Medications I Need To Know

Question 1

What are the trade names for albuterol?

Answer 1

Ventolin, proventil

Question 2

What are the trade names for aspirin?

Answer 2

Bayer, St. Joseph, and multiple others.

Question 3

What are the trade names for nitroglycerin?

Answer 3

Nitrostat, Nitro-bid, Nitrolingual

Question 4

What is the class for albuterol?

Answer 4

Sympathomimetic, selective beta 2 agonist

Question 5

Define Sympathomimetic.

Answer 5

Substances that mimic the effects of the sympathetic nervous system, such as catecholamines, epinephrine, norepinephrine, dopamine, etc.. Such drugs are used to treat cardiac arrest, low blood pressure, or even delay premature labor, amongst other things. Note that albuterol is not used for above circumstances.

Question 6

Define Beta 2 agonist.

Answer 6

Class of drug is used to treat asthma and other pulmonary disease states. They act on the beta 2 adrenergic receptor, thereby causing smooth muscle relaxation, resulting in dilation of bronchial passages.

Question 7

What class is aspirin?

Answer 7

Antiplatelet

Question 8

What are the actions of aspirin?

Answer 8

• Interrupts Thromboxane A2
*Thromboxane is produced by activated platelets and has prothrombotic properties, meaning that it stimulates activation of new platelets as well as increasing platelet aggregation (grouping together).
• Inhibits the normal tendency for platelets to accumulate inside injured or occluded cardiac arteries there by promoting better blood flow through vessels to better perfuse the heart.
• Onset = 15-30 minuets Duration = 4-6 hours

Question 9

What class is nitroglycerine?

Answer 9

Nitrate

Question 10

What are the actions of nitroglycerine?

Answer 10

• Relaxes systemic venous and arterial vessels causing vasodilation thereby
- Decreasing cardiac preload and afterload.
- Decreasing myocardial workload
- Decreasing myocardial O2 consumption
• Dilates coronary arteries
• Onset = approximately 2 minutes SL; approximately 30-60 minutes topical.
• Duration = approximately 30-60 minutes SL; approximately 24 hours topical.

Question 11

What are the actions of albuterol?

Answer 11

• Activates the beta 2 adrenergic receptors to relax smooth muscle
• Bronchodilation, relieves Bronchospasms, and reduces airway resistance
• Onset = 5 minuets Duration = 3-4 hours

Question 12

What indicates need for albuterol?

Answer 12

• Respiratory distress with bronchospasms

 - respiratory origin
 - allergic reaction/anaphylaxis
 - Pneumonia

Question 13

What indicates need for Aspirin?

Answer 13

• Chest pain of suspected cardiac origin

Question 14

What indicates the need for nitroglycerine?

Answer 14

• Angina or angina-equivalent discomfort

* Cardiac pulmonary edema- (paramedics only)

Question 15

What are the contradictions for albuterol?

Answer 15

• MI
• Cardiac pulmonary edema
• Cardiac dysrhythmias associated with tachycardia (relative, >120) - paramedic is responsive for EKG, paramedic and EMT are responsible for identifying heart rate

Question 16

What are the contradictions for aspirin?

Answer 16

• Unable to swallow

* Caution if patient has history of active bleeding ulcer

Question 17

What are the contradictions for nitroglycerine?

Answer 17

• Systolic BP < 100 (some protocols suggest systolic BP < 90)
• Suspected right ventricular MI - paramedic only, after 12-lead EKG interpretation
• Phosphodiesterase incubator use with in last 24 hours-ED medications such as Viagra (sildenafil), Cialis (tadalafil) or Levitra (vardenafil) taken along with nitro can cause profound hypertension and tachycardia.

Question 18

What are the side effects for albuterol?

Answer 18

• Restlessness/anxiety
• Vertigo
• Tachycardia/palpations
• Dysrhythmias-paramedic

Question 19

What are the side effects for aspirin?

Answer 19

• Stomach irritation (nausea/vomiting, epigastric pain, heartburn, indigestion)
• Bronchospasms in some patients with asthma-cause yet to be fully understood.

Question 20

What are the side effects for nitroglycerine?

Answer 20

• Headache
• hypotension
• increased HR
• vertigo
• nausea

Question 21

Special information for albuterol.

Answer 21

•Albuterol may precipitate angina pectoris and dysrhythmias. Check lung sounds, O2 saturation, paramedic checks capnography, respiratory rate before and after administration of albuterol.

Question 22

Special information for aspirin.

Answer 22

• Pills need to be chewed and swallowed. Small amount of water can be used.
• Aspirin interferes with thromboxane A2 (TA2) “message” from being sent to other platelets, thus causing the platelets to pass by and not let the clot grow, minimizing the clotting process.
• ASA has no effect on existing blood clot. It just stops it from getting bigger.
• Can be given if patient is on anti-coagulants.

Question 23

Special information for nitroglycerine.

Answer 23

• Nitro has a cumulative effect; repeat doses are usually necessary.
• Nitro has a short shelflife and is light sensitive.
• Don’t shake the nitro bottle (spray or pill). Nitro in this form is not explosive; however, shaking the pill bottle will likely fracture the pills (never administer a partial pill) and shaking the spray bottle will break down the medication.
• Be sure to inform the patient that nitro can cause headache and increased heart rate, and that this is a normal side effect of nitro. Nitro may also cause vertigo and nausea.
• Remind the patient not swallow the Nitro, spray or pill.
• Inform the patient that they may experience a burning sensation under their tongue after administration.

Question 24

Albuterol dosage/route

Answer 24

• For adults and children, Place 2.5 mg Albuterol in 3 mL of NS via SVN, repeat as needed. Connect oxygen tubing or SVN and run at 6-8 lpm.
• The EMT-B must also remember that each metered dose from and inhaler is equal to 90 mcg.

Question 25

Aspirin dosage/route

Answer 25

• Oral route (PO)
• Dose can range from 162 mg to 325 mg.
• 2 to 4, 81 mg tablets
• It is highly suggested that the EMS provider administer a total of four, 81 mg tablets for a total of 324 mg. Most protocols will recommend/require this dosage. Also note that EMS agencies will administer chewable ASA, commonly orange flavored, and commonly St. Joseph brand.

Question 26

Nitroglycerine dosage/route

Answer 26

• Sublingual (SL) route.
• If systolic BP>100 it is suggested that you administer 0.4 mg SL q 3-5 minuets. Generally a total of 3 doses (3, 0.4 mg SL) are administered as dosages beyond this recommendation tend to be less effective.