Drug Doses and Emergency Medicine Extra Things Flashcards
Low dose aspirin is?
75 mg
High dose aspirin is?
300 mg
Dose of aspirin for secondary prevention of stroke, cardiovascular disease or pre-eclampsia?
low dose aspirin - 75mg
Dose of aspirin used in management of a STEMI or NSTEMI?
300 mg
After ischaemic stroke anti platelets?
300 mg aspirin for 14 days plus clopidogrel 75 mg lifelong
Dose of aspirin for fever/ pain?
300-600mg every 4-6 hours, max 2.4 g
What is the first line statin?
atorvastatin
Primary prevention dose of statin (i.e. those who have never had a cardiac event before) ?
start at 10mg (sometimes 20mg) can be increased up to 80 mg
Secondary prevention dose of statin following a MI?
80 mg
Dose of clopidogrel in cardiac disease?
300 mg for 4 weeks to 12 months
Dose of clopidogrel following strokes?
75 mg lifelong (first line)
First line anti platelet post strokes?
clopidogrel
Ibuprofen dosing?
400mg 3x daily (6 tablets)
max dose = 1.2 g
Paracetamol dosing?
1g 4x daily (8 tablets)
max dose = 4g
Adrenaline dosing in a cardiac arrest?
Adrenaline dose = 1mg
In non shockable give ASAP
In shockable give once chest compressions have restarted after the 3rd shock
Repeat 1mg every 3-5mg whilst ALS continues
Amiodarone dosing in cardiac arrest?
Amiodarone dose = 300mg or 150mg
amiodarone is not used in non-shockable rhythms
In shockable give 300mg amiodarone after 3 shocks with the adrenaline
after 5 shocks give 150mg
Anaphylaxis adrenaline dosing?
IM injection - best site - anterolateral thigh
adult dose = 500 micrograms - 0.5ml of 1 in 1000
6-12 years = 300 micrograms
6M - 6years = 150 micrograms
< 6 M = 100 -150 micrograms
Adrenaline can be repeated every 5 minutes if necessary
Opioid overdose naloxone dosing?
400 micrograms, then 800 micrograms up to 2 doses, 2mg for 1 dose, if still no response review diagnosis
Hypoglycaemia management?
Im community:
10-20g oral glucose
IM glucagon pen if available
Hospital:
oral glucose as above
10% glucose if no responding (150-160ml)
20% if unconsciousness (75-80ml)
Cardiac arrest shockable drugs?
give 1 mg adrenaline after 3rd shock
give adrenaline every 3-5 minutes
give 300mg amiodarone after 3rd shock
give 150 mg amiodarone after 5th shock
Cardiac arrest non shockable drugs?
give 1mg adrenaline ASAP
Give adrenaline every 3-5 minutes
In adult tachycardia anyone who is haemodynamically unstable gets?
synchronised shocks
VT with a pulse acute management?
amiodarone 300mg over 10-60 minutes and then shock if needed
in torsades de pointes give magnesium
SVT acute management?
- Vagal manœuvres
- IV adenosine (have to give as a fast bolus or it will not work first try 6mg, then 12mg, then 18mg)
- verapamil or a beta blocker
- synchronised shocks
Difference between synchronised and unsynchronised shocks?
synchronised shocks - timed with the ECG pattern - should give in any rhythm where a patient is conscious, basically tachycardias originating in the atria and in VT with a pulse
unsynchronised shocks are not timed with the ECG pattern - give this in rhythm where patient is unconsciousness - pulseless VT and VF
Acute AF management?
- beta blocker
- digoxin
- amiodarone
Management of adult bradycardia?
anyone who is haemodynamically unstable should be treated
- 500 micrograms IV, can be repeated up to 3mg
- Adrenaline, isoprenaline or transcutaneous pacing
Anti cholinergic toxidrome?
Increased: heart rate, BP
No change to respiratory rate
Decreased bowel sounds and sweating
dilated pupils
Cholinergic toxidrome
No change to resp rate, heart rate, BP, temperature
increased bowel sounds, sweating
pinpoint pupils
Opioid toxidrome?
decreased bowel sounds, temperature, sweating, heart rate, rest rate, blood pressure
pinpoint pupils
Sympathomimetic toxidrome?
dilated pupils
increased everything
Sedative hypnotic toxidrome?
no change in pupils
decreased everything
Who with a paracetamol overdose gets n-acetylcysteine?
- anyone who hits the line on treatment threshold curve after four hours
- anyone who presents with an unclear/ staggered overdose (taken paracetamol over more than 1 hr)
- anyone who presents within 8-24 hours who has taken more than 150mg/ kg
- anyone who presents after 24 hours with AST/ ALT above normal, hepatic tenderness or clear jaundice
In acute liver failure who gets a transplant?
hypoglycaemia
ph < 7.3 or bicarb < 18 mmcl/l
AKI or oliguria
metabolic acidosis
encephalopathy
Management of a patient with acute asthma who is not responding to medical treatment and becoming acidotic?
intubation and ventilation
Salicylate overdose blood gas picture?
mixed primary respiratory alkalosis (presents first) and metabolic acidosis (presents later)
Adenosine dosing for SVT?
6mg, then 12mg, then 18mg
All patients with a new diagnosis of anaphylaxis?
should be referred to a specialist allergy clinic
VT/ VF should be treated with a shock when?
as soon as identified
C peptide?
is only present in endogenous insulin not insulin you inject
When should IV adrenaline be considered in anaphylaxis?
after two failed doses of IM adrenaline (refractory anaphylaxis) if they still have respiratory or cardiovascular issues
In ALS if IV access cannot be obtained drugs should be delivered by?
intraosseous route
Single most important factor for liver transplantation in paracetamol overdose?
arterial pH
When thinking about pre-op assessment good glycemic control is defined as?
HbA1c < 69 mmol/l
Those with good glycemic control going for elective/ minor procedures with diabetes on insulin?
can manage on the day with adjustment of usual regime
Once daily insulins (Lantus, Levemir) : day before and day or reduce dose by 20%
Twice daily or ultra long (Humulin M3, Novomir): no change on day before, halve the morning dose, leave evening dose unchanged
Other diabetic drugs what to do on day of surgery and before?
all other diabetic drugs take as normal on the day before
SGLT2i should be omitted on day of surgery
sulfonylureas omit morning dose but can take afternoon dose, if afternoon surgery omit both morning and afternoon dose
metformin, if take 3x daily omit lunch dose, if only take 1 or 2 then take as normal
DPP4 (gliptins) and GLPS (glitides) taken as normal
COCP guidelines before surgery?
VTE risk
stop 4 weeks before surgery, wait 2 weeks after surgery
Antiplatelets guidelines before surgery?
stop 7-10 days before although this is being challenged
Anticoagulants guidelines?
stop 2-4 days before
if high risk of clotting could then give LMWH up until day before
ACEi guidelines?
stop day of/ omit dose day of
Main agents that cause malignant hyperthermia?
suxamethonium and halothane
Presentation of malignant hyperthermia?
increased body temperature, increased CO2 production, tachycardia, muscle rigidity, acidosis, hyperkalaemia
What is malignant hyperthermia treated with?
dantrolene
Isolated fever in a well patient in the first 24 hours following surgery?
physiological reaction to operation
Anastomotic leak?
surgical emergency, return to theatre
What is ketamine good for?
anaesthetic agent for HD unstable patients, has good analgesia and doesn’t cause a drop in BP so is good for trauma
What can etomidate result in?
adrenal suppression
What anaesthetic has a strong analgesic effect?
ketamine
Use of what drug can slow bone healing?
NSAIDs
Prednisolone should be replaced with what during surgery?
hydrocortisone
ECG abnormality in tricyclic overdose?
widened QRS
In CPR if PE is suspected what should be considered alongside normal drugs?
thrombolytic therapy - alteplase
