Anaesthetics and A&E Flashcards
What are common uses of lidocaine?
local anaesthetic
uncommon - antiarrythmic for VT/VF
How does lidocaine work?
blocks voltage-gated sodium channels to prevent initiation of action potentials in nerves and muscles
What are important adverse effects of lidocaine?
stinging, drowsiness, restlessness, tremor, fits
What are some warnings for lidocaine?
redcued cardiac output
What are some important interactions for lidocaine?
adrenaline can prolong effect
What is the indication for naloxone?
opioid overdose
How does nalaxone work?
it is competitive antagonist for opioid receptor
What are important adverse reactions to naloxone?
withdrawal reaction - restlessness, nausea, cold
What are warnings for nalaxone?
opioid dependance
palliative care - avoid complete reversal
What are interactions for nalaxone?
N/A
What are the indications for oxygen?
hypoxia, CO poisoning, treating pneumothorax
What is the mechanism of action of oxygen?
increases delivery of oxygen to tissue, shorten half life of CO
What are adverse effects of oxygen?
uncomfortable device, lack of water vapour (dry)
What are the warnings of oxygen?
COPD high O2 can cause high CO2
oxygen is flamable
What are the interactions with oxygen?
N/A
What are the indications of paracetamol?
first line analgesic
reduce fever
What is the mechanism of action of paracetamol?
weak inhibitor of COX
What are the adverse reactions of paracetamol?
overdose
liver toxicity/failure
What are the interactions with paracetamol?
CYP inducers increase risk of liver toxicity
What are the warnings with paracetamol?
chronic excessive alcohol misuse, malnutirition, <50kg, severe hepatic impairment
What are common indicators of morphine?
acute severe pain
chronic pain
reduce breathlessness
What is the mechanism of action of morphine?
activation of opioid receptors
reduce sympathetic nervous system
What are the adverse reactions of morphine?
respiratory or neuro depression nausea and vomiting pupillary constriction constipation itching tolerance, dependance, withdrawal
What are the warnings of morphine?
hepatic, renal, respiratory failure
elderly
biliary colic
What are the interactions of morphine?
Other sedating drugs
What is acetylcystine and how does it work?
it is usec to treat paracetamol poisoning , to reduce viscosity of respiratory secretions
glutathione combines so paracetamol is not toxic - it replenishes glutathione supplies, has antioxident effects
What are adverse effects of acetylcysteine?
anaphylactoid reaction
bronchospasm
What are warnings of acetylcysteine?
previous anaphlaxis - be cautious
What are interactions with acetylcysteine?
N/A
What are common indications of activated charcoal?
reduce absorption of poisons
What is the mechanism of action of activated charcoal?
molecules adsorb to the surface of the charcoal so their absorption is reduced
What are adverse reactions of activated charcoal?
can aspirate charcoal = pneumonitis, bronchospasm, airway obstruction
intestinal obstruction
black stools and vomiting
What are warnings of activated charcoal?
Do not give to patients with decreased consciousness
persistent vomiting, reduced gut motility
What are important interactions with activated charcoal?
reduces absorption of therapeutic drugs too
What is the indications of ondansetron?
anti-emetic
What are the adverse reactions of ondasetron?
constipation, diarrhoea, headaches
What are the warnings of ondasetron?
it can prolong QT interval
What are interactions of ondasetron?
drugs that prolong QT intervals
What is propofol and its indication?
it is an anaesthesia used for induction or maintainence of sedation
What are adverse reactions of propofol?
apnoea, arrhythmias, headache, hypotension, localised pain, nausea, vomiting
What are cautions of propofol?
shock, cardiac problems, elderly, epilepsy, fixed CO, hypotension, hypovolaemia, raised ICP, respiratory impairment
What are interactions with propofol?
other drugs that cause hypotension or CNS depression
Valporate can increase concentration of propofol
What are indications of adrenaline?
anaphylaxis, cardiac arrest, induce local vasoconstriction
What is mechanism of action of adrenaline?
potent agonist of adrenoreceptors = vasocontriction, bronchodilation, redistribution of blood flow to heart, suppression of inflammatory mediator release from mast cells
What are some adverse reactions of adrenaline?
hypertension, anxiety, tremor, headache, palpitations
angina, myocardial infarction, arrhythmias
What are some warnings of adrenaline?
no contraindications in cardiac arrest and anaphylaxis
heart disease - vasocontriction
What are some interactions with adrenaline?
beta blockers - can cause widespread vasoconstriction
What are some weak/moderate opioids?
tramadol, codeine, dihydrocodeine
What are some adverse effects of weak/moderate opioids?
nausea, constipation, dizzy, drowsy
neurological and respiratory depression
What are some warnings and interactions of weak/moderate opioids?
significant respiratory disease, renal or hepatic impairment, elderly, epilepsy
don’t prescribe with other sedating drugs, drugs that lower seizure thresholds, serotonergic drugs
