemic agent).

Actions: Causes uptake of glucose by thecells, decreases blood glucose level,promotes glucose storage.

Indications: Elevated blood glucose,diabetic ketoacidosis.

Contraindications: Avoidovercompensation of blood glucose level; if

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possible, administration should wait untilthe patient is in the emergencydepartment.

Precautions: Administration of excessivedose may induce hypoglycemia. Glucoseshould be available.

Side Effects: Few in emergencysituations.

Dosage: 10-25 units regular insulin IVfollowed by an infusion at 0.1 units/kg/hr.

Routes: IV subQ.

Pediatric Dosage: Dosage is based onblood glucose level.

30.Ipatropium (Atrovent)

Class: Anticholinergic.

Actions: Causes bronchodilation, driesrespiratory tract secretions.

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Indications: Bronchial asthma, reversiblebronchospasm associated with chronicbronchitis and emphysema.

Contraindications: Patients with historyof hypersensitivity to the drug, should notbe used as primary agent in acutetreatment of bronchospasm.

Precautions: Blood pressure, pulse, and

EKG must be constantly monitored.Side Effects: Palpitations, dizziness,anxiety, tremors, headache, nervousness,dry mouth.

Dosage: Small-volume nebulizer: 500 gshould be placed in small volume nebulizer(typically administered with a agonist).

Routes: Inhalation only.

Pediatric Dosage: Safety in children hasnot been established.

31.Isoetharine (Bronkosol)

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Class: Sympathomimetic (2 selective).

Actions: Bronchodilation, increases heart

rate.Indications: Asthma, reversiblebronchospasm associated with chronicbronchitis and emphysema.

Contraindications: Patients with historyof hypersensitivity to the drug.

Precautions: Blood pressure, pulse, andEKG must be constantly monitored.

Side Effects: Palpitations, tachycardia,anxiety and tremors, headache.

Dosage:Hand nebulizer: four inhalations.

Small-volume nebulizer: 0.5 ml (1:3 withsaline).

Routes: Inhalation only.

Pediatric Dosage: 0.25-0.5 ml diluted

with 4 ml normal saline.

32.Ketorolac (Toradol)

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Class: Non-steroidal anti-inflammatory

agent.Actions: Anti-inflammatory, analgesic(peripherally-acting).

Indications: Mild to moderate pain.

Contraindications: Patients with a history

of hypersensitivity to the drug, patientsallergic to Aspirin.

Precautions: GI irritation or hemorrhagecan occur.

Side Effects: Edema, rash, heartburn.

Dosage: IV 15-30 mg, IM 30-60 mg.

Routes: IV, IM.

Pediatric Dosage: Safety in children hasnot been established.

33.Labetalol (Trandate) (Normodyne)

Class: Sympathetic blocker.

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Actions: Selectively blocks 1 receptorsand nonselectively blocks receptors.

Indications: Sypertensive crisis.Contraindications: Sronchial asthma,congestive heart failure, heart block,bradycardia, cardiogenic shock.

Precautions: Blood pressure, pulse, andEKG must be constantly monitored.

Atropine and transcutaneous pacing shouldbe available.

Side Effects: Bradycardia, heart block,congestive heart failure, bronchospasm,postural hypotension.

Dosage: Method 1: 20 mg by slow IVinfusion over 2 minutes; doses of 40 mgcan be repeated in 10 minutes until desiredsupine blood pressure is obtained or until300 mg of the drug has been given.

Method 2: 200 mg placed in 500 ml d5w to

deliver 2 mg/minute.

Routes: IV infusion or slow IV bolus asdescribed earlier.

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Pediatric Dosage: Safety in children hasnot been established.

34.Lidocaine (Xylocaine)

Class: Antiarrhythmic.

Actions: Suppresses ventricular ectopicactivity, increases ventricular fibrillationthreshold, reduces velocity of electricalimpulse through conductive system.

Indications: Malignant PVCs, ventriculartachycardia, ventricular fibrillation,prophylaxis of arrhythmias associated withacute myocardial infarction andthrombolytic therapy, premedication priorto rapid sequence induction.

Contraindications: High-degree heartblocks, PVCs in conjunction with

bradycardia.Precautions: Dosage should not exceed300 mg/hr. Monitor for CNS toxicity.Dosage should be reduced by 50% inpatients older than 70 years of age or who

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have liver disease in cardiac arrest, useonly bolus therapy.

Side Effects: Anxiety, drowsiness,dizziness, and confusion, nausea andvomiting, convulsions, widening of QRS.

Dosage: Bolus: Initial bolus of 1.5 mg/kg;additional boluses of 0.5 - 0.75 mg/kg canbe repeated at 8-10-minute intervals until

the arrhythmia has been suppressed oruntil 3 mg/kg of the drug has beenadministered; reduce dosage by 50% inpatients older than 70 years of age.

Drip: after the arrhythmia has beensuppressed a 2-4 mg/minute infusion may

be started to maintain adequate bloodlevels.

Routes: IV bolus, IV infusion.

Pediatric Dosage: 1 mg/kg.

35.Magnesium Sulfate

Class: Anticonvulsant/Antiarrhythmic.

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Actions: CNS depressant, anticonvulsant,antiarrhyhmic.

Indications: Obstetrical eclampsia(toxemia of pregnancy), pre-eclampsia/PIH,cardiovascular severe refractory ventricularfibrillation, pulseless ventriculartachycardia, post-MI as prophylaxis forarrhythmias, torsades de pointes (multi-axial ventricular tachycardia).

Contraindications: Shock, heart block.

Precautions: Caution should be used inpatients receiving digitalis. Hypotension.Calcium Chloride should be readilyavailable as an antidote if respiratory

depression ensues. Use with caution inpatients in renal failure.

Side Effects: Respiratory depression,drowsiness.

Dosage: 1-4 g.

Routes: IV, IM.

Pediatric Dosage: Not indicated.

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36.Mannitol (Osmotrol)

Class: Osmotic diuretic.

Actions: Decreases cellular edema,increases urinary output.

Indications: Acute cerebral edema, bloodtransfusion reactions.

Contraindications: Pulmonary edema,patients who are dehydrated,hypersensitivity to the drug.

Precautions: Rapid administration cancause circulatory overload crystallization ofthe drug can occur at lower temperatures.An in-line filter should be used.

Side Effects: Pulmonary congestion,sodium depletion, transient volumeoverload.

Dosage: 1.5-2.0 g/kg.

Routes: IV.

Pediatric Dosage: 0.25-0.5 g/kg IV over60 minutes.

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37.Methylprednisolone (Solu-Medrol)

Class: Steroid.

Actions: Anti-inflammatory, suppressesimmune response (especially in allergicreactions).

Indications: Severe anaphylaxis,asthma/COPD, possibly effective as anadjunctive agent in the management ofspinal cord injury.

Contraindications: None in theemergency setting.

Precautions: Must be reconstituted andused promptly. Onset of action may be 2-6hours and thus should not be expected tobe of use in the critical first hour followingan anaphylactic reaction.

Side Effects: GI bleeding, prolongedwound healing, suppression of naturalsteroids.

Dosage: General usage: 125-250 mg.

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Spinal cord injury: Initial bolus of 30 mg/kgadministered over 15 minutes, followed bya maintenance infusion of 5.4 mg/kg/hr.

Routes: IV, IM.

Pediatric Dosage: 30 g/kg.

38.Midazolam (Versed)

Class: Benzodiazepine tranquilizer.

Actions: Hypnotic, sedative.

Indications: Premedication prior to

cardioversion/RSI, acute anxiety states.Contraindications: Patients with knownhypersensitivity to the drug, narrow-angleglaucoma, shock.

Precautions: Emergency resuscitationequipment should be available. Flumazenil(Romazicon) should be available. Dilutewith normal saline or D5W prior tointravenous administration. Respiratory

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depression more common with Midazolamthan with other Benzodiazepines.

Side Effects: Drowsiness, hypotension,amnesia, respiratory depression, apnea.

Dosage: 1.0- 2.5 mg IV.

Routes: IV, IM, intranasal.

Pediatric Dosage: 0.03 mg/kg.

39.Morphine

Class: Narcotic.

Actions: CNS depressant, causesperipheral vasodilation, decreasessensitivity to pain.

Indications: Severe pain, pulmonaryedema.

Contraindications: Head injury, volumedepletion undiagnosed abdominal pain,patients with history of hypersensitivity tothe drug.

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Precautions: Respiratory depression(narcan should be available), hypotension,nausea.

Side Effects: Dizziness, altered level ofconsciousness.

Dosage: IV: 2-5 mg followed by 2 mgevery few minutes until the pain is relievedor until respiratory depression ensues.

IM: 5-15 mg based on patient weight.

Routes: IV, IM.

Pediatric Dosage: 0.1-0.2 mg/kg IV.

40.Nalbuphine (Nubain)

Class: Synthetic analgesic.

Actions: CNS depressant, decreasessensitivity to pain.

Indications: Moderate to severe pain.

Contraindications: Patients with a historyof hypersensitivity to the drug.

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Precautions: Use with caution in patientswith impaired respiratory function,respiratory depression (Naloxone should be

available). Patients dependent on narcoticsmay experience, symptoms of withdrawal,nausea.

Side Effects: Dizziness, altered level ofconsciousness.

Dosage: 5-10 mg.Routes: IV, IM.

Pediatric Dosage: Rarely used.

41.Naloxone (Narcan)

Class: Narcotic antagonist.

Actions: Reverses effects of narcotics.

Indications:

Narcotic overdoses including thefollowing: Codeine, Demerol, Dilaudid,Fentanyl, Heroin, Lortabs, Methadone,

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Morphine, Paregoric, Percodan, Tylox,Vicodin, synthetic analgesics,

Overdoses including the following:

Darvon, Nubain, Stadol, Talwin,alcoholic coma,

To rule out narcotics in coma ofunknown origin.

Contraindications: Patients with a historyof hypersensitivity to the drug.

Precautions: Should be administered withcaution to patients dependent on narcoticsas it may cause withdrawal effects. Short-acting, should be augmented every 5minutes.

Side Effects: none.Dosage: 1-2 mg.

Routes: IV, IM.

ET (ET dose is 2.0-2.5 times IV dose).

Pediatric Dosage: < 5 years old > 5years old 0.1 mg/kg 2.0 mg.

42.Nifedipine (Procardia)

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Class: Calcium channel blocker.

Actions: Relaxes smooth muscle causingarteriolar vasodilation decreases peripheralvascular resistance.

Indications: Severe hypertension, anginapectoris.

Contraindications: Knownhypersensitivity to the drug, hypotension.

Precautions: Blood pressure should beconstantly monitored. May worsencongestive heart failure. Nifedipine shouldnot be administered to patients receiving

intravenous beta blockers.

Side Effects: Dizziness, flushing, nausea,headache, and weakness.

Dosage: 10 mg sublingually; puncture thecapsule several times with a needle and

place it under the patient's tongue andhave them withdraw the liquid medication.

Routes: Oral, sublingual.

Pediatric Dosage: 0.25-0.5 mg/kg.

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43.Nitroglycerin Spray (Nitrolingual

Spray)

Class: Antianginal.

Actions: Smooth-muscle relaxant,decreases cardiac work, dilates coronary

arteries, dilates systemic arteries.

Indications: Angina pectoris, chest painassociated with myocardial infarction.

Contraindications: Hypotension.

Precautions: Constantly monitor vital

signs. Syncope can occur.

Side Effects: Dizziness, hypotension,headache.

Dosage: One spray administered underthe tongue; may be repeated in 10-15

minutes; no more than three sprays in a15-minute period; spray should not beinhaled.

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Routes: Sprayed under tongue on mucousmembrane.

Pediatric Dosage: Not indicated.

44.Nitropaste (Nitro-Bid)

Class: Antianginal.

Actions: Smooth-muscle relaxant,decreases cardiac work, dilates coronaryarteries, dilates systemic arteries.

Indications: Angina pectoris, chest painassociated with myocardial infarction.

Contraindications: Children younger than12 years of age, hypotension.

Precautions: Constantly monitor bloodpressure, syncope, drug must be protectedfrom light, expires quickly once bottle is

opened.Side Effects: Dizziness, hypotension.

Dosage: 1/2 to 3/4 inches.

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Routes: Topical.

Pediatric Dosage: Not indicated.

45.Norepinephrine (Levophed)

Class: Sympathomimetic.

Actions: Causes peripheralvasoconstriction.

Indications: Hypotension refractory toother sympathomimetics, neurogenicshock.

Contraindications: Hypotensive statesdue to hypovolemia.

Precautions: Can be deactivated byalkaline solutions. Constant monitoring ofblood pressure is essential. Extravasationcan cause tissue necrosis.

Side Effects: Anxiety, palpitations,hypertension.

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Dosages: 0.5-30 g/minute. Method: 8 mgshould be placed in 500 ml of D5W, givinga concentration of 16 g/ml.

Routes: IV drip only.

Pediatric Dosage: 0.01-0.5 g/kg/minute(rarely used).

46.Oxygen (O2)

Class: gas.

Actions: Necessary for cellularmetabolism.

Indications: Hypoxia.

Contraindications: None.

Precautions: Use cautiously in patientswith COPD, humidify when providing high-flow rates.

Side Effects: Drying of mucousmembranes.

Dosage: Cardiac arrest: 100%.

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Other critical patients: 100%.

COPD: 35%.

Routes: Inhalation.

Pediatric Dosage: 24-100% as required.

47.Phenytoin (Dilantin)

Class: Anticonvulsant/antiarrhythmic.

Actions: Inhibits spread of seizure activitythrough motor cortex, antiarrhythmic.

Indications: Status epilepticus,arrhythmias due to digitalis toxicity.

Contraindications: Any arrhythmiaexcept those due to digitalis toxicity,patients with history of hypersensitivity tothe drug.

Precautions: Should not be administeredwith glucose solutions. Hypotension. EKGmonitoring during administration isessential.

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Side Effects: Local venous irritation,central nervous system depression.

Dosages: Status epilepticus: 150-250 mg(10-15 mg/kg) not to exceed 50mg/minute.

Digitalis toxicity: 100 mg over 5 minutesuntil the arrhythmia is suppressed or untilsymptoms of central nervous system

depression occur.Routes: IV (dilute with saline).

Pediatric Dosage: Status epilepticus: 8-10 mg/kg IV.

Digitalis toxicity: 3-5 mg/kg IV over 10

minutes.

48.Procainamide (Pronestyl)

Class: Antiarrhythmic.Actions: Slows conduction throughmyocardium, elevates ventricular

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fibrillation threshold, suppressesventricular ectopic activity.

Indications: Persistent cardiac arrest dueto ventricular fibrillation and refractory toLidocaine, PVCs refractory to Lidocaine,ventricular tachycardia refractory toLidocaine.

Contraindications: High-degree heart

blocks, PVCs in conjunction withbradycardia.

Precautions: Dosage should not exceed17 mg/kg. Monitor for central nervoussystem toxicity.

Side Effects: Anxiety, nausea,convulsions, widening of QRS.

Dosage: Initial: 20 mg/minute untilarrhythmia abolished, hypotension ensues,QRS widened by 50% of original width totalof 17 mg/kg has been given.

maintenance: 1-4 mg/minute.

Routes: slow IV bolus, IV drip.

Pediatric Dosage: Rarely used.

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49.Prochlorperazine (Compazine)

Class: Phenothiazine antiemetic.

Actions: Antiemetic.

Indications: Nausea and vomiting, acutepsychosis.

Contraindications: Comatose states,patients who have received a large amountof depressants (including alcohol), patientswith a history of hypersensitivity to thedrug.

Precaution: EPS (extra-pyramidal seizure)(dystonic) reactions have been reported.

Side Effects: May impair mental andphysical ability, drowsiness.

Dosage: 5-10 mg slow IV or IM.

Routes: IV, IM.

Pediatric Dosage: Not recommended.

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50.Promethazine (Phenergan)

Class: Antihistamine (h1 antagonist).

Actions: Mild anticholinergic activity,antiemetic, potentiates actions ofanalgesics.

Indications: Nausea and vomiting, motion

sickness, to potentiate the effects ofanalgesics, sedation.

Contraindications: Comatose states,patients who have received a large amountof depressants (including alcohol).

Precautions:Avoid accidental intra-

arterial injection.

Side Effects: May impair mental andphysical ability, drowsiness.

Dosage: 25 mg.

Routes: IV.Pediatric Dosage: 0.5 mg/kg.

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56.Racemic Epinephrine (Micronefrin)(VapoNefrin)

Class: Sympathomimetic.

Actions: Bronchodilation, increases heartrate, increases cardiac contractile force.

Indications: Croup

(laryngotracheobronchitis).

Contraindications: Epiglottitis,hypersensitivity to the drug.

Precautions: Vital signs should beconstantly monitored. Should be used onlyonce in the prehospital setting.

Side Effects: Palpitations, anxiety,headache.

Dosage: 0.5-0.75 ml of a 2.25% solution in2.0 ml normal saline.

Routes: Inhalation only (small-volumenebulizer).

Pediatric Dosage: 0.25-0.75 ml of a2.25% solution in 2.0 ml normal saline.

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57.Rifabutin:

Description: A drug used to help preventmycobacterium avium complex disease inpatients with HIV infections.

Ringer's Solution (lactated):

Description: A sterile solution of specifiedamounts of calcium, potassium chloride,sodium chloride, and sodium lactate inwater for injection. It is used intravenouslyto treat dehydration and replaceelectrolytes.

58.Sodium Bicarbonate

Class: Alkalinizing agent.

Actions: Combines with excessive acids toform a weak volatile acid, increases ph.

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Indications: Late in the management ofcardiac arrest, if at all, tricyclicantidepressant overdose, severe acidosis

refractory to hyperventilation.

Contraindication: Alkalotic states.

Precautions: Correct dosage is essentialto avoid overcompensation of ph. Candeactivate catecholamines. Can precipitate

with calcium preparations. Delivers largesodium load.

Side Effects: Alkalosis.

Dosage: 1 mEq/kg initially followed by 0.5mEq/kg every 10 minutes as indicated byblood gas studies.

Routes: IV.

Pediatric Dosage: 1 mEq/kg initiallyfollowed by 0.5 mEq/kg every 10 minutes.

59.Succinylcholine (Anectine)

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Class: Neuromuscular blocking agent(depolarizing).

Actions: Skeletal muscle relaxant,paralyzes skeletal muscles includingrespiratory muscles.

Indications: To achieve paralysis tofacilitate endotracheal intubation.

Contraindications: Patients with known

hypersensitivity to the drug.

Precautions: Should not be administeredunless persons skilled in endotrachealintubation are present. Endotrachealintubation equipment must be available.Oxygen equipment and emergencyresuscitative drugs must be available.Paralysis occurs within 1 minute and lastsfor approximately 8 minutes.

Side Effects: Prolonged paralysis,hypotension, bradycardia.

Dosage: 1-1.5 mg/kg (40-100 mg in anadult).

Routes: IV.

Pediatric Dosage: 1 mg/kg.

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60.Terbutaline (Brethine)

Class: Sympathomimetic.

Actions: Bronchodilator, increases heartrate.

Indications: Bronchial asthma, reversiblebronchospasm associated with COPD,preterm labor.

Contraindications: Batients with knownhypersensitivity to the drug.

Precautions: Blood pressure, pulse, and

EKG must be constantly monitored.

Side Effects: Palpitations, tachycardia,and PVCs, anxiety, tremor, and headache.

Dosage: Metered-dose inhaler: twoinhalations, 1 minute apart.

Subcutaneous injection: 0.25 mg; may berepeated in 15-30 minutes.

Preterm labor: 0.25 mg IM or IV. may berepeated in 15-30 minutes as needed.

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Routes: Inhalation, subcutaneousinjection, IV (preterm labor only).

Pediatric Dosage: 0.01 mg/kgsubcutaneously.

61.Thiamine (Vitamin B1)

Class: Vitamin.

Actions: Allows normal breakdown ofglucose.

Indications: Coma of unknown origin,alcoholism, delirium tremens.

Contraindications: None in theemergency setting.

Precautions: Rare anaphylactic reactionshave been reported.

Side Effects: Rare, if any.

Dosage: 100 mg.

Routes: IV, IM.

Pediatric Dosage: Rarely indicated.

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62.Torsemide (Demadex)

Class: Potent diuretic.

Actions: Inhibits reabsorption of sodiumchloride, promotes prompt diuresis.

Indications: Congestive heart failure,pulmonary edema.

Contraindications: Patients with knownhypersensitivity to the drug, anuria.

Precautions: Should be used with cautionin patients taking NSAIDs, dehydration.

Side Effects: Dizziness, headache,nausea.

Dosage: 10-20 mg.

Routes: IV.

Pediatric Dosage: Safety not established.

63.Vecuronium (Norcuron)

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Class: Neuromuscular blocking agent (non-

depolarizing).Actions: Skeletal muscle relaxant,paralyzes skeletal muscles includingrespiratory muscles.

Indications: To achieve paralysis tofacilitate endotracheal intubation.

Contraindications: Patients with knownhypersensitivity to the drug.

Precautions: Should not be administeredunless persons skilled in endotrachealintubation are present. Endotracheal

intubation equipment must be available.Oxygen equipment and emergencyresuscitative drugs must be available.Paralysis occurs within 1 minute and lastsfor approximately 30 minutes.

Side Effects: Prolonged paralysis,

hypotension, bradycardia.

Dosage: 0.08-0.10 mg/kg.

Routes: IV.

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Pediatric Dosage: 0.1 mg/kg.

64.Verapamil (Isoptin) (Calan)

Class: Calcium channel blocker.

Actions: Slows conduction through the AVnode, inhibits reentry during PSVT,decreases rate of ventricular response,decreases myocardial oxygen demand.

Indications: PSVT.

Contraindications: Heart block,conduction system disturbances.

Precautions: should not be used inpatients receiving intravenous blockers,hypotension.

Side Effects: Nausea, vomiting,hypotension, and dizziness.

Dosage: 2.5 - 5.0 mg. a repeat dose of 5 -10 mg can be administered after 15-30minutes if PSVT does not convert.maximum dose is 30 mg in 30 minutes.

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Routes: IV.

Pediatric Dosage: 0-1 year: 0.1-0.2

mg/kg (maximum of 2.0 mg) administeredslowly.

1-15 years: 0.1-0.3 mg/kg (maximum of 5.0mg) adminis