AEMT Pharmacology Quiz #2 (Aspirin, Nitro, Nitrous Oxide, Epi 1:1, Epi 1:10)

What is Aspirin’s Chemical Name?

Acetylsalicylic acid, ASA

What is the Class of Aspirin?

Salicylate, analgesic, anti-inflammatory, antipyretic, platelet aggregation inhibitor

What is the Mechanism of Action of Aspirin?
(How does Aspirin work in the body?)

Aspirin inhibits the production of cyclooxygenase, the physiological precursor to thromboxane A2. This inhibits platelet aggregation. It accomplishes this at normal doses, as well as pain and fever reduction. At much higher doses it also acts as an anti-inflammatory. Many of the ancillary mechanisms are still not completely understood.

What are the Indications of giving Aspirin?
(What would make you think a patient needs Aspirin?)

Acute coronary syndrome: non-traumatic chest pain. (and stroke under the National Standard Curriculum).

What are the Contraindications of Aspirin?
(Why you SHOULD NOT give this)

Hypersensitivity; not given to children or adolescents with suspected viral Illnesses as it can increase the risk of Reye's syndrome.

What are the Precautions of Aspirin?

Administer with caution in patients with asthma, stomach ulcers, liver disease, alcohol abuse, kidney disease or known clotting problems.

What is the Side Effects of Aspirin?

GI upset, GI bleeding with prolonged use, N/V, wheezing, acidosis in large quantities.

What is the Interactions of Aspirin?

Normal prehospital use has demonstrated no significant interactions.

What is the Dosage of Aspirin?

4, 81mg chewable tablets for a total dose of 324.

What Routes do you Administer Aspirin?

Chewable is preferred due to quicker rate of absorption. If chewable is not available, non-enteric-coated aspirin is preferred as enteric coatings delay absorption further.

Side Notes about Aspirin.

Many disease processes carry specific allergies. People who have been diagnosed with asthma have a higher incidence of Aspirin allergy.

What is Nitroglycerin’s Chemical name?

Nitroglycerin or glyceryl trinitrate.

What are Nitroglycerin’s trade names?

(Nitrostat, Nitrobid, NTG)

What Class is Nitroglycerin?

Nitrate, vasodilator

What is the Mechanism of Action of Nitroglycerin?
(How does Nitroglycerin work inside the body?)

Once it enters the body, nitroglycerin is broken down or "denitrated" to work with a number of different chemicals to produce the active metabolite nitric oxide. Nitric oxide is a naturally occurring substance within the body which is a powerful vasodilator with a short half-life. The mechanisms by which nitroglycerin are transformed into nitric oxide are still debated. Recent evidence indicates there may a proven mechanism of action soon.

What are the Indications of giving Nitro?
(What would make you think a patient needs Nitro?)

Congestive heart failure, or chest pain associated with acute coronary syndrome.

What are some Contraindications of Nitro?
(Reasons to NOT give a patient Nitro)

Hypotension, increased ICP, and use of phosphodiesterase type 5 (PDE-5) Inhibitors 24-36 hours. PDE-5 inhibitors are more commonly known as erectile dysfunction medications.

What are some Precautions of giving Nitro?

NTG will deteriorate rapidly when exposed to light or air. Closely monitor hemodynamics and document VS both before and after administering. National standard curriculum lists 90 mmHg as the cut off for administration. Refer to state protocols for actual administration in your area.

What are the Side Effects of Nitro?

Instant headache, weakness, dizziness, hypotension, Tachycardia, dry mouth, N/V. "Fresh" nitro tabs may cause a burning sensation under the tongue.

What are the Interactions of Nitro?

The effects of nitro will be increased when given alcohol, PDE-5's and beta blockers.

What is the Dosage of Nitro?

0.4 mg q 5 minutes while chest pain persists and the SBP remains at least 100 mmHg for acute coronary syndromes (90 mmHg according to National Standard Curriculum). 0.4 mg q 5 minutes while symptoms persist and the SBP is above 140 mmHg for congestive heart failure. IV MUST BE IN PLACE PRIOR TO ADMINISTRATION.

What are the delivery Routes of Nitro?

Sublingual only for spray and tablets.

Side Notes about Nitro

When using SL nitro spray, be sure to clean it after the call. If you put the Cap back on during the call, clean that too. Use gloves to administer the SL Tabs.

What is Nitrous Oxide’s Chemical name?

Nitrous Oxide

What are Nitrous Oxide’s trade names?

Nitronox

What Class is Nitrous Oxide?

Analgesic, Anesthetic

What is the Mechanism of Action of Nitrous Oxide?
(How does Nitrous Oxide work inside the body?)

Depressant with analgesic properties.

What are the Indications of giving Nitrous Oxide?
(What would make you think a patient needs Nitrous Oxide?)

Severe musculoskeletal pain, Chest pain associated with ACS not relieved by Nitro.

What are some Contraindications of Nitrous Oxide?
(Reasons to NOT give a patient Nitrous Oxide)

Decreased level of consciousness, inability to follow directions, TBI (Traumatic brain injury) COPD, suspected pneumothorax, abdominal pain, bowel obstructions, or any use of any opiates or ketamine.

What are some Precautions of giving Nitrous Oxide?

Use in a well ventilated area to prevent sedation of surrounding providers. Teratogenic – do NOT use with pregnant patients or around pregnant caregivers.

What are the Side Effects of Nitrous Oxide?

Dizziness, light-headedness, decreased mental status, hallucinations, N/V.

What are the Interactions of Nitrous Oxide?

Not to be used with other sedative-hypnotics, narcotics or alcohol.

What is the Dosage of Nitrous Oxide?

Self-Administered mixture of 50% Nitrous Oxide and 50% Oxygen.

What is the delivery Route of Nitrous Oxide?

Inhalation via demand valve mask.

Side Notes about Nitrous Oxide

Due to costs and safeguards associated with this medication, it is not currently being used by most AEMT services in NH. In Maine, Nitrous Oxide can only be used by Paramedics but isn’t widely used due to costs

What is Epinephrine’s Chemical name?

Epinephrine 1:1,000

What is Epinephrine’s trade name?

Adrenalin

What Class is Epi 1:1?

Sympathomimetic

What is the Mechanism of Action of Epi 1:1?
(How does Epi 1:1 work inside the body?)

Epinephrine is a naturally occurring catecholamine, which acts directly on the alpha- and beta-adrenergic receptors.

Its positive inotropic, chronotropic and dromotropic effects cause increased contractility, rate and conduction in the myocardial cells through its beta¹ effects.

Beta² effects result in bronchodilation, and alpha effects result in peripheral vasoconstriction.

Although epinephrine targets all 4 adrenergic receptors (A¹, A², B¹, B²) these alpha effects are the principle purpose for administering this medication during anaphylaxis to reverse systemic vasodilation.

What are the Indications of giving Epi 1:1?
(What would make you think a patient needs Epi 1:1)

Anaphylaxis NOTE: Know the signs of anaphylaxis. It is NOT only airway.

What are some Contraindications of Epi 1:1?
(Reasons to NOT give a patient Epi1:1)

There are no contraindications to the administration of epinephrine during an anaphylactic reaction.

What are some Precautions of giving Epi 1:1?

Epinephrine can be deactivated by exposure to sunlight and alkaline solutions. Administration with bicarbonate will cause a chalky precipitate to form.

What are the Side Effects of Epi 1:1?

Palpitations, tachycardia, anxiety, headache, dizziness and N/V.
Tissue necrosis at the injection site.

What are the Interactions of Epi 1:1?

None significant for this indication.

What is the Dosage of Epi 1:1?

Adult: 0.3mg.
Pediatric: 0.15mg.
25kg is the break point.
Weight based dosing for pediatrics is 0.01mg/kg (a popular registration question).

What are the delivery Route of Epi 1:1?

IM – Many states have moved away from the autoinjectors due to cost. Make sure you are up to date on your “Ready, Check, Inject” training in your state.

Side Notes about Epi 1:1

Do NOT use an autoinjector through clothing. Also avoid using the same injection site twice.

What is Epinephrine’s Chemical name?

Epinephrine 1:10,000

What is Epinephrine’s trade name?

Adrenaline

What Class is Epi 1:10?

Sympathomimetic

What is the Mechanism of Action of Epi 1:10?
(How does Epi 1:10 work inside the body?)

Epinephrine is a naturally occurring catecholamine, which acts directly on the alpha- and beta-adrenergic receptors.

Its positive inotropic, chronotropic and dromotropic effects cause increased contractility, rate and conduction in the myocardial cells through its beta¹ effects.

Beta² effects result in bronchodilation, and alpha effects result in peripheral vasoconstriction.

Although epinephrine targets all 4 adrenergic receptors (A¹, A², B¹, B²) these alpha effects are the principle purpose for administering this medication during cardiac arrest to shunt blood flow to the vital organs.

What are the Indications of giving Epi 1:10?
(What would make you think a patient needs Epi 1:10)

V-Fib, pulseless VT, asystole, PEA

What are some Contraindications of Epi 1:10?
(Reasons to NOT give a patient Epi1:10)

There are no contraindications to the administration of epinephrine during cardiac arrest per the NHA, National standard Curriculum and all state protocols. There is one form of Cardiac Arrest which Epi 1:10 IS contraindicated which is “Catecholaminergic Polymorphic Ventricular Tachycardia”.

What are some Precautions of giving Epi 1:10?

Epinephrine can be deactivated by exposure to sunlight and alkaline solutions. Administration with bicarbonate will cause a chalky precipitate to form.

What are the Side Effects of Epi 1:10?

There will be no side effects during the cardiac arrest. Resuscitated patients may experience Palpitations, tachycardia, anxiety, headache, dizziness and N/V.

What are the Interactions of Epi 1:10?

}None significant for this indication.

What is the Dosage of Epi 1:10?

1mg IV/IO q 3-5 minutes during cardiac arrest. No max dosage is listed. Continue until efforts are terminated, ROSC is achieved, or patient arrives at the hospital.

What are the delivery Routes of Epi 1:10?

IV/IO.

(NOTE: 1:10,000 is for IV/IO use. 1:1,000 is NOT.)

Side Notes about Epi 1:10

The AHA makes conflicting statements regarding the improved outcome based on the use of Epi 1:10,000 during cardiac arrest. Other sources (including NIH papers) question it’s use