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Paramedic Drug List
2022 Drug List
| Drug | Class | Action | Indications | Contraindications | Adult Dose/Route | Peds Dose/Route | Side Effects | Notes |
|---|---|---|---|---|---|---|---|---|
| Acetaminophen | Analgesic, antipyretic | Increases pain threshold by inhibiting cyclooxygenase and reduces fever by acting on the hypothalamus. Has no anti-inflammatory properties or effect on platelets. | Fever, pain relief | Hypersensitivity and use caution in patients with liver disease. | 325-1000 mg PO every 4-6 hr | 15 mg/kg PO/PR every 4-6 hr | Nausea/vomiting, hepatotoxicity | |
| Activated Charcoal | Antidote, adsorbent | Binds to and adsorbs ingested toxins thereby inhibiting their GI absorption. Once the drug binds to the charcoal, the combined complex is excreted. | Acute ingested poisonings that were ingested within the last hour | Cyanide, mineral acids, caustic alkalis, iron, ethanol, methanol, corrosives, petroleum distillates. | 1 g/kg PO/ NG | 1-2 g/kg PO/ NG | Nausea, vomiting, abdominal cramping, constipation | |
| Adenosine / Adenocard | Misc. antidysrhythmic, endogenous nucleoside | Decreases electrical conduction through the AV node without causing negative inotropic effects. It also acts on the SA node and vagal nerve terminals to decrease HR. | Supraventricular tachycardia (SVT/PSVT) | Hypersensitivity, bradycardia, drug induced tachycardia, 2nd or 3rd degree heart blocks, A-Fib, A-Flutter, V-Tach, WPW with A-Fib/flutter. | 6 mg rapid IV/IO push followed by 20 cc saline flush. May repeat in 1-2 min at 12 mg rapid IV push followed by 20 cc saline flush. May repeat twice. | 0.1mg/kg (max 6mg) IV/IO followed by 5-10 cc saline flush. May repeat in 1-2 min at 0.2 mg/kg (max 12mg) IV/IO followed by 5-10 cc saline flush. | Dizziness, headache, shortness of breath, hypotension, flushing, palpitations, chest pain, nausea/vomiting | Methylxanthine classified stimulants (caffeine & theophylline) usage will antagonize adenosine |
| Albuterol / Proventil | Sympathomimetic, bronchodilator, beta-2 agonist | Sympathomimetic that is selective for Beta-2 adrenergic receptors. Relaxes smooth muscles of the bronchial tree and peripheral vasculature by stimulating adrenergic receptors of sympathetic nervous system. | Asthma, bronchospasms, reversible obstructive airway disease, anaphylaxis, hyperkalemia | Hypersensitivity, caution with pts with cardiac dysrhythmias | 2.5 mg diluted in 3 mL of Normal Saline, repeat as needed | 2.5 mg diluted in 3 mL of Normal Saline, repeat as needed | Tremors, tachycardia, hypertension, anxiety, nausea, headache, palpitations, cough, dizziness. | Albuterol may precipitate angina & cardiac dysrhythmias. Use with caution in pt’s with cardiovascular disorder, diabetes, seizure disorder, hyperthyroidism. Beta blockers may antagonize albuterol. |
| Amiodarone / Cordarone | Class III antidysrhythmic | Prolongs duration of the action potential and prolongs the refractory period, also may have beta adrenergic receptor and calcium channel blocking activity. Works on both the ventricles and the atria. | V-Fib, hemodynamically unstable V-Tach, treatment for some stable atrial rhythms | CHF, cardiogenic shock, bradycardia, 2nd or 3rd degree heart blocks with no pacemaker present, hypersensitivity to amiodarone or iodine | Pulseless V-Tach/V-Fib arrest - 300mg IV/IO may repeat once at 150mg IV/IO. V-Tach with a pulse 150mg IV drip over 10 minutes up to max of 2.2g in 24 hours | Pulseless V-Tach/V-Fib arrest - 5mg/kg IV/IO. V-Tach with a pulse 5mg/kg IV drip over 20-60 minutes with a max of 15mg/kg/day. | Bradycardia, hypotension, headache, CHF, abnormal liver/thyroid functions. In rare cases can cause pulmonary fibrosis | |
| Aspirin (Salicylate) | Analgesic, nonsteroidal anti-inflammatory drug (NSAID), antipyretic, and antiplatelet | Inhibits prostaglandins involved in the production of inflammation, pain and fever. Dilates peripheral vessels and inhibits platelet aggregation by blocking the formation of thromboxane A2. | Acute coronary syndrome (ACS) such as myocardial infarction, ischemic chest pain or angina, and given for mild to moderate pain or fever. | GI bleeding, hemorrhagic stroke, active gastric ulcers, bleeding disorders, asthma, hypersensitivity to salicylates, children | Mild pain/fever – 325-650 mg PO every 4 hours. ACS – 2 to 4 baby chewable aspirin, 162-324 mg OR 1 adult aspirin, 325mg PO. | Not indicated | Stomach irritation, GI bleeding, nausea/vomiting | Children under 12 should not be given Aspirin as they may develop Reye’s syndrome. |
| Atropine Sulfate | Anticholinergic, Parasympatholytic | Inhibits actions of acetylcholine (mostly at muscarinic receptor sites) causing decreased salivation and bronchial secretions, increased heart rate and decreased gastric motility. | Hemodynamically unstable bradycardia, organophosphate or nerve gas poisoning | Tachycardia, hypersensitivity, avoid use with hypothermic pts, caution in pts with an active MI and hypoxia | Bradycardia – 1 mg IV/IO q 3-5 min up to max total of 3 mg. Organophosphate poisoning – 1 to 5mg IV/IM/IO repeated 3-5 min until cessation of bronchial secretions | Bradycardia not responding to Epi: 0.02mg/kg IV/IO (min 0.1mg, max 0.5mg), total 1mg child, 3mg adolescent. Organophosphate <12yrs: 0.05mg/kg IV/IM/IO, repeat 20-30min until secretions stop. | Tachycardia, paradoxical bradycardia if given too slow or too small of dose, mydriasis (dilated pupils), dysrhythmias, headache, nausea/vomiting, headache, dizziness, flushed, anticholinergic effects | Effects of atropine may be potentiated by antihistamines, procainamide, quinidine, antipsychotics, antidepressants, and thiazides. |
| Calcium Chloride | Electrolyte, hypertonic solution | It is an essential element for regulating the excitation threshold of nerves and muscles, normal cardiac contractility, and blood coagulation. | Hyperkalemia, hypocalcemia, hypermagnesemia, calcium channel blocker overdose | V-Fib during cardiac resuscitation, digitalis toxicity, hypercalcemia | 1-2 g (10-20 ml) slow IV of 10% solution | 20 mg/kg slow IV of 10% solution | Bradycardia, hypotension, Metallic taste in mouth, local necrosis if given IM or IV infiltration | |
| Dextrose 50%, 25%, 10% | Carbohydrate, hypertonic solution | A monosaccharide, which provides calories for metabolic needs, spares body proteins and loss of electrolytes | Hypoglycemia. If protocol allows also for altered ALOC, coma, and seizure of unknown origin | Intracranial hemorrhage, increased intracranial pressure, known or suspected stroke in the absence of hypoglycemia | 12.5-25 g slow IV (25-50 ml 50% dextrose; 125-250 ml 10% dextrose) | Peds: 0.5-1 g/kg (2-4 ml/kg) IV of 25% dextrose Neonates: 0.5-1 g/kg (2-4 ml/kg) IV of 10% dextrose | Hyperglycemia, thrombophlebitis | Infiltrated IV risks necrosis; use large vein, flush w/ saline for patency. D50 may cause Wernicke's encephalopathy in thiamine-deficient patients; if suspected, give 100mg Thiamine IV before D50. |
| Diazepam / Valium | Benzodiazepine | Increases the activity of the inhibitory neurotransmitter GABA, thereby producing a sedative effect, relaxing skeletal muscles, and raising the seizure threshold. | Seizure activity, acute anxiety, skeletal muscle relaxation, sedation for pacing/ cardioversion, acute alcohol withdrawal | Hypersensitivity, respiratory depression, head injury w/ CNS depression, shock, and coma. Use with caution in pts with acute substance abuse. | Seizures – 5 to 10 mg IV over 2 mins every 10-15 min as needed & a max of 30 mg. Premedication for pacing/ cardioversion – 5-15 mg IV 10 minutes prior to | 30 days to 5 yrs – 0.2-0.5 mg slow IV push over 2 mins every 2-5 min to a max of 5 mg. Peds 5 yrs or older – 1 mg slow IV push over 2 mins every 2-5 min with a max of 10 mg. | Respiratory depression, altered LOC, hypotension, amnesia, confusion, nausea, vomiting, blurred vision | |
| Diltiazem (Cardizem) | Calcium channel blocker | Inhibits calcium ion influx through slow channels into the cell of myocardial and arterial smooth muscle. Slows SA and AV nodal conduction. Dilates coronary arteries and arterioles thus inhibits coronary artery spasms. | A-Fib and A-Flutter, multifocal atrial tachycardia, SVT/PSVT refractory to Adenosine. | Hypersensitivity, 2nd and 3rd degree heart block, hypotension, cardiogenic shock, ventricular rhythms, sick sinus syndrome, Wolf-Parkinson-White syndrome, AMI, V-Tach. | 15-20 mg IV (0.25mg/kg) over 2 min, may be repeated in 15 min at 20-25 (0.35mg/kg) mg IV over 2 min. Maintenance infusion 5-15 mg/hr titrated to HR. | Not recommended | Headache, dizziness, hypotension, 1st and 2nd degree heart block, bradycardia, palpitations, CHF, chest pain, ventricular rhythms. | Use caution with renal/liver impaired pt’s and those taking beta blockers. |
| Diphenhydramine (Benadryl) | Antihistamine | Blocks histamine H1 receptor sites thereby inhibiting actions of histamine release. | Allergic reactions, anaphylaxis, acute extrapyramidal reaction (dystonia) | Hypersensitivity, pt’s taking MAO inhibitors, caution with narrow-angle glaucoma, newborns and nursing mothers. | 25-50mg IV/IM/PO with a max of 400 mg/day | 1 mg/kg IV/IM/PO with a max of 300 mg/day | Drowsiness, palpitations, hypotension, tachycardia or bradycardia, disturbed coordination, dry mouth/throat, thickening of bronchial secretions. | Use with caution in CNS depressed pts and pts with lower respiratory tract diseases such as asthma. |
| Dopamine (Intropin) | Sympathomimetic, vasopressor | α1, β1 adrenergic receptor action. 2-5 mcg/kg/min affect dopaminergic receptors for renal, mesenteric, cerebral dilation. 5-10 mcg/kg/min stimulate β1 for ↑ cardiac output. 10-20 mcg/kg/min show α1 effects causing arterial/venous constriction. | Hemodynamically significant hypotension in the absence of hypovolemia such as in cardiogenic shock, neurogenic shock, septic shock. Second line pharmacological treatment for bradycardia after atropine. | Hypovolemia, trauma, tachydysrhythmias, V-Fib, pt’s with pheochromocytoma. | 2-20 mcg/kg/min IV drip and titrate to desired effect | 2-20 mcg/kg/min IV drip and titrate to desired effect | Tachycardia, hypertension, anxiety, headache, nausea/vomiting, increased myocardial oxygen demand, mydriasis, dose-related tachydysrhythmias | |
| Epinephrine (Adrenalin) | Sympathomimetic | Endogenous catecholamine stimulates α1, β1, β2 receptors. Effects: ↑ contractile force, rate, cardiac output. Potent vasoconstrictor & bronchodilator. Slows gastric motility, causes miosis, pale skin. | Anaphylaxis, cardiac arrest, asthma, bradycardia (first line in peds), shock not caused by hypovolemia, severe hypotension accompanied with bradycardia when pacing and atropine fail. | Hypovolemic shock. Caution should be used in patients with known cardiovascular disease or pts > 45 y/o | -Cardiac arrest: 1mg (0.1mg/1mL) IV/IO, 3-5min, no max. -Anaphylaxis/asthma: 0.3-0.5mg SQ/IM (1mg/1mL); if no response, 0.3-0.5mg IV (0.1mg/1mL). -Post arrest/bradycardia w/ hypotension: 2-10mcg/min IV drip. | -Cardiac arrest: 0.01mg/kg (0.1mg/1mL) IV/IO, max 1mg, 3-5min. -Anaphylaxis/asthma: 0.01mg/kg (1mg/1mL) SQ/IM, max 0.3mg. | Tachycardia, hypertension, anxiety, cardiac dysrhythmias, tremors, dyspnea | Always use epinephrine 1mg/1mL when given SQ/IM and 0.1mg/1mL when given IV/IO. Giving concurrently with alkaline solutions such as sodium bicarbonate will cause crystallization of fluid. |
| Epinephrine, Racemic (Micronefrin) | Sympathomimetic | Racemic Epinephrine, inhaled epinephrine, acts as bronchodilator & anti-inflammatory for laryngeal/tracheal swelling. Similar to epinephrine, has systemic & localized effects. | Laryngotracheobronchitis (croup), asthma, bronchospasms, laryngeal edema | Hypertension, epiglottitis. Use caution in patients with known cardiovascular disease or in pts > 45 y/o. | 0.5mL (2.25%) in 5mL NS over 15 min | For pts < 6 months – 0.25 ml (2.25%) diluted in 3 ml NS. For pts > 6 months – 0.5 ml (2.25%) diluted in 3 ml NS. | Tachycardia, hypertension, anxiety, cardiac dysrhythmias, tremors | |
| Etomidate (Amidate) | Anesthetic, non-barbiturate hypnotic | Etomidate is a very potent drug that acts on the reticular activating system to produce a short-acting anesthesia with amnesic properties. Etomidate has very little effect on respiratory drive which makes it ideal for certain procedures. | Premedication prior to procedures such as endotracheal intubation, synchronized cardioversion, conscious sedation for bone dislocation relocation. | Hypersensitivity, labor and delivery | 0.3mg/kg IV over 30-60 sec, limited to one dose | >10 years- 0.3mg/kg IV over 30-60 sec with a max dose of 20 mg | Hypotension, hypertension, dysrhythmias, hypoventilation, nausea/vomiting, cortisol suppression | Primarily used for Rapid Sequence Intubation/induction (RSI) in the prehospital setting |
| Fentanyl (Sublimaze) | Synthetic Opioid analgesic | Combines with the receptor sites in the brain to produce potent analgesic effects. | Pain and sedation, sedation for invasive airway procedures | Hypersensitivity to opiates, hypotension, head injury, respiratory depression, cardiac dysrhythmias, myasthenia gravis | 0.5 – 2 mcg/kg IV/IN/IM over 2 mins, q 5 min, max single dose of 100 mcg, max total dose of 300 mcg. | 0.5 – 1 mcg/kg IV/IN/IM over 2 mins, q 5 min, max single dose of 100 mcg, max total dose of 3 mcg/kg. | Respiratory depression, hypotension or hypertension, bradycardia, nausea/vomiting, and rigidity of chest wall muscles | |
| Furosemide (Lasix) | Loop diuretic | Furosemide is a potent diuretic that inhibits the reabsorption of sodium and chloride in the proximal tubule and loop on Henle. IV doses can also reduce cardiac preload by increasing venous capacitance. | Pulmonary edema (CHF) with SBP > 90, hypertensive emergencies, hyperkalemia | Anuria, hypersensitivity, hypovolemia, hypokalemia | 20-40 mg IV over 1-2 min. If no response double dose up to 2 mg/kg over 1-2 min. Most services allow up to a max of 40-80 mg IV. | 1 mg/kg/dose IV over 1-2 min with a total max of 6 mg/kg | Tinnitus and hearing loss (if given too quickly), hypotension, hypokalemia, hyponatremia, hypocalcemia, hyperglycemia | Must give slowly or may cause permanent hearing problems. |
| Glucagon | Pancreatic hormone | Glucagon breaks down glycogen, raises blood glucose, and stimulates glucose synthesis. Effective inotropic action on heart, useful for beta-blocker/calcium channel blocker OD. Relaxes GI tract smooth muscle, aiding esophageal obstruction. | Hypoglycemia (when IV access is not available), beta-blocker overdose, calcium channel blocker overdose, esophageal obstruction | Hypersensitivity (usually to proteins) | Hypoglycemia – 1 mg IM/IN may repeat in 10 min if protocol allows. Can be mixed in 9mL NS for IV administration. Calcium channel or beta blocker overdose – 3-10 mg IV over 3-5 min followed by an infusion at 3-5 mg/hr. | < 20 kg – 0.5 mg IM/IN, > 20 kg - 1.0 mg IM/IN | Tachycardia, hypotension, nausea/vomiting, urticaria | Glucagon requires glycogen stores in the liver to increase blood glucose. If patient is malnourished, glucagon may not work. |
| Haloperidol (Haldol) | Antipsychotic, neuroleptic | Blocks dopamine type-2 receptors in the brain thereby altering mood and behavior. | Acute psychotic episodes, emergency sedation of severely agitated or delirious pts | Hypersensitivity, CNS depression, pregnancy, Parkinson’s disease, seizure disorder, liver or cardiac disease | 5 mg IV or 10 mg IM, q 5-10 min, max of 15 mg. | (6-12 years) 1-3mg IM (max 0.15 mg/kg) | Dose-related extrapyramidal reactions, hypotension, nausea/vomiting, blurred vision, drowsiness. | |
| Hydroxocobalamin (Cyanokit) | Vitamin, antidote | Active form of Vitamin B12 used to treat known or suspected cyanide poisoning. | Known or suspected cyanide poisoning | Hypersensitivity | 5 g IV infusion over 15 min. Can repeat 5 g IV infusion over 2 hrs up to 10 g total. | 70 mg/kg IV infusion over 15 min. | Hypertension, headache, nausea, photophobia, red-colored urine and skin | The vial should be repeatedly inverted or rocked, not shaken, for at least 60 sec prior to administration. Use vented IV administration tubing. |
| Ibuprofen | Nonsteroidal Anti-Inflammatory (NSAID) | Slows prostaglandin synthesis by inhibiting COX-1 and COX-2 enzymes, thereby decreasing inflammation. | Pain, fever, various inflammatory disorders. | Hypersensitivity, bleeding disorders, renal failure or disease, active peptic ulcer disease, preterm infants with infection, congenital heart disease from patent ductus arteriosis. | 400-800 mg PO, every 6-8 hrs | 10 mg/kg PO, (up to 400 mg) every 4-6 hrs | Bleeding disorders, nausea, headache, rash, edema. | May antagonize effects of Angiotensin Converting Enzyme (ACE) inhibitors, beta blockers, angiotensinreceptor antagonist medications, salicylates, and certain classes of diuretic medications |
| Ipratropium (Atrovent) | Anticholinergic, bronchodilator | Ipratropium blocks interaction of acetylcholine at receptor sites on bronchial smooth muscle resulting in bronchodilation, reduced mucus production, and decreased levels of cyclic guanosine monophosphate. | Persistent bronchospasms, asthma, COPD exacerbation | Hypersensitivity to ipratropium, atropine | 0.5 mg diluted in 2.5 ml NS via nebulizer. May repeat dose twice per most protocols | 250-500 mcg diluted in 2.5 ml saline via nebulizer every 20 mins up to 3 doses | Mydriaisis, tachycardia, blurred vision, nausea/vomiting, headache, anxiety, blurred vision. | |
| Ketamine (Ketalar) | Nonbarbiturate anesthetic | Acts on the limbic system and cortex to block afferent transmission of impulses associated with pain perception. It produces short-acting amnesia without muscular relaxation. A derivative of phencyclidine (PCP). | Pain, sedation and sometimes used as an adjunct to nitrous oxide | Stroke, hypersensitivity, severe hypertension, cardiac instability. Caution with schizophrenia. | Sedation- 1-2 mg/kg IV over 1 min or 4 mg/kg IM. Pain – 0.3 mg/kg IV/IO/IM/IN | Sedation (> 2 y/o) 1-2 mg/kg IV over 1 min. Pain – 0.3 mg/kg IV/IO/IM/IN | Hypertension, increased heart rate, hallucinations, delusions, explicit dreams. | Common street use these days in conjunction with narcotics because they potentiate each other for a longer/higher euphoria. Giving Narcan will only affect the narcotic NOT the Ketamine therefore only a minimal short-lasting effect. |
| Lidocaine (Xylocaine) | Class 1B Antidysrhythmic | Lidocaine is a sodium channel blocker that acts primarily on the ventricles of the heart during phase 4 diastolic depolarization which decreases automaticity, suppresses premature ventricular complexes, and raises the V-Fib threshold. | Significant ventricular ectopy with ischemia/MI, pulseless V-tach or V-Fib cardiac arrest, stable V-tach with a pulse | Hypersensitivity, prophylactic use in an acute MI, 2nd or 3rd degree heart block in the absence of a pacemaker, Stokes-Adams syndrome | Cardiac arrest: 1-1.5mg/kg IV/IO, repeat 0.5-0.75mg/kg in 5-10min, max 3mg/kg; post-arrest infusion 1-4mg/min. PVCs/V-tach w/ pulse: 0.5-0.75mg/kg IV/IO, up to 1-1.5mg/kg, max 3mg/kg total. | Cardiac Arrest - 1 mg/kg IV/IO bolus followed by maintenance infusion drip of 20-50 mcg/kg/min IV/IO post-cardiac arrest. For PVC’s or V-tach with a pulse – 1 mg/kg IV/IO. | Blurred vision, dizziness, hypotension, bradycardia, seizures, altered LOC | Use caution in patients with impaired liver/renal function and the elderly. May half the initial dose for pts >70 y/o. |
| Lorazapam (Ativan) | Benzodiazepine | Increases the activity of the inhibitory neurotransmitter GABA, thereby producing a sedative effect, relaxing skeletal muscles, and raising the seizure threshold. | Seizures, agitation, anxiety, alcohol withdrawal. | Hypersensitivity, hypotension, respiratory depression, CNS depression. | 1-4 mg IM/IV, every 15-20 min up to 8 mg max total dose. | 0.1 mg/kg IV/IO/IM/PR/IN over 2 min, can be repeated once in 5-10 min up to 4 mg. | Respiratory depression, hypotension, tachycardia, bradycardia, CNS depression, blurred vision. | |
| Magnesium Sulfate | Electrolyte, anticonvulsant | Reduces striated muscle contractions and blocks peripheral neuromuscular transmission by reducing acetylcholine release at the myoneural junction. | Seizures due to eclampsia after seizure activity is stopped, torsades de pointes, unstable V-Tach attributed to digitalis toxicity, hypomagnesemia, status asthmaticus unresponsive to beta-adrenergic drugs | Any heart block or myocardial damage, hypotension | Pulseless arrest (hypomagnesemia, torsades) & status asthmaticus: 1-2g in 10ml D5W/NS IV/IO. Torsades/hypomagnesemia w/ pulse: 1-2g in 100ml D5W/NS, 5-60min IV. Eclampsia: 4g IV drip, 20min; max 30-40g/day. | ulseless arrest or hypomagnesemia/torsades with a pulse – 25-50 mg/kg IV/IO (max 2 g) over 10-20 mins. Status asthmaticus - 25-50 mg/kg IV/IO (max 2 g) diluted 100 ml D5W/NS over 15-30 mins. | Hypotension, facial flushing, hyporeflexia (decreased reflexes), bradycardia, respiratory depression, diaphoresis. | If overdose is suspected (indicated by decreased deep tendon reflexes) may give calcium chloride or calcium gluconate to reverse effects. |
| Methylprednisolone (Solu-Medrol) | Corticosteroid, Glucocorticoid | Synthetic steroid that suppresses acute and chronic inflammation. It also potentiates vascular smooth muscle relaxation by beta-adrenergic agonists and may alter airway hyperactivity. | Anaphylaxis, asthma unresponsive to bronchodilators, adrenal insufficiency | Caution in pt’s with GI bleeding, diabetes, severe infection | 2 mg/kg (Max 125mg) IV | 1-2 mg/kg (Max 60mg) IV | Hypertension, hypokalemia, headache, alkalosis, sodium and water retention | Use in spinal injury and shock is controversial |
| Metoprolol (Lopressor) | Beta blocker | Blocks beta-adrenergic receptors in heart, lungs, vessels. Beta 1 action decreases heart rate, conduction, contractility, cardiac output. Beta 2 effects may cause bronchoconstriction. | Supraventricular tachycardia (SVT/PSVT), Atrial Fibrillation, Atrial Flutter, to reduce myocardial ischemia and damage in acute myocardial infarction/unstable angina | Hypersensitivity, hemodynamically unstable pts, CHF, decreased cardiac output, cardiogenic shock, 2nd or 3rd degree heart blocks, bradycardia, SBP < 100. | 5 mg slow IV at 5 min intervals and may repeat up to 15 mg max. | Not recommended | Bradycardia, hypotension, AV conduction delays, palpitations | If given concurrently with calcium channel blockers, such as verapamil and cardizem, may cause severe hypotension. Caution in pt’s with liver/renal dysfunction and asthma. |
| Midazolam (Versed) | Benzodiazepine | Increases the activity of the inhibitory neurotransmitter GABA, thereby producing a sedative effect, relaxing skeletal muscles, and raising the seizure threshold. Provides anterograde amnesia. | Seizures and anxiety. Premedication for intubation, cardioversion or conscious sedation procedures. | Hypersensitivity, shock, respiratory depression, depressed VS. Use caution with CNS depressants including barbiturates, alcohol, and narcotics and glaucoma. | 0.1 mg/kg IV/IO/IM/IN, every 5 min up to 10 mg max total dose. | 0.05-0.3 mg/kg IV/IO/IM/IN, every 5 min up to 5 mg max single dose. | Hypotension, respiratory depression or arrest, CNS depression, hiccups, oversedation, blurred vision. | May be given IM since Midazolam is water based. Should be given with analgesic for painful procedures. |
| Morphine Sulfate | Opioid analgesic | Morphine is a natural opioid analgesic. Morphine also causes venous dilation and decreased venous return to the heart thus reducing myocardial oxygen demand. Morphine also causes euphoria, central nervous system depression and sedation. | Acute pain, chest pain associated with ACS, pulmonary edema | Hypersensitivity to narcotics, CNS depression, respiratory depression, hypotension, hypovolemia, head injury, increased ICP, respiratory depression, pts that took MAO inhibitors in last 14 days, and caution with pt’s with RV infraction/MI | 2-5 mg IV/IM repeat every 10 min prn | 0.1 mg/kg IV, every 10 min up to 5 mg max single dose (max total dose of 15 mg) | Hypotension, CNS depression, tachycardia, respiratory depression | CNS depressants and Phenothiazines may potentiate morphine. Use Narcan for Morphine overdoses. |
| Naloxone (Narcan) | Opioid antagonist | Narcan is a competitive opiate antagonist used in known or suspected opioid overdose. | Suspected or known opioid overdose with respiratory depression. | Hypersensitivity. Caution with narcotic dependent pt’s who may experience withdrawal syndrome to include neonates of narcotic-dependent mothers. Avoid use with Meperidine induced seizures. | 0.4 – 2mg IV/IO/IM/IN may repeat up to 10 mg max | 0.1 mg/kg IV/IO/IM/IN, max single dose of 2 mg | Withdrawal symptoms, dysrhythmias, nausea/vomiting, hypertension, tachycardia, seizures, blurred vision. | Titrate to control airway and breathing, should NOT be used to completely reverse narcotic effects due to complications with withdrawal syndrome, combativeness, etc. |
| Nitroglycerin (Nitro-Stat) | Nitrate, vasodilator | Nitroglycerin is an organic nitrate and potent vasodilator. It relaxes vascular smooth muscle resulting in coronary artery dilation while also reducing blood pressure, preload, afterload, and myocardial oxygen demand. | Chest pain, acute coronary syndromes (ACS), pulmonary edema associated with CHF, hypertensive emergencies | Hypersensitivity, recent ED drug use (24-72h), head injury, SBP<100, cerebral stroke/hemorrhage, extreme bradycardia/tachycardia, right ventricular infarction, volume depletion. | 0.4 mg SL, every 3-5 min up to three total doses for 1.2 mg; metered dosing at 0.4mg/dose (Max 5 doses within 15 min) o Pulmonary edema- 0.8mg (SBP >160mmHg) or 1.2mg (SBP >200mmHg) | Not recommended i | Headache, hypotension, palpitations, dizziness, reflex tachycardia, nausea/vomiting, postural syncope, diaphoresis. | NTG must be kept in an airtight container and, if exposed to light, air or heat, it decomposes which is why most pt’s own prescription doesn’t relieve their symptoms since pt’s need to refill every 30 days if opened/used. |
| Nitro-Paste (Nitro-Bid Ointment) | Vasodilator, Nitrate | Nitroglycerin is an organic nitrate and potent vasodilator. It relaxes vascular smooth muscle resulting in coronary artery dilation while also reducing blood pressure, preload, afterload, and myocardial oxygen demand. | Typically given for ACS and chest pain with an associated acute myocardial infarction | Hypersensitivity, recent use of ED drugs (Cialis, Levitra, Viagra, etc.), head injury, SBP <100, cerebral stroke/hemorrhage, extreme bradycardia/tachycardia, right ventricular infarction, volume depletion. | 1-2 inches applied to skin (usually the chest) that is free of hair. Applied with Nitro-Paste paper or other transdermal application paper/tape | Not recommended | Headache, hypotension, palpitations, dizziness, reflex tachycardia, nausea/vomiting, postural syncope, diaphoresis. | Nitro-Paste contains 2% nitroglycerin in an absorbent paste and is applied to the pt’s skin to be absorbed through the skin (transdermal). Typically paste is administered in the pre-hospital setting during longer ground transport times. |
| Nitrous Oxide (Nitronox) | Gaseous analgesic, anesthetic | Nitrous Oxide, a 50/50 mix of nitrous oxide and oxygen, depresses the CNS for analgesia and increases blood oxygen tension to reduce hypoxia when inhaled. | Traumatic musculoskeletal injury, burns, moderate to severe pain | ALOC, hypotension, chest trauma (pneumothorax), COPD, Abdominal pain or injury, head injury, bowel obstruction. | Self administered by pt via held mask or mouthpiece until effects are felt | Self administered by pt via held mask or mouthpiece until effects are felt | Altered LOC, apnea, dizziness, nausea/vomiting, malignant hypertension (rare but serious) | Must be mixed 50% Nitrous Oxide and 50% Oxygen, if 100% Nitrous Oxide is administered the patient will become hypoxic and die. Pt MUST be able to follow instructions and hold mask/mouthpiece on their own to administer! |
| Norepinephrine (Levophed) | Sympathomimetic, vasopressor | Alpha-1 and beta-1 agonist, causing vasoconstriction and increased myocardial contractility. | Cardiogenic shock, neurogenic shock, hemodynamically significant hypotension refractory to other sympathomimetics. | Hypotension due to hypovolemia | 2-20 mcg/min IV, titrated to effect | 0.05-0.1 mcg/kg/min IV, titrated to effect up to max of 2 mcg/kg/min | Headache, dysrhythmias, tachycardia, reflex bradycardia, angina pectoris, hypertension. | Beta-adrenergic antagonists may blunt inotropic response. Can cause tissue necrosis if extravasation occurs. |
| Ondansetron (Zofran) | Antiemetic | First marketed selective serotonin blocker, targeting 5-HT3 receptors in the chemoreceptor trigger zone and vagal nerve terminals in intestines, reducing nausea and vomiting. | Nausea and vomiting | Hypersensitivity, GI obstruction, and use caution with liver disease pt’s. | 4 mg IV/IO/IM | (>6mo – 14 yrs) 0.15 mg/kg IV/IO/IM (Max 4mg) | ECG irregularities (rare), dizziness, headache, hiccups, pruritus, chills, drowsiness | |
| Oral Glucose | Carbohydrate | Directly increases blood glucose levels | Known or suspected hypoglycemia | Unconscious, unable to swallow, unable to protect airway. Use caution with ALOC. | 15 g buccal, variable depending on manufacturer | 15 g buccal, variable depending on manufacturer | Hyperglycemia, nausea/vomiting | Place glucose on tongue blade, administer glucose between cheek and gum. |
| Oxygen | Gas | Colorless, odorless, tasteless gas in room air at 21%, oxygen enters via the respiratory system, transported to tissues for energy, reverses hypoxemia, and aids glucose oxidation to produce ATP. | Hypoxia, hypoperfusion, ischemic chest pain, respiratory insufficiency, suspected stroke, confirmed/suspected carbon monoxide poisoning, cardiac insufficiency or arrest. | None in the prehospital emergency setting | 1-6 lpm via nasal cannula and 10-15 lpm via nonrebreather mask | Same as adult but using age appropriate sized devices | Nausea/vomiting, irritation to respiratory tract | Administer and titrate to maintain a minimum SpO2 of 94%. Use caution with high flow oxygen in patients with stroke and acute coronary syndrome patients. |
| Oxytocin (Pitocin) | Hormone | Oxytocin is a natural hormone secreted by the posterior pituitary gland. Oxytocin promotes contraction of the uterus and promotes milk ejection. | Post-partum hemorrhage | Hypertonic or hyperactive uterus, presence of 2nd fetus, fetal distress. | 10-40 units diluted in 1000 mL NS, titrated to control bleeding | Not recommended | Hypotension, tachycardia, chest pain/coronary artery spasm, cardiac dysrhythmias, hypertension, seizures, nausea/vomiting, uterine rupture. | |
| Pralidoxime (2-PAM) | Cholinesterase reactivator and antidote | Pralidoxime reactivates the enzyme acetylcholinesterase, which allows acetylcholine to be degraded, thus relieving the parasympathetic overstimulation caused by excess acetylcholine as seen in organophosphate poisoning. | Organophosphate poisoning | Hypersensitivity | 600 mg IM, every 15 min up to 3 doses. 1-2 g IV over 15-30 min | 20-50 mg/kg IV over 15-30 min | Tachycardia, hypertension, laryngospasm, hyperventilation, nausea, weakness | Should be given concurrently with Atropine. Commonly seen in the prehospital setting packaged with atropine in DuoDote or Mark 1 autoinjector kits. |
| Promethazine (Phenergan) | Phenothiazine, antihistamine, antiemetic | Promethazine is an H1 receptor antagonist that blocks the actions of histamine by competitive antagonism at the H1 receptor. Promethazine also acts as an antiemetic and sedative agent with some anticholinergic properties. | Nausea and vomiting, motion sickness, to potentiate the effects of analgesics, pre/post-op obstetrical sedative, allergic reactions | Hypersensitivity, CNS depression or coma, CNS depression from alcohol, barbiturates, or narcotics, signs associated with Reyes syndrome. Use with caution in pt’s with asthma, peptic ulcer disease, and bone marrow depression. | 12.5 – 25 mg IV (diluted in 10cc Normal Saline with doses of 25 mg or less) given over 10-15 min. Deep IM doses can be given undiluted (FDA recommends IM over IV) | Not recommended | Sedation, dizziness, hypotension, dystonias/EPS reaction, hallucinations, dysrhythmias, phlebitis, hyperexcitability, nausea/vomiting. Extravasation may cause massive tissue damage/ necrosis | If dystonias/EPS reactions occur, administer Diphenhydramine. |
| Rocuronium (Zemuron) | Non-depolarizing neuromuscular blocker | Competitively blocks acetylcholine at the neuromuscular junction causing chemical paralysis. | Paralysis for advanced airway placement and mechanically ventilated patients. | Hypersensitivity and anticipated difficult/ failed airway, chronic neuromuscular conditions (myasthenia gravis). | 1 mg/kg IV with 0.5 mg/kg for subsequent doses | 1 mg/kg IV with 0.5 mg/kg for subsequent doses | Apnea, tachycardia, hypertension, anaphylaxis, dysrhythmias | Rocuronium has no sedative/ analgesic effects. |
| Sodium Bicarbonate | PH buffer, alkalizing agent, electrolyte supplement | Sodium bicarbonate, a potent acid buffer, binds to hydrogen ions, forming carbonic acid, which breaks down in the lungs into water and CO2, reducing plasma hydrogen ion concentration and raising blood pH. | Tricyclic antidepressant (TCA) overdose, management of metabolic acidosis, prolonged cardiac arrest down time, known preexisting hyperkalemia, DKA, alkalinization treatment for specific intoxications/rhabdomyolysis | Hypocalcemia, suspected metabolic and respiratory alkalosis, hypokalemia, hypernatremia, pt’s with chloride loss due to vomiting and GI suction, severe pulmonary edema | 1 mEq/kg IV | Same as adult but infuse slowly and only if ventilations are adequate | Metabolic alkalosis, seizures, electrolyte disturbance. | Should not be given at the same time as other electrolytes or vasopressors, be sure to flush IV thoroughly or use separate IV sites. Not recommended for and ineffective in hypercarbic acidosis such as seen in cardiac arrest and CPR without intubation |
| Succinylcholine (Anectine) | Depolarizing neuromuscular blocker | Succinylcholine, a short-acting depolarizing neuromuscular blocker, binds to acetylcholine receptors, causing muscle paralysis, fasciculations, and contractions, making it ideal for rapid sequence intubation. | To facilitate endotracheal intubation, terminate laryngospasm, muscle relaxation. | Hypersensitivity, burns/crush injuries >72h old, muscle myopathies, inability to control airway/support ventilation, history of malignant hyperthermia/rhabdo. Caution with potential hyperkalemia (renal failure, trauma, electrolyte disturbances, etc.). | 1-1.5 mg/kg IV/IO for RSI | Peds: 1-1.5mg/kg IV/IO for RSI Infants: 2 mg/kg IV/IO for RSI | Fasciculations, bradycardia, hypotension, tachycardia, hypertension, dysrhythmias, malignant hyperthermia, hyperkalemia, respiratory depression, excessive salivation, hyperkalemia | Although after administering Succinylcholine it may appear that the patient is not conscious, it has NO effect on the central nervous system, so the patient will be completely aware of procedures unless appropriate sedation is also given. |
| Thiamine (Betaxin) | Vitamin (B1) | Thiamine is also known as vitamin B1. Thiamine combines with adenosine triphosphate to form thiamine pyrophosphate, a coenzyme necessary for carbohydrate metabolism. The brain is especially sensitive to thiamine deficiency. | Hypoglycemia with malnourishment or suspected alcoholism, delirium tremors, Wernicke’s encephalopathy | None in the emergency prehospital setting | 100 mg slow IV or IM | Not recommended | Hypotension (if given rapidly or too large a dose), nausea/vomiting, anxiety, diaphoresis | |
| Tranexamic Acid (TXA) | Antifibrinolytic, hemostatic agent | Binds with lysine sites on plasminogen, preventing conversion of plasminogen to plasmin and ultimately inhibiting the breakdown of fibrin during bleeding episodes. | Trauma, hemorrhage following surgery or dental procedures, excessive menstrual bleeding. | Hypersensitivity, thromboembolic disorders, certain vision disorders, onset of bleeding > 3 hrs. | 1 g IV slow push over 1-2 minutes | 10 mg/kg IV | Seizures, headache, visual changes, hypotension, thromboembolism. | |
| Amyl Nitrate | antidote, vasodilator | First lime antidote for cyanide poisoning: inhalation induces methemoglobinemia, binds with cyanide to form less-toxic cyanomethemoglobin, causes vasodilation for improved hepatic circulation and cyanide metabolism. | cyanide poisoning | concurrent carbon monoxide exposure, known methemoglobinemia, hypotension. | 1 ampule crushed into gauze or similar material to be inhaled for 30 seconds, alternated by 30 seconds without. Continue until IV access is established. | Hypotension, methemoglobinemia, flushing, dizziness, nausea, and vomiting | No longer the preferred treatment for toxic cyanide exposures. |
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SelynaEM
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