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San Diego EMTP Drugs

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Nitroglycerin (NTG, NITRO) Class Nitrates (vasodilator)
Nitroglycerin Action Vasodilation by relaxing systemic venous & arterial vessels; decreases preload & afterload; decreases myocardial workload and o2 consumption; dilates coronary arteries.
Nitroglycerin Onset SL 2min; Topical 30-60min
Nitroglycerin Duration SL 30-60min; Topical 24hrs
Nitroglycerin Indications (pain or discomfort of suspected cardiac origin; S-126) If BP ≥ 100 = 0.4mg SL; MR q3-5" or Topical ointment/paste 1"*If BP < 100 = 0.4mg SL BHO; MR BHPO
Nitroglycerin Indications (respiratory distress ?CHF/cardiac origin; S-136) If BP ≥ 100 = Topical ointment/paste 1"*If BP ≥ 100 but < 150 = 0.4mg SL; MR q3-5"*If BP ≥ 150 = 0.8mg SL; MR q3-5"; MR BHO*If BP < 100 = 0.4mg SL BHO; MR BHPO
Nitroglycerin Contraindications Pt who has taken sexual enhancement Rx (e.g. Viagra/Cialis/Levitra) within 48hrs.
Nitroglycerin Side Effects Orthostatic hypotension (can be profound); Dizziness/syncope; Temporary pulsating headache; Facial Flushing
Nitroglycerin Special Information Concentration: 1 metered spray or 1 tablet = 0.4mg; ointment/paste 1" = 15mg
Albuterol (Proventil, Ventolin) Class Bronchodilator: Sympathomimetic (beta-2 specific)
Albuterol Action Relaxes bronchial smooth muscles by stimulating beta-2 adrenergic receptors; Produces bronchodilation, releives bronchospasm, and reduces airway resistance.
Albuterol Onset, Peak, and Duration Onset = 5min; Peak = 1 hr; Duration = up to 5 hrs
Albuterol Indications Resp. Distress of ?asthma/COPD/resp. origin (S-136, S-137); Allergic reaction/anaphylaxis (S-122, S-162); Burns (S-124, S-170); Hemodialysis Pt with suspected hyperkalemia if ≥ 72hrs since last dialysis (S-131)
Albuterol Dosage/Route Adult: 6ml (0.083%) via nebulizer; MR * Peds: PDC via nebulizer; MR
Albuterol Contraindications None in adults; Croup in pediatric Pts
Albuterol Side Effects Tachycardia/palpitations; Dizziness, headache; Tremors, nervousness
Albuterol Special Information Concentration 2.5mg/3ml
Albuterol Special Information Cont. I Use w/ 4-6 liters of o2 for handheld mouthpiece; Use w/ 6-10 liters of o2 for aerosol mask, CPAP, and ET tube routes of administration
Albuterol Special Information Cont. II Do NOT add Atrovent to Albuterol in respiratory burn Pt and ?hyperkalemia Pt; Atrovent IS added to first does of Albuterol in Pt w/ respiratory distress of asthma/COPD/respiratory origin and dyspnea from allergic reactions
Epinephrine (Adrenalin, Epi) Class Catecholamine: Sympathomimetic (both alpha and beta effects)
Epinephrine Action On the bronchi: bronchodilation (beta-2); On the peripheral vasculature: vasoconstriction (alpha); On the heart: increased HR (beta-1)/chronotropic, increased contractility/inotropic, increased AV conduction/dromotropic, increased automacity/dromotropic
Epinephrine Onset IV/IO 1-2min; IM/SC 5-10min
Epinephrine Duration IV/IO 5-10mins; IM/SC 1-4hrs
Epinephrine Indications Allergic reaction acute (facial/cervical angioedema, bronchospasm or wheezing); Anaphylaxis; Severe Resp. distress ?asthma/COPD respiratory origin - severe SOB or inadequate response to albuterol/atrovent;
Epinephrine Indications Cont. Resp. distress with stridor at rest - Ped Pt; Cardiac arrest (pulseless Pt) Unstable bradycardia (Peds); Newborn deliveries if HR remains <60 after 30 seconds of CPR
Epinephrine Dosage/Route for Allergic reaction acute ADULT: 0.3mg IM 1:1,000; MR x2 q10" PEDS: PDC IM 1:1,000; MR x2 q10"
Epinephrine Dosage/Route for Anaphylaxis ADULT: 0.3mg IM 1:1,000; MR x2 q10" * 0.1mg IV/IO 1:10,000 BHO; MR x2 q3-5" BHO PEDS: PDC IM 1:1,000: MR x2 q10" PDC IV/IO 1:10,000 BHO; MR x2 q3-5" BHO
Epinephrine Dosage/Route for Severe Resp. Distress ?asthma/COPD/ resp. origin - Severe SOB or inadequate response to Albuterol/Atrovent ADULT: If KNOWN cardiac disease or Hx of HTN or BP ≥ 150 or age ≥ 40 years and no definite Hx of asthma, 0.3mg IM 1:1,000 BHPO MR x2 q10"BHPO * PEDS: PDC - IM 1:1,000; MR x2 q10"
Epinephrine Dosage/Route for Respiratory Distress w/ Stridor at rest - Pediatric Patients 1:1,000 PDC via nebulizer MR x1
Epinephrine Dosage/Route for Cardiac arrest (pulseless patient); Unstable Bradycardia (Peds) ADULT: 1mg IVP/IO 1:10,000; MR q3-5" * PEDS: PDC - IVP/IO 1:10,000; MR x2 q3-5"; MR q3-5" BHO
Epinephrine Dosage/Route for Newborn deliveries if HR remains < 60 after 30sec of CPR PEDS: PDC IVP/IO 1:10,000; MR x2 q3-5"; MR q3-5" BHO
Epinephrine Contraindications None
Epinephrine Side Effects Anxiety/restlessness; Palpitations/tachyarrhythmias; Ventricular irritability; Increased myocardial o2 demands; Hypertension; Angina
Epinephrine Special Information Concentrations 1:10,000 = 1mg/10ml; 1:1,000 = 1mg/1ml
Epinephrine Special Information Cont. I Monitor ECG, may aggravate pre-existing tachycardia; BHPO REQUIRED for if KNOWN cardiac disease or Hx of HTN or BP ≥ 150 or age ≥ 40 years and no definite Hx of asthma; Use IV Epic in Anaphylaxis with S/S of poor perfusion (Sever Hypotension; Cyanosis);
Epinephrine Special Information Cont. II Alpha effets override Beta effects in peripheral vasculature
Epinephrine Special Information Cont. III Nebulized Epinephrine 1:1,000 concentrations only: Can cause sensitivity/irritation to providers (may need goggles and face shield); May cause rebound exacerbation of croup
Epinephrine Special Information Cont. IV Nebulized Epinephrine 1:1,000 concentrations only: Is used full strength in nebulizer (DO NOT DILUTE); Up to 5 single dose ampules may be required if no multi dose vials are available
Charcoal (Activated Charcoal) Class Absorbent
Charcoal Action Binds and absorbs ingested toxins present in the GI tract; Inhibits intestinal absorption, preventing systemic toxicity;
Charcoal Onset/Duration Onset = immediate; Duration = 4-12 hours
Charcoal Indications Oral ingestion of poison or overdose if ingestion is within 60 minutes and recommended by Poison Control (S-134, S-135)
Charcoal Dosage/Route ADULT: 50grams PO; PEDS: PDC PO
Charcoal Contraindications None
Charcoal Side Effects Nausea/vomiting; Constipation/diarrhea; Abdominal cramping
Charcoal Special Information I Concentration: 50Gm/240ml
Charcoal Special Information II Do not use Sorbitol/charcoal mixture because of potential for dehydration, hypotension and electrolyte disturbances; Call Poison Control early to confirm recommendation for use of Charcoal; The phone number for Poison Control is 1-800-222-1222
Charcoal Special Information III Use with caution in poisonings due to cyanide, corrosives, ethanol, methanol, petroleum distillates, organic solvents, caustic agents ingestions, isolated alcohol ingestions, heavy metal ingestions, hydrocarbon ingestions, ...
Charcoal Special Information III Cont. iron ingestion or mineral oils due to marginal effect and potential to cause harmful vomiting and burns.
Charcoal Special Information IV Use with caution with OD of drugs known to cause rapid onset of seizures (TCA's, etc.) due to risk of vomiting and aspiration; Administer to alert, cooperative patient with gag reflex
Charcoal Special Information V Charcoal is most effective if administered immediately after the ingestion. Contact Poison Control early and administer promptly if indicated; Anticipate vomiting complications during administration. Consider Zofran.
Created by: leper