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EMTI Drugs > Pharmocology > Flashcards

Pharmocology Flashcards

0
Q

What are the indications for Acetaminophen?

A
  • Fever in pediatric patients during long transports
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1
Q

What class of drug is Acetaminophen?

A

Analgesic, Antipyretic

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2
Q

What are the contraindications for Acetaminophen?

A
  • Hypersensitivity to the drug

- Hepatic (liver) failure or impairment

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3
Q

What is the adult dose for Acetaminophen?

A

None

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4
Q

What is the ped dose for Acetaminophen?

A

10-15 mg/kg PO

Not to exceed 50 mg/kg/24hrs

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5
Q

What is Acetaminophen used for in the field?

A

Fever control in ped patients during long transports to prevent febrile seizures

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6
Q

What class of drug is Aspirin?

A

Anti-platelet

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7
Q

What are the indications for Aspirin?

A

MI patient, including suspected AMI, chest pain

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8
Q

Contraindications for Aspirin?

A

Hypersensitivity
Bleeding disorders
Asthma (Relative)

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9
Q

Adult does for a Aspirin?

A

162-324 mg PO for AMI chewed

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10
Q

Ped does for Aspirin?

A

None

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11
Q

What class of drug is Activated Charcoal?

A

Gastrointestinal Adsorbent

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12
Q

Indications for Activated Charcoal?

A

Used to treat cases of poisoning and over doses in alert patients. Long transport anticipated

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13
Q

Contraindications for Activated Charcoal?

A
  • Acids and alkali ingestion unless other drugs have been ingested
  • GI obstruction
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14
Q

Drug interactions for Activated Charcoal

A
  • Contact MCEP before giving for acetaminophen OD’s. Charcoal interferes with the function of N- Acetylcysteine, an antidote for acetaminophen
  • milk products decrease effectiveness
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15
Q

Adult and ped dose for Activated Charcoal?

A

1g/kg PO

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16
Q

What class of drug is Albuterol?

A

Sympathomimetic, Beta 2 selective adrenergic bronchodilator

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17
Q

Indications for Albuterol?

A

Used to treat reversible airway obstruction caused by:

  • Wheezing associated with asthma
  • COPD (emphysema)
  • Chronic bronchitis
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18
Q

Contraindications for Albuterol?

A

Hypersensitivity

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19
Q

Drug interaction for Albuterol

A

Beta adrenergic agents- potentiates the effects
MAO inhibitors (anti-depressant)- May lead to hypersensitive crisis, may lead to stroke
Beta adrenergic blockers- decrease the effectiveness

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20
Q

Adult dose for Albuterol

A

2.5-5 mg up to 10mg in 3 ml of NS over 5-15min NEB

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21
Q

Ped dose for Albuterol

A

1.5-2.5 mg up to 5 mg in 3 ml NS over 5-15 min NEB

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22
Q

What is the other name for Promethazine?

A

Phenergan

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23
Q

What class of drug is Phenergan?

A

Anti-emetic

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24
Q

Indications for Phenegran?

A

Treatment and prevention of nausea and vomiting

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25
Q

Contraindications for Phenergan

A
  • hypersensitivity
  • comatose patients
  • CNS depression due to drugs
  • children < 2yrs old, or critically ill or dehydrated
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26
Q

Drug interaction with Phenergan

A

1) CNS depressants- May increase, prolong or intensify the sedative action
2) Anticholinergics- use caution
3) MAO inhibitors- use caution

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27
Q

Adult dose for Phenergan

A

6.25-25 mg PO, IM, IV/IO every 4 hrs as needed

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28
Q

Peds dose for Phenergan

A

> 2yrs .25-.5 mg/kg PO, IM, every 4 hours as needed

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29
Q

Special notes for Phenergan

A
  • use cautiously in patients with hypertension, epilepsy, sleep apnea, cardiovascular disease, impairment of the liver, and pregnancy
  • May cause drowsiness
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30
Q

What is the other name for Ondansetron?

A

Zofran

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31
Q

What class of drug is Zofran?

A

Anti-emetic, selective serotonin blocking agent

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32
Q

Indications for Zofran

A

Treatment and prevention of nausea and vomiting

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33
Q

Contraindications for Zofran

A

Known sensitivity to Ondansetron or related agents

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34
Q

Drug interactions for Zofran

A

None

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35
Q

Adult dose for Zofran

A

4mg IV/IO slow IVP, IM. May repeat in 30 min

8mg Oral Dissolving Tablets (ODT)

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36
Q

Peds does for Zofran

A

0.1 mg/kg IV/IO slow IVP, IM

4mg ODT (12-17 years of age)

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37
Q

How many tablets of Zofran can you administer?

A

Only one. Do not exceed adult or ped dose

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38
Q

Special notes for Zofran?

A

Do not use in patients with known prolonged QT syndrome

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39
Q

What class of drug is Atropine Sulfate?

A

Anticholinergics (parasympatholytic)

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40
Q

Indications for Atropine Sulfate

A

1) Symptomatic sinus bradycardia or A-V blocks
2) Anticholinesterase poisoning- organophosphate, mushroom (specific type)’ and nerve gasses
3) adjunct in the treatment of bronchial asthma

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41
Q

Contraindications for Atropine sulfate

A

None

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42
Q

Drug interactions with Atropine Sulfate

A

Antihistamines, tricyclic antidepressants - additive effect

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43
Q

Adult dose for Atropine Sulfate

A

2mg IV repeated to control parasympathomimetic signs

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44
Q

Peds dose for Atropine Sulfate

A

.05 mg/kg IV, ET, or IO repeated to desired effect

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45
Q

Special notes for Atropine Stulfate

A
  • May not be effective with high degree AV block

- increases workload and myocardial O2 consumption of heart.

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46
Q

What is the brand name for Methylprednisolone?

A

Soul-Medrol

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47
Q

What class of drug is Solu-Medrol?

A

Anti-Inflammatory, immunosuppressant

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48
Q

Drug interactions for Solu-Medrol

A
  • Reactive airway disease with no response to Albuterol and other treatments
  • Allergic reaction
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49
Q

Contraindications for Solu-Medrol

A

Absolute - Hypersensitivity

Relative - Immunocompromised state, serious infection, psychotic disorders

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50
Q

Adult dose for Solu-Medrol

A

125-250 mg IV q 6 hours

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51
Q

Ped dose for Solu-Medrol

A

1-2 mg/kg IV q 6 hours

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52
Q

Special notes for Solu-Medrol

A

1) Adverse effects- hyperglycemia; psychosis

2) May be ordered by a neurosurgeon for spinal cord injury

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53
Q

What class of drug is Dextrose

A

Carbohydrate, nutrient, short acting osmotic diuretic

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54
Q

Indications for Dextrose? (4)

A

1) Symptomatic hypoglycemia
2) Unconsciousness of unknown origin
3) Seizures (associated with decreased BGL) of:
- Unknown etiology
- New onset of seizures
- Known diabetic actively seizing
4) Refractory medical cardiac arrest (especially in neonates)

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55
Q

Contraindications for Dextrose? (5)

A

1) intra-cranial bleeds
2) Delirium tremens with dehydration
3) administration through the same infusion set as blood
4) Unconscious (for oral dextrose)
5) Suspected CVA

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56
Q

Oral and adult IV dose for Dextrose

A

Oral: 12-25 g of paste

IV: 25-50g slow push if patient can’t protect own airway for oral glucose

57
Q

Peds and Neonate dose for Dextrose?

A

Ped: dilute 1:1 with sterile saline to make 25% solution (0.25mg/ml) Give (0.5-1 g/kg) slow IV push

Neonate: Use 10% Dextrose solution (dilute 50ml D50 in 500ml bag of D5W) at (0.2g/kg)

58
Q

Special notes for Dextrose

A

1) attempts at documenting hypoglycemia via automatic glucometry should be made before administration
2) Must insure patent IV line, and recheck latency during administration

59
Q

What is the brand name for Diphenhydramine HCL?

A

Benadryl

60
Q

What class of drug is Benadryl?

A

Antihistamine, H1 blocker

61
Q

Indications for Benadryl (3)

A

1) Allergic reactions
2) Anaphylaxis
3) Dystonic reaction to Phenothiazines (Phenergan)

62
Q

Contraindications for Benadryl

A

Acute Asthma

63
Q

Drug interaction for Benadryl (Diphenhydramine)

A

Additive CNS depression with alcohol, sedatives, narcotics

64
Q

Adult and Ped dose for Benadryl

A

Adult - 12.5-50 mg slow IV/IO at a rate of 1ml/min or deep IM injection

Ped - 1mg/kg slow IV/IO; deep IM injection with a max dose of 50 mg

65
Q

Special notes for Benadryl

A

1) May have an immediate effect in Dystonic reactions

2) No early benefit in allergic reactions

66
Q

What class of drug is Epinephrine?

A

Sympathomimetic

67
Q

Indications for Epi (5)

A

1) Severe Bronchospasm
2) Bronchospasms unresponsive to Albuterol
3) Anaphylaxis
4) Cardiac arrest
5) Symptomatic bradycardia after other treatments

68
Q

Drug interaction for Epi

A

Reduced effects with Beta-adrenergic blocker

69
Q

Epi 1:10,000 adult and Ped dose

A

Adult: 1mg every 3-5 min IV/IO preferred, may be given ET [2-2.5 times IV dose]

Ped: .01mg/kg

70
Q

Epi (1:1,000) adult and ped dose for Bronchospasm/Anaphylaxis

A

Adult : .3mg SQ or IM or [.1 mg(1:10,000) IV/IO over 5 min. Infusion of 1-4 mcg/min]

Ped : 0.01 mg/kg SQ or IM to max dose of .3mg/dose

71
Q

What class of drug is Glucagon

A

Hormone - hyperglycemic agent

72
Q

Indications for Glucagon

A

Documented symptomatic hypoglycemia (BGL less then 60 mg/dl) when an IV/IO can’t be started

73
Q

Contraindications for Glucagon (3)

A

1) Patients who will be unable to receive supplemental glucose orally, IV
2) Hypersensitivity to pork/beef
3) Use with caution on patients with pheochromocytoma (vascular tumor)

74
Q

Drug interactions with Glucagon

A

1) Hyperglycemic effects intensified and prolong by Epi

2) Will precipitate when mixed with calcium preparation

75
Q

Adult and Ped dose of Glucagon for Hypoglycemia

A

Adult : 0.5-1 mg IM, my repeat in 10-20 min if no response

Ped : 0.1 mg/kg IM may repeat in 10-20 min if no response

76
Q

Adult and Ped dose of Glucagon for Beta Blocker overdose

A

Adult : 3-10 mg IV/IO over 1 min. It may be followed by an infusion do 2-5 mg/hr

Ped : 0.1 mg/kg up to 1 mg over 1 min repeat in 5 min if needed

77
Q

Adult and Ped dose of Glucagon for Anaphylaxis

A

Adult : 1-2 mg slow IV/IO, May be repeated every 5-10 min

Ped : 0.1 mg/kg up to 1 mg IV/IO may be repeated every 5-10 min

[1ml of NS for each 1mg of powder and shake well]

78
Q

Special note for Glucagon

A
  • Glucagon will release all of the patients available Glycogen. If the patient is not provided with glucose, the subsequent hypoglycemia will be greater than before glucagon.
79
Q

What class of drug is Hydroxocobalamin

A

Antidote

80
Q

Indications for Hydroxocobalamin

A

Treatment for cyanide poisoning

81
Q

Contraindications for Hydroxocobalamin

A

Rare anaphylactic reactions

82
Q

Drug interactions with Hydroxocobalamin

A

Used in combination with sodium thiosulfates to treat methemoglobinemia. No more effective then sodium nitrite

83
Q

Adult and ped dose for Hydroxocobalamin

A

Adult : 5 grams IV/IO over 30 min

Ped : (<70kg): 70 mg/kg IV/IO

84
Q

Special notes for Hydroxocobalamin

A

1) transient hypertension

2) reddish discoloration of skin and mucous membranes

85
Q

What is the brand name for Ipratroprium

A

Atrovent

86
Q

What class of drug is Ipratroprium

A

Anticholinergic

87
Q

Indications for Ipratroprium

A

1) Bronchial asthma

2) Reversible bronchospasm associated with chronic bronchitis and emphysema

88
Q

Contraindications for Ipratroprium

A

1) hypersensitivity to the drug, especially with Atropine products, soy and peanuts
2) acute treatment of bronchospasm where rapid response is required

89
Q

Drug interactions with Ipratroprium

A

Oxivent and Spiriva

90
Q

Dose for Ipratroprium

A

1-2 inhalation via metered dose inhaler
[250-500 mcg (.25-.5 mg)] via NEB

  • use caution when administering it to elderly patients and those with cardiovascular disease or hypertension
91
Q

What class of drug is Lidocaine Hydrochloride (Xylocaine)

A

Antidysrhythmic, local anesthetic

92
Q

Indications for Lidocaine

A

1) Symptomatic ventricular dysrhythmias
2) Sustained ventricular tachycardia
3) Ventricular fibrillation/pulseless ventricular tachycardia
4) Local anesthetic for nasal intubation

93
Q

Contraindications of Lidocaine

A

1) hypersensitivity

2) high AV Blocks

94
Q

Drug interactions with Lidocaine

A

Additive cardiac depression with phenytoin, quinidine, procainamide, and propranolol

95
Q

IV/IO Bolus technique for Lidocaine for adults and Peds

A

2%

96
Q

IV Drip technique for Lidocaine adult

A

Adult : mix 1g of lidocaine in 250 ml D5W or NS for a con. of 4mg/kg
A.) if up to 2mg/kg has been admin., set drip to 2mg/min
B.) if 2mg/kg has been admin., set drip to 3mg/min
C.) if 3 mg/kg has been admin., set drip to 4mg/min
* a second Bolus after 10 min may be given per physicians order

97
Q

IV Drip technique for Lidocaine for Peds

A

Mix 120 mg of lidocaine in 100 ml D5W
A.) set drip at 20-50 uh/kg per min. (1-2.5 cc/kg/hr at above dilution)

ET 2-2.5 times the Bolus dose

98
Q

Special note for lidocaine

A

For patients over 70 years of age, or with hepatic or renal failure, the loading dose remains the same, but maintenance infusion is run at half the normal rate

99
Q

What class of drug is Narcan

A

Narcotic antagonist

100
Q

Indications for Narcan

A
  • Reversal of narcotic effects

- For unconsciousness of unknown etiology to rule out or reverse narcotic depression of CNS

101
Q

Contraindications for Narcan

A
  • Hypersensitivity

- Absence of indications

102
Q

Adult, ped, and neonate, dose for Narcan

A

Adult : 0.4-2mg IV/IO, IM, SQ, ET may be repeated at 2-3 minutes

Ped : 0.1 mg/kg < 5 yrs or _< 20 kg (2mg) > 5yrs or > 20kg IV, ET,IM, SQ, IO, May be repeated at 0.1 mg/kg

Neonate : 0.1 mg/kg slow IV, ET, IM, SQ, IO
(Mix 1ml of Narcan, 0.4 mg in 9 ml of D5W, which gives 0.04 mg/ml)

103
Q

What class of drug is Hydromorphone (Dilaudid)

A

Opiate analgesic

104
Q

Indications for Dilaudid

A

1) Analgesia for patients with moderate to severe pain

105
Q

Contraindications for Dilaudid (5)

A

1) hypersensitivity
2) hypotension is relative. Pain may cause patient to be hypotensive
3) Head or abdominal injuries, since the analgesic effect removes the clinical signs that need to be watched
4) Respiratory difficulty

106
Q

Drug interactions with Dilaudid (2)

A

1) additive effects with other CNS depressants

2) MAO inhibitors can cause sever reactions, reduce does to 25% normal dose

107
Q

Adult and Ped dose for Dilaudid

A

Adult : 0.5-1.0 mg slow IV/IO push until desired effect

Ped : None

108
Q

Special notes for Dilaudid (4)

A

1) Take vital signs before and 2 min after administration
2) IV/IO only
3) Often causes vomiting; administer SLOWLY
4) On-line medical control should be contacted before administering to the non-cardiac patient

109
Q

What class of drug is Fentanyl (Sublimaze)

A

Opiate Analgesic

110
Q

Indications for Fentanyl

A

Analgesia for patients with moderate to sever pain
Isolated extremity fractures
AMI

111
Q

Contraindications for Fentanyl (4)

A

1) Hypersensitivity/ known intolerance
2) Patients particularly sensitive to respiratory
3) Myasthenia gravis (generalized muscle weakness)
4) Pregnancy
- abdominal pain
- increased ICP

112
Q

Adult and Ped dose for Fentanyl

A

Adult : 25-50 mcg IV/IO

Ped : 2-12yrs of age - [0.5 - 1 mcg/kg] IV/IO

113
Q

Special notes for Fentanyl

A

1) Use cautiously in geriatric or debilitated patient (use lower doses), diabetics, patients with pulmonary or hepatic disease, head trauma, increased ICP, undiagnosed abdominal pain and cardiac disease.
2) Abdominal distension, muscle rigidity, and/or urinary retention may be seen at high doses

114
Q

What class of drug is Morphine Sulfate

A

Opiate analgesic

115
Q

Indications for Morphine

A
  • isolated extremity trauma
  • cardiac chest pain (preferred drug)
  • burns
116
Q

Contraindications for Morphine (5)

A

1) Hypersensitivity
2) Hypotension is a relative contraindications to use. Remember that some people will be hypotensive in response to pain itself.
3) Head or abdominal injuries also contraindicated
4) Do not use in persons with respiratory difficulties because their respiratory drive might be depressed, expect in pulmonary edema
5) Do not use with presence of major blood loss

117
Q

Adult and Ped dose for Morphine

A

Adult : 2-10 mg SLOW IV/IO push until desired effect achieved

Ped : 0.1 mg/kg slow IV/IO titrated to effect

118
Q

Special notes for Morphine (4)

A

1) Take vitals before and 2 mins after administration
2) IV/IO only (unless ordered IM by physician)
3) Often causes vomiting; administer slowly
4) On-line medical control should be contracted before administering to the non-cardiac patient

119
Q

What class of drug is Nitroglycerin

A

Anti-anginal agent/vascular dilating agent

120
Q

Indications for Nitroglycerin

A

1) Chest pain, anginal pain

2) CHF with severe pulmonary edema

121
Q

Contraindications for Nitro (6)

A

1) Hypersensitivity
2) Severe hypotension
3) Pericardial tamponade
4) Increased intra-cranial pressure
5) Hypovolemia/ severe anemia
6) Can cause a lethal drop in BP when patients are taking Viagra within 48 hours of ingestion

122
Q

Adult and Ped dose for Nitro

  • SL
  • Spray
A

Adult:
SL- 0.3-0.4 mg tablet. Repeat at 3-5 mins to total of 3 tabs

Spray- 0.4 mg (one spray) metered dose, under tongue. Repeat at 3-5 mins to total of 3 spray

Ped: Not recommend for pre-hospital

123
Q

Special notes for Nitro (7)

A

1) Side effects : throbbing headache, flushed, dizziness, and burning under the tongue
2) marked hypotension, particularly orthostatic (sitting upright)
3) use your nitro not patients
4) Use caution with patient not previously receiving nitro
5) Generalized vasodilation may cause profound hypotension and reflex tachycardia
6) tabs loose potency easily, nitro spray doesn’t have this problem
7) Use only with medical control on patients with systolic BP below 100 mm Hg

124
Q

What class of drug is Oxygen

A

Class III gas, Oxidizer

125
Q

What class of drug is Potassium

A

Electrolyte

126
Q

Indications for Potassium

A

1) Renal (Kidney) Failure

2) IV preparations are used for treatment or prophylaxis of hypokalemia (potassium deficiency in the blood)

127
Q

What is the requirement for potassium

A

Not to exceed 20 mEq/1000cc or more than 10 mEq/hr.

128
Q

Contraindications for potassium (4)

A

1) Severe renal impairment
2) Hyperkalemia (high level of potassium)
3) Untreated Addison’s disease (low BP)
4) Severe tissue trauma

129
Q

Adult and Ped dose for potassium

A

Adult : 10-20 mEq/hr IV/IO dependent on patient presentation.

Ped : 2 - 3 mEq/kg/day IV

130
Q

Special notes for Potassium

A

Cardiac Monitoring required

131
Q

What class is Paralidoxime (2pam)

A

Cholinesterase re-activator (choline-reactivating oximes are effective antidotes in organophosphorus insecticide poisoning,

132
Q

Indications for Pralidoxime (2pam)

A
  • Organophosphate pesticide or nerve agent poisoning AFTER ATROPINE HAS BEEN ADMINISTERED
  • Unknown cholinesterase inhibitor poisoning
133
Q

Contraindications for Pralidoxime (2pam)

A

1) Relative
- Myasthenia gravis (serious muscle weakness)
- Renal Failure
2) Absolute
- Inability to perform endotracheal intubation, if neuromuscular blockade were to occur

134
Q

Adult and Ped dose for Pralidoxime (2pam)

A

[600 mg] IM by auto injector “Mark 1” antidote kit. May be repeated in 3-5 min after first dose. If weakness has not been resolved

135
Q

What class of drug is Nitrous Oxide

A

Inhalation Anesthetic, Gas

136
Q

Mechanism of action for Nitrous Oxide

A
  • Provides a sedative effect which decreases the patient’s perception of pain. May partially act on opiate receptors systems to cause mild analgesia
  • Diffuses through tissue more easily than oxygen or CO2
137
Q

Indications for Nitrous Oxide

A

Pain management of the following: fractures, burns, kidney stones, musculoskeletal trauma, abdominal pain, back pain, acute urinary retention, chest pain, secondary to angina or infraction after full initiation of ACS protocol

138
Q

Contraindications for Nitrous Oxide (12)

A

1) Altered LOC
2) Head injuries
3) Chest injuries
4) Intoxication or drug ingestion
5) Maxillofacial injuries
6) Psychiatric problems
7) COPD
8) <12 yrs of age or less than 75 lbs
9) OB patient not in active labor
10) Respiratory distress
11) Bowel obstruction or traumatic abdominal injury
12) Inner ear pain

139
Q

Side effects of Nitrous Oxide

A
  • Dizziness
  • Apnea
  • Cyanosis
  • Nausea/vomiting
  • Hypotension

EMTI Drugs (2 decks)

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