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EMT Pharmacology

EMT NAIT Pharmacology (drug reference guide)

Selectively stimulates beta-adrenergic receptors of the lungs, uterus and vascular smooth muscle Salbutamol/Ventolin Mechanism(s) of action 1
Bronchodilation results from relaxation of the vascular smooth muscles which relieves bronschospasm and reduces airway resistance Salbutamol/Ventolin Mechanism(s) of action 2
Higher doses will drive serum potassium (K+) into the cells Salbutamol/Ventolin Mechanism(s) of action 3
Bronchospasm due to bronchial asthma, chronic bronchitis, and other chronic bronchiopulmonary disorders Salbutamol/Ventolin Indications
Respiratory Distress with bronchospasm Salbutamol/Ventolin Indications 2
Hypersensitivity Salbutamol/Ventolin Contraindications 1
Use with caution- Tachycardia Salbutamol/Ventolin Precautions/Interactions 1
Should not be used with Pt presenting with acute heart failure Salbutamol/Ventolin Precautions/Interactions 2
CV disease- cardiac dysrythmias, hypertension Salbutamol/Ventolin Precautions/Interactions 3
Diabetes Mellitus- risk of drug induced hyperglygemia Salbutamol/Ventolin Precautions/Interactions 4
Hypokalemia- risk further reducing serum potassium levels and possible adverse cardiovascular events Salbutamol/Ventolin Precautions/interactions 5
Tachycardia Salbutamol/Ventolin Adverse Effects 1
Palpitations Salbutamol/Ventolin Adverse Effects 2
Dizziness Salbutamol/Ventolin Adverse Effects 3
Headache Salbutamol/Ventolin Adverse Effects 4
Angina Salbutamol/Ventolin Adverse Effects 5
Anxiety Salbutamol/Ventolin Adverse Effects 6
Adult 2.5-5.0 mg nebule q 10 min prn MDI min 6 puffs max 10 Salbutamol/Ventolin Dosage-Route Adult
Pediatric- 0.15mg/kg diluted to 2.5ml saline via nebulizer OR <10kg give 1.25 mg with NS to 2.5 ml 10-20kg give 2.5 mg >20kg give 2.5 to 5.0 mg MDI pediatrics minimum 2 puffs max 10 Salbutamol/Ventolin Dosage-Route Pediatric
2.5 mg in 2.5 ml plastic nebs MDI 100ug puff Combivent 2.5mg Ventolin with 500mcg Atrovent Salbutamol/Ventolin Supplied
Bronchodilator Salbutamol/Ventolin Class
Rapid and Reversible Analgesia Nitrous Oxide/Entonox Mechanism of Action
Pain of musculoskeletal origin, particularly fractures Nitrous Oxide/Entonox Indications 1
Burns Nitrous Oxide/Entonox Indications 2
Suspected Ischemic Chest Pain Nitrous Oxide/Entonox Indications 3
Pregnancy- only in active labor Nitrous Oxide/Entonox Indications 4
Altered LOC, Pt unable to self administer, Closed head injury, Chest or ABD trauma, Shock, Respiratory compromise/distress, bowel obstruction, suspected pneumothorax, decompression sickness(diving in last 48hrs), Pregnancy (except in active labor) Nitrous Oxide/Entonox Contraindications (all)
Anytime >50% O2 is required Nitrous Oxide/Entonox Precautions/Interactions 1
Prolonged use can cause Hypoxia- provide supplemental O2 Nitrous Oxide/Entonox Precautions/Interactions 2
1 Lightheadedness Nitrous Oxide/Entonox Adverse Effects 1
2 Nausea and Vomiting Nitrous Oxide/Entonox Adverse Effects 2
3 Decreased LOC Nitrous Oxide/Entonox Adverse Effects 3
4 Numbness and Tingling Nitrous Oxide/Entonox Adverse Effects 4
Self Administered by Pt for relief of pain Nitrous Oxide/Entonox Dosage/Route Adults/Peds
Premixed tank: 50%oxygen and 50% Nitrous Oxide Nitrous Oxide/Entonox supplied
Use in Well ventilated area Invert tank 3x prior to use (to mix contents) Do not use if outside ambient temp < -6c Do not use if frost on tank Nitrous Oxide/Entonox Notes on tank use
Anticholinergic, Bronchodilator Ipratropium Bromide/Atrovent Class
Inhibits cholinergic receptors in bronchial smooth muscle, resulting in decreased concentrations of cyclic guanosine monophospate (cyclic GMP) Ipratropium Bromide/Atrovent Mechanism of Action 1
Decreased levels of cyclic GMP produce local- not systemic bronchodilation Ipratropium Bromide/Atrovent Mechanism of Action 2
Bronchospasm from asthma Ipratropium Bromide/Atrovent Indications 1
Chronic bronchitis Ipratropium Bromide/Atrovent Indications 2
Emphysema Ipratropium Bromide/Atrovent Indications 3
Atropine Ipratropium Bromide/Atrovent Contraindications 1
Aerosol Propellants Ipratropium Bromide/Atrovent Contraindications 2
pt's with Soy or peanut allergies Ipratropium Bromide/Atrovent Contraindications 3
Use with caution with Pt with narrow angle glaucoma, prostatic hypertrophy, urinary retention Ipratropium Bromide/Atrovent Precautions/Interactions 1
hypersensitivity to soy lecithin or related food products (soy, peanuts) Ipratropium Bromide/Atrovent Precautions/Interactions 2
Be careful to avoid accidental release into eyes Ipratropium Bromide/Atrovent Precautions/Interactions 3
Dry mouth, vomiting, palpitations, headache, tremor, cough, flushing, dizziness Ipratropium Bromide/Atrovent Adverse Effects (all)
Adult 250-500mcg via Nebulizer with Salbutamol (mixed) up to 2x if neccessary *only 1-2 doses with emphysema/chronic bronchitis Ipratropium Bromide/Atrovent Adult Dose Nebulizer
Combivent- 2.5-5.0 nebule q10 minutes prn (not to exceed max dose for Atrovent) Ipratropium Bromide/Atrovent Adult Dose Combivent
MDI min 1-4 puffs prn; max 10 (give after salbutamol, ipratropium has much slower onset of action) Ipratropium Bromide/Atrovent Adult Dose MDI
Pediatric: (ages 5-11) 25-250mcg via nebulizer with Salbutamol (mixed) q 2x if neccessary Ipratropium Bromide/Atrovent Pediatric Dose nebulizer
MDI minimum 2 puff, max 4 (give after salbutamol) Ipratropium Bromide/Atrovent Pediatric Dose MDI
Unit dose vials available in 125mcg/ml, 250mcg/ml, 500mcg/ml Ipratropium Bromide/Atrovent Supplied
Sympathomimetic, Adrenergic Epinephrine/Adrenalin Class
Directly stimulates alpha and beta-adrenergic receptors in the sympathetic nervous system Epinephrine/Adrenalin Mechanism of Action 1
Bronchodilation: relaxes bronchial smooth muscle (beta2 receptors) and inhibits histamine release Epinephrine/Adrenalin Mechanism of Action 2
CV and vasopressor: produces positive chronotropic and inotropic effects (beta1 receptors) increasing cardiac output, myocardial O2 consumption and force of contraction Epinephrine/Adrenalin Mechanism of Action 3
Vasodilation (beta2 receptors)and vasoconstriction (alpha receptors) in anaphylaxis it re-stabilizes the mast cells Epinephrine/Adrenalin Mechanism of Action 4
Anaphylaxis Epinephrine/Adrenalin Indications
None in anaphylactic shock Epinephrine/Adrenalin Contraindications
Use with caution- preexisting cardiac conditions- Pt must be monitored Epinephrine/Adrenaline Precautions/Interactions
Palpitations, angina, dysrhythmias, N&V, headache, Nervousness Epinephrine/Adrenalin Adverse Effects
Adult 0.3mg (1:1000) IM q 5-10 minutes prn Epinephrine/Adrenalin Adult Dose
Pediatric .01 mg/kg IM/SQ do not exceed .3 mg Epinephrine/Adrenalin Pediatric Dose
Hyperglycemic Agent Glucagon Class
Stimulates hepatic production of glucose from glycogen stores (glycogenolysis) Glucagon Mechanism of Action 1
Relaxes the musculature of the GI tract Glucagon Mechanism of Action 2
Has positive inotropic and chronotropic effects Glucagon Mechanism of Action 3
Confirmed symptomatic hypoglycemia (BGL <4.0mmol/l) and unable to administer D50W (no IV access) Glucagon Indications
Known hypersensitivity to glucagon, beef or pork proteins Glucagon Contraindications 1
Pheochromocytoma (catecholamine producing tumor of the adrenal gland) Glucagon Contraindications 2
Hyperglycemia Glucagon Contraindications 3
Hepatic or renal insufficiency- only effective if glycogen stores are present- malnourished patients may not respond well Glucagon Precautions/Interactions 1
Use with caution- underlying CV disease Glucagon Precautions/Interactions 2
After pt regains LOC, supplemental carbohydrates should be provided ASAP Glucagon Precautions/Interactions 3
Lowers serum potassium levels Glucagon Precautions/Interactions 4
Can cause tachycardia, nausea, vomiting, hypertension Glucagon Precautions/Interactions 5
Tachycardia, Nausea, Vomiting Glucagon Adverse Effects
Adult; hypoglycemia: 1mg IM q 15-20 minutes prn Glucagon Adult Dose
Pediatric: hypoglycemia: <5yrs, 0.5mg IM >5yrs, 1.0mg IM Glucagon Pediatric Dose
1mg powder supplied with 1ml dilutent for reconstitution Glucagon Supplied
Anti-Anginal Vasodilator Nitroglycerine/Nitrostat Class
Antianginal: relaxes vascular smooth muscle of both venous and arterial beds, resulting in a net decrease in the myocardial oxygen consumption. Nitroglycerine/Nitrostat Mechanism of Action 1
Dilates coronary vessels leading to redistribution of blood flow to ischemic tissue and improves collateral circulation Nitroglycerine/Nitrostat Mechanism of Action 2
Vasodilating: dilates peripheral vessels decreasing venous return to the heart (preload) useful in treating pulmonary edema in heart failure Nitroglycerine/Nitrostat Mechanism of Action 3
Arterial vasodilation decreases afterload, thereby decreasing Left Ventricular work and aiding the failing heart Nitroglycerine/Nitrostat Mechanism of Action 4
Angina Ischemic Chest Pain Nitroglycerine/Nitrostat Indications
Hypersensitivity to Nitrates, unable to initiate IV, Increased ICP Nitroglycerine/Nitrostat Contraindications 1
Hypotension, uncorrected hypovolemia, suspected cardiac tamponade or pericarditis Nitroglycerine/Nitrostat Contraindications 2
Sildenafil (viagra) or similar generic drug use within 24 hrs, Avoid use in extreme bradycardia (<50bpm) or severe tachycardia (>180bpm) BP <100mm/hg Nitroglycerine/Nitrostat Contraindications 3
NOR FOR USE WITH Right Ventricular Infarction Nitroglycerine/Nitrostat Precautions/Interactions
Headache, Dizziness, N&V, tachycardia, hypotension Nitroglycerine/Nitrostat Adverse Effects
Adult 1 tablet (0.3mg) or 1 spray (0.4mg)SL q5minutes prn max 3 doses or BP<100systolic Nitroglycerine/Nitrostat Adult dose
Hyperglycemic Agent (oral) Oral Glucose/Insta Glucose Class
Provides a quickly abosrbed form of glucose to increase BGL Oral Glucose/Insta Glucose Mechanism of Action
Conscious patient with intact gag reflex (able to swallow and maintain own airawy) Oral Glucose/Insta Glucose Indications
Decreased LOC (no gag reflex, cannot swallow or maintain airway) Oral Glucose/Insta-Glucose Contraindications 1
Hyperglycemia Oral Glucose/Insta-Glucose Contraindications 2
Nausea, Vomiting Oral Glucose/Insta-Glucose Precautions/Interactions
Nausea, Vomiting Oral Glucose/Insta-Glucose Adverse Effects
Adult/Pediatric 25g administered slowly until improvement is noted Oral Glucose/Insta-Glucose Adult/Pediatric Dose
Platelet aggregation inhibitor Acetylsalicylic Acid/Aspirin
Impedes clotting action and platelet aggregation by inhibiting platelet aggregation to slow or prevent further growth of clots Acetylsalicylic Acid/Aspirin Mechanism of Action 1
Blocks the formation of Thromboxane A2 responsible for platelet aggregation and artery constriction Acetylsalicylic Acid/Aspirin Mechanism of Action 2
ASA's effects on platelets is irreversible and lasts the life of the platelets (5-7 days) Acetylsalicylic Acid/Aspirin Mechanism of Action 3
ASA also has anti-pyretec, analgesic and antiinflammatory properties Acetylsalicylic Acid/Aspirin Mechanism of Action 4
Recent onset of ischemic chest pain suggestive of AMI Acetylsalicylic Acid/Aspirin Indications
Hypersensitivity (SEVERE allergy known) Bleeding disorders Acetylsalicylic Acid/Aspirin Contraindications 1
Unconsciousness Active GI bleed Acetylsalicylic Acid/Aspirin Contraindications 2
Children <14years Asthmatic with prev. sensitivity to ASA or NSAIDS Acetylsalicylic Acid/Aspirin Contraindications 3
Impaired renal/hepatic function May produce bronchoconstricion in Asthmatics Acetylsalicylic Acid/Aspirin Precautions/Interactions 1
Pregnancy Children/Adolescents with flu or varicella Acetylsalicylic Acid/Aspirin Precautions/Interactions 2
Nausea, vomiting, heartburn, bronchospasm, bleeding, urticaria Acetylsalicylic Acid/Aspirin Adverse Effects
160-325 mg po; chew tablet before swallowing *give even if Pt has taken own ASA Acetylsalicylic Acid/Aspirin Dose
Hyperglycemic agent (IV) Dextrose 50% in Water Class
Rapid replacement of blood glucose to normal levels in hypoglycemia Dextrose 50% in Water Mechanism of Action 1
Hypertonic solution produces transient movement of water from interstitial spaces into venous system Dextrose 50% in Water Mechanism of Action 2
Confirmed symptomatic hypoglycemia (BGL <4.0mmol) Dextrose 50% in Water Indications 1
Unable to bring BGL up using other measures Dextrose 50% in Water Indications 2
Hyperglycemia Dextrose 50% in Water Contraindications
Increased ICP or intracranial bleed, CVA Dextrose 50% in Water Precautions/Interactions 1
Dextrose > 5% considered hypertonic, can be very irritating to vein, could cause cerebral bleeding if not administered slowly Dextrose 50% in Water Precautions/Interactions 2
Ensure Patency of IV, can cause tissue sloughing if interstitial. Minimum 18gauge cathalon- very viscous solution Dextrose 50% in Water Precautions/Interactions 3
Chronic Alcoholosm Dextrose 50% in Water Precautions/Interactions 4
Phlebitis, irritating to veins and tissues, ensure patent IV before and during administration, Large vein and large bore IV preferred Dextrose 50% in Water Adverse Effects
Adult 0.5-1.0g/kg SIVP 2nd dose may be given if first dose ineffective Dextrose 50% in Water Adult Dose
Pediatric 0.5-1.0 g/kg of D25W (2-4mls/kg) SIVP Dextrose 50% in Water Pediatric Dose
Suspected Head Injury 12.5g D50W slow IVP Dextrose 50% in Water Suspected Head Injury
To prepare D25W expel half the contents of preloaded syringe and draw up 25ml NS Dextrose 50% in Water D25W prep
Pt must be given carbs after hypoglycemia is corrected Dextrose 50% in Water Post care
Created by: staggeringduck