• Trade: Toradol 
• Class: NSAID
• MOA: inhibits the production or prostaglandins in inflamed tissue, which decreases the responsiveness of pain receptors. 
• Indications: Moderately severe acute pain
• Contraindications: Patients with a hx of peptic ulcer disease or GI bleed, patients with renal insufficiency, hypovolemic patients, 3rd trimester pregnancy, nursing mothers, allergy to other nsaids, stroke or head trauma, having surgery within the next 7 days.  
• Side effects:  headache, drowsiness, dizziness, abdominal pain, dyspepsia, N/V, Diarrhea.
• Dosing:

Adult 

IV 30mg

IM 60mg 

Senior (65 and older)/ Pediatric < 50kgs

IV 15mg

IM 30mg

• Trade: Morphine
• Class: Opiate agonist/Narcotic Analgesic 
• MOA: Binds to the opiate receptors. Reduces stimulation of the sympathetic nervous system caused by pain and anxiety. Reduction of sympathetic stimulation reduces heart rate, cardiac work, and myocardial O2 consumption
• Indications: moderate to severe pain including chest pain associated with ACS, CHF, and pulmonary edema.
• Contraindications: Respiratory depression, shock.
• Side effects: Respiratory depression, hypotension, N/V, dizziness, lightheadedness, sedation, diaphoresis, euphoria, seizures, cardiac arrest, anaphylactoid reaction.
• Dosage:

Adult  

2-10mg IV/IO/IM

Pediatric 

< 110 lbs 0.025 – 0.2mg/kg IV/IO/IM

• Trade: Sublimaze
• Class: Narcotic Analgesic 
• MOA: Binds to opiate receptors producing analgesia and euphoria
• Indication: Pain
• Contraindication: Use caution in traumatic brain injury, Respiratory depression 
• Side effects: Respiratory depression, apnea, hypotension, N/V, dizziness, sedation euphoria, Sinus bradycardia, sinus tachycardia, palpitations, HTN, diaphoresis, syncope
• Dosing

Adult 

50-100mcg IM/IV

Pedi 

1-2mcg/kg IM/IV

• Trade: Valium 
• Class: Benzodiazepine
• MOA: Binds to the benzodiazepine receptor and enhances the effects of GABA
• Indications: Anxiety, Skeletal muscle relaxation, anticonvulsant 
• Contraindications: Children younger then 6 months, acute angle glaucoma, CNS depression, alcohol intoxication. 
• Side effects:  Respiratory depression, drowsiness, fatigue, headache, pain at the injection site, confusion, nausea, hypotension, cardiac arrest at high doses
• •Dosing:

Adult: 

Anxiety: 2-10mg IV/IM

Seizure: 5-10mg IV/IO

Pediatric:

Anxiety: 0.2 – 0.3mg/kg IV/IM

Seizure:  Older then 5 years: 1mg IV/IO

Older then 30 days less then 5 years: 0.2 to 0.5mg IV/IO

                Neonate: 0.1-0.3mg/kg IV/IO

• Trade: Tegretol 
• Class:  Anticonvulsant 
• MOA: Binds preferably to voltage gated Sodium channels in their inactive conformation, which prevents repetitive and sustained firing of an action potential.
• Indications: Partial and generalized tonic – clonic seizures 
• Contraindications: AV Block, bundle branch block, agranulocytosis, bone marrow supression, monoamine oxidase inhibitor therapy
• Side effects: Dizziness, drowsiness, ataxia, N/V, blurred vision, confusion, headache, transient diplopia, visual hallucinations, life threatening rashes.
• Dosing:

Adult:

200mg PO

Pediatric:

6-12 years old: 100mg PO

        Less then 6: 10mg/kg PO

First and foremost, THANK YOU to everyone who was listened to this Podcast over the past year. In just under 12 months we have risen to one of the top listened to and searched paramedic pod casts on spotify and apple podcasts. Again, thank you so much!

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Trade – Cardene

Class – Calcium Channel blocker 

MOA – Blocks calcium movement into the smooth muscle of the blood vessel walls, causing vasodilation.

Indication – Angina, HTN

Contraindication – Aortic stenosis, hypotension, use caution in heart failure, cardiac conduction abnormalities, Cerebrovascular disease, depressed AV node conduction. 

Side effects – Edema, headaches, flushing, sinus tachycardia, hypotension 

Dosages :

Adult: 5mg/hr IV/IO 

Pedi: 0.5 – 5 mcg/kg/min

• Trade – Cyanokit
• MOA:  Antidote, cyanide poisoning adjunct Binds with cyanide to form nontoxic cyanocobalamin, preventing its toxic effects; excreted renally
• Indications: Treatment of known or suspected cyanide poisioning.
• Contraindications:  None is the emergency setting
• Side Effects:  Hypertension, allergic reactions, GI bleeding, nausea, vomiting, dyspepsia, dyspnea, dizziness, headache, injection site reactions.
• Dosage:  

Adult: 5 g IV infusion over 15 minutes at a rate of 15 mL/min.

Pedi:  70 mg/kg IV one time, may be repeated one time at the same dose.

• Trade – Isoptin
• Class – Calcium Channel blocker
• MOA – Blocks calcium from moving into the heart muscle cell, which prolongs conduction of the electrical impulses through the AV node.
• Indications – AF, HTN, paroxysmal SVT, Paroxysmal SVT prohylaxis
• Contraindications – 2nd or 3rd degree AV block, Hypotension, cardiogenic shock, Sick sinus syndrome, WPW.
• Side effects – Sinus bradycardia, 1st, 2nd, or 3rd degree AV blocks, CHF, reflex tachycardia, transient asystole, hypotension.
• Dosing 

Adult

 2.5-10mg IV/IO over 2 minutes. May repeat at 5-10mg every 15-30 mins to a maximum dose of 30mg

Pedi 

1-16 years old: 0.1mg/kg IV/IO max single dose 5mg over 2mins may repeat in 30 mins to a max dose of 10mg

• Trade – Plavix
• Class – Antiplatelet 
• MOA – Blocks platelet aggregation by antagonizing the IIb/IIIa receptors 
• Indications – ACS, chronic coronary and vascular disease, ischemic stroke.
• Contraindications – Hx of intracranial hemorrhage, GI bleed or trauma.
• Side effects – Nausea, Abdominal pain, hemorrhage. 
• Dosing : 

Unstable angina pectoris or non Q wave AMI.

Adult – Loading dose 300-600mg PO

Pedi – Not recommended for pedi patients