Essential Pre-Hospital Medications

Classification Confusion

Classification of drugs
Therapeutic use.
Antiarrhythmics , analgesic, respiratory, etc.
Mechanism of action.
Class I II III Similar therapeutic use with
different mechanisms of action. (VaughnWilliams classifications of antiarrhythmics).
Probable effectiveness. (Class of
recommendation.) Class I, II -a, II-b
indeterminate and III (AHA).

Vaughn-Williams Classifications
of Antiarrhythmics
Class I: Sodium Channel Blockers.
I a: Supra-ventricular myocardial effects.
I b & I c: Ventricular myocardial effects.
Class II Beta blocker agents
Class III Prolong depolerization.
Class IV Calcium channel blockers.
Miscellaneous: Cardiac glycosides: Sodium,
Potassium ATP inhibitors. (Digitalis).
Adenosine: Potassium channel activator.

Class of Recommendation.
Based on clinical study evidence of
effectiveness. (AHA)

Class I : Interventions are always acceptable, safe and

effective. Considered 1st line standard of
care.
Class II-a: Interventions are safe and useful. Considered
interventions of choice by most experts.
Class II-b: Interventions are safe and useful. Considered
alternate or optional interventions by majority
of experts.
Indeterminate: Evidence insufficient to support a class
decision
Class III: Not acceptable , not useful, may be harmful.

Therapeutic classifications: Cardiac

Drugs:
Antiarrhythmics: Atrial / Ventricular
Adernergics: (Sympathomimetics) used to
increase heart rate and blood pressure.
Beta 1 Heart effects: Increase rate, force of contraction.
Beta 2 Respiratory effects: Bronchodilation / vasodilation
Alpha 1 Vascular effects : Vasoconstriction /
bronchoconstriction.
Alpha 2 Inhibits release of Norepinephrine
Dopaminergic Vascular effects: dilates renal, cerebral and
coronary arteries

Therapeutic classifications: Cardiac

Drugs contd:
AntiCholinergics: (Parasympatholytic) Vagal
nerve blocker; Blocks acetylcholine receptors.
Antianginals: (Nitrate vasodilators.) Dilate
coronary arteries, reduce cardiac oxygen demand.
Analgesics: Pain relievers.
Thrombolytics: (Platelet aggregate inhibitors)
Prevent blood clot formation or dissolve existing
clots.

Therapeutic Classifications:
Respiratory Drugs
Diuretics: Loop (Blocks sodium re-absorption) treatment
of CHF induced pulmonary edema. Osmotic: (promotes
fluid shift from intra-cellular to extra-cellular space) Mannitol
Beta 2 selective Sympathomimetics: Beta 2 agonists:
Bronchodilators.
Corticosteroids: Inhibit inflammatory responses.
Antihystamines: Blocks histamine release in allergic
reactions.
Paralytics: Neuromuscular blocker Agents
(Succinylcholine (Anectine) Used in rapid sequence intubation
to prevent laryngospasm..

Therapeutic Classifications:
Other Emergency Drugs
Carbohydrates: (Simple sugar)
Opioid antagonist (Blocks effects of narcotics)
Vitamin (Specifically B1) Needed for glucose
metabolism.
Alkalizing agent (Hydrogen ion buffer)
Anticonvulsant / tranquilizers: siezure control
create retrograde amnesia.

A look at whats in the box.

Atrial Antiarrhythmics
Adenosine (Adenocard) Potassium channel
activator.
Verapamil (Calan, Isoptin) Calcium channel
blocker.
Digitalis (Digoxin) Cardiac glycoside
(Sodium,potassium and ATP inhibitor) Note: Digitalis is
not a pre-hospital drug but may be the cause of arrhythmia your
patient is in. Digitalis toxicity is a major cause of ventricular
irritability. Usual dose 0.25 to 0.50 mg slow IV over 5-8 minutes.

Adenosine (Adenocard)
Class: Atrial Anti-dysrhythmic
Action: Slows conduction through SA and AV
node. Acts as chemical cardioverter of supraventricular dysrhthmias. Activates potassium
channels.

Adenosine
Indications:
Narrow complex tachycardia SVT & PSVT .

Precautions:
Less effective in patients taking theophylline
(bronchodilator), Avoid in patients taking
Dipyridomole (persantine) a platelet inhibitor
used post cardiac surgery.
May cause hypotension or deterioration of
patients with wide complex tachycardia.

Adenosine
Contraindication:
Poison or drug-induced tachycardia.

Side effects:
Flushing, chest pain or tightness, brief period
of asystole or bradycardia and ventricular
ectopy.
Note: Sinus bradycardia and PVCs are
common after termination of SVT.

Adenosine
Dosage and route of administration:
Place patient in mild reverse Trendelenberg
position. (Lazy-boy recliner position) Note: use
IV injection port closest to patient.
Initial dose 6 mg rapid IV push followed
immediately by 20 ml Normal saline flush.
Repeat at 12 mg in 1-2 min if needed may give
third dose at 12mg. Do not exceed 30 mg total.

Verapamil ( Calan, Isoptin)

Class: Atrial Anti-arrhythmic
Calcium cannel blocker.
Action:
Delays AV nodal conduction and inhibits atrial
dysrhythmias.

Indications:
1st line for treatment of atrial fibrillation or
atrial flutter with rapid ventricular rates. 2nd
line for treatment of narrow complex
tachycardias refractory to Adenosine.

Verapamil
Precautions:
Give only to patients with narrow complex
PSVT or arrhythmia known to be of supraventricular origin (narrow QRS).
Use with caution in patients taking oral beta
blockers (may cause severe hypotension)

Verapamil
Side effects:
Hypotension due to decreased peripheral
vasodilation. Hypotension may be reversed by
administration of Calcium.
Exacerbation of CHF due to decreased myocardial
contractility in patients with left ventricular
dysfunction.

Contraindications:
Hypotension; Wide complex tachycardia

Verapamil
Dosage and route of administration:
2.5 to 5.0 mg IV bolus over 2 minutes.(slow IV
push)
Repeat at 5.0 to 10 mg (Double initial dose) if
needed in 15 to 30 minutes. Maximum dose: 20
mg
Note: In elderly patient administer dose over 3
minutes to prevent hypotension.

Ventricular Antiarrhythmics
Amiodarone
(Cordarone) (class III)*
Lidocaine
(Xylocaine) (class I-b)*
Procainamide
(Pronestyl)
(class Ia)*
Bretylium Tosylate
(Bretylol)
(class
III)*
Magnesium sulfate
(class II-a)*
* Vaughn -Williams classification of antiarrhythmics

Amiodarone (Cordarone)
Classification: Ventricular Antiarrhythmic.
Action:
Class I,II &III antiarrhythmic properties.
Sodium/potassium channel blocker.

Indications:
Pulseless V-Tach and V-Fib refractory to defibrillation.
V-Tach with pulse refractory to cardioversion
2nd line to Adenosine for PSVT refractory to
cardioversion. 2nd line to Verapamil for A-fib & Aflutter refractory to cardioversion

Amiodarone
Indications contd.:
Wide complex tachycardia of undetermined
origin.
Torsades de pointe following Magnesium
sulfate and refractory to cardioversion.

Amiodarone
Precautions:
May cause hypotension due to vasodilation.
Due to long half life (40 days) use with caution
in patients with renal failure.
May prolong QT interval.

Amiodarone
Side effects:
Hypotension (treat by slowing IV rate,
dopamine may be indicated in extreme
cases.)

Contraindications:
Cardiogenic shock, Hypotension, Sinus
Bradycardia, II and III degree AV-block.

Amiodarone
Dosage and route of administration:
Cardiac Arrest: 300 mg IV push. May repeat at
half initial dose in 3-5 minutes.
Maximum cumulative dose: 2.2 gm IV / 24hrs.
Wide-Complex Tachycardia (Stable V-Tach): 150
mg IV infusion over 10 min (15mg/ min.) Repeat
every 10 min as needed.
Maintainance Infusion: 1mg/min IV

Lidocaine (Xylocaine)
Classification:
Ventricular antiarrhythmic (class 1b), Local
anesthetic

Action:
Suppresses ventricular ectopy and increases
ventricular fibrillation threshold. Decreases
automaticity and refractory period of ischemic
ventricular myocardium.

Lidocaine
Indications:
Ventricular fibrillation and pulseless
ventricular tachycardia. Wide complex
tachycardia ( stable V-Tach) and ventricular
ectopy( malignant PVCs).

Precautions:
Reduce dosage and rate of infusion in
patients over 60 and patients with liver
disease or CHF.

Lidocaine
Side effects:
Numbness, tingling, drowsiness,
disorientation, convulsions, coma and
respiratory arrest. (Slow or stop IV infusion if
side effects occur.)

Contraindications:
Prophylactic use in AMI patients. Bradycardia
with ventricular ectopy (treat with atropine or
pacemaker not lidocaine.)

Lidocaine
Dose and route of administration:
Cardiac arrest: 1-1.5 mg / kg IV push loading
dose. Followed in 5-10 minutes by half initial
dose. Up to 3mg/kg total dose.
Wide complex tachycardia (stable V-Tach)
Ventricular ectopy (PVCs) Same as above but
should be pushed slowly over one minute.
Note: Initial dose of Lidocaine can be given
down the ET tube at 2 to 2.5 times the IV dose.

Lidocaine Maintenance Drip

Mix 1 gm lidocaine with 250 ml D5W
or 2 gm lidocaine with 500ml D5W = 0.4%
solution 4mg /ml. ( 1- 4 mg / minute standard
dose)
60 gtt / minute = 4mg/minute
45 gtt / minute = 3mg/minute
30 gtt /minute = 2mg/min
15 gtt / minute = 1 mg /minute

Procainamide (Pronestyl)
Classification: Ventricular antiarrhythmic
(class 1a)
Action:
Suppresses depolarization in normal
Ventricular muscle and Purkinje fibers
reducing the automaticity of ectopic
pacemaker sites. Suppresses reentry
dysrhythmias by slowing intraventricular
conduction.

Procainamide
Indications:
Control of PSVT in patients resistant to Adenosine
and vagal maneuvers if blood pressure is stable.
Stable Wide complex tachycardia of unkown origin.
Atrial fibrillation with rapid rate caused by Wolf
Parkinson White syndrome.
V-Tach and V-fib refractory to Amiodrone or Lidocaine.

Procainamide
Precautions:
Reduce dosage in patient with renal
dysfunction.
May cause hypotension in patients with
impaired left ventricular function.
Use with caution with other drugs that prolong
QT interval (Amiodarone)

Procainamide
Side effects:
Hypotension, bradycardia, reflex tachycardia,
AV block, widened QRS or prolonged P-R
interval or Q-T interval, CNS depression,
confusion and seizures.

Contraindications:
2nd and 3rd degree heart block. Digitalis
toxicity, Torsades de pointe and tricyclic
antidepressant toxicity.

Procainamide
Dose and route of administration:
Cardiac arrest: 20 mg / minute IV infusion.
Maximum total dose of 17 mg /kg Stop infusion if
patient develops hypotension or 50% increase
in QRS width.
Refractory V-F and V-T: 100 mg IV push may
be repeated in 5 minutes.

Procainamide Maintenance Drip

After resuscitation from cardiac arrest in
response to Procainamide therapy.
Mix 1g with 500 ml D5W = 2 mg/ml = 2mg/ml
or Mix 1g with 250 ml D5W = 4 mg /ml (same as
a Lidocaine or Bretylium drip)

Bretylium Tosylate (Bretylol)

Classification:Ventricular antiarrhythmic
(class III) (2nd or 3rd line drug)
Action:
Adernergic neuronal blocking agent with
direct myocardial effects suppresses
ventricular ectopy raises fibrillation
threshhold.

Bretylium
Indications:
V-F & V-T refractory to other ventricular
antidysrhythmics.

Note: No longer included in current

AHA 2000 cardiac resuscitation
guidelines or ACLS algorithms .
However it is still currently in use in
many systems.

Bretylium
Side effects:
Vertigo, vomiting, syncope, bradycardia,
angina pectoris and transient hypotension
lasting approximately 20 minutes.

Contraindications:
Digitalis toxicity induced dysrhythmia.

Bretylium
Dose and route of administration:
5 mg/kg rapid IV bolus, initial dose.
Repeat in 5-10 minutes at 10mg /kg (maximum
total IV bolus dose of 30 mg / kg)
Maintenance drip: Mix 2 g with 500 ml D5W or
1g with 250 ml D5W = 4mg/ml solution ( same
as Lidocaine or Procainamide)

Magnesium Sulfate
Classification: Electrolyte,
Anticonvulsant, (Class II a) ventricular
anti-arrhythmic.
Action:
Reduces striated muscle contractions and
blocks peripheral neuromuscular transmission
by reducing acetylcholine release.

Magnesium Sulfate
Indication: Tosades de pointe, eclampsia,
hypo-magnesemia and refractory ventricular
fibrillation.
Precautions: May cause hypotension if
administered too rapidly. Use cautiously in renal
failure patients.

Magnesium Sulfate
Side effects:
Diaphoresis, facial flushing, hypotension,
hypothermia, reduced heart rate, respiratory
depression and diarrhea.

Contraindications:
Heart blocks

Magnesium Sulfate
Dose and route of administration:
Torsades and refractory V-F:
1-2 g (2-4 ml of 50% solution) diluted with 10 ml
of D5W over 1-2 minutes in Torsades. Rapid IV
push for V-F
Seizures: 2-4 g IV slow iv push.

Parasympatholytic
(Anticholinergic agent)

Atropine Sulfate (Atropine)

Atropine Sulfate
Classification: Parasympatholytic
(anticholinergic)
Action :
Blocks acetylcholine receptor sites. Reverses
vagal induced bradycardias. Increases heart
rate. Potentiates the sympathetic response
in asystolic patients.

Atropine
Indications:
Symptomatic bradycardia. Asystole, PEA,
Organophosphate poisoning or nerve gas (sarin)
poisoning.

Precautions:
Bradycardia in acute myocardial infarct patient may
be compensatory. Increasing heart rate may increase
infarct of myocardial tissue due to increased Oxygen
demand. TCP is treatment of choice in this case.

Atropine
Side effects:
Tachycardia, palpitations, dry mouth, headache,
dizziness, N & V, flushed hot dry skin. If pushed too
slowly or at too low of dose may worsen the
bradycardia.

Contraindicated:
Tachycardia, Narrow Angle Glucoma, GI tract
obstruction, Ischemic chest pain due to AMI. Known
drug allergy. Patients on IV diueretic therapy, may
cause inability to void.

Atropine
Dosage and route of administration:
Bradycardia: 0.5 - 1 mg IV push. May be
repeated in 3-5 minutes. Maximum cumulative
dose of 0.4 mg/kg. (3 mg)
Cardiac arrest: 1 mg IV push every five minutes
up to Maximum dose of 0.4 mg/kg (3mg).
Initial dose of Atropine may be give down the ET
tube at 2-2.5 times the IV dosage.

Sympathomimetics
(Adrenergic agents)
Cardiac: Beta 1
Epinephrine (Adrenalin)
Dopamine (Dopastat, Intropin)
Respiratory: Beta 2
Albuterol (Proventil, Ventolin)
Metaproterenol (Alupent)

Epinephrine (Adrenalin)
Classification:
Sympathomimetic / Bronchodilator.

Actions:
Stimulates alpha and beta adrenergic
receptor sites.

Epinephrine
Indications:
Cardiac arrest (V-T, V-F, PEA and asystole) ,
symptomatic bradycardia, anaphlactic shock
and asthma.

If you need CPR, you need Epi.

Precautions:
Do not mix with sodium bicarb. Use with other
sympathomimetic drugs causes additive
effects.

Epinephrine
Side effects:
None in cardiac arrest. Palpitations, angina,
tachy-arrythmias, nausea, vomiting,
headache, or dizziness in non-cardiac arrest
patients.

Contraindications:
None in life threatening conditions.

Epinephrine
Dosage and route of administration:
Epinephrine comes in two concentrations :

1:10,000 = 1mg / 10 ml (cardiac use)

( respiratory use)
Cardiac arrest: 1mg IV push every every 3-5
minutes during resuscitation. Follow each dose
with 20ml saline flush and 1 minute of CPR .

1:1000 = 1mg / 1 ml

Epinephrine
Cardiac arrest: High Dose: 0.2 mg/kg IV push
every 3- 5 minutes.
Continuous infusion: 30 mg 1:1000 solution
added to 250 ml normal saline run at 100 ml /hr
Tracheal: 0.2 - 2.5 mg 1:1000 mixed with 10 ml.
normal saline down endotracheal tube. Often
preferred for initial dose.

Epinephrine
Bradycardia / Hypotension: 2 to 10 mcg /min.
( add 1mg of 1:1000 to 500 ml normal saline):
infuse at 2-10 mcg /min. titrate to effect.
Anaphylaxis / asthma: 0.3 to 0.5 mg 1:1000
SC
Pediatric dose: 0.01mg/kg

Dopamine (Intropin)
Classification: Sympathomimetic
Actions: Stimulates both alpha and beta receptors.
Effects are dose dependant.
Low dose: 1 -5 mcg/kg/min. = (Renal & mesenteric
vasodilation)
Moderate dose: 5 -10 mcg/kg/min. = (Cardiac,
increased rate, force of contraction)
High dose: 10 -20 mcg/kg/min.= (Vasopressor
peripheral and renal vasoconstriction.)

Dopamine
Indications:
Hypotension associated with cardiogenic
shock or bradycardia. May be used to treat
hypotension caused by hypovolemia after
fluid replacement.

Precautions:
Use with extreme caution in patients with
ischemic heart disease or occlusive vascular
disease. May worsen their condition due to
vasoconstriction.

Dopamine
Side effects:
Ectopic heart beats, tachycadrdia,
bradycardia, angina, nausea & vomiting,
hypertension and headache.

Contraindications:
Hypovolemic Shock in prehospital setting
(concentrate on fluid replacement and rapid
transport).

Dopamine
Dosage and route of administration:
Always administered IVP Drip.
Mix 400mg with 250 ml D5W or N/S
or 800mg with 500 ml = 1.6 mg /ml
concentration = 1600 mcg / ml.
Low dose: 1-5 mcg /kg / min.
Moderate dose: 5-10 mcg / kg / min.
High dose: 10-20 mcg/kg/min.

Respiratory Drugs
Sympathomimetics: Beta 2 selective
Albuterol: (Ventolin, Proventil)
Metaproterenol (Alupent)
Corticosteroids:
Methylprednisolone: (Solu-Medrol)
Antihystamines:
Diphenhydramine: (Benadryl)
Diuretics: Furosemide: (Lasix)

Albuterol (Ventolin, Proventil)

Classification: Sympathomimetic /
Bronchodilator.
Action:
Selectively stimulates Beta 2 adrenergic
receptor sites. Relaxes smooth muscles in the
bronchiol tree and peripheral vascular system.

Albuterol
Indications:
Relief of bronchospasm in patients with reversible
obstructive pulmonary disease (Asthma). Prevention
of exercise induced bronchospasm.

Precautions:
Use with caution in patients taking other
sympathomimetics, may cause cardiac arrythmias.
Pts. on antidepressants may become hypotensive.
Beta blockers antagonize albuterol.

Albuterol
Side effects:
Usually dose dependant. Restlessness,
apprehension, dizziness, palpitations,
tachycardia, dysrhythmias.

Contraindications:
Tachycardia, known drug allergy.

Albuterol
Dosage and route of administration:
Metered Dose Inhaler: 1 to 2 inhalations 90
to180 mcg q 4-6 hours (5 min. between
inhalations) Max of 12 inhalations /day.
O2 Nebulizer : 2.5 mg in 5 ml over 5 to 10
minutes inhalation.

Metaproterenol (Alupent)
Class : Beta 2 selective Sympathomimetic
Action: Bronchodilator.
Indications, Side effects, contraindications
and precautions same as Albuterol.
Dosage and route of administration:
O2 nebulizer 5-15 inhalations of 15% solution.
or MDI 2-3 inhalations 2 min between inhalations
q 3-4 hrs.

Methylprednisolone (Solu-Medrol)
Classification: Corticosteroid (antiinflamatory agent)
Action:
Synthetic steroid that suppresses acute and
chronic inflammation. Potentiates smooth
muscle relaxation by beta adrenergic
agonists.

Methylprednisolone
Indications:
Anaphylaxis, asthma, acute spinal cord injury.

Precautions: May cause hypoglycemia

in insulin dependant diabetics.

Methylprednisolone
Side effects:
Headache, hypertension, sodium and water
retention, hypokalemia, hypoglycemia,
alkalosis.

Contraindications:
Diabetes mellitus, severe infection (sepsis),
GI bleeding.

Methylprednisolone
Dosage and route of administration:
Asthma / Anaphylaxis: 40 -125 mg IV push.
Spinal cord injury: 30 mg/ kg IV bolus followed
by IV infusion of 5.4 mg/kg/hour.
Note: Use for spinal cord injury is not a pre-hospital
intervention at this time. Airway management, spinal
immobilization and rapid transport is priority.

Diphenhydramine (Benadryl)
Classification: Antihistamine
Actions:Blocks the effects of histamine

Diphenhydramine
Indications:
Mild to moderate allergic reactions. Use with
Epinephrine to treat anaphylactic shock.

Precautions:
Use with caution in patients with Hypertension,
narrow angle glaucoma, heart disease. Elderly
patients may be extremely sensitive monitor
closely for hypotension and seizures.

Diphenhydramine
Side effects:
Drowsiness, headache, wheezing,
palpitations, tachycardia, hypotension,
nausea and vomiting.

Contraindications:
Astma, COPD attacks.

Diphenhydramine
Dosage and route of administration:
10 - 50mg IV or deep IM

Furosemide (Lasix)
Classification: Loop Diuretic
Action:
Inhibits re-absorption of sodium and chloride
in the loop of Henley in the kidneys.
Promotes rapid diuresis, reduces venous
return to right atria (pre-load), helps remove
excess fluid in conditions of fluid over load,
decreases after-load.

Furosemide
Indication:
Used to relieve acute pulmonary edema in patients
with systolic blood pressure above 90 mm/ Hg (with
no signs and symptoms of shock.)

Hypertensive crisis, increased intracranial

pressure.
Precautions:
Diuretic therapy may cause hypotension, dehydration,
hypovolemia, hypokalemia and other electrolyte
imbalances.

Furosemide
Side effects:
Orthostatic hypotension, dehydration, nausea
and vomiting if administered to rapidly.

Contraindications:
Pregnancy, hypotension, hypovolemia, known
drug allergy.

Furosemide
Dosage and route of administration:
0.5 to 1.0 mg/kg over 1-2 minutes slow IV push.
May repeat at double initial dose in 5-10
minutes if initial dose was not effective.
Standard pre-hospital dose ranges for adult.
20 - 40 mg IV (Pt. not on oral diuretics)
40 - 80 mg IV (Pt. on oral diuretics.)

Other Cardiac Emergency Drugs

Anti-anginal Agent: Nitroglycerine (Nitrostat)

Platelet Aggregate Inhibitor: (Asprin)
Analgesics: Morphine, Meperidine (Demoral)
Alkalinizing Agent: Sodium Bicarbonate.

Electrolyte: Calcium Chloride

Nitroglycerine (Nitrostat /Nitrobid)

Classification: Vasodilator / Anti-anginal
Action:
Relaxes vascular smooth muscle, causes
vasodilation which increases coronary blood
flow; reduces preload. Lowers myocardial
oxygen demand.

Nitroglycerine
Indications:
Ischemic chest pain, CHF, hypertension crisis.

Precautions:
Lowers blood pressure (limit drop in B/P to
10% in cardiac patients and 30 % in
hypertensive patients). Patient should be
sitting or lying down when drug is
administered. If using aerosol spray form do
not shake, as this affects metered dose.
Potentiates effects of other vasodilators.

Nitroglycerine
Side effects:
Headache, hypotension, nausea, vomiting,
tachycardia.

Contraindications:
Do not administer to any patient who has
used the anti-impotence drug Viagra with in
the past 24-36 hours. Systolic B/P less than
90 mm/Hg.

Nitroglycerine
Dosage and route of administration:
Sublingual tablets: 0.3 -0.4 mg 1 tablet every 5
minute up to a total of 3 maximum. Monitor B/P
between Tabs.
Sublingual Spray: 0.4 mg/spray (same as
above)
Trans-dermal ointment/paste: 1 to 2 inches
(15 -30 mg) applied to skin of chest wall.

Aspirin (ASA)
Classification:
Platelet aggregate inhibitor, thrombolytic,
analgesic and anti-inflammatory.

Action:
Impedes clotting action and platelet
aggregation by blocking prostaglandin
synthetase action, (Thromboxane A2 the
enzyme that causes platelets to stick together
to form a blood clot and constricts injured
vessels).

Aspirin
Indications:
Symptomatic ischemic chest pain. Sings and
symptoms of acute CVA.

Precautions:
Use with caution in patients with history of
asthma, post operative surgical patients, and
patients taking Warfarin (Coumadin)

Aspirin
Side effects:
Nausea, vomiting, heartburn, bronchospasm,
dizziness and occult bleeding.

Contraindications:
Recent history of GI bleeding or ulcers.
Known bleeding disorders. Known sensitivity
or allergy to ASA.

Aspirin
Dosage and route of administration:
160 to 325 mg chewed.
Note: (Use of chewable baby aspirin is highly
recommended.)

Morphine Sulfate (Astramorph/PF)

Classification:
Opioid (narcotic) Analgesic (Schedule II controlled
substance)

Action:
CNS depressant with analgesic and hemo-dynamic
effects. Increases systemic venous capacitancy which
decreases venous return and vascular resistance,
relieving pulmonary congestion and reducing myocardial
oxygen demand. Reduces sensitivity to pain.

Morphine
Indications:
Pain and anxiety associated with acute
myocardial infarction. Acute pulmonary
edema associated with CHF. Severe pain.

Precautions:
Watch for respiratory depression. Naloxone
(Narcan) should be available to reverse
possible adverse affects.

Morphine
Side effects:
Dizziness, nausea, vomiting, altered level of
consciousness and respiratory depression.

Contraindications:
Head injury, significant hypotension,
abdominal pain, COPD, Known
hypersensitivity.

Morphine
Dosage and route of administration:
2 to 5 mg slow IV push no faster than 2 mg /
minute titrate to 50% reduction of pain. Do not
exceed a total dose of 15 mg.

Meperidine (Demoral)
Classification: Opioid (narcotic)
analgesic. (Schedule II controlled
substance)
Action:
Synthetic opioid agonist that works at opioid
receptors sites in CNS to induce analgesia
and euphoria.

Meperidine
Indication:
Moderate to severe pain. Pain caused by
musculoskeletal injury and kidney stones.

Precaution:
May cause CNS and respiratory depression.
Use with caution in patients with history of
seizure disorder. Have Naloxone available to
reverse adverse effects.

Meperidine
Side effects:
Respiratory depression, lightheadedness,
euphoria, nausea, vomiting, hypotension and
bradycardia.

Contraindications:
Ischemic chest pain (unless patient is allergic
to morphine.) Head injury, abdominal pain and
hypersensativity to drug.

Sodium Bicarbonate
Classification: Alkalinizing agent; buffer.
Action:
Neutralizes excess build up of acid (Hydrogen
ions) caused by severe hypoxic states, Helps
restore normal pH.

Sodium Bicarbonate
Indications:
Treatment of tricyclic antidepressant
overdose. For severe acidotic states. Used in
prolonged cardiac arrest after defibrillation
and cardiac medications.

Precautions:
Use with caution in CHF. Dosage should be
calculated based on arterial blood gas
analysis when ever possible. Note: Adequate
ventilation airway management and CPR are the
major buffer agents used in cardiac arrest.

Sodium Bicarbonate
Side effects: Alkalosis, CHF and muscle
cramps.
Contraindications:
Should not be used in metabolic or respiratory
alkalosis.
Note: No longer recommended for routine
use in cardiac arrest patients.(AHA 2000
guidelines)

Sodium Bicarbonate
Dosage and route of administration:
1 mEq/kg IV bolus followed by half dose every
10 minutes. Consult Medical control

Calcium Chloride
Classification: Electrolyte
Action:
Essential component for the proper
functioning of nervous, musculoskeletal and
endocrine systems. Increases force of
myocardial contractions.

Calcium Chloride
Indications:
Hypocalcemia, Hyperkalemia, overdose of
Magnesium Sulfate, Verapamil and other
calcium channel blockers. Black Widow
spider bite. Cardiac arrest when
hyperkalemia is suspected.

Precautions:
Renal failure and history of heart disease.

Calcium Chloride
Side effects:
Cardiac arrhythmias, headache, dizziness,
hypotension, nausea, vomiting and
hypercalcemia.

Contraindications:
Known hypercalcemia, Digitalis toxicity,
ventricular fibrillation.

Calcium Chloride
Dose and route of administration:
4 to 12 mg/kg slow IV push at rate of 0.5 to 2.0
ml per minute; 1 ml of 10% solution=100mg of
drug.
May be repeated at same dose in 10 minutes if
needed.

Drugs Used To Treat

Unconsciousness

Vitamin B1: (Thiamine)

Narcotic Antagonist: Naloxone (Narcan)
Carbohydrate: Dextrose 50%
Anti-hypoglycemic agent: Glucagon
Anticonvulsant: Diazepam (Valium)

Thiamine
Classification: Vitamin B1
Action:
Coenzyme necessary for carbohydrate
metabolism and the breakdown of glucose.

Thiamine
Indication:
Administered prior to Dextrose 50%
(particularly in known alcoholics) to prevent
Wernickes encephalopathy, (brain swelling
and resulting increased ICP)

Precautions:
Very safe in emergency setting; anaphylactic
reactions are extremely rare.

Thiamine
Side effects: Hypotension and / or nausea are
possible but rare.
Contraindications: None in emergency setting.

Thiamine
Dosage and route of administration:
100 mg slow IV push or IM

Naloxone (Narcan)
Classification: Narcotic Antagonist
Action:
Reverses effects of narcotics and certain
synthetic analgesics.

Naloxone
Indications:
To reverse CNS depression effects of narcotics and
synthetic analgesics. Used to rule out narcotic
overdose in coma of unknown origin.

Precautions:
duration of action is less than the drug effects of agents
it is used to treat. Patient may relapse and require
repeat dosing. May induce withdrawal syndrome in
addicts. (Patient should be restrained prior to
administration.)

Naloxone
Side effects:
Nausea and vomiting at high doses when
rapidly administered.

Contraindications:
None; except known hypersensitivity to drug.

Naloxone
Dosage and route of administration:
0.4 to 2.0 mg IV may be repeated as needed up
to maximum of 10 mg.
IV is route of choice, may also be given IM, SC,
or via ET, if IV access is unavailable.
Higher doses may be needed to reverse effects
of synthetic narcotics such as Fentanyl.

Dextrose 50%
Classification: Carbohydrate (simple
sugar)
Action:
Rapidly elevates blood glucose levels.

Dextrose 50 %
Indications:
Treatment of hypoglycemia. Used to rule out
hypoglycemia as cause in coma of unknown origin.
Also used to treat seizures caused by hypoglycemia.

Precautions:
Administer Thiamine first if alcohol abuse is
suspected. Contact medical control prior to
administration in suspected CVA or increased ICP.
Check patency of IV line prior to administration.

Dextrose 50 %
Side effects:
Local venous irritation and possible tissue
necrosis if subcutaneous infiltration occurs.
Wernickes encephalopathy can occur in
patients that are B1 deficient.

Contraindications:
None in emergency situation.

Dextrose 50%
Dosage and route of administration:
Adult: 25 gm slow IV push. (50 ml of 50 %
solution.)
Pediatric: Use 25 % solution. 0.5 to 2 gm/kg
slow IV push.

Glucagon
Classification: Anti-hypoglycemic agent
Action:
Promotes the breakdown of glycogen to
glucose in liver, releasing stored glucose into
blood increasing blood glucose level.
Relaxes gastrointestinal smooth muscle.

Glucagon
Indications:
Hypoglycemia, Esophogitis, for relaxation of
smooth muscle in cases of food obstruction of
esophagus.

Precautions: None in emergency setting.

Glucagon
Side effects:
Dizziness, lightheadedness, nausea, vomiting
and urticaria.

Contraindications:
Known hypersensitivity.

Glucagon
Dosage and route of administration:
0.5 to 1.0 units IV, IM, SC may be repeated in
10-15 minutes if needed.
Note: Obtain pre-administration blood sample for
hospital use prior to administration.

Diazepam (Valium)
Classification:Tranquilizer,
Anticonvulsant
Action:
Reduces anxiety, suppresses seizure activity,
induces amnesia, relaxes skeletal muscle.

Diazepam
Indications:
Generalized seizures and status epilepticus,
acute anxiety, pre-medication before
cardioversion, relaxation of skeletal muscle.

Precautions:
Short duration of effect may require repeat
dosing. Local venous irritation may occur at IV
site.

Diazepam
Side effects:
Respiratory depression, drowsiness,
hypotension, apnea.

Contraindications:
Respiratory depression of any source.
Patients who have taken alcohol or other
sedatives, severe hypotension.

Diazepam

Dosage and route of administration:

Status epilepticus: 5 to 15 mg IV
Acute anxiety: 2 to 10 mg IV or IM
Cardioversion: 5 to 15 mg IV