Download AEMT-Pharmacology-ver-2-4-2013

AEMT- Medication Card Guidelines
(2.2013)
The AEMT must have knowledge of the following drugs for EMSP 1338. The student will prepare the
drug cards and turn them in by the due date. Keep in mind that the student is preparing the cards to
take into the clinical setting where they MUST know the drugs completely before being allowed to
administer them to a patient. The guidelines needed to successfully complete this assignment are as
follows:
1.
The cards need to be done on Index cards in a spiral notebook; the other alternative is to do them on
index cards and then place them in a binder of some sorts so the cards do not “fall out” after completing
them. I will NOT take them LOOSE or held together with a binder clip since they can come loose easily.
2. The size of the cards is up to the student in what you are willing to carry but keep in mind that the smaller
they are makes it easier
to place them in your lab coat.
3. The following information must be on EVERY card.
a.
Class
b. Mechanism of Action
c.
Indications
d. Contradictions
e.
Side Effects
f.
Precautions
g.
How Supplied
h. Administration/Dosage
4. THEY MUST BE LEGIBLE IN YOUR HANDWRITING – not anyone’s else’s.
5. The Packet will NOT be scanned into computers and made into drug cards. Commercial Drug Cards are also
NOT acceptable either.
6. CARDS MUST BE HANDWRITTEN
7. Under Side Effects Charts, the Key is the following:
When it is underlined and has a “C”=COMMON; When it is Bolded and has italics= LT-Life
Threatening
EPINEPHRINE (1:1,000)
Class: Sympathomimetic, vasopressor, bronchodilator
Mechanism of Action
- Catecholamine that stimulates alpha- and beta- adrenergic receptors
1. Beta1 stimulation leads to:
- positive inotropic effects ( force of cardiac contraction)
- positive chronotropic effects ( rate of cardiac contraction)
- positive dromotropic effects ( conduction velocity)
- increased cardiac output (CO)
- increased myocardial oxygen requirements
2. Beta2 stimulation leads to:
- peripheral vasodilation and bronchodilation
3. Alpha1 stimulation leads to peripheral vasoconstriction:
- arterial / venous vasoconstriction (vasopressor) = increased SVR
- constriction to renal, mesenteric, coronary, and cerebral vessels
- pulmonary vasoconstriction
- making the heart more susceptible to direct countershock in cardiac arrest (Ventricular fibrillation) = reason it is given during
cardiac arrest
4. Inhibits histamine release (stops degranulation) during anaphylactic reaction
(Effects start within 90 seconds and are short lived)
Indications
1. Acute asthma attacks
2. Exacerbation of some forms of COPD
3. Mild anaphylaxis
4. Symptomatic Bradycardia (refractory, not responding, to oxygen and atropine) (infusion)
5. Symptomatic heart blocks (second type II and third degree) (infusion)
Contraindications
1. Hypersensitvity
2. Patients with underlying cardiovascular disease
3. Tachyarrhythmias
4. Not with alkaline drugs
5. Shock
6. Patients with hypertension
EPINEPHRINE (1:1,000)
Side Effects
CNS
Anxiety
Dizziness
Cardiovascular
Anginal pain
Dysrhythmias LT
Hypertension
Palpitations - LT
Ischemia
Headache
Restlessness
Subarachnoid
Hemorrhage =
LT
Tremors
Weakness
Italic = C = common side
GI / GU
Nausea - C
Vomiting-C
Respiratory
Dyspnea
Skin
Pallor
Coldness
Urinary retention
Necrosis
Urticaria
Bold italics = LT = life-threatening reactions
Precautions
1. Increased myocardial workload may lead to ischemia, infarction
2. May have increased airway resistance due to sulfites in the preparation = hypersensitivity
3. Use cautiously with:
- Heart disease
- Diabetes
- Hypertension
4. Excreted into breast milk – use cautiously on nursing mothers
How supplied
- Ampules and prefilled syringes containing
- 1mg/1ml
- Vials containing:
- 30mg/30cc
Administration / dosage
Administered – SQ / IM / IV infusion
Mild Anaphylaxis or Acute Asthma Attack
0.3 to 0.5mg - IM / SQ
Mix infusion:
Refractory Bradycardia
Every 15 – 20 minutes, PRN
Dosage range:
1-2mg / 250 or 500cc
2-10g / minute
Low doses – 2-5g / minute =  effects
High doses – 5-10g / minute =  effects
Eyes
Pupil dilation
EPINEPHRINE (1:10,000)
Class: Sympathomimetic, vasopressor, bronchodilator
Mechanism of Action
- Catecholamine that stimulates alpha- and beta- adrenergic receptors
1. Beta1 stimulation leads to:
- positive inotropic effects ( force of cardiac contraction)
- positive chronotropic effects ( rate of cardiac contraction)
- positive dromotropic effects ( conduction velocity)
- 3 above help with rate post-arrest
- increased cardiac output (CO)
- increased myocardial oxygen requirements
2. Beta2 stimulation leads to:
- peripheral vasodilation and bronchodilation
3. Alpha1 stimulation leads to peripheral vasoconstriction:
- arterial / venous vasoconstriction (vasopressor) = increased SVR (perfusion pressure)
- constriction to renal, mesenteric, coronary, pulmonary and cerebral vessels
- makes the heart more susceptible to direct countershock in cardiac arrest (Ventricular fibrillation) (due to
increased hydrostatic pressure) = reason it is given during cardiac arrest
4. Inhibits histamine release (stops degranulation) during anaphylactic reaction
(Effects start within 90 seconds and are short lived)
Indications
1. Asystole
2. Ventricular-Fibrillation/pulseless Ventricular-Tachycardia
3. Pulseless electrical activity (PEA)
4. Severe anaphylaxis
Contraindications
1. Hypersensitvity
2. Patients with underlying cardiovascular disease
3. Tachyarrhythmias
5. Hypovolemic shock
6. Not with alkaline drugs
Side Effects
CNS
Cardiovascular
GI / GU
Anxiety
Anginal pain
Nausea
Dizziness
Vomiting
Dysrhythmias- LT
Headache
Hypertension
Urinary retention
Restlessness
Palpitations
Ischemia
Subarachnoid
Hemorrhage- LT
Tremors
Weakness
Bold italics = LT = life-threatening reactions
Respiratory
Dyspnea
2
Skin
Pallor
Coldness
Necrosis
Urticaria
Eyes
Pupil dilation
EPINEPHRINE (1:10,000)
Precautions:
1. increased myocardial workload may lead to ischemia, infarction
2. hypersensitivity (may have increased airway resistance due to sulfites in the preparation)
3. use cautiously in patients with:
- Heart disease
- Diabetes
- Hypertension
- Given along with other sympathomimetics or with phosphodiesterase inhibitors (caffeine, amiophylline,
Dipyridamole, Erectile dysfunction meds) may exacerbate dysrhythmia response
4. Deactivated with sodium bicarbonate / lasix (alkaline solutions)
5. Patients on MAO inhibitors (Marplan, Nardil, Parnate)  (Anti-depressant drugs) – potentiates the effects
How Supplied
- 1mg/10ml = 1:10,000 (prefilled syringe)
Administration/Dosage
Administered by: - IVP, IO, ET
Cardiac Arrest
1mg (1:10,000) IVP or IO
Followed by a 20cc flush and raising the patients arm
Repeat every 3-5 minutes
Endotracheal dose
2-2.5 times the IVP dose
Use 1:1,000 and place in 10cc of fluid
Use ONLY if IV or IO site cannot be established
May produce transient β effects = vasodilation = ↓
Coronary perfusion pressure
Severe Anaphylaxis: 1.0mg SIVP (1:10,000) over 5 minutes
- Repeat in 5-15 minutes PRN (as needed))
Pediatric dose: Cardiac arrest - 0.01mg/kg IVP (0.1 mL/kg)
ASPIRIN
Class: Nonsteroidal Anti-inflammatory Drug (NSAID), antipyretic, platelet inhibitor, nonnarcotic analgesic
Mechanism of Action
1.
2.
3.
4.
-
Inhibits prostaglandin synthesis and release (from mast cells). This action:
decreases pain and fever produced
Antipyretic agent by:
inhibition of prostaglandins
action on hypothalamus heat-regulating center
vasodilation and sweating
Analgesic agent
acts on peripheral nervous system
Platelet inhibitor = prevents formation of thromboxane A2
Post-plaque rupture in vessels  “sticky” platelets adhere to damaged vessel (within 1-5 seconds)  platelets release thromboxane A2
(chemical causes  platelet aggregation and vasoconstriciton)
Aspirin delivery leads to:
- Vasodilation (platelet inhibitor / thromboxane A2 inhibitor)
- Decreased clot formation (platelet inhibitor / thromboxane A2 inhibitor)
- Reduces inflammation (inhibition of prostaglandin synthesis)
- Reduces fever (inhibition of prostaglandin synthesis and antipyretic properties)
- Pain reduction (analgesic property)
IF STARTED WITHIN 24 HOURS OF ONSET OF ACUTE MI – IT REDUCES MORTALITY ALMOST TO THE SAME
DEGREE OF THROMBOLYTIC THERAPY
Indications
1.
2.
3.
4.
5.
Mild to moderate pain and fever
Reducing the risk of recurrent transient ischemic attacks (TIA)
Chest pain or other signs/symptoms of acute MI
EKG changes suggestive of acute MI
To reduce inflammation
Contraindications
1.
2.
3.
4.
5.
Active ulcer disease
Hemophilia
Hemorrhagic states
- Active GI bleeding
- Hemorrhagic stroke
Known hypersensitivity to NSAIDs or salicylates
Children or adolescents with flu-like symptoms / chickenpox (Varicella)
ASPIRIN
Side effects
CNS
Confusion
Eyes / Ears
Dim vision
Dizziness
Reversible
hearing loss
Tinnitus
Drowsiness
Headache
Blood
 plasma iron
concentration
Leukopenia = LT
GI
Reversible
hepatotoxicity
Anorexia
Metabolic
Hypoglycemia
Respiratory
Hypernea
Skin
Angioedema
Hypokalemia
Wheezing
Bruising
Prolonged bleeding
Diarrhea
Hyponatremia
Hives
Shortened
erythrocyte survival
time
Thrombocytopenia=
LT
Dyspepsia (inhibits
pepsin) = GI
discomfort = C
Peptic ulcer
formation
Bleeding
Heartburn
Bronchospasms
Laryngeal
edema
Italic = C = common side effects
Nausea = C
Bold Italic = LT = life-threatening reactions
Precautions
1. Chronic use may lead to GI ulcerations, bleeding, or perforation
2. Alcohol may increase the risk of GI bleeding
3. Allergic reactions are more likely if the patient has a history of asthma (hypersensitivity)
4. Use cautiously with:
- GI disorders
- Asthma
- Impaired renal / liver function
- Dehydrated children
- Histories of coagulation defects
- Bleeding disorders
Administration / Dosage
Administered - PO (orally) –
Mild pain and fever
325-650mg - PO
Myocardial Infarction
160-325mg / day - PO
NON-ENTERIC – chewing is preferred
Rash
Urticaria
NITROGLYCERIN (NITROSTAT)
Class: antianginal, vasodilator, and nitrate
Mechanism of action
1. Relaxes vascular smooth muscle - promoting vasodilation
2. Decreases preload (predominately)
- venous dilation =  preload =  heart size
-  heart size =  blood flow to coronary and collateral vessels = myocardial perfusion is improved
3. Decreases afterload
-  arteriole pressure =  aortic pressure = left ventricle works better
4. Decreases myocardial O2 consumption / workload
5. Improves collateral flow to ischemic regions
6. Dilates pulmonary capillary beds
- fluid in alveoli and interstitial space are pulled back into the vessels
Pain relief occurs within 2 minutes & therapeutic effects observed up to 30 minutes.
Indications – systolic pressure  100 mmHg
1. Angina
2. Chest pain with myocardial infarction
3. Pulmonary edema associated with CHF or MI
4. Hypertensive emergencies with Acute Coronay Syndromes or acute CHF
Contraindications
1. Increased ICP
2. Hypotension
3. Hypovolemia
4. Viagra use within 24 hours
5. Right ventricular infarct
6. Severe bradycardia or tachycardia
7. Hypersensitivity
Side effects
CNS
Anxiety
Confusion
Dizziness - C
Uncoordination
Headache - C
Nervousness
Cardiovascular
Atrial fibrillation
GI
Abdominal
pain
GU
Dysuria
Collapse - LT
Increase in angina
Diarrhea
Dyspepsia
Impotence
Urinary
frequency
Dysrhythmias LT
Palpitations
Nausea
Sweating
Vomiting
Pallor
Postural
hypotension - C
Vertigo
PVC’s
Weakness
Reflex
Tachycardia
Syncope
Italic = C = common side effects
Bold italic = LT = life-threatening reaction
Eyes
Blurred vision
Skin
Flushing - C
Pallor
Burning sensation in
contact area - C
NITROGLYCERIN (NITROSTAT)
Precautions
1. The drop in B/P may lead to decreased cerebral perfusion
2. Patient may develop tolerance to the drug
3. A reduction in the diastolic pressure may lead to ischemia and angina developing
4. Use cautiously with:
- the patient having an inferior wall MI with possible RV involvement
- severe renal / hepatic impairment
- glaucoma
Administration / dosage – ESTABLISH AN IV PRIOR TO ADMINISTRATION (on borderline patients- pressure close to 100mmHg)
Administered: - pills, spray, patches, ointments, IV infusion
- Prehospital - administer nitro. sublingually through pills or spray
Dose: - 1 - 0.3 - 0.4mg tablet sublingual - repeated every 5 minutes (give up to 3 tablets)
Sit or lie patient down – instruct not to swallow until tablet is entirely dissolved
Dose: - 1-2 sprays - 0.4mg per spray sublingual - every 5 minutes (up to 3 sprays in 15 minutes)
Spray for 0.5 to 1.0 seconds – Do not shake canister (may produce bubbles and alter medication delivery)
MONITOR VITALS AFTER EACH DOSE PRIOR TO ADMINISTERING MORE DRUG
SYSTOLIC BLOOD PRESSURE SHOULD NOT BE LESS THAN 100 mmHg PRIOR TO ADMINISTRATION.
When administering to patients with:
1. Acute MI – don’t let systolic pressure drop more than 10%
2. Hypertension – don’t let systolic pressure drop more than 30%
50% DEXTROSE (D50W)
Class: carbohydrate, caloric agent
Mechanism of action
1. Increases blood glucose concentrations
2. Provides calories
3. Decreases rate of ketone production
4. Osmotic diuretic
Indications
1. Acute alcoholism with coma (deliver thiamine prior to D50W)
2. Hypoglycemia
3. Coma of unknown cause (NEED TO CHECK BG)
4. Status epilepticus of uncertain cause
5. Hyperkalemia – with insulin may shift K+ back to the intracellular space
Contraindications
1. Hypersensitivity to corn or corn products
2. Thiamine deficient patients (may cause Korsakoff’s psychosis or Wernicke’s encephalopathy)
3. Intracranial hemorrhage (unless patient is hypoglycemic)
Side effects
Cardiovascular
Hypertension
CHF - LT
Pulmonary edema - LT
GU
Osmotic diuresis
Metabolic
 K+ and Mg++
Fluid overload
bold italic = LT - life-threatening reactions
Precautions
1. Excessive IV administration may cause fluid volume or solute overload
2. Use cautiously with:
- Carbohydrate intolerance; renal insufficiency; chronic alcoholism (give Thiamine first); diabetes
How supplied
- 25gm / 50ml (50% solution)
Administration / dosage
Administration - Slow IVP (in a large vein)
Dose – 12.5 to 25 grams (25 to 50 cc)
- Perform a D-stick prior to administration if possible
- Give Thiamine prior if alcohol use is suspected
Skin
Irritation
Necrosis
Glucagon
Class:
Hyperglycemic agent; pancreatic hormone, insulin antagonist
Mechanism of action:
1. Protein secreted by alpha cells of the pancreas. When released results in blood glucose elevation by increasing the breakdown of
glycogen to glucose (glycogenolysis) and stimulating glucose synthesis (gluconeogenesis).
2. Only effective in treating hypoglycemia if liver glycogen is available and therefore may be ineffective in chronic states of:
a. Hypoglycemia
b. Starvation
c. Adrenal insufficiency
3. Exerts (+) inotropic action on the heart and decreases renal vascular resistance
a. Why used to manage patient with beta-blocker and calcium-channel blocker cardiotoxicity (that do not respond to other
conventional therapy)
Indications:
1. Altered LOC when hypoglycemia is suspected
2. Beta-blocker and calcium channel blocker toxicity.
Contraindications:
1. Hyperglycemia
2. Hypersensitivity to proteins
Side effects
CNS
Cardiovascular
GI
tachycardia
Hypotension
Vomiting=C
GU
Respiratory
common side effects=C
How supplied
1unit (1mg) white powder with 1 mL of diluting solution (supplied)
Reconstitute the powder with the diluent
DO NOT MIX WITH NORMAL SALINE
Administration / dosage - IM
Adult - 0.5mg-1mg IM - repeat in 7-10 min
Calcium Channel OD/Beta blocker OD: 3mg – followed by infusion at 3 mg / hour, prn
Skin
Urticaria
Nitrous oxide:Oxygen (50/50)
Nitronox
Class: gaseous analgesic/anesthetic
Mechanism of action
A blend of 50% O2 and nitrous oxide. When inhaled, depresses the CNS causing anesthesia; In addition, the high concentration of oxygen
delivered along with the nitrous oxide increases oxygen tension in the blood, thereby reducing hypoxia. It is self administered
Indications
Moderate to severe pain
Anxiety
Apprehension
Contraindications
1. Impaired LOC
2. Head injury
3. Chest trauma (pnemothorax)
4. Inability to comply with instructions
5. Decompression sickness (nitrogen narcosis, air transport, air embolus)
6. Undiagnosed abdominal pain or marked distention
7. Bowel obstruction
8. Hypotention
9. Shock
10. COPD
Side effects
CNS
Dizzy
Cardiovascular
GI
GU
Malignant
Nausea/vomiting
hypertention
**Rare but
dangerous
common side effect=C
bold italic = LT = life-threatening reaction
Respiratory
Apnea (LT)
Skin
Cyanosis
How supplied
- D or E cylinders - blue and green in USA; blue and white in Canada
Administration / dosage – start an IVP prior to administration
Adult: ENSURE enough O2 is in the tank to ensure oxygenation - invert cylinder several times before use – this mixes O2 and nitrous
oxide
Instruct the patient to inhale deeply through a patient held mask or mouthpiece
Pediatric: Same
Special Consideration:
Pregnancy: Nitrous oxide has been shown to increase the incident of spontaneious abortion
Nitrous oxide - is 34 times more soluble than nitrogen and will diffuse into pockets of trapped gas in the patient (intestinal obstruction,
pneumothorax, blocked middle ear. As nitrogen leaves and is replaced by larger amts of nitrous oxide, increase pressures or volumes may
cause serious damage, for example, intestinal rupture
Nitrous oxide is non-explosive gas
Patient must hold mask and self administer
ALBUTEROL (PROVENTIL)
Class: Beta2 adrenergic agonist
Mechanism of Action
1. Predominately stimulates 2 receptors
2. Minimal 1 stimulation
3. May cause reflex tachycardia (with high doses)
4. Promotes intracellular shift of K+ from serum
5. Inhibits histamine release from Mast cells
6. Increased diuresis
Indications
1. Relief of bronchospasms associated with asthma, chronic bronchitis, emphysema
- Reduces mucus secretions, capillary leaking, mucosal edema (by blocking histamine release)
2. Prevention of exercise-induced asthma and bronchospasms
Contraindication
1. Hypersensitivity
2. Tachydysrhythmias
3. Severe cardiac disease
Side Effects
CNS
Anxiety
Cardiovascular
Angina
GI
Heartburn
Dysrhythmias
Dizziness - C
Flushing
Hallucinations
Hypertension
Nausea - C
Vomiting
Palpitations - C
Headache - C
Irritability
Tachycardia - C
Stimulation - C
Tremors - C
Italic = LT - C = common side
Precautions
1. May develop tolerance with prolonged use (vm)
2. Repeated or excessive use may lead to paradoxical bronchoconstriction
3. Use cautiously with:
- cardiac disorders
- hypertension
- diabetes
- prostatic hypertrophy
Musculoskeletal
Inhibition of uterine
contractions
Muscle cramps
Respiratory
Cough
ALBUTEROL (PROVENTIL)
How Supplied
- 2.5mg/ 2.5ml
Administration/Dosage
Two ways to administer:
1. Metered dose inhaler:
- 1- 2 sprays (90 - 180g is delivered) q 4-6 hours – Max.: 12 inhalations / day
2. Nebulizer:
- Adults and children over 12: Dilute 2.5mg in 3.0 ml of NS
- Nebulizer should deliver 3.0 ml over 5 to 15 minutes – 3-4 times / day
NALOXONE (NARCAN)
Class: Opiate antagonist
Mechanism of Action
1. Reverses effects of narcotics or synthetic narcotics
- Competes for and displaces narcotic molecules from opiate receptors in the brain
- Reverses stupor, coma, respiratory depression caused by opiates
- Duration of action is shorter than opiates
Indications
- Narcotic / synthetic narcotic overdose
- Coma of unknown cause
- Coma from alcohol
Narcotics -
heroin, morphine, methadone, codeine, Demerol, Dilaudid, Paregoric, fentanyl, Percodan, hydromorphone, meperidine,
oxycodone, propoxyphene
Synthetic narcotics (narcotic agonists / antagonist) - Talwin, Darvon, Nubain, Stadol
Contraindications
-
Hypersensitivity to the drug
Respiratory depression is due to nonopiate drugs
Side effects
CNS
Seizures - LT
Tremors
Cardiovascular
Hypertension
Hypotension
Ventricular
Dysrhythmias - LT
Cardiac arrest - LT
Bold italic = LT - life-threatening
GI
Nausea
Vomiting
Respiratory
Pulmonary edema LT
Hyperventilation
Skin
Sweating
Side effects usually occur due to rapid IVP causing withdrawal to occur = deliver slow IVP to increase respirations
Precautions
- May need to repeat the dose (effects of Narcan may wear off before narcotic)
- May cause excitement, hypertension, tachycardia (due to rapid IVP)
- May cause hypertension or hypotension, pulmonary edema, ventricular fibrillation if given to patients with
cardiovascular disorders.
How supplied
- Ampoules or prefilled syringes containing - 2 mg / 2ml or 0.4mg / 1mL or 10mL
- Vials containing 10mg / 10ml
NALOXONE (NARCAN)
Administration and dosage:
Administered - Slow IVP, IM, SQ, ET (diluted) , Infusion
Slow IVP
0.4-2mg SIVP
Repeat at 2-3 minute
intervals
ET
2-2.5 times the SIVP dose
Dilute in 10cc of fluid
After 10mg have been
given, with no response,
reevaluate diagnosis
Repeat S/A IVP route
Darvon / Alcohol
2-5mg SIVP
Infusion
8mg / 1000cc of D5W
Infuse at 2/3 of the initial
reversal dose – titrated to
desired effect
*** GIVE THE DRUG SLOWLY TO INCREASE THE PATIENTS MINUTE VOLUME
*** If GIVEN RAPIDLY IT CAN CAUSE WITHDRAWAL LEADING TO ADVERSE SIDE EFFECTS
The