These are the drugs used in the NCTI riverside paramedic program
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| What is the mechanism of action for Calcium Chloride? | 1. Necessary for proper function of the muscular, endocrine, respiratory, digestive, and nervous systems.
2. Positive inotropic avtivity increases the strength of myocardial contrqctions
3. Increases ventricular automaticity
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| What is the class of Calcium Chloride? | Electrolyte.
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| What are the indications for Calcium Chloride? | 1. Calcium channel blocker or Beta blocker overdose.
2. Acute hyperkalemia or cardiac arrest when hyperkalemia is suspected.
3. Hypocalcemia
4. Suspected hypermagnesemia with respiratory depression.
5. Crush syndrome.
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| What are the contraindications for Calcium Chloride? | 1. Digitalis toxicity
2. Hypercalcemia
3. Ventricular fibrillation
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| What are the side effects of Calcium Chloride? ` | Cardiovascular: Hypotension, dysrhythmias, cardiac arrest.
Neurological: Syncope, tingling sensations.
Gastrointestinal: Metallic taste.
Other: Sense of heat waves, necrosis/cellulitis upon infiltration of IV
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| What are the Dosages/Routes for Calcium Chloride? (Adult) | Adult: Known or suspected hyperkalemia or Blocker OD, cardiac arrests: 500 mg to 1 gm IVP/IO over 5-10 minutes (May repeat every 10 mins as necessary). Repeat as clinically indicated.
Calcium Channel blocker (prophylaxis): 2-4 mg/kg
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| What are the Dosages/Routes for Calcium Chloride? (Pediatric) | 20 mg/kg (0.2 ml/kg)) slow IVP/IO (no faster than 100mg/min). Repeat as clinically indicated.
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| What is the class of Magnesium Sulfate? | 1. Electrolyte
2. Anticonvulsant
3. CNS depressant
4. Anti-dysrhythmic
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| Mechanism of action for Magnesium Sulfate | 1. Decreases Acetylcholine in the motor nerve terminals
2. Produces neuromuscular blockade in the CNS
3. Physiologic calcium channel blocker
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| Indications for Magnesium sulfate | 1. Refractory VFIB/pulseless VTAC (ACLS)
2. Treatment for Torsades De Pointes (polymorphic VTAC)
3. /seizures associated with alcohol withdrawal and eclampsia
4. Dysrhythmias associated with Digitalis toxicity
5.Bronchospasms refractory to trad med
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| Contraindications for magnesium sulfate | 1. Cardiogenic shock
2. Heart blocks
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| Side effects for Magnesium sulfate | Cardiovascular: dysrhythmias, bradycardia, hypotension, heart blocks
Neurological: drowsiness
Respiratory: decreased respiratory rate, respiratory paralysis
Other: flushing, sweating
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| Dosages for Magnesium Sulfate | Adult: 1-4 g in 50-100 ml Normal Saline IVPB/IVP over 5 minutes
Pediatric: 20-50 mg/kg in 50-100 Normal Saline IVPB Maximum single dose is 2 g
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| Classification of Epinephrine | Vasopressor, catecholamine, sympathomimetic
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| Mechanism of action for Epinephrine (1 & 2) | 1.Increases cardiac output and BP increasing inotropy, chronotropy, and dromotropy (beta1 effect)
2. Vasoconstriction; increases systolic BP (alpha)
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| Mechanism of action for Epinephrine (3 &4) | 3. Relaxes smooth muscles in the respiratory tract, dilating the bronchioles (beta2 effect)
4. Increases coronary perfusion during CPR by increasing aortic diastolic pressure (from vasoconstriction)
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| Indications for Epinephrine | 1. Cardiac arrest
2. Asthma and allergic reaction
3. Anaphylaxis
4. Symptomatic bradycardia (PEDS)
5. Beta Blocker Overdose (PEDS)
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| Contraindications for Epinephrine | 1. Hypovolemia
2. Hypertension
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| Side Effects for Epinephrine | Cardiovascular: tachycardia, hypertension, palpitations, chest pain, ventricular fibrillation
Neurological: tremors/seizures
Respiratory: paradoxical bronchospasms (with excessive use in inhalers)
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| Dosages for Epinephrine (Adult) | Cardiac arrest: 1 mg (1:10,000) IV/IO MR q 3-5 mins
Asthma/allergic reaction: 0.3-0.5 mg SQ/IM MR q 20 mins x 2
Anaphylaxis: 0.1-0.5 mg(1:10,000)IV/IO (over 1-5 mins) MR q 3-5 mins
Vasopressor: 1-4 mcg/min IVPB
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| Dosages for Epinephrine (Pediatric) (cardiac arrest, allergic reaction) | Cardiac Arrest: 0.01 mg/kg (1:10,000) IV/IO MR 0.01 mg/kg IV/IO q 3-5 mins Asthma/Allergic Reaction:0.01mg/kg (1:1,000) SQ/IM to a max dose of 0.3 mg MR q 20 mins x2
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| Dosages for Epinephrine (Pediatric)bradydysrhythmia,vasopressor | Bradydysrhythmia: Neonate/Infant:0.01 mg/kg (1:10,000) IV/IO/ET (dilute ET dose with 1-2ml of NS)may repeat every 3-5 mins Child:0.01 mg/kg (1:10,000)IV/IO may repeat every 3-5 mins Vasopressor:1-4 mcg/min IVPB
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| Dosages for Epinephrine (Pediatric) Anaphylaxis | Anaphylaxis with Shock:0.01 mg/kg (1:10,000) slow IV/IO (over 1 minute) to a maximum single dose of 0.1 mg MR q 3-5 mins
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| Class for Dopamine | Sympathomimetic, Catecholamine, Vasopressor
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| Mechanism of action for Dopamine (Low dose) | Renal/Mesenteric Dose : 1.Dilates renal and mesenteric arteries by stimulating dopaminergic receptors 2.Increases urinary output
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| Mechanism of action for Dopamine (moderate dose) | Inotropic Dose:1. Increases inotropy without increasing chronotropy2. Increases blood pressure by stimulating the beta1 receptors
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| Mechanism of action for Dopamine (high dose) | Vasopressor Dose:1. Causes vasoconstriction (alpha); increasing blood pressure Increase inotropy and chronotropy (beta 1); increasing blood pressure
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| Indications for dopamine |
1. Cardiogenic shock
2. Distributive shock after fluids
3. Hemodynamically significant hypotension
4. Symptomatic bradycardia (second line drug)
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| Contraindications for dopamine | 1. Hyperthermia
2. Tachydysrhythmias
3. Hypovolvemia
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| Side effects for dopamine | Cardiovascular: tachycardia, hypertension/hypotension, chest pain, ventricular irritability
Respiratory: dyspnea
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| Dosages for dopamine | Adult and pediatric:
Low dose:1-5 mcg/kg/min
Moderate dose: 5-10 mcg/kg/min
High dose: 10-20 mcg/kg/min
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| Class for diphenhydramine | Antihistamine, Antidyskinetic (anticholinergic), Sedative/Hypnotic
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| Mechanism of action for diphenhydramine | 1.Competes with histamine receptor sites
2.CNS depressant and anticholinergic
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| Indications for diphenhydramine | 1.Allergic symptoms
2.Dystonic reactions or extrapyramidal symptoms
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| Contraindications for diphenhydramine | 1.Acute asthma (relative contraindication)
2.Nursing mothers
3.Glaucoma
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| Side effects for diphenhydramine | Cardiovascular: tachycardia, hypotension, palpitations
Neurological: drowsiness, seizures
Respiratory: mucus plugs, wheezing
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| Dosages for DIPHENHYDRAMINE | Adult: 25-100 mg slow IVP/IO (25 mg per minute) or deep IM
Pediatric: 1 mg/kg slow IVP/IO (25 mg per minute) or deep IM
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| Classification of DILTIAZEM HYDROCHLORIDE | Antidysrhythmic, Calcium channel blocker, Antihypertensive
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| MOA for DILTIAZEM HYDROCHLORIDE | 1. Inhibits calcium influx across cellular membranes
2. Coronary artery dilation – increasing myocardial oxygen delivery
3. Smooth muscle relaxation – decreases peripheral vascular resistance
4. Slows SA/AV node conduction
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| Indications for DILTIAZEM HYDROCHLORIDE | 1. Symptomatic AFIB/AFLU
2. SVT/PSVT
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| Contraindications for DILTIAZEM HYDROCHLORIDE | 1. BP < 90 mmHg systolic
2. 2nd and 3rd degree heart blocks
3. Sick Sinus Syndrome
4. AMI
5. Wolf-Parkinson-White Syndrome
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| Side effects for DILTIAZEM HYDROCHLORIDE | Cardiovascular: bradycardia, hypotension, CHF, heart blocks
CNS: dizziness, drowsiness, confusion
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| Dosages for DILTIAZEM HYDROCHLORIDE | Adult: 15-20 mg IVP/IO
Pediatric: 0.25 mg/kg IV push over 2-5 min; repeat at 0.35 mg/kg if no
response/improvement in 15 minutes. Max dose of 3.5 mg/kg
in a 24 hour period
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| Classification of Adenosine | Antidysrhythmic, Endogenous nucleoside 1
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| Mechanism of action for Adenosine | 1. Slows conduction of the SA and AV nodes
2.Can interrupt reentry pathways through the AV and SA nodes
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| Indications for Adenosine | 1. SVT or PSVT unresponsive to Valsalva (vagal) maneuvers
2. Wide complex tachycardia as diagnostic drug (not used for torsades)
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| Contraindications for Adenosine | 1.Sick Sinus Syndrome
2.2nd or 3rd degree heart block
3.Hypovolemia – do not give adenosine prior to fluid administration
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| Side Effects for Adenosine | CV: CP/pressure, hypoT, transient PACs/PVCs, brady, asystole, 2&3 AVB Neuro: seizures, blurred vision, tingling/numbness, dizziness
Resp: SOB/dyspnea, respiratory failure GI: nausea, metallic taste/ other: flushed skin
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| Dosages for Adenosine: | Adult:6 mg rapid IVP/IO followed by 10-20 ml flush May repeat with 12 mg twice after 1-2 minutes each
Pediatric: 0.1 mg/kg rapid IVP/IO followed by 10 ml flush May repeat with 0.2 mg/kg twice after 1-2 minutes
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| Classification for Amiodarone | Antidysrhythmic
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| Mechanism of Action for Amiodarone | 1. Prolongs duration of action potential and refractory period without significantly effecting the resting potential
2.Relaxes smooth muscles causing vasodilation (especially in the coronary arteries)
3. Raises the threshold for VFIB
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| Indications for Amiodarone | 1. Monomorphic VTAC
2. Pulseless VTAC/VFIB refractory to defibrillation attempts
3. Symptomatic PVC’s
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| Contraindications for Amiodarone | 1. Cardiogenic shock
2. Bradycardia
3. Sick Sinus Syndrome
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| Side Effects for Amiodarone | Cardiovascular: cardiogenic shock, hypotension, bradycardia, CHF
Neurological: muscle weakness, tingling/numbness, dizziness, headache
Respiratory: pulmonary toxicity
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| Dosages for Amiodarone (Arrest) | Adult: Arrest: 300 mg IVP/IO followed by 10-20 ml NS flush 150 mg IVP/IO followed by 10-20 ml NS flush in 3-5 minutes if no conversion
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| Dosages for Amiodarone (Wide-complex Tachycardia/symptomatic PVC’s and maintenance infusion) | Wide-complex/ Tachycardia/ symptomatic PVC’s: 150 mg slow IVP/IO over 10 minutes (max dose 450 mg)Maintenance Infusion (IVPB): 0.5 mg per minute for post conversion (540 mg over 18 hours)
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| Dosages for Amiodarone (Pediatric) | Pediatric: VTAC/ VFIB Arrest: 5 mg/kg IVP/IO followed by 10 ml NS flush,max dose is 15 mg/kg
Tachydysrhythmias: 5 mg/kg IVP/IO over 20-60 minutes, max dose 15 mg/kg
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| Classification of Metaproterenol | Sympathmomimetic Bronchodilator
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| Mechanism of Action for Metaproterenol | 1.Selective Beta2 agonist
2.Relaxes bronchial smooth muscle
3.Inhibits histamine release from mast cells, reducing mucus production, capillary leaking and mucosal edema caused by allergic reaction in lungs
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| Indications for Metaproterenol | 1.Asthma
2.Bronchospasms associated with COPD
3.Allergic reaction/anaphylaxis
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| Contraindications for Metaproterenol | 1.Narrow angle glaucoma
2.cardiac dysrhythmias associated with tachycardia
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| Side effects of Metaproterenol | Cardiovascular: palpitations, tachydysrhythmias, hypertension
CNS: nervousness, weakness, drowsiness, tremors
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| Dosages for Metaproterenol (Adult) | Adult: 10-15 mg (0.2-0.3 mL of a 5% solution), dilute in 2.5 mL of NS
every 4 hours
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| Dosages for Metaproterenol (pediatric | Pediatric: 0.5 to 1 mg/kg (0.01 to 0.02 mL/kg of 5% solution); dilute in 3 mL NS
(age > 5 yrs) minimum dose: 5 mg (0.1 mL); maximum dose: 15 mg (0.3 mL); every 4 hours
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