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What is the main side effect of amiodarone?
Hypotension
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What are the main side effects of adenosine? What drug class is it?
Facial flushing, shortness of breath, chest pain, & marked bradycardia. Misc. antidysrhythmic.
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What are the main side effects of lidocaine?
Tinnitus, confusion, convulsions
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What are the main side effects of atropine?
Dry mouth, blurred vision, urinary retention, increased intraocular pressure, tachycardia, constipation, anhidrosis (decreased sweating)
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What are the properties of Alpha 1 receptor sites?
Peripheral vasoconstriction, mild bronchoconstriction, stimulation of metabolism
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What are the properties of Alpha 2 receptor sites?
Prevents the over release of norepinephrine
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What are the properties of Beta 1 receptor sites?
Increase in heart rate, cardiac contractile force, automaticity & conduction.
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What are the properties of Beta 2 receptor sites?
Vasodilation & bronchodilation
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What is the major cause of respiratory acidosis?
Retention of CO2
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What is the major cause of respiratory alkalosis?
Increased respiration causing excess elimination of CO2
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What are the major causes of metabolic acidosis?
Production of lactic acid, dehydration, diabetes & certain medications
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What are the major causes of metabolic alkalosis?
Administration of diuretics, prolonged vomiting, sodium bicarb overdose.
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What is the most prominent characteristic of cardiogenic shock?
Pulmonary edema
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What are the main characteristics of hypovolemic shock?
"Classic signs of shock". Altered mental status, pale, cool diophoretic skin. Late sign is hypotension.
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What are some characteristics of anaphylatic shock?
Uticaria, breathing difficulty, tachycardia, hypotension, n/v, altered mental status, seizures.
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What are some characteristics of septic shock?
Vary widely. Hyper/hypothermic, respiratory issues, altered mental status.
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What are some of the class characteristics of benzodiazepines?
Hyperpolarize the membranes of the CNS neurons decreasing response to stimuli. Increases activity of GABA to open chloride ion channels leading to the hyperpolarization (negative charge) of the cell which then requires more stimulus to depolarize.
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What are some of the characteristics of barbiturates?
Hyperpolarize the membranes of the CNS neurons decreasing response to stimuli. Increases activity of GABA to open chloride ion channels leading to the hyperpolarization (negative charge) of the cell which then requires more stimulus to depolarize. At higher doses can mimic GABA causing unlimited effects.
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What are some of the characteristics of opiates?
Treat pain in a similar manner to endorphins. Decrease sensory neurons' ability to propagate impulses to the brain or spinal cord.
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What are some of the class characteristics of amphetamines?
Increase the release of excitatory neurotransmitters including norepinephrine and dopamine.
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What are two types of hypotonic solutions that are used in prehospital medicine?
5% dextrose in water, 0.45% sodium chloride.
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What is the most commonly used isotonic prehospital care iv solution?
0.9% sodium chloride
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What are NSAID's?
Nonopioid analgesic, tylenol, ibuprofen, motrin
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What class of drug is naloxone? What are some of its side effects and precautions?
Opioid antagonist. Shorter half-life than most opioid so many doses may be required.
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What class of drug is nalbuphine (Nubaine)?
Opioid angonist-antagonist.
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What is flumazenil (Romazicon)? What are some of its side effects and precautions?
Benzodiazepine antagonist. Patients may develop seizures.
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What are the side effects of morphine?
Analgesia, euphoria, sedation, miosis, decreases cardiac preload & afterload, respiratory depression.
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What is lithium? What are some of its side effects and precautions?
Psychotherapeutic. Headache, dizziness, n/v, & fatigue.
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What is physostigmine? What is it used for?
Reversible cholinesterase inhibitor. Given for atropine overdose.
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What is ipratropium bromide? What is its most common side effect?
Muscarinic cholinergic antagonist, anticholinergic or parasympatholytic. Dry mouth.
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What is epinephrine? What are the receptors sites it can effect?
Adrenergic agonist, catacholamine. Alpha 1 & 2, beta 1 & 2.
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What is terbutaline? What are the receptors sites it can effect?
Adrenergic agonist, noncatacholamine. Beta 2.
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What is verapamil? What are some of its side effects?
Class IV antidysrhythmic (calcium channel blocker). Hypotension & bradycardia.
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What is the therapeutic index of digoxin?
Very narrow
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What drug class is furosemide? What are some of its side effects?
Loop diuretic. Hyponatremia, hypovolemia, hypokalemia & dehydration.
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What drug class is heparin? What is its major side effect?
Anticoagulant. Bleeding
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What drug class is coumadin? What is its major side effect?
Anticoagulant. Bleeding
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What is methyprendisolone? What are some of its side effects?
Glucocorticoid. If given over a lond time adrenal suppression & hyperglycemia.
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What are antibiotics used for?
To kill off or stop the growth of bacteria.
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What is the H2 antagonist prototype? What are the other key H2 antagonists?
Cimetidine (Tagamet). ranitidine (Zantac), famotidine (Pepcid), & nizatidine (Axid Pulvules)
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What are the two main proton pump inhibitors? What are their side effects?
Omeprazole (Prilosec) & lansoprazole (Prevacid). Side effects are minor, headache & diarreha.
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What class of drug is asprin and what are its side effects?
Antiplatelet, bleeding
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What vitamin plays a key role in the clotting cascade?
Vitamin K
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What is a possible side effect of some antiemetics, phenothiazines (Compazine, Phenergan)?
Extrapyramidal symptoms
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What are two posterior pituitary drugs?
Oxytocin & vasopressin (ADH)
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What are the two drugs secreted by the pancreas that regulate blood glucose levels?
Alpha cells secrete glucagon, beta cells release insulin.
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What is oxytocin and what are its side effects?
Induce labor & treat postpartum hemorrhage. Main side effect is water retention.
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What is sildenafil and what are its side effects?
Male sexual behavior, when used with nitrates can cause decreased preload, lowering BP, leading to MI.
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What is dopamine? What receptor sites does it act upon?
Adrenergic agonist (catecholamine), Beta 1 & dopaminergic.
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What class of drug is phenytoin (Dilantin)?
Barbiturate with very few side effects.
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What class of drug is hydrochlorothiazide? What are some side effects?
Thiazide, diuretic. Hyponatremia, hypovolemia, hypokalemia, & dehydration.
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What drug class is alteplase (tPA)?
Fibrinolytic.
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What is dextran 40? What is a possible side effect?
A colloidal solution that has sugar based molecules. Anaphylaxis.
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What is afterload?
The resistance a contraction of the heart must overcome in order to eject blood.
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What are aural medications?
Used to treat local ear infections and other ear pain.
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What are B lymphocytes responsible for?
Production of antibodies that will attack an antigen, develop a memory of the antigen and confer long term immunity to the antigen.
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Define bioassay.
A test to acertain a drug's availability in a biological model.
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Define bioequivalence.
Relative therapeutic effectiveness of chemically equivalent drugs.
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Define pharmacokinetics.
How a drug is absorbed, distributed, metabolized and excreted.
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Define pharmacodynamics.
How a drug interacts with the body to cause its effects.
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Define diffusion.
Movement of a solute in a solution from an area of higher concentration to an area of lower concentration.
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Define osmosis.
Movement of a solvent in a solution from an area of of lower solute concentration to an area of higher solute concentration.
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Define bioavailability.
The amount of drug that is still active after it reaches its target tissue.
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Define biotransformation.
A special name given to the metabolism of drugs.
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Define efficacy.
A drugs ability to cause the expected response.
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What is an agonist-antagonist?
A drug that binds to a receptor site and stimulates some of its effects but blocks others.
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Define competitive antagonism.
One drug binds to a receptor and causes the expected effect while also blocking another drug from triggering the same receptor.
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What is an idosyncrasy?
A drug effect that is unique to the individual and is different than what is seen or expected in the general population.
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Define therapeutic index.
A ratio of the drugs lethal dose for 50% of the population to its effective dose for 50% of the population.
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What is the onset of action?
The time it takes from time of administration until a medication reaches its minimum effective concentration.
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What is the difference between analgesia and anesthesia?
Analgesia is the absence of pain and anesthesia is the absence of ALL sensation.
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What is the body's chief line of defense against injury and infection?
The skin.
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How much of the average persons body weight is water?
60% (total body water)
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What are the side effects of oral contraceptives?
Pregnancy, thromboembolism, hypertension, & abnormal uterine bleeding.
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Why is sublingual medication administration advantagous?
The region is highly vascular and permits rapid absorption with systemic delivery.
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What is the disadvantage to of nebulizers and metered dose inhalers?
If the patients tidal or minute volume is poor they will not get the medication into the lungs making the treatment ineffective.
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How many milliliters is in one teaspoon?
5
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Define an oral medication.
Any medication that is taken by mouth and swallowed into the GI tract, then absorbed and distributed throughout the body.
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What is a capsule form of medication?
Contains liquid, dry or beaded medication in a soluable casing. Should be swallowed whole.
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What is a tablet form of medication?
Medicated powder compressed into a small solid disk, basically the same as a pill.
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What is an elixir?
A liquid medication combinded with alcohol or placed in a sweetened fluid.
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What is a lozenge?
A solid form of medication that slowly dissolves in the mouth permitting swallowing gradually.
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Describe the medication form suspension.
A iquid that contains small particles of solid medication.
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How and why do we use subcutanious injections?
Inject no more than 1 ml of fluid with a 24g-26g, 3/8"-1" long needle at a 45 degree angle into a 1" pinched fold of skin, verify placement by drawing back the plunger. There should be no blood. SQ injections promote slow absorption prolonging the effect on the body.
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What is the dorsal gluteal muscle and what is its relevance?
The buttock. Common site for IM injections of up to 5 mL or more. All medications must be administered in the upper/outer quadrant.
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What are the three common sites for central venous access?
Internal jugular, subclavian, & femoral veins.
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What is the preferred site for an IO?
The proximal tibia
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When is the external jugular indicated for access?
Only after all other peripheral sites have been exhausted.
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Define carrier mediated or facilitated diffusion.
Process in which carrier proteins transport large molecules across the cell membrane.
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What is a drugs generic name?
A name suggested by the manufacturer and confirmed by the US Adopted Name Council. Then becomes the FDA offical name and is listed in the USP.
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Describe a Schedule I drug.
High potetial for abuse, may lead to severe dependence. There are no medical indications. Ex: heroin, LSD, mescaline
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What is a FDA Pregnancy Category A drug?
One in which many studies in pregnant women have not demonstrated a risk to the fetus in the first or later trimesters.
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Why do we prefer to give medications by iv?
Rapid onset
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How do medications treat seizures on the cellular level?
Benzodiazepines act on GABA and allow chloride ion channels to open hyperpolarizing the cell requiring a greater stimulus to depolarize. Phenytoin (Dilantin) and carbamazepine (Tegretol) block sodium channels decreasing a cells ability to depolarize. Valproic acid and ethosuximine interact with calcium channels in the hypothalamus.
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Define parasympathomimetic.
A drug or other substance that causes effects like those of the parasympathetic nervous system, also called cholinergic.
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Define parasympatholytic.
A drug or other substance that blocks or inhibits the actions of the parasympathetic nervous system, also called anticholinergic.
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What does SLUDGE stand for?
- Salivation
- Lacrimation
- Urination
- Defecation
- Gastric motility
- Emesis
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Define sympathomimietic.
A drug or other substance that causes effects like those of the symathetic nervous system, also called adrenergic.
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Define sympatholytic.
A drug or other substance that blocks the actions of the sympathetic nervous system, also called antiadrenergic.
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Briefly describe the symathetic nervous system.
Part of the autonomic nervous system and arises from the thoracic and lumbar regions of the spine. The adrenergic receptors are alpha 1 & 2, beta 1 & 2 and dopaminergic.
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Define extrapryamidal symptoms.
A common side effect of antipsychotic medications, including tremors and parkinsonism-like effects.
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How do ACE inhibitors work?
They interupt the renin-angiotensin-aldosterone system (RAAS) by preventing the conversion of angiotensin I to angiotensin II. Angiotensin II is the most potent vasoconstrictor yet discovered. By preventing this conversion peripheral vascular resistance is decreased thus decreasing blood bressure.
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Define extravasation.
The leakage of fluid or medication from the blood vessel that is commonly found with infiltration.
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What is GABA? Explain GABA receptor sites.
Gamma aminobutyric acid, the chief inhibitory neurotransmitter in the CNS. GABA receptors are spread out on proteins that make up chloride ion channels on cell membranes. When GABA binds to the GABA receptors it allows an influx of chloride giving the cell a negative charge.
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Define hypernatremia.
An abnormal increase in the level of sodium in the body.
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What are some properties of tricyclic antidepressants (TCA's)?
Block the reuptake of serotonin and norepinephrine extending duration of their action. Several undesired side effects including: anticholinergic properties, orthostatic hypotension, lowering seizure threshold, cardiotoxic (hypotension, MI, dysrhythymias) effects if overdose.
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What is a pyrogenic reaction?
Can be caused by iv administration tubing or solution. Typically occurs within 30-60 minutes after initiation of iv. Sudden onset of high fever, chills, n/v, head or back ache, possible cardiovascular collaspe.
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Define tachyphylaxis.
A rapidly occuring tolerance to a drug. May occur after a single dose. Typically occurs with sympathetic agonists, specifically decongestant and bronchodilation agents.
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Define cross tolerance.
Tolerance for a drug that develops after administration of a different drug. Morphine and other opioid agents are common examples. Tolerance for one agent implies tolerance for others as well.
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Teratogenesis
Regarding birth defects
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What are the transmitters involved in the vomiting reflex?
Serotonin, dopamine, acetylcholine & histamine.
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Briefly describe type I diabetes mellitus.
Insulin dependant. Results from an inadequate release of insulin from the beta cells in the pancreas. Usually manifests before age 30.
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What are some treatment modalities for poisoning emergencies?
Generally emptying gastric contents, increasing gastric motility, alkalinizing the urine with sodium bicarb, filtering the blood with dialysis. Antidotes are few, but effective.
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Describe the vagus nerve.
Cranial nerve X, the longest cranial nerve, part of the parasympathetic nervous system. Long preganglionic neurons, short post ganglionic neurons. It controls the visceral organs of the head, neck, thoracic cavity, & most of the abdominopelvic cavity.
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