ASA
ASA Indications
Suspected ACS
Naloxone indications
1. Respiratory and neurologic depression induced by opiate intoxication unresponsive to oxygen and hyperventilation
2. Decreased LOC or coma of unknown etiology believed to be induced by narcotics
Epinephrine classifications
Sympathomimetic; endogenous catecholamine
Nitroglycerine trade name
Nitrostat
Oral Glucose Action
A simple monosaccharide used to increase circulating blood glucose levels
Salbutamol Indications
Treatment of bronchospasm due to asthma, COPD, anaphylaxis or associated with airway burn injury
ASA Trade Name
Asprin
Naloxone pharmacokinetics
Onset: Within two minutes (IV/IO)
Duration of action: Dependent on route, dose and amount of pre-existing opioid present in patient
Epinephrine trade name
Adrenalin
Nitroglycerine actions
Causes relaxation of vascular smooth muscle; dilation of both arterial and venous blood vessels, decreasing both preload and afterload. Myocardial perfusion is increased through coronary and collateral blood vessel dilation.
Salbutamol Contraindications
1. Hypersensitivity
2. Uncorrected tachydysrhythmias
Side effects of ASA
1. GI irritation
2. NV
3. Tinnitus
4. Increased risk of bleeding
1. Displaces previously administered opioid analgesics from all three opioid receptor sites and competitively inhibits their actions.
2. Naloxone is metabolized more quickly than most narcotics.
Epinephrine indications
Anaphylaxis
Antianginal, Vasodilator
Oral glucose contraindications
Unconscious
Hyperglycemic
Salbutamol Classification
Bronchodilator (sympathomimetic)
Contraindications of ASA
1. Hypersensitivity to salicylates/NSAIDS
2. Asthma (relative contraindication)
3. Patients with active ulcer disease (active GI hemorrhage)
4. Bleeding disorders
5. Pregnancy (especially third trimester)
6. Children under 15 years old
7. Unconscious
Naloxone side effects
1. Restlessness
2. Seizures
3. Narcotic withdrawal
4. Combative
Epinephrine contraindications
None in emergent situations
2. Hypersensitivity to epinephrine
3. Uncorrected tachydysrhythmias
4. Shock (non-anaphylactic)
Nitroglycerine contraindications
1. Systolic BP less than 100 mmHg
2. Right ventricular infarction
3. Patients taking phosphodiesterase inhibitors
Oral Glucose indications
Conscious patients with suspected hypoglycemia
Salbutamol Trade name
Ventolin
Dosage ASA Adult
160mg PO chewed do not repeat
Narcotic Antagonist
Epinephrine pharmacokinetics
Onset of Action: 5-10min (IM)
Peak effects: 20 min
Nitroglycerine indications
Suspected ACS
Salbutamol Pharmacokinetics
Onset: Less than 15 mins 2. Duration of action: 2 – 6 hours
Pharmacokinetics ASA
Onset: 1-2 hrs
Duration 4-5 hrs
Naloxone trade name
Narcan
Epinephrine dosage
0.3mg 1:1,000 IM q 5 min prn, max 0.9mg
Nitroglycerine side effects
1. Headache
2. Hypotension
3. Dizziness/Lightheadedness
4. Nausea/Vomiting
5. Flushing
Salbutamol Actions
1. Selective Beta2 stimulation
2. Bronchodilation, some peripheral vasodilation, slight tachycardia
3. Beta2 selectively lost with high doses (Beta1 effects more common)
ASA classifications
Antiplatelet; analgesic; antipyretic; anti-inflammatory (Nonsteroidal Anti-Inflammatory Drug (NSAID)
Naloxone contraindications
None significant.
*Use with caution in the setting of mixed opioid / stimulant (methamphetamine, cocaine PMMA, MDMA) overdose, since the narcotic may be exerting a mediating effect on sympathomimetic symptoms.
Epinephrine side effects
1. Palpitation
2. Tremors
3. Hypertension
4. Tachycardia
5. Nervousness
Nitroglycerine dosage
0.4 mg SL spray q 5 min prn or until systolic BP less than 100 mmHg (AHS)
0.8 mg/hr patch (AHS)
Oral glucose pharmacokinetics
Onset: 5-15 min
Duration of action: varies
Salbutamol Dosages (both MDI and Neb)
1 Puff MDI (100mcg/puff) with spacer q 30-60 secs prn, max 30 puffs Or 5 mg nebulized continuously
ASA Therapeutic Actions
1.Blocks the formation of thromboxane A2, which is responsible for platelets aggregating and arteries constricting
2. Produces analgesia and has anti-inflammatory, and antipyretic effects by inhibiting the
production of prostaglandins.
0.4 mg IV/IO push q 2 minutes to total max of 1.6 mg
Or 0.8 mg IM q 5 min prn, total max 3.2mg
Or 2mg intranasal (1mg per nostril) q 3-5 minutes prn, total max 4mg
Epinephrine actions
1. Alpha 1 agonista. Peripheral vasoconstriction improving coronary and cerebral perfusion
2. Beta 1 agonista. Positive chronotropic, inotropic, and dromotropic properties b. Increases automaticity in the heart
3. Beta 2 agonist-
a. Bronchodilation
Nitroglycerine pharmacokinetics
Onset: 1-3 min (SL), Patch 40-60 min
Duration of Action: SL - 3-60 min, Patch – 8- 24 hours
Oral glucose side effects
Nausea/Vomiting
Salbutamol Side effects
1. Tremors
2. Palpitations
3. Headache
4. Tachycardia
5. Dizziness
6. Nervousness