CPG pharmacology Flashcards
up to date as of may 2017
1
Q
Adrenaline presentation and pharmacology (6)
A
1mg in 1ml or 1mg in 10ml ampoules.
A naturally occurring alpha and beta-adrenergic stimulant
- Increases HR by increasing SA node firing rate (Beta1)
- Increases conduction velocity through the A-V node (Beta1)
- Increases myocardial contractility (Beta1)
- Increases the irritability of the ventricles (Beta1)
- Causes bronchodilation (Beta2)
- Causes peripheral vasoconstriction (Alpha)
2
Q
Adrenaline primary emergency indications (6)
A
- Cardiac arrest - VF/VT, asystole or PEA
- Inadequate perfusion (cardiogenic or non-cardiogenic/ non-hypovolaemic)
- Bradycardia with poor perfusion
- Anaphylaxis
- Severe asthma - imminent life threat or not responding to nebulized therapy, or unconscious with no BP
- Croup
3
Q
Adrenaline contraindications (1)
A
Hypovolaemic shock without adequate fluid replacement
4
Q
Adrenaline precautions (4)
A
consider reduced doses for:
- Elderly/frail patients
- Patients with cardiovascular disease
- Patients on monoamine oxidase inhibitors
- Higher doses may be required for patients on beta blockers
5
Q
Adrenaline side effects (7)
A
Sinus tachycardia Supraventricular arrhythmias Ventricular arrhythmias Hypertension Pupillary dilatation May increase size of MI Feeling of anxiety/palpitations in the conscious patient
6
Q
Adrenaline special notes and times+duration
A
IV adrenaline should be reserved for life threatening situations. IV effects: Onset: 30 seconds Peak: 3-5 minutes Duration: 5-10 minutes IM effects: Onset: 30-90 seconds Peak: 4-10 minutes Duration: 5-10 minutes
7
Q
Aspirin presentation and pharmacology
A
300mg chewable tablets
300mg soluble or water dispersible tablets
An analgesic, antipyretic, anti-inflammatory, and antiplatelet aggregation agent.
Actions:
- To minimize platelet aggregations and thrombus formation in order to retard the progression of coronary artery thrombosis in ACS
- Inhibits synthesis of prostaglandins - anti-inflammatory actions
8
Q
Aspirin primary emergency indications (1)
A
ACS
9
Q
Aspirin contraindications (5)
A
- Hypersensitivity
- Actively bleeding peptic ulcers
- Bleeding disorders
- Suspected dissecting aortic aneurysm
- Chest pain associated with psychostimulant OD if SBP >160mmHg
10
Q
Aspirin precautions (3)
A
- Peptic ulcer
- Asthma
- Patients on anticoagulants
11
Q
Aspirin side effects (5)
A
Heartburn, nausea, gastrointestinal bleeding
Increased bleeding time
Hypersensitivity reactions
12
Q
Aspirin special notes and times+duration
A
Aspirin in C/I for use in acute febrile illness in children and adolescents.
The anti-platelet effects of aspirin persist for the natural life of platelets
Onset: n/a
Peak: n/a
Duration: 8-10 days
13
Q
Ceftriaxone presentation and pharmacology
A
1g sterile powder in a glass vial
Cephalosporin antibiotic
14
Q
Ceftriaxone primary emergency indications (2)
A
- Suspected meningococcal septicaemia
2. Severe sepsis (consult only)
15
Q
Ceftriaxone contraindications (1)
A
- Allergy to cephalosporin antibiotics
16
Q
Ceftriaxone precautions (1)
A
- Allergy to penicillin antibiotics
17
Q
Ceftriaxone side effects (3)
A
nausea, vomiting, skin rash
18
Q
Ceftriaxone special notes and times+duration
A
Usual dose: adult 1g, child 50mg/kg (max. 1g)
Ceftriaxone IV must be made up to 10mL using sterile water and dose administered over 2 minutes
Ceftriaxone IM must be made up to 4mL using 1% Lignocaine and dose administered in lateral upper thigh
IM/IV effects:
Onset: n/a
Peak: n/a
Duration: n/a
19
Q
Dextrose 10% presentation and pharmacology
A
25g in 250 mL infusion soft pack A slightly hypertonic crystalloid solution Composition: - Sugar - 10% dextrose - Water Actions: - Provides a source of energy - Supplies body water
20
Q
Dextrose 10% primary emergency indications (1)
A
- Diabetic hypoglycaemia (BGL analysis <4mmol/L) in patients with an altered conscious state who are unable to self-administer oral glucose
21
Q
Dextrose 10% contraindications (1)
A
- Nil of significance in the above indication
22
Q
Dextrose 10% precautions (1)
A
- Nil of significance in the above indication
23
Q
Dextrose 10% side effects (1)
A
- Nil of significance in the above indication
24
Q
Dextrose 10% special notes and times+duration
A
IV effects:
Onset: 3 minutes
Peak: n/a
Duration: depends on severity of hypoglycaemic episode
25
Fentanyl presentation and pharmacology (4 actions)
100 mcg in 2mL glass ampoule
200mcg in 1mL glass ampoule or cartridge (IN use only)
A synthetic opioid analgesic
Actions:
CNS effects:
- Depression - leading to analgesia
- Respiratory depression - leading to apnoea
- Dependence (addiction)
Cardiovascular effects:
- Decreases conduction velocity through the A-V node
26
Fentanyl primary emergency indications (3 + 5)
1. Sedation to facilitate intubation
2. Sedation to maintain intubation
3. Analgesia - IV/IN
- History of hypersensitivity or allergy to morphine
- Known renal impairment/failure
- Short duration of action desirable
- Hypotension
- Nausea and/or vomiting
- Severe headache
27
Fentanyl contraindications (2)
1. History of hypersensitivity
| 2. Late second stage of labour
28
Fentanyl precautions (7)
1. Elderly/frail patients
2. Impaired hepatic function
3. Respiratory depression, e.g. COPD
4. Current asthma
5. Patients on monoamine oxidase inhibitors
6. Known addiction to opioids
7. Rhinitis, rhinorrhea or facial trauma (IN route)
29
Fentanyl side effects (4)
Respiratory depression
Apnoea
Rigidity of the diaphragm and intercostal muscles
Bradycardia
30
Fentanyl special notes and times+duration
Fentanyl is a schedule 8 drug under the Poisons Act and its use must be carefully controlled with accountability and responsibility.
Respiratory depression can be reversed with naloxone
100 mcg fentanyl is equivalent in analgesic activity to 10mg morphine
IV effects:
Onset: immediate
Peak: <5 minutes
Duration: 30-60 minutes
IN effects:
Peak: 2 minutes
31
Glucagon presentation and pharmacology
1mg (IU) in 1mL hypokit
A hormone normally secreted by the pancreas
Actions:
- Causes an increase in blood glucose concentration by converting stored liver glycogen to glucose
32
Glucagon primary emergency indications (1)
1. Diabetic hypoglycaemia (BGL <4mmol/L) in patients with an altered conscious state who are unable to self-administer oral glucose
33
Glucagon contraindications (1)
1. Nil of significance in the above indication
34
Glucagon precautions (1)
1. Nil of significance in the above indication
35
Glucagon side effects (2)
Nausea and vomiting (rare)
36
Glucagon special notes and times+duration
```
Not all patients will respond to glucagon, e.g. those with inadequate glycogen stores in the liver (alcoholics, malnourished)
IM effects:
Onset: 5 minutes
Peak: n/a
Duration: 25 minutes
```
37
Glyceryl trinitrate (GTN) presentation and pharmacology (2actions + 5effects)
0.6mg tablets (and also 0.3mg tablets)
Transdermal GTN patch (50mg 0.4mg/hr release)
Principally, a vascular smooth muscle relaxant
Actions:
- Venous dilation promotes venous pooling and reduces venous return to the hear (reduces preload)
- Arterial dilatation reduces systemic vascular resistance and arterial pressure (reduces afterload)
The effects of the above are:
- Reduced myocardial O2 demand
- Reduced systolic, diastolic, and mean arterial blood pressure, whilst usually maintaining coronary perfusion pressure
- Mild collateral coronary arterial dilatation may improve blood supply to ischaemic areas of myocardium
- Mild tachycardia secondary to fall in blood pressure
- Preterm labour: Uterine quiescence in pregnancy
38
GTN primary emergency indications (5)
1. Chest pain with ACS
2. Acute LVF
3. Hypertension associated with ACS
4. Autonomic dysreflexia
5. Preterm labour (consult)
39
GTN contraindications (9)
1. Known hypersensitivity
2. Systolic blood pressure <110mmHg tablet
3. Systolic blood pressure <90mmHg patch
4. Sildenafil citrate (Viagra) or vardenafil (Levitra) administration in the previous 24hr or tadalafil (Cialis) administration in the previous 4 days (PDE5 inhibitors)
5. Heat rate >150bpm
6. Heat rate >50bpm (excluding autonomic dysreflexia)
7. VT
8. Inferior STEMI with systolic BP <160mmHg
9. Right ventricular MI
40
GTN precautions (4)
1. No previous administration
2. Elderly patients
3. Recent MI
4. Concurrent use with other tocolytics
41
GTN side effects (5)
```
Tachycardia
Hypotension
Headache
Skin flushing (uncommon)
Bradycardia (occasionally)
```
42
GTN special notes and times+duration
Storage:
- GTN is susceptible to heat and moisture. Make sure that tablets are stored in their original light resistant, tightly sealed bottles. The foil pack of the patches should be intact
- Do not administer patient's own medication, as its storage may not have been in optimum conditions or it may have expired.
- Tablets should be discarded and replaced after 1 month
- Patches should be discarded prior to use-by date
- Since both men and women can be prescribed sildenafil citrate (Viagra) or vardenafil (Levitra) or tadalafil (Cialis) all patients should be asked if and when they last had the drug to determine if GTn is C/I
- Tadalafil (Cialis) may also be prescribed to men for treatment of benign prostatic hypertrophy. This is a new indication for the drug and may lead to an increased number of patients under this treatment regimen
- GTN by IV infusion may be required for an interhospital transfer as per the treating doctor's orders
Interhospital transfer:
The IV dose is to be prescribed and signed by the referring hospital medical officer. Infusions usually run in the range of 5mcg/minute to 200mcg/minute and increased 3-5 mcg/minute
S/L effects:
Onset: 30 seconds - 2 minutes
Peak: 5- 10 minutes
Duration: 15 - 30 minutes
Intraveneous effects:
Onset: 30 seconds - 1 minute
Peak: 3 - 5 minutes
Duration: 15 - 30 minutes
Transdermal effect:
Onset: up to 30 minutes
Peak: 2 hours
43
Ipratropium Bromide presentation and pharmacology
250mcg in 1mL nebule or polyamp
Anticholinergic bronchodilator
Actions:
- Allows bronchodilatation by inhibiting cholinergic bronchomotor tone (i.e. blocks vagal reflexes which mediate bronchoconstriction)
44
Ipratropium Bromide primary emergency indications (2)
1. Severe respiratory distress associated with bronchospasm
| 2. Exacerbation of COPD irrespective of severity
45
Ipratropium Bromide contraindications (1)
1. Known hypersensitivity to atropine or its deirvatives
46
Ipratropium Bromide precautions (2)
1. Glaucoma
| 2. Avoid contact with eyes
47
Ipratropium Bromide side effects (7)
```
Headache
Nausea
Dry mouth
Skin rash
Tachycardia (rare)
Palpitations (rare)
Acute angle closure glaucoma secondary to direst eye contact (rare)
```
48
Ipratropium Bromide special notes and times+duration
There have been isolated reports of ocular complications (dilated pupils, increased intraocular pressure, acute angle glaucoma, eye pain) as a result of direct eye contact with ipratropium bromide formulations.
The nebulizer mask must therefore be fitted properly during inhalation and care take to avoid ipratropium bromide solution entering the eyes.
Ipratropium bromide must be nebulised in conjunction with salbutamol and is to be administered as a single dose only.
Onset: 3 - 5 minutes
Peak: 1.5 - 2 hours
Duration: 6 hours
49
Ketamine presentation and pharmacology (7)
200mg in 2mL vial
A rapid acting dissociative anaesthetic agent (primarily an NMDA receptor antagonist)
Actions:
- Produces a dissociative state characertised by:
- A trance-like state with eyes open but not responsive
- Nystagmus
- Profound analgesia
- Normal pharyngeal and laryngeal reflexes
- Normal or slightly enhanced skeletal muscle tone
- Occasionally a transient and minimal respiratory depression
50
Ketamine primary emergency indications (3)
1. Rapid sequence intubation
2. Extreme traumatic pain refractory to opioid analgesia
3. Extreme agitation
51
Ketamine contraindications (2)
1. Known hypersensitivity
| 2. Severe hypertension (SBP >180)
52
Ketamine precautions (2)
1. Any condition where significant elevation of BP would be hazardous, e.g.
- Hypertension
- CVA
- Recent AMI
- CCF
2. If being administered for analgesia, inject slowly over 1 minute to minimize risk of respiratory depression and hypertension
53
Ketamine side effects (9)
```
Cardiovascular:
- Increase in BP and HR
CNS:
- Respiratory depression or apnoea
- Emergence reactions (nightmares, restlessness, vivid dreams, confusion, hallucinations, irrational behavior)
- Enhanced skeletal tone
- Nausea and vomiting
Ocular:
- Diplopia and nystagmus with slight increase in intraocular pressure
Other:
- Local pain at injection site
- Lacrimation
- Salivation
```
54
Ketamine special notes and times+duration
```
Emergence reactions, hallucinations or other behavioural disturbances associated with ketamine administration for analgesia in adult patients may be managed with midazolam.
Consultation with the RCH is required to administer midazolam in paediatric patients.
IV effects:
Onset: 30 seconds
Peak: n/a
Duration: 10 minutes
IM effects:
Onset: 3 - 4 minutes
Peak: n/a
Duration: 12 - 25 minutes
```
55
Lignocaine 1% presentation and pharmacology
50 mg in 5mL amp (1%)
A local anaesthetic agent
Actions:
- Prevents initiation and transmission of nerve impulses causing local anaesthesia (1% solution)
56
Lignocaine 1% primary emergency indications (2)
1. Diluent for ceftriaxone for IM administration in suspected meningococcal disease
2. Chest wall infiltration as local anaesthesia to facilitate chest decompression in patients with GCS>10
57
Lignocaine 1% contraindications (1)
1. Known hypersensitivity
58
Lignocaine 1% precautions (1)
1. When using lignocaine 1% under these indications it is important to rule out inadvertent IV administration due to potential CNS complications
59
Lignocaine 1% side effects (1)
Nil - unless inadvertent IV administration
60
Lignocaine 1% special notes and times+duration
IM effects:
Onset: rapid
Peak: n/a
Duration: 1 - 1.5 hours
61
Methoxyflurane presentation and pharmacology
3mL glass bottle
| Inhalational analgesic agent at low concentrations
62
Methoxyflurane primary emergency indications (1)
1. Pain relief
63
Methoxyflurane contraindications (5)
1. Pre-existing renal disease/ renal impairment
2. Concurrent use of tetracycline antibiotics
3. Exceeding total dose of 6mL in a 24 hour period
4. Personal or family history of malignant hyperthermia
5. Muscular dystrophy
64
Methoxyflurane precautions (3)
1. The penthrox inhaler must be hand-held by the patients so that if unconsciousness occurs it will fall from the patient's face. Occasionally the operator may need to assist but must be continuously assess the level of consciousness
2. Pre-eclampsia
3. Concurrent use with oxytocin may cause hypotension
65
Methoxyflurane side effects (3)
Drowsiness
Decrease in blood pressure and bradycardia (rare)
Exceeding the maximum dose of 6mL in a 24 hour period may lead to renal toxicity
66
Methoxyflurane special notes and times+duration
The maximum initial priming dose for methoxyflurane is 3mL. This will provide approximately 25 minutes of analgesia and may be followed by one further 3mL dose once the initial dose is exhausted if required. Analgesia commences after 8 - 10 breaths and lasts for approximately 3 - 5 minutes once discontinued.
Do not administer in a confined space. Ensure adequate ventilation in ambulance.
Malignant hyperthermia is a very rare condition that can be induced by volatile anaesthetics such as methoxyflurane. Ask patients about any past history or family history of adverse reactions to inhaled anaesthetics.
In patients with muscular dystrophy, volatile agents may precipitate life-threatening rhabdomyolysis.
67
Midazolam presentation and pharmacology (3)
```
5mg in 1mL glass ampoule
15mg in 3mL glass ampoule
Short acting CNS depressant
Actions:
- Anxiolytic
- Sedative
- Anti-convulsant
```
68
Midazolam primary emergency indications (6)
1. Status epilepticus
2. Sedation to enable intubation (RSI/IFS)
3. Post intubation sedation
4. Sedation to enable synchronized cardioversion
5. Sedation in the agitated patient (including patients under the Mental Health Act 2014
6. Sedation in psychostimulant OD
69
Midazolam contraindications (1)
1. Known hypersensitivity to benzodiazepines
70
Midazolam precautions (4)
1. Reduced doses may be required for the elderly/frail , patients with chronic renal failure, CCF, or shock
2. The CNS depressant effects of benzodiazepines are enhanced in the presence of narcotics and other tranquilisers including alcohol
3. Can cause severe respiratory depression in patients with COPD
4. patients with myasthenia gravis
71
Midazolam side effects (4)
Depressed level of consciousness
Respiratory depression
Loss of airway control
Hypotension
72
Midazolam special notes and times+duration
```
IM effects:
Onset: 3- 5 minutes
Peak: 15 minutes
Durations: 30 minutes
IV effects:
Onset: 1 - 3 minutes
Peak: 10 minutes
Duration: 20 minutes
```
73
Misoprostol presentation and pharmacology
200mcg tablet
A synthetic prostaglandin
Actions:
Enhances uterine contractions
74
Misoprostol primary emergency indications (1)
1. Primary postpartum haemorrhage (PPH)
75
Misoprostol contraindications (2)
1. Allergy to prostaglandins
| 2. Exclude multiple pregnancy before drug administration
76
Misoprostol precautions (1)
1. History of asthma
77
Misoprostol side effects (4)
Hyperpyrexia
Shivering
Abdominal pain
Diarrhoea
78
Misoprostol special notes and times+duration
Side effects are more likely with >600mcg oral dose.
Onset: 8 - 10 minutes
Peak: n/a
Duration: 2 - 3 hours
79
Morphine presentation and pharmacology (7 actions)
```
10mg in 1mL glass ampoule
An opioid analgesic
Actions:
CNS effects:
- Depression (leading to analgesia)
- Respiratory depression
- Depression of cough reflex
- Stimulation (changes of mood, euphoria or dysphoria, vomiting, pin-point pupils)
- Dependence (addiction)
Cardiovascular effects:
- Vasodilation
- Decreases conduction velocity through the A-V node
```
80
Morphine primary emergency indications (5)
1. Pain relief
2. Acute LVF with shortness of breath and full field crackles
3. Sedation to maintain intubation
4. Sedation to enable intubation
5. RSI
81
Morphine contraindications (3)
1. History of hypersensitivity
2. Renal impairment/ failure
3. Late second stage of labour
82
Morphine precautions (8)
1. Elderly/ frail patients
2. Hypotension
3. Respiratory depression
4. Current asthma
5. Respiratory tract burns
6. Known addiction to opioids
7. Acute alcoholism
8. Patients on monoamine oxidase inhibitors
83
Morphine side effects (8)
```
CNS:
- Drowsiness
- Respiratory depression
- Euphoria
- Nausea, vomiting
- Addiction
- Pin-point pupils
Cardiovascular effects:
- Hypotension
- Bradycardia
```
84
Morphine special notes and times+duration
Morphine is a schedule 8 drugs under the Poisons Act and its use must be carefully controlled with accountability and responsibility.
Side effects or morphine can be reversed with naloxone
Occasional wheals are seen in the line of the vein being used for IV injection. This is not an allergy, only a histamine release.
IV effects:
Onset: 2- 5 minutes
Peak: 10 minutes
Durations: 1 - 2 hours
IM effects:
Onset: 10 - 30 minutes
Peak: 30 - 60 minutes
Duration: 1 - 2 hours
85
Naloxone presentation and pharmacology
0.4mg in 1mL glass ampoule
An opioid antagonist
Action:
- Prevents or reverses the effects of opioids
86
Naloxone primary emergency indications (1)
1. Altered conscious state and respiratory depression secondary to administration of opioids or related drugs
87
Naloxone contraindications (1)
1. Nil of significance in the above indication
88
Naloxone precautions (2)
1. If the patient is known to be physically dependent on opioids, be prepared for a combative patient after administration
2. Neonates
89
Naloxone side effects (5)
Symptoms of opioid withdrawal:
- Sweating, goose flesh, tremor
- Nausea and vomiting
- Agitation
- Dilatation of pupils, excessive lacrimations
- Convulsions
90
Naloxone special notes and times+duration
The duration of action of naloxone is often less than that of the opioid used, therefore repeated doses may be required.
Naloxone reverses the effects of opioids with none of the actions produced by other opioid antagonists when no opioid is present in the body. (For example, it does not depress respiration or cause pupillary constriction). In the absence of opioids, naloxone has no perceivable effects.
Following an opioid associated cardiac arrest naloxone should not be administered. Maintain assisted ventilation.
Following head injury naloxone should not be administered. Maintain assisted ventilation if required.
IV effects:
Onset: 1 - 3 minutes
Peak: n/a
Duration: 30 - 45 minutes
IM effects:
Onset: 1 - 3 minutes
Peak: n/a
Duration: 30 - 45 minutes
91
Normal saline presentation and pharmacology
10mL polyamp
500mL and 1000mL infusion soft pack
An isotonic crystalloid solution
Composition:
- Electrolytes (sodium and chloride in a similar concentration to that of extracellular fluid)
Action:
- Increases the volume of the intravascular compartment
92
Normal saline primary emergency indications (5)
1. As a replacement fluid in volume-depleted patients
2. To expand intravascular volume in the non-cardiac, non-hypovolaemic hypotensive patient e.g. anaphylaxis, burns, sepsis
3. As a fluid challenge in unresponsive, non-hypovolaemic hypotensive patients (other than LVF). e.g. PEA, asthma
4. Fluid for diluting and administering IV drugs
5 Fluid TKVO for IV administration of emergency drugs
93
Normal saline contraindications (1)
1. Nil of significance in the above indication
94
Normal saline precautions (1)
1. Consider modifying factors when administering for hypovolaemia
95
Normal saline side effects (1)
Nil of significance in the above indication
96
Normal saline special notes
IV half life:
| Approximately 30 - 60 minutes
97
Ondansetron presentation and pharmacology
4mg orally dissolving tablet
Anti-emetic
Action:
5HT3 antagonist which blocks receptors both centrally and peripherally
98
Ondansetron primary emergency indications (3)
1. undifferentiated nausea and vomiting
2. Prophylaxis for spinally immobilized or eye injured patients
3. Vestibular nausea in patients <21 years of age
99
Ondansetron contraindications (4)
1. Known hypersensitivity
2. Concurrent apomorphine use
3. Known long Q-T syndrome
4. Hypokalaemia or hypomagnesaemia
100
Ondansetron precautions (5)
1. Patients with liver disease should not receive more than 8mg of ondansetron per day
2. Care should be taken with patients on diuretics who may have an underlying electrolyte imbalance
3. Ondansetron contains aspartame and should not be given to patients with phenylketonuria
4. Concurrent use of tramadol
5. Pregnancy
101
Ondansetron side effects (12)
```
Rare (<0.1%)
Hypersensitivity reactions (including anaphylaxis)
Q-T prolongation
Widened QRS complex
Tachyarrhythmias (including AF and SVT)
Seizures
Extrapyramidal reaction
Visual disturbances (including transient loss of vision)
```
```
Common (>1%)
Constipation
Headache
Fever
Dizziness
Rise in liver enzymes
```
102
Ondansetron special notes and times+duration
Onset: 2 minutes
Peak: 20 minutes
Duration: 120 minutes
103
Paracetamol presentation and pharmacology
```
500mg tablets
120mg in 5mL oral liquid (24mg/mL)
An analgesic and antipyretic agent
Actions:
- Exact mechanism of action unclear; thought to inhibit prostaglandin synthesis in the CNS
```
104
Paracetamol primary emergency indications (2)
1. Mild pain
| 2. Headache
105
Paracetamol contraindications (5)
1. Hypersensitivity to paracetamol
2. Children <1 month of age
3. Paracetamol already administered within past 4 hours
4. Total paracetamol intake within past 24 hours exceeding 4g (adults) or 60mg/kg (children)
5. Chest pain in suspected acute coronary syndrome
106
Paracetamol precautions (3)
1. Impaired hepatic function or liver disease
2. Elderly/ frail
3. Malnourished
107
Paracetamol side effects (2)
1. Hypersensitivity reactions including severe skin rashes (rare)
2. Haematological reactions (rare)
108
Paracetamol special notes and times+duration
There are several brands of paracetamol available in Australia. Paracetamol is also found in many combination medicines, both prescription and over-the counter. Carefully determine previous paracetamol intake before dose administration.
The usual dose of paracetamol for children is 15mg/kg per dose. The maximum total dose of 60mg/kg therefore equates to 4 doses within a 24 hour period.
Hepatic damage is very rare when paracetamol is taken at recommended dosages.
Paracetamol is not indicated for the treatment of fever in the emergency setting.
Onset: 30 minutes
Peak:
Duration: 4 hours
109
Prochloperazine (stemetil) presentation and pharmacology
12.5mg in 1mL glass ampoule
An anti-emetic
Action:
- Acts on several neuro-transmitter systems
110
Prochloperazine (stemetil) primary emergency indications (1 + 5)
1. Treatment or prophylaxis of nausea/ vomiting for
- Motion sickness
- Planned aeromedical evacuation
- Known allergy or C/I to ondansetron administration
- Headache irrespective of nausea/ vomiting
- Vertigo
111
Prochloperazine (stemetil) contraindications (5)
1. Circulatory collapse (cool, pale, clammy skin, tachycardia, hypotension)
2. CNS depression
3. Previous hypersensitivity
4. Children
5. Pregnancy
112
Prochloperazine (stemetil) precautions (3)
1. Hypotension
2. Epilepsy
3. Pts affected by alcohol or on anti-depressants
113
Prochloperazine (stemetil) side effects (6)
```
Drowsiness
Blurred vision
Hypotension
Sinus tachycardia
Skin rash
Extrapyramidal reactions (usually the dystonic type)
```
114
Prochloperazine (stemetil) special notes and times+duration
IM effects:
Onset: 20 minutes
Peak: 40 minutes
Duration: 6 hours
115
Salbutamol presentation and pharmacology
```
5mg in 2.5mL polyamp
pMDI (100mcg per actuation)
A synthetic adrenergic stimulant with primarily beta 2 effects.
Action:
- Causes bronchodilatation
```
116
Salbutamol primary emergency indications (1 + 5)
1. Respiratory distress with suspected bronchospasm
- Asthma
- Severe allergic reactions
- COPD
- Smoke inhalation
- Oleoresin capsicum spray exposure
117
Salbutamol contraindications (1)
1. Nil of significance in the above indications
118
Salbutamol precautions (1)
1. Large doses of salbutamol have been reported to cause intracellular metabolic acidosis
119
Salbutamol side effects (2)
```
Sinus tachycardia
Muscle tremor (common)
```
120
Salbutamol special notes and times+duration
Salbutamol nebules/ polyamps have a shelf life of one month after the wrapping is opened. The date of opening of the packaging should be recorded and the drug should be stores in an environment of <30deg C
Although infrequently used, salbutamol by IV infusion may be required during interhospital transfers of women in premature labour.
The dose is to be prescribed and signed by the referring hospital medical officer.
Nebulised effects:
Onset: 5 - 15 minutes
Peak: n/a
Duration: 15 - 50 minutes
121
Dexamethasone presentation and pharmacology
```
8mg in 2mL glass vial.
A corticosteroid secreted by the adrenal cortex.
Actions:
- Relieves inflammatory reactions
- Provides immunosupression
```
122
Dexamethasone indications
1. Bronchospasm associated with acute respiratory distress not responsive to nebulised salbutamol
2. Moderate - severe croup
3. Acute exacerbation of COPD
123
Dexamethasone contraindications
1. Known hypersensitivity
124
Dexamethasone precautions
1. Solutions which are not clear or are contaminated should be discarded
125
Dexamethasone side effects
None of significance in the above indication
126
Dexamethasone special notes and duration
```
Does not contain an antimicrobial agent, therefore use solution immediately and discard any residue
Iv effects:
Onset: 30-60 minutes
Peak: 2 hours
Duration: 36-72 hours
```
