Pharm. Basics
What is the mechanism of action for medications ending in "--lol"
Beta Blockers
Explain the AHA ACLS recommended guidelines for treating Tachycardia arrhythmias in an adult (include symptomatic and asymptomatic)
Adenosine administration
Synchronized cardioversion
True or False:
Any medication you can push IV can also be pushed IO
True
You respond to the Ameri-Stay in Sunset on the report of a 24 YOF with AMS. After your initial assessment, you note pinpoint pupils and shallow respirations. What is your drug of choice (include dosage)?
Nalaxone, 0.4 - 2mg (titrate to maintain respirations)
Anticholinergics work to block this neurotransmitter which affects the body's Parasympathetic NS responses
Acetylcholine
According to the Drug Schedules of Narcotics, there are 5 specific schedules. Explain the difference between schedule 1 and schedule 2 narcotics. Give examples of each, if possible.
Sched. I - High abuse potential with NO medical purpose (LDS, Heroin, Marijuana)
Sched. II - High abuse potential with legitimate medical purposes (Fentanyl)
This medication acts as a Class I, II, III, and IV antiarrhythmic, resulting in Sodium, Potassium, and Beta adrenergic blockers
Amiodarone
Describe how to calculate a drip rate (without a pump)
Volume (in mL) x Drip Set
---------------------------------- = Drops/Min
Time (min)
You respond to a diabetic patient with severe hypoglycemia (26g/dL) and altered mental status. IV access cannot be obtained, the patient cannot safely take oral glucose, and has a history of bone infections in both humerus bones, and double leg amputations at the waist secondary to bone cancer.
This medication can raise blood glucose by stimulating hepatic glycogen breakdown. Include the dose.
Glucagon 1mg IM
Alzheimer's is implicated in low levels of this neurotransmitter (which heavily impacts the body's motivation/reward system, ability to control movement in the CNS and control of blood vessels and GI motility in PNS)
These substances work by binding to anbd activating mu, kappa, and delta receptors in the CNS and PNS. This results in a state of analgesia, euphoria, and respiratory depression.
Opioids
While it may be ineffective for Atrioventricular blocks, this medication is indicated for symptomatic bradycardia and my be repeated up to 3 times in 5 minute intervals. Provide the name and dose.
Atropine, 1mg
Describe how to make Push-Dose Epinephrine.
Waste 1, draw 1
You respond to a 48 YOM with a sudden onset of seizures and confusion. History taking reveals that he has been sober from alcohol for two weeks but has only experienced an AMS today. The Seizure is on-going. What is your medication of choice? And Why?
Benzodiazepines (Versed or Ativan).
Benzodiazepines work on the GABA receptors in the body to inhibit neurons from "firing", effectively slowing or stopping the driving force in seizures.
This is the body's main INHIBITORY neurotransmitter
Gamma Aminobutyric Acid (GABA) (Mostly in the brain)
or
Glycine (mostly in the spinal cord)
This medication CLASS works to stimulate GABA receptors in the body, resulting in a hyperpolarized state which decreases neuron excitability.
Benzodiazepines
Amiodarone works partially by blocking sodium channels at rapid pacing frequencies which causes an increase in the duration of the myocardial action potential. If given too frequently (or too much), this may prolong the action potential TOO much, causing a reduce in cardiac excitability and resulting in a secondary depolarization due to Ca++ and K+ imbalance. The resulting arrhythmia is called:
Torsades de Pointes
Describe how to make an Epi Drip using Clinton FD protocols.
Ex. Inject 2mg of Epi 1:10,000 into a 500mL bag of NS. With a 60gtt set at 1 gtt/sec, this will give you 4mcg per minute.
OR
Ex. Inject 1mg of Epi 1:10,000 into 100mL NS bag. With a 60gtt set, dripping 1gtt per second, you will have 10mcg per minute.
You respond to a patient in Hooper who was out in a field while a crop-duster plane flew overhead and dusted him with chemicals. With suspected poisoning, you find the Pt presenting with copious secretions, bronchoconstriction, and muscle fasciculations. What is your medication of choice (include the dose)?
Atropine, 2mg repeated every 10 minutes until control of secretions is obtained.
This is the body's main EXCITATORY neurotransmitter
Glutamate (Also NMDA or AMPA)
This medication works by IRREVERSIBLY inhibiting Cyclooxygenase-1 enzymes (via acetylation) which results in thromboxane A2 formation inhibition.
Acetylsalicylic acid (Aspirin)
This antiarrhythmic medication works by blocking the sodium channels responsible for depolarization (phase 0), resulting in decreased ventricular excitability, and prolonging the effective refractory period of the cardiac action potential.
Secondarily, this medication also inhibits the conduction of action potentials across nerve fibers, resulting in the inhibition of pain perception by the brain. Include the name and dose.
What is the abbreviation for intramuscular injection
IM
This medication is administered through an IV (over 4 minutes, preferably mixed with 100mL of D5W) for eclamptic seizures. This may be repeated once at half the dose. Provide the name and dose.
Magnesium Sulfate, 4mg
This works as both an inhibitory AND excitatory neurotransmitter affecting both H1 and H2 receptors (responsible for wakefulness and attention) as well as H3 receptors (responsible for the release of secondary neurotransmitters like dopanine, acetylcholine, serotonin, etc)
Histamine