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Pharm final review
Quiz Notes
| Question | Answer |
|---|---|
| The movement of ions from an area of high concentration to an area of low concentration is an example of? | Simple diffusion |
| Write the 8 Rights? | Right Patient Right Time Right Medications Right Dose Right Documentation Right Route Right Reason Right Response |
| If you have a medication that is 2% how many grams is that in how many mL's? | 2 Grams in 100 mL |
| If you have a medication that is 5% how many milligrams per milliliter. | 50 Milligrams on 1 mL **Move the decimal 1 to the right** |
| Albuterol Sulfate is 0.083% • How many mg/mL would this be? | 0.83 mg/mL |
| What are the routes of administration? | -Enteral, -Parenteral, -Percutaneous -Pulmonary |
| What are the Enteral Medication Administrations Routes? | - Orally (PO) - Gastric Tube (OG) (NG) - Rectally (PR) affected by the “first pass effect” |
| What are the Parenteral Medication Administration Routes? | – Intradermal injection (ID) – Subcutaneous injection (SQ) – Intramuscular injection (IM) – Intravenous access (IV) – Intraosseous infusion (IO) **Typically involves the use of a needle** |
| Parenteral Intradermal Injections Write down the Insertion Degrees and the Max volumes and the injection sites. | -10-15 degrees -Less than 1 mL -Forearm under epidermis |
| Parenteral IV Injections Write down the Insertion Degrees and the Max volumes and the injection sites. | -10-30 degrees -TKO KVO 20-25 -Scalp veins -E.J. -Arm, Axillary, Basilic, Cephalic, Median Basilic, Median Cephalic, Radial, Ulnar. -Hand -Foot |
| What are the Central Venous Access sites? | -IJ -Subclavian -Femoral -PIIC Peripherally Inserted Central Cath Line -Port a Cath |
| Parenteral Subcutaneous Injections write down the insertion Degrees, the Max volumes, and the injections sites. | -45 degrees Less than 1 mL Upper arm Abdomen Upper legs |
| Parenteral Intramuscular Injection write down the insertion degrees, max volume, and injection sites. | -90 degrees • Dorsal Gluteal (5 or more mL’s) • Vastus Lateralis (5 or more mL’s) • Rectus Femoris (up to 5 mL’s) • Deltoid (up to 2 mL’s) |
| What are the different fluid compartments? | Intracellular Extracellular Interstitial Intravascular |
| The Intravascular space is responsible for what percentage of fluid retention? | 4.5% **plasma in blood** |
| The Interstitial space is responsible for what percentage of fluid retention? | 10.5% **gaps between cells** |
| The Extracellular space is responsible for what percentage of fluid retention? | 15% **both interstitial and intravascular** |
| The Intracellular space is responsible for what percentage of fluid retention? | 45% **inside the cells** |
| What effect does hypotonic solutions have on the cells? | Hypo makes them blow |
| You just administered 0.4 mg of nitro to a patient sublingually this is an example of which of the following routes of medication administration? | Percutaneous. |
| Which medication route would have the fastest route of absorption? | IV |
| When performing an intradermal injection the needle should be inserted into the skin at a... | 10-15 degree angle |
| The movement of water from an area of low solute concentration to an area of high solute concentration is an example of... | osmosis |
| After establishing a saline lock the line should be injected with how much normal saline? | 3-5 mL's |
| What blood type is considered the universal recipient? | AB+ |
| What blood type is considered the universal donor? | O- |
| Most of the water in the human body can be found in which of the following compartments? -Intracellular -Extracellular -Interstitial -Intravascular | Intracellular |
| What are three parts of a long bone? | Epiphysis Metaphysis Diaphysis |
| The epiphysis of a long bone contains mostly? | Spongy bone |
| What sites are appropriate for the insertions of an IO needle? | -Proximal Tibia -Distal Tibia -Proximal Humerus -Manubrium -Distal Femur |
| The diaphysis of a long bone contains mostly? | Cortical bone |
| An adult Bone Injector Gun B.I.G. is used on patient how old? | Over 8-years of age. |
| When using the E-Z IO Drill on a 12 year-old to establish IO access which of the following needles would be most appropriate to use on this patient? Pink 15mm Red 20mm Blue 25mm Yellow 45mm | Blue needle (25mm) |
| When Using the EZ IO Drill on a neonate to establish IO access, which of the following needles would be most appropriate to use on this patient? Pink 15mm Red 20mm Blue 25mm Yellow 45mm | Pink |
| When using the pediatric Bone Injector Gun (B.I.G.) which of the following sites should be used for insertion? -Proximal Tibia -Proximal Humerus -Distal Femur -Distal Tibia -Sternal | Proximal Tibia |
| When using the EZ IO Drill on a 44-year-old to establish IO access in the proximal humerus which of the following needles would be most appropriate to use on this patient? Pink 15mm Red 20mm Blue 25mm Yellow 45mm | Yellow needle 45 mm |
| The FAST1 sternal IO device in indicated for use on patient how old? | 12 year of age and up |
| What are considered the Enteral routes? | Nasogastric Oral Rectal |
| If a cell was to open a channel that was selective only for potassium ions, what should occur? | |
| A pediatric Bone Injector Gun (B.I.G.) is used on patients? | Less than 12 years of age |
| What are the IO sites for an Infant? | Distal Femur Proximal Tibia Distal Tibia |
| For what age group would you use a 15 gauge B.I.G. | >12 years of age |
| For what age group would you use an 18 gauge B.I.G. | <12yaers of age |
| What medication would you administer before inserting an IO? | 2% Lidocaine 20-40 mg |
| A Huber needle is always used for? | Accessing in implanted central venous port |
| Which one of the following compartmens contains the least amount of water in the human body | Intravascular 4.5% **plasma in blood** |
| The chance of a pulmonary embolism is greater with a peripheral IV access versus central venous access T/F | False |
| When attempting to access a central venous line what is considered the minimum syringe size that you should use? | 20 mL |
| The movement of potassium from the inside of a call to the outside is an example of | Simple diffusion! |
| The movement of an ion from an area of high concentration to an area of low concentration is an example of? | Simple diffusion! |
| Which of the following is not considered a peripheral IV site? Saphenous Femoral External Jugular Cephalic | Femoral |
| Write down the compartments in the body that contain the most and least amount of water. | Intracellular 45% **inside the cells** Interstitial 10.5% **gaps between cells** Intravascular 4.5 **plasma in blood** |
| What would happen in the body if you were to administer a Parasympathomimetic medication? | mimicking the "rest and digest" state bradycardia, hypotension stimulates digestive secretions (saliva and gastric acid). bronchoconstriction increase in sweating, tearing |
| What would happen in the body if you were to administer a Parasympatholytic medication? | It allows the sympathetic nervous system ("fight or flight") to become dominant. urinary retention. Inhibition of sweating (anhidrosis), dry mouth, dry eyes mydriasis, bronchodilation constipation. tachycardia |
| What would occur if a patient was to have an overstimulation of the parasympathetic nervous system? Overdose of a parasympathomimetic. | Salivation Lacrimation Urination Defecation GI Upset Emesis Miosis |
| What are the signs and symptoms of a parasympatholytic medication? | Blind as a bad Mad as a hatter Dry as a bone Red as a beet Hot as a Desert Mydriasis, Tachycardia, Shaking, |
| What medication would you give fo the overdose of a parasympatholytic? | Physostigmine |
| What medication would you give for the overdose of a parasympathomimetic medication? | Atropine |
| What does SLUDGEM stand for? Used for the over stimulation of the parasympathetic nervous system | Salivation Lacrimation Urination Defecation Gi Upset Emesis Miosis |
| Where are Nicotinic Nm and Nn receptors found in the body? | Nm (Nicotinic Muscle) in Neuromuscular Junction Nn (Nicotinic Neuronal) throughout the CNS and PNS Ganglia |
| What is the action potential of a neuron? | -55mV |
| The parasympathetic nervous system branches off of the spinal cord at what two sections? | Cranial, Sacral |
| Atropine exerts its therapeutic effects by? | Blocking Muscarinic acetylcholine receptors |
| You have just administered a potent B2 agonist medication which would you anticipate occurring? | Bronchodilation and a decrease in the pulmonary resistance. |
| What is the part of the nervous system that controls the GI system? | 12 |
| The part of the nervous system we have voluntary control over is the? | Somatic nervous system |
| Alpha 1 adrenergic receptor stimulation results in...? | 17 |
| Parasympathetic stimulation of the heart primarily affects...? | 18 |
| You just administered a medication to a patient that is a potent A1 agonist. Which of the following would you anticipate occurring? | 20 |
| Atropine sulfate has a positive chronotropic effect on the heart because it is a ..? | Parasympatholytic Med block acetylcholine at muscarinic receptors, inhibiting stopping "rest and digest" parasympathetic nervous system activity |
| Repolarization is all about..? | Potassium |
| What do alpha 1 receptors do? | constriction of arterioles and veins positive inotropic effects pupil dilation |
| Define chronotropy | Chronotropy: Heart rate. |
| Define Inotropy | Inotropy: Muscle contractility. |
| Define drom | Dromotropy: Conduction speed. |
| What are the signs and symptoms of Opioid/ Opiate use? | -Altered mental status -Respiratory depression -Pinpoint pupils (Miosis) |
| Define Bradykinesia | Slowness of movement |
| What is the treatment for Parkinson's Disease | Levadopa (L-dopa) Sinemet (combines carbidopa & L-Dopa) |
| What is the formula for cardiac output the volume of blood that the heart pumps on one minute? | CO= Stroke volume X Heart rate |
| What is the formula for blood pressure? | BP=(SV x HR) x SVR |
| What is the postganglionic neurotransmitter of the sympathetic nervous system. "adrenergic" | Norepinephrine |
| What medications are used to treat hypertension? | – Diuretics – ACE Inhibitors – Calcium Channel Blockers – Beta Blockers & Antiadrenergic Meds – Direct Vasodilators |
| How do Diuretics decrease your blood pressure ? | – Causes an excretion of water from the body in urine to reduce overall blood volume. |
| What are three kinds of Diuretics? | – Loop Diuretics – Thiazides – K+ Sparring |
| What is the normal firing rate of the AV node? | 40-60 bpm |
| What is the resting potential of an autorhythmic cell? | -60 |
| What is the action potential of an Autorhythmic cell? | -40 |
| Once a cell reaches action potential, the influx of what ion causes an autorhythmic cell to depolarize? | 10 |
| What is the resting potential of a cardiac contractile cell? | -90 |
| What is the action potential of a cardiac contractile cell? | -85 |
| Once a cardiac contractile cell reaches its action potential the influx of what ion causes the cell to depolarize? | Sodium |
| What is considered the resting potential of a neuron? | -70 |
| What is considered the action potential of a neuron? | -55 |
| What is considered the normal ratio of bicarbonate ions to carbonic acid in a healthy adult patient? | 20:1 |
| As blood travels into an area of the body where there is a decrease in the amount of carbon dioxide, a decrease in temperature, and an increase in the pH, hemoglobin should do what? | Increase its affinity towards oxygen |
| The left shift of oxygen dissociation curve is known as the..? | Haldane effect |
| What buffer mechanism acts the quickest to keep homeostasis of the pH of blood in the human body? | Carbonic acid-bicarbonate system |
| What buffer mechanism acts the slowest to keep homeostasis of the pH of blood in the human body? | Phosphate buffer system |
| What food or drinks does a patient who is taking a MAO Inhibitor need to stay away from? | Cheese and red wine |
| You have just administered a medication that is classified as a sympathomimetic. Which of the following would you anticipate occurring with your patient? | Mydriasis Bronchodilation Increased heart rate Increase in blood glucose levels |
| Define a Parasympatholytic Para sympatho lytic | Blocks acetylcholine at M receptors inhibiting the rest and digest. |
| What is the resting potential on an autorhythmic cell? | -60 |
| What is the action potential of an Autorhythmic cell? | -40 |
| What is the resting potential of a cardiac contractile cell? | -90 |
| What is the action potential of a cardiac contractile cell? | -85 |
| The rapid influx of what ion causes an autorhythmic cell to depolarize ? | Calcium |
| The rapid influx of what ion causes a contractile cell to depolarize? | Sodium |
| The efflux of what ion causes an autorhythmic cell to repolarize? | Potassium |
| The efflux of what ion causes a contractile cell to repolarize? | Potassium |
| What is considered the resting potential of a neuron? | -70 |
| What is considered the action potential of a neuron? | -55 |
| What is cardiac output? | The amount of blood that is pumped by the heart in one minute |
| What is the equation for cardiac output | sv x hr |
| What is the equation for blood pressure? | BP = (SV x HR) X SVR |
| Phase 1 of the ETCO2 wave is called the? | Respiratory baseline |
| Phase 2 of the ETCO2 wave is called the? | Respiratory upstroke |
| Phase 3 of the ETCO2 wave is called the? | Expiratory plateau |
| Phase 4 of the ETCO2 wave is called the? | Inspiratory downstroke |
| What effects does the release of histamine have in the body? | ØBronchoconstriction ØVasodilation |
| What cells release histamine? | ØMast Cells & Basophils ØDegranulation |
| What are the two functions of the pancreas? | Exocrine Endocrine |
| Alpha Cells: Produce | Glucagon increases blood sugar |
| Beta Cells: Produce | Insulin decreases blood sugar |
| What is the action potential of a cell in the SA node? | -40 |
| What is the action potential of a cell directly involved in a cardiac muscle contraction | -85 |
| Lidocaine is classified as what type of antiarrhythmic? | Sodium Channel Blocker class 1 |
| Amiodarone is classified as what type of antiarrhythmic? | Class 3 potassium channel blocker |
| Diltiazem is classified as what type of antiarrhythmic? | Class 4 Calcium Channel blocked |
| What kind of specific heart condition may occur with the consumption of cocaine? | Prinzmetal Angina |
| You are taking care of a patient who is found bradycarbic after taking too much of their Diltiazem (class 4) medication. Which of the following medications would you administer as an antagonist to this overdose? | Calcium Chloride |
| Droperidol is classified as what type of medication? | Antipsychotic |
| You are treating a patient who has consumed a large amount of cocaine and presents with a wide complex tachycardia. Which of the following medications would you administer as a treatment for this particular overdose? | Sodium Bicarb |
| What medication is considered the antagonist for a benzodiazepine? | Flumazenil |
| Which of the following correctly explains the mechanism of action of a benzodiazepine? | It allows more chloride to enter the cell, thus making it more negative |
| What is the correct dose of flumazenil for a pediatric patient? | 0.01 mg/kg IV/IO over 15 seconds |
| A patient consumed two bottles of nitroglycerin what medication would you give? | Methylene Blue |
| A patient overdosed on a beta blocker what medication would you give? | Glucagon |
| How does the administration of Glucagon cause an increase in the heart rate in a patient that has overdosed on beta blockers? | It causes an up-regulation of Calcium channels in the cardiac cells |
| What medication would you give for a pt that has cyanide poisoning? | Hydroxocobalamin |
| Hydroxocobalamin is administered to an adult patient for the treatment of suspected cyanide poisoning at a dose of? | 5 Grams over 15 minutes |
| What medication would you give for the overdose of Atenolol ? | Glucagon |
| A patient presents with excessive drooling, vomiting, diarrea, and is bradycardic what medication would you give to save his life? | Atropine |
| Overdosing on cocaine can have what effect on the heart? | Sodium Channel Blocker |
| What is the action of antipsychotics | blocks dopamine receptors in the brain |
| Opioid opiate overdoses are one of the most common overdoses seen in the prehospital realm what the the signs and symptoms? | AMS Bradypnea/ Apnea Miosis |
| What is the antidote for a opioid overdose? | Narcan |
| What is the adult dose for narcan? | 0.4-2 mg IV/IO/IM/IN |
| What is the pediatric dose for narcan | 0.1 mg/kg Max dose 2mg IV/IO/IM/IN |
| What is the Mechanism of action of a benzodiazepine | They bind to gaba receptors and causes an increase in attraction to gaba which opens chloride channels and hyperpolarizes the neurons |
| What are the signs and symptoms of a benzodiazepine overdose | – AMS/Confusion – Slurred speech – Bradypnea/Apnea – Dilated pupils – N/V – Unconsciousness – Seizures |
| What is the treatment for a benzodiazepine overdose? | Flumazenil (Romazicon) **Competitively blocks benzodiazepines at the GABA/benzodiazepine receptor complex** |
| What is the adult dose for Flumazenil (Romazicon)? | • 0.2 mg IV/IO over 15 seconds (1st dose) • 0.3 mg IV/IO over 30 seconds (2nd dose) • 0.5 mg IV/IO over 30 seconds (3rd dose) • May repeat as needed up to 3 mg total dose |
| What is the pediatric dose for Flumazenil (Romazicon) | 0.01 mg/kg every 15 seconds, up to 0.05 mg/kg total dose |
| What medication would you use for a beta blocker overdose | Glucagon |
| What is the adult dose for Glucagon when treating a suspected beta blocker overdose? | -3-10 mg IV slowly over 3-5 minutes. -Followed by an infusion of 3-5 mg per hour |
| What is the pediatric dose for Glucagon when treating a suspected beta blocker Overdose? | -0.05 – 0.15 mg/kg IV/IO, -followed by 0.05-0.1 mg/kg per hour IV/IO infusion |
| What is the Adult dose of glucagon for hypoglycemia | 1mg IM/IN |
| What is the pediatric dose of glucagon for hypoglycemia | • <20 kg 0.5 mg IM/IN • >20 kg 1 mg IM/IN |
| What is hemoglobin called that is carrying carbon monoxide (CO)? | Carboxyhemoglobin |
| What is hemoglobin called that has carbon dioxide (CO2) attached to it? | Carbaminohemoglobin |
| What is hemoglobin called when it isn’t working right? | Methemoglobin |
| What are the signs and symptoms of Cholinergic Poisoning? | SALIVATION LACRIMATION URINATION DEFECATION GI UPSET EMESIS MIOSIS |
| What are the causes of cholinergic poisonings ? | – Nerve agents – Insecticides |
| What is the mechanism of action for a Cholinergic Poisoning ? | Blocks acetylcholinesterase (AChE) |
| What are the signs and symptoms of Cholinergic Poisoning? | – Diarrhea – Urination – Miosis – Bradycardia, Bronchospasm, Bronchorrhea. – Emesis – Lacrimation – Seizures, Salivation, Sweating |
| What medication would you give for someone who has Cholinergic Poisoning? | -Atropine -Pralidoxime |
| What is the Adult dose for Atropine? | 2-4 mg (or more) IV/IO push |
| What is the pediatric dose for Atropine? | 0.02-0.05 mg/kg (or more) IV/IO push |
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