Meds compiled flashcards for memorization

Generic Name Ventolin

Salbutamol (Canada), Albuterol sulfate (US)

Trade Name Salbutimol

Ventolin

Classification Salbutimol

Bronchodilator, beta2-selective adrenergic agonist (sympathomimetic)

Supplied SALB

2.5 mL nebule (1mg/mL), MDI 100 mcg/spray, Combivent (Ventolin 2.5 mg/Atrovent 500 mcg)

Salbutamol Actions

 Selectively stimulates beta2-adrenergic receptors of the lungs, uterus, and vascular smooth muscle.  Bronchodilation results from relaxation of the vascular smooth muscles, which relieves bronchospasm and reduces airway resistance.  Higher doses will drive serum potassium (K+) into the cells.

Indications Salbutimol

Bronchospasm due to asthma, chronic bronchitis, other chronic broncho-pulmonary disorders and anaphylaxis

Hyperkalemia

Dosage for Adults - Nebulizer-Bronchospasm SAL

2.5-5.0 mg NEB every 5 minutes as needed, no max dose.

Dosage for Adults - MDI SAL- Bronchospasm

MDI 1-2 puffs (100mcg/Puff) with spacer q 30 seconds to a maximum of 30 doses

<20kg Neb Bronchospasm SAL

2.5 mg NEB to a total max of 7.5 mg

>20kg NEB Bronchospasm SAL

5 mg NEB to a total max of 15 mg

<20kg MDI with spacer bronchospasm SAL

1 puff of 100mcg/Puff MDI to a total max dose of 15 puffs

>20kg MDI with spacer bronchospasm SAL

1 puff of 100 mcg/Puff MDI to a total max dose of 30 puffs

Hyperkalemia NEB Adult SAL

5 mg NEB continuous

Hyperkalemia NEB <20kg SAL

2.5 mg NEB continuous

Hyperkalemia NEB >20kg SAL

5 mg NEB continuous

Hyperkalemia Adult MDI with Spacer SAL

10 puffs of 100 mcg Puff MDI q 15 mins

Hyperkalemia MDI with Spacer <20kg SAL

5 puffs of 100 mcg/Puff MDI q 15 mins

Hyperkalemia MDI with Spacer >20kg SAL

10 puff of 100 mcg MDI q 15 mins

Salbutamol: IV continuous infusion - *this is used only for special circumstances (severe bronchospasms refractory to other treatments, ex: status asthmaticus)

For adults only over the age of 18 years old: 3 – 20 mcg/min (usual starting dose is 5 mcg/min) may increase by 5-10 mcg/min intervals every 15-30 minutes as needed. Add 5 mg of IV salbutamol to 500 ml NS or D5W for a concentration of (10 mcg/ml)

Contraindications SAL

Hypersensitivity to salbutamol.

Precautions SAL

 Congestive heart failure  Cardiovascular disease – Myocardial Infarction, Angina, cardiac dysrhythmias, hypertension, tachycardia associated with digitalis toxicity  Diabetes risk of drug induced hyperglycemia  Glaucoma  Hypokalemia – risk further reducing serum potassium levels and possible adverse cardiovascular events  Seizure disorders  Use during pregnancy/breastfeeding only if potential maternal benefit justifies potential fetal risk  Use with MOA inhibitors may cause hypertensive crisis  Concurrent use with other adrenergic agents will have ↑ adrenergic side effects  Cardiovascular effects are potentiated in patients receiving tricyclic antidepressants.  Risk of hypokalemia ↑ concurrent use of potassium-losing diuretics

Salbutamol Notes

 Administer continuously during rapid transport in patients who are in severe respiratory distress  When used at recommended doses, short-acting-beta-agonists (SABAs) are generally may cause adverse effects of cardiac stimulation and tremors are most likely with systemic therapy and higher-dose therapies.  Because beta2-adrenergic agonists and ipratropium bromide promote bronchodilation by different mechanisms, their beneficial effects are additive, hence combined use makes sense. For MDI use, alternate single puffs of salbutamol and ipratropium bromide during recharge periods.  Salbutamol is a tocolytic drug  Paradoxical bronchospasm may occur (usually with high doses or patient excessive use of MDI)  Assess lung sounds, LOC, pulse, resps, BP and ECG during administration of medication.

Paradoxical Bronchospasm SAL

May occur with high doses or excessive MDI use.

Administration Notes SAL

Wait 30 seconds between MDI puffs, assess lung sounds, vital signs during use.

Generic Name for penthrox

Methoxyflurane

Trade Name -ANE

Penthrox

Classification -ANE

Analgesic

Supplied -ANE

3ml bottle

Actions (Pharmacodynamics) -ANE

Is a volatile anesthetic gas. Penthrox is unique to its benefits of analgesia in the halogenated hydrocarbon group, it’s mechanism of action is unclear as an analgesia. It is believed Penthrox reduces the effects of the pain receptors in the brain and spinal cord making them less responsive to excitement and pain by interfering with the release and re-uptake of neurotransmitters at the post-synaptic terminals. It also activates GABA.

Indications- ANE

For short-term relief of moderate to severe acute pain associated with trauma or interventional medical procedures in conscious adults.

Dosage -ANE

Adults ONLY: 3 ml of Penthrox administered via self-administered vaporized inhaler.

Contraindications- ANE

 Hypersensitivity to the drug, methoxyflurane or other halogenated anesthetics.  Children < 18 years old  Altered level of consciousness  Head injury  Significant renal impairment  History of liver impairment  History or known genetic or family history of malignant hyperthermia  Hemodynamic instability (hypotension, signs of shock)  Respiratory impairment, distress, or depression  Other CNS depressants, opioids, sedatives, hypnotics, general anesthetics, phenothiazines, skeletal muscle relaxants, sedating antihistamines, or alcohol.

Precautions -ANE

Elderly patients (high potential for hypotension and bradycardia.)

Penthrox Notes

3 ml of Penthrox contains 99.9% methoxyflurane  See instructions on Moodle to work the Penthrox inhaler.

Oxygen (medical)

A colorless, odorless, tasteless gas essential to respiration.

Oxygen Actions

 Colorless, odorless, tasteless gas essential to respiration.  At sea level, oxygen makes up approximately 10% - 16% of venous blood and 17% - 21% of arterial blood.  Transported from the lungs to the body’s tissues attached to hemoglobin in the red blood cells.  Inhalation/administration will increase arterial oxygen tension (PaO2) and hemoglobin saturation.  Pulmonary vasodilator

Oxygen Indications

 Hypoxia/Hypoxemia (SPO2 <94%)  Hypoxia with STEMI (SPO2,90%)  Respiratory distress/failure  Cardiopulmonary failure  Shock  Trauma  Cardiac arrest / ROSC  Altered LOC

Nasal Cannula

1-6 L/min (24% - 44% O2 concentration.)

Simple & Pocket Mask:

@ 6 – 10 L/min (35% - 60% O2 concentration)

Partial/ Non-Rebreather (NRB):

@ 10 – 15 L/min (60%-100% O2 concentration)

Bag-Valve Mask (BVM):

@15 L/min (95% to 100% O2 concentration)

Venturi Masks:

@ 4 - 12 L/min (24% - 50% O2 concentration)

Contraindication for oxygen administration

Known paraquat poisoning.

Oxygen Precautions

 Respiratory: In some cases of COPD, oxygen administration may reduce the patient’s respiratory drive. Note: This is not a reason to withhold oxygen, but be prepared to assist ventilations.  Oxygen that is not humidified may dry out or be irritating to mucous membranes.  Insufficient flow rates delivered via 02 masks, 02 hoods and 02 tents may cause C02 retention.

Oxygen Notes

Nasal Cannula (NC) should be set to 15 LPM anytime that a patient requires hyperoxygenation/preoxygenation during BVM PPV; It is recommended to place NC on and to provide a constant flow of 15 LPM of oxygen during intubation attempts (apneic oxygenation). ©Portage College Paramedic Program Page 2  Administering unneeded oxygen to ACS/Stroke/ROSC patients can lead to vasoconstriction and ischemia follow the newest recommendations of ACLS and PALS.  Pulse oximetry may be inaccurate in low cardiac output states with vasoconstriction, or with exposure to carbon monoxide

Glucose (oral)

A monosaccharide used to treat hypoglycemia, supplied in 25 g tubes.

Oral Glucose Actions

monosaccharide that is given orally and is readily absorbed in the intestine.

Insta-glucose

The trade name for oral glucose, a form of glucose gel.

Indications for Oral Glucose

Hypoglycemia in alert patients who can follow commands and swallow.

Dosage for Adults/Pediatrics -GLUCO

25 g orally, may repeat in 5 minutes if necessary, up to a maximum of 50 g. (Administer the entire contents of tube (25g) slowly and intermittently while patient swallows).

Contraindications for Oral Glucose

Not for patients who are not alert, unable to follow commands, or lack a gag reflex.

Precautions for Administering Glucose

May cause nausea; patient may gag when administered.

Oral Glucose Notes

 Oral glucose is not absorbed sublingually or buccally, must be swallowed.  Glucose gel acts slowly, increasing less than 1 mmol/l over 20 minutes.  Other carbohydrates must be given to prevent relapse after hypoglycemia is corrected  The maximal clinical effect is 50 min

Onset of Action for Glucose Gel

Acts slowly, increasing blood glucose less than 1 mmol/l over 20 minutes.

Follow-up Treatment after Hypoglycemia

Other carbohydrates must be given to prevent relapse.

Maximal Clinical Effect Duration -GLUCO

The maximal effect of glucose lasts about 50 minutes.

Nitrous oxide

A gaseous analgesic used for pain relief, known by the trade name Entonox.

N2O Classification

gaseous analgesic

N2O Supplied

compressed gas cylinder (50% nitrous oxide with 50% oxygen)

Actions N2O

Potent analgesic, weak anesthetic at these percentages

CNS depressant with analgesic properties

Indications for nitrous oxide

Pain of musculoskeletal origin, particularly fractures, dislocations  Transcutaneous pacing  Burns  Suspected ischemic chest pain (BLS)  Pregnancy (only in active labor)

Contraindications for nitrous oxide

 Unable to follow commands – due to interpretive problem, drugs, alcohol  Altered LOC  Significant COPD  Any traumatic chest injury  Any suspicion of pneumothorax, obstructed bowel (abd pain with distension)  Decompression sickness (diving in last 48 hours)  Pregnancy – except in active labor

Dosage for nitrous oxide

Administered as self-administered until pain relief is reached or patient drops mask.

Notes Nitrous Oxide

 Use in well ventilated area  May cause nausea and vomiting  Ensure to invert tank three times prior to use  Do not use outside if below minus six degrees Celsius (-6 C).  Do not use if frost on the tank  Nitrous oxide is such a potent analgesic that inhaling 20% nitrous oxide can produce pain relief equivalent to that of morphine about 5 to 7 mg (very high analgesic property)

Nitroglycerin

Generic Name

Trade Names NITRO

Common commercial names for nitroglycerin include Nitrostat, Nitro-Bid, and Tridil.

Classification NITRO

nitrate, anti-anginal, and vasodilator.

Pharmacodynamics NITRO

 Antianginal: relaxes vascular smooth muscle of both venous and arterial beds, resulting in a net decrease in the myocardial oxygen consumption. It also dilates coronary vessels, leading to redistribution of blood flow to ischemic tissue and improves collateral circulation.  Vasodilating: dilates peripheral vessels, decreasing venous return to the heart (preload) useful in treating pulmonary edema and heart failure. Arterial vasodilation decreases afterload, thereby decreasing left ventricular work and aiding the failing heart.

Indications NITRO

Initial antianginal for suspected ischemic chest pain  For initial 24 – 48 hours in patient with AMI and CHF, large interior wall infarction, persistent or recurrent ischemia  Continued use (beyond 48 hours) for patients with recurrent angina or persistent pulmonary congestion  Pulmonary Edema

Dosage - Adult- SL NITRO

0.3 mg or 0.4 mg spray every 5 minutes, with a maximum of 3 doses.

Dosage- Adult IV NITRO

begin infusion at 5 mcg/min; titrate to effect; increase prn by 5 – 10 mcg/min q 5 min. Max dose of 200 mcg/min; Mix: 25 mg of nitroglycerin to a 250 ml NS or D5W (100 mcg/ml)

Dosage- Adult- Transdermal Patch NITRO

0.2 – 0.8 mg/hr. Topical nitrates are acceptable alternatives for antianginal therapy with hemodynamic stability in the absence of ongoing refractory ischemic symptoms.

Dosage PED NITRO

Infusion: 0.25 - 0.5 mcg/kg/min IV/IO increase by 0.5- 1 mcg/kg/min prn as tolerated q 15-20 mins to a max of 5 mcg/kg/min.

Contraindications NITRO

Hypersensitivity to nitrates

Right ventricular infarction (Sublingual Spray Administration- 0.3mg to 0.4 mg are too large a dose and will drop preload and significantly decreasing cardiac output. These increases mortality rates in these patients)

Avoid use in extreme bradycardia (<50 bpm) or extreme tachycardia (>160 bpm)

Hypotension (<90 mmHg) or a drop of >30 mmHg below baseline (systolic BP)

Uncorrected hypovolemia

sildenafil (Viagra), vardenafil (Levitra), avanafil (Stendra),) use within 24 hours or tadalafil (Cialis) within 48 hours

Severe anemia

Pericardial Tamponade and pericarditis

Precautions NITRO

Head trauma  Closed-angle glaucoma  Orthostatic hypotension may occur – consider administering while patient recumbent or after placing on stretcher

NITRO notes

 Prime aerosol spray  An IV must be initiated prior to the administration of nitroglycerin.  Remove other nitro sources (e.g. Nitro patch before administering SL or IV nitro).  Monitor vital signs closely  Use glass bottles and special tubing provided by the manufacturer for infusion. (PVC plastic may absorb up to 80% of the nitroglycerin. Can be mixed in a plastic solution bag for temporary use.  Single most effective agent for the treatment of acute pulmonary edema  For IV nitroglycerine: Ischemic chest discomfort: keep SBP greater than 90 mmHg, Limit drop in SBP to 30 mm HG below bassline in hypertensive patients Pulmonary edema: Limit drop in SBP to 10% of baseline in normotensive patients, Limit drop in SBP to 30 mmHg below baseline in hypertensive patients.  Initiating nitroglycerin infusions at higher does for acute pulmonary edema may be beneficial. Consider initiating rate at 20 mcg/min depending upon vital signs.

Naloxone HCL

Generic name

Trade Name for Naloxone

Narcan.

Classification of Naloxone

Narcotic (Opioid) antagonist.

Narcan Supplied

0.4 mg/mL, 1 mg/mL

Actions of Naloxone

Antagonizes opioid effects, especially respiratory depression, sedation, and hypotension.

Indications for Naloxone Use

Known or suspected narcotic-induced respiratory depression, including those caused by natural and synthetic narcotics

Dosage Adult Narcan IV/IO

preferred route: 0.02 - 2.0 mg IV/IO q 3 min to a maximum accumulation dose of 10 mg (lower doses are used for patients breathing, higher doses is used with apnea)

Dosage Adult Narcan IM

2.0 mg IM q 5 min

Dosage Adult Narcan IN

2 mg (1mg/nostril) IN q 3-5 min

Dosage Adult Narcan Infusion

0.4 – 2.0 mg in a 50 or 100ml NS/D5W running over 60 minutes use the dose that the patient responded to - wake-up dose/hr (ie) 0.4 mg/hr

Narcan Recommended Dosing Per Case

Postoperative induced respiratory depression: 0.02-0.2 mg IV

Opioid induced respiratory depression with chronic opioid use: 0.02–0.04 mg IV, given as small, frequent (every min) boluses or as an infusion titrated to improve respiratory function without reversing analgesia.

Patients suspected to be opioid dependent: Initial dose should be ↓ to 0.1–0.2 mg IV every 2–3 min

Patients not suspected of being opioid dependent: 0.4 mg (10 mcg/kg); may repeat every 2–3 min

Pediatric Dosage of Naloxone

0.1 mg/kg slow IV/IO/IM/IN max 2mg q 5 min prn.

Contraindications for Naloxone

Hypersensitivity to the drug or its components.

Precaution in Administration of Naloxone in Addicts

Opiate addition/dependence; may become very agitate or violent and may cause withdrawal symptoms in these patients.  Cardiovascular disease

Narcan Notes

Ensure ventilation is performed prior to administration of Narcan  Administration of Narcan in neonates is no longer recommended  Small doses to improve and maintain adequate respirations of patients is recommended.  Patients maybe at risk of agitation and combativeness with Narcan administration.  In persons with long-term addictions or cardiovascular disease, naloxone may markedly increase heart rate and blood pressure and cause acute pulmonary edema, cardiac arrhythmias (including asystole), and seizures.  Opioid-induced respiratory depression usually lasts longer than the duration of Narcan, therefore repeated doses may be necessary

Ipratropium Bromide

Generic Name for Atrovent

Trade Name IPATROPIUM

Atrovent, the commercial name under which ipratropium bromide is sold.

Classification IPATROPIUM

anti-cholinergic, bronchodilator.

Atrovent Supplied

250 mcg or 500 mcg in 2.5 mL nebula, MDI 17 & 18 mcg/spray

Ipratropium Bromide Actions

Anticholinergic action: Appears to inhibit vagally mediated reflexes by antagonizing the action of acetylcholine. Anticholinergics prevent the increase in intracellular concentration of cyclic guanosine monophosphate (cGMP) that results from interaction of acetylcholine with the Muscarinic receptor on bronchial smooth muscle.

Bronchodilation action: following inhalation is primarily a local, site specific effect, not systemic one. Blocks action of acetylcholine and muscarinic receptors (parasympathetic sites) on bronchial smooth muscles.

Indications IPATROPIUM

bronchospasm in asthma, anaphylaxis, bronchitis, and emphysema

Atrovent- NEB- Dose- Adult

500 mcg NEB – repeat prn q 5 mins total max dose of 1500 mcg

Atrovent- NEB- Dose- <20kg

125 - 250 mcg NEB to a total max of 3 doses

Atrovent- NEB- Dose- <20kg

250 - 500 mcg NEB to a total max of 3 doses