Drug Name

Adenosine

(Adenocard)

Mechanism Of Action

·        Slows Conduction through AV node

·        Interrupts AV nodal reentry pathways

Indications

·        Defined, stable, narrow-complex AV or sinus nodal reentry tachycardia (reentry SVT)

·        ACLS Class I Recommendation

Precautions

·        Transient bradycardia (asystole!), ventricular ectopy, flushing, dyspnea, and chest pain

·        Caution in patients prone to bradycardia or conduction defects without pacemaker

Misc

(drug interactions)

·        Reduce dose to 3 mg – Dispyridamole, Carbamazepine, Cardiac Transplant, CVL Admin

·        Dose at 12 mg – Theophylline, Caffeine

Diagnostic

·        Undefined, stable narrow-complex SVT

·        Will not convert atrial tachycardias or VT as reentry not involving the AV or sinus node

Dose

·        6mg rapid IVP  followed by immediate saline flush

·        May repeat with 12 mg rapid IVP followed by immediate saline flush if no conversion

Drug Name

Albuterol

(Proventil, Ventolin)

Mechanism Of Action

·        Sympathomimetic, Beta2 selective adrenergic bronchodilator

·         

Indications

·        Albuterol is used to treat reversible airway obstruction caused by

·        Wheezing associated with Asthma

·        COPD

·        Chronic Bronchitis

Precautions

·        Hypersensitivity

Misc

(drug interactions)

·        Beta adrenergic agents – potentiates the effects

·        MAO inhibitors-may lead to hypertensive crisis

·        Beta adrenergic blockers-decreases effectiveness

Dose

·        Adult - (2.5-5 mg) up to (10mg) in 3 ml sterile NS, inhaled of 5-10 minutes

·        Pedi - (2.5-5 mg) up to (5mg) in 3 ml sterile NS, inhaled of 5-10 minutes

Special Notes

·        Most side effects are dosage related

·        May decrease arterial oxygen tension acutely by causing bronchodilation in areas of lungs with poor blood perfusion

·        Possible severe paradoxical airway resistance with repeated excessive use

Drug Name

Amiodarone

(Cordarone)

Mechanism Of Action

·        Delays repolarization (prolongs refractory period)

·        Blocks A & B adrenergic receptors

·        Affects sodium, potassium, and calcium channels

Indications

·        Persistent pr recurrent VF / pulseless VT

·        ACLS Class II Recommendation

·        Effective in Atrial & Ventricular arrythmias

Precautions

·        Hypotension, dizziness, fatigue, N/V

·        Significant bradycardia & heart block

·        Pulmonary & hepatic toxicities

Misc

(drug interactions)

·        Provided as 150 mg syringe

·        Multiple drug interactions

Dose

·        Cardiac Arrest(VF/pulseless VT) given as 300 mg rapid IV infusion in 20-30 mL D5W

·        One supplement dose of 150 mg may be given in 3-5 min if refractory VF/pulsless VT

·        VT(with pulse), dose is 150 mg IV every 10 minutes

Continuous Infusion Dose

·        Max of 2.2 grams/24 hours

·        150 mg in 50 mL D5W over 10 minutes

Please read and study local Protocols

Drug Name

Atropine

Mechanism Of Action

·        Enhances sinus node automaticity & AV conduction

·        Parasympatholytic (direct vagolytic action)

Indications

·        Symptomatic bradycardia

• ACLS Class I recommendation
• 1^st degree AV Block
• ACLS class IIa recommendation
• Mobitz type 1 AV block
• ACLS class IIb recommendation
• Slow PEA/Asystole
• ACLS class indeterminate recommendation

Precautions

·        Existing tachycardia

·        Avoid in hypothermic bradycardia

·        Increases myocardial O2 demand

Misc

·        May be used for organophosphate poisoning

·        Extremely large doses may be needed in this case (2-4 mg or higher with exposure to nerve agent)

Dose

·        Symptomatic Bradycardia: .5 mg IV

·        Doses less than .5 mg may cause paradoxical bradycardia

·        Do not delay pacing for symptomatic patients

·        Cardiac Arrest

·        Cardiac Arrest: 1 mg IV

·        Repeat dose every 5 minutes to total of 3 mg

·        Fully vagolytic at 3 mg

·        ACLS guideline for max dose is .04mg/kg

·        May give ET

Drug Name

Benadryl

(Diphenhydramine)

Mechanism Of Action

·        Antihistamine

·        Blocks histamine receptors, has some sedative effect

Indications

·        Anaphylaxis, allergic reactions, dystonic reactions due to phenothiazines

Precautions

·        Hypotension

·        Asthma

·        Nursing Mothers

Side Effect

·        Sedation, Dries bronchial secretions, blurred vision, headache, palpitations

Diagnostic

·        Hives, Itching

Dose

·        25-50 mg Slow IV push or Deep IM

·        Pedi – 2-5 mg/kg

Drug Name

Dextrose 50%

Mechanism Of Action

·        Carbohydrate

·        Elevates blood glucose level rapidly

Indications

·        Hypoglycemia

Precautions

·        A blood sample should be drawn before administration

Misc

Side Effects

·        Local venous irritation

Diagnostic

·        Blood sugar less than 60mg/dl combined with a diminished level of consciousness

Dose

·        25 grams

·        Pedi - .5g/kg slow IV push; dilute 1:1 with sterile water to form a 25% solution

Drug Name

Epinephrine

(Adrenaline)

Mechanism Of Action

·        A and B adrenergic activity

Indications

·        VF/ pulseless VT unresponsive to defib

• ACLS class IIb recommendation
• Asystole/Pea
• ACLS class indeterminate recommendation
• Symptomatic Bradycardia, severe hypotension, anaphylaxis

Precautions

·        Tachycardia, hypertension, pulmonary edema

·        Myocardial Ischemia, Angina

·        Increased myocardial O2 demand

·        Overdose treatment is supportive

Misc

·        Provided as 1:10,000 prefilled 10mL=1mg

·        Provided as 1:1000 vial 1 mL=1mg

Dose

·        Standard dose = 1 mg every 3-5 minutes

·        Follow dose with saline

·        May be given ET

·        Epinephrine Drip – Initiate at 1mcg/min, titrate to hemodynamic endpoint (2-10 mcg/min)

Drug Name

Dopamine

(Intropin)

Mechanism Of Action

·        Increases cardiac contractility, causes periphel vasoconstriction

Indications

·        Hemodynamically significant hypotension, not resulting from hypovolemia, cardiogenic shock

Precautions

·        Should not be administered in the presence of severe tachyarythmias

·        Should not be administered in the presence of ventricular fibrillation, ventricular irritability

Misc

(Contraindications)

·        Hypovolemic shock where complete fluid resuscitation has not occurred

Dose

·        400 mg in 250 cc of D5W IV add mixture at 10-30 microdrips/minute, titrate to BP

Drug Name

Sodium Bicarbonate

Indications

·        Hyperkalemia

·        ACLS class I recommendation

·        Tricyclic Antidepressant Overdose

·        ACLS class IIa recommendation

·        Phenobarbital overdose, preexisting acidosis, prolonged arres

Dose

·        1 mEq/kg initial, then ½ dose every 10 min

Precautions

·        Monitor ABG’s, paradoxical acidosis due to CO2 diffusion & deleterious shift in oxygen dissociation curve

·        ACLS class II recommendation if not intubated & hypercarbic acidosis

Drug Name

Magnesium Sulfate

Mechanism Of Action

·         

Indications

·        Torsades de pointes

·        ACLS class IIb recommendation if known or suspected hypomagnesaemia

Dose

·        Dose based on patient stability: 1-2 gm

·        In 10 mL NS over 1-2 minutes in cardiac arrest

·        In 50 mL over 5-60 minutes in Torsades w/ pulse

·        Follow with infusion of .5 to 1 gm/hr for up to 24 hr

Dose

·         

Drug Name

Vasopressin

Mechanism Of Action

·        Naturally occurring antidiuretic hormone

·        Acts as non-adrenergic peripheral vasoconstrictor

·        Direct Stimulation of smooth muscle V1 receptors

·        No beta effects

·        Levels higher in patients who survive CPR

Indications

·        VF/pulseless VT unresponsive to defib

• ACLS class IIb recommendation
• Asystole/PEA
• ACLS class indeterminate recommendation
• Vasodilatory Shock
• May be helpful in prolonged arrest
• Longer half-life than epi

Precautions

·        Hypertension, Tremor

·        Myocardial Ischemia, Angina

·        Overdose treatment is supportive

·        Consider osmotic diuretics if severe overdose

Misc

·        Provided as 20 unit/mL ampule

Dose

·        Dose is 40 units IV x 1 dose

·        Re-dosing (Class Indeterminate)

·        No response in 10-20 minutes, resume epi

·        Re-dosing vasopressin seems rational, but is not supported

Drug Name

Naloxone

(Narcan)

Mechanism Of Action

·        Reverses opiate activities, including respiratory depression from natural & synthetic opioids

Indications

·        Opiate or other Narcotic overdose

Misc

·        Duration of 20-60 min, typically shorter than most opioids so will need repeat doses

Dose

·        .4-2 mg every 2-3 minutes up to 10mg

Drug Name

Morphine

Mechanism Of Action

·        CNS depressant, causes peripheral vasodilatation, decreases sensitivity to pain

Indications

·        Severe Pain, pulmonary edema

Precautions

·        Respiratory depression, hypotension, nausea

Misc

·        Dizziness, altered LOC

Dose

·        2-5 mg followed by 2 mg every few minutes until pain relief

·        IM 5-15 mg based on patient weight

·        Pedi- .1-.2 mg/kg IV

Drug Name

Racemic Epinephrine

(Micronefrin, VapoNefrin)

Mechanism Of Action

·        Sympathomimetic

·        Bronchodilation, Increases Heart Rate, Increases cardiac contractile force

Indications

·        Croup

Precautions

·        Vital Signs should be monitored

·        Use only once prehospital

Misc

Side Effects

·        Palpitations, anxiety, headache

Dose

·        Inhalation only

·        .5-.75 ml of a 2.25% solution in 2.0 mL of NS

·        >1 or > 10 kg - .5 ml in 3 mL NS over 15 minutes

·        <1 or < 10 kg - .25 ml in 3 mL NSover 15 minutes

Drug Name

Furosemide

(Lasix)

Mechanism Of Action

·        Inhibits reabsorption of sodium chloride, promotes promt diuresis, vasodilation

Indications

·        Congestive heart failure

Precautions

·        Protect from sunlight

Misc

Contraindications

·        Pregnancy, dehydration

Dose

·        40-80 mg IVP

·        Pedi – 1 mg/kg

Drug Name