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Medical Emergencies Final > Adverse Drug Reactions > Flashcards

Adverse Drug Reactions Flashcards

1
Q

Drug dosages should be decreased for:

A

ages under 6 and over 65

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2
Q

If you have lean body weight, you can tolerate ____ dosages of drugs before overdose due to _____. If you are adipose/obese, you can tolerate _____ dosages of drugs before overdose due to _____.

A

larger
greater blood volume
smaller
lower blood volume

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3
Q

Patients with CHF show blood levels ___ those of healthy patients at the same dosage. Why?

A

twice

  • decreased blood volume
  • diminished hepatic blood flow
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4
Q

If you have a pulmonary disease with CO2 retention, what happens?

A

Inc. CO2 causes respiratory acidosis, and respiratory acidosis lowers seizure levels for LAs.

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5
Q

Effects of atypical pseuodocholinesterase metabolism:

A
  • decreased metabolism of ester anesthetics and succinylocholine
  • leads to overdose, prolonged actions
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6
Q

If your patient is stressed, their convulsive threshold is_____.

A

lowered

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7
Q

An apprehensive patient would perceive ____ as ____, so the dentist would give additional anesthesia leading to a potential ______.

A

perceive pressure as
pain
overdose

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8
Q

If a LA has a higher level of protein binding, they will have ____absorption into blood leading to ____ activity and ____safety. An example of a LA with these characteristics is _____.

A

slower absorption
prolonged activity
increased safety
bupivicaine

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9
Q

The greater the degree of vasodilation, the more _______ the absorption.

A

more rapid

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10
Q

What determines dosage blood level?

A

mg of drug given, not concentration of the drug.

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11
Q

The larger the dose, the _______ ___ ____ of blood level of the drug.

A

the larger the dose, the higher the peak

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12
Q

A LA should be injected _______ because a _____ intravascular injection will lead to _______ levels and _____ effects.

A

should be injected slowly
because a rapid injection will lead to
high blood levels with overdose effects

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13
Q

The ______ the vascularity of an injection site, the more _____ the drug is absorbed into circulation. The mouth is highly vascular which is why we use ______.

A

greater
rapid
vasoconstrictors

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14
Q

If your liver has decreased function, which LA should you limit?

A

amides

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15
Q

Give me three options for topicals:

A
  1. 5% lidocaine
  2. dentipatch
  3. benzocaine- poorly absorbed with lower H2O solubility
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16
Q

If you inject intravascularly, you will see:

A
  • rapid onset of signs/symptoms

- unconsciousness and seizures within minutes

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17
Q

If you overdose an injection, you will see signs and symptoms appear within ______ for LAs without vasoconstrictors, and within _______ for LAs with vasoconstrictors.

A

5-10 minutes LAs w/out vasoconstrictors and
30 minutes LAs w/ vasoconstrictors
A mild overdose signs and symptoms may not occur for 90 minutes.

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18
Q

Signs of minimal to moderate blood levels:

A
  • Apprehension or excitedness (polar opposites, ok)
  • Talkativeness, slurred speech, stutter
  • Confusion
  • Muscle twitching, tremor
  • nystagmus (eye twitching)
  • Increase HR, BP, respiratory rate
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19
Q

Symptoms of minimal to moderate blood levels:

A
  • Headache, lightheaded, dizzy
  • blurred vision, ringing in ears, numb tongue
  • flushed or chilled; drowsy
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20
Q

Three signs/symptoms of moderate to high blood levels:

A
  1. Generalized tonic-clonic seizure
  2. CNS depression after convulsions
  3. Decreased HR, BP, respiratory rate
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21
Q

An overdose of ______ or ______ may appear initially as _______ and _______ before unconsciousness or seizure activity.

A

overdose of lidocaine or mepivicaine may appear initially as drowsiness and nystagmus

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22
Q

_____ depression occurs before _____ depression

A

CNS depression occurs before CVS depression

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23
Q

Your patient has a mild overdose. What four diagnostic cues tell you they have a mild overdose? What steps do you take to manage it?

A
  1. talkative
  2. increased anxiety
  3. facial muscle twitching
  4. increased BP, HR, respiratory rate
    P: comfortable position and reassure patient (LOL I did this to you.)
    CAB: not a concern
    D: administer oxygen, monitor vitals
    Administer anticonvulsant IV midazolam or diazepam
    Activate EMS
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24
Q

If a patient has rapid onset, what is their discharge procedure?

A

Recovery as needed, but can continue with treatment. Patient can leave unescorted, but evaluate by physician if there are questions.

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25
Q

If a patient has delayed onset, what is their discharge procedure?

A

Recovery as needed, but patient needs to be escorted to hospital for physician evaluation.

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26
Q

Your patient has a severe overdose with a RAPID onset. What diagnostic cues can tell you they have a severe overdose?

A
  1. Symptoms appear during injection or seconds after completion.
  2. Generalized tonic-clonic seizures
  3. Loss of consciousness
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27
Q

What are the steps of management for a patient with severe overdose with rapid onset?

A

P: supine
ACTIVATE EMS with any seizure with LA injection. If unconsciousness continues after supine position, it’s not vasodepressor syncope, med assistance needed.
CAB: as indicated
D:
-administer oxygen- airway maintenance and assisted ventilation are necessary to prevent hypercarbia and hypoxia which lead to lower threshold level.
-protect patient and monitor vitals
-IV anticonvulsant

28
Q

During postictal periods for a patient with severe overdose with rapid onset, how do you mange the patient?

A
  1. close monitoring of vitals, strict attention to CABs

2. Discharge with medical personnel

29
Q

What are the symptoms and steps of management for a patient with severe overdose with slow onset?

A
  1. Overdose progresses from mild to tonic-clonic seizures over a relatively brief period of time (5 mins)
  2. Same management as severe with rapid onset
    (P: supine
    Activate EMS
    CAB: as indicated
    D: O2, protect patient, monitor vitals, give anticonvulsant)
30
Q

A patient taking __________ cannot eliminate epinephrine at the normal rate and are more susceptible to epinephrine overdose. Patients on __________ may also result in an epi overdose.

A

MAO inhibitors

noncardioselective B blockers

31
Q

Two signs of an epinephrine overdose:

A

Elevated BP and HR

32
Q

Symptoms of epinephrine overdose:

A
  • fear, anxiety
  • restless, dizzy, headache, tremor, weakness
  • perspiration, respiratory difficulty, palpitations
33
Q

What four complications can incur from epinephrine overdose?

A
  1. increased BP could produce CVA
  2. Cardiac dysrhythmias
  3. Anginal pain
  4. MI
34
Q

How do you manage an Epinephrine overdose?

A 
P: comfortable position but AVOID supine
CAB
D: 
-Reassure patient
-Monitor vitals
-Activate EMS (markedly elevated BP)
-O2
-Administer vasodilator if BP doesn't return to baseline
-if patient's symptoms persist, take to hospital
35
Q

Name four diagnostic cues of a sedative hypnotic overdose:

A
  1. Decreased consciousness
  2. Respiratory depression
  3. Slurred speech
  4. Loss of motor coordination
36
Q

Management of sedative hypnotic overdose:

A

P: supine
CAB: Make sure adequate oxygenation
-assisted ventilation if necessary: Adult 1br/5sec or child 1br/3sec
D: Activate EMS
-Oxygen
-Vitals
-BLS until cerebral blood level of drug decreases
-Start IV line after opening airway
-Give antagonist (Flumazenil: reversal agenet for benzodiazepines

37
Q

Diagnostic cues of an opioid overdose:

A
  1. Altered loss of consciousness
  2. Respiratory depression
  3. Miosis
38
Q

Management of sedative opioids or narcotics overdose:

A 
P: supine
CAB: Make sure adequate oxygenation
D: Activate EMS
-O2
-Vitals
-IV after opening airway
-Give antagonist (Naloxone IV or IM): .1mg per minute IV until respiratory rate increases or .4mg IM
39
Q

What is chief manifestation of aspirin allergy?

A

bronchospasm

40
Q

Patients with a history of these three things have a greater risk for anaphylactic reactions with aspirin:

A

nasal polyps
pansinusitis
asthma

41
Q

What two components of a local anesthetic cartridge could a patient have an allergy to?

A

methylparaben and sodium bisulfite

42
Q

If a patient has an allergy to local anesthetics, what are two viable options?

A
  • general anesthesia
  • histamine blocker like benadryl with 1:100,000 epi (pulpal anesthesia up to 30 mins, burns on injection, tissue swelling and soreness)
43
Q

If a patient has an ester allergy, it is safe to use_____.

A

amides

44
Q

If a patient has a paraben allergy, there is ______ when using dental cartridges.

A

no concern

45
Q

If a patient has a sulfite allergy, use local anesthetics __________.

A

without a vasoconstrictor

46
Q

If a patient has an amide (what UNMC uses) allergy, the patient should ___________.

A

go under with general anesthesia.

47
Q

Type I, II, III allergic reactions are _______ onset within _______. The more _______ the signs and symptoms the more _____ the ultimate reactions.

A
  • immediate onset
  • within minutes to hours
  • the more rapid the more intense the reaction
48
Q

Type IV allergic reactions are _____ onset within ____ with a ______ intense reaction.

A
  • delayed
  • hours to days
  • less
49
Q

A person is considered to be in anaphylactic shock if they are ______ and ________.

A

hypotensive and unconscious

50
Q

__________ anaphylaxis involved reactions in one organ system.

A

Localized

51
Q

Three common types of sensitization reactions:

A

Urticaria
Erythema
Angioedema

52
Q

Two types of urticaria and descriptions:

A

pruritis (itching)

wheals ( smooth, slightly elevated)

53
Q

Three types of localized swelling involved in angioedema:

A

periorbital
perioral
intraoral

54
Q

Common signs and symptoms of respiratory reactions (identical to non allergic asthma)

A 
Respiratory distress
Dyspnea
Wheezing
Flushing
Perspiration
Tachycardia
Anxiety
Accessory muscles of respiration
55
Q

When is generalized anaphylaxis most likely to occur and when do most fatalities occur after generalized anaphylaxis?

A
  • occur after parenteral administration

- fatalities occur within first 30 mins

56
Q

Look over top of page 13 for common system progressions

A

–

57
Q

How to manage delayed skin reaction (appear after 60 mins):

A

P: comfortable
CAB: not a problem
D: if localization reaction, use oral histamine blocker
-chlorpheniramine: Adult: 4 mg Child: 2 mg
-diphenhydramine: A: 50 mg C: 25 mg
3 to 4 doses for three days
Do not discharge until symptoms go away

58
Q

Diagnostic clues of delayed onset skin reaction:

A

Hives, itching
Edema
Flushed skin

59
Q

Diagnostic clues of rapid onset skin reaction:

A

Hives, itching
Edema
Flushed skin
Conjunctivitis and rhinitis (these two diff. it from delayed onset)

60
Q

How to manage rapid onset skin reaction:

A

P: comfortable
CAB: not a problem
D: in absence of CV and respiratory involvement, administer a histamine blocker IM or IV with oral prescription for 3 days
Activate EMS

61
Q

How to manage rapid onset skin reaction in presence of CV and respiratory involvement:

A

P: supine with feet elevated if hypotensive
CAB: not a problem
D: administer oxygen
-start IV
-administer epinephrine: 1ml of 1:10,000 IV slowly over 3 minutes repeated if necessary over next 15 to 30 minutes up to a total of 5 ml (.3ml of 1:1,000 IM or SC in adult up to 3 doses, .15mg for child)
Activate EMS

62
Q

When would you likely see a bronchospasm?

A

Asthmatic patient allergic to bisulfites and aspirin allergies

63
Q

Steps in managing bronchospasm:

A

P: comfortable, usually upright
CAB
D: Calm patient
-EMS
-Administer bronchodilator (EPI or albuterol)
-Administer epi IM or IV repeat every 3 mins
-Discharge with EMS

64
Q

Diagnostic cues in laryngeal edema:

A

respiratory distress, exaggerated chest movements, high pitched crowing or no sound, cyanosis, loss of consciousness

65
Q

Steps in managing laryngeal edema:

A

P: comfortable or supine if loss of consciousness
CAB: head tilt, chin lift
D: EMS
-EPI IM or IV repeat every 3 to 5 minutes
-maintain airway
-if resolution with epi, administer histamine blocker and corticosteroid to help provent recurrence
- if loss of airway, CRICK ‘EM.

66
Q

Management of generalized anaphylaxis:

A

P: Supine with legs elevated
CAB
D: EMS
-EPI (.3mg intralingual or sublingual, repeat within 5 minutes if no improvement)
-O2
-Monitor vitals
-If initial resolution, administer histamine blocker and corticosteroid

Medical Emergencies Final (4 decks)

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