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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
EPINEPHRINE (NON-CARDIAC) - MOA
Bronchodilation, vasoconstriction, increased heart rate/contraction strength
26
EPINEPHRINE (NON-CARDIAC) - INDICATIONS
1. ALLERGIC REACTION 2. SEVERE ASTHMA NOT RESPONDING TO OTHER THERAPIES 3. CROUP
27
EPINEPHRINE (NON-CARDIAC) - CONTRAINDICATIONS
1. Hypertension 2. Hypothermia 3. Pulmonary edema 4. Myocardial ischemia 5. Hypovolemic shock
28
EPINEPHRINE (NON-CARDIAC) - ADVERSE REACTIONS/SE
1. CNS: nervousness, restlessness, headache, tremor 2. CV: arrhythmias, chest pain, hypertension, tachycardia 3. GI/GU: N/V
29
EPINEPHRINE (NON-CARDIAC) - DRUG INTERACTIONS
Potentiates other sympathomimetics
30
EPINEPHRINE (NON-CARDIAC) - DOSE + ADMINISTRAION ADULT NAT
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
EPINEPHRINE (NON-CARDIAC) -DOSE + ADMINISTRAION PEDI NAT
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
EPINEPHRINE (NON-CARDIAC) -DOSE + ADMINISTRAION ADULT RI
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
EPINEPHRINE (NON-CARDIAC) -DOSE + ADMINISTRAION PEDI RI
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
EPINEPHRINE (NON-CARDIAC) - DURATION OF ACTION
Onset: immediate Peak: immediate Duration: several minutes
35
EPINEPHRINE (NON-CARDIAC) - SPECIAL CONSIDERATIONS
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
ALBUTEROL -AKA
1 Proventil 2. Ventolin
37
ALBUTEROL -CLASS
1. Sympathomimetic 2. Bronchodilator
38
ALBUTEROL - MOA
Selective beta 2 agonist, stimulates sympathomimetic NS-result is smooth muscle relaxation in bronchial tree and peripheral vasculature
39
ALBUTEROL- INDICATIONS
Bronchospasm (COPD, asthma, RAD etc.)
40
ALBUTEROL - CONTRAINDICATIONS
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
ALBUTEROL - ADVERSE REACTIONS/SE
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
ALBUTEROL - DRUG INTERACTIONS
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
ALBUTEROL -DOSAGE ADMINISTRATION ADULT NAT
Adult: 2.5 mg via inhalation over 10-15 min. May repeat 3 times. NEBULIZER 6-8LPM.
44
ALBUTEROL-DOSAGE ADMINISTRATION PEDI NAT
Pedi: 2.5 mg via inhalation over 10-15 min. May repeat 3 times. NEBULIZER 6-8LPM.
45
ALBUTEROL --DOSAGE ADMINISTRATION ADULT RI
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
ALBUTEROL -DOSAGE ADMINISTRATION PEDI RI
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
ALBUTEROL -DURATION OF ACTION
Onset: 5-15 min Peak: 30 min - 2 hrs Duration: 3-4 hrs
48
ALBUTEROL -SPECIAL CONSIDERATIONS
1. May worsen angina pectoris and arrhythmias 2. Administer EMS albuterol rather than pts own
49
NITROGLYCERIN - AKA
1. Nitrostat 2. Nitro-bid 3. Tridil
50
NITROGLYCERIN - CLASS
Vasodilator
51
NITROGLYCERIN - MOA
1. smooth muscle relaxant - VASODILATION 2. Reduces preload & afterload - result reduced workload on the heart & decreased myocardial O2 demand
52
NITROGLYCERIN - INDICATIONS
chest pain that has cardiac etiology (cause)
53
NITROGLYCERIN - CONTRAINDICATIONS
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
NITROGLYCERIN - ADVERSE REACTIONS/SE
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
NITROGLYCERIN - DRUG INTERACTIONS
OTHER VASODILATORS/ ERECTILE DYSFUNCTION DRUGS --- CAUSE EXTREME HYPOTENSION
56
NITROGLYCERIN - DOSAGE AND ADMINISTRATION ADULT NAT
0.4 mg SL (repeat every 5min if SBP > 100 with no max)
57
NITROGLYCERIN - DOSAGE AND ADMINISTRATION PEDI NAT
NOT RECOMMENDED
58
NITROGLYCERIN - DOSAGE AND ADMINISTRATION ADULT RI
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
NITROGLYCERIN - DOSAGE AND ADMINISTRATION PEDI RI
NOT RECOMMENDED
60
NITROGLYCERIN - DURATION OF ACTION
onset: 1-3 min peak: 5-10 min duration: 20-30min
61
NITROGLYCERIN - SPECIAL CONSIDERATIONS
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
NITROUS OXIDE - AKA
1. Nitronox 2. N2O
63
NITROUS OXIDE - CLASS
Inhaled anesthetic
64
NITROUS OXIDE -MOA
Causes general CNS depression by partially inhibiting action potential in neurons
65
NITROUS OXIDE - INDICATIONS
PAIN
66
NITROUS OXIDE - CONTRAINDICATIONS
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
NITROUS OXIDE - ADVERSE REACTIONS/SE
1. CNS: dizziness, euphoria, confusion Respiratory: respiratory depression 2. CV: hypotension 3. GI/GU: N/V
68
NITROUS OXIDE - DRUG INTERACTIONS
Other CNS depressants potentiate CNS and respiratory effects
69
NITROUS OXIDE - DOSAGE ADMINISTRATION ADULT NAT
Adult: 50/50 nitrous oxide/oxygen blend via facemask
70
NITROUS OXIDE - DOSAGE ADMINISTRATION PEDI NAT
Pedi: 50/50 nitrous oxide/oxygen blend via facemask + not recommended in infants
71
NITROUS OXIDE - DOSAGE ADMINISTRATION ADULT RI
Pt comfort, moderate to severe pain (scale >6): inhaled NITRONOX (50/50 nitrous oxide and oxygen blend)
72
NITROUS OXIDE - DOSAGE ADMINISTRATION PEDI RI
Pt comfort, severe pain (scale >6), consider: inhaled NITRONOX (50/50 nitrous oxide and oxygen blend)
73
NITROUS OXIDE - DURATION OF ACTION
onset: immediate peak: 2-5 min duration: 1 min after cessation of administration
74
NITROUS OXIDE - SPECIAL CONSIDERATIONS
1. Pt must be able to self administer and hold mask themselves 2. Keep in mind blend only delivers 50% O2

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