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27 Cards in this Set
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GENERIC NAME: CHARCOAL, ACTIVATED
BRAND NAME: Charcoal, Actidose-Aqua |
GENERIC NAME: CHARCOAL, ACTIVATED
Mechanism of Action: Pharmacological: Physical binding (adsorption) of poisons from GI tract. Clinical effects: Prevents/reduces systemic absorption of poisons. Indications and Field Use: Sole prehospital therapy of oral ingestion of poisons Pre-lavage of oral ingestions of poison substances Contraindications: Ingestion of caustics (risk of gastrointestinal hemorrhage) Ingestion of hydrocarbons (relative) Oral administration to comatose patient Simultaneous administration of other oral drugs Absence of bowel sounds Gastrointestinal perforation Intestinal obstruction Recent surgery Adverse Reactions: May provoke vomiting, diarrhea and constipation May worsen overdosed induced Ileus Pulmonary aspiration Fecal discoloration (black) Acute pancreatitis Adult Dosage: 50-100 Gm (1-2 Gm/kg) as a single initial dose; if not in pre-mixed slurry, mix one part charcoal with four parts water. Routes of Administration: Oral (po), nasogastric tube (ng), orogastric (og) Onset of Action: Immediate |
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GENERIC NAME: ADENOSINE
BRAND NAME: Adenocard |
GENERIC NAME: ADENOSINE
Mechanism of Action: Slows conduction time through AV node; can interrupt re-entrant pathways through the AV node. Slows sinus rate. Larger doses decrease BP by decreasing peripheral resistance. Indications and Field Use: Conversion of supraventricular tachycardias with no known atrial fibrillation or atrial flutter. Wide complex tachycardia of uncertain origin unresponsive to lidocaine. Contraindications: Sick sinus syndrome, 2nd or 3rd degree AV blocks; except in patients with a functioning ventricular pacemaker. Use cautiously in patients with known asthma (has precipitated acute bronchospasm). Patients on theophylline and related methylxanthines. Patients on dipyridamole (Persantine) or carbamazepine (Tegretol). Cardiac transplant patients are more sensitive to adenosine and require only a small dose (relative). Known atrial fibrillation or atrial flutter. Pregnancy (no controlled studies) Adverse Reactions: CV: Transient dysrhythmias (systole, bardycardia, PVC's) occur in 55% of patients (none reported as irreversible). Palpitations, chest pressure, chest pain, hypotension, transient hypertension; facial flushing, sweating. Resp: Dyspnea, hyperventilation, tightness in throat, bronchospasm. CNS: Lightheadedness, headache, dizziness, paresthesias, apprehension, blurred vision, neck-back pain. GI: Nausea, metallic taste. Adult Dosage: Initial: 6 mg rapid IV bolus over 1-3 seconds Special administration procedure: Follow immediately with 20 ml normal saline flush. IV site recommended is antecubital fossa (close to central circulation); use injection port nearest hub of IV catheter; arm elevated during procedure; constant ECG monitoring. Repeat: If no response in 1-2 minutes (of each dose, respectively) may repeat 12 mg, twice, utilizing the same procedure for repeat dose. Pediatric Dosage: (Drug of choice for treating SVT in symptomatic infants and children) Initial: 0.1 mg/kg as a rapid IV bolus. Special administration procedure: Follow immediately with 2-3 ml normal saline flush. Use injection port nearest the hub of IV catheter for procedure; constant ECG monitoring. Repeat: If no response, dose may be doubled 1 time (0.2 mg/kg) using same administration procedure. Maximum singe dose: Should not exceed 12 mg. Infants with SVT associated with shock: Adenosine may precede cardioversion if vascular access is available, but cardioversion should not be delayed while IV access is achieved. Routes of Administration: Rapid IV push Onset of Action: Seconds Duration of Action: 10-12 seconds (1/2 life 5 seconds) |
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GENERIC NAME: ALBUTEROL SULFATE
BRAND NAME: Proventil, Ventolin |
GENERIC NAME: ALBUTEROL SULFATE
CLASS: sympathomimetic, bronchodilator Mechanism of Action: ß agonist (primarily ß2); relaxes bronchial smooth muscle, resulting in bronchodilation; also relaxes vascular and uterine smooth muscle; decreases airway resistance Indications and Field Use: Treatment of bronchospasm Contraindications: Synergistic with other sympathomimetics Use caution in patients with diabetes, hyperthyroidism, and cerebrovascular disease Adverse Reactions: CV: Dysrhythmias, tachycardia (with excessive use), peripheral vasodilation Resp: Bronchospasm (rare paradoxical with excessive use) CNS: Tremors, nervousness GI: Nausea, vomiting Endocrine: Hyperglycemia Adult Dosage: Give 2.5 mg of premixed solution for inhalation (0.083%) via SVN with a mouth piece, or in-line with a ventilatory device. Repeated according to medical control preference Pediatric Dosage: (children <40 lbs) For children < 40 lbs., administer half of 0.083% premixed solution; add 1-1.5 ml NS to make 2.5-3 cc inhalation treatment administered via SVN with a mouth piece, O2 mask or in-line with a ventilatory device. May be repeated according to medical control preference Onset of Action: 5-15 minutes Duration of Action: 3-4 hours |
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Generic Name: AMIODARONE
Class: Antiarrhythmic Agent |
Generic Name: AMIODARONE
Mechanism of Action: Multiple effects on sodium, potassium and calcium channels. Prolongs action potential, refractory period. Ventricular automaticity (potassium channel blockade). Slows membrane depolarization and impulse conduction (sodium channel blockade). Negative chronotropic activity in nodal tissue, rate reduction, and antisympathetic activity (calcium channel and β-blockade). Dilates coronary arteries due to calcium channel and alpha-adrenergic blocking action. Indications for use: Treatment of: defibrillation-refractory VF/pulseless VT, polymorphic VT, and wide complex tachycardia of uncertain origin. Control hemodynamically stable ventricular tachycardia when cardioversion unsuccessful. Adjunct to cardioversion of SVT and PSVT. Rate control in atrial fibrillation or flutter. Contraindications: Bradycardia Second or third degree heart block unless a functioning pacemaker is present Cardiogenic shock Hypotension Pulmonary congestion Adverse Reactions: Cardiovascular: bradycardia, hypotension, asystole/cardiac arrest, atrio-ventricular block Torsades de Pointes (prolongs QTc interval), congestive heart failure GI & Hepatic: nausea, vomiting, abnormal liver function tests Skin: slate-blue pigmentation Other: fever, headache, dizziness, flushing, abnormal salivation, photophobia Adult Dosage: VF/Pulseless VT 300 mg IV push over 30 – 60 seconds, may repeat in 3-5 minutes with 150 mg IV push Wide-Complex Tachycardias, Atrial Flutter, Atrial Fibrillation, SVT with cardioversion 150 mg IV over 10 minutes (mix in 50 mL bag of D5W) may repeat every 10 minutes Maintenance Infusion Post Resuscitation/Conversion After successful defibrillation, follow with up to 1mg/min IV infusion for 6 hours, then up to 0.5 mg/min IV infusion for up to 18 hours, maximum daily dose is 2.2 grams Mix 450 mg in 250 mL of D5W (special polyolefin bag), concentration 1.8 mg/mL, and run at 33.3 mL/hr for 1 mg/min or 16.7 mL/hr for 0.5 mg/min For Other Maintenance infusion Rates range from 0.5 mg/min to 1mg/min. Maximum daily dose is 2.2 grams Pediatric Dosage: VF/Pulseless VT 5 mg/kg IV push (max 300 mg single dose), may repeat every 5 minutes two times to a total maximum of 15 mg/kg/day Probable VT with pulse 5 mg/kg IV administered over 20 minutes may repeat two more times to a total of 15 mg/kg/day |
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GENERIC NAME: ACETYLSALICYLIC ACID, ASPIRIN, ASA
BRAND NAME: Bufferin, Anacin, APC, among others |
GENERIC NAME: ACETYLSALICYLIC ACID, ASPIRIN, ASA
Mechanism of Action: In small doses aspirin blocks thromboxane A2, a potent platelet aggregant and vasoconstrictor. This property has lead to its use in the acute phase of management of the myocardial infarction. Decreased platelet aggregation. Indications and Field Use: Chest pain or other signs/symptoms suggestive of acute myocardial infarction ECG changes suggestive of acute myocardial infarction Unstable angina Pain, discomfort, fever in adult patient only Contraindications: Bleeding ulcer, hemorrhagic states, hemophilia Known hypersensitivity to salicylates or other non-steroidal anti-inflammatories that has lead to hypotension and/or bronchospasm Children and adolescents (prehospital personnel should not administer ASA to this age group) Adverse Reactions: Use with caution in the patient with history of asthma. Anaphylactic reactions in sensitive patients have occurred; skin eruptions Other side effects rare with single dose Adult Dosage: Cardiac: 160- 325 mg (2-4 pediatric chewable tabs), chew or swallow Pain/discomfort/fever: 325 mg po (4 pediatric chewable tablets), chew or swallow Pediatric Dosage: Not recommended for prehospital use in children Onset of Action: 20-30 minutes |
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GENERIC NAME: ATROPINE SULFATE
CLASS: Anticholinergic agent, antidote, antispasmodic agent, antiarrhythmic, antimuscarinic |
GENERIC NAME: ATROPINE SULFATE
Mechanism of Action: CV: Increased heart rate (positive chronotropic effect); increased conduction velocity; increased force of contraction (slight), increase cardiac output. Resp: Decreased mucus production; increased bronchial smooth muscle relaxation (bronchodilation). GI: Decreased GI secretion and motility. GU: Decreased urinary bladder tone. Misc: Mydriasis (pupillary dilation); decreased sweat production. Indications and Field Use: Symptomatic bradycardia (sinus, junctional, and AV blocks causing significant hypotension, ventricular ectopy, chest pain, altered level of consciousness, etc.), monitored patient only. Asystole (after epinephrine) monitored patient only. PEA with actual or relative bradycardia (after epinephrine) monitored patient only. Acetylcholinesterase inhibitor poisoning (organophosphate, carbamate cholinergic poisoning). Contraindications: Hypersensitivity to atropine or any component of the formulation – Belladonna alkaloid allergy Glaucoma, acute narrow angle (relative contraindication for patient with symptomatic bradycardia), adhesions between the iris and lens Tachycardia Obstructive GI disease, paralytic ileus, intestinal atony of the elderly or debilitated patient, severe ulcerative colitis, or toxic megacolon complicating ulcerative colitis Hepatic disease Renal disease, obstructive uropathy Myasthenia gravis (unless used to treat side effects of acetylcholinesterase inhibitor Asthma Thyrotoxicosis Mobitz type II block 3rd degree heart block Adverse Reactions: Major: Tachydysrhythmias; flushing; ventricular irritability; exacerbation/initiation of angina; acute narrow angle glaucoma; blurred vision; mydriasis; agitation to delirium; bloating; constipation; decreased gastric emptying Minor: Dry mouth/mucous membranes; loss of taste; nausea; vomiting; urinary retention; neuromuscular weakness; decreased sweating/increased body temperature. Adult Dosage: Symptomatic Bradycardia: IV – 0.5 mg every 5 minutes. Do NOT exceed a total dose of 3 mg or 0.04mg/kg if symptoms profound. Organophosphate or carbamate poisoning: IV – Initially: 1-5 mg. Doses should be doubled every 5 minutes until signs of muscarinic excess abate (clearing of bronchial secretions, bronchospasm, and adequate oxygenation) Pediatric Dosage: Symptomatic Bradycardia: IV – 0.02 mg/kg (minimum of 0.1 mg), may repeat at 5 minute intervals to a maximum total dose of 1 mg in children and 2 mg in adolescents Maximum single doses: Child 0.5 mg; Adolescent 1 mg. Organophosphate or carbamate cholinergic poisoning: IV – 0.03-0.05 mg/kg every 10 to 20 minutes until cholinergic symptoms minimize, then every 1 to 4 hours for at least 24 hours |
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GENERIC NAME: CALCIUM CHLORIDE
CLASS: electrolyte |
GENERIC NAME: CALCIUM CHLORIDE
Mechanism of Action: Increases extracellular and intracellular calcium levels Stimulates release of catecholamines Increases cardiac contractile state (positive inotropic effect) May enhance ventricular automaticity Inhibits the effects of adenosine on mast cells Indications and Field Use: Acute hypocalcemia Calcium channel blocker OD Acute hyperkalemia (known or suspected) Hypermagnesemia (Magnesium OD) Pre-treatment for IV verapamil administration Contraindications: Hypercalcemia Concurrent digoxin therapy (relative) Adverse Reactions: Brady-asystolic arrest Severe tissue necrosis if solution extravasates Use cautiously in patients on digitalis; may cause serious arrhythmias skeletal muscle tingling sensation Adult Dosage: Hypocalcemia, calcium channel blocker OD, hyperkalemia and hypermagnesemia: 5-10 ml (0.5-1 Gm) of 10% calcium chloride. May repeat in 10-20 minutes. Pre-treatment for IV verapamil administration: 3 ml of 10% calcium chloride. May be repeated once. Pediatric Dosage: Hypocalcemia, calcium channel blocker OD hyperkalemia and hypermagnesemia: 0.2 - 0.25 ml/kg of a 10% solution infused slowly. Should not be repeated without documented calcium deficiency. |
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GENERIC NAME: DEXTROSE 50%
CLASS: carbohydrate, hyperglycemic |
GENERIC NAME: DEXTROSE 50%
Mechanism of Action: Pharmacological: Aerobic metabolic substrate (ATP production). Clinical effects: Reverses CNS effects of hypoglycemia by rapidly increasing serum glucose levels. Provides short-term osmotic diuresis. Indications and Field Use: Known hypoglycemia Altered level of consciousness of unknown etiology Seizures of unknown etiology Hyperkalemia Contraindications: Hypersensitivity Known thiamine deficiency (relative, if suspected give thiamine close to same time). Delirium tremens; use with caution in patients with acute alcoholism, may be ineffective without thiamine. Head injury (unless documented hypoglycemia). Intra cranial hemorrhage (relative). Severe pain (paradoxical excitement may occur). Diabetic coma with hyperglycemia Glucose-galactose malabsorption symdrome Anuria and hepatic coma Cerebral edema in children when given IV undiluted. Worsening elevated ICP or cerebral edema from trauma or cerebral vascular accident. Extravasation leads to severe tissue necrosis. Sclerosing effect on peripheral veins. Tachypnea Pulmonary edema Adult Dosage: Hypoglycemia, altered level of consciousness or seizures of unknown etiology: 25-100 ml of D50 (12.5-50 Gm, 1/2 to 2 amps) IV. Hyperkalemia: 50 Gm of Dextrose IV total may be given over 1 hour. This is part of a combination drug therapy. See: profiles for calcium chloride and sodium bicarbonate. Insulin may be given upon arrival to ED. Pediatric Dosage: (14 yrs and below includes infant) Administer 0.5 - 1 Gm/kg of a dextrose 10% solution; recommended to give slowly over a 20 minute period. Dilute D50 (dextrose 50% containing 25 Gm of dextrose) to a 1:4 solution. To prepare, obtain a 250 ml container of normal saline for IV use; waste 50 ml and add 50 ml of dextrose 50%. The resulting solution is dextrose 10% in normal saline or 10 grams/100ml. Onset of Action: Seconds |
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GENERIC NAME: DIAZEPAM
BRAND NAME: Valium CLASS: Benzodiazepine |
GENERIC NAME: DIAZEPAM
Mechanism of Action: Acts on parts of the limbic system, the thalamus, and hypothalamus producing calming effects; decreases seizures by increasing the seizure threshold; transient analgesia; amnesic; sedative. Indications and Field Use: Grand mal seizures, especially status epilepticus. Transient analgesia/amnesia for medical procedures (e.g., fracture reduction, cardioversion, pacing). Delirium tremens. Treat the cause first. Contraindications: Hypersensitivity (allergy) Glaucoma, acute narrow angle (relative) Allergy to soy protein (Diazepam rectal gel only) Adverse Reactions: CV: Bradycardia, hypotension, cardiovascular collapse; venous thrombosis; phlebitis; vascular spasm Resp: Respiratory arrest; may be prolonged in neonate CNS: Somnolence, confusion, coma, diminished reflexes; s/s may be prolonged in neonate Other: Burning proximal to IV injection site; local irritation; swelling; extravasation will cause tissue necrosis Adult Dosage: 2 mg increments slow IV push. Administer no faster than 5 mg/minute. Status epilepticus: 5-10 mg IV push. May repeat at intervals of 10-15 min., to a total of 30 mg. Pediatric Dosage: IV Dose: 0.2-0.3 mg/kg every 15-30 minutes (max. of 1.0 mg/kg); administer IV over at least 3 minutes or until seizure activity subsides. IV Dose after rectal dose: 0.1 mg/kg with same administration instructions. Rectal dose (<6 years): 0.3-0.5 mg/kg rectally at IV push rate; may repeat in 15-30 min at 0.25 mg/kg. Status epilepticus: Neonates: 0.15-0.5 mg/kg IV Infants (>30 days old) 0.2-0.5 mg IV every 2-5 minutes to a max of 5 mg Children (>5 yrs old) 1 mg every 2-5 minutes, to a max of 10 mg Onset of Action: Minutes |
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GENERIC NAME: DIPHENHYDRAMINE HCl
BRAND NAME: Benadryl CLASS: Antihistamine; anticholinergic |
GENERIC NAME: DIPHENHYDRAMINE HCl
Mechanism of Action: Blocks cellular histamine receptors, but does not prevent histamine release; results in decreased capillary permeability and decreased vasodilation, as well as prevention of bronchospasm. Has some anticholinergic effects. Indications and Field Use: Anaphylaxis (2nd line) Phenothiazine reactions (extrapyramidal symptoms) Antiemetic Contraindications: Known hypersensitivity to diphenhydramine or drugs of similar chemical structure. Newborn or premature infants; nursing mothers. Considerable caution in patients with glaucoma, acute narrow angle; stenosing or obstructive diseases of the GI tract; bronchial asthma; hyperthyroidism; cardiovascular disease or hypertension; age greater than 60 years (all relative benefit vs risk). Adverse Reactions: CV: Hypotension; palpitations; arrhythmias; hemolytic anemia. Resp: Anaphylaxis; thickening of bronchial secretions, tightness in chest; wheezing; nasal stuffiness. CNS: Sedation; visual disturbances; seizures. GU/GI: Urinary frequency or retention; vomiting. Children: In children, may cause paradoxical CNS excitation, seizures, palpitations, thickening of bronchial secretions. Adult Dosage: Allergic Reaction: 25-50 mg slow IV push or deep IM Anaphylaxis: 25-50 mg slow IV push or deep IM. Extrapyramidal symptoms and antiemetic: 10-50 mg IV or deep IM, dose should be individualized according to the needs and patient response. Pediatric Dosage: Allergic Reaction: 1.0-1.25 mg/kg slow IV push or deep IM Anaphylaxis or Phenothiazine Overdose: 1-2 mg/kg slow IV push Routes of Administration: IV, Deep IM Onset of Action: IV 5 - 10 minutes |
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GENERIC NAME: DILTIAZEM
BRAND NAME: Cardizem CLASS: Calcium Channel Blocker Calcium antagonist |
GENERIC NAME: DILTIAZEM
Mechanism of Action: Pharmacological: Inhibits calcium ion influx across cell membranes during cardiac depolarization, decreases SA and AV conduction and dilates coronary and peripheral arteries and arterioles. Clinical effects: Slows the rapid ventricular rate associated with atrial fibrillation and atrial flutter, and reduces coronary and peripheral vascular resistance. Indications and Field Use: Rapid ventricular rates associated with atrial fibrillation and atrial flutter, and for PSVT refractory to adenosine. Contraindications: Severe Hypotension Hypotension (less than 90 mmHg systolic) Acute Myocardial infarction Cardiogenic shock Ventricular tachycardia or wide-complex VT of unknown origin Second or third-degree AV block Wolff-Parkinson-White (WPW) syndrome Sick Sinus syndrome Concomitant IV Beta Blocker use within a few hours Hypersensitivity Adverse Reactions: CV: hypotension, bradycardia, heart block, chest pain, and asystole GI: nausea and vomiting CNS: headache, fatigue, drowsiness Adult Dosage: Initial: 0.25 mg/kg IVP (usually 20 mg) administered over 2 minutes If response is inadequate, repeat in 15 minutes: 0.35 mg/kg IVP administered over 2 minutes Maintenance infusion: 5.0 to 15 mg/hr Pediatric Dosage: The safety and efficacy of this drug for use in children has not been established. Onset of Action: IV - immediately |
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GENERIC NAME: DOPAMINE
BRAND NAME: Intropin CLASS: Sympathomimetic |
GENERIC NAME: DOPAMINE
Mechanism of Action: Immediate metabolic precursor to norepinephrine Effects are dose-dependent: 1-2 μg/kg/min Acts on dopaminergic receptors to stimulate cerebral, renal and mesenteric vasculature to dilate; HR and B/P are usually unchanged; may increase urine output 2-10 μg/kg/min ß1 stimulant action is primary effect (increases cardiac output and partially antagonizes the a-adrenergic-mediated vasoconstriction. Overall effect is increased cardiac output and only modest increase in systemic vascular resistance (SVR) 10-20 μg/kg/min a-adrenergic effects predominate resulting in renal, mesenteric and peripheral arterial and venous vasoconstriction with marked increase in SVR, pulmonary vascular resistance and further increased preload > 20 μg/kg/min Produces hemodynamic effects similar to norepinephrine; may increase HR and O2 demand to undesirable limits Indications and Field Use: Symptomatic bradycardias. Second line choice after Atropine Hemodynamically significant hypotension in the absence of hypovolemia (Cardiogenic or septic shock only after fluid administration; assess breath sounds first). Contraindications: Hypersensitivity Hypovolemic shock (relative) Pheochromocytoma MAO inhibitors, such as Marplan, Nardil, or Parnate Tachyarrythmias / Ventricular Fibrillation Adverse Reactions: CV: Cardiac arrhythmias may occur due to increased myocardial oxygen demand (usually tachydysrhythmias), hypertension, hypotension at low doses. GI: Nausea and vomiting GU: Renal shutdown (at higher doses) Other: Extravasation may cause tissue necrosis Adult Dosage: (dosage range 2-20 μg/kg/min) Preparation: (If premixed not carried) Add 400 mg/ 250 ml NS or Dextrose = 1600 μg/ml. Bradycardia: Start at 5 μg/kg/min Shock: cardiogenic or septic (non-hypovolemic) BP < 70 systolic: Start drip at 5 μg/kg/min BP > 70 systolic: Start drip at 2.5 μg/kg/min Pediatric Dosage: 2-20 μg/kg/min for circulatory shock or shock unresponsive to fluid administration. To prepare infusion for small children: 6 x body wt. in kg = mg added to NS to make 100 ml. With this mixture 1 ml/hr delivers 1 μ/kg/min; titrate to effect. Onset of Action: Almost immediate, upon presentation to central circulation |
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GENERIC NAME: EPINEPHRINE HCl
CLASS: sympathomimetic |
GENERIC NAME: EPINEPHRINE HCl
Mechanism of Action: Pharmacological Effects: Direct acting a and ß agonist; a-bronchial, cutaneous, renal, and visceral arterial constriction (increased systemic vascular resistance); ß1-positive inotropic and chronotropic actions (increases myocardial workload and oxygen requirements), increases automaticity and irritability; ß2 bronchial smooth muscle relaxation and dilation of skeletal vasculature. Other: blocks histamine release Clinical Effects: Cardiac Arrest-increases cerebral and myocardial perfusion pressure; increases systolic and diastolic blood pressures; increases electrical activity in the myocardium; can stimulate spontaneous contractions in asystole. Bradycardia-increases heart rate, increases BP; Bronchospasm/Anaphylaxis-reverse signs/symptoms Indications and Field Use: Cardiac arrest - VF/Pulseless VT; asystole; PEA (First line pharmacologic agent for any pulseless dysrhythmia in cardiopulmonary arrest). Severe bronchospasm, i.e., bronchiolitis, asthma. Anaphylaxis. Bradycardia, refractory with profound hypotension, monitored patient only. Hypotension unresponsive to other therapy, monitored patient only. Croup Contraindications: None known for cardiac arrest Hypothermia, relative contraindication Adverse Reactions: CV: Hypertension, ventricular dysrhythmias; tachycardia; angina CNS: Anxiety, agitation GI: Nausea/vomiting Adult Dosage: Pulseless Arrest – IV/IO: 1 mg of 1:10,000 solution repeat every 3 - 5 minutes or, ET: Give 2 - 2.5 mg via the ET tube. May use 1:10,000 or dilute 1:1000 to equal 10 mL via ET tube for adult. (i.e., 2 mg of 1:1,000 epinephrine diluted with 8 mL NS in a 10 mL syringe) Continuous Infusion for Hypotension or Symptomatic Bradycardia: 1 mg added to 500 mL of NS administered at 1 mcg/min titrated to desired hemodynamic response (range 2-10 mcg/min); not first-line therapy. Anaphylaxis and asthma: Give 0.3 - 0.5 mg of 1:1,000 solution IM (preferred), SC, or inject SL, may repeat every 15 to 20 minutes; or in extreme cases only. Pediatric Dosage: Pulseless Arrest or Refractory Bradycardia: IV/IO: 0.01 mg/kg of 1:10,000 repeat every 3 - 5 minutes, maximum single dose 1 mg. ET: 0.1 mg/kg of 1:1,000; diluted with NS to a volume of 3 - 5 mL prior to instillation or followed with flush of 3 - 5 mL of NS after instillation repeat every 3 - 5 minutes, maximum single dose 10 mg. Asthma/anaphylaxis: Use 1:1,000 solution; give 0.01 mg/kg IM (preferred), SC (maximum single dose of 0.5 mg/dose). IV Infusion: 0.1 – 1 mcg/kg/min; to prepare for small children 0. 6 x body wt. in kg = mg added to NS to make 100 mL. With this mixture, 1 mL/hr delivers 0.1 mcg/kg/min. Croup: 3 mg 1:1,000 mixed in 3 mL NS via SVN. |
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GENERIC NAME: ETOMIDATE
CLASS: sedative/hypnotic agent |
GENERIC NAME: ETOMIDATE
Mechanism of Action: Produces hypnosis rapidly causing CNS depression and anesthesia No analgesic effect Indications and Field Use: Induction of anesthesia for rapid sequence intubation (RSI) Contraindications: Hypersensitivity Adverse Reactions: Transient muscle movements Apnea Causes minimal but not clinically significant suppression of cortisol levels May cause myoclonus and tremors that can resemble seizure activity Adult Dosage: 0.3 mg/kg IV over 30-60 seconds Onset of Action: 1 minute |
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GENERIC NAME: FUROSEMIDE
CLASS: Loop diuretic |
GENERIC NAME: FUROSEMIDE
Mechanism of Action: Pharmacologic: Inhibits electrolyte reabsorption in the ascending Loop of Henle. Promotes excretion of sodium, potassium, chloride. Vasodilation increases venous capacitance and decreases afterload. Clinical: Diuresis Indications and Field Use: Pulmonary edema; congestive heart failure Contraindications: Anuria (relative) Hypovolemia (relative) Hypotension (relative) Hypersensitivity Adverse Reactions: May exacerbate hypovolemia Hyperglycemia (due to hemoconcentration) Hypokalemia May decrease the response to pressors Adult Dosage: 0.5 to 1.0 mg/kg IVP to maximum dose of 40 mg CHF/Pulmonary Edema: 20-40 mg IV over 1-2 minutes Pediatric Dosage: 1 mg/kg IV over 1-2 minutes Onset of Action: 5 minutes (vasodilation) |
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GENERIC NAME: GLUCAGON
BRAND NAME: Glucagon CLASS: Pancreatic hormone, polypeptide, hyperglycemic agent |
GENERIC NAME: GLUCAGON
Mechanism of Action: Pharmacologic: Acts only on liver glycogen, converting it to glucose. Counteracts the effect of insulin. Relaxes GI smooth muscle causing dilation and decreased motility. Cardiac inotrope. Clinical effects: May reverse hypoglycemia (if patient has glycogen stored in liver) within 4-8 minutes (could be as long as 15 or more). Indications and Field Use: Symptomatic hypoglycemia when IV access is delayed. Beta Blocker Overdose Contraindications: Known hypersensitivity Pheochromocytoma Insulinoma Should not be routinely used to replace dextrose when IV access has been obtained Adverse Reactions: Rare side effects Nausea and vomiting Generalized allergic reactions including urticaria, respiratory distress and hypotension (made from beef/pork pancreas) Palpitations, hypertension, tachycardia Adult Dosage: (children and adults greater than 20 kg or 44 lbs) Hypoglycemia: 1 mg IM, may repeat in 20 minutes. IM preferred, but may give IM, IV or SC) Pediatric Dosage: (for children under 20 kg or 44 lbs) Hypoglycemia: 0.5 mg IM or a dose equivalent to 20-30 μg/kg, may repeat in 20 minutes. IM preferred, but may give IM, IV or SC. Onset of Action: (dose and route dependent) 1 mg IM, 8-10 minutes IV, 1 minute |
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GENERIC NAME: IPRATROPIUM BROMIDE
BRAND NAME: Atrovent CLASS: anticholinergic, bronchodilator |
GENERIC NAME: IPRATROPIUM BROMIDE
Mechanism of Action: Anticholinergic (parasympatholytic) agent appears to inhibit vagally-mediated reflexes by antagonizing the action of acetylcholine, the transmitter released from the vagal nerve. Indications and Field use: Treatment of bronchospasm associated with chronic obstructive pulmonary disease (emphysema and chronic bronchitis). To be used either alone or in combination with other bronchodilators especially beta adrenergics (i.e., albuterol). Contraindications: Ipratropium bromide is contraindicated in known or suspected cases of hypersensitivity to ipratropium bromide or to atropine and its derivatives. Precaution: should be used with caution in patients with narrow angle glaucoma. Adverse Reactions: Resp: Coughing. Sputum increased CNS: Dizziness. Insomnia. Tremor. Nervousness GI: Nausea Adult Dosage: Give 500 mcg in 2.5 ml normal saline (1 unit dose vial) via SVN with a mouth piece or in-line with a ventilatory device. Repeat according to medical control preference. May mix one unit dose vial of ipratropium with one unit dose vial of albuterol. Onset of Action: 5-15 minutes |
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GENERIC NAME: LIDOCAINE HCl
BRAND NAME: Xylocaine CLASS: antiarrhythmic, local anesthetic |
GENERIC NAME: LIDOCAINE HCl
Mechanism of Action: Decreases automaticity by slowing the rate of spontaneous phase 4 depolarization. Terminates re-entry by decreasing conduction in re-entrant pathways (by slowing conduction in ischemic tissue, equalizes conduction speed among fibers). Increases ventricular fibrillation threshold. Indications and Field Use: Suppression of ventricular arrhythmias (ventricular tachycardia, ventricular fibrillation, PVC's). Prophylaxis against recurrence after conversion from ventricular tachycardia or ventricular fibrillation. Frequent PVC's (>than 6 per minute; 2 or more in a row; multiform PVC's; or R-on-T phenomenon). Pre-intubation for head trauma or suspected Intra cranial hemorrhage (hypertension and focal neurologic S/S). Contraindications: Known hypersensitivity/allergy. Use extreme caution in patients with conduction disturbance (second or third degree block). > Do not treat ectopic beats if heart rate is < 60. They are probably compensating for the bradycardia; instead, treat the bradycardia! Adverse Reactions: CV: May also cause SA nodal depression or conduction problems and hypotension in large doses, or if given too rapidly. Excessive doses in pediatric patient may produce myocardial and circulatory depression. CNS: In large doses drowsiness, disorientation, paresthesias, decreased hearing acuity, muscle twitching, agitation, focal or generalized seizures. Adult Dosage: Pulseless VF/VT: Initial bolus of 1.0-1.5 mg/kg IV PUSH every 3-5 minutes to a total of 3 mg/kg. An initial bolus of 1.5 mg/kg should be given for cardiac arrest situations. Following the return of a spontaneous rhythm, initiate a drip at 2-4 mg/min. See: Maintenance Infusion below. Antidysrhythmic or rhythms with a pulse: Initial boluses can be given as 1.0-1.5 mg/kg IV PUSH and additional boluses can be given as 0.5-0.75 mg/kg every 5-10 minutes to a total dose of 3 mg/kg. Following the return of a spontaneous rhythm, initiate a drip at 2-4 mg/min; see below. Maintenance Infusion: Started after return of spontaneous rhythm for either indication above. Add 1 gm - 2 gms to a 250 ml NS or 5 % dextrose solution or use premixed solution (2 gm in 500 ml) and initiate a drip at 2-4 mg/min according to concentration. Patients > 70 years or with hepatic, renal disease or poor perfusion state, reduce maintenance infusion by half. Pre-intubation for head trauma or suspected Intra cranial hemorrhage (hypertension and focal neurologic S/S). Consider administration of 1 mg/kg IV bolus 1-2 minutes prior to intubation. Pediatric Dosage: Initial Bolus doses: 1 mg/kg, may repeat 1 time in 3-5 minutes for VF/Pulseless VT or in 15 minutes if used for refractory dysrhythmias with a pulse (VT with pulse, significant ventricular ectopy). Infusion with return of spontaneous rhythm, optional: 20-50 μg/kg/min; prepared by adding 120 mg (3cc) of 1 Gm/25 ml (40 mg/ml) solution to 97 ml of NS, yielding 1200 μg/ml. 1 ml/kg/hr delivers 20 μg/kg/min. 2.5 ml/kg/hr delivers 50 μg/kg/min. Reduce to < 20 μg/kg/min for children with low cardiac output, severe CHF or compromised hepatic blood flow. Infusion should be avoided unless infusion pump available. Onset of Action: 1-5 minutes |
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GENERIC NAME: MAGNESIUM SULFATE
BRAND NAME: Magnesium Sulfate CLASS: Electrolyte, tocolytic |
GENERIC NAME: MAGNESIUM SULFATE
Mechanism of Action: Pharmacology: Second most plentiful intracellular cation; essential to enhance intracellular potassium replenishment and activity of many enzymes; important role in neurochemical transmission and muscular excitability (may decrease acetylcholine released by nerve impulses); decreases myocardial irritability and neuromuscular irritability. Clinical: Cardiac-reduces ventricular irritability, especially when associated with hypomagnesemia; inhibition of muscular excitability. Indications and Field Use: • Torsade de pointes, drug of choice • VF/Pulseless VT refractory to lidocaine and/or amiodarone • Hypomagnesemia • Pre-term labor (PTL) • Pregnancy-induced hypertension (PIH, toxemia of pregnancy, pre-eclampsia and/or eclampsia). • Hyperreactive Airway - Severe Asthma Contraindications: • Hypermagnesemia • Use cautiously in patients with impaired renal function and pre-existing heart blocks (relative). • Precautions: Caution when used with barbituates, narcotics, or other hypnotics (or system anesthetics) in conjunction with Magnesium Sulfate due to the additive central depressive effects of magnesium. Adverse Reactions: Cardiovascular: hypotension (may be transient), flushing, circulatory collapse, depressed cardiac function, heart block, asystole, smooth muscle relaxant (antihypertensive effects). Respiratory: respiratory depression and/or paralysis. This adverse reaction may occur in both mother and/or infant during or up to 24 hours after the administration of Magnesium Sulfate. CNS: sweating, drowsiness, hypothermia, depressed reflexes progressing to flaccidity and paralysis. This adverse reaction may occur in both mother and/or infant during the administration of or up to 24 hours after the administration of Magnesium Sulfate. Adult Dosage: Cardiac: • VF/Pulseless VT: 1-2 Gm IV diluted in 50-100 ml NS or D5W, administered over 1-2 minutes. • Torsade de pointes: 1-2 Gm IV diluted in 50-100 ml NS or D5W administered over 1-2 minutes, followed by the same amount infused over 1 hour. • Hypomagnesemia: Dilute 1-2 Gm in 50-100 ml NS or D5W administered IV push over 5-60 minutes. • Respiratory/Severe Asthma: Initial Infusion (field) 2 Gm Magnesium Sulfate mixed in 50 ml NS or D5W to be infused IV using microdrip tubing over 5 to 10 minutes. Stop infusion if hypotension, respiratory depression or bradycardia develop. Pregnancy: Pre-term labor (PTL): Initial bolus (Field and Interfacility): 4-6 Gm over 15-20 minutes (Suggested method is the addition of 4 Gm to 100 ml D5W, LR or NS. Resultant concentration is 40 mg/ml.) Maintenance Infusion (Interfacility only): 1-4 Gm/hour infusion rate. (Suggested method for treatment of premature labor is to follow initial bolus with infusion of 2 Gm/hr which may be continued until uterine contractions are reduced to < 1 every 10 minutes. Then, infusion is decreased to 1 Gm/hr and continued for 24-72 hrs. One method for mixing infusion is the addition of 40 Gm to 1000 ml LR. Resultant concentration equals 40 mg/ml. If this concentration is run at 50 ml/hr, Magnesium Sulfate delivered equals 2 Gm/hr). Pregnancy induced hypertension, pre-eclampsia/eclampsia, (PIH): Initial bolus (Field and Interfacility): 3-6 Gm over 10-15 minutes (Suggested method is the addition of 4 Gm to 100 ml D5W, LR or NS. Resultant concentration is 40 mg/ml). Maintenance Infusion (Interfacility only): Follow bolus with 1-3 Gm/hour infusion rate. (Same mixture as for PTL). Rebolus: In an eclamptic emergency may rebolus with Magnesium Sulfate, 2-4 Gm depending on patient size (mixed as an initial bolus) over 10-15 minutes if respirations >12/minute and urine output >30 ml/hr. Onset of Action: Seconds 20 minutes for IV Infusion (respiratory) |
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GENERIC NAME: METHYLPREDNISOLONE SODIUM SUCCINATE
BRAND NAME: Solu-Medrol CLASS: corticosteroid, glucocorticoid, steroid, anti-inflammatory |
GENERIC NAME: METHYLPREDNISOLONE SODIUM SUCCINATE
Mechanism of Action: Enters target cells and causes many complex reactions that are responsible for its anti-inflammatory and immunosuppressive effects; thought to stabilize cellular and intracellular membranes. Indications and Field Use: Reactive airway disease: Acute exacerbation of emphysema, chronic bronchitis, asthma Anaphylaxis Burns potentially involving the airway ** Acute spinal cord trauma (large loading and maintenance doses) Contraindications: Preterm infants Adverse Reactions: None from single dose Adult Dosage: Reactive Airway Disease, Anaphylaxis, Burns Potentially Involving the Airway Usual dose 125 mg slow IV bolus (much larger doses can be used). ** Acute Spinal Cord Trauma: Should be within 6 hours of insult and patient meeting criteria, initial bolus dose of 30 mg/kg IV administered over 15 minutes; bolus followed by a 45 minute rest period, then a 23-hour continuous infusion of 5.4 mg/kg/hr. See: Special Notes. Pediatric Dosage: Reactive Airway Disease, Anaphylaxis, Burns Potentially Involving the Airway 2-4 mg/kg slow IV bolus Onset of Action: 1 - 6 hours; dogmatic 6 hour time to onset of benefit has decreased markedly during the last few years |
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GENERIC NAME: MIDAZOLAM HYDROCHLORIDE
BRAND NAME: Versed CLASS: Central nervous system depressant, benzodiazepine |
GENERIC NAME: MIDAZOLAM HYDROCHLORIDE
Mechanism of Action: CNS effects are mediated through the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) Acts at the limbic, thalamic, and hypothalamic levels of the CNS, producing anxiolytic, sedative, hypnotic, and anticonvulsant effects. Capable of producing all levels of CNS depression, from mild sedation to coma. Indications and Field Use: Anti-convulsant Sedation Management of acute agitation Treat cause first Induction for intubation Contraindications: Hypersensitivity to midazolam Relative contraindication in: Myasthenia gravis or other neuromuscular disorders; Acute alcohol intoxication; Severe, chronic obstructive pulmonary disease; and Acute pulmonary insufficiency Adverse Reactions: CV: Hypotension (especially in patients premedicated with narcotic); cardiac arrest; irregular or fast heartbeat Respiratory: Apnea; respiratory depression, respiratory arrest; hyperventilation; wheezing or difficulty in breathing; hiccups; coughing CNS: Emergence delirium; muscle tremor; uncontrolled or jerky movements of body; unusual excitement, irritability, or restlessness; dizziness, light-headedness, or feeling faint; prolonged drowsiness; headache GI: nausea and/or vomiting Adult Dosage: Patients14 to 60 years of age: 2 to 5 mg IM 1 to 5 mg IV, titrate to effect, administer slowly in small increments of no more than 2.5 mg over at least 2 minutes. Patients over 60 years of age: 1 to 3 mg IM 1 to 3.5 mg IV, titrate to effect, administer slowly in small increments of no more than 1.5 mg over at least 2 minutes. Total dose: Should not exceed 20 mg For emergency intubation: 0.1 mg/kg up to 0.3 mg/kg with dosage limit of 20 mg. Seizures: 0.2 mg/kg IM for status seizures if no IV Access 0.3 IN (intranasal) Adults over 50 kg: 10 mg (2ml) Total volume (5mg/ml concentration) = (Total mg dose divided in each nostril). Pediatric Dosage: Pediatric patients: 0.05 to 0.1 mg/kg slow IV PUSH 0.2 mg/kg IM for status seizures if no IV Access Calculate appropriate dose of IN (intranasal midazolam) using the following formula: Children: Total kg wt X 0.2 mg = total mg maximum of 10mg Onset of Action: IM - 15 minutes, IV - immediate Duration of Action: 2 to 6 hours |
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GENERIC NAME: MORPHINE SULFATE
BRAND NAME: Morphine Sulfate CLASS: narcotic agonist |
GENERIC NAME: MORPHINE SULFATE
Mechanism of Action: Alleviates pain by acting on the pain receptors in the brain; elevates pain threshold. Depresses central nervous system; depresses brainstem respiratory centers; decreases responsiveness to changes in PaC02. Increases venous capacitance (venous pooling), vasodilates arterioles, reducing preload and afterload. Histamine release. Indications and Field Use: Analgesia, especially in patients with burns, myocardial infarction, or renal colic. Pulmonary edema (cardiogenic). Contraindications: Respiratory depression Head injuries Elevated Intra cranial pressure Asthma, relative Abdominal pain, relative Adverse Reactions: CV: Brady or tachydysrhythmias, orthostatic hypotension Resp: Respiratory depression or arrest CNS: Excess sedation, seizures to coma and arrest, pupillary constriction GI: Nausea and vomiting, GI spasm Derm: Histamine release may cause local urticaria Adult Dosage: IV Dose: Administer 1-3 mg increments slow IV PUSH (over 1-5 minutes) until desired effect. Up to 20mg max Pediatric Dosage: 100-200 μg/kg slow IV push Onset of Action: Seconds Peak Effects: 20 minutes Duration of Action: 2-4 hours |
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Generic Name: Ondansetron
Brand Name: Zofran Class: Antiemetic agent |
Generic Name: Ondansetron
Mechanism of Action: Selectively blocks serotonin 5-HT3 receptors located in the CNS at the chemoreceptor trigger zone and in the peripheral nervous system on nerve-terminals of the vagus nerve Indications for use: Nausea and vomiting Contraindications: Hypersensitivity Use with caution in patients with hepatic impairment Adverse Reactions: CNS: Headache, malaise, fatigue, dizziness, fever, sedation, extrapyramidal syndrome Cardiovascular: Chest pain, arrhythmias Respiratory: Hypoxia GI & Hepatic: Diarrhea, constipation, abdominal pain, xerostomia, decreased appetite Skin: Rash Adult Dosage: 4 – 8 mg IV slow push over 2 – 5 minutes 8 mg PO ODT or tablet Pediatric Dosage: (1 month to 12 years old) Greater than 40 kg- 4 mg IV slow push over 2 – 5 minutes Less than 40 kg- 0.1 mg/kg IV slow push over 2 – 5 minutes Onset of Action: Unknown but probably 10 to 30 minutes Peak effects: Unknown Duration of Action: Half life is approximately 4 hours. Exact duration unknown but appears to be prolonged compared to half-life |
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GENERIC NAME: SODIUM BICARBONATE 8.4%
BRAND NAME: Sodium Bicarbonate 8.4% CLASS: buffer |
GENERIC NAME: SODIUM BICARBONATE 8.4%
Mechanism of Action: Buffers H+ and increases pH Indications and Field Use: Pre-existing metabolic acidosis Overdose of aspirin, cyclic antidepressants (alkalinization of blood) Cardiac arrest after other interventions and ventilation is adequate Contraindications: Alkalosis Adverse Reactions: CV: Congestive heart failure, edema secondary to sodium overload. Metabolic: Hyperosmolarity, metabolic alkalosis, hypernatremia, in cardiac arrest may cause extracellular alkalosis and intracellular acidosis. Adult Dosage: Pre-existing Metabolic Acidosis or Alkalinization of Blood: 50-100 mEq IV per medical control authority. Infusion: 50 mEq of sodium bicarbonate/250 ml of D5W NS or as determined by medical control. Cardiac arrest: First dose usually 0.5 - 1 mEq/kg (or as determined by blood gas analysis), with subsequent doses of 0.5 mEq/kg every 10 minutes in cardiac arrest after other standard treatment (defibrillation, CPR, intubation, ventilation and more than one trial of epinephrine) has been used. Pediatric Dosage: 0.5 - 1 mEq/kg IV or IO slowly, if ventilation is adequate according to medical control authority. Can contribute to acidosis and cause fluid overload. Onset of Action: Seconds Peak Effects: 1-2 minutes Duration of Action: 10 minutes |
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GENERIC NAME: SUCCINYLCHOLINE
CLASS: ultra-short-acting depolarizing-type skeletal muscle relaxant |
GENERIC NAME: SUCCINYLCHOLINE
Mechanism of Action: Combines with cholinergic receptors of the motor end plate to produce depolarization Hydrolyzed by acetylcholinesterase Indications and Field Use: Endotracheal intubation requiring paralysis (RSI) by a qualified EMT-P with authorization from the EMT-P’s administrative medical director Contraindications: Muscle disorders Personal or family history of malignant hyperthermia History of hyperkalemia Burn injured patients* Ocular injuries Patients in whom successful endotracheal intubation is doubtful Adverse Reactions: Vagal stimulation leading to bradycardia or asystole Hyperkalemia Rhabdomyolysis Hypersalivation Elevated intraocular pressure Release of histamine Route of Administration: IV Onset of Action: <1 minute Duration of Action: Muscle paralysis lasting 4-6 minutes |
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GENERIC NAME: THIAMINE HCl (vitamin B1)
BRAND NAME: Betalin CLASS: vitamin |
GENERIC NAME: THIAMINE HCl (vitamin B1)
Mechanism of Action: Required for carbohydrate metabolism. Deficiency leads to anemia, polyneuritis, Wernicke's encephalopathy, cardiomyopathy. Administration may reverse symptoms of deficiency, but effects are dependent upon duration of illness and severity of disease. Indications and Field Use: Alcoholism, delirium tremens Coma of unknown origin, especially if alcohol or malnourishment may be involved. Suspect Wernicke or Korsakoff Syndrome Other thiamine deficiency syndromes Severe congestive heart failure Contraindications: Do not give intra-arterial Adverse Reactions: Hypotension (rare) Adult Dosage: 100 mg Pediatric Dosage: Rarely used Routes of Administration: IM IV over several minutes Onset of Action: Hours Peak Effects: 3-5 days Duration of Action: Unavailable |
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GENERIC NAME: VERAPAMIL HCl
BRAND NAME: Isoptin, Calan, Verelan CLASS: calcium channel blocker |
GENERIC NAME: VERAPAMIL HCl
Mechanism of Action: Blocks calcium ion influx into cardiac and smooth muscle cells causing a depressant effect on the contractile mechanism resulting in negative inotropy. Reduces contractile tone in vascular smooth muscle resulting in coronary and peripheral vasodilation. Slows conduction and prolongs refractory period in the AV node due to calcium channel blocking. Slows SA node discharge. In summary, decreases myocardial contractile force and slows AV conduction. Indications and Field Use: Supraventricular tachycardia Atrial fibrillation and atrial flutter with rapid ventricular response Contraindications: AV block, Sick sinus syndrome, any wide QRS complex tachycardia Shock Severe CHF Adverse Reactions: Extreme bradycardia Asystole AV block Hypotension Congestive heart failure Adult Dosage: 2.5 - 5.0 mg IV PUSH over 2-3 minutes. May rebolus in 15-30 minutes with 5-10 mg IV PUSH until a maximum dose of 20 mg Pediatric Dosage: IV form not used in children in the field Routes of Administration: IV slow push (See: Special Notes) Onset of Action: 1-3 minutes Peak Effects: 3-5 minutes Duration of Action: 2-5 hours |