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All the things Flashcards

1
Q

Adrenaline

Contraindications, Precautions & Side effects

Jul 2022

A

Adrenaline

✘ Nil

! Hypertension
! Hypovolaemic shock
! Concurrent MAOI therapy
! Quetiapine toxicity

֎ Anxiety
֎ Hypertension
֎ Palpitations/tachyarrhythmias
֎ Pupil dilation
֎ Tremor

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2
Q

Adrenaline

Drug class, Presentation & Pharmacology

Jul 2022

A

Adrenaline

Drug class: Sympathomimetic

Presentation: Ampoule, 1mg/1mL (1:1,000) adrenaline
Ampoule, 1mg/10mL (1:10,000) adrenaline

Adrenaline is a naturally occurring catecholamine which primarily acts on Alpha (α) and Beta (β) adrenergic receptors.

The actions of these receptors causes:
* Increase in heart rate β1
* Increase in the force of myocardial contraction β1
* Increase in the irritability of the ventricles β1
* Bronchodilation β2
* Peripheral vasoconstriction α1

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3
Q

Adrenaline

Indications & Adult Dosages

Jul 2022

A

Adrenaline

✓ Cardiac arrest

Adult) IV 1 mg. 3-5min. NMD.

✓ Anaphylaxis OR severe allergic reaction

Adult) IM 500 microg (300 preg). 5min. NMD.
Adult) NEB 5 mg. SD (refract. to 3x IM).

✓ Severe life-threatening bronchospasm OR silent chest

Adult) IM 500 microg (300 preg). 5min. NMD.

✓ Croup

CCP - ✓ Shock unresponsive to adequate fluid resuscitation
CCP - ✓ Bradycardia with poor perfusion

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4
Q

Adrenaline

Indications & Paediatric Dosages

Jul 2022

A

Adrenaline

✓ Cardiac arrest

Paed) IV > 10 kg (> 1 year) 10 microg/kg 3-5mins. NMD.
Paed) IV < 10 kg (ex newborn) 100 microg 3-5mins. NMD.
Paed) IV newly born 50 microg 3-5mins. NMD.

✓ Anaphylaxis OR severe allergic reaction

Paed) IM > 6yrs 300 microg. 5min. NMD.
Paed) IM 1-5yrs 150 microg. 5min. NMD.
Paed) IM 6mon-1yr 100 microg. 5min. NMD.
Paed) IM < 6mon 50 microg. 5min. NMD.
Paed) NEB 5 mg. SD (refract. to 3x IM).

✓ Severe life-threatening bronchospasm OR silent chest

Paed) IM > 6yrs 300 microg. 5min. NMD.
Paed) IM 1-5yrs 150 microg. 5min. NMD.
Paed) IM 6mon-1yr 100 microg. 5min. NMD.
Paed) IM < 6mon 50 microg. 5min. NMD.

✓ Croup

Paed) NEB 5 mg. SD

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5
Q

Aspirin

Drug class, Presentation & Pharmacology

Aug 2022

A

Aspirin

Drug class: Antiplatelet

Presentation: Tablet (white), 300mg aspirin

Aspirin inhibits platelet aggregation by irreversibly inhibiting cyclo-oxygenase (COX), reducing the synthesis of thromboxane A2 (an inducer of platelet aggregation) for the life of the platelet.

This action forms the basis of preventing platelets from aggregating to exposed collagen fibres at the site of vascular injury.

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6
Q

Aspirin

Indications & Dosages

Aug 2022

A

Aspirin

✓ Suspected ACS
✓ Acute cardiogenic pulmonary oedema

Adult) PO > 18 300 mg.

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7
Q

Aspirin

Contraindications, Precautions & Side effects

Aug 2022

A

Aspirin

✘ Allergy AND/OR Adverse Drug Reaction to aspirin OR any NSAID
✘ Chest pain associated with psychostimulant OD
✘ Bleeding OR clotting disorders (haemophilia)
✘ Current GI bleeding OR peptic ulcers
✘ Patient < 18 years

! Possible aortic aneurysm or any other condition that may require surgery
! Pregnancy
! Hx of GI bleeding or peptic ulcers
! Concurrent anticoagulant therapy (warfarin)

֎ Epigastric pain/discomfort
֎ Nausea and/or vomiting
֎ Gastritis
֎ GI bleeding
֎ NSAID induced bronchospasm

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8
Q

Ceftriaxone

Drug class, Presentation & Pharmacology

Jul 2022

A

Ceftriaxone

Drug class: Antibiotic

Presentation: Vial (powder), 1g ceftriaxone

Ceftriaxone is a third generation cephalosporin antibiotic with a bactericidal action.

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9
Q

Ceftriaxone

Indications & Adult Dosages

Jul 2022

A

Ceftriaxone

✓ Suspected meningococcal septicaemia

IV > IM

Adult) IM 2g (2x inj). SD. Reconstitute 2x 1g vials with 2.4mL water or lidocaine 1% in 3mL syringe. 1g/3mL.
Adult) IV 2g over 5min. SD. Reconstitute 2g with 18.8mL water in 20mL syringe. 2g/20mL

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10
Q

Ceftriaxone

Contraindications, Precautions & Side effects

Jul 2022

A

Ceftriaxone

✘ Allergy AND/OR Adverse Drug Reaction to cephalosporin antibiotics
✘ Known immediate OR severe hypersensitivity to penicillin OR carbapenem based drugs
✘ Patient < 1 month *** call QAS Consultation

! Any allergy or hypersensitivity to penicillin or carbapenem – (isolated minor drug rash attributed to penicillin does not contraindicate the use of ceftriaxone)

֎ Severe pain at IM site

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11
Q

Ceftriaxone

Indications & Paediatric Dosages

Jul 2022

A

Ceftriaxone
✓ Suspected meningococcal septicaemia

IV > IM

Paed) IM 50mg/kg (nearest 5kg). TMD 1g. SD.
Reconstitute 1g vials with 2.4mL water or lidocaine 1% in 3mL syringe.

Paed) IV >20kg 50mg/kg (nearest 5kg). TMD 2g. SD.
Reconstitute 2g with 18.8mL water in 20mL syringe. 2g/20mL.

Paed) IV <20kg 50mg/kg (nearest 5kg). TMD 1g. SD.
Reconstitute 1g with 9.4mL water in 10mL syringe. 1g/10mL.

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12
Q

Dexamethasone

Drug class, Presentation & Pharmacology

Jul 2022

A

Dexamethasone

Drug class: Corticosteroid

Presentation: Vial, 8mg/2mL dexamethasone

Dexamethasone is a long acting synthetic corticosteroid that produces anti-inflammatory and immunosuppressive effects.

The precise mechanism by which corticosteroids exert their effect on croup are not fully known.

It is presumed to be based on vasoconstrictive actions in the upper airway, followed by the systemic anti-inflammatory effect.

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13
Q

Dexamethasone

Indications & Dosages

Jul 2022

A

Dexamethasone

✓ Croup

Paed) PO 6mon-6yrs 0.3mg/kg (to nearest 0.5mL). Repeat once. TMD 0.6mg/kg or 12mg.

Oral preparation: Mix required dose with small amount of juice/cordial/glucose paste.

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14
Q

Dexamethasone

Contraindications, Precautions & Side effects

Jul 2022

A

Dexamethasone

✘ Allergy AND/OR Adverse Drug Reaction
✘ Children less than 6 months OR greater than 6 years of age (consult)
✘ Steroid administration within 4 hours

! Nil in this setting

֎ Nil

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15
Q

Droperidol

Drug class, Presentation & Pharmacology

Jul 2022

A

Droperidol

Drug class: Antipsychotic

Presentation: Vial, 10mg/2mL droperidol

Droperidol is an antipsychotic drug from the butyrophenone group that produces sedation.

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16
Q

Droperidol

Indications & Dosages

Jul 2022

A

Droperidol

✓ Acute behavioural disturbances (SAT > 2)

QAS Consult >65 OR 13-15yrs

Adult) IM/IV > 65 5 mg. 15mins. TMD 10mg.
Adult) IM/IV 16-<65 10 mg. 15mins. TMD 20mg.

Paed) IM/IV 13-15 0.1-0.2 mg/kg (max 10mg). 15mins. TMD 20mg.

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17
Q

Droperidol

Contraindications, Precautions & Side effects

Jul 2022

A

Droperidol

✘ Allergy AND/OR Adverse Drug Reaction
✘ Parkinson’s disease
✘ Known Lewy body dementia
✘ Previous dystonic reaction to droperidol
✘ Patients < 8 years
✘ Suspected sepsis *** call QAS Consultation

! Hypoperfused state
! Concomitant use of CNS depressants

֎ Vasodilation/hypotension
֎ Extrapyramidal effects e.g. dystonic reactions (rare)

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18
Q

Fentanyl

Drug class, Presentation & Pharmacology

Jul 2022

A

Fentanyl

Drug class: Narcotic analgesic

Presentation: Ampoule, 100microg/2mL fentanyl

Fentanyl is a synthetic narcotic analgesic that acts on the central nervous system (CNS) by binding with the opioid receptors.

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19
Q

Fentanyl

Indications & Adult Dosages

Jul 2022

A

Fentanyl

✓ Significant pain
✓ Autonomic dysreflexia (SBP > 160mmHg)

Adult) NAS > 70 – 25-50 microg. 10mins. TMD 100mcg.
NAS < 70 – 50-100 microg. 10mins. TMD 200mcg.

Adult) IM > 70 – 25-50 microg. 10mins. TMD 100mcg.
IM < 70 – 25-100 microg. 10mins (50mcg). TMD 200mcg.

Adult) IV > 70 – 25 microg. 5mins. TMD 100mcg.
IV < 70 – 25-50 microg. 5mins. TMD 200mcg.

CCP - ✓ Sedation
CCP - ✓ Induction for RSI

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20
Q

Fentanyl

Contraindications, Precautions & Side effects

Jul 2022

A

Fentanyl

✘ Allergy AND/OR Adverse Drug Reaction

! Hypotension
! Respiratory tract burns
! Respiratory depression and/or failure
! Known addiction to narcotics
! Current MAOI therapy

֎ Bradycardia
֎ Drowsiness
֎ Hypotension
֎ Nausea and/or vomiting
֎ Pin-point pupils
֎ Respiratory depression
֎ Muscular rigidity (particularly muscles of respiration)

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21
Q

Fentanyl

Indications & Paediatric Dosages

Jul 2022

A

Fentanyl

✓ Significant pain
✓ Autonomic dysreflexia (SBP > 160mmHg)

Paed) NAS > 1 – 1.5mcg/kg (50). 10mins (1mcg/kg). TMD 100mcg.
Paed) IM > 1 – 2mcg/kg (50). 10mins. TMD 100mcg.
Paed) IV > 1 – 1mcg/kg (25). 5mins (0.5mcg/kg). TMD 100mcg.

Paed) NAS/IM/IV < 1 *** call QAS Consultation.

CCP - ✓ Sedation
CCP - ✓ Induction for RSI

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22
Q

Glucagon

Drug class, Presentation & Pharmacology

Jul 2022

A

Glucagon

Drug class: Hyperglycaemic

Presentation: Vials (powder and solvent), 1mg glucagon

Glucagon is a hyperglycaemic agent that mobilises hepatic glycogen, which is released in the blood as glucose.

Glucagon has inotropic and chronotropic effects that are not mediated through beta-receptors.

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22
Q

Glucagon

Drug class, Presentation & Pharmacology

Jul 2022

A

Glucagon

Drug class: Hyperglycaemic

Presentation: Vials (powder and solvent), 1mg glucagon

Glucagon is a hyperglycaemic agent that mobilises hepatic glycogen, which is released in the blood as glucose.

Glucagon has inotropic and chronotropic effects that are not mediated through beta-receptors.

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23
Q

Glucagon

Indications & Adult Dosages

Jul 2022

A

Glucagon

✓ Symptomatic hypoglycaemia (inability to self-administer oral glucose)

Adult) IM 1 mg. Reconstitute with 1mL water in 3mL syringe.

✓ Refractory anaphylaxis (unresponsive to 3x IM adrenaline and adequate fluid resuscitation)

IV > IM

Adult) IM/IV 1 mg. Reconstitute with 1mL water in 3mL syringe.

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24
Q

Glucagon

Contraindications, Precautions & Side effects

Jul 2022

A

Glucagon

✘ Allergy AND/OR Adverse Drug Reaction

! Nil

֎ Nil

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25
Q

Glucagon

Indications & Paediatric Dosages

Jul 2022

A

Glucagon

✓ Symptomatic hypoglycaemia (inability to self-administer oral glucose)

Paed) IM >25kg - 1mg. SD. Reconstitute with 1mL water in 3mL syringe. 1mg/1mL.
Paed) IM <25kg – 0.5mg. SD. Reconstitute with 1mL water in 3mL syringe. 1mg/1mL. Decant 0.5mL to achieve final concentration of 0.5mg/0.5mL.

✓ Refractory anaphylaxis (unresponsive to 3x IM adrenaline and adequate fluid resuscitation)

IV > IM

Paed) IM >25kg - 1mg. SD. Reconstitute with 1mL water in 3mL syringe. 1mg/1mL.
Paed) IM <25kg – 0.5mg. SD. Reconstitute with 1mL water in 3mL syringe. 1mg/1mL. Decant 0.5mL to achieve final concentration of 0.5mg/0.5mL.

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26
Q

Glucose gel

Drug class, Presentation & Pharmacology

Jul 2022

A

Glucose gel

Drug class: Hyperglycaemic

Presentation: Tube, 15g glucose

Glucose gel is a form of pure glucose that is absorbed quickly in the intestinal tract after ingestion.

It is the principal energy source for body cells, especially the brain.

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27
Q

Glucose gel

Indications & Dosages

Jul 2022

A

Glucose gel

✓ Symptomatic hypoglycaemia (with ability to self-administer oral glucose)

Adult) PO 15 g. 15mins (if BGL < 4.0). TMD 30g.

Paed) PO 15 g. 15mins (if BGL < 4.0). TMD 30g

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28
Q

Glucose gel

Contraindications, Precautions & Side effects

Jul 2022

A

Glucose gel

✘ Unconsciousness
✘ Patients with difficulty swallowing
✘ Patients < 2yrs

! Nil

֎ Nausea and/or vomiting
֎ Diarrhoea

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29
Q

Glucose 10%

Drug class, Presentation & Pharmacology

Feb 2023

A

Glucose 10%

Drug class: Hyperglycaemic

Presentation: Viaflex plastic container, 250mL glucose monohydrate 10%

Glucose is a sugar that is the principal energy source for body cells, especially the brain.

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30
Q

Glucose 10%

Indications & Adult Dosages

Feb 2023

A

Glucose 10%

✓ Symptomatic hypoglycaemia (with the inability to self-administer oral glucose)

Adult) IV INF 15 g (150 mL). Repeated at 100 mL (10 g) boluses every 5mins until BGL > 4.0 mmol/L.

CCP - ✓ Unconscious hypoglycaemia (as specifically authorised in AMP 001/23)

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31
Q

Glucose 10%

Contraindications, Precautions & Side effects

Feb 2023

A

Glucose 10%

✘ Nil

! Hyperglycaemia

֎ Nil

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32
Q

Glucose 10%

Indications & Paediatric Dosages

Feb 2023

A

Glucose 10%

✓ Symptomatic hypoglycaemia (with the inability to self-administer oral glucose)
Paed) IV INF 0.25g/kg (2.5mL/kg). Repeated at 0.1g/kg (1mL/kg) boluses every 5mins until BGL > 4.0 mmol/L.

CCP - ✓ Unconscious hypoglycaemia (as specifically authorised in AMP 001/23)

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33
Q

Glyceryl trinitrate

Drug class, Presentation & Pharmacology

Jul 2022

A

Glyceryl trinitrate

Drug class: Vasodilator

Presentation: Spray (sublingual), 400microg/dose, 200 doses, nitrolingual pump spray

Glyceryl trinitrate (GTN) is a potent vasodilator that decreases preload by increasing venous capacity, pooling venous blood in the peripheral veins, reducing ventricular filling pressure and decreasing arterial blood pressure (after load).

Because of this cascade it also causes vasodilation in coronary arteries that are in spasm and may assist the redistribution of blood flow along the collateral channels in the heart.

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34
Q

Glyceryl trinitrate

Indications & Dosages

Jul 2022

A

Glyceryl trinitrate

✓ Suspected ACS (with pain)
✓ Acute cardiogenic pulmonary oedema
✓ Autonomic dysreflexia (with a systolic BP > 160 mmHg)
✓ Irukandji syndrome (with a systolic BP > 160 mmHg)

Adult) SUBLING 400 microg. 5mins. NMD.

Paed) SUBLING *** call QAS Consultation

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35
Q

Glyceryl trinitrate

Contraindications, Precautions & Side effects

Jul 2022

A

Glyceryl trinitrate

✘ Allergy AND/OR Adverse Drug Reaction
✘ Heart rate < 50 OR > 150 beats per minute
✘ Systolic BP < 100 mmHg
✘ Acute CVA
✘ Head trauma
✘ Phosphodiesterase inhibitor medication administration:
- Sildenafil OR vardenafil in the previous 24 hours
- Tadalafil in the previous 48 hours

! Suspected inferior AMI
! Cerebral vascular disease
! Risk of hypotension and/or syncope
! Intoxication (GTN effects are enhanced)
! Phosphodiesterase inhibitor medication administration in the previous 4 days

֎ Dizziness
֎ Hypotension
֎ Syncope
֎ Reflex tachycardia
֎ Vascular headaches

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36
Q

Hydrocortisone

Drug class, Presentation & Pharmacology

Nov 2022

A

Hydrocortisone

Drug class: Corticosteroid

Presentation: Vial (powder), 100mg hydrocortisone sodium succinate

Hydrocortisone is an adrenocorticoid steroid with multiple mechanisms of action including anti-inflammatory activity, immunosuppressive properties and anti-proliferative actions.

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37
Q

Hydrocortisone

Indications & Adult Dosages

Nov 2022

A

Hydrocortisone

✓ Asthma (excluding mild)
✓ Acute exacerbation of COPD (with evidence of respiratory distress)
✓ Suspected, or at risk of, an acute adrenal insufficiency (adrenal crisis)

Adult) IM 100 mg. SD.
Adult) IV 100 mg. SD. Slow push over 1 minute.

✓ Refractory anaphylaxis with persistent wheeze (and unresponsive to 3 x IM adrenaline (epinephrine))

Adult) IM 200 mg. SD.
Adult) IV 200 mg. SD. Slow push over 1 minute.

38
Q

Hydrocortisone

Contraindications, Precautions & Side effects

Nov 2022

A

Hydrocortisone

✘ Allergy and/or Adverse Drug Reaction

! Hypertension

֎ Nil

39
Q

Hydrocortisone

Indications & Paediatric Dosages

Nov 2022

A

Hydrocortisone

✓ Asthma (excluding mild)
✓ Refractory anaphylaxis with persistent wheeze (and unresponsive to 3 x IM adrenaline (epinephrine))

Paed) IM 4mg/kg (100mg). SD.
Paed) IV 4mg/kg (100mg). SD. Slow push over 1 minute.

✓ Suspected, or at risk of, an acute adrenal insufficiency (adrenal crisis

Paed) IM 0-4yrs – 25 mg. SD.
IM 5-10yrs – 50 mg. SD.
IM >10yrs – 100 mg. SD.
Paed) IV 0-4yrs – 25 mg. SD. Slow push over 1 minute.
IV 5-10yrs – 50 mg. SD. Slow push over 1 minute
IV >10yrs – 100 mg. SD. Slow push over 1 minute

40
Q

Ibuprofen

Drug class, Presentation & Pharmacology

Jul 2022

A

Ibuprofen

Drug class: Non-steroidal anti-inflammatory drug (NSAID)

Presentation: Tablet, 200 mg ibuprofen

Ibuprofen is a non-selective NSAID that inhibits the synthesis of prostaglandins resulting in analgesic, antipyretic and anti-inflammatory actions.

41
Q

Ibuprofen

Indications & Dosages

Jul 2022

A

Ibuprofen

✓ Moderate pain due to acute inflammation and tissue injury

Adult) PO 200-400 mg. Must not be administered within 6 hours of previous ibuprofen administration.

42
Q

Ibuprofen

Contraindications, Precautions & Side effects

Jul 2022

A

Ibuprofen

✘ Allergy and/or Adverse Drug Reaction to any NSAID OR aspirin
✘ Concurrent NSAID therapy
✘ Current GI bleeding OR peptic ulcers
✘ Dehydration AND/OR hypovolaemia
✘ Renal impairment
✘ NSAID induced asthma
✘ Heart failure
✘ Pregnancy
✘ Angiotensin converting enzyme (ACE) inhibitor OR Angiotensin II receptor blocker (ARB) therapy
✘ Patients less than 13 years OR older than 65 years of age
✘ Patients taking anticoagulant medications
✘ Diuretic treatment

! Asthma
! Hepatic dysfunction
! History of GI bleeding or peptic ulcers

֎ Nausea
֎ Dyspepsia
֎ GI bleeding
֎ Dizziness

43
Q

Ipratropium bromide

Drug class, Presentation & Pharmacology

Jul 2022

A

Ipratropium bromide
Drug class: Anticholinergic agent

Presentation: Nebule, 250microg/1mL ipratropium bromide monohydrate

Ipratropium bromide is an antimuscarinic agent which promotes bronchodilation by inhibiting cholinergic bronchomotor tone.

44
Q

Ipratropium bromide

Indications & Adult Dosages

Jul 2022

A

Ipratropium bromide

✓ Moderate bronchospasm (unresponsive to initial QAS salbutamol NEB)
✓ Severe bronchospasm

Adult) NEB 500 microg. 20mins. TMD 1.5mg.

45
Q

Ipratropium bromide

Contraindications, Precautions & Side effects

Jul 2022

A

Ipratropium bromide

✘ Allergy and/or Adverse Drug Reaction
✘ Patients less than 1 year of age

! Glaucoma

֎ Dilated pupils
֎ Dry mouth
֎ Palpitations

46
Q

Ipratropium bromide

Indications & Paediatric Dosages

Jul 2022

A

Ipratropium bromide

✓ Moderate bronchospasm (unresponsive to initial QAS salbutamol NEB)
✓ Severe bronchospasm

Paed) NEB >6yrs - 500 microg. 20mins. TMD 1.5mg.
Paed) NEB 1-5yrs – 250 microg. 20mins. TMD 750 microg.

47
Q

Loratadine

Drug class, Presentation & Pharmacology

Jul 2022

A

Loratadine

Drug class: Antihistamine (less sedating)

Presentation: Tablet, 10 mg loratadine

Loratadine is a long-acting, second generation peripheral histamine H1-receptor antagonistic used to treat allergies.

48
Q

Loratadine

Indications & Adult Dosages

Jul 2022

A

Loratadine

✓ Symptomatic urticaria (without evidence of anaphylaxis)

Adult) PO 10 mg. SD. Not to be administered within 24 hours of previous antihistamine administration unless approval gained from QAS Clinical Consultation and Advice Line.

49
Q

Loratadine

Contraindications, Precautions & Side effects

Jul 2022

A

Loratadine

✘ Allergy and/or Adverse Drug Reaction
✘ Anaphylaxis
✘ Patients less than 8 years of age

! Severe hepatic impairment
! Increased risk of sedation and anticholinergic effects in older people

֎ Drowsiness
֎ Fatigue
֎ Headache
֎ Nausea
֎ Dry mouth

50
Q

Loratadine

Indications & Paediatric Dosages

Jul 2022

A

Loratadine

✓ Symptomatic urticaria (without evidence of anaphylaxis)

Paed) PO > 8 years – 10 mg. SD. Not to be administered within 24 hours of previous antihistamine administration unless approval gained from QAS Clinical Consultation and Advice Line.

51
Q

Methoxyflurane

Drug class, Presentation & Pharmacology

Aug 2022

A

Methoxyflurane

Drug class: Analgesic (at low doses)

Presentation: Bottle, 3mL methoxyflurane

Methoxyflurane is a volatile, self-administered inhalation analgesic indicated for short-term pain relief.

Methoxyflurane is more susceptible to metabolism than other halogenated ethers and has a greater propensity to diffuse into fatty tissue.

52
Q

Methoxyflurane

Indications & Dosages

Aug 2022

A

Methoxyflurane

✓ Pain

Adult) INH 3 mL. 20mins. TMD 6mL.

Paed) INH > 1 year – 3 mL. SD.

53
Q

Methoxyflurane

Contraindications, Precautions & Side effects

Aug 2022

A

Methoxyflurane

✘ Allergy and/or Adverse Drug Reaction
✘ Patients < 1 year
✘ History of significant liver or renal disease
✘ History of malignant hyperthermia

! ALOC
! Intoxicated or drug affected patients
! Cardiovascular instability
! Respiratory depression

֎ ALOC
֎ Cough
֎ Renal/hepatic failure (following repeated high dose exposure)

54
Q

Midazolam

Drug class, Presentation & Pharmacology

Sep 2022

A

Midazolam
Drug class: Benzodiazepine (short acting)

Presentation: Ampoule, 5mg/1mL midazolam

Midazolam hydrochloride is a short acting CNS depressant that induces amnesia, anaesthesia, hypnosis and sedation.

It achieves this by enhancing the action of the inhibitory neurotransmitter gamma-amino butyric acid (GABA).

Depressant effects occur at all levels of the CNS.

55
Q

Midazolam

Indications & Adult Dosages

Sep 2022

A

Midazolam

✓ Generalised seizures/focal seizure (GCS < 12)

Adult) NAS/IM 5 mg. 10mins. TMD 20mg.
Adult) IV 5mg. 5mins. TMD 20mg.

✓ Acute behavioural disturbance (with a SAT score > 2) unresponsive to droperidol (max dose) administration

Adult) IM/IV *** call QAS Consultation

CCP - ✓ Sedation
- For maintenance of an established LMA/ETT
- For procedures (e.g. TCP or cardioversion)
- CPR induced consciousness
- To facilitate safe assessment and treatment of agitated head injured patient
- As an adjunct to opiate analgesia (fracture splinting/ extrication/ burns)
- For ketamine emergence

56
Q

Midazolam

Contraindications, Precautions & Side effects

Sep 2022

A

Midazolam

✘ Allergy and/or Adverse Drug Reaction

! Reduced dosages must be considered in:
- Low body weight, older or frail patients
- Patients with chronic renal failure, congestive cardiac
failure or shock
! Can cause severe respiratory depression in patients with COPD
! Myasthenia gravis
! Multiple sclerosis

֎ Hypotension
֎ Respiratory depression particularly when associated with other CNS depressants including alcohol and narcotics

57
Q

Midazolam

Indications & Paediatric Dosages

Sep 2022

A

Midazolam

✓ Generalised seizures/focal seizure (GCS < 12)

Paed)

✓ Acute behavioural disturbance (with a SAT score > 2) unresponsive to droperidol (max dose) administration

Paed) IM/IV *** call QAS Consultation

CCP - ✓ Sedation
- For maintenance of an established LMA/ETT
- For procedures (e.g. TCP or cardioversion)
- CPR induced consciousness
- To facilitate safe assessment and treatment of agitated head injured patient
- As an adjunct to opiate analgesia (fracture splinting/ extrication/ burns)
- For ketamine emergence

58
Q

Morphine

Drug class, Presentation & Pharmacology

Jul 2022

A

Morphine

Drug class: Narcotic analgesic

Presentation: Ampoule, 10mg/1mL morphine sulphate pentahydrate

Morphine is a narcotic analgesic that acts on the central nervous system by binding with opioid receptors, altering processes affecting pain perception and emotional response to pain.

It also combines to cause respiratory depression, vasodilation, decreases in the gag reflex and slows AV node conduction.

59
Q

Morphine

Indications & Adult Dosages

Jul 2022

A

Morphine

✓ Significant pain
✓ Autonomic dysreflexia (with a systolic BP > 160 mmHg)

Adult) IM > 70 – 2.5-5mg. 10mins. TMD 10mg.
IM < 70 – 2.5-10mg. 10mins (5mg). TMD 20mg.
Adult) IV > 70 – 2.5mg. 5mins. TMD 10mg.
Adult) IV < 70 – 2.5-5mg. 5mins. TMD 20mg.

CCP - ✓ Sedation

NOTE: Morphine is the preferred narcotic agent except under the following circumstances:
- Allergy and/or Adverse Drug Reaction to morphine;
- Haemodynamic instability;
- Known/suspected kidney disease;
- When NAS narcotic administration is the preferred treatment; AND/OR
- Suspected ACS.

60
Q

Morphine

Contraindications, Precautions & Side effects

Jul 2022

A

Morphine

✘ Allergy and/or Adverse Drug Reaction
✘ Kidney disease (renal failure)

! Hypotension
! Respiratory tract burns
! Respiratory depression and/or failure
! Known addiction to narcotics
! Concurrent MAOI therapy
! Cardiac chest pain

֎ Bradycardia
֎ Drowsiness
֎ Hypotension
֎ Nausea and/or vomiting
֎ Pin point pupils
֎ Respiratory depression

61
Q

Morphine

Indications & Paediatric Dosages

Jul 2022

A

Morphine

✓ Significant pain
✓ Autonomic dysreflexia (with a systolic BP > 160 mmHg)

Paed) IM > 1 year – 100-200 microg/kg (5mg). 10mins. TMD 200 microg/kg.
Paed) IV > 1 year – 100 microg/kg (2.5mg). 5mins. TMD 200 microg/kg.

Paed) IM/IV < 1 *** call QAS Consultation.

CCP - ✓ Sedation

NOTE: Morphine is the preferred narcotic agent except under the following circumstances:
- Allergy and/or Adverse Drug Reaction to morphine;
- Haemodynamic instability;
- Known/suspected kidney disease;
- When NAS narcotic administration is the preferred treatment; AND/OR
- Suspected ACS.

62
Q

Naloxone

Drug class, Presentation & Pharmacology

Jul 2022

A

Naloxone

Drug class: Opioid antagonist

Presentation: Ampoule, 400microg/mL naloxone hydrochloride dihydrate

Naloxone is an opioid antagonist that prevents or reverses the effects of opioids including respiratory depression, sedation and hypotension.

Naloxone antagonises the opioid effects by competing for the same receptor sites.

63
Q

Naloxone

Indications & Adult Dosages

Jul 2022

A

Naloxone

✓ Respiratory depression (secondary to the administration of narcotic drugs)

Adult) IM 1.6mg. SD.

64
Q

Naloxone

Contraindications, Precautions & Side effects

Jul 2022

A

Naloxone

✘ Allergy and/or Adverse Drug Reaction
✘ The newly born patient

! Use with caution on patients with pre-existing cardiac disease

֎ Narcotic reversal can cause combativeness, vomiting, sweating, tachycardia and hypertension
֎ May produce acute withdrawal convulsions in the chronic narcotic user
֎ Pulmonary oedema

65
Q

Naloxone

Indications & Paediatric Dosages

Jul 2022

A

Naloxone

✓ Respiratory depression (secondary to the administration of narcotic drugs)

Paed) IM 20 microg/kg (800 microg). SD.

66
Q

Ondansetron

Drug class, Presentation & Pharmacology

Jul 2022

A

Ondansetron

Drug class: Anti-emetic – 5-HT3 antagonist

Presentation: Ampoule, 4mg/2mL ondansetron
Orally Disintegrating Tablet (ODT), 4mg ondansetron

Ondansetron is a serotonin 5-HT3 receptor antagonist.

It works by blocking the action of serotonin, a natural substance that may cause nausea and vomiting.

67
Q

Ondansetron

Indications & Adult Dosages

Jul 2022

A

Ondansetron

✓ Significant nausea AND/OR vomiting

Adult) PO/IM 4-8mg. TMD 8mg.
Adult) IV 4-8mg. Slow push 2-3mins. TMD 8mg.

68
Q

Ondansetron

Contraindications, Precautions & Side effects

Jul 2022

A

Ondansetron

✘ Allergy and/or Adverse Drug Reaction
✘ Congenital long QT syndrome
✘ Current apomorphine therapy (used in severe Parkinson’s disease)
✘ Patients less than 2 years of age
✘ First trimester pregnancy (may only be administered for extreme and uncontrolled hyperemesis)

! Hepatic impairment
! Elderly patients
! Intestinal obstruction
! Patients with risk factors for QT interval prolongation or cardiac arrhythmias

֎ Headache
֎ Constipation
֎ Hypersensitivity reactions (including anaphylaxis)
֎ ECG changes

69
Q

Ondansetron

Indications & Paediatric Dosages

Jul 2022

A

Ondansetron

✓ Significant nausea AND/OR vomiting

Paed) PO > 5 years – 4 mg. SD.
PO 2-4 years – 2 mg. SD.
Paed) IM > 2 years – 100 microg/kg (rounded to nearest 5 kg[4 mg]).

Paed) IV > 2 years – 100 microg/kg (4 mg). Slow push 2-3mins. SD.

Must not be given within 8 hours of previous ondansetron administration.

70
Q

Oxytocin

Drug class, Presentation & Pharmacology

Jul 2022

A

Oxytocin

Drug class: Oxytocic

Presentation: Ampoule, 10 International units (IU) / 1 mL

Synthetic oxytocin is a uterine stimulant that causes uterine contractions by changing calcium concentrations within uterine muscle cells.

Oxytocin administered during the third stage of labour assists with placental separation, raises the tone of the uterine musculature and minimises further uterine blood loss.

71
Q

Oxytocin

Indications & Dosages

Jul 2022

A

Oxytocin

✓ Active management of the third stage of labour (following confirmed of delivery of all fetuses) AND the prevention of primary post-partum haemorrhage

Adult) IM 10 International Units. SD

✓ Management of uncontrolled primary or secondary post-partum haemorrhage

Adult) IV Loading dose – 10 International Units. Slow push over 2-5 minutes.
May be given in addition to a dose that may have been administered for: Active management of the third stage of labour/the prevention of primary PPH.

72
Q

Oxytocin

Contraindications, Precautions & Side effects

Jul 2022

A

Oxytocin

✘ Allergy and/or Adverse Drug Reaction
✘ Undelivered fetuses

! Myocardial ischaemia
! May potentiate hypotension when administered with analgesia

֎ Nausea and/or vomiting
֎ Headache
֎ Bradycardia
֎ Tachycardia

73
Q

Paracetamol

Drug class, Presentation & Pharmacology

Jul 2022

A

Paracetamol
Drug class: Analgesic, Antipyretic

Presentation: Tablet, 500mg paracetamol
Elixir, 120mg/5mL paracetamol

Paracetamol is a rho-aminophenol derivative that exhibits analgesic and antipyretic activity.

It does not possess significant anti-inflammatory activity.

74
Q

Paracetamol

Indications & Adult Dosages

Jul 2022

A

Paracetamol

✓ Mild to moderate pain
✓ Fever (causing distress)

Adult) PO 0.5-1g. 4hrs. TMD 4g in 24hrs.

Must not be administered within 4 hours of previous paracetamol administration.

75
Q

Paracetamol

Contraindications, Precautions & Side effects

Jul 2022

A

Paracetamol

✘ Allergy and/or Adverse Drug Reaction
✘ Patients < 1 month old

! Hepatic dysfunction
! Soluble tablets
- Patients with sodium restriction (heart failure, chronic kidney disease)
- Phenylketonuria

֎ Nausea

76
Q

Paracetamol

Indications & Paediatric Dosages

Jul 2022

A

Paracetamol

✓ Mild to moderate pain
✓ Fever (causing distress)

Paed) PO > 1 month – 15 mg/kg (1g).

Must not be administered within 4 hours of previous paracetamol administration.

77
Q

Salbutamol

Drug class, Presentation & Pharmacology

Jul 2022

A

Salbutamol
Drug class: Beta-adrenergic agonist

Presentation: Metered Dose Inhaler, 100 microg/puff salbutamol
Nebule, 2.5 mg/2.5 mL salbutamol
Nebule, 5 mg/2.5 mL salbutamol
Ampoule, 500 mcg/1 mL salbutamol

Salbutamol is a direct acting sympathomimetic agent which mainly affects β2 – adrenoceptors.

It primarily acts as a bronchodilator but also has inotropic and chronotropic actions.

Additionally, it lowers serum potassium levels through its direct stimulation of the sodium/potassium ATPase pump, drawing potassium into cells.

78
Q

Salbutamol

Indications & Adult Dosages

Jul 2022

A

Salbutamol

✓ Bronchospasm

Adult) MDI 12 (1.2mg) inhalations. 10mins. NMD.
Adult) NEB 5mg. PRN. NMD.

CCP - ✓ Suspected hyperkalaemia (with QRS widening AND/OR AV dissociation)

79
Q

Salbutamol

Contraindications, Precautions & Side effects

Jul 2022

A

Salbutamol

✘ Allergy and/or Adverse Drug Reaction
✘ Patients less than 1 year

! Acute pulmonary oedema
! Ischaemic heart disease

֎ Anxiety
֎ Tachyarrhythmias
֎ Tremors
֎ Hypokalaemia and metabolic acidosis

80
Q

Salbutamol

Indications & Paediatric Dosages

Jul 2022

A

Salbutamol

✓ Bronchospasm

Paed) MDI 1-5 years – 6 (600 microg) inhalations. 10mins. NMD.
MDI > 6 years – 12 (1.2 mg) inhalations. 10mins. NMD.
Paed) NEB 1-5 years – 2.5mg. PRN. NMD.
NEB > 6 years – 5mg. PRN. NMD.

CCP - ✓ Suspected hyperkalaemia (with QRS widening AND/OR AV dissociation)

81
Q

Sucrose 24%

Drug class, Presentation & Pharmacology

Aug 2022

A

Sucrose 24%

Drug class: N/A

Presentation: Twist-tip vial, 2 mL 24% sucrose

Sucrose 24% is an oral, sterile, liquid preparation used as a short-term analgesic in infants.

When small amounts of sucrose are placed on an infant’s tongue it causes an increase of endogenous opioids resulting in approximately 5-8 mins of analgesia.

82
Q

Sucrose 24%

Indications & Paediatric Dosages

Aug 2022

A

Sucrose 24%

✓ Short term procedural pain management (e.g. IV cannulation)
✓ Distress due to pain

Paed) PO Initial dose of sucrose 24% must be administered using the following scale:

May be repeated once at 5 minutes.

83
Q

Sucrose 24%

Contraindications, Precautions & Side effects

Aug 2022

A

Sucrose 24%

✘ Patients greater than 12 months of age
✘ Sucrose intolerance
- Congenital sucrase-isomaltase deficiency (CSID)
✘ Fructose intolerance
✘ Glucose-galactose malabsorption
✘ Concurrent muscle relaxant/paralysis therapy

! Nil

֎ Hyperglycaemia

84
Q

Tenecteplase

Drug class, Presentation & Pharmacology

Jul 2022

A

Tenecteplase

Drug class: Fibrinolytic

Presentation: Injection, (powder and solvent) 50 mg (10,000 IU) graduated syringe tenecteplase

Tenecteplase is a thrombolytic agent which combines with the fibrin component of the thrombus and converts thrombus-bound plasminogen to plasmin.

This degrades the fibrin matrix of the thrombus.

85
Q

Tenecteplase

Indications & Adult Dosages

Jul 2022

A

Tenecteplase

✓ Patient with STEMI who meet the criteria for pre-hospital Tenecteplase administration (as defined by the relevant QAS coronary artery reperfusion checklist)

Adult) IV Weight calculated dose (as listed below) administered into a pre-existing IV line containing sodium chloride 0.9% over 10 seconds.

86
Q

Tenecteplase

Contraindications, Precautions & Side effects

Jul 2022

A

Tenecteplase

✘ Patients less than 18 OR greater than 75 years of age
✘ Uncontrolled hypertension (systolic BP > 180 mmHg AND/OR diastolic BP > 110 mmHg at any stage during current acute episode)
✘ Allergy AND/OR Adverse Drug Reaction to any of: Tenecteplase, enoxaparin OR clopidogrel
✘ Left BBB identified on 12-Lead ECG
✘ Current OR history of thrombocytopenia
✘ Active tuberculosis
✘ Known cerebral disease, in particular a malignant intracranial neoplasm OR arteriovenous malformation
✘ Prior intracranial haemorrhage
✘ Ischaemic stroke OR Transient Ischaemic Attack (TIA) within last 3 months
✘ History of significant closed head OR facial trauma within last 3 months
✘ Suspected aortic dissection (including new neurological symptoms)
✘ History of major trauma OR surgery (including laser eye surgery) within last 6 weeks
✘ Internal bleeding (e.g. gastrointestinal (GI)/urinary tract bleed) within last 6 weeks (excluding menses)
✘ Bleeding OR clotting disorder (e.g. haemophilia)
✘ Current use of anticoagulants (e.g. warfarin)
✘ Non-compressible vascular punctures
✘ Prolong (> 10 minutes) cardio pulmonary resuscitation (CPR)
✘ Known to be pregnant OR delivered within the last 2 weeks
✘ History of serious systemic disease (e.g. advanced/terminal cancer, severe liver OR kidney disease)
✘ Resident of an aged care facility requiring significant assistance with activities of daily living
✘ Acute myocardial infarction in the setting of trauma

! Nil

֎ Haemorrhage
֎ Post-administration dysrhythmias

87
Q

Ticagrelor

Drug class, Presentation & Pharmacology

Jul 2022

A

Ticagrelor

Drug class: Antiplatelet

Presentation: Tablet, 90 mg ticagrelor
Orally Disintegrating Tablet (ODT), 90 mg ticagrelor

Ticagrelor is a reversibly binding, direct-acting adenosine diphosphate (ADP) receptor antagonist that inhibits platelet activation and aggregation.

88
Q

Ticagrelor

Indications & Adult Dosages

Jul 2022

A

Ticagrelor

✓ Patients with STEMI (as defined by the relevant QAS coronary artery reperfusion checklist) who have been accepted for pPCI (as an adjunct medication to aspirin and heparin) AND the receiving interventional cardiologist is requesting ticagrelor administration

Adult) PO > 18 years – 180 mg

89
Q

Ticagrelor

Contraindications, Precautions & Side effects

Jul 2022

A

Ticagrelor

✘ Allergy and/or Adverse Drug Reaction
✘ Patient currently taking ticagrelor OR clopidogrel
✘ Patient less than 18 years of age
✘ Active bleeding (excluding menses)
✘ Prior intercranial haemorrhage
✘ History of hepatic impairment

! Concurrent medication known to induce bradycardia (e.g. β blocker, calcium channel blocker, digoxin)
! Symptomatic bradycardia (HR less than 60)

֎ Haemorrhage
֎ Bradycardia

90
Q

Tranexamic acid

Drug class, Presentation & Pharmacology

Jul 2022

A

Tranexamic acid

Drug class: Antifibrinolytic

Presentation: Ampoule, 1 g/10 mL tranexamic acid

Tranexamic acid (TxA) is a competitive inhibitor of plasminogen activation through the formation of a reversible complex displacing plasminogen from fibrin.

This inhibits the process of fibrinolysis in addition to the protein breakdown caused by plasma.

91
Q

Tranexamic acid

Indications & Adult Dosages

Jul 2022

A

Tranexamic acid

✓ Recent traumatic injuries (3 hours or less) with a COAST score of 3 or greater
✓ Management of uncontrolled primary post-partum haemorrhage (3 hours or less)

Adult) IV 1g. Slow push over 10 minutes. SD
Adult) IV INF 1 g over 10 minutes. SD
Infusion preparation: Mix 1 g of tranexamic acid in a 100 mL bag of sodium chloride 0.9%. Ensure bag is appropriately labelled. Administer over 10 minutes (approx. 3 dops/second).

92
Q

Tranexamic acid

Contraindications, Precautions & Side effects

Jul 2022

A

Tranexamic acid

✘ Allergy and/or Adverse Drug Reaction

! Nil

֎ Headache
֎ Hypotension
֎ Nausea and/or vomiting
֎ Seizures

93
Q

Tranexamic acid

Indications & Paediatric Dosages

Jul 2022

A

Tranexamic acid

✓ Recent traumatic injuries (3 hours or less) with a COAST score of 3 or greater

Paed) QAS Clinical Consultation and Advice Line approval required in all situations.
Paed) 15 mg/kg. Slow push over 10 minutes. SD. TMD 1g.

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