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OSCE Study > Drugs > Flashcards

Drugs Flashcards

1
Q

What are the indications for salbutamol?

A
  1. Respiratory distress with bronchospasm
    - Asthma
    - Severe allergic reactions
    - COPD
    - Smoke inhalation
    - Oleoresin capsicum spray exposure
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2
Q

What are the contraindications for salbutamol?

A

None

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3
Q

What is the dose and timing of Salbutamol?

A

Asthma

Mild/Moderate respiratory distress
- pMDI 4-12 doses @ 20/60 intervals until resolved (4 breaths per dose)

Asthma Severe or unimproved after 20/60

  • Salbutamol 10mg neb
  • Repeat 5mg neb @ 5/60

COPD exacerbation
- Salbutamol 10mg neb

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4
Q

What are the indications for Ipratropium Bromide?

A
  1. Severe respiratory distress associated with bronchospasm

2. Exacerbation of COPD irrespective of severity

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5
Q

What are the contraindications of Ipratropium bromide?

A
  1. Known hypersensitivity to atropine or its derivatives
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6
Q

What is the dose and timing of Ipratropium Bromide?

A

Severe Asthma

- 500mcg neb

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7
Q

What is the action of Dexamethasone?

A

Corticosteroid

  • relieves inflammatory reactions
  • provides immunosuppression
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8
Q

What are the indications for dexamethasone?

A
  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)
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9
Q

What are the contraindications for dexamethasone?

A

Known hypersensitivity

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10
Q

What is the dose and timing of dexamethasone?

A

Severe asthma
- 8mg PO/IV

Stridor
- 8mg IV/IM

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11
Q

What are the actions of GTN?

A
  • reduces preload
  • reduces after load
    Resulting in:
  • reduced myocardial O2 demand
  • Reduced systolic, diastolic, MAP,
  • Mild collateral coronary arterial dilatation may improve blood supply to ischaemic areas of myocardium
  • Mild tachycardia secondary to slight fall in BP
  • Preterm labour: uterine quiescence in pregnancy
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12
Q

What are the indications for GTN?

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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13
Q

What are the contraindications for GTN?

A
  1. Known hypersensitivity
  2. SBP < 110 (tablet)
  3. SBP <90 (patch)
  4. Sildenafil Citrate (Viagra) or Vardenafil (Levitra) administration in the previous 24hrs of Tadalafil (Cialis) administration in the previous 4 days
  5. Heart rate >150
  6. Bradycardia <5 bpm (excluding autonomic dysreflexia)
  7. VT
  8. Inferior STEMI with SBP <160
  9. Right ventricular MI
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14
Q

What is the dose and timing for GTN?

A

APO and ACS same admin

GTN 600mcg SL if SBP >110
or
GTN 300mcg SL if no prev admin, borderline BP or small (<60kg), elderly or frail

Repeat 300mcg or 600mcg SL @ 5 minute intervals titrated to pain or side effects

GTN Patch 50mg (0.4mg/hr)
- Remove if BP <90

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15
Q

What are the actions of Adrenaline?

A
  • increases HR by increasing SA node firing rate
  • increases conduction velocity and contractility
  • causes bronchodilation
  • causes peripheral constriction
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16
Q

What are the indications for Adrenaline?

A
  1. Cardiac arrest - VF, VT, Aystole, PEA
  2. Inadequate perfusion
  3. Bradycardia with poor perfusion
  4. Anaphylaxis
  5. Severe asthma - imminent life threat not responding to nebulised therapy, or unconscious with no BP
  6. Croup
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17
Q

What are the contraindications of Adrenaline?

A
  1. Hypovolaemic shock without adequate fluid replacement
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18
Q

What is the dose and timing for Adrenaline?

A

Asthma (Inadequate response to salbutamol and ipratropium)

  • Adrenaline 500mcg IM (1:1000)
  • Repeat 500mcg IM @ 5/60 (Max 1.5mg)
  • Consult with Clinician for IV adrenaline if Thunderstorm asthma (unresponsive to at least 1 dose of IM adrenaline) or Orolingual oedema secondary to tPA infusion

Medical Cardiac Arrest
- 1mg IV every second cycle (or @ 4/60 intervals)

Stridor

  • 5mg neb
  • consult for repeat doses

Anaphylaxis
- 500mcg IM - repeat @ 5/60 intervals as requred

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19
Q

What is the pharmacology/action for aspirin?

A
  • 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 synthesis of prostaglandins - anti-inflammatory actions
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20
Q

Indications for aspirin?

A
  1. ACS
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21
Q

What are the contraindications for Aspirin?

A

BACHS

  1. Bleeding disorders
  2. Actively bleeding peptic ulcers
  3. Chest pain associated with Psycho-stimulant OD if SBP >160
  4. Hypersensitivity to aspirin/salicylates
  5. Suspected dissecting aortic aneurysm
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22
Q

What is the dose and timing for Aspirin?

A

300mg PO Aspirin if not already administered

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23
Q

What is the pharmacology of Heparin?

A
  1. Anticoagulant

2. Inactivates clotting factors by binding to antithrombin

24
Q

What are the indications of Heparin?

A
  1. Acute STEMI
25
Q

What are the contraindications for Heparin?

A

SHARK BO

  1. Severe hepatic impairment/ disease
  2. History of heparin induced thrombocytopenia
  3. Acute bleeding
  4. Recent trauma or surgery in last 3/52
  5. Known allergy or hypersensitivity
  6. Bleeding disorders
  7. Oral anticoagulants
    known allergy or hypersensitivity
26
Q

What is the dose and timing for Heparin?

A

Heparin IV bolus 4000 IU
Repeat IV bolus 1000 IU at 1 hour intervals
Must call CCS prior to administering Heparin

27
Q

What is the pharmacology of Normal saline?

A
  • Isotonic crystalloid

- Increases the volume of the intravascular compartment

28
Q

What are the indications of Normal Saline?

A
  1. Fluid replacement in volume depleted patients
  2. Cardiac arrest secondary to hypovolaemia or where the patient may be fluid responsive
  3. To expand intravascular volume in the non-cardiac, non-hypovolaemic hypotensive patient (e.g. anaphylaxis, burns, sepsis)
  4. As a fluid challenge in unresponsive, non-hypovolaemic, hypotensive patients other than LVF e.g. Asthma
  5. Fluid for diluting and administering IV drugs
  6. Fluid TKVO for IV admin of emergency drugs
29
Q

What are the contraindications of Normal Saline?

A

None

30
Q

What is the dose and timing for Normal Saline?

A

Medical arrest (if pt is suspected hypovolaemia, anaphylaxis or asthma - NaCl IV 20ml/kg + NaCl TKVO

31
Q

What is the pharmacology of paracetamol?

A

Analgesia and antipyretic

32
Q

What are the indications of Paracetamol?

A
  1. Mild pain

2. Headache

33
Q

What are the contraindications of paracetamol?

A

CHANT

  1. Chest pain in suspected ACS
  2. Hypersensitivity
  3. Already administered in past 4 hours
  4. Neonate (<1 month old)
  5. Total intake exceeding 4 grams in past 24/24
34
Q

What is the dose and timing for Paracetamol?

A

1g PO
or
500mg (<60kg/frail/elderly/malnourished/liver disease)

Max dose 4g per day

35
Q

What are the actions of Fentanyl?

A

Synthetic opioid analgesia

Causes
- CNS and resp depression

36
Q

What are the indications of Fentanyl?

A
  1. Sedation to facilitate - RSI, maintain intubation, transthoracic pacing, synchronised cardioversion
  2. CPR interfering patient - ALS
  3. Analgesia
    - History of hypersensitivity or allergy to morphine
    - Known renal impairment/failure
    - short duration of action desirable
    - Hypotension
    - Nausea and/or vomiting
    - Severe headache
37
Q

Contraindications of fentanyl?

A
  1. History of hypersensitivity

2. Late second stage of labour

38
Q

What is the dose and timing for fentanyl?

A

Pain relief
IV
- Up to 50mcg at 5 minute intervals up to 200mcg (consult after max dose)

IN
- 200mcg
- Repeat up to 50mcg at 5 minute intervals if required
- Max dose 400mcg IN
or
- 100mcg (<60kg/frail/elderly)
- Repeat up to 50mcg at 5 min intervals if required (max 200mcg IN)

IM
- 100mcg
- repeat 50mcg after 15 mins if required (once only)
or
- 1mcg/kg (<60kg/frail/elderly)
- No repeat dose

Patient interfering with CPR

  • 100mcg IV every 1-2mins (no max dose)
  • if no IV access Fentanyl 200mcg IM single dose
39
Q

What is the action of morphine?

A

Opioid analgesic

  • CNS depression
  • Resp depression
  • Depression of cough reflex
  • Vasodilation
40
Q

What are the primary indications for morphine?

A
  1. Pain releif

2. Sedation to facilitate and maintain intubation (where fentanyl not appropriate for RSI)

41
Q

What are the contraindications for morphine?

A
  1. History of hypersensitivity
  2. Renal impairment/failure
  3. Late second stage of labour
42
Q

What is the dose and timing of morphine?

A

IV

  • Up to 5mg at 5 minute intervals
  • ALS consult after 20mg
IM
- 10mg
- Repeat 5mg after 15 mins if required (once only)
or
0.1mg/kg (<60kg/frail/elderly)
- No repeat dose
43
Q

What is the action for Ketamine?

A

Anaesthetic agent

44
Q

What are the indications of Ketamine?

A
  • Intubation
  • Analgesia
  • Sedation
45
Q

What are the contraindications for Ketamine?

A
  • Suspected non-traumatic brain injury with severe hypertension (SBP>180)
46
Q

What is the dose and timing of Ketamine?

A 
IN 
- 75mg
- repeat 50mg at 20/60 intervals
- No max dose
or 
- 50mg (<60kg/frail/elderly)
- Repeat 25mg at 20min intervals
- no max dose
  • IN add 0.1ml to required volume to account for dead space in MAD)

ALS must consult if wanting to give IV analgesic dose

  • 200mg in 20mls
  • 10-20mg at 5-10 min intervals
47
Q

What is the action of Methoxyflurane?

A

Inhalational analgesia

48
Q

What are the indications for Methoxyflurane?

A
  1. Pain releif
49
Q

What are the contraindications for Methoxyflurane?

A

MMERC

  1. Malignant hyperthermia (personal or family hx)
  2. Muscular dystrophy
  3. Exceeding total dose 6ml in 24/24
  4. Renal disease/impairment
  5. Concurrent use of tetracycline antibiotics
50
Q

What is the dose and timing for Methoxyflurane?

A
  • Initial dose of 3ml - will provide 25 mins of analgesia
  • It may be followed by an additional 3ml if required
  • Analgesia commences after 8-10 breaths and lasts for 3-5 minutes once discontinued.
51
Q

What are the indications for ondansetron?

A
  1. Undifferentiated nausea and vomiting
  2. Prophylaxis for spinally immobilised or eye injured patients
  3. Vestibular nausea in patients <21 years old
52
Q

What are the contraindications of Ondansetron?

A

HHAP

  1. Hypersensitivity
  2. Hypokalaemia or hypomagnesaemia
  3. Apomorphine use
  4. Prolonged QT syndrome
53
Q

What is the dose and timing of ondansetron?

A

Undifferentiated nausea and vomiting

  • 4mg PO
  • repeat 4mg after 5-10 mins (Max 8mg)

If pt unable to tol PO
- 8mg IV

54
Q

What is the class of Prochlorperazine?

A

Anti-emetic

55
Q

What are the indications for Prochlorperazine?

A
  1. Treatment of prophylaxis of nausea/vomiting for
    - motion sickness
    - planned aeromedical evacuation
    - Known allergy or C/I to ondansetron administration
    - Headache irrespective of nausea/vomiting
    - Vertigo
56
Q

What are the contraindications for Prochlorperazine?

A

PPPCC

  1. Previous hypersensitivity
  2. Patients <21 years of age
  3. Pregnancy
  4. Circulatory collapse (cool, pale, clammy skin, tachycardia, hypotension)
  5. CNS depression
57
Q

What is the dose and timing for Prochlorperazine?

A
  • 12.5mg IM

- once

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