2nd Year Drugs

Question 1

Adrenaline Cardiac Arrest

Answer 1

IV - 1mg in a 10mL syringe. 3-5 minute (every second loop).

Contras:
NONE.

Question 2

Adrenaline Anaphylaxis + Severe Asthma

Answer 2

IM - 0.5mg in 3mL syringe. Repeat every 5 minutes.

Contras:
NONE.

Question 3

Adrenaline - ROSC

Answer 3

IV - 50-100mcg in 10mL syringe.

Add 9mL NaCl to make 1mg/10mL.

Repeat as required until BP >100mmHg. POST 2x 250mL saline boluses.

Contras:
NONE.

Question 4

Amiodorone

Answer 4

Cardiac Arrest - Refractory VF/VT.

Post 3 shocks.

IV - 300mg (6mL). 10mL syringe.

Can consider additional 150mg (3mL). 1 Repeat.

Contras:
None in this use.

Question 5

Aspirin - ACS.

Answer 5

Cardiac chest pain.

300mg tablet. PO - single dose.

Contras:
Hypersensitivity to salicylates, active bleeding or severe bleeding tendency.

Question 6

Cophenylcaine

Answer 6

Epistaxis (IN) + oral haemorrhage (PO).

50mg/mL pump spray.

5mg - 1 spray. 1-2 min. Max 25mg.

Contras:
Hypersensitivity to amide anaesthetics, Pregnancy.

Question 7

Fentanyl

Answer 7

Significant pain.
IV/IM - 100mcg/2mL
IN - 600mcg/2mL

IM - 25mcg (0.5mL) - 3mL syringe
IN - 60mcg (0.2mL) - 1mL syringe
IV - 25mcg (2.5mL) - + 8mL NaCl = 100mcg in 10mL

Repeat every 5 mins - No Max.

Contras:
Hypersensitivity to fentanyl or other phenylpiperdines.

Question 8

Glucagon

Answer 8

Hypoglycaemia - 2nd line agent.

IM - 1mg in 1mL - 1mL syringe.
Use hypokit.

5 minutes - repeat once.

Contras:
Hypersensitivity to glucagon or lactose, Pheochromocytoma (tumour of adrenal medulla).

Question 9

Glucose 10%

Answer 9

Hypoglycaemia - 1st line agent if unable to swallow. 50g in 500mL.

IV - 10g (100mL). Have IV bag insitu for immediate flush. Repeat every 5 minutes as required.

Contras:
NONE in this setting.

Question 10

Glucose Gel

Answer 10

1st line agent - if alert and can swallow.
PO - 15g. Repeat as required

Contras:
Altered conscious state, paeds <2.

Question 11

GTN

Answer 11

ACS + APO (Cardiogenic).

SL - 400mcg spray. Repeat every 5 minutes if required.

Keep an eye on BP + HR.

Contras:
Hypotension (usually <90mmHg), symptomatic bradycardia/tachycardia, use of erectile dysfunction meds in 24 hours (Cialis, Viagra, Levitra).

Question 12

Hydrocortisone

Answer 12

100mg/2mL vial.

Asthma (Mod - Severe),
Exacerbation of COPD + Anaphylaxis.

IM - 200mg in 4mL - 5mL syringe - single dose.
IV - 200mg in 10mL + NaCl to vial = 10mL - 10mL syringe. Single dose.

Contras:
Hypersensitivity.

Question 13

Ipratropium Bromide

Answer 13

250mcg/1mL.

Bronchospasm (Mod - Severe). Asthma/COPD.

500mcg in 2mL. Administer with 5mg Salbutamol (2.5mL). Nebulised - Repeat as required.

Contras:
Hypersensitivity to ipratropium or atropine.

Question 14

Methoxyflurane

Answer 14

Pain.

3mL - inhaled. Repeat every 20minutes. Single repeat.

Contras:
Hyperthermia, liver or renal disease, altered GCS, current tetracycline antibiotic use, behavioural disturbances, malignant hyperthermia, pre-eclampsia + eclampsia.

Question 15

Midazolam

Answer 15

Prolonged seizure activity (>5/60), Sedation.

NAS - 5mg in 1mL - 1mL syringe. Repeat every 5 minutes, max. dose 15mg.

IM - 5mg in 1mL - 3mL syringe. Repeat every 5 minutes, max. dose 15mg.

IV - 2.5mg in 2.5mL + 9mL NaCl = 15mg in 15mL - 20mL syringe. Repeat every 5 minutes, max. dose 15mg.

Contras:
Hypersensitivity to benzodiazepines, symptomatic hypotension and shock.

Question 16

Morphine

Answer 16

10mg/1mL.

Significant pain.

IM - 5mg in 0.5mL - 3mL syringe - repeat every 5 minutes.

IV - 5mg in 5mL + 9mL NaCl = 0.4mL in 10mL - 10mL syringe. Repeat every 5 minutes.

Contras:
Active labour, symptomatic hypotension, hypersensitivity to opiates.

Question 17

Naloxone

Answer 17

400mcg/1mL.

Respiratory Depression - Secondary to Narcotic Overdose.

IM - 400mcg in 1mL - 3mL - repeat as needed. No max.

IV - 40mcg in 1mL + 9mL NaCl = 4mg in 10mL - 10mL syringe - repeat as needed. No max.

Contras:
NONE in this setting.

Question 18

Ondansetron

Answer 18

4mg wafer or 4mg/2mL.

Nausea or vomiting.
Prophylaxis for spinal injury.

SL - 4mg - 1 wafer. Single dose.
IM - 4mg - 2mL in 3mL syringe. Single dose.
IV - 4mg + 8mL NaCl = 4mg in 10mL (slow push) - 10mL syringe. Single dose.

Contras:
Hypersensitivity to ondansetron, or other 5HT3 receptor antagonists.

Question 19

Paracetamol

Answer 19

Minor pain/headache.

PO - 500mg - 1g (1-2 tablets). Repeat every 4 hours if required. Max dose 4g in 24hours.

Contras:
Hypersensitivity, previous dose in last 24 hours, or greater than 4g in 24 hours, respiratory distress.

Question 20

Phenergan

Answer 20

Minor allergy. 10mg tablet.

PO - 10mg - 1 tablet. Single dose.

Contras:
Hypersensitivity, patients breast feeding and have a history of dystonic reactions.

Question 21

Prochlorperazine

Answer 21

12.5mg/1mL.

Motion sickness/vertigo.

IM - 12.5mg in 1mL - 3mL syringe. Single dose.

Contras:
Hypotension shock, altered GCS, hypersensitivity, to prochlorperazine or other phenothiazines.

Question 22

Salbutamol

Answer 22

5mg/2.5mL.

Bronchospasm - Asthma, Anaphylaxis, APO (Non-Cardiac only). Smoke inhalation. COPD. Salt water aspiration syndrome.

NEB - 5mg - 1 nebule - Repeat as needed. No max.

Contras:
Hypersensitivity.

Question 23

Sodium Chloride 0.9%

Answer 23

Ampoule 500mL - 1,000mL soft pack.

Hypovolaemic shock - IV - 20mL per kg. 250mL bolus. PRN titrated.

Hypovolaemic Cardiac Arrest - IV - 20mL per kg. Weight based. Once only - max 2L.

ROSC - IV - 250mL - as required until BP >100mmHg. Max 2 boluses prior to Adrenaline.

Contras:
Fluid overload.