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EMS POCKET DRUG
GUIDE

EDITOR
Patrick T. Gomella, MPH, NREMT-P

www.emsdrugbook.com

New York Chicago San Francisco Lisbon

London Madrid Mexico City Milan New Delhi
San Juan Seoul Singapore Sydney Toronto
Copyright © 2010 by Patrick T. Gomella, based on The Clinician’s Pocket Drug Reference © 2009 by Leonard G. Gomella.
Published by The McGraw-Hill Companies, Inc. All rights reserved. Except as permitted under the United States Copyright
Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, or stored in a database
or retrieval system, without the prior written permission of the publisher.

ISBN: 978-0-07-170270-6

MHID: 0-07-170270-9

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Medicine is an ever-changing science. As new research and clinical experience broaden our knowledge, changes in treatment
and drug therapy are required. The authors and the publisher of this work have checked with sources that are believed to be
reliable in their efforts to provide information that is complete and generally in accord with the standards accepted at the
time of publication. However, in view of the possibility of human error or changes in medical sciences, neither the authors
nor the publisher nor any other party who has been involved in the preparation or publication of this work warrants that the
information contained herein is in every respect accurate or complete, and they disclaim all responsibility for any errors or
omissions or for the results obtained from use of the information contained in this work. Readers are encouraged to confirm
the information contained herein with other sources. For example and in particular, readers are advised to check the product
information sheet included in the package of each drug they plan to administer to be certain that the information contained
in this work is accurate and that changes have not been made in the recommended dose or in the contraindications for
administration. This recommendation is of particular importance in connection with new or infrequently used drugs.

TERMS OF USE

This is a copyrighted work and The McGraw-Hill Companies, Inc. (“McGrawHill”) and its licensors reserve all rights in
and to the work. Use of this work is subject to these terms. Except as permitted under the Copyright Act of 1976 and the
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 CONTENTS

PREFACE xi
MEDICATION KEY xiii
ABBREVIATIONS xvii

I EMS FIELD MEDICATIONS 1

Prehospital Drug Classification 1
Allergy 1
Antidotes 1
Cardiovascular (CV) Agents 1
Central Nervous System Agents 2
Dietary Supplements 3
Endocrine System Agents 3
Gastrointestinal Agents 3
Hematologic Agents 3
Musculoskeletal Agents 4
OB/GYN Agents 4
Pain Medications 4
Respiratory Agents 5

II COMMONLY PRESCRIBED MEDICATIONS: 33

CLASSIFICATION
Allergy 33
Antidotes 33
Antimicrobial Agents 33
Antifungals 35
Antiretrovirals 36
Antineoplastic Agents 36
Cardiovascular (CV) Agents 38
Central Nervous System Agents 41
Dermatologic Agents 42

iii
iv Contents

Dietary Supplements 43
Ear (Otic) Agents 44
Endocrine System Agents 44
Eye (Ophthalmic) Agents 45
Gastrointestinal Agents 47
Hematologic Agents 49
Immune System Agents 50
Musculoskeletal Agents 51
OB/GYN Agents 51
Pain Medications 53
Respiratory Agents 54
Urinary/Genitourinary Agents 56
Wound Care 56
Miscellaneous Therapeutic Agents 56
Natural and Herbal Agents 57

III COMMONLY PRESCRIBED MEDICATIONS: 59

GENERIC AND SELECTED BRAND DATA

IV COMMONLY USED MEDICINAL HERBS 323

V COMMON STREET DRUGS 337

VI TABLES 345
Table VI-1 Comparison of Systemic Steroids 345
Table VI-2 Topical Steroid Preparations 346
Table VI-3 Comparison of Insulins 348
Table VI-4 Commonly Used Oral Contraceptives 349
Table VI-5 Some Common Oral Potassium Supplements 352
Table VI-6 Common Multivitamins Available OTC 353
Table VI-7 Antiarrhythmics: Vaughn Williams Classification 354
Table VI-8 Cytochrome P-450 Isoenzymes and Common 355
Drugs They Metabolize, Inhibit, and Induce
Table VI-9 SSRIs/SNRI/Triptan and Serotonin Syndrome 357
Table VI-10 Weight Conversion Table 358
Contents v

Table VI-11 Burn Management: Rule of “9’s” 359

and Parkland Formula
Table VI-12 Adult Injury Severity Measures 360
(Glasgow Coma Score and Revised Trauma Score)
Table VI-13 Pediatric Injury Severity Measures 362
(Glasgow Coma Score and Pediatric Trauma Score)
Table VI-14 APGAR Scoring for Newborns 364
Table VI-15 Bioterrorism Agents 365
Table VI-16 List of Substances with a General Overview 370
of Prehospital Treatment and Specific Antidotes for Poisoning
and Overdose
Table VI-17 Rapid Sequence Induction (RSI) Intubation 374
Table VI-18 Cardiac Algorithms: ADULT 376
Table VI-19 Cardiac Algorithms: PEDIATRIC 382

INDEX 387

ADULT EMERGENCY CARDIAC CARE MEDICATIONS

INSIDE BACK COVER AND BACK PAGE

This page intentionally left blank
EDITORS

EDITOR
Patrick T. Gomella, MPH, NREMT-P
Class of 2013
Jefferson Medical College
Thomas Jefferson University
Philadelphia, Pennsylvania
Firefighter/Paramedic
Concordville Fire and Protective Association
Concordville, Pennsylvania
ASSOCIATE EDITORS
Rex Mathew, MD, FACEP
Vice President for Emergency Medicine Clinical Operations
Thomas Jefferson University Hospitals
Assistant Professor
Department of Emergency Medicine
Thomas Jefferson University
Philadelphia, Pennsylvania
Matthew McMullan, BS, NREMT-P, CCEMT-P, FP-C
Paramedic/Firefighter
Malvern Fire Company
Malvern, Pennsylvania
David J. Schoenwetter, DO, PhP, FACEP
Medical Director, Geisinger EMS
Medical Director, Geisinger Life Flight
Attending Physician, Emergency Medicine
Geisinger Health System
Danville, Pennsylvania
Jason P. Zielewicz, MS, NREMT-P
Platoon Chief
Susquehanna Health/Regional EMS
Senior Partner
EMERGE Public Safety, LLC.
Williamsport, Pennsylvania

vii
viii Editors

CONSULTING EDITORS
Aimee G. Adams, PharmD
Clinical Pharmacist Specialist, Ambulatory Care
Adjunct Assistant Professor
College of Pharmacy and Department of Internal Medicine
University of Kentucky HealthCare
Lexington, Kentucky
Judith A. Barberio, PhD, APN,C, ANP, FNP, GNP
Assistant Professor
Coordinator, Adult & Family Nurse Practitioner Tracks
Rutgers, The State University of New Jersey
College of Nursing
Newark, New Jersey
Leonard G. Gomella, MD, FACS
The Bernard W. Godwin, Jr, Professor
Chairman, Department of Urology
Jefferson Medical College
Associate Director of Clinical Affairs
Kimmel Cancer Center
Thomas Jefferson University
Philadelphia, Pennsylvania
Tricia L. Gomella, MD
Part-Time Clinical Assistant Professor of Pediatrics
Johns Hopkins University School of Medicine
Baltimore, Maryland
Steven A. Haist, MD, MS, FACP
Clinical Professor
Department of Medicine
Drexel University College of Medicine,
Philadelphia, Pennsylvania
Nick A. Pavona, MD
Professor, Department of Surgery
Benjamin Franklin University Medical Center
Chadds Ford, Pennsylvania
CONTRIBUTORS AND TECHNICAL REVIEWERS
Carol Beck, PhD
Assistant Dean, Jefferson College of Graduate Studies
Assistant Professor, Department of Pharmacology
and Experimental Therapeutics
Thomas Jefferson University
Philadelphia, Pennsylvania
Editors ix

Shawn M. Maguire, BS, NREMT-B

Emergency Medical Technician
University Ambulance Service
Pennsylvania State University
University Park, Pennsylvania
Glenn R. Oettinger, PharmD
Clinical Pharmacist, Emergency Medicine
Thomas Jefferson University Hospital
Philadelphia, Pennsylvania
This page intentionally left blank
 PREFACE

I am pleased to present the first edition of the EMS Pocket Drug Guide. This guide
is based on the popular Clinician’s Pocket Drug Reference and adapted for use in
the field by front-line EMS providers.
As an EMS provider, I found the many “pocket” drug guides available were
either too large to carry while working or did not provide sufficient drug informa-
tion beyond simply listing a name and classification. While knowing the drug class
is useful for formulating a medically sound treatment plan for your patient, addi-
tional drug-specific information is often necessary to tailor your treatment based
on the specific drugs your patient is currently prescribed. Recent data suggests that
51% of insured Americans take at least one prescription drug for at least one
chronic condition and over 20% of the US population take three or more medica-
tions chronically. Knowing key drug information in the field is becoming more
essential as people begin to use more and more prescription medications.
This book provides several resources that can be accessed quickly to provide
the best care possible. A section is devoted to descriptions of over 70 drugs com-
monly used in the pre-hospital setting, followed by descriptions of about 1000 of
the most commonly used prescription and over-the-counter medications. Knowing
the dosing commonly used for FDA approved and so called off label uses is helpful
in determining if an excessive dose was ingested. A section on commonly used
medicinal herbs and supplements is also included as some of these can be very
clinically significant. A section dedicated to “street drugs” is also included for
quick reference.
A key feature of this guide is the concise “must know” medication information
with drug-specific EMS pearls, which includes signs and symptoms of overdose
and any specific overdose management. This guide is designed with sufficient
detail while maintaining its utility as a truly pocket drug reference. The book also
includes several reference charts and tables relevant to pre-hospital care.
I would like to thank Joe Morita and the entire production staff at McGraw-Hill
for their willingness to bring this book to the emergency service provider. The
opportunity to use the Clinician’s Pocket Drug Reference as a basis for the com-
monly used medications and adapt this information for the EMS provider is appreci-
ated. I would also like to thank my associate editors, consulting editors, contributors,
and technical reviewers who were asked to provide input to the book often on very
short notice. And lastly, my sincerest thanks go to my entire family, several of whom
xi
xii Preface

helped with various aspects of this book, for their support and guidance during the
process.
I encourage providers to take an active role and provide constructive feedback
about this book. Please feel free to e-mail me with any suggestions, drugs or refer-
ence charts you would like to see included in future editions.

Patrick T. Gomella, MPH, NREMT-P

Philadelphia, Pennsylvania
 MEDICATION KEY

Medications are generally listed by prescribing class and the individual medica-
tions are then listed in alphabetical order by generic name for both EMS field
mediations (Section I) and the commonly prescribed medications (Section III).
Some of the more frequently recognized trade names are listed for each medication
(in parentheses after the generic name) or if available without prescription, noted
as OTC (over-the-counter).

Generic Drug Name (Selected Common Brand Names)

[Controlled Substance] [Drug Classification] WARNING:
Summarized versions of the “Black Box” precautions deemed necessary
by the FDA. These are significant precautions and contraindications con-
cerning the individual medication. Uses: This includes both FDA-labeled
indications bracketed by ** and other “off-label” uses of the medication.
Because many medications are used to treat various conditions based on
the medical literature and not listed in their package insert, we list com-
mon uses of the medication in addition the official “labeled indications”
(FDA approved) based on input from our editorial board Action: How
the drug works. This information is helpful in comparing classes of drugs
and understanding side effects and contraindications Dose: Adults. Where
no specific pediatric dose is given, the implication is that this drug is not
commonly used or indicated in that age group. Caution: [pregnancy/fetal
risk categories, breast-feeding (as noted below)] precautions concerning
the use of the drug in specific settings Contra: Contraindications Disp:
Drug primary formulation or route (ie, IV, Tabs, and Susp) SE: Common
or significant side effects EMS: Important facts/information relevant to
EMS providers in the field OD: Common symptoms of overdose and
specific treatment suggestions if available and appropriate

CONTROLLED SUBSTANCE CLASSIFICATION

Medications under the control of the US Drug Enforcement Agency (Schedules I–V
controlled substances) are indicated by the symbol [C]. Most medications are
“uncontrolled” and do not require a DEA prescriber number on the prescription. The
following is a general description for the schedules of DEA-controlled substances:

xiii
xiv Medication Key

Schedule (C-I) I: All nonresearch use forbidden (eg, heroin, LSD, mescaline).

Schedule (C-II) II: High addictive potential; medical use accepted. No tele-
phone call-in prescriptions; no refills. Some states require special prescription form
(eg, cocaine, morphine, methadone).

Schedule (C-III) III: Low to moderate risk of physical dependence, high risk of
psychologic dependence; prescription must be rewritten after 6 months or five
refills (eg, acetaminophen plus codeine).

Schedule (C-IV) IV: Limited potential for dependence; prescription rules same
as for schedule III (eg, benzodiazepines, propoxyphene).

Schedule (C-V) V: Very limited abuse potential; prescribing regulations often

same as for uncontrolled medications; some states have additional restrictions.

FDA FETAL RISK CATEGORIES

Category A: Adequate studies in pregnant women have not demonstrated a risk

to the fetus in the first trimester of pregnancy; there is no evidence of risk in the
last two trimesters.

Category B: Animal studies have not demonstrated a risk to the fetus, but no
adequate studies have been done in pregnant women.
or
Animal studies have shown an adverse effect, but adequate studies in pregnant
women have not demonstrated a risk to the fetus during the first trimester of preg-
nancy, and there is no evidence of risk in the last two trimesters.

Category C: Animal studies have shown an adverse effect on the fetus, but no
adequate studies have been done in humans. The benefits from the use of the drug
in pregnant women may be acceptable despite its potential risks.
or
No animal reproduction studies and no adequate studies in humans have been done.

Category D: There is evidence of human fetal risk, but the potential benefits from
the use of the drug in pregnant women may be acceptable despite its potential risks.

Category X: Studies in animals or humans or adverse reaction reports, or both,

have demonstrated fetal abnormalities. The risk of use in pregnant women clearly
outweighs any possible benefit.

Category ?: No data available (not a formal FDA classification; included to

provide complete dataset).
Medication Key xv

BREAST-FEEDING CLASSIFICATION
No formally recognized classification exists for drugs and breast-feeding although
the FDA is considering developing one. This shorthand was developed for the
Clinician’s Pocket Drug Reference.

+ Compatible with breast-feeding

M Monitor patient or use with caution
± Excreted, or likely excreted, with unknown effects or at unknown
concentrations
?/− Unknown excretion, but effects likely to be of concern
− Contraindicated in breast-feeding
? No data available
This page intentionally left blank
 ABBREVIATIONS

* *: FDA-labeled indications ACLS: advanced cardiac life support

bracketed by asterisks ACS: acute coronary syndrome,
#: drugs marked with this in Section I American Cancer Society,
have additional information on American College of Surgeons
prescription use included in the ADH: antidiuretic hormone
generic drug section (Section III) ADHD: attention-deficit
÷: divided hyperactivity disorder
: check or monitor ADR: adverse drug reaction
↑ glucose: hyperglycemia AE: adverse events
↑ HR: increased heart rate AF: atrial fibrillation
(tachycardia) AHA: American Heart Association
↑: increase or increased Al: aluminum
↓ BM: bone marrow suppression, ALL: acute lymphocytic leukemia
myelosuppression ALS: amyotrophic lateral sclerosis
↓ BP: hypotension ALT: alanine aminotransferase
↓ plt: decreased platelets (a liver enzyme)
(thrombocytopenia) AMI: acute myocardial infarction
↓: decrease or decreased AML: acute myelogenous leukemia
5-FU: 5-fluorouracil (chemotherapy amp: ampule
drug) AMS: acute myocardial syndrome
5-HT: 5-hydroxytryptamine ANC: absolute neutrophil count
AA: African American ANS: autonomic nervous system
AB: abortion APACHE: Acute Physiologic and
Ab: antibody Chronic Health Evaluation; ICU
abd: abdomen/abdominal illness severity scoring system
ABMT: autologous bone marrow APAP: acetaminophen [N-acetyl-p-
transplantation aminophenol]
Abs: antibodies aPTT: activated partial
ac: before meals (Latin “ante cibum”) thromboplastin time
ACE: angiotensin-converting enzyme ARB: angiotensin II receptor blocker
ACEI: angiotensin-converting ARDS: adult respiratory distress
enzyme inhibitor syndrome

xvii
xviii Abbreviations

ARF: acute renal failure CHF: congestive heart failure

ASA 1-5: American Society of CHI: closed head injury
Anesthesiology; 1-5 scoring CLA: cis-linoleic acid
system for anesthesia risk CLL: chronic lymphocytic leukemia
ASA: aspirin (acetylsalicylic acid) CML: chronic myelogenous leukemia
ASAP: as soon as possible CMV: cytomegalovirus
AUB: abnormal uterine/vaginal CNS: central nervous system
bleeding Comps: complications
AUC: area under the curve COMT: catechol-O-methyltransferase
AV: atrioventricular Contra: contraindicated
AVM: arteriovenous malformation COPD: chronic obstructive
(blood vessel abnormality) pulmonary disease
b/c: because COX: cyclooxygenase
BB: beta blockers CP: chest pain
BCL: B-cell lymphoma CPAP: continuous positive airway
BCL-ABL: a type of cancer gene pressure
bid: twice a day (Latin “bis in die”) CPK: creatine phosphokinase
BiPAP: bilevel continuous airway CPP: central precocious puberty
pressure CR: controlled release
BM: bone marrow; bowel movement CrCl: creatinine clearance
BMT: bone marrow transplantation CRF: chronic renal failure
BOO: bladder outlet obstruction CV: cardiovascular
BP: blood pressure CVA: cerebrovascular accident,
BPH: benign prostatic hypertrophy costovertebral angle
bpm: beats per minute CVD: cardiovascular disease
BSA: body surface area CVH: common variable
BUN: blood urea nitrogen (measure hypergammaglobulinemia
of hydration and kidney function) CYP: cytochrome p 450 (CYP)
BW: body weight isoenzymes (such as
C: constipation CYP3A/CYP2D6/CYP1A2) are
Ca/Ca2+: calcium important in increasing or
CA: cancer decreasing the effects and
CABG: coronary artery bypass graft metabolism of many medications
CAD: coronary artery disease (See Table XXX)
CAP: community acquired pneumonia D/C: discontinue
caps: capsule d/t: due to
cardiotox: cardiotoxicity d: day
CBC: complete blood count D: diarrhea
CCB: calcium channel blocker D5LR: 5% dextrose in lactated
CF: cystic fibrosis Ringer’s solution
cGMP: cyclic GMP, an intracellular D5NS: 5% dextrose in normal saline
chemical D5W: 5% dextrose in water
Abbreviations xix

DBP: diastolic blood pressure muscle contractions [dystonia],

DI: diabetes insipidus changes in breathing and heart
Disp: dispensed as, how the drug is rate); a side effect of some
supplied medications
DKA: diabetic ketoacidosis ER: extended release
dL: deciliter esp: especially
DM: diabetes mellitus ESRD: end-stage renal disease
DMARD: disease-modifying ET: endotracheal
antirheumatic drug; drugs defined EtOH: ethanol
in randomized trials to decrease ext/exts: extracts
erosions and joint space narrowing F/U: follow up
in rheumatoid arthritis FACEP: Fellow American College
(eg, D-penicillamine, methotrexate, of Emergency Physicians
azathioprine) FACP: Fellow American College
DN: diabetic nephropathy of Physicians
DOT: directly observed therapy FACS: Fellow American College
(method used commonly in the of Surgeons
treatment of infectious disease FDA: Food and Drug Administration
such as sexually transmitted Fe: iron
disease or TB) FSH: follicle-stimulating hormone
dppr: dropper Fxn: function
DVT: deep venous thrombosis g: gram
Dz: disease GABA: gamma-aminobutyric acid
EC: enteric-coated GAD: generalized anxiety disorder
ECC 2005: Emergency Cardiac Care G-CSF: granulocyte colony
guidelines 2005 stimulating factor
ECC: emergency cardiac care gen: generation
ECG: electrocardiogram GERD: gastroesophageal reflux
ED: Emergency department, Erectile disease
dysfunction GF: growth factor
EGFR: epidermal growth factor GFR: glomerular filtration rate
receptor (cancer cell marker that is GH: growth hormone
a target for anti-neoplastic therapy) GHB: gamma hydroxybutyrate
ELISA: enzyme-linked GI: gastrointestinal
immunosorbent assay GIST: gastrointestinal stromal tumor
(measurement method) GLA: gamma-linoleic acid
EMIT: enzyme-multiplied GM-CSF: granulocyte-macrophage
immunoassay test colony-stimulating factor
epi: epinephrine GnRH: gonadotropin-releasing
EPS: extrapyramidal symptoms hormone
(tardive dyskinesia, tremors and gt, gtt: drop, drops (Latin “gutta”)
rigidity, restlessness [akathisia], GTT: glucose tolerance test
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