Pharmacology Flashcards
Dextrose 5%
Class - Carbohydrate, Hypertonic solution
Action - A monosaccharide, which provides calories for metabolic needs, spares body proteins and loss of electrolytes. Readily excreted by kidneys producing diuresis. Hypertonic solution
Indication - Hypoglycemia
Contraindication - Intracranial or intraspinal hemorrhage, DTs with dehydration, blood glucose >60mg/dl
Dose - 8 yrs & up50cc of 50% solution; 25mg IV or if conscious 25gm PO; Pediatric 2-4 ml/kg slow IV of 25% solution; Newborn 4ml/kg of 12.5%solution dilute with D50 4:1 with NS
Adverse Affects - Thrombosis, sclerosing if given in peripheral vein, tissue irritation/necrosis if infiltration
*May cause Wernicke-Korsakoff syndrome in acute alcohol intoxication, prevent with Thiamine 100mg IM or IV, Check glucose level before and after administering
Epinephrine 1:1000
Class: Sympathomimetic.
Description: Epinephrine is a naturally occurring hormone (adrenalin) secreted by the adrenal glands in response to sympathetic nervous system stimulation. Epinephrine binds to alpha1, beta1, and beta2-adrenergic receptor sites, causing vasoconstriction, increased heart rate and force of contraction, and bronchiolar smooth muscle relaxation.
Mechanism of action: Epinephrine 1:1,000 is administered in anaphylaxis to cause vasoconstriction and relax bronchiolar smooth muscle.
Indications: Acute anaphylaxis.
Contraindications: Use with caution in patients with significant cardiovascular disease or hypertension.
Precautions: Epinephrine is inactivated by exposure to sunlight or when given with an alkaline solution. Because epinephrine causes a strong sympathetic stimulus, patients may experience chest pain, palpitations, anxiety, nausea, or headache. Monitor the patient’s heart rate and blood pressure.
Side effects: Palpitations, tachycardia, anxiety, headache, dizziness, nausea, and vomiting are common side effects. Patients with underlying cardiac disease also may experience chest pain and acute myocardial infarction.
Interactions: The effects of epinephrine can be intensified in patients taking some antidepressants.
Dosage: Adult dose, 0.3 to 0.5 mg subcutaneously or intramuscularly every 15 minutes as needed; pediatric dose, 0.01 mg/kg.
Route: Subcutaneous or intramuscular injection.
How supplied: 1 mg/1 mL in vials, ampules, or prefilled auto-injector devices.
Normal Saline
Class - Carbohydrate, Hypertonic solution
Action - A monosaccharide, which provides calories for metabolic needs, spares body proteins and loss of electrolytes. Readily excreted by kidneys producing diuresis. Hypertonic solution
Indication - Hypoglycemia
Contraindication - Intracranial or intraspinal hemorrhage, DTs with dehydration, blood glucose >60mg/dl
Dose - 8 yrs & up50cc of 50% solution; 25mg IV or if conscious 25gm PO; Pediatric 2-4 ml/kg slow IV of 25% solution; Newborn 4ml/kg of 12.5%solution dilute with D50 4:1 with NS
Adverse Affects - Thrombosis, sclerosing if given in peripheral vein, tissue irritation/necrosis if infiltration
*May cause Wernicke-Korsakoff syndrome in acute alcohol intoxication, prevent with Thiamine 100mg IM or IV, Check glucose level before and after administering
Lactated Ringers
Class: Isotonic crystalloid solution.
Description: Sterile water containing the following electrolytes: sodium, 130 mEq/L; potassium, 4 mEq/L; calcium, 30 mEq/L; chloride, 109 mEq/L; and lactate, 28 mEq/L.
Mechanism of action: Lactated Ringer’s solution is used to replace fluid and electrolytes.
Indications: Significant burns and hypovolemia.
Contraindications: Do not use in patients with heart failure, renal failure, or suspected hyperkalemia.
Precautions: Monitor closely for signs of circulatory overload.
Side effects: Rare in therapeutic dosages.
Interactions: Do not use with blood product infusion.
Dosage: Depends on the condition for which lactated Ringer’s solution is being administered. Follow your protocols. A keep-open rate is 30 mL/hour.
Route: IV infusion.
How supplied: Lactated Ringer’s solution is commonly supplied in 1,000 mL bags.
Naloxone
Class: Narcotic antagonist.
Description: Medication used to reverse respiratory depression associated with narcotic overdose.
Mechanism of action: Naloxone has a higher affinity for narcotic receptor sites and, when administered, displaces the narcotic, blocking its effects.
Indications: Naloxone is indicated to reverse the respiratory depression associated with narcotic overdose.
Contraindications: Known hypersensitivity.
Precautions: Rapid administration and large doses may cause withdrawal in narcotic-addicted patients. Many EMS systems titrate the dosage to the minimum amount needed to ensure adequate breathing rather than complete reversal of the narcotic.
Side effects: These are rare, but hypotension, hypertension, nausea, vomiting, and cardiac arrhythmias may occur.
Interactions: May cause withdrawal symptoms in patients addicted to narcotics.
Dosage: 1 to 2 mg slow IV push titrated to restore respiratory rate. If no effect, may be repeated at five-minute intervals. An intranasal formulation is also available.
Route: Slow IV push.
How supplied: Prefilled syringe, vial, or ampule.
Nitrous Oxide
Class: Analgesic and anesthetic.
Description: A 50/50 mix of oxygen and nitrous oxide delivered to a modified-demand valve and mask that the patient self-administers by holding the mask and inhaling.
Mechanism of action: Central nervous system (CNS) depressant.
Indications: Severe musculoskeletal pain, and chest pain associated with acute coronary syndrome and not relieved by nitroglycerin.
Contraindications: Decreased level of responsiveness, inability to follow instructions, traumatic brain injury, COPD, suspected pneumothorax, abdominal pain, and suspected bowel obstruction.
Precautions: Use only in well-ventilated area to prevent sedation of the medical staff. Teratogenic; should not be used by or around pregnant patients or health care providers.
Side effects: Dizziness, decreased mental status, hallucinations, nausea, and vomiting.
Interactions: Do not use with sedative–hypnotic medications, narcotics, or alcohol.
Dosage: Self-administered mixture of 50 percent nitrous oxide and 50 percent oxygen.
Route: Inhalation.
How supplied: Modified-demand valve with mixer to combine 50 percent of each gas for inhalation.
Albuterol
Class: Beta2-selective sympathomimetic bronchodilator.
Description: Albuterol sulfate (Proventil, Ventolin) is a sympathetic beta agonist used to reverse bronchiolar smooth muscle constriction in patients with asthma and chronic obstructive pulmonary disease (COPD).
Mechanism of action: Acts on beta2 sympathetic receptors in bronchiolar smooth muscle to cause bronchodilation.
Indications: Wheezing caused by asthma, COPD, and some other conditions.
Contraindications: Hypersensitivity and symptomatic tachycardia.
Precautions: Albuterol has minimal beta1-adrenergic effects, but it may increase heart rate and myocardial oxygen demand. Use with caution in patients with heart disease.
Side effects: Anxiety, palpitations, chest discomfort, headache, and perspiration.
Interactions: Other beta agonists should not be administered concurrently with albuterol.
Dosage: Metered-dose inhaler: one or two 90 mcg sprays. The use of a spacer device is preferred when administering albuterol by metered-dose inhaler, especially in pediatric patients. Small-volume nebulizer: 2.5 mg diluted in 2.5 mL over five to 15 minutes; pediatric dosage, 0.15 mg/kg diluted in 2.5 mL normal saline.
Route: Inhalation.
How supplied: Metered-dose inhaler or 2.5 mg/0.5 mL nebule.
Aspirin
Class: Platelet aggregation inhibitor; nonsteroidal anti-inflammatory; analgesic.
Description: Aspirin is a salicylate that reduces platelet aggregation by inhibiting the release of a prostaglandin called thromboxane A2.
Mechanism of action: Aspirin blocks part of the chemical reaction responsible for activating platelets.
Indications: In the prehospital setting, acute coronary syndrome and stroke.
Contraindications: Hypersensitivity; not given to children or adolescents with suspected viral illnesses because it is associated with an increased risk of Reye’s syndrome.
Precautions: Administer with caution in patients with asthma or seasonal allergies, stomach ulcers, liver disease, alcohol abuse, kidney disease, or coagulopathies.
Side effects: GI upset, bleeding, nausea, vomiting, and wheezing.
Interactions: Few interactions for a single dose in the prehospital setting.
Dosage: The American Heart Association currently recommends 160 to 325 mg of chewable aspirin. Children’s aspirin is preferred because it is chewable, which increases the rate of absorption, and does not require water to assist swallowing (O’Connor et al., 2010).
Route: Oral.
How supplied: Chewable tablets containing 81 mg/tablet.
Glucagon
Class: Hormone with antihypoglycemic action.
Description: Glucagon is a pancreatic hormone that affects the blood glucose level by promoting glycogenolysis and gluconeogenesis and inhibiting glycogenesis.
Mechanism of action: Glucagon causes a release of stored glycogen and its conversion to glucose when released into the circulation. When administered, it causes an increase in blood glucose levels if the patient has adequate stores of glycogen for conversion to glucose.
Indications: Inability to establish intravenous access in patients with significant hypoglycemia.
Contraindications: Hypersensitivity.
Precautions: Glucagon is not effective if the patient has already depleted glycogen stores.
Side effects: Side effects are rare, but hypotension, dizziness, headache, nausea, and vomiting may occur.
Interactions: Few interactions when given in an emergency situation in therapeutic doses.
Dosage: 1 mg.
Route: Intramuscular injection.
How supplied: Glucagon is supplied as a kit containing the powdered medication and solvent that must be combined before administration.
Glucose
Class: Carbohydrate.
Description: Glucose is a simple carbohydrate that can be absorbed across the buccal mucosa or through the gastrointestinal tract.
Mechanism of action: Increases blood glucose levels.
Indications: Acute hypoglycemia in a patient who is awake and can protect his own airway.
Contraindications: Inability to maintain a patent airway.
Precautions: Carefully monitor the patient for the potential of aspiration.
Side effects: Nausea and vomiting.
Interactions: None.
Dosage: 15 grams by mouth or applied to the buccal mucosa.
Route: Oral or buccal.
How supplied: Single-dose 1.3 oz (37.5 g) sealed tube containing 15 g d-glucose (40 percent glucose); tube has a twist-off cap.
Nitroglycerin (Tablets & Spray)
Class: Nitrate; vasodilator.
Description: Supplied as tablets or a metered-dose spray for sublingual administration in the treatment of acute coronary syndrome.
Mechanism of action: Nitrates are potent vasodilators that increase blood flow to the coronary arteries and decrease cardiac workload by dilating the peripheral vasculature and reducing preload.
Indications: Chest pain associated with acute coronary syndrome.
Contraindications: Hypotension, increased intracranial pressure, and use of erectile dysfunction medications within 24 to 36 hours.
Precautions: NTG deteriorates rapidly when exposed to light or air. Monitor blood pressure closely and discontinue administration if the systolic blood pressure falls below 90 mmHg.
Side effects: NTG is a potent vasodilator and commonly causes an immediate headache. May cause dizziness, weakness, tachycardia, hypotension, dry mouth, nausea, and vomiting. The spray or tablets may cause a burning sensation on administration.
Interactions: Effects may be accentuated by alcohol use, erectile dysfunction medications, and beta blockers.
Dosage: Administer 0.4 mg sublingually. If chest pain persists and the systolic blood pressure remains at least 90 mmHg, the dose may be repeated every five minutes to a total of three doses.
Route: Sublingual.
How supplied: Calibrated spray delivering 0.4 mg/spray or as a small tablet containing 0.4 mg/tablet.
Oxygen
Class: Gas.
Description: Colorless, odorless, tasteless gas.
Mechanism of action: Oxygen is necessary for cellular energy production. When inhaled, oxygen molecules cross the respiratory membrane to attach to hemoglobin in red blood cells for transport to the tissues.
Indications: Dyspnea, hypoxia; SpO2 < 95 percent.
Contraindications: There are no absolute contraindications to the use of oxygen. However, there are complications associated with hyperoxemia, particularly in neonates and patients resuscitated from cardiac arrest.
Precautions: Patients with COPD who depend on hypoxic drive for respiratory drive may experience respiratory depression if high concentrations of oxygen are administered for a prolonged period of time. Oxygen is a vasoactive drug that causes cerebral and coronary artery vasoconstriction. Oxygen is not recommended for routine use in uncomplicated acute coronary syndrome. Oxygen administration should be titrated to maintain an SpO2 of 95 percent or higher. Do not use near an open flame or sources of combustion. Compressed gas cylinders may become projectile hazards if knocked over and damaged. Always leave the bottle on its side and use a protective guard over the flow meter to prevent damage.
Side effects: There are few side effects associated with short-term administration of therapeutic amounts of oxygen. If used for prolonged periods of time without a humidifier, it may cause drying of the mucous membranes and nosebleeds.
Interactions: None.
Dosage: Oxygen administration should be titrated to maintain an SpO2 of 95 percent or higher. High oxygen concentrations for prolonged periods of time can cause oxygen toxicity. Therefore, ventilator patients are often kept below 50 percent oxygen when possible.
Route: Inhalation via nasal cannula, face mask, nonrebreather mask, or bag-valve-mask device.
How supplied: Oxygen is supplied as a compressed gas in a high-pressure cylinder.
Nitro Paste
Class - nitrate
Action - relaxes vascular smooth muscle causing vasodilation, decreased cardiac work and improved coronary blood flow
Indications - Chest pain, CHF
Contraindications - Hypotension, increased ICP
Dose - 0.5-1” transdermal
Adverse affect - headache, dizziness, weakness, tachycardia, hypotension
*Do not get paste on your finger as this may cause headache.
**Monitor BP closely
Dextrose 50%
Class: Carbohydrate.
Description: High concentration (50 g/100 mL) of dextrose in sterile water for IV administration.
Mechanism of action: Increases glucose concentration in the blood for the reversal of acute hypoglycemia.
Indications: Hypoglycemia in adult patients.
Contraindications: Intracranial hemorrhage (traumatic brain injury, stroke) and hyperglycemia.
Precautions: Check the blood glucose level prior to administration. A solution of 50 percent dextrose is hypertonic and causes severe tissue necrosis if infiltration occurs.
Side effects: Localized irritation of the vein.
Interactions: There are no significant interactions in emergency situations.
Dosage: 25 g slow IV push; may be repeated in 10 to 15 minutes if blood glucose level (BGL) remains below 70 mL/dL. Pediatric dosage: 0.5 g/kg (500 mg kg) of a 25percent solution (25 g/100 mL) of dextrose; 10 percent (10 g/100 mL) for neonates.
Route: Slow IV push through at least an 18-gauge IV catheter in a large vein. Monitor the IV site for infiltration during administration.
How supplied: Prefilled syringe containing 25 grams of dextrose in 50 mL.
Activated Charcoal
Class: Adsorbent.
Description: Finely powdered charcoal activated with oxygen, commonly diluted in water for oral administration.
Mechanism of action: Binds with ingested toxins in the GI tract to prevent adsorption.
Indications: Oral ingestion of toxins.
Contraindications: Decreased level of responsiveness or increased risk of aspiration; or ingestion of corrosives, caustics, or petroleum distillates.
Precautions: Activated charcoal inactivates other oral medications.
Side effects: Black, tarry stools, and constipation.
Interactions: None.
Dosage: 1 g/kg orally (adults and pediatric patients).
Route: Oral.
How supplied: Premixed slurry of 50 grams/250 mL.
Acetaminophen
Class: Analgesic, antipyretic (fever reducer).
Description: Nonprescription medication used for the relief of mild to moderate pain and as a fever reducer.
Mechanism of action: The mechanism of action is not completely understood, but acetaminophen increases the pain threshold by blocking prostaglandin synthesis and inhibits the effect of pyrogens in the central nervous system.
Indications: Mild to moderate pain and fever.
Contraindications: Hypersensitivity.
Precautions: Acetaminophen is hepatotoxic in high doses and should be used with caution in patients who have known liver disease.
Side effects: Acetaminophen is generally well tolerated and there are no significant side effects in therapeutic doses. In large doses, the medication can be hepatotoxic.
Interactions: Alcohol increases liver toxicity.
Dosage: Adults 650 to 1,000 mg every four to six hours, 4-gram maximum per 24 hours; pediatric dosage, 10 to 15 mg/kg every four to six hours, 40 mg/kg maximum per 24 hours.
Route: Oral.
How supplied: Capsules, tablets, chewable tablets, suspension, elixir, and suppositories (for rectal administration).
Iburpofen
Class: NSAID (analgesic and antipyretic).
Description: Nonprescription medication used for the relief of mild to moderate pain and to reduce fever.
Mechanism of action: Inhibits inflammatory response by blocking formation of cyclo-oxygenase (COX-2), a chemical mediator of inflammatory chemicals such as prostaglandins.
Indications: Mild to moderate pain and fever.
Contraindications: Known allergy to ibuprofen or other NSAIDs.
Precautions: High-dose ibuprofen is known to cause significant gastrointestinal irritation and increases the risk of gastrointestinal bleeding.
Side effects: Gastric irritation.
Interactions: Do not give with aspirin or other NSAIDs.
Dosage: 200 to 400 mg every six to eight hours; pediatric dosage, 5 to 10 mg/kg every six to eight hours.
Route: Oral.
How supplied: Coated tablets, chewable tablets, capsules, suspension, and elixir.
Nerve Agent Antidote Kits
prefilled injectors of atropine (2 mg) and pralidoxime chloride (600 mg). The medications are antidotes for organophosphate nerve agents, such as tabun, sarin, and VX. They reduce parasympathetic nervous system stimulation by blocking the production and uptake of acetylcholine. The kits are not intended for the public but rather for the EMS crew on the ambulance if they are exposed to a suspected nerve agent. You can use the auto-injectors to inject the medication subcutaneously in either the gluteus or the vastus lateralis muscles.
Which one of the following medications is indicated for the treatment of chest pain associated with acute coronary syndrome?
50 percent dextrose
Naloxone
Nitroglycerin
Epinephrine
NItroglycerin
Which one of the following is a contraindication to administering nitroglycerin?
Chest pain
Systolic blood pressure less than 90 mmHg
Hyperglycemia
SpO2 below 95 percent
Systolic blood pressure less than 90 mmHg
Which one of the following IV fluids is the best choice for a patient with a history of heart failure?
Normal saline
Lactated Ringer’s solution
2 percent sodium chloride
5 percent dextrose in water
5 percent dextrose in water
Which one of the following is an analgesic?
Naloxone
Oxygen
Glucagon
Nitrous oxide
NItrous Oxide
Which one of the following medications can be administered by Advanced EMTs in the treatment of wheezing due to asthma?
Albuterol
Epinephrine
Aspirin
Nitrous oxide
Albuterol
Which one of the following IV fluids is recommended for patients with metabolic acidosis?
Lactated Ringer’s solution
Normal saline
5 percent dextrose in water
0.45 percent sodium chloride
Lactated Ringer’s solution
You are caring for a 40-year-old diabetic patient who is unresponsive and severely hypoglycemic (BGL = 20 mg/dL). You are unable to obtain an IV. Which one of the following should you administer?
50 percent dextrose, IM
2 mg naloxone, IM
0.5 mg epinephrine, 1:1,000 IM
1 mg glucagon IM
1 mg glucagon IM
