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Ambulance Victoria - GAP 1 > Drug Sheets > Flashcards

Drug Sheets Flashcards

1
Q

Side effects of Dexamethasone

A

Nil

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2
Q

How long do we give in administering IV ceftriaxone

A

Slow push over 2 mins

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3
Q

How is morphine metabolised

A

By the liver, excreted by the kidney

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4
Q

how is Ipratropium bromide metabolised

A

excreted by kidneys

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5
Q

What is the onset peak and duration of fentanyl

A

IV:
onset - immediate
peak - <5 mins
duration - 30-60mins

IN
peak - 2mins

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6
Q

Contras of ketamine

A

suspected non-traumatic head injury with severe hypertension (over 180SBP)

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7
Q

side effects of Ipratropium bromide

A
  • headache
  • nausea
  • dry mouth
  • skin rash
  • tachycardia (rare)
  • palpitations (rare)
  • acute angle-closure glaucoma
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8
Q

What is the presentation of Aspirin

A

300mg chewable tablet

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9
Q

Presentation of Ipratropium bromide

A

250mch in 1 ml nebule

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10
Q

Indications of ketamine

A
  • Intubation
  • Analgesia
  • Sedation (agitation/Pt movement during CPR)
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11
Q

Side effects of dextrose

A

Nil

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12
Q

how is fentanyl metabolised?

A

By the liver, excreted by kidneys

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13
Q

Contras of morphine

A
  1. hypersensitivity
  2. renal impairment/failure
  3. Late second stage of labour
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14
Q

special notes for heparin

A
  • do not inject IM due to risk of haematoma

- Plasma half life of heparin is 60 mins, so pt will also require repeat dose if time to PCI >1 hour

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15
Q

What is the presentation of GTN

A

300mcg or 600mcg tab

50mg transdermal patch

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16
Q

How is methoxy metabolised

A

by lungs, excreted by liver

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17
Q

Side effects of GTN

A
  • tachycardia
  • hypotension
  • headache
  • skin flushing (uncommon)
  • Bradycardia (occasionally)
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18
Q

precautions for glucagon

A

nil

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19
Q

Presentation of midazolam

A

5mg in 1mL

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20
Q

WHat is the pharmacology of midazolam

A

Short acting CNS depressant

Actions:

  • Anxiolytic
  • Sedative
  • Anti-convulsant
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21
Q

What is the pharmacology of Morphine

A

Opioid analgesic

CNS effects:

  • Depression (leading to analgesia)
  • Respiratory depression
  • Depression of cough reflex
  • Stimulation
  • Dependence

CV effects:

  • Vasodilation
  • Decreased conduction velocity through the A-V node
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22
Q

Contras of midaz

A

hypersensitivity to benzodiazapines

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23
Q

Precautions of dextrose

A

Nil

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24
Q

Precautions for dexamethasone

A

Solutions which are not clear or are contaminated should be discarded

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25
Q

What are the side effects of Adrenaline

A
  • sinus tach
  • supraventricular arrhythmias
  • Ventricular arrhythmias
  • Hypertension
  • Pupillary dilation
  • May increase size of MI
  • Feelings of anxiety/palpitations in conscious pt
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26
Q

indications for Ipratropium bromide

A
  1. Severe respiratory distress associated with bronchospasm

2. Exacerbation of COPD

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27
Q

What is sometimes seen in the veins with IV morphone release

A

Occassional wheals. Not an allergic reaction, just a histamine release

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28
Q

what is the pharmacology of dextrose 10%

A

hypertonic crystalloid solution which provides the body with a source of energy and supplier body water

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29
Q

What are the side effects of aspirin

A
  • Heartburn, nausea, gastrointestinal bleeding
  • Increased bleeding time
  • Hypersensitivity reactions
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30
Q

precautions of midaz

A
  1. reduced doses for elderly/frail, pts with chronic renal failure, CCF or shock
  2. CNS depressant effects are enhanced in the presence of narcotics and tranquilisers including alcohol
  3. Can cause severe resp depression in pt’s with COPD
  4. Pts with myasthenia gravis
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31
Q

What is the presentation of Glucagon

A

1mg IU in 1 mL hypokit

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32
Q

What are the contras for aspirin

A
  1. Hypersensitivity to aspirin / salicylates
  2. Actively bleeding peptic ulcers
  3. Bleeding disorders
  4. Suspected dissecting aortic aneurysm
  5. Chest pain associated with psychostimulant OD
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33
Q

How is midaz metabolised

A

in the liver, excreted by the kidneys

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34
Q

Presentation of heparin?

A

5000 IU in 5ml plastic ampoule

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35
Q

What are the precautions of aspirin

A
  1. peptic ulcer
  2. asthma
  3. Pts on anticoagulants
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36
Q

What are the precautions for ceftriaxone

A

Allergy to penicillin antibiotics

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37
Q

contras for glucagon

A

nil

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38
Q

Precautions for GTN

A
  1. no previous administration
  2. Elderly
  3. Recent MI
  4. Concurrent use with other tocolytics
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39
Q

What are the precautions of adrenaline?

A
  1. Elderly/frail
  2. Pts with cardiovascular disease
  3. Pts on Monoamine oxidase inhibitors
  4. Higher doses may be required for pts on beta blockers
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40
Q

Side effects of morphine

A

CNS effects:

  • Drowsiness
  • Resp depression
  • Euphoria
  • Nausea, Vomitting
  • Addiction
  • Pin-point pupils

Cardiovascular effects:

  • Hypotension
  • Bradycardia
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41
Q

What is the indication of Aspirin

A

ACS

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42
Q

How is Adrenaline metabolised

A

By Monoamine oxidise and other enzymes in the blood, liver and nerve endings. Secreted by kidneys

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43
Q

Contras of methoxy

A
  1. renal impairement/disease
  2. concurrent use of tetracycline antibiotics
  3. exceeding 6ml in a 24 hour period
  4. Personal or family Hx of malignant hyperthermia
  5. Muscular distrophy
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44
Q

Contras for Ipratropium bromide

A

hypersensitivity to atropine and its derivatives

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45
Q

What are the side effects of ceftriaxone

A

nausea
vomiting
skin rash

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46
Q

what is the pharmacology of fentanyl

A

Synthetic opioid analgesic:

CNS effects:

  • depression
  • resp depression
  • addiction

Cardiovascular effects:
- Decreased conduction velocity through AV node

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47
Q

What is the presentation of dexamethasone

A

8mg in 2 ml glass vial

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48
Q

What is the pharmacology of Aspirin

A

Analgesic, Antipyretic, anti-inflam, antiplatelet aggregation agent

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49
Q

What is the presentation of fentanyl

A

100mcg in 2ml

250mcg in 1ml Cartridge

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50
Q

side effects of heparin

A
  • bleeding
  • bruising and pain at the injection site
  • hyperkalaemia
  • thrombocytopaenia
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51
Q

What is the presentation of dextrose 10%

A

25g in 250ml infusion soft pack

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52
Q

Indications for Midaz?

A
  1. Status epileptics
  2. Sedations to maintain intubation
  3. sedation to facilitate intrubation
  4. Sedation to facilitate synchronised cardioversion
  5. Sedation to facilitate transthoracic pacing
  6. sedation in the agitated pt
  7. Sedation in psychostimulant OD
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53
Q

Presentation of ceftriaxone

A

1g sterile powder in glass vial

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54
Q

What is the pharmacology of dexamethasone

A

a corticosteroid that:

  • relieves inflammatory reactions
  • provides immunosuppression
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55
Q

How is glucagon metabolised?

A

by the liver, kidneys and in plasma

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56
Q

Precautions of lignocaine?

A

IM and local infiltration - Inadvertent IV admin may result in system toxicity

IO - impaired CV function

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57
Q

Indications for morphine

A
  1. Pain relief
  2. Sedation to maintain intubation
  3. Sedation facilitate intubation
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58
Q

Rout of admin for dexamethasone

A

IV (over 1-3 mins)

Oral

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59
Q

How is dextrose metabolised?

A

Broken down in most tissues

Stored in the liver and muscle as glycogen

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60
Q

Contras for heparin

A
  1. Known allergy or hypersensitivity
  2. Active bleeding (excluding menses)
  3. oral anticoaglants
  4. bleeding disorders
  5. Hx of heparin-induced thrombocytopaenia
  6. Severe hepatic impairment/disease including oesophageal varices
  7. Recent trauma or surgery (<3 weeks)
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61
Q

How is aspirin metabolised?

A

Converted by salicylate in the gut mucosa and liver

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62
Q

indications for glucagon

A
  1. diabetic hypoglycaemia (BGL<4) in pts with an altered conscious state who are unable to administer oral glucose
  2. anaphylaxis (adlts) where a pt remains hypotensive following adrenaline therapy with past hx of heart failure or pts taking beta blockers
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63
Q

Precautions of fentanyl

A
  1. eldery/frail
  2. impaired hepatic function
  3. resp depression eg. COPD
  4. Current asthma
  5. Pts on MAOIs
  6. Known addiction to opioids
  7. Rhinitis, rhinorrhea, facial trauma
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64
Q

Precautions of methoxy

A
  1. Must be hand held by the pt. occasionally may need assistance bt continious assessment required.
  2. pre-eclampsia
  3. concurrent use with oxytocin may cause hypotension
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65
Q

What is the pharmacology of adrenaline

A

A naturally occurring alpha and beta-adrenergic stimulant:

  • Increases HR by SA node firing rate
  • Increases conduction velocity through AV node
  • Increases myocardial contractility
  • Causes bronchodilation
  • Causes peripheral vasoconstriction
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66
Q

What are the storage notes for GTN

A
  1. GTN is sucessiptable to hear.
  2. DO not use pts GTN as it may not be stored properly
  3. Discard patches prior to use by date
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67
Q

Is ketamine safe for pregnant pt’s?

A

Considered safe to use.

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68
Q

side effects of fentanyl

A
  • resp depression
  • apnoea
  • rigidity of the diaphragm and intercostals
  • bradycardia
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69
Q

Presentation of Lignocaine

A

50mg in 5mL ampule

70
Q

Contras for GTN

A
  1. hypersensitivity
  2. SBP <110 for tablet
  3. SBP <90 patch
  4. Viagra/Lavitra in 24 hours
  5. Cialis in 4 days
  6. HR <50 (excluding autonomic dysreflexia) or >150
  7. VT
  8. Inferior STEMI w/ SBP <160
  9. RVMI
71
Q

contras of fentanyl

A
  1. hypersensitvity

2. late 2nd stage labour

72
Q

Can lignocaine be used with pregnant or breast feeding pts?

A

yes

73
Q

What are the contraindications of adrenaline

A

Hypovolaemic shock without adequate fluid replacement

74
Q

precautions for heparin

A

renal impairment

75
Q

contras for dexamethasone

A

Hypersensitivity

76
Q

Indications of GTN

A
  1. Chest pain with ACS
  2. Acute LVF
  3. Hypertension associated with ACS
  4. Autonomic dysreflexia
  5. Preterm labour (consult)
77
Q

How is heparin metabolised

A

by the liver, excreted by the kidneys

78
Q

side effects of midaz

A
  • depressed level of consciousness
  • Respiratory depression
  • Loss of airway control
  • Hypotension
79
Q

What is the pharmacology of ceftriaxone

A

cephalosporin antibiotic

80
Q

what is the pharmacology of glucagon?

A

naturally occuring hormone secreted by the pancrease.

Increases blood glucose by converting stored liver glycogen to glucose

81
Q

WHat is the mode of action for ketamine

A

Anaesthetic agent with analgesic properties.

Creates dissociative effect while preserving laryngeal and pharyngeal reflexes

82
Q

What is the pharmacology of heparin

A

Anticoagulant. Inactivates clotting factors

83
Q

What are the indications for adrenaline?

A
  • Cardiac Arrest (VF/VT, Asystole or PEA)
  • Inadequate perfusions (cardiogenic or non-cardiogenic/non-hypovolaemic - MICA)
  • Bradycardia with poor perfusion (MICA)
  • Anaphylaxis
  • Severe Asthma
  • Croup
84
Q

side effects of glucagon

A

nausea

vomitting

85
Q

mode of action of lignocaine

A

sodium channel blocker - interrupts impulses conduction in peripheral nerves

86
Q

indications for lignocaine

A

local anaesthetic to reduce pain of:

- IM admin of ceftriaxone

87
Q

Indications for heparin

A

Acute STEMI

88
Q

Why is muscular distrophy a contra for methoxy

A

with muscular dystrophy, volatile agents may precipitate life-threatening rhabdomyolisis

89
Q

Presentation of methoxyflurance

A

3ml Glass bottle

90
Q

what are signs of lignocaine toxicity?

A

CNS:
- tinnitus, blurred vision, changes to GCS, agitation, convulsions

CV:
- Hypotension, bradycardia, arrythmias, cardiac arrest

91
Q

Presentation of morphine

A

10mg in 1ml glass ampoule

92
Q

Special notes for Ipratropium bromide

A
  • nebuliser mask must be properly fitted to avoid direct eye contact with Ipratropium bromide
  • must be nebulised with salbutamol
93
Q

how is GTN metabolised

A

by the liver

94
Q

What are the contras for dextrose?

A

Nil

95
Q

precautions for Ipratropium bromide

A
  1. glaucoma

2. avoid contact with eyes

96
Q

What is the special notes for aspirin?

A

Aspirin is C/I for use in acute febrile illness in children and adolescents

97
Q

What is the indication for dextrose

A

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

98
Q

What are the contras for ceftriaxone

A

Allergy to cephalosporin antibiotics

99
Q

Precautions of morphine

A
  1. elderly/frail
  2. hypotension
  3. respiratory depression
  4. current asthma
  5. respiratory tract burns
  6. Known addiction to opioids
  7. Acute alcoholism
  8. Patients on monoamine oxidaise inhibitors
100
Q

Contras for lignocaine?

A

hypersensitivity to lignocaine or related local anaesthetics

101
Q

What is the pharmacology of GTN

A

a vascular smooth muscle relaxant

Actions:
- venous dilatation promotes venous pooling and reduces venous return to the heart (REDUCES PRELOAD)

  • arterial dilatation reduces systematic vascular resistance and arterial pressure (REDUCES AFTERLOAD)

which causes:

  • reduces myocardial O2 demand
  • reduced systolic, diastolic and MAP while maintaining coronary perfusion pressure
  • Coronary arterial dilation may improve blood flow to ischaemic areas of myocardium
  • Mild tachycardia due to lowering bp
102
Q

Precautions of ketamine

A

May exacerbate cardiovascular conditions due to its effects on HR and BP

103
Q

indications for dexamethasone

A
  1. Bronchospasm associated with acute respiratory distress not responsive to nebulised salbutamol
  2. moderate - severe croup
  3. Acute exacerbation of COPD
  4. Adult stridor (non foreign-body obstruction)
104
Q

What is the presentation of ketamine

A

200mg in 2mL

105
Q

indications for methoxy

A

pain relief

106
Q

pharmacology of Ipratropium bromide

A

anticholinergic bronchodilator

107
Q

What else needs to be considered with glucagon (special notes)

A

nit all pts will respond well especially those with inadequate glycogen stores (alcoholics, malnourished)

108
Q

Side effects of ketamine

A

Cardiovascular:

  • HTN
  • Tachycardia

Central nervous system:

  • emergence reactions
  • increased skeletal muscle tone

Respiratory:
- transient resp depression and apnoea

GI:

  • nausea
  • vomiting

Other:

  • injection site pain
  • lacrimation
  • hypersalivation
  • diplopia
  • nystagmus
109
Q

What is the presentation of Adrenaline

A

1mg in 1ml

110
Q

Indications for fentanyl?

A
  1. Sedation to facilitate Intubation
  2. Sedation to maintain intubation
  3. Sedation to facilitate transthoracic pacing
  4. Sedation to facilitate synchronised cardioversion
  5. CPR interfering patient
  6. Analgesia in the setting of:
    - Hx of hypersensitivity to morphine
    - Known renal impairment
    - SHort duration of action is desirable
    - Hypotension
    - Nausea/vo,iting
    - Severe headache
111
Q

Side effects of methoxy

A
  • drowsiness
  • decrease in BP and bradycardia (rare)
  • Exceeding max dose can cause renal toxicity
112
Q

Pharmacology of methoxyflurane

A

inhalational analgesic agent

113
Q

Presentation of Naloxone

A

400mcg in 1 ml glass amooule

114
Q

Pharmacology of naloxone

A

opioid antagonist

115
Q

where is naloxone metabolised?

A

in the liver

116
Q

indications of naloxone

A

altered conscious state and in respiratory distress secondary to administration of opioids or related drugs

117
Q

contras for naloxone

A

nil

118
Q

Precautions of naloxone

A
  1. If pt is known to be dependent on opioids, prepare for combative pt after administration
  2. neonates
119
Q

side effects of naloxone?

A

symptoms of opioid withdrawal:

  • sweating, goosebumps, tremor
  • nausea and vomiting
  • agitation
  • dilated pupils
  • excessive lacrimation
  • convulsions
120
Q

When should naloxone not be administered?

A
  • following opioid associated cardiac arrest

- following head injury

121
Q

presentation of olanzapine

A

5mg Oral tablet

122
Q

Mode of action of olazapine

A

atypical antipsychotic - antagonist at receptor sites serotonin, dopamine and histamine.

123
Q

Indications of olanzapine

A

Mild agitation

124
Q

Contras of olanzapine?

A

Nil

125
Q

Precautions of Olanzapine

A
  1. may be less effective if pt agitation is due to drug intoxication or alcohol withdrawal
  2. elderly/frail
126
Q

Side effects of olanzapine

A

CNS: sedation, dizziness
Other: Extrapyramidal symptoms and QT prolongation

127
Q

Significant interactions related to olanzapine?

A

sedative medications/alcohol. Results in over sedation

128
Q

Is olaznapine safe to use with pregnant pts and breastfeeding pts

A

limited evidence for pregnancy, only use when benefit outweighs risk

safe for breastfeeding pts

129
Q

When can olanzapine be given to pts under 16

A

only after consultation with the receiving hospital

130
Q

WHat should be considered when administering olanzapine?

A

Pt should self administer under paramedic supervision

131
Q

presentation of ondansetron

A

4mg oral dissolving tablet

8mg in 4ml ampoule

132
Q

Mode of action for ondansetron

A

anti-emetic

- 5HT3 (serotonin) antagonist blocking receptors centrally and peripherally

133
Q

How is ondans metabolised

A

by the liver

134
Q

Indications for Ondansetron

A
  1. Undifferentiated nausea and vomiting
  2. Prophylaxis for spinally immobilised or eye injured patients
  3. Vestibular nausea in patients <21 YO
135
Q

Contras for ondansetron

A
  1. Known hypersensitvity
  2. concurrent apomorphine use
  3. Long QT syndrome
  4. Hypokalaemia or hypomagnasaemia
136
Q

Precautions for ondansetron

A
  1. Pts with liver disease should not receive more than 8mg per day
  2. Care should be taken with pts on diuretics who may have underlying electrolyte imbalance
  3. ondans contains aspartame and should not be given to pts with phenylketonuria
  4. concurrent use of tramadol
  5. pregnancy
137
Q

Side effects of ondans

A

Rare:

  • hypersensitivity reactions
  • QT prolongation
  • Widened QRS
  • Tachyarrythmias
  • Seizures
  • Extrapyramidal reactions
  • Visual disturbances

Common:

  • Constipation
  • Headache
  • Fever
  • Dizziness
  • Rise in liver enzymes
138
Q

Presentation of Oxytocin

A

10 units (IU) in 1 mL glass ampoule

139
Q

WHat is the mode of action of oxytocin

A

A synthetic oxytocic

- Stimulates smooth muscle of the uterus producing contraction

140
Q

How is oxytocin metabolised

A

By the liver, excreted by the kidneys

141
Q

What are the indications for oxytocin

A

Primary Postpartum Haemorrhage

142
Q

COntras for oxytocin

A
  1. hypersensitivity
  2. Severe toxaemia (pre-eclampsia)
  3. Exclude multiple pregnancy before drug administration
  4. Cord prolapse
143
Q

Precautions of oxytocin

A
  1. If given by IV may cause transient Hypotension

2. Concurrent use with methoxyflurane may cause hypotension

144
Q

Side effects of oxytocin

A

Tachycardia
Bradycardia
Nausea

145
Q

Presentation of paracetamol

A

500mg tablets

120mg in 5ml oral liquid

146
Q

What is the mode of action of paracetamol

A

An analgesic and antipyretic agent

147
Q

How is paracetamol metabolised

A

by the liver, excreted by kidneys

148
Q

Indications for paracetamol

A
  1. Mild pain

2. Headache

149
Q

Contraindications for paracetamol

A
  1. hypersensitivity
  2. Children <1month
  3. Paracetamol administed in last 4 hours
  4. Total paracetamol in past 24 hours exceeding 4g (adults and 60mg.kg (children)
  5. Chest pain associated with suspected ACS
150
Q

Precautions of paracetamol

A
  1. Impaired hepatic function or liver disease
  2. elderly/frail
  3. malnourished
151
Q

Presentation of salbutamol

A

5mg in 2.5ml polyamp

pmdi (100mcg per actuation)

152
Q

what is the pharmacology of salbutamol

A

a synthetic beta adrenergic stimulant with primary beta 2 effects

153
Q

How is salbutamol metabolised

A

by the liver, excreted by the kidneys

154
Q

Indications of salbutamol

A
  1. Respiratory distress with suspected bronchospasm:
  • asthma
  • severe allergic reactions
  • COPD
  • smoke inhalation
  • oleoresin capsicum spray exposure
155
Q

Contras of salbutamol

A

nil

156
Q

Precautions of salbutamol

A

Large doses have been reported to cause intracellular metabolic acidosis.

157
Q

Side effects of salbutamol

A
  • Sinus tachycardia

- Muscle tremor

158
Q

what is the shelf life of salbutamol nebules once wrapping is opened?

A

1-month shelf life after wrapping is opened. date of the opening should be recorded on packaging

159
Q

Presentation of tenecteplase

A

50mg in glass vial

160
Q

WHat is the pharmacology of tenecteplase

A

fibrinolytic

161
Q

how is tenecteplase metabolised

A

by the liver

162
Q

what is the indications for tenecteplase

A

Acute STEMI

163
Q

Presentation of prochlorperazine

A

12.5mg in 1 mL

164
Q

Pharmacology of prochlorperazine

A

An anti-emetic

165
Q

How is prochlorperazine metabolised

A

by liver, excreted by kidneys

166
Q

Indications for prochlorperazine

A
  1. Treatment of prophylaxis of nausea/vomitting for:
  • motion sickness
  • planned aeromedical evacuation
  • Known allergy or C/I to ondans
  • Headache irrespective of nausea/vomiting
  • Vertigo
167
Q

Contras for prochlorperazine

A
  1. Circulatory collapse
  2. CNS depression
  3. Hypersensitivity
  4. Pts <21
  5. Pregnancy
168
Q

Precautions of Prochlorperazine

A
  1. Hypotesion
  2. Epilepsy
  3. Pts affected by alcohol or anti-depressants
169
Q

Side effects of prochlorperazine

A
  • drowsiness
  • blurred vision
  • hypotension
  • sinus tach
  • skin rash
  • extrapyramidal reactions
170
Q

Indications of Normal saline

A
  1. fluid replacement in volume-depleted patients
  2. Cardiac arrest secondary to hypovolaemia or where pt may be fluid responsive
  3. to expand intravascular volume in non-cardiogenic, non-hypovolaemic hypotensive pt (anaphylaxis, sepsis, burns)
  4. As a fluid challenge in unresponsive, non-hypovolaemic, hypotensive patients (other than LVF) eg. asthma
  5. Fluid for diluting and administering IV drugs
  6. Fluid TKVO for IV admin of emergency drugs

Ambulance Victoria - GAP 1 (8 decks)

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