Drugs - Pharmacology, Metabolism, Special Notes and Pharmacokinetics Flashcards

Question

Glucose 10% Metabolism

Answer 1

Broken down in most tissues and distributed throughout total body water

Answer 2

A sugar that is the principal energy source for body cells, especially the brain

Answer 3

the preferred treatment for hypoglycaemia for patients unable to take oral glucose due to its rapid onset and ability to quickly restore blood glucose concentration to normal values

Answer 4

Broken down in most tissues and distributed throughout total body water

Answer 5

Quickly absorbed in the intestinal tract - principal energy source for body cells, especially the brain.

Answer 6

readily absorbed and metabolised by the liver

Answer 7

decreases preload and afterload, dilates blood vessels to allow blood through the coronary veins and arteries and pools blood in peripheral veins

Answer 8

Subling GTN first line Tx for ACS, however IV GTN should be considered as part of the mgmt regime for all Pts unresponsive to subling GTN, narcotics and/or blockers GTN is first line Tx for autonomic dysreflexia, however morphine should be considered as part of the mgmt regime if Pt unresponsive to initial Tx

Answer 9

Metabolised by the liver, excreted by the kidneys

Answer 10

Inhibit the inflammatory action of the phospholipase A2 enzyme and used for multiple reasons for infections in a variety of setting for long term disease processes

Answer 11

Each 100 mg hydrocortisone vial is to be reconstituted with 2 mL sodium chloride 0.9% or water for injection All canulae and IV lines must be flushed thoroughly with sodium chloride 0.9% following each medication administration Prepare in aseptic manner, disinfect rubber stopper with antimicrobial swab and allow to dry before piercing

Answer 12

Metabolised by the liver and exreted mainly by the kidneys

Answer 13

Non-selective NSAID that inhibits the synthesis of prostaglandins resulting in analgesic, antipyretic and anti-inflammatory actions

Answer 14

Consider previous doses by the Pt, carer, parent or guardian Administer with or shortly following food/milk Can be used in conjunction with paracetamol for additional pain relief

Answer 15

metabolised by the liver and excreted by the kidneys

Answer 16

Antimuscurinic agent that promotes bronchodilation by inhibiting cholinergic bronchomotor tone

Answer 17

Must be administered in conjunction with salbutamol - solutions may be mixed and administered via the same nebuliser mask

Answer 18

absorbed in the GI tract with rapid first-pass hepatic metabolism

Answer 19

long acting, second generation peripheral histamine H1 receptor antagonist

Answer 20

Antihistamines have no role in the Tx or prevention of respiratory or cardiovascular symptoms in anaphylaxis May be administered with or without food

Answer 21

Metabolised by the liver and excreted mainly by the lungs

Answer 22

More susceptible to metabolism than other halogenated ethers and has a greater propensity to diffuse into fatty tissue

Answer 23

At no time should unconsciousness be deliberately induced using methoxyflurane The lowest dose of methoxyflurane to provide analgesia should be used Pt not to be left unattended If the Pt prefers simultaneous inhalation through both nose and mouth, the inhaler may be connected into a standard anaesthetic face mask prior to administration Only one dose of 3 mL should be administered per Pt whilst in the ambulance No single officer should administer more than 2 doses in the ambulance per shift Where possible, ambulance should be adequately ventilated

Answer 24

Metabolised by the liver, excreted by the kidneys

Answer 25

Short acting CNS depressant that enhances the action of the inhibitory neurotransmitter GABA, inducing amnesia, anaesthesia, hypnosis and sedation

Answer 26

Focal seizure activity in an unconscious or altered (GCS_\<_12) treated as a generalised seizure - GCS \>12 contact QAS Clinical Consultation and Advice Line Take into account previous doses prior to arrival of midazolam or diazepam Contact QAS Clinical Consltation and Advice Line if not responding to QAS initiated Tx First dose of midazolam for seizures must be administered NAS or IM injection unless IV cannula already in situ All IV doses must be diluted with sodium chloride 0.9% to make 5 mg midazolam in 5 mL presentation

Answer 27

Metablised by the liver, kidneys and lungs

Answer 28

Narcotic analgesic that acts on CNS by binding with opioid receptors altering pain perception processes and emotional response to pain. Causes respiratory depression, vasodilation, decreases gag reflex and slows AV node conduction.

Answer 29

When combined narcotic (orphine and fentanyl) therapy is administered, the total maximum dose is to be calculated using a combination of all morphine and morphine milligram equivalent (MME) medication (eg fentanyl), eg 10 mg morphine and 100 microg fentanyl would equl the ACP total max dose of 20 mg MME When administered to hypotensive Pt, ACPs must call for CCP backup where available Hypotensive adult Pts (SBP \< 90 mmHg), all incremental morphine doses are to be no greater than 2.5 mg IV or 5 mg IM Single IM dose morphine is suitable anagesic for moderate to severe labour pain in full term mothers. Advise receiving hospital of dose.

Answer 30

ampoules should be protected from light IV cannula not to be inserted for ondansetron administration only transient adverse effects have been reported with rapid IV injections

Answer 31

metabolised by the liver and excreted by the kidneys

Answer 32

Serotonin 5-HT3 antagonist which inhibits the vagus nerve and blocks serotonin receptors in the chemoreceptor trigger zone

Answer 33

A colourless, odourless gas essential for the production of cellular energy

Answer 34

Diving accidents are not covered by this DTP - administer high flow oxygen Sat monitors unable to differentiate between carboxyhaemoglobin and oxyhaemoglobin, therefore carbon monoxide poising Pts must be administered the maximum oxygen dose irrespective of SpO2 readings COPD Pts must have a rate of 6 L/min - all other Pts at 8 L/min FiO2 levels influenced by delivery systems, rep rate and open or closed mouth

Answer 35

metabolised by the liver and excreted by the kidneys

Answer 36

Stimulates uterine contractions by altering calcium concentrations within the uterine muscle cells increasing it tonicity

Answer 37

Oxytocin is only to be administered to the consenting patient - women who prefer a physiological management must birth the placenta unaided, by maternal effort and the natural force of gravity to allow for the benefits of delayed cord clamping it is acceptable to do a modified active third stage management by waiting until the cord has stopped pulsating to administer oxytocin. This is particularly important in neonatal resuscitation where the baby is resuscitated between the mum's legs to receive the benefit of a pulsing cord and placental perfusion.

Answer 38

Metabolised by the liver, excreted by the kidneys

Answer 39

A p-aminophenol derivative that exhibits analgesic and antipyretic activity. It does not possess significant anti-inflammatory activity

Answer 40

Consider previous doses administered May be administered with or without food

Answer 41

metabolised by the liver, excreted by the kidneys

Answer 42

Acts on B2 adrenoreceptors causing bronchodilation, inotropic and chronotropic actions. It stimulates the sodium/potassium ATPase pump, increasing intracellular K+ and reducing serum K+. ``` inotropic = heart contractility chronotropic = increased HR ```

Answer 43

When clinically appropriate, MDI is preferred to minisise aerosol generation, especially if infectious Different preparation for IM and IV - using the incorrect one will cause serious adverse effects COPD Pts received NEB salbutamol at 6 L/min, all other Pts at 8 L/min Nebulised salbutamol will reduce serum potassium by 0.5 - 1 mmol/L within 30 minutes Nebules to be stored within foil packet and discarded three months after opening - write date on packet when opened

Answer 44

100% bioavailability. Excess sodium is predominantly excreted by the kidneys.

Answer 45

Electrolyte replenisher for maintenance or replacement of fluid and a vehicle for parenteral drug administration

Answer 46

Use of volume expansion in uncontrolled haemorrhage (without concurrent TBI) may be associated with poor outcomes - only administer the minimum amount of IV/IO fluid to maintain a radial pulse Hypotension with a concurrent TBI is associated with poor outcomes - only administer the minimum amount of IV fluid required to maintain a systolic BP 100 - 120mmHg (adult) Excessive fluid infusion may lead to neurogenic pulmonary oedema in the spinal cord injured patient Too rapid infusion of fluids in a patient without fluid deficit, or with underlying cardiac problems, may cause pulmonary oedema and congestive heart failure A gentle fluid challenge may be considered for patients with suspected right ventricular infarct (following 12-Lead ECG acquisition with V4R) and no signs of left ventricular failure (e.g. pulmonary oedema) BD PosiFlushSP pre-filled are for vascular devices only and NOT for any dry product reconstitution AND/OR medication dilution

Answer 47

mucosal absorption with hepatic metabolism

Answer 48

increases endogenous opioids resulting in approximately 5−8 mins of analgesia in infants

Answer 49

Alternate support measures (e.g. breast feeding, appropriate positioning, distraction) should always precede oral sucrose administration Oral sucrose is not considered appropriate for the management of continuing pain or distress Oral sucrose to manage mpain should be used in conjunction with analgesics (eg paracetamol, NAS fentanyl)

Answer 50

metabolised by the liver, excreted by the kidneys

Answer 51

Stops the conversion of plasminogen to plasmin, stopping the breakdown of fibrin and promoting clot strength, inhibiting lysis.

Answer 52

Sterilised H₂O

Answer 53

QAS medications approved for dilution with water for injection include: ceftriaxone, glucagon, hydrocortisone and ketamine Water for injection may be used to assist with the administration of oral medication if required (aspirin, clopidogrel, paracetamol and ticagrelor)

Answer 54

blocks Na+, K+, Ca++, alpha & beta channels prolonging action potential & refractory period, decreases excitability & improves potential for ROSC

Answer 55

Majority is excreted by the liver and GI tract in biliary excretion, may be some hepatic recirculation

Answer 56

* If the Pt is on oral amiodarone cardic arrest administration is authorised * Pts with Torsade de Pointes due to suspected prolonged QT interval from excess amiodarone magnesium sulphate should be considered - contct QAS Clinical Consultation and Advice Line

Answer 57

Absorption Distribution Metabolism Excretion

Answer 58

Route of administration

Answer 59

Lipid solubility Perfusion & transportation

Answer 60

Hepatic first-pass effect Biotransformation

Answer 61

Elimination & excretion

Answer 62

Lipid solubility Plasma protein binding Body composition Tissue and organ perfusion Organ function

Answer 63

influences in which body compartments the drug may accumulate, directly affecting drug effect and dosage schedules

Answer 64

affects bioavailability and transportation of the drug

Answer 65

relative proportions and absolute amount of lean and adipose tissues

Answer 66

impacts distribution of the drug throughout the body, and therefore effect, metabolism, and excretion

Answer 67

relates to those organ systems involved in the metabolism, elimination, and excretion of the drug

Answer 68

tissue perfusion, and therefore cardiac function, blood pressure, and shock

Answer 69

functionality of kidneys and liver, for metabolism and excretion

Answer 70

* 1. Anticholinergic action inhibits vagus innervation of the heart * 1. loss of parasympatheic tone resulting in increased heart rate and contractility

Answer 71

Provides extracellular sodium to overcome Na+ blockade Reverses metabolic acidosis by reacting with H+ ions

Answer 72

* Improves contractility * Myocardial protection in hyperkalaemia * Provides extracellular calcium to overcome Ca++ blockade

Answer 73

Stabilises the membrane in Torsades de Points by reducing Ca++ influx into the cell

Answer 74

opioid antagonist that prevents or reverses the effects of opioids including respiratory depression, sedation and hypotension. Naloxone antagonises the opioid effects by competing for the same receptor sites.

Answer 75

* should only be administered following adequate patient oxygenation and ventilation * should be administered cautiously to patients who are known or suspected to be physically dependent on narcotics * not required in the vast majority of cases, and the patient will need only supportive therapy followed by transport * duration of the narcotic may exceed that of naloxone and renarcotisation is possible * Administration in the pre-hospital environment may unmask potentially unwanted side effects in the setting of poly pharmacy overdose * should not be administered to the newly born, even in the setting of suspected or identified opiate exposure/overdose, as administration of naloxone may lead to acute withdrawal and seizures

Answer 76

Dopamine-2 receptor antagonist that increases brain turnover of dopamine; and Mild alpha-adrenergic receptor blockade which can result in mild hypotension

Answer 77

Hepatic metabolism with biliary/renal excretion as inactive metabolites

Answer 78

Where a second dose of droperidol has been administered by an ACP2, a CCP must be requested and they may be cancelled if the second dose of droperidol achieves the desired sedation effect Dosages and times of administration prior to QAS arrival must be considerd to ensure compliance with the QAS Droperidol DTP In Lewy body dementia, antipsychotic (e.g. droperidol) can cause deterioration in cognitive and motor function, and may paradoxically increase agitation and worsen behaviour For other presentations of dementia (e.g. Alzeheimer’s disease) droperidol is a suitable pharmacological agent for the management of acute behavioural disturbance Under no circumstances is an IV cannula to be inserted for the sole purpose of droperidol administration. IV droperidol administration is only to occur when an IV cannula is already insitu

Answer 79

It causes vasodilation and bronchodilation through inhibition of smooth muscle contraction. Magnesium ions also possess anticonvulsant and anti-dysrrhythmic properties

Answer 80

filtered in the kidneys and excreted predominantly in urine with small amounts in faeces and saliva

Answer 81

contains concentrated immunoglobulin that acts to neutralise the toxins present in the venom of the box jellyfish

Answer 82

Hepatic and in muscle tissue

Answer 83

* The dose of antivenom is related to the dose of venom, not based on the size of the patient * At all times during antivenom therapy adrenaline (epinephrine) * must be available in case of an anaphylactic reaction. If reaction * occurs, immediately cease the administration of box jellyfish * antivenom and treat patient in accordance with CPG: Anaphylaxis * and allergy. * IV injection is the preferred route of administration for all indications. * If a patient is in cardiac arrest due to box jellyfish envenomation, the box jellyfish antivenom is only to be administered following the commencement of effective CPR, advanced life support measures and administration of cardioactive drugs * Box jellyfish antivenom must be protected from light and stored between 2–8°C. DO NOT FREEZE

Answer 84

(an injectable form of vitamin B12), binds with circulating and cellular cyanide to form cyanocobalamin, which is then excreted in urine

Answer 85

excreted by the kidneys

Answer 86

* Hydroxocobalamin infusions are only to be administered by appropriately trained QAS clinicians within the following response catchments: - Central Queensland District: Orica Yarwun Cyanide Plant - Darling Downs District: Texas Silver Mine - North West District: Great Australian Mine, Lorena Gold Project * Substantial increases in blood pressure may occur * There are no adequate and well-controlled studies of hydroxocobalamin * administration in pregnant women. Hydroxocobalamin should be used * during pregnancy ONLY if the potential benefits justifies the potential * risk to the fetus

Answer 87

a rapid acting dissociative anaesthetic agent that is primarily an NMDA receptor antagonist but also interacts with opioid, monoaminergic, muscarinic receptors and voltage sensitive Ca ion channels

Answer 88

contains concentrated immunoglobulin that acts to neutralise the box jellyfish toxins

Answer 89

selectively inhibits the binding of adenosine diphosphate (ADP) to its platelet receptor, thereby inhibiting platelet aggregation

Answer 90

Hepatic metabolism with near equal amounts excreted in urine and faeces

Answer 91

15–48% of patients have a poor platelet inhibition response to clopidogrel. Therefore, the interventional cardiologist may request the administration of ticagrelor

Answer 92

Binds to antithrombin III and inhibits thrombin generation and factor Xa and thrombin

Answer 93

Hepatic but mostly eliminated unchanged

Answer 94

IV administrations an enoxaparin 60 mg/0.6 mL graduated pre-filled syringe must be used. The air bubble MUST NOT be administered with the medication. SUBCUT administrations an enoxaparin 100 mg/1 mL graduated pre-filled syringe must be used. The volume to be injected (1 mg/kg) should be measured precisely using the markings on the syringe. When adjusting to the correct dose, hold the syringe with the needle tip pointing down. Depress the plunger so the bottom of the air bubble is level with the marking on the syringe that corresponds to the dose required. The air bubble is required to be administered with the medication.

Answer 95

hypertonic solution that reacts with excess hydrogen ions forming carbon dixoide and water, restoring plasma pH levels

Answer 96

to C02 and H2)

Answer 97

Antagonises dopamine receptors in the CNS

Drugs - Pharmacology, Metabolism, Special Notes and Pharmacokinetics Flashcards

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