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26 Cards in this Set
- Front
- Back
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Nitroglycerin
pharmacology & actions |
NTG/Nitro
1. Cardiovascular effects A. Reduced venous tone causes pooling in periph veins, decreased blood return to heart B. decreased periph resistance C. Dilation of coronary arteries 2. Generalized Smooth Muscle Relaxation |
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NTG
indications |
A. angina
B. cx, arm or neck pain thought possibly to be related to coronary ischemia, can be used diagnostically C. pulmonary edema: to increase venous pooling lowering cardiac preload & afterload D. Food impaction located in the esophagus (may relieve muscle spasm) |
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NTG
precautions and side EFX |
A. throbbing H/A, flushing, dizziness, ad burning under the tongue
B. marked hypotension, NTG contraindicated if any ED meds on board from last 24 hours (doctor call in) C. generalized vasodilation may cause reflex tachy D. less then 90 systo |
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NTG
admin |
Standing order
Cx Pn 0.4 mg (1/150 grain) SL spray or tab total 3 dose every 5 min Nitropaste 2 inches to cx wall by standing order if needed Pulmonary Edema 0.4mg (1/150grain) SL spray or Tab may then apply nitropaste: 2inches to cx wall OR 1 NTG every 3-5min X 2 (total 3) Food Impaction 0.4 mg SL spray or Tablet -repeat by MD order |
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NTG
special notes |
A. use with caution in hypotensive pt
B. upright may increase threapuetic effect as well as adverse effects |
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NTG
Storage |
loose potency easily, should be stored in a dark glass container with a tight lid, and not exposed to heat
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Aspirin
pharmacology & actions |
ACETYLSALICYCLIC ACID / ASA
A. In 2mg/kg oral or IV doses, produces rapid antithrombolic due to inhibition of Thromboxane A2 B. All platelets in circulation are inhibited by ASA at the time of exposure. life span 8-10 days, 5 days later 50% platelets inhibited |
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ASA
Indications |
A. anticoagulant effect, ASA therapy should be given as soon as possible after the onset of cardiac Cx Pn in MI cases
B. Associated symptoms of suspected MI: nauseau, SOB, diaphoresis, palpitations |
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ASA
precautions & side effects |
contraindications
1. allergy to ASA 2. active bleeding |
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ASA
Admin |
Cardiac Cx Pn
Standing order 4 X 81 mg cheqable tabs (baby ASA) total 324 mg, have pt chew ASA completely IF PT HAS TAKEN 324 MG IN THE LAST 2 HOURS, DO NOT ADMIN |
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Dopamine
Indications |
INTROPIN
1. cardiogenic shock 2. other shock (NOT hypovolemia) |
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Dopamine
precautions and side effects |
A. may induce tachyarrhythmias (decrease or stop infusing)
B. high doses cause extreme periph vasoconstriction, low doses = low bp due to periph dilation C. antidepressents, sympathomimetics potentiate effects D. inactivated by sodium bicarb or other alkaline solutions |
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Dopamine
admin |
MD ORDER
start at 10mcg/kg/min 2-20mcg/kg/min |
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Dopamine
Notes |
A. most common side effects include ectopic beats, n/v angina
B. hypertensive crisis in some individuals C. treat hypovolemia first, contraindicated for hypovolemic shock |
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Fentanyl
pharmacology & actions |
SUBLIMAZE
A. synthetic opiod analgesic 100mcg fent = 10mg morphine B. Does not cause hypotension C. Duration 30-60 min IV 60-120 min IM |
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Fent
Indications |
A. Pain
1. best choice when hypotension is a concern 2. when short term analgesia is preferred B. RSI treatment 1. Adjunct for sedation, blunts ICP elevations |
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Fent
Contraindications |
patients with known intolerance to fent (rare)
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Fent
Precautions |
A respiratory depression
1. peak effect/respiratory depression occurs 5-15 min after IV dose 2. pts should be on continuous pulse ox B. synergistic effects concomitant benzodiazepine admin (versed) C. In large dose and rapid admin, may cause muscle rigidity (respiratory muscles) EMERGENCY = SUXX do not use narcan D. use reduced dose in the elderly, debilitated |
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Fent
side effects |
A. may cause N/V
B. Will cause Miosis (pupilary constriction) |
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Fent
Admin |
STANDING ORDER
A. Narcotic Analgesia 1. 50 mcg = 1cc 2. Adult 50-100mcg IV/IM [SLOWLY over 1-2min] start with 25-50mcg in elderly/debilitated administer in 50-100mcg increments minimum every 5 min Call above 300 MCG Peds Standing Order 1mcg/kg repeat in 10 min |
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Fent
Notes |
Rapid IV admin may cause cx wall rigidity leading to respiratory depression or apnea seen 5-15 minutes after admin
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Morphine Sulfate
pharmacology and action |
MS
A. Analgesia B. Pupil Constriction C. Respiration: decreased rate and tidal volume D. Periperal vasodilation 1. causes no problems if supine and not volume-diluted 2. May cause problems if a. upright b. hypovolemic c. decreased cardiac output (after MI) 3. Cardiac effect of vasodilation a. Decreases myocardial O2 consumption b. Decreases LV End Diastolic Pressure c. Decreases cardiac work d. May increase incidence of arrhythmias Max effect within 7 min IV |
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MS
Indications |
Use in management of acute pain
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MS
Precautions and Side Effects |
A. Hypotension is a contraindication to use. pn causes hypotension (consult MD)
B. Use Fent in pts with abdominal pain C. Use with caution in patients with respiratory difficulties, because their respiratory drive must ot be depressed D. Do not use with major blood loss E. May cause vomiting, administer slowly |
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MS
Admin |
Standing Order
Adult 0.1 mg/kg starting dose typically 5mg IV or IM repeat every 5-10 minutes Administer up to 20mg without MD consultation Peds Standing order 0.1-0.2 mg/kg IV or IM |
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MS
Special Notes |
side effects are more pronounced in elderly patients, give slowly and have bvm and narcan available
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