Common Emergency Medications

Epinephrine
Classification: Sympathomimetic, Alpha-adrenergic agonist, Beta1- and beta2-
adrenergic agonist, Cardiac stimulant, Vasopressor, Bronchodilator, Antasthmatic, Nasal
decongestant, Mydriatic
Indications: In ventricular standstill after other measures have failed to restore
circulation; treatment and prophylaxis of cardiac arrest and attacks; acute
hypersensitivity reactions, acute asthmatic attacks to relieve bronchospasm not
controlled by inhalation, additive to local anesthetic solutions for injection to prolong
their duration of action and limit systemic absorption
Stock: 1mg/ml (1ml ampule)
Adverse Effects: anxiety, sweating, dizziness, arrythmias
Note: Used by athletes before
Auto-injectors for patients with hx of severe
anaphylactic reaction
Loss of effectiveness in high doses
Dose: Adults: 1mg/ml every 3-5 mins
Pedia: 0.01mg/kg every 3-5 mins
Epinephrine Drip: 1mg of Epinephrine in D5W250ml
Dose: 16 – 150ugtts/min
0.06mg to
Atropine Sulfate
Classification:Anticholinergic, Parasympatholytic, Antiparkinsonian,
Antidote, Diagnostic agent (ophthalmic preparations)
Indication: To temporarily increase heart rate or decrease AV-block until
definitive intervention can take place, when bradycardia or AV-block are
judged to be hemodynamically significant
Stock: 1mg/ml (1ml ampule)

Notes: Increases the automaticity of SA node

Historically used for aesthetic purpose
Administrated prior to anesthesia to reduce or
prevent secretions of respiratory tract
Watch out for decreased urine output

Adult Dose: 0.5 – 1mg every 3-5 minutes until improved

Max Dose: 3mg
Pediatric Dose: 0.02mg/kg IV, IO or ET
Max Dose: 1mg
Isoptin (Verapamil)

Classification: Calcium Channel Blocker, Class IV Antidysrhythmic

Indication: Rapid conversion to sinus rhythm of paroxysmal
supraventricular tachycardias, continuous Arrythmia due to atrial
fibrillation. Hypertensive Crises
Stock: 5mg/2ml (ampule)

Notes: Given as slow IV push at least 2 mins

May inhibit AV conduction---- asystole in
extreme case
Maybe given as drip
Digoxin (Lanoxin)

Classification: Cardiac Glycoside

Indication: indicated for the treatment of mild to moderate heart
failure in adults. Digoxin Injection increases left ventricular ejection
fraction and improves heart failure
symptoms, as evidenced by improved exercise capacity
indicated for the control of ventricular response rate in adult patients
with chronic atrial fibrillation.
Stock: 0.5mg/2ml (ampule)
Notes: The term digitalize refers to this drug
Initially used to treat edema
Improves effect with diuretics and vasodilators
(ACE
inhibitors)
Has minimal diuretic effect
Phenytoin (Dilantin)

Classification: Anticonvulsant
Indication: used to control certain type of seizures, and to treat and
prevent seizures that may begin during or after surgery to the brain
or nervous system.
Stock: 100mg/2ml (ampule)
Notes: Given as sandwich if not using PNSS or PLR
Crystalizes
May cause suicidal ideation
Works by decreasing electrical activity
in the brain
Loading Dose: 300mg (3 Very irritating
ampules) giventovia
theSIVP
vein
Maintenance Dose: 100mg q8
Maximum: 50 mg/min
Recommended rate for most adults:
40 mg/min.
Elderly (rate): 20 mg/min
Paracetamol (Aeknil)

Classification: Analgesic/ Antpyretic

Indication: indicated as analgesic/antipyretic, where patient is
unable to take oral medication. Aeknil can be administered with
advantage for prevention of febrile convulsion especially in children
Stock: 300mg/2ml (ampule)

Notes: Specific therapy with antibiotics or

chemotherapeutic drugs of choice should be carried
out whenever indicated.
Overdose may present after 5-6 days
Very rare adverse effects
Furosemide (Lasix)

Classification: Loop Diuretic

Indication: used to treat excessive accumulation of fluid and/or
swelling of the body caused by heart failure, cirrhosis, chronic kidney
failure, and the nephrotic syndrome. It is sometimes used alone or in
conjunction with other blood pressure pills to treat high blood
pressure. It also is used for treating high levels of potassium
(hyperkalemia), calcium (hypercalcemia), and magnesium
(hypermagnesemia).
Stock: 20mg/2ml (ampule)
Notes: Potentially fatal adverse effect: cardiac arrest
The onset of action: oral administration within one hour,
and the diuresis lasts about 6-8 hours. The onset of action:
IV is five minutes and the duration of diuresis is
2 hours
WOF:
Usual Dose: for Acute Hypotension
Pulmonary Edema/ Congestion: 40 – 80mg IV Stat
Dose up to 600mg/day
Metoclopramide (Plasil)

Classification: Anitemetics
Indication: Prevention of chemotherapy-induced emesis. Treatment
of postsurgical and diabetic gastric stasis. Facilitation of small bowel
intubation in radiographic procedures. Management
of esophageal reflux. Treatment and prevention of postoperative
nausea and vomiting when nasogastric suctioning is undesirable
Stock: 10mg/2ml (ampule)

Notes: Stimulates motility of the upper GI tract and

accelerates gastric emptying.
Unlabeled uses: Treatment of hiccups.
Adjunct management of migraine
headaches
Augments lactation
Hydrocortisone (Solu-Cortef)

Classification: Steroid, Anti-inflamatory

Indication: To reduce inflammation during an allergic reaction,
severe anaphylaxis, asthma, or COPD. To treat urticaria
Stock: 250mg/2ml, 100mg/2ml (vial)

Notes: Affects nearly all systems of the body; more

susceptible to infections, increasing
dose = higher rate of occurrence of infections
Onset 30 - 45 mins
May delay cardiac healing
Given earliest during an acute asthma attack

Usual Dose: 250mg IV as loading dose, then 100mg IV q6

Diazepam (Valium)

Classification: Anxiolytic, benzodiazepines

Indication: used to treat anxiety and muscle spasms. It is also used in patients with
alcohol withdrawal to prevent seizures and treat other symptoms (e.g., agitation,
anxiety, hallucinations).This medication is also used for short-term treatment of serious
seizures that do not stop
Stock: 10mg/2ml (ampule).
Notes: It is not for ongoing daily use to
prevent seizures.
also used before surgeries to cause
drowsiness and cause
forgetfulness
GABA = calm
May cause withdrawal reactions but
rarely addictive
Seizure precaution
Alcohol increases its effect
Given to ACS patients
Nalbuphine Hydrochloride (Nubain)
Classification: Narcotic agonist-antagonist analgesic
Indication: Relief of moderate to severe pain. Preoperative
analgesia, as a supplement to surgical anesthesia, and for obstetric
analgesia during labor and delivery.
Stock: 10mg/ml (ampule)

Notes: Use cautiously with emotionally unstable clients or

those with a history of narcotic abuse
Not recommended for pediatric patients
Has Ceiling effect
Not given with other opiods, produces
withdrawal
less respiratory depression and addictive
potential
Midazolam (Dormicum)

Classification: Anti-anxiety agents, sedative/hypnotics,

benzodiazepines
Indication: Short-term sedation, post-operative amnesia
Stock: 5mg/ml (ampule)

Notes: Acts at many levels of the CNS to produce

generalized CNS depression.
Preferred for Pediatric patients
May cause extravasation
Can cause severe respiratory depression specially
for
patients with COPD
GABA = calm
Can be given as drip (ICU)
May develop physical dependence
Takes effect after 2 mins (IV)
Phenobarbital (Luminal)

Classification: Barbiturate, Sedative, Hypnotic, Antiepileptic

Indication: Preanesthetic, Treatment for generalized tonic-clonic
seizures and focal seizures, Emergency control of acute seizures
Stock: 130mg/ml (ampule)

Adverse Effect: Bradycardia, hypotension, syncope; drowsiness,

lethargy, nervousness, headache, insomnia, nightmares,
hallucinations
Notes: Has a hangover effect
Taper dosage gradually after repeated use, especially
in patients with epilepsy
Abrupt discontinuation could result in a serious
increase in seizures
Works best when the amount of drug in your body is
kept at a constant level
Diphenhydramine (Benadryl)

Classification: Antihistamine, Anti-motion sickness drug, Sedative-

hypnotic, Antiparkinsonian
Indication: Relief of symptoms associated with allergies, adjunctive
therapy in anaphylactic reactionsActive and prophylactic treatment
of motion sickness, Nighttime sleep aid, Parkinsonism
Stock: 50mg/ml (ampule)

Notes: Also causes sedation and has some

anticholinergic action.
Antiparkinsons for the elderly (unable to tolerate
more potent agents)
Serious sedation with alcohol
Effective with acute psychosis (cocktail with
Haldol)
Given as premed for blood transfusion
Phytomenadione (Vitamin K)

Classification: Nutritional supplement, prothrombogenic,

antihemorrhagic
Indication: treatment and prevention of various coagulation
disorders involving impaired formation of factors II, VII, IX, and X
resulting from vitamin K deficiency or impairment of vitamin K
activity
Stock: 10mg/ml (ampule)
Notes: Given initially to babies to prevent hemorrhagic disease
May counteract effects of too much anticoagulants
Nephrotoxic
hepatic formation of active prothrombin
Failure to respond to vitamin K may indicate
coagulation defects
Monitor PT to determine dosage effectiveness
Magnesium Sulfate
Classification: Electrolyte
Indication: commonly used for the treatment of preeclampsia
during pregnancy. Used as a tocolytic medicine to slow uterine
contractions or to help protect the baby's brain during preterm labor.
Stock: 1g/2ml (ampule)

Notes: Magnesium Sulfate vs. Calcium Gluconate

Calcium in the muscles causes the contractions
If birth is imminent, given to delay birth until
corticosteroids could take
effect
May help reduce the risk of Cerebral Palsy in
preterm babies
Constant assessment of mothers` reflexes
Recently advised as treatment for Asthma for its
bronchodilation effects specially for
pediatric patients
Tranexamic Acid (Hemostan)
Classification: Antifibrinolytic, antihemorrhagic
Indication: Treating heavy menstrual bleeding, hemorrhage
following surgery, Post abortion or post partum hemorrhage,
Effective in promoting hemostasis in traumatic injuries
Stock: 500mg/5ml (ampule)

Notes: Prevents fibrinolysis and breakdown of blood clots

Crosses the placenta
Effectiveness in children have not been
confirmed
Commonly used in cardiac surgery
Increases risk of bleeding if given 3 hours post
trauma
Commonly used in dental surgery as a mouth
rinse
Sodium Bicarbonate
Classification: Fluid and Electrolyte Balance, GI Agent, Anatcid
Indication: treatment of metabolic acidosis which may occur in severe
renal disease, uncontrolled diabetes, circulatory insufficiency due to
shock or severe dehydration, extracorporeal circulation of blood,
cardiac arrest and severe primary lactic acidosis
Stock: 50meqs/50ml

Notes: Given via slow IV push

Metabolic Acidosis is common in renal failure
patients
May present with Kussmauls Breathing, lethargy,
stupor, coma
Bicarbonate Deficit: 0.5 x weight in Kg x Pts Bicarb
Level
Calcium Gluconate
Classification: fluid and electrolytic and water balance agent, ,
Minaeral
Indication: conditions arising from calcium deficiencies such as
hypocalcemic tetany, hypocalcemia related to hypoparathyrodism
and hypocalcemia due to rapid growth or pregnancy
Stock: 10% solution in 10ml polyvial

Notes: Magnessium Sulfate vs. Calcium Gluconate

Given as SIVP, may cause fatal bradycardia
Contains aluminum
Synergistic with Cardiac Glycosides – Arrythmias
Calcium: Essential to a number of physiologic
processes, including transmission of
nerve impulses; contraction of cardiac,
smooth, and skeletal muscles; renal
function; respiration; and blood coagulation
Given post multiple blood transfusion
Mannitol
Classification: Osmotic Diuretics
Indication: Preventing or treating excess body water in certain
kidney conditions, reducing swelling of the brain, or reducing
pressure in the eye
Stock: 500ml

Notes: Causes dizziness

Classified as a sugar alcohol, used as sweeteners for
DM
Facilitating agent for the transportation of
pharmaceuticals directly into the brain (blood-brain barrier)
Mixed with street drugs like heroin, meth and
cocaine
Effect at 10 – 15 mins and effective until 2 hours
 (Voluven)
Hydroxyethyl Starch in Sodium Chloride

Classification: Plasma Volume Expander

Indication: treatment and prophylaxis of hypovolemia. Prevents
shock post blood loss
Stock: 500ml
Notes: Given to Dengue Shock Syndrome patients
Given to patients only when actual blood
products are unavailable, not a replacement for RBC
Recently discovered to cause severe renal
impairment
May cause overloading of the circulatory system
– pulmonary edema
No longer used in other countries *Europe, in the
US banned in critically ill patients and
those with renal impairment
Isoket Isosorbide Dinitrate

Classification: Anti-Anginal, Nitrate, Vasodilator

Indication: treatment of unresponsive left ventricular failure
secondary to acute myocardial infarction, unresponsive left
ventricular failure of various aetiology and severe or unstable angina
pectoris. (CAD, maintenance therapy after MI)
Stock: 10mg/10ml (ampule)
Adverse Effect: Weakness, Vertigo, dizziness, hypotension, nausea,
diarrhea, perspiration, orthostatic hypotension/hypertension

Preparation: Single Concentration: 90ml D5W + 1 amp Isoket

(10ml) to make 100ml in Soluset
Double Concentration: 80ml D5W + 2
amps Isoket
(20ml) to make 100ml in Soluset
Computation: Single Concentration: Dose x 10
Double Concentration: Dose x 10/2
Isoket Isosorbide Dinitrate

Sample Computation:
Doctor’s Order: Start Isoket Drip at 1mg/hr
(Single
Concentration)
Formula: Dose x 10
Dose: 1mg/hr x 10 = 10cc/hr

Sample Computation:
Doctor’s Order: Increase Isoket drip to 2mg/hr
Formula: Dose x 10
Dose: 2mg/hr x 10 = 20cc/hr
Sample Computation:
Doctor’s Order: Restart Isoket Drip at 2mg/hr
(double
concentration)
Formula: Dose x 10 /2
Dose: 2mg/hr x 10 = 20/2 = 10cc/hr
Nicardipine Nicardipine Hydrochloride

Classification: Calcium Channel Blocker

Indication: Used to treat severe chest pain (angina) or high blood
pressure (hypertension)
Stock: 10mg/10ml (ampule)
Adverse Effect: Hypotension, Headache, Nausea, Vomiting

Preparation: Single Concentration: 90ml D5W +

1amp Isoket (10ml)
to make 100ml in
Soluset
Double Concentration: 80ml
D5W + 2
amps Isoket (20ml) to make
100ml in
Soluset
Computation: Single Concentration: Dose x 10
Double Concentration:
Nicardipine Nicardipine Hydrochloride

Sample Computation:
Doctor’s Order: Start Nicardpine Drip at 1.5mg/hr (Single
Concentration)
Formula: Dose x 10
Dose: 1.5mg/hr x 10 = 15cc/hr
Sample Computation:
Doctor’s Order: Increase Nicardipine drip to
2mg/hr Formula: Dose x 10
Dose: 2mg/hr x 10 = 20cc/hr

Sample Computation:
Doctor’s Order: Restart Nicardipine
Drip at
1.5mg/hr (double concentration)
Formula: Dose x 10 /2
Dose: 1.5mg/hr x 10 = 15/2 = 7.5cc/hr
Aminophylline
Classification: Anti-Asthma, COPD Preparation, Bronchodilator
Indication: Bronchial Asthma, Bronchopenumonia, Bronchitis, Severe
Bronchospasm, Paroxysmal nocturnal dyspnea
Stock: 250mg/10ml (ampule)
Loading Dose: 5mg/kg over 30mins
Compatibility: Dextrose 5%, Sodium Chloride 0.9%
Incompatible with any other drug
Adverse Effect: Hypotension, Nausea, Vomiting, Restlessness,
Palpitations, Visual Disorders, Convulsion, Sinus Tachycardia, Life-
threatening Arrythmias
Preparation: 500mg of Aminophylline (2 ampules) in D5W500 ml
or PNSS 500ml = 1mg/ml
Computation: Dose x weight in kg/hr = mg/kg/hr
Aminophylline Weight: 60Kgs.

Sample Computation:
Doctor’s Order: Give Loading Dose of
Aminophylline at 5mg/kg to be infused in 30 mins
then continue infusion at 0.3mg/kg/hr
Formula: Dose x weight/hr
Dose: 5mg x 60kg= 300mg/kg/hr
5mg x 60kg= 300mg/kg
0.5hr
Answer: 600 mg/kg/hr
Formula: Dose x weight
0.3mg x 60kg/hr = Answer: 18mg/kg/hr
Cordarone Amiodarone Hydrochloride

Classification: Wide – Spectrum Antiarrhythmic

Indication: Suppresses PVCs and Ventricular Tachycardia, Prophylactic
control of Ventricular Dysrrhythmias, Prevents recurrence of
paroxysmal Afib, Flutter, supraventrcular tachycardias

Adverse Effect: Photosensitivity, Bradycardia, Blurred vision,

Anorexia, nausea, vomiting, tremors of hands, muscle weakness

Stock: 150mg/3ml ampule

Loading Dose: (depends on Doctors order) but usually
150mg IV infusion in 10mins (15mg/min)
Loading Dose Dilution: 150mg (1 ampule) in 97ml of D5W in
a soluset
Preparation: 300mg of Cordarone (2 ampules) in 250ml of D5W. Or
600mg of Cordarone (4 ampules) in 500ml of D5W. Computation: Dose x
weight in kg/hr = mg/kg/hr
Cordarone Amiodarone Hydrochloride

Sample Computation:
Doctor’s Order: Then start Cordarone Drip
2 amps of Cordarone in 250ml D5W to run for
12 hours.
Formula: Volume(ml) / Time (hour)
250ml / 12mins
Answer: 250ml/12hrs = 20 – 21ml/hr
How many mg of Cordarone per hour?
Answer: 300mg/250ml = 1.2mg/ml
1.2 mg/ml x 20.5ml/hr = 24.6mg/hr
Dopamine Hydrochloride
Classification: Inotropic Agent
Indication: Hemodynamically significant hypotension in the absence
of hypovolemia, Septic Shock, Hypotension with symptomatic
bradycardia
Stock: Premixed Bottle: 200mg/250ml or 400mg/250ml
Ampule: 200mg/5ml
Precautionary Measures: Increases HR and induce
supraventricular/ventricular tachycardia, Can exacerbate congestion,
Nausea and Vomiting in high doses
Preparation: Single Concentration: 250ml D5W + 1 amp
Dopamine ampule or Premixed
Solution
Double Concentration: 250ml D5W + 2
amps Dopamine ampule or Premixed
Solution
Computation: Single Concentration: Dose x weight (kgs) / 13.3
Double Concentration: Dose x weight
Dopamine Hydrochloride Weight: 65 kgs

Sample Computation:
Doctor’s Order: Start Dopamine Drip at
5mcg/kg/min (single concentration)
Formula: Dose x weight /13.3
Answer: 5 x 65/ 13.3 = 24.4 ml/hr

Sample Computation:
Doctor’s Order: Start Dompamine Drip at
3mcg/kg/min (double concentration)

Formula: Dose x weight /26.6

Answer: 3 x 65/ 26.6 = 7.3 ml/hr
Dobutamine Hydrochloride
Classification: Inotropic Agent
Indication: Treatment of refractory congstive Heart Failure, Acute
Myocardial Infarction, Cardiogenic Shock, Septic Shock, Marked
Hypotension
Stock: Premixed: 250mg/250ml or 500mg/250ml
Ampule: 250mg/5ml
Precautionay Measures: May cause tachycardia and arrythmias can
provoke myocardial ischemia, Headache, nausea, tremor and
hypokalemia
Preparation: Single Concentration: 250ml D5W + 1 amp
Dobutamine ampule or Premixed
Solution
Double Concentration: 250ml D5W + 2
amps Dobutamine ampule or Premixed
Solution
Computation: Single Concentration: Dose x weight (kgs) / 16.6
Double Concentration: Dose x weight
Dobutamine Hydrochloride
Weight: 70kg

Sample Computation:
Doctor’s Order: Start Dobutamine Drip at
3mcg/kg/min (single
concentration)
Formula: Dose x weight /16.6
Answer: 3 x 70 / 13.3 = 12.6 ml/hr

Sample Computation:
Doctor’s Order: Start Dobutamine Drip at
8mcg/kg/min (double concentration)

Formula: Dose x weight /33.2

Answer: 8 x 70 / 33.2 = 16.8 ml/hr
NorEpinephrine (Levophed)
Classification: Inotropic Agent
Indication: Adjunctive treatment in cardiac arrest and profound
hypotension.
Stock: Ampule: 2mg/2ml and 4mg/4ml
Preparation: Single Concentration: D5w 250ml + 1 amp (2mg)

of levophed
Double Concentration: D5W 250ml +
2amps (4mg)
Formula: Dose x Weight x 60 / 8 in single concentration
Dose x Weight x 60 / 16 in double
of levophed
concentration
Notes: Preferred for Sepsis (beta vs alpha)
Short Acting but very potent
Dilution in saline is not recommended
NorEpinephrine (Levophed)
Weight: 70kg

Sample Computation:
Doctor’s Order: Start Levophed drip at 0.1mg
(single concentration)
Formula: Dose x weight x 60 / 8
Answer: 52.5 cc/hr