Symptom Relief
Provincial Reciprocity Attainment Program
Terms
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Pharmacodynamics
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The study of how a drug acts on a living organism.
Pharmacokinetics
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The study of how the body handles a drug over a period of time,
including the processes of:
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Pharmacology
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Absorption
Distribution
Biotransformation
Excretion.
The science of drugs used to prevent, diagnose, and treat disease.
Toxicology
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The scientific study of poisons, their detection, their effects and
treatments for the conditions they create.
Drug Nomenclature
 Generic
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Reflects the chemical structure of the drug
Diazepam
 Trade
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Also the brand name, is registered by manufacturer
Valium
 Official
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The official name used to list the drug
Valium USP
 Chemical
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The precise chemical description
Chloro-1,3 dehydor, 1 methyl, 5 phenyl -2H, 1,4 benzodiazepine one
Medications given by the PCP
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ASA
Nitroglycerine
Ventolin
Epinephrine 1:1,000
Oral Glucose
Glucagon
Tetracaine (Alcaine, Diocaine…)
Routes
 Sub-Lingual (Nitroglycerine)
 Orally (ASA, Glucose)
 Subcutaneous (Epinephrine 1:1,000, Glucagon)
 Inhaled (Ventolin)
 Intravenous
 Endotracheal
6 Rights of Drug
Administration
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The Right Patient
The Right Drug
The Right Dose
The Right Route
The Right Time
The Patients’ Right to Refuse
ASA
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Origin:
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Class:
Non-steroidal anti-inflammatory (NSAID);
Analgesic;
Antipyretic; Anti-coagulant
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Action:
Synthesized version of salicin found in the White
Willow tree
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Anti-coagulant effects: ASA inhibits Thromboxane A2 production
which is responsible for platelet aggregation. With the decrease
in platelet aggregation the blood does not form clots as easily.
The changes to the blood cell from ASA are irreversible, though
the cell only lives from 5 to 7 days.
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Other information: At high doses there is a direct stimulation of
the respiratory center in the medulla which increases rate and
depth of respirations (hyperventilation). You may also find
increase of respiratory alkalosis from the hyperventilation as O2
consumption and CO2 production increase. Also at high doses
ASA will block the secretion and reabsorption of uric acid.
ASA
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Onset:
Peak:
Duration:
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Indications:
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Contraindications: Sensitivity
Active peptic ulcer
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Side Effects:
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30 minutes
2 hours (6 - 8 hours with enteric coated)
dose dependent
Ischemic Chest Pain
Acute MI
Unstable Angina
GI:
Heartburn, N & V, diarrhea @ high doses, hemorrhage
Renal: Necrosis of renal papillary with long term use
Reye’s syndrome (a CNS infection relative to viral infection in
children such as chicken pox or influenza)
ASA
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Precautions:
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History of Gastrointestinal ulcers
Previous intake of daily aspirin
Asthma (asthmatic patients may have hypersensitivity to ASA
and precaution should be taken with first time use, a good history
prior to administration is essential)
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Dose:
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Preparation:
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Route:
PO
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Antidote:
500 mg/kg is fatal
Induce vomiting and administer activated
charcoal
160 mg PO
80 mg tablets
Nitroglycerine
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Class:
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Actions:
It was originally believed that nitroglycerin dilated coronary blood
vessels, thereby increasing blood flow to the heart. It is now believed that atherosclerosis
limits coronary dilation and that the benefits of nitrates are due to dilation of arterioles and
veins in the periphery, reducing preload and to a lesser extent, after load.
Nitrate, Antianginal
Therefore: Relaxes vascular smooth muscle (Veins…arterioles. arteries)
Decreases peripheral vascular resistance (PVR)
Decreases myocardial workload
Decreases myocardial oxygen consumption (MvO2)
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Onset/Peak/Duration:
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Onset:
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Duration:
Indications:
Spray/Tabs/IV:
Paste:
20 - 30 minutes
18 - 24 hours (paste)
1 – 3 minutes
30 minutes
Ischemic chest pain
Hypertension
Congestive Heart Failure (CHF) (ICP and ACP only)
Nitroglycerine
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Adverse Effects:
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headache, postural syncope
reflex tachycardia, hypotension
muscle twitching
diaphoresis, skin rash
nausea, vomiting
Precautions/Interactions:
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CNS:
Cardiovascular:
PNS:
Integumentary:
GI:
Additive effects may occur with other vasodilators.
Hypotension may result when combined with alcohol.
Contraindications:
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Relative: Glaucoma
Absolute: Allergy
Hypotension (BP < 100/50 mmHg)
Viagra usage 24 hours prior
If used within last 72 contact OLMC
Hypovolemia
Head injury
Cerebral hemorrhage
Nitroglycerine
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Preparation:
spray bottle (0.4 mg per spray)
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Dose:
0.4 mg SL q.5min (max of 3 doses)
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Max Dose:
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No maximum (the administration of NTG SL should be titrated to
effect while maintaining blood pressure >= 100 systolic.)
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Route:
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Antidote:
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SL
Manage nitroglycerin induced hypotension by terminating SL,
Trendelenburg position, and administration of NaCl bolus to
reestablish normotensive state may be attempted if protocols
allows
Epinephrine (1:1,000)
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Type:
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Action:
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Sympathomimetic; Sympathetic Agonist
This drug acts directly on the  (veins) and  (1-heart, 2- lungs)
receptor sites in the heart, lungs, skeletal muscles, skin, kidneys,
gastrointestinal tract, and other viscera.
There is a vasodilatation of the coronary arteries and the vessels
of the lungs and skeletal muscles.
Epinephrine has an inhibitory effect causing widespread
vasoconstriction in all other receptors sites within the body.
Therefore:
Increased vascular resistance
Increased BP and Pulse
Increased coronary & cerebral flow
Increased MVO2
Increased automaticity
Bronchodilatation
Epinephrine (1:1,000)
 Onset:
< 2 minutes
 Peak:
Is usually reached approximately 10
minutes after administration.
 Duration: relatively short may require readministration to maintain therapeutic levels.
 Indications:
Severe Anaphylaxis
 Contraindications:
 hypersensitivities
 no indications present
 Precautions:
 None
Epinephrine (1:1,000)
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Adverse Effects:
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Preparation:
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Ampules 1 mg/ml (1:1,000)
Epipens 0.3mg/2ml (1:1,000 adult)
0.15mg/2ml (1:2,000 child)
Dose:
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Palpitations, anxiety, tremulousness, headache, dizziness, nausea and
vomiting.
Due to its strong inotropic (force of contraction) and chronotropic (speed)
effects epinephrine increases myocardial oxygen demand.
Hypertension, tachycardia
Even low doses can result in myocardial ischemia.
Anaphylaxis:
Antidote:
Adult
Child
0.3 mg of 1:1,000 SC q 10-20 min
0.01 mg/kg of 1:1,000 SC q 20 min
There is no known antidote for epinephrine
Salbutamol
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Classification:
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Mechanism Of Action:
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β-2 stimulation causing smooth muscle relaxation of the bronchioles resulting in
bronchodialation
Slight β-1 stimulation causing a possible tachycardia
Dosage:
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Adult > 30kg (66 lbs)
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5.0 mg nebule with 8-10 lpm O2
4-6 puffs MDI prn
Peds 10-30kg (22 - 66 lbs)
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2.5 mg nebule & 8-10 lpm O2
2-3 puffs MDI
Infant < 10kg (< 22 lbs)
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β-2 agonist
1.25mg nebule & 8-10 lpm O2
Indications: Wheezing
Anaphylaxis
Salbutamol
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Contra-Indications:
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Side effects
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Tachycardia, Hypertension
Tremor, Headache
Dry Nose, throat
Arrhythmias
Supplied
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Allergy
Ischemic chest pain
5.0 mg nebules (2.5 mg/ml)
90 - 100 μg MDI
Precautions
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Vital signs before
Transport must not be delayed
Glucose
 Classification:
Anti-hypoglycemic
 Mechanism Of Action:
 Provides glucose to the system to allow for proper metabolism
 Dosage:
 1-2 tubes PO
 Indications:
 Hypoglycemic patient with Glucose less < 4.0
Glucose
 Contra-Indications:
 No indications present
 Loss of gag reflex
 Side effects
 May progress to hyperglycemia
 Supplied
 24 g tubes of carbohydrates
 Precautions
 Should be given to conscious patients
Glucagon
 Classification:
Anti-hypoglycemic
 Mechanism Of Action
 Stimulates glycogen release from the liver.
 Dosage:
 1.0 mg SQ Mid Deltoid area
 Indications:
 Hypoglycemic patient with altered Level of consciousness &
Glucose less <4,
 Unable to start IV & give D50
 Unable to give sugar PO
Glucagon
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Contra-Indications:
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Side effects
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nausea, vomiting
Dizziness
Possible BP Changes
Supplied
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No indications present
Allergy
History of pheochromocytoma
2 vials
#1
#2
1.0 mg powder
1.0 cc of diluting solution
Precautions
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Do not dilute powder with saline
Tetracaine
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Classification:
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Mechanism Of Action:
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Xylocaine Family
Topical Anesthetic
Stabilizes membranes of conjunctival and corneal pain fibers to
inhibit depolarization and perception of pain
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Dosage:
2-3 gtts in affected eye(s)
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Indications:
To allow flushing of the eye
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Contraindications:
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Possible penetrating injuries
Allergy to local anaesthetics
Tetracaine
 Supplied:
Single disposable ampules
 Side effects: May briefly increase eye
irritation
 Precautions: Removes patient’s blink reflex
Charcoal
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Classification: None (Prevention of Toxic Absorption)
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Mechanism Of Action:
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Dosage:
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Adult:
Pediatric:
1.0 – 2.0 g/kg
1.0 g/kg
Indications:
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Binds to most toxins or poisons
Reabsorbs poisons from liver or GI tracts
Alert and cooperative
Pts who have ingested a toxic substance
Contraindication
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Acid/alkali ingestions
Patient not alert/cooperative
No bowel sounds
Charcoal
 Side effects: Constipation
 Supplied:
Bottles of 50 g
 Precautions:
 Stains clothing
 Not effective against
 Lithium or Acids/Alkali
Calculations
 Amount to be administered in volume=
Want/Have X Volume
Ex:
give 0.1 ml/kg to a 70 kg pt
vial comes 10 mg/5 ml
0.1 mg/kg X 70 kg=7.0 mg
(7.0 mg/10 mg) X 5.0 ml=3.5 ml