Drugs Flashcards
Indications of Paracetamol
- Minor Pain
2. Fever (causing distress)
Contraindications of Paracetamol
- KSAR
2. Patients < 1 month
Precautions of Paracetamol
- Hepatic or renal dysfunction
2. Pt taking anticoagulant medications
Side effects of Paracetamol
Nausea
Presentation of Paracetamol
Tablet, 500mg
Elixir 120mg/5ml
Adult dose of Paracetamol for minor pain and fever
PO 0.5g - 1g, repeat every 4 hours (must not admin within) total max dose 4g in 24hrs
Paediatric dose of Paracetamol for minor pain and fever ≥ 1 month
15mg/kg, single does only. Must not admin within 4 hrs of previous paracetamol admin.
Indications for Methoxyflurane
Pain
Contraindications for Methoxyflurane
- KSAR
- Pt < 1 year
- Hx or significant liver of renal disease
- Hx of malignant hyperthermia
Precautions for Methoxyflurane
- ALOC
2. Intoxicated or drug affected people
Presentation for Methoxyflurane
Bottle 3ml
Adult dose of Methoxyflurane for pain
INH 3ml, repeat once after 20min, max dose 6ml
Paediatric dosage for Methoxyflurane ≥1 yr
INH 3ml, single does only
True or false, you can leave a pt unattended who is self administering Methoxyflurane
False
What is the total weekly dose of Methoxyflurane that shouldn’t be exceed?
15ml, with admin on consecutive day not recommended
What dose should be administered per pt whilst in the ambulance
One dose of 3ml
How many doses can an ambulance officer administer in the ambulance per day?
2 doses
Indications for Salbutamol
- Bronchospasms
2. Suspected hyperkalaemia (with QRS widening AND/OR AV dissociation
Contraindications for Salbutamol
- KSAR
2. Pt < 2 years
Precautions for Salbutamol
- Acute Pulmonary Oedema
2. Ischaemic heart disease
Side effects of Salbutamol
- Anxiety
- Tachyarrhythmias
- Tremors
- hypokalaemia and metabolic acidosis
Presentation of Salbutamol
Nebule, 5mg/2.5ml
Ampoule 500microg/1ml
Adult dosage of Salbutamol for Bronchospasms
NEB 5mg, repeat PRN, no max dose.
Paediatric dose of salbutamol for Bronchospasm ≥ 2yrs
NEB 5mg, repeated PRN, no max dose.
Indications for GTN
- Suspected ACS with pain
- Acute cardiogenic pulmonary oedema
- Autonomic dysreflexia (with sysBP ≥160mmHg)
- Irukandji syndrome (with sysBP ≥160mmHg)
Contraindications for GTN
- KSAR
- HR< 50 OR > 150bpm
- SysBP <100mmHg
- Acute CVA
- Head Trauma
- Phosphodiasterase inhibitor medication admin (i.e. viagra, Levita) in previous 4 days
Side effects of GTN
- Dizziness
- Syncope
- Vascular headaches
- Hypotension
- Reflex Tachycardia
Presentation of GTN
Spray (SUBLING), 400microg/dose, 200 doses.
Ampoule, 50mg/10ml
Adult dose of GTN for Suspected ACS
SUBLING: 400microg, repeat 5 min, no max dose
Adult dose of GTN for acute cardiogenic pulmonary oedema
SUBLING: 400microg, repeat 5 min, no max dose
Adult dose of GTN for Autonomic dysreflexia and irukandji syndrome (with a sysBP ≥160mmHg
SUBLING: 400microg, repeat 5 min, no max dose
Paediatric dose of GTN for Autonomic dysreflexia and irukandji syndrome (with a sysBP ≥160mmHg
SUBLING: Consult
Indications for Aspirin
- Suspected ACS
2. Acute cardiogenic pulmonary oedema
Contraindications for Aspirin
- KSAR or hypersensitivity to NSAIDs
- Chest pain associated with psychostimulant overdose
- Bleeding OR clotting disorders (e.g. haemophilia)
- Current GI bleeding OR peptic ulcers
- Pts < 18yrs
Precautions for Aspirin
- Possible Aortic aneurysm or any other condition that may require surgery
- Pregnancy
- Hx of GI bleeding or peptic ulcers
- Concurrent anticoagulant therapy (e.g. Warfarin)
Side effects of Aspirin
- N/V
- NSAID induced bronchospasm
- Epigastric pain/discomfort
- GI bleeding
- Gastritis
Presentation of Aspirin
Tablet 300mg
Adult dose of Aspirin for suspected ACS and acute cardiogenic pulomary oedema ≥18yrs
PO: 300mg, chewed followed by a small sip of water.
For pts who have had < 300mg aspirin in last 24hrs and present with suspected ACS or APO, what total daily dose should be admin?
300-450mg
True or False, Aspirin is indicated for pt with suspect ACS or APO even if pain free.
True
True or false,in suspected ACS or APO, aspirin should be admin following the initial dose of GTN
True
Indications for Droperidol
Acute Behavioural Disturbances (with a SAT Score of >/= 2)
Contraindications for Droperidol
- KSAR or hypersensitivity to droperidol
- Parkinson’s disease
- Previous dystonic reaction to droperidol
- Patient’s < 16 years
Precautions for Droperidol
Concomitant use of CNS depressants
Side effects for Droperidol
Extrapyramidal effects e.g. dystonic reactions (rare)
Presentation of Droperidol
Vial, 10mg/2ml droperidol (DORM)
What is the dose for Droperidol for pts 16yo to <65yo
10mg repeated once at 15ins. Total max dose 20mg.
What is the dose for droperidol for >65 years.
Consult QCC
Indications for Adrenaline
- Anaphylaxis or Sever allergic reaction
- Severe life-threatening bronchospasms OR silent chest (speak in single words or haemodynamic compromise or ALOC)
- Bradycardia with poor perfusion (Unresponsive to atropine or TCP)
- Cardiac arrest
- Croup (stridor at rest)
- Shock unresponsive to adequate fluid resuscitation (excluding haemodynamic cause)
Contraindications for Adrenaline
Nil
Precautions for Adrenaline
- Hypertension
- Hypovolaemic shock
- Concurrent MOAI therapy
Side effects of Adrenaline
- Anxiety
- Hypertension
- Palpitations /Tachyarrhythmias
- Pupil dilation
- Tremor
What is the Presentation of Adrenaline
Ampoule, 1mg/1m; (1:1,000) adrenaline
Ampoule, 1mg/10ml (1:10,000) adrenaline
What is the adult dose of IM adrenaline for Anaphylaxis or severe allergic reaction?
300mcg, repeated at 5 min intervals, no max dose
What is the adult dose of NEB adrenaline for Anaphylaxis or sever allergic reaction?
5mg, Single dose only.
What is the adult dose of IM Adrenaline for Severe Life-threatening bronchospasm or silent chest?
300mcg, repeated at 5 min intervals, no maximum dose.
What is the adult dose if IV Adrenaline for Cardiac arrest
1mg, repeated at 3-5min intervals, no max dose.
What is the > 6 yo Paed dose of IM Adrenaline for Anaphylaxis OR Severe allergic reaction
300mcg, at 5 min intervals, no max dose
What is the < 6 yo Paed dose of IM Adrenaline for Anaphylaxis OR Severe allergic reaction
150mcg, at 5 min intervals, no max dose
What is the Paed dose of NEB adrenaline for Anaphylaxis OR Severe allergic reaction.
5mg, Single dose only
What is the > 6 yo Paed dose of IM Adrenaline for Severe Life threatening bronchospasm OR Silent Chest
300 mcg, at 5 min intervals, no max dose
What is the >10kg ( > 1 yo) Paed dose of IV adrenaline for Cardiac Arrest
10mcg/kg, repeat at 3-5 min intervals, no max dose
What is the <10kg ( < 1 yo) Paed dose of IV adrenaline for Cardiac Arrest
100mcg, repeat at 3-5 min intervals, no max dose
What is the Paed dose of NEB adrenaline for Croup (with stridor at rest)
5mg, Single dose only
Indications of Fentanyl
- Significant Pain
- Sedation (for the maintenance of an established ETT)
- Autonomic dysreflexia (with sysBP > 160mmHg)
Contraindications of Fentanyl
KSAR or hypersensitivity to fenanyl
Precautions of Fentanyl
- Elderly patients
- Hypotension
- Respiratory tract burns
- Respiratory depression and/or failure
- Known addiction to narcotics
- Current MAOI therapy
Side affects of Fentanyl
- Bradycardia
- Drowsiness
- Hypotension
- Nausea and/ or vomiting
- Pin point pupils
- Respiratory depression
- Muscular rigidity (particularly muscles of Respiration)
What is the presentation of Fentanyl
Ampoule, 100mcg/2ml Fentanyl
What is the >70yo IM dose of Fentanyl for significant pain.
25 - 50mcg, repeated up to 50mcg every 10mins, total max dose 100mcg.
What is the <70yo IM dose of Fentanyl for significant pain.
25 - 100mcg, repeated up to 50mcg every 10 mins, total max dose 200mcg.
What is the >70yo IV dose of Fentanyl for significant pain
25 mcg, repeated at up to 25mcg every 5min, total max dose 100mcg
What is the <70yo IV dose of Fentanyl for significant pain
25-50mcg repeated up to 50mcg every 5 mins total max dose 200mcg.
What is the > 1 yo Paed dose of NAS Fentanyl for significant pain
1.5mcg/kg, repeat once at 1mcg/kg at 10 mins, total max dose 100mcg.
What is the < 1 yo Paed dose of NAS Fentanyl for significant pain
Need to contact the QCC advise line in all situations
What is the Paed dose of SUCUT Fentanyl for significant pain
Need to contact the QCC advise line in all situations
What is the > 1 yo Paed dose of IM Fentanyl for significant pain
1-2 mcg/kg, single max dose 50mcg, total max dose 2mcg/kg
What is the < 1 yo Paed dose of IM Fentanyl for significant pain
Need to contact the QCC advise line in all situations
What is the > 1 yo Paed dose of IV Fentanyl for significant pain
1 mcg/kg, single Max dose 25mcg. Repeated at 0.5mcg/kg (max 25mcg) at 10 min intervals. Total max dose 2mcg/kg.
What is the < 1 yo Paed dose of IV Fentanyl for significant pain
Need to contact the QCC advise line in all situations
Indications of Glucagon
- Symptomatic hypoglycaemia (with the inability to self-administer oral glucose)
Contraindications of Glucagon
- KSAR or hypersensitivity to glucagon.
Precautions of Glucagon
- Nil
Side effects of Glucagon
- Nil
What is the presentation of Glucagon
Vials (powder and solvent), 1 mg glucagon
What is the adult dose of IM Glucagon for Symptomatic hypoglycaemia
1mg, single dose, Reconstitue 1mg of glucagon with 1 ml of water for injection in a 3ml syringe. (1mg/1ml)
What is the > 25kg Paed dose of IM Glucagon for Symptomatic Hypoglycaemia
1 mg single dose only
What is the < 25kg Paed dose of IM Glucagon for Symptomatic Hypoglycaemia
0.5mg single dose only
Indications of Glucose gel
- Symptomatic hypoglycaemia (with the ability to self-administer oral glucose)
Contraindications of glucose gel
- Unconscious
- pts with difficulty swallowing.
- Pts < 2 years
Precautions of glucose gel
Nil
Side effects of glucose Gel
- Nausea and/ or vomiting
2. Diarrhoea
Presentation of glucose gel
Tube, 15g glucose
What is the adult and Paediatric dose of PO oral glucose
15g, repeated once at 15mins if BGL <4.0 mmol/L. total max dose 30g.
Indications for Glucose 10%
Symptomatic hypoglycaemia (with inability to self-administer oral glucose)
Contraindications for glucose 10%
Nil
Precautions for glucose 10%
- Hyperglycaemia
Side effects for glucose 10%
Nil
What is the presentation of 10% Glucose
Viaflex Plastic container, 250ml glucose 10% (25g)
What is the adult dose of IV INF 10% Glucose for symptomatic hypoglycaemia
15g (150ml) repeated at 100ml (10g) boluses ever 5 mins until BGL > 4.0mmol/L.
What is the Paed dose of IV INF 10% Glucose for Symptomatic Hypoglycaemia
0.25g/kg (2.5ml/kg), repeated at 1ml/kg (0.1g/kg) boluses every 5 minutes until BGL > 4.0mmol/L
Indications of Midazolam
- Generalised Seizure / focal seizure (GSC = 12)
2. Sedation
Contraindications of Midazolam
- KSAR or hypersensitivity to Midazolam
Precautions of Midazolam
- Reduced dosages should be used in elderly pts, pts with chronic renal failure, congestive cardiac failure, or shock.
- Can cause sever respiratory depression
- Myasthenia gravis
- Multiple sclerosis
Side effects of Midazolam
- Hypotension
2. Respiratory depression particularly when associated with other CNS depressants including alcohol and narcotics.
What is presentation for Midazolam
Ampoule 5mg/1ml, Midazolam
What is >70yo adult dose of IM/NAS Midazolam for generalised/focal seizures
2.5mg repeated every 10mins, total max dose 10mg.
What is <70yo adult dose of IM/NAS Midazolam for generalised/focal seizures
5.0 mg repeated every 10mins, total max dose 20mg.
What is the Paed dose of IM/NAS Midazolam for Generalise/focal seizures
200mcg/kg, single dose not to exceed 5mg. repeat at half initial does (max 2.5mg) at 10min intervals. Total max dose 10mg.
Indications of morphine
- Significant pain
- Autonomic dysreflexia (with sys BP >160mmHg)
- Sedation for the maintenance of an established LMA/ETT
Contraindications of Morphine
- KSAR or hypersensitivity to morphine
2. Renal failure
Precautions of Morphine
- Elderly pts
- Hypotension
- Respiratory tract burns
- Respiratory depression and/or failure
- Known addition to narcotics
- Concurrent MOAI therapy
- Cardiac chest pain
Side effects of Morphine
- Bradycardia
- Drowsiness
- Hypotension
- Nausea and/or vomiting
- Pin point pupils
- Respiratory depression
What is the presentation of Morphine
Ampoule, 10mg/1mL Morphine
What is the >70yo Adult dose of IM morphine for Significant pain
2.5-5mg repeated at up to 5 mg every 10mins, total max dose 10mg.
What is the <70yo Adult dose of IM morphine for Significant pain
2.5-10mg, repeated at up to 5mg every 10mins. Total max dose 20mg.
What is the >70yo Adult dose of IV morphine for Significant pain
2.5mg, repeated at up to 2.5mg every 5 mins, total max dose 10mg
What is the <70yo Adult dose of IV morphine for Significant pain
2.5 - 5mg, repeated at up to 2.5mg every 5 mins, total max dose 20mg
What is the >1 yo Paed dose of IM Morphine for Significant Pain or Autonomic Dysreflexia (with a significant BP >160mmHg)
100-200mcg/kg, single max dose 5mg. Total max dose 200mcg/kg.
What is the < 1 yo Paed dose of IM Morphine for Significant Pain or Autonomic Dysreflexia (with a significant BP >160mmHg)
Need to contact the QCC advise line in all situations
What is the >1 yo Paed dose of IV Morphine for Significant Pain or Autonomic Dysreflexia (with a significant BP >160mmHg)
100mcg/kg, single max dose 2.5mg, repeat at 50mcg/kg (max 2.5mg) at 5 min intervals. Total max dose 200mcg/kg.
What is the < 1 yo Paed dose of IV Morphine for Significant Pain or Autonomic Dysreflexia (with a significant BP >160mmHg)
Need to contact the QCC advise line in all situations
Indications for Naloxone
- Respiratory Depression (Secondary to the administration of narcotic drugs)
Contraindications for Naloxone
- KSAR or hypersensitivity to naloxone
Precautions for Naloxone
- Use with caution on pts with pre-existing cardiac disease
Side effects for Naloxone
- Narcotic reversal can cause combativeness, vomiting, sweating, tachycardia and hypertension
- May produce acute withdrawal convulsions in the chronic narcotic user
- Pulmonary oedema
What is the presentation of Naloxone
400mcg/1ml, Naloxone
What is the adult dose of IM Naloxone for respiratory depression
1.6mg single dose only
What is the Paed dose of IM Naloxone for respiratory depression
20mcg/kg, single dose only, not to exceed 800mcg
Indications for Ondansetron
- Nausea and/OR vomiting
2. Prophylactic administration for pt presenting with ACS
Contraindications for Ondansetron
- KSAR to ondansetron or other 5-HT3 receptor Antagonists
- Congenital long QT syndrome.
- Concurrent apomorphine (apamine agonist use in the treatment of parkinsonism) therpay.
- Pts < 3 years.
Precautions of Ondansetron
- Hepatic impairment
- Intestinal obstruction
Pts with risk factors for QT interval prolongation or cardiac arrhythmias.
Side effects of Ondansetron
- Headache
- Constipation
- Sensation of warmth or flushing
- Dysrhythmias
What is the presentation of Ondansetron
Ampoule, 4mg/2ml Ondansetron
What is the adult dose of IM/IV Ondansetron for Nausea or Vomiting
4-8mg, total max dose 8mg
What is the > 3 years Paed dose of IM/IV Ondansetron for Nausea and/or vomiting
100mcg/kg Single dose only, not to exceed 4mg (slow push over 2-3 mins for IV)
Indications for Ipratropium bromide
- Moderate or Severe Bronchospasm
Contraindications for Ipratropium bromide
- KSAR or hypersensitivity to Anticholinergics
2. Pts < 2 years
Precautions for Ipratropium bromide
- Glaucoma
Side effects for Ipratropium bromide
- Dilated pupils
- Dry mouth
- Palpitations
What is the presentation of Ipratropium brominde?
Nebule, 250mcg/1mL
What is the adult dose of NEB Ipratropium bromide for Moderate or Severe bronchospams
500mcg, single dose only
What is the > 2 yo dose of NEB Ipratropium bromide
250mcg, single dose only.
Indications for Ceftriaxone
- Suspected meningococcal septicaemia (with a non-blanching petechial and/or purpuric rash)
Contraindications for Ceftriaxone
- KSAR or hypersensitivity to cephalosporin drugs
- Known Anaphylaxix or sever allergic reaction to penicillin based drugs (isolated minor drug rash attributed to penicillin dose not contraindicate the use of ceftriaxone)
Precautions for Ceftriaxone
- Nil.
Side effects for Ceftriaxone
- Nausea and/or vomiting
2. pain at the IM administration site.
What is the presentation of Ceftriaxone?
Vile 1g ceftriaxone
What is the adult dose of IM/IV Ceftriaxone for Suspected meningococcal septicaemia
1g, single dose only
What is the IM preparation of Ceftriaxone?
Reconstitute 1g of Ceftriaxone with 3.6ml of water for injectino in a 10ml syringe. (250mg/1ml)
What is the IV preparation of Ceftriaxone?
Reconstitute 1g or ceftriaxone with 9.6ml of water for injection in a 10ml syringe (100mg/1ml)
What is the Paed dose of IM/IV Ceftriaxone?
50mg/kg rounded up to the nearest 5kg)
Indications for Oxytocin
- Active management fo the thirds stage of labour (following confirmed deliver of all foetuses)
- Prevention and/or treatment of primary postpartum haemorrhage
Contraindications for Oxytocin
- KSAR
- Pre-eclampsia
- Cord Prolapse
- Undelivered foetuses
Precautions for Oxytoncin
- Myocardial ischemia
2. May potentiate hypotension when administered with analgesia
Side effects for Oxytoncin
- Nausea and/or vomiting
- Headache
- Bradycardia
- Tachycardia
Presentation of Oxytocin
Ampoule, 10 international units (IU)/1ml
What is the adult dose of IM Oxytocin
10 IU, single dose only.