3rd Year Drugs Flashcards
Adrenaline - Anaphylaxis/Severe Asthma
1:1,000 - 1mg/1ml
IM - 500 mcg every 5 minutes
Contras: NONE
Adrenaline - Cardiac Arrest
1:1,000 - 1mg/1ml
IV/IO - 1mg in 1ml - every 3-5 minutes
CONTRAS: None
Adrenaline - ROSC
1:1,000 - 1mg/1ml
IV/IO - 50mcg - 0.5 -1ml
Add 9ml NaCl = 1mg in 10ml
As required, until BP >90mmHg
POST two 250ml saline boluses
CONTRAS: None
Amiodorone - cardiac arrest + refractory VF/VT (post 3 shocks)
150mg/3ml
IV/IO - 300mg - 6ml - no dilution
Single dose
CONTRAS:
None in this setting
Aspirin - ACS
PO - 300mg - single dose
CONTRAS:
Hypersensitivity to salicylates/aspirin, children under 12 years
Adrenaline - EpiPen
CONTRAS: None. But must not be used for Asthma
Atropine - Symptomatic bradycardia, organophosphate poisoning
1.2mg/1ml
IV - Symptomatic bradycardia - 600mcg (0.6mg) - 0.5ml - NO dilution - repeat 3-5 minutes (max 3mg)
IV - Organophosphate poisoning - 1-2mg -
10-20mls - Add 11ml NaCl = 1.2mg/12ml
Repeat every 5 minutes until Atropinisation
CONTRAS: Hypersensitivity, Third degree AV block, patients with cardiac transplant
Co-Phenylcaine - Epistaxis, oral haemorrhage, local pain (abrasions)
50mg/ml pump spray, 5mg dose per spray
IN/PO - 1 spray - 5mg - Repeat - 1-2 minutes, max 25mg
CONTRAS: Hypersensitivity to phenylephrine/lignocaine/other anaesthetics, pregnancy, children under 2 years
Fentanyl Citrate - 100mcg/2ml
IV dose
IV dose - Moderate to Severe pain
UNDER 70 years - Weight based
1mcg/kg (max 100mcg)
Add 8ml NaCl = 100mcg in 10 ml
Repeat 25mcg after 5 minutes
OVER 70 years - Weight based
0.5mcg/kg (max 50mcg)
Add 8ml NaCl to make 100mcg in 10ml
Repeat 25 mcg after 5 minutes
CONTRAS:
Hypersensitivity to Fentanyl, aged under 1 year (IV/IO)
Fentanyl - 450mcg/1.5ml
IN dose
Moderate to Severe pain
Prime atomiser first
Small/elderly/frail :
120mcg - 2 x 0.2ml
Repeat: 60mcg after 5 minutes
Adult :
180mcg - 3 x 0.2ml
Repeat: 60mcg after 5 minutes
CONTRAS:
Hypersensitivity to Fentanyl, occluded nasal passages of epistaxis (IN)
Glucagon - Hypoglycaemia - 3rd line agent
IM - 1mg/1ml
Repeat: after 5 minutes
Once only
CONTRAS: Pheochromocytoma, Hypersensitivity
Glucose 10% - Hypoglycaemia
1st line agent if unable to swallow
IV - 50mg in 500ml
Have bag insitu for immediate flush
10g/100ml - Repeat: every 5 minutes, as required
CONTRAS:
Not to be used if IV line is not patent
Glucose gel - 15mg sachet
PO - 1st line agent if can swallow
CONTRAS: None
GTN -
Chest pain
Cardiogenic APO/BO over 90mmHg
Autonomic Dysreflexia BP over 160mmHg
SL - 400mcg spray
Repeat: every 5 minutes, no max
CONTRAS:
Hypotension (under 90mmHg), hypersensitivity, use of erectile dysfunction meds in last 24 hours (Sildenafil, Vardenafil)
Heparin - 5000 units/5ml
Confirmed STEMI - going in to cath lab
IV - 5000 units/5ml
Single dose
CONTRAS:
Hypersensitivity to Heparin, presence of known haemorrhagic states
Ipratropium Bromide
Severe to life threatening asthma
Asthma/COPD
250mcg/1ml
NEB: 500mcg in 2ml
Combine with 5mg/2.5ml Salbutamol
MDI: 12 puffs. Repeat: Once only. 1 breath per puff
Contras: Hypersensitivity
Ketamine - IV/IM
2nd line agent for traumatic pain following administration of 200mcg Fentanyl
1st line agent for sedation of combative TBI
200mg/2ml
Pain IV - 10mg/1ml. Add 18ml NaCl = 10mg/19ml?
Repeat: every 5 minutes
Pain IM: weight based.
1mg/kg - max 100mg.
Repeat: every 5 minutes
Sedation for TBI - IM: weight based.
2mg/kg - max 200mg.
Single dose.
CONTRAS:
Hypersensitivity, acute cardiovascular disease, active psychiatric condition, non traumatic pain (IM IV IO), aged under 12 months
Ketamine - wafer
2nd line agent for moderate to severe acute pain when 1st line agent has failed
25mg wafer - SL
Dose: 50mg. Repeat: every 5 minutes. Max 125mg (4 tablets)
CONTRAS: under 12 years old
Lignocaine
Local anaesthesia for IV cannulation - ID
Local anaesthesia for IO infusion - IO
1% - 20mg/2ml
ID for IV - 0.1mg - 0.1ml
IO - small adult: 20mg - 2ml
IO - adult: 40mg - 4ml
Use in second site if needed.
CONTRAS:
Hypersensitivity
Methoxyflurane
FINISH
3ml - IH
Malignant hyperthermia E T Hyperthermic L Altered conscious state B
Midazolam
Prolonged seizure activity - over 5 minutes
Sedation of disturbed/abnormal behaviour
15mg/3ml
IN: 5mg - 1ml.
IM: 5mg - 1ml.
IV: 2.5mg - 2.5ml. Add 12ml NaCl = 15mg in 15ml
ALL: Repeat every 5 minutes. Max dose 15mg
CONTRAS: Hypersensitivity
Naloxone
Reversal of respiratory depression in suspected narcotic overdose
400mcg/1ml
IM: 400mcg/1ml.
Repeat every 5 minutes. Max 10mg.
IV: 400mcg/1ml
Repeat every 2 minutes. Max 10mg. 10mls titrated.
Add 9ml NaCl = 0.4mg in 10ml
CONTRAS:
None
Ondansetron
Prophylaxis: spinal injury, eye injury
Moderate-Severe nausea
Active vomiting
4mg wafer
4mg/2ml vial
SL: 1 wafer.
IM: 2ml.
IV: slow push. Add 8ml NaCl = 4mg/10ml
ALL: Repeat once after 30 minutes
CONTRAS:
Hypersensitivity, children under 2 years of age.
Paracetamol
Mild pain + headache
PO
500mg tablet.
1-2 tablets. Repeat after 4 hours.
Max dose 4g in 24 hours
CONTRAS:
Hypersensitivity, previous dode in last 4/24 or greater than 4g in 24 hours
Salbutamol - MDI + NEB
Bronchospasm: Asthma, Anaphylaxis, non cardiac APO, bronchitis, smoke inhalation, COPD, salt water aspiration syndrome
5mg/2.5ml
MDI: 4 puffs. Repeat: every 4 minutes as required.
NEB: 5mg - 1 nebule. PRN - no max.
CONTRAS:
Hypersensitivity, cardiogenic APO, children under 12 months old
Sodium Chloride - 0.9%
Ampoule 1000ml soft packs
Fluid Replacement Therapy
Hypovolaemic shock/Hyperosmolar Hyperglycaemic state - IV/IO:
20ml/kg at 250ml bolus - 250ml
PRN titrated
Hypovolaemic cardiac arrest: IV/IO - weight based.
20ml/kg.
Max 2 Litres. Once only. Max 2 Litres
ROSC: IV/IO
250ml - Repeat as required until BP over 100mmHg. Max 2 boluses prior to Adrenaline
CONTRAS: Severe Pulmonary Oedema
Tranexamic Acid
Major trauma with uncontrolled excessive bleeding injury - under 3/24
1g/10ml
IV - 1g/10ml - slow push. Single dose
CONTRAS:
Hypersensitivity, injury time more than 3/24
