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| Nitroglycerin (NTG, NITRO) Class | Nitrates (vasodilator)
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| Nitroglycerin Action | Vasodilation by relaxing systemic venous & arterial vessels; decreases preload & afterload; decreases myocardial workload and o2 consumption; dilates coronary arteries.
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| Nitroglycerin Onset | SL 2min; Topical 30-60min
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| Nitroglycerin Duration | SL 30-60min; Topical 24hrs
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| 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
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| 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
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| Nitroglycerin Contraindications | Pt who has taken sexual enhancement Rx (e.g. Viagra/Cialis/Levitra) within 48hrs.
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| Nitroglycerin Side Effects | Orthostatic hypotension (can be profound); Dizziness/syncope; Temporary pulsating headache; Facial Flushing
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| Nitroglycerin Special Information | Concentration: 1 metered spray or 1 tablet = 0.4mg; ointment/paste 1" = 15mg
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| Albuterol (Proventil, Ventolin) Class | Bronchodilator: Sympathomimetic (beta-2 specific)
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| Albuterol Action | Relaxes bronchial smooth muscles by stimulating beta-2 adrenergic receptors; Produces bronchodilation, releives bronchospasm, and reduces airway resistance.
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| Albuterol Onset, Peak, and Duration | Onset = 5min; Peak = 1 hr; Duration = up to 5 hrs
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| 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)
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| Albuterol Dosage/Route | Adult: 6ml (0.083%) via nebulizer; MR * Peds: PDC via nebulizer; MR
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| Albuterol Contraindications | None in adults; Croup in pediatric Pts
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| Albuterol Side Effects | Tachycardia/palpitations; Dizziness, headache; Tremors, nervousness
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| Albuterol Special Information | Concentration 2.5mg/3ml
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| 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
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| 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
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| Epinephrine (Adrenalin, Epi) Class | Catecholamine: Sympathomimetic (both alpha and beta effects)
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| 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
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| Epinephrine Onset | IV/IO 1-2min; IM/SC 5-10min
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| Epinephrine Duration | IV/IO 5-10mins; IM/SC 1-4hrs
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| 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;
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| 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
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| 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"
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| 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
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| 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"
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| Epinephrine Dosage/Route for Respiratory Distress w/ Stridor at rest - Pediatric Patients | 1:1,000 PDC via nebulizer MR x1
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| 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
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| 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
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| Epinephrine Contraindications | None
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| Epinephrine Side Effects | Anxiety/restlessness; Palpitations/tachyarrhythmias; Ventricular irritability; Increased myocardial o2 demands; Hypertension; Angina
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| Epinephrine Special Information | Concentrations 1:10,000 = 1mg/10ml; 1:1,000 = 1mg/1ml
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| 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);
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| Epinephrine Special Information Cont. II | Alpha effets override Beta effects in peripheral vasculature
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| 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
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| 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
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| Charcoal (Activated Charcoal) Class | Absorbent
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| Charcoal Action | Binds and absorbs ingested toxins present in the GI tract; Inhibits intestinal absorption, preventing systemic toxicity;
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| Charcoal Onset/Duration | Onset = immediate; Duration = 4-12 hours
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| Charcoal Indications | Oral ingestion of poison or overdose if ingestion is within 60 minutes and recommended by Poison Control (S-134, S-135)
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| Charcoal Dosage/Route | ADULT: 50grams PO; PEDS: PDC PO
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| Charcoal Contraindications | None
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| Charcoal Side Effects | Nausea/vomiting; Constipation/diarrhea; Abdominal cramping
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| Charcoal Special Information I | Concentration: 50Gm/240ml
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| 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
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| 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, ...
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| Charcoal Special Information III Cont. | iron ingestion or mineral oils due to marginal effect and potential to cause harmful vomiting and burns.
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| 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
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| 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.
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