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Drug Therapy Protocols Flashcards

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1
Q

Indications for Adrenaline

A
  • Cardiac Arrest
  • Severe Anaphylaxis
  • Severe Life-threatening Bronchospasm
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2
Q

Contraindications for Adrenaline

A

Nil

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3
Q

Adult Dosages for Adrenaline - Cardiac Arrest, Severe Bronchospasm Anaphylaxis (IV & IM)

A

Cardiac arrest:
- (IV) 1mg repeated at 3-5 min intervals (NO MAX)

Anaphylaxis/ Severe Bronchospasm:

  • (IM - Epipen) 300mcg single dose ONLY
  • (IM) 500mcg repeated at 5 min intervals (NO MAX)
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4
Q

Paed Dosages for Adrenaline - Cardiac Arrest, Anaphylaxis and Severe Bronchospasm (IV & IM)

A

Cardiac Arrest:

  • (IV) 10kg or more (over 1 year) 10mcg/kg repeated at 3-5 min intervals (NO MAX)
  • (IV) Less than 10kg (excl. newborn) 100mcg repeated at 3-5 min intervals (NO MAX)
  • (IV) Newborn 50mcg repeated at 3-5 min intervals (NO MAX)

Anaphylaxis/ Severe Bronchospasm:

  • (IM - Epipen) >6 YO 300mcg single dose
  • (IM - Epipen) <6 YO 150mcg single dose
  • (IM) >6 YO 300mcg repeated at 5 min intervals (NO MAX)
  • (IM) 1-6 YO 150mcg repeated at 5 min intervals (NO MAX)
  • (IM) 6mnths - 1 YO 100mcg repeated at 5 min intervals (NO MAX)
  • (IM) <6mnths - 50mcg repeated at 5 min intervals (NO MAX)
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5
Q

Indications for Aspirin

A
  • Suspected ACS

- Acute Cardiogenic Pulmonary Oedema

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6
Q

Contraindications for Aspirin

A
  • Allergy or adverse reaction to aspiring or any NSAID
  • Chest pain associated with psychostimulant OD
  • Bleeding or clotting disorders
  • Current GI bleeding or peptic ulcers
  • Patients <18 YO
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7
Q

Adult Dosages for Aspirin (PO)

A
  • (PO) 300mg (Daily max 300-450mg)
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8
Q

Indications for Ceftriaxone

A
  • Suspected meningococcal septicaemia
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9
Q

Contraindications for Ceftriaxone

A
  • Allergy or adverse drug reaction to cephalosporin antibiotics
  • Known immediate or severe hypersensitivity to penicillin or carbapenem based drugs
  • Patient >1mnth (consult)
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10
Q

Adult Dosages for Ceftriaxone (IM & IV)

A
  • (IM) 2g (2x1g injections) single dose only
  • (IV) 2g over 20 mins single dose only
    • Refer document for more details & paeds concentration
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11
Q

Indications for Clopidogrel

A
  • Patients with STEMI who have been accepted for pPCI
    EITHER:
    (as an adjunct medication to aspirin and heparin) WHEN the cardiologist requests clopidogrel
    (patients who have received tenecteplase and have been administered aspirin and enoxaparin)
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12
Q

Contraindications for Clopidogrel

A
  • Allergy or adverse drug reaction
  • Patients contraindications for pre-hospital fibrinolysis
  • Current clopidogrel OR ticagrelor therapy
  • Patients <18 YO
  • Active bleeding
  • Prior intracranial haemorrhage
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13
Q

Adult Doses for Clopidogrel for request of intervening cardiologist and in addition to enoxaparin, aspirin and tenecteplase (PO)

A
  • (PO) 600mg - where the intervening cardiologist has requested clopidogrel - pPCI (adjunct with aspirin and heparin)
  • (PO) 300mg - patients who have received tenecteplase, enoxaparin and aspirin
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14
Q

Indications for Dexamethasone

A
  • Croup
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15
Q

Contraindications for Dexamethasone

A
  • Allergy or adverse drug reaction
  • Children >6mnths or <6 YO (consult)
  • Steroids within 4/24
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16
Q

Paed Dosage for Dexamethasone (PO)

A
  • (PO) 6mnths - 6YO 0.3mg/kg (rounded to nearest 0.5ml)

* * Refer spreadsheet in database

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17
Q

Indications for Droperidol

A
  • Acute behavioural disturbance with SAT Score >2
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18
Q

Contraindications for Droperidol

A
  • Allergy or adverse drug reaction
  • Parkinson’s disease
  • Known lewy body dementia
  • Previous dystonic reaction to droperidol
  • Patients < 8 years
  • Suspected sepsis (consult)
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19
Q

Adult dosages for Droperidol (IV & IM)

A
  • (IM & IV) > 65 YO 5mg and can be repeated at 15 min (MAX 10mg)
  • (IM & IV) 16-65 YO 10mg and can be repeated at 15 min (MAX 20mg)
  • (IM & IV) 13-15 YO 0.1-0.2mg/kg (max 10mg) and can be repeated at 15 min (MAX 20MG)
    • Consult for >65 AND 13-15 YO
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20
Q

Indications for Enoxaparin

A
  • Patients with STEMI who have received tenecteplase (as an adjunct with aspirin and clopidogrel)
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21
Q

Contraindications for Enoxaparin

A
  • Allergy or adverse reaction

- Patients contraindicated for pre-hospital fibrinolysis

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22
Q

Adult dosage for Enoxaparin (IV)

A
  • (IV) loading dose of 30mg to be administered 15 mins before SUBCUT dose
  • (IV) maintenance dose (1mg/kg - not to exceed 100mg) to be administered 15 min after loading dose
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23
Q

Indications for Fentanyl

A
  • Significant Pain
  • Autonomic dysreflexia (SBP >160mmHg)
    • Morphine is preferred EXCEPT for haemodynamic instability, kidney disease, suspected ACS, allergy or adverse reaction
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24
Q

Contraindications for Fentanyl

A
  • Allergy or adverse reaction
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25
Q

Adult dosages for Fentanyl (IM, IV & NAS)

A
  • (IM & NAS) >70 YO 25-50mcg repeated at up to 50mcg every 10 mins (MAX 100mcg)
  • (IM & NAS) <70 YO 25-100mcg repeated at up to 50mcg every 10 mins (MAX 200mcg)
  • (IV) >70 YO 25mcg repeated at 15mcg every 5 mins (MAX 100mcg)
  • (IV) <70 YO 25-50mcg repeated at up to 50mcg every 5 mins (MAX 200mcg)
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26
Q

Paed dosages for Fentanyl (NAS, IM, IV)

A
  • (NAS) >1 YO 1.5mcg/kg (single max 50mcg) repeated once at 1mcg/kg at 10 mins (MAX 100mcg)
  • (IM) >1 YO 1-2mcg/kg (single max 50mcg) (MAX 2mcg/kg)
  • (IV) >1 YO 1mcg/kg (single max 25mcg) repeated at 0.5mcg/kg at 5 min intervals (MAX 2mcg/kg)
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27
Q

Indications for Glucagon

A
  • Symptomatic hypoglycaemia (inability to self administer glucose)
  • Refractory anaphylaxis with persistent hypotension/shock (unresponsive to 3x IM adrenaline and fluid challenge)
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28
Q

Contraindications for Glucagon

A
  • Allergy or adverse reaction
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29
Q

Adult dosage for Glucagon with symptomatic hypoglycaemia and refractory anaphylaxis (IM & IV)

A
  • (IM & IV) 1mg single dose only, reconstitute 1mg with 1ML of water for injection in 3mL syringe
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30
Q

Paed dosage for Glucagon with symptomatic hypoglycaemia and refractory anaphylaxis (IM)

A
  • (IM & IV) >25kg 1mg single dose, reconstitute 1mg with 1ml of water in 3mL syringe
  • (IM & IV) <25kg 0.5mg single dose, reconstitue 1mg with 2ml of water in 3ml syringe for concentration of (1mg/2mL - give 0.5mg/1mL)
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31
Q

Indications for Glucose Gel

A
  • Symptomatic hypoglycaemia with ability to self admin
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32
Q

Contraindications for Glucose Gel

A
  • Unconciousness
  • Patients with difficulty swallowing
  • Patients <2 YO
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33
Q

Adult & Paed dosages for Glucose Gel (PO)

A
  • (PO) 15g repeated once at 15 min if BGL <4.0mmol/L (MAX 30G)
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34
Q

Indications for Glucose 10%

A
  • Symptomatic hypoglycaemia (with the inability to self-administer oral glucose)
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35
Q

Contraindications for Glucose 10%

A
  • Nil
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36
Q

Adult Dosage for Glucose 10% (IV)

A
  • (IV) 15g (150mL) repeated at 10g/100mL boluses every 5 mins until BGL >4.0mmol/L
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37
Q

Indications for Glyceryl Trinitrate

A
  • Suspected AC (with pain)
  • Acute cardiogenic pulmonary oedema
  • Autonomic dysreflexia (SPB >160mmHg)
  • Irukandji Syndrome (SBP >160mmHg)
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38
Q

Contraindications for Glyceryl Trinitrate

A
  • Allergy or adverse reaction
  • HR <50 or >150 bpm
  • SBP <100mmHg
  • Acute CVA
  • Head trauma
  • Phosphodiesterase 5 inhibitor medication admin (sildenafil, vardenafil 24/24 and tadalafil 48/24)
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39
Q

Indications for Heparin

A
  • Patients with STEMI who have been accepted for pPCI (adjunct medication with aspirin and EITHER ticagrelor or clopidogrel)
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40
Q

Contraindications for Heparin

A
  • Allergy or adverse drug reaction
  • Patient <18 YO
  • Active bleeding or clotting problem
  • Prior intracranial haemorrhage
  • Current use of anticoagulants e.g. warfarin
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41
Q

Adult dosages for Heparin (IV)

A
  • (IV) 5000 units (or dose requested by the intervening cardiologist)
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42
Q

Indications for Hydrocortisone

A
  • Asthma
  • Acute exacerbation of COPD (evidence of respiratory distress)
  • Refractory Anaphlyaxis with persistent wheeze (unresponsive to 3x IM adrenaline)
  • Symptomatic adrenal insufficiency
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43
Q

Adult dosages of Hydrocortisone for refractory anaphylaxis, COPD and adrenal insufficiency (IM & IV)

A

COPD & Adrenal Insufficiency:
- (IM & IV) 100mg single dose only

Refractory Anaphylaxis:
- (IM & IV) 200mg single dose only

44
Q

Paed dosages of Hydrocortisone for refractory anaphylaxis, COPD and adrenal insufficiency (IM & IV)

A

Asthma & Refractory Anaphlyaxis:
- (IM & IV) 4mg/kg single dose only, not to exceed 100mg

Symptomatic Adrenal Insufficiency:

  • (IM & IV) 0-4 YO 25mg single dose
  • (IM & IV) 5-10 YO 50mg single dose
  • (IM & IV) >10 YO 100mg single dose
45
Q

Indications for Ibuprofen

A
  • Moderate pain due to acute inflammation and tissue injury
46
Q

Contraindications for Ibuprofen

A
  • Allergy or adverse reaction to any NSAID or aspirin
  • Concomitant NSAID therapy
  • Current GI bleeding or peptic ulcers
  • Dehydration and or hypovolaemia
  • Renal impairment
  • NSAID induced asthma
47
Q

Adult dosages for Ibuprofen (PO)

A
  • (PO) 200-400mg not to be administered within 6 hours of previous admin
48
Q

Indications for Ipratropium Bromide

A
  • Moderate bronchospasm (unresponsive to QAS salbutamol NEB)

- Severe bronchospasm

49
Q

Contraindications for Ipratropium Bromide

A
  • Allergy and or adverse reaction

- Patients less than 1 YO

50
Q

Adult Dosages for Ipratropium Bromide (NEB)

A
  • (NEB) 500mcg repeated at 20 minute intervals (MAX 1.5mg)
51
Q

Adult Dosages for Ipratropium Bromide (NEB)

A
  • (NEB) >6 YO 500mcg repeated at 20 minute intervals (MAX 1.5mg)
  • (NEB) 1-5 YO 250mcg repeated at 20 minute intervals (MAX 750mcg)
52
Q

Indications for Loratadine

A
  • Symptomatic urticaria (without evidence of anaphylaxis)
53
Q

Contraindications for Loratadine

A
  • Allergy or adverse drug reaction

- Anaphylaxis

54
Q

Adult Dosages for Loratadine (PO)

A
  • (PO) 10mg single dose & not to be administered within 24 hours of previous antihistamine
55
Q

Paed Dosages for Loratadine (PO)

A
  • (PO) > 8 YO 10mg single dose only
56
Q

Indications for Methoxyflurane

A
  • Pain
57
Q

Contraindications for Methoxyflurane

A
  • Allergy or adverse drug reaction
  • Patients <1 year
  • History of significant liver or renal disease
  • History of malignant hyperthermia
58
Q

Adult Dosages for Methoxyflurane (INH)

A
  • (INH) 3mL repeated once after 20 mins (MAX 6mL)
59
Q

Paed Dosages for Methoxyflurane (INH)

A
  • (INH) >1 YO 3mL single dose
60
Q

Indications for Midazolam

A
  • Generalised focal seizure (GCS <12)
61
Q

Contraindications for Midazolam

A
  • Allergy or adverse reaction
62
Q

Adult dosages for Midazolam (NAS, IM, IV)

A
  • (NAS, IM) 5mg repeated every 10 minutes (MAX 20mg)

- (IV) 5mg repeated every 5 minutes (MAX 20mg)

63
Q

Paed Dosages for Midazolam (NAZ, & IM)

A
  • (NAS, IM) 200mcg/kg (single dose not to exceed 5mg) repeated at half the initial dose (max 2.5mg) at 10 min intervals (MAX 10mg)
64
Q

Indications for Morphine

A
  • Significant pain
  • Sedation
  • Autonomic dysreflexia (SBP >160mmHg)
    • Morphine is preferred EXCEPT for haemodynamic instability, kidney disease, suspected ACS, allergy or adverse reaction
65
Q

Contraindications for Morphine

A
  • Allergy or adverse reaction

- Kidney disease (renal failure)

66
Q

Adult Dosages for Morphine (IV & IM)

A
  • (IM) >70 YO 2.5-5mg repeated at up to 5mg every 10 mins (MAX 10mg)
  • (IM) <70 YO 2.5-10mg repeated at up to 5mg every 10 mins (MAX 20mg)
  • (IV) >70 YO 2.5mg repeated at up to 2.5mg every 5 minutes (MAX 10mg)
  • (IV) <70 YO 2.5-5mg repeated at up to 5mg every 5 mins (MAX 20mg)
67
Q

Paed Dosages for Morphine (IM & IV)

A
  • (IM) >1 YO 100-200mcg/kg (single max dose 5mg) (MAX 200mcg/kg)
  • (IV) >1 YO 100mcg/kg (single max dose 2.5mg)repeated at 50mcg/kg at 5 min intervals (MAX 200mcg/kg)
68
Q

Indications for Naloxone

A
  • Respiratory depression (secondary to the administration of narcotic drugs)
69
Q

Contraindications for Naloxone

A
  • Allergy or adverse drug reaction

- Newly born patient

70
Q

Adult Dosages for Naloxone (IM)

A
  • (IM) 1.6mg single dose only
71
Q

Paed Dosages for Naloxone (IM)

A
  • (IM) 20mcg/kg single dose only, not to exceed 800mcg
72
Q

Indications for Ondansetron

A
  • Significant nausea or vomiting
73
Q

Contraindications for Ondansetron

A
  • Allergy or adverse drug reaction
  • Congenital long QT syndrome
  • Current apomorphine therapy (used in severe Parkinson’s disease)
  • Patients less than 2 YO
74
Q

Adult Dosages for Ondansetron (IM, IV, PO)

A
  • (PO & IM) 4-8mg with slow push over 2-3 min (MAX 8mg)
75
Q

Paed Dosages for Ondansetron (PO, IM, IV)

A
  • (PO) >5 YO 4mg single dose only
  • (PO) 2-4 YO 2mg single dose only
  • (IM) >2 YO 100mcg/kg (rounded to nearest 5kg) single dose not to exceed 4mg
  • (IV) >2 YO 100mcg/kg single dose only, not to exceed 4mg (slow push over 2-3 min)
76
Q

Indications for Oxygen

A
  • A wide range of conditions resulting in, or potentially resulting in systematic or localised hypoxia
77
Q

Contraindications for Oxygen

A
  • Known paraquat poisoning with SpO2 equal or greater than 88%
  • History of bleomycin therapy with SpO2 equal or greater than 88%
78
Q

Adult & Paed Dosages for Oxygen (INH)

A

Intra-arrest, CO poisoning, cyanide poisoning, preoxygenation for RSI:
- (INH) administer 100% O2

Paraquat toxicity, bleomycin treatment, obesity, COPD, CF, neuromuscular disease:
- (INH) titrate oxygen to achieve 88-92%

All other presentations:
- (INH) titrate oxygen to achieve 92-96%

79
Q

Indications for Oxytocin

A
  • Active management of the third stage labour (following confirmed delivery of all foetuses) AND the prevention of primary post-partum haemorrhage
  • Management of uncontrolled primary or secondary post-partum haemorrhage
80
Q

Contraindications for Oxytocin

A
  • Allergy or adverse drug reaction

- Undelivered foetuses

81
Q

Adult dosages for Oxytocin (IM & IV)

A
  • (IM) 10 IU single dose only

- (IV) 10 IU slow push over 2-5 mins (may be given in addition to dose given for active management of 3rd stage)

82
Q

Indications for Paracetamol

A
  • Mild to moderate pain

- Fever (causing distress)

83
Q

Contraindications for Paracetamol

A
  • Allergy or adverse drug reaction

- Patients < 1 mnth old

84
Q

Adult dosages for Paracetamol (PO)

A
  • (PO) > 16 YO 0.5-1g repeated every 4 hours (MAX 4g in 24/24)
85
Q

Paed Dosages for Paracetamol (PO)

A
  • (PO) >1mnth 15mg/kg single dose only (Elixir)

- (PO) >7 YO 15mg/kg single dose only (Soluble tablets)

86
Q

Indications for Salbutamol

A
  • Bronchospasm

- Suspected Hyperkalaemia

87
Q

Contraindications for Salbutamol

A
  • Allergy or adverse drug reaction

- Patients less than 1 year old

88
Q

Adult Dosages for Salbutamol (NEB)

A
  • (NEB) 5mg repeated PRN (NO MAX)
89
Q

Paed Dosages for Salbutamol (NEB)

A
  • (NEB) 1-5 years 2.5mg single dose only

- (NEB) >6 YO 5mg single dose only

90
Q

Indications for Sodium Chloride 0.9%

A
  • Inadequate tissue perfusion/shock
  • Hypovolaemia
  • Significant burns (TBSA >20% for adults or >10% for paeds)
  • To dissolve and dilute drugs
  • As a flush following IV administration
91
Q

Contraindications for Sodium Chloride 0.9%

A
  • Nil
92
Q

Adult doses for Sodium Chloride 0.9% (IV)

A
  • (IV) PRN, titrate according to the patients physiological response to treatment
  • (IV) mL/hr to be infused = 15/mL/hr x TBSA (nearest 10%) if >100kg administer an additional 200mL/hr
93
Q

Paed Dosages for Sodium Chloride 0.9%

A
  • (IV) 10-20mL/kg, may be repeated twice if required (max dose 60mL/kg)
    • Required Consult in all cases
94
Q

Indications for Sucrose 24%

A
  • Short term procedural pain management (IV cannulation)

- Distress due to pain

95
Q

Contraindications for Sucrose 24%

A
  • Patients >12 mnths of age
  • Sucrose intolerance (CSID)
  • Fructose intolerance
  • Glucose-galactose malabsorption
  • Concurrent muscle relaxant/ paralysis therapy
96
Q

Paed Dosages for Sucrose 24% (PO)

A
  • (PO) 0-1mth 0.1mL (2 drops) can be repeated once at 5 mins

- (PO) 2-12mnths 0.5mL (10 drops) can be repeated once at 5 mins

97
Q

Indications for Tenecteplase

A
  • Patient with STEMI who meet the criteria as defined by QAS coronary artery reperfusion checklist
98
Q

Contraindications for Tenecteplase

A
  • <18 or >75 YO
  • Uncontrolled hypertension (SBP >180mmHg OR DBP >100mmHG at any stage)
  • Allergy or adverse drug reaction to any of: tenecteplase, enoxaparin or clopidogrel
  • Left BB on 12-lead
  • Current OR history of thrombocytopenia
  • Active tuberculosis
  • Known cerebral disease
  • Previous intracranial haemorrhage
  • Ischaemic stroke or TIA within 3/12
  • History of significant close head or facial trauma in last 3/12
  • Suspected aortic dissection
  • History of major trauma or surgery within last 6/52
  • Internal bleeding within last 6/52 (GI, UT)
  • Bleeding or clotting disorder
  • current use of anticoagulants (warfarin)
  • Non compressible vascular punctures
  • Prolonged (>10 mins) CPR
  • Known to be pregnant or delivered within last 2/52
  • History of serious systemic disease
  • Resident of aged care facility requiring significant assistance
  • Acute MI in the setting of trauma
99
Q

Adult Dosages for Tenecteplase (IV)

A
  • (IV) weight calculated dose (refer chart) administered into a pre-existing IV line containing sodium chloride 0.9% over 10 sec
100
Q

Indications for Ticagrelor

A
  • Patients with STEMI who have been accepted for pPCI (in adjunct with aspirin and heparin where there cardiologist is requesting ticagrelor)
101
Q

Contraindications for Ticagrelor

A
  • Allergy or adverse drug reaction
  • Patient currently taking ticagrelor or clopidogrel
  • Patient less than 18 YO
  • Active bleeding
  • Prior intracranial haemorrhage
  • History of hepatic impairment
102
Q

Adult Dosages for Ticagrelor (PO)

A
  • (PO) >18 YO 180mg
103
Q

Indications for Tranexamic Acid

A
  • Recent Traumatic injuries (< 3 hours) with a COAST score >3
  • Management of uncontrolled PPH (< 3 hours)
104
Q

Contraindications for Tranexamic Acid

A
  • Allergy or adverse drug reaction
105
Q

Adult Dosages for Tranexamic Acid (IV)

A
  • (IV) 1g slow push over 10 mins, single dose

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