Chapter 13 Medications AEMT
50 percent dextrose class
carbohydrate
glucose class
carbohydrate
hypotonic fluids
cause a shift of fluid from the intravascular space to the intracellular space. the sugar in dextrose solutions may make them isotonic or even hypertonic, but the dextrose is metabolized quickly upon administration, rendering the solution hypotonic
hypertonic fluids
cause water to leave the cells and enter the vascular space. the increased osmotic pressure of hypertonic crystalloid solutions can increase the circulating volume by more than the volume of IV fluid administered
50% dextrose precautions
check blood glucose level prior to administration. a solution of 50% dextrose is hypertonic and causes severe tissue necrosis if infiltration occurs.
nitroglycerin indications
chest pain associated with acute coronary syndrome
glucagon contraindications/ precautions
hypersensitivity, glucagon is not effective if the patient has already depleted glycogen stores
Aspirin Contraindications
hypersensitivity, under 18
Acetaminophen Contraindications/ precautions
hypersensitivity; it is hepatotoxic in high doses and should be used with caution in patients who have known liver disease
50% dextrose indications
hypoglycemia in adults
nitroglycerin contraindications/precautions
hypotension, increased intracranial pressure, and use of erectile dysfunction medications within 24-36 hours; NTG deteriorates rapidly when exposed to light or air. monitor blood pressure closely and discontinue administration if the systolic blood pressure falls below 90mmHg
normal saline indications
hypovolemia, heat exhaustion, heat stroke, and diabetic ketoacidosis
glucagon indications
inability to establish IV access in patients with significant hypoglycemia
Glucose Contraindications/ precautions
inability to maintain a patent airway, carefully monitor for potential of aspiration
glucose mechanism of action
increases blood glucose levels
50% dextrose mechanism of action
increases glucose concentration in the blood for reversal of acute hypoglycemia
acetaminophen interactions
increases liver toxicity when used with alcohol
ibuprofen mechanism of action
inhibits inflammatory response by blocking formation of cyclooxygenase (COX-2), a chemical mediator of inflammatory chemicals such as prostaglandins
50% Dextrose Contraindications
intracranial hemorrhage (traumatic brain injury, stroke) and hyperglycemia
albuterol sulfate indications
wheezing caused by asthma, COPD, and some other conditions
epinephrine 1:1,000 class
Sympathomimetic
glucagon route
IM
ibuprofen precautions
high dose can cause significant GI irritation and increases risk of GI bleeeding
naloxone dosage
1 to 2mg slow IV push titrated to restore respiratory rate. if no effect, may be repeated at 5 minute intervals. an intranasal formulation is also available.
glucagon dosage
1 mg
what are the 2 general indications for obtaining IV access in a prehospital setting?
1. replace lost circulatory volume from blood loss, burns, and dehydration 2. establish a route for administration of medications
glucose dose
15 g by mouth or applied to the buccal mucosa
ibuprofen dosage
200-400mg every 6-8 hours; pedes dose is 5-10mg every 6-8 hours
50% dextrose dosage
25 g slow IV push; may be repeated in 10-15 minutes if blood glucose remains below 70ml/dl. pediatric dosage: 0.5g/kg of a 25% solution of dextrose; 10% for neonates
epinephrine 1:1,000 dosage
ADULT: 0.3 - 0.5 mg every 15 minutes PEDI: 0.01 mg / kg up to 0.3 mg
nitrous oxide class
Analgesic/Anesthetic
epinephrine 1:1,000 indications
Anaphylaxis, Acute Allergic Reactions, Asthma
albuterol sulfate side effects
Anxiety, palpitations, chest discomfort, headache, perspiration
albuterol sulfate class
Beta2-selective sympathomimetic bronchodilator
nitrous oxide mechanism of action
CNS depression and rapid pain relief
nitrous oxide how supplied
modified-demand valve with mixer to combine 50 percent of each gas for inhalation
D5W mechanism of action
D5W combines dextrose and water in a hypotonic concentration that will not remain in the vascular space, thus reducing the danger of fluid overload.
D5W indications
D5W is used for prophylactic IV access or to dilute concentrated drugs for IV infusion
D5W precautions
D5W may be more irritating to the tissues than normal saline, so the IV site should be closely monitored for irritation, swelling, or redness.
D5W contraindications
D5W should not be used for patients who require IV fluid replacement or in patients who are hyperglycemic. do not use in patients with traumatic brain injury or stroke
nitrous oxide side effects
Dizziness, decreased mental status, hallucinations, nausea, vomiting
lactated ringers precautions
monitor closely for signs of circulatory overload
aspirin side effects
GI upset, bleeding, nausea, vomiting and wheezing
D5W class
Hypotonic dextrose/carbohydrate-containing solution
glucagon class
Hormone with antihypoglycemic action
albuterol sulfate contraindications
Hypersensitivity, symptomatic tachycardia
colloids
IV fluids that contain proteins or large starch molecules. these molecules do not leave the intravascular space, allowing them to exert substantial osmotic pressure (in the form of colloid oncotic pressure). relatively small amounts of colloid solutions increase the circulating volume by attracting interstitial fluid into the vascular space.
Lactated Ringers solution (LR)
LR is an isotonic crystalloid that contains sodium, chloride, potassium, calcium, and lactate. because lactate is involved in the blood buffer system, it can be useful in patients with acidosis, such as those with hypovolemic shock or diabetic ketoacidosis. the addition of potassium makes lactated ringers solution useful in patients with suspected hypokalemia, but it is potentially dangerous in patients with hyperkalemia, such as patients with crush syndrome
ibuprofen class
NSAID (analgesic and antipyretic)
nitroglycerin side effects
NTG is a potent vasodilator and commonly causes a headache. may cause dizziness, weakness, tachycardia, hypotension, dry mouth, nausea, and vomiting. thee spray or tablets may cause a burning sensation on administration
naloxone class
Narcotic antagonist
epinephrine 1:1,000 side effects
Palpitations, tachycardia, anxiousness, headache, tremor. patients with underlying cardiac disease may also experience chest pain and acute myocardial infarction
aspirin class
Platelet Aggregation Inhibitor; nonsteroidal anti-inflammatory; analgesic
normal saline contraindications
Should not be given to patients with heart failure, because fluid overload may occur
lactated ringers solution mechanism of action
used to replace fluid and electrolytes
D5W dosage
usually administered at a keep open rate of 30mL/hour
nitrous oxide description
a 50/50 mix of oxygen and nitrous oxide delivered to modified demand valve and mask that the patient self administers by holding the mask and inhaling; used in the presence of severe pain from a musculoskeletal injury or an AMI.
isotonic fluids
a solution that has the same solute concentration as the solution to which it is being compared; does not cause significant fluid or electrolyte shifts in patients with normal fluid status, however, in patients with blood loss, only about 1/3rd of the fluid is still in the vascular space after it is administered.
albuterol sulfate mechanism of action
acts on beta2 sympathetic receptors in bronchiolar smooth muscle to cause bronchodilation
aspirin indications
acute coronary syndrome and stroke
glucose indications
acute hypoglycemia in a patient who is away and can protect his own airway
nitroglycerin dosage
administer 0.4 mg sublingually, if chest pain persists and the systolic blood pressure remains at least 90 mmHg, the dose may be repeated every 5 minutes to a total of 3 doses
aspirin precautions
administer in caution in patients with asthma or seasonal allergies, stomach ulcers, liver disease, alcohol abuse, kidney disease, or coagulopathies
epinephrine 1:1,000 mechanism of action
administered in anaphylaxis to cause vasoconstriction and relax bronchiolar smooth muscle
normal saline side effetcs
administration of large amounts of normal saline may result in hemodilution and electrolyte imbalance
acetaminophen dosage
adults 650-1000 mg every 4-6 hours, 4 gram maximum for 24 hours; pedes dose is 10-15 mg/kg every 4-6 hours with a 40mg/kg maximum every 24 hrs
albuterol sulfate precautions
albuterol has a minimal beta1-adrenergic effects, but it may increase heart rate and myocardial oxygen demand. use with caution in patients with heart disease
crystalloid solution
an intravenous fluid that consists of water and electrolytes or small carbohydrate molecules, such as glucose, but does not contain proteins or large starch molecules. crystalloid solutions may be hypotonic, isotonic, or hypertonic with respect to body fluids
acetaminophen class
analgesic, antipyretic (fever reducer)
aspirin mechanism of action
aspirin blocks part of the chemical reaction responsible for activating platelets
aspirin description
aspirin is a salicylate that reduces platelet aggregation by inhibiting the release of prostaglandin called thromboxane A2
nerve agent antidote kits
consists of prefilled injectors of atropine (2mg) and pralidoxime chloride (600mg). the medications are antitdotes for organophosphate nerve agents like tabun, sarin, and VX. they reduce parasympathetic nervous system stimulation by blocking the production and uptake of acetylcholine. you can use the autoinjectors to inject the medication subcutaneously
Nitrous Oxide Contraindications
decreased level of consciousness, inability to follow instructions, traumatic brain injury, COPD, suspected pnuemothorax, abdominal pain, and suspected bowel obstruction
normal saline dosage
depends on the condition, a keep-open rate is 30mL/hour
lactated ringers contraindications
do not use in patients with heart failure, renal failure, or suspected hyperkalemia
lactated ringers interactions
do not use with blood product infusion
nitrous oxide interactions
do not use with sedative-hypnotic medications, narcotics, or alcohol
nitroglycerin interactions
effects may be accentuated by alcohol use, erectile dysfunction medications, and beta blockers
epinephrine 1:1,000 description
epinephrine is a naturally occurring hormone (adrenaline) secreted by the adrenal glands in response to nervous system stimulation. epinephrine binds to alpha1, beta1, and beta2-adrenergic receptor sites, causing vasoconstriction, increased heart rate and force of contraction, and bronchiolar smooth muscle relaxation
ibuprofen side effects
gastric irritation
glucagon mechanism of action
glucagon causes a release of stored glycogen and its conversion of glucose when released into circulation. when administered, it causes an increase in blood glucose levels if the patient has adequate stores of glycogen for conversion to glucose.
glucagon description
glucagon is a pancreatic hormone that affects the blood glucose level by promoting glycogenesis and gluconeogenesis and inhibiting glycogenesis
glucagon how supplied
glucagon is supplied as a kit containing the powdered medication and solvent that must be combined before administration
glucose description
glucose is a simple carbohydrate that can be absorbed across the buccal mucosa or through the GI tract
class of saline
isotonic crystalloid
class of lactated ringers
isotonic crystalloid solution
what kind of solution is preferred for fluid replacement in the prehospital setting?
isotonic crystalloid solutions
Naloxone Contraindications/Precautions
known hypersensitivity, rapid administration in large doses may cause withdrawal in narcotic-addicted patients. many ems systems titrate the dosage to the minimum amount needed to ensure adequate breathing rather than complete reversal of the narcotic.
50% dextrose side effects
localized irritation of the vein
epinephrine 1:1,000 interactions
may be intensified in patients taking some antidepressants
naloxone interactions
may cause withdrawal symptoms in patients addicted to narcotics
naloxone description
medication used to reverse respiratory depression associated with narcotic overdose
acetaminophen indications
mild to moderate pain and fever
ibuprofen indications
mild to moderate pain and fever
naloxone mechanism of action
naloxone has a higher affinity for narcotic receptor sites and, when administered, displaces the narcotic, blocking its effects
glucose side effects
nausea and vomiting
nitroglycerin class
nitrate; vasodilator
nitroglycerin mechanism of action
nitrates are potent vasodilators that increase blood flow to the coronary arteries and decrease cardiac workload by dilating the peripheral vasculature and reducing preload
acetaminophen description
nonprescription medication used for the relief of mild to moderate pain and as a fever reducer
glucose route
oral or buccal
albuterol sulfate interactions
other beta agonists should not be administered concurrently with albuterol
normal saline precautions
patients receiving large volumes of normal saline should be monitored carefully for fluid overload. in patients who have lost significant amounts of electrolytes, it may be more appropriate to use lactated ringers or an alternative IV fluid containing electrolyte replacement
50% dextrose how supplied
prefilled syringe containing 25 grams of dextrose in 50mL
naloxone side effects
rare, but hypotension, nausea, hypertension, vomiting, and cardiac arrhythmias may occur
naloxone indications
respiratory depression associated with narcotic overdose
nitrous oxide dosage
self administered mixture of 50 percent nitrous oxide and 50 percent oxygen
nitrous oxide indications
severe musculoskeletal pain, and chest pain associated with acute coronary syndrome and not relieved by nitroglycerin
D5W interactions
should not be used for blood product infusion
glucagon side effects
side effects are rare, but hypotension, dizziness, headache, nausea, and vomiting may occur
lactated ringers indications
significant burns and hypovolemia
50% dextrose route
slow IV push through at least an 18-gauge IV catheter in a large vein
five percent dextrose in water (D5W)
solution of sterile water containing 5 percent dextrose. there are 5 grams of dextrose in every 100mL of water. dextrose solution is also available in 10 percent solution and in combination with other IV fluids, such as normal saline or lactated ringers solution. dextrose solutions are used when the patient can benefit from intravenous carbohydrates, such as patients who cannot have anything by mouth for a period of time. D5W also is useful for a keep-open IV in patients who are prone to fluid overload because it does not remain in the vascular space
Normal Saline (0.9% NaCl)
sterile water with sodium chloride added to equal the amount found in the body. normal saline is used for rehydration, vascular volume replacement, and diluting medications for intravenous infusion. saline solutions also come in other concentrations, both hypotonic and hypertonic
nitroglycerin description
supplied as tablets or a metered dose spray for sublingual administration in the treatment of acute coronary syndrome
albuterol sulfate description
sympathetic beta agonist used to reverse bronchiolar smooth muscle constriction in patients with asthma and COPD
acetaminophen mechanism of action
the mechanism of action is not completely understood, but acetaminophen increases the pain threshold by blocking prostaglandin synthesis and inhibits the effects of pyrogens in the CNS
Nitrous Oxide Precautions
use only in well ventilated area to prevent sedation of medical staff, teratogenic; should not be used by or around pregnant patients or healthcare providers
epinephrine 1:1,000 contraindications/ precautions
use with caution in patients with significant cardiovascular disease/hypertension. epinephrine is inactivated by exposure to sunlight or when given with an alkaline solution. because epi causes a strong sympathetic stimulus, patients may experience chest pain, palpitations, anxiety, nausea, or headache. monitor the patients heart rate and blood pressure
normal saline mechanism of action
used to expand the vascular volume temporarily by replacing water and electrolytes