Ch.4 Aemt Drug Cards

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Nitroglycerin

Back 1

Generic Name: nitroglycerin, nitroglycerin translingual, nitroglycerin transdermal, nitroglycerin intravenous, nitroglycerin topical

Trade Name: Nitrostat; Nitrobid; Nitrolingual

Class of Medication: nitrates, vasodilator

Mechanism of Action: Relaxes blood vessels; decreases workload of the heart, Smooth muscle relaxant acting on vascular, bronchial, uterine, and intestinal smooth muscle; dilation of aterioles and veins in the periphery: reduces preload and afterload; decreases the work load of the heart and thereby, myocardialoxygen demand

Dose: 0.4 mg; 1/150 of the grain; every 3 to 5 minutes based on blood pressure; max dose is three in 15 minutes, Nitroglycerine spray: 0.4 mg under the tongue 1-2 sprays

Route(s) of Administration: Sublingual

Indications: Acute angina, chest pain, hypertension, CHF, pulmonary edema

Contraindications: Hypotension, hypovolemia; Baseline BP below 100mm Hg systolic; intracranial bleeding, or head injury; patient has already received max dosage; patient has taken Viagra, Revatio, Levitra, Cialis within the last 24 hours; child

Common Side Effects: Hypotension; headache; syncope, reflex tachycardia, flushing, nausea, vomiting, diaphoresis, muscle twitching, increased pulse rate;

Precautions: Acute MI, heart failure, monitor, Hypotensive or volume depleted

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Oral glucose

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Generic Name: Glucose

Trade Name: Glutose ; Insta-glucose

Class of Medication: Hyperglycemic

Mechanism of Action: Increases blood and brain sugar levels, provides quickly absorbed glucose to increase blood glucose levels

Dose: One tube 15g

Route(s) of Administration: Oral, buccal; Placed upon the pressure between cheek and gum and allow to dissolve in mouth

Indications: Hypoglycemia; Patients with altered mental status and known history of diabetes

Contraindications: Unconscious; unable to swallow, Hyperglycemia; nausea, vomiting

Common Side Effects: Nausea, vomiting

Precautions: Unconsciousness

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Epinephrine

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Generic Name: Epinephrine

Trade Name: Adrenaline; Epipen

Class of Medication: Sympathomimetic, Dilates bronchioles; constrict blood vessels

Mechanism of Action: Direct-acting alpha- and beta-agonist. Alpha: vasco constriction. Beta-1 positive inotropic, chronotropic, and dromotrophic effects. Beta-2 bronchial relaxes smooth muscles to improve breathing, stimulates heartbeat, reverses swelling and hives, Mimics response of sympathetic nervous system, constricts blood vessels to improve BP

Dose: For an adult, 0.3 mg to 0.5 mg (1 mL of 1000), child .15 mg

Route(s) of Administration: Autoinjector; intramuscular

Indications: Patient exhibits signs and symptoms of a severe allergic reaction, including either respiratory distress or shock, anaphylaxis, asthma

Contraindications: None is used in a life-threatening anaphylaxis, Hypertension, hypothermia, pulmonary edema, myocardial ischemia, hypovolemic shock.

Common Side Effects: Increased heart rate; pallor; dizziness; chest pain; headache; nausea or vomiting; excitability; anxiety

Precautions: Potentiates other sympathomimetics, MAOIs may potentiate effects, beta blockers may blunt effects

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Activated charcoal

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Generic Name: charcoal; activated charcoal

Trade Name: Superchar; Insta char; liquidchar; Actidose

Class of Medication: poison antidote

Mechanism of Action: Binds with poisons in the stomache and prevents absorption into the body

Dose: 0.5-1 gm for Adult, 0.6-2 gm

Route(s) of Administration: Orally

Indications: Poisoning by mouth

Contraindications: Altered mental status; ingestion of acids are alkaline's; unable to swallow

Common Side Effects: Black stools; constipation, diarrhea, nausea, vomiting

Precautions: use with caution if decreased LOC (ensure airway is protected)

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Oxygen

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Generic Name: Oxygen

Trade Name: Oxygen

Class of Medication: Naturally occuring atmospheric gas

Mechanism of Action: Reverses hypoxemia

Dose: Adult and pediatric 1-6 lpm nasal canula, 10-15 lpm non-rebreather, 15 lpm bag valve mask

Route(s) of Administration: Inhalation

Indications: Hypoxia or anticipated hypoxia, or in any medical or trauma patient to improve respiratory efficiency; ischemic chest pain, respiratory insufficiency, prophylactically during air transport, confirmed or suspected carbon monoxide poisoning, all other causes of decreased tissue oxygenation, decreased level of consciousness

Contraindications: Certain patients with COPD or emphysema who will not tolerate oxygen concentrations over 35%, hyperventilation

Common Side Effects: Decreased level of consciousness and respiratory depression in patients with chronic carbon dioxide retention

Precautions: Oxygen is a safe gas as it is used properly

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glucagon

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Generic Name: GLUCAGON

Trade Name: Glucagon

Class of Medication: Hyperglycemic agent, pancreatic hormone, insulin antagonist

Mechanism of Action: Increases blood glucose level by stimulating glycogenesis. Unknown mechanism of stabilizing cardiac rythm in beta blocker overdose. Minimal positive inotropic and chronotropic response. Decreases GI motility and secretions.

Dose: Adult Hypoglycemia 0.5-1 mg IM, Pediatric Hypoglycemia 0.5-1 mg IM

Route(s) of Administration: IM

Indications: Altered level of consciousness when hypoglycemia is suspected. May be used as inotropic agent in beta blocker overdose.

Contraindications: Hyperglycemia, hypersensitivity

Common Side Effects: Nausea, vomiting, tachycardia, hypertension

Precautions: Incompatible is solutions with most other substances. No significant drug interactions with other emergency medications.

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D50 (50% Dextrose in water)

Back 7

Generic Name: Dextrose 50%, D50

Trade Name: Dextrose 50%, D50

Class of Medication: Carbohydrate, hypertonic solution

Mechanism of Action: Rapidly increases serum glucose levels. Short-term osmotic diuresis.

Dose: Adult 12.5-25g Pediatric 0.5-1

Route(s) of Administration: IV, IO

Indications: Hypoglycemia, altered level of consciousness, coma of unknown etiology, seizure of unknown etiology, status epilepticus.

Contraindications: Intracranial hemorrhage

Common Side Effects: Extravasation leads to tissue necrosis. Warmth, pain, burning, thrombophlebitis, rhabdomyolysis, hyperglycemia.

Precautions: Use with caution in patients with increasing ICP the added glucose may worsen the cerebrial edema. Consider blood glucose monitoring before and after administration.

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IV Crystalloids (normal saline and lactated ringer's)

Back 8

Generic Name: sodium chloride, sodium lactate, potassium chloride and calcium chloride;

Trade Name: Lactated Ringer's Solution; Normal Saline Solution; 0.9% Sodium Chloride Solution

Class of Medication: Isotonic crystalloid solution

Mechanism of Action: replaces water and electrolytes

Dose: The specific situation being treated will dictate the rate in which IV Crystalloids will be administered.

Route(s) of Administration: IV

Indications: Hypovolemic shock; Heat related problems; freshwater drowning; hypovolemia; diabetic ketoacidosis

Contraindications: Should not be used in patients with congestive heart failure or renal failure

Common Side Effects: rare in therapeutic dosages

Precautions: few in emergency situations

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albuterol sulfate (nebulized)

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Generic Name: albuterol inhalation

Trade Name: AccuNeb, Albuteral, ProAir HFA, Ventolin HFA, Proventil HFA

Class of Medication: Sympathomimetic, bronchodilator

Mechanism of Action: Beta-2 agonist that stimulates adrenergic receptors of the sympathomimetic nervous system. Causes smooth muscle relaxation in the bronchial tree and peripheral vasculature.

Dose: Adult 2.5 mg, Dilute 0.5 mL of 0.5 % solution for inhalation with 2.5 mL normal saline in nebulizer. Pediatric 0.01-0.03 mL (0.05-0.15 mg diluted in 2 mL of 0.9% normal saline)

Route(s) of Administration: Inhalation

Indications: Treatment of bronchospasm in patients with reversible obstructive airway disease.

Contraindications: known prior hypersensitivity reactions to albuterol. Tachycardia arrhythmias, especially those caused by digitalis. Synergistic with other sympathomimetics.

Common Side Effects: Restlessness, tremors, dizziness, palpitations, tachycardia, nervousness, peripheral vasodilation, nausea, vomiting, hyperglycemia, increased blood pressure, and paradoxical bronchospasm.

Precautions: May potentiate hypokalemia in some patients.

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ipratromium bromide

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Generic Name: ipratropium bromide

Trade Name: Atrovent, Apovent, Ipraxa, Aerovent, Rinatec

Class of Medication: bronchodilator

Mechanism of Action: anticholinergic agent, It blocks muscarinic cholinergic receptors

Dose: 2.5 mL which is 1 unit

Route(s) of Administration: Inhalation

Indications: bronchospasm associated with COPD, and chronic bronchitis and emphysema

Contraindications: known or suspected cases of hypersensitivity to ipratropium bromide, or to atropine and it's derivatives

Common Side Effects: dry mouth, nausea, headache, dizziness, heartburn, constipation, urination issues. Some can be serious like rash, hives, itching, swelling of the eyes, face, lips, toungue, throat, hands, feet, ankles, or lower legs. Hoarseness, difficulty breathing, fast heartbeat, and chest pain.

Precautions: use with caution in patients with narrow angle glaucoma, prostatic hypertrophy or bladder neck obstruction

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nitrous oxide (50/50 mix)

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Generic Name: Azote, protoxyde, Nitrous Oxide, Nitro

Trade Name: Nitronox

Class of Medication: Gaseous analgesic and anesthetic

Mechanism of Action: Exact mechanism unknown; affects CNS phospholipids

Dose: Adult inhale deeply through demand valve and mask or mouthpiece; Pediatric Same as adult

Route(s) of Administration: Inhalation

Indications: Moderate to severe pain, anxiety, apprehension

Contraindications: Impaired level of consciousness, head injury, inability to comply with instructions; decompression sickness (nitrogen narcosis, air embolism, air transport); undiagnosed abdominal pain or marked distension, bowel obstruction; hypotension, shock, COPD (with history/suspicion of carbon dioxide retention); cyanosis; chest trauma with pneumothorax

Common Side Effects: Dizziness, apnea, expansion of gasfilled pockets, cyanosis, nausea, vomiting, milagnant hyperthermia, drowsiness, euphoria

Precautions: should not be used for analgesia patients with head injuries; use caution in patients with cardiac, respiratory, renal or hepatic impairment

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naloxone (narcan)

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Generic Name: naloxone hydrochloride

Trade Name: Narcan

Class of Medication: Narcotic antagonist

Mechanism of Action: Competitive inhibition at narcotic receptor sites, reverse respiratory depression secondary to depressant drugs, completely inhibits the effect of morphine.

Dose: Adult 0.4-2.0 mg

Route(s) of Administration: IV, intranasal

Indications: Opiate overdose, coma, complete or partial reversal of CNS and respiratory depression induced by opiods, decreased level of consciousness, coma of unknown origin, narcotic agonist for the following morphine, heroin, hydromorphone (Dilaudid), methadone, meperidine (Demerol), paregoric, fentanyl (Sublimaze), oxycodone (Percodan), codeine, propoxyphene (Darvon); narcotic agonist and antagonist for the following butorphanol (Stadol), pentazocine (Talwin), nalbuphine (Nubain)

Contraindications: Use with caution in narcotic-dependent patients, use with caution in neonates of narcotic-addicted mothers.

Common Side Effects: withdrawal symptoms in the addicted patient, tachycardia, hypertension,arrhythmias, nausea, vomiting, diaphoresis

Precautions: Incompatible with bisulfite and alkaline solutions

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acetaminophen

Back 13

Generic Name: acetaminophen

Trade Name: Tylenol, Anacin-3

Class of Medication: analgesics and antipyretics

Mechanism of Action: exact action is not known, it may reduce production of prostaglandins in the brain.

Dose: Adult 325- 650 mg every 4 hours, Less than 12 years old 10-15 mg every 6-8 hours (for a child the dosage is determined by the childs age and weight), older than 12 is 40-60 mg every 6 hours

Route(s) of Administration: orally, chewable tablets, liquid, tablets

Indications: for pain and fever control

Contraindications: Hypersensitivity, children under 3 years

Common Side Effects: side effects are rare when used appropriately, Liver damage is the most serious

Precautions: allergy to it, caution advised if you have diabetes or PKU, if you have liver disease,

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ibuprofen

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Generic Name: ibuprofen

Trade Name: Advil, Motrin, Nuprin, Excedrin IB

Class of Medication: NSAIDs

Mechanism of Action: exact action is unknown, nonselective inhibitor of cyclooxygenase

Dose: Adult 200-800 mg; Pediatric 6 months- 12 years of age 5-10 mg,

Route(s) of Administration: orally

Indications: Reduce fever and relieve minor to moderate pain

Contraindications: Allergies to aspirin or other NSAIDs; patients with GI bleeding; renal insufficiency; patients currently taking anticoagulants

Common Side Effects: rash, ringing in ears, headaches, dizziness, drowsiness, abdominal pain, nausea, diarrhea, constipation and heartburn, it reduces the ability of blood to clot and it increases bleeding after injury

Precautions: allergy to medication or to asprin or NSAIDs. If you have liver disease, stomache problems such as ulcers, or heart burn, blood disorders, asthma, heart disease, high blood pressure

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Aspirin

Back 15

Generic Name: aspirin

Trade Name: Arthritis Foundation Pain Reliever, Bayer Children's Aspirin, Ecotrin

Class of Medication: Platelet inhibitor, anti-inflammatory agent

Mechanism of Action: Prostaglandin inhibition

Dose: 81 mg, 160 mg and 325 mg

Route(s) of Administration: oral

Indications: New-onset chest pain suggestive of acute myocardial infarction

Contraindications: Hypersensitivity, Relatively contraindicated in patients with active ulcer disease or asthma.

Common Side Effects: Heartburn, GI bleeding, prolonged bleeding, nausea, and vomiting. Wheezing in allergic patients.

Precautions: Use caution in patients allergic to NSAIDs.

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Atropine (Auto Injector)

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Generic Name: atropine

Trade Name: Atreza, Sal-Tropine, AtroPen

Class of Medication: Anticholinergic, Muscarinic receptor antagonists

Mechanism of Action: Blocks acetylcholine receptors, increases heart rate, decreases gastrointestinal secreations

Dose: Adult 1 to 2 mg IM otherwise as directed by medical control, Pediatric per medical control only child weighing 40-90 lbs 1mg, child 15- 40 lbs 0.5 mg

Route(s) of Administration: Auto injector

Indications: Organophosphate poisoning (insecticides, pesticides, cyanide, mustard gas, Sarin)

Contraindications: None in an emergency setting

Common Side Effects: Dry mouth, blurred vision, urinary retention, tachycardia, constipation, decreased sweating

Precautions: anyone who has had previous anaphylactic reactions to atropine. use extreme caution when you have these disorders hypersensitive to any component of the product, disorders of heart rhythm such as arterial flutter, severe narrow angle glaucoma, pyloric stenosis, prostatic hypertrophy,renal insufficiency, or recent MI

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Pralidoxime

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Generic Name: PRALIDOXIME AUTO-INJECTOR

Trade Name: 2-PAM, Protopam Chloride

Class of Medication: Cholinesterase Reactivator

Mechanism of Action: antidote, it binds to site of acetylcholinesterase, which results in reversible inactivation of the enzymes

Dose: Adult 30 mg, Pediatric per medical control only 20-50 mg

Route(s) of Administration: IV, IM

Indications: Organophosphate poisoning

Contraindications: Carbamate insecticides (Sevin), inorganic phosphates, and organophosphates having no anticholienesterase activity, asthma,peptic ulcer disease, severe cardiac disease or patients recieving aminophylline, theophylline, morphine, succinlycholine, reserpine, or phenothiazines

Common Side Effects: blurred or double vision, difficulty in focusing eyes, difficulty in speaking, difficult or rapid breathing, dizziness, fast heartbeat muscle stiffness or weakness, pain at a place of injection

Precautions: allergy to medication, Kidney disease, certain nerve/muscle problem