Drugs Flashcards
Adrenaline presentation
1mg in 1ml
1mg in 10ml
Adrenaline contras
hypovolaemic shock without adequate fluid replacement
Adrenaline precautions
consider reduced doses for: elderly, pts with CVD, pts on monoamine oxidase inhibitors
beta blockers
Side effects of Adrenaline
Sinus tachy, supraventricular arrhythmias, ventricular arrhythmias, hypertension, pupillary dilation, may increase size of MI, feeling of anxiety/palpitations in the conscious pt
Presentation of Aspirin
300mg tablet
PEI Aspirin
ACS
Contras of Aspirin
hypersensitivity, actively bleeding peptic ulcers, bleeding disorders, suspected dissecting aortic aneurysm, chest pain assoc with psychostim OD if SBP greater than 160
Precautions of Aspirin
peptic ulcer
asthma
pts on anticoagulants
Side effects of Aspirin
heartburn, nausea, GI bleeding, increased bleeding time, hypersensitivity reactions
Dextrose 10% presentation
25g in 250ml soft pack
contras of Dextrose 10%
nil
Precautions of Dxtrose 10%
nil
Side effects of Dextrose 10%
nil
Presentation of Fentanyl
100mcg in 2ml
200mcg in 1ml
600mcg in 2ml
PEI of Fentanyl
sedation to facilitate intubation
sedation to maintain intubation
drug facilitated intubation
analgesia
contras of Fentanyl
known hypersensitivity
IV amiodarone
precautions of Fentanyl
elderly impaired renal function resp depression current asthma pts on MOA inhibitors known addition to opioids rhinitis, rhinorrhea or facial trauma oral amiodarone
Side effects of Fentanyl
resp depression
apnoea
rigid diaphragm
bradycardia
Fentanyl presentation used for Adult IN
600mcg in 2ml
Fentanyl Presentation used for Paed IN
100mcg in 2ml
GTN presentation
0.6mg tablets
50mg patch
PEI for GTN
chest pain with ACS acute LVF hypertension assoc with ACS autonomic dysreflexia preterm labour
contras for GTN
hypersensitivity SBP less than 110 tablet SBP less than 90 patch viagra or levitra in 24 hours or cialis in 4 days HR greater than 150 HR less than 50 VT inferior STEMI with SBP less than 160 right ventricular MI
Precautions of GTN
no previous admin
elderly pts
recent MI
concurrent use with other tocolytics
Side effects of GTN
tachycardia, hypotension, eadache, skin flushing, bradycardia
Presentation of Ipratropium Bromide
250mcg in 1ml
PEI for Ipratropium Bromide
severe resp distress associated with bronchospasm
contras of Atrovent
known hypersensitivity to Atropine or its derivatives
Precautions of Atrovent
glaucoma
avoid contact with eyes
Side effects of Atrovent
headache, nausea, dry mouth, skin rash, tahcycardia, palpitations, acute angle closure glaucoma
Methoxy presentation
3ml
PEI of Methoxyflurane
pain relief
contras of Methoxy
preexisting renal disease
concurrent use with tetracycline antibiotics
exceeding total dose in 24 hours
Precautions of Methoxy
penthrox held by pt
pre-eclampsia
concurrent use with oxytocin
Side effects of Methoxy
drowsiness, decrease in BP and bradycardia, renal toxicity
Presentaiton of Metoclopramide
10mg in 2ml
PEI for Metoclopramide
nausea and vomiting assoc with chest pain, opioid admin for pain, cytotoxic or radiotherapy, previously diagnosed migraine, severe gastro
awake spinal immobilized pts, eye trauma
contras of Metoclopramide
children
suspected bowel obstruction
GI haemorrhage
precautions of Metoclopramide
undiagnosed abdo pain
adolescents
admin slowly over 1min
side effects of metoclopramide
drowsiness lethargy dry mouth muscle tremor extrapyrimidal reactions
Midazz presentations
5mg in 1ml
15mg in 3ml
PEI of Midaz
status epilepticus sedation to enable intubation post intubation sedation sedation to enable synchronized cardioversion sedation in the agitated pt sedation in psychostim OD
Contras for Midaz
known hypersensitivity to benzos
Precautions for Midaz
reduced doses may be required for the elderly, renal failure, CCF or shock
CNS depressant effects enhanced in the presence of narcotics
can causes severe resp depression in COPD
pts with myasthenia gravis
Side effects of Midaz
depressed level of consciousness
resp depression
loss of airway control
hypotension
Presentation of Morphin
10mg in 1ml
PEi for Morphine
pain relief acute LVF with SOB and FF crackles sedation to maintain intubation sedation to enable intubation RSI
contras of Morphine
known hypersensitivity
late second stage labour
Precautions of Morphine
elderly hypotension resp depression asthma resp tract burns known addiction to opioids alcoholism MOA inhibitors
Side effects of Morphine
drowsiness resp depression euphoria n+v addication pin point pupils hypotension bradycardia
NAloxone presentation
0.4mg in 1ml
contras of Naloxone
nil
Precautions of NAloxone
physical dependence
neonates
side effects of naloxone
sweating, goosebumps, tremor
n+v, agitation, dilation of pupils, convulsions
Presentation of stemitil
12.5mg in 1ml
Contras of Stemitil
circulatory collapse
CNS depression
previous hypersensitivity
children
precautions of Stemitil
hypotension
epilepsy
pts affected by alcohol or antidepressants
side effects of Stemitil
drowsiness, blurred vision, hypotension, sinus tachy, skin rash, extrapyrimidal reactions
Presentation of salbutamol
5mg in 2.5ml
500mcg in 1ml
5mg in 5ml
Contras of Salbutamol
IV
Precautions of Salbutamol
large doses of IV cause intracellular metabolic acidosis
PEI of Salbutamol
resp distress with suspected bronchospasm, asthma, severe allergic reactions, COPD, smoke inhalation, capsicum spray exposure
Side effects of Salbutamol
sinus tachy
muscle tremor
Actual Time Critical
Moderate or severe resp distress
Oxygen sats less than 90% room air
Less than adequate perfusion
GCS less than 13
Emergent Time Critical
ACS Acute stroke Severe sepsis, including suspected meningococcal disease Possible AAA Undiagnosed severe pain Need for hyperbaric treatment Hypo or hyperthermia
Causes of PEA
Hypoxia Exsanguination Asthma TPT Anaphylaxis Airway obstruction
Contras for LMA
intact gag reflex or resistance to insertion
strong jaw tone and/or trismus
suspected epiglottitis or upper airway obstruction
the use of sedation to assist placement
Precautions of LMA
inability to prepare pt in sniffing position
pts who require high airway pressures
Pts less than 14
significant volume of vomit
RSI preparation
Optimise position C-spine considerations Oxygen supply sufficient Nasal prongs IV/IO access x2 Normal saline at least 10ml/kg Suction tested O.P airway
Causes of APO
LVF nutritional deficiency liver disease renal disease fluid overload
Adult initial dose of Fentanyl IN for all adults (ml)
200mcg in 0.75ml
Adult Subsequent dose of Fentanyl IN for all adults (ml)
50mcg in 0.25ml
Adults initial dose of Fentanyl IN for frail adults (ml)
100mcg in 0.45ml
Adults subsequent dose of Fentanyl IN for frail adults (ml)
50mcg in 0.25ml
Morphine doses for adults
IV - up to 5mg repeat after 5 mins
IM - over 60kg 10mg repeat 5mg after 15 mins
under 60kg 0.1mg/kg once only
Severe headache doses
Methoxy 3ml and Stemitil 12.5mg IM
Morphine 2.5mg IV every 5mins
Fentanyl 25mcg IV every 5mins
Elderly or frail: 50mcg IN Fentanyl repeat 25mcg after 5 mins
Other adults: 100mcg IN Fentanyl repeat 25mcg after 5mins
Contras for CPAP
GCS less than 13 Facial trauma Pneumothorax Active vomiting Life threatening arrhythmias Pts requiring airways management Hypoventilation
Seizure treatment
Midaz 10mg IM (2 ampoules)
OXYGEN
Anaphylaxis symptoms
R-resp distress
A-abdo symptoms
S-skin/mucosal symptoms
H-hypotension
Anaphylaxis treatment
500mcg Adrenaline IM repeat after 5 mins
300mcg for elderly or frail
neb adrenaline 5mg in 5ml if required
Evidence of Opioid overdose
altered consious state resp depression substance involved exclude other causes pin point pupils track marks
Treatment of Opioid overdose
Naloxone 1.6-2mg (4-5 ampoules)
repeat 0.8mcg after 10mins (2ampoules)
Assessment of the agitated patient
Alcohol Epilepsy Insulin Overdose Underdose Trauma Infection/sepsis Pain/psycho Stroke/TIA
Sedation of the agitated pt
Midaz 5-10mg IM
lower doses for elderly
repeat after 10 mins
Autonomic Dysreflexia symptoms
previous CI at T6 or above
severe headache
SBP greater than 160
Stroke Mimics
H-hypo/hyperglycaemia I-intoxication B-brain tumour E-electrolyte imbalance S-sepsis S-subdural haematoma S-seizure S-syncope M-migraine M-middle ear disorder
Modifying Factors of hypovolaemia
SCI chest injury penetrating trunk injury AAA uncontrolled external heamorrhage GI haemorrhage
Paed weights
Newborn 3.5kg 2 months 5kg 5 months 7kg 1 year 10kg 1-9yrs age x2 + 8 10-14 age x 3.3
Paed perfusion
HR: 120-160 100-160 80-120 80-100 BP N/a 70 80 90 RR: 40-60 20-50 20-35 15-25
Paed GCS verbal
Appropriate words, social smiles, fixes cries but consolable Persistently irritable Restless and agitated None
Paed dose of Fentanyl IN initial
small child 25mcg in 0.6ml
large child 50mcg in 1.1ml
Unconsciouos asthma ventilation rates
infant 15-20
small child 10-15
large child 8-12
Unconscious asthma adrenaline dose
10mcg/kg IM repeat after 20mins (max 30mcg/kg)
Seizure of a paed
large child 5mg in 1ml Midaz small child 2.5mg in 0.5ml infant 1mg in 0.2ml newborn 0.5mg in 0.1ml repeat after '10 mins once only
Anaphylaxis treatment for paeds
Adrenaline 10mcg/kg IM repeat after 5 mins
