Page 171 - 2022 Ranger Medic Handbook

HYDROMORPHONE (DILAUDID) – CONTROLLED SUBSTANCE II
Class: CNS agent – narcotic (opiate) agonist; analgesic
Action: Semisynthetic derivative structurally similar to morphine with 8–10 × more potent analgesic effect, more rapid
onset, shorter duration of action, less hypnotic effect, and less tendency to produce nausea and vomiting; also has
antitussive properties
Dose: 1mg IV; 1–2mg IM q4–6hr prn
Onset/Peak/Duration:
IV – Onset in 10–15 minutes/Peak in 15–30 minutes/Duration 2–3 hours
IM – Onset in 15 minutes/Peak in 30–60 minutes/Duration 4–5 hours
Indications: For moderate to severe pain management, and control of persistent nonproductive cough
Contraindications: Opiate hypersensitivity, acute bronchial asthma, COPD, decreased respiratory reserve, severe
respiratory depression, opiate-naïve patients; pregnancy category consider alternative during pregnancy and caution
advised while breastfeeding (caution advised in patients trying to conceive)
Adverse/Side-effects: Nausea, vomiting, constipation; euphoria, dizziness, sedation, drows iness; hypotension, brady-
cardia, tachycardia; respiratory depression; blurred vision
Interactions: Alcohol and other CNS depressants compound sedation and CNS depression; herbal (St. John’s wort) SECTION 4
may increase sedation
Mission Impact: GROUNDING medication for personnel on flight status
K9 Dosage: 3–6mg (0.1–0.2mg/kg) IV/IM q2–4hr using lower dose if IV

IBUPROFEN (MOTRIN, ADVIL)
Class: NSAID (nonselective COX-1); anti-inflammatory, analgesic, antipyretic
Action: Propionic acid inhibitor prototype that blocks prostaglandin synthesis, modulates T-cell function, inhibits
inflammatory cell chemotaxis, decreases release of superoxide radicals or increases scavenging of these compounds
at inflammatory sites, inhibits platelet aggregation and prolongs bleeding time
Dose: 400–800mg PO tid–qid (max: 3,200mg/d)
Indications: For mild to moderate pain management, symptomatic relief of arthritis, and to reduce fever
Contraindications: NSAID- or aspirin-induced urticaria, severe rhinitis, bronchospasm, angioedema, nasal polyps;
active peptic ulcer, bleeding abnormalities; pregnancy category caution advised during 1st trimester and avoid use
> 19 week gestation. Drug of choice while breastfeeding (caution advised in patients trying to conceive)
Adverse/Side-effects: Headache, dizziness, light-headedness, anxiety, emotional labil ity, fatigue, malaise, drowsi-
ness, anxiety, confusion, depression, aseptic meningitis, hypertension, palpitation, CHF, peripheral edema; amblyopia
(blurred vision, decreased visual acuity, scotomas, changes in color vision), nystagmus, visual-field defects; tinnitus,
impaired hearing; dry mouth, gingival ulcerations, dyspepsia, heartburn, nausea, vomiting, anorexia, diarrhea, con-
stipation, bloating, flatulence, epigastric or abdominal discomfort or pain, GI ulceration, occult blood loss; thrombo-
cytopenia, neutropenia, hemolytic or aplastic anemia, leukopenia; decreased Hgb/Hct; acute renal failure, polyuria,
azotemia, cystitis, hematuria, nephrotoxicity, decreased creatinine clearance; maculopapular and vesiculobullous skin
eruptions, erythema multiforme, pruritus, acne; fluid retention with edema, Stevens-Johnson syndrome, toxic hepati-
tis, hypersensitivity reactions, anaphylaxis, bronchospasm, serum sickness, SLE, angioedema
Interactions: Oral anticoagulants and heparin may prolong bleeding time; may increase lithium and methotrexate
toxicity; herbals (feverfew, garlic, ginger, ginkgo) may increase risk of bleeding; do not take aspirin concurrently; con-
current alcohol use may increase risk of GI ulceration and bleeding tendencies

2022 RANGER MEDIC HANDBOOK 157