1st 5

Question 1

Adrenaline:

Dose/Route?

Answer 1

Dose / Route:

1: 1000 = 500 mcg IM
1: 10,000 = 1mg IV/IO given as a rapid bolus

Question 2

Adrenaline:

Indication?

Answer 2

Indicated:

1: 1000 = Anaphylaxis, Life threatening asthma.
1: 10,000 = Cardiac arrest

Question 3

Adrenaline:

Contra-indications?

Answer 3

Contraindicated:

Question 4

Adrenaline:

Cautions?

Answer 4

Cautions:
Severe HTN in patients on non-cardioselective beta-blockers.
Do not give repeated doses in hypothermic patients.

Question 5

Adrenaline:

Actions & A&P?

Answer 5

Actions:
Catecholamine, non-selective sympathomimetic.

Agonises Alpha- & Beta-Adrenoreceptors in the cardiac, pulmonary and blood vessel tissue, leading to tachycardia, bronchodilation & vasoconstriction.

Alpha-adrenoreceptor stimulus increases peripheral resistance, resulting in increased myocardial and cerebral blood flow during CPR.

Beta-1 adrenoreceptor agonist, and so is a positive inotrope (increased contractility), chronotrope (increased frequency of SA node depolarisation) and dromotrope (increased conduction through AV node).

Beta-2 adrenoreceptor stimulus causes smooth muscle relaxation, notably in the lungs, causing subsequent bronchodilation, consequently improving ventilation and aiding oxygenation. Also, a histamine antagonist.

Question 6

Adrenaline:
A = Absorption, 
D = Distribution, 
M = Metabolism, 
E = Excretion.

Answer 6

A - Parenteral
D- Plasma Proteins
M – Liver
E- urine

Question 7

Amiodarone:

1.Dose/Route?

Answer 7

Dose / Route:
300 mg, 150 mg IV/IO.
Given as a rapid bolus into a large vein, and well flushed.

Question 8

Amiodarone:

2. Indication?

Answer 8

Indicated:

Shockable rhythm following 3rd/5th unsuccessful defibrillation attempts.

Question 9

Amiodarone:

3. Contra-indications?

Answer 9

Contraindicated:

None.

Question 10

Amiodarone:

4. Cautions?

Answer 10

Side effects:

Bradycardia, Vasodilation causing Hypotension, Bronchospasm, Arrhythmias – Torsardes de pointes

Question 11

Amiodarone:

Actions & A&P?

Answer 11

Actions:
Class III Anti-arrhythmic (although displays characteristics of all 4 classes).
Non-competitive Alpha and Beta-adrenergic inhibitor.

Acts on the myocardium, nodal and connective tissues, delaying the efflux of K+ from the cell by blocking K+ channels, prolonging the refractory period of depolarisation. Also blocks sodium channels at rapid pacing frequencies.

Prolonging plateau phase (phase 3) of the cardiac action potential, refractory period (via Na/K channels) and slows AV conduction (Na channel)

Shows beta blocker-like and calcium channel blocker-like actions on the SA and AV nodes, depressing their automaticity.

Question 12

Amiodarone:
A = Absorption, 
D = Distribution, 
M = Metabolism, 
E = Excretion.

Answer 12

A – Parenteral.
D – Plasma Proteins, widespread, esp. liver & amp; adipose tissue.
M – Liver, bile.
E - Faeces.

Question 13

Atropine Sulphate:

Dose/Route?

Answer 13

Dose / Route:

600 mcg IV/IO, delivered as a rapid bolus.

Question 14

Atropine Sulphate:

Indication?

Answer 14

Indicated:
Symptomatic bradycardia in the presence of:
Absolute bradycardia; hypotension; paroxysmal ventricular arrhythmias requiring suppression; inadequate perfusion causing confusion etc; bradycardia following ROSC.

Question 15

Atropine Sulphate:

Contra-indications?

Answer 15

Contraindicated:

Should not be given to treat bradycardia in suspected hypothermia.

Question 16

Atropine Sulphate:

Cautions?

Answer 16

Side effects: 
Dry mouth, 
Visual blurring, 
Pupil dilation. 
Confusion/hallucinations. 
Tachycardia. 
Small dose / Slow administration may cause paradoxical bradycardia. 
In older people, retention of urine may occur.

Question 17

Atropine Sulphate:

Actions & A&P?

Answer 17

Actions:
Anti-cholinergic.

Acts as a competitive antagonist at cholinergic receptors (specifically at muscarinic acetylcholine receptors M1-M5, non-selectively), inhibiting stimulation from parasympathetic nerve fibres (such as the vagus nerve) by blocking the effects of the neurotransmitter acetylcholine and allowing a more dominant sympathetic response.

Also causes the increased velocity of conduction through the AV node, potentially correcting 2nd and 3rd degree AV conduction blocks, particularly those induced by digitalis toxicity.

Question 18

Atropine Sulphate:
A = Absorption, 
D = Distribution, 
M = Metabolism, 
E = Excretion.

Answer 18

A – Parenteral.
D – Plasma Proteins.
M – Liver.
E - Urine.

Question 19

Benzylpenicillin:

Dose/Route?

Answer 19

Dose / Route:
IV/IO (Slow injection).
1.2g dissolved in 20ml of WFI.

IM
1.2g dissolved in 4ml WFI.

Question 20

Benzylpenicillin:

Indication?

Answer 20

Suspected Meningococcal Septicaemia with:
1. Non-blanching rash
and/or
2. Signs/symptoms suggestive of meningococcal septicaemia.

Question 21

Benzylpenicillin:

Contra-indications?

Answer 21

Contraindicated:

Severe Penicillin allergy (more than a simple rash alone).

Question 22

Benzylpenicillin:

Actions & A&P?

Answer 22

Actions:
Narrow-spectrum Abx.

Acts against gram-positive and gram-negative bacteria, binding to Penicillin-binding proteins and inhibiting bacterial wall synthesis, making the cell wall osmotically unstable.
Cell lysis is then mediated by bacterial cell wall autolytic enzymes, destroying the cell wall and causing bacterial death.

Question 23

Benzylpenicillin:
A = Absorption, 
D = Distribution, 
M = Metabolism, 
E = Excretion.

Answer 23

A – Parenteral.
D – Plasma Proteins.
M – Small amount by bile, largely unchanged.
E - Urine.

Question 24

Chlorphenamine:

Dose/Route?

Answer 24

Dose / Route:

10 mg IV/IO/IM (slowly, over a minute).

Question 25

Chlorphenamine:

Indication?

Answer 25

Indicated:

1.Anaphylactic reactions (following IM ADR). 2.Symptomatic allergic reactions causing pt distress (e.g. itching).

Question 26

Chlorphenamine:

Contra-indications?

Answer 26

Contraindicated:
Known hypersensitivity.
Children <1 year of age.

Question 27

Chlorphenamine:

Cautions?

Answer 27

Cautions: 
Hypotension. 
Epilepsy. 
Glaucoma. 
Hepatic disease. 
Prostatic disease.

Question 28

Chlorphenamine:

Side effects?

Answer 28

Side effects: 
Sedation. Dry mouth. Headache. Blurred vision. Psychomotor impairment. 
Gastrointestinal disturbance. 
Transient hypotension. 
Convulsions (rare).

Older people are more likely to suffer side effects. Warn patients against driving/complex psychomotor tasks.

Question 29

Chlorphenamine:

Actions & A&P?

Answer 29

Anti-histamine.

Competitive non-selective antagonist for central and peripheral H1-receptors.
Blocks effects of histamine, leading to temporary relief of negative symptoms, such as swelling, sneezing and diarrhoea.

Crosses the blood-brain barrier easily, and so causes sedation/drowsiness side effects.

Question 30

Chlorphenamine:
A = Absorption, 
D = Distribution, 
M = Metabolism, 
E = Excretion.

Answer 30

A – Parenteral.
D – Plasma Proteins.
M – Liver.
E - Urine.