Pharmocology Flashcards
(140 cards)
0
Q
What are the indications for Acetaminophen?
A
- Fever in pediatric patients during long transports
1
Q
What class of drug is Acetaminophen?
A
Analgesic, Antipyretic
2
Q
What are the contraindications for Acetaminophen?
A
- Hypersensitivity to the drug
- Hepatic (liver) failure or impairment
3
Q
What is the adult dose for Acetaminophen?
A
None
4
Q
What is the ped dose for Acetaminophen?
A
10-15 mg/kg PO
Not to exceed 50 mg/kg/24hrs
5
Q
What is Acetaminophen used for in the field?
A
Fever control in ped patients during long transports to prevent febrile seizures
6
Q
What class of drug is Aspirin?
A
Anti-platelet
7
Q
What are the indications for Aspirin?
A
MI patient, including suspected AMI, chest pain
8
Q
Contraindications for Aspirin?
A
Hypersensitivity
Bleeding disorders
Asthma (Relative)
9
Q
Adult does for a Aspirin?
A
162-324 mg PO for AMI chewed
10
Q
Ped does for Aspirin?
A
None
11
Q
What class of drug is Activated Charcoal?
A
Gastrointestinal Adsorbent
12
Q
Indications for Activated Charcoal?
A
Used to treat cases of poisoning and over doses in alert patients. Long transport anticipated
13
Q
Contraindications for Activated Charcoal?
A
- Acids and alkali ingestion unless other drugs have been ingested
- GI obstruction
14
Q
Drug interactions for Activated Charcoal
A
- Contact MCEP before giving for acetaminophen OD’s. Charcoal interferes with the function of N- Acetylcysteine, an antidote for acetaminophen
- milk products decrease effectiveness
15
Q
Adult and ped dose for Activated Charcoal?
A
1g/kg PO
16
Q
What class of drug is Albuterol?
A
Sympathomimetic, Beta 2 selective adrenergic bronchodilator
17
Q
Indications for Albuterol?
A
Used to treat reversible airway obstruction caused by:
- Wheezing associated with asthma
- COPD (emphysema)
- Chronic bronchitis
18
Q
Contraindications for Albuterol?
A
Hypersensitivity
19
Q
Drug interaction for Albuterol
A
Beta adrenergic agents- potentiates the effects
MAO inhibitors (anti-depressant)- May lead to hypersensitive crisis, may lead to stroke
Beta adrenergic blockers- decrease the effectiveness
20
Q
Adult dose for Albuterol
A
2.5-5 mg up to 10mg in 3 ml of NS over 5-15min NEB
21
Q
Ped dose for Albuterol
A
1.5-2.5 mg up to 5 mg in 3 ml NS over 5-15 min NEB
22
Q
What is the other name for Promethazine?
A
Phenergan
23
Q
What class of drug is Phenergan?
A
Anti-emetic
24
Indications for Phenegran?
Treatment and prevention of nausea and vomiting
25
Contraindications for Phenergan
- hypersensitivity
- comatose patients
- CNS depression due to drugs
- children < 2yrs old, or critically ill or dehydrated
26
Drug interaction with Phenergan
1) CNS depressants- May increase, prolong or intensify the sedative action
2) Anticholinergics- use caution
3) MAO inhibitors- use caution
27
Adult dose for Phenergan
6.25-25 mg PO, IM, IV/IO every 4 hrs as needed
28
Peds dose for Phenergan
> 2yrs .25-.5 mg/kg PO, IM, every 4 hours as needed
29
Special notes for Phenergan
- use cautiously in patients with hypertension, epilepsy, sleep apnea, cardiovascular disease, impairment of the liver, and pregnancy
- May cause drowsiness
30
What is the other name for Ondansetron?
Zofran
31
What class of drug is Zofran?
Anti-emetic, selective serotonin blocking agent
32
Indications for Zofran
Treatment and prevention of nausea and vomiting
33
Contraindications for Zofran
Known sensitivity to Ondansetron or related agents
34
Drug interactions for Zofran
None
35
Adult dose for Zofran
4mg IV/IO slow IVP, IM. May repeat in 30 min
8mg Oral Dissolving Tablets (ODT)
36
Peds does for Zofran
0.1 mg/kg IV/IO slow IVP, IM
4mg ODT (12-17 years of age)
37
How many tablets of Zofran can you administer?
Only one. Do not exceed adult or ped dose
38
Special notes for Zofran?
Do not use in patients with known prolonged QT syndrome
39
What class of drug is Atropine Sulfate?
Anticholinergics (parasympatholytic)
40
Indications for Atropine Sulfate
1) Symptomatic sinus bradycardia or A-V blocks
2) Anticholinesterase poisoning- organophosphate, mushroom (specific type)' and nerve gasses
3) adjunct in the treatment of bronchial asthma
41
Contraindications for Atropine sulfate
None
42
Drug interactions with Atropine Sulfate
Antihistamines, tricyclic antidepressants - additive effect
43
Adult dose for Atropine Sulfate
2mg IV repeated to control parasympathomimetic signs
44
Peds dose for Atropine Sulfate
.05 mg/kg IV, ET, or IO repeated to desired effect
45
Special notes for Atropine Stulfate
- May not be effective with high degree AV block
| - increases workload and myocardial O2 consumption of heart.
46
What is the brand name for Methylprednisolone?
Soul-Medrol
47
What class of drug is Solu-Medrol?
Anti-Inflammatory, immunosuppressant
48
Drug interactions for Solu-Medrol
- Reactive airway disease with no response to Albuterol and other treatments
- Allergic reaction
49
Contraindications for Solu-Medrol
Absolute - Hypersensitivity
| Relative - Immunocompromised state, serious infection, psychotic disorders
50
Adult dose for Solu-Medrol
125-250 mg IV q 6 hours
51
Ped dose for Solu-Medrol
1-2 mg/kg IV q 6 hours
52
Special notes for Solu-Medrol
1) Adverse effects- hyperglycemia; psychosis
| 2) May be ordered by a neurosurgeon for spinal cord injury
53
What class of drug is Dextrose
Carbohydrate, nutrient, short acting osmotic diuretic
54
Indications for Dextrose? (4)
1) Symptomatic hypoglycemia
2) Unconsciousness of unknown origin
3) Seizures (associated with decreased BGL) of:
- Unknown etiology
- New onset of seizures
- Known diabetic actively seizing
4) Refractory medical cardiac arrest (especially in neonates)
55
Contraindications for Dextrose? (5)
1) intra-cranial bleeds
2) Delirium tremens with dehydration
3) administration through the same infusion set as blood
4) Unconscious (for oral dextrose)
5) Suspected CVA
56
Oral and adult IV dose for Dextrose
Oral: 12-25 g of paste
IV: 25-50g slow push if patient can't protect own airway for oral glucose
57
Peds and Neonate dose for Dextrose?
Ped: dilute 1:1 with sterile saline to make 25% solution (0.25mg/ml) Give (0.5-1 g/kg) slow IV push
Neonate: Use 10% Dextrose solution (dilute 50ml D50 in 500ml bag of D5W) at (0.2g/kg)
58
Special notes for Dextrose
1) attempts at documenting hypoglycemia via automatic glucometry should be made before administration
2) Must insure patent IV line, and recheck latency during administration
59
What is the brand name for Diphenhydramine HCL?
Benadryl
60
What class of drug is Benadryl?
Antihistamine, H1 blocker
61
Indications for Benadryl (3)
1) Allergic reactions
2) Anaphylaxis
3) Dystonic reaction to Phenothiazines (Phenergan)
62
Contraindications for Benadryl
Acute Asthma
63
Drug interaction for Benadryl (Diphenhydramine)
Additive CNS depression with alcohol, sedatives, narcotics
64
Adult and Ped dose for Benadryl
Adult - 12.5-50 mg slow IV/IO at a rate of 1ml/min or deep IM injection
Ped - 1mg/kg slow IV/IO; deep IM injection with a max dose of 50 mg
65
Special notes for Benadryl
1) May have an immediate effect in Dystonic reactions
| 2) No early benefit in allergic reactions
66
What class of drug is Epinephrine?
Sympathomimetic
67
Indications for Epi (5)
1) Severe Bronchospasm
2) Bronchospasms unresponsive to Albuterol
3) Anaphylaxis
4) Cardiac arrest
5) Symptomatic bradycardia after other treatments
68
Drug interaction for Epi
Reduced effects with Beta-adrenergic blocker
69
Epi 1:10,000 adult and Ped dose
Adult: 1mg every 3-5 min IV/IO preferred, may be given ET [2-2.5 times IV dose]
Ped: .01mg/kg
70
Epi (1:1,000) adult and ped dose for Bronchospasm/Anaphylaxis
Adult : .3mg SQ or IM or [.1 mg(1:10,000) IV/IO over 5 min. Infusion of 1-4 mcg/min]
Ped : 0.01 mg/kg SQ or IM to max dose of .3mg/dose
71
What class of drug is Glucagon
Hormone - hyperglycemic agent
72
Indications for Glucagon
Documented symptomatic hypoglycemia (BGL less then 60 mg/dl) when an IV/IO can't be started
73
Contraindications for Glucagon (3)
1) Patients who will be unable to receive supplemental glucose orally, IV
2) Hypersensitivity to pork/beef
3) Use with caution on patients with pheochromocytoma (vascular tumor)
74
Drug interactions with Glucagon
1) Hyperglycemic effects intensified and prolong by Epi
| 2) Will precipitate when mixed with calcium preparation
75
Adult and Ped dose of Glucagon for Hypoglycemia
Adult : 0.5-1 mg IM, my repeat in 10-20 min if no response
Ped : 0.1 mg/kg IM may repeat in 10-20 min if no response
76
Adult and Ped dose of Glucagon for Beta Blocker overdose
Adult : 3-10 mg IV/IO over 1 min. It may be followed by an infusion do 2-5 mg/hr
Ped : 0.1 mg/kg up to 1 mg over 1 min repeat in 5 min if needed
77
Adult and Ped dose of Glucagon for Anaphylaxis
Adult : 1-2 mg slow IV/IO, May be repeated every 5-10 min
Ped : 0.1 mg/kg up to 1 mg IV/IO may be repeated every 5-10 min
[1ml of NS for each 1mg of powder and shake well]
78
Special note for Glucagon
- Glucagon will release all of the patients available Glycogen. If the patient is not provided with glucose, the subsequent hypoglycemia will be greater than before glucagon.
79
What class of drug is Hydroxocobalamin
Antidote
80
Indications for Hydroxocobalamin
Treatment for cyanide poisoning
81
Contraindications for Hydroxocobalamin
Rare anaphylactic reactions
82
Drug interactions with Hydroxocobalamin
Used in combination with sodium thiosulfates to treat methemoglobinemia. No more effective then sodium nitrite
83
Adult and ped dose for Hydroxocobalamin
Adult : 5 grams IV/IO over 30 min
Ped : (<70kg): 70 mg/kg IV/IO
84
Special notes for Hydroxocobalamin
1) transient hypertension
| 2) reddish discoloration of skin and mucous membranes
85
What is the brand name for Ipratroprium
Atrovent
86
What class of drug is Ipratroprium
Anticholinergic
87
Indications for Ipratroprium
1) Bronchial asthma
| 2) Reversible bronchospasm associated with chronic bronchitis and emphysema
88
Contraindications for Ipratroprium
1) hypersensitivity to the drug, especially with Atropine products, soy and peanuts
2) acute treatment of bronchospasm where rapid response is required
89
Drug interactions with Ipratroprium
Oxivent and Spiriva
90
Dose for Ipratroprium
1-2 inhalation via metered dose inhaler
[250-500 mcg (.25-.5 mg)] via NEB
* use caution when administering it to elderly patients and those with cardiovascular disease or hypertension
91
What class of drug is Lidocaine Hydrochloride (Xylocaine)
Antidysrhythmic, local anesthetic
92
Indications for Lidocaine
1) Symptomatic ventricular dysrhythmias
2) Sustained ventricular tachycardia
3) Ventricular fibrillation/pulseless ventricular tachycardia
4) Local anesthetic for nasal intubation
93
Contraindications of Lidocaine
1) hypersensitivity
| 2) high AV Blocks
94
Drug interactions with Lidocaine
Additive cardiac depression with phenytoin, quinidine, procainamide, and propranolol
95
IV/IO Bolus technique for Lidocaine for adults and Peds
2%
96
IV Drip technique for Lidocaine adult
Adult : mix 1g of lidocaine in 250 ml D5W or NS for a con. of 4mg/kg
A.) if up to 2mg/kg has been admin., set drip to 2mg/min
B.) if 2mg/kg has been admin., set drip to 3mg/min
C.) if 3 mg/kg has been admin., set drip to 4mg/min
* a second Bolus after 10 min may be given per physicians order
97
IV Drip technique for Lidocaine for Peds
Mix 120 mg of lidocaine in 100 ml D5W
A.) set drip at 20-50 uh/kg per min. (1-2.5 cc/kg/hr at above dilution)
ET 2-2.5 times the Bolus dose
98
Special note for lidocaine
For patients over 70 years of age, or with hepatic or renal failure, the loading dose remains the same, but maintenance infusion is run at half the normal rate
99
What class of drug is Narcan
Narcotic antagonist
100
Indications for Narcan
- Reversal of narcotic effects
| - For unconsciousness of unknown etiology to rule out or reverse narcotic depression of CNS
101
Contraindications for Narcan
- Hypersensitivity
| - Absence of indications
102
Adult, ped, and neonate, dose for Narcan
Adult : 0.4-2mg IV/IO, IM, SQ, ET may be repeated at 2-3 minutes
Ped : 0.1 mg/kg < 5 yrs or _< 20 kg (2mg) > 5yrs or > 20kg IV, ET,IM, SQ, IO, May be repeated at 0.1 mg/kg
Neonate : 0.1 mg/kg slow IV, ET, IM, SQ, IO
(Mix 1ml of Narcan, 0.4 mg in 9 ml of D5W, which gives 0.04 mg/ml)
103
What class of drug is Hydromorphone (Dilaudid)
Opiate analgesic
104
Indications for Dilaudid
1) Analgesia for patients with moderate to severe pain
105
Contraindications for Dilaudid (5)
1) hypersensitivity
2) hypotension is relative. Pain may cause patient to be hypotensive
3) Head or abdominal injuries, since the analgesic effect removes the clinical signs that need to be watched
4) Respiratory difficulty
106
Drug interactions with Dilaudid (2)
1) additive effects with other CNS depressants
| 2) MAO inhibitors can cause sever reactions, reduce does to 25% normal dose
107
Adult and Ped dose for Dilaudid
Adult : 0.5-1.0 mg slow IV/IO push until desired effect
Ped : None
108
Special notes for Dilaudid (4)
1) Take vital signs before and 2 min after administration
2) IV/IO only
3) Often causes vomiting; administer SLOWLY
4) On-line medical control should be contacted before administering to the non-cardiac patient
109
What class of drug is Fentanyl (Sublimaze)
Opiate Analgesic
110
Indications for Fentanyl
Analgesia for patients with moderate to sever pain
Isolated extremity fractures
AMI
111
Contraindications for Fentanyl (4)
1) Hypersensitivity/ known intolerance
2) Patients particularly sensitive to respiratory
3) Myasthenia gravis (generalized muscle weakness)
4) Pregnancy
- abdominal pain
- increased ICP
112
Adult and Ped dose for Fentanyl
Adult : 25-50 mcg IV/IO
Ped : 2-12yrs of age - [0.5 - 1 mcg/kg] IV/IO
113
Special notes for Fentanyl
1) Use cautiously in geriatric or debilitated patient (use lower doses), diabetics, patients with pulmonary or hepatic disease, head trauma, increased ICP, undiagnosed abdominal pain and cardiac disease.
2) Abdominal distension, muscle rigidity, and/or urinary retention may be seen at high doses
114
What class of drug is Morphine Sulfate
Opiate analgesic
115
Indications for Morphine
- isolated extremity trauma
- cardiac chest pain (preferred drug)
- burns
116
Contraindications for Morphine (5)
1) Hypersensitivity
2) Hypotension is a relative contraindications to use. Remember that some people will be hypotensive in response to pain itself.
3) Head or abdominal injuries also contraindicated
4) Do not use in persons with respiratory difficulties because their respiratory drive might be depressed, expect in pulmonary edema
5) Do not use with presence of major blood loss
117
Adult and Ped dose for Morphine
Adult : 2-10 mg SLOW IV/IO push until desired effect achieved
Ped : 0.1 mg/kg slow IV/IO titrated to effect
118
Special notes for Morphine (4)
1) Take vitals before and 2 mins after administration
2) IV/IO only (unless ordered IM by physician)
3) Often causes vomiting; administer slowly
4) On-line medical control should be contracted before administering to the non-cardiac patient
119
What class of drug is Nitroglycerin
Anti-anginal agent/vascular dilating agent
120
Indications for Nitroglycerin
1) Chest pain, anginal pain
| 2) CHF with severe pulmonary edema
121
Contraindications for Nitro (6)
1) Hypersensitivity
2) Severe hypotension
3) Pericardial tamponade
4) Increased intra-cranial pressure
5) Hypovolemia/ severe anemia
6) Can cause a lethal drop in BP when patients are taking Viagra within 48 hours of ingestion
122
Adult and Ped dose for Nitro
- SL
- Spray
Adult:
SL- 0.3-0.4 mg tablet. Repeat at 3-5 mins to total of 3 tabs
Spray- 0.4 mg (one spray) metered dose, under tongue. Repeat at 3-5 mins to total of 3 spray
Ped: Not recommend for pre-hospital
123
Special notes for Nitro (7)
1) Side effects : throbbing headache, flushed, dizziness, and burning under the tongue
2) marked hypotension, particularly orthostatic (sitting upright)
3) use your nitro not patients
4) Use caution with patient not previously receiving nitro
5) Generalized vasodilation may cause profound hypotension and reflex tachycardia
6) tabs loose potency easily, nitro spray doesn't have this problem
7) Use only with medical control on patients with systolic BP below 100 mm Hg
124
What class of drug is Oxygen
Class III gas, Oxidizer
125
What class of drug is Potassium
Electrolyte
126
Indications for Potassium
1) Renal (Kidney) Failure
| 2) IV preparations are used for treatment or prophylaxis of hypokalemia (potassium deficiency in the blood)
127
What is the requirement for potassium
Not to exceed 20 mEq/1000cc or more than 10 mEq/hr.
128
Contraindications for potassium (4)
1) Severe renal impairment
2) Hyperkalemia (high level of potassium)
3) Untreated Addison's disease (low BP)
4) Severe tissue trauma
129
Adult and Ped dose for potassium
Adult : 10-20 mEq/hr IV/IO dependent on patient presentation.
Ped : 2 - 3 mEq/kg/day IV
130
Special notes for Potassium
Cardiac Monitoring required
131
What class is Paralidoxime (2pam)
Cholinesterase re-activator (choline-reactivating oximes are effective antidotes in organophosphorus insecticide poisoning,
132
Indications for Pralidoxime (2pam)
- Organophosphate pesticide or nerve agent poisoning AFTER ATROPINE HAS BEEN ADMINISTERED
- Unknown cholinesterase inhibitor poisoning
133
Contraindications for Pralidoxime (2pam)
1) Relative
- Myasthenia gravis (serious muscle weakness)
- Renal Failure
2) Absolute
- Inability to perform endotracheal intubation, if neuromuscular blockade were to occur
134
Adult and Ped dose for Pralidoxime (2pam)
[600 mg] IM by auto injector "Mark 1" antidote kit. May be repeated in 3-5 min after first dose. If weakness has not been resolved
135
What class of drug is Nitrous Oxide
Inhalation Anesthetic, Gas
136
Mechanism of action for Nitrous Oxide
- Provides a sedative effect which decreases the patient's perception of pain. May partially act on opiate receptors systems to cause mild analgesia
- Diffuses through tissue more easily than oxygen or CO2
137
Indications for Nitrous Oxide
Pain management of the following: fractures, burns, kidney stones, musculoskeletal trauma, abdominal pain, back pain, acute urinary retention, chest pain, secondary to angina or infraction after full initiation of ACS protocol
138
Contraindications for Nitrous Oxide (12)
1) Altered LOC
2) Head injuries
3) Chest injuries
4) Intoxication or drug ingestion
5) Maxillofacial injuries
6) Psychiatric problems
7) COPD
8) <12 yrs of age or less than 75 lbs
9) OB patient not in active labor
10) Respiratory distress
11) Bowel obstruction or traumatic abdominal injury
12) Inner ear pain
139
Side effects of Nitrous Oxide
- Dizziness
- Apnea
- Cyanosis
- Nausea/vomiting
- Hypotension
