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Bachelor of Paramedic Science > Drugs > Flashcards

Drugs Flashcards

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1
Q

Adrenaline adult IM dose for anaphylaxis or severe allergic reaction

A

500 microg
Repeated at 5 minute intervals
No max dose

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2
Q

Adrenaline adult IV dose for cardiac arrest

A

1 mg
Repeated at 3-5 minute intervals
No max dose

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3
Q

Adrenaline adult IM dose for severe life-threatening bronchospasm or silent chest (Pt must only be able to speak in single words and/or have haemodynamic compromise and/or ALOC)

A

500 microg
Repeated at 5 minute intervals
No maximum dose

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4
Q

Adrenaline Contraindications

A

Nil

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5
Q

Adrenaline Drug Class

A

Sympathomimetic

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6
Q

Adrenaline Paediatric NEB Dose for Anaphylaxis or Severe Allergic Reaction

A

5mg Single dose only

May be administered for upper airway obstruction that is refractory to 3 x IM adrenaline injections

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7
Q

Adrenaline paediatric 1 - 5 yrs IM dose for anaphylaxis or severe allergic reaction

A

150 mcg
every 5 mins
no max dose

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8
Q

Adrenaline paediatric 6mths - 1yr IM dose for anaphylaxis or severe allergic reaction

A

100 mcg
every 5 mins
no max dose

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9
Q

Adrenaline paediatric <6mths IM dose for anaphylaxis or severe allergic reaction

A

50 mcg
every 5 mins
no max dose

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10
Q

Adrenaline paediatric ≥6yrs IM dose for anaphylaxis or severe allergic reaction

A

300 mcg every
5 mins
no max dose

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11
Q

Adrenaline Paediatric 1 - 5yrs IM Dose for Severe Life-threatening Bronchospasm or Silent Chest (pts must only be able to speak in single words and/or have haemodynamic compromise and/or ALOC)

A

150 mcg
every 5 mins
no max dose

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12
Q

Adrenaline Paediatric 6mths - 1yr IM Dose for Severe Life-threatening Bronchospasm or Silent Chest (pts must only be able to speak in single words and/or have haemodynamic compromise and/or ALOC)

A

100 mcg
every 5 mins
no max dose

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13
Q

Adrenaline Paediatric <6mths IM Dose for Severe Life-threatening Bronchospasm or Silent Chest (pts must only be able to speak in single words and/or have haemodynamic compromise and/or ALOC)

A

50 mcg
every 5 mins
no max dose

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14
Q

Adrenaline Paediatric ≥6yrs IM Dose for Severe Life-threatening Bronchospasm or Silent Chest (pts must only be able to speak in single words and/or have haemodynamic compromise and/or ALOC)

A

300 mcg
every 5 mins
no max dose

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15
Q

Adrenaline Indications

A

Cardiac arrest
Anaphylaxis OR severe allergic reaction
Severe life-threatening bronchospasm OR silent chest (patients must only be able to speak in single words AND/OR have haemodynamic compromise AND/OR an ALOC)
Croup (moderate to severe)

CCP only
Shock unresponsive to adequate fluid resuscitation
Bradycardia with poor perfusion

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16
Q

Adrenaline adult NEB dose for anaphylaxis or severe allergic reaction

A

5mg
Single dose only

May be administered for upper airway obstruction that is refractory to 3 X IM adrenaline injections

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17
Q

Adrenaline Paediatric Newly Born IV Dose for Cardiac Arrest

A

50 microg
Repeated every 3 - 5 mins
No max dose

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18
Q

Adrenaline Paediatric ≥10kg (≥1yr) IV Dose for Cardiac Arrest

A

10 microg/kg
Repeated every 3 - 5 mins
No max dose

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19
Q

Adrenaline Paediatric <10kg (excl newly born) IV Dose for Cardiac Arrest

A

100 microg
Repeated every 3 - 5 mins
No max dose

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20
Q

Adrenaline Precautions

A

Concurrent MAOI therapy

Quetiapine toxicity

Hypertension

Hypovolaemic shock

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21
Q

Adrenaline Paediatric NEB Dose for Croup

A

5 mg

Single dose only

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22
Q

Adrenaline Presentation

A

Ampoule, 1 mg/1 mL (1:1,000) adrenaline

Ampoule, 1 mg/10 mL (1:10,000) adrenaline

Prefilled syringe EpiPen auto-injector, 300 microg adrenaline (yellow)

Prefilled syringe Epi Pen auto-injector, 150 microg adrenaline (green)

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23
Q

Adrenaline side effects

A

anxiety

pupil dilation

palpitations/tacharrhythmias

hypertension

tremor

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24
Q

Adrenaline Timing

A

Onset
30 seconds IV
60 seconds IM

Duration
5 - 10 minutes

Half-Life
2 minutes

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25
Q

Analgesic Pain Levels

A

1 - 4 Mild

5 - 7 Moderate

8 - 10 Severe

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26
Q

Aspirin Adult PO Dose for:

Suspected ACS

A

300 mg
Chewed and followed by a small sip of water (where possible)
Pts who have had <300mg in the prev 24hrs should be administered a dose totaling 300-450mg

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27
Q

Aspirin Adult PO Dose for:

Acute cardiogenic pulmonary oedema

A

300 mg
Chewed and followed by a small sip of water (where possible)
Pts who have had <300mg in the prev 24hrs should be administered a dose totaling 300-450mg

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28
Q

Aspirin contraindications

A

Allergy AND/OR Adverse Drug Reaction to aspirin OR any non-steroidal anti-inflammatory drug (NSAID)

Bleeding OR clotting disorders (e .g. haemophilia)

Current GI bleeding OR peptic ulcers

Patient < 18 years

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29
Q

Aspirin Drug Class

A

antiplatelet

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30
Q

Aspirin indications

A

Suspected ACS

Acute cardiogenic pulmonary oedema

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31
Q

Aspirin precautions

A

Possible aortic aneurysm or any other condition that may require surgery
Concurrent anticoagulant therapy (e.g. warfarin)
History of GI bleeding or peptic ulcers
Pregnancy

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32
Q

Aspirin Presentation

A

tablet (white), 300 mg aspirin

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33
Q

Aspirin Routes of Administration

A

PO

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34
Q

Aspirin Side Effects

A

NSAID induced bronchospasm

epigastric pain/discomfort

gastritis

GI bleeding

nausea and/or vomiting

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35
Q

Aspirin Timing

A

Onset
≈ 10 minutes (variable)

Duration
≈ 1 week (antiplatelet)

Half-Life
3. 2 hours (300 - 650 mg)

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36
Q

Calculating Volume from Dose

A

Calculating Volume from Dose

V required = (strength required (SR) / stock strength (SS)) x volume of stock

or; sunrise over sunset

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37
Q

Ceftriaxone Adult IV Dose for Suspected Meningococcal Septicaemia (with non-blanching petechial and/or purpuric rash)

A

2 g
Slow push over 5 minutes
Single dose only
Syringe prep: Reconstitute 2 g of ceftriaxone with 18.8 m water for injection in a 20 mL syringe to achieve a final concentration of 2 g/20 mL. Ensure syringe is appropriately labelled.

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38
Q

Ceftriaxone Contraindications

A

Absolute

  • Allergy and/or adverse drug reaction to cephalosporin antibiotics
  • Known immediate or severe hypersensitivity to penicillin or carbapenem based drugs

Relative (requires consultation with the QAS Clinical Consultation and Advice Line)

  • Pts < 1mth
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39
Q

Ceftriaxone Drug Class

A

Antibiotic

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40
Q

Ceftriaxone Paediatric IM Dose for Suspected Meningococcal Septicaemia (with non-blanching petechial and/or purpuric rash)

A

QAS clinical consultation and advice line consultation and approval required in all Pts <1 mth

50mg/kg (rounded up to nearest 5kg)
total max dose 2g
single dose only

  • Syringe prep: reconstitute 1g of ceftriaxone with 2.4mL water for injection, withdraw the required dose from the vial using a 3 mL syringe**
  • Footnote For paeds over 20kg, clinicians must advising the hospital that only a partial dose has been administered*
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41
Q

Ceftriaxone Indications

A

Suspected meningococcal septicaemia (with a non-blanching petechial and/or purpuric rash)

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42
Q

Ceftriaxone Adult IM Dose for Suspected Meningococcal Septicaemia (with non-blanching petechial and/or purpuric rash)

A 
2 g (2 x 1 g IM injections)
Single dose only
*Syringe prep: Reconstitute two separate vials each containing 1 g of ceftriaxone with 2.4mL water for injection in a 3 ml syringe to achieve a final concentraion of 1 g/3 mL*
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43
Q

Ceftriaxone Paediatric IV >20kgs Dose for Suspected Meningococcal Septicaemia (with non-blanching petechial and/or purpuric rash)

A

Single dose only

Syringe prep: Reconstitute 2 g of ceftriaxone with 18.8 mL water for injection in 20 mL syringe to achieve a concentration of 100 mg/mL (2 g/20 mL). Withdraw required dose leaving any excess ceftriaxone in the vial.

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44
Q

Ceftriaxone IV Paediatric ≤20kgs Dose for Suspected Meningococcal Septicaemia (with non-blanching petechial and/or purpuric rash)

A

QAS clinical consultation and advice line consultation and approval required in all Pts ≤1 mth.

Single dose only

Syringe prep: Reconstitute 1 g of ceftriaxone with 9.4 mL water for injection in 10 mL syringe to achieve a concentration of 100 mg/mL (1 g/10 mL). Withdraw required dose leaving any excess ceftriaxone in the vial.*

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45
Q

Ceftriaxone Precautions

A

any allergy or hypersenitivity to penicilin or carbapenem (isolated minor drug rash attributed to penicillin does not contrindicate the use of cefriaxone)

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46
Q

Ceftriaxone Presentation

A

Vial (powder), 1 g ceftriaxone

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47
Q

Ceftriaxone Routes of Administration

A

IM
IV
IO

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48
Q

Ceftriaxone Side Effects

A

Pain and/or inflammation at the injection site

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49
Q

Ceftriaxone Timing

A

Onset
dose/route variable

Duration
approx 1 day

Half-Life
6 - 9 hours

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50
Q

Common Pain Assessment Tools

A

number rating scale (0-10 severity)

verbal rating scales (description - mild/moderate/severe)

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51
Q

Dexamethasone Contraindications

A

Allergy AND/OR Adverse Drug Reaction

<6 months OR >8 years of age (consultation required)

Steroid administration within 4 hours

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52
Q

Dexamethasone Drug Class

A

corticosteroid

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53
Q

Dexamethasone Indications

A

Croup

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54
Q

Dexamethasone Paediatric PO Dose for Croup for children 6 months to 6 years

A

Can be repeated once if child spits it out

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55
Q

Dexamethasone Precautions

A

Nil in this setting

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56
Q

Dexamethasone Presentation

A

Vial, 8mg/2mL dexamethasone

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57
Q

Dexamethasone Routes of Administration

A

PO

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58
Q

Dexamethasone Side Effects

A

Nil

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59
Q

Dexamethazone Timing

A 
**Onset**
30 mins (croup)

Duration
72 hours

Half-Life
4-5 hours (children)

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60
Q

Drug Checks

A

Right pt - Pt doesn’t have any: Allergies, Contras, Precautions, Meds that may interact, Age appropriate

Right drug - Indication - the righ drug to treat this presentation

Right dose - Right dose, expressed as mass only, e.g. “Five milligrams of midazolam”, consider also noting timing & max dose

Right route - Clearly stated, and dose must be correct for this route

Right Strength/Presentation - Mass in volume as provided in the drug kit

Right Appearance & Drug Safety Check - The ampoule is unbroken, does not leak, and the liquid is clear and free of floaties
* The drug is <drug>, <mass>, and expires <sometime></sometime></mass></drug>

E.g.: “This bag of sodium chloride 0.9% is undamaged, does not leak when squeezed, and the fluid is clear and
uncontaminated. Drug check: Sodium chloride 0.9%, 500mL bag, expires 10/2023”
* E.g.: “Ampoule is unbroken with clear liquid; adrenaline; 1mg in 1mL; expires 10/2023”

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61
Q

Fentanyl adult <70yrs IM dose for:
Significant Pain
Autonomic Dysreflexia (with SBP >160 mmHg)

A

25-100 microg
Repeated up to 50 microg every 10 mins
Total max dose 200 microg (or MME)

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62
Q

Fentanyl adult <70yrs IV dose for:
Significant Pain
Autonomic Dysreflexia (with SBP >160 mmHg)

A

25-50 microg
Repeated up to 50 microg every 5 mins
Total max dose 200 microg (or MME)

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63
Q

Fentanyl Adult Subcut Dose for Significant Pain

A

QAS clinical consultation and advice line approval required in all situations

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64
Q

Fentanyl Contraindications

A

Allergy AND/OR Adverse Drug Reaction

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65
Q

Fentanyl Drug Class

A

narcotic analgesic

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66
Q

Fentanyl Adult ≥70yrs/cachectic or frail IM dose for:
Significant Pain
Autonomic Dysreflexia (with SBP >160 mmHg)

A

25-50 microg
Repeated up to 50 microg every 10 mins
Total max dose 100 microg (or MME)

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67
Q

Fentanyl paediatric IM dose for significant pain

A

≥1yr - 1-2 microg/kg
Single max dose 50 microg
Total max dose 2 microg/kg (or MME)

Less than 1yr - QAS clinical consultation and advice line approval required in all situations

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68
Q

Fentanyl Indications

A

significant pain

autonomic dysreflexia (with SBP > 160 mmHg)

Sedation - CCP only

Induction for rapid sequence intubation - CCP only

Note: Morphine is the preferred narcotic agent except:

  • allergy and or KSAR to morphine
  • haemodynamic instability
  • known/suspected kidney disease
  • when NAS narcotic administration is preferred
  • suspected ACS
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69
Q

Fentanyl Adult ≥70yrs/cachectic or frail IV dose for:

significant pain

autonomic dysreflexia (with SBP >160 mmHg)

A

25 microg
Repeated up to 25 microg every 5 mins
Total max dose 100 microg (or MME)

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70
Q

Fentanyl paediatric IV dose for significant pain

A

≥1yr - 1 microg/kg
Single max dose 25 microg
Repeated every 5 mins at 0.5 microg/kg (max 25 microg)
Total max dose 2 microg/kg (or MME)

<1yr - QAS clinical consultation and advice line approval required in all situations

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71
Q

Fentanyl Adult ≥70yrs/cachectic or frail NAS Dose for:

Significant Pain

Autonomic Dysreflexia (SBP >160 mmHg)

A

25-50 microg
Repeated up to 50 microg every 10 mins
Total max dose 100 microg (or MME)

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72
Q

Fentanyl Adult <70 NAS Dose for:

Significant Pain

Autonomic Dysreflexia (SBP >160 mmHg)

A

50-100 microg
Repeated up to 100 microg every 10 mins
Total max dose 200 microg (or MME)

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73
Q

Fentanyl paediatric NAS dose for significant pain

A

≥1yr - 1.5 microg/kg
Single max dose 50 microg
Repeated once at 1 microg/kg at 10 mins
Total max dose 100 microg (or MME)

<1yr - QAS clinical consultation and advice line approval required in all situations

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74
Q

Fentanyl Precautions

A

known addiction to narcotics

current MAOI therapy

respiratory tract burns

respiratory depression and/or failure

hypotension

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75
Q

Fentanyl Presentation

A

ampoule, 100 microg/2 mL fentanyl

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76
Q

Fentanyl Routes of Administration

A

IM

IV

NAS

SUBCUT

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77
Q

Fentanyl Side Effects

A

drowsiness

pin point pupils

respiratory depression

muscular rigidity (particularly muscles of respiration)

hypotension

bradycardia

nausea and/or vomiting

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78
Q

Fentanyl paediatric SUBCUT dose for significant pain

A

QAS clinical consultation and advice line approval required in all situations

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79
Q

Fentanyl Timing

A

Onset
≤3 minutes

Duration
30-60 minutes

Half-life
2-3 hours

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80
Q

Glucagon Adult IM Dose - Refractory anaphylaxis with persistent hypotension/shock (unresponsive to 3 x IM adrenaline injections and adequate fluid challenges)

A

May be administered when paramedics are unable to achieve IV access.

1mg
Single dose only.
Syringe preparation: Reconstitute 1 mg of glucagon with 1 ml of water for injection in a 3 ml syringe to achieve a final concentration of 1 mg/ 1 ml.

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81
Q

Glucagon Adult IM Dose - Symptomatic hypoglycaemia

A

1mg
Single dose only
Syringe preparation: reconstitute 1 mg glucagon with 1 mL of water for injection in a 3 mL syringe to achieve a final concentration of 1 mg/1 mL

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82
Q

Glucagon Contraindications

A

Allergy AND/OR adverse drug reaction

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83
Q

Glucagon Drug Class

A

Hyperglycaemic

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84
Q

Glucagon Paediatric IV Dose for refractory anaphylaxis with persistent hypotension/shock (unresponsive to 3 x IM adrenaline injections and adequate fluid) for children ≤25kg

A

0.5 mg
Single dose only
Syringe prep: Reconstitute 1 mg of glucagon with 1 mL water for injection in 3 mL syinge to achieve final concentration of 1 mg/1 mL. Decant 0.5 mL of the prepared solution to achieve a final concentration of 0.5 mg/0.5mL.1 mg

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85
Q

Glucagon Paediatric IV Dose for refractory anaphylaxis with persistent hypotension/shock (unresponsive to 3 x IM adrenaline injections and adequate fluid) for children >25kg

A

1 mg
Single dose only
Syringe Prep: Reconstitute 1 mg of glucagon with 1 mL water for injection in a 3 mL syringe to achieve a final concentration of 1 mg/1 mL.

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86
Q

Glucagon Indications

A

Symptomatic hypoglycaemia (with the inability to self-administer oral glucose)

Refractory anaphylaxis with persistent hypotension/shock (unresponsive to 3 x IM adrenaline injections and adequate fluid challenges)

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87
Q

Glucagon Paediatric IM Dose for refractory anaphylaxis with persistent hypotension/shock (unresponsive to 3 x IM adrenaline injections and adequate fluid) for children >25kg

A

May be administered when paramedics are unable to achieve IV access

1 mg
Single dose only
Syringe Prep: Reconstitute 1 mg of glucagon with 1 mL water for injection in a 3 mL syringe to achieve a final concentration of 1 mg/1 mL.

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88
Q

Glucagon Paediatric IM Dose for refractory anaphylaxis with persistent hypotension/shock (unresponsive to 3 x IM adrenaline injections and adequate fluid) for children ≤25kg

A

May be administered when paramedics are unable to achieve IV access

0.5 mg
Single dose only
Syringe prep: Reconstitute 1 mg of glucagon with 1 mL water for injection in 3 mL syringe to achieve final concentration of 1 mg/1 mL. Decant 0.5 mL of the prepared solution to achieve a final concentration of 0.5 mg/0.5mL.

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89
Q

Glucagon Paediatric IM Dose for Symptomatic hypoglycaemia (with the inability to self-administer oral glucose) for children ≤25kg

A

0.5 mg
Single dose only
Syringe preparation: Reconstitute 1 mg of glucagon with 1 mL of water for injection in a 3 mL syringe to achieve a final concentration of 1 mg/1 mL. Decant 0.5 mL of the prepared solution to achieve a final concentration of 0.5 mg/1 mL

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90
Q

Glucagon Paediatric IM Dose for Symptomatic hypoglycaemia (with the inability to self-administer oral glucose) for children >25kg

A

1 mg
Single dose only
Syringe preparation: Reconstitute 1 mg of glucagon with 1 mL of water for injection in a 3 mL syringe to achieve a final concentration of 1 mg/1 mL

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91
Q

Glucagon Precautions

A

Nil

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92
Q

Glucagon Presentation

A

Vials (powder and solvent), 1mg glucagon

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93
Q

Glucagon Routes of Administration

A

IM

IV

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94
Q

Glucagon Side Effects

A

Nil

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95
Q

Glucagon Timing

A

Onset
4-7 minutes

Duration
Variable

Half-Life
3-6 minutes

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96
Q

Glucagon Adult IV Dose - Refractory anaphylaxis with persistent hypotension/shock (unresponsive to 3 x IM adrenaline injections and adequate fluid challenges)

A

1 mg
Single dose only.
Syringe preparation: Reconstitute 1 mg of glucagon with 1 ml of water for injection in a 3 ml syringe to achieve a final concentration of 1 mg/1 ml.

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97
Q

Glucose 10% Adult IV Dose

A

15g (150mL)
Repeated at 10g (100 mL) boluses every 5 minutes until BGL >4.0mmol/L

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98
Q

Glucose 10% Adult INF Dose

A

15g (150mL)
Repeated at 10g (100 mL) boluses every 5 minutes until BGL >4.0mmol/L

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99
Q

Glucose 10% Contraindications

A

Nil

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100
Q

Glucose 10% Drug Class

A

hyperglycaemic

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101
Q

Glucose 10% Indications

A

Symptomatic hypoglycaemia (with the inability to self-administer oral glucose)
Unconscious hypoglycaemia - EACP2 only

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102
Q

Glucose 10% Paediatric IV Dose

A

0.25 g/kg (2.5 mL/kg)
Repeated at 0.1 g/kg (1 mL/kg) boluses every 5 mins until BGL > 4.0 mmol/L

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103
Q

Glucose 10% Paediatric INF Dose

A

0.25 g/kg (2.5 mL/kg)
Repeated at 0.1 g/kg (1 mL/kg) boluses every 5 mins until BGL > 4.0 mmol/L

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104
Q

Glucose 10% Precautions

A

Hyperglycaemia

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105
Q

Glucose 10% Presentation

A

Viaflex plastic container, 250 mL glucose monohydrate 10%

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106
Q

Glucose 10% Routes of Administration

A

INF

IV

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107
Q

Glucose 10% Side Effects

A

Nil

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108
Q

Glucose 10% Timing

A

Onset
Rapid

Duration
N/A

Half-Life
N/A

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109
Q

Glucose Gel Adult PO Dose

A

15g
Repeated once at 15 minutes if BGL ≤ 4mmol/L
Total maximum dose 30g

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110
Q

Glucose Gel Contraindications

A

Unconsciousness

Patients with difficulty swallowing

Patients < 2 years

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111
Q

Glucose Gel Drug Class

A

hyperglycaemic

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112
Q

Glucose Gel Indications

A

Symptomatic hypoglycaemia (with the ability to self-administer oral glucose)

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113
Q

Glucose Gel Paediatric PO Dose

A

≥2 yrs - 15 g
Repeated once at 15 mins if BGL ≤4 mmol/L
Total max dose 30 g

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114
Q

Glucose Gel Precautions

A

Nil

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115
Q

Glucose Gel Presentation

A

Tube, 15g Glucose (Glutose 15)

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116
Q

Glucose Gel Routes of Administration

A

PO

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117
Q

Glucose Gel Side Effects

A

nausea and/or vomiting

diarrhoea

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118
Q

Glucose Gel Timing

A

Onset
≈ 10 mins

Duration
Variable

Half-Life
N/A

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119
Q

Glyceryl Trinitrate (GTN) Adult Subling Dose - Acute Cardiogenic Pulmonary Oedema

A

400 microg
Repeated at 5 min intervals
No maximum dose

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120
Q

Glyceryl Trinitrate (GTN) Adult Subling Dose - Suspected ACS (with pain)

A

400 microg
Repeated at 5 min intervals
No maximum dose

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121
Q

Glyceryl Trinitrate (GTN) Adult Subling Dose:
Autonomic Dysreflexia (SBP >160 mmHG)

A

400 microg
Repeated at 5 min intervals
No maximum dose

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122
Q

Glyceryl Trinitrate (GTN) Adult Subling Dose:

Irukandji Syndrome (SBP > 160 mmHG)

A

400 microg
Repeated at 5 min intervals
No maximum dose

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123
Q

Glyceryl Trinitrate (GTN) Contraindications

A

allergy and/or adverse drug reaction

acute CVA

head trauma

heart rate < 50 or > 150 beats per minute

systolic BP < 100 mmHg

phosphodiesterase 5 inhibitor medication administration:
- sildenafil OR vardenafil in the previous 24 hours
- tadalafil in the previous 48 hours

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124
Q

Glyceryl Trinitrate (GTN) Drug Class

A

Vasodilator

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125
Q

Glyceryl trinitrate (GTN) Indications

A

Suspected ACS (with pain)

Acute cardiogenic pulmonary oedema

Autonomic dysreflexia (with a systolic BP >160 mmHg)

Irukandji syndrome (with a systolic BP >160 mmHg)

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126
Q

Glyceryl Trinitrate (GTN) Paediatric Subling Dose for:

Irukandji syndrome (with a SBP >160mmHg)

A

QAS clinical consultation and advice line approval required in all situations

Note: In all other instances, QAS officers are NOT authorised to administer GTN to paediatric Pts

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127
Q

Glyceryl Trinitrate (GTN) Paediatric Subling Dose for:

Autonomic dysreflexia (with a SBP >160 mmHg)

A

QAS clinical consultation and advice line approval required in all situations

Note: In all other instances, QAS officers are NOT authorised to administer GTN to paediatric Pts

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128
Q

Glyceryl Trinitrate (GTN) Precautions

A

cerebral vascular disease

risk of hypotension and/or syncope

inferior AMI

intoxication (GTN effects are enhanced)

Phosphodiesterase 5 inhibitor medication administration (eg tadalafil, sildenafil, vardenafil) administration in the previous 4 days

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129
Q

Glyceryl Trinitrate (GTN) Presentation

A

Spray (sublingual), 400 microg/dose, 200 doses, nitrolingual pump spray

Ampoule, 50 mg/10mL glyceryl trinitrate

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130
Q

Glyceryl Trinitrate (GTN) Routes of Administration

A

SUBLING

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131
Q

Glyceryl Trinitrate (GTN) Side Effects

A

vascular headaches

dizziness

syncope

hypotension

reflex tachycardia

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132
Q

Glyceryl Trinitrate (GTN) Timing

A

Onset
≤2 minutes

Duration
20 - 30 minutes

  • *Half Life**
    5. 5 minutes
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133
Q

Hydrocortisone Drug Class

A

corticosteroid

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134
Q

Hydrocortisone Adult IM Dose for:

Suspected, or at risk of, an acute adrenal insufficiency (adrenal crisis)

A

100 mg
Single dose only

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135
Q

Hydrocortisone Adult IM Dose for:

Asthma (excluding mild)

A

100 mg
Single dose only

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136
Q

Hydrocortisone Adult IM Dose for:

Acute Exacerbation of COPD

A

100 mg
Single dose only

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137
Q

Hydrocortisone Adult IM Dose for Refractory Anaphylaxis with Persistent Wheeze

A

200 mg
Single dose only

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138
Q

Hydrocortisone Contraindications

A

Allergy AND/OR Adverse Drug Reaction

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139
Q

Hydrocortisone IV Adult Dose for:

Asthma (excluding mild)

A

100 mg
Slow push over 1 minute
Single dose only

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140
Q

Hydrocortisone IV Adult Dose for:

Acute Exacerbation of COPD

A

100 mg
Slow push over 1 minute
Single dose only

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141
Q

Hydrocortisone IV Adult Dose for:

Suspected, or at risk of, an acute adrenal insufficiency (adrenal crisis)

A

100 mg
Slow push over 1 minute
Single dose only

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142
Q

Hydrocortisone Indications

A

Asthma (excluding mild)

Acute exacerbation of COPD (with evidence of respiratory distress)

Refractory anaphylaxis with persistent wheeze (and unresponsive to 3 x IM adrenaline (epinephrine))

Suspected, or at risk of, an acute adrenal insufficiency (adrenal crisis)

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143
Q

Hydrocortisone Adult IV Dose for Refractory Anaphylaxis with Persistent Wheeze

A

200mg
Slow push over 1 minute
Single dose only

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144
Q

Hydrocortisone Paediatric IV Dose for:

Asthma (excluding mild)

A

4 mg/kg
Slow push over 1 minute
Single dose only
Not to exceed 100 mg

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145
Q

Hydrocortisone Paediatric IV Dose

Refractory anaphylaxis with persistent wheeze (and unresponsive to 3 x IM adrenaline)

A

4 mg/kg
Slow push over 1 minute
Single dose only
Not to exceed 100

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146
Q

Hydrocortisone Paediatric >10yrs IV Dose for Suspected, or at risk of, an acute adrenal insufficiency (adrenal crisis)

A

100 mg
Slow push over 1 minute
Single dose only

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147
Q

Hydrocortisone Paediatric 0 to 4yrs IV Dose for Suspected, or at risk of, an acute adrenal insufficiency (adrenal crisis)

A

25 mg
Slow push over 1 minute
Single dose only

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148
Q

Hydrocortisone Paediatric 5 - 10yrs IV Dose for Suspected, or at risk of, an acute adrenal insufficiency (adrenal crisis)

A

50 mg
Slow push over 1 minute
Single dose only

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149
Q

Hydrocortisone Paediatric IM Dose for:

Asthma (excluding mild)

A

4 mg/kg

Single dose only, not to exceed 100 mg

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150
Q

Hydrocortisone Paediatric IM Dose for:

Refractory anaphylaxis with persistent wheeze (and unresponsive to 3 x IM adrenaline)

A

4 mg/kg
Single dose only
Not to exceed 100 mg

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151
Q

Hydrocortisone Paediatric >10yrs IM Dose for:

Suspected, or at risk of, an acute adrenal insufficiency (adrenal crisis)

A

100 mg
Single dose only

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152
Q

Hydrocortisone Paediatric 5 - 10yrs IM Dose for:

Suspected, or at risk of, an acute adrenal insufficiency (adrenal crisis)

A

50 mg
Single dose only

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153
Q

Hydrocortisone Paediatric 0 - 4yrs IM Dose for:

Suspected, or at risk of, an acute adrenal insufficiency (adrenal crisis)

A

25 mg
Single dose only

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154
Q

Hydrocortisone Precautions

A

Hypertension

(retains Na+ in kidneys, inc blood and plasma fluid)

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155
Q

Hydrocortisone Presentation

A

Vial (powder) - 100mg,

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156
Q

Hydrocortisone Routes of Administration

A

IM

IV

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157
Q

Hydrocortisone Side Effects

A

Nil

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158
Q

Hydrocortisone Timing

A

Onset (IV)
1 - 2 hours

Duration (IV)
6 - 12 hours

Half-Life
1 - 2 hours

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159
Q

Ibuprofen Adult PO Dose

A

200 - 400 mg
Must not be administered within 6 hours of previous ibuprofen administration

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160
Q

Ibuprofen contraindications

A
  • Pts <13yrs or >65yrs
  • Allergy AND/OR known severe adverse reaction (KSAR) to any NSAID OR aspirin
  • Concurrent NSAID therapy
  • NSAID induced asthma
  • Heart failure
  • Angiotensin-converting enzyme (ACE) inhibitor OR Angiotensin II receptor blocker (ARB)
  • Anticoagulant medications
  • Current GI bleeding or peptic ulcers
  • Dehydration AND/OR hypovolaemia
  • Pregnancy
  • Renal impairment
  • Diuretic treatment
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161
Q

Ibuprofen Drug Class

A

Non-steroidal anti-inflammatory drug (NSAID)

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162
Q

Ibuprofen indications

A

Moderate pain due to acute inflammation & tissue injury

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163
Q

Ibuprofen paediatric dose

A

QAS officers are NOT authorised to dminister ibuprofen to paediatric pts

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164
Q

Ibuprofen precautions

A

Asthma

Hepatic dysfunction

History of GI bleeding or peptic ulcers

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165
Q

Ibuprofen presentation

A

tablet, 200 mg

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166
Q

Ibuprofen Routes of Administration

A

PO

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167
Q

Ibuprofen side effects

A

dizziness

dyspepsia

nausea

GI bleeding

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168
Q

Ibuprofen Timing

A

Onset
≈ 15 mins

Duration
4 - 6 hours

Half-Life
2 hours

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169
Q

Ipratropium bromide Adult NEB Dose for:

Moderate bronchospasm (unresponsive to initial QAS salbutamol NEB)

A 
500 microg (2 x 250 microg vials)
Repeated at 20 minute intervals
Total maximum dose - 1.5 mg
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170
Q

Ipratropium bromide Adult NEB Dose for:

Severe bronchospasm

A 
500 microg (2 x 250 microg vials)
Repeated at 20 minute intervals
Total maximum dose - 1.5 mg
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171
Q

Ipratropium bromide Contraindications

A

Allergy and/or Adverse Drug Reaction

Patients less than 1 year of age

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172
Q

Ipratropium Bromide Drug Class

A

anticholinergic agent

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173
Q

Ipratropium bromide Indications

A

Moderate bronchospasm (unresponsive to initial QAS salbutamol NEB)

Severe bronchospasm

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174
Q

Ipratropium Bromide Paediatric NEB dose for children 1 to 5 yrs for:

Moderate Bronchospasm (unresponsive to initial QAS salbutamol NEB)

A 
250 microg (1 x 250 microg vial)
Repeated at 20 min intervals
Total max dose 750 microg
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175
Q

Ipratropium Bromide Paediatric NEB dose for children 1 to 5 yrs for:

Severe Bronchospasm

A 
250 microg (1 x 250 microg vial)
Repeated at 20 min intervals
Total max dose 750 microg
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176
Q

Ipratropium Bromide Paediatric NEB dose for children 6 yrs and older for:

Severe Bronchospasm

A 
500 microg (2 x 250 microg vials)
Repeated at 20 min intervals
Total max dose 1.5 mg
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177
Q

Ipratropium Bromide Paediatric NEB dose for children 6 yrs and older for:

Moderate Bronchospasm (unresponsive to initial QAS salbutamol NEB)

A 
500 microg (2 x 250 microg vials)
Repeated at 20 min intervals
Total max dose 1.5 mg
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178
Q

Ipratropium bromide Precautions

A

Glaucoma

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179
Q

Ipratropium bromide Presentation

A

Nebule, 250 microg/1 mL ipratropium bromide monohydrate

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180
Q

Ipratropium bromide Routes of Administration

A

NEB

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181
Q

Ipratropium bromide Side Effects

A

dilated pupils

dry mouth

palpitations

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182
Q

Ipratropium bromide Timing

A
  • *Onset**
    1. 5 - 3 minutes (peak 1.5 - 2 hours)

Duration
4 - 6 hours

Half-life
3 hours

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183
Q

Loratadine Contraindications

A

allergy and/or adverse drug reaction

anaphylaxis

pts less than 8 years

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184
Q

Loratadine Drug Class

A

antihistamine (less sedating)

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185
Q

Loratadine Indications

A

Symptomatic urticaria (without evidence of anaphylaxis)

186
Q

Loratadine adult PO dose for symptomatic urticaria (without evidence of anaphylaxis)

A

10 mg
Single dose only

Not to be administered within 24 hours of previous antihistamine administration unless QAS approval

187
Q

Loratadine paediatric PO dose for symptomatic urticaria (without evidence of anaphylaxis) for children 8 years and older

A

10 mg
Single dose only

Not to be administered within 24 hours of previous antihistamine administration unless QAS approval

188
Q

Loratadine Precautions

A

Increased risk of sedation and anticholinergic effects in older people

Severe hepatic impairment

189
Q

Loratadine presentation

A

tablet, 10 mg

190
Q

Loratadine Routes of Administration

A

PO

191
Q

Loratadine Side Effects

A

fatigue

drowsiness

headache

dry mouth

nausea

192
Q

Loratadine Timing

A

Onset
1-2 hrs

Duration
≈ 24 hrs

Half-Life
≈ 8 hrs

193
Q

Methoxyflurane Adult INH Dose

A

3 mL - Repeated once after 20 minutes
Total maximum dose 6 mL

Total weekly dose should not exceed 15 mL with administration on consecutive days not recommended

194
Q

Methoxyflurane Contraindications

A

Allergy and/or Adverse Drug Reaction

Patients <1 year

Hx of signigicant liver or renal disease

Hx of malignant hyperthermia

195
Q

Methoxyflurane Drug Class

A

analgesic (at low doses)

196
Q

Methoxyflurane Indications

A

Pain

197
Q

Methoxyflurane Paediatric INH Dose for children 1 yr and older

A

3 mL
Single dose only

198
Q

Methoxyflurane precautions

A

ALOC

Intoxicated or drug affected patients

cardiovascular instability

respiratory depression

199
Q

Methoxyflurane presentation

A

bottle, 3 mL

200
Q

Methoxyflurane Routes of Administration

A

INH

201
Q

Methoxyflurane side effects

A

ALOC

cough

renal/hepatic failure (following repeated high dose exposure)

202
Q

Methoxyflurane Timing

A

Onset (INH)
1 - 3 minutes

Duration (INH)
5 - 10 minutes

Half-Life
Not available

203
Q

Midazolam Adult IM Dose - Acute Behavioural Disturbance (SAT score ≥2) unresponsive to droperidol (max dose) administration

A

QAS Clinical Consultation and Advice Line approval required in all situations

204
Q

Midazolam Adult IV Dose - Acute Behavioural Disturbance (SAT score ≥2) unresponsive to droperidol (max dose) administration

A

QAS Clinical Consultation and Advice Line approval required in all situations

205
Q

Midazolam Adult NAS Dose - Generalised Seizure/Focal Seizure

A

5mg
Repeat every 10 minutes
Total max dose 20mg

206
Q

Midazolam Adult IM Dose - Generalised Seizure/Focal Seizure

A

5mg
Repeat every 10 minutes
Total max dose 20mg

207
Q

Midazolam Contraindications

A

allergy and/or adverse drug reaction

208
Q

Midazolam Drug Class

A

Benzodiazepine (short acting)

209
Q

Midazolam Indications

A

Generalised seizure/focal seizure (GCS ≤12)

Acute behaviour disturbance (SAT score ≥2) unresponsive to droperidol (max dose) administration

Sedation - CCP only

210
Q

Midazolam Adult IV Dose - Generalised Seizure/Focal Seizure (GCS 12 or less)

A

If IV already there
5mg
Repeat every 5 minutes
Total max dose 20mg

211
Q

Midazolam Paediatric IM Dose for Acute Behavioural Disturbance (with a SAT score ≥2), unresponsive to droperidol (max dose) administration

A

QAS clinical consultation and advice line approval required in all situations

212
Q

Midazolam Paediatric IV Dose for Acute Behavioural Disturbance (with a SAT score ≥2), unresponsive to droperidol (max dose) administration

A

QAS clinical consultation and advice line approval required in all situations

213
Q

Midazolam Paediatric IM Dose for Generalised/Focal Seizures (GCS ≤12)

A

200 microg/kg
Single dose not to exceed 5 mg
Repeated at half initial dose every 10 min (max 2.5 mg)
Total max dose 10 mg

214
Q

Midazolam Paediatric NAS Dose for Generalised/Focal Seizures (GCS ≤12)

A

200 microg/kg
Single dose not to exceed 5 mg
Repeated at half initial dose every 10 min (max 2.5 mg)
Total max dose 10 mg

215
Q

Midazolam Precautions

A
  • Reduced dosages must be considered in:
    • low body weight, older or cachectic Pts
    • Pts with chronic renal failure, congestive heart failure or shock
  • can cause severe respiratory depression in Pts with COPD
  • myasthenia gravis
  • multiple sclerosis
216
Q

Midazolam Presentation

A

Ampoule, 5mg/1mL, midazolam

217
Q

Midazolam Routes of Administration

A

NAS

IM

IV

218
Q

Midazolam Side Effects

A

hypotension

respiratory depression particularly when associated with other CNS depressants incl alcohol and narcotics

219
Q

Midazolam Timing

A

Onset
5-15 minutes (IM)
1-3 minutes (IV)

Duration
Variable

  • *Half Life**
    2. 5 hours
220
Q

Morphine <70yrs IM adult dose for:

Significant pain

Autonomic dysreflexia (with SBP >160mmHg)

A

2.5 - 10mg
Repeated at up to 5mg every 10mins
Total max dose 20mg (or MME)

221
Q

Morphine ≥70yrs/cachectic or frail IM adult dose for:

Significant pain

Autonomic dysreflexia (with SBP >160mmHg)

A

2.5-5mg
Repeated at up to 5mg every 10 mins
Total max dose 10 mg (or MME)

222
Q

Morphine adult dose for significant pain via SUBCUT

A

QAS clinical consultation and advie line approval required in all situations

223
Q

Morphine Contraindications

A

Allergy and/or adverse drug reaction

Kidney disease (renal failure)

224
Q

Morphine Drug Class

A

Narcotic analgesic

225
Q

Morphine <70 IV adult dose for:

Significant pain

Autonomic dysreflexia (with SBP >160mmHg)

A

2.5 - 5mg
Repeated at up to 5mg every 5mins
Total max dose 20mg (or MME)

226
Q

Morphine ≥70yrs/cachectic or frail IV adult dose for:

Significant pain

Autonomic dysreflexia (with SBP >160mmHg)

A

2.5mg
Repeated at up to 2.5mg every 5 mins
Total max dose 10 mg (or MME)

227
Q

Morphine Indications

A

Significant pain

Autonomic dysreflexia (with SBP >160mmHg)

Sedation - CCP Only

Is the preferred narcotic agent except when:

  • allergy or KSAR to morphine
  • haemodynamic instability
  • known/suspected kidney disease
  • when NAS narcotic admin is preferred
  • suspected ACS
228
Q

Morphine paediatric IV dose for:

Significant pain

Autonomic dysreflexia (with SBP >160mmHg)

A

≥1yr - 100 microg/kg
Single max dose 2.5mg
Repeated at 50 microg/kg (max 2.5mg) every 5 mins
Total max dose 200 microg/kg (or MME)

<1yr - QAS clinical consultation and advice line approval required in all situations

229
Q

Morphine Milligram Equivalent (MME)

A

100 microg fentanyl = 10 mg morphine

230
Q

Morphine SUBCUT paediatric dose for significant pain

A

QAS clinical consultation and advice line approval required in all situations

231
Q

Morphine paediatric IM dose for:

Significant pain

Autonomic dysreflexia (with SBP >160mmHg)

A

≥1yr - 100-200 microg/kg
Single max dose 5 mg
Total max dose 200 microg/kg (or MME)

<1yr - QAS clinical consultation and advice line approval required in all situations

232
Q

Morphine Precautions

A

concurrent MAOI therapy

known addiction to narcotics

respiratory tract burns

respiratory depression and/or failure

cardiac chest pain

hypotension

233
Q

Morphine Presentation

A

Ampoule, 10mg/1 mL morphine sulphate pentahydrate

234
Q

Morphine Routes of Administration

A

IM

IO

IV

SUBCUT

235
Q

Morphine Side Effects

A

drowsiness

pin point pupils

respiratory depression

bradycardia

hypotension

nausea and/or vomiting

236
Q

Morphine Timing

A

Onset
5-10 mins IM (peak 20-30 mins)
2-5 mins IV (peak 20 mins)

Duration
1 - 2 hours

Half-Life
2 hours

237
Q

Non-pharmacological Pain Management Options

A

Reassurance, empathy and information

Comfort

Parents presence

Choice and control

Laughter and fun

Hot/cold

Diversion

Positioning

Splinting

238
Q

Ondansetron Adult PO Dose for Significant Nausea and/or Vomiting

A

4 - 8 mg
Total maximum dose 8 mg

Must not be given within 8 hours of previous ondansetron administration

239
Q

Ondansetron Adult IM Dose for Significant Nausea and/or Vomiting

A

4 - 8 mg
Total maximum dose 8 mg

Must not be given within 8 hours of previous ondansetron administration

240
Q

Ondansetron Contraindications

A

Absolute

Allergy AND/OR Adverse Drug Reaction

Congenital long QT syndrome

Current apomorphine therapy (used in severe Parkinson’s disease)

Patients less than 2 years of age

Relative

1st trimester pregnancy (only use if uncontrolled hyperemesis present)

241
Q

Ondansetron Drug Class

A

Antiemetic

242
Q

Ondansetron Paediatric IM Dose for Significant Nausea and/or Vomiting

A

Must not be given within 8 hours of previous dose

243
Q

Ondansetron Indications

A

Significant nausea AND/OR vomiting

244
Q

Ondansetron Adult IV Dose for Significant Nausea and/or Vomiting

A

4 - 8 mg
Slow push over 2 - 3 minutes
Total maximum dose 8 mg

Must not be given within 8 hours of previous dose

245
Q

Ondansetron Paediatric IV Dose for Significant Nausea and/or Vomiting for children 2 years and older

A

100 microg/kg
Slow push over 2 - 3 mins
Single dose only
Total max dose 4mg

Must not be administered within 8 hours of previous dose

246
Q

Ondansetron Paediatric PO Dose for Significant Nausea and/or Vomiting for children 2 to 4 years

A

2 mg
Single dose only

247
Q

Ondansetron Paediatric PO Dose for Significant Nausea and/or Vomiting for children 5 yrs and older

A

4 mg
Single dose only

248
Q

Ondansetron Precautions

A

elderly Pts

Pts with risk factors for QT interval prolongation or cardiac arrhythmias

hepatic impairment

intestinal obstruction

249
Q

Ondansetron Presentation

A

Ampoule, 4 mg/2 mL ondansetron

Orally Disintegrating Tablet (ODT), 4 mg ondansetron

250
Q

Ondansetron Routes of Administration

A

PO

IM

IV

251
Q

Ondansetron Side Effects/Adverse Events

A

Common >1%
headache
constipation

Rare <0.1%
hypersensitivity reactions (including anaphylaxis)
ECG changes (dysrhythmias)

252
Q

Ondansetron Timing

A

Onset (IV)
5 minutes

Duration (IV)
Several hours

Half-Life (IV)
3 - 4 hours

253
Q

Oxygen Adult/Paediatric INH Dose for:

Intra-arrest

A

Administer 100% O2

254
Q

Oxygen Adult/Paediatric INH Dose for:

CO poisoning

A

Administer 100% O2

255
Q

Oxygen Adult/Paediatric INH Dose for:

Cyanide poisoning

A

Administer 100% O2

256
Q

Oxygen Adult/Paediatric INH Dose for:

Preoxygenation for RSI

A

Administer 100% O2

257
Q

Oxygen adult/paediatric INH dose - All other presentations

A

Titrate oxygen to achieve SpO2 92-96%

258
Q

Oxygen adult/paediatric INH dose for:

Paraquat toxicity

A

Titrate oxygen to achieve SpO2 88-92%

259
Q

Oxygen adult/paediatric INH dose for:

Bleomycin treatment

A

Titrate oxygen to achieve SpO2 88-92%

260
Q

Oxygen adult/paediatric INH dose for:

Obesity

A

Titrate oxygen to achieve SpO2 88-92%

261
Q

Oxygen adult/paediatric INH dose for:

COPD

A

Titrate oxygen to achieve SpO2 88-92%

262
Q

Oxygen adult/paediatric INH dose for:

Cystic fibrosis

A

Titrate oxygen to achieve SpO2 88-92%

263
Q

Oxygen adult/paediatric INH dose for:

Neuromuscular Disease

A

Titrate oxygen to achieve SpO2 88-92%

264
Q

Oxygen Contraindications

A

Known paraquat poisoning with SpO2 ≥ 88%

Hx of bleomycin therapy with SpO2 ≥ 88%

265
Q

Oxygen Drug Class

A

Gas

266
Q

Oxygen Indications

A

A wide range of conditions resulting in, or potentially resulting in systematic and/or localised hypoxia

267
Q

Oxygen Precautions

A

Patients with paraquat poisoning or bleomycin lung injury may be harmed by supplemental oxygen. Avoid oxygen unless the patient is hypoxaemic - target 88-92%

Prolonged administration to premature neonates

Neborns will have low Sp02 for the first 10 minutes following birth - refer to CPG: Resuscitation - Newly born

Patients with cyanotic heart disease may have saturation targets between 75°/o to 85%. Ascertain optimal target saturation levels for these patients from carers or HCP

A BVM will not supply adequate oxygen unless IPPV is provided

Using high flow oxygen to protect against subsequent hypoxaemia in the event of deterioration may delay the recognition of such a deterioration. This may provide a false reassurance that the patient is stable.

268
Q

Oxygen Presentation

A

Size C cylinder, 450 L medical oxygen (in kit)

Size D cylinder, 1600 L medical oxygen (in van)

269
Q

Oxygen Side Effects

A

Hypoventilation in some COPD Pts with hypoxic drive

Drying of airway mucous membranes

270
Q

Oxygen Timing

A

Onset
Immediate

Duration
N/A

Half-Life
N/A

271
Q

Oxytocin Adult IM Dose for active management of the third stage of labour (following confirmed delivery of all foetuses) AND the prevention of primary post partum haemorrhage (PPH)

A

10 international units
single dose only

272
Q

Oxytocin Adult IV Dose for management of uncontrolled primary or secondary post partum haemorrhage (PPH)

A

Loading dose - 10 international units
slow push over 2-5 minutes
May be given in addition to a dose that may have been administered for active management of the third stage of labour/the prevention of primary post partum haemorrhage (PPH)

273
Q

Oxytocin Contraindications

A

allergy and/or adverse drug reaction

undelivered foetuses

274
Q

Oxytocin Drug Class

A

oxytocic

275
Q

Oxytocin Indications

A

active management of the third stage of labour (following confirmed delivery of all foetuses) AND the prevention of primary post partum haemorrhage (PPH)

management of uncontrolled primary or secondary post partum haemorrhage (PPH)

276
Q

Oxytocin Precautions

A

myocardial ischaemia

may potentiate hypotension when administered with analgesia

277
Q

Oxytocin Presentation

A

ampoule, 10 international units (IU)/1 mL

278
Q

Oxytocin Side Effects

A

headache

bradycardia

tachycardia

nausea and/or vomiting

279
Q

Oxytocin Timing

A

Onset
2-4 minutes

Duration
30-60 minutes

Half Life
N/A

280
Q

Paracetamol Adult PO Dose for:

mild to moderate pain

A

0.5g - 1g
Must not be administered within 4 hours of previous dose
Repeated every 4 hours
Total max dose 4g in 24 hours

281
Q

Paracetamol Adult PO Dose for:

fever (causing distress)

A

0.5g - 1g
Must not be administered within 4 hours of previous dose
Repeated every 4 hours
Total max dose 4g in 24 hours

282
Q

Paracetamol contraindications

A

Allergy/known severe adverse reaction (KSAR)

Patients <1 month old

283
Q

Paracetamol Drug Class

A

analgesic and antipyretic

284
Q

Paracetamol indications

A

Mild to moderate pain

Fever (causing distress)

285
Q

Paracetamol Paediatric PO Dose for children 1 month and older for:

mild to moderate pain

A

15 mg/kg
Single dose only
Must not be administered within 4 hours of previous dose

286
Q

Paracetamol Paediatric PO Dose for children 1 month and older for:

fever (causing distress)

A

15 mg/kg
Single dose only
Must not be administered within 4 hours of previous dose

287
Q

Paracetamol precautions

A

Hepatic or renal dysfunction

Soluble tablets:

  • Pts with sodium restriction (heart failure, chronic kidney disease)
  • Phenylketonuria
288
Q

Paracetamol presentation

A

elixir - 120 mg/5 mL

tablet - 500 mg

289
Q

Paracetamol side effects

A

nausea

290
Q

Paracetamol Timing

A

Onset (PO)
10 - 60 minutes

Duration (PO)
4 hours

Half-Life
≈ 2 hours

291
Q

Salbutamol Adult MDI Dose for Bronchospasm

A

12 (1.2 mg) MDI inhalations
Repeat at 10 minutes
No max dose

292
Q

Salbutamol Contraindications

A

Allergy AND/OR adverse drug reaction

Patients less than 1 year

293
Q

Salbutamol Drug Class

A

Beta-adrenergic agonist

294
Q

Salbutamol Indications

A

Bronchospasm

Suspected hyperkalaemia (with QRS widening and/or AV dissociation) - CCP only

295
Q

Salbutamol Adult NEB Dose for Bronchospasm

A

5 mg
Repeated PRN
No max dose

296
Q

Salbutamol paediatric NEB dose for bronchospasm for children 6 years and older

A

5mg
Repeated PRN
No max dose

297
Q

Salbutamol paediatric NEB dose for bronchospasm for children 1 to 5 years

A

2.5mg
Repeated PRN
No max dose

298
Q

Salbutamol paediatric MDI dose for bronchospasm for children 6 years and older

A

12 (1.2 mg) MDI inhalations
Repeated every 10 minutes
No max dose

299
Q

Salbutamol paediatric MDI dose for bronchospasm for children 1 to 5 years

A

6 (600 microg) MDI inhalations
Repeated every 10 mins
No max dose

300
Q

Salbutamol Precautions

A

Acute pulmonary oedema

lschaemic heart disease

301
Q

Salbutamol Presentation

A

Metered Dose Inhaler - 100 microg/puff, salbutamol

Nebule - 2.5mg/2.5mL

Nebule - 5mg/2.5mL

Ampoule - 500mcg/1mL

302
Q

Salbutamol Side Effects

A

anxiety

tachyarrhythmias

tremors

hypokalaemia and metabolic acidosis

303
Q

Salbutamol Timing

A

Onset
2 - 5 minutes

Duration
16 - 60 minutes

  • *Half-Life**
    1. 6 hours
304
Q

Sodium Chloride 0.9% adult IV/INF dose - significant burns (TBSA > 20%)

A

mL/hr to be infused = 15 mL/hr x TBSA (nearest 10%)
if > 100 kg administer additional 200 mL/hr
Re-assess Pt after every 250-500 mL fluid administration

For burns management: use PHIFTEEN B (15-B) formula in adults to identify the hourly parenteral fluid rate goal to be administered for the time of injury

305
Q

Sodium Chloride 0.9% adult/paediatric IM/IV dose to dissolve and dilute drugs

A

As authorised on individual DTPs

306
Q

Sodium Chloride 0.9% adult IV/INF dose:

hypovolaemia

A

PRN - titrate according to the indication and the pt’s physiological response to treatment

Re-assess Pt after every 250-500 mL fluid administration

In uncontrolled haemorrhage administer the minimum amount of IV/IO fluid required to maintain a radial pulse

307
Q

Sodium Chloride 0.9% adult IV/INF dose:

inadequate tissue perfusion/shock

A

PRN - titrate according to the indication and the pt’s physiological response to treatment

Re-assess Pt after every 250-500 mL fluid administration

In uncontrolled haemorrhage administer the minimum amount of IV/IO fluid required to maintain a radial pulse

308
Q

Sodium Chloride 0.9% adult/paediatric IV dose as a flush following IV or IO drug administration

A

PRN

309
Q

Sodium Chloride 0.9% contraindications

A

Nil

310
Q

Sodium Chloride 0.9% Drug Class

A

isotonic crystalloid solution

311
Q

Sodium Chloride 0.9% Indications

A

Inadequate tissue perfusion/shock

Hypovolaemia

Significant burns (Total Body Surface Area > 20% for adults or> 10% for paediatrics)

To dissolve and dilute drugs (for the purpose of IM, IV or 10 administration)

As a flush following IV or 10 drug administration

312
Q

Sodium chloride 0.9% paediatric IV/INF dose for significant burns (TBSA >10%)

A

QAS clinical consultation and advice line consultation and approval required in all situations

Paediatric pts must be re-assessed after every 10 mL/kg of fluid administration

313
Q

Sodium chloride 0.9% IV/INF paediatric dose for:

hypovolaemia

A

QAS clinical consultation and advice line approval required in all situations

10-20mL/kg
May be repeated twice following Pt assessment
Total max dose 60mL/kg

Paediatric pts must be re-assessed after every 10 mL/kg of fluid administration

314
Q

Sodium chloride 0.9% IV/INF paediatric dose for:

inadequate tissue perfusion/shock

A

QAS clinical consultation and advice line approval required in all situations

10-20mL/kg
May be repeated twice following Pt assessment
Total max dose 60mL/kg

Paediatric pts must be re-assessed after every 10 mL/kg of fluid administration

315
Q

Sodium Chloride 0.9% precautions

A

acute or Hx of heart failure

pre-existing renal failure

uncontrolled haemorrhage (unless associated with severe head injury)

316
Q

Sodium Chloride 0.9% presentation

A

Ampoule, 10 mL sodium chloride 0.9%

Viaflex plastic container, 100 mL sodium chloride 0.9%

Viaflex plasitc container, 500 mL sodium chloride 0.9%

BD PosiFlush 10 mL pre-filled sodium chloride 0.9% syringe

317
Q

Sodium Chloride 0.9% side effects

A

excessive administration will result in fluid overload

318
Q

Sodium chloride 0.9% Timing

A

Onset
Immediate

Duration
Variable

Half-Life
N/A

319
Q

Steps in Paediatric Drug Calculations

A

Estimated weight = (age x 3) + 7
eg (4 x 3) + 7 = 19kg

Work out dose
eg (15mg/kg) = 15 x 19 = 285mg

Confirm using right unit of measurement
(mg)

Do conversion if required
eg, mg to microgram

Calculate dose
Stock required x volume
Stock strength

320
Q

Sucrose 24% Contraindications

A

Patients greater than 12 months of age

Sucrose intolerance - Congenital sucrase-isomaltase deficiency (CSID)

Fructose intolerance

Glucose-galactose malabsorption

Concurrent muscle relaxant/paralysis therapy

321
Q

Sucrose 24% Drug Class

A

N/A

322
Q

Sucrose 24% Paediatric PO Dose for:

Distress Due to Pain

A

0 - 1 month
0.1 mL (2 drops)
May be repeated once at 5 minutes

2 - 12 months
0.5 mL (10 drops)
May be repeated once at 5 minutes

323
Q

Sucrose 24% Paediatric PO Dose for:

Short Term Procedural Pain Management

A

0 - 1 month
0.1 mL (2 drops)
May be repeated once at 5 minutes

2 - 12 months
0.5 mL (10 drops)
May be repeated once at 5 minutes

324
Q

Sucrose 24% Precautions

A

Nil

325
Q

Sucrose 24% Presentation

A

Twist-tip vial, 2 mL 24% sucrose

326
Q

Sucrose 24% Side Effects

A

hyperglycaemia

327
Q

Sucrose 24% Timing

A

Onset
minutes

Duration
5-8 minutes

Half-life
N/A

328
Q

Sucrose 24% Indications

A

Short term procedural pain management (e.g. IV cannulation)

Distress due to pain

329
Q

Tips for paediatric drug administration

A

Be honest - explain what you are doing and what you need them to do before,
during and after the procedure

Use clear and simple language that is tailored to the child’s developmental level

Use positive language: ‘Keep your arm nice and relaxed for me’

Avoid negative terms: ‘Don’t move’, ‘Sting’

Ensure the child is positioned comfortably where they are able to see, hear and/or touch their carer during the procedure

Try to have one person at a time talk to the child

330
Q

To go from big units to small

A

multiply

331
Q

To go from gram to kilogram

A

divide by 1000

332
Q

To go from gram to milligram

A

multiply by 1000

333
Q

To go from kilogram to gram

A

multiply by 1000

334
Q

To go from microgam to milligram

A

divide by 1000

335
Q

To go from milligram to gram

A

divide by 1000

336
Q

To go from milligram to microgram

A

multiply by 1000

337
Q

To go from small units to big

A

divide

338
Q

Tranexamic Acid Paediatric IV Dose for:

Recent traumatic injuries (<3 hours) with a COAST score _>_3

A

QAS Clinical Consultation and Advice Line approval required in all situations.

15mg/kg
Slow push over 10 minutes
Single dose only
Total maximum dose 1g

339
Q

Tranexamic Acid (TXA) Contraindications

A

Allergy and/or adverse drug reaction

340
Q

Tranexamic Acid (TXA) Indications

A

Recent traumatic injuries (3 hours or less) with a COAST score ≥3

Management of uncontrolled primary post-partum haemorrhage (3 hours or less)

341
Q

Tranexamic Acid (TXA) Precautions

A

Nil

342
Q

Tranexamic Acid (TXA) Presentation

A

1gm/10mL

343
Q

Tranexamic Acid (TXA) Side Effects

A

Headache

Seizures

Hypotension

Nausea and/or vomiting

344
Q

Tranexamic Acid Adult INF Dose for:

Recent traumatic injuries (<3 hours) with a COAST score >3

A

1gm over 10 minutes
Single dose only

Infusion preparation: Mix 1g of tranexamic acid in a 100 mL bag of sodium chloride 0.9%. Ensure bag is appropriately labelled. Administer over 10 minutes (approx 3 drops per second)

345
Q

Tranexamic Acid Adult INF Dose for:

Management of uncontrolled primary post-partum haemorrhage (≤3 hours)

A

1gm over 10 minutes
Single dose only

Infusion preparation: Mix 1g of tranexamic acid in a 100 mL bag of sodium chloride 0.9%. Ensure bag is appropriately labelled. Administer over 10 minutes (approx 3 drops per second)

346
Q

Tranexamic Acid (TXA) Drug Class

A

Antifibrinolytic

347
Q

Water for injection IM/IV adult/paediatric dose

A

As authorised on individual DTPs

348
Q

Water for injection contraindications

A

Nil

349
Q

Water for Injection Drug Class

A

N/A

350
Q

Water for injection indications

A

To dissolve AND/OR dilute drugs for the purpose of IM, IV or IO administration

351
Q

Water for injection precautions

A

Nil

352
Q

Water for injection presentation

A

Ampoule 20 mL water for injection

353
Q

Water for injection side effects

A

nil

354
Q

Water for injection timing

A

Onset
N/A

Duration
N/A

Half Life
N/A

355
Q

What influences pain?

A

culture

beliefs

mood

coping ability

previous pain experiences

356
Q

What is the weight calculation formula?

A

(Age x 3) + 7 = weight in kilograms

357
Q

Oxytocin Routes of Administration

A

IM

IV

358
Q

Water for Injection Routes of Administration

A

IM

IV

359
Q

Tranexamic Acid Routes of Administration

A

INF

IV

360
Q

Sucrose 24% Routes of Administration

A

PO

361
Q

Sodium Chloride 0.9% Routes of Administration

A

INF

IV

362
Q

Salbutamol Routes of Administration

A

MDI

NEB

363
Q

Paracetamol Routes of Administration

A

PO

364
Q

Oxygen Routes of Administration

A

NC

NEB

SFM

NRBM

BVM

SAD

ETT

CPAP

365
Q

Amiodarone Indications

A
  • Cardiac arrest (if refractory to three DCCS)
  • Sustained conscious VT (CCP only)
366
Q

Amiodarone Contraindications

A

For Pts in cardiac arrest:
TCA overdose

367
Q

Amiodarone Side Effects

A

hypotension
bradycardia
nausea and/or vomiting
peripheral paraesthesia

368
Q

Amiodarone Drug Class

A

Anti-arrhythmic

369
Q

Amiodarone Timing

A

Onset (IV)
5 minutes

Duration (IV)
30 minutes

Half-Life
14 - 110 days (with chronic dosing)

370
Q

Amiodarone Routes of Administration

A

IV
IO (CCP only)
IV INF (CCP only)

371
Q

Amiodarone Presentation

A

Ampoule, 150mg/3mL

372
Q

Amiodarone adult IV dose for cardiac arrest (refractory to 3 DCCS)

A

300 mg
Slow push over 1-2 minutes
Repeated once at 150 mg if refractory to 5 DCCS
Total max dose 450 mg

Syringe Preparation: draw up and administer neat - first dose = 2 undiluted ampoules, second dose 1 undiluted ampoule

373
Q

Amiodarone paediatric dose for cardiac arrest (refractory to 3 DCCS)

A

CCP only

374
Q

Atropine Indications

A

CCP only
* bradycardia (with poor perfusion)
* envenomation (with increased parasympathetic activity)
* hypersalivation (secondary to ketamine administration)
* organophosphate toxicity (with cardiac and/or respiratory compromise)

375
Q

Atropine Presentation

A

1.2mg/1mL

376
Q

Atropine Side Effects

A

reduces airway secretions
mydriasis (pupil dilation/blown pupils)

377
Q

Naloxone Drug Class

A

opioid antagonist

378
Q

Naloxone Indications

A

Respiratory depression (secondary to the administration of narcotic drugs)

379
Q

Naloxone Contraindications

A

allergy/KSAR
newly born pts

380
Q

Naloxone Precautions

A

Use with caution on patients with pre-existing cardiac disease

381
Q

Naloxone Side Effects

A

Narcotic reversal can cause combativeness, vomiting, sweating, tachycardia and hypertension
May produce acute withdrawal convulsions in the chronic narcotic user
Pulmonary oedema

382
Q

Naloxone Presentation

A

Ampoule, 400 microg/mL

383
Q

Naloxone Routes of Administration

A

IM

384
Q

Naloxone Adult IM dose for Respiratory depression (secondary to the administration of narcotic drugs)

A

1.6 mg
Single dose only

385
Q

Naloxone paediatric IM dose for Respiratory depression (secondary to the administration of narcotic drugs)

A

20 microg/kg
Single dose only, not to exceed 800 microg

386
Q

Naloxone Timing

A

Onset
3–5 minutes (IM)
1–3 minutes (IV)
Duration
≈ 60 minutes
Half-Life
60 minutes

387
Q

Droperidol Drug Class

A

antipsychotic

388
Q

Droperidol Indications

A

Acute behavioural disturbances (with a SAT Score ≥ 2)

389
Q

Droperidol Contraindications

A

Absolute:
Allergy AND/OR KSAR
Parkinson’s disease
Known Lewy body dementia
Previous dystonic reaction to droperidol
Patients less than 8 years of age
Relative (requires consultation with the QAS Clinical Consultation & Advice Line)
suspected sepsis

390
Q

Droperidol Precautions

A

Hypoperfused state
Concurrent use of CNS depressants

391
Q

Droperidol side Effects

A

Vasodilation/hypotension
Extrapyramidal effects e.g. dystonic reactions (rare)

392
Q

Droperidol Presentation

A

Vial, 10 mg/2 mL

393
Q

Droperidol Timing

A

Onset
5-15 minutes
Duration
4-6 hours
Half-Life
N/A

394
Q

Droperidol Routes of Administration

A

IM
IV

395
Q

Droperidol Adult 13-15 years IM or IV dose for Acute behavioural disturbances (with a SAT Score ≥ 2)

A

QAS Clinical Consultation and Advice Line consultation and approval required in all patients 65 or older and 13-15 yrs

0.1–0.2 mg/kg
Single max dose 10 mg
Repeated once at 15 minutes
Total max dose 20 mg

396
Q

Droperidol Adult 65 and older years IM or IV dose for Acute behavioural disturbances (with a SAT Score ≥ 2)

A

QAS Clinical Consultation and Advice Line consultation and approval required in all patients 65 or older and 13-15 yrs

5 mg
Repeated once at 15 minutes
Total max dose 10 mg

397
Q

Droperidol Adult 16 - 65 years IM or IV dose for Acute behavioural disturbances (with a SAT Score ≥ 2)

A

10 mg
Repeated once at 15 minutes
Total max dose 20 mg

398
Q

Droperidol Paediatric 8 - 12 years IM or IV dose for Acute behavioural disturbances (with a SAT Score ≥ 2)

A

QAS Clinical Consultation and Advice Line consultation and approval required in all situations

0.1 - 0.2 mg/kg
Single max dose 10 mg
Repeated once at 15 minutes
Total max dose 20 mg

399
Q

Box Jellyfish Antivenom Drug Class

A

antivenom

400
Q

Box Jellyfish Antivenom Indications

A

Box jellyfish (chironex fleckeri) envenomation associated with any of the following:
* a Pt currently in cardiac arrest
* decreased level of consciousness
* cardiac and/or respiratory distress or collapse
* total surface area affected greater than half the surface area of one limb
* intractable pain unrelieved by icepacks, methoxyflurane and/or narcotic analgesia

401
Q

Box Jellyfish Antivenom Contraindications

A

Allergy and/or KSAR

402
Q

Box Jellyfish Antivenom Precautions

A

a foreign protein that can cause allergic reaction, anaphylaxis or sensitisation

403
Q

Box Jellyfish Antivenom Side Effects

A

allergic reaction including anaphylaxis and delayed serum sickness
intense stinging sensation on injection

404
Q

Box Jellyfish Antivenom Presentation

A

20,000 units/1.5 - 4 mL

405
Q

Box Jellyfish Antivenom Timing

A

Onset
N/A
Duration
N/A
Half-Life
N/A

406
Q

Box Jellyfish Antivenom Routes of Administration

A

IM
IV (preferred)

407
Q

Box Jellyfish Antivenom Adult/Paediatric IM dose for Box jellyfish (chironex fleckeri) envenomation associated with any of the following:
* decreased level of consciousness
* cardiac and/or respiratory distress or collapse
* total surface area affected greater than half the surface area of one limb
* intractable pain unrelieved by icepacks, methoxyflurane and/or narcotic analgesia

A

60,000 units
single dose only
(3 injection sites)

408
Q

Box Jellyfish Antivenom Adult/Paediatric IV dose for Box jellyfish (chironex fleckeri) envenomation associated with any of the following:
* decreased level of consciousness
* cardiac and/or respiratory distress or collapse
* total surface area affected greater than half the surface area of one limb
* intractable pain unrelieved by icepacks, methoxyflurane and/or narcotic analgesia

A

20,000 units
infusion over 20 minutes
administer via springfusor 30mL
single dose only

Syringe Preparation: mix 20,000 units of antivenom with sodium chloride 0.9% in a 30 mL springfusor syringe to achieve a final concentration of 20,000 units/20 mL at a rate of 60 mL/hour (over 20 minutes)

409
Q

Box Jellyfish Antivenom Adult/Paediatric IV dose for Box jellyfish (chironex fleckeri) envenomation associated with a patient currently in cardiac arrest

A

20,000 units
Slow push over 2-5 minutes
Repeated immediately up to 2 times
Total max dose 60,000 units

Syringe Preparation: mix 20,000 units of antivenom with sodium chloride .9% to achieve a final concentration of 20,000 units/20 mL

410
Q

Magnesium Sulphate Drug Class

A

electrolyte

411
Q

Magnesium Sulphate Indications

A
  • Irukandji syndrome (with intractable pain unrelieved by narcotic analgesia and/or SBP > 160mmHg)
  • Box jellyfish (chironex fleckeri) envenomation (unresponsive to antivenom therapy)

CCP Only:
* Eclampsia
* Torsades de Pointes
* Severe life-threatening (asthma (only in Pts who have required IM/IV adrenaline (epinephrine))

412
Q

Magnesium Sulphate Contraindications

A
  • Allergy AND/OR Adverse Drug Reaction
  • Atrioventricular (AV) block
  • Renal failure
413
Q

Magnesium Sulphate Precautions

A

Renal impairment

414
Q

Magnesium Sulphate Side Effects

A
  • Pain at the cannulation site
  • Magnesium toxicity
    • hypotension/respiratory depression
    • loss of deep tendon reflexes
415
Q

Magnesium Sulphate Presentation

A

Ampoule, 10 mmol (2.5 g)/5 mL

416
Q

Magnesium Sulphate Timing

A

Onset
Immediate
Duration
30 minutes
Half-Life
Variable

417
Q

Magnesium Sulphate Routes of Administration

A

IV
INF

418
Q

Magnesium Sulphate Adult IV dose for Irukandji syndrome (with intractable pain unrelieved by narcotic analgesia AND/OR systolic BP > 160 mmHg)

A

10 mmol over 20 minutes
Repeated once at 20 minutes.
Total maximum dose 20 mmol.
Administer via SPRINGFUSOR® 30 mL

Syringe preparation: Mix 10 mmol (5 mL) of magnesium sulphate with 15 mL sodium chloride 0.9% in a 30 mL SPRINGFUSOR® syringe to achieve a final concentration of 10 mmol/20 mL. Ensure syringe is appropriately labelled. Administer infusion via the SPRINGFUSOR® at a rate of 60 mL/hour (over 20 mins).

419
Q

Magnesium Sulphate Adult IV dose for Box jellyfish (Chironex fleckeri ) envenomation (unresponsive to antivenom therapy)

A

10 mmol over 20 minutes
Repeated once at 20 minutes
Total maximum dose 20 mmol
Administer via SPRINGFUSOR® 30 mL

Syringe preparation: Mix 10 mmol (5 mL) of magnesium sulphate with 15 mL sodium chloride 0.9% in a 30 mL SPRINGFUSOR® syringe to achieve a final concentration of 10 mmol/20 mL. Ensure syringe is appropriately labelled. Administer infusion via the SPRINGFUSOR® at a rate of 60 mL/hour (over 20 mins).

420
Q

Magnesium Sulphate Paediatric IV dose for:
* Irukandji syndrome (with intractable pain unrelieved by narcotic analgesia AND/OR systolic BP > 160 mmHg)
* Box jellyfish (Chironex fleckeri ) envenomation (unresponsive to antivenom therapy)

A

0.1 mmol/kg over 15 minutes
(rounded up to the nearest 0.5 mmol)
Administer via SPRINGFUSOR® 30 mL
Single dose not to exceed 5 mmol
Repeated once at 15 minutes
Total maximum dose 10 mmol

Syringe preparation: Mix 0.1 mmol/kg of magnesium sulphate with sodium chloride 0.9% in a 30 mL SPRINGFUSOR® syringe to achieve a final concentration of 0.1 mmol/kg in 15 mL. Ensure syringe is appropriately labelled. Administer infusion via the SPRINGFUSOR®. at a rate of 60 mL/hour (over 15 mins)

421
Q

Hydroxocobalamin Drug Class

A

antidote

422
Q

Hydroxocobalamin Indications

A

Life-threatening cyanide toxicity (e.g. shock, respiratory failure, seizure, ALOC or myocardial ischaemia)

423
Q

Hydroxocobalamin Contraindications

A

Allergy AND/OR Adverse Drug Reaction

424
Q

Hydroxocobalamin Precautions

A

hypertension
pregnancy

425
Q

Hydroxocobalamin Side Effects

A

Headache
Anaphylaxis
Hypertension
Renal failure
Nausea and/or vomiting
Pain at infusion site
Chromaturia
Erythema
Rash (acne like)

426
Q

Hydroxocobalamin Presentation

A

Vial, 5g

427
Q

Hydroxocobalamin Timing

A

Onset
Immediate
Duration
several days
Half-Life
26-31 hours

428
Q

Hydroxocobalamin Routes of Administration

A

IV
INF

429
Q

Hydroxocobalamin Adult IV/INF dose for Life-threatening cyanide toxicity (e.g. shock, respiratory failure, seizure, ALOC or myocardial ischaemia)

A

5g over 5 minutes

430
Q

Amiodarone precautions

A

For Pts in cardiac arrest
Nil

431
Q

Levetiracatem indications?

A

CCP only

convulsive status epilepticus continuing >20 mins post first midazolam administration

432
Q

Calcium gluconate indications

A

CCP only

Following pre-hospital blood product transfusion
Hypotension associated with a magnesium infusion
Hydrofluoric acid inhalation
Suspected hyperkalaemic cardiac arrest
Severe hyperkalaemia
Verapamil AND/OR diltiazem toxicity

433
Q

Calcium gluconate presentation

A

vial 2.2mmol/10mL
pre-filled syringe 4.4mmol/25mL

434
Q

Clopidogrel Drug Class

A

Antiplatelet

435
Q

Clopidogrel Indications

A

Pts with STEMI and
- have been accepted for pPCI (as an adjunct medication to aspirin and heparin) and the receiving interventional cardiologist is requesting clopidogrel administration; OR
- who have received tenecteplase (and have been administered aspirin and enoxaparin)

436
Q

Clopidogrel contraindications

A

Patients less than 18 years of age
Allergy AND/OR Adverse Drug Reaction
Patients contraindicated for pre-hospital fibrinolysis administration
Prior intracranial haemorrhage
Current clopidogrel OR ticagrelor therapy
Active bleeding (excluding menses)

437
Q

Clopidogrel precautions

A

severe renal impairment

438
Q

Clopidogrel side effects

A

haemorrhage

439
Q

Clopidogrel presentation

A

tablet (pink), 75mg

440
Q

Clopidogrel Timing

A

Onset
~ 30 mins
Duration
7-10 days
Half-Life
8 hours

441
Q

Clopidogrel routes of administration

A

PO

442
Q

Clopidogrel adult dose for Pts with STEMI who have been accepted for pPCI and receiving interventional cardiologist is requesting clopidogrel administration

A

600mg
swallowed with a small quantity of water

443
Q

Clopidogrel adult dose for Pts with STEMI who have received tenecteplase (and have been administered aspirin and enoxaparin)

A

300 mg
swallowed with a small quantity of water

444
Q

Enoxaparin drug class

A

anticoagulant

445
Q

Enoxaparin indications

A

Patients with STEMI who have received QAS tenecteplase (as an adjunct medication to aspirin and clopidogrel)

446
Q

Enoxaparin contraindications

A

Allergy AND/OR Adverse Drug Reaction
Patients contraindicated for pre-hospital fibrinolysis administration

447
Q

Enoxaparin precautions

A

Renal/hepatic impairment
Low bodyweight (women < 45 kg and men < 57 kg)
Older people

448
Q

Enoxaparin side effects

A

harmorrhage
thrombocytopenia

449
Q

Enoxaparin presentation

A

Injection, 60 mg/0.6 mL enoxaparin sodium
Injection, 100 mg/1 mL enoxaparin sodium

450
Q

Enoxaparin timing

A

Onset
immediate
Duration
12-24 hours
Half-Life
4.4 hours for 40mg dose

451
Q

Enoxaparin routes of administration

A

IV
subcut

452
Q

Enoxaparin adult IV dose fore Patients with STEM who have received QAS tenecteplase (as an adjunct medication to aspirin and clopidogrel)

A

loading dose 30mg

to be administered 15 mins prior to subcut maintenance dose

453
Q

Enoxaparin adult SUBCUT dose fore Patients with STEM who have received QAS tenecteplase (as an adjunct medication to aspirin and clopidogrel)

A

maintenace dose
1mg/kg
single dose only not to exceed 100 mg

to be administered 15 mins after IV loading dose

454
Q

What pain assessment tool is used in children aged 3 and above?

A

wong baker faces

455
Q

What pain assessment tool is used in infants who are unalbe to speak, comprehend or use self-reporting tools?

A

FLACC behavioural assessment scale

456
Q

What are the components of the FLACC behavioural assessment scale?

A

Face
Legs
Activity
Cry
Consolability

457
Q

Sodium Bicarbonate Drug Class

A

Alkalising agent

458
Q

Sodium Bicarbonate Indications

A

CCP Only
* Cardiac arrest:
- secondary to suspected hyperkalaemia (e.g. chronic renal failure)
- secondary to tricyclic antidepressant (TCA) OR propranolol overdose
* Significant injury with potential for crush syndrome
* TCA poisoning (with QRS > 0.14 AND terminal R wave in aVR)
* Sodium channel blockade due to non-TCA poisoning (with QRS > 0.14 AND terminal R wave in aVR)
* Suspected hyperkalaemia (with QRS widening AND/OR AV dissociation)

459
Q

Sodium Bicarbonate Presentation

A

Vial 100mL

460
Q

Sodium Bicarbonate

A

Bachelor of Paramedic Science (19 decks)

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