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Provincial Reciprocity Attainment Program Provincial Reciprocity Attainment Program Symptom Relief

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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 - PowerPoint PPT Presentation

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Page 1: Symptom Relief

Provincial Reciprocity Attainment ProgramProvincial Reciprocity Attainment Program

Symptom Relief

Page 2: 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 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.

Page 3: Symptom Relief

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

Page 4: Symptom Relief

ASA Nitroglycerine Ventolin Epinephrine 1:1,000 Oral Glucose Glucagon Tetracaine (Alcaine, Diocaine…)

Medications given by the PCP

Page 5: Symptom Relief

Sub-Lingual (Nitroglycerine)

Orally (ASA, Glucose)

Subcutaneous (Epinephrine 1:1,000, Glucagon)

Inhaled (Ventolin)

Intravenous

Endotracheal

Routes

Page 6: Symptom Relief

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

Page 7: Symptom Relief

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.

Page 8: Symptom Relief

ASA

Onset: 30 minutes Peak: 2 hours (6 - 8 hours with enteric coated) Duration: dose dependent

Indications: Ischemic Chest PainAcute MIUnstable Angina

Contraindications: SensitivityActive 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)

Page 9: Symptom Relief

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 fatalInduce vomiting and administer activated charcoal

Page 10: Symptom Relief

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 workloadDecreases 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 painHypertensionCongestive Heart Failure (CHF) (ICP and ACP only)

Page 11: Symptom Relief

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 OLMCHypovolemiaHead injuryCerebral hemorrhage

Page 12: Symptom Relief

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

Page 13: Symptom Relief

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 resistanceIncreased BP and PulseIncreased coronary & cerebral flowIncreased MVO2

Increased automaticityBronchodilatation

Page 14: Symptom Relief

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

Page 15: Symptom Relief

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

Page 16: Symptom Relief

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: WheezingAnaphylaxis

Salbutamol

Page 17: Symptom Relief

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

Page 18: Symptom Relief

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

Page 19: Symptom Relief

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

Page 20: Symptom Relief

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

Page 21: Symptom Relief

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

Page 22: Symptom Relief

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

Page 23: Symptom Relief

Tetracaine

Supplied: Single disposable ampules

Side effects: May briefly increase eye irritation

Precautions: Removes patient’s blink reflex

Page 24: Symptom Relief

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

Page 25: Symptom Relief

Charcoal

Side effects: Constipation

Supplied: Bottles of 50 g

Precautions: Stains clothing Not effective against

Lithium or Acids/Alkali

Page 26: Symptom Relief

Calculations

Amount to be administered in volume=

Want/Have X Volume

Ex: give 0.1 ml/kg to a 70 kg ptvial 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