Pharmacology and fluid therapy PART 1

Question 1

The word pharmacology comes from the Greek words

Answer 1

Pharmakon meaning drug or poisonlogos meaning word or discourse

Question 2

The goal of emergency pharmacology in the prehospital setting is

Answer 2

to use medication’s to reverse, prevent or control various diseases and illnesses, chronic and acute

Question 3

Ancient Health Care

Answer 3

Ancient Egyptian healthcare was heavily influenced by spiritual beliefs however it incorporated Basic first aid and chemical compounds to treat certain ailments

Question 4

The Pre-Renaissance and Post- Renaissance Periods

Answer 4

Doctors had no concept of viruses or bacteria it was believed that sickness represents punishment for one sins Attempts to treat ailments centered on approaches intended to counteract the presenting symptoms Presenting symptoms were categorized based on their moisture and temperature blood was hot and wet, phlegm was cold and wet, black bile was cold and dry, and yellow bile was hot and dry

Question 5

Modern Health Care

Answer 5

The modern pharmaceutical industry began in the 19 century with the discovery of highly active medicinal compounds that could be manufactured on a large scale Although not every condition has a cure virtually all diseases can be treated to some degree with medications

Question 6

Pharmacology is defined as

Answer 6

the study of drugs and their effects on the body

Question 7

Common Pharmacology Abbreviations -IV-IM-SQ-ET

Answer 7

IV (intravenous) IM (intramuscular) SQ or SC (subcutaneously) ET (endotracheal)

Question 8

Common Pharmacology Abbreviations -IO-PO-PRN-NEB

Answer 8

IO (intraosseous) PO (per os or by mouth) PRN (pro re nata or as needed) NEB (nebulized)

Question 9

Common Pharmacology Abbreviations -o.d -b.i.d-t.i.d-q.i.d 

Answer 9

o.d (once a day) b.i.d (twice a day) t.i.d (three times a day) q.i.d (four times a day)

Question 10

Common Pharmacology Abbreviations -q-IN-p.r.

Answer 10

q (every) IN (Intra Nasal) p.r. (Per Rectum)

Question 11

Pharmaceutical preparations

Answer 11

are preparations that make a drug suited to certain method(s) of administration.

Question 12

characteristics or properties that dictate in what form drugs will be manufactured

Answer 12

Some drugs deteriorate when dissolved in solution and are, therefore, manufactured in powder form and dissolved just prior to administration. —This is usually the case with injectable antibiotics. Some drugs are destroyed when taken by mouth. —For example, insulin can only be injected and is manufactured in a sterile liquid form that can be injected.

Question 13

Today, drug companies try to prepare drugs in forms that:

Answer 13

Can be easily administered. Contain the exact dose that a physician prescribes.

Question 14

Extract

Answer 14

Concentrated preparation of a drug made by putting the drug into a solution and evaporating the excess solvent

Question 15

Powder

Answer 15

A drug that has been ground into a pulverized form

Question 16

Capsule

Answer 16

 A gelatin container that encloses a dose of medication

Question 17

Pulvule

Answer 17

 Similar to a capsule except that it is not made of gelatin

Question 18

Tablet

Answer 18

 A powdered drug that has been pressed into a small disk

Question 19

Suppository

Answer 19

A drug in a firm base that is designed to melt at body temperature

Question 20

Ointment

Answer 20

 A semisolid preparation that is designed for external application

Question 21

Patch

Answer 21

Contains medication on the surface of an adhesive patch

Question 22

Solution

Answer 22

 A liquid containing one or more chemicals dissolved in water

Question 23

Suspension

Answer 23

Supplied as a powder and requiring the addition of water

Question 24

Fluid extract

Answer 24

Concentrated form of the drug prepared by dissolving the drug in the fluid

Question 25

Tincture

Answer 25

Dilute alcoholic extract of a drug

Question 26

Spirits

Answer 26

Preparation of a volatile substance dissolved in alcohol

Question 27

Elixir

Answer 27

Solution with alcohol and flavoring added

Question 28

Milk

Answer 28

Aqueous suspension of an insoluble drug

Question 29

Emulsion

Answer 29

One liquid (usually oil) distributed in small globules in another liquid (usually water)

Question 30

Liniments

Answer 30

A lotion that is designed for external use

Question 31

Vapour

Answer 31

Liquid form that when placed in a device that allows vaporization, allows the patient to inhale the medication

Question 32

drug use: -define-examples Prevention

Answer 32

A drug used to prevent the occurrence of a disease. Heptavax B® Tetanus toxoid

Question 33

drug use: -define-examplesDiagnosis

Answer 33

A drug used to determine the nature of an illness or disease. Radiopaque dyes  

Question 34

drug use: -define-examplesTreatment

Answer 34

A drug used in the management of a disease or disorder. Lidocaine Atropine

Question 35

drug use: -define-examplesCure

Answer 35

A drug used to eliminate the disease process. Ampicillin Cloxacillin

Question 36

drug use: -define-examplesContraception

Answer 36

A drug used to prevent pregnancy. Ortho® 7/7/7 28 days Norinyl® 1/50

Question 37

drug use: -define-examplesHealth Maintenance

Answer 37

A drug taken to maintain homeostasis and supplement deficient body chemistry. Vitamins B12 Vitamin C Humulin N Novolin® ge Toronto

Question 38

Sources of Medications

Answer 38

plantanimalmineralsynthetic

Question 39

plant meds

Answer 39

can come from a root, leaf, flower or seed of a plant Morphine is generally accepted to be the first active ingredient isolated from a plant for pharmacological purposes; it was first isolated from the opium poppy in the early 1800s Digitalis  for heart failure is prepared from the dried leaves of a flower called Purple Foxglove (Digitalis purpurea)

Question 40

animal meds

Answer 40

Common medications that are derived from animal source are select types of insulin and a thyroid medication called Armour® Both of these medications are derived from pigs (porcine). —-Insulin is derived from the pig’s pancreas — Armour® from the pig’s thyroid.

Question 41

mineral meds

Answer 41

Minerals can be used to treat many medical problems Common minerals that are used as part of a treatment for patients are calcium, potassium, iron, and magnesium

Question 42

synthetic meds

Answer 42

derived from a synthetic source are created in a laboratory may provide an alternative source to those found in nature or be an entirely new medication A common medication that is derived from a synthetic source is Demerol

Question 43

Health Canada’s Therapeutic Products Directorate (TPD)

Answer 43

ensures the safe and efficacious medication’s are available in Canada aims to balance potential health benefits with risk to patient safety post by drugs

Question 44

Compendium of Pharmaceuticals and Specialties (CPS)

Answer 44

complies data on most medication’s available in Canada uses; includes info on indications, dosages, contraindications and adverse reactions

Question 45

Hospital formulary

Answer 45

a list of medication’s, dosage forms, package sizes and medication strength stocked by particular hospitals and it’s pharmacies

Question 46

Drug inserts

Answer 46

printed document included in the packaging provided by medication to manufacture often referred to as product monograph

Question 47

American Hospital Formulary Service Drug Info

Answer 47

provides another source of useful in miscellaneous drug info for pharmacist and medical practitioners includes generic and trade names

Question 48

Epocrates, Lexi-Comp, Micromedex

Answer 48

reliable and popular resources online easy to use great source of drug info

Question 49

Every medication is assigned 4 names

Answer 49

Chemical name Trade name Generic name Official Name

Question 50

define medication

Answer 50

is a drug that has been approved by the government agency that regulates pharmaceuticals

Question 51

Health Products and Food Branch (HPFB)

Answer 51

is the Canadian agency that regulate pharmaceuticals The Food and Drugs Act is the applicable legislation that ensures public safety with regard to medication

Question 52

A drug as defined by health Canada

Answer 52

is any substance or mixture of substances manufactured, sold or represented for use in: The diagnosis, treatment, mitigation, or prevention of a disease, disorder, or abnormal physical state or its symptoms in human beings are animals Restoring, corrected or modifying organic functions in human beings or animals Disinfection in premises in which food is manufactured, prepared or kept

Question 53

Pharmaceutical companies protect their investments by obtaining patents on their new drugs

Answer 53

A patent gives its holder exclusive rights to produce and sell the drug until the patent expires After it loses its patent the medication may then be available as generic drug (nonpatented) from multiple sources

Question 54

The chemical name

Answer 54

describes the drugs chemical makeup, it’s composition and molecular structure

Question 55

The generic name

Answer 55

is a general name for a drug and is usually created by the company that first manufactures the chemical

Question 56

International Nonproprietary Name Program

Answer 56

1950s the world health organization initiated to standardize generic names

Question 57

The trade name or brand name

Answer 57

is the unique name under which the original manufacture registers the new drug with the HPFB

Question 58

Drug legislation

Answer 58

responsible for ensuring that standards are maintained

Question 59

Every health worker must have a working knowledge of the legal implications associated with giving drugs so that he/she will be able to

Answer 59

Interpret drug data Evaluate therapeutic (desired) response Recognize his/her responsibilities when administering narcotics and controlled drugs Remain within the necessary restrictions imposed by the laws Recognize their responsibilities when involved with clinical tests of experimental drugs

Question 60

Canadian Regulation of Pharmaceuticals

Answer 60

They prohibit manufactures from making false claims about their medication benefits or advising patients to administer the medication’s incorrectly They seek to protect patients from medication’s that might cause harm and require drug manufacturers to publish information about side effects unknown potential harmful effects of their products Outline standards for drug manufacturers to ensure the medication is produced by different manufacturers are of uniform strength and purity

Question 61

Manufacturing Related Regulations

Answer 61

Guarantee standardization of doses Standardization assures patients that when they take a medication with a stated amount of the active ingredient they will receive that amount of the medication The amount of active ingredient must be within 95% to 105% of that stated on the label AssayBioassay

Question 62

AssayBioassay

Answer 62

Assay: an Analysis of the drug itself to evaluate its potency Bioassay: it’s a procedure for determining the concentration, purity and/or biological activity of a substance by measuring its effect on an organism, tissue, cell or enzyme

Question 63

The HPFB

Answer 63

is Canada’s federal authority responsible for regulation of health products and food through enforcement of the food and drug act

Question 64

Within HPFP there are three directorates:

Answer 64

The Therapeutic Products Directorate reviews the safety and efficacy of pharmaceuticals and medical devices and authorizes their use in Canada The National Health Products Directorate regulates natural health products such as vitamins or herbal supplements The Biologics and Genetic Therapies Directorate regulates biological and radiopharmaceutical drugs

Question 65

The Office of Controlled Substances

Answer 65

ensures that controlled substances and drugs are not diverted for illegal use it developed legislation, regulations, policies and operations to support the control of illicit drug use

Question 66

The Pharmaceutical Advertising Advisory Board and Advertising Standards Canada

Answer 66

independently review pharmaceutical advertisements to determine compliance with the Food and Drug Act

Question 67

The Marketed Health Products Directorate is responsible for post marketing surveillance of adverse events secondary to market and drugs

Answer 67

In the event that a product quality or safety comes into question it can work with other health Canada directorates to remove the product from the market or provide safety information

Question 68

The Drug Approval Process

Answer 68

the average time for a drug to be developed, tested and approved is approximately nine years All new drugs must go through animal studies and clinical trials in humans before they are approved for distribution

Question 69

Clinical trials proceed in four phases

Answer 69

Phase 1: the new drug is tested in healthy volunteers to compare human data with those in animals to determine safe doses of drug and to assess its safety Phase 2: these trials are performed in homogeneous population of patients one group receives the drug in the other group receives the placebo Phase 3: in these clinical trials the drug is made available to a large group of patients Phase 4: after successful completion of phase 3 the drug company can submit a New Drug Submission to the HPFB for approval to market the drug

Question 70

The Canadian Health Protection Branch of the Department of National Health and Welfare

Answer 70

is responsible for administration and enforcement of federal legislation for the Food and Drugs Act and the Controlled Drugs and Substances Act

Question 71

Canadian Drug Legislation

Answer 71

the Food and Drugs Act and the Controlled Drugs and Substances Act together with provincial acts and regulations that govern the sale of poisons and drugs and those that govern the health professions, are designed to protect the Canadian consumer from health hazards, deceptive advertising of drugs, cosmetics, and devices, and adulteration of food and drugs

Question 72

The Canadian Food and Drugs Act

Answer 72

First passed in 1920 and most recently revised in 1985 Aims to protect the public from mislabeled, poisonous or otherwise harmful foods and medications  divide drugs into various categories.

Question 73

There are three major classifications of drugs under the Food and Drugs Act:

Answer 73

Non-prescription drugs Prescription drugs, and Restricted drugs.

Question 74

The Canadian Controlled Drugs and Substances Act 

Answer 74

governs the possession, sale, manufacture, production, and distribution of narcotics in Canada Only authorized persons can be in possession of a narcotic and must keep a record of the name and quantity of all narcotics dispensed and they must ensure the safekeeping of narcotics

Question 75

The  Controlled Drugs and Substances Act  organizes drugs into eight schedules, depending on

Answer 75

their dependence and abuse potential and their usefulness in medical therapy:

Question 76

The  Controlled Drugs and Substances Act: Schedule i

Answer 76

Includes narcotics such as opium, heroin, morphine, and cocaine

Question 77

The  Controlled Drugs and Substances Act: Schedule ii

Answer 77

Includes cannabis and cannabis resin

Question 78

The  Controlled Drugs and Substances Act: Schedule iii

Answer 78

Includes stimulants and hallucinogens

Question 79

The  Controlled Drugs and Substances Act: Schedule iv

Answer 79

Includes anabolic steroids, barbiturates, and benzodiazepines

Question 80

The  Controlled Drugs and Substances Act: Schedule v

Answer 80

Includes phenylpropanolamine

Question 81

The  Controlled Drugs and Substances Act: Schedule vi

Answer 81

Includes precursors that can be converted or used to produce “designer drugs” or other controlled substances

Question 82

The  Controlled Drugs and Substances Act: Schedule vii

Answer 82

Defines limits associated with application of cannabis — related penalties, cannabis (3 kg), and cannabis resin (3 kg)

Question 83

The  Controlled Drugs and Substances Act: Schedule viii

Answer 83

Defines limits associated with application of cannabis — related penalties, cannabis (30 kg), and cannabis resin (1 g)

Question 84

MedSask

Answer 84

provides health care professionals and consumers with objective, concise and unbiased information on drug therapy

Question 85

Canada Vigilance Regional Office (Saskatchewan)

Answer 85

Report adverse drug reactions to the Canadian Vigilance Program

Question 86

RxFiles Academic Detailing Program

Answer 86

The RxFiles provides objective comparative drug information to promote optimal drug therapy

Question 87

The Saskatchewan Formulary

Answer 87

is a list of the drugs of proven high quality that have been approved for coverage under the Drug Plan

Question 88

Pharmacokinetics

Answer 88

what the body does to the drug

Question 89

ADME

Answer 89

determine how and how much of a drug arrives at its target body tissues and how long it exerts its therapeutic effect(A) Absorption (D) Distribution (M) Metabolism (E) Excretion

Question 90

Absorption

Answer 90

refers to the transfer of medication from its site of administration into the body to specific target organs and tissuesThe  rate of absorption  determines the  onset  of action The extent of absorption  determines the  intensity  of action

Question 91

factors affecting the absorption of a medication including

Answer 91

Solubility of the drug Concentration of the drug pH of the body Site of absorption Absorbing surface area Blood supply to absorption site Medication’s bioavailability (the amount of medication that is still active once it reaches it’s target tissue)

Question 92

Distribution

Answer 92

As a drug passes through the body, its form and its concentration in the tissues influences the effect it will have Plasma protein binding is an important mechanism of distribution

Question 93

bound drugfree drug

Answer 93

bound drug: Plasma protein binding is an important mechanism of distribution.Drugs are bound in variable degrees to proteins or become stored in fatty tissues free drug: Only those drug particles that are not bound can be active in the cells

Question 94

metabolism (biotransformation)

Answer 94

changes a drug into forms that can be used by the body or which can be readily excreted (or both) Metabolism occurs immediately and most often in the liver. first pass effect: the liver inactivates some medications and some can only be given parenterally

Question 95

Excretion

Answer 95

A drug and its metabolites must be excreted If a drug is excreted more slowly than it is administered, accumulation occurs causing adverse effects and toxicity.

Question 96

Drug Half-Life

Answer 96

represents the time required for the amount of the drug in the blood serum to diminish by one-halfthe concentration (M) of a drug in the blood during a period of time after administration of a single dose

Question 97

The  minimum effective concentration (MEC) or therapeutic index

Answer 97

is a term indicating the lowest concentration of drug in the blood able to produce a therapeutic effect useful in determining adequate dosages

Question 98

The therapeutic range describes

Answer 98

the range between MEC and the toxic concentration where the drug can seriously harm the client

Question 99

Onset of Action

Answer 99

is the time after administration when the drug reaches the MEC and begins to produce its effects

Question 100

Principles Related to Onset of Action

Answer 100

Route of administrationsometimes a loading or priming dose is given to achieve the MEC quicklySome drugs have a latency period peak effect  occurs when blood level is highest

Question 101

The duration of actionThe termination of action

Answer 101

–The duration of action–is usually defined as how long the medication can be expected to remain above the minimum level to provide the effectsit is the time the blood level is above the MEC -The termination of action-the amount of time after the concentration level falls below the minimum level to the time it is eliminated from the body

Question 102

Duration of action of : -fentanyl (Sublimaze®),-meperidine (Demerol®), -morphine, -acetaminophen (Tylenol®),

Answer 102

fentanyl (Sublimaze®), 1–2 hours meperidine (Demerol®), 2–4 hours morphine, 3-7 hours acetaminophen (Tylenol®), 4–6 hours

Question 103

Principles Related to Duration of Action

Answer 103

Short acting drugs must be given frequently. Duration of action can be maintained by giving drugs at regular intervals (maintaining the blood level). Duration can be used to help predict the time of next dose. Occasionally a drug’s effects may persist even after it has been excreted. Duration is influenced by pharmacokinetics and can vary with different routes of administration.

Question 104

Sites of Elimination

Answer 104

Kidneys (main site of elimination) GI tract Perspiration Respiration

Question 105

Pharmacodynamics

Answer 105

what the drug does to the body

Question 106

Drugs either alter the ——- —- or change the —— — — — —-

Answer 106

Drugs either alter the cell environment or change the rate of cell functions

Question 107

the receptor theory of drug action

Answer 107

Drugs “attach” to cells because their molecular structure matches All cell receptors will be exposed to the drug circulating in the blood stream but only those that fit (visualize a lock and key) will bind to each otherIf many receptors are available, we can increase the drug dosage and thus drug effect. If few receptors are available, increasing the drug dosage will have no effect.

Question 108

the cell is said to be receptive to the drug if…

Answer 108

If at least three sites on the surfaces of both drug and cell match

Question 109

what are receptors usually made of

Answer 109

cellular proteins or nucleic acids but can be enzymes, carbohydrate residues, and lipids

Question 110

Agonist

Answer 110

a drug that directly alters the rate of a cellular process

Question 111

Affinity for the target tissue

Answer 111

An agonist has a natural tendency to bind with the receptor

Question 112

Efficacy

Answer 112

ability to initiate drug action

Question 113

Partial agonists 

Answer 113

are agonists that produce only moderate effect.They occupy a receptor site and produce moderate effect prevent any other drug from binding to those receptor sites.

Question 114

Antagonists

Answer 114

do not alter cellular rates or environments. they compete with agonists to occupy the same receptor site If successful in binding more tightly, the antagonist will prevent the agonist from acting Antagonists are often given to act as antidotes excreted more rapidly than the agonist they oppose, therefore have short-lived actions and must be administered repeatedly to prevent toxicity from recurring

Question 115

Numerous factors affect an individual’s response to drugs, including:

Answer 115

Age Weight Gender Environment Time of administration Condition of the patient Genetic factors Psychologic factors

Question 116

Types of Responses

Answer 116

predictableunpredictableiatrogenic

Question 117

Predictable response

Answer 117

extensive research to determine the therapeutic action (desired effect) of a drug in order for a response to be classed as predictable it must have occurred in 50% of the population going to be some potential negative results that may occur (side effects) Through research and testing, most side effects can be anticipated

Question 118

Unpredictable response

Answer 118

If the response seen is unique to that patient and not seen in other patients in a similar setting, the response is classed as an  idiosyncrasyWhen medications are given in successive doses or in conjunction with other medications, we can see unpredictable responses as well

Question 119

 idiosyncrasy

Answer 119

an abnormal or unusual response to a drug

Question 120

Tolerance

Answer 120

decreased effects of a drug due to long term use These patients will build a tolerance to that medication resulting in the need for a higher than normal dose to achieve the same result

Question 121

Cross-tolerance

Answer 121

drug tolerance in which patients who takes a medication for an extended period of time can build up a tolerance to other medications in the same class

Question 122

Tachyphlaxis

Answer 122

condition where patient rapidly becomes tolerant to a medication

Question 123

Drug dependence

Answer 123

a physical or emotional need for drug

Question 124

Cumulative effect

Answer 124

occurs when several does of a medication are administered or when absorption occurs more quickly than elimination If repeat doses are given too quickly, a cumulative effect may result, causing possible nontherapeutic effects

Question 125

Summative effect

Answer 125

the process where multiple medications can produce a response that the individual medications alone do not produce If two medications of similar effect are given to a patient

Question 126

Synergism

Answer 126

combined action of two drugs that is greater than the sum of their individual responses

Question 127

Potentiation

Answer 127

enhanced action of the drug by another administered concurrently

Question 128

Iatrogenic response

Answer 128

is an adverse condition that is inadvertently induced in a patient by the treatment given An example of this would be a patient developing an urinary tract infection after the insertion of urinary catheter.

Question 129

in the metabolic phase The liver can act on a drug in 2 phases

Answer 129

Phase1: the enzymes may oxidize the drug or bind it with oxygen molecules and can also hydrolyze the medication; both causes medication to be more soluble with water Phase 2: the medication molecules combine with a chemical found in the body (known as conjugation reaction)

Question 130

excretion occurs primarily through the kidneys 3 mechanisms

Answer 130

Glomelur filtration Tubular secretion Partial reabsorption

Question 131

Glomelur filtration

Answer 131

a passive process in which blood flows through the glomeruli of the kidneys a differential in pressure forces waste away from the blood into the capsule where it is transported for excretion

Question 132

Tubular secretion

Answer 132

an active transport process in which medications are bound to specific transporters aiding in their elimination

Question 133

Partial reabsorption

Answer 133

this occurs when some amount of the drug is reabsorbed after being filtered

Question 134

Medications cause their action on the body by four mechanisms:

Answer 134

They may bind to a receptor site They may change physical properties of cells They may chemically combine with other chemicals They may alter a normal metabolic pathway

Question 135

A medication molecule witll have 1 of 2 effects when it binds to a receptor site

Answer 135

It may stimulate the receptor site to cause the response it normally does (agonist) It may block the receptor site from being stimulated by other chemical mediators and inhibit the normal response (antagonist)

Question 136

The autonomic nervous system

Answer 136

is composed of nerve fibers that send impulses from the CNS to smooth muscles, cardiac muscles, and glands

Question 137

The autonomic nervous system (ANS) consists of two further subdivisions:

Answer 137

Parasympathetic  nervous system Sympathetic  nervous system

Question 138

Nerve fibers associated with the parasympathetic system originate

Answer 138

from the spinal cord at the level of the cervical and sacral regions

Question 139

Parasympathetic nervous system is responsible for actions such as:

Answer 139

Decreased heart rate Decreased cardiac contractile force Decreased blood pressure Increased circulation to digestive organs Increased peristalsis Constriction of the pupils Bronchoconstriction

Question 140

The principle neurotransmitter of the parasympathetic nervous system is

Answer 140

acetylcholineuh·seh·tuhl·kow·leen

Question 141

acetylcholine

Answer 141

Acetylcholine is very short lived. within seconds of release it is deactivated by another chemical called acetylcholinesterase

Question 142

Within the parasympathetic nervous system there are two main types of acetylcholine receptors

Answer 142

nicotinic and muscarinic

Question 143

Muscarinic receptors

Answer 143

are primarily responsible for parasympathetic overactivity responses

Question 144

Muscarinic responses and what reverses them

Answer 144

including bradycardia, miosis (pinpoint pupils), sweating, blurred vision, tearing, wheezing, SOB, coughing, vomiting, abdominal cramps, diarrhea atropine reverses them

Question 145

nicotinic receptors

Answer 145

are primarily responsible for sympathetic overactivity response and neuromuscular disfunction causes muscular contractionsopened by nicotine

Question 146

nicotinic responses

Answer 146

responses include tachycardia, hypertension, dilated pupils, muscle fasciculation (involuntary twitching etc) and muscle weakness

Question 147

cholinergic receptors

Answer 147

these receptors respond to acetylcholinenicotinic and muscarinic

Question 148

parasympathomimetic  or cholinergic agonists

Answer 148

producing effects that resemble (mimic) the stimulation of the parasympathetic nervous system If a medication binds to and stimulates those receptors

Question 149

parasympatholytic  or anticholinergic

Answer 149

blocking effects or producing effects that resemble interruption of the parasympathetic nervous system If a medication blocks the actions of the parasympathetic nervous system ex: atropine

Question 150

Nerve fibers associated with the sympathetic system originate

Answer 150

from the spinal cord at the level of the thoracic and lumbar regions

Question 151

Sympathetic nervous system is responsible for actions such as:

Answer 151

Increase heart rate Increase blood pressure Peripheral vasoconstriction Increase circulation to vital organs Sweat gland stimulation

Question 152

The principle neurotransmitters of the sympathetic nervous system are

Answer 152

catecholamines norepinephrine epinephrine

Question 153

Within the sympathetic nervous system there are two main types of receptors

Answer 153

adrenergic  and  dopaminergic.

Question 154

Dopaminergic receptors

Answer 154

are believed to cause renal, coronary, and cerebral artery dilation

Question 155

Adrenergic receptors

Answer 155

are the receptors that are most common within the sympathetic nervous systemthe receptors stimulated by prehospital medications

Question 156

Adrenergic receptors 4 classes

Answer 156

Alpha1 Alpha2 Beta1 Beta2

Question 157

where are the following receptors primarily locatedAlpha 1Alpha 2Beta 1Beta 2

Answer 157

Alpha 1: on peripheral blood vesselsAlpha 2: on nerve endingsBeta 1: within the cardiovascular systemBeta 2: on bronchial smooth muscle

Question 158

Alpha 1 stimulation results in:

Answer 158

Peripheral vasoconstriction Mild bronchoconstriction Increased metabolism Stimulation of sweat glands

Question 159

Alpha 2 stimulation results in:

Answer 159

Control release of neurotransmitters

Question 160

Beta 1 stimulation results in:

Answer 160

Increased heart rate (positive chronotropic) Increased strength of cardiac contraction (positive inotropic) Increased cardiac conduction (positive dromotropic)

Question 161

Beta 2 stimulation results in:

Answer 161

Bronchodilation Peripheral vasodilation

Question 162

sympathomimetic  or adrenergic agonists

Answer 162

If a medication binds to and stimulates any of the adrenergic receptors

Question 163

what do sympathomimetic or adrenergic agonists do

Answer 163

producing effects that resemble the stimulation of the sympathetic nervous system

Question 164

sympatholytic or adrenergic antagonist

Answer 164

blocking effects or producing effects that resemble interruption of the sympathetic nervous system

Question 165

Selective beta blockers

Answer 165

bind and block only beta 1 or beta 2 receptors

Question 166

non-selective beta blockers

Answer 166

would block both beta 1 and beta 2 receptors

Question 167

Drugs are organized into classifications according to

Answer 167

the body system they affect, their therapeutic use or clinical indication, and/or their physiologic or chemical action

Question 168

13 classifications of drugs

Answer 168

Opioid antagonists Non-narcotic  analgesics Inhalation  anesthetics Adrenergic agonists Bronchodilators Antianginal agents Anticoagulants Platelet inhibitors Uterotonics Vitamin and electrolyte supplementsAntihypoglycemic agents Antimicrobials Antidotes or neutralizing agents

Question 169

Opioid

Answer 169

binds to opioid receptors to provide analgesic effects

Question 170

Analgesic

Answer 170

medication that relieves pain

Question 171

Anesthetics

Answer 171

medication that makes the body less sensitive to the perception of pain

Question 172

Bronchodilators

Answer 172

medication which increases airflow to lungs by dilating the bronchi and bronchioles

Question 173

Antiangina

Answer 173

medication to manage or reduce the heart condition angina

Question 174

Anticoagulants

Answer 174

medication to prevent blood clots

Question 175

Platelet inhibitors

Answer 175

medications which reduce blood clotting by preventing platelet cohesion

Question 176

Uterotonics

Answer 176

medication to induce contraction of uterus

Question 177

Antihypoglycemic

Answer 177

counteracting low blood glucose  

Question 178

Antimicrobials

Answer 178

medication to destroy or slow growth of microorganisms

Question 179

Antidotes

Answer 179

medication to counteract poison

Question 180

The CNS

Answer 180

which is comprised of the brain and spinal cord, receives signals from sensory receptors (e.g., pain, vision, cold, pressure, smell), processes these signals, and controls body responses to them

Question 181

The classifications that you are going to study that affect the central nervous system are:

Answer 181

Opioid antagonists Non-narcotic analgesics Inhalation anesthetics

Question 182

Opioid Antagonist

Answer 182

Narcotic medications elicit both analgesic and CNS effects Some patients experience a feeling of well-being with their use Opioid antagonists may be used to treat both narcotic abuse symptoms as well as therapeutic narcotic symptoms

Question 183

Mechanism of Action of Opioid Antagonist

Answer 183

Opioid antagonists attach to opioid receptors and displace the narcotic, thereby rapidly reversing the effects of the narcotic

Question 184

Types of Opioid Antagonists

Answer 184

Pure antagonists Partial antagonists

Question 185

Pure antagonists

Answer 185

Competitive blocking drugs Occupy a receptor site so that narcotic cannot, but do not have any effect themselves

Question 186

Partial antagonists

Answer 186

Bind with receptor sites Produce weak narcotic-like effects in the absence of other narcotics

Question 187

common uses of Opioid Antagonists

Answer 187

Narcotic induced respiratory depression Narcotic addictions

Question 188

common examples of Opioid Antagonists

Answer 188

*Naloxone Nalmefene Butorphanol Nalbuphine Pentazocine

Question 189

cautions of Opioid Antagonists

Answer 189

Partial antagonists may cause worsening of respiratory depression Use caution when administering to individuals that are addicted to narcotics due to resulting withdrawal symptoms

Question 190

Non-Narcotic Analgesics

Answer 190

Pain levels must be assessed before and after an analgesic is administered to determine its effectiveness Analgesics inhibit the body’s reaction to pain Non-narcotic analgesics differ from narcotic analgesics as they produce analgesia through both the CNS and peripheral mechanism of action at the site of injury

Question 191

Mechanism of Action of Non-Narcotic Analgesics

Answer 191

provide analgesia by blocking prostaglandin stimulation in the CNS cause fever reduction by affecting the hypothalamic center to reduce temperature, and they increase sweating and peripheral blood flow in order to increase heat loss Select non-narcotic analgesics will also reduce inflammation by stabilizing cell membranes so that cells are less permeable, thus limiting edema formation

Question 192

Common Uses of Non-Narcotic Analgesics

Answer 192

Mild pain management Reduce fever Pain from inflammation

Question 193

Common Examples of Non-Narcotic Analgesics

Answer 193

Nonsteroidal anti-inflammatory drugs (NSAID) *Ibuprofen *Ketorolac Naproxen Salicylates *Aspirin® Analgesic/Antipyretic *Acetaminophen (Tylenol®)

Question 194

Cautions of Non-Narcotic Analgesics

Answer 194

May cause gastric erosion and ulceration, increased risk of bleeding, and renal impairment Overdose of salicylates and acetaminophen may result in acidosis and respiratory complications

Question 195

Anesthetics

Answer 195

An anesthetic is any drug that has the capability of causing loss of all sensations, not only the sensation of pain

Question 196

two types of general anesthetics:

Answer 196

Inhalation  anesthetic Injection  anesthetic

Question 197

Mechanism of Action of general anesthetics

Answer 197

There are 4 stages to anesthesia, and mechanism of action depends on the stage that is achieved by the drug.

Question 198

4 stages of Anesthetics

Answer 198

Stage 1: AnalgesiaStage 2: Involuntary movementStage 3: Surgical anesthesiaStage 4: Medullary paralysis

Question 199

Stage 1 of anesthetics

Answer 199

Stage 1: Analgesia. Cerebral cortex is inhibited causing a decreased response to pain, a feeling of euphoria, and possible unconsciousness.

Question 200

stage 2 of anesthetics

Answer 200

Stage 2: Involuntary movement. Cerebral cortex is completely depressed and the hypothalamus takes over control of bodily functions. There is an increase in sympathetic tone which causes an increase in heart rate, blood pressure, respirations, and muscle tone.

Question 201

stage 3 of anaesthetics

Answer 201

Stage 3: Surgical anesthesia. The hypothalamus is depressed, and cardiac and respiratory function returns to normal. Spinal reflexes are blocked and skeletal muscles relax.

Question 202

stage 4 of anesthetics

Answer 202

Stage 4: Medullary paralysis. The medulla is paralyzed, thus cardiac and respiratory centres are affected, and death may occur.

Question 203

common uses of anesthetics

Answer 203

Surgeries Dental procedures Pain control (nitrous oxide’s main use)

Question 204

Common Types of Inhalation Anesthetics

Answer 204

Volatile liquids –Ether –Enflurane –Halothane

Question 205

Gases

Answer 205

• Nitrous oxide -Penthrox 

Question 206

cautions of anesthetics

Answer 206

Oxygen must be included with all inhalation anesthetics or hypoxia will result They may cause nausea and vomiting in patients, so must monitor airway Potentially  hepatotoxic May cause heart to be sensitive to catecholamines (naturally occurring hormones such as dopamine or epinephrine), thus resulting in possible  dysrhythmias Potentially fatal malignant hyperthermia may result, characterized by temperatures as high as 43° C and muscle rigidity

Question 207

non-opiod analgesics

Answer 207

have antipyretic properties

Question 208

3 main types of non-opiod analgesics

Answer 208

Salicylates (asprin) Non steroidal anti-inflammatory medications (NSAIDs) (ibuprofen) Para-aminophenol derivatives (tylenol)

Question 209

Sedation

Answer 209

used to couteract anxiety before procedure

Question 210

Hypnosis

Answer 210

medications that ensure they sleep through event

Question 211

Benzodiazepines and MOA

Answer 211

seditatives used to prepare pts for invasive procedures MOA: affect the inhibitory neurotransmitter gamma-aminobutyrate acid (GABA) in the brain causing brain activity to slow

Question 212

Midazolam (Versed)

Answer 212

is a popular benzodiazepine has potent amnesic effect that inhibits patients ability to recall the procedure Onset of action is 1-3mins has a 30-60min duration of action

Question 213

Diazepam (Vilum)

Answer 213

moderatley longer acting benzodiazepine 30-90 min duration of action Onset of action 5mins

Question 214

Barbiturates and MOA

Answer 214

believed to work similarto benzo’s; MOA: increase affinity between receptor sites and the inhibitory neurotransmitter GABA

Question 215

Thiopental (pentothal)

Answer 215

short acting barbiturate Onset action of 10-20secs Duration of action 5-10mins

Question 216

Nonbarbiturate hypnotics

Answer 216

almost identical properties to benzo’s and barbiturates

Question 217

Etomidate(Amidate/Lipuro)

Answer 217

ultra short common choice Onset action of 5-15 secs Duration of action of 3-5 mins Minimal effects on hemodynamic stability and decreases intracranial pressure and cerebral oxygen metabolism

Question 218

Propofol (diprivan)

Answer 218

Onset of 10-20 secs Duration lasts 10 to 15mins

Question 219

Anticonvulsants and MOA

Answer 219

anti seizure medsMOA: work by inhibiting the influx of sodium into cells enhancing the inhibitory GABA system reducing excitatory glutamingeric neurotransmission and reducing activity in calcium channels

Question 220

Classes of anticonvulstants include

Answer 220

hydantoins (phenytoin [Dilantin]),iminostilbenes (carbamazepine) valproic acid

Question 221

Stimulation of CNS can be acomplished in 2 ways

Answer 221

increasing excitatory neurotransmitters by decreasing inhibatory neurotransmitters

Question 222

Amphetamines

Answer 222

are CNS stimulants They increase the release of dopamine and norepinephrine to increase wakefullness and awarness Increase tachycardia, hypertension and can cause seizures and psychosis

Question 223

Methylphenidate (Ritalin)

Answer 223

intended to allow pts to better focus and avoid distraction

Question 224

Psychotherapeutic Medications and MOA

Answer 224

MOA: work by blocking dopamine receptors

Question 225

Depression often treated with

Answer 225

seretonin reuptake inhibitors

Question 226

Monoamine oxidase inhibitors

Answer 226

block the metabolism of monoamines in the brain

Question 227

Tricyclic antidepressants (TCAs)

Answer 227

have powerful inhibitory effects: They Block the neurotransmitters norepinephrine and serotonin from being reabsorbed in the brain They block ACH from reaching its receptors which may lead to tachycardia They block alpha 1 receptors which may produce orthostatic hypotension

Question 228

CNS Agents

Answer 228

a class of drugs that produce physiological and psychological effects through a variety of mechanisms

Question 229

specific agents

Answer 229

which bring about an identifiable mechanism with unique receptors for the agent

Question 230

Nonspecific agents

Answer 230

which produce effects on different cells through a variety of mechanisms and are generally classified by the focus of action or specific therapeutic use

Question 231

Stimulants

Answer 231

exert their action by excitation of the CNS some of the specific drugs included in this group are caffeine, cocaine and various amphetamines

Question 232

Patient may be prescribed CNS depressants which

Answer 232

slow brain activity to treat anxiety, muscle tension, pain, insomnia, stress, panic attacks and sometimes seizures

Question 233

CNS depressant examples

Answer 233

lorazepam (Atrivan) triazolam (Halcion), chlordiazepoxide (Librium). Diazepam (Valium), alprazolam (xanax) opiclone (Imovane)

Question 234

the sympathetic branch of the ANS is based on… the parasympathetic branch function is to…

Answer 234

The sympathetic branch of the ANS is based on the parasympathetic branch function is to return the body to balance (homeostasis)

Question 235

neurotransmitters for the adrenergic (sympathetic) response

Answer 235

epinephrine and norepinephrine

Question 236

Medications that affect the ANS will…

Answer 236

either trigger or block an autonomic response

Question 237

Adrenergic Agonists

Answer 237

often referred to as sympathomimetic drugs because they “mimic” the actions of the sympathetic nervous system.

Question 238

Mechanism of Action of Adrenergic Agonists

Answer 238

are used to stimulate peripheral adrenergic receptors, alpha (α) and beta (β), and mimic the actions of the sympathetic nervous system Drugs that act directly on the receptor are  direct-acting, and those that alter the release of norepinephrine are indirect-acting The drug can be either  non-selective or  selective to the receptor sites they stimulate.

Question 239

Non-selective α and β Agonists uses and action

Answer 239

*Treatment of anaphylaxis/shock (currently only use for PCP) -Stimulates α1 receptors causing vasoconstriction, thus increasing blood pressure Treatment of cardiac arrest -Stimulates β1 receptors stimulate the heart, causing an increase in heart rate, force of contraction, and impulse contraction Treatment of glaucoma -Decreases intraocular pressure

Question 240

α1 agonist uses and action

Answer 240

Decongestants -Stimulate α1 receptors causing vasoconstriction and thereby decreasing congestion in the area

Question 241

α2 Agonists uses and action

Answer 241

Treatment of glaucoma -Stimulates α2 receptors causing a decrease in intraocular pressure

Question 242

β1 Agonists: uses and action

Answer 242

Treatment of cardiac arrest and hypotension -Stimulates β1 receptors causing an increase in heart rate, force of cardiac contraction, and cardiac conduction

Question 243

β2 Agonists: uses and actions

Answer 243

Bronchodilators -Stimulate β2 receptors, decreasing bronchoconstriction and causing bronchodilation

Question 244

adrenergic drug cautions and side effects

Answer 244

CNS stimulation — anxiety, jitters, insomnia, tremors Cardiac stimulation (β1 effect) — increase heart rate, force of cardiac contraction, and cardiac impulse conduction; palpitations and arrhythmias can occur Increased blood pressure (α1 effect) Urinary retention (α1 effect)

Question 245

Beta-receptor - general(non-specific)ex: eye-effect-beta agonist-beta antagonist

Answer 245

-effectrelaxes ciliary muscle-beta agonistnon specific agonists: isoproterenol epinephrine-beta antagonistpropranololtimololnadolol

Question 246

b1 selective drugsex: myocardium-effect-beta agonist-beta antagonist

Answer 246

-effectincreases contractility increases heart rate-beta agonistnorepinephrine-beta antagonistmetoprololatenolol

Question 247

b2 selective adrenergic drugsex: lungs -effect-beta agonist

Answer 247

-effectbronchodilation-beta agonistbronchodilators:fenoterolalbuterolterbutaline

Question 248

Alpha-receptor - generalex: vascular smooth muscle-effect-beta agonist-beta antagonist

Answer 248

-effectskin and skeletal muscle vessel constriction-beta agonistepinephrinenorepinephrine-beta antagonistphentolamine

Question 249

a1 drugsex: vascular smooth muscle-effect-beta agonist-beta antagonist

Answer 249

-effectvasoconstriction-beta agonistphenylephrine-beta antagonistprazosin

Question 250

a2 drugsex: vascular smooth muscle-effect-beta agonist-beta antagonist

Answer 250

-effectOpposes α1 vasoconstriction Inhibits NE release Decreases adrenergic activity-beta agonistclonidine-beta antagonistyohimbine

Question 251

Neuromuscular blocking agents

Answer 251

affect the somatic nervouse system by inducing paralysis

Question 252

Depolarizing neuromuscular blocking agents

Answer 252

stimulate depolarization of muscle cells which manifests as muscle twitches the medication then produces continuous stimulation of muscle cell which does not allow it to return to its resting state

Question 253

Nondepolarizing neuromuscular blocking agents

Answer 253

find in a competitive but non-stimulatory manner to part of the ACH receptor as a result these drugs do not cause muscle twitches

Question 254

Succinycholine

Answer 254

a depolarizing neuromuscular blocking agents that is paralytic for prehospital airway management Rapid onset action less than 45 seconds Short duration of action 4 to 5 mins

Question 255

Vecuronium

Answer 255

a non-depolarizing neuromuscular blocker that produces paralysis Onset action of 30 seconds Duration of action of 30 minutes

Question 256

Pancuronium

Answer 256

neuromuscular blocking agents that may be used in prehospital setting Onset action of 90 to 120 seconds Duration of action of 45 minutes to 90 minutes

Question 257

Adrenergic Agonists (sympathomimetics)

Answer 257

stimulates the adrenal medulla to release norepinephrine and epinephrin which stimulate one of two types of sympathetic receptors dopaminergic receptors and adrenergic receptors

Question 258

Dopiminergic receptors

Answer 258

produce dilation of renal, coronary and cerebral arteries there are no medication’s that specifically target these receptors

Question 259

3 categories of bronchodilators

Answer 259

β2 agonists  Anticholinergics Xanthines

Question 260

β2 Agonists

Answer 260

Act on the sympathetic nervous system “Fit and act” at β2 receptors in the lungs Stimulate bronchial smooth muscle causing bronchodilation and decreased respiratory secretions Stabilize inflammatory cells, but do not treat inflammation classified as short acting or long acting

Question 261

short acting β2 Agonists

Answer 261

can be used about 15 minutes prior to exercise or exposure to a known trigger as a preventative measure common examples: *salbutamol,terbutaline,salmeterol

Question 262

long acting β2 Agonists

Answer 262

onset is slower but effects last 12 hours common example: formoterol

Question 263

Anticholinergics

Answer 263

Act on the parasympathetic nervous system Block action of acetacholine on bronchial smooth muscle resulting in bronchodilation and decreased respiratory secretions Stabilize inflammatory cells, but do not treat inflammation

Question 264

common anticholinergics

Answer 264

ipratropium bromide  combined  ipratropium bromide salbutamol

Question 265

Xanthines

Answer 265

Act directly on respiratory muscle to cause bronchodilation Most commonly used orally, but sometimes by injection Not very effective for acute management, used mainly as chronic or maintenance treatment to prevent asthma symptoms Have a narrow therapeutic range, which leads to a low safety margin

Question 266

common Xanthines

Answer 266

theophylline, aminophylline

Question 267

common uses of all bronchodilators

Answer 267

Treat acute asthmatic episodes –Short acting β2 agonists are used because they act quickly –Longer acting β2 agonists are of little value for acute episodes due to the length of onset Prevent acute asthmatic episodes Treat chronic obstructive pulmonary disease (COPD). –Best treatment involves anticholinergics, but other bronchodilators may be used

Question 268

bronchodilator cautions

Answer 268

Short acting β2 agonists should only be used as required; not as a regular or daily drug

Question 269

bronchodilator Side Effects

Answer 269

CNS stimulation — anxiety, insomnia, restlessness, tremors Cardiac stimulation — tachycardia, palpitations, hypertension May precipitate angina, myocardial infarction, and dysrhythmias Nausea and vomiting Abdominal cramps

Question 270

bronchodilator drug interactions

Answer 270

Beta blockers may block the effect Monoamine oxidase inhibitors and tricyclic antidepressants may potentiate effects

Question 271

what is the preferred receptor to treat respiratory emergencies

Answer 271

beta 2 because they produce smaller increases in heart rate and force of contraction which decreases the body’s rate of oxygen consumption

Question 272

what is a well known CNS Stimulant which is also a Xanthine

Answer 272

caffeine

Question 273

common decongestants and cold products

Answer 273

pseudoephedrinedextromethorphandiphenhydramine

Question 274

Antianginal agents

Answer 274

are used to treat a cardiac condition called angina

Question 275

Angina

Answer 275

is an ischemic heart disease that results in a decreased blood flow to the myocardium due to a buildup of atherosclerotic plaques, or coronary artery vasospasm

Question 276

Three main classes of antianginal agents are:

Answer 276

*Nitrates (currently only class that can be administered by PCP) Beta-blockers Calcium channel blockers

Question 277

Nitrates

Answer 277

can relieve symptoms of ischemic heart disease, but are not a cure for it.

Question 278

nitrates MOA

Answer 278

is to relax vascular smooth muscles the vascular endothelium converts nitrates to nitric oxide (NO) which causes vasodilationDilation of veins is greater than arteriolar dilation at the lower dosage ranges of these drugs

Question 279

Vasodilation results in:

Answer 279

Decreased amount of blood returning to the heart (preload); therefore, less blood for the heart to pump out Decreased pressure for the heart to pump against (afterload) Decreased afterload and preload decreases the hearts work; therefore, the heart requires less oxygen

Question 280

common uses of nitrates

Answer 280

To prevent angina attacks –May be used as acute or long-term prophylaxis of angina To relieve acute angina attacks Treatment of myocardial infarctions To help decrease blood pressure –May be combined in hospital with other medications to control blood pressure

Question 281

common examples of nitrates

Answer 281

*Nitroglycerin 

Question 282

cautions of nitrates

Answer 282

Vasodilatation may cause headaches or orthostatic hypotension (resulting in weakness, dizziness, or fainting) Alcohol potentiates the effects of nitrates Drug loses its effects when exposed to light or air Do not shake the spray as can affect dosage by displacing air in the bottle Tolerance can be developed if used 24 hours a day

Question 283

drug interactions with nitrate

Answer 283

Viagra® Cialis® Levitra®

Question 284

Beta Blockers

Answer 284

another treatment and management used for angina.They are effective with angina pectoris, but are not effective when used for vasospastic angina.

Question 285

Beta Blockers MOA

Answer 285

in treatment of angina is to block beta 1 receptors in the heart, thus decreasing heart rate and contractility This in turn will help reduce oxygen demand by causing a decrease in afterload.

Question 286

common uses of beta blockers

Answer 286

Reducing the severity and frequency of exertional angina attacks Post myocardial infarction

Question 287

common examples of beta blockers

Answer 287

Metoprolol Atenolol Timolol

Question 288

cautions of beta blockers

Answer 288

May produce bradycardia, decreased atrioventricular (AV) conduction, and reduced cardiac contractility Should not be administered to patients with sick sinus syndrome or an AV block. Use with caution in patients with heart failure Asthmatics should only receive beta blockers that are beta1 selective to reduce risk of bronchoconstriction May mask signs of hypoglycemia

Question 289

Calcium Channel Blockers

Answer 289

Calcium channel blockers are another treatment used to help treat and manage angina.

Question 290

Calcium Channel Blockers MOA

Answer 290

The mechanism of action of calcium channel blockers is to block calcium channels, primarily in arterioles, resulting in arteriolar dilation and reduction in peripheral resistance (afterload) They can also result in relaxation of coronary vasospasm, thus resulting in increased oxygen supply Select calcium channel blockers may also block calcium channels in the heart, causing a decrease in heart rate, AV conduction, and contractility

Question 291

Calcium Channel Blockers common uses

Answer 291

Angina Variant angina (Prinzmetal’s angina and vasospastic angina)

Question 292

Common Examples of Calcium Channel Blockers

Answer 292

Verapamil Diltiazem Nifedipine 

Question 293

cautions of Calcium Channel Blockers

Answer 293

Dilation of peripheral arterioles can cause hypotension and a resultant tachycardia. Use caution with administration of calcium channel blockers that cause depression of the heart to patients taking beta blockers or that have bradycardia, heart failure, or an AV block.

Question 294

Chronotropic effectInotropic effectsDromotropic effects

Answer 294

Chronotropic effect: medications that affect the heart rate Inotropic effects: are changes in the force of contraction Dromotropic effects: when a drug alters the velocity of the conduction of electricity through the heart

Question 295

Cardiac glycosides

Answer 295

our class of medications that are derived from plants These medication’s block certain ionic pumps in the heart cells membranes which increases calcium concentration

Question 296

Antidysrhythmic medications

Answer 296

used to treat and prevent cardiac rhythm disorders further classified into four groups according to the fundamental mode of action on the heart

Question 297

four groups of antidysrhythmic medications

Answer 297

Sodium channel blockersBeta blockersPotassium chanel blockersCalcium channel blocker’s

Question 298

Sodium channel blockers effect on heart

Answer 298

slow the conduction through the heart (negative dromotropic effect)

Question 299

Beta blockers effect on heart

Answer 299

reduce the adrenergic stimulation of the beta receptors

Question 300

Potassium channel blockers effect on heart

Answer 300

increase the heart contractility (positive inotrophy) and work against the reentry of blocked impulses

Question 301

Calcium channel blockers effect on heart

Answer 301

block the inflow of calcium into the cardiac cells decreasing the force of contraction in automaticity and may decrease the conduction velocity (negative dromotropic effect)

Question 302

thrombolytics

Answer 302

designed to break down (lyse) the clot and improve client outcomes if given shortly after the development of the clot

Question 303

Anticoagulants

Answer 303

may also be called  antithrombotics most effective at preventing venous thrombosis, and are used to prevent formation of clots in veins and to stabilize an existing clot so it does not break off into circulation Anticoagulants do not dissolve existing clots

Question 304

MOA of anticoagulants

Answer 304

anticoagulants disrupt the coagulation cascade and prevent the production of fibrin They block the action of certain clotting factors, which cause platelets to stick together and form blood clots, but the method of action differs for each anticoagulant as each one works at different points in the clotting cascade After addition of antiplatelet drugs, the formation of blood clots is reduced Anticoagulants may be given to patients undergoing surgery to prevent blood clots from forming and decrease the risk of embolism

Question 305

Common Examples of anticoagulants

Answer 305

*Heparin (monitor only) Low molecular weight heparins Warfarin

Question 306

common uses of coagulants

Answer 306

During or after surgeries A combination of anticoagulants may be used when a patient is first beginning oral anticoagulant therapy

Question 307

anticoagulants cautions

Answer 307

When doses are too high the following bleeding may result: Bleeding gums Nosebleeds Easy bruising

Question 308

Platelet inhibitors

Answer 308

also called  antithrombotics inhibit the normal functioning of plateletsmost effective for preventing  arterial thrombosis (blood clot in artery) taken by people with a tendency to form clots in the heart and arteries where blood flow is fastthey are used to prevent clot formation after certain types of surgery (clots can lead to myocardial infarctions, strokes, etc.). Platelet inhibitors do not dissolve existing clots.

Question 309

MOA of platelet inhibitors

Answer 309

Platelet inhibitors act at the level of platelets to prevent clots in arteries They decrease the ability of platelets to stick together (therefore decreasing platelet aggregation) by inhibiting TXA2 or ADP. reduce the tendency of platelets to stick together when blood flow is disrupted and prevent clot formation

Question 310

TXA2

Answer 310

thromboxane A2 a type of thromboxane with prothrombotic properties

Question 311

Common Examples platelet inhibitors

Answer 311

*ASA Dipyridamole Ticlopidine Clopidogrel

Question 312

Common Uses platelet inhibitors

Answer 312

Primary prevention of a myocardial infarction Prevention of a reinfarction in patients with previous myocardial infarction history Prevention of thrombotic stroke

Question 313

Cautions platelet inhibitors

Answer 313

Increased risk of gastrointestinal bleeding and hemorrhagic stroke Increased risk of bleeding

Question 314

fibrolytic agent

Answer 314

Once a blood clot has formed it may be administered to dissolve the thrombus and prevent it from breaking off and entering the bloodstreamPromote the digestion of fibrin

Question 315

two different classifications of medications used to stop preterm labour, induce labour, or control postpartum hemorrhage

Answer 315

uterine stimulants and uterine relaxants.

Question 316

Uterotonics

Answer 316

given to facilitate uterine contraction

Question 317

MOA of uterotonics

Answer 317

is stimulation of uterine contractions and compression of maternal blood vessels at the placental site in an attempt to induce labour and control postpartum hemorrhage.

Question 318

Common Uses of uterotonics

Answer 318

Induce or speed up labour Facilitate contractions following a spontaneous abortion Treat postpartum hemorrhage

Question 319

Common Examples of uterotonics

Answer 319

*Oxytocin® (monitor only) Misoprostol Syntometrine Ergometrine

Question 320

Cautions of uterotonics

Answer 320

Ergometrine is contraindicated in women with a history of hypertension, pre-eclampsia, eclampsia, or heart disease. Overstimulation of the uterus could result in uterine rupture, trauma to both mom and baby due to the fetus being forced through an incompletely dilated cervix, and decreased uterine perfusion.

Question 321

oxytocin

Answer 321

Naturally occurring hormone that has multiple reproductive functions it increases the force and frequency of contractions used to reduce postpartum haemorrhage

Question 322

tocolytic medication

Answer 322

Suppress the force and frequency metre and contractionsex: magnesium sulfateex: terbutaline

Question 323

magnesium sulfate

Answer 323

Relaxes the smooth muscles including those in the uterus

Question 324

terbutaline

Answer 324

Beta agonist that has been used as a tocolytic agent

Question 325

Vitamin and Electrolyte Supplements

Answer 325

The body is unable to synthesize vitamins and electrolytes and must, therefore, rely on an adequate and constant supply through diet

Question 326

MOA of Vitamin and Electrolyte Supplements

Answer 326

Vitamins and electrolytes are equally as important for the body to maintain normal function. If the demand is not met, body function will be compromised. Depending on what component is lacking will determine the body function that is affected

Question 327

Vitamin A

Answer 327

Required for production of rhodopsin which enables specialized retinal cells (rods) to adapt to dim light

Question 328

Vitamin D

Answer 328

Regulates serum calcium levels in conjunction with parathormone and calcitonin

Question 329

Vitamin E

Answer 329

Prevents formation and accumulation of toxic metabolites; maintenance of red blood cell membranes

Question 330

Vitamin K

Answer 330

Synthesis of blood clotting factors II, VII, IX, X

Question 331

Vitamin B

Answer 331

Necessary for cell reproduction and maturation

Question 332

Vitamin C

Answer 332

Involved in formation of catecholamines, steroids, and conversion reactions

Question 333

Sodium

Answer 333

Helps to maintain normal fluid balance

Question 334

*Potassium

Answer 334

Maintains cell structure and function; regulates muscle function (monitor only)

Question 335

Calcium

Answer 335

Plays role in muscle contraction, blood coagulation and bone formation

Question 336

Hydrogen

Answer 336

Regulates acidity and alkalinity of body fluids

Question 337

Cautions of Vitamin and Electrolyte Supplements

Answer 337

There is specific balance that is required when administering certain electrolytes and vitamins, blood levels must be monitored as too much can be sometimes as detrimental as too little.

Question 338

Antihypoglycemic Agents

Answer 338

The brain requires a certain level of glucose in order to sustain life; if the blood sugar drops below that level, coma, or death can result Antihypoglycemic agents are used when blood sugar levels drop and the patient’s needs are no longer met.

Question 339

MOA of Antihypoglycemic Agents

Answer 339

Antihypoglycemic agents work in one of two ways to increase plasma glucose levels: Break down glycogen stores from the liver Supply usable glucose directly to the patient’s blood stream

Question 340

common uses of Antihypoglycemic Agents

Answer 340

Hypoglycemia

Question 341

Common Examples of Antihypoglycemic Agents

Answer 341

*Glucagon *D5/D10 *D50W *Oral glucose

Question 342

Cautions of Antihypoglycemic Agents

Answer 342

Ensure that glucose levels are monitored before and after administration

Question 343

Antimicrobials

Answer 343

Bacteria have only a few strategies to fight these drugs. However, bacteria often have the upper hand because of their high numbers and their ability to adapt and reproduce Antibiotics, antiviral, and  anti-fungal  agents  are used to treat a variety of infections

Question 344

General Guidelines for Use of Antimicrobials

Answer 344

Take as directed for the full course of treatment  Space doses evenly apart Be aware of compliance issues, reinfection, and superinfection

Question 345

Antibiotics

Answer 345

Antibiotics or antibacterial drug classes are used to treat bacterial infections Each antibiotic drug is generally effective for only certain pathogenic bacteria

Question 346

Types of Antibiotics

Answer 346

Beta-lactam Sulfonamide Tetracycline Macrolide Aminoglycoside Fluoroquinolone Miscellaneous

Question 347

type of Beta-lactam antibiotics

Answer 347

Penicillins Cephalosporin antibiotics Carbapenem antibiotics

Question 348

MOA of antibiotics

Answer 348

Preventing cell wall synthesis (penicillins) Blocking the synthesis of folic acid (sulfonamides) Interfering with protein synthesis (tetracyclines, macrolides, aminoglycosides) Interfering with DNA synthesis (quinolones)

Question 349

common uses of antibiotics

Answer 349

Skin and soft tissue infections Dental infections Respiratory tract infections Eye, ear, nose, and throat infections Urinary tract infections Gastrointestinal infections Some sexually transmitted diseases

Question 350

cautions of antibiotics

Answer 350

Stopping too early can cause a relapse of symptoms, or it may cause the bacteria to become resistant to the medication, which could lead to ineffectiveness of the antibiotic at a later date. Dairy products, antacids, and iron preparations containing minerals such as calcium, iron, aluminum, and magnesium may interact with some antibiotics and prevent them from being properly absorbed into the body (tetracycline, ciprofloxacin, norflaxacin) May interfere with effectiveness of oral contraceptives Disruption of normal flora can be disrupted causing the bacteria Clostridium difficile to over grow. This results in pseudomembranous colitis that can cause bloody diarrhea, abdominal pain, fever, and cramps.

Question 351

Antivirals

Answer 351

Antibiotics are not effective against viruses Antivirals are a type of antimicrobial drug used to treat viral infections. Their mechanism of action is to inhibit, not destroy, the growth of the virus. Since viruses insert themselves into a cell’s DNA, it is very difficult to make antiviral drugs that are effect against the virus, but do not harm the healthy cells

Question 352

Types of Antivirals

Answer 352

Viral DNA Polymerase Inhibitors Antiretrovirals –RNA Reverse Transcriptase Inhibitors –Protease Inhibitors Viral Uncoating Blockers

Question 353

MOA of antivirals

Answer 353

Antiviral drugs work by: Preventing virus from replicating, but do not destroy the virus. Inhibit reverse transcriptase, an enzyme used by RNA viruses to build their DNA (RNA Reverse Transcriptase Inhibitors). Inhibit protease, an enzyme used by RNA viruses in the final stages of creating new virus particles (Protease Inhibitors). Prevent the virus from incorporating into the host cells (Viral Uncoating Blockers).

Question 354

Common Uses of antivirals

Answer 354

Treatment of herpes Decrease HIV virus production (antiretrovirals) Influenza A prophylaxis

Question 355

Cautions of antivirals

Answer 355

Since viruses reproduce very quickly, treatment must be started immediately Possible adverse effects are nausea, headache, dizziness or drowsiness  Antiretrovirals may have harmful side effects, so regular blood tests are required to monitor effects on the liver, pancreas, and bone marrow.

Question 356

Antifungals

Answer 356

Fungi exist as yeasts or molds and can invade mucous membranes and the skin. Treatment of fungi is directed at destroying the fungal cell wall Antifungal medications are used to treat fungal infections such as athlete’s foot, diaper rash, and thrush. They can be administered either topically or systemically.

Question 357

Types of Antifungals

Answer 357

Azole Nystatin Amphotericin B Terbinafine

Question 358

MOA of antifungals

Answer 358

Inhibiting ergosterol synthesis in fungal cell membranes, thus inhibiting fungal cell membrane synthesis When fungal cell membrane synthesis does not occur, the membrane becomes permeable and cell contents leak out, causing the fungal cell to die.

Question 359

Common Uses of antifungals

Answer 359

Skin and mucus membrane infections Systemic fungal infections Nail fungal infections

Question 360

Cautions

Answer 360

Amphotericin B is very potent and has a narrow therapeutic range, so dose must be closely monitored and blood tests must be performed to monitor drug levels Some azole antifungals need an acidic environment in order to absorb, so no stomach acid neutralizing medications can be taken for two hours after taking it All systemic azoles are hepatotoxic, therefore patients must be monitored with blood tests

Question 361

Medications used to treat HIV

Answer 361

Classified as antiretrovirals -Nucleoside reverse transcriptase inhibitors: -Non nucleoside reverse transcriptase inhibitors: -Protease inhibitors

Question 362

Antidotes and Neutralizing Agents

Answer 362

Antidotes and neutralizing agents are administered in poisoning and overdose situations in an attempt to antagonize or inactivate the substance

Question 363

MOA of Antidotes and Neutralizing Agents

Answer 363

Depending on the drug or poison they are working against, there are several ways that antidotes and neutralizing agents work. They may: -Compete and displace drug from receptor sites -Use a different cellular mechanism to overcome effects of poison -Prevent biotransformation -Bind and inactivate the poison

Question 364

Common Uses of Antidotes and Neutralizing Agents

Answer 364

Intentional and accidental overdose and poisonings

Question 365

Common Examples of Antidotes and Neutralizing Agents

Answer 365

-Antidotes *Narcan (Naloxone) for opioid overdose N-acetyl-L-cysteine for acetaminophen overdose Chelating agents for metal ion poisoning Glucagon for beta blocker overdose Flumazenil for benzodiazepine overdoses -Neutralizing agents *Activated charcoal

Question 366

cautions of Antidotes and Neutralizing Agents

Answer 366

Most poisons have no specific antidote, so care must be supportive in nature, focus on prevention of further absorption, and promote poison elimination

Question 367

common medication classifications that affect the gastrointestinal system

Answer 367

Antacids, Antiflatulents, Digestants, Antiemetics, LaxativesAntidiarrheals

Question 368

Antiemetics

Answer 368

Antiemetic is a classification of medication used to control nausea and vomiting in patients

Question 369

N/V is typically triggered by four main mechanisms:

Answer 369

Stimulation of the cerebral cortex and limbic system.  Stimulation of the chemoreceptor trigger zone (CTZ). Stimulation of the vestibular system.  Stimulation of peripheral pathways. 

Question 370

how Stimulation of the cerebral cortex and limbic system. cause n/v

Answer 370

The common causes of this type of N/V are increasing intracranial pressure, irritation of the meninges and emotional stress

Question 371

how Stimulation of the chemoreceptor trigger zone (CTZ). cause N/V

Answer 371

The CTZ is an area within the ventricle of the brain that is outside of the blood brain barrier that is directly exposed to substances in the blood and Cerebral Spinal Fluid (CSF). Common causes of this type of N/V are metabolic abnormalities, toxins and medications.

Question 372

primary neurotransmitters within the chemoreceptor trigger zone (CTZ)

Answer 372

Dopamine (D2), Serotonin (5HT3) and Neurokinin (NK1) are the primary neurotransmitters within this area of the brain.

Question 373

How Stimulation of the vestibular system.  cause n/v

Answer 373

This is part of the inner ear that controls balance. Stimulation of this system is mediated by Histamine. Common causes of this type of N/V are movement related, i.e. motion sickness, vertigo.

Question 374

how Stimulation of peripheral pathways.  causes N/V

Answer 374

This pathway is triggered by stimulation of receptors in the GI tract, heart and kidneys. Common causes of this type of N/V are toxins in the GI tract, blockage or decreased motility within the bowels.

Question 375

5-HT3 receptor antagonist

Answer 375

This type of antiemetic drug blunts or blocks the effects of Serotonin. It is the most effective in controlling N/V associate with stimulation of the CTZ.

Question 376

H1 Histamine antagonist

Answer 376

This type of antiemetic drug blunts or blocks the effects of H1 Histamine and blunts the vestibular inputs.  this mechanism is effective in treating N/V associated with simulation of the vestibular system.    

Question 377

Some common examples of antiemetics are:

Answer 377

*Gravol (H1 Histamine antagonist) *Ondansetron (5-HT3 receptor antagonist)

Question 378

Acetaminophen-Generic name-Trade name-Classification

Answer 378

Generic name:-AcetaminophenTrade name: -Tylenol®Classification-Analgesic, antipyretic

Question 379

Acetaminophen-Mechanism of action

Answer 379

MOA-Antipyretic action by acting on heat regulating centers in the hypothalamus causing increased heat loss through vasodilation and sweating-Analgesic action by inhibiting prostaglandin synthesis in the central nervous system

Question 380

Acetaminophen-Indications-Contraindications

Answer 380

Indications-Pyrexic child-Severe sepsis-septic shockContraindications-hypersensitivity-Acetaminophen-induced liver disease

Question 381

Acetaminophen-precautions- side effects

Answer 381

Precautions- hepatotoxicity- medications that induce hepatic enzymes-All acetaminophen containing products taken by patient need to be accounted for during 24-hour period including cough and cold remedies, analgesic or arthritis formulations and antipyreticsSide Effects-Nausea / vomiting-Cramping: overdoses in children

Question 382

Acetaminophen-route-dose-pharmacokinetics

Answer 382

Route-PO/PRDose-A: 325–650 mg p 4–6 hours, DNE 4000 mg/24 hrs-P: 10–15 mg/kg p 4–6 hours, DNE 5 doses in 24 hoursPharmacokinetics-Onset: 48 minutes-Peak effects: 48 minutes-Duration: 4–6 hours

Question 383

SKIP FOR NOWAcetaminophen-how supplied

Answer 383

How Supplied-OralImmediate release tablet (325 mg, 500 mg), caplet (325 mg, 500 mg), extended release caplet (650 mg), gel cap (500 mg), chewable tablet (80 mg, 160 mg), rapidly-dissolving tablet (80 mg, 160 mg), suspension (80 mg/mL, 32 mg/mL)-Rectal – Suppository (120 mg, 160 mg, 325 mg, 650 mg)

Question 384

Activated Charcoal-Generic name-Trade name-Classification

Answer 384

Generic:-Activated charcoalTrade names:- Liqui-Char®, Actidose®, Charcodote®Classification-Antidote

Question 385

Activated Charcoal-Mechanism of action

Answer 385

Mechanism of Action-Binds and adsorbs ingested toxins from the gastrointestinal tract

Question 386

Activated Charcoal-Indications-Contraindications

Answer 386

Indications-Oral poisoning or overdoseContraindications-Caustic or corrosive substances-petroleum distillates

Question 387

Activated Charcoal-precautions- side effects

Answer 387

Precautions-decreased LOC.-If ipecac has been administered, wait 10 minutes.Side Effects-Nausea, vomiting-Constipation, cramping, bloating

Question 388

Activated Charcoal-route-dose-pharmacokinetics

Answer 388

Route-PODose-1 g/kg-In massive overdoses, may consider 2 g/kg for adults**Requires Online Medical ControlPharmacokinetics-Onset: Immediate-Peak effects: Varies-Duration: Varies based on gastrointestinal function, will act until excreted

Question 389

SKIP FOR NOWActivated Charcoal-how supplied

Answer 389

-Premixed with water or sorbitol-25 g / 125 mL bottle (200 mg/mL)-50 g / 250 mL bottle (200 mg/mL)

Question 390

Amyl Nitrate-trade name-classification

Answer 390

Trade name: -Amyl Nitrate®Classification-Vasodilator-Antidote

Question 391

Amyl Nitrate-Mechanism of Action

Answer 391

-Binds with hemoglobin to help biodegrade cyanide

Question 392

Amyl Nitrate-indications-contraindications

Answer 392

Indications-Acute cyanide poisoning with impaired LOCContraindications-no concrete proof of cyanide poisoning

Question 393

Amyl Nitrate-precautions-side effects

Answer 393

Precautions-FlammableSide Effects-Drowsiness

Question 394

Amyl Nitrate-route-dose-pharmacokinetics

Answer 394

Route-InhalationDose-0.2–0.3 mL inhaled for 15–30 sec with breaks for 15–30 sec. -New ampoule every 3 min until arrival at emergency departmentPharmacokinetics-Onset: Immediate-Peak effects: 3-5 minutes-Duration: 20 minutes

Question 395

SKIP FOR NOWAmyl Nitrate-how supplied

Answer 395

0.2 mL or 0.3 mL glass ampoule

Question 396

Amyl Nitrate-Special Considerations

Answer 396

Only services that respond to industries where cyanide exposure can occur will stock drug.Retraining and certification is required by a physician every 2 years.

Question 397

Acetylsalicylic Acid (ASA)-generic names-trade name-classification

Answer 397

Generic name:-Acetylsalicylic Acid (ASA)Trade name:-Aspirin®Classification-Platelet inhibitor-anti-inflammatory

Question 398

Acetylsalicylic Acid (ASA)- mechanism of action

Answer 398

Reduces production of thromboxane which mediates platelet aggregation.

Question 399

Acetylsalicylic Acid (ASA)- indications-contraindications

Answer 399

Indications-Chest pain, cardiac in originContraindications-Hypersensitivity to ASA or other NSAIDs-active peptic ulcers

Question 400

Acetylsalicylic Acid (ASA)-precautions-side effects

Answer 400

Precautions-Asthma patientSide Effects-Heartburn,-nausea/vomiting, -wheezing, -prolonged bleeding

Question 401

Acetylsalicylic Acid (ASA)-route-dose-pharmacokinetics

Answer 401

Route-PO, chewedDose-160–325 mgPharmacokinetics-Onset: Within 20 min-Peak effects: Varies-Duration: 2–3 hours

Question 402

SKIP FOR NOWAcetylsalicylic Acid (ASA)-how supplied

Answer 402

81 mg and 325 mg tablets

Question 403

Acetylsalicylic Acid (ASA)-special considerations

Answer 403

Administer regardless whether patient has taken their daily ASA dose

Question 404

Glucose-trade name-classification

Answer 404

Trade name: -Dextrose 50% (D50W), -Dextrose 25% (D25W),-Dextrose 10% (D10W),- Dextrose 5% (D5W)Classification-Carbohydrate, -Antihypoglycemic agent

Question 405

Glucose- mechanism of action

Answer 405

Increases blood sugar levels rapidly

Question 406

glucose-indications-contraindications

Answer 406

IndicationsHypoglycemiaContraindicationsHyperglycemia

Question 407

glucose-precautions-side effects

Answer 407

Precautions-Intracranial pressure – may worsen cerebral edemaSide Effects-Tissue necrosis-local venous irritation

Question 408

glucose-route-dose-pharmacokinetics

Answer 408

Route-IVDose-Adult: 0.5 g/kg IV/IO max 10 g (if suspected head injury or stroke, give in 5-10g increments)-Pediatric: 2 mL/kg D10W IV/IOPharmacokinetics-Onset: Less than 1 min-Peak effects: Varies-Duration: Varies

Question 409

SKIP FOR NOWglucose-how supplied

Answer 409

-How Supplied25 g in 50 mL prefilled syringe (D50W)12.5 g in 25 mL prefilled syringe (D25W)10 g/100 mL in 50 mL, 100 mL, 250 mL, 500 mL and 1000 mL IV bag (D10W)5 g/100 mL in 50 mL, 100 mL, 250 mL, 500 mL and 1000 mL IV bag (D5W)

Question 410

glucose-special considerations

Answer 410

Always ensure that a blood glucose reading is obtained before administration.Since tissue necrosis can occur if IV is interstitial, you must aspirate blood to ensure IV is patent prior to medication administration.

Question 411

Dimenhydrinate-generic name-trade name-classification

Answer 411

Generic name:-DimenhydrinateTrade name: -Gravol®, Dramamine®Classification-Antiemetic (med for N/V)

Question 412

Dimenhydrinate-mechanism of action

Answer 412

Not precisely known, but evidence is that it acts to depress hyperstimulated labyrinthine functions or associated neural pathways. It is also thought to inhibit cholinergic stimulation in the vestibular and associated neural pathways.

Question 413

Dimenhydrinate-indications-contraindications

Answer 413

Indications-Relief of nausea and vomitingContraindications-Hypersensitivity to dimenhydrinate or tartrazine.

Question 414

Dimenhydrinate-interactions

Answer 414

-Narcotics, sedatives or hypnotics, and alcohol – potentiates CNS depression

Question 415

Dimenhydrinate-side effects

Answer 415

Drowsiness, dizziness, blurred visionDry mouth, dry nose and bronchiTinnitus

Question 416

Dimenhydrinate-route-dose

Answer 416

Route-IM, IVDoseIV-Adult: 50 mg over 2 minutes.-Peds: 1 mg/kg over 2 minutes, not to exceed 50 mg.-IM: Concentration 50 mg/1mL-Over 12 yrs: 50 mg q4 hrs.-8–12 yrs: 25–50 mg q8 hrs.-6–8 yrs: 12.5–25 mg q8 hrs.

Question 417

Dimenhydrinate-pharmacokinetics

Answer 417

Excreted in urine, crosses placentaOnset: Immediate (IV), 20–30 minutes (IM)Peak effects: VariesDuration: 3–6 hours

Question 418

SKIP FOR NOWDimenhydrinate- how supplied

Answer 418

50 mg/mL

Question 419

Dimenhydrinate-special considerations

Answer 419

-Should be used cautiously ) in patients with: glaucoma, (COPD), asthma, prostatic hypertrophy, are intoxicated, decreased (LOC).patients with a head injury as it may result in a decreased level of consciousness. C-spine immobilized on a back board, emesis may result in aspiration and obstruction of the airway.

Question 420

Epinephrine 1 mg/mL-generic name-trade name-classification

Answer 420

Generic Name: -EpinephrineTrade name:-AdrenalineClassification-Sympathomimetic

Question 421

Epinephrine 1 mg/mL-mechanism of action

Answer 421

Mechanism of action: Alpha and beta agonist-Alpha-1: Systemic vasoconstriction-Beta-1: Positive inotropic, chronotropic, and dromotropic effects-Beta-2: Bronchial smooth muscle relaxation

Question 422

Epinephrine 1 mg/mL-indications-contraindications

Answer 422

Indications-Anaphylaxis, status asthmaticus, and croupContraindications-Hypersensitivity

Question 423

Epinephrine 1 mg/mL-precautions-side effects

Answer 423

Precautions-Patients with cardiac history, pregnancySide Effects-Tachycardia, palpitations, arrhythmiasHeadache, anxiety, nausea/ vomiting

Question 424

Epinephrine 1 mg/mL-route -

Answer 424

IM, SQ, Nebulized

Question 425

Epinephrine 1 mg/mL-dose adult anaphylaxis

Answer 425

Anaphylaxis:-Mild / Moderate: 0.3 mg IM (of a 1 mg/mL concentration) q 5 minutes prn to a total maximum of 0.9 mg-Severe: 0.5 mg IM (of a 1 mg/mL concentration) q 5 minutes prn to a total maximum of 1.5 mg

Question 426

Epinephrine 1 mg/mL-dose adult status asthmaticus

Answer 426

0.3 – 0.5 mg SC/IM (of 1 mg/mL concentration) q 5 – 10 minutes prn to a total of 1 mg

Question 427

Epinephrine 1 mg/mL- dose Peds anaphylaxis

Answer 427

Anaphylaxis-Mild / Moderate: 0.01 mg/kg (0.01 mL/kg of a 1 mg/mL concentration) IM to a single maximum dose of 0.3 mg q 5 minutes prn to a total maximum of 0.9 mg-Severe: 0.01 mg/kg (0.01 mL/kg of a 1 mg/mL concentration) IM to a single maximum dose of 0.5 mg q 5 minutes prn to a total maximum of 1.5 mg

Question 428

Epinephrine 1 mg/mL- dose Peds status asthmaticus

Answer 428

0.01 mg/kg IM single minimum dose of 0.1 mg to a single maximum dose of 0.3 mg (of a 1 mg/mL concentration) q 5 minutes prn to a total maximum of 0.03 mg/kg

Question 429

Epinephrine 1 mg/mL- dose Peds croup

Answer 429

0.5 mg/kg to a max of 5 mg diluted in 2-3 ml NaCl, repeat dose x 1 prior to Online Medical Control (OLMC)

Question 430

Epinephrine 1 mg/mL-pharmacokinetics

Answer 430

Onset: ImmediatePeak effects: VariesDuration: 5–10 min

Question 431

Epinephrine 1 mg/mL-how supplied-special considerations

Answer 431

1 mg/mLCan be deactivated by alkaline solutions

Question 432

Glucagon-trade name-classification

Answer 432

Trade name:-GlucagonClassification-Hormone-anti-hypoglycemic agent

Question 433

Glucagon-mechanism of action

Answer 433

Increases blood glucose levels by causing breakdown of glycogen to glucose, increases heart rate and cardiac contractility

Question 434

glucagon-indications-contraindications

Answer 434

Indications-LOC due to hypoglycemia where an IV cannot be establishedContraindications-Hypersensitivity,-hyperglycemia

Question 435

glucagon -precautions-side effects

Answer 435

Precautions-Hepatic or renal insufficiencySide Effects-Tachycardia,-nausea/vomiting,-hypertension

Question 436

glucagon-route-dose-pharmokinetics

Answer 436

Route-SQ, IMDose-12 years and older: 1 mg with repeat in 15 min as needed-Under 12 years: 0.1 mg/kg to a max of 1 mg with repeat in 15 min as neededPharmacokinetics-Onset: 13-20 min-Peak effects: 30 min-Duration: 1–2 hours

Question 437

glucagon-how supplied SKIP FOR NOW-special considerations

Answer 437

How Supplied-1 mg/mL (requires reconstitution)Special Considerations-Ineffective if glycogen stores are depleted

Question 438

Ibuprofen -generic name-trade name-class

Answer 438

Generic name: -Ibuprofen Trade name: -Motrin®, Advil®Classification -NSAID, Analgesic, Antipyretic

Question 439

Ibuprofen -MOA

Answer 439

-Anti-Inflammatory, analgesic, and antipyretic activities by inhibiting prostaglandin synthesis in the central nervous system.  -Inhibits both COX-1 and COX-2

Question 440

Ibuprofen -Indications -Contraindications

Answer 440

Indications -Mild to moderate pain, fever reduction Contraindications -Hypersensitivity

Question 441

Ibuprofen -precautions-side effects

Answer 441

Precautions -Use caution with cardiovascular dysfunction, hypertension, peptic ulcers, GI bleeds, pregnancy, and impaired hepatic or renal function -When taken with lithium, may cause increase risk of lithium toxicity -If taken with a diuretic may cause diuretic to have a decreased effect -May cause a decreased antihypertensive effect of B-adrenergic blocking drugs

Question 442

Ibuprofen -side effects

Answer 442

GI upset, epigastric pain, heartburn, and abdominal pain

Question 443

Ibuprofen -route-dose-pharmacokinetics

Answer 443

Route-PODose-Adult: 200–400 mg every 4–6 hours, not to exceed 3200 mg/24 hours-Pediatric: 5–10 mg/kg every 6 hours, not to exceed 40 mg/kg in 24 hoursPharmacokinetics-Onset: 30 min-Peak effects: 1–2 hours-Duration: 4–6 hours

Question 444

SKIP FOR NOWIbuprofen - how supplied

Answer 444

-Oral – tablet (100 mg, 200 mg, 400mg, 600mg, 800mg), chewable tablets (50 mg, 100 mg), capsules (200 mg), Suspension (100 mg/2.5mL, 100 mg/5mL), oral drops (40 mg/mL)

Question 445

Ipratropium Bromide -generic name-trade name-class

Answer 445

Generic name:-Ipratropium Bromide Trade name:-Atrovent® Classification -Anticholinergic

Question 446

Ipratropium Bromide -MOA

Answer 446

-Bronchodilation, smooth muscle relaxation

Question 447

Ipratropium Bromide -indications -contraindications

Answer 447

Indications -Bronchial asthma that has not responded to salbutamol -Severe bronchospasm -Bronchospasm associated with Chronic Obstructive Pulmonary Disease (COPD) Contraindications -Hypersensitivity -Administered within last 4 hours

Question 448

Ipratropium Bromide -precautions-side effects

Answer 448

Precautions -Monitor vitals -Caution in elderly Side Effects -Dry mouth, metallic taste -Headache, dizziness -Anxiety, palpitations

Question 449

Ipratropium Bromide - route-dose-pharmockinetics

Answer 449

Route -Inhalation via nebulizer Dose -12 years and older: 250 mcg–500 mcg -5 to 12 years: 125 mcg - 250 mcg Pharmacokinetics -Onset: 5–15 min -Peak effects: Varies -Duration: 4–6 hours

Question 450

Ipratropium Bromide-how supplied SKIP FOR NOW-Special Considerations

Answer 450

How Supplied -250 mcg in 2 mL Special Considerations -Patients with glaucoma should wear goggles while administered

Question 451

Ketorolac -generic name-trade name-class

Answer 451

Generic name: -Ketorolac Trade name:-Toradol® Classification -Nonsteroidal Anti-Inflammatory Drug (NSAID)

Question 452

Ketorolac -MOA

Answer 452

-Exhibits peripherally acting non-narcotic analgesia activity by inhibiting prostaglandin synthesis

Question 453

Ketorolac -indications-contraindications

Answer 453

Indications  -Pain refractory to opioids -Renal colic Contraindications -Hypersensitivity to ketorolac or other non-steroidal anti-inflammatory agents -Asthma -History of significant renal disease, except renal colic -Suspected intracranial bleed -History of GI bleeding -Subarachnoid hemorrhage (indicated by sudden onset/most severe ever headache/thunderclap) Pregnancy

Question 454

Ketorolac -precautions-side effects

Answer 454

Precautions -Can cause peptic ulcers, should not use for abdominal or chest pain Side Effects -Headache, heartburn, nausea, vomiting, diarrhea, stomach pain, bloating

Question 455

Ketorolac -route-dose-pharmacokinetics

Answer 455

Route -IV or IM Dose -30 mg IV/IM -15 mg IV/IM If the patient is over 65 years of age Pharmacokinetics -Onset: approx. 30 minutes -Peak effects: 45–60 minutes -Duration: 4–6 hours

Question 456

Ketorolac -How Supplied SKIP FOR NOW-special considerations

Answer 456

How Supplied -Vials or Ampules doses per vial or ampule can vary from 10, 15, 30 or 60 mg/mL Special Considerations -Patient should be placed on the cardiac monitor after administration.

Question 457

Naloxone -generic name-trade name-class

Answer 457

Generic name:-Naloxone Trade name: -Narcan® Classification Opioid Antagonist

Question 458

Naloxone -MOA

Answer 458

Reverses effects of narcotics by competing and displacing narcotic from opiate receptors in the brain

Question 459

Naloxone -indications-contraindications

Answer 459

Indications  -Suspected narcotic overdose with respiratory depression Contraindications -Hypersensitivity

Question 460

Naloxone -precautions-side effects

Answer 460

Precautions -Use with caution with narcotic-dependent patients and neonates of narcotic-addicted mothers Side Effects -Acute withdrawal symptoms

Question 461

Naloxone -route-dose-pharmocokinetics

Answer 461

Route -IM, IV, IN Dose -Adult: 0.4–2 mg (titrate to effect) -Pediatric: 0.01 mg/kg–0.1 mg/kg to max of 2 mg (titrate to effect) Pharmacokinetics -Onset: Within 2 min -Peak effects: Varies -Duration: 45 min

Question 462

Naloxone - how supplied SKIP FOR NOW-Special Considerations

Answer 462

How Supplied -0.02 mg/mL, 0.4 mg/mL, and 2 mg/2 mL Special Considerations -Short acting, may need a repeat dose in 5 min

Question 463

Nitroglycerin -generic name-trade name-class

Answer 463

Generic name: -nitroglycerin Trade name: -Nitrostat®, Nitrolingual® Classification -Vasodilator, antianginal

Question 464

Nitroglycerin -MOA

Answer 464

Relaxes vascular smooth muscle causing vasodilation (increases blood flow and decreases preload)

Question 465

Nitroglycerin -indications-contraindications

Answer 465

Indications -Suspected cardiac chest pain, pulmonary edema Contraindications -Systolic blood pressure below 100 mmHg -Pulse less than 50/min -Viagra® (sildenafil), Levitra® (vardenafil), or Cialis® (tadalafil) within the last 24 hours

Question 466

nitroglycerin-Precautions -side effects

Answer 466

Precautions -Continuously monitor vitals Side Effects -Syncope, dizziness, hypotension, headache,

Question 467

nitroglycerin-route-dose-pharmocokinetics

Answer 467

Route -SL Dose -0.3–0.4 mg q 5 min to max of 3 Pharmacokinetics -Onset: 1–3 min -Peak effects: 5–10 min -Duration: 20–30 min

Question 468

nitroglycerin-How Supplied SKIP FOR NOW-Special Considerations

Answer 468

How Supplied -Spray: 0.4 mg -Tablet: 0.3 mg, 0.6 mg Special Considerations -Keep out of heat and light 

Question 469

Nitrous Oxide (N20) -generic name-trade name-class

Answer 469

Generic name: -Nitrous Oxide (N20) Trade name: -Nitronox®, Entonox® Classification -Analgesic gas

Question 470

Nitrous Oxide (N20) -MOA

Answer 470

Depresses the central nervous system and relieves pain

Question 471

Nitrous Oxide (N20) -indications-contraindications

Answer 471

Indications -Musculoskeletal injuries, burns, active childbirth Contraindications -Abdominal pain indicative of a bowel obstruction -Pneumothorax -Head injury, impaired mental status, intoxication, decompression sickness, inability to follow commands -Severe Chronic Obstructive -Pulmonary Disease (COPD)

Question 472

Nitrous Oxide (N20) -precautions-side effects

Answer 472

Precautions -Use in well-ventilated area Side Effects -Headache, nausea, vomiting

Question 473

Nitrous Oxide (N20) -route-dose-pharmacokinetics

Answer 473

Route -Inhalation Dose -Self-administered via demand valve Pharmacokinetics -Onset: 2–5 min -Peak effects: Varies -Duration: 2–5 min

Question 474

Nitrous Oxide (N20) -How Supplied SKIP FOR NOW-Special Considerations

Answer 474

How Supplied -Cylinder containing 50% nitrous oxide and 50% oxygen Special Considerations -May not work in low temperatures -Monitor SpO2

Question 475

Ondansetron -generic name-trade name-class

Answer 475

Generic name: -Ondansetron Trade name:- Zofran®, Zofran ODT®, Zuplenz® Classification -Antiemetic, selective 5-HT3 antagonist

Question 476

Ondansetron -MOA

Answer 476

-Not fully characterized; selective 5-HT3 receptor antagonist; binds to 5-HT3 receptors both in PNS and CNS with primary effect on GI tract. -It has no effect on dopamine receptors, therefore does not cause extrapyramidal symptoms.

Question 477

Ondansetron -indications-contraindications

Answer 477

Indications -Nausea and vomiting (chemotherapy, postoperative, and radiation) -Nausea and vomiting NOT cause by vertigo, motion sickness or inner ear disturbances -Hyperemesis Contraindications -Hypersensitivity -Co-administration with apomorphine has been reported to cause profound hypotension and loss of consciousness

Question 478

Ondansetron -cautions-side effects

Answer 478

Cautions -Reduce dose with severe hepatic impairment Side Effects -Gastrointestinal: nausea and vomiting -Anaphylaxis -General: flushing, rare cases of hypersensitivity reactions, sometimes severe (e.g., anaphylactic reactions, angioedema, bronchospasm, cardiopulmonary arrest, hypotension, laryngeal edema, laryngospasm, shock, shortness of breath or stridor) -Local reactions: pain, redness, burning feeling at site -Lower respiratory: hiccups -Neurological: oculogyric crisis -Integumentary: Urticaria, Stevens-Johnson syndrome and toxic epidermal necrosis -Ocular: transient blindness (mostly IV administration) reported to resolve within 48hrs -Musculoskeletal: arthralgia

Question 479

Ondansetron -route-pharmacokinetics

Answer 479

Route -IM, IV, Orally Pharmacokinetics -Onset: 30 mins -Peak effects:  1–2 hours (IV) -Duration: 3–6 hours (IV)

Question 480

Ondansetron -dose

Answer 480

Adult <65: 4–8 mg IV/IM-IV push over 2–5 min, repeat q 8 hours (can be diluted in 10 mLs of NS or undiluted) Adult >65:4–8 mg- IV/IM-IV is mixed in 50 mL bag and infused over 15–20 minutes, repeat q 8 hours Note: Can be given orally if necessary, when IV/IM not possible Pediatrics (8–15 kg): 2 mg IV/IM- IV push over 2–5 minutes (can be diluted in 10 mLs NS or undiluted) Pediatrics (over 15 kg): 4 mg IV/IM - IV push over 2–5 minutes (can be diluted in 10 mLs NS or undiluted), with one repeat.

Question 481

Ondansetron -how supplied SKIP FOR NOW-special considerations

Answer 481

How Supplied -2 mg/mL (2 mL) OR 2 mg/mL (4 mL) Special Considerations -Ondansetron is generally given to patients undergoing Chemotherapy and/or radiation therapy to treat the nausea and vomiting. -Note: for children, it does not appear to be a drug of choice to treat nausea and vomiting. -Dose-dependent  QT  prolongation -Avoid in patient with congenital long QT syndrome -ECG monitoring recommended in patient who have electrolyte abnormalities, congestive heart failure (CHF) or bradycardia arrhythmias, or who are also receiving other medications that cause QT prolongation.

Question 482

Oral Glucose -generic name-trade name-class

Answer 482

Generic name:- Oral glucose Trade name: -Glutose®, Insta-Glucose® Classification -Carbohydrate, monosaccharide

Question 483

Oral Glucose -MOA

Answer 483

Provides prompt increase in circulating blood sugar

Question 484

Oral Glucose -indications-contraindications

Answer 484

Indications -Hypoglycemia Contraindications -Hyperglycemia

Question 485

Oral Glucose -precautions-side effects

Answer 485

Precautions -If patient has decreased level of consciousness, patient must be placed on side and glucose applied buccally Side Effects -Nausea and vomiting

Question 486

Oral Glucose -route-dose-pharmacokinetics

Answer 486

Route -PO Dose -15–45 g Pharmacokinetics -Onset: Immediate -Peak effects: Varies -Duration: Varies

Question 487

Oral Glucose -how supplied-special considerations

Answer 487

How Supplied -In tubes and tablets of varying concentrations Special Considerations -Always ensure that a blood glucose reading is obtained before administration

Question 488

oxygen-trade name-class

Answer 488

Trade name: -Oxygen Classification -Gas

Question 489

oxygen-MOA

Answer 489

Reverses hypoxemia, necessary for cellular metabolism

Question 490

oxygen-indications-contraindications

Answer 490

Indications -Hypoxia, signs of inadequate tissue perfusion Contraindications -None

Question 491

oxygen-precautions-side effects

Answer 491

Precautions -Chronic obstructive pulmonary disease (COPD) Side Effects -Drying of mucus membranes

Question 492

oxygen-route-dose-pharmacokinetics

Answer 492

Route -Inhalation Dose -2–15 lpm (titrate to effect) Pharmacokinetics -Onset: Immediate -Duration: Less than 2 min

Question 493

oxygen-how supplied-special considerations

Answer 493

How Supplied -Oxygen cylinders containing 100% compressed gas Special Considerations -Humidify if using for long periods of time

Question 494

Methoxyflurane (Penthrox®) -generic name-trade name-class

Answer 494

Generic name:-Methoxyflurane Trade name: -Penthrox® Classification Analgesic gas -

Question 495

Methoxyflurane (Penthrox®) -MOA

Answer 495

Active ingredient is methoxyflurane, works by decreasing the CNS and making patients less responsive to pain. Research is unsure how this drug effects the CNS.

Question 496

Methoxyflurane (Penthrox®) -indications-contraindications

Answer 496

Indications -Moderate to severe pain related to trauma Contraindications -Inadequate understanding/patient cooperation -Decreased level of consciousness -Psychosis -Pre-eclampsia -Moderate to severe renal and/or liver impairment -Hypersensitivity/ family history of malignant hyperpyrexia without negative personal test -Significant cardiovascular compromise -Raised intracranial pressure

Question 497

Methoxyflurane (Penthrox®) -precautions-side effects

Answer 497

Precautions -Used with care in patients with underlying hepatic conditions -Previous exposure to halogenated hydrocarbon anesthetic (methoxyflurane when used as an anesthetic agent) especially if the interval is less than 3 months.  -May increase the potential for hepatic injury. Side Effects -Altered level of consciousness -Cough

Question 498

Methoxyflurane (Penthrox®) -route-dose-pharmacokinetics

Answer 498

Route -Inhalation Dose -Self-administered -One bottle containing 3 mL of Penthrox® to be vaporized is a supplied inhaler -Maximum dose is 6 mL in a 48-hour period Pharmacokinetics -Onset 1 to 3 minutes -Duration 1 hour -Half-life unavailable

Question 499

Methoxyflurane (Penthrox®) -how supplied SKIP FOR NOW-special notes

Answer 499

How Supplied -Bottle containing 3 mL Penthrox® Special Notes -When disposing Penthrox®, the inhaler and medication is to be placed in plastic bags provided, sealed and disposed

Question 500

Salbutamol -generic name-trade name-class

Answer 500

Generic name: -Salbutamol Trade name: -Ventolin® Classification -Bronchodilator