CCP drugs Flashcards
Adenosine MOA
Nucleoside that depresses conduction through AV node which interrupts re-entry circuits that may restore sinus rhythm in pts with SVT
Adenosine indications
pt > 12 years with SVT and a rate > 150 and; moderate compromise, mild compromise if known to be responsive to adenosine
Adenosine contraindications
Known severe allergy
Known sick sinus syndrome without internal pacemaker
2nd or 3rd degree block without internal pacemaker
Heart transplant without internal pacemaker
Adenosine cautions
Asthma/CORD: may precipitate bronchospasm and should be withheld if pt has had recurrent life-threatening bronchospasm or is currently experiencing exacerbation of Asthma/CORD.
WPW syndrome if rhythm possibly fast AF - in this setting risk of causing VF
Adenosine dose
6 mg, 2nd dose 12 mg if rhythm fails to revert
Adenosine administration
fast push IV with 20 ml flush
Adenosine common adverdse effects
Bradycardia
SOB
Light headed
Nausea and flushing
Chest tigthness
Adenosine preparation
ampoule 6 mg in 2 ml
Adenosine onset and duration
Onset: 5-10 secs
DOA: 10-20 secs
Amiodarone MOA
Class III antidysrhythmic that prolongs the action potential and refractory period od atrial, nodal and ventrcular tissues reducing abnormal conduction, reducing HR and stabilising SA and AV nodes
Amiodarone Indications
Cardiac arrect with VT or VF at any time
Adults - sustained VT
Adults with moderate compromise from fast AF or fast atrial flutter
Amiodarone contraindications
Known severe allergy
Known severe allergy iodine
VT secondary to tricyclic antidepressant OD
Amiodarone cautions
*None in cardiac arrest
Poor perfusion or signs of low CO
Hypotension
AF secondary to sepsis
Amiodarone dose
CA - 300 mg IV push, 2nd dose if persistant VF/VT 15 mins after 1st dose 150 mg
Tachydysrhythmia - 300 mg IV infusion over 30 mins, 2nd dose can be given over 30 mins 150 mg infusion
Amiodarone administration
CA - IV push
VT/AF/Aflutter 300 mg IV infusion over 30 mins, add to 100 ml 5% glucose. Further 150mg over 30 mins if rate remains above 120 BPM
Amiodarone adverse effects
Hypotension
light headed
Bradydysrhythmia
Amiodarone onset/duration
Onset 5-10 mins
DOA 1-4 hrs
Amiodarone preparation
ampoule 150 mg in 3 ml
Atropine MOA
Anticholinergic that blocks muscarinic AcH receptors causing vagal inhibition
Atropine indications
Adults with bradycardia, particularly if the rhythm is narrow complex
Organophosphate poisoning
Atropine contraindications
Known severe allergy
Atropine cautions
Myocardial Ischaemia. Atropine will increase myocardial oxygen consumption.
Atropine dose
0.6 mg IV, repeat as required without maximum dose if bradycardia is responsive to atropine
Repeated and escalating doses will likely be required for organophosphate poisoning
Atropine administration
Undilute as rapid IV bolus
Atropine onset and duration
onset - 5-10 secs
DOA 15-60 mins
Atropine preparation
Ampoule 0.6 mg in 1 ml
Magnesium sulphate MOA
Reduces bronchial smooth muscle contraction causing bronchodilation
Magnesium sulphate indications
Bronchospasm secondary to severe or immediately life threatening asthma
Bronchospasm secondary to severe COPD or imminent respiratory arrest from COPD
Magnesium sulphate contraindication
known severe allergy
Magnesium sulphate cautions
Hypotension - vasodilator which may make hypotension worse
Magnesium sulphate dose
10 mmol, second dose if transport time is longer than 30 mins and not improving
Magnesium sulphate administration
Add to 100 ml 5% glucose and give as infusion over 15 mins
Dilute to 10 ml with NaCl and give 1 ml every 1-2 mins through running IV
Magnesium sulphate onset/duration
Onset 5-10 mins
DOA 30-60 mins
Magnesium sulphate preparation
ampoule 10 mmol in 5 ml
Metaraminol MOA
Alpha receptor agonist causing peripheral vasoconstriction
Metaraminol indications
Hypotension in the setting of septic shock, post CA, cardiogenic shock, severe TBI, neurogenic shock, RSI and post intubation
Metaraminol contraindications
known severe allergy
Metaraminol dose
Titrate to effect - 0.5 mg-1 mg every 5-10 mins
Metaraminol administration
Draw up into 10 mg in 10 ml
Metaraminol preparation
ampoule 10 mg in 1 ml
Metaraminol onset/duration
onset 1-2 mins
DOA 10-15 mins
Rocuronium MOA
Neuromuscular blocker which antagonises nicotinic acetylcholine receptors at the neuromuscular junction
Rocuronium indications
RSI, post intubation provided ETT position confirmed with capnography
Rocuronium contraindications
Known severe allergy, ETT not confirmed by capnography
Rocuronium cautions
Predicted difficult intubation, chronic muscle weakness (HALVE DOSE), adult with poor prognosis post cardiac arrest
Rocuronium dose
RSI <70 kg 150 mg, 70-90 kg 150 mg, >90 kg 200 mg
Post intubation - ≤80 kg 50 mg, >80 kg 100 mg
Rocuronium onset and duration
onset 30-60 secs, duration 30-60 mins
Rocuronium preparation
Ampoule 50mg in 5 ml
Rocuronium administration
IV undiluted as a bolus
Rocuronium storage
If not refrigerated it loses 5-10% activity per month, once in kits it must be dated 8 weeks post removal from fridge
Rocuronium vs suxamethonium
Rocuronium antagonist which blocks acetylcholine at neuromuscular junction - no stimulation prior to blockade = no fasciculations
Suxamethonium is an acetylcholine agonist which binds to receptors and keeps the channels open - stimulates receptor so will see fasciculations
Ripovacaine 0.75% MOA
local anaesthetic which blocks the initiation and transmission of nerve impulses by blocking the movement of sodium ions across the nerve cell membrane
Ripovacaine 0.75% indications
- FI blocks - severe pain with obvious NOF or proximal femur fracture where pain is not adequately controlled with opiates and transport time is > 30mins (including extrication time)
- Ring blocks - isolated injuries to digits with moderate to severe pain and transport time is > 60 mins
Ripovacaine 0.75% contraindications
Known severe allergy, infection at site of injection, *for FI block - previous surgery in the groin, age < 12 years
Ripovacaine 0.75% dose
FI blocks: ADMINISTER BLOCK ONCE ONLY
> 60 kg 40 ml of 0.375% (20ml of 0.75% diluted to 40ml)
<60 kg 30 ml of 0.375% (15 ml of 0.75% diluted to 30 ml)
Ring blocks:
1-2 ml of 0.75% into tissue either side of digit. If more than 20 ml is required dilute to 0.375%
Ripovacaine 0.75% preparation
ampoule 150 mg in 20 ml
Ripovacaine 0.75% onset and duration
Onset 5-10 mins, duration 1-2 hrs
Metaraminol cautions
Bradycardia, may make bradycardia worse from decreased release of endogenous adrenaline. Consider adrenaline if hypotensive and bradycardic
Ketamine for dissociation dose
1 mg/kg up to 100 mg IV, repeat once after 5 mins
Ketamine for agitated delirium
IV 1 mg/kg (up to 100 mg), repeat every 5 mins
IM 5mg/kg rounded up to the nearest 100 mg, (up to 400mg), repeat once only after 20 mins
Midazolam for agitated delirium
2-3 mg IV every 5 mins as required
Midazolam for pain/adjunct
Indicated when pain is spasmodic, or anxiety related and opiate/ketamine is not appropriate
0.5-1 mg IV every 10 mins as required
