-
Epinephrine
Trade names:
Adrenalin, Epinephrine
-
Epinephrine
Class:
Sympathominmetic
-
Epinephrine
Action:
- Directly stimulates Alpha & Beta adrenegic receptors in sympathic NS
- Bronchodialtion=> relaxes smooth muscle (Beta2)
- inhibits histomine release
- positive chronotropic & inotrophic (Beta1)
- increase cardiac output + myocardial 02 consumption
-
Epinephrine
Indications:
Anaphylaxis
-
Epinephrine
Contraindications:
None in emergent anaphylaxis
-
Epinephrine
Adverse Effects:
Palpitations, anxiousness, headache, tremors
-
Epinephrine
Onset & Duration & Dosage & Rout
- Onset: 5-10 min IM
- Duration: 5-10 min IM
- Adult Dosage: 0.3mg (1:1000) IM Repeat q 5-10 minutes prn
- Ped Dosage: 0.01 mg/kg IM/SQ (do not exceed 0.3 mg)
- Route: IM - Massaging the site after an IM injection may hasten absorption
-
Epinephrine
Interactions/Precautions:
- hypotension in circulatory callapse
- hypotension by pheothiazines antagonized by Alpha and Beta receptors
- additive toxicities with other sympathominmetics
- pH dependent
- deactivated when given with high alkaline solutions
-
Glucagon
Class:
hormone (antihypoglycemic agent)
-
Glucagon
Action:
- cause break down of glycogen to glucose
- inhibits glycogen synthesis
- elevates blood glucose level
- positive chronotropic & inotropic
-
Glucagon
Indication:
Hypoglycemia
-
Glucagon
Contraindication:
hypersensitivity
-
Glucagon
Adverse effects:
dizziness, headache, hypotension, N/V hyperglycemia, hypokalemia
-
Glucagon
Dosing
(Onset, Duration, Adult, Peds, Route)
- Onset:: 5-20 min, peak @ 30 min
- Duration: 1- 1.5hrs
- Adult Dosage: 1 mg IM, q 15-20 minutes (prn)
- Ped Dosage:
- (<5 years) 0.5 mg IM
- (>5 years) 1.0 mg IM
- Route: IM
-
Glucagon
Interactions/Precautions:
After patient regains LOC – supplemental carbohydrates should be provided as soon as possible
-
Nitroglycerin Spray
Trade names:
Nitrostat, Nitro-Bid, Tridil
-
Nitroglycerin Spray
Class:
nitrate, anti-anginal, vasodilator
-
Nitroglycerin Spray
Actions:
- Antianginal relaxes vascular smooth muscle of both venous and arterial beds, resulting in a net decrease in the myocardial oxygen consumption. It also dilates coronary vessels, leading to redistribution of blood flow to ischemic tissue and improves collateral circulation
- Vasodilating dilates peripheral vessels, decreasing venous return to the heart (preload) useful in treating pulmonary edema and heart failure. Arterial vasodilation decreases afterload, thereby decreasing
- left ventricular work and aiding the failing heart
-
Nitroglycerin Spray
Indications:
- Acute coronary syndromes (pain & ischemia with Acute Myocardiac
- Infarction without hypotension), Suspected ischemic cardiac pain
-
Nitroglycerin Spray
Contraindications:
- Hypersensitivity to nitrates
- Unable to initiate IV
- Increased intracranial pressure
- Hypotension (Systolic pressure under 100mmHg)
- Uncorrected hypovolemia
- Suspected cardiac tamponade or pericarditis
- Sildenafil (Viagra) or similar generic drug use within 24 hours
- Avoid use in extreme bradycardia (<50 bpm) or severe tachycardia (> 180 bpm)
- Important! Right ventricular infarction: use with Extreme Caution- if at all!
-
Nitroglycerin Spray
Adverse effects:
- Hypotension
- Palpitations
- Tachycardia
- Syncope
- Dry mouth
- N/V
- Headache
- Dizziness
- Skin rash
-
Nitroglycerin Spray
Dosage
(Onset Duration Adult Dosage Route)
- Onset: 1-3 minutes
- Duration: may last 30-60 minutes
- Adult Dosage: SL 0.3 mg tabSL 0.4 mg spray q 5 minute intervals (prn) as long as BP remains > 100 mmHg
- Route: sublingual spray or tablet
-
Nitroglycerin Spray
Interactions/Precautions:
- Do not shake canister if administered as a spray as it will altered the metered dose in a single spray
- Do not have patient inhale drug on administration as it will alter absorption rate
- Establish IV prior to or immediately following administration to combat hypotension if necessary
-
ASA
Trade names:
Asprine, Alka Seltzer, Aspergum, Bayer, Cosprin....
-
ASA
Class
- Anit-infammatory
- analgesic
- antipyretic
- platelet inhibitor
-
ASA
Actions
- Anticoagulant: at low doses, appears to impede clotting by blocking prostaglandin synthesis, which prevents
- formation of platelet-aggregating substance thromboxane A2
- Analgesia/anti-inflammatory: inhibits the synthesis of prostaglandin, preventing or reducing pain (this is irreversible and can prolong bleeding time)
- Antipyretic: acts on the hypothalamus to produce peripheral vasodilation causing sweating which leads to heat loss and cooling by evaporation
-
ASA
Indications
Acute coronary syndroms suggestive of an acute myocardial infraction
-
ASA
Contraindications
- Hypersensitivity
- GI bleeds
- ulcers
- asthma (May produce bronchoconstriction in asthmatics)
- unconsciousness
-
ASA
Adverse effects
Heartburn, N/V, wheezing
-
ASA
Dosing
(Onset Duration Adult Dosage Route )
- Onset: 5-30 min
- Duration: 1-4 hours, halflife 15-20min, peak effects 15min -2hrs
- Adult Dose: 160mg - 325mg chewed as soon as possible
- Route: PO
-
ASA
Interactions-Precautions
- Anticoagulants increase risk of bleeding
- Impaired renal and hepatic function
- The effects of a single dose of aspirin persist for the life of the platelet (about 8 days)
-
Dextrose D50W/D25W
Class:
carbohydrate, antihypoglycemic
-
Dextrose D50W/D25W
Actions
- Rapidly metabolized calories given parenterally, which promotes glycogen
- stores and prevents ketosis in patients with inadequate oral intake
-
Dextrose D50W/D25W
Indications:
- Hypoglycemia
- Coma of unknown origin (if unable to obtain blood glucose reading)
-
Dextrose D50W/D25W
Contraindications:
Hyperglycemia Patients with increased ICP or intracranial hemorrhage
-
Dextrose D50W/D25W
Adverse effects:
- Hyperglycemia
- Thrombophlebitis [phlebitis (vein inflammation) related to a thrombus (blood clot)]
-
Dextrose D50W/D25W
Dosing:
(Onset Duration Adult Dosage Pediatric Dosage Route)
- Onset: 30-60 seconds
- Duration: depends upon degree and cause of hypoglycemia
- Adult Dosage: 0.5 – 1.0 g/kg of D50W slow IVP Second dose may be given if first dose ineffective
- Suspected head injury 12.5 g D50W slow IVP Re-check chemstrip in opposite limb and assess patient
- Pediatric Dosage: 0.5-1.0 g/kg of D25W (2-4 mls/kg) slow IVP
- Route: IV
-
Dextrose D50W/D25W
Interactions/Precautions:
- Dextrose greater (>) than 5% is considered a hypertonic solution. It can be very irritating to the vein and could cause cerebral bleeding if not given slowly
- Patients with increased intracranial pressure (give a half dose and reassess – Never withhold, if the patient’s metabolic needs are deficient)
- Ensure patency of IV – can cause tissue sloughing if interstitial Localized venous irritation and tissue necrosis may result
- IV cathalon should be 18g minimum as solution is very viscous
-
Nitrous Oxide
Trade Name:
Entonox
-
Nitrous Oxide
Class:
gaseous analgesic/anesthetic
-
Nitrous Oxide
Action:
- Potent analgesic, weak anesthetic at 50% nitrous oxide with 50% oxygen
- CNS depressant with analgesic properties
-
Nitrous Oxide
Indications:
- Pain of musculoskeletal origin, particularly fractures
- Burns
- Suspected ischemic chest pain (BLS)
- Pregnancy (only in active labor)
-
Nitrous Oxide
Contraindications:
- Unable to follow commands – due to interpretive problem, drugs, alcohol
- Altered LOC
- Significant COPD
- Any traumatic chest injury
- Any suspicion of pneumothorax, obstructed bowel (abd pain with distension)
- Decompression sickness (diving in last 48 hours)
- Pregnancy – except in active labor
-
Nitrous Oxide
Adverse effects:
- Dizziness
- ALOC
- Hallucinations
- N/V
-
Nitrous Oxide
Dosage
(Onset, Duration,Adult Dosage,Pediatric Dosage,Route)
- Onset: ~50sec
- Duration: effects last only 2-5 minuets after administration ceases
- Dosage: (Adult and Ped)Self administrated inhalation until pain is relieved or patient drops the mask.
- Route: Inhalation by demand valve and mask
-
Nitrous Oxide
Interactions/Precautions:
- Use in well ventilated area
- Ensure to invert tank three times prior to use
- Do not use outside if ambient temperature is below minus six degrees Celsius (-6°C).
- Do not use if frost on the tank
- Prolonged use can cause hypoxemia- provide supplemental Oxygen
-
Medical Oxygen
Class:
Medical Gas
-
Medical Oxygen
Action:
- Colorless, odorless, tasteless gas essential to respiration
- At sea level, oxygen makes up approximately 10% - 16% of venous blood and 17% - 21% of arterial blood
- Transported from the lungs to the body’s tissues attached to hemoglobin in the red blood cells
- Inhalation/administration will increase arterial oxygen tension (PaO2) and hemoglobin saturation
-
Medical Oxygen
Indications:
- Hypoxia from any cause
- Chest pain due to cardiac ischemia
- Altered level of consciousness
-
Medical Oxygen
Contraindications:
None for emergency use.
-
Medical Oxygen
Adverse effects:
None
-
Medical Oxygen
Dosing
(Onset,Duration,Adult Dosage,Pediatric Dosage,Route)
- Onset: immediate
- Duration: until administration ceases
- Dosage: Nasal Cannula: @ 1-6 L/min (24% - 40% O2 concentration)
- Simple & Pocket Mask: @ 6 – 10 L/min (40% - 60% O2 concentration)
- Partial/ Non-Rebreather (NRB): @ 10 – 15 L/min (up to 98% O2 concentration)
- Bag-Valve Mask (BVM): @ 10 – 15 L/min (up to 100% O2 concentration)
- Venturi Masks: @ 4 L/min (24% - 28% O2 concentration) @ 8 L/min (35% - 40% O2 concentration) Note: liter flow is dependent on the Venturi mask used.
- Route: Inhalation
-
Medical Oxygen
Interactions/Precautions:
- In some cases of COPD, oxygen administration may reduce the patient’s respiratory drive This is not a reason to withhold oxygen, but be prepared to assist ventilations.
- Oxygen that is not humidified may dry out or irritate mucous membranes
- Monitor long-term high flow in neonates as retrolental fibroplasia may develop
- Open flames
- 1 L/minute increase from 25% = 4% increase in dose
- Example:
- 1 L/minute = 25%
- 2 L/minute = 29%
-
Dimenhydrinate
Trade name:
Gravol, Dramamine
-
Dimenhydrinate
Class:
antiemetic, antihistamine, anticholinergic, antivertigo
-
Dimenhydrinate
Action:
antiemetic,antivertigo: inhibits nausea and vomiting by centrally depressing sensitivity to the labyrinth apparatus that relays stimuli to the chemoreceptor trigger zone and stimulates the vomiting center of the brain
-
Dimenhydrinate
Indications:
Nausea, vomiting
-
Dimenhydrinate
Contraindications:
- Hypersensitivity (contains benzyl alcohol)
- Seizures
- Any condition which may be worsened by anti-cholinergic effects
-
Dimenhydrinate
Adverse effects:
- Can cause sedation
- dry mouth
- blurred
- vision
- urinary retention
-
Dimenhydrinate
Onset:
Duration:
Adult Dosage:
Pediatric Dosage:
Route:
- Onset: Immediate
- Duration: 4-7 hours Peak :1-4 hours
- Adult Dosage: 25 – 50 mg slow IVP 50 – 10 mg IM Note: IV dose must be diluted with NS to 10 ml
- Pediatric Doseage:
1 mg/kg IM or slow IVP (diluted) - 2 – 5 years do not exceed 25 mg
- 6 – 12 years do not exceed 50 mg
- Route: IV, IM
-
Dimenhydrinate
Interactions/Precautions:
- Seizure disorders
- Asthma
- Patients with increased intraocular pressure or angle-closure glaucoma.
- Undiluted solution is irritating to the veins and may produce sclerosis
-
Glucose (oral)
Trade name:
Insta-glucose, Monogel, Glutose
-
Glucose (oral)
Class:
glucose
-
Glucose (oral)
Action:
A monosaccharide that is given orally and is readily absorbed in the intestine
-
Glucose (oral)
Indications:
Hypoglycemia in patients who are alert, are able to follow commands & can swallow
-
Glucose (oral)
Contraindications:
- Any patient who is not alert
- Any patient unable to follow commands
- Any patient who lacks a gag reflex
- Hyperglycemia
-
Glucose (oral)
Adverse effects:
Nausea and vomiting
-
Glucose (oral)
Onset:
Duration:
Dosage:
Route:
- Onset: 1 minute
- Duration: Depends on the degree of hypoglycemia
- Dosage: 25 g orally (may repeat in 10 minutes if necessary) (Administer the entire contents of tube (25 g) slowly and intermittently while patient swallows)
- Route: Oral
-
Glucose (oral)
Interactions/Precautions:
- May cause nausea or the patient may gag when administered
- Oral glucose is not absorbed sublingually or buccally
-
Salbutamol (Canada), albuterol sulfate
Trade name:
Ventolin
-
Salbutamol
Class:
bronchodilator, beta2-selective adrenergic agonist (sympathomimetic)
-
Salbutamol
Action:
- Selectively stimulates beta-adrenergic receptors of the lungs, uterus, and vascular smooth muscle
- Brochodilation results from relaxation of the vascular smooth muscles, which relieves bronchospasm and reduces airway resistance
- Higher doses will drive serum potassium (K+) into the cells.
-
Salbutamol
Indications:
- Bronchospasm due to bronchial asthma
- chronic bronchitis and other chronic bronchopulmonary disorders
- Respiratory distress with bronchospasm
-
Salbutamol
Contraindications:
Hypersensitivity
-
Salbutamol
Adverse effects:
- Often dose-related and include
- restlessness, tremors dizziness,
- palpitations, tachycardia, nervousness, peripheral vasodilation, nausea,
- vomiting, hyperglycemia, increased blood pressure, and paradoxical bronchospasm.
-
Salbutamol
Onset:
Duration:
Adult Dosage:
Pediatric Dosage:
Route:
- Adverse effects:
- Onset: 5-15 minutes
- Duration: 3-4 hours Peak effect: in 30 minutes to 2 hours
- Adult Dosage: 2.5 – 5.0 mg nebule – repeat q 10 minutes prn
- MDI minimum 6 puffs max 20
- Pediatric Dosage: 0.15 mg/kg diluted to 2.5 ml saline via nebulizer
- < 10 kg give 1.25 mg with NS to 2.5 ml
- 10-20 kg give 2.5 mg
- > 20 kg give 2.5 – 5.0 mg
- MDI pediatrics minimum 2 puff max 10
- Route: Nebulizer or metered dose inhaler
-
Salbutamol
Interactions/Precautions:
- Should not be used with patients presenting with acute heart failure Cardiovascular disease – cardiac dysrhythmias, hypertension
- Diabetes mellitus – risk of drug induced hyperglycemia
- Hypokalemia – risk further reducing serum potassium levels and possible adverse cardiovascular events
-
Ipratropium bromide
Trade name:
Atrovent
-
Ipratropium bromide
Class:
anti-cholinergic, bronchodilator
-
Ipratropium bromide
Action:
Inhibits cholinergic receptors in the bronchial smooth muscle, resulting in decreased concentrations of cyclic guanosine monophosphate (cyclic GMP). Decreased levels of cyclic GMP produce local, not systemic, bronchodilation
-
Ipratropium bromide
Indications:
bronchospasm in asthma, chronic bronchitis and emphysema
-
Ipratropium bromide
Contraindications:
Hypersensitivity to drug or atropine or its derivatives
-
Ipratropium bromide
Adverse effects:
- alpitations
- Dizziness
- Anxiety
- Headache
- Nervousness
-
Ipratropium bromide
Onset:
Duration:
Adult Dosage:
Pediatric Dosage:
Route:
- Onset: 1-3 min
- Duration: 4-6 hrs, Peak 1-2hrs
- Adult Dosage: 250 –500 mcg via nebulizer with Salbutamol (mixed) repeat up to two times if necessary
- Normally only 1-2 doses in other conditions (eg. emphysema, chronic bronchitis)
- Combivent: 2.5 – 5.0 ml nebule – repeat q 10 minutes prn (not to exceed max dose for Atrovent )
- MDI: minimum 1- 4 puffs prn; max 10 (give after salbutamol; ipratropium has a much slower onset of action) Pediatric Dosage: (ages 5-11) – 25-250 mcg via nebulizer with salbutamol (mixed) repeat up to times two if necessary
- MDI: minimum 2 puff prn; max 4 (give after salbutamol; ipratropium has a much slower onset of action)
- safety and efficacy in children under 12 years of age haven’t been established.
- Route: Nebulizer or metered dose inhaler
-
Ipratropium bromide
Interactions/Precautions:
- Hypersensitivity to soy lecithin or related food products (soybeans, peanuts)
- Patients with narrow angle glaucoma
- Be careful to avoid accidental release into the eyes (use mouth piece neb if possible)
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