Chapter 16,17,18

Question 1

Drug names

Answer 1

Chemical names
Generic name
Brand name

Question 2

Aspirin

Answer 2

In event of heart attack reduces. Bloods ability to clot, and clot formation that causes damage to heart

Indications-chest pain, not allergic, no asthma, no mess to prevent clotting, patient able to swallow

Contradictions- unable to swallow, allergic, asthma,GI ulcer, bleeding disorder,

Form- tablet baby aspirin 81 mg chewable tabs

Administration-
gather history appropriate for cardiac patient,
contact medical direction,
ensure right patient time dose route,
ensure patient is alert,
ask patient to chew,
record administration route and time, reassessment

Actions-
prevents blood clotting after myocardial infarction, when administered to cardiac patients not used to relieve pain

Side effects- nausea, vomiting, heartburn, if allergic bronchospasm and wheezing, bleeding

Reassessment-
evaluate for new onset of difficulty breathing from bronchospasm,
bleeding from aspirin unlikely to occur before patient arrives at hospital,
record the assessments

Question 3

Nitroglycerin

Answer 3

Drug that helps to dilate the coronary vessels that supply heart muscle with blood

Nitrostat, nitrolingual

Indications- 
complains of chest pain, 
history of cardiac problems, 
was prescribed nitro, 
systolic blood pressure is greater than 90, 
medical direction authorized

Contradictions- 
has hypotension or systolic BP below 90, 
head injury, 
infant or child, 
taken maximum dosage, 
recently taken viagra, cialis, levitra

Form- tablet, sublingual (under tongue) spray

Dosage- one dose.
Repeat in 5 min,
if less than complete relief or systolic remains above 90 and if authorizes by medical direction
up to three doses

Administration-
focused assessment for the cardiac patient,
take the patients blood pressure must be above 90 to 100,
contact medical direction if no standing orders, ensure right patient,time,medication,dose, right route,
check expiration date,
question patient on last dose taken,
ask patient to lift tongue place tablet under tongue or spray under tongue,
recheck BP within 2 min,
record administration, route and time,
reassess

Actions- relaxed blood vessels, decreases workload of heart

Side effects- hypotension(low BP) headache, pulse rate changes

Reassessment- monitor BP,
ask patient about effect on pain relief,
seek medical direction before re-administering, record

Question 4

Oral glucose

Answer 4

Form of glucose taken by mouth for a conscious patient with altered mental status and history of diabetes

Glutose, insta-glucose

Indications- patients with altered mental status and known history of diabetes

Contradictions- unconsciousness, known diabetic who has not taken insulin for days, unable to swallow

Medication form- gel, toothpaste style tubes

Dosage- one tube

Administration-ensure signs and symptoms of altered mental status and history of diabetes,
ensure patient is conscious,
administer on tongue depressor between cheek and gum or have patient do so,
reassess

Action- increases blood sugar

Side effects-none if given properly

Question 5

Activated charcoal

Answer 5

Treat poisoning or overdose when a substance is swallowed

Superchar, instachar, Actidose, liqui-char

Indications- poisoning by mouth

Contradictions-altered mental status, ingestion of acids or alkalis, inability to swallow

Form- premixed in water, plastic bottle 12.5 grams

Dosage- adults and children 1g, usual adult dose 25 to 50 g, usual pediatric dose 12.5 to 25g

Administration- consult medical direction, shake container, record the name, dose, route, and time of administrative

Actions- activated charcoal adsorbs certain poisons and prevents them from being absorbed into the body, consult about which brand to use because different brands dissolve different ways

Side effects- some patients have black stools, patients may vomit, repeat the dose

Question 6

Bronchodilator inhalers

Answer 6

Spray device with a mouth piece that contains an aerosol form of a medication that a patient can spray into his airway

Proventil, ventolin, alupent, metaprel

Indications
Signs and symptoms of respiratory emergency
Has physician- prescribed handheld inhaler
Medical direction gives authorization

Contraindictions
Patient is unable to use device not alert
Not prescribed for patient
Has already taken the maximum dosage prior to EMT arrival

Form
Handheld metered-dose inhaler

Dosage
Number of inhalations based on medical direction order or physicians order

Administration
Obtain order from medical direction
Ensure 5 rights
Check expiration
Check if patient has taken doses
Ensure inhaler is at room temperature
Shake inhaler several times
Have patient exhale deeply
Have patient depress inhaler as the inhale deeply
Have patient hold breath as long as they comfortably can
Allow patient to breathe a few times and repeat the second dose of ordered by medical direction

Actions
Beta-agonist bronchodilator dilates bronchioles reducing airway resistance

Side effects
Increased pulse rate
Tremors
Nervousness

Reassessment
Vitals
Perform reassessment of the Chest and respiratory function
Observe for deterioration of the patient if breathing becomes inadequate provide artificial respirations

Question 7

Epinephrine

Answer 7

Drug that helps to constrict the vessels and relax passages of the airway. Used to counter allergic reaction

Adrenalin

Epipen, epipen Jr, twinject, auvi-q (adult or child size)

Indications-
patient exhibits signs of severe allergic reaction, respiratory distress or shock,
prescribed for patient or carried on ambulance

Contraindications - none

Form- administered by auto- injector

Administration-obtain auto- injector,
ensure prescription is for the patient, or able to carry on ambulance,
medication not discolored or expired,
obtain an order from medical direction,
place auto- injector tip next to patient thigh (lateral), push injector firmly against thigh until injector activates
Hold in place at least 10 seconds for Epi-pen and 5 for auvi-Q,
record administration and time,
dispose in a biohazard container

Actions- dilates bronchioles, constricts blood vessels, makes the capillaries less permeable

Side effects- increased heart, pallor, dizziness, chest pain, headache, nausea, vomiting, excitability

Reassessment- transport
Continue secondary assessment of airway, breathing and circulatory status

If patients condition continues to worsen decreasing and mental staus, increasing breathing difficulty, decreasing blood pressure

Obtain medical direction for an additional dose of epinephrine 
Treat for shock 
Prepare basic life support CPR, AED
Continue oxygen 
Treat for shock

Question 8

Naloxone

Answer 8

An antidote for narcotic overdoses

Narcan

Indications-
Suspected narcotic overdose
Coma of unknown cause

Contradictions-
Patient breathing adequately and able to maintain own airway

Form- liquid

Dose- 0.4-2.0 mg

Administration
Obtain medical direction
Inspect the patients nostrils to be sure there are no obstructions to intranasal administration
Considered restraining the patient before drug administration if you believe the patient may become combative
Attach the atomizer gently but firmly into nostril opening
Push the plunger of the syringe firmly but briefly until the desired amount of liquid has been expelled
Limit the amount of fluid at one time to 0.5 ml per nostril
Repeat as needed with the other nostril
Record the name, dose, route, and time of the medication

Question 9

The five rights

Answer 9

Do I have the right patient

Is it the right time administer the medication

Is this the right medication

Is this the right dose

Am I giving this medication by the right route of administration

Question 10

Route of administration

Answer 10

How the drug is administered

Oral or swallowed

Sublingual or dissolved under the tongue

Inhaled or breathed into the lungs

Intranasal or sprayed into the nostrils

Intravenous or injected into a muscle

Subcutaneous or injected under the skin

Intraosseous or injected into the bone marrow cavity

Endocrinetracheal or sprayed directly into the trachea

Question 11

Pharmacodynamics

Answer 11

The study of the effects of medications on the body

Question 12

Rate of adequate breathing

Answer 12

Adult-12/20 breaths per min
Child-15/30 breaths per min
Infant-25/50 breaths per min

Question 13

OPQRST

Answer 13

Onset- when did the pain begin
Provocation- what makes the pain better/ worse
Quality- can you describe the the pain
Radiation- does the pain spread?
Severity- scale 1-10 pain?
Time- how long have you had this feeling?

Question 14

CPAP (continuous positive airway pressure)

Answer 14

Form of noninvasive positive pressure ventilation consisting of a mask and a means of blow oxygen or air into the mask to prevent airway collapse

Contradictions- mental status so depressed that the patient cannot protect his airway or follow instructions
Inability to sit-up
Inability to get a good mask seal
Nausea and vomiting
Penetrating chest trauma
Upper GI bleeding
Or any surgery that would prevent a good mask seal

Question 15

Chronic obstructive pulmonary disease

Answer 15

Chronic bronchitis, emphysema

These patients need oxygen assist with ventilations

Pg478

Question 16

Asthma

Answer 16

Chronic diseases that has episodic exacerbation or flares, small bronchioles become narrowed because of contractions of the muscles that make up the airway

Question 17

Pulmonary edema

Answer 17

Abnormal accumulation of fluid in the alveoli of the lungs

Symptoms include anxiety, pale and sweaty skin, tachycardia, hypertension, respirations that are rapid and labored

Treatment includes high concentration oxygen by mask unless the patient breathing is inadequate and need to ventilate the patient

Question 18

Pneumonia

Answer 18

Infection of one or both lungs caused by bacteria, viruses or fungi

Symptoms are coughing, fever, chest pain, severe chills, fever, pale sweaty skin, and confusion

Question 19

Untoward effect

Answer 19

An effect of a medication to its desired effect that may be potentially harmful to patient

Question 20

Spontaneous pneumothorax

Answer 20

When lung collapses without injury or any other obvious cause

Question 21

Pulmonary embolism

Answer 21

When something that is not blood - such as a blood clot, air, or fat tries to go through these blood vessels it gets stuck and blocks an artery in the lungs

Question 22

Epiglottitis

Answer 22

When infection inflames the area around and above the epiglottis the tissue swells enough to close off airway

Question 23

Cystic fibrosis

Answer 23

Cause thick sticky mucus that accumulates in the lungs which can cause life- threatening lung infections

Coughing with large amounts of mucus from lungs
Fatigue
Frequent occurrences of pneumonia
Abdominal pain
Coughing up blood
Nausea
Weight loss

Question 24

Acute coronary syndrome

Answer 24

Cardiac compromise

Anytime the heart may not be getting enough oxygen

Question 25

Dyspnea

Answer 25

Shortness of breath labored or difficult breathing

Question 26

Bradycardia

Answer 26

When heart rate is slow usually 60 beats per min

Question 27

Tachycardia

Answer 27

When heart rate is fast more than 100 beats per min

Question 28

Acute coronary syndrome

Answer 28

Pain, pressure or discomfort in chest or upper abdomen
Difficulty breathing
Palpitations
Sudden onset of sweating and nausea or vomiting
Anxiety ( feeling of impending doom)
Generalized weakness
Abnormal pulse (rapid, slow, or irregular
Abnormally blood pressure

Question 29

Coronary artery disease

Answer 29

Coronary arteries are narrowed or blocked, blood flow is reduced. Reducing the amount of oxygen delivered to the heart

Buildup of fatty deposits on the inner walls of arteries

Question 30

Thrombus

Answer 30

A clot formed of blood and plaque attached to the inner wall of an artery or vein

Question 31

Aneurysm

Answer 31

The dilation or ballooning of a weakened section of the wall of an artery

If the artery bursts there could be rapid life- threatening internal bleeding

Question 32

Angina pectoris

Answer 32

Literally a pain in the chest

Question 33

Acute myocardial infarction

Answer 33

Portion of the myocardium (heart muscle) dies as a result of oxygen starvation

Heart attack by laypersons

Question 34

Congestive heart failure

Answer 34

Excessive buildup of fluid in the lungs or other organs because of the inadequate pumping of the heart

Brought on by diseased heart valves, hypertension, or some form of pulmonary disease like emphysema

Tachycardia,
dyspnea(shortness of breath),
Normal or elevated blood pressure 
Cyanosis
Engorged pulsating veins(late sign)
Enlarged liver and spleen