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SpaceBoys Drug Cards

Paramedic Pharmocology & Skills

QuestionAnswer
Sodium Bicarb chemical name NaHCO3
Sodium Bicarb indications Late in management of cardiac arrest (if at all), severe acidosis refractory to hyperventilation,hyperkalemia, upon return of spontaneous circulation after long arrest interval, tricyclic antidepressant overdose, phenobarbital overdose.
Sodium Bicarb contraindications In patients with chloride loss from vomiting and GI suction, Metabolic and respiratory alkalosis, Hypocalcemia, Hypokalemia
Sodium Bicarb side effects Metabolic alkalosis, fluid overload, tissue necrosis if extravasation occurs.
Sodium Bicarb adult dose 1 mEq/kg, repeat with 0.5 mEq/kg every 10 minutes
Sodium Bicarb pediatric dose 1 mEq/kg, repeat with 0.5 mEq/kg every 10 minutes (infuse slowly)
Sodium Bicarb class buffer
Norepinephrine trade names Levophed, Levarterenol
Norepinephrine indications cardiogenic shock, significant hypotension (>70mm Hg)
Norepinephrine contraindications Hypotension with hypovolemia, pregnancy
Norepinephrine class Sympathomimetic
Norepinephrine adult dose Dilute 8 mg in 500 mL of D5W or 4 mg in 250 mL of D5W (16ug/mL); infuse by IV piggyback at 0.5-1.0 ug/min, titrated to improve blood pressure (up to 30ug/min)
Norepinephrine pediatric dose 0.1-1.0 ug/ming IV insfusion, titrated to patient response
Norepinephrine side effects Headache, arrhythmias, tachycardia, reflex bradycardia, angina pectoris, HTN, decreased perfusion to GI, kidney, skeletal muscle, and skin
Albuterol Class Sypathomimetic, bronchodilator
Albuterol trade names Proventil, Ventolin
Albuterol indications bronchospasm in patients with reversible obstructive airway disease (COPD/Ashtma). Prevention of exercise induced bronchospasm.
Albuterol contraindications Known prior hypersensitivity reactions to albuterol. Tachycardia arrhythmias, especially those caused by digitalis. Synergistic with other sympathomimetics.
Albuterol side effects Often dose related including: restlessness, tremors, dizziness, palpitations, tachycardia, nervousness, peripheral vasodilation, nausea, vomiting, hyperglycemia, increased blood pressure, and paradoxical bronchospam
Albuterol Adult dose for Nebulizer 2.5 mg. Dilute 0.5 mL or 0.5% solution for inhalation with 2.5 mL normal saline in nebulizer and administer over 10-15 minutes.
Albuterol Adult dose for MDI 1-2 inhalations (90-180 ug). Five minutes between inhalations.
Albuterol Pediatric dose for Nebulizer solution of 0.01-0.03 mL (0.05-0.15 mg/kg/dose diluted in 2 mL of 0.9% normal saline. May repeat every 20 minutes 3 times.
Oxygen class Naturally occuring gas. DUH.
Oxygen indications Confirmed or suspected hypoxemia, ischemic chest pain, respitory insufficiency, prophylactically during air transport, confirmed or suspected carbon monoxide poisoning, all other causes of decreased tissue deoxygenation, deceased level of consciousness.
Oxygen contraindications Certain patients with COPD or emphysema who will not tolerate oxygen concentrations over 35%, hyperventilation.
Oxygen adult/pedi dose Cardiac arrest and carbon monoxide poisoning: 100%. Hypoxemia 10-15 L/min via NRB. COPD 1-6 L/min via NC or 28%-35% VM. EXCEPTION: Premature infant, no more than 30-40% oxygen
Oxygen side effects Decreased level of consciousness and respitory depression in patients with chronic carbon dioxide retention. Retrolental fibroplasia if high concentrations are given to premature infants.
OPA indications Unresponsive patients, absent gag reflex
OPA contraindications Conscious patients, patients WITH gag reflex
OPA advantages Noninvasive, easily placed, prevents blockage of the glottis by the tongue
OPA disadvantages Does not prevent aspiration
NPA indications Unresponsive patients, patients with AMS who have a gag reflex
NPA contraindications Patient intolerance, most facial fractures or skull fractures
NPA advantages Can be suctioned through, provides a patent airway, can be tolerated by conscious patients, may be placed blindly, does not require use of the oropharynx
NPA disadvantages May result in excessive bleeding, does not protect from aspiration.
BVM indications patients in respitory failure
BVM contraindications patients who are breathing adequately, patients who cannot tolerate the device
BVM advantages Delivers 100% O2 to the patient, allows extended ventilation time without rescuer fatigue, provides excellent barrier from body fluids
BVM disadvantages Difficult to maintain proper seal, requires great effort to master technique, can result in inadequate tidal volume if rescuer is inexperienced with device
Epinephrine class Sympathomimetic
Epi-Cardiac arrest indications Cardiac Arrest (V-fib/pulseless V-tach, asystole, PEA)
Epi-Cardiac related indications Symptomatic bradycardia as an alternative to dopamine infusion. For severe hypotension secondary to bradycardia when atropine and subcutaneous pacing are unsuccessful.
Epi-Non-Cardiac related indications Allergic Reactions, Anaphalaxis, Ashtma
Epi-Contraindications HTN, hypothermia, pulmonary edema, myocardial ischemia, hypovolemic shock
Epi-Side effects HTN, tachycardia, angina, arrythmias, pulmonary edema, psychomotor agitation, headache, nausea, anxiety, restlessness
Epi-Adult dose for mild allergic reactions and Asthma 0.3-0.5 mg
Epi-Pediatric dose for mild allergic reactions and asthma 0.1 mg/kg up to 0.3 mg
Epi-Adult dose for Anaphalaxis 0.1 mg (1ml of 1:10000) IV/IO over 5 minutes
Epi-Adult dose for Cardiac arrest IV/IO dose: 1 mg (10 mL of 1:10,000 solution) every 3-5 minutes during resuscitation. Follow each dose with 20 mL flush and elevate arm for 10-20 seconds after dose. Higher dose for beta blocker or calcium channel blocker overdose: up to .2mg/kg
Epi-Pediatric dose for cardiac arrest 0.01 mg/kg (0.1 mL/kg) of 1:10,000 solution every 3-5 minutes during arrest.
Epi-Adult dose for Cardiac arrest with ET tube 2-2.5 mg diluted in 10 mL normal saline.
Epi-Pediatric dose for cardiac arrest with ET tube 0.1 mg/kg (0.1 mL/kg) or 1:1,000 solution.
Epi-Adult dose for profound bradycardia or hypotension 2-10 ug/min titrate to patient response.
Epi-Pediatric dose for symptomatic bradycardia 0.1 mg/kg (0.1 mL/kg) of 1:10,000 solution
Epi-Adult dose for continuous infusion Add 1 mg (1 mL of 1:1,000 solution) to 500 mL normal saline or D5W. Initial infusion rate or 1 ug/min titrated to effect (typical dose:2-10 ug/min)
Epi-Pediatric dose for continuous infusion begin with rapid infusion, then titrate to response. Typical initial infusion: 0.1-1 ug/min. Higher doses may be effective.
Atropine Sulfate Class Anticholinergic Agent
Atropine Sulfate Indications Hemodynamically unstable bradycardia, bradycardic PEA, asystole, bronchospastic pulmonary disorders, organophosphate poisoning
Atropine Sulfate Contraindications Tachycardia, unstable cardiovascular status in acute hemorrhage and myocardial ischemia, hypersensitivity, narrow-angle glaucoma, Pregnancy Category C
Atropine Sulfate Side Effects Tachycardia, arrythmias, palpitations, paradoxical bradycardia when pushed slowly or in low doses, headache, dizziness, flushed/hot/dry skin, blurred vision, dry mouth, urinary retention
Atropine Sulfate Adult Dose for Asystole or Bradycardic PEA 1 mg IV/IO push. May repeat every 3-5 minutes up to 3 mg.
Atropine Sulfate Pedi Dose 0.02 mg/kg via IV/IO ush, may double for second dose. Minimum Dose is 0.1 mg, maximum dose is 0.5 mg up to 1.0 mg / adolescent 1.0 mg up to 2.0 mg
Atropine Sulfate Adult ET Dose for Asystole or Bradycardic PEA 2.3 mg diluted in 10 ml of water or normal saline.
Atropine Sulfate Pedi ET Dose 0.03 mg/kg (absorption may be unreliable)
Atropine Sulfate Adult Dose for Unstable Bradycardia 0.5 mg IV/IO every 3-5 minutes, not to exceed 3.0 mg. In severe cases, shorter time interval of 3 minutes and higher dosage may help.
Atropine Sulfate Adult Dose for Organophosphate poisoning 2-4 mg or higher may be needed
Methylprednisolone Class Anti-Inflammatory glucocorticoid
Methylprednisolone Trade Name Solu-Medrol
Methylprednisolone Indications Acute spinal cord trauma, anaphylaxis, bronchodilator for unresponsive asthma
Methylprednisolone Contraindications Premature infants, systemic fungal infections, caution for GI bleeds
Methylprednisolone Side Effects Sodium and Water retention, HTN, CHF, Headache, Nausea and Vomiting, Hypokalemia, Alkalosis, Peptic Ulcer Disease
Methylprednisolone Adult Dose for Acute Spinal Cord Trauma 30mg/kg IV over 30 minutes followed by infusion @ 5.4mg/kg/h
Methylprednisolone Pedi Dose for Acute Spinal Cord Trauma 30mg/kg IV over 30 minutes followed by infusion @ 5.4mg/kg/h
Methylprednisolone Adult Dose for Asthma & COPD 1-2mg/kg IV
Methylprednisolone Pedi Dose for Asthma 1-2 mg/kg/dose IV
Dopamine Class Sympathomimetic, Inotropic Agent
Dopamine Trade Name Intropin
Dopamine Indications Cardiogenic/Septic/Spinal/Distributive Shock, Hypotension with Low Cardiac Output
Dopamine Contraindications Hypovolemic Shock, Tachyarrythmias, V-Fib, Pheochromocytoma
Dopamine Side Effects HTN, Arrhythmias, Increased Cardiac Oxygen Demand, Tissue Necrosis if Extravated
Dopamine Adult Dose 2-20ug/kg/min tirtrated to patient response
Dopamine Pedi Dose 2-20 ug/kg/min titrated to patient response
Dobutamine Class Sympathomimetic, Inotropic Agent
Dobutamine Trade Name Dobutrex
Dobutamine Indications CHF, Left Ventricular Dysfuntion, Cardiogenic Shock
Dobutamine Contraindications Tachyarrhythmias, IHSS, Severe Hypotension, Incompatable with Sodium Bicarbonate and Furosemide
Dobutamine Side Effects HTN, Headache, Arrythmias, PVC's, May increase Infart Size
Dobutamine Adult Dose IV infusion at 2-20ug/kg/min titrated to desired effect
Dobutamine Pedi Dose IV infusion at 2-20ug/kg/min titrated to desired effect
Diphenhydramine Class Antihistamine, Anticholinergic
Diphenhydramine Trade Name Benadryl
Diphenhydramine Indications Allergic Reactions, Anaphylaxis, Actue Dystonic Reactions (Phenothiazines), Blood Administration Reactions, Motion Sickness, Hay Fever
Diphenhydramine Contraindications HTN, Asthma, Glaucoma, Narrow Angle Glaucoma, MAOI Inhibitors, Pregnancy, Infants
Diphenhydramine Side Effects Hypotension, Sedation, Seizures, Visual Disturbances, Urinary Retention, Vomiting, Arrythmias, Palpitations, Dry Mouth and Throat, Paradoxical CNS excitation in children
Diphenhydramine Adult Dose 25-50mg IM or IV or PO
Diphenhydramine Pedi Dose 1-2mg/kg IV, IO slowly or IM / PO 5mg/kg/24 hours
Midazolam Class Short acting Benzodiazepine, CNS Depressant
Midazolam Trade Name Versed
Midazolam Indications Sedation, Anxiolytic prior to intubation, Conscious Sedation
Midazolam Contraindications Shock, Depressed Vitals, Coma, Overdose, Glaucoma, Concomitant use with other CNS Depressants: Barbiturates, Alcohol, Narcotics, Not recommended in Pediatrics
Midazolam Adult Dose 2.0-2.5 mg IV slowly over 2-3 minutes, may be repeated to total maximum of 0.1 mg/kg.
Dilatiazem Hydrochloride Class Calcium Channel Blocker
Dilatiazem Hydrochloride Trade Name Cardizem, Lyo-Ject
Dilatiazem Hydrochloride Indications Control of Rapid Ventricular Rates due to Atrial Flutter, Atrial Fib, And Re-Entry SVT; Angina Pectoris
Dilatiazem Hydrochloride Contraindications Hypotesion, High Degree AV Blocks, Sick Sinus Syndrome, Wide-Complex Tachycardias, Poison/Drug Induced Tachycardia, Cardiogenic Shock
Dilatiazem Hydrochloride Side Effects Bradycardia, High-Degree AV Blocks, Chest Pain, CHF, Syncope, V-Fib, V-Tach, Nausea, Vomiting, Dizziness, Dry Mouth, Dyspnea, Headache
Dilatiazem Hydrochloride Adult Dose 0.25mg/kg (about 15-20mg) IV over 2 Minutes. May wait 15 minutes and administer 0.35mg/kg (about 20-25mg) IV over 2 minutes. Maintenance Infusion of 5-15 mg/h. Not Recommended for Pediatrics.
Morphine Sulfate Class Opiod Analgesic
Morphine Sulfate Trade Name Astramorph/PF and many others
Morphine Sulfate Indications Severe CHF, Pulmonary Edema, Chest Pain Associated with Actue MI, Analgesia for Moderate to Severe Acute and Chronic Pain (use with caution)
Morphine Sulfate Contraindications Head Injury, Exacerbated COPD, Depressed Respiratory Drive, Hypotension, Undiagnosed Abdominal Pain, Decreased Level of Consciousness, Suspected Hypovolemia, MAOI use within the past 14 days
Morphine Sulfate Side Effects Respiratory Depression, Hypotension, Decreased LOC, Nausea, Vomiting, Bradycardia, Tachycardia, Syncope, Facial Flushing, Euphoria :-), Bronchospasm, Dry Mouth
Morphine Sulfate Adult Dose 2-4mg IV over 1-5 minutes, every 5-30 minutes. May repeat dose at 2-8mg at 5-15 minute intervals
Morphine Sulfate Pedi Dose 0.1-0.2mg/kg via IV, IO, IM, or SC. Max dose of 5mg
Nitroglycerin Class Vasodilator
Nitroglycerin Trade Name Nitrostat, Tridil, and others
Nitroglycerin Indications Actue Angina Pectoris, Ishcemic Chest Pain, Hypertension, CHF, Pulmonary Edema
Nitroglycerin Contraindications Hypotension, Hypovolemia, Intracranial Bleeding or Head Injury, Phosphodiesterase Inhibitors (ex. Viagra) in the past 24 hours
Nitroglycerin Side Effects Headache, Hypotension, Syncope, Reflex Tachycardia, Flushing, Nausea, Vomiting, Diaphoresis, Muscle Twitching
Nitroglycerin Adult Dose 0.3-0.4mg Tablets / 0.4mg Spay SL; May repeat every 3-5 minutes up to 3 doses (not recommended for use in pediatrics)
Adenosine Class Endogenous Nucleotide
Adenosine Trade Name Adenocard
Adenosine Indications Conversion of PSVT to Sinus Rythym. May convert Re-Entry SVT due to Wolff-Parkinson-White Syndrome.
Adenosine Contraindications Second or Third Degree Block or Sick Sinus Syndrome, A-Flutter, A-Fib, V-Tach, Hypersensitivy to Adenosine, Poison-Induced Tachycardia
Adenosine Side Effects Facial Flushing, SOB, Chest Pain, Headache, Paresthesia, Diaphoresis, Palpitations, Hypotension, Nausea, Metallic Taste
Adenosine Adult Dose 6mg rapid IV push immediately followed by 20ml Saline Flush and Extremity Elevation. May Administer a Second and Third dose of 12mg in 1-2 Minute Intervals if no Initial Response
Adenosine Pedi Dose 0.1-0.2mg/kg rapid IV push, Maximum Single Dose of 12mg
Amiodarone Class Antiarrhythmic
Amiodarone Trade Name Cordaron, Pacerone
Amiodarone Indications V-Fib, Pulseless V-Tach and Unstable V-Tach in Patients Refractory to Other Therapy
Amiodarone Contraindications Known Hypersensitivity, Cardiogenic Shock, Sinus Bradycardia, Second or Third Degree Block in Absence of a Functioning Pacemaker
Amiodarone Side Effects Hypotension, Bradycardia, Prolongation or the P-R, QRS, and Q-T Intervals
Amiodarone Adult Dose For V-Fib/Pulseless V-Tach 300mg IV Push, Repeated in 3-5 Minutes with 150mg IV Push
Amiodarone Adult Dose for Life Threatening and Recurring Ventricular Arrythmias Rapid Infusion: 150 mg IV over 10 minutes. May Repeat Every Ten Minutes Slow Infusion: 360 mg over 6 Hours Maintenance Infusion: 540mg over 10 Hours Max Dose is 2.2g over 24 Hours
Amiodarone Pedi Dose for Refractory V-Fib/Pulseless V-Tach / Perfusing SVT/VT 5mg/kg IV Bolus (Over 20-60 Minutes for Perfusing SVT/VT) Max single dose is 300mg
Vasopressin Class Antidiuretic Hormone
Vasopressin Trade Name Pitressin Synthetic
Vasopressin Indications Cardiac Arrest
Vasopressin Contraindications Responsive Patients with CAD
Vasopressin Side Effects Bronchoconstriction, Ischemic Chest Pain, Nausea and Vomiting, Abdominal Pain
Vasopressin Adult Dose 40 Units to Replace Either the First or Second Dose of Epinephrine during Cardiac Arrest. Not Recommended for Pediatrics.
Diltiazem Hydrochloride Class Calcium Channel Blocker
Diltiazem Hydrochloride Trade Name Cardizem, Lyo-Ject
Diltiazem Hydrochloride Indications Control of Rapid Ventricular Rates Due to A-Flutter, A-Fib, and Re-Entry SVT; Angina Pectoris
Diltiazem Hydrochloride Contraindications Hypotension, Sick Sinus Syndrome, Second or Third Degree Blocks, Cardiogenic Shock, Wide-Complex Tachycardias, Poison/Drug Induced Tachycardia
Diltiazem Hydrochloride Side Effects Bradycardia, Second or Third Degree Blocks, Chest Pain, CHF, Syncope, V-Fib, V-Tach, Nausea, Vomiting, Dizziness, Dry Mouth, Dypsnea, Headache
Diltiazem Hydrochloride Adult Dose 0.25mg/kg IV over 2 minutes. May repeat in 15 minutes at 0.35mg/kg IV over 2 minutes. Maintainence Infusion of 5-15 mg/h. Not Recommended in Pediatrics
Glucagon Class Hyperglycemic Agent, Pancreatic Hormone, Insulin Antagonist
Glucagon Trade Names Glucagon
Glucagon Indications Altered LOC when Hypoglycemia is suspected. May be uses as an Inotropic Agent in Beta-Blocker Overdose
Glucagon Contraindications Hyperglycemia, Hypersensitivity
Glucagon Side Effects Nausea, Vomiting, Tachycardia, Hypertension
Glucagon Adult Dose Hypoglycemia: 0.5-1mg IM, May repeat in 7-10 Minutes Calcium Channel/Beta Blocker Overdose: 3mg , followed by infusion at 3mg/hr as necessary
Glucagon Pedi Dose Hypoglycemia: 0.5-1mg IM for children less than 20kg. Not recommended for Calcium Channel/Beta Blocker Overdose in Pediatrics.
Oral Glucose Class Hyperglycemic
Oral Glucose Trade Name Insta-Glucose
Oral Glucose Indications Concious Patients with suspected Hypoglycemia
Oral Glucose Contraindications Decreased LOC, Nausea, Vomiting
Oral Glucose Side Effects Nausea, Vomiting
Oral Glucose Dose Should be Sipped Slowly Until Clinical Improvement Noted in Adults and Pediatrics
Thiamine Class Vitamin B1
Thiamine Trade Name Vitamin B1
Thiamine Indications Coma of Unknown Origin, Delirium Tremens, Beribei, Wernicke's Encephalopathy
Thiamine Contraindications None.
Thiamine Side Effects Hypotension from Too Rapid of an Injection or Too High of a Dose, Anxiety, Diaphoresis, Nausea, Vomiting, Allergy
Thiamine Adult Dose 100mg Slow IV or IM
Thiamine Pediatric Dose 10-25 Slow IV or IM
Dextrose Class Carbohydrate, Hypertonic Solution
Dextrose Trade Name Dextrose
Dextrose Indications Hypoglycemia, Altered LOC, Coma of Unknown Cause, Seizure of Unknown Cause, Status Epilepticus
Dextrose Contraindications Intercranial Hemorrage
Dextrose Side Effects Extraversion Leads to Tissue Necrosis. Warmth, Pain, Burning, Thrombophlebitis, Rhabdomyloysis, Hyperglycemia
Dextrose Adult Dose 12.5-25g Slow IV, repeat as Necessary
Dextrose Pedi Dose 0.5-1g/kg Slow IV, repeat as Necessary
Naloxone Hydrochloride Class Narcotic Antagonist
Naloxone Hydrochloride Trade Name Narcan
Naloxone Hydrochloride Indications Opiate OD, Coma of Unknown Origin
Naloxone Hydrochloride Contraindications Caution in Narcotic Dependant Patients, and Neonates of Narcotic Dependant Mothers
Naloxone Hydrochloride Side Effects Withdrawal Symptoms in Addicted Patients, Tachycardia, Hypertension, Nausea and Vomiting, Diaphoresis
Naloxone Hydrochloride Adult Dose 0.4-2mg IV, IM, SC, or ET. Repeat in 5 Minutes to Max dose of 10mg. Infusion: 2mg in 500ml D5W at 0.4mg/hr
Naloxone Hydrochloride Pedi Dose 0.1mg/kg IV, IM, SC, or ET, Max dose of 0.8mg, repeat in 10 Minutes at 0.1mg/kg
Created by: saxman6699