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Pharmacology > Pharmacology Manual > Flashcards

Pharmacology Manual Flashcards

1
Q

Generic Name for Tylenol

A

Acetaminophen

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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*)

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3
Q

Classifications of Tylenol

A

Non-opioid analgesic; antipyretic

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4
Q

Actions of Tylenol

A
  1. Inhibits the synthesis of prostaglandins that may serve as mediators of pain and fever; does not have any significant anti-inflammatory properties
  2. Inhibits prostaglandin synthesis in the CNS by blocking pain impulse generation
  3. Acts on the hypothalamic heat regulating centre to produce peripheral vasodilation resulting in
    increased blood flow through the skin, sweating, and heat loss.
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5
Q

Indications for Tylenol

A
  1. Treatment of pain
  2. Reduction of fever
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6
Q

Contraindications for Tylenol

A
  1. Hypersensitivity to alcohol, aspartame, saccharin, sugar, or FDC yellow dye # 5 (food colouring)
  2. Active liver disease/hepatic impairment
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7
Q

Dosage/Administration for Tylenol

A

Adult: 975 mg PO, do not repeat

Child: 15mg/kg PO, max 975 mg

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8
Q

Side Effects of Tylenol

A

Renal failure with high doses/chronic use

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9
Q

Pharmacokinetics of Tylenol

A

Onset: 15-30 minutes
Duration: 4-6 hours

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10
Q

EMS Considerations for Tylenol

A
  1. Do not administer if the patient has taken the maximum dose of 975 mg within 4 hours
  2. 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.
  3. Ensure to document patient’s temperature prior to administration
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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

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12
Q

Generic Name of Aspirin

A

Acetylsalicylic Acid (ASA)

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13
Q

Other Names for ASA

A

Aspirin or Bufferin

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14
Q

AHS Protocol for ASA

A

Acute Coronary Syndrome (suspected)

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15
Q

Classifications of ASA

A

Anti-platelet; analgesic; anti-pyretic, anti-inflammatory (NSAID)

*Not a blood thinner

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16
Q

Actions of ASA

A
  1. Blocks the formation of thromboxane A2, which is responsible for platelets aggregating and
    arteries constricting
  2. Produces analgesia and has anti-inflammatory, and antipyretic effects by inhibiting the
    production of prostaglandins
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17
Q

Indications for ASA

A

Anti-platelet therapy in Acute Coronary Syndrome (ACS)

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18
Q

Contraindications for ASA

A
  1. Hypersensitivity to salicylates/NSAIDS
  2. Unconscious/Unable to follow commands
  3. Patients with active ulcer disease (active GI hemorrhage)
  4. Bleeding disorders
  5. Pregnancy (especially third trimester)
  6. Children under 15 years old
  7. ASA induced Asthma (relative contraindication- which means that if the patient has had a
    bronchospasm reaction prior with the use of ASA)
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19
Q

Dosage/Administration for ASA

A

Adult: 160 mg (162 mg) PO chewed, max dose in 24 hours

Child: not advised

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19
Q

Side Effects of ASA

A
  1. GI Irritation
  2. Nausea/Vomiting
  3. Tinnitus
  4. Increased risk of bleeding
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19
Q

Pharmacokinetics of ASA

A

Onset: 1-2 hours
Duration: 4-5 hours

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20
Q

EMS Considerations for ASA

A
  1. If confirmed that patient took ASA properly by dispatch instructions or by other first responder, withhold EMS dose
  2. ASA must still be administered even if patient has taken their daily dose or if they are currently taking blood thinners (Plavix or Warfarin)
  3. Patients receiving anticoagulant therapy (ie: Warfarin); ASA may potentiate the effect
  4. Diabetics taking ASA and oral hypoglycemic or insulin should be closely monitored for hypoglycemia
  5. 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)
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21
Q

AHS Protocol for Dextrose in Water

A

Adult: Head injury, hypoglycemia, stroke

Pediatric: Hypoglycemia (D10W and D25W), head injury (D25W)

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22
Q

Classification of Dextrose in Water

A

Caloric Agent

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23
Q

Actions of Dextrose in Water

A
  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)
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24
Q

Indications for Dextrose in Water

A
  1. Severe, symptomatic hypoglycemia from any cause
  2. Head injury with symptomatic hypoglycemia (half the dose)
  3. Stroke with symptomatic hypoglycemia (half the dose)
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25
Q

Contraindications for Dextrose in Water

A
  1. Allergy to corn or corn products
  2. Hyperglycemia
  3. Hypersensitivity to dextrose solution
  4. Relative Contraindication - Intracranial hemorrhage (half the dose)
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26
Q

Adult Dosage for Dextrose in Water (symptomatic hypoglycemia)

A

25 g D50W SIVP/IO q 5 min prn, titrate to BGL >/= 4.0 mmol/Lor patient improvement to max 50g

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27
Q

Adult Dosage for Dextrose in Water (suspected stroke)

A

12.5 g D50W SIVP/IO q 5 min prn, titrate to BGL = 3.0 mmol/L or patient improvement to max 50 g

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28
Q

Adult Dosage for Dextrose in Water (suspected head injury)

A

12.5 g D50W SIVP/IO q 5 min prn, titrate to BGL = 4 mmol/L or patient improvement max 50 g

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29
Q

Child Dosage for Dextrose in Water

A

(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

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30
Q

How to make D10W

A

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

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31
Q

How to Create D25W

A

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

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32
Q

Side Effects of Dextrose in Water

A
  1. Rebound hyperglycemia
  2. May aggravate hypertension and CHF
  3. May cause neurological symptoms in the alcoholic patient
  4. Wernicke’s encephalopathy/Korsakoffs Syndrome
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33
Q

Pharmacokinetics of Dextrose in Water

A

Onset: <1 minute
Duration: Varies

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34
Q

EMS Considerations for Dextrose in Water

A
  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:
  5. 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
  6. 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
  7. 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.
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35
Q

Generic Name for Gravol

A

dimenhyDRINATE

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36
Q

Classification of Gravol

A

Antiemetic

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37
Q

Actions of Gravol

A
  1. Depresses vestibular (equilibrium) function by inhibiting histamine H1 receptors
  2. Sedative effects due to inhibition of histamine
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38
Q

Indications for Gravol

A

Nausea and Vomiting associated with motion sickness and vertigo

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39
Q

Contraindications of Gravol

A
  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
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40
Q

Dosage/Administration for Gravol

A

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

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41
Q

Side Effects of Gravol

A
  1. Drowsiness
  2. Sedative effect
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42
Q

Pharmacokinetics for Gravol

A

Onset: IV immediate; IM 20-30 min
Duration of action: 3-6 hours

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43
Q

EMS Considerations for Gravol

A
  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
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44
Q

Generic Name for Benadryl

A

diphenhydrAMINE

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45
Q

Classifications of Benadryl

A

Antihistamine

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46
Q

Actions of Benadryl

A
  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
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47
Q

Indications for Benadryl

A
  1. Allergic reactions
  2. Adjunct to epinephrine (used after epinephrine deployed) in the management of anaphylaxis
  3. Management of drug induced extrapyramidal symptoms
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48
Q

Contraindications for Benadryl

A
  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
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49
Q

Adult Dose/Administration for Benadryl

A

(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)

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50
Q

Pediatric Dose/Administration for Benadryl

A

(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)

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51
Q

Side Effects of Benadryl

A
  1. Dry mouth
  2. Blurred vision
  3. Hypotension
  4. Thickening of bronchial secretions
  5. bronchospasm
52
Q

Pharmacokinetics of Benadryl

A
  1. Onset of action:
    a. PO - 15min
    b. IV / IM 5 – 10 mins
  2. Peak effects: 1-4 hours
53
Q

EMS Considerations for Benadryl

A

Diphenhydramine is not recommended in neonates due to increased susceptibility to
anticholinergic effects however should be administered judiciously in setting of anaphylaxis

54
Q

AHS Protocol for Benadryl

A

Adult: Allergic reaction, Anaphylaxis

Child: Allergic reaction, anaphylaxis

55
Q

AHS Protocol for Gravol

A

Nausea and vomiting for adults ONLY

56
Q

AHS Protocol for Epinephrine 1mg/ml

A

Adult and Child: Anaphylaxis

57
Q

Classifications of Epinephrine 1mg/ml

A

Sympathomimetic; endogenous catecholamine

58
Q

Actions of Epinephrine 1mg/ml

A

Allergy/Anaphylaxis Effects
1. Inhibits the release of histamine associated with allergic and anaphylactic reactions.

  1. Alpha 1 agonist-
    a. Peripheral vasoconstriction improving coronary and cerebral perfusion
  2. Beta 1 agonist-
    a. Positive chronotropic, inotropic, and dromotropic properties
    b. Increases automaticity in the heart
  3. Beta 2 agonist-
    a. Bronchodilation - adrenergic receptors in the lungs to relax bronchial smooth muscle
59
Q

Indications for Epinephrine 1mg/mL

A

Anaphylaxis

60
Q

Contraindications for Epinephrine 1mg/mL

A
  1. None in emergency situations
  2. Hypersensitivity to epinephrine
61
Q

Adult dose/administration of Epinephrine 1mg/mL

A

Adult: 0.3mg (1mg/mL) IM q 5 min prn, max 0.9 mg

62
Q

Child dose/administration of Epinephrine 1mg/mL

A

(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
Q

Side Effects of Epinephrine 1mg/mL

A
  1. Palpitation
  2. Tremors
  3. Nervousness
  4. Dizziness
  5. Anxiety
  6. Headache
  7. Hypertension
  8. Tachycardia
64
Q

Pharmacokinetics of Epinephrine 1mg/mL

A

Onset of Action: 5-10min (IM)
Peak effects: 20 min

65
Q

EMS Considerations for Epinephrine 1mg/mL

A
  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
Q

Generic Name for Advil

A

Ibuprofen

67
Q

AHS Protocol for Advil

A

Adult: pain management, anti-pyretic therapy (>38*), headache

Child: pain management, anti-pyretic (>38*)

68
Q

Classification of Advil

A

Non-steroidal Anti-Inflammatory Drug (NSAID); Non-Opioid analgesic

69
Q

Actions of Advil

A

Inhibits prostaglandin synthesis, decreasing pain and inflammation through non-selective,
reversible inhibition of the cyclooxygenase enzymes COX-1 and COX-2

70
Q

Indications for Advil

A
  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
Q

Contraindications of Advil

A
  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
Q

Dose/administration of Advil

A

Adult: 400 mg PO – Do not repeat dose

Child: 10 mg/kg PO to a maximum of 400 mg

73
Q

Side Effects of Advil

A
  1. Mild Hypertension
  2. GI Irritation
  3. Nausea/Vomiting
  4. Constipation
  5. Tinnitus
  6. Increased risk of bleeding
74
Q

Pharmacokinetics of Advil

A

Onset: 30 mins
Duration of action: 4 - 8 hrs

75
Q

EMS Considerations for Advil

A
  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
Q

Generic Name for Atrovent

A

Ipratropium Bromide

77
Q

AHS Protocol for Atrovent

A

Adult and pediatric bronchospasms

78
Q

Classification of Atrovent

A

Anticholinergic Bronchodilator

79
Q

Actions of Atrovent

A
  1. Derivative of atropine
  2. Exerts anticholinergic action in the bronchioles thereby inhibiting bronchoconstriction
  3. Blocks increased mucus secretions
80
Q

Indications for Atrovent

A
  1. Bronchospasm (used with salbutamol)
  2. Anaphylaxis with salbutamol
81
Q

Contraindications for Atrovent

A

1.Hypersensitivity
2.Hypersensitivity to atropine

82
Q

Adult dose/administration for Atrovent

A

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
Q

Child dose/administration for Atrovent

A

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
Q

Side Effects of Atrovent

A
  1. Dry mouth/throat
  2. Headache
  3. Cough
  4. Palpitations
  5. Tremors
  6. Dizziness
85
Q

Pharmacokinetic of Atrovent

A
  1. Onset of action: 5-15 min
  2. Peak: 1-2 hours
86
Q

EMS Considerations for Atrovent

A
  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
Q

AHS Protocol for Isotonic Solutions

A

Adult: Shock, sepsis, trauma, and burn management

Child: Shock, sepsis, trauma, hyperglycemia, and burn trauma

88
Q

Actions of Isotonic Solutions

A
  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
Q

Indications for Isotonic Solutions

A
  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
Q

Examples of Isotonic Solutions

A
  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
Q

EMS Considerations for Isotonic Solutions

A
  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
Q

Generic name for Narcan

A

Naloxone

93
Q

AHS Protocol for Naloxone

A

Adult: Opiate Overdose

Child: Opiate overdose, Newborn/neonatal care and resuscitation

94
Q

Classification of Naloxone

A

Narcotic Antagonist

95
Q

Actions of Naloxone

A
  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
Q

Indications of Naloxone

A
  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
Q

Contraindications of Naloxone

A

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
Q

Adult dose/administration for Naloxone

A

(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
Q

Child dose/administration for Naloxone

A

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
Q

Side Effects of Naloxone

A
  1. Narcotic withdrawal
  2. Restlessness
  3. Combative
  4. Seizures
101
Q

Pharmacokinetics of Naloxone

A
  1. Onset: Within two minutes (IV/IO)
  2. Duration of action: Dependent on route, dose and amount of pre-existing opioid present in patient
102
Q

EMS Considerations for Naloxone

A
  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
Q

AHS Protocol for Nitroglycerin

A

Adult Acute Coronary Syndrome (suspected)

104
Q

Classification of Nitroglycerin

A

Antianginal, vasodilator

105
Q

Actions of Nitroglycerin

A
  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
Q

Indication for Nitroglycerin

A

Suspected Acute Coronary Syndrome

107
Q

Contraindications for Nitroglycerin

A
  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
Q

Dose/administration for Nitroglycerin

A

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
Q

Side Effects of Nitroglycerin

A
  1. Headache
  2. Hypotension
  3. Dizziness/lightheadedness
  4. Nausea/Vomiting
110
Q

Pharmacokinetics of Nitroglycerin

A
  1. Onset: 1-3 min (SL), Patch 40-60 min
  2. Duration of Action: SL - 3-60 min, Patch – 8- 24 hours
111
Q

Generic Name for Entonox

A

Nitrous Oxide

112
Q

AHS Protocol for Nitrous Oxide

A

Adult: Fracture and dislocation management, pain management

Child: Fracture and dislocation management

113
Q

Classification of Nitrous Oxide

A

Gaseous Analgesic

114
Q

Actions of Nitrous Oxide

A
  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
Q

Indications for Nitrous Oxide

A
  1. Fracture/dislocation management
  2. Active Labour
  3. Burns
  4. Kidney Stones
116
Q

Contraindications for Nitrous Oxide

A
  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
Q

Dose/administration for Nitrous Oxide

A

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
Q

Side Effects of Nitrous Oxide

A
  1. Dizziness/Lightheaded
  2. Drowsiness
  3. Headache
  4. Nausea/Vomiting
119
Q

Pharmacokinetics of Nitrous Oxide

A
  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
Q

EMS Considerations for Nitrous Oxide

A
  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
Q

Generic Name for Ventolin

A

Salbutamol

122
Q

AHS Protocols for Ventolin

A

Adult and child bronchospasm

123
Q

Classification of Ventolin

A

Sympathomimetic bronchodilator

124
Q

Actions of Ventolin

A
  1. Selective Beta2 stimulation
  2. Bronchodilation, some peripheral vasodilation, slight tachycardia
  3. Beta2 selectively lost with high doses (Beta1 effects more common)
125
Q

Indications for Ventolin

A

Bronchospasm due to asthma, COPD, anaphylaxis or associated with airway burn injury

126
Q

Contraindications for Ventolin

A
  1. Hypersensitivity
  2. Uncorrected tachydysrhythmias

ie. ventricular tachycardia

127
Q

Adult dose/administration for Ventolin

A

1 Puff MDI (100mcg/puff) with spacer q 30-60 secs prn, (AHS)
Or
5 mg nebulized continuously

128
Q

Child dose/administration for Ventolin

A

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
Q

Side Effects of Ventolin

A
  1. Tremors
  2. Palpitations
  3. Headache
  4. Tachycardia
  5. Dizziness
  6. Nervousness
130
Q

Pharmacokinetics of Ventolin

A
  1. Onset: Less than 15 mins
  2. Duration of action: 2 – 6 hours

Pharmacology (7 decks)

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