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Paramedic Pharmacology > Drug Study > Flashcards

Drug Study Flashcards

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1
Q

What are the Indications for Adrenaline 1;1000?

A

Anaphylaxis or life threatening asthma

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2
Q

What are the Actions of Adrenaline 1;1000?

A
  • Sympathomimetic that stimulates both alpha and beta adrenergic receptors.
  • It increases myocardial perfusion pressure by increasing peripheral resistance.
  • Reverses allergic manifestations of acute anaphylaxis
  • Reverses bronchospasms in acute severe asthma
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3
Q

Cautions of adrenaline 1;1000. (added extra - do not need to remember)

A

Can cause severe hypertension in patients with non-cardio selective beta blockers for example - Propranolol

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4
Q

How would you administer adrenaline 1;1000?

A

Intramuscular Injection - antero-lateral aspect of thigh.

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5
Q

What is the initial dosage, interval and max dose of adrenaline 1;1000 for an adult?

A

500 micrograms every 5 minutes and there is no maximum dose.

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6
Q

What are the pharmacodynamics of Adrenaline?

A
  • Increases the heart rate
  • Myocardial contractility
  • Renin release via beta 2 receptors ( which produce bronchodilation)
  • It works by relaxing the muscles in the airways and tightening the blood vessels.
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7
Q

What is the pharmacological class of Adrenaline?

A

Adrenaline (Epinephrine) belongs to a class of drugs called sympathomimetic agents.

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8
Q

Where in the body is Adrenaline metabolised?

A

The liver

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9
Q

How is adrenaline excreted?

A

The majority is eliminated through urine.

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10
Q

What is the half life of Adrenaline?

A

Lasts approximately 2-3 minutes in the blood stream.

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11
Q

What are the indications of Adrenaline 1;10,000?

A
  • Cardiac arrest
  • Post ROSC circulatory support.
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12
Q

What are the actions of Adrenaline 1;10,000

A
  • Sympathomimetic that stimulates both alpha and beta adrenergic receptors
  • Increased myocardial perfusion pressure by increasing peripheral resistance.
  • As a result myocardial and cerebral blood flow is enhanced during CPR and CPR becomes more effective due to increased peripheral resistance which improves perfusion pressures.
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13
Q

What are Sympathomimetic drugs?

A

Sympathomimetic drugs are stimulant compounds which mimic the effects of endogenous agonists of the sympathetic nervous system.

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14
Q

What are the cautions of Adrenaline 1;10,000?

A

The hypothermic heart may be unresponsive to cardio-active drugs and pre-hospital core temperature measurement is difficult, therefore where the primary cause of the cardiac arrest is hypothermia, double intervals between drugs should be used. E.g. Adrenaline every 6-10 minutes.
- Severe hypertension may occur in patients on non-cardio selective beta-blockers (e.g. propranolol).
- Do NOT administer adrenaline when the patient’s core temperature is less than 30˚C. When the patient’s temperature is between 30˚C and 35˚C, double the time period between doses.

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15
Q

When would you give post-rosc adrenaline 1;10,000?

A
  • To maintain blood pressure until systolic above 90mmHg
    For example -
    Patients who remain hypotensive following fluid administration (systolic less than 90mmHg / absent radial pulse) may be administered 1:10,000 adrenaline, titrated to response in 10mcg aliquots, until the systolic blood pressure is 90mmHg or higher, if they meet all of the following requirements:
    -Aged 18 years of age or over.
    -Hypotensive despite fluid administration.
    -Pulse rate under 100 beats per minute.
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16
Q

When do you give adrenaline 1;10,000 in a cardiac arrest?

A
  • Shockable rhythms: administer adrenaline after the 3rd shock and then after alternate shocks (i.e. 5th, 7th etc).
  • Non-shockable rhythms: administer adrenaline immediately IV access is achieved then alternate loops.
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17
Q

What are the contraindications of adrenaline 1;10,000?

A

Patients not in cardiac arrest/all patients with a palpable central pulse.

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18
Q

What are the adult doses of adrenaline 1;10,000 in a cardiac arrest along with the intervals?

A

Initial: 1mg in 10ml prefilled syringe
Repeat: 1mg in 10ml prefilled syringe
Interval: Every 3-5 minutes.

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19
Q

What are the indications for Amiodarone hydrochloride?

A

Shockable rhythms: if unresponsive to defibrillation administer amiodarone after the 3rd shock and an additional bolus depending on age to unresponsive VF or pulseless VT following the 5th shock.

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20
Q

What are the actions of Amiodarone hydrochloride?

A

Antiarrhythmic; lengthens cardiac action potential and therefore effective refractory period. Prolongs QT interval on ECG.
Blocks sodium and potassium channels in cardiac muscle.
Acts to stabilise and reduce electrical irritability of cardiac muscle.

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21
Q

What are the contraindications for Amiodarone hydrochloride?

A

No contra-indications in the context of the treatment of cardiac arrest.

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22
Q

What are the side affects to Amiodarone hydrochloride? (Do not need to know - added extra)

A
  • Bradycardia.
  • Vasodilatation causing hypotension, flushing.
  • Bronchospasm.
    Arrhythmias – Torsade’s de pointes.
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23
Q

What are the adult dosages, intervals, repeated dose and max dose of Amiodarone hydrochloride?

A

Initial: 300micrograms IV
Next dose: 150micrograms IV
Interval: After 3rd and 5th shock
Max dose: 450micrograms

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24
Q

What class is amiodarone hydrochloride?

A

It is a class 3 antiarrhythmic drug.

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25
Q

How long does it take for amiodarone hydrochloride to be absorbed by the body?

A

1-30 minutes through IV

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26
Q

How is amiodarone hydrochloride metabolised?

A

The liver and intestines.

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27
Q

What’s the elimination rate of amiodarone hydrochloride?

A

Ranges from 9-100 days.

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28
Q

What are the pharmacodynamics of amiodarone hydrochloride?

A

It acts to relax smooth muscles that line vascular walls, decreases peripheral vascular resistance (afterload) increases cardiac index by a small amount, and prolongs QRS and QT intervals.

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29
Q

What are the indications of Aspirin?

A

Adults with clinical or ECG evidence suggestive of myocardial infarction or ischaemia.

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30
Q

What are the contraindications of Aspirin?

A
  • Known aspirin allergy or sensitivity.
  • Children under 16 years (see additional information).
  • Active gastrointestinal bleeding.
  • Haemophilia or other known clotting disorders.
  • Severe hepatic failure with jaundice.
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31
Q

What is the route and the initial, repeated and max dose of aspirin?

A

Route: Oral – chewed or dissolved in water.

300 milligrams must be given unless the patient has already had 300 milligrams for this episode. If the patient has had a smaller dose that day (less than 300 milligrams) a dose of 300 milligrams should be given.

No repeated dose
Max dose: 300 milligrams

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32
Q

What is the action of Aspirin?

A

Has an antiplatelet action which reduces clot formation.

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33
Q

What are the indications for atropine sulfate?

A

Symptomatic bradycardia in the presence of ANY of these adverse signs:

  • Absolute bradycardia (pulse <40 beats per minute).
  • Systolic blood pressure below expected for age (refer to Page-for-Age for age related blood pressure readings in children).
  • Paroxysmal ventricular arrhythmias requiring suppression.
  • Inadequate perfusion causing confusion, etc.
  • Bradycardia following return of spontaneous circulation (ROSC).

NB Hypoxia is the most common cause of bradycardia in children, therefore interventions to support ABC and oxygen therapy should be the first-line therapy.

34
Q

What are the contra-indications of atropine sulfate?

A

Should NOT be given to treat bradycardia in suspected hypothermia.

Do NOT give atropine sulfate to patients with cardiac transplants; their hearts will not respond to vagal blocking by atropine and paradoxical high degree AV block or sinus arrest may result.

35
Q

What are the actions of atropine sulfate?

A
  • Reverses effects of vagal overdrive.
  • Increases heart rate by blocking vagal activity in sinus bradycardia, second or third degree heart block.
  • Enhances A-V conduction.
36
Q

What is the route and the initial, repeated and max dose of atropine sulfate?

A

Route: IV
Initial: 600micrograms
Repeat: 600micrograms
Max dose: 3 milligrams

37
Q

What are the side effects of atropine sulfate? (Do not need to know - added extra)

A
  • Dry mouth, visual blurring and pupil dilation.
  • Confusion and occasional hallucinations.
  • Tachycardia.
  • Do not use small (<100 micrograms) doses as they may cause paradoxical bradycardia.
38
Q

What are the indications for Benzylpenicillin Sodium?

A

Suspected meningococcal disease in the presence of:
1. a non-blanching rash (the classical, haemorrhagic, non-blanching rash (may be petechial or purpuric)
and/or
2. signs/symptoms suggestive of meningococcal septicaemia

39
Q

What are the contra-indications of Benzylpenicillin Sodium?

A

Known severe penicillin allergy (more than a simple rash alone).

40
Q

What is the route and the initial, repeated and max dose of Benzylpenicillin Sodium?

A

Route: IV/IO/IM Tablet dissolved in 20ml of water for injection.
Initial dose: 1.2 Grams
No repeated dose
Max dose: 1.2 Grams.

41
Q

What are the actions of Benzylpenicillin Sodium?

A

Main answer : It is an antibiotic.

More in-depth: Antibiotics disrupt essential processes or structures in the bacterial cell. This either kills the bacterium or slows down bacterial growth

42
Q

What are the actions of Chlorphenamine?

A

An antihistamine that blocks the effect of histamine released during a hypersensitivity (allergic) reaction.

43
Q

What are the contra-indications of Chlorphenamine?

A
  • Known hypersensitivity.
  • The anticholinergic properties of chlorphenamine are intensified by monoamine oxidase inhibitors (MAOIs). Chlorphenamine injection is therefore contraindicated in patients who have been treated with MAOIs within the last 14 days.
44
Q

What are the indications for Chlorphenamine?

A
  • Symptomatic allergic reactions falling short of anaphylaxis but causing patient distress (e.g. severe itching).
  • Alleviating distressing cutaneous symptoms in anaphylaxis only after emergency treatment with adrenaline and the patient is stable and oral antihistamine administration is not possible.
45
Q

What routes are available to give Chlorphenamine?

A

IM,IV or tablet form.

46
Q

What are the indications for Diazepam?

A
  • Patients who have prolonged convulsions (lasting 5 minutes or more) OR repeated convulsion (three or more in an hour), and are CURRENTLY CONVULSING – not secondary to an uncorrected hypoxic or hypoglycaemic episode (see Additional Information below).
  • Eclamptic convulsions (initiate treatment if seizure lasts over 2–3 minutes or if it is recurrent).
  • Symptomatic cocaine toxicity (severe hypertension, chest pain or convulsions).
47
Q

What are the actions of Diazepam?

A

Central nervous system depressant, acts as an anticonvulsant and sedative.

48
Q

What are the contra-indications for Diazepam?

A

Patients with known hypersensitivity.

49
Q

What is first pass metabolism?

A

The chemical change of medicine by the body is known as drug metabolism. The first pass effect pharmacology occurs when a drug is metabolized at a specific spot in the body, resulting in a lower concentration of the active substance when it reaches its site of action or the systemic circulation.

50
Q

What is specificity?

A

The ability of a drug to bind with one type of receptor.

51
Q

What is affinity?

A

The likelihood the drug is to bind to the receptor.

51
Q

What is affinity?

A

The likelihood the drug is to bind to the receptor.

52
Q

What is a drug?

A

A drug is any chemical you take that affects the way the body works.

52
Q

What is a drug?

A

A drug is any chemical you take that affects the way the body works.

53
Q

What does POM stand for?

A

Prescription only meds.

53
Q

What does POM stand for?

A

Prescription only meds.

54
Q

What does GSL stand for?

A

General sales list - sold in shops by a pharmacist

55
Q

What are the 5 rights of medication?

A

Identify the right patient
Confirm the right medication
Confirm the right dosage
Confirm the right route
Right time.

56
Q

What Schedule of drugs do paramedics work under?

A

Schedule 17

57
Q

Name all routes of medication

A

Oral, rectal, inhalation, IM, IV, IO, Topical (lotions, creams) , Sublingual, Buccal (cheek), Subcutaneous (under fatty layer of tissue)

58
Q

What are the indications for Furosemide?

A

Consider IV furosemide for pulmonary oedema and/or respiratory distress due to acute heart failure.

59
Q

What are the actions of Furosemide?

A

Furosemide is a potent diuretic with a rapid onset (within 30 minutes) and short duration.

60
Q

What are the contra-indications for Furosemide?

A

Reduced GCS with liver cirrhosis.
Cardiogenic shock.
Severe renal failure with anuria. (when the heart is unable to pump as much blood as the body needs.)
Children under 18 years old.

61
Q

What are the indications for Glucagon?

A

Hypoglycaemia, clinically suspected hypoglycaemia or unconscious patients where hypoglycaemia is considered a likely cause (blood glucose <4.0 millimoles per litre).

NB Glucagon should only be administered when oral glucose administration is not possible or is ineffective, AND/OR when IV access to administer 10% glucose is not possible.

62
Q

What are the actions of Glucagon?

A

Glucagon is a hormone that induces the conversion of glycogen to glucose in the liver, thereby raising blood glucose levels.

63
Q

What are the contraindications of Glucagon?

A

Pheochromocytoma (a rare tumour of the adrenal glands, which sit above the kidneys.)

Glucagon should NOT be given by IV injection because of increased vomiting associated with IV use.

64
Q

What are the indications of Glucose 10%?

A

Hypoglycaemia (blood glucose <4.0 millimoles per litre) or suspected hypoglycaemia when oral administration is not possible and a rapid improvement in clinical state and blood glucose level is required.

An unconscious patient, where hypoglycaemia is considered a likely cause.

Management of hypoglycaemia in patients who have not responded to the administration of IM Glucagon after 10 minutes.

65
Q

What are the actions of Glucose 10%?

A

Reversal of hypoglycaemia by direct delivery of glucose (sugar) to the systemic circulation.

66
Q

What are the contra-indications of Glucose 10%?

A

IM or subcutaneous injection.

67
Q

What are the indications of Glucose gel 40%?

A

Known or suspected hypoglycaemia in a conscious patient where there is no risk of choking or aspiration.

68
Q

What is the action of Glucose gel 40%?

A

Rapid increase in blood glucose levels via buccal absorption.

69
Q

What are the contra-indications of Glucose gel 40%?

A

None

70
Q

What are the indications for Glyceryl Trinitrate (GTN)?

A

Cardiac chest pain due to angina or myocardial infarction, when systolic blood pressure is greater than 90mmHg.

Breathlessness due to pulmonary oedema in acute heart failure when systolic blood pressure is greater than 110mmHg.

Patients with suspected cocaine toxicity presenting with chest pain.

71
Q

What are the contra-indications for Glyceryl Trinitrate (GTN)?

A
  • Hypotension (systolic blood pressure < 90mmHg in angina/myocardial infarction, or < 110 mmHg in acute heart failure).
  • Hypovolaemia.
  • Head trauma.
  • Cerebral haemorrhage.
  • Sildenafil (Viagra) and other related drugs – glyceryl trinitrate must not be given to patients who have taken sildenafil or related drugs within the previous 24 hours.
  • Profound hypotension may occur.
  • Unconscious patients.
  • Known severe aortic or mitral stenosis.
72
Q

What are the actions of Glyceryl Trinitrate (GTN)?

A

A potent vasodilator drug resulting in:

  • Dilatation of coronary arteries/relief of coronary spasm.
  • Dilatation of systemic veins resulting in lower pre-load.
  • Reduced blood pressure.
73
Q

What is WETFAG?

A

Weight ( age +4 ) x 2

Energy (4 joules) x weight

Tube

Fluids

Lorazepam

Glucose.

74
Q

How much Calpol can 6-8 year olds have?

A

Children 6-8 years
5ml

Up to 4 times in 24 hours

75
Q

How much paracetamol in 5ml of Calpol?

A

250mg paracetamol

76
Q

What are the indications for Hydrocortisone?

A

Severe or life-threatening asthma.

Acute exacerbation of COPD.

Adrenal crisis (including Addisonian crisis) which is a time-critical medical emergency with an associated mortality.

Adrenal crisis may occur in patients on long-term steroid therapy, either:
as replacement therapy for adrenal insufficiency from any cause,
in long-term therapy at doses of 5+ mg prednisolone, e.g. for immune suppression.

77
Q

What are the actions of Hydrocortisone?

A

Glucocorticoid drug that restores blood pressure, blood sugar, cardiac synchronicity and volume. High levels are important to survive shock. Therapeutic actions include suppression of inflammation and immune response.

78
Q

What are the contraindications to Hydrocortisone?

A

Known allergy to the product/excipients.

Where a patient has adrenal crisis it is preferable to give whatever preparation is available.

Paramedic Pharmacology (3 decks)

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