ICEMA Drugs

CLASS: Antidysrhythmic
MOA: A naturally occurring nucleotide present in all cells of the body, it acts to slow conduction through the AV node & also dilates coronary arteries & peripheral vessels. Adenosine's half life is about 10-12 seconds & is also referred to as the “chemical cardioversion” drug.
INDICATIONS: Narrow Complex Tachycardias, SVT
CONTRAINDICATIONS: 2nd & 3rd degree AV blocks, also give with caution to pt’s w/ history of asthma for potential bronchospasms.
SIDE EFFECTS: Transient asystole, chest pain, SOB, flushing
DOSAGES: Adult: 6mg rapid IV push, followed by 20ml of NS. If no change w/ in 2 minutes, give 12mg rapid IV push, followed by 20ml of NS. If no conversion may try a third time of 12mg rapid IV push, followed by 20ml of NS.
Pediatric- BASE CONTACT ONLY

CLASS: Anti-platelet
MOA: Inhibits platelet aggregation by blocking the formation of thromboxane.
INDICATIONS: Chest pain of unknown etiology, MI & TIA
CONTRAINDICATIONS: History of GI bleed, inter cranial hemorrhage, hypersensitivity, major surgery w/ in 2 weeks & previous thrombosis.
SIDE EFFECTS: Nausea, vomiting & hemorrhage
DOSAGES: Adult: 162mg PO (2 81mg tablets)
Pediatric- NOT INDICATED

CLASS: Parasympatholytic Agent
MOA: Blocks the effects of the parasympathetic nervous system by blocking the acetylcholine receptors. Used to increase heart rate in bradycardias originating above the ventricles.
INDICATIONS: Asystole, Bradycardia, Organophosphate Poisonings & in PEA (less than 60 BPM)
CONTRAINDICATIONS: Documented MI, in 2ND & 3RD Degree AV Blocks & Children 8 & under in Cardiac Emergencies
SIDE EFFECTS: Increased Heart Rate, Increased Blood Pressure
DOSAGES: Adult: BRADYCARDIA- 0.5mg IV to max of 3mg or 0.04mg/kg, PEA/ASYSTOLE- 1mg IV to a max of 3mg or
0.04mg/kg, ORGANOPHOSPHATE POISONING- 2mg IV, repeat in 2mg increments as long as pt’s symptoms persist
Pediatric- NOT INDICATED

CLASS: Electrolyte
MOA: Neutralizes hydrochloric acid by forming sodium chloride & CO2. And is also a systemic urinary alkalizer.
INDICATIONS: Extended down time during cardiac arrest & tricyclic antidepressant overdose/poisoning
CONTRAINDICATIONS: No real contraindications, but to much given can cause metabolic alkalosis
SIDE EFFECTS: Metabolic alkalosis
DOSAGES: Adult: BASE HOSPITAL ORDER ONLY- CARDIAC ARREST- 1mEq/kg IV. TRICYCLIC OVERDOSE/POISONING- 1mEq/kg IV
Pediatric- BASE HOSPITAL ORDER ONLY

CLASS: Sympathomimetic
MOA: Naturally occurring catecholamine. It acts on alpha receptors to cause vasoconstriction. Increases heart rate with out increasing myocardial oxygen demand. In lower doses it maintains renal and mesenteric blood flow, medium doses increase Beta I properties & higher doses cause vasoconstriction.
INDICATIONS: Cardiac Arrest post resuscitation, significant hypotension & when fluid replacement is unsuccessful
CONTRAINDICATIONS: Children under 8 yrs of age, do not give IO
SIDE EFFECTS: Increased Heart Rate, can cause narrow or wide complex arrhythmias
DOSAGES: Adult: 5-20mcg/kg/min titrate to effect(typical preparation 400mg in 250ml of NS)
Pediatric- Contraindicated in children under 8 years of age

CLASS: Sympathomimetic
MOA: An Adrenergic receptor w/ both alpha & beta actions, it vasoconstricts which increases heart rate & contractility, & is used as a smooth muscle relaxant during severe bronchospasms during anaphylaxis.
INDICATIONS: PEA/Asystole, Anaphylaxis, Bronchospasms
CONTRAINDICATIONS: None for Cardiac Arrest, pt’s over the age of 40 or history of CAD or HTN.
SIDE EFFECTS: Increased Heart Rate & Increased Blood Pressure
DOSAGES: Adult: CARDIAC ARREST- 1mg IV/IO (1:10,000 Solution) repeat after 2 min cycle of CPR. ALLERGIC REACTION/BRONCHOSPASM- 0.3mg SC (1:1,000 Solution) may repeat once to a max of 0.5mg
Pediatric- ALLERGIC REACTION/BRONCHOSPASM- 0.01mg/kg SC (1:1000) up to 0.3mg, CARDIAC ARREST- 0.01mg/kg IV/IO

CLASS: Antidysrhythmic
MOA: Used to suppress the automaticity of ectopic pacemakers in the His-Purkinje system & elevates the electrical stimulation threshold of the ventricles during diastole & also lowers the threshold for defibrillation & cardioversion. Used for numbing properties during IO Infusion and Intubation.
INDICATIONS: V-tach, V-fib, intubation w/ head injury, prior to IO infusion
CONTRAINDICATIONS: in 2ND & 3RD Degree AV Blocks, do not give in conjunction w/ PVC’S or Bradycardia , hypersensitivity
SIDE EFFECTS: Irritability, Confusion, Seizures, Coma
DOSAGES: Adult: PULSELESS V-tach/V-fib- 1.5mg/kg IV/IO after 2 min cycles of CPR, may repeat twice at 0.75mg/kg to a max of 3mg/kg (if suppressed begin maintenance dose of 2mg/min). V-tach/V-fib w/ PULSES- 1mg/kg IV/IO, may repeat at 0.5mg/kg to a max of 3mg/kg (if suppressed begin maintenance dose of 2mg/min). INTUBATION- prior to intubation w/ head trauma administer 1.5mg/kg. IO INFUSION- Administer 0.5mg/kg to a max of 50mg
Pediatric- CARDIAC ARREST- V-fif/Pulseless V-tach- 1.0mg/kg IV/IO, may repeat at 0.5mg/kg after 5 minutes up to a max dose of 3mg/kg

CLASS: Electrolyte
MOA: Is an essential element w/ in the body that is responsible for neurotransmission & muscle excitability.
INDICATIONS: Torsades de pointes & seizures associated w/ eclampsia
CONTRAINDICATIONS: Shock, hypocalcemia, hypertension & heart blocks
SIDE EFFECTS: Drowsiness, respiratory depression, hypotension & circulatory collapse
DOSAGES: Adult: SEIZURES/ECLAMPSIA- 4gm diluted w/ 20ml of NS over 3 to 4 minutes, TORSADES DE POINTES- 2gm in 100ml of NS infused over 5 minutes.
Pediatric- NOT INDICATED

CLASS: Narcotic Anelgesic
MOA: It decreases systemic vascular resistance, which reduces myocardial oxygen demands. A potent CNS depressant used for pt’s experiencing pain, thereby reducing discomfort, apprehension & fear.
INDICATIONS: MI, burns & isolated extremity fractures
CONTRAINDICATIONS: Multi systems trauma, hypotension & respiratory distress
SIDE EFFECTS: Respiratory depression, hypotension, nausea & vomiting
DOSAGES: Adult: MI- 2mg increments every 3 minutes, not to exceed 10mg w/ out base contact. BURNS- 5mg increments every 5 minutes with signs of adequate tissue perfusion, up to 20mg. ISOLATED FRACTURES- 5mg increments every 5 minutes with signs of adequate tissue perfusion, up to 20mg.
Pediatric- 0.1mg/kg IV up to 5mg, 0.2mg IM up to 10mg

CLASS: Smooth Muscle Relaxant
MOA: A direct vasodilator on both the arteries & veins, it increases perfusion to ischemic myocardial tissue. It reduces the work & oxygen consumption, thereby leading to pain relief. In CHF & Pulmonary Edema nitro decreases preload & afterload improving cardiac output.
INDICATIONS: Chest Pain, Left sided MI, CHF, Pulmonary Edema
CONTRAINDICATIONS: Inadequate tissue perfusion, right sided MI & Recent use of sexual enhancements
SIDE EFFECTS: Hypotension, headache & flushing
DOSAGES: Adult: Chest pain/MI- 0.4mg metered dose, may repeat as needed with signs of adequate tissue perfusion. CHF/Pulmonary Edema- 0.4mg metered dose, may repeat as needed with signs of adequate tissue perfusion.
Pediatric- NOT INDICATED

CLASS: Antidysrhythmic
MOA: Is used for ventricular dysrhythmias by suppressing the automaticity of ventricular ectopic pacemakers and also slows conduction through the bundle of his.
INDICATIONS: Stable V-tach
CONTRAINDICATIONS: Myashenia gravis, Acute MI, Hypersensitivity & Renal Failure
SIDE EFFECTS: Hypotension, Nausea, Vomiting, Confusion & Seizures
DOSAGES: Adult: Mix 1gm/250ml of NS, Give 20mg (5ml) slowly over one minute via IV push. Repeat until arrhythmia is suppressed or one of four end points have been reached: 1-max dose of 17mg/kg, 2-QRS widens by 50%, 3-inadequate tissue perfusion develops, 4- or arrhythmia has been suppressed.
Pediatric- NOT INDICATED

CLASS: Slow Channel Calcium Blocker
MOA: Inhibits calcium ions from entering channels of myocardial & arterial smooth muscle. It also slows conduction through the AV node & prolongs refractoriness of the AV node. Decreases oxygen demand & causes coronary artery & peripheral vasodilation.
INDICATIONS: Uncontrolled A-fib & A-flutter
CONTRAINDICATIONS: Hypotension, cardiogenic shock, pulmonary edema, v-tach, beta blockers & WPW
SIDE EFFECTS: Hypotension
DOSAGES: Adult: 5mg IV over 3 minutes, repeat dose after 15 minutes of 10mg over 3 minutes
Pediatric- NOT INDICATED

CLASS: Sedative/hypnotic
MOA: A short acting benzodiazepine w/ amnesic properties. It relaxes skeletal muscle during seizure activity & is used for its amnesic properties during cardioversion & pacing.
INDICATIONS: Seizure activity, cardioversion & pacing
CONTRAINDICATIONS: Allergies to cherries, signs of inadequate tissue perfusion, sensitvivty & shock
SIDE EFFECTS: Bronchospasm, dyspnea, respiratory depression & bradycardia
DOSAGES: Adult: SEIZURES- 5-10mg IM or 2.5-5mg IV/IO
CARDIOVERSION/PACING- 1-2mg IV
Pediatric- SEIZURES- 0.1mg/kg IV up to a max of 5mg IV or 0.2mg/kg IM up to a max of 10mg

CLASS: Sympathomimetic Bronchodilator
MOA: A beta II adrenergic receptor stimulant that affects the respiratory tract in the form of smooth muscle relaxation.
INDICATIONS: Bronchospasm, asthma, emphysema & bronchitis
CONTRAINDICATIONS: Hypersensitivity, use w/ caution on CHF pt’s
SIDE EFFECTS: Anxiety, dizziness & tachycardia
DOSAGES: Adult: BRONCHOSPASMS- 2.5mg in nebulizer over 5-15 minutes at 6-8 LPM, may repeat 2 times
Pediatric- SAME AS ADULT DOSE

CLASS: Parasympatholytic Bronchodilator
MOA: Used in the treatment of respiratory emergencies to bronchodilate & dry respiratory secretions. It acts to block acetylcholine receptors, therefore inhibiting parasympathetic stimulation.
INDICATIONS: Acute bronchospasms
CONTRAINDICATIONS: Hypersensitivity, allergies to peanuts & soy products
SIDE EFFECTS: Nausea, vomiting, epistaxis & headache
DOSAGES: Adult: BRONCHOSPASM- 0.5mg nebulized over 5-15 minutes at 6-8 LPM, may repeat 2 times
Pediatric- 1 day to 12 months 0.25mg, 1 year of age & up same as adult dose, may repeat 2 times

CLASS: Antihistamine
MOA: Competes for the H1 receptor sites on effector cells w/ in the GI tract, respiratory tract & blood vessels there for blocking the release of histamines.
INDICATIONS: Signs & symptoms of allergic reactions/anaphalaxis
CONTRAINDICATIONS: Hypersensitivity to antihistamines of similar structure
SIDE EFFECTS: Fatigue, headache, sedation & sleepiness
DOSAGES: Adult: 50mg IM or 25mg IV slowly
Pediatric- 2mg/kg IM or 1mg/kg IV slowly

CLASS: Electrolyte
MOA: An electrolyte that is necessary for myocardial contractions to occur, it increases the myocardial contractile force & enhances ventricular excitability.
INDICATIONS: Calcium channel blocker overdose/poisoning
CONTRAINDICATIONS: V-fib, hypercalcemia & digitalis toxicity
SIDE EFFECTS: Bradycardia, arrhythmias, cardiac arrest & syncope
DOSAGES: Adult: BASE HOSPITAL ORDER ONLY- CALCIUM CHANNEL BLOCKER OVERDOSE- 1gm IV
Pediatric- BASE HOSPITAL ORDER ONLY

CLASS: Absorbant
MOA: It acts by binding many toxic substances, therefore inhibiting absorption w/ in the GI tract.
INDICATIONS: Ingestion of toxic substance
CONTRAINDICATIONS: Unresponsive, ingestion of greater than 1 hour, cyanide, caustic alkalis, organic solvents & methanol
SIDE EFFECTS: Nausea, vomiting, cramping & abdominal bloating
DOSAGES: Adult: OVERDOSE- 50gm PO
Pediatric- 1gm/kg up to a max of 50gm

CLASS: Carbohydrate
MOA: A form of sugar used by the body in order to create energy.
INDICATIONS: Hypoglycemia
CONTRAINDICATIONS: Hyperglycemia
SIDE EFFECTS: Hyperglycemia & tissue necrosis
DOSAGES: Adult: HYPOGLYCEMIA- D50, 25gm IV/IO, may repeat w/ extended transport times.
Pediatric- pt. less than 10kg & sugar less than 60mg/dl, give D25 0.5gm/kg (2ml/kg) IV/IO
pt. greater than 10kg but less than 25kg & sugar less than 60mg/dl, give D50 0.5gm/kg DILUTED 1:1 (2ml/kg) IV/IO
pt. greater than 25kg & sugar less than 80mg/dl, give D50 0.5gm/kg DILUTED 1:1 (2ml/kg) IV/IO

CLASS: Pancreatic Hormone
MOA: Elevates blood glucose levels by causing a breakdown of glycogen, stored in the liver, into glucose. Can act as a smooth muscle relaxant & stimulates the sympathetic nervous system through other means besides alpha & beta receptors, which is why it is used on beta blocker overdoses.
INDICATIONS: Hypoglycemia, beta blocker OD & esophageal foreign body obstruction w/ BHO
CONTRAINDICATIONS: Hypersensitivity & hyperglycemia
SIDE EFFECTS: Hyperglycemia, dizziness & headache
DOSAGES: Adult: HYPOGLYCEMIA- 1mg IM/SC, may give once
BETA BLOCKER OVERDOSE- 1mg IV FOREIGN BODY OBSTRUCTION- BASE HOSPITAL ORDER ONLY
Pediatric- 0.025mg/kg IM, may repeat once after 20 minutes up to a max of 1mg

CLASS: Loop Diuretic
MOA: Inhibits reabsorption of sodium & chloride primarily in the loop of Henle, as well as proximal & distal renal tubules. Causes venous dilation, which reduces cardiac preload, which then decreases the overall cardiac workload.
INDICATIONS: Pulmonary edema & peripheral edema (CHF)
CONTRAINDICATIONS: Hypotension, pneumonia & dehydration
SIDE EFFECTS: Excessive diuresis, dehydration & fluid & electrolyte imbalance
DOSAGES: Adult: BASE HOSPITAL ORDER ONLY- PULMONARY/PERIPHERAL EDEMA- 40-100mg IV, or 2 times the pt’s daily dose, up to a max of 100mg.
Pediatric- 1mg/kg IV w/ BASE HOSPITAL ORDER ONLY

CLASS: Narcotic Antagonist
MOA: It reverses the effects of narcotics by competing for & displacing narcotic molecules from opiate receptors in the brain. It is mainly used to reverse respiratory depression caused by narcotic overdoses.
INDICATIONS: ALOC w/ suspicion of narcotic use, respiratory depression & constricted pupils
CONTRAINDICATIONS: Hypersensitivity
SIDE EFFECTS: Nausea, vomiting, sweating & tachycardia
DOSAGES: Adult: NARCOTIC OVERDOSE- 2mg IV/IM, may repeat every 2-3 minutes if needed
Pediatric- NARCOTIC OVERDOSE- 0.1mg/kg IV/IM, do not exceed adult dose of 2mg increments

CLASS: Antiemetic
MOA: It reduces the activity of the vagus nerve, which deactivates the vomiting center located w/ in the medulla oblongata.
INDICATIONS: Nausea & vomiting
CONTRAINDICATIONS: Allergies to Ondansetron, Granisetron, Dolasetron or Palonosetron
SIDE EFFECTS: Blurred vision, dizziness & headache
DOSAGES: Adult: NAUSEA/VOMITING- 4mg ODT, or 4mg IV push greater than 30 seconds, may repeat 2 more times prior to base contact
Pediatric- NAUSEA/VOMITING- for pt’s 4-8 years of age 4mg ODT, or 4mg IV (4mg is max dose prior to base contact)