drugs

Question 1

methoxyflurane

Answer 1

Presentation:
3mL

Indications:
- Pain relief

Contraindications:

1. Administered in the last 24 hours
2. Concurrent use of tetracycline antibiotics
3. History of malignant hyperthermia
4. Muscular dystrophy
5. Renal impairment
6. Hypersensitivity

Dose:
Adults: 3mL, 3mL single repeat (max 6mL)
Paeds: 3mL, 3mL single repeat (max 6mL)

Question 2

morphine

Answer 2

Presentation:
10mg in 1mL

Indications:

• Pain relief
• Sedation for intubation

Contraindications:

1. Hypersensitivity
2. Late second stage labour
3. Renal impairment/failure

Other:

• Precaution of nausea/vomiting
• Lasts longer
• Slower onset

Dose:
Adult -
IV: 5mg (0.5mL), 5mg 5/60, consult 20mg
IM: 10mg (1mL), 5mg 15/60 once
IM E/F: 0.1mg/kg single dose

Question 3

fentanyl

Answer 3

Presentation:
100mcg in 2mL

Indications:

• Pain
• Sedation

Contraindications:

1. Hypersensitivity
2. Late second stage labour

Other:

• No nausea/vomiting
• Quicker onset
• Shorter half-life

Dose:
Adult:
IN: 200mcg (4mL), 50mcg 5/60, 400mcg max
IN E/F: 100mcg (2mL), 50mcg 5/60, 200mcg max
IV: 50mcg (1mL), 50mcg 5/60, consult 200mcg
IM: 100mcg (2mL), 50mcg 15/60 once
IM E/F: 1mcg/kg single dose

Paeds
IN: 
10-17kg: 25mcg
18-39kg: 25-50mcg
-> repeat dose 5-10/60, max of 3 doses

Question 4

paracetamol

Answer 4

Presentation:
500mg tablets, 120mg in 5mL oral liquid

Indications:

• Pain
• Headache

Contraindications:

1. Hypersensitivity
2. <1 month old
3. Administered in 4 hours
4. Total dose administered in 24 hours
5. Chest pain associated with ACS

Dose:
Adults: 1000mg (2x tablets)
E/F: 500mg (1x tablet)
Paeds: 15mg/kg oral

Question 5

ondansetron

Answer 5

Presentation:
8mg in 4mL, 4mg tablet

Indications:

• Nausea + vomiting
• Spinal immobilisation
• Injuries indicative of stabilisation

Contraindications:

1. Hypersensitivity
2. Long Q-T syndrome
3. Concurrent apomorphine use
4. Low magnesium or potassium

Dose:
Adults:
IV: 8mg (4mL) single dose
Oral: 4mg tablet, 5-10/60 repeat if needed

Question 6

prochloperazine

Answer 6

Presentation:
12.5mg in 1mL

Indications:

• Nausea + vomiting
• Motion sickness
• Headache
• Vertigo
• Evacuation

Contraindications:

• Hypersensitivity
• Circulatory collapse
• CNS depression
• Patients <21
• Pregnancy

Dose:
12.5mg (1mL) IM

Question 7

normal saline

Answer 7

Presentation:
10mL polyamp, 500-1000mL soft pack

Indications:

• Replacing fluid in volume-depleted patient
• Cardiac arrest secondary to hypovolaemia
• Expand intravascular volume
• Fluid for diluting/administering drugs
• TKVO
• Fluid challenge in unresponsive patients

Dose:
Haemorrhage hypovolaemia: 250mL boules (SBP <70)
Isolated SCI: 10mL/kg (SBP <90)
Traumatic arrest: 20mL/kg 
TBI: 40mL/kg (aim SBP >120)

Question 8

adrenaline

Answer 8

Presentation:
1mg in 1mL, 1mg in 10mL

Indications:

• Cardiac arrest
• Inadequate perfusion
• Bradycardia with poor perfusion
• Anaphylaxis
• Severe asthma
• Croup

Contraindications:
1. Hypovolaemic shock without adequate fluid resus

Dose:
Cardiac arrest: 1mg in 1mL, 10mL N/S flush, 4/60

Question 9

ketamine

Answer 9

Presentation:
200mg in 2mL

Indications:

• Sedation
• Analgesia

Contraindications:
- Suspected non-traumatic brain injury with severe hypertension SBP >180

Dose:
IN: 75mg (0.75mL + 0.1), 50mg 20/60
IN E/F: 50mg (0.5mL + 0.1), 25mg 20/60
IV: consult only