Pharmacology

Nitroglycerin

• dilates blood vessels to increase coronary blood flow

• use for cardiac chest pain

• contraindications: hypotension, head injury, phosphodiesterase inhibitors within 24-48 hours, or SBP < 120 mmHg

• dose: 1 tab (0.4 mg), give up to 3 doses

• route: sublingual

Asprin

• anti-platelet

• use for chest pain

• contraindications: GI bleeding or head trauma, be cautious with patients on anticoagulation therapy

• dose: 81 mg x 4 = 324 mg

• route: oral - chew and swallow

Rescue Inhaler

• bronchodilation

• use for shortness of breath with bronchospasm

• contraindications: patient unable to follow commands

• dose: as directed on label

• route: inhaled

• must be patient’s own prescription

Nebulized Albuterol

• bronchodilation

• use for shortness of breath with bronchospasm

• contraindications: cardiac disease such as MI or angina, less than 6 months old, no diagnosis of RAD, or no Rx for rescue medication

• dose: for patients more than 2 years old: 2.5 mg, for patients 6 months-2 years old: 1.25 mg

• route: nebulized with 6-8 LPM oxygen using aerosol chamber

Atrovent (Ipratropium Bromide)

• bronchodilation - a more potent antimuscarinic and bronchial dilator of smooth muscle

• use for shortness of breath with bronchospasm

• contraindications: cardiac disease such as MI, angina, less than 6 months old, or no RX for rescue medication

• dose: for patients over 2 years old: 500 mcg, for patients 6 months - 2 years old: 250 mcg

• route: nebulize with 6-8 LPM oxygen using aerosol chamber

Naloxone (Narcan)

• competitive opioid antagonist

• use for respiratory depression

• contraindications: do not administer to a neonate (<1 month old)

• dose: 2-4 mg IN

• route: intranasal

Oxygen

• reverses hypoxia

• use for hypoxia, hypoxemia, or dyspnea

• contraindications: none

• dose: 1-6 LPM NC or 12-15 LPM NRBM

• route: inhalation

• titrate to maintain SpO3 greater than or equal to 94%

Epinephrine

• adrenergic stimulant causes bronchodilation

• use for anaphylactic reaction with sever respiratory distress

• contraindiciations: hypertension, hypothermia, or cardiac chest pain

• dose: for adult: 0.3 mg, for child: 0.15 mg

• route: IM

• contact medical control, standing order

Glucose (Oral)

• increases blood glucose

• use for altered mental status - hypoglycemia (blood glucose <70 mg/dl)

• contraindications: inability to manage own airway, vomiting

• dose: 1 tube

• route: buccal/oral, tongue depressor between cheek and jaw

• may administer second dose after 15 minutes if no change in MS, other sugar sources are appropriate

Glucagon (Glucagen)

• increases blood glucose levels by stimulating glycogenolysis

• altered mental status - hypoglycemia (blood glucose <70 mg/dl)

• contraindications: hyperglycemia

• dose: 1 mg

• route: IM, IN

• recheck blood glucose 15 minutes after administration of glucagon. may repeat glucagon 1 mg IM/IN if blood glucose does not increase

Acetaminophen

• alleviation of pain symptoms (NSAID)

• use for mild-to-moderate pain or fever

• contraindications: severe hepatic impairment or severe active hepatic disease

• dose: 650-1000 mg

• route: oral

• liquid or oral tablet/capsule

Ibuprofen

• NSAID, reduces hormones that cause inflammation and pain in body

• use for mild-to-moderate pain, inflammation, or fever

• contraindications: stomach ulcers, bleeding, liver, or kidney disease

• dose: 600 mg

• route: oral

• liquid or oral tablet/capsule