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Flashcards in Trauma Care/anaphylaxis Deck (54)
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0
Q

What class is fentanyl?

A

Narcotic analgesic (schedule 2)

1
Q

What is fentanyl also called?

A

Sublimase

2
Q

What is the MOA for fentanyl?

A

Agonist actions at the body’s opioid (eg, morphine) receptor. Increases tone and decreases smooth muscles of the GI tract

3
Q

What are the indications for fentanyl?

A

This drug is used to treat severe pain, used as an anesthetic or for procedural sedation.

4
Q

What are the contraindications for fentanyl?

A

Myasthenia gravis, children under 2 years old.

5
Q

Adverse reactions for fentanyl?

A

Skeletal and thoracic muscular rigidity, bradycardia, seizures and diaphoresis

6
Q

Drug interactions for fentanyl?

A

May interact with alcohol or any CNS depressants.

7
Q

How fentanyl supplied?

A

50 ug/mL ampules

8
Q

Dosage and administration for fentanyl

A

Adult dose is 25-100 ug (.5-2 ug/kg) IM, IO, IVP or atomized intranasal. (Varies considerably by protocols).

Pediatric 2-12 years: 1.7-3.3 ug/kg IM, IO, IVP

9
Q

Duration of action for fentanyl

A
Onset: immediate IV
7-15 minutes IM
Peak effect: 3-5 minutes IV, 30 minutes IM
Duration m: 30-60 minutes IV
1-2 hours IM
10
Q

Special considerations for fentanyl

A

Pregnancy safety: category C. May cause life threatening hypoventilation, naloxone hydrochloride [narcan] should be readily available.

11
Q

What is morphine sulfate also called?

A

Astramorph/PF and others

12
Q

What class is morphine?

A

Opioid analgesic (schedule 2 narcotic)

13
Q

MOA for morphine

A

Alleviates pain through CNS action, suppresses fear and anxiety centers in the brain; depresses brain stem respiratory centers, increases peripheral venous capacitance and decreases venous return, decreases preload and after load, which decreases myocardial oxygen demand.

14
Q

Indications for morphine

A

Severe CHF, pulmonary edema, chest pain associated with acute MI, analgesia for moderate to severe acute and chronic pain (use with caution)

15
Q

Contraindication for morphine

A

Head injury, exacerbated COPD, depressed respiratory drive, hypotension, undiagnosed abdominal pain, decreased level of consciousness, suspected hypovolemia, patients who have taken MAOIs within the past 14 days.

16
Q

Adverse reactions for morphine

A

Respiratory depression, hypotension, decreased level of consciousness, nausea, vomiting, bradycardia, tachycardia, syncope, facial flushing, euphoria, bronchospasm, dry mouth.

17
Q

Drug interactions for morphine

A

Potentiates sedative effects of phenothiazine. CNS depressant may potentiate effects of morphine. MAOIs may cause paradoxical excitation.

18
Q

How is morphine supplied?

A

10mg in 1ml of solution, ampules and tubex syringes.

19
Q

Dosage and administration for morphine

A

Adult: initial dose: 2-4mg IV (over 1-5 minutes) every 5-30 minutes.
Repeat dose: 2-8mg at 5- to 15- minute intervals.

Pediatric: .1-.2mg/kg per dose via IV, IO, IM or SC; maximum dose of 5mg.

20
Q

Duration of action for morphine

A

Onset: immediate
Peak effect: 20 minutes
Duration: 2-7 hours

21
Q

Special considerations for morphine

A

Pregnancy safety: category C. Morphing rapidly crosses the placenta. Safety in neonate not established. Use with caution in geriatric population and those with COPD, asthma. Vagotonic effect in patient with acute inferior MI (bradycardia, heart block). Naloxone hydrochloride (narcan) should be readily available as an antidote.

22
Q

What is nitrous oxide also known as?

A

Oxygen (50:50) nitronox

23
Q

What class is nitrous oxide?

A

Gaseous analgesic and anesthetic

24
Q

MOA for nitrous oxide

A

Exact mechanism unknown; affects central nervous system phospholipids

25
Q

Indications for nitrous oxide

A

Moderate to severe pain, anxiety, apprehension

26
Q

Contraindications for nitrous oxide

A

Impaired level of consciousness, head injury, inability to comply with instructions; decompression sickness (nitrogen narcosis, air embolism, air transport); undiagnosed abdominal pain or marked distention, bowel obstruction; hypotension, shock, COPD (with history/suspicion of carbon dioxide retention); cyanosis; chest trauma with pneumothorax

27
Q

Adverse reactions to nitrous oxide

A

Dizziness, apnea, expansion of gas filled pockets, cyanosis, nausea, vomiting, malignant hyperthermia, drowsiness, euphoria

28
Q

Drug interactions for nitrous oxide

A

None of significance

29
Q

How is nitrous oxide supplied?

A

D and E cylinders (blue and Green) of 50% nitrous oxide and 50% oxygen compressed gas

30
Q

Dosage and administration for nitrous oxide

A

Adult: (note: invert cylinder several times before use) instruct the patient to inhale deeply through demand valve and mask or mouthpiece. Pediatric: same as adult

31
Q

Duration of action for nitrous oxide

A

Onset: 2-5 minutes.
Peak effect: variable
Duration: 2-5 minutes.

32
Q

Special considerations for nitrous oxide

A

Pregnancy safety: nitrous oxide increases the incidence of spontaneous abortion. Ventilate patient area during use. Nitrous oxide is a nonflammable and nonexpolsive gas. Nitrous oxide is ineffective in 20% of the population.

33
Q

What class is oxygen?

A

Naturally occurring atmospheric gas

34
Q

MOA for oxygen

A

Reverses hypoxemia

35
Q

Indications for oxygen

A

Confirmed or expected hypoxemia, ischemic chest pain, respiratory insufficiency, prophylactically during air transport, confirmed or suspected carbon monoxide poisoning, all other causes of decreased tissue oxygenation, decreased level of consciousness

36
Q

Contraindications for oxygen

A

Certain patients with COPD or emphysema who will not tolerate oxygen concentrations over 35%, hyperventilation. Oxygen should never be withheld from a patient who needs it. Be prepared to assist with ventilations in a patient with COPD who requires high concentration, as apnea may result.

37
Q

Adverse reactions for oxygen

A

Decreased level of consciousness and respiratory depression in patients with chronic carbon dioxide retention. Retrolental fibroplasia if giving high concentrations to premature infants (maintain 30-40% oxygen)

38
Q

Drug interactions for oxygen

A

None

39
Q

How is oxygen supplied?

A

Oxygen cylinders (usually green and white) of 100% compressed oxygen gas

40
Q

Dosage and administration for oxygen

A

Adult: cardiac arrest and carbon monoxide poisoning: 100%.
Hypoxemia 10-15 l/min via NRB. COPD 1-6 l/min via nasal cannula or 28-35% Venturi mask. Be prepared to provide ventilatory support if higher concentrations of oxygen needed. Pediatric: same as for adult with exception of premature infant

41
Q

Duration of action for oxygen

A

Onset: immediate
Peak effect: not applicable
Duration: less than 2 minutes

42
Q

Special considerations for oxygen

A

Be familiar with liter flow and each type of delivery device used. Supports possibility of combustion.

43
Q

What is diphenhydramine also called?

A

Benadryl

44
Q

What class is diphenhydramine

A

Antihistamine; anticholinergic

45
Q

MOA for diphenhydramine

A

Blocks cellular histamine receptors; decreases vasodilation; decreases motion sickness. Reverses extrapyramidal reactions.

46
Q

Indications for diphenhydramine

A

Symptomatic relief allergies, allergic reactions, anaphylaxis, acute dystonic reactions (phenothiazines). Blood administration reactions; used for motion sickness, hay fever.

47
Q

Contraindications for diphenhydramine

A

Asthma, glaucoma, pregnancy, hypertension, narrow-angle glaucoma, infants, patients taking monoamine oxidase inhibitors (MAOIs)

48
Q

Adverse reactions for diphenhydramine

A

Sedation, hypotension, seizures, visual disturbances, vomiting, urinary retention, palpitations, arrhythmias, dry mouth, and throat and paradoxical CNS excitation in children.

49
Q

Drug interactions for diphenhydramine

A

Potentiates effects of alcohol and other anticholinergic may inhibit corticosteroid activity; MAOIs prolong anticholinergic effects of diphenhydramine

50
Q

How is diphenhydramine supplied?

A

Tablets: 25,50mg
Capsules: 25,50mg
Prefilled syringes: 50- or 100 mg vials(IV or IM)
Elixir, 12.5 mg/5ml.

51
Q

Dosage and administration for diphenhydramine

A

Adult: 25-50 mg IM or IV or PO.
Pediatric: 1-2ng/kg IV, IO slowly or IM. If given PO: 5mg/kg/24 hours.

52
Q

Duration of action for diphenhydramine

A

Onset: 15-30 minutes
Peak effect: 1 hour
Duration: 3-12 hours

53
Q

Special considerations for diphenhydramine

A

Not used in infants or in pregnancy. Category B. If used in anaphylaxis, will be in conjunction with epinephrine, corticosteroids