Drug Quiz 3

Question 1

Nitroglycerin

Answer 1

Nitrostat

Question 2

Nitroglycerin Mechanism of Action

Answer 2

Nitroglycein is a pro-drug which must be de-nitrated to form the active metabolite nitric oxide (NO). Then, NO activates the conversion of GTP->cGMP +2Pi in vascular smooth muscle cells (VSMC). cGMP activates a cascade of reactions that cause a reduction in intracellular Ca2+, VSMC relaxation (in arterioles and decreased cardiac preload and afterload

Question 3

Nitroglycerin Pharmacokinetics

Answer 3

Onset of Action=1-3 minutes SL, 30 minutes topical
Peak Effects=5-10 minutes SL, varies topical
Duration of Effect=20-30 minutes SL, 3-6 hours topical
Half-Life=1-4 minutes

Question 4

Nitroglycerin Indications/Field Use

Answer 4

1) Chest pain associated with angina or MI

2) Acute pulmonary edema/CHF

Question 5

Nitroglycerin Contraindications

Answer 5

1) Shock, hypotension
2) Increased ICP
3) Children under 12
4) ED drugs within 48 hours

Question 6

Nitroglycerin Side Effects/Adverse Reactions

Answer 6

HA, dizziness, weakness, tachycardia, hypotension, rash, dry mouth, N+V

Question 7

Nitroglycerin Dose

Answer 7

Spray (Adult): 0.4mg SL q3-5min until effect achieved or BP drops (max 3x25min)
Paste (Adult): 0.5-1 inch topical
Tablet (Adult): 0.4mg SL

Question 8

Nitroglycerin Precautions

Answer 8

1) Monitor vitals
2) Expect HA from cerebral vasodilation
3) routine use may cause tolerance
4) 12-lead ECG prior to administration-use extreme caution if R-side MI

Question 9

Nitroglycerin Drug-Drug Interactions

Answer 9

1) Orthostatic hypotension with B-blockers

2) Severe hypotension with alcohol

Question 10

Oxygen Drug Classification

Answer 10

Gas

Question 11

Nitroglycerin Drug Classification

Answer 11

Vasodilator/Nitrate

Question 12

Oxygen Mechanism of Action

Answer 12

Enters body via Respiratory system, transported to cells by hemoglobin, required for efficient breakdown of glucose into usable energy

Question 13

Oxygen Pharmacokinetics

Answer 13

Onset of Action=Immediate
Peak Effects=<2min inhaled
Half-Life=N/A

Question 14

Oxygen Indications/Field Use

Answer 14

1) Hypoxia
2) Difficulty Breathing
3) SPO2<94%

Question 15

Oxygen Contraindications

Answer 15

1) ROSC post cardiac arrest with SPO2 >94%

2) Chest pain, acute MI, suspected cellular injury and death with SPO2>94%

Question 16

Oxygen Side Effects/Adverse Reactions

Answer 16

Free Radical formation in the presence of injured tissues, causing secondary cell death

Question 17

Oxygen dose

Answer 17

(Adult): 2-6L NC, 12-15 NRB, 15L BVM
CPAP/Vent (Adult): Varies by O2 demand to meet cmH2O requirement
(Pedi): 2-6L NC, 10-15L NRB, 15L BVM

Question 18

Oxygen Precautions

Answer 18

1) Avoid heperoxia

2) high concentrations to neonates can cause eye damage

Question 19

Oxygen Drug-Drug Interactions

Answer 19

None EMS

Question 20

Furosemide

Answer 20

Lasix

Question 21

Furosemide Drug Classification

Answer 21

Loop Diuretic

Question 22

Furosemide Mechanism of Action

Answer 22

Furosemide reversibly binds to chloride binding site on NA+/2Cl-/K+ cotransporter found on the luminal surface of the thick ascending limb of the loop of Henle->inhibits sodium and chloride reabsorption in the kidneys, thus impacting the osmotic gradient and reducing water reabsorption in the descending limb; causes venous dilation and subsequently reduces preload

Question 23

Furosemide Pharmacokinetics

Answer 23

Onset of Action=5-10 minutes vasodilation, 5-30 minutes diuresis
Peak Effects=30 minutes vasodilation, 20-60 minutes diuresis
Duration of Effect= 2 hours vasodilation, 6 hours diuresis
Half-Life=30 minutes

Question 24

Furosemide Indications/Field Use

Answer 24

1) CHF

2) Pulmonary Edema

Question 25

Furosemide Contraindications

Answer 25

1) Caution with sulfa allergies 2) Caution with renal failure] 3) Pregnancy unless life threatening

Question 26

Furosemide Side Effects/Adverse Reactions

Answer 26

HA, dizziness, hypotension, volume depletion, potassium depletion, dysrhythmias, diarrhea, N+V

Question 27

Furosemide Dose

Answer 27

(Adult): 40mg slow IV, IO; if Pt takes Lasix daily incl. today, give their dose, if Pt takes Lasix but didn;t today, double their dose (Pedi): 0.5-1mg/kg slow IVP (not for children under 12)

Question 28

Furosemide Precautions

Answer 28

1) Note LS and BP before and after 2) Protect from Light 3) May cause dehydration

Question 29

Furosemide Drug-Drug Interactions

Answer 29

1) May cause additive effects and/or electrolyte imbalance if given with other diuretic 2) NSAIDS may antagonize effects of Lasix

Question 30

Epinephrine

Answer 30

Adrenalin, EpiPen, EpiPen Jr.

Question 31

Epinephrine Drug Classification

Answer 31

1) alpha 1 agonist->peripheral vasoconstriction, increases SVR and BP 2) beta 1 agonist->positive inotropy, chronotropy, dromotropy 3) beta 2 agonist-> bronchodilation 4) Blocks destruction of MAST cells (which release Histamine) in anaphylaxis

Question 32

Epinephrine Pharmacokinetics

Answer 32

Onset of Action= < 2 minutes IV, 3-10 minutes IM Peak Effects= < 5 minutes IV, 20 minutes IM Duration of Effect= 5-10 minutes IV, 20-30 minutes IM Half-Life= 5 minutes IV

Question 33

Epinephrine Indications/Field Use

Answer 33

1) Cardiac arrest 2) Anaphylaxis/Severe reactive airway disease/asthma 3) Symptomatic bradycardia/hypotension

Question 34

Epinephrine Contraindications

Answer 34

1) HTN and tachydysrhythmias | 2) use caution with pregnancy and CAD

Question 35

Epinephrine Side Effects/Adverse Reactions

Answer 35

Anxiety, HA, dysrhythmias, tremulousness, dizziness, N+V, *Leads to increased myocardial oxygen demand*

Question 36

Epinephrine Dose

Answer 36

Cardiac arrest (Adult): 0.5-1mg IV, IO (1:10,000) q3-5 min Bradycardia/Hypotension (Adult): 2-10 ug/min Anaphylaxis/Asthma (Adult): 0.3-0.5mg IM, SC (1:1000), then 0.1mg (1:10,000) slow IV, IO over 3 minutes Cardiac arrest (Pedi): 0.01mg/kg IV, IO (1:10,000) q3-5 min Anaphylaxis/Asthma (Pedi): 0.01 mg/kg IM, SC (1:1000), then 0.01mg/kg (1:10,000), max dose 0.3mg, slow IV,IO

Question 37

Epinephrine Precautions

Answer 37

Should be protected from light

Question 38

Epinephrine Drug-Drug Interactions

Answer 38

1) pH dependent, deactivated by alkaline solutions 2) effect intensified with pts taking antidepressants 3) reacts with CaCl2 and NaHCO3 to form PPT (in IV tubing)