Drugs Flashcards
Adrenaline 1:1,000 (1mg/1mL) is indicated in:
Life-threatening asthma
Anaphylaxis
Adrenaline 1:10,000 (1mg/10mL) is indicated in:
Cardiac arrest
Post-ROSC circulatory support
Amiodarone is indicated in:
Cardiac arrest with VF or pulseless VT if unresponsive to 3 x DCCS
Aspirin is indicated in:
Clinical or ECG evidence suggestive of myocardial ischaemia or infarction
Suspected TIA where all symptoms have resolved AND the patient is not being conveyed to hospital AND the patient has been referred to the local TIA pathway
Atropine is indicated in:
Symptomatic bradycardia with ANY of the following:
Pulse < 40 bpm
SBP below average for age
Paroxysmal ventricular arrythmia requiring suppression
Confusion secondary to impaired cerebral perfusion
Bradycardia following ROSC
Benzylpenicillin is indicated in:
Suspected meningococcal disease + non-blanching rash and/or signs of sepsis
Chlorphenamine is indicated in:
Symptomatic allergic reaction (falling short of anaphylaxis) that causes the patient distress and/or alleviating distressing cutaneous symptom only after emergency
treatment with adrenaline and the patient is stable
Dexamethasone is indicated in:
Croup
Diazepam (5mg/1mL) is indicated in:
Status epilepticus
Eclamptic seizures if initial seizure lasts 2 - 3 minutes or if recurrent
Cocaine toxicity with cardiac presentation
Diazepam emulsions (5mg/1mL) is indicated in:
Status epilepticus
Eclamptic seizures if initial seizure lasts 2 - 3 minutes or if recurrent
Cocaine toxicity with cardiac presentation
Diazepam stesolid (2.5mg/1.25mL or 5mg/2.5mL) is indicated in:
Status epilepticus
Eclamptic seizures if initial seizure lasts 2 - 3 minutes or if recurrent
Glucagon is indicated in:
Hypoglycaemia
Clinically suspected hypoglycaemia where PO glucose is inappropriate
Glucose 10% INF is indicated in:
Hypoglycaemia
Clinically suspected hypoglycaemia where PO glucose is inappropriate
Glucose gel is indicated in:
Hypoglycaemia
Glyceryl trinitrate is indicated for:
Cardiac chest pain due to angina or myocardial infarction, when systolic blood pressure is greater than 90mmHg.
Consider administering GTN in Acute Heart Failure with ischaemia or uncontrolled hypertension.
Patients with suspected cocaine toxicity presenting with chest pain
Hydrocortisone is indicated in:
Severe or life-threatening asthma.
Acute exacerbation of COPD.
Adrenal crisis (including Addisonian crisis) which is a time-critical medical emergency with an associated mortality.
Prevention of Adrenal crisis in patients who suffer trauma or acute illness and are on long-term steroid therapy, either:
as replacement therapy for adrenal insufficiency from any cause, in long-term therapy at doses of 5+ mg prednisolone, e.g. for immune suppression.
Administer hydrocortisone to:
1. Patients in an established adrenal crisis (IV or IM administration preferable). Ensure parenteral hydrocortisone is given prior to transportation.
2. Patients with suspected adrenal insufficiency or on long-term steroid therapy who have become unwell, to prevent them having an adrenal crisis (IM administration is usually sufficient).
3. Pregnant women with known Addison’s Disease who are in established labour (regular painful contractions).
NB If in doubt about adrenal insufficiency, it is better to administer hydrocortisone.
Can be considered in post ROSC patients that may have arrested due to adrenal crisis.
Ibuprofen is indicated in:
Mild to moderate pain
Pyrexia with associated discomfort
Soft tissue injuries
Misoprostol is indicated in:
For the treatment of primary postpartum haemorrhage (>500 mL blood loss within first 24 hours after birth)
For the treatment of life threatening bleeding following a confirmed diagnosis of miscarriage.
Misoprostol can be administered as a second-line drug treatment after Syntometrine® or as an alternative firstline drug treatment if Syntometrine® is contraindicated or unavailable
Morphine is indicated in
Severe pain including pain associated with myocardial infarction
Naloxone is indicated in:
Respiratory depression or arrest secondary to opioid overdose
Patients exposed to high-potency veterinary or anaesthetic preparations should be given naloxone if ALOC or exposure within 10 minutes even if asymptomatic
Naloxone IV is indicated in:
Opioid overdose producing
respiratory/cardiovascular/central nervous system depression
Loss of consciousness with respiratory depression
Nitric oxide is indicated in:
Moderate - severe pain including labour pains
Ondansetron is indicated in:
Nausea and vomiting
Paracetamol (tablet) is indicated for:
Mild - moderate pain
Febrile
Paracetamol (suspension) is indicated for:
Mild - moderate pain
Febrile
Paracetamol (INF) is indicated for:
Mild - moderate pain
Febrile
Salbutamol (NEB) is indicated for:
Acute asthma attacks
Expiratory wheeze associated with allergy, anaphylaxis, smoke inhalation, beta-blocker overdose or lower airway cause
Exacerbation of COPD
Sodium chloride is indicated in:
Medical-related conditions +/- haemorrhage
Trauma-related haemorrhage
Burns
Crush injury
Sepsis
As a flush for cannulas
Syntometrine is indicated for:
Primary or secondary post-partum haemorrhage (PPH*) where there is excessive bleeding from the birth canal. See PPH guidance for definitions of primary and secondary PPH.
Confirmed miscarriage (or termination of pregnancy) with excessive bleeding (e.g. where a patient has gone home with medical management and starts to bleed). See Vaginal Bleeding during Pregnancy up to 20 weeks Gestation for the definition of confirmed miscarriage.
Tranexamic acid is indicated for:
Prevention and treatment of significant haemorrhage following trauma
Head injury patients, age 18 and over with a Glasgow Coma Score (GCS) of 12 or less;
Post-partum haemorrhage after the administration of a uterotonic drug or where a uterotonic medicine is contraindicated. N.B. A post-partum haemorrhage may start within 4 but up to 24 hours after delivery
Adrenaline (1mg/1mL) cautions include
Severe hypertension in patients on non-cardio-selective beta-blockers (propanolol)
Adrenaline (1mg/1mL) dose and administration:
Adults - 500 mcg (0.5 mL) every 5 minutes NMD
Paediatrics (6 - 11 years) - 300 mcg (0.3 mL) every 5 minutes NMD
Paediatrics (birth - 6 years) - 150 mcg (0.15 mL ever 5 minutes NMD
Asthmatics taking non-cardio-selective beta-blockers (propranolol) who receive IM or IV adrenaline may develop:
Severe hypertension
The correct adrenaline IM dose for a 4 year old with life-threatening asthma is:
150 mcg / 0.15mL
Adrenaline 1:10,000 is permitted to be administered as per normal when a patient is hypothermic. True or false
False - adrenaline cannot be administered in a core body temperature < 30 degrees
For patients with a core body temperature of 30 - 35 degrees, drug dose intervals must be doubled.
Adrenaline 1:10,000 dose and administration
Cardiac arrest (>12 years) - 1mg/10 mL every 3 - 5 minutes NMD
See JRCALC for patients < 12 years
Post ROSC circulatory support (All ages) - 50 mcg/0.5mL repeated at 50 mcg - 100 mcg every 3 - 5 minutes NMD
A 20 mL NaCl flush is required after all doses
Adrenaline (1mg/10mL) dose in shockable and non-shockable rhythms:
Shockable rhythms - administer adrenaline after the 3rd shock, and then after every second shock (5th, 7th, 9th…)
Non-shockable rhythms - immediate administration following access
Maximum dose of adrenaline (1mg/10mL) in cardiac arrest
There is no maximum
What is the one contra-indication for repeat doses of adrenaline in cardiac arrest?
Hypothermia (core temp < 30 degrees)
Oxygen is indicated for:
Significant injury or illness
Hypoxaemia
COPD
Cardiac arrest
Major trauma
Sepsis
Shock
CO poisoning
Seizures
Hypothermia
Amiodarone MOA
Antiarrhythmic; lengthens cardiac action potential and therefore effective refractory period. Prolongs QT interval on ECG.
Blocks sodium and potassium channels in cardiac muscle.
Acts to stabilise and reduce electrical irritability of cardiac muscle.
Contraindications to amiodarone
Hypothermia (core body temp < 30 degrees)
Amiodarone administration can result in:
Bradycardia
Vasodilation causing hypotension and cutaneous flushing
Bronchospasm
Torsades
Amiodarone dose and administration:
Cardiac arrest unresponsive to 3 x DCCS (adult) - 300 mg / 10 mL (pre-filled syringe) with a 20mL NaCl flush. Repeated at 150 mg after 5th shock for a maximum dose of 450 mg
See JRCALC for patients < 12 years
Amiodarone must be administered via…
Large bore cannula as extravasation can cause burns
Which medicine guideline includes a second dose that is the same as the first in children but halved in adults?
Amiodarone
Aspirin is contraindicated for patients with:
Known allergy
Patients less than 16 years old
Active GIT bleeding
Haemophilia or other known clotting disorders
Severe hepatic failure with jaundice
Aspirin may be given to patients with asthma, pregnancy, renal failure, hepatic failure without jaundice, ulcers, and concurrent anticoagulant treatment because…
The likely benefits outweigh potential risks
Aspirin administration may result in:
Increased risk of GIT bleeding and wheezing in some asthmatics
Reye’s syndrome can be caused by aspirin given to a child and has a mortality rate of:
50%
Atropine is permitted to be administered in response to bradycardia in the hypothermia patient. True or false?
False
Bradycardia in the patient with a heart transplant can be treated with atropine. True or false
False - Do NOT give atropine sulfate to patients with cardiac transplants; their hearts will not respond to vagal blocking by atropine and paradoxical high degree AV block or sinus arrest may result.
Contraindications to atropine include:
Hypothermia
Patients with cardiac transplants
Atropine MOA
Reverses effects of vagal overdrive.
Increases heart rate by blocking vagal activity in sinus bradycardia, second or third degree heart block.
Enhances A-V conduction
Atropine may result in:
Dry mouth, visual blurring and pupil dilation.
Confusion and occasional hallucinations.
Tachycardia.
Do not use small (<100 micrograms) doses as they may cause paradoxical bradycardia.
Atropine should be administered as a…
Rapid bolus
Which drug may reverse the effects of vagal overdrive, increase the heart rate and enhance A-V conduction?
Atropine
Can atropine increase the heart rate by blocking vagal activity in third degree heart block?
Yes
Which drug can result in urine retention in the elderly?
Atropine
Benzylpenicillin MOA
Narrow-spectrum ABx
Contraindications to benzylpenicillin:
Known severe penicillin reaction (more than a rash alone)
Do IV/IO and IM doses of benzylpenicillin have different or the same concentrations and volumes of administration?
Different - check JRCALC
What is the dose of intravenous benzylpenicillin for an adult with meningococcal septicaemia?
1.2 g
Chlorphenamine MOA
Antihistamine
Chlorphenamine contraindications
Known hypersensitivity
Treatment with MOA - The anticholinergic properties of chlorphenamine are intensified by monoamine oxidase inhibitors (MAOIs). Chlorphenamine injection is therefore contraindicated in patients who have been treated with MAOIs within the last 14 days.
Chlorphenamine cautions include
Pregnancy and breastfeeding
Hypotension
Epilepsy
Glaucoma
Severe liver disease
Side effects of chlorphenamine:
Sedation, dry mouth, headache, blurred vision, urinary retention, psychomotor impairment, GIT upset, convulsions
(anticholinergic)
Dexamethasone contraindications
Impending respiratory failure
Dexamethasone MOA
Corticosteroid that reduces subglottic inflammation
Upper airway compromise can be worsened by any procedure that distresses the child – this might include the administration of _______ medication.
Dexamethasone
Side effects of dexamethasone:
GIT upset and anaphylactic reaction
Diazepam (rectal) is indicated in:
Patients who have prolonged convulsions (lasting 5 minutes or more) OR repeated convulsion (three or more in an hour), and are CURRENTLY CONVULSING – (not secondary to an uncorrected hypoxic or hypoglycaemic episode)
Eclamptic convulsions (initiate treatment if seizure lasts over 2–3 minutes or if it is recurrent).
Symptomatic cocaine toxicity (severe hypertension, chest pain or convulsions).
Contraindications to diazepam include:
Known hypersensitivity
Side effects of diazepam include:
Respiratory depression is common with concurrent ETOH or opioids
Hypotension, light-headedness, unsteadiness, drowsiness, confusion, amnesia
All patients who continue to convulse should receive a total of ___ doses of benzodiazepine (midazolam or diazepam) __ minutes apart, the second dose should be IV/IO if possible.
Only give a second rectal dose if IV/IO access cannot be obtained in the 10 minutes between the first and second doses. Seek clinical advice if the convulsion continues 10 minutes after the second dose.
2 doses, 10 minutes apart
Adult dose > 70 years diazepam:
10 mg repeated at 10 mg after 10 minutes TMD 20 mg
Adult dose < 70 years diazepam dose:
20 mg repeated at 10 mg after 10 minutes TMD 30 mg
Paediatric dose 5 - 11 years diazepam
10 mg repeated at 10 mg after 10 minutes TMD 20 mg
Paediatric dose < 4 years diazepam
5 mg repeated at 5 mg after 10 minutes TMD 10 mg
Glucagon MOA
Converts glycogen to glucose
Glucagon contraindications:
Pheochromocytoma (tumour on adrenal gland)
Glucagon cautions:
Low glycogen stores (anorexia, ETOH)
Side effects of glucagon include:
Nausea, vomiting, abdominal pain, hypokalaemia, hypotension (adults), diarrhoea (paeds), hypersensitivity
Glucagon can be administered ____
Once, and may have already been administered by a carer
Hypoglycaemic patients who are convulsing should preferably be given _____
Glucose 10% IV
Glucose 10% is indicated in:
Hypoglycaemia where oral glucose is inappropriate and a rapid improvement is required
For the management of patients who have not responded to the administration of IM glucagon within 10 minutes
Contraindications to glucose 10% are:
IM or SUBCUT injections
Glucose poses a risk of extravasation. True or false
True - use large bore cannula and flush thoroughly
Adult dose of glucose 10% is:
10g repeated at further 10g after 5 minutes. TMD 30g
GTN is contraindicated in:
Hypotension (systolic blood pressure < 90mmHg in angina/myocardial infarction, or < 110 mmHg in acute heart failure).
Hypovolaemia.
Head trauma.
Cerebral haemorrhage.
Sildenafil (Viagra) and other related drugs – glyceryl trinitrate must not be given to patients who have taken sildenafil or related drugs within the previous 24 hours. Profound hypotension may occur.
Unconscious patients.
Known severe aortic or mitral stenosis
Patients with suspected posterior myocardial infarction or right-ventricular infarction are cautioned for:
GTN
Side effects of GTN are related to:
Potent vasodilation - headache, dizziness, hypotension
Which medicine requires the oral mucosa to be moist for absorption and clinicians are advised to ‘moisten if necessary’?
GTN
MI w/ RV) involvement in a patient who is haemodynamically stable is contraindicated in the administration of GTN. True or false
False - not a contraindication
What is the age limit for GTN
No age limit
Hydrocortisone is contraindicated for patients with:
Known allergy
Hydrocortisone MOA:
Glucocorticoid drug that restores blood pressure, blood sugar, cardiac synchronicity and volume.
High levels are important to survive shock. Therapeutic actions include suppression of inflammation and immune response.
Burning and stinging may be associated with hydrocortisone due to _____
Significant amounts of phosphate preservative within the solution.
If there is any doubt about previous steroid administration, it is better to administer ______
Further hydrocortisone
Contraindications to ibuprofen include:
Dehydration
Hypovolaemia
Renal insufficiency
Active GIT disturbance (peptic ulcer, dyspepsia)
Pregnancy within 3rd trimester
Paediatric with chicken pox
Known hypersensitivity to ibuprofen or NSAIDS (asthma, rhinitis, angioedema)
Patients with severe heart failure
Anticoagulant therapy
An elderly or frail adult with a fracture
Ipratropium bromide is indicated in:
All forms of asthma
Exacerbation of COPD
Expiratory wheezing
There are no contraindications to:
Ipratropium bromide
Syntometrine is contraindicated in:
Severe hypertension
Known anaphylaxis to medication constituents
Pregnancy
Severe cardiac, liver, or kidney disease (unless bleeding is life-threatening)
Morphine is contraindicated in:
Children < 1 year
Respiratory depression
Hypotension
Head injury with ALOC
Hypersensitivity to morphine
None apply to EOL care as benefits outweigh risk
Neonates born to opioid addicted mothers can suffer from serious withdrawal effects. Emphasis should be on _____
Bag-valve-mask ventilation and oxygenation.
Entonox is contraindicated in patients with:
Chest injury and suspected pneumothorax
Severe head injury
Decompression sickness
Psychiatric patients
An intraocular injection within last 8 weeks
Abdominal pain with query intestinal obstruction
Nitrous oxide may have a deleterious effect if administered to patients with closed body cavities containing air since nitrous oxide diffuses into such a space with a resulting increase in pressure
Contraindications to ondansetron include
Known sensitivity
Paediatrics < 1 month old
Congenital long QT syndrome
Ondansetron administration can result in:
Hiccups.
Constipation.
Flushing.
Hypotension.
Chest pain.
Arrhythmias.
Bradycardia.
Headache.
Seizures.
Movement disorders.
Injection site reactions
Ondansetron should always be given in a separate syringe to ____
Morphine sulphate – the drugs must NOT be mixed.
Paracetamol should not be administered to patients with:
A known paracetamol allergy
Contraindications to salbutamol include:
None
Salbutamol administration may result in:
Tremor, tachycardia, palpitations, headache, feeling of tension, peripheral vasodilation, muscle cramps, rash
TXA should not be administered to patients with:
Known hypersensitivity
Bleeding > 3 hours old
Resolution of haemorrhage
Critical interventions required (airway management, haemorrhage control)
