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Flashcards in Pharmacology Deck (61):
1

Albuterol - Generic Name

Albuterol

2

Albuterol - Trade Name

Ventolin, Proventil

3

Albuterol - Class

Sympathomimetic, Selective Beta 2 Agonist

4

Albuterol - Actions

Activates the beta 2 adrenergic receptors to relax smooth muscle

Brochodilation, relieves bronchospasms, and reduces airway resistance

5

Albuterol - Onset & Duration

Onset: ~5 minutes

Duration: 3-4 hours

6

Albuterol - Indications

Respiratory distress with bronchospasms

Respiratory origin

Allergic reaction/anaphylaxis

Pneumonia

7

Albuterol - Contraindications

MI - Myocardial Infarction

Cardiac Pulmonary Edema

Cardiac dysrhythmias associated with tachycardia (relative, >120)

8

Albuterol - Side Effects

Restlessness/Anxiety

Vertigo

Tachycardia/Palpations

Dysrhythmias

9

Albuterol - Special Information

Albuterol may precipitate angina pectoris and dysrhythmias.

Check lung sounds, O2 saturation, capnography, respiratory rate before and after administration of Albuterol

10

Albuterol - Dosage & Route

Adults - 2.5mg Albuterol in 3mL of NS via SVN, repeat as needed.

Pediatrics - 2.5mg Albuterol in 6mL of NS via SVN, repeat as needed.

Connect oxygen to SVN at 6-8 lpm.

11

Albuterol - MDI dose

90 mcg

12

Aspirin - Generic Names

ASA, Acetylsalicylic Acid

13

Aspirin - Trade Names

Bayer, St. Josephs, multiple others

14

Aspirin - Class

Antiplatelet

15

Aspirin - Actions

Interrupts Thomboxane A2

Inhibits the normal tendency for platelets to accumulate inside injured or occluded cardiac arteries thereby promoting better blood flow through vessels to better perfuse the heart

16

Aspirin - Onset & Duration

Onset: 15-30 minutes

Duration: 4-6 hours

17

Aspirin - Indications

Chest pain of suspected cardiac origin

18

Aspirin - Contraindications

Unable to swallow

Caution if patient has history of active bleeding ulcer

19

Aspirin - Side Effects

Stomach irritation

Bronchospasms in some patients with asthma

20

Aspirin - Special Information

Pills need to be chewed and swallowed. Small amount of water can be used. 

Aspirin interferes with Thromboxane A2 (TA2) "message" from being sent to other platelets, thus causing the platelets to pass by and not let the clot grow, minimizing the clotting process. ASA has no effect on existing blood clot. It just stops it from getting bigger.

Can be given if patient is on anti-coagulants.

21

Aspirin - Dosage & Route

Oral route (PO)

Dose can range from 162mg to 325mg 2-4 81mg tablets

It is highly suggested that the EMS provider administer a total of 4, 81mg tablets for a total of 324mg.

22

Nitroglycerine - Generic Name

Nitroglycerine, Nitro

23

Nitroglycerine - Trade Name

Nitrostat, Nitro-bid, Nitrolingual

24

Nitroglycerine - Class

Nitrate

25

Nitroglycerine - Actions

  • Relaxes systemic venous and arterial vessels causing vasodilation thereby
    • Decreasing cardiac preload and after load
    • Decreasing myocardial workload
    • Decreasing myocardial O2 comsumption
  • Dilates coronary arteries

26

Nitroglycerine - Onset & Duration

Onset: 2 minutes SL; ~30-60 minutes topical

Duration: ~30-60 minutes SL; ~24 hours topical

27

Nitroglycerine - Indications

Angina or angina-equivalent discomfort

Cardiac pulmonary edema

28

Nitroglycerine - Contraindications

Systolic BP < 100

Suspected right ventricular MI

Phosphodiesterase inhibitor use with last 24 hours - ED medications such as Viagra (sildenafil), Cialis (tadalafil) or Levitra (vardenafil) taken along with Nitro can cause profound hypertension and tachycardia

29

Nitroglycerine - Side Effects

Headache

Hypotension

Increased HR

Vertigo

Nausea

30

Nitroglycerine - Special Information

Nitro has a cumulative effect; repeat doses are usually necessary

Nitro has a short shelf life and is light sensitive

Don't shake the nitro bottle (spray or pill). Nitro in this form is not explosive; however, shaking the pill bottle will likely fracture the pills (never administer a partial pill) and shaking the spray bottle with break down the medication

Be sure to inform the patient that nitro can cause headache and increases heart rate, and that this is a normal side effect. Nitro may also cause vertigo and nausea.

Remind the patient not to swallow the nitro, spray or pill.

Inform the patient that they may expedience a burning sensation under their tongue after administration.

31

Nitroglycerine - Dosage & Route

Sublingual (SL) route

If systolic BP is >100 it is suggested that you administer 0.4mg SL q 3-5 minutes. Generally a total of 3 doses (3, 0.4mg SL) are administered as dosages beyond this recommendation tend to be less effective.

32

Oral Glucose - Generic Name

Oral Glucose

33

Oral Glucose - Trade Name

Glutose, Insta-Glucose

34

Oral Glucose - Class

Monosaccharide, Carbohydrate

35

Oral Glucose - Actions

After absorbing from GI tract, glucose is distributed in the tissues and provides a prompt increase in circulating blood sugar.

Glucose is the body's basic fuel and is required for cellular metabolism. A sudden drop in blood sure level will result in disturbance of normal metabolism, manifested clinically as decreased in mental status, diaphoreses, and tachycardia. Further decreases in blood sugar may result in coma, seizures, and cardiac arrhythmias.

36

Oral Glucose - Onset & Duration

Onset: 1-10 minutes

Duration: Varies

37

Oral Glucose - Indications

Hypoglycemia (altered mental status with history of diabetes)

The ability to swallow the medication

38

Oral Glucose - Contraindications

Unresponsive

Unable to swallow

39

Oral Glucose - Precautions

Altered LOC - Level of Consciousness

Ascertain the patients ability to swallow an oral preparation of glucose without airway compromise.

Must be swallowed, not absorbed sublingually, or buccally.

40

Oral Glucose - Side Effects

Nausea is the most typical side effect

Can cause hyperglycemia; however this is not common with oral glucose

Typically no side effects if administered properly

41

Oral Glucose - Special Information

Symptomatic hypoglycemia nearly always means an altered mental status. Altered mental status often means a scene safety issue. Make sure you are aware of your environment and have the assistance you need.

Check a glucometer reading before administering glucose if at all possible.

It is possible and acceptable to revive a hypoglycemic patient without using an entire 45 gram tube. Base your treatment/dosage on the promptness of the patient response.

If the patient refuses transport it is important to get them something supplemental to eat. Also consider who is there with the patient (family, bystanders) and suggest that someone remains with them for awhile.

Commonly, there is an explanation for hypoglycemia if you look for it. Poor compliance, increased stress, decreased sleep, illness, change in insulin regiment, etc...

Glucose comes in various forms. Gel is the most common form administered by EMS. Also note that it comes in liquid (Dextrose) and tablet forms as well.

42

Oral Glucose - Dosage & Route

1 tube of oral glucose PO as the dose, or a total of 15 grams. Most protocols suggest 2-3 tubes PO, or a total of 30-45 grams, for patients with intact gag reflex and who are able to manage their own airway.

Can either be packaged in 15 gram tubes or 45 gram tubes.

It is suggested that pediatric patients receive the same dosage as the adult patient. However, note that some protocols may vary. Some protocols suggest 5-45 grams for pediatrics.

43

Activated Charcoal - Generic Name

Activated Charcoal

44

Activated Charcoal - Trade Name

SuperChar, InstaChar, Actidose, LiquiChar, others...

45

Activated Charcoal - Class

Antidote, absorbent

46

Activated Charcoal - Actions

Binds to certain poisons and prevents them from being absorbed into the body.

Not all brands of activated charcoal are the same; some bind much more poison that others, so consult with medical direction regarding any questions about the brand that you carry.

47

Activated Charcoal - Indications

Poisoning by mouth, oral poisoning

48

Activated Charcoal - Contraindications

Ingestion of acids or alkalis.

Some protocols also suggest petroleum products.

Unable to swallow.

Patients with oral acids, alkalis, and petroleum product poisoning.

49

Activated Charcoal - Side Effects

Black stools

Patients that have ingested poisons that cause nausea may vomit.

50

Activated Charcoal - Special Information

If the patient vomits, the dose should be repeated once.

Reassessment strategies - be prepared for the patient to vomit or further deteriorate

Activated charcoal adsorbs many but not all toxins. Some of the things that do not stick to charcoal can generally be remembered using the mnemonic PHAILS

  • PHAILS
    • Pesticides
    • Hydrocarbons (gasoline, kerosene, lighter fluid, etc...) Heavy metals (arsenic mercury, etc...)
    • Alcohols / Acids / Alkalis
    • Iron
    • Lithium
    • Solvents

51

Activated Charcoal - Dosage & Route

Dose is based off of body weight; 1 gram per kilogram of body weight (1g/kg)

Obtain orders from medical directions

Container must be shaken thoroughly

52

Epinephrine - Generic Name

Epinephrine

53

Epinephrine - Trade Name

Adrenaline, Epi-Pen, Epi-Pen Jr.

54

Epinephrine - Class

Sympathomimetic

55

Epinephrine - Actions

Bronchodilation of the bronchi

Vasoconstriction of the peripheral vasculature

Increased heart rate, increased contractility and increased automaticity of the heart

56

Epinephrine - Onset & Duration

Onset: IM tends to be variable, SQ 5-10 minutes

Duration: 1-4 hours (can as short as 5-10 minutes)

57

Epinephrine - Indications

Must meet the following 3 criteria

  1. Emergency medical care for the treatment of the patient exhibiting the assessment findings of an allergic reaction.
  2. Medication is prescribed for this patient by a physician.
  3. Medical direction authorizes use for this patient.

May also be authorized for patient having an asthma attack if patient is prescribed medication by physician.

58

Epinephrine - Contraindications

None if used in a life threatening situation

Administration caution must be observed if patient is experiencing a possible MI

59

Epinephrine - Side Effects

Increased heart rate, pallor, vertigo, chest pain, headache, nausea, vomiting, anxiousness

60

Epinephrine - Special Information

Administration increases myocardial oxygen demand; therefore, your patient with an allergic reaction (or severe asthma attack) should be on high flow oxygen not only before, but after the administration of epinephrine.

61

Epinephrine - Dosage & Route

Obtain orders from medical direction

Ensure that the epinephrine is prescribed to that patient and that the medication is not discolored.

Remove safety cap from the auto-injector

Place tip of auto injector against patients thigh

  • Lateral portion of the thigh
  • Midway between the waist and the knee

Push the injector firmly against the thigh until the injector activates

Hold the injector inlace until the medication is injected

Record activity and time

Dispose of injector in sharps container

  • Dose
    • Adult: one auto injector contains 0.3mg (1:1000 epi)
    • Pediatric: on auto injector contains 0.15 mg (1:2000 epi)