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Zofran (ondansetron Hydrochloride)

Zofran (ondansetron Hydrochloride). North Country EMS Protocol Option July 2010. Brand versus Generic. Brand- Zofran Cost- ~$66.00 for 4 mg Generic – Ondansetron Hydrochloride Cost- ~ $5.00 for 4mg.

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Zofran (ondansetron Hydrochloride)

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  1. Zofran (ondansetron Hydrochloride) North Country EMS Protocol Option July 2010

  2. Brand versus Generic • Brand- Zofran • Cost- ~$66.00 for 4 mg • Generic – Ondansetron Hydrochloride • Cost- ~ $5.00 for 4mg

  3. Zofran (ondansetron hydrochloride) can be used instead of Reglan (metoclopramide)as an antiemetic. • North Country EMS 2007 Protocols • Acute Coronary Syndrome (page 18) • Nausea/Vomiting (page 35)

  4. Zofran (ondansetron hydrochloride) • This is approved for use in adult protocols. • Not approved for use in pediatric protocols. • Medical control order would be needed for Pediatric patient and dose is 0.1 mg/kg for children 2-12 y/o, if under 40 kg (88lbs) • Optional for agencies to carry.

  5. OLD • CARDIAC – ACUTE CORONARY SYNDROME (ACS) • (Suspected Cardiac Chest Pain) • Routine Medical Care • Chewable Aspirin 162 mg total • EMT-CC / EMT-P • If SBP >100 Nitroglycerine 0.4 mg SL* • May repeat every 3-5 min. x 2 • Transport patient as soon as feasible. Obtain 12 Lead ECG (if available) • Do not delay transport • Nausea/Vomiting present - Metoclopramide (Reglan) 10 mg IV/IM • If chest pain persists and SBP >100 • Morphine 2 mg IV • May repeat every 5 min. up to 20 mg • If heart rate >75 and SBP >100 • Metoprolol (Lopressor) 5 mg IV slow May repeat X 2 every 5 min. • Complete fibrinolytic checklist (Pg. 81, if transport time allows) • Do not delay initial Nitroglycerin therapy to establish IV access. • Nitroglycerine is contraindicated in patients who have taken • Erectile Dysfunction medication within 24 hours. • If SBP <100 without Altered Mental Status; consider Medical Control consultation for Nitroglycerine administration. NEW • CARDIAC – ACUTE CORONARY SYNDROME (ACS) • (Suspected Cardiac Chest Pain) • Routine Medical Care  • Chewable Aspirin 162 mg total • EMT-CC / EMT-P • If SBP >100 Nitroglycerine 0.4 mg SL* • May repeat every 3-5 min. x 2  • Transport patient as soon as feasible. Obtain 12 Lead ECG (if available)  • Do not delay transport  • Nausea/Vomiting present – Metoclopramide (Reglan) 10 mg IV/IM or • Ondansetron (Zofran) 4 mg IV/IM (may repeat X 1 after 5 minutes if no relief) • If chest pain persists and SBP >100 • Morphine 2 mg IV • May repeat every 5 min. up to 20 mg • If heart rate >75 and SBP >100  • Metoprolol (Lopressor) 5 mg IV slow May repeat X 2 every 5 min.  Complete fibrinolytic checklist (Pg. 81, if transport time allows) • Do not delay initial Nitroglycerin therapy to establish IV access. •  Nitroglycerine is contraindicated in patients who have taken • Erectile Dysfunction medication within 24 hours. • If SBP <100 without Altered Mental Status; Control consultation for Nitroglycerine administration.

  6. NAUSEA / VOMITING Indicated for patients experiencing nausea and/or vomiting as a result of disease, medications or acute motion sickness. EMT-CC / EMT-P Routine Medical Care Consider Fluid Challenge (Pg. 26) Metoclopramide (Reglan) 10 mg IV/IM Or Ondansetron (Zofran) 4 mg IV/ IM (Slow IV Push 2-5 minutes) (May repeat x 1 if no relief after 5 minutes)

  7. Zofran (Ondansetron Hydrochloride) • Class-Antiemetic • Description –Serotonin (5-HT₃) receptor antagonist-Blocking action may take place in CNS at area postema (chemoreceptor trigger zone) and in peripheral nervous system on terminals of vagus nerve • Indications- nausea and vomiting • Contra Indications – Hypersensitive to drug • Precautions-In pregnant and breast-feeding women use cautiously, may be excreted in breast milk, may cause syncope if pushed to fast • Dosage- 4 mg slow IV push (over 2-5 minutes) or 4 mg IM

  8. Zofran (ondansetron Hydrochloride)Pharmacokinetics • Absorption: Variable; bioavailability is 50% to 60% • Distribution: 70% to 76% is protein bound • Metabolism: Extensively metabolized. • Excretion: Primarily excreted in urine, can be excreted in feces or breast milk. • Half-life : 4 hours

  9. Zofran (ondansetron Hydrochloride)Adverse Reactions • CNS: - Headache • GI: Diarrhea, Constipation • Skin: Rash Side effects may include: constipation, diarrhea, drowsiness, dizziness, fatigue, headache, impaired wound healing, itch, decreased heart rate, fever, anxiety/agitation

  10. Any questions please contact North Country EMS at 315-379-3977. • You must complete training program and quiz prior to using medication. • Agencies must keep copy of providers completed quiz on file, provider must obtain 80% or better on quiz. • Documented remediation from training officer or medical director required if score is 80% or less

  11. Works Sited • Springhouse Nurses Drug Guide 2005, pg 942. • North Country EMS 2007 Protocol Book • Physician Desk Reference Health (pdrhealth.com)

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