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