Medication Formulary. Contents. Reference for Medication Listings

Medication Formulary Contents Reference for Medication Listings Activated Charcoal (Liqui-Char) Albuterol (Proventil, Ventolin) Aspirin Epinephrine (A...
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Medication Formulary Contents Reference for Medication Listings Activated Charcoal (Liqui-Char) Albuterol (Proventil, Ventolin) Aspirin Epinephrine (Adrenalin) Levalbuterol (Xopenex) Metaproterenol 5% (Alupent) Nitroglycerin (Nitrostat, Tridil, and others) Oral Glucose (Insta-Glucose) Oxygen MARK 1 or NAAK Kit • Atropine Sulfate • Pralidoxime Chloride (2-PAM Chloride, Protopam)



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Medication Formulary

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Reference for Medication Listings

Name of Medication (Other Common Names)

Class How the medication is categorized as compared to other medications. This is usually done by grouping those medications with similar

characteristics, traits, or primary components.

Mechanism of action The manner of combination of parts, processes, etc., which form a common function. Indications A circumstance that points to or shows the cause, pathology, treatment, or issue of an attack of disease; that which points out; that

which serves as a guide or warning. Contraindications Any condition, especially any condition of disease, which renders some particular line of treatment improper or undesirable. Adverse reactions This is an abnormal or harmful effect to an organism caused by exposure to a chemical. It is indicated by some result such as

death, a change in food or water consumption, altered body and organ weights, altered enzyme levels, or visible illness. An effect may be classed as adverse if it causes functional or anatomic damage, causes irreversible change in the homeostasis of the organism, or increases the susceptibility of the organism to other chemical or biologic stress. A nonadverse effect will usually be reversed when the organism is no longer being exposed to the chemical. Drug interactions This refers to any potential effects that a medication may have when administered in conjunction or in the presence of another medication already in the patient’s system, a medication delivery device, or fluid. How supplied This is how the manufacturer packages the medication for distribution and sale. Typical methods of packaging are prefilled syringes, vials, or ampules. Dosage and administration This is the typical or average volume of the medication that is to be administered to the patient and the route of introduction of the medication to the patient. Duration of action Three values are given; (1) Onset: the estimated amount of time it will take for the medication to enter the body/system and begin to take effect, (2) Peak effect: the estimated amount of time it will take for the medication to have its greatest effect on the patient/system and (3) Duration: the estimated amount of time that the medication will have any effect on the patient/system. Special considerations Additional pertinent information concerning a medication.

Activated Charcoal (Liqui-Char) Class Adsorbent. Mechanism of action Adsorbs toxic substances from the gastrointesti-

nal tract; onset of action is immediate. Indications Most oral poisonings and medication overdoses; can be used after evacuation of poisons. Contraindications Oral administration to comatose patient; after ingestion of corrosives, caustics, or petroleum distillates (ineffective and may induce vomiting); simultaneous administration with other oral drugs. Adverse reactions May induce nausea and vomiting; may cause constipation; may cause black stools. Drug interactions Bonds with and generally inactivates whatever it is mixed with, eg, syrup of ipecac.

How supplied 25 g (black powder)/125-mL bottle (200 mg/mL); 50 g

(black powder)/250-mL bottle (200 mg/mL) Dosage and administration Note: if not in premixed slurry, dilute with

1 part charcoal/4 parts water. Adult: 1–2 g/kg PO or via NGT. Pediatric: 1–2 g/kg PO or via NGT Duration of action Depends on gastrointestinal function; will act until excreted. Special considerations Often used in conjunction with magnesium citrate. Must be stored in a closed container. Does not adsorb cyanide, lithium, iron, lead, or arsenic.

Albuterol (Proventil, Ventolin) Class Sympathomimetic, bronchodilator.

How supplied Solution for aerosolization: 0.5% (5 mg/mL). Metered

Mechanism of action Elective beta-2 agonist that stimulates adrenergic

dose inhaler: 90 µg/metered spray (17-g canister with 200 inhalations). Syrup: 2 mg/5 mL. Dosage and administration Adult: Administer 2.5 mg (0.5 mL of 0.5% solution) added to 2 mL normal saline for inhalation by nebulizer treatment and administer over 10–15 minutes. MDI: 1–2 inhalations (90–180 µg). Five minutes between inhalations. Pediatric: (between the ages of 2 and 12) Administer 2.5 mg (0.5 mL of 0.083% solution) added to 2 mL normal saline for inhalation by nebulizer treatment and administer over 10–15 minutes. May repeat every 20 minutes, up to three times. Duration of action Onset in 5–15 minutes with peak effect in 30 minutes to 2 hours and duration of 3–4 hours. Special considerations Pregnancy safety: Category C. Antagonized by beta-blockers (eg, Inderal, Lopressor). May precipitate angina pectoris and arrhythmias. Should only be administered by inhalation methodology in prehospital management.

receptors of the sympathomimetic nervous system resulting in smooth muscle relaxation in the bronchial tree and peripheral vasculature. Indications Treatment of bronchospasm in patients with reversible obstructive airway disease (COPD/asthma). Prevention of exerciseinduced bronchospasm. Contraindications Known prior hypersensitivity reactions to albuterol. Tachycardia arrhythmias, especially those caused by digitalis. Synergistic with other sympathomimetics. Adverse reactions Often dose-related and include restlessness, tremors, dizziness, palpitations, tachycardia, nervousness, peripheral vasodilatation, nausea, vomiting, hyperglycemia, increased blood pressure, and paradoxical bronchospasm. Drug interactions Tricyclic antidepressants may potentiate vasculature effects. Beta-blockers are antagonistic. May potentiate hypokalemia caused by diuretics.

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Aspirin Class Platelet inhibitor, anti-inflammatory agent.

Drug interactions Use with caution in patients allergic to NSAIDs.

Mechanism of action Prostaglandin inhibition.

How supplied 81-mg, 160-mg, or 325-mg tablets (chewable and

Indications New onset chest pain suggestive of acute myocardial

infarction. Signs and symptoms suggestive of recent cerebrovascular accident. Contraindications Hypersensitivity. Relatively contraindicated in patients with active ulcer disease or asthma. Adverse reactions Heartburn, GI bleeding, prolonged bleeding, nausea, and vomiting. Wheezing in allergic patients.

standard).

Dosage and administration 160 mg to 325 mg PO (chewed if pos-

sible). Duration of action Onset: 30–45 minutes. Peak effect: variable. Dura-

tion: variable. Special considerations Pregnancy safety: Category D. Not recom-

26 Respiratory Emergencies mended in pediatric population. Emergencies 27 Cardiovascular Epinephrine (Adrenalin) of 1:10,000) IV/IO over 5 minutes. Cardiac arrest: IV/IO dose: 1 mg Sympathomimetic. Neurologic Emergencies 28 (10 mL of 1:10,000 solution) every 3–5 minutes during resuscitaDirect-acting alpha- and beta-agonist. Alpha: tion. Follow each dose with 20 mL flush and elevate arm for 10 to vasoconstriction. Beta-1: positive inotropic, chronotropic, and 29 Endocrine Emergencies 20 seconds after dose. Higher dose: Higher doses (up to 0.2 mg/kg) dromotropic effects. Beta-2: bronchial smooth muscle relaxation and may be used for specific indications (beta-blocker or calcium channel dilation of skeletal vasculature. Allergic Reactions 30 Cardiac blocker overdose). Continuous infusion: Add 1 mg (1 mL of 1:1,000 arrest (V-fib/pulseless V-tach, asystole, PEA), solution) to 500 mL normal saline or D W. Initial infusion rate of 1 symptomatic bradycardia as an alternative infusion to dopamine, Gastrointestinal Emergencies µg/min titrated to effect (typical dose: 2–10 µg/min). Endotracheal 31 severe hypotension secondary to bradycardia when atropine and (ET) dose: 2–2.5 mg diluted in 10 mL normal saline. Profound transcutaneous pacing are unsuccessful, allergic reactions, anaphybradycardia or hypotension: 2–10 µg/min; titrate to patient response. Renal and Urologic Emergencies laxis, asthma. 32 Pediatric: Mild allergic reactions and asthma: 0.01 mg/kg (0.01 mL/ Hypertension, hypothermia, pulmonary edema, of 1:1,000 solution SC (maximum of 0.3 mL). Cardiac arrest: Substance Abuse kg) and Poisoning myocardial ischemia, hypovolemic shock. 33 Toxicology: IV/IO dose: 0.01 mg/kg (0.1 mL/kg) of 1:10,000 solution every 3–5 Hypertension, tachycardia, arrhythmias, pulmominutes during arrest. All endotracheal (ET) doses: 0.1 mg/kg (0.1 Hematologic Emergencies nary edema, anxiety, restlessness, psychomotor agitation, nausea, 34 mL/kg) of 1:1,000 solution. Symptomatic bradycardia: IV/IO dose: headache, angina. 0.01 mg/kg (0.1 mL/kg) of 1:10,000 solution. Continuous IV/IO Potentiates other sympathomimetics, deactivated Environmental Emergencies 35 infusion: Begin with rapid infusion, then titrate to response. Typical by alkaline solutions (ie, sodium bicarbonate), monamine oxidase initial infusion: 0.1–1 µg/min. Higher doses may be effective. inhibitors (MAOIs) may potentiateand effects, beta-blockers may blunt Infectious Communicable Diseases 36 Onset: immediate. Peak effect: minutes. Duration: effects. several minutes. 1:1,000 solution: ampules and vials containing 1 mg/ Emergencies 37 Behavioral Pregnancy safety: Category C. May cause synmL. 1:10,000 solution: prefilled syringes containing 1 mg in 10 mL cope in asthmatic children. May increase myocardial oxygen demand. (0.1 mg/mL). Auto-injector (EpiPen): 0.5 mg/mL (1:2,000). Emergencies 38 Gynecologic Adult: Mild allergic reactions and asthma: 0.3–0.5 mg (0.3–0.5 mL of 1:1,000) SC. Anaphylaxis: 0.1 mg (1 mL 39 Obstetrics

Class

Mechanism of action

Indications

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Contraindications

Adverse reactions

Drug interactions

Duration of action

How supplied

Special considerations

Dosage and administration

Levalbuterol (Xopenex) Class Bronchodilator, adrenergic beta-2 agonist. Mechanism of Action Causes bronchodilation by action on the beta-2

pulmonary receptors to relax smooth muscle as well as produce CNS and cardiac stimulation. Indications Used to treat or prevent bronchospasm in patients 6 years or older. Relaxes the smooth muscles of the lower airways. Contraindications Known sensitivity to the drug. Hypersensitivity to sympathomimetics, tachyarrhythmias, and severe cardiac disease. Adverse reactions Tremors, anxiety, insomnia, headache, dizziness, restlessness, hallucinations, flushing, irritability, vomiting, nausea, palpitations, tachycardia, hypertension, angina, hypotension, and arrhythmias.

Drug interactions Increased actions of aerosol bronchodilators, tricy-

clic antidepressants, MAOIs, and other adrenergics. How supplied Solution for inhalation 0.63 mg, 1.25 mg/3 mL. Dosage and administration For adults and pediatrics over 6 years old:

1.25 mg in 3 mL administered by the nebulizer route. For adults only: 2 puffs by MDI. Duration of action Onset: 5-15 minutes, peak effect: 60–90 minutes, duration: 6-8 hours. Metabolized in the liver. Special considerations Crosses the placenta, breast milk, blood-brain barrier. Precautions should be taken with lactation, pregnancy (Class C), cardiac disorders, hyperthyroidism, diabetes mellitus, hypertension, prostatic hypertrophy, narrow-angle glaucoma, and seizures.

Metaproterenol 5% (Alupent) Class Sympathomimetic bronchodilator. Mechanism of action Beta-2 agonist acts directly on bronchial smooth

muscle causing relaxation of the bronchial tree and peripheral vasculature.

Indications Bronchial asthma, reversible bronchospasm secondary to

bronchitis, COPD. Contraindications Tachyarrhythmias, hypersensitivity, tachycardias

due to digitalis toxicity.



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Medication Formulary

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Adverse reactions Tachyarrhythmias, anxiety, nausea, vomiting, rest-

lessness, apprehension, palpitations, hypotension, coughing, facial flushing, diaphoresis. Drug interactions Other sympathomimetics may exacerbate cardiovascular effects. MAOIs may potentiate hypotensive effects. Beta-blockers may antagonize metaproterenol. How supplied MDI: 0.65 mg/dose/spray (15-mL inhaler). Solution: 5% solution in bottles of 10 and 30 mL with calibrated dropper; Alupent inhalation solution unit-dose vial, 0.4% or 0.6%. Dosage and administration Adult: MDI: 2–3 inhalations every 3–4 hours (2 minutes between inhalations). Inhalation solution 5%: via

hand-held nebulizer 0.2–0.3 mL diluted in 2.5 mL saline. Inhalation solution unit-dose 0.4% or 0.6% vials: intermittent positive-pressure breathing device only: one vial/treatment. Pediatric: MDI: not recommended. Inhalation solution 5%: age 6–12 years: 0.1–0.2 mL diluted in 3 mL saline. Duration of action Onset: 1 minute after inhalation. Peak effect: 45 minutes. Duration: 3–6 hours. Special considerations Pregnancy safety: Category C. Monitor for hypotension or tachycardia. Use with caution in patients with diabetes mellitus and coronary artery disease.

Nitroglycerin (Nitrostat, Tridil, and others) Class Vasodilator. Mechanism of action Smooth muscle relaxant acting on vascular, bron-

chial, uterine, and intestinal smooth muscle; dilation of arterioles and veins in the periphery; reduces preload and afterload; decreases the work load of the heart and, thereby, myocardial oxygen demand. Indications Acute angina pectoris, ischemic chest pain, hypertension, CHF, pulmonary edema. Contraindications Hypotension, hypovolemia; intracranial bleeding or head injury; previous administration of Viagra, Revatio, Levitra, Cialis, or similar agents within past 24 hours. Adverse reactions Headache, hypotension, syncope, reflex tachycardia, flushing, nausea, vomiting, diaphoresis, muscle twitching. Drug interactions Additive effects with other vasodilators; incompatible with other drugs IV. How supplied Tablets: 0.15 mg (1/400 grain); 0.3 mg (1/200 grain);

0.4 mg (1/150 grain); 0.6 mg (1/100 grain). NTG spray: 0.4 mg–0.8 mg under the tongue. NTG IV (Tridil). Dosage and administration Adult: Tablets: 0.3–0.4 mg SL; may repeat in 3–5 minutes to maximum of 3 doses. NTG spray: 0.4 mg under the tongue; 1–2 sprays. NTG IV infusion: begin at 10 to 20 µg/min; increase by 5–10 µg/min every 5 minutes until desired effect. Pediatric: Not recommended. Duration of action Onset: 1–3 minutes. Peak effect: 5–10 minutes. Duration: 20–30 minutes or if IV, 1–10 minutes after discontinuation of infusion. Special considerations Pregnancy safety: Category C. Hypotension more common in geriatric population. NTG decomposes if exposed to light or heat. Must be kept in airtight containers. Active ingredient may have a stinging effect when administered.

Oral Glucose (Insta-Glucose) Class Hyperglycemic. Mechanism of action Provides quickly absorbed glucose to increase

blood glucose levels. Indications Conscious patients with suspected hypoglycemia. Contraindications Decreased level of consciousness, nausea, vomiting. Adverse reactions Nausea, vomiting. Drug interactions None.

How supplied Glucola: 300-mL bottles. Glucose pastes and gels in

various forms. Dosage and administration Adult: Should be sipped slowly by patient

until clinical improvement noted. Pediatric: Same as adult. Duration of action Onset: immediate. Peak effect: variable. Duration:

variable. Special considerations As noted in indications section.

Oxygen Class Naturally occurring atmospheric gas.

Drug interactions None.

Mechanism of action Reverses hypoxemia.

How supplied Oxygen cylinders (usually green and white) of 100%

Indications Confirmed or expected hypoxemia, ischemic chest pain,

respiratory insufficiency, prophylactically during air transport, confirmed or suspected carbon monoxide poisoning, all other causes of decreased tissue oxygenation, decreased level of consciousness. Contraindications Certain patients with COPD or emphysema who will not tolerate oxygen concentrations over 35%, hyperventilation. Oxygen should never be withheld from a patient who needs it however. Be prepared to assist with ventilations in a patient with COPD who requires high concentration, as apnea may result. Adverse reactions Decreased level of consciousness and respiratory depression in patients with chronic carbon dioxide retention. Retrolental fibroplasia if giving high concentrations to premature infants (maintain 30%-40% oxygen).

compressed oxygen gas. Dosage and administration Adult: Cardiac arrest and carbon monox-

ide poisoning: 100%. Hypoxemia: 10–15 L/min via nonrebreathing mask. COPD: 1–6 L/min via nasal cannula or 28%–35% Venturi mask. Be prepared to provide ventilatory support if higher concentrations of oxygen needed. Pediatric: Same as for adult with exception of premature infant. Duration of action Onset: immediate. Peak effect: not applicable. Duration: Less than 2 minutes. Special considerations Be familiar with liter flow and each type of delivery device used. Supports possibility of combustion.

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MARK 1 or NAAK Kit A Mark 1 or NAAK , Nerve Agent Antidote Kit, may be provided by the service you work or volunteer with. This kit is to be utilized only in the event of a chemical exposure to nerve agent event. Prior to the utilization of the Kit the EMT must be knowledgeable concerning local protocol. The kit contains two medications, Atropine and 2-PAM Chloride. Atropine should be administered first. The EMT should first recognize the primary signs and symptoms of nerve agent exposure. A common mnemonic to assist you in remembering these is SLUDGEM: Salivation, Lacrimation, Urination, Defecation, GI disturbances, Emesis, Miosis, and muscle twitching. Nerve agent exposure results in a buildup of excess acetylcholine at nerve receptor sites.

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Duration of action Onset: immediate. Peak effect: 1–2 minutes. Dura-

tion: 2–6 hours.

Special considerations Pregnancy safety: Category C. Moderate doses

may cause pupillary dilation.

Pralidoxime Chloride (2-PAM Chloride, Protopam)

26 Respiratory Emergencies Reactivation of cholinesterase to effectively act as an antidote to nerve or organophosphate poisoning. This action the bond between the nerve agent and the aceytlcholinester27 Cardiovascular Emergenciesbreaks ase and allows for destruction of accumulated acetylcholine at the Atropine Sulfate neuromuscular junction. Neurologic Emergencies 28 Anticholinergic agent. As an antidote in the treatment of poisoning by nerve Parasympatholytic: inhibits action of acetylchoagents. Endocrine Emergencies 29 line at postganglionic parasympathetic neuroeffector sites. None in the event of a nerve agent exposure event. Although there are cardiac indications for atropine the Dizziness, blurred vision, diplopia, headache, Reactions indication the MARK I/ NAAK kit is nerve agent exposure. 30 forAllergic drowsiness, nausea, tachycardia, hyperventilation, muscular weakNone in the event of a nerve agent exposure event. ness, excitement, and manic behavior. Gastrointestinal Emergencies Headache; dizziness; palpitations; nausea and 31 No direct drug interactions; however, patients with vomiting; tachycardia; arrhythmias; anticholinergic effects (blurred organophosphate poisoning should not be given barbiturates, morvision, mouth, urinary retention); paradoxical bradycardia when and Urologic Emergencies 32dry Renal phine, theophylline, aminophylline, succinylcholine, reserpine, and pushed slowly or at low doses; flushed, hot, dry skin. phenothiazines. Potential adverse effects when administeredAbuse with Toxicology: Substance and Poisoning 33 Emergency Single Dose Kit containing: One 600 mg in 2 digoxin, cholinergics, physostigmine. Effects enhanced by antihismL autoinjector. tamines, procainamide, quinidine, antipsychotics, benzodiazepines, Emergencies 34 Hematologic Should be administered immediately after and antidepressants. atropine. Emergency Single Dose Kit containing: 2 mg in 0.7 mL Emergencies 35 Environmental Onset: minutes. Peak effects: variable. Duration: autoinjector. variable. Adult: Nerve agent poisoning: Extremely Infectious and Communicable DiseasesPregnancy safety: unknown. Treatment will be 36 large doses (2–4 mg or higher) may be needed. The dose of 2 mg most effective if given within a few hours after poisoning. should be repeated if symptoms remain after 10 minutes. 37 Behavioral Emergencies 38 Gynecologic Emergencies 39 Obstetrics Class

Mechanism of action Indications

Class Oxime Cholinesterase reactivator. Mechanism of action

Indications

Contraindications

Adverse reactions

Contraindications

Adverse reactions

Drug interactions

Drug interactions

How supplied

Dosage and administration

How supplied

Dosage and administration

Duration of action

Special considerations