Non-Cardiac drugs 119
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| Dextrose Class | Carbohydrate
Hypertonic Solution
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| Dextrose Route and Dose | Adult: 12.5-25 gm slow IV
Pediatric:
12 and up: D50 25 gm may repeat x1
1 month - 12 years: D25 2ml/kg. May repeat x1
<1 month: D10 5ml/kg
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| Dextrose Actions |
6-carbon sugar that is principle form of carbohydrate in the body.
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| Dextrose Indications |
Hypoclycemia
Altered LOC
Coma or seizure of unknown origin
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| Dextrose Precautions |
Obtain accucheck (blood glucose) if possible.
Extravasation may cause tissue necrosis.
May precipitate Wernicke’s encephalopathy in thiamine deficient patients.
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| Dextrose Contraindications | Intracranial hemorrhage
Increased intracranial pressure
CVA in absence of hypoglycemia
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| Glucagon Class | Pancreatic Hormone
Insulin antagonist
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| Glucagon Route and Dose | IM, IV, IO, IN
Adult hypoglycemia: 0.5mg-1.0mg IM. May q 7-10 minutes.
Adult b blocker or CC Blocker Tox: 1-5mg (average 3mg) IV/IO or 1mg IM if no access.
Ped:
Hypoglycemia: 1-12 yo 1mg IM.
<1 yo 0.5mg IM
BB/CC Blocker tox: 1-12 yo 1mg (consult med
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| Glucagon Action | When administered or released by pancreas, increases breakdown of glycogen to glucose. May be ineffective in chronic states of hypoglycemia.
Also has positive inotropic effect on heart.
Onset within 1 minute
Duration 60-90 minutes.
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| Glucagon Precautions |
Use caution with patients with cardiovascular disease.
Patients with kidney or liver dysfunction.
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| Glucagon Adverse Reactions | Hypotension
Nausea/Vomiting
Tachycardia
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| Glucagon Contraindication | Hypersensitivity to proteins
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| Activated Charcoal Actions | Binds and removes ingested toxins
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| Activated Charcoal Duration | Continuous duration, as long as it remains in the GI tract and has not become saturated with toxin.
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| Activated Charcoal How supplied | 2 types, Actidose Aqua and Actidose with sorbitol.
Actidose w/sorbitol is charcoal mixed with a sugar alcohol which creates defecation through osmosis. It also sweetens the taste.
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| Activated Charcoal Indications | Ingestion of pills, capsules, and tablets.
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| Activated Charcoal Contraindications | NOT used for ingestion of liquids, corrosives, caustics, or petroleum products.
Patients with ALOC or the possibility of becoming altered.
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| Activated Charcoal Time | Best if administered within 30 minutes of ingestion.
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| Activated Charcoal Dose | 1-2 Grams/kg PO/NG/OG
Usually supplied in 125mL with 25G or 250mL with 50G
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| Narcan (Naloxone) Class | Opioid Antagonist
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| Narcan (Naloxone) Action | Competes for and replaces narcotic molecules in the brain.
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| Narcan (Naloxone) Onset and Duration | Works within 1-2 minutes and lasts for about 30-60 minutes.
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| Narcan (Naloxone) Indications | Used for respiratory depression due to narcotic overdose.
Also, may be used in idiopathic coma.
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| Narcan (Naloxone) Contraindications | Will NOT work in barbituate, GHB, Rohypnol or benzodiazepine overdoses.
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| Narcan (Naloxone) Precautions | Use caution in narcotic dependent patients who may experience withdrawal.
May cause projectile vomiting and/or VT if given too rapidly.
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| Narcan (Naloxone) Dose | .4mg-2mg IV/IM/IN/SQ
Normally .4mg titrated to respiratory rate
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| Diazepam (Valium) Class | Benzodiazepine:
sedative/hypnotic
anticonvulsant
anxiolytic
amnesic
muscle relaxant
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| Diazepam (Valium) Dose and Route | Adult: SLOW IV/IM/Rectal Push (1 minute for each 5mg)
2.5mg increments titrated to achieve effect (usually up to 10mg)
Sedation: 2.5mg - 5.0mg (max 10mg)
Seizure: up to 10mg
Pediatric: 0.5mg/kg rectal up to 10mg
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| Diazepam (Valium) Action | Central nervous system depressant
Amnesia
Sedation
Muscle relaxation
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| Diazepam (Valium) Onset and duration | 1-5 minutes
Duration 2-4 hours
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| Diazepam (Valium) Indications | Active seizure/status epilepticus
Sedation for cardioversion
Chest pain or tachycardia following O.D. or ingestion of stimulant or hallucinogen (cocaine, meth, extacy, LSD, PCP, ketamine)
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| Diazepam (Valium) Precautions | Monitor respiratory status closely.
Administer at site closest to IV catheter, flush well before and after, utilize large veins (scorches veins).
IM is absorbed erratically and has a long onset.
Can cause cleft palate in 1st trimester of pregnancy.
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| Diazepam (Valium) Side effects | CNS/Respiratory depression
Hypotension
Confusion
Stupor
Vein irritation, phlebitis, and sclerosis
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| Diazepam (Valium) Contraindications | Alcohol or sedative use
Head injury
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| Diazepam (Valium) Antidote: | Romazicon (flumazenil) - Benzodiazepine antagonist
Duration of action 30-60 minutes
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| Benadryl Class | Antihistamine
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| Benadryl Action | Blocks the effects of histamine in the body related to allergic reactions.
Used in adjunctive therapy in anaphylaxis with epinephrine.
Used in the treatment of extrapyramidal (dystonic) reactions.
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| Benadryl Dose | Adult: 25-50mg IM or IV
1-2mg/kg IM or IV
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| Benadryl Onset and Duration | Max effects in 1-3 hours
Duration is up to 6-12 hours after administration.
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| Benadryl Indications | moderate to severe allergic reactions (after epi)
Anaphylaxis
Acute extrapyramidal (dystonic) reactions
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| Benadryl Drug interactions | CNS depressant that may increase depressant effects, ie: alcohol or valium.
MAO inhibitors may prolong and intensify anticholinergic effects of antihistamines.
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| Benadryl Adverse reactions | Drowsiness
Hypotension
Palpitations
Tachycardia or bradycardia
overexcitement in children
disturbed coordination
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| Benadryl Contraindications | Patients taking MAOI's
Hypersensitivity
Narrow-angle glaucoma
Newborns and nursing mothers
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| Promethazine HCL (Phenergan) Class | Phenothiazine and antihistamine with antiemetic, antimotion, and sedative effects.
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| Promethazine HCL (Phenergan) Route | SIVP over 1 minute
IM - deep into muscle
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| Promethazine HCL (Phenergan) Dose | Adult: Titrated doses of 12.5-25mg, to achieve desired effect.
Pediatric: Not used in the prehospital setting.
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| Promethazine HCL (Phenergan) Action | Potent antiemetic with sedative effects.
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| Promethazine HCL (Phenergan) Indications | Persistent vomiting due to gastrointestinal problems
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| Promethazine HCL (Phenergan) Precautions | Monitor LOC
Avoid antra-arterial or subcutaneous administration. Give slowly in small boluses and flush well, can cause vein irritation, phlebitis, and sclerosis.
Watch for signs/symptoms of excessive sedation and dystonic reaction.
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| Promethazine HCL (Phenergan) Side effects | Marked drowsiness/sedation
Dystonic reaction
Tissue necrosis if IV infiltrates, or if not given deep IM
Dysrhythmias
In children can cause hallucinations, convulsions, and sudden death.
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| Promethazine HCL (Phenergan) Contraindications | Hypersensitivity
Comatose states
CNS depression from alcohol, barbituates, or narcotics
Signs associated with Reye's syndrome
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| Promethazine HCL (Phenergan) Antidote | For dystonic reactions, administer diphenhydramine (Benadryl)
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| Ondansetron HCL (Zofran) Class | Antiemetic
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| Ondansetron HCL (Zofran) Route | Slow IV Push (over 1 minute)
IM
IN
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| Ondansetron HCL (Zofran) Dose | Adult: For nausea and or vomiting:
2mg IV Push given slowly (over 1 minute) with 10mL saline
Do not exceed 4mg cumulative
Pediatric: for nausea and/or vomiting: 0.1mg/Kg given slowly (over 1 minute)
Do not exceed 4mg cumulative
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| Ondansetron HCL (Zofran) Action | selectively blocks serotonin receptor (those that produce nausea/vomiting)
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| Ondansetron HCL (Zofran) Indications | prevention of nausea and vomiting
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| Ondansetron HCL (Zofran) Precautions | Ondansetron does not work effectively in every patient.
Patients who fail to respond to a single IV dose often do not respond to additional doses.
If valium is used, do not use Zofran.
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| Ondansetron HCL (Zofran) Side effects | Headache, Dizziness, Musculoskeletal pain, Drowsiness/Sedation, burning sensation at injection site, hypersensitivity
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| Ondansetron HCL (Zofran) Contraindications | Hypersensitivity
Children under the age of 2 years
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| Methylprednisolone Sodium Succinate (Solu-Medrol) Class | Synthetic steroid
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| Methylprednisolone Sodium Succinate (Solu-Medrol) Route | SIVP (over 5 minutes)
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| Methylprednisolone Sodium Succinate (Solu-Medrol) Dose | Adult: 60-125mg IV push for anaphylaxis or airway emergencies; 30mg/kg IV over 15 minutes followed by a maintenance infusion for 23 hours.
Pediatric: 1-2 mg/kg/IV
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| Methylprednisolone Sodium Succinate (Solu-Medrol) Action | Strengthens and stabilizes cell membranes, leading to:
decreases in capillary permeability - prevents leakage and edema.
Blockage of the release of histamine, bradykinin and other substances that cause vasodilation, tissue permeability, and irritation.
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| Methylprednisolone Sodium Succinate (Solu-Medrol) Action | Controls symptoms, suppresses acute and chronic inflammation for asthma, COPD, allergies, but does not cure the underlying disease.
In asthma, increases the number of beta receptors and increases responsiveness to beta bronchodilators.
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| Methylprednisolone Sodium Succinate (Solu-Medrol) Indications | An adjunct to, but not a substitute for bronchodilators during:
wheezing associated with refractory asthma and status asthmaticus.
Wheezing associated with COPD
Allergic reactions/anaphylaxis
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| Methylprednisolone Sodium Succinate (Solu-Medrol) Precautions | Consult Med Control for patients who are diabetic (hypoglycemic responses to insulin and oral hypoglycemia), have severe infections, and active gastrointestinal bleeding.
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| Methylprednisolone Sodium Succinate (Solu-Medrol) Side Effects | Hypertension
Sodium and water retention
Headache
Hypokalemia
Alkalosis
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| Methylprednisolone Sodium Succinate (Solu-Medrol) Contraindications | Hypersensitivity
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| Proparacaine HCL (Alcaine) Class | Topical anesthetic
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| Proparacaine HCL (Alcaine) Route | Dropped into the affected eye or eyes
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| Proparacaine HCL (Alcaine) Dose | Adult: 1-2 drops in the affected eye or eyes repeat dose (if indicated) every 5 minutes.
No max dose.
Pediatric: same as adult
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| Proparacaine HCL (Alcaine) Action | Topical anesthetic for eyes that blocks nerve impulses from sensory nerves.
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| Proparacaine HCL (Alcaine) Indications | Burns to the eyes or corneal abrasions.
Patient comfort prior to irrigation of eyes exposed to chemicals such as pepper spray or mace.
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| Proparacaine HCL (Alcaine) Precautions | Caution patient not to rub eye.
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| Proparacaine HCL (Alcaine) Side effects | Initial burning or stinging sensation.
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| Proparacaine HCL (Alcaine) Contraindications | Trauma/lacerations to the eyes.
Foreign bodies in the eyes.
Allergies to the "caine" drugs.
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| Nitrous Oxide:Oxygen (50:50) (Nitronox) Class | Gaseous Analgesic/Anesthetic
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| Nitrous Oxide:Oxygen (50:50) (Nitronox) Route | Inhalation: self-administered.
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| Nitrous Oxide:Oxygen (50:50) (Nitronox) Dose | Adult: Instruct patients to inhale deeply as they hold the mask.
Pediatric: Same as above.
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| Nitrous Oxide:Oxygen (50:50) (Nitronox) Action | CNS Analgesic/Anesthetic whose actions are short lived
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| Nitrous Oxide:Oxygen (50:50) (Nitronox) Indications | Patients who are alert and complaining of pain caused by the following:
Musculoskeletal injuries/fractures
Kidney stones
Suspected AMI (if NTG or Morphine are ineffective or contraindicated)
Active labor during an uncomplicated delivery.
Thermal burn
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| Nitrous Oxide:Oxygen (50:50) (Nitronox) Precautions | Must be self administered
Check machine gauges daily for proper concentrations.
Monitor blood pressure and pulse oximetry values.
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| Nitrous Oxide:Oxygen (50:50) (Nitronox) Side effects | Hypotension
Dizziness
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| Nitrous Oxide:Oxygen (50:50) (Nitronox) Contraindications | Acutely psychotic patients
Decompression sickness
Patients who cannot self-administer
Any altered LOC or head injury
Abdominal distension
Major facial trauma
Chest trauma or actual/suspected pneumothorax
Chronic obstructive pulmonary disease
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| Furosemide (Lasix) Class | Loop Diuretic
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| Furosemide (Lasix) Action | Affects sodium and chloride re-absorption at the Loop of Henle
Decreased osmotic gradient
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| Furosemide (Lasix) Onset and Duration | Onset 15-20 minutes.
Duration 2-6 hours.
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| Furosemide (Lasix) Indications | Pulmonary edema
Renal disease
Hyperkalemia
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| Furosemide (Lasix) Contraindications | Dehydration
Hypovolemia
Pregnancy
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| Furosemide (Lasix) Adverse Reactions | Hypotension
Electrolyte imbalance
Ototoxicity
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| Furosemide (Lasix) Drug interactions | Digitalis toxicity
Increased ototoxicity when used with some antibiotics
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| Furosemide (Lasix) How supplied | 10mg/mL
2,4,8,10mL
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| Furosemide (Lasix) Dose/Route | 20-40mg SIVP
(20mg/min)
Double the usual daily single dose
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| Ipratropium Bromide (Atrovent) Class | Topical Anticholinergic
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| Ipratropium Bromide (Atrovent) Route | Inhalation (nebulized)
ETT (alternate route)
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| Ipratropium Bromide (Atrovent) Dose | All doses are combined with 2.5mg of Albuterol.
Adult: Nebulizer: 0.5mg in 2.5mL NS
Pediatric: Nebulizer:
<1yr old - 0.25mg in 2.5mL NS
>1yr or older - 0.5mg in 2.5mL NS
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| Ipratropium Bromide (Atrovent) Action | Bronchodilator
Dries respiratory tract secretions
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| Ipratropium Bromide (Atrovent) Indications | Bronchospasm associated with asthma or COPD that does not respond to the first dose of Albuterol.
Bronchospasm from chemical toxins: nerve agents, cyanide, blistering agents, choking agents.
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| Ipratropium Bromide (Atrovent) Precautions | Use caution if patients have a history of glaucoma, prostatic hypertrophy, or bladder neck obstruction.
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| Ipratropium Bromide (Atrovent) Side effects | Dry mouth
Cough, worsening of symptoms
skin rash
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| Ipratropium Bromide (Atrovent) Contraindications | Sensitivity to soy lecithin products (soybeans, peanuts)
Sensitivity to Atropine
Bronchoconstriction that is caused by allergic reaction.
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| Albuterol (Ventolin, Proventil) Class | Sympathomimetic
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| Albuterol (Ventolin, Proventil) Route | Inhalation (nebulized)
ETT (alternate route)
May be administered via either lumen of the Combitube
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| Albuterol (Ventolin, Proventil) Supplied | Liquid
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| Albuterol (Ventolin, Proventil) Dose | Nebulizer: 2.5mg over 5-15minutes 2-15 Liters per minute - preferably 8 lpm.
Pediatric: same as adult
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| Albuterol (Ventolin, Proventil) Action | Bronchodilation (beta2)
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| Albuterol (Ventolin, Proventil) Indications | Bronchospasm associated with asthma and COPD
Bronchospasm from chemical toxins: nerve agents, cyanide, blistering agents, choking agents, allergic reactions unresponsive to Epinephrine or Diphenhydramine (Benadryl)
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| Albuterol (Ventolin, Proventil) Precautions | Known heart disease
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| Albuterol (Ventolin, Proventil) Side effects | Restlessness
Hypertension
Tachycardia - palpations
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| Albuterol (Ventolin, Proventil) Contraindications | Pregnancy, except in life-threatening situations
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| Midazolam (Versed) Class | Schedule IV, short-acting benzo.
Benzodiazepine
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| Midazolam (Versed) Midazolam (Versed) Actions | Enhances the affect of the neurotransmitter gamma-aminobutyric acid (GABA)
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| Midazolam (Versed) Indications | Active seizure/status epilepticus
Procedural sedation
Chest pain or tachy following an overdose or ingestion of a stimulant or hallucinogen (cocaine, amphetamine, extacy, LSD, PCP, ketamine)
Sedation in struggling patients when med restraints applied.
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| Midazolam (Versed) Dose and Route | Adult: Sedation, combative pts, CP from SNS.
Seizures: 1-2.5mg titrated up to 10mg SLOW IV/IO/IN push.
PAI: 0.1mg/kg IV/IO to achieve effect with max dose 5.0mg.
Pediatric: 0.5mg/mg rectal up to 10mg or 0.1mg/kg IN up to 10mg or 0.1mg/kg IV
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| Midazolam (Versed) Action | CNS depressant
Amnesia
Sedation
Muscle relaxation
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| Midazolam (Versed) Onset and duration | Onset: 1-3 minutes
Duration: 15 minutes to 6 hours (dose dependent)
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| Midazolam (Versed) Precautions | Titrate in small doses to avoid side effects
Monitor respiratory status closely
Monitor B/P closely
Administer at site closest to IV catheter, flush well before and after.
Do not mix with other drugs or solutions.
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| Midazolam (Versed) Side effects | Hypotension
Respiratory depression
Confusion
Stupor
Vein irritation, phlebitis, and sclerosis
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| Midazolam (Versed) Contraindications | Alcohol or sedative use
Head injury
Acute narrow angle glaucoma
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| Midazolam (Versed) Antidote | Romazicon (flumazenil) benzodiazepine antagonist
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