Pharm 21-27 (Fentanyl, Morphine, Ketamine, Glucagon, Haldol, Nitrous Oxide, Thiamine) Flashcards
Fentanyl (Sublimaze): Class?
Synthetic Opioid analgesic
Fentanyl (Sublimaze): Action?
Combines with the receptor sites in the brain to produce potent analgesic effects
Fentanyl (Sublimaze): Indications? (2)
Pain and sedation
Fentanyl (Sublimaze): Contraindications? (6)
1.Hypersensitivity to opiates 2.Hypotension 3.Cardiac dysrhythmias 4.Respiratory depression 5.Head injury 6.Myasthenia gravis
Fentanyl (Sublimaze): Onset/Duration?
Onset 1-2 min IV
Duration 30-60 min
Fentanyl (Sublimaze): Dose/Route?
Adult: 0.5 – 2 mcg/kg slow IV/IO/IM/IN over 2 mins, q 5 min, max single dose of 100 mcg, max total dose of 300 mcg.
Peds: 0.5 – 1 mcg/kg IV/IN over 2 mins, q 5 min, max single dose of 100 mcg, max total dose of 3 mcg/kg.
Fentanyl (Sublimaze): Side effects? (5)
- Nausea/Vomiting 2.Respiratory depression 3.Hypotension or hypertension 4.Bradycardia 5.Rigidity of chest wall muscles
Fentanyl (Sublimaze): Notes?
None
Morphine Sulfate (Astramorph): Class?
Opioid analgesic
Morphine Sulfate (Astramorph): Action?
Morphine is a natural opioid analgesic. Morphine also causes venous dilation and decreased venous return to the heart thus reducing myocardial oxygen demand. Morphine also causes euphoria, central nervous system depression and sedation.
Morphine Sulfate (Astramorph): Indications? (3)
1.Acute pain 2.Chest pain associated with ACS 3.Pulmonary edema
Morphine Sulfate (Astramorph): Contraindications? (9)
1.Hypersensitivity to narcotics 2.CNS depression 3.Respiratory depression 4.Hypotension 5.Hypovolemia 6.Head injury 7.Increased ICP 8.Pts that took MAO inhibitors in last 14 days 9.Caution with pt’s with RV infraction/MI
Morphine Sulfate (Astramorph): Onset/Duration?
Onset: 5-10 min
Duration: 4-5 hrs
Morphine Sulfate (Astramorph): Dose/Route?
Adult: 2-5 mg IV/IO repeat every 10 min as needed
Peds: 0.1 mg/kg IV/IO, every 10 min up to 5 mg max single dose, max total dose of 15 mg
Morphine Sulfate (Astramorph): Side effects? (4)
1.Hypotension 2.CNS depression 3.Respiratory depression 4.Tachycardia
Morphine Sulfate (Astramorph): Notes?
CNS depressants and Phenothiazines may potentiate morphine. Use Narcan for Morphine overdoses.
Ketamine (Ketalar): Class?
Nonbarbiturate anesthetic
Ketamine (Ketalar): Action?
Acts on the limbic system and cortex to block afferent transmission of impulses associated with pain perception. It produces short-acting amnesia without muscular relaxation. A derivative of phencyclidine (PCP).
Ketamine (Ketalar): Indications? (2)
- Pain 2.Sedation and sometimes used as an adjunct to nitrous oxide
Ketamine (Ketalar): Contraindications? (5)
1.Stroke 2.Hypersensitivity 3.Severe hypertension 4.Cardiac instability 5.Caution with schizophrenia.
Ketamine (Ketalar): Onset/Duration?
Onset: 30 sec
Duration: 5-10 min up to 1-2 hours
Ketamine (Ketalar): Dose/Route?
Adult: Sedation - 1-2 mg/kg IV over 1 min or 4 mg/kg IM.
Pain – 0.3 mg/kg IV/IO/IM/IN
Peds > 2 y/o: 1-2 mg/kg IV over 1 min.
Pain – 0.3 mg/kg IV/IO/IM/IN
Ketamine (Ketalar): Side effects? (5)
1.Hypertension 2.Increased heart rate 3.Hallucinations 4.Delusions 5.Explicit dreams
Ketamine (Ketalar): Notes?
Common street use these days in conjunction with narcotics because they potentiate each other for a longer/higher euphoria. Giving Narcan will only affect the narcotic NOT the Ketamine therefore only a minimal short-lasting effect.
Glucagon (Glucagen): Class?
Pancreatic hormone
Glucagon (Glucagen): Action?
Glucagon stimulates the liver to breakdown glycogen into glucose resulting in an increase in blood glucose. Also stimulates glucose synthesis.
Glucagon also has a positive inotropic action on the heart even in the presence of beta blockade or calcium channel blockade which makes it useful for beta blocker or calcium channel blocker overdose.
Glucagon also relaxes smooth muscle of the GI tract, primarily the esophagus which makes it useful for esophageal obstruction.
Glucagon (Glucagen): Indications? (4)
1.Hypoglycemia (when IV access is not available) 2.Beta blocker overdose 3.Calcium channel blocker overdose 4.Esophageal obstruction
Glucagon (Glucagen): Contraindications? (1)
Hypersensitivity (usually to proteins)
Glucagon (Glucagen): Onset/Duration?
Onset: 10-20 min IM, 1 min if IV
Duration: 60-90 min
Glucagon (Glucagen): Dose/Route?
Adult: Hypoglycemia – 1 mg IM/IN may repeat in 10 min if protocol allows.
Calcium channel or beta blocker overdose – 3-10 mg IV over 3-5 min followed by an infusion at 3-5 mg/hr.
Peds: < 20 kg – 0.5 mg IM/IN, > 20 kg - 1.0 mg IM/IN
Glucagon (Glucagen): Side effects? (4)
1.Tachycardia 2.Hypotension 3.Nausea/vomiting 4.Urticaria
Glucagon (Glucagen): Notes?
Glucagon requires glycogen stores in the liver to increase blood glucose. If patient is malnourished glucagon may not work.
Haloperidol (Haldol): Class?
Antipsychotic, neuroleptic
Haloperidol (Haldol): Action?
Blocks dopamine type-2 receptors in the brain thereby altering mood and behavior.
Haloperidol (Haldol): Indications? (2)
1.Acute psychotic episodes 2.Emergency sedation of severely agitated or delirious pts
Haloperidol (Haldol): Contraindicaitons? (6)
1.Hypersensitivity 2.CNS depression 3.Pregnancy 4.Parkinson’s disease 5.Seizure disorder 6.Liver or cardiac disease
Haloperidol (Haldol): Onset/Duration?
Onset: 30-60 min IM
Duration: 12-24 hrs
Haloperidol (Haldol): Dose/Route?
Adult: 5 mg IV or 10 mg IM, q 5-10 min, max of 15 mg.
Peds: Not recommended
Haloperidol (Haldol): Side effects? (5)
1.Dose-related extrapyramidal reactions 2.Hypotension 3.Nausea/vomiting 4.Blurred vision 5.Drowsiness.
Haloperidol (Haldol): Notes?
None
Nitrous Oxide (Nitronox): Class?
Gaseous analgesic, anesthetic
Nitrous Oxide (Nitronox): Action?
Nitrous Oxide is a blended mixture of 50% nitrous oxide and 50% oxygen. When inhaled it depresses the CNS causing analgesia. Due to being administered with high oxygen concentrations it also increases oxygen tension in the blood thereby reducing hypoxia.
Nitrous Oxide (Nitronox): Indications? (3)
1.Traumatic musculoskeletal injury 2.Moderate to severe pain 3.Burns
Nitrous Oxide (Nitronox): Contraindications? (7)
1.ALOC 2.Hypotension 3.COPD 4.Chest trauma (pneumothorax) 5.Abdominal pain or injury 6.Head injury 7.Bowel obstruction.
Nitrous Oxide (Nitronox): Onset/Duration?
Onset: 2-5 min
Duration: 2-5 min
Nitrous Oxide (Nitronox): Dose/Route?
Adult: Self administered by pt via held mask or mouthpiece until effects are felt
Peds: Same as adult
Nitrous Oxide (Nitronox): Side effects? (5)
1.Altered LOC 2.Apnea 3.Dizziness 4.Nausea/vomiting 5.Malignant hypertension (rare but serious)
Nitrous Oxide (Nitronox): Notes?
Must be mixed 50% Nitrous Oxide and 50% Oxygen, if 100% Nitrous Oxide is administered the patient will become hypoxic and die. Pt MUST be able to follow instructions and hold mask/mouthpiece on their own to administer!
Thiamine (Betaxin): Class?
Vitamin (B1)
Thiamine (Betaxin): Action?
Thiamine is also known as vitamin B1. Thiamine combines with adenosine triphosphate to form thiamine pyrophosphate, a coenzyme necessary for carbohydrate metabolism. The brain is especially sensitive to thiamine deficiency.
Thiamine (Betaxin): Indications? (3)
1.Hypoglycemia with malnourishment or suspected alcoholism 2.Delirium tremors 3.Wernicke’s encephalopathy
Thiamine (Betaxin): Contraindicaitons?
None in the emergency prehospital setting
Thiamine (Betaxin): Onset/Duration?
Onset: Rapid
Duration: Variable depending on degree of deficiency
Thiamine (Betaxin): Dose/Route?
Adult: 100 mg slow IV or IM
Peds: Not recommended in the prehospital setting
Thiamine (Betaxin): Side effects? (4)
1.Hypotension (if given rapidly or too large a dose) 2.Nausea/vomiting 3.Anxiety 4.Diaphoresis
Thiamine (Betaxin): Notes?
none
