Drug Monographs Flashcards
Acetaminophen: Brand Names
Albenol
Actimol
Atasol
Tylenol
Acetaminophen: Indications
Mild to moderate pain
Severe pain in multimodal approach
Symptomatic pyrexia
- Greater than 38C
- Myalgias, chills, rigors
- Children: 38C, fussiness, irritability, inability to soothe
Acetaminophen: Contradindications
Have you ever had a reaction to acetaminophen (Tylenol)?
Do you take it daily?
Do you have any medical conditions with your liver or kidneys? Such as reduced function.
How much have you taken today or in past 24 hours?
Is the patient overdosing? (vomiting, nauseated or URQ pain)
HHOLI:
H - Hypersensitivity
H - Hepatic impairment
O - Overdose
L - Liver disease
I - Intake in last 4 hours or daily max
- Hypersensitivity to Acetaminophen or any component of the formulation
- Severe hepatic impairment or severe active liver disease
- Acetaminophen given in past 4 hours or total in 24 hours exceeds daily maximum
- Suspected overdose indicated by symptoms such as nausea, vomiting or upper right quadrant pain
Acetaminophen: Adult Dosage PO
PO
- 500-1000mg
- Repeat: once after 4 hours
- 24-hour maximum: 4 g
- Decrease 24 max to 2g: Known liver dysfunction (such as advanced chronic liver disease, cirrhosis, heavy alcohol use) or malnutrition.
- May be used concurrently with ibuprofen for analgesia
Acetaminophen: Pediatric Dosage
PO
- 15 mg/kg use liquid: 80 mg/mL
- May repeat once after 4 hours
IV
- Age 12-17
- >50kg
- 1000mg IV q6h PRN
- NOT AUTHORIZED: <12, <50kg
24 max: 75mg/kg or 4,000mg from all sources
Ibuprofen: Classification
Analgesic
Antipyretic
Nonsteroidal anti-inflammatory
Ibuprofen: Brand Names
Advil
Actiprofen
Motrin
Ibuprofen: Indication
Mild to moderate pain
Severe pain in a multimodal approach
Symptomatic pyrexia
Ibuprofen: Contraindications
Have you ever had a reaction to ibuprofen (Advil)? Or any other drug?
Do you have any problems with your kidneys?
Do you have any active GI bleeding (in stool or vomit)? Trauma or intracranial.
Are you pregnant?
Have you taken an anticoagulant?
- Known hypersensitivity to ibuprofen or other nonsteroidal anti-inflammatory drugs (including aspirin)
- Known or suspected renal dysfunction
- Concern for severe active bleeding (trauma, intracranial hemorrhage, GI bleeding)
- Pregnancy
- Use of anticoagulant (eg. apixaban, rivaroxaban, warfarin, ibuprofen, celecoxib, naproxen)
Ibuprofen: Adult Dosing
300-400 mg PO
May repeat: Every 4-6 hours
Maximum daily dose: 1,200 mg/day
Ibuprofen: Pediatric Dosing
No EMR
Salbutamol: Indications
Bronchospasm
Salbutamol: Contraindications
Known hypersensitivity to salbutamol
Salbutamol: Adult Dosing
5 mg nebulized; repeat doses back to back as necessary
4 x 100 mcg via metered dose inhaler with spacer; repeat as required
Salbutamol: Pediatric Dosing
Via nebulizer
- < 1 year: 2.5 mg
- ≥ 1 year: 5 mg
Via metered dose inhaler
- < 10 kg: not indicated
- 10-20 kg: 5 x 100 mcg per course; may repeat up to 3 times
- > 20 kg: 10 x 100 mcg per course; may repeat up to 3 times
Methoxyflurane: Brand Name
Penthrox
Methoxyflurane (Penthrox): Indications
Self-administered relief from moderate to severe pain in conscious, hemodynamically stable patients
Methoxyflurane (Penthrox): Contraindications
- Patients < 18 years of age
- Pregnancy, intended pregnancy, or current breast-feeding
- Inadequate patient understanding or lack of cooperation
- Decreased level of consciousness or head injury
- History of clinically significant renal impairment, e.g., reduced renal output
- History of liver dysfunction following previous exposure to halogenated anesthetics
- Current use of tetracycline antibiotics
- Personal or genetic history of malignant hyperthermia
- Muscular dystrophy
Methoxyflurane Mnemonic
CHECK A MAP
- Cardiac instability or respiratory depression (hemodynamic stability)
- Hypersensitivity (liver dysfunction from previous exposure)
- Established diagnosis of malignant hyperthermia
- Consciousness (i.e., altered level of consciousness, cooperating, understanding, injury)
- Kidneys – signs of kidney failure or renal impairment
- Age (Patient under 18)
- Muscular dystrophy
-Antibiotic (Current use of tetracycline antibiotics) - Pregnancy, trying or breastfeeding
Methoxyflurane (Penthrox): Adult dosage
3 mL self-administered via inhaler; may repeat after 20 minutes; maximum total volume 6 mL
Glucagon: Indications
Confirmed hypoglycemia where patient mentation is unable to safely support administration of oral glucose
Glucagon: Contraindications
- Intranasal glucagon is contraindicated in patients under 4 years of age
- Hypersensitivity
- Pheochromocytoma (tumour on adrenal gland)
- Insulinoma (tumour in pancreas)
Glucagon: Adult dosage
- 3 mg IN or 1 mg IM (choice will depend upon availability of product pending changeover)
- If no clinical response within 15 minutes is seen following the first dose, consider administration of second 3 mg intranasal dose. CliniCall consultation is required prior to administration of second dose.
Glucagon: Pediatric dosage
Same as adults
Epinephrine: Indications
Anaphylaxis
Epinephrine: Contraindications
There are no absolute contraindications to EPINEPHrine use in life-threatening situations such as anaphylaxis
Epinephrine: Adult dosage
0.5 mg IM every 5 minutes
Repeat up to 3 times
Epinephrine: Pediatric dosage
0.01 mg/kg IM to a maximum of 0.5 mg (0.5mg at 50kg or 110lbs)
Repeat up to 3 times
Glucose: Indications
Known or suspected hypoglycemia in a conscious patient where there is no risk of aspiration or choking
Glucose: Contraindications
None
Glucose: Adult Dosage
15 g glucose PO (equivalent to one 38 g tube or 32 ml pouch)
Repeat at 5 minutes as necessary; no limit
Glucose: Pediatric Dosage
15 g glucose, pediatrics may require a smaller dose depending on age
Repeat at 5 minutes if necessary
30 g glucose max
Naloxone: Indications
Reversal of respiratory depression caused by suspected narcotic intoxication
Naloxone: Contraindications
Allergy or known hypersensitivity to naloxone
Neonates
Naloxone: Adult dosage
Naloxone IM every 3 minutes as required
First dose: 0.4 mg IM
Second dose: 0.4 mg IM if required
Third dose: 0.8 mg IM if required
Fourth dose: 2 mg IM if required
Maximum 4 doses: CliniCall consultation required prior to administration of further doses
Naloxone: Pediatric dosage
0.1 mg/kg to maximum of 2 mg per dose (2mg dose at 20 kg or 44 lbs)
Repeat every 3 minutes
Maximum 4 doses
Higher dose for pediatric patients as they are unlikely to experience withdrawal
Nitroglycerin: Indications
Relief from chest pain suggestive of acute coronary syndrome
Nitroglycerin: Contraindications
BAE (Blood pressure, allergy, erectile dysfunction)
Known allergy or hypersensitivity to nitroglycerin
Use of Viagra (sildenafil) or Levitra (vardenafil) within the previous 24 hours
Use of Cialis (tadalafil) within the previous 48 hours
Severe anemia
Restrictive pericarditis or pericardial tamponade
Documented right sided acute myocardial infarction
Hypotension or uncorrected hypovolemia
Systolic blood pressure < 110 mmHg
Heart Rate <50 or >150
Nitroglycerin: Adult dosage
0.4 mg SL every 3-5 minutes
Verify systolic blood pressure prior to administering each dose; systolic blood pressure must be ≥ 110 mmHg and heart rate must be between 50 and 150 beats/minute
Nitroglycerin: Pediatric dosage
Not authorized for use in pediatrics
Nitrous Oxide (Entonox): Indications
Self-administered relief from moderate to severe pain
Nitrous Oxide (Entonox): Contraindications
mnemonic CDCPAIN:
Ability to Comply
Decompression sickness
Altered level of Consciousness
Pneumothorax
Air embolism
Inhalation injury
Nitroglycerin use within five minutes
Nitrous Oxide (Entonox): Adult dosage
Self-administered to effect
Nitrous Oxide (Entonox): Pediatric dosage
Self-administered to effect
Acetylsalicylic Acid: Brand Names
Aspirin
Acetylsalicylic Acid: Indications
Chest pain or signs and symptoms consistent with cardiac ischemia
Acetylsalicylic Acid: Contraindication
BAAP (Bleeding, asthma, allergy, Pediatric)
Hypersensitivity to ASA or drug components
Patients who have experienced bronchospasm or other respiratory reaction precipitated by ASA or nonsteroidal anti-inflammatory drugs
Active or recent bleeding of any kind, including head injury or peptic ulcer disease
Pediatric patients with signs and symptoms consistent with viral illnesses (due to Reye’s Syndrome)
Acetylsalicylic Acid: Contraindication
BAAP (Bleeding, asthma, allergy, Pediatric)
Hypersensitivity to ASA or drug components
Patients who have experienced bronchospasm or other respiratory reaction precipitated by ASA or nonsteroidal anti-inflammatory drugs
Active or recent bleeding of any kind, including head injury or peptic ulcer disease
Pediatric patients with signs and symptoms consistent with viral illnesses (due to Reye’s Syndrome)
Acetylsalicylic Acid: Adult dosage
162 mg PO chewed and swallowed
Acetylsalicylic Acid: Pediatric dosage
CliniCall consultation required prior to pediatric administration.
Chest pain in children is unlikely to be the result of ischemia; ASA is therefore not indicated unless there are rare, specific histories of disease.
Acetaminophen: Classification
Analgesic
Antipyretic
Acetaminophen: Cautions
HHAM
H - Hepatic impairment
H - Hypovolemia
A - Heacy alcohol use
M - Chronic malnutrition
Acetaminophen: Adult Dosage IV
Oral administration preferred route
Severe pain: IV route for rapid analgesia
Weight & age dependent:
>= 50kg 1000mg IV q6h PRN
< 50kg NOT AUTHORIZED
24 hour max: 4,000mg
Infuse: 1000mg/100mL undiluted over 15 minutes using standard 10gtts IV set. (66gtts/min)
Ibuprofen: Cautions
- Severe volume depletion
- Active cardiac emergency (MI)
- Anti-inflammatory within the last 6-12 hours (eg ibuprofen, celecoxib, naproxen)
