1. Emergency Medications
Adult II 2015
Emergency Medications 1

2. National EMS Education Standard Competencies
Emergency Medications
Names
Effects
Indications
Routes of administration
Dosages for the medications administered

3. National EMS Education Standard Competencies
Emergency Medications (cont’d)
Actions
Contraindications
Complications
Side Effects
Interactions

4. AHA Classification of Recommendations and Level of Evidence
A treatment should be administered.
Class IIa
It is reasonable to administer treatment.
Class IIb
Treatment may be considered. 4

5. AHA Classification of Recommendations and Level of Evidence
Class III
Treatment should NOT be administered.
It is harmful, not helpful.
Class Indeterminate
Research is either beginning or continuing on this treatment.
Cannot be recommended for or against 5

6. Medication Listings Name of medication Class And other common names
How the medication is classified compared to other medications 6

7. Medication Listings Mechanism of action Indications Contraindications
The way a medication produces the intended response
Indications
Circumstance that shows cause or warning of disease
Contraindications
Any condition that renders some particular line of treatment improper or undesirable 7

8. Medication Listings Adverse reaction/side effects Drug interactions
An abnormal or harmful effect to an organism caused by exposure to a chemical
Drug interactions
Any potential effects a medication may have when administered with or in the presence of something else in the patient’s system 8

9. Adenosine (Adenocard)
Contraindications
Bronchoconstrictive or bronchospastic lung disease
Adverse reactions
Generally short duration and mild
Considerations
Evaluate elderly for signs of dehydration
Dose:by rapid IV bolus only given over 1_2 seconds administered directly into a vein or as proximal as possible ; follow with a rapid saline flush .
Classification:
anti arrhythmatic, diagnostic agent
Mechanism of action
Slows conduction through the AV node
Can interrupt reentrant pathways
The drug of choice for reentry SVT
Indications
Most forms of stable narrow-complex SVT 9

10. Albuterol (Proventil, Ventolin)
Mechanism of action
Results in smooth-muscle relaxation in the bronchial tree
Indications
Treatment of bronchospasm in patients with COPD/asthma)
Contraindications
Hypersensitivity reactions to albuterol
Adverse reactions
Often dose-related and include headache, fatigue, lightheadedness, irritability, restlessness
Considerations
Pregnancy safety: Category C
May precipitate angina pectoris and dysrhythmias 10

11. Alteplase, Recombinant (Tissue Plasminogen Activator or rTPA, Activase)
Classification: Thrombolytic agent
Mechanism of action
Restores perfusion
Indications
Acute myocardial infarction, STEMI, massive pulmonary emboli, acute ischemic cerebrovascular accident
Contraindications
Active internal bleeding
Recent surgery
Dose: 100mg IV over 2 hr, followed immediately by heparin therapy .
Adverse reactions
Intracranial bleeding, reperfusion dysrhythmias, chest pain, hypotension, GI bleeding, nausea, abdominal pain
Considerations
Monitor vital signs closely.
Observe for bleeding. 11

12. Amiodarone (Cordarone, Pacerone)
Classification antiarrhythmatic
Mechanism of action
Delays repolarization and increases the duration of action potential
Indications
Ventricular fibrillation
Contraindications
Known hypersensitivity to amiodarone or iodine
Cardiogenic shock
Dose:1000mg IV over 24hours,150 mg loading dose over 10min,followed
Over 6 hr at rate 1mg/min
For maintenance infusion 540mg at 0.5 mg / min over 18 hr .
Adverse reactions
Dizziness, fatigue, malaise
Congestive heart failure
Considerations
Pregnancy safety: Category D
Monitor patient for hypotension. 12

13. Aspirin (ASA) Adverse reactions Considerations Classification:
antiplatelet
Mechanism of action
Prevents platelets from clumping together and forming emboli
Indications
New onset chest pain suggestive of acute myocardial infarction
Contraindications
Relatively contraindicated in patients with active ulcer disease or asthma
Adverse reactions
Bronchospasm, anaphylaxis, wheezing in allergic patients, prolonged bleeding
Considerations
Pregnancy safety: Category D
Use cautiously with impaired renal function . 13

14. Atropine Sulfate Adverse reactions Considerations Classification:
Parasympathetic,Anticholinergic
Mechanism of action
Increases heart rate in life-threatening bradydysrhythmias
Indications
Hemodynamically unstable bradycardia
Contraindications
Tachycardia, hypersensitivity
Dose:
for bradycardia 0.4mg to1mg (up to 2 mg )IV every 1-2 hr as needed .
Adverse reactions
Drowsiness, confusion, headache, tachycardia, palpitations
Considerations
Pregnancy safety: Category C
Moderate doses may cause pupillary dilation. 14

15. Calcium Gluconate Adverse reactions Considerations
Classification:
Electrolytes
Mechanism of action
Helps maintain cardiac function
Indications
Hyperkalemia, hypocalcemia
Contraindications
Ventricular fibrillation, digitalis toxicity, hypercalcemia
Dose :infusion slowly ,0.5ml-2ml/min, (500mg /kg/day IV given in divided
Doses.
Adverse reactions
Syncope, cardiac arrest, dysrhythmia, bradycardia
Considerations
Pregnancy safety: Category C
Do not administer by IM or SQ,stop infusion if patient complains of discomfort; resume when symptoms disappear . 15

16. Clopidogrel (Plavix) Classification:Antiplatelet Mechanism of action
Inhibits platelet aggregation by blocking Adenosine diphosphate receptors on platelets(ADP), preventing clumping of platelets.
Indications
Acute coronary syndrome
Substitute for aspirin in patients unable to take aspirin
Dose: recent MI,stroke 75mg daily
ACS (Acute Coronary Syndrome )300mg PO loading dose , then 75mg/day with aspirin .
Contraindications
Active GI bleeding, intracranial hemorrhage
Adverse reactions
Severe neutropenia
Hemorrhaging
Considerations
Pregnancy safety: Category B
Often given with other anticoagulants 16

17. Dexamethasone Sodium Phosphate (Decadron)
Classification: corticosteroid ,Hormone
Mechanism of action
Suppresses acute and chronic inflammation
Indications
Anaphylaxis, asthma, spinal cord injury,cerebral edema associated with brain tumor ,craniotomy, or head injury .
Contraindications
Hypersensitivity, use caution in suspected systemic sepsis
Adverse reactions
Headache, restlessness, euphoria, psychoses
Considerations
Pregnancy safety: Category C
Protect medication from heat. Toxicity and side effects occur with long-term use. 17

18. Diazepam (Valium and Others)
Classification :
Benzodiazepine, Anxiolytic, Antiepileptic, Skeletal muscle relaxant (centrally acting ).
Mechanism of action
Raises the seizure threshold; induces amnesia and sedation
Indications
Acute anxiety states and agitation, acute alcohol withdrawal
Dose :Status epilepticus5-10mg by slow IV. May repeat q 5-10 min to total dose 30mg .
Contraindications
Hypersensitivity, narrow-angle glaucoma
Adverse reactions
Dizziness, drowsiness, confusion, headache
Considerations
Pregnancy safety: Category D
Short duration for anticonvulsant effect
Reduce dose by 50% in elderly patients. 18

19. Digoxin (Lanoxin) Classification : Mechanism of action Indications
Cardiac glycoside ,Cardiotonic
Mechanism of action
Increases force of myocardial contraction
Indications
Congestive heart failure, reentry SVTs, ventricular rate control in atrial flutter and atrial fibrillation
Dose:evaluate patient carefully to determine the appropriate dose
loading dose mg IV, maintenance dose mg /day PO .
Adverse reactions
Fatigue, headache, blurred yellow or green vision, seizures
Considerations
Pregnancy safety: Category C
Patient receiving IV digoxin must be on a monitor
Assessment for renal function , serum K+, Mg++ level.
Contraindications
Ventricular fibrillation, ventricular tachycardia, digitalis toxicity 19

20. Diltiazem (Cardizem) Adverse reactions Considerations
Classification :
Calcium channel blocker, antianginal ,antihypertensive .
Mechanism of action
Reduces myocardial oxygen demand
Indications
Controls rapid ventricular rates(Paroxysmal supra ventriculartachycardia , atrial fibrillation , atrial flutter.
Dose :direct IV bolus :0.25mg/Kg (20mg for the average patient ) second bolus of 0.35mg /kg .
Continuous IV infusion 5-10 mg /hr
Adverse reactions
Dizziness, weakness, headache, dyspnea
Considerations
Pregnancy safety: Category C
Use with caution in patients with renal or hepatic dysfunction.
Contraindications
Hypotension
Sick sinus syndrome 20

21. Dobutamine Hydrochloride (Dobutrex)
Classification:
Sympathomimetic ,Beta1 selective adrenergic agonist.
Mechanism of action
Increased myocardial contractility, stroke volume, and increased cardiac output
Indications
Cardiogenic shock, CHF
Dose :Administer only by IV infusion using an infusion pump
2.5mg -10mg /kg/min IV is ususl rate to increase cardiac output .
Adverse reactions
Headache, dyspnea, tachycardia, hypertension, chest pain
Considerations
Pregnancy safety: Category B
Monitor blood pressure closely.
Contraindications
Tachydysrhythmias, severe hypotension 21

22. Dopamine Hydrochloride (Intropin)
Classification:
Sympathomimetic
Alpha –adrenergic agonist , Beta1-selective adrenergic agonist, Dopaminergic drug .
Mechanism of action
Increases myocardial contractility and stroke volume
Indications
Cardiogenic and septic shock, hypotension with low cardiac output states
Dose :Administer only by IV infusion using an infusion pump
Initially 2-5mcg/kg/min IV patients who more seriously ill,5mcg/kg/min up to a rate of 20-50mcg/kg/min.
Adverse reactions
Headache, anxiety, dyspnea, dysrhythmias
Considerations
Pregnancy safety: Category C
Effects are dose-dependent
Contraindications
Hypovolemic shock, pheochromocytoma, tachydysrhythmias 22

23. Epinephrine (Adrenalin)
Classification: Sympathomimetic ,Alpha-adrenergic agonist,Beta1-and beta2- adrenegic agonist ,cardiac stimulant .
Mechanism of action
Blocks histamine receptors
Indications
Cardiac arrest, symptomatic bradycardia
Dode:cardiac arrest ;0.5IV during resuscitation q 5 min.
Adverse reactions
Nervousness, restlessness, headache, tremor
Considerations
Pregnancy safety: Category C
May cause syncope in asthmatic children
Contraindications
Hypertension, hypothermia, pulmonary edema 23

24. Furosemide (Lasix) Adverse reactions Considerations Contraindications
Classification : loop diuretic
Mechanism of action
Causes increased urine output
Indications
CHF, pulmonary edema, hypertensive crisis
Dose: in pulmonary edema 40 mg IV over 1-2 min.may be increased to 80mg IV given over 1-2 min if response unsatisfactory after 1 hour .
in hypertension 40mg bid. if needed additional anti hypertensive may be needed .
Adverse reactions
Dizziness, headache, ECG changes, weakness
Considerations
Pregnancy safety: Category C
Ototoxicity, deafness, and projectile vomiting can occur with rapid administration.
Contraindications
Hypovolemia, anuria, hypotension 24

25. Haloperidol Lactate (Haldol)
Classification :
Dopaminergic –blocking drug Antipsychotic.
Mechanism of action
Inhibits central nervous system catecholamine receptors
Indications
Acute psychotic episodes
Dose:IV unlabeled use for acute situations2-25mg IV q hr at arate of 5mg /min.
Adverse reactions
Seizures, sedation, confusion, restlessness
Considerations
Pregnancy safety: Category C
Treat hypotension secondary to haloperidol with fluids and norepinephrine, not epinephrine
Contraindications
Parkinson's disease, depressed mental status 25

26. Heparin Sodium Classification :Anticogulant Mechanism of action
Inhibiting thrombus and clot formation by blocking the conversion of prothrombin to thrombin and fibronogen to fibrin plasmin; does not lyses existing clots
Indications
Acute myocardial infarction, prophylaxis and treatment of thromboembolic disorders
Dose:Adjust dose according
To cogulation tests. Dosage is adequate when PTT=1.5-3 times control value .
Adverse reactions
Pain, anaphylaxis, shock, hematuria
Considerations
Pregnancy safety: Category C
Heparin does not lyse existing clots.
Contraindications
Hypersensitivity, active bleeding 26

27. Hydrocortisone Sodium Succinate (Solu-Cortef)
Classification :
corticosteroid short acting ,glucocorticoid ,Adrenal cortical steroid, hormone.
Mechanism of action
Anti-inflammatory; immunosuppressive with salt-retaining actions
Indications
Shock due to acute adrenocortical insufficiency, anaphylaxis, asthma, and COPD.
Dose: 100mg- 500mg initially and q 2-10h based on condition and response .
Adverse reactions
Headache, vertigo, pulmonary tuberculosis
Considerations
Pregnancy safety: Category C
May be used in status asthmaticus as a second-line drug
Contraindications
Systemic fungal infections, premature infants 27

28. Lidocaine Hydrochloride (Xylocaine)
Classification: Antiarrhythmatic ,local anesthetic .
Mechanism of action
Decreases automaticity of ventricular cells , increase ventricular fibrillation threshold .
Indications
Alternative to amiodarone in cardiac arrest from ventricular tachycardia
Dose :Arrhythmias, monitor ECG constantly ,give mg at rate of 25-50mg /min, 1/3 to 1/2the initial dose may be given after 5min if needed .do not exceed mgin 1 hr .
Adverse reactions
Anxiety, drowsiness, confusion, seizures
Considerations
Apnea induced with succinylcholine may be prolonged with high doses of lidocaine.
Exceedingly high doses can result in coma or death.
Contraindications
Hypersensitivity, second- or third-degree AV block in the absence of an artificial pacemaker 28

29. Magnesium Sulfate Classification: Mechanism of action Indications
Electrolyte Antiepileptic .
Mechanism of action
Reduces striated muscle contractions
Indications
Seizures of eclampsia, torsades de pointes, hypomagnesemia
Dose:
1-4 gm of a 10%-20%solution .Do not exceed 1.5 ml/min of a10% solution. or 4-5 gm in 250ml of 5%dextrose. Do not exceed 3ml / min .
Adverse reactions
Drowsiness, CNS depression, respiratory depression
Considerations
Pregnancy safety: Category A
Recommended that the drug not be administered in the 2 hours before delivery, if possible
Contraindications
Heart block, myocardial damage 29

30. Mannitol (Osmitrol) Dose: Classification : Mechanism of action
osmotic diuretic, diagnostic agent,
Mechanism of action
Decreases cerebral edema and intracranial pressure
Indications
Cerebral edema
Dose:
In reduction of intracranial pressure and cerebral edema:1.5-2 gm/kg as a 15%-25% solution over min.Evidence of reduced pressure should be seen in 15 min.
Adverse reactions
Headache, confusion, seizures, pulmonary edema
Considerations
Pregnancy safety: Category C
May crystallize at low temperatures; store at room temperature
Have ventilatory support available.
Contraindications
Hypotension, pulmonary edema, severe dehydration, intracranial bleeding, CHF 30

31. Methylprednisolone Sodium Succinate (Solu-Medrol)
Classification:
corticosteroid,glucocorticoid , hormone.
Mechanism of action
Suppresses acute and chronic inflammation
Indications
Acute spinal cord trauma, anaphylaxis, bronchodilator for unresponsive asthma
Dose:10-40mg IV administered over 1 min to several minutes .give subsequent dosesIVor IM.
Warning :Rapid IV administration of large doses (more than0.5mg-1gm in less than 10-20min)has caused serious cardiac complications.
Adverse reactions
Depression, euphoria, headache, restlessness, seizure
Considerations
Pregnancy safety: Category C
Not effective if time of spinal cord injury greater than 8 hours
Contraindications
Premature infants, systemic fungal infections 31

32. Midazolam Hydrochloride (Versed)
Classification:
Benzodiazepine (short acting )
CNS depressant
Mechanism of action
Causes sedative, anxiolytic, amnesic, and hypnotic effects
Indications
Sedation for medical procedures.
Continuous sedation of intubated and mechanically ventilated patients during treatment in critical care setting .
Adverse reactions
Headache, somnolence, respiratory depression
Considerations
Pregnancy safety: Category D
Administer immediately prior to intubation procedure.
Contraindications
Acute narrow-angle glaucoma, shock, coma, alcohol intoxication 32

33. Morphine Sulfate (Roxanol, MS Contin)
Classification: Opoid agonist analgesic .
Mechanism of action
Alleviates pain through CNS action
Indications
Severe CHF, acute cardiogenic pulmonary edema
Dose :2.5mg -15mg /70kg of body weight in 4-5ml water for injection administered over 4-5 min. Continuous IV infusion mg /ml in 5% dextrose in water by controlled infusion device .
Adverse reactions
Confusion, sedation, headache, CNS depression
Considerations
Pregnancy safety: Category C
Morphine rapidly crosses the placenta.
Contraindications
Head injury, exacerbated COPD, depressed respiratory drive 33

34. Naloxone Hydrochloride (Narcan)
Classification :
Opoid antagonist , Diagnostic agent .
Mechanism of action
Reverses respiratory depression secondary to opiate drugs
Indications
Opiate overdose, complete or partial reversal of central nervous system and respiratory depression induced by opioids
Dose:
Opoid overdose initial dose of mg IV additional doses may be repeated at 2-3 min intervals. If no response after 10mg question the diagnosis .
Contraindications
Use with caution in narcotic-dependent patients
Adverse reactions
Restlessness, seizures, dyspnea, pulmonary
Considerations
Pregnancy safety: Category C 34

35. Nitroglycerin (Nitrostat, Nitro-Bid, Tridil)
Classification:
Antianginal
Mechanism of action
Smooth muscle relaxant acting on vasculature, with a resultant decrease in venous return and decrease in arterial BP ,which reduces myocardial oxygen cosumption .
Indications
Acute angina pectoris, ischemic chest pain
Dose: Initial dose , 5mcg/min delivered through an infusion pump .inceased by 5mcg/min .if no response
20mcg/min.Once BP response is obtained reduce dose and llengthen dosage intervals. continually monitor response and titrate carefully .
Adverse reactions
Headache, dizziness, weakness, reflex tachycardia
Considerations
Pregnancy safety: Category C
Hypotension more common in the elderly
Contraindications
Hypotension, hypovolemia, intracranial bleeding or head injury 35

36. Norepinephrine Bitartrate (Levophed)
Classification:
Sympathomimetic
Alpha-adrenergic agonist ,Beta1adrenergic agonist , cardiac stimulant ,vasopresser.
Mechanism of action
Potent alpha-agonist resulting in intense peripheral vasoconstriction
Indications
Cardiogenic shock, unresponsive to fluid resuscitation
Dose :Add 4ml of the solution (1mg/ml)to 1000ml of 5% dextrose solution for a concentration of 4mcg base /ml
Initially give 8-12 mcg /min adjust dose gradually to maintain desired Bp .
Adverse reactions
Headache, anxiety, dizziness
Considerations
Pregnancy safety: Category C.
May cause fetal anoxia when used in pregnancy
Contraindications
Hypotensive patients with hypovolemia 36

37. Ondansetron Hydrochloride (Zofran)
Classification: Antiemetic
Mechanism of action
Blocks action of serotonin
Indications
Prevention and control of nausea or vomiting
Dose:
Prevention of chemotherapy - induced nausea and vomiting three 0.15mg /kg doses IV first dose is given over 15 min, before 30min of starting the chemotherapy .
Adverse reactions
Headache, malaise, wheezing
Considerations
Pregnancy safety: Category B
Contraindications
Known allergy to ondansetron 37

38. Oxygen Mechanism of action Indications Contraindications
Reverses hypoxemia
Indications
Confirmed or expected hypoxemia, ischemic chest pain
Contraindications
Certain patients with COPD will not tolerate oxygen concentrations over 35%.
Adverse reactions
Decreased level of consciousness (COPD patients), decreased respiratory drive in COPD patients
Considerations
Be familiar with liter flow and each type of delivery device used. 38

39. Phenytoin (Dilantin) Classification: Mechanism of action Indications
Antiepileptic , antiarrhythmic group Ib.
Mechanism of action
Promotes sodium efflux from neurons
Effective in treating cardiac arrhythmias, especially those induced by digitalis.
Indications
Prophylaxis and treatment of major motor seizures
Dose:
status epilepticus mg /kg by slow IV .for maintenance 100mg 6-8 hr .
Adverse reactions
Ataxia, agitation, dizziness, headache, drowsiness
Considerations
Pregnancy safety: Category D
Carefully monitor vital signs.
Contraindications
Hypersensitivity, bradycardia 39

40. Propofol (Diprivan) Adverse reactions
Mechanism of action
Produces rapid and brief state of general anesthesia
Indications
Anesthesia induction/ maintenance, sedation for mechanically ventilated patients
Dose:Inducción anestésicaIV: 1 – 2,5 mg/kgMantenimiento anestésicoPerfusión IV: 50 – 150 mcg/kg/minSedaciónDosis de carga IV: 0,25 – 1 mg/kgMantenimiento IV: 10 – 50 µg/kg/min
Adverse reactions
Seizure, apnea, dysrhythmias, asystole, hypotension, hypertension
Considerations
Pregnancy safety: Category B
Avoid rapid administration in elderly patients to avoid hypotension and airway obstruction.
Contraindications
Hypovolemia, known sensitivity 40

41. Propranolol Hydrochloride (Inderal)
Classification :
Beta-adrenergic blocker (nonselective) antianginal,antiarrhythmic.
Mechanism of action
Reduces chronotropic, inotropic, and vasodilator response to beta-adrenergic stimulation
Indications
Hypertension, angina pectoris
Dose : life threatening arrhythmias 1-3 mg IV with careful monitoring ,not to exceed 1mg /min .
Adverse reactions
Weakness, depression, fatigue, anxiety, dizziness, bronchospasm
Considerations
Pregnancy safety: Category C
Closely monitor patient during administration.
Use with caution in elderly patients.
Atropine should be readily available.
Contraindications
Sinus bradycardia, second- or third-degree AV block 41

42. Sodium Bicarbonate Adverse reactions Classification :
Electrolyte , systemic alkalinizer,
Mechanism of action
Buffers metabolic acidosis and lactic acid buildup
Indications
Metabolic acidosis during cardiac arrest.
Dose:for severe metabolic acidosis ,dose depends on blood CO2 content , PH, and patient clinical condition ,90-180mEq/L.IVduring first hour then adjust PRN.
Adverse reactions
Hypernatremia, metabolic alkalosis, tissue sloughing, cellulitis
Considerations
Pregnancy safety: Category C
Repeat as needed in tricyclic antidepressant overdose until QRS narrows
Contraindications
Metabolic/respiratory alkalosis, hypokalemia, electrolyte imbalance 42

43. Tirofiban Hydrochloride (Aggrastat)
Classification:
Antiplatelet
Mechanism of action
Inhibits aggregation of platelets
Indications
Acute coronary syndrome
Dose:
0.4mcg/kg/min infusion over 30min .then continue at rate of 0.1 mcg/kg/min.
Adverse reactions
Dizziness, pain, sweating, intracranial bleeding, CVA
Considerations
Pregnancy safety: Category B
Must be administered only with an infusion pump direct from bottle with a vented IV set
Severe spontaneous bleeding risk
Contraindications
Trauma or major surgery within the past 30 days 43

44. IV Solutions (Colloids and Crystalloids)
Expand plasma volume
Most often used in hypovolemic shock states
Crystalloid solutions are used for:
Electrolyte replacement
A route for medication
Short-term intravascular volume expansion 44

45. Dextran Mechanism of action Indications Contraindications
Sugar-containing colloid used as an intravascular volume expander
Indications
Hypovolemic shock
Contraindications
Patients with congestive heart failure, renal failure, or known bleeding disorders
Adverse reactions
Rash, itching, dyspnea, chest tightness, and mild hypotension
Considerations
In the management of burn shock, it is especially important to follow standard fluid resuscitation regimens to prevent possible circulatory overload. 45