PREHOSPITAL PHARMACOLOGY CHEAT SHEET
Amy Gutman MD ~ February 2014
This information is provided as a summary of basic information needed to treat patients and study for
Board Reviews. Dosages reflect national standards and may be slightly different that OEMS
2% LIDOCAINE GEL
Class:
Acetamide local anesthetic
Actions:
Stabilizes nerve membrane by inhibiting initiation /conduction of pain impulses
Indications:
Procedural anesthetic lubricant, gastritis (GI cocktail)
C/I:
Allergy, familial malignant hyperthermia
Side Effects:
Anxiety, seizures, AMS, blurred vision, respiratory depression, bradycardia, hypotension
Critical Info:
Few systemic effects
Dose:
Apply small amount of gel to external ETT surface for lubrication
ACTIVATED CHARCOAL
Class:
Adsorbent
Actions:
Adsorbs toxic substances from GI tract
Indications:
Oral poisonings / medication overdoses
C/I:
Depressed gag reflex, after ingestion of corrosives, caustics or petroleum distillates
Side Effects:
N/V, black stool (not GI bleeding); bonds /inactivates most medications in GI tract
Critical Info:
Does not adsorb cyanide, lithium, iron, lead or arsenic
Dose:
Adult/ Pediatric: 1-2 gm/kg mixed with 6-8 oz water PO/NGT
ADENOSINE / ADENOCARD
Class:
Class V antiarrhythmic, naturally occurring nucleoside
Actions:
Slows AV node conduction, interrupts AV reentry pathways (SVT)
Indications:
PSVT refractory to vagal maneuvers
C/I:
2nd/3rd degree HB, sick sinus syndrome; theophylline decreases effectiveness
Side Effects:
Facial flushing, headache, SOB, dizziness, nausea
Critical Info:
Transient arrhythmias / asystole at time of cardioversion; caution in COPD, ½ life 5 secs
Dose:
Adult: 6mg rapid IVP; may repeat at 12mg x 2
ALBUTEROL / PROAIR
Class:
Sympathetic Agonist
Actions:
Sympathomimetic selective for beta-2 adrenergic receptors causing bronchodilation
Indications:
Asthma, bronchospasm associated with COPD
C/I:
Cautious in the elderly, known cardiovascular disease, HTN
Side Effects:
Anxiety, dizziness, HA, tremor, HTN, arrhythmias, CP, N/V
Critical Info:
Worsens tachycardia; beta blockers may blunt the effects of Albuterol.
Dose:
2.5 mg in 3mL NS via nebulizer, repeat as needed.
AMIODARONE
Class:
Class III antiarrhythmic (non-competitive sodium channel blocker)
Actions:
Lengthens cardiac action potential. Negative chronotropic effect on nodal tissue. Blocks
potassium channels prolonging conduction refractoriness. Vasodilatation decreases
myocardial oxygen consumption
Indications:
Ventricular arrhythmias unresponsive to other antiarrythmics
C/I:
Breast-feeding, bradycardia, 2nd/3rd degree HB.
Side Effects:
Hypotension, bradycardia, arrythmogenic via prolongation of PR/QRS /QT intervals
Critical Info:
Caution in CHF, causes pulmonary toxicity, warfarin toxicity
Dose:
Unstable: 300mg IV/IO; 150mg in conscious / stable
Prehospital Pharmacology Cheat Sheet
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ASPIRIN
Class:
Actions:
Indications:
C/I:
Side Effects:
Critical Info:
Dose:
ATROPINE
Class:
Actions:
Indications:
C/I:
Side Effects:
Critical Info:
Dose:
Platelet aggregator inhibitor, NSAID
Anti-inflammatory, inhibitor of platelet function. Blocks formation of thromboxane A2,
causing platelet aggregation and arterial constriction
Chest pain
Relatively contraindicated if active ulcer disease, NSAID allergies or asthma
Heartburn, GI bleeding, nausea, vomiting, wheezing, and prolonged bleeding.
Can be given PR if patient vomiting
324-325mg (4 81mg chewable tablets)
Anticholinergic, parasympatholytic
Respiratory
emergencies
(bronchodilator,
dries
respiratory
secretions).
Organophosphate poisoning antidote. Bradycardia: reduces vagal tone, increases SA
node automaticity, increases AV conduction. Positive chronotrope, little inotropic effect.
Bradycardia, asystole, COPD, bronchospasm, organophosphate overdose
No significant prehospital contraindications
Blurred vision/ mydriasis, dry mouth, tachycardia, drowsiness, confusion, arrhythmia,
anxiety, dizziness, HA, rash, N/V
May worsen bradycardia if 2nd/3rd degree AV blocks (consider pacing); no response in
post-cardiac transplant patients (no vagus nerve)
Bradycardia 0.5-1mg IV/IO, may repeat in 5 min up to 1mg.
Asystole: 1mg IV/IO, may repeat every 3 mins to max 0.04 mg/kg
Organophosphate Toxicity: 2-5mg IV/IM/IO every 10-15 mins
Pediatrics: 0.05 mg/kg IV/IM/IO every 10- 15 minutes to max 3mg
CALCIUM CHLORIDE 10%
Class:
Calcium supplement
Actions:
Increases myocardial contractile force and ventricular automaticity
Indications:
Magnesium / calcium channel blocker OD; treatment for hyperkalemia, hypocalcemia
C/I:
May precipitate digitalis toxicity
Side Effects:
Bradycardia, arrhythmias, syncope, N/V, cardiac arrest
Dose:
Adult: 4mg/kg IVP, 25-50mg IM
Pediatrics: 0.5mg/kg IM; 1mg/kg PR
CETACAINE / BENZOCAINE / TETRACAINE
Class:
Cholinesterase (ester) anesthetic
Actions:
Local anesthetic, blocks initiation & conduction of pain impulses. Reversible nerve
conduction blockade by decreasing sodium nerve membrane permeability. Decreases
rate of membrane depolarization, increasing electrical excitability threshold.
Indications:
Anesthesia of all mucous membranes except eyes; limits gagging for NTI
C/Is:
Application to large open wounds, cholinesterase deficiencies, methemoglobinemia
Side Effects:
Contact dermatitis, erythema, pruritus, vesiculation, urticaria, edema, anaphylaxis
Dizziness, lethargy, sweating; arrhythmia, tremor, N/V, dyspnea, anxiety, eye irritation
Critical Info:
Only use the formulation specifically for eyes (tetracaine) in eyes; may enhance effects
of CNS depressants, hypotension if used with vasodilators
Dose:
14%, 2% Gel/Liquid/Spray, apply for 1-2 secs; 1-2 drops in eye; may repeat in 5 mins
Prehospital Pharmacology Cheat Sheet
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CYANOKIT / HYDROXYCOBALAMIN
Class:
Vitamin B
Actions:
Cyanide causes rapid death via cytochrome oxidase inhibition (stops cellular
respiration). Cyanide binds with mitochromial cytochrome a3, prevents cell from using
oxygen, forcing anaerobic metabolism, lactate production, cellular hypoxia and
metabolic acidosis. Hydroxycobalamin binds cyanide ions forming cyanocobalamin,
which is excreted in urine rapidly increasing BP/HR, due to improving cellular respiration
Indications:
Suspected hydrogen cyanide exposure / toxicity
C/Is:
None
Side Effects:
Transient photosensitivity, red skin & urine coloration
Critical Info:
Cyanide poisoning must be recognized and treated quickly. Antidote must be used in
conjunction with aggressive airway and cardiopulmonary resuscitation
Dose:
5g IV over 15 minutes; 2nd dose of 5g over 15mins-2 hrs if clinically indicated
DEXTROSE
Class:
Actions:
Indications:
C/I:
Side Effects:
Critical Info:
Dose:
Carbohydrate, hypertonic solution
Rapidly increases serum glucose levels with short-term osmotic diuresis
Hypoglycemia, AMS, coma of unknown etiology, seizure of unknown etiology
ICH, head injury. Interacts with sodium bicarbonate, warfarin
Warmth, pain, burning, thrombophlebitis, tissue necrosis, rhabdomyolysis
Thiamine prior to D50 in alcoholics. Do not give if suspected CVA with normal glucose
Adult: 50% 25g D5W (50mL) IV
Pediatric: 25% 0.5-1 gm/kg/dose slow IV; may be repeated as necessary
DIAZEPAM / VALIUM
Class:
Benzodiazepine, GABA inhibitory neurotransmitter
Actions:
Hypnotic, sedative, anxiolytic, amnesic, anticonvulsant, muscle relaxant. GABA inhibitor
(major CNS inhibitory neurotransmitter)
Indications:
Anxiety / agitation, alcohol withdrawal, muscle relaxant, seizures, procedural analgesia
C/I:
Glaucoma, coma, shock, substance abuse, head injury. Pregnancy category D
Side Effects:
Respiratory depression, hypotension, somnolence, ataxia, reflex tachycardia, phlebitis
Critical Info:
Multiple drug incompatibilities. Flumazenil (benzo antagonist) causes acute withdrawal
if chronic benzodiazepine usage, resulting in intractable seizures. Pregnancy category C
Dose:
Adult: 5-10mg IV/IM to max 30mg
Sedation for cardioversion: 5- 15 mg IV over 5 mins
Pediatric: 0.2-0.3 mg/kg (0.5-2mg) slow IV; PR 0.5mg/kg every 15-30 mins to max 10mg
DILTIAZEM / CARDIAZEM
Class:
Class IV antiarrythmics, calcium channel blocker
Actions:
Slows AV nodal conduction time, prolongs AV refractoriness. Blocks influx of calcium
ions into cardiac muscle, prevents spasm of coronary arteries, arterial and venous
vasodilator to reduce preload, afterload and myocardial oxygen demand.
Indications:
Control of rapid ventricular rates due to AF / Aflutter, SVT, angina
C/I:
Hypotension, sick sinus syndrome, 2nd/3rd degree HB, cardiogenic shock, wide-complex
tachycardias, pregnancy category C
Side Effects:
Bradycardia, 2nd/3rd degree AV blocks, CP, CHF, syncope, VF/VT, N/V, dizziness, SOB, HA
Critical Info:
Caution in patients using medications that affect cardiac contractility (i.e. beta blockers)
Dose:
0.25mg/kg (1st dose), 0.35mg/kg (2nd dose); infusion 5-15 mg / hr
Prehospital Pharmacology Cheat Sheet
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DIPHENHYDRAMINE / BENADRYL
Class:
Antihistamine, anticholinergic, sedative
Actions:
Blocks histamine1 receptor stimulation (bronchoconstriction, visceral contractions) and
histamine2 receptor stimulation (peripheral vasodilation, gastric acid secretion)
Indications:
Anaphylaxis, allergic reactions, dystonic reactions accompanying phenothiazines
C/I:
Asthma, breastfeeding
Side Effects:
Sedation, dries bronchial secretions, blurred vision, HA, palpitations, tachycardia
Critical Info:
Effects potentiated with other CNS depressants
Dose:
Adult: 25-50mg IV/IM/PO
Pediatric: 1-2 mg/kg IV/IO/IM. PO: 5 mg/kg/24hrs
DOPAMINE / INTROPIN
Class:
Sympathetic agonist, naturally occurring catecholamine
Actions:
Dose-dependent effect on alpha-adrenergic receptors (peripheral vasoconstriction).
Inotropic effect on myocardium (increased cardiac output, peripheral vasoconstriction
and pulmonary occlusive pressure).Positive inotropic effect on beta-1 receptors.
Dopaminergic effect maintains renal and mesenteric blood flow via increasing systolic
and pulse pressures (less effect on diastolic pressure)
Indications:
Significant hypotension not resulting from hypovolemia, cardiogenic shock
C/Is:
Pheochromocytoma. Not used as sole agent in management of hypovolemic shock
Side Effects:
Deactivated by alkaline solutions. Anxiety, HA, arrhythmias, CP, SOB, N/V
Critical Info:
Induce or worsen SVT and ventricular arrhythmias. Hypotension when used
concomitantly with phenytoin (dilantin)
Dose:
400mg in 250cc (1600mcg/cc concentration; 2-20mcg/kg/min titrated to effect
EPINEPHRINE
Class:
Sympathetic agonist, naturally occurring catecholamine
Actions:
Direct effects on alpha and beta-adrenergic receptors increases HR, cardiac contractile
force, myocardial electrical activity, systemic vascular resistance, BP, and automaticity.
Bronchodilator. Effects within 90 secs of administration, effect for 3-5 mins
Indications:
Asystole, PEA, cardiac arrest, bronchospasm (asthma, COPD, anaphylaxis)
C/Is:
Bronchospasm: Underlying cardiovascular disease, HTN
Side Effects:
Arrhythmia, anxiety, tremor, HA dizziness, N/V, cardiac ischemia and increased
myocardial oxygen demand
Critical Info:
Protect from light. Deactivated by alkaline solutions.
Dose:
Adult Arrest: 1mg 1:10,000 IV/IO every 3-5 min
Pediatric Arrest: 0.01mg/kg 1:10,000 IV/IO (~1mg in 10cc); Subsequent 0.1mg/kg IV/IO
Adult Allergic: 0.3-0.5 1:1,000 SQ every 5 min (~3mg); 0.5-1mg 1:10,000 IV
Pediatric Allergic: 0.01mg/kg 1:1,000 SQ every 5 min; 0.01mg/kg 1:10,000 IV
FENTANYL / SUBLIMAZE
Actions:
Narcotic Analgesic
Indications:
Analgesia for trauma, chest pain, procedural premedication
C/Is:
Respiratory depression, hypotension; pregnancy category C
Side Effects:
Respiratory depression/ arrest, apnea, chest rigidity, bradycardia, hypotension,
paradoxical HTN, cardiac arrest, N/V, dizziness, blurred vision, laryngospasm,
Critical Info:
100mcg analgesic equivalent to 10mg morphine or 75mg meperidine
Dose:
Adult: 1 mcg/kg to max 150mcg. slow IV/IM/IN
Prehospital Pharmacology Cheat Sheet
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FUROSEMIDE / LASIX
Class:
Loop diuretic
Actions:
Inhibits NaCl reabsorption in proximal and distal renal tubules and loop of Henle. Direct
vasodilator (onset in 5-10 mins, onset of diuresis in 20-30 mins)
Indications:
CHF, pulmonary edema, HTN emergency
C/I:
Pregnancy, sulfa allergy
Side Effects:
HA, dizziness, hypotension, volume depletion, potassium depletion, arrhythmias, N/V
Critical Info:
Protected from light
Dose:
Adult: 40-120 mg slow IV
Pediatric: 1 mg/kg slow IV
GLUCAGON
Class:
Actions:
Indications:
C/I:
Side Effects:
Critical Info:
Dose:
GLUCOSE
Class:
Actions:
Indications:
C/Is:
Side Effects:
Critical Info:
Dose:
Hormone, antihypoglycemic
Breakdown of stored glycogen to glucose, inhibits synthesis of glycogen from glucose.
Positive cardiac inotrope, decreases renal vascular resistance
Hypoglycemia, beta-blocker and calcium channel overdoses
Caution if history of cardiovascular or renal disease.
Hypotension, dizziness, headache, N/V
Slow return to consciousness following administration (5-20 mins) Treats beta blocker
OD (bypasses beta adrenergic signaling system). High levels from pancreatic tumors
(insulin-resistant hyperglycemia). Only effective if glycogen stores in liver
Adult: 1mg IM/SC, may repeat in 5 mins
Pediatrics:
0.1mg/kg
IM/SC/IV
(<10kg);
1mg/kg
IM/SC/IV
(>10kg)
Beta-blocker OD: 50-150 mg/kg IV/IO
Monosaccharide, carbohydrate
Distributed in tissues / CNS producing rapid increase in circulating blood sugar
AMS with history of diabetes & demonstrated low blood sugar
Not alert, unable to swallow, depressed gag
Hyperglycemia
Do not given to patient with suspected stroke and normal blood sugar
25-50gm IV/IO
IPRATROPIUM / ATROVENT
Class:
Anticholinergic, parasympatholytic
Actions:
Chemically related to atropine. Blocks acetylcholine receptors, inhibiting
parasympathetic stimulation. Causes bronchodilation, dries respiratory secretions.
Indications:
Asthma, reversible bronchospasm associated with COPD
C/I:
Soybean / peanut allergy
Side Effects:
Arrhythmia, anxiety, dizziness, HA, tremor, HTN, CP, N/V
Critical Info:
Caution in elderly, cardiovascular disease, HTN
Dose:
Adult: 500mcg in 2.5-3mL NS via nebulizer; 2 sprays of a MDI
Pediatric: 125-250mcg in 2.5-3ml NS via nebulizer, 1-2 sprays of a MDI
LIDOCAINE
Class:
Actions:
Class Ib antiarrhythmic, amide anesthetic
Decreases ventricular automaticity, depresses ventricular depolarization
automaticity but increases VF threshold by increasing phase IV repolarization
Prehospital Pharmacology Cheat Sheet
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Indications:
C/I:
Side Effects:
Critical Info:
Dose:
VF/VT, malignant PVCs
2nd/3rd degree HB
AMS, seizures, hypotension, bradycardia, heart blocks, N/V
High doses can result in seizures, coma, death; effects potentiated with other
antiarrythmics. No longer 1st line ACLS medication as of 2010
VT/VF 1-1.5 mg/kg IV repeated every 3-5min to 3mg/kg, follow with 2- 4 mg/min drip
Peds: 1mg/kg IV, repeat every 3-5 min to 3mg/kg, follow with 20-50 mcg/kg/min drip
MAGNESIUM SULFATE
Class:
Antiarrhythmic, mineral, electrolyte
Actions:
Essential for numerous biochemical reactions (ATD, ADP). Limits seizure by blocking
neuromuscular transmission and decreasing acetylcholine liberated at motor endplates.
CNS depressant without effects on fetus (eclampsia). Peripheral vasodilatator.
Indications:
Refractory VF / VT, torsades, post-MI for arrhythmia; severe bronchospasm, eclampsia
C/I:
Shock, 3rd degree HB, dialysis, hypocalcemia; arrhythmias with digitalis
Side Effects:
Flushing, sweating, bradycardia, decreased DTRs, drowsiness, respiratory depression,
arrhythmia, hypotension, hypothermia, itching, rash.
Critical Info:
As hypermagnesemia can occur, calcium chloride should be available as an antidote
Dose:
VF/VT/Torsades: 1-2g IV over 2 min followed by infusion of 0.5-1g/hr
AMI: 1-2g IV over 5-30 min
Eclampsia: 2- 4g IV/IM
METHYLPREDNISOLONE / MEDROL
Class:
Synthetic corticosteroid, anti-inflammatory
Actions:
Potent anti-inflammatory related to natural adrenal cortex hormones
Indications:
Allergic reactions, asthma, anaphylaxis, COPD
C/I:
None in prehospital setting
Side Effects:
GI bleed, prolonged wound healing, adrenal gland suppression, edema, CHF, HTN,
vertigo, HA, nausea, malaise, hiccups
Critical Info:
Onset of action 20-40 mins, ½ life 3- 4 hours
Dose:
125mg IV/IO/IM
MIDAZOLAM / VERSED
Class:
Benzodiazepine
Actions:
Potent, short-acting CNS depressant, sedative / hypnotic / amnestic
Indications:
Premedication before cardioversion, anti-seizure, muscle relaxant
C/I:
Hypersensitivity, narrow angle glaucoma, shock
Side Effects:
Laryngo/bronchospasm, respiratory depression, AMS, arrhythmia (bradycardia), N/V
Critical Info:
Potential for respiratory depression. 2-4 times more potent than diazepam
Dose:
Adult: 0.5-2.5 mg slow IVP; may repeat to max 0.1mg/kg
Pediatric: To facilitate ETI medical control may order: 0.05-0.1mg/kg IV to max 5 mg
MORPHINE
Class:
Actions:
Indications:
C/I:
Side Effects:
Narcotic analgesic
Acts on CNS opiate receptors causing analgesia and sedation. Decreases preload,
increases peripheral vasodilatation, decreases myocardial oxygen demand
Severe pain
Volume depletion, hypotension, hypersensitivity, head injury, +/- abdominal pain
N/V, abdominal cramps, miosis, AMS, HA, respiratory depression
Prehospital Pharmacology Cheat Sheet
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Critical Info:
Dose:
Can cause severe respiratory depression; Naloxone available as an antagonist.
Adult: 1-3 mg(0.1mg/kg) IV/IM/SC/IO every 5 mins titrated to maximum of 10 mg
Pediatric: 0.1-0.2 mg/kg/dose IV/ IO/IM/SC every 5 mins titrated to max 5 mg
NALOXONE / NARCAN
Class:
Narcotic antagonist
Actions:
Antagonizes opiate effects by competing at same receptor sites
Indications:
Chemically similar to narcotics but with antagonistic properties reversing respiratory
depression from OD. Competitively displaces narcotic molecules from opiate receptors.
C/I:
Known hypersensitivity; abrupt and complete reversal can cause acute withdrawal
Side Effects:
Hypotension, HTN, ventricular arrhythmias, N/V
Critical Info:
Almost Immediate effects. Rarely causes non-dose dependent pulmonary edema
Dose:
Adult: 0.4-2mg IV/IM/IN; may repeat up to max 10mg
Pediatric: 0.01 mg IV/IM/IN; may repeated up to max 10mg
MORPHINE
Class:
Actions:
Indications:
C/I:
Side Effects:
Critical Info:
Dose:
Schedule II opiod analgesic
Suppresses CNS pain, anxiety, respiratory centers. Decreases venous return, preload,
afterload and myocardial oxygen demand.
Analgesia for moderate to severe pain, CHF, pulmonary edema, chest pain
Head injury, apnea, hypotension, AMS, hypovolemia; pregnancy category C.
Respiratory depression, hypotension, AMS, N/V bradycardia, tachycardia, syncope, facial
flushing, euphoria, bronchospasm, dry mouth
Caution in geriatrics, COPD, asthma; vagotonic effect in inferior STEMI (bradycardia,
heart block); naloxone readily available as antidote.
Adult: 0.1mg/kg every 5 mins to max of 10mg IV/IO/IM/SC
Pediatric: 0.1-0.2 mg/kg every 5 mins to max of 5mg IV/IO/IM/SC
NITROGLYCERIN
Class:
Nitrate, direct vasodilator
Actions:
Potent smooth muscle relaxant and direct vasodilator acts primarily on peripheral
venous system, with direct effects on coronary arteries (vasodilatation). Decreases
venous return (decreases cardiac workload and myocardial oxygen demand)
Indications:
CP, angina pectoris, STEMI/NSTEMI, pulmonary edema, HTN emergency
C/I:
Hypotension, increased intracranial pressure
Side Effects:
HA (cerebral vessel vasodilation), dizziness, weakness, tachycardia, hypotension,
orthostasis, rash, dry mouth, N/V
Critical Info:
Profound hypotension if used within 24hrs of erectile dysfunction meds (compounded
vasodilatation). Rapidly deteriorates in sunlight. Tolerance over time.
Dose:
0.4 mg SL/spray; may repeat x 3 every 5 mins. ½ inch topical ointment
ODANSETRON / ZOFRAN
Class:
Selective serotonin-antagonist, antiemetic
Actions:
Blocks serotonin peripherally (vagus nerve terminals), and at CNS chemoreceptor zon
Indications:
Treatment and prevention of nausea and vomiting
C/I:
Allergy, QT prolongation; pregnancy category B
Side Effects:
Headache, drowsiness, pruritus
Critical Info:
May prolong QT interval causing arrhythmia (torsades)
Dose:
Adult: 4mg IV/IM
Pediatric: <30kg 1 mg. IV/IM; >30kg 2 mg. IV/IM.
Prehospital Pharmacology Cheat Sheet
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PROCAINAMIDE / PRONESTYL
Class:
Class Ia antiarrhythmic, ester-type local anesthetic
Actions:
Reduces automaticity of AV/SA nodes, slows intra-ventricular conduction
Indications:
Ventricular arrhythmias refractory to lidocaine
C/I:
2nd / 3rd degree HB, sick sinus syndrome, multifocal PVCs
Side Effects:
Hypotension, lethargy, seizures, AMS, bradycardia, heart blocks, N/V, cardiac arrest
Critical Info:
No longer 1st line ACLS medication as of 2010
Dose:
Adult: 20-50 mg/min until arrhythmia controlled, hypotension occurs, QRS complex
widens by 50% original width, or max 17 mg/kg
Pediatric: 3-6 mg/kg (max 100mg/dose); may repeat every 5mins to max 15 mg/kg
SODIUM BICARBONATE
Class:
Alkalinizing salt
Actions:
Acts as by combining with excess body acids to form a weak acid which is broken down
into CO2 and H2O. Increases urine pH speeding excretion
Indications:
TCA / phenobarbital antidepressant OD, severe acidosis, hyperkalemia
C/I:
No significant prehospital interactions
Side Effects:
May deactivate catecholamines and vasopressors (i.e epinephrine, dopamine)
Critical Info:
Metabolic alkalosis (large quantities) eventually causes metabolic acidosis secondary to
CO2 production. Causes calcium chloride precipitation if used in save IV line
Dose:
Adults/Pediatric: 1mEq/kg IV/IO, then 0.5 mEq/kg/10min
THIAMINE
Class:
Actions:
Indications:
C/I:
Side Effects:
Dose:
Vitamin BI
Converts pyruvic acid to acetyl coenzyme A allowing utilization of energy from glucose
Coma, especially in alcoholics (Wernicke’s encephalopathy, Korsakoff’s psychosis, DTs)
None
Hypotension, dyspnea, respiratory failure
Adult: 50-100mg IV/IM
Pediatric: 10-25 mg IV/IM
VASOPRESSIN
Class:
Pituitary antidiuretic hormone, non-adrenergic peripheral vasoconstrictor
Actions:
Effects via direct stimulation of smooth muscle. Increases coronary perfusion pressure,
vital organ blood flow and oxygen delivery. Vasoconstriction of splanchnic, portal
vessels, peripheral, cerebral, pulmonary, and coronary vessels
Indications:
Alternative to epinephrine (VF/VT), hemodynamic support in vasodilatory shock,
vasoconstriction for esophageal varices
C/I:
Vascular disease, angina pectoris.
Side Effects:
N/V, tremor, sweating, vertigo, skin blanching, bronchoconstriction, water intoxication
(lethargy, HA, coma, convulsions).
Critical Info:
May provoke cardiac ischemia. High doses of epinephrine, heparin, or ETOH decrease
response to Vasopressin.
Dose:
Arrest: 40 units IV (single dose)
Esophageal Varices: 0.2 to 0.4 units/min IV drip.
REFERENCES
www.Drugs.com, www.id44.com, www.EMSNOTES.com, OEMS Prehospital Protocols. 2013, www.NAEMSE.org, www.EMSSuccess, Brian
Bledsoe MD, Brady 11th Edition
Prehospital Pharmacology Cheat Sheet
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