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SpaceBoys Drug Cards
Paramedic Pharmocology & Skills
| Question | Answer |
|---|---|
| Sodium Bicarb chemical name | NaHCO3 |
| Sodium Bicarb indications | Late in management of cardiac arrest (if at all), severe acidosis refractory to hyperventilation,hyperkalemia, upon return of spontaneous circulation after long arrest interval, tricyclic antidepressant overdose, phenobarbital overdose. |
| Sodium Bicarb contraindications | In patients with chloride loss from vomiting and GI suction, Metabolic and respiratory alkalosis, Hypocalcemia, Hypokalemia |
| Sodium Bicarb side effects | Metabolic alkalosis, fluid overload, tissue necrosis if extravasation occurs. |
| Sodium Bicarb adult dose | 1 mEq/kg, repeat with 0.5 mEq/kg every 10 minutes |
| Sodium Bicarb pediatric dose | 1 mEq/kg, repeat with 0.5 mEq/kg every 10 minutes (infuse slowly) |
| Sodium Bicarb class | buffer |
| Norepinephrine trade names | Levophed, Levarterenol |
| Norepinephrine indications | cardiogenic shock, significant hypotension (>70mm Hg) |
| Norepinephrine contraindications | Hypotension with hypovolemia, pregnancy |
| Norepinephrine class | Sympathomimetic |
| Norepinephrine adult dose | Dilute 8 mg in 500 mL of D5W or 4 mg in 250 mL of D5W (16ug/mL); infuse by IV piggyback at 0.5-1.0 ug/min, titrated to improve blood pressure (up to 30ug/min) |
| Norepinephrine pediatric dose | 0.1-1.0 ug/ming IV insfusion, titrated to patient response |
| Norepinephrine side effects | Headache, arrhythmias, tachycardia, reflex bradycardia, angina pectoris, HTN, decreased perfusion to GI, kidney, skeletal muscle, and skin |
| Albuterol Class | Sypathomimetic, bronchodilator |
| Albuterol trade names | Proventil, Ventolin |
| Albuterol indications | bronchospasm in patients with reversible obstructive airway disease (COPD/Ashtma). Prevention of exercise induced bronchospasm. |
| Albuterol contraindications | Known prior hypersensitivity reactions to albuterol. Tachycardia arrhythmias, especially those caused by digitalis. Synergistic with other sympathomimetics. |
| Albuterol side effects | Often dose related including: restlessness, tremors, dizziness, palpitations, tachycardia, nervousness, peripheral vasodilation, nausea, vomiting, hyperglycemia, increased blood pressure, and paradoxical bronchospam |
| Albuterol Adult dose for Nebulizer | 2.5 mg. Dilute 0.5 mL or 0.5% solution for inhalation with 2.5 mL normal saline in nebulizer and administer over 10-15 minutes. |
| Albuterol Adult dose for MDI | 1-2 inhalations (90-180 ug). Five minutes between inhalations. |
| Albuterol Pediatric dose for Nebulizer | solution of 0.01-0.03 mL (0.05-0.15 mg/kg/dose diluted in 2 mL of 0.9% normal saline. May repeat every 20 minutes 3 times. |
| Oxygen class | Naturally occuring gas. DUH. |
| Oxygen indications | Confirmed or suspected hypoxemia, ischemic chest pain, respitory insufficiency, prophylactically during air transport, confirmed or suspected carbon monoxide poisoning, all other causes of decreased tissue deoxygenation, deceased level of consciousness. |
| Oxygen contraindications | Certain patients with COPD or emphysema who will not tolerate oxygen concentrations over 35%, hyperventilation. |
| Oxygen adult/pedi dose | Cardiac arrest and carbon monoxide poisoning: 100%. Hypoxemia 10-15 L/min via NRB. COPD 1-6 L/min via NC or 28%-35% VM. EXCEPTION: Premature infant, no more than 30-40% oxygen |
| Oxygen side effects | Decreased level of consciousness and respitory depression in patients with chronic carbon dioxide retention. Retrolental fibroplasia if high concentrations are given to premature infants. |
| OPA indications | Unresponsive patients, absent gag reflex |
| OPA contraindications | Conscious patients, patients WITH gag reflex |
| OPA advantages | Noninvasive, easily placed, prevents blockage of the glottis by the tongue |
| OPA disadvantages | Does not prevent aspiration |
| NPA indications | Unresponsive patients, patients with AMS who have a gag reflex |
| NPA contraindications | Patient intolerance, most facial fractures or skull fractures |
| NPA advantages | Can be suctioned through, provides a patent airway, can be tolerated by conscious patients, may be placed blindly, does not require use of the oropharynx |
| NPA disadvantages | May result in excessive bleeding, does not protect from aspiration. |
| BVM indications | patients in respitory failure |
| BVM contraindications | patients who are breathing adequately, patients who cannot tolerate the device |
| BVM advantages | Delivers 100% O2 to the patient, allows extended ventilation time without rescuer fatigue, provides excellent barrier from body fluids |
| BVM disadvantages | Difficult to maintain proper seal, requires great effort to master technique, can result in inadequate tidal volume if rescuer is inexperienced with device |
| Epinephrine class | Sympathomimetic |
| Epi-Cardiac arrest indications | Cardiac Arrest (V-fib/pulseless V-tach, asystole, PEA) |
| Epi-Cardiac related indications | Symptomatic bradycardia as an alternative to dopamine infusion. For severe hypotension secondary to bradycardia when atropine and subcutaneous pacing are unsuccessful. |
| Epi-Non-Cardiac related indications | Allergic Reactions, Anaphalaxis, Ashtma |
| Epi-Contraindications | HTN, hypothermia, pulmonary edema, myocardial ischemia, hypovolemic shock |
| Epi-Side effects | HTN, tachycardia, angina, arrythmias, pulmonary edema, psychomotor agitation, headache, nausea, anxiety, restlessness |
| Epi-Adult dose for mild allergic reactions and Asthma | 0.3-0.5 mg |
| Epi-Pediatric dose for mild allergic reactions and asthma | 0.1 mg/kg up to 0.3 mg |
| Epi-Adult dose for Anaphalaxis | 0.1 mg (1ml of 1:10000) IV/IO over 5 minutes |
| Epi-Adult dose for Cardiac arrest | IV/IO dose: 1 mg (10 mL of 1:10,000 solution) every 3-5 minutes during resuscitation. Follow each dose with 20 mL flush and elevate arm for 10-20 seconds after dose. Higher dose for beta blocker or calcium channel blocker overdose: up to .2mg/kg |
| Epi-Pediatric dose for cardiac arrest | 0.01 mg/kg (0.1 mL/kg) of 1:10,000 solution every 3-5 minutes during arrest. |
| Epi-Adult dose for Cardiac arrest with ET tube | 2-2.5 mg diluted in 10 mL normal saline. |
| Epi-Pediatric dose for cardiac arrest with ET tube | 0.1 mg/kg (0.1 mL/kg) or 1:1,000 solution. |
| Epi-Adult dose for profound bradycardia or hypotension | 2-10 ug/min titrate to patient response. |
| Epi-Pediatric dose for symptomatic bradycardia | 0.1 mg/kg (0.1 mL/kg) of 1:10,000 solution |
| Epi-Adult dose for continuous infusion | Add 1 mg (1 mL of 1:1,000 solution) to 500 mL normal saline or D5W. Initial infusion rate or 1 ug/min titrated to effect (typical dose:2-10 ug/min) |
| Epi-Pediatric dose for continuous infusion | begin with rapid infusion, then titrate to response. Typical initial infusion: 0.1-1 ug/min. Higher doses may be effective. |
| Atropine Sulfate Class | Anticholinergic Agent |
| Atropine Sulfate Indications | Hemodynamically unstable bradycardia, bradycardic PEA, asystole, bronchospastic pulmonary disorders, organophosphate poisoning |
| Atropine Sulfate Contraindications | Tachycardia, unstable cardiovascular status in acute hemorrhage and myocardial ischemia, hypersensitivity, narrow-angle glaucoma, Pregnancy Category C |
| Atropine Sulfate Side Effects | Tachycardia, arrythmias, palpitations, paradoxical bradycardia when pushed slowly or in low doses, headache, dizziness, flushed/hot/dry skin, blurred vision, dry mouth, urinary retention |
| Atropine Sulfate Adult Dose for Asystole or Bradycardic PEA | 1 mg IV/IO push. May repeat every 3-5 minutes up to 3 mg. |
| Atropine Sulfate Pedi Dose | 0.02 mg/kg via IV/IO ush, may double for second dose. Minimum Dose is 0.1 mg, maximum dose is 0.5 mg up to 1.0 mg / adolescent 1.0 mg up to 2.0 mg |
| Atropine Sulfate Adult ET Dose for Asystole or Bradycardic PEA | 2.3 mg diluted in 10 ml of water or normal saline. |
| Atropine Sulfate Pedi ET Dose | 0.03 mg/kg (absorption may be unreliable) |
| Atropine Sulfate Adult Dose for Unstable Bradycardia | 0.5 mg IV/IO every 3-5 minutes, not to exceed 3.0 mg. In severe cases, shorter time interval of 3 minutes and higher dosage may help. |
| Atropine Sulfate Adult Dose for Organophosphate poisoning | 2-4 mg or higher may be needed |
| Methylprednisolone Class | Anti-Inflammatory glucocorticoid |
| Methylprednisolone Trade Name | Solu-Medrol |
| Methylprednisolone Indications | Acute spinal cord trauma, anaphylaxis, bronchodilator for unresponsive asthma |
| Methylprednisolone Contraindications | Premature infants, systemic fungal infections, caution for GI bleeds |
| Methylprednisolone Side Effects | Sodium and Water retention, HTN, CHF, Headache, Nausea and Vomiting, Hypokalemia, Alkalosis, Peptic Ulcer Disease |
| Methylprednisolone Adult Dose for Acute Spinal Cord Trauma | 30mg/kg IV over 30 minutes followed by infusion @ 5.4mg/kg/h |
| Methylprednisolone Pedi Dose for Acute Spinal Cord Trauma | 30mg/kg IV over 30 minutes followed by infusion @ 5.4mg/kg/h |
| Methylprednisolone Adult Dose for Asthma & COPD | 1-2mg/kg IV |
| Methylprednisolone Pedi Dose for Asthma | 1-2 mg/kg/dose IV |
| Dopamine Class | Sympathomimetic, Inotropic Agent |
| Dopamine Trade Name | Intropin |
| Dopamine Indications | Cardiogenic/Septic/Spinal/Distributive Shock, Hypotension with Low Cardiac Output |
| Dopamine Contraindications | Hypovolemic Shock, Tachyarrythmias, V-Fib, Pheochromocytoma |
| Dopamine Side Effects | HTN, Arrhythmias, Increased Cardiac Oxygen Demand, Tissue Necrosis if Extravated |
| Dopamine Adult Dose | 2-20ug/kg/min tirtrated to patient response |
| Dopamine Pedi Dose | 2-20 ug/kg/min titrated to patient response |
| Dobutamine Class | Sympathomimetic, Inotropic Agent |
| Dobutamine Trade Name | Dobutrex |
| Dobutamine Indications | CHF, Left Ventricular Dysfuntion, Cardiogenic Shock |
| Dobutamine Contraindications | Tachyarrhythmias, IHSS, Severe Hypotension, Incompatable with Sodium Bicarbonate and Furosemide |
| Dobutamine Side Effects | HTN, Headache, Arrythmias, PVC's, May increase Infart Size |
| Dobutamine Adult Dose | IV infusion at 2-20ug/kg/min titrated to desired effect |
| Dobutamine Pedi Dose | IV infusion at 2-20ug/kg/min titrated to desired effect |
| Diphenhydramine Class | Antihistamine, Anticholinergic |
| Diphenhydramine Trade Name | Benadryl |
| Diphenhydramine Indications | Allergic Reactions, Anaphylaxis, Actue Dystonic Reactions (Phenothiazines), Blood Administration Reactions, Motion Sickness, Hay Fever |
| Diphenhydramine Contraindications | HTN, Asthma, Glaucoma, Narrow Angle Glaucoma, MAOI Inhibitors, Pregnancy, Infants |
| Diphenhydramine Side Effects | Hypotension, Sedation, Seizures, Visual Disturbances, Urinary Retention, Vomiting, Arrythmias, Palpitations, Dry Mouth and Throat, Paradoxical CNS excitation in children |
| Diphenhydramine Adult Dose | 25-50mg IM or IV or PO |
| Diphenhydramine Pedi Dose | 1-2mg/kg IV, IO slowly or IM / PO 5mg/kg/24 hours |
| Midazolam Class | Short acting Benzodiazepine, CNS Depressant |
| Midazolam Trade Name | Versed |
| Midazolam Indications | Sedation, Anxiolytic prior to intubation, Conscious Sedation |
| Midazolam Contraindications | Shock, Depressed Vitals, Coma, Overdose, Glaucoma, Concomitant use with other CNS Depressants: Barbiturates, Alcohol, Narcotics, Not recommended in Pediatrics |
| Midazolam Adult Dose | 2.0-2.5 mg IV slowly over 2-3 minutes, may be repeated to total maximum of 0.1 mg/kg. |
| Dilatiazem Hydrochloride Class | Calcium Channel Blocker |
| Dilatiazem Hydrochloride Trade Name | Cardizem, Lyo-Ject |
| Dilatiazem Hydrochloride Indications | Control of Rapid Ventricular Rates due to Atrial Flutter, Atrial Fib, And Re-Entry SVT; Angina Pectoris |
| Dilatiazem Hydrochloride Contraindications | Hypotesion, High Degree AV Blocks, Sick Sinus Syndrome, Wide-Complex Tachycardias, Poison/Drug Induced Tachycardia, Cardiogenic Shock |
| Dilatiazem Hydrochloride Side Effects | Bradycardia, High-Degree AV Blocks, Chest Pain, CHF, Syncope, V-Fib, V-Tach, Nausea, Vomiting, Dizziness, Dry Mouth, Dyspnea, Headache |
| Dilatiazem Hydrochloride Adult Dose | 0.25mg/kg (about 15-20mg) IV over 2 Minutes. May wait 15 minutes and administer 0.35mg/kg (about 20-25mg) IV over 2 minutes. Maintenance Infusion of 5-15 mg/h. Not Recommended for Pediatrics. |
| Morphine Sulfate Class | Opiod Analgesic |
| Morphine Sulfate Trade Name | Astramorph/PF and many others |
| Morphine Sulfate Indications | Severe CHF, Pulmonary Edema, Chest Pain Associated with Actue MI, Analgesia for Moderate to Severe Acute and Chronic Pain (use with caution) |
| Morphine Sulfate Contraindications | Head Injury, Exacerbated COPD, Depressed Respiratory Drive, Hypotension, Undiagnosed Abdominal Pain, Decreased Level of Consciousness, Suspected Hypovolemia, MAOI use within the past 14 days |
| Morphine Sulfate Side Effects | Respiratory Depression, Hypotension, Decreased LOC, Nausea, Vomiting, Bradycardia, Tachycardia, Syncope, Facial Flushing, Euphoria :-), Bronchospasm, Dry Mouth |
| Morphine Sulfate Adult Dose | 2-4mg IV over 1-5 minutes, every 5-30 minutes. May repeat dose at 2-8mg at 5-15 minute intervals |
| Morphine Sulfate Pedi Dose | 0.1-0.2mg/kg via IV, IO, IM, or SC. Max dose of 5mg |
| Nitroglycerin Class | Vasodilator |
| Nitroglycerin Trade Name | Nitrostat, Tridil, and others |
| Nitroglycerin Indications | Actue Angina Pectoris, Ishcemic Chest Pain, Hypertension, CHF, Pulmonary Edema |
| Nitroglycerin Contraindications | Hypotension, Hypovolemia, Intracranial Bleeding or Head Injury, Phosphodiesterase Inhibitors (ex. Viagra) in the past 24 hours |
| Nitroglycerin Side Effects | Headache, Hypotension, Syncope, Reflex Tachycardia, Flushing, Nausea, Vomiting, Diaphoresis, Muscle Twitching |
| Nitroglycerin Adult Dose | 0.3-0.4mg Tablets / 0.4mg Spay SL; May repeat every 3-5 minutes up to 3 doses (not recommended for use in pediatrics) |
| Adenosine Class | Endogenous Nucleotide |
| Adenosine Trade Name | Adenocard |
| Adenosine Indications | Conversion of PSVT to Sinus Rythym. May convert Re-Entry SVT due to Wolff-Parkinson-White Syndrome. |
| Adenosine Contraindications | Second or Third Degree Block or Sick Sinus Syndrome, A-Flutter, A-Fib, V-Tach, Hypersensitivy to Adenosine, Poison-Induced Tachycardia |
| Adenosine Side Effects | Facial Flushing, SOB, Chest Pain, Headache, Paresthesia, Diaphoresis, Palpitations, Hypotension, Nausea, Metallic Taste |
| Adenosine Adult Dose | 6mg rapid IV push immediately followed by 20ml Saline Flush and Extremity Elevation. May Administer a Second and Third dose of 12mg in 1-2 Minute Intervals if no Initial Response |
| Adenosine Pedi Dose | 0.1-0.2mg/kg rapid IV push, Maximum Single Dose of 12mg |
| Amiodarone Class | Antiarrhythmic |
| Amiodarone Trade Name | Cordaron, Pacerone |
| Amiodarone Indications | V-Fib, Pulseless V-Tach and Unstable V-Tach in Patients Refractory to Other Therapy |
| Amiodarone Contraindications | Known Hypersensitivity, Cardiogenic Shock, Sinus Bradycardia, Second or Third Degree Block in Absence of a Functioning Pacemaker |
| Amiodarone Side Effects | Hypotension, Bradycardia, Prolongation or the P-R, QRS, and Q-T Intervals |
| Amiodarone Adult Dose For V-Fib/Pulseless V-Tach | 300mg IV Push, Repeated in 3-5 Minutes with 150mg IV Push |
| Amiodarone Adult Dose for Life Threatening and Recurring Ventricular Arrythmias | Rapid Infusion: 150 mg IV over 10 minutes. May Repeat Every Ten Minutes Slow Infusion: 360 mg over 6 Hours Maintenance Infusion: 540mg over 10 Hours Max Dose is 2.2g over 24 Hours |
| Amiodarone Pedi Dose for Refractory V-Fib/Pulseless V-Tach / Perfusing SVT/VT | 5mg/kg IV Bolus (Over 20-60 Minutes for Perfusing SVT/VT) Max single dose is 300mg |
| Vasopressin Class | Antidiuretic Hormone |
| Vasopressin Trade Name | Pitressin Synthetic |
| Vasopressin Indications | Cardiac Arrest |
| Vasopressin Contraindications | Responsive Patients with CAD |
| Vasopressin Side Effects | Bronchoconstriction, Ischemic Chest Pain, Nausea and Vomiting, Abdominal Pain |
| Vasopressin Adult Dose | 40 Units to Replace Either the First or Second Dose of Epinephrine during Cardiac Arrest. Not Recommended for Pediatrics. |
| Diltiazem Hydrochloride Class | Calcium Channel Blocker |
| Diltiazem Hydrochloride Trade Name | Cardizem, Lyo-Ject |
| Diltiazem Hydrochloride Indications | Control of Rapid Ventricular Rates Due to A-Flutter, A-Fib, and Re-Entry SVT; Angina Pectoris |
| Diltiazem Hydrochloride Contraindications | Hypotension, Sick Sinus Syndrome, Second or Third Degree Blocks, Cardiogenic Shock, Wide-Complex Tachycardias, Poison/Drug Induced Tachycardia |
| Diltiazem Hydrochloride Side Effects | Bradycardia, Second or Third Degree Blocks, Chest Pain, CHF, Syncope, V-Fib, V-Tach, Nausea, Vomiting, Dizziness, Dry Mouth, Dypsnea, Headache |
| Diltiazem Hydrochloride Adult Dose | 0.25mg/kg IV over 2 minutes. May repeat in 15 minutes at 0.35mg/kg IV over 2 minutes. Maintainence Infusion of 5-15 mg/h. Not Recommended in Pediatrics |
| Glucagon Class | Hyperglycemic Agent, Pancreatic Hormone, Insulin Antagonist |
| Glucagon Trade Names | Glucagon |
| Glucagon Indications | Altered LOC when Hypoglycemia is suspected. May be uses as an Inotropic Agent in Beta-Blocker Overdose |
| Glucagon Contraindications | Hyperglycemia, Hypersensitivity |
| Glucagon Side Effects | Nausea, Vomiting, Tachycardia, Hypertension |
| Glucagon Adult Dose | Hypoglycemia: 0.5-1mg IM, May repeat in 7-10 Minutes Calcium Channel/Beta Blocker Overdose: 3mg , followed by infusion at 3mg/hr as necessary |
| Glucagon Pedi Dose | Hypoglycemia: 0.5-1mg IM for children less than 20kg. Not recommended for Calcium Channel/Beta Blocker Overdose in Pediatrics. |
| Oral Glucose Class | Hyperglycemic |
| Oral Glucose Trade Name | Insta-Glucose |
| Oral Glucose Indications | Concious Patients with suspected Hypoglycemia |
| Oral Glucose Contraindications | Decreased LOC, Nausea, Vomiting |
| Oral Glucose Side Effects | Nausea, Vomiting |
| Oral Glucose Dose | Should be Sipped Slowly Until Clinical Improvement Noted in Adults and Pediatrics |
| Thiamine Class | Vitamin B1 |
| Thiamine Trade Name | Vitamin B1 |
| Thiamine Indications | Coma of Unknown Origin, Delirium Tremens, Beribei, Wernicke's Encephalopathy |
| Thiamine Contraindications | None. |
| Thiamine Side Effects | Hypotension from Too Rapid of an Injection or Too High of a Dose, Anxiety, Diaphoresis, Nausea, Vomiting, Allergy |
| Thiamine Adult Dose | 100mg Slow IV or IM |
| Thiamine Pediatric Dose | 10-25 Slow IV or IM |
| Dextrose Class | Carbohydrate, Hypertonic Solution |
| Dextrose Trade Name | Dextrose |
| Dextrose Indications | Hypoglycemia, Altered LOC, Coma of Unknown Cause, Seizure of Unknown Cause, Status Epilepticus |
| Dextrose Contraindications | Intercranial Hemorrage |
| Dextrose Side Effects | Extraversion Leads to Tissue Necrosis. Warmth, Pain, Burning, Thrombophlebitis, Rhabdomyloysis, Hyperglycemia |
| Dextrose Adult Dose | 12.5-25g Slow IV, repeat as Necessary |
| Dextrose Pedi Dose | 0.5-1g/kg Slow IV, repeat as Necessary |
| Naloxone Hydrochloride Class | Narcotic Antagonist |
| Naloxone Hydrochloride Trade Name | Narcan |
| Naloxone Hydrochloride Indications | Opiate OD, Coma of Unknown Origin |
| Naloxone Hydrochloride Contraindications | Caution in Narcotic Dependant Patients, and Neonates of Narcotic Dependant Mothers |
| Naloxone Hydrochloride Side Effects | Withdrawal Symptoms in Addicted Patients, Tachycardia, Hypertension, Nausea and Vomiting, Diaphoresis |
| Naloxone Hydrochloride Adult Dose | 0.4-2mg IV, IM, SC, or ET. Repeat in 5 Minutes to Max dose of 10mg. Infusion: 2mg in 500ml D5W at 0.4mg/hr |
| Naloxone Hydrochloride Pedi Dose | 0.1mg/kg IV, IM, SC, or ET, Max dose of 0.8mg, repeat in 10 Minutes at 0.1mg/kg |
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