ACC drugs Flashcards
Adenosine indications
SVT - diagnostic and therapeutic
Reduces spontaneous depolarisation + increases resistance to depolarisation, breaking the re-entry circuit.
Will induce cardioversion (SAN resume control of HR) in SVT = can help diagnose it.
Very short acting. Always given IV.
Requires continuous cardiac monitoring
Adenosine side effects and CI
Bradycardia/asystole
“impending sense of doom”
CI: hypotension, coronary ischaemia, HF, asthma
Atropine indications and MOA
Severe or symptomatic bradycardia (used as an emergency drug in anaesthetics)
Anti-muscarinic = competitively inhibit acetylcholine, preventing parasympathetic “rest and digest” responses.
Increases heart rate.
IV administration and supervision needed.
Atropine side effects and CI
SE; tachycardia, dry mouth, constipation, urinary retention, blurred vision.
CI; angle closure glaucoma (increase intraocular pressure), arhythmias
Amiodarone indications and MOA
Tachyarrythmias when other other drugs/cardioversion have been unsucessful (incl AF, VF, VT, SVT)
Blocks Na+, Ca2+, K+ channels and is a a and b adrenergic receptor antagonist.
Reduces ventricular rate by reducing spontaneous depolarisation, slowing conduction velocity and increasing resistance to depolarisation.
Increases chance of conversion to and maintenance of sinus rhythm.
Amiodarone SE and and CI
Acute SE: hypotension during infusion
Chronic SE: pneumonitis, bradycardia, AV block, hepatitis, photosensitivity, grey discolouration of skin, IODINE ABNORMALITIES
CI: severe hypotension, heart block, thyroid disease
Adrenaline indications
Cardiac arrest
Anaphylaxis
Local vasoconstriction to control bleeding/prolong local anaesthetic
Adrenaline MOA
Enhances sympathetic nervous system.
Peripheral vasoconstriction and cardiac vasodilation, positively inotropic and chronotropic –> helps redistribute blood towards the heart in cardiac arrest.
Bronchodilation and suppression of inflammatory mediator release from mast cells –> helps in anaphylaxis
Adrenaline SE and CI
SE; hypertension, anxiety, tremor, arrhythmias, palpitations
NEVER CI IN CARDIAC ARREST/ANAPHYLAXIS but should be avoided in heart disease for local vasoconstriction
Adrenaline dose in cardiac arrest and anaphylaxis
Cardiac arrest: IV 1:10,000 (1mg in 10ml) + 10ml NaCl flush
Anaphylaxis: IM 1:1000 (1mg in 1ml)
Metoprolol indications
IV beta blocker of choice for ACS as short half life so more responsive to dose adjustment and can be stopped quickly if necessary (change to bisoprolol once stable)
Negatively inotropic and chronotropic, relieving myocardial work and thus ischaemia.
Metoprolol SE and CI;
SE; fatigue, cold extremeties, headache, GI disturbance, sleep disturbance, impotence in men.
CI; asthma, heart block
Calcium chloride indications
Cardiac arrest - positively inotropic, so can stabilise contraction of myocytes in cardiac arrest.
Must be given IV
Calcium chloride SE
Acidosis
Hypotension (causes peripheral vasodilation)
Nitrates indications
Acute angina and ACS
Buccal - GTN
IV - isosorbide mononitrate
Relax venous capitance muscles, reducing cardiac preload, reducing cardiac work and thus myocardial oxygen demand.
Nitrates SE and CI
SE: flushing, light headedness, hypotension
CI: aortic stenosis, haemodynamic instability, hypotension
Aspirin indications (+dose)
ACS = 300mg loading dose, then 75mg daily
Ischaemic stroke = 300mg daily for 2 weeks
Reduces platelet aggregation and therefore risk of arterial occlusion.
Aspirin SE and CI
SE: GI irritation (e.g. peptic ulcer), bronchospasm (hypersensitivity)
PRESCRIBE GASTRIC PROTECTION (PPI) ALONGSIDE
CI: children under 16, third trimester of pregnancy
Ticagrelor indications
ACS = in combination with aspirin as rapid platelet aggregation inhibition can prevent/limit arterial thrombosis.
Use 300mg loading dose, then 75mg daily
Ticagrelor SE and CI
SE: bleeding, GI upset, thrombocytopenia
CI: active bleeding
LMWH indications
ACS = to reduce clot prevention or maintain revascularisation
VTE prophylaxis
LMWH SE
SE; haemorrhage, hyperkalaemia
Vitamin K (phytomenadione) indications
Reverse anti-coagulation effect of warfarin (give alongside prothombin comlplex in major bleeding)
Provides a fresh supply of vitamin K for synthesis of vitamin K dependent clotting factors.
MUST BE GIVEN IV IN MAJOR OR MINOR BLEEDING
10mg IV given in major bleeding.
Alteplase indications and MOA
Acute ischaemic stroke (within 4.5 hrs)
STEMI (within 12 hrs if PCI not immediately available)
Massive PE with haemodynamic instability
PATIENTS MUST BE MONITORED IN HIGH DEPENDENCY UNIT
MOA; dissolves fibrinous clots
Alteplase SE and CI
SE: n+v, bruising, hypotension, bleeding, cardiogenic shock.
Reperfusion of infarcted brain = cerebral oedema
Reperfusion of infarcted heart = arrythmias
CI: bleeding, intracranial haemorrhage
Prednisolone indications
Anaphylaxis
Acute asthma
Modify the immune response and suppress inflammation
Nimodipine indications
SAH
Ca2+ channel blocker, reduces vasospasm
Pharmacological management of acute asthma
O-SPIM
Oxygen Salbutamol nebs (5mg) back to back Prednisolone (PO) or IV hydrocortisone Ipratropium (if severe) Mg2+ IV if not improving
Pharmacological management of acute COPD exacerbation
COSICAAR
Controlled oxygen Salbutamol nebs (5mg) Ipratropium Corticosteriods (prednisolone PO or hydrocortisone IV) Antibiotics Aminophylline (if not improving) Respiratory support (e.g. NIV)
Octaplex indications
Warfarin overdose.
Used when rapid correction is required
Contains vitamin K dependent clotting factors (1972 - X, IX, VII, II)
Warfarin indications
VTE Tx (after initial tx with heparin - warfarin takes several days to fully establish anti-coagulation)
Secondary VTE prophylaxis
Prophylaxis of arterial embolism in AF
Inhibits production of vitamin K dependent clotting factors
Warfarin SE and CI
SE: bleeding (from minor trauma)
CI: first trimester of pregnancy, patients at immediate risk of bleeding, use with caution in liver disease.
Check INR
Tranexamic acid (TXA) indications and MOA
Given alongside packed RBC transfusion to reduce coagulopathy and increase survival.
Works by preventing fibrinolysis §
Clopidogrel indications and dose
ACS in combination with aspirin
Rapid inhibition of platelet aggregation can limit arterial thrombosis and improve mortality.
300mg loading dose used, then 75mg for maintenance
Entonox indications
Analgesia (short term for painful procedures such as acute trauma)
50:50 Nitrous oxide: oxygen
CI of entonox
Can raise ICP so do not use in head injury
Also avoid in pneumothorax/intestinal obstruction –> expansion of air would be dangerous
Ketamine indications in trauma
Reduces pain and agitation (produces dissociative sedation)
Can make patient unaware of their surroundings, while also allowing them to maintain their own airway
Facilitates painful, short ED procedures
Morphine in ED
Acute, severe pain treatment
2-10mg IV initial dose
N-acetylcystine indications and MOA
Paracetamol poisoning (weight-adjusted dose, given IV)
Replenishes glutathione supplies so that it can bind to the hepatotoxic paracetamol metabolite (NAPQI) and detoxify it.
CAUTION; can produce anaphylactoid reaction
Naloxone indications and MOA
Opioid overdose
400-1200 micrograms IV (titrated to effect)
CAUTION; can cause opioid withdrawal if patient has opioid dependence
Diazepam indications in A&E and doses
First line for alcohol withdrawal reactions (dose is individual dependent)
First line for management of seizures/status epilepticus (10mg IV)
Short term treatment of agitation/anxiety (lowest possible dose)
Diazepam SE and CI
SE; drowziness, sedation, coma, long-term use can produce dependence
AVOID in elderly, respiratory impairment, neuromuscular disease and liver failure.
Sodium bicarbonate indications and MOA
Tricyclic anti-depressent (e.g. amitryptiline) overdose
Helps correct hypotension and prevent arrythmias
Insulin dextrose indications, dose and MOA
Hyperkalaemia
10 units ACTRAPID in 25g of dextrose (25g in 100ml) infused over 15 mins
Insulin drives cellular K+ uptake, must be given alongside dextrose to prevent hypoglycaemia
Insulin therapy for DKA
1 unit/ml = 50 units ACTRAPID in 50ml 0.9% NaCl
Adjust infusion rate as necessary
Inotropes indications, MOA and examples
Low CO, causing tissue hypoperfusion and shock (e.g. cardiogenic shock following MI)
Increase force/strength of myocardial contractility, increasing CO, MAP and vital organ perfusion
E.g. dobutamine
Lorezapam indications
Seizures/status epilepticus (4mg IV)
Haloperidol indications in A&E
Acute agitation/violent behaviour (anti-psychotic)
Give single dose (amount depends on clinical context and patient)
use with caution in elderly patients who are particularly sensitive (+ dementia/Parkinsons)
Indications for packed RBC
Acute blood loss
Symptomatic anaemia
1 unit increases Hb by 10g/L
Indications for FFP
DIC
Haemorrhage secondary to liver disease
All massive haemorrhages (usually given after 2nd unit of packed red cells)
Give over 30 mins
Indications for platelets
Haemorrhagic shock in trauma patient
Thrombocytopenia
Given over 30 mins
First choice antibiotics for COPD exacerbation
Amoxicillin (500mg TDS for 5 days)
Doxycycline (200mg then 100g OD for 5 days)
Clarythromycin (500mg BD for 5 days)
Antibiotic management of meningitis in community vs hospital
Community = IM benzylpenicillin ASAP
hospital = IV ceftriaxone
Antibiotics for cellulitis
Flucloxacillin 500-1000mg QDS for 5-7 days
Clarythromycin if penicillin allergy
Antibiotics for CAP and HAP
CAP: co-amoxiclav/clarythromycin for 7 days
HAP: IV aminoglycoside (gentamycin) and cephalosporin
Antibiotics for cystitis
trimethoprim/nitrofurantoin
3 days for women
7 days for men
Antibiotics for pyelonephritis
Co-amoxiclav (broad-spectrum), then according to local guidelines
Prothrombin complex concentrate (PCC) indications
Reverse warfarin when the INR is high.
Contains clotting factors X, IX, VII, II
Give alongside vitamin K in major bleeding
