Chapter 12 Phramacology Flashcards
1
Q
Albuterol (proventil, ventolin) class
A
Sympathomimetic, bronchodialator
2
Q
Albuterol (proventil, ventolin) Mechanism of action
A
B2 agonist, stimulates adrenergic receptors of sympathetic nervous system.
Smooth muscle relaxation in bronchial tree
3
Q
Albuterol (proventil, ventolin) Indication
A
Bronchospasm
4
Q
Albuterol (proventil, ventolin) Contraindication
A
Hypersensitivity, Tachycardia dysrythmias. Other sympathomimetics
5
Q
Albuterol (proventil, ventolin) Adverse reactions/side effects
A
Heache, fatigue, light headedness, irritability, restlessness, aggressive behavior, pulmonary edema, hoarseness, nasal congestion, increased sputum, hypertension, tachycardia, dysrhythimas, chest pain, palpitations, nausea/vomiting, dry mouth, epigastric pain, tremors.
6
Q
Albuterol (proventil, ventolin) Drug interactions
A
Tricyclic antidepressants increased vasculature effects, Beta-blockers are antagonistic, diuretics may potentiate hypokalemia
7
Q
Albuterol (proventil, ventolin) Route
A
Inhalation
8
Q
Albuterol (proventil, ventolin) Dosage
A
Adult: 2.5 mg in 0.5 mL of 0.5% solution with 2.5 mL normal saline nebulizer over 10-15 minutes. 1-2 inhalations, wait 5 minutes.
Ped: < 20 kg 1.25 mg/dose over 20 min
> 20kg 2.5 mg/dose over 20 min
Repeat every 20 min
9
Q
Albuterol (proventil, ventolin) Duration of action
A
Onset: 5-15 minutes. Peak effect: 30 min to 2 hr. Duration 3-4 hrs
10
Q
Albuterol (proventil, ventolin) Special considerations
A
Pregnancy: Safer than withholding.
11
Q
Asprin (Acetylsalicyclic Acid) Class
A
Platelet inhibitor, Anti-inflammatory
12
Q
Asprin (Acetylsalicyclic Acid) MOA
A
Prevent thromboxane A2 (Causes platelet to clump and obstruct)
Antipyretic and analgesic properties
13
Q
Asprin (Acetylsalicyclic Acid) indications
A
New-onset chest discomfort that suggests ACS
14
Q
Asprin (Acetylsalicyclic Acid) Contraindications
A
Hypersensitivity. Relative to active ulcer disease or asthma
15
Q
Asprin (Acetylsalicyclic Acid) adverse reactions/ side effects
A
Bronchospasm, anaphylaxis, wheezing, prolonged bleeding, GI bleed, epigastric distress, NV, Hearburn, reye syndrome
16
Q
Asprin (Acetylsalicyclic Acid) Interactions
A
Cation in patients allergic to NASAIDs
17
Q
Asprin (Acetylsalicyclic Acid) Route
A
Oral
18
Q
Asprin (Acetylsalicyclic Acid) Dose and admin
A
Adult: 160 - 325 mg PO. Chew
Ped: not recommended
19
Q
Asprin (Acetylsalicyclic Acid) Duration
A
Onset: 5-30 min. Peak effect 1-3 hrs Duration: 3-6 hrsq
20
Q
Asprin (Acetylsalicyclic Acid) Special considerations
A
Pregnancy: Use with caution
21
Q
Dextrose class
A
Carbohydrate, antihypoglycemic, hypertonic solution
22
Q
Dextrose MOA
A
Rapid increase serum glucose levels. Short term osmotic diuresis.
23
Q
Dextrose indications
A
Hypoglycemia, ALOC, coma of unknown origin, seizure of unkown origin, status epilepticus
24
Q
Dextrose Contraindications
A
Intracranial hemorrhage with normal blood glucose level
25
Dextrose side effects
Extravasation leads to tissue necrosis. Cerebral hemorrhage; cerebral ischemia; pulmonary edema; warmth, pain, burning from iv infusion; hyperglycemia
26
Dextrose drug interactions
Sodium bicarbonate, warfin (coumadin)
27
Dextrose Route
IV, IO
28
Dextrose Dose
Adult: 12.5 - 25g slow iv push. Condsider 10% Dextrose over 50% or 25%.
Ped: 1yr+ D25 or D10 0.5-1g/kg/dos slow iv push.
-1yr D10 only 200-500 mg/kg slow iv push.
29
Dextrose Duration
Onset: < 1 min. Peak: variable Duration: variable
30
Dextrose Special considerations
Pregnancy: check glucose level.
No CVA without hypoglycemia.
31
Epinephrine (Adrenaline) class
Sympathomimetic
32
Epinephrine (Adrenaline) MOA
Alpha and beta agonist.
Alpha: vasoconstiction
Beta 1: positive inotropic, chronotropic, and dromotropic effects.
Beta 2: Bronchial smooth muscle relaxation, dilation of skeletal vasculature.
Histamine blocker
33
Epinephrine (Adrenaline) indications
Allergic reaction; anaphylaxis, asthma.
34
Epinephrine (Adrenaline) contraindications
None
Relative: hypertension, hypothermia, pulmonary edema, myocardial ischemia, hypovolemic shock
35
Epinephrine (Adrenaline) side effects
Nervousness, restlessness, headache, tremor, pulmonary edema, dysrhythmias, chestpain, hypertension, tachycardia, NV
36
Epinephrine (Adrenaline) drug interactions
Other sympathomimetics, MAOIs, beta blockers
37
Epinephrine (Adrenaline) Route
IM, Subq
38
Epinephrine (Adrenaline) Dosage
Adult: 0.3-0.5 mg (1mg/mL 1:1000) IM
Ped: Anaphylaxis/ sever status asthmaticus: 0.01 mg/kg 1:1000 dose. Max single dose 0.3 mg.
39
Epinephrine (Adrenaline) special considerations
Pregnancy: Anaphylaxis = administer.
Syncope in children with asthma
Increase in myocardial oxygen demand
40
Glucagon (glucagen) Class
Hyperglycemic agent, pancreatic hormone, insulin antagonist
41
Glucagon (glucagen) MOA
Increase blood glucose level by stimulating glycogenolysis.
Minimal positive inotropic and chronotropic response. Decrease GI motility and secretions
42
Glucagon (glucagen) Indications
ALOC when hypoglycemic
Reversal in beta-blocker overdose
43
Glucagon (glucagen) contraindications
Hyperglycemia, hypersensitivity
44
Glucagon (glucagen) side effects
Dizziness, headache, hypertension, tachycardia, NV, rebound hypoglycemia
45
Glucagon (glucagen) interactions
Incompatible in solution with other substances,
No significant interaction
46
Glucagon (glucagen) Route
IM, IN
47
Glucagon (glucagen) Dose
Adult: hypoglycemia; 1 mg Im/IN, may repeat 7-10 min
Ped: hypoglycemia 1 mg IM/IN if 20 kg+ (or 5+)
0.5 mg IM/IN if < 20 kg or < 5 yo
48
Glucagon (glucagen) Duration
Onset: 1 min Peak: 5-20 duration: 60-90 min
49
Glucagon (glucagen) Considerations
Pregnancy: Only if cleared. Not recommended if lactating. Used in conjunction with D50 when possible. Administer D50 if 2nd does is ineffective.
50
Naloxone hydrochloride (Narcan) Class
Opioid antagonist/ antidote
51
Naloxone hydrochloride (Narcan) MOA
Competitive inhibition. Reverse respiratory depression. Inhibits effects of morphine
52
Naloxone hydrochloride (Narcan) indication
Opiate overdose. Partial CNS depression from opiods.
DLOC or Coma when unknown.
53
Naloxone hydrochloride (Narcan) Contraindications
Use caution on narcotic dependent patients, neonates and addicted mothers
54
Naloxone hydrochloride (Narcan) Side effects
Restlessness, seizures, dyspnea, pulmonary edema, tachycardia, hypertension, dysrhythmias, NV, withdrawl symptoms, diaphoresis.
55
Naloxone hydrochloride (Narcan) Drug interactions
Incompatible with bisulfite and alkaline solutions
56
Naloxone hydrochloride (Narcan) route
IV, IN, IO, IM (auto-injector)
57
Naloxone hydrochloride (Narcan) Dose
Adult: 0.4-2.0 mg IM/IV/IO. Min recommended is 2mg. Repeat every 5 min for max of 10 mg. IN = half of dose in each nostril. Max dose is 1 mL per nostril.
Ped: 0.1 mg/kg per dose IV/IO/IM every 2 min as needed. Max = 2 mg. If no response in 10 min do an additional 0.1 mg/kg dose
58
Naloxone hydrochloride (Narcan) Duration
Onset: < 2 min
Peak: variable
Duration: 30-60 min
59
Naloxone hydrochloride (Narcan) Special considerations
Pregnancy: when clearly indicated.
Not beneficial in cardiac arrest
60
Nitroglycerin (Nitrostat, Nitro-bid, tridil) Class
Vasodilator
61
Nitroglycerin (Nitrostat, Nitro-bid, tridil) MOA
Smooth muscle relaxant acting on vasculature, bronchial, uterine, intestines.
Dilation of atrioles and veins in the periphery. Reduces preload and afterload, decreasing work lod of the heart and myocardial oxygen demand.
62
Nitroglycerin (Nitrostat, Nitro-bid, tridil) indication
Acute angina pectoris, ischemic chest pain, hypertension, heart failure, pulmonary edema.
63
Nitroglycerin (Nitrostat, Nitro-bid, tridil) Contraindications
Hypotension, hypovelemia, intracranial bleeding or head injury, pericardial tamponade, severe bradycardia or tachycardia,
previous administration in the last 24 hrs: Sildenafil (Viagra) or
48 hrs: vardenafil (levitra) or tadalafil (cialis)
64
Nitroglycerin (Nitrostat, Nitro-bid, tridil) Side effects
Headache, dizziness, weakness, reflex tachycardia, syncope, hypotension, NV, dry mouth, diaphoresis, muscle twitching.
65
Nitroglycerin (Nitrostat, Nitro-bid, tridil) interactions
Additive to vasodilators. Incompatible with other IV drugs
66
Nitroglycerin (Nitrostat, Nitro-bid, tridil) Route
SL (rapid absorption) IV
67
Nitroglycerin (Nitrostat, Nitro-bid, tridil) Dose
Adult: 0.4 mg SL: repeat 3-5 min max 3 dose
Spray: 0.4 mg under tounge; 1-2 sprays.
IV: begin at 10-20 mcg/min every 5 min untill desired effect
Ped: not recommended.
68
Nitroglycerin (Nitrostat, Nitro-bid, tridil) Duration
Onset: 1-3 min
Peak: 5-10 min
Duration: SL:20-30 min IV 1-10 min after IV
69
Nitroglycerin (Nitrostat, Nitro-bid, tridil) Special considerations
Pregnancy: safe. Monitor infant if breast feeding.
Hypotension common in elderly.
Decomposes when exposed to light or heat’ airtight containers.
Sting when administered.
70
Nitropaste (nitro-bid ointment) Class
Vasodilator
71
Nitropaste (nitro-bid ointment) MOA
Muscle relaxant on vasculature smooth muscle,Bronchial, uterine, intestinal.
Dilation of arterioles and vein in periphery.
Reduces preload and afterload, decreasing workload of the heart and thereby myocardial oxygen demand.
72
Nitropaste (nitro-bid ointment) indications
Angina pectoris, chest pain with AMI, hypertension, heart failure, pulmonary edema.
73
Nitropaste (nitro-bid ointment) Contraindications
Hypotension, hypovelemia, intracranial bleeding or head injury.
Administered ED in 24 or 48 hrs
74
Nitropaste (nitro-bid ointment) side effects
Headache, dizziness, weakness, reflex tachycardia, syncope, hypotension, nausea, nomiting, dry mouth, muscle twitching, diaphoresis.
75
Nitropaste (nitro-bid ointment) interactions
Additive with other vasodialators
76
Nitropaste (nitro-bid ointment) Route
Transdermal
77
Nitropaste (nitro-bid ointment) Dosage
Adult: Paste, 1/2 -3/4 inch line (15-30 mg), Cover, wrap, tape. Max 5 in.
Transdermal: apply unit to intact skin (usually chest wall) in varying doses.
Ped: not recommended.
78
Nitropaste (nitro-bid ointment) Duration
Onset: 30 min
Peak: Variable
Duration 18-24 hrs
79
Nitropaste (nitro-bid ointment) Special considerations
Pregnancy: safe. Monitor infant if breast feeding.
Not great value in prehospital arena.
Wear gloves
Store in cool place with tube tightly capped.
Erratic absorption rates quite common.
80
Nitrous Oxide 50:50 (Nitronox) Class
Gasseous analgesic and anesthetic.
81
Nitrous Oxide 50:50 (Nitronox) MOA
Exact mechanism unknown; affects CNS phospholipids
82
Nitrous Oxide 50:50 (Nitronox) Indications
Moderate to sever pain, anxiety, apprehension
83
Nitrous Oxide 50:50 (Nitronox) contraindications
Impaired level of consciousness, head injury, inability to follow of comply with instructions, decompression sickness, undiagnosed abdominal pain or marked distention bowel obstruction, hypotension, shock, COPD, Cyanosis, Chest trauma w/ pneumothorax.
84
Nitrous Oxide 50:50 (Nitronox) Side effects
Light-headedness, drowsiness
Respiratory depression, apnea, NV, malignant hyperthermia
85
Nitrous Oxide 50:50 (Nitronox) Route
Inhalation
86
Nitrous Oxide 50:50 (Nitronox) Dosage
Adult: instruct patient to inhale deeply through demand valve and mask or mouthpiece
Ped: same
87
Nitrous Oxide 50:50 (Nitronox) Duration
Onset: 2-5 min
Peak: Variable
Duration: 2-5 min
88
Nitrous oxide 50:50 (Nitronox) Special considerations
Pregnancy: Can cause spontaneous abortion.
Ventilate patient care area during use.
Nitrous oxide is nonflammable and nonexplosive.
Nitrous oxide is ineffective in 20% of the population.
89
Oral Glucose (Insta-glucose) Class
Hyperglycemic, carbohydrate
90
Oral Glucose (Insta-glucose) MOA
After absorption in the GI tract, glucose is distributed to the tissues providing an increase in circulating blood glucose levels.
91
Oral Glucose (Insta-glucose) Indications
Alert patient with suspected hypoglycemia.
92
Oral Glucose (Insta-glucose) contraindications
Decreased level of consciousness, nausea vomiting.
93
Oral Glucose (Insta-glucose) side effects
Nasea vomiting
94
Oral Glucose (Insta-glucose) route
Oral, buccal
95
Oral Glucose (Insta-glucose) Dosage
Adult: 25 g PO in patient with intact gag reflex, airway and secretions
Peds: 0.5 - 1 g
96
Oral Glucose (Insta-glucose) Duration
Onset: 10 min
Peak: variable
Duration: variable
97
Oral Glucose (Insta-glucose) Special Considerations
Able to swallow. Check BGL after 10 minutes
98
Oxygen Class
Naturally occurring atmospheric gas
99
Oxygen MOA
Reverse hypoxemia
100
Oxygen Indications
Hypoxemia, ischemic chest pain, respiratory insufficiency, prophylactically during air transport, confirmed or suspected carbon monoxide poisoning, causes of decreased oxygenation, decreased level of consciousness.
101
Oxygen Contraindications
Certain patients with COPD or emphysema who will not tolerate oxygen concentrations greater than 35%, hypertension.
102
Oxygen side effects
Decreased level of consciousness (COPD), Decreased respiratory drive in COPD patients, dry mucous membrane.
103
Oxygen interactions
None
104
Oxygen Route
Inhalation
105
Oxygen Dosage
Adult: cardiac arrest and CO poisoning: 100% 10-15 L/min via nonrebreathing mask. COPD 0-2 L/min via nasal cannula or 28%-35% venturi mask.
PED: Same for adult except premature infant.
106
Oxygen Duration
Onset: Immediate
Peak: n/a
Duration: < 2 min
107
Oxygen Special Considerations
Delivery device needs to match flow rate.
108
IV solutions
Lactated ringer (Hartmann) Class
Isotonic crystalloid solution
109
IV solutions
Lactated ringer (Hartmann) MOA
Lactated ringer solution replaces water and electrolytes
110
IV solutions
Lactated ringer (Hartmann) Indications
Hypovolemic shock; Keep open IV line, hypoperfusion.
111
IV solutions
Lactated ringer (Hartmann) Contraindications
Lactated ringer solution should not be used in patients with heart failure or renal failure.
112
IV solutions
Lactated ringer (Hartmann) Side effects
Rare therapeutic dosages.
113
IV solutions
Lactated ringer (Hartmann) Drug interactions
Few in emergency setting.
114
IV solutions
Lactated ringer (Hartmann) Route
IV
115
IV solutions
Lactated ringer (Hartmann) Dosage
Hypovolemic shock; titrate according to patient’s physiologic response.
116
IV solutions
Lactated ringer (Hartmann) Duration
Short-term therapy
117
IV solutions
Lactated ringer (Hartmann) Special considerations
None
118
5% dextrose in water Class
Hypotonic dextrose -containing solution
119
5% dextrose in water MOA
Provide nutrients
120
5% dextrose in water indications
IV access for emergency medications; dilution of concentrated medications for IV infusion.
121
5% dextrose in water Contraindications
Not used for hypovolemic states
122
5% dextrose in water Side effects
Rare
123
5% dextrose in water interactions
Not used with phenytoin (dilantin) or amrinone (inocor)
124
5% dextrose in water route
IV
125
5% dextrose in water Dosage
Minidrip (60 drop/mL) set at “to keep open” TKO
126
5% dextrose in water Duration
Short term
127
5% dextrose in water Special considerations
None
128
0.9% sodium chloride (normal saline) Class
Isotonic crystalloid solution
129
0.9% sodium chloride (normal saline) MOA
Saline that replaces water and electrolytes
130
0.9% sodium chloride (normal saline) Indications
Heat problems (Heat exhaustion/ heatstroke) Freshwater drowning, hypovolemia, diabetic ketoacidosis. Keep open IV.
131
0.9% sodium chloride (normal saline) Contraindications
Not for use in hear failure.
132
0.9% sodium chloride (normal saline) Side effects
Rare
133
0.9% sodium chloride (normal saline) interactions
Few
134
0.9% sodium chloride (normal saline) Route
IV
135
0.9% sodium chloride (normal saline) Dosage
Titrate to physiological response
136
0.9% sodium chloride (normal saline) Durations
Short term
137
0.9% sodium chloride (normal saline) Special considerations
Over administration = dependent or pulmonary edema
