Page 179 - 2022 Ranger Medic Handbook

MODAFINIL (PROVIGIL) – CONTROLLED SUBSTANCE IV
Class: CNS stimulant
Dose: 200mg daily. Shift work sleep disorder 200mg 1 hour prior to start. Max dose 400mg
Indications: Improve wakefulness in patients with narcolepsy, obstructive sleep apnea-hypopnea syndrome, and
shift work sleep disorder
Contraindications: Hypersensitivity, pregnancy category avoid use during pregnancy and caution advised while
breastfeeding
Adverse/Side-effects: Aggressiveness, agitation, anxiety, confusion, delusions, depression, hallucinations, HA, in-
somnia, mania, nervousness, psychosis, suicidal ideations, nausea, rash, Stevens-Johnson syndrome, anaphylaxis,
or angioedema.
Interactions: Amitriptyline, diazepam, propanolol, carbamazepine, cimetidine, clarithromycin, erythromycin, flucon-
azole, oral contraceptives, dexamethasone, rifampin, warfarin
Mission Impact: Must be approved by medical officer and command leadership prior to administration. Individual
must be screen tested in noncombat environment prior to administration during operational timeframes.

MORPHINE SULFATE (MSO 4 ) – CONTROLLED SUBSTANCE II SECTION 4
Class: CNS agent – narcotic (opiate) agonist; analgesic
Action: Natural opium alkaloid with agonist activity as it binds with three types of the same receptors as endogenous
opioid peptides; analgesia at supraspinal level, euphoria, respiratory depression and physical dependence; sedation
and miosis; dysphoric, hallucinogenic, and cardiac stimulant effects
Dose: 5–10mg slow IV push, titrate to pain
Onset/Peak/Duration:
IV – Onset in 5–20 minutes/Peak in 20 minutes/Duration 4–5 hours
IM – Onset in 10–30 minutes/Peak in 30–60 minutes/Duration 4–5 hours
Indications: For severe acute and chronic pain management, preanesthesia and as adjunct to anesthesia, and for
relief of dyspnea from acute left ventricular failure and pulmonary edema
Contraindications: Opiate hypersensitivity; seizures; acute bronchial asthma, chronic pulmonary disease, severe
respiratory depression; chemical-irritant induced pulmonary edema; BPH; diarrhea due to poisoning until toxic mate-
rial has been eliminated; following biliary tract surgery and surgical anastomosis; pancreatitis; acute ulcerative colitis;
severe liver or renal insufficiency; hypothyroidism; pregnancy category consider alternative during pregnancy and may
use while breastfeeding (caution advised in patients trying to conceive)
Adverse/Side-effects: Pruritus, rash, urticaria, edema, anaphylactoid reaction; sweating, skeletal muscle flaccidity;
cold, clammy skin, hypothermia; euphoria, insomnia, disorientation, visual disturbances, dysphoria, paradoxical CNS
stimulation (restlessness, tremor, delirium, insomnia), convulsions; decreased cough reflex, drowsiness, dizziness,
deep sleep, coma; miosis; bradycardia, palpitations, syncope; flushing of face, neck, and upper thorax; orthostatic
hypotension, cardiac arrest; constipation, anorexia, dry mouth, biliary colic, nausea, vomiting, elevated LFTs; urinary
retention or urgency, dysuria, oliguria, reduced libido or potency; severe respiratory depression or arrest; pulmonary
edema
Interactions: CNS depressants, sedatives, barbiturates, alcohol, benzodiazepines, and TCAs potentiate CNS-
depressant effects; MAOIs may precipitate hypertensive crisis; phenothiazines may antagonize analgesia
Mission Impact: GROUNDING medication for personnel on flight status
K9 Dosage: 2–3mg IV OR 10–20mg IM/SQ. Nausea/emesis and defecation common. Reverse with 1mg naloxone
IV/IM/SQ

2022 RANGER MEDIC HANDBOOK 165