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