Morphine Sulfate Paramedic Drug Profile

GENERIC NAME morphine sulfate CLASSES • Narcotic analgesic • Narcotic agonist STANDARD SUPPLIES • Vial • Ampule MECHANISMS OF ACTION • Alleviates pain by depressing the central nervous system • Depresses brainstem respiratory centers • Decreases venous return to the heart • Decreases preload • Decr...

GENERIC NAME morphine sulfate CLASSES • Narcotic analgesic • Narcotic agonist STANDARD SUPPLIES • Vial • Ampule MECHANISMS OF ACTION • Alleviates pain by depressing the central nervous system • Depresses brainstem respiratory centers • Decreases venous return to the heart • Decreases preload • Decreases afterload INDICATIONS • Pain management • Chest pain and/or signs and symptoms suggestive of the acute coronary syndrome • Acute cardiogenic pulmonary edema CONTRAINDICATIONS • Known hypersensitivity to the drug • Head injury • Decreased level of consciousness • Hemodynamically significant hypotension ADVERSE REACTIONS/SIDE EFFECTS • Central nervous system depression • Respiratory depression • Respiratory arrest • Hypotension • Bradycardia • Tachycardia • Dysrhythmias • Syncope • Dyspnea • Nausea • Vomiting MORPHINE SULFATE 1 ROUTES OF ADMINISTRATION • IV • IO • IM ONSETS OF ACTION • IV/IO: Immediate • IM: 10 to 30 minutes ADULT DOSAGES • 1.0 to 4.0 mg increments over 1 to 5 minutes PEDIATRIC DOSAGES • 0.1 to 0.2 mg/kg SPECIAL CONSIDERATIONS • The peak effect of IV/IO administration of the drug is 20 minutes • The duration of IV/IO administration of the drug is 2 to 4 hours • The peak effect of IM administration of the drug is 30 to 60 minutes • The duration of IM administration of the drug is 4 to 5 hours • Respiratory arrest/depression can be reversed by naloxone (Narcan®) • The drug can cross the placental barrier MORPHINE SULFATE 2 GENERIC NAME naloxone TRADE, BRAND, OR PROPRIETARY NAME • Narcan® CLASS • Narcotic antagonist STANDARD SUPPLIES • Prefilled syringe • Prefilled syringe with a mucosal atomizer device (MAD) • Intranasal spray device MECHANISMS OF ACTION • Acts as a competitive antagonist at opiate receptors in the central nervous system • Reverses the effects of narcotics and synthetic analgesic drugs o central nervous system depression o respiratory depression o respiratory arrest INDICATIONS • Narcotic and synthetic analgesic overdoses including o morphine (MSContin®) o heroin o oxycodone (OxyContin®) o methadone o codeine o meperidine (Demerol®) o fentanyl (Sublimaze®) o hydrocodone (Vicodin®) o hydromorphone • Unconsciousness of unknown etiology CONTRAINDICATION • None in the emergency setting NALOXONE 1 ADVERSE REACTIONS/SIDE EFFECTS • Withdrawal symptoms o Confusion o Hypotension o Tachycardia o Hypertension o Dysrhythmias o Diaphoresis o Nausea o Vomiting ROUTES OF ADMINISTRATION • IV • IM • IO • ET • Intra-nasal (IN) ONSETS OF ACTION • IV/IO: less than 2 minutes • IM/IN: 2 to 10 minutes ADULT DOSAGES • 2.0 mg • May repeat the dosage every 2 minutes • ET: 4.0 mg diluted in 10 mL normal saline • Intra-nasal (IN): 1.0 mg sprayed in each nostril • May repeat the dosage every 2 minutes PEDIATRIC DOSAGES • 0.1 mg/kg (up to 2.0 mg per dosage) • May repeat the dosage every 2 minutes • ET: 2.0 to 4.0 mg diluted in 3.0 to 5.0 mL normal saline • Intra-nasal (IN): 1.0 mg sprayed in each nostril • May repeat the dosage every 2 minutes SPECIAL CONSIDERATIONS • The peak effect of IV/IO administration of the drug is less than 2 minutes • The duration of IV/IO administration of the drug is 20 minutes to 2 hours • The peak effect of IM/IN administration of the drug is 2 to 10 minutes • The duration of IM/IN administration of the drug is 20 minutes to 2 hours • The peak effect of IN administration of the drug is 20 minutes • The duration of IN administration of the drug is 30 to 90 minutes NALOXONE 2 GENERIC NAME nitroglycerin TRADE, BRAND, OR PROPRIETARY NAMES • Nitro-Bid® • Nitrolingual® • Nitrostat® • Others CLASSES • Vasodilator • Antianginal • Nitrate STANDARD SUPPLIES • Tablet • Spray bottle MECHANISMS OF ACTION • Relaxes vascular smooth muscle • Dilates coronary arteries resulting in increased blood flow to the myocardium • Decreases workload on the heart • Decreases myocardial oxygen demand • Decreases preload • Decreases afterload INDICATIONS • Chest pain and signs/symptoms suggestive of the acute coronary syndrome • Congestive heart failure with pulmonary edema CONTRAINDICATIONS • Hemodynamically significant hypotension • Hypovolemia • The patient has taken an erectile dysfunction medication in the previous 48 hours including o sildenafil (Viagra®) o tadalafil (Cialis®) o vardenafil (Levitra®) o Other phosphodiesterase-5 inhibitor medications • Not recommended for use with pediatric patients NITROGLYCERIN 1 ADVERSE REACTIONS/SIDE EFFECTS • Hypotension • Bradycardia • Tachycardia • Headache • Dizziness • Weakness • Syncope • Nausea • Vomiting ROUTE OF ADMINISTRATION • Sublingual ONSET OF ACTION • 1 to 3 minutes ADULT DOSAGES • Tablet: 0.4 mg • Single spray: 0.4 mg • May repeat the dosage in 3 to 5 minutes twice after the initial dosage SPECIAL CONSIDERATION • The peak effect of the drug is 5 to 10 minutes • The duration of the drug is 20 to 30 minutes NITROGLYCERIN 2 GENERIC NAME nitrous oxide 50% TRADE, BRAND, OR PROPRIETARY NAME • Nitronox® CLASS • Inhaled analgesic STANDARD SUPPLIES • Cylinders with a fixed ratio setup of nitrous oxide 50% and oxygen 50% with a self-administration mask MECHANISM OF ACTION • Alleviates pain by depressing the central nervous system INDICATION • Pain management CONTRAINDICATIONS • The patient cannot understand verbal instructions for use of the drug • Alcohol intoxication • Head injury • Abdominal pain and distention ADVERSE REACTIONS/SIDE EFFECTS • Headache • Dizziness • Giddiness • Nausea • Vomiting ROUTE OF ADMINISTRATION • Inhalation ONSET OF ACTION • 30 seconds ADULT DOSAGE • Self-administered and self-regulated inhalation by the patient PEDIATRIC DOSAGE • Self-administered and self-regulated inhalation by the patient NITROUS OXIDE 1 SPECIAL CONSIDERATIONS • The patient must hold the mask to their face while inhaling the drug • The peak effect of the drug is 1 minute • The duration of the drug is 1 to 5 minutes NITROUS OXIDE 2 GENERIC NAME norepinephrine TRADE, BRAND, OR PROPRIETARY NAME • Levophed® CLASS • Sympathomimetic STANDARD SUPPLY • Premix bag for infusion MECHANISMS OF ACTION • Alpha-adrenergic response o Vasoconstriction • Beta1-adrenergic responses o Increases the heart rate o Increases myocardial contractility INDICATIONS • Severe hypotension refractory to IV boluses caused by o Cardiogenic shock o Septic shock o Neurogenic shock CONTRAINDICATION • Hypotension caused by hypovolemia ADVERSE REACTIONS/SIDE EFFECTS • Extravasation of the IV/IO may cause tissue necrosis • Tachycardia • Increased myocardial oxygen demand • Hypertension • Dysrhythmias • Dyspnea • Palpitations • Chest pain • Nervousness NOREPINEPHRINE 1 ADVERSE REACTIONS/SIDE EFFECTS (continued) • Anxiety • Dizziness • Headache • Tremors • Nausea • Vomiting ROUTE OF ADMINISTRATION • Infusion ONSET OF ACTION • Immediate ADULT DOSAGES • Infusion: 0.05 to 4.0 mcg/kg/minute, titrated to effect PEDIATRIC DOSAGES • Infusion: 0.05 to 0.2 mcg/kg/minute, titrated to effect SPECIAL CONSIDERATIONS • The drug can increase adverse reactions and side effects when administered with another sympathomimetic drug • The peak effect of the drug is less than 1 minute • The duration of the drug is 1 to 2 minutes • An infusion pump should be used to administer the drug NOREPINEPHRINE 2 GENERIC NAME ondansetron TRADE, BRAND, OR PROPRIETARY NAME • Zofran® CLASS • Antiemetic STANDARD SUPPLIES • Orally-disintegrating tablet (ODT) • Vial MECHANISMS OF ACTION • Blocks serotonin 5-HT3 receptor sites in the central nervous system • Inhibits nausea and vomiting INDICATION • Nausea and vomiting CONTRAINDICATION • Known hypersensitivity to the drug ADVERSE REACTIONS/SIDE EFFECTS • Headache • Dizziness ROUTES OF ADMINISTRATION • Oral • IV • IO ONSET OF ACTION • 5 to 30 minutes ADULT DOSAGES • Oral/IV/IO: 4.0 to 8.0 mg PEDIATRIC DOSAGES • 4 to 14 years oral/IV/IO: 4.0 mg • Maximum dosage 4.0 mg ONDANSETRON 1 SPECIAL CONSIDERATIONS • The peak effect of the drug is 1½ to 2 hours • The duration of the drug is 3 to 8 hours ONDANSETRON 2 GENERIC NAME oral glucose TRADE, BRAND, OR PROPRIETARY NAMES • Glutose® • Insta-Glucose® • Others CLASSES • Carbohydrate • Hyperglycemic STANDARD SUPPLY • Tube MECHANISM OF ACTION • Increases the glucose levels in the blood INDICATION • Hypoglycemia CONTRAINDICATIONS • The patient cannot protect their airway • Nausea and vomiting ADVERSE REACTIONS/SIDE EFFECTS • Nausea • Vomiting ROUTES OF ADMINISTRATION • Buccal • Sublingual ONSET OF ACTION • Variable ADULT DOSAGES • 15 to 50 gm • May repeat the dosage PEDIATRIC DOSAGES • 5.0 to 50 gm • May repeat the dosage ORAL GLUCOSE 1 SPECIAL CONSIDERATIONS • Check the blood glucose level before administering the drug • Check the blood glucose level after each additional dosage of the drug • The peak effect of the drug is variable • The duration of the drug is variable ORAL GLUCOSE 2 GENERIC NAME oxygen CLASS • Natural atmospheric gas STANDARD SUPPLIES • Cylinders of various sizes MECHANISMS OF ACTION • Reverses hypoxia • Increases oxygenation of tissues • Increases the saturation of hemoglobin INDICATIONS • Hypoxia • Suspected hypoxia where pulse oximetry indicates less than 94% with an unstable patient CONTRAINDICATION • Oxygen supports combustion from an ignition source ADVERSE REACTIONS/SIDE EFFECTS • Oxygen that is not humidified may dry or irritate mucous membranes in the nose and throat ONSET OF ACTION • Varies according to the delivery device, ventilation device, and liter flow OXYGEN 1 Oxygen Delivery and Ventilation Devices Rates & Percentages Oxygen Delivery & Ventilation Devices nasal cannula simple face mask partial nonrebreather mask nonrebreather mask Venturi® mask mouth-to-mask device without supplemental oxygen mouth-to-mask device with supplemental oxygen bag-valve mask with reservoir continuous positive air pressure (CPAP) 1 to 6 L/minute 8 to 10 L/minute 15 L/minute 10 to 15 L/minute variable Oxygen Percentages 24 to 44% 40 to 60% 80 to 90% up to 90% 24 to 40% N/A 16 to 17% 15 L/minute up to 55% 15 L/minute up to 100% variable up to 80% Delivery Rate SPECIAL CONSIDERATIONS • In the emergency setting, administration of oxygen does not have a significant depressive respiratory effect on the patient with a cardiovascular condition or chronic obstructive pulmonary disease, including emphysema • The peak effect of the drug is variable • The duration of the drug is variable OXYGEN 2 GENERIC NAME oxytocin TRADE, BRAND, OR PROPRIETARY NAME • Pitocin® CLASSES • Pituitary hormone • Uterine stimulant STANDARD SUPPLY • Vial MECHANISMS OF ACTION • Binds to oxytocin receptor sites on the surface of uterine smooth muscles • Increases the force and frequency of uterine contractions INDICATION • Postpartum hemorrhage CONTRAINDICATIONS • Known hypersensitivity to the drug • Presence of a fetus with impending delivery • Not recommended for use with pediatric patients ADVERSE REACTIONS/SIDE EFFECTS • Hypotension • Nausea • Vomiting ROUTES OF ADMINISTRATION • Infusion • IM ONSETS OF ACTION • Infusion: immediate • IM: 3 to 5 minutes ADULT DOSAGES • Infusion: 10 to 20 U in 1,000 mL (1.0 L) of NS or LR • IM: 10 U OXYTOCIN 1 SPECIAL CONSIDERATIONS • The peak effect of the infusion of the drug is variable • The duration of the drug is 1 hour after the infusion is discontinued • The peak effect of IM administration of the drug is variable • The duration of IM administration of the drug is 2 to 3 hours • An infusion pump should be used to administer the drug when possible OXYTOCIN 2 GENERIC NAME phenylephrine nasal spray 0.5% TRADE, BRAND, OR PROPRIETARY NAME • Neo-Synephrine® CLASS • Topical vasoconstrictor STANDARD SUPPLY • Spray bottle MECHANISMS OF ACTION • Stimulates alpha receptors to vasoconstrict blood vessels in the nasal mucosa • Reduces the risk of bleeding during insertion of a nasotracheal tube INDICATION • Administered prior to insertion of a nasotracheal tube CONTRAINDICATION • Known hypersensitivity to the drug ADVERSE REACTIONS/SIDE EFFECTS • None in the emergency setting ROUTE OF ADMINISTRATION • Nasal ONSET OF ACTION • Immediate ADULT DOSAGES • 1 to 2 sprays SPECIAL CONSIDERATIONS • The drug is used in conjunction with a properly-sized nasotracheal tube and lubrication • The peak effect of the drug is 30 minutes • The duration of the drug is 30 minutes to 4 hours PHENYLEPHRINE NASAL SPRAY 0.5% 1 GENERIC NAME pralidoxime chloride (2-Pam) TRADE, BRAND, OR PROPRIETARY NAME • Protopam® CLASS • Antidote STANDARD SUPPLY • Auto-injector MECHANISM OF ACTION • Regenerates cholinesterase activity that became inhibited by an organophosphate pesticide INDICATION • Organophosphate pesticide poisoning CONTRAINDICATIONS • None in the emergency setting • Not recommended for use with pediatric patients ADVERSE REACTIONS/SIDE EFFECTS • Tachycardia • Hypertension • Dizziness • Headache • Blurred vision ROUTE OF ADMINISTRATION • IM ONSET OF ACTION • Variable ADULT DOSAGES • Auto-injector: 600 mg • May repeat the dosage after 15 minutes SPECIAL CONSIDERATIONS • The drug may be used in conjunction with atropine sulfate • The peak effect of the drug is 10 to 20 minutes • The duration of the drug is variable PRALIDOXIME CHLORIDE (2-PAM) 1 GENERIC NAME proparacaine ophthalmic solution 0.5% TRADE, BRAND, OR PROPRIETARY NAME • Alcaine® CLASS • Topical anesthetic STANDARD SUPPLY • Eye drop bottle MECHANISM OF ACTION • Alleviates pain at the ophthalmic nerve cell membrane INDICATION • Chemical exposure to the eyes requiring irrigation CONTRAINDICATION • Known hypersensitivity to the drug ADVERSE REACTIONS/SIDE EFFECTS • Stinging • Burning • Irritation • Conjunctival redness ROUTE OF ADMINISTRATION • Ocular ONSET OF ACTION • 30 seconds to 2 minutes ADULT DOSAGES • 1 to 2 drops PEDIATRIC DOSAGES • 1 to 2 drops SPECIAL CONSIDERATIONS • The peak effect of the drug is 30 seconds to 2 minutes • The duration of the drug is 5 to 10 minutes PROPARACAINE OPHTHALMIC SOLUTION 0.5% 1 GENERIC NAMES racemic epinephrine TRADE, BRAND, OR PROPRIETARY NAMES • MicroNefrin® • S2® CLASS • Sympathomimetic STANDARD SUPPLY • Premixed solution in a unit dose MECHANISMS OF ACTION • Beta2-adrenergic response • Relaxes bronchial smooth muscle resulting in bronchodilation INDICATIONS • Croup • Bronchospasm associated with asthma, chronic bronchitis, and bronchiolitis CONTRAINDICATION • None in the emergency setting ADVERSE REACTIONS/SIDE EFFECTS • Tachycardia • Hypertension • Dysrhythmias • Palpitations • Nervousness • Anxiety • Dizziness • Tremors • Nausea • Vomiting ROUTE OF ADMINISTRATION • Nebulized for inhalation ONSET OF ACTION • 5 minutes RACEMIC EPINEPHRINE 1 ADULT DOSAGES • Bronchospasm associated with asthma and chronic bronchitis: dilute 5.0 mL (1%) in 5.0 mL normal saline PEDIATRIC DOSAGES • Children 4 years or younger: croup, bronchiolitis, and bronchospasm associated with asthma: 0.25 mL of 2.25% inhalation solution mixed in 3.0 mL normal saline or 0.5 mL/kg of 1.0 mg/1.0 mL epinephrine (1:1,000) mixed in 3.0 mL normal saline • Maximum dose: 2.5 mL • Children 4 years or older: croup, bronchiolitis, and bronchospasm associated with asthma: up to 0.5 mL of 2.25% inhalation solution mixed in 3.0 mL normal saline or 0.5 mL/kg of 1.0 mg/1.0 mL epinephrine (1:1,000) mixed in 3.0 mL normal saline • Maximum dose: 5.0 mL SPECIAL CONSIDERATIONS • The drug can increase adverse reactions and side effects when administered with another sympathomimetic drug • The peak effect of the drug is 5 to 15 minutes • The duration of the drug is 1 to 3 hours RACEMIC EPINEPHRINE 2 GENERIC NAME rocuronium TRADE, BRAND, OR PROPRIETARY NAME • Zemuron® CLASSES • Non-depolarizing neuromuscular blocker • Paralytic STANDARD SUPPLY • Vial MECHANISMS OF ACTION • Binds to nicotinic cholinergic receptor sites at the nerve fiber’s motor end plate • Antagonizes acetylcholine binding at the nerve fiber’s motor end plate resulting in neuromuscular blockade INDICATION • Induction of paralysis to facilitate rapid sequence intubation CONTRAINDICATION • Known hypersensitivity to the drug ADVERSE REACTIONS/SIDE EFFECTS • Hypotension • Hypertension • Nausea • Vomiting ROUTES OF ADMINISTRATION • IV • IO ONSET OF ACTION • 30 to 60 seconds ADULT DOSAGES • 0.6 to 1.2 mg/kg PEDIATRIC DOSAGES • 0.6 to 1.2 mg/kg ROCURONIUM 1 SPECIAL CONSIDERATIONS • The peak effect of the drug is 1 to 3 minutes • The duration of the drug is 30 to 60 minutes ROCURONIUM 2 GENERIC NAME sodium bicarbonate 7.5 – 8.4% CLASS • Alkalizing agent STANDARD SUPPLY • Prefilled syringe MECHANISMS OF ACTION • Buffers metabolic acidosis • Increases the pH of blood and urine INDICATIONS • Pre-existing or known metabolic acidosis • Acidosis refractory to effective ventilation • Salicylate overdose • Tricyclic antidepressant overdose • Hyperkalemia • Prolonged cardiac arrest • Crush syndrome CONTRAINDICATION • None in the emergency setting ADVERSE REACTIONS/SIDE EFFECTS • Extravasation may cause tissue necrosis ROUTES OF ADMINISTRATION • IV • IO ONSET OF ACTION • Immediate ADULT DOSAGES • 1.0 mEq/kg • May repeat the dosage 0.5 mEq/kg every 10 minutes PEDIATRIC DOSAGES • 1.0 mEq/kg • May repeat dosage 0.5 mEq/kg every 10 minutes SODIUM BICARBONATE 7.5 – 8.4% 1 SPECIAL CONSIDERATIONS • The drug must be used in conjunction with effective ventilation • The peak effect of the drug is less than 15 minutes • The duration of the drug is 1 to 2 hours SODIUM BICARBONATE 7.5 – 8.4% 2 GENERIC NAME succinylcholine TRADE, BRAND, OR PROPRIETARY NAME • Anectine® CLASSES • Depolarizing neuromuscular blocking agent • Paralytic STANDARD SUPPLY • Vial MECHANISM OF ACTION • Inhibits neuromuscular transmission resulting in temporary paralysis INDICATION • Induction of paralysis to facilitate rapid sequence intubation CONTRAINDICATION • Known hypersensitivity to the drug ADVERSE REACTIONS/SIDE EFFECTS • Respiratory depression • Respiratory arrest • Dysrhythmias ROUTES OF ADMINISTRATION • IV • IO ONSET OF ACTION • 30 seconds to 1 minute ADULT DOSAGES • 0.6 to 2.0 mg/kg • May repeat the dosage once in 2 to 3 minutes PEDIATRIC DOSAGES • 1.0 to 2.0 mg/kg • May repeat the dosage once in 2 to 3 minutes SUCCINYLCHOLINE 1 SPECIAL CONSIDERATIONS • The peak effect of the drug is 1 to 3 minutes • The duration of the drug is 7 to 10 minutes SUCCINYLCHOLINE 2 GENERIC NAME tetracaine TRADE, BRAND, OR PROPRIETARY NAME • Altacaine® CLASS • Topical anesthetic STANDARD SUPPLY • Eye drop bottle MECHANISM OF ACTION • Alleviates corneal pain INDICATION • Chemical exposure to the eyes requiring irrigation CONTRAINDICATIONS • Known hypersensitivity to the drug • Not recommended for use with pediatric patients ADVERSE REACTIONS/SIDE EFFECTS • Stinging • Burning • Irritation • Conjunctival redness ROUTE OF ADMINISTRATION • Ocular ONSET OF ACTION • Immediate ADULT DOSAGES • 1 to 2 drops SPECIAL CONSIDERATIONS • The peak effect of the drug is 15 to 30 seconds • The duration of the drug is 10 to 20 minutes TETRACAINE 1 GENERIC NAME thiamine (vitamin B1) TRADE, BRAND, OR PROPRIETARY NAME • Betalin® CLASS • Vitamin STANDARD SUPPLY • Vial MECHANISM OF ACTION • Metabolizes carbohydrates INDICATIONS • Delirium tremens • Wernicke encephalopathy • Korsakoff syndrome • Unconsciousness of unknown etiology • Alcoholism • Malnutrition CONTRAINDICATION • None in emergency setting ADVERSE REACTIONS/SIDE EFFECTS • Nausea • Vomiting ROUTES OF ADMINISTRATION • IV • IO • IM ONSETS OF ACTION • IV/IO: 1 to 2 hours • IM: variable ADULT DOSAGE • 100 mg THIAMINE 1 PEDIATRIC DOSAGES • 10 to 25 mg SPECIAL CONSIDERATIONS • The drug may be administered prior to dextrose 50% • The drug should be administered before dextrose 50% or glucagon to a patient with malnutrition or alcohol abuse • The peak effect of the drug is 3 to 5 days • The duration of the drug is variable THIAMINE 2 GENERIC NAME vasopressin TRADE, BRAND, OR PROPRIETARY NAME • Pitressin® CLASS • Vasopressor STANDARD SUPPLY • Vial MECHANISM OF ACTION • Produces vasoconstriction INDICATIONS • Cardiac arrest: o ventricular fibrillation o pulseless ventricular tachycardia o asystole o pulseless electrical activity CONTRAINDICATION • Not recommended for use with pediatric patients ADVERSE REACTIONS/SIDE EFFECTS • Nausea • Vomiting ROUTES OF ADMINISTRATION • IV • IO • ET ONSET OF ACTION • 1 to 3 minutes ADULT DOSAGES • Cardiac arrest IV/IO: 40 U administered once • Cardiac arrest ET: 40 U diluted in 10 mL normal saline VASOPRESSIN 1 SPECIAL CONSIDERATIONS • The peak effect of the drug is 15 minutes • The duration of the drug is 30 to 60 minutes VASOPRESSIN 2 GENERIC NAME verapamil TRADE, BRAND, OR PROPRIETARY NAMES • Isoptin® • Calan® CLASSES • Calcium channel blocker • Antidysrhythmic STANDARD SUPPLY • Vial MECHANISMS OF ACTION • Slows extracellular calcium ion influx across myocardial cell membranes • Slows conduction through the sinoatrial node and the atrioventricular node • Slows the ventricular conduction rate in atrial fibrillation and atrial flutter INDICATIONS • Atrial fibrillation with rapid ventricular rate • Atrial flutter with rapid ventricular rate • Supraventricular tachycardia CONTRAINDICATIONS • Known hypersensitivity to the drug • Hypotension • Myocardial infarction • Cardiogenic shock • Ventricular tachycardia • Second-degree and third-degree heart block • Wolff-Parkinson-White (WPW) syndrome • Not recommended for use with pediatric patients VERAPAMIL 1 ADVERSE REACTIONS/SIDE EFFECTS • Hypotension • Dysrhythmias • Bradycardia • Dizziness • Weakness • Headache • Nausea • Vomiting ROUTES OF ADMINISTRATION • IV • IO ONSET OF ACTION • 2 to 5 minutes ADULT DOSAGES • 2.5 mg over 2 minutes • May repeat the dosage 5.0 to 10 mg in 15 to 30 minutes • Maximum dosage 30 mg SPECIAL CONSIDERATIONS • Administer the drug over 3 minutes to elderly patients • The peak effect of the drug is 1 to 5 minutes • The duration of the drug is 1 to 6 hours VERAPAMIL 2 Paramedic Drug Profile Format GENERIC NAME • The generic name is an abbreviated version of the drug’s chemical name usually created by the pharmaceutical manufacturer. • The first letter of the generic name is not capitalized. • Examples: o nitroglycerin o diphenhydramine o albuterol • The drug receives its official name from the Federal Drug Administration (FDA) when it approves the drug for entry into the United States Pharmacopeia (USP). TRADE, BRAND, OR PROPRIETARY NAME • The trade, brand, or proprietary name is protected by a patent from the drug’s pharmaceutical company. • The first letter of the trade, brand, or proprietary name is capitalized and followed by the trademark symbol. • Examples: o Nitro-Bid® o Benadryl® o Proventil® • There may be multiple trade, brand, or proprietary names for the drug. CLASS • The class of the drug describes o characteristics and traits of the drug o desired therapeutic effects of the drug o the drug’s physiologic effects on the body o indications for administering the drug • The drug may be identified in multiple classes. STANDARD SUPPLY • The standard supply describes the form of the drug packaged for the provider. • The drug may be packaged in multiple forms. PARAMEDIC DRUG PROFILE FORMAT 1 MECHANISM OF ACTION • The mechanism of action describes how the drug produces its desired therapeutic effects. • There may be multiple mechanisms of action of the drug. INDICATION • An indication is a medical condition for which the drug has proven to produce desired therapeutic effects. • There may be multiple indications to administer the drug. CONTRAINDICATION • A contraindication is a situation when the drug is not administered to a patient. • There may be multiple contraindications to administer the drug. ADVERSE REACTIONS/SIDE EFFECTS • An adverse reaction or side effect is an undesirable response to administration of the drug. • There may be multiple adverse reactions/side effects to administration of the drug. ROUTE OF ADMINISTRATION • The route describes how the drug is administered. • There may be multiple routes to administer the drug. ONSET OF ACTION • The onset of action is the amount of time it takes the drug to produce its desired therapeutic effects. ADULT DOSAGE • The adult dosage is the amount of the drug administered to an adult according to protocols or medical control preference. • There may be multiple adult dosages for the drug. PEDIATRIC DOSAGE • The pediatric dosage is the amount of the drug administered to an infant, child, or adolescent according to protocols or medical control preference. • There may be multiple pediatric dosages for the drug. PARAMEDIC DRUG PROFILE FORMAT 2 SPECIAL CONSIDERATION • A special consideration is additional information to consider when administering the drug. • There may be multiple special considerations to consider when administering the drug. PARAMEDIC DRUG PROFILE FORMAT 3 MCCCD Paramedic Drug Profiles Disclosure Statement MCCCD Paramedic Drug Profiles v6.0 serves as a resource monograph for students in Maricopa County Community College District Paramedicine education programs. It is a formulary compiled from recent EMS national recommendations and references. As such, the profiles do not reflect local standing orders or protocols from any specific department, agency, or provider service. References: AAOS and Nancy Caroline, Emergency Care in the Streets, 8th Edition Volumes I & 2 (Jones and Bartlett Learning, 2018) American Heart Association 2020 Guidelines for Emergency Cardiac Care AzDHS/BEMTS Paramedic Drug Profiles (2023) Bryan Bledsoe and Dwayne Clayden, Prehospital Emergency Pharmacology, 8th Edition (Pearson, 2018) National Emergency Medical Services Education Standards (NHTSA, 2021) National Model EMS Clinical Guidelines v3.0 (NASEMSO, 2022) National Registry Paramedic Prep, 3rd Edition (Kaplan Publishing, 2022) Sander’s Paramedic Textbook, 5th Edition (AAOS, 2019) Table of Contents MCCCD Paramedic Drug Profiles Disclosure Statement Authorization for the Paramedic to Administer Drugs in the State of Arizona Paramedic Drug Profile Format Paramedic Drug Profiles acetaminophen acetylsalicylic acid / ASA activated charcoal adenosine albuterol sulfate amiodarone atropine sulfate bumetanide calcium chloride calcium gluconate 2.5% topical gel calcium gluconate dexamethasone dextrose 50% diazepam diltiazem diphenhydramine dopamine epinephrine etomidate fentanyl furosemide glucagon hydroxocobalamin ibuprofen ipratropium bromide ketamine lidocaine TABLE OF CONTENTS 1 lorazepam magnesium sulfate methylprednisolone midazolam morphine sulfate naloxone nitroglycerin nitrous oxide 50% norepinephrine ondansetron oral glucose oxygen oxytocin phenylephrine nasal spray 0.5% pralidoxime chloride (2-Pam) proparacaine ophthalmic solution 0.5% racemic epinephrine rocuronium sodium bicarbonate 7.5 – 8.4% tetracaine thiamine vasopressin verapamil IV Solutions Profiles Disclosure Statement IV Solutions Profile Format IV Solutions Profiles 0.9% sodium chloride solution (normal saline solution/NS) lactated Ringer’s solution (LR) dextrose 5% in water (D5W) TABLE OF CONTENTS 2 0.9% sodium chloride solution normal saline solution (NS) Description • • • water sodium chloride pH = 5.6 Class • Isotonic crystalloid solution Mechanisms of Action • • Parenteral maintenance and replacement of extracellular fluid loss Parenteral maintenance and replacement of extracellular electrolyte loss Indications • • • Parenteral replacement of fluids and sodium chloride loss, including hypovolemia IV and IO access for drug administration Dilution of drugs for infusion Relative Contraindications • • • Circulatory overload in the patient with CHF Trauma in pregnancy Burn injury Adverse Reaction • Rare in therapeutic dosages Routes of Administration • • • Intravenous (IV) bolus following drug administration IV infusion Intraosseous (IO) infusion Standard Supply • Poly-type bags of various sizes (50, 100, 250, 500, and 1000 mL) lactated Ringer’s solution LR, Ringer's lactate solution, Ringer's saline solution, Ringer's solution, RL, Hartman's solution, Sodium lactate solution Description • • • • • • water sodium chloride sodium lactate potassium chloride calcium chloride pH = 6.6 Class • Isotonic crystalloid solution Mechanisms of Action • • Parenteral maintenance and replacement of extracellular fluid loss Parenteral maintenance and replacement of extracellular electrolyte loss Indications • • • • Parenteral replacement of fluids and electrolyte loss, including hypovolemia IV and IO access for drug administration Trauma in pregnancy Burn injury Relative Contraindication • Circulatory overload in the patient with CHF Adverse Reaction • Rare in therapeutic dosages Routes of Administration • • • Intravenous (IV) bolus following drug administration IV infusion Intraosseous (IO) infusion Standard Supply • Poly-type bags of various sizes (50, 100, 250, 500, and 1000 mL) 5% dextrose in water D 5W Description • water • dextrose • pH = 4.3 Class • Dextrose-containing hypotonic solution Mechanism of Action • Parenteral maintenance and replacement of carbohydrate Indications • • • Parenteral maintenance of water and carbohydrate required by the clinical condition of the patient IV and IO access for drug administration Dilution of concentrated drugs for infusion Contraindication • Fluid replacement in hypovolemia Adverse Reactions • • Circulatory overload Leakage of D5W and blood from a vein (infiltration or extravasation) can cause damage and death (necrosis) to surrounding tissue Routes of Administration • • • Intravenous (IV) bolus following drug administration IV infusion Intraosseous (IO) infusion Standard Supply • Poly-type bags of various sizes (50, 100, 250, 500, and 1000 mL) MCCCD IV Solution Profiles Disclosure Statement MCCCD IV Solutions Profiles serves as a resource monograph for students in Maricopa County Community College District (MCCCD) Paramedicine Education Programs. It is a formulary compiled from recent national recommendations and references. As such, the profiles do not reflect local standing orders or protocols from any specific EMS department, agency, or provider service. References: AAOS and Nancy Caroline, Emergency Care in the Streets, 8th Edition Volumes I & 2 (Jones and Bartlett Learning, 2018) Bryan Bledsoe and Dwayne Clayden, Prehospital Emergency Pharmacology, 8th Edition (Pearson, 2018) National Emergency Medical Services Education Standards (NHTSA, 2021) National Model EMS Clinical Guidelines v3.0 (NASEMSO, 2022) Sander’s Paramedic Textbook, 5th Edition (AAOS, 2019) MCCCD IV Solutions Profile Format DESCRIPTION • The electrolyte concentration of the IV solution. • pH of the IV solution. CLASS • The class of the IV solution is determined by its tonicity. MECHANISM OF ACTION • The mechanism of action describes how the IV solution produces desired therapeutic effects. • The IV solution can have multiple mechanisms of action. INDICATION • An indication is a medical condition for which the IV solution should be administered. • The IV solution can have multiple indications. RELATIVE CONTRAINDICATION • A relative contraindication is a medical condition for which the IV solution may not be as effective as an alternative IV solution. • The IV solution can have multiple relative contraindications. ADVERSE REACTION • An adverse reaction is an undesirable response to administration of the IV solution. • The IV solution can have multiple adverse reactions. ROUTE OF ADMINISTRATION • The route describes how the IV solution is administered. • The IV solution can have multiple routes of administration. STANDARD SUPPLY • The standard supply describes various sizes of IV bags in which the solution is ready-for-use. EMT IV SOLUTION PROFILES FORMAT 1