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EPINEPHRINE

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Name/Class: EPINEPHRINE (Adrenalin)/Sympathomimetic
 Description: Epinephrine is a naturally occurring catecholamine that increases heart rate, cardiac contractile
 force myocardial electrical activity, systemic vascular resistance, and systolic blood pressure and
 decreases overall airway resistance and automaticity. It also, through bronchial artery constriction, may
 reduce pulmonary congestion and increase tidal volume and vital capacity.
 Indications: To restore rhythm in cardiac arrest and severe allergic reactions.
 Contraindications: Hypersensitivity to sympathomimetic amines, narrow angle glaucoma; hemorrhagic,
 traumatic, or cardiac shock; coronary insufficiency; dysrhythmias; organic brain or heart disease; or
 during labor.
 Precautions: Elderly, debilitated patients, hypertension, diabetes, hyperthyroidism, Parkinson’s disease,
 tuberculosis, asthma, emphysema, and in children < 6 years.
 Dosage/Route: Arrest: 1 mg of 1:10,000 IV/3 to 5 min (ET: 2 to 2.5 mg 1:1,000).
 Allergic reactions: 0.3 to 0.5 mg of 1:1,000 subcutaneously/5 to 15 min as needed or 0.5 to
 1 mg of 1:10,000 IV if subcutaneous dose ineffective or severe reaction.

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AMIODARONE

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Name/Class: AMIODARONE (Cordarone, Pacerone)/Antidysrhythmic
 Description: Amiodarone is an antidysrhythmic that prolongs the duration of the action potential and
 refractory period and relaxes smooth muscles, reducing peripheral vascular resistance and increasing
 coronary blood flow.
 Indications: Life-threatening ventricular and supraventricular dysrhythmias, frequently atrial fibrillation.
 Contraindications: Hypersensitivity, cardiogenic shock, severe sinus bradycardia, or advanced heart block.
 Precautions: Hepatic impairment, pregnancy, nursing mothers, children.
 Dosage/Route: 150 to 300 mg IV over 10 min, then 1 mg/min over next 6 hours.

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ATROPINE

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Name/Class: ATROPINE/Parasympatholytic
 Description: Atropine blocks the parasympathetic nervous system, specifically the vagal effects on heart rate.
 It does not increase contractility but may increase myocardial oxygen demand. Decreases airway
 secretions.
 Indications: Hemodynamically significant bradycardia, bradyasystolic arrest, and organophosphate
 poisoning.
 Contraindications: None in the emergency setting.
 Precautions: AMI, glaucoma.
 Dosage/Route: Symptomatic bradycardia: 0.5 to 1 mg IV/2 mg ET. Repeat 3 to 5 min to 0.04 mg/kg.

Asystole: 1 mg IV or 2 mg ET, may
 repeat 3 to 5 min up to 0.04 mg/kg.
 Organophosphate poisoning: 2 to 5 mg IV/IM/IO/10 to 15 min.
 
 

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ADENOSINE

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Name/Class: ADENOSINE (Adenocard)/Antidysrhythmic
Description: Adenosine is a naturally occurring agent that can “chemically cardiovert” PSVT to a normal
 sinus rhythm. It has a half-life of 10 seconds and does not cause hypotension.
Indications: Narrow, complex paroxysmal supraventricular tachycardia refractory to vagal
 maneuvers.
 Contraindications: Hypersensitivity, 2nd- and 3rd-degree heart block, sinus node disease, or asthma.
Precautions: It may cause transient dysrhythmias. COPD.
 Dosage/Route: 6 mg rapidly (over 1 to 2 sec) IV, then flush the line rapidly with saline. If
 ineffective, 12 mg in 1 to 2 min, may be repeated.

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LABETALOL

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Name/Class: LABETALOL (Trandate, Normodyne)/Beta Blocker

Description: Labetalol is a beta blocker with some alpha blocker characteristics. It induces vasodilation,

reduces peripheral vascular resistance, and lowers blood pressure.

Indications: Acute hypertensive crisis.

Contraindications: Asthma, CHF, 2nd- and 3rd-degree heart block, severe bradycardia, or cardiogenic

shock.

Precautions: COPD, heart failure, hepatic impairment, diabetes, peripheral vascular disease.

Dosage/Route: 20 mg slow IV, then 40 to 80 mg/10 min as needed, up to 300 mg OR a continuous drip

2 mg/min up to 300 mg

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NOREPINEPHRINE

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Name/Class: NOREPINEPHRINE (Levophed)/Sympathomimetic Agent

Description: Norepinephrine is a naturally occurring catecholamine and causes vasoconstriction, cardiac

stimulation, and increased blood pressure, myocardial oxygen demand, and coronary blood flow.

Indications: Refractory hypotension and neurogenic shock.

Contraindications: Hypotension due to hypovolemia.

Precautions: Hypertension, hyperthyroidism, severe heart disease, elderly, MAO inhibitor therapy, patients receiving tricyclic antidepressants. Monitor blood pressure frequently and infuse the drug through the

largest vein available as it may cause tissue necrosis.

Dosage/Route: 0.5 to 30 mcg/min IV, titrated to BP. 

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SODIUM BICARBONATE

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Name/Class: SODIUM BICARBONATE (NaHCO3)/Alkalizing Agent

Description: Sodium bicarbonate provides vascular bicarbonate to assist the buffer system in reducing the effects of metabolic acidosis and in the treatment of some overdoses.

Indications: Tricyclic antidepressant and barbiturate overdose, refractory acidosis, or hyperkalemia.

Contraindications: None when used in severe hypoxia or late cardiac arrest.

Precautions: May cause alkalosis if given in too large a quantity. It may also deactivate vasopressors and may precipitate with calcium chloride.

Dosage/Route: 1 mEq/kg IV, then 0.5 mEq/kg/10 min. 

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DOPAMINE 

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Name/Class: DOPAMINE (Intropin)/Sympathomimetic

Description: Dopamine is a naturally occurring catecholamine that increases cardiac output without

appreciably increasing myocardial oxygen consumption. It maintains renal and mesenteric blood flow

while inducing vasoconstriction and increasing systolic blood pressure.

Indications: Nonhypovolemic hypotension (70 to 100 mmHg) and cardiogenic shock.

Contraindications: Hypovolemic hypotension without aggressive fluid resuscitation, tachydysrhythmias,

ventricular fibrillation, and pheochromocytoma.

Precautions: Occlusive vascular disease, cold injury, arterial embolism. Ensure adequate fluid resuscitation

of the hypovolemic patient.

Dosage/Route: 2 to 5 mcg/kg/min up to 20 mcg/kg/min, titrated to effect. 

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NITROGLYCERIN

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Name/Class: NITROGLYCERIN (Nitrostat)/Nitrate

Description: Nitroglycerin is a rapid smooth muscle relaxant that reduces peripheral vascular resistance,

blood pressure, venous return, and cardiac workload.

Indications: Chest pain associated with angina and acute myocardial infarction, and acute pulmonary

edema.

Contraindications: Hypersensitivity, tolerance to nitrates, severe anemia, head trauma, hypotension,

increased ICP, patients taking sildenafil, glaucoma, and shock.

Precautions: May induce headache that is sometimes severe. Nitroglycerin is light sensitive and will lose

potency when exposed to the air.

Dosage/Route: 1 tablet (0.4 mg) SL. May be repeated/3 to 5 min up to 3 tablets, or 1⁄2 inch of topical

ointment, or 0.4 mg (one spray)SL up to 3 sprays/25 min.

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VASOPRESSIN

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Name/Class: VASOPRESSIN (Pitressin)/Hormone, Vasopressor

Description: Vasopressin is a hormone with strong vasopressive and antidiuretic properties but that may

precipitate angina and/or AMI.

Indications: To increase peripheral vascular resistance in arrest (CPR) or to control bleeding from

esophageal varices.

Contraindications: Chronic nephritis with nitrogen retention, ischemic heart disease, PVCs, advanced

arteriosclerosis, or 1st stage of labor.

Precautions: Epilepsy, migraine, heart failure, angina, vascular disease, hepatic impairment, elderly, and

children.

Dosage/RouteArrest: 40 units IV.

Esophageal varices: 0.2 to 0.4 units/min IV drip.

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Digoxin

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Name/Class: digoxin [lanoxin]

Description: derived from foxglove . increases intracellular calcium to  improve myocardial contractility. Decreases sa rate, av node conduction; sodium loss may cause increased automaticity.

Indications: atrial flutter and atrial fibrillation 

Contraindications: v-fib, v-tach, av blocks, digitalis toxicity, 2nd or 3rd degree blocks without pacing

 Dosage/Route: .004-.006 mg/kg (4-6 mcg/kg]

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Dilitiazem

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Name/Class: Dilitiazem ( Cardizem) Anti-dysrhythmic

Description: calcium channel blocker that slows conduction; causes coronary and peripheral vasodilation. Used to control a-fib, a-flutter 

 Indications: control rate in a-fib and a-flutter

Contraindications: wide qrs or unknown origin; sick sinus syndrome; av blocks; hypotension, cardiogenic shock; wpw, v-tach or ami

Dosage/Route: 25 mg or 50 mg [don’t give with Lasix]

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Q:

EPINEPHRINE

A:

Name/Class: EPINEPHRINE (Adrenalin)/Sympathomimetic
 Description: Epinephrine is a naturally occurring catecholamine that increases heart rate, cardiac contractile
 force myocardial electrical activity, systemic vascular resistance, and systolic blood pressure and
 decreases overall airway resistance and automaticity. It also, through bronchial artery constriction, may
 reduce pulmonary congestion and increase tidal volume and vital capacity.
 Indications: To restore rhythm in cardiac arrest and severe allergic reactions.
 Contraindications: Hypersensitivity to sympathomimetic amines, narrow angle glaucoma; hemorrhagic,
 traumatic, or cardiac shock; coronary insufficiency; dysrhythmias; organic brain or heart disease; or
 during labor.
 Precautions: Elderly, debilitated patients, hypertension, diabetes, hyperthyroidism, Parkinson’s disease,
 tuberculosis, asthma, emphysema, and in children < 6 years.
 Dosage/Route: Arrest: 1 mg of 1:10,000 IV/3 to 5 min (ET: 2 to 2.5 mg 1:1,000).
 Allergic reactions: 0.3 to 0.5 mg of 1:1,000 subcutaneously/5 to 15 min as needed or 0.5 to
 1 mg of 1:10,000 IV if subcutaneous dose ineffective or severe reaction.

Q:

AMIODARONE

A:

Name/Class: AMIODARONE (Cordarone, Pacerone)/Antidysrhythmic
 Description: Amiodarone is an antidysrhythmic that prolongs the duration of the action potential and
 refractory period and relaxes smooth muscles, reducing peripheral vascular resistance and increasing
 coronary blood flow.
 Indications: Life-threatening ventricular and supraventricular dysrhythmias, frequently atrial fibrillation.
 Contraindications: Hypersensitivity, cardiogenic shock, severe sinus bradycardia, or advanced heart block.
 Precautions: Hepatic impairment, pregnancy, nursing mothers, children.
 Dosage/Route: 150 to 300 mg IV over 10 min, then 1 mg/min over next 6 hours.

Q:

ATROPINE

A:

Name/Class: ATROPINE/Parasympatholytic
 Description: Atropine blocks the parasympathetic nervous system, specifically the vagal effects on heart rate.
 It does not increase contractility but may increase myocardial oxygen demand. Decreases airway
 secretions.
 Indications: Hemodynamically significant bradycardia, bradyasystolic arrest, and organophosphate
 poisoning.
 Contraindications: None in the emergency setting.
 Precautions: AMI, glaucoma.
 Dosage/Route: Symptomatic bradycardia: 0.5 to 1 mg IV/2 mg ET. Repeat 3 to 5 min to 0.04 mg/kg.

Asystole: 1 mg IV or 2 mg ET, may
 repeat 3 to 5 min up to 0.04 mg/kg.
 Organophosphate poisoning: 2 to 5 mg IV/IM/IO/10 to 15 min.
 
 

Q:

ADENOSINE

A:

Name/Class: ADENOSINE (Adenocard)/Antidysrhythmic
Description: Adenosine is a naturally occurring agent that can “chemically cardiovert” PSVT to a normal
 sinus rhythm. It has a half-life of 10 seconds and does not cause hypotension.
Indications: Narrow, complex paroxysmal supraventricular tachycardia refractory to vagal
 maneuvers.
 Contraindications: Hypersensitivity, 2nd- and 3rd-degree heart block, sinus node disease, or asthma.
Precautions: It may cause transient dysrhythmias. COPD.
 Dosage/Route: 6 mg rapidly (over 1 to 2 sec) IV, then flush the line rapidly with saline. If
 ineffective, 12 mg in 1 to 2 min, may be repeated.

Q:

LABETALOL

A:

Name/Class: LABETALOL (Trandate, Normodyne)/Beta Blocker

Description: Labetalol is a beta blocker with some alpha blocker characteristics. It induces vasodilation,

reduces peripheral vascular resistance, and lowers blood pressure.

Indications: Acute hypertensive crisis.

Contraindications: Asthma, CHF, 2nd- and 3rd-degree heart block, severe bradycardia, or cardiogenic

shock.

Precautions: COPD, heart failure, hepatic impairment, diabetes, peripheral vascular disease.

Dosage/Route: 20 mg slow IV, then 40 to 80 mg/10 min as needed, up to 300 mg OR a continuous drip

2 mg/min up to 300 mg

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Q:

NOREPINEPHRINE

A:

Name/Class: NOREPINEPHRINE (Levophed)/Sympathomimetic Agent

Description: Norepinephrine is a naturally occurring catecholamine and causes vasoconstriction, cardiac

stimulation, and increased blood pressure, myocardial oxygen demand, and coronary blood flow.

Indications: Refractory hypotension and neurogenic shock.

Contraindications: Hypotension due to hypovolemia.

Precautions: Hypertension, hyperthyroidism, severe heart disease, elderly, MAO inhibitor therapy, patients receiving tricyclic antidepressants. Monitor blood pressure frequently and infuse the drug through the

largest vein available as it may cause tissue necrosis.

Dosage/Route: 0.5 to 30 mcg/min IV, titrated to BP. 

Q:

SODIUM BICARBONATE

A:

Name/Class: SODIUM BICARBONATE (NaHCO3)/Alkalizing Agent

Description: Sodium bicarbonate provides vascular bicarbonate to assist the buffer system in reducing the effects of metabolic acidosis and in the treatment of some overdoses.

Indications: Tricyclic antidepressant and barbiturate overdose, refractory acidosis, or hyperkalemia.

Contraindications: None when used in severe hypoxia or late cardiac arrest.

Precautions: May cause alkalosis if given in too large a quantity. It may also deactivate vasopressors and may precipitate with calcium chloride.

Dosage/Route: 1 mEq/kg IV, then 0.5 mEq/kg/10 min. 

Q:

DOPAMINE 

A:

Name/Class: DOPAMINE (Intropin)/Sympathomimetic

Description: Dopamine is a naturally occurring catecholamine that increases cardiac output without

appreciably increasing myocardial oxygen consumption. It maintains renal and mesenteric blood flow

while inducing vasoconstriction and increasing systolic blood pressure.

Indications: Nonhypovolemic hypotension (70 to 100 mmHg) and cardiogenic shock.

Contraindications: Hypovolemic hypotension without aggressive fluid resuscitation, tachydysrhythmias,

ventricular fibrillation, and pheochromocytoma.

Precautions: Occlusive vascular disease, cold injury, arterial embolism. Ensure adequate fluid resuscitation

of the hypovolemic patient.

Dosage/Route: 2 to 5 mcg/kg/min up to 20 mcg/kg/min, titrated to effect. 

Q:

NITROGLYCERIN

A:

Name/Class: NITROGLYCERIN (Nitrostat)/Nitrate

Description: Nitroglycerin is a rapid smooth muscle relaxant that reduces peripheral vascular resistance,

blood pressure, venous return, and cardiac workload.

Indications: Chest pain associated with angina and acute myocardial infarction, and acute pulmonary

edema.

Contraindications: Hypersensitivity, tolerance to nitrates, severe anemia, head trauma, hypotension,

increased ICP, patients taking sildenafil, glaucoma, and shock.

Precautions: May induce headache that is sometimes severe. Nitroglycerin is light sensitive and will lose

potency when exposed to the air.

Dosage/Route: 1 tablet (0.4 mg) SL. May be repeated/3 to 5 min up to 3 tablets, or 1⁄2 inch of topical

ointment, or 0.4 mg (one spray)SL up to 3 sprays/25 min.

Q:

VASOPRESSIN

A:

Name/Class: VASOPRESSIN (Pitressin)/Hormone, Vasopressor

Description: Vasopressin is a hormone with strong vasopressive and antidiuretic properties but that may

precipitate angina and/or AMI.

Indications: To increase peripheral vascular resistance in arrest (CPR) or to control bleeding from

esophageal varices.

Contraindications: Chronic nephritis with nitrogen retention, ischemic heart disease, PVCs, advanced

arteriosclerosis, or 1st stage of labor.

Precautions: Epilepsy, migraine, heart failure, angina, vascular disease, hepatic impairment, elderly, and

children.

Dosage/RouteArrest: 40 units IV.

Esophageal varices: 0.2 to 0.4 units/min IV drip.

Q:

Digoxin

A:

Name/Class: digoxin [lanoxin]

Description: derived from foxglove . increases intracellular calcium to  improve myocardial contractility. Decreases sa rate, av node conduction; sodium loss may cause increased automaticity.

Indications: atrial flutter and atrial fibrillation 

Contraindications: v-fib, v-tach, av blocks, digitalis toxicity, 2nd or 3rd degree blocks without pacing

 Dosage/Route: .004-.006 mg/kg (4-6 mcg/kg]

Q:

Dilitiazem

A:

Name/Class: Dilitiazem ( Cardizem) Anti-dysrhythmic

Description: calcium channel blocker that slows conduction; causes coronary and peripheral vasodilation. Used to control a-fib, a-flutter 

 Indications: control rate in a-fib and a-flutter

Contraindications: wide qrs or unknown origin; sick sinus syndrome; av blocks; hypotension, cardiogenic shock; wpw, v-tach or ami

Dosage/Route: 25 mg or 50 mg [don’t give with Lasix]

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