Acetaminophen is a synthetic non-opiate derivative of p-aminophenol which produces analgesia and antipyresis. Acetaminophen is rapidly and almost completely absorbed from the GI tract. Following administration of acetaminophen, peak plasma concentrations are attained within 10-60 minutes.Therapeutic doses of acetaminophen appear to have little effect on cardiovascular and respiratory systems. Toxic doses may cause circulatory failure and rapid, shallow breathing.
Acetaminophen - Indications
Acetaminophen is used frequently to lower body temperature in pediatric febrile patients in whom fever may be deleterious or in whom considerable relief is obtained when fever is lowered.
Acetaminophen - Precautions
A. Acetaminophen is relatively nontoxic in therapeutic does.
B. Acetaminophen should be used with caution in patients with preexisting anemia.
C. Repeated administration of acetaminophen is contraindicated in patients with anemia or cardiac, pulmonary, renal, or hepatic disease.
Acetaminophen - Route/Dose
General dose is 10 mg/kg. Pediatric patients over the age of 1yrs may receive 120 mg rectal suppository.
Activated Charcoal - Action
Adsorbs toxic substances ingested, and inhibits gastrointestinal absorption by forming an effective barrier between remaining particulate material and the gastrointestinal mucosa.
Activated charcoal - Indications
Effective in the management of poisoning or overdose of many substances.
Activated charcoal - Precautions
A. May not be given to patients who are unconscious or with diminishing level of consciousness.
B. May be ineffective in ingestion such as mineral acids, alkalis, petroleum products or cyanide.
C. Never give simultaneously with Ipecac - may prevent emesis.
D. May result in aspiration or significant particulate obstruction of the airway.
Activated Charcoal - Route/Dose
A. 1gm/kg. of Activated Charcoal. If administered, an aqueous-based solution must be used. Dosage may be higher as directed by a physician.
B.Consider administration per nasogastric tube if patient refuses oral ingestion.
Adenosine - Action
1. Adenosine is a naturally occurring nucleoside.
2. Acts on AV node to slow conduction and inhibit reentry pathways. Half life of 10 seconds. Onset immediate.
Adenosine - Indications
To convert paroxysmal supraventricular tachycardia into sinus rhythm.
Adenosine - Contraindications
1. 2nd and 3rd degree heart block
2. Sick Sinus Syndrome
3. Ventricular tachycardia
4. Known Atrial Fib./Flutter
5. Patients taking Tegretol (carbamazepine)
6. Denervated heart (heart transplant)
Adenosine - Precautions
1. Patients may develop a transient heart block, other transient dysrythmias, or asystole.
2. Chest pain, dizziness, blurred vision; low BP, backache, headache, heaviness in arms, etc. are all possible side effects.
Adenosine - Route/Dose
1. IV should be started in AC region of arm or higher. Fluid should be Normal Saline for rapid bolus after administration.
2. 6mg very rapid I.V. push, if not effective in 1-2 minutes, give 12 mg very rapid I.V. push ASAP. May repeat 12mg dose once if first two doses (18mgs) is unsuccessful. When 12mg used, both unit doses (6mg) must be mixed together, then flushed.
Albuterol - Actions
Aqueous solution administered by oral inhalation with the aid of hand-held nebulizer system. It is a very selective Beta-2 agonist with very little Beta-1 stimulation. Onset of action is 5-15 minutes. Duration of action is 4-6 hrs. Primary effect is to relax bronchial smooth muscles with resultant relief of bronchospasm.
Albuterol - Indications
1. Acute asthma.
2. Reversible bronchospasm associated with obstructive airway disease, bronchitis or mild CHF.
Albuterol - Precautions
1. As with other adrenergic aerosols, the potential for paradoxical bronchospasm exists.
2. Use with caution for patients being treated with monoamine oxidase inhibitors (i.e. Elavil, Sinequan) since the action of albuterol may be potentiated on the vascular system.
3. Use with caution for patients with history of HTN, coronary artery disease, CHF or MI.
4. Do not use in patients exhibiting signs of acute CHF, MI or cardiac arrythmia without consult from medical control.
5. Use with caution in Pregnancy.
Albuterol - Route/Dose
1. Use one 3cc ampule containing 2.5mg of albuterol. Administer by nebulizer. If patient is intubated, double the dose and give ET (non nebulized).
2. Use this dosage for adults and children over age of 12.
3. For under age 12 dosage per medical control. WEIGHT // ALBUTEROL DOSE // SALINE DILUTION <15 kg 1cc (.83 mg) 2 cc // 15-25 kg 2cc (1.66 mg) 1 cc // >25 kg3cc (2.5 mg)0 cc* Total solution in nebulizer should be 3.0 cc.
1. Via nebulization with mouthpiece or aerosol mask.
2. Oxygen source at 8 liters per min.
3. Have patient inhale slowly and exhale passively through the nose.
4. On every 4th breath, inhale deeply and pause 1-2 seconds before exhaling (may improve the anxious dyspneic patient and drug absorption).
Albuterol - Side Effects
Tremor is most common. Also palpitations, tachycardia, nervousness,dizziness, hypertension, nausea, vomiting, angina, headache, and drying of the oropharynx.
Amiodarone - Actions
1. Prolongation of myocardial cell action potential.
A. 300mg IVP, may repeat in 3-5 minutes with 150mg IVP. Do not administer over 2.2grams IV in 24 hours.
B. PEDIATRIC – 5mg/kg IVP/IO
2. Narrow and Wide Complex Tachycardia:
150mg slow IVP over 10 minutes. May repeat 150mg slow IVP once or for maintenance if rhythm converts.
Supplied in 150mg pre-loaded syringe; add 150-300mg of amiodarone to 100ml NaCl bag and run wide-open through a macrodrip. Ensure all air/foam remains at top of fluid bag.
Ancef - Actions
Cefazolin is a first generation semi-synthetic cephalosporin antibiotic. It works well against many gram positive cocci but has limited activity against gram-negative bacteria.
Ancef - Indications
For infection prophylaxis.
Ancef - Contraindications
1. Allergies to cephalosporins.
2. Use with caution with known allergies to penicillin.
Ancef - Route/Dose
1. Adult:1gm may be given IV over 3-5 minutes.
2. For IV dilute powder with 2.5cc of saline and shake or roll vial until completely dissolved. Then withdraw the contents of the vial into a 10cc syringe and dilute further with saline to a total volume of 10cc. Concentration shall be 100 mg/ml. Slowly push over 3-5 minutes.
1. Cefazolin may be diluted, as above, with 2-5cc of normal saline for deep IM administration.
2. Pediatric: 15mg/kg given IV over 3-5 minutes. IM administration may have to be divided and given in two sites because of volume.
Aspirin - Actions
Aspirin exhibits analgesic, anti-inflammatory, and antipyretic activity. It also increases bleeding time.
Aspirin - Indications
1. Aspirin may be used to reduce the risk of death and/or nonfatal myocardial infarction in patients with unstable angina.
2. Aspirin should be given when a high suspicion exists for chest pain related to a myocardial event.
Aspirin - Contraindications
1. Patients with bleeding disorders such as hemophilia, von Willebrand's disease, or telangiectasia.
2. Active GI lesions (e.g., erosive gastritis, peptic ulcers).
3. GI bleeding.
Aspirin - Precautions
1. Impaired renal function.
2. Patients should be informed that alcohol has a synergistic effect with aspirin in causing GI bleeding.
3. Cerebrovascular Disease.
Aspirin - Route/Dose
Give four 81.0 mg.(total dose 324mg)chewable tablets.
Atropine - Actions
Atropine Sulfate is a muscarinic-cholinergic blocking agent. As such, it has the following effects:
1. Increases the heart rate by blocking vagal influences.
2. Increases conduction through AV node.
3. Reduces motility and tone of gastrointestinal tract.
4. Reduces action and tone of urinary bladder.
5. Dilates pupils
Atropine - Indications
1. To increase the heart rate in bradycardias.
2. To improve conduction in 2nd and 3rd degree heart block.
3. As an antidote for some insecticide exposures (anticholinesterases, i.e., organophosphates) and nerve gas.
4. To counteract excessive vagal influences responsible for some bradysystolic and asystolic arrests.
Atropine - Precautions
1. Use with caution in atrial fibrillation and atrial flutter because increased conduction will speed ventricular rate excessively.
2. Use with caution in the Myocardial infarcted patient.
Atropine - Route/Dose
1. Adult: 0.5-1.0 mg IV/IO, repeated if needed at 3-5 min. intervals to a total dose of 2-3 mg (0.04 mg/kg) or when ventricular rate is 60 or better/min.
2. Pediatric: 0.02 mg/kg IV/IO/ET. Minimum dose is 0.1mg.
3. Organophosphate Overdose: 1.0-2.0 mg IV/IO every 5 minutes until secretions have substantially decreased.
Atrovent - Actions
Atrovent (ipratropium bromide), a quaternary ammonium derivative of atropine, produces a local, site-specific effect and is relatively free of the systemic side effects associated with earlier anticholinergic compounds. Pulmonary vagal tone is the major determinant of resting airway caliber and resistance. Parasympathetic or cholinergic receptors are found on bronchial smooth muscle. This anatgonizes the action of acetylcholine and thus decreases the formation of active cyclic GMP. Thus Atrovent improves impaired pulmonary function by decreasing resting bronchial smooth muscle tone and blocking reflex bronchospasm. Atrovent acts differently from sympathomimetic agents in that it directly inhibits bronchial smooth muscle contractility by cholinergic blockade. Sympathomimetics, on the other hand, stimulate adrenergic receptor sites, which results in a series of chemical events that serve to decrease bronchoconstriction.