NCTI Paramedic Pharmacology
Activated Charcoal
Pharmacology/
onset of action - Answer- Binds and absorbs ingested toxins present in the GI tract
following emesis or lavage
Typically not effective unless administered within 30 minutes of ingestion
Onset of action: Immediate
Activated Charcoal
Indications - Answer- Poisoning/Overdose (after emesis/lavage or in cases where
emesis /lavage may be contraindicated)
Activated Charcoal
Alternative names - Answer- Actidose-Aqua, LiquiCharcoal
Activated Charcoal
Contraindications - Answer- Not for use with heavy metal ingestion (lithium or iron),
hydrocarbons, caustic alkalis
ALOC (unless given by nasogastric or orogastric tube)
Activated Charcoal
Precautions and Side Effects - Answer- Abdominal cramping, black stools, constipation,
nausea & vomiting Other:
Currently many physicians are choosing to lavage the stomach before charcoal. Lavage
is then followed by the administration of activated charcoal. • Not effective with
hydrocarbons - gasoline, propane, etc
Activated Charcoal
Dosage
How supplied - Answer- V. Dosage
• Adult: 1g/kg, typically 50 grams PO or gastric tube
• Pediatric: 1g/kg, typically 25 grams PO or gastric tube
VI. How Supplied
A. Bottles containing 25g/125ml or 50g/250ml
Procainamide
,Pharmacology and Actions - Answer- Antiarrhythmic, regarded as a cardiac depressant
Suppresses phase 4 depolarization dereasing automaticity of the ectopic pacemakers
Procainamide
Alternative name - Answer- Pronestyl
Procainamide
Indications - Answer- * PSVT (after adenosine, amiodarone and vagal maneuvers, for
stable patients)
• Stable wide complex tachycardia of unknown origin
• Atrial fibrillation and atrial flutter with rapid ventricular response rate (above 150)
• WPW syndrome
• Pulsing or pulseless ventricular tachycardia or ventricular fibrillation
Procainamide
Contraindications - Answer- • Second and Third - Degree AV block
• Digitalis Toxicity
• Tosades de Pointes
• TCA overdose
Procainamide
Precautions and Side Effects/ Cardiovascular - Answer- A. Use with caution in
myocardial infarction or CHF.
B. Hypotension in patients with impaired left venticular function
C. It may cause arrhythmias in the presence of AMI, Hypokalemia, or Hypomagnesemia
D. Use with caution with other drugs that prolong the QT interval (Amiodarone)
E. Bradycardia, heart blocks
F. Widened QRS, prolonged PR or QT interval, and ventricular ectopy
Procainamide
Precautions and Side Effects/
Neurological and other - Answer- Seizures, confusion
Other:
H. Use with caution in hepatic or renal dysfunction
Procainamide
Dosage for Adult - Answer- A. WPW, Pulsing V-Tach, PSVT, atrial fibrillation, atrial
flutter - 20 mg/min
B. Pulselesss V-tach or V-fib - 20 mg/min or 100 mg IV at 5 minute intervals
,C. Maintenance infusion (post conversion): 1-4 mg/min
D. Max Dose: 17 mg/kg OR until reach one of the following:
a. Arrhythmia suppression
b. Hypotension
c. QRS widens by more than 50%
E. Reduce dose to 12 mg/min if cardiac or renal dysfunction
Procainamide
Dosage for Pediatric - Answer- SVT, atrial flutter, ventricular tachycardia with pulses: 15
mg/kg over 30 to 60 minutes
Procainamide
How supplied - Answer- 1g/2 mL or 1g/10 mL - to mix, place 1 g into 50 mL buretrol to
make drip
Procainamide
Special Note for this drug (Should not be.........) - Answer- Note: Should not be exposed
to light.
Romazicon
Pharmacology ad Actions - Answer- Antagonizes the effects of benzodiazepines by
competitive inhibition at the GABAbenzodiazepine receptor site
• Does not compete with alcohol or narcotic sites
• Reversal of benzodiazepine effects in 1 to 2 minutes
Romazicon
Onset of Actions - Answer- 1 to 3 minutes
Romazicon
Alternative name - Answer- Flumazenil
Romazicon
Indications - Answer- Reverse respiratory depression associated with benzodiazepines
Romazicon
Contraindications - Answer- A. Hypersensitivity
B. Cocaine or other stimulant intoxication
C. Should not be used to rule out benzodiazepine overdose
, D. Not administered to patients who were given benzodiazepines for status seizure
Romazicon
Precautions and Side Effects - Answer- Neurological:
A. May cause withdrawal effects
B. May cause seizure
C. Dizzy, vertigo, ataxia, headache, fatigue
Respiratory:
Dyspnea, hyperventilation
Romazicon
Dosage - Answer- Adult:
• 0.2 mg IV over 30 seconds, repeat with 0.3 mg over 30 seconds. Max dose 3 mg/hour
Pediatrics
• Not recommended
Oxytocin
Pharmacology and Actions - Answer- • Naturally occurring hormone secreted by the
posterior pituitary that causes marked contraction of the uterine smooth muscle and
promotes lactation
• Normally a neurogenic reflex caused by irritation or stretching of the uterine cervix, as
occurs at the end of pregnancy, stimulates release of this hormone
• Duration: up to 30 minutes after infusion
Oxytocin
Alternative name - Answer- Pitocin
Oxytocin
Onset of action: - Answer- within 1 minute
Oxytocin
Indications - Answer- • Postpartum hemorrhage with hypotension or significant vaginal
bleeding after presentation of the placenta, if fundal massage and breast stimulation by
the infant are unsuccessful
Oxytocin
Contraindications - Answer- • Should not be used to induce labor in the field
Activated Charcoal
Pharmacology/
onset of action - Answer- Binds and absorbs ingested toxins present in the GI tract
following emesis or lavage
Typically not effective unless administered within 30 minutes of ingestion
Onset of action: Immediate
Activated Charcoal
Indications - Answer- Poisoning/Overdose (after emesis/lavage or in cases where
emesis /lavage may be contraindicated)
Activated Charcoal
Alternative names - Answer- Actidose-Aqua, LiquiCharcoal
Activated Charcoal
Contraindications - Answer- Not for use with heavy metal ingestion (lithium or iron),
hydrocarbons, caustic alkalis
ALOC (unless given by nasogastric or orogastric tube)
Activated Charcoal
Precautions and Side Effects - Answer- Abdominal cramping, black stools, constipation,
nausea & vomiting Other:
Currently many physicians are choosing to lavage the stomach before charcoal. Lavage
is then followed by the administration of activated charcoal. • Not effective with
hydrocarbons - gasoline, propane, etc
Activated Charcoal
Dosage
How supplied - Answer- V. Dosage
• Adult: 1g/kg, typically 50 grams PO or gastric tube
• Pediatric: 1g/kg, typically 25 grams PO or gastric tube
VI. How Supplied
A. Bottles containing 25g/125ml or 50g/250ml
Procainamide
,Pharmacology and Actions - Answer- Antiarrhythmic, regarded as a cardiac depressant
Suppresses phase 4 depolarization dereasing automaticity of the ectopic pacemakers
Procainamide
Alternative name - Answer- Pronestyl
Procainamide
Indications - Answer- * PSVT (after adenosine, amiodarone and vagal maneuvers, for
stable patients)
• Stable wide complex tachycardia of unknown origin
• Atrial fibrillation and atrial flutter with rapid ventricular response rate (above 150)
• WPW syndrome
• Pulsing or pulseless ventricular tachycardia or ventricular fibrillation
Procainamide
Contraindications - Answer- • Second and Third - Degree AV block
• Digitalis Toxicity
• Tosades de Pointes
• TCA overdose
Procainamide
Precautions and Side Effects/ Cardiovascular - Answer- A. Use with caution in
myocardial infarction or CHF.
B. Hypotension in patients with impaired left venticular function
C. It may cause arrhythmias in the presence of AMI, Hypokalemia, or Hypomagnesemia
D. Use with caution with other drugs that prolong the QT interval (Amiodarone)
E. Bradycardia, heart blocks
F. Widened QRS, prolonged PR or QT interval, and ventricular ectopy
Procainamide
Precautions and Side Effects/
Neurological and other - Answer- Seizures, confusion
Other:
H. Use with caution in hepatic or renal dysfunction
Procainamide
Dosage for Adult - Answer- A. WPW, Pulsing V-Tach, PSVT, atrial fibrillation, atrial
flutter - 20 mg/min
B. Pulselesss V-tach or V-fib - 20 mg/min or 100 mg IV at 5 minute intervals
,C. Maintenance infusion (post conversion): 1-4 mg/min
D. Max Dose: 17 mg/kg OR until reach one of the following:
a. Arrhythmia suppression
b. Hypotension
c. QRS widens by more than 50%
E. Reduce dose to 12 mg/min if cardiac or renal dysfunction
Procainamide
Dosage for Pediatric - Answer- SVT, atrial flutter, ventricular tachycardia with pulses: 15
mg/kg over 30 to 60 minutes
Procainamide
How supplied - Answer- 1g/2 mL or 1g/10 mL - to mix, place 1 g into 50 mL buretrol to
make drip
Procainamide
Special Note for this drug (Should not be.........) - Answer- Note: Should not be exposed
to light.
Romazicon
Pharmacology ad Actions - Answer- Antagonizes the effects of benzodiazepines by
competitive inhibition at the GABAbenzodiazepine receptor site
• Does not compete with alcohol or narcotic sites
• Reversal of benzodiazepine effects in 1 to 2 minutes
Romazicon
Onset of Actions - Answer- 1 to 3 minutes
Romazicon
Alternative name - Answer- Flumazenil
Romazicon
Indications - Answer- Reverse respiratory depression associated with benzodiazepines
Romazicon
Contraindications - Answer- A. Hypersensitivity
B. Cocaine or other stimulant intoxication
C. Should not be used to rule out benzodiazepine overdose
, D. Not administered to patients who were given benzodiazepines for status seizure
Romazicon
Precautions and Side Effects - Answer- Neurological:
A. May cause withdrawal effects
B. May cause seizure
C. Dizzy, vertigo, ataxia, headache, fatigue
Respiratory:
Dyspnea, hyperventilation
Romazicon
Dosage - Answer- Adult:
• 0.2 mg IV over 30 seconds, repeat with 0.3 mg over 30 seconds. Max dose 3 mg/hour
Pediatrics
• Not recommended
Oxytocin
Pharmacology and Actions - Answer- • Naturally occurring hormone secreted by the
posterior pituitary that causes marked contraction of the uterine smooth muscle and
promotes lactation
• Normally a neurogenic reflex caused by irritation or stretching of the uterine cervix, as
occurs at the end of pregnancy, stimulates release of this hormone
• Duration: up to 30 minutes after infusion
Oxytocin
Alternative name - Answer- Pitocin
Oxytocin
Onset of action: - Answer- within 1 minute
Oxytocin
Indications - Answer- • Postpartum hemorrhage with hypotension or significant vaginal
bleeding after presentation of the placenta, if fundal massage and breast stimulation by
the infant are unsuccessful
Oxytocin
Contraindications - Answer- • Should not be used to induce labor in the field
