Drugs Flashcards
Acetaminophen (Tylenol)
Classification, action, indications, contraindications, cautions, side effects, dosage, paediatric considerations, route, and dosing, onset, peak, duration, elimination
Classification: analgesic, antipyretic
Action: inhibits prostaglandin synthesis in the central nervous system, reducing pain and fever
Indications: chest pain or atypical symptoms suggestive of cardiac ischemia myocardial infarction
Contraindications: allergy or hypersensitivity to acetaminophen and severe liver impairment of severe active liver disease
Cautions: limit acetaminophen dose from all sources and route of administration to less than 4 grams a day for adults
Side effects: adverse reactions are uncommon with short term use, rash and hives are rarely reported but can occur, nausea and vomiting, constipation can occur with long term use
Dosage: 500-1,000 mg PO (specifically, 15mg/kg to a maximum of 1,000 mg) may repeat once after 4 hours, 24hr maximum: 3,000 mg, in patients with suspected or known liver dysfunction the 24hr maximum should be lowered to 1,000-2,000 mg, may be used concurrently with ibuprofen for analgesia
Ped dosing: <30kg: 15mg/kg PO (use liquid preparation) 30-50kg: 500 mg PO, >50kg: 500-1,000 mg PO (may repeat once after 4hr) (24hr max: 1,000mg)
Route: PO (by mouth)
Onset: 30min
peak: 1-3hr
duration: 4hr
Elimination: primarily renal
EPINEPHrine hydrochloride (Epi)
Classification, action, indications, contraindications, cautions, side effects, dosage, paediatric considerations, route, and dosing, onset, peak, duration, elimination
Classification: sympathomimetic, Alpha-/Beta- Agonist
Action: stimulates alpha and beta adrenergic receptors within the sympathetic nervous system, alpha adrenergic effects include peripheral vasoconstriction at higher doses, beta adrenergic effects include: increased heart rate, increased force of cardiac contractility, increased AV conduction, bronchial smooth muscle relaxation resulting in bronchodilation, inhibits histamine release
Indications: anaphylaxis
Contraindications: known hypersensitivity or allergy to epinephrine
Cautions: HELPT hypothermia, extremities at risk of loss of blood flow, keep in light resistant container (do not use if discoloured or has precipitates), pregnancy, tachycardia or underlying coronary disease
Side effects: common reactions to systemically administered epi include anxiety, tremor, dizziness, sweating, palpitations, headache, and nausea
Dosage: IM 0.5 mg; may repeat every 5 minutes up to 3 times(max 1.5mg)
Ped dosage: IM 0.01mg/kg to a max of 0.5 mg repeat q5 up to 3 times
Onset, duration
IM Onset: 30-90 seconds, IM Peak: 4-10 minutes, IM Duration: 5-10 minutes
Elimination
Rapidly metabolized by enzymes in the blood, liver, and other tissues, Excreted in urine
Iatrogenic Overdose
• Epinephrine overdose may produce significantly elevated blood pressures and heart rate, which may in turn cause cerebral hemorrhage and lethal cardiac arrhythmias.
Glucagon
Classification, action, indications, contraindications, cautions, side effects, dosage, paediatric considerations, route, and dosing, onset, peak, duration, elimination
Classification
• Insulin antagonist
• Anti-hypoglycemic
Action
Glucagon is a pancreatic hormone that, together with insulin, helps to maintain normal blood sugar levels.
Glucagon acts on liver glycogen, converting it to glucose (glycogenolysis). This causes a temporary increase in blood glucose levels.
Indications
• Known or suspected hypoglycemia in a patient who is unable to protect their airway or is unable to follow commands
Contraindications
• Known hypersensitivity or allergy to Glucagon
• Known pheochromocytoma
Cautions
• Glucagon is only effective in treating hypoglycemia if there is available glycogen in the liver to be broken down into glucose. Use glucagon with caution in patients whose hepatic glycogen levels may be inadequate for glucagon to have an effect at raising blood sugar (ex: patients with chronic hypoglycemia, adrenal insufficiency, or in starvation states).
Patients given Glucagon must be given supplemental carbohydrates as soon as possible, to restore glycogen levels and to prevent rebound hypoglycemia.
Side Effects
• Nausea
• Vomiting
• Headache
• Increased blood pressure and heart rate
Dosage
• IM: Weight equal to or greater than 25 kg: 1 mg IM
• IM: Weight less than 25 kg: 0.5 mg IM
• IN: 3 mg IN, administered into one nostril
Pediatric Considerations and Dosing
• Follow weight-based dosing
• Weight less than 25 kg: 0.5 mg IM
• IN glucagon is not indicated in children under 4
• IN administration for children over 4: 3 mg administered as one actuation of the intranasal device instead one nostril
Onset, Duration
IM Onset: 5-10 minutes
IM Peak: 30-45 minutes
• IM Duration: 60-90min
• IN Onset: 10-13 min
• IN Peak: 90 min
• IN Duration: 60-90 min
Elimination
Rapidly degraded by the liver, kidneys and in plasma. Destroyed by the GI tract if accidentally ingested (First pass Effect).
Half-life is 3 - 6 minutes in plasma
latrogenic Overdose
Excessive parenteral administration of glucagon can cause nausea, vomiting, and diarrhea. Ingestion of glucagon is unlikely to result in symptoms as it is rapidly broken down in the gastrointestinal tract.
Ibuprofen
Classification, action, indications, contraindications, cautions, side effects, dosage, paediatric considerations, route, and dosing, onset, peak, duration, elimination
Classification
• Analgesic
• Antipyretic
Action
• ibuprofen is a Nonsteroidal anti-inflammatory drug (NSAID) that exhibits analgesic and antipyretic activities by inhibiting prostaglandin synthesis.
Indications
• Mild to moderate pain
Contraindications
• Allergy or hypersensitivity to ibuprofen or other nonsteroidal anti-inflammatory drugs
• Active Gl hemorrhage or ulcers
• Pregnancy (first, second, or third trimesters)
Cautions
• Alternative treatment options should be considered in patients with a history of gastrointestinal, renal, or significant cardiovascular disease; ibuprofen, and all NSAIDs, have the potential to cause significant adverse reactions. The risk appears to increase with dose, duration of therapy, and underlying risk factors.
• Increased risk of gastrointestinal bleeding and peptic ulcer disease, especially in high-risk groups (e.g., patients with a history of gastric or duodenal ulcers, patients older than 75 years old, with concomitant use of oral or parenteral corticosteroids, anticoagulants, or antiplatelet agents).
• Can cause sodium and water retention and occasional acute renal failure.
Side Effects
• Gastrointestinal upset, ranging from abdominal discomfort to gastric ulceration, bleeding, and perforation.
Dosage
300-400 mg PO; may repeat every 4-6 hours; maximum daily dose 1,200 mg/day
Pediatric Considerations and Dosing
• Follow weight-based dosing
• 10 mg/kg PO; may repeat once after 6 hours; maximum daily dose 40 mg/kg/day
Route
• PO, by mouth
Onset, Peak, Duration
• Onset: 30-60 minutes
• Peak: 1-2 hours
• Duration: 4-6 hours
Elimination
Metabolized by liver
Majority is excreted by the renal system
Ipratropium bromide (atrovent)
Classification, action, indications, contraindications, cautions, side effects, dosage, paediatric considerations, route, and dosing, onset, peak, duration, elimination
Classification
• Anticholinergic
Action
• Ipratropium bromide blocks the action of acetylcholine at parasympathetic sites in the bronchial smooth muscle resulting in bronchodilation.
Indications
• Bronchospasm associated with shortness of breath, to be used in combination with salbutamol.
Contraindications
• Hypersensitivity to atropine or its derivatives
• Hypersensitivity to ipratropium bromide or any other component of the product
Cautions HAPPI BUG
Acute bronchospasm; Ipratropium Bromide is not indicated for rescue therapy use alone; it is indicated in. combination with a short acting-beta-2 agonist
Bladder-neck obstruction may be precipitated or worsened
Glaucoma, narrow-angle; may be precipitated or worsened
Hypersensitivity reactions, immediate (urticaria, angioedema, rash, bronchospasm, anaphylaxis, and oropharyngeal edema) have occurred; discontinue if reaction occur
Intraocular pressure increases may occur
Paradoxical bronchospasm may occur; discontinue if bronchospasm occurs (inhalation aerosol),
Prostatic hyperplasia may be precipitated or worsened
Urinary retention may occur
Side Effects
• Blurred vision
• Coughing
• Urinary retention
• Paradoxical bronchospam
Dosage
• MDI. 20 mcg x 4, may repeat once, maximum of 160 mcg by MDI
• Nebulized: 0.5 mg, added into nebulizer with short acting - beta-2 agonist (Ventolin)
Pediatric Considerations and Dosing:
MANDATORY EPOS CONSULT PRIOR TO DELIVERY
• MDI: 20 mcg x 4, may repeat once, maximum 160 mcg by MDI
• Nebullzed. 0.25 mg to 0.5 mg, added into nebulizer with short acting- beta-2 agonist (Ventolin)
Routes and Methods of Administration
• Metered dose inhaler, spacer use recommended but not required
• Ensure the MDI is shaken thoroughly and is allowed a full 30s between deliveries to allow the propellant to recharge
• Nebulized with nebulizer mask running on oxygen at 6-8|pm
Onset, Duration
• Onset: 5-30 minutes
• Duration: 3-5 hours
latrogenic Overdose
• Extremely high doses of ipratropium (up to 1.2 mg) have been given to volunteers without the development of serious systemic side effects.
Topical hemostatic agents: kaolin (quick clot)
Classification, action, indications, contraindications, cautions, side effects, dosage, paediatric considerations, route, and dosing, onset, peak, duration, elimination
Classification
• Topical hemostatic agent
Action
• Activates factor XII of the coagulation cascade, accelerating the pathway to clot formation, leading to faster bleeding control
Indications
• Local management of bleeding wounds such as cuts, lacerations, and abrasions.
• Temporary treatment of severely bleeding wounds such as traumatic injuries and surgical wounds.
Contraindications
• Topical hemostatic agents should not be used intravascularly, because they will cause thrombosis
Cautions
• Infection
Route
• Topical
Onset
• Immediate
latrogenic Overdose
• characteristics
Kaolin does not trigger skin allergies
Naloxone hydrochloride (narcan)
Classification, action, indications, contraindications, cautions, side effects, dosage, paediatric considerations, route, and dosing, onset, peak, duration, elimination
Classification
• Opioid antagonist
Actions
Competes for opioid receptor sites. Displaces previously administered opioids from their receptors.
Reverses respiratory depression caused by narcotic overdoses.
Indications
• Suspected opioid-induced collapse with respiratory depression
• Respiratory rate of <10 requiring assisted ventilation
• Altered Mental status with a differential diagnosis suggestive of opioid overdose.
Contraindications
• Allergy or hypersensitivity to Naloxone
• Neonates (0-28 days)
Cautions
• Can cause abrupt state of opioid withdrawal in the physically dependent patient.
• Side effects such as agitation and aggressiveness can be symptoms of opioid withdrawal.
• Naloxone’s half-life (60 to 90 minutes) is shorter than that of all opioids; therefore, a patient must be observed until the opioid effect has worn off.
• Be aware that due to Naloxone’s half-life being shorter than that of opioids there is a risk of re overdose after Naloxone administration. Consider transport for patients who have been administered Naloxone.
Side Effects
• Excitation and tremors due to abrupt reversal of analgesia
• Nausea and vomiting
• Tachycardia, hypertension, arrhythmias
• Sweating
Dosage
• IM: administration every three minutes as required, maximum of four doses
- First dose: 0.4 mg IM
- Second dose: 0.4 mg IM
- Third dose: 0.8 mg IM
- Fourth dose: 2 mg IM
• IN: 2mg repeated q 3-5 min, 1mg in administered to each nostril. If using the prepared IN formulation you may administer the whole 4mg nasal spray dose into one nostril, may repeat q 3 min, alternating nostrils
Pediatric Considerations and Dosing
• Follow weight-based dosing
• IM: 0.1 mg/kg, to a max of 2 mg per dose may repeat a 3 min
• IN: 2mg repeated q 3-5 min, 1mg in administered to each nostril. If using the prepared IN formulation y may administer the whole 4mg nasal spray dose into one nostril, may repeat q 3 min, alternating nostr
• The dose is higher in pediatric patients as they are less likely to experience withdrawal
Route and Methods of Administration
• IM
•IN
Onset, Peak, Duration
• Onset: 1-3 minutes
• Peak: 5-15 minutes
• Duration: 30-45 minutes
Elimination
• Metabolized in the Liver
Cautions
• Can cause abrupt state of opioid withdrawal in the physically dependent patient.
• Side effects such as agitation and aggressiveness can be symptoms of opioid withdrawal.
• Naloxone’s half-life (60 to 90 minutes) is shorter than that of all opioids; therefore, a patient must be observed until the opioid effect has worn off.
Be aware that due to Naloxone’s half-life being shorter than that of opioids there is a risk of re overdose after Naloxone administration. Consider transport for patients who have been administered Naloxone.
Iatrogenic Overdose
• May produce withdrawal signs and symptoms
• Hypotension or hypertension
• Nausea and vomiting, sweating, tachycardia
Nitrous oxide (entonox)
Classification, action, indications, contraindications, cautions, side effects, dosage, paediatric considerations, route, and dosing, onset, peak, duration, elimination
Classification
• Analgesic
Action
• Inhalation of 50% mixture of Nitrous Oxide and Oxygen produces CNS depression as well as rapid pain
relief.
Indications
• Patient presenting with moderate to severe pain
Contraindications
• Altered level of consciousness
• Acute pulmonary edema
• Known pneumothorax
• Decompression sickness
• Air embolism
• Signs of cyanosis
• Inability to ventilate an enclosed treatment area
• Patient has taken Nitroglycerin within the last 5 minutes
• inhalation injury
Cautions
• Abdominal distension
• Shock
• Chronic obstructive pulmonary disease
• Major facial trauma
• Patient has taken a depressant drug
• Improper storage: low temperature, stagnant, vertical position
• Combustion/inhalation/dependence
Side Effects
• CNS: Drowsiness, headache
Dosage
• Seif administered
Routes and method of administration
• inhalation via bites stick
Onset, Duration
• Onset: less than one minute following 4-5 deep breaths
• Peak: immediate
• Duration: requires continuous use
Oral glucose
Classification, action, indications, contraindications, cautions, side effects, dosage, paediatric considerations, route, and dosing, onset, peak, duration, elimination
Classification
• Caloric
Action
• Absorbed into the bloodstream, increasing blood glucose levels
Indications
• Suspected or known Hypoglycemia
Contraindications
• In patients where there is a risk of choking or aspiration
Cautions
• Consider airway management, patient must be able to protect their own airway
Side Effects
• Oral glucose administration in has the potential to increase airway management problems
Dosage
• PO: 15 grams every 5 minutes to a max of 50 grams PO or Buccal: administer ½ tube, q 5 min to a max of 50
• There are different brand of oral glucose that have different grams of glucose for volume of product, be sure to read the label of the product you are administering to be certain you are administering the correct volume.
Routes and method of administration
• PO
Onset, Duration
• Onset - 10 minutes
• Peak - 40 minutes
• Duration - 30 minutes
Methoxyflurane (penthrox)
Classification, action, indications, contraindications, cautions, side effects, dosage, paediatric considerations, route, and dosing, onset, peak, duration, elimination
Classification
Inhaled volatile anaesthetic
Action
Methoxyflurane is a volatile anaesthetic agent, the exact mechanism of action is unknown.
Indications
Relief of moderate to severe acute pain in conscious hemodynamically stable adult patients
Contraindications (PimPma RRHd)
Allergy to methoxyflurane
Patients less than 18 years old
Hemodynamic instability
Respiratory Depression
Patients unable to self-administer due to lack of cooperation or understanding
Decreased level of consciousness from any cause, including head injury, drugs, or alcohol
Renal impairment
Pregnant or breast feeding
Personal or genetic history of malignant hyperthermia
Cautions
(tedscoc) temp, enclosed space, dose attendant, safety of op, carbon chamber on top, outside vent, coaching
Care providers must limit their exposure to no more than 3 doses (9mL) administered in a 24 hour period.
Consider operator safety, turn on the exhaust fan and close the window between patient compartment and driver compartment
If possible, begin administration in a well-ventilated area
The carbon chamber must always be attached to the Penthorax container during administration
If possible, fill the Pentorax container outside of the response vehicle
Do not store methoxyflurane in environments over 40 degrees Celsius
Carbon chamber Methoxyflurane has a pungent odor and taste, patients may need coaching to be able to tolerate it
Effects
Dizziness
Drowsiness
Headache
Cough
Nausea or vomiting
Decrease inhibition
Dosage
• Inhaled: 3 mL self-administered; may repeat once to a max of 6mL
• No more than 6 mL of methoxyflurane to be administered to a patient in a 48 hour period.
• Pediatric Considerations and Dosing
• Not recommended for use in patients under 18 years of age
Route
• Inhaled (self-administered)
Onset, Peak, Duration
• Onset: 1 - 3 minutes or approximately 8 - 10 regular breaths
• Duration: 3 - 5 minutes once self administration discontinued; a 3 mL dose lasts approximately 25 minutes
Elimination
• The methoxyflurane that is not exhaled unaltered is metabolized by the liver, and excreted in urine
latrogenic Overdose
• Methoxyflurane causes significant nephrotoxicity at higher doses
• Overdose may cause respiratory depression
Salbutamol (ventolin)
Classification, action, indications, contraindications, cautions, side effects, dosage, paediatric considerations, route, and dosing, onset, peak, duration, elimination
Classification
Bronchodilator
Sympathomimetic
Action
Relaxes the smooth muscle of the bronchial tree by stimulating beta- adrenergic receptors of the sympathetic nervous system
Action is relatively selective, affecting primarily the beta-2 receptors, although beta-1 adrenergic receptors are stimulated at higher doses.
As the dose of the drug is increased, more and more beta-1 effects are produced
Indications
Bronchospasm
Contraindications
Known sensitivity or allergy to Ventolin
Hemodynamically significant tachycardia
Cautions:
Careful charting of air entry, lung sounds, degree of respiratory distress and use of accessory muscles should be done pre- and post-treatment.
Beta-2 agonists may decrease serum potassium
• Beta 2 agonists may increase serum glucose
Side Effects
• CNS: Restlessness, apprehension, tremor, dizziness, headache
• CVS: Arrhythmias, blood pressure changes, chest discomfort
• Respiratory: Coughing, bronchospasm
• Gl: Nausea
Skin: Pallor, Flush, sweating
Dosage
Nebulized: 5 mg
MDI: 4 x 100 mcg inhalations, may repeat up to 3 times
Pediatric Considerations and Dosing
Follow weight-based dosing
Nebulized:
- Age < 1 years old: 2.5 mg
- Age > 1 years old: 5 mg
Metered Dose Inhaler:
- Not indicated in children under 10 kg
- 10 - 20 kg: 4 x 100 mcg inhalations, may repeat up to 3 times
- > 20 kg: 10 x 100 mcg inhalations, may repeat up to 3 times
Routes and Methods of Administration
• Nebulizer mask with oxygen at 6-8 liters per minute
• Metered dose inhaler (MDI)
Ensure the MDI is shaken thoroughly and is allowed a full 30s between deliveries to allow the propellant to recharge
Onset, Duration
• Onset: 5-15 minutes (inhaled)
• Peak: 60-90 minutes (inhaled)
• Duration: 3-6 hours (inhaled)
Elimination
• Metabolized in liver into inactive metabolites
latrogenic Overdose
• Discontinue administration if signs of toxicity: heart rate > 150/minute (> 200/minute in pediatrics); severe tremors; ventricular arrhythmias.
Nitroglycerin (Nitro, NTG)
Classification, action, indications, contraindications, cautions, side effects, dosage, paediatric considerations, route, and dosing, onset, peak, duration, elimination
Classification
Antianginal
• Vasodilator
Actions
Reduces cardiac oxygen demand primarily by dilating blood vessels resulting in decreased blood flow (preload) to the heart from the body, decreased resistance to the heart’s pumping (after load). Dilation of coronary arteries results in increased blood flow to cardiac tissue
Indications
• For cardiac chest pain
• If patient is prescribed Nitroglycerin, the Systolic BP must remain above or equal to 110 mmHg
• If patient does not have a prescription for Nitro, but appears to be having cardiac type chest pain with a SBP >110mmHg, HR >50 and <150, call EPOS for Nitro administration orders
Contraindications (BEAP)
Blood pressure (systolic of >=110)
Erectile dysfunction drugs (viagra/levitra in 24hrs or cialis within 48hrs)
Allergy to nitrates
Prescription (if pt doesn’t have call EPOS)
Caution
Hypotension- sit the patient down
Side effects
Hypotension
Dizziness
Weakness
Headache
Nausea
Vomitting
Dosage
Q3 minutes maintaining target systolic BP (based on indication)
Onset, Duration
Onset 1-3 min
Peak unknown
Duration- 30min
Special considerations
Do not shake the container prior to administering
Only spray is approved for EMR USE
Doesn’t matter if they have patch or prescribed tablets NOT CHANGE PROTOCOL
If pain is completely relieved for more than 5 minutes, you may initiate the chest pain protocol again if the pain returns. This is considered a new episode.
