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ACEM Fellowship > Drugs > Flashcards

Drugs Flashcards

1
Q

GTN infusion

A

10 mcg/minute

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2
Q

Amiodarone

A

5mg/kg child.
300mg IV bolus
900mg IVI over 24 hours

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3
Q

Dobutamine

A

2.5 - 15mcg/kg/min IVI (typical 100-200mcg/min)

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4
Q

Lignocaine

A

1mg/kg IV bolus (75-100mg) over 1-2 minutes
Infusion 4mg/minute if successful for one hour then
1-3mg/min IVI

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5
Q

Sodium nitroprusside

A

0.3 mcg/kg/minute IVI max 10mcg/kg/min

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6
Q

Esmolol

A

500 mcg/kg/min IV over one minute (bolus)

50 - 200 mcg/kg/min IV infusion

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7
Q

Labetalol

A

2-4mg/min until BP in target range, then 5-20mg/hour

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8
Q

Isoprenaline

A

1-4mcg/min max 30mcg/min

10-20mcg bolus

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9
Q

Adrenaline or Noradrenaline

A

10mcg bolus

1-4mcg/min (0.05 - 0.1mcg/kg/min) max 100

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10
Q

Metaraminol

A

0.5 - 1 mg bolus every 2-5 minutes

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11
Q

Vasopressin

A

0.6 units/hour

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12
Q

Fentanyl

A

Induction 2-10mcg/kg

Sedation 1-4mcg/kg IV

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13
Q

Ketamine

A

Induction 2-4mg/kg IV

Sedation 1-2mg/kg IV or 2-4mg/kg IM

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14
Q

Propofol

A

Induction 2mg/kg IV

Sedation 0.5-1mg/kg

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15
Q

Rocuronium

A

1.2mg/kg IV

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16
Q

Suxamethonium

A

1-2mg/kg IV

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17
Q

Atropine

A

600mcg (20mcg/kg) bolus

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18
Q

Calcium

A

Child 0.5mL/kg (50mg/kg)

adult 10mL of 10%

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19
Q

Sodium bicarbonate

A

1mmol/kg

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20
Q

Hyperkalaemia

A

10U actrapid + 50mL of 50% glucose
Nebulised salbutamol 10-20mg
Calcium 10mL of 10%

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21
Q

Procainamide

A

20-50mg/minute slow push until

  • hypotension
  • widening of QRS
  • improvement in rhythm
  • or max 17mg/kg (1.2g for 70kg adult)
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22
Q

Rapid AF

A
  • DCCV 100J if unstable
  • Metoprolol PO 25-50mg or IV 2.5 - 5mg
  • Verapamil IV 2.5-10mg (avoid if heart failure/hypotension)

If unable to cardiovert and has heart failure, give
- amiodarone 300mg IV over 30-60mins

RHYTHM control
- can use flecainide if normal LV function and no coronary artery disease 1.5-2mg/kg IV (150mg) over 10minutes

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23
Q

SVT (AVNRT or AVRT with orthodromic conduction)

A
  1. Vagal manouevres
  2. DCCV if unstable
  3. Adenosine 6/12/18mg IV push with 30ml flush
    - 0.1mg/kg in child
  4. Verapamil 2.5-10mg IV slow push (contraindicated in heart failure or hypotension)
  5. Metoprolol 2.5 - 5mg max 15mg
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24
Q

AVRT with antidromic conduction
OR
AF with WPW

A
  1. DCCV if unstable or if unsure (could be VT)

2. Procainamide 20-50mg/min until max 17mg/kg

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25
Q

Pantoprazole

A

IV bolus 80mg then

Infusion 8mg/hour

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26
Q

Octreotide

A

For suspected variceal bleeding

50mcg bolus
then
50mcg/hour infusion

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27
Q

IVABx for Infective Endocarditis

A
  1. Benzylpenicillin 1.8q q4h IV

PLUS

  1. Flucloxacillin 2g IV q4h

PLUS

  1. Gentamicin 5-7mg/kg load

REPLACE
Benpen with Vancomycin if MRSA suspected

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28
Q

IVABx for cholangitis

A

Gentamicin

PLUS

Amoxicillin/ampicillin 2g IV q6h

for patients with chronic biliary obstruction, add
Metronidazole 500mg IV bd

(+ early biliary tract decompression - ERCP/MRCP/surgery)

29
Q

ABx for Clostridium Difficile infection

A

MILD
Metronidazole 400mg PO q8h for 10 days

OR

Vancomycin 125mg PO q6h for 10 days

NB - ORAL

30
Q

Spontaneous Bacterial Peritonitis Rx

A

Ceftriaxone 2g IV daily

May require albumin 20% 7.5mL/kg within 6 hours of diagnosis and 5mL/kg IV as a single dose on day 3 if impaired renal function or jaundice, due to high risk of developing hepatorenal syndrome

PREVENTION = trimethoprim + sulfamethoxazole 160+800mg daily

31
Q

Rx Meningitis

A

For adults and children 2 months or older

  • Ceftriaxone 50mg/kg (2g) IV bd

PLUS

  • dexamethasone 0.15mg/kg (10mg) IV q6h, preferably starting before or with the first dose of antibiotics

If Listeria is suspected (age > 50, immunocompromised, pregnant or debilitated, alcoholics) ADD
- benpen 60mg/kg (2.4g) IV q4h

If HSV suspected
- aciclovir 10mg/kg IV q8h

32
Q

IVABx necrotising fasciitis

A
  • Benzylpenicillin 1.8g q4h (2.4g if requiring ICU)

PLUS EITHER

  • Clindamycin 600mg q8h
    OR
  • Lincomycin 600mg IV q8h

PLUS
- IVIG 2g/kg IV as a single dose ASAP, but not later than 72 hours

33
Q

PID Empiric treatment

A

NON SEVERE
- Ceftriaxone 500mg in 2mL 1% lignocaine IM or 500mg IV stat
+ Metronidazole 400mg PO bd for 14/7
+ either
Doxycycline 100mg PO bd for 14/7
or
Azithromycin 1g PO stat, repeated 1 week later

SEVERE
- Ceftriaxone 2g IV daily
+ Azithromycin 500mg IV daily
+ Metronidazole 500mg IV bd

34
Q

Thrombolysis for Stroke, PE

A

Alteplase

PE = 100mg over 2 hours (10% bolus can be given up front)

CVA = 0.9mg/kg (max 90mg) over 60mins (give 10% as a bolus over one minute)

35
Q

Care of the Dying drugs

A

Pain
- fentanyl 25mcg subcut q4h

Agitation

  • Haloperidol 0.5-1mg subcut q4h
  • midazolam 2.5mg subcut q1h

Nausea

  • ondansetron 4-8mg subling q8h
  • haloperidol 0.5-1mg subcut q4h

Secretions
- glycopyrrolate 0.1-0.2mg subcut q4h

36
Q

Thyroid Storm

A

Propranolol 60-80mg PO q4h or 0.5mg IV aliquots

Propylthiouracil (PTU) 500-1000mg load, then 250mg q4h
(Inhibition of thyroid hormone synthesis)

Lugol’s iodine 5-7 drops PO tds
(inhibition of thyroid hormone release)

Hydrocortisone 300mg IV then 100mg tds
(inhibit T3->T4 conversion, treat adrenal insufficiency)
or
Dexamethason 2-4mg IV qid

Consider diazepam for anxiolysis

37
Q

Midazolam for status epilepticus

A
  1. 2-0.3mg/kg (5-10mg) buccal/intranasal x 2
  2. 15mg/kg IV/IO
  3. 2mg/kg IM
38
Q

Sodium valproate

A

40mg/kg IV load (max 3g)

39
Q

Levetiracetam

A

10-20mg/kg IV

40
Q

Phenytoin

A

20mg/kg IV load

41
Q

Phenobarbitone

A

20mg/kg IV load max rate 60mg/min

42
Q

Nimodipine

A

60mg PO q4h

to prevent vasoconstriction in SAH

43
Q

Pre-term labour drugs

A
  1. Antenatal corticosteroids
    - < 35 weeks gestation
    - betamethasone 11.4mg IM then second dose in 24 hours
  2. Tocolysis
    - nifedipine 20mg PO
    - repeat for a total of 3 doses 30mins apart if contractions persist
    - maintenance therapy = 20mg q6h for 48 hours
  3. Antibiotics
    - GBS prophylaxis if established labour, regardless of status
    - if chorioamnionitis present, give
    ampicillin 2g IV
    + gentamicin 5mg/kg IV
    + metronidazole 500mg IV
  4. Neuroprotection
    - gestational age 24-30 weeks
    - magnesium sulfate 4g loading bolus IV over 20mins
    - maintenance 1g/hr for 24 hours or until birth
44
Q

Post partum Haemorrhage

A 
Supportive/resuscitative care
TXA 1g over 10 minutes
Uterine massage
Oxytocin 5 units IV then 10 units/hr
Empty bladder
Bimanual compression
Uterine balloon tamponade
OT
45
Q

Pre-eclampsia

A

Target SBP 140-160mmHg and DBP 90-100mmHg

  • labetalol 20-50mg IV
  • hydralazine 5-10mg IV
  • nifedipine 10-20mg PO
46
Q

Eclampsia

A

Magnesium sulfate

  • 4g IV over 10-15 minutes
  • infusion 1-2g/h continued for 24 hours after the last seizure

Diazepam up to 10mg IV when magnesium not immediately available

Repeat magnesium 2-4g IV over 10mins if second seizure

HTN treatment as for pre-eclampsia

Delivery

47
Q

Modified Parkland Formula

A

3-4mLs x TBSA % burn x weight (kg) = total in first 24 hours

  • 1/2 in first 8 hours since injury
  • 1/2 in second 16 hours since injury
  • Hartmann’s
  • add maintenance fluid in kids
48
Q

Mannitol

A

0.25 - 1g/kg

49
Q

Hypertonic saline

A

3mL/kg of 3% over 10 minutes

50
Q

Dabigatran reversal

A

Idarucizumab 5g IV over 10-20 minutes

FFP
Prothrombinex 25-50IU/kg
FVIIa 100mcg/kg
dialysis

51
Q

Rivaroxaban, apixaban reversal

A

Andexanet alfa

TXA
Prothrombinex

52
Q

LMWH Reversal

A

Protamine sulfate

1mg per 100U of dalteparin IV

1mg per 1mg of enoxaparin (max 50mg) IV over 10 mins

53
Q

Warfarin reversal

A

Vitamin K 5-10mg IV
Prothrombinex 25-50IU/kg
FFP 150-300mL

If prothrombinex unavailable, increase FFP dose to 15mL/kg

54
Q

IVABx for epidural abscess

A

Flucloxacillin 2g IV q6h

PLUS

Ceftriaxone 2g IV bd

PLUS

Vancomycin 20-30mg/kg IV if risk of MRSA

55
Q

Prostaglandin infusion

A

0.1mcg/kg/min

Effect usually seen within 30-60mins

56
Q

DKA in children - fluid and insulin

A

Fluid
[(Maintenance + Deficits) - Fluid bolus already given] / 48

Insulin
0.1units/kg/hr actrapid infusion

57
Q

Asthma in children

A

Salbutamol

  • <20kg: 6 puffs or 2.5mg neb
  • > 20kg: 12 puffs or 5mg neb
  • IV: bolus 100mcg/kg over 20mins (max 5mg)
  • IVI: 1mcg/kg/min

Ipratropium

  • < 20kg: 4puffs or 250mcg neb
  • > 20kg: 8 puffs or 500mcg neb

Magnesium

  • 500mg nebs
  • IV bolus 50mg/kg (0.2mmol/kg) over 20mins max 8mmol/2g
  • IVI 30mg/kg/hr (0.01-0.05mmol/kg/hr)

Hydrocortisone
- 4mg/kg q4-5h IV

Prednisone
- 2mg/kg load

58
Q

Lignocaine (local anaesthetic)

A

Max dose = 3mg/kg

7mg/kg with adrenaline

59
Q

Bupivocaine

A

Max dose = 2mg/kg plain

3mg/kg with adrenaline

60
Q

Prilocaine

A

Max dose 6mg/kg plain

3mg/kg for Bier’s block

61
Q

Rx for peritoneal dialysis associated peritonitis

A 
Nystatin 500,000 IU PO qid 
\+
Cefazolin 15mg/kg IP
\+ 
Gentamicin 0.6mg/kg (50mg) IP

CHANGE
Cefazolin to Vancomyin 30mg/kg (2g) IP if MRSA

OPTIONAL
heparin 500U/L each exchange

62
Q

Methylene Blue

A

For methaemoglobinaemia

1mg/kg over 5mins, repeat dose at 30-60mins

63
Q

Octreotide for Sulfonylurea toxicity

A

50mcg bolus then 25mcg/hr infusion

64
Q

Naloxone

A

0.4 - 2mg IV/IM/SC

Infusion 1-10mcg/kg/hr

65
Q

Activated charcoal

A

1g/kg (child)

50g adult

66
Q

NAC

A

150mg/kg loading dose
50mg/kg over 4 hours
100mg/kg over 16 hours

67
Q

Treatment of:

  • acute mountain sickness
  • high-altitude cerebral oedema
  • high-altitude pulmonary oedema
A

Everyone needs descent and oxygen
Hyperbaric oxygen when descent not possible

Specific:

  • acute mountain sickness = acetazolamide 250mg PO bd
  • high-altitude cerebral oedema = dexamethasone 8mg PO followed by 4mg qid
  • high-altitude pulmonary oedema = nifedipine SR 10mg initially followed by 20-30mg bd
68
Q

Thrombolysis in STEMI

A
  • Aspirin 300mg PO
  • Clopidogrel 300mg PO
TENECTEPLASE
<60kg: 30mg
60-70kg: 35mg
70-80kg: 40mg
80-90kg: 45mg
>90kg: 50mg
(remember, half of top number until maxing out over 90kg)

CLEXANE
Age < 75yrs = load 30mg IV, then 1mg/kg sc bd (start 15 mins after bolus)

Age >75yrs = no load. 0.75mg/kg sc bd.

ACEM Fellowship (10 decks)

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