Aemt pharmacology-ver-2-4-2013 (2)


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Aemt pharmacology-ver-2-4-2013 (2)

  1. 1. AEMT- Medication Card Guidelines (2.2013) The AEMT must have knowledge of the following drugs for EMSP 1338. The student will prepare the drug cards and turn them in by the due date. Keep in mind that the student is preparing the cards to take into the clinical setting where they MUST know the drugs completely before being allowed to administer them to a patient. The guidelines needed to successfully complete this assignment are as follows: 1. The cards need to be done on Index cards in a spiral notebook; the other alternative is to do them on index cards and then place them in a binder of some sorts so the cards do not “fall out” after completing them. I will NOT take them LOOSE or held together with a binder clip since they can come loose easily. 2. The size of the cards is up to the student in what you are willing to carry but keep in mind that the smaller they are makes it easier to place them in your lab coat. 3. The following information must be on EVERY card. a. Class b. Mechanism of Action c. Indications d. Contradictions e. Side Effects f. Precautions g. How Supplied h. Administration/Dosage 4. THEY MUST BE LEGIBLE IN YOUR HANDWRITING – not anyone’s else’s. 5. The Packet will NOT be scanned into computers and made into drug cards. Commercial Drug Cards are also NOT acceptable either. 6. CARDS MUST BE HANDWRITTEN
  2. 2. 7. Under Side Effects Charts, the Key is the following: When it is underlined and has a “C”=COMMON; When it is Bolded and has italics= LT-Life Threatening EPINEPHRINE (1:1,000) Class: Sympathomimetic, vasopressor, bronchodilator Mechanism of Action - Catecholamine that stimulates alpha- and beta- adrenergic receptors 1. Beta1 stimulation leads to: - positive inotropic effects (↑ force of cardiac contraction) - positive chronotropic effects (↑ rate of cardiac contraction) - positive dromotropic effects (↑ conduction velocity) - increased cardiac output (CO) - increased myocardial oxygen requirements 2. Beta2 stimulation leads to: - peripheral vasodilation and bronchodilation 3. Alpha1 stimulation leads to peripheral vasoconstriction: - arterial / venous vasoconstriction (vasopressor) = increased SVR - constriction to renal, mesenteric, coronary, and cerebral vessels - pulmonary vasoconstriction - making the heart more susceptible to direct countershock in cardiac arrest (Ventricular fibrillation) = reason it is given during cardiac arrest 4. Inhibits histamine release (stops degranulation) during anaphylactic reaction (Effects start within 90 seconds and are short lived) Indications 1. Acute asthma attacks 2. Exacerbation of some forms of COPD 3. Mild anaphylaxis 4. Symptomatic Bradycardia (refractory, not responding, to oxygen and atropine) (infusion) 5. Symptomatic heart blocks (second type II and third degree) (infusion) Contraindications 1. Hypersensitvity 2. Patients with underlying cardiovascular disease 3. Tachyarrhythmias
  3. 3. 4. Not with alkaline drugs 5. Shock 6. Patients with hypertension EPINEPHRINE (1:1,000) Side Effects CNS Anxiety Dizziness Cardiovascular Anginal pain Dysrhythmias LT Hypertension Palpitations - LT Ischemia Headache Restlessness Subarachnoid Hemorrhage = LT Tremors Weakness Italic = C = common side GI / GU Nausea - C Vomiting-C Respiratory Dyspnea Urinary retention Skin Pallor Coldness Necrosis Urticaria Bold italics = LT = life-threatening reactions Precautions 1. Increased myocardial workload may lead to ischemia, infarction 2. May have increased airway resistance due to sulfites in the preparation = hypersensitivity 3. Use cautiously with: - Heart disease - Diabetes - Hypertension 4. Excreted into breast milk – use cautiously on nursing mothers How supplied - Ampules and prefilled syringes containing - 1mg/1ml - Vials containing: - 30mg/30cc Administration / dosage Administered – SQ / IM / IV infusion Mild Anaphylaxis or Acute Asthma Attack Refractory Bradycardia Eyes Pupil dilation
  4. 4. 0.3 to 0.5mg - IM / SQ Mix infusion: Every 15 – 20 minutes, PRN Dosage range: 1-2mg / 250 or 500cc 2-10µg / minute Low doses – 2-5µg / minute = β effects High doses – 5-10µg / minute = α effects EPINEPHRINE (1:10,000) Class: Sympathomimetic, vasopressor, bronchodilator Mechanism of Action - Catecholamine that stimulates alpha- and beta- adrenergic receptors 1. Beta1 stimulation leads to: - positive inotropic effects (↑ force of cardiac contraction) - positive chronotropic effects (↑ rate of cardiac contraction) - positive dromotropic effects (↑ conduction velocity) - 3 above help with rate post-arrest - increased cardiac output (CO) - increased myocardial oxygen requirements 2. Beta2 stimulation leads to: - peripheral vasodilation and bronchodilation 3. Alpha1 stimulation leads to peripheral vasoconstriction: - arterial / venous vasoconstriction (vasopressor) = increased SVR (perfusion pressure) - constriction to renal, mesenteric, coronary, pulmonary and cerebral vessels - makes the heart more susceptible to direct countershock in cardiac arrest (Ventricular fibrillation) (due to increased hydrostatic pressure) = reason it is given during cardiac arrest 4. Inhibits histamine release (stops degranulation) during anaphylactic reaction (Effects start within 90 seconds and are short lived) Indications 1. Asystole 2. Ventricular-Fibrillation/pulseless Ventricular-Tachycardia 3. Pulseless electrical activity (PEA) 4. Severe anaphylaxis Contraindications 1. Hypersensitvity 2. Patients with underlying cardiovascular disease 3. Tachyarrhythmias 5. Hypovolemic shock 6. Not with alkaline drugs Side Effects
  5. 5. CNS Cardiovascular GI / GU Anxiety Anginal pain Nausea Dizziness Dysrhythmias- LT Vomiting Headache Hypertension Urinary retention Restlessness Palpitations Subarachnoid Ischemia Hemorrhage- LT Tremors Weakness Bold italics = LT = life-threatening reactions Respiratory Dyspnea Skin Pallor Coldness Necrosis Urticaria Eyes Pupil dilation 2 EPINEPHRINE (1:10,000) Precautions: 1. increased myocardial workload may lead to ischemia, infarction 2. hypersensitivity (may have increased airway resistance due to sulfites in the preparation) 3. use cautiously in patients with: - Heart disease - Diabetes - Hypertension - Given along with other sympathomimetics or with phosphodiesterase inhibitors (caffeine, amiophylline, Dipyridamole, Erectile dysfunction meds) may exacerbate dysrhythmia response 4. Deactivated with sodium bicarbonate / lasix (alkaline solutions) 5. Patients on MAO inhibitors (Marplan, Nardil, Parnate) ← (Anti-depressant drugs) – potentiates the effects How Supplied - 1mg/10ml = 1:10,000 (prefilled syringe) Administration/Dosage Administered by: - IVP, IO, ET Cardiac Arrest 1mg (1:10,000) IVP or IO Followed by a 20cc flush and raising the patients arm Repeat every 3-5 minutes Endotracheal dose 2-2.5 times the IVP dose Use 1:1,000 and place in 10cc of fluid Use ONLY if IV or IO site cannot be established May produce transient β effects = vasodilation = ↓ Coronary perfusion pressure Severe Anaphylaxis: 1.0mg SIVP (1:10,000) over 5 minutes - Repeat in 5-15 minutes PRN (as needed)) Pediatric dose: Cardiac arrest - 0.01mg/kg IVP (0.1 mL/kg)
  6. 6. ASPIRIN Class: Nonsteroidal Anti-inflammatory Drug (NSAID), antipyretic, platelet inhibitor, nonnarcotic analgesic Mechanism of Action 1. 2. 3. 4. - Inhibits prostaglandin synthesis and release (from mast cells). This action: decreases pain and fever produced Antipyretic agent by: inhibition of prostaglandins action on hypothalamus heat-regulating center vasodilation and sweating Analgesic agent acts on peripheral nervous system Platelet inhibitor = prevents formation of thromboxane A2 Post-plaque rupture in vessels → “sticky” platelets adhere to damaged vessel (within 1-5 seconds) → platelets release thromboxane A2 (chemical causes → platelet aggregation and vasoconstriciton) Aspirin delivery leads to: - Vasodilation (platelet inhibitor / thromboxane A2 inhibitor) - Decreased clot formation (platelet inhibitor / thromboxane A2 inhibitor) - Reduces inflammation (inhibition of prostaglandin synthesis) - Reduces fever (inhibition of prostaglandin synthesis and antipyretic properties) - Pain reduction (analgesic property) IF STARTED WITHIN 24 HOURS OF ONSET OF ACUTE MI – IT REDUCES MORTALITY ALMOST TO THE SAME DEGREE OF THROMBOLYTIC THERAPY Indications 1. 2. 3. 4. 5. Mild to moderate pain and fever Reducing the risk of recurrent transient ischemic attacks (TIA) Chest pain or other signs/symptoms of acute MI EKG changes suggestive of acute MI To reduce inflammation Contraindications 1. 2. 3. Active ulcer disease Hemophilia Hemorrhagic states
  7. 7. 4. 5. - Active GI bleeding - Hemorrhagic stroke Known hypersensitivity to NSAIDs or salicylates Children or adolescents with flu-like symptoms / chickenpox (Varicella) ASPIRIN Side effects CNS Confusion Eyes / Ears Dim vision Dizziness Reversible hearing loss Tinnitus Drowsiness Headache Blood ↓ plasma iron concentration Leukopenia = LT GI Reversible hepatotoxicity Anorexia Metabolic Hypoglycemia Respiratory Hypernea Skin Angioedema Hypokalemia Wheezing Bruising Prolonged bleeding Diarrhea Hyponatremia Hives Shortened erythrocyte survival time Thrombocytopenia= LT Dyspepsia (inhibits pepsin) = GI discomfort = C Peptic ulcer formation Bleeding Heartburn Bronchospasms Laryngeal edema Italic = C = common side effects Nausea = C Bold Italic = LT = life-threatening reactions Precautions 1. Chronic use may lead to GI ulcerations, bleeding, or perforation 2. Alcohol may increase the risk of GI bleeding 3. Allergic reactions are more likely if the patient has a history of asthma (hypersensitivity) 4. Use cautiously with: - GI disorders - Asthma - Impaired renal / liver function - Dehydrated children - Histories of coagulation defects - Bleeding disorders Rash Urticaria
  8. 8. Administration / Dosage Administered - PO (orally) – Mild pain and fever Myocardial Infarction 160-325mg / day - PO 325-650mg - PO NON-ENTERIC – chewing is preferred NITROGLYCERIN (NITROSTAT) Class: antianginal, vasodilator, and nitrate Mechanism of action 1. Relaxes vascular smooth muscle - promoting vasodilation 2. Decreases preload (predominately) - venous dilation = ↓ preload = ↓ heart size - ↓ heart size = ↑ blood flow to coronary and collateral vessels = myocardial perfusion is improved 3. Decreases afterload - ↓ arteriole pressure = ↓ aortic pressure = left ventricle works better 4. Decreases myocardial O2 consumption / workload 5. Improves collateral flow to ischemic regions 6. Dilates pulmonary capillary beds - fluid in alveoli and interstitial space are pulled back into the vessels Pain relief occurs within 2 minutes & therapeutic effects observed up to 30 minutes. Indications – systolic pressure ≥ 100 mmHg 1. Angina 2. Chest pain with myocardial infarction 3. Pulmonary edema associated with CHF or MI 4. Hypertensive emergencies with Acute Coronay Syndromes or acute CHF Contraindications 1. Increased ICP 2. Hypotension 3. Hypovolemia 4. Viagra use within 24 hours 5. Right ventricular infarct 6. Severe bradycardia or tachycardia 7. Hypersensitivity Side effects CNS Cardiovascular GI GU Eyes Skin
  9. 9. Anxiety Atrial fibrillation Abdominal pain Dysuria Confusion Collapse - LT Increase in angina Diarrhea Dyspepsia Impotence Urinary frequency Dysrhythmias LT Palpitations Nausea Sweating Vomiting Pallor Dizziness - C Uncoordination Blurred vision Flushing - C Pallor Burning sensation in contact area - C Headache - C Nervousness Postural hypotension - C Vertigo PVC’s Weakness Reflex Tachycardia Syncope Italic = C = common side effects Bold italic = LT = life-threatening reaction NITROGLYCERIN (NITROSTAT) Precautions 1. The drop in B/P may lead to decreased cerebral perfusion 2. Patient may develop tolerance to the drug 3. A reduction in the diastolic pressure may lead to ischemia and angina developing 4. Use cautiously with: - the patient having an inferior wall MI with possible RV involvement - severe renal / hepatic impairment - glaucoma Administration / dosage – ESTABLISH AN IV PRIOR TO ADMINISTRATION (on borderline patients- pressure close to 100mmHg) Administered: - pills, spray, patches, ointments, IV infusion - Prehospital - administer nitro. sublingually through pills or spray Dose: - 1 - 0.3 - 0.4mg tablet sublingual - repeated every 5 minutes (give up to 3 tablets) Sit or lie patient down – instruct not to swallow until tablet is entirely dissolved Dose: - 1-2 sprays - 0.4mg per spray sublingual - every 5 minutes (up to 3 sprays in 15 minutes) Spray for 0.5 to 1.0 seconds – Do not shake canister (may produce bubbles and alter medication delivery) MONITOR VITALS AFTER EACH DOSE PRIOR TO ADMINISTERING MORE DRUG SYSTOLIC BLOOD PRESSURE SHOULD NOT BE LESS THAN 100 mmHg PRIOR TO ADMINISTRATION. When administering to patients with: 1. Acute MI – don’t let systolic pressure drop more than 10% 2. Hypertension – don’t let systolic pressure drop more than 30%
  10. 10. 50% DEXTROSE (D50W) Class: carbohydrate, caloric agent Mechanism of action 1. Increases blood glucose concentrations 2. Provides calories 3. Decreases rate of ketone production 4. Osmotic diuretic Indications 1. Acute alcoholism with coma (deliver thiamine prior to D50W) 2. Hypoglycemia 3. Coma of unknown cause (NEED TO CHECK BG) 4. Status epilepticus of uncertain cause 5. Hyperkalemia – with insulin may shift K+ back to the intracellular space Contraindications 1. Hypersensitivity to corn or corn products 2. Thiamine deficient patients (may cause Korsakoff’s psychosis or Wernicke’s encephalopathy) 3. Intracranial hemorrhage (unless patient is hypoglycemic) Side effects Cardiovascular Hypertension CHF - LT Pulmonary edema - LT GU Osmotic diuresis Metabolic ↓ K+ and Mg++ Fluid overload bold italic = LT - life-threatening reactions Precautions 1. Excessive IV administration may cause fluid volume or solute overload 2. Use cautiously with: - Carbohydrate intolerance; renal insufficiency; chronic alcoholism (give Thiamine first); diabetes How supplied Skin Irritation Necrosis
  11. 11. - 25gm / 50ml (50% solution) Administration / dosage Administration - Slow IVP (in a large vein) Dose – 12.5 to 25 grams (25 to 50 cc) - Perform a D-stick prior to administration if possible - Give Thiamine prior if alcohol use is suspected Glucagon Class: Hyperglycemic agent; pancreatic hormone, insulin antagonist Mechanism of action: 1. Protein secreted by alpha cells of the pancreas. When released results in blood glucose elevation by increasing the breakdown of glycogen to glucose (glycogenolysis) and stimulating glucose synthesis (gluconeogenesis). 2. Only effective in treating hypoglycemia if liver glycogen is available and therefore may be ineffective in chronic states of: a. Hypoglycemia b. Starvation c. Adrenal insufficiency 3. Exerts (+) inotropic action on the heart and decreases renal vascular resistance a. Why used to manage patient with beta-blocker and calcium-channel blocker cardiotoxicity (that do not respond to other conventional therapy) Indications: 1. Altered LOC when hypoglycemia is suspected 2. Beta-blocker and calcium channel blocker toxicity. Contraindications: 1. Hyperglycemia 2. Hypersensitivity to proteins Side effects CNS Cardiovascular GI tachycardia Hypotension Vomiting=C common side effects=C GU Respiratory Skin Urticaria
  12. 12. How supplied 1unit (1mg) white powder with 1 mL of diluting solution (supplied) Reconstitute the powder with the diluent DO NOT MIX WITH NORMAL SALINE Administration / dosage - IM Adult - 0.5mg-1mg IM - repeat in 7-10 min Calcium Channel OD/Beta blocker OD: 3mg – followed by infusion at 3 mg / hour, prn Nitrous oxide:Oxygen (50/50) Nitronox Class: gaseous analgesic/anesthetic Mechanism of action A blend of 50% O2 and nitrous oxide. When inhaled, depresses the CNS causing anesthesia; In addition, the high concentration of oxygen delivered along with the nitrous oxide increases oxygen tension in the blood, thereby reducing hypoxia. It is self administered Indications Moderate to severe pain Anxiety Apprehension Contraindications 1. Impaired LOC 2. Head injury 3. Chest trauma (pnemothorax) 4. Inability to comply with instructions 5. Decompression sickness (nitrogen narcosis, air transport, air embolus) 6. Undiagnosed abdominal pain or marked distention 7. Bowel obstruction 8. Hypotention 9. Shock 10. COPD Side effects CNS Dizzy Cardiovascular GI GU Malignant Nausea/vomiting hypertention **Rare but dangerous common side effect=C bold italic = LT = life-threatening reaction How supplied Respiratory Apnea (LT) Skin Cyanosis
  13. 13. - D or E cylinders - blue and green in USA; blue and white in Canada Administration / dosage – start an IVP prior to administration Adult: oxide ENSURE enough O2 is in the tank to ensure oxygenation - invert cylinder several times before use – this mixes O2 and nitrous Instruct the patient to inhale deeply through a patient held mask or mouthpiece Pediatric: Same Special Consideration: Pregnancy: Nitrous oxide has been shown to increase the incident of spontaneious abortion Nitrous oxide - is 34 times more soluble than nitrogen and will diffuse into pockets of trapped gas in the patient (intestinal obstruction, pneumothorax, blocked middle ear. As nitrogen leaves and is replaced by larger amts of nitrous oxide, increase pressures or volumes may cause serious damage, for example, intestinal rupture Nitrous oxide is non-explosive gas Patient must hold mask and self administer ALBUTEROL (PROVENTIL) Class: Beta2 adrenergic agonist Mechanism of Action 1. Predominately stimulates β2 receptors 2. Minimal β1 stimulation 3. May cause reflex tachycardia (with high doses) 4. Promotes intracellular shift of K+ from serum 5. Inhibits histamine release from Mast cells 6. Increased diuresis Indications 1. Relief of bronchospasms associated with asthma, chronic bronchitis, emphysema - Reduces mucus secretions, capillary leaking, mucosal edema (by blocking histamine release) 2. Prevention of exercise-induced asthma and bronchospasms Contraindication 1. Hypersensitivity 2. Tachydysrhythmias 3. Severe cardiac disease Side Effects CNS Anxiety Cardiovascular Angina GI Heartburn Dysrhythmias Dizziness - C Flushing Hallucinations Hypertension Palpitations - C Nausea - C Vomiting Musculoskeletal Inhibition of uterine contractions Muscle cramps Respiratory Cough
  14. 14. Headache - C Irritability Tachycardia - C Stimulation - C Tremors - C Italic = LT - C = common side Precautions 1. May develop tolerance with prolonged use (vm) 2. Repeated or excessive use may lead to paradoxical bronchoconstriction 3. Use cautiously with: - cardiac disorders - hypertension - diabetes - prostatic hypertrophy ALBUTEROL (PROVENTIL) How Supplied - 2.5mg/ 2.5ml Administration/Dosage Two ways to administer: 1. Metered dose inhaler: - 1- 2 sprays (90 - 180µg is delivered) q 4-6 hours – Max.: 12 inhalations / day 2. Nebulizer: - Adults and children over 12: Dilute 2.5mg in 3.0 ml of NS - Nebulizer should deliver 3.0 ml over 5 to 15 minutes – 3-4 times / day
  15. 15. NALOXONE (NARCAN) Class: Opiate antagonist Mechanism of Action 1. Reverses effects of narcotics or synthetic narcotics - Competes for and displaces narcotic molecules from opiate receptors in the brain - Reverses stupor, coma, respiratory depression caused by opiates - Duration of action is shorter than opiates Indications - Narcotic / synthetic narcotic overdose - Coma of unknown cause - Coma from alcohol Narcotics - heroin, morphine, methadone, codeine, Demerol, Dilaudid, Paregoric, fentanyl, Percodan, hydromorphone, meperidine, oxycodone, propoxyphene Synthetic narcotics (narcotic agonists / antagonist) - Talwin, Darvon, Nubain, Stadol Contraindications - Hypersensitivity to the drug Respiratory depression is due to nonopiate drugs Side effects CNS Seizures - LT Cardiovascular Hypertension GI Nausea Tremors Hypotension Ventricular Dysrhythmias - LT Vomiting Respiratory Pulmonary edema LT Hyperventilation Skin Sweating
  16. 16. Cardiac arrest - LT Bold italic = LT - life-threatening Side effects usually occur due to rapid IVP causing withdrawal to occur = deliver slow IVP to increase respirations Precautions - May need to repeat the dose (effects of Narcan may wear off before narcotic) - May cause excitement, hypertension, tachycardia (due to rapid IVP) - May cause hypertension or hypotension, pulmonary edema, ventricular fibrillation if given to patients with cardiovascular disorders. How supplied - Ampoules or prefilled syringes containing - 2 mg / 2ml or 0.4mg / 1mL or 10mL - Vials containing 10mg / 10ml NALOXONE (NARCAN) Administration and dosage: Administered - Slow IVP, IM, SQ, ET (diluted) , Infusion Slow IVP 0.4-2mg SIVP Repeat at 2-3 minute intervals ET 2-2.5 times the SIVP dose Dilute in 10cc of fluid After 10mg have been given, with no response, reevaluate diagnosis Darvon / Alcohol 2-5mg SIVP Infusion 8mg / 1000cc of D5W Infuse at 2/3 of the initial reversal dose – titrated to desired effect Repeat S/A IVP route *** GIVE THE DRUG SLOWLY TO INCREASE THE PATIENTS MINUTE VOLUME *** If GIVEN RAPIDLY IT CAN CAUSE WITHDRAWAL LEADING TO ADVERSE SIDE EFFECTS The