2nd Four Drug Cards - Combined

generic name - oral glucose

oral glucose

trade name - oral glucose

Glutose, Insta-glucose

drug classification - oral glucose

hyperglycemic

supply - oral glucose

gel in toothpaste-like tube; tablets (NOT for EMS use)

mechanism of action - oral glucose

increases amount of circulating blood sugar, reverses signs/symptoms of hypoglycemia, including decreased LOC

indications - oral glucose

signs/symptoms of hypoglycemia: altered level of consciousness, BG level reading less than 60 mg/dL

contraindications - oral glucose

patients who cannot protect their own airway (risk of aspiration) - must be alert enough to swallow, patients with NO gag reflex, head trauma

side effects - oral glucose

airway compromise, nausea/vomiting

dosage - oral glucose

one complete tube (15 grams) if possible + 2nd dose ONLY IF blood sugar remains below 60 mg/dL - administered via standing order if indications are met

route of administration - oral glucose

orally, apply gel between the cheek and gums

special considerations - oral glucose

monitor airway closely if patient is at risk of aspiration, patient may become combative or confused upon improved level of consciousness, oral glucose has a short lifetime within the body → patient must eat something to maintain blood sugar levels

oral glucose may be administered in the local EMS systems if patients have/are _____ before contact with medical control

blood sugar levels below 60 mg/dL, are alert to at least verbal stimuli, able to sit upright, and has good airway control / intact gag reflex

generic AND trade name - glucagon

Glucagon

drug classification - glucagon

amino acid peptide hormone

supply - glucagon

1 mg and 1 unit vial diluent

mechanism of action - glucagon

promotes conversion of glycogen to glucose in the liver, and raises blood glucose levels

indication - glucagon

hypoglycemia, if unable to initiate an IV

contraindication - glucagon

patients with pheocromocytosis (tumor of adrenal gland - glucagon causes excess release of epi-/norepinephrine potentially leading to a hypertensive crisis)

side effects - glucagon

hypotension, nausea/vomiting, hypokalemia, bronchospasm, respiratory distress

adult dosage - glucagon

1 mg IM injection (mix 1 mg with 1 mL diluent)

pediatric dosage - glucagon

1 mg IM injection

special considerations - glucagon

monitor blood glucose concentrations before/after administration, once patient is awake, give oral glucose to prevent secondary hypoglycemia

why must glucagon be diluted prior to administration? And what must NOT be done to the mixed solution?

glucagon comes in powdered form, DO NOT shake the mixed solution, instead roll it gently prior to administration

generic name - nitroglycerine

Nitroglycerine

trade name - nitroglycerine

Nitrostat, Nitrospray, Nitro-Bid

drug classification - nitroglycerine

vasodilator, anti-anginal (angina = chest pain)

supply - nitroglycerine

0.4 mg sublingual tablets OR metered dose spray ; 2% in 1g packet - ointment

mechanism of action - nitroglycerin

dilates arterial and venous vasculature, decreases amount of pressure the heart has to pump against, and increases blood flow to the myocardium

indications - nitroglycerin

ischemic chest pain (angina/MI), cardiogenic pulmonary edema + systolic BP over 100 mmHg

contraindications - nitroglycerin

ED drug use within 24-48 hours, hypotension, severe bradycardia OR tachycardia, hypovolemia, head trauma, cerebral hemorrhage

side effects - nitroglycerine

orthostatic hypotension, reflex tachycardia, palpitations, headache, dizziness, blurred vision, weakness, sublingual burning, dry mouth, nausea/vomiting

adult dosage - nitroglycerin (NOT COMMON FOR CHILDREN)

1 metered dose sublingual spray OR tablet at 0.4 mg every 3-5 minute intervals, may repeat, for a total of 3 doses

when is it indicated to give up to 3 doses for nitroglycerin

when chest pain is unresolved, and systolic BP remains above 100 mmHg

what does nitroglycerin require before administration per local protocol

medical control order, unless patient is older than 30 yoa and is having chest pain consistent with an MI

special considerations - nitroglycerine

established IV access is strongly recommended prior to administration, uses with acute inferior MI → may cause hypotension and bradycardia, monitor vital signs before, during, and after administration

route(s) - nitroglycerin

orally - sublingual (spray and tablets)

generic name - epinephrine

Epinephrine

trade name - epinephrine

Adrenaline

drug classification - epinephrine

natural catecholamine sympathomimetic

supply - epinephrine

1 mg / 1 mL (1:1000 solution) ampule ; 0.3 mg Epi-Pen auto injector

mechanism of action - epinephrine

vasoconstriction, increases heart rate, bronchodilation

indications - epinephrine

anaphylactic shock, severe bronchospasm in status asthmaticus after failed response to albuterol/atrovent treatment

contraindications - epinephrine

tachydysrhythmias, hypertension, ventricular irritability, cardiovascular disease, pulmonary edema*

side effects - epinephrine

tachydysrhythmias, angina (chest pain) or MI, palpitations, hypertension, anxiety/nervousness, tremor, headache, pupil dilation, nausea/vomiting

adult dosage - epinephrine

0.3 mg IM injection - via medical control order

pediatric dosage - epinephrine - anaphylaxis

0.01 mg/kg (1:1000) → 0.3 mg (max) IM injection - every 20 minutes

pediatric dosage - epinephrine - respiratory distress/failure

0.01 mg/kg → 0.3 mg (max) sub cutaneous injection - every 20 minutes

special considerations - epinephrine

monitor VS and cardiac monitor frequently - watch for arrhythmias if given for anaphylaxis

special consideration should be given to administering epinephrine if the patient is _____

over 40 yoa, has irregular heart rate, has a heart rate above 150 BPM, or has a history of heart disease or hypertension