DIAZEPAM (VALIUM)

1. DIAZEPAM (VALIUM) Class: CNS agent – benzodiazepine; anticonvulsant; anxiolytic Action: Anticonvulsant and antianxiety psychotherapeutic drug with actionat both limbic and subcortical levels of CNS Dose: Adults: Status Epilepticus: 5-10 mg slow IV push, repeat in 3-4h Sedation: 5-15 mg slow IV push Pediatrics: 1month- 5yrs: 0.25mg/kg every 5 min IV, max dose 5.0 mg 6yrs and older: 0.25 mg/kg every 5min IV, max dose 10.0 mg. Indications: For anxiety, seizures, skeletal muscle spasm relief; also used as an amnesic, for treatment of restless leg syndrome, acute alcohol withdrawal, and is the drug of choice for status epilepticus Contraindications: Shock, coma, alcohol intoxication, depressed vital signs; acute narrow-angle glaucoma, untreated open-angle glaucoma; MAOIs; pregnancy category D Adverse Effects: Throat and chest pain; drowsiness, fatigue, ataxia, confusion, paradoxic rage, dizziness, vertigo, amnesia, vivid dreams, headache, slurred speech, tremor; EEG changes, tardive dyskinesia; hypotension, tachycardia, edema, cardiovascular collapse; blurred vision, diplopia, nystagmus; xerostomia, nausea, constipation, hepatic dysfunction; incontinence, urinary retention, gynecomastia (prolonged use); hiccups, coughing, laryngospasm; venous thrombosis, phlebitis Interactions: Alcohol, CNS depressants, anticonvulsants, and herbals (kava kava, valerian) potentiate CNS depression; cimetidine increases levels and toxicity; may decrease effects of levodopa; may increase phenytoin levels; smoking decreases sedative and antianxiety effects DIPHENHYDRAMINE (BENADRYL) Class: H1-blocker; antihistamine Action: H1-receptor antagonist and antihistamine as it competes for H1-receptor sites on effector cells; significant central anticholinergic activity as it prolongs action of dopamine by inhibiting its reuptake and storage, thus decreasing parkinsonism and drug-induced extrapyramidal symptoms Dose: Adults: 25-50 mg IVP or IM every 4-6 hrs. Pediatrics: 1.0 mg/kg IV, IO or IM every 4-6 hrs. Indications: For allergic conditions, treatment or prevention of motion sickness, vertigo, blood or plasma reactions, treatment of Parkinsonism and drug-induced extrapyramidal reactions; also used with epinephrine for anaphylaxis, as a cough suppressant, a sedative-hypnotic, and for intractable insomnia Contraindications: Antihistamine hypersensitivity; lower respiratory tract symptoms, asthma; narrow-angle glaucoma; prostatic hypertrophy, bladder neck obstruction; GI obstruction; pregnancy category C Adverse Effects: Drowsiness, dizziness, headache, fatigue, disturbed coordination, tingling, heaviness and weakness of hands, tremors, euphoria, nervousness, restlessness, insomnia; confusion; excitement, fever, palpitation, tachycardia, hypo- or hypertension, cardiovascular collapse, tinnitus, vertigo, dry nose, throat, nasal stuffiness; blurred vision, diplopia, photosensitivity, dry eyes, dry mouth, nausea, epigastric distress, anorexia, vomiting, constipation, diarrhea; urinary frequency or retention, dysuria; thickened bronchial secretions, wheezing, chest tightness Interactions: Alcohol, other CNS depressants, and MAOIs compound CNS depression

2. EPINEPHRINE Class: Autonomic nervous system agent – natural and synthetic catecholamine; alpha- and beta-adrenergic agonist; bronchodilator Action: Sympathomimetic that acts directly on both alpha and beta receptors; the most potent activator of alpha receptors; strengthens myocardial contraction; increases systolic but may decrease diastolic blood pressure; increases cardiac rate and output; constricts bronchial arterioles and inhibits histamine release, thus reducing congestion and edema and increasing tidal volume and vital capacity Dose: All should be rapid infused, titrate to effect, flush after every dose. Adults:0.1–0.5 mL SC/IM q10–15min (1:1000 soln = 1mg/1ml) Pulseless arrest: 1mg (10mL of 1:10000) given every 3-5 min Symptomatic bradycardia: 2-10ug/min (add 1mg of 1:1000 to 500mL normal saline; infuse at 1-5mL/min) Pediatrics: Pulseless arrest:0.01 mg/kg (of 1:10000) every 3-5 minutes Symptomatic bradycardia:0.01 mg/kg (1:10000) Indications: For hypersensitivity and anaphylactic reactions, acute asthma attack, bronchospasm, mucosal congestion, syncope due to heart block or carotid sinus hypersensitivity, and to restore cardiac rhythm in cardiac arrest; prolong action and delay absorption of anesthetics; control superficial bleeding Contraindications: Sympathomimetic amine hypersensitivity; narrow-angle glaucoma; hemorrhagic, traumatic, or cardiogenic shock; cardiac dilatation, cerebral arteriosclerosis, coronary insufficiency, arrhythmias, organic heart or brain disease; do NOT use with local anesthesia of fingers, toes, ears, nose, genitalia; pregnancy category C Adverse Effects: Nervousness, restlessness, sleeplessness, fear, anxiety, tremors, headache, CVA, weakness, dizziness, syncope, pallor, sweating, dyspnea; nausea, vomiting; precordial pain, palpitations, hypertension, MI, tachyarrhythmias; bronchial and pulmonary edema; urinary retention; tissue necrosis; metabolic acidoses; altered state of perception and thought, psychosis Interactions: May increase hypotension in circulatory collapse; additive toxicities with other medications FENTANYL Class: CNS agent - potent narcotic (opiate) agonist Action: Action similar to morphine with more rapid and less prolonged analgesia and sedation, but less emetic effect Dose: Adults:400-800 mcg oral-tranmucosally, titrate to pain up to max 1600 mcg/d; lozenge on a stick to be placed in mouth between cheek and lower gum and sucked, not chewed (have opioid antagonist [naloxone/ narcan] immediately available!) Pediatrics: DO NOT USE-NOT EVALUATED FOR PEDS Indications: For moderate to severe pain management Contraindications: MAOIs; myasthenia gravis; pregnancy category C Side Effects: Sedation, euphoria, dizziness, diaphoresis, delirium, convulsions; bradycardia, hypotension, circulatory depression, cardiac arrest; miosis, blurred vision; nausea, vomiting, constipation, ileus; muscle and thoracic muscle rigidity; urinary retention, rash; laryngospasm, bronchoconstriction, respiratory depression or arrest have Interactions: Alcohol and other CNS depressants potentiate effects; MAOIs may precipitate hypertensive crisis

3. MORPHINE SULFATE (MSO4) Class: CNS agent – narcotic (opiate) agonist; analgesic Action: Natural opium alkaloid with agonist activity as it binds with 3 types of the same receptors as endogenous opioid peptides; analgesia at supraspinal level, euphoria, respiratory depression and physical dependence; sedation and miosis; dysphoric, hallucinogenic, and cardiac stimulant effects Dose: Contact Med Control prior to giving ANY dose. Adults:2mg slow IV push, titrate to pain, max dosage 10mg. Pediatrics: 0.1 mg/kg IV, Contact Med Control for max dosage. Indications: For severe acute and chronic pain management, MI pain relief, preanesthesia and as adjunct to anesthesia, and for relief of dyspnea from acute left ventricular failure and pulmonary edema Contraindications: Opiate hypersensitivity; increased ICP; seizures; acute alcoholism; acute bronchial asthma, chronic pulmonary disease, severe respiratory depression; chemical-irritant induced pulmonary edema; BPH; diarrhea due to poisoning untiltoxic material has been eliminated; undiagnosed acute abdominal conditions; following biliary tract surgery and surgical anastomosis; pancreatitis; acute ulcerative colitis; severe liver or renal insufficiency; hypothyroidism; pregnancy category B Adverse Effects: Pruritus, rash, urticaria, edema, anaphylactoid reaction; sweating, euphoria, insomnia, visual disturbances, dysphoria, paradoxic CNS stimulation (restlessness, tremor, delirium, insomnia), convulsions; decreased cough reflex, drowsiness, dizziness, deep sleep, miosis; bradycardia, palpitations, syncope; orthostatic hypotension, constipation, anorexia, dry mouth, biliary colic, nausea, vomiting, urinary retention or urgency, dysuria, oliguria, severe respiratory depression or arrest; pulmonary edema Interactions: CNS depressants, sedatives, barbiturates, alcohol, benzodiazepines, and TCAs potentiate CNS depressant effects; MAOIs may precipitate hypertensive crisis; phenothiazines may antagonize analgesia; herbals (Kava-kava, valerian, St. John's wort) may increase sedation NALOXONE (NARCAN) Class: CNS agent – narcotic (opiate) antagonist Action: A "pure" narcotic antagonist, essentially free of agonistic (morphine-like) properties; thus, produces no significant analgesia, respiratory depression, psychotomimetic effects, or miosis when administered in the absence of narcotics and possesses more potent narcotic antagonist action Dose: Adults:2.0 mg IV or IM, repeat every 2–3min up to 10 mg or until narcotic effects are reversed. Pediatrics: Less than 5 yrs- 0.1 mg/kg IV, IO, SQ, ET 5yrs and older- 2.0 mg IV, IO, SQ, ET Indications: For narcotic opiate overdose and reversal of effects of natural and synthetic narctotics (opiates), including respiratory depression, sedation, and hypotension; drug of choice when depressant drug is unknown and for diagnosis of suspected acute opioid overdose Contraindications: Non-opioid drug respiratory depression; pregnancy category B Adverse Effects: Analgesia reversal, tremors, hyperventilation, drowsiness, sweating; increased BP, tachycardia; nausea, vomiting; elevated PTT Interactions: Reverses analgesic effects of narcotic (opiate) agonists and agonist-antagonists

4. PROMETHAZINE (PHENERGAN) Class: GI agent – phenothiazine; antiemetic, antivertigo Action: Long-acting phenothiazine derivative with prominent sedative, amnesic, antiemetic, and anti-motion-sickness actions and marked antihistamine activity; antiemetic action due to depression of CTZ in medulla; as with other antihistamines, it exerts antiserotonin, anticholinergic, and local anesthetic action Dose: 12.5-25 mg PO/IM/IV q4-6h prn Indications: For symptomatic relief from nausea, vomiting, motion sickness, and allergic conditions; also used for pre- and postoperative sedation, and as adjunct to analgesics for control of pain Contraindications: Phenothiazine hypersensitivity; narrow-angle glaucoma; stenosing peptic ulcer, pyloroduodenal obstruction; BPH; bladder neck obstruction; epilepsy; bone marrow depression; comatose or severe depressed states; Reye's syndrome, encephalopathy, hepatic diseases; pregnancy category C Adverse Effects: Deep sleep, coma, convulsions, cardiorespiratory symptoms, extrapyramidal reactions, nightmares, CNS stimulation, abnormal movements; irregular respirations, respiratory depression; sedation drowsiness, confusion, dizziness, disturbed coordination, restlessness, tremors; transient mild hypo- or hypertension; anorexia, nausea, vomiting, constipation; leukopenia, agranulocytosis; blurred vision, dry mouth, nose, or throat; photosensitivity; urinary retention Interactions: Alcohol and other CNS depressants add to CNS depression and anticholinergic effects ONDANSETRON (ZOFRAN) Class: GI agent – 5-HT3 antagonist, antiemetic Action: Selective serotonin (5-HT3) receptor antagonist, acting centrally in the chemoreceptor trigger zone (CTZ) and peripherally on the vagal nerve terminals; serotonin is released from the wall of the small intestine, stimulates the vagal efferents through the serotonin receptors, and initiates the vomiting reflex Dose: 8-16 mg PO q8h prn; 4mg slow IVP or IM q8h prnIndications: Prevention of nausea and vomiting associated with anesthesia, postoperative state, and chemotherapy Contraindications: Hypersensitivity to ondansetron; pregnancy category B Adverse Effects: Dizziness, light-headedness, headache, sedation; diarrhea, constipation, dry mouth Interactions: Rifampin may decrease ondansetron levels

5. ETOMIDATE (AMIDATE) Class: Sedative/Hypnotic Action: is a hypnotic drug without analgesic activity. It produces hypnosis characterized by rapid onset of action, usually within 1 minute. Dose: Adults: (10 and older) 0.3mg/kg (max dose: 20mg) IV Infused over 30 to 60 seconds will produce rapid sedation that lasts 10 to 15 minutes. Pediatrics: DO NOT USE-NOT EVALUATED FOR PEDS Indications: RSI Contraindications: Patients under 10 should not be used on, do not use with ketamine, use with caution in the elderly (especially those with high blood pressure), pregnancy/breastfeeding Adverse Effects: More common effects are shivering or trembling, blurred or double vision or other vision problems; dizziness, lightheadedness, or feeling faint; drowsiness; headache; mood or mental changes; nausea (mild) or vomiting; nightmares or unusual dreams. Adverse Effects: Brief pain in the veins; coughing; drowsiness; hiccups; nausea; temporary uncontrollable muscle movements; vomiting. Interactions: Amiodarone because the risk of side effects, such as slowed heart rate or heart block may be increased; Do not give with Droxidopa because its actions and side effects may be increased. Other medical problems: Do not use with CNS depressants or antihistamines, medications for hay fever, other allergies, or colds, sedatives, tranquilizers, sleeping medicine or prescription pain medicine such as narcotics or other barbiturates; patients should not be given if patient is on medicine for seizures or muscle relaxants. LORAZEPAM (ATIVAN) Class: Anticonvulsant / sedative Action: Status Epilepticus, Anti-anxiety, Sedative-hypnotic, skeletal muscle relaxant Dose: Adults: Status Epilepticus: 2-4mg slow IV or IM Anxiety, Sedation: 0.05mg/kg up to 4mg IM For IV or IO use: dilute 1:1 in NS, D5W. Pediatrics: 0.05mg- 0.2mg/kg IV, IO, IM slow. Indications:RSI Contraindications:hypersensitivity, acute narrow-angle glaucoma, pregnancy/breastfeeding Adverse Effects: confusion, depressedmood, thoughts of suicide or hurting yourself; hyperactivity, agitation, hostility; hallucinations; or feeling light-headed, fainting. Interactions: Barbiturates, MAO inhibitors or medicines to treat psychiatric disorders, narcotic medications such as Stadol, Codeine, Hydrocodone, Loratab, Vicodine, Demerol, Methadone, Morphine, Narcan, Oxycodone Darvocet or antidepressants such as Elavil, Celexa, Prozac, Paxil or Zoloft should not take this medication. Other medical problems-The presence of other medical problems may affect the use of benzodiazepines. Make sure you tell your doctor if you have any other medical problems, especially: History of alcohol abuse may make effects of alcohol worse while taking this medication. Epilepsy or history of seizures should not take these medications.

6. NITROGLYCERIN (NITRO) Class: Potent Vasodilator Action: Vascular smooth muscle relaxation, which leads to venous coronary and arterial vasodilatation. This causes a decrease in preload and myocardial oxygen demand, it also dilates pulmonary capillaries. Dose: Adults: Sublingual: 0.4mg (1 tablet) SL, repeat every 5 minutes if no relief for a total of 3 doses. DO NOT ADMINISTER UNTIL IV ACCESS IS ESTABLISHED; DO NOT ADMINISTER IF SYSTOLIC BP IS LESS THAN 90mm Hg. If the Patient has a Topical Patch: REMOVE for Defibrillation. Pediatrics: DO NOT USE. Indications: AMI, Congestive Heart Failure, Acute Angina, Presumed cardiac chest pain. Contraindications: Allergy or hypersensitivity, hypotension, head trauma, pregnant/breastfeeding Adverse Effects: May cause dizziness, lightheadedness, or fainting or blurred vision. Burning or tingling in the mouth flushing, headache, heavy sweating, nausea, pale skin, vomiting may also occur. Interactions: Beta-blockers (propranolol), calcium channel blockers (diltiazem), phenothiazines (thioridazine), or phosphodiesterase type 5 inhibitors (sildenafil) because side effects such as severely low blood pressure may occur; Alteplase or heparin because the effectiveness of these medicines may be decreased; Salicylates (aspirin) because the effectiveness of nitroglycerin may be altered. Other medical problems- Alcohol, hot weather, exercise, and fever can increase these effects. • VECURONIUM (NORCURON) • Class: Non-depolarizing neuromuscular blocking agent. • Action: Paralyzes respiratory and skeletal muscles, blocks acetylcholine from binding to receptors on motor endplates inhibiting depolarization • Dose: • Adults: 0.1mg/kg IV. • Pediatrics:0.1mg/kg IV • WARNING: DO NOT USE THIS AGENT UNLESS; • PREPARED WITH SUCTION, A BVM APPARATUS AND SURGICAL CRICOTHYROIDOTOMY SET IN THE EVENT OF INTUBATION FAILURE OR BAG THE PATIENT UNTIL THE EFFECT SUBSIDES IN THE PATIENT. • THIS MEDICATION DOES NOT PROVIDE SEDATION OR ANALGESIA; DO NOT USE THIS MEDICATION IN A PATIENT THAT HAS NOT ALSO RECEIVED SOME FORM OF SEDATION. • Indications: To maintain paralysis during long transport times. May be used initially to facilitate endotracheal intubation if Succinylcholine is contraindicated. • Contraindications: Suspected heart attack, ICP, • severe anemia, currently taking a phosphodiesterase type 5 inhibitor (sildenafil) or other medications used frequently for sexual dysfunction, children less than 31 days old, obesity, and hypersensitivity. • Adverse Effects: Prolonged paralysis, hypotension, bradycardia, malignant hyperthermia. • Interactions: Aminoglycosides (gentamicin), clindamycin, cyclosporine, inhalation anesthetics (eg, enflurane), lincomycin, magnesium salts, polypeptide antibiotics (bacitracin), quinidine, quinine, trimethaphan, or verapamil because the side effects of Vecuronium may be increased. • Carbamazepine, hydantoins, other nondepolarizing neuromuscular blockers (pancuronium), tetracyclines (doxycycline), theophyllines, or thiopurines because the effectiveness of Vecuronium may be decreased. • Other medical problems- Pregnant/breast-feeding. If you are taking any prescription or nonprescription medicine, herbal preparation or dietary supplements; history of asthma, an enlarged prostate, trouble urinating, circulation problems, electrolyte problems, a blockage of your bladder, irregular heartbeat or other heart problems, liver or kidney problems, adrenal gland problems, underactive thyroid, lung problems (COPD), myasthenia gravis or Eaton-Lambert syndrome, mood, mental problems, suicidal thoughts or behaviors, serious head injury, ICP, unusual growths in the brain, seizures, or severe inflammatory bowel disease; history of substance abuse or you are having stomach or intestinal surgery.

7. Norepinephrine bitartrate (Levophed) Class: Sympathomimetic amine Action:.Functions as a peripheral vasoconstrictor and as an inotropic stimulator of the heart and dilator of coronary arteries. Dose: Adults: Add a 4 mL ampul (4 mg) of Levophed to 1,000 mL of a 5 percent dextrose containing solution. After observing the response to an initial dose of 2 mL to 3 mL (from 8 mcg to 12 mcg of base) per minute, adjust the rate of flow to establish and maintain a low normal blood pressure (usually 80 mm Hg to 100 mm Hg systolic) sufficient to maintain the circulation to vital organs. Pediatrics: Indications: For blood pressure control in certain acute hypotensive states (pheochromocytomectomy, sympathectomy, poliomyelitis, spinal anesthesia, myocardial infarction, septicemia, blood transfusion, and drug reactions). As an adjunct in the treatment of cardiac arrest and hypotension. Contraindications: allergy to Sulfites; should not be given to patients who are hypotensive from blood volume deficits except as an emergency measure to maintain coronary and cerebral artery perfusion until blood volume replacement therapy can be completed; avoid with patients with mesenteric or peripheral vascular thrombosis. Adverse Effects: Use with caution in patients with profound hypoxia or hypercarbia as V-Tach or V-Fib may occur. Interactions: cyclopropane and halothane anesthesia is generally considered contraindicated because of the risk of producing V-Tach or V-Fib; should be used with extreme caution in patients receiving MAOI or antidepressants drugs; Other medical problems: use in a large vein due to possible necrosis in smaller veins; Ischemic injury due to potent vasoconstrictor action and tissue hypoxia. bradycardia, probably as a reflex result of a rise in blood pressure, arrhythmias. anxiety, headache, dyspnea, necrosis at injection site. prolonged administration may result in plasma volume depletion which should be continuously corrected by electrolyte IV. • Midazolam (Versed) • Class: Anesthetic, adjunct sedative-hypnotic, anticonvulsant • Action: Is a short-acting benzodiazepine CNS depressant. • Dose: • Adults:To rapidly initiate sedation, 0.02 to 0.05 mg/kg IV (may be given slowly or infused over several minutes. • Pediatrics: • 0-6 months- DO NOT USE-NOT EVALUATED FOR PEDS • 6 months to 12 years of age- Initial dose 0.03mg/kg IV. WARNING-MEDICATION HAS BEEN ASSOCIATED WITH RESPIRATORY DEPRESSION AND RESPIRATORY ARREST, HAVE AGE/SIZE APPROPRIATE EQUIPMENT FOR BAG/VALVE/MASK VENTILATION AND INTUBATION READY. • Indications: Is used to produce loss of consciousness sleepiness or drowsiness and to relieve anxiety before certain procedures or for preoperative sedation/anxiolysis/amnesia. • Contraindications: Do not give if patient has ever had an allergic reaction to midazolam or other benzodiazepines (such as Xanax ,Lectopam, Librium, Klonopin, Tranxen, Valium, ProSom, Dalmane, Paxipam, Loftran, Ativan, Mogadon, Serax, Centrax, Doral, Restoril or Halcion.) Avoid giving to pregnant/ breastfeeding mothers, newborn infants or elderly. • Adverse Effects: Do not give in patients with history of heart, kidney, lung or liver, nerve or muscle disease (esp myasthenia gravis)-medication may make the condition worse. • Interactions: Central nervous system (CNS) depressants (medicines that cause drowsiness) or alcohol- effects may be increased and may last longer. Avoid if patient is taking Saquinavir drugs (Fortovase, Invirase)—combination may interfere with the removal of midazolam from the body, which could lead to serious side effects. • Other medical problems: Effects of medication may be prolonged in obese pts.

8. Succinylcholine • Class: neuromuscular blocking agent. • Action: Relaxing muscles during surgery or when using a ventilator. Used to induce anesthesia or when intubating. It is depolarizing muscle relaxant and causes paralysis of the muscles in the face and those used to breathe. • Dose: • Adults:1.0-1.5 mg/ kg IV, max dose 150 mg. • Pediatrics: 1 mg/kg IV • Indications: indicated as an adjunct to general anesthesia to facilitate tracheal intubation by providing skeletal muscle relaxation during surgery or mechanical ventilation. • Contraindications: Recent severe burn, trauma, nerve damage, or upper body movement injury of family history of muscle disease or malignant hyperthermia (high body temp);if you are pregnant/planning/breast-feeding, herbal preparation or dietary supplement; glaucoma, electrolyte imbalance, liver problems, plasma cholinesterase deficiency, bone fracture, muscle spasms, high levels of potassium or low levels of calcium or potassium in the blood, dehydrated or recent eye surgery/injury, history of stomach infections or bleeding the brain. • Adverse Effects: Increased saliva; muscle pain following surgery; muscle twitching; chest pain; fast breathing; fast or slow heartbeat; high temp; increased pressure in the eye; slowed/pauses in breathing; pounding in the chest; tightening of jaw or other muscles. • Interactions: Digoxin due to risk of arrhythmias may be increased; Aminoglycosides (gentamicin), beta-adrenergic blockers (propranolol), chloroquine, clindamycin, cyclophosphamide, glucocorticoids (prednisone), lithium, magnesium salts, metoclopramide, oxytocin, oral contraceptives, procainamide, quinidine, quinine, terbutaline, or trimethaphan because effects may decrease. Cefazolin (ANCEF) Class: Antibiotic (cephalosporins) Action: Fights bacteria in the body used to treat bacterial infections for respiratory, skin, genital, urinary, bone & joint. Dose: Adults: 250 milligrams (mg) to 1.5 grams 6-12 hours, IM or IV Pediatrics: Infants and children 1 month of age and older—6.25 to 25 mg per kilogram (kg) (2.84 to 11.36 mg per pound) of body weight every 6 hours, or 8.3 to 33.3 mg per kg (3.77 to 15.13 mg per pound) of body weight every 8 hours, IM or IV Newborns—20 mg per kg (9.09 mg per pound) of body weight every 8-12 hours, IV only. Indications: Are used in the treatment of infections caused by bacteria. They work by killing bacteria or preventing their growth. Given by injection are also used to prevent infections before, during, and after surgery. Contraindications: Allergic reaction to another cephalosporin or PCN; kidney, GI or liver disease or diabetes or patients with phenylketonuria (PKU) Adverse Effects: Severe nausea, vomiting, or diarrhea with mucous or blood in the stool, chest pain, SOB, unusual bleeding or bruising. Interactions: probenecid (Benemid); diuretics (water pill-furosemide, bumex, demadex, edecrin, coumadin or another antibiotic. Other medical problems: difficult urination/ decreased output; sores, ulcers, or white spots on lips or in mouth; seizures; side effects also may occur up to several weeks after you stop taking this medicine.

9. Sodium Bicarbonate Class: Systemic alkalizer, urinary antacid, electrolyte replenisher Action: Treats metabolic acidosis (too much acid in the body) and certain drug intoxications, It is an electrolyte. It works by neutralizing excess acid in the blood. Dose: Follow medication with adequate ventilation Adults:1mEq/kg IV bolus with a 15-20 cc flush of NS Pediatrics: 1mEq/kg per dose; administer as slow bolus with a 15-20 cc flush of NS Contraindications: Vomiting, CHF, heart disease or hypertension, liver or kidney problems, a decreased urine or no urine, peripheral edema, or rectal bleeding of unknown cause. Adverse Effects: Frequent urge to urinate; headache, loss of appetite, mood or mental changes; muscle pain or twitching; nausea or vomiting, nervousness or restlessness; slow breathing; swelling of feet or lower legs; unusual tiredness or weakness. Interactions: Sympathomimetics (pseudoephedrine) because side effects may be increased by this medicine Anorexiants (phentermine), azole antifungals (itraconazole), cephalosporins (cephalexin), corticosteroids (prednisone), corticotropin, lithium, or tetracyclines (doxycycline) because effectiveness may be decreased by Sodium bicarbonate Other medical problems: Toxemia of pregnancy-causes retention of water, which may precipitate condition. Alkalosis (too little acid in the body), low blood levels of calcium or chloride, Metoprolol (Lopressor) Class: Beta-adrenergic blocking agent Action: Works by reducing the amount of work the heart has to do (reduces angina) and the amount of blood the heart pumps out (lowers HBP). Also used to stabilize the heart rhythm in conditions in which the heart is beating too fast or at an irregular rhythm. Adults: 5 mg every two minutes for three doses. Pediatrics: DO NOT USE- NOT EVALUATED FOR PEDS Indications: Treats hypertension, long-term treatment of angina; reduces risk of death in MI patients Contraindications: Bradycardia or suspected AV block; heart failure controlled by diuretics (furosemide or digoxin); low systolic blood pressure (<100 mm Hg); taking mibefradil; history of liver, heart, or blood circulation problems, diabetes mellitus, COPD dyspnea or asthma Adverse Effects: Blurred vision; confusion; dizziness; itching; lightheadedness; muscle aches; nausea; nightmares; memory loss; stomach pain; unusual tiredness or weakness, chest pain; fainting; pounding in the chest; peripheral edema or wheezing Interactions: Barbiturates (phenobarbital), indomethacin, or phenylpropanolamine because they may decrease effectiveness; Amiodarone, cimetidine, disopyramide, flecainide, hydralazine, ketanserin, mefloquine, mibefradil, quinazolines (imatinib), quinidine, birth control pills, thioamines (propylthiouracil) or verapamil because serious side effects, bradycardia and very LBP may occur. Bupivacaine, disopyramide, flecainide, hydralazine, ketanserin, or lidocaine because the risk of their side effects may be increased by medication or Clonidine because stopping either of these medicines suddenly can lead to a rapid increase in BP. Other medical problems: tumors on your adrenal gland, have an overactive thyroid, or are scheduled to have surgery

10. Lidocaine 1% Class: Antiarrhythmic agent Action: Attenuates phase 4 diastolic depolarization, decreases automaticity, decreases action potential duration, and raises ventricular fibrillation threshold; inhibits conduction of nerve impulses from sensory nerves. Dose: Adults: IV bolus 50 to 100 mg at rate of 25 to 50 mg/min; may repeat, but do not exceed 200 to 300 mg/h. Continuous infusion 1 to 4 mg/min. Pediatrics: IV bolus/ intratracheal 1 mg/kg/dose every 5 to 10 min (max dose, 5 mg/kg). Maintenance dose is 20 to 50 mcg/kg/min. Indications: Acute management of ventricular arrhythmias Contraindications: Stokes-Adams syndrome; Wolff-Parkinson-White syndrome; severe degrees of sinoatrial, AV or intraventricular block in absence of pacemaker; Adverse Effects: Hypotension; bradycardia; CV collapse; cardiac arrest, CNS, dizziness; lightheadedness; nervousness; drowsiness; apprehension; confusion; mood changes; hallucinations; tremors, visual disturbances; diplopia; nausea; vomiting, respiratory depression or arrest, difficulty in speaking, breathing and swallowing, numbness of lips or tongue and paresthesias. Interactions: Beta-adrenergic blockers increased lidocaine levels; Cimetidine decreases lidocaine levels; antiarrhythmic agents (tocainide, mexiletine) produce toxic effects are additive and potentially synergistic; Procainamide additive to neurological and cardiac effects; Succinylcholine prolongs neuromuscular blockade; Do not use with Amphotericin B, parenteral cephalosporins, doxycycline, epinephrine, isoproterenol, methohexital, nitroprusside, norepinephrine, phenytoin, sodium bicarbonate, sulfadiazine. Other medical problems: Use with caution in patients with CHF, reduced cardiac output, digitalis toxicity, may result in excessive depression of cardiac conductivity. Atropine Class: Antiarrhythmic; anticholinergics; antispasmodic Action: Anticholinergics/antispasmodics are used emergency procedures to help relax and decrease secretions; used to help keep the heartbeat normal. Dose: DO NOT give to patients under 1 year old. Adults: Asystole/PEA:1mg IVP every 3-5 min, max dose 0.04 mg/kg Symptomatic bradycardia: 0.5-1.0 mg IVP every 3-5 min, max dose 0.04 mg/kg Pediatrics: 0.02 mg/kg, minimum dose will be at least 0.1 mg. Indications: Temporarily increase heart rate or decrease AV-block until definitive intervention can take place. Contraindications: kidney disease; severe ulcerative colitis, glaucoma, GI, liver or lung disease or myasthenia gravis, severe bleeding, hypertension, toxemia of pregnancy or overactive thyroid. Adverse Effects: Blurred vision; difficulty in swallowing; drowsiness, headache; increased sensitivity of eyes to light; loss of memory; nausea, vomiting; unusual tiredness, irregular or fast heart rate; flushing and eye pain; dizziness, lightheadedness, weakness or nervousness; large pupils, may increase heart rate Interactions: amantadine (Symmetrel); quinidine (Quinaglute, Cardioquin, Quinora, Quinidex); antihistamines such as diphenhydramine (Benadryl), brompheniramine (Dimetapp, Bromphen), triprolidine (Actifed) and chlorpheniramine (Chlor-Trimeton).phenylpropanolamine (Dexatrim), phenylephrine (Neo-Synephrine), and pseudoephedrine (Sudafed), phenothiazines such as chlorpromazine (Thorazine) and prochlorperazine (Compazine); fluphenazine (Prolixin), mesoridazine (Serentil), perphenazine (Trilafon), thioridazine (Mellaril), trifluoperazine (Stelazine), and promazine (Sparine); tricyclic antidepressants such as amitriptyline (Elavil, Endep), doxepin (Sinequan), nortriptyline (Pamelor), amoxapine (Asendin), clomipramine (Anafranil), desipramine (Norpramin), imipramine (Tofranil), protriptyline (Vivactil), and trimipramine (Surmontil).

11. Mannitol 20% Class: Osmotic diuretic. Action: Works by increasing the amount of fluid excreted by the kidneys and helps the body to decrease pressure in the brain and eyes. Dose: Adults: In adults a dose of 0.25 to 2 g/kg body weight as a 15% to 25% solution administered over a period of 30 to 60 minutes; Pediatrics: pediatric patients 1 to 2 g/kg body weight or 30 to 60 g/m2 body surface area over a period of 30 to 60 minutes Indications: Reduction of intracranial pressure and brain mass. Contraindications: renal disease or damage, severe pulmonary congestion or pulmonary edema, intracranial bleeding, severe dehydration. Adverse Effects: Pulmonary congestion, fluid and electrolyte imbalance, acidosis, electrolyte loss, edema, headache, blurred vision, convulsions, nausea, vomiting, skin necrosis, thrombophlebitis, chills, dizziness, dehydration, hypotension, tachycardia, fever and angina. Interactions: None recorded at this time. Calcium chloride Class: Antihyperkalemic; antihypermagnesemic; antihypocalcemic, cardiotonic, electrolyte replenisher Action: Necessary for the restoration of normal cardiac function and aids in the coagulation of blood. Dose: Adults: The usual adult dosage in hypocalcemic disorders ranges from 200 mg to 1 g (2−10 mL) at intervals of 1 to 3 days. Pediatrics: The pediatric dosage in hypocalcemic disorders ranges from 2.7 to 5.0 mg/kg hydrated Calcium Chloride Indications: indicated for the treatment of hypocalcemia in those conditions requiring a prompt increase in plasma calcium levels. Contraindications: contraindicated for cardiac resuscitation in the presence of ventricular fibrillation or in patients with the risk of existing digitalis toxicity. Is not recommended in the treatment of asystole and electromechanical dissociation, Heart disease Hypercalcemia (blood) or Hypercalciuria (urine) Hyper/ or hypo parathyroidism, kidney disease or stones Adverse Effects: moderate fall in BP, dizziness; irregular heartbeat; nausea or vomiting; burning at injection site; sweating, weakness Interactions: Cellulose sodium phosphate (Calcibind), digitalis glycosides (heart med), Etidronate (Didronel), Gallium nitrate (Ganite) Magnesium sulfate (for injection), Phenytoin (Dilantin) phenytoin tetracyclines (antibiotics) Other medical problems: Patient may complain of tingling sensations, a calcium taste, a sense of “heat wave” or hot flashes.

12. Adenosine Class: Antiarrhythmic. Action: Slows conduction time through the A-V node, can interrupt the reentry pathways through the A-V node, and can restore NSR in patients with paroxysmal supraventricular tachycardia (PSVT); used primarily to treat SVT. Dose: Adults: Initial dose is 6 mg given as rapid IV bolus over 1- 2 seconds; repeat administration if the first dose does not result in elimination of SVT within 1-2 minutes, 12 mg should be given as a rapid IV bolus and may be repeated a second time if required. Pediatrics: (Body Weight < 50 kg) initial dose is given 0.05-0.1 mg/kg as a rapid IV bolus followed by saline flush; repeat administration if conversion of PSVT does not occur within 1-2 minutes, additional bolus injections of Adenosine can be administered at incrementally higher doses, increasing the amount given by 0.05 to 0.1 mg/kg. Follow each with saline flush, continue process until sinus rhythm is established or max single dose of 0.3 mg/kg is used. Peds with body weight ≥ 50 kg should be given adult dose. Indications: Conversion to SR of paroxysmal supraventricular tachycardia (PSVT), including that associated with accessory bypass tracts (Wolff-Parkinson-White Syndrome). Med DOES NOT convert atrial flutter, A-FIB, or V-TACH to NSR. In the presence of atrial flutter or A-FIB, a transient modest slowing of ventricular response may occur immediately. Contraindications: Second- or third-degree A-V block (except in patients with a functioning artificial pacemaker). Sinus node disease, such as sick sinus syndrome or symptomatic bradycardia (except in patients with a functioning artificial pacemaker). Adverse Effects: Chest pressure/discomfort; dizziness; flushing of the face; headache; HBP; lightheadedness; nausea; SOB; throat, neck, or jaw discomfort; tingling in the arms. Interactions: Digoxin or verapamil, carbamazepine or dipyridamole or methylxanthines (caffeine, theophylline) Other medical problems:. None noted. Dopamine Class: Alpha and beta-adrenergic agent (sympathomimetic, cardiac inotrope and vasoconstrictor) Action: Treats shock and LBP due to MI, trauma, infections, surgery, other causes. Helps improve heart function when it is unable to pump enough blood, increasing the pumping strength of the heart and the kidney blood supply. Dose: DO NOT mix with Sodium Bicarbonate Adults: Mix 400-800mg in 250ml NS, LR or D5W, titrate to patient response. Pediatrics: Mix from 40mg/mL in 5 or 10 mL vial, initial dose often 5-10 ug/kg per minute.; typical is 2-20 ug/kg per min. Indications: Cardiogenic and/or septic shock. Contraindications: you are taking droxidopa or have taken furazolidone or MAOI (phenelzine) within the past 21 days, adrenal gland tumors or irregular heartbeat diabetes, history of HBP, MI, or blood vessel disease (arteriosclerosis, Raynaud disease, Buerger disease), or a decreased amount of blood in the body (hypovolemia) Adverse Effects: Tachycardia; headache; nausea;vomiting. Interactions: Catechol-O-methyltransferase (COMT) inhibitors (tolcapone) Cyclopropene, droxidopa, ergot derivatives (methylergonovine), furazolidone, halogenated hydrocarbon anesthetics (halothane), or MAO inhibitors (phenelzine), Alpha-blockers (prazosin), beta-blockers (propranolol), butyrophenones (haloperidol), hydantoins (phenytoin) or phenothiazines. Bromocriptine or tricyclic antidepressants (amitriptyline) Guanadrel or guanethidine. Other medical problems: None noted.

13. Amiodarone Class: Antiarrhythmic. Action: Treating life-threatening recurrent heart rhythm by stabilizing the heart rhythm in conditions in which the heart is beating too fast or in an irregular rhythm. Produces its helpful effects by slowing nerve impulses in the heart and acting directly on the heart tissues correcting abnormal heart rhythms. Dose: Adults: Cardiac Arrest- 300 mg IV push, consider additional 150mg push in 3-5 min. Wide-Complex Tachycardia- First dose is rapid infusion 150 mg injected into a vein for ten minutes, followed by a dose of 360 mg slow in fusion for six hours, subsequent should be managed in the hospital. Pediatrics: For refractory pulseless VT,VF- 5mg/kg rapid IV/IO bolus Supraventricular and ventricular arrhythmias- loading dose is 5mg/kg IV/IO over 20-60 mintues (repeat to max of 15 mg/kg per day IV) Indications: Used in a wide variety of atrial and ventricular tachyarrhythmias Contraindications: allergy to iodine, complete/second/third or severe sinoatrial heart block; bradycardia; or shock due to serious heart problems; or fainting due to bradycardia (except if patient has a pacemaker)history of liver/heart/thyroid or eye problems, lung disease, LBP, electrolyte problems (low blood potassium or magnesium), post-operation. Adverse Effects: Cough; painful breathing; SOB, dizziness, lightheadedness or fainting; fever (slight); numbness or tingling in fingers or toes; trembling or shaking of hands; trouble walking; unusual and uncontrolled movements of the body; weakness of arms/legs Interactions: Cholestyramine, hydantoins (phenytoin), rifampin, St. John's wort, Antiarrhythmics (flecainide), arsenic, azole antifungals (ketoconazole), cimetidine, cisapride, diuretics (furosemide, hydrochlorothiazide), dofetilide, droperidol, H1 antagonists (astemizole, loratadine, terfenadine), HIV protease inhibitors (ritonavir), ketolides (telithromycin), macrolide antibiotics (erythromycin), phenothiazines (thioridazine), phosphodiesterase type 5 inhibitors (vardenafil), pimozide, quinolones (ciprofloxacin), serotonin receptor antagonists (dolasetron), streptogramins (dalfopristin, quinupristin), trazodone, ziprasidone, narcotic pain relievers (fentanyl) Anticoagulants (warfarin), beta-blockers (propranolol), calcium channel blockers (verapamil, diltiazem), cyclosporine, dextromethorphan, digoxin, HMG-CoA reductase inhibitors (simvastatin), lidocaine, methotrexate, thyroid hormones (levothyroxine) or Clopidogrel. Other medical problems:. None noted.