Pharm Manual Flashcards
1
Q
Mechanisms of action for Acetimonphen
A
- Inhibits prostaglandins synthesis which produces analgesic effect
- Acts on Hypothalamic heat regulating Center
2
Q
Contraindication of Acetimnophen
A
-Hypersensitivity
-liver disease
Major Burns
3
Q
Dose of Acetaminophen
A
500-1000mg q4-6 prn PO (adult)
10-15 mg/kg q4-6 prn PO (Pediatrics)
4
Q
Precautions of Acetaminophen
A
Commonly seen in cases of overdoes, may cause severe hepatic damage
5
Q
What is the name of Acetaminophen
A
Tylenol
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
7
Q
ASA Contraindications
A
- GI Bleed (active GI bleed)
- Asthmatics sensitive to ASA
- Hypersensitivity
8
Q
Side Effects of ASA
A
- indigestion
- gastric bleeding
- Urticaria
- Anaphylaxis
- Nausea
- Vomitting
9
Q
Dose of ASA
A
160mg-325mg PO (Chewed)
10
Q
Side Effects of ASA
A
Indigestion Gastric bleeding Urticaria Anaphylaxis Nausea Vomitting
11
Q
Precautions of ASA
A
Patient on other platelet inhibitors
12
Q
D50W Classification
A
Carbohydrate
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
14
Q
Indications of D50W
A
Hypoglycaemia
15
Q
Contraindications of D50W
A
Hyperglycaemia
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
17
Q
Side effects of D50W
A
Phlebitis
Tissue Necrosis
Rebound hyperglycaemia
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
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
20
Q
Contraindications of gravol
A
None
21
Q
Classifications of Gravol
A
Antiemetic, Antihistamine, Anticholinergic
22
Q
Gravol indications
A
- Nausea and vomiting associated with Meniere’s disease
- Nausea/vomiting
- Relief or prevention of motion sickness and vertigo
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
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
25
Precautions of Gravol
- Pneumonia
- Asthmatic Attack
- Dilute with normal saline prior to IV administration to avoid vein irritation
26
Diphenhydramine (Benadryl) Classification
Antihistamine, Anticholinergic
27
Benadryl Mechanism of action
- 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)
28
Benadryl Indications
Allergic and anaphylactic reactions involving respiratory difficulties, edema or severe itching
29
Contraindications of Benadryl
Hypersensitivity
30
Dose of Benadryl
Adult- 25-50mg IV, IM
| Paediatric- 1-2 mg/kg IV, IM (50 Max mg)
31
Side effects of Benadryl
Drowsiness, dizziness, headaches, excitable states, thickening of bronchial secretions, chest tightness, reflex tachycardia, hypotension
32
Precautions of Benadryl
Sedative effects of Benadryl can be potentiated by the administration of CNS depressants, other antihistamines, narcotic, alcohol
Acute Asthma as it may thicken secretions
33
Epinephrine Classification
Sympathomimetic, Adrenergic
34
Mechanism of Action of Epi
```
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
```
35
Indications of Epi
Anaphylaxis
Near death Asthma
Croup/Stridor (nebulized)
36
Contraindications of Epi
Hypersensitivity
| No indications
37
Dose of Epi
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
38
Side Effects of Epi
```
Anxiety
Headache
Cardiac dysrhythmias
Tremors
Chest Pain
Nausea/Vomiting
Hyper Tension
```
39
Precautions of Epi
Cardiovascular Disease
Elderly patients
Hypertension
Pregnancy
40
Glucagon Drug Classification
Anti-hypoglycaemic
41
Mechanisms of Action for glucagon
- Stimulates the release of glycogen from the liver, for glycogenolysis (increase blood glucose levels)
- Smooth muscle relaxation
42
Indications of Glucagon
Hypoglycaemia (BGL under 4.o moly/L and unable to take oral glucose or IV d50)
43
Contraindications of Glucagon
Hypersensitivity
| Pheochromocytoma
44
Dose of Glucagon
Hypoglycaemia
Adult- 1mg IM, SQ may repeat in 20 min if required
Paediatric- 0.5mg IM, SQ (lower then 20 kg)
45
Side Effects of Glucagon
Nausea/Vomiting, rebound hyperglycaemia, hypotension, Tachycardia
46
Precautions of glucagon
Effective only if there are sufficient of glycogen within the liver
Use with caution in patients with cardiovascular or renal disease
47
Oral Glucose Classification
Sugar
48
Mechanism of Action of glucose
Provides glucose content for regular cell metabolism
| Usually absorbed through mucus membrane
49
Indications of Glucose
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
Contraindications of Glucose
Unable to maintain their own airway
| Altered LOC
51
Dose of Glucose
1 tube (15g) orally/buccal PRN
52
Ibuprofen Classification
Non-steroidal, Anti inflammatory drug q
53
Mechanism of Action Ibuprofen
- Treatment of mild to moderate pain
- Reduction of Fever
- Anti-inflammatory
54
Contraindications of Ibuprofen
- 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
Dose of Ibuprofen
- Adult- 200-600mg PO q6-8h
| - Paediatric ( older then 6 mothers)- 7.5mg/kg PO6-8 h
56
Side effects of Ibuprofen
Dizziness, drowsiness, light headed ness, peripheral edema, diarrhea, nausea and vomiting
57
Precautions of ibuprofen
Renal impairment
History of GI bleeds
CHF
Elderly Patients (older then 65)
58
Ipratropium Bromide (Atrovent) Classification
Anticholinergic
59
Mechanism of Action Atrovent
- 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
Indications of Atrovent
Bronchial Asthma
| Broncos spasm associated with COPD
61
Contraindications of Atrovent
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
Dose of Atrovent
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
Side effects of Atrovent
Palpitations, anxiety, dizziness, headache, nervousness, rash, nausea and vomitting
64
Precautions of Atrovent
Narrow angle glaucoma and patients with BPH and or bladder-neck obstruction
65
Ketorlac (Toradol) Classification
Nonsteroidal Anti-inflammatory analgesic
66
Mechanism of Action Toradol
- 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
Indications of Toradol
Treatment for moderate to severe paint (major burns, CA pain, renal colic, neck/back
68
Contraindications of Toradol
-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
Dose of Torolac
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
Side effects of Toradol
Dizziness, headache, drowsiness, bronchospasm, heartburn, nausea, diarrhea, renal failure, edema, rash
71
Precautions of Toradol
- HTN, CHF, Elderly
- Hepatic insufficiency
- GI tract irritation and hemorrhage with long term us e
72
Metoclopramide (Maxeran) classification
Antiemetic
73
Mechanism of action for maxeran
- 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
Indications of Maxeran
Treatment of nausea and vomiting
| Migraine headaches
75
Contraindications of maxeran
- 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
Dose of Maxeran
Adult- 10mg IV/IM/SQ q 4-6h
| Paediatric- 0.15 mg/kg IM/IV max 10mg
77
Side effects of Maxeran
Drowsiness, fatigue, sedation, dizziness, mental depression hypertension, hypotension, tachycardia, bradycardia, diarrhea
78
Precautions of Maxeran
- 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
Naloxone (Narcan) Classification
Narcotic Antagonist
80
Narcan Mechanism of Action
Displaces opioids from receptors, reversing the effects of narcotic overdoes
81
Narcan indications
Decreased LOC and respiratory depression in a suspected opioid overdose
82
Contraindications of Narcan
Allergy or known sensitivity
83
Dose of Narcan
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
Side effects of Narcan
Seizures, dizziness, headaches, tremulousness, tachycardia, hypotension, hypertension, nausea and vomiting
85
Precautions fo Narcan
- 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
Nitroglycerin (NItro) Classification
Anti-Angina, Vascular smooth muscle relaxer, vasodilator
87
Mechanism of Action NItro
- 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
Indications of Nitro
Possible ischemia due to ACS
Unstable Angina
AMI
Pulmonary Edema/CHF
89
Contraindications of Nitro
-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
Dose of Narcan
0.4mg SL q 5 min
91
Side effects of Narcan
Headaches, hypotension, bradycardia, postural syncope, weakness, dizziness, nausea/vomiting, reflex tachycardia
92
Precautions of Nitro
Administration to right ventricular infarction patients, due to preload dependency, can result in hypotension
93
Nitrous Oxide (Entonox) Classification
Analgesic gas
94
Entonox mechanism of action
- 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
Indications of Entonox
- 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
Contraindications of Entonox
-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
Dose of Entonox
Self Administered
98
Side effects of Entonox
Dizziness, light headedness, altered mental status, hallucinations, apnea, N/V
99
Precautions of Entonox
Use in well ventilated areas (inhalation by provider possible)
Anytime more then 50% O2 is required
Gases may separate at -6 degrees Celsius
100
Salbutamol (Ventolin) Classification
Bronchodilator, Sympathomimetic B-2 Agonist
101
Mechanism of Action of Sabutamol
-Selective B-2 Stimulation allows smooth muscle relaxation of the bronchioles. Also has some B01 affects causing and increase in HR
102
Indications of Salbutamol
Bronchi constriction (wheeze) with SOB
103
Contraindications of Sabutamol
- Hypersensitivity
| - Ischemic Chest Pain
104
Dose of Sabutamol
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
Side effects of salbutamol
Hypertension, tachycardia, muscle cramps, dry nose and throat, headache
106
Precautions of salbutamol
Pts with pulmonary edema (cardiac in origin)
107
Tetracaine (tetcaine) Classification
Topical anesthetic
108
Mechanism of Action for Tetracaine
Topical ophthalmic anesthetic to allow for flushing of an eye by removing the blink reflex
109
Indications of tetracaine
To facilitate eye flushing
110
Contraindications of tetracaine
Hypersensitivity to local anesthetics (Caine family)
| Possible penetrating eye injury
111
Dose of tetracaine
2-3 drops in affected eye
| Once treatment is done, moist gauze should be placed over eye until blink reflex returns
112
Side effects of tetracaine
May briefly increase irratation
113
Precautions of tetracaine
May cause blurred vision
