Emergency Drugs Worksheet
FIRST LINE DRUGS
DRUG
Epinephrine
(alpha and beta
adrenergic agonist)
INDICATIONS
ACTION
severe allergic reactions;
upper airway obstruction;
severe hypotension
associated w/ septic
shock
bronchodilation,
vasoconstriction;
inhibits
hypersensitivity
reactions
sinus bradycardia and if
symptomatic, but if
asymptomatic, no tx
required
first line treatment for
symptomatic bradycardia
increases HR,
decreases
GI/respiratory
secretions; reverses
muscarinic effects
A-V Dissociation
Adenosine
(Adenocard)
(antiarrhythmic, class
IA)
PSVT-paroxysmal
supraventricular
tachycardia
slows conduction
through the AV node,
restores nl sinus
rhythm by interrupting
reentrant pathway into
AV node
Initial dose: 6 mg over 1-3 seconds. Follow
with 20 ml 9% NACL.
Subsequent doses (after 1-2 minutes): 12
mg over 1-3 seconds. May repeat once.
SE: HA, Dizziness,
Transient Facial
Flushing, Dyspnea
Amiodarone
(Cordarone)
(antiarrhythmic class
11A/11B)
life threatening ventricular
arrhythmias
slows sinus rate,
causes vasodilation,
increases PR/QT
intervals; inhibits
adrenergic stimulation
Cardiac arrest: 300 mg IVP. May repeat
150 mg IVP in 3-5 minutes. (Max: 2.2 g IV/
24 hrs)
Wide-complex tachycardia (stable): Rapid
infusion: 150 mg IV over first 10 minutes
(15 mg/min). May repeat rapid infusion
(150 mg IV) every 10 minutes as needed.
Slow infusion: 360 mg IV over 6 hours (1
mg/min). Maintenance infusion: 540 mg IV
over 18 hours (0.5 mg/min) Max: same as
above.
SE: Palpitations, HTN
Atropine
(Anticholinergic)
SE: HA, Dizziness,
↑↓ BP, V Tach, V Fib,
SE: Muscle weakness,
fatigue, dizziness,
hypotension, corneal
microdeposits
Cannot use in patients
with iodine allergy
first line treatment of
supraventricular
tachycardia
short term therapy is ideal
DOSAGE (IV)
1 mg IV/IO every 3-5 minutes
HIGH ALERT MED
0.5-1 mg repeated every 3-5 minutes to
maximum dosage of 0.04 mg/kg
BEERS
cardiac arrest
ACLS, PALS, VF, VT
BEERS, HIGH ALERT
Vasopressin
(Pitressin)
SE: ↑BP, bradycardia,
heart block, N & V,
Tremor
antidiuretic
replace the second or first
second dose of
epinephrine; many of the
same indications for epi
use; will find in a crash
cart
can cause heart
block, tremors,
increased blood
pressure; alters
permeability of renal
collecting ducts,
allowing greater
reabsorption of water
40 U IV/IO to replace the first or second
dose of epinephrine, over 30-60 min
SECOND-LINE DRUGS
DRUG
Lidocaine (Xylocaine)
(antiarrhythmic class
IIB)
SE: Confusion,
Difficulty
breathing/swallowing
Procainamide
(Pronestyl)
(antiarrhythmic class
IIA)
SE: Agranulocytosis
with repeated use.
V Fib, Hypotension
Magnesium
sulfate
(electrolyte)
SE: 3° heart block,
respiratory
paralysis,
respiratory
paralysis
Diltiazem
(Cardizem) (calcium
channel blocker)
INDICATIONS
ventricular
arrhythmias
MI
antiarrhythmic
second line drug
premature
atrial/ventricular
contractions
ventricular tachycardia,
paroxysmal atrial
tachycardia
second line drug
will find in a crash cart
antiarrhythmic use
irregular heartbeat that
could lead to HF or stroke
replacement of Mg+2
Atrial flutter/fibrillation
Supraventricular
tachycardia
SE: HA, ↓BP,
Constipation
Dopamine (Intropin)
SE: Hypertension,
Tachycardia,
Severe tissue
damage with
extravasation/IV
infiltration
ACTION
Decreases automaticity of
ventricles; reduces amount of
sodium that can enter cells;
decreases sodium slow impulse
conduction; causes small
sodium blockade in
myocardium.
second line drug to treat
symptomatic bradycardia
Suppression of arrhythmias
Decreases myocardial
excitability
Slows conduction velocity
May depress myocardial
contractility
Plays important role in
neurotransmission and
muscular excitability
(myocardial)
DOSAGE (IV)
1.0-1.5 mg/kg
repeated every 3-5
minutes to a maximum
dosage of 3 mg/kg
Initial dose 1-1.5 mg/kg
Subsequent doses:
0.50.75 mg/kg repeated
every 5-10 minutes to
maximum dosage of
3 mg/kg
20-30 mg/minute
repeated until
dysrhythmia is
suppressed,
hypotension occurs,
QRS complex widens
by 50% or maximum
dosage of 17 mg/kg is
reached.
1-2 g in 100 mL
D5W over 1-2 minutes
HIGH ALERT
Essential electrolyte in the
body; necessary for many
enzymatic reactions
Initial dose: 0.25 mg//kg
(20 mg in average
adult). Second dose of
0.35 mg/kg may be
given in 15 min. to
achieve HR reduction.
Follow by infusion.
Low: 1-3 mcg/kg/min
Moderate: 310 mcg/kg/min
High: 10-20 mcg/kg/min
BEERS
DRUG
Dobutamine
(Dobutrex)
INDICATIONS
can use in heart
failure
SE: ↑HR, ↑BP,
ACTION
increases ventricular
contraction/excitability of
the heart; helping the
heart to work
HIGH ALERT
Anginal pain
Calcium Chloride
SE: ↓BP,
Bradycardia, Cardiac
arrest with rapid
infusion.
essential for nl heart Acts as an activator in the
function;
adjunct
in transmission of nerve
cardiac arrest
impulses/contraction of
cardiac/skeletal/smooth
Used in emergency muscles
treatment hyperkalemia Essential for
nervous/muscular systems
and hypermagnesemia
Maintains cells membrane
and capillary permeabilities
slow IV push
will be drawing labs
for this patient to
measure the values
Isoproterenol
(Isuprel) (BetaAdrenergic Agonist)
DOSAGE (IV)
0.5-2 mcg/kg/min by
continuous IV infusion
250 mg IV push
initially (2.5-5 ml of a
10% solution) over 3-5
min; may be repeated
q 10 min. if needed
May be given by
intracardiac injection if
necessary (rarely, if
ever, seen)
Caution: Don’t administer
in the same IV line with
alkaline solutions (such
as sodium bicarbonate).
HIGH ALERT
heart block, HF, cardiac
arrest
bradycardia
asthma
produces bronchodilation
inhibits hypersensitivity
reactions
SE: Ventricular
arrhythmias,
severe tissue
damage with
extravasation.
Start IV drip of 2 mg in
500 ml D5W at 2-10
mcg/min (30 ml/hr or 30
microdrops/min) Titrate
to produce heart rate of
60 or systolic blood
pressure of > 90.
Caution: Don’t give IV
push and don’t mix with
other drugs.
HIGH ALERT
Phenylephrine
HCL
(Neosynephrine)
vasopressor,
adrenergic, alpha
adrenergic agonist
SE: Tachycardia,
Bradycardia with OD,
severe hypotension
vasoconstriction by way of
stimulation of alpha
adrenergic receptors
IV initial dose:
10 mg in 250-500 ml
D5W or 0.9%
NaCl@ 0.1-0.18
mg/min.
Maintenance
dose: 0.04-0.06
mg/min
HIGH ALERT
↑BP, severe
tissue damage
with
extravasation
have to be careful
because of
extravasation;
medicine is
damaging tissues
(drug has leaked
into the tissue)
Propranolol
(Inderal) (Beta
adrenergic blocker)
lower bp
decreases bp/hr
antiarrhythmic
SE: confusion,
fatigue, drowsiness,
bradycardia
P.O.: 10-60 mg. BIDQID
IV 0.5-3 mg in 0.5-1 mg
increments. May repeat
in 2 min. (Lifethreatening
dysrhythmias only)
HIGH ALERT
SECOND/THIRD LINE DRUGS
DRUG
Digoxin (Lanoxin)
SE: N & V, AV
Block, visual
disturbances
INDICATIONS
HF
atrial fibrillation/flutter
ACTION
increases force of
myocardial contraction
DOSAGE (IV)
PO/IV
Loading dose: 0.5-1.0 mg
Maintenance
dose: 0.1250.25 mg qd
carefully
monitor for
Dig toxicity;
will not give
Digoxin until
we know
what their Dig
level; draw
lab va
HIGH ALERT
BEERS
inotropic
antiarrhythmic
Furosemide (Lasix)
SE: ↓BP, circulatory
collapse, hypo K
edema, HF,
emergency use for
hypertensive crisis
inhibits reabsorption of
sodium and chloride from
loop of Henle/distal tubule
increases excretion of
sodium, magnesium,
Usual IV dose:
20-40 mg (10mg/min)
loop diuretic,
potassium wasting
diuretic
Nitroglycerin (Tridil)
chloride, potassium, water,
and calcium
HF, chest pain
increases blood flow to
the heart; vasodilator;
increases collateral
blood flow to ischemic
regions of the heart
hypertensive crisis
produces peripheral
vasodilation (by direction
actions on arterial/venous
smooth muscle)
antianginal/nitrates
SE: HA, Postural
hypotension,
anaphylactoid reaction
Sodium
Nitroprusside
(Nipride)
cardiac pump failure or
cardiogenic shock
antihypertensive
SE: Thiocyanate
toxicity (profound
hypotension, tinnitus,
blurred vision)
Norepinephrine
(Levophed)
IV initial dose: 5-10
mcg/min, increase by 510 mcg/min q 5- 10 min
until angina subsides
(use special tubing and
glass bottle)
Sublingual 5 mg; usually
3 tries
IV slow drip or push
Initial: 0.3 mcg/kg/min,
increase slowly q 2-3
min until BP controlled.
Maintain at less than 3
mcg/kg/min.
*(Light Sensitive)
HIGH ALERT
severe hypotension
cardiogenic shock
produces vasoconstriction
and myocardial
stimulation
vasopressor
Initial: 2 mcg/min
Range: 2-12 mcg/min
HIGH ALERT
SE: Hepatic or renal
necrosis, fatal
arrhythmias, cerebral
hemorrhage, severe
tissue damage with
extravasation (treated
with phentolamine
(Regitine)
caustic med
Oxygen
Milrinone (Primacor)
inotropic
SE: Ventricular
ectopics, possible ↓BP
cardiac or respiratory
arrest
respiratory distress or
hypotension
systolic HF,
cardiogenic shock
increases amount of
oxygen available to be
delivered to your lungs,
and then tissues
100% in arrest.
(absolutely no
contraindications in
cardiac arrest)
increases myocardial
contractility
Loading dose:
0.05 mg/kg IV over
10 min. Maintenance
dose:
0.375-0.75 mcg/kg/min
HIGH ALERT