Pharm Exam 1 Flashcards
Covert the different types of medication concentrations.
Kilogram→ gram→ milligram→ microgram & %= (%# x 10) / 100mL
how many micrograms are in a milligram, or how many micrograms are in a gram?
1000mcgs=1mg
a 4% medication, what does that mean to you?
How many milligrams per mL would that contain?
=4Gs/100mLs
=4Gs—>4000mgs
What is the three-step process that I have instilled into your brains when solving a med math problem?
What are we solving for? Weight based? All units the same?
administer a medication via an intramuscular injection.
90 degree angle; deltoid(up to 2mLs), Dorsal gluteal(butt (5 mLs or more) upper lateral side, vastus lateralus (5mLs or more), Rectus femoris (up to 5mL)
Solve a med math problem to administer a medication bolus via either the IO route
find epiphysis/ growth plate of bone, 90 degree angle push needle till 1 line showing, then drill, aspirate at least with a 10mL (20mL preferred), (3-way-cockstop push & push method for kids), admin 2% lidocaine for pain
Solve a med math problem that deals with administering a bolus of IV fluid over time.
TAV
Time, Admin Set , Volume
Solve a med math problem that deals with administering a medicated IV/IO infusion.
CAD
Concentration , Admin Set , Dosage
the “8 Rights” of medication administration.
PT, Dose, Doc, med, time, response, reason, route
What is the difference between antiseptic and a disinfectant? When would we use one versus another?
Antiseptic = person
Disinfectant = tools
what is medical asepsis
providing a medical environment that is free of pathogens
What technique should be used if you ever must recap a needle?
Pick up cap on a surface alone with needle
what are the 4 different general routes of medication administration:
Enteral, Parental, Pulmonary, Percutaneous
Enteral med admin/=
GI; PO, NG/OG Tubes, SL, PR, Buccal
Parenteral med admin/=
“needles”; IV, IO, ET, IM, Umbilical, Subcutaneous, Topical, IN
Percutaneous med admin/=
per skin ;Sublingual, buccal, ocular, aural (ear),
Pulmonary med admin/=
Inhaled (albuterol): musclnaric receptors on smooth M. of bronchioles
What is the “first past effect” and during what type of medication administration would that apply?
Liver filtering the med/ & applies only to Enteral med/s
what are the different types of oral medication forms:
tablets, capsules, enteric coated/time release, syrups (dissolved in sugary based), suspensions (water based), elixirs (meds mixed w/ alcohol based), lozenges (melt w/ heat)
When would you use an OG tube versus an NG tube?
PT is unconscious
How would you measure for the correct insertion depth of the different types of gastric tubes?
“?” measuring technique Confirm placement with air while listening to epigastric
How would you administer medications to a patient utilizing their gastric tube?
Crush meds into 30mLs of warm water then admin w/ 50-100mLs warm flush after
the different ways that we carry parenteral medications
glass ampules, single and multi-dose vials & pre-filled/loaded syringes
What are the three different parts of a syringe?
Flashback chamber, Hub (base before needle), stylet =needle
Hypodermic needle is what/used for?
What are the different parts of a hypodermic needle?
hypodermic needle=hollow metal tube used w/ the syringe to admin/ med/s. It’s sharp enough to puncture tissues, blood vessels, or IV medication poorts
Parts: hilt & shaft. Hilt is a threaded plastic tube that screws securely onto the syringe’s distal adapter. shaft is a thin metal tube through which med/s can flow from the syringe into the site. A bevel at the shaft’s distal end accounts for its sharpness
intradermal medication administration:
what sites can you use:
What degree of insertion would you use?
How much fluid can you administer using this route?
=Deposit med into the dermal layer of the skin
=Anywhere
= 10-15 degrees
= less than 1 mL
Subcutaneous medication admin/:
What sites can we use:
What degree of insertion would you use?
How much fluid can you administer using this route?
=Tissue Comp/: Loose connective tissue between skin and muscle.
= skin on the upper arms, thighs, abdomen (avoid tattoos & superficial important vessels & ligaments/tissues)
= 15 degrees
=No more than 1mL to avoid irritation/ possible abscess.
Intramuscular medication admin/:
What sites can you use?
What degree of insertion would you use?
How much fluid can you administer into the four ?
= deposit into muscle through muscle
= deltoid, Dorsal gluteal(butt) upper lateral side), vastus lateralis (back of thigh), Rectus femoris, PEDIS & stabilize
= straight on 90 degrees
;delt=2mL, butt & Vas Lat/ = 5 or more mLs, , Butt= up to 5mLs
what are the different types of percutaneous medication administration routes:
Sublingual, buccal, ocular, nasal, aural (ear), pulmonary, trans/subdermal
What medications could (but probably shouldn’t be) administered down an ET tube?
=(NAVEL) Narcan, Atropine, Vasopressin, Epi, Lidocaine
Vaso-irratators (really any med that isn’t nutritional replacement)
Water is contained in what 3 compartments in the human body? What are the percentages?
60% of body weight is water 45%=intracellular & 15% extracellular (outside cell)
Interstitial 10.5%
Intravascular 4.5%
What is osmosis?
What is simple diffusion?
What is Facilitated Diffusion?
What is Active transport?
= water moving to high solute concentration from low
= molecules moving high to low
= Molecules moving with a helper EX metformin or insulin
= Molecules moving low to high concentration with use of ATP
different types of IV fluid:
Hypo/Iso/Hyper tonic, fluids, blood, crystalloids, & colloids,
What are the two most common types of isotonic crystalloid solutions that are used in the prehospital environment?
Lactate Ringer’s & 0.9% sodium Chloride
If you were administering isotonic crystalloid solutions, how much would move out of the intravascular compartment within 1 hour?
2/3s would move out
What would occur to the cells in the body if admin/ a isotonic solution?
What’d occur to the cells in the body if admin/ a hypertonic solution?
What’d occur to the cells in the body if admin/ hypotonic solution?
= cells stay same
=cells shrink & can shrink to crenation
= Cells would swell up & can blow up
What is hydrostatic pressure in the vascular system & what creates it?
What is oncotic pressure in the vascular system and what creates it?
=Pressure from heart in blood vessels & forces water to cross the capillary membrane into the interstitial space.
=Pulling water back into the blood vessels by the presence of large proteins in the blood (pulling back in)
What IV sites are considered “peripheral IV” sites?
Arms, Feet, hands, Legs, External Jugular
What are central venous sites?
(IJ) intra jugular, subclavian, femoral, peripherally inserted central cath (PICC) line, Port-a-cath
What type of needle must be utilized to access a Port-a-Cath?
Huber needle –> slanted needle with hole laterally also
What is a Micro IV administer set & How many drops equals 1 mL?
60ggts
What are the different Macro IV administer sets?
20,15,12,10 gtts/min
What are the different types of needles used of intravenous therapy?
Butterfly, Teflon, Hallow, Huber, hyperdermic
When performing an IV stick, what degree of insertion would you use?
15-30 degrees
What size of IV catheter would you use to access an EJ?
16-18 gauge
What does the acronym “TKO” mean?
What does the acronym “KVO” mean?
(to keep open) = 20-25mLs/Hr
( keep vein open)= 20-25mLs/Hr
the different complications that can come from intravenous therapy.
Infiltration, pyrogenic reaction, air emboli, catheter shear, vein blowing, necrosis, thrombophlebitis, artery puncture, circulatory overload
Can you use a scalp vein for IV access, and if you can, what must you remember?
Yes you can, and remember can easily blow
When is it okay to perform an IO? (i.e. what type of patient/conditions)
Cardiac arrest, cant get IV, Critical PTs
What are the different parts of a bone? (ends, middle, etc..)
Epi/ Meta/ Dia/physis, medullary canal, red & yellow bone marrow
Where is red bone marrow found?
Epiphysis
Where is Yellow bone marrow found?
Diaphysis -> medullary canal
What is a more technical name for the growth plate of a bone?
Metaphysis
What sites can you use for the placement of an IO? (adult versus pediatric)
Proximal Tibia (~2 inches for stability)
Proximal Humorous (in peoples way)
Distal Tibia (easier for manual IO),
Sternal aka manubrium (for adults)
Distal femur (for kids)
What are some potential complications with IO access?
What are the contraindications for the placement of an IO?
=PE, Fat emboli, Infiltration, breaking bone
= Infection, previous attempt @ same site, Brittle bones, broken bones
What are the 3 most common types of central venous catheters that you will see in the prehospital environment?
PICC line, tunneled, med/ port
Accessing a central venous catheter, what’s min/ syringe size that should be used?
10mL
use 20mL preferably
If a patient has their tunneled venous access device utilized for dialysis therapy, can we access it?
NO, b/c line have been used already
What are some techniques that you could use if you encounter difficulties while trying to aspirate fluid from a PICC line or tunneled venous line?
Roll & Shrug shoulders, Turn head side to side
What are the two main branches of the nervous system?
Central & Peripheral
The central nervous system (CNS) is made up of what structures?
Brain & Spinal Cord
What are the two subdivisions of the peripheral nervous system (PNS)?
Somatic & Autonomic
What are the 2 subdivisions of the autonomic NS (ANS)?
Sympathetic & Parasympathetic
What effects would you see if the sympathetic nervous system (SNS) was to take over?
“Fight or Flight”
increase HR & electricity, GI constriction, ect
What type of receptors are used by the sympathetic nervous system?
A1, B1, B2
What is the main pre and post ganglionic neurotransmitter for the SNS?
Epinephrine
What part of the spinal cord does the SNS originate from?
Lumbar & Thoracic Spine
How do the nerves of the SNS differ from the PSNS?
shorter Pre & longer Post ganglions
What would you call a med/ that caused a direct increase in the SNS?
Sympathomimetic
What would you call a medication that directly blocked the SNS?
Sympatholytic
What effects would you see if the parasympathetic nervous system (PSNS) was to take over?
“Rest & Digest”
“calms down” bodies’ organs
What type of receptors are used by the parasympathetic nervous system?
Nm (nicotinic muscle), Nn (nicotinic neuronal),
& Muscarinic = found in heart
What is the main pre and post ganglionic neurotransmitter for the PSNS?
Acetylcholine
hat part of the spinal cord does the PSNS originate from?
Cervical & Sacral Spine
How do the nerves of the PSNS differ from the SNS?
longer Pre & shorter Post Ganglion
What would you call a med/ that caused a direct increase in the PSNS?
Parasympathomimetic
What would you call a medication that directly blocked the PSNS?
Parasympatolytic
What is the difference between an agonist and an antagonist?
Agonist= Stimulates Antagonist= Inhibits
The very small area between two nerve cells is known as a?
Synapse
What is the difference between a positive and negative feedback loop?
Neg/= maintains/ brings back to homeostasis Pos/= Continues effects
Autoclave means?
clean/sanitize w/ heat
ET tube meds you can give:
(NAVEL) Narcan, Atropine, Vasopressin, Epi, Lidocaine
Chemical med name:
Generic med name:
Official med name:
Brand med name:
least common EX 7-chlor-1-3dihydro….
manufactured EX diazepam, (usually capitalized) EX Ibuprofen
name registered listed with USP EX Diazepam, USP
name by company followed by trademark/propriety EX Motrin Advil
Where meds come from:
plants, animals, minerals, synthetic (lab-made),
Harrison-Narcotic act (1914):
aimed a controlling the importation, manufacture, & sale of opium & coca plant & its derivatives
FDA & Cosmetic act (1938)
truth-in-labeling cause→ state whether prep has habit-forming drugs and its%
Durham-Humphrey amendments (1951)=
requires pharmacists to have either a prescription for certain meds
Kufauver-Harris amendment (1962)=
amendment to FDCA, → mandates pharmaceutical manufacturers to list complications
Drug abuse (1970)=
classifies the drugs used in medicine into 5 different schedules
Schedule 1 med:
Schedule 2 med:
Schedule 3 med:
Schedule 4 med:
schedule 5 med:
=never give, highest abuse potential
=high abuse ~dependence accepted med indi/s (codeine, morphine)
=less abuse potential low dependence (acetaminophen)
=low abuse potential = benzos (diazepam, lorazepam)
=lowest abuse potential w/ lil bits of opioids often for cough/diarrhea
Phase 1 med studies:
Phase 2 med studies:
Phase 3 med studies:
Phase 4 med studies:
=meds/ pharmacokinetics, toxicity, safe dose (therapeutic dose)
=test on limited population
= refined therapeutic dose; collects data on side effects
= post-marketing analysis during conditional approval
FDA pregnancy category A:
FDA pregnancy category B:
FDA pregnancy category C:
FDA pregnancy category D:
FDA pregnancy category X:
=studied a lot and had not showed harmful effects to fetus/mom
=animals studies hadn’t showed harm effects to animals but not humans
=animals studies pos/ prob/ w/ no studies on pregnant mother no good studies on animals/pregnant
= fetal risks have been demonstrated benefits could outweigh risks
=fetal risk demonstrated risk outweighs possible benefits to mother
Med Bioavailability:
Med Biotransformation:
Med Prodrug:
=how much the body breaks down the dose
=METABOLISM→ liver #1 ⅔ filter → means of body filtering med
=body has to break drug down for med to work as intended EX aspirin
Idiocrasy effect:
Cross tolerance effect:
Tachyphylaxis effect:
Cumulative effect:
Med antagonist effect:
Summation effect:
Synergism effect:
Potentiation effect:
Interference effect:
=individual reaction is unusually dif/ from what is commonly seen
= body builds up tolerance to 1 med thus, tolerance to another med
=rapid occurring tolerance to med
= when med admin/ in many doses thus increased effect, due to quantitative buildup of the drug in the blood
=effects of one med blocks the response to another drug
=2 meds that enhance each other
= 2 meds admin/ together that produces a greater response (“1+1=5”)
=when med enhances effects of another (promethazine + morphine)
=med directly effects the pharm/ of another “football” EX: non-selective beta blocker w/ albuterol so asthma worsts
Bioequivalence:
Assay:
Bioassay:
Efficacy:
Teratogenic med:
=relative therapeutic effectiveness of chemically equivalent med/s
= test done to determine the amount of purity of a given chemical
=test to ascertain a med/s in a biological model
= ability of med/ to cause a expected response
=medication that can kill/deform the fetus in the mother
