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KETAMINE (Ketalar)

increases the effects of opiates, barbiturates, and nondepolarizing neuromuscular blockers.

HYDROCORTISONE/METHYLPREDNISOLONE (Solu-Cortef, Solu-Medrol)

Calcium

LIDOCAINE HCL (2%)

Apnea induced with succinylcholine may be prolonged with high doses of Lidocaine. Cardiac depression may occur in conjunction with IV Dilantin. Metabolic clearance decreased in Pt. with liver disease or Pt. taking beta-blockers.

ASPIRIN

Use with caution in Pt. allergic to NSAIDS.

DILTIAZEM HCL (Cardizem)

Caution in Pt. using medications that affect cardiac contractility. I should not be used in Pt. on Beta-blockers.

VERAPAMIL (Isoptin)

Verapamil increases serum concentration of digoxin. Beta-adrenergic blockers may have additive negative inotropic and chronotropic effects. Antihypertensives may potentiate hypotensive effects.

MIDAZOLAM (Versed)

Should not be used in Pt. who have taken CNS depressants

NOREPINEPHRINE (Levophed)

Can be deactivated by alkaline solutions. Sympathomimetic and phosphodiesterase inhibitors may exacerbate dysrhythmias.

VECURONIUM (Norcuron)

Can interact with opiate agonists by increasing the incidence and severity of bradycardia and hypotension. Administration of IV phenytoin to Pt. currently receiving vecuronium has been noted to augment the neuromuscular activity of vecuronium.

ACTIVATED CHARCOAL

Inactivate oral meds

CALCIUM CHLORIDE / CALCIUM GLUCONATE

Do not mix with Sodium Bicarbonate in running IV, flush prior to administration in same IV line May worsen dysrhythmias secondary to digitalis. May antagonize effects of Verapamil.

TRANEXAMIC ACID (TXA, Cyklokapron)

Hormonal contraceptives

EPINEPHRINE

Potentates other sympathomimetics. Deactivated by alkaline solutions. MAOIs may potentate effects of epinephrine.

KETOROLAC (Toradol)

increase bleeding in Pt. taking anticoagulants. Effects of lithium and methotrexate may be increased.

AMIODARONE (Cordarone)

incompatible NA Bicarb

LORAZEPAM (Ativan)

May precipitate CNS depression if Pt. is already taking CNS depressant medications

FLUMAZENIL (Romazicon)

Toxic effects of mixed drug overdose (especially tricyclic antidepressants) may emerge with the reversal of the benzodiazepine effects.

MANNITOL 20%

May precipitate digitalis toxicity in when given concurrently.

ROCURONIUM (Zemuron)

Positive chronotropic drugs may potentiate tachycardia.

PRALIDOXIME CHLORIDE (2-PAM, Protopam)

No direct drug interactions, however, Pt. with organophosphate poisoning should not be given barbiturates, morphine, theophylline, aminophylline, succinylcholine, reserpine and phenothiazines. How Supplied: Emergency Single Dose Kit containing: One 20 ml vial of 1 gram sterile Protopam Chloride. One 20 ml ampule of sterile diluent, disposable 20 ml syringe.

DEXAMETHASONE (Decadron)

Calcium, Metaraminol.

ADENOSINE (Adenocard)

Methylxanthines (theophylline-like drugs) antagonize the effects of adenosine. Dipyridamole (Persantine) potentiates the effects of adenosine Carbamazepine (Tegretol) may potentate the AV Node blocking effects of adenosine.

METOPROLOL (Lopressor)

Drugs which slow AV conduction (digoxin): effects may be additive with beta-blockers. Glucagon: Metoprolol may blunt the hyperglycemic action of glucagon. Verapamil or diltiazem may have synergistic or additive pharmacological effects when taken concurrently with beta-blockers; avoid concurrent I.V. use.

PANCURONIUM (Pavulon)

Positive chronotropic drugs may potentiate tachycardia

HALOPERIDOL (Haldol)

Enhanced CNS depression and hypotension in combination with alcohol. Other CNS depressants may potentiate effects

MORPHINE SULFATE

CNS depressant may potentate effects of morphine.

ALBUTEROL (Proventil, Ventolin)

Drug Interactions Tricyclic antidepressants may potentate vasculature effects. Beta-blockers are antagonistic. May potentate hypokalemia caused by diuretics

ACETAMINOPHEN (Tylenol, Ofrimev)

N/A

RACEMIC EPINEPHRINE

Beta blockers may blunt the effect. MAOIs may potentiate the effect.

AMYL NITRITE, SODIUM NITRITE, SODIUM THIOSULFATE (Cyanide Antidote Kit)

N/A

VASOPRESSIN (Pitressin)

No significant drug reactions have been reported

ATROPINE SULFATE

Effects enhanced by antihistamines, antipsychotics, benzodiazepines and antidepressants.

ETOMIDATE (Amidate)

Effects may be enhanced when given with other CNS depressants

SUCCINYLCHOLINE (Anectine)

Oxytocin, beta-blockers, and organophosphates may potentiate effects. Diazepam may reduce the duration of action.

GLUCAGON

Incompatible in solution with most other substances. No significant drug interactions with other emergency medications.

DEXTROSE

Sodium bicarbonate, coumadin.

NITROGLYCERIN

Additive effects with other vasodilators

DIPHENHYDRAMINE (Benadryl)

Potentates alcohol and other anticholinergics,inhibit corticosteroid

HYDROMORPHONE (Dilaudid)

Respiratory depression, hypotension, or sedation may be potentiated by CNS depressants. Therapeutic doses of hydromorphone have caused additive CNS or respiratory depression and hypotension in Pt. taking MAO inhibitors.

MEPERIDINE (Demerol)

Do not give concurrently with MAOIs (even with a dose in the last 14 days!). Exacerbates CNS depression when given with these medications.

SODIUM BICARBONATE 8.4%

May precipitate in calcium solutions. Vasopressors may be deactivated.

PROMETHAZINE (Phenergan)

Concomitant use of central nervous system depressants may have an additive sedative effect. Increased incidence of extrapyramidal effects occurs when given with some MAO inhibitors.Concomitant use of epinephrine may decrease blood pressure further.

HEPARIN SODIUM

Salicylates, some antibiotics and quinidine may increase risk of bleeding.

MAGNESIUM SULFATE

May enhance effects of other CNS depressants. Serious changes in overall cardiac function may occur with cardiac glycosides.

DOPAMINE (Inotropin) dopaminergic

incompatible in alkaline solutions. Beta blockers may antagonize effects

FUROSEMIDE (Lasix)

Lithium/Digitalis toxicity may be potentiated by sodium depletion.

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