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ADVANCE EMT CARDIAC > MED QUIZ 2 > Flashcards

MED QUIZ 2 Flashcards

Glucagon, Dextrose, Epinephrine (non-cardiac), Albuterol, Nitrous Oxide, Nitroglycerin

1
Q

GLUCAGON - AKA

A

GlucaGen

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2
Q

GLUCAGON - class

A
  1. HYPERGLYCEMIC AGENT
  2. PANCREATIC HORMONE
  3. INSULIN ANTAGONIST
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3
Q

GLUCAGON - MOA

A

INCREASE BLOOD GLUCOSE LEVEL BY STIMULATING GLYCOGENOLYSIS

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4
Q

GLUCAGON - INDICATIONS

A
  1. HYPOGLYCEMIA
  2. BETA-BLOCKER/ CALCIUM CHANNEL BLOCKER TOXICITY (medicines that lower blood pressure) TOXICITY
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5
Q

GLUCAGON - CONTRINDICATIONS

A
  1. HYPERGLYCEMIA
  2. HYPERSENSITIVITY
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6
Q

GLUCAGON - ADVERSE REACTIONS/SIDE EFFECTS

A
  1. CNS: DIZZINESS, HEADACHE
  2. CV: HYPERTENSION, TACHYCARDIA
  3. GI/GU: N/V
    OTHER: REBOUND HYPOGLYCEMIA
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7
Q

GLUCAGON - DRUG INTERACTIONS

A

INCOMPATABLE IN SOLUTION WITH MOST OTHER SUBSTANCES

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8
Q

GLUCAGON - DOSAGE ADMINISTRATION ADULT

A

HYPOGLYCEMIA: 1 mg IM
BETA BLOCKER/CALCIUM-CHANNEL BLOCK TOXICITY: 1-5 mg IV/IO (may repeat 1 in 15 min)

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9
Q

GLUCAGON - DOSAGE ADMINISTRATION PEDI

A

0.1 mg/kg (max: 1mg) IM

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10
Q

GLUCAGON- DURATION OF ACTION

A

ONSET: 1 minute
PEAK EFFECT: 5-20 minutes
DURATION: 60-90 minutes (1hr-1 1/2 hr)

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11
Q

GLUCAGON - CONSIDERATIONS

A
  1. FIRST LINE AGENT-ONLY IF CANT GET IV ACCESS
  2. INEFFECTIVE IF GLYCOGEN STORES DEPLETED
  3. HIGHER INCIDENCE OF REBOUND HYPOGLYCEMIA-USE WITH ORAL GLUCOSE/DEXTROSE IF CAN
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12
Q

DEXTROSE - CLASS

A

Carbohydrate

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13
Q

DEXTROSE -AKA

A

D5W, D10, D25

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14
Q

DEXTROSE - INDICATIONS

A

Hypoglycemia (<60 mg/dl) and unresponsive

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15
Q

DEXTROSE -MOA

A

Rapidly increases serum glucose levels

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16
Q

DEXTROSE -CONTRAINDICATIONS

A

Suspected ICP or intracranial hemorrhage

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17
Q

DEXTROSE -ADVERSE REACTIONS/SE

A

CNS: cerebral hemorrhage, cerebral ischemia
Respiratory: PE
Other: hyperglycemia, extravasation leads to tissue necrosis

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18
Q

DEXTROSE - DRUG INTERACTIONS

A

Sodium bicarb. may decrease effectiveness

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19
Q

DEXTROSE - DOSAGE ADMINISTRATION NATIONAL (ADULT+PEDI)

A

Adult: 12.5-25 gm slow IV/IO push. May repeat x1 in 5 min if BGL < 60 mg/dl
Pedi: 0.5 gm/kg slow IV push. May repeat in 1x in 5 min if BGL < 60 mg/dl

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20
Q

DEXTROSE - DOSAGE ADMINISRATION RI (ADULT+PEDI)

A

Adult: D10W 250 ml (25g) IV over 5 minutes, may repeat in 5 minutes if bG <60 mg/dl.
Pedi: D10W 5 ml/kg over 5 minutes, may repeat in 5 minutes if bG <60 mg/dl.

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21
Q

DEXTROSE - DURATION OF ACTION

A

Onset: < 1 min
Peak: variable
Duration: variable

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22
Q

DEXTROSE - SPECIAL CONSIDERATIONS

A

Administer thiamine prior to dextrose in known or suspected alcoholic or malnourished pts
Don’t administer to pt with known CVA unless hypoglycemia documented

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23
Q

EPINEPHRINE (NON-CARDIAC) - AKA

A

Adrenalin

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24
Q

EPINEPHRINE (NON-CARDIAC) - CLASS

A

Sympathomimetic

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25
Q

EPINEPHRINE (NON-CARDIAC) - MOA

A

Bronchodilation, vasoconstriction, increased heart rate/contraction strength

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26
Q

EPINEPHRINE (NON-CARDIAC) - INDICATIONS

A
  1. ALLERGIC REACTION
  2. SEVERE ASTHMA NOT RESPONDING TO OTHER THERAPIES
  3. CROUP
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27
Q

EPINEPHRINE (NON-CARDIAC) - CONTRAINDICATIONS

A
  1. Hypertension
  2. Hypothermia
  3. Pulmonary edema
  4. Myocardial ischemia
  5. Hypovolemic shock
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28
Q

EPINEPHRINE (NON-CARDIAC) - ADVERSE REACTIONS/SE

A
  1. CNS: nervousness, restlessness, headache, tremor
  2. CV: arrhythmias, chest pain, hypertension, tachycardia
  3. GI/GU: N/V
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29
Q

EPINEPHRINE (NON-CARDIAC) - DRUG INTERACTIONS

A

Potentiates other sympathomimetics

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30
Q

EPINEPHRINE (NON-CARDIAC) - DOSE + ADMINISTRAION ADULT NAT

A
  1. Anaphylaxis or extreme asthma: 0.3 mg of a 1:1,000 solution IM or one adult autoinjector. May repeat every 5 min if no effect to a max od 3 doses
  2. Epipen: 0.3mg of 1:2000 solution
31
Q

EPINEPHRINE (NON-CARDIAC) -DOSE + ADMINISTRAION PEDI NAT

A
  1. Anaphylaxis or extreme asthma
    Pt under 30kg (66lbs): 0.15mg of a 1:1000 solution IM or one pediatric autoinjector (May repeat every 5 min if no effect to a max of 3 doses)
  2. Pt over 30kg: same as adult
  3. Suspected croup: 0.5mL of 2.25% epinephrine solution in 3mL Normal Saline (“Racemic Epinephrine”), via nebulizer
  4. Epipen: 0.15mg of 1:2000 solution
32
Q

EPINEPHRINE (NON-CARDIAC) -DOSE + ADMINISTRAION ADULT RI

A
  1. Anaphylaxis or extreme asthma:
    1:1000, 0.3 mg IM (lateral thigh) [auto-injector preferred] every 5 min, if no improvement, max of 3x doses. Additional doses require MEDICAL CONTROL authorization.
    > pts > 50 y.o. or w/ history of cardiac disease, administer 0.15 mg.
  2. Respiratory Distress (Asthma/COPD/RAD):
    asthma in extremis, contact MEDICAL
    CONTROL authorization to administer EPINEPHRINE (1:1,000) 0.3 mg IM (lateral thigh) [auto-injector preferred], repeat every 15 minutes x2.
33
Q

EPINEPHRINE (NON-CARDIAC) -DOSE + ADMINISTRAION PEDI RI

A
  1. Anaphylaxis or extreme asthma: (1:1000) 0.15 for
    patients 15-30 kg (33-66 lbs. or 0.3 mg for patients > 30 kg (66 lbs.) IM [lateral] thigh (auto-injector preferred) every 5 minutes if no improvement to max of 3 doses.
    Additional doses require authorization from MEDICAL CONTROL.
  2. Respiratory Distress (Asthma/RAD/Croup): significant respiratory distress or stridor at rest, EPINEPHRINE (2.25% solution) 0.5 ml/3 ml NS or EPINEPHRINE 5 mg (1mg/1ml concentration) via SVN, may repeat x1… if continued MED CONTROL (1:1000) 0.15-0.3 mg IM (lateral thigh) [auto-injector preferred]
34
Q

EPINEPHRINE (NON-CARDIAC) - DURATION OF ACTION

A

Onset: immediate
Peak: immediate
Duration: several minutes

35
Q

EPINEPHRINE (NON-CARDIAC) - SPECIAL CONSIDERATIONS

A
  1. Use of antihistamines, corticosteroids and epinephrine offer no benefit in ACE-I related angioedema.[lisinopril, ramipril, captopril, benzapril, quinapril, enalapril]
  2. MAKE 1:10,000 EPI FROM 1:1,000 EPI [1ML 1:1,000 : 9ML NORMAL SALINE = 1:10,000 EPI]
36
Q

ALBUTEROL -AKA

A

1 Proventil
2. Ventolin

37
Q

ALBUTEROL -CLASS

A
  1. Sympathomimetic
  2. Bronchodilator
38
Q

ALBUTEROL - MOA

A

Selective beta 2 agonist, stimulates sympathomimetic NS-result is smooth muscle relaxation in bronchial tree and peripheral vasculature

39
Q

ALBUTEROL- INDICATIONS

A

Bronchospasm (COPD, asthma, RAD etc.)

40
Q

ALBUTEROL - CONTRAINDICATIONS

A
  1. Known hypersensitivity
  2. Tachycardia (high HR)!
  3. CHF!
    … IF GIVE TO PT W/ HIGH HR AND/OR CHF WILL FLASH THEM AKA TANK BP
41
Q

ALBUTEROL - ADVERSE REACTIONS/SE

A

Often dose related
CNS: headache, fatigue, lightheadedness, irritability, restlessness, aggressive behavior
Respiratory: PE, hoarseness, nasal congestion, increased sputum
CV: hypertension, tachycardia, arrhythmias, chest pain
GI/GU: N/V, dry mouth, epigastric pain
Musculoskeletal: tremors

42
Q

ALBUTEROL - DRUG INTERACTIONS

A

Tricyclic antidepressants may potentiate vascular effects. Common ones include:
Amitriptyline (Elavil)
Amoxapine (Asendin)
Desipramine (Norpramin)
Doxepin (Sinequan)
Imipramine (Tofranil)
Nortriptyline (Pamelor)
Protriptyline (Vivactil)
Trimipramine (Surmontil)

43
Q

ALBUTEROL -DOSAGE ADMINISTRATION ADULT NAT

A

Adult: 2.5 mg via inhalation over 10-15 min. May repeat 3 times. NEBULIZER 6-8LPM.

44
Q

ALBUTEROL-DOSAGE ADMINISTRATION PEDI NAT

A

Pedi: 2.5 mg via inhalation over 10-15 min. May repeat 3 times. NEBULIZER 6-8LPM.

45
Q

ALBUTEROL –DOSAGE ADMINISTRATION ADULT RI

A
  1. Respiratory distress(COPD…): 2.5-5 mg (initial dose should include IPRATROPIUM 500 mcg, subsequent doses may be +/- IPRATROPIUM) via SVN 6-8LPM (may repeat to a max of 4 doses).
  2. Allergic reaction: 2.5-5 mg (+/- IPRATROPIUM) via SVN for continued wheezing (may
    repeat x3).
  3. Crush injury: 5 mg via SVN for patients with suspected hyperkalemia
46
Q

ALBUTEROL -DOSAGE ADMINISTRATION PEDI RI

A
  1. ≥ 2 yo with suspected reactive airway disease (RAD)/asthma: 2.5-5 mg (initial dose should include IPRATROPIUM 500 mcg, subsequent doses may be +/- IPRATROPIUM) via SVN 6-8LPM for continued wheezing,
    (may repeat x3).
  2. Allergic reaction: 2.5-5 mg (+/- IPRATROPIUM) via SVN for continued wheezing (may repeat x3).
47
Q

ALBUTEROL -DURATION OF ACTION

A

Onset: 5-15 min
Peak: 30 min - 2 hrs
Duration: 3-4 hrs

48
Q

ALBUTEROL -SPECIAL CONSIDERATIONS

A
  1. May worsen angina pectoris and arrhythmias
  2. Administer EMS albuterol rather than pts own
49
Q

NITROGLYCERIN - AKA

A
  1. Nitrostat
  2. Nitro-bid
  3. Tridil
50
Q

NITROGLYCERIN - CLASS

A

Vasodilator

51
Q

NITROGLYCERIN - MOA

A
  1. smooth muscle relaxant - VASODILATION
  2. Reduces preload & afterload - result reduced workload on the heart & decreased myocardial O2 demand
52
Q

NITROGLYCERIN - INDICATIONS

A

chest pain that has cardiac etiology (cause)

53
Q

NITROGLYCERIN - CONTRAINDICATIONS

A
  1. Hypotension
  2. Hypovolemia
  3. Intracranial bleeding OR head injury
  4. Pericardial tamponade (JVD, faint H sounds)
  5. in past 24 hrs pt took male enhancement/blood thinner:
    a. Cialis aka tadalafil (48hrs)
    b. Levitra aka Vardenafil
    c. Viagra aka Sildenafil
54
Q

NITROGLYCERIN - ADVERSE REACTIONS/SE

A
  1. CNS: headache, dizziness, weakness
  2. CV: reflex, tachycardia, syncope, hypotension
  3. GI/GU: N/V, dry mouth
  4. MUSCULOSKELETAL: muscle twitching
  5. OTHER: diaphoresis
55
Q

NITROGLYCERIN - DRUG INTERACTIONS

A

OTHER VASODILATORS/ ERECTILE DYSFUNCTION DRUGS — CAUSE EXTREME HYPOTENSION

56
Q

NITROGLYCERIN - DOSAGE AND ADMINISTRATION ADULT NAT

A

0.4 mg SL (repeat every 5min if SBP > 100 with no max)

57
Q

NITROGLYCERIN - DOSAGE AND ADMINISTRATION PEDI NAT

A

NOT RECOMMENDED

58
Q

NITROGLYCERIN - DOSAGE AND ADMINISTRATION ADULT RI

A
  1. ACUTE DECOMPENSATED HEART FAILTURE/CHEST PAIN: 0.4 mg SL every 5 minutes if SBP > 100
    0.4 mg tabs, 0.4 mg metered
    dose spray, or lingual powder
59
Q

NITROGLYCERIN - DOSAGE AND ADMINISTRATION PEDI RI

A

NOT RECOMMENDED

60
Q

NITROGLYCERIN - DURATION OF ACTION

A

onset: 1-3 min
peak: 5-10 min
duration: 20-30min

61
Q

NITROGLYCERIN - SPECIAL CONSIDERATIONS

A
  1. HYPOTENSION MORE COMMON IN ELDERLY
  2. NITRO DECOMPOSES IN LIGHT/HEAT MUST BE IN AIRTIGHT CONTAINER - ASK PTS ABOUT HOW THEY STORE PERSCRIBED NITRO
  3. MAY HAVE STINGING EFFECT UNDER TONGUE
62
Q

NITROUS OXIDE - AKA

A
  1. Nitronox
  2. N2O
63
Q

NITROUS OXIDE - CLASS

A

Inhaled anesthetic

64
Q

NITROUS OXIDE -MOA

A

Causes general CNS depression by partially inhibiting action potential in neurons

65
Q

NITROUS OXIDE - INDICATIONS

66
Q

NITROUS OXIDE - CONTRAINDICATIONS

A
  1. Known hypersensitivity
  2. AMS
  3. Alc/drug intoxication
  4. Pregnancy
  5. chest trauma
  6. respiratory distress
  7. traumatic brain injury
  8. ICP
  9. decompression sickness
67
Q

NITROUS OXIDE - ADVERSE REACTIONS/SE

A
  1. CNS: dizziness, euphoria, confusion
    Respiratory: respiratory depression
  2. CV: hypotension
  3. GI/GU: N/V
68
Q

NITROUS OXIDE - DRUG INTERACTIONS

A

Other CNS depressants potentiate CNS and respiratory effects

69
Q

NITROUS OXIDE - DOSAGE ADMINISTRATION ADULT NAT

A

Adult: 50/50 nitrous oxide/oxygen blend via facemask

70
Q

NITROUS OXIDE - DOSAGE ADMINISTRATION PEDI NAT

A

Pedi: 50/50 nitrous oxide/oxygen blend via facemask + not recommended in infants

71
Q

NITROUS OXIDE - DOSAGE ADMINISTRATION ADULT RI

A

Pt comfort, moderate to severe pain (scale >6): inhaled NITRONOX (50/50 nitrous oxide and oxygen blend)

72
Q

NITROUS OXIDE - DOSAGE ADMINISTRATION PEDI RI

A

Pt comfort, severe pain (scale >6), consider:
inhaled NITRONOX (50/50 nitrous oxide and oxygen blend)

73
Q

NITROUS OXIDE - DURATION OF ACTION

A

onset: immediate
peak: 2-5 min
duration: 1 min after cessation of administration

74
Q

NITROUS OXIDE - SPECIAL CONSIDERATIONS

A
  1. Pt must be able to self administer and hold mask themselves
  2. Keep in mind blend only delivers 50% O2

ADVANCE EMT CARDIAC (5 decks)

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