Test Tomorrow

Question 1

Intravenous dosage Normal Saline 0.9% for Adults hypovolemic shock, dehydration

Answer 1

1,000 mL IV bolus. Repeat dose and/or titrate as needed to target hemodynamic stability.

Question 2

Intravenous dosage Normal Saline 0.9% for Adults septic shock

Answer 2

20 mL/kg IV or more within the first 3 hours of resuscitation.
If further fluid therapy is required, use small repeat boluses guided by stroke volume or cardiac output.

Question 3

Intravenous dosage Normal Saline 0.9% for Adults cardiogenic shock

Answer 3

250 mL IV bolus in patients without evidence of fluid overload.
Repeat dose and/or titrate as needed to target hemodynamic
stability

Question 4

Intravenous dosage Normal Saline 0.9% for Adults diabetic ketoacidosis

Answer 4

15 to 20 mL/kg (or 1,000 to 1,500 mL) IV during the first hour of
treatment, then 250 to 500 mL/hour continuous IV infusion

Question 5

Lactated Ringers Solution Adults hypovolemic shock, dehydration

Answer 5

1,000 mL IV bolus. Repeat dose and/or titrate as needed
to target hemodynamic stability

Question 6

Lactated Ringers Solution Adults septic shock

Answer 6

• 20 mL/kg IV or more within the first 3 hours of
  resuscitation.
• If further fluid therapy is required, use small repeat
  boluses guided by stroke volume or cardiac output.

Question 7

Lactated Ringers Solution Adults cardiogenic shock

Answer 7

250 mL IV bolus in patients without evidence of fluid
overload. Repeat dose and/or titrate as needed to target
hemodynamic stability.

Question 8

Lactated Ringers Solution Adults diabetic ketoacidosis

Answer 8

15 to 20 mL/kg (or 1,000 to 1,500 mL) IV during the first
hour of treatment, then 250 to 500 mL/hour continuous IV
infusion

Question 9

Anti-Emetics (nausea control)

Zofran (Ondansetron)

Answer 9

Name — Zofran®, Zofran ODT®, Zuplenz®
Class — Antiemetic, selective 5-HT3 antagonist
**Pharmacologic Action **— Mechanism not fully characterized; selective 5-HT3 receptor antagonist; binds to 5-HT3 receptors both in periphery and in CNS, with primary effects in GI tract. Has no effect on dopamine receptors and therefore does not cause
extrapyramidal symptoms
Indications — For the management of nausea or vomiting
Dose-4 mg, may repeat in 20 minutes
Supplied-4mg/2mL
Route-IV, IM, IO
Contraindications — Hypersensitivity, coadministration with apomorphine; combination reported to cause profound hypotension and loss of consciousness

Question 10

Anti-Emetics (nausea control)

Phenergan (Promethazine)

Answer 10

Class - Anti-emetic
Mechanism of Action- Blocker of the emetic center in the brain, dopamine receptors and alpha-adrenergic receptors in the brain
Indication - Nasuea & Vomiting
Contraindications- Hypersensitivity, respiratory depressions
Red Flags/Warning- servere tissue injury can occur from perivascular extravasation, unitentional intra-arterial injection, and intranueronal or perineuronal infiltration
Dose - 12.5mg to 25 mg
Route - IV, IM, IO
Supplied- 25mg / 1mL

Question 11

Analgesics (Pain Control)

Acetaminophen (Tylenol®)

Answer 11

Class — Analgesics, antipyretic, other
Mechanism of Action—May work peripherally to block pain impulse generation; may also inhibit prostaglandin synthesis in CNS
Indications—Pain control, fever control
Contraindications—Hypersensitivity, severe acute liver disease
Route-Oral
Dose 500 mg to 1000 mg every 6 hours, not to exceed 4 grams/day

Question 12

Analgesics (Pain Control)

Fentanyl (Sublimaze)

Answer 12

Class — Synthetic opioid, opioid analgesics
**Mechanism of Action **— Narcotic agonist-analgesic of opiate receptors; inhibits ascending pain pathways, thus altering response to pain; increases pain threshold; produces analgesia, respiratory depression, and sedation
Indications— Management of acute pain
Contraindications — Hypersensitivity
Red Flags / Warnings: Should be used with caution in the elderly and in patients with hypotension, suspected gastrointestinal obstruction, head injury, and concomitant CNS depressants. Serious, life-threatening, or fatal respiratory depression may occur. Monitor for respiratory depression, especially during initiation or following a dose increase
Dose-50 mcg to 100 mcg slow IVP 1-2 mins.) IM, IO.
Supplied-100 mcg/2mL

Question 13

Analgesics (Pain Control)

Morphine Sulfate

Answer 13

Class — Opioid analgesic
**Pharmacologic Action **— Narcotic agonist-analgesic of opiate receptors; inhibits ascending pain pathways, thus altering response to pain; produces analgesia, respiratory depression, and sedation; suppresses cough by acting centrally in medulla
Indications— Management of acute pain
Contraindications — Hypersensitivity, respiratory depression, acute or severe bronchial asthma, upper airway obstruction.
Red Flags/Warnings- Serious, life-threatening, or fatal respiratory depression may occur. Monitor for respiratory depression, especially during initiation or following a dose increase
Dose- IM, IV push: Dilute 2.5-15 mg in 4-5 mL of NS,
Supplied-5 mg/10 mL

Question 14

Analgesics (Pain Control)

Ketorolac (Toradol)

Answer 14

Class — Non-steroidal anti-inflammatory drug (NSAID)
Mechanism of Action — Inhibits synthesis of prostaglandins in body tissues by inhibiting at least 2 cyclo-oxygenase (COX) isoenzymes, COX-1 and COX-2. May inhibit chemotaxis, alter lymphocyte activity, decrease proinflammatory cytokine activity, and inhibit neutrophil aggregation; these effects may contribute to anti-inflammatory activity
Indications — For the acute management of moderately severe pain
Contraindications — Allergy to aspirin, ketorolac, or other NSAIDS; women who are in active labor or are breastfeeding, significant renal impairment particularly when associated with volume depletion, previous or current GI bleeding, intracranial
bleeding, coagulation defects, patients with a high-risk of bleeding
Dose-Adults weighing 50 kg or more
* 30 mg IV or 60 mg IM.
Adults weighing less than 50 kg and Geriatric patients
* 15 mg IV or 30 mg IM.
Supplied form-30 mg / 1mL

Question 15

Emergency Pharmacology for Endocrine Emergencies

Thiamine

Answer 15

Thiamine, also known as vitamin B₁, is a vitamin, an essential micronutrient, that cannot be made in the body. Thiamine is required by our bodies to properly use
carbohydrates. It also helps maintain proper nerve function.
Indications-Alcoholism, delirium tremens Coma of unknown origin, especially if alcohol or malnourishment may be involved. Suspect Wernicke or Korsakoff Syndrome
Contraindications-Do not give intra-arterial
Adverse Reactions-Hypotension (rare)
Dose-100 mg /one minute

Question 16

Emergency Pharmacology for Endocrine Emergencies

Dextrose 50%

Answer 16

Class- Carbohydrate
Indications- 50% Dextrose Injection is indicated in the treatment of insulin hypoglycemia (hyperinsulinemia or insulin shock) to restore blood glucose levels, and
seizures resulting from hypoglycemia
Contraindications- A concentrated dextrose solution should not be used when intracranial or intraspinal hemorrhage is present, nor in the presence of delirium tremens if the patient is already dehydrated.
Dose- Intravenous injection of 10 to 25 grams of dextrose (20 to 50 mL of 50% dextrose) is usually adequate. Repeated doses and supportive treatment may be required in severe cases. A specimen for blood glucose determination should be taken before
injecting the dextrose. In such emergencies, dextrose should be administered promptly without awaiting pretreatment test results.
Adverse Reactions- Hyperosmolar syndrome, resulting from excessively rapid administration of concentrated dextrose may cause mental confusion and/or loss of consciousness.
Tissue necrosis may occur if extravasation occurs