PCP medications Flashcards
Acetaminophen
Tylenol, Tempra
Classification of Acetaminophen
Anti-Pyretic, Non-opioid analgesic
MOA for Acetaminophen
It inhibits the synthesis of Prostaglandins in the CNS blocking the generation of pain impulses.
Works on the Hypothalamus heat regulating center to increase vasodilation resulting in increased blood flow to the skin allowing the release of heat
Contraindications of Acetaminophen
Hypersensitivity to Yellow 5, Saccharin, Aspartame, Sugar, Alcohol
Active liver disease or hepatic impairment
Chemotherapy
Indications for Acetaminophen
Mild pain (Non-Opioid Analgesic)
Reduction of fever (Anti-Pyretic)
Dosage of Acetaminophen
Adult 975mg Do Not repeat
Pediatric 15mg/kg up to 975mg Do Not Repeat
EMS considerations for Acetaminophen
document PT temperature before and after administration
If PT has not received the max dose in the last 4 hrs administer the remaining dose. Do Not Administer if PT has had max dose in the last 4 hours
Toxicology and Side Effects of Acetaminophen
Toxic at 150mg/kg or 7.5g
Renal failure with High dose or chronic use
Hepatic Damage
Acetylsalicylic acid
ASA, Aspirin, Bufferin
Classification of Acetylsalicylic Acid
Anti Platelet aggregator, Anti-Pyretic, Analgesic, Non Steroidal Anti-inflammatory drug (NSAID)
MOA of Acetylsalicylic Acid
Blocks Thromboxane which starts the clotting process
Inhibits the production of prostaglandins
Indications for Acetylsalicylic Acid
Acute Coronary Syndrome (ACS)
Contraindications of Acetylsalicylic Acid (7)
Hypersensitivity to salicylates/NSAIDS
Unable to follow commands
Active ulcer disease or GI hemorrhage
Bleeding Disorder
Pregnancy (especially 3rd trimester)
Children under 15
ASA induced Asthma
Dosage for Acetylsalicylic Acid
160mg (162mg) PO Chewed, Do Not repeat within 24 hrs
Onset 1-2 hrs
Duration 4-5 hrs
Side Effects of Acetylsalicylic Acid (4)
GI irritation
Nuasea vomiting
Tinnitus
Increased risk of bleeding
EMS Considerations for Acetylsalicylic Acid (5)
Confirm that PT took ASA properly by Dispatch or alternative First responder instructions before Administering EMS dose
ASA must still be administered if daily prescribed dose has been taken
Diabetics at risk for developing hypoglycemia
Reye’s syndrome: fatal disease characterized by edema of the brain, hypoglycemia, fatty infiltration and liver dysfunction. And is the reason for children under 15 being a contraindications
Dextrose in water
D10W, D25W, D50W
Dextrose in water Classification
Caloric Agent
Dextrose in Water MOA
- increase blood sugar to normal in hypoglycemia
- Hypertonic solution producing a transient movement of water from interstitial spaces into the venous system (osmotic diuretic)
Indications for dextrose in water
- severe hypoglycemia
- Head injury with symptomatic hypoglycemia (half dose)
- Stroke with symptomatic hypoglycemia (half dose)
Contraindications for dextrose in water
- allergy to corn
- hyperglycemia
- hypersensitivity to dextrose solution
- relative contraindications- intracranial hemorrhage (half dose)
Adult dosage for dextrose in water (3)
- 25g D50W SIVP/IO q 5 min prn, titrate to BGL >/= 4.0 mmol/L or PT improvement to max 50g
- Suspected stroke: 12.5g D50W SIVP/IO q 5 min prn, titrate to BGL = 3.0mmol/l or PT improvement to max 50g
- suspected head injury: 12.5g D50W SIVP/IO q 5min prn, titrate to BGL = 4.0mmol/L or PT improvement max 50g
side effects of dextrose in water (4)
- rebound hyperglycemia
- May aggravate hypertension and CHF
- may cause neurological symptoms in alcoholic PT
- Wernicke’s encephalopathy/ Korsakoff’s syndrome
Ems considerations for dextrose in water
- Tissue necrosis if infiltration occurs, to avoid:
a. Give ½ the total volume and check IV patency before giving the rest - Utilize a large bore catheter in a large vein
- D50W has a short duration of action, therefore follow drug administration with an oral
complex carbohydrate (ie: toast, crackers, pasta, sandwich) - May precipitate severe neurological symptoms in alcoholics; give thiamine prior to D50W
(ACP only)
**Severe thiamine deficiency can reduce glucose utilization by half and may precipitate: - Wernicke’s Encephalopathy: is an acute and reversible disorder as a result of lack of
thiamine associated with chronic alcoholism. It is characterized by poor voluntary
muscle coordination, eye muscle weakness and mental derangement
9 - Korsakoff’s Syndrome: is a frequent result of severe deficiency of vitamin B1(thiamine)
resulting in significant memory loss and can be irreversible, Wernicke’s usually precedes
Korsakoff’s - Increased intracellular glucose levels in the setting of cerebral ischemia and hypoxia result in
increased intracellular acidosis due to anaerobic metabolism of glucose and subsequent
neuronal death
dimenhydrinate
Gravol
Classification for dimenhydrinate
Antiemetic
MOA for dimenhydrinate (2)
- Depresses vestibular (equilibrium) function by inhibiting histamine H1 receptors
- Sedative effects due to inhibition of histamine
Indications for dimenhydrinate
Nausea and Vomiting associated with motion sickness and vertigo, pregnancy, narcotic admin and alcohol withdrawal.
Contraindications for dimenhydrinate (3)
- Hypersensitivity to dimenhydrinate and diphenhydramine or propylene glycol (food additive)
- Narrow angle glaucoma
- Patients who have ingested large quantities of depressants including alcohol
Dosage for dimenhydrinate (2)
50mg SIVP/IM/IO q 4hrs
Half dose and do not repeat in PT over 65 yrs
side effects for dimenhydrinate (2)
- drowsiness
- sedative effect
dimenhydrinate considerations (2)
- 10ml syringe with NS for IV administration; lessens vein irritation
- preferred antiemetic for nausea and vomiting associated with vertigo, motion sickness or narcotic side effect
diphenhydramine
benadryl
classification of diphenhydramine
antihistamine
MOA of diphenhydramine
- Competes with histamine for H1 receptor sites on effector cells. They thereby prevent, but do not
reverse responses mediated by histamine alone - Does not inhibit histamine release
indications for diphenhydramine
- Allergic reactions
- Adjunct to epinephrine (used after epinephrine deployed) in the management of anaphylaxis
- Management of drug induced extrapyramidal symptoms
Contradictions for diphenhydramine
- Hypersensitivity to either diphenhydramine or dimenhydrinate
- Relative : avoid antihistamine in nursing mothers and/or in neonates (less than 28 days) unless life
threatening anaphylaxis/allergy
diphenhydramine dosage
ADULT:
(ELIXIR) 50mg PO - Do not repeat dose
Or
1mg/kg IM/SIVP/IO, single max dose 50mg - Do not repeat dose (use vastus lateralis for IM injection)
PEDIATRIC:
(ELIXIR) 1mg/kg PO, single max dose of 50 mg – Do not repeat dose
Or
1mg/kg SIVP/IM/IO, single max dose 50mg - Do not repeat dose (use vastus lateralis for IM injection)
Side effects of diphenhydramine (5)
- Dry mouth
- Blurred vision
- Hypotension
- Thickening of bronchial secretions
- bronchospasm
EPINEPHRINE 1mg/mL
Adrenalin
classification of epinephrine
sympathomimetic; endogenous catecholamine
MOA for epinephrine (4)
- Inhibits the release of histamine associated with allergic and anaphylactic reactions.
- Alpha 1 agonist-
a. Peripheral vasoconstriction improving coronary and cerebral perfusion - Beta 1 agonist-
a. Positive chronotropic, inotropic, and dromotropic properties
b. Increases automaticity in the heart - Beta 2 agonist-
a. Bronchodilation - adrenergic receptors in the lungs to relax bronchial smooth muscle
indications for epinephrine
anaphylaxis
contraindications for epinephrine
none in an emergent situation
dosage for epinephrine
0.3mg IM q5 prn, max 0.9mg
side effects for epinephrine (8)
- Palpitation
- Tremors
- Nervousness
- Dizziness
- Anxiety
- Headache
- Hypertension
- Tachycardia
Considerations for epinephrine (5)
- All patients receiving this medication MUST be cardiac monitored (12 Lead)
- DO NOT administer 1mg/mL (1:1,000) solution by direct IV
- Epinephrine in pregnancy can cause fetal hypoxia
- Ensure the patient is in a recumbent position prior to administration of epinephrine
- The concentration of 1 mg/mL was previously known at 1:1000
glucagon classification
hormone
