Other Medications Flashcards

Question

**Reglan (Metoclopramide)** **(mechanism of action)**

Answer 1

♦ Metoclopramide enhances gastric motility without stimulating gastric secretions. ♦ High doses of metoclopramide depress the mechanical activity of GI smooth muscle, while low doses stimulate it. **♦ Antiemetic** effects of metoclopramide are mainly the result of central dopamine antagonism and increased gastric motility

Answer 2

**onset** of action is ***1 to 3 minutes*** after IV injection

Answer 3

Dystonic Reaction / Seizures / Hallucinations, CHF Hypertension / Hypotension SVT Dizziness / Diarrhea / Rash, Laryngospasm, Hepatic Toxicity

Answer 4

**\>\> Nausea/Vomiting \<\<**

Answer 5

Hypersensitivity Phenochromocytoma Seizures GI bleeding GI obstruction

Answer 6

**5 - 10 mg** IO/IV/IM **every 6-8 hours**

Answer 7

**0.1 - 0.2 mg/kg** IO/IV/IM ## Footnote **up to 10 mg every 6-8 hours**

Answer 8

♦ Corticosteroids bind to the glucocorticoid receptor, ***inhibiting pro-inflammatory signals, and promoting anti-inflammatory signals*** ♦ The short term effects of corticosteroids are ***decreased vasodilation*** ***and permeability of capillaries***, as well as decreased leukocyte migration to sites of inflammation ♦ Decreases inflammation by suppression of migration of polymorphonuclear leukocytes and reversal of increased capillary permeability

Answer 9

**Onset IV**: 1 hour excretion is almost complete within 12 hours **Onset IM**: Systemic absorption is rapid following IM administration

Answer 10

**Arrhythmias, bradycardia, headache, depression** Increased ICP (in children only) Anxiety and Tremors

Answer 11

♦ Steroid used in **respiratory distress** to _reverse inflammatory and allergic reactions_ ♦ Circulation: Blood Administration ♦ Anaphylactic Shock /Allergic Reaction ♦ Reactive Airway Disease

Answer 12

Active untreated infections Some forms of meningitis Lactation Cushing's syndrome Uncontrolled hyperglycemia

Answer 13

## Footnote **125 mg IO/IV**

Answer 14

**2 mg/kg** IO/IV (**Maximum 125 mg)**

Answer 15

Pregnancy **Class C** ## Footnote There are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks. Complications, including cleft palate, stillbirth, and premature abortion, have been reported when corticosteroids were *_administered during pregnancy in animals_*. **Corticosteroids distribute into breast milk**, and the manufacturer states that because of the potential for serious adverse reactions in nursing babies,

Answer 16

***Relaxes*** bronchial and ***uterine smooth muscles*** by selectively binding to the Beta2 receptors ***causing bronchodilation***, inhibiting the release of mediators of immediate hypersensitivity reactions from mast cells and relaxing the uterus.

Answer 17

**Onset**: 6 - 15 min Half Life: 5.7 hrs **Duration**: 1.5 - 4 hrs

Answer 18

Tremors, Anxiety, Tachycardia, Palpitations, Drowsiness, Nausea/Vomiting, Diaphoresis, Muscle Cramps

Answer 19

**Premature Labor**

Answer 20

## Footnote **Known Hypersensitivity**

Answer 21

Pre-term labor **0.25 mg** **subcutaneous q 20 min** **max dose of 1 mg in 4 hrs**.

Answer 22

Thiamine combines with adenosine triphosphate (ATP) in the liver, kidneys, and leukocytes to produce thiamine diphosphate. Thiamine diphosphate acts as a coenzyme in carbohydrate metabolism, in transketolation reactions, and in the utilization of hexose in the hexose-monophosphate shunt. Without adequate thiamine, pyruvic acid does not undergo conversion to acetyl-CoA and cannot enter the Krebs cycle. Pyruvic acid accumulates in the blood and is subsequently converted to lactic acid, with the potential development of lactic acidosis. Diminished production of NADH in the Krebs cycle also results in lactic acid production through facilitation of anaerobic glycolysis.

Answer 23

**Onset**: 1 hr **Duration**: Unknown

Answer 24

None (can't find any)

Answer 25

Vitamin B1 Deficiency Wernicke-Korsakoff Syndrome Chronic Alcohol Abuse

Answer 26

**Hypersensitivity**

Answer 27

100 mg Intramuscular (**AL CC Protocol - not listed in AC Protocol**)

Answer 28

**Not currently indicated**

Answer 29

TXA is a synthetic lysine amino acid derivative that inhibits the activation of plasminogen to plasmin to prevent the breakdown of fibrin clots. With the reduction of plasmin activity, it also reduces complement and C1 activation associated with the hereditary angioedema.

Answer 30

**Onset**: Immediate Half Life: 3 hrs **Duration**: 24 hrs

Answer 31

Increased clot formation Blurred vision Anxiety Nausea/Vomiting DVT PE

Answer 32

♦ Patient \> 18years signs and symptoms of severe hemorrhage (internal or external) ♦ Hemodynamic Instability: SBP \< 90, Pulse rate \> 110 bpm, Respiratory rate \> 24 breaths per minute, evidence of peripheral vasoconstriction. Duration from initial injury is less than 180 min.

Answer 33

Time of initial traumatic injury \> 180 min, Patients who have contraindications to antifibrinolytic therapy agents, and medical control discretion.

Answer 34

Mix 1 gram of TXA in 100 ml of normal saline ## Footnote **administer over 10 min**

Answer 35

## Footnote **Not indicated for patients less than 18 years of age**

Answer 36

Famotidine competitively **inhibits** the binding of histamine to H2-receptors on the gastric basolateral membrane of parietal cells, reducing basal and nocturnal **gastric acid secretions**. The drug also **decreases the gastric acid response to stimuli** _such as food, caffeine, insulin, betazole, or pentagastrin_. _Famotidine reduces the total volume of gastric juice_, thus indirectly decreasing pepsin secretion. The drug **does not appear to alter** _gastric motility, gastric emptying, esophageal pressures, biliary secretions, or pancreatic secretions_.

Answer 37

Fever, Fatigue, Arrhythmia, Urticaria, Depression, Anxiety, Tinnitus

Answer 38

H-2 blocker used for allergic reactions

Answer 39

Known Hypersensitivity

Answer 40

## Footnote **20 mg IO/IV**

Answer 41

0.25-0.5 mg/kg **Max dose of 20 mg**

Answer 42

The predominant action of promethazine is antagonism of H1-receptors. Although promethazine is classified as a phenothiazine, its ability to antagonize dopamine is approximately one-tenth that of chlorpromazine. Like other H1-antagonists, promethazine does not prevent the release of histamine, but competes with free histamine for binding at H1-receptor sites. The relief of motion sickness and nausea/vomiting appear to be related to central anticholinergic actions and may implicate activity on the medullary chemoreceptor trigger zone.

Answer 43

**Onset IV**: 3 - 5 min Antihistaminic and sedative effects are **sustained** for **4—6 hours and 2—8 hours**, respectively. **Onset IM**: within 20 minutes Antihistaminic and sedative effects are **sustained** for **4—6 hours and 2—8 hours**, respectively.

Answer 44

Dizziness, Drowsiness

Answer 45

Nausea/vomiting

Answer 46

Lactating females, MAOI use, COPD, HTN, Pregnancy (\*AL Critical Care Protocols)

Answer 47

12.5 mg IV diluted in 10-20 ml of normal saline, administered over 5-10 min (**\*** AL Critical Care Protocols)

Answer 48

0.5mg/kg IV diluted in 10-20 ml of normal saline, administered over 10-15 min **\*Max dose 12.5 mg** **\*Do not administer less than 2 years of age** (**\*** AL Critical Care Protocols)

Answer 49

Pregnancy **Class C** ## Footnote Promethazine crosses the placenta. Platelet aggregation may be inhibited in newborns following maternal use of promethazine within 2 weeks of delivery.

Answer 50

Effects the myocardium, bronchial tree, skeletal and smooth muscle by **reducing the release of acetylcholine at the neuromuscular junction reducing muscle contractions and promoting relaxation**.

Answer 51

**Onset**: Immediate **Duration**: 30 min

Answer 52

Bradycardia, Hypotension, Hyporeflexia, Diaphoresis and Drowsiness, Decreased Respiratory Rate, Flaccid Paralysis

Answer 53

Torsades de Pointe Digitalis induced ventricular arrhythmias Anticonvulsant in eclampsia Suspected hypomagnesium

Answer 54

Hypermagnesium Hypocalcemia Anuria Heart block Active labor

Answer 55

**Eclampsia / Pre-Eclampsia**  4 grams IO/IV over 20 minutes **Pulseless V-Tach / V-Fib**  If patient is in refractory V-Tach unresponsive to Amiodarone or in Torsades de Pointes, administer 2 grams slow IO/IV push over 20 minutes. **Reactive Airway Disease**  2 grams IO/IV over 10 minutes.  If patient is being transferred with Magnesium Sulfate administering, continue at current rate. If rate is \> 4 grams/hr, contact receiving MD.

Answer 56

Pulseless V-Tach / V-Fib  If patient is in refractory V-Tach unresponsive to Amiodarone or in Torsades de Pointes, administer 50 mg/kg slow IO/IV over 20 minutes  **Maximum 2 grams**

Answer 57

Intravenous mannitol **exerts its osmotic diuretic effect** as a solute of relatively small molecular size being largely **confined to the extracellular space**. Mannitol **hinders tubular reabsorption of water** and **enhances excretion of sodium and chloride** by elevating the osmolarity of the glomerular filtrate. The increase in extracellular osmolarity induces the **movement of intracellular water to the extracellular and vascular spaces**. This action underlies the role of mannitol in in **_reducing intracranial pressure, intracranial edema, and intraocular pressure._**

Answer 58

distributes into the extracellular space within 20 to 40 minutes Diuresis generally occurs in 1 to 3 hours Decrease in the cerebrospinal fluid pressure will occur in approximately 15 minutes Will persist for 3 to 8 hours after the infusion is stopped

Answer 59

**Dizziness**, **Fever**, **Headache, Seizures,** **Angina**, **Edema** - with vascular congestion or pulmonary edema - manitol administration may result in hypervolemia leading to or exacerbating existing congestive heart failure **Hypotension -** mannitol acutely raises plasma and extracellular osmolality, which leads to an increase in circulating blood volume. This leads to increase in stroke volume, cardiac output, and blood pressure. Following diuresis, patients may be slightly hypovolemic with associated decreases cardiac output and blood pressure. **Tachycardia**, **Blurred Vision**, **Dehydration -** Too rapid infusion of large amounts of mannitol will cause a shift of intracellular water into the extracellular compartment resulting in cellular dehydration **Urticarial**, **Chills**, **Thrombophlebitis**, **Fluid and electrolyte imbalance -** Excessive loss of water and electrolytes may lead to serious imbalances. (hyponatremia, hypernatremia, hyperkalemia, hypokalemia; metabolic acidosis) **CHF** - mannitol administration may result in hypervolemia leading to or exacerbating existing congestive heart failure. Accumulation of mannitol due to insufficient renal excretion increases the risk of hypervolemia. GI distress

Answer 60

Increased intracranial pressure associated with cerebral edema

Answer 61

Known hypersensitivity Renal Disease Active Intracranial Bleeding Severe Pulmonary Edema/CHF

Answer 62

1g/kg IV administered over 10 minutes. Filter must be used.

Answer 63

1g/kg IV administered over 10 minutes. Filter must be used

Answer 64

Pregnancy **Class C** Mannitol crosses the placenta and may cause fluid shifts that could potentially result in adverse effects in the fetus _No adequate and well-controlled studies in humans, but potential benifits **may** warrant use_

Answer 65

Lidocaine stabilizes neuronal membranes by inhibiting the ionic fluxes required for the initiation and conduction of impulses, **thereby effecting local anesthetic action.** Lidocaine **produces** its **analgesics effects** _through a reversible nerve conduction blockade by diminishing nerve membrane permeability to sodium,_ just as it affects sodium permeability in myocardial cells. **Lidocaine's antiarrhythmic effects** result from its ability to **inhibit the influx of sodium through the "fast" channels of the myocardial cell membrane**, thereby **increasing the recovery period** after repolarization. Lidocaine **suppresses automaticity** and **decreases** the effective **refractory period** and the **action potential duration** **in the His-Purkinje system** at concentrations that do not suppress automaticity at the SA node.

Answer 66

After intravenous injection, lidocaine distributes in 2 phases **early phase** represents distribution into the most highly perfused tissues the **second**, **slower phase**, the drug distributes into adipose and skeletal muscle tissues **Onset**: Immediate **Duration**: 10 to 20 minutes

Answer 67

Hypotension, Decreased LOC, Irritability, Muscle Twitching, Eventually Seizures

Answer 68

Pain Management for IO insertion Cardiac Arrest

Answer 69

Known sensitivity

Answer 70

♦ 40 mg 2% for **IO insertion** ♦ 1.5mg/kg IV/IO followed by 0.75 mg/kg, up to **max dose of 3mg/kg** for pulseless V-fib/V-Tach. **Followed** by a _maintenance infusion of 2-4 mg/min_

Answer 71

♦ 0.5mg/kg (**max dose 40 mg**) for **IO insertion** **♦ Not indicated for pediatric arrest.**

Answer 72

Pregnancy **Calss B** Local anesthetics are **known to cross the placenta rapidly** and, when administered for epidural, paracervical, pudendal, or caudal block anesthesia, and to cause fetal toxicity. There are, however, _no adequate and well-controlled studies in pregnant women_.

Answer 73

Pregnancy **Class B** Animal reproduction studies have failed to demonstrate a risk to the fetus, and there are no adequate and well-controlled studies in pregnant women.