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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