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emergency drug .
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- Breathing pat. in labor
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- Breathing Pat. In Labor
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Emergency Drug IndexAbciximab Naloxone
Activated charcoal Nitroglycerin
Adenosine Nitropaste
Albuterol Nitroprusside
Alteplase Nitrous oxide/oxygen
Amiodarone Norepinephrine
Aspirin Ondansetron
Atenolol Oxygen
Atropine sulfate Oxytocin
Calcium chloride Pancuronium
Dexamethasone Phenytoin
Dextrose 50% Pralidoxime
Diazepam Procainamide
Digoxin Promethazine
Digoxin Immune Fab Propranolol
Diltiazem Reteplase
Diphenhydramine Sodium bicarbonate
Dobutamine Sotalol
Dopamine Streptokinase
Epinephrine Succinylcholine
Epinephrine racemic Tenecteplase
Eptifibatide Tetracaine
Esmolol Thiamine
Etomidate Tirofiban
Fentanyl Vasopressin
Flumazenil Vecuronium
Furosemide Verapamil
Glucagon
Haloperidol lactate
Heparin sodium DRUG IDENTIFICATION GUIDE
Hydromorphone The Emergency Drug Index is a list of commonly prescribed
Hydroxocobalamin medications that are used in prehospital care; it is not
Ibutilide intended to be a complete guide to all emergency medi-
Insulin cations. For additional drug information, consult other
Ipratropium standard references. Drugs included in this index are
Isoproterenol listed alphabetically by generic name. Common trade
Ketamine names are shown in parentheses following the generic
Ketorolac tromethamine listing.
Labetalol
Levalbuterol
Lidocaine
Lorazepam N OT E
Magnesium sulfate The way in which drugs are packaged and supplied
Mannitol varies by manufacturer. It is important that paramedics
Meperidine verify how a particular drug is supplied by their EMS service. In
Methylprednisolone addition, paramedics should verify the recommended dose or
Metoclopramide formula, know the indications and contraindications of any drug
Metoprolol they administer, and take all safety precautions. Any concerns
Midazolam hydrochloride regarding the dose or administration of any drug should be
Morphine sulfate guided by medical direction.
1574
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company
, Emergency Drug Index 1575
PREGNANCY CATEGORY INDICATIONS
RATINGS FOR DRUGS Patients with NSTEMI, unstable angina, or PCI within
24 hr
Drugs have been categorized by the Food and Drug
Administration according to the level of risk to the fetus. CONTRAINDICATIONS
These categories are listed for each drug herein under Active internal bleeding
“Pregnancy safety” and are interpreted as follows: Bleeding disorder
Category A: Controlled studies in women fail to demon- History of intracranial hemorrhage, neoplasm, AV malfor-
strate a risk to the fetus in the first trimester, and there mation, aneurysm, or stroke within 2 years
is no evidence of risk in later trimesters; the possibility Major surgical procedure or trauma within 6 weeks
of fetal harm appears to be remote. Aortic dissection, pericarditis, and severe hypertension
Category B: Either (1) animal reproductive studies have not Hypersensitivity to any GP IIb/IIIa inhibitor
demonstrated a fetal risk but there are no controlled Low platelet count (<100,000/mm3)
studies in pregnant women or (2) animal reproductive
studies have shown an adverse effect (other than ADVERSE REACTIONS
decreased fertility) that was not confirmed in controlled Anaphylactoid reaction/anaphylactic shock may occur
studies on women in the first trimester and there is no Bleeding (secondary to drug-induced platelet dysfunction)
evidence of risk in later trimesters. GI bleeding
Category C: Either (1) studies in animals have revealed Hematemesis
adverse effects on the fetus and there are no controlled Hematuria
studies in women or (2) studies in women and animals Hypotension
are not available. Drugs in this category should be given Intracranial bleeding
only if the potential benefit justifies the risk to the Platelet dysfunction
fetus. Retroperitoneal bleeding
Category D: Positive evidence of human fetal risk exists, but Stroke
the benefits for pregnant women may be acceptable Thrombocytopenia
despite the risk, as in life-threatening diseases for which
safer drugs cannot be used or are ineffective. An appro- DRUG INTERACTIONS
priate statement must appear in the “Warnings” section Concomitant use of other agents that may affect hemo-
of the labeling of drugs in this category. stasis, such as anticoagulants, other platelet inhibitors,
Category X: Studies in animals or human beings have dem- NSAIDs, and thrombolytic agents, may be associated with
onstrated fetal abnormalities, there is evidence of fetal an increased risk of bleeding.
risk based on human experience, or both; the risk of
using the drug in pregnant women clearly outweighs any HOW SUPPLIED
possible benefit. The drug is contraindicated in women 2 mg/mL (must be given with heparin)
who are or may become pregnant. An appropriate state-
ment must appear in the “Contraindications” section of DOSAGE AND ADMINISTRATION (ADULT)
the labeling of drugs in this category. PCI only: 0.25 mg/kg IV bolus (10-60 min before proce-
dure); then 0.125 mcg/kg/min (max 10 mcg/min) IV
infusion for 12 hr
ABCIXIMAB (REOPRO) ACS with planned PCI within 24 hr: 0.25 mg/kg IV bolus;
CLASS then 10 mcg/min IV infusion for 18-24 hr, concluding
Glycoprotein IIb/IIIa inhibitor 1 hr after PCI
DESCRIPTION SPECIAL CONSIDERATIONS
Glycoprotein IIb/IIIa inhibitors inhibit the integrin GP Pregnancy safety: Category C
IIb/IIIa receptor in the membrane of the platelets. As a Readministration may cause hypersensitivity reaction.
result, they inhibit the common final pathway activation
of platelet aggregation. Abciximab (in combination with ACTIVATED CHARCOAL (ACTIDOSE-
aspirin and heparin) is indicated for use in patients under-
going PCI as well as for the treatment of unstable angina
AQUA, ACTIDOSE, LIQUI-CHAR)
or NSTEMI infarction when PCI is planned within 24 hr. CLASS
Adsorbent, antidote
ONSET AND DURATION
Onset: 2 hr DESCRIPTION
Duration: Platelet aggregation restored within 24-48 hr Activated charcoal is a fine black powder that binds and
after infusion is stopped adsorbs ingested toxins. Once the drug binds to the
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company
,1576 Emergency Drug Index
activated charcoal, the combined complex is excreted in
the feces.
ADENOSINE (ADENOCARD)
CLASS
ONSET AND DURATION Endogenous nucleoside, miscellaneous antidysrhythmic
Onset: Immediate
Duration: Continual while in gastrointestinal tract; reaches
equilibrium once saturated DESCRIPTION
Adenosine primarily is formed from the breakdown of
INDICATIONS adenosine triphosphate. Adenosine triphosphate and ade-
Many oral poisonings and medication overdoses nosine are found in every cell of the human body and have
a wide range of metabolic roles. Adenosine slows supraven-
CONTRAINDICATIONS tricular tachycardias by decreasing electrical conduction
Corrosives, caustics, petroleum distillates (relatively through the atrioventricular node without causing negative
ineffective and may induce vomiting) inotropic effects. It also acts directly on sinus pacemaker
cells and vagal nerve terminals to decrease chronotropic
ADVERSE REACTIONS (heart rate) activity. First drug of choice for most forms of
May indirectly induce nausea and vomiting. stable, narrow-complex SVT. May be considered for unsta-
May cause constipation or mild, transient diarrhea. ble narrow-complex reentry tachycardia while preparing for
cardioversion. Adenosine does not convert atrial fibrilla-
DRUG INTERACTIONS tion, atrial flutter, or VT.
Syrup of ipecac (adsorbed by activated charcoal and will
result in vomiting of the charcoal)
ONSET AND DURATION
HOW SUPPLIED Onset: Immediate
25 g (black powder)/25g/125mL bottle (200 mg/mL) Duration: 10 sec
50 g (black powder)/50g/240ml bottle (200 mg/mL)
Other sizes include 15 g and 30 g, bottles and squeeze
tubes. Most products come premixed (not powder) INDICATIONS
with water (aqueous preparations) or with sorbitol, a First drug for most forms of narrow-complex paroxysmal
cathartic. supraventricular tachycardia and dysrhythmias associ-
ated with bypass tracts such as Wolff-Parkinson-White
DOSAGE AND ADMINISTRATION (WPW) syndrome in adults and pediatric patients.
From 1 to 2 g/kg body mass (larger amounts if food In undifferentiated regular stable wide-complex tachy-
is also present), prepared in a slurry and admin- cardia, IV adenosine may be considered relatively safe.
istered PO or slowly via nasogastric or orogastric It may convert the rhythm to sinus, and may help diag-
tube nose the underlying rhythm.
Adult: 30-100 g
Pediatric (1-12 yr): 15-30 g or 1-2 g/kg
Infant (less than 1 yr): 1 g/kg CONTRAINDICATIONS
Drug-induced tachycardia
SPECIAL CONSIDERATIONS Second- or third-degree atrioventricular block
Pregnancy safety: Category C Hypersensitivity to adenosine
Charcoal frequently is administered to pregnant patients, Atrial flutter, atrial fibrillation, ventricular tachycardia,
and the potential benefit versus risk is very high. WPW with atrial fibrillation/flutter. (Adenosine is not
Because charcoal remains within the gastrointestinal effective in converting these rhythms to sinus rhythm.)
tract, its risk to the fetus virtually is eliminated,
unless the charcoal and other stomach contents are
aspirated. ADVERSE REACTIONS
Activated charcoal also may be known as “AC.” Facial flushing
Activated charcoal is relatively insoluble in water. Light-headedness
Activated charcoal may blacken feces. Paresthesias
Activated charcoal must be stored in a closed container. Headache
Different charcoal preparations may have varying adsorp- Diaphoresis
tive capacity. Palpitations
Activated charcoal does not adsorb all drugs and toxic sub- Chest pain
stances (e.g., phenobarbital, aspirin, cyanide, lithium, Flushing
iron, lead, and arsenic). Hypotension
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company
, Emergency Drug Index 1577
Shortness of breath ALBUTEROL (PROVENTIL
Transient periods of sinus bradycardia, sinus pause, or
bradyasystole
AND OTHERS)
Ventricular ectopy (fibrillation, flutter, tachycardia, tor- CLASS
sades de pointes) Sympathomimetic, bronchodilator, beta2 agonist
Nausea
Metallic taste DESCRIPTION
Albuterol is a sympathomimetic that is selective for
beta2-adrenergic receptors. It relaxes smooth muscles of
DRUG INTERACTIONS the bronchial tree and peripheral vasculature by stimu-
Methylxanthines (e.g., caffeine and theophylline) antag- lating adrenergic receptors of the sympathetic nervous
onize the action of adenosine. system.
Dipyridamole potentiates the effect of adenosine; reduc-
tion of adenosine dose may be required. ONSET AND DURATION
Carbamazepine may potentiate the atrioventricular-nodal Onset: 5-8 min after inhalation
blocking effect of adenosine. Duration: 2-6 hr after inhalation
INDICATIONS
HOW SUPPLIED Relief of bronchospasm in patients with reversible obstruc-
Parenteral for IV injection tive airway disease
3 mg/mL in 2-mL and 5-mL flip-top vials Prevention of exercise-induced bronchospasm
Anaphylaxis
Hyperkalemia
DOSAGE AND ADMINISTRATION
Adult: Initial dose: 6-mg rapid IV bolus over 1-3 sec, fol- CONTRAINDICATIONS
lowed by a 20-mL saline bolus; then elevate extremity. A Prior hypersensitivity reaction to albuterol or levalbuterol
second dose (12 mg) may be given in 1-2 min if needed. Cardiac dysrhythmias associated with tachycardia
Injection technique: Place patient in mild reverse (precaution)
Trendelenburg position before drug administration.
Record ECG during drug administration. Draw up ADVERSE REACTIONS
adenosine and flush in 2 separate syringes. Attach both Usually dose-related
syringes to the IV injection port closest to the patient. Restlessness, apprehension
Clamp IV tubing above injection port. Push adenosine Dizziness
as quickly as possible (1-3 sec). Maintain pressure on Palpitations, tachycardia
adenosine plunger while pushing saline flush as rapidly Dysrhythmias
as possible after adenosine. Unclamp IV tubing. Tremors
Pediatric: Initial dose 0.1 mg/kg IV/IO (max single dose:
6 mg); second dose 0.2 mg/kg IV/IO rapid push; fol- DRUG INTERACTIONS
lowed with 5-10 mL NS flush1 Other sympathomimetics may exacerbate adverse cardio-
vascular effects.
MAO inhibitors and tricyclic antidepressants may
SPECIAL CONSIDERATIONS potentiate effects on the vasculature (vasodilation).
Pregnancy safety: Category C Beta blockers may antagonize albuterol.
A brief period of asystole (up to 15 sec) following conver- Albuterol may potentiate diuretic-induced hypokalemia.
sion, followed by resumption of normal sinus rhythm,
is common after rapid administration. HOW SUPPLIED
Reduce initial dose to 3 mg in patients receiving dipyridam- Metered-dose inhaler: 90 mcg/metered spray (17-g canister
ole or carbamazepine, in heart transplant patients, or if with 200 inhalations)
given by central venous access. Solution for aerosolization: 0.5% (5 mg/mL); 0.083%
Patients taking theophylline or caffeine may require larger (2.5 mg) in 3-mL unit dose/nebulizer
doses of adenosine.
Deterioration (including hypotension) may result if given DOSAGE AND ADMINISTRATION
for irregular, polymorphic wide-complex tachycardia/ Bronchial Asthma/Anaphylaxis/Hyperkalemia
VT. Adult:
Adenosine may produce bronchoconstriction in patients Metered-dose inhaler: 1-2 inhalations (90-180 mcg) q
with asthma and in patients with bronchopulmonary 4-6 hr (wait 5 min between inhalations); max 12
disease. inhalations/day
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company
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