Aspirin, Atropine, Morphine

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aspirin
class
description

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CLASS: Analgesic, anti-inflammatory, antipyretic, antiplatelet

DESCRIPTION: Aspirin decreases inflammation, blocks pain impulses in the central nervous system, dilates peripheral vessels, and decreases platelet aggregation. The use of aspirin is strongly recommended for all patients with acute myocardial infarction.

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aspirin
onset & duration
indications
contraindications

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ONSET AND DURATION
Onset: 15-30 min
Duration: 4-6 hr

INDICATIONS: Mild to moderate pain or fever, Prevention of platelet aggregation in ischemia and thromboembolism, Unstable angina, Prevention of myocardial infarction or reinfarction

CONTRAINDICATIONS: Hypersensitivity to salicylates, Gastrointestinal bleeding, Active ulcer disease, Hemorrhagic stroke, Bleeding disorders, Children with flulike symptoms

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aspirin
adverse reactions
drug interactions
how supplied

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ADVERSE REACTIONS: Stomach irritation, Heartburn or indigestion, Nausea or vomiting, Allergic reaction

DRUG INTERACTIONS: Decreased effects with antacids and steroids, Increased effects with anticoagulants, insulin, oral hypoglycemics, fibrinolytic agents

HOW SUPPLIED
Tablets (65, 81, 325, 500, 650, 975 mg)
Capsules (325, 500 mg)
Controlled-release tablets (800 mg)
Suppositories (varies from 60 mg to 1.2 g)

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aspirin
dosage & administration
special considerations

Back 4

DOSAGE AND ADMINISTRATION
Adult:
Mild pain and fever: 325-650 mg PO q 4 hr
Myocardial infarction: 160-325 mg PO (chewing is preferable to swallowing)
Pediatric (over 12 years of age): Mild pain and fever—40-100 mg/kg/day in divided doses

SPECIAL CONSIDERATIONS
Pregnancy safety: Category D
Should be given as soon as possible to the patient with acute myocardial infarction

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atropine
class
description

Back 5

CLASS: Anticholinergic agent

DESCRIPTION: Atropine sulfate (a potent parasympatholytic) inhibits actions of acetylcholine at postganglionic parasympathetic (primarily muscarinic) receptor sites. Small doses inhibit salivary and bronchial secretions; moderate doses dilate pupils and increase heart rate. Large doses decrease gastrointestinal motility, inhibit gastric acid secretion, and may block nicotinic receptor sites at the autonomic ganglia and at the neuromuscular junction. Blocked vagal effects result in increased heart rate and enhanced atrioventricular conduction with limited or no inotropic effect. In emergency care, atropine primarily is used to increase the heart rate in life-threatening or symptomatic bradycardia and to antagonize excess muscarinic receptor stimulation caused by organophosphate insecticides or chemical nerve agents (e.g., sarin and soman).

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atropine
onset & duration
indications
contraindications

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ONSET AND DURATION
Onset: Rapid
Duration: 2-6 hr

INDICATIONS: Hemodynamically significant bradycardia, Asystole, Pulseless electrical activity with absolute bradycardia
Organophosphate or nerve gas poisoning

CONTRAINDICATIONS: Tachycardia, Hypersensitivity to atropine, Obstructive disease of gastrointestinal tract, Obstructive uropathy, Unstable cardiovascular status in acute hemorrhage with myocardial , ischemia, Narrow-angle glaucoma, thyrotociosis

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atropine
adverse reactions
drug interactions

Back 7

ADVERSE REACTIONS: Tachycardia, Paradoxical bradycardia when pushed too slowly or when used at doses , less than 0.5 mg,
Palpitations, Dysrhythmias, Headache, Dizziness, Anticholinergic effects (dry mouth/nose/skin, photophobia, blurred vision, urinary retention, constipation), Nausea and vomiting, Flushed, hot, dry skin, Allergic reactions,

DRUG INTERACTIONS: Use with other anticholinergic agents may increase vagal blockade. Potential adverse effects may occur when administered with digitalis, cholinergics, neostigmine. The effects of atropine may be enhanced by antihistamines, procainamide, quinidine, antipsychotics and antidepressants, and thiazides. Increased toxicity: Amantadine

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atropine
how supplied
special considerations

Back 8

HOW SUPPLIED
Parenteral: There are various injection preparations.
In emergency care, atropine usually is supplied in prefilled syringes containing 1 mg in 10 mL of solution.

SPECIAL CONSIDERATIONS
Pregnancy safety: Category C
Follow endotracheal tube administration with several positive-pressure ventilations.
Atropine causes pupillary dilation, rendering the pupils nonreactive; pupil response may not be useful in monitoring central nervous system status.

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atropine
dosage & administration

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DOSAGE AND ADMINISTRATION
Bradydysrhythmias
Adult: 0.5 mg every 3-5 min for desired response (max total dose: 3 mg
Pediatric: 0.02 mg/kg IV/IO/endotracheal tube (diluted to 3-5 mL); min dose: 0.1 mg; max single dose of 0.5 mg for a child and 1 mg for an adolescent; may be repeated in 5 min for a max total dose of 1 mg for a child and 2 mg for an adolescent
Asystole or Pulseless Electrical Activity
Adult: 1 mg IV, endotracheal tube (2-3 mg diluted to a total of 10 mL of NS); may be repeated every 3-5 min (max: 0.03-0.04 mg/kg)
Pediatric: Efficacy has not been established.
Anticholinesterase Poisoning
Adult: 1-2 mg IV push every 5-15 min until atropine effects are observed; then every 1-4 hr for at least 24 hr
Pediatric: 0.02-0.05 mg/kg/dose (usual dose 1-5 mg) IV; may be repeated every 10-20 min until atropine effect is observed; then 1-4 hr for at least 24 hr

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morphine
class
description

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DESCRIPTION: Morphine sulfate is a natural opium alkaloid that has a primary effect of analgesia. It also increases peripheral venous capacitance and decreases venous return (chemical phlebotomy). Morphine sulfate causes euphoria and respiratory and central nervous system depression. Secondary pharmacological effects of morphine include depressed responsiveness of alpha-adrenergic receptors (producing peripheral vasodilation) and baroreceptor inhibition. In addition, because morphine decreases preload and afterload, it may decrease myocardial oxygen demand. The properties of this medication make it extremely useful in emergency care. Morphine sulfate is a Schedule II drug.

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morphine
onset & duration
indications
contraindications

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ONSET AND DURATION
Onset: 1-2 min after administration
Duration: 2-7 hr

INDICATIONS: Chest pain associated with myocardial infarction; Pulmonary edema, with or without associated pain; Moderate to severe acute and chronic pain

CONTRAINDICATIONS: Hypersensitivity to narcotics, Hypovolemia, Hypotension, Head injury or undiagnosed abdominal pain, Increased intracranial pressure, Severe respiratory depression, Patients who have taken MAO inhibitors within 14 days

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morphine
adverse reactions
drug interactions

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ADVERSE REACTIONS: Hypotension, Tachycardia, Bradycardia, Palpitations, Syncope, Facial flushing, diaphoresis, itching, Respiratory depression, Euphoria, Bronchospasm, Dry mouth, Allergic reaction

DRUG INTERACTIONS
Central nervous system depressants may potentiate effects of morphine (respiratory depression, hypotension, sedation).
Phenothiazines may potentiate analgesia.
MAO inhibitors may cause paradoxical excitation.

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morphine
how supplied
dosage & administration

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HOW SUPPLIED
Morphine is supplied in tablets, suppositories, and solution. In emergency care, morphine sulfate usually is administered IV.
Parenteral preparations are available in many strengths. A common preparation is 10 mg in 1 mL of solution, ampules and Tubex syringes.

DOSAGE AND ADMINISTRATION
Adult: 2-4 mg slow IV over 1-5 min every 5-30 min; titrated to effect
Pediatric: 0.1-0.2 mg/kg/dose IV (max total dose: 15 mg)

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morphine
special considerations

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SPECIAL CONSIDERATIONS
Pregnancy safety: Category B (if not used for prolonged periods or in high doses at term); narcotics rapidly cross the placenta
Safety in neonates has not been established.
Use with caution in the elderly, those with asthma, and in those susceptible to central nervous system depression.
Morphine should be used with caution in chronic pain syndromes.
Morphine may worsen bradycardia or heart block in inferior myocardial infarction (vagotonic effect).
Naloxone should be readily available.