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Drawer 1: Drugs

	Drug	Purpose	Mechanism of Action	Precautions	Use in Emergencies
1	Naloxone (Narcan) 0.4 mg/ml	Reverses the effects of opioid overdose.	Pure opioid antagonist that competes and displaces opioids at opioid receptor sites.	Avoid in patients with known hypersensitivity to naloxone. May precipitate opioid withdrawal syndrome.	Administer to patients with suspected opioid overdose whose respirations are < 12/minute. Titrate to desired clinical effect by administering a diluted preparation (0.04 mg/mL) slow IV push. Dilute 0.4 mg (1 mL) ampul with 9 mL of normal saline for a total volume of 10 mL to achieve a concentration of 0.04 mg/mL.
2	Amiodarone (Cordarone) 150 mg vial	Treats acute life-threatening dysrhythmias, including ventricular tachycardia/fibrillation and supraventricular tachycardia.	Inhibits adrenergic stimulation (alpha- and beta-blocking properties). Affects sodium, potassium, and calcium channels. Prolongs the action potential and refractory period in myocardial tissue.	Avoid in patients with: Known hypersensitivity to amiodarone, iodine, or any component of the formulation Severe sinus node dysfunction causing marked sinus bradycardia Second- and third-degree heart block (except in patients with a functioning artificial pacemaker) Bradycardia causing syncope (except in patients with a functioning artificial pacemaker) Cardiogenic shock	Administer undiluted over 10 minutes for the treatment of pulseless ventricular tachycardia/ventricular fibrillation unresponsive to CPR, defibrillation, and vasopressor therapy.
3	Adenosine 6 mg vial	Suppresses supraventricular tachycardia.	Slows conduction time through the AV node by interrupting the re-entry pathways and restoring normal sinus rhythm.	Avoid in patients with: Known hypersensitivity to adenosine Second- or third-degree AV block (except in patients with a functioning artificial pacemaker) Sinus node disease, such as sick sinus syndrome or symptomatic bradycardia (except in patients with a functioning artificial pacemaker)	If vagal maneuvers do not correct supraventricular tachycardia, administer 6 mg rapid IV bolus over a 1- to 2-second period. Note: Initial dose of adenosine should be reduced to 3 mg IV bolus if patient is currently receiving carbamazepine or dipyridamole, has a transplanted heart, or if adenosine is administered via central line. If the first dose does not result in elimination of the SVT within 1 to 2 minutes, give 12 mg IV bolus. Follow each dose with 20 mL normal saline flush.
4	Norepinephrine 1 mg/mL in 4 mL vials	Increases blood pressure in patients with hypotension or shock who are not responsive to IV fluids.	Stimulates beta-1 adrenergic receptors and alpha adrenergic receptors, causing increased contractility and heart rate, as well as vasoconstriction, thereby increasing systemic blood pressure and coronary blood flow. Alpha effects (vasoconstriction) are greater than beta effects (inotropic and chronotropic effects).	Infuse into a large vein whenever possible to prevent infiltration of perivascular tissue adjacent to the infusion site. Extravasation can cause necrosis and sloughing of the surrounding tissue. Some formulations contain meta-bisulfite, which is known to exacerbate asthma.	Dosage range varies greatly depending on clinical situation. Typical dosing is between 0.5 to 4 mcg/minute continuous IV infusion.
5	Sodium chloride 0.9% 10-20 mL vial for drug dilution	Used to dilute drugs for administration. Provide replacement fluids in the setting of dehydration or hypotension.	Serves as principal extracellular cation. Functions in fluid and electrolyte balance, osmotic pressure control, and water distribution.	Must be isotonic to avoid damaging tissues. Use hypertonic sodium chloride solutions with extreme caution.	For fluid resuscitation, give 30 mL/kg IV within 1 hour.
6	Magnesium sulfate, 50% 2 mL vials (1 g/mL)	Use for polymorphic VT (with pulse) associated with QT prolongation or VF/pulseless VT associated with torsades de pointes. Also used for profound hypomagnesemia, acute asthma exacerbations, or seizures due to eclampsia.	Assists in movement of calcium, sodium, and potassium in and out of cells, as well as stabilizing excitable membranes. Parenterally administered magnesium decreases acetylcholine in motor nerve terminals and acts on myocardium by slowing rate of SA node impulse formation and prolonging conduction time.	Use with caution in patients with existing heart blocks. Can enhance the effect of neuromuscular-blocking agents.	IV infusion Dilute solutions to a concentration of < 20% prior to administration. Polymorphic VT (with pulse) associated with QT prolongation 1 to 2 g (diluted in 50 to 100 mL D5W) IV over 15 minutes (range: 5 to 60 minutes). Can follow with a continuous IV infusion of 0.5 to 1 g/hour. VF/pulseless VT associated with torsades de pointes 1 to 2 g (diluted in 10 mL D5W) administered as an IV or intraosseous bolus.
7	Epinephrine 0.1 mg/mL Abboject™	Increases blood pressure or heart rate or treats type I allergic reactions, including anaphylaxis.	Stimulates alpha, beta-1, and beta-2 adrenergic receptors, resulting in relaxation of smooth muscle of the bronchial tree, cardiac stimulation (increasing myocardial oxygen consumption), and dilation of skeletal muscle vasculature. Small doses: causes vasodilation via beta-2 vascular receptors. Large doses: constricts skeletal and vascular smooth muscle.	No absolute contraindications to the use of epinephrine in a life-threatening situation.	Administer 1 mg IV push for: asystole/pulseless arrest, pulseless ventricular fibrillation, or ventricular tachycardia unresponsive to defibrillation shocks. May also be used for allergic reactions (intramuscularly) or profound hypotension and shock.
8	Lidocaine 0.4% (4 mg/mL) in 250 mL bag	Treats life-threatening arrhythmias, particularly those that are ventricular in origin, such as those that occur during acute MI.	Class Ib antiarrhythmic agent and local anesthetic. Suppresses automaticity of conduction tissue by increasing the electrical stimulation threshold of the ventricles and the His-Purkinje system; increases spontaneous depolarization of the ventricles during diastole by a direct action on these tissues. Blocks both the initiation and conduction of nerve impulses by decreasing the neuronal membrane's permeability to sodium ions, resulting in inhibition of depolarization with resultant blockade of conduction.	Avoid in patients with: Hypersensitivity to local anesthetics of the amide type Stokes-Adams syndrome, Wolff-Parkinson-White syndrome Severe degrees of sinoatrial, atrioventricular, or intraventricular block in the absence of an artificial pacemaker Malignant hyperthermia or methemoglobinemia can occur in a small subset of patients.	Administer lidocaine injection IV at a rate of approximately 25 to 50 mg/min.
9	Dextrose 50% (dextrose 25% if treating pediatrics)	Corrects acute hypoglycemia.	Provides calories and fluid for patients unable to obtain an adequate oral intake.	Avoid in patients with: Hypersensitivity to dextrose, corn, or corn products Intracranial or intraspinal hemorrhage, delirium tremens, or dehydration, as the hypertonic solution may exacerbate the conditions	Administer as a slow IV push if patient has signs and symptoms consistent with profound hypoglycemia and/or measured blood glucose < 54 mg/dL.
10	Lidocaine, 2% (20 mg/mL) in 5 mL prefilled syringe	Treats life-threatening arrhythmias, particularly those that are ventricular in origin, such as those that occur during acute MI.	Class Ib antiarrhythmic agent and local anesthetic. Suppresses automaticity of conduction tissue by increasing the electrical stimulation threshold of the ventricles and the His-Purkinje system; increases spontaneous depolarization of the ventricles during diastole by a direct action on these tissues. Blocks both the initiation and conduction of nerve impulses by decreasing the neuronal membrane's permeability to sodium ions, resulting in inhibition of depolarization with resultant blockade of conduction.	Avoid in patients with: Hypersensitivity to local anesthetics of the amide type Stokes-Adams syndrome, Wolff-Parkinson-White syndrome Severe degrees of sinoatrial, atrioventricular, or intraventricular block in the absence of an artificial pacemaker Malignant hyperthermia or methemoglobinemia can occur in a small subset of patients.	Administer lidocaine injection IV at a rate of approximately 25 to 50 mg/min.
11	Atropine sulfate 1 mg Abboject™	Increases the heart rate and is an antidote for cholinergic poisoning.	Blocks the action of acetylcholine at parasympathetic sites in smooth muscle, secretory glands, and the central nervous system. Increases cardiac output and dries secretions. Reverses the muscarinic effects of cholinergic poisoning due to agents with acetylcholinesterase inhibitor activity by acting as a competitive antagonist of acetylcholine at muscarinic receptors.	Avoid in patients with known hypersensitivity to atropine. Use with caution in patients with myocardial ischemia, heart failure, tachyarrhythmias (including sinus tachycardia), and/or hypertension.	Administer 1 mg as an IV push if patient has symptomatic bradycardia (< 50 beats per minute and hypotension, altered mental status, signs of shock or signs of acute heart failure) or signs and symptoms of cholinergic poisoning (titrated to an effective dose that stops secretions).
12	Dopamine (1.6 mg/mL in 250 mL or 500 mL bag)	Improves perfusion of vital organs and/or increases cardiac output.	Stimulates both adrenergic and dopaminergic receptors. Lower doses are dopaminergic and produce renal and mesenteric vasodilation. Higher doses are both dopaminergic and beta-1 adrenergic and produce cardiac stimulation and renal vasodilation. Large doses stimulate alpha adrenergic receptors.	For IV use only. Infuse into a large vein whenever possible to prevent the infiltration of perivascular tissue adjacent to the infusion site. Extravasation can cause necrosis and sloughing of the surrounding tissue.	Individually titrate patients to desired hemodynamic and/or renal response with dopamine. Begin infusion with 2 to 5 mcg/kg/minute IV and increase dose gradually, using 5 to 10 mcg/kg/minute increments. Dose rates should not exceed 50 mcg/kg/minute.
13	Sodium bicarbonate 8.4% 1 mEq/mL in a 50 mL prefilled syringe	Corrects low blood pH due to metabolic acidosis. Also used to treat acute symptomatic hypokalemia and tricyclic antidepressant overdose.	Dissociates to provide bicarbonate ions, which neutralize hydrogen ions and raise blood and urinary pH. Stimulates opening of cellular potassium channels.	Infuse into a large vein whenever possible to prevent the infiltration of perivascular tissue adjacent to the infusion site. Extravasation may cause necrosis and sloughing of the surrounding tissue. Avoid administration with catecholamines in same IV catheter or tubing; inactivation of catecholamines will result.	For cardiac arrest with acidosis, administer a rapid IV dose of 200 to 300 mEq of bicarbonate, given as a 7.5% or 8.4% solution.
14	Epinephrine 1 mg/mL vial	Increases blood pressure or heart rate. Treats type I allergic reactions, including anaphylaxis.	Stimulates alpha, beta-1, and beta-2 adrenergic receptors, resulting in relaxation of smooth muscle of the bronchial tree, cardiac stimulation (increasing myocardial oxygen consumption), and dilation of skeletal muscle vasculature. Small doses: causes vasodilation via beta-2 vascular receptors. Large doses: constricts skeletal and vascular smooth muscle.	No absolute contraindications to the use of epinephrine in a life-threatening situation.	1 mg in 250mL of NS or D5W administered at 0.1 to 0.5 mcg/kg/minute IV for severe symptomatic hypotension/shock unresponsive to volume resuscitation.
15	Calcium chloride 10% 100 mg/mL in a 10 mL prefilled syringe	Use when epinephrine fails to improve weak or ineffective myocardial contractions. Should not be used routinely to support circulation in a cardiac arrest setting. Treats hypocalcemia in conditions requiring a prompt increase in blood plasma calcium levels. Combats the deleterious effects of hyperkalemia as measured by electrocardiogram (ECG), pending correction of the increased potassium level in the extracellular fluid.	Moderates nerve and muscle performance via action potential excitation threshold regulation across calcium channels.	For IV use only. Irritates veins. Do not use scalp vein or small hand or foot veins for IV administration; central-line administration is preferred. Do not inject into tissues because severe necrosis and sloughing can occur. Overdosage or rapid IV administration can result in serious cardiac effects, including bradycardia, arrhythmia, and ventricular fibrillation.	Administer at a rate not to exceed 1 mL per minute. Administer through a small needle into a large vein to minimize venous irritation and to avoid undesirable reactions.

Drawer 2: Drugs

	Drug	Purpose	Mechanism of Action	Precautions	Use in Emergencies
1	Aspirin 81 mg tablet	Reduces platelet aggregation during myocardial infarction. Dramatically reduces morbidity and mortality in patients with active myocardial infarction.	Irreversibly inhibits cyclooxygenase-1 and 2 (COX-1 and 2) enzymes via acetylation, resulting in decreased formation of prostaglandin precursors. Irreversibly inhibits formation of prostaglandin derivative, thromboxane A2, via acetylation of platelet cyclooxygenase, thus inhibiting platelet aggregation. Displays antipyretic, analgesic, and anti-inflammatory properties.	Avoid in patients with known salicylate allergy, risk of bleeding, and in children with viral infections.	Chew and swallow two tablets.
2	Nitroglycerin spray or 0.4 mg sublingual tablets	Improves cardiac blood flow and reduces symptoms of angina.	Relaxes smooth muscle in blood vessels, resulting in direct vasodilation. Forms free-radical nitric oxide in smooth muscle that activates guanylate cyclase, which in turn increases guanosine 3’5’ monophosphate (cGMP), leading to dephosphorylation of 3 myosin light chains and smooth muscle relaxation. Produces a vasodilator effect on the peripheral veins and arteries, with more prominent effects on the veins. Primarily reduces cardiac oxygen demand by decreasing preload (left ventricular end-diastolic pressure). Modestly reduces afterload by dilating coronary arteries to improve collateral flow in ischemic regions.	Avoid in patients with known hypersensitivity to nitroglycerin, circulatory failure (shock), or increased intracranial pressure. Risk of hypotension increases with concurrent use of phosphodiesterase type 5 (PDE5) inhibitor.	Administer sublingually if the patient has signs and symptoms consistent with angina or myocardial infarction.
3	Adult epinephrine auto injector (EpiPen) 0.3 mg	Increases blood pressure or heart rate or treats type I allergic reactions, including anaphylaxis.	Stimulates alpha, beta-1, and beta-2 adrenergic receptors, resulting in relaxation of smooth muscle of the bronchial tree, cardiac stimulation (increasing myocardial oxygen consumption), and dilation of skeletal muscle vasculature. Small doses: cause vasodilation via beta-2 vascular receptors. Large doses: constrict skeletal and vascular smooth muscle.	No absolute contraindications to the use of epinephrine in a life-threatening situation.	Administer 0.3 mg intramuscularly in patients having allergic reactions. Repeat every 5 to 15 minutes in the absence of clinical improvement.
4	Pediatric epinephrine auto injector (EpiPenJr) 0.15 mg	Increases blood pressure or heart rate or treats type I allergic reactions, including anaphylaxis.	Stimulates alpha, beta-1, and beta-2 adrenergic receptors, resulting in relaxation of smooth muscle of the bronchial tree, cardiac stimulation (increasing myocardial oxygen consumption), and dilation of skeletal muscle vasculature. Small doses: cause vasodilation via beta-2 vascular receptors. Large doses: constrict skeletal and vascular smooth muscle.	No absolute contraindications to the use of epinephrine in a life-threatening situation.	Administer 0.15 mg intramuscularly in pediatric patients (15-29 kg) having allergic reactions. Repeat every 5 to 15 minutes in the absence of clinical improvement.
5	Procainamide 1 g in 10 ml 100 mg/ml vial	Effective and recommended treatment alternative for hemodynamically stable monomorphic ventricular tachycardia in adults with preserved left ventricular function.	Class Ia antiarrhythmic agent. Decreases myocardial excitability and conduction velocity and can depress myocardial contractility. Increases the electrical stimulation threshold through direct cardiac effects by inhibiting sodium and potassium channels (to a lesser extent).	Avoid in patients with known: Procainamide or ester-type local anesthetic hypersensitivity Prolonged QT interval	Administer 100 mg IV every 5 minutes until arrhythmia is controlled, hypotension occurs, or QRS complex widens by 50% of its original width.
6	Diltiazem 20 mg vial	Treats symptoms (e.g., palpitations) associated with non-sustained ventricular tachycardia or ventricular premature beats. Used for acute management of supraventricular tachycardia.	L-type calcium channel blocker. Reduces vascular tone in blood vessels. Inhibits atrioventricular conduction in cardiac tissue.	Avoid in patients who are taking a beta blocker or who have heart failure with reduced ejection fraction (due to its negative inotropic and chronotropic effects). Avoid in patients with sinus node dysfunction or second- or third-degree atrioventricular block (unless a functioning pacemaker has been placed).	Administer 20 mg IV if vagal maneuvers or adenosine are ineffective for supraventricular tachycardia. Can also be used to treat hypertensive emergencies.
7	Metoprolol 10 mg vial	Lowers blood pressure.	Selective inhibitor of beta-1 adrenergic receptors. Competitively blocks beta-1 receptors, with little or no effect on beta-2 receptors at oral doses < 100 mg (in adults). Does not exhibit membrane stabilizing or intrinsic sympathomimetic activity.	Avoid in patients with known: Hypersensitivity to metoprolol or severe sinus bradycardia (heart rate less than 45 bpm) Second- and third-degree heart block Significant first-degree heart block (PR interval at least 0.24 seconds) Systolic blood pressure less than 100 mm Hg Moderate to severe cardiac failure	Administer 5 mg and titrate to desired heart rate and blood pressure in hemodynamically stable acute MI to reduce cardiovascular mortality. Generally administered in addition to amiodarone for acute ventricular arrhythmias.
8	Diphenhydramine (Benadryl) 50 mg vial	Blunts the effect of excess histamine.	Competes with histamine for H1-receptor sites on effector cells in the gastrointestinal tract, blood vessels, and respiratory tract. Exhibits antimuscarinic and sedative effects.	Avoid in patients with known hypersensitivity to diphenhydramine.	Administer 25-50 mg as an adjunct to epinephrine in patients with type I allergic reactions. Can be used for drug-induced extrapyramidal reactions (dystonic reactions) at 25-50 mg.
9	Methylprednisolone 125 mg vial	Reduces inflammation.	Regulates gene expression subsequent to binding specific intracellular receptors and translocation into the nucleus. Exerts a wide array of physiologic effects, including modulation of carbohydrate, protein, and lipid metabolism and maintenance of fluid and electrolyte homeostasis. Influences cardiovascular, immunologic, musculoskeletal, endocrine, and neurologic physiology. Decreases inflammation by suppression of migration of polymorphonuclear leukocytes and reversal of increased capillary permeability.	Avoid in patients with known hypersensitivity to any component of the formulation (including those with milk allergies).	Off-label therapy for a variety of issues. Reduces cerebral edema or acute respiratory distress syndrome (1 mg/kg). Improves outcomes post myocardial infarction.