Pharmacology
Mechanism of Action for Epinephrine
Sympathomimetic catecholamine that has pharmacological effects on both Alpha and Beta Receptors.
Agonist at α1, β1 and β2 adrenergic receptors, causing vasoconstriction, increased chronotropy & inotropic effects, and bronchodilation. β2 effects also stabilizes MAST cell walls by increasing intracellular cAMP, preventing further degranulation and histamine release.
Benadryl(Diphenhydramine) Dosage and Contraindications
1mg/kg IM/SIVP/IO to a max dose of 50mg
Contraindications: Hypersensitivity to Benadryl or Gravol
List the 3 forms of carbohydrates, provide an example of each
Monosaccharaide: simple sugars, contain 3-7 carbon atoms example is glucose
Disaccharides: Combination of two Monosaccharaide and dehydration synthesis example is sucrose or lactose
Polysaccharides: tens to hundreds of monosaccharaides, example is glycogen, starch, or cellulose
How does the cycle of 2 Person CPR change after the insertion of an advanced airway?
When should you switch out the individual doing the compressions?
insertion of advanced airway allows continuous compressions and rescue breaths to occur.
Switch every 2 mins
When should a PCP follow the steps C-A-B instead of A-B-C?
When the PT is unresponsive
Mechanism of Action Acetaminophen
Acetaminophen inhibits prostaglandin synthesis in the CNS and works peripherally to block pain impulse generation. Prostaglandins cause transmission of pain by peripheral nerve endings. Acetaminophen does not suppress platelet aggregation and does not cause gastric ulceration. Acetaminophen has only minimal effects on cyclooxygenase at peripheral sites and this is thought to be a reason why it cannot reduce inflammation.
Ibuprofen Dosage and Class
400mg, no repeat dose
Non-Steroidal Anti-Inflammatory Drug
Blood is composed of two elements; Plasma and Formed Elements. Name the 3 types of Formed Elements
red blood cells, white blood cells, and platelets
What are the shockable rhythms?
Pulseless V-Tac, V-Fib
Define Kussmaul respirations, what causes these respirations?
Dimenhydrinate MOA
Dimenhydrinate blocks receptors for acetylcholine in addition to receptors for histamine. Suppression of motion sickness is thought to be a result of blocking histamine (H1) and muscarinic cholinergic receptors in the neuronal pathway that connects the inner ear to the vomiting center.
Nitroglycerin Dosage/Repeat Dose(Patch and Spray)
3 Contraindications
.4mg SL Spray, q every 5 mins OR Systolic BP less then 100mmHg
.8mg/hr patch
Contraindications: Systolic BP less than 100 mmHg, EKG reading with STEMI present/ Right ventricular Infarcts
PT has taken phosphodiesterase inhibitors(Call OLMC)
What are the two regulatory proteins responsible for muscle contraction in skeletal and cardiac muscle?
Troponin and Tropomyosin.
Possible Reversible causes of Cardiac Arrest (9)
Hypovolemia, Hypoxia, Hypoglycemia, Hypothermia, Hyper/hypokalemia/hydrogen ions
Tension Pneumo, Cardiac tamponade, Toxins(overdose), Thrombosis
What is PEEP? How does it benefit the patient?
Positive End-Expiratory Pressure. benefits include improvement in oxygenation, recruitment of alveoli units, and improvement in compliance.
Formula for Fluid Infusion Rate
Give an example of a microdrip set and a macrodrip set
gtt/min = Volume X gtt/mL of set
Total time of infusion in minutes
Microdrip=60gtt/mL
Macrodrip= 10-15gtt/mL
Ipratropium Bromide and Salbutamol Dosages( nebulizer and MDI)
Atrovent: 20mcg/puff, q 30-60second
500mcg neb, q 5 mins to max of 1500mcg
Ventolin: 100mcg/puff, q 30-60 second max 30 puffs
5mg nebulized, continuous prn
what are the 4 principle structures of the Brain? List structures 4 additional structures found throughout the brain
4 main Structures: Cerebrum, Diencephalon, Brainstem, and Cerebellum
Located within the Diencephalon is: Thalamus, hypothalamus, and pineal gland
Located within the brainstem: Midbrain, Pons, and Medulla Oblongata
Residing directly inferior to the anterior portion of the cerebrum is the Pituitary Gland
Common acronym for potential causes of altered LOC, what does each letter represent?
AEIOUTIPS
Alcohol/Acidosis, Epilepsy, Insulin, Overdose, Underdose/Uremia, Trauma, Infection, Psych, Stroke/Shock
Formula for calculating MAP?
What does MAP stand for?
Mean Arterial Pressure
MAP= Diastolic + 1/3(Systolic-Diastolic)
MAP= (2 x Diastolic +Systolic) / 3
Mechanism of Action for Nitroglycerin,
Class of Nitro
Class: Antianginal
MOA:Converted to nitric oxide intracellularly, inhibits myosin in vascular smooth muscle, causing vasodilation in veins and
arterioles. Decreases preload and afterload on the heart, and therefore decreases myocardial oxygen demand.
Your ACP partner asks you to draw up Ketamine and Succinylcholine to intubate a 110kg patient. How much of each do you draw up?
Ketamine- 1.5mg/kg =165mg
Succ- 1.5mg/kg to a max of 150mg= 150mg
How does the body remove Hydrogen Ions from the body (3). Briefly describe each mechanism
Buffer Systems: temporarily bind H+ to remove excess H+ from solutions
Exhalation of CO2: Increasing rate and depth of respirations reduces the amount of carbonic acid in blood
Kidney Excretion of H+: slowest method, but is is the only method to actually eliminate acids via urine
In Cardiac Arrests patients suffering from hypothermia, what does the CBT need to be before you can discontinue Resuscitation efforts?
>35 C
What is the Critical Minimum Threshold? what happens to the brain if it is not met?
it is the minimum Cerebral perfusion pressure required to perfusion the brain (60 mmHg).
A CPP of less than 60mmHg leads to cerebral ischemia, potential for long term neurological deficits. A single drop below 60mmHg doubles chance of death in patients with a brain injury