Pharm 11-15 (Aspirin, Narcan, Epi, Nitro, Dextrose/Glucose) Flashcards
Aspirin (Salicylate): Class?
Analgesic, nonsteroidal anti-inflammatory drug (NSAID), antipyretic, and antiplatelet
Aspirin (Salicylate): Action?
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
Aspirin (Salicylate): Indication?
Acute coronary syndrome (ACS) such as myocardial infarction, ischemic chest pain or angina, and given for mild to moderate pain or fever
Aspirin (Salicylate): Contraindication?
GI bleeding, hemorrhagic stroke, active gastric ulcers, bleeding disorders, asthma, hypersensitivity to salicylates, children
Aspirin (Salicylate): Onset/Duration?
Onset: 15-30 min
Duration: 4-6 hours
Aspirin (Salicylate): Dose/Route
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
Aspirin (Salicylate): Side effects?
Stomach irritation, GI bleeding, Nausea/vomiting
Aspirin (Salicylate): Notes?
Children under 12 should not be given Aspirin as they may develop Reye’s syndrome.
Naloxone (Narcan): Class?
Opioid antagonist
Naloxone (Narcan): Action?
Narcan is a competitive opiate antagonist used in known or suspected opioid overdose.
Naloxone (Narcan): Indication?
Suspected or known opioid overdose with respiratory depression.
Naloxone (Narcan): Contraindication?
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.
Naloxone (Narcan): Onset/Duration?
Onset: 2 min
Duration: 30-120 min
Naloxone (Narcan): Dose/Route?
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
Naloxone (Narcan): Side effects?
Withdrawal symptoms, dysrhythmias, nausea/vomiting, hypertension, tachycardia, seizures, blurred vision.
Naloxone (Narcan): Notes?
Titrate to control airway and breathing, should NOT be used to completely reverse narcotic effects due to complications with withdrawal syndrome, combativeness, etc.
Nitroglycerin (Nitro-Stat): Class?
Nitrate, vasodilator
Nitroglycerin (Nitro-Stat): Action?
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.
Nitroglycerin (Nitro-Stat): Indication?
Chest pain, acute coronary syndromes (ACS), pulmonary edema associated with CHF, hypertensive emergencies
Nitroglycerin (Nitro-Stat): Contraindication?
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.
Nitroglycerin (Nitro-Stat): Onset/Duration?
Onset: 1-3 min
Duration: 25 min SL
Nitroglycerin (Nitro-Stat): Dose/Route?
Adult: 0.4 mg SL, every 3-5 min up to three total doses for 1.2 mg
Peds: Not recommended in prehospital setting
Nitroglycerin (Nitro-Stat): Side effects?
Headache, hypotension, palpitations, dizziness, reflex tachycardia, nausea/vomiting, postural syncope, diaphoresis.
Nitroglycerin (Nitro-Stat): Notes?
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.
Epinephrine (Adrenalin): Class?
Sympathomimetic
Epinephrine (Adrenalin): Action?
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.
Epinephrine (Adrenalin): Indications?
Anaphylaxis, cardiac arrest, asthma, bradycardia (first line in peds), shock not caused by hypovolemia, severe hypotension accompanied with bradycardia when pacing and atropine fail.
Epinephrine (Adrenalin): Contraindications?
Hypovolemic shock. Caution should be used in patients with known cardiovascular disease or pts > 45 y/o
Epinephrine (Adrenalin): Onset/Duration?
Onset: 1-2 min IV, 5-10 mins SQ
Duration: 5-10 min IM
Epinephrine (Adrenalin): Dose/Route?
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.
Epinephrine (Adrenalin): Side effects?
Tachycardia, hypertension, anxiety, cardiac dysrhythmias, tremors, dyspnea
Epinephrine (Adrenalin): Notes?
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.
Dextrose 50%, 25%, 10%: Class?
Carbohydrate, hypertonic solution
Dextrose 50%, 25%, 10%: Action?
Dextrose increases available blood sugar to be used as energy by the body
Dextrose 50%, 25%, 10%: Indications?
Hypoglycemia. If protocol allows also for altered ALOC, coma, and seizure of unknown origin
Dextrose 50%, 25%, 10%: Contraindications?
Intracranial hemorrhage, increased intracranial pressure, known or suspected stroke in the absence of hypoglycemia
Dextrose 50%, 25%, 10%: Onset/Duration?
Onset: 1 min
Duration: Variable depending on degree of hypoglycemia
Dextrose 50%, 25%, 10%: Dose/Route?
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
Dextrose 50%, 25%, 10%: Side effects?
Hyperglycemia
Dextrose 50%, 25%, 10%: Notes?
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.
