Medications

Question 1

What is the classification, pharmacologic action, indications, contraindications, warnings, side effect, dosage, routes, onset and duration for Acetylsalicylic acid (Aspirin, ASA)

Answer 1

• Classification: analgesics, Platelet inhibitor/ non steroid anti-inflammatory drug (NSAID)
• Pharmacologic action: blocks platelet aggregation and vasoconstrictions
• Indications: chest pain of atypical symptoms suggestive of cardiac ischemia and myocardial infarction
• Contraindications: AAPDA
  
  • asthma exacerbation: ask if if Pt’s asthma has ever been exacerbated by taking NASAIDs
  • Allergy/Hypersensitivity: ask if Pt is allergic or has a hypersensitivity to NSAIDS (aspirin, naproxen, Ibuprofen)
  • Pediatric: Pediatric with viral illness contraindicated, Chest pain in children = No Aspirin unless rare specific ischemic cardiac history
  • Dose: Pt may not exceed 162mg within a 12 hour window
  • Acute bleed: signs/symptoms of an acute bleed including CVA or recent head trauma
• Cautions: PRBAS
  
  • Pregnancy: Ask Pt about the possibility of pregnancy
  • Recent internal bleeding: Ask about blood in vomit/Stool (GI Bleed)
  • Bleed disorders: Review history (hemophilia)
  • Surgery: Ask about major surgeries (heart, vascular, abdominal, angioplasty, angiograms)
• Side Effects:
  
  • Wheezing
  • GI: heartburn, nausea and vomiting
  • Has been linked to Reye’s Syndrome in Children with Viral symptoms
• Dosage: 160mg-162mg (may top up to this amount within 12 hours)
• Routes: PO
• Onset/duration:
  
  • Onset: 1 hour or 20 minutes if chewed
  • Peak: 1-2 hours
  • Durations: 4-6 hours, platelet inhibitory effects last the lifetime of platelet
  • Half life: 3 Hours (low dose)

Question 2

What is the classification, pharmacologic action, indications, contraindications, warnings, side effect, dosage, routes, onset and duration and Special considerations for Naloxone Hydrochloride (Narcan)

Answer 2

• Classifications: Narcotic antagonist, opioid reversal agent
• Pharmacologic action; Competes for opioid receptor sites. Displaces previously administered opioids from their receptors. No pharmacological activity on its own
• Indications:
  
  • Decreased levels of responsiveness
  • Respiratory depression (requiring BVM)
  • Signs/Symptoms suggesting Narcotic overdose
• Contradictions: KP
  
  • Known allergy to Naloxone: Ask family/bystanders if they know of an allergy
  • Pediatric: naloxone not given to neonate
• Cautions:
  
  • Acute withdrawal symptom/aggression: Prepare for withdrawal
• Side effects:
  
  • CNS- excitation due to abrupt reversal of analgesia
  • CVS-tachycardia, hypertension, hypotension, arrhythmias
  • SKIN- sweating (diaphoretic)
• Dosage: Delivered q 3 minutes until LOC/RR improve: 0.4mg, 0.4mg, 0.8mg, 2.0mg
• Route: IM
• Onset/duration:
  
  • Onset: 3-5 minutes
  • peak: unknown
  • Duration; 45 mins
• Special considerations:
  
  • Can cause abrupt state of narcotic withdrawal in the physically dependent patient
  • Side effects such as agitation and aggressiveness can be symptoms of narcotic withdrawal
  • Naloxone’s half-life is shorter than that of all opioids; therefore, a patient must be observed until the narcotic effect has worn of

Question 3

What is the classification, pharmacologic action, indications, contraindications, warnings, side effect, dosage, routes, onset and duration and special considerations for Nitroglycerin (Nitro, NTG)

Answer 3

• Classification: Antianginal, vasodilator
• Pharmacologic action: 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 Pt is prescribed Nitroglycerin, the Systolic BP must remain above or = to 90mmhg
  • If Pt doesn’t have a prescription for nitro but appears to having type chest pain with a SBP> 100mmhg, 50< HR >150, Call EPOS for nitro administration orders
• Contraindications: BEAP
  
  • BP: Asses BP with each nitro dose
  • Erectile Dysfunction drugs:
    
    • if Pt has taken Viagra/Levitra in 24 or Cialis within 48 hours
  • Allergy/Hypersensitivity to nitrates: Any adverse reactions to nitrates in the past
  • Prescriptions: Ask Pt is prescribed NTG if not call EPOS
• Cautions:
  
  • Hypotension: May cause hypotension in Pt after administrations
• Side effects:
  
  • CVS- hypotension
  • CNS-dizziness, weakness, headache
  • GI: Nausea, vomiting
• Dosage:
  
  • 0.4 mg SL to max of 3 doses prior to calling EPOS for further orders
  • Q 3 minutes maintaining target Systolic BP (based on indication)
  • Contact EPOS if Systolic BP drops 20 mmHg or more after administration of any single dose of Nitroglycerin
• Onset/Duration:
  
  • Onset: 1-3 minutes
  • Peak: Unknown
  • Durations: 30 minutes
• Special Considerations;
  
  • Do not shake the container prior to administration.
  • Nitroglycerin comes in forms other than spray and/or tablet, none for which are approved for EMR use. If your patient has a Nitroglycerin patch applied or is prescribed nitroglycerin tablets, it does not change the Nitroglycerin 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

Question 4

What is the classification, pharmacologic action, indications, contraindications, warnings, side effect, dosage, routes, onset and duration and special considerations for Nitrous Oxide (Entonox)

Answer 4

• Classification: analgesic
• Pharmacologic action; Inhalation of 50% mixture of N₂O and O₂ produces CNS depression as well as rapid pain relief
• Indications: Relief of moderate pain
• Contraindications: PAINDIE
  
  • Pneumothorax
  • Air embolism
    
    • Any Iv therapy, DVT
  • Inhalations injury
    
    • soot, charring, stridor, laryngeal, swelling
  • Nitroglycerin
    
    • Has Pt taken Nitro in the last 5 mins
  • Decompression illness
    
    • Has Pt been diving recently
  • Inability to comply
    
    • Is Pt able to understand and safely administer
  • Enclosed spaces:
    
    • Access spaces for adequate ventilations
• Cautions: SADFC
  
  • Shock
    
    • Assess for shock
  • Abdominal Distension
  • Depressant drugs:
    
    • Cannabis, morphine….ect
  • Facial injuries
  • COPD
    
    • History of COPD
• Side effects;
  
  • drowsiness, sedation, disorientation, headache, dizziness, vomiting
• Dosage
  
  • Self-administrating
• Route
  
  • inhalation
• Onset/duration
  
  • Onset: rapid
  • peak: Immediate
  • Duration: until discontinued
• Special considerations:
  
  • Entonox must always be mixed by inverting the tank 3 times prior to administration
  • always use a bacterial/ viral filter between the Pt and the Demand regulator