Drugs

Question 1

Aspirin Description

Answer 1

Aspirin has the following pharmacological
actions.
 Analgesic
 Antipyretic
 Anti-inflammatory
 Anti-platelet aggregation agent
Reduces mortality significantly in Acute
Myocardial Infarction by minimising platelet
aggregation and thrombus formation in order to
retard the progression of coronary artery
thrombosis.

Question 2

Apirin Indications

Answer 2

Chest pain/discomfort of presumed cardiac

origin.

Question 3

Aspirin Contra-Indications

Answer 3

Known hypersensitivity to aspirin /
salicylates.
 In asthmatic patients with known
hypersensitivity to salicylates.
 Children

Question 4

Aspirin Management/Dose

Answer 4

300mg oral administration, preferably
chewed.
 Administered even if patient has taken
aspirin that day or on anticoagulants.

Question 5

Aspirin Complications/ Side Effects

Answer 5

Heart burn, nausea, GI bleeding.

 Increased bleeding time.

Question 6

Aspirin Precautions/Notes

Answer 6

 Actively bleeding peptic ulcers.

 Suspected AAA

Question 7

ADRENALINE Description

Answer 7

Pharmacology and Action:
 1mg in 1ml (1:1000);
 A naturally occurring sympathomimetic
agent;
 Causes peripheral vasoconstriction;
 Stimulation of cardiac conduction system
causes increased contractions;
 Causes bronchodilatation and dilation of
blood vessels in muscles;
 IV/IO: Onset 30 seconds, peak 3-5
minutes, duration 5-10 minutes;
 IM: Onset 30-90 seconds, peak 5-10
minutes, duration 5-10 minutes.

Question 8

ADRENALINE Contra-indications

Answer 8

 Nil.

Question 9

ADRENALINE Indications

Answer 9

Cardiac arrest;
 Anaphylaxis;
 Severe asthma;
 Severe croup with retractive breathing;
 Post ROSC.

Question 10

ADRENALINE Precautions/Notes

Answer 10

Ischaemic Heart Disease;
 In the hypothermic patient, withhold until
body temperature is above 30C.
Between 30-35C double the interval
between doses.

Question 11

ADRENALINE Management/Dose

Answer 11

Cardiac Arrest:
 Adult: 1mg IV/IO every 3-5 minutes;
 Paediatric: 10mcg/kg IV/IO to a max 1mg
IV/IO every 3-5 minutes;
Post Resus Care:
 Fluid resuscitation as per CPG 4.6.
 Dilute 1mg Adrenaline in 9ml normal
saline (1000 mcg in 10mls);
 Adults: 50 mcg (0.5ml) every 3-5 min as
required to maintain SBP > 90mmHg;
 Paediatric: 1mcg/kg every 3-5 min (max
bolus 50mcg) as required to maintain SBP > 80 mmHg;
 Reassess blood pressure after each dose.
Anaphylaxis/Severe Asthma:
 Adult: 0.5mg IM into lateral mid-thigh
(0.5ml of 1:1000);
 Paediatric: IM into lateral mid-thigh
AGE WEIGHT
(KG)
ADRENALINE
VOLUME
1:1000
12 >40 0.5mL
Note: Repeat every 5-10 minutes as clinically
required for adults and paediatrics.
 Croup: 5mg / 5mls nebulised once only.

Question 12

ADRENALINE Complications/Side Effects

Answer 12

Dysrhythmias;
 Hypertension;
 Pupil dilation;
 Tremor;
 Anxiety;
 Palpitations;

Question 13

EPIPEN Description

Answer 13

Presentation
 EpiPen (yellow label) = 0.3mg.
 EpiPen Jnr (green label) = 0.15mg.
 Anapen (yellow label) = 0.3mg.
 Anapen Jnr (green label) = 0.15mg.
Pharmacology and Action
 A naturally occurring sympathomimetic
agent.
 Causes peripheral vasoconstriction.
 Stimulation of cardiac conduction system
causes increased contractions.
 Causes bronchodilatation and dilation of
blood vessels in muscles.

Question 14

EPIPEN Contra-indications

Answer 14

There are no absolute contraindications for

adrenaline.

Question 15

EPIPEN Indications

Answer 15

Mild to moderate allergic reactions:
 Swelling of lip, face, eyes.
 Hives or welts (weal-like swellings).
 Tingling mouth.
 Abdominal pain, vomiting (these are signs
of severe allergic reaction to insects).
Anaphylaxis:
 Difficult/noisy breathing.
 Swelling of tongue.
 Swelling/tightness in throat.
 Difficulty talking and/or hoarse voice.
 Wheeze or persistent cough.
 Persistent dizziness and/or collapse.
 Pale and floppy (young children).

Question 16

EPIPEN Precautions/Notes

Answer 16

Ischaemic heart disease.

Question 17

EPIPEN Management/Dose

Answer 17

Position appropriately with dependent
drainage for secretions – this is usually on
the side, or sometimes in the sitting
position for the conscious patient, but do
not allow patient to stand or walk even if
they appear to have recovered.
 Prepare auto injector. (Note: patient’s own
injector may be used).Give IM auto injection into lateral mid-thigh
 Record dose and time.
 Repeat doses every 5 minutes as
clinically required.
 Monitor and record vital signs.
Dose:
 Adult or over 20kg
 0.3mg repeat every 5 minutes as
clinically indicated.
 Children less than 20kg
 0.15mg repeat every 5 minutes as
clinically indicated.
Onset:
 Onset 30-90 seconds, maximum up to 20
minutes.

Question 18

EPIPEN Complications/ Side Effects

Answer 18

Tachycardia, arrhythmias.
 Increase in blood pressure (may be
marked).
 Tremor, anxiety.
 Patient should be taken to a medical facility
where they can be monitored for 4 hours
after the last dose of adrenaline

Question 19

AMIODARONE Description

Answer 19

150mg in a 3ml ampoule;
 Amiodarone has effects within the first
four classes of the Vaughan-Williams
classification. However it is primarily
classified as a Class III antidysrhythmic
agent that prolongs the action potential
duration and hence the refractory period
of atrial, nodal and ventricular tissue. It
has characteristics of all VaughanWilliams
classes of antidysrhythmics;
 Immediate onset, peak

Question 20

AMIODARONE Contra-indications

Answer 20

(CCP only):
 Hypersensitivity to Amiodarone or
iodine;
 Bradycardia or AV block;
 Sick sinus syndrome;
 Severe conduction disorders;
 Hypotension;
 Severe respiratory failure;
 Circulatory collapse;

Question 21

AMIODARONE Indications

Answer 21

Cardiac Arrest with persistent/shock
resistant Ventricular
Fibrillation/Ventricular Tachycardia (Post
3 consecutive shocks only);
 Tachydysrhythmias including (CCP
only):
 SVT;
 Nodal and Ventricular tachycardia;
 Atrial flutter and fibrillation;
 WPW syndrome.

Question 22

AMIODARONE Precautions/Notes

Answer 22

Heart failure;
 Thyroid dysfunction;
 Glucose 5% must be used as a
diluent when administered as an
infusion in the conscious patient;
 Amiodarone is only indicated for
shock resistant VF/VT, and should be
administered post 3 consecutive
shocks;
 In the hypothermic patient, withhold
until body temperature is above
30OC.

Question 23

AMIODARONE Management/Dose

Answer 23

Cardiac Arrest:
 Adult: 300mg in 6ml IV/IO once
only;
 Paediatric: 5mg/kg IV/IO once only;
 Tachydysrhythmias (CCP only):
 300mg infusion over 20 minutes.

Question 24

AMIODARONE Complications/ Side Effects

Answer 24

Bradycardia;
 Hypotension;
 Polymorphic tachycardia;
 Nausea;
 Tremor;
 Dizziness;
 Paraesthesia;
 Headaches;