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Drug Sheets Flashcards

1
Q

Fentanyl pharmacology

A 
A synthetic opioid analgesic
CNS effects 
 -depression leading to analgesia
 -respiratory depression
 -dependence (addiction)
Cardiovascular effects
 -decreases conduction velocity through the AV node
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2
Q

Fentanyl - primary indications

A
  1. Sedation the facilitate intubation
  2. Sedation to maintain intubation
  3. Analgesia - IV/IN
    - history of hypersensitivity
    - known renal impairment/failure
    - short duration of action desirable
    - hypotension
    - nausea and/or vomiting
    - severe headache
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3
Q

Fentanyl - contraindications

A
  1. History of hypersensitivity

2. Late second stage of labour

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4
Q

Fentanyl - precautions

A
  1. Elderly/frail pts
  2. Impaired hepatic functions
  3. Respiratory depression. Eg COPD
  4. Current asthma
  5. Patients on monoamine oxidase inhibitors
  6. Known addiction to opioids
  7. Rhinitis, rhinorrhea or facial trauma (IN)
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5
Q

Fentanyl - side effects

A
  • Respiratory depression
  • Apnoea
  • Rigidity of the diaphragm & intercostal muscles
  • Bradycardia
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6
Q

Fentanyl action times

A 
IV 
Onset: immediate 
Peak: <5min 
Duration: 30-60 minutes
IN 
Peak: 2 minutes
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7
Q

GTN pharmacology

A

Principally a vascular smooth muscle relaxant
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)
The effects of the above are:
- reduced myocardial O2 demand
- reduced systolic, diastolic and mean arterial blood pressure, whilst usually maintaining coronary perfusion pressure
- mild collateral coronary arterial dilatation may improve blood supply to ischaemic areas of myocardium
-mil tachycardia secondary to slight fall in blood pressure
-preterm labour: uterine quiescence in pregnancy

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8
Q

GTN indications

A
  1. chest pain with ACS
  2. acute LVF
  3. hypertension associated with ACS
  4. autonomic dysreflexia
  5. preterm labour (consult)
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9
Q

GTN contraindications

A
  1. known hypersensitivity
  2. systolic BP <110 tablet
  3. systolic BP <90 patch
  4. viagra levitra <24 hours, cialis <4days (PDE5 inhibitors)
  5. heart rate >150
  6. bradycardia <50 (excluding autonomic dysreflexia)
  7. VT
  8. inferior STEMI with BP <160
  9. Right ventricular MI
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10
Q

GTN precautions

A
  1. no previous administration
  2. elderly patients
  3. recent MI
  4. concurrent use with other tocolytics
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11
Q

GTN side effects

A 
tachycardia 
hypotension
headache 
skin flushing (uncommon)
bradycardia (occasionally)
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12
Q

GTN action times

A 
S/L
onset: 30 seconds-2 minutes 
peak: 5-10 minutes
duration: 15-30 minutes 
Patch
onset: up to 30 minutes
peak: 2 hours
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13
Q

Aspirin pharmacology

A

An analgesic, antipyretic, anti-inflammatory and antiplatelet aggregation agent
Actions:
- to minimise platelet aggregation and thrombus formation in order to retard the progression of coronary artery thrombosis in ACS
- inhibits the synthesis of prostaglandins - anti-inflammatory actions

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14
Q

Aspirin indications

A
  1. ACS
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15
Q

Aspirin contraindications

A
  1. hypersensitivity to aspirin/salicylates
  2. actively bleeding peptic ulcers
  3. bleeding disorders
    4, suspected dissecting aortic aneurysm
  4. chest pain associated with psychostimulant OD if BP >160
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16
Q

Aspirin precautions

A
  1. peptic ulcer
  2. asthma
  3. patients on anticoagulants
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17
Q

Aspirin side effects

A

gastrointestinal bleeding, heartburn, nausea
increased bleeding time
hypersensitivity reactions

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18
Q

Aspirin action times

A

onset: n/a
peak: n/a
duration: 8-10days

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19
Q

Midazolam pharmacology

A

short acting CNS depressant

  • anxiolytic
  • sedative
  • anticonvulsant
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20
Q

Midazolam indications

A
  1. status epilepticus
  2. sedation to enable intubation (RSI/IFS)
  3. post intubation sedation
  4. sedation to enable synchronised cardioversion
  5. sedation in the agitated patient (mental health act)
  6. sedation in psychostimulant OD
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21
Q

Midazolam contraindications

A
  1. hypersensitivity to benzodiazepines
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22
Q

Midazolam precautions

A
  1. reduced doses may be required for the elderly/frail, pts with chronic renal failure, CCF or shock.
  2. the CNS depressant effects of benzos are enhanced in the presence of narcotics and other tranquilisers including alcohol.
  3. can cause severe respiratory depression in pts with COPD
  4. patients with myasthenia gravis
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23
Q

Midazolam side effects

A

depressed level of consciousness
respiratory depression
loss of airway control
hypotension

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24
Q

Midazolam action times

A

IM

onset: 3-5 minutes
peak: 15 minutes
duration: 30 minutes

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25
Adrenaline pharmacology
A naturally occurring alpha and beta-adrenergic stimulant - increases HR by increasing SA node firing rate (beta 1) - increases conduction velocity through the AV node (beta1) - increases myocardial contractility (beta 1) - increases the irritability of the ventricles (beta1) - causes bronchodilatation (beta 2) - causes peripheral vasoconstriction (alpha)
26
Adrenaline indications
1. Cardiac arrest-VF/VT, asystole or PEA 2. Inadequate perfusion (cardiogenic or non-cardiogenic/non-hypovolaemic) 3. Anaphylaxis 4. Severe asthma - imminent life threat not responding to nebuliser therapy, or unconscious with no BP 5. Croup
27
Adrenaline Contraindications
1. Hypovolaemic shock without adequate fluid replacement
28
Adrenaline Precautions
1. Elderly/frail patients 2. Patients with cardiovascular 3. Patients on monoamine oxidase inhibitors 4. Higher doses may be required for patients on beta blockers
29
Adrenaline Side effects
``` Sinus tachycardia Supraventrivular arrhythmias Ventricular arrhythmias Hypertension Pupillary dilatation May increase size of MI Feelings of anxiety and palpitations in the conscious pt ```
30
Adrenaline action times
IV Onset: 30seconds Peak: 3-5 minutes Duration: 5-10minutes IM onset: 30-90 seconds Peak: 4-10 minutes Duration: 5-10 minutes
31
Ceftriaxone pharmacology
Cephalosporin antibiotic
32
Ceftriaxone indications
1. Suspected meningococcal septicaemia | 2. Severe sepsis(consult only)
33
Ceftriaxone contraindications
Allergy to cephalosporin antibiotics
34
Ceftriaxone precautions
Allergy to penicillin antibiotics
35
Ceftriaxone side effects
Nausea Vomiting Skin rash
36
Ceftriaxone dilution IM/IV
IV - made up into 10ml using sterile water and administered over 2 minutes IM - made up into 4ml using 1% lignocaine and administered in lateral upper thigh
37
Dextrose 10% onset
3 minutes
38
Glucagon onset & duration
Onset - 5minutes | Duration -25 minutes
39
Glucagon pharmacology
A hormone normally secreted by the pancreas | - causes an increase in blood glucose concentration by converting stored liver glycogen to glucose
40
Ipratrpium bromide pharmacology
Anticholinergic bronchodilator -allows bronchodilatation by inhibiting cholinergic bronchomotor (ie blocks vagal reflexes which mediate bronchoconstriction)
41
Ipratropium bromide indications
1. Severe respiratory distress associated with bronchospasm | 2. exacerbation of COPD irrespective of severity
42
Ipratropium bromide contraindications
1. Known hypersensitivity to atropine or its derivatives
43
Ipratropium bromide precautions
1. glaucoma | 2. Avoid contact with eyes
44
Ipratropium bromide side effects
``` Headache Nausea Dry mouth Skin rash Tachycardia (rare) Palpitations (rare) Acute angle closure glaucoma secondary to direct eye contact (rare) ```
45
Ipratropium bromide action times
Onset 3-5 minutes Peak 1.5-2 hours Duration 6hours
46
Ketamine pharmacology
A rapid acting dissociative anaesthetic agent (primarily an NMDA receptor antagonist) >produces a dissociative state characterised by: - a trance 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
47
Ketamine primary emergency indication
1. Rapid sequence intubation 2. Extreme traumatic pain refractory to opioid analgesia 3. Extreme agitation 4. CPR interfering patient
48
Ketamine contraindications
1. Known hypersensitivity | 2. Severe hypertension (>180)
49
Ketamine precautions
1. Any condition where significant elevation of BP would be hazardous - hypertension - CVA - recent AMI - CCF 2. If being administered for analgesia, inject slowly over 1min to minimise risk of respiratory depression and hypertension
50
Ketamine side effects
``` Cardiovascular: - Increased BP and HR CNS: - Respiratory depression - Emergence reactions - Enhanced skeletal tone - N&V Ocular: - Diplopia and nystagmus with slight increase in intraoccular pressure Other: - Local pain at injection site - Lacrimation - Salivation ```
51
Ketamine action times
IV effects: Onset 30seconds Peak N/A Duration 10 minutes IM effects: Onset 3-4 minutes Peak
52
Misoprostol pharmacology
A synthetic prostaglandin | - enhances uterine contractions
53
Misoprostol indications
Primary postpartum haemorrhage (PPH) > blood loss >500 ml in <24hrs from birth >use if fundus massage not successful and mother has emptied bladder and the fundus is not firm
54
Misoprostol contraindications
1. Allergy to prostaglandins | 2. Exclude multiple pregnancy before drug administration
55
Misoprostol precautions
Hx of asthma
56
Misoprostol Side effects
Hyperpyrexia Shivering Abdominal pain Diarrhoea
57
Morphine pharmacology
``` An opiod analgesic CNS - depression (leading to analgesia) - respiratory depression - depression of cough reflex - stimulation (changes in mood, euphoria or dysphoria, vomiting, pinpoint pupils) - dependence (addiction) Cardiovascular - vasodilatation - decrease in conduction velocity through the A-V node ```
58
Morphine indications
1. Pain relief 2. Acute LVF with SOB and full field crackles 3. Sedation to maintain intubation 4. Sedation to enable intubation 5. RSI
59
Morphine contraindications
1. History of hypersensitivity 2. Renal impairment/failure 3. Late second stage of labour
60
Misoprostol action times
Onset : 8-10 minutes Peak: N/a Duration: 2-3 hours
61
Morphine precautions
1. Elderly/frail pts 2. Hypotension 3. Respiratory depression 4. Current asthma 5. Respiratory tract burns 6. Known addiction to opioids 7. Acute alcoholism 8. Patients on monoamine oxidase inhibitors
62
Morphine side effects
``` CNS - drowsiness - respiratory depression - euphoria - N&V - addiction - pinpoint pupils Cardiovascular - hypotension - bradycardia ```
63
Morphine action times
IV effects Onset: 2-5 minutes Peak: 10 minutes Duration: 1-2 hours IM effects Onset: 10-30 minutes Peak: 30-60 minutes Duration: 1-2 hours
64
Methoxyflurane pharmacology
Inhalational analgesic agent at low concentrations
65
Methoxyflurane indications
Pain relief
66
Methoxyflurane contraindications
1. Pre-existing renal disease/renal impairment 2. Concurrent use of tetracycline antibiotics 3. Exceeding total dose of 6ml in a 24hr period 4. Personal or family hx of malignant hyperthermia 5. Muscular dystrophy
67
Methoxyflurane precautions
1. The penthrox inhaler must be hand held by the patients so that if unconsciousness occurs it will fall from the patients face. Occasionally the operator may need to assist but continually assess the level of consciousness. 2. Pre-eclampsia 3. Concurrent use with oxytocin may cause hypotension
68
Methoxyflurane side effects
Drowsiness Decrease in blood pressure and bradycardia (rare) Exceeding the maximum total dose of 6ml in a 24hr period may lead to renal toxicity
69
Methoxyflurane action times
Onset 8-10 breaths | Duration 25minutes
70
Naloxone pharmacology
An opioid antagonist | - prevents or reverses the effects of opioids
71
Naloxone indications
Altered conscious state and respiratory depression secondary to administration of opioids or related drugs
72
Naloxone contraindication
Nil significance of the indications
73
Naloxone precautions
1. If patient is known to be physically dependent on opioids, be prepared for a combative patient after administration 2. Neonates
74
Naloxone side effects
Symptoms of opioid withdrawal - sweating, goose flesh, tremor - nausea and vomiting - agitation - dilatation of pupils, excessive lacrimation - convulsions
75
Naloxone action times
``` IV effects Onset: 1-3 minutes Peak: n/a Duration: 30-45 minutes IM effects Onset: 1-3 minutes Peak: n/a Duration: 30-45 minutes ```
76
Ondansetron pharmacology
Anti-emetic | 5HT3 antagonist which blocks receptors both centrally and peripherally
77
Ondansetron indications
1. Undifferentiated nausea and vomiting 2. Prophylaxis for spinally immobilised or eye injured patients 3. Vestibular nausea in patients <21 years of age
78
Ondansetron contraindications
1. Known hypersensitivity 2. Concurrent apomorphine use 3. Known long QT syndrome 4. Hypokalaemia or hypomagnesaemia
79
Ondansetron precautions
1. Patients with liver disease should not receive more than 8mg of ondansetron per day 2. Care should be taken with patients on diuretics who may have an underlying electrolyte imbalances 3. Ondansetron contains aspartame and should not be given to patients with phenylketonuria 4. Concurrent use of tramadol 5. Pregnancy
80
Ondansetron action times
Oral Onset: 2 minutes Peak: 20minutes Duration: 120 minutes

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