Albuterol (Proventil, Ventolin)
Class:
Sympathomimetic, Selective beta-2 agonist
Action:
Activates the beta-2 adrenergic receptors to relax smooth muscle
Bronchodilation, relieves bronchospasms and reduces airway resistance
ONSET = 5 min DURATION = 3-4 hours
Indications: Respiratory distress with bronchospasms -Asthma -Allergic reaction/anaphylaxis -Pneumonia -COPD
Dosage/Route
-Adult 2.5 mg in 3 ml of NS via SVN, repeat as needed
Contraindications:
- MI
- Cardiac pulmonary edema
Side Effects:
- Restlessness/anxious
- Dizziness
- Tach/Palpations
- Dysrhythmias
Special Information:
Albuterol may precipitate angina pectoris and dysrhythmias
Check lung sounds, SpO2, capno and respiratory rate before and after administration of albuterol to determine effectiveness
Adenosine (Adenocard)
Class:
Endogenous Nucleoside
Action:
- Slow electrical conductivity through AV node
- ONSET = within 30 seconds, Duration = 10 seconds
Indications:
SVT / Fast narrow complex >160 in stable pt
Dosage/Route:
6mg rapid IVP: follow with 20 ml NS
12mg rapid IVP: follow with 20 ml NS
12mg rapid IVP: follow with 20 ml NS
Contraindications:
- sick sinus syndrome
- A-Flutter
- A-Fib
- V-Tach
Side Effects:
Chest pain
SOB
Transient arrhythmis: brady, AV blocks, ventricular ectopy
Special Information:
Place pt in mild reverse Trendelenburg position before administration
A brief period of asystole (up to 15 sec) followed by resumption of NSR, is common after rapid administration
May produce bronchoconstriction in pt’s with asthma and bronchopilmonary disease
Monitor ECG during administration; start printing before administration
AMIODARONE (CORDARONE)
Class:
-Class III antidysrhythmic (K+ blockade)
Action:
- Prolongs duration of action potential and effective refractory period
- Includes noncompetitive beta-adrenoreceptor and calcium channel blocker activity
- ONSET = within min DURATION = variable
Indications:
- V-Tach with pulse
- Pulseless V-Tach or V-Fib
Dose/Route:
- If pt is stable 150 mg SIV infusion in 50 ml over 10-15 min repeat x1
- 300 mg IVP, 2nd dose 150 mg IVP Max = 450 mg
Contraindications:
- Cardiogenic shock
- Hypotension
- Brady
Side Effects:
- Hypotension
- Headache
- Brady
Special Information:
- Amiodarone has actions of all classes
- Maintenance drip of 1 mg/min
- Do not exceed 2 grams
ASPIRIN (ASA, ACETYLSALCYCLIC ACID)
Class:
-Antiplatelet/ Salicylate
Action:
- Interrups Thromboxone A2 (TA2)
- Inhibits prostaglandins
- ONSET = 15-30 min DURATION 4-6 hours
Indications:
-CP of suspected cardiac origin
Dosage/Route:
-162-324 mg PO chew and swallow (2-4, 81 mg pills)
Contraindications:
- unable to swallow
- Active bleeding ulcer
- ASA allergy
Side Effects:
- Stomach irritation (Nausea/vomiting, epigastric pain, heartburn, indigestion)
- Bronchospasms in some pt with asthma
Special Information:
- Pills need to be chewed and swallowed with small amount of water
- ASA has no effect on existing blood clots
- Can give if pt is on anticoagulants
ATROPINE SULFATE
Class:
-Anticholinergic
Action:
- Competes with acetycholine receptor sites at the SA & AV nodes
- Increases heart rate by increasing conduction at SA & AV nodes
- Inhibits secretions by decreasing PNS effect on bronchial, salivary, sweat and GI glands
- ONSET IV2-4 min DURATION 2-6 hours
Indications:
- Symptomatic brady
- Organophosphate OD
Dose/Route:
- 0.5 mg IVP, q 3-5 min
- 2 mg IVP q 3-5 min until effective
Contraindications:
- High degree heart block
- Glaucoma
Side Effects:
- Tachy
- Dry/flush skin
- Dilated pupils
- Increase BP
BRETHINE (TERBUTALINE)
Class:
-Beta-2 agonist
Action:
- Causes effects of beta 2
- Has some effects on Beta 1
- ONSET 10 min Duration 30 min
Indications:
- Obstructive SOB
- Asthma, bronchitis, emphysema
- When refractory to albuterol and atrovent
Dose/Route:
0.25 IM or SQ, PRN
Contraindications:
- MI
- Cardiac pulmonary edema
Side Effects:
- tachy
- Anxiety/restlessness
- Sleeplessness
Special Information:
- Brethine has a synergistic effect with albuterol and atrovent
- Brethine is not used as a first line (admin of albuterol and atrovent 1st)
CALCIUM GLUCONATE
Class:
-Electrolyte
Action:
Cardioprotective agent in hyperkalemia
Indication:
-Adult pulseless arrest associated with any of the following:
-known hyperkalemia
-renal failure with or without hemodialysis history
-hemodialysis history
-calcium channel blocker
Not indicated for routine treatment of pulseless arrest
Adult or pediatric calcium channel blocker overdose with hypotension and brady
Dose/Route:
- 1 g slow IV push
- 3 g slow IV/IO push over 2-3 min dose may be repeated every 10 min for a total of 3 doses
Contraindications:
- Known hypercalcemia
- Suspected digoxin toxicity
Side Effects:
- Extravasation may cause tissue necrosis
- In setting of digoxin toxicity, may worsen cardiovascular function
Special Effects:
-10% calcium gluconate solution contains 1 g calcium gluconate per 10 mL, which is only 90 mg of elemental calcium
CARDIZEM (DILTIAZEM) Rate control medication
Class:
-Non-DHP calcium channel blocker
Action:
- Slows conduction at the AV node
- Causes coronary and peripheral vasodilation
- ONSET 2-5 min DURATION 1-3 hours
Indications: Rapid A-Fib >170 Rapid A-Flutter >170 Multifocal atrial tach SVT refractory to Adenosine
Dosage/Route:
0.25 mg/kg SIVP (over 2 min)
Contraindications: BP<90 WPW syndrome or short P-R interval syndrome Heart Block Sinus Tach Cardiogenic shock
Side Effects:
Hypotention, brady, syncope
Dizziness, nausea, vomiting, dry mouth
Dyspnes
Special Information:
- Known A-Fib or Flutter, cardizem is drug of choice
- Hypotension may result - monitor vital signs
DEXTROSE 50%
Class:
Carbohydrate
Action:
Increase blood glucose by providing free sugar quickly released into the blood stream
ONSET 1 min DURATION varies
Indications:
- Documented hypoglycemia
- Coma of unknown origin
- Seizure of unknown origin
Dose/Route:
-25 g SIVP
PEDS D25%
0.5 1 g/kg or 2-4 ml/kg
Contraindications:
- Intracranial hemorrhage
- Known of a suspected cerebral accident in the absence of hypoglycemia
Side Effects:
-Hyperglycemia
Special Information:
- Must have patient IV
- Draw blood sample prior to administration
- Document BGL pre and post
- Tissue necrosis if infiltrated
DIAZEPAM (VALIUM)
Class:
-Benzodiazepine
Action:
- Increases the effect of gamma - aminyobutyvic acid (GABA)
- Acts on the CNS to raise the seizure threshold in the motor cortex
- causes amnesia
- ONSET 1-5 min IV, 15-30 min IM DURATION 15-60 min
Indications:
- Seizure activity
- Procedures (cardioversion)
- Extreme anxiety
Dose/Route
-2 - 10mg SIVP over 2 min
q 10-15 min PRN
Max dose 30 mg
Contraindications
-Respiratory depression
Side Effects:
- Respiratory depression
- Ataxia
- Confusion
- Psychomotor impairment
- Hypotension
Special Information:
- Like other benzodiazepines, diazepam has no effect on pain
- Be prepared to control the airway
DIPHENHYDRAMINE (BENADRYL)
Class:
-Antihistamine (H1)
Action:
- Binds to histamine receptor sites, suppressing histamine induces allergic symptoms
- ONSET 15-30 min, PEAK 1-3 hours, DURATION 6-12 hours
Indications:
- Allergic Reaction/Anaphylaxis
- Acute dystonia
Dose/Route:
_40-50 mg IVP or deep IM
Contraindications:
-Asthma (relative)
Side Effects:
- Anticholinergic effects
- Drowsiness
Special Information:
Histamine 1 blocker
Does not prevent histamine release
DOPAMINE (INTROPIN)
Class:
-Sympathomimetic/inotrope Beta agonistic drug
Action:
- At low and medium dose beta effects, mostly inotropic (SA,AV,Vent)
- Med to high dose alpha and beta effects (periferial constriction)
- High dose alpha effects
- ONSET 2-4 min DURATION 10-15 min
Indications: Unable to control pressure in -Cardiogenic shock -Symptomatic brady refractory to atropine -Distributive shock
Dose/Route: 2-10 mcg/kg/min mix 400 mg in 250 ml bag med dose 10-20 mcg/kg/min distributive shock 10-20 mcg/kg/min
Contraindications:
-Hypovolemia
Side Effects:
- Increase HR
- Decrease BP
- Chest Pain
- SOB
- MI
- Ectopy
Special Information
- Low dose 5 mcg/kg/min (beta effects, mostly inotropic)
- Med dose 10 mcg/kg/min (alpha and beta effects)
- High dose 20 mcg/kg/min (alpha effects, no beta)
EPINEPHRINE 1:1000 (ADRENALINE)
Class:
Sympathomimetic
Action:
Bronchodilation beta 2
Vasoconstriction apla
On the heart beta-1
Increase heart rate/chronotropic
Increase contractility/inotropic
Increase AV conduction/dromotropic
Increase automaticity/dromotropic
ONSET 5-10 min SQ. DURATION 5-10 minIndications:
Asthma refractory to Albuterol
Allergic reaction with SOB
Symptomatic brady refractory to atropine
Dose/Route:
0.3-0.5 mg IM
1 mg into 250 ml at 2-10 mcg/min; start at 30 gtts/min
Contraindications:
Hypovolemic shock (correct hypovolemia first)
MI
MAOI’s
Side Effects: Hypertension Tach V-Tach or V-Fib Restlessness/nausea MI/Chest pain
Special Information:
Epi has a very low pH, do not mix with sodium bicarbonate
Causes increase in myocardial oxygen demand
EPINEPHRINE 1:10,000 (ADRENALINE)
Class:
Sympathomimetic
Action:
-Bronchodilation beta 2
-Vasoconstriction alpha
-On the heart
-Increase heart rate/chronotropic
-Increase contractility/inotropic
-Increase AV conduction/dromotropic
-Increase automaticity/dromotropic
ONSET 1-2 min IV/IO DURATION 5-10minIndications:
- Pulseless V-Tach/Fib, PEA, Asystole
- Anaphylaxis (shock)
Dose/Route:
- 1 mg IVP, IO, q 3-5min
- 0.01 mg/kg IVP, IO, q 3-5 min
0. 1-0.3 mg IVP, q 5 min
Contraindications:
-None
Side Effects:
- Hypertension
- Tach
- V-Tack/Fib
- Restlessness/nausea
Special Information:
- Epi has a very low pH, do not mix with sodium bicarbonate
- Causes increase in myocardial O2 demand
ETOMIDATE (AMIDATE)
Class:
-Non-Benzo sedative hypnotic
Action:
- Exact measure is unknown but appears to have gamma-aminobutyia (GABA) effects
- ONSET within 30 sec DURATION 3-5 min
Indications:
- RSI
- Procedures
Dose/Route:
-0.2-0.6 mg/kg IVP/IO
Contraindications:
-None
Side Effects:
-Respiratory Depression
Special Information:
-Has a short life span
FENTANYL (SUBLIMAZE)
Class:
-Synthetic opioid analgesic
Action:
- Combines with receptor in the brain to produce analgesic effects
- ONSET 7-8 min DURATION 15-20 min
Indications:
- Pain control
- Undiagnosed ABD pain
- Isolated Trauma
- MI
Dose/Route:
-1-2 mcg/kg IV or IM or IO
Contraindications:
- Head injury
- BP < 90
Side Effects:
- Decreased respiratory rate and depth
- Pinpoint pupils
- Hypotension
Special Information:
- Fentanyl is a synthetic opioid analgesic
- Has a short half-life, 20-30 minutes
- can be reversed with Narcan
FLUMAZENIL (ROMAZICON)
Class:
-Benzodiazepine
Action:
- Decreases the effect of hamma-aminobutyric acid (GABA)
- ONSET 1-2 min DURATION Varies
Indications:
- Provider caused overdose
- Reverse sedation of Benzodiazepine
Dose/Route:
-0.2 mg IVP, ONLY ONCE!
Contraindications:
-Not overdosed by provider
Side Effects:
-Seizures
Special Information:
- Flumazenil does not antagonize CNS effects of ethanol, barbiturates or opioids
- Stimulates the CNS to override the benzo
FUROSEMIDE (LASIX)
Class:
-Loop diuretic
Action:
- Inhibits reabsorption of sodium and chloride primarily in Loop of Henle and also in proximal and distal renal tubules
- ONSET within 5 min DURATION 2 hours
Indications:
-Cardiac pulmonary edema
Dose/Route
-20-40 mg SIVP, over 1-2 min
Contraindications:
-BP<90
Side Effects:
- Polyuria
- Hypotension
- Hypokalemia
Special Information:
- Give nitro first
- Can cause tinnitus or deafness if pushed too fast
- Pt will need to urinate soon after administration 8-12min
GLUCAGON
Class:
-Hormone
Action:
- Increase blood glucose by converting glycogen in the liver to glucose
- ONSET within 1 min DURATION 60-90 min
Indications:
- Hypoglycemic with no vascular access
- Esophageal Spasm
- Beta blocker OD
Dose/Route:
- 0.5-1 units IM
- 2 units IVP, repeat PRN
Contraindications:
-None
Side Effects:
- Tachy
- Hypotension
Special Information:
-Dependent on sugar stores for treatment of hypoglycemia
HALOPERIDOL (HALDOL)
Class:
- Butyrophenone
- Similar effects to Phenothiazine
Action:
- Blocks dopamine receptors in the brain associated with mood or behavior
- Exerts strong antiemetic effects and impairs central thermoregulation
- ONSET 6-9 min DURATION hours
Indications:
-Chemical restraint
Dose/Route:
-2-5mg IM
Contraindications:
-None
Side Effects:
- Hypotension
- Long QT syndrome
- Sedation
- Distonic reaction
- Anticholonergic toxidrome
IPRATROPRIUM (ATROVENT)
Class:
-Anticholinergic
IPRATROPRIUM (ATROVENT)
Class:
-Anticholinergic
ACTION:
- Blocks acetylcholine at receptor sites on bronchial smooth muscle
- ONSET 5-15 min DURATION 4-6 hours
Indications: Obstructed SOB: -Asthma -Bronchitis -Emphysema -Pneumonia
Dose/Route:
0.5 mg / 2.5 ml SVN; repeat 30-45 min
Contraindications:
- MI/Angina
- Cardiac pulmonary edema
- Glaucoma (relative)
Side Effects:
- Tachy
- Anxiety/restlessness
- Anticholonergic toxidrome
Special Information:
- Atrovent provides a synergistic effect with albuterol
- Albuterol should be given first
LIDOCANE (XYLOCAINE) 2%
Class:
-Class Ib
Action:
- Sodium channel blocker
- Alters phase “O” diastolic depolarization
- ONSET 30-90 sec DURATION 10-20 min
Indications:
- V Tach with pulses 1-1.5 mg/kg q 8min 1/2 initial dose 0.5-0.75 max dose of 3 mg/kg
- Pulseless V Tach or V Fib 1.5 mg/kg q 5 min make dose 3 mg/kg
- Local anesthetic for relief of pain during intraosseous fluid administration 0.5 mg/kg IO bolus, slowly, max dose 50mg
Contraindications:
-Heart blocks
Side Effects:
- Slurred speach, seizures, heart blocks, increase in conduction with AFib and Flutter
- Neurologic anesthesia (aphasia, numbnes/tingling in face, seizures that are hard to stop, visual disturbances)
Special Information:
- Geriatric >70 or known liver or kidney failure, sequential dose is 1/4 of initial dose
- Maintenance drip: 1g/250ml at 1 mg/min above conversion dose 2-4mg/min
- Pt must be monitored closely with maintenance drip
LORAZEPAM (ATIVAN)
Class:
-Benzodiazopine
Action:
- Enhances the effects of gamma-aminobutyric acid (GABA)
- Effects: anxiolytic, sedative, hypnotic, and skeletal muscle relaxant
- ONSET 1-5 min DURATION: 6-8 hours
Indications:
- Seizure
- Procedures
- Extreme anxiety
Dose/Route:
-2mg IVP, IM, IO, PR
Contraindications:
- Respiratory depression
- CNS depression
Side Effects:
- Respiratory depression
- CNS depressions
- Hypotension
- Tachy
Special Informations
- Strongest of the Benzos
- Shorter half life than Diazepam
- Dilute for IV use with NS
