1
Class-Narcotic (opioid)
Action-Analgesia and sedation through binding of opiate receptors
Indications-moderate to severe pain
Contraindications-Hypotension, hypersensitivity to the drug
Doses-2-10 mg
Routes-IV, IO, IM, SQ, PO
Adverse Effects-Hypotension, Syncope, Tachycardia, Bradycardia, Apnea, Nausea, Vomitting, Respitory depression
Other-Use appropriate monitors. Naloxone is an antagonist
Morphine
Duramorph
Class-NSAID
Action-Anti-inflammatory and antipyretic through inhibition of prostaglandins
Indications-Mild to moderate pain, fever, inflammation, renal colic
Contraindications-Hypersensitivity to the drug, bronchospasm, angioedema
Doses-30 mg (IV and the elderly) 60 mg IM
Routes-IV, IM
Adverse Effects-Nausea, Vomiting, GI bleeding, Allergic reactions
Other-Can cause dizziness and headache
Ketorolac
Torodal
Class-Benzodiazepine
Action-Binds to Type A GABA receptors causing seation
Indications-Anxiety, Seizures, Sedation
Contraindications-History of hypersensitivity to the drug
Doses-1-4 mg
Routes-IV, IM, IO, PO, rectal
Adverse Effects-Hypotension, Sedation, Amnesia, Respitory depression, Nausea, Vomiting
Other-Flumazenil is an antagonist
Lorazepam
Ativan
Class-Butyrophenone
Action-Blocks dopamine receptors associated with mood and behavior
Indications-Psychosis
Contraindications-Hypotension, Hypersensitivity to the drug
Doses-15-69yoa 5 mg, >69yoa 2.5 mg, 12-14yoa 2.5-5 mg, 6-11yoa 0.05 mg/kg max 2.5 mg, <6yoa contraindivated, NR 2-10 mg
Routes-IM, PO
Adverse Effects-Extrapyramidal reactions, Insomnia, Restlessness, Dry mouth, Hypotension, Tachycardia
Other-Hypotension more common in patients taking antihypertensives
Haloperidol
Haldol
Class-Sympathetic agonist
Action-α- and β- adrenergic agonist
Indications-Normovolemic hypotension, Symptomatic bradycardia, Septic shock, Cardiogenic shock
Contraindications-Should not be used in hypovolemia until volume replacement has occured
Doses-2-20 mcg/kg/min (titrate to effect)
Routes-IV
Adverse Effects-Palpations, Anxiety, Tremulousness, Headache, Dizziness, Hypertension, Can worsen cardiac ischemia, Reflex bradycardia
Other-Extravasation can cause localized tissue damage, Best administered through a central line, Proposed renal benefit has been disproven
Dopamine
Intropin
Class-Narcotic (opioid)
Action-Analgesia and sedation through binding to opiate receptors
Indications-Moderate to severe pain
Contraindications-Hypersensitivity to the drug
Doses-0.5-2 mg
Routes-IV, IO, IM, SQ, PO
Adverse Effects-Nausea, Vomitting, Cramps, Respitory depression
Other-use appropriate monitors. Naloxone is an antagonist
Hydromophone
Dilaudid
Class-NSAID
Action-Platlet inhibitor, Anti-inflammatory and antipyretic through inhibition of thromboxane A2
Indications-Chest pain when acute myocardial infarction is suspected, Mild to moderate pain, Fever, Platelet aggregation inhibitor
Contraindications-Hypersensitivity to the drug, Bronchospasm, Angioedema, Patients receiving MAOIs
Doses-Pediatric:not indicated, Adult: 324 mg or 325 mg chewed. NR 350-650 mg
Routes-PO
Adverse Effects-Heartburn, Wheezing, Nausea, Vomiting, GI bleeding, Allergic reactions
Other-commonly causes gastric upset, avoid enteric-coated asperin in chest pain
Aspirin
Class-Dissociative anesthetic
Action-Causes dissociation between the cortical and limbic system
Indications-Sedation, Analgesia
Contraindications-History of hypersensitivity to the drug, Hypertension
Doses-0.5-1 mg/kg (IV), 2-4 mg/kg (IM)
Routes-IV, IM
Adverse Effects-Hallucinations
Other-All monitors should be in place, Resuscitative equipment should be immediately available
Ketamine
Ketalar
Class-Muscarinic anticholinergic (Parasympatholytic)
Action-Selectively blocks muscarinic receptors inhibiting parasympathetic stimulation
Indications-Bradycardia, Antidote for organophosphate poisoning, Premedication for RSI
Contraindications-Hypersensitivity to the drug
Doses-0.5-2 mg
Routes-IV, IO
Adverse Effects-Blurred vision, Dry mouth, Dilated pupils, Confusion
Other-Organophosphate poisonings may require a significantly higher dose
Atropine
Class-β-agonist
Action-β-agonist with preference for β2 adrenergic receptors
Indications-Bronchospasm, Allergies/anaphylaxis, Hyperkalemia
Contraindications-Known Hypersensitivity to the medication
Doses-2.5 mg (SVN), 90 mcg (MDI)
Routes-Inhalation
Adverse Effects-Palpations, Anxiety, Tremulousness, Headache, Dizziness, Tachycardia
Other-The patient's heart rate and SpO2 should be monitored during treatment
Albuterol
Ventolin, Proventil
Class-Narcotic (opioid)
Action-Analgesic through binding to opiate receptors
Indications-Moderate to severe pain. Anesthetic
Contraindications-Hypersensitivity to the drug
Doses-50-100 mcg
Routes-IV, IO, IM, SQ, IN
Adverse Effects-Nausea, Vomitting, Cramps, Chest wall rigidity, Respitory depression
Other-Use appropriate monitors. Nalaxone is an antagonist
Fentanyl
Sublimaze
Class- Opiate antagonist
Action-Opioid antagonist w/o opiate agonist properties (it has no activity when given in the absence of an opiate agonist)
Indications-Partial reversal of opiate drug effects, opiate overdose
Contraindications-Hypersensitivity to the drug
Doses-0.4-2 mg
Routes-IV, IO, SQ, IN, Nebulizer
Adverse Effects-Fever, Chills, Nausea, Vomiting, Diarrhea, Opiate withdrawal
Other-Administer enough to reverse respitory depression and avoid full narcotic withdrawal syndrome
Naloxone
Narcan
Class-Sedative/ anesthetic gas
Action-CNS depressant
Indications-Pain, Sedation
Contraindications-COPD, Pneumothorax, Bowel obstruction
Doses-Self-administered
Routes-Inhalation
Adverse Effects-Dizziness, Hallucinations, Nausea, Vomiting, Altered mental status
Other-Should not be used in any patient who cannot comprehend verbal instructions or who is intoxicated with alcohol or other medications
Nitrous Oxide
Class-Muscarinic anticholinergic (parasympatholytic)
Action-Selectively blocks muscarinic receptors inhibiting parsympathetic stimulation
Indications-Bronchospasm associated with obsructive lung disease (asthma, COPD)
Contraindications-Hypersensitivity to the drug
Doses-500 mcg
Routes-Inhaled
Adverse Effects-Blurred vision, Dry mouth, Dilated pupils, Cough, Confusion
Other-Typically administered with a beta agonist (although not as frequently)
Ipratropium
Atrovent
Class-β-agonist
Action-β-agonist with preference for β2 adrenergic receptors. It is racemic isomer of albuterol
Indications-Bronchospasm, Allergies/anaphylaxis, Hyperkalemia
Contraindications-Known Hypersensitivity to the medication
Doses-0.63 mcg (SVN)
Routes-Inhalation
Adverse Effects-Palpations, Anxiety, Tremulousness, Headache, Dizziness, Tachycardia
Other-The patient's heart rate and SpO2 should be monitored during treatment
Levalbuterol
Xopenex
Class-Nonnarcotic analgesic, antipyretic (para-aminophenol derivative)
Action-Exact mechanism uncertain but felt to inhibit cyclooxygenase
Inications-Mild-moderate pain, fever
Contraindications-Hypersensitivity to the drug, alcoholism, chronic liver disease, head injury, hypotension, previously taken the drug, inability to swallow, respitory distress, persistent vomitting, under 3 years of age
Doses-3-5 yo 160mg/5ml, 6-9 yo 320mg/10ml, 10 yo an up 640mg/20ml, NR 325-650 mg
Routes-PO
Adverse Effects-Not clinically significant
Other-can be liver toxic- use minimal dose necessary
Acetaminophen
Tylenol
Class-Benzodiazepine
Action-Binds to Type A GABA receptors causing seation
Indications-Anxiety, Seizures, Muscle relaxation
Contraindications-History of hypersensitivity to the drug
Doses-2-10 mg
Routes-IV, IM, IO, PO, rectal
Adverse Effects-Hypotension, Sedation, Amnesia, Respitory depression, Nausea, Vomiting
Other-Incompatible with other medications because not as water soluble, Can cause irritation with injection, Flumazenil is an antagonist
Diazepam
Valium
Class-Nonbarbiturate, nonbenzodiazepine sedative
Action-Uncertain, but appears to potentiate GABA receptors
Indications-Sedation
Contraindications-History of hypersensitivity to the drug. Hypersensitivity to egg or soy products
Doses-25-75 mcg/kg/min
Routes-IV
Adverse Effects-Pain on induction, Nausea, Vomiting, Respitory depression
Other-All monitors should be in place, Resusitative equipment should be immediately available
Propofol
Diprivan
Class-Depolarizing neuromuscular blocker
Action-Binds to acetylcholine receptors at the neuromuscular junction causing depolarization and subsequent paralysis
Indications-Rapid sequence intubation (RSI)
Contraindications-Hyperkalemia, Neuromuscular disease, Crush injury, Burns, Increased intracranial pressure, Severe trauma
Doses-1.5 mg/kg (60-150 mg) rapid IV push may repeat at 0.5 mg/kg (20-50 mg) rapid IV push, NR 1-2 mg/kg
Routes-IV, IO
Adverse Effects-Hyperkalmia, Bradycardia, Prolonged paralysis, Malignant hyperthermia, Increased intracranial pressure, muscle fasciculations, Trismus
Other-These agents should only be used by person skilled in their use, competent at complicated airway managment, and necessary resusitative equipment available
Succinylcholine
Anectine
Class-Class III antiarrhythmic
Action-Prolongs action potentialand duration in cardiac tissues through sodium, potassium, and calcium channels; blocks α- and β- adrenergic receptors
Indications-Ventricular tachycardia, Ventricular fibrillation, Narrow-complex tachycardias
Contraindications-Breast feeding, Bradycardia, High-grade heart block, Hypersensitivity to the drug
Doses-150-300 mg
Routes-IV
Adverse Effects-Hypotension, Bradycardia, Prolonged PR, QRS, and QT
Other-Constant ECG monitoring, Now first-line agent in ventricular fibrillation and tachycardia
Amiodarone
Cordarone
Class-NSAID
Action-Anti-inflammatory and antipyretic through inhibition of prostaglandins
Indications-Mild to moderate pain, fever, inflammation
Contraindications-Hypersensitivity to the drug, bronchospasm, angioedema
Doses-200-800 mg
Routes-PO
Adverse Effects-Nausea, Vomiting, GI bleeding, Allergic reactions
Other-Commonly causes gastric upset
Ibuprofen
Motrin, Advil
Class-Benzodiazepine
Action-Binds to Type A GABA receptors causing seation
Indications-Anxiety, Seizures, Sedation
Contraindications-History of hypersensitivity to the drug
Doses-1-5 mg
Routes-IV, IM, IO
Adverse Effects-Hypotension, Sedation, Amnesia, Respitory depression, Nausea, Vomiting
Other-Flumazenil is an antagonist
Midazolam
Versed
Class-Nonbarbiturate, nonbenzodiazepine sedative
Action-Uncertain, but appears to potentiate GABA receptors
Indications-Sedation
Contraindications-History of hypersensitivity to the drug.
Doses-0.1-0.3 mg/kg
Routes-IV
Adverse Effects-Myoclonic jerks, Respitory depression, Laryngospasm
Other-Does not have analgesic properties, Calcium-channel blockers can prolong respitory depression, Can cause increased cortisol levels, All monitors should be in place, Resusitative equipment should be immediately available
Etomidate
Amidate
Class-Sympathetic agonist
Action-α- and β- adrenergic agonist (β effects more pronounced although dose-related)
Indications-Cardiac arrest, Sympathetic bradycardia, Normovolemic hypotension, Allergies/anaphalaxis, Severe bronchospasm
Contraindications-Few in emergency setting
Doses-Cardiac Arrest 1 mg (1;100000), Anaphylaxis, Asthma 0.01 mg/kg IM (1:1000) max single dose 0.5 mg, NR 0.3-1 mg
Routes-IV, IO, IM, SQ, ET, Inhaled
Adverse Effects-Palpations, Anxiety, Tremulousness, Headache, Dizziness, Hypertension, Can worsen cardiac ischemia
Other-Two preperations are commonly available: 1:1000 (1mg/ml) 1:10000 (1mg/10ml)
Epinephrine
Class-Class IB antiarrhythmic; local anesthetic
Action-Amide-type local anesthetic; slows depolarization and automaticity
Indications-Ventricular tachycardia and fibrillation refactory to amiodarone, Local anesthetic
Contraindications-Should not be administered to patients receiving IV calcium channel blockers
Doses-1-1.5 mg/kg
Routes-IV
Adverse Effects-Drowsiness, Slurred speach, Confusion, Seizures, Hypotension
Other-Use with caution when administered with other antiarrhythmics
Lidocaine
Xylocaine