ALS medications Flashcards
Adrenaline
1mg in 1ml (1:1000)
1mg in 10ml (1:10000)
Alpha and beta adrenergic stimulant.
Action:
beta 1;
- Increases HR by increasing SA node firing rate
- increases conduction velocity through the AV node
- Increases myocardial contractility
- increases irritability of the ventricles
beta 2;
- causes bronchodilation
alpha;
-Causes peripheral vasoconstriction
Metabolism:
By monoamine oxidase and other enzymes in the blood, liver and around nerve endings. Excreted by kidneys.
Indications:
- Cardiac arrest
- Inadequate perfusion
- Brady cardia with poor perfusion
- Anaphalaxis
- Severe asthma- imminent life threat not responding to nebuliser therapy, or unconscious with NO BP
- Croup
Contraindictations:
1. Hypvolaemic shock without adequate fluid replacement.
Precautions:
Consider reduced doses for:
1. elderly /frail
2. patients with cardiovascular disease
3. patients on monoamine oxidase inhibitors
4. higher doses may be required for pts on beta blockers
Side effects: ST Supraventricular arrhythmia's ventricular arrhythmia's hypertension pupillary dilation may increase size of MI feelings anxiety/palpitations in conscious patient.
IV onset 30 sec
duration 5-10 min
iM
onset 30-90 seconds
peak 3-5 min
duration 5-10 minutes
Aspirin
300mg tablets
Pharmacology:
An analgesic, antipyretic, anti inflammatory and antiplatlet
Actions:
To minimise platelet aggregation and thrombus formation in order to retard the progression of coronary artery thrombosis in ACS
Metabolised:
Converted into salicylate in the gut mucosa and liver, excreted mainly by kidneys.
Indications:
ACS
C/I:
- Hypersensitivity to asprin/salicylates
- Actively bleeding peptic ulcers
- Suspected AAA
- Bleeding disorders
- CP associated with psychostimulant OD with SBP >160
Precautions:
- peptic ulcer
- asthma
- pts on anticoagulants
Side effects:
- Heartburn, nausea, gastrointestinal bleeding
- increased bleeding time
- hypersensitivity reactions
Special notes:
Aspirin is CI in acute febrile illness in children and adolescents.
The anti platelets effects of Aspirin persist for the natural life of platelets.
Onset NA
Peak NA
Duration 8-10 days
Ceftriaxone
1g sterile powder in glass vial
Pharmacology:
Cephlesporin antibiotic
Metabolism:
Excreted unchanged in urine 33-67% and in bile
Indications:
- Suspected meningococcal septicaemia
- Severe sepsis (consult only)
C/I
1. allergy to cephlesporin abx
Precautions:
1. Allergy to penicillin
Route:
IV (preferred)
IM (if unable to gain IV)
Side effects:
- nausea
- vomiting
- skin rash
Special notes:
Usual dose adult 1g, child 50mg/kg (max 1g)
IV- Must be made up with 10ml sterile water and given over 2 minutes
IM- made up to 4ml 1% Lignocaine and given lateral upper thigh
IM/IV effects:
Onset NA
Peak NA
Duration NA
Dexamethasone
Presentation:
8mg in 2 ml glass vial
Pharmacology:
A corticosterioid secreted by the adrenal cortex
- relieves inflammatory reactions
- provides immunosuppression
Metabolism:
By liver and other tissues, excreted predominantly by kidneys.
Indications:
- Bronchospasm:
- Severe (adult) or Critical (paeds) asthma - Croup
- Acute exacerbation of COPD
- Adult stridor (not foreign body obstruction)
- Severe Covid
C/I
known hypersensitivity
Precautions
Solutions that are not clear or are contaminated should be discarded
Route:
IV (over 1-3 mins), oral, IM
Side effects:
Nil of significance in above indication
Special notes:
Does not contain and antimicrobial agent, therefore use solution immediately and discard any residue.
IV effects:
Onset: 30-60 min
Peak 2 hours
Duration 36-72 hours
Fentanyl
100mcg in 2ml glass ampoule 250mcg in 1 ml glass ampoule (IN use)
Pharmacology:
Synthetic opioid analgesic
Actions CNS effects: - Depression= leading to analgesia - resp depression- leading to apnoea - dependence (addiction)
Cardiovascular effects:
- Decrease conduction velocity through AV node
Metabolism:
By liver, excreted by kidneys
Indications:
- Sedation to facilitate intubation
- Sedation to maintain intubation
- Sedation to facilitate trans thoracic pacing
- Sedation to facilitate synchronised cardio version
- CPR interfering pt- ALS
- Analgesia
- hx allergy to Morphine
- known renal impairment
- short duration action desirable
- hypotension
- nausea and vomiting
- severe headache
C/I
- Hypersensitivity
- Late 2nd stage labour
- Seretonin syndrome
- Monoamine oxadase inhibitors (MAOIs) in past 14 days
Precautions:
- elderly/frail
- impaired hepatic function
- respiratory depression COPD
- current asthma
- patients on monoamine oxidase inhibitors
- known addiction to opioids
- rhinitis, rhinorrhea, or facial trauma (IN)
Route:
IV, IN, SC
Side effects:
- respiratory depression
- apnoea
- rigidity of diaphragm and intercostal muscles
- bradycardia
IV effects:
- onset immediate
Peak <5 min
Duration 30-60 min
IN effects Peak 2 min
Morphine
10mg in 1ml
Pharmacology: CNS effects: - Depression - Resp depression - Depression cough reflex - stimulation- feeling of euphoria, vomiting, pin point pupils. - Dependance (addiction)
Cardiovascular effects:
- vasodilation
- decrease conduction velocity though AV node
Metabolised:
by liver, excreted through kidneys
Indications:
- Pain relief
- Sedation to maintain intubation
- sedation to facilitate intubation
- Hypersensitivity
- Late 2nd stage labour
- Renal impairment and failure
Precautions:
- Elderly/frail patients
- Hypotension
- Resp depression
- Current asthma
- Resp tract burns
- Known addiction to opioids
- Acute alcoholism
- Pts on monoamine oxidase inhibitors
Side effects: CNS effects - drowsiness - resp dep - euphoria - nausea and vomiting - addiction - pin point pupils
CVS effects:
- Hypotension
- bradycardia
Onset times
- IV onset 2-5 min
peak 10 mins
duration 1-2 hours
IM effects
onset 10-30 min
peak 30-60 min
duration 1-2 hours
Ondansetron
C/I:
1. Apomorphine use
Precautions:
- pregnancy 1st trimester - consult receiving hospital
- Congenital long QT
- severe hepatic disease (cirrhosis) max 8mg daily
- ODT may contain aspartame which should be avoided in patients with phenylketonuria
Paracetamol
500mg tablet
120mg in 5ml liquid
An analgesic and antipyretic.
Exact mechanism of action is unclear, thought to inhibit prostaglandin synthesis in the CNS
Metabolised by liver, excreted by kidneys
Indications: 1. Mild pain
2. Headache
CI:
- Children <1 month
Precautions:
1. Hepatotoxicty can occur with overdose. Do not administer is paracetamol has been given within last 4 hours, or total paracetamol intake within 24 hours exceeded 4g (adults) and 60mg/kg (paeds)
- Risk of hepatotocity is increased in following circumstances;
- impaired hepatic function or liver disease
- elderly and frail
-. malnourished
Morphine
Opioid analgesic. CNS effects: - Depression (leading to analgesia ) - resp dep - depression cough reflex - stimulation - dependence
CVS
- vasodilation
- decrease conduction velocity through AV node.
Metabolised by liver, excreted by kidneys
Indications:
- Pain relief
- Sedation to maintain intubation
- Sedation facilitate intubation
C/I:
1. Hypersensitivity
2. Renal impairment/failure
3. Late 2nd stage labour
Precaution:
- Elderly/frail
- Hypotension
- Resp dep
- Current asthma
- Resp tract burns
- Known addiction to opioids
- acute alcoholism
- monoamine oxidase inhibitors
Side effects:
- drowsiness
- resp dep
- euphoria
- nausea, vomiting
- addiction
- pin point pupils
Onset IV Onset 2-5 min Peal 10 min Duration1-2 hours
IM onset 10-30 min
Peak 30-60 min
duration 1-2 hours
Fentanyl
100mcg in 2 ml
250mcg in 1 ml (IN)
Pharmacology:
Synthetic opioid analgesia
CNS effects:
- depression- leading to analgesia
- resp dep- causes apnoea
- dependance (addiction)
CVS effects:
- decreases conduction velocity through AV node
Metabolised liver excreted through kidneys
Indications:
- CPR interfering pt (ALS)
- Analgesia
- hx hypersensitivity Morphine
- Short duration desirable
- hypotensive
- nausea and vomiting
- known renal impairment
- severe headache
C/I: 1. Hypersensitivity
2. Late 2nd stage labour
Precautions;
- Elderly/frail
- impaired hepatic function
- resp dep ie COPD
- current asthma
- monoamine oxidase inhibitors
- known addiction to opioids
- rhinitis, rhinorrhea or facial trauma (IN)
Side effects:
- resp dep
- apnoea
- diaphragm rigidity and intercostal muscles
- bradycardia
IV effects
onset immediate
peak <5 min
duration 30-60 min
IN peak 2 min
Ketamine
Mode of action:
Anaesthetic agent with analgesic properties at low doses.
Works on NMDA receptors. Also interacts with opiod, muscarinic and other receptors. Produces trance like state with amnesia, with preservation of laryngeal and pharyngeal reflexes.
Indication:
- intubation
- analgesia
- sedation - agitation and pt moving during CPR
C/I: 1. Suspected non traumatic brain injury with severe HTN >180
Precaution:
- May exacerbate cardiovascular conditions (uncontrolled hypertension, stroke, recent MI, cardiac failure, due to effects on HR and BP
Adverse effects: hypertension tachycardia CNS effects- confusion, hallucinations, irrational behaviour, increases skeletal muscle tone (may resemble seizures) Transient resp dep and apnoea (rare) nausea and vomiting hyper salivation
safe in pregnancy
Onset IM
3-4 min
Peak 20 min
Duration 12-25 min
IN
onset 5 min
duration 45 min
Methoxyflurane
3ml glass vial
Pharmacology: Inhalational analgesic agent at low concentrations
Metabolised
Excreted mainly by lungs and by liver
Indicated
pain relief
C/I:
- Renal impairment (on dialysis)
- Personal or family history of Malignant hyperthermia
Precautions:
- Pt’s shouldnt have >6ml in 24 hours due to risk of nephrotoxicity
- shouldnt be used in enclosed spaces.
Side effects
- drowsiness, dizziness
- hypotension
- N+V
duration 25 mins
analgesia commenced after 8-10 breaths and lasts 3-5 mins once discontinued
Prochlorperazine
12.5mg in 1 ml
Pharmacology
Anti emetic
Acts on several central Neuro transmitter systems
Indications Treatment or prophylaxis of nausea/vomiting for - motion sickness - planned aeromedical evacuation - known allergy or CO to Ondansetron -Headache irrespective of N+V -Vertigo
Metabolised by liver, excreted by kidneys
C/I:
1. CNS depression
Precautions
Hypotension
Epilepsy
Pt affected by alcohol/anti depressants
Route IM
Side effects - Drowsiness - blurred vision hypotension ST Skin rash Extrapyramidal reactions (usually dystonic)
IM effects
Onset 20 mins
Peak 40 min
Duration 6 hours
Ondansetron
4mg oral dissolving tablet
8mg in 4ml vial
Pharmacology:
Anti emetic
Acts on 5HT3 antagonist which blocks receptors both centrally and peripherally
Metabolised by liver
Indications:
- Undifferentiated N+V
- Prophylaxis for spinally immobilised or eye injury pts
- Vestibular nausea in pts <21 years
C/I:
1. Apomorphine use
Precautions
- Pt’s with liver disease shouldn’t receive more than 8mg per day
- care with pt’s on diuretics may have underlying electrolyte imbalance
- ODT contains aspartame and should not be given to ts with phenylketonuria
- concurrent use tramadol
- pregnancy
Side effects: Common - constipation - fever - headache - dizziness - rise in liver enzymes
Rare
- hypersensitivity reactions
- QT prologed
- widening QRS
- tachyarrythmias (inc AF and SVT)
- seizures
- visual disturbances
Onset
2 min
peak 20 min
duration 120 min
IV onset 5 min
peak 10 min
duration 2.5-6.1 hours
Slow push as IV (min 30 sec)
Midazolam
Presentation
5mg in 1 ml
15mg in 3ml
Pharmacology Short acting CNS depressant Actions: - Anxiolytic - sedative - anti convulsant
Metabolised in liver, excreted by kidneys
Indications
- Status epilepticus
- sedation agitated pt
- sedation in psychostimulant OD
C/I:
1. Known hypersensitivity to benzodiazepines
Precautions
- Reduced doses may be required for elderly/frail, pts with chronic renal failure, CCF or shock
- The CNS depressant effects of benzos are enhanced in presence of narcotics and alcohol
- Can cause severe resp depression in pt with COPD
- Pt with myasthenia graves
Side effects:
- depressed level of consciousness
- resp dep
- loss of airway control
- hypotension
IM effects
Onset 3-5 min
Peal 15 min
Duration 30 min
IV
onset 1-3 min
peal 10 min
duration 20 min
