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Prehospital Pharmocology > EMS Pharmacology Test 2 > Flashcards

EMS Pharmacology Test 2 Flashcards

1
Q

Analgesia

A

The blunting or absence of sensation of pain or noxious stimuli.

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2
Q

Sedation

A

The state in which functional activity is decreased. Reduces or irritability, loss of excited state.

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3
Q

Why are injections such a big cause of anaphylaxis?

A

Injection allows the allergen to be rapidly distributed throughout the body resulting in a massive histamine release.

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4
Q

What body systems are affected by anaphylaxis reactions?

A

Cardio, respiratory, GI, and the integumentary system.

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5
Q

What assessment findings would one expect to find in a patient with anaphylaxis?

A

Rapid onset: with 30 to 40 seconds following exposure. Previous allergies and reactions, and respiratory difficulty is indicative.

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6
Q

Allergic reaction

A

exaggerated immune response by the immune system to a foreign substance.

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7
Q

Anaphylaxis

A

An exaggerated , life threatening hypersensitivity reaction to a previously encountered antigen.

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8
Q

What is the most common cause of anaphylaxis?

A

Injections: like shots, stings, or bites.

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9
Q

Anaphylaxis and allergic reactions are included in a wider group of conditions called:

A

Hypersensitivity reactions

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10
Q

allergens

A

Materials that can produce a hypersensitivity or allergic reaction.

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11
Q

Antigens that produce an exaggerated allergic reaction are called

A

allergens

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12
Q

Antigens

A

Foreign materials that initiate a normal immune response

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13
Q

What chemicals are released by a hypersensitive person when exposed to an allergen?

A

histamine, serotonin, bradykinin, slow reacting substance of anaphylaxis

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14
Q

The release of histamine causes:

A

vasodilation, increased capillary permeability, and smooth muscle spasm.

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15
Q

What happens after a foreign invader or material has been targeted in the body?

A

Various cells attack the invader, releasing various chemicals, principally histamine.

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16
Q

What distinguishes a normal immune response from an anaphylactic reaction?

A

The magnitude of the chemical release.

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17
Q

What does histamine cause?

A

Vasodilation, increased capillary permeability, and smooth muscle spasm.

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18
Q

Vasodilation results in:

A

a drop in systemic blood pressure and a decrease in peripheral tissue perfusion and oxygen delivery.

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19
Q

Spasm of the smooth muscle causes:

A

diarrhea, vomiting, and laryngospasm

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20
Q

The most common cause of death from allergic reaction is what, and why?

A

Obstruction of the airway because increased capillary permeability results in edema of the airway.

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21
Q

What physical exam findings would you expect for an anaphylaxis patient?

A

Facial or laryngeal edema, abnormal breath sounds, hives and uticaria, hyperactive bowel signs, vital sign deterioration as reaction progresses.

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22
Q

What are the management steps of anaphylaxis?

A

Scene safe, protect the airway, support of breathing, IV access, administer medications, psychological support.

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23
Q

What are the medications used for the management of anaphylaxis?

A

Oxygen, epinephrine, antihistamines, corticosteroids, vasopressors, beta agonists, other agents

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24
Q

Why is establishment of IV access so important for anaphylaxis patients?

A

Because the patient may be volume depleted due to third spacing of fluid.

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25
Q

What are the indications for oxygen therapy?

A

Respiratory compromise: Cyanosis, tachypnea, hypoxemia, partially obstructed airway. Cardiac compromise: chest pain, shock, tachycardia, arrhythmias. Neurological compromise: CVA/TIA, Spinal injuries, coma.

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26
Q

What are the aims of oxygen therapy?

A

To increase PaO2 to acceptable level with concentration of oxygen. To decrease the respiratory rate and work of breathing.

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27
Q

What is the classification of Norepinephrine?

A

Vasopressor.

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28
Q

Vasopressor

A

an agent that tends to raise blood pressure.

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29
Q

Phenylephrine

A

Vasopressor: Pressor of choice in spinal cord injury patients.

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30
Q

What are the indications of epinephrine (adrenalin)?

A

allergic reactions, bronchoconstriction, vasopressor/inotrope, cardiac resuscitation

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31
Q

What is the classification of epinephrine?

A

vasopressor/inotrope

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32
Q

What are the indications of norepinephrine?

A

cardiac arrest; adjunct with hypotension. Acute hypotension.

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33
Q

What are the contraindications of norepinephrine?

A

Hypotension due to blood volume deficit.

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34
Q

What are the side effects of norepinephrine?

A

tachyarrhythmias, extravasation, extremity eschemia

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35
Q

What are the indications of phenylephrine?

A

Indications: shock, glaucoma, hypotension.

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36
Q

What are the contraindications of phenylephrine?

A

ventricular tachycardia, arteriosclerotic or cerebrovascular disease, peds

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37
Q

What are the side effects of phenylephrine?

A

reflex bradycardia, extravasation

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38
Q

What it the classification of pitressin (vasopressin)?

A

vasopressor

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39
Q

What are the indications of vasopressin?

A

Refractory shock, GI hemorrhage

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40
Q

What are the contraindications of vasopressin?

A

anaphylaxis

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41
Q

What are side effects of vasopressin?

A

End organ ischemia, myocardial infarction

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42
Q

Name the hemodynamic drugs

A

dopamine, norepinephrine, phenylephrine, vasopressin, epinephrine, dobutamine

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43
Q

What are the bronchodilators?

A

Albuterol, levalbuterol, ipratropium, albuterol/ipratropium, amionophylline/theophylline, racemic epinephrine

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44
Q

What is the class of Albuterol?

A

bronchodilators

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45
Q

What are the indications of albuterol?

A

asthma, bronchitis w/ bronchospasm. and COPD

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46
Q

What is the mechanism of action for albuterol?

A

Beta-adrenergic agonist that selectively acts on beta (2) adrenergic receptors resulting in bronchial smooth muscle relaxation.

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47
Q

What are the side effects of albuterol?

A

tachycardia, nervousness, hypokalemia, and tremor

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48
Q

What are the contraindications of albuterol?

A

Use with caution in patients with cardiovascular disease.

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49
Q

What is the class of Levalbuterol (Xopanex)?

A

bronchodilators

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50
Q

What is the mechanism of action for levalbuterol?

A

Beta-adrenergic agonist that selectively acts on beta (2) adrenergic receptors resulting in bronchial smooth muscle relaxation.

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51
Q

What are the side effects of levalbuterol?

A

tachycardia, nervousness, hypokalemia, and tremor

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52
Q

What are the contraindications of levalbuterol?

A

Use with caution in patients with cardiovascular disease.

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53
Q

What are the indications of levalbuterol?

A

asthma, bronchitis w/ bronchospasm. and COPD

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54
Q

What class is ipratropium (atrovent)?

A

bronchodilator

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55
Q

What are the indications of ipratropium?

A

asthma, bronchospasm associated with COPD

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56
Q

What are the contraindications of ipratropium?

A

peanut allergy, benign prostatic hyperplasia

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57
Q

What is the mechanism of action of ipratropium?

A

Cholinergic antagonist of acetylcholine at the cholinergic receptors producing bronchodilation.

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58
Q

What are the side effects of ipratropium?

A

cough, dry mouth, and bronchospasm.

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59
Q

What is the class of racemic epinephrine?

A

bronchodilators

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60
Q

What are the indications of racemic epinephrine?

A

asthma and croup

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61
Q

What is the mechanism of action of racemic epinephrine?

A

Stimulates alpha, beta, and beta 2 adrenergic receptors resulting in relaxation of smooth muscle of the bronchial tree, cardiac stimulation (increase in myocardial oxygen consumption) and dilation of skeletal muscle vasculature.

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62
Q

What are the adverse reactions of racemic epinephrine?

A

anxiety, dizziness, headache, tremor, palpitations, tachycardia, cardiac dysrhythmias, and hypertension

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63
Q

What are the contraindications of racemic epinephrine?

A

hypertension and glaucoma

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64
Q

What are the corticosteroids?

A

methylprednisolone and hydrocortisone

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65
Q

What are the indications for methylprednisolone?

A

Anaphylaxis, COPD, asthma

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66
Q

What is the MOA of methylprednisolone?

A

Highly potent steroid w/ greater anti inflammatory activity than prednisolone and lesser tendency to induce sodium and water retention.

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67
Q

What are the adverse reactions of methylprednisolone?

A

Depression, euphoria, HTN, hyperglycemia, and fluid retention

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68
Q

What are the contraindications for methylprednisolone?

A

Cushing’s disease, fungal infection

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69
Q

What are the indications of hydrocortisone?

A

adrenal insufficiency, allergic reaction, anaphylaxis, asthma, and COPD

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70
Q

What is the MOA of hydrocortisone?

A

Adrenocorticosteroid with salt retaining properties with greater anti inflammatory activity than prednisolone.

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71
Q

What are the adverse reactions of hydrocortisone?

A

Anxiety, dizziness, headache, tremor, palpitations, tachycardia, cardiac dysrhythmias, hypertension

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72
Q

What are the contraindications of hydrocortisone?

A

hypertension and glaucoma

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73
Q

What are the indications of Magnesium Sulfate?

A

Pre eclampsia, eclampsia, status asthmaticus

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74
Q

What is the MOA of Magnesium Sulfate?

A

Magnesium also may have a direct depressant effect on smooth muscle. Real mechanism is unknown.

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75
Q

What are the adverse reactions of Magnesium Sulfate?

A

hypotension, respiratory depression

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76
Q

What is the contra indication of Magnesium Sulfate?

A

Heart block

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77
Q

How many histamine receptors are there?

A
  1. H1, H2, H3
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78
Q

Explain the H1 receptor

A

Allergic responses.

79
Q

Explain the H2 receptor

A

Gastric secretion (important for ulcer treatment and acid reflux.)

80
Q

Explain the H3 receptor

A

CNS receptors

81
Q

What are the indications of diphenhydramine?

A

anaphylaxis

82
Q

What is the MOA of diphenhydramine?

A

Acts as a antihistamine by competing with histamine for receptor sites on effector cells

83
Q

What are the side effects of diphenhydramine?

A

Drowsiness, dizziness, headache, hypotension, dry mouth, blurred vision

84
Q

What are the contraindications of diphenhydramine?

A

heart block

85
Q

Describe the management of allergic reactions.

A

Scene safety, protect the airway, support breathing, establish IV access, antihistamines, epinephrine

86
Q

Visual Analog Scale

A

A 100mm line with “no pain” at the beginning, and “worst pain” at the end. Patients place a mark to estimate their pain, and the distance from the origin (no pain) is measured.

87
Q

Numeric rating scale

A

Patients rate their pain with numbers from 0 to 10.

88
Q

Verbal rating scale / Adjective rating scale

A

Patients choose the best adjective that describes their pain, none, mild, moderate, severe, unbearable.

89
Q

Faces pain scale

A

Pediatric pain scale.

90
Q

Name the non pharmacological treatment interventions for pain

A

Bed rest, bracing, manipulation, mobilization, traction, therapeutic modalities, TENS, electrical stimulation, ultrasound, superficial heat, cryotherapy, exercise, education, psychological intervention.

91
Q

Pharmacological treatment interventions for pain

A

Opioids/ opiates, NSAIDS, Gases, General anesthetics, benzodiazepines, antiemetics

92
Q

These drugs include the natural products morphine, codeine, thebaine.

A

Opioids

93
Q

Opioids suppress their pain by their action on ______, ________, and _______.

A

brain, spinal cord, and PNS

94
Q

The pharmacokinetic and pharmacodynamics properties of opiates are effected by:

A

age, body weight, organ failure, shock

95
Q

Name the naturally occurring opiates

A

Morphine, codeine, papaverine, thebaine

96
Q

Name the semisynthetic opioids

A

Heroine, Buprenorphine

97
Q

Name the synthetic opioiods

A

Butorphanol, Methadone, Meperidine, Fentanyl

98
Q

What are the three opioid receptors?

A

mu, kappa, delta

99
Q

Where is the delta receptor located?

A

The brain

100
Q

Where is the kappa receptor located?

A

The brain and spinal cord

101
Q

Where is the mu receptor located?

A

Brain, spinal cord, intestinal tract

102
Q

What are the functions of the delta receptor?

A

Analgesia, antidepressant effect, physical dependence

103
Q

What are the functions of the kappa receptor?

A

Spinal analgesia, sedation, miosis, dysphoria

104
Q

What are the functions of the mu receptor?

A

Supraspinal analgesia, respiratory depression, miosis, euphoria, reduced GI motility, physical dependence

105
Q

What are the indications for morphine sulfate?

A

Pain, Heart failure, acute MI

106
Q

What is the MOA of morphine?

A

Morphine sulfate is a pure opioid agonist.
Selective to the mu receptor.
In the CNS, it promotes analgesia and respiratory depression.
It also decreases gastric, biliary and pancreatic secretion, induces peripheral vasodilation and promotes opioid-induced hypotension due to histamine release .

107
Q

Adverse drug effects of morphine?

A

respiratory depression, hypotension, nausea and vomiting, allergic reactions

108
Q

What are the contraindications of morphine?

A

renal failure, respiratory depression

109
Q

What is the indication for fentanyl?

A

pain

110
Q

What is the MOA for fentanyl?

A

Fentanyl acts primarily with the opioid mu-receptors in the central nervous system including the brain, spinal cord and other tissues causing analgesia, mood alterations, euphoria, dysphoria, and drowsiness.

111
Q

What are the adverse reactions to fentanyl?

A

respiratory depression, hypotension, nausea/vomiting

112
Q

What are the contraindications to fentanyl?

A

respiratory depression

113
Q

What is the indication for meripidine?

A

Pain

114
Q

What is the MOA for Meripidine?

A

Meperidine produces analgesia by interacting with opioid receptors in the CNS.

115
Q

What are the adverse side effects for meripidine?

A

respiratory depression and nausea/vomiting

116
Q

What are the contraindications of meripidine?

A

pregnancy, and MAO inhibitors

117
Q

What is the MOA of Butorphenol?

A

Butorphanol tartrate, a synthetic mixed agonist-antagonist analgesic, is a kappa-opioid receptor agonist which has low intrinsic activity at mu-opioid receptor.
Its analgesic effects are mediated by the interactions of these receptors in the CNS .

118
Q

What are the side effects of Butorphenol?

A

dizziness, respiratory depression

119
Q

What are the contraindications of Butorphenol?

A

not recommended for pediatric patients, hepatic or renal dysfunction

120
Q

What is the indication for Nalbuphine?

A

Pain

121
Q

What is the MOA for Nalbuphine?

A

Nalbuphine hydrochloride is a opioid analgesic with binding affinity to mu, kappa, and delta receptors with no affinity to sigma receptors, but acts primarily as a kappa agonist/partial mu antagonist .

122
Q

What are the side effects of Nalbuphine

A

Respiratory Depression
Hypotension
Nausea/Vomiting

123
Q

Narcan

A

Nalaxone is an opioid antagonist with the greatest affinity for the mu receptor. It acts my competing for the mu, kappa, and delta opiate receptors.

124
Q

Why are NSAIDs unusual?

A

Because they are non narcotic.

125
Q

What is the indication for aspirin?

A

Pain, fever, inflammation, acute MI, angina

126
Q

What is the mechanism of action for aspirin?

A

Aspirin is a more potent inhibitor of both prostaglandin synthesis and platelet aggregation than its other salicylic derivatives due to the acetyl group on the aspirin molecule, which inactivates cyclooxygenase via acetylation .

127
Q

What are the side effects of aspirin?

A

Anaphylaxis
Angioedema/Bronchospasm
Bleeding

128
Q

What are the contraindications of aspirin?

A

GI Bleeding/PUD
Hemorrhagic stroke and other bleeding issues
Children

129
Q

What toxicity issues should be addressed with aspirin?

A

reye’s syndrome

130
Q

What is the indication of ibuprofen?

A

fever/pain

131
Q

What is the MOA of ibuprofen?

A

Ibuprofen is a nonsteroidal antiinflammatory drug (NSAID) that exhibits analgesic and antipyretic activities by inhibiting prostaglandin synthesis.

132
Q

What are the side effects of ibuprofen?

A

nausea, vomiting, diarrhea

133
Q

What are the contraindications of ibuprofen?

A

asthma, HTN, CAD, HF, fluid retention, renal dysfunction

134
Q

What is the indication for Ketorolac?

A

Pain

135
Q

What is the MOA for Ketorolac?

A

Ketorolac tromethamine, a nonsteroidal anti-inflammatory drug, blocks prostaglandin complex formation and production through its S-enantiomeric form.
It is a potent analgesic that does not possess any sedative or anxiolytic activities.

136
Q

What are the side effects of Ketorolac?

A

Headache

Nausea/Vomiting/Diarrhea

137
Q

What are the contraindications for Ketorolac?

A

Renal dysfunction, hypovolemia

138
Q

What is the indication for nitrous oxide?

A

pain

139
Q

What is the MOA of nitrous oxide?

A

Nitrous oxide produces a euphoric and anxiolytic effect.
Nitrous oxide has been demonstrated to be a partial agonist at mu, kappa, and sigma receptors of the endogenous opioid system.
This may explain the emetic and addictive properties of nitrous oxide.
Naloxone appeared to partially reverse nitrous oxide-induced analgesia.

140
Q

What are the side effects of nitrous oxide?

A

Delirium
Hypoxia
Respiratory depression

141
Q

What are the contraindications of nitrous oxide?

A

increased ICP, COPD

142
Q

Define a general anesthetic

A

General anesthetic is a drug that brings about a reversible loss of consciousness.

143
Q

What is the indication of Etomidate?

A

Procedural sedation / RSI

144
Q

What is the MOA for Etomidate?

A

Etomidate is a short-acting hypnotic, which appears to have gamma-aminobutyric acid (GABA)–like effects.

145
Q

What is the RSI dosage for Etomidate?

A

.3 mg/kg

146
Q

What are the side effects of Etomidate?

A

Hypotension
Respiratory depression
Myoclonus

147
Q

What are the contraindications of Etomidate?

A

adrenal insufficiency, significant trauma

148
Q

What is the indication for Ketamine?

A

RSI and procedural sedation

149
Q

What is the MOA for Ketamine?

A

Ketamine hydrochloride is a rapid acting general anesthetic.
Its pharmaceutical effects produce analgesia, normal pharyngeal-laryngeal reflexes, skeletal muscle tone, cardiovascular and respiratory stimulation, and transient respiratory depression.

150
Q

What are the side effects of Ketamine?

A

Emergence phenomena, hypotension

151
Q

What are the contraindications of Ketamine?

A

Elevated ICP, hypertensive crisis

152
Q

What toxicity warnings should you Ketamine?

A

high doses can cause respiratory failure

153
Q

What is the indication for Propofol?

A

general sedation, RSI

154
Q

What is the MOA for Propofol?

A

Propofol is a short-acting hypnotic. Its mechanism of action has not been well-defined.

155
Q

What are the side effects of Propofol?

A

Respiratory depression, bradycardia

156
Q

What are the contraindications of Propofol?

A

Allergy to eggs

157
Q

Benzodiazepines effect what neurotransmitter?

A

GABA

158
Q

This neurotransmitter has an inhibitory effect on motor neurons, thus the presence of _____ slows or stops neuronal activity.

A

GABA

159
Q

Benzodiazepines ______ the activity of GABA, effectively slowing nerve impulses throughout the body.

A

enhance

160
Q

What are the indications for the benzodiazepines?

A

anxiety, seizures, alcohol withdrawal, muscle spasms

161
Q

What is the MOA for midazolam?

A

Midazolam hydrochloride, a short-acting benzodiazepine central nervous system depressant (CNS),
reversibly interacts with gamma-amino butyric acid (GABA) receptors in the central nervous system which then exhibits sedative, anxiolytic, amnesic and hypnotic activities.

162
Q

What are the side effects of midazolam?

A

Respiratory depression

Injection site pain

163
Q

What is the contraindication for midazolam?

A

alcohol intoxication

164
Q

What is the MOA for Lorazepam?

A

Lorazepam, a benzodiazepine clinically used as antianxiety, sedative and anticonvulsant agent, binds highly to the gamma-aminobutyric acid (GABA)-benzodiazepine receptor complex without displacing GABA.
The drug binds to its specific attachment site to improve GABA’s attraction to its own receptor site on the GABA-benzodiazepine receptor complex.

165
Q

What is the MOA for Diazepam?

A

Diazepam, a benzodiazepine derivative, is an anxiolytic, agent that reduces neuronal depolarization resulting in decreased action potentials.
It enhances the action of gamma-amino butyric acid (GABA) by tightly binding to A-type GABA receptors, thus opening the membrane channels and allowing the entry of chloride ions.

166
Q

What is the indication for Dolasetron?

A

prevention and treatment of nausea and vomiting

167
Q

What is the mechanism of action for Dolasetron?

A

stops the chemoreceptor trigger zone

168
Q

“Setrons” can cause?

A

Prolonged QR

169
Q

What are the indications for the antiemetics?

A

prevention and treatment of nausea and vomiting

170
Q

What are the antimietics we have gone over?

A

dolasetron, ondansetron, promethazine

171
Q

What are the adverse reactions of the antimimetics?

A

hypotension, fatigue

172
Q

What is the MOA for ondansetron?

A

Ondansetron, binds to the 5-HT(3) receptors located on the vagal neurons in the lining of the gastrointestinal tract, blocking the signal to the vomiting center in the brain, thus preventing nausea and vomiting .

173
Q

What is the MOA for promethazine?

A

Promethazine hydrochloride is a phenothiazine derivative that competitively blocks histamine H(1) receptors without blocking the secretion of histamine.
The drug has sedative, antimotion-sickness, antiemetic, and anticholinergic effects.

174
Q

What are the outward signs of respiratory distress?

A 
Breathing Rate
Color Changes
Grunting
Nasal Flaring
Retractions
Sweating
Wheezing
175
Q

What are the clinical signs of respiratory distress?

A 
Pulse Oximetry
Respiratory Rate
Heart Rate
Blood Pressure
Arterial Blood Gases
176
Q

This term implies conscious perception of “air hunger” or a sense of shortness of breath, and is subjective in nature. This term is not ideal to use in reference to veterinary patients, as they cannot relay this sense or perception of respiratory difficulty.

A

dyspnea

177
Q

Greater than normal respiratory rate.

A

tachyapnea

178
Q

Increased respiratory distress when the patient is lying down or the chest is compressed.

A

orthopnea

179
Q

Ventilation that exceeds metabolic demands; defined as ventilation causing a reduction in PaCO2 < 35 mmHg at sea level.

A

hyperventilation

180
Q

Ventilation that does not meet metabolic demands; by definition, ventilation that results in a PaCO2 > 45 mmHg at sea level.

A

hypoventilation

181
Q

Cessation of breathing for an indeterminate period.

A

apnea

182
Q

Crackles

A 
Discontinuous, intermittent, nonmusical, brief sounds
Heard more commonly with inspiration
Classified as fine or coarse 
Normal at anterior lung bases 
Maximal expiration
Prolonged recumbency
Crackles caused by air moving through secretions and collapsed alveoli 
Associated conditions 
pulmonary edema, early CHF, PNA
183
Q

wheeze

A

Continuous, high pitched, musical sound, longer than crackles
Hissing quality, heard > with expiration, however, can be heard on inspiration
Produced when air flows through narrowed airways
Associated conditions
Asthma, COPD

184
Q

rhonci

A

Similar to wheezes
Low pitched, snoring quality, continuous, musical sounds
Implies obstruction of larger airways by secretions
Associated condition
acute bronchitis

185
Q

stridor

A 
Inspiratory musical wheeze
Loudest over trachea
Suggests obstructed trachea or larynx
Medical emergency requiring immediate attention
Associated condition 
inhaled foreign body
186
Q

What are the common causes of respiratory distress?

A

asthma, COPD, pleural effusion, pneumothorax, ARDS, atelectasis

187
Q

COPD

A

characterized by abnormalities in the lings that make it difficult to exhale normally.

188
Q

What 2 distinct diseases are involved in COPD

A

emphysema and chronic bronchitis

189
Q

Emphysema and chronic bronchitis are

A

abnormalities in ling structure that permanently obstruct airflow

190
Q

Asthma

A

Reversible inflammation of the airways

191
Q

What are the treatment options for COPD and asthma?

A

oxygen, bronchodilators, anticholinergics, steroid

192
Q

What are the indications of oxygen?

A

respiratory, cardiac, and neurological compromise

193
Q

Humidification

A

prevents cilia destruction, prevents damage to mucous glands, aids sputum clearance

194
Q

What are the indications for humidification?

A

oxygen therapy at higher flow rates, and patients with copious secretions

Prehospital Pharmocology (2 decks)

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