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Symptom Relief

Symptom Relief. Terms. Pharmacodynamics The study of how a drug acts on a living organism. Pharmacokinetics The study of how the body handles a drug over a period of time, including the processes of: Absorption Distribution Biotransformation Excretion. Pharmacology

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Symptom Relief

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  1. Symptom Relief

  2. Terms • Pharmacodynamics • The study of how a drug acts on a living organism. • Pharmacokinetics • The study of how the body handles a drug over a period of time, including the processes of: • Absorption • Distribution • Biotransformation • Excretion. • Pharmacology • The science of drugs used to prevent, diagnose, and treat disease. • Toxicology • The scientific study of poisons, their detection, their effects and treatments for the conditions they create.

  3. Drug Nomenclature • Generic • Reflects the chemical structure of the drug • Diazepam • Trade • Also the brand name, is registered by manufacturer • Valium • Official • The official name used to list the drug • Valium USP • Chemical • The precise chemical description • Chloro-1,3 dehydor, 1 methyl, 5 phenyl -2H, 1,4 benzodiazepine one

  4. Medications given by the PCP • ASA • Nitroglycerine • Ventolin • Epinephrine 1:1,000 • Oral Glucose • Glucagon • Tetracaine (Alcaine, Diocaine…)

  5. Sub-Lingual (Nitroglycerine) Orally (ASA, Glucose) Subcutaneous (Epinephrine 1:1,000, Glucagon) Inhaled (Ventolin) Intravenous Endotracheal Routes

  6. 6 Rights of Drug Administration • The Right Patient • The Right Drug • The Right Dose • The Right Route • The Right Time • The Patients’ Right to Refuse

  7. ASA • Origin: Synthesized version of salicin found in the White Willow tree • Class: Non-steroidal anti-inflammatory (NSAID); Analgesic; Antipyretic; Anti-coagulant • Action: • 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. • 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.

  8. ASA • Onset: 30 minutes • Peak: 2 hours (6 - 8 hours with enteric coated) • Duration: dose dependent • Indications: Ischemic Chest Pain Acute MI Unstable Angina • Contraindications: Sensitivity Active peptic ulcer • Side Effects: • 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)

  9. ASA • Precautions: • 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) • Dose: 160 mg PO • Preparation: 80 mg tablets • Route: PO • Antidote: 500 mg/kg is fatal Induce vomiting and administer activated charcoal

  10. Nitroglycerine • Class: Nitrate, Antianginal • 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. Therefore: Relaxes vascular smooth muscle (Veins…arterioles. arteries) Decreases peripheral vascular resistance (PVR) Decreases myocardial workload Decreases myocardial oxygen consumption (MvO2) • Onset/Peak/Duration: • Onset: Spray/Tabs/IV: 1 – 3 minutes Paste: 30 minutes • Duration: 20 - 30 minutes 18 - 24 hours (paste) • Indications: Ischemic chest pain Hypertension Congestive Heart Failure (CHF) (ICP and ACP only)

  11. Nitroglycerine • Adverse Effects: • CNS: headache, postural syncope • Cardiovascular: reflex tachycardia, hypotension • PNS: muscle twitching • Integumentary: diaphoresis, skin rash • GI: nausea, vomiting • Precautions/Interactions: • Additive effects may occur with other vasodilators. • Hypotension may result when combined with alcohol. • Contraindications: • 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

  12. Nitroglycerine • Preparation: spray bottle (0.4 mg per spray) • Dose: 0.4 mg SL q.5min (max of 3 doses) • Max Dose: • No maximum (the administration of NTG SL should be titrated to effect while maintaining blood pressure >= 100 systolic.) • Route: SL • Antidote: • Manage nitroglycerin induced hypotension by terminating SL, Trendelenburg position, and administration of NaCl bolus to reestablish normotensive state may be attempted if protocols allows

  13. Epinephrine (1:1,000) • Type: Sympathomimetic; Sympathetic Agonist • Action: • 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

  14. Epinephrine (1:1,000) • Onset: < 2 minutes • Peak: Is usually reached approximately 10 minutes after administration. • Duration: relatively short may require re-administration to maintain therapeutic levels. • Indications: Severe Anaphylaxis • Contraindications: • hypersensitivities • no indications present • Precautions: • None

  15. Epinephrine (1:1,000) • Adverse Effects: • 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. • Preparation: • Ampules 1 mg/ml (1:1,000) • Epipens 0.3mg/2ml (1:1,000 adult) 0.15mg/2ml (1:2,000 child) • Dose: • Anaphylaxis: Adult 0.3 mg of 1:1,000 SC q 10-20 min Child 0.01 mg/kg of 1:1,000 SC q 20 min • Antidote: There is no known antidote for epinephrine

  16. Classification: β-2 agonist Mechanism Of Action: β-2 stimulation causing smooth muscle relaxation of the bronchioles resulting in bronchodialation Slight β-1 stimulation causing a possible tachycardia Dosage: Adult > 30kg (66 lbs) 5.0 mg nebule with 8-10 lpm O2 4-6 puffs MDI prn Peds 10-30kg (22 - 66 lbs) 2.5 mg nebule & 8-10 lpm O2 2-3 puffs MDI Infant < 10kg (< 22 lbs) 1.25mg nebule & 8-10 lpm O2 Indications: Wheezing Anaphylaxis Salbutamol

  17. Contra-Indications: Allergy Ischemic chest pain Side effects Tachycardia, Hypertension Tremor, Headache Dry Nose, throat Arrhythmias Supplied 5.0 mg nebules (2.5 mg/ml) 90 - 100 μg MDI Precautions Vital signs before Transport must not be delayed Salbutamol

  18. 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

  19. 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

  20. 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

  21. Glucagon • Contra-Indications: • No indications present • Allergy • History of pheochromocytoma • Side effects • nausea, vomiting • Dizziness • Possible BP Changes • Supplied • 2 vials • #1 1.0 mg powder • #2 1.0 cc of diluting solution • Precautions • Do not dilute powder with saline

  22. Tetracaine • Classification: Xylocaine Family • Mechanism Of Action: • Topical Anesthetic • Stabilizes membranes of conjunctival and corneal pain fibers to inhibit depolarization and perception of pain • Dosage: 2-3 gtts in affected eye(s) • Indications: To allow flushing of the eye • Contraindications: • Possible penetrating injuries • Allergy to local anaesthetics

  23. Tetracaine • Supplied: Single disposable ampules • Side effects: May briefly increase eye irritation • Precautions: Removes patient’s blink reflex

  24. Charcoal • Classification: None (Prevention of Toxic Absorption) • Mechanism Of Action: • Binds to most toxins or poisons • Reabsorbs poisons from liver or GI tracts • Dosage: • Adult: 1.0 – 2.0 g/kg • Pediatric: 1.0 g/kg • Indications: • Alert and cooperative • Pts who have ingested a toxic substance • Contraindication • Acid/alkali ingestions • Patient not alert/cooperative • No bowel sounds

  25. Charcoal • Side effects: Constipation • Supplied: Bottles of 50 g • Precautions: • Stains clothing • Not effective against • Lithium or Acids/Alkali

  26. 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

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