Drugs Flashcards
What presentation does Adrenaline come in?
- 1mg in 1ml glass ampoule (1:1,000)
- 1mg in 10ml glass ampoule (1:10,000)
What is the pharmacology of Adrenaline? and what are its actions?
- A naturally occuring alpha and beta-adrenergic stimulant
Actions: Beta 1, Beta 2 and Alpha
Beta 1 effects
* Increases HR by increasing SA node firing rate
* Increases conduction velocity throuygh the AV node
* Increases myocardial contractility
* Increases the irritability of the ventricles
Beta 2 effects
* causes bronchodilation
Alpha effects
* causes peripheral vasoconstriction
How is Adrenaline metabolised?
- By monoamine oxidase and other enzymes in the blood, liver and around nerve endings
- It is excreted by the kidneys
What are the 6 primary incidations of Adrenaline?
- Cardiac arrest (VT, VF, Asystole or PEA)
- Shock
- Bradycardia with poor perfusion
- Anaphylaxis
- Severe asthma - imminent life threat not responding to nebulised therapy or unconscious with no BP
- Croup
What are the contraindications to Adrenaline?
- Hypovolaemic shock without adequate fluid replacement
What are the 4 precautions for Adrenaline?
Consider reduced doses for
1. Elderly/frail patients
2. Patients with cardiovascular disease
3. Patients on monoamine oxidase inhibitors
Higher doses
4. Higher doses may be required for patients on beta blockers
How can adrenaline be administered?
Route
- IV
- IM
- Nebulised
- IV infusion
- IO
What are some side effects of Adrenaline?
- Sinus tachycardia
- SVT
- Ventricular arryhtmias
- HTN
- Pupillary dilation
- May increase size of MI
- Feeling of anxiety/palpitations in the conscious patient
What is the ONSET time of IV Adrenaline?
30 seconds
What is the PEAK time of IV Adrenaline?
3-5 mins
What is the duration of IV Adrenaline?
5-10 mins
What is the ONSET time of IM Adrenaline?
30-90 secs
What is the PEAK time of IM Adrenaline?
4-10 mins
What is the duration of IM Adrenaline?
5-10 mins
What is the mode of action for Amiodarone?
- Class III antiarrhythmic
- Prolongs cardiac action potential and delays refractory period
What are the indications of Amiodarone?
- VF/Pulseless VT refractory to defibrillation
- Sustained or recurrent VT
What are the contraindications of Amiodarone?
- Tricyclic antidepressant toxicity
- QTc > 500 milliseconds
- VT following ondansetron administration
- Pregnancy (if not in cardiac arrest)
What are the adverse effects of Amiodarone?
CVS
* rebound bradycardia
* hypotension
* phlebitis
GI
* nausea
* vomiting
* metallic taste in mouth
What are some significant interactions of Amiodarone?
- infusion is only compatible with Dextrose 5% (sodium chloride 0.9% can be used to flush line for administration during cardiac arrest)
- Flush the line thoroughly prior to administration if the same line has been previously been used to administer dexamethasone, heparin, hydrocortisone or sodium bicarbonate
Is Amiodarone safe during pregnancy?
- Avoid unless mother is in cardiac arrest
- Maternal use of amiodarone has been associated with congenital hypothyroidism or hyperthyroidism and neurologic abnormalities
Can a mother breastfeed post administration of amiodarone?
No, the child should not be breast fed following administration without first consulting specialist physician
How does amiodarone come?
Presentation
150mg in 3ml ampoule
How can you administer amiodarone?
- IV
- IO
What is the onset of action of Amiodarone?
2 mins
What is the duration of action of Amiodarone?
2 hours
What presentation does Aspirin come in?
- 300mg chewable tablets
- 300mg soluble or water dispersible tablets
What is the pharmacology of Aspirin?
- Analgesic
- Antipyretic
- Anti-inflammatory
- Anti-platelet aggregation agent
Actions:
* To minimise platelet aggregation and thrombus formation in order to retard the progression of coronary artery thrombosis in ACS
* Inhibits synthesis of prostaglandins - anti-inflammatory conditions
How is Aspirin metabolised?
Converted into salicylate in the gut mucosa and liver
Excreted by mainly the kidneys
What are the indications for aspirin?
ACS
What are the contraindications of aspirin?
- Hypersensitivity to aspirin/salicylates
- Actively bleeding peptic ulcers
- Bleeding disorders
- Suspected dissecting aortic aneurysm
- Chest pain associated with psychostimulant OD if SBP > 160
When do you need to take precautions when administering Aspirin?
- Peptic ulcer
- Asthma
- Patients on anticoagulants
What are the side effects of Aspirin?
- heart burn
- nausea
- GIT bleeding
- Increased bleeding time
- Hypersensitivity reactions
Can you give aspirin in acute febrille illness in children and adolescents?
No, it is contraindicated
How long do the anti-platelet effects of aspirin persist?
- For the life of the platelets
- Typically 7-10 days
What is the onset time of Aspirin?
N/a
What is the Peak time of aspirin?
N/a
What is the duration of aspirin?
8-10 days
