Pharmacology Flashcards

Question

Nitroglycerine - Actions

Answer 1

* Relaxes systemic venous and arterial vessels causing vasodilation thereby * Decreasing cardiac preload and after load * Decreasing myocardial workload * Decreasing myocardial O2 comsumption * Dilates coronary arteries

Answer 2

Onset: 2 minutes SL; ~30-60 minutes topical Duration: ~30-60 minutes SL; ~24 hours topical

Answer 3

Angina or angina-equivalent discomfort Cardiac pulmonary edema

Answer 4

Systolic BP \< 100 Suspected right ventricular MI Phosphodiesterase inhibitor use with last 24 hours - ED medications such as Viagra (sildenafil), Cialis (tadalafil) or Levitra (vardenafil) taken along with Nitro can cause profound hypertension and tachycardia

Answer 5

Headache Hypotension Increased HR Vertigo Nausea

Answer 6

Nitro has a cumulative effect; repeat doses are usually necessary Nitro has a short shelf life and is light sensitive Don't shake the nitro bottle (spray or pill). Nitro in this form is not explosive; however, shaking the pill bottle will likely fracture the pills (never administer a partial pill) and shaking the spray bottle with break down the medication Be sure to inform the patient that nitro can cause headache and increases heart rate, and that this is a normal side effect. Nitro may also cause vertigo and nausea. Remind the patient not to swallow the nitro, spray or pill. Inform the patient that they may expedience a burning sensation under their tongue after administration.

Answer 7

Sublingual (SL) route If systolic BP is \>100 it is suggested that you administer 0.4mg SL q 3-5 minutes. Generally a total of 3 doses (3, 0.4mg SL) are administered as dosages beyond this recommendation tend to be less effective.

Answer 8

Oral Glucose

Answer 9

Glutose, Insta-Glucose

Answer 10

Monosaccharide, Carbohydrate

Answer 11

After absorbing from GI tract, glucose is distributed in the tissues and provides a prompt increase in circulating blood sugar. Glucose is the body's basic fuel and is required for cellular metabolism. A sudden drop in blood sure level will result in disturbance of normal metabolism, manifested clinically as decreased in mental status, diaphoreses, and tachycardia. Further decreases in blood sugar may result in coma, seizures, and cardiac arrhythmias.

Answer 12

Onset: 1-10 minutes Duration: Varies

Answer 13

Hypoglycemia (altered mental status with history of diabetes) The ability to swallow the medication

Answer 14

Unresponsive Unable to swallow

Answer 15

Altered LOC - Level of Consciousness Ascertain the patients ability to swallow an oral preparation of glucose without airway compromise. Must be swallowed, not absorbed sublingually, or buccally.

Answer 16

Nausea is the most typical side effect Can cause hyperglycemia; however this is not common with oral glucose Typically no side effects if administered properly

Answer 17

Symptomatic hypoglycemia nearly always means an altered mental status. Altered mental status often means a scene safety issue. Make sure you are aware of your environment and have the assistance you need. Check a glucometer reading before administering glucose if at all possible. It is possible and acceptable to revive a hypoglycemic patient without using an entire 45 gram tube. Base your treatment/dosage on the promptness of the patient response. If the patient refuses transport it is important to get them something supplemental to eat. Also consider who is there with the patient (family, bystanders) and suggest that someone remains with them for awhile. Commonly, there is an explanation for hypoglycemia if you look for it. Poor compliance, increased stress, decreased sleep, illness, change in insulin regiment, etc... Glucose comes in various forms. Gel is the most common form administered by EMS. Also note that it comes in liquid (Dextrose) and tablet forms as well.

Answer 18

1 tube of oral glucose PO as the dose, or a total of 15 grams. Most protocols suggest 2-3 tubes PO, or a total of 30-45 grams, for patients with intact gag reflex and who are able to manage their own airway. Can either be packaged in 15 gram tubes or 45 gram tubes. It is suggested that pediatric patients receive the same dosage as the adult patient. However, note that some protocols may vary. Some protocols suggest 5-45 grams for pediatrics.

Answer 19

Activated Charcoal

Answer 20

SuperChar, InstaChar, Actidose, LiquiChar, others...

Answer 21

Antidote, absorbent

Answer 22

Binds to certain poisons and prevents them from being absorbed into the body. Not all brands of activated charcoal are the same; some bind much more poison that others, so consult with medical direction regarding any questions about the brand that you carry.

Answer 23

Poisoning by mouth, oral poisoning

Answer 24

Ingestion of acids or alkalis. Some protocols also suggest petroleum products. Unable to swallow. Patients with oral acids, alkalis, and petroleum product poisoning.

Answer 25

Black stools Patients that have ingested poisons that cause nausea may vomit.

Answer 26

If the patient vomits, the dose should be repeated once. Reassessment strategies - be prepared for the patient to vomit or further deteriorate Activated charcoal adsorbs many but not all toxins. Some of the things that do not stick to charcoal can generally be remembered using the mnemonic PHAILS * PHAILS * Pesticides * Hydrocarbons (gasoline, kerosene, lighter fluid, etc...) Heavy metals (arsenic mercury, etc...) * Alcohols / Acids / Alkalis * Iron * Lithium * Solvents

Answer 27

Dose is based off of body weight; 1 gram per kilogram of body weight (1g/kg) Obtain orders from medical directions Container must be shaken thoroughly

Answer 28

Epinephrine

Answer 29

Adrenaline, Epi-Pen, Epi-Pen Jr.

Answer 30

Sympathomimetic

Answer 31

Bronchodilation of the bronchi Vasoconstriction of the peripheral vasculature Increased heart rate, increased contractility and increased automaticity of the heart

Answer 32

Onset: IM tends to be variable, SQ 5-10 minutes Duration: 1-4 hours (can as short as 5-10 minutes)

Answer 33

Must meet the following 3 criteria 1. Emergency medical care for the treatment of the patient exhibiting the assessment findings of an allergic reaction. 2. Medication is prescribed for this patient by a physician. 3. Medical direction authorizes use for this patient. May also be authorized for patient having an asthma attack if patient is prescribed medication by physician.

Answer 34

None if used in a life threatening situation Administration caution must be observed if patient is experiencing a possible MI

Answer 35

Increased heart rate, pallor, vertigo, chest pain, headache, nausea, vomiting, anxiousness

Answer 36

Administration increases myocardial oxygen demand; therefore, your patient with an allergic reaction (or severe asthma attack) should be on high flow oxygen not only before, but after the administration of epinephrine.

Answer 37

Obtain orders from medical direction Ensure that the epinephrine is prescribed to that patient and that the medication is not discolored. Remove safety cap from the auto-injector Place tip of auto injector against patients thigh * Lateral portion of the thigh * Midway between the waist and the knee Push the injector firmly against the thigh until the injector activates Hold the injector inlace until the medication is injected Record activity and time Dispose of injector in sharps container * Dose * Adult: one auto injector contains 0.3mg (1:1000 epi) * Pediatric: on auto injector contains 0.15 mg (1:2000 epi)