Pharm 11-15 (Aspirin, Narcan, Epi, Nitro, Dextrose/Glucose)

Question 1

Aspirin (Salicylate): Class?

Answer 1

Analgesic, nonsteroidal anti-inflammatory drug (NSAID), antipyretic, and antiplatelet

Question 2

Aspirin (Salicylate): Action?

Answer 2

Inhibits prostaglandins involved in the production of inflammation, pain and fever. Dilates peripheral vessels and also inhibits platelet aggregation by blocking the formation of thromboxane A2

Question 3

Aspirin (Salicylate): Indication?

Answer 3

Acute coronary syndrome (ACS) such as myocardial infarction, ischemic chest pain or angina, and given for mild to moderate pain or fever

Question 4

Aspirin (Salicylate): Contraindication?

Answer 4

GI bleeding, hemorrhagic stroke, active gastric ulcers, bleeding disorders, asthma, hypersensitivity to salicylates, children

Question 5

Aspirin (Salicylate): Onset/Duration?

Answer 5

Onset: 15-30 min
Duration: 4-6 hours

Question 6

Aspirin (Salicylate): Dose/Route

Answer 6

Adult: Mild pain/fever – 325-650 mg PO every 4 hours. ACS – 2 to 4 baby chewable aspirin, 162-324 mg OR 1 adult aspirin, 325mg PO.
Peds: Not indicated in pre-hospital setting

Question 7

Aspirin (Salicylate): Side effects?

Answer 7

Stomach irritation, GI bleeding, Nausea/vomiting

Question 8

Aspirin (Salicylate): Notes?

Answer 8

Children under 12 should not be given Aspirin as they may develop Reye’s syndrome.

Question 9

Naloxone (Narcan): Class?

Answer 9

Opioid antagonist

Question 10

Naloxone (Narcan): Action?

Answer 10

Narcan is a competitive opiate antagonist used in known or suspected opioid overdose.

Question 11

Naloxone (Narcan): Indication?

Answer 11

Suspected or known opioid overdose with respiratory depression.

Question 12

Naloxone (Narcan): Contraindication?

Answer 12

Hypersensitivity. Caution with narcotic dependent pt’s who may experience withdrawal syndrome to include neonates of narcotic-dependent mothers. Avoid use with
Meperidine induced seizures.

Question 13

Naloxone (Narcan): Onset/Duration?

Answer 13

Onset: 2 min
Duration: 30-120 min

Question 14

Naloxone (Narcan): Dose/Route?

Answer 14

Adult: 0.4 – 2mg IV/IO/IM/IN may repeat up to 10 mg max
Peds: 0.1 mg/kg IV/IO/IM/IN, max single dose of 2 mg

Question 15

Naloxone (Narcan): Side effects?

Answer 15

Withdrawal symptoms, dysrhythmias, nausea/vomiting, hypertension, tachycardia, seizures, blurred vision.

Question 16

Naloxone (Narcan): Notes?

Answer 16

Titrate to control airway and breathing, should NOT be used to completely reverse narcotic effects due to complications with withdrawal syndrome, combativeness, etc.

Question 17

Nitroglycerin (Nitro-Stat): Class?

Answer 17

Nitrate, vasodilator

Question 18

Nitroglycerin (Nitro-Stat): Action?

Answer 18

Nitroglycerin is an organic nitrate and potent vasodilator. It relaxes vascular smooth muscle resulting in coronary artery dilation while also reducing blood pressure, preload, afterload, and myocardial oxygen demand.

Question 19

Nitroglycerin (Nitro-Stat): Indication?

Answer 19

Chest pain, acute coronary syndromes (ACS), pulmonary edema associated with CHF, hypertensive emergencies

Question 20

Nitroglycerin (Nitro-Stat): Contraindication?

Answer 20

Hypersensitivity, pts that have taken erectile dysfunction drugs (Cialis, Levitra, Viagra, etc.) within the last 24-72 hours, head injury, SBP < 100, cerebral stroke or hemorrhage, extreme bradycardia or tachycardia, right ventricular infarction, volume depletion.

Question 21

Nitroglycerin (Nitro-Stat): Onset/Duration?

Answer 21

Onset: 1-3 min
Duration: 25 min SL

Question 22

Nitroglycerin (Nitro-Stat): Dose/Route?

Answer 22

Adult: 0.4 mg SL, every 3-5 min up to three total doses for 1.2 mg
Peds: Not recommended in prehospital setting

Question 23

Nitroglycerin (Nitro-Stat): Side effects?

Answer 23

Headache, hypotension, palpitations, dizziness, reflex tachycardia, nausea/vomiting, postural syncope, diaphoresis.

Question 24

Nitroglycerin (Nitro-Stat): Notes?

Answer 24

NTG must be kept in an airtight container and, if exposed to light, air or heat, it decomposes which is why most pt’s own prescription doesn’t relieve their symptoms since pt’s need to refill every 30 days if opened/used.

Question 25

Epinephrine (Adrenalin): Class?

Answer 25

Sympathomimetic

Question 26

Epinephrine (Adrenalin): Action?

Answer 26

Endogenous catecholamine that directly stimulates both alpha-1, beta-1 and beta-2 adrenergic receptors. The effects this will have on the heart include increased contractile force, increased rate, and increased cardiac output. Epinephrine is also a potent vasoconstrictor as well as a bronchodilator. Other effects include slowing of gastric motility, miosis, and pale skin.

Question 27

Epinephrine (Adrenalin): Indications?

Answer 27

Anaphylaxis, cardiac arrest, asthma, bradycardia (first line in peds), shock not caused by hypovolemia, severe hypotension accompanied with bradycardia when pacing and atropine fail.

Question 28

Epinephrine (Adrenalin): Contraindications?

Answer 28

Hypovolemic shock. Caution should be used in patients with known cardiovascular disease or pts > 45 y/o

Question 29

Epinephrine (Adrenalin): Onset/Duration?

Answer 29

Onset: 1-2 min IV, 5-10 mins SQ
Duration: 5-10 min IM

Question 30

Epinephrine (Adrenalin): Dose/Route?

Answer 30

Adult: Cardiac arrest – 1 mg 1:10,000 IV/IO every 3-5 min with no max.
Anaphylaxis/asthma – 0.3-0.5 mg SQ/IM 1:1,000. If no response, some protocols give 0.3-0.5 mg IV 1:10,000.
Post cardiac arrest or for bradycardia with severe hypotension – 2-10 mcg/min IV drip and titrate to effect.

Peds: Cardiac arrest – 0.01 mg/kg 1:10,000 IV/IO max of 1 mg every 3-5 mins.
Anaphylaxis/asthma – 0.01 mg/kg 1:1,000 SQ/IM with a max single dose 0.3 mg.

Question 31

Epinephrine (Adrenalin): Side effects?

Answer 31

Tachycardia, hypertension, anxiety, cardiac dysrhythmias, tremors, dyspnea

Question 32

Epinephrine (Adrenalin): Notes?

Answer 32

Always use epinephrine 1:1,000 when given SQ/IM and 1:10,000 when given IV/IO. Giving concurrently with alkaline solutions such as sodium bicarbonate will cause crystallization of fluid.

Question 33

Dextrose 50%, 25%, 10%: Class?

Answer 33

Carbohydrate, hypertonic solution

Question 34

Dextrose 50%, 25%, 10%: Action?

Answer 34

Dextrose increases available blood sugar to be used as energy by the body

Question 35

Dextrose 50%, 25%, 10%: Indications?

Answer 35

Hypoglycemia. If protocol allows also for altered ALOC, coma, and seizure of unknown origin

Question 36

Dextrose 50%, 25%, 10%: Contraindications?

Answer 36

Intracranial hemorrhage, increased intracranial pressure, known or suspected stroke in the absence of hypoglycemia

Question 37

Dextrose 50%, 25%, 10%: Onset/Duration?

Answer 37

Onset: 1 min
Duration: Variable depending on degree of hypoglycemia

Question 38

Dextrose 50%, 25%, 10%: Dose/Route?

Answer 38

Adult: 12.5-25 g slow IV (25-50 ml 50% dextrose; 125-250 ml 10% dextrose)
Peds: 0.5-1 g/kg (2-4 ml/kg) IV of 25% dextrose
Neonates: 0.5-1 g/kg (2-4 ml/kg) IV of 10% dextrose

Question 39

Dextrose 50%, 25%, 10%: Side effects?

Answer 39

Hyperglycemia

Question 40

Dextrose 50%, 25%, 10%: Notes?

Answer 40

If given through infiltrated IV, will cause tissue necrosis so use large vein and flush with saline to ensure IV patency. D50 may cause Wernicke’s encephalopathy in thiamine deficient patient (alcoholics and malnourished pts) so if these conditions are suspected, administer 100 mg Thiamine IV prior to administering D50.