Page 161 - PJ MED OPS Handbook 8th Ed

Famotidine (Pepcid)
Aviation personnel are grounded for 72 hours when taking an H2 blocker for the first time.
No grounding period if aviation personnel have taken before without side-effects.
• Description: histamine 2 blocker, ↓ secretion of stomach acid
• Indications: antacid, prevention of stress ulcers in burn victims or patients on steroid treat-
ment, anaphylaxis, adjunct in treatment of urticaria
• Adult dose: 20mg IV q12hr for ulcers, burns, steroid use, upper GI bleeds, urticaria, or
anaphylaxis
• Pediatric dose: 0.5mg/kg IV q12hr (q24 if under 2 mos old)
Contraindications: known/suspected liver disease
• Side-effects: muscle aches, vertigo
• Adverse reactions: thrombocytopenia; liver toxicity

Fentanyl

Grounding for personnel on flight status
• Description: opioid analgesic
• Indications: moderate to severe pain from medical etiology (non-trauma pain) and burns;
second line to ketamine for moderate to severe trauma pain, as a second line sedative
• Dose:
○ 50–100mcg IV/IO/IM
○ 400–1600mcg oral transmucosal fentanyl citrate (OTFC) aka fentanyl lozenge
n The patient should place the ACTIQ unit in his or her mouth between the cheek and
gum, occasionally moving the drug matrix from one side to the other using the handle.
The ACTIQ unit should NOT be sucked, bitten or swallowed. Tape the lozenge to the
patient’s finger to help prevent accidental overdose.
n The ACTIQ unit should be consumed over a 15-minute period. Longer or shorter con-
sumption times may produce less efficacy than reported in ACTIQ clinical trials. If signs of
excessive opioid effects appear before the unit is consumed, the drug matrix should be
removed from the patient’s mouth immediately and future doses should be decreased.
• Treatment of overdose:
○ Narcan for respiratory depression, but beware of possibility of precipitating an acute with-
drawal syndrome
○ Ventilatory support
○ IV/IO access and fluids for hypotension
Contraindications: known allergy to fentanyl or other opioid, pregnancy
• Side-effects: respiratory depression or arrest, suppression of gag reflex, and hypotension

Gatifloxacin 0.3% Ophthalmic Liquid (Zymar)
Aviation personnel are grounded for the initial 24 hours of antibiotic therapy and until the
medical condition no longer interferes with safely performing aviation duties and the patient is free
of side-effects.
• Description: ocular fluoroquinolone antibiotic
• Indications: eye infections, for use after performing lateral canthotomy
• Adult dose: 1 drop q2–3hr for 2 days then 1 drop qid

Chapter 9. Pararescue Drug Formulary n 159