King Saud University College of Nursing

Common Emergency Drugs

By : Hatem Alsrour

Adenosine
Anti-dysrhythmic Indication.; SVT Dose: 6mg rapid IVP followed by 20ml saline flush. May repeat in 1-2 min if no response. 12 mg IVP, then again in 1-2 min.

Adenosine
Contraindications Second- or third-degree AV block, or sicksinus syndrome (sss). Atrial flutter. Atrial fibrillation. Ventricular tachycardia. Hypersensitivity to adenosine

Amiodarone
Antidysrhythmic Indicated for Prophylaxis of VF & unstable VT refractory to other therapy Contraindicated Pulmonary congestion Cardiogenic shock hypotension

Amiodarone
Dose
300

mg loading dose (cardiac arrest) flush with 10 ml of D5 or saline 150 mg supplemental bolus dose (cardiac arrest) flush with 10 ml of D5 or saline 540 mg maintenance infusion over 18 hr

Aspirin
Analgesic, anti-inflammatory, antiplatelet Indications AMI Contraindication : Only systemic sensitivity in the context of MI Dose 160-325 mg .

Atropine Sulfate
Anticholinergic Indications Symptomatic bradycardia Asystole Bronchospastic disorders

Atropine Sulfate
Contraindication: Tachycardia Obstructive disease of GI tract Unstable cardiovascular status in the context of cardiac ischemia & hemorrhage

Atropine Sulfate
Dose Bradydysrhymias 0.5-1.0mg 5 min to a max of 0.03-0.04 mg/kg. Asystole 1.0 mg IV or ETT(dilute to 10 ml) 0.1 mg/mI (Adult) 0.05 mg/mL (Pediatric)

Calcium Chloride
Electrolyte Indications Hyperkalemia (except dig toxic) Hypocalcaemia Hypermagnesmia

Calcium Chloride
Contraindications VF during cardiac resuscitation Dig toxic Renal or cardiac disease Dose 2-4 mg/kg slow IV 10 min .

Dobutamine (Dobutrex)
Sympathomimetic Indications Inotropic support for patients with LV dysfunction Contraindications Severe hypotension.

Dobutamine (Dobutrex)
Dosage and Administration Adult: The drug is infused at 2-20 mcg/kg/min (instead of 2.5-20). Pediatric: 2-20 mcg/kg/min (titrated to desired effect

Dopamine (Intropin)
Sympathomimetic Indications Hemodynamically significant hypotension in the absence of hypovolemia Contraindications Tachydysrhythmias VF

Dopamine (Intropin)
Dose renaldose 1-5mcg/kg/min cardiac dose 5-15 mcg/kg/min vasopressor dose 15mcg/kg/min

Furosemide (Lasix)
Loop Diuretic Indications Associated with CHF, hepatic or renal disease Contraindications Anuria Hypovolemia/dehydration Electrolyte depletion

Furosemide (Lasix)
Dose 20-40 mg slow IV (1-2min)

Isoproterenol (Isuprel)
Sympathomimetic Indications Hemodynamically significant bradycardia refractive to other therapy.

Isoproterenol (Isuprel)
Contraindications VF/VT Hypotension Ischemia heart disease Cardiac arrest

Isoproterenol (Isuprel)
Dose 1mg in 250 ml (4mcg/ml) infuse at 2-20 mcg/min Infusion mix 200 in 250 (0.8 mg/ml) infuse at 2mg/min. Keep the patient in the supine position

Lidocaine (Xylocaine)
Antidysrhythmic . Indications VT/VF Wide complex tachycardia . Significant ventricular ectopy in the setting of MI

Lidocaine (Xylocaine)
Contraindications Adams-Stokes Syndrome Dose 1.0-1.5 mg/kg consider repeat in 3 min Total IV dose is 3 mg/kg ETT is 2.5 times IV dose

Norepinephrine (Levophed)
Sympathomimetic Indications Cardiogenic shock Neurogenic shock Inotropic support Hemodynamically significant hypotension refractory to other sympaths

Norepinephrine (Levophed)
Contraindications Hypotensive pts with hypovolemia Dose Dilute

Propranolol (Inderal)
Beta adrenergic blocker Indications Hypertension VF/VT and SVT refractory to other therapy

Propranolol (Inderal)
Contraindications Sinus bradycardia 2nd or 3rd degree AV block Asthma Cardiogenic shock Pulmonary edema Uncompensated CHF COPD

Propranolol (Inderal)
Dose 1-3 mg IV over 2-5 min Can be repeated after 2 min Total dose not to exceed 0.1mg/kg

Sodium Bicarbonate
Buffer, alkalinizing agent, electrolyte Indications Known bicarbonate responsive acidosis Intubated pt with long arrest interval Metabolic acidosis

Sodium Bicarbonate
Contraindications Chloride loss from vomiting & GI Met or resp alkalosis Severe pulmonary edema Abdominal pain of unknown origin Hypo; Calcemia, kalemia, natremia

Sodium Bicarbonate
Dose 1 mEq/kg IV with 0.5 mEq/kg repeat q 10 min

Verapamil (Calan)
Calcium channel blocker Indications PSVT A flutter with rapid response A fib with rapid response Vasospastic and unstable angina Chronic stable angina

Verapamil (Calan)
Contraindications SSS (without pacemaker) 2nd & 3rd degree AV block Hypotension/Cardiogenic shock Wide complex tachycardia Severe CHF IV beta blockers

Verapamil (Calan)
Dose 2.5-5 mg IVP over 1-2 minutes Repeat 5-10 mg 15-30 mins after initial dose Max dose 30mg

Dextrose 50%
Dextrose is the 6 carbon sugar that is the principal carbohydrate used by the body. Indications Hypoglycemia Coma/seizure of unknown etiology

Dextrose 50%
Contraindications Intracranial hemorrhage Increased intracranial pressure Dose 12.5-25 G IV slowly

Diazepam (Valium)
Benzodiazepine sedative-hypnotic, anticonvulsant Indications Acute anxiety states/alcohol withdrawal Skeletal muscle relaxation Seizure activity Premedication prior to cardioversion

Diazepam (Valium)
Contraindications in coma (unless there is seizure activity) CNS depression as a result of head injury respiratory depression Shock

Diazepam
Dosage and Administration
Seizure activity Adult: 5-10 mg IV q 10-15 min (maximum dose 30 mg) Pediatric: 0.2-0.3 mg/kg/dose IV (< = 1 mg/min) q 2-5 min (maximum total dose 10 mg) Amnesia for cardioversion Adult: 5-15 mg IV, 5-10 min before procedure

Epinephrine (Adrenalin)
Sympathomimetic Indications Bronchial asthma Acute allergic reaction Cardiac arrest Symptomatic bradycardia

Epinephrine (Adrenalin)
Contraindications Hypovolemia shock- correct volume deficit Use with caution in coronary insufficiency Dose Cardiac arrest 1 mg IVP q 3-5 min 2.5 times the normal dose if via ETT

Glucagon
Pancreatic Hormone, insulin antagonist Indications Persistent hypoglycemia despite glucose Contraindications Only hypersensitivity Dose 0.5-1 mg IM with one repeat in 7-10 min

Nitroglycerin (Nitrostat)
Vasodilator Indications Ischemia chest pain Pulmonary hypertension CHF Hypertensive emergencies

Nitroglycerin (Nitrostat)
Contraindications Hypotension Head injury Cerebral hemorrhage Dose 0.15-0.6 mg SL q 5 minutes . Infusion- 200-400 mcg/ml .

Naloxone (Narcan)
Opiod antagonist Indications Narcotic Coma unknown origin

Naloxone (Narcan)
Contraindications Use with caution in addicted pts may precipitate violent withdrawal issues. Dose 0.4-2mg IV, IM or ETT (dilute)

Morphine Sulfate
Opiod analgesic Indications Chest pain associated with MI Pulmonary edema . Moderate to severe acute or chronic pain

Morphine Sulfate
Contraindications Head injury or undiagnosed abdom. Pain Increased ICP Severe resp depression

Magnesium Sulfate
Electrolyte, Anticonvulsant Indications Seizures of eclampsia Hypomagnesaemia Refractory VF

Magnesium Sulfate
Contraindications Heart block or myocardial damage Dose Eclampsic seizures 1-4G (8-32 mEq) IV max dose of 3040G/day

Vasopressin
Naturally occuring hormone (ADH) Indications May be used as an alternate vasopressor in cardiac arrest May be useful in hemodynamic support of dilatory shock

Vasopressin
Contraindications Not recommended for responsive pts with CAD Dose 40 U IV push- one dose only ( about 10 min)

Midazolam (Versed)
Short-acting benzodiazepine CNS depressant
Indications Seizures Contraindications Glaucoma Shock, Coma.

Midazolam (Versed)
Dose 1-2.5 mg IV slowly (1-2 min) Total max dose not to exceed 0.1 mg/kg

Digoxin (Lanoxin)
Cardiac Glycoside Indications SVT , A fib/flut CHF Cardiogenic shock

Digoxin (Lanoxin)
Contraindications VF/FT AV Block Dig toxicity

heparin
Anti coagulent Two preparations Unfractionated (UFH) . Low molecular weight .

heparin

UFH
Indications AMI Begin with fibrin specific lytics (alteplase) Contraindications Active bleeding Recent intracranial, spinal or eye surgery

heparin
Contraindications Severe hypertension Bleeding disorders GI bleeding Dose Initial bolus- 60IU/kg (max bolus 4000IU)