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CPGs Cass > Drug Mix 2 > Flashcards

Drug Mix 2 Flashcards

1
Q

Fentanyl presentation

A

100mcg/1mL

250mcg/1mL

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2
Q

Fentanyl pharmacology

A

Synthetic opioid analgesic

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3
Q

Fentanyl actions

A

CNS effects:
- depression leading to analgesia
- respiratory depression leading to apnoea
- dependence
CVS effects:
- decreases conduction velocity through the AV node

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4
Q

Fentanyl metabolism

A

Metabolised by the liver, excreted by the kidneys

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5
Q

Fentanyl indications (6)

A
  1. Sedation to facilitate intubation
  2. Sedation to maintain intubation
  3. Sedation to maintain transthoracic pacing
  4. Sedation to facilitate synchronised cardioversion
  5. CPR interfering patient
  6. Analgesia
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6
Q

When is fentanyl preferable for analgesia?

A 
1. Hx of hypersensitivity or allergy to morphine
2 known renal impairment/failure
3. Short duration of action desirable
4. Hypotension
5. Nausea/vomiting 
6. Severe headache
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7
Q

Fentanyl contraindications (2)

A
  1. Hypersensitivity

2. Late second stage labour

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8
Q

Fentanyl precautions (7)

A
  1. Elderly/frail pts
  2. Impaired hepatic function
  3. Respiratory depression
  4. Current asthma
  5. Pts on monoamine oxidase inhibitors
  6. Known addiction to opioids
  7. Rhinitis, rhinorrhoea or facial trauma
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9
Q

Fentanyl side effects

A

Respiratory depression
Apnoea
Rigidity of the diaphragm and intercostal muscles
Bradycardia

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10
Q

Fentanyl special notes

A

Respiratory depression can be reversed with naloxone

100mcg is the equivalent of 10mg morphine

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11
Q

Fentanyl IV times

A

Onset immediate
Peak <5 mins
Duration 30-60 mins

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12
Q

Fentanyl IN times

A

Peak 2 mins

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13
Q

Glucagon presentation

A

1mg IU in 1ml hypokit

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14
Q

Glucagon pharmacology

A

Hormone secreted by the pancreas

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15
Q

Glucagon actions

A

Increases blood glucose concentration by converting stored liver glycogen to glucose

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16
Q

Glucagon metabolism

A

Metabolised by the liver, kidneys and plasma

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17
Q

Glucagon indication

A

Diabetic hypoglycaemia (BGL<4) in pts with an altered conscious state who are unable to self-administer oral glucose

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18
Q

Glucagon contraindications

A

None

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19
Q

Glucagon precautions

A

None

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20
Q

Glucagon side effects

A

Nausea and vomiting

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21
Q

Glucagon special notes

A

Pts with inadequate glycogen stores in the liver will not respond to glucagon (alcoholics, malnourished)

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22
Q

Glucagon times

A

Onset 5 mins

Duration 25 mins

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23
Q

GTN presentation

A

0.3mg tablet

50mg patch

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24
Q

GTN pharmacology

A

Vascular smooth muscle relaxant

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25
Q

GTN actions

A

Venous dilatation promotes venous pooling and reduces venous return to the heart (reduces preload)
Arterial dilatation reduces systemic vascular resistance and arterial pressure (reduces afterload)

26
Q

What are the benefits of GTN actions?

A
  1. Reduced myocardial O2 demand
  2. Reduced systolic, diastolic and mean arterial BP, whilst maintaining coronary perfusion pressure
  3. Mild collateral coronary Arenal dilatation May improve bloody supply to ischaemic areas of myocardium
  4. Mild tachycardia secondary to slight fall in BP
  5. Preterm labour: uterine quiescence in pregnancy
27
Q

GTN metabolism

A

In the liver

28
Q

GTN indications (5)

A
  1. Chest pain with ACS
  2. Acute LVF
  3. Hypertension associated with ACS
  4. Autonomic dysreflexia
  5. Preterm labour
29
Q

GTN contraindications (9)

A
  1. Hypersensitivity
  2. SBP <110 tablet
  3. SBP <90 patch
  4. HR >150
  5. HR <50 (excluding autonomic dysreflexia)
  6. Viagra or Levitra in 24hrs or Cialis in 4 days
  7. VT
  8. Inferior STEMI with SBP <160
  9. Right ventricular MI
30
Q

GTN precautions (4)

A

Elderly pts
No previous administration
Recent MI
Concurrent use with other tocolytics

31
Q

GTN side effects

A 
Tachycardia
Hypotension
Headache
Skin flushing
Bradycardia
32
Q

GTN S/L times

A

Onset 30 sec to 2 mins
Peak 5-10 mins
Duration 15-30 mins

33
Q

GTN patch times

A

Onset up to 30 mins

Peak 2 hrs

34
Q

Heparin presentation

A

5000 units/5mL

35
Q

Heparin pharmacology

A

Anticoagulant

36
Q

Heparin action

A

Inactivates clotting factors IIa (thrombin) and Xa by bonding to antithrombin III

37
Q

Heparin metabolism

A

Metabolised by the liver

Excreted by the kidneys

38
Q

Heparin indication

A

Acute STEMI

39
Q

Heparin contraindications (7)

A
  1. Hypersensitivity
  2. Active bleeding (excluding menses)
  3. Oral anticoagulants
  4. Bleeding disorders
  5. History of heparin-induced thrombocytopenia
  6. Severe hepatic impairment/disease, including oesophageal varices
  7. Recent trauma or surgery (<3 weeks)
40
Q

Heparin precautions

A

Renal impairment

41
Q

Heparin side effects

A

Bleeding
Bruising and pain at injection site
Hyperkalaemia
Thrombocytopenia

42
Q

Heparin special notes

A

Don’t inject IM due to risk of causing haemorrhage

43
Q

Heparin times

A

Onset immediate

Duration 3-6 hours

44
Q

Atrovent presentation

A

250mcg/1mL

45
Q

Atrovent pharmacology

A

Anticholinergic bronchodilator

46
Q

Atrovent actions

A

Allows bronchodilation by inhibiting cholinergic bronchomotor tone
Blocks vagal reflexes which mediate bronchoconstriction

47
Q

Atrovent indications (2)

A
  1. Severe respiratory distress associated with bronchospasm

2. Exacerbation of COPD

48
Q

Atrovent contraindications

A
  1. Hypersensitivity to atropine or any of its derivatives
49
Q

Atrovent precautions (2)

A
  1. Glaucoma

2. Avoid contact with eyes

50
Q

Atrovent side effects

A 
Headache
Nausea
Dry mouth
Skin rash
Tachycardia 
Palpitations
Acute angle closure glaucoma secondary to direct eye contact
51
Q

Atrovent times

A

Onset 3-5 mins
Peak 1.5-2 hrs
Duration 6 hrs

52
Q

Ketamine presentation

A

200mg/2mL

53
Q

Ketamine pharmacology

A

Rapid acting dissociative anaesthetic agent (primarily an NMDA receptor antagonist)

54
Q

Ketamine actions

A

Produces a dissociative state characterised by:

  • trace-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
55
Q

Ketamine metabolism

A

Metabolised by the liver, excreted by the kidneys

56
Q

Ketamine indications (4)

A
  1. RSI
  2. Extreme traumatic pain refractory to opioid analgesia
  3. Extreme agitation
  4. CPR interfering patient
57
Q

Ketamine contraindications (2)

A
  1. Hypersensitivity

2. Severe hypertension (SBP >180)

58
Q

Ketamine precautions (2)

A
  1. Any condition where significant elevation of BP would be hazardous
    - hypertension
    - CVA
    - recent AMI
    - CCF
  2. For analgesia, object over 1 minute to minimise respiratory depression and hypertension
59
Q

Ketamine side effects

A 
CVS: hypertension, tachycardia
CNS:
- respiratory depression, apnoea
- emergence reactions
- enhanced skeletal tone
- nausea, vomiting
Ocular: diplopia and nystagmus with slight increase in intraocular pressure
Other:
- local pain at injection site
- lacrimation 
- salivation
60
Q

Ketamine special notes

A

Emergence reactions may be managed with midazolam

61
Q

Ketamine IV times

A

Onset 30 secs

Duration 10 mins

62
Q

Ketamine IM times

A

Onset 3-4 mins

Duration 12-25 mins

CPGs Cass (16 decks)

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