Ch 11: Pharmacology Flashcards
Pharmacology
The study of drugs and how they interact with the body
The 6 Rights
Patient Medication Dose Route Time Documentation
Addiction
A strong dependence on a drug
Antagonists
Drugs that combine with a receptor to prevent a response
Contraindication
A factor that makes it harmful to administer a medication
Depressant
A substance that decreases a body function or activity
Drug Allergy
A systemic reaction to a drug from previous exposure and development of a immunological mechanism;
An allergy to a medication
Drug Interaction
A modification (beneficial or detrimental) of the effects of one drug by the prior
Indications
The conditions that make administration of a drug appropriate
Potentiation
The enhancing effect of one drug on another when administered together
Side Effect
An unavoidable effect of using a drug
Synergism
The combined action of two drugs where the total effect is more than the sum of the individual effects.
Therapeutic Action
The desired, intended action of a drug
Chemical Name
The name to describe a drug’s chemical composition and molecular structure.
Ie:
Acetylsalicylic Acid
Generic Name (Non Proprietary Name)
An abbreviated form of the chemical name
Ie:
meperidine hydrochloride
Trade Name (Brand Name / Proprietary Name)
A copyrighted name designated by the drug company that owns the medication license
Ie:
Demerol
Official Name
Followed by the initials “USP” or “NF”, this name denotes the medication’s listing in official publications; usually the same as the generic name.
Ie:
meperidine hyrochloride USP
Oxygen
Give
Classification: Oxidizing Agent (gas)
Mechanism:
When inhaled, increases the amount of oxygen in erythrocyte hemoglobin
Indication:
Hypoxia
Patient involved in medical or trauma situation
Improve respiratory efficiency
Contraindication:
None
Precaution:
Patients with COPD
Prolonged administration in high concentration to newborns
Dose: Nasal Cannula; 1-4 lpm, 36% Resuscitation Mask; 6+ lpm, breathing 50%, non breathing 35% Nonrebreather Mask: 15+ lpm, 100% Bag Valve Mask: 15+ lpm, 100%
Route:
Inhaled
Oral Glucose
Give
Classification:
Monosaccharide
Carbohydrate caloric
Mechanism:
Absorbs into bloodstream, increasing blood glucose levels
Indications:
Known Diabetic History
BGL less than 4
Altered LOC
Contraindications:
Airway management cannot be controlled
Precautions:
Patient in Semi-Prone position or risk aspiration
Adverse Effects:
May increase airway management problems
Dose:
1 entire tube every 3 - 5 minutes until BGL normal
Route:
Buccal or Oral
Acetylsalicylic Acid
ASA
Aspirin
Give
Classification: Salicylate Antiplatelet Antipyretic Anti-inflammatory Non-opioid analgesic
Mechanism: Blocks prostaglandin production Impedes blood clotting Prevents or reduces pain Induces peripheral vasodilation, causing sweating
Indications:
Acute symptoms suggesting myocardial infarction
Contraindications: Drug Allergy or sensitivity Patient has bleeding disorder Patient is unconscious Airway maintenance impeded
Precautions:
Patients with active ulcer disease or asthma
Dose:
1 160mg or 325mg tablet, once
Route:
Oral
Salbutamol
Albuterol
“Ventolin”
Assist
Classification:
Bronchodilator, Sympathomimetic
Mechanism:
Mimics sympathetic response by affecting beta2 receptors, causing relaxation of bronchial muscles and peripheral vasculature.
Indications:
Respiratory distress
Dyspnea
Anaphylaxis
Contraindications:
Drug allergy or sensitivity
Precautions: Patient is a child or has sensitivity Myocardial insufficiency Dysrhythmia Hypertension Diabetes Thyrotoxicosis (overactive thyroid) Do not use with other beta-adrenergic drugs Safety in pregnancy not firmly established
Adverse Effects: Coughing Bronchospasm Restlessness Apprehension Tremors Dizziness Headache Palpitations Blood pressure changes Tachycardia Dysaryhthmia Cardiac Arrest Chest discomfort Nausea Pallor Flushing Sweating
Dose:
100mcg spray;
Adult 6 puffs every 10 minutes Max 20
Child 2 puffs every 10 minutes Max 10
Route:
Metered Dose Inhaler
Inhaled
Ipratropium Bromide
“Atrovent”
Assist
Classification:
Anticholinergic, Bronchodilator
Mechanism:
Blocks certain receptors from activating a response from the parasympathetic nervous system and dilates the bronchi and bronchioles.
Indications:
Dyspnea
Contraindications:
Drug Allergy
Ventolin must be assisted first
Precautions:
Use caution on patients with history of narrow angled glaucoma
Adverse Effects:
Coughing, increased sputum, dizziness, insomnia, tremors, nervousness, nausea.
Dose:
20mcg per spray
2 - 4 sprays every 10 minutes, Max 10
Route
Metered Dose Inhaler
Inhalation
Epinephrine Hydrochloride
Adrenaline
“Epi Pen”
Assist
Classification:
Sympathomimetic
Mechanism:
Mimics adrenaline response causing an increase in heart rate, cardiac output, AV conduction, irritability and bronchodilation.
In high doses it causes peripheral vasoconstriction.
Indication:
Bronchospasm
Anaphylaxis
Cardiac Dysrhythmias (Asystole, Ventricular Tachycardia, Ventricular Fibrillation)
Contraindications:
None in cardiac arrect
Drug Allergy
Precautions: Extreme caution in bronchospasm Cardiovascular disease Narrow-angled glaucoma Pregnancy Pre Existing tachycardia
Adverse Effects: Pulmonary Edema Dyspnea Nervousness Tremors Anxiety Headache Cerebral hemorrhage Agitation Tachycardia Ventricular fibrillation Palpitations Widened pulse pressure Hypertension Stroke Anginal Pain Pallor Sweating Necrosis due to vasoconstriction
Dose:
Adult: 0.3 mg concentration of 1:1000 every 10 minutes
Child: 0.15 mg concentration of 1:1000 every 10 minutes
Route:
Intramuscular
Nitroglycerin
Assist
Classification:
Antianginal, Vasodilator
Mechanism:
Reduces cardiac oxygen demand by dilating the blood vessels, resulting in increased blood flow to cardiac tissue.
Indications:
Patient has previously prescribed nitroglycerin
Ischemia
Systolic blood pressure above 100
Contraindications:
Systolic blood pressure equal to or below 100
Drug allergy or sensitivity
Previous consumption of erectile dysfunction medication. Viagra 24 hrs, Levitra 24 hrs, Cialis 48 hrs
Precautions:
Hypotension
Administer while patient is lying comfortably
Carefully monitor vitals and blood pressure
Adverse Effects: Hypotension Dizziness Weakness Headache Nausea Vomiting Syncope Tachycardia Tingling or burning under the tongue
Dose:
1 0.4 mg spray every 5 minutes Max 3
Route:
Sublingual
Routes of Drug Administration
Enteral
Parenteral
Enteral
Pertaining to the small intestine; within the small intestine.
Types of Enteral Administration
Oral
Buccal
Sublingual
Rectal
Oral Administration
Drug is consumed by mouth
Buccal Administration
Drug is placed between the check and gum and absorbed through the mucous membranes
Sublingual Administration
Drug is delivered under the tongue where it is rapidly absorbed into the bloodstream
Rectal Administration
Drug is delivered via the rectum. Solid drugs dissolve with body heat, liquid drugs can be instilled with a syringe
Parenteral
Introduction of a substance into the body through a route other than the digestive system
Intravenous Administration
Drug administered directly into vein, requires an IV line to be started
Aseptic Technique
The use of sterile procedures to prevent bacteria from entering the body, thus limiting the risk of infection
Endotracheal Administration
Intubation; placement of a flexible tube into the trachea. Reserved for advanced life support practitioners
Intramuscular Administration
Administration of drug into a large muscle.
Sucutaneous Administration
Drug administered in small volumes above muscle, below skin
Inhalation Administration
Drug is breathed into the lungs
Pharmacokinetics
The study of how the body handles a drug over a period of time.
Drug Absorption
The movement of drug molecules from the site of entry to the general circulation.
Variables include Blood Flow Solubility pH Concentration Dosage Route of Administration
Drug Distribution
The Transport of a drug through the blood stream to its site of action
Variables include:
Capillary permeability
Cardiac output
Regional blood flow
Biotransformation
The process by which a drug is chemically converted to a metabolite; to detoxify a drug and render it less active
Variables include:
Liver drug metabolism
Excretion
The elimination of toxic or inactive metabolites
Pharmacodynamics
The theory of drugs and the mechanism of their actions.
Drug receptor interaction Agonists Antagonists Affinity Efficacy Types of receptors Drug Enzyme interaction Non-specific drug interaction
Drug-Receptor Interaction
The chemical reaction between the drug and various receptors throughout the body.
Autonomic Nervous System (ANS)
The part of the nervous system that functions below consciousness.
Ie: Heart rate and Digestion
Sympathetic Nervous System
Prepares the body for stress and emergencies
Parasympathetic Nervous System
Rest and restore the body to normal conditions
Types of Receptors
Alpha
Beta1
Beta2
Alpha Receptors
When stimulated cause peripheral vasoconstriction
Beta1 Receptors
When stimulated cause increased heart rate and force of cardiac contraction
Beta2 Receptors
When stimulated cause bronchodilation
Intravenous Therapy
An advanced skill of drug administration directly to the venous system.
EMR IV Permission
Set up a peripheral IV line
Replace a solution bag
Prepare an IV line
How to Set Up a Peripheral Intravenous Line
- Inspect the solution and packaging prior to assembly
- Confirm and assemble the appropriate drip set and lock off the line
- Hold the solution bag inverted and remove the protective cap on the port using the aseptic technique
- Support the inverted solution bag and insert the spiked end of the IV drip chamber with a straight push
- Place the solution bag in the proper vertical position and squeeze the drip chamber to fill it 1/2 - 2/3 full
- Release the line lock and purge air from the line
- Confirm the indicated solution is flowing then lock off the line
- Once IV therapy has been initiated, adjust until the correct flow rate is acheived
Crystalloid Solution Types
Normal Saline
Dextrose
Ringers Lactate
D5W
Normal Saline Solution
0.9% sodium chloride solution.
Isotonic volume expander
Dextrose Solution
- 3% Dextrose
- 3% Sodium Chloride
2/3 and 1/3
Ringer’s Lactate Solution
Sodium Chloride Potassium Chloride Calcium Chloride Sodium Lactate Distilled Water
D5W Solution
5% dextrose in Water
Calculating Flow Rate
Drops/minute = ((Volume to be infused)(drops/ml of administered set)) / (Total time of infusion in minutes)
When to Change an IV bag
- The bag is empty or has less than 50ml
- You are given instruction to change the bag en route from medical staff. You can request that it be changed prior to or that a replacement bag is provided
- A glass bottle is changed to a plastic bag during air evacuation
How to Change an IV Bag
- Wash your hands and ensure aspetic technique
- Remove a new bag from out wrapping and inspect for leaks, discoloration and expiry date
- Close the flow clamp or line lock on the tubing
- Note how much solution remains in the old bag and invert the bag
- Remove the spike from the original bag, taking care not to contaminate it
- Remove the protective cap from the new IV port and insert the spike
- Unlock the line and confirm flow rate, adjust if necessary
- Document the procedure by noting the time you changed the IV bag and the amount and type of solution hung as well as the amount discarded.
How to Discontinue an IV
- Wash your hands, put on gloves, ensure aseptic technique
- Gather and prep supplies
- Turn off flow control clamp
- Remove the transparent dressing and tape from the site, minimizing movement of the IV and catheter. Stabilize the hub with one hand and remove with the other.
- Hold sterile gauze over the puncture site.
- Grasp the hub and pull straight back
- Do not use an alcohol swab.
- Immediately apply firm pressure to the site using gauze and continue for at least three to five minutes to stop the bleeding
- Once bleeding has stopped, cover the puncture site with an adhesive bandage
- Inspect the catheter for completeness
- Document the time the IV was discontinued, the amount of solution infused and the condition of the catheter.
Interstitial
IV fluid is flowing into the surrounding tissue
Care for Interstitial Complication
- Discontinue IV
- Record the time and the amount infused
- If swollen area is small, apply cold pack
- If swollen area is large, apply a warm, wet compress to promote reabsorption of fluid
Circulatory Overload
Patient’s system is unable to manage the extra fluids administered, leading to heart failure or pulmonary edema.
Care for Circulatory Overload
- Slow the rate of the IV to keep the vein open
- Place patient in semi fowler position
- Transport patient as quickly as possible
- Monitor vitals
- Keep patient warm to promote circulation
- Document findings, including slowing the IV rate
- Treat as if congestive heart failure
Thrombosis
Formation of a blood clot
Thrombophlebitis
Inflammation of a vein due to the formation of a blood clot
Care for Thrombosis and Thrombophlebitis
- Discontinue the IV
- Record the time and the amount infused
- Apply a warm, wet compress to decrease pain and promote healing
- Do not massage the area as it may dislodge the clot that has formed
Clots May Form If:
- The IV is running too slowly
- There is injury to the vein wall
- The catheter is too large for the lumen of the vein
- The vein is too small to handle the amount of type of solution
- There is irritation to the vein by medications
Catheter Embolism
The catheter or a portion of it has broken off and been carried away in the bloodstream. Can be caused by attempting to rethread the needle during insertion.
Care for a Catheter Embolism
- Discontinue the IV but do not discard the catheter
- Give the catheter to hospital staff
- Record the time and the amount infused
- Be careful not to obstruct arterial flow, check distal pulse to ensure its presence
- Apply high flow oxygen to the patient
- Notify the hospital and transport the patient as an emergency
Infection of Site
Caused by hypersensitivity to an IV or an additive, resulting in a generalized rash, SOB, and hypotension
Care for Infection of Site
- Decrease the IV rate to keep the vein open
- Record the time the rate was changed
- Notify the hospital
- Administer oxygen
Air Embolism
Can be caused by allowing an IV bag to run dry, significant air in the tubing or loose connections between tubing and catheter or at piggybacking sites.
Make sure you clear tubing of all air bubbles. Change the IV bags before they are empty and make sure all connections are secured
Care for an Air Embolism
- Turn the patient to their left side with the head down 30 degrees. If air has enters the heart chambers this position may keep the air bubbles on the right side of the heart, where they can then enter the pulmonary circulation and be absorbed.
- Check the IV system for leaks
- Administer O2
- Notify the hospital and transport immediately
