EMS Pharmacology Test 2 Flashcards
1
Q
Analgesia
A
The blunting or absence of sensation of pain or noxious stimuli.
2
Q
Sedation
A
The state in which functional activity is decreased. Reduces or irritability, loss of excited state.
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.
4
Q
What body systems are affected by anaphylaxis reactions?
A
Cardio, respiratory, GI, and the integumentary system.
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.
6
Q
Allergic reaction
A
exaggerated immune response by the immune system to a foreign substance.
7
Q
Anaphylaxis
A
An exaggerated , life threatening hypersensitivity reaction to a previously encountered antigen.
8
Q
What is the most common cause of anaphylaxis?
A
Injections: like shots, stings, or bites.
9
Q
Anaphylaxis and allergic reactions are included in a wider group of conditions called:
A
Hypersensitivity reactions
10
Q
allergens
A
Materials that can produce a hypersensitivity or allergic reaction.
11
Q
Antigens that produce an exaggerated allergic reaction are called
A
allergens
12
Q
Antigens
A
Foreign materials that initiate a normal immune response
13
Q
What chemicals are released by a hypersensitive person when exposed to an allergen?
A
histamine, serotonin, bradykinin, slow reacting substance of anaphylaxis
14
Q
The release of histamine causes:
A
vasodilation, increased capillary permeability, and smooth muscle spasm.
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.
16
Q
What distinguishes a normal immune response from an anaphylactic reaction?
A
The magnitude of the chemical release.
17
Q
What does histamine cause?
A
Vasodilation, increased capillary permeability, and smooth muscle spasm.
18
Q
Vasodilation results in:
A
a drop in systemic blood pressure and a decrease in peripheral tissue perfusion and oxygen delivery.
19
Q
Spasm of the smooth muscle causes:
A
diarrhea, vomiting, and laryngospasm
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.
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.
22
Q
What are the management steps of anaphylaxis?
A
Scene safe, protect the airway, support of breathing, IV access, administer medications, psychological support.
23
Q
What are the medications used for the management of anaphylaxis?
A
Oxygen, epinephrine, antihistamines, corticosteroids, vasopressors, beta agonists, other agents
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.
25
What are the indications for oxygen therapy?
Respiratory compromise: Cyanosis, tachypnea, hypoxemia, partially obstructed airway. Cardiac compromise: chest pain, shock, tachycardia, arrhythmias. Neurological compromise: CVA/TIA, Spinal injuries, coma.
26
What are the aims of oxygen therapy?
To increase PaO2 to acceptable level with concentration of oxygen. To decrease the respiratory rate and work of breathing.
27
What is the classification of Norepinephrine?
Vasopressor.
28
Vasopressor
an agent that tends to raise blood pressure.
29
Phenylephrine
Vasopressor: Pressor of choice in spinal cord injury patients.
30
What are the indications of epinephrine (adrenalin)?
allergic reactions, bronchoconstriction, vasopressor/inotrope, cardiac resuscitation
31
What is the classification of epinephrine?
vasopressor/inotrope
32
What are the indications of norepinephrine?
cardiac arrest; adjunct with hypotension. Acute hypotension.
33
What are the contraindications of norepinephrine?
Hypotension due to blood volume deficit.
34
What are the side effects of norepinephrine?
tachyarrhythmias, extravasation, extremity eschemia
35
What are the indications of phenylephrine?
Indications: shock, glaucoma, hypotension.
36
What are the contraindications of phenylephrine?
ventricular tachycardia, arteriosclerotic or cerebrovascular disease, peds
37
What are the side effects of phenylephrine?
reflex bradycardia, extravasation
38
What it the classification of pitressin (vasopressin)?
vasopressor
39
What are the indications of vasopressin?
Refractory shock, GI hemorrhage
40
What are the contraindications of vasopressin?
anaphylaxis
41
What are side effects of vasopressin?
End organ ischemia, myocardial infarction
42
Name the hemodynamic drugs
dopamine, norepinephrine, phenylephrine, vasopressin, epinephrine, dobutamine
43
What are the bronchodilators?
Albuterol, levalbuterol, ipratropium, albuterol/ipratropium, amionophylline/theophylline, racemic epinephrine
44
What is the class of Albuterol?
bronchodilators
45
What are the indications of albuterol?
asthma, bronchitis w/ bronchospasm. and COPD
46
What is the mechanism of action for albuterol?
Beta-adrenergic agonist that selectively acts on beta (2) adrenergic receptors resulting in bronchial smooth muscle relaxation.
47
What are the side effects of albuterol?
tachycardia, nervousness, hypokalemia, and tremor
48
What are the contraindications of albuterol?
Use with caution in patients with cardiovascular disease.
49
What is the class of Levalbuterol (Xopanex)?
bronchodilators
50
What is the mechanism of action for levalbuterol?
Beta-adrenergic agonist that selectively acts on beta (2) adrenergic receptors resulting in bronchial smooth muscle relaxation.
51
What are the side effects of levalbuterol?
tachycardia, nervousness, hypokalemia, and tremor
52
What are the contraindications of levalbuterol?
Use with caution in patients with cardiovascular disease.
53
What are the indications of levalbuterol?
asthma, bronchitis w/ bronchospasm. and COPD
54
What class is ipratropium (atrovent)?
bronchodilator
55
What are the indications of ipratropium?
asthma, bronchospasm associated with COPD
56
What are the contraindications of ipratropium?
peanut allergy, benign prostatic hyperplasia
57
What is the mechanism of action of ipratropium?
Cholinergic antagonist of acetylcholine at the cholinergic receptors producing bronchodilation.
58
What are the side effects of ipratropium?
cough, dry mouth, and bronchospasm.
59
What is the class of racemic epinephrine?
bronchodilators
60
What are the indications of racemic epinephrine?
asthma and croup
61
What is the mechanism of action of racemic epinephrine?
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.
62
What are the adverse reactions of racemic epinephrine?
anxiety, dizziness, headache, tremor, palpitations, tachycardia, cardiac dysrhythmias, and hypertension
63
What are the contraindications of racemic epinephrine?
hypertension and glaucoma
64
What are the corticosteroids?
methylprednisolone and hydrocortisone
65
What are the indications for methylprednisolone?
Anaphylaxis, COPD, asthma
66
What is the MOA of methylprednisolone?
Highly potent steroid w/ greater anti inflammatory activity than prednisolone and lesser tendency to induce sodium and water retention.
67
What are the adverse reactions of methylprednisolone?
Depression, euphoria, HTN, hyperglycemia, and fluid retention
68
What are the contraindications for methylprednisolone?
Cushing's disease, fungal infection
69
What are the indications of hydrocortisone?
adrenal insufficiency, allergic reaction, anaphylaxis, asthma, and COPD
70
What is the MOA of hydrocortisone?
Adrenocorticosteroid with salt retaining properties with greater anti inflammatory activity than prednisolone.
71
What are the adverse reactions of hydrocortisone?
Anxiety, dizziness, headache, tremor, palpitations, tachycardia, cardiac dysrhythmias, hypertension
72
What are the contraindications of hydrocortisone?
hypertension and glaucoma
73
What are the indications of Magnesium Sulfate?
Pre eclampsia, eclampsia, status asthmaticus
74
What is the MOA of Magnesium Sulfate?
Magnesium also may have a direct depressant effect on smooth muscle. Real mechanism is unknown.
75
What are the adverse reactions of Magnesium Sulfate?
hypotension, respiratory depression
76
What is the contra indication of Magnesium Sulfate?
Heart block
77
How many histamine receptors are there?
3. H1, H2, H3
78
Explain the H1 receptor
Allergic responses.
79
Explain the H2 receptor
Gastric secretion (important for ulcer treatment and acid reflux.)
80
Explain the H3 receptor
CNS receptors
81
What are the indications of diphenhydramine?
anaphylaxis
82
What is the MOA of diphenhydramine?
Acts as a antihistamine by competing with histamine for receptor sites on effector cells
83
What are the side effects of diphenhydramine?
Drowsiness, dizziness, headache, hypotension, dry mouth, blurred vision
84
What are the contraindications of diphenhydramine?
heart block
85
Describe the management of allergic reactions.
Scene safety, protect the airway, support breathing, establish IV access, antihistamines, epinephrine
86
Visual Analog Scale
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
Numeric rating scale
Patients rate their pain with numbers from 0 to 10.
88
Verbal rating scale / Adjective rating scale
Patients choose the best adjective that describes their pain, none, mild, moderate, severe, unbearable.
89
Faces pain scale
Pediatric pain scale.
90
Name the non pharmacological treatment interventions for pain
Bed rest, bracing, manipulation, mobilization, traction, therapeutic modalities, TENS, electrical stimulation, ultrasound, superficial heat, cryotherapy, exercise, education, psychological intervention.
91
Pharmacological treatment interventions for pain
Opioids/ opiates, NSAIDS, Gases, General anesthetics, benzodiazepines, antiemetics
92
These drugs include the natural products morphine, codeine, thebaine.
Opioids
93
Opioids suppress their pain by their action on ______, ________, and _______.
brain, spinal cord, and PNS
94
The pharmacokinetic and pharmacodynamics properties of opiates are effected by:
age, body weight, organ failure, shock
95
Name the naturally occurring opiates
Morphine, codeine, papaverine, thebaine
96
Name the semisynthetic opioids
Heroine, Buprenorphine
97
Name the synthetic opioiods
Butorphanol, Methadone, Meperidine, Fentanyl
98
What are the three opioid receptors?
mu, kappa, delta
99
Where is the delta receptor located?
The brain
100
Where is the kappa receptor located?
The brain and spinal cord
101
Where is the mu receptor located?
Brain, spinal cord, intestinal tract
102
What are the functions of the delta receptor?
Analgesia, antidepressant effect, physical dependence
103
What are the functions of the kappa receptor?
Spinal analgesia, sedation, miosis, dysphoria
104
What are the functions of the mu receptor?
Supraspinal analgesia, respiratory depression, miosis, euphoria, reduced GI motility, physical dependence
105
What are the indications for morphine sulfate?
Pain, Heart failure, acute MI
106
What is the MOA of morphine?
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
Adverse drug effects of morphine?
respiratory depression, hypotension, nausea and vomiting, allergic reactions
108
What are the contraindications of morphine?
renal failure, respiratory depression
109
What is the indication for fentanyl?
pain
110
What is the MOA for fentanyl?
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
What are the adverse reactions to fentanyl?
respiratory depression, hypotension, nausea/vomiting
112
What are the contraindications to fentanyl?
respiratory depression
113
What is the indication for meripidine?
Pain
114
What is the MOA for Meripidine?
Meperidine produces analgesia by interacting with opioid receptors in the CNS.
115
What are the adverse side effects for meripidine?
respiratory depression and nausea/vomiting
116
What are the contraindications of meripidine?
pregnancy, and MAO inhibitors
117
What is the MOA of Butorphenol?
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
What are the side effects of Butorphenol?
dizziness, respiratory depression
119
What are the contraindications of Butorphenol?
not recommended for pediatric patients, hepatic or renal dysfunction
120
What is the indication for Nalbuphine?
Pain
121
What is the MOA for Nalbuphine?
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
What are the side effects of Nalbuphine
Respiratory Depression
Hypotension
Nausea/Vomiting
123
Narcan
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
Why are NSAIDs unusual?
Because they are non narcotic.
125
What is the indication for aspirin?
Pain, fever, inflammation, acute MI, angina
126
What is the mechanism of action for aspirin?
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
What are the side effects of aspirin?
Anaphylaxis
Angioedema/Bronchospasm
Bleeding
128
What are the contraindications of aspirin?
GI Bleeding/PUD
Hemorrhagic stroke and other bleeding issues
Children
129
What toxicity issues should be addressed with aspirin?
reye's syndrome
130
What is the indication of ibuprofen?
fever/pain
131
What is the MOA of ibuprofen?
Ibuprofen is a nonsteroidal antiinflammatory drug (NSAID) that exhibits analgesic and antipyretic activities by inhibiting prostaglandin synthesis.
132
What are the side effects of ibuprofen?
nausea, vomiting, diarrhea
133
What are the contraindications of ibuprofen?
asthma, HTN, CAD, HF, fluid retention, renal dysfunction
134
What is the indication for Ketorolac?
Pain
135
What is the MOA for Ketorolac?
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
What are the side effects of Ketorolac?
Headache
| Nausea/Vomiting/Diarrhea
137
What are the contraindications for Ketorolac?
Renal dysfunction, hypovolemia
138
What is the indication for nitrous oxide?
pain
139
What is the MOA of nitrous oxide?
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
What are the side effects of nitrous oxide?
Delirium
Hypoxia
Respiratory depression
141
What are the contraindications of nitrous oxide?
increased ICP, COPD
142
Define a general anesthetic
General anesthetic is a drug that brings about a reversible loss of consciousness.
143
What is the indication of Etomidate?
Procedural sedation / RSI
144
What is the MOA for Etomidate?
Etomidate is a short-acting hypnotic, which appears to have gamma-aminobutyric acid (GABA)–like effects.
145
What is the RSI dosage for Etomidate?
.3 mg/kg
146
What are the side effects of Etomidate?
Hypotension
Respiratory depression
Myoclonus
147
What are the contraindications of Etomidate?
adrenal insufficiency, significant trauma
148
What is the indication for Ketamine?
RSI and procedural sedation
149
What is the MOA for Ketamine?
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
What are the side effects of Ketamine?
Emergence phenomena, hypotension
151
What are the contraindications of Ketamine?
Elevated ICP, hypertensive crisis
152
What toxicity warnings should you Ketamine?
high doses can cause respiratory failure
153
What is the indication for Propofol?
general sedation, RSI
154
What is the MOA for Propofol?
Propofol is a short-acting hypnotic. Its mechanism of action has not been well-defined.
155
What are the side effects of Propofol?
Respiratory depression, bradycardia
156
What are the contraindications of Propofol?
Allergy to eggs
157
Benzodiazepines effect what neurotransmitter?
GABA
158
This neurotransmitter has an inhibitory effect on motor neurons, thus the presence of _____ slows or stops neuronal activity.
GABA
159
Benzodiazepines ______ the activity of GABA, effectively slowing nerve impulses throughout the body.
enhance
160
What are the indications for the benzodiazepines?
anxiety, seizures, alcohol withdrawal, muscle spasms
161
What is the MOA for midazolam?
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
What are the side effects of midazolam?
Respiratory depression
| Injection site pain
163
What is the contraindication for midazolam?
alcohol intoxication
164
What is the MOA for Lorazepam?
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
What is the MOA for Diazepam?
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
What is the indication for Dolasetron?
prevention and treatment of nausea and vomiting
167
What is the mechanism of action for Dolasetron?
stops the chemoreceptor trigger zone
168
"Setrons" can cause?
Prolonged QR
169
What are the indications for the antiemetics?
prevention and treatment of nausea and vomiting
170
What are the antimietics we have gone over?
dolasetron, ondansetron, promethazine
171
What are the adverse reactions of the antimimetics?
hypotension, fatigue
172
What is the MOA for ondansetron?
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
What is the MOA for promethazine?
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
What are the outward signs of respiratory distress?
```
Breathing Rate
Color Changes
Grunting
Nasal Flaring
Retractions
Sweating
Wheezing
```
175
What are the clinical signs of respiratory distress?
```
Pulse Oximetry
Respiratory Rate
Heart Rate
Blood Pressure
Arterial Blood Gases
```
176
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.
dyspnea
177
Greater than normal respiratory rate.
tachyapnea
178
Increased respiratory distress when the patient is lying down or the chest is compressed.
orthopnea
179
Ventilation that exceeds metabolic demands; defined as ventilation causing a reduction in PaCO2 < 35 mmHg at sea level.
hyperventilation
180
Ventilation that does not meet metabolic demands; by definition, ventilation that results in a PaCO2 > 45 mmHg at sea level.
hypoventilation
181
Cessation of breathing for an indeterminate period.
apnea
182
Crackles
```
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
wheeze
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
rhonci
Similar to wheezes
Low pitched, snoring quality, continuous, musical sounds
Implies obstruction of larger airways by secretions
Associated condition
acute bronchitis
185
stridor
```
Inspiratory musical wheeze
Loudest over trachea
Suggests obstructed trachea or larynx
Medical emergency requiring immediate attention
Associated condition
inhaled foreign body
```
186
What are the common causes of respiratory distress?
asthma, COPD, pleural effusion, pneumothorax, ARDS, atelectasis
187
COPD
characterized by abnormalities in the lings that make it difficult to exhale normally.
188
What 2 distinct diseases are involved in COPD
emphysema and chronic bronchitis
189
Emphysema and chronic bronchitis are
abnormalities in ling structure that permanently obstruct airflow
190
Asthma
Reversible inflammation of the airways
191
What are the treatment options for COPD and asthma?
oxygen, bronchodilators, anticholinergics, steroid
192
What are the indications of oxygen?
respiratory, cardiac, and neurological compromise
193
Humidification
prevents cilia destruction, prevents damage to mucous glands, aids sputum clearance
194
What are the indications for humidification?
oxygen therapy at higher flow rates, and patients with copious secretions
