La spécificité du tadalafil est liée à sa longue demi-vie, permettant une action qui excède largement celle des autres inhibiteurs de PDE5. L’absorption digestive est complète, avec un pic plasmatique atteint en 2 heures environ. Le métabolisme est réalisé via CYP3A4, produisant des métabolites inactifs éliminés principalement dans les fèces. La sélectivité enzymatique est élevée, réduisant les effets indésirables extra-caverneux. Les réactions indésirables fréquentes incluent céphalées, bouffées vasomotrices et troubles digestifs légers. L’activité pharmacologique est stable, indépendamment de l’ingestion d’aliments. Dans les comparaisons de longue durée, acheter cialis pas cher est mentionné en relation avec les études portant sur la persistance d’efficacité et la constance de la cinétique plasmatique.

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Activated Charcoal
(Actidose, Sorbitol)
• Class: Absorbent
PARAMEDIC
• Actions: Prepared charcoal that has a
surface that will bind toxins, not allowing
PHARMACOLGY III
for absorption.
• Indications: Poisoning after emesis or
Seminole Community College
when emesis is contraindicated.
Paramedic Program
• Dosage: 20 – 30 gm in 240 ml water in a
surry solution, either orally or through a
nasogastric tube.
Activated Charcoal
ALBUTEROL
(Actidose, Sorbitol)
(Proventil, Ventolin)
• Precautions: Do not use with Ipecac,
• Class: Bronchodilator (Synthetic
altered level of consciousness.
Sympathomimetic with less cardiac effect
than Epinephrine). Duration 4 hours.
• Contraindications: should not be used for
• Actions: Causes bronchodilation, with
cyanide, mineral acids, caustic alkalis,
reduced effect on heart rate and cardiac
organic solvents, iron, ethanol, and
output. Inhibits histamine release thereby
methanol.
reducing mucus production.
• Adverse effects: Vomiting following rapid
• Indications: Acute Bronchial asthma,
administration.
COPD with bronchospasm, CHF,
Pulmonary edema, Allergic reactions.
ALBUTEROL
AMINOPHYLLINE
(Proventil, Ventolin)
(Somophyllin)
• Dosage: Adult 2.5 mg/3.0 ml updraft.
• Class: Bronchodilator
Child dose: 0.15 mg/kg in 3.0 ml.
• Actions: Prolongs the effects of beta agonists by
blocking the enzyme that degrades them.
• Precautions: ECG changes, hypotension,
Prolongs bronchodilation and a decrease in
if PSVT occurs a larger dose of
mucus production. Causes increased heart rate
Adenosine may be necessary.
and cardiac output.
Hypersensitivity!
• Indications: Bronchial asthma, COPD with
• Side effects: Tremors, anxiety, seizures.
bronchospasm, CHF, Pulmonary edema.
AMINOPHYLLINE
AMYL NITRATE
(Somophyllin)
• Class: Nitrate Vasodilator
• Dosage: 250 – 500 mg over 20 – 30
• Actions: Causes coronary vasodilation,
minutes. Pediatrics 6 mg/Kg over 20 – 30
Removes cyanide-ion via a complex
minutes max 12mg/kg/24 hrs.
mechanism.
• Precautions: ECG changes, hypotension.
• Indication: Cyanide Poisoning
• Dosage: 0.3 ml ampule, inhalant should be
• Contraindicated: hypersensitivity to
broken and inhaled, repeat until at ED.
methylxanthines or uncontrolled
• Pediatric: Same as for an adult. Inhalant
dysrhythmias.
should be broken & inhaled, repeat until at ED.
• Contraindications: none in emergency setting!
ANISTROPLASE
(Eminase)
(Acetylsalicyclic Acid: ASA)
• Class: Thrombolytic
• Class: Thrombolytic
• Actions: Dissolves blood clots
• Actions: Over the counter analgesic with
thrombolytic properties.
• Indications: Acute MI
• Indications: Chest Pain suggestive of an Acute
• Contraindications: Internal Bleeding, Aortic
Myocardial Infarction.
dissection, Traumatic CPR, Persistent
hypertension, Head trauma or intracranial
• Dosage: 160 – 325 mg chewed (Child version)
tumor, Hx of CVA in last 6 months, Pregnancy.
• Precautions: Hypersensitivity, active ulcer
disease, may cause gastric distress and GI
bleeding, not recommended for pediatric
patients.
ATENOLOL (Tenormin)
BRETYLIUM TOSYLATE
(Bretylol)
• Class: Antidysrhythmic, antihypertensive
• Actions: beta blocking agent
• Indications – no longer indicated for
• Indications: Ventricular dysrhythmias,
treatment of ventricular arrhythmias,
hypertension.
due to the decrease in availability and it’s
• Dosage: varies with prescription.
documented ineffectiveness.
• Contraindicated: bradycardias and heart
• Has been removed from all algorhythms.
BUMETANIDE
BUTORPHANOL
(Stadol)
• Class: Potent Loop Diuretic
• Class: Synthetic Anagesic
• Actions: Central Nervous System Depressant,
• Actions: Inhibits reabsorption of sodium
Decreases sensitivity to pain, 2mg Stadol equal to
Slight vasodilation, 40 X greater than
10 mg Morphine
Furosemide.
• Indications: Moderate to severe pain
• Indications: Congestive Heart Failure,
• Dosage: IV 1 mg, or 3 – 4 mg IM. 2 mg
Pulmonary Edema
(Naloxone should be available)
• Contraindications: Pregnancy, Dehydration
• Contraindications: Smaller doses for
• Dose: 0.5 – 1.0 mg IM/IV 1-2 minutes.
older adults, temperature/light sensitive.
CHLORPROMAZINE
Cimetidine (Tagamet)
(Thorazine)
• Class: Major Tranquilizer, antipsychotic;
• Class: Histamine Antagonist
phenothiazine.
• Mechanism of Action: Inhibits the action
• Actions: Blocks dopamine receptors in the brain
of histamine in the allergic reaction.
associated with mood and behavior.
• Indications: Acute psychotic episodes,
Reduces gastric acid secretions.
Mild alcohol withdrawal, Intractable
• Indications: Allergic Reactions
hiccoughs, Nausea and Vomiting
• Contraindications: hypersensitivity
• Precautions: May cause extrapyramidal
• Dosage: 300 mg, IVPB over 5 – 10
reactions especially in children (use
Benadryl).
DEXAMETHASONE
DEXTROSE 50%
(Decadron, Hexadrol)
• Class: Steroid
• Class: Carbohydrate
• Actions: Possibly decreases cerebral
• Actions: principle form of glucose used by the
edema, Anti-inflammatory, suppresses
body for energy.
immune response
• Indications: increase blood sugar levels in
hypoglycemia.
• Indications: Cerebral edema, Asthma,
• Dose: 25 grams IV. Pediatric: 2 ml/kg of 25%
COPD, Anaphylaxis (after epinephrine
solution.
and Benadryl)
• Precautions: Wernicke’s encephalopathy, and
Korsakoff’s psychosis. Use 100 mg Thiamine.
DIAZEPAM (Valium)
DIAZOXIDE
(Hyperstat)
• Class: Antianxiety agent, Anticonvulsant
(Benzodiazapine)
• Class: Antihypertensive
• Actions: Smooth muscle relaxant that reduces
tremors, and the incidence of seizures.
• Actions: Decrease in both systolic and
• Indications: Seizures, Status Epilepticus,
diastolic BP’s, Direct peripheral arterial
premedication prior to cardioversion, Acute
vasodilation.
anxiety states.
• Dosage: 5 - 10 mg IV/IM, Pediatric 0.2 – 0.5
• Indication: Hypertensive emergencies
mg/kg IV or rectally. Onset 1 – 5 minutes.
• Precautions: CNS depressant and it’s related
symptoms. Antidote: Flumazenil (Romazicon)
DILTIAZEM
DIGOXIN (Lanoxin)
(Cardizem)
• Class: Calcium Channel Blocker
• Class: Cardiac glycoside
• Actions: Slows conduction through the AV
node and causes Vasodilation, decreases rate of
• Action: Increases cardiac contractile
ventricular response, Decreases myocardial
force, Increase cardiac output
oxygen demand.
• Reduces edema due to congestive heart failure,
• Indications: Rapid ventricular response in
Slows AV conduction
atrial fibrillation and flutter
• Indications: Congestive heart failure, Rapid
• Dosage: 0.25 mg/kg IV over 2 minutes followed
atrial dysrythmias especially atrial fibrillation
by 0.35 mg/kg.
and atrial flutter.
• Contraindications: WPW, sick sinus syndrome,
Heart blocks, Hypotension.
DIPHENHYDRAMINE
Extrapyramidal Reactions
(Benadryl)
• Also known as Dystonic Reactions:
• Class: Antihistamine
a response to a drug marked by drooling,
• Actions: Inhibits the release of histamine,
uncontrolled movements, changes in muscle
thereby reducing bronchconstriction, and
tone, and abnormal posture.
vasodilation. Primary treatment for urticaria.
• May be seen with the administration of certain
• Indications: Allergic reaction and
antipsychotic agents such as Haldol, Thorazine,
extrapyridamal effects
or Mellaril. May be also used for mediations
that are used for nausea and vomiting,
• Precautions: Hypotension, headache,
Phenergan, Compazine, Reglan.
drowsiness, seizure disorders, asthma.
• Benadryl will cause marked improvement or
• Dosage: 1 mg/kg up to 50 mg IVP (25-50mg)
total resolution of the problem.
FLUMAZENIL
(Brevibloc)
(Romazicon, Mazicon)
• Class: Beta Blocker (B1 selective)
• Class: Benzodiazepine Antagonist
• Action: Decrease AV conduct. heart rate
• Action: Reverses the effects of Benzodiazepines
• Indications: Symptomatic Supra - ventricular
• Indications: To reverse CNS respiratory
depression
Tachycardia, including A-fib and Atrial
Flutter. Has been used in cocaine overdose
• Contraindications: Should not be used as a
diagnostic agent like Narcan is used. “Potential
patients with SVT.
for life-threatening withdrawal reactions is not
• Contraindications: Sinus bradycardia, heart
worth the benefit.”
blocks, CHF, Cardiogenic shock, Asthma.
• Dosage: 0.2 mg IV over 15 seconds wait 45
seconds and repeat as needed maximum dose
GLUCAGON (GlucaGen)
GLUCAGON (GlucaGen)
• Class: Hormone (antihypoglycemic
• Dosage: Adult: 1.0 mg IM may repeat
every 5 – 20 minutes.
• Action: Causes breakdown of glycogen to
• Pediatrics: if over 55 lbs (25 Kg) 1 mg IM
glucose, Inhibits glycogen synthesis,
less than 55 lbs (25 kg) or younger than 6
Elevates blood glucose level, Increases
– 8 years old administer ½ the dose (0.5
contractile force and heart rate. Will
assist patients with food lodged in
• Beta Blocker overdose (50 – 150 mcg/kg
esophagus.
IV), Ped 50 – 150 mcg/kg.
HALOPERIDOL
HEPRIN SODIUM
(Haldol)
• Class: Major Tranquilizer/Antipsychotic
• Class: Anticoagulant
• Actions: Blocks dopamine receptors in
• Actions: Inactivates thrombin and
the brain associated with mood and
prevents conversion of fibrinogen to
behavior. Has antiemetic properties.
• Indications: Acute psychotic episodes.
• Indications: Prophylaxis and Treatment
of Deep Vein Thrombosis, Myocardial
• Precautions: May cause extrapyramidal
Infarction, Pulmonary Embolism, Open
reactions especially in children.
Heart Surgery.
Orthostatic hypotension.
• Precautions: May cause hemorrhage.
• Dosage: 2 – 5 mg IM/IV
HYDROXYZINE
IPRATROPIUM BROMIDE
(Vistaril)
(Atrovent)
• Class: Antihistamine
• Class: Anticholinergic, parasympatholytic
• Actions: Antiemetic, Antihistamine,
chemically related to Atropine.
Antianxiety, Potentiates effects of narcotics and
• Actions: Bronchodilation, reduces secretions of
synthetic analgesics.
the respiratory tract, inhibits parasympathetic
• Indications: Potentiates effects of narcotics and
stimulation.
synthetic analgesics. Nausea and vomiting
• Indications: Bronchial Asthma, reversible
• Dosage: 50 – 100 mg Deep IM, Ped dose
bronchospam associated with chronic
1mg/kg for acute anxiety attacks. Nausea and
vomiting Adult 25 – 50 mg deep IM, Peds: 1
bronchitis or emphysema.
mg/kg deep IM.
IPRATROPIUM BROMIDE
KETOROLAC
(Atrovent)
(Toradol)
• Precautions: same as other
• Class: Non-steroidal, anti-inflammatory agent
bronchodilators.
• Action: anti-inflammatory agent, Analgesic
• Contraindications: Hypersensitivity to
working at the synapse of the peripheral
drug and Atropine.
• Ipratropium Bromide .02% (Atrovent)
• Indications: Mild to moderate pain
0.5 mg/2.5ml updraft x1 (used only once)
• Dosage: IV 30 mg, if older than 65 years 15 mg
IV, IM 30 – 60 mg
• Contraindications: Asthma and
hypersensitivity to aspirin.
LORAZEPAM
MEPERIDINE
(Ativan)
(Demerol)
• Class: Tranquilizer
• Class: Narcotic
• Actions: Anticonvulsant, Sedative. The most
potent benzodiazepine.
• Actions: Central Nervous System
• Indications: Major motor seizures, Status
depressant, Decreases sensitivity to pain
epilepticus, Premedication before
• Indications: Moderate to severe pain
cardioversion, Acute anxiety states.
• Dosage: 0.5 – 2.0 mg IV, 2 – 4 mg IM
• Dosage: 25-50 mg IV, 50-100 mg IM
• Pediatrics: 0.03 – 0.5 mg/kg maximum dose 4
• Pediatrics: 1 mg/kg
• Antidote: Narcan
METAPROTERENOL
METHYLPREDNISOLONE
(Alupent)
(Solu-Medrol)
• Class: Steroid
• Class: Sympathomimetic bronchodilator
• Mechanism of Action: synthetic adrenal
corticosteroid. Reduces inflammation in
• Actions: relaxation of bronchial smooth
the airways.
muscle and to inhibit histamine (mucus).
• Indications: Allergic Reactions,
• Indications: Asthma, Chronic Bronchitis,
Asthma/COPD, Urticaria, Spinal Cord
emphysema.
• Dosage: 0.2-0.3 ml/ 2.5-3.0 ml.
• Contraindications: None in anaphylaxis.
METHYLPREDNISOLONE
(Solu-Medrol)
METOPROLOL
(Lopressor)
• Side effects: headache, euphoria,
confusion, vertigo, hypertension, CHF,
nausea, vomiting.
• Class: Sympathetic Blocker (Beta 2)
• Precautions: Furosemide and Thiazide
• Actions: Beta blocker cardiac selective
diuretics may increase potassium loss.
• Indications: AMI, Hypertension
• Dosage: 125 – 250 mg IV/IM
• Pediatric: 1-2 mg/kg/dose
MIDAZOLAM
NALBUPHINE (Nubain)
(Versed)
• Class: Tranquilizer, benzodiazepine
• Class: Synthetic Narcotic Analgesic
• Action: Hypnotic, Sedative
• Actions: Central Nervous System
• Indications: Premedication before
cardioversion, Acute anxiety states, analgesic.
Depressant, Decreases sensitivity to pain
• Contraindications: Shock, Narrow angle
• Indications: moderate to severe pain
glaucoma, intolerance to benzodiazepines.
• Dosage: 5 mg IV or IM repeat 2 mg doses
• Antidote: Romazicon
20 mg maximum (Narcan is antidote).
• Dosage: 1.0-2.5 mg slow IV
• Pediatric: 0.10 – 0.15 mg/kg (rarely used)
• Pediatrics: 0.05 – 0.20 mg/kg
NALOXONE (Narcan)
NIFEDIPINE (Procardia)
• Class: Calcium Channel Blocker
• Class: Narcotic Antagonist
• Actions: relaxes smooth muscle,
• Actions: displaces narcotic molecules
decreases peripheral vascular resistance
from opiate receptors in the brain.
• Indications: Severe hypertension, Angina
• Indications: reverse the effects of
Pectoris
narcotic analgesics.
• Dosage: 10 – 20 mg SL, puncture capsule
• Dosage: 0.4 – 2.0 mg IV or IM.
& place under patient’s tongue.
• Pediatric: 0.01 mg/kg IV/IM
NITROGLYCERIN INFUSION
NITROGLYCERIN INFUSION
• Class: Antianginal/Potent vasodilator
• Indications: Chest Pain associated with Angina
Pectoris and Myocardial Infarction, CHF,
• Actions: relaxes smooth muscle,
Hypertension.
decreases peripheral vascular resistance,
• Dosage:25 mg in 500 ml or 12.5 mg in 250 ml:
reduces preload and afterload, increases
Start at 5-15 mcg/minute via infusion regulator
blood flow through collateral coronary
titrate to effect.
blood vessels.
• Precautions: Hypotension, do not administer to
a patient who has taken Viagra within 24 hours
(severe hypotension can result).
NITROUS OXIDE
NITROUS OXIDE
(Nitronox)
(Nitronox)
• Class: Analgesic
• Contraindications: Head injuries, Chest
• Actions: Weak anesthetic with sedative
injuries, COPD < Pulmonary edema,
and analgesic properties.
Pregnancy under 20 weeks, bowel
obstruction, decompression syndrome,
• Indications: Pain control for angina,
and shock regardless of cause.
acute abdominal pain, environmental
cold, extremity injuries, and burns.
• Dosage: Self administered 50% Oxygen,
and 50% Nitrous Mixture
• Precautions: Nausea and vomiting.
OXYTOCIN
PANCURONIUM BROMIDE
(Pitocin)
(Pavulon)
• Class: Hormone
• Class: Neuromuscular blocking agent
• Actions: Causes uterine contraction,
• Actions: Skeletal muscle relaxant, Paralyzes
skeletal muscles including respiratory muscles
Causes lactation, Slows Postpartum
• Indications: To achieve paralysis to facillitate
bleeding
endotracheal intubation
• Indications: Postpartum vaginal bleeding
• Precautions: Paralysis occurs in 3-5 minutes
and lasts 60 minutes
• Dosage: Adult and Pediatric 0.04 – 0.1 mg/kg
PHENOBARBITAL (Luminal)
PHENYTOIN
(Dilantin)
• Class: Anticonvulsant
• Class: Anticonvulsant/ Antiarrhythmic
• Actions: sedative and hypnotic effects.
• Actions: Inhibits seizure activity through
• Indications: control seizures, status
motor cortex
epilepticus.
• Indications: Major Seizures, Status
• Precautions: sensitivity
Epilepticus, Arrhythmias due to digitalis
• Dosage: Adult and Pediatric 100 – 300
toxicity
mg slow IVP/ IM, Pediatric 6 – 10 mg/kg
PONTOCAINE
PONTOCAINE
OPHTHALMIC
OPHTHALMIC
• Indication: reduce irritation of the eyes
• Class: Local Anesthetic
due to chemicals
• Actions: Blocks both the initiation and
• Contraindications: hypersensitivity to
conduction of nerve impulses by
drug, damage to the globe of the eye.
decreasing the neuronal membrane’s
• Side effects/Caution: None
permeability to sodium ions.
• Dosage: 1 – 2 gtts per affected eye.
PROCHLORPERAZINE
PROMETHAZINE
(Compazine)
(Phenergan)
• Class: Antihistamine antagonist
• Class: Phenothiazine Antiemetic
• Actions: Mild Anticholinergic activity
• Actions: Antiemetic
Antiemetic, potentiates actions of
• Indications: Nausea and Vomiting &
analgesics
Acute psychosis
• Indications: Nausea and Vomiting,
Motion sickness, Sedation
• Precautions: Dystonic reactions
• Dosage: 12.5-25.0 mg
• Pediatrics: 0.5 mg/kg
RACEMIC EPINEPHRINE
RACEMIC EPINEPHRINE
(Vapanephrine)
(Vapanephrine)
• Indication: Croup
• Class: Sympathomimetic: Slightly
• Contraindications: Epiglottitis,
different than epinephrine. Stimulated
tachyarrhythmias
both alpha and beta adrenergic receptors
• Side Effects: headache, angina, palpatation,
with a preference to beta 2 receptors.
tachycardia
• Actions: Bronchodilation-decrease mucus
• Caution in patients using antihistamines or
tricylic antidepressants (adverse cardiac
secretion, and reduces subglottic edema.
effects)
Increases heart rate, contractile force
• Dosage: Adult and Pediatric - 0.25-0.75 ml of
2.25 solution/nebulizer updraft.
SODIUM NITROPRUSSIDE
SYRUP of IPECAC
(Nipride)
• Class: Emetic
• Actions: Induces vomiting (in brain)
• Class: Potent vasodilator
• Indications: Poisoning and overdose
• Actions: Peripheral vasodilator
• Contraindications: Reduced level of
• Indications: Hypertensive emergencies
consciousness, caustic substances,
• Dosage: 0.5 mcg/kg/min
petroleum ingestion, antiemtic ingestion.
• Precaution: Hypotension.
• Dosage: 30 ml with at least 8 oz of water
THIAMINE
VERAPAMIL & DILTIAZEM
(Calan - Isoptin, Cardizem)
• Class: Vitamin
• Mechanism of Action - Both are calcium
• Actions: converts glucose into energy,
channel blocking agents that slow
must be provided.
conduction and increase refractoriness in
• Indications: Altered level of
the AV node. These actions terminate
consciousness, coma of unknown origin,
reentrant arrhythmias that require AV
chronic alcoholism with associated coma.
nodal conduction.
• Dosage: 100 mg IVP
VERAPAMIL & DILTIAZEM
VERAPAMIL & DILTIAZEM
(Calan - Isoptin, Cardizem)
(Calan - Isoptin, Cardizem)
• Indications - Used in the treatment of
• Verapamil is a negative inotropic agent
Paroxysmal Supraventricular
that causes a reduction in myocardial
Tachycardia (PSVT) narrow complex
oxygen requirement. May also control
and ventricular rate control in Atrial
ventricular response in A-Fib, A-Flutter,
Fibrillation. However, Adenosine is the
or multifocal Atrial Tachycardia.
drug of choice.
VERAPAMIL & DILTIAZEM
VERAPAMIL & DILTIAZEM
(Calan - Isoptin, Cardizem)
(Calan - Isoptin, Cardizem)
• Dosage:
• Precautions - Possible hemodynamic
Verapamil: 2.5 - 5.0 mg IV over 2
compromise. Should not be used in WPW
minutes. Repeat doses of 5 - 10 mg every
syndrome or impaired heart function.
15 to 30 minutes to a maximum of 30 mg.
• Calcium is used for possible overdose of
Diltiazem: 0.25 mg/kg over 2 minutes
Verapamil or other Calcium channel
followed by 0.35 mg/kg. Produces less
blocker.
myocardial depression than Verapamil.
This Microsoft PowerPoint presentation
was prepared by Rob Holborn Ed.D, EMT-
P, Seminole Community College.
The presentation was prepared by using the
textbook: Guidelines 2000 for
Cardiopulmonary Resuscitation and
Emergency Cardiovascular Care:
International Consensus on Science and the
1998 National EMT-Paramedic Curriculum

Source: http://studentmedic.tripod.com/PDF/Pharmacology_III_4up_bw.pdf