EMT

1. Copyright © 2023 by Jones & Bartlett Learning, LLC, an Ascend Learning Company and the American Academy of Orthopaedic Surgeons.
Emergency
Medications
CHAPTER 15

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©
2023
by
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Learning,
LLC,
an
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and
the
American
Academy
of
Orthopaedic
Surgeons.
Pharmacology Formulary (1 of 3)
 A reference for paramedic students as they progress through their education
 “Tall man” lettering helps to avoid confusion of medications with similar
spellings

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Learning,
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Surgeons.
Pharmacology Formulary (2 of 3)
 Emergency medication are broken down into the following components:
 Generic name (Trade Name[s])
 Class
 Mechanism of action
 Indications
 Contraindications
 Adverse/side effects
 Drug interactions
 Dosage and administration
 Adult and pediatric
 Duration of action
 Onset, peak effect, duration
 Special considerations

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Learning,
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the
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Academy
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Surgeons.
Pharmacology Formulary (3 of 3)
 Medications used in health care delivery are presented using a similar but less
detailed format
 Not carried/administered by paramedics
 State and regional EMS systems have the right to include other medications in
their own formularies
 Always follow your local protocols

5. Copyright © 2023 by Jones & Bartlett Learning, LLC, an Ascend Learning Company and the American Academy of Orthopaedic Surgeons.
Drug Profiles

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Acetaminophen (Tylenol) (1 of 2)
 Class: Nonopioid analgesic, antipyretic
 Mechanism of action: Not fully established
 Indications: Pain, fever
 Contraindications: Hypersensitivity, severe liver disease
 Adverse/side effects: Nausea, upper abdominal pain, skin rash, itching, loss of
appetite
 Drug interactions: Caffeine; antacids, anticholinergics, carbamazepine,
phenytoin

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Learning,
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Surgeons.
Acetaminophen (Tylenol) (2 of 2)
 Dosage and administration
 Adult: 15 mg/kg orally
 Pediatric: 15 mg/kg via PR/IV/IO or orally
 Duration of action
 Onset: 10–30 min
 Peak effect: 30–60 min
 Duration: 4–6 hours
 Special considerations
 Pregnancy safety: Category B
 FDA limits dose to 325 mg when combined with other drugs

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Surgeons.
AcetaZOLAMIDE (Diamox, Diamox Sequels) (1 of 2)
 Class: Carbonic anhydrase inhibitor, diuretic
 Mechanism of action: Inhibits hydrogen ion excretion in the renal tubules
 Indications: AMS, prevention of HACE
 Contraindications: Hypersensitivity to sulfa, known hypokalemia or
hyponatremia, renal or liver dysfunction
 Adverse/side effects: Fluid and electrolyte imbalance, metabolic acidosis,
seizures, nausea, vomiting
 Drug interactions: High-dose aspirin; diuretics, anticonvulsants

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Learning,
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Surgeons.
AcetaZOLAMIDE (Diamox, Diamox Sequels) (2 of 2)
 Dosage and administration
 Adult: 250 mg orally every 12 hours
 Pediatric: 2.5 mg/kg orally every 12 hours
 Duration of action
 Onset: 1–1.5 hours
 Peak effect: 2–4 hours
 Duration: 4–12 hours
 Special considerations
 Pregnancy safety: Category C

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Learning,
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Academy
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Surgeons.
Acetic Acid (vinegar) (1 of 2)
 Class: Otic anti-infective, irrigating solution
 Mechanism of action: Provides an acidic medium during irrigation of the ear
 Indications: Otitis externa, pain control for envenomation by jellyfish outside US
 Contraindications: Hypersensitivity, perforated tympanic membranes, nematocyst
discharge from US jellyfish
 Adverse/side effects: Skin irritation, sensitivity, stinging sensation
 Drug interactions: None

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Academy
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Surgeons.
Acetic Acid (vinegar) (2 of 2)
 Dosage and administration
 Adult and pediatric: 4–6 drops into external ear, repeat every 2–3 hours; outside the
US, rinse for 30 seconds
 Duration of action
 Onset: 5 min
 Peak effect: 45–90 min
 Duration: 2–3 hours
 Special considerations
 Pregnancy safety: Category C
 Safety and efficacy has not been established in children under 3 years old.

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Acetylcysteine (Mucomyst, Acetadote) (1 of 2)
 Class: Acetaminophen antidote
 Mechanism of action: Restores glutathione concentrations within the liver
 Indications: Acetaminophen overdose
 Contraindications: Hypersensitivity, acute asthma
 Adverse/side effects: Urticaria, flushing, rash, angioedema, nausea
 Drug interactions: Nitroglycerin

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Acetylcysteine (Mucomyst, Acetadote) (2 of 2)
 Dosage and administration
 Adult and pediatric: 150 mg/kg IV, mix in 200 mL of D5W and infuse over 1 hour;
then give 50 mg/kg IV in 500 mL D5W and infuse over 4 hours; if IV access is not
available, give acetylcysteine 140 mg/kg orally
 Duration of action
 Onset: 1 min
 Peak effect: 5–15 min
 Duration: 100 min
 Special considerations
 Pregnancy safety: Category B
 Can cause anaphylactoid-type reactions

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Activated Charcoal (Insta-Char, Actidose-Aqua, Liqui-Char) (1 of 2)
 Class: Adsorbent, antidote
 Mechanism of action: Adsorbs ingested toxic substances from the GI tract
 Indications: Oral poisonings and medication overdoses in the alert patient
 Contraindications: Hypersensitivity, unprotected airway, absence of gag reflex,
ileus, intestinal obstruction; ingestion of petroleum distillates, hydrocarbons,
heavy metals, acids or alkalis, alcohols, iron, lithium, solvents; use caution in
patients experiencing abdominal pain
 Adverse/side effects: Emesis, constipation, black stools, diarrhea, bowel
obstruction
 Drug interactions: Bonds with and inactivates whatever it is mixed with

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Surgeons.
Activated Charcoal (Insta-Char, Actidose-Aqua, Liqui-Char) (2 of 2)
 Dosage and administration
 Adult and pediatric (> 1 y/o): 25–100 g orally or via NG tube
 Pediatric (< 1 y/o): 1 g/kg orally or via NG tube
 Duration of action
 Onset: Immediate
 Peak effect: Depends on GI function
 Duration: Will act until excreted
 Special considerations
 Pregnancy safety: Category C
 Shake vigorously before use
.

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Surgeons.
Adenosine (Adenocard) (1 of 2)
 Class: Antidysrhythmic
 Mechanism of action: Short-acting; slows conduction through the AV node
 Indications: Most forms of stable, regular, narrow-complex SVT
 Contraindications: Hypersensitivity; second- or third-degree AV block; poison- or
drug-induced tachycardia; use caution with history of seizure disorder
 Adverse/side effects: Flushing, sweating, dizziness, nervousness, paresthesia,
hypotension, feeling of impending doom, severe bronchospasm
 Drug interactions: Methylxanthines, Dipyridamole, Carbamazepine, Nicotine

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Surgeons.
Adenosine (Adenocard) (2 of 2)
 Dosage and administration
 Adult: 6-mg rapid IV/IO bolus over 1–3 seconds, followed by 10-mL saline flush; If no conversion
occurs after 1–2 min, administer 12-mg rapid IV/IO bolus over 1–3 seconds
 Pediatric: Initial dose 0.1 mg/kg rapid IV/IO push over 1–3 seconds, followed by 5–10-mL saline
flush; Second dose 0.2 mg/kg rapid IV/IO push followed by 5–10-mL saline flush
 Duration of action
 Onset: Seconds
 Peak effect: Seconds
 Duration: 10 seconds
 Special considerations
 Pregnancy safety: Category C
 Continuously monitor ECG and record rhythm strip
 Should not be administered for hemodynamically unstable, irregularly irregular, or polymorphic wide-
complex tachycardias

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Albuterol (Proventil, Ventolin, Proair, Accuneb) (1 of 3)
 Class: Sympathomimetic, bronchodilator, short-acting beta-2 adrenergic agonist
 Mechanism of action: Selective beta-2 adrenergic agonist that causes bronchial
smooth muscle relaxation and inhibits mediator release
 Indications: Bronchospasm with reversible obstructive airway disease; inhaled
airway/respiratory irritant agents; hyperkalemia
 Contraindications: Hypersensitivity; dysrhythmias; synergistic with other
sympathomimetics
 Adverse/side effects: Tremors, headaches, nervousness, dizziness,
dysrhythmias, chest discomfort, palpitations, nausea/vomiting, and dry mouth
 Drug interactions: TCAs, MAOIs, other sympathomimetics; diuretics

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Surgeons.
Albuterol (Proventil, Ventolin, Proair, Accuneb) (2 of 3)
 Dosage and administration
 Adult: Respiratory distress: 2.5–5 mg via nebulizer or 1–2 inhalations (90–180 mcg)
via MDI; Respiratory distress with signs of bronchospasm: 5 mg via nebulizer or 6
puffs via MDI; Hyperkalemia: 5 mg via nebulizer
 Pediatric: Mild to moderate asthma, anaphylaxis, hyperkalemia: 4–8 puffs by MDI
every 20 min or 2.5–5 mg via nebulizer every 20 min; Respiratory distress with signs
of bronchospasm: 5 mg via nebulizer or 6 puffs via MDI
 Duration of action
 Onset: 5–15 min
 Peak effect: 30 min–2 hours
 Duration: 3–6 hours

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Learning,
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Surgeons.
Albuterol (Proventil, Ventolin, Proair, Accuneb) (3 of 3)
 Special considerations
 Pregnancy safety: Category C
 May precipitate angina pectoris and dysrhythmias

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Amiodarone (Cordarone, Pacerone) (1 of 3)
 Class: Antidysrhythmic (Class III)
 Mechanism of action: Blocks sodium, potassium, and calcium channels; prolongs
potential’s duration and delays repolarization; decreases AV conduction
 Indications: Cardiac arrest resulting from VF or pulseless VT after CPR, defibrillation,
and epinephrine; stable, regular narrow-complex tachycardia
 Contraindications: Hypersensitivity, iodine hypersensitivity, cardiogenic shock,
second- or third-degree AV block
 Adverse/side effects: Hypotension, heart failure, worsening of dysrhythmias,
prolonged QT interval, bradycardia, AV block, dizziness, fatigue, cough, progressive
dyspnea, nausea, vomiting, burning at the IV site, Stevens-Johnson syndrome
 Drug interactions: Digoxin, disopyramide, fentanyl, lidocaine, procainamide, quinidine,
or warfarin

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Amiodarone (Cordarone, Pacerone) (2 of 3)
 Dosage and administration
 Adult: VF/pulseless VT: Initial dose 300 mg IV/IO push, second dose (if needed) 150
mg IV/IO push; Other: Loading dose 150 mg IV/IO over 10 min
 Pediatric: VF/pulseless VT: 5 mg/kg IV/IO bolus, can repeat up to 15 mg/kg IV per 24
hours; Poor perfusing ventricular or atrial dysrhythmias: 5 mg/kg IV/IO over 20–60
min, can repeat up to 15 mg/kg IV per 24 hours
 Duration of action
 Onset: 2 hours
 Peak effect: 3–7 hours
 Duration: Variable

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Amiodarone (Cordarone, Pacerone) (3 of 2)
 Special considerations
 Pregnancy safety: Category D
 Dysrhythmias, hypotension, increasing PR and QT intervals
 Dosage may change per current ILCOR recommendations

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Antibiotics
 Kill bacteria or inhibit their growth and replication
 Classified by their chemical structure or spectrum of activity

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Anticoagulants
 Prevent the formation of new clots but do not dissolve existing clots
 Coagulation monitoring prevents excessive anticoagulation
 Patients are typically advised to wear medical identification

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Aspirin (Acetylsaliylic Acid) (1 of 2)
 Class: Platelet inhibitor, NSAID, anti-inflammatory agent
 Mechanism of action: Prevents thromboxane A2 formation; antipyretic and
analgesic properties
 Indications: New-onset chest discomfort suggestive of ACS
 Contraindications: Hypersensitivity to ASA or NSAIDs, bleeding disorders,
hemolytic anemia, breastfeeding
 Adverse/side effects: Anaphylaxis, bronchospasm/wheezing, GI bleeding,
epigastric distress, nausea, vomiting, heartburn, Reye syndrome
 Drug interactions: Other NSAIDs and certain herbs; ACE inhibitors; ASAs

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Aspirin (Acetylsaliylic Acid) (2 of 2)
 Dosage and administration
 Adult: 162–325 mg orally
 Pediatric: Not recommended
 Duration of action
 Onset: 15–30 min
 Peak effect: 1–2 hours
 Duration: 4–6 hours
 Special considerations
 Pregnancy safety: Category D
 If no contraindications, aspirin should be given as soon as possible to patients with
a suspected ACS.

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Atropine Sulfate (1 of 2)
 Class: Anticholinergic agent
 Mechanism of action: Inhibits acetylcholine at postganglionic parasympathetic
neuroeffector sites; increases heart rate; reverses muscarinic effects
 Indications: Hemodynamically unstable bradycardia, acetylcholinesterase
inhibitor poisoning, RSI in pediatrics, beta blocker
 Contraindications: Hypersensitivity; narrow-angle glaucoma, GI obstruction,
severe ulcerative colitis, toxic megacolon, bladder outlet obstruction,
myasthenia gravis, hemorrhage with cardiovascular instability, thyrotoxicosis
 Adverse/side effects: Drowsiness; confusion; headache; palpitations;
dysrhythmias; nausea; vomiting; pupil dilation; dryness; blurred vision; urinary
retention; constipation; flushed skin
 Drug interactions: Digitalis, cholinergics, physostigmine

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Atropine Sulfate (2 of 2)
 Dosage and administration
 Adult: Symptomatic bradycardia: 0.5–1 mg IV/IO every 3–5 min;
Acetylcholinesterase inhibitor poisoning: 2–4 mg or higher
 Pediatric: Symptomatic bradycardia: 0.02 mg/kg IV/IO; Acetylcholinesterase
inhibitor poisoning: 0.05 mg/kg, repeat and double dose every 5 min (< 12 y/o) or 1
mg IV/IO, repeat and double dose every 5 min (> 12 y/o)
 Duration of action
 Onset: Immediate
 Peak effect: 2–4 min
 Duration: 2–4 hours
 Special considerations
 Pregnancy safety: Category C
 Ineffective in hypothermic bradycardia, heart transplantation, infranodal AV blocks

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Benzocaine Spray (Hurricane) (1 of 2)
 Class: Topical anesthetic
 Mechanism of action: Prevents impulse transmission
 Indications: Topical anesthetic; suppression of pharyngeal and tracheal gag reflex
 Contraindications: Hypersensitivity
 Adverse/side effects: Pale, gray- or blue- colored skin, lips, and nail beds;
headache, light-headedness, shortness of breath; anxiety, fatigue, and
tachycardia
 Drug interactions: Nitrites and nitrates

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Benzocaine Spray (Hurricane) (2 of 2)
 Dosage and administration
 Adult: 0.5–1-second spray; repeat as needed
 Pediatric: 0.25–0.5-second spray; repeat as needed
 Duration of action
 Onset: Immediate
 Peak effect: < 5 min
 Duration: 15–20 min
 Special considerations
 Pregnancy safety: Category C
 Amount in a single spray varies among manufacturers
 Use in the mouth/throat can result in potentially dangerous methemoglobin levels

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Beta Blocking Agents (1 of 2)
 Antagonize the effects of epinephrine on beta adrenergic receptors
 Beta-1 selective blockers
 Cardioselective beta blockers
 Slow the heart rate and force of contraction
 Safer for use in patients with lung disease

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Beta Blocking Agents (2 of 2)
 Nonselective beta blockers
 Antagonize beta-1 and beta-2 receptors
 Decrease heart rate and force of contraction
 Cause some degree of bronchoconstriction
 Contraindicated in patients with asthma
 Should be used with caution in patients with COPD

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Bumetanide (Bumex) (1 of 2)
 Class: Loop diuretic
 Mechanism of action: Inhibits the reabsorption of sodium and chloride
 Indications: Pulmonary edema, heart failure
 Contraindications: Hypersensitivity to bumetanide, furosemide, or sulfonamides;
hypovolemia, anuria, acid–base imbalance, electrolyte imbalance, hepatic
coma; use caution with hepatic cirrhosis, ascites, or diabetes
 Adverse/side effects: Dehydration, dizziness, headache, hypotension, ECG
changes, nausea/vomiting, itching, fatigue
 Drug interactions: NSAIDs; lithium; antihypertensives

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Bumetanide (Bumex) (2 of 2)
 Dosage and administration
 Adult: 0.5–1 mg IV slowly over 1–2 min or IM
 Pediatric: Not recommended for children younger than 12 years
 Duration of action
 Onset: Immediate
 Peak effect: 15–30 min
 Duration: 3–6 hours
 Special considerations
 Pregnancy safety: Category C
 Does not have the vasodilatory effects of furosemide; diuretic potency is about 40
times greater than furosemide

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Calcium Chloride (1 of 2)
 Class: Electrolyte
 Mechanism of action: Component of bones and teeth; cofactor in enzymatic
reactions; essential for neurotransmission, blood clotting, and muscle contraction
 Indications: Hypocalcemia, hyperkalemia, beta blocker, antidote for magnesium
sulfate overdose
 Contraindications: Hypersensitivity, digoxin toxicity, hypercalcemia, hypokalemia
 Adverse/side effects: Syncope, bradycardia, asystole, hypotension, nausea,
vomiting, metallic taste, tissue necrosis, coronary and cerebral artery spasm
 Drug interactions: Digitalis toxicity; thiazide diuretics; incompatible with most
medications

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Surgeons.
Calcium Chloride (2 of 2)
 Dosage and administration
 Adult: 500–1,000 mg slow IV/IO push over 5 min; repeat as needed
 Pediatric: 20 mg/kg slow IV/IO push; may repeat dose
 Duration of action
 Onset: 1–3 min
 Peak effect: Variable
 Duration: 20–30 min; may persist for 4 hours
 Special considerations
 Pregnancy safety: Category C
 Contains 3x more elemental calcium than calcium gluconate
 Constant ECG and vital sign monitoring are essential
 Do not administer by either the IM or subcutaneous routes.

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Calcium Gluconate (1 of 2)
 Class: Electrolyte
 Mechanism of action: Component of bones and teeth; cofactor in enzymatic
reactions; essential for neurotransmission, blood clotting, muscle contraction
 Indications: Hydrofluoric acid burn management, hypocalcemia, hyperkalemia,
beta blocker and calcium channel blocker toxicity
 Contraindications: Hypersensitivity, digoxin toxicity, hypercalcemia, suspected
severe hypokalemia
 Adverse/side effects: Syncope, cardiac arrest, dysrhythmias, hypotension,
asystole, peripheral vasodilation, nausea, vomiting, metallic taste, tissue
necrosis, coronary and cerebral artery spasm
 Drug interactions: Calcium channel blockers; incompatible with most
medications

39. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Calcium Gluconate (2 of 2)
 Dosage and administration
 Adult: 1.5–3 g (15–30 mL of 10% solution) slow IV/IO push over 5 min
 Pediatric: 60 mg/kg slow IV/IO push over 10 min; may repeat
 Duration of action
 Onset: 1–3 min
 Peak effect: Immediate
 Duration: 30 min–2 hours
 Special considerations
 Pregnancy safety: Category C
 Constant ECG and vital signs monitoring are essential
 Do not administer by either the IM or subcutaneous routes.

40. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Cimetidine (Tagamet) (1 of 2)
 Class: Antiulcer, H2 blocker
 Mechanism of action: Blocks the effects of histamine at H2 receptors of gastric
parietal cells
 Indications: Gastric or duodenal ulcers, GERD, hives and/or itching
 Contraindications: Hypersensitivity
 Adverse/side effects: Headache, dizziness, diarrhea, muscle aches, skin
rashes, fatigue
 Drug interactions: May result in increased plasma levels of certain drugs

41. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Cimetidine (Tagamet) (2 of 2)
 Dosage and administration
 Adult: 400 mg orally four times daily
 Pediatric: Not recommended; 20–40 mg/kg per day orally in divided doses
 Duration of action
 Onset: 60 min
 Peak effect: 45–90 min
 Duration: 4–5 hours
 Special considerations
 Pregnancy safety: Category B
 Can be given orally or IV in conjunction with diphenhydrAMINE for urticaria

42. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Dexamethasone Sodium Phosphate (Decadron) (1 of 2)
 Class: Corticosteroid, adrenal glucocorticoid, anti-inflammatory agent
 Mechanism of action: Suppresses acute and chronic inflammation;
immunosuppressive effects
 Indications: Anaphylaxis, acute exacerbation of bronchial asthma, AMS, HACE,
spinal cord injury, croup, elevated ICP, adjunct for shock, COVID-19
 Contraindications: Hypersensitivity, systemic fungal infection, preterm infants
 Adverse/side effects: Headache, restlessness, nervousness, increased appetite,
insomnia, sodium and water retention
 Drug interactions: ASA and NSAIDs; diuretics; echinacea

43. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Dexamethasone Sodium Phosphate (Decadron) (2 of 2)
 Dosage and administration
 Adult: AMS: 4 mg IM/IV/orally every 6 hours; HACE: 8 mg IM/IV/orally, followed by
4 mg every 6 hours; Bronchospasm: 0.6 mg/kg IM/IV/orally
 Pediatric: AMS, HACE: 0.15 mg/kg IM/IV/orally every 6 hours; Croup: 0.6 mg/kg
orally/IM/IV/IO given once; Asthma: 0.6 mg/kg IM/IV/IO every 24 hours
 Duration of action
 Onset: 4–8 hours
 Peak effect: 6–12 hours
 Duration: 24–72 hours
 Special considerations
 Pregnancy safety: Category C
 Steroids can mask infection
 Can increase blood glucose levels

44. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Dextrose (1 of 2)
 Class: Carbohydrate, glucose-elevating agent
 Mechanism of action: Rapidly increases serum glucose levels; short-term osmotic
diuresis
 Indications: Hypoglycemia, acutely altered mental status, coma or seizure of
unknown origin, status epileptic
 Contraindications: Hypersensitivity, hyperglycemia, dehydration, anuria, diabetic
coma, hemorrhage, glucose-galactose malabsorption syndrome
 Adverse/side effects: Cerebral hemorrhage; cerebral ischemia; warmth, pain,
burning, or phlebitis from IV infusion
 Drug interactions: Sodium bicarbonate, warfarin (Coumadin)

45. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Dextrose (2 of 2)
 Dosage and administration
 Adult: 25 g of D10W to D50W IV; may be repeated
 Pediatric: 0.5–1 g/kg of D10W to D25W slow IV/IO push; may be repeated
 Duration of action
 Onset: < 1 min
 Peak effect: Variable
 Duration: Variable
 Special considerations
 Pregnancy safety: Category C
 Draw blood to determine the patient’s glucose level before administering
 Document vital signs and mental status after administration

46. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Diazepam (Valium, Diastat AcuDial) (1 of 2)
 Class: Benzodiazepine, anticonvulsant, anxiolytic, sedative, skeletal muscle relaxant
 Mechanism of action: Acts on limbic system to induce a calming effect; inhibits GABA
receptors; raises seizure threshold; induces amnesia and sedation
 Indications: Uncontrolled shivering
 Contraindications: Hypersensitivity, neurologic or respiratory depression, narrow-angle
glaucoma, myasthenia gravis, head injury
 Adverse/side effects: Dizziness, drowsiness, confusion, headache, respiratory
depression, hiccups, hypotension, reflex tachycardia, nausea, vomiting, muscle
weakness, ataxia, thrombosis, phlebitis
 Drug interactions: Incompatible with most drugs and fluids

47. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Diazepam (Valium, Diastat AcuDial) (2 of 2)
 Dosage and administration
 Adult: Hyperthermia: 2 mg IV/IO; Chemical restraint: 5 mg IV or 10 mg IM
 Pediatric: Seizure: 0.1 mg/kg slow IV/IO; Hyperthermia: 0.1 mg/kg IV/IO; Chemical
restraint: 0.05–0.1 mg/kg IV or 0.1–0.2 mg/kg IM
 Duration of action
 Onset: 2–5 min IV; 15–30 min IM
 Peak effect 15 min IV; 30–45 min IM
 Duration: 15–60 min
 Special considerations
 Pregnancy safety: Category D
 Consider decreasing dose by 50% in patients > 60 y/o

48. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Diltiazem (Cardizem, Dilacor, Diltiaz) (1 of 2)
 Class: Calcium channel blocker, antidysrhythmic (Class IV), antianginal agent
 Mechanism of action: Inhibits extracellular calcium ion influx across membranes;
substantial inhibitory effects on the cardiac conduction system
 Indications: Stable narrow-QRS tachycardia
 Contraindications: Hypersensitivity, hypotension, cardiogenic shock, wide-complex
tachycardia, second- or third-degree AV block, poison- or drug-induced tachycardia
 Adverse/side effects: Dizziness, weakness, headache, dyspnea, dysrhythmias,
heart failure, peripheral edema, hypotension, syncope, chest pain, nausea, vomiting,
dry mouth
 Drug interactions: Medications that affect cardiac contractility, IV beta blockers,
erythromycin

49. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Diltiazem (Cardizem, Dilacor, Diltiaz) (2 of 2)
 Dosage and administration
 Adult: 15–20 mg (0.25 mg/kg) IV/IO slowly over 2 min; after 15 min, a second bolus
of 20–25 mg (0.35 mg/kg) IV/IO can be given slowly over 2 min
 Pediatric: Not recommended
 Duration of action
 Onset: 2–5 min
 Peak effect: Usually within 7 min
 Duration: 1–3 hours
 Special considerations
 Pregnancy safety: Category C
 Dysrhythmias may be observed during pharmacologic conversion
 Carefully monitor BP and ECG before, during, and after administration

50. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
DiphenhydrAMINE (Benadryl) (1 of 2)
 Class: Antihistamine (H1 blocker)
 Mechanism of action: Blocks H1 receptors; reverses extrapyramidal reactions
 Indications: Allergic reactions, dystonia, extrapyramidal signs or symptoms caused
by phenothiazines, antiemetic, chemical restraint
 Contraindications: Hypersensitivity, newborns and premature infants, breastfeeding
 Adverse/side effects: Drowsiness, sedation, seizures, dizziness, headache, blurred
vision, wheezing, thickening of bronchial secretions, palpitations, hypotension,
dysrhythmias, dry mouth, diarrhea, nausea, vomiting
 Drug interactions: Alcohol and other CNS depressants; MAOIs

51. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
DiphenhydrAMINE (Benadryl) (2 of 2)
 Dosage and administration
 Adult: Urticaria, pruritus, anaphylaxis, allergic reaction: 1 mg/kg IM/IV/orally; Antiemetic:
12.5–25 mg IV/IM/ orally; Dystonic/extrapyramidal symptoms: 25–50 mg IV/IM
 Pediatric: Urticaria, pruritus, anaphylaxis, allergic reaction: 1 mg/kg IM/IV/orally;
Antiemetic: 0.1 mg/kg IV; Dystonic/extrapyramidal: 1–1.25 mg/kg IV/IO/IM; Chemical
restraint: 1 mg/kg IM/IV/orally
 Duration of action
 Onset: 10–15 min
 Peak effect: 1 hour
 Duration: 6–8 hours
 Special considerations
 Pregnancy safety: Category B
 Increases the effectiveness of epinephrine

52. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
DOBUTamine Hydrochloride (Dobutrex) (1 of 2)
 Class: Adrenergic, inotropic agent
 Mechanism of action: Stimulates beta-1 receptors; increases myocardial contractility
and stroke volume; increases renal blood flow secondary to increased cardiac output
 Indications: Heart failure with a SBP of 70–100 mm Hg and no signs of shock
 Contraindications: Hypersensitivity, poison/drug-induced shock, SBP less than 100
mm Hg and signs of shock, idiopathic hypertrophic subaortic stenosis
 Adverse/side effects: Headache, dyspnea, tachycardia, hypertension, chest pain,
dysrhythmias, nausea, vomiting
 Drug interactions: Sodium bicarbonate and furosemide; beta blockers

53. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
DOBUTamine Hydrochloride (Dobutrex) (2 of 2)
 Dosage and administration
 Adult: IV infusion at 2–20 mcg/kg/min titrated to desired effect
 Pediatric: IV infusion at 2–20 mcg/kg/min titrated to desired effect
 Duration of action
 Onset: 2 min
 Peak effect: 10 min
 Duration: 1–2 min after inclusion discontinued
 Special considerations
 Pregnancy safety: Category B
 Monitor BP closely; hemodynamic monitoring recommended
 Titrate dose to maintain a heart rate increase of no greater than 10% of baseline

54. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
DOPamine Hydrochloride (Intropin) (1 of 2)
 Class: Endogenous catecholamine, adrenergic, vasopressor, inotropic agent
 Mechanism of action: Immediate metabolic precursor to norepinephrine with mixed
alpha adrenergic, beta adrenergic, and dopaminergic effects that are dose-dependent
 Indications: Refractory cardiogenic or distributive shock, hypotension with low cardiac
output states, second-line drug for symptomatic bradycardia
 Contraindications: Hypersensitivity, hypovolemia, pheochromocytoma, uncorrected
tachydysrhythmias, VF
 Adverse/side effects: Headache, anxiety, dyspnea, dysrhythmias, hypotension,
hypertension, palpitations, chest pain, nausea, vomiting
 Drug interactions: Alkaline solutions; MAOIs; TCAs; beta blockers

55. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
DOPamine Hydrochloride (Intropin) (2 of 2)
 Dosage and administration
 Adult: IV/IO infusion at 5–20 mcg/kg/min, slowly titrated to patient response
 Pediatric: Safety and effectiveness not established
 Duration of action
 Onset: Within 5 min
 Peak effect: 5–10 min
 Duration: < 10 min
 Special considerations
 Pregnancy safety: Category C
 Correct hypovolemia before administering; administer via infusion pump
 Extravasation may cause necrosis and sloughing of surrounding tissue
 Slow or stop infusion if tachydysrhythmias or increased ventricular ectopy is
observed

56. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Droperidol (Inapsine) (1 of 2)
 Class: Antiemetic, antipsychotic
 Mechanism of action: Produces tranquilization and sedation; reduces motor
activity and anxiety
 Indications: Chemical restraint, acute delirium or psychosis
 Contraindications: Hypersensitivity; prolonged QT interval; bradycardia, cardiac
disease, MAOI therapy, drugs that prolong QT interval and cause electrolyte
disturbances
 Adverse/side effects: QT interval prolongation, VT, TdP, cardiac arrest,
hypotension, hypertension, tachycardia, dizziness, drowsiness, restlessness,
anxiety, dysphoria, hyperactivity, hallucinations, extrapyramidal symptoms
 Drug interactions: CNS depressants, epinephrine

57. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Droperidol (Inapsine) (2 of 2)
 Dosage and administration
 Adult: Chemical restraint: 2.5 mg slow IV or 5 mg IM
 Pediatric: Not routinely recommended
 Duration of action
 Onset: 3–10 min
 Peak effect: 30 min
 Duration: 2–4 hours
 Special considerations
 Pregnancy safety: Category C
 Cases of QT prolongation and/or TdP have occurred
 Closely monitor vital signs and ECG; monitor the QT interval with a 12-lead ECG
 Document the QT interval and relay findings to the receiving facility staff

58. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Epinephrine (Adrenalin, EpiPen, AsthmaNefrin) (1 of 2)
 Class: Sympathomimetic, sympathetic agonist
 Mechanism of action: Strong alpha adrenergic, strong beta-1, and moderate beta-2
effect
 Indications: Cardiac arrest, bradycardia, shock, anaphylaxis, severe refractory
wheezing, croup/bronchiolitis
 Contraindications: Hypersensitivity, coronary insufficiency, cardiac dilation
 Adverse/side effects: Nervousness, restlessness, headache, tremor, dysrhythmias,
chest pain, increased myocardial oxygen demand, hypertension, palpitations,
nausea, vomiting
 Drug interactions: Other sympathomimetics; alkaline solutions; MAOIs and
antidepressants; beta blockers

59. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Epinephrine (Adrenalin, EpiPen, AsthmaNefrin) (2 of 2)
 Dosage and administration
 Adult: Anaphylaxis: 0.3 mg IM in anterolateral thigh
 Pediatric: Anaphylaxis: (weight < 25 kg) 0.15 mg IM; (weight > 25 kg) 0.3 mg IM
 Duration of action
 Onset: Less than 2 min IV, 3–10 min IM
 Peak effect: Less than 5 min IV, 20 min IM
 Duration: 5–10 min IV, 20–30 min IM
 Special considerations
 Pregnancy safety: Category C
 Carefully document dosage, concentration, route, time of administration, and
patient response
 Administer ASAP in cardiac arrest associated with PEA or asystole

60. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Etomidate (Amidate) (1 of 2)
 Class: Nonbarbiturate hypnotic, anesthesia induction agent
 Mechanism of action: Ultra-short-acting, produces rapid sedation with minimal
cardiovascular or respiratory depression
 Indications: Premedication for medication-facilitated intubation or procedural
sedation
 Contraindications: Hypersensitivity, labor/delivery, or septic shock
 Adverse/side effects: Apnea, respiratory depression, hypoventilation,
hyperventilation, nystagmus, dysrhythmias, hypotension, hypertension, nausea,
vomiting, transient involuntary skeletal muscle movement, pain at injection site
 Drug interactions: Other CNS depressants

61. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Etomidate (Amidate) (2 of 2)
 Dosage and administration
 Adult: 0.2–0.4 mg/kg IV over 30–60 seconds
 Pediatric: 0.2–0.4 mg/kg IV/IO over 30–60 seconds
 Duration of action
 Onset: 30–60 seconds
 Peak effect: 1 min
 Duration: 5–10 min
 Special considerations
 Pregnancy safety: Category C
 Avoid administration into small veins
 Can temporarily cause adrenal gland failure

62. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Famotidine (Pepcid) (1 of 2)
 Class: Antiulcer, H2 blocker
 Mechanism of action: Inhibits volume and concentration of gastric secretions
 Indications: GI ulcer, GI bleeding, GERD, urticaria and/or pruritus
 Contraindications: Hypersensitivity to famotidine or other H2 blockers
 Adverse/side effects: Constipation, diarrhea, rhabdomyolysis, seizures,
pneumonia, agitation, vomiting, headache, dizziness, vitamin B12 deficiency;
prolonged QT interval
 Drug interactions: Iron; ketoconazole, naproxen, pseudoephedrine; metformin

63. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Famotidine (Pepcid) (2 of 2)
 Dosage and administration
 Adult: 20 mg IV, 20 mg orally twice daily
 Pediatric: 0.25 mg/kg dose every 12 hours IV, 0.5 mg/kg orally
 Duration of action
 Onset: 60 min
 Peak effect: 1–3 hours
 Duration: 10–12 hours
 Special considerations
 Pregnancy safety: Category B
 Fewer adverse effects and drug interactions and a longer duration of action than
cimetidine
 Can be given orally or IV

64. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Fentanyl Citrate (Sublimaze) (1 of 3)
 Class: Opioid analgesic; synthetic opioid; Schedule II drug
 Mechanism of action: Binds to opioid receptors
 Indications: Pain management, anesthesia adjunct, severe respiratory distress
 Contraindications: Hypersensitivity; MAOI taken in past 14 days; GCS <15,
hypotension, hypoxia, hypoventilation
 Adverse/side effects: Confusion, paradoxical excitation, delirium, drowsiness, CNS
or respiratory depression, apnea, dyspnea, dysrhythmias, hypotension, syncope,
nausea, vomiting, abdominal pain, dehydration, fatigue
 Drug interactions: Other CNS depressants

65. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Fentanyl Citrate (Sublimaze) (2 of 3)
 Dosage and administration
 Adult: Severe respiratory distress: 25 mcg mixed in 2 mL saline nebulized; Moderate
discomfort: 1 mcg/kg IM/IN; Severe discomfort: 1 mcg/kg IV/IO
 Pediatric: Moderate discomfort: 1 mcg/kg IM/IN; Severe discomfort: 1 mcg/kg IV/IO
 Duration of action
 Onset: Immediate
 Peak effect: 3–5 min
 Duration: 30–60 min

66. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Fentanyl Citrate (Sublimaze) (3 of 3)
 Special considerations
 Pregnancy safety: Category C
 Opioid overdose: may rapidly exhibit chest wall rigidity and require positive end-expiratory
pressure, in addition to multiple/larger doses of naloxone

67. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Fibrinolytic Agents
 Dissolve blood clots and restore blood flow
 Can be given with other agents to maintain vessel patency after the clot is
dissolved

68. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Glucagon (GlucaGen) (1 of 2)
 Class: Hyperglycemic agent, pancreatic hormone, insulin antagonist
 Mechanism of action: Increases blood glucose level; stabilizes cardiac rhythm in beta
blocker overdose; minimal positive inotropic and chronotropic responses; decreases
GI motility and secretion
 Indications: Altered mental status with hypoglycemia; symptomatic bradycardia
caused by beta blocker/calcium channel blocker overdose
 Contraindications: Hypersensitivity, pheochromocytoma, hyperglycemia, insulinoma
 Adverse/side effects: Dizziness, headache, hypotension, tachycardia, nausea,
vomiting, rebound hypoglycemia
 Drug interactions: Incompatible in solution with most other substances

69. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Glucagon (GlucaGen) (2 of 2)
 Dosage and administration
 Adult: Hypoglycemia: 1 mg IM/IN; Calcium channel or beta blocker overdose: 5 mg slowly
via IV push
 Pediatric: Hypoglycemia: 1 mg IM/IN (>20 kg or >5 y/o.) or 0.5 mg IM/ IN (<20 kg or <5
y/o); Calcium channel or beta blocker overdose: 1 mg slowly via IV push (25–40 kg) every
5 min; 0.5 mg slowly via IV push (less than 25 kg) every 5 min
 Duration of action
 Onset: 1 min
 Peak effect: 5–20 min
 Duration: 60–90 min
 Special considerations
 Pregnancy safety: Category B
 Ineffective if glycogen stores are depleted

70. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Glucose, Oral (Insta-Glucose) (1 of 2)
 Class: Hyperglycemic, carbohydrate
 Mechanism of action: Increases circulating blood glucose levels
 Indications: Conscious patients with suspected hypoglycemia
 Contraindications: Hypersensitivity
 Adverse/side effects: Nausea, vomiting
 Drug interactions: None

71. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Glucose, Oral (Insta-Glucose) (2 of 2)
 Dosage and administration
 Adult: 25 g orally
 Pediatric: 0.5–1 g/kg orally
 Duration of action
 Onset: 10 min
 Peak effect: Variable
 Duration: Variable
 Special considerations
 Must be swallowed
 Check reading before administering and repeat at least 10 min after administration
 Document reassessment of vital signs and mental status.

72. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Glycoprotein IIb/IIIa Inhibitors
 Block the bindings of fibrinogen to glycoprotein IIb/IIIa receptors
 Inhibit platelet aggregation

73. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Haloperidol (Haldol) (1 of 2)
 Class: Tranquilizer, antipsychotic
 Mechanism of action: Antagonizes dopamine-1 and dopamine-2 receptors;
depresses reticular activating system and inhibits release of hypothalamic and
hypophyseal hormones
 Indications: Acute psychotic episodes or agitated/violent behavior, anxiety
 Contraindications: Hypersensitivity, CNS depression, neuroleptic malignant
syndrome, seizure disorder, Parkinson disease, agitation, shock and hypoxia
 Adverse/side effects: Seizures, sedation, confusion, restlessness,
extrapyramidal reactions, dystonia, respiratory depression, hypotension,
tachycardia, constipation, dry mouth, nausea, vomiting, drooling, blurred vision
 Drug interactions: Alcohol; antihypertensive medications; amphetamines and
epinephrine; other CNS depressants

74. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Haloperidol (Haldol) (2 of 2)
 Dosage and administration
 Adult: Chemical restraint: 5 mg IV or 10 mg IM; Anxiety: 5 mg IV
 Pediatric (6–12 y/o): Chemical restraint: 1–3 mg IM
 Duration of action
 Onset: 5–10 min IV, 10–20 min IM
 Peak effect: 30–45 min
 Duration: 12–24 hours
 Special considerations
 Pregnancy safety: Category C
 Continuous cardiac monitoring is required if administering IV
 Monitor QT interval with a 12-lead ECG.

75. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Helium Gas Mixture (Heliox) (1 of 2)
 Class: Medical gas
 Mechanism of action: Reduces airflow resistance within bronchial tree; may also
reduce work of breathing and improve pulmonary gas exchange efficiency
 Indications: Bronchospasm
 Contraindications: None
 Adverse/side effects: May reduce effectiveness of coughing
 Drug interactions: Unknown

76. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Helium Gas Mixture (Heliox) (2 of 2)
 Dosage and administration
 Adult and pediatric: Mixture of 80% helium and 20% oxygen using nonrebreathing
mask (normoxic); 70% helium and 30% oxygen or 60% helium and 40% oxygen
(hypoxemic)
 Duration of action
 Onset: Immediate
 Peak effect: Minutes
 Duration: Eliminated within a few breaths
 Special considerations
 Pregnancy safety: Not classified
 The lower the helium percentage, the less effective in reducing work of breathing
 Should not be routinely administered to children with respiratory distress

77. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
HydrALAZINE (Apresoline) (1 of 2)
 Class: Antihypertensive, vasodilator
 Mechanism of action: Relaxes arteriolar smooth muscle; thought to interfere with
calcium movement resulting in lower BP
 Indications: Pregnancy-induced hypertension lasting more than 15 min
 Contraindications: Hypersensitivity, CAD, mitral valve rheumatic heart disease
 Adverse/side effects: Headache, nausea, flushing, hypotension, palpitations,
tachycardia, dizziness, angina; paresthesia, numbness, tingling
 Drug interactions: MAOIs; other antihypertensives; NSAIDs

78. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
HydrALAZINE (Apresoline) (2 of 2)
 Dosage and administration
 Adult: 5 mg IV
 Pediatric: Not usually indicated in prehospital setting
 Duration of action
 Onset: 5–20 min
 Peak effect: 10–80 min
 Duration: 2–12 hours
 Special considerations
 Pregnancy safety: Category C, not recommended for long-term use
 Usually lowers DBP more than SBP

79. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Hydrocortisone Sodium Succinate (Solu-Cortef) (1 of 2)
 Class: Corticosteroid, adrenal glucocorticoid
 Mechanism of action: Anti-inflammatory; immunosuppressive
 Indications: Shock with history of adrenal insufficiency or long-term steroid
dependence: anaphylaxis, asthma, and COPD
 Contraindications: Hypersensitivity, systemic fungal infections, premature infants
 Adverse/side effects: Headache, vertigo, heart failure, hypertension, fluid
retention, nausea
 Drug interactions: ASA and NSAIDs; diuretics

80. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Hydrocortisone Sodium Succinate (Solu-Cortef) (2 of 2)
 Dosage and administration
 Adult: 2 mg/kg IV/IM; IM administration preferred
 Pediatric: Consult medical direction
 Duration of action
 Onset: 1 hour
 Peak effect: Variable
 Duration: 8–12 hours
 Special considerations
 Pregnancy safety: Category C
 Can mask infection and increase blood glucose levels
 Prolonged use can result in many adverse reactions and side effects

81. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
HYDROmorphone (Dilaudid) (1 of 2)
 Class: Synthetic opioid analgesic; Schedule II drug
 Mechanism of action: Inhibits pain pathways; produces analgesia, respiratory
depression, and sedation
 Indications: Acute moderate to severe pain
 Contraindications: Hypersensitivity, MAOI use in past 14 days, GI obstruction,
older adults, GCS < 15, hypotension, hypoxia, hypoventilation, head injury,
concomitant use of CNS depressants
 Adverse/side effects: Dizziness, drowsiness, headache, weakness,
hypotension, syncope, apnea
 Drug interactions: MAOIs, SSRIs; CNS depressants

82. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
HYDROmorphone (Dilaudid) (2 of 2)
 Dosage and administration
 Adult and pediatric: 0.015 mg/kg IM/IV/IO
 Duration of action
 Onset: 5 min IV, 15–30 min oral
 Peak effect: Variable IM, 10–20 min IV, 30–60 min oral
 Duration: 2–3 hours
 Special considerations
 Pregnancy safety: Category C
 Reportedly 5–7 times more potent than morphine with shorter duration of analgesia
 Respiratory depression is managed with naloxone.
 Document pain severity.

83. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Hydroxocobalamin (Cyanokit) (1 of 2)
 Class: Antidote, cyanide poisoning adjunct
 Mechanism of action: Binds with cyanide to form nontoxic cyanocobalamin
preventing toxic effects
 Indications: Known or suspected cyanide poisoning
 Contraindications: Hypersensitivity
 Adverse/side effects: Hypertension, allergic reactions, GI bleeding, nausea,
vomiting, dyspepsia, dyspnea, dizziness, headache, injection site reactions
 Drug interactions: Diazepam, DOBUTamine, DOPamine, fentanyl, NTG, propofol,
sodium nitrite, or sodium thiosulfate

84. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Hydroxocobalamin (Cyanokit) (2 of 2)
 Dosage and administration
 Adult: 5 g over 15 min at a rate of 10–15 mL/min
 Pediatric: 70 mg/kg IV at a rate of 10–15 mL/min
 Duration of action
 Onset: Rapid
 Peak effect: 8–10 min
 Duration: Varies
 Special considerations
 Pregnancy safety: Category C
 Preferred agent in known or suspected cyanide poisoning
 Causes discoloration of skin and urine, rendering pulse oximetry values inaccurate
 Best to perform prehospital phlebotomy before administration

85. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Ibuprofen (Advil, Motrin) (1 of 2)
 Class: NSAID, nonopioid analgesic
 Mechanism of action: Inhibits prostaglandin synthesis
 Indications: Acute pain management, antipyretic
 Contraindications: ASA/NSAID hypersensitivity, ASA-sensitive asthma, renal
function impairment, pregnancy, peptic ulcer disease, GI bleeding,
thrombocytopenia, coagulation defects, necrotizing enterocolitis, perioperative
pain in the setting of coronary artery bypass graft surgery
 Adverse/side effects: Headache, dizziness, drowsiness, fatigue, restless sleep,
thirst, sweating, tingling/numbness in hands and feet, tinnitus, eye irritation,
fluid retention, nausea, vomiting, frequent urination
 Drug interactions: Other agents that affect hemostasis

86. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Ibuprofen (Advil, Motrin) (2 of 2)
 Dosage and administration
 Adult: 10 mg/kg orally for patients older than 6 months
 Pediatric: Febrile seizures: 10 mg/kg orally
 Duration of action
 Onset: 30–60 min
 Peak effect: 1–2 hours
 Duration: 6–8 hours
 Special considerations
 Can increase risk of heart attack or stroke in patients with risk factors for heart
disease; can also increase risk of heart failure

87. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Ipratropium Bromide (Atrovent) (1 of 2)
 Class: Anticholinergic, bronchodilator, short-acting antimuscarinic agent
 Mechanism of action: Antagonizes action of acetylcholine on bronchial smooth
muscle, resulting in bronchodilation
 Indications: Persistent bronchospasm, COPD exacerbation, toxic inhalation
 Contraindications: Hypersensitivity to ipratropium, atropine, alkaloids, peanuts
 Adverse/side effects: Headache, dizziness, nervousness, tremor, dyspnea,
worsening COPD symptoms, hypertension, tachycardia, palpitations, flushing,
MI, dry mouth, nausea, vomiting, GI distress
 Drug interactions: Other antimuscarinic or anticholinergic medications

88. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Ipratropium Bromide (Atrovent) (2 of 2)
 Dosage and administration
 Adult and pediatric: 0.5 mg nebulized, up to three doses, in conjunction with albuterol
 Duration of action
 Onset: 5–15 min
 Peak effect: 1.5–2 hours
 Duration: 4–6 hours
 Special considerations
 Pregnancy safety: Category B
 Shake well before use.
 Should not be given to children with bronchiolitis in the prehospital setting

89. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Isopropyl Alcohol (1 of 2)
 Class: Secondary alcohol
 Mechanism of action: Used as an antiseptic and may be used as an antiemetic
 Indications: Nausea and vomiting
 Contraindications: None
 Adverse/side effects: None in adults
 Drug interactions: None

90. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Isopropyl Alcohol (2 of 2)
 Dosage and administration
 Adult: Inhale vapor from wipe three times every 15 min
 Pediatric: Consult medical direction
 Duration of action
 Onset: Within 10 min
 Peak effect: Variable
 Duration: Variable
 Special considerations
 None

91. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Ketamine (Ketalar) (1 of 2)
 Class: Analgesic, general anesthetic, dissociative anesthetic; Schedule III drug
 Mechanism of action: Blocks pain receptors, minimizes spinal cord activity
 Indications: Procedural sedation, agitated/violent behavior, pain control
 Contraindications: Hypersensitivity, infants younger than 3 months, pregnancy,
angina, heart failure, hyperthyroidism, schizophrenia, hazardous hypertension;
head trauma, intracranial mass lesions, intracranial bleeding, or hydrocephalus
 Adverse/side effects: Hypertension, hallucinations, nausea/vomiting,
nystagmus, bronchodilation, tachycardia, increased secretions, hypersalivation,
laryngospasm, respiratory depression, elevations in BP and heart rate
 Drug interactions: Alcohol, cannabis, opioids, barbiturates, and nondepolarizing
neuromuscular blockers

92. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Ketamine (Ketalar) (2 of 2)
 Dosage and administration
 Adult: Procedural sedation: 1–2 mg/kg IV push over 1–2 min; Moderate discomfort:
0.5 mg/kg IN; Severe discomfort: 0.25 mg/kg IM/IV/IO; Chemical restraint: 2 mg/kg
IV or 4 mg/kg IM
 Pediatric: Procedural sedation: 1–2 mg/kg IV/IO push over 1–2 min; Chemical
restraint: 1 mg/kg IV or 3 mg/kg IM
 Duration of action
 Onset: 30 seconds
 Peak effect: 30 seconds–5 min
 Duration: 10–15 min
 Special considerations
 Pregnancy safety: Not classified
 Shorting acting and less toxic than PCP

93. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Ketorolac Tromethamine (Toradol) (1 of 2)
 Class: NSAID, nonopioid analgesic
 Mechanism of action: Inhibits prostaglandin synthesis
 Indications: Moderate to severe pain
 Contraindications: NSAID or ASA allergy; ASA-sensitive asthma; renal
insufficiency; pregnancy; peptic ulcer disease; hypotension; breastfeeding;
renal impairment; GI bleeding; coagulation defects
 Adverse/side effects: Drowsiness, dizziness, headache, sedation,
bronchospasm, dyspnea, edema, vasodilation, hypotension, hypertension, GI
bleeding, diarrhea, dyspepsia, nausea
 Drug interactions: Anticoagulants; TCAs

94. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Ketorolac Tromethamine (Toradol) (2 of 2)
 Dosage and administration
 Adult: Moderate discomfort: 30 mg IM; Severe discomfort: 15 mg IV
 Pediatric (2–16 y/o): Moderate discomfort: 1 mg/kg IM; Severe discomfort: 0.5
mg/kg IV; Febrile seizures: 1 mg/kg IV
 Duration of action
 Onset: 10 min
 Peak effect: 1–2 hours
 Duration: 2–6 hours
 Special considerations
 Pregnancy safety: Category C
 Use caution if pain is from a traumatic source.
 Document pain severity.

95. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Levalbuterol (Xopenex) (1 of 2)
 Class: Sympathomimetic, bronchodilator, short-acting beta-2 adrenergic agonist
 Mechanism of action: Stimulates beta-2 receptors, resulting in smooth muscle
relaxation of the bronchial tree and peripheral vasculature
 Indications: Acute bronchospasm with reversible obstructive airway disease;
bronchospasm prophylaxis with asthma
 Contraindications: Hypersensitivity; MAOI use in past 14 days; angioedema,
tachydysrhythmias, and severe cardiac disease; drugs that prolong QT interval
 Adverse/side effects: Headache, dizziness, restlessness, hallucinations, throat
irritation, tachycardia, hypertension, hypotension, dysrhythmias, angina,
nausea, vomiting, dyspepsia, tremors, hypokalemia, hyperglycemia
 Drug interactions: Bronchodilators, TCAs, MAOIs, other adrenergic drugs

96. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Levalbuterol (Xopenex) (2 of 2)
 Dosage and administration
 Adult: 1.25 mg in 3 mL NS by nebulizer over 5–15 min; repeat as necessary
 Pediatric: 0.63–1.25 mg in 3 mL NS by nebulizer over 5–15 min; repeat as
necessary
 Duration of action
 Onset: 5–15 min
 Peak effect: 60–90 min
 Duration: 6–8 hours
 Special considerations
 Pregnancy safety: Category C

97. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Lidocaine Hydrochloride (Xylocaine) (1 of 2)
 Class: Antidysrhythmic (Class Ib), anesthetic
 Mechanism of action: Inhibits recovery after repolarization, decreases
myocardial excitability and conduction velocity; blocks conduction of nerve
impulses; decreases ICP response
 Indications: Cardiac arrest; stable polymorphic VT; local anesthetic
 Contraindications: Hypersensitivity, second- or third-degree AV block,
prophylactic use in AMI
 Adverse/side effects: Drowsiness, confusion, seizures, slurred speech,
hypotension, dysrhythmias, cardiac arrest, nausea, vomiting
 Drug interactions: IV phenytoin; procainamide

98. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Lidocaine Hydrochloride (Xylocaine) (2 of 2)
 Dosage and administration
 Adult: Cardiac arrest: 1–1.5 mg/kg IV/IO; Stable VT and tachycardia: 1–1.5 mg/kg
IV/IO
 Pediatric: IV/IO dose: 1 mg/kg IV/IO push; ET dose: 2–3 mg/kg; RSI: 1–2 mg/kg
IV/IO
 Duration of action
 Onset: 1–5 min
 Peak effect: 5–10 min
 Duration: 10–20 min
 Special considerations
 Pregnancy safety: Category B
 Reduce maintenance infusion with impaired liver function or left ventricular
dysfunction; discontinue if signs of toxicity develop

99. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Lorazepam (Ativan) (1 of 2)
 Class: Benzodiazepine, sedative-hypnotic, anticonvulsant; Schedule IV drug
 Mechanism of action: Anxiolytic, anticonvulsant, and sedative effect;
suppresses seizure activity; inhibits GABA receptors
 Indications: Uncontrolled shivering associated with heat exposure, active
seizures, anxiety/sedation, chemical restraint
 Contraindications: Hypersensitivity, neurologic or respiratory depression,
glaucoma, sleep apnea, shock, suspected drug abuse
 Adverse/side effects: Dizziness, drowsiness, CNS depression, apnea,
hypotension, bradycardia
 Drug interactions: Other CNS depressants

100. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Lorazepam (Ativan) (2 of 2)
 Dosage and administration
 Adult: Anxiety/sedation: 0.1 mg/kg IV slowly over 2 min or 4 mg IM; Heat exposure:
1 mg IV/IO or 2 mg IM; Chemical restraint: 2 mg IV or 4 mg IM
 Pediatric: Seizures: 0.1 mg/kg IV/IO slowly over 2 min; Heat exposure: 0.1 mg/kg
IV/IM/IO; Chemical restraint: 0.05 mg/kg IV/IM
 Duration of action
 Onset: 2–5 min IV; 15–30 min IM
 Peak effect: Less than 15 min IV, 2–3 hours IM
 Duration: 6–8 hours
 Special considerations
 Pregnancy safety: Category D
 Monitor respiratory rate and BP; have advanced airway equipment readily available

101. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Magnesium Sulfate (1 of 2)
 Class: Electrolyte, Class V antidysrhythmic
 Mechanism of action: Depresses CNS, blocks peripheral neuromuscular
transmission, produces anticonvulsant effects
 Indications: TdP, bronchoconstriction with impending respiratory failure, seizure
during third trimester of pregnancy or postpartum
 Contraindications: Hypersensitivity, heart block, myocardial damage, diabetic
coma, hypermagnesemia, hypercalcemia
 Adverse/side effects: Drowsiness, CNS and respiratory depression, respiratory
tract paralysis, vasodilation
 Drug interactions: Other CNS depressants

102. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Magnesium Sulfate (2 of 2)
 Dosage and administration
 Adult: Hypertension: 4 g of 20% solution IV/IO over 20 min, followed by 1 g/h IV/IO;
Seizure with pregnancy: 4 g of 50% solution IV/IO over 10–20 min, followed by 1
g/h IV/IO; Cardiac arrest: 1–2 g IV/IO
 Pediatric: Pulseless VT with TdP: 25–50 mg/kg IV/IO bolus of 50% solution; TdP
with pulses: 25–50 mg/kg IV/IO of 50% solution over 10–20 min; Status
asthmaticus: 25–50 mg/kg IV/IO of 50% solution over 15–30 min
 Duration of action
 Onset: Immediate
 Peak effect: Variable
 Duration: 30 min
 Special considerations
 Pregnancy safety: Category D

103. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Mannitol (Osmitrol) (1 of 2)
 Class: Osmotic diuretic
 Mechanism of action: Promotes movement of fluid from intracellular space to
extracellular space; decreases cerebral edema and ICP; promotes excretion of toxins
 Indications: ICP in neurologic emergencies; toxic substances and metabolites
 Contraindications: Hypersensitivity, hypotension, pulmonary edema, electrolyte
abnormalities, severe dehydration, intracranial bleeding, heart failure
 Adverse/side effects: Headache, confusion, blurred vision, tachycardia, chest pain,
heart failure, hypotension, hypokalemia, hyponatremia, nausea/vomiting, dehydration,
rebound increases in ICP
 Drug interactions: Salicylates and NSAIDs; nitrates

104. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Mannitol (Osmitrol) (2 of 2)
 Dosage and administration
 Adult: 0.5–1 g/kg IV infusion over 5–10 min
 Pediatric: Consult medical direction
 Duration of action
 Onset: 1–3 hours for diuretic effect; 15 min for reduction of ICP
 Peak effect: Variable
 Duration: 4–6 hours for diuretic effect; 3–8 hours for reduction of ICP
 Special considerations
 Pregnancy safety: Category C
 Usage and dosages in emergency care are controversial
 Have ventilatory support available.

105. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Meperidine Hydrochloride (Demerol) (1 of 2)
 Class: Opioid analgesic; synthetic opioid; Schedule II drug
 Mechanism of action: Acts as an analgesic and sedative
 Indications: Analgesia for moderate to severe pain
 Contraindications: Hypersensitivity, diarrhea caused by poisoning, MAOI in past
14 days, delivery of premature infant, GCS < 15, hypotension, hypoxia,
hypoventilation
 Adverse/side effects: Seizures, confusion, sedation, headache, hallucinations,
increased ICP, respiratory depression, apnea, hypotension, syncope,
dysrhythmias, nausea/vomiting, constipation, sweating
 Drug interactions: TCAs, alcohol, other CNS depressants

106. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Meperidine Hydrochloride (Demerol) (2 of 2)
 Dosage and administration
 Adult: 50–100 mg IM; 25–50 mg slowly IV/IO
 Pediatric: Not recommended
 Duration of action
 Onset: 10–15 min IM, within 1 min IV
 Peak effect: Within 60 min IM, 5–7 min IV
 Duration: 2–4 hours IV
 Special considerations
 Pregnancy safety: Category C
 Use with caution in patients with asthma and COPD.
 May aggravate seizures in patients with known convulsive disorders
 Document pain severity.

107. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
MethyIPREDNISolone Sodium Succinate (Solu-Medrol) (1 of 2)
 Class: Corticosteroid, synthetic glucocorticoid, anti-inflammatory agent
 Mechanism of action: Suppresses acute and chronic inflammation; potentiates
vascular smooth muscle relaxation
 Indications: Allergic reaction, anaphylaxis, acute bronchospastic disease, shock
 Contraindications: Hypersensitivity, infections, premature infants, GI bleeding,
heart failure, hypertension, recent AMI, renal disease, seizure disorder, Cushing
disease
 Adverse/side effects: Depression, euphoria, headache, restlessness, seizure,
nausea, vomiting, peptic ulcer, fluid retention, hypernatremia, hyperkalemia
 Drug interactions: Insulin and hypoglycemic agents

108. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
MethyIPREDNISolone Sodium Succinate (Solu-Medrol) (2 of 2)
 Dosage and administration
 Adult: Bronchospasm: 2 mg/kg IV/IO/IM; Shock: 2 mg/kg IV
 Pediatric: Anaphylaxis: 2 mg/kg IV/IO/IM (loading), 0.5 mg/kg IV every 6 hours or 1
mg/kg IV every 12 hours up to 120 mg/day (maintenance)
 Duration of action
 Onset: 1–2 hours
 Peak effect: Variable
 Duration: 8–24 hours
 Special considerations
 Pregnancy safety: Category C
 Can mask infection
 Can increase blood glucose levels

109. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Metoclopramide (Reglan) (1 of 2)
 Class: Antiemetic, direct-acting cholinergic agonist, prokinetic age
 Mechanism of action: Blocks dopamine and serotonin receptors; sensitizes
tissues to acetylcholine; increases upper GI motility; increases lower
esophageal sphincter tone
 Indications: Nausea, vomiting
 Contraindications: Hypersensitivity, GI hemorrhage, mechanical obstruction;
history of seizures, tardive dyskinesia, dystonic reaction; pheochromocytoma;
Parkinson disease
 Adverse/side effects: Nausea/vomiting, headache, fatigue, rash, dystonic
reaction, confusion, AV block, bradycardia, hallucinations, laryngospasm
 Drug interactions: CNS depressants, antihistamines, anticholinergics, MAOIs;
dopamine agonists; ASA

110. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Metoclopramide (Reglan) (2 of 2)
 Dosage and administration
 Adult: 10 mg IV/IM
 Pediatric (>2 y/o, >12 kg): 0.1 mg/kg IM/IV; may repeat once in 20–30 min
 Duration of action
 Onset: 1–3 min IV, 30–60 min
 Peak effect: Immediate
 Duration: 1–2 hours
 Special considerations
 Pregnancy safety: Category B
 Geriatric patients should receive the lowest dose that is effective

111. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Midazolam Hydrochloride (Versed) (1 of 3)
 Class: Benzodiazepine, anticonvulsant, antianxiety agent, anxiolytic, sedative-
hypnotic; Schedule IV drug
 Mechanism of action: Causes sedative, anxiolytic, amnesic, and hypnotic
effects
 Indications: Uncontrolled shivering with heat exposure, active seizures,
chemical restraint, severe respiratory distress, sedation, poisoning/overdose
 Contraindications: Hypersensitivity, neurologic or respiratory depression, acute
narrow-angle glaucoma, sleep apnea, shock, alcohol intoxication, overdose
 Adverse/side effects: Headache, somnolence, respiratory depression/arrest,
hypotension, cardiac arrest, nausea, vomiting
 Drug interactions: Other CNS depressants

112. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Midazolam Hydrochloride (Versed) (2 of 3)
 Dosage and administration
 Adult: Heat exposure: 2.5 mg IV/IN/IO or 5 mg IM; Seizures: 0.1 mg/kg IV/IO slowly
over 2 min; Chemical restraint: 5 mg IV/IM/IN; Respiratory distress: 2–5 mg IV;
Procedural sedation: 0.1–0.3 mg/kg IV; Overdose: 0.1 mg/kg in 2-mg increments
via slow IV push over 1–2 min
 Pediatric: Heat exposure: 0.1 mg/kg IV/IO or 0.2 mg/kg IN/IM; Seizures: 0.1 mg/kg
IV/IO slowly over 2 min; Chemical restraint: 0.05–0.1 mg/kg IV or 0.1–0.15 mg/kg
IM or 0.3 mg/kg IN; Overdose: 0.1 mg/kg in 2-mg increments via slow IV push over
1–2 min or 0.2 mg/kg IN

113. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Midazolam Hydrochloride (Versed) (3 of 3)
 Duration of action
 Onset: Immediate IV/IN, 15 min IM
 Peak effect: 3–5 min IV/IN, 30–60 min IM
 Duration: <2 hours IV/IN, 1–6 hours IM
 Special considerations
 Pregnancy safety: Category D

114. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Milrinone (Primacor) (1 of 2)
 Class: Inotrope
 Mechanism of action: Increases myocardial contractility; dilating effect on vascular
smooth muscle
 Indications: Heart failure in postoperative cardiovascular surgical patients, shock
 Contraindications: Hypersensitivity
 Adverse/side effects: Headache, nausea, vomiting, hypotension, hypokalemia,
bronchospasm, SVT, ventricular dysrhythmias
 Drug interactions: Catecholamines

115. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Milrinone (Primacor) (2 of 2)
 Dosage and administration
 Consult medical direction or follow dosing ordered by sending physician
 Duration of action
 Onset: 5–15 min
 Peak effect: Unknown
 Duration: 3–6 hours
 Special considerations
 Pregnancy safety: Category C
 Hemodynamic monitoring is required.
 Closely monitor BP and heart rate.

116. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Morphine Sulfate (Roxanol, MS Contin) (1 of 2)
 Class: Opioid analgesic; Schedule II drug
 Mechanism of action: Alleviates pain, suppresses fear and anxiety
 Indications: Acute pain
 Contraindications: Hypersensitivity, MAOI in past 14 days, paralytic ileus,
diarrhea, heart failure, head injuries, brain tumors, delirium tremens, seizure
disorders, premature birth, bronchial asthma, upper airway obstruction, GCS
<15, hypotension, hypoventilation
 Adverse/side effects: Confusion, sedation, headache, CNS or respiratory
depression, apnea, bronchospasm, dyspnea, hypotension, orthostatic
hypotension, syncope, bradycardia, tachycardia, nausea, vomiting, dry mouth
 Drug interactions: Other CNS depressants; MAOIs

117. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Morphine Sulfate (Roxanol, MS Contin) (2 of 2)
 Dosage and administration
 Adult: Discomfort: 0.1 mg/kg IM; Severe discomfort: 0.1 mg/kg slow IV/IO; STEMI:
2–4 mg slow IV (initial dose), 2–8 mg at 5–15-min intervals (repeat dose);
NSTEMI/unstable angina: 1–5 mg slow IV push
 Pediatric: 0.1–0.2 mg/kg per dose IV/IO/ IM
 Duration of action
 Onset: Immediate
 Peak effect: 20 min
 Duration: 2–4 hours
 Special considerations
 Pregnancy safety: Category C
 Use with caution in older patients and patients with asthma or susceptible to CNS
depression

118. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Naloxone Hydrochloride (Narcan, EVZIO) (1 of 2)
 Class: Opioid antagonist, opioid reversal agent, antidote
 Mechanism of action: Reverses respiratory depression and sedation secondary to
opioids
 Indications: CNS and respiratory depression
 Contraindications: Hypersensitivity or allergy
 Adverse/side effects: Restlessness, seizures, dyspnea, pulmonary edema,
hypotension, hypertension, dysrhythmias, diaphoresis, nausea, vomiting,
withdrawal symptoms
 Drug interactions: Bisulfite and alkaline solutions

119. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Naloxone Hydrochloride (Narcan, EVZIO) (2 of 2)
 Dosage and administration
 Adult: 0.4–2 mg IV/IO/IM/ET tube or up to 4 mg IN
 Pediatric: 0.1 mg/kg IV/IO/IM/IN/ET tube; 2 mg IV/IM/ET tube
 Duration of action
 Onset: <2 min IV, 2–10 min IM/IN
 Peak effect: <2 min IV, 2–10 min IM/IN
 Duration: 20–120 min
 Special considerations
 Pregnancy safety: Category C
 Repeat dosing may be required
 Can result in the sudden onset of opioid withdrawal

120. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
NIFEdipine (Procardia, Adalat, Nifedical) (1 of 2)
 Class: Calcium channel blocker
 Mechanism of action: Inhibits movement of calcium ions across cell
membranes; inhibits cardiac and vascular smooth muscle contraction
 Indications: HAPE, pregnancy-induced hypertension
 Contraindications: Hypersensitivity; cardiogenic shock; immediate-release
preparation for urgent or emergent hypertension
 Adverse/side effects: Headache, dizziness, nervousness, weakness, mood
changes, dyspnea, cough, wheezing, heart failure, MI, ventricular dysrhythmias,
hypotension, syncope, nausea, abdominal discomfort, diarrhea
 Drug interactions: Beta blockers, theophylline, antihypertensives

121. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
NIFEdipine (Procardia, Adalat, Nifedical) (2 of 2)
 Dosage and administration
 Adult: HAPE: 30 mg extended-release preparation orally every 12 hours or 20 mg
every 8 hours; Hypertension: 10 mg orally
 Pediatric: Data unavailable
 Duration of action
 Onset: 15–30 min
 Peak effect: 1–3 hours
 Duration: 6–8 hours
 Special considerations
 Pregnancy safety: Category C
 Can be used for HAPE when descent is impossible or delayed and reliable access
to supplemental oxygen or portable hyperbaric therapy is unavailable

122. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Nitroglycerin (Nitrostat, Nitrolingual Pumpspray,
NitroQuick, Nitro-Bid, Tridil) (1 of 2)
 Class: Vasodilator, nitrate, antianginal
 Mechanism of action: Smooth muscle relaxant; dilates peripheral arterioles and
veins; decreases heart’s workload and myocardial oxygen demand
 Indications: Ischemic chest pain, hypertension, heart failure, pulmonary edema
 Contraindications: Hypersensitivity, hypotension, hypovolemia, intracranial
bleeding, pericardial tamponade, severe bradycardia or tachycardia, RV
infarction; hepatic disease, anemia, diabetes mellitus, pregnancy, breastfeeding
 Adverse/side effects: Headache, dizziness, reflex tachycardia, syncope,
hypotension, nausea, vomiting, dry mouth, muscle twitching, diaphoresis
 Drug interactions: Alcohol, beta blockers, calcium channel blockers,
antihypertensives, benzodiazepines, phenothiazines, and other vasodilators

123. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Nitroglycerin (Nitrostat, Nitrolingual Pumpspray,
NitroQuick, Nitro-Bid, Tridil) (2 of 2)
 Dosage and administration
 Adult: SL: 0.3–0.4 mg; Spray: 1–2 sprays; NTG IV: 12.5–25 mcg bolus, then 10
mcg/min infusion; increase by 10 mcg/min every 3–5 min
 Pediatric: Not recommended
 Duration of action
 Onset: 1–3 min
 Peak effect: 5–10 min
 Duration: 20–30 min SL, 1–10 min after IV
 Special considerations
 Pregnancy safety: Category C
 Rule out RV infarction before administering.

124. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Nitroprusside (Nitropress) (1 of 2)
 Class: Antihypertensive, vasodilator
 Mechanism of action: Reduces afterload, resulting in decreased BP and
increased cardiac output
 Indications: Heart failure, acute and symptomatic hypertension
 Contraindications: Hypersensitivity, hypotension, decreased cerebral perfusion,
heart failure with reduced peripheral vascular resistance
 Adverse/side effects: Confusion, restlessness, flushing, dizziness, headache,
palpitations, dysrhythmias, hypotension, methemoglobinemia,
cerebrovasodilation leading to increased ICP
 Drug interactions: Ganglionic blocking agents, general anesthetics, other
antihypertensives, and sympathomimetics

125. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Nitroprusside (Nitropress) (2 of 2)
 Dosage and administration
 Consult medical direction or follow dosing ordered by sending physician
 Duration of action
 Onset: Immediate
 Peak effect: Rapid
 Duration: 1–10 min
 Special considerations
 Pregnancy safety: Category C
 Light sensitive; keep covered with an opaque material
 Can cause cyanide toxicity

126. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Nitrous Oxide 50:50 (Nitronox) (1 of 2)
 Class: Gaseous analgesic and anesthetic.
 Mechanism of action: Exact mechanism is unknown.
 Indications: Analgesia in patient who is capable of self-administration
 Contraindications: Hypersensitivity, impaired consciousness, head injury,
inability to follow instructions, decompression illness, respiratory compromise,
abnormal air-filled cavities, maxillofacial trauma or facial burns
 Adverse/side effects: Light-headedness, headache, dizziness, confusion,
nausea, vomiting, hallucinations
 Drug interactions: CNS depressants

127. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Nitrous Oxide 50:50 (Nitronox) (2 of 2)
 Dosage and administration
 Adult and pediatric: Self-administered
 Duration of action
 Onset: 2–5 min
 Peak effect: 2–5 min
 Duration: 2–5 min
 Special considerations
 Pregnancy safety: Category C
 Risk of rescuer exposure
 Ineffective in 20% of the population
 Document pain severity

128. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Norepinephrine Bitartrate (Levophed, Levarterenol) (1 of 2)
 Class: Sympathomimetic, vasopressor
 Mechanism of action: Increases systemic BP and coronary artery blood flow
 Indications: Neurogenic shock, hypotension unresponsive to fluid resuscitation
 Contraindications: Hypersensitivity; hypotension caused by hypovolemia;
pregnancy (relative)
 Adverse/side effects: Headache; anxiety, dizziness, restlessness, dyspnea;
hypertension, dysrhythmias, chest pain, peripheral cyanosis, cardiac arrest;
nausea, vomiting; urinary retention, renal failure; tissue necrosis; decreased
blood flow to GI tract, kidneys, skeletal muscle, skin
 Drug interactions: TCAs, sympathomimetics, phenothiazines

129. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Norepinephrine Bitartrate (Levophed, Levarterenol) (2 of 2)
 Dosage and administration
 Adult: 0.1–0.5 mcg/kg/min IV/IO infusion titrated to effect
 Pediatric: Begin at 0.05–0.1 mcg/kg/min IV infusion
 Duration of action
 Onset: Immediate
 Peak effect: <1 min
 Duration: 1–2 min
 Special considerations
 Pregnancy safety: Category C
 Correct hypovolemia before administering.
 Use an infusion pump and administer through a large, stable vein to avoid extravasation
and tissue necrosis.
 Close monitoring of the IV/IO site and vital signs is essential.

130. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Octreotide (Sandostatin) (1 of 2)
 Class: Synthetic hormone, antidiarrheal
 Mechanism of action: Decreases visceral blood flow and inhibits the release of
serotonin, gastrin, vasoactive intestinal peptide, secretin, motilin, and
pancreatic polypeptide
 Indications: Active GI bleeding during transport
 Contraindications: Hypersensitivity
 Adverse/side effects: Nausea, vomiting, bloating, dizziness, headache,
dysrhythmias
 Drug interactions: CycloSPORINE

131. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Octreotide (Sandostatin) (2 of 2)
 Dosage and administration
 Consult medical direction or follow the dosing ordered by the sending physician
 Duration of action
 Onset: 30 min
 Peak effect: 30 min
 Duration: Up to 12 hours
 Special considerations
 Pregnancy safety: Category B

132. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Olanzapine (Zyprexa) (1 of 2)
 Class: Second-generation antipsychotic, antimanic agent
 Mechanism of action: May act through dopamine and serotonin type 2 receptor
site antagonism
 Indications: Agitated patients with a behavioral emergency; chemical restraint
 Contraindications: Hypersensitivity; caution with patients who have dehydration
or heat exposure, are taking medications with anticholinergic effects, have a
history of seizures or urinary retention
 Adverse/side effects: Drowsiness, dry mouth, difficulty speaking, unsteady gait,
headache, depression, insomnia, extrapyramidal symptoms
 Drug interactions: Alcohol, CNS depressants; IM/IV benzodiazepines and
olanzapine

133. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Olanzapine (Zyprexa) (2 of 2)
 Dosage and administration
 Adult: Chemical restraint: 10 mg IM
 Pediatric: Chemical restraint: 5 mg IM (6–11 y/o), 10 mg IM (12–18 y/o)
 Duration of action
 Onset: 15–30 min
 Peak effect: 15–45 min
 Duration: Variable
 Special considerations
 Pregnancy safety: Category C
 Risk for severe sedation or delirium after each injection; observe for at least 3 hours

134. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Ondansetron Hydrochloride (Zofran, Zofran ODT, Zuplenz) (1 of 2)
 Class: Selective serotonin receptor (5-HT3) antagonist, antiemetic
 Mechanism of action: Blocks action of serotonin
 Indications: Nausea or vomiting
 Contraindications: Hypersensitivity, QT syndrome, coadministration with
apomorphine
 Adverse/side effects: Headache, malaise, syncope, wheezing, bronchospasm,
dysrhythmias, ECG changes, palpitations, constipation, diarrhea, hives, skin
rash, serotonin syndrome
 Drug interactions: Other drugs that prolong the QT interval

135. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Ondansetron Hydrochloride (Zofran, Zofran ODT, Zuplenz) (2 of 2)
 Dosage and administration
 Adult: Antiemetic: 4 mg IV/SL/orally; Vomiting with AMS: 4 mg IV/SL/orally every 6
hours; Stimulant poisoning/overdose: 8 mg slow IV over 2–5 min or 4–8 mg IM or 8
mg tablet
 Pediatric (6 months–14 y/o): Antiemetic: 0.15 mg/kg IV/orally
 Duration of action
 Onset: 30 min
 Peak effect: 1.3 hours oral, 10 min IV
 Duration 3–6 hours
 Special considerations
 Pregnancy safety: Category B
 ECG monitoring recommended with electrolyte abnormalities, heart failure, or
bradydysrhythmias, or with other medications that cause QT prolongation

136. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Oxygen (1 of 2)
 Class: Naturally occurring atmospheric gas
 Mechanism of action: Reverses hypoxemia
 Indications: Suspected cardiopulmonary emergency, shortness of breath and
ischemic chest discomfort, other causes of decreased tissue oxygenation
 Contraindications: Observe closely when using with patients who have
pulmonary conditions that are dependent on hypoxic respiratory drive
 Adverse/side effects: Decreased level of consciousness, decreased respiratory
drive (patients with COPD), dry mucous membranes
 Drug interactions: None

137. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Oxygen (2 of 2)
 Dosage and administration
 Adult: Respiratory/cardiac arrest and carbon monoxide poisoning: 100%; After
return of spontaneous circulation: Spo2 of 92–98%; Patients not in
respiratory/cardiac arrest: Spo2 of 95–98%; ACS: Spo2 of 90%; AMS, HACE,
HAPE: Spo2 higher than 90%
 Pediatric: Respiratory/cardiac arrest: 100%; After return of spontaneous circulation,
Spo2 of 94–99%
 Duration of action
 Onset: Immediate
 Peak effect: N/A
 Duration: <2 min
 Special considerations
 Be familiar with liter flow rates and each type of delivery device used

138. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Oxymetazoline (Afrin, Dristan 12-hr, Vicks Sinus-12 hr) (1 of 2)
 Class: Intranasal decongestant, vasoconstrictor, topical sympathomimetic
 Mechanism of action: Stimulates alpha adrenergic receptors in the arterioles of
the nasal mucosa to produce vasoconstriction
 Indications: Epistaxis in a patient experiencing facial trauma
 Contraindications: Hypersensitivity, severe hypertension
 Adverse/side effects: Rebound nasal congestion, nasal mucosa irritation
 Drug interactions: Alpha-1 agonists, sympathomimetics

139. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Oxymetazoline (Afrin, Dristan 12-hr, Vicks Sinus-12 hr) (2 of 2)
 Dosage and administration
 Adult: 2–3 sprays in each nare
 Pediatric: 1–2 sprays in each nare
 Duration of action
 Onset: Immediate
 Peak effect: 5 min
 Duration: Up to 5 hours
 Special considerations
 Pregnancy safety: Category B

140. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Oxytocin (Pitocin) (1 of 2)
 Class: Pituitary hormone, uterine vasoconstrictor
 Mechanism of action: Increases the force and frequency of uterine contractions;
Increases renal, coronary, and cerebral blood flow
 Indications: Postpartum hemorrhage due to uterine atony after delivery
 Contraindications: Hypersensitivity, presence of a remaining fetus, unfavorable
fetal position, anticipated nonvaginal delivery, fetal distress when delivery is not
imminent, prolonged use in severe toxemia
 Adverse/side effects: Coma, seizures, anxiety, hypotension, dysrhythmias,
nausea, vomiting, anaphylaxis, painful uterine contractions, electrolyte
disturbances, maternal intracranial hemorrhage
 Drug interactions: Vasopressors

141. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Oxytocin (Pitocin) (2 of 2)
 Dosage and administration
 Adult: 10 units IM after delivery of placenta or mix 10–40 units in 1,000 mL of a
compatible IV solution infused at 10–15 drops/min, titrated to severity of response
 Pediatric: N/A
 Duration of action
 Onset: 3–5 min IM, within 1 min IV/IO
 Peak effect: 40 min IM, unknown IV/IO
 Duration: 2–3 hours IM, 1 hour after IV/IO infusion is stopped
 Special considerations
 Pregnancy safety: Category C
 Closely monitor vital signs, including fetal heart rate and uterine tone

142. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Pancuronium Bromide (Pavulon) (1 of 2)
 Class: Nondepolarizing neuromuscular blocking agent, cholinergic receptor
antagonist
 Mechanism of action: Skeletal muscle relaxation
 Indications: Skeletal muscle relaxation, tracheal intubation and ventilation
 Contraindications: Hypersensitivity, inability to control airway, neuromuscular
disease, hepatic or renal failure; Use caution with pulmonary disease
 Adverse/side effects: Bronchospasm, angioedema, hypotension, edema,
tachycardia, flushing, weakness, hypersalivation, itching, hives, prolonged
neuromuscular block; respiratory depression
 Drug interactions: Neuromuscular blockade, positive chronotropic drugs,
opioids

143. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Pancuronium Bromide (Pavulon) (2 of 2)
 Dosage and administration
 Adult: 0.06–0.1 mg/kg via slow IV, followed by incremental doses of 0.01 mg/kg at
25–60-min intervals
 Pediatric: Consult medical direction
 Duration of action
 Onset: 2–3 min
 Peak effect: Paralysis in 4 min
 Duration: 35–45 min
 Special considerations
 Pregnancy safety: Category C
 Intubation and ventilatory support must be readily available

144. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Phenylephrine (Neo-Synephrine) (1 of 2)
 Class: Adrenergic, alpha agonist, nasal vasoconstrictor
 Mechanism of action: Stimulates alpha adrenergic receptors in the arterioles of
the nasal mucosa to produce vasoconstriction
 Indications: Epistaxis; bleeding during nasotracheal intubation
 Contraindications: Hypersensitivity; use caution in geriatric patients with
preexisting cardiovascular disease
 Adverse/side effects: Tremors, palpitations, hypertension
 Drug interactions: MAOI; TCAs, guanethidine, methyldopa, and atropine-like
drugs

145. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Phenylephrine (Neo-Synephrine) (2 of 2)
 Dosage and administration
 Adult: Two sprays in the selected nare before nasotracheal tube insertion
 Duration of action
 Onset: Seconds
 Peak effect: 30 min
 Duration: 30 min–4 hours
 Special considerations
 Pregnancy safety: Category C

146. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Potassium Iodide (Pima Syrup, SSKI, ThyroSafe, ThyroShield) (1 of 2)
 Class: Antidote
 Mechanism of action: Protects thyroid gland from radiation injury and reduces
the risk of thyroid cancer
 Indications: Environmental radiation emergency
 Contraindications: Hypersensitivity, hyperthyroidism, respiratory failure
 Adverse/side effects: Skin rash, salivary gland swelling, iodism
 Drug interactions: Drugs that may increase serum potassium levels; NSAIDs

147. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Potassium Iodide (Pima Syrup, SSKI, ThyroSafe, ThyroShield) (2 of 2)
 Dosage and administration
 Consult medical direction
 Duration of action
 Onset: Data unavailable
 Peak effect: Data unavailable
 Duration: 24 hours per dose
 Special considerations
 Pregnancy safety: Category D
 May be distributed and administered in a mass casualty incident involving radiation
release or exposure

148. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Pralidoxime (2-PAM, Protopam) (1 of 2)
 Class: Cholinesterase reactivator, antidote
 Mechanism of action: Binds to organophosphates and breaks their alkyl
phosphate–cholinesterase bonds to restore the activity of acetylcholinesterase
 Indications: Poisoning by organophosphate pesticides and related nerve gases
 Contraindications: Hypersensitivity; reduce dose in patients with impaired renal
function, older adults with hypertension, and patients with myasthenia gravis
 Adverse/side effects: Dizziness, drowsiness, headache, neuromuscular
blockade, seizure, laryngospasm, hyperventilation, apnea, tachycardia, cardiac
arrest, nausea, muscle rigidity, muscle weakness, rash
 Drug interactions: Succinylcholine, morphine, aminophylline, theophylline, and
other respiratory depressants

149. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Pralidoxime (2-PAM, Protopam) (2 of 2)
 Dosage and administration
 Consult with medical direction
 Duration of action
 Onset: minutes
 Peak effect: 10–20 min IM, 5–15 min IV
 Duration: Variable
 Special considerations
 Pregnancy safety: Category C
 Consider drawing a blood sample before administration for the hospital
 Should be administered shortly after the nerve agent or organophosphate
poisoning exposure

150. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Procainamide Hydrochloride (Pronestyl) (1 of 2)
 Class: Class Ia antidysrhythmic
 Mechanism of action: Decreases myocardial excitability and conduction velocity
 Indications: Stable monomorphic VT with normal QT interval, reentry SVT
uncontrolled by vagal maneuvers and adenosine if BP is stable, stable wide-
complex tachycardia of unknown origin, AF with a rapid ventricular rate in
patients with Wolff-Parkinson-White syndrome
 Contraindications: Hypersensitivity, TdP, second- and third-degree heart AV
block, systemic lupus erythematosus, preexisting QT prolongation, digitalis
toxicity, TCA overdose
 Adverse/side effects: Cardiac dysrhythmias, anorexia, nausea, vomiting,
confusion, seizures, hypotension, and widening of PR, QRS, and QT intervals
 Drug interactions: Other antidysrhythmic agents, beta agonists

151. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Procainamide Hydrochloride (Pronestyl) (2 of 2)
 Dosage and administration
 Adult: Recurrent VF/pulseless VT: 20 mg/min slow IV infusion; Other indications:
20 mg/min slow IV infusion
 Pediatric: Not recommended in the prehospital setting
 Duration of action
 Onset: 10–30 min
 Peak effect: Variable
 Duration: 3–6 hours
 Special considerations
 Pregnancy safety: Category C
 Hypotension may occur with rapid infusion

152. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Prochlorperazine (Compazine) (1 of 2)
 Class: Antiemetic, first-generation (typical) antipsychotic, phenothiazine
 Mechanism of action: Depresses brain’s chemoreceptor trigger zone; produces
sedation, muscle relaxation, and cardiovascular effects
 Indications: Nausea and vomiting
 Contraindications: Hypersensitivity, concurrent use of CNS depressants,
concomitant use of anticholinergic medications, cardiac conduction
abnormalities, seizure disorder, narrow-angle glaucoma, prostatic hypertrophy,
tardive dyskinesia, subcortical brain damage, pediatric surgery, children <2 y/o
 Adverse/side effects: Drowsiness, dizziness, headache, blurred vision,
tachycardia, hypotension, prolonged QT interval, extrapyramidal symptoms
 Drug interactions: Other medications that cause respiratory depression

153. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Prochlorperazine (Compazine) (2 of 2)
 Dosage and administration
 Adult: 5–10 mg IV/IM
 Pediatric (>2 y/o, >12 kg): 0.1 mg/kg slow IV or deep IM
 Duration of action
 Onset: 10–20 min IM, rapid IV
 Peak effect: 30–60 min IV
 Duration: 3–4 hours IM/IV
 Special considerations
 Pregnancy safety: Category C

154. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Promethazine Hydrochloride (Phenergan) (1 of 2)
 Class: Phenothiazine, antiemetic, antihistamine
 Mechanism of action: Blocks action of histamine; possesses sedative,
antimotion, antiemetic, and anticholinergic activity; potentiates effects of opioids
 Indications: Nausea and vomiting
 Contraindications: Hypersensitivity, CNS depressants, Reye syndrome, lower
respiratory symptoms, children <2 y/o; sleep apnea, respiratory impairment or
seizure disorders
 Adverse/side effects: Headache, dizziness, drowsiness, confusion,
restlessness, wheezing, chest tightness, thickening of bronchial secretions,
palpitations, bradycardia, reflex tachycardia, QT prolongation, postural
hypotension, diarrhea, nausea, vomiting
 Drug interactions: Other CNS depressants, MAOIs

155. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Promethazine Hydrochloride (Phenergan) (2 of 2)
 Dosage and administration
 Adult: 12.5–25 mg deep IM
 Pediatric (> 2 y/o): 0.25–0.5 mg/kg deep IM
 Duration of action
 Onset: 20 min
 Peak effect: 30–60 min
 Duration: 4–6 hours
 Special considerations
 Pregnancy safety: Category C
 Do not administer if haloperidol or droperidol will be or has been given.
 Document the QT interval and relay the findings to the receiving facility staff.

156. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Proparacaine Ophthalmic (Alcaine, Ophthaine) (1 of 2)
 Class: Topical ophthalmic anesthetic
 Mechanism of action: Produces local anesthesia by blocking sodium ion channels
 Indications: Induction of topical anesthesia before eye irrigation in the management
of a chemical injury to the eye
 Contraindications: Hypersensitivity, trauma that may have resulted in intraocular
injury; use caution with cardiac disease or hyperthyroidism
 Adverse/side effects: Temporary stinging, burning, and conjunctival redness
 Drug interactions: Unavailable

157. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Proparacaine Ophthalmic (Alcaine, Ophthaine) (2 of 2)
 Dosage and administration
 Adult and pediatric: 1–2 drops in the affected eye
 Duration of action
 Onset: 15–60 seconds
 Peak effect: 30–120 seconds
 Duration: 10–20 min
 Special considerations
 Pregnancy safety: Category C
 Corneal epithelium may become dry during use because the blink reflex is
temporarily lost.
 Affected eye will be insensitive to touch for as long as 20 min after use.

158. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Propofol (Diprivan) (1 of 2)
 Class: Short-acting general anesthetic, sedative-hypnotic
 Mechanism of action: Produces a rapid and brief state of general anesthesia
 Indications: Maintenance of sedation in mechanically ventilated patients
 Contraindications: Hypovolemia; sensitivities
 Adverse/side effects: Seizure, apnea, dysrhythmias, hypotension,
hypertension, rash, itching, involuntary muscle movement
 Drug interactions: Alcohol, antihistamines, opioids; medications that cannot
pass through lipids; fentanyl

159. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Propofol (Diprivan) (2 of 2)
 Dosage and administration
 Consult medical direction
 Duration of action
 Onset: < 1 min
 Peak effect: 1 min
 Duration: As long as the infusion is running
 Special considerations
 Pregnancy safety: Category B
 Use with caution in patients with difficult airways.
 Carefully monitor vital signs and oxygenation.
 Infusions may need to be increased during transport.

160. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Sildenafil (Revatio, Viagra) (1 of 2)
 Class: Phosphodiesterase-5 enzyme inhibitor
 Mechanism of action: Relaxes pulmonary vascular smooth muscle cells and
subsequent vasodilation of the pulmonary vasculature
 Indications: HAPE prevention
 Contraindications: Hypersensitivity, coadministration with nitrates, significant
cardiovascular disease
 Adverse/side effects: Headache, nasal congestion, flushing, epistaxis,
erythema, diarrhea, skin rash, tinnitus
 Drug interactions: Nitrates, alpha blockers, antihypertensives, alcohol

161. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Sildenafil (Revatio, Viagra) (2 of 2)
 Dosage and administration
 Adult: 50 mg orally every 8 hours
 Pediatric: Data unavailable
 Duration of action
 Onset: 20 min
 Peak effect: 30–120 min
 Duration: 4 hours
 Special considerations
 Pregnancy safety: Category B

162. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Sodium Bicarbonate (1 of 2)
 Class: Systemic hydrogen ion buffer, alkalizing agent
 Mechanism of action: Corrects metabolic acidosis; increases blood/urinary pH
 Indications: Cardiac arrest with hyperkalemia or TCA overdose, QRS
prolongation in TCA overdose, crush syndrome
 Contraindications: Hypersensitivity, metabolic or respiratory alkalosis,
hypokalemia, hypernatremia, hypocalcemia; use caution with heart failure and
renal disease
 Adverse/side effects: Electrolyte imbalance, heart failure, and pulmonary
edema; tremors, twitching, and seizures
 Drug interactions: Amphetamines; benzodiazepines and TCAs;
sympathomimetics

163. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Sodium Bicarbonate (2 of 2)
 Dosage and administration
 Adult: 1 mEq/kg slow IV/IO push
 Pediatric: 1 mEq/kg slow IV/IO push
 Duration of action
 Onset: Seconds
 Peak effect: < 15 min
 Duration: 1–2 hours
 Special considerations
 Pregnancy safety: Category C
 Monitor closely for signs and symptoms of fluid overload.
 Ensure patient has adequate airway and ventilatory support.

164. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Sodium Thiosulfate (Nithiodote) (1 of 2)
 Class: Cyanide antidote
 Mechanism of action: Converts cyanide to the less toxic thiocyanate, which is
then excreted in the urine
 Indications: Known or suspected cyanide poisoning
 Contraindications: Hypersensitivity
 Adverse/side effects: Diarrhea
 Drug interactions: None

165. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Sodium Thiosulfate (Nithiodote) (2 of 2)
 Dosage and administration
 Adult: 12.5 g (50 mL of 25% solution) IV/IO slow push over 10 min
 Pediatric: 0.5 g/kg slow IV/IO (2 mL/kg of 25% solution)
 Duration of action
 Onset: 2–10 min
 Peak effect: Varies
 Duration: 30 min–2 hours
 Special considerations
 Pregnancy safety: Category C; hydroxocobalamin is the only agent that is
considered safe for treating cyanide poisoning in the pregnant patient

166. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Succinylcholine Chloride (Anectine) (1 of 2)
 Class: Depolarizing neuromuscular blocker; skeletal muscle relaxant
 Mechanism of action: Ultra-short-acting, mimics acetylcholine
 Indications: Skeletal muscle relaxation, tracheal intubation and ventilation
 Contraindications: Hypersensitivity, inability to control airway, renal failure,
muscular dystrophy, paraplegia/quadriplegia, immobilization, stroke,
hyperthermia; acute injury after multisystem trauma, major burns, hyperkalemia
 Adverse/side effects: Apnea, respiratory depression, dysrhythmias, cardiac
arrest, excessive salivation, prolonged muscle rigidity, rhabdomyolysis,
malignant hyperthermia, hyperkalemia; increased
intracranial/intraocular/intragastric pressure
 Drug interactions: CNS depressants; oxytocin, beta blockers, and
organophosphates; Diazepam

167. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Succinylcholine Chloride (Anectine) (2 of 2)
 Dosage and administration
 Adult: 1–1.5 mg/kg rapid IV
 Pediatric: 1–1.5 mg/kg for children, 2 mg/kg for infants
 Duration of action
 Onset: 45–60 seconds
 Peak effect: 1–3 min
 Duration: 4–6 min
 Special considerations
 Pregnancy safety: Category C
 Appropriate sedation and analgesia should be provided before initiation.
 Time management is crucial.
 Postintubation sedation and analgesia should be readily available.

168. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Tadalafil (Cialis, Adcirca) (1 of 2)
 Class: Phosphodiesterase-5 enzyme inhibitor
 Mechanism of action: Relaxes pulmonary vascular smooth muscle cells
 Indications: HAPE prevention
 Contraindications: Hypersensitivity, coadministration with nitrates, Stevens-
Johnson syndrome, exfoliative dermatitis
 Adverse/side effects: Headache, nasal congestion, back pain, flushing,
epistaxis, erythema, diarrhea, skin rash, tinnitus
 Drug interactions: Nitrates, alpha blockers, antihypertensives, or alcohol

169. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Tadalafil (Cialis, Adcirca) (2 of 2)
 Dosage and administration
 Adult: 10 mg orally twice daily
 Pediatric: Data unavailable
 Duration of action
 Onset: 30–45 min
 Peak effect: 2 hours
 Duration: Up to 36 hours
 Special considerations
 Pregnancy safety: Category B

170. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Tetracaine Ophthalmic Solution (Pontocaine) (1 of 2)
 Class: Topical ophthalmic anesthetic
 Mechanism of action: Produces local anesthesia
 Indications: Induction of topical anesthesia before eye irrigation in the
management of a chemical injury to the eye
 Contraindications: Hypersensitivity, intraocular injury
 Adverse/side effects: Blurry vision, transient stinging, burning, and conjunctival
redness
 Drug interactions: Methemoglobin-inducing drugs

171. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Tetracaine Ophthalmic Solution (Pontocaine) (2 of 2)
 Dosage and administration
 Adult and pediatric: 1–2 drops in the affected eye
 Duration of action
 Onset: Immediate
 Peak effect: 15–30 seconds
 Duration: 10–20 min
 Special considerations
 Pregnancy safety: Not classified
 Affected eye will be insensitive to touch for as long as 20 min.

172. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Thiamine Hydrochloride (Vitamin B1) (1 of 2)
 Class: Vitamin
 Mechanism of action: Combines with adenosine triphosphate to form thiamine
pyrophosphate
 Indications: Adjunctive therapy that should precede the administration of
dextrose 50% or glucagon if alcoholism or malnourishment is suspected
 Contraindications: Hypersensitivity
 Adverse/side effects: Vasodilation, hypotension, weakness, sweating, itching,
hives, nausea, feeling of warmth
 Drug interactions: Alkaline solutions

173. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Thiamine Hydrochloride (Vitamin B1) (2 of 2)
 Dosage and administration
 Adult: 100 mg as a very slow IV/IO bolus over 5 min or 100 mg deep IM
 Pediatric: Consult medical direction
 Duration of action
 Onset: hours
 Peak effect: 3–5 days
 Duration: Data unavailable
 Special considerations
 Pregnancy safety: Category A

174. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Tranexamic Acid (Cyklokapron, Lysteda) (1 of 2)
 Class: Hemostatic agent, antifibrinolytic agent, plasminogen inhibitor
 Mechanism of action: Hinders fibrin’s breakdown so clotting factors and
circulating platelet plugs can form a seal and reduce bleeding
 Indications: Blunt or penetrating trauma less than 3 hours from onset with
hemodynamic compromise, bleeding
 Contraindications: Hypersensitivity; mechanism of injury more than 3 hours prior
to EMS care; subarachnoid hemorrhage; history of PE, DVT, or other
thromboembolic disorder; reduce dose with renal insufficiency
 Adverse/side effects: Fatigue, headache, dizziness, abdominal and back pain,
joint pain, musculoskeletal pain, anemia
 Drug interactions: Hormonal contraceptives and clotting factor complexes

175. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Tranexamic Acid (Cyklokapron, Lysteda) (2 of 2)
 Dosage and administration
 Adult: 1 g IV infusion over 10 min
 Pediatric: Not recommended
 Duration of action
 Onset: Unknown
 Peak effect: Unknown
 Duration: 7–8 hours
 Special considerations
 Pregnancy safety: Category B
 Must be mixed into an infusion bag, typically 100 mL of NS

176. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Vecuronium Bromide (Norcuron) (1 of 2)
 Class: Nondepolarizing neuromuscular blocking agent, cholinergic receptor
antagonist
 Mechanism of action: Neuromuscular blockade
 Indications: Skeletal muscle relaxation, tracheal intubation and ventilation
 Contraindications: Hypersensitivity, inability to control airway, neuromuscular
disease, acute narrow-angle glaucoma, penetrating eye injuries, newborns,
hepatic or renal failure
 Adverse/side effects: Hypersensitivity reactions, itching, weakness, prolonged
neuromuscular blockade, excessive salivation
 Drug interactions: Opioid, sedative, or anesthetic agent

177. Copyright
©
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by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Vecuronium Bromide (Norcuron) (2 of 2)
 Dosage and administration
 Adult: 0.08–0.1 mg/kg IV push over 1 min; maintenance dose within 20–45 min:
0.01–0.015 mg/kg IV push every 12–15 min
 Pediatric: 0.1–0.3 mg/ kg IV/IO
 Duration of action
 Onset: 3–5 min
 Peak effect: Varies
 Duration: 20–35 min
 Special considerations
 Pregnancy safety: Category C
 Will not stop neuronal seizure activity
 Intubation and ventilatory support must be readily available.
 Anaphylactic and anaphylactoid-type adverse reactions have been reported.

178. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Verapamil Hydrochloride (Isoptin, Calan) (1 of 2)
 Class: Calcium channel blocker
 Mechanism of action: Slows AV node conduction, shortens the refractory period
of accessory pathways, and acts as a negative inotrope and vasodilator
 Indications: Stable narrow-QRS tachycardia if rhythm persists or if the
tachycardia is recurrent; AF or atrial flutter without preexcitation
 Contraindications: Hypersensitivity; Wolff-Parkinson-White syndrome, Lown-
Ganong-Levine syndrome; second- or third-degree AV block, sick sinus
syndrome, hypotension, cardiogenic shock, severe left ventricular dysfunction,
wide-complex tachycardias; children < 12 months
 Adverse/side effects: Dizziness, headache, dysrhythmias, nausea, vomiting
 Drug interactions: Digoxin; IV beta blockers; antihypertensives; neuromuscular
blocking agents

179. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
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Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Verapamil Hydrochloride (Isoptin, Calan) (2 of 2)
 Dosage and administration
 Adult: 2.5–5 mg IV bolus over 2 min (3 min in older patients); Alternative dosing: 5
mg IV bolus every 15 min to total dose of 30 mg
 Pediatric: Consult medical direction
 Duration of action
 Onset: 2–5 min
 Peak effect: Variable
 Duration: 10–20 min
 Special considerations
 Pregnancy safety: Category C
 Carefully monitor BP, heart rate, and ECG.
 AV block or asystole may occur because of slowed AV conduction.

180. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
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Ascend
Learning
Company
and
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American
Academy
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Orthopaedic
Surgeons.
Ziprasidone (Geodon) (1 of 2)
 Class: Second-generation antipsychotic
 Mechanism of action: Blocks synaptic reabsorption of serotonin and
norepinephrine, binds to alpha adrenergic receptors, dopamine receptors, and
serotonin receptors
 Indications: Agitated patients experiencing behavioral emergency, anxiety
 Contraindications: Hypersensitivity, QT prolongation, drugs that prolong QT
interval, recent AMI, uncompensated heart failure; use caution with impaired
renal function
 Adverse/side effects: Dizziness, headache, extrapyramidal symptoms,
orthostatic hypotension, suicide attempt, bradycardia, prolonged QT interval
 Drug interactions: Drugs that prolong QT interval; CNS depressants

181. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Ziprasidone (Geodon) (2 of 2)
 Dosage and administration
 Adult: Chemical restraint: 10 mg IM; Anxiety: 20 mg IM
 Pediatric: Chemical restraint: 5 mg IM (6–11 y/o); 10 mg IM (12–18 y/o)
 Duration of action
 Onset: 10 min IM
 Peak effect: 60 min
 Duration: Unknown
 Special considerations
 Pregnancy safety: Category C
 Monitor the QT interval with a 12-lead ECG, and relay findings to facility staff.

182. Copyright © 2023 by Jones & Bartlett Learning, LLC, an Ascend Learning Company and the American Academy of Orthopaedic Surgeons.
IV Solutions (Colloids and
Crystalloids)

183. Copyright
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by
Jones
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Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Colloids Overview
 Expand plasma volume by taking advantage of colloidal osmotic pressure
 Most often used in patients in hypovolemic shock states

184. Copyright
©
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by
Jones
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Bartlett
Learning,
LLC,
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Ascend
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Academy
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Surgeons.
Crystalloids Overview
 Substances in solution that can diffuse through the intravascular compartment
 Most often used for electrolyte replacement and short-term intravascular
volume expansion

185. Copyright
©
2023
by
Jones
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Bartlett
Learning,
LLC,
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Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Albumin (Albumarc, Albutein, Flexbumin) (1 of 2)
 Class: Colloid, blood modifier agent, volume expander
 Mechanism of action: Causes the body to shift approximately 3.5 times the
amount administered into the intravascular space
 Indications: Hypovolemia
 Contraindications: Hypersensitivity, risk of hypervolemia; use caution with renal
insufficiency or anemia
 Adverse/side effects: Nausea, vomiting, itching, hives, abdominal pain,
angioedema, dysrhythmias, bronchospasm
 Drug interactions: None

186. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Albumin (Albumarc, Albutein, Flexbumin) (2 of 2)
 Dosage and administration
 Infusion rate is adjusted to the patient’s requirement.
 Duration of action
 Onset: 15–30 min
 Peak effect: Unknown
 Duration: 24 hours
 Special considerations
 Pregnancy safety: Category C
 Administered with 0.9% NS, D5W, or sodium lactate

187. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
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Ascend
Learning
Company
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the
American
Academy
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Orthopaedic
Surgeons.
Bacteriostatic Water (1 of 2)
 Class: Diluent or solvent
 Mechanism of action: Works as a solvent or dilutional agent
 Indications: Diluting or dissolving drugs for IV, IM, or subcutaneous injections
based on the drug manufacturer’s recommendations
 Contraindications: Hypersensitivity to benzyl alcohol due to use as a preservative
 Adverse/side effects: None
 Drug interactions: None

188. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Bacteriostatic Water (2 of 2)
 Dosage and administration
 According to the drug manufacturer’s recommendations
 Duration of action
 N/A
 Special considerations
 Pregnancy category: C
 Due to the presence of a benzyl alcohol additive, other dilutional agents should be
used if available.
 Solution should be made approximately isotonic before use.

189. Copyright
©
2023
by
Jones
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Bartlett
Learning,
LLC,
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Ascend
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Company
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Academy
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Orthopaedic
Surgeons.
Dextran (1 of 2)
 Class: Artificial colloid
 Mechanism of action: Intravascular volume expander
 Indications: Hypovolemic shock
 Contraindications: Hypersensitivity, heart or renal failure, bleeding disorders
 Adverse/side effects: Rash, itching, dyspnea, chest tightness, mild hypotension;
increased bleeding time
 Drug interactions: Anticoagulants

190. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Dextran (2 of 2)
 Dosage and administration
 Titrate according to the patient’s physiologic response.
 Duration of action
 8–12 hours
 Special considerations
 In the management of burn shock, it is essential to follow standard fluid
resuscitation regimens to prevent possible circulatory overload.

191. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Hetastarch (Hespan) (1 of 2)
 Class: Artificial colloid
 Mechanism of action: Intravascular volume expander
 Indications: Hypovolemic shock; septic shock
 Contraindications: No significant contraindications
 Adverse/side effects: Nausea, vomiting, mild febrile reactions, chills, itching,
urticaria; rare severe anaphylactic reactions
 Drug interactions: Anticoagulants; patients allergic to corn

192. Copyright
©
2023
by
Jones
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Learning,
LLC,
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Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Hetastarch (Hespan) (2 of 2)
 Dosage and administration
 Titrated according to the patient’s physiologic response
 Duration of action
 24–36 hours
 Special considerations
 Pregnancy safety: Category C

193. Copyright
©
2023
by
Jones
&
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Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Lactated Ringer (Hartmann) Solution (1 of 2)
 Class: Isotonic crystalloid solution
 Mechanism of action: Replaces water and electrolytes
 Indications: Hypovolemic shock; keep open IV, hypoperfusion
 Contraindications: Heart failure or renal failure; crush injuries/compartment
syndrome
 Adverse/side effects: Rare
 Drug interactions: Few

194. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Lactated Ringer (Hartmann) Solution (2 of 2)
 Dosage and administration
 Hypovolemic shock: Titrate according to physiologic response.
 Hypoperfusion: 20 mL/kg IV/IO over 15 min; repeat as needed
 Duration of action
 Short-term therapy
 Special considerations
 None

195. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Plasma Protein Fraction (Plasmanate) (1 of 2)
 Class: Natural colloid
 Mechanism of action: Increases intravascular volume by attracting water from
other fluid compartments by virtue of its colloid osmotic pressure
 Indications: Hypovolemic shock; hypoproteinemia
 Contraindications: No significant contraindications
 Adverse/side effects: Chills, fever, hives, nausea, vomiting
 Drug interactions: Other IV fluids

196. Copyright
©
2023
by
Jones
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Learning,
LLC,
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Ascend
Learning
Company
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the
American
Academy
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Orthopaedic
Surgeons.
Plasma Protein Fraction (Plasmanate) (2 of 2)
 Dosage and administration
 Titrate according to hemodynamic response.
 In the management of shock secondary to bums, closely follow the physician’s
orders regarding the administration rate.
 Standard formulas for IV fluid administration have been developed; the medical
control physician will use these to determine the correct rate of IV administration.
 Duration of action
 24–36 hours
 Special considerations
 Do not use if the solution is cloudy or if sedimentation is seen.

197. Copyright
©
2023
by
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Learning,
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Company
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Academy
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Surgeons.
Total Parenteral Nutrition (TPN; varies based on mixture)
 Class: Electrolyte, nutrition
 Mechanism of action: Replenishes electrolytes and nutrients
 Indications: Ordered and customized to each patient based on needs identified
from lab work
 Contraindications: Vary based on specific mixture
 Adverse/side effects: Vary based on specific mixture
 Drug interactions: Vary based on specific mixture
 Dosage and administration: Vary based on specific mixture

198. Copyright
©
2023
by
Jones
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Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
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the
American
Academy
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Orthopaedic
Surgeons.
5% Dextrose in Water (1 of 2)
 Class: Hypotonic dextrose-containing solution
 Mechanism of action: Provides nutrients in the form of dextrose and free water
 Indications: IV access for emergency drugs; dilution of concentrated drugs for
IV infusion
 Contraindications: Should not be used as a fluid replacement for hypovolemic
states
 Adverse/side effects: Rare
 Drug interactions: Phenytoin (Dilantin) or amrinone (Inocor)

199. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
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Ascend
Learning
Company
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American
Academy
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Orthopaedic
Surgeons.
5% Dextrose in Water (2 of 2)
 Dosage and administration
 Usually administered through a minidrip (60 drops/mL) set at a TKO rate
 Duration of action
 Short-term therapy
 Special considerations
 D5W should not be administered simultaneously with blood through the same IV
administration set because of the possibility of hemolysis.

200. Copyright
©
2023
by
Jones
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Learning,
LLC,
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Learning
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Academy
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Surgeons.
10% Dextrose in Water (1 of 2)
 Class: Hypertonic dextrose-containing solution
 Mechanism of action: Provides nutrients in the form of dextrose and free water
 Indications: Neonatal resuscitation, hypoglycemia
 Contraindications: Should not be used as a fluid replacement for hypovolemic
states
 Adverse/side effects: Rare
 Drug interactions: Phenytoin (Dilantin) or amrinone (Inocor)

201. Copyright
©
2023
by
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Learning,
LLC,
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Ascend
Learning
Company
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Academy
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Orthopaedic
Surgeons.
10% Dextrose in Water (2 of 2)
 Dosage and administration
 Infusion rate is usually dependent on the patient’s condition
 Duration of action
 Short-term therapy
 Special considerations
 None

202. Copyright
©
2023
by
Jones
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Learning,
LLC,
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Ascend
Learning
Company
and
the
American
Academy
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Orthopaedic
Surgeons.
0.9% Sodium Chloride (Normal Saline) (1 of 2)
 Class: Isotonic crystalloid solution
 Mechanism of action: Replaces water and electrolytes
 Indications: Heat-related problems (heat exhaustion, heatstroke), freshwater
drowning, hypovolemia, diabetic ketoacidosis, keep open IV
 Contraindications: History of heart failure or renal failure
 Adverse/side effects: Rare
 Drug interactions: Few

203. Copyright
©
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by
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Learning,
LLC,
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Ascend
Learning
Company
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Academy
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Orthopaedic
Surgeons.
0.9% Sodium Chloride (Normal Saline) (2 of 2)
 Dosage and administration
 Infusion rate will depend on the specific situation being treated
 Duration of action
 Short-term therapy
 Special considerations
 None

204. Copyright
©
2023
by
Jones
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Learning,
LLC,
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Ascend
Learning
Company
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American
Academy
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Orthopaedic
Surgeons.
0.45% Sodium Chloride (1 of 2)
 Class: Hypotonic crystalloid solution
 Mechanism of action: Replaces free water and electrolytes
 Indications: Diminished renal or cardiovascular function when rapid rehydration
is not indicated
 Contraindications: Cases in which rapid rehydration is indicated
 Adverse/side effects: Rare
 Drug interactions: Few

205. Copyright
©
2023
by
Jones
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Bartlett
Learning,
LLC,
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Ascend
Learning
Company
and
the
American
Academy
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Orthopaedic
Surgeons.
0.45% Sodium Chloride (1 of 2)
 Dosage and administration
 The specific situation and patient condition will dictate the rate at which one-half
normal saline is administered.
 Duration of action
 Short-term therapy
 Special considerations
 None

206. Copyright
©
2023
by
Jones
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Learning,
LLC,
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Ascend
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Company
and
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American
Academy
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Orthopaedic
Surgeons.
3% Sodium Chloride (Hypertonic Saline) (1 of 2)
 Class: Hypertonic crystalloid solution
 Mechanism of action: Reduces the amount of fluid in the cranial cavity and
decreases the ICP
 Indications: Traumatic brain injuries, fluid resuscitation in severe sepsis,
hyponatremia
 Contraindications: Hypotension; use caution in pediatric patients; rapid
increases can cause significant neurologic complications
 Adverse/side effects: Increases sodium levels, seizures, neurologic deficits
 Drug interactions: None

207. Copyright
©
2023
by
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Learning,
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Surgeons.
3% Sodium Chloride (Hypertonic Saline) (2 of 2)
 Dosage and administration
 Infusion rate will depend on the specific situation being treated
 Duration of action
 Onset: Rapid
 Peak effect: Unknown
 Duration: Unknown
 Special considerations
 Should be administered through a central line due to its high osmolarity and tonicity

208. Copyright
©
2023
by
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Learning,
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Surgeons.
5% Dextrose in 0.45% Sodium Chloride (1 of 2)
 Class: Hypertonic dextrose-containing crystalloid solution
 Mechanism of action: Replaces free water and electrolytes, provides nutrients
in the form of dextrose
 Indications: Heat exhaustion, diabetic disorders; KVO solution in patients with
impaired renal or cardiovascular function
 Contraindications: Indications for rapid fluid resuscitation
 Adverse/side effects: Rare
 Drug interactions: Phenytoin (Dilantin) or amrinone (Inocor)

209. Copyright
©
2023
by
Jones
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Learning,
LLC,
an
Ascend
Learning
Company
and
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American
Academy
of
Orthopaedic
Surgeons.
5% Dextrose in 0.45% Sodium Chloride (2 of 2)
 Dosage and administration
 Infusion rate will depend on the specific situation being treated
 Duration of action
 Short-term therapy
 Special considerations
 None

210. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
5% Dextrose in 0.9% Sodium Chloride (1 of 2)
 Class: Hypertonic dextrose-containing crystalloid solution
 Mechanism of action: Replaces free water and electrolytes, provides nutrients
in the form of dextrose
 Indications: Heat-related disorders, freshwater drowning, hypovolemia,
peritonitis
 Contraindications: Impaired cardiac or renal function
 Adverse/side effects: Rare
 Drug interactions: Phenytoin (Dilantin) or amrinone (Inocor)

211. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
5% Dextrose in 0.9% Sodium Chloride (2 of 2)
 Dosage and administration
 Infusion rate will depend on the specific situation being treated
 Duration of action
 Short-term therapy
 Special considerations
 None

212. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
5% Dextrose in Lactated Ringer Solution (1 of 2)
 Class: Hypertonic dextrose-containing crystalloid solution
 Mechanism of action: Replaces water and electrolytes, provides nutrients in the
form of dextrose
 Indications: Hypovolemic shock, hemorrhagic shock, some instances of
acidosis
 Contraindications: Decreased renal or cardiovascular function
 Adverse/side effects: Rare
 Drug interactions: Phenytoin (Dilantin) or amrinone (Inocor)

213. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
5% Dextrose in Lactated Ringer Solution (2 of 2)
 Dosage and administration
 Infusion rate will depend on the specific situation being treated
 Duration of action
 Short-term therapy
 Special considerations
 None