Adult Drug List

Source & verification: “L01 Med ADULT Drug List,” Texas 2025. Every entry below matches the source document exactly. The notation (MC) next to any indication means it requires medical control orders before administration. Confirm dosing and preparation against your agency’s own medical direction before use.

Adenosine

Tachycardia – Narrow Complex: Elevate arm, 12 mg IVP RAPID (1–3 sec), followed by a 10 ml RAPID bolus with saline syringe in tubing port above injection port. Repeat 12 mg dose in 1–2 minutes if needed.

Albuterol

Allergic Reaction / Asthma / COPD: 2.5 mg by nebulizer; set O2 flow rate at 8 LPM. Repeat PRN. Ipratropium in initial treatment only.

Amiodarone

Post-Resuscitation (MC): Maintenance infusion at 1 mg/min if the patient received a bolus of Amiodarone. Preparation: 150 mg in 250 ml of D5W with macro drip (10 gtts/ml) at rate of 16 gtts/min.

Tachycardia – Wide Complex: 150 mg IV/IO infusion over 10 minutes. Preparation: 150 mg in 100 ml normal saline/macro tubing at rate of 100 gtts/min.

Ventricular Fibrillation / Pulseless Ventricular Tachycardia: 300 mg IV/IO. Consider repeating 150 mg IV/IO in 3–5 minutes. Disregard the packaging suggestion that amiodarone must be diluted.

Aspirin

Acute Coronary Syndrome: 81 mg chewable (baby). Give 4 tablets PO (324 mg).

Atropine

Bradycardia: 1 mg IV/IO q 3 minutes, maximum dose of 3 mg.

Etiology of Arrest: Overdose / Toxic Ingestion, Organophosphate Poisoning: 2 mg IV/IO q 5 minutes until symptoms relieved.

Calcium Chloride

Asystole/PEA / Ventricular Fibrillation: 1 g IV/IO q 10 minutes.

Crush Injury (MC): 1 g IV infusion over 10 minutes. Preparation: 1 g in 100 ml of normal saline/macro drip at 100 gtts/min.

Dextrose 50%

Diabetic Emergency: 25 g IV/IO. Glucagon should be given BEFORE giving Dextrose 50% via IO route.

Etiology of Arrest: 25 g IV/IO.

Diltiazem

Tachycardia – Narrow Complex: 10 mg IV/IO slow over 2 minutes. Repeat 10 mg dose in 5 minutes if needed. Any additional repeat doses require Medical Control orders. Preparation: Inject 10 ml of NS into 100 mg vial (10 mg/ml concentration). Gently shake vial until the medication is dissolved.

Diphenhydramine

Allergic Reaction: 50 mg IM/IV/IO.

Droperidol

Psychiatric Emergency – Sedation: 2.5 mg IV or 5 mg IM (may repeat one time, if needed).

Epinephrine 1:1000

Allergic Reaction / Asthma: 0.3 mg IM. Repeat 1 time if needed.

Epinephrine 1:10,000

Asystole/PEA / Ventricular Fibrillation: 1 mg IV/IO q 3–5 minutes.

Epinephrine Push Dose 1:100,000

Airway – Orotracheal Intubation procedure / Allergic Reaction / Bradycardia / Post Resuscitation: 10 mcg IV push. Repeat every 2–5 minutes PRN. Titrate to SBP > 90 mmHg. Preparation: 10 ml syringe of NS. Waste 1 ml. Draw up 1 ml of Epinephrine 1:10,000 (prefilled), yielding 10 mcg/ml.

Fentanyl

Advanced Airway Confirmation/Management / Pain Management: 1 mcg/kg IV/IM/IN q 5 minutes. Maximum 3 mcg/kg. Preparation (IV only): Dilute Fentanyl 100 mcg/2 ml with 8 ml of NS to yield a 10 mcg/ml concentration. See the Fentanyl Dosage Chart for the full weight-based volume table.

Inter-Facility Transport (CCT only): Preparation (IV infusion with pump): 200 mcg in 100 ml NS. This is only for inter-facility transports when the patient is already receiving this medication, but the sending facility will not send additional controlled substances to last throughout the duration of patient contact. The preparation above is to be continued at the same dose as determined by the sending facility. Mix additional bags as needed.

Fluid – D5W

Various: Used for mixing medication infusions.

Diabetic Emergency – Hypoglycemia: 250 ml/hr.

Fluid – Normal Saline

Various: KVO for IV access.

Burn: 500 ml bolus, then per Medical Control.

Childbirth (Mother): 125 ml/hr.

Diabetic Emergency – DKA: Bolus 250 ml.

Obstetrical Emergencies: KVO.

Etiology of Arrest: Bolus 250 ml if hypovolemia is suspected.

Sepsis: Fluid bolus 250 ml to maximum of 1000 ml.

Shock – Medical: Fluid bolus 250 ml.

Shock – Trauma: Fluid bolus 250 ml to systolic BP of 80 mmHg.

Syncope: Fluid bolus 250 ml to maximum of 1000 ml.

Glucagon

Diabetic Emergency: 1 mg IM/IN.

Glucose (Oral)

Diabetic Emergency: 15 g, may be repeated in 10 minutes.

Ipratropium

Asthma / COPD: 500 mcg by nebulizer (only administer with first albuterol treatment).

Ketamine

Adult Airway Breathing / Ketamine Assisted Ventilation: 2 mg/kg slow IN/IV or 4 mg/kg IM.

Advanced Airway Confirmation/Mgmt: 1 mg/kg IN/IV, repeat PRN.

External Pacing: 0.1–0.3 mg/kg IV/IN.

Head Injury / Psychiatric Emergency – Sedation: 2 mg/kg IN/IV or 4 mg/kg IM, may be repeated in 10 minutes.

Seizure: 2 mg/kg IN/IV or 4 mg/kg IM, may be repeated in 10 minutes, for seizures refractory to Midazolam.

Pain Management (MC): 0.1–0.3 mg/kg IN/IV for pain refractory to Fentanyl.

Inter-Facility Transport (CCT only): Preparation (IV infusion with pump): 500 mg in 250 ml D5W. Same inter-facility-transport-only caveat as Fentanyl above: continue at the sending facility’s determined dose, mix additional bags as needed.

See the Ketamine Dosage Chart for the full weight-based volume table.

Ketorolac

Pain Management: 15 mg IV or 30 mg IM.

Labetalol

Pre-Eclampsia/Eclampsia:

• Initial dose: 20 mg over 2 minutes. Reassess after 10 minutes.
• If continued SBP ≥ 160 or DBP ≥ 110, second dose: 40 mg IV over 2 minutes. Reassess after 10 minutes.
• If continued SBP ≥ 160 or DBP ≥ 110, third dose: 80 mg IV over 2 minutes.
• Repeat the 80 mg dose every 10 minutes if needed, to a max dose of 300 mg. Target SBP of 130–150 and DBP of 80–100.

Stroke/t-PA Drip & Ship (MC): 20 mg IV q 20 minutes PRN if SBP > 180 or DBP > 105 (if HR > 65).

Lidocaine 2%

Intraosseous (EZ-IO): 2.5 ml IO, for a conscious patient receiving IO only.

Magnesium Sulfate

Asthma / COPD (MC): 2 g IV infusion over 10 minutes. Preparation: 2 g in 100 ml of normal saline/macro drip at 100 gtts/min.

Pre-Eclampsia/Eclampsia: 4 g IV infusion over 20 minutes. Preparation: 4 g in 100 ml of normal saline/macro drip at 50 gtts/min.

Tachycardia – Wide Complex: 1 g IV infusion over 10 minutes. Preparation: 1 g in 100 ml of normal saline/macro drip at 100 gtts/min.

Etiology of Arrest: 2 g IV/IO.

Methylprednisolone

Allergic Reaction / Asthma / COPD: 125 mg IV/IM/IO.

Metoprolol

Tachycardia – Narrow Complex: 5 mg IVP q 5 min. Maximum dose of 15 mg.

Midazolam

Advanced Airway Confirmation Management: 5 mg IN/IV, repeat q 2 minutes as needed for effective sedation, maximum dose of 20 mg via standing orders. Preparation (IV only): Dilute Midazolam 10 mg/2 ml with 8 ml of NS to yield a 1 mg/ml concentration.

Psychiatric Emergency – Sedation: 5 mg IN/IM/IV. Maximum dose of 10 mg via standing orders. If Ketamine is unavailable, Midazolam maximum dose via standing orders is 20 mg. 2.5 mg IN/IV may be given via standing order for emergence following Ketamine administration. Same IV preparation as above.

External Pacing Procedure: 2.5 mg IN/IV. Maximum dose of 2.5 mg via standing orders (if Ketamine is unavailable). Same IV preparation as above.

Pain Management (MC): 2.5 mg IN/IV is the typical dose for pain refractory to Fentanyl. Same IV preparation as above.

Sedation Facilitated Intubation Procedure: 5 mg IN/IV q 2 minutes as needed for effective sedation, maximum dose of 10 mg via standing orders. Same IV preparation as above.

Pre-Eclampsia/Eclampsia: Seizure: 5 mg IN/IV or 10 mg IM. IN/IV dose may be repeated q 2 minutes until termination of seizure, maximum of 10 mg via standing orders. Same IV preparation as above.

Inter-Facility Transport (CCT only): Preparation (IV infusion with pump): 20 mg in 100 ml NS. Same inter-facility-transport-only caveat as Fentanyl/Ketamine above.

Naloxone

Altered Mental Status / Etiology of Arrest / Overdose/Toxic Ingestion: 0.5–2 mg IN/IM/IV.

Nicardipine

Stroke/t-PA Drip & Ship (MC): Initial infusion rate of 2 mg/hr PRN for SBP 180–200 or DBP > 105; initial infusion rate of 5 mg/hr PRN for SBP > 200. Titrate to maintain those BP parameters by increasing the dose by 2.5 mg/hr as often as every 15 minutes, to a maximum dose of 15 mg/hr.

t-PA Drip & Ship (North Texas and Houston CCT only): 5 mg/hr infusion. Titrate to desired effect by increasing the dose by 1–2.5 mg/hr every 5 minutes, to a maximum dose of 15 mg/hr.

Nitroglycerin

Acute Coronary Syndrome: 1 spray 0.4 mg SL q 3 minutes as long as SBP > 100. Apply 1“ paste after 3 doses of SL NTG.

Congestive Heart Failure: 2 sprays 0.4 mg SL as long as SBP > 100. Do NOT repeat SL administration if Nitroglycerin IV (Tridil) is administered.

Nitroglycerin IV (Tridil)

Acute Coronary Syndromes (CCT only): 5 mcg/min infusion. Titrate by increasing the dose by 5 mcg/min every 3–5 minutes up to 20 mcg/min; beyond that, can increase by 10 mcg/min, but doses beyond 20 mcg/min are rare and typically don’t deliver additional benefit. Preparation: Mix 50 mg of Nitroglycerin IV (Tridil) in 250 ml D5W, yielding a concentration of 200 mcg/ml. Use an infusion pump.

Congestive Heart Failure: 1 mg IV bolus. After 5 minutes, if SBP is above 160, repeat 1 mg IV bolus. Any additional doses require Medical Control orders. Preparation: 1 ml Nitroglycerin IV (Tridil) in 9 ml NS, yielding a concentration of 0.5 mg/ml. Administer 2 ml for a 1 mg dose.

Norepinephrine

Congestive Heart Failure/Pulmonary Edema (MC) / Sepsis / Shock-Medical / Shock-Trauma: 2–10 mcg/minute, goal SBP > 90 mmHg. Preparation: 4 mg in 250 ml D5W/mini drip.

Norepinephrine infusion rate table (4 mg in 250 ml D5W/mini drip set):

Ondansetron

Abdominal Pain / GI Problem: 4 mg IV/IM. May repeat in 10 minutes if necessary.

Oxygen

CORE / Airway Protocols / Etiology of Arrest / Pre-Oxygenation procedure:

• 1–6 liters/min via nasal cannula
• 6–15 liters/min via NRB mask
• 15 liters via BVM
• 15 lpm high-flow nasal cannula

Oxymetazoline HCl 0.05%

Epistaxis: 2–4 sprays in affected nare.

Nasotracheal Intubation: 2–4 sprays in each nostril before attempting nasal intubation.

Sodium Bicarbonate

Crush Injury: Infusion x 2. Preparation: each infusion includes 50 mEq of Sodium Bicarb in 1000 ml of normal saline, wide open.

Crush Injury (MC): Bolus 100 mEq IV/IO (if available).

Etiology of Arrest: 50 mEq IV/IO, may repeat 25 mEq in 10 minutes.

Overdose (Tricyclics) (MC): 50 mEq, may repeat 25 mEq in 10 minutes if signs/symptoms persist.

Tachycardia – Wide Complex: 1 mEq/kg IV/IO.

Sodium Nitroprusside (MC, CCT only)

0.25 mcg/kg/min infusion. Titrate to desired effect by increasing the dose by 1 mcg/kg/min up to a maximum dose of 10 mcg/kg/min. Preparation: Mix 50 mg of Sodium Nitroprusside (Nipride) in 250 ml D5W, yielding a concentration of 200 mcg/ml. Use an infusion pump.

Tranexamic Acid (TXA)

Blood Administration: 1 g slow IV/IO.

Shock – Trauma (patients ≥ 18 years old only): 2 g slow IV/IO.

Vecuronium Bromide

Advanced Airway Confirmation/Mgmt (MC, CCT only): 0.1 mg/kg IV/IO.