EMT205 Flashcards
Tetrahydrocannabinols are what class drug?
Schedule I
Morphine is what class drug?
Schedule II
Agency that regulates biological products?
Public Health Service
Agency that suppresses false or misleading advertising?
FTC
Science of dispensing drugs called…?
Pharmaceutics
Study of how a body handles a drug over a period of time?
Pharmacokinetics
NAVEL stands for…?
Naloxone, Atropine, Vasopressin, Epinephrine, Lidocaine
What compounds absorbed through skin?
Lipid-soluble compounds
Drugs distributed first where…?
Organs that have rich blood supply (e.g. heart, liver, kidneys, brain)
2 processes that create drug reservoirs are called what?
Plasma protein binding and Tissue binding
Albumin does what to drugs?
Traps it in the bloodstream (albumin molecule attaches to drugs, but is too large to pass through cell membrane)
“Free drug” is what?
The portion of the drug not bound to albumin, and that is thus biologically active
What happens as free drugs are eliminated?
Drug-protein complex dissociates, and releases more drug into the bloodstream to replace free drug
Type of drug with affinity for adipose tissue?
Lipid-soluble
Blood-brain barrier allows only what type of drug through cell membrane?
Lipid-soluble
Placental barrier allows what type of drug to pass?
Certain non-lipid-soluble drugs
Process by which drugs are chemically converted to metabolites is called what?
Biotransformation (metabolism)
First-pass metabolism is what?
Occurs when orally administered drugs travel to the liver and are partially metabolized before entering circulation—reduces amount of drug that enters circulation
Drugs excreted by which organ systems? (5)
- Kidneys
- Intestines
- Lungs
- Sweat/salivary glands
- Mammary glands
Study of how a drug acts on a living organism is called what?
Pharmacodynamics
Reactive cellular sites known as…?
Receptors
Therapeutic range for most drugs is what?
The concentration that 1. provides for the highest probability of response with 2. the least risk of toxicity
Biological half-life is what?
The time it takes to metabolize or eliminate 50% of a drug in the body
A drug is considered the be eliminated from the body after ___?
After 5 half-lives have passed (~3% of the drug will be left in the body—test question will ask “under 5%”)
Therapeutic index is what?
A measure of the relative safety of a drug
Wide TI indicates what? Narrow TI?
Wide TI = drug is fairly safe
Narrow TI = drug is fairly dangerous
Two drugs that will crystallize when mixed together?
- Calcium chloride
2. Sodium bicarbonate
Category ratings for pregnancy patients?
Category A (safest), B, C, D, and X (significant fetal risk)
Important difference in infants vs. adults concerning drug distribution?
Infants have more total body water (70-75% compared to 50-60% in adults); means that higher dosages (weight-proportionate) of water soluble drugs may be needed to have effective blood levels in an infant
Protein binding - increased or decreased in infants?
Reduced -> greater chance of toxicity in an infant
What unit of measurement is used to measure body organs or blood pressure?
Centimeters and millimeters
1 gram = ?
= the weight of 1 mL of distilled water at 4 degrees C
Primary unit of the apothecary system?
Grain
What medications are available in units of the apothecary system? (2)
Aspirin and nitroglycerin
Household system: average coffee cup and average teaspoon?
Coffee cup = 5-9 oz
Teaspoon = 4-6 mL
Normal body temperature in degrees C and F?
Celsius = 37 Farenheit = 98.6
Conversion formula: temp C to F?
Multiply by 9/5 and add 32
Conversion formula: temp F to C?
Subtract 32 and multiply by 5/9
Five patient rights?
- Right patient
- Right dose
- Right drug
- Right route
- Right time
Ok to give a med from unlabeled container or one on which label is not legible?
Never
Ok to give a med that was prepared by someone else?
Never
How long should you monitor a patient for any adverse effects after giving a medication?
At least 5 minutes
What is the removal or destruction of disease-causing organisms or infected material called?
Medical asepsis
Chemical used only on nonliving objects that are toxic to living tissue?
Disinfectants
Chemical used on living tissue that are more dilute and prevent cell damage?
Antiseptic
What is the most frequent method of drug administration?
Oral
How to check that gastric tube has been inserted correctly?
Inject 30-50 mL of air into the tube and auscultate the epigastric region for sounds of air movement
After giving drug via gastric tube, what should you do?
Flush the drug with about 30 mL of water
Tuberculin syringes marked in what increments?
0.01 mL increments
Insulin syringes marked how?
1 unit increments
SubQ injections usually given with what size needle?
23- or 25-gauge needle
IM injections usually given with what size needle?
19- or 21-gauge needle
What did the year 2000 signify in needle-stick prevention?
Congress passed the Healthcare Worker Needlestick Prevention Act, OSHA in 2001 followed up to recommend needleless or “needle safe” devices
Single-dose glass containers that hold one dose of medication for injection are called what?
Ampules
Why is filter needle used with ampules?
To prevent shards of glass from entering syringe
Glass containers with rubber stoppers are called what?
Multidose vials
Why do we inject a volume of air into vial equivalent to amount of solution to be withdrawn?
Prevents a vacuum in the vial
Procedure to protect fingers when withdrawing solution from an ampule?
Wrap neck of glass ampule with alcohol swab or gauze dressing
Procedure for cleansing an injection site with alcohol swab?
Work outward in concentric circles from the site to prevent recontamination
Amount usually injected for intradermal injection?
Less than 0.5 mL
Common sites for intradermal injection? (2)
Forearm
Back
What to do with skin for intradermal injection? What angle do you go in? Bevel up or down?
Hold skin taut
10-15 degree angle
Bevel up
Amount usually injected for subQ injection?
Less than 0.5 mL
How to prepare skin for subQ injection?
Elevate slightly by gently pinching site
What angle for subQ injection? Bevel up or down?
45-degrees
Bevel up
Why do we aspirate after needle placement on subQ injections?
To ensure we are not in a blood vessel
After subQ injection, what can we do to help distribute medication?
Massage site with alcohol swab
Maximum volume for IM injection?
5 mL
Common muscles used for IM injections? (5)
- Deltoid (shoulder)
- Dorsogluteal site (butt)
3and4. Vastus lateralis and rectus femoris (thigh) - Ventrogluteal (side of hip)
Where in deltoid for IM injection? Avoid what?
Inverted triangle with acromion process as base
Radial nerve
Where in dorsogluteal for IM injections? Do not give here for what age range? Avoid what?
Divide buttock into quadrants, site is upper outer quadrant in center
Do not give for under 3 years
Want to avoid sciatic nerve
Where for vastus lateralis and rectus femoris for IM injections?
One hand on upper thigh, one just above knee, thumbs in—site is between thumbs
Rectus femoris is on anterior thigh, vastus lateralis is on lateral aspect of thigh
IV—which extremities first?
Upper, then if unavailable, go to lower
Which type of needle not advised for prehospital care because stabilizing the needle is difficult?
Hollow (butterfly)
What type of needle preferred for prehospital care?
Over-the-needle catheter
Incidences of embolism higher at which two IV sites?
Jugular veins in neck
Long saphenous veins in the leg
If second puncture necessary after first IV, place where?
Proximal to first puncture
How to place patient for external jugular IV placement?
Supine, head-down, turn pt’s head to opposite side
What angle for IV needle penetration?
15-20 degrees
How to know needle placement correct for IV?
Penetrate until flash (blood return in hub encountered), continue to advance approx. 2mm further before placing catheter
Local complications for IV include? (5)
- Hematoma
- Thrombosis
- Cellulitis
- Phlebitis
- Sloughing/necrosis
Collection of blood at site of injection is what?
Hematoma
Blood clot formed inside a blood vessel is what?
Thrombosis
A potentially serious bacterial infection of connective tissue is called what?
Cellulitis
Inflammation of a vein is called what?
Phlebitis
What causes phlebitis? (2)
Catheter too large for vein, or
Catheter has been left in place longer than 48 hours
Why does sloughing or necrosis occur?
Infiltration of some IV medicines (d50, sodium bicarb, promethazine)
Separation of tissue called what?
Sloughing
Tissue death called what?
Necrosis
What are some systemic complications of IV therapy? (3)
- Sepsis
- Pulmonary embolism
- Catheter fragment embolism
A bacterial infection in the bloodstream is called what?
Sepsis
The sudden blocking of an artery in the lung is called what?
Pulmonary embolism
Sudden onset of chest pain, shortness of breath, tachycardia and hypotension can indicate what?
PE
How does catheter fragment embolism occur?
Reinsertion of a needle through catheter during IV insertion
What to do if you suspect catheter shear?
IV stopped, vein should be palpated for catheter tip, venous tourniquet should be placed above tip to prevent further movement
Part of the catheter shears off, allowing embolus to travel in bloodstream–called what?
Catheter fragment embolism
How to know you’ve punctured an artery during IV placement?
Bright red, pulsating blood in catheter hub
Coolness around the skin, swelling at puncture site, and sluggish or absent flow rate can indicate what?
Infiltration of an IV site
How to check for infiltration?
Fluid reservoir lowered to dependent position, look for blood in tubing (absence of backflow = infiltration)
How much air is needed for air embolism? For a critically injured pt?
100 mL
10 mL can be fatal for critically injured pt
When pushing medications through IV port, how long do you push?
1 to 3 minutes, slowly
Drugs administered IO should be followed by what?
Saline flush of at least 5 mL
Site of choice for IO is where?
Tibia, just below tubercle on anteromedial surface
Alternate site for IO for children? Adults?
Children = femur, above lateral condyles in midline Adults = sternum, just below sternal notch
Contraindications for IO?
Fx at site or proximal to site Traumatized extremity Cellulitis Burns Congenital bone disease
When using MDI, how long should pt inhale during administration? How long to hold in lungs? Repeat after how long?
Inhales over 5 sec
Hold breath for 5-10 sec
Repeat in 5-10 min
Devices that use the Bernoulli principle to create aerosol mist are called what?
Handheld nebulizers
When giving drugs via ET route, how much medication?
2 to 2.5 times the IV dose
For ET route, dilute to what?
Dilute to 10 mL with normal saline
When giving eye drops, administer where?
Conjunctival sac of lower lid
Ear medications: remain in ear up position for how long?
10 minutes to allow medication to disperse