inhibition of norepinephrine release
Increased myocardial contractility (inotropic effect)
Increased myocardial conduction (dromotropic effect)
Renin secretion for urinary retention
Arterial dilation in certain key organs
Mechanism of Action: Reduces fever and pain by decreasing the prostaglandin syntheses in the CNS
Indications: Fever symptoms, or to prevent febrile seizures in pediatric patients.
Contraindications: Hepatic impairment, use caution if hypothermia related to the toxic events of medications or environmental exposure, if malnutrition, alcohol use.
Adverse Effects: Overdose can cause severe liver injury.
Doseage and Administration: Adults and children over 12 years is 325 to 650mg every 4 to 6 hrs, up to 4000mg/day. 3 mo 40mg/4hrs. 4-11mo 80mg/4hrs. 12-23mo 120mg/4hrs. 2-3yr 160mg/4hrs. 4-5yr 240mg/4hrs. 6-8yr 320mg/4-6hr. 9-10yr 400mg/4-6hr. 11yr 480mg/4-6hr. 12yr 640mg/4-6hr
Duration: Rapidly absorbed from GI tract, Peak: 30-120 mins. Absorption slows when combined with diphenhydramine
Mechanism of Action: Absorbs toxic substances from the gastrointestinal tract
Indications: Most oral poisonings and medication overdoses; can be used after evacuation of poisons
Contraindications: Oral administration to comatose patients; after ingestion of corrosives, caustics, petroleum distillates (ineffective and may induce vomiting); simultaneous administration with other oral drugs. Use caution in patients experiencing abdominal pain of unknown origin or known GI obstruction
Adverse reactions/side effects: If aspirated, can induce fatal form of pneumonitis; constipation, black stools, diarrhea, vomiting, bowel obstruction
Drug Interactions: Bonds with and generally inativates whatever it is mixed with (eg, syrup of ipecac)
How supplied: 25g (black powder)/125-mL bottle (200mg/mL); 50g (black powder)/250-mL bottle (200mg/mL)
Duration of Action: Onset: Immediate. Peak effect: Depends on gastrointestinal function. Duration: Will act until excreted
Special Considerations: Pregnancy safety: Category C. Often used in conjunction with magnesium citrate. Must be stored in a closed container. Be sure to mix contents well before administration due to separation while being stored. Does not absorb cyanide, lithium, iron, lead, or arsenic.
Mechanism of Action: Slows conduction through the AV node; can interrupt re-entrant pathways; slows heart rate by acting directly on the sinus pacemaker cells by slowing impulse formation. The drug of choice for re-entry SVT. Can be used diagnostically for stable, wide-complex tachycardia of unknown origin after two doses of lidocaine.
Indications: Conversion of PSVT to sinus rhythm. May convert re-entry SVT due to Wolff-Parkinson-White syndrome. Not effective in converting atrial fibrillation/flutter or V-Tach. Most forms of stable narrow-complex SVT.
Contraindications: Second- or third-degree. AV block (if no pacemaker is present), sick sinus syndrome (If no pacemaker present), bronchoconstrictive or bronchospastic lung disease (asthma, COPD), poison- or drug-induced tachycardia
Adverse reactions/side effects: Generally short duration and mild; headache, dizziness, dyspnea, bronchospasm dysrhythmias, palpations, hypotension, chest pain, facial flushing, cardiac arrest, nausea, metallic taste, pain in the head or neck, paresthesia, diaphoresis
Drug interactions: Methylzanthines (theophylline-like drugs) antagonize the effects of adenosine. Dipyridamole (Persantine) potentiates the effect of adenosine. Carbamazepine (tegretol) may potentiate the AV node blocking effect of adenosine.
How supplied: 3mg/mL in 2-mL and 5-mL flip-top vials
Dosage and administration: Adult: 6mg rapid IV push, followed by 20mL saline flush and elevate extremity. If no response after 1-2 mins administer second dose of 12mg rapid IV push. Pediatric: Initial dose 0.1mg/kg rapid IV/IO push (maximum first dose 6mg), followed by 5-10mL saline flush. Second dose 0.2mg/kg rapid IV/IO push (maximum second dose 12mg/kg) followed by a 5-10 mL saline flush
Duration of action: Onset: Seconds. Peak effect: Seconds. Duration: 12 seconds
Special Considerations: Pregnancy safety: Category C. May cause brochoconstriction
in asthma patients. Evaluate elderly for signs of dehydration requiring fluid replacement prior to administering adenosine. Short half-life limits side effects in most patients
Mechanism of Action: Selective beta-2 agonist that stimulates adrenergic receptors of the sympathomimetic nervous system. Results in smooth-muscle relaxation in the brochial tree and preipheral vasculature
Indications: Treatment of broncospasm in patients with reversible obstructive airway disease (COPD/asthma). Prevention of exercise-induced bronchospasm
Contraindications: Known prior hypersensitivity reactions to albuterol, Tachycardia, dysrhythmias, especially those caused by digitalis. Synergistic with other sympathomimetics.
Adverse reactions/side effects: Often dose-related and include headache, fatigue, lightheadedness, irritability, restlessness, aggressive behavior, pulmonary edema, hoarseness, nasal congestion, increased sputum, hypertension, tachycardia, dysrhythmias, chest pain, palpations, nausea/vomiting, dry mouth, epigastric pain, and tremors.
Drug interactions: Tricyclic antidepressants may potentiate vasculature effects. Beta blockers are antagonistic and may block pulmonary effects. May potentiate hypokalemia caused by diuretics.
How supplied: metered-dose inhaler: 90mcg/metered spray. Solution for aerosolization: 0.5% (5mg/mL), 0.083% (2.5mg) in 3mL unit dose nebulizer
Dosage and administration: Adult: Administer 2.5mg. Dilute in 0.5mL of 0.5% solution for inhalation with 2.5mL normal saline in nebulizer and administer over 10-15 mins. Metered-dose inhaler: 1-2 inhalations (90-180mcg) wait 5 mins between inhalations. Pediatric: <20kg: 1.25mg/dose via hand-held nebulizer or mask over 20 mins. >20kg: 2.5 mg/dose via hand-held nebulizer or mask over 20 mins. Repeat once in 20 mins.
Duration of Action: Onset: 5-15 mins. Peak effect: 30 mins to 2 hrs. Duration: 3-4 hrs
Special Considerations: Pregnancy safety: Category C. May precipitate angina pectoris and dysrhythmias. In prehospital emergency care, albuterol should be administered only via inhalation
Mechanism of Action: Blocks sodium channels and myocardial potassium channels, delaying repolarization and increasing the duration of action potential
Indications: Ventricular fibrillation, pulseless ventricular tachycardia, unstable ventricular tachycardia in patients refractory to other therapy
Contraindications: Known hypersensitivity to amiodarone or iodine, cardiogenic shock, sinus bradycardia, second or third degree AV block (if no pacemaker is present), severe sinus node dysfunction
Adverse reactions/side effects: Dizziness, fatigue, malaise, tremor, ataxia, lack of coordination, adult respiratory distress syndrome, pulmonary edema, cough, progressive dyspnea, congestive heart failure, bradycardia, hypotension, worsening of dysrhythmias, prolonged QT interval, nausea, vomiting, burning at IV site, Stevens-Johnson syndrome
Drug Interactions: Use with digoxin may cause digitalis toxicity. Antidysrhythmias may cause increased serum levels. Beta blocker and calcium channel blockers may potentiate bradycardia, sinus arrest, and AV heart blocks
How supplied: 50mg/mL vials and prefilled syringes. For rapid infusion, add 150mg/3mL to a 10mL D5W (1.5mg/mL) run at 600 mL/hr on infusion pump
Dosage and administration: Adult: Ventricular fibrillation/pulseless ventricular tachycardia unresponsive to CPR, defibrillation, and vasopressors: 300mg IV/IO push. Initial dose can be followed one time in 3-5 mins at 150mg IV/IO push. Recurrent life-threatening ventricular dysrhythmias. Maximum cumulative dose: 2.2g IV/24hr administered as follows: Rapid infusion: 150mg IV/IO over 10 mins (15mg/min) May repeat rapid infusion (150mg IV/IO) every 10 mins as needed. Pediatric: Refractory ventricular fibrillation pulseless ventricular tachycardia: 5mg/kg IV/IO bolus can repeat the 5mg/kg IV/IO bolus up to a total dose of 15 mg/kg/24hr. Maximum single dose: 300mg. Perfusing supraventricular and ventricular tachycardias: Loading dose 5mg/kg Iv/IO over 20-60 mins (maximum single dose of 300 mg). Can repeat to maximum dose of 15 mg/kg/day (2.2g in adolescents). Maximum single dose: 300 mg
Duration of Action: Onset: Immediate. Peak effect: 10-15 mins. Duration 30-45 mins
Special Considerations: Pregnancy safety: Category D. Monitor patient hypotension. May worsen or precipitate new dysrhythmias