Drug Cards - Week 3

Proventil, Ventolin

Class: Sympathomimetic Bronchodilator

• - Selective beta-2 adrenergic bronchodilator
• - Bronchial smooth muscle relaxation
• - Minimal beta-1 stimulation, little alpha stimulation
• - Stimulates CNS
• - Inhibits histamine release, reducing mucus secretions and mucosal edema
• - Onset of action: from 5-15 minutes

• Indications:
• - Acute attacks of bronchospasm (such as in asthma, anaphylaxis, emphysema, chronic-bronchitis, pneumonia, burns)

• Contraindications:
• - Hypersensitivity and symptomatic tachycardia (absolute)
• - Patients with cardiovascular disorders such as cardiac arrhythmias and hypertension (relative)

• - Tremors/dizziness/anxiety
• - Headache/diaphoresis
• - Angina/chest pain/palpitations
• - Tachycardia
• - CNS Stimulation
• - Hypertension

• Adult Dosage:
• 2.5mg in 3ml saline via hand help nebulizer.
• May repeat PRN

• How:
• Unit dose vials: 2.5mg in 3ml saline (pillow packs)

Pitressin

Hormone, Vasopressor

Vasopressin is a hormone with strong vasopressive and antidiuretic properties but that may precipitate angina and/or AMI

• Indications:
• - To increase peripheral vascular resistance in arrest (CPR) or to control bleeding from esophageal varices

• Contraindications:
• - Ischemic heart disease
• - PVC's
• - 1st stage of labor
• - Chronic nephritis with nitrogen retention

• - hypertension
• - bradycardia
• - PAC's
• - heart block

Arrest: 40 u IV

Esophageal varices: 0.2 - 0.4 u/min IV drip

• Name:
• Nitrostat, Nitrobid, Notrol

• Class:
• Nitrate, Anti-anginal

• Cardiovascular effects:
• - Reduce venous tone; causes blood to pool in peripheral veins, decreasing venous return to the heart (preload)
• - Decreased peripheral resistance (afterload)
• - Dilation of coronary arteries (if not already at maximum) and relief of coronary artery spasm

• Vasodilation of cerebral arteries, increasing oxygen to the brain
• Generalized smooth muscle relaxation
• Onset of action: 1 - 2 minutes

• Indications:
• - Angina
• - Chest pain suggestive of an MI
• - Pulmonary edema

• Contraindications:
• - Hypotension
• - Chest trauma
• - Cerebral bleeding
• - Head trauma
• - Increased ICP
• - Use of sexually enhancing drugs (Viagra, Cialis, sildenafil, tadalafil, vardenafil) within previous 72 hours
• - Hypersensitivity

- Hypotension: do not give if blood pressure is <90 mmHg systolic ( If hypotension develops, treat with IV fluids and lower the patients head)

• - Common side effects include:
• throbbing headache
• flushing,
• dizziness,
• tachycardia
• burning under the tongue.
• (These side effects may be used to check potency)

• Dose:
• 0.4 mg (1/150 grain) tblet or spray (1 to 2 sprays) Sublingually
• May repeat every 5 minutes as needed for effect - up to 3 doses. May provide additional doses with Base Hospital Order
• ***Adults only***

• Supplied:
• 0.4 mg tablets (1/150 grain)
• 0.4 mg in spray canisters that deliver 0.4 mg per spray

Atrovent

Parasympatholytic (anticholinergenic) Bronchodilator

• - Bronchodilation by competitive inhibition of cholinergic receptors on bronchial smooth muscle
• - Decreases respiratory secretions
• - Abolishes vagally mediated reflex bronchospasm

• Indications:
• - Asthma, in combination with other bronchodilators
• - COPD

• Contraindications:
• - Hypersensitivity to Atrovent, Atropine or Atropine derivatives
• - Not to be used as primary treatment for bronchospam

• - Dry mouth
• - GI distress
• - N/V
• - Nervousness
• - dizziness
• - headache
• - palpitations
• - blurred vision

• Adult Dosage:
• 500mcg in 3ml saline via hand held nebulizer

• How supplied:
• Unit dose vials: 500mcg in 3ml saline (pillow packs)

Name: Valium

Class: Anticonvulsant, Benzodiazepine, Sedative, Anti-anxiety

• - Sedative-hypnotic agent that causes depression of central nervous system and reduces anxiety
• - Anti-convulsant
• - Skeletal muscle relaxant
• - Onset of action: 1-5 minutes IV, 15-30 minutes IM
• - Peak action: 5-10 minutes

• Indications:
• - Generalized seizures/status epilepticus
• - Sedation/pre-medication prior to cardioversion for conscious patients
• - To relax skeletal muscle (spasm)
• - Anxiety
• - Chemical restraint
• - Hyperadrenergic compound overdose

• Contraindications:
• - Hypotension
• - coma
• - acute alcohol intoxication
• - Hypersensitivity (absolute)

• - Drowsiness, ataxia, dizziness, confusion, stupor (lack of critical cognitive function) and fatigue
• - Respiratory and/or cardiac arrest in elderly, the very ill and those with pulmonary disease is possible
• - Hypotension
• - Should be given with great caution in patients who have ingested other sedative drugs or alcohol, since apnea may result
• - Do not mix with other drugs or IV solutions, since precipitation will occur when mixed. Inject as close to the IV catheter site as possible
• - Valium is SHORT ACTING. Additional doses may be needed to prevent recurrent seizure activity.

• Adult Dosage:
• Seizures:
• - 5-15 mg slow IV (not to exceed 5mg/min) in increments titrated to seizure control and systolic pressure > 90mmHg. May repeat as in 5-15 min as needed to max dose of 30 mg

• Premedication prior to cardioversion:
• - 2-15 mg slow IVP titrated to patient sedation

• Anxiety:
• - 2-10 mg IV/IM

• Chemical restraint:
• - 5-10 mg IV/IM

• Hyperadrenergic overdose:
• - 5-25 mg IV

• How supplied:
• - 10mg/2mL of solvent
• - 20mg/4mL of solvent