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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
GTN actions
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
What are the benefits of GTN actions?
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
GTN metabolism
In the liver
28
GTN indications (5)
1. Chest pain with ACS 2. Acute LVF 3. Hypertension associated with ACS 4. Autonomic dysreflexia 5. Preterm labour
29
GTN contraindications (9)
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
GTN precautions (4)
Elderly pts No previous administration Recent MI Concurrent use with other tocolytics
31
GTN side effects
``` Tachycardia Hypotension Headache Skin flushing Bradycardia ```
32
GTN S/L times
Onset 30 sec to 2 mins Peak 5-10 mins Duration 15-30 mins
33
GTN patch times
Onset up to 30 mins | Peak 2 hrs
34
Heparin presentation
5000 units/5mL
35
Heparin pharmacology
Anticoagulant
36
Heparin action
Inactivates clotting factors IIa (thrombin) and Xa by bonding to antithrombin III
37
Heparin metabolism
Metabolised by the liver | Excreted by the kidneys
38
Heparin indication
Acute STEMI
39
Heparin contraindications (7)
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
Heparin precautions
Renal impairment
41
Heparin side effects
Bleeding Bruising and pain at injection site Hyperkalaemia Thrombocytopenia
42
Heparin special notes
Don’t inject IM due to risk of causing haemorrhage
43
Heparin times
Onset immediate | Duration 3-6 hours
44
Atrovent presentation
250mcg/1mL
45
Atrovent pharmacology
Anticholinergic bronchodilator
46
Atrovent actions
Allows bronchodilation by inhibiting cholinergic bronchomotor tone Blocks vagal reflexes which mediate bronchoconstriction
47
Atrovent indications (2)
1. Severe respiratory distress associated with bronchospasm | 2. Exacerbation of COPD
48
Atrovent contraindications
1. Hypersensitivity to atropine or any of its derivatives
49
Atrovent precautions (2)
1. Glaucoma | 2. Avoid contact with eyes
50
Atrovent side effects
``` Headache Nausea Dry mouth Skin rash Tachycardia Palpitations Acute angle closure glaucoma secondary to direct eye contact ```
51
Atrovent times
Onset 3-5 mins Peak 1.5-2 hrs Duration 6 hrs
52
Ketamine presentation
200mg/2mL
53
Ketamine pharmacology
Rapid acting dissociative anaesthetic agent (primarily an NMDA receptor antagonist)
54
Ketamine actions
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
Ketamine metabolism
Metabolised by the liver, excreted by the kidneys
56
Ketamine indications (4)
1. RSI 2. Extreme traumatic pain refractory to opioid analgesia 3. Extreme agitation 4. CPR interfering patient
57
Ketamine contraindications (2)
1. Hypersensitivity | 2. Severe hypertension (SBP >180)
58
Ketamine precautions (2)
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
Ketamine side effects
``` 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
Ketamine special notes
Emergence reactions may be managed with midazolam
61
Ketamine IV times
Onset 30 secs | Duration 10 mins
62
Ketamine IM times
Onset 3-4 mins | Duration 12-25 mins

CPGs Cass (16 decks)

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