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Paramedic Pharmacology Test 2
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186
Pharmacology
Undergraduate 1
10/06/2013

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Term
The advantages of morphine sulfate
Definition
Analgesic, amensic +, reversible w/ Narcan, longer duration
Term
Disadvantages of morphine sulfate
Definition
Respiratory depression, longer duration
Term
Morphine sulfate is used for...
Definition
Pain relief, pacing, and Post ETT
Term
The advantages of Fentanyl
Definition
Analgesic, amnesic +, reversible w/ Narcan, short duration
Term
Disadvantages of Fentanyl
Definition
Respiratory depression, short duration
Term
Fentanyl is used for...
Definition
Pain relief, pacing, and post ETT
Term
Advantages of Versed (midazolam)
Definition
Quick acting, IN/IM/IV, somnolence, amnesic ++++, short duration
Term
Disadvantages of Versed
Definition
Short duration
Term
Versed is used for...
Definition
Combative pts, post ETT, pacing, and severe anxiety
Term
Advantages of Valium (diazepam)
Definition
Short acting, IV/IM, somnolence, and amnesic ++
Term
Disadvantages of Valium
Definition
Moderate duration
Term
Valium is used for...
Definition
Combative pts, post ETT, pacing, and sever anxiety
Term
Advantages of Haldol
Definition
Rapid onset, IV/IM, somnolence
Term
Disadvantages of Haldol (hypnotic)
Definition
No amnesic effect, EPR
Term
Haldol is used for...
Definition
Acute psychosis and aggressive pts
Term
Advantages of Etomidate (hypnotic)
Definition
Short acting (5-10 min)
Term
Disadvantages of Etomidate
Definition
Short acting
Term
Etomidate is used for...
Definition
Cardioversion, pre ETT
Term
These are small-diameter afferent fibers that cause sensation of pain when activated.
Definition
Nociceptor
Term
This is the primary pain inducing neurotransmitter.
Definition
Substance P
Term
What do nociceptors release when stimulated?
Definition
Substance P
Term
These drugs act at the tissue site to reduce pain and inflammation by interfering with prostaglandin synthesis/release.
Definition
Peripherally acting drugs
Term
How do peripherally acting drugs reduce pain/inflammation?
Definition
Interfere with prostaglandin synthesis/release
Term
Centrally acting drugs are...
Definition
Narcotic analgesics
Term
These neuro pathways, located in the dorsal horn of the spinal cord, release substance P upon nociceptor stimulation, which results in pain and analgesia system activation.
Definition
Ascending Pathways
Term
These neuro pathways, located in the spinal cord, release NE when stimulated, inhibiting Substance P.
Definition
Descending Pathways
Term
Drugs or meds produced exclusively from opium.
Definition
Opiates
Term
Synthetic drugs that mimic opium products.
Definition
Opioids
Term
Any substance that induces a dream-like sleep.
Definition
Narcotics
Term
What are the three types of opioid receptors?
Definition
Mu, Kappa, and Delta
Term
These opioid receptors cause analgesia, respiratory depression, meiosis (pin-pt pupils, euphoria and physical dependence.
Definition
Mu receptors
Term
These opioid receptors are located primarily in the dorsal horn of the spinal cord, and produce analgesia by depressing pain transmission. To a lesser degree, also produce miosis and sedation.
Definition
Kappa receptors
Term
What are the benefits of targeting Kappa opioid receptors?
Definition
They do not cause respiratory depression or euphoria.
Term
These opioid receptors are poorly understood; may cause analgesia and respiratory depression.
Definition
Delta receptors
Term
This group of opioids exhibits a high affinity for Mu receptors, and a moderate affinity for Kappa receptors.
Definition
Agonist opioids
Term
This is a commonly carried agonist opioid.
Definition
Morphine sulfate
Term
This opioid is 6-10x more potent than morphine sulfate.
Definition
Hydromorphone (Dilaudid)
Term
This is a naturally occuring opioid, is 1/10th as potent as morphine, but is absorbed better orally.
Definition
Codeine
Term
Codeine is often combined with...
Definition
ASA (aspirin) or APAP (tylenol)
Term
This is an oral opioid that is less potent than codeine, and is a commonly abused street med.
Definition
Propoxyphene (Darvon)
Term
This is a synthetic opioid that is 1/10th as potent as morphine, works well for extremity fractures, but was pulled due to manufacturing issues.
Definition
Meperidine (Demerol)
Term
This is a short acting opioid, 100x more powerful than morphine, but short acting. Commonly administered via IV.
Definition
Fentanyl (Sublimaze)
Term
This is an oral opioid analgesic, removed by the manufacture in 2003, often used illegally as a heroin substitute.
Definition
LAAM (Orlaam)
Term
Why was LAAM discontinued?
Definition
Side-effect of severe ventricular dysrhythmia
Term
This is used in Europe as a med, 3x more potent than morphine, high lipid solubility, and is metabolized to morphine.
Definition
Heroin
Term
These opioids bind to opioid receptors with varying affinity, but they do not exert agonist activity at any receptor (ex. Narcan).
Definition
Antagonist opioids
Term
MOA of aspirin
Definition
Blocks prostaglandin synthesis (analgesic), lowers temp by causing direct vasodilation (antipyretic), and 100 mg will inhibit platelet aggregation for the life span of the platelet
Term
Aspirin toxicity info
Definition
Classic signs of Aspirin toxicity include febrile, tachycardia, and tachypnea; 400 mg/kg to reach LD50, and non-enteric coated forms clump in the stomach (slowing absorption)
Term
MOA of acetaminophen
Definition
Blocks prostaglandin synthesis (analgesic) and resets the hypothalamus (the body's thermostat/antipyretic)
Term
Acetaminophen toxicity info
Definition
Liver dies over the course of 7-8 days, treatment is with NAC w/in 24 hr, and levels are 15 g for an adult, 10 g for a child
Term
MOA of NSAIDs
Definition
Block prostaglandin synthesis (analgesic); antipyretic effects are unclear.
Term
NSAID toxicity info
Definition
Rare, takes 1255 mg/kg in mice, but may cause GI disturbances/bleeding and renal failure in extreme cases
Term
These meds stabilize cell membranes to prevent the release of harmful bronchoconstricting substances and inflammation mediators.
Definition
Corticosteroids
Term
Corticosteroids are indicated for...
Definition
Severe chronic asthma and COPD
Term
These meds prevent inflammation in the lungs, maintain bronchiole relaxation, decrease mucus production, and prevent vascular permeability.
Definition
Antileukotrienes/Leukotriene Receptor Agonists (LTRAs)
Term
These meds are indicated for prophylaxis and chronic treatment of asthma in adults and children older than 12.
Definition
Antileukotrienes/LRTAs
Term
Although drugs from this class are not recommended in the use of children under 12, this specific drug is acceptably used in children over 2 to treat chronic asthma and prophylaxis.
Definition
Singulair
Term
T or F, antileukotrienes are indicated for acute asthma attack.
Definition
False
Term
These drugs, used to prevent chronic bronchospasm, stabilize mast cells walls to limit degranulation, but possess ZERO direct bronchodilation properties.
Definition
Mast Cell Stabilizers
Term
Mast cell stabilizers are indicated for...
Definition
Rx of severe, chronic asthma (but not acute asthma attacks)
Term
These drugs, used to prevent and treat bronchospasm, work by stimulating cAMP action resulting in bronchodilation.
Definition
Xanthine Derivatives
Term
What are the respiratory effects of xanthine derivatives?
Definition
-Stimulates medulla to stimulate respiratory activity
-Relaxes bronchial smooth muscle
-Decreases mast cell degranulation
Term
What are the cardiovascular effects of xanthine derivatives?
Definition
-Positive inotrope/chronotrope
-Vasodilation
Term
What are the CNS effects of xanthine derivatives?
Definition
-Decreases drowsiness and fatigue
-Improves concentration and clarity of thought
-Interferes w/ delicate muscle coordination and timing
Term
In addition to asthma Rx, xanthine derivatives can be used as _______.
Definition
Diuretics
Term
Indications for xanthine derivatives:
Definition
-Asthma
-Chronic bronchitis
-Chronic emphysema
Term
These drugs, used in the Rx of bronchospasm, blocks the parasympathetic-controlled J receptors in the lungs that cause bronchoconstriction, and inhibits secretions.
Definition
Anticholinergics
Term
What are the indications for anticholinergics?
Definition
-Prevention of bronchoconstriction (asthma/COPD)
-Early use in PNS-induced bronchospasm
Term
Why do you not want to use anticholinergics in late stage asthma attacks?
Definition
Inhibits secretions, which results in thicker mucus.
Term
These drugs are used in the Rx of acute bronchospasm, they are nonspecific A and B agonists which increase the HR and have a potent vasoconstrictive effect (reduces swelling).
Definition
Non-selective Adrenergics
Term
What are the indications for use of non-selective adrenergics?
Definition
Acute bronchospasm
Term
These non-selective adrenergics are mainly used for group in peds as its primary benefit is the reduction of swelling.
Definition
Racemic epi
Term
These drugs, used in the Rx of acute bronchospasm, cause rapid relaxation of smooth muscle in the bronchioles adn the GI tract via stim of B2 receptors.
Definition
Non-selective Beta-agonists
Term
What are the indications for use of non-selective beta-agonists?
Definition
Acute bronchospasm
Term
Used for the Rx of acute bronchospasm, this is a rapid onset, short duration drug with rapid tolerance development.
Definition
Non-selective Beta-Agonists
Term
These drugs, used in the Rx of acute bronchospasm, stimulate B2 receptors resulting in relaxation of the smooth muscles of the airway and bronchial dilation.
Definition
Beta2 Selective Agonists
Term
What are the indications for B2 selective agonists use?
Definition
-Asthma attack
-Exacerbated COPD Pts
-Allergic rxn
-Toxic inhalation
-Pneumonia (off-label use)
-Cardiac asthma (off-label and controversial)
Term
T or F, you should not give Beta2's to CHF Pts w/ reflex bronchospasm.
Definition
True
Term
These drugs, used to Rx acute bronchospasm, block Ca++ through smooth muscle Ca++ channels, resulting in smooth muscle relaxation.
Definition
Smooth Muscle Dilators
Term
What are the indications for smooth muscle dilators?
Definition
-Bronchospasm refractory to B2 agonists and oxygenation
Term
HA, nausea, diahhrea and liver dysfunction are side-effects of...
Definition
Antileukotrienes/LRTAs
Term
Nervousness/restlessness/insomnia, tremors, myocardial irritability, and seizures refractory to anticonvulsants are side-effects of...
Definition
Xanthine Derivatives
Term
What kind of side effects do non-selective adrenergics have?
Definition
Significant cardiovascular side-effects
Term
What are the side-effects of non-selective beta-agonists?
Definition
Positive inotrope, chronotrope, and dromotrope (and increases BP)
Term
What drugs are used in the prevention of bronchospasm?
Definition
-Corticosteroids
-Antileukotrienes/LRTAs
-Mast Cell Stabilizers
-Xanthine Derivatives
-Anticholinergics
Term
What drugs are used in the Rx of acute bronchospasm?
Definition
-Non-selective Adrenergics
-Non-selective Beta-agonists
-Beta2 Selective Agonists
-Smooth Muscle Dilators
Term
These meds block the Pt's physiologic repsonses to intubation, minimizing bradycardia, hypoxia, cough/gag relex, increases in intracranial, intraocular, and intragastric pressure.
Definition
Pre-Sedation medications
Term
T or F, you would not use pre-sedation meds in peds or Pts with head injury.
Definition
False (these are the circumstances you WOULD use them)
Term
This medication is thought to blunt the rise of ICP associated with intubation, and is given to Pt's with suspected head injury.
Definition
Lidocaine
Term
What is the pre-sedation dosage of lidocaine?
Definition
1.5-3 mg/kg (avg 100 mg) given 3 min prior to intubation
Term
This pre-sedation drug minimizes vagal effects (which minimizes bradycardia and secretions).
Definition
Atropine
Term
What is the pre-sedation dosage of atropine?
Definition
0.02 mg/kg, minimum 0.1 mg IV, max 1 mg, three minutes prior to intubation
Term
T or F, children develop profound bradycardia during intubation.
Definition
True
Term
What drug would be used to minimize bradycardia in a child?
Definition
Atropine
Term
Used to decrease muscle fasciculations caused by depolarizing agents and attenuates rise in ICP.
Definition
Defasciculating Doses
Term
What does a defasciculating dose consist of?
Definition
Non-depolarizing blocking agents usually 1/10 standard dose
Term
These are agents administered at doses capable of producing unconsciousness, and should nearly always be used when paralyzing a Pt.
Definition
Sedative agents
Term
Which sedative agent has minimal hemodynamic effects, and can be used on hypotensive Pts?
Definition
Etomidate
Term
This sedative is a non-barbituate hypnotic that decreases ICP/IOP, and has a rapid onset/short duration.
Definition
Etomidate
Term
What is the intubation dose of etomidate?
Definition
0.3 mg/kg IV
Term
This sedative is a dissociative anesthetic, has rapid onset/short duration, is a potent bronchodilator and increases secretions.
Definition
Ketamine
Term
This sedative increases ICP/IOP/IGP and emergence phenomenon can occur, though rarely in children less than 10 y/o.
Definition
Ketamine
Term
Would you use Ketamine in a Pt with a head injury?
Definition
No (increases ICP/IOP/IGP)
Term
What is the sedative dose of Ketamine?
Definition
1-2 mg/kg
Term
This sedative has a slower onset, does not increase ICP, but does cause respiratory/cardio depression.
Definition
Midazolam
Term
What is the sedative dose of midazolam?
Definition
2-5 mg (adults), 0.1 mg/kg (peds)
Term
This sedative is moderate/long lasting, but has a longer onset than Midazolam. May be more beneficial for post-ETT sedation.
Definition
Diazepam
Term
What is the sedative dose of diazepam?
Definition
5-10 mg (adult), 0.2-0.3 mg/kg (ped)
Term
These opiates are used as sedatives.
Definition
Fentanyl and Morphine Sulfate
Term
This is a rapid acting sedative, with a short duration (30 min). It can be reversed with naloxone, and may decrease tachycardia/hypertension associated with ETT.
Definition
Fentanyl
Term
What is the sedative dosage of fentanyl?
Definition
25-50 mcg (adult), 2-5 mcg/kg (ped) IV
Term
This opiate sedative has a longer onset and duration (4-6 hr), but may not blunt tachycardia, HTN, and ICP as well as Fentanyl.
Definition
Morphine Sulfate
Term
What is the sedative dose of morphine sulfate?
Definition
2-5 mg (adult), 0.2-0.3 mgkg (ped) IV
Term
What are the two types of paralyzing agents?
Definition
Depolarizing and Non-depolarizing Agents
Term
These paralyzing agents bind with ACh receptors at the NMJ, causing sustained depolarization.
Definition
Depolarizing Agents
Term
These paralyzing agents bind to ACh receptors in a competitive, non-stimulatory manner preventing depolarization.
Definition
Non-depolarizing Agents
Term
What type of paralyzing agent is succinylcholine?
Definition
Depolarizing agent
Term
With this paralyzing agent, you must be cautious of malignant hyperthermia and trismus.
Definition
Succinylcholine
Term
This paralyzing agent stimulates nicotinic/muscarinic receptors, has a 45 sec onset, an 8 min duration and is the standard for paralytics.
Definition
Succinylcholine
Term
How is masseter spasm treated?
Definition
BVM and non-depolarizing NMJB
Term
Pancuronium, vecuronium, and rocuronium are what type of paralytics?
Definition
Non-depolarizing Agents
Term
What is the dosage of succinylcholine?
Definition
1.5 mg/kg (adult) and 2.0 mg/kg (ped)
Term
What is the dosage for pancuronium?
Definition
0.10-0.15 mg/kg IV
Term
What is the dosage for vecuronium?
Definition
0.1 mg/kg, priming dose 0.01 mg/kg
Term
What is the dosage for rocuronium?
Definition
0.6-1.2 mg/kg
Term
If you needed a longer lasting non-depolarizing paralytic, which drug would you use?
Definition
Pancuronium (45-90 min)
Term
What drugs can be used to reverse non-depolarizing agents?
Definition
Edrophonium or neostigmine
Term
List the pre-sedation drugs.
Definition
Lidocain
Atropine
Term
List the drugs used for sedation.
Definition
Etomidate
Ketamine
Midazolam
Diazepam
Fentanyl
Morphine
Term
List the drugs used for post-ETT sedation.
Definition
Midazolam
Diazepam
Fentanyl
Morphine
Term
List the drugs used as paralyzing agents.
Definition
Succinylcholine
Vecuronium
Pancuronium
Rocuronium
Term
Discuss asthma in pregnant Pts.
Definition
Those with a Hx of asthma tend to have an increase in bronchospasm, but Rx remains the same.
Term
This condition is characterized by HTN, proteinuria, and edema (at least 2 of 3) in Pt of 20 wk or more gestation.
Definition
Pre-eclampsia
Term
In pregnancy, HTN is defined as...
Definition
BP of 140/90, or a rise of at least 20 mmHg in systolic or 10 mmHg diastolic above pre-pregnancy levels.
Term
Rx for HTN in pregnant Pts.
Definition
Labetolol or hydralazine are preferred, nitroglycerin may be used in some systems.
Term
This is pre-eclampsia with generalized seizure or coma.
Definition
Eclampsia
Term
Drug use/dosage to prevent eclampsia seizures
Definition
MgSO4, admin 4-6 g (in 50 mL) over 20-30 min
Term
Primary drug use/dosage for Rx of eclampsia seizures
Definition
MgSO4, admin 2-4 g (in 50 mL) over 2 min
Term
What is option #2 for Rx of eclampsia seizures?
Definition
Diazepam or midazolam
Term
What is the Rx of pediatric bradycardia?
Definition
Usually caused by hypoxia, Rx involves oxygenation and ventilation, epi or atropine admin (>12 y/o epi is the drug of choice).
Term
What is the Rx of pediatric tachycardia?
Definition
Rx is fluid, rather than drugs (10-20 cc/kg). For PSVT use adenosine and cardioversion, and treat ventricular dysrhythmias with electiricity.
Term
What tends to cause pediatric tachycardia?
Definition
Hypovolemia
Term
These are the physiological changes in geriatric pts that influence pharmacological interventions...
Definition
-Decreased muscle mass/body wt
-Slower metabolizm
-Reduced liver/kidney fxn
-Alterations in receptor site fxn
-Reduced proteins (for drugs to bind to)
-Reduced cognition/memory
Term
This occurs when a Pt is taking multiple meds for the Rx of several medical disorders.
Definition
Polypharmacy
Term
What are the med considerations for geriatric Pts?
Definition
Doses not altered for geriatric Pts, but desired action may be delayed or hindered due to physiological changes/polypharmacy issues.
Term
These are used primarily for Rx of HTN, but some are also used to maintain kidney fxn.
Definition
Diuretics
Term
These diuretics inhibit carbonic anhydrase (an enzyme in RBCs) and NaCl reabsorption in the DCT.
Definition
Thiazide Diuretics
Term
These diuretics increase Ca++ reabsorption, which can decrease cardiac fxn.
Definition
Thiazides
Term
Basically, thiazides stop _____ reabsorption.
Definition
Na+
Term
Thiazides may also cause _______ in the proximal tubule.
Definition
Natriuresis (excessive excretion of sodium in the urine)
Term
This type of diuretics inhibits the Na+/K+2Cl- transport system in the luminal membrane of the ascending Loop of Henle.
Definition
Loop Diuretics
Term
These diuretics inhibit NaCl reabsorption, which leads to increased Mg++ and Ca++ excretion.
Definition
Loop
Term
These diuretics antagonize the effects of aldosterone in the collecting tubules and ducts.
Definition
Postassium-sparing Diuretics
Term
This type of diuretic is most useful in Pts taking Digitalis.
Definition
Potassium-sparing
Term
This is the major side-effect of potassium-sparing diuretics.
Definition
Hyperkalemia
Term
These are the three types of meds used in the Rx of UT infections.
Definition
Antimicrobials, antispasmodics, and antiseptics
Term
This type of drug, used to Rx UT infections, blocks DNA transcription or weakens bacterium cell walls.
Definition
Antimicrobials
Term
These drugs, used to Rx UTIs, have parasympatholytic properties which cause an increase in bladder capacity, thus decreasing UTI related incontinence.
Definition
Antispasmodic Agents
Term
This class of drug, used to Rx UTIs, produces high levels of formaldehyde to kill bacteria.
Definition
Antiseptics
Term
Hyponatremia is defined as Na+ levels less than _____.
Definition
135 mEq/L
Term
Hyperkalemia is defined as K+ levels greater than ______.
Definition
5.5 mEq/L
Term
Dilution, cardiac/renal/liver failure, sepsis and SIADH can all cause...
Definition
Hyponatremia
Term
What is the Rx of hyponatremia?
Definition
IV of sodium solutions, possible diuretics.
Term
What are the four meds used to Rx hyperkalemia?
Definition
Calcium chloride, Bicarb, D50W, and Beta-adrenergic Agents (albuterol)
Term
What is the MOA, dose and route of calcium chloride admin?
Definition
MOA-antagonizes K+ (doesn't alter levels, just overcomes negative effects)
Dose-250-500 mg slow IVP
Route-IV
Term
What is the MOA, dose and route of bicarb admin?
Definition
MOA-tends to reduce serum K+ by driving it into cells
Dose-50-100 mEq
Route-IV
Term
What is the MOA, dose and route of D50W?
Definition
MOA-increases blood sugar, triggering pancreas to release insulin which drives K+ into cells
Dose-25-50 g
Route-IV
Term
What is the MOA, dose and route of abluterol (used to Rx hyperkalemia)?
Definition
MOA-drives K+ into the cell equivalent to insulin
Dose-@ least 10 mg, and must keep it coming
Route-Nebulizer
Term
These classes of meds are used to Rx hyperacidity.
Definition
-Protein pump inhibitors
-H2-Receptor blockers
-Cytoprotective agentgs
-Antacids
Term
This class of drug is used for Rx of esophageal reflux and both chronic/acute erosive esophagitis.
Definition
Protein pump inhibitors
Term
This class of drug is used to Rx esophageal reflux/ulcers. Works by inhibiting actions of hydrochloric acid producing cells in the stomach.
Definition
H2-Receptor Blockers
Term
This class of drugs, used to Rx hyperacidicty, does not decrease acidity, rather it binds w/ stomach proteins to form a barrier over exposed tissue ulcerations.
Definition
Cytoprotective Agents
Term
Through various buffers, this class of meds neutralizes excessive acid in the stomach (temp relief only).
Definition
Antacids
Term
These drugs work locally, irritating gastric mucosa and centrally stimulating the emetic center in the medulla to induce vomiting.
Definition
Emetics
Term
These meds are used to treat NV, and variously work by blocking neurotransmitters in the emetic center of the brain, or at the end of the vagus nerve; and some block histamine, serotonin, or dopamine.
Definition
Anti-emetics
Term
When do anti-emetics tend to work best?
Definition
Before the Pt experiences NV
Term
Drugs that Rx IBS block serotonin centrally and peripherally. How does this Rx the hyperkinetic state of IBS?
Definition
-Decreases NV (centrally) and decreases peristaltic activity (peripherally)
Term
What are the two different actions of anti-diarrheal meds?
Definition
-Block ACh to limit peristaltic activity
-Bind with toxins to eliminate peristaltic activity
Term
This class of drugs tends to have generic names that end in "-one" or "-ide.
Definition
Corticosteroids
Term
This class of drugs tends to end in "-phylline".
Definition
Xanthine derivatives
Term
T or F, anticholinergics are effective in the Rx of late stage asthma attacks.
Definition
False, won't stop chem mediators that are causing bronchospasm, and will inhibit secretions, causing mucus to become a thick glob.
Term
This drug is used to Rx croup.
Definition
Racemic Epi
Term
Bronchosol, albuterol and levalbuterol belong to what class of drug?
Definition
Beta2 Selective Agonists
Term
Albuterol has two parts, S. albuterol and R. albuterol. Which part is responsible for side-effects, and often results in reflex bronchospasm 2-6 hr after taking large amts of albuterol?
Definition
S. Albuterol
Term
Racemic means that two drugs are...
Definition
Mirror images of each other.
Term
Which is responsible for bronchodilation, S. albuterol or R. albuterol?
Definition
R. Albuterol
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