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Pharm Manual Flashcards

1
Q

Mechanisms of action for Acetimonphen

A
  • Inhibits prostaglandins synthesis which produces analgesic effect
  • Acts on Hypothalamic heat regulating Center
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2
Q

Contraindication of Acetimnophen

A

-Hypersensitivity
-liver disease
Major Burns

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3
Q

Dose of Acetaminophen

A

500-1000mg q4-6 prn PO (adult)

10-15 mg/kg q4-6 prn PO (Pediatrics)

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4
Q

Precautions of Acetaminophen

A

Commonly seen in cases of overdoes, may cause severe hepatic damage

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5
Q

What is the name of Acetaminophen

A

Tylenol

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6
Q

Acetylsalic Acid (ASA) Mechanism of Action

A

Inactivated cyclooxgenase enzyme which decreases the production of prostaglandin in the tissue, blocking the pain receptors sensitivity and decreases inflammation. Due to this inactivation of COX, thromboxane A2 production is also inhibited, which is responsible for platelet aggregation

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7
Q

ASA Contraindications

A
  • GI Bleed (active GI bleed)
  • Asthmatics sensitive to ASA
  • Hypersensitivity
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8
Q

Side Effects of ASA

A
  • indigestion
  • gastric bleeding
  • Urticaria
  • Anaphylaxis
  • Nausea
  • Vomitting
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9
Q

Dose of ASA

A

160mg-325mg PO (Chewed)

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10
Q

Side Effects of ASA

A 
Indigestion
Gastric bleeding
Urticaria
Anaphylaxis
Nausea
Vomitting
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11
Q

Precautions of ASA

A

Patient on other platelet inhibitors

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12
Q

D50W Classification

A

Carbohydrate

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13
Q

Mechanism of Action for D50W

A
  • Increase Blood Glucose Levels

- Hypertonic solution producing a transient movement of water from interstitial spaces into venous system

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14
Q

Indications of D50W

A

Hypoglycaemia

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15
Q

Contraindications of D50W

A

Hyperglycaemia

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16
Q

Does of D50W

A

Adults- 25g IVP may repeat once
Paediatric- 0.5-1g/kg slow IVP; dilute 1:1 with sterile water (NS can be used if no sterile water available) forming D25W

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17
Q

Side effects of D50W

A

Phlebitis
Tissue Necrosis
Rebound hyperglycaemia

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18
Q

Precaution of D50W

A
  • Tissue necrosis if infiltration occurs
  • May Precipitate severe neurological symptoms in alcoholics (thiamine should be considered prior to administration
  • Patients with increased intracranial pressure, may worsen cerebral edema
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19
Q

Dimenhydinate (Gravol) Mechanism of Action

A
  • Blocks histamine and Ach receptors in the vomiting center as well as blocks the pathway between the inner ear and the Vomitting center that can cause nausea and vomiting
  • Similar chemical composition to that of diphenhydramine
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20
Q

Contraindications of gravol

A

None

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21
Q

Classifications of Gravol

A

Antiemetic, Antihistamine, Anticholinergic

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22
Q

Gravol indications

A
  • Nausea and vomiting associated with Meniere’s disease
  • Nausea/vomiting
  • Relief or prevention of motion sickness and vertigo
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23
Q

Gravol Dose

A

Adult- 25-100mg IM q 4h PRN
12.50- 50mg IV q 4h PRN
Paediatric- 1.0mg/kg IV/IM max of 25mg

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24
Q

Gravol Side-effects

A
  • CNS depression
  • Headache
  • Anti-muscadine (blurred vision, dry mouth, urinary retention, constipation)
  • Thickened Bronchial Secretions
  • Paradoxal excitation can occur in children
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25
Q

Precautions of Gravol

A
  • Pneumonia
  • Asthmatic Attack
  • Dilute with normal saline prior to IV administration to avoid vein irritation
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26
Q

Diphenhydramine (Benadryl) Classification

A

Antihistamine, Anticholinergic

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27
Q

Benadryl Mechanism of action

A
  • Competes with free histamine for binding and blocks H1 histamine receptors
  • Antagonizes the effects of histamine on Histamine (HA) receptors, leading to reduction of the negative symptoms brought on by histamine
  • CNS depressant
  • Has Antiemetic properties (H2 histamine receptors in the GI system)
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28
Q

Benadryl Indications

A

Allergic and anaphylactic reactions involving respiratory difficulties, edema or severe itching

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29
Q

Contraindications of Benadryl

A

Hypersensitivity

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30
Q

Dose of Benadryl

A

Adult- 25-50mg IV, IM

Paediatric- 1-2 mg/kg IV, IM (50 Max mg)

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31
Q

Side effects of Benadryl

A

Drowsiness, dizziness, headaches, excitable states, thickening of bronchial secretions, chest tightness, reflex tachycardia, hypotension

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32
Q

Precautions of Benadryl

A

Sedative effects of Benadryl can be potentiated by the administration of CNS depressants, other antihistamines, narcotic, alcohol

Acute Asthma as it may thicken secretions

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33
Q

Epinephrine Classification

A

Sympathomimetic, Adrenergic

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34
Q

Mechanism of Action of Epi

A 
Stimulates alpha and beta receptors
     Increase heart rate
     Increase AV conduction
     Increases force of myocardial contractility 
     Increase vasoconstriction 
Release bronchial smooth muscle 
Increases coronary and verbal blood flow
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35
Q

Indications of Epi

A

Anaphylaxis
Near death Asthma
Croup/Stridor (nebulized)

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36
Q

Contraindications of Epi

A

Hypersensitivity

No indications

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37
Q

Dose of Epi

A

Adult- Asthma/Anaphylaxis 0.3-0.5 mg IM/SQ 1:1,000
Paediatric- Asthma/ Anaphylaxis; 0.1mg/kg (1:1000) IM or SQ max 0.5mg
Croup/stridor (see chart)- Nebulized (0.5mg/kg 1:1000 to a max of 5.0 mg mixed with NaCl 0.9% to make 5.0 ml of solution)
Every 3-5 min until symptoms subside

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38
Q

Side Effects of Epi

A 
Anxiety
Headache 
Cardiac dysrhythmias
Tremors
Chest Pain
Nausea/Vomiting 
Hyper Tension
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39
Q

Precautions of Epi

A

Cardiovascular Disease
Elderly patients
Hypertension
Pregnancy

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40
Q

Glucagon Drug Classification

A

Anti-hypoglycaemic

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41
Q

Mechanisms of Action for glucagon

A
  • Stimulates the release of glycogen from the liver, for glycogenolysis (increase blood glucose levels)
  • Smooth muscle relaxation
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42
Q

Indications of Glucagon

A

Hypoglycaemia (BGL under 4.o moly/L and unable to take oral glucose or IV d50)

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43
Q

Contraindications of Glucagon

A

Hypersensitivity

Pheochromocytoma

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44
Q

Dose of Glucagon

A

Hypoglycaemia
Adult- 1mg IM, SQ may repeat in 20 min if required
Paediatric- 0.5mg IM, SQ (lower then 20 kg)

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45
Q

Side Effects of Glucagon

A

Nausea/Vomiting, rebound hyperglycaemia, hypotension, Tachycardia

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46
Q

Precautions of glucagon

A

Effective only if there are sufficient of glycogen within the liver
Use with caution in patients with cardiovascular or renal disease

47
Q

Oral Glucose Classification

A

Sugar

48
Q

Mechanism of Action of glucose

A

Provides glucose content for regular cell metabolism

Usually absorbed through mucus membrane

49
Q

Indications of Glucose

A

BGL lower then 4.0, in a conscious patient who can maintain their own airway
Confusion with recorded BGL lower then 4.0 (Altered LOC)

50
Q

Contraindications of Glucose

A

Unable to maintain their own airway

Altered LOC

51
Q

Dose of Glucose

A

1 tube (15g) orally/buccal PRN

52
Q

Ibuprofen Classification

A

Non-steroidal, Anti inflammatory drug q

53
Q

Mechanism of Action Ibuprofen

A
  • Treatment of mild to moderate pain
  • Reduction of Fever
  • Anti-inflammatory
54
Q

Contraindications of Ibuprofen

A
  • Hypersensitivity to NSAIDs/ Salicylates
  • ASA induced Asthma
  • CVA or TBI in previous 24 hours
  • Major Burns
  • Renal failure or solitary kidney
  • Age under 6 Months
55
Q

Dose of Ibuprofen

A
  • Adult- 200-600mg PO q6-8h

- Paediatric ( older then 6 mothers)- 7.5mg/kg PO6-8 h

56
Q

Side effects of Ibuprofen

A

Dizziness, drowsiness, light headed ness, peripheral edema, diarrhea, nausea and vomiting

57
Q

Precautions of ibuprofen

A

Renal impairment
History of GI bleeds
CHF
Elderly Patients (older then 65)

58
Q

Ipratropium Bromide (Atrovent) Classification

A

Anticholinergic

59
Q

Mechanism of Action Atrovent

A
  • Causes Bronchodilation by competitive inhibition of cholinergic receptors on bronchial muscle
  • Blocks the action of Acetylcholine, which inhibits parasympathetic stimulation, thus decreasing bronchial secretions
  • Dries respiratory tract secretions
60
Q

Indications of Atrovent

A

Bronchial Asthma

Broncos spasm associated with COPD

61
Q

Contraindications of Atrovent

A

Known hypersensitivity
Is not indicated for acute treatment of bronchospasm for which rap is response is required
Ischemic chest pain
Acute narrow angle glaucoma

62
Q

Dose of Atrovent

A

Adult- 250-500 mcg mixed with ventolin q20minutes x 3
-2-4 puffs q 20 minutes x 3
Pediatric- 125-250 mcp mixed with ventolin q 20 minutes x 3
-2-4 puffs q 20 minutes x 3

63
Q

Side effects of Atrovent

A

Palpitations, anxiety, dizziness, headache, nervousness, rash, nausea and vomitting

64
Q

Precautions of Atrovent

A

Narrow angle glaucoma and patients with BPH and or bladder-neck obstruction

65
Q

Ketorlac (Toradol) Classification

A

Nonsteroidal Anti-inflammatory analgesic

66
Q

Mechanism of Action Toradol

A
  • Inhibits prostaglandin synthesis producing peripherally mediated analgesia, anti-inflammatory, and antipyretic effects
  • At analgesic doses little anti-inflammatory or antipyretic activity seen
  • Acts peripherally verses narcotics which act upon the the CNS, therefore, no CNS depression
67
Q

Indications of Toradol

A

Treatment for moderate to severe paint (major burns, CA pain, renal colic, neck/back

68
Q

Contraindications of Toradol

A

-Hypersensitivity to ASA or NSAID
-Asthmatics due to bronchospastic activity
- renal impairment
-pt’s at risk for bleeding as ketorolac inhibits platelet function thereby increasing bleeding time
Trauma
GI
CVA/TBI lower then 24 hours

69
Q

Dose of Torolac

A

Adults- 30-60 mg IM/IV q4-6 h Mac 120mg/day

Pediatrics older then 6 months- 0.5 mg/kg IM/IV q 4-6 h, max 30mg/dose and 0.5 mg/kg/day

70
Q

Side effects of Toradol

A

Dizziness, headache, drowsiness, bronchospasm, heartburn, nausea, diarrhea, renal failure, edema, rash

71
Q

Precautions of Toradol

A
  • HTN, CHF, Elderly
  • Hepatic insufficiency
  • GI tract irritation and hemorrhage with long term us e
72
Q

Metoclopramide (Maxeran) classification

A

Antiemetic

73
Q

Mechanism of action for maxeran

A
  • Antagonizes central and peripheral dopamine receptors, as well as 5HT4 receptor agonistic properties, which raises the threshold of activity in the chemoreceptor trigger zone, resulting in antiemetic effects
  • Increases the amplitude and tone of gastric contractions, increases peristalsis and causes accelerated gastric emptying and intestinal tract
74
Q

Indications of Maxeran

A

Treatment of nausea and vomiting

Migraine headaches

75
Q

Contraindications of maxeran

A
  • Hypersensitivity
  • GI hemorrhage, mechanical obstruction or perforation
  • Pheochromocytoma (may cause HTN crisis)
  • Seizure Disorder
  • Patients receiving medications that put them at risk for extrapyramidal reactions such as haloperidol and fluphenazine
76
Q

Dose of Maxeran

A

Adult- 10mg IV/IM/SQ q 4-6h

Paediatric- 0.15 mg/kg IM/IV max 10mg

77
Q

Side effects of Maxeran

A

Drowsiness, fatigue, sedation, dizziness, mental depression hypertension, hypotension, tachycardia, bradycardia, diarrhea

78
Q

Precautions of Maxeran

A
  • Hx fo epilepsy or Parkinson’s disease (potential for exacerbation of their conditions)
  • Anticholinergic drugs antagonize the effects of Maxeran on GI Motility
  • Sedative effects of the drug can be potentiated by other CNS depressants
  • May cause extra pyramidal symptoms, treat with 50mg of Diphenhydramine
79
Q

Naloxone (Narcan) Classification

A

Narcotic Antagonist

80
Q

Narcan Mechanism of Action

A

Displaces opioids from receptors, reversing the effects of narcotic overdoes

81
Q

Narcan indications

A

Decreased LOC and respiratory depression in a suspected opioid overdose

82
Q

Contraindications of Narcan

A

Allergy or known sensitivity

83
Q

Dose of Narcan

A

Adult- 0.4-2.0mg IV/IN/IM q 2-3 min PRN

Pediatric- 0.1 mg/kg IV/IN/IM/SC q 2-3 min PRN max 2.0 mg per dose

84
Q

Side effects of Narcan

A

Seizures, dizziness, headaches, tremulousness, tachycardia, hypotension, hypertension, nausea and vomiting

85
Q

Precautions fo Narcan

A
  • Use cautiously in patients dependent on opioids, acute withdrawal may occur
  • Cardiac collapse in patients postoperative with cardia dysfunction or patients on cardiotoxic medications
  • Administer Cautiously as pt may experience withdrawal symptoms or aggressive behaviour
86
Q

Nitroglycerin (NItro) Classification

A

Anti-Angina, Vascular smooth muscle relaxer, vasodilator

87
Q

Mechanism of Action NItro

A
  • Relaxes vascular smooth muscle, there by dilating the veins and arterioles (at higher doses), causing blood pooling, which reduces the preload thus decreasing workload of the heart muscle
  • reduces left ventricular systolic wall tension, decreases after load
88
Q

Indications of Nitro

A

Possible ischemia due to ACS
Unstable Angina
AMI
Pulmonary Edema/CHF

89
Q

Contraindications of Nitro

A

-Hypotension (below 90mmhg)
-Severe bradycardia/ tachycardia (below 50 or above 150bpm)
-Increase ICP or intracranial hemorrhage
-pts taking ED meds
Viagra 24 Hours
Challis, levitin, Staxyn, within 36 hours

90
Q

Dose of Narcan

A

0.4mg SL q 5 min

91
Q

Side effects of Narcan

A

Headaches, hypotension, bradycardia, postural syncope, weakness, dizziness, nausea/vomiting, reflex tachycardia

92
Q

Precautions of Nitro

A

Administration to right ventricular infarction patients, due to preload dependency, can result in hypotension

93
Q

Nitrous Oxide (Entonox) Classification

A

Analgesic gas

94
Q

Entonox mechanism of action

A
  • blended mixture of 50% O2 and 50% N20 that has potent analgesic effects
  • CNS depressant with analgesic properties
  • Effects last only 2-5 minutes after administration ceases
95
Q

Indications of Entonox

A
  • Acute pain associated with MSK injury, ACS, Renal colic, perinatal, burns and ABD pain
  • Temporary relief of mild to moderate pain from painful procedures (splinting, etc)
  • Acute anxiety
96
Q

Contraindications of Entonox

A

-Patients that cannot comprehend verbal instructions or who are intoxicated
-Gas trapping conditions
Possible bowel obstruction
Air embolism
Pneumothorax
Middle ear infection
Middle ear infection
Decompression sickness
-COPD or signs of resp distress including SPO2 lower then 90%
-Head injury
-Altered LOC

97
Q

Dose of Entonox

A

Self Administered

98
Q

Side effects of Entonox

A

Dizziness, light headedness, altered mental status, hallucinations, apnea, N/V

99
Q

Precautions of Entonox

A

Use in well ventilated areas (inhalation by provider possible)
Anytime more then 50% O2 is required
Gases may separate at -6 degrees Celsius

100
Q

Salbutamol (Ventolin) Classification

A

Bronchodilator, Sympathomimetic B-2 Agonist

101
Q

Mechanism of Action of Sabutamol

A

-Selective B-2 Stimulation allows smooth muscle relaxation of the bronchioles. Also has some B01 affects causing and increase in HR

102
Q

Indications of Salbutamol

A

Bronchi constriction (wheeze) with SOB

103
Q

Contraindications of Sabutamol

A
  • Hypersensitivity

- Ischemic Chest Pain

104
Q

Dose of Sabutamol

A

Adults- 5.omg aerosol
400-600mcg (4-6 puffs) via MD1 (1 puff q 30 Sec)
Paediatrics- (10-30kg) -2.5 mg aerosol
200-300 mcg (2-3 puffs) via MD1 (1 puff q 30 sec)
Infant (lower then 10 kg)- 1.25 mg via aerosol

105
Q

Side effects of salbutamol

A

Hypertension, tachycardia, muscle cramps, dry nose and throat, headache

106
Q

Precautions of salbutamol

A

Pts with pulmonary edema (cardiac in origin)

107
Q

Tetracaine (tetcaine) Classification

A

Topical anesthetic

108
Q

Mechanism of Action for Tetracaine

A

Topical ophthalmic anesthetic to allow for flushing of an eye by removing the blink reflex

109
Q

Indications of tetracaine

A

To facilitate eye flushing

110
Q

Contraindications of tetracaine

A

Hypersensitivity to local anesthetics (Caine family)

Possible penetrating eye injury

111
Q

Dose of tetracaine

A

2-3 drops in affected eye

Once treatment is done, moist gauze should be placed over eye until blink reflex returns

112
Q

Side effects of tetracaine

A

May briefly increase irratation

113
Q

Precautions of tetracaine

A

May cause blurred vision

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