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Study Guide: National Registry Paramedic Exam: Medications
Source: https://www.fatskills.com/paramedic/chapter/national-registry-paramedic-exam-medications

National Registry Paramedic Exam: Medications

By Fatskills Exam Guides Team — the exam nerds behind 28,500+ quizzes and 2.1M practice questions across 500+ global exams.

⏱️ ~19 min read

Medication list:

Activated Charcoal
Class Adsorbent
Mechanism Toxic
substances in the GI tract attached to it
Indications Oral
poisonings and overdoses within about an hour of ingestion
Contraindications Unresponsive
patient or patient unable to protect his or her own airway; ingestion of acids, bases, or petroleum products
Interactions Aspiration
can be fatal
Form 25 g
suspended in 125 mL liquid
Dosage 1–2 g/kg
Considerations Mix
and shake well
Adenosine
Class Antidysrhythmic
Mechanism Slows
conduction through the AV node, disrupting reentry pathways
Indications Paroxysmal
SVT, SVT unresponsive to vagal maneuver
Contraindications Sick
sinus syndrome, junctional rhythms, 2nd- and
3rd-degree blocks, bronchoconstrictive lung disease
Interactions Methylxanthines
antagonize; carbamazepine potentiates
Form 3 mg/mL
in 2 mL vials, 12 mg prefilled syringes
Dosage 1st
dose: 6 mg
rapid intravenous bolus followed by a 10 mL flush;
2nd and
3rd doses: 12 mg rapid intravenous bolus followed by flush
Considerations Short
half-life and duration of action; patient may pass out
Albuterol
Class Sympathomimetic
Mechanism Beta-2
agonist
Indications Bronchospasm
in COPD and patients with asthma
Contraindications Hypersensitivity
Interactions Beta-blockers
may antagonize effects; tricyclic antidepressants may potentiate vascular
effects
Form 2.5 mg
in 3 mL solution for nebulization or MDI
Dosage 2.5 mg
diluted to 3 mL in a nebulizer with 6–10 LPM O2
Considerations May
cause tachycardia and feelings of anxiety
Alteplase
Class Fibrinolytic
Mechanism Converts
plasminogen to plasmin, which digests fibrin strands in a clot
Indications AMI, PE, and CVA
Contraindications Active
bleeding; recent surgery; previous CVA, CPR, AVM or aneurysm; uncontrolled
hypertension
Interactions Anticoagulants
increase risk of bleeding
Form 50 mg
and 100 mg powders that need to be reconstituted to 1 mg/mL
Dosage 15 mg
bolus over 2 minutes, followed by 0.75 mg/kg infusion over 30 minutes to a
maximum of 50 mg/kg
Considerations Monitor vital signs and watch for bleeding
Amiodarone
Class Antidysrhythmic
Mechanism Blocks
cardiac Na+ and K+ channels, delaying repolarization
Indications VF, VT
Contraindications Hypersensitivity and STs with aberrancy
Interactions May
precipitate digitalis toxicity; beta-blockers and calcium channel blockers may
cause sinus arrest; AV blocks
Form 50 mg/mL
vials and prefilled syringes
Dosage VF/pulseless
VT: 300 mg as intravenous bolus; 150 mg after 3–5 minutes if no response; stable VT with
pulses: 150 mg over 10 minutes
Considerations Foams
when shaken; may increase hypotension
Amyl Nitrite
Class Cyanide
poisoning antidote
Mechanism Prevents
cyanide’s toxic effects by converting hemoglobin to methemoglobin
Indications Cyanide
poisoning
Contraindications None
Interactions Antihypertensives, beta-blockers, and alcohol will worsen hypotension
Form 0.3 mg
ampules for inhalation
Dosage 1–2
ampules crushed and inhaled for 30–60 seconds; repeat every 5 minutes until
conscious
Considerations Highly
flammable; psychoactive recreational use; 1st
step of 3-step treatment, followed by sodium nitrite and sodium thiosulfate
Aspirin
Class Antiplatelet and anti-inflammatory
Mechanism Prevents
platelets from aggregating
Indications Chest
pain of a cardiac origin
Contraindications Hypersensitivity, active bleeding, or ulcers
Interactions None
Form 81 mg
chewable tablets
Dosage 162–324 mg, chewed
Considerations Not
recommended for children
Atenolol
Class Beta-1
selective antagonist
Mechanism Decreases
HR, cardiac contractility, and cardiac output
Indications Hypertension, SVT, AF, atrial flutter; reduces myocardial damage during AMI
Contraindications Heart
failure, cardiogenic shock, bradycardia, lung disease, and hypotension
Interactions Potentiates
antihypertensive effects of calcium channel blockers and monoamine oxidase inhibitors (MAOIs)
Form 5 mg
in 10 mL ampules
Dosage 5 mg
for 5 minutes; repeat dose in 10 minutes
Considerations Use
with caution in patients with liver and renal dysfunction and patients with COPD
Atropine
Class Anticholinergic
Mechanism Inhibits
ACH at postsynaptic receptors; increases HR in sinus bradydysrhythmias
Indications Hemodynamically
significant bradycardia and organophosphate poisoning
Contraindications AMI and myocardial ischemia
Interactions Effects
enhanced by antihistamines, procainamide, antipsychotics, and benzodiazepines
Form 1 mg
in 10 mL prefilled syringes
Dosage 0.5–1 mg as intravenous bolus; repeatable to a maximum of 3 mg
Considerations None
Benzocaine
Class Topical
anesthetic
Mechanism Blocks
initiation and conduction of nerve impulses
Indications Suppression
of gag reflex during intubation
Contraindications Hypersensitivity
Interactions None
Form Aerosol
can of 20% benzocaine
Dosage 1-second long spray; repeated as needed
Considerations Topical
only
Bumetanide
Class Loop
diuretic
Mechanism Inhibits
reabsorption of sodium and chloride ions in the ascending limb of the loop of
Henle
Indications Pulmonary
edema and CHF
Contraindications Hypersensitivity and renal failure
Interactions May
increase risk of lithium poisoning
Form 0.25 mg/mL
vials
Dosage 0.5–1 mg
intravenously for 1–2 minutes
Considerations 1 mg
bumetanide is equal to 40 mg furosemide
Calcium Chloride
Class Electrolyte
Mechanism Positive
inotrope and ventricular automaticity
Indications Hypocalcemia, hyperkalemia, hypermagnesemia, and beta-blocker and calcium channel blocker
overdose
Contraindications VF
and digitalis toxicity
Interactions Do
not administer in the same intravenous line as sodium bicarbonate
Form 1 g in 10 mL prefilled syringe
Dosage 1 g, repeated as needed
Considerations Do
not use routinely in cardiac arrest
Calcium Gluconate
Class Electrolyte
Mechanism Positive
inotrope and ventricular automaticity
Indications Hypocalcemia, hyperkalemia, hypermagnesemia, and beta-blocker and calcium channel blocker
overdose
Contraindications VF
and digitalis toxicity
Interactions Do
not administer in the same intravenous as sodium bicarbonate
Form 1 g in 10 mL prefilled syringe
Dosage 1 g, repeated as needed
Considerations Do
not use routinely in cardiac arrest
Clopidogrel
Class Antiplatelet
Mechanism Glycoprotein
IIb/IIIa inhibitor
Indications AMI and acute coronary syndromes
Contraindications Active
bleeding and ICH
Interactions Should
not be taken with proton pump inhibitors
Form 75 mg
and 300 mg tablets
Dosage 300–600 mg
loading dose
Considerations None
Dexamethasone
Class Corticosteroid
Mechanism Suppresses
acute and chronic inflammation
Indications Anaphylaxis, asthma, COPD, and spinal cord injury
Contraindications Hypersensitivity and uncontrolled infection
Interactions Calcium
Form 100 mg/5 mL
vials
Dosage 1 mg/kg as intravenous bolus
Considerations Protect
from heat
Dextrose (D50)
Class Carbohydrate
Mechanism Increased
serum glucose levels
Indications Hypoglycemia
Contraindications Intracranial
hemorrhage
Interactions Sodium
bicarbonate
Form 25 g in 50 mL prefilled syringe
Dosage 12.5–25 g
Considerations Dilute
for pediatric patients
Diazepam
Class Benzodiazepine
Mechanism Induces
amnesia and sedation
Indications Severe
anxiety, seizures, and alcohol withdrawal
Contraindications Hypersensitivity, glaucoma, myasthenia gravis, and head injury
Interactions Incompatible
with most drugs
Form 10 mg
in 2 mL prefilled syringes
Dosage 5–10 mg slowly via intravenous administration
Considerations Seizures
may reoccur
Digoxin
Class Inotropic
agent
Mechanism Positive
inotrope; increases AV node refractory period
Indications CHF, AF with rapid ventricular response, and atrial flutter
Contraindications VF, VT, and hypersensitivity
Interactions Amiodarone, verapamil, and quinidine
Form 0.25 mg/mL
vials
Dosage 4–6 mcg/kg
for 5 minutes
Considerations Keep
patient on a monitor
Diltiazem
Class Calcium
channel blocker
Mechanism Reduces
preload and afterload; blocks cardiac calcium channels during depolarization
Indications AF
with rapid ventricular response and SVT
Contraindications Hypotension, sick sinus syndrome with no pacemaker, cardiogenic shock, and VT
Interactions Avoid
in patients on beta-blockers
Form 5 mg/mL
(refrigerated)
Dosage 0.25 mg/kg
for 2 minutes
Considerations Caution
in renal and hepatic insufficiency
Diphenhydramine
Class Antihistamine and anticholinergic
Mechanism Blocks
histamine receptors; vasoconstricts
Indications Allergic
reactions and anaphylaxis
Contraindications Asthma, pregnancy, glaucoma, hypertension, children, and MAOIs
Interactions Potentiates
alcohol and other anticholinergics; MAOIs prolong effects
Form 50 mg/mL
vials
Dosage 25–50 mg
either intramuscularly or as intravenous bolus
Considerations None
Dobutamine
Class Sympathomimetic
Mechanism Increases
myocardial stroke volume, contractility, and output without increasing HR
Indications CHF and cardiogenic shock
Contraindications tachydysrhythmias and severe hypotension
Interactions Incompatible
with furosemide and bicarbonate
Form 1 mg/mL
intravenous infusion
Dosage 2–20 mcg/kg/min, titrated to effect
Considerations May
increase infarct in patients with active AMI
Dopamine
Class Sympathomimetic
Mechanism Increases
myocardial stroke volume, contractility, HR, and cardiac output; increases
peripheral vascular resistance and preload while maintaining renal and mesenteric blood flow
Indications CHF and cardiogenic shock
Contraindications Tachydysrhythmias, severe hypotension, and pheochromocytoma
Interactions MAOIs
potentiate; beta-blockers and bicarbonate inhibit
Form 200 mg/5 mL
vials
Dosage Dilute
200 mg in 250 mL D5W; 2–20 mcg/kg/min, titrated to effect
Considerations May
increase infarct in patients with active AMI
Epinephrine, 1:1,000
Class Sympathomimetic
Mechanism Alpha, beta-1, and beta-2 agonist
Indications Anaphylaxis and asthma
Contraindications None
in emergency setting
Interactions MAOIs
potentiate; beta-blockers and bicarbonate inhibit
Form 1 mg
in 1 mL ampule
Dosage 0.3 mg
intramuscularly or subcutaneously
Considerations Increases
myocardial O2 demand
Epinephrine, 1:10,000
Class Sympathomimetic
Mechanism Alpha, beta-1, and beta-2 agonist
Indications Cardiac
arrest
Contraindications None
in emergency setting
Interactions MAOIs
potentiate; beta-blockers and bicarbonate inhibit
Form 1 mg
in 10 mL prefilled syringe
Dosage 1 mg
as intravenous bolus every 3–5 minutes during the arrest; double dose for ETT
Considerations Increases
myocardial O2 demand
Epinephrine, Racemic
Class Sympathomimetic
Mechanism Alpha, beta-1, and beta-2 agonist
Indications Anaphylaxis, asthma, croup
Contraindications Epiglottitis and hypertension
Interactions MAOIs
potentiate; beta-blockers and bicarbonate inhibit
Form 0.16 mg
in MDI
Dosage 2–3
puffs every 3–5 minutes as needed
Considerations Increases
myocardial O2 demand
Eptifibatide
Class Glycoprotein
IIb/IIIa inhibitor
Mechanism Inhibits
platelet aggregation and prevents binding of fibrinogen and von Willebrand
factors
Indications Angina, ACS, and Percutaneous Transluminal Coronary Angioplasty (PTCA)
Contraindications Prior
ICH, AAA, active bleeding or bleeding disorder, recent head or facial trauma, or ischemic stroke within past 3 months
Interactions Incompatible
with furosemide
Form 2 mg/mL
vials
Dosage 180 mcg/kg
as intravenous bolus over 1–2 minutes
Considerations Avoid
invasive procedures with risk of bleeding; must be administered directly from
the glass bottle with vented intravenous setup
Etomidate
Class Hypnotic
Mechanism Acts
on reticular activating system
Indications Premedication
for intubation or cardioversion
Contraindications Hypersensitivity
Interactions None
Form 2 mg/mL
vials
Dosage 0.2–0.6 mg/kg intravenously infused over 30–60 seconds
Considerations Consider
decreasing dose in elderly
Fentanyl
Class Opiate analgesic
Mechanism Binds
to opiate receptors
Indications Pain
management
Contraindications Hypersensitivity
Interactions None
Form 100 mcg/2 mL
ampules
Dosage 1 mcg/kg
slowly
Considerations Chest
wall rigidity with rapid high dose
Flumazenil
Class Benzodiazepine
antagonist
Mechanism Reverses
sedative effects
Indications Respiratory
depression because of benzodiazepines
Contraindications Hypersensitivity and tricyclic antidepressant overdose
Interactions Tricyclic
antidepressants
Form 0.1 mg/mL
vials
Dosage First dose:
0.2 mg intravenously or intraosseously;
2nd dose: 0.3 mg intravenously or intraosseously;
3rd dose: 0.5 mg intravenously or intraosseously
Considerations May
precipitate seizures in patients who take benzodiazepines regularly
Fosphenytoin
Class Anticonvulsant
Mechanism Inhibits
calcium movement across neuronal membrane; increases neuronal excitability
Indications Seizures
Contraindications Hypersensitivity
and bradycardias
Interactions Dopamine
can cause severe hypotension; additive effect with other CNS depressants
Form 75 mg/mL
vials
Dosage 15–20 mg PE/kg intravenously; infuse at
100–150 mg PE/min
Considerations Use caution in
patients with renal and hepatic insufficiency. Dosing is expressed in Phenytoin Equivalents (PE) to avoid dose conversions between products.
Furosemide
Class Loop
diuretic
Mechanism Inhibits
reabsorption of sodium and chloride ions in the ascending limb of the loop of
Henle
Indications Pulmonary
edema and CHF
Contraindications Hypersensitivity, renal failure, and hypovolemia
Interactions May
increase risk of lithium poisoning
Form 10 mg/mL
vials
Dosage 0.5–1 mg/kg
intravenously over 1–2 minutes
Considerations Ototoxic; projectile vomiting can occur with rapid infusion
Glucagon
Class Pancreatic hormone
Mechanism Increased
blood glucose level by releasing glycogen stores in the liver
Indications Hypoglycemia and beta-blocker overdose
Contraindications Hyperglycemia
Interactions None
Form 1 mg powder requiring reconstitution with 1 mL
saline
Dosage Hypoglycemia:
1 mg intramuscularly; beta-blocker overdose: 3–10 mg intravenously over 10 minutes
Considerations Ineffective
with no glycogen stores
Haloperidol
Class Tranquilizer
Mechanism Inhibits
CNS catecholamine receptors and ascending reticular activating system
Indications Acute
psychosis
Contraindications Parkinson disease; agitation from shock, hypoxia, or other source
Interactions Alcohol
potentiates; amphetamines and epinephrine antagonize
Form 5 mg/mL
vials and ampules
Dosage 2–5 mg
every 30–60 minutes
Considerations Treat
resulting hypotension with fluids and norepinephrine
Heparin
Class Anticoagulant
Mechanism  
Indications AMI and prophylaxis of clotting issues
Contraindications Hypersensitivity, active bleeding, recent surgery, and thrombocytopenia
Interactions None
Form 25,000
units/500 mL
Dosage 60 units/kg
up to 4,000 units
Considerations Does
not lyse existing clots
Hydrocortisone
Class Corticosteroid
Mechanism Suppresses
acute and chronic inflammation
Indications Anaphylaxis, asthma, COPD, and spinal cord injury
Contraindications Hypersensitivity, fungal infection, and premature infants
Interactions Incompatible
with heparin
Form 500 mg
powder with reconstituting diluent
Dosage 4 mg/kg
slowly
Considerations None
Hydroxocobalamin
Class Cyanide
antidote
Mechanism Binds
with cyanide to form cyanocobalamin
Indications Cyanide
poisoning
Contraindications None
Interactions Avoid
using the same intravenous line as other medications
Form 2.5 g
in 250 mL glass vial
Dosage 5 g
over 15 minutes
Considerations Patient
may become hypertensive (180/110 common)
Hydroxyzine
Class Antihistamine, antiemetic, and anxiolytic
Mechanism Potentiates
analgesics
Indications Nausea
and vomiting
Contraindications Hypersensitivity and early pregnancy
Interactions Potentiates
CNS depressants
Form 50 mg/mL
vials
Dosage 25–100 mg
intramuscularly only
Considerations Injection
site burning
Ipratropium
Class Anticholinergic, bronchodilator
Mechanism Inhibits
ACH receptor sites of bronchial smooth muscle
Indications Asthma
and COPD
Contraindications Hypersensitivity
to atropine, alkaloids, and peanuts
Interactions None
Form 0.5 mg/mL
for nebulizer
Dosage 0.5 mg/mL
for nebulizer
Considerations Use
after at least 1 dose of nebulized beta-agonist
Ketorolac
Class NSAID
Mechanism Analgesic
that does not sedate
Indications Moderate
to severe pain
Contraindications Allergies
to severe pain or other NSAIDs; patients with asthma, renal failure, or GI
bleeding
Interactions None
Form 30 mg/mL
vials
Dosage 30–60 mg
intramuscularly
Considerations None
Labetolol
Class Selective
alpha blocker; nonselective beta-blocker
Mechanism Total
peripheral vascular resistance reduced without altering cardiac output
Indications Hypertension
Contraindications Asthma, CHF, cardiogenic shock, and bradycardias
Interactions May
inhibit bronchodilator effects of other beta-agonists
Form 5 mg/mL
vials
Dosage 10 mg as intravenous bolus
Considerations Closely
monitor vital signs and ECG for signs of cardiogenic shock, bradycardias, and
bronchospasm
Lidocaine
Class Antidysrhythmic
Mechanism Slows
the rate of spontaneous phase 4 depolarization
Indications VT and VF
Contraindications Hypersensitivity
Interactions Potentiates
succinylcholine; procainamide exacerbates CNS depression
Form 20 mg/mL
in prefilled syringe
Dosage Initial:
1.5 mg/kg; repeat doses 0.75 mg/kg every 10 minutes until 3 mg/kg total
Considerations High
doses can result in seizures, coma, or death
Lorazepam
Class Benzodiazepine
Mechanism Anxiolytic, anticonvulsant, and sedative
Indications Seizures and anxiety
Contraindications Glaucoma and drug abuse
Interactions Additive
effects with other CNS depressants
Form 2 mg/mL
prefilled syringes
Dosage 2–4 mg
intramuscularly or intravenously; may be repeated
Considerations Monitor
respiratory rate and blood pressure
Magnesium Sulfate
Class Electrolyte
Mechanism Reduces
ACH release at the neuromuscular junction for smooth muscles
Indications Hypomagnesemia, torsades de pointes, and eclampsia
Contraindications Heart
blocks
Interactions Changes
in cardiac function with cardiac glycosides
Form 0.5 mg/mL
vials
Dosage Seizures:
1–4 g over 3 minutes; torsades: 1–2 g for 5 minutes; asthma: 1–2 g over 3 minutes
Considerations Calcium
should be available as an antagonist if needed
Mannitol
Class Osmotic
diuretic
Mechanism Promotes
movement of fluid from intracellular space to extracellular space
Indications Cerebral
edema, ICH, and rhabdomyolysis
Contraindications CHF, hypotension, and pulmonary edema
Interactions Digitalis
Form 200 mg/mL
solution for intravenous piggyback bolus
Dosage 1 g/kg
over 10 minutes
Considerations May
crystallize in cold; have ventilatory support available
Meperidine
Class Opiate
analgesic
Mechanism Binds
to opiate receptors
Indications Pain
management
Contraindications Hypersensitivity, undiagnosed head injury, or abdominal pain
Interactions Do
not give with current or recent MAOI use
Form 100 mg/mL
prefilled syringes
Dosage 50–100 mg
intramuscularly or subcutaneously; 25–50 mg intravenously
Considerations May
precipitate seizures in those with a history
Metaproterenol
Class Beta-2
agonist
Mechanism Bronchial
smooth muscle relaxant
Indications Asthma and COPD
Contraindications Hypersensitivity and tachydysrhythmias
Interactions Additive
effects with other sympathomimetics; beta-blockers antagonize
Form MDI:
0.65 mg/puff
Dosage 2–3
puffs every 3 hours
Considerations May
cause hypotension and tachycardia
Methylprednisolone
Class Corticosteroid
Mechanism Suppresses
acute and chronic inflammation
Indications Anaphylaxis, asthma, COPD, and spinal cord injury
Contraindications Hypersensitivity, fungal infection, and premature infants
Interactions Incompatible
with heparin
Form 250 mg
powder with reconstituting diluent
Dosage Spinal:
30 mg/kg over 30 minutes; respiratory: 1–2 mg/kg as intravenous bolus
Considerations Crosses
placental barrier
Metoprolol
Class Beta-1
selective
Mechanism Negative
inotrope and dromotrope
Indications SVT, AF, atrial flutter, and AMI
Contraindications Heart
failure, cardiogenic shock, and bradydysrhythmias
Interactions MAOIs
and calcium channel blockers potentiate
Form 1 mg/mL
ampules
Dosage Three
5 mg doses at 5-minute intervals
Considerations Concurrent
intravenous calcium channel blocker use may cause severe hypotension
Midazolam
Class Benzodiazepine
Mechanism Binds
with GABA receptors in brain to produce sedation
Indications Sedation
for procedures
Contraindications Glaucoma
Interactions CNS
depressants
Form 1 mg/mL
vials
Dosage 2–5 mg
as intravenous bolus
Considerations Monitor
cardiac and respiratory function
Morphine Sulfate
Class Opiate
analgesic
Mechanism Binds
to opiate receptors
Indications Pain
management
Contraindications Hypersensitivity, undiagnosed head injury, or abdominal pain
Interactions Do
not give with current or recent MAOI use
Form 100 mg/mL
prefilled syringes
Dosage 2–4 mg
as intravenous bolus, repeatable
Considerations Crosses
placental barrier
Naloxone
Class Opiate
antagonist
Mechanism Competitive
inhibition at opiate receptors
Indications Opiate
overdose
Contraindications Use
with caution in patients who are narcotic dependent
Interactions Incompatible
with bisulfite and alkaline solutions
Form 1 mg/mL
vials and prefilled syringes
Dosage 0.4–2 mg
intravenously, intramuscularly, intranasally, subcutaneously, or via ETT
Considerations May
need to readminister because of short half-life; may cause vomiting; patient may
be violent after receiving
Nifedipine
Class Calcium
channel blocker
Mechanism Inhibits
movement of calcium ions across cell membrane
Indications Hypertensive
crisis and angina
Contraindications Compensatory
HTN, cardiogenic shock
Interactions Beta-blockers
potentiate
Form 10 and 20 mg liquid-filled capsules
Dosage 10 mg
sublingually or buccally; have the patient bite the capsule and swallow
Considerations Have
beta-blocker available for reflex tachycardia
Nitroglycerine
Class Vasodilator
Mechanism Relaxes
vascular, GI, and uterine smooth muscle; reduces preload
Indications Chest
pain, AMI, CHF, and pulmonary edema
Contraindications Hypotension, hypovolemia, emergency department medications within the last 48 hours
Interactions Additive
effects with other vasodilators
Form 0.4 mg
tablets, 6 g tubes
Dosage 0.4 mg
sublingually for angina; 0.4–1.2 mg for CHF; 1/2–1-inch paste
Considerations Avoid
giving in a right-sided MI until fluid can be administered; keep in a dark
container
Nitrous Oxide
Class Gaseous
analgesic
Mechanism Unknown
Indications Pain
relief
Contraindications Decreased
level of consciousness, head injury, unable to follow instructions, and abdominal pain
Interactions None
Form D&E
cylinders
Dosage Have
patient inhale deeply until he or she has pain relief
Considerations Causes
spontaneous abortion; ventilate area well
Norepinephrine
Class Sympathomimetic
Mechanism Potent
alpha agonist results in peripheral vasoconstriction; positive chronotrope
and inotrope
Indications Cardiogenic
shock and significant hypotension
Contraindications Hypotension
caused by hypovolemia
Interactions Sympathomimetics
exacerbate dysrhythmias
Form 1 mg/mL
vials
Dosage Dilute
8 mg in 500 mL bag and infuse as intravenous piggyback bolus at 0.1–2 mcg/kg/min, titrated to effect
Considerations May
cause fetal anoxia
Ondansetron
Class Antiemetic
Mechanism Blocks
action of serotonin, which causes vomiting
Indications For
prevention of vomiting
Contraindications Allergy
to medication or other similar medications
Interactions None
in the emergency situation
Form 2 mg/mL
vials
Dosage 4 mg
as intravenous bolus or intramuscularly; repeatable
Considerations None
Oral Glucose
Class Carbohydrate
Mechanism Increases
blood glucose levels
Indications Hypoglycemia
Contraindications Decreased
level of consciousness, nausea, and vomiting
Interactions None
Form 15 g
tubes of gel
Dosage 15–45 g
by mouth
Considerations Must
be swallowed, so it is slow to act
Oxygen
Class Gas
Mechanism Reverses
hypoxemia
Indications Hypoxemia and shock
Contraindications High
concentrations for patients with COPD and premature infants
Interactions None
Form O2
cylinders
Dosage 1–15 LPM
Considerations None
Oxytocin
Class Hormone
Mechanism Increases
uterine contractions
Indications Postpartum
hemorrhage
Contraindications
2nd fetus
Interactions None
Form 10 units/mL
Dosage 10 units
intramuscularly
Considerations Monitor
vital signs
Pancuronium
Class Paralytic
Mechanism Blocks
ACH receptors at the neuromuscular junction
Indications Induction
or maintenance of paralysis
Contraindications Hypersensitivity and inability to control airway once given
Interactions Positive
chronotropes potentiate effects
Form 2 mg/mL
vials and ampules
Dosage 0.1 mg/kg as slow intravenous bolus
Considerations Prepare intubation equipment and have ventilatory support available prior to giving
Phenobarbital
Class Barbiturate
Mechanism Generally
unknown
Indications Seizures
Contraindications Patients
with a history of sedative or hypnotic addiction
Interactions Additive
effects with other CNS depressants, anticonvulsants, and MAOIs
Form 60 mg/mL
vials and ampules
Dosage 100–250 mg
as intravenous bolus
Considerations Use
with caution in the elderly; decrease dosage
Phenytoin
Class Anticonvulsant
Mechanism Moves
sodium out of the neuron, which reduces excitability; Does the same in the
ventricles
Indications Seizures
and digitalis-induced dysrhythmias
Contraindications Hypersensitivity
and bradydysrhythmias
Interactions Sulfonamides
anticoagulant; salicylates potentiate; may precipitate
Form 50 mg/mL
vials
Dosage 10–20 mg/kg a slow intravenous bolus to a max of 1 g
Considerations  
Pralidoxime
Class Cholinesterase
reactivator
Mechanism Reactivates
cholinesterase in the neuromuscular junction
Indications Organophosphate
poisoning
Contraindications None
Interactions Avoid
concurrent use with respiratory depressants
Form 1 g powder for reconstitution
Dosage 1–2 g infusion over 30 minutes
Considerations  None
Procainamide
Class Antidysrhythmic
Mechanism Reduces
ectopic pacemaker’s automaticity and intraventricular conduction
Indications Monomorphic
VT, reentry SVT refractory to adenosine, and AF with rapid ventricular response
Contraindications Torsades de pointes and bradycardias
Interactions Increases
plasma levels of amiodarone and quinidine
Form 500 mg
vials
Dosage 50 mg/min
to a max of 17 mg/kg; stop administration if QRS widens by >50% over
baseline; dysrhythmia suppressed
Considerations Potent
vasodilator and negative inotrope
Propofol
Class Sedative
Mechanism Rapid
onset sedation and anesthesia
Indications Induction
and maintenance of anesthesia and sedation
Contraindications Hypovolemia
and sensitivities to soy, peanuts, and eggs
Interactions None
Form 10 mg/mL
intravenous emulsion
Dosage Induction:
1.5–3 mg/kg intravenous or intraosseously; maintenance: 25–75 mcg/kg/min as intravenous piggyback bolus
Considerations None
Propranolol
Class Beta-blocker
Mechanism Nonselective
blocker and negative chronotrope and inotrope
Indications Hypertension, chest pain, VT, and VF
Contraindications Bradydysrhythmias, cardiogenic shock, and CHF
Interactions Effects
reversed by norepinephrine and dopamine
Form 1 mg/mL
vials
Dosage 1–3 mg
diluted in 10–30 mL D5W, given at a max of 1 mg/min, with max total 5 mg
Considerations Keep
atropine available
Rocuronium
Class Paralytic
Mechanism Blocks
ACH receptors at the neuromuscular junction
Indications Induction
or maintenance of paralysis
Contraindications Hypersensitivity and inability to control airway once given
Interactions Positive
chronotropes potentiate effects
Form 10 mg/mL
vials
Dosage 0.1 mg/kg as slow intravenous bolus
Considerations Prepare intubation equipment and have ventilatory support available prior to giving
Sodium Bicarbonate
Class Alkalinizing
agent
Mechanism Buffers
metabolic acidosis
Indications Metabolic
acidosis in cardiac arrest and tricyclic antidepressant and aspirin overdoses
Contraindications Alkalosis and hypokalemia
Interactions Should
not be used in the same intravenous line as calcium
Form 1 mEq/mL
in 50 mL prefilled syringe
Dosage 1 mEq/kg
as intravenous bolus
Considerations Repeat
as needed in tricyclic antidepressant overdose
Sodium Nitrate
Class Cyanide
antidote
Mechanism Reacts
with hemoglobin to form methemoglobin
Indications Cyanide
poisoning
Contraindications None
Interactions None
Form 30 mg/mL
vials
Dosage 300 mg
for 10 minutes
Considerations Potent
vasodilator will cause significant hypotension if given too rapidly;
2nd drug in 3-step treatment after amyl nitrite
Sodium Thiosulfate
Class Cyanide
antidote
Mechanism Converts
cyanide to nontoxic thiocyanate
Indications Cyanide
poisoning
Contraindications None
Interactions None
Form 12.5 g/50 mL
vial
Dosage 12.5 g for 10 minutes
Considerations
3rd step in 3-step treatment after sodium nitrite 
Streptokinase
Class Fibrinolytic
Mechanism Converts
plasminogen to plasmin, which digests fibrin strands in a clot
Indications AMI, PE, and CVA
Contraindications Active
bleeding; recent surgery; previous CVA, CPR, AVM or aneurysm; and uncontrolled
hypertension
Interactions Anticoagulants
increase risk of bleeding
Form 250,000;
750,000; and 1.5 million unit powders that need to be reconstituted
Dosage 0.5–1.5 million units diluted to 45 mL, given over 1 hour
Considerations Monitor vital signs and watch for bleeding
Succinylcholine Chloride
Class Depolarizing
paralytic
Mechanism Attaches
to ACH receptors in the neuromuscular junction, depolarizing the muscle
Indications Rapid
sequence intubation
Contraindications Glaucoma, eye injuries, malignant hyperthermia, multisystem trauma, and major burns
Interactions Oxytocin, beta-blockers, and organophosphates potentiate
Form 20 mg/mL
vials
Dosage 1.5 mg/kg
rapid as intravenous bolus
Considerations Premedication
with lidocaine may blunt increase in ICP; benzodiazepines should be used
1st in the conscious patient
Terbutaline
Class Beta-2
selective agonist
Mechanism Smooth
muscle relaxant in bronchioles
Indications Asthma
and COPD
Contraindications Hypersensitivity
Interactions MAOIs
and other sympathomimetics potentiate; beta-blockers antagonize
Form 1 mg/mL
vials
Dosage 0.25 mg
subcutaneously; repeatable once
Considerations Use
with caution in patients who are diabetic, are hypertensive, and have had a seizure
Thiamine
Class Vitamin
Mechanism Necessary
for carbohydrate metabolism
Indications Coma
of unknown origin, delirium tremens, beri-beri, and Wernicke encephalopathy
Contraindications None
Interactions Always
give thiamine before dextrose
Form 100 mg/mL
vials
Dosage 100 mg
intravenous or intramuscularly
Considerations Large
doses associated with respiratory issues and hypotension
Tirofiban
Class Glycoprotein
Iib/IIIa inhibitor
Mechanism Inhibits
platelet aggregation and prevents binding of fibrinogen
Indications Angina, ACS, and PTCA
Contraindications Prior
ICH, AAA, active bleeding or bleeding disorder, recent head or facial trauma, and ischemic stroke within past 3 months
Interactions None
Form 50 mcg/mL
vials
Dosage 0.4 mcg/kg/min
intravenously over 30 minutes
Considerations Avoid
invasive procedures with risk of bleeding; must be administered directly from
the glass bottle with vented intravenous setup
Vasopressin
Class Vasopressor
Mechanism Potent
vasoconstrictor in high doses
Indications Alternative
to
1st or
2nd dose of epinephrine in cardiac arrest
Contraindications None
in emergency setting
Interactions None
Form 20 units/mL
vials
Dosage 40 units
Considerations None
Vecuronium
Class Paralytic
Mechanism Blocks
ACH receptors at the neuromuscular junction
Indications Induction
or maintenance of paralysis
Contraindications Hypersensitivity and inability to control airway once given
Interactions Positive
chronotropes potentiate effects
Form 2 mg/mL
vials and ampules
Dosage 20 mg
powder
Considerations Prepare intubation equipment and have ventilatory support available prior to giving
Verapamil
Class Calcium
channel blocker
Mechanism Selectively
blocks calcium channels in cardiac and arterial smooth muscles
Indications SVT, AF, and atrial flutter
Contraindications Wolff-Parkinson-White syndrome, Lown-Ganong -Levine syndrome, bradycardias without pacemaker, cardiogenic shock, LV EF <30%
Interactions Additive
effects with beta-blockers; potentiates antihypertensives
Form 2.5 mg/mL
vials
Dosage 2.5–5 mg
as intravenous bolus over 2 minutes
Considerations Be
prepared to resuscitate; AV blocks and asystole may occur

 


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