Contraindications

Question 1

Adrenaline (epinephrine)

Answer 1

Nil

Question 2

Amiodarone

Answer 2

For patients who are in cardiac arrest:
- Nil
For patients with sustained conscious VT (haemodynamically stable):
- Allergy AND/OR Adverse Drug Reaction
- severe conduction disorder (unless pacemaker or AICD in situ)
- current amiodarone therapy
- concurrent anti-arrhythmic therapy that prolongs the QT interval
- pregnancy AND/OR lactation

Question 3

Aspirin

Answer 3

Allergy AND/OR Adverse Drug Reaction to aspirin OR any non-steroidal anti-inflammatory drug (NSAID)
Bleeding OR clotting disorders (e.g. haemophilia)
Current GI bleeding OR peptic ulcers
Patients less that 18 years of age

Question 4

Box jellyfish antivenom

Answer 4

Allergy AND/OR Adverse Drug Reaction

Question 5

Ceftriaxone

Answer 5

Absolute contraindications:
- Allergy AND/OR Adverse Drug Reaction to cephalosporin antibiotics
- Known immediate OR severe hypersensitivity to penicillin OR carbapenem based drugs
Relative contraindications (requires consultation with the QAS Clinical Consultation & Advice Line):
- Patients less than 1 month of age

Question 6

Clopidogrel

Answer 6

Allergy AND/OR Adverse Drug Reaction
Patients contraindicated for pre-hospital fibrinolysis administration
Current clopidogrel OR ticagrelor therapy
Patients less than 18 years of age
Active bleeding (excluding menses)
Prior intracranial haemorrhage

Question 7

Dexamethasone

Answer 7

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

Question 8

Droperidol

Answer 8

Absolute contraindications:
- Allergy AND/OR Adverse Drug Reaction
- Parkinson’s disease
- Known Lewy body dementia
- Previous dystonic reaction to droperidol
- Patients less than 8 years of age
Relative contraindication (requires consultation with the QAS Clinical Consultation & Advice Line);
- Suspected sepsis

Question 9

Enoxaparin

Answer 9

Allergy AND/OR Adverse Drug Reaction
Patients contraindicated for pre-hospital fibrinolysis administration

Question 10

Fentanyl

Answer 10

Allergy AND/OR Adverse Drug Reaction

Question 11

Glucagon

Answer 11

Allergy AND/OR Adverse Drug Reaction

Question 12

Glucose gel

Answer 12

Unconsciousness
Patients with difficulty swallowing
Patients less than 2 years of age

Question 13

Glucose 10%

Answer 13

Nil

Question 14

Glyceryl trinitrate

Answer 14

Allergy AND/OR Adverse Drug Reaction
Heart rate <50 OR >150 beats per minute
Systolic BP <100 mmHg
Acute CVA
Head trauma
Phosphodiesterase 5 inhibitor medication administration:
- Sildenafil OR vardenafil in the previous 24 hours
- Tadalafil in the previous 48 hours

Question 15

Heparin

Answer 15

Absolute contraindications:
- Allergy AND/OR Adverse Drug Reaction
- Patient less than 18 years of age
- Active bleeding (excluding menses) OR clotting problem (haemophilia)
- Prior intracranial haemorrhage
- Current use of anticoagulants (e.g. warfarin)
Relative contraindications (requires consultation with the accepting Interventional Cardiologist OR RSQ Clinical Coordinator (as appropriate) prior to administration):
- Uncontrolled hypertension (systolic BP >180 mmHg AND/OR diastolic BP >110 mmHg at any stage during current acute episode)
- Known cerebral disease, in particular a malignant intracranial neoplasm OR arteriovenous malformation
- Ischaemic stroke OR TIA within the last 3 months
- History of significant closed head/facial trauma within last 3 months
- History of major trauma OR surgery (including laser eye surgery) within last 6 weeks

Question 16

Hydrocortisone

Answer 16

Allergy AND/OR Adverse Drug Reaction

Question 17

Hydroxocobalamin

Answer 17

Allergy AND/OR Adverse Drug Reaction

Question 18

Ibuprofen

Answer 18

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

Question 19

Influenza vaccine

Answer 19

Allergy AND/OR Adverse Drug Reaction to an influenza vaccine and/or components
Known allergy to eggs or egg products
[Refer to General Practitioner for any of the following]
Current immune-oncologic therapy
Hypersensitivity to the influenza vaccine AND/OR its components (as listed on the Consumer Medicines Information)
Current episode of febrile illness (temperature greater than 38.5 degrees C) or acute systemic illness
Bleeding disorders OR current anti-coagulant therapy
History of Guillain-Barre syndrome

Question 20

Ipratropium bromide

Answer 20

Allergy AND/OR Adverse Drug Reaction
Patients less than 1 year of age

Question 21

Loratadine

Answer 21

Allergy AND/OR Adverse Drug Reaction
Anaphylaxis
Patients less than 8 years of age

Question 22

Magnesium sulphate

Answer 22

Allergy AND/OR Adverse Drug Reaction
Atrioventricular (AV) block
Renal failure

Question 23

Methoxyflurane

Answer 23

Allergy AND/OR Adverse Drug Reaction
Patients less than 1 year of age
History of significant liver OR renal disease
History of malignant hyperthermia

Question 24

Midazolam

Answer 24

Allergy AND/OR Adverse Drug Reaction

Question 25

Morphine

Answer 25

Allergy AND/OR Adverse Drug Reaction
Kidney disease (renal failure)

Question 26

Naloxone

Answer 26

Allergy AND/OR Adverse Drug Reaction
The newly born patient

Question 27

Ondansetron

Answer 27

Absolute contraindications
- 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
Relative contraindication:
- First trimester pregnancy (may only be administered for extreme and uncontrolled hyperemesis)

Question 28

Oxygen

Answer 28

Known paraquat poisioning with Sp02 equal to or greater than 88%
History of bleomycin therapy with Sp02 equal to or greater than 88%

Question 29

Oxytocin

Answer 29

Allergy AND/OR Adverse Drug Reaction
Undelivered fetuses

Question 30

Paracetamol

Answer 30

Allergy AND/OR Adverse Drug Reaction
Patients less than 1 month of age

Question 31

Salbutamol

Answer 31

Allergy AND/OR Adverse Drug Reaction
Patients less than 1 year of age

Question 32

Sodium chloride 0.9%

Answer 32

Nil

Question 33

Sucrose 24%

Answer 33

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

Question 34

Tenecteplase

Answer 34

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
Prolonged (>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

Question 35

Ticagrelor

Answer 35

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

Question 36

Tranexamic acid

Answer 36

Allergy AND/OR Adverse Drug Reaction

Question 37

Water for injection

Answer 37

Nil