Drug Administration Flashcards
How is activated charcoal presented?
50 grams in 250ml in either granules or suspension in the water
What are some indications for use of activated charcoal?
Acute oral poisoning or oral drug overdose
Adults and children aged 1 and over who have ingested toxins less that 1 hour before ambulance attendance
Adults and children, irrespective of time of ingestion, who have ingested toxins and where Toxbase or The National Poisons Information Service (0344 8920111) have been contacted and advised the administration of activated charcoal
What is considered a paracetamol overdose?
Recommended dose is 4g in 24 hours for adults
Ingestion exceeding 4g is an overdose but toxicity is extremely unlikely if less than 75mg/kg paracetamol has been ingested within 24 hours
Single acute overdose is defined as an ingestion or less than 4g in a period of less than an hour
How is the toxic dose of activated charcoal for pregnant patients?
Use patients pre-pregnancy weight
What is the volume of activated charcoal an adult can orally consume?
50mg in 250ml
What is the max dose of activated charcoal for an adult?
50mg
How much activated charcoal should children aged 1 year to under 12 years consume?
Should drink 125ml, which is equivalent to 25 grand of activated charcoal or half of contents of one bottle unless large quantity of poison has been ingested
What cab activated charcoal be consumed with?
Soft drinks or fruit juice
How is adrenaline 1mg in 10ml (1:10,000) presented?
Pre-filled syringe containing 1mg of adrenaline (epinephrine) in 10ml (1:10,000)
When should adrenaline 1:10,000 be used?
Cardiac arrest
When should repeated doses of adrenaline 1:10,000 not be used?
Cannot be repeated on hypothermic patients
During cardiac arrest, when should adrenaline 1:10,000 be administered?
Shockable rhythms:
Administer adrenaline after 3rd shock and then after alternate shocks (ie. 5th, 7th etc)
Non-shockable:
Administer adrenaline immediately IV access is achieved then alternate loops
What is the recommended adrenaline dose IV/IO for an adult?
1mg in the 10ml
What is the dose interval for adrenaline 1:10,000 and what is the max dose?
3-5 minutes
No limit to dose. Repeat 1mg dose
How is adrenaline 1mg in 1ml (1:1000) presented?
Pre-filled syringe or ampoule containing 1mg of adrenaline (epinephrine) in 1ml (1:1000)
When should adrenaline 1:1000 be used?
Anaphylaxis
Life-threatening asthma with failing ventilation and continued deterioration despite nebuliser therapy
When should adrenaline 1:1000 not be administered?
Should not be administered IV in cases of anaphylaxis
What is the recommended dose of adrenaline 1:1000 adults and children over the age of 12?
IM 500mcg in 0.5ml
What is the dose interval for adrenaline 1:1000 and what is the max dose?
5 minutes
No max dose. Repeat dose is 500mcg
How is aspirin presented?
300mg aspirin in tablet form. Dispersible or chewable
When can aspirin be given?
Adults with clinical or ECG evidence suggestive of myocardial infarction or ischaemia
What does aspirin do?
Has an anti-platelet action which reduces clot formation
What are some contraindications of aspirin?
Allergy or sensitivity Children under 16 years Active gastrointestinal bleed Haemophilia or other known clotting disorders Severe hepatic disease
What type of patients can have aspirin who also have MI or ischaemia?
Asthma Pregnancy Kidney or liver failure Gastric or duodenal ulcer Current treatment with anticoagulants
What are some side effects of activated charcoal?
Black stools
Intestinal obstruction (blockage of digestive system)
Bezoar formation (ball of material in the stomach that is not passed out)
Intestinal perforation (rare, but can occur after several treatments)
What is the side effects of aspirin?
Increased risk of gastric bleeding
Wheezing in some asthmatics
Who can have aspirin?
Children over the age of 16 and adults
What is the dose of aspirin for an adults?
Oral - 300mg in 1tablet
What is the max dose of aspirin?
300mg
Cannot be repeated
How is glucagon presented?
Glucagon injection, 1mg of powder in vial for reconstitution with water for injection
When would glucagon be administered?
Hypoglycaemia or unconscious patients where hypoglycaemia is considered likely cause (less than 4 BM)
Glucagon IM should only be administered when oral glucose administration is not possible or is ineffective, and/or when IV access to administer 10% glucose is not possible
Why should glucagon not be given by IV injection?
Increased vomiting associated with IV use
What are the side effect of glucagon?
Nausea and vomiting Abdominal pain in adults Diarrhoea in children Hypokalaemia Hypotension in adults Acute hypersensitivity reaction, although is rare
If patient is unconscious due to hypoglycaemia, how should glucagon be administered and how much?
Glucose 10% IV
What is the IM dose of glucagon in thigh or upper arm?
1mg in 1 vial
Can glucagon dose be repeated?
No and max dose is 1mg
If no response to IM glucagon, what is next point of treatment?
If no response within 10 minutes administer intravenous glucose 10%
How is glucose 40% oral gel presented?
Plastic tube containing 25g glucose 40% oral gel
What is the recommended dose of glucose 40% oral gel for an adult and children older than 12?
Route is buccal
10-20g in 1-2tubes
What is the max dose of glucose 40% oral gel?
2 tubes/20grams
How is glyceryl trinitrate (GTN) presented?
Sublingual spray containing 400mcg per metered dose
What are the indications of the use of GTN?
Cardiac chest pain due to angina or MI, when systolic BP is greater than 90mmHg
Breathlessness due to pulmonary oedema in acute heart failure when systolic BP is greater than 110mmHg
What are the side effects of GTN?
Headache
Dizziness
Hypotension
What is the dose of GTN for angina, MI and Acute Heart Failure?
400-800mcg in 1-2 sprays
What is the dose interval for GTN?
5-10mins
How is ibuprofen presented?
Solution or suspension containing ibuprofen 100mg in 5ml (20mg in 1ml)
What are some indications of ibuprofen?
Relief of mild to moderate pain
Pyrex is with discomfort
Soft tissue injuries
What is the dose of ibuprofen for children aged 12 years and over, and adults?
400mg
What is the dose interval of ibuprofen and what is the repeat dose and max dose?
8 hours
4mg
1.2g per 24 hours
How is Ipratropium Bromide presented?
Nebuliser liquid Ipratropium 250mcg per 1ml liquid unit dose vial
Nebuliser liquid Ipratropium 500mcg per 2ml liquid unit dose vial
What are the indications for the use of Ipratropium bromide?
Acute, severe or life threatening asthma
Acute asthma unresponsive to salbutamol
Exacerbation of COPD unresponsive to salbutamol
What are some side effects of Ipratropium?
Nausea Dry mouth Tachycardia/arrhythmia Tightness of chest Allergic reaction
If COPD, what is the time interval for Ipratropium?
6 minutes
What is the adult dose of Ipratropium?
6-8 litres per minute oxygen
500mcg in 2ml
Half for child
What is the dose of paracetamol for an infant? (3 months to 5 years)
120mg in 5ml
What is the dose of paracetamol for 6 and over?
250mg in 5ml
What is the paracetamol dose for a 16 year old - adult?
500mg-1g in 10-20ml
What is the dose interval for paracetamol for a 16 year old - adult?
4-6 hours
What is the max dose of paracetamol for 16 years - adult?
2-4 grams in 24 hours
For all ages of paracetamol administration, what should be checked?
JRCALC
How is salbutamol presented?
Nebules containing salbutamol 2.5mg in 2.5ml or 5mg in 2.5ml
When is salbutamol used?
Acute asthma attack where normal inhaler therapy has failed
Expository wheezing associated with allergy, anaphylaxis, smoke inhalation or other lower airway causes
Exacerbation of COPD
What are the side effects of using salbutamol?
Tremor (shaking) Tachycardia Palpitations Headache Feeling of tension Peripheral vasodilation Muscle cramps Rash
What is the adult dose of salbutamol?
6-8 litres of oxygen
5mg in 5ml
