ACS Medications Flashcards
Nitroglycerin (Nitrostat, Tridil)
Class
Vasodilators
•Mechanism of Action
Prodrug: metabolized in body to active drug NO
Smooth muscle relaxant acting on vascular,
bronchial, uterine and intestinal smooth muscle.
Dilation of arterioles and veins in the periphery
Reduces preload and afterload
Decreases the workload of the heart
Decreases myocardial oxygen demand
Nitroglycerin
(Nitrostat, Tridil)
•Indications
Acute angina pectoris
Ischemic chest pain
Hypertension
CHF
Pulmonary edema
•Contraindications
Hypotension
Hypovolemia
Intracranial bleeding or head injury
Cumulative effect with other NO producing drugs (Viagra, Cialis)
Loading…
Nitroglycerin
(Nitrostat, Tridil)
•Adverse Reactions
Headache
Hypotension
Syncope
Reflex tachycardia
Flushing
Nausea
Vomiting
Diaphoresis
Muscle twitching
Nitroglycerin
(Nitrostat, Tridil)
•Drug Interactions
Additive effects with other vasodilators
Incompatible with other drugs IV
•How Supplied
Tablets: 0.15 mg (1/400 grain); 0.3 mg (1/200
grain); 0.4 mg (1/150 grain); 0.6 mg
(1/100 grain)
NTG spray: 0.4 mg - 0.8 mg under the tongue.
NTG IV (TRIDIL)
Nitroglycerin
(Nitrostat, Tridil)
•Dosage and Administration
Adult:
Tablets: 0.3 - 0.4 mg SL; may repeat in 3-5
minutes to maximum of 3 doses.
NTG spray: 0.4 mg under the tongue q 3-5 min ; 1-2 sprays.
NTG IV infusion: 5 ug / min.; increase by 5-10 ug /
min. every 5 minutes until desired
effect.
Pediatric: not recommended
Nitroglycerin
(Nitrostat, Tridil)
•Duration of Action
Onset: 1-3 minutes
Peak effect: 5-10 minutes
Duration: 20-30 minutes or. if IV, 1-10 minutes after
discontinuation of infusion
•Special Considerations
Pregnancy safety: category C
Hypotension more common in geriatric population
NTG decomposes if exposed to light or heat
Must be kept in airtight containers
Active ingredient may have a stinging effect when
administered SL
Patients often take their own before EMS arrival (check expiration)
RI OEMS Protocols
•3.01 Acute Decompensated Heart Failure-Pulmonary Edema
0.4 mg SL (tablet, lingual spray/powder) every 5 minutes if the SBP is >100
If the patient is hypertensive or in severe distress, NITROGLYCERIN IV infusion starting at 100 mcg/min and titrated rapidly to symptom improvement or hemodynamics (30% reduction in MAP). Discontinue infusion if the SBP is <100
NTG should not be administered to patients who have used sildenafil (Viagra, Revatio) or vardenafil (Levitra) in the past 24 hours or tadalafil (Cialis, Adcirca) in the past 36 hours. Revatio is prescribed for pulmonary hypertension.
RI OEMS Protocols
Nitropaste (Nitro-Bid, Nitrol Ointment)
Nitropaste
(Nitro-Bid, Nitrol Ointment)
•Class:
Vasodilator
•Mechanism of Action:
Smooth muscle relaxant acting on vascular, bronchial,
uterine and intestinal smooth muscle
Dilation of arterioles and veins in the periphery
Reduces preload and afterload
Decreases the workload of the heart
Decreases myocardial oxygen demand
Nitropaste
(Nitro-Bid, Nitrol Ointment)
•Indications:
Angina pectoris & chest pain associated with acute MI
CHF
PE
Hypertension (HTN)
•Contraindications:
Hypotension
Hypovolemia
Intracranial bleeding or head injury
Nitropaste
(Nitro-Bid, Nitrol Ointment)
•Adverse Reactions:
Headache
Hypotension
Syncope
Reflex tachycardia
Flushing
Nausea
Vomiting
Diaphoresis
Muscle twitching
Nitropaste
(Nitro-Bid, Nitrol Ointment)
•How Supplied:
Topical Ointment:(Nitrol) 2% [20 mg/g] (30g, 60g)
•Dosage and Administration
Adult: For CHF/PE; HTN
Paste:
Apply 1 inch (15 mg) cover with plastic wrap & secure with tape
Pediatric: not recommended
Nitropaste
(Nitro-Bid, Nitrol Ointment)
•Duration of Action
Onset: 30 minutes
Peak effect: Variable
Duration: 18-24 hours
•Special Considerations
Pregnancy safety: Category C
Apply in thin uniform layer on non-hairy area
1 inch equals approximately 15 mg nitroglycerin
Avoid using fingers to spread paste
Store past in cool place with tube tightly capped
Erratic absorption rates quite common
RI OEMS Protocols
•Not in the RI OEMS Protocols
Furosemide (Lasix)
Class
Diuretic
•Mechanism of Action
Inhibits electrolyte Na+, K+, Cl- Cotransport in Ascending nephron loop
Promotes excretion of:
sodium
potassium
chloride
Furosemide (Lasix)
Furosemide (Lasix)
•Indications
Congested Heart Failure
Pulmonary Edema
Hypertensive Crisis
•Contraindications
Hypovolemia
Hypotension (relative contraindication)
Hypersensitivity
Furosemide (Lasix)
•Adverse Reactions
May exacerbate:
Hypovolemia
Hypokalemia
ECG changes
Dry mouth
Hyponatremia
Loading…
Furosemide (Lasix)
•How Supplied
100 mg / 5 ml, 20 mg / 2 ml, 40 mg / 4 ml vials
Furosemide (Lasix)
•Dosage and Administration
Congested Heart Failure, Pulmonary Edema
20-40mg IV/IO
Hypertensive Crisis
.5-1mg/kg
•Duration of Action
Onset: 5 minutes
Peak Effects: 20-60 minutes
Duration: 4-6 hours
Furosemide (Lasix)
•Special Considerations
This was a standard prehospitally for CHF
CHF results from a fluid shift that overloads the vasculature
The result is that the left ventricle cannot keep up and fluid leaks out from the pulmonary capillaries to the alveoli
If the initial issue was a fluid shift how can we better treat CHF?
RI OEMS Protocols
•3.01 Acute Decompensated Heart Failure-Pulmonary Edema
If the transport time is ≥ 30 minutes and the patient takes
Aspirin (Acetylsalicylic Acid-ASA)
•Class: Platelet inhibitor, anti-inflammatory agent
•Mechanism of Action/Pharmacodynamics
Cyclooxygenase (COX) Enzyme: Produces Prostaglandins and Thromboxane
Pain relief:
Inhibits the production of Prostaglandins by inhibiting COX enzyme
Inhibiting blood clotting:
ASA inhibits Thromboxane (lipid) by inhibiting COX enzyme resulting
in decreased platelet aggregation
Aspirin
(Acetylsalicylic Acid-ASA)
•Indications:
New onset chest pain suggestive of AMI
Signs and symptoms suggestive of recent CVA
Aspirin
(Acetylsalicylic Acid-ASA)
•Drug Interactions:
Use with caution in patients allergic to NSAIDS
•How Supplied:
81 mg chewable tablets
•Dosage and Administration:
162 mg or 324 mg PO
Aspirin
(Acetylsalicylic Acid-ASA)
•Duration of Action:
Onset: 30-45 minutes
Peak effect: Variable
Duration: Variable
•Special Considerations:
Pregnancy Safety: Category D
Not recommended in pediatric population
Patient may be on 81 mg ASA PO qd –OK to give 3 more
RI OEMS Protocols
•2.07 Patient Comfort-Adult
For mild to moderate pain (scale of 1-6), consider: ASPIRIN 324- 650 mg PO.
RI OEMS Protocols
•3.01 Acute Decompensated Heart Failure-Pulmonary Edema
81 mg x4 orally (chewed), unless allergic or unable to swallow safely.
Fentanyl (Sublimase)
Class: Synthetic Opioid
•Binds to and inhibits the action of nociceptors which deliver sensation of pain to the spinal cord and brain
•At the same time inhibits the nociceptor pathway to the limbic system so no emotional response to pain
•Endogenous analgesic receptors (mu receptors-endorphins) are activated by opioids causing release of dopamine (pleasure)
•Fentanyl is fat soluble so can cross the blood brain barrier and inhibit H+ receptors in brain stem
Fentanyl (Sublimase)
•Indications: analgesic/pain management
1mcg/kg up to 150mcg slow IV/IO/IM/IN
•Therapeutic Hypothermia, Shivering
50mcg q. 5 minutes to a maximum of 200mcg
IV/IO/IM/IN
RI OEMS Protocols
•2.07 Patient Comfort
For severe pain (scale >6): 0.5-1 mcg/kg IV/IM/IN [max single dose 100 mcg] (may repeat every 10 minutes to a max of 300 mcg). IV doses should be given over 2 minutes
For patients with an advanced airway in place (ETI/BIAD/cricothyrotomy) requiring sedation and analgesia:
1-1.5 mcg/kg slow IV push.
