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Pharmacology > Drug Profiles: Winter quiz 2 > Flashcards

Drug Profiles: Winter quiz 2 Flashcards

1
Q

Ketorolac: indications

A

mild to moderate pain

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2
Q

Calcium Chloride: pharmacokinetics

A

onset: immediate peak: immediate

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2
Q

Calcium Gluconate: side effects

A

Tissue necrosis if given subcutaneously, or if it extravasates.

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3
Q

Droperidol: dosage

A

14-60 y/o: 2.5-5 mg IV/IM (may be combined with 2 mg midazolam in same syringe for increased sedation), may be repeated once as needed. Over 60 y/o: 2.5 mg IV/IM (with or without midazolam). Not recommended as first-line N&V med because of “black box” warning from FDA.

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4
Q

Sodium Bicarbonate: contraindications

A

none prehospital setting

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5
Q

Promethazine: side effects

A

Drowsiness, sedation, blurred vision, tachycardia, bradycardia, and dizziness

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6
Q

Magnesium Sulfate: interactions

A

may block effects of digitalis

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7
Q

Calcium Chloride: interactions

A

Will precipitate if mixed with sodium bicarbonate.

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8
Q

Calcium Gluconate: precautions

A

Use with caution in patients with potential to digoxin toxicity. Consider contacting OLMC.

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9
Q

Ketorolac: mechanism of action

A

NSAIDs inhibit cyclooxygenase and prevent the synthesis of prostaglandins and thromboxane, which reduce inflammation and ultimately provide pain relief.

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10
Q

Diphenhydramine: class

A

antihistamine; H1 antagonist

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11
Q

Droperidol: indications

A

Chemical restraint requiring rapid tranquilizationn, anti-emetic.

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12
Q

Calcium Gluconate: dosage

A

10-30 ml slow IV. topical application inside surgical glove (gel or not) for finger/ thumb/ hand fluoride burns. 10 ml vile of 10% calcium gluconate contains 4.6 mEq of calcium.

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12
Q

Haloperidol: contraindications

A

Hypotension, prolonged QT interval

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12
Q

Promethazine: precautions

A

May impair mental and physical abilities. Never give subcutaneously. Extra-pyramidal symptoms have been reported following use. Diphenhydramine should be available.

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13
Q

Calcium Chloride: dosage

A

5-10 ml slow IVP. 10 ml of 10% solution contains 13.6 mEq of calcium

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13
Q

Droperidol: precautions

A

BP and respiratory status should be monitored frequently. If used for chemical restraint, patient should be restrained in a fashion that allows careful observation and the ability to breathe normally. Cardiac monitoring is required as the FDA has issued a “black box” warning stating that Droperidol may cause torsades de pointes.

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14
Q

Calcium Chloride: class

A

electrolyte

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15
Q

Droperidol: mechanism of action

A

Exact mechanism of action is unknown, but main action is antagonism of the dopamine (D2) within the CNS. Neuroleptic similar to haloperidol; reduces anxiety and produces a mental state of detachment and indifference; as anti-emetic and anti-nausea properties.

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16
Q

Ondansetron: indications

A

Uncontrollable nausea and vomiting

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17
Q

Diphenhydramine: interactions

A

Sedation in presence of CNS depressants

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18
Q

Acetaminophen: mechanism of action

A

Produces analgesia by blocking generation of pain impulses probably by inhibition of prostaglandin synthesis. It relieves fever by central chain action in the hypothalamus heat regulating center.

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19
Q

Fentanyl Citrate: precautions

A

Monitor respiratory status. Naloxone will reverse the effects of fentanyl.

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20
Q

Magnesium Sulfate: mechanism of action

A

increases the magnesium levels, correcting for possible hypomagnesemia, which is associated with cardiac dysrhythmias. Magnesium interferes with neuromuscular transmission, which reduces muscle contractions in seizures. Additionally magnesium is a smooth muscle relaxer and vasodilator. The MOA’s of magnesium for all indications are complex and multifactorial, and therefore, not well understood.

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20
Q

Magnesium Sulfate: contraindications

A

hypotension, heart block

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20
Q

Acetaminophen: side effects

A

none

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21
Q

Droperidol: contraindications

A

Hypotension, prolonged QT interval

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23
Q

Sodium Bicarbonate: dosage

A

1 milliequivalent/kg IVP

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24
Q

Diphenhydramine: pharmacokinetics

A

Onset: < 2 minutes IV; 15-30 minutes IM Peak: 5 minutes IV; 20 minutes IM Duration: 5-10 minutes IV; 20-30 minutes IM

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25
Q

Fentanyl Citrate: note

A

100 mcg fentanyl equals 10 mg morphine. Schedule II narcotic.

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25
Q

Acetaminophen: indications

A

fever

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26
Q

Calcium Chloride: side effects

A

Tissue necrosis if given subcutaneously, or if it extravasates. Because calcium chloride contains approximately 3 times as much calcium as calcium gluconate, it is far more irritating to blood vessels.

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26
Q

Diphenhydramine: mechanism of action

A

Antagonizes central and peripheral H1 receptors, which decreases the itching and urticaria caused by histamine release. Additionally, possesses anticholinergic properties, resulting in anti-dyskinetic, anti-emetic and sedative effects.

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26
Q

Diphenhydramine: indications

A

Allergic and anaphylactic reactions. Dystonic reactions/extra-pyramidal symptoms (from phenothiazines, thioxanthins, and butyrophenones.

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27
Q

Calcium Gluconate: indications

A

Hyperkalemia, CCB OD, hypotension associated with magnesium sulfate or calcium channel blocker administration, and hydrofluoric acid burns.

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28
Q

Fentanyl Citrate: side effects

A

Drowsiness, hypotension, bradycardia, and respiratory depression are the most common, however it may cause nausea and vomiting, weakness, and dizziness, increased excitability (paradoxical)

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28
Q

Haloperidol: indications

A

Chemical restraint requiring rapid tranquilization

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30
Q

Sodium Bicarbonate: side effects

A

few in prehospital setting

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32
Q

Calcium Chloride: precautions

A

Use with caution in patients with potential digoxin toxicity. Consider contacting OLMC.

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32
Q

Haloperidol: precautions

A

BP and respiratory status should be monitored frequently. Patients should be restrained in a fashion that allows careful observation and the ability to breathe normally. Cardiac monitoring is required

34
Q

Fentanyl Citrate: contraindications

A

Severe hemorrhage and shock. Patients who have taken MAOIs (Marplan, Eutonyl, Parnate, Nardil) within the last 14 days should avoid fentanyl. Severe and then predictable potentiation is possible. Use with caution, if at all in any patient with a head injury (except during RSI). If the patient’s mentation becomes altered after administration, assessment of the head injury because more difficult in the ED.

36
Q

Calcium Gluconate: pharmacokinetics

A

onset: immediate peak: immediate

37
Q

Ketorolac: precautions

A

Use cautiously, if at all, in patients with renal or hepatic disease.

38
Q

Ondansetron: dosage

A

4 mg slow IVP/IM

39
Q

Haloperidol: side effects

A

Extra-pyramidal or dystonic reactions, frequently given concurrently with diphenhydramine.

40
Q

Haloperidol: interactions

A

Anti-hypertensive medications may increase the likelihood of a patient developing hypotension. haloperidol potentiates other CNS depressants

41
Q

Fentanyl Citrate: interactions

A

Other CNS depressants enhance the opioid action, resulting in decreased LOC, hypotension, and respiratory depression. Careful monitoring is required.

42
Q

Promethazine: contraindications

A

Coma, those who have received large amounts of depressants, nursing mother, neonate.

43
Q

Droperidol: class

A

Sedative, butyrophenone anti-psychotic

44
Q

Promethazine: class

A

Antihistamine and anti-emetic, phenothiazine anti-psychotic

45
Q

Sodium Bicarbonate: precautions

A

Patients must be breathing spontaneously or adequately ventilated before receiving sodium bicarbonate.

46
Q

Magnesium Sulfate: dosage

A

Cardiac arrest: 1-2 g IVP Torsades de pointes (with pulse): 1-2 g IV drip 5-60 minutes Preeclampsia and eclampsia: 2 g IV drip 5-60 minutes

47
Q

Diphenhydramine: contraindications

A

None in acute prehospital use

48
Q

Magnesium Sulfate: side effects

A

hypotension, respiratory depression, flushing, loss of deep tendon reflexes.

49
Q

Fentanyl Citrate: pharmacokinetics

A

Onset: < 1 minute IV Duration: 30-60 minutes

51
Q

Calcium Gluconate: mechanism of action

A

Calcium antagonizes cardiotoxicity of hyperkalemia by stabilizing cardiac cell membrane against undesirable depolarization. Soluble calcium ions bind with sodium fluoride ions to produce the insoluble and therefore inactive calcium fluoride salt.

52
Q

Diphenhydramine: precautions

A

Altered mental status, asthma, nursing mothers

53
Q

Promethazine: dosage

A

N&V: 12.5-25 mg IV/IM Analgesic adjunctive: 25 mg IV

54
Q

Haloperidol: dosage

A

2-5 mg IM (may be combined with midazolam)

55
Q

Diphenhydramine: dosage

A

Adult: 25-50 mg IV/IM/PO Pediatric: 1 mg/kg up to adult dose

57
Q

Ketorolac: class

A

non-steroidal anti-inflammatory agent

58
Q

Sodium Bicarbonate: note

A

mass actually effect = H2O + CO2 <> H2CO3 <> H+ +HCO3-

59
Q

Acetaminophen: OD management

A

Early symptoms are sweating, anorexia, nausea or vomiting, abdominal pain or cramping and/or diarrhea; usually in 6-14 hours after ingestion, lasting up to 24 hours. Late symptoms include abdominal swelling (ascites), tenderness or pain 2-4 days post exposure. Give activated charcoal > 2 hours post ingestion. The patient will require N-acetylcysteine and will need serum acetaminophen levels determined at the ED.

60
Q

Droperidol: side effects

A

Extra-pyramidal or dystonic reactions, especially in children. Diphenhydramine should be available.

61
Q

Promethazine: pharmacokinetics

A

Onset: 3-5 minutes

62
Q

Droperidol: interactions

A

Anti-hypertensive medications may increase the likelihood of a patient developing hypotension. Droperidol potentiates other CNS depressants.

64
Q

Ketorolac: contraindications

A

allergy to any NSAID

65
Q

Promethazine: mechanism of action

A

Blocks receptors for dopamine (D2), acetylcholine, and histamine (H1). All three of these neurotransmitter sites are implicated in the vomiting reflex, so thought to be involved in promethazine anti-emetic effects. Sedative effect is thought to be mostly related to antihistamine properties. EPS (adverse effects) are thought to be mostly related to dopamine antagonism.

66
Q

Acetaminophen: dosage

A

Adult: 650-1000 mg PO Pediatric: 10-20 mg/kg

67
Q

Haloperidol: class

A

Sedative, neuroleptic, butyrophenone anti-psychotic

68
Q

Calcium Gluconate: interactions

A

Will precipitate if mixed with sodium bicarbonate.

69
Q

Fentanyl Citrate: class

A

opioid analgesic (narcotic)

70
Q

Sodium Bicarbonate: class

A

alkalinizing agent

70
Q

Ondansetron: mechanism of action

A

Selective inhibitor of serotonin (5-HT3) receptors

71
Q

Ondansetron: class

A

Anti-emetic

73
Q

Fentanyl Citrate: indications

A

Moderate to severe pain, adjunct in rapid sequence induction (intubation).

75
Q

Droperidol: pharmacokinetics

A

Onset: 3-10 minutes IV/IM

76
Q

Acetaminophen: contraindications

A

none in prehospital setting

77
Q

Haloperidol: mechanism of action

A

Not well understood but blocks dopamine (D2) receptors in brain; produces marked tranquilization and sedation.

79
Q

Ketorolac: side effects

A

increased risk of bleeding, especially given with other NSAIDs.

80
Q

Calcium Gluconate: class

A

electrolyte

81
Q

Acetaminophen: precautions

A

Many nonprescription products contain acetaminophen, consider this when calculating dosage.

82
Q

Sodium Bicarbonate: indications

A

TCA OD, late in the management of cardiac arrest, if at all. Hyperkalemia (controversial)- routine use of sodium bicarbonate for hyperkalemia is falling out of favor, but it is still present in some protocols.

83
Q

Fentanyl Citrate: mechanism of action

A

Binds to various opioid receptors, producing analgesia and sedation (opioid agonist).

85
Q

Magnesium Sulfate: indications

A

Torsades de pointes, cardiac arrest only if torsades de pointes is present or was the rhythm that preceded VF or if hypomagnesemia is suspected, preeclampsia and eclampsia, refractory bronchoconstriction, TCA OD (if QRS is wide) (controversial)- no longer universally thought to be effective for TCA ODs, but still in some protocols.

86
Q

Sodium Bicarbonate: interactions

A

Deactivates catecholamines, forms precipitate with calcium chloride (if sodium bicarbonate is given before or after any of these drugs, flushed the IV line to prevent interactions)

87
Q

Ondansetron: contraindications

A

None known, use with caution in setting of bowel obstruction.

88
Q

Fentanyl Citrate: dosage

A

2 mcg/kg IV/IO/IM, usually up to 100 mcg

89
Q

Acetaminophen: class

A

antipyretic, non-narcotic analgesic

90
Q

Acetaminophen: how supplied

A

PO or rectal suppositories

91
Q

Magnesium Sulfate: precautions

A

calcium chloride is antidote if respiratory depression ensues, caution in renal failure patients.

92
Q

Ketorolac: dosage

A

60 mg IM or 30 mg IV (decreased dose by 1/2 if > 65 y/o)

93
Q

Sodium Bicarbonate: mechanism of action

A

When disassociated, bicarbonate binds with hydrogen ions to decrease metabolic acidosis (mass action effect). When administered for TCA overdose, acts as an anti-dysrhythmic. It is unlikely that sodium bicarbonate decreases the effects of hyperkalemia by shifting potassium into cells as has been previously thought. However sodium bicarbonate can still be useful in the treatment of hyperkalemia, since this condition is frequently accompanied by metabolic acidosis.

94
Q

Promethazine: indications

A

Nausea and vomiting, motion sickness, and sedation (to potentiate the effects of analgesics).

95
Q

Calcium Chloride: mechanism of action

A

Calcium antagonizes cardiotoxicity of hyperkalemia by stabilizing cardiac cell membrane against undesirable depolarization. Soluble calcium ions bind with soluble fluoride ions to produce the insoluble and therefore inactive calcium fluoride salt.

96
Q

Diphenhydramine: side effects

A

Anticholinergic effects. Most common are constipation, decreased sweating, difficulty in initiating urine stream, visual disturbances, photosensitivity, and dry mouth.

97
Q

Calcium Chloride: indications

A

Hyperkalemia, CCB OD, hypotension associated with magnesium sulfate or calcium channel blocker administration, and hydrofluoric acid burns.

98
Q

Acetaminophen: interactions

A

Increased risk of hepatic damage if patient has ingested ethanol.

99
Q

Magnesium Sulfate: class

A

electrolyte, anti-dysrhythmic

Pharmacology (24 decks)

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