Drug Box 2-1A

  1. Aspirin

    Generic Name
    acetylsalicylic acid, aspirin, asa
  2. Aspirin

    Brand Name
    Bufferin, Anacin, APC, among others
  3. Aspirin

    analgesic; antipyretic; anti-inflammatory
  4. Aspirin

    Mechanism of Action
    • * In small doses aspirin blocks thromboxane A2, a potent platelet aggregant and vasoconstrictor.
    • * This property has lead to its use in the acute phase of management of the myocardial infarction.
    • * Decreased platelet aggregation.
  5. Aspirin

    Indications and Field Use
    • * Chest pain or other signs/symptoms suggestive of acute myocardial infarction.
    • * ECG changes suggestive of acute myocardial infarction.
    • * Unstable angina.
    • * Pain, discomfort, fever in adult patient only.
  6. Aspirin

    • * Bleeding ulcer, hemorrhagic states, hemophilia.
    • * Known hypersensitivity to salicylates or other non-steroidal anti-inflammatories that has lead to hypotension and/or bronchospasm.
    • * Children and adolescents (prehospital personnel should not admister ASA to this age group).
  7. Aspirin

    Adverse Reactions
    • * Use with caution in the patient with history of asthma.
    • * Anaphylactic reactions in sensitive patients have occurred; skin eruptions.
  8. Aspirin

    Adult Dosage
    • * Cardiac: 160- 325 mg PO (2-4 pediatric chewable tabs), chew or swallow.
    • * Pain/discomfort/fever: 325 mg PO (4 pediatric chewable tablets), chew or swallow.
  9. Aspirin

    Pediatric Dosage
    Not recommended for prehospital use in children
  10. Aspirin

    Bonus Points
    Special Notes
    Baby ASA is heat and light sensitive. The odor of acetic acid (vinegar-like smell) indicates degradation of product
  11. Sodium Bicarbonate 8.4%

    Generic Name
    sodium bicarbonate 8.4%
  12. Sodium Bicarbonate 8.4%

    Brand Name
    Sodium Bicarbonate 8.4%
  13. Sodium Bicarbonate 8.4%

  14. Sodium Bicarbonate 8.4%

    Mechanism of Action
    Buffers H+ and increases pH
  15. Sodium Bicarbonate 8.4%

    Indications and Field Use
    • * Pre-existing metabolic acidosis.
    • * Overdose of aspirin, cyclic antidepressants (alkalinization of blood).
    • * Cardiac arrest after other interventions and ventilation is adequate.
  16. Sodium Bicarbonate 8.4%

  17. Sodium Bicarbonate 8.4%

    Adverse Reactions
    • * CV: Congestive heart failure, edema secondary to sodium overload.
    • * Metabolic: Hyperosmolarity, metabolic alkalosis, hypernatremia, in cardiac arrest may cause extracellular alkalosis and intracellular acidosis.
  18. Sodium Bicarbonate 8.4%

    Adult Dosage
    • * Pre-existing Metabolic Acidosis or Alkalinization of Blood: 50-100 mEq IV/IO per medical control authority.
    • * Cardiac arrest: First dose usually 1 mEq/kg with subsequent doses of 0.5 mEq/kg every 10 minutes after other standard treatment (defibrillation, CPR, intubation, ventilation and more than one trial of epinephrine) has been used.
  19. Sodium Bicarbonate 8.4%

    Pediatric Dosage
    1 mEq/kg IV/IO slowly, if ventilation is adequate according to medical control. Can contribute to acidosis and cause fluid overload.
  20. Sodium Bicarbonate 8.4%

    Neonatal Dosage
    1 mEq/kg IV/IO of 4.2% slowly. Waste 25 ml of 8.4% solution and add 25 ml of NS, each ml contains 0.5 mEq of sodium bicarbonate
  21. Sodium Bicarbonate 8.4%

    Bonus Points
    Special Notes
    • * Flush tubing before and after administration, especially with concurrent use of calcium chloride.
    • * Sodium bicarbonate administration should be considered only for treatment of documented severe acidosis associated with prolonged cardiac arrest or an unstable hemodynamic state, hyperkalemia or certain overdoses (i.e. cyclic antidepressants, ASA, phenobarbital, etc.).
    • * Severe tissue necrosis will occur with extravasation.
  22. Vasopressin

    Generic Name
  23. Vasopressin

    Brand Name
  24. Vasopressin

    pituitary (antidiuretic) hormone
  25. Vasopressin

    Mechanism of Action
    Causes vasoconstriction (pressor effect) of peripheral, cerebral, pulmonary, and coronary vessels
  26. Vasopressin

    Indications of Field Use
    Adult shock-refractory ventricular fibrillation/pulseless ventricular tachycardia
  27. Vasopressin

    • * Responsive patient with coronary artery disease (CAD
    • * Hypertension
  28. Vasopressin

    Adverse Reactions
    • * Can increase peripheral vascular resistance and provoke cardiac ischemia and angina pectoris.
    • * Abdominal distress.
    • * Nausea and vomiting.
    • * Tremors.
    • * Tissue necrosis if extravasation occurs
  29. Vasopressin

    Adult Dosage
    V-Fib/ Pulseless V-Tach - 40 Units IV/IO/ET, one time only prior to administration of 1st or 2nd dose of epinephrine
  30. Vasopressin

    Pediatric Dosage
    Not used in the pediatric population
  31. Magnesium Sulfate

    Generic Name
    magnesium sulfate
  32. Magnesium Sulfate

    Brand Name
    Magnesium Sulfate
  33. Magnesium Sulfate

    Electrolyte, tocolytic
  34. Magnesium Sulfate

    Mechanism of Action
    • * Pharmacology: Second most plentiful intracellular cation; important role in neurochemical transmission and muscular excitability (may decrease acetylcholine released by nerve impulses); decreases myocardial irritability and neuromuscular irritability.
    • * Clinical: Cardiac-reduces ventricular irritability, especially when associated with hypomagnesemia; inhibition of muscular excitability.
  35. Magnesium Sulfate

    Indications and Field Use
    • * Torsade de pointes, drug of choice.
    • * VF/Pulseless VT refractory to lidocaine and/or amiodarone.
    • * Hypomagnesemia
    • * Pre-term labor (PTL)
    • * Pregnancy-induced hypertension (PIH, toxemia of pregnancy, pre-eclampsia and/or eclampsia).
    • * Hyperreactive Airway - Severe Asthma
  36. Magnesium Sulfate

    • * Hypermagnesemia
    • * Use cautiously in patients with impaired renal function and pre-existing heart blocks (relative).
  37. Magnesium Sulfate

    Adverse Reactions
    • * Cardiovascular: hypotension, flushing, circulatory collapse, depressed cardiac function, heart block, asystole, smooth muscle relaxant (antihypertensive effects).
    • * Respiratory: respiratory depression and/or paralysis. This adverse reaction may occur in both mother and/or infant during or up to 24 hours after the administration.
    • * CNS: sweating, drowsiness, hypothermia, depressed reflexes progressing to flaccidity and paralysis. May occur in both mother and/or infant up to 24 hours.
    • * GI: nausea
    • * GU: mild diuretic
    • * Metabolic: hypocalcemia, hypermagnesemia
  38. Magnesium Sulfate

    Adult Dosage
    • * Cardiac: VF/Pulseless VT: 1-2 Gm IV diluted in 50-100 ml NS or D5W, administered over 1-2 minutes.
    • * Torsade de pointes: 1-2 Gm IV diluted in 50-100 ml NS or D5W administered over 1-2 minutes, followed by the same amount infused over 1 hour.
    • * Hypomagnesemia: 1-2 Gm IV diluted in 50-100 ml NS or D5W administered IV push over 5-60 minutes.
    • * Resp: Respiratory/Severe Asthma: Initial Infusion (field) 2 Gm mixed in 50 ml NS or D5W to be infused IV using microdrip tubing over 5 to 10 minutes. Stop infusion if hypotension, respiratory depression or bradycardia develops.
    • * Pre-term labor (PTL): Initial bolus: 4-6 Gm over 15-20 minutes (Suggestion is to add 4 Gm to 100 ml D5W, LR or NS. Resultant concentration is 40 mg/ml.)
    • * Pregnancy induced hypertension, pre-eclampsia/eclampsia: Initial bolus: 3-6 Gm over 10-15 minutes (Suggestion is to add 4 Gm to 100 ml D5W, LR or NS. Resultant concentration is 40 mg/ml).
  39. Magnesium Sulfate

    Bonus Points
    Special Notes
    • * O2 should be administered to patients receiving Magnesium Sulfate.
    • * For IV/IO infusions (respiratory) start and stop times should be closely monitored and documented per administration guidelines of 20 minutes or greater.
    • * Evaluate cardiac status and ECG assessing for prolonged PR and widened QRS intervals.
    • * Keep Calcium Chloride (10%) 10 ml available to reverse magnesium toxicity.
    • * Use extreme caution if the patient is on digoxin.
    • * Hourly intake and output should be monitored on long transport; urine output should be greater than 30 cc/hr.
    • * In treatment of seizures associated with PIH it may be necessary to use an anticonvulsant such as diazepam.
    • * Eclampsia may occur up to six weeks after delivery.
Card Set
Drug Box 2-1A
Drug Box 2-1A