All drugs contras

Question 1

Adrenaline contras (1)

Answer 1

1. Hypovolaemic shock without adequate fluid replacement

Question 2

Lignocaine contras (1)

Answer 2

1. Known hypersensitivity to lignocaine or related local anaesthetics (ending in –caine)

Question 3

Amiodarone contras (4)

Answer 3

1. QTc> 500 milliseconds
2. VT following Ondansetron administration
3. TCA toxicity
4. Pregnancy (if not in cardiac arrest)

Question 4

Aspirin contras (5)

Answer 4

1. Hypersensitivity to aspirin / salicylates
2. Actively bleeding peptic ulcers
3. Bleeding disorders
4. Suspecting dissecting aortic aneurysm
5. Chest pain associated with psychostimulant overdose if SBP >160mmHg

Question 5

GTN contras (7)

Answer 5

1. BP <100mmHg
2. HR >150BPM
3. HR <50BPM (except in autonomic dysreflexia)
4. Ventricular tachycardia
5. Current or recent use of PDE5 inhibitors
6. Current Riociguat use
7. Bleeding in pregnancy

Question 6

Heparin contras (7)

Answer 6

1. Known allergy or hypersensitivity
2. Active bleeding excluding menses
3. Oral anticoagulants
4. Bleeding disorders
5. Hx of Heparin induced Thrombocytopaenia (HIT)
6. Severe hepatic impairment / disease, including oesophageal varices
7. Recent trauma or surgery (<3 weeks)

Question 7

Tenecteplase contras (9)

Answer 7

1. Major surgery in past 3 months
2. Significant head injury in past 3 months
3. Major trauma in past 3 months
4. Stroke / TIA in past 3 months
5. ICH at any time
6. GI/GU bleed in past month
7. Current bleeding disorder, active bleeding (excluding menses) or bleeding tendencies
8. Anticoagulants or glycoprotein IIB / IIA inhibitors
9. Allergy to tenecteplase or gentamicin

Question 8

Paracetamol contras (1)

Answer 8

1. Children <1 month of age

Question 9

Methoxyflurane contras (2)

Answer 9

1. Pre-existing renal disease (renal impairment or failure)
2. Known or genetic susceptibility to malignant hyperthermia

Question 10

Morphine contras (3)

Answer 10

1. Hx of hypersensitivity
2. Renal impairment / failure
3. Late second stage labour

Question 11

Fentanyl contras (3)

Answer 11

1. Monoamine oxidase inhibitors within the last 14 days
2. Serotonin syndrome
3. Late second stage labour

Question 12

Ketamine contras (1)

Answer 12

1. Suspected non-traumatic brain injury with severe hypertension (SBP>180)

Question 13

Prochlorperazine (stemetil) contras (2)

Answer 13

1. CNS depression (unconscious / severely intoxicated)
2. Patients <21 years of age
   
   • Children / young adults are more susceptible to extrapyramidal reactions

Question 14

Salbutamol contras

Answer 14

Nil of significance for the above indication

Question 15

Ipratropium bromide (atrovent) contras (1)

Answer 15

1. Known hypersensitivity to atropine or its derivatives

Question 16

Dexamethasone contras (1)

Answer 16

1. Known hypersensitivity

Question 17

Ondansetron contras (1)

Answer 17

1. Concurrent apomorphine use

Question 18

Glucose paste, dextrose and glucagon contras

Answer 18

Nil

Question 19

Midazolam contras (1)

Answer 19

1. Known hypersensitivity to benzodiazepines

Question 20

Olanzapine contras

Answer 20

Nil

Question 21

Droperidol contras

Answer 21

Nil

Question 22

Hydrocortisone contras

Answer 22

Nil

Question 23

Ceftriaxone contras (1)

Answer 23

1. Allergy to cephalosporin antibiotics

Question 24

Naloxone (Narcan) contras

Answer 24

Nil

Question 25

Oxytocin contras

Answer 25

None, provided all babies have been delivered prior to administration

Question 26

Normal saline contras

Answer 26

Nil

Question 27

Water for injection contras

Answer 27

Nil