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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
What are the side effects of Adrenaline
- sinus tach - supraventricular arrhythmias - Ventricular arrhythmias - Hypertension - Pupillary dilation - May increase size of MI - Feelings of anxiety/palpitations in conscious pt
26
indications for Ipratropium bromide
1. Severe respiratory distress associated with bronchospasm | 2. Exacerbation of COPD
27
What is sometimes seen in the veins with IV morphone release
Occassional wheals. Not an allergic reaction, just a histamine release
28
what is the pharmacology of dextrose 10%
hypertonic crystalloid solution which provides the body with a source of energy and supplier body water
29
What are the side effects of aspirin
- Heartburn, nausea, gastrointestinal bleeding - Increased bleeding time - Hypersensitivity reactions
30
precautions of midaz
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
31
What is the presentation of Glucagon
1mg IU in 1 mL hypokit
32
What are the contras for aspirin
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
33
How is midaz metabolised
in the liver, excreted by the kidneys
34
Presentation of heparin?
5000 IU in 5ml plastic ampoule
35
What are the precautions of aspirin
1. peptic ulcer 2. asthma 3. Pts on anticoagulants
36
What are the precautions for ceftriaxone
Allergy to penicillin antibiotics
37
contras for glucagon
nil
38
Precautions for GTN
1. no previous administration 2. Elderly 3. Recent MI 4. Concurrent use with other tocolytics
39
What are the precautions of adrenaline?
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
40
Side effects of morphine
CNS effects: - Drowsiness - Resp depression - Euphoria - Nausea, Vomitting - Addiction - Pin-point pupils Cardiovascular effects: - Hypotension - Bradycardia
41
What is the indication of Aspirin
ACS
42
How is Adrenaline metabolised
By Monoamine oxidise and other enzymes in the blood, liver and nerve endings. Secreted by kidneys
43
Contras of methoxy
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
44
Contras for Ipratropium bromide
hypersensitivity to atropine and its derivatives
45
What are the side effects of ceftriaxone
nausea vomiting skin rash
46
what is the pharmacology of fentanyl
Synthetic opioid analgesic: CNS effects: - depression - resp depression - addiction Cardiovascular effects: - Decreased conduction velocity through AV node
47
What is the presentation of dexamethasone
8mg in 2 ml glass vial
48
What is the pharmacology of Aspirin
Analgesic, Antipyretic, anti-inflam, antiplatelet aggregation agent
49
What is the presentation of fentanyl
100mcg in 2ml | 250mcg in 1ml Cartridge
50
side effects of heparin
- bleeding - bruising and pain at the injection site - hyperkalaemia - thrombocytopaenia
51
What is the presentation of dextrose 10%
25g in 250ml infusion soft pack
52
Indications for Midaz?
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
53
Presentation of ceftriaxone
1g sterile powder in glass vial
54
What is the pharmacology of dexamethasone
a corticosteroid that: - relieves inflammatory reactions - provides immunosuppression
55
How is glucagon metabolised?
by the liver, kidneys and in plasma
56
Precautions of lignocaine?
IM and local infiltration - Inadvertent IV admin may result in system toxicity IO - impaired CV function
57
Indications for morphine
1. Pain relief 2. Sedation to maintain intubation 3. Sedation facilitate intubation
58
Rout of admin for dexamethasone
IV (over 1-3 mins) | Oral
59
How is dextrose metabolised?
Broken down in most tissues | Stored in the liver and muscle as glycogen
60
Contras for heparin
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)
61
How is aspirin metabolised?
Converted by salicylate in the gut mucosa and liver
62
indications for glucagon
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
63
Precautions of fentanyl
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
64
Precautions of methoxy
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
65
What is the pharmacology of adrenaline
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
66
What are the storage notes for GTN
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
67
Is ketamine safe for pregnant pt's?
Considered safe to use.
68
side effects of fentanyl
- resp depression - apnoea - rigidity of the diaphragm and intercostals - bradycardia
69
Presentation of Lignocaine
50mg in 5mL ampule
70
Contras for GTN
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
contras of fentanyl
1. hypersensitvity | 2. late 2nd stage labour
72
Can lignocaine be used with pregnant or breast feeding pts?
yes
73
What are the contraindications of adrenaline
Hypovolaemic shock without adequate fluid replacement
74
precautions for heparin
renal impairment
75
contras for dexamethasone
Hypersensitivity
76
Indications of GTN
1. Chest pain with ACS 2. Acute LVF 3. Hypertension associated with ACS 4. Autonomic dysreflexia 5. Preterm labour (consult)
77
How is heparin metabolised
by the liver, excreted by the kidneys
78
side effects of midaz
- depressed level of consciousness - Respiratory depression - Loss of airway control - Hypotension
79
What is the pharmacology of ceftriaxone
cephalosporin antibiotic
80
what is the pharmacology of glucagon?
naturally occuring hormone secreted by the pancrease. Increases blood glucose by converting stored liver glycogen to glucose
81
WHat is the mode of action for ketamine
Anaesthetic agent with analgesic properties. Creates dissociative effect while preserving laryngeal and pharyngeal reflexes
82
What is the pharmacology of heparin
Anticoagulant. Inactivates clotting factors
83
What are the indications for adrenaline?
- 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
side effects of glucagon
nausea | vomitting
85
mode of action of lignocaine
sodium channel blocker - interrupts impulses conduction in peripheral nerves
86
indications for lignocaine
local anaesthetic to reduce pain of: | - IM admin of ceftriaxone
87
Indications for heparin
Acute STEMI
88
Why is muscular distrophy a contra for methoxy
with muscular dystrophy, volatile agents may precipitate life-threatening rhabdomyolisis
89
Presentation of methoxyflurance
3ml Glass bottle
90
what are signs of lignocaine toxicity?
CNS: - tinnitus, blurred vision, changes to GCS, agitation, convulsions CV: - Hypotension, bradycardia, arrythmias, cardiac arrest
91
Presentation of morphine
10mg in 1ml glass ampoule
92
Special notes for Ipratropium bromide
- nebuliser mask must be properly fitted to avoid direct eye contact with Ipratropium bromide - must be nebulised with salbutamol
93
how is GTN metabolised
by the liver
94
What are the contras for dextrose?
Nil
95
precautions for Ipratropium bromide
1. glaucoma | 2. avoid contact with eyes
96
What is the special notes for aspirin?
Aspirin is C/I for use in acute febrile illness in children and adolescents
97
What is the indication for dextrose
diabetic hypoglycaemia (BGL <4mmoL) in pts with an altered conscious state who are unable to self administer oral glucose
98
What are the contras for ceftriaxone
Allergy to cephalosporin antibiotics
99
Precautions of morphine
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
Contras for lignocaine?
hypersensitivity to lignocaine or related local anaesthetics
101
What is the pharmacology of GTN
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
Precautions of ketamine
May exacerbate cardiovascular conditions due to its effects on HR and BP
103
indications for dexamethasone
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
What is the presentation of ketamine
200mg in 2mL
105
indications for methoxy
pain relief
106
pharmacology of Ipratropium bromide
anticholinergic bronchodilator
107
What else needs to be considered with glucagon (special notes)
nit all pts will respond well especially those with inadequate glycogen stores (alcoholics, malnourished)
108
Side effects of ketamine
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
What is the presentation of Adrenaline
1mg in 1ml
110
Indications for fentanyl?
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
Side effects of methoxy
- drowsiness - decrease in BP and bradycardia (rare) - Exceeding max dose can cause renal toxicity
112
Pharmacology of methoxyflurane
inhalational analgesic agent
113
Presentation of Naloxone
400mcg in 1 ml glass amooule
114
Pharmacology of naloxone
opioid antagonist
115
where is naloxone metabolised?
in the liver
116
indications of naloxone
altered conscious state and in respiratory distress secondary to administration of opioids or related drugs
117
contras for naloxone
nil
118
Precautions of naloxone
1. If pt is known to be dependent on opioids, prepare for combative pt after administration 2. neonates
119
side effects of naloxone?
symptoms of opioid withdrawal: - sweating, goosebumps, tremor - nausea and vomiting - agitation - dilated pupils - excessive lacrimation - convulsions
120
When should naloxone not be administered?
- following opioid associated cardiac arrest | - following head injury
121
presentation of olanzapine
5mg Oral tablet
122
Mode of action of olazapine
atypical antipsychotic - antagonist at receptor sites serotonin, dopamine and histamine.
123
Indications of olanzapine
Mild agitation
124
Contras of olanzapine?
Nil
125
Precautions of Olanzapine
1. may be less effective if pt agitation is due to drug intoxication or alcohol withdrawal 2. elderly/frail
126
Side effects of olanzapine
CNS: sedation, dizziness Other: Extrapyramidal symptoms and QT prolongation
127
Significant interactions related to olanzapine?
sedative medications/alcohol. Results in over sedation
128
Is olaznapine safe to use with pregnant pts and breastfeeding pts
limited evidence for pregnancy, only use when benefit outweighs risk safe for breastfeeding pts
129
When can olanzapine be given to pts under 16
only after consultation with the receiving hospital
130
WHat should be considered when administering olanzapine?
Pt should self administer under paramedic supervision
131
presentation of ondansetron
4mg oral dissolving tablet | 8mg in 4ml ampoule
132
Mode of action for ondansetron
anti-emetic | - 5HT3 (serotonin) antagonist blocking receptors centrally and peripherally
133
How is ondans metabolised
by the liver
134
Indications for Ondansetron
1. Undifferentiated nausea and vomiting 2. Prophylaxis for spinally immobilised or eye injured patients 3. Vestibular nausea in patients <21 YO
135
Contras for ondansetron
1. Known hypersensitvity 2. concurrent apomorphine use 3. Long QT syndrome 4. Hypokalaemia or hypomagnasaemia
136
Precautions for ondansetron
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
Side effects of ondans
Rare: - hypersensitivity reactions - QT prolongation - Widened QRS - Tachyarrythmias - Seizures - Extrapyramidal reactions - Visual disturbances Common: - Constipation - Headache - Fever - Dizziness - Rise in liver enzymes
138
Presentation of Oxytocin
10 units (IU) in 1 mL glass ampoule
139
WHat is the mode of action of oxytocin
A synthetic oxytocic | - Stimulates smooth muscle of the uterus producing contraction
140
How is oxytocin metabolised
By the liver, excreted by the kidneys
141
What are the indications for oxytocin
Primary Postpartum Haemorrhage
142
COntras for oxytocin
1. hypersensitivity 2. Severe toxaemia (pre-eclampsia) 3. Exclude multiple pregnancy before drug administration 4. Cord prolapse
143
Precautions of oxytocin
1. If given by IV may cause transient Hypotension | 2. Concurrent use with methoxyflurane may cause hypotension
144
Side effects of oxytocin
Tachycardia Bradycardia Nausea
145
Presentation of paracetamol
500mg tablets | 120mg in 5ml oral liquid
146
What is the mode of action of paracetamol
An analgesic and antipyretic agent
147
How is paracetamol metabolised
by the liver, excreted by kidneys
148
Indications for paracetamol
1. Mild pain | 2. Headache
149
Contraindications for paracetamol
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
Precautions of paracetamol
1. Impaired hepatic function or liver disease 2. elderly/frail 3. malnourished
151
Presentation of salbutamol
5mg in 2.5ml polyamp | pmdi (100mcg per actuation)
152
what is the pharmacology of salbutamol
a synthetic beta adrenergic stimulant with primary beta 2 effects
153
How is salbutamol metabolised
by the liver, excreted by the kidneys
154
Indications of salbutamol
1. Respiratory distress with suspected bronchospasm: - asthma - severe allergic reactions - COPD - smoke inhalation - oleoresin capsicum spray exposure
155
Contras of salbutamol
nil
156
Precautions of salbutamol
Large doses have been reported to cause intracellular metabolic acidosis.
157
Side effects of salbutamol
- Sinus tachycardia | - Muscle tremor
158
what is the shelf life of salbutamol nebules once wrapping is opened?
1-month shelf life after wrapping is opened. date of the opening should be recorded on packaging
159
Presentation of tenecteplase
50mg in glass vial
160
WHat is the pharmacology of tenecteplase
fibrinolytic
161
how is tenecteplase metabolised
by the liver
162
what is the indications for tenecteplase
Acute STEMI
163
Presentation of prochlorperazine
12.5mg in 1 mL
164
Pharmacology of prochlorperazine
An anti-emetic
165
How is prochlorperazine metabolised
by liver, excreted by kidneys
166
Indications for prochlorperazine
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
Contras for prochlorperazine
1. Circulatory collapse 2. CNS depression 3. Hypersensitivity 4. Pts <21 5. Pregnancy
168
Precautions of Prochlorperazine
1. Hypotesion 2. Epilepsy 3. Pts affected by alcohol or anti-depressants
169
Side effects of prochlorperazine
- drowsiness - blurred vision - hypotension - sinus tach - skin rash - extrapyramidal reactions
170
Indications of Normal saline
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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