PHARMA W6 Flashcards
5,5L is how many ml?
5500ml
4 mg mixed in 10 ml is how many mg/ml?
0,4 mg/ml
4,2g/ml is how many mg/ml
4200 mg/ml
What is the difference between generic and brand name?
- The generic name is the drug it self. (e.g. Fentanyl)
- The brand name is typically a catchy name invented by the company that produces it (E.g. Haldid)
What is the difference between systemic and local function of a drug?
- Systemic means the drug enters the bloodstream
- Local means the primary effect of the drug is at the area were it is dispersed
Enteral means?
Intake of a drug via the mouth and GI-tract
Parenteral means?
Administration of a drug into the blood stream
What are the 4 stages of pharmacokinetics
ADME
1. Absorbtion
2. Distribution
3. Metabolisation
4. Excretion
Pharmacokinetics means…
What the body does to the drugs
Pharmacodynamics means…
What the drug does to the body
What happens during absorption?
The body absorbs the drug from the GI-tract. If the drug is given IV it skips this part.
What is distribution in pharmacokinetics?
Transport of the drug to the cells of the body e.g. through the blood stream
Were does metabolisation of drugs primarily happen?
In the liver by enzymes
Were does excretion of drugs happen primarily?
In the kidneys, but also in lungs and in the liver (as bile)
Bioavailability means?
The percentage of drugs that reaches the circulation. It is depended upon administration method and wether it undergoes first pass metabolism
First pass metabolism means?
The blood from the GI-tract containing digested nutrients and drugs flows to the liver and gets degraded before entering the systemic blood stream
T 1/2 means?
The time it takes for a drug to half its concentration in the blood
If you administer a drug repeatedly what phase can you enter?
Plateuphase were a balance between drug intake and T 1/2 occurs
What interactions can occur with drugs?
- Drugs with other drugs
- Drugs with food/liquid (e.g. alcohol or grapefruit)
What is the primary consequence if you overdose a drug?
- Liver failure
- Multiorgan failure in consequence to the failing liver
How should you store drugs?
- Fridge 2-8 degrees
- Room temp 15-25 degrees
- No specific 3-30 degrees
- Dry and dark
What is Nicolau syndrome?
Necrosis of tissue usually caused by wrong injection of IM drugs e.g. due to a too short needle
Miosis means?
Small pinpoint pupils (contracted)
What do we use fluid for?
Resuscitation in:
1. Trauma
2. Crush
3. Burns
4. Dehydration
What are the elements of the lethal triad
- Coagulopathy
- Hypotmernia
- Metabolic acidosis
What is the goal urinary output in treatment of crush-injuries?
100-200 ml /hr
What is the optimal treatment for crush injuries prior to extraction/reperfusion of limb?
Administer 2000ml of NaCl IV.
Or place TQ above crush injury
What is the suggested treatment for crush-injuries post extraction/reperfusion of limb?
- Fluid therapy to urine output of 100-200ml/hr
- Calcium 10ml 10% IV/IO
- Ertapenem 1g IV/IO
- Analgesia
What is the treatment goal for fluid resuscitation in burn injuries?
Urine output of 30-50ml/hr
What are the clinical signs of dehydration?
- Low or absent urine output
- Skin turgor
- Dry mucous membranes
What is the treatment goal in fluid resuscitation for dehydration?
Urine output of 0,5ml/kg/hr
What solution should you always flush IV/IO with?
NaCl 0,9%
Pain in the joints, skin, muscles or bones are called
Somatic pain
Pain from organs are called
Visceral pain
Were are nociceptors found
Everywhere in the body basically
What is effective pain relief?
- Decline of 2 points on NRS
- 30% decrease in pain score
- Patient feels relief
What happens if you combine NSAID’S?
You risk having more side-effects
What are the contraindications for NSAIDS?
- Gastric ulcers
- Gastric bleeding (blood in vomit or faces)
- Allergy/hypersensivity
NSAIDS effect what enzymes?
COX 1 and COX 2
What does NSAID do to COX1?
Inhibits COX1’s function in coagulation causing bleedings to be hard to stop
What does NSAID do to COX2?
Inhibits COX2’s function in the inflammatory process
What is the dosage of NSAID per NNSOCM?
- 400mg capsule 3 times a day
- 600 mg capsule 2 times a day
Max dose of 1200mg/day
What is the pharmacodynamic function of paracetamol?
Works antipyretic and analgesic (precise function unknown)
What is the antidote for paracetamol overdose?
Acetylcysteine IV
What is the dosage of tablet paracetamol per NNSOCM
2 capsules of 500g 3-4 times a day
Max dose of 4g/day
What is the pharmacodynamic function of an opioid?
- Binds to opioid receptors in CNS
- Blocks transmission of pain signals to the brain
What are the 7 symptoms of opiod intake/overdose?
- Sedation
- Respiratory depression
- Bradycardia
- Hypotension
- Obstipation
- Nausea/vomiting
- Miosis (contracted pin-point pupils)
When is opiod drugs indicated?
In severe pain if no contraindications
What are the contraindications for Morphine?
- GCS <12
- Hemodynamical instability
- Respiratory depression (bradypnea)
What is the dosage of Morphine per NNSOCM?
5mg IV “slow push” over 5 mins.
Repeatable every 30 minutes
How fast does Morphine work when administered IV, IM or SC?
- IV after 20 min
- IM after 30-60 min
- SC after 50-90 min
What is true for Fentanyl vs Morphine
- Fentanyl is 100 times stronger than morphine
- Fentanyl can pass the blood/brain barrier faster
How fast does fentanyl work when administered IV?
After 2-3 min
How long will the effect of Morphine last?
Approx 5 hrs
How long will the effect of fentanyl last?
Approx 30-60 min
What is the dosage of fentanyl lozenge per NNSOCM?
PO 800micg lollipop
Repeatable after 15 mins
What is the initial dosage of fentanyl IV?
1 micg/kg
What are the contraindications for fentanyl?
- Respiratory depression (bradypnea)
- Cyanosis
- AVPU=(PU)
- Ileus (intestines not moving/working properly)
What is the antidote for opiods?
Nalaxone
What is the pharmacodynamic function of naloxone?
Has higher affinity than opioids so it pushes opioids of the receptors and occupies the receptors, causing the opioids to be inactive for a while
What is true for the relationship between T1/2 for naloxone and opioids?
Nalaxone has shorter T/12 causing opioids to regain its function at the receptor after a while. Reassess and repeat injection of naloxone if needed
What is the dosage of nalaxone per NNSOCM?
0,2mg IV every 5 mins until desired effect (normal respiration regained)
Max dose 0,8mg
What is the side-effects of naloxone?
- Nausea/vomiting
- Sweating
- Dizziness
- Headache
- Tachycardia
What is the medical treatment for nausea caused by opioids?
Odensetron IV
What is the dosage of odansetron per NNSOCM?
4-8mg IV
How do you prep Ertapenem for IV use?
- Add 10 ml of NaCl to the powder
- Stir
- Put the 10ml into a 100ml NaCl bag
What are common side effects of most antibiotics?
- Stomach complaints
- Diarrea
- Nausea
- Headache
What are the 5 ways of preventing infection?
- Hygiene
- Protection
- Avoid contact
- Boil water and heat food
- Vaccinations
What type of pathogen are antibiotics effective against?
Bacterias
How does antibiotics work?
They attack/inhibit different structures of the bacteria-cell. e.g. some of the enzymes inside the bacteria causing it to die
What are the cons and pros with broad spectrum antibiotics?
Cons: Attacks also “friendly” bacteria in the body
Pros: If we don’t know what bacteria has infected a person, broad spectrum will attack most bacteria
What are the pros and cons with narrow spectrum antibiotics?
Pros: Only attacks the specific bacteria
Cons: We need to know which bacteria to attack
What can happen if antibiotics are overused or used when not necessary?
The bacteria in the body might become resistant to the treatment we have. Then antibiotics cannot treat possible infections of that bacteria in the future
Name a multi resistant bacteria?
MRSA
Multi resistant streptococcus arius
Name the most common antibiotics per NNSOCM?
- Ertapenem
- Moxifloxacine
What is the indications for Ertapenem IV?
Prophylactic treatment of penetrating battle field trauma
What is the dosage of Ertapenem IV per NNSOCM?
1g / day in 3-14 days
Name some of the side effects of Ertapenem
- Diarrhea
- Nausia/vomiting
- Headache
- Thrombophlebitis
- Rash
- Itching
How long can you store Ertapenem when diluted into solution?
6 hours
What are the indications for moxifloxacine
- Penetrating eye injury
- Complicated skin/intra abdominal infections
- Pneumonia, bronchitis, sinusitis
What is the dosage for moxifloxacine per NNSOCM?
400mg PO pr day over 5-10 days
What 2 things can S-ketamine be used for?
- Sedation
- Analgesia
What is the initial dosage of S-ketamine when used as anesthetic per NNSOCM?
20-25 mg IV or 50 mg IN
What is the preferred dosage for S-Ketamine when titrating
10 mg
How do you create a solution of S-ketamine with the concentration of 10mg/ml
Draw up 2 ml of S-ketamine into 3ml of NaCl.
The total is now 50mg S-ketamine in 5 ml (or 10mg/ml)
Now you can give 1ml containing 10mg
What is the dosage of S-Ketamine when used as sedative?
1mg/kg initial dose. Maintained by 0,5mg/kg after 15-20 min.
or
0,5-3mg/kg/hr when used as a drip
What are the side-effects of S-Ketamine?
- Tachycardia
- Hypertension
- Hallucinations
- Respiratory depression
What other drug can be nice to use together with S-Ketamine to calm the patient down?
Midazolam 2,5mg IV
Adrenalin is the treatment for…?
Anaphylaxis
What is the dosage for adrenalin in anaphylactic shock per NNSOCM?
0,3-0,5mg IM repeatable every 5 minutes
What are the side effects of adrenaline?
- Tachycardia
- Sweating
- Arrythmias
- Anxiety
- Tremor (shivering)
What is the indication for TXA?
Massive traumatic bleeding
What is the dosage of TXA per NNSOCM?
2g over 2 minutes
What are the contraindications for TXA?
Bleeding that existed over 3 hours
What is the pharmacodynamic function of TXA?
Inhibits fibrinolysis (plasminogen) which lets the blood clots stay longer in place
What are the side effects of TXA?
- Nausea, vomiting
- Diarrea
Can/should you administer TXA in the same IV infusion line as penicillin?
No
Can/should you administer TXA directly into the IV?
Yes
Can/should you administer TXA in the same IV infusion line as blood products?
No
What is the indication for Midazolam?
- Agitation/anxiety
- Seizure
- Treatment of S-ketamine side effects
What type of drug is midazolam?
Benzodiazepine
What are the contraindications for midazolam?
Do not use with opioids unless to treat seizures
What is the dosage of midazolam per NNSOCM?
Agitation/anxiety: 5mg IV repeat if necessary
S-ketamine side effects: 2,5mg IV single dose
Seizure: 10mg IM/IN or 5mg IV/IO repeat after 5 mins
Max dosage 20 mg
What are the side effects of midazolam?
- Sedation
- Confusion
- Slurred speech
What is the dosage of paracetamol IV?
1g every 6h
What is the indication for Calcium gluconate 10%?
- Crush syndrome
- Blood transfusion
What is the contraindication for Calcium gluconate 10%?
Hypercalcemia
What is the dosage of calcium gluconate 10% per NNSOCM?
Crush injury: 10ml in case of arrhythmias/CPR
Blood transfusion: 10ml after 1. infusion and after each 4.th
What are the side effects of calcium gluconate 10%?
- Hyper/hypotension
- Bradycardia
- Arrhythmia
- Nausea
- Blush (redness in face)
Citrizine is a type of
Antihistamine
What are the indications for citrizine
- Allergic rhinitis
- Pollen allergy
- Hives
What are the dosage of citrizine per NNSOCM?
10mg tablet a day
What are the contraindications for citrizine?
None relevant
What are the side effects of citrizine?
- Abdominal complaints
- Sleepiness
- Dry mouth
- headache
What should you be cautious about after having taken citrizine?
It may impair the ability to react fast
Dexamethasone is a type of…
Corticosteroid
What are the indications for dexamethasone?
- HACE/AMS
- Anaphylaxis
- Asthma
What are the dosage of dexamethasone in anaphylaxis per NNSOCM?
8mg IV/IO/IM
What are the side effects of dexamethasone?
- Abdominal complaints
- Nausea, vomiting
- Diarrea
- Obstipation
What are the pharmacodynamics of dexamethasone?
It lowers the sensitivity of the body’s inflammatory response
What is odansetron?
Anti-emetic
What is a scopoderm patch good at preventing
Motion sickness
What are the pharmacodynamics of scopolamine?
Blocks M1 receptor of the vestibulocochlear nerves.
What are the pharmacodynamics of odansetron?
Block serotonin nerotransmitter release
What does Epinephrine (Adrenaline) do to the body?
Increases cardiac output by increasing strength and rate of contractions.
What does Norepinephrine (Noradrenaline) do to the body?
Constricts blood vessels.