Drug indication/contraindications

Acetaminophen (Tylenol�)
***FOUND IN THE DRUG BOX**

Indication: fever reduction, minor pain control Fever ? we only use
Tylenol to reduce fevers
Contraindication: liver insufficiency/failure

Activated Charcoal (Actidose�, Charcoaide�)

Indication: oral poisonings, oral medication overdose
Contraindication: ingestion of corrosives, caustics, and petroleum
distillates, pregnancy

Adenosine (Adenocard�)
***FOUND IN THE DRUG BOX***

Indication: conversion of SVT/atrial tachycardia to a sinus rhythm
***Only time we use adenosine is for SVT***
Contraindication: second or third degree AV blocks, atrial flutter,
atrial fibrillation, ventricular tachycardia, hypersensitivity to
adenosine Any and all cardiac rhythms EXCEPT SVT

Albuterol (Proventil�, Ventolin�)
***FOUND IN THE DRUG BOX AND APACK***

Indication: relief of bronchospasm in patients with reversible
obstructive pulmonary disease. Prevention of exercise induced
bronchospasm. Wheezing
Contraindication: hypersensitivity, tachydysrhythmias over 140 (MDI only)

Aminophylline (Amoline�, Somophyllin�, Aminophyllin�)

Indication: severe bronchospasm associated with asthma, chronic
bronchitis, emphysema or pulmonary edema, CHF, bronchospasm refractory
to sympathomimetic therapy. Bronchospasms Contraindication: allergy to
xanthines (like caffeine), hypersensitivity, dysrhythmias

Amiodarone (Cordarone�)
***FOUND IN THE DRUG BOX***

Indication: stable VT, VF/pulseless VT
Contraindication: breast-feeding patients in cardiogenic shock,
heart blocks, symptomatic bradycardia Any rhythm other than
ventricular tachycardia or ventricular fibrillation

Amyl Nitrite

Indication: cyanide poisonings Contraindication: none

Aspirin (Bayer�, Bufferin�)
***FOUND IN THE DRUG BOX AND APACK***

Indication: acute coronary syndrome, unstable angina, undiagnosed
chest pressure, pain or discomfort Anyone having chest pain or a
cardiac event
Contraindication: ASA induced asthma, bleeding disorders,
hemorrhagic stroke, pediatrics exhibiting flu like symptoms. Always
consider risks vs. benefits Strokes, pediatrics and during pregnancy

Atropine Sulfate
***FOUND IN THE DRUG BOX***

Indication: symptomatic bradycardias, organophosphate poisonings
Contraindication: tachycardia, hypersensitivity, acute hemorrhage,
myocardial ischemia/infarction

Bumetanide (Bumex�)

Indication: CHF, pulmonary edema
Contraindication: anuria, hypovolemia, dehydration, hypersensitivity
to sulfonamides, severe electrolyte depletion

Calcium Chloride
***FOUND IN THE DRUG BOX***

Indication: hyperkalemia, hypocalcemia, calcium channel blocker
toxicity, hypermagnesemia, PEA or asystole rhythms in the known renal
failure patient, antidote for calcium channel blocker-induced
hypotension/bradycardia Most common prehospital reason is for asystole
and PEA in known dialysis patients who have missed treatments
Contraindication: VF cardiac resuscitation, Digoxin toxicity, hypercalcemia

Dexamethasone (Decadron�, Hexadrol�)

Indication: cerebral edema, allergic states, asthma, spinal cord
injury (especially with associated neurogenic shock) Anaphylaxis and
trouble breathing in hypersensitive airways such as asthma and COPD
Contraindication: hypersensitivity, use cautiously with hypertensive
crisis and pulmonary edema

Dextrose 50% (D50)
***FOUND IN THE DRUG BOX AND APACK***

Indication: hypoglycemia, altered LOC, coma of unknown origin,
seizures of unknown origin Our only indication is hypoglycemia
Contraindication: intracranial hemorrhage, increased ICP, known or
suspected CVA without hypoglycemia Hyperglycemia and CVA

Diazepam (Valium�)

Indication: acute anxiety states, seizure activity, pre-cardioversion
sedative, acute alcohol withdrawal Seizure activity and
precardioversion sedative for electrical cardioversion
Contraindication: hypersensitivity, coma, shock, substance abuse,
may worsen existing respiratory depression. Don�t administer valium to
intoxicated patients, unless they are seizing.

Digoxin (Lanoxin�

Indication: CHF, SVT, atrial fibrillation/flutter
Contraindication: ventricular fibrillation, ventricular tachycardia,
Digoxin toxicity, hypersensitivity

Diltiazem (Cardizem�)

Indication: atrial fibrillation, atrial flutter, SVT/atrial tachycardia
Contraindication: 2nd or 3rd degree heart blocks, severe
hypotension, cardiogenic shock, hypersensitivity, WPW or short PR syndrome

Diphenhydramine (Benadryl�)
***FOUND IN THE DRUG BOX**

Indication: moderate to severe allergic reactions, anaphylaxis
Anaphylaxis, urticaria, dystonic reactions
Contraindication: respiratory distress, CNS depression. MAO
inhibitors, hypersensitivity, narrow angle glaucoma

Dobutamine (Dobutrex�)

Indication: inotropic support in left ventricular dysfunction
Congestive heart failure (CHF)
Contraindication: tachydysrhythmias, severe hypotension

Dopamine Hydrochloride (Intropin�)

Indication: bradycardia, septic shock, neurogenic shock, hypotension
Hypotension, bradycardia
Contraindication: tachydysrhythmias, ventricular fibrillation, hypovolemia

Epinephrine (Adrenalin�)
***FOUND IN THE DRUG BOX***

Indication: bronchial asthma, acute allergic reaction/anaphylaxis ,
asystole, PEA, ventricular fibrillation, bradycardia refractory to atropine
Contraindication: hypovolemia, coronary insufficiency, hypertension, CHF

Epinephrine Racemic (Micronefrin�)
***FOUND IN THE DRUG BOX***

Indication: bronchial asthma, prevention of bronchospasm, croup and
laryngeal edema
Contraindication: epiglottitis, hypertension, underlying
cardiovascular disease

Etomidate (Amidate�)

Indication: premedication for RSI or cardioversion
Contraindication: hypersensitivity, labor and delivery

Fentanyl (Duragesic�, Sublimaze�)
***FOUND IN THE DRUG BOX***

Indication: chest pain, procedural sedition during RSI, patients with
severe pain or as an alternative to morphine sulfate.
Contraindication: MAOI use within 14 days, myasthenia gravis. Use
with caution in head injuries, increased ICP, COPD, bradydysrhythmias
and high-risk patients

Flumazenil (Romazicon�)

Indication: reversal of benzodiazepines
Contraindication: hypersensitivity to benzodiazepines or flumazenil,
cyclic antidepressant overdose

Furosemide (Lasix�)

Indication: pulmonary edema, CHF, hypertensive crisis
Contraindication: anuria, hypovolemia, dehydration, hypersensitivity
to sulfonamides, severe electrolyte depletion Hypotension

Glucagon (GlucaGen�)

Indication: hypoglycemia, beta-blocker cardiotoxicity
Contraindication: hypersensitivity, emaciated patients or patients
suffering from starvation, severe +ETOH

Haloperidol (Haldol�)

Indication: acute psychotic episodes
Contraindication: Parkinson�s disease, depressed mental status,
agitation from shock and/or hypoxia

Heparin Sodium

Indication: AMI, also used in the hospital setting to prevent emboli,
clots, thrombophlebitis and arterial occlusion Acute MI and CVA
Contraindication: active bleeding, recent intracranial, intraspinal
or eye surgery, hypertension and bleeding tendencies/disorders

Ipratropium Bromide (Atrovent�)
***FOUND IN THE DRUG BOX AND APACK***

Indication: used in conjunction or in combination with other
bronchodilators. Chronic or acute exacerbation of acute asthma Asthma,
anaphylaxis, COPD ? wheezing
Contraindication: hypersensitivity to atropine, peanuts, soybeans or
soy lecithin. Atrovent is given after or in combination with beta2
agonists to reduce the risk of rebound bronchoconstriction

Ketamine Hydrochloride (Ketalar�)
***FOUND IN THE DRUG BOX***

Indication: induction, sedation, analgesia and aesthesia.
Bronchodilation makes ketamine a favored induction agent for RSI
during status asthmaticus excited delirium, sedation, pain management
Contraindication: patients in whom signification elevation of BP
would constitute a serous hazard

Ketorolac Tromethamine (Toradol�)
***FOUND IN THE DRUG BOX***

Indication: short-term management of moderate to severe pain
Contraindication: allergy to salicylates or other nonsteroidal
anti-inflammatory drugs (NSAID�s), renal failure, bleeding ulcers or
disorders On blood thinners or have any bleeding disorders,
possibility of requiring surgery, renal failure, hypersensitivity

Lidocaine (Xylocaine�)
***FOUND IN THE DRUG BOX***

Indication: acute ventricular dysrhythmias as an alternative to
amiodarone Ventricular tachycardia and ventricular fibrillation
Contraindication: 2nd or 3rd degree heart blocks in the absence of
an artificial pacemaker, idioventricular rhythms, ventricular escape rhythms

Lorazepam (Ativan�)

Indication: initial control of status epilepticus or severe recurrent
seizures, severe anxiety, sedation Seizure, anxiety, post intubation
sedation (RSI)
Contraindication: coma, shock, suspected drug abuse

Magnesium Sulfate
***FOUND IN THE DRUG BOX***

Indication: eclamptic seizures, Torsades de Pointes, hypomagnesemia,
refractory asthma and COPD
Contraindication: heart block, hypermagnesemia

Mannitol (Osmitrol�)

Indication: increased ICP with closed head injury, diuresis with
certain drug overdoses, blood transfusions, cerebral edema
Contraindication: severe hypotension, profound hypovolemia,
dehydration, hyponatremia, pulmonary edema, CHF Used only for head injuries

Metoprolol (Lopressor�)

Indication: SVT, atrial flutter, atrial fibrillation, junctional
tachycardia, MAT and in AMI patients (to reduce myocardial ischemia,
and to reduce the incidence of ventricular fibrillation) SVT, atrial
fibrillation, atrial flutter, in MI patients
Contraindication: heart failure, cardiogenic shock, bradycardia,
bronchial asthma, 2nd or 3rd degree heart blocks, hypersensitivity
Bradycardias, hypotension, asthma patients

Methylprednisolone (Solu-Medrol�)
***FOUND IN THE DRUG BOX***

Indication: anaphylaxis, bronchodilator unresponsive asthma, acute
spine cord injury Anaphylaxis, trouble breathing in asthma, COPD patients
Contraindication: GI bleeds, use with caution in Diabetes Mellitus

Midazolam Hcl (Versed�)
***FOUND IN THE DRUG BOX***

Indication: conscious sedation, premeditation for intubation or
cardioversion, seizures Seizures, RSI, pre-cardioversion
Contraindication: (+) ETOH, overdose, respiratory depression,
concurrent use with barbiturates, narcotics or other CNS depressants

Morphine Sulfate (MS Contin�, Roxanol�)

Indication: chest pain associated with myocardial infarction and
pulmonary edema Chest pain, musculoskeletal pain, cardiac events,
hypertensive crisis
Contraindication: hypersensitivity to narcotics, hypovolemia,
hypotension SBP<90mm/Hg, MAOI administration within 14 days, head
injury or undiagnosed abdominal pain. Use caution with inferior
wall/right ventricle AMI

Naloxone (Narcan�)
***FOUND IN THE DRUG BOX AND APACK***

Indication: coma of unknown origin, decreased LOC, reversal of
CNS/respiratory depression induced by opioids, narcotic overdose
Contraindication: hypersensitivity, narcotic-dependency patients
(including neonates)

Nitroglycerin (Nitrobid�, Nitrostat�)
***FOUND IN THE DRUG BOX AND APACK***

Indication: ischemic chest pain, hypertension, CHF, pulmonary edema
Contraindication: hypotension SBP <90mm/Hg, head injury, cerebral
hemorrhage, hypersensitivity. Use caution with inferior wall/right
ventricle AMI. Previous administration of vardenafil(Levitra),
sildenafil(Viagra), tadalafil(Cialis) within the prior 48 hours.

Nitrous Oxide/Oxygen 50/50 (Nitronox�)

Indication: moderate to severe pain, anxiety, apprehension
Contraindication: impaired LOC, head injury, chest trauma,
decompression sickness, undiagnosed abdominal pain or distention,
bowel obstruction, hypotension, shock (hypovolemia), COPD

Norepinephrine (Levophed�)

Indication: cardiogenic shock, neurogenic shock, inotropic support,
hemodynamically significant hypotension refractor to other
sympathomimetic amines When the heart needs to be stimulated when
nothing else helps for hypotension (heart failure, cardiogenic shock,
post arrest) Generally ONLY used when nothing else works due to its potency
Contraindication: hypotensive patients with hypovolemia

Ondansetron (Zofran�)
***FOUND IN THE DRUG BOX AND APACK***

Indication: nausea and vomiting caused by head injury, narcotic
administration, GI issues Nausea/vomiting
Contraindication: hypersensitivity, liver insufficiency/failure

Oxygen

Indication: hypoxia, ischemic chest pain, respiratory distress,
carbon monoxide poisoning and any other cause of decreased perfusion
Contraindication: none, oxygen should never be withheld in any
critical patient. Use with caution with high concentration in COPD
patients. Use enough to keep SpO2 between 94%-99% in patients with
uncomplicated chest pain

Oxytocin (Pitocin�)

Indication: post-partum hemorrhage after infant and placental
delivery secondary to fundal massage Post partum hemorrhage after
fundal massage has been performed
Contraindication: presence of second fetus

Pancuronium (Pavulon�)

Indication: induction or maintenance of paralysis for intubation
(RSI) Paralysis for RSI
Contraindication: hypersensitivity, neuromuscular disease
(Myasthenia Gravis), inability to control airway with positive
pressure ventilations Neuromuscular diseases, inability to control the airway

Pheynytoin

Indications: Seizure, dig toxicity
Contraindications: bradycardia, 2nd and 3rd degree heart blocks

Pralidoxime (2-PAM�, Protopam�)

Indication: organophosphate poisonings
Contraindication: reduce dose in patients with impaired renal
function, Myasthenia Gravis

Prednisone (Deltasone�, Orapred�, Pediapred�)
***FOUND IN THE DRUG BOX AND APACK***

Indication: anaphylaxis, bronchial asthma, acute spinal cord injury
Anaphylaxis, trouble breathing in asthma, COPD patients
Contraindication: systemic fungal infections, GI bleeds, use with
caution in DM

Propofol (Diprivan�)

Indication: sedation for ventilated patients
Contraindication: hypovolemia, known hypersensitivity to soy bean
oil, peanuts and eggs

Sodium Bicarbonate
FOUND IN DRUG BOX

Indications: known acidosis, cardiac arrest, cardiac arrest with
extended down time, hyperkalemia, overdose of TCA's, phenobarbital,
diphenhydramine, asa, cocaine
Contraidications: hypokalemia, unknown acidosis

Succinylcholine (Anectine�)

Indication: to facility endotracheal intubation, termination of
laryngospasm, muscle relaxation Paralysis for RSI
Contraindication: penetrating eye injury, inability to control
airway with positive pressure ventilations

Thiamine (Betaxin�)

Indication: coma of unknown origin, delirium tremens (DT�s) Beriberi
(a rare condition caused by severe vitamin B deficiency), Wernicke�s
encephalopathy, Korsakoff�s Psychosis When administration of D50 is
required in vitamin B deficient, malnourished or chronic alcoholic patients
Contraindication: pediatrics

Verapamil (Isoptin�, Calan�)

Indication: SVT, atrial flutter/atrial fibrillation with a rapid
ventricular response (RVR)
Contraindication: hypersensitivity, 2nd or 3rd degree heart blocks,
hypotension, cardiogenic shock, severe CHF, WPW with afib/flutter, IV
beta blockers, wide complex tachycardias Anything other than
tachycardias, hypotension