AEMT Review (Drug Cards, etc.)

Drip Rate Calculation

Drops (gtts) per minute= [(mL) x (gtts/mL)] / minutes {(volume to be infused x drip factor [10, 15, or 60]) / total time for infusion}

Aspirin

(ASA=Acetylsalicylic acid, baby aspirin, Bayer), : *Dose: 4x 81 mg (324 mg) chewable tablets; *Route: Oral; *Indications: in prehospital setting, MI, coronary artery disease, pericarditis; *Contraindications: Hypersensitivity, and not given to chilren or adolescents with suspected viral illnesses (associated with increased risk of Reye's syndrome), pt. already on anticoagulants, bleeding disorders; *Precautions: administer with caution in patients with asthma or seasonal allergies, stomach ulcers, GI bleeding, liver disease, alcohol abuse, kidney disease, or coagulopathies, and children; *Side effects: GI upset, bleeding, nausea, vomiting, wheezing, heartburn, tinnitus; *Mechanism of Action: decreases platelet aggregation, prolongs clotting time; antipyretic activity; *Classification: anti-platelet, antipyretic, NSAID

Activated Charcoal

(Actidose, Super Char, Charcodate, Liqui-Char, Aqua-Char)*Dose: 1 g/1 kg of weight (kg= lb/2) orally (adults and pediatric patients) {premixed slurry of 50 g/250 mL}; *Route: oral (PO), or slow through nasogastric or orogastric tubes; *Indications: oral ingestion of toxins (non-caustic); *Contraindications: decreased Level of responsiveness, increased risk of aspiration, or ingestion of corrosives, caustic acids, alkalis, iron tablets, lithium, or petroleum distillates (there is NO value for the ETOH OD pt.); *Precautions: activated charcoal will inactivate other oral medications; some people like to spit it out at you!; *Side effects: black, tarry stools, constipation, vomiting; *Mechanism of Action: adsorbs poisonous compounds to its surface, reducing the absorption; *Classification: antidote, adsorbent

Adenosine

(Adenocard); *Dose: 6mg IV push with 20cc NS fluid bolus, a repeat dose of 12 mg in 1-2 minutes up to 2x may be given if not converted; *Pediatric dose: 0.1mg/kg rapid IV push followed by 5cc bolus, repeat 0.2mg/kg x 1; *Route: IV; *Indications: PSVT rhythm (after vagal maneuvers); *Contraindications: hypersensitivity; 2nd and 3rd degree AV heart block, sick sinus syndrome, A-fib; *Precautions: half life is 5 seconds; pediatric doses don't exceed adult doses; *Side Effects: syncope, chest pain, facial flushing, SOB, dizziness, hypotension; *Mechanism of Action: slows supraventricular tachycardia, decreasing the electrical activity by interrupting the reentry pathways through the AV node; *Classification: Antiarrhythmic

Normal Saline Solution

(NS) 0.9% saline solution: sterile water with sodium chloride (NaCl) added to equal the amount found in the human body (isotonic). Useful for rehydration of fluid and electrolytes in the vascular system, vascular volume replacement, and diluting medications for IV infusion (can come in other concentrations, both hypotonic and hypertonic). *Dose: 200-500cc bolus or TKO, after listening to lung sounds; *Max= 3L for trauma pts. may be suggested; for heat exhaustion or dehydrated pts, you may exceed the 3L max; (*Pediatric dose= 20cc/kg with a max of 60cc/kg); *Indication: IV maintenance, fluid bolus, combination with blod sets on trauma pts., volume replacement, dehydration, hypotension; *Contraindications: hypersensitivity, pulmonary edema; *Side Effects: 3rd spacing of fluid is possible on bolus dosing; pulmonary edema; *Precautions: overloading pediatrics/geriatrics, and pulmonary edema; *Classification: isotonic fluid IV

Epinephrine 1:1,000

(Adrenalin 1-1,000); *Dose: Epipen= 0.5 mg adult; 0.25 mg child; 0.3 to 0.5 mg subcutaneous or intramuscular injection every 15 minutes as needed for adult, 0.01 mg/kg of weight in pediatrics, with max pediatric dose of 0.3mg for anaphylaxis (kg= lb/2) {1 mg/ 1 mL in vials, ampules, or prefilled autoinjector devices}; *Route: Subcutaneous or intramuscular injection; *Indications: acute anaphylaxis, asthma, shock; *Contraindications: Use with caution in patients with significant cardiovascular disease or hypertension; *Precautions: Epinephrine is inactivated by exposure to sunlight or when given with an alkaline solution. Patient may experience chest pain, palpitations, anxiety, nausea, or headache. Monitor patient's heart rate and blood pressure; use caution with pregnancy and preexisting heart disease; *Side effects: palpitations, tachycardia, anxiety, headache, dizziness, nausea, and vomiting are common side effects. Patients with underlying cardiac disease also may experience chest pain and acute myocardial infarction; *Mechanism of action: SQ= bronchodilator and relief of bronchial edema, Beta 1 & 1; *Classification: Bronchodilator, cardiac stimulant, sympathomimetic

Epinephrine 1:10,000

(Adrenalin 1:10,000); *Dose: 1.0 mg IV every 3-5 minutes (ET is 2-2 1/2 times the dose with 20cc flush; NO max in a life-threatening emergency); *Pediatric dose= 0.01 mg/kg with a max dose of 1 mg (Pediatric: 0.1 mg/kg ET (1:1,000?) every 3-5 minutes with 3-5 cc flush; *Route: IV/IO; *Indications: cardiac arrest V-fib, v-tach, asystole, PEA, and profound bradycardia; *Contraindications: Use with caution in patients with significant cardiovascular disease or hypertension??; *Precautions: Do not mix with NaHCO3; heat destroys this drug; *Side Effects: hypertension, peripheral constriction; *Mechanism of Action: increases cardiac resistance, BP, electrical activity, O2 needs, contractility, and myocardial activity; Alpha 1 and Beta 1; *Classification: sympathomimetic, cardiac stimulant, bronchodilator

Atropine Sulfate

(Atropine); *Dose: bradycardia- 0.5 mg per every 3-5 minutes IV/ET; 2-5 mg for organophosphate poisioning (vary w/pt. symptoms); *Route: IV/ET; *Indications: symptomatic bradycardia, organophosphate poisoning; *Contraindications: hypersensitivity, tachycardia, relative or not functional uses: 2nd and 3rd degree AV heart block; *Precautions: A-fib, A-flutter, glaucoma, and COPD; *Side Effects: increased cardiac consumption, dryness in mouth, headache, dizziness, nausea, and vomiting; *Mechanism of Action: increases, heart rate, contractility, automaticity, conduction, and dilation of the peripheral vessels; works mainly on the atrium; *Classification: Parasympatholytic, anticholinergic agent

Amiodarone

(Cordarone); *Dose: 150-300 mg (300 mg IV loading dose, 150 mg 2nd dose if needed); *Pediatric dose: 5mg/kg IV/IO (check your protocols for additional doses); *Route: IV/IO; *Indications: V-fib, v-tach, pulseless; *Contraindications: hypersensitivity; *Precautions: ??; *Side Effects: lung problems, liver problems, epididymitis? in long term use; *Mechanism of Action: prolongs phase 3 of the cardiac action potential; increases the refractory period of sodium and potassium channels, which slows the cardiac action potential; *Classification: antiarrhythmic

Glucagon

(GlucaGen); *Dose: 1 mg IM/IV (usually given IM); *Pediatric dose- 0.02-0.03mg/kg IM/IV with max of 1mg; *Route: IM or IV; *Indications: hypoglycemia; *Contraindications: hypersensitivity; *Precautions: patient may have emergency glucagon kit; may be used with calcium channel blocker and beta-blocker toxicity; *Side Effects: hypotension, nausea, hypokalemia; *Mechanism of Action: raises glucose level by using the glycogen in the liver for glucose, stimulating glucose synthesis; *Classification: pancreatic hormone, insulin antagonist

Lactated Ringer's Solution

(LR): an isotonic, crystalloid that contains sodium, chloride, potassium, calcium, and lactate. Because lactate is involved in the blood buffer system, it can be useful for patients with acidoses, such as those with hypovolemic shock or diabetic ketoacidosis. The addition of potassium makes lactated Ringer's solution useful in patients with suspected hypokalemia, but potentially dangerous in patients with hyperkalemia (such as patients with crush syndrome)

Morphine Sulfate

(MS); *Dose: IV 2-4 mg titrated to max of 15 mg [immediate onset]; IM/SC 5-20mg [10-30 min onset]; *Pediatric dose= IV 0.1mg/kg; Pediatric IM/SC= 0.1-0.2 mg/kg; *Route: IV/IM/SC; *Indications: moderate to severe pain with trauma; chest pain associated with MI; *Contraindications: hypersensitivity, head injury, CVA, hypotension, and repiratory depression; *Precautions: have Narcan ready in case of severe adverse reaction; *Side Effects: depressed CNS, constipation, dry mouth; *Mechanism of Action: acts on opiate receptors in the brain, providing analgesia and sedation; vasodilator, reducing venous return and myocardial oxygen demand; *Classification: Narcotic analgesic, opioid analgesic

Ibuprofen

(Motrin, Advil)*Dose: 200 to 400 mg (or 200-800 mg) every 6 to 8 hours; pediatric dosage: 5 to 10 mg/kg of weight (kg= lb/2) every 6 to 8 hours, with a pediatric max of 40 mg/kg per day {coated tablets, chewable tablets, capsules, suspension, and elixir}; *Route: PO; *Indications: fever, pain, inflammation reducer (not commonly used for adults in EMS); *Contraindications: hypersensitivity; *Precautions: you may want to alternate with Acetaminophen; *Side effects: GI intolerance, many other possible effects; *Mechanism of action: antipyretic activity, analgesic activity- inhibition of central and peripheral prostaglandid synthesis- reduces inflammatory response through chemotaxis; *Classification: non-narcotic analgesic, antipyretic, NSAID;

Nitroglycerin

(NTG= nitroglycerin; Nitrostat): *Dose: 0.4 mg sublingually (tablet or spray). If chest pain persists and the systolic BP remains at least 90 mmHg, the dose may be repeated every 5 minutes to a total of three doses; *Route: Sublingual (tablets and spray); *Indications: chest pain associated with acute coronary syndrome, AMI, pulmonary edema, hypertension emergencies, CHF; *Contraindications: hypotension (systolic BP< 90 mmHg), increased intracranial pressure, CVA, head injury, and use of erectile dysfunction medications (Cialis, Levitra, Viagra) within 24 to 36 hours; *Precautions: it deteriorates rapidly when exposed to light or air. Monitor BP closely and discontinue administration if systolic BP falls below 90 mmHg; if the pt. is wearing a nitroglycerin patch or pase, additional administration may not be effective; *Side effects: immediate headache, dizziness, weakness, tachycardia, severe hypotension, dry mouth, nausea, syncope, and vomiting. May also cause a burning sensation among administration; *Mechanism of Action: decreases cardiac work, increases circulation to the heart, dilates coronary and systemic arteries; *Classification: coronary vasodilator

Glucose

(Oral Glucose); *Dose: 15 g by mouth or applied to buccal mucosa {single-dose 1.3 oz (37.5 g) sealved tube containing 15 g d-glucose (40% glucose)}; *Route: oral or buccal; *Indications: acute hypoglycemia in a patient who is awake and can protect his own airway; *Contraindications: inability to maintain a patent airway; *Precautions: carefully monitor patient for potential aspiration; *Side effects: nausea and vomiting; *Mechanism of action: raises blood sugar level; *Classification: carbohydrate

Albuterol Sulfate

(Proventil, Ventolin) *Dose: Metered-dose inhaler (MDI): one or two 90-ug sprays. The use of a spacer device is preferred when administering albuterol by MDI, especially in pediatric patients. Small-volume nebulizer: 2.5 mg diluted in 2.5 mL over 5 to 15 minutes; pediatric dosage: 0.15 mg/kg weight (kg=lb/2) diluted in 2.5 mL normal saline; {MDI or 2.5 mg/0.5 mL nebule} *Route: inhalaton; *Indications: wheezing caused by asthma, COPD, and some other conditions; relief of bronchospasm with reversible obstructive airway disease; *Contraindications: hypersensitivity and symptomatic tachycardia, relative to pt. symptoms= cardiac dysrhythmias, tachyarrhythmias, angina, hypertension, diabetes; *Precautions: may increase heart rate and myocardial oxygen demands. Use with caution in patients with heart disease; be aware of prior doses/ can interact with diuretics, digoxin, beta-blockers, & MAO inhibitors/ can have toxicity deffects on vascular system if used with tricyclic antidepressants; *Side effects: anxiety, palpitations, chest discomfort, headache, and perspiration, dizziness, tachycardia; *Mechanism of Action: a beta 2-adrenergic agonist which helps relax the bronchiole smooth muscles; *Classification: bronchodilator, sympathomimetic

Acetaminophen

(Tylenol); *Dose: adults 650 (or 325) to 1,000 mg every 4-6 hours, 4 g maximum per 24 hours; pediatric dosage: 10 to 15 mg/kg weight (kg=lb/2) every 4-6 hours, 40 mg/kg weight maximum per 24 hours {capsules, tablets, chewable tablets, suspension, elixir, and suppositories (for rectal administration); *Route: PO or PR (rectal); *Indications: fever, pain; *Contraindications: hypersensitivity; *Precautions: extreme caution liver dysfunction; *Side effects: possible sleepiness; *Mechanism of Action: antipyretic activity, analgesic activity- inhibition of central and peripheral prostaglandin synthesis; *Classification: non-narcotic analgesic, antipyretic

5% Dextrose in Water (D5W) for IV Infusion

*Dose: usually administered at a keep-open rate (30 mL/hr) {commonly supplied in 250 mL or 500 mL bags}; *Route: IV infusion; *Indications: used for prophylactic IV access or to dilute concentrated drugs for IV infusion; *Contraindications: should not be used for patients who require IV fluid replacement or in patients who are hyperglycemic. Do not use in patients with traumatic brain injury (TBI) or stroke; *Precautions: may be more irritating to the tissues than normal saline, so the IV site should be closely monitored for irritation, swelling, or redness; *Side effects: rare when given in therapeutic doses

Normal Saline for Intravenous Infusion

*Dose: 0.9% NaCl solution; Dosage depends on the condition for which normal saline is being administered- follow your protocols. A keep-open rate is 30 mL/hour. *Route: intravenous infusion; *Indications: hypovolemia, heat exhuastion, heat stroke, and diabetic ketoacidosis; *Contraindications: should not be given to patients with heart failure, because fluid overload may occur; *Precautions: monitor for fluid overload; in patients who have lost significant amounts of electrolytes, it may be more appropriate to use lactated Ringer's solution or an alternative IV fluid containing electrolyte replacement; *Side effects: large amounts may result in hemodilution and electrolyte imbalance

Naloxone (Narcan)

*Dose: 1-2 mg slow IV push titrated to restore respiratory rate. If no effect, may be repeated at 5-minute intervals. (*Pediatric Dose= 0.1mg/kg, with a max of 2mg) An intranasal formulation is also available; *Route: IV/IM/IN/ET/IO; *Indications: narcotic overdose, repiratory depression, coma of unknown origin; *Contraindications: Hypersensitivity; *Precautions: it can cause seizure from withdrawal in chronic opiate users; *Side effects: nausea and vomiting (N/V), seizures, tachycardia, hypertension, diaphoresis, blurred vision, withdrawal; *Mechanism of Action: displaces narcotics at the receptor sites in the CNS; attaches to the receptors and inhibits the narcotics' action; *Classification: Narcotic antagonist/ Opioid antagonist

50% Dextrose (D50)

*Dose: 25 g slow IV push; may be repeated in 10 to 15 minutes if blood glucose level (BGL) remains below 70 mg/dL. *Pediatric dosage: 0.5(-1) g/kg (500 mg kg) of a 25% solution (25 g/ 100 mL= D25) of dextrose (Pediatric max= 25 grams); 10% (10 g/100 mL= D10) for neonates; *Route: IV/IO only; *Indications: hypoglycemia; *Contraindications: Intracranial hemorrhage and possible CVA (stroke)- consider D25; *Precautions/*Side Effects: Tissue necrosis if infiltration occurs with IV; *Mechanism of action: raises blood sugar level using electrolytes; *Classification: carbohydrate

Oxygen

*Dose: O2 administration should be titrated to maintain a SpO2 of 95% or higher. Higher oxygen concentrations for prolonged periods of time can cause oxygen toxicity. Therefore, ventilator patients are often kept below 50% O2 when possible.; *Route: inhalation vis nasal cannula, face mask, nonrebreather mask, or bag-valve-mask device; *Indications: dyspnea, hypoxia, or when SpO2 < 95%; *Contraindications: None! (however, there are complications associated with hyperoxemia, specifically in neonates and patients resuscitated from cardiac arrest; *Precautions: Patients with COPD; not recommended for routine use in uncomplicated acute coronary syndrome...?; Do not use near open flame or combustion sources; O2 tanks may become projective hazard if knocked over and damaged; always leave bottle on its side... and use a protective guard over the flow meter to prevent damage; *Side effects: if used for prolonged periods of time without a humidifier, O2 may cause drying of the mucous membranes and nose bleeds

Lactated Ringer's Solution for IV infusion

*Dose: depends on the condition for which it is being administered (200-500cc with a max of 2-3 L; *Pediatric dose= 20cc/kg for fluid replacement, with a pediatric max of 60cc/kg); follow protocols; a keep-open rate is 30 mL/hour {commonly supplied in 1,000 mL bags}; *Route: IV infusion (isotonic fluid but is slightly more hypertonic than NS); *Indications: IV fluid for IV maintenance or electrolyte replacement, significant burns and hypovolemia (used to replace fluid and electrolytes); *Contraindications: do not use in patients with heart failure, renal failure, or suspected hyperkalemia; *Precautions: CVA, diabetes, mixing with blood sets, monitor closely for signs of circulatory overload; *Side effects: Rare in therapeutic dosages

Nitrous Oxide (Nitronox)

*Dose: self-administered mixture of 50% nitrous oxide and 50% oxygen {modified-demand valve with mixer to combine 50% of each gas for inhalation; D & E cylinders blue and green canisters holding compressed gas}; *Route: inhalation through mask; *Indications: moderate to severe pain, anxiety, apprehension; *Contraindications: impaired LOC, head injury, chest trauma (pneumothorax), inability to comply with instructions, decompression sickness, undiagnosed abdominal pain or marked distension, bowel obstruction, hypotension, shock, COPD; *Precautions: it is not effective in about 20% of the population; *Side effects: dizziness, apnea, cyanosis, nausea and vomiting, malignant hyperthermia; *Onset/Duration: 2-5 minutes for onset/ 2-5 minute duration; *Drug Interactions: none; *Mechanism of Action: it depressed the central nervous system, causing anesthesia; the high concentration of oxygen delivered along with the nitrous oxide increases oxygen tension in the blood, thereby reducing hypoxia

D5W Solution

5% dextrose in sterile water (D5W) {there are 5 g dextrose in every 100 mL water}; Also available in 10% solution (10g dextrose per 100 mL water) and in combination with other IV fluids, such as normal saline or lactated Ringer's solution. D5W is used when the patient can benefit from IV carbohydrates, such as patients who cannot have anything by mouth for a period of time. It is also useful for a keep-open IV in patients who are prone to fluid overload because it does not remain in the vascular space [can be used for a keep-open IV because the danger of fluid overload is reduced; however, a saline lock is also used for that purpose]; *Dose: medication dependent; *Indication: mixing medications (lidocaine, dopamine); *Precautions: use caution if used for main IV solution; *Classification: hypotonic solution

Nerve Agent Antidote Kits

Contain prefilled injectors of Atropine (2 mg) and Pralidoxime chloride (600 mg)- antidotes for organophosphate nerve agents, such as tabun, sarin, and VX

Lidocaine HCl

Xylocaine, Xylocard; *Dose: 1 mg/kg or 2 1/2 times the dose for ET ; *2nd Doses= 1/2 initial dose for 2nd and subsequent dosing (*0.75-1.5 mg/kg for 3-5 minutes followed by a drip of 1-4 mg/minute depending on prior boluses) (*Max= 3mg/kg); *Route: IV/ET/IO; *Indications: V-fib/ V-Tach, Post V-fib/ V-tach, (after conversion), possible symptomatic PVC's (premature ventricular contractions); *Contraindications: Bradycardia, AV heart blocks; *Precautions: 1/2 doses for patients over 70 years old or those with liver disease; *Side Effects: seizures, coma, respiratory depression may occur if given rapidly or in high doses, sinus bradycardia, hypotension; *Mechanism of Action: decreases the depolarization, automaticity, and excitability in the ventricles during the diastolic phase by the direct action on the tissue, especially the Purkinje network; *Classification: Antiarrhythmic agent