approvedMeds.md

Approved Medications for Administration

| .... | .... | .... | .... | | | | | | | Acetylsalicylic Acid | Activated Charcoal |Adenosine |Albuterol | | Aminophylline | Amiodarone |Ativan (Lorazepam) |Atropine Sulfate | | Bumetanide |Calcium Chloride |Calcium gluconate |Dexamethasone sodium phosphate | | Dextrose |Diazepam (Valium) |Diltiazem hydrochloride (Cardizem) |Diphenhydramine Hydrochloride | | Dobutamine hydrochloride |Dopamine Hydrochloride |Epinephrine 1:1,000 |Epinephrine 1:10,000 | | Esmolol |Etomidate |Fentanyl |Flumazenil | | Furosemide |Glucagon |Haloperidol |Heparin sodium | | Insulin |Ipecac Syrup |Ipratropium Bromide |Isoproterenol hydrochloride | | Ketamine |Labetalol |Lidocaine Hydrochloride |Magnesium Sulfate | | Methylprednisolone sodium succinate |Metoprolol Tartrate |Midazolam hydrochloride (Versed) |Morphine Sulfate | | Nalbuphine hydrochloride |Nalmefene (Narcan substitute) |Naloxone hydrochloride (Narcan) |Nitroglycerin | | Normal Saline Solution |Oxygen |Phenylephrine |Pralidoxine chloride (mark-1 kit) | | Procainamide hydrochloride |Reglan |Ringers Lactate solution |Rocuronium | | Sodium bicarbonate |Sodium thiosulfate |Solu-cortef |Succinylcholine | | Terbutaline Sulfate |Thiamine |Transexamic Acid (TXA) |Vasopressin | | Vecuronium |Verapamil |Xylocaine Jelly |Zofran (ondansetron) | | CYANOKIT - Amy Nitrate, Sodium Nitrate, Sodium Thiosulfate | | |

Acetylsalicylic Acid

Generic Name:

Acetylsalicylic Acid

Trade Names:

Aspirin, Bayer, Ecotrin

Actions:

Aspirin is an antiplatelet agent and anti-inflammatory drug. It irreversibly inhibits cyclooxygenase (COX-1 and COX-2) enzymes, leading to decreased formation of prostaglandins and thromboxanes, which reduces inflammation, pain, and fever, and inhibits platelet aggregation.

Indications:

Pain and fever Acute coronary syndrome (ACS) Secondary prevention of cardiovascular events Anti-inflammatory conditions such as rheumatoid arthritis

Contraindications:

Hypersensitivity to aspirin or other NSAIDs Active peptic ulcer disease or gastrointestinal bleeding Severe renal or hepatic impairment Children and teenagers with viral infections (due to risk of Reye's syndrome)

Dosage Range:

Pain/Fever: 325-650 mg every 4-6 hours as needed. Maximum: 4,000 mg/day. Cardiovascular: 81-325 mg once daily.

Routes of Administration:

Oral (tablets, chewable tablets) Rectal (suppositories)

Adverse Reactions:

Gastrointestinal disturbances (nausea, dyspepsia, bleeding) Increased risk of bleeding Hypersensitivity reactions (asthma, anaphylaxis) Reye's syndrome in children with viral infections

Activated Charcoal

Generic Name:

Activated Charcoal

Trade Names:

Actidose, CharcoalAid

Actions:

Activated charcoal is an adsorbent that binds to toxins in the gastrointestinal tract, preventing their absorption into the bloodstream.

Indications:

Treatment of acute oral poisoning or overdose of certain substances

Contraindications:

Unprotected airway (risk of aspiration) Ingestion of corrosive agents, hydrocarbons, or heavy metals (ineffective and potentially harmful) Gastrointestinal obstruction

Dosage Range:

Adults and Children: 25-100 grams as a single dose (typically 1 gram/kg).

Routes of Administration:

Oral (suspension) Nasogastric tube (NG tube)

Adverse Reactions:

Gastrointestinal disturbances (nausea, vomiting, constipation) Aspiration pneumonitis Black stools

Adenosine

Generic Name:

Adenosine

Trade Names:

Adenocard, Adenoscan

Actions:

Adenosine is an antiarrhythmic agent that slows conduction time through the AV node, restoring normal sinus rhythm in patients with paroxysmal supraventricular tachycardia (PSVT).

Indications:

Conversion of PSVT to sinus rhythm, including that associated with accessory bypass tracts (Wolff-Parkinson-White syndrome)

Contraindications:

Second- or third-degree AV block (except in patients with a functioning artificial pacemaker) Sick sinus syndrome (except in patients with a functioning artificial pacemaker) Hypersensitivity to adenosine

Dosage Range:

Adults: Initial dose: 6 mg rapid IV bolus. If not effective within 1-2 minutes, 12 mg rapid IV bolus. May repeat 12 mg dose if necessary. Children: Initial dose: 0.05-0.1 mg/kg rapid IV bolus. May increase by 0.05-0.1 mg/kg every 1-2 minutes as needed. Maximum single dose: 0.3 mg/kg or 12 mg.

Routes of Administration:

Intravenous (IV)

Adverse Reactions:

Transient arrhythmias Flushing Dyspnea Chest discomfort Hypotension Dizziness

Albuterol

Generic Name:

Albuterol

Trade Names:

Ventolin, Proventil, ProAir

Actions:

Albuterol is a beta2-adrenergic agonist that relaxes bronchial smooth muscle by stimulating beta2 receptors, resulting in bronchodilation.

Indications:

Treatment or prevention of bronchospasm in patients with reversible obstructive airway disease (asthma, chronic obstructive pulmonary disease - COPD) Prevention of exercise-induced bronchospasm

Contraindications:

Hypersensitivity to albuterol or any component of the formulation

Dosage Range:

Adults and Children (older than 4 yrs): 2.5 mg via nebulizer every 6-8 hours as needed. Inhalation (MDI): 1-2 puffs (90-180 mcg) every 4-6 hours as needed. Children (<4 years): Dose individualized based on age and weight.

Routes of Administration:

Inhalation (MDI, nebulizer) Oral (tablets, syrup)

Adverse Reactions:

Tremor Nervousness Tachycardia Palpitations Hypokalemia Nausea

Aminophylline

Generic Name:

Aminophylline

Trade Names:

Aminophylline

Actions:

Aminophylline is a bronchodilator that relaxes smooth muscles of the bronchial airways by inhibiting phosphodiesterase, leading to increased cyclic AMP levels.

Indications:

Treatment of symptoms and reversible airway obstruction due to asthma or other chronic lung diseases such as emphysema or chronic bronchitis

Contraindications:

Hypersensitivity to theophylline, ethylenediamine, or any component of the formulation Active peptic ulcer disease Seizure disorders (uncontrolled)

Dosage Range:

Adults: 380-760 mg/day divided every 6-8 hours (initial IV dose typically 5-6 mg/kg followed by maintenance). Children: Dose individualized based on age and weight.

Routes of Administration:

Oral (tablets, syrup) Intravenous (IV)

Adverse Reactions:

Nausea, vomiting Headache Insomnia Tremors Irritability Tachycardia, arrhythmias Seizures (overdose)

Amiodarone

Generic Name:

Amiodarone

Trade Names:

Cordarone, Pacerone

Actions:

Amiodarone is an antiarrhythmic agent that prolongs phase 3 of the cardiac action potential. It affects sodium, potassium, and calcium channels and has alpha- and beta-adrenergic blocking properties.

Indications:

Treatment and prophylaxis of ventricular fibrillation (VF) and hemodynamically unstable ventricular tachycardia (VT) Supraventricular arrhythmias, including atrial fibrillation

Contraindications:

Severe sinus-node dysfunction causing marked sinus bradycardia Second- or third-degree AV block Cardiogenic shock Hypersensitivity to amiodarone or iodine

Dosage Range:

Adults: 150 mg IV over 10 minutes, followed by 360 mg IV over the next 6 hours, then 540 mg IV over 18 hours (loading dose). Maintenance: 0.5 mg/min IV infusion or 400-600 mg/day orally. Children: Dose individualized based on age and weight.

Routes of Administration:

Oral (tablets) Intravenous (IV)

Adverse Reactions:

Hypotension Bradycardia Pulmonary toxicity Hepatotoxicity Thyroid dysfunction Corneal microdeposits Photosensitivity

Lorazepam

Generic Name:

Lorazepam

Trade Names:

Ativan

Actions:

Lorazepam is a benzodiazepine that enhances the effect of the neurotransmitter GABA at the GABA-A receptor, leading to sedative, anxiolytic, anticonvulsant, and muscle relaxant properties.

Indications:

Anxiety disorders Preoperative sedation Status epilepticus

Contraindications:

Hypersensitivity to lorazepam or other benzodiazepines Acute narrow-angle glaucoma Severe respiratory insufficiency Myasthenia gravis

Dosage Range:

Anxiety: 2-6 mg/day in divided doses. Preoperative sedation: 0.05 mg/kg IM (usual range 2-4 mg). Status epilepticus: 4 mg IV slow push. May repeat after 10-15 minutes if needed.

Routes of Administration:

Oral (tablets, solution) Intramuscular (IM) Intravenous (IV)

Adverse Reactions:

Sedation Dizziness Weakness Unsteadiness Respiratory depression Paradoxical reactions (agitation, aggression)

Atropine Sulfate

Generic Name:

Atropine Sulfate

Trade Names:

Atropine

Actions:

Atropine is an anticholinergic agent that inhibits the action of acetylcholine on muscarinic receptors, increasing heart rate and reducing secretions.

Indications:

Bradycardia (hemodynamically significant) Organophosphate poisoning Preoperative reduction of secretions

Contraindications:

Hypersensitivity to atropine or any component of the formulation Glaucoma (narrow-angle) Tachycardia due to cardiac insufficiency or thyrotoxicosis

Dosage Range:

Bradycardia: 0.5-1 mg IV every 3-5 minutes as needed. Maximum: 3 mg. Organophosphate poisoning: 2-4 mg IV initially, then 2 mg every 5-10 minutes as needed.

Routes of Administration:

Intravenous (IV) Intramuscular (IM) Subcutaneous (Sub-Q)

Adverse Reactions:

Dry mouth Blurred vision Photophobia Tachycardia Urinary retention Confusion

Bumetanide

Generic Name:

Bumetanide

Trade Names:

Bumex

Actions:

Bumetanide is a loop diuretic that inhibits the reabsorption of sodium and chloride in the ascending loop of Henle, leading to increased urine output.

Indications:

Edema associated with heart failure, liver cirrhosis, and renal disease

Contraindications:

Hypersensitivity to bumetanide or sulfonamides Anuria Severe electrolyte depletion

Dosage Range:

Adults: 0.5-2 mg orally once daily. May repeat every 4-5 hours up to a maximum of 10 mg/day. Children: Dose individualized based on age and weight.

Routes of Administration:

Oral (tablets) Intravenous (IV) Intramuscular (IM)

Adverse Reactions:

Hypokalemia Hyponatremia Dehydration Hypotension Ototoxicity Hyperuricemia

Calcium Chloride

Generic Name:

Calcium Chloride

Trade Names:

Calcium Chloride

Actions:

Calcium chloride provides elemental calcium, which is necessary for the maintenance of the functional integrity of the nervous, muscular, and skeletal systems and cell membrane and capillary permeability.

Indications:

Hypocalcemia Hyperkalemia Hypermagnesemia Calcium channel blocker overdose

Contraindications:

Hypercalcemia Ventricular fibrillation Digitalis toxicity

Dosage Range:

Adults: 500-1,000 mg IV over 5-10 minutes. May repeat as necessary. Children: 20 mg/kg IV over 5-10 minutes. Maximum single dose: 1,000 mg.

Routes of Administration:

Intravenous (IV)

Adverse Reactions:

Hypercalcemia Extravasation necrosis Hypotension Bradycardia Nausea, vomiting

Calcium Gluconate

Generic Name:

Calcium Gluconate

Trade Names:

Calcium Gluconate

Actions:

Calcium gluconate provides elemental calcium, which is necessary for the maintenance of the functional integrity of the nervous, muscular, and skeletal systems and cell membrane and capillary permeability.

Indications:

Hypocalcemia Hyperkalemia Hypermagnesemia Calcium channel blocker overdose

Contraindications:

Hypercalcemia Ventricular fibrillation Digitalis toxicity

Dosage Range:

Adults: 1-3 grams IV over 5-10 minutes. May repeat as necessary. Children: 60-100 mg/kg IV over 5-10 minutes. Maximum single dose: 3,000 mg.

Routes of Administration:

Intravenous (IV)

Adverse Reactions:

Hypercalcemia Extravasation necrosis Hypotension Bradycardia Nausea, vomiting

Dexamethasone

Generic Name:

Dexamethasone Sodium Phosphate

Trade Names:

Decadron, DexPak

Actions:

Dexamethasone is a corticosteroid that prevents the release of substances in the body that cause inflammation. It suppresses the immune response and decreases edema and scar tissue formation.

Indications:

Allergic conditions Asthma Cerebral edema Inflammatory conditions Adrenal insufficiency Management of acute and chronic inflammatory and autoimmune conditions

Contraindications:

Hypersensitivity to dexamethasone or any component of the formulation Systemic fungal infections

Dosage Range:

Adults: 0.75-9 mg/day IV or IM in divided doses every 6-12 hours. Children: 0.08-0.3 mg/kg/day IV or IM in divided doses every 6-12 hours.

Routes of Administration:

Oral (tablets, solution) Intravenous (IV) Intramuscular (IM)

Adverse Reactions:

Hyperglycemia Increased risk of infection Osteoporosis Gastrointestinal disturbances Mood changes Hypertension

Dextrose

Generic Name:

Dextrose

Trade Names:

Glucose, D50, D25, D10

Actions:

Dextrose is a simple sugar that provides a rapid increase in blood glucose levels. It is used to treat hypoglycemia and as a source of carbohydrate calories.

Indications:

Hypoglycemia Nutritional support in patients unable to consume adequate oral intake

Contraindications:

Hyperglycemia Diabetic coma (if no hypoglycemia is present) Intra-cranial or intraspinal hemorrhage

Dosage Range:

Adults: 25-50 ml of 50% dextrose solution (D50) IV push. Children: 0.5-1 g/kg of 25% dextrose solution (D25) IV push. Infants: 0.2-0.5 g/kg of 10% dextrose solution (D10) IV push.

Routes of Administration:

Intravenous (IV)

Adverse Reactions:

Hyperglycemia Phlebitis at injection site Extravasation injury Hypokalemia

Diazepam

Generic Name:

Diazepam

Trade Names:

Valium

Actions:

Diazepam is a benzodiazepine that enhances the effect of the neurotransmitter GABA at the GABA-A receptor, leading to sedative, anxiolytic, anticonvulsant, and muscle relaxant properties.

Indications:

Anxiety disorders Seizures (status epilepticus) Muscle spasms Alcohol withdrawal

Contraindications:

Hypersensitivity to diazepam or other benzodiazepines Acute narrow-angle glaucoma Severe respiratory insufficiency Myasthenia gravis

Dosage Range:

Anxiety: 2-10 mg orally 2-4 times daily. Seizures: 5-10 mg IV initially, may repeat every 10-15 minutes as needed. Maximum: 30 mg. Muscle spasms: 2-10 mg orally 3-4 times daily. Alcohol withdrawal: 10 mg orally 3-4 times during the first 24 hours, then 5 mg 3-4 times daily as needed.

Routes of Administration:

Oral (tablets, solution) Intramuscular (IM) Intravenous (IV) Rectal (gel)

Adverse Reactions:

Sedation Dizziness Weakness Unsteadiness Respiratory depression Paradoxical reactions (agitation, aggression)

Diltiazem

Generic Name:

Diltiazem Hydrochloride

Trade Names:

Cardizem

Actions:

Diltiazem is a calcium channel blocker that inhibits the influx of calcium ions during membrane depolarization of cardiac and vascular smooth muscle. It decreases heart rate, myocardial contractility, and causes vasodilation.

Indications:

Hypertension Angina pectoris Atrial fibrillation or flutter Paroxysmal supraventricular tachycardia (PSVT)

Contraindications:

Hypersensitivity to diltiazem Severe hypotension Second- or third-degree AV block Sick sinus syndrome (without a pacemaker) Acute myocardial infarction and pulmonary congestion

Dosage Range:

Hypertension: 180-360 mg/day orally in divided doses or once daily (extended-release). Angina: 30-120 mg orally 3-4 times daily or 120-480 mg once daily (extended-release). Atrial fibrillation/flutter: 0.25 mg/kg IV bolus over 2 minutes, then 5-15 mg/hour IV infusion.

Routes of Administration:

Oral (tablets, extended-release capsules) Intravenous (IV)

Adverse Reactions:

Bradycardia Hypotension Peripheral edema Dizziness Headache Gastrointestinal disturbances

Diphenhydramine

Generic Name:

Diphenhydramine Hydrochloride

Trade Names:

Benadryl

Actions:

Diphenhydramine is an antihistamine that blocks H1 receptors, reducing the effects of histamine, such as vasodilation, increased vascular permeability, and smooth muscle contraction.

Indications:

Allergic reactions Anaphylaxis Insomnia Motion sickness Cough suppression

Contraindications:

Hypersensitivity to diphenhydramine or other antihistamines Newborns or premature infants Breastfeeding

Dosage Range:

Allergic reactions: 25-50 mg orally every 4-6 hours. Maximum: 300 mg/day. Insomnia: 50 mg orally at bedtime. Motion sickness: 25-50 mg orally 30 minutes before exposure, then every 4-6 hours as needed. Cough: 25 mg orally every 4 hours. Maximum: 150 mg/day.

Routes of Administration:

Oral (tablets, capsules, liquid) Intramuscular (IM) Intravenous (IV)

Adverse Reactions:

Drowsiness Dizziness Dry mouth Urinary retention Constipation Blurred vision

Dobutamine

Generic Name:

Dobutamine Hydrochloride

Trade Names:

Dobutrex

Actions:

Dobutamine is a beta1-adrenergic agonist that increases cardiac contractility and stroke volume, leading to increased cardiac output without significantly increasing heart rate.

Indications:

Short-term treatment of cardiac decompensation due to depressed contractility from organic heart disease or cardiac surgery

Contraindications:

Hypersensitivity to dobutamine or any component of the formulation Idiopathic hypertrophic subaortic stenosis

Dosage Range:

Adults and Children: 2-20 mcg/kg/min IV infusion, titrated to patient response. Maximum: 40 mcg/kg/min.

Routes of Administration:

Intravenous (IV)

Adverse Reactions:

Hypertension Tachycardia Arrhythmias Angina Hypotension (with excessive doses) Nausea

Dopamine

Generic Name:

Dopamine Hydrochloride

Trade Names:

Intropin

Actions:

Dopamine is an adrenergic agonist that stimulates dopaminergic, beta1-, and alpha-adrenergic receptors, leading to increased cardiac output, renal blood flow, and systemic vascular resistance depending on the dose.

Indications:

Treatment of hemodynamic imbalances in shock syndrome due to myocardial infarction, trauma, sepsis, open-heart surgery, and renal failure

Contraindications:

Pheochromocytoma Uncorrected tachyarrhythmias Hypersensitivity to dopamine or any component of the formulation

Dosage Range:

Adults and Children: 2-20 mcg/kg/min IV infusion, titrated to patient response. Maximum: 50 mcg/kg/min.

Routes of Administration:

Intravenous (IV)

Adverse Reactions:

Tachycardia Arrhythmias Hypertension Vasoconstriction Nausea, vomiting Extravasation injury

Epinephrine 1:1,000

Generic Name:

Epinephrine

Trade Names:

Adrenaline, EpiPen

Actions:

Epinephrine is a sympathomimetic agent that stimulates alpha- and beta-adrenergic receptors, leading to vasoconstriction, increased heart rate, bronchodilation, and increased blood glucose levels.

Indications:

Anaphylaxis Asthma exacerbation Cardiac arrest (as adjunct)

Contraindications:

Hypersensitivity to epinephrine Narrow-angle glaucoma Non-anaphylactic shock

Dosage Range:

Anaphylaxis (Adults): 0.3-0.5 mg IM every 5-10 minutes as needed. Asthma (Adults): 0.3 mg IM or Sub-Q every 20 minutes for 3 doses if needed. Children: 0.01 mg/kg IM (maximum single dose: 0.3 mg).

Routes of Administration:

Intramuscular (IM) Subcutaneous (Sub-Q)

Adverse Reactions:

Tachycardia Hypertension Tremor Anxiety Palpitations Headache

Epinephrine 1:10,000

Generic Name:

Epinephrine

Trade Names:

Adrenaline

Actions:

Epinephrine is a sympathomimetic agent that stimulates alpha- and beta-adrenergic receptors, leading to vasoconstriction, increased heart rate, bronchodilation, and increased blood glucose levels.

Indications:

Cardiac arrest Severe anaphylaxis Symptomatic bradycardia (as adjunct)

Contraindications:

Hypersensitivity to epinephrine None in emergency situations

Dosage Range:

Cardiac arrest (Adults): 1 mg IV/IO every 3-5 minutes during resuscitation. Cardiac arrest (Children): 0.01 mg/kg IV/IO every 3-5 minutes during resuscitation.

Routes of Administration:

Intravenous (IV) Intraosseous (IO)

Adverse Reactions:

Tachycardia Hypertension Tremor Anxiety Palpitations Headache

Esmolol

Generic Name:

Esmolol

Trade Names:

Brevibloc

Actions:

Esmolol is a beta1-selective adrenergic blocker that decreases heart rate, myocardial contractility, and cardiac output.

Indications:

Supraventricular tachycardia (SVT) Intraoperative and postoperative tachycardia and/or hypertension Noncompensatory sinus tachycardia

Contraindications:

Severe sinus bradycardia Heart block greater than first degree Cardiogenic shock Decompensated heart failure Hypersensitivity to esmolol

Dosage Range:

Adults: Initial dose: 500 mcg/kg IV bolus over 1 minute, followed by an infusion of 50 mcg/kg/min. Maintenance infusion: 50-200 mcg/kg/min, titrated to response. Children: Dose individualized based on age and weight.

Routes of Administration:

Intravenous (IV)

Adverse Reactions:

Hypotension Bradycardia Heart block Bronchospasm Dizziness Nausea

Etomidate

Generic Name:

Etomidate

Trade Names:

Amidate

Actions:

Etomidate is a short-acting non-barbiturate hypnotic used for induction of general anesthesia and sedation. It acts on the GABA-A receptors.

Indications:

Induction of general anesthesia Procedural sedation

Contraindications:

Hypersensitivity to etomidate Pregnancy (relative contraindication unless benefits outweigh risks)

Dosage Range:

Adults: 0.2-0.6 mg/kg IV over 30-60 seconds. Children: 0.2-0.3 mg/kg IV over 30-60 seconds.

Routes of Administration:

Intravenous (IV)

Adverse Reactions:

Myoclonus Adrenal suppression Nausea, vomiting Hypotension Pain at injection site

Fentanyl

Generic Name:

Fentanyl

Trade Names:

Sublimaze, Duragesic

Actions:

Fentanyl is a potent synthetic opioid analgesic that binds to the mu-opioid receptors, producing analgesia and sedation.

Indications:

Management of pain (severe) Anesthesia adjunct Procedural sedation

Contraindications:

Hypersensitivity to fentanyl or other opioids Severe respiratory depression Acute or severe asthma Paralytic ileus

Dosage Range:

Adults (Pain management): 25-100 mcg IV/IM every 1-2 hours as needed. Adults (Anesthesia): 50-100 mcg/kg IV. Children: Dose individualized based on age and weight.

Routes of Administration:

Intravenous (IV) Intramuscular (IM) Transdermal (patch) Transmucosal (lozenge)

Adverse Reactions:

Respiratory depression Bradycardia Hypotension