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UCLA – Daniel Freeman Paramedic Education Program
Pharmacology Reference Guide
UNIVERSITY OF CALIFORNIA LOS ANGELES
CENTER FOR PREHOSPITAL CARE –
DANIEL FREEMAN HOSPITAL
PARAMEDIC EDUCATION PROGRAM
PHARMACOLOGY REFERENCE GUIDE
Compiled by:
William J. Dunne, MS, NREMT-P
Program Director
Tyler Dixon, NREMT-P
Class of September 2000
Federico Jimenez, NREMT-P
Class of September 2000
Reviewed by:
Heather M. Davis, MS, NREMT-P
Clinical Coordinator
Joshua W. Binder, BA, NREMT-P
Clinical Supervisor
Class of January 1989
Revised 9/2003
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UCLA – Daniel Freeman Paramedic Education Program
Pharmacology Reference Guide
INDEX
Medication
Acetaminophen (Tylenol)
Acetylcysteine (Mucomyst)
Activated Charcoal (Acta-Char)
Adenosine (Adenocard)
Albuterol (Proventil, Ventolin)
Alteplase, tPA (Tissue Plasminogen
Activator/Activase)
Aminophylline (Somophylline)
Amiodarone (Cordarone)
Amrinone Lactate (Inocor)
Amyl Nitrate (Vaporole)
Anistreplase (Anisoylated Plasminogen
Streptokinase Activator Complex(APSAC),
Eminase)
Aspirin (Acetylsalicylic Acid/ASA)
Atenolol (Tenormin)
Atropine Sulfate
Bretylium Tosylate (Bretylol)
Bumetanide (Bumex)
Butorphanol Tartrate (Stadol)
Calcium Chloride (CaCl)
Calcium Gluconate (Kalcinate)
Chlorpromazine (Thorazine)
Dexamethasone (Decadron)
Dextrose (50%, 25%, 10%)
Diazepam (Valium)
Diazoxide (Hyperstat)
Digoxin (Lanoxin)
Digoxin Immune FAB (Digibind)
Diltiazem Hydrochloride (Cardizem)
Dimenhydrinate (Dramamine)
Diphenhydramine (Benadryl)
Dobutamine (Dobutrex)
Dopamine (Intropin)
Droperidol (Inapsine)
Edrophonium Chloride (Tensilon)
Epinephrine (Adrenalin)
Esmolol (Brevibloc)
Etomidate (Amidate)
Fentanyl Citrate (Sublimaze)
Flumazenil (Romazicon)
Furosemide (Lasix)
Glucagon (GlugaGen)
Glycopyrolate (Robinol)
Haloperidol (Haldol)
Page Number
5
6
7-8
9
10-11
12
13-14
15-16
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21
22-24
25
26
27
28-29
30-31
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34
35-36
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42-43
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45-46
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49-50
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54-55
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57-58
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UCLA – Daniel Freeman Paramedic Education Program
Pharmacology Reference Guide
Heparin
Hydralazine (Apresoline)
Hydrocortisone (Solu-Cortef, Cortisol)
Hydromorphone (Dilaudid)
Hydroxyzine (Vistaril)
Ibutilide (Corvert)
Insulin (NPH, Humulin, Novolin)
Ipecac, Syrup of
Ipratropium (Atrovent)
Isoetharine (Bronkosol)
Isoproterenol (Isuprel)
Ketamine (Ketalar)
Ketorolac Tromethamine (Toradol)
Labetalol (Normodyne)
Lidocaine (Xylocaine)
Lorazepam (Ativan)
Magnesium Sulfate (MgSO4)
Mannitol (Osmolol/Osmitral)
Meperidine (Demerol)
Metaproterenol (Alupent)
Metaraminol (Aramine)
Methohexital (Brevital)
Methylprednisolone (Solu-Medrol)
Metoclopramide (Reglan)
Metoprolol (Lopressor)
Midazolam Hydrochloride (Versed)
Milrinone (Primacor)
Morphine Sulfate (Duramorph)
Nalbuphine (Nubain)
Naloxone (Narcan)
Nifedipine (Procardia, Adalat)
Nitroglycerine (Nitrostat)
Nitroprusside (Nipride)
Nitrous Oxide (Nitronox)
Norepinephrine (Levophed)
Oral Glucose
Oxygen (O2)
Oxytocin (Pitocin)
Pancuronium Bromide (Pavulon)
Phenobarbital (Luminal)
Phenytoin (Dilantin)
Physostigmine (Antilirium)
Potassium Chloride (KCl)
Pralidoxime (Protopam/2-PAM)
Procainamide (Pronestyl, Procan)
Prochlorperazine (Compazine)
Promethazine (Phenergan)
Propanolol (Inderal)
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75-76
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87-88
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90-91
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96-97
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102-103
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108
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110-111
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Pharmacology Reference Guide
Propofol (Diprivan)
Prostaglandin E1 (PG E1)
Racemic Epinephrine (Micronephrin)
Reteplase (Retavase)
Rocuronium (Zemuron)
Sodium Bicarbonate (NaHCO3)
Streptokinase (Streptase)
Succinylcholine (Anectine)
Terbutaline (Brethine)
Thiamine (B1 Vitamin)
Thiopental (Pentothal)
Trimethobenzamide (Tigan)
Vasopressin (Pitressin)
Vecuronium (Norcuron)
Verapamil (Isoptin, Calan, Verelan)
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121-122
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125
126
127
128
129
130
131
List of Classifications
References
132-133
134-135
Bold Text indicates Los Angeles County, California Scope of Practice
The authors of this guide have taken care to make certain that the doses of drugs and
schedules of treatment are correct and compatible with the standards generally accepted
at the time of publication. Nevertheless, as new information becomes available, changes
in treatment and in the use of the drugs become necessary. The reader is advised to
carefully consult the instruction and information material included in the package insert
of each drug or therapeutic agent before administration. The authors disclaim all
responsibility for any liability, loss, injury, or damage incurred as a consequence, directly
or indirectly, of the use and application of any of the contents of this guide. Emergency
Medical Services (EMS) Personnel should always rely on medical direction and the
outlined scope of practice within individual jurisdictions for specific medication
administration guidelines.
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Pharmacology Reference Guide
acetaminophen
(Tylenol)
Classification: analgesic, antipyretic, Non-steroidal anti-inflammatory (NSAID)
Mechanism of action: elevates the pain threshold in the CNS and acts on the
hypothalamic thermoregulatory centers
Indications: fever, mild to moderate pain
Contraindications: hypersensitivity, children <3yo
Side Effects: dizziness, lethargy, anorexia, nausea, vomiting, abdominal pain, diarrhea,
hepatic failure, renal failure, diaphoresis, chills, hypoglycemia
Precautions: Use cautiously in pediatric patients <12 years of age, anemic or hepatic
disease, alcoholism, malnutrition, and thrombocytopenia.
Interactions: may increase hepatotoxicity with chronic co-administration with many
other drugs.
Routes of Administration: PO, PR
Onset & Duration of actions:
Dosages:
30-60 minutes, 3-4 hours
Adult: 325-650 mg PO q 4-6 hours, 650 mg PR q 4-6 hours (max 4g/day)
Pediatric: 15mg/kg q 4-6 hours (PO or PR)
LA Co: N/A
LA Co Peds: N/A
Overdose Treatment: Consider activated charcoal for overdose < 1 hour or
acetylcysteine (Mucomyst) (140mg/kg) for > 1 hour
Notes:
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UCLA – Daniel Freeman Paramedic Education Program
Pharmacology Reference Guide
acetylcystine
(Mucomyst)
Classification:
mucolytic, antidote
Mechanism of action:
Breaks up and decreases viscosity of respiratory secretions,
prevents liver damage with acetaminophen overdose by increasing hepatic glutathione
Indications: acute and chronic bronchitis, emphysema, pneumonia, tuberculosis,
atelectasis, cystic fibrosis, acetaminophen overdose
Contraindications: increasing intracranial pressure, status asthmaticus,
hypersensitivity, gastric bleeding
Side Effects: bronchospasm, hemoptysis, tightness in chest, weakness and dizziness,
headache, nausea & vomiting, rhinorrhea, urticaria, fever, epistaxis
Precautions: hypothyroidism, Addison’s disease, altered level of consciousness, asthma
Interactions: Do not mix with antibiotics
Routes of Administration: PO or inhaled nebulizer
Onset & Duration of actions: onset 1min (inhaled); duration 20 minutes
Dosages:
Adult: Mucolytic: 1-10ml of 20% solution (nebulized)
Acetaminophen OD: 140mg/kg followed by 70mg/kg for 17 doses
(5% solution PO)
Pediatric:
Mucolytic: 3-5ml of 20% solution (nebulized)
Acetaminophen OD: 140mg/kg followed by 70mg/kg for
17 doses (5% solution PO)
LA County: N/A
Note: Mucomyst has a high occurrence of being effective in preventing liver damage if
administered soon after the Tylenol OD.
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UCLA – Daniel Freeman Paramedic Education Program
Pharmacology Reference Guide
activated charcoal
(Acta-Char, Liqui-Char, Actidose, Insta-Char, Charcoaid)
Classification: Chemical adsorbent, antidote
Mechanism of action: Binds to and adsorbs ingested drugs and chemicals and inhibits
absorption in the GI tract
Indications: Known or suspected drug or poison ingestion
Contraindications: Ingestion of cyanide, mineral acids, methanol, caustic acids or bases,
heavy metals, petroleum products, corrosives, or iron ingestion
LA County – Altered level of consciousness or potential for altered level of
consciousness, absent gag reflex
Side Effects: Aspiration, vomiting, diarrhea, constipation
Precautions: Monitor patient’s airway
Interactions: Milk products reduce the effectiveness of charcoal
Routes of Administration: PO, OGT/NGT
Onset & Duration of actions:
Dosages:
Immediate; 12-24 hours
Adult: 1 g/kg (50 - 100 g)
Pediatric: 1 g/kg (10 - 30 g)
LA Co: 25 - 50 g PO as tolerated WITHOUT Sorbitol
LA Co Peds: 0 - 2 years : Not recommended
> 2 years : 25 - 50 g
Note: -Most effective if administered within 30 minutes after ingestion of poison
-Shake container vigorously
-Monitor patient closely for reduction in level of consciousness, aspiration and
vomiting.
-May also be administered via nasogastric or orogastric tube with or without
prior lavage
-Use caution with acetaminophen overdose over 24 hours as charcoal may
interfere with the antidote.
-Do not administer prior to syrup of Ipecac
-Use caution with patients who exhibit altered level of consciousness and/or
potential airway compromise
-In LA County, do not use preparations with Sorbitol. Sorbitol is a potent
cathartic and may cause major fluid and electrolyte disturbances
especially in young children.
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UCLA – Daniel Freeman Paramedic Education Program
Pharmacology Reference Guide
adenosine
(Adenocard)
Classification: Antidysrhythmic
Mechanism of action: Depresses automaticity in SA node, slows conduction of SA and
AV nodes, inhibits re-entry through AV node, “Chemical Cardioversion”
Indications: SVT or PSVT unresponsive to valsalva maneuver
Contraindications: Hypersensitivity
2nd or 3rd degree AV Block
History of Sick Sinus Syndrome
Patients on Tegretol (carbamazepine-anticonvulsant) or Persantine
(dipyridamole – anticoagulant)
Side Effects: Chest pain or pressure, hypotension, heart blocks, bradycardia, asystole,
transient premature complexes, seizures, blurred vision, headache, tingling, numbness,
lightheadedness, dizziness, shortness of breath, dyspnea, bronchoconstriction in asthmatic
patients, flushed skin, nausea, metallic taste, throat tightness
Precautions: May produce new dysrhythmias; are usually transient
Interactions: Tegretol and Persantine (intensification of effect), theophylline and
xanthines (render ineffective)
Routes of Administration: Rapid IVP, IO
Onset & Duration of actions: Immediate ; Less than 10 seconds
Dosages:
Adult: 6 mg; 12 mg; 12 mg (flush with 10-20 cc NS)
Pediatric: 0.1 mg/kg ; 0.2 mg/kg
(flush with 10 cc NS)
LA Co: 6 mg rapid IVP; repeat 1-2 minutes later @ 12 mg twice (flush
with 10-20 cc NS)
LA Co Peds: 0.1 mg/kg ; repeat 1-2 minutes later @ 0.2 mg/kg
(flush with 10 cc NS)
Note: -Cannulate large vein (antecubital fossa) with an 18 or 20 gauge catheter
-Drug must be administered RAPIDLY (1 - 2 seconds)
-Flush with 10-20 cc Normal Saline
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UCLA – Daniel Freeman Paramedic Education Program
Pharmacology Reference Guide
albuterol
(Proventil, Ventolin)
Classification: Sympathomimetic (relatively Beta-2 specific), bronchodilator
Mechanism of action: Relaxes bronchial smooth muscle (stimulation of beta-2
receptors) causing bronchodilation & reduction of airway resistance
Indications: Asthma
Bronchospasms associated with: COPD, Bronchitis, toxic gas inhalation,
near drowning, drug overdose, pulmonary edema (LA COUNTY)
Crush syndrome with suspected hyperkalemia & crush force > 4 hours
Contraindications: Hypersensitivity, symptomatic tachydysrhythmias
Side Effects: Chest pain, tachycardia, palpitations, arrhythmias, hypertension, headache,
dizziness, tremors, nervousness, anxiety, nausea, coughing, wheezing
Precautions: Use caution in patients with history of cardiac disease, severe
hypertension, and/or tachydysrhythmias
Always provide patient with supplemental oxygen prior to and after
administration. Monitor patients for rhythm disturbances.
Interactions: Epinephrine and other sympathomimetics may intensify Albuterol; Beta
Blockers may inhibit effects
Routes of Administration: Nebulizer
Onset & Duration of actions: 5 minutes; 4 - 6 hours
Dosages:
Adult: 2.5 mg in 3cc NS (0.5% solution) over 5-15 minutes utilizing 6-8
LPM of oxygen, prn (for hyperkalemia: 10-20mg over 15 minutes)
Pediatric: 0.1 – 0.3 mg/kg of a 0.5% solution, prn
LA Co: Respiratory - 5 mg in 3 cc of NS with hand held nebulizer/mask
over 5-15 minutes, repeat as needed.
Crush Syndrome – 5mg in 3ml NS by continuous mask
nebulization
LA Co Peds: 0 - 1 year old – 2.5 mg in 1.5 cc of NS, prn
Over 1 year old – 5 mg in 3 cc of NS, prn
Note: -Monitor airway closely
-In LA Co mask strap may not be strapped onto to patient’s head due to inability
to monitor tidal volume and level of consciousness except in crush injury
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UCLA – Daniel Freeman Paramedic Education Program
Pharmacology Reference Guide
Alteplase Recombinant (tPA)
(Tissue Plasminogen Activator, Activase)
Classification: Thrombolytic / fibrinolytic
Mechanism of action: plasminogen activator that catalyzes the cleavage of endogenous
plasminogen to generate plasmin (which degrades thrombus matrix) causing
thrombolysis.
Indications: acute myocardial infarction (<12 hours onset), deep vein thrombosis,
pulmonary embolism, occlusive stroke (Prehospital for AMI only)
Contraindications: Active internal bleed, severe hypertension, history of hemorrhagic
stroke, any stroke within the last 12 months, COPD, any recent surgery
Side Effects: Can cause severe internal bleeding, rash and urticaria, dyspnea,
anaphylaxis, bronchospasms, pulmonary edema, hypotension, headache, nausea,
vomiting, weakness, dizziness, dysrhythmias
Precautions: Pregnancy (C), Patient >75 y/o, recent trauma, known bleeding disorders,
traumatic CPR
Interactions: anticoagulants increase bleeding
Routes of Administration: IV
Onset & Duration of actions: onset rapid; duration 10min
Dosages:
Adult: total of 100mg (10mg over 1-2min, 50mg over first hr, 20mg over
second hr, 20mg or 1.25mg over third hr)
Pediatric: N/A
LA County: N/A
Note: The sooner this drug is used the more effective it will be, however two 12 lead
ECG’s must be ran to compare. The goal in the ER is usually <30min door to drug time.
The side effects of thrombolytics are so devastating that typically there is a sheet of
contra indications that must be gone over with the pt. prior to administration. Start a
second line prior to administration, and do not use IM as a route post administration to
avoid bleeding.
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UCLA – Daniel Freeman Paramedic Education Program
Pharmacology Reference Guide
aminophylline
(Somophylline)
Classification:
Bronchodilator (smooth muscle relaxant)
Methyl-xanthine bronchodilator
Mechanism of Action:
Relaxes & dilates bronchial smooth muscle, also is a mild
diuretic. Stimulates the respiratory center in the CNS. Increases heart rate. Blocks
antagonists which breakdown beta agonist tone.
Indications: Asthma (refractory to first line drugs such as albuterol)
Other bronchial spasms caused by chronic bronchitis & emphysema
Mild CHF and pulmonary edema
Contraindications: Hypersensitivity, uncontrolled cardiac dysrhythmias (because
aminophylline can cause and exacerbate dysrhythmias), hypotension, peptic ulcer disease
Side Effects: Tachycardia, dysrhythmias (especially PVCs), palpitations, chest pain
nervousness, headache, seizures, nausea and vomiting, tremors, anxiety, dizziness
Precautions: Cardiac monitoring, look for PVC’s and tachycardia, monitor vitals
closely
Cardiovascular disease and hypertension
Suspected myocardial infarction, or cardiac ischemia
Pregnancy (C)
Interactions: Theophylline (another xanthine bronchodilator): If patient has taken
theophylline within 24hrs aminophylline should not be pushed in the field in a regular
dose. Beta blockers: can cause toxic effects Sympathomimetics: increases CNS and
cardiovascular side effects
Routes of Administration: IV
Onset & Duration of actions: onset rapid; duration 6-8 hrs
Dosages:
Adult: Bolus: 5mg/kg, max 500mg, (over 20 min)
Infusion: 0.5-0.7mg/kg/hr
Pediatric:
Bolus: Peds 5-7mg/kg, (over 20 min)
Infusion: Peds 1mg/kg/hr
LA County:
N/A
Note:
With overdose consider ACLS (for dysrhythmias), benzodiazepine (for
seizures), consider antiemetics (for uncontrolled vomiting). Extremely low therapeutic
range, therefore overdose or toxic conditions are not uncommon.
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UCLA – Daniel Freeman Paramedic Education Program
Pharmacology Reference Guide
amiodarone
(Cordarone)
Classification:
Antidysrhythmic
Mechanism of Action:
Class III antidysrhythmic (potassium channel blocker), also
has antianginal & anti-adrenergic properties. Prolongs duration of action potential and
refractory period without significantly effecting resting potential. Relaxes smooth
muscles causing vasodilation especially in coronary arteries. Sympathetic blocker.
Indications: Prophylaxis & treatment of Pulseless V-tach / V-fib
SVT including Atrial fibrillation, Atrial flutter, Junctional & Atrial
tachycardias
Ventricular tachycardia & wide complex tachycardia of unknown origin
Treatment of non-exertional angina
Contraindications: hypersensitivity, cardiogenic shock, high degree AV blocks &
bradycardia (profound), sick sinus syndrome
Side Effects: muscle weakness, numbness, tingling, fatigue, dizziness, headache,
hypotension, cardiogenic shock, nausea, vomiting, anorexia, pulmonary toxicity
Precautions: Hashimoto’s thyroiditis, goiter, history of thyroid dysfunction, CHF,
electrolyte imbalance, Pregnancy (D), hypersensitivity to iodine, children.
Interactions: Increases digoxin levels, enhances other ventricular anti-arrhythmics,
Incompatible with bicarbonate, heparin, aminophylline.
Routes of Administration: IVB, IVPB, IO
Dosages:
Adult: V-fib/tach Arrest: 300mg IV, followed by 150 mg in 3-5 minutes.
Wide or narrow complex Tachycardia or V-tach: IVPB – 150mg
over 10 min (15mg/min), repeat every 10 min as needed. – Or –
360 mg over 6 hours (1mg/min)
Maintenance Infusion: 540 mg IV over 18 hours (0.5mg/min)
MAX Dose: 2.2g IV in 24 hours
Pediatric:
Arrest: 5mg/kg rapid IV/IO Bolus
Tachydysrhythmias: 5mg/kg IV/IO over 20-60 min(repeat
to max of 15mg/kg per day)
LA County:
N/A
Notes:
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UCLA – Daniel Freeman Paramedic Education Program
Pharmacology Reference Guide
amrinone
(Inocor)
Classification:
Inotropic agent (phosphodiesterase inhibitor)
Mechanism of Action:
Fast acting inotrope by inhibiting phosphodiesterase (not
well understood-increases cardiac contractility). Mild vasodilation. Reduces preload and
afterload by relaxing vascular smooth muscle.
Indications: Severe CHF refractory to other agents (Short term management only)
Septic shock & cardiac dysfunction in children (cardiomyopathy or recent
surgery
Contraindications: hypersensitivity to drug or other bisulfite chemicals
Side Effects: arrhythmias, hypotension, nausea, vomiting, abdominal pain,
thrombocytopenia.
Precautions: Increases cardiac ischemia, use with caution in potential AMI patients,
should only be diluted in NS solutions. Monitor vital signs closely.
Interactions: Furosemide should be administered via different IV line (precipitation)
and should not be mixed with dextrose solutions.
Routes of Administration: IVB, IVPB
Onset & Duration of Action: onset 2-5 min, 2 hour duration
Dosages:
Adult: IVB – 0.75 mg/kg over 2-3 minutes
IVPB – 5-15mcg/kg/min (mix 100mg in 500ml NS)
Pediatric: IVB – 0.75- 1 mg/kg over 5 minutes, may repeat twice to total
dose of 3mg/kg
IVPB – 5-10mcg/kg/min follow-up infusion
LA County:
N/A
Notes:
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UCLA – Daniel Freeman Paramedic Education Program
Pharmacology Reference Guide
amyl nitrite
(Vaporole)
Classification:
nitrate; vasodilator; antidote
Mechanism of action:
Relaxes vascular smooth muscle, decreases myocardial
oxygen demand, decreases peripheral vascular resistance (PVR); decrease cyanide
toxicity by turning hemoglobin into methemoglobin, which forms a nontoxic complex
with the cyanide ion to create cyanomethemoglobin (which can be excreted in the liver)
Indications: angina, hypertension, cyanide poisoning
Contraindications: hypotension, Viagra use within the last 24-36hrs, none with
cyanide poisoning
Side Effects: Hypotension, tachycardia, headache, palpitations, nausea and vomiting,
weakness, dizziness
Precautions: Pregnancy, Shock, tendency for abuse
Interactions: other vasodilators such as ACE-inhibitors, beta blockers, narcotics, certain
phenothiazines and other nitrates
Routes of Administration: inhaled
Onset & Duration of actions: 10-30 seconds, 3-5 minutes
Dosages:
Adult: 1 or 2, 0.3mL ampules crushed and inhaled for 30sec, q 1-2min
Pediatric: 1, 0.3mL ampule crushed and inhaled for 15-30sec,q 1-2min
LA County: 1 ampule for cyanide exposure only (crush ampule, use new
ampule every 2-3 minutes, tape to inside BVM Mask, ventilate for 60
seconds, remove ampule, continue to ventilate for 15 seconds, repeat
steps)
Note: Typical field use is for cyanide poisoning only, in which the contra indications
listed above are only relative. High Flow oxygen should be administered in-between
doses. Amyl nitrate is a drug of common misuse and abuse, therefore, providers should
make sure that ampules are secured.
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UCLA – Daniel Freeman Paramedic Education Program
Pharmacology Reference Guide
anistreplase
(Anisoylated plasminogen streptokinase activator complex (APSAC), Eminase)
Classification:
thrombolytic / fibrinolytic
Mechanism of action:
plasminogen activator that catalyzes the cleavage of
endogenous plasminogen to generate plasmin (which degrades thrombus matrix) causing
thrombolysis.
Indications: acute myocardial infarction
Contraindications: Active internal bleed, severe hypertension, stroke of any form,
intra-cranial surgery
Side Effects: Can cause severe internal bleeding, rash and urticaria, shortness of breath,
anaphylaxis, bronchospasms, pulmonary edema, hypotension, headache, nausea and
vomiting, weakness, dizziness, dysrhythmias
Precautions: Pregnancy (c), ulcers, colitis, enteritis, renal and hepatic disease, COPD,
any recent surgery, cardiac valvular disorder.
Interactions: anticoagulants increase bleeding
Routes of Administration: IV
Onset & Duration of actions: onset varies; duration 105min
Dosages:
Adult: 30U (over 2-5min) one time only
Pediatric: N/A
LA County: N/A
Note: The sooner this drug is used the more effective it will be, however two 12 lead
ECG’s must be ran to compare. The goal in the emergency department (ED) is usually
<30min door to drug time. The side effects of thrombolytics are so devastating that
typically there is a sheet of contra indications that must be gone over with the patient
prior to administration. Start a second line prior to administration, and do not use IM as a
route post administration to avoid bleeding.
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UCLA – Daniel Freeman Paramedic Education Program
Pharmacology Reference Guide
aspirin
(acetylsalicylic acid, ASA, Bayer)
Classification: Anticoagulant
Anti-inflammatory (Non steroidal anti-inflammatory drug – NSAID)
Antipyretic
Analgesic
Mechanism of action: Impedes clotting action and prolongs bleeding by blocking
platelet aggregation by slowing prostaglandin synthesis action, which also impedes
inflammation response
Indications: acute myocardial infarction or myocardial ischemia, signs and symptoms of
recent thrombotic stroke
Contraindications: Hypersensitivity, history of gastrointestinal bleeding or ulcers
Patients with known bleeding disorders, acute asthma
Side Effects: Prolonged bleeding, nausea, vomiting, heartburn, GI bleeding, epigastric
pain, wheezing
Precautions: Patients taking warfarin (Coumadin) or other anticoagulants
Recent history of surgery, patients with renal or hepatic disease or failure,
hypersensitivity to other NSAIDs, asthmatic patients (may increase viscosity of
respiratory secretions and cause mucous plug formation)
Interactions: warfarin (Coumadin) may potentiate the effects of aspirin
Routes of Administration: PO
Onset & Duration of actions: 5 - 30 minutes; 1-4 hours (24 hours for anticoagulant
effect)
Dosages:
Adult: 160 - 325 mg
Pediatric: Not recommended
LA Co: 160 - 325 mg PO chewed or swallowed
LA Co Peds: Not recommended
Note: -Children’s aspirin is commonly used in the field
-Aspirin should be chewed then swallowed for faster absorption and to decrease
potential GI distress.
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UCLA – Daniel Freeman Paramedic Education Program
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atenolol
(Tenormin)
Classification:
Beta-adrenergic blocker, anti-hypertensive
Mechanism of Action:
Selectively blocks Beta 1 receptors (dose specific & will
block Beta 2 receptors in high doses). Negative inotrope, chronotrope, & dromotrope.
Suppresses renin production because of relative vasoconstriction.
Indications: hypertension, stable angina, acute myocardial infarction
Contraindications: sinus bradycardia, AV conduction blocks, congestive heart failure,
cardiogenic shock, bronchial asthma
Side Effects: dizziness, lightheadedness, syncope, fatigue, bradycardia, hypotension,
congestive heart failure, nausea, vomiting, decreased sexual ability, complete heart block,
cardiac arrest
Precautions: Pregnancy (Class C), asthmatics, COPD
Interactions: Increases lidocaine toxicity, synergistic with verapamil
Routes of Administration: IVP slow, IVPB
Onset & Duration of Action:
Dosages:
rapid onset (30-60 sec), peak 5 min, duration
24hours.
Adult: 5mg over 5min (repeat in 10 minutes)
Pediatric:
N/A
LA County:
N/A
Overdose Treatment: Treat underlying rhythms, fluid bolus for hypotension, glucagon
administration in severe case.
Notes:
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UCLA – Daniel Freeman Paramedic Education Program
Pharmacology Reference Guide
atropine sulfate
Classification:
Parasympatholytic (cholinergic blocking agent)
Antidysrhythmic agent, bronchodilator, antidote
Mechanism of action: Decreases action of the parasympathetic nervous system by
blocking cholinergic receptors, therefore:
 Increases heart rate and increases conduction through atrioventricular (AV) junctional
node (blocking vagal tone)
 Causes bronchodilation and reduces respiratory secretions
 Decreases gastrointestinal secretions and motility
Indications: Symptomatic bradycardia
Asystole
Pulseless Electrical Activity (PEA) < 60 bpm
Premedication for Rapid Sequence Intubation (RSI) (especially pediatrics)
Organophosphate (pesticide) or Nerve Agent poisoning
Asthma/COPD induced bronchospasms
Contraindications: Neonates
Side Effects: Tachycardia, hypertension, palpitations, increases myocardial oxygen
demand, seizures, dizziness, confusion, dilated pupils, blurred vision, mucous plugs,
difficulty swallowing, dry mouth, hot, dry skin, increase in intraoccular pressure,
headache
Precautions: Use with caution in patients with suspected acute myocardial infarction
(AMI) and glaucoma patients and those with Second and Third Degree AV Blocks.
Interactions: Other anticholinergics or sympathomimetics may cause an additive effect
Routes of Administration: IV, IO, ET (IM in poisonings)
Onset & Duration of actions: 2 - 5 minutes; 20 minutes
Dosages:
Adult: 0.5 - 1.0 mg ; max 0.03 - 0.04 mg/kg, 2mg (repeat PRN) for
poisonings (No Max in poisonings) (Double ET dose)
Pediatric: 0.02 mg/kg; min 0.1 mg; max single 0.5 - 1.0 mg, 0.05mg/kg
(repeat PRN) for poisonings
LA County:
Bradycardia: 0.5 - 1 mg IVP; 1-2 mg ET (repeat q 3-5
minutes to max 0.04 mg/kg)
PEA< 60 or Asystole: 1 mg IVP or 2 mg ET (repeat q 3-5
minutes to max 0.04 mg/kg)
Organophosphate Poisoning: 2 mg IV or IM, or 4mg ET
(Repeat q 5 minutes until symptoms subside)
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LA Co Peds: Bradycardia/Asystole/PEA<60: 0.02 mg/kg IVP or
0.04mg/kg ET; minimum single dose 0.1mg, max single
dose 0.5mg. May repeat IVP dose in 3-5 minutes, no repeat
for ET (max total dose 0.04 mg/kg)
Organophosphate/Nerve Agent Poisoning : 0.05 mg/kg
IVP, IM, or 0.1mg/kg ET. May repeat every 5 minutes
until symptoms subside. (minimum single dose 0.1mg,
maximum single dose 2mg)
Note: -Atropine is not recommended in asymptomatic bradycardia. The increase in
myocardial O2 demand may cause/extend an AMI
-Atropine is not recommended in neonates
-If paradoxical bradycardia develops, wait 2 - 3 minutes. Bradycardia often resolves itself
quickly no corrective treatment
Signs & Symptoms of Organophosphate poisoning:
 Tearing of eyes, ataxia, hypotension, wheezing, seizures, confusion,
abdominal cramps, watery nasal discharge, mausea/vomiting, loss of reflexes,
generalized weakness, constricted pupils, bradycardia, diarrhea, extreme
salivation, sweating, & urination.
 Cholinergic Toxidrome: SLUDGE pneumonic (Excessive Salivation,
Lacrimation, Urination, Defication/Diarrhea, GI cramping, Emesis)
Common Cholinergic Nerve Gas Toxins:
 Soman
 Sarin
 Tabun
 VX
Common Organophosphate Containing Pesticides/Insecticides
 See table on next page
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Organophosphate Pesticides: Common Names and Common Trade
Names
Active Ingredient
Trade Names
Acephate
Azinphos-methyl
Bensulide
Chlorethoxyphos
Chlorpyrifos
Coumaphos
Diazinon
Dichlorvos
Dicrotophos
Dimethoate
Disulfoton
Ethion
Ethoprop
Ethyl-parathion
Fenamiphos
Fenitrothion
Fenthion
Fonofos
Isofenphos
Malathion
Methamidophos
Methidathion
Methyl parathion
Naled
Oxydemeton-methyl
Phorate
Phosmet
Phostebupirim
Pirmimphos-methyl
Profenofos
Propetamphos
Sulfotepp
Sulprofos
Tebupirimiphos
Temephos
Terbufos
Tetrachlorvinphos
Tribufos
Trichlorfon
Orthene, Payload
Guthion, Sniper
Betasan, Prefar
Fortress
Lorsban
Co-Ral
D-Z-N
DDVP, Vapona
Bidrin
Cygon
Di-syston
Ethion, Tomahawk
Mocap
Orthophos, Phoskil
Nemacur
Sumithion, Rothion
Baytex, Tiguvon
Dyfonate
Oftanol, Lighter
Cythion
Monitor
Supracide
Penncap M
Dibrom, Legion
Metasystox R
Thimet
Imidan
former common name for tebupirimiphos
Silosan
Curacron
Safrotin
Bladafum
Bolstar
Aztec
Abate
Counter
Rabon, Gardona
DEF6, Folex
Dylox
bretylium
(Bretylol)
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Classification:
Antidysrhythmic (Class III – Potassium Channel Blocker)
Mechanism of action: Increases fibrillation threshold
Suppresses re-entry of dysrhythmias by prolonging the depolarization period and the
refractory period (“Chemical defibrillation”)
Indications: Refractory ventricular tachycardia and fibrillation
Contraindications: None in life threatening emergencies
Side Effects: Bradycardia, hypotension, chest pain, nausea and vomiting, syncope,
tachycardia, hypertension, dizziness, weakness, anxiety, confusion
Precautions: Infuse slowly; severe bradycardia or nausea and vomiting may occur,
postural hypotension
Interactions: Interactions with procainamide or other anti-dysrhythmics may cause
severe hypotension. When used with catecholamines, dose should be reduced.
Routes of Administration: IVP
Onset & Duration of actions:
Dosages:
mg/kg
5 minutes; 5 - 10 hours
Adult: 5 mg/kg ; repeat with 10 mg/kg every 15-30 min to Max = 30
Infuse at 1 - 2 mg/min
Pediatric: 5mg/kg repeat at 10mg/kg in 15-30 min
LA Co: 5 mg/kg ; repeat every 5 min at 10 mg/kg to Max = 35 mg/kg
LA Co Peds: N/A
Note: Not used as a first-line antidysrhythmic agent.
- Initially causes norepinephrine to be release (adrenergic effect), then after
approximately 20 minutes, norepinephrine is blocked causing anti-adrenergic
effects
- Keep patient supine during administration as postural hypotension is very
common.
- No Longer utilized in ACLS algorithms or LA COUNTY
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bumetanide
(Bumex)
Classification:
potent loop diuretic; antihypertensive
Mechanism of action:
Prevents sodium and chloride reabsorption in the Loop of
Henle; promoting the excretion of water, and electrolytes. Decreases peripheral vascular
resistance (PVR) with slight vasodilation.
Indications: CHF, pulmonary edema, second line medication for hypertension,(non-field
use: ascites, and renal disease)
Contraindications: hypersensitivity, severe dehydration, hypotension, pregnancy
Side Effects: weakness, dizziness, headache, dehydration, electrolyte imbalances,
dysrhythmias, and other EKG changes, hearing loss, chest pain, hypotension,
hyperglycemia
Precautions: diabetics, pregnancy, renal disease, dehydration can occur rapidly.
Should be protected from light.
Interactions: anti-hypertensives and other diuretics (increased dehydration),
aminoglycosides (ototoxicity), NSAID’S will decrease the effects of Bumex
Routes of Administration: IV, IM
Onset & Duration of actions:
Dosages:
onset IV 5min/ IM 40min; duration IV 2-3hrs/ IM
4hrs
Adult: 0.5 -1mg IV over 1-2min (repeat in field setting rare, but if so
would be q 2-3hrs x 3 doses, max within 24hrs 10mg)
Pediatric: N/A
LA County: N/A
Note:
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butorphanol tartrate
(Stadol)
Classification: Synthetic narcotic analgesic, Schedule IV Controlled Substance,
CNS depressant
Mechanism of action: Alters pain perception in CNS (CNS depression)
Binds to opiate receptor sites in CNS to block pain
Indications: Moderate to severe pain
Contraindications: hypersensitivity, head injury
Side Effects: Respiratory depression, respiratory arrest, altered level of consciousness,
severe hypotension, seizures, withdrawal symptoms for those dependent on narcotics,
nausea
Precautions: Watch for respiratory depression (naloxone should be available)
Patients who are dependent on narcotics or who have renal impairment
Interactions: Use with caution with patients taking other analgesics, depressants or
narcotics
Routes of Administration: IV or IM (nasal – research)
Onset & Duration of actions: 1 min (IV) 10 - 30 min (IM);2 – 4 hours
Dosages:
Adult: 1 mg (IV) 2 mg (IM)
Pediatric: Not recommended
LA Co: N/A
LA Co Peds: N/A
Note: -Administer butorphanol slow IV or IM push
-Antidote for overdose of butorphanol is Narcan (naloxone)
-Watch for respiratory depression
-Butorphanol is four times as potent as morphine
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calcium chloride
(CaCl2)
Classification: electrolyte, antidote
Mechanism of action: Increases inotropy and automaticity (ventricular)
Restores myocardial conduction in presence of hyperkalemia
Actively competes with potassium ions at cardiac and neuromuscular receptors
Indications: Cardiac arrest with suspected hypocalcemia or hyperkalemia
Known calcium channel blocker overdose
Crush Syndrome (suspected hyperkalemia or crush force greater than 4 hours)
Magnesium Overdose – hypermagnesemia
Black widow and scorpion bites/stings
Contraindications: hypercalcemia, digitalis toxicity, ventricular fibrillation, cardiac
arrest of other etiologies
Side Effects: bradycardia, hypotension, syncope, headache, nausea, vomiting, dizziness,
acidosis
Precautions: Patients with renal insufficiency or heart disease, pregnancy (C)
Interactions: Avoid mixing with Sodium Bicarbonate. Use with digoxin can increase
cardiac irritability.
Routes of Administration: Slow IV push
Onset & Duration of actions:
Dosages:
Immediate ; 30 minutes - 2 hours
Adult: 2 - 4 mg/kg repeat in 10 minutes as needed for prophylaxis prior to
calcium channel blocker administration
8-16 mg/kg repeat in 10 minutes as needed for hyperkalemia and
calcium channel blocker overdose
Pediatric: 5-20 mg/kg repeat in 10 minutes as needed
LA Co: 1g (1000mg) slow IVP over 1 min. Repeat in 10 min prn
May not repeat in crush injury
LA Co Peds: 20 mg/kg slow IVP over 1 min; (max of 500mg – single
dose). Repeat in 10 min prn
May not repeat in crush injury
Note: -Slow IV push (Over 1minute)
- Flush IV line before and after to avoid precipitation (precipitates with Sodium
Bicarbonate)
- Verify IV patency prior to infusion, will cause tissue necrosis with
extravasation.
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Hyperkalemia is common in dialysis patients due to potassium retention and can occur
with anoverdose of potassium supplements or crush injury.
Signs of hyperkalemia:
 Peaked “T” waves on ECG
 Possibly absent “P” waves
 Widened QRS complexes
Common Calcium Channel Blockers:
 amlodipine (Norvasc)
 bepridil (Vascor)
 diltiazem (Cardizem)
 felodipine (Plendil)
 isradipine (DynaCirc)
 nicardipine (Cardene)
 nifedipine (Procardia, Adalat)
 nimodipine (Nimotrop)
 nisodipine (Sular)
 verapamil (Calan, Isoptin)
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calcium gluconate
(Kalcinate)
Classification: Electrolyte, antidote
Mechanism of action: Increases inotropy
Restores myocardial conduction in presence of hyperkalemia
Actively competes with potassium ions at cardiac and neuromuscular receptors
Indications: hypocalcemia, hyperkalemia, calcium channel blocker overdose, insect bites
(black widow), antidote for magnesium sulfate overdose, hydrofluric acid burns (topical)
Contraindications: hypercalcemia, digitalis toxicity, ventricular fibrillation
Side Effects: bradycardia, hypotension, syncope, headache, nausea, vomiting, tissue
necrosis
Precautions: Patients with renal insufficiency or heart disease
Interactions: Avoid mixing with sodium bicarbonate
Routes of Administration: Slow IV push / topical (for hydrofluoric acid burns)
Onset & Duration of actions:
Dosages:
Immediate; 30 minutes - 2 hours
Adult: 5-8 mL of 10% solution. Repeat PRN every 10 minutes or
15-30 mL (7-14 mEq) repeat in 1-2 minutes
Pediatric: N/A
LA Co: N/A
Note: -Slow IV push. Over 1 minute
- Flush IV line before and after to avoid precipitation (precipitates with Sodium
Bicarbonate)
- Verify IV patency prior to infusion, will cause tissue necrosis with extravasation.
Signs of hyperkalemia:
 Peaked “T” waves on ECG
 Possibly absent “P” waves
 Widened QRS complexes
Common Calcium Channel Blockers:
 amlodipine (Norvasc)
 bepridil (Vascor)
 diltiazem (Cardizem)
 felodipine (Plendil)
 isradipine (DynaCirc)
nifedipine (Procardia, Adalat)
nimodipine (Nimotrop)
nisodipine (Sular)
verapamil (Calan, Isoptin)
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
nicardipine (Cardene)
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chlorpromazine
(Thorazine, Largactil)
Classification:
major tranquilizer, phenothiazine, CNS depressant, antiemteic,
sedative
Mechanism of Action: blocks dopamine receptors in the brain associated with mood and
behavior, suppresses vomit centers in the CNS.
Indications: Acute psychotic episodes, mild alcohol withdrawal, hiccoughs, nausea &
vomiting
Contraindications: should not be used with other sedatives or with patients in
comatose states, or those who have taken hallucinogens or phencyclidine-like compounds
Side Effects: mental & physical impairment, extrapyramidal symptoms, insomnia,
restlessness, sedation, seizures, respiratory depression, dry mouth constipation, increased
salivation, hypotension, drowsiness, and tachycardia
Precautions: dystonic reactions or extrapyramidal symptoms (especially in children),
orthostatic hypotension, pregnancy (C)
Interactions: may potentiate anti-hypertensives
Routes of Administration: IM or IV
Onset & Duration of Action:
Dosages:
onset 30-60min, duration 2-6 hours
Adult: 25-50mg IM
Pediatric: 0.5mg/kg IM or IV
LA County: N/A
Notes: Dystonic reactions: typically caused by phenothiazine use. Characterized by:
 Nuchal rigidity
 Muscle spasms of the face, tongue, neck, jaw, and/or back
 Thickening and protrusion of tongue
 Fixed upward gaze, facial grimaces, difficulty swallowing and/or talking
 Hyperextension of neck and truck and arching of back
Counteracted by use of diphenhydramine (Benadryl).
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dexamethasone
(Decadron)
Classification:
Corticosteroid
Anti-inflammatory
Mechanism of action: Decreases inflammation, by suppressing the immune systems
response; binds with intracellular corticosteroid receptors
Indications: cerebral edema, spinal cord injury, anaphylaxis & status asthmatics
Contraindications: none in field setting for single dose except hypersensitivity
Side Effects: hypertension, headache, nausea, vomiting, hyperglycemia
Precautions: CHF, hypertension, seizures
Interactions: Barbiturates decrease the actions of dexamethasone
Routes of Administration: IV
Onset & Duration of actions:
Dosages:
Immediate; 2 - 4 hours
Adult: 4 - 24 mg
Pediatric: 0.2 - 0.5 mg/kg
LA Co: N/A
LA Co Peds: N/A
Notes:
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dextrose
(D50W, D25W, D10W)
Classification:
Carbohydrate
Hyperglycemic Agent
Mechanism of action: Increases blood glucose levels to provide immediate source of
glucose that can be rapidly used for cellular metabolism.
Indications: hypoglycemia, altered level of consciousness of unknown origin
Contraindications: none in emergency setting with presence of hypoglycemia
Side Effects: venous irritation
Precautions: May cause tissue necrosis
Use with caution with patients of suspected hemorrhagic stroke
Consider thiamine before administering dextrose
Interactions: None
Routes of Administration: Slow IV push
Onset & Duration of actions: 30 - 60 seconds; Depends on severity of hypoglycemia
Dosages:
Adult: 25 g
Pediatric: 0.5 - 1 g/kg (Dextrose 25%)
LA Co: 25 g (50 mL), may repeat one time
LA Co Peds: 0-2 years: 2 ml/kg (Dextrose 25%) (0.5g/kg) slow IVP @
10mL/min (may repeat one time)
> 2 years: 1 ml/kg (Dextrose 50%) (0.5g/kg) slow IVP @
10mL/min (may repeat one time)
Note: -Obtain a blood glucose level, whenever possible before administration
-Aspirate every 10 ml to assure venous patency
-Flush line before and after with normal saline
-Utilize D10W or D12W for neonates
-Utilize largest vein possible for IV administration to decrease chance of extravisation
and venous irritation.
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diazepam
(Valium)
Classification: benzodiazepine, anticonvulsant, sedative/hypnotic/amnestic,
skeletal muscle relaxant, CNS depressant
Mechanism of action: Suppresses seizure activity, relaxes skeletal muscles, induces
amnesia by depressing the CNS
Indications: seizures, status epilepticus, pre medication for pacing, cardioversion, rapid
sequence intubation (RSI), prevent/suppress seizures cause by organophosphate nerve
agents, acute anxiety
Contraindications: Hypersensitivity, shock/hypotension, head injury, patients on
sedatives or alcohol (intoxication)
Side Effects: respiratory depression, apnea, hypotension, tachycardia, altered level of
consciousness, bradycardia, slurred speech, withdrawal, drowsiness, confusion, blurred
vision, weakness, dizziness
Precautions: May cause venous irritation; Avoid administering with other drugs due to
potential of precipitation. Be prepared to support the patient’s airway due to the potential
for severe respiratory depression.
Interactions: Narcotics, barbiturates, alcohol, antidepressants, D5W
Routes of Administration: IV, IM, PR
Onset & Duration of actions:
Dosages:
1 - 5 min; 2 - 3 hours
Adult:
5-10 mg IVP (seizures), 2-5 mg IV or IM (anxiety),
5-15 mg IV (premedication prior to cardioversion),
0.02mg/kg IV (sedation prior to paralytics)
Pediatric:
(IV) 0.1-0.2 mg/kg; max 5 - 15 mg
(PR) 0.5 mg/kg every 10 - 15 min. Max 3 doses
LA Co:
5 - 10 mg slow IV push; titrate to effect and repeat to max
total dose of 20 mg IV;
(IM 10 mg Auto injector if seizure or 3rd Mark I
administered)
Slow IVP (5mg/min) titrate to sedation or seizure activity
LA Co Peds: (IV) 0.2 mg/kg at 1 mg/min repeat to max prn; (max total
dose - 10 mg)
Slow IVP (5mg/min) titrate to sedation or seizure activity
(PR) 0.5 mg/kg; may repeat 0.25mg/kg in 15 min
Not to exceed 0.75 mg/kg or 10 mg
(IM) 0.2mg/kg IM one time for severe organophosphate/
nerve agent poisoning (Max dose – 10 mg IM)
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Note: -Administer slow IVP at a rate of 5 mg/min (adults) and 1 mg/min (peds)
-Use Flumazenil to reverse effects of Valium
-Flush IV before and after and utilize proximal IV site
-May be given for focal seizures with altered level of consciousness
-In LA County, do not use auto injector for pediatric patients
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diazoxide
(Hyperstat)
Classification:
antihypertensive, vasodilator
Mechanism of Action:
causes a decrease in both systolic & diastolic pressure by
causing vasodilation of the peripheral arterioles (perhaps due to direct competition for
calcium receptor sites).
Indications: severe hypertension or hypertensive crisis
Contraindications: hypersensitivity to drug or thiazides, hypotension, hyperglycemia
Side Effects: headache, dizziness, altered mental status, tachycardia, arrhythmias, chest
pain, CHF, edema, hyperglycemia, nausea, & vomiting.
Precautions: Potent vasodilator – hypotension can occur rapidly and dramatically. Use
caution in patients with AMI or ischemic heart disease. Pregnancy (C).
Interactions: can be potentiated by other antihypertensives & can decrease levels of
phenytoin & precipitate seizures.
Routes of Administration: IVP slow
Onset & Duration of Action:
Dosages:
rapid onset (30-60 sec), peak 5 min, duration 2-12
hours.
Adult:
1-3mg/kg over 30 sec (max 150mg) (may be repeated at 515 minute intervals to titrate to effect)
Pediatric:
not recommended
LA County:
N/A
Overdose Treatment: Treat underlying rhythms, fluid bolus for hypotension,
norepinephrine infusion
Notes: decreases insulin release from pancreas & with hypotension, sympathetic
response may intiate further release of glucose from liver.
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digoxin
(Lanoxin)
Classification: Cardiac glycoside, antidysrhythmic, inotropic agent
Mechanism of action: Increases inotropy, slows AV conduction, increases cardiac
output, decreases chronotropy. Inhibits sodium/potassium ATPase Pump, therefore
increasing intracellular calcium levels.
Indications: atrial fibrillation, atrial flutter, refractory supraventricular tachycardia
(SVT), (patient at home for CHF)
Contraindications: Ventricular-Fibrillation, digitalis toxicity, patient has already taken
normal dose of digoxin, 2nd & 3rd degree heart blocks, hypersensitivity.
Side Effects: headache, confusion; bradycardia, atrioventricular (AV) blocks, and other
dysrhythmias, nausea, vomiting, blurred vision.
Precautions: Acute myocardial infarction, renal failure, sinus node disease.
Interactions: Use with loop diuretics and calcium. May increase risks of dysrhythmias;
Use with beta blockers may decrease actions of digoxin.
Routes of Administration: IV
Onset & Duration of actions: onset: 5-30 min; duration: up to 24 hrs.
Dosages:
Adult: 5-15 mcg/kg IVP or 0.25-0.5 mg IVP
Pediatric: N/A
LA County: N/A
Notes: Digitalis has extremely narrow therapeutic range therefore overdose/toxicity is
common.
Signs of digitalis toxicity include:
-Severe sinus bradycardia, second or third degree heart blocks, ventricular
tachycardia, ventricular fibrillation, blurry or snowy vision or
yellowing/greening of vision.
-Drowsiness, lethargy, fatigue, neuralgia, headache, dizziness, confusion
-Anorexia, nausea, vomiting, abdominal pain, diarrhea
-Palpitations, shortness of breath, syncope
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digoxin immune FAB
(Digibind)
Classification:
Antidote
Mechanism of Action:
Comprised of purified fragments of antibodies specific for
digoxin. Selectively forms a complex with circulating digoxin or digitoxin thereby
preventing the drug from binding with receptor sites and then elimination in urine.
Indications: Digoxin or Digitoxin OD or toxicity (with hyperkalemia, arrhythmias,
CHF, or shock)
Contraindications:
hypersensitivity, renal or cardiac failure
Side Effects: digitalis withdrawal on heart (tachycardia or CHF), hypokalemia
Precautions: Category C for pregnancy and lactation, impaired renal function
Interactions: None known
Routes of Administration: IV
Onset & Duration of Action:
Dosages:
1 minute, 14-20 hours
Adult: 3-5 vials (40 mg each)
Pediatric:
see package insert
LA County:
N/A
Overdose Treatment:
N/A
Notes: Digitalis has extremely narrow therapeutic range therefore overdose/toxicity is
common.
Signs of digitalis toxicity include:
-Severe sinus bradycardia, second or third degree heart blocks, ventricular
tachycardia, ventricular fibrillation, blurry or snowy vision or
yellowing/greening of vision.
-Drowsiness, lethargy, fatigue, neuralgia, headache, dizziness, confusion
-Anorexia, nausea, vomiting, abdominal pain, diarrhea
-Palpitations, shortness of breath, syncope
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diltiazem hydrochloride
(Cardizem)
Classification:
Calcium channel blocker, antidysrhythmic (class IV),
antihypertensive
Mechanism of action:
Inhibits calcium influx across cell membranes, causing
coronary arteries to dilate, smooth muscle relaxation, decreases PVR, slows SA/AV node
conduction.
Indications: Symptomatic Atrial-Fibrillation, Atrial-Flutter, SVT/PSVT
Patient at home – Angina, Prinz-Metal Angina & hypertension
Contraindications: Hypotension with systolic B/P < 90 mm Hg
2nd & 3rd degree heart blocks, sick sinus syndrome, acute myocardial infarction,
hypersensitivity
Side Effects: headache, bradycardia, hypotension, CHF, heart block, nausea and
vomiting, weakness, dizziness
Precautions: CHF, renal disease, pregnancy (C), lactation
Interactions: Do not use concomitantly with Beta blockers.
Routes of Administration: IV
Onset & Duration of actions:
Dosages:
onset:30-60min; duration: 3.5-9 hrs.
Adult: 15-20 mg or 0.25mg/kg (-q x1 in 15 min @ 20-25 mg)
infusion: 5-15 mg/hr
Pediatric: N/A
LA County: N/A
Overdose Treatment: consider calcium chloride and fluid challenge, glucagon to
increase inotropy
Note:
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dimenhydrinate
(Dramamine, Gravol)
Classification:
Antihistamine, antiemetic
Mechanism of Action: depresses sensitivity of labyrinth apparatus, blocks synapse at the
vomit center
Indications: Nausea & vomiting
Motion sickness
Potentiation of effects of analgesics
Contraindications: Comatose states, patients under the influence of a large amount of
depressants including alcohol, hypersensitivity or hypersensitivity to other antihistamines
Side Effects: mental & physical impairment, drowsiness, headaches, seizures,
hypotension, blurred vision
Precautions: use with caution in patients with seizure disorders, asthma
Interactions: significant CNS depression may occur with use with barbiturates,
narcotics, alcohol, or tranquilizers.
Routes of Administration: IV, IM, PO
Onset & Duration of Action:
Dosages:
Adult: 12.5-100mg slow IV
50-100 mg IM or PO
Pediatric: 12.5 – 50 mg IV or IM
LA County: N/A
Notes:
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diphenhydramine
(Benadryl)
Classification: Antihistamine
Mechanism of action: Competes with histamines at receptor sites, reverses dystonic
reactions
Indications: Anaphalaxis secondary to Epinephrine
Mild - Moderate allergic reactions
Dystonic reactions
Contraindications: Glaucoma, asthma or COPD attacks, Late stage pregnancy or
lactating mother
Side Effects: Hypotension, tachycardia, palpitations, wheezing, mucous plugs,
drowsiness, nausea, vomiting, dry mouth, headache, dizziness, confusion, seizures,
dilated pupils
Precautions: Patients with heart disease and hypertension. May precipitate an acute
asthma attack due to thickening of mucosal secretions. May increase intra-occular
pressure (glaucoma)
Interactions: Use with caution on patients on alcohol, sedatives, or tranquilizers
Routes of Administration: IV or IM
Onset & Duration of actions:
Dosages:
(IV) 1 - 5 min.(IM) 10 - 15 min; 3 - 4 hours
Adult: 25 - 50 mg ; slow IVP (25 mg/min)
Pediatric: 1 -2 mg/kg; slow IVP (IM not recommended)
LA Co: 50-100 mg; slow IVP (25 mg/min) or Deep IM
LA Co Peds: 1 mg/kg IVP; over several minutes
(IM not recommended)
Note: -Monitor patients for seizures and hypotension
- Use caution when administering to elderly patients
- Signs of dystonic reaction include:
 Nuchal rigidity
 Muscle spasms of the face, tongue, neck, jaw, and/or back
 Thickening and protrusion of tongue
 Fixed upward gaze, facial grimaces, difficulty swallowing and/or talking
 Hyperextension of neck and truck and arching of back
Common Phenothiazines:
 chlorpromazine (Thorazine)
prochlorperazine (Compazine)
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



thioridazine (Mellaril)
mesoridazine (Serentil)
fluphenazine (Permitil, Prolixin)
perphenazine (Trilafon)
trifluoperazine (Stelazine)
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dobutamine
(Dobutrex)
Classification:
sympathomimetic, sympathetic agonist, inotropic agent
Mechanism of Action:
Acts directly on Alpha & Beta receptors of the SNS.
Primarily B1 specific. Effects include:

Increased HR (chronotropy)

Increased Cardiac Contractile Force (inotropy) (Most desired effect)

Increased electrical activity with in myocardium (dromotropy)

Increased Automaticity
Indications: Congestive Heart Failure with mild hypotension (70-100mm Hg systolic)
Contraindications: hypovolemic shock without prior fluid resuscitation
Side Effects: palpitations, anxiety, tremulousness, headache, dizziness, chest pain,
dyspnea, nausea, and vomiting. Will increase myocardial oxygen demand and potential
increase myocardial ischemia
Precautions: Can worsen tachydysrhythmias, increase myocardial oxygen demand,
extend myocardial infarction, terminate use if HR increases by greater than 10%, have
lidocaine available for PVCs. Pregnancy, Lactation, children
Interactions: pH dependant and can be inactivated by alkaline solutions such as sodium
bicarbonate, can be intensified in patients taking anti-depressants, may also cause
hypertension in pts taking tricyclic antidepressants
Routes of Administration: IVPB
Onset & Duration of Action:
onset 90 sec, 3-5min duration
Dosages:
Mix 800mg in 500cc NS or D5W (1,600mcg/ml)
1-20mcg/kg/min – inotropic effects
Adult: IV Infusion:
Pediatric: IV Infusion:
LA County:
1-20mcg/kg/min – inotropic effects
N/A
Notes:
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dopamine
(Intropin)
Classification:
sympathomimetic, sympathetic agonist, catecholamine,
antidysrhythmic, vasopressor, inotropic agent
Mechanism of Action:
Acts directly on Alpha & Beta receptors of the SNS. Alpha
effects more profound than Beta effects. Effects include:

Increased HR (chronotropy)

Increased Cardiac Contractile Force (inotropy)

Increased electrical activity with in myocardium (dromotropy)

Increased Systemic Vascular Resistence

Increased Blood Pressure

Increased Automaticity

Increased renal, mesenteric, and coronary artery vasodilation (in low doses)
Indications: Hemodynamically significant hypotension
Cardiogenic shock (CHF)
Distributive shock (Anaphylaxis, Septic)
Symptomatic Bradycardia (2nd line)
Contraindications: hypovolemic shock without prior fluid resuscitation,
pheochromocytoma (tumor of adrenal gland), tachydysrhythmias
Side Effects: tachycardia, ventricular irritabiliy, hypertension, hypotension,
vasoconstriction, palpitations, anxiety, tremulousness, headache, dizziness, chest pain,
dyspnea, nausea, and vomiting. Will increase myocardial oxygen demand and potential
increase myocardial ischemia
Precautions: Can worsen tachydysrhythmias, increase myocardial oxygen demand,
extend myocardial infarction. Use large vein for administration, causes tissue necrosis if
infused into interstitial space.
Interactions: pH dependant and can be inactivated by alkaline solutions such as sodium
bicarbonate, can be intensified in patients taking anti-depressants, may also cause
hypotension in pts taking phenytoin (Dilantin)
Routes of Administration: IVPB
Onset & Duration of Action:
onset 90 sec, 3-5min duration
Dosages:
Mix 800mg in 500cc NS or D5W (1,600mcg/ml)
0.5 –2 mcg/kg/min – renal/mesenteric dose
(dopamergic effects)
5-10mcg/kg/min – inotropic effects (beta 1 effects)
10-20mcg/kg/min – vasopressor (alpha 1 effects)
Adult: IV Infusion:
Pediatric: IV Infusion:
Mix 800mg in 500cc NS or D5W
(1,600mcg/ml)
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1-5mcg/kg/min – renal/mesenteric (dopaminergic)
5-10mcg/kg/min – inotropic effects (beta 1)
10-20mcg/kg/min – vasopressor dose (alpha 1)
LA County:
1-2mcg/kg/min – renal/mesenteric dose
2-10mcg/kg/min – inotropic effects
10-20mcg/kg/min – vasopressor dose
Adult: Concentration equal to 200mg/250ml NS IVPB.
Start at 30mcgtts/minute. Titrate to B/P of 90-100 systolic
and signs of adequate perfusion or maximum of
120mcgtts/min.
Pediatric: Concentration equal to 6mg/kg/100ml NS
IVPB. Start at 10mcgtts/min. Titrate to signs of adequate
perfusion or maximum of 20mcgtts/min.
Notes:
-
Use largest vein possible to decrease chance for tissue necrosis.
Do not administer sodium bicarbonate in same IV line as sodium bicarbonate
inactives catecholamines.
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droperidol
(Inapsine)
Classification:
Anti-emetic, anti-psychotic, sedative, tranquilizer, CNS depressant
Mechanism of action:
Blocks subcortical receptors in the CNS,
Causing CNS depression and also works to suppress vomiting at trigger sites.
Indications: To suppress vomiting, can be used in rapid sequence intubation (RSI),
acute anxiety or psychosis
Contraindications: hypersensitivity, <2 y/o, pregnancy (C)
Side Effects: Hypotension, respiratory depression, extrapyramidal reaction, drowsiness,
dizziness, restlessness, anxiety, tachycardia, bronchospasm
Precautions: Pregnancy (c), other CNS depressants, hypotension, hepatic, renal disease.
Interactions: CNS depressants such as opiates
Routes of Administration: IM/IV
Onset & Duration of actions:
Dosages:
onset 3-10min; duration 3-6hrs
Adult: 2.5-10mg, q 10-15min one time
Pediatric: 0.05-0.1mg/kg
LA County: N/A
Notes:
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edrophonium
(Tensilon)
Classification:
antidysrhythmic/cholinesterase inhibitor
Mechanism of Action:
inhibits the actions of the enzyme acetylcholinesterase
(similar to physostigmine). The inhibition of acetylcholinesterase serves to enhance
acetylcholine secreted by the vagus nerve on the heart.
Indications: PSVT refractory to vagal maneuver and adenosine
Myasthenia gravis in the non-emergent setting
Contraindications: hypersensitivity to drug, hypotension, bradycardia
Side Effects: dizziness, weakness, sweating, increased salivation, constricted pupils,
hypotension, bradycardia, abdominal cramps, nausea, & vomiting.
Precautions: continuously monitor the patient for bradycardia, use with caution in the
elderly
Interactions: crystalizes with use in dextrose solutions, bradycardia more common
when given in presence of digoxin
Routes of Administration: IV
Onset & Duration of Action:
Dosages:
rapid onset (30-60 sec), peak 5 min, duration 2-12
hours.
Adult: 5mg , second dose after 10min (10mg)
Pediatric:
not recommended
LA County:
N/A
Notes:
- may initiate cholinergic type toxidrome/syndrome (SLUDGE symptomotology)
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epinephrine
(Adrenalin)
Classification:
sympathomimetic, sympathetic agonist, catecholamine,
antidysrythmic, inotropic agent, vasopressor, bronchodilator
Mechanism of Action:
Acts directly on Alpha & Beta receptors of the SNS. Beta
effect is more profound than Alpha effects. Effects include:

Increased HR (chronotropy)

Increased Cardiac Contractile Force (inotropy)

Increased electrical activity with in myocardium (dromotropy)

Increased Systemic Vascular Resistence / decreases vascular permeability

Increased Blood Pressure

Increased Automaticity

Increased Bronchial Smooth Muscle Dilation
Indications: Cardiac Arrest (asystole, PEA, V-Fib, Pulseless V-Tach)
Severe Anaphylaxis, Allergic Reaction
Severe Reactive Airway Disease (asthma, COPD)
Symptomatic Bradycardia
Contraindications: hypertension, tachydysrhythmias, pregnancy, underlying
cardiovascular disease, hypovolemia
Side Effects: palpitations, anxiety, tremulousness, headache, dizziness, nausea, and
vomiting. Will increase myocardial oxygen demand and potential increase myocardial
ischemia. Chest pain, tachycardia, hypertension, ventricular fibrillation, seizures
Precautions: Protect from light, deactivated by alkaline solutions, use care with patients
who are pregnant or history of cardiovascular disease
Interactions: pH dependant and can be inactivated by alkaline solutions such as sodium
bicarbonate, can be intensified in patients taking anti-depressants
Routes of Administration: IV, SQ, ET, IO
Onset & Duration of Action:
onset 90 sec, 3-5min duration
Dosages:
Asystole/PEA/V-Fib/V-tach: 1mg q3-5 min IV
(Double ET dose)
Anaphylaxis: 0.1 – 0.5 mg slow IV
Asthma/Anaphylaxis: 0.3-0.5mg SQ
1mg in 500cc of D5W or NS
Symptomatic Bradycardia: 2-10 mcg/min
Adult: 1:10,000
1:1,000
IV Infusion:
Pediatric:
1:10,000
Asystole/PEA/V-Fib/V-tach: 0.01mg/kg IV/IO (1st round)
Symptomatic Bradycardia: 0.01mg/kg IV/IO (0.1mg/kg ET dose)
1:1,000
Asystole/PEA/V-Fib/V-tach: 0.1mg/kg IV/IO
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(subsequent rounds) (0.1mg/kg ET dose)
Asthma/Anaphylaxis: 0.01mg/kg (up to 0.3mg) (SQ)
IV Infusion – 1mg in 500ml of NS or D5W
0.1-1.0mcg/kg/min
LA County:
Adult Cardiac Arrest: IVP: (1:10,000) 1mg (q3-5min or
0.1mg/kg (high dose))
ET: (1:1000) 2 mg diluted in 10cc NS (q 35 min)
Adult Asthma / Allergic Reaction without Shock:
SQ (1:1000) 0.3mg (q 20 min x2)
Anaphylaxis with shock:
IVP (1:10,000) 0.1mg over 60
seconds (q 3-5 min)
-orSQ (1:1000) 0.3mg (q 20 min x2)
Peds Cardiac Arrest: IVP (1:10,000) 0.01mg/kg – 1st dose
(0.2mg/kg IVP q 3-5 min – subsequent
doses)
-orET (1:1000) 0.1mg/kg diluted in 2cc NS (q
3-5 min)
Peds Symptomatic Bradycardia:
IVP(1:10,000) 0.01mg/kg – 1st dose
(1:1,000) 0.1mg/kg q 3-5 min (Neonates
only)
Peds Asthma/Allergic Reaction:
SQ (1:1000) 0.01mg/kg (max
dose 0.3mg) repeat q 20 min
x2
Peds Anaphylaxis with Shock:
IVP (1:10,000) 0.01mg/kg –
1st dose over 60 seconds
(Max 0.1mg) q 3-5 min
SQ (1:1,000) 0.01mg/kg (max
0.1mg) (repeat q 20 min x2)
Notes:
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esmolol
(Brevibloc)
Classification:
Beta-adrenergic blocker, anti-dysrhythmic
Mechanism of Action:
Selectively blocks Beta 1 receptors (dose specific & will
block Beta 2 receptors in high doses). Negative inotrope, chronotrope, & dromotrope.
Suppresses renin production because of relative vasoconstriction.
Indications: SVT
Contraindications: sinus bradycardia, AV conduction Blocks, CHF, cardiogenic
shock, bronchial asthma
Side Effects: dizziness, lightheadedness, syncope, fatigue, bradycardia, hypotension,
CHF, nausea, vomiting, decreased sexual ability, complete heart block, cardiac arrest
Precautions: Pregnancy (Class C), asthmatics, COPD
Interactions: Increases lidocaine toxicity, synergistic with verapamil, morphine increase
levels of esmolol
Routes of Administration: IVP slow, IVPB
Onset & Duration of Action:
Dosages:
rapid onset (30-60 sec), peak 5 min, duration 10-30
minutes
Adult:
500mcg/kg/min (loading dose),
50-200mcg/kg/min (infusion)
Pediatric:
N/A
LA County:
N/A
Overdose Treatment:
hypotension
Treat underlying rhythms, fluid bolus for
Notes:
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etomidate
(Amidate)
Classification: Anesthetic, sedative/hypnotic, non-barbiturate, CNS depressant
Mechanism of action: Short acting non-barbiturate hypnotic. Produces analgesia and
amnesia
Indications: General anesthesia
Premedication for RSI
Supplements low potency anesthetics (Nitronox)
Contraindications: Immunosuppressed patients
Hypersensitivity to drug
Status asthmaticus
Side Effects: hypoventilation, apnea, dysrhythmias, laryngospasms
Precautions: Use caution with other CNS depressants
Interactions: Verapamil may potentiate the anesthetic and respiratory depressant effects
Diuretics, calcium channel blockers, antihypertensive medications may increase
hypotension
Routes of Administration: IV
Onset & Duration of actions: Immediate; 3 - 5 minutes
Dosages:
Adult: 0.02 - 0.06 mg/kg over 1 minute
Pediatric: 0.1 mg/kg
LA Co: N/A
LA Co Peds: N/A
Note: -Watch for respiratory depression, ventilate as needed
-Monitor blood pressure for hypotension
-Etomidate can suppress the adrenal gland’s production of steroid hormones
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fentanyl
(Sublimaze)
Classification:
narcotic analgesic, opiate agonist, CNS depressant
Mechanism of action:
increases pain threshold.
Alters pain perception by binding to opiate receptors;
Indications: pain management, rapid sequence intubation (RSI)
Contraindications: hypersensitivity, myasthenia gravis, head injury.
Side Effects: Bradycardia, hypotension, blurred vision, respiratory depression,
laryngospasms, weakness, dizziness, nausea, vomiting, altered level of consciousness.
Precautions: Increases ICP, seizure disorders, cardiac dysrhythmias, pregnancy (C).
Interactions: Effects increased with other CNS depressants.
Routes of Administration: IV, IM
Onset & Duration of actions: onset:7-8 min. duration: 1-2 hrs.
Dosages:
Adult: 3-5 mcg/kg or (25-100 mcg) slow IVP
Pediatric: 1.7-3.3 mcg/kg
LA County: N/A
Overdose Treatment: support ventilations and consider naloxone to reverse repiratory
depression
Note:
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flumazenil
(Romazicon)
Classification:
Benzodiazepine antagonist/antidote
Mechanism of action:
Antagonizes the actions of benzodiazepines on the CNS,
inhibits activity @ benzodiazepine receptors.
Indications: Benzodiazepine OD/toxicity. Can use to reverse sedative actions of
benzodiazepines.
Contraindications: Patient that has been given a benzodiazepine to control a condition
such as status epilepticus, patient with history or signs and symptoms of tricyclic
antidepressant overdose. Hypersensitivity.
Side Effects: Vertigo, nausea, vomiting, hypertension, palpitations, dysrhythmias,
seizures, flushing from cutaneous vasodilation, blurred vision.
Precautions: pregnancy (C), very young/old, renal disease, head injury, history of
seizures, panic disorder, hyperventilation.
Interactions: Be cautious in possible cases of poly-drug overdose.
Routes of Administration: IV
Onset & Duration of actions: onset: Unknown duration: short half-life
Dosages:
Adult: 0.2mg (over 1 min) 0.3mg (over 1 min) 0.5mg over 1 min then
0.5mg every 1 min prn (max 3mg)
Pediatric: 10mcg/kg (max 1 mg)
LA County: N/A
Note: This drug has a short ½ life, so repeated doses will most likely be needed. Also
be ready to treat for seizures when administering this drug especially when there is a
history.
Common benzodiazepines:
 alprazolam (Xanax)
 clonazepam (Klonopin)
 diazepam (Valium)
 estazolam (ProSom)
 flurazepam (Dalmane)
 halazepam (Paxipam)
 ketazolam (Loftram)
 lorazepam (Ativan)
 midazolam (Versed)
 nitrazepam (Mogadon)
chlordiazepoxide (Librium, Libritab)
clorazepate (Tranxene)
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




oxazepam (Serax)
prazepam (Centrax)
quazepam (Doral)
temazepam (Restoril)
triazolam (Halcion)
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furosemide
(Lasix)
Classification:
diuretic
Mechanism of action: Inhibits reabsorption of sodium and chloride in Loop of Henle
therefore increasing urinary output, causes venous pooling due to vasodilation, decreases
workload on heart
Indications: CHF, Pulmonary edema
Contraindications: hypersensitivity, dehydration, hypovolemia, pregnancy, renal failure
Side Effects: Hearing loss, tinnitus, nausea, vomiting, postural hypotension, tachycardia,
ventricular -fibrillation, dehydration, circulatory collapse, confusion, headache, syncope,
blurred vision
Precautions: Patients with renal dysfunction, protect drug from light (inactivated in
direct sunlight)
Interactions: Increased risk of dysrhythmias if patient is taking digitalis or lithium
Routes of Administration: IV
Onset & Duration of actions:
Dosages:
5 - 20 minutes; 2- 3 hours
Adult: 0.5 - 1 mg/kg; slow IVP (20 mg/min) or 40-80 mg
Pediatric: 1 - 2 mg/kg slow IVP
LA Co: 40 - 80 mg slow IVP (10-20 mg/min)
LA Co Peds: Not recommended
Note: -Assess lung sounds before and after
-Administer drug SLOWLY to prevent hearing loss or tinnitus (10-20mg/min)
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glucagon
(GlucaGen)
Classification:
antihypoglycemic agent, gastrointestinal agent, hormone and
hormone modifier, hyperglycemic agent, antidote
Mechanism of Action:
A protein secreted by the alpha cells of the pancreas, which
causes breakdown of stored glycogen to glucose, therefore increasing blood glucose
levels. Also causes relaxation of the smooth muscles of the GI tract, positive inotropic
and chronotropic effects on the myocardium, and decreasing renal vascular resistance.
Indications: Hypoglycemia (altered level of consciousness with suspected
hypoglycemia – no IV line), GI obstruction, beta blocker and calcium
channel blocker overdose
Contraindications: adrenal insufficiency, hypersensitivity, lactation, insulinoma,
malnutrition, pheochromocytoma.
Precautions: administration effective only when there are sufficient stores of glycogen
in the liver, may be ineffective in chronic hypoglycemia, starvation, or renal
insufficiency. Patients with coronary artery disease or heart disease may increase risk of
AMI.
Interactions: Beta blockers, phenytoin, warfarin
Side effects: tachycardia, hypertension, anaphylaxis, angina, dizziness, hypotension,
nausea, vomiting, urticaria,
Routes of Administration: IM, SQ, IV
Onset & Duration of Action: 5-10 min, 1-2 hours
Dosages:
Adult: 1-5mg IV or IM may repeat every 5-20 minutes
Beta blocker OD:
2-3 mg then 5mg/hr IV infusion or
3-10 mg followed by 2-5 mg/hr infusion
Peds: 0.1-0.3mg/kg to max of 1mg
Beta blocker OD: 2-3 mg then 5mg/hr IV
LA County: 1mg IM (may repeat every 20 minutes two times)
LA Co Peds: 1mg IM if known diabetic. No repeat.
Notes: Mix 1 mg of glucagon powder with dilutent supplied. Precipitate will form if
mixed with chloride solutions.
Common Beta Adrenergic Blockers:
 acebutolol (Sectral)
 atenolol (Tenormin)
 betaxolol (Kerlone)
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











bisoprolol (Zebeta)
carteolol (Cartrol)
carvedilol (Coreg)
esmolol (Brevibloc)
labetalol (Normodyne)
metoprolol (Lopressor)
nadolol (Corgard)
penbutolol (Levatol)
pindolol (Visken)
propanolol (Inderal)
sotalol (Betapace)
timolol (Blocadren)
Common Calcium Channel Blockers:
 amlodipine (Norvasc)
 bepridil (Vascor)
 diltiazem (Cardizem)
 felodipine (Plendil)
 isradipine (DynaCirc)
 nicardipine (Cardene)
 nifedipine (Procardia, Adalat)
 nimodipine (Nimotrop)
 nisodipine (Sular)
 verapamil (Calan, Isoptin)
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glycopyrrolate
(Robinul)
Classification:
parasympatholytic, anticholinergic, antispasmotic
Mechanism of Action:
similar to atropine, inhibits muscarinic actions of
acetylcholine, inhibits GI/GU motility, decreases GI secretions, saliva, perspiration, and
respiratory secretions
Indications: reversal of neuromuscular blockade with physostigmine
drying of secretions associated with bronchial asthma
management of peptic ulcers, spastic colon
Contraindications: glaucoma
prostatic hypertrophy
myasthenia gravis
tachycardia, children <12
Side Effects: urinary retention, constipation, blurred vision, palpitations, tachycardia,
drowsiness, weakness, dizziness, hyperthermia
Precautions:
may precipitate extrapyramidal effects, pregnancy class B
Interactions:
antihistamines, TCAs, procainamide, Levodopa
Routes of Administration: IV, Nebulizer
Onset & Duration of Action:
Dosages:
onset 1min, duration 2-7 hours
Adult: 0.1-0.2 mg (per 2mg of physostigmine)
4-10mcg/kg to control secretions
Pediatric: 0.1-0.2 mg
LA County:
N/A
Notes:
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haloperidol
(Haldol)
Classification:
major tranquilizer, sedative, CNS depressant
Mechanism of Action: Blocks dopamine receptors in the brain associated with mood and
behavior.
Indications: Acute psychotic episodes
Contraindications: should not be used with other sedatives, Talwin administration
Side Effects: mental & physical impairment, extrapyramidal symptoms, insomnia,
restlessness, sedation, seizures, respiratory depression, dry mouth constipation, increased
salivation, hypotension, and tachycardia
Precautions: dystonic reactions or extrapyramidal symptoms (especially in children),
orthostatic hypotension
Interactions: may potentiate anti-hypertensives & should not be used with patients
taking lithium (encephalopathic syndrome)
Routes of Administration: IM
Onset & Duration of Action:
Dosages:
onset 30-45min, duration 2-6 hours
Adult: 2-5mg
Pediatric: PO use only
LA County: N/A
Notes:
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heparin sodium
Classification: Anticoagulant
Mechanism of action: Prevents the formation of blood clots
Prevents the conversion of fibrinogen to fibrin and prothrombin to thrombin by
enhancing inhibitory effects of antithrombin III
Indications: Maintain IV catheter patency and venous access, acute myocardial
infarction (AMI), angina pectoris, deep vein thrombosis, deep emboli
Contraindications: Hypersensitivity, active bleeding, hemophilia and leukemia patients,
renal failure and liver disease
Side Effects: spontaneous bleeding, fever, chills, nausea, vomiting, diarrhea
Precautions: Alcoholics , pregnant patients, elderly, gastrointestinal bleeding
Interactions: Aspirin, Non-Steroidal Anti-inflammatory drugs (NSAIDs), Nitroglycerin
may decrease effectiveness
Routes of Administration: IV, SQ
Onset & Duration of actions: Immediate; 2 - 6 hours
Dosages:
Adult: 5,000 – 100,000 units deep SQ
5,000 units IVP, then 5,000-10,000 units every 4-6 hours
Pediatric: 50 U/kg units deep SQ or IV
LA Co: N/A
LA Co Peds: N/A
Note: -To prevent incompatibility with other medications, flush Heparin lock with 3 - 5
ml of Normal Saline before and after administration
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hydralazine
(Apresoline)
Classification:
antihypertensive, vasodilator
Mechanism of Action:
relaxes vascular smooth muscles, primarily in arterial
system, decreasing arterial pressure and peripheral resistance. (similar to nitroprusside)
Indications: severe hypertension, hypertensive crisis, hypertension complicating
pregnancy (pre-eclampsia)
Contraindications: hypersensitivity to drug, hypotension, coronary artery disease,
rheumatic heart disease involving the mitral valve, dissecting aneurysm.
Side Effects: headache, dizziness, altered mental status, orthostasis, tachycardia,
arrhythmias, chest pain, nausea, & vomiting.
Precautions: Can cause ECG changes and angina pectoris because of increase in
cardiac output, use extreme caution and continuously monitor vital signs. Pregnancy (C).
Interactions: can be potentiated by other antihypertensives
Routes of Administration: IVP slow or IM
Onset & Duration of Action:
hours.
Dosages:
rapid onset (30-60 sec), peak 5 min, duration 2-12
Adult: 20-40 mg, repeat in 4-6 hours
Pediatric:
not recommended
LA County:
N/A
Overdose Treatment:
Treat underlying rhythms, fluid bolus for hypotension
Notes: Hypertensive Crisis is defined as diastolic pressure greater than 120-130 mmHg
with signs and symptoms related to hypertension.
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hydrocortisone
(Solu-Cortef, Cortisol)
Classification: Corticosteroid, Anti-inflammatory
Mechanism of action: Decreases inflammation, by suppressing the immune systems
response; binds with intracellular corticosteroid receptors
Indications: Anaphylaxis, status asthmatics, spinal cord swelling, cerebral edema
Contraindications: None in field setting
Side Effects: hypertension, headache, nausea, vomiting, CHF, weakness, dizziness,
euphoria, reduction in skin elasticity (skin tears), sodium & fluid retention.
Precautions: CHF, seizures, pregnancy (C), immunosuppression
Interactions: Barbiturates decrease the actions of hydrocortisone
Routes of Administration: IV/IM
Onset & Duration of actions: Immediate; 1 - 2 hours
Dosages:
Adult: 40-250mg
Pediatric: 4-8mg/kg
LA Co: N/A
LA Co Peds: N/A
Notes:
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hydromorphone
(Dilaudid)
Classification:
opioid narcotic analgesic, CNS depressant
Mechanism of Action: centrally acting analgesic that binds to the opiate receptor sites in
the CNS.
Indications: Moderate to severe pain
Contraindications: hypersensitivity, head injury, or undiagnosed abdominal pain
Side Effects: headache, altered mental status, hypotension, bradycardia, respiratory
depression, nausea, & vomiting.
Precautions: may cause significant respiratory depression, reduce doses in elderly
patients, use precaution in those with convulsive disorders
Interactions: can potentiate CNS depression associated with narcotics, sedatives,
hypnotics, anti-histamines, & alcohol
Routes of Administration: IV, IM
Onset & Duration of Action:
Dosages:
2-3min onset, 3-6 hour duration
Adult: IV – 1mg followed by 0.5-1mg q 3-5min prn
IM – 2-4mg q 3-4 hours
Pediatric:
not recommended
LA County:
N/A
Overdose Treatment:
naloxone administration & ventilatory support
Notes:
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hydroxyzine
(Vistaril, Atarax)
Classification:
Antihistamine, anti-emetic, anti-anxiety
Mechanism of Action: blocks synapse at the vomit center and causes generalized CNS
depression
Indications: Nausea & Vomiting
Anxiety reactions
Potentiation of effects of analgesics
Contraindications: Comatose states, patients under the influence of a large amount of
depressants including alcohol, hypersensitivity or hypersensitivity to other antihistamines
Side Effects: mental & physical impairment, drowsiness, headaches, seizures,
hypotension, blurred vision
Precautions: urinary retention, orthostatic hypotension, Be careful with narcotic
analgesic use
Interactions: significant CNS depression may occur with use with barbiturates,
narcotics, alcohol, or tranquilizers.
Routes of Administration: IM deep
Onset & Duration of Action:
Dosages:
onset 15-30min, duration, 4-6 hours
Adult: 50-100mg
Pediatric: 1mg/kg
LA County: N/A
Notes:
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ibutilide
(Corvert)
Classification:
Antidysrhythmic
Mechanism of Action:
prolongs cardiac resting potential & increase atrial &
ventricular refractoriness. Class III antiddysrhythmic which slows sodium ion influx into
the cell and does not effect potassium ion influx out of the cell.
Indications: A-fib, A-flutter
Contraindications:
hypersensitivity, hypokalemia, hypomagnesemia
Side Effects: Headache, polymorphic V-tach, torsades de pointes, AV block, budle
branch block, hypotension, bradycardia, tachycardia, palpitations, prolonged QT interval,
nausea.
Precautions: CHF, recent MI, liver disease, prolonged QT interval, lactation, children
Interactions: phenothiazines & TCAs increase dysrhythmia potential, Other
anitidysrhythmics may increase refractory period significantly
Routes of Administration: IV
Onset & Duration of Action:
Dosages:
30 minutes, 2-21 hours
Adult: >60kg – 1mg over 10 minutes, repeat once after 10 minutes
<60kg – 0.01mg/kg over 10 minutes, repeat once after 10 minutes
Pediatric:
not recommended
LA County:
N/A
Overdose Treatment:
Treat underlying symptoms
Notes:
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insulin
(NPH, Humulin, Novolin)
Classification:
hormone, hypoglycemic agent
Mechanism of action: Promotes conversion of glucose to glycogen and lowers blood
glucose levels
Indications: Diabetic ketoacidosis, Patients with severely elevated blood glucose levels
Contraindications: Hypoglycemia
Side Effects: allergic reactions, headaches, hypoglycemia, nausea, vomiting
Precautions: Excess dosing can cause hypoglycemia, pregnancy (class C)
Interactions: Beta-blockers may mask certain signs of hypoglycemia
Routes of Administration: IV (SQ)
Onset & Duration of actions: 30 minutes - 1 hour ; 2 - 3 hours
Dosages:
Adult: 10 - 25 Units
Infuse 0.1 U/kg/hr
Pediatric: 10 - 25 Units
Infuse 0.1 U/kg/hr
LA Co: N/A
LA Co Peds: N/A
Note: -Obtain blood glucose reading before administering insulin
-Administer dextrose or oral glucose (conscious patient) if blood glucose is low
-Recheck every 10 - 15 minutes
-Insulin must be refrigerated if kept for greater than one month.
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ipecac, syrup of
Classification:
emetic syrup, antidote
Mechanism of action: Irritates gastric mucosa & stimulates vomit centers in the brain
stem causing vomiting.
Indications: To induce vomiting in conscious patients with gag reflex, in some cases
when oral poisoning or drug overdose has occurred.
Contraindications: altered level of consciousness, loss of gag reflex, caustic ingestion,
or ingestion of petroleum products (hydrocarbons), seizure activity.
Side Effects: Dysrhythmias, bradycardia, hypotension, convulsions/seizures(rare),
myocarditis, respiratory depression, CNS depression, headache, prolonged vomiting.
Precautions: Pregnancy, patient that may lose consciousness, cardiac disease.
Interactions: Do not use with activated charcoal.
Routes of Administration: PO
Onset & Duration of actions: onset: 15-30 min. duration: 6 hours
Dosages:
Adult: 30ml PO followed by 8+ ounces. of water (repeat x1 in 20 min if
vomiting does not occur.)
Pediatric:
6mos-1yr = 10ml followed by 4 + ounces of water
1-5y/o = 15ml followed by 4 + ounces of water
over 5yrs = 30ml followed by 4 + ounces of water
LA County: N/A
Note:
1) Ipecac is not effective with all patients.
2) Be cautious to use Ipecac on OD patient, because you have no way of knowing what
their level of consciousness will be like (Ipecac can have a 15-30 minute onset).
3) Delays the adminisration of activated charcoal which may be more effective.
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ipratropium
(Atrovent)
Classification: Bronchodilator; parasympatholytic
Mechanism of action: Inhibits acetylcholine @ receptor sites of bronchial smooth
muscle, causing bronchodilation. Decreases repiratory secretions.
Indications: Asthma, bronchospasms associated with COPD.
Contraindications: Patient has been administered atropine, hypersensitivity
Side Effects: headache, nausea, vomiting, weakness, dizziness, palpitations, tachycardia,
hypertension, airway dryness
Precautions: Children < 12 y/o, Narrow-angle glaucoma.
Interactions: Not significant to emergency field use.
Routes of Administration: Nebulized & inhaled.
Onset & Duration of actions: onset: rapid duration: 2 hrs.
Dosages:
Adult: 0.5mg nebulized
Pediatric: N/A
LA County: N/A
Note:
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isoetharine
(Bronkosol)
Classification: beta-2 specific adrenergic bronchodilator, sympathomimetic
Mechanism of action: Stimulates beta 2 receptors; relaxes bronchial smooth muscle,
causing bronchodilation
Indications: Bronchial asthma, and bronchospasms associated with COPD
Contraindications: Hypersensitivity (sulfite agents)
Side Effects: headache, weakness, dizziness, hypertension, chest pain, dysrhythmias,
nausea, vomiting
Precautions: angina, cardiac disease, hypertension, congestive heart failure
Interactions: Concomitant use with other sympathomimetics may cause increased
cardiovascular side effects; beta blockers can decrease the actions of isoetharine
Routes of Administration: Nebulized with oxygen and inhaled
Onset & Duration of actions:
Dosages:
onset immediate; duration 1-4hrs
Adult: 0.5mL of a 1% solution (5 mg)
Pediatric: 0.01-0.03mL/Kg of a 1% solution
LA County: N/A
Note: This drug may come in many different solutions.
Strong odor of “rotten eggs” due to sulfer base.
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isoproterenol
(Isuprel)
Classification: sympathomimetic (beta 1&2), antidysrythmic, bronchodilator
Mechanism of action: Acts on both beta 1&2 adrenergic receptors, increases cardiac
output, also relaxes bronchial smooth muscle; bronchodilation
Indications: Symptomatic bradycardia, refractory to 1st line medications
(not often used in field for bronchoconstriction)
Contraindications: hypersensitivity, tachydysrhythmias, AMI
Side Effects: headache, dysrhythmias, hypertension, nausea, vomiting, palpitations
Precautions: Cardiac history, elderly, pregnancy (C)
Interactions: sympathomimetics, beta-blockers decrease action
Routes of Administration: IVPB
Onset & Duration of actions: onset rapid; duration 10min
Dosages:
Adult: 2-10mcg/min infusion titrate to effect
Pediatric: 0.1mcg/kg/min infusion titrate (max 1mcg/kg/min)
LA County: N/A
Note:
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ketamine
(Ketalar)
Classification: Anesthetic
Non-barbiturate amnestic
Hypnotic/sedative/amnestic
CNS Depressant / Schedule III controlled substance
Mechanism of action: Fast acting CNS agent used to induce anesthesia which does not
cause muscle relaxation
Indications: General anesthesia
Premedication for RSI
Supplements low potency anesthetics (Nitronox)
Contraindications: hypersensitivity to drug, head injury
Side Effects: hypertension, tachycardia, hypotension, respiratory depression, nausea,
vomiting, drowsiness
Precautions: Use caution with other CNS depressants
Interactions: None
Routes of Administration: IV or IM
Onset & Duration of actions: 3 - 4 minutes; 5 - 10 minutes
Dosages:
Adult: 1 - 2 mg/kg (IV) 5 - 10 mg/kg (IM)
Pediatric: Not recommended
LA Co: N/A
LA Co Peds: N/A
Note: -Ketamine produces analgesia and amnesia without loss of respiratory function
-Ketamine will increase secretions of the salivary and bronchial glands
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ketorolac
(Toradol)
Classification:
Non-steriodal anti-inflammatory agent (NSAID), analgesic,
antipyretic
Mechanism of Action:
analgesic, anti-inflammatory, & anti-pyretic effect occurs
by peripheral blockage of pain receptors in analgesic effects & inhibitition of synthesis of
prostaglandins
Indications: Mild to moderate pain
Contraindications: hypersensitivity, or allergies to aspirin or other NSAIDs
Side Effects: edema, hypertension, rash, itching, nausea, vomiting, heartburn,
constipation, diarrhea, drowsiness, dizziness
Precautions: may cause GI irritation & hemorrhage, those with renal impairment may
have extended effects
Interactions: can potentiate other NSAIDs & can reduce diuretic effect of furosemide.
Routes of Administration: IV, IM
Onset & Duration of Action:
Dosages:
peak 30-60 min, 4-6 hour duration
Adult: IV – 30-60mg
IM – 30-60mg
Pediatric:
not recommended
LA County:
N/A
Overdose Treatment:
None
Notes:
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labetalol
(Normodyne)
Classification:
Beta-adrenergic blocker, anti-hypertensive
Mechanism of Action:
Selectively blocks Beta 1 receptors (dose specific & will
block Beta 2 receptors in high doses). Negative inotrope, chronotrope, & dromotrope.
Suppresses renin production because of relative vasoconstriction.
Indications: Hypertension, stable angina, AMI
Contraindications: sinus bradycardia, AV conduction blocks, CHF, cardiogenic shock,
bronchial asthma
Side Effects: dizziness, lightheadedness, syncope, fatigue, bradycardia, hypotension,
CHF, nausea, vomiting, decreased sexual ability, complete heart block, cardiac arrest
Precautions: Pregnancy (Class C), asthmatics, COPD
Interactions: Increases lidocaine toxicity, synergistic with verapamil
Routes of Administration: IVP slow, IVPB
Onset & Duration of Action:
Dosages:
rapid onset (30-60 sec), peak 5 min, duration
24hours.
Adult: 20mg over 2min (2mg/min infusion) (Max 300mg)
Pediatric:
N/A
LA County:
N/A
Overdose Treatment:
hypotension
Treat underlying rhythms, fluid bolus for
Notes:
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lidocaine
(Xylocaine)
Classification: Antidysrthymic (Class II – Sodium channel blocker), local anesthetic
Mechanism of action: Suppresses ventricular ectopy and dysrythmias
Increases ventricular fibrillation threshold
Decreases automaticity & speed of electrical impulse through the
conduction system
Indications: Cardiac Arrest (Ventricular tachycardia and fibrillation)
Malignant PVC’s
Wide QRS complex tachycardias of unknown origin / V-tach with a pulse
Post conversion of ventricular tachydysrhythmias & fibrillation (Post
defib/cardioversion)
Contraindications: Hypersensitivity
2nd and 3rd degree Heart Blocks
Junctional rhythms
Idioventricular rhythms
Bradycardic rhythms
Side Effects: Bradycardia, arrest, respiratory depression, respiratory arrest, seizures,
nausea, vomiting, anxiety, drowsiness, confusion, widening QRS complex,
lightheadedness, hypotension, dyspnea, paraesthesias, restlessness, slurred speech,
blurred vision, tinnitus, muscle twitching.
Precautions: Patients with liver disease or kidney failure, elderly (reduce dose by 50% in
population over 70 yo)
Interactions: Increased effects with beta -blockers, cimetidine (Tagamet), H2 Blockers,
quinidine, phenytoin. Decreased effects with barbiturates.
Routes of Administration: IV, ET, IO
Onset & Duration of actions:
Dosages:
1- 3 minutes ; 10-20 min
Adult: Cardiac Arrest (V-fib/Tach): 1 - 1.5 mg/kg (repeat every 3-5 min
to max of 3 mg/kg for arrest) or 3mg/kg for ET dose
Malignant PVCs:
1 - 1.5 mg/kg, repeat at 0.5-0.75 mg/kg
Post conversion maintenance infusion: 2 - 4 mg/min
Pediatric:
1 mg/kg (repeat every 3-5 min to max of 3 mg/kg for
arrest)
2 mg/kg for ET dose
maintenance infusion 20-50 mcg/kg/min
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LA County:
Vent. Dysrythmias or Post conversion/defibrillation of
Vent. Rhythms: 1 mg/kg @ 50mg/min slow IVP or 2
mg/kg ET;
Repeat 0.5 mg/kg every 5-10 minutes to max dose
of 3mg/kg or (ET) 1 mg/kg to max dose of 3mg/kg
(one time)
Cardiac Arrest: 1.5 mg/kg IVP; repeat 1.5mg/kg x1, ET
3mg/kg – no repeat
LA County Peds:
1 mg/kg (IV) over 1 minute or 2 mg/kg (ET)
Repeat IVP every 3-5 minutes two times;
Repeat ET one time @ 1mg/kg
Max 3 mg/kg
Note: -Administer Lidocaine slow IVP (50 mg/min)
-Reduce dosage 50% in elderly patients for repeat bolus doses (0.25mg/kg)
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lorazepam
(Ativan)
Classification:
Benzodiazepine, anticonvulsant, antianxiety agent, sedative, CNS
depressant
Mechanism of action: Depresses the CNS and relaxes skeletal smooth muscle
Indications: Status epilepticus, anxiety disorders, alcohol withdrawals
Contraindications: Hypersensitivity, acute narrow angle glaucoma, alcohol intoxication
Side Effects: Respiratory depression, bradycardia, hypotension, drowsiness, decreased
level of consciousness
Precautions: Elderly patients with impaired respiratory function
Interactions: Other CNS depressants will potentiate effects
Routes of Administration: IV or IM
Onset & Duration of actions:
Dosages:
1 - 5 min (IV), 15 -30 minutes (IM); 12 - 24 hours
Adult: 2 - 6 mg (IV) 2 - 4 mg (IM) (max 0.1mg/kg)
Pediatric: Not recommended
LA County: N/A
LA County Peds: N/A
Note: -Administer slow IVP
-Use flumazenil to reverse effects of lorazepam
-Watch for respiratory depression
-IV dosage diluted with equal amount of NS
-IM dosage left undiluted
-Most potent benzodiazepine
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magnesium sulfate
Classification: Electrolyte
Antidysrhythmic
Anticonvulsant
CNS depressant
Mechanism of action: Essential for Na+ - K+ ATP pumps, Decreases Acetylcholine in
motor nerve terminals, produces neuromuscular blockade in CNS, physiological calcium
channel blocker
Indications: Refractory V-fib, V-tach (Torsades de Pointes)
Seizures associated with eclampsia and alcohol withdrawal
Dysrhythmias associated with digitalis toxicity
Hypomagnesemia
Research (Acute asthma, stroke – neuroprotective)
Contraindications: Shock, heart blocks, hypersensitivity, hypermagnesemia
Side Effects: Bradycardia, respiratory depression, flushing, sweating
hypotension, heart blocks, hypocalcemia, decreased tendon reflexes
, drowsiness,
Precautions: Renal disease, hypotension, digitalis use, pregnancy (Class A)
Interactions: Caution with other CNS depressants, digitalis, and neuromuscular blockers
Routes of Administration: IV, IM, IVPB
Onset & Duration of actions:
Dosages:
3 - 5 minutes ; 30 minutes
Adult: Arrest: 1 - 2 g in 10mL D5W IV or 1-4 g IM
Non-arrest: 1-2g in 50-100mL of D5W over 5-60 minutes
maintenance infusion 0.5 - 1 g/hr
Seizures: 1 – 4 g in 10-20% sol IV or 1-5 g IM 25-50% sol
Pediatric: 20 - 50 mg/kg (max 2g) over 10-20 minutes
LA Co: N/A
LA Co Peds: N/A
Note: -Administer Magnesium slowly (1 g/min)
-Monitor airway; positive pressure ventilations may be needed
- Calcium chloride used as antidote to fight symptoms of respiratory depression or
paralysis
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mannitol
(Osmitrol)
Classification:
osmotic diuretic
Mechanism of Action:
inhibits sodium and water absorption in the kidneys,
promotes fluid movement from the intracellular into the extracellular space, dehydrates
brain tissue and decreases ICP
Indications: acute cerebral edema
blood transfusion reactions
Contraindications: acute pulmonary edema
severe pulmonary congestion
hypovolemia
Side Effects: chills, headache, dizziness, lethargy, mental status change, chest pain,
nausea, & vomiting
Precautions:
May cause transient increase in intravascular volume & CHF,
diuresis may cause sodium depletion (hyponatremia), will crystalize in low temperatures
and should be used with in-line filters when given. Pregnancy (C).
Interactions:
should not be administered with blood transfusions
Routes of Administration: IV Slow bolus or infusion
Onset & Duration of Action:
Dosages:
onset 15 min to reduce ICP, 1-3 h for diuresis,
duration 3-8 hours
Adult: 1.5 – 2 grams/kg infusion over 20-60 minutes
Pediatric: 200mg/kg over 3-5 min then 0.25-0.5g/kg
LA County:
N/A
Notes:
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meperidine hydrocloride
(Demerol)
Classification:
narcotic analgesic, CNS depressant
Mechanism of action:
Depresses pain perception by acting on opioid receptors in
the CNS
Indications: moderate to severe pain
Contraindications: head injury, abdominal pain of unknown etiology,
altered level of consciousness, multi-system trauma, hypovolemia
Side Effects: respiratory depression, lightheadedness, bradycardia, hypotension,
increased intracranial pressure, nausea, vomiting, sedation, dry mouth, urinary retention;
with high amounts
Precautions: history of seizures; have naloxone available to reverse side effects,
pregnancy (B)
Interactions: Other CNS depressants
Routes of Administration: IV / IM
Onset & Duration of actions:
Dosages:
onset: 5min IV, 10 min IM; duration: 2-4 hours
Adult: IV 25-50mg
IM 50-100mg
Pediatric: 1mg/kg
LA County: N/A
Note: Overdose will cause exaggerated side effects: pinpoint pupils, bradycardia,
hypotension, depressed respiratory status to apnea, and convulsions. To treat overdose,
administer supportive ALS, consider activated charcoal or ipecac, administer Narcan.
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metaproterenol
(Alupent, Metaprel)
Classification:
bronchodilator, sympathomimetic
Mechanism of action:
Selective beta 2 agonist, relaxes bronchial smooth muscle
Indications: Asthma, bronchospasm associated with COPD
Contraindications: Narrow angle glaucoma, hypersensitivity
Side Effects: headache, weakness, dizziness, palpitations, tachydysrhythmias,
hypertension, nausea, vomiting
Precautions: Pregnancy (C), cardiac disease, diabetes
Interactions: other sympathomimetics will potentiate effects, beta blockers will
decrease actions
Routes of Administration: Nebulized and inhaled
Onset & Duration of actions:
Dosages:
onset within 5min; duration 4hrs
Adult: 0.3mL of a 5% solution (15mg)
Pediatric: 0.1mL of a 5% solution (5mg)
LA County: N/A
Note:
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metaraminol
(Aramine)
Classification:
sympathomimetic, alpha & beta adrenergic agonist, vasopressor,
inotropic agent
Mechanism of Action:
similar to norepinephrine (less potent, more gradual onset
and longer action of duration), acts directly on alpha and beta receptors of sympathetic
nervous system (vasoconstriction & increase in inotropy)
Indications: Acute hypotension secondary to minor hemorrhage, anaphylaxis,
cardiogenic shock, & septicemia, increase cardiac output in cardiac tamponade.
Contraindications: MAO inhibitor use, thrombosis, pulmonary edema, cardiac arrest,
pregnancy (Class D), acidosis, hypercarbia
Side Effects: apprehension, restlessness, headache, N&V, palpitation, tachycardia,
hypertension, arrhythmias, cardiac arrest, seizures, pulmonary edema, CHF
Precautions: do not use as primary treatment for hypovolemia without fluid
replacement
Interactions:
MAO inhibitors, tricyclic antidepressants potentiate effects
Routes of Administration: SQ/IM/IV
Onset & Duration of Action:
duration 20-90min
Dosages:
onset 1-2min IV, <10min IM, 5-20min SQ,
Adult: 2-10mg IM/SQ
0.5-5mg IV
Pediatric:
0.1mg/kg IM/SQ
0.01mg/kg IV
LA County:
N/A
Notes:
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methohexital
(Brevital)
Classification:
anesthetic
sedative /hypnotic
short acting barbiturate
CNS depressant
Mechanism of action: Depresses CNS producing analgesia and amnesia
Indications: General anesthesia, premedication for RSI
Contraindications: hypersensitivity, status asthmaticus
Side Effects: hypoventilation, apnea, dysrhythmias, headache, hypotension
Precautions: Use caution with other CNS depressants, may induce seizures
Interactions: Diuretics, calcium channel blockers, antihypertensive medications may
increase hypotension
Routes of Administration: IV
Onset & Duration of actions:
Dosages:
Immediate ; 5 - 7 minutes
Adult: 1 - 2 mg/kg
Pediatric: 1 - 2 mg/kg
LA County: N/A
LA County Peds: N/A
Note: -Watch for respiratory depression, ventilate as needed
-Monitor blood pressure for hypotension
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methylprednisolone
(Solu-Medrol)
Classification: Corticosteroid, anti-inflammatory
Mechanism of action:
Decreases inflammation, by suppressing the immune
systems response; binds with intracellular corticosteroid receptors
Indications: Anaphylaxis, status asthmatics, spinal cord swelling, exacerbated COPD,
distributive shock
Contraindications: Hypersensitivity
Side Effects: headache, hypertension, CNS depression, change in behavior, decreased
circulation
Precautions: Pregnancy, glaucoma, renal disease, CHF, myasthenia gravis,
hypertension, diabetes
Interactions: Causes decreased action of anticonvulsants, theophylline, phenytoin;
barbiturates decrease the actions of methylpredisolone
Routes of Administration: IV or IM
Onset & Duration of actions:
Dosages:
onset 1-2 hours; duration 1-2 weeks
Adult: 125-250mg (IV and IM)
Pediatric: 30mg/kg (IV and IM)
LA County: N/A
Note: If overdose, treat supportively.
- Often supplied in powder form and must be reconstituted
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metoclopramide
(Reglan)
Classification:
anti-emetic
Mechanism of Action: Potent central dopamine receptor antagonist, increases
acetylcholine action on GI smooth muscles
Indications: nausea & vomiting
gastroesophageal reflux
Contraindications: GI hemorrhage, bowel obstruction or perforation, hypersensitivity
Side Effects: mental & physical impairment, drowsiness, sedation, headaches, blurred
vision
Precautions: renal dysfunction, dystonic reactions
Interactions: significant CNS depression may occur with use with barbiturates,
narcotics, alcohol, or tranquilizers.
Routes of Administration: IV, IM
Onset & Duration of Action:
Dosages:
onset 30-60min, duration, 4-6 hours
Adult: 10-20mg IM, 10mg slow IV (1-2min)
Pediatric: 0.4-0.8mg/kg IV or IM
LA County: N/A
Notes:
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metoprolol
(Lopressor)
Classification:
Beta-adrenergic blocker, anti-hypertensive
Mechanism of Action:
Selectively blocks Beta 1 receptors (dose specific & will
block Beta 2 receptors in high doses). Negative inotrope, chronotrope, & dromotrope.
Suppresses renin production because of relative vasoconstriction.
Indications: Hypertension, stable angina, AMI
Contraindications: sinus bradycardia, AV conduction Blocks, CHF, cardiogenic
shock, bronchial asthma
Side Effects: dizziness, lightheadedness, syncope, fatigue, bradycardia, hypotension,
CHF, nausea, vomiting, decreased sexual ability, complete heart block, cardiac arrest
Precautions: Pregnancy (Class C), asthmatics, COPD
Interactions: Increases lidocaine toxicity, synergistic with verapamil
Routes of Administration: IVP slow, IVPB
Onset & Duration of Action:
Dosages:
rapid onset (30-60 sec), peak 5 min, duration 10 –
30 minutes
Adult: 5mg q 2min x3
Pediatric:
N/A
LA County:
N/A
Overdose Treatment:
hypotension
Treat underlying rhythms, fluid bolus for
Notes:
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midazolam
(Versed)
Classification:
benzodiazepine, nticonvulsant, CNS depressant, amnesic agent,
sedative/hypnotic, antianxiety agent
Mechanism of action: Reduces anxiety, relaxes skeletal muscles, produces short term
CNS depression and amnesia
Indications: Seizures, Acute anxiety disorder, status epilepticus, pre medication for
endotracheal intubation, synchronized cardioversion, pacing, or rapid sequence intubation
(RSI)
Contraindications: Hypersensitivity to medication, acute narrow angle gluacoma,
shock, hypotension, head injury, alcohol/drug intoxication
Side Effects: Respiratory depression, dyspnea, laryngospasm, bronchospasm,
bradycardia, tachycardia, hypotension, PVCs, amnesia, blurred vision, headache,
drowsiness, nausea, vomiting, cough, altered level of consciousness, pain during
injection, phlebitis
Precautions: Elderly patients with impaired respiratory function, patients with COPD,
renal or hepatic failure
Interactions: Other CNS depressants and benzodiazipines
Routes of Administration: IV or IM
Onset & Duration: 1 - 5 min (IV) 5 - 15 minutes (IM); > 2 hours (IV) 2 - 6 hours (IM)
Dosages:
Adult: 1.0 - 2.5 mg (IV), 5mg (IM)
Pediatric: 0.05-0.2 mg/kg (IV), 0.1-0.15mg/kg (IM)
LA Co: 1- 2.5 mg IVP over 2-3 minutes, titrate to effect
Repeat to max dose of 0.1 mg/kg (total)
LA Co Peds: 6 month - 6 years: 0.05 - 0.1 mg/kg slow IVP over 2-3
minutes
6 years - 12 years: 0.025 - .05 mg/kg slow IVP over 2-3 minutes
Over 12 years: Same as adult slow IVP over 2-3 minutes
Note: -Administer slow IVP; titrate to suppress seizure activity
-Use flumazenil to reverse effects of midazolam
-Watch for respiratory depression
- Not yet implemented in LA COUNTY SCOPE OF PRACTICE (08/02)
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milrinone
(Primacor)
Classification:
Inotrope (phosphodiesterase inhibitor)
Mechanism of Action:
Fast acting inotrope by inhibiting phosphodiesterase (not
well understood). Mild vasodilation.
Indications: Severe CHF refractory to other agents
Contraindications: hypersensitivity to drug or other bisulfite chemicals
Side Effects: arrhythmias, hypotension, nausea, vomiting, abdominal pain, &
thrombocytopenia.
Precautions: Increases cardiac ischemia, use with caution in potential AMI patients,
should only be diluted in NS solutions.
Interactions: Furosemide should be administered via different IV line and should not be
mixed with dextrose solutions.
Routes of Administration: IVB, IVPB, IO
Onset & Duration of Action:
Dosages:
2 minutes, 2 hours
Adult: IVB – 50mcg/kg over 10minutes
IVPB – 0.375-0.75mcg/kg/min
Pediatric:
50-75 mcg/kg IV/IO over several minutes
0.5-0.75mcg/kg/min infusion
LA County:
N/A
Notes:
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morphine sulfate
(Duramorph, Astramorph)
Classification: Narcotic analgesic, CNS depressant, Schedule II narcotic
Mechanism of action: Alters pain perception in CNS & produces euphoria, binds to
opiate receptor sites in CNS to block pain, decreases peripheral vascular resistance (PVR)
due to venous dilation/pooling, decreases myocardial oxygen demand by decreasing
preload and afterload
Indications: Chest pain of suspected acute myocardial infarction origin
Acute pulmonary edema (cardiogenic origin)
Moderate - severe pain
Contraindications: hypersensitivity, head injury, altered level of consciousness,
abdominal pain of unknown origin, patients at risk for respiratory depression,
hypovolemia
Side Effects: Respiratory depression, respiratory arrest, altered level of consciousness,
severe hypotension, seizures, tachycardia, bradycardia, hypertension, sedation, dizziness,
headache, confusion, hallucinations, tremors, nausea, & vomiting
Precautions: Watch for respiratory depression, hypotension, and nausea
Interactions: Use with caution with patients taking other analgesics, depressants or
narcotics
Routes of Administration: IV or IM
Onset & Duration of actions: (IV) 2 - 5 min (IM) 5- 10 min ; 3 - 5 hours
Dosages:
Adult: 1 - 10 mg every 5 - 30 minutes (IVP); 5-15mg (IM)
Pediatric: 0.1 - 0.2 mg/kg every 2 - 4 min (max 15 mg)
LA Co:
Pain - 2 - 10 mg slow IVP at 2mg/min or 5 - 10(IM – no
repeat) (titrate to pain relief to max 20 mg)
Pulmonary Edema – 5-10 mg slow IVP at 2mg/min
LA Co Peds: 0.1 mg/kg (IV or IM) at 1mg/min titrate to effect (no repeat
dose)
Note: -Administer morphine slow IV or IM push [2 mg/min (adults) & 1 mg/min (Peds)]
-Preferred method of dilution is 1 ml (10 mg) morphine with 9 ml normal saline
-Antidote for overdose of morphine is Narcan (naloxone) which will reverse the effects
of respiratory depression only.
-Watch for respiratory depression
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nalbuphine
(Nubain)
Classification:
Synthetic analgesic (opiate agonist/antagonist), CNS depressant
Mechanism of Action:
sites in the CNS.
centrally acting analgesic that binds to the opiate receptor
Indications: Moderate to severe pain
Contraindications: hypersensitivity, head injury, or undiagnosed abdominal pain
Side Effects: headache, altered mental status, hypotension, bradycardia, blurred vision,
rash, respiratory depression, nausea, & vomiting.
Precautions: may cause significant respiratory depression, reduce doses in elderly
patients, pregnancy (B)
Interactions: can potentiate CNS depression associated with narcotics, sedatives,
hypnotics, & alcohol, antagonistic properties against narcotics – may cause withdrawal
symptoms with those dependent on narcotics.
Routes of Administration: IV, IM, SQ
Onset & Duration of Action:
Dosages:
2-3min onset, 3-6 hour duration
Adult: 5mg initially, 2mg q 5min – titrate to effect
Pediatric:
not recommended
LA County:
N/A
Overdose Treatment:
naloxone administration & ventilatory support
Notes:
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naloxone
(Narcan)
Classification: Narcotic antagonist, antidote
Mechanism of action: Reverses effects of certain narcotic and synthetic narcotic
analgesics by competing with analgesic at opiate receptor site
Indications: Known or suspected narcotic overdose with respiratory rate <12 or
decreased tidal volume
Contraindications: Hypersensitivity
Side Effects: Seizures, nausea, vomiting, withdrawals, anger, tachycardia, hypertension,
tremors, dysrhythmias
Precautions: Nausea and vomiting may occur if administered too quickly, seizures and
severe withdrawal symptoms may occur with patients who are known to be dependent on
narcotics, pregnancy (B).
Interactions: None
Routes of Administration: IV, IM, SQ, IO, or ET (Intranasal spray under research)
Onset & Duration of actions: Immediate - 2 minutes; 20 - 30 minutes
Dosages:
Adult: 0.4 - 2.0 mg every 2 minutes (max 10 mg) titrate to respiratory rate
and tidal volume
Pediatric: 0 - 5 years: 0.1 mg/kg (max 10mg) titrate to effect
>5 years: 0.4-2 mg
LA County: 0.8 mg - 2.0 IV or IM; 2 - 4 mg ET titrate to effect to increase
respiratory rate & tidal volume
Repeat every 5 minutes prn
LA County Peds: 0.1 mg/kg IV or IM; 0.2 mg/kg ET titrate to effect to
increase respiratory rate & tidal volume
Repeat every 5 minutes prn
Note: -Titrate dosage to adequate respiratory rate and tidal volume
-Administer Narcan before endotracheal intubation
-Monitor HR and B/P, Narcan does not reverse narcotic induced hypotension
- Many narcotics have a longer duration and half-life than naloxone, therefore, providers
should be diligent concerning transport to observe the patient even after the effects of
naloxone have subsided. Rebinding of the initial narcotic to the opiate receptor sites is
common and often will cause secondary decline in respiratory effort.
Common Narcotics:
 codeine
 buprenorphine (Buprenex)
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
















butorphanol (Stadol)
dezocine (Dalgan)
fentanyl (Sublimaze, Duragesic)
heroin
hydrocodone (Hycodan)
hydromorphone (Dilaudid)
levorphanol (Levo-Dromoran)
meperidine (Demerol)
methadone (Dolophine, Methadose)
morphine (Duramorph, MS Contin)
nalbuphine (Nubain)
oxycodone (OxyContin)
oxymorphone (Numorphan)
pentazocine (Talwin)
propoxyphene (Darvon)
propoxyphene/napsylate combinations (Darvocet)
tramadol (Ultram)
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nifedipine
(Procardia, Adalat)
Classification:
calcium-channel blocker, antianginal, antihypertensive
Mechanism of action: Inhibits calcium influx across cell membranes; relaxes coronary
vascular smooth muscle, decreases myocardial oxygen demand, decreases SA & AV
node conduction, decreases PVR
Indications: Angina, severe hypertension
investigational use: migraine headaches
Contraindications: Hypotension, hypersensitivity
Side Effects: weakness, dizziness, headache, blurred vision, paresthesia, tinnitus,
dysrhythmia, hypotension, CHF, nausea, vomiting, palpitations, acute myocardial
infarction
Precautions: CHF, Heart blocks, Pregnancy (C).
Interactions: Concomitant use with Beta blockers may cause CHF, may create digitalis
and phenytoin toxicity
Routes of Administration: PO, SL
Onset & Duration of actions
Dosages:
onset: 20 min. duration: 6-8 hrs.
Adult: 1 tablet q3-5 min x 3 tablets max (tablet 10-20mg)
Pediatric: N/A
LA County: N/A
Overdose Treatment:
consider calcium chloride, fluid boluses, and glucagon
Note: SL administration – preferred method is to perforate capsule with needle prior to
administration
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nitroglycerine
(Nitrolingual, Nitrostat, Nitrobid, Tridil)
Classification: Vasodilator, nitrate, antianginal
Mechanism of action: Relaxes smooth muscle causing venous dilation / pooling
Decreases myocardial oxygen demand
Decreases preload and afterload
Increases coronary artery perfusion by dilation of arteries &
relaxation of coronary vasospasms
Indications: Chest pain of cardiac origin (angina, acute myocardial infarction)
Acute pulmonary edema
Contraindications: Hypersensitivity to nitrates, blood pressure below 90mmHg systolic
(100 mmHg in LA County)
Patients who have taken sildenafil (Viagra) within 24 hours
Patients with suspected head trauma or cerebral hemorrhage (increased intracranial
pressure), poor systemic perfusion
Side Effects: hypotension, bradycardia, rebound hypertension, reflex tachycardia,
headache, nausea, vomiting, dizziness, confusion, blurred vision, dry mouth, flushed skin,
sublingual burning
Precautions: Monitor B/P closely for hypotension
Interactions: Use with caution with patients on vasodilators, alcohol, calcium channel
blockers, beta blockers, and phenothiazides
Routes of Administration: SL or TM, IVPB, TD
Onset & Duration of actions: 1 - 3 minutes ; 30 - 60 minutes
Dosages:
Adult: 0.3 - 0.4 mg every 5 minutes up to 3 times SL or TM, 0.5 – 2inches
paste TD, maintenance infusion 10 - 20 mcg/min
Pediatric: Not recommended
LA County:
1 spray (0.4 mg) repeat every 5 minutes (two times) (SL
Spray only) (max 3 doses)
LA County Peds: Not recommended
Note:-If hypotension occurs, place patient in shock position and consider fluids if lungs
sounds are clear
-In LA Co B/P must be above 100 mmHg systolic
-Take B/P before and 5 minutes after administration of Nitroglycerine
-Do not shake container. This will alter dose of spray. Instruct patient not to inhale spray.
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nitroprusside
(Nipride)
Classification: Vasodilator, antihypertensive, nitrate.
Mechanism of action: Relaxes arterial and venous smooth muscle, causing peripheral
vasodilation, decreases pre-load and after-load, decreases blood pressure.
Indications: Hypertensive crisis, CHF with hypertension
Contraindications: Hypersensitivity to nitrates, nitroprusside or any other nitrate
should not be given to a patient who has taken Viagra within the last 24 hours, head
injury, hypotension, shock.
Side Effects: weakness, dizziness, headache, altered level of consciousness, blurred
vision, hypotension, palpitations, dyspnea, nausea, vomiting, pain at injection site, reflex
tachycardia
Precautions: renal insufficiency, pregnancy (C), pediatrics, hypothyroidism, hepatic
disease, elderly.
Interactions: Use with other antihypertensives can cause additive effects.
Routes of Administration: IV
Onset & Duration of actions: onset: 1-2 min. duration:1-10 mins.
Dosages:
Adult: 0.1 mcg/kg/min to a max of 10mcg/kg/min, titrate to effect
Pediatric: rarely used, same as adult
LA County: N/A
Note: Preferred mixture 50 mg in 250 or 500 ml or D5W
This drug is very sensitive to light and should be protected from it, aluminum foil can be
used to wrap around bag and tubing.
Use the smallest dose needed for effect.
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nitrous oxide
(Nitronox)
Classification:
Analgesic gas, mixture, 50% nitrous oxide & 50% oxygen,
CNS depressant
Mechanism of action: Provides rapid relief from pain by depressing the CNS, and
causes vasodilation through relation of coronary artery smooth muscle
Indications: To relieve pain such as pain from: burns, cardiac, musculoskeletal injury
Contraindications: Altered level of consciousness, head injury, abdominal trauma or
pain, COPD, chest injury with possible pneumothorax, pulmonary edema, pulmonary
embolism, alcohol or drug intoxication, moderate to severe shock state
Side Effects: Lightheadedness, decreased level of consciousness, nausea, vomiting,
respiratory depression, apnea, hallucinations
Precautions: Monitor vital signs, level of consciousness, and airway. Prgenancy.
Interactions: CNS depressants
Routes of Administration: inhaled
Onset & Duration of actions:
Dosages:
pain is
Adult:
onset immediate; duration 5min
Self-administered by patient with hand-held mask until
relieved, or patient drops mask
Pediatric:
Same as adult
LA County:
N/A (Burbank FD utilizes this drug)
Note: Make sure ambulance is well vented to avoid inhalation by paramedic.
Post administration of this drug administer high flow oxygen
May not operate properly at low temperatures
Common drug of abuse and misuse
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norepinephrine
(Levophed)
Classification: Adrenergic vasopressor, Sympathomimetic
Mechanism of action: Causes vasoconstriction by acting directly on alpha receptors
Increases blood pressure, cardiac output, and coronary perfusion
Indications: Shock with B/P <70mmHg systolic; cardiogenic & neurogenic shock
Contraindications: hypovolemia, severe hypoxia, ventricular fibrillation, tachycardia
Side Effects: headache, weakness, dizziness, palpitations, angina, ectopy, hypertension,
dyspnea, necrosis at IV site, nausea, vomiting, bradycardia
Precautions: patients with history of myocardial infarction, increases myocardial oxygen
demand, hypertension, pregnancy (c), heart disease, peripheral vascular disease, MAO
Inhibitor and TCA use, and geriatrics.
Interactions: Beta and alpha blocking agents may antagonize effects, tricyclic
antidepressant use may potentiate effects.
Routes of Administration: IV
Onset & Duration of actions: onset:1-2min duration: 10 minutes
Dosages:
Adult: 0.5-1mcg/min to a max of 30mcg/min
Mix 4mg to 250cc of Normal Saline
Pediatric: Rarely used, 0.1-1mcg/min titrate to effect.
LA County: N/A
Note: Ensure IV placement to prevent tissue necrosis with extravasation
Protect drug from light
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oral glucose
(Glucose paste or Glucose Gel)
Classification: Carbohydrate, hyperglycemic agent
Mechanism of action: Increased blood glucose levels to serve as an immediate sources
of glucose which is rapidly utilized for cellular metabolism
Indications: Conscious patients with signs/symptoms of hypoglycemia
Contraindications: Unresponsive patients, patients who are unable to swallow or have a
diminished gag reflex, patients complaining of nausea (LA County Only)
Side Effects: Aspiration, obstructed airway, vomiting/nausea
Precautions: Monitor airway
Interactions: None
Routes of Administration: PO
Onset & Duration of actions: 5 - 20 minutes; Depends on severity of hypoglycemia
Dosages:
Adult: 10 g
Pediatric: 10 g
LA Co: 75 - 100 g of solution or 1 inch of paste PO
LA Co Peds: 1 g/kg; paste not recommended
Note: -Administer solution to patients who can hold container and drink without
assistance
-Entire amount does not need to be administered if patient’s conditions improves
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oxygen
Classification:
gas, antidysrhythmic agent
Mechanism of Action:
increases percentage of oxygen in inspired air (FiO2)
available for mechanical ventilation, internal and external respiration (diffusion of gas by
partial pressure), and cellular respiration
Indications: Increased O2 demand
Hypoxemia/hypoxia
Chest pain of myocardial origin/cardiovascular compromise or
emergencies
Respiratory insufficiency/SOB/respiratory emergencies
Neurological diseases/disorders
Hypoperfusion states/trauma/toxic inalation
Contraindications: None
Side Effects: nausea & vomiting
Precautions: Patients with respiratory insufficiency should be monitored closely in
ensure adequate ventilation. COPD patients may develop respiratory depression with
administration of high flow oxygen, however, NEVER WITHOLD oxygen from any
patient in distress. Non-humidified oxygen may cause drying of mucous membranes and
associated bleeding. Neonates should not receive high concentrations for long periods of
time.
Interactions: None
Routes of Administration:
Inhalation By:
Flow Rate
Nasal Cannula
0.5-6 LPM
Simple Mask
6-15 LPM
NRB Mask
10-15 LPM
BVM with reservoir
10-25 LPM
BVM with ET
10-25 LPM
Venturi Mask
4-12 LPM
Onset & Duration of Action:
Dosages:
FiO2
25-40%
50-60%
90-100%
40-90%
100%
24, 28, 35, & 40%
onset: 1-2 min
Duration: up to 30 minutes
Adult: 0.5-25LPM
Pediatric:
0.5-25LPM
LA County:
0.5-15LPM
Notes:
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oxytocin
(Pitocin)
Classification: Hormone, oxytocic agent
Mechanism of action: Causes uterine contraction, stimulates lactation
Indications: to control postpartum hemorrhage >500cc
(In hospital- to induce labor)
Contraindications: hypersensitivity, use prior to delivery of the placenta or multiple
births, Cesarean section
Side Effects: nausea, vomiting, hypotension, dysrhythmias, anaphylaxis
Precautions: In field use make sure placenta and all fetuses have delivered prior to
administration, overdose can cause uterine rupture
Interactions: Use with vasopressors may cause hypertension
Routes of Administration: IV/IM
Onset & Duration of actions:
Dosages:
onset IV= 1min/IM= 3-7min.;duration IV=
30min/IM= 1hr
Adult: IV: 10-20 U added to 1000 ml of NS or D5W and titrated to effect
IM: 3-10 U
Pediatric: N/A
LA County: N/A
Note:
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pancuronium bromide
(Pavulon)
Classification:
Non-depolarizing neuromuscular blocking agent; Paralytic
Mechanism of action:
Inhibits neuromuscular transmission, by competing for and
binding with cholinergic receptor sites, which causes paralysis of skeletal and respiratory
muscles; Prevents acetylcholine from binding to receptor sites
Indications: rapid sequence intubation (RSI)
Contraindications: Neuromuscular diseases like myasthenia gravis
Hypersensitivity
Side Effects: respiratory depression, tachycardia, wheezing
Precautions: Pregnant women on magnesium sulfate, Children < 2 y/o, known renal
failure, dehydration
Interactions: Concomitant use with narcotics can prolong paralysis and respiratory
depression, theophylline can increase the side effect of dysrhythmias
Routes of Administration: IV
Onset & Duration of actions: onset 30-45sec ; duration 60minutes
Dosages:
Adult: 0.04 - 0.1mg/kg
Pediatric: 0.04 - 0.1mg/kg
LA County: N/A
Note: prior to administration give a benzodiazepine or narcotic to create sedation
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phenobarbital
(Luminal)
Classification:
barbiturate, tranquilizer, anticonvulsant, sedative-hypnotic, CNS
depressant
Mechanism of Action:
Interference with impulse transmission of cerebral cortex
by inhibition of the RAS, increases threshold for motor cortex stimuli
Indications: Major motor seizure, status epilepticus
Premedication prior to cardioversion or pacing
Acute anxiety states, acute alcohol withdrawl
Contraindications: hypersensitivity, respiratory depression, altered level of
consciousness, hepatic failure, pregnancy/lactation (D)
Side Effects: drowsiness, hypotension, respiratory depression, apnea, altered level of
consciousness, laryngospasm, agranulocytosis, circulatory collapse
Precautions: hepatic/renal impairment, hyperthyriodism, diabetes, anemia
Interactions: additive effects with alcohol, barbiturates, antidepressants, phenothiazines,
& narcotics
Routes of Administration: IV, IM
Onset & Duration of Action:
Dosages:
onset 1-5min IV, 30 min peak, 4-6h duration
Adult: IM/IV 200-600mg / 20mg/kg max (slow IV push)
Pediatric:
3-18 mg/kg – max dose 20mg/kg (slow IVP)
LA County:
N/A
Note:
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phenytoin
(Dilantin)
Classification: Anticonvulsant, antiarrhythmic
Mechanism of action: Decreases voltage, frequency, and spread of electrical discharges
within brain, increases AV node conduction and prolongs refractory period
Indications: Status epilepticus, Arrhythmias cause by digitalis toxicity
Contraindications: Bradycardia, heart blocks
Side Effects: Hypotension, arrhythmias, N/V, headache, allergic reaction, hyperglycemia
(blocks release of insulin)
Precautions: Cardiovascular disease, pregnant patients
Interactions: CNS depressants, dextrose solutions
Routes of Administration: IV
Onset & Duration of actions: 1 - 2 hours; 12 - 24 hours
Dosages:
Adult: Seizures: 15 - 20 mg/kg (max: 20 mg/min)
Digitalis Toxicity: 100mg over 5 minutes (repeat until dysrhythmia
suppressed or max dose of 1000mg reached)
Pediatric: 15 - 20 mg/kg (max: 1 mg/kg/min)
LA Co: N/A
LA Co Peds: N/A
Note: -Pain at injection site is common, dilute with normal saline
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physostigmine chloride
(Antilirium)
Classification:
Cholinesterase inhibitor and antimuscarinic agent, antidote
Mechanism of action:
effects of acetylcholine
Inhibits the effects of cholinesterase, and increases the
Indications: Tricyclic antidepressant overdose, anticholinergic poisoning, reversal of
neuromuscular blockade.
Contraindications: Hypersensitivity, narrow angle glaucoma
Side Effects: weakness, dizziness, hallucinations, seizures, bradycardia, hypotension,
brochospasms, vomiting and diarrhea
Precautions: bradycardia, hypotension, diabetics, history of seizures, pregnancy (C)
Interactions: minimal
Routes of Administration: IV (primary) may be given IM
Onset & Duration of actions:
Dosages:
onset 3- 8 minutes; duration 0.5 – 1 hour
Adult: 0.5-2mg Slow IVP, q 5-10min 1 time
Pediatric: 0.02mg/kg Slow IVP, q 5-10min 1 time
LA County: N/A
Note: Overdose will present very much like an cholinergic poisoning with signs and
symptoms matching the SLUDGE pneumonic. Treatment with atropine (typically a
larger dose than the standard cardiac dose, so >1mg)
To avoid toxicity do not push physostigmine faster than 1mg/min.
Pralidoxime is not a standard adjunct in a case of physostigmine overdose even though it
presents like a cholinergic poisoning.
Commom tricyclic antidepressants: amitriptyline (Elavil, Endep), clomipramine
(Anafranil), desipramine (Norpramin, Pertofrane), doxepin (Adapin, Sinequan),
imipramine (Janamine, Tofranil), nortriptyline (Aventyl, Pamelor), protriptyline
(Vivactil), trimipramine (Surmontil).
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potassium chloride
(K-Dur, Slow-K)
Classification: Electrolyte
Mechanism of action: Vital electrolyte used for normal nerve conduction, muscles,
kidney function
Indications: Treatment/prevention of hypokalemia secondary to diuretic or corticosteroid
therapy
Indicated in severe diarrhea, vomiting, severe diuresis
Contraindications: hyperkalemia, severe renal failure
Side Effects: Respiratory depression, respiratory apnea, dysrhythmias, cardiac arrest,
muscular paralysis, abdominal pain, nausea, vomiting, paraestesia, confusion,
hyperkalemia, venous thrombosis.
Precautions: EKG monitor for dysrhythmias
Interactions: Potassium sparing diuretics, ACE inhibitors
Routes of Administration: IV or PO
Onset & Duration of actions:
Dosages:
Immediate; 12 - 24 hours
Adult: 10 - 40 mEq/hour (IV)
Pediatric: 0.02 mEq/kg/min, max 3 mEq/kg/day (IV)
LA Co: 10 - 40 mEq/liter added to a main line @ TKO
LA Co Peds: 10 - 40 mEq/liter added to a main line @ TKO
Note: -Paramedics may not start an IV of KCl or add KCl in LA Co
-Administer CaCl2 for hyperkalemia
1 g slow IVP (over 1 min)repeat in 10 min prn
-Monitor IV site for infiltration
KCl causes tissue necrosis
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pralidoxime chloride
(2-Pam Chloride, Protopam)
Classification: Cholinesterase reactivator, antidote
Mechanism of action: Reactivates cholinesterase in cases of organophosphate poisoning
Deactivates certain chemical organophosphate/nerve agents by direct chemical reaction
Indications: Organophosphate/Nerve Agent poisoning characterized by respiratory
distress, muscle twitching, paralysis/generalized weakness, seizure
(Nerve agents include: Sarin (GB), Soman (GD), Tabun (GA), and VX)
Contraindications: Inorganic phosphate poisoning
Side Effects: Excitement, manic behavior, difficulty breathing, nausea, vomiting,
muscular weakness, tachycardia, hypertension, tachypnea, blurred vision, headache,
drowsiness
Precautions: ALWAYS ASSURE SCENE SAFETY
Interactions: Should only use following atropine use. May potentiate narcotics,
phenothiazines, antihistamines, and alcohol
Routes of Administration: IV, IM, SQ
Onset & Duration of actions:
Dosages:
10 - 20 minutes ; 1 hour
Adult: 1 - 2 g into a 250/500 ml bag of NS given over 30 minutes IV
or 1-2g IM/SQ
Pediatric:
20 - 40 mg/kg into a 250/500 ml bag of NS given over 30
minutes IV or 20-40mg/kg IM/SQ
LA Co:
600 mg IM repeated 2 times prn (Mark I Auto Injector)
LA Co Peds: < 20 kg or under 2 years = 20 mg/kg IM 1 time
> 20 kg or over 2 years = 600 mg IM 1 time
(may use Mark I Auto Injector with caution)
Note: -Pralidoxime is used in conjunction with Atropine
-Always assure scene safety for all personal
-Select large muscle to inject medication for IM, hold auto injector in place for 10
seconds
-Do not use auto injector in children under 2 years old, vial of reconstituted
powder provided for pediatric patients, & do not use buttocks for IM
administration in any pediatric patient (may cause nerve & tissue damage).
-See atropine for common organophosphate containing substances.
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procainamide
(Pronestyl, Procan)
Classification: Antidysrhythmic agent (Class IA – Sodium Channel Blocker)
Mechanism of Action: Decreases myocardial excitability
Slows Conduction of the heart
Suppresses ventricular ectopy (by reducing automaticity) and increase refractory period
May depress myocardial contractility
Increases fibrillation threshold.
Indications: General: atrial & ventricular dysrhythmias
Specific: SVT, PSVT, V-Tach,V-Fib
Contraindications: Hypersensitivity, 2nd and 3rd degree heart blocks, patient suffering
from digitalis toxicity, Torsade de pointes.
Side Effects: hypotension, ventricular dysrhythmias, heart blocks, widening QRS
complex, lengthened QT interval, seizures, confusion, dizziness, headache, weakness,
irritability, nausea, vomiting
Precautions: Myasthenia gravis, hepatic or renal disease, possible MI, Pregnancy (C),
pediatrics, CHF, hypotension, asthma
Interactions: Concomitant use with anti-hypertensives can cause severe Hypotension.
Procainamide increases the affects of: neuromuscular blockers, anticholinergics, antihypertensives.
Routes of Administration: IV/IO
Onset & Duration of actions: onset immediate; duration 3-4 hours
Dosages:
Adult: IV Bolus 100mg over 5min
IV infusion 20 - 30mg / min (max 17mg / Kg)
Maintenance infusion 2 - 4mg / min
Pediatric: 15 mg/kg IV/IO over 30-60 minutes
LA County: N/A
Note: Reasons to stop administration- Max dose is met, QRS widens by 50% or more,
dysrhythmias are suppressed, hypotension occurs. Monitor vitals, EKG, and deliver high
flow oxygen. Hypotension: IV fluid challenge, shock position, consider vasopressors.
Dysrhythmias: Treat per ACLS
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prochlorperazine
(Compazine)
Classification:
Antihistamine, anti-emetic, phenothiazine, tranquilizer, CNS
depressant
Mechanism of Action: Competitively blocks histamine receptors in the GI tract, blocks
cholinergic receptors in vomit centers, increases acetylcholine action on GI smooth
muscles, blocks dopamine receptors in the CNS
Indications: nausea & vomiting
acute psychosis
Contraindications: hypersensitivity, comatose states, patients who have received large
amounts of depressants, Parkinson’s Disease
Side Effects: mental & physical impairment, drowsiness, headaches, blurred vision,
tachycardia, bradycardia, dizziness, dystonic reactions
Precautions: renal dysfunction, dystonic reactions, lactation
Interactions: significant CNS depression may occur with use with barbiturates,
narcotics, alcohol, or tranquilizers.
Routes of Administration: IV, IM, PO, PR
Onset & Duration of Action:
Dosages:
onset 30-60min, duration, 4-6 hours
Adult: 2.5-10mg IM or IV
Pediatric: 0.13mg/kg IV or IM
LA County: N/A
Notes: Dystonic reactions: typically caused by phenothiazine use. Characterized by:
 Nuchal rigidity
 Muscle spasms of the face, tongue, neck, jaw, and/or back
 Thickening and protrusion of tongue
 Fixed upward gaze, facial grimaces, difficulty swallowing and/or talking
 Hyperextension of neck and truck and arching of back
 Counteracted by use of diphenhydramine (Benadryl).
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promethazine
(Phenergan)
Classification:
antihistamine, anti-emetic, phenothiazine
Mechanism of Action: Competitively blocks histamine receptors in the GI tract, blocks
cholinergic receptors in vomit centers, increases acetylcholine action on GI smooth
muscles
Indications: nausea & vomiting
motion sickness
potentiation of effects of analgesics
sedation
Contraindications: hypersensitivity, comatose states, pts who have received large
amounts of depressants
Side Effects: mental & physical impairment, drowsiness, headaches, blurred vision,
tachycardia, bradycardia, dizziness
Precautions: renal dysfunction, dystonic reactions
Interactions: significant CNS depression may occur with use with barbiturates,
narcotics, alcohol, or tranquilizers.
Routes of Administration: IV, IM, PR
Onset & Duration of Action:
Dosages:
onset 30-60min, duration, 4-6 hours
Adult: 12.5-25 mg IM or IV
Pediatric: 0.25-0.5 mg/kg IV or IM
LA County: N/A
Notes: Dystonic reactions: typically caused by phenothiazine use. Characterized by:
 Nuchal rigidity
 Muscle spasms of the face, tongue, neck, jaw, and/or back
 Thickening and protrusion of tongue
 Fixed upward gaze, facial grimaces, difficulty swallowing and/or talking
 Hyperextension of neck and truck and arching of back
 Counteracted by use of diphenhydramine (Benadryl).
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propanolol
(Inderal)
Classification:
Beta-adrenergic blocker, anti-hypertensive, anti-dysrhythmic
Mechanism of Action:
Selectively blocks Beta 1 receptors (dose specific & will
block Beta 2 receptors in high doses). Negative inotrope, chronotrope, & dromotrope.
Suppresses renin production because of relative vasoconstriction. Propanolol also class II
antidysrhythmic.
Indications: hypertension, stable angina, acute myocardial infarction,
tachydysrhythmias associated with digitalis toxicity
Contraindications: sinus bradycardia, AV conduction blocks, CHF, cardiogenic shock,
bronchial asthma
Side Effects: dizziness, lightheadedness, syncope, fatigue, bradycardia, hypotension,
CHF, nausea, vomiting, decreased sexual ability, complete heart block, cardiac arrest
Precautions: Pregnancy (Class C), asthmatics, COPD
Interactions: Increases lidocaine toxicity, synergistic with verapamil
Routes of Administration: IVP slow, IVPB
Onset & Duration of Action: rapid onset (30-60 sec), peak 5 min, duration 10 – 30
minutes
Dosages:
Adult: 0.5 –3mg q 4hr prn
Pediatric:
10-20mcg/kg/min over 10min
LA County:
N/A
Overdose Treatment:
Treat underlying rhythms, fluid bolus for hypotension
Notes:
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propofol
(Diprivan)
Classification:
Anesthetic
Sedative/hypnotic
CNS depressant
Mechanism of action: Fast acting CNS agent used to induce and maintain anesthesia or
sedation
Indications: General anesthesia and/or sedation, rapid sequence intubation (RSI)
Contraindications: hypersensitivity, intra cranial pressure, impaired cerebral circulation
Side Effects: drowsiness, headache, nausea, vomiting, abdominal cramping,
twitching, ventricular asystole
Precautions: Severe cardiac and renal failure, epileptic/seizure patients, lactation
Interactions: Use caution with other CNS depressants
Routes of Administration: IV
Onset & Duration of actions: 30 sec - 1 min. ; 6 - 10 min.
Dosages:
Adult: 2 - 2.5 mg/kg
Pediatric: 2.5 -3.5 mg/kg
LA Co: N/A
LA Co Peds: N/A
Note: -Watch for respiratory depression, ventilate as needed
-Monitor blood pressure for hypotension
-Pain at injection site is common
-Milky white color
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prostaglandin E1
(Prostin VR Pediatric)
Classification:
vasodilator, hormone
Mechanism of Action: causes vasodilation, inhibits platelet aggregation, & stimulates
uterine & GI smooth muscle. Keeps ductus arteriosus open until surgical repair can be
made to congenitally malformed heart.
Indications: maintain patent ductus arteriosus in infants with cyanotic congenital heart
disease.
Contraindications:
none with indications
Side Effects: Flushing, bradycardia, hypotension, tachycardia, CHF, heart blocks,
dysrhythmias, seizures, hyperpyrexia, lethargy, apnea, respiratory depression
Precautions: Apnea may occur, monitor for respiratory depression
Interactions: none known
Routes of Administration: IV, IO
Onset & Duration of Action:
Dosages:
immediate, 1 minute
Adult: N/A
Pediatric:
0.05-0.1 mcg/kg/min
LA County:
N/A
Overdose Treatment:
Stop infusion if dysrhythmias develop.
Notes:
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racemic epinephrine
(Vaponefrin, Micronefrin)
Classification: Sympathomimetic, bronchodilator
Mechanism of action: Stimulates bronchial smooth muscle relaxation
Affects both Alpha and Beta adrenergic receptors
Indications: Croup (laryngotracheobronchitis), bronchospams
Contraindications: Epiglottitis
Side Effects: Anxiety, angina, tachycardia, palpitations, headache
Precautions: Use caution with elderly and patients with cardiac disease or cardiac
dysrhythmias, pregnancy (C).
Interactions: Use with other antihistamines and tricyclic antidepressants may cause
adverse cardiac effects
Routes of Administration: Inhalation (nebulizer)
Onset & Duration of actions:
Dosages:
3 - 5 minutes; 1 - 3 hours
Adult: 0.25 - 0.75 ml of a 2.25% solution in 2.0 ml of Normal Saline
Pediatric: 0.25 - 0.75 ml of a 2.25% solution in 2.0 ml of Normal Saline
LA Co: N/A
LA Co Peds: N/A
Note: -Monitor patient closely for dysrhythmias
-Dilute epinephrine 1:1000 of a 2.25% solution in 3 ml NS
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reteplase
(Retavase)
Classification: thrombolytic / fibrinolytic
Mechanism of Action: plasminogen activator that catalyzes the cleavage of endogenous
plasminogen to generate plasmin (which degrades thrombus matrix) causing
thrombolysis.
Indications: Acute myocardial infarction (AMI)
Contraindications: active internal bleeding, history of stroke, recent surgery or
trauma, brain tumor, aneurysm, severe uncontrolled hypertension
Side Effects: hemorrhage, embolism, ventricular fibrillation, CHF, cardiac arrest,
cardiac tamponade, pulseless electrical activity (PEA), pericarditis, anaphylactic reaction
Precautions: lactation, not recommended in children, pregnancy (C).
Interactions: abciximab, aspirin, dipyridamole, heparin, or vitamin K may increase
bleeding.
Routes of Administration: IV
Onset & Duration of Action: 13-16 minutes, 30 minutes
Dosages:
Adult: 10 U over 2 minutes, then 30 minutes later repeat
Pediatric:
not recommended
LA County:
N/A
Overdose Treatment:
Stop administration and treat for anaphylaxis in severe
hypersensitivity reaction, treat reperfusion dysrhythmias.
Notes:
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rocuronium
(Zemuron)
Classification:
paralytic, non-depolarizing neuromuscular blocker
Mechanism of Action: competitively binds with cholenergic receptor sites at the motor
end plates to antagonize the action of acetylcholine.
Indications: rapid sequence intubation (RSI), skeletal muscle relation
Contraindications:
hypersensitivity
Side Effects: bronchospasm, apnea, respiratory arrest, tachycardia, hypertension,
nausea, vomiting, urticaria.
Precautions: must aggressively maintain ventilation, pregnancy (C), renal & hepatic
disease.
Interactions: prolonged effects with succinylcholine, anesthetics, lidocaine, quinidine,
procainimide, beta blockers, diuretics, & magnesium
Routes of Administration: IV
Onset & Duration of Action: 60-90 seconds, 30 minutes
Dosages:
Adult: 600mcg/kg (0.6mg/kg)
maintenance dose = 100-200mcg/kg/min infusion
Pediatric:
0.6 mg/kg
LA County:
N/A
Overdose Treatment:
Prepare to intubate and aggressively mechanically ventilate
until paralysis subsides. For reversal, utilize combination of physostigmine,
edrophonium, &/or neostigmine.
Notes:
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sodium bicarbonate
(NaHCO3)
Classification: alkalizing agent, electrolyte, antidote
Mechanism of action: Neutralizes excess buildup of acid (binds with hydrogen ions to
form carbonic acid), helps restore normal pH, decreases precipitation of myoglobin in
renal tubules
Indications: Prolonged cardiac arrest with suspected hyperkalemia (dialysis patients) or
metabolic acidosis, tricyclic antidepressant overdose, crush syndrome with suspected
hyperkalemia or crush injury greater than 4 hours
Contraindications: None in emergency settings (Alkalotic states)
Side Effects: Alkalosis, pulmonary edema, seizures, cramps, hypokalemia,
hypocalcemia, increased tissue acidosis, headache, confusion, tetany
Precautions: Use with caution with CHF
Interactions: May form precipitate if mixed with calcium agents, may be deactivated by
catecholamines
Routes of Administration: IV, IO
Onset & Duration of actions:
Dosages:
Immediate; 1 - 2 hours
Adult: 1 mEq/kg
Pediatric: 1 mEq/kg
LA Co: 1 mEq/kg; Repeat 0.5 mEq/kg in 10 - 15 minutes
Crush syndrome : 1 mEq/kg added to first1000 ml NS
LA Co Peds: 1 mEq/kg slow IVP (10 ml/min) Repeat 0.5 mEq/kg in 10 15 minutes
Crush syndrome : 1 mEq/kg added to first1000 ml NS
Note: -Verify IV patency before administration of medication
-Flush before and after to avoid precipitation
-Crush Syndrome -Administer medication only if patients have sihns pf
hyperkalemia including peaked T waves, absent P waves, widened QRS
complexes or the crush force is more than 4 hours.
-Common signs & symptoms of tricyclic antidepressant OD: agitation, ataxia,
drowsiness, hyperactive reflexes, stupor, seizures, coma, dysrhythmis, CHF,
tachycardia, & widening QRS complex.
Commom tricyclic antidepressants:
 amitriptyline (Elavil, Endep)
 clomipramine (Anafranil)
 desipramine (Norpramin, Pertofrane)
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

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
doxepin (Adapin, Sinequan)
imipramine (Janamine, Tofranil)
nortriptyline (Aventyl, Pamelor)
protriptyline (Vivactil)
trimipramine (Surmontil)
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streptokinase
(Streptase)
Classification:
Thrombolytic / fibrinolytic
Mechanism of action:
plasminogen activator that catalyzes the cleavage of
endogenous plasminogen to generate plasmin (which degrades thrombus matrix) causing
thrombolysis.
Indications: acute myocardial infarction (AMI), deep vein thrombosis, pulmonary
embolism
Contraindications: hypersensitivity, active internal bleed, severe hypertension, stroke
of any form, ulcers, colitis, enteritis, renal and hepatic disease, COPD, any recent
surgery, cardiac valvular disorder.
Side Effects: Can cause severe internal bleeding, rash and urticaria, dyspnea,
anaphylaxis, bronchospasms, pulmonary edema, hypotension, headache, nausea,
vomiting, weakness, dizziness, dysrhythmias
Precautions: Pregnancy (Class C)
Interactions: anticoagulants increase bleeding
Routes of Administration: IV
Onset & Duration of actions:
Dosages:
onset immediate; duration <12hrs
Adult: AMI= 1,500,000 IU infused over 1hr
PE= 250,000 IU infused over 30mins, followed by 100,000 IU per
hour for 24-72hrs
Pediatric: N/A
LA County: N/A
Note: The sooner this drug is used the more effective it will be, however two 12 lead
ECG’s must be ran to compare. The goal in the emergency department (ED) is usually
<30min door to drug time. The side effects of thrombolytics are so devastating that
typically there is a sheet of contra indications that must be gone over with the patient
prior to administration. Start a second line prior to administration, and do not use IM as a
route post administration to avoid bleeding.
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succinylcholine
(Anectine)
Classification: Depolarizing neuromuscular blocking agent; paralytic
Mechanism of action:
Binds with cholinergic recpetor sites at neuromuscular
endplate and causes depolarization of skeletal muscle cells followed by paralysis due to
the continued binding of the receptor site and blockage of acetylcholine.
Indications:
rapid sequence intubation (RSI)
Contraindications: Hypersensitivity to the drug, narrow angle glaucoma, penetrating
eye injury (increases intraoccular pressure), malignant hyperthermia, myasthenia gravis,
risk of hyperkalemia (i.e. burns, crush injury).
Side Effects: Hypotension, bradycardia, prolonged respiratory depression,
bronchospasm, increased intraocular pressure, dysrhythmia, flushing of skin,
hyperkalemia.
Precautions: Patient with myasthenia gravis, burns, cardiac disease, pediatrics less than
two years old, elderly, respiratory disease, increases intragastric/occular/cranial pressures
Interactions: Diazepam may shorten duration. Theophylline and cardiac glycosides
may cause dysrhythmias. Narcotics and oxytocin may increase neuromuscular blockade.
Routes of Administration:
IV / IM
Onset & Duration of Action:
2-3 minutes
Dosages:
Adult:
IV onset 1 minute duration 6-10 minutes / IM onset
1-1.5 mg/kg IVP
3-4 mg/kg IM (max 150 mg)
Pediatric: 1-1.5 mg/kg IVP
LA County:
N/A
Notes:
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terbutaline
(Brethine)
Classification: Sympathomimetic; bronchodilator (also tocolytic with preterm labor)
Mechanism of Action: Relaxes bronchial smooth muscle, causing broachodilation, by
selectively acting on beta 2 adrenergic receptors; relaxes uterine smooth muscle
inhibiting contractions
Indications: Moderate-severe Asthma, bronchospasms associated with COPD. Also
used secondary to Magnesium Sulfate in premature labor to inhibit contradictions.
Contraindications:
Hypersensitivity, uncontrolled tachydysrythmias (relative).
Side Effects: Anxiety, dizziness, palpitations, tachycardia, other dysrhythmias,
hypertension, headache, premature ventricular contractions (PVCs), nausea, vomiting
Precautions: Patients with Cardiac disease, especially with dysrhythmias,
hypertension, diabetes mellitus, glaucoma, pregnancy (B)
Interactions: None in the field. Be aware; beta blockers will decrease actions of
terbutaline.
Routes of Administration:
SQ, IV infusion (preterm)
Onset & Duration of Action: immediate, 15 min.
Dosages:
Adult: Bronchodilation: 0.25 mg SQ (repeat in 15-30 min)
Tocolytic: 10mcg/min titrate to max of 80mcg/min
Pediatric: 0.01 mg/kg SQ (max 0.25 SQ)
LA County:
N/A
Notes:
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thiamine
(Vitamin B1, Biamine)
Classification: Water soluable vitamin
Mechanism of action: Coenzyme necessary for carbohydrate metabolism of glucose
Indications: Coma associated with delerium tremens or alcohol withdrawal prior to
Dextrose 50% (D50W), alcoholism/malnutrition or coma of unknown origin.
Contraindications: None in emergency setting
Side Effects: mild hypotension, weakness, nausea vomiting, diarrhea, sweating,
pulmonary edema
Precautions: None in emergency setting
Interactions: None
Routes of Administration: IV or IM
Onset & Duration of actions: immediate, unknown
Dosages:
Adult: 50-100 mg
Pediatric: 10-25 mg IV or IM
LA Co: N/A
LA Co Peds: N/A
Note -Medication should be administered prior to Dextrose 50%
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thiopental
(Pentothal)
Classification:
General anesthesia, sedative /hypnotic, barbiturate, CNS
depressant, Schedule III controlled substance
Mechanism of action: Ultra short acting barbiturate which causes depression of CNS
Indications: Rapid Sequence Intubation (RSI)
General anesthesia and/or sedation
Commonly used in conjunction with other anesthetics
Psychiatric disorders
Contraindications: Status asthmaticus and other respiratory diseases
Side Effects: Respiratory depression, respiratory apnea, laryngospasms, circulatory
collapse
Precautions: Coronary disease, hypotension, hepatic or renal dysfunction
Interactions: CNS depressants
Routes of Administration: IV
Onset & Duration of actions: 30 - 60 seconds; 10 - 30 minutes
Dosages:
Adult: 50 - 100 mg
Pediatric: 2 - 6 mg/kg, max of 100 mg
LA Co: N/A
LA Co Peds: N/A
Note: -Watch for respiratory depression, ventilate as needed
-Monitor blood pressure for hypotension
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trimethobenzamide
(Tigan)
Classification:
Anti-emetic
Mechanism of Action: Blocks the chemoreceptor trigger zones of the medulla oblongata
Indications: nausea & vomiting
Contraindications: hypersensitivity & children
Side Effects: blurred vision, diarrhea, dizziness, headache, muscle cramps, & allergic
symptoms
Precautions: dystonic reactions or extrapyramidal symptoms
Interactions: significant CNS depression may occur with use with barbiturates,
narcotics, alcohol, or tranquilizers.
Routes of Administration: IM only
Onset & Duration of Action:
Dosages:
onset 30-60min, duration, 4-6 hours
Adult: 200mg IM
Pediatric: not used
LA County: N/A
Notes:
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vasopressin
(Pitressin)
Classification:
Vasopressor, hormone
Mechanism of Action:
Acts by direct stimulation of smooth muscle receptors
causing smooth muscle constriction. Minimal beta effects (inotropy). This results in
blood being directed toward the vital organs along with increased return of spontaneous
circulation (ROSC) without increased oxygen demand.
Indications: Cardiac Arrest (to increase PVR with CPR) (V-Fib/V-Tach arrest only)
Esophageal varices (in-hospital setting)
Contraindications: chronic nephritis, ischemic heart disease, PVCs
Side Effects: pallor, abdominal cramps, nausea, hypertension, bradycardia, arrhythmias,
PACs, heart block, AMI
Precautions: Epilepsy, migraines, asthma, CHF, angina, renal disease, pediatrics,
geriatrics
Interactions: Alcohol, epinephrine, heparin, lithium, neostigmine
Routes of Administration: IV, IO
Onset & Duration of Action:
Dosages:
immediate, 30-60 minutes
Adult: 40 U IV (IVPB 0.2-0.4 U/min for varices)
Pediatric:
not recommended
LA County:
N/A
Overdose Treatment:
Stop use and treat underlying dysrhythmias.
Notes: Closely related to anti-diuretic hormone (ADH).
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vecuronium
(Norcuron)
Classification:
Non-depolarizing neuromuscular blocking agent, paralytic
Mechanism of action:
Inhibits neuromuscular transmission, competing for and
binding to with cholinergic receptor sites, which causes paralysis
Indications: rapid sequence intubation (RSI)
Contraindications: Neuromuscular diseases like myasthenia gravis, hypersensitivity
Side Effects: Prolonged paralysis, respiratory depression
Precautions: Pregnant women on magnesium sulfate, Children < 2 y/o, renal / hepatic
disease
Interactions: Concomitant use with narcotics can prolong paralysis and respiratory
depression
Routes of Administration: IV
Onset & Duration of actions:
Dosages:
onset 1-5min; duration 45-60min
Adult: 0.1mg/kg IVP
Pediatric: same as adult
LA County: N/A
Note: This drug is typically refrigerated
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verapamil
(Isoptin, Calan, Verelan)
Classification: Calcium channel-blocker, antihypertensive, antidysrhythmic, antianginal
Mechanism of action:
Inhibits calcium influx across cell membranes; relaxes
coronary vascular smooth muscle, decreases myocardial oxygen demand, decreases SA &
AV node conduction, decreases PVR
Indications: SVT/PSVT refractory to adenosine, Atrial fibrillation/flutter, hypertension,
angina
Contraindications: hypersensitivity, severe CHF, Sick Sinus Syndrome, 2nd & 3rd
degree heart blocks, systolic B/P <90 mmHg (severe hypotension)
Side Effects: weakness, dizziness, headache, CHF, bradycardia, hypotension, AV block,
tachycardia
Precautions: Hepatic and renal disease, pregnancy (C), Wolff-Parkinson-White
syndrome, hypotension
Interactions: Beta blockers should not be used concomitantly, may create digitalis
toxicity
Routes of Administration: IV
Onset & Duration of actions: onset 3min; duration 10-20min
Dosages:
Adult: 2.5-5mg, 2nd dose can be 5-10mg after 15-30 min (max total 30mg)
Pediatric: Infant: 0.1-0.2mg/kg (max 2.0 mg)
Child: 0.1-0.3mg/kg (max 5.0 mg)
LA County: N/A
Overdose Treatment:
Consider calcium chloride, fluid bolus, and glucagon.
Note:
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Pharmacological Classifications
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ACE Inhibitor:
inhibits the conversion of angiotensin I to
angiotensin II, therefore preventing vasoconstriction
Alkalinizing agent:
combines with hydrogen ions to increase blood pH
Analgesic:
relieve pain
Anticoagulant:
prevents or delays blood coagulation
Anticonvulsant:
stops or prevents seizure activity
Antidepressant:
utilized to treat depressive and obsessive
compulsive disorders
Antidote:
opposes the action of a poison
Antidysrhythmic:
prevent or control cardiac dysrhythmias
Antiemetic:
utilized to manage nausea and vomiting and may
also inhibit motion sickness
Antihistamine:
counteracts allergic responses
Antihypertensive:
lower blood pressures to normal levels
Anti-inflammatory:
decrease of inhibit the inflammation response to
decrease swelling
Antipyretic:
blocks pyrogens to decrease fever
Beta blocker:
blocks the effects of beta adrenergic stimulation
Bronchodilator:
dilates the smooth muscles of the bronchioles
Calcium channel blocker:
blocks the influx of calcium into muscle cells,
inhibiting contractility of cardiac and vascular
smooth muscles
Chemical Adsorbant:
adsorbs to chemical substances in the GI tract
Cholinesterase Inhibitor:
inactivates the chemical cholinesterase which is
necessary to breakdown the neurotransmitter
acetylcholine
Cholinesterase Reactivator: reactivates the chemical cholinesterase which is
necessary to breakdown the neurotransmitter
acetylcholine
Chronotropic agent:
affects heart rate (positive = increase, negative =
decrease)
CNS Depressant:
depresses normal function of the CNS resulting in
slowed bodily functions and decreased level of
consciousness
Diuretic:
increase to excretion of sodium and water, increase
quantity of urine production
Electrolyte:
ionized salts in the blood, tissue fluid, and cells
Emetic:
induces vomiting
Gas:
nonmetallic elements that exist in gaseous form at
room temperature
Hormone:
natural or synthetic substances that have a specific
effect on a target organ
Hyperglycemic agent:
elevates blood glucose levels
Hypnotic:
depresses mental status and produces a sleep like
state
Hypoglycemic agent:
decreases blood glucose levels
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Inotropic agent:

Mucolytic:

Narcotic analgesic:

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
Narcotic antagonist:
Paralytic:
Parasympathomimetic:

Parasympatholytic:

Sedative:

Sympathomimetic:

Sympatholytic:

Thrombolytic:

Tranquilizer:

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
Vasopressor:
Vasodilator:
Vitamin:
affects myocardial contractility (positive = increase,
negative = decrease)
decrease the production or viscosity of respiratory
secretions
relieves pain through suppression of CNS by
binding with opiate receptors
reverses the effects of narcotics
create inability to contract skeletal muscles
causes effects that mimic the parasympathetic
nervous system
blocks the effects of the parasympathetic nervous
system
depresses the CNS to create a soothing, tranquil
effect
causes effects that mimic the sympathetic nervous
system
blocks the effects of the sympathetic nervous
system
dissolves clots after their formation by promoting
the digestion of fibrin
produces a calming effect for agitated or anxious
patients
constricts blood vessels
dilates blood vessels
organic compounds that help maintain normal
metabolic functions, growth, and tissue repair
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References
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Amrican Academy of Pediatrics. (2000). Pediatric Education for Prehospital
Professionals, Sudbury, MA: Jones and Bartlett Publishers.
Azzara, AJ. (2000). Prehospital Providers’ Guide to Medication, Philadelphia,
PA: W.B. Saunders.
Beck, RK. (2002). Drug Reference for EMS Providers, Albany, NY: Delmar.
Bledsoe, BE, Clayden, DE, Papa, FJ. (2001). Prehospital Emergency
Pharmacology, 5th Edition, Upper Saddle Hill, NJ: Prentice Hall, Inc.
Bledsoe, BE, Porter, RS, Cherry, RA. (2000). Paramedic Care: Principles &
Practice, Upper Saddle Hill, NJ: Prentice Hall, Inc.
Cherry, RA, & Bledsoe, BE. (2001). Drug Guide for Paramedics, Upper Saddle
Hill, NJ: Prentice Hall, Inc.
Dalton, AL, Limmer, D, Mistovich, JJ, Werman, HA. (1999). Advanced Medical
Life Support, Upper Saddle Hill, NJ: Prentice Hall, Inc.
Deglin, JH, Vallerand, AH. (2003). Davis’s Drug Guide for Nurses, 8th Edition,
Philadelphia, PA: F.A. Davis Company.
Grajeda-Higley, L. (2000). Understanding Pharmacology: A Physiologic
Approach, Stamford, CT: Appleton & Lang.
Gonsoulin, SM, Sanders, MJ, Raynovich, W. (2002). Prehospital Drug
Therapy, St. Louis, MO: Mosby, Inc.
Hazinski, MF, Cummins, RO, Field, JM. (2000). 2000 Handbook of Emergency
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