Pharmacology

Question 1

Track marks are usually a sign of what

Answer 1

Sclerosis, hardening of body tissue, caused by frequent cannulation, commonly from drug misuse

Question 2

What is Osmolarity

Answer 2

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.

Question 3

Lower concentration of sodium than the cell, water flows into cell, cell swells, may burst from increase intracellular osmotic pressure

Answer 3

Hypotonic solutions

Question 4

same concentration of sodium as the cell, water does not shift, no changes in cell shape

Answer 4

isotonic solutions

Question 5

greater concentration of sodium, water drawn out of cell, cell may collapse from increased extracellular osmotic pressure

Answer 5

hypertonic solutions

Question 6

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

Answer 6

Lactated Ringers

Question 7

dissolved crystals in water have ability to cross membranes and alter fluid levels.

Answer 7

Crystalloids

Question 8

contains proteins usually too large to pass through capillary membrane, high osmolarity, causes fluid shifts

Answer 8

colloids

Question 9

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.

Answer 9

Vasovagal reactions

Question 10

Know the steps of IV insertion

Answer 10

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

Question 11

sudden hypotension, pallor, cool/clammy, weak/thready rapid pulse, chest/shoulder/back pain, decreased LOC, respiratory arrest

Answer 11

air emboli’s

Question 12

range mild to severe, tape/meds, etc. rapid or gradual onset. Chills, fever, hives, itching, SOB, wheezing.

Answer 12

Allergic reaction

Question 13

when an excessive amount of fluid volume is adm. Can lead to pulmonary edema; esp in pts with cardiac/pulm/renal dysfunction.

Answer 13

Circulatory overload

Question 14

abrupt temp change, as high as 106, w/chills, HA, weakness, N/V.

Answer 14

Pyrogenic reactions

Question 15

Av fistulas used in what disorder

Answer 15

ESRD

Question 16

IV pump is useful when admissions of iv maintain infusion, why?

Answer 16

IV pumps are not vulnerable to variability in drip rates based on bag height, movement, and other factors.

Question 17

What would happen if you failed to pinch off tubing prior to administering medication on fluid bolus

Answer 17

medication will take the pathway of least resistance, it will flow into the bag instead of the pt.

Question 18

Contraindications for IO’s

Answer 18

if a peripheral vein is available. Fx of the bone intended for the IO. Osteoporosis, Osteogenesis (fragile bones), B knee replacements, prosthetic limb.

Question 19

If an adult pt rq fluid replacement from shock, what would be the minimum catheter size to use.

Answer 19

Generally an 18g should be used

Question 20

Posterior aspect of leg has edema after io infusion, what should you do

Answer 20

suspect infiltration, d/c infusion, and reattempt insertion on opposite leg.

Question 21

OLMD gives order, does not seem appropriate, what should you do?

Answer 21

obtain clarification on order, if continued wrong, do not administer, its your ass on the line

Question 22

Difference between disinfectant and antiseptic

Answer 22

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.

Question 23

When do you use a Prehospital saline locks?

Answer 23

who do not need additional fluids but may need intermittent iv fluids or medications.

Question 24

What situation would you most likely give a medication through a gastric tube

Answer 24

Toxic ingestion. Needing activated charcoal

Question 25

How would you define medical asepsis

Answer 25

The practice of preventing contamination from pathogens, using aseptic technique. Sterilization of equipment, antiseptics, & disinfectants.

Question 26

Bruising, pain, swelling around injection site

Answer 26

hematoma

Question 27

inflammation of vein, redness, swelling, pain, may feel warm

Answer 27

phlebitis

Question 28

decreasing flow rate, presence of blood in tubing. Do not try and flush an occlusion, could release clot into bloodstream. Remove cath, apply bandage.

Answer 28

Vein occlusion

Question 29

inflammation/blood clot r/t IV. Slowed or stopped infusion rate, burning sensation, warm, red skin, swelling of extremity.

Answer 29

thrombophlebitis

Question 30

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.

Answer 30

EJ canulation

Question 31

First step in discontinuing iv line?

Answer 31

Shutting off flow from iv w/ clamp.

Question 32

What the main benefit in using prefilled medication syringe?

Answer 32

Quick admistration of drug in emergent situations, rather than drawing up medication.

Question 33

Purpose of a volutrol?

Answer 33

allows to fill with a specific amount of fluid and administer only that.

Question 34

What questions should the paramedic ask themselves when determining most appropriate Iv solution

Answer 34

Will the pt need fluid replacement

Question 35

An inflammation of the bone & muscle caused by an infection. Can occur as a result of IO insertion, but is rare.

Answer 35

Osteomyelitis

Question 36

Which of the following steps is necessary when giving a drug io but not iv-

Answer 36

pressure infuser

Question 37

S/s when an iv catheter becomes sheared and free flows in the circulatory system

Answer 37

S/s when an iv catheter becomes sheared and free flows in the circulatory system

Question 38

Once cath in position and contents are flowing properly, what do you do?

Answer 38

Check for infiltration.

Question 39

Neither sq or IM injections should be given to pt’s with what?

Answer 39

Most important- Inadequate perfusion. Secondary- skin that is hardened, bruised, red, otherwise discolored or stained.

Question 40

pnemonic for blood draw tubes

Answer 40

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)

Question 41

Most common cause of circulatory overload in prehospital setting

Answer 41

failure to readjust drip rate after flushing IV line immediately after insertion

Question 42

What’s the most prominent clinical indicator for a pyrogenic reaction-

Answer 42

headache/ backache

Question 43

Thrombophlebitis is most commonly caused by what

Answer 43

misuse of drugs, pts receiving long term iv therapy (hospice, ospital)

Question 44

what Does the % on drugs mean?

Answer 44

Number of grams of drug present per 100ml Weight/volume of concentration/100g (ex: 2%= 2g/100ml)

Question 45

Shortly after establishing iv, pt reports a burning sensation along the vein, what should you do next?

Answer 45

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.

Question 46

what degree angle for IM med administration

Answer 46

90 degree

Question 47

what size needles for IM administration

Answer 47

19-23g/ 1-2in (4-5cm)

Question 48

Know about SQ route

Answer 48

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

Question 49

What do you do to the skin when preparing to give an IM injection? What about SQ?

Answer 49

IM- stretch the skin SQ- pinch the skin

Question 50

Going to use IN route, what do you have to do to the dose

Answer 50

2-2.5 time the dose

Question 51

muscle sites and muscle groups

Answer 51

Vastus Lateralis muscle- lateral thigh rectus femoris- anterior thigh glutes- ass, upper lateral side deltoid- upper arm covers shoulder

Question 52

Medication absorption through nitro patch would be increased if the pt has what?

Answer 52

Changes in pt temp, and pt perfusion

Question 53

administering isotonic fluid to pt, you should what?

Answer 53

Continuously reassess pt, specifically for fluid over

Question 54

Changing iv bag, important to do what

Answer 54

making sure the first bag never empty completely or always ensuring some fluids remain in the drip chamber.

Question 55

When determining an Occluding iv line, you should do what

Answer 55

assess drip rate (first sign of occlusion), look for blood in tubing

Question 56

Know how to withdrawal drugs from an ampule

Answer 56

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.

Question 57

Which med, can require an initial BOLUS, and then require a maintenance infusion maintain therapeutic something of drug

Answer 57

gonna have to have the list of drugs, cause a lot can given then used for maintenance

Question 58

What is s/s of dehydration-

Answer 58

orthostatic hypotension, ams, tachypnea, dry mucous membranes, decreased urine output, tachycardia, poor skin turgor, flushed dry skin.

Question 59

Ex of colloid solutions

Answer 59

albumin, dextran, plasmanate, hetastarch (Hespan)

Question 60

Give EX of peripheral veins

Answer 60

lower extremity vein.

Question 61

Which of the following is a sign, or signs of iv occlusion

Answer 61

decreasing drip rate, presence of blood in the IV tubing, when IV is placed in positional site (AC), position of extremity.

Question 62

Which medication is okay to administer via recatally

Answer 62

diazapam

Question 63

Which route is the most commonly used admin route prehospital

Answer 63

parenteral route

Question 64

To make push dose epi, how do you do it?

Answer 64

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.

Question 65

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.

Answer 65

Osmotic draw

Question 66

Where does Majority of the body’s fluid live?

Answer 66

intracellularly

Question 67

properly inserted/ manual io in adult, it should

Answer 67

pops” it’s the only one that actually mentions a pop manual IO’s have a trocar(SOLID BORING NEEDLE)