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EMT Pharmacology
EMT NAIT Pharmacology (drug reference guide)
| Term | Definition |
|---|---|
| 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 |
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