Summary REMSA Paramedic Program Drug List (47 drugs) Revised 7/22/19

REMSA Paramedic Program Drug List (47 drugs) Revised 7/22/19 Acetaminophen (APAP) Activated Charcoal Adenosine (Adenocard) Albuterol (Proventil) Amiodarone (Cordarone) Aspirin (Salicylate) Atr opine Sulfate Calcium Chloride Dextrose 50%, 25%, 10% Diazepam (Valium) Diltiazem (Cardizem) Diphenhydramine (Benadryl) Dopamine (Intropin) Epinephrine (Adrenalin) Epinephrine, Racemic (Micronefrin) Etomidate (Amidate) Fentanyl (Sublimaze) Furosemide (Lasix) Glucagon Haloperidol (Haldol) Hydroxocobalamin Ibuprofen Ipratropium (Atrovent) Ketamine (Ketalar) Lidocaine (Xylocaine) Lorazepam (Ativan) Magnesium Sulfate Methylprednisolone (Solu-Medrol) Metoprolol (Lopressor) Midazolam (Versed) Morphine Sulfate Naloxone (Narcan) Nitroglycerin (Nitro-Stat) Nitro-Paste (Nitro-Bid Ointment) Nitrous Oxide (Nitronox) Norepinephrine (Levophed) Ondansetron (Zofran) Oral Glucose Oxygen Oxytocin (Pitocin) Pralidoxime (2-PAM) Procainamide Pralidoxime (2-PAM) Sodium Bicarbonate Succinylcholine (Anectine) Thiamine (Betaxin) Tranexamic Acid (TXA) Acetaminophen (APAP) Class: Analgesic, antipyretic Action: Increases pain threshold and reduces fever by acting on the hypothalamus. Indications: Fever, pain relief Contraindications: Hypersensitivity and use caution in patients with liver disease. Onset/Duration: Onset: 10-30 min PO Duration: 3-4 hours PO Dose/route: Adult: 325-1000 mg PO every 4-6 hr Peds: 15 mg/kg PO/PR every 4-6 hr Side Effects: Nausea/vomiting, hepatotoxicity Activated Charcoal Class: Antidote, adsorbent Action: Binds to and adsorbs ingested toxins thereby inhibiting their GI absorption. Once the drug binds to the charcoal the combined complex is excreted. Indications: Acute ingested poisonings that were ingested within the last hour Contraindications: Cyanide, mineral acids, caustic alkalis, iron, ethanol, methanol, corrosives, petroleum distillates. Onset/Duration: Onset: Immediate Duration: Continual while in GI tract and reaches equilibrium once saturated Dose/Route: Adult: 1 g/kg PO Peds: 1-2 g/kg PO Side Effects: Nausea, vomiting, abdominal cramping, constipation Adenosine (Adenocard) Class: Misc. antidysrhythmic, endogenous nucleoside Action: Decreases electrical conduction through the AV node without causing negative inotropic effects Indications: Supraventricular tachycardias (SVT/PSVT) Contraindications: Hypersensitivity, bradycardia, drug induced tachycardia, 2 nd or 3 rd degree heart blocks, A-Fib, A-Flutter, V-Tach, WPW with A-Fib/flutter. Onset/Duration: Onset: Immediate Duration/half-life: 10 seconds Dose/Route: Adult: 6 mg rapid IV/IO push followed by 20 cc saline flush. May repeat in 1-2 min at 12 mg rapid IV push followed by 20 cc saline flush. Peds: 0.1mg/kg (max 6mg) IV/IO followed by 5-10 cc saline flush. May repeat in 1-2 min at 0.2 mg/kg (max 12mg) IV/IO followed by 5-10 cc saline flush. Side Effects: dizziness, headache, shortness of breath, hypotension, flushing, palpitations, chest pain, nausea/vomiting Note: Methylxanthine classified stimulants (caffeine & theophylline) usage will antagonize adenosine Albuterol (Proventil) Class: Sympathomimetic, bronchodilator, beta-2 agonist Action: Sympathomimetic that is selective for Beta-2 adrenergic receptors/ Relaxes smooth muscles of the bronchial tree and peripheral vasculature by stimulating adrenergic receptors of sympathetic nervous system. Indications: Asthma, bronchospasms, reversible obstructive airway disease Contraindications: Hypersensitivity, caution with pts with cardiac dysrhythmias Onset/Duration: Onset: 5-8 min Duration: 2-6 hours Dose/Route: Adult/Peds: 2.5 mg diluted in 3 mL of Normal Saline Side Effects: Tremors, tachycardia, hypertension, anxiety, nausea, headache, palpitations, cough, dizziness Note: Albuterol may precipitate angina & cardiac dysrhythmias. Use with caution in pt’s with cardiovascular disorder, diabetes, seizure disorder, hyperthyroidism. Amiodarone (Cordarone) Class: Class III antidysrhythmic Action: Prolongs duration of the action potential and prolongs the refractory period, also has beta adrenergic receptor and calcium channel blocking activity. Works on both the ventricles and the atria Indications: V-Fib, hemodynamically unstable V-Tach, treatment for some stable atrial rhythms Contraindications: CHF, cardiogenic shock, bradycardia, 2nd or 3rd degree heart blocks with no pacemaker present, hypersensitivity to amiodarone or iodine Onset/Duration: Onset: within minutes and Duration: Variable but considered 30 – 45 days Dose/Route: Adult: Pulseless V-Tach/V-Fib arrest - 300mg IV/IO may repeat once at 150mg IV/IO. VTach with a pulse 150mg IV drip over 10 minutes up to max of 2.2g in 24 hours Peds: Pulseless V-Tach/V-Fib arrest - 5mg/kg IV/IO. V-Tach with a pulse 5mg/kg IV drip over 20-60 minutes with a max of 15mg/kg/day. Side Effects: Bradycardia, hypotension, headache, CHF, abnormal liver/thyroid functions. In rare cases can cause pulmonary fibrosis Aspirin (Salicylate) Class: Analgesic, nonsteroidal anti-inflammatory drug (NSAID), antipyretic, and antiplatelet Action: Inhibits prostaglandins involved in the production of inflammation, pain and fever. Dilates peripheral vessels and also inhibits platelet aggregation by blocking the formation of thromboxane A2. Indications: Acute coronary syndrome (ACS) such as myocardial infarction, ischemic chest pain or angina, and given for mild to moderate pain or fever. Contraindications: GI bleeding, hemorrhagic stroke, active gastric ulcers, bleeding disorders, asthma, hypersensitivity to salicylates, children Onset/Duration: Onset: 15-30 min Duration: 4-6 hours Dose/Route: Adult: Mild pain/fever – 325-650 mg PO every 4 hours. ACS – 2 to 4 baby chewable aspirin, 162-324 mg OR 1 adult aspirin, 325mg PO. Peds: Not indicated in pre-hospital setting Side Effects: Stomach irritation, GI bleeding, Nausea/vomiting Note: Children under 12 should not be given Aspirin as they may develop Reye’s syndrome. Atropine Sulfate Class: Anticholinergic, Parasympatholytic Action: Inhibits actions of acetylcholine (mostly at muscarinic receptor sites) causing decreased salivation and bronchial secretions, increased heart rate and decreased gastric motility. Indications: Hemodynamically unstable bradycardia, organophosphate or nerve gas poisoning Contraindications: Tachycardia, hypersensitivity, avoid use with hypothermic pts, caution in pts with an active MI and hypoxia Onset/Duration: Onset: Rapid Duration: 2-6 hours Dose/Route: Adult: Bradycardia – 0.5 mg IV/IO q 3-5 min up to max total of 3 mg Organophosphate poisoning – 1 to 5mg IV/IM/IO repeated 3-5 min until cessation of bronchial secretions Peds: Bradycardia NOT responding to Epi- 0.02mg/kg IV/IO (min dose of 0.1 mg and max single dose 0.5 mg) with maximum total of 1 mg for a child and 3 mg for an adolescent. Organophosphate peds < 12 yrs old - 0.05mg/kg IV/IM/IO may be repeated every 20-30 mins until cessation of bronchial secretions. Side Effects: Tachycardia, paradoxical bradycardia if given too slow or too small of dose, mydriasis (dilated pupils), dysrhythmias, headache, nausea/vomiting, headache, dizziness, flushed, anticholinergic effects (dry mouth/nose/skin, blurred vision, urinary retention, constipation) Note: Effects of atropine may be potentiated by antihistamines, procainamide, quinidine, antipsychotics, antidepressants, and thiazides