Name the Receptor
Stimulation causes bronchodilation and vasodilation
Beta 2
Drugs that stimulate the sympathetic nervous system are known as ___________________ drugs.
Sympathomimetic
adrenergic
sympathetic agonist
What is the dose of aspirin for chest pain presumed to be cardiac in origin?
162-325 mg
Drug that inhibits Na+ reabsorption in the kidneys and has some vasodilitory effects, thus helping patients with CHF.
Furosemide
Name the neurotransmitter released at the parasympathetic postsynaptic neuron end bulb.
acetylcholine (ACh)
Cyanokit treats what and how does it work?
= hydroxocobalamin
used for Cyanide poisoning.
Binds to cyanide and forms cyanocobalamin (form a B12) and is excreted by kidneys
Stimulation primarily causes peripheral vasoconstriction and also causes some bronchoconstriction.
alpha 1
Lidocaine belongs to which class of drug?
Class I anti-dysrhythmic: Na+ channel blocker
What's the dose of Ketamine for sedation?
1 - 2 mg/kg (Max 200 mg)
Diabetic patient with AMS and BGM < 70.
D10 25 g
Bonus question: How much dextrose is in a 250 ml bag of 10% dextrose?
The rapid influx of Ca++ causes depolarization of these cells, thus causing an action potential?
Pacemaker cells (SA and AV node)
What drug and dose works on the serotonin 5HT receptors to prevent nausea and vomiting?
Zofran (ondansetron) 4 mg ODT/IV/IO
Stimulation of these receptors causes renal artery dilation.
dopaminergic
The enhancement of one drug's effects by another is called ______________.
Potentiation
What's the first dose of Labetalol for hypertensive crisis (>220systolic, >110 diastolic) and when do you repeat it?
10 mg IV/IO over 2 min; repeat 20 mg every 10 minutes.
Hold if SBP < 180, DBP < 100 or HR< 60
35 yo patient with severe pain from a kidney stone.
ketorolac (Toradol) 30 mg IM or 15 mg IV
Flumazenil isn't typically used prehospital as it may cause this.
uncontrolled seizures
What's the dose, onset and duration of action of succinylcholine?
1 - 1.5 mg/kg IVP
onset within 1 minute
lasts 4 - 6 minutes
Stimulation of these receptors causes positive cardiac inotropy, automaticity and conduction.
Beta 1
What's another name for an anticholinergic?
Parasympatholytic
Parasympathetic antagonist
If you want to use Dopamine to primarily increase heart rate, what is your dose?
2 - 10 mcg/kg/min
25 yo patient with status asthmaticus that has been refractory to nebs and magnesium.
Epi 1 mg/ml = 0.3 mg IM
Terbutaline 0.25 SQ (if > 50 yo)
Name 2 treatments you can start prehospital for suspected hyperkalemia to decrease serum potassium.
Albuterol: B agonist shifts potassium into cells
Sodium Bicarb: causes H+ to move out of cells and then K+ will move in.
CaCl: thought to stabilize cell membrane; improved AV conduction
Hospital: insulin/glucose, diuretics if kidney function good, potassium binders in GI tract
What's the dose of oxytocin used after the placenta has delivered?
10U IM
Stimulation of this receptor in the brain slows down neuronal impulse transmission.
GABA
If you repeat doses of a drug, you may increase the drugs effects causing _______________ action of the drug.
Cumulative
What's the initial dose of amiodarone during cardiac arrest?
300 mg IVP
Elderly patient with renal disease with fever and headache who tolerates oral intake.
Acetaminophen (Tylenol) 15 mg/kg. Max 1000 mg.
What drug causes all of this: breakdown of glycogen, increased cardiac contractility without using beta 1, relaxes smooth muscle to help esophageal food impaction?
Glucagon
use higher doses than for hypoglycemia for BB OD, CCB OD, refractory anaphylaxis when on beta blockers.
Name 3 indications for magnesium.
Eclampsia: 4g in 100 ml IV over 10 min
Status asthmaticus: 1 - 2 G in 100 ml IV over 10 min
Torsades: 2G IV/IO
Stimulation of this receptor slows down the heart and causes bronchoconstriction.
Muscarinic cholinergic receptors
We use this class of drug as an anti-inflammatory during allergic reactions and conditions resulting in airway edema (asthma; anaphylaxis).
Corticosteroids (Solumedrol)
What's the initial dose of diltiazem for Afib RVR?
0.25 mg/kg over 2 min (Max 20 mg)
Patient with dystonia (involuntary, sustained or repetitive muscle contractions) after taking an antiemetic.
Name the antiemetic they likely took and your antidote.
prochlorperazine (Compazine)
antidote: diphenhydramine (Benadryl) 50 mg IM/IV
Why is it important to make sure the patient you give NaHCO3 to is adequately ventilated?
can cause paradoxical intracellular acidosis
-HCO3 + H+ <--> CO2 + H2O
Also can shift oxyhemoglobin curve to the Left.
What's the dose of lidocaine IO for pain associated with infusion through the IO.
40 mg (2 ml)
Succinylcholine is used to block these receptors at what location?
Nicotinic receptors on skeletal muscles.
This class of drug is used for seizures, anxiety and sedation in the prehospital setting.
benzodiazepines
What is the dose of Push-dose epi for hypotension?
10 - 20 mcg (1 - 2 ml) every 2 min
Patient with septic hypotensive shock refractory to first line treatment (fluids). Drug other than epi.
norepinephrine 0.1-0.5 mcg/kg/min titrate to effect
Dopamine: 10 - 20 mcg.kg/min will get vasopressor effects, > 20 mcg/kg/min pure alpha.
True or False? Diltiazem slows the atrial response to the ectopic foci causing Afib.
False. It slows the ventricular response by slowing conduction at the AV node.
How long can you expect paralysis to occur with Rocuronium?
30 - 60 min.
Ketamine blocks these receptors to induce sedation.
NMDA (glutamate)
Group of neuronal nuclei in the CNS that filters stimuli
Reticular Activating System (RAS)
What is the dose of etomidate for sedation?
0.2 - 0.4 mg/kg IV/IO
Mercy 0.3 mg/kg (Max 30 mg)
Patient with tricyclic acid overdose and widened QRS?
Sodium Bicarb 1 mEq/kg up to 50 mEq
Name the drug and used to decrease plasmin at the fibrin mesh.
TXA 1 gram in 100 ml over 10 min.
What autonomic nervous system is being stimulated if you see the following:
dilated pupils, tachycardia, dilation of arteries of the skeletal muscles
Sympathetic
Midazolam stimulates these receptors to induce sedation.
GABA
Atropine and ipratropium medications are listed (classified) as ____________________ medications.
anticholinergics (parasympatholytics).
Droperidol dose for a very agitated (non-violent) patient that you can't perform routine care?
5mg IM
Patient with agitated delirium (violent and combative).
Ketamine 4 mg/kg IM. Max 400 mg IM
Dopamine increases _____________, thus is contraindicated in CHF.
Preload
Lidocaine can be used instead of what drug in Vfib or pulseless VT cardiac arrest instead of what drug and at what dose?
Amiodarone
Dose: 1 - 1.5 mg/kg and repeat at 1/2 first dose in 4 minutes if still shockable. (max 3 mg total)
Note: generally requires infusion to maintain ventricular ectopy suppression, raises VF threshold,
Labetalol blocks these receptors.
Beta 1, some 2 and alpha
What neurotransmitter and receptor are found at the pre-synaptic neuron ganglia of the sympathetic and parasympathetic nervous system?
NT released is ACh and binds to Nicotinic receptors
Dose of Rocuronium for RSA?
0.6 - 1.2 mg/kg IVP
Drug that may help patient with air hunger from pulmonary edema or emphysema and advanced COPD.
Morphine (low dose 2 mg)
* decreases respiratory drive--> slows breathing and allows for prolonged expiration and avoiding air trapping.
* decreases anxiety
* decreases systemic vascular resistance
Name the enzyme that breaks down the following neurotransmitters: norepinephrine, epinephrine, dopamine.
monoamine oxidase
Name a direct vasodilator used to treat chest pain from cardiac origin and give the dose used.
NTG 0.4 mg SL