Fentanyl citrate (Sublimaze)

Special Considerations:

• Pregnancy Safety: Category C

Glucagon

Special Considerations:

• Ineffective if glycogen stores depleted.
• Pregnancy Safety: Category C.

Hydrocortisone sodium succinate (Cortef, Solu-Cortef)

Special Consideration:

• Protect medication from heat.
• Toxicity and side effects with long-term use.

Hydroxocobalamin (Vitamin B 12)
*cyano-kit

Special Considerations:

• Emergency Patient Management:
  In addition to [Rx], treatment of cyanide poisoning must include immediate attention to airway patency, adequacy of oxygenation and hydration, cardiovascular support, and management of any seizure activity. Consideration should be given to decontamination measures based on the route of exposure.
• Use with other cyanide antidotes:
  Caution should be exercised when administering other cyanide antidotes simultaneously with [Rx], as the safety of co-administration has not been established. If a decision is made to administer another cyanide antidote with [Rx], these drugs should not be administered concurrently in the same IV line.
• Preparation of Solution for Infusion
  Each 2.5 g vial of [Rx] for injection is to be reconstituted with 100 mL of diluent (not provided with [Rx]) using the supplied sterile transfer spike. The recommended diluent is 0.9% Sodium Chloride injection (0.9% NaCl). Lactated Ringers injection and 5% Dextrose injection (D5W) have also been found to be compatible with [Rx] and may be used if 0.9% NaCl is not readily available. The line on each vial label represents 100 mL volume of diluent. Following the addition of diluent to the lyophilized powder, each vial should be repeatedly inverted or rocked, not shaken, for at least 30 seconds prior to infusion.
  [Rx] solutions should be visually inspected for particulate matter and color prior to administration. If the reconstituted solution is not dark red or if particulate matter is seen after the solution has been appropriately mixed, the solution should be discarded.

Ketamine (Ketalar)

Special Considerations:

• Use in caution in older patients due to a higher risk of renal and fatal GI adverse reactions.
• Contraindicated for use during pregnancy.
• Pregnancy Safety: Category C.

Lorazepam (Ativan)

Special Considerations:

• Inadvertent arterial injection may result in vasospasm and gangrene.
• Expires in 6 weeks if not refrigerated.
• Pregnancy Safety: Category D.

Note from Drug Control Program: Re: Storage of [Rx].
According to stability information, [Rx] injection requires refrigeration and should be stored at 2 - 8º C (35 - 45º F). [Rx] injection should be protected from light, which can be accomplished by retaining the vial in the carton until ready for use. In addition, freezing of the injection should be avoided. Ambulances are required to ensure stability of all drug products stored on site. Those ambulances unable to meet the above-mentioned storage conditions should refrain from using [Rx]. For further information, contact the Drug Control Program at (617) 983-6700 or the Office of Emergency Medical Services at (617) 753-7300.

Methylprednisolone sodium succinate (Solu-Medrol)

Special Consideration:

• Protect medication from heat.
• Toxicity and side effects with long-term use.

Midazolam (Versed)

Special Considerations:

• Administer immediately prior to intubation procedure.
• Requires continuous monitoring of respiratory and cardiac function.
• Pregnancy Safety: Category D.

Naloxone (Narcan)

Special Considerations:

• Seizures without causal relationship have been reported.
• May not reverse hypotension.
• Use caution when administering to narcotic addicts (violent behavior, etc.).
• Pregnancy safety: category B.

Ondansetron (Zofran)

Special Considerations:

• Pregnancy Safety: Category B.

Pralidoxime chloride (2-PAM, Protopam)

Special Considerations:

• Treatment will be most effective if given within a few hours after poisoning. Cardiac monitoring should be considered in all cases of severe organophosphate poisoning.
• Pregnancy Safety: unknown.

Tranexamic acid (TXA)

Special Considerations:

• Must be mixed into an infusion bag, typically 100 mL of NS.
• Use in pregnant and breastfeeding women should be clearly indicated.
• Pregnancy Safety: Category C