Pharmacology/MACC/Narcotics

Question 1

MACC procedure

Answer 1

Know it, Pg 1

Question 2

EMT-B Medications

Answer 2

Duotone (2PAM/Atropine), Aspirin, Albuterol, Glucose, Nitroglycerin, O², Diphenhydramine (Benadryl), Epi 1:1000, Glucagon, Oral Glucose, Narcan, Acetaminophen (Tylenol)

Question 3

When to give each medication:

Answer 3

Duotone: WMD Verve Agents
Aspirin: (A) ACS or CP
Albuterol: (A) Allergic Reaction/Anaphylaxis, Dyspnea/Resp. distress; (Ped.) Allergic Reaction/Anaphylaxis, Dyspnea/Resp. distress, Croup
Benadryl: (A/Ped.) Allergic Reaction/Anaphylaxis
Epinephrine 1:1000: (A/Ped.) Allergic Reaction/Anaphylaxis
Glucagon: (A) Hypo/hyperglycemia, hypothermia (for low BGA), violent pt.; (Ped.) Hypo/hyperglycemia
Oral Glucose: (A) Hypo/hyperglycemia, violent pt.
Narcan: (A) AMS/CVA, overdose/poisoning: (Ped.) AMS, OD/ poisoning
Nitroglycerin: (A) ACS/CP
Zofran: (A) ACS/CP, Abd./Genitalia. EMER, heat illness/heat storke, hypertensive EMER, nausea/vomiting, pain management, pre-eclampsia, weakness; (Ped.) Abd. pain, AMS, nausea/vomiting, pain management; (Trauma) Abd. trauma, Amputations, burns, chest trauma, crush injury, head/spinal cord injury, trauma during pregnancy

Question 4

Duodote

Answer 4

Indication: Expose to nerve agent with mod.-s. symptoms
Contra.: none in EMER
Dose: (A) mod.: 1 Duodote IM; s.: 3 Duodote IM in rapid succession; (Ped.) (>20kg mod.-s.) 1 Duodote IM
Additional dose: N/A
Side Effects: pain at injection site, blurred/double vision, tachycardia, nausea, vomiting, resp./cardiac arrest, increased effects of Atropine

Question 5

Aspirin

Answer 5

Indication: CP or discomfort suggestive of MI/cardiac is chemical
Contra.: hypersensitivity/allergy, active GI ulcers, already taken prearrival (via dispatch info.)
Dose: (A) 324 mg (chewed and swallowed); (Ped.) Not given
Additional doses: none
Side Effects: gastritis, nausea, vomiting, heartburn, GL bleeding, wheezing

Question 6

Albuterol

Answer 6

Indication: wheezing, diminished breath sounds from acute bronchospasm (asthma/COPD), bronchospams from chronic bronchitis, emphysema, allergic reaction or toxin inhalation
Contra.: hypersensitivity/allergy
Dose: 2.5 mg SVN (7.5 mg in-line neb.)
Additional dose: as pt. needs
Side Effects: palpitations, anxiety, distress, headache, nervousness, tremor, HTN arrhythmia, CP, nausea, vomiting

Question 7

Oral Glucose

Answer 7

Indication: hypoglycemia
Contra.: allergy, pt. not awake or uncapable of swallowing, hyperglycemia
Dose: 15 g tube (PO)
Additional dose: N/A
Side Effects: none

Question 8

Nitroglycerin

Answer 8

Indications: CP indicative of acute coronary syndrome
Contra.: allergy, SBP < 100 mm Hg, if pt. has taken EDF meds within the last 48 hrs
Dose: (A) 0.4 mg Tab SL; (Ped.) not given
Additional dose: every 3-5 min/up to 3 doses
Side Effects: headache, dizziness, weakness, tachycardia, and hypotension

Question 9

Benadryl

Answer 9

Indication: Anaphylaxis/allergic reaction
Contra.: allergy
Dose: (A) 25 mg IM (mild), 50 mg IM (severe); (Ped.) 1 mg/kg IM up to 25 mg
Additional dose: none
Side Effects: hypotension, headache, palpitations, tachycardia, sedation, drowsiness, disturbed coordination

Question 10

Epinephrine 1:1000

Answer 10

Indication: severe anaphylaxis and severe bronchospasms
Contra.: N/A
Dose: (A) 0.3 mg IM; (Ped.) 0.15 mg IM
Additional dose: none
Side Effects: tachycardia, hypertension, (less common: palpitations, anxiety, tremors, headache, dizziness, nausea, vomiting)

Question 11

Glucagon

Answer 11

Indication: hypoglycemia
Contra.: allergy
Dose: (A) 1mg IM;(Ped.) 0.1 mg/kg IM up to 1 mg
Additional dose: N/A
Side Effects: hypotension, dizziness, headache, nausea, vomiting

Question 12

Narcan

Answer 12

Indication: complete/partial reverse of CNS depression associated with respiratory depression caused by narcotics and synthetic narcotic analgesics
Contra.: allergy
Dose: (A) 2 mg IM/IN; (Ped.) 0.1 mg/kg IM/IN up to 2mg
Additional Dose: rare, but as pt. needs
Side Effects: flushing, nausea, vomiting, can induce rapid withdrawals in pt. dependent on narcotics

Question 13

Acetaminophen (Tylenol)

Answer 13

Indications: pain and fever management
Contra.: active/severe liver disease, severe liver impairment, allergy or hypersensitivity, taken prior in the last 4 hrs.
Dose: (A) 20 mL PO; (Ped.) Chart on the bottle/protocols
Additional dose: N/A
Side Effects: skin rash, kidney toxicity, liver failure

Question 14

Zofran

Answer 14

Indication: nausea, vomiting
Contra.: allergy, child < 1 year old
Dose: (A) 4 mg IM/IN; (Ped.) EMT-B not allowed
Additional Dose: none
Side Effects: headache