Medication Infusions (LO3)

Question 1

Anti-microbial

• what is it
• how much of it can be given over what period of time

Answer 1

is an agent used to kill microbes or prevent the replication of microbes in an infected host

most, if not all, can be given intravenously over 15–20 minutes

Question 2

what is the procedure for PCP and anti microbial infusion

Answer 2

1. Ask the attending MD or RN to complete the administration of the IV anti-microbial before setting out on the transfer
2. A dosage sticker must be affixed to the IV mini-bag indicating: 
   - The name of the anti-microbial.
   - The dose and the time of preparation.
3. The anti-microbial will be given by constant IV infusion using an infusion control device at a predetermined rate according to the local pharmacy protocol

Question 3

what is the procedure for PCP and anti microbial infusion during transport

Answer 3

Vital signs every 15 minutes.

Discontinue if any unexplained symptoms or signs of hypersensitivity develop. (If there is any doubt concerning the etiology of any new signs or symptoms during the transport, contact the referring physician.)

Discontinue if any signs or symptoms of anaphylaxis develop.

Treat anaphylaxis as per protocol.

If the patient’s condition deteriorates, arrange for an ALS intercept.

Question 4

Heparin

Answer 4

directed primarily towards preventing development of intravascular  thrombosis and the treatment of  thromboembolitic disorders such as acute myocardial infarction, pulmonary embolism, and deep venous thrombosis

Question 5

2 classes of anticoagulant drugs

Answer 5

parenteral  (administered via IV)  

oral  agents

Question 6

The patient receiving IV Heparin must meet certain criteria before being infused
-what does not meet the criteria

Answer 6

Anyone who has a known hypersensitivity to Heparin,

is actively bleeding,

is in shock,

is suffering from some form of severe bleeding disorder (hemophilia)

Question 7

If any adverse reactions are going to occur, such as anaphylaxis, they usually begin within

Answer 7

the first several minutes to 1 hour of the infusion

Question 8

why does a pt on heparin need to be closely monitored

Answer 8

This drug classification is potentially dangerous, capable of causing severe, possibly fatal hemorrhaging

Question 9

Possible Complications of heparin

Answer 9

Localized bleeding

Irritation at the IV site

Hemorrhaging

Hypersensitivity (chills, urticaria, fever, anaphylaxis, bronchospasm)

Elevated blood pressure

Chest pain

Impaired renal function

Question 10

Management of heparin

Answer 10

Observe for bleeding (GI urinary, epistaxis, etc.) and discontinue the infusion if present and significant.

Vital signs are to be recorded every 15 minutes, watching for any signs and symptoms of shock.

Ensure that you have an accurate baseline of all vital signs before the transport begins.

A record of the patient’s vital signs over the last several hours or days will provide you with some criteria to gather your baseline data.

Stop Heparin if unexplained hypotension occurs.

If there is any doubt about the origin of any new signs or symptoms during transport, contact the medical control physician for further orders.

Question 11

Drug Interactions with heparin

Answer 11

very stable medication when mixed in normal saline, D5W or Ringer’s Lactate for a period of up to 24 hours

has to be given in a separate IV site if other medications are also being infused

Heparin will interact with salicylates (ASA), nonsteroidal anti-inflammatory drugs, NSAIDs, and will interfere with platelet aggregation.

Heparin will also antagonize the action of insulin.

Question 12

Potassium

Answer 12

Potassium is an electrolyte that is frequently administered intravenously to maintain a serum level

Question 13

what should the serum level of potassium be between

what is considered a low serum level and symptoms

what serum level is too low and what can happen

Answer 13

between 3.5 and 5.3
mmol/L

below 3.0 mmol/L may be associated with symptoms such as weakness and malaise.

below 2.5 mmol/L, lethal arrhythmias may occur

Question 14

what can potassium added to an iv bag be infused up to in a patient with normal renal function

Answer 14

up to 40 mEq/hr

Question 15

Sudden boluses of potassium may cause lethal arrhythmias meaning…

Answer 15

the rate of infusion of a potassium drip cannot be increased rapidly if the patient develops hypotension

Question 16

To prevent a rapid infusion of potassium, the following must be adhered to:

Answer 16

must be administered via an IV pump.

ensure that a medication sticker is affixed to the IV bag which identifies potassium as the medication being infused, as well as the dose of potassium.

The rate of administration must be in writing and is not to be exceeded under any circumstances.

If the patient has the potential to develop hypotension enroute, a second IV line is to be established.

The patient may complain of burning along the vein where potassium is infusing; however, this is a common symptom the pre-hospital care provider should ensure the infusion is not exceeding the specified rate, and should provide reassurance to the patient.

Under no circumstances is the flow rate of potassium-containing solution to be increased.

Question 17

Oxytocin

Answer 17

a naturally occurring hormone that is secreted by the posterior pituitary gland.

When secreted, it causes contraction of the uterine smooth muscles and lactation.

Question 18

When  postpartum hemorrhage  cannot be controlled with breastfeeding or fundal massage, an IV infusion containing

Answer 18

10 – 20 units of synthetic oxytocin (Syntocinon®) may be administered

Question 19

Possible Complications of oxytocin

Answer 19

Hypotension

Dysrhythmias

Tachycardia

Seizures

Coma

Nausea

Vomiting

Uterine rupture from overstimulation of uterus

Question 20

Management of oxytocin

Answer 20

Monitor vital signs.

Due to the fact that excessive oxytocin can cause overstimulation of the uterus, uterine tone must be monitored throughout transport.

If there is any doubt about the origin of any new signs or symptoms during transport, contact the medical control physician for further orders.

Question 21

Drug Interactions with oxytocin

Answer 21

Syntocinon® can cause hypertension when administered with a vasoconstrictor such as norepinephrine.

Question 22

Total Parenteral Nutrition (TPN)

Answer 22

the most common site for administration is via a central venous catheter due to the high concentration of the solution

TPN is given to patients that have a long-term need for intravenous feeding, cannot receive adequate nutrition to meet their physiologic needs, do not have a functioning gastrointestinal (GI) tract or have a condition that has them on total bowel rest

Question 23

possible patients that may receive TPN:

Answer 23

Hypercatabolic states (burns, trauma, sepsis)

Gastrointestinal diseases

Renal failure

Congenital GI abnormalities

Short bowel syndrome due to surgery

Question 24

Standard dosing for an adult of TPN

Answer 24

is 2 liters per day of standard solution

Question 25

Adverse reactions related to TPN’s components:

Answer 25

Water:
-Fluid overload

Insulin and dextrose:
-Hypoglycemia or hyperglycemia

Heparin:
-Hemorrhage

Electrolytes:
-Abnormal levels of sodium
chloride, potassium, and magnesium

Vitamins:

• Deficiency in vitamin D
• excess of vitamin A

Dextrose:

• Respiratory distress
• liver dysfunction

Allergic reaction

Question 26

TPN Administration

Answer 26

When administering TPN via the central line, maintain sterility to help prevent infection.

The line that is used for TPN administration should not be used for any other purpose.

The TPN infusion must be transported on an infusion pump, and the prescribed rate must never be exceeded.

Question 27

Acetylcysteine (Mucomyst®)

Answer 27

is an antidote for acetaminophen poisoning.

Question 28

Acetylcysteine (Mucomyst®) classification

Answer 28

Its classification is Antitode (Mucolytic).

Question 29

Acetylcysteine (Mucomyst®) Dosage

Answer 29

Loading dose: Dilute 150 mg/kg in 250 mL D5W; infuse over one hour

Second infusion (repeat): Dilute 50 mg/kg in 500 mL D5W, infuse over four hours

Third infusion (repeat): Dilute 100 mg/kg in 1000 mL D5W; infuse over sixteen hours or as directed

Question 30

EMS Contraindications for Acetylcysteine (Mucomyst®)

Answer 30

No contraindications when used to treat acetaminophen overdose

Hypersensitivity to acetylcysteine when used for indications other than treating acetaminophen overdose

Question 31

Cautions for Acetylcysteine (Mucomyst®)

Answer 31

Encephalopathy, due to hepatic failure

Asthma, chronic pulmonary disease, or sensitivity to acetylcysteine; administer loading dose slowly and be prepared to treat anaphylactoid reactions

Pregnancy/Breast Feeding: Contact pharmacy for most recent information

Question 32

what is an iatrogenic  response

Answer 32

is an adverse condition that is inadvertently induced in a patient by a treatment given.

Question 33

what is an iatrogenic  overdose

Answer 33

an overdose of medication by a medical personnel

It can be a result of wrong dosing or wrong route of administration.