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Emergency medication ppt
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- 2. National EMS Education StandardCompetencies Pharmacology Integrates comprehensive knowledge of pharmacology to formulate a treatment plan intended to mitigate emergencies and improve the overall health of the patient.
- 3. National EMS Education StandardCompetencies Emergency Medications • Names • Effects • Indications • Routes of administration • Dosages for the medications administered
- 4. National EMS Education StandardCompetencies Emergency Medications (cont’d) • Actions • Contraindications • Complications • Side Effects • Interactions
- 5. Introduction • Paramedics musthave a comprehensive understanding of all medications they might administer. − Pharmacology is one of the more difficult subjects to master.
- 6. Introduction • Paramedics haveto make quick decisions about: − When to administer medications − What medications to administer − When administering certain medications would be harmful to the patient
- 7. Introduction • Pharmacology isconstantly changing. − Stay up to date on the latest pharmacologic information. • State and regional EMS systems have the right to include medications and indications. − Always follow local protocols.
- 8. AHA Classification of Recommendationsand Level of Evidence • Class I − A treatment should be administered. • Class IIa − It is reasonable to administer treatment. • Class IIb − Treatment may be considered.
- 9. AHA Classification of Recommendationsand Level of Evidence • Class III − Treatment should NOT be administered. − It is harmful, not helpful. • Class Indeterminate − Research is either beginning or continuing on this treatment. − Cannot be recommended for or against
- 10. Pregnancy Category Ratings forDrugs • Category A − Possibility of fetal harm appears to be remote • Category B − Either: • Animal studies have not demonstrated a fetal risk but there are no controlled studies in women or • Animal reproductive studies have shown an adverse effect that was not confirmed in controlled studies on women in the first trimester
- 11. Pregnancy Category Ratings forDrugs • Category C − Drugs in this category should be given only if the potential benefit justifies the risk to the fetus. • Category D − There is positive evidence of human fetal risk, but the benefits for pregnant women may be acceptable despite the risk.
- 12. Pregnancy Category Ratings forDrugs • Category X − The risk of using the drug in pregnant women clearly outweighs any possible benefit. − The drug is contraindicated in women who are or may become pregnant.
- 13. Federal “Controlled SubstanceAct of 1970” Schedule Summary • The legal foundation of the government’s fight against abuse of drugs and other substances. − Consolidation of many laws regulating the manufacture/distribution of controlled substances − Enforced by the DEA
- 14. Radio Communications • Becomefamiliar with terminology related to medications and medication administration. • Be familiar with common medical abbreviations.
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- 17. Drug Dosage Calculations •Desired dose − Quantity of a medication that is to be administered • Concentration − Amount of medication that is present in vial • Volume − Amount of fluid medication is dissolved in • Yield − The amount of drug in 1 mL
- 18. Medication Listings • Nameof medication − And other common names • Class − How the medication is classified compared to other medications
- 19. Medication Listings • Mechanismof action − The way a medication produces the intended response • Indications − Circumstance that shows cause or warning of disease • Contraindications − Any condition that renders some particular line of treatment improper or undesirable
- 20. Medication Listings • Adversereaction/side effects − An abnormal or harmful effect to an organism caused by exposure to a chemical • Drug interactions − Any potential effects a medication may have when administered with or in the presence of something else in the patient’s system
- 21. Medication Listings • Howsupplied − How the manufacturer packages the medication for distribution and sale • Dosage and administration − Typical or average volume of the medication to be administered and the route of introduction
- 22. Medication Listings • Durationof action − Onset − Peak effect − Duration • Special considerations
- 23. Activated Charcoal (EZ-Char, Actidose,Liqui-Char) • Mechanism of action − Absorbs toxic substances from the gastrointestinal tract • Indications − Most oral poisonings/ medication overdoses • Contraindications − Oral administration to comatose patients • Adverse reactions − If aspirated, can induce fatal form of pneumonitis − Bowel obstruction • Considerations − Mix contents well before administration. − Does not absorb cyanide, lithium, iron, lead, or arsenic
- 24. Adenosine (Adenocard) • Mechanism ofaction − Slows conduction through the AV node − Can interrupt reentrant pathways − The drug of choice for reentry SVT • Indications − Most forms of stable narrow-complex SVT • Contraindications − Bronchoconstrictive or bronchospastic lung disease • Adverse reactions − Generally short duration and mild • Considerations − Evaluate elderly for signs of dehydration
- 25. Albuterol (Proventil, Ventolin) • Mechanismof action − Results in smooth- muscle relaxation in the bronchial tree • Indications − Treatment of bronchospasm in patients with COPD/asthma) • Contraindications − Hypersensitivity reactions to albuterol • Adverse reactions − Often dose-related and include headache, fatigue, lightheadedness, irritability, restlessness • Considerations − Pregnancy safety: Category C − May precipitate angina pectoris and dysrhythmias
- 26. Alteplase, Recombinant (Tissue PlasminogenActivator or rTPA, Activase) • Mechanism of action − Restores perfusion • Indications − Acute myocardial infarction, STEMI, massive pulmonary emboli, acute ischemic cerebrovascular accident • Contraindications − Active internal bleeding − Recent surgery • Adverse reactions − Intracranial bleeding, reperfusion dysrhythmias, chest pain, hypotension, GI bleeding, nausea, abdominal pain • Considerations − Monitor vital signs closely. − Observe for bleeding.
- 27. Amiodarone (Cordarone, Pacerone) • Mechanismof action − Delays repolarization and increases the duration of action potential • Indications − Ventricular fibrillation • Contraindications − Known hypersensitivity to amiodarone or iodine − Cardiogenic shock • Adverse reactions − Dizziness, fatigue, malaise − Congestive heart failure • Considerations − Pregnancy safety: Category D − Monitor patient for hypotension.
- 28. Amyl Nitrite • Mechanismof action − Converts hemoglobin to methemoglobin to prevent toxic effects • Indications − Cyanide poisoning • Contraindications − None in emergency settings • Adverse reactions − Headache, dizziness, weakness • Considerations − Pregnancy safety: Category X − Highly flammable
- 29. Aspirin (ASA, Bayer,Ecotrin, St. Joseph, and Others) • Mechanism of action − Prevents platelets from clumping together and forming emboli • Indications − New onset chest pain suggestive of acute myocardial infarction • Contraindications − Relatively contraindicated in patients with active ulcer disease or asthma • Adverse reactions − Bronchospasm, anaphylaxis, wheezing in allergic patients, prolonged bleeding • Considerations − Pregnancy safety: Category D − Not recommended in pediatric population
- 30. Atenolol (Tenormin) • Mechanism ofaction − Decreases heart rate, myocardial contractility, and cardiac output • Indications − To reduce myocardial ischemia and damage in acute myocardial infarction patients • Contraindications − Heart failure, cardiogenic shock, bradycardia • Adverse reactions − Dizziness, bronchospasm, bradycardia • Considerations − Pregnancy safety: Category D − Atenolol must be given slowly IV over 5 minutes − Should be used with caution in patients with liver or renal dysfunction and COPD
- 31. Atropine Sulfate • Mechanismof action − Increases heart rate in life-threatening bradydysrhythmias • Indications − Hemodynamically unstable bradycardia • Contraindications − Tachycardia, hypersensitivity • Adverse reactions − Drowsiness, confusion, headache, tachycardia, palpitations • Considerations − Pregnancy safety: Category C − Moderate doses may cause pupillary dilation.
- 32. Benzocaine Spray (Hurricane) •Mechanism of action − Stabilizes neuronal membrane, which blocks the initiation and conduction of nerve impulses • Indications − Suppresses pharyngeal and tracheal gag reflex • Contraindications − People with known hypersensitivity to benzocaine • Adverse reactions − Methemoglobinemia has been reported on extremely rare occasions. • Considerations − Pregnancy safety: Category C − Topical use only; not for ocular use or injection
- 33. Bumetanide (Bumex) • Mechanism ofaction − Inhibits the reabsorption of sodium and chloride in the ascending limb of the loop of Henle • Indications − Pulmonary edema, congestive heart failure • Contraindications − Hypersensitivity to bumetanide or sulfonamides • Adverse reactions − Dizziness, headache, orthostatic hypotension • Considerations − Pregnancy safety: Category C
- 34. Calcium Chloride • Mechanismof action − Increases cardiac contractile state • Indications − Hypocalcemia, hyperkalemia, hypermagnesemia • Contraindications − Hypercalcemia, ventricular fibrillation, digitalis toxicity • Adverse reactions − Syncope, cardiac arrest, dysrhythmia, bradycardia • Considerations − Pregnancy safety: Category C − Do not use routinely in cardiac arrest.
- 35. Calcium Gluconate • Mechanismof action − Counteracts the toxicity of hyperkalemia • Indications − Hyperkalemia, hypocalcemia • Contraindications − Ventricular fibrillation, digitalis toxicity, hypercalcemia • Adverse reactions − Syncope, cardiac arrest, dysrhythmia, bradycardia • Considerations − Pregnancy safety: Category C − Do not administer by IM or SQ
- 36. Clopidogrel (Plavix) • Mechanism ofaction − Inhibits platelet aggregation • Indications − Acute coronary syndrome − Substitute for aspirin in patients unable to take aspirin • Contraindications − Active GI bleeding, intracranial hemorrhage • Adverse reactions − Severe neutropenia − Hemorrhaging • Considerations − Pregnancy safety: Category B − Often given with other anticoagulants
- 37. Dexamethasone Sodium Phosphate (Decadron) •Mechanism of action − Suppresses acute and chronic inflammation • Indications − Anaphylaxis, asthma, spinal cord injury • Contraindications − Hypersensitivity, use caution in suspected systemic sepsis • Adverse reactions − Headache, restlessness, euphoria, psychoses • Considerations − Pregnancy safety: Category C − Protect medication from heat. Toxicity and side effects occur with long-term use.
- 38. Dextrose • Mechanism ofaction − Rapidly increases serum glucose levels • Indications − Hypoglycemia, altered level of consciousness • Contraindications − Intracranial hemorrhage • Adverse reactions − Cerebral hemorrhage − Cerebral ischemia − Pulmonary edema • Considerations − Pregnancy safety: Category C
- 39. Diazepam (Valium and Others) •Mechanism of action − Raises the seizure threshold; induces amnesia and sedation • Indications − Acute anxiety states and agitation, acute alcohol withdrawal • Contraindications − Hypersensitivity, narrow-angle glaucoma • Adverse reactions − Dizziness, drowsiness, confusion, headache • Considerations − Pregnancy safety: Category D − Short duration for anticonvulsant effect − Reduce dose by 50% in elderly patients.
- 40. Digoxin (Lanoxin) • Mechanism ofaction − Increases force of myocardial contraction • Indications − Congestive heart failure, reentry SVTs, ventricular rate control in atrial flutter and atrial fibrillation • Contraindications − Ventricular fibrillation, ventricular tachycardia, digitalis toxicity • Adverse reactions − Fatigue, headache, blurred yellow or green vision, seizures • Considerations − Pregnancy safety: Category C − Patient receiving IV digoxin must be on a monitor
- 41. Diltiazem (Cardizem) • Mechanism ofaction − Reduces myocardial oxygen demand • Indications − Controls rapid ventricular rates • Contraindications − Hypotension − Sick sinus syndrome • Adverse reactions − Dizziness, weakness, headache, dyspnea • Considerations − Pregnancy safety: Category C − Use with caution in patients with renal or hepatic dysfunction.
- 42. Diphenhydramine (Benadryl) • Mechanism ofaction − Blocks cellular histamine receptors • Indications − Symptomatic relief of allergies, allergic reactions, and anaphylaxis • Contraindications − Asthma, glaucoma, pregnancy, hypertension • Adverse reactions − Drowsiness, sedation, seizures • Considerations − Pregnancy safety: Category B − Not used in infants
- 43. Dobutamine Hydrochloride (Dobutrex) • Mechanismof action − Increased myocardial contractility, stroke volume, and increased cardiac output • Indications − Cardiogenic shock, CHF • Contraindications − Tachydysrhythmias, severe hypotension • Adverse reactions − Headache, dyspnea, tachycardia, hypertension, chest pain • Considerations − Pregnancy safety: Category B − Monitor blood pressure closely.
- 44. Dolasetron (Anzemet) • Mechanism ofaction − Selectively blocks the action of serotonin • Indications − Prevention and control of nausea or vomiting • Contraindications − Use caution in patients with cardiac dysrhythmias or electrolyte abnormalities • Adverse reactions − ECG changes, dysrhythmias, anaphylactic reaction, headache, hypotension • Considerations − Pregnancy safety: Category B − Injectable form should not be used in patients with chemotherapy- induced nausea and vomiting.
- 45. Dopamine Hydrochloride (Intropin) • Mechanismof action − Increases myocardial contractility and stroke volume • Indications − Cardiogenic and septic shock, hypotension with low cardiac output states • Contraindications − Hypovolemic shock, pheochromocytoma, tachydysrhythmias • Adverse reactions − Headache, anxiety, dyspnea, dysrhythmias • Considerations − Pregnancy safety: Category C − Effects are dose- dependent
- 46. Epinephrine (Adrenalin) • Mechanism ofaction − Blocks histamine receptors • Indications − Cardiac arrest, symptomatic bradycardia • Contraindications − Hypertension, hypothermia, pulmonary edema • Adverse reactions − Nervousness, restlessness, headache, tremor • Considerations − Pregnancy safety: Category C − May cause syncope in asthmatic children
- 47. Epinephrine Racemic (Micronefrin) • Mechanismof action − Reduces airway resistance • Indications − Bronchial asthma, prevention of bronchospasm, croup • Contraindications − Hypertension, underlying cardiovascular disease, epiglottitis • Adverse reactions − Headache, anxiety, fear, nervousness, respiratory weakness • Considerations − May cause tachycardia and other dysrhythmias − Monitor vital signs.
- 48. Eptifibatide (Integrilin) • Mechanism ofaction − Prevents the aggregation of platelets • Indications − Unstable angina and NSTEMI (ACS) being managed medically • Contraindications − Any prior intracranial hemorrhage, known malignant intracranial neoplasm, suspected aortic dissection • Adverse reactions − Cerebral hemorrhage, pulmonary hemorrhage, hypotension, GI bleeding • Considerations − Pregnancy safety: Category B − Must be administered only with an infusion pump direct from bottle with a vented IV set
- 49. Etomidate (Amidate) • Mechanism ofaction − Short-acting hypnotic • Indications − Premedication for tracheal intubation or cardioversion • Contraindications − Hypersensitivity, labor/delivery • Adverse reactions − Apnea of short duration, respiratory depression, hypoventilation, hyperventilation • Considerations − Pregnancy safety: Category C − Carefully monitor vital signs.
- 50. Fentanyl Citrate (Sublimaze) • Mechanismof action − Produces analgesia and euphoria • Indications − Pain management, anesthesia adjunct • Contraindications − Known hypersensitivity. Use with caution in traumatic brain injury. • Adverse reactions − Confusion, paradoxical excitation, delirium, drowsiness • Considerations − Pregnancy safety: Category C − Chest wall rigidity possible with a high- dose rapid infusion
- 51. Flumazenil (Romazicon) • Mechanism ofaction − Reverses the sedative effects of benzodiazepines • Indications − Reversal of respiratory depression and sedative effects from benzodiazepine • Contraindications − Hypersensitivity, tricyclic antidepressant overdose, seizure- prone patients • Adverse reactions − Seizures, dizziness, agitation, confusion, headache, visual disturbances • Considerations − Pregnancy safety: Category C − Not recommended in combined drug overdoses
- 52. Fosphenytoin (Cerebyx) • Mechanism ofaction − Elevates the excitability threshold of the cell, reducing its response to stimuli • Indications − Status epilepticus, seizure disorder • Contraindications − Bradycardia, Adams- Stokes syndrome, second- or third- degree AV blocks • Adverse reactions − Severe hypotension, bradycardia, dysrhythmias • Considerations − Pregnancy safety: Category D − Use with caution in patients with hepatic and renal impairment and diabetic, elderly, and debilitated patients.
- 53. Furosemide (Lasix) • Mechanism ofaction − Causes increased urine output • Indications − CHF, pulmonary edema, hypertensive crisis • Contraindications − Hypovolemia, anuria, hypotension • Adverse reactions − Dizziness, headache, ECG changes, weakness • Considerations − Pregnancy safety: Category C − Ototoxicity, deafness, and projectile vomiting can occur with rapid administration.
- 54. Glucagon (GlucaGen) • Mechanism ofaction − Increases blood glucose level • Indications − Altered level of consciousness when hypoglycemia is suspected • Contraindications − Hyperglycemia, hypersensitivity • Adverse reactions − Dizziness, headache, hypertension, tachycardia • Considerations − Pregnancy safety: Category B − Should be used in conjunction with 50% dextrose whenever possible
- 55. Haloperidol Lactate (Haldol) • Mechanismof action − Inhibits central nervous system catecholamine receptors • Indications − Acute psychotic episodes • Contraindications − Parkinson's disease, depressed mental status • Adverse reactions − Seizures, sedation, confusion, restlessness • Considerations − Pregnancy safety: Category C − Treat hypotension secondary to haloperidol with fluids and norepinephrine, not epinephrine
- 56. Heparin Sodium • Mechanismof action − Affects clotting factors IX, XI, XII, plasmin; does not lyse existing clots • Indications − Acute myocardial infarction, prophylaxis and treatment of thromboembolic disorders • Contraindications − Hypersensitivity, active bleeding • Adverse reactions − Pain, anaphylaxis, shock, hematuria • Considerations − Pregnancy safety: Category C − Heparin does not lyse existing clots.
- 57. Hydrocortisone Sodium Succinate (Solu-Cortef) •Mechanism of action − Anti-inflammatory; immunosuppressive with salt-retaining actions • Indications − Shock due to acute adrenocortical insufficiency, anaphylaxis, asthma, and COPD • Contraindications − Systemic fungal infections, premature infants • Adverse reactions − Headache, vertigo, pulmonary tuberculosis • Considerations − Pregnancy safety: Category C − May be used in status asthmaticus as a second-line drug
- 58. Hydroxocobalamin (Cyanokit) • Mechanismof action − Binds with cyanide to prevent its toxic effects • Indications − Treatment of known or suspected cyanide poisoning • Contraindications − None in the emergency setting • Adverse reactions − Hypertension, allergic reactions, GI bleeding, nausea, vomiting • Considerations − Pregnancy safety: Category C − Make sure to reassess the patient’s airway, oxygenation, and hydration during administration.
- 59. Hydroxyzine (Atarax, Vistaril) • Mechanismof action − Potentiates effects of analgesics • Indications − Controls nausea and vomiting in anxiety reactions and motion sickness • Contraindications − Hypersensitivity, early pregnancy • Adverse reactions − Drowsiness, agitation, ataxia, dizziness, headache, weakness • Considerations − Pregnancy safety: Category C − Should be administered by IM injection only
- 60. Insulin • Mechanism ofaction − Allows glucose transport into cells of all tissues • Indications − Not used in emergency prehospital setting • Contraindications − Hypoglycemia, hypokalemia • Adverse reactions − Weakness, fatigue, confusion, headache • Considerations − Pregnancy safety: Category B − Insulin is the drug of choice for control of diabetes in pregnancy.
- 61. Ipratropium (Atrovent) • Mechanism ofaction − Inhibits interaction of acetylcholine at receptor sites of bronchial smooth muscle • Indications − Persistent bronchospasm, COPD exacerbation • Contraindications − Hypersensitivity to ipratropium, atropine, alkaloids, peanuts • Adverse reactions − Headache, dizziness, nervousness, fatigue • Considerations − Pregnancy safety: Category B − Shake well before use.
- 62. Isoetharine (Bronchosol, Bronkometer) • Mechanismof action − Relaxes smooth muscle of bronchioles • Indications − Acute bronchial asthma, bronchospasm • Contraindications − Use with caution in patients with diabetes, hyperthyroidism, and cardiovascular and cerebrovascular disease. • Adverse reactions − Nervousness, dose- related tachycardia, palpitations • Considerations − None
- 63. Ketorolac Tromethamine (Toradol) • Mechanismof action − Potent analgesic • Indications − Short-term management of moderate to severe pain • Contraindications − Allergy to salicylates or other nonsteroidal anti-inflammatory drugs • Adverse reactions − Drowsiness, dizziness, headache, sedation • Considerations − Pregnancy safety: Category C − Use with caution in elderly patients due to higher risk of renal and fatal GI adverse reactions.
- 64. Labetalol (Normodyne, Trandate) • Mechanismof action − Blood pressure reduction without reflex tachycardia • Indications − Moderate to severe hypertension • Contraindications − Bronchial asthma, congestive heart failure, cardiogenic shock • Adverse reactions − Fatigue, weakness, depression, headache, dizziness • Considerations − Pregnancy safety: Category C − Blood pressure, pulse rate, and ECG should be monitored continuously.
- 65. Levalbuterol (Xopenex) • Mechanism ofaction − Relaxation of bronchial tree and peripheral vasculature • Indications − Treatment of acute bronchospasm in patients with reversible obstructive airway disease • Contraindications − Hypersensitivity to drug and other sympathomimetics • Adverse reactions − Headache, anxiety, dizziness, restlessness, hallucinations • Considerations − Pregnancy safety: Category C − Use with caution in patients with cardiac dysrhythmias and cardiovascular disorders.
- 66. Lidocaine Hydrochloride (Xylocaine) • Mechanismof action − Decreases automaticity • Indications − Alternative to amiodarone in cardiac arrest from ventricular tachycardia • Contraindications − Hypersensitivity, second- or third- degree AV block in the absence of an artificial pacemaker • Adverse reactions − Anxiety, drowsiness, confusion, seizures • Considerations − Apnea induced with succinylcholine may be prolonged with high doses of lidocaine. − Exceedingly high doses can result in coma or death.
- 67. Lorazepam (Ativan) • Mechanism ofaction − Anxiolytic, anticonvulsant, and sedative effect • Indications − Initial control of status epilepticus or severe recurrent seizures • Contraindications − Acute narrow-angle glaucoma, coma, shock • Adverse reactions − Dizziness, drowsiness, CNS depression, headache • Considerations − Pregnancy safety: Category D − Monitor respiratory rate and blood pressure during administration.
- 68. Magnesium Sulfate • Mechanismof action − Reduces striated muscle contractions • Indications − Seizures of eclampsia, torsades de pointes, hypomagnesemia • Contraindications − Heart block, myocardial damage • Adverse reactions − Drowsiness, CNS depression, respiratory depression • Considerations − Pregnancy safety: Category A − Recommended that the drug not be administered in the 2 hours before delivery, if possible
- 69. Mannitol (Osmitrol) • Mechanism ofaction − Decreases cerebral edema and intracranial pressure • Indications − Cerebral edema • Contraindications − Hypotension, pulmonary edema, severe dehydration, intracranial bleeding, CHF • Adverse reactions − Headache, confusion, seizures, pulmonary edema • Considerations − Pregnancy safety: Category C − May crystallize at low temperatures; store at room temperature − Have ventilatory support available.
- 70. Meperidine Hydrochloride (Demerol) • Mechanismof action − Primarily acts as an analgesic and a sedative • Indications − Analgesia for moderate to severe pain • Contraindications − Hypersensitivity to narcotics • Adverse reactions − Seizures, confusion, sedation, dysphoria, headache • Considerations − Pregnancy safety: Category C − Use with caution in patients with asthma and COPD
- 71. Metaproterenol Sulfate (Alupent) • Mechanismof action − Acts directly on bronchial smooth muscle causing relaxation • Indications − Bronchial asthma, COPD • Contraindications − Tachydysrhythmia, hypersensitivity, tachycardia caused by digitalis toxicity • Adverse reactions − Nervousness, tremor, headache, anxiety • Considerations − Pregnancy safety: Category C − Monitor for hypotension and tachycardia.
- 72. Methylprednisolone Sodium Succinate (Solu-Medrol) •Mechanism of action − Suppresses acute and chronic inflammation • Indications − Acute spinal cord trauma, anaphylaxis, bronchodilator for unresponsive asthma • Contraindications − Premature infants, systemic fungal infections • Adverse reactions − Depression, euphoria, headache, restlessness, seizure • Considerations − Pregnancy safety: Category C − Not effective if time of spinal cord injury greater than 8 hours
- 73. Metoprolol Tartrate (Lopressor) • Mechanismof action − Decreases heart rate • Indications − PSVT, atrial flutter, atrial fibrillation • Contraindications − Heart failure, second- or third-degree AV block • Adverse reactions − Weakness, dizziness, depression, bronchospasm • Considerations − Pregnancy safety: Category C − Metoprolol must be given slow IV over 5 minutes
- 74. Midazolam Hydrochloride (Versed) • Mechanismof action − Causes sedative, anxiolytic, amnesic, and hypnotic effects • Indications − Sedation for medical procedures • Contraindications − Acute narrow-angle glaucoma, shock, coma, alcohol intoxication • Adverse reactions − Headache, somnolence, respiratory depression • Considerations − Pregnancy safety: Category D − Administer immediately prior to intubation procedure.
- 75. Morphine Sulfate (Roxanol, MSContin) • Mechanism of action − Alleviates pain through CNS action • Indications − Severe CHF, acute cardiogenic pulmonary edema • Contraindications − Head injury, exacerbated COPD, depressed respiratory drive • Adverse reactions − Confusion, sedation, headache, CNS depression • Considerations − Pregnancy safety: Category C − Morphine rapidly crosses the placenta.
- 76. Nalbuphine Hydrochloride (Nubain) • Mechanismof action − Activates opiate receptor • Indications − Chest pain with acute MI, acute pain • Contraindications − Head injury, undiagnosed abdominal pain, diarrhea from poison, hypovolemia, hypotension • Adverse reactions − Headache, dizziness, vertigo, seizure • Considerations − Pregnancy safety: Category B − Use with caution in patients with impaired respiratory function.
- 77. Naloxone Hydrochloride (Narcan) • Mechanismof action − Reverses respiratory depression secondary to opiate drugs • Indications − Opiate overdose, complete or partial reversal of central nervous system and respiratory depression induced by opioids • Contraindications − Use with caution in narcotic-dependent patients • Adverse reactions − Restlessness, seizures, dyspnea, pulmonary • Considerations − Pregnancy safety: Category C
- 78. Nifedipine (Procardia, Adalat) • Mechanismof action − Inhibits movement of calcium ions across cell membranes • Indications − Hypertensive crisis, angina pectoris • Contraindications − Compensatory hypertension, hypotension • Adverse reactions − Headache, dizziness, nervousness, weakness, mood changes • Considerations − Pregnancy safety: Category C − Have beta blocker available for control of reflex tachycardia
- 79. Nitroglycerin (Nitrostat, Nitro-Bid, Tridil) •Mechanism of action − Smooth muscle relaxant acting on vasculature, bronchial, uterine, intestinal smooth muscle • Indications − Acute angina pectoris, ischemic chest pain • Contraindications − Hypotension, hypovolemia, intracranial bleeding or head injury • Adverse reactions − Headache, dizziness, weakness, reflex tachycardia • Considerations − Pregnancy safety: Category C − Hypotension more common in the elderly
- 80. Nitropaste (Nitro-Bid Ointment) • Mechanismof action − Smooth muscle relaxant • Indications − Acute angina pectoris • Contraindications − Hypotension, hypovolemia, intracranial bleeding or head injury • Adverse reactions − Headache, dizziness, weakness • Considerations − Pregnancy safety: Category C − Not a great value in prehospital arena
- 81. Nitrous Oxide 50:50(Nitronox) • Mechanism of action − Exact mechanism unknown • Indications − Moderate to severe pain, anxiety, apprehension • Contraindications − Impaired level of consciousness, head injury • Adverse reactions − Lightheadedness, drowsiness, respiratory depression • Considerations − Pregnancy safety: Category C − Nitrous oxide increases the incidence of spontaneous abortion.
- 82. Norepinephrine Bitartrate (Levophed) • Mechanismof action − Potent alpha-agonist resulting in intense peripheral vasoconstriction • Indications − Cardiogenic shock, unresponsive to fluid resuscitation • Contraindications − Hypotensive patients with hypovolemia • Adverse reactions − Headache, anxiety, dizziness • Considerations − Pregnancy safety: Category C. − May cause fetal anoxia when used in pregnancy
- 83. Ondansetron Hydrochloride (Zofran) • Mechanismof action − Blocks action of serotonin • Indications − Prevention and control of nausea or vomiting • Contraindications − Known allergy to ondansetron • Adverse reactions − Headache, malaise, wheezing • Considerations − Pregnancy safety: Category B
- 84. Oral Glucose (Insta-Glucose) • Mechanismof action − Provides an increase in circulating blood glucose levels • Indications − Conscious patients with suspected hypoglycemia • Contraindications − Decreased level of consciousness, nausea, vomiting • Adverse reactions − Nausea, vomiting • Considerations − Must be swallowed. Glucose is not absorbed sublingually or buccally.
- 85. Oxygen • Mechanism ofaction − Reverses hypoxemia • Indications − Confirmed or expected hypoxemia, ischemic chest pain • Contraindications − Certain patients with COPD will not tolerate oxygen concentrations over 35%. • Adverse reactions − Decreased level of consciousness (COPD patients), decreased respiratory drive in COPD patients • Considerations − Be familiar with liter flow and each type of delivery device used.
- 86. Oxytocin (Pitocin) • Mechanism ofaction − Increases uterine contractions • Indications − Postpartum hemorrhage after infant and placental delivery • Contraindications − Presence of second fetus, unfavorable fetal position • Adverse reactions − Coma, seizures, anxiety • Considerations − Pregnancy safety: Category C − Monitor vital signs including fetal heart rate and uterine tone closely.
- 87. Pancuronium Bromide (Pavulon) • Mechanismof action − Binds to the receptor for acetylcholine at the neuromuscular junction • Indications − Induction or maintenance of paralysis after intubation to assist ventilations • Contraindications − Hypersensitivity, inability to control airway and/or support ventilations with oxygen and positive pressure • Adverse reactions − Weakness, prolonged neuromuscular block, bronchospasm • Considerations − Always sedate the patient before administering.
- 88. Phenobarbital (Luminal) • Mechanism ofaction − Generally unknown but believed to reduce neuronal excitability • Indications − Prevention and treatment of seizure activity, status epilepticus • Contraindications − Patients with porphyria, history of sedative or hypnotic addiction • Adverse reactions − Coma, drowsiness, headache, vertigo, paradoxic excitation • Considerations − Pregnancy safety: Category D − Potential for abuse − Carefully monitor vital signs.
- 89. Phenytoin (Dilantin) • Mechanism ofaction − Promotes sodium efflux from neurons • Indications − Prophylaxis and treatment of major motor seizures • Contraindications − Hypersensitivity, bradycardia • Adverse reactions − Ataxia, agitation, dizziness, headache, drowsiness • Considerations − Pregnancy safety: Category D − Carefully monitor vital signs.
- 90. Pralidoxime (2-PAM, Protopam) • Mechanismof action − Acts as an antidote to organophosphate and pesticide poisonings • Indications − As an antidote in the treatment of poisoning • Contraindications − Reduce dose in patients with impaired renal function, and patients with myasthenia gravis • Adverse reactions − Dizziness, drowsiness, headache, neuromuscular blockade • Considerations − Pregnancy safety: Category C − Slow IV infusion prevents tachycardia, laryngospasm, muscle rigidity
- 91. Procainamide Hydrochloride (Pronestyl) • Mechanismof action − Suppresses intraventricular conduction • Indications − Stable monomorphic ventricular tachycardia with normal QT interval • Contraindications − Torsades de pointes, second- and third- degree heart atrioventricular block • Adverse reactions − Confusion, seizures, hypotension, bradycardia • Considerations − Pregnancy safety: Category C − Potent vasodilation and negative inotropic effects
- 92. Promethazine Hydrochloride (Phenergan) • Mechanismof action − H-1 receptor antagonist; blocks action of histamine • Indications − Nausea/vomiting, motion sickness, sedation for patients in labor • Contraindications − Coma, central nervous system depression from alcohol, barbiturates, or narcotics • Adverse reactions − Headache, dizziness, drowsiness, confusion, restlessness, wheezing • Considerations − Pregnancy safety: Category C − Convulsions and sudden death when used with children
- 93. Propofol (Diprivan) • Mechanism ofaction − Produces rapid and brief state of general anesthesia • Indications − Anesthesia induction/ maintenance, sedation for mechanically ventilated patients • Contraindications − Hypovolemia, known sensitivity • Adverse reactions − Seizure, apnea, dysrhythmias, asystole, hypotension, hypertension • Considerations − Pregnancy safety: Category B − Avoid rapid administration in elderly patients to avoid hypotension and airway obstruction.
- 94. Propranolol Hydrochloride (Inderal) • Mechanismof action − Reduces chronotropic, inotropic, and vasodilator response to beta-adrenergic stimulation • Indications − Hypertension, angina pectoris • Contraindications − Sinus bradycardia, second- or third- degree AV block • Adverse reactions − Weakness, depression, fatigue, anxiety, dizziness, bronchospasm • Considerations − Pregnancy safety: Category C − Closely monitor patient during administration. − Use with caution in elderly patients. − Atropine should be readily available.
- 95. Rocuronium Bromide (Zemuron) • Mechanismof action − Produces skeletal muscle paralysis • Indications − Rapid sequence intubation • Contraindications − Known sensitivity to bromides. Use with caution in heart and liver disease. • Adverse reactions − Bronchospasm, wheezing, rhonchi, respiratory depression, apnea • Considerations − Pregnancy safety: Category B − Decrease doses for patients with renal disease. − Sedate patient before administering.
- 96. Sodium Bicarbonate • Mechanismof action − Buffers metabolic acidosis and lactic acid buildup • Indications − Metabolic acidosis during cardiac arrest, tricyclic antidepressant, aspirin • Contraindications − Metabolic/respiratory alkalosis, hypokalemia, electrolyte imbalance • Adverse reactions − Hypernatremia, metabolic alkalosis, tissue sloughing, cellulitis • Considerations − Pregnancy safety: Category C − Repeat as needed in tricyclic antidepressant overdose until QRS narrows
- 97. Sodium Nitrate • Mechanismof action − Reacts with hemoglobin to form methemoglobin, which reacts with cyanide • Indications − Cyanide poisoning • Contraindications − None in the emergency setting • Adverse reactions − Hypotension, tachycardia, fainting, nausea, vomiting • Considerations − Pregnancy safety: Category C − Potent vasodilator causes significant hypotension if given too rapidly
- 98. Sodium Thiosulfate • Mechanismof action − Converts cyanide to the less toxic thiocyanate, which is then excreted in the urine • Indications − Cyanide poisoning • Contraindications − None in the emergency setting • Adverse reactions − Diarrhea • Considerations − Pregnancy safety: Category C − If response to treatment is inadequate, repeat sodium nitrite and sodium thiosulfate
- 99. Streptokinase (Streptase) • Mechanism ofaction − Combines with plasminogen to convert free plasminogen to the proteolytic enzyme, plasmin • Indications − Acute myocardial infarction, massive pulmonary emboli, arterial thrombosis/ embolism, to clear intraventricular cannula • Contraindications − Hypersensitivity, active bleeding, recent cerebral vascular accident • Adverse reactions − Intracranial hemorrhage, bronchospastic hemoptysis, ARDS • Considerations − Pregnancy safety: Category C
- 100. Succinylcholine Chloride (Anectine) • Mechanismof action − Ultra-short-acting depolarizing skeletal muscle relaxant • Indications − Rapid-sequence intubation • Contraindications − Acute narrow-angle glaucoma, penetrating eye injuries, malignant hyperthermia • Adverse reactions − Apnea, respiratory depression, bradydysrhythmia, tachydysrhythmia • Considerations − Pregnancy safety: Category C − If the patient is conscious, explain the effects of the drug before administration.
- 101. Terbutaline Sulfate (Brethine) •Mechanism of action − Relaxation of bronchial tree and peripheral vasculature with minimal cardiac effects • Indications − Bronchial asthma, bronchospasm associated with exercise • Contraindications − Hypersensitivity, tachydysrhythmias • Adverse reactions − CNS stimulation, headache, seizure, restlessness, apprehension • Considerations − Pregnancy safety: − Category B − Monitor vital signs.
- 102. Thiamine (Betaxin) • Mechanism ofaction − Combines with ATP to form thiamine pyrophosphate coenzyme • Indications − Coma of unknown origin, delirium tremens, beriberi, Wernicke encephalopathy • Contraindications − None • Adverse reactions − Anxiety, dyspnea, respiratory failure, vasodilation • Considerations − Pregnancy safety: Category A − Rapid or large IV doses may cause respiratory difficulties, hypotension, and vasodilation.
- 103. Tirofiban Hydrochloride (Aggrastat) • Mechanismof action − Inhibits aggregation of platelets • Indications − Acute coronary syndrome • Contraindications − Trauma or major surgery within the past 30 days • Adverse reactions − Dizziness, pain, sweating, intracranial bleeding, CVA • Considerations − Pregnancy safety: Category B − Must be administered only with an infusion pump direct from bottle with a vented IV set − Severe spontaneous bleeding risk
- 104. Vasopressin (Pitressin) • Mechanism ofaction − Stimulation of smooth muscle receptors • Indications − Alternative vasopressor to the first or second dose of epinephrine in cardiac arrest • Contraindications − Use with caution in patients with coronary artery disease, epilepsy, or heart failure. • Adverse reactions − Dizziness, headache, bronchial constriction, MI, chest pain, angina • Considerations − Pregnancy safety: Category C − May increase peripheral vascular resistance and provoke cardiac ischemia and angina
- 105. Vecuronium Bromide (Norcuron) • Mechanismof action − Neuromuscular agent that results in neuromuscular blockade • Indications − Rapid-sequence intubation • Contraindications − Acute narrow-angle glaucoma, penetrating eye injuries • Adverse reactions − Weakness, prolonged neuromuscular block, bronchospasm, apnea • Considerations − Pregnancy safety: Category C − If patient is conscious, explain the effect of the medication before administration and always sedate the patient before using vecuronium.
- 106. Verapamil Hydrochloride (Isoptin, Calan) •Mechanism of action − Prolongs AV nodal refractory period, dilates coronary arteries and arterioles • Indications − Paroxysmal supraventricular tachycardia, atrial flutter, and atrial fibrillation with rapid ventricular response • Contraindications − Wolff-Parkinson-White syndrome, Lown- Ganong-Levine syndrome • Adverse reactions − Dizziness, headache, pulmonary edema • Considerations − Pregnancy safety: Category C − Closely monitor patient’s vital signs.
- 107. IV Solutions (Colloidsand Crystalloids) • Colloids − Expand plasma volume − Most often used in hypovolemic shock states • Crystalloid solutions are used for: − Electrolyte replacement − A route for medication − Short-term intravascular volume expansion
- 108. Plasma Protein Fraction (Plasmanate) •Mechanism of action − Increases intravascular volume • Indications − Hypovolemic shock, especially burn shock • Contraindications − No major contraindications • Adverse reactions − Chills, fever, urticaria (hives), nausea, and vomiting • Considerations − Do not use if the solution is cloudy or if you see sedimentation.
- 109. Dextran • Mechanism ofaction − Sugar-containing colloid used as an intravascular volume expander • Indications − Hypovolemic shock • Contraindications − Patients with congestive heart failure, renal failure, or known bleeding disorders • Adverse reactions − Rash, itching, dyspnea, chest tightness, and mild hypotension • Considerations − In the management of burn shock, it is especially important to follow standard fluid resuscitation regimens to prevent possible circulatory overload.
- 110. Hetastarch (Hespan) • Mechanism ofaction − A starch-containing colloid used as an intravascular volume expander • Indications − Hypovolemic shock, especially burn shock; septic shock • Contraindications − No major contraindications • Adverse reactions − Nausea, vomiting, mild febrile reactions, chills, itching, and urticaria • Considerations − Pregnancy safety: Category C − Patients allergic to corn may be allergic to hetastarch.
- 111. Lactated Ringer’s (Hartmann’s Solution) •Mechanism of action − Replaces water and electrolytes • Indications − Hypovolemic shock; keep open IV • Contraindications − Should not be used in patients with congestive heart failure or renal failure • Adverse reactions − Rare in therapeutic dosages • Considerations − None
- 112. 5% Dextrose inWater (D5W) • Mechanism of action − Provides nutrients in the form of dextrose as well as free water • Indications − For dilution of concentrated drugs for intravenous infusion • Contraindications − Should not be used as a fluid replacement for hypovolemic states • Adverse reactions − Rare in therapeutic dosages • Considerations − Should not be used with phenytoin or amrinone
- 113. 10% Dextrose inWater (D10W) • Mechanism of action − Provides nutrients in the form of dextrose as well as free water • Indications − Neonatal resuscitation, hypoglycemia • Contraindications − Should not be used as a fluid replacement for hypovolemic states • Adverse reactions − Rare in therapeutic dosages • Considerations − None
- 114. 0.9% Sodium Chloride (NormalSaline) • Mechanism of action − Replaces water and electrolytes • Indications − Heat-related problems (heat exhaustion, heat stroke), freshwater drowning, hypovolemia • Contraindications − Should not be used in patients with congestive heart failure • Adverse reactions − Rare in therapeutic dosages • Considerations − None
- 115. 0.45% Sodium Chloride (½Normal Saline) • Mechanism of action − Replaces free water and electrolytes • Indications − Patients with diminished renal or cardiovascular function for which rapid rehydration is not indicated • Contraindications − Cases in which rapid rehydration is indicated • Adverse reactions − Rare in therapeutic dosages • Considerations − None
- 116. 5% Dextrose in0.45% Sodium Chloride (D5½NS) • Mechanism of action − Replaces free water and electrolytes and provides nutrients in the form of dextrose • Indications − Heat exhaustion, diabetic disorders • Contraindications − Should not be used when rapid fluid resuscitation is indicated • Adverse reactions − Rare in therapeutic dosages • Considerations − None
- 117. 5% Dextrose in0.9% Sodium Chloride (D5NS) • Mechanism of action − Replaces free water and electrolytes and provides nutrients in the form of dextrose • Indications − Heat-related disorders, freshwater drowning • Contraindications − Should not be given to patients with impaired cardiac or renal function • Adverse reactions − Rare in therapeutic dosages • Considerations − None
- 118. 5% Dextrose inLactated Ringer’s (D5LR) • Mechanism of action − Replaces water and electrolytes and provides nutrients in the form of dextrose • Indications − Hypovolemic shock, hemorrhagic shock • Contraindications − Should not be administered to patients with decreased renal or cardiovascular function • Adverse reactions − Rare in therapeutic dosages • Considerations − None
- 119. Summary • Paramedics arerequired to know the names, class, mechanism of action, adverse reactions and side effects, interactions, indications, contraindications, complications, routes of administration, dose, and specific administration considerations for many emergency medications and intravenous fluids. • Individual states have the authority to include additional medications, which may be taught by your local training agency.
- 120. Summary • Because paramedicsmust make quick decisions about when to administer medications, what medications to administer, and when administering certain medications would be harmful to the patient, it is critically important they develop a solid understanding of the information in this chapter and stay up to date on the latest pharmacologic information.
- 121. Credits • Chapter opener:© Jones & Bartlett Learning. Courtesy of MIEMSS. • Backgrounds: Orange—© Keith Brofsky/ Photodisc/Getty Images; Red—© Margo Harrison/ShutterStock, Inc.;Gold—Jones & Bartlett Learning. Courtesy of MIEMSS; Lime—© Photodisc. • Unless otherwise indicated, all photographs and illustrations are under copyright of Jones & Bartlett Learning, courtesy of Maryland Institute for Emergency Medical Services Systems, or have been provided by the American Academy of Orthopaedic Surgeons.