Medication reference
Paramedic drug list.
The ALS drug box organized by category — doses, indications, and contraindications.
Cardiac arrest and dysrhythmia
| Drug | Dose | Indications | Contraindications |
|---|---|---|---|
| Epinephrine 1:10,000 | 1 mg IV/IO q3–5 min in arrest | Cardiac arrest (all rhythms), profound bradycardia (infusion) | None in arrest |
| Amiodarone | 300 mg IV/IO arrest, then 150 mg; 150 mg over 10 min for stable VT | VF/pulseless VT, stable wide-complex tachycardia | Second/third-degree block without pacing, polymorphic VT from long QT, cardiogenic shock |
| Lidocaine | 1–1.5 mg/kg IV/IO, repeat 0.5–0.75 mg/kg | VF/pulseless VT alternative to amiodarone | High-degree AV block, Stokes-Adams, amide anesthetic allergy |
| Adenosine | 6 mg rapid IV, then 12 mg | Stable narrow-complex SVT | Second/third-degree block, sick sinus, known WPW with wide/irregular rhythm, asthma (relative) |
| Atropine | 1 mg IV q3–5 min, max 3 mg | Symptomatic bradycardia, organophosphate poisoning (large doses) | Not effective in high-degree block with wide QRS — pace instead |
| Calcium chloride | 500–1,000 mg IV slow | Hyperkalemia, calcium channel blocker overdose, hypocalcemia | Digoxin toxicity (relative); never in the same line as bicarb |
| Sodium bicarbonate | 1 mEq/kg IV | Hyperkalemia, TCA overdose with wide QRS, severe acidosis, ASA overdose | Adequate ventilation required first; incompatible with calcium |
| Magnesium sulfate | 1–2 g IV over 5–20 min; 4–6 g for eclampsia | Torsades, eclampsia, refractory asthma | Heart block, hypermagnesemia; monitor reflexes and respirations |
Perfusion and vasoactive
| Drug | Dose | Indications | Contraindications |
|---|---|---|---|
| Norepinephrine | 0.05–0.5 mcg/kg/min infusion | Septic and cardiogenic shock after fluid | Uncorrected hypovolemia; extravasation risk |
| Push-dose epinephrine | 10–20 mcg IV q1–5 min (10 mcg/mL) | Transient hypotension, peri-intubation | Concentration errors — verify dilution |
| Dopamine | 5–20 mcg/kg/min | Bradycardia with hypotension, cardiogenic shock | Uncorrected hypovolemia, tachydysrhythmia, pheochromocytoma |
| Nitroglycerin | 0.4 mg SL; 5–200 mcg/min infusion | ACS, hypertensive pulmonary edema | SBP < 100, PDE-5 inhibitors, RV infarct |
| Tranexamic acid (TXA) | 1 g IV over 10 min within 3 h of injury | Hemorrhagic trauma, postpartum hemorrhage | Known thrombosis, > 3 h since injury per protocol |
Airway and respiratory
| Drug | Dose | Indications | Contraindications |
|---|---|---|---|
| Ketamine | 1–2 mg/kg IV (RSI); 4–5 mg/kg IM; 0.2–0.3 mg/kg analgesia | Induction, excited delirium, analgesia, refractory asthma | Caution in severe hypertension/aortic dissection; laryngospasm risk in infants |
| Etomidate | 0.3 mg/kg IV | RSI induction | Adrenal suppression concern in sepsis |
| Rocuronium | 1–1.2 mg/kg IV | Paralysis for RSI | No airway plan; must sedate alongside |
| Succinylcholine | 1.5 mg/kg IV | Paralysis for RSI | Hyperkalemia, burns > 24 h, crush injury, myopathy, malignant hyperthermia history |
| Albuterol / ipratropium | 2.5 mg / 0.5 mg nebulized | Bronchospasm | Caution with tachydysrhythmia |
| Methylprednisolone / dexamethasone | 125 mg IV / 10 mg IV | Asthma, COPD, croup (dex) | Systemic fungal infection (relative) |
Neuro, metabolic, and analgesia
| Drug | Dose | Indications | Contraindications |
|---|---|---|---|
| Midazolam | 2–5 mg IV/IM/IN; 0.1–0.2 mg/kg peds | Seizures, sedation, agitation | Respiratory depression, hypotension |
| Fentanyl | 1 mcg/kg IV/IN, typical 50–100 mcg | Moderate to severe pain | Hypotension, respiratory depression, MAOI use |
| Morphine | 2–4 mg IV q5–15 min | Pain, pulmonary edema per protocol | Hypotension, head injury, respiratory depression |
| Dextrose 10% | 10–25 g IV titrated | Hypoglycemia | Extravasation; suspected stroke without documented hypoglycemia |
| Naloxone | 0.4–2 mg IV/IM/IN titrated | Opioid overdose with hypoventilation | Titrate to respirations, not alertness |
| Ondansetron | 4 mg IV/ODT | Nausea and vomiting | Long QT (caution) |
| Diphenhydramine | 25–50 mg IV/IM | Allergic and dystonic reactions | Acute asthma, narrow-angle glaucoma |
Related references
FAQ
How many drugs are in a paramedic drug box?
Most ALS services carry 25 to 40 medications. The exact list is set by your state scope of practice and local medical director, but the core cardiac, airway, analgesia, and metabolic categories are nearly universal.
What is the first drug in cardiac arrest?
Epinephrine 1 mg IV/IO of the 1:10,000 concentration every 3 to 5 minutes, with an antiarrhythmic such as amiodarone or lidocaine added for shock-refractory VF or pulseless VT. High-quality compressions and defibrillation matter more than any drug.
Which medications do paramedics give that AEMTs cannot?
Antiarrhythmics (amiodarone, adenosine, lidocaine), vasopressors, RSI sedatives and paralytics, benzodiazepines for seizures, opioids in most states, calcium, bicarbonate, and magnesium.
How do I memorize the paramedic drug list for the NREMT?
Study by category rather than alphabetically, and learn each drug as indication, contraindication, dose, and the failure mode. The exam tests whether the drug is appropriate for the scenario far more often than the exact number.
Drill paramedic pharmacology
Paramedic-level practice questions with rationales on every answer.
Educational reference only. Scope and doses vary by state and local medical direction — follow your protocols. NREMT is a registered trademark of the National Registry of Emergency Medical Technicians, which does not endorse this site.