Drug Formulary

Hutchinson Community College
Emergency Medical Services Education
Drug Formulary
Version 2018.1.3
HUTCHCC EMS EDUCATION DRUG FORMULARY
Table of Contents  Indicates in National Paramedic Curriculum

Activated Charcoal  3
Adenosine  4
Albuterol  5
Amiodarone  6
Aspirin  7
Atropine  8
Dextrose – Intravenous  9
Diazepam  10
Diltiazem  11
Diphenhydramine HCL  12
Dopamine  13
Epinephrine 1:1,000  14
Epinephrine 1:10,000  15
Fentanyl  16
Glucagon  17
Glucose - Oral  18
Ipatroprium Bromide  19
Lidocaine  20
Lorazepam  22
Magnesium Sulfate  23
Midazolam  24
Morphine Sulfate  25
Naloxone  26
Nitroglycerine  27
Nitrous Oxide  28
Oxygen  29
Oxytocin  30
Promethazine HCL  31
Thiamine  32
IV Fluid - Dextrose 5% in water  33
IV Fluid - 9% Sodium Chloride  34
IV Fluid - Lactated Ringers  35
Calcium Chloride 36
Captopril 37
EpiPen, EpiPen Jr 38
Etomodate 39
Furosemide 40
Glucagon Auto Injector 41
Hydromorphone Hydrochloride 42
Ketamine 43
Ketorolac 44
Labetalol 45
Meperidine 46
Methylprednisolone 47
Metoclopramide 48
Ondansetron 49
Prednisone 50
Sodium Bicarbonate 51
Succinylcholine 52
Vecuronium Bromide 53
2 Version 2018.1
ACTIVATED CHARCOAL  EMR EMT AEMT PM
(Actidose, EZ-Char, Liqui-Char)
CLASSIFICATION
Adsorbent, Antidote
MECHANISM OF ACTION
Adsorbs toxic substances from the GI tract.
USES/INDICATIONS
Most oral poisonings and medication overdoses; can be used after evacuation of
poisons.
CONTRAINDICATIONS
Oral administration to comatose patients; after ingestion of corrosives, caustics,
petroleum distillates (ineffective and may induce vomiting); simultaneous administration
with other oral drugs. Use caution in patients experiencing abdominal pain of unknown
origin or known GI obstruction.
ADVERSE REACTIONS/SIDE EFFECTS
If aspirated, can induce fatal form of pneumonitis; constipation, black stools, diarrhea,
vomiting, bowel obstruction.
DRUG INTERACTIONS
Bonds with and generally inactivates whatever it is mixed with (e.g. syrup of ipecac).
DOSE/ROUTE
Adult: 1-2 g/kg PO (BLS) or NG tube (ALS)
Pediatric: 1-2 g/kg PO (BLS) or NG tube (ALS)

PHARMACOKINETICS
Onset: Immediate; Peak effect: Depends on GI function; Duration: Will act until excreted
SPECIAL CONSIDERATIONS
Pregnancy safety: Category C. Often used in conjunction with magnesium citrate. Must
be stored in a closed container. Be sure to mix contents well before administration due
to separation while being stored. Does not absorb cyanide, lithium, iron, lead or
arsenic.
NOTES (a place to log your notes and learning points on this medication)
• Activated Charcoal is no longer used in some EMS systems, but it may still be encountered.
3 Version 2018.1
ADENOSINE  EMR EMT AEMT PM
(Adenocard) Peds dose corrected 9-18-18
CLASSIFICATION
Antidysrhymic
MECHANISM OF ACTION
Slows conduction through the AV node; can interrupt reentrant AV nodal pathways.
USES/INDICATIONS
Conversion of narrow-complex regular tachycardia to sinus rhythm. May convert reentry
SVT due to Wolff-Parkinson-White syndrome.
CONTRAINDICATIONS
Torsades de pointes, atrial fibrillation, second- or third-degree heart block,
hypersensitivity
Generally short duration and mild; headache, dizziness, dyspnea, bronchospasm,
dysrhythmias, palpitations, hypotension, chest pain, facial flushing, cardiac arrest,
nausea, metallic taste, pain in the head or neck, paresthesia, diaphoresis.
DRUG INTERACTIONS
Methylzathines (theophylline-like drugs) antagonize the effects. Dipyridamole
potentiates the effect. Carbamazepine may potentiate the AV node blocking effect.
DOSE/ROUTE
Adult: HCC Route – 6 mg IV rapid bolus. Procedure: with fluid running wide open, pinch
tubing and give the dose followed immediately by releasing the pinched tubing and
squeezing the bag for the flush. If no response after 1-2 minutes, repeat at 12 mg dose
and the same procedure.
6 mg given as a rapid IV bolus over 1-2 seconds, follow immediately with 20 ml saline
flush. If no response after 1-2 minutes, repeat at 12 mg dose with 20 ml saline flush.
Pediatric: 0.1 mg/kg (max 6 mg) rapid IV/IO bolus, follow immediately with 5-10 ml
saline flush. Second dose 0.2 mg/kg max 12 mg) rapid IV/IO bolus, follow immediately
with 5-10 ml saline flush.
PHARMACOKINETICS
Onset: Seconds; Peak effect: Seconds; Duration: 12 seconds
Arrhythmias, including blocks, are common at the time of cardioversion. Pregnancy
safety: Class C. Use only in pregnant women if clearly indicated. Not effective in
converting A-fib, A-flutter, or VTach.
4 Version 2018.1
ALBUTEROL  EMR EMT AEMT PM
(Proventil, Ventolin)
CLASSIFICATION
Sympathomimetic, bronchodilator
MECHANISM OF ACTION
Selective beta-2 agonist - Smooth muscle relaxation in the bronchial tree and peripheral
vasculature.
USES/INDICATIONS
Reversible bronchospasm associated with obstructive airway disease (COPD/asthma)
CONTRAINDICATIONS
Hypersensitivity, symptomatic tachycardia, dysrhythmias, especially those caused by
digitalis.
Often dose related, include headaches, fatigue, dizziness, restlessness, aggressive
behavior, increased sputum, hypertension, tachycardia, palpitations, dry mouth,
tremors.
DRUG INTERACTIONS
Tricyclic antidepressants may potentiate vascular effects. Beta-blockers may block
pulmonary effects.
DOSE/ROUTE
Adult: Small volume nebulizer - 2.5 mg in 3 ml normal saline
Metered Dose Inhaler 1-2 inhalations, wait 5 minutes between inhalations
Pediatric: Small volume nebulizer – 2.5 mg in 3 ml normal saline
PHARMACOKINETICS
Onset: 5-15 minutes; Peak effect: 30 min – 2 hours; Duration: 3-4 hours
Pregnancy Category C. May precipitate angina pectoris and dysrhythmias.
5 Version 2018.1
AMIODARONE  EMR EMT AEMT PM
(Cordarone)
CLASSIFICATION
Antidysrhythmic (Class III)
MECHANISM OF ACTION
Blocks sodium, potassium, and calcium channels; prolongs the action potential and
repolarization; decreases AV conduction and SA node function.
USES/INDICATIONS
V-fib, pulseless VT, wide complex VT with pulse
CONTRAINDICATIONS
Hypersensitivity, severe sinus node dysfunction, sinus bradycardia, second- and third-
degree AV block
Dizziness, tremor, ataxia, pulmonary edema, cough, heart failure, bradycardia,
hypotension, worsening dysrhythmias, prolonged QT interval.
DRUG INTERACTIONS
May cause digitalis toxicity. Beta-blockers and calcium channel blockers may potentiate
bradycardia, sinus arrest, and AV blocks.
DOSE/ROUTE
Adult: Ventricular fibrillation or pulseless ventricular tachycardia - 300 mg IV/IO push,
may be repeated at 150 mg in 3-5 min for recurring or refractory arrhythmias.
Wide complex tachycardia with pulse: 150 mg IV/IO over 10 minutes
Pediatric: 5 mg/kg IV/IO
PHARMACOKINETICS
Onset: 2 hours; Peak effect:3-7 hours; Duration: Unknown
Pregnancy Category D. May worsen or precipitate new dysrhythmias. Monitor for
hypotension and increasing PR and QT intervals.
6 Version 2018.1
ASPIRIN  EMR EMT AEMT PM
(ASA)
CLASSIFICATION
Platelet inhibitor, anti-inflammatory. (Most Important Cardiac Drug)
MECHANISM OF ACTION
Inhibits platelet aggregation, has antipyretic and analgesic properties
USES/INDICATIONS
New onset chest pain suggestive of AMI/ACS
CONTRAINDICATIONS
Hypersensitivity
Bronchospasm, anaphylaxis, wheezing in allergic patients, prolonged bleeding, GI
bleeding, epigastric distress, nausea, vomiting, heartburn.
DRUG INTERACTIONS
Use caution with patients allergic to NSAIDs
DOSE/ROUTE
Adult: 160-325 mg by mouth chewed
Pediatric: not recommended
PHARMACOKINETICS
Onset: 5-30 minutes; Peak effect: 1-3 hours; Duration: 3-6 hours
Pregnancy Category D.
EMS personnel give aspirin for its anti-platelet effect in suspected acute myocardial infarction. It is not given for pain
relief. Therefore, the incidence of giving aspirin to pediatric patients in EMS is essentially non-existent.
If the patient has taken a full dose of aspirin since the onset of acute coronary syndrome symptoms, the paramedic
does not need to repeat administration. For patients who have taken a partial dose, who took the dose prior to
symptoms, or in whom it is unclear what and how much aspirin they have taken, the paramedic should administer the
dose of aspirin.
7 Version 2018.1
ATROPINE SULFATE  EMR EMT AEMT PM
(Atropine)
CLASSIFICATION
Anticholinergic agent
MECHANISM OF ACTION
Blocks acetylcholine receptors, increases heart rate, decreases GI secretions
USES/INDICATIONS
Hemodynamically significant bradycardia
Organophosphate poisoning
CONTRAINDICATIONS
Unstable cardiovascular status in acute hemorrhage with myocardial ischemia,
hypothermic bradycardia.
Confusion, headache, tachycardia, palpitations, anxiety, pupil dilation, dysrhythmias, dry
mouth, blurred vision, flushed, hot, dry skin; paradoxical bradycardia when pushed to
slowly or given at low dose.
DRUG INTERACTIONS
Effects enhanced by antihistamines, antipsychotics, benzodiazepines, and
antidepressants.
DOSE/ROUTE
Adult: Bradycardia – 0.5 mg IV/IO every 3-5 minutes, to a total max of 3 mg.
Organophosphate – 2.0 mg IM/IV every 3-5 minutes until atropinization effect
Pediatric: unstable bradycardia – 0.02 mg/kg IV/IO (minimum dose 0.1 mg, max single
dose 0.5 mg), may repeat x1.
PHARMACOKINETICS
Onset: Immediate; Peak effect: 2-4 minutes; Duration: 4-6 hours
Atropine in Organophosphates is repeated every 3-5 minutes until easing of ventilation
and reduction of secretions (atropinization effect) occurs. Ineffective on 2nd or 3rd
degree AV blocks. Will not work on heart transplant patients.
8 Version 2018.1
DEXTROSE  EMR EMT AEMT PM
(50 percent)
CLASSIFICATION
Carbohydrate, antihypoglycemic agent
MECHANISM OF ACTION
Increases serum glucose levels. Short-term osmotic diuresis.
USES/INDICATIONS
Hypoglycemia
CONTRAINDICATIONS
Intracranial hemorrhage
Extravasation leads to tissue necrosis. Cerebral hemorrhage, cerebral ischemia,
hyperglycemia
DRUG INTERACTIONS
DOSE/ROUTE
Adult: 25 gm D50 slow IV push
Pediatric: 0.5 gm/kg of D25 slow IV push
Pediatric < 10kg: 0.5 mg/kg of D10 slow IV push
5 kg 7 kg 9 kg 10 kg 12 kg 15 kg 20 kg 30 kg 40 kg
Dextrose 10% 20 mL 35 mL 45 mL 50 mL 60 mL 75 mL 100
(mL) IV mL
Dextrose 25% 24 mL 30 mL 40 mL 60 mL 80 mL
(mL) IV
PHARMACOKINETICS
Onset: < 1 minute; Peak effect: variable; Duration: variable
9 Version 2018.1
DIAZEPAM  EMR EMT AEMT PM
(Valium)
CLASSIFICATION
Benzodiazepine, sedative, anticonvulsant, (schedule IV)
MECHANISM OF ACTION
Potentiates effects of inhibitory neurotransmitters. Raises seizure threshold, induces
amnesia and sedation.
USES/INDICATIONS
Status epilepticus, major motor seizures, premedication before cardioversion, skeletal
muscle relaxant, acute anxiety states.
CONTRAINDICATIONS
Hypersensitivity, coma, head injury, respiratory depression
Drowsiness, confusion, headache, respiratory depression, hypotension, reflex
tachycardia, nausea, vomiting, ataxia, tissue necrosis
DRUG INTERACTIONS
Incompatible with most drugs
DOSE/ROUTE
Adult: Seizure – 5 mg IV slow push or 10 mg IM. Anxiety – 2-5 mg IM, Pre-medicate for
cardioversion – 5-15 mg IV over 5-10 min prior to cardioversion.
Pediatric: Seizure – 0.5-1.0 mg/kg IV slow or 0.1-2.0 mg IM
PHARMACOKINETICS
Onset: 2-5 minutes; Peak effect: 15-30 minutes; Duration: 20-50 minutes
Pregnancy Category D, contraindicated in first trimester, rectal administration no longer
recommended
AEMT may give benzodiazepines only in status epilepticus. No other administration of benzodiazepines is allowed in Kansas Scope
of Practice.
10 Version 2018.1
DILTIAZEM HYDROCHLORIDE  EMR EMT AEMT PM
(Cardizem)
CLASSIFICATION
Calcium channel blocker, antidysrhythmic (class IV)
MECHANISM OF ACTION
Blocks calcium ion influx during depolarization of cardiac and vascular smooth muscles,
slows conduction thru the AV node, decreases rate of ventricular response, decreases
myocardial oxygen demand, causes vasodilation.
USES/INDICATIONS
Stable, narrow-complex tachycardia if rhythm remains uncontrolled or unconverted by
adenosine or vagal maneuvers or if SVT is recurrent. Control ventricular rate in patients
with atrial fibrillation or atrial flutter.
CONTRAINDICATIONS
Hypersensitivity, hypotension, cardiogenic shock, wide complex tachycardia, second- or
third-degree AV blocks, WPW syndrome.
Dizziness, weakness, headache, dyspnea, cough, heart failure, dysrhythmias,
bradycardia, hypotension, AV blocks, syncope, chest pain, cardiac arrest, vomiting, dry
mouth
DRUG INTERACTIONS
Caution in patients using medications that affect cardiac contractility, should not be
administered within 2-4 hours of IV beta-blockers.
DOSE/ROUTE
Adult: 0.25 mg/kg IV over 2 minutes, may repeat in 15 minutes at 0.35 mg/kg IV over 2
minutes.
Pediatric: Not recommended
PHARMACOKINETICS
Onset: 2-5 minutes; Peak effect: usually within 7 minutes; Duration: 1-3 hours
Pregnancy category C. Use caution with renal/hepatic dysfunction.
11 Version 2018.1
DIPHENHYDRAMINE  EMR EMT AEMT PM
(Benadryl)
CLASSIFICATION
Antihistamine (H1 blocker)
MECHANISM OF ACTION
Blocks H1 histamine receptors in the respiratory tract, blood vessels, and GI smooth
muscles; decreases motion sickness. Reverses extrapyramidal reactions.
USES/INDICATIONS
Anaphylaxis, allergic reactions, dystonic reactions due to phenothiazones
CONTRAINDICATIONS
Hypersensitivity to antihistamines, breastfeeding. Use caution with infants, children,
older adults, asthma, narrow-angle glaucoma, MAOI’s
Drowsiness, sedation, seizures, dizziness, headache, wheezing, thickening of bronchial
secretions, palpitations, hypotension. Hallucinations, confusion and paradoxical CNS
excitation can occur in children.
DRUG INTERACTIONS
Potentiates effects of alcohol and other CNS depressants. MAOIs prolong and intensify
anticholinergic effects.
DOSE/ROUTE
Adult: 25-50 mg IM, IV
Pediatric: 1-2 mg/kg IV, IO slowly, or IM.
PHARMACOKINETICS
Onset: 15-30 minutes; Peak effect: 1 hour; Duration: 3-12 hours
Pregnancy Category B.
12 Version 2018.1
DOPAMINE  EMR EMT AEMT PM
(Intropin)
CLASSIFICATION
Adrenergic, vasopressor, inotropic agent
MECHANISM OF ACTION
Immediate metabolic precursor to norepinephrine. Positive inotropic and chronotropic
effects. Constricts systemic vasculature, increasing BP and preload. Increases
myocardial contractility and stroke volume.
USES/INDICATIONS
Cardiogenic and septic shock, hypotension with low cardiac output, distributive shock,
symptomatic bradycardia refractory to atropine.
CONTRAINDICATIONS
Hypersensitivity, hypovolemic shock, uncorrected tachydysrhythmias, VF,
pheochromocytoma
Extravasation may cause tissue necrosis. Headache, anxiety, dyspnea, dysrhythmias,
hypotension, hypertension, palpitations, increased myocardial oxygen demand, cold
extremities.
DRUG INTERACTIONS
Incompatible with alkaline solutions. MAOIs will enhance the effect.
DOSE/ROUTE
Adult: 5-20 mcg/kg/min IV/IO infusion, slowly titrated to patient response.
Pediatric: 5-20 mcg/kg/min IV/IO infusion, slowly titrated to patient response.
PHARMACOKINETICS
Onset: 1-4 minutes; Peak effect: 5-10 minutes; Duration: effects cease almost
immediately when infusion is discontinued
Pregnancy Category C. Effects are dose dependent. Doses greater than 20
mcg/kg/min may compromise circulation in the limbs. Should be administered by
infusion pump. Dopaminergic effect helpful for renal blood flow.
13 Version 2018.1
EPINEPHRINE 1:1,000  EMR EMT AEMT PM
(Adrenaline)
CLASSIFICATION
Sympathomimetic
MECHANISM OF ACTION
Stimulates alpha, beta1, and beta2 adrenergic receptors resulting in relaxation of smooth
muscle of the bronchial tree. Cardiac stimulation and constriction of the vasculature.
USES/INDICATIONS
Anaphylaxis (allergic reaction with wheezing/dyspnea), asthma
CONTRAINDICATIONS
None for field emergent situations
Nervousness, restlessness, headache, tremor, pulmonary edema, dysrhythmias, chest
pain, hypertension, tachycardia
DRUG INTERACTIONS
Beta-blockers may blunt effects, deactivated by alkaline solutions
DOSE/ROUTE
Adult: 0.3 mg IM
Pediatric: 0.01 mg/kg up to 0.3 mg
PHARMACOKINETICS
Onset: immediate; Peak effect: minutes; Duration: several minutes
Pregnancy Category C.
EMR and EMT may only administer epinephrine 1:1,000 as a part of an auto-injector (EpiPen©).
AEMT may administer epinephrine either through auto-injector or via Subcutaneous or Intramuscular route.
14 Version 2018.1
EPINEPHRINE 1:10,000  EMR EMT AEMT PM
(Adrenaline) Ped cardiac arrest dose corrected 9-18-18
CLASSIFICATION
Sympathomimetic
MECHANISM OF ACTION
Cardiac stimulation and constriction of the vasculature. Stimulates alpha, beta1, and
beta2 adrenergic receptors resulting in relaxation of smooth muscle of the bronchial
tree.
USES/INDICATIONS
Cardiac Arrest (VF/VT non-perfusing, PEA, Asystole)
Profound bradycardia or hypotension as an alternative infusion to dopamine.
CONTRAINDICATIONS
None for cardiac arrest. Diabetes mellitus, cardiovascular disease
Nervousness, restlessness, headache, tremor, pulmonary edema, dysrhythmias, chest
pain, hypertension, tachycardia
DRUG INTERACTIONS
Beta-blockers may blunt effects, deactivated by alkaline solutions
DOSE/ROUTE
Adult: Cardiac Arrest - 1 mg IV/IO push every 3-5 minutes.
Pressor Agent:
Profound bradycardia or hypotension
Drip: 2-10 mcg/min titrate to response. Mix 1 mg in 250 ml normal saline or 5%
dextrose in water (D5W; 4 mcg/ml).
Push dose: 5-20 mcg IV every 2-5 minutes. (Take a 10 ml syringe with 9 ml normal
saline. Into this syringe, draw up 1 ml of 1: 10,000 epinephrine. Now you have 10 ml
epinephrine at a concentration of 10 mcg/ml.)
Pediatric: Cardiac Arrest – 0.01 mg/kg IV/IO push every 3-5 minutes
Drip: 0.1-1 mcg/kg/min
PHARMACOKINETICS
Pregnancy Category C. Epinephrine is 3A, 2B where norepinephrine is 1A, 4B
15 Version 2018.1
FENTANYL  EMR EMT AEMT PM
(Sublimaze)
CLASSIFICATION
Opioid analgesic; schedule II drug, (go-to-drug for cardiac pain)
MECHANISM OF ACTION
Binds to opiate receptors producing analgesia
USES/INDICATIONS
Pain management, Acute Coronary Syndrome
CONTRAINDICATIONS
Hypersensitivity, use caution with traumatic brain injury
Respiratory depression, CNS depression, apnea, sedation, confusion, paradoxical
excitation, delirium, drowsiness, bradycardia, tachycardia, hypotension, nausea.
DRUG INTERACTIONS
Increased respiratory effects when given with other CNS depressants.
DOSE/ROUTE
Adult: 25-100 mcg IM/IV (1mcg/kg) slow push over 1-2 minutes or 50-150 mcg IN
Pediatric: 1-2 mcg/kg IM, IV or IN slow push over 1-2 minutes.
Safety and efficacy in children younger than 2 years of age has not been established.
PHARMACOKINETICS
Onset: 1-3 minutes; Peak effect: 3-5 minutes; Duration: 30-60 minutes
Pregnancy Category C. Chest wall rigidity possible with high-dose rapid infusion. A
dose of 100 mcg fentanyl is equivalent to 10 mg morphine or 75 mg meperidine.
16 Version 2018.1
GLUCAGON  EMR EMT AEMT PM
(Glucagon)
CLASSIFICATION
Hyperglycemic agent, pancreatic hormone, insulin antagonist
MECHANISM OF ACTION
Increases blood glucose level by stimulating glycogenolysis. Unknown mechanism of
stabilizing cardiac rhythm in beta-blocker overdose. Decreases GI motility and
secretions. Minimal positive inotropic and chronotropic response.
USES/INDICATIONS
Hypoglycemia when IV access is unobtainable. Beta-blocker and calcium channel
blocker overdoses.
CONTRAINDICATIONS
Hyperglycemia, hypersensitivity
Headache, dizziness, hypertension, tachycardia, rebound hypoglycemia, nausea
DRUG INTERACTIONS
DOSE/ROUTE
Adult: Hypoglycemia - 1 mg IM/IN, may repeat in 7-10 minutes.
Calcium channel blocker or beta blocker overdose – 3-10 mg IV slowly over 3-5
minutes.
Pediatric: Hypoglycemia - 1 mg IM/IN, 0.5 gm if less than 20kg.
Calcium channel blocker or beta blocker overdose – 0.05-0.15 mg/kg IV/IO over 3-5
minutes.
PHARMACOKINETICS
Onset: 1 minute; Peak effect: 5-20 minutes; Duration: 60-90 minutes
Pregnancy Category C. Use in pregnancy only if clearly indicated. Ineffective if
glycogen stores in the liver have been depleted. Requires reconstitution with supplied
solution.
17 Version 2018.1
GLUCOSE  EMR EMT AEMT PM
(Insta-Glucose)
CLASSIFICATION
Hyperglycemic agent
MECHANISM OF ACTION
Provides quickly absorbed glucose to increase blood glucose levels
USES/INDICATIONS
Hypoglycemia
CONTRAINDICATIONS
Patients with altered mental status, nausea/vomiting
Nausea
DRUG INTERACTIONS
None
DOSE/ROUTE
Adult: 24 gm PO in patients with intact gag reflex and ability to manage their own
secretions.
Pediatric: 0.5-1 gm PO in patients with intact gag reflex and able to manage their own
secretions.
PHARMACOKINETICS
Onset: 10 minutes; Peak effect: variable; Duration: variable
Must be swallowed, glucose is not absorbed sublingually or buccally. Check a
glucometer reading before administering oral glucose and repeat at least 10 minutes
after.
18 Version 2018.1
IPRATROPIUM BROMIDE  EMR EMT AEMT PM
(Atrovent)
CLASSIFICATION
Anticholinergic, bronchodilator
MECHANISM OF ACTION
Blocks the action of acetylcholine at parasympathetic sites in bronchial smooth muscle
resulting in bronchodilation.
USES/INDICATIONS
Asthma, bronchospasm, COPD
CONTRAINDICATIONS
Hypersensitivity to ipratropium, atropine, alkaloids, peanuts.
Headache, dizziness, nervousness, tremor, blurred vision, cough, dyspnea, worsening
COPD symptoms, tachycardia, palpitations, flushing, MI, dry mouth, nausea, GI distress
DRUG INTERACTIONS
None reported
DOSE/ROUTE
Adult: 250-500 mcg in small volume nebulizer inhaled (typically administered with
albuterol) every 20 minutes. (3 doses max)
Pediatric: 250-500 mcg in small volume nebulizer inhaled (typically administered with
albuterol) every 20 minutes. (3 doses max)
PHARMACOKINETICS
Onset: 1-3 minutes; Peak effect: 90-120 minutes; Duration: 4-6 hours
EMTs may only administer ipratropium to patients in an “assist” manner, using the patient’s prescription Atrovent inhaler.
19 Version 2018.1
LIDOCAINE  EMR EMT AEMT PM
(Xylocaine)
CLASSIFICATION
Antiarrhythmic (Class IB), anesthetic
MECHANISM OF ACTION
Cardiac: Suppresses automaticity of conduction tissue by increasing electrical
stimulation threshold of ventricle.
Local anesthetic: Inhibits transport of ions across the neuronal membrane, blocking
conduction of normal nerve impulses.
USES/INDICATIONS
Ventricular tachycardia/fibrillation refractory to amiodarone
Local anesthetic for IO infusions
CONTRAINDICATIONS
Hypersensitivity, second- or third-degree blocks, ventricular escape rhythms, PVC’s in
conjunction with bradycardia
Anxiety, confusion, seizures, slurred speech, respiratory arrest, hypotension,
bradycardia, dysrhythmias, widening of QRS complex, cardiac arrest, AV block, nausea
DRUG INTERACTIONS
Prolongs apnea induced by succinylcholine, metabolic clearance decreased with liver
disease or beta-blockers.
DOSE/ROUTE
Adult: Local anesthetic for IO infusion – 40 mg IO slow over 2 minutes, wait 1 minute
then flush with 5-10 ml saline, then give another 20 mg IO slow over 1 minute. May be
repeated in 10 minutes if needed – 20 mg.
Cardiac Arrest – 1-1.5 mg/kg IV/IO push, repeat 0.5-0.75 mg/kg IV/IO in 5-10 minutes.
Max total dose 3 mg/kg. Maintenance infusion – 1-4 mg/min.
Pediatric: Local anesthetic for IO infusion – 0.5 mg/kg (MAX 20 mg) IO slow over 2
minutes, wait 1 minute then flush with 2-5 ml saline, then give another 0.25 mg/kg (MAX
10 mg) IO slow over 1 minute. May be repeated in 10 minutes if needed – 0.25 mg/kg
Cardiac Arrest – 1 mg/kg IV push (MAX dose 100 mg). Maintenance infusion – 20-50
mcg/kg/min.
PHARMACOKINETICS
Onset: 1-minute anesthetic, 1-5 minutes cardiac; Peak effect: 5-10 minutes; Duration:
15 minutes - 2 hours
Continued on next page
20 Version 2018.1
LIDOCAINE  EMR EMT AEMT PM
(Xylocaine)
Continued…
Pregnancy Category C. Reduce maintenance infusion by 50% if patient is older than 70
years of age, has liver or renal disease, is in heart failure or shock. A 75-100 mg bolus
maintains blood levels for only 20 minutes (if not in shock). Exceedingly high doses of
lidocaine can result in coma and death. Cross-reactivity with other forms of local
anesthetics.
AEMTs may only give lidocaine IO bolus or IV bolus. Either bolus may be repeated. Continuous infusion is not allowed at the
AEMT level.
Prepare maintenance drip by placing 2 gram of Lidocaine in 500 mL bag of NS. This gives a concentration of 4 mg/mL.
The overall benefit of Lidocaine for the treatment of arrhythmias in cardiac arrest has come under scrutiny. No short or long terms
efficacy has been shown. Prophylactic use in AMI is contraindicated.
21 Version 2018.1
LORAZEPAM  EMR EMT AEMT PM
(Ativan)
CLASSIFICATION
Benzodiazepine, anticonvulsant, sedative (schedule IV drug)
MECHANISM OF ACTION
Depresses all levels of the central nervous system (CNS)
USES/INDICATIONS
Status epilepticus, anxiety, sedation
CONTRAINDICATIONS
Hypersensitivity, coma, shock, suspected drug abuse, acute narrow-angle glaucoma
CNS depression, dizziness, drowsiness, headache, sedation, respiratory depression,
apnea, hypotension, bradycardia
DRUG INTERACTIONS
Other CNS depressant medications
DOSE/ROUTE
Adult: 1-4 mg IV/IO or deep IM. Must be diluted with equal volume sterile water if given
IV/IO. IM is not diluted.
Pediatric: 0.05-0.10 mg/kg IV/IO or deep IM (max 4 mg). Must be diluted with equal
volume sterile water if given IV/IO. IM is not diluted
PHARMACOKINETICS
Onset: 2-5 minutes IV, 15-30 minutes IM; Peak effect: variable; Duration: 6-8 hours
Pregnancy Category D. Fetal risk and maternal benefit should be considered prior to
using in emergency setting. Monitor respiratory rate and BP during administration.
Inadvertent arterial injection may result in vasospasm and gangrene. Lorazepam
expires in 6 weeks when not refrigerated.
of Practice.
22 Version 2018.1
MAGNESIUM SULFATE  EMR EMT AEMT PM
CLASSIFICATION
Electrolyte, anticonvulsant, antiarrhythmic
MECHANISM OF ACTION
Magnesium is necessary for the maintaining of serum potassium and calcium levels due
to its effect on the renal tubule. In the heart, it acts as a calcium channel blocker.
USES/INDICATIONS
Torsades de pointes, eclampsia (seizures), severe bronchoconstriction with impending
respiratory failure
CONTRAINDICATIONS
Heart block, myocardial damage,
CNS depression, respiratory depression, respiratory tract paralysis, abnormal ECG, AV
block, hypotension, vasodilation, hyporeflexia
DRUG INTERACTIONS
May enhance other CNS depressants
DOSE/ROUTE
Adult: Cardiac Arrest – 1-2 gm IV diluted to 10% solution, push over 2 minutes
Eclampsia – 2-4 gm IV diluted in 50-100 ml administered no faster than 150 mg/minute
Pulsatile patients – 1-2 gm IV diluted in 50-100 ml administered no faster than 150
mg/min.
Pediatric: 25-50 mg/kg IV/IO with rate considerations the same as for adult patients.
PHARMACOKINETICS
Onset: immediate; Peak effect: varies; Duration:1 hour
Pregnancy Category D. Due to confirmed evidence of human fetal risk, must be used
cautiously although administration may be justified. Recommended that the drug not be
administered in the 2 hours prior to delivery if possible. Use with caution in patients with
renal failure
When given to non-arrest patients, monitor respiratory rate and blood pressure closely, monitor patient for signs of magnesium
toxicity (hypotension, altered mental status, depressed respiratory effort, depressed cardiac function, conduction blocks, loss of
reflexes)
Eclamptic patients may need concurrent administration of benzodiazepines to stop seizures.
23 Version 2018.1
MIDAZOLAM  EMR EMT AEMT PM
(Versed)
CLASSIFICATION
Benzodiazepine, anticonvulsant, sedative
MECHANISM OF ACTION
Depresses all levels of Central Nervous System (CNS) function and provides
anterograde amnestic effects.
USES/INDICATIONS
Seizures, sedation for pacing or cardioversion
CONTRAINDICATIONS
Acute narrow angle glaucoma, shock, coma, alcohol intoxication, overdose, depressed
vital signs, shock
Somnolence, respiratory depression, respiratory arrest, apnea, hypotension, cardiac
arrest, nausea
DRUG INTERACTIONS
Other CNS depressants
DOSE/ROUTE
Adult: 2.5-5 mg IV or 5-10 mg IM/IN
Pediatric: 0.05 mg/kg IV or 0.1 mg/kg IM/IN
PHARMACOKINETICS
Onset: 1-3 minutes IV, 15 minutes IM; Peak effect: 20-60 minutes; Duration: <2 hours
IV, 1-6 hours IM
Pregnancy Category D. Requires continuous monitoring of respiratory and cardiac
function. Decrease dose by 50%in older patients or with hepatic or renal dysfunction.
of Practice.
The RAMPART study (Rapid Anticonvulsant Medications Prior to Arrival Trial) demonstrated effective seizure control with IM
Midazolam as compared to IV Clonazepam. Patients receiving IM Midazolam were more likely to be seizure free upon arrival at the
hospital and less likely to require hospitalization than those receiving IV Lorazepam.
24 Version 2018.1
MORPHINE SULFATE  EMR EMT AEMT PM
(MSO4)
CLASSIFICATION
Narcotic, analgesic, schedule II drug
MECHANISM OF ACTION
Binds to opioid receptors, displacing pain reception. Depresses brainstem respiratory
centers. Increases peripheral venous capacitance and decreases venous return.
USES/INDICATIONS
Severe pain - Burns
CONTRAINDICATIONS
Head injury, exacerbated COPD, depressed respiratory drive, hypotension,
undiagnosed abdominal pain, decreased level of consciousness, suspected
hypovolemia, MAOIs within past 14 days
Confusion, sedation, headache, CNS depression, respiratory depression, apnea,
bronchospasm dyspnea, hypotension, bradycardia, tachycardia, nausea
DRUG INTERACTIONS
CNS depressants may potentiate effects of morphine, MAOIs may cause paradoxical
excitation
DOSE/ROUTE
Adult: 2-10 mg IV slow push, titrate to effect
Pediatric: 0.1-0.2 mg/kg IV slow push or IM (max dose 5 mg)
PHARMACOKINETICS
Onset: immediate; Peak effect: 20 minutes; Duration: 2-7 hours
Pregnancy Category C. Morphine rapidly crosses the placenta, use cation during
pregnancy. Use caution with older patients, asthma, and those susceptible to CNS
depression.
25 Version 2018.1
NALOXONE  EMR EMT AEMT PM
(Narcan)
CLASSIFICATION
Narcotic antagonist
MECHANISM OF ACTION
Competes and displaces narcotics at the narcotic receptor sites
USES/INDICATIONS
Narcotic overdose including the following: morphine, hydromorphone (Dilaudid),
fentanyl (Sublimaze), meperidine (Demerol), paregoric, methadone, heroin,
hydrocodone, oxycodone (Percodan).
Synthetic analgesic overdoses including the following: Nubain, Stadol, Talwin, Darvon
CONTRAINDICATIONS
hypersensitivity
Seizures, restlessness, dyspnea, pulmonary edema, tachycardia, hypertension,
dysrhythmias, cardiac arrest, withdrawal symptoms in opioid-addicted patients,
diaphoresis
DRUG INTERACTIONS
Incompatible with bisulfite and alkaline solutions
DOSE/ROUTE
Adult: 0.5-2 mg IM/IV/IO/IN. Titrate to return of sufficient respiratory effort. For IN,
route, administer half the dose in each nostril. Max dose is 1 ml per nostril.
Pediatric: 0.1 mg/kg IM/IV/IO/IN. (Max total dose 2 mg).
PHARMACOKINETICS
Onset: <2 minutes IV, 15 minutes IM; Peak effect: <2 minutes; Duration: 20-120
minutes
Pregnancy Category C. Do NOT intubate until after having given naloxone without
effect. Use caution when administering to narcotic addicts (potential violent behavior).
Half-life of naloxone is often shorter than the half-life of narcotics; repeat dosing may be
required. Naloxone is generally not beneficial in cardiac arrest.
26 Version 2018.1
NITROGLYCERIN  EMR EMT AEMT PM
(Nitrostat, NTG) (Nitropaste, Nitro-Bid)
CLASSIFICATION
Vasodilator, antianginal
MECHANISM OF ACTION
Dilates coronary arteries and vasculature, decreases myocardial oxygen demand
USES/INDICATIONS
Acute angina pectoris, chest pain of suspected Acute Myocardial Infarction (AMI) or
suspected cardiac origin, heart failure, pulmonary edema
CONTRAINDICATIONS
Hypersensitivity, hypotension, hypovolemia, intracranial bleed or head injury, systolic
B/P less than 90 mm Hg, a pulse rate above 100 bpm, and patients who have taken
erectile dysfunction medications in the last 36 hours (Viagra, Levitra, Cialis, Revatio).
Headache, dizziness, reflex tachycardia, weakness, syncope, hypotension, nausea,
muscle twitching, diaphoresis.
DRUG INTERACTIONS
Additive effects with other vasodilators
DOSE/ROUTE
Adult: Tablet or Spray – 0.4 mg SL; may repeat every 5 minutes if SBP ≥ 90 mmHg.
Paste – 2% ointment applied 1” if SBP is ≥ 90 mmHg
PHARMACOKINETICS
Onset: 1-3 minutes SL, 30 minutes for paste; Peak effect: 20-30 minutes SL, variable
for paste; Duration: 20-30 minutes SL, 18-24 hours for paste
Pregnancy Category C. Hypotension more common in older patients. If 12-lead ECG
shows inferior wall infarct, rule out RV infarction via right-sided 12-lead ECG prior to
administering NTG. NTG decomposes when exposed to light or heat, must be kept in
airtight container. Active ingredient may have stinging effect when administered.
Wear gloves when applying or removing paste. Store paste in cool place with tube
tightly capped. Erratic absorption rates quite common with paste.
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NITROUS OXIDE  EMR EMT AEMT PM
(Nitronox, Enonox)
CLASSIFICATION
Analgesic
MECHANISM OF ACTION
CNS depressant, potent analgesic gas that contains a mixture of 50% oxygen and 50%
nitrous oxide.
USES/INDICATIONS
Moderate to severe pain, anxiety
CONTRAINDICATIONS
Altered LOC, head injury, inability to follow or comply with instructions, undiagnosed
abdominal pain or marked distension, bowel obstruction, hypotension, shock, COPD,
cyanosis, chest trauma with pneumothorax.
Dizziness, drowsiness, respiratory depression, apnea, nausea, malignant hyperthermia
DRUG INTERACTIONS
None of significance
DOSE/ROUTE
Adult: Patient self-administered until pain is relieved, only using fixed 50% nitrous oxide
and 50% oxygen blender.
Pediatric: same as adult
PHARMACOKINETICS
Onset: 2-5 minutes; Peak effect: variable; Duration: variable
28 Version 2018.1
OXYGEN  EMR EMT AEMT PM
CLASSIFICATION
Naturally occurring atmospheric gas
MECHANISM OF ACTION
Reverses hypoxia, necessary for cellular metabolism
USES/INDICATIONS
Hypoxia, any cause of decreased tissue oxygenation
CONTRAINDICATIONS
Non-hypoxic patients
May cause respiratory depression in patients with chronic carbon dioxide retention
DRUG INTERACTIONS
None
DOSE/ROUTE
Adult and Pediatric:
Nasal Cannula: 1-6 L/min
Non-rebreather mask: 10-15 L/min
Bag Valve Mask: 15-25 L/min
PHARMACOKINETICS
Onset: Immediate; Peak effect: N/A; Duration: Varies
Be familiar with liter flow rates and each type of delivery device used. Supports
combustion. Use caution with COPD
29 Version 2018.1
OXYTOCIN  EMR EMT AEMT PM
(Pitocin)
CLASSIFICATION
Pituitary hormone
MECHANISM OF ACTION
Increases uterine contractions
USES/INDICATIONS
Postpartum hemorrhage after infant and placental delivery
CONTRAINDICATIONS
Presence of second fetus, unfavorable fetal position
Coma, seizures, anxiety, subarachnoid hemorrhage, hypotension, tachycardia,
dysrhythmias, chest pain, nausea, painful uterine contractions, uterine rupture
DRUG INTERACTIONS
Other vasopressors may potentiate hypotension
DOSE/ROUTE
Adult: 10 units IM following delivery of placenta.
Pediatric: not applicable
PHARMACOKINETICS
Onset: IM - 3-5 minutes; Peak effect: variable; Duration: IM – 30-60 minutes
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PROMETHAZINE  EMR EMT AEMT PM
(Phenergan)
CLASSIFICATION
Phenothiazine, antiemetic, antihistamine
MECHANISM OF ACTION
H-1 receptor antagonist; blocks action of histamine; sedative, anti-motion, antiemetic,
and anticholinergic activity. Potentiates effects of narcotics to induce analgesia.
USES/INDICATIONS
Nausea/Vomiting
CONTRAINDICATIONS
Coma, CNS depression from alcohol, barbiturates, or narcotics, Reye syndrome,
asthma
Headache, dizziness, drowsiness, confusion, restlessness, wheezing, chest tightness,
thickening of bronchial secretions, palpitations, bradycardia, reflex tachycardia, QT
prolongation, postural hypotension.
DRUG INTERACTIONS
Additive with other CNS depressants, increased extrapyramidal effects with MAOIs
DOSE/ROUTE
Adult: 12.5-25 mg IV, deep IM
Pediatric: (over 2 years of age) 0.25-0.5 mg/kg deep IM
PHARMACOKINETICS
Onset: IV Immediate; Peak effect: 30-60 minutes; Duration: 4-6 hours
Pregnancy Category C. Contraindicated in breastfeeding women. Convulsions and
sudden death when used with children. Use caution with asthma, peptic ulcer, and bone
marrow suppression. Warn patient of impending burning with IM. Some systems have
removed IM administration due to reported pain and potential for tissue necrosis.
31 Version 2018.1
THIAMINE  EMR EMT AEMT PM
(Vitamin B1)
CLASSIFICATION
Vitamin
MECHANISM OF ACTION
Allows normal breakdown of glucose
USES/INDICATIONS
Should only be given if you are giving IV Dextrose and the patient has a history of
ETOH abuse, malnutrition, or is emaciated in appearance.
CONTRAINDICATIONS
Hypersensitivity
Rare anaphylactic reactions. Nausea, sweating, mild rash or itching, restlessness
DRUG INTERACTIONS
DOSE/ROUTE
Adult: 100 mg IM or IV slow push
Pediatric: Not applicable
PHARMACOKINETICS
Onset: Rapid; Peak effect: varies; Duration: varies
Should not be used as part of a “coma cocktail”
32 Version 2018.1
IV FLUID – DEXTROSE 5% IN WATER  EMR EMT AEMT PM
(D5W)
CLASSIFICATION
Hypotonic sugar solution
MECHANISM OF ACTION
Glucose nutrient solution
USES/INDICATIONS
IV access for emergency drugs, for dilution of concentrated drugs for infusion
CONTRAINDICATIONS
D5W should not be used as fluid replacement for hypovolemic states
Rare in therapeutic dosages.
DRUG INTERACTIONS
Do not use with phenytoin (Dilantin) or amrinone (Inocor)
DOSE/ROUTE
Adult and Pediatric: IV therapy generally administered thru a minidrip (60 drops/ml) set
at TKO rate
PHARMACOKINETICS
Duration: Short term therapy
None
33 Version 2018.1
IV FLUID – LACTATED RINGERS  EMR EMT AEMT PM
CLASSIFICATION
Isotonic crystalloid solution
MECHANISM OF ACTION
Approximates the electrolyte concentration of the blood. It is a balanced solution with
the idea that it will stay in the vascular space.
USES/INDICATIONS
Hypovolemic shock, hypoperfusion, TKO IV
CONTRAINDICATIONS
Congestive heart failure, renal failure, burns (lactate)
Rare in therapeutic dosages
DRUG INTERACTIONS
Few in the emergency setting
DOSE/ROUTE
Adult: Titrate to physiologic response.
Pediatric: 20 mL/kg IV/IO over 10-15 minutes; may be repeated
Neonate: Fluid bolus – 10mL/kg IV over 5-10 minutes, may be repeated
PHARMACOKINETICS
Duration: Short-term therapy
Monitor for circulatory overload. LR is a 3:1 replacement meaning for every liter lost, it
needs to be replaced with 3 liters of LR
34 Version 2018.1
IV FLUID – 9% SODIUM CHLORIDE  EMR EMT AEMT PM
(Normal Saline)
CLASSIFICATION
Isotonic crystalloid solution
MECHANISM OF ACTION
Fluid and sodium replacement
USES/INDICATIONS
Heat-related problems, freshwater drowning, hypovolemia, diabetic ketoacidosis, TKO
IV
CONTRAINDICATIONS
Congestive heart failure
Rare in therapeutic dosages
DRUG INTERACTIONS
Few in the emergency setting
DOSE/ROUTE
Adult: Dependent on patient’s condition and situation being treated; in freshwater
drowning and heat emergencies, administration is usually rapid.
Pediatric: Dependent on patient size and condition
PHARMACOKINETICS
Duration: Short-term therapy
Monitory for circulatory overload. NS is a 3:1 replacement meaning for every liter lost, it
needs to be replaced with 3 liters of NS
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CALCIUM CHLORIDE
CLASSIFICATION
Electrolyte
MECHANISM OF ACTION
Increases cardiac contractility
USES/INDICATIONS
Acute hyperkalemia, acute hypocalcemia, acute hypermagnesemia, beta-blocker and
calcium channel blocker overdose, abdominal muscle spasm associated with spider bite
and Portuguese man-of-war stings.
CONTRAINDICATIONS
Hypercalcemia, patients receiving digitalis
Syncope, cardiac arrest, dysrhythmia, bradycardia, hypotension, asystole, peripheral
vasodilation, nausea, vomiting, metallic taste, tissue necrosis at injection site, coronary
and cerebral artery spasm. Must be pushed slow – if pushed too fast, will cause a
“stone heart”.
DRUG INTERACTIONS
Incompatible with most all medications, flush IV/IO line before and after administration.
May cause severe bradycardia in patients taking digitalis. May antagonize effects of
calcium channel blockers.
DOSE/ROUTE
Adult: 500-1000 mg (5-10 ml of 10% solution) IV/IO slow push. May repeat at 10
minute intervals.
Pediatric: 20 mg/kg (0.2 ml/kg of a 10% solution) IV/IO slow push, max 1-g dose. May
repeat in 10 minutes.
PHARMACOKINETICS
Onset: 1-3 minutes; Peak effect: variable; Duration: 20-30 minutes but may persist for 4
hours (dose dependant).
Pregnancy Category C. Do not routinely use in cardiac arrest unless the underlying
cause of the arrest is an indication. Monitor IV site carefully, infiltration can result in
severe tissue necrosis and soughing. DO NOT administer IM or SQ.
Some orders call for up to a full gram of calcium in cardiac arrest.
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CAPTOPRIL
(Capoten)
CLASSIFICATION
Angiotension-converting enzyme (ACE) inibitor
MECHANISM OF ACTION
Peripheral smooth muscle relaxant thus lowering blood pressure (both systolic and
diastolic).
USES/INDICATIONS
Hypertension, congestive heart failure
CONTRAINDICATIONS
Pregnancy, angioedema, known hypersensitivity
Hypotension, cough, headache, dizziness, syncope
DRUG INTERACTIONS
N/A
DOSE/ROUTE
Adult: 12.5-25 mg SL
Pediatric: not indicated in prehospital setting
PHARMACOKINETICS
Onset: 30-40 minutes; Peak effect: 1 hour; Duration: 6-12 hours
Pregnancy Category C
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EPI-PEN, EPI-PEN JR
(Adrenaline)
CLASSIFICATION
Sympathomimetic, Catecholamine
MECHANISM OF ACTION
Causes vasoconstriction to reverse hypotension as well as bronchodilation to open
closed airways and correct wheezing in anaphylaxis.
USES/INDICATIONS
Anaphylaxis (allergic reaction with wheezing/dyspnea)
CONTRAINDICATIONS
None in anaphylaxis
Hypertension, tachycardia, arrhythmias, anxiety, restlessness, headache, nausea.
DRUG INTERACTIONS
DOSE/ROUTE
Adult: 0.3 mg EpiPen auto-injector >30 kg (66 lbs)
Pediatric: 0.15 mg EpiPen Jr auto-injector 15-30 kg (33-66 lbs)
PHARMACOKINETICS
EMR and EMT may only administer epinephrine 1:1,000 as a part of an auto-injector (EpiPen©).
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ETOMIDATE
(Amidate)
CLASSIFICATION
Nonbarbiturate hypnotic, anesthesia induction agent
MECHANISM OF ACTION
Short-acting hypnotic acts at the level of the reticular activating system.
USES/INDICATIONS
Premedication for medication-facilitated intubation (RSI) or procedural sedation.
CONTRAINDICATIONS
Hypersensitivity, labor/delivery, septic shock (particularly in children).
Apnea of short duration, respiratory depression, hypoventilation, hyperventilation,
dysrhythmias, hypotension, hypertension, involuntary muscle movement.
DRUG INTERACTIONS
Effects may be enhanced when given ith other CNS depressants.
DOSE/ROUTE
Adult: 0.2-0.6 mg/kg IV over 30-60 seconds (typical adult dose is 20 mg).
Pediatric: 0.2-0.4 mg/kg IV/IO over 60 seconds for RSI (older than 10 years of age) one
time only. Max dose 20 mg.
PHARMACOKINETICS
Onset: less than 1 minute; Peak effect: 1 minute; Duration: 5-10 minutes
Pregnancy Category C. Consider decreasing dose in older patients and patients with
cardiac conditions. Some suggest 0.1 mg/kg followed by a repeat of 0.1 mg/kg if
needed for those with a lower therapeutic threshold and/or clearance issues.
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FUROSEMIDE
(Lasix)
CLASSIFICATION
Loop diuretic
MECHANISM OF ACTION
Inhibits reabsorption of electrolytes in the distal and proximal tubules and the loop of
Henle, causing increased urine output. Some vasodilator effect, causing reduced
preload and blood pressure (BP)
USES/INDICATIONS
Heart failure, pulmonary edema, hypertensive crisis.
CONTRAINDICATIONS
Hypovolemia, anuria, hypotension (relative), hypersensitivity.
ECG changes, weakness, orthostatic hypotension, dysrhythmias, dry mouth, may
exacerbate hypovolemia and hypokalemia, hyperglycemia (due to hemoconcentration).
DRUG INTERACTIONS
Lithium toxicity may be potentiated because of sodium depletion; Digitalis toxicity may
be potentiated by potassium depletion.
DOSE/ROUTE
Adult: 0.5-1 mg/kg IV over 1-2 minutes. If no response, double the dose to 2 mg/kg IV
slowly over 1-2 minutes.
Pediatric: 1 mg/kg IV/IO
PHARMACOKINETICS
Onset: 5 minutes; Peak effect: 20-60 minutes; Duration: 4-6 hours
Pregnancy Category C. Ototoxicity, deafness, and projectile vomiting can occur with
rapid administration. Vasodilatory effects within 5 minutes. Expect a 10-12 mm Hg
systolic and 5-7 mm Hg diastolic drop in BP. Furosemide administration has decreased
with the advent of CPAP, and many CHF patients are already dehydrated.
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GLUCAGON AUTOINJECTOR
(Glucagon) – THIS PRODUCT DOES NOT EXIST
CLASSIFICATION
Hyperglycemic agent, pancreatic hormone, insulin antagonist
MECHANISM OF ACTION
Increases blood glucose concentration by stimulating glycogenolysis.
USES/INDICATIONS
Altered level of consciousness when hypoglycemia is suspected.
CONTRAINDICATIONS
Hypersensitivity, hyperglycemia.
Headache, hypertension, tachycardia, nausea, rebound hyperglycemia
DRUG INTERACTIONS
No significant interactions with other emergency medications.
DOSE/ROUTE
Adult: 1 mg IM via auto-injector
Pediatric: 1 mg IM via auto-injector
PHARMACOKINETICS
Pregnancy Category B. Use in pregnancy only if clearly indicated. Ineffective if
glycogen stores are depleted.
EMT may only give glucagon via auto-injector.
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HYDROMORPHONE HYDROCHLORIDE
(Dilaudid)
CLASSIFICATION
Narcotic Analgesic; schedule II
MECHANISM OF ACTION
Binds to opioid receptors in CNS
USES/INDICATIONS
Moderate to severe pain
CONTRAINDICATIONS
Hypersensitivity, GI obstruction, respiratory depression, shock
Hypotension, syncope, increased intracranial pressure, apnea, constipation
DRUG INTERACTIONS
MAOIs, SSRIs, sedatives
DOSE/ROUTE
Adult: 1-2 mg IM, 0.2-1 mg IV
Pediatric: 0.8-2 mg IM, 0.2-0.6 mg IV (0.015mg/kg IV)
PHARMACOKINETICS
Onset: IM variable, IV 5 minutes; Peak effect: IM variable, 10-20 minutes IV; Duration:
2-3 hours
Pregnancy Category C. Increased side effects in the elderly.
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KETAMINE
(Ketalar)
CLASSIFICATION
Sedative, analgesic dissociative anesthetic
MECHANISM OF ACTION
Blocks pain receptors and minimizes spinal cord activity, affecting the association
pathways of the brain between the thalamus and limbic system.
USES/INDICATIONS
Excited delirium, pain management, procedural sedation.
CONTRAINDICATIONS
Hypersensitivity, significant elevation of blood pressure
Hypertension, dysrhythmia, bronchodilation, respiratory depression, hallucinations,
increased skeletal muscle tone
DRUG INTERACTIONS
Ketamine increases the effect of opiates, barbiturates, and nondepolarizing
neuromuscular blockers
DOSE/ROUTE
Adult: 1.25-2.5 mg/kg IV push over 1-2 minutes, 2.5-5.0 mg/kg IM. Max dose 500 mg
Pediatric > 6 months: 1.25-2.5 mg/kg IV push over 1-2 minutes, 2.5-5.0 mg/kg IM.
PHARMACOKINETICS
Onset: 30 seconds; Peak effect: unknown; Duration: 5-10 minutes
Ketamine can cause hallucinations following waking that can be quite severe; the
incidence of these is higher in adults than in children. Hallucinations can be avoided by
keeping the environment quiet while the patient emerges from anesthesia. Keep
resuscitation equipment available. Monitor EKG, SpO2, and EtCO2 during
administration.
Psych effects increase if given too fast.
Alternate administration method for pain management/sedation

Put dose in 50 cc, flow wide open (deliver over 2-5 minutes). This negates side effects
and can be shut down when desired effect is reached.
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KETOROLAC
(Toradol)
CLASSIFICATION
Nonsteroidal anti-inflammatory (NSAID)
MECHANISM OF ACTION
Anti-inflammatory, analgesic, antipyretic
USES/INDICATIONS
Mild to moderate pain
CONTRAINDICATIONS
Allergy to salicylates or other NSAIDs, asthma
Headache, sedation, bronchospasm, dyspnea, edema, vasodilation, hypotension,
hypertension, GI bleeding, diarrhea, dyspepsia, nausea
DRUG INTERACTIONS
May increase bleeding time in patients taking anticoagulants.
DOSE/ROUTE
Adult: 30-60 mg IM, 15-30 mg IV
PHARMACOKINETICS
Onset: 10 minutes; Peak effect: 1-2 hours; Duration: 2-6 hours
Pregnancy Category C. Use with caution in older patients due to higher risk of renal and
fatal GI adverse reactions. Use caution if pain is possibly from a traumatic source.
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LABETALOL
(Trandate, Normodyne)
CLASSIFICATION
Antihypertensive agent, selective alpha and nonselective beta-adrenergic blocker.
MECHANISM OF ACTION
Blocks alpha1, beta1, and beta2 adrenergic receptor sites
USES/INDICATIONS
Moderate to severe hypertension
CONTRAINDICATIONS
Bronchial asthma, heart failure, cardiogenic shock, second- and third-degree heart
block, bradycardia
Weakness, depression, headache, dizziness, bronchospasm, wheezing, dyspnea,
bradycardia, heart failure, pulmonary edema, orthostatic hypotension, ventricular
dysrhythmias, nausea.
DRUG INTERACTIONS
May block bronchodilator effects of beta-adrenergic agonists. NTG may augment
hypotensive effects.
DOSE/ROUTE
Adult: 20 mg IV slow push, follow with 20-80 mg IV slow push every 10 minutes until
desired supine blood pressure is obtained or until 300 mg total has been given.
PHARMACOKINETICS
Onset: less than 5 minutes; Peak effect: variable; Duration: 3-6 hours
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MEPERIDINE
(Demerol)
CLASSIFICATION
Narcotic analgesic, schedule II drug
MECHANISM OF ACTION
Synthetic opioid analgesic, primarily acting as an analgesic and sedative, similar to
morphine
USES/INDICATIONS
Moderate to severe pain
CONTRAINDICATIONS
Hypersensitivity to narcotics, diarrhea caused by poisoning, MAOIs, undiagnosed
abdominal pain or head injury
Seizures, confusion, sedation, dysphoria, headache, hallucinations, increased ICP,
respiratory depression, apnea, hypotension, orthostatic hypotension, bradycardia,
dysrhythmias, nausea, constipation, sweating
DRUG INTERACTIONS
MAOIs (within last 14 days), exacerbates CNS depression when given with other CNS
depressants
DOSE/ROUTE
Adult: 25-50 mg IV slow or 50-100 mg IM
Pediatric: 1-2 mg/kg IV/IO/IM
PHARMACOKINETICS
Onset: IM – 10-45 minutes, IV - immediate; Peak effect: 30-60 minutes; Duration: 2-4
hours
Pregnancy Category C. Use with caution in patients with asthma and COPD. May
aggravate seizures in patients with known convulsive disorders.
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METHYLPREDNISOLONE
(Solu-Medrol)
CLASSIFICATION
Corticosteroid
MECHANISM OF ACTION
Inhibits the synthesis of pro-inflammatory enzymes, immediate acting steroid,
suppresses immune response (especially in allergic reactions)
USES/INDICATIONS
Anaphylaxis, allergic reactions, asthma/COPD, hypersensitivity conditions
CONTRAINDICATIONS
Hypersensitivity
Euphoria, headache, restlessness, seizure, increased ICP, pulmonary tuberculosis,
hypertension, heart failure, nausea, fluid retention, hypernatremia, hyperkalemia
DRUG INTERACTIONS
Hypoglycemic responses to insulin and hypoglycemic agents may be blunted
DOSE/ROUTE
Adult: 125-250 mg IV/IO/IM
Pediatric: 1-2 mg/kg IV/IO/IM (max dose 60 mg/24 hours)
PHARMACOKINETICS
Onset: 1-2 hours; Peak effect: variable; Duration: 8-24 hours
Pregnancy Category C. Crosses the placenta and may cause fetal harm. Use caution in
pregnant and breastfeeding women.
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METOCLOPRAMIDE
(Reglan)
CLASSIFICATION
Antiemetic
MECHANISM OF ACTION
Metoclopramide is a dopamine receptor antagonist, which stops the relaxation of the
stomach muscles. At low doses, metoclopramide speeds the emptying of the stomach.
At high doses, metoclopramide works by blocking the messages to the part of the brain
responsible for nausea and vomiting.
USES/INDICATIONS
Nausea, vomiting
CONTRAINDICATIONS
Hypersensitivity, epilepsy, GI bleed or obstruction, heart failure, liver disease, Parkinson
disease, pheochromocytoma, renal failure, seizure disorder.
Fluid retention, headache, somnolence, dystonic reaction, dizziness, confusion, AV
block, bradycardia.
DRUG INTERACTIONS
CNS depressants, antihistamines, anticholinergics, MAOIs
DOSE/ROUTE
Adult: 10 mg IV slow push over 1-2 minutes or IM
Pediatric: 0.1-0.2 mg/kg IV over 1-2 minutes or IM (max dose 10mg)
PHARMACOKINETICS
Onset: 1-3 minutes; Peak effect: 30-60 minutes; Duration: 1-2 hours
Pregnancy Category B
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ONDANSETRON
(Zofran)
CLASSIFICATION
Anti-emetic, Serotonin receptor antagonist
MECHANISM OF ACTION
Blocks action of serotonin, a natural substance that causes nausea and vomiting
USES/INDICATIONS
Nausea/vomiting
CONTRAINDICATIONS
Hypersensitivity or allergy to ondansetron or other 5-HT3 receptor antagonists
Headache, malaise, wheezing, bronchospasm, AF, abnormal ECG, prolonged QT
interval, ST segment depression, second-degree AV block, hives, skin rash, diarrhea
DRUG INTERACTIONS
Not recommended if the patient is taking apomorphine, mesoridazine, pimozide, or
thioridazine
DOSE/ROUTE
Adult: 4 mg IV over 2 minutes, may repeat once in 10 minutes
Pediatric: 1 month – 12 years old – 0.1 mg/kg IVSP, max dose is 4.0 mg
 12 years old or > 40 kg – 4.0 mg IVSP
PHARMACOKINETICS
Onset: 30 minutes; Peak effect: 2 hours; Duration: 3-6 hours
Pregnancy Category B. Ondansetron prolongs QT interval in dose-dependent manner.
Torsade’s has been reported following ondansetron administration. Avoid use with
congenital long QT syndrome. Monitor ECG with electrolyte imbalances
(hypmagnesemia/hypokalemia), CHF, brady-arrhythmias, or patients taking other meds
that lead to QT prolongation.
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PREDNISONE
CLASSIFICATION
Corticosteroid
MECHANISM OF ACTION
Suppresses inflammation and normal immune response
USES/INDICATIONS
Asthma, COPD, allergic reaction
CONTRAINDICATIONS
Hypersensitivity, fungal infections
Fluid retention, GI perforation, pancreatitis, thromboembolic disorders, pulmonary
edema, electrolyte imbalances, myocardial damage, heart failure, shock, syncope,
cardiac arrest, increased blood glucose
DRUG INTERACTIONS
Thiazides, NSAIDs, digoxin
DOSE/ROUTE
Adult: 20-60 mg PO
Pediatric: 1-2 mg/kg PO
PHARMACOKINETICS
Onset: hours; Peak effect: unknown: Duration: 1-25-1.5 days
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SODIUM BICARBONATE
(Na2HCO3)
CLASSIFICATION
Alkalinizing agent, systemic hydrogen ion buffer
MECHANISM OF ACTION
Dissociates to provide bicarbonate ion, which neutralized hydrogen ion concentrations
and raises blood and urinary pH
USES/INDICATIONS
Symptomatic Tricyclic Antidepressant (TCA) overdose, cardiac arrest with suspected
hyperkalemia and acidosis
CONTRAINDICATIONS
Metabolic and respiratory alkalosis, hypokalemia, electrolyte imbalance due to severe
vomiting and dehydration, precipitates with calcium chloride
Hypernatremia, metabolic alkalosis, tissue soughing, cellulitis, necrosis at injection site,
seizures, hypokalemia, electrolyte imbalance, tetany
DRUG INTERACTIONS
Increases effects of amphetamines, decreases effects of benzodiazepines, tricyclic
antidepressants.
DOSE/ROUTE
Adult: 1 mEq/kg IV slow push over 2 minutes. May repeat at 0.5 mEq/kg every 10
minutes
Pediatric: 1 mEq/kg IV/IO slow push over 2 minutes. May repeat at 0.5 mEq/kg every 10
minutes
PHARMACOKINETICS
Onset: seconds; Peak effect: 1-2 minutes; Duration: 10 minutes
Pregnancy Category C. Repeat as needed in tricyclic antidepressant overdose until
QRS narrows. Avoid contact with other medications; may precipitate or inactivate them.
Always flush IV line well before and after injecting. Use caution with heart failure or
renal disease. Monitor closely for fluid overload.
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SUCCINYLCHOLINE
(Anectine)
CLASSIFICATION
Neuromuscular blocker, depolarizing; skeletal muscle relaxant
MECHANISM OF ACTION
Ultra-short-acting depolarizing skeletal muscle relaxant that mimics acetylcholine as it
binds with the cholinergic receptors on the motor end plate, producing a phase 1 block
as manifested by fasciculations.
USES/INDICATIONS
Facilitate endotracheal intubation
CONTRAINDICATIONS
Hypersensitivity, malignant hyperthermia, acute narrow-angle glaucoma, penetrating
eye injuries, acute injury after multisystem trauma, major burns, extensive muscle injury
that may result in hyperkalemia
Apnea, respiratory depression, bradydysrhythmia, tachydysrhythmia, cardiac arrest,
salivation, prolonged muscle rigidity, rhabdomyolysis, malignant hyperthermia,
increased ocular pressure, hyperkalemia (trauma patients)
DRUG INTERACTIONS
Oxytocin, beta blockers and organophosphates may precipitate effects.
DOSE/ROUTE
Adult and Pediatric: 1-2 mg/kg rapid IV
Pediatric:
PHARMACOKINETICS
Pregnancy Category C. If patient is conscious, explain effects of drug before
administration. Appropriate sedation and analgesia should be used in any conscious
patient before undergoing neuromuscular blockade. Time management is crucial. Post-
intubation sedation and analgesia should be readily available.
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VECURONIUM BROMIDE
(Norcuron)
CLASSIFICATION
Neuromuscular blocker, nondepolarizing
MECHANISM OF ACTION
Neuromuscular agent with intermediate duration of action that competes with
acetylcholine for receptors at the motor end plate, resulting in neuromuscular blockade.
USES/INDICATIONS
Facilitate endotracheal intubation
CONTRAINDICATIONS
Acute narrow-angle glaucoma, penetrating eye injuries, newborns, myasthenia gravis,
hepatic or renal failure
Prolonged neuromuscular block, weakness, bronchospasm, apnea, dysrhythmias,
bradycardia, tachycardia, PVCs, transient hypotension, cardiac arrest, excessive
salivation
DRUG INTERACTIONS
Inhalation anesthetics will enhance neuromuscular blockade
DOSE/ROUTE
Adult and Pediatric (over 1 year of age): 0.1-0.2 mg/kg IV push.
PHARMACOKINETICS
Onset: 1-3 minutes; Peak effect: varies; Duration: 45-90 minutes
Pregnancy Category C. If patient is conscious, explain the effect of the medication
before administration and always sedate the patient before using vecuronium.
Vecuronium has no effect on consciousness or pain. Will not stop neuronal seizure
activity. Pulse rate and cardiac output are increased. Decrease doses for patients with
renal disease.
53 Version 2018.1

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Hutchinson Community College

Emergency Medical Services Education

Table of Contents  Indicates in National Paramedic Curriculum

ACTIVATED CHARCOAL  EMR EMT AEMT PM

(Actidose, EZ-Char, Liqui-Char)

Pediatric: 1-2 g/kg PO (BLS) or NG tube (ALS)

ADENOSINE  EMR EMT AEMT PM

(Adenocard) Peds dose corrected 9-18-18

ALBUTEROL  EMR EMT AEMT PM

AMIODARONE  EMR EMT AEMT PM

ASPIRIN  EMR EMT AEMT PM

ATROPINE SULFATE  EMR EMT AEMT PM

DEXTROSE  EMR EMT AEMT PM

DIAZEPAM  EMR EMT AEMT PM

DILTIAZEM HYDROCHLORIDE  EMR EMT AEMT PM

DIPHENHYDRAMINE  EMR EMT AEMT PM

DOPAMINE  EMR EMT AEMT PM

EPINEPHRINE 1:1,000  EMR EMT AEMT PM

EPINEPHRINE 1:10,000  EMR EMT AEMT PM

(Adrenaline) Ped cardiac arrest dose corrected 9-18-18

FENTANYL  EMR EMT AEMT PM

GLUCAGON  EMR EMT AEMT PM

GLUCOSE  EMR EMT AEMT PM

IPRATROPIUM BROMIDE  EMR EMT AEMT PM

LIDOCAINE  EMR EMT AEMT PM

Continued on next page

LIDOCAINE  EMR EMT AEMT PM

LORAZEPAM  EMR EMT AEMT PM

MAGNESIUM SULFATE  EMR EMT AEMT PM

Eclamptic patients may need concurrent administration of benzodiazepines to stop seizures.

MIDAZOLAM  EMR EMT AEMT PM

MORPHINE SULFATE  EMR EMT AEMT PM

NALOXONE  EMR EMT AEMT PM

NITROGLYCERIN  EMR EMT AEMT PM

(Nitrostat, NTG) (Nitropaste, Nitro-Bid)

NITROUS OXIDE  EMR EMT AEMT PM

OXYGEN  EMR EMT AEMT PM

OXYTOCIN  EMR EMT AEMT PM

PROMETHAZINE  EMR EMT AEMT PM

THIAMINE  EMR EMT AEMT PM

IV FLUID – DEXTROSE 5% IN WATER  EMR EMT AEMT PM

IV FLUID – LACTATED RINGERS  EMR EMT AEMT PM

IV FLUID – 9% SODIUM CHLORIDE  EMR EMT AEMT PM

EMR EMT AEMT PM

EMR EMT AEMT PM

EMR EMT AEMT PM

EMR EMT AEMT PM

EMR EMT AEMT PM

EMR EMT AEMT PM

EMR EMT AEMT PM

EMR EMT AEMT PM

Alternate administration method for pain management/sedation

EMR EMT AEMT PM

EMR EMT AEMT PM

EMR EMT AEMT PM

EMR EMT AEMT PM

EMR EMT AEMT PM

EMR EMT AEMT PM

EMR EMT AEMT PM