Pharmacology Manual Flashcards
1
Q
Generic Name for Tylenol
A
Acetaminophen
2
Q
AHS Protocols for Tylenol
A
Adult: Pain management, anti-pyretic therapy (greater than 38 degrees), headache
Pediatrics: pain management, anti-pyretic therapy (>38*)
3
Q
Classifications of Tylenol
A
Non-opioid analgesic; antipyretic
4
Q
Actions of Tylenol
A
- Inhibits the synthesis of prostaglandins that may serve as mediators of pain and fever; does not have any significant anti-inflammatory properties
- Inhibits prostaglandin synthesis in the CNS by blocking pain impulse generation
- Acts on the hypothalamic heat regulating centre to produce peripheral vasodilation resulting in
increased blood flow through the skin, sweating, and heat loss.
5
Q
Indications for Tylenol
A
- Treatment of pain
- Reduction of fever
6
Q
Contraindications for Tylenol
A
- Hypersensitivity to alcohol, aspartame, saccharin, sugar, or FDC yellow dye # 5 (food colouring)
- Active liver disease/hepatic impairment
7
Q
Dosage/Administration for Tylenol
A
Adult: 975 mg PO, do not repeat
Child: 15mg/kg PO, max 975 mg
8
Q
Side Effects of Tylenol
A
Renal failure with high doses/chronic use
9
Q
Pharmacokinetics of Tylenol
A
Onset: 15-30 minutes
Duration: 4-6 hours
10
Q
EMS Considerations for Tylenol
A
- Do not administer if the patient has taken the maximum dose of 975 mg within 4 hours
- If the patient has received less than 975 mg within 4 hours, administer remaining medication to
obtain the maximum dose of 975 mg or closest total amount to 975 mg. - Ensure to document patient’s temperature prior to administration
11
Q
Toxicology of Tylenol
A
Acetaminophen is commonly seen in cases of overdose and may result in severe hepatic damage.
Damage can be exacerbated by alcohol ingestion
A latent period of 24 – 36 hours exists between ingestion and the onset of symptoms of hepatic injury.
Treatment should be initiated as soon as possible and should include administration of activated charcoal,
and acetylcysteine (Mucomyst) which is effective in preventing acetaminophen induced hepatotoxicity
Toxic levels of acetaminophen: Pediatric: ≥ 150 mg/kg, Adult: ≥ 150 mg/kg or a total dose of 7.5grams
12
Q
Generic Name of Aspirin
A
Acetylsalicylic Acid (ASA)
13
Q
Other Names for ASA
A
Aspirin or Bufferin
14
Q
AHS Protocol for ASA
A
Acute Coronary Syndrome (suspected)
15
Q
Classifications of ASA
A
Anti-platelet; analgesic; anti-pyretic, anti-inflammatory (NSAID)
*Not a blood thinner
16
Q
Actions of ASA
A
- Blocks the formation of thromboxane A2, which is responsible for platelets aggregating and
arteries constricting - Produces analgesia and has anti-inflammatory, and antipyretic effects by inhibiting the
production of prostaglandins
17
Q
Indications for ASA
A
Anti-platelet therapy in Acute Coronary Syndrome (ACS)
18
Q
Contraindications for ASA
A
- Hypersensitivity to salicylates/NSAIDS
- Unconscious/Unable to follow commands
- Patients with active ulcer disease (active GI hemorrhage)
- Bleeding disorders
- Pregnancy (especially third trimester)
- Children under 15 years old
- ASA induced Asthma (relative contraindication- which means that if the patient has had a
bronchospasm reaction prior with the use of ASA)
19
Q
Dosage/Administration for ASA
A
Adult: 160 mg (162 mg) PO chewed, max dose in 24 hours
Child: not advised
19
Q
Side Effects of ASA
A
- GI Irritation
- Nausea/Vomiting
- Tinnitus
- Increased risk of bleeding
19
Q
Pharmacokinetics of ASA
A
Onset: 1-2 hours
Duration: 4-5 hours
20
Q
EMS Considerations for ASA
A
- If confirmed that patient took ASA properly by dispatch instructions or by other first responder, withhold EMS dose
- ASA must still be administered even if patient has taken their daily dose or if they are currently taking blood thinners (Plavix or Warfarin)
- Patients receiving anticoagulant therapy (ie: Warfarin); ASA may potentiate the effect
- Diabetics taking ASA and oral hypoglycemic or insulin should be closely monitored for hypoglycemia
- Reye’s Syndrome is an acute, often fatal disease of childhood, characterized by acute edema of the brain, hypoglycemia, fatty infiltration, and liver dysfunction (this is why this medication is not recommended in children under the age of 15)
21
Q
AHS Protocol for Dextrose in Water
A
Adult: Head injury, hypoglycemia, stroke
Pediatric: Hypoglycemia (D10W and D25W), head injury (D25W)
22
Q
Classification of Dextrose in Water
A
Caloric Agent
23
Actions of Dextrose in Water
1. Increases blood sugar levels to normal cases in hypoglycemia
2. Hypertonic solution producing a transient movement of water from interstitial spaces into the
venous system (osmotic diuretic)
24
Indications for Dextrose in Water
1. Severe, symptomatic hypoglycemia from any cause
2. Head injury with symptomatic hypoglycemia (half the dose)
3. Stroke with symptomatic hypoglycemia (half the dose)
25
Contraindications for Dextrose in Water
1. Allergy to corn or corn products
2. Hyperglycemia
3. Hypersensitivity to dextrose solution
4. Relative Contraindication - Intracranial hemorrhage (half the dose)
26
Adult Dosage for Dextrose in Water (symptomatic hypoglycemia)
25 g D50W SIVP/IO q 5 min prn, titrate to BGL >/= 4.0 mmol/Lor patient improvement to max 50g
27
Adult Dosage for Dextrose in Water (suspected stroke)
12.5 g D50W SIVP/IO q 5 min prn, titrate to BGL = 3.0 mmol/L or patient improvement to max 50 g
28
Adult Dosage for Dextrose in Water (suspected head injury)
12.5 g D50W SIVP/IO q 5 min prn, titrate to BGL = 4 mmol/L or patient improvement max 50 g
29
Child Dosage for Dextrose in Water
(Less than 10kg) 0.5g/kg D10W SIVP/IO q 5 min prn, titrate to BGL >/= 4 mmol/L or patient improvement
(More than 10KG and less than 40kg) 0.5g/kg D25W SIVP/IO to a single max dose of 12.5g q 5 min,
titrate to BGL >= 4.0mmol/L or patient improvement
(More than/equal to 40kg) 12.5g D50W SIVP/IO q 5 min prn, single max dose, titrate to BGL >= 4.0mmol/L or patient improvement
30
How to make D10W
To create D10W, remove 40 ml from the D50W pre-load and replace with 40 ml of normal saline (for a
new concentration of 5 g/50 ml = 100 mg/mL)
7
(0.5g x kg) x 50 mL/5 g
Check your math: 0.5g/kg = 5mL/kg
31
How to Create D25W
To create D25W, remove 25 mL from the D50W pre-load and replace with 25 mL normal saline (for a
new concentration of 12.5 g/50 mL = 250 mg/mL)
(0.5g x kg) x 50 mL/12.5g
Check your math: 0.5g/kg = 2 mL/kg
32
Side Effects of Dextrose in Water
1. Rebound hyperglycemia
2. May aggravate hypertension and CHF
3. May cause neurological symptoms in the alcoholic patient
4. Wernicke’s encephalopathy/Korsakoffs Syndrome
33
Pharmacokinetics of Dextrose in Water
Onset: <1 minute
Duration: Varies
34
EMS Considerations for Dextrose in Water
1. Tissue necrosis if infiltration occurs, to avoid:
a. Give ½ the total volume and check IV patency before giving the rest
2. Utilize a large bore catheter in a large vein
3. D50W has a short duration of action, therefore follow drug administration with an oral
complex carbohydrate (ie: toast, crackers, pasta, sandwich)
4. May precipitate severe neurological symptoms in alcoholics; give thiamine prior to D50W (ACP
only)
**Severe thiamine deficiency can reduce glucose utilization by half and may precipitate:
1. Wernicke’s Encephalopathy: is an acute and reversible disorder as a result of lack of
thiamine associated with chronic alcoholism. It is characterized by poor voluntary
muscle coordination, eye muscle weakness and mental derangement
2. Korsakoff’s Syndrome: is a frequent result of severe deficiency of vitamin B1(thiamine)
resulting in significant memory loss and can be irreversible, Wernicke’s usually precedes
Korsakoff’s
5. Increased intracellular glucose levels in the setting of cerebral ischemia and hypoxia result in
increased intracellular acidosis due to anaerobic metabolism of glucose and subsequent
neuronal death.
35
Generic Name for Gravol
dimenhyDRINATE
36
Classification of Gravol
Antiemetic
37
Actions of Gravol
1. Depresses vestibular (equilibrium) function by inhibiting histamine H1 receptors
2. Sedative effects due to inhibition of histamine
38
Indications for Gravol
Nausea and Vomiting associated with motion sickness and vertigo
39
Contraindications of Gravol
1. Hypersensitivity to dimenhydrinate and diphenhydramine or propylene glycol (food additive)
2. Narrow angle glaucoma
3. Patients who have ingested large quantities of depressants including alcohol
40
Dosage/Administration for Gravol
Adult: 50mg SIVP/IM q 4 hours 25 mg SIVP/IM for patients over 65 years old prn q 15 mins max 50 mg
Child: N/A
41
Side Effects of Gravol
1. Drowsiness
2. Sedative effect
42
Pharmacokinetics for Gravol
Onset: IV immediate; IM 20-30 min
Duration of action: 3-6 hours
43
EMS Considerations for Gravol
1. Generally administered in 10 mL syringe with NS for IV administration; lessens vein irritation
2. Preferred antiemetic for nausea and vomiting associated with vertigo, motion sickness or narcotic side effect
44
Generic Name for Benadryl
diphenhydrAMINE
45
Classifications of Benadryl
Antihistamine
46
Actions of Benadryl
1. Competes with histamine for H1 receptor sites on effector cells. They thereby prevent, but do not reverse responses mediated by histamine alone
2. Does not inhibit histamine release
47
Indications for Benadryl
1. Allergic reactions
2. Adjunct to epinephrine (used after epinephrine deployed) in the management of anaphylaxis
3. Management of drug induced extrapyramidal symptoms
48
Contraindications for Benadryl
1. Hypersensitivity to either diphenhydramine or dimenhydrinate
2. Relative : avoid antihistamine in nursing mothers and/or in neonates (less than 28 days) unless life
threatening anaphylaxis/allergy
49
Adult Dose/Administration for Benadryl
(ELIXIR) 50mg PO - Do not repeat dose
Or
1mg/kg IM/SIVP/IO, single max dose 50mg - Do not repeat dose (use vastus lateralis for IM injection)
50
Pediatric Dose/Administration for Benadryl
(ELIXIR) 1mg/kg PO, single max dose of 50 mg – Do not repeat dose
Or
1mg/kg SIVP/IM/IO, single max dose 50mg - Do not repeat dose (use vastus lateralis for IM injection)
51
Side Effects of Benadryl
1. Dry mouth
2. Blurred vision
3. Hypotension
4. Thickening of bronchial secretions
5. bronchospasm
52
Pharmacokinetics of Benadryl
1. Onset of action:
a. PO - 15min
b. IV / IM 5 – 10 mins
2. Peak effects: 1-4 hours
53
EMS Considerations for Benadryl
Diphenhydramine is not recommended in neonates due to increased susceptibility to
anticholinergic effects however should be administered judiciously in setting of anaphylaxis
54
AHS Protocol for Benadryl
Adult: Allergic reaction, Anaphylaxis
Child: Allergic reaction, anaphylaxis
55
AHS Protocol for Gravol
Nausea and vomiting for adults ONLY
56
AHS Protocol for Epinephrine 1mg/ml
Adult and Child: Anaphylaxis
57
Classifications of Epinephrine 1mg/ml
Sympathomimetic; endogenous catecholamine
58
Actions of Epinephrine 1mg/ml
Allergy/Anaphylaxis Effects
1. Inhibits the release of histamine associated with allergic and anaphylactic reactions.
2. Alpha 1 agonist-
a. Peripheral vasoconstriction improving coronary and cerebral perfusion
3. Beta 1 agonist-
a. Positive chronotropic, inotropic, and dromotropic properties
b. Increases automaticity in the heart
4. Beta 2 agonist-
a. Bronchodilation - adrenergic receptors in the lungs to relax bronchial smooth muscle
59
Indications for Epinephrine 1mg/mL
Anaphylaxis
60
Contraindications for Epinephrine 1mg/mL
1. None in emergency situations
2. Hypersensitivity to epinephrine
61
Adult dose/administration of Epinephrine 1mg/mL
Adult: 0.3mg (1mg/mL) IM q 5 min prn, max 0.9 mg
62
Child dose/administration of Epinephrine 1mg/mL
(Less than 30kg) 0.15 mg IM q 5 min, total max 0.45 mg (AHS) (use vastus lateralis for
IM injection)
(More than/equal to 30kg) 0.3 mg IM q 5 min, total max 0.9 mg (AHS) (use vastus
lateralis for IM injection)
63
Side Effects of Epinephrine 1mg/mL
1. Palpitation
2. Tremors
3. Nervousness
4. Dizziness
5. Anxiety
6. Headache
7. Hypertension
8. Tachycardia
64
Pharmacokinetics of Epinephrine 1mg/mL
Onset of Action: 5-10min (IM)
Peak effects: 20 min
65
EMS Considerations for Epinephrine 1mg/mL
1. All patients receiving this medication MUST be cardiac monitored (12 Lead)
2. DO NOT administer 1mg/mL (1:1,000) solution by direct IV
3. Epinephrine in pregnancy can cause fetal hypoxia
4. Ensure the patient is in a recumbent position prior to administration of epinephrine
5. The concentration of 1 mg/mL was previously known at 1:1000
66
Generic Name for Advil
Ibuprofen
67
AHS Protocol for Advil
Adult: pain management, anti-pyretic therapy (>38*), headache
Child: pain management, anti-pyretic (>38*)
68
Classification of Advil
Non-steroidal Anti-Inflammatory Drug (NSAID); Non-Opioid analgesic
69
Actions of Advil
Inhibits prostaglandin synthesis, decreasing pain and inflammation through non-selective,
reversible inhibition of the cyclooxygenase enzymes COX-1 and COX-2
70
Indications for Advil
1. Treatment of mild pain associated with arthritis or pain in muscle, joints, or bones
2. Reduction of fever for adults or children over 6 months old
3. Dysmenorrhea or headaches
71
Contraindications of Advil
1. Hypersensitivity to NSAID’s/salicylates
2. Suspected intracranial bleeding
3. Sub-arachnoid hemorrhage (indicated by sudden onset/most severe ever headache)
4. Ibuprofen induced asthma (relative contraindication- which means that if the patient has had a bronchospasm reaction prior with the use of
5. History if significant renal disease, except renal colic
6. Diagnosis of crohns/ulcerative colitis/IBD
7. Patient currently taking oral anticoagulants (Apixaban, Dabigatran, Edoxaban, Rivaroxaban,
Warfarin)
8. Patient currently undergoing chemotherapy
9. Pregnancy
72
Dose/administration of Advil
Adult: 400 mg PO – Do not repeat dose
Child: 10 mg/kg PO to a maximum of 400 mg
73
Side Effects of Advil
1. Mild Hypertension
2. GI Irritation
3. Nausea/Vomiting
4. Constipation
5. Tinnitus
6. Increased risk of bleeding
74
Pharmacokinetics of Advil
Onset: 30 mins
Duration of action: 4 - 8 hrs
75
EMS Considerations for Advil
1. Do not administer if the patient has taken the maximum dose within 6 hours
2. If patient has received less than maximum dose of 400 mg within six hours, administer remaining
medication up to the maximum dose of 400 mg
3. Works well for pain associated with renal colic, dental or musculoskeletal
4. Cautious use with patients who have past medical Hx of: --
Recent trauma or suspected subarachnoid hemorrhage
Renal impairment
GI bleed
CHF
Elderly (over 65 y/o)
Chronic alcoholics (can cause bleeding)
76
Generic Name for Atrovent
Ipratropium Bromide
77
AHS Protocol for Atrovent
Adult and pediatric bronchospasms
78
Classification of Atrovent
Anticholinergic Bronchodilator
79
Actions of Atrovent
1. Derivative of atropine
2. Exerts anticholinergic action in the bronchioles thereby inhibiting bronchoconstriction
3. Blocks increased mucus secretions
80
Indications for Atrovent
1. Bronchospasm (used with salbutamol)
2. Anaphylaxis with salbutamol
81
Contraindications for Atrovent
1.Hypersensitivity
2.Hypersensitivity to atropine
82
Adult dose/administration for Atrovent
MDI with spacer 1 puff (20mcg/puff) q 30-60 sec prn, max 15 puffs (AHS)
OR
500mcg q 5 min via neb, max 1500mcg (AHS)
500mcg q 30 min for 3 doses, then q 2-4 hrs prn (Pharmacology for EMS providers)
83
Child dose/administration for Atrovent
Less than 20kg: 1 puff (20mcg/puff) MDI with spacer q 30-60 sec, total max 12 puffs (AHS)
More than/equal to 20kg: 1 puff (20mcg/puff) MDI with spacer q 30-60 sec total max 15 puffs (AHS
OR
Less than 20kg: 250mcg via neb prn, total max 750mcg (AHS)
More than/equal to 20 kg : 500mcg via neb prn,
max 1500mcg (AHS)
84
Side Effects of Atrovent
1. Dry mouth/throat
2. Headache
3. Cough
4. Palpitations
5. Tremors
6. Dizziness
85
Pharmacokinetic of Atrovent
1. Onset of action: 5-15 min
2. Peak: 1-2 hours
86
EMS Considerations for Atrovent
1. Invert canister numerous 3 times prior to administration
2. Depress canister once to prime prior to administration directed to the floor
3. Direct patient to inhale slowly while administering and hold their breath for 5-10 seconds if possible, and repeat 1-2 times to inhale any remaining medication in chamber before
removing from mouth.
4. MDI needs 30 seconds minimum recharge time between puffs
5. Alternate single puffs with salbutamol during recharge period
6. Nebulizer administration - Usually combined with salbutamol to create Combivent
7. Nebulizer administration - Use non-humidified O2 source at 6-8 L/minute
8. Enhanced by other anticholinergic drugs
87
AHS Protocol for Isotonic Solutions
Adult: Shock, sepsis, trauma, and burn management
Child: Shock, sepsis, trauma, hyperglycemia, and burn trauma
88
Actions of Isotonic Solutions
1. Have similar osmolar concentrations as plasma
2. Osmotic pressure is equal between intracellular and extracellular spaces, resulting in less shifting
of fluids between compartments
3. Used for expansion of extracellular fluid volume without altering the electrolyte concentration of the plasma
89
Indications for Isotonic Solutions
1. Used to run TKVO in patients with stable vitals but where hypotension and instability can occur
2. Fluid replacement in patients with blood or fluid loss
90
Examples of Isotonic Solutions
1. Normal Saline 0.9% (NS)
2. Ringers Lactate (RL)-contains potassium
3. NOT USED FOR FLUID RESUSCITATION →D5W (solution starts as isotonic then becomes hypotonic
when the dextrose is metabolized, it is used in EMS to facilitate some medication IV infusions in
the ACP scope)
91
EMS Considerations for Isotonic Solutions
1. Careful administration is necessary as can result in circulatory overload if not carefully monitored
2. Lung sounds and Blood Pressure must be evaluated every 250 mL in medical patients
3. Lung sounds and Blood Pressure must be evaluated every 500 mL in trauma patients
4. Lab values needed to use RL with caution in patients with hyperkalemia as this solution contains
potassium
92
Generic name for Narcan
Naloxone
93
AHS Protocol for Naloxone
Adult: Opiate Overdose
Child: Opiate overdose, Newborn/neonatal care and resuscitation
94
Classification of Naloxone
Narcotic Antagonist
95
Actions of Naloxone
1. Displaces previously administered opioid analgesics from all three opioid receptor sites and competitively inhibits their actions.
2. Naloxone is metabolized more quickly than most narcotics
96
Indications of Naloxone
1. Respiratory and neurologic depression induced by opiate intoxication unresponsive to oxygen
and hyperventilation
2. Decreased LOC or coma of unknown etiology believed to be induced by narcotics
97
Contraindications of Naloxone
None significant.
*Use with caution in the setting of mixed opioid / stimulant (methamphetamine, cocaine PMMA,
MDMA) overdose, since the narcotic may be exerting a mediating effect on sympathomimetic
symptoms
98
Adult dose/administration for Naloxone
(Preferred Route) 0.05 mg IV/IO q 2 minutes to total
max of 1 mg (AHS)
Or
0.8 mg IM q 5 min prn, total max 3.2mg
(AHS)
Or
2mg intranasal (1mg per nostril) q 3-5 minutes prn, total max 4mg
(AHS)
99
Child dose/administration for Naloxone
0.1mg/kg IV/IO, single max dose of 2mg q 2 minutes to total max of 10mg (AHS)
OR
0.1mg/kg IM, single max dose 2mg in divided doses (1/2 of required dose in each of 2 sites) q 2 min, max
10mg (AHS)
OR
0.1mg/kg IN, single max dose 2mg (divided evenly into each nostril), q 5 min prn, max 4mg (AHS
100
Side Effects of Naloxone
1. Narcotic withdrawal
2. Restlessness
3. Combative
4. Seizures
101
Pharmacokinetics of Naloxone
5. Onset: Within two minutes (IV/IO)
6. Duration of action: Dependent on route, dose and amount of pre-existing opioid present in patient
102
EMS Considerations for Naloxone
1. If sedation is reversed within the prehospital setting, be prepared for a potentially combative,
aggressive or seizing patient. If the patient’s vital signs are stable defer use until arrival within
the ED
2. May induce acute withdrawal symptoms in narcotic dependent patients (Seizures, N/V and other withdrawal symptoms)
3. Duration of Narcan (naloxone) is shorter in narcotic dependent patients
4. Consider fluid administration in hypotensive opioid OD’s - auscultate lungs every 250 mL of normal saline to ensure no fluid overload
5. Consider Opioid Triad: Life threatening hypertension / tachycardia may occur in patients
taking large doses of sympathomimetic drugs (methamphetamine, MDMA, cocaine etc.)
along with opioids - do not use as a diagnostic tool
103
AHS Protocol for Nitroglycerin
Adult Acute Coronary Syndrome (suspected)
104
Classification of Nitroglycerin
Antianginal, vasodilator
105
Actions of Nitroglycerin
1. Causes relaxation of vascular smooth muscle; dilation of both arterial and venous blood vessels,
decreasing both preload and afterload.
2. Myocardial perfusion is increased through coronary and collateral blood vessel dilation
106
Indication for Nitroglycerin
Suspected Acute Coronary Syndrome
107
Contraindications for Nitroglycerin
1. Systolic BP less than 100 mmHg
2. Right ventricular infarction – 12 lead message (see EMS considerations)
3. Patients taking phosphodiesterase inhibitors – MANDATORY OLMC
108
Dose/administration for Nitroglycerin
0.4 mg SL spray q 5 min prn or until systolic BP less than 100 mmHg (AHS)
0.8 mg/hr patch (AHS)
0.3mg SL tablet q 5 min prn or until systolic BP less than 100 mmHg
Child: N/A
109
Side Effects of Nitroglycerin
1. Headache
2. Hypotension
3. Dizziness/lightheadedness
4. Nausea/Vomiting
110
Pharmacokinetics of Nitroglycerin
1. Onset: 1-3 min (SL), Patch 40-60 min
2. Duration of Action: SL - 3-60 min, Patch – 8- 24 hours
111
Generic Name for Entonox
Nitrous Oxide
112
AHS Protocol for Nitrous Oxide
Adult: Fracture and dislocation management, pain management
Child: Fracture and dislocation management
113
Classification of Nitrous Oxide
Gaseous Analgesic
114
Actions of Nitrous Oxide
1. Rapidly reversible CNS depression and analgesia.
2. Inhaled anesthetics act on the lipid matrix of neuronal membranes. This changes the
membrane thickness, which in turn affects the gating properties of ion channels in neurons
115
Indications for Nitrous Oxide
1. Fracture/dislocation management
2. Active Labour
3. Burns
4. Kidney Stones
116
Contraindications for Nitrous Oxide
1. Inability to follow verbal instructions.
2. ALOC and /or Intoxication with drugs or alcohol
3. Head Injury
4. Respiratory compromise where 100% O2 is needed
5. Thoracic trauma with potential or actual pneumothorax (N2O collects in dead air spaces and may increase pneumothorax)
6. Abdominal pain and distension suspicious of bowel obstruction
7. Abdominal Trauma
8. Pregnant (not including active labour
117
Dose/administration for Nitrous Oxide
Self-administered prn via specialized demand valve and mask run at 15 lpm (AHS)
Note PSI before use and after for amount taken by patient
118
Side Effects of Nitrous Oxide
1. Dizziness/Lightheaded
2. Drowsiness
3. Headache
4. Nausea/Vomiting
119
Pharmacokinetics of Nitrous Oxide
1. Onset: within 1 minute
2. Duration of action: elimination half-life is approximately five minutes, effect of the gas is usually not noticeable within a few minutes of discontinuing use
120
EMS Considerations for Nitrous Oxide
1. Store and administer with cylinder horizontal.
2. Cannot be used if patient deemed to require greater than 50% oxygen.
3. Use in ventilated areas.
4. Invert canister three times prior to administration
5. Administer early in pain management as necessary, while initiating vascular access to provide
pain relief with narcotics etc.
6. Gases may separate at –6 degrees Celsius resulting in improper device operation
121
Generic Name for Ventolin
Salbutamol
122
AHS Protocols for Ventolin
Adult and child bronchospasm
123
Classification of Ventolin
Sympathomimetic bronchodilator
124
Actions of Ventolin
1. Selective Beta2 stimulation
2. Bronchodilation, some peripheral vasodilation, slight tachycardia
3. Beta2 selectively lost with high doses (Beta1 effects more common)
125
Indications for Ventolin
Bronchospasm due to asthma, COPD, anaphylaxis or associated with airway burn injury
126
Contraindications for Ventolin
1. Hypersensitivity
2. Uncorrected tachydysrhythmias
ie. ventricular tachycardia
127
Adult dose/administration for Ventolin
1 Puff MDI (100mcg/puff) with spacer q 30-60 secs prn, (AHS)
Or
5 mg nebulized continuously
128
Child dose/administration for Ventolin
Less than 20 kg: 1 puff (100mcg/puff) MDI with spacer q 30-60 secs, max 15 puffs (AHS)
More than/equal to 20 kg: 1 puff (100mcg/puff) MDI with spacer q 30-60 secs, max 30 puffs (AHS)
Or
Less than 20 kg: 2.5 mg nebulized, max 7.5mg (AHS)
More than/equal to 20 kg: 5 mg nebulized
repeat, max 15 mg (AHS)
129
Side Effects of Ventolin
1. Tremors
2. Palpitations
3. Headache
4. Tachycardia
5. Dizziness
6. Nervousness
130
Pharmacokinetics of Ventolin
1. Onset: Less than 15 mins
2. Duration of action: 2 – 6 hours
