EMT-PARAMEDIC –Drug Cards
Pharmacology
Please note
 Many drugs have nausea, vomiting, dizziness as side effects
 All drugs are metabolized/eliminated by the liver and kidneys and should be given
cautiously to patients with diseases in these body systems
 You should never give any drug to a patient with a known hypersensitivity to that drug
Cardiac Drugs / Vasopressors
*Epinephrine, 1:10,000, 1:1,000

Type of drug; B-1 and B-2 agonist.

Mechanism of Action; Stimulates alpha and beta adrenergic receptors causing bronchodilation,
cardiac and CNS stimulation.

Indications; Acute asthma attacks, severe allergic reactions, cardiac arrest, sinus bradycardia
causing severe hypotension.

Contraindications; None in cardiac arrest.

Precautions; Cardiac disorders, hypertension, elderly.

Route and Dosage; onset usually ~ 90 seconds
Bronchodilator; Adult SQ/IM 0.1 – 0.5 mg (1:1,000 soln) q 10 – 15 min., max. dose 1 mg; for
Adult neb 0.5 ml (1:1000 soln) in 2.5 ml NS
Anaphylactic reaction/asthma; Adult SQ/IM 0.1 – 0.5 mg (1:1,000 soln) q 10-15 min., max. dose
1 mg; Peds 0.01 mg/kg.
Cardiac Arrest; Adult 1 mg q 3 – 5 min. (1:10,000 soln); Peds 0.01 mg/kg.

Adverse reactions and side effects; cerebral hemorrhage, palpitations, tachycardia,
dysrhythmias
*Vasopressin

Type of drug; Pituitary hormone

Mechanism of Action; Promotes reabsorption of water by action on renal tubular epithelium;
potent peripheral vasoconstrictor.

Indications; Cardiac arrest; Vf/Pulseless VT

Contraindications; none in cardiac arrest

Precautions; none in cardiac arrest

Route and Dosage; IV 40 U, one time only

Adverse reactions and side effects
*Dopamine

Type of drug; Sympathomimetic, vasopressor, inotropic agent

Mechanism of Action; Causes increased cardiac output; acts on B-1 and Alpha receptors,
causing vasoconstriction to blood vessels; B-1 stimulation produces inotropic effects with
increased cardiac output.

Indications; Hypotension (not related to hypovolemia)

Contraindications; vf, tachydysrhythmias

Precautions; Treat hypovolemia with fluid before administering dopamine.

Route and Dosage; IV, 2 – 20 mcg/kg/min., titrated to effect

Adverse reactions and side effects; tachyarrhythmias
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Cardiac Drugs / Vasopressors
*Atropine
 Type of drug; antidysrhythmic, anticholinergic, parasympatholytic

Mechanism of Action; blocks acetylcholine at parasympathetic neuroeffector sites on AV and
SA nodes; increases cardiac output, heart rate by blocking vagal stimulation

Indications; Symptomatic bradycardia < 60 bpm

Contraindications;

Precautions; Increases myocardia oxygen demand, CHF, HTN. May be harmful if used to treat
AV block (Mobitz II and 3rd degree block; doses less than the minimum may slow the heart rate.

Route and Dosage; Bradycardia Adult IV 0.5 mg q 3-5 min., max 0.03-0.04 mg/kg; Peds 0.02
mg/kg (min. dose 0.1mg, max dose 0.5 mg)
Asystole or PEA Adult IV 1 mg q 3-5 min., max 0.03-0.04 mg/kg (3 mg)

Adverse reactions and side effects; tachycardia, paradoxical slowing in 3rd degree block, dry
mouth, dilated pupils.
*Lidocaine

Type of drug; Antidysrhythmic

Mechanism of Action; Increases electrical stimulation threshold of ventricle, His-Purkinje
system by affecting sodium channels, which stabilizes cardiac membrane, decreases
automaticity

Indications; Ventricular tachycardia, ventricular fibrillation, malignant PVC’s

Contraindications; hypersensitivity, heart blocks, supraventricular dysrhythmias, bradycardia
with PVCs, systolic < 90 mmHg systolic

Precautions; hepatic disease, CHF, respiratory depression, elderly

Route and Dosage; IV, 1-1.5 mg/kg q 5-8 min, max dose 3 mg/kg; Peds 1mg/kg;

NOTE bolus dose of lidocaine lasts approx. 20 min. administer lidocaine gtt to maintain desired
levels once arrhythmia is corrected or spontaneous circulation returns. Add 1 gm lidocaine to 250
cc of NS (concentration of 4 mg/ml); gtt at 1-4 mg/min.

Adverse reactions and side effects; heart block, respiratory depression, seizures, hypotension
*Amiodarone

Type of drug; Antidysrhythmic

Mechanism of Action; prolongs duration of action potential and effective refractory period; noncompetitive  and -adrenergic inhibitions; increases PR and QT intervals; decreases sinus rate,
decreases peripheral vascular resistance.

Indications; Ventricular tachycardia, ventricular fibrillation, cardiac arrest

Contraindications; 2nd and 3rd degree blocks, bradycardia, neonates, infants

Precautions; CHF, severe hepatic, respiratory diseases, children; half-life 40 days

Route and Dosage; IV
Ventricular dysrhythmias; 150 mg over 10 minutes. May repeat 150 mg over 10 min.
Cardiac arrest; 300 mg IV push; may repeat once 150 mg in 3-5 min.

Adverse reactions and side effects; sinus arrest, CHF, dysrhythmias, SA node dysfunction;
hepatotoxicity; ARDS
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Cardiac Stimulator/Vasoconstrictor (cont.)
*Adenosine

Type of drug; Antidysrhythmic

Mechanism of Action; Slows conduction through AV node; inhibits reentry pathways through
AV node.

Indications; to convert SVT to sinus rhythm

Contraindications; 2nd or 3rd degree heart block; prolonged asystole in patients taking
Dipyridamole (Persantine, an antiplatelet agent) or Tegretol (an antiseizure drug)

Precautions; Pt may transiently develop asystole, PVCs, PACs, sinus bradycardia, and sinus
tachycardia after administration; asthma

Route and Dosage; IV; 6 mg rapid IV bolus, followed in 1-2 min. with 12 mg if no response. May
admin. an additional 12 mg. Peds 0.05 mg/kg, may increase by 0.05 mg/kg every 2 minutes to a
max of .25 mg/kg. Note: rapid bolus is crucial – half-live is ~ 30 seconds;
follow rapid IV bolus (in proximal IV site) with rapid IV flush of NS.

Adverse reactions and side effects; prolonged asystole, dyspnea, chest pressure
*Diltiazem (Cardizem)

Type of drug; Calcium channel blocker

Mechanism of Action; Inhibits calcium ion influx across cell membrane during cardiac
depolarization; decreases conduction velocity and ventricular rate; produces relaxation of
coronary vascular smooth muscle.

Indications; Atrial fibrillation, atrial flutter

Contraindications; 2nd or 3rd degree block, hypotension (SBP <90), AMI.

Precautions; CHF, hypotension.

Route and Dosage; 0.25 mg/kg bolus over 2 min.; may repeat at 0.35 mg/kg after 15 min. (avg
initial dose 25 mg)

Adverse reactions and side effects; heart block, hypotension, bradycardia, CHF.
*Magnesium Sulfate

Type of drug; Electrolyte, antiarrhythmic, anticonvulsant

Mechanism of Action; essential for muscle contraction; causes CNS depression and controls
seizures by blocking release of acetylcholine at the myoneural junction; decreases sensitivity of
motor end plate to acetylcholine and decreases excitability of motor membrane.

Indications; correct hypomagnesemia in Torsade de pointes; management of eclampsia of
pregnancy

Contraindications; hypocalcemia, heart block; do not administer in toxemia during the 2-hour
period before delivery.

Precautions; rapid IV administration. May cause respiratory or cardiac arrest

Route and Dosage; Cardiac arrest: 1-2 gm in 10 ml IVP; Torsade de pointes; 1-2 gm in 50-100
ml of NS IV over 5-20 min.; Eclampsia: 4 – 5 g IV infusion over 5-10 min

Adverse reactions and side effects; resp. depression and arrest, arrhythmias, hypotension; to
reverse these effects, hyperventilate pt. and admin. IV bolus of 10% calcium gluconate 10-20 ml.
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Vasodilator
*Nitroglycerine
 Type of drug; coronary vasodilator, antianginal

Mechanism of Action; relaxes vascular smooth muschle, causes vasodilation which results in
increased coronary blood flow; dec. preload.

Indications; prophylaxis of angina pain, CHF associated with acute MI

Contraindications; Cerebral hemorrhage; use of Viagra or other EDD drugs within 24-36 hrs,
SBP<90.

Precautions; postural hypotension, severe hepatic disease

Route and Dosage; SL or Spray, 0.4 mg q 5 min. max dose 3 tabs/sprays, Transdermal 1-2
inches on skin

Adverse reactions and side effects; headache, hypotension, tachycardia
Antidote
Narcan (naloxone)
 Type of drug; Opioid antagonist, antidote
 Mechanism of Action; competes with opioids at opiate receptor sites
 Indications; respiratory depression induced by opioids, coma of unknown origin (to rule out
narcotic OD)
 Contraindications; none in the emergency setting
 Precautions; pregnancy, cardiovascular disease, opioid dependency, seizure disorder. NOTE:
repeat doses of narcan may be necessary due to shorter half life than narcotics
 Route and Dosage; IV/SQ/IM; 0.4-2 mg q 2-3 min.(slow IV bolus); Peds 0.01 mg/kg
 Adverse reactions and side effects; recurrent respiratory depression
Activated Charcoal
 Type of drug; antidote
 Mechanism of Action; binds poisons, toxins, irritants; increases adsorption in the GI tract;
inactivates toxins and binds until excreted
 Indications; poisoning
 Contraindications; unconsciousness (unless with NG tube), poisoning of cyanide, mineral acids,
caustic acids and alkalines, absent gag reflex, ethanol intoxication
 Precautions;
 Route and Dosage; PO/NG; Adult and child; 30-100 g or 1 g/kg NOTE: most effective if given
within 30 minutes of ingestion
 Adverse reactions and side effects; vomiting, black stools
Antihistamine
Benadryl (diphenhydramine)

Type of drug; antihistamine

Mechanism of Action; decreases allergic response by blocking histamine

Indications; allergic reaction

Contraindications; acute asthma attack, COPD

Precautions; cardiac disease, hypertension, glaucoma, elderly

Route and Dosage: IV 10-50 mg; Peds 2-5 mg/kg IV/IM

Adverse reactions and side effects; seizures, CNS depression
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Bronchodilator
*Albuterol (Proventil, Ventolin)

Type of drug; Adrenergic -2 agonist, sympathomimetic, bronchodilator

Mechanism of Action; Dilates bronchial smooth muscle, selectively stimulates B-2 adreneric
receptors of bronchial smooth muscle and lungs.

Indications; asthma, acute bronchospasm assoc. with COPD, bronchiectasis or other reversible
airway obstruction.

Contraindications; hypersensitivity to this drug and peanuts, tachydysrhythmias

Precautions; cardiac disorders, hypertension

Route and Dosage; nebulized inhaler; 2.5 mg tid-qid (in 2.5 ml NS ‘fish’)

Adverse reactions and side effects; bronchospasm, tremors, anxiety, palpitations,
tachycardia, hypertension
*Atrovent (ipratropium)

Type of drug; Anticholinergic, bronchodilator

Mechanism of Action; inhibits interaction of acetylcholine at receptor sites on the bronchial
smooth muscle resulting in bronchodilation

Indications; COPD, asthma

Contraindications; hypersensitivity to this drug, atropine, soya lecithin, peanuts

Precautions;

Route and Dosage; Nebulized, 0.5 mg in 2.5 mL saline ‘fish’

Adverse reactions and side effects; bronchospasms, dizziness, headache, N/V, cramps
Diuretic
Lasix (furosemide)

Type of drug; loop diuretic

Mechanism of Action; inhibits reabsorption of sodium and chloride at proximal and distal tubule
and in the loop of Henle causing an increase in urine output and decreased venous return to right
atria.

Indications; pulmonary edema, edema in CHF

Contraindications; hypersensitivity to sulfonamides(glucose lowering oral medications),
hypovolemia, pneumonia

Precautions; severe renal disease

Route and Dosage; IV 20-40 mg increased by 20 mg q 2 h until desired results, give slowly;
Peds 1 mg/kg

Adverse reactions and side effects; hypotension, arrhythmias
Antiplatelet
Aspirin (acetylsalicylic acid, ASA)
 Type of drug; non-opioid analgesic; non-steroidal anti-inflammatory (NSAID); antipyretic;
antiplatelet

Mechanism of Action; blocks pain impulses in CNS, reduces inflammation by inhibition of
prostaglandin synthesis; decreases platelet aggregation

Indications; mild to moderate pain or fever, TIA, ischemic stroke, prophylaxis of MI, angina

Contraindications; bleeding disorders, taking Coumadin, pediatric pts.

Precautions; recent history of gastrointestinal bleeding or ulcers.

Route and Dosage; MI, angina: PO 160-325 mg (Chewable tabs 81 mg, 325 mg tablets)

Adverse reactions and side effects; GI bleeding, laryngeal edema, bronchospasm
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Analgesic
*Morphine (Morphine sulfate)
Controlled substance, schedule II

Type of drug; Opioid analgesic

Mechanism of Action; depresses pain impulse transmission at the spinal cord level by
interacting with opioid receptors; produces generalized CNS depression; dec. systemic vascular
resistance, relieving pulmonary congestion.

Indications; severe pain, Pulmonary edema

Contraindications; COPD, hypotension

Precautions; head trauma/increased ICP, patients who regularly intake alcohol

Route and Dosage; IV, SQ, IM; 2-10 mg, titrated to relief; Peds 0.1-0.2 mg/kg

Adverse reactions and side effects; respiratory depression, hypotension
Fentanyl (Sublimaze)
Controlled substance, schedule II

Type of drug; Opioid analgesic

Mechanism of Action; Binds to opiate receptors in the CNS, altering the perception of and
response to painful stimuli; produces CNS depression.

Indications; Severe pain

Contraindications; myasthenia gravis

Precautions; pt. with head trauma/increased ICP, severe respiratory disease, elderly.

Route and Dosage; Sedation; IM or IV; 0.5-1 mcg/kg; Peds age 2-12: 2-3 mcg/kg

Adverse reactions and side effects; respiratory depression, bradycardia
Tylenol (Acetaminophen)

Type of drug; Nonopioid analgesic; antipyretic

Mechanism of Action; May block pain impulses peripherally; does not possess antiinflammatory properties; antipyretic action due to inhibition of prostaglandins in the CNS

Indications; mild to moderate pain, fever

Contraindications; hepatic disease

Precautions; hepatic disease

Route and Dosage; Adult; PO & Rectal, 650 mg; Child, Rectal & PO Child <12: 10-15 mg/kg

Adverse reactions and side effects; hepatotoxicity, renal failure
Antihypoglycemic
*D50 (50% Dextrose)

Type of drug; Carbohydrate, Antihypoglycemic

Mechanism of Action; rapidly increases blood glucose which is needed for adequate utilization
of amino acids; decreases protein, nitrogen loss; prevents ketosis

Indications; acute hypoglycemia

Contraindications; hyperglycemia, CVA, delirium tremens

Precautions; renal, hepatic, cardiac disease, diabetes mellitus

Route and Dosage; IV, 25-50 Gm slow IVP; Peds 0.5-1 Gm/kg

Adverse reactions and side effects; CHF, pulmonary edema, venous irritation
Glucagon

Type of drug; Hormone

Mechanism of Action; acts on hepatocytes to stimulate release of glucose; promotes
breakdown of glycogen to glucose in liver to increase blood glucose

Indications; severe hypoglycemia

Contraindications;

Precautions; may increase anticoagulant effect of warfarin

Route and Dosage; IM or SQ, 1 mg (supplied 1 mg of glucagon and 1 ml of glycerin; must be
mixed just prior to administration)

Adverse reactions and side effects; hypotension
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Benzodiazepine
*Versed (Midazolam)
Schedule IV
 Type of drug; short-acting benzodiazepine; sedative, anxiolytic
 Mechanism of Action; CNS depressant causing sedative, anxiolytic, amnesic and hypnotic
activity.
 Indications; sedation for RSI or cardioversion, generalized seizures, anxiety
 Contraindications; shock
 Precautions; COPD, renal failure, geriatric
 Route and Dosage; Sedation for RSI: IV; 0.1 mg/kg; max single dose 5 mg; Anxiolytic; IV 2.5-5
mg., give slowly Note: may be given deep IM. Onset ~ 2 min.; Not recommended for peds <12
 Adverse reactions and side effects; respiratory depression and arrest, hypotension
Neuromuscular Blocker
*Succinylcholine (Anectine)

Type of drug; Depolarizing neuromuscular blocking drug

Mechanism of Action; prevents muscles from contracting by prolonging time during which the
receptors at the neuromuscular junction cannot respond to acetylcholine

Indications; to facilitate ET intubation

Contraindications; Hx of malignant hyperthermia; penetrating eye injuries

Precautions; severe burns, myasthenia gravis

Route and Dosage; IV: 1-1.5 mg/kg. May be given IM; up to 3-4 mg/kg, max dosage 150 mg
total. NOTE: Onset IV admin. 1-2 min., recovery 4-6 min; IM onset 2-3 min., recovery 4-6 min.;
Peds 1-1.5 mg/kg

Adverse reactions and side effects; apnea, prolonged respiratory depression, arrhythmias,
bronchial spasms, hypotension, inc. ocular pressure
*Vecuronium (Norcuron)

Type of drug; Nondepolarizing neuromuscular blocking drug

Mechanism of Action; a competitive nondepolarizing drug that competes with acetylcholine for
receptor sites in the muscle cells, preventing the muscles from contracting

Indications; to facilitate ET intubation

Contraindications; Myasthenia gravis

Precautions; use with caution in elderly patients

Route and Dosage; IV: 0.1 mg/kg (onset 1 min. recovery; 45 min.); not recommended in
children under age 10

Adverse reactions and side effects; apnea, profound weakness, bronchospasms, NOTE;
monitor vitals and ECG; Vecuronium can cause vagal stimulation resulting in bradycardia,
hypotension and arrhythmias
Vitamin
Thiamine

Type of drug; B-complex vitamin (vitamin B-1)

Mechanism of Action; required for metabolism of carbohydrates.

Indications; Coma of unknown origin, alcohol abuse, and DTs

Contraindications: none

Precautions; Thiamine deficiency can cause Wernicke’s encophalopathy and Korsakoff’s
syndrome(irreversible psychosis) in the alcohol dependent patient.

Route and Dosage; IV: 100 mg mixed in 1 liter of fluid; IM 50 mg

Adverse reactions and side effects; hypotension if administered too rapidly
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Hypnotic
Etomidate

Type of drug; Short acting hypnotic

Mechanism of Action; Depresses the activity and reactivity of the brain stem reticular formation;
does not cause significant cardiovascular or respiratory depression may cause brief apnea,
slightly decreases intracranial pressure

Indications; Rapid sequence intubation, induction of anesthesia.

Contraindications;

Precautions; marked hypotension, severe asthma, severe cardiovascular disease

Route and Dosage: 15-.3 mg/kg IV; not recommended in children under age 10

Adverse reactions and side effects; hypotension, myoclonus (transient skeletal muscle
movements)
Alkalinizer
Sodium Bicarbonate

Type of drug; Systemic hydrogen ion buffer

Mechanism of Action; Buffers acid buildup in the body to correct metabolic acidosis and assist
returning the blood to a physiologic pH.

Indications; TCA overdose, after prolonged cardiac arrest

Contraindications;

Precautions; Sodium bicarbonate administ. can result in metabolic alkalosis or sodium overload.
Use with caution in patients with CHF and renal failure.

Route and Dosage; Adult/Peds IV bolus, 1 mEq/kg

Adverse reactions and side effects; CHF, metabolic alkalosis, tissue necrosis at IV site.
Anti-Nausea
Phenergan (Promethazine)

Type of drug; Antihistamine, anticholinergic, anti-emetic

Mechanism of Action; Competes with histamine

Indications; treatment and prevention of nausea

Contraindications; should not be used in children <2, asthma

Precautions; use caution in geriatric patients; they are more likely to experience confusion,
dizziness and hypotension. Use cautiously with a history of seizures.

Route and Dosage; IV: 12.5-25 mg; IM 25 mg , Peds 0.25-0.5 mg/kg

Adverse reactions and side effects; Thickened bronchial secretions, wheezing, palpitations
Ondansetron (Zofran)

Type of drug; serotonin receptor antagonistc

Mechanism of Action; prevents nausea/vomiting by blocking serotonin peripherally, centrally
and in small intestine.

Indications; prevention of nausea and vomiting

Contraindications;

Precautions; pregnancy, pediatric, geriatric

Route and Dosage; IV (or IM) 4 mg undiluted >30 seconds

Adverse reactions and side effects; drowsiness, bronchospasm, shivering
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