Medications Flashcards
1
Q
Acetaminophen Trade Names
A
Tylonol, Tempra
2
Q
Acetaminophen AHS Protocols - Adult
A
-Pain management
-Antipyretic therapy; greater than 38° C
-Headache
3
Q
Acetaminophen AHS Protocols - Pediatric
A
-Pain management
-Antipyretic therapy; greater than 38° C
4
Q
Acetaminophen Classification
A
-Non-Opioid analgesic
-Antipyretic
5
Q
Acetaminophen Mechanism Of Action
A
-Inhibits the synthesis of prostaglandins that may serve as mediators of pain and fever; does not have any significant anti-inflammatory properties.
-Inhibits prostaglandin synthesis in the central nervous system by blocking pain impulse generation.
-Acts on the hypothalamic heat regulating canter to produce peripheral vasodilation resulting in increased blood flow through the skin, sweating, and heat loss.
6
Q
Acetaminophen Indications
A
-Mild pain management
-Reduction of fever
7
Q
Acetaminophen Contraindications
A
-Hypersensitivity to alcohol, aspartame, saccharin, sugar, FDC yellow dye #5 (food colouring)
-Active liver disease / hepatic impairment
8
Q
Acetaminophen Dosage - Adult
A
975mg PO, No repeat dose
9
Q
Acetaminophen Dosage - Pediatric
A
15mg/kg PO, max dose of 975mg
10
Q
Acetaminophen Side Effects
A
-Renal failure due to high doses / chronic use
11
Q
Acetaminophen Pharmacokinetics
A
Onset - 15-30 minutes
Duration - 4-6 hours
12
Q
Acetaminophen EMS Considerations
A
-Do not administer if the patient has taken the maximum dose of 975mg witching 4 hours.
-If the patient has received less than 975mg witching 4 hours, administer remaining medication to obtain max dose of 975mg.
-Ensure to document patient’s temperature prior to administration.
13
Q
Acetylsalicylic Acid Trade Names
A
-ASA
-Aspirin
-Bufferin
14
Q
Acetylsalicylic Acid AHS Protocols
A
Acute Coronary Syndrome (suspected)
15
Q
Acetylsalicylic Acid Classifications
A
-Antiplatelet
-Analgesic
-Antipyretic
-Non-steroidal anti-inflammatory drug (NSAID)
16
Q
Acetylsalicylic Acid Mechanism Of Action
A
-Blocks the formation of thromboxane A2, which is responsible for platelets aggregating and arteries constricting.
-Producing analgesia and has anti-inflammatory, and antipyretic effects by inhibiting the production of prostaglandins.
17
Q
Acetylsalicylic Acid Indications
A
-Antiplatelet therapy in Acute Coronary Syndrome
18
Q
Acetylsalicylic Acid Contraindications
A
-Hypersensitivity to salicylates / NSAIDs
-Unconscious / unable to follow commands
-Active ulcer disease / GI hemorrhage
-Bleeding disorders
-Pregnancy (especially 3rd trimester)
-Children under 15 years of age
-ASA induced asthma
19
Q
Acetylsalicylic Acid Dosage
A
160mg - 162mg PO chewed, total max in 24 hours
20
Q
Acetylsalicylic Acid Side Effects
A
-GI irritation
-Nausea / vomiting
-Tinnitus
-Increased risk of bleeding
21
Q
Acetylsalicylic Acid Pharmacokinetics
A
Onset - 1-2 hours
Duration - 4-5 hours
22
Q
Acetylsalicylic Acid EMS Considerations
A
-Withhold EMS dose if it is confirmed that patient took ASA properly previous to arrival of EMS.
-ASA must still be administered even if patient has taken their daily dose or are on blood thinners.
-Patients taking anticoagulant therapy, ASA may potentiate the effect.
-Diabetics taking ASA and oral hypoglycemic or insulin should be closely monitored for hypoglycemia.
23
Q
Dextrose in Water Trade Names
A
-D10W
-D25W
-D50W
24
Q
Dextrose in Water AHS Protocol - Adult
A
-Head injury
-Hypoglycemia
-Stroke
25
Dextrose in Water AHS Protocols - Pediatric
-Hypoglycemia (D10W; D25W)
-Head injury (D25W)
26
Dextrose in Water Classification
-Caloric agent
27
Dextrose in Water Mechanism Of Action
-Increases blood sugar levels to normal cases on hypoglycemia.
-Hypertonic solution producing a transient movement of water from interstitial spaces into the venous system (osmotic diuretic).
28
Dextrose in Water Indications
-Severe, symptomatic hypoglycemia from any cause.
-Head injury with symptomatic hypoglycemia (half dose).
-Stroke with symptomatic hypoglycemia (half dose).
29
Dextrose in Water Contraindications
-Allergy to corn or corn products
-Hyperglycemia
-Hypersensitivity to dextrose solution
-Intracranial hemorrhage (half dose)
30
Dextrose in Water Dosage - Adult; Symptomatic Hypoglycemia
25g D50W SIVP / IO q 5 min prn, titrate to BGL >/= 4.0mmol/L or patient improvement
Max 50g
31
Dextrose in Water Dosage - Adult; Suspected Stroke
12.5g D50W SIVP / IO q 5 min prn, titrate BGL = 3.0mmol/L or patient improvement
Max 50g
32
Dextrose in Water Dosage - Adult; Suspected Head Injury
12.5g D50W SIVP / IO q 5 min prn, titrate BGL = 4.0mmol/L or patient improvement
Max 50g
33
Dextrose in Water Dosage - Pediatric; Less than 10kg
0.5g/kg D10W SIVP / IO q 5 min prn, titrate to BGL 4.0mmol/L or patient improvement
34
Dextrose in Water Dosage - Pediatric; More than 10kg / less than 40kg
0.5g/kg D25W SIVP / IO to a single max dose of 12.5g q 5 min, titrate BGL 4.0mmol/L or patient improvement
35
Dextrose in Water Dosage - Pediatric; More than / Equal to 40kg
12.5g D50W SIVP / IO q 5 min prn, single max dose, titrate BGL 4.0 mmol/L or patient improvement
36
Dextrose in Water - Create D10W
-Remove 40mL D50W preload, replace with 40mL of normal saline
-New concentration of 5g/50mL = 100mg/mL
((0.5g X kg) X 50mL) divided by 5g
37
Dextrose in Water - Create D25W
-Remove 25mL from the D50W preload, replace with 25mL of normal saline.
-New concentration of 12.5g/50mL = 250mg/mL
((0.5g X kg) X 50mL) divided by 12.5g
38
Dextrose in Water Side Effects
-Rebound hyperglycemia
-May aggravate hypertension / CHF
-May cause neurological symptoms in an alcoholic patient
-Werkinick’s encephalopathy / Korsakoff’s syndrome
39
Dextrose in Water Pharmacokinetics
Onset - <1 minutes
Duration - Varies
40
Dextrose in Water EMS Considerations
-Tissue necrosis if infiltration occurs, to avoid; give 1/2 the total volume and check IV patency before administering the rest.
-Utilize a large bore catheter in a large vein.
-D50W has a short duration of action, therefore follow drug administration with an oral complex carbohydrate (toast, pasta, sandwich).
-Increased intracellular glucose levels in the setting of cerebral ischemia and hypoxia result in increased intracellular acidosis due to anaerobic metabolism of glucose and subsequent neuronal death.
41
Dimenhydrinate Trade Name
Gravol
42
Dimenhydrinate AHS Protocols
Nausea / vomiting
43
Dimenhydrinate Classification
Antiemetic
44
Dimenhydrinate Mechanism Of Action
-Depresses vestibular (equilibrium) function by inhibiting histamine H1 receptors
-Sedative effects due to inhibition of histamine
45
Dimenhydrinate Indications
Nausea / vomiting associated with motion sickness and vertigo
46
Dimenhydrinate Contraindications
-Hypersensitivity to Dimenhydrinate and Diphenhydramine or propylene glycol (food additive)
-Narrow angle glaucoma
-Patients who have ingested large quantities of depressants including alcohol
47
Dimenhydrinate Dosage
50mg SIVP / IM q 4 hours
25mg SIVP / IM for patients over 65 years, no repeat dose
48
Dimenhydrinate Side Effects
-Drowsiness
-Sedative effect
49
Dimenhydrinate Pharmacokinetics
Onset- IV immediate; IM 20-30 minutes
Duration- 3-6 hours
50
Dimenhydrinate EMS Considerations
-Generally administered in 10mL syringe with normal saline for IV administration
-Preferred antiemetic for nausea / vomiting associated with vertigo, motion sickness, narcotic side effect, pregnancy
51
Diphenhydramine Trade Name
Benadryl
52
Diphenhydramine AHS Protocols - Adult
-Allergic reaction
-Anaphylaxis
53
Diphenhydramine AHS Protocols - Pediatric
-Allergic reaction
-Anaphylaxis
54
Diphenhydramine Classification
Antihistamine
55
Diphenhydramine Mechanism Of Action
-Competes with histamine for H1 receptor sites on effector cells. They thereby prevent, but do not reverse responses mediated by histamine alone.
-Does not inhibit histamine release
56
Diphenhydramine Indications
-Allergic reactions
-Adjunct to epinephrine (used after epinephrine deployed) in the management of anaphylaxis
-Management of drug induced extrapyramidal symptoms
57
Diphenhydramine Contraindications
-Hypersensitivity to Diphenhydramine and Dimenhydrinate
-Avoid antihistamine n nursing mothers and / or in neonates (less than 28 days) unless life threatening anaphylaxis / allergy
58
Diphenhydramine Dosage - Adults
- (Elixer) 50mg PO, no repeat dose
-1mg/kg SIVP / IM / IO, 50mg, no repeat dose
59
Diphenhydramine Dosage - Pediatrics
-(Elixer) 1mg/kg PO, 50mg max dose, no repeat dose
-1mg/kg SIVP / IM / IO, 50mg max dose, no repeat dose
60
Diphenhydramine Side Effects
-Dry mouth / throat
-Blurred vision
-Hypotension
-Thickening of bronchial secretions
-Bronchospasm
61
Diphenhydramine Pharmacokinetics
Onset - 15 minutes PO, 5-10 minutes IM / IV
Peak effects - 1-4 hours
62
Diphenhydramine EMS Considerations
-Diphenhydramine is not recommended in neonates due to increased susceptibility to anticholinergic effects however should be administered judiciously in setting of anaphylaxis
63
Epinephrine 1mg/mL (1:1000) Trade Name
Adrenaline
64
Epinephrine 1mg/mL (1:1000) AHS Protocols - Adult
Anaphylaxis
65
Epinephrine 1mg/mL (1:1000) AHS Protocols - Pediatric
Anaphylaxis
66
Epinephrine 1mg/mL (1:1000) Classifications
Sympathomimetic, endogenous catecolamine
67
Epinephrine 1mg/mL (1:1000) Mechanism Of Action
-Inhibits the release of histamine associated with allergic and anaphylactic reactions.
- Alpha 1 agonist - peripheral vasoconstriction improving coronary and cerebral perfusion.
-Beta 1 agonist - positive chronotripic, inotropic, dromotropic properties, increases automaticity in the heart.
-Beta 2 agonist - bronchodilation - adrenergic receptors in the lungs to relax bronchial smooth muscle.
68
Epinephrine 1mg/mL (1:1000) Indication
Analphylaxis
69
Epinephrine 1mg/mL (1:1000) Contraindications
-None in emergent situations
-Hypersensitivity to epinephrine
70
Epinephrine 1mg/mL (1:1000) Dosage - Adult
0.3mg (1mg/mL) IM q 5 prn, max 0.9mg
71
Epinephrine 1mg/mL (1:1000) Dosage - Pediatric; Less than 30kg
0.15mg IM q 5 min, total max 0.45mg
Vastus lateralis for injection
72
Epinephrine 1mg/mL (1:1000) Dosage - Pediatric; More than / Equal to 30kg
0.3mg IM q 5 min, total max 0.9mg
Vastus lateralis for injection
73
Epinephrine 1mg/mL (1:1000) Side Effects
-Palpitation
-Tremors
-Nervousness
-Dizziness
-Anxiety
-Headache
-Hypertension
-Tachycardia
74
Epinephrine 1mg/mL (1:1000) Pharmacokinetics
Onset - 5-10 minutes (IM)
Peak effects - 20 minutes
75
Epinephrine 1mg/mL (1:1000) EMS Considerations
-All patients receiving this medication must be cardiac monitored.
-Do not administer 1mg/mL solution by direct IV.
-Epinephrine in pregnancy can cause fetal hypoxia.
-Ensure patient is in recumbent position prior to administration of epinephrine.
76
Glucagon AHS Protocols - Adult
Hypoglycemia
77
Glucagon AHS Protocols - Pediatric
Hypoglycemia
78
Glucagon Classification
Hormone
79
Glucagon Mechanism Of Action
-Causes an increase in blood glucose by stimulating glucagen breakdown in the liver, converting glucagen to glucose.
80
Glucagon Indications
-Confirmed hypoglycemia in which an IV cannot be established
81
Glucagon Contraindications
-Hypersensitivity to glucagon, beef, or pork proteins
-Pheochromocytoma
-Hyperglycemia
82
Glucagon Dosage - Adult
1mg IM q 15 prn, total max 2mg
83
Glucagon Dosage - Pediatric; Less than 20kg
0.5mg IM q 15 min prn, total max 1mg
84
Glucagon Dosage - Pediatric; More than 20kg
1mg IM q 15 min prn, total max
85
Glucagon Side Effects
-Dizziness
-Headache
-Hypertension
-Tachycardia
-Rebound hyperglycemia
86
Glucagon Pharmacokinetics
Onset - 5- 15 minutes (IM)
87
Glucagon EMS Considerations
-Use of glucagon in patients with pheochromocytoma can cause the tumour to release catecholamines resulting in hypertensive crisis.
-D50W is the drug of choice in hypoglycemia.
-Effective only if there are sufficient stores of glycogen within the liver.
-A complex carbohydrate must be given after administration of medication to prevent relapse after hypoglycemia is corrected (toast, pasta, sandwich).
88
Ibuprofen Trade Names
-Advil
-Motrin
89
Ibuprofen AHS Protocols - Adult
-Pain Management
-Antipyretic therapy; greater than 38° C
-Headache
90
Ibuprofen AHS Protocols - Pediatric
-Pain management
-Antipyretic therapy; greater than 38° C
91
Ibuprofen Classifications
-Non-steroidal anti-inflammatory drug (NSAID)
-Non-opioid analgesic
92
Ibuprofen Mechanism Of Action
-Inhibits prostaglandin synthesis, decreasing pain and inflammation through non-selective, reversible inhibition of cyclooxygenase enzymes, COX-1 and COX-2
93
Ibuprofen Indications
-Treatment of mild pain associated with arthritis, pain in muscles, joints, or bones.
-Reduction of fever for adults or children over 6 months old.
-Dysmenorrhea or headaches
94
Ibuprofen Contraindications
-Hypersensitivity to NSAIDs / salicylates
-Suspected intracranial bleeding
-Sub-arachnoid hemorrhage (indicated by sudden onset / most severe headache ever)
-Ibuprofen induced asthma
-Renal disease, except renal colic
-Diagnosis of crohns / ulcerative colitis / IBD
- Patient currently taking oral anticoagulants
-Patient undergoing chemotherapy
-Pregnancy
95
Ibuprofen Dosage - Adult
400mg PO - No repeat dose
96
Ibuprofen Dosage - Pediatric
10mg/kg PO - max dose 400mg
97
Ibuprofen Side Effects
-Mild hypertension
-GI irritation
-Nausea / vomiting
-Constipation
-Tinnitus
-Increased risk of bleeding
98
Ibuprofen Pharmacokinetics
Onset - 30 mins
Duration - 4-8 hours
99
Ibuprofen EMS Considerations
-Do not administer if the patient has taken maximum dose writhing 6 hours.
-If patient has received less than ten maximum dose of 400mg within 6 hours, administer remaining medication up to the maximum dose of 400mg.
-Works well with pain associated with renal colic, dental, muscoskeletal.
-Cautious use with patients who have past medical history of: recent trauma / suspected subarachnoid hemorrhage, renal impairment, GI bleed, CHF, elderly over 65yrs, chronic alcoholics; can cause bleeding
100
Ipratropium Bromide Trade Name
Atrovent
101
Ipratropium Bromide AHS Protocols - Adult
Bronchospasm
102
Ipratropium Bromide AHS Protocols - Pediatric
Bronchospasm
103
Ipratropium Bromide Classification
Anticholinergic Bronchodilator
104
Ipratropium Bromide Mechanism Of Action
-Derivative of atropine.
-Exerts anticholinergic action in the bronchioles thereby inhibiting bronchoconstriction.
-Blocks increased mucus secretions.
105
Ipratropium Bromide Indications
-Bronchospasm (used with salbutamol)
-Anaphylaxis (used with salbutamol)
106
Ipratropium Bromide Contraindictions
-Hypersensitivity
-Hypersensitivity to atropine
107
Ipratropium Bromide Dosage - Adult
-MDI with spacer 1 puff (20mcg/puff) q 30-60 seconds prn, max 15 puffs
-500mcg q 5 minutes via nebulizer, max 1500mcg
108
Ipratropium Bromide Dosage - Pediatric; Less than 20kg
-1 puff (20mcg/puff) MDI with spacer q 30-60 seconds, max 12 puffs
-250mcg via nebulizer prn, max 750mcg
109
Ipratropium Bromide Dosage - Pediatric; More than / Equal to 20kg
-1 puff (20mcg/puff) MDI with spacer q 30-60 seconds, max 15 puffs
-500mcg via nebulizer, max 1500mcg
110
Ipratropium Bromide Side Effects
-Dry mouth / throat
-Headache
-Cough
Palpitations
-Tremors
-Dizziness
111
Ipratropium Bromide Pharmacokinetics
Onset - 5-15 minutes
Peak - 1-2 hours
112
Ipratropium Bromide EMS Considerations
-Invert canister 3 times prior to administration.
-Depress canister to prime prior to administration directed to the floor.
-Direct patient to inhale slowly while administering and hold their breath for 5-10 seconds if possible, repeat 1-2 times to inhale any remaining medication in chamber before removing from mouth.
-MDI needs 30 seconds minimum recharge time between puffs.
-Alternate single puffs with salbutamol during recharge period.
-Nebulizer administration - usually combined with salbutamol to create combivent.
-Nebulizer administration - use non-humidified O2 source at 6-8LPM.
_Enhanced by other anticholinergic drugs.
