Drug cards - Epinephrine & Nitroglycerine

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 1 g packet - ointment

mechanism of action - nitroglycerin

dilates arterial and venous vasculature, decreases amount of pressure the heart has to pump against, 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 (erectile dysfunction) 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, and nausea/vomiting

adult dosage - nitroglycerin (NOT COMMON FOR CHILDREN)

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

when is it indicated to give upto 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

a medical control order must be established, UNLESS patient is older than 30 yoa and is having chest pain consistent with an MI

special considerations - nitroglycerine

established IV access is recommended prior to administration, use 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 (intramuscular) injection - via medical control order

pediatric dosage - epinephrine - anaphylaxis

0.01 mg/kg (1:1000) to 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, watching 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