Pharmacology Flashcards
Track marks are usually a sign of what
Sclerosis, hardening of body tissue, caused by frequent cannulation, commonly from drug misuse
What is Osmolarity
concentration of sodium- The ability to influence the movement of water across a semipermeable membrane. Pts with HTn & heart failure are are risk for fluid overload.
Lower concentration of sodium than the cell, water flows into cell, cell swells, may burst from increase intracellular osmotic pressure
Hypotonic solutions
same concentration of sodium as the cell, water does not shift, no changes in cell shape
isotonic solutions
greater concentration of sodium, water drawn out of cell, cell may collapse from increased extracellular osmotic pressure
hypertonic solutions
contains lactate, metabolized by the liver to form bicarbonate which is key buffer that combats acidosis, used w/ significant blood loss, isotonic, contraindicated when giving blood product transfusion because it can create blood clots, also contraindicated in pt’s receiving mannitol, solu medrol, nitro, nitroprusside, norepi, procainamide, and propranolol infusions
Lactated Ringers
dissolved crystals in water have ability to cross membranes and alter fluid levels.
Crystalloids
contains proteins usually too large to pass through capillary membrane, high osmolarity, causes fluid shifts
colloids
Can happen when a pt’s body overreacts to a specific trigger, such as the site of blood/needles. Venous vasculature dilates, drop in BP decreased blood flow to brain, syncopal episode. Pt may feel N/V, dizzy, pale, diaphoretic. Quickly resolved when pt is laid supine & blood flow to brain is restored.
Vasovagal reactions
Know the steps of IV insertion
Prepare equipment, choose appropriate fluids & drip set
Examine bag for clarity, expiration, turn bag upright, spike the bag, squeeze drip chamber, open roller clamp, flush tubing to remove air, close clamp
Standard precautions
touriniquet
palpate for vein, choose appropriate sized catheter
bevel up, poke, flash, advance cath, stabilze needle
occlude vein, remove needle, dispose of needle
connect IV line, open IV line, observe for signs of infiltration, secure cath & IV tubing
sudden hypotension, pallor, cool/clammy, weak/thready rapid pulse, chest/shoulder/back pain, decreased LOC, respiratory arrest
air emboli’s
range mild to severe, tape/meds, etc. rapid or gradual onset. Chills, fever, hives, itching, SOB, wheezing.
Allergic reaction
when an excessive amount of fluid volume is adm. Can lead to pulmonary edema; esp in pts with cardiac/pulm/renal dysfunction.
Circulatory overload
abrupt temp change, as high as 106, w/chills, HA, weakness, N/V.
Pyrogenic reactions
Av fistulas used in what disorder
ESRD
IV pump is useful when admissions of iv maintain infusion, why?
IV pumps are not vulnerable to variability in drip rates based on bag height, movement, and other factors.
What would happen if you failed to pinch off tubing prior to administering medication on fluid bolus
medication will take the pathway of least resistance, it will flow into the bag instead of the pt.
Contraindications for IO’s
if a peripheral vein is available. Fx of the bone intended for the IO. Osteoporosis, Osteogenesis (fragile bones), B knee replacements, prosthetic limb.
If an adult pt rq fluid replacement from shock, what would be the minimum catheter size to use.
Generally an 18g should be used
Posterior aspect of leg has edema after io infusion, what should you do
suspect infiltration, d/c infusion, and reattempt insertion on opposite leg.
OLMD gives order, does not seem appropriate, what should you do?
obtain clarification on order, if continued wrong, do not administer, its your ass on the line
Difference between disinfectant and antiseptic
Antiseptic - capable of destroying pathogens, not harmful to living tissue, used to cleanse an area before an invasive procedure.
Disinfectants - destroys pathogens, harmful to living tissue, used to cleanse equipment.
When do you use a Prehospital saline locks?
who do not need additional fluids but may need intermittent iv fluids or medications.
What situation would you most likely give a medication through a gastric tube
Toxic ingestion. Needing activated charcoal
How would you define medical asepsis
The practice of preventing contamination from pathogens, using aseptic technique. Sterilization of equipment, antiseptics, & disinfectants.
Bruising, pain, swelling around injection site
hematoma
inflammation of vein, redness, swelling, pain, may feel warm
phlebitis
decreasing flow rate, presence of blood in tubing. Do not try and flush an occlusion, could release clot into bloodstream. Remove cath, apply bandage.
Vein occlusion
inflammation/blood clot r/t IV. Slowed or stopped infusion rate, burning sensation, warm, red skin, swelling of extremity.
thrombophlebitis
Supine position, to fill jugular vein, turn the head to the side, always feel for pulse, as not to pierce the carotid artery. Tends to roll if not anchored appropriately during cannulation.
EJ canulation
First step in discontinuing iv line?
Shutting off flow from iv w/ clamp.
What the main benefit in using prefilled medication syringe?
Quick admistration of drug in emergent situations, rather than drawing up medication.
Purpose of a volutrol?
allows to fill with a specific amount of fluid and administer only that.
What questions should the paramedic ask themselves when determining most appropriate Iv solution
Will the pt need fluid replacement
An inflammation of the bone & muscle caused by an infection. Can occur as a result of IO insertion, but is rare.
Osteomyelitis
Which of the following steps is necessary when giving a drug io but not iv-
pressure infuser
S/s when an iv catheter becomes sheared and free flows in the circulatory system
S/s when an iv catheter becomes sheared and free flows in the circulatory system
Once cath in position and contents are flowing properly, what do you do?
Check for infiltration.
Neither sq or IM injections should be given to pt’s with what?
Most important- Inadequate perfusion. Secondary- skin that is hardened, bruised, red, otherwise discolored or stained.
pnemonic for blood draw tubes
Red Blood Gives Life (red, blue, green, lavender) Red - clot activators (plastic tubes) for serum based tests (CMP, BMP, Lipids)
Blue - contains citrate, an anticoagulant, used for coagulation tests, such as Prothrombin for blood clots
Green - contains heparin, used for plasma based determinations.
Lavender - contains EDTA, used for CBC’s (RBC, WBC, HIstamines, etc)
Most common cause of circulatory overload in prehospital setting
failure to readjust drip rate after flushing IV line immediately after insertion
What’s the most prominent clinical indicator for a pyrogenic reaction-
headache/ backache
Thrombophlebitis is most commonly caused by what
misuse of drugs, pts receiving long term iv therapy (hospice, ospital)
what Does the % on drugs mean?
Number of grams of drug present per 100ml
Weight/volume of concentration/100g (ex: 2%= 2g/100ml)
Shortly after establishing iv, pt reports a burning sensation along the vein, what should you do next?
Doesn’t specifically say, thrombophlebitis typically occurs after hours, but if s/s suggests that, DC the iv, and warm compresses. Other causes could be pushing a drug too fast, if so don’t do that.
what degree angle for IM med administration
90 degree
what size needles for IM administration
19-23g/ 1-2in (4-5cm)
Know about SQ route
sq route is beneath the dermis in the fatty tissue, 24g-26g, 0.5-1in (1-3cm), 45 degree angle adult, 90 degree pads, 2ml or less in adults, 0.5-1ml peds.
Upper arms, anterior thighs, ABD
What do you do to the skin when preparing to give an IM injection? What about SQ?
IM- stretch the skin
SQ- pinch the skin
Going to use IN route, what do you have to do to the dose
2-2.5 time the dose
muscle sites and muscle groups
Vastus Lateralis muscle- lateral thigh
rectus femoris- anterior thigh
glutes- ass, upper lateral side
deltoid- upper arm covers shoulder
Medication absorption through nitro patch would be increased if the pt has what?
Changes in pt temp, and pt perfusion
administering isotonic fluid to pt, you should what?
Continuously reassess pt, specifically for fluid over
Changing iv bag, important to do what
making sure the first bag never empty completely or always ensuring some fluids remain in the drip chamber.
When determining an Occluding iv line, you should do what
assess drip rate (first sign of occlusion), look for blood in tubing
Know how to withdrawal drugs from an ampule
bring medication to the base on ampule, snap the neck of ampule away from you, using a filter needle and draw drug up careful not to touch the outer sides or rim of ampule.
Which med, can require an initial BOLUS, and then require a maintenance infusion maintain therapeutic something of drug
gonna have to have the list of drugs, cause a lot can given then used for maintenance
What is s/s of dehydration-
orthostatic hypotension, ams, tachypnea, dry mucous membranes, decreased urine output, tachycardia, poor skin turgor, flushed dry skin.
Ex of colloid solutions
albumin, dextran, plasmanate, hetastarch (Hespan)
Give EX of peripheral veins
lower extremity vein.
Which of the following is a sign, or signs of iv occlusion
decreasing drip rate, presence of blood in the IV tubing, when IV is placed in positional site (AC), position of extremity.
Which medication is okay to administer via recatally
diazapam
Which route is the most commonly used admin route prehospital
parenteral route
To make push dose epi, how do you do it?
If my thinking is right cause i cant find it, take 0.1mg epi in 10cc of nacl now you have epi 1:100,000. Your thinking is right.
the way bob describes this, is that the type of solution can cause shifts in fluids. A fluid higher in sodium than the cells will cause the water to draw out of the cell. (Hypertonic). If a fluid has a lower concentration of sodium it will cause the fluid to flow inside of the cell, causing the cell to swell (hypotonic). Basically the “draw” is the osmotic pressure of the solution that causes the fluid shifts in cells.
Osmotic draw
Where does Majority of the body’s fluid live?
intracellularly
properly inserted/ manual io in adult, it should
pops” it’s the only one that actually mentions a pop
manual IO’s have a trocar(SOLID BORING NEEDLE)
