Drug Indications, Contraindications, Precautions and Side Effects Flashcards
What are the indications for olanzipine?
Behavioural disturbance
What are the contraindications for olanzipine?
Known hypersensitivity to olanzapine or to any other excipients in olanzapine ODTs (Mannitol, microcrystalline cellulose, carmellose calcium, sucralose, magnesium stearate, colloidal anhydrous silica).
What are the precautions for olanzapine?
- May cause respiratory depression or worsen depression associated with alcohol or benzodiazepine use
- May cause orthostatic hypotension; use cautiously in people whose condition may worsen if this occurs or in those with risk factors for hypotension, e.g. hypovolaemia, taking an anti-hypertensive.
- Pts with limited physiological reserves and the elderly have an increased risk of adverse effects.
- Used cautiously in patients who have a history of seizures or are subject to factors which may lower the seizure threshold.
- Effects on ability to drive and operate machines: Patients must be advised that olanzapine may cause drowsiness and may increase the effects of alcohol, cannabis or sleeping tablets. If affected, they do not drive or operate machinery.
What are the side effects of olanzipine?
Common (>1%) – sedation, dizziness, orthostatic hypotension, hyperglycaemia, peripheral oedema.
Infrequent (0.1 – <1%) – Extrapyramidal Side Effects (EPSE), elevation of liver aminotransferases.
Rare (<0.1%) – rhabdomyolysis, venous thromboembolism (VTE), hepatic failure, multi-organ hypersensitivity syndrome, QT prolongation.
What are the indications for droperidol?
Behavioural disturbance SAT score 2 or more
Palliative care
What are the contraindications for droperidol?
Allergy or hypersensitivity to droperidol.
Patients < 6 years of age.
Patients with Parkinson’s disease.
What are the precautions for droperidol?
- May prolong QT interval. Risk assessment and ECG monitoring is recommended in patients with cardiovascular disease or significant risk factors for cardiac arrhythmia. When used for severe behavioural disturbances, ECG is recommended once acute symptoms have resolved.
- May cause mild to moderate hypotension.
- Use in the elderly: The initial dose of droperidol should be reduced in the elderly, debilitated and other poor risk patients. The effect of the initial dose should be considered in determining incremental doses.
- Effects on ability to drive and use machines: Droperidol may impair mental and/or physical abilities for operating machinery or driving a motor vehicle. Patients must be advised to only drive or operate a machine if sufficient time has elapsed after the administration of droperidol, i.e. about 10 hours after a dose of up to 5 mg and 24 hours after higher doses.
What are the indications for ketamine?
Agitation in the trauma and critically ill patient
Analgesia
Behavioural disturbance
Cardiac arrest
What are the indications for midazolam?
- Agitation in the trauma and critically ill patient
- Behavioural disturbance
- Palliative care - Breathlessness
- Palliative care - restlessness and/or agitationSeizures
ICP only:
* Cardiac Arrest
* Distressing psychological reactions post ketamine administration
* Dysrhythmias
* Hypertensive disorders of pregnancy
* Limb realignment and/or difficult extrication
* Return of spontaneous circulation
What are the contraindications for midazolam?
Allergy or known hypersensitivity to benzodiazepines
What are the precautions for midazolam?
- Consider reduced doses in patients who have low body weight, respiratory disease, sleep apnoea, acute alcohol intoxication, shock and coma, myasthenia gravis, muscular dystrophies and myotonias
- Use in the elderly due to an increased risk of oversedation, ataxia, confusion, falls, respiratory depression, and short-term memory impairment; reduce dose and monitor closely
- Use in renal impairment – There is a greater likelihood of adverse drug reactions in patients with severe renal impairment
- Use in hepatic impairment – Hepatic impairment reduces the clearance of i.v. midazolam with a subsequent increase in terminal half-life. Therefore, the clinical effects may be stronger and prolonged. The required dose of midazolam may have to be reduced and proper monitoring of vital signs should be established
- Use in pregnancy (Category C) – Benzodiazepines should be avoided during pregnancy unless there is no safer alternative. Midazolam crosses the placenta and the administration of midazolam in the last weeks of pregnancy or at high doses during labour have resulted in neonatal CNS depression and can be expected to cause irregularities in the foetal heart rate, hypothermia, hypotonia, poor sucking and moderate respiratory depression due to the pharmacological action of the product
- Use in lactation - There is evidence that midazolam is excreted in breast milk and its effects on the newborn are not known
- Effects on Ability to Drive and Use Machines - Patients should be warned to take extra care as a pedestrian and not to drive a vehicle or operate a machine until the patient has completely recovered from the effects of the drug, such as drowsiness. The physician should decide when activities such as driving a vehicle or operating a machine may be resumed. The patients’ attendants should be made aware that the patients’ anterograde amnesia may persist longer than the sedation and therefore, patients may not carry out instructions even though they appear to acknowledge them. If sleep duration is insufficient or alcohol is consumed, the likelihood of impaired alertness may be increased
What are the side effects of midazolam?
- Common (>1%) – hypotension, hiccup, cough.
- Infrequent (0.1 – <1%) – pain on injection, erythema at injection site, rash, laryngospasm, bronchospasm, nausea, vomiting, headache, confusion, restlessness.
- Rare (<0.1%) – arrhythmias, cardiorespiratory arrest, anaphylactic/anaphylactoid reactions.
What are the indications for fentanyl?
Agitation in the trauma and critically ill patient
Analgesia
What are the contraindications for fentanyl?
- Epistaxis or occluded nasal passages (IN route)
- Previous or known allergy or adverse reaction
- Pregnant women ≥ 20 weeks gestation in labour
What are the side effects of fentanyl?
- Common (>1%): rash, bradycardia; may have a lower incidence of nausea, vomiting and constipation than other opioids
- Rare (<0.1%): chest wall rigidity with rapid/very high IV doses
What are the precautions for fentanyl?
Pregnant women ≥ 20 weeks.
Bradyarrhythmias - may be exacerbated.
MAOIs - Fentanyl should be administered with caution for patients who are receiving or have received treatment within 14 days, with an MAOI due to the risk of serotonin toxicity (fentanyl can contribute to serotonin toxicity). Where an alternate analgesic agent (e.g. morphine) is available it should be used.
Respiratory depression - Use opioids with extreme caution in patients with respiratory depression, severe obstructive airways disease, at risk of upper airways obstruction (e.g. sleep apnoea), asthma or decreased respiratory reserve as they may depress respiration, decrease the cough reflex and dry secretions.
Newborns - Opioid analgesics may cause respiratory depression in the newborn, withdrawal effects may occur in neonates of dependent mothers.
Effects on ability to drive and use machines - Fentanyl may cause drowsiness and general impairment of co-ordination and may impair the mental and/or physical abilities required for the performance of potentially hazardous tasks, such as driving a car or operating machinery. Ambulatory patients should be cautioned against driving or operating machinery. Patients should only drive or operate a machine if sufficient time has elapsed (at least 24 hours) after the administration of fentanyl.
What are the indications for hydrocortisone?
- asthma
- anaphylaxis and allergic reactions
- COPD exaserbation
- adrenal crisis
What are the contraindications for hydrocortisone?
- Known or suspected allergy to corticosteroids, sodium succinate or sodium phosphate
- Active peptic ulcer disease
What are the side effects of hydrocortisone?
rarely induces adverse reactions for one off emergency use
What are the indications for compound sodium lactate?
- Anaphylaxis & Allergic Reactions
- Burns
- Cardiogenic Shock
- Crush Injuries & Trapped Patients
- Dehydration
- Diving Emergencies
- Hyperglycaemia
- Hyperkalaemia
- Medical Hypoperfusion/Hypovolaemia
- Meningococcal Disease
- Sepsis
- Trauma in Pregnancy (with any key sign of shock)
- Traumatic Cardiac Arrest
- Traumatic Hypovolaemia
ICP Only:
Newborn Resuscitation
What are the contraindications for compound sodium lactate?
Nil
What are the indications for glucagon?
- Anaphylaxis and Allergic Reactions
- Hypoglycaemia
What are the contraindications for glucagon?
nil
What are the indications for salbutamol?
- Asthma
- COPD Exacerbation
- Anaphylaxis & Allergic Reactions
- Palliative Care
What are the contraindications for salbutamol?
Nil
What are the indications for hydrocortisone?
- asthma
- anaphylaxis & allergic reactions
- COPD exacerbation
- adrenal crisis
What are the contraindications for hydrocortisone?
- Known or suspected allergy to corticosteroids, sodium succinate or sodium phosphate
- Active peptic ulcer disease
What are the indications for ipratropium bromide?
- asthma
- chronic obstructive pulminary disease (COPD)
What are the contraindications for ipratropium bromide?
- Pts < 6 months of age
- Allergy or hypersensitivity to ipratropium bromide
- Glaucoma
What are the indications for adrenaline?
- Asthma
- Anaphylaxis & Allergic Reactions
- Cardiac arrest
- Croup
ICP Only:
* Bradycardia
* Cardiogenic shock
* Newborn resuscitation
* Return of Spontaneous Circulation
What are the contraindications for adrenaline?
nil
Where does the T Piece go when administering nebulised medication with a mask and bvm?
between the mask and filter (filter attached to bvm)
What are the indications for CPAP?
- basal crackles - if nil response to oxygen and GTN +/- frusemide
- mid zone to full field crackles - concurrently with pharmacology
What are the contraindications for CPAP?
- Pt does not consent
- LOC = P or U
- facial trauma
- epistaxis
- pneumothorax
- hypoventilation
- vomiting
- SBP <90mmHg
- Pt removes consent/does not tolerate CPAP
What are the indications for glucose 10%?
- hypoglycaemia
- newborn resuscitation
What are the contraindications for glucose 10%?
Nil
What are the indications for glucose gel?
hypoglycaemia
What are the contraindications for glucose gel?
- ↓ LOC
- altered gag reflex
What are the indications for midazolam?
- Seizures
- Agitation in the trauma and the critically ill patient
- Behavioural disturbance
- Hypertensive disorders of pregnancy
- Palliative Care
What are the contraindications for midazolam?
Allergy or known hypersensitivity to benzodiazepines
Compound sodium lactate note for anaphylaxis cardiac arrest.
If the patient deteriorates into cardiac arrest a further bolus of compound sodium lactate should be administered irrespective of previous administration.
What are the indications for aspirin?
ACS
What are the contraindications for aspirin?
- allergy or hypersensitivity
- active, suspected or known bleeding tendency
- Pts <16 yrs
- T1 trauma criteria
What are the indications for GTN?
- Acute Coronary Syndrome (ACS)
- Cardiogenic Pulmonary Oedema (CPO)
- Autonomic dysreflexia
What are the contraindications for GTN?
- BP < 90mmHg systolic
- Pulse rate < 50/min or > 150/min
- Patients < 16 years of age
- Viagra type drugs:
- Sildenafil (Viagra®) or Vardenafil (Levitra®) within 24 hours
- Tadalafil (Cialis®) within 96 hours
What are the indications for fentanyl?
- Agitation in the trauma and critically ill patient
- Analgesia
What are the contraindications of fentanyl?
- Epistaxis or occluded nasal passages (IN route)
- Previous or known allergy or adverse reaction
- Pregnant women ≥ 20 weeks gestation in labour
What are the indications for clopidogrel?
Cardiac Reperfusion - Prehospital Thrombolysis
What are the contraindications for clopidogrel?
- Allergy or hypersensitivity to clopidogrel
- Active, suspected or known bleeding tendency
- Patients < 18 years of age
- Pregnancy or breast feeding
- Any exclusion via Prehospital Thrombolysis Checklist
What are the indications of tenecteplase?
Cardiac reperfusion - Prehospital Thrombolysis (PHT)
What are the contraindications of tenecteplase?
- Patients <18 years of age
- Any exclusion via Prehospital Thrombolysis Checklist
What are the indications for enoxaparin?
Cardiac Reperfusion - Prehospital Thrombolysis
What are the contraindications for enoxaparin?
- Allergy or hypersensitivity to enoxaparin sodium
- Any exclusion per Prehospital Thrombolysis Checklist
What are the indications for naloxone?
Opioid overdose
What are the contraindications for naloxone?
Neonates born to opioid addicted mothers due to risk of inducing opioid withdrawal
What are the side effects of naloxone?
- Opioid withdrawal (nausea, vomiting, sweating, tachycardia, hypertension & combative behaviour)
- Pulmonary Oedema in patients with pre-existing cardiac disease
- Dysrhythmias (VF,VT)
What are the side effects of adrenaline?
- Anxiety
- Pupillary dilation
- Tachycardia
- Dysrhythmias, including ventricular fibrillation
- Hypertension
- Nausea & Vomiting
What are the side effects of salbutamol?
dysrhythmias (in large doses)
shaking and trembling
What are the side effects of glucagon?
nausea & vomiting
allergic reactions (rarely)
Why should caution be used when flushing medications in patients < 16 years of age?
as excessive volume administration may inadvertently occur
