ALS Paramedic Pharmo

  1. Acetylsalicylic Acid

    Platelet Aggregator Inhibitor
  2. Acetylsalicylic Acid

    EMS Indications?
    Suspected Acute Coronary Syndrome (ACS)
  3. Acetylsalicylic Acid

    • -Hypersensitivity 
    • -Active GI bleeds
    • -Asthmatic with Pm Hx of sensitivity to ASA / NSAIDS
  4. Acetylsalicylic Acid

    • 160mg chewed PO
    • Repeat: NO Repeat
  5. Acetylsalicylic Acid

    Therapeutic Action?
    Inhibit the formation of Thromboxane A2, which ihibits platelet aggregation.  ASA affects platelet function by inhibiting the enzyme prostaglandin cyclooxygenase in platelets, thereby preventing the formation of the aggregating agent thromboxane A2. 
  6. Nitroglycerin

    Antianginal Vasodilator
  7. Nitroglycerin

    EMS Indications?
    Suspected ACS
  8. Nitroglycering

    • - Hypesensitivity
    • - Systolic BP less than 100mmHg
    • - Taken any Erectile Disfunction (ED) drugs withing 24 hrs
    • - PT taking phosphodiesterase inhibitors
    • - Right Ventricular Infarct 
  9. Nitroglycerin

    0.4mg = 1 spray q 5 mins prn or until BP drops below 100 or more than 30mmgh in one dose.
  10. Nitorglycerin

    Therapeutic Action?
    • Reduction in left ventricular preload and afterload because of venous (predominantly) and arterial dilation with a more efficient redistribution of blood flow within the myocardium.
    • Vasodilation (relaxes vascular smooth muscle) decreasing preload and afterload which results in decreased myocardial workload
    • Increases use of coronary collaterals to enhance myocardial perfusion
    • Relieves coronary vasospasm
    • Dilates coronary arteries
  11. Glucose

  12. Glucose 

    EMS Indications?
    Comfirmed Hypo - Glycemia
  13. Glucose

    Decreased LOC (potential for aspiration)    
  14. Glucose

    • 25 g PO, prn 
    • Repeat: q 5 mins to a max to 50mg
  15. Glucose

    Therapeutic Actions?
    Provides a quickly absorbed form of glucose to increase blood glucose levels
  16. Glucagon

    Protein Pancreatic Hormone / Insulin Antagonist (Antihypoglycemic)
  17. Glucagon 

    EMS Indication?
    Confirmed hypoglycemia in which an IV cannot be established
  18. Glucagon

    Hypersensitivity to glucagon, beef or pork proteins.
  19. Glucagon

    • 1 mg IM (1 unit)
    • Repeat: q 15 minutes prn to max 2mg (2 units)
  20. Glucagon 

    Therapeutic Actions?
    • Promotes hepatic glycogenolysis and gluconeogenesis.
    • Stimulates adenylate cyclase to produce increased cyclic adenosine monophosphate (cAMP), which is involved in a series of enzymatic activities. The resultant effects are increased concentrations of plasma glucose, a relaxant effect on smooth musculature, and a positive chronotropic and inotropic myocardial effect via non-alpha and non-beta receptor
    • Stimulates glycogen breakdown in the liver, converting glycogen to glucose which raises blood glucose levels.
    • Onset of action is 5-20 minutes
    • Hepatic stores of glycogen are necessary for glucagon to elicit an antihypoglycemic effect
  21. D50W (Dextrose 50%)

    Carbohydrate, Hyperglycemic, Hypertonic solution of 50% dextrose in H2O
  22. D50W

    EMS Indication?
    Comfirmed Systomatic Hypoglycemia
  23. D50W

  24. D50W

    • 25g SIVP/IO in 50ml
    • Repeat: q 5 minutes to a max of 50 g
  25. D50W

    Therapeutic Actions?
    • Increases blood glucose levels
    • Hypertonic solution producing a transient movement of water from interstitial spaces into the venous system (osmotic diuretic)
  26. Epi 1:1000

    Adrenergic Sympathomimetic
  27. Epi 1:1000

    EMS Indications
  28. Epi 1:1000

    No contraindications when used in emergency situations
  29. Epi 1:1000

    • 0.3 mg IM 
    • Repeat: q 5 mins to a max of 0.9 mg
  30. Epi 1:1000 

    Therapeutic Action?
    Alpha 1 Effects

    Peripheral vasoconstriction (increases perfusion pressure during CPR which improves coronary and cerebral perfusion)

    Beta 1 Effects

    • Positive chronotropic
    • Positive inotropic
    • Positive dromotropic
    • Increases automaticity

    Beta 2 Effects

    • 1. Bronchodilation
    • 2. Peripheral vasodilation (minimal)

    Bronchodilator Effect

    • Acts by stimulating beta2 – adrenergic receptors in the lungs to relax bronchial smooth muscle, thereby relieving bronchospasm. This action is believed to result from increased production of cyclic adenosine3,5-monophosphate and ensuing reduction in intracellular calcium concentration caused by activation of the enzyme adenylate cyclase that catalyzes the conversion of adenosine triphosphate (ATP) to cAMP. Increased cAMP concentrations, in addition to relaxing bronchial smooth muscle, inhibit release of
    • mediators of immediate hypersensitivity from cells, especially from mast cells.

    Allergy/Anaphylaxis Effects

    Stimulates the release of cyclic adenosine monophosphate (cAMP). CAMP inhibits the release of mediators associated with allergic and anaphylactic reactions. These mediators are stored in granules within the cytoplasm of basophiles and mast cells. One of the involved mediators is histamine which is responsible for vasodilation and increased permeability of blood vessels.
  31. Salbutamol

    Bronchodilator (sympathomimetic)    
  32. Salbutamol

    EMS Indications?
    Treatment of bronchospasm from (asthma, chronic bronchitis, COPD, anaphylaxis or emphysema)    
  33. Salbutamol

    • Uncotrolled tachyarrythmias
    • Hypersensitivity
  34. Salbutamol

    • -Adult Dosage: 5mg mixed with ipratropium bromide via nebulized
    • -Repeat: PRN

    • -Pediatric: < 20kg, 2.5mg mixed with ipratropium bromide via nebulized. > 20kg, 5mg (same as adult dosage)
    • -Repeat: PRN
  35. Salbutamol 

    Therapeutic Actions?
    • Salbutamol acts by stimulating beta2 receptors in the lungs to relax bronchial smooth muscle, thereby relieving bronchospasm. This action is believed to result from increased production of cyclic adenosine 3,5-monophosphate (cyclic 3,5-AMP; cAMP) and ensuing reduction in intracellular calcium concentration caused by activation of the enzyme adenylate cyclase that catalyzes the conversion of adenosine triphosphate (A TP) to cAMP. Increased cAMP concentrations, in addition to relaxing bronchial smooth muscle, inhibit release of mediators of immediate hypersensitivity from cells, especially from mast cells. Onset of action is 5-15 minutes.
    • Mild Beta1 effects
    • Mild peripheral vasodilation
    • Beta2 selectively lost with high doses (Beta1 and Beta2 effects seen)
  36. Ipratropium Bromide

    Anticholinergic Bronchodilator, Parasympatholytic
  37. Ipratropium Bromide

    EMS Indications?
    • Bronchospasm induce by anaphalaxys.
    • Bronchospasm in general.
  38. Ipratropium Bromide

    Use with caution in patients with know sensativity, but there are no containdications.
  39. Ipratropium Bromide

    • Adult: 500mcg nebulized
    • Repeat: PRN

    • Pediatric: < 20kg = 250mcg nebulized
    •                 > 20kg = 500mcg nebulized 
    • Repeat PRN

    • - Can also be administered via MDI with spacer, dose = 10 puff. 
    • - Repeat: q 20 mins prn to total max of 30 puffs.
  40. Ipratropium Bromide

    Therapeutic Actions?
    • Produces bronchodilation by competitive inhibition of cholinergic receptors on bronchial smooth muscle. This effect antagonizes the action of acetylcholine at its membrane-bound receptor site and thereby blocks the brochoconstrictor action of vagal efferent impulses
    • Through blockade of acetylcholine, which inhibits parasympathetic stimulation, bronchial secretions are also decreased 
    • Onset of action is 5-15 minutes, with a peak at 1-2 hours
  41. Entonox ( nitrous oxide + oxygen)

    Gaseous Analgesic
  42. Entonox ( nitrous oxide + oxygen)

    EMS Indications? 
    Pain management
  43. Entonox ( nitrous oxide + oxygen)

    • Inability to follow instructions.
    • Intoxication.
    • Head injury with altered LOC.
    • Thoracic injury.
    • ABD pain/distension.
  44. Entonox ( nitrous oxide + oxygen)

    Self administration via Demand Valve Mask
  45. Entonox ( nitrous oxide + oxygen)

    Therapeutic Actions?
    • Rapid reversible CNS depression and analgesia
    • Inhaled anesthetics act on the lipid matrix of neuronal membranes or other lipophilic sites. This changes the membrane thickness, which in turn affect the gating properties of ion channels in neurons
  46. Morphine 


    Narcotic (opiate) Analgesic    
  47. Morphine

    EMS Indications?
    Pain management
  48. Morphine 

    • Systolic BP 90mmhg or less.
    • Hypersensitivity.
  49. Mophine

    0.1mg/kg IV/IM/IO to a max single dose of 5mg.

    Repeat: PRN q 5 mins to a max total of 20mg.
  50. Morphine 

    Therapeutic Actions?
    • Opioid analgesics bind with stereospecific receptors at many sites within the CNS to alter processes affecting both the perception of pain and the emotional response to pain
    • Analgesia (exerts its main effect by acting as an opioid agonist at specific opioid receptor sites in the CNS and other tissues).
    • Maximum analgesia occurs 20 minutes after IV administration and 30-60 minutes after IM injection.
    • Analgesia persists for 2.5-7 hours
  51. Fentanyl

    Narcotic (opiate) Analgesic    
  52. Fentanyl

    EMS Indications?
    Pain management
  53. Fentanyl

    • Hypersensitivity.
    • MOAI (MonoAmine Oxidase Inhibitor) therapy within last 14 days.
    • Systolic BP < 80mmHg.
  54. Fentanyl

    • BP greater than 90mmHg.
    • -1mcg/kg IV/IM/IO to a single max dose of 100mcg
    • -Repeat: PRN q 3 mins to a total max of 250mcg

    • BP between 80 and 90mmHg.
    • -0.5mcg/kg IV/IM/IO to a single max dose of 25mcg
    • -Repeat: PRN 5 mins to a total max of 250mcg
  55. Fentanyl

    Terapeutic Actions?
    • Opioid analgesics bind with stereospecific receptors at many sites within the CNS to alter processes affecting both the perception of pain and the emotional response to pain
    • Analgesic (immediate onset, 30-60 minute duration)
    • CNS depressant – more potent, faster onset & shorter duration than morphine 
  56. Toradol (Ketorolac)

    Nonsteroidal Anti-inflammatory Analgesic    
  57. Toradol (ketorolac)

    EMS Idications?
    Pain Management, refractory to Fentanyl and Morphine
  58. Toradol (Ketorolac)

    • Hypersensitivity to it or other NSAID's.
    • Asthma.
    • Renal failure.
    • Suspected intracranial bleed.
    • History of GI bleeding.
  59. Toradol (Ketorolac)

    • With OLMC 30mg IV/IM
    • Repeat: With OLMC
  60. Toradol (Ketorolac) 

    Therapeutic Actions?
    • Inhibits the activity of the enzyme cyclo-oxygenase, resulting in decreased formation of precursors of prostaglandin’s and thromboxanes from arachidaonic acid
    • At analgesic doses little anti-inflammatory or antipyretic activity is seen.
    • Ketorolac acts peripherally versus narcotics, which act upon the CNS, therefore, no CNS depression 
Card Set
ALS Paramedic Pharmo
Paramedics 1st year Practicum