LA County Drugs Exam Questions
with Answers
Benadryl Pharmacokinetics - Answer-Onset 15-30 min
Benadryl Interactions - Answer-Increases CNS depression with alcohol and other CNS
depressants, or MOA inhibitors
Benadryl Adverse Effects - Answer--Confusion
-drowsiness
-mild hypotension
-palpitations
-paradoxical
excitement in children
-tachycardia
Benadryl Considerations - Answer--Deep IM in large muscle group (lateral thigh,
gluteus)
- Does not treat anaphylaxis/airway edema; if signs of anaphylaxis administer EPI IM
- use with caution in older adults due to increased confusion/drowsiness
-may causes paradoxical agitation in beds
Epi Class - Answer-Sympathomimentic
Epi Indications - Answer-- anaphylaxis
- CA non-traumatic; CA resuscitation, hypotension unresponsive to fluids in ROSC
- Cardiac dysrhythmias: symptomatic Brady not responsive too atropine and TCP for
adults; and for symptomatic Brady not responsive to O2 and ventilation in Peds
- Resp. Distress/bronchospasm; asthma, reactive bronchospasm
airway obstruction: stridor or visible airway swelling, croup in peds
- shock/hypotension; non traumatic hypotension not responsive to IV fluids
Eli Adult Doses - Answer--anaphylaxis = 0.5mg (1:1000) IM lateral thigh, rpt 10 min x2
prn, max 3 doses
- CA = 1mg (1:10,000) 10mL IV/IO, rpt every 5 min x2, max 3mg
- Non traumatic shock = push dose 1mL every 1-5 min prn to maintain SBP > 90
Resp. Distress/Bronchospasm= 0.5mg (1:1000) IM lateral thigh
- Airway obstruction/Stridor = 5mg via neb (1:1000) rpt x1 in 10 min prn
- Airway Obstruction/Swelling = 0.5mg (1:1000) rpt every 10 min x2, max 3 doses
Epi Peds Doses - Answer-- Anaphylaxis = 0.01mg/kg (1:1000) IM, rpt 10 min x2 prn for
persistent symptoms, max 3 doses
,-CA = 0.01 mg/kg (1:10,000) IV/IO every 5 min, max single dose 1mg, max total 3
doses
- Shock/Hypotension = push dose every 1-5 min prn to maintain SBP > 70
- Resp. Distress/Bronchospasm = 0.01mg/kg IM (1:1000) in lateral thigh
- Airway (croup) = <1: 2.5mL (1:1000) via neb; >1+ 5mL via neb (1:1000), rpt x1 in 10
min prn, max 2 doses prior to BHC
- Airway swelling = 0.01mg/kg IM (1:1000), rpt every 10 min x2 prn, max 3 doses prior
to BHC
EPI MOA - Answer-naturally occurring catecholamine. Acts directly on Alpha and Beta
receptors; most potent on alpha vasoconstriction the aorta and peripheral vasculature.
- B1 = increases inotropy, chronotropy, and AV conduction
- B2 = bronchial smooth muscle relaxation and vasodilation to internal organs and
skeletal muscles
Epi pharmacokinetics - Answer-Onset < 2 min IV, 1-3 min IM; duration 5-10 min IV, 20-
30 min IM
Epi Contraindication and Interactions - Answer-no contraindications
interactions - can be partially deactivated by highly alkaline solutions like sodium bicarb
Epi Adverse Effects - Answer-- Anxiety
- CVA or MI (rare, IV only)
- HTN
- Palpitations
- Tachydysrhythmias
- Tremors
Epi Considerations - Answer-Inadvertent IV injection or usual IM formulation and dose
constitutes a 10x OD than can result in sudden sever HTN and possible cerebral
hemorrhage
Fentanyl Class - Answer-Synthetic Opioid
Fent Indications - Answer-Multiple PI's, pain management
Adult Dose - Answer-50 mcg IV/IO push or IM/IN, rpt every 5 min prn for max of 150
mcg
- contact base for additional 100 mcg for max total dose 250 mcg
Fent Peds Dose - Answer-1mcg/kg slow IV/IO push or IM or 1.5 mcg/kg for IN
- repeat every 5 min x1 prn, max 2 doses prior to base, max total 4 doses
, Fent MOA - Answer-Narcotic agonist-analgesic of opiate receptors; inhibits ascending
pathways thus altering response to pain, increases pain threshold, produces analgesia,
respiratory depression and sedation
Fent pharmacokinetics - Answer-immediate onset
peak in 3-5 min
duration 30-60 min
Fent Contraindications - Answer-Hypersensitivity
Active Labor
Fent Interactions - Answer-Alcohol and other CNS depressants potentiate its effect
Fent Adverse Effects - Answer-Chest wall stiffness
Delirium/Convulsions (uncommon)
Muscle Stiffness
Nausea and vomiting (most common)
Resp. Depression
Fent Considerations - Answer--Monitor resp. status. Resp. depression can last longer
than alagesia
- Give slowly to reduce risk of chest stiffness (life threatening)
- Compared to morphine, onset is quicker and duration is shorter, does not cause
histamine release, and unlikely to cause hypotension
-Give narcan if reversal is needed
Glucagon Class - Answer-Pancreatic Hormone
Glucagon Indications - Answer-- Hypoglycemia < 60 and IV access cannot be
established
- clearance of impacted esophageal FB (via smooth muscle relaxation) in an ED setting
- Beta-blocker OD treatment and adjunctive CCB OD
Glucagon Adult Dose - Answer-1mg IM, may repeat x1 in 20 min prn
Glucagon Peds Dose - Answer-< 1 year = 0.5 mL IM, rpt x1 in 20 min prn
=> 1 year = 1 mL, rpt x1 in 20 min prn
Glucagon MOA - Answer-Produced by pancreatic alpha cells of the islets of langerhans.
Causes breakdown of glycogen to glucose and inhibits the synthesis of glycogen from
glucose. Combined actions increase BGL.
Glucagon Pharmacokinetics - Answer-Onset 5-20 min, duration 1-1.5 hrs
Glucagon Contraindications - Answer-Known insulinoma, glucagon will produce
worsening hypoglycemia
