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Drugs Flashcards

1
Q

What is the dose of amiodarone given to pediatrics? Is there an age restriction?

A

5mg/kg up to adult dose of 300mg.
No age restriction.

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2
Q

Nebulised adrenaline in severe croup; when should 2.5mg be administered?
When should 5mg be administered?

A

2.5mg for pt< 6mo

5mg for pt >= 6mo

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3
Q

What dose of IV adrenaline is given to pediatrics in cardiac arrest? In what concentration is it given?

A

10microg/kg.
For all pts < 16yrs, concentration should be 100 microg/1ml (dilute 1mg/1ml in 9ml saline).

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4
Q

What dose of IM adrenaline is given to pediatrics in anaphylaxis / asthma?

A

10 microg/kg up to 500microg

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5
Q

Which patients are indicated for nebulised adrenaline?

A

Croup - severe or life threatening
Anaphylaxis with upper airway swelling.
n.b. - in anaphylaxis neb can be given after FIRST IM adrenaline

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6
Q

What dose of benzylpenicillin is given to pediatrics?

What is the concentration of the prepared solution?

Is it given IM, IV or both?

A

Dose: 60mg/kg up to 2400mg

Concentration: 1200mg/4ml = 300mg/ml (1.2g powder with 3.2ml water)

May be given IM or IV; IV preferred - slow push over 3-4min (rapid administration of large doses may result in seizures)

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7
Q

What are the contraindications / precautions for benzylpenicillin?

A

No absolute contraindications
Relative contraindication of allergy / adverse drug reaction - discuss with SAAS medical practitioner via ECP.

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8
Q

What is the dose of IV fentanyl given to pediatrics?
What is the dosage interval?
What concentration is given?
What is the total max dose?

A

Dose: 0.5 microg/kg to single max 25 microg
Interval: 5min
Concentration: 100microg / 10ml (100microg / 2ml mixed with 2ml saline)
Total max dose: 2 microg/kg

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9
Q

When is consultation required for administering fentanyl?

A

Consultation required for
* IV fentanyl: pts < 6yrs
* IN fentanyl: for pts < 1yr

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10
Q

In giving IN fentanyl, when should the 450microg/1.5ml formulation be used?
When should 100microg/2ml be used?

A

The 100microg/2ml formulation should be used where less than 30 microg of fentanyl is being given. i.e. patients less than 20kg (approx 5yrs).

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11
Q

What is the dose of IN fentanyl given to pediatrics?
Dosage interval?
Max dose?

A

1.5microg/kg
Interval 5min
Max dose 4.5microg/kg

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12
Q

What is the dose of of IN fentanyl given to adults?
What is the dosage interval?
What is the max dose?

A

180microg, repeat prn every 5min, max dose 400microg

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13
Q

What is the dose of glucagon for adults? Paediatrics? When does the dose change?

A

Adults: 1mg
Pediatrics >=25kg get 1mg
Pediatrics < 25kg (approx 6yrs) get 0.5mg

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14
Q

If glucagon fails to correct hypoglycemia, when should IV glucose be considered?

A

Use IV glucose if hypoglycemia not corrected after 10min

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15
Q

What nebulised dose of ipratropium is given to paediatrics?
Adults?
At what age does the dose change?

A

Paediatrics 250microg
Adults 500microg
Dose changes at 6yrs

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16
Q

When is nebulised ipratropium indicated?
What is the dosage interval?
Max dose?

A

Indicated for
* asthma (moderate, severe and life-threatening) anaphylaxis with bronchospasm (moderate, severe and life-threatening)
* Exacerbation of moderate to severe COPD if MDI ineffective

Dosage interval - repeat every 20min up to 3x in severe / life-threatening bronchospasm and moderate to severe COPD. Once only for moderate bronchospasm.

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17
Q

What is the concentration of IV glucose 10%?
What is the initial dose for IV glucose 10%?
Repeat dose?
Max dose?

A

Concentration 100mg/ml
Dose is 2ml/kg up to 250ml (i.e. 200mg/kg up to 25g)
Repeat at 1ml/kg (100mg/kg)
Max dose 5ml/kg

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18
Q

When is IV glucose 10% indicated?

A

Adult hypoglycemia (BGL< 3.5mmol) with inability to tolerate oral glucose

Paediatric hypoglycemia (BGL< 3.5mmol) if unable to tolerate oral glucose AND glucagon ineffective. Consult required.

Hypoglycemia post-ROSC

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19
Q

What volume of saline should be given as a flush following administration of IV glucose 10%?
How should this be administered to paediatrics?

A

Adults 100ml
Pediatrics 1ml/kg
In pediatrics fluid should be administered using a burette.

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20
Q

What are the indications for droperidol?

A

Indications:
* Patient aged 16–64 yrs AND uncooperative in taking oral medications AND SAT ≥ +2 from likely or apparent non-medical cause
- Consult required for pts >=65yrs
* Nausea/vomiting as second line therapy (adults only)

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21
Q

What is dose of droperidol may be given for challenging behaviours?
What is the concentration?
Dosage interval?
Max dose?

A

Dose 5-10mg IM (1-2ml)
Concentration 10mg/2ml
Can repeat once after 15min if SAT>=+2
Max dose droperidol + olanzapine is 20mg in 24hrs

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22
Q

What is dose of droperidol may be given as a second line therapy for nausea/vomiting?
What is the concentration?
Max dose?

A

Dose: 250-500microg IV - slow push over 1min.
Consider smaller dose in pts >=65yrs

Concentration: 100 microg/ml; 10mg (2ml) droperidol added to 100ml saline, required dose decanted via syringe.

Max dose: 500microg.

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23
Q

What is the concentration of amiodarone?
What is the dose for adult patients?
Pediatrics?

A

Concentration 150mg/3ml (50mg/ml)
Adult dose is 300mg (6ml)
Pediatric dose 5mg/kg (0.1ml/kg)
≤ 1 yr use 1 mL syringe to draw up age appropriate dose

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24
Q

When is amiodarone indicated? When is it contraindicated?

A

Indicated for cardiac arrest / shockable rhythm refractory to 3x DCCS

Contraindicated for hypothermic patients < 30C (all cardiac arrest drugs withheld)

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25
What are the contraindications for aspirin? Adverse effects? What is the onset time?
Contraindications * Anaphylaxis (**not hypersensitivity**) to aspirin and NSAIDs * Severe active bleeding * Use in paediatrics (associated with Reye’s syndrome) Adverse effects - GI irritation and increased clotting time Onset 10min.
26
What are the contraindications for droperidol?
Contraindications * Hx of neuroleptic malignant syndrome * Parkinsons disease * Pregnancy * Phaeochromocytoma (hormone secreting tumour of adrenals) Relative: pts with long QT syndrome (anti-emetic doses unlikely to affect QT)
27
What are the adverse effects of droperidol?
Significant adverse effects include * Hypotension * Respiratory depression * Extrapyramidal effects (dystonias including torticollis, trismus, and oculogyric crisis)
28
What are the indications for fentanyl? What is the IV dose for adults? What is the max dose?
Indications: * Moderate to severe pain * Chest pain IV dose 25-50microg (slow push over 1min) Max dose * Moderate to severe pain: Max 300microg in 1st hour and 100microg every subsequent hour * Chest pain: Total max dose not to exceed 300microg
29
What is the dose for fexofenadine? What is the age restriction?
Dose 180mg (single tablet), single dose. Given to pts >=12
30
When is fexofenadine indicated? Can it be given in anaphylaxis? What if pt has already had an antihistamine today?
* Indicated for mild/moderate allergic reaction (i.e. single body system affected). * Can be given in anaphylaxis if prominent itch after systemic effects resolved * Safe to give if pt has already had antihistamine today
31
What are the side effects of fexofenadine? What are the risks?
Common adverse effects include drowsiness, headache, nausea and dry mouth Increased risk of sedation and anticholinergic effects (dry mouth, blurred vision & postural hypotension) in elderly pts
32
What are the contraindications for oral glucose in hypoglycemia?
Unsuitable for patients with altered conscious state/ inability to swallow who are incapable of self-administration
33
When is oral glucose indicated for neonates? How should it be administered?
Indicated for BGL< 2.5mmol In neonates use a 3 mL syringe (dry buccal mucosa with dressing) and apply gel, massaging gently with gloved hand
34
When are the indications for GTN? What are the contraindications?
Indicated for chest pain and ACPO Contraindications * recent use of PDE-5 inhibitor drug (commonly for erectile dysfunction or pulmonary arterial hypertension): - 24 hrs: sildenafil (Viagra), vardenafil (Levitra) or avanafil (Stendra); or 48 hrs: tadalafil (Cialis) * in hypovolaemic states that cannot be corrected * if SBP < 100 mmHg * Previous GTN tablet not fully dissolved
35
What are the adverse effects of GTN?
* Severe headache * Flushing * Palpitations * Orthostatic hypotension (falls risks) * Fainting * Peripheral oedema
36
What are the indications for ibuprofin? What are the contraindications? What is the age restriction?
Indicated for pain management as part of a multimodal approach Contraindications * Chronic kidney disease * Active peptic ulcer disease * GI bleeding * Congestive cardiac failure (CCF) * Hx of MI * Presenting with acute coronary syndrome (ACS) * Pregnancy * Hypoperfused state * Ibuprofin use within 6hrs Not to be used in infants < 3mo
37
What are the precautions for ibuprofin?
Cardiovascular disease Pre-existing renal disease including nephrectomy Concurrent use of ACEi/ARB and diuretics Dehydration Age ≥ 65
38
What are the common adverse effects of ibuprofin?
* Nausea * Dyspepsia * GI ulceration or bleeding * Increased risk of bleeding Bronchospasm and rash are less common adverse effects and may be associated with NSAID allergy
39
What is the pediatric dose for ibuprofin? What is the presentation / concentration of pediatric ibuprofin?
Pediatric dose is 10mg/kg Presentation is 100mg/5ml -> 20mg/ml
40
What are the indications for midazolam?
* Prolonged / repeated seizures (IM) * Mental health transfer with SAT>=2 (IM/IV) (Consult) * CPR induced consciousness (IV/IO)
41
What is the midazolam dose for a patient with prolonged/repeated seizures? What is the dosage interval? How many doses may be given?
100microg/kg up to 10mg Repeat once after 5min If seizure not controlled following 2 doses of midazolam, levetiracetam (ICP only) is recommended
42
What is the midazolam dose for CPR induced consciousness? Repeat doses / dose interval? Max dose?
Dose 1-2mg IV/IO (1-2ml of 5mg/5ml). Consider co-administration with fentanyl. Repeat every 5min prn Max dose 5mg
43
What are the indications and contraindications for ketorolac?
Used as part of multimodal approach in pain management Contraindications Chronic kidney disease Active peptic ulcer disease GI bleeding Congestive cardiac failure (CCF) Hx of MI ACS Pregnancy Hypoperfused state Age < 16 (not for use in pediatrics)
44
What is presentation of ketorolac? What are the administration routes? What is the dose? Repeat dose?
Presentation 10mg/1ml Can be given IM or IV IM: 10mg/1ml. IV 10mg/10ml (diluted with saline) No repeat dose.
45
What are the indications for oral lorazepam? What age ranges can be given lorazepam without consult? With consult?
Acute behavioural disturbance - 1st line therapy for anxiety, situational crisis, mental health presentation with suspected medical cause, alcohol withdrawal Without consult: 16-64yrs With consult: 8-15yrs and >=65yrs
46
What is the dose of oral lorazepam? Repeat dose? Max dose? What if the patient has already had benzodiazepines?
Dose 1mg tablet - may consider single dose of 2mg; 1mg may be appropriate for pts with precautions. Repeat once to total max dose of 2mg Safe if patient has already taken benzodiazepines with standard monitoring applicable
47
What are the adverse effects of lorazepam? What are the precautions?
Adverse effects include vertigo, disorientation, paradoxical excitation and aggression. Precautions are respiratory depression or reduced respiratory drive (disease, sleep apnoea)
48
What are the indications for morphine?
* Uncontrolled pain, and * Chest pain if first line agents ineffective or unsuitable
49
When is consultation required for morphine?
Consult required for all paediatrics Consult required when exceeding daily limit of 30mg for adult palliative care patients
50
Which patient groups are more likely to develop respiratory depression from morphine?
Elderly and/or patients with diminished renal function are more likely to develop respiratory depression
51
Which patient groups are more sensitive to opioid induced CNS depression from morphine?
Elderly patients and children < 1 yr are significantly more sensitive to opioid-induced CNS depression
52
What is the time of onset and duration of IV morphine?
Onset 5-15min Duration 1-2hr
53
What are the adverse effects of morphine?
Notable adverse effects include: * dose-related respiratory depression * euphoria / dysphoria * delirium / hallucinations * urticaria * orthostatic hypotension
54
What is the dose for morphine? Dosage interval? Max dose?
Dose 2.5-5mg IV Interval: repeat prn at 5min intervals (but consider that time to peak effect is approx 15min) Max dose 30mg
55
What are the IM, IN and IV doses of naloxone for adults? What is the dosage interval?
IM 400microg IN 120microg (0.3ml) IV 50-100microg For all: repeat prn every 2-3min
56
What is the presentation of naloxone? What concentration is administered IV?
Presentation is 400microg / 1ml For IV add 3ml saline to get 400microg / 4ml (give 0.5-1ml for 50-100microg)
57
What is the time of onset for naloxone for each of IM, IV and IN?
IM 2-5min IN and IV 1-2min
58
Which patients may require high cumulative doses of naloxone?
High cumulative dose of IV/IM naloxone (up to 2 mg) may be warranted: * for high-potency synthetic opioid overdoses * with overdoses due to partial opioid agonists (e.g. buprenorphine)
59
Which patients will likely require multiple doses of naloxone?
The duration of action of naloxone may be insufficient and require repeat doses for overdoses of: * long-acting opioids (e.g. methadone) * opioids with active metabolites (e.g. codeine)
60
Which opioid OD patients should not receive naloxone?
Newborns with opioid respiratory depression due to maternal opioid use do not give naloxone due to risk of causing seizures
61
Can naloxone be used as a diagnostic aid for opioid OD?
Yes, useful as a diagnostic aid in suspected opioid overdose
62
What is the max dose for naloxone?
No firm limit, however, if a large therapeutic dose of naloxone (e.g. 2 mg) has been administered to no effect, consider and treat other causes of unconsciousness
63
What are the adult doses of ondansetron for each of ODT, IM and IV?
ODT 4mg IV 4mg (slow push over 1min) IM 4mg
64
What is the presentation of liquid ondanstron? What concentration is given IV?
Presentation 4mg/2ml For IV dilute with 2ml saline to make 4mg/4ml
65
What is the pediatric dose of ondansetron ODT? What is the age cutoff?
For 2yrs - < 6yrs give half tablet (2mg) For >=6yrs give full tablet (4mg) Can repeat once prn. ODT not indicated for children < 2yrs
66
What is the dose of IM/IV ondansetron for paediatrics? When is consultation required?
150microg / kg Repeat once prn Consult for pts < 1yr
67
Which nausea / vomiting patients may not respond to ondansetron?
Patients with cannabinoid hyperemesis syndrome may not repond to ondansetron
68
What are the indications for prednisolone?
* Croup * Asthma (moderate / severe) * Anaphylaxis with bronchospasm (moderate / severe) * COPD
69
What dose of prednisolone is given to adults? Paediatrics?
Adults: 50mg Paediatrics: 1mg/kg up to 50mg
70
What are the contraindications for prednisolone?
In moderate / severe croup: none, administer prednisolone if no allergy / adverse drug reaction Asthma / anaphylaxis with bronchospasm / COPD only administer prednisolone if no dose within 24hrs, unless asthma / COPD management plan indicates otherwise. If time of last dose not confirmed, administer prednisolone.
71
What are the presentations of prednisolone?
Oral liquid 30ml, 5mg/ml Tablet 25mg
72
What are the indications for TxA?
* PPH within 3hrs of birth (pts >=16yrs) Blunt or penetrating trauma patients with ALL of * >=16yrs * injury within 3hrs * SBP < 90 and HR > 120
73
What is the presentation of TxA? What is the dose given? Routes?
Presentation 1g/10ml Dose 1g (undiluted) Can be given IV and IO as a slow push over 2-3min
74
In anaphylaxis what dose of saline is given? What is the max dose? What is the target / end point for adults and paediatrics?
Dose 10ml/kg aliquots up to 250ml Repeat prn up to 20ml/kg Target: Adults - SBP 100mmHg, pediatrics aim for BP at lower range of normal
75
When is fluid indicated in burns? In which burns should fluids be used with caution?
Indicated for * Adults: BSA>20% * Pediatrics: BSA>10% with poor perfusion Use with caution in airway burns
76
How much fluid may be given in cardiac arrest?
Up to 30ml/kg; consult if further fluids required.
77
How much fluid should be administered in crush patients (adults and pediatric) pre-release? Post-release?
Pre-release: fluid should be given in 10ml/kg aliquots (up to 250ml) up to 20ml/kg Post release: * Adults - 250ml aliquots up to 20ml/kg * Pediatrics - target SBP at lower end or normal
78
What is the target for fluid resuscitation in trauma patients?
Aim for minimal volume required for patient to respond appropriately to verbal commands; consult if further required
79
What is the target for fluid resuscitation in adult patients with Neurogenic Shock with Isolated SCI? Paediatric patients?
Adult target: SBP 100mmHg or MAP 80mmHg Paediatrics: target lower normal SBP as per RDR
80
What is the target for fluid resuscitation in adult patients with Traumatic Brain Injury? Paediatric patients?
Adults: aim to establish/maintain MAP ≥ 90 mmHg or SBP ≥ 110 mmHg. Paediatrics: lower end of normal range for age per RDR chart
81
When is fluid indicated in patients post-ROSC? How much may be given? What is the target? Is consultation required?
Indicated for hypotensive patients with altered GCS. Up to 1000mL may be given (consult if more required). Aim for SBP 100 mmHg, or radial pulse Consult for Pts < 16yrs
82
When in fluid indicated for adult patients with suspected sepsis? Pediatric patients? How much fluid may be given to these patients? What is the target / endpoint? Does this change for suspected meningococcal septicemia?
Adults: suspected sepsis with MAP<= 65mmHg and/or SBP<= 100mmHg Pediatrics: indicated for suspected sepsis with poor perfusion Up to 20ml/kg in10ml/kg (up to 250ml) aliquots; consult if more required Adults: aim for SBP 100 mmHg; Children: aim for BP @ lower end of normal range for age per RDR chart Same indications / volume / target apply for meningococcal septicemia.
83
What are the contraindications for fluid resuscitation? What are the precautions?
Contraindication - signs of fluid overload Precautions Exercise extreme caution in setting of airway burns (risk of oedema) Patient conditions prone to fluid overload may include: * CCF * Pulmonary oedema * Significant renal dysfunction * Liver failure * Severe cardiovascular disease
84
What are the contraindications for GTN (3x)?
GTN contraindicated: * if recent use of PDE-5 inhibitor drug (commonly for erectile dysfunction or pulmonary arterial hypertension): 24 hrs: sildenafil, vardenafil or avanafil; or 48 hrs: tadalafil * in hypovolaemic states that cannot be corrected * if SBP < 100 mmHg
85
What are the contraindications for aspirin (3x)?
* Anaphylaxis/severe allergy to aspirin and NSAIDs * Severe active bleeding * Pediatrics (associated with Reyes Syndrome)
86
What are the contraindications for olanzapine (x2)?
Parkinsons disease Hx of Neuroleptic Malignant Syndrome
87
What are the potential adverse effects of olanzapine (x4)?
* Hypotension * Respiratory depression * ECG changes * Extrapyramidal events (dystonias including torticollis, trismus, and oculogyric crisis)
88
What age patients can be given olanzapine without consult? With consult?
Without consult: 16-64yrs With consult: 8-15yrs and >=65yrs
89
What age ranges can be given sublingual ketamine without consult? With consult?
Without consult: 16-64yrs With consult: < 16 or >=65yrs
90
What are the contraindications for ketamine (x2)?
Allergy/adverse reaction Pts experiencing psychiatric episode
91
What are the onset, peak time and duration of sublingual ketamine?
Onset 10min Peak 20-30min Duration 1-2hrs
92
What is the dose for sublingual ketamine? Can a repeat dose be given? How much and when? What is the max dose?
25-50mg (1-2 wafers) Can give additional 25mg after 15min in **uncontrolled severe pain** Max doses: 75mg in 1st hour, can give subsequent 50mg in second hour (total max 5 wafers)

SAAS CPGs (9 decks)

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