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Drugs JRCALC Flashcards

1
Q

Strength of Adrenaline for Cardiac Arrest?

A

1:10,000

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2
Q

Indications for adrenaline 1:10,000?

A

Cardiac Arrest
Post ROSC

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3
Q

Contra-indications for adrenaline 1:10,000?

A

None

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4
Q

Cautions for adrenaline 1:10,000?

A

DO NOT administer if core temperature is less than 30
Double time between doses if core temperature is between 30-35
Severe hypertension may occur in patients on non-cardioselective beta blockers such as propanolol

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5
Q

Dosage of adrenaline 1:10,000?

A

1 milligram

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6
Q

How often do we administer adrenaline 1:10,000?

A

If unshockable rhythm, every 3-5 minutes.
If shockable rhythm, after 3rd shock and alternate loops thereafter.

Once you have started administering ADX, regardless of electrical activity, provide this every 3-5 minutes.

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7
Q

Actions of adrenaline 1:10,000?

A

a sympathomimetic drug.
stimulates alpha and beta-adrenergic receptors.
Enhances myocardial and cerebral blood flow during CPR.
CPR then more effective as peripheral resistance is increased, improving perfusion pressures.

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8
Q

Dosage of Amiodarone?

A

300 milligrams, then 150 milligrams

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9
Q

When do we administer amiodarone?

A

After 3rd and 5th shock.

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10
Q

MAX DOSE of adrenaline 1:10,000?

A

NONE

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11
Q

MAX DOSE of Amiodarone?

A

450 milligrams

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12
Q

Contraindications of amiodarone?

A

NONE

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13
Q

Indications of amiodarone?

A

Cardiac Arrest where shockable rhythms (ventricular fibrillation or pulseless ventricular tachycardia) is unresponsive to defibrillation.

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14
Q

Actions of amiodarone?

A

Anti-arrhythmic.
Lengthens cardiac action potential and therefore effective refractory period.
Prolongs QT interval on ECG
Blocks Sodium and Potassium channels in cardiac muscle
Acts to stabilise and reduce electrical irritability of the cardiac muscle

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15
Q

Side Effects of Amiodarone?

A

Bradycardia
Vasodilation causing hypotension - flushing
Bronchospasm
Arrhythmias - Torsades de pointes

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16
Q

Dosage of Atropine?

A

600 micrograms

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17
Q

Dosage interval of atropine?

A

3-5 mins

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18
Q

MAX dose of atropine?

A

Up to 3 milligrams

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19
Q

Indications of Atropine?

A

Symptomatic Bradycardia:
absolute bradycardia
bradycardia post ROSC
systolic bp less than expected
inadequate perfusion causing confusion
paroxysmal ventricular arrhythmias requiring suppression

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20
Q

contraindications of atropine?

A

Do not administer if bradycardia is induced by suspected hypothermia
do not give to those with cardiac transplants

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21
Q

Why do we not give atropine to those with cardiac transplants?

A

their hearts will not respond to vagal blocking by atropine and paradoxical high degree AV block or sinus arrest may result

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22
Q

actions of atropine?

A

reverses the effects of vagal overdrive
increases HR by blocking vagal activity in sinus bradycardia, 2nd or 3rd degree heart block
enhances AV conduction

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23
Q

Side effects of atropine?

A

dry mouth, visual blurring, pupil dilation
confusion and occasional hallucinations
tachycardia
do not use small doses (<100mcg) as they may cause paradoxical bradycardia.

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24
Q

Dose of salbutamol?

A

5 milligrams

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25
Presentation for salbutamol
Goes in a neb
26
Indx of Salbutamol?
Acute asthma attack where normal inhaler therapy has failed to relieve symptoms Expiratory wheezing associated with allergy, anaphylaxis, beta blocker overdose, smoke inhalation or other lower airway cause Exacerbation of COPD
27
Actions of salbutamol?
selective beta2 adrenoreceptor stimulant drug. Relaxant effect on the smooth muscle in the medium and smaller airways, which are in spasm in acute asthma attacks.
28
Contraindications of salbutamol?
NONE
29
Cautions of salbutamol?
Hypertension Angina Overactive thyroid Late pregnancy as can relax uterus Bronchomalacia/laryngomalacia/tracheomalacia (abnormal softening) Severe hypertension may occur for those on beta blockers - use half doses unless profound hypotension
30
Nebulisation with oxygen for those COPD should be limited to:
6 mins
31
side effects of salbutamol?
tremor tachycardia palpitations headache feeling of tension peripheral vasodilation muscle cramps rash
32
indications of ipratropium bromide?
Expiratory wheezing Acute, severe or life-threatening asthma acute asthma unresponsive to salbutamol exacerbation of COPD, unresponsive to salbutamol
33
dosage of ipratropium bromide?
500 mcg
34
contraindications of ipratropium bromide?
NONE
35
Actions of ipratropium bromide?
Antimuscarinic bronchodilator. Short term relief in acute asthma considered of greater benefit in: children suffering acute asthma and adults suffering with COPD
36
Cautions of ipratropium bromide?
Use with care in patients in: Glaucoma (protect eyes from the mist) Pregnancy and breastfeeding Prostatic hyperplasia Limit nebuliser with oxygen to 6 minutes
37
Side Effects of ipratropium bromide?
Nausea Dry mouth tachycardia / arrhythmia paroxsymal tightness of the chest allergic reaction
38
Dose of Diazepam?
10 milligrams
39
Contraindications of diazepam?
Patients with known hypersensitivity
40
indications of diazepam?
Patients with prolonged convulsions (lasting 5 mins or more) OR repeated convulsions (3< in an hour) and are CURRENTLY CONVULSING Eclamptic convulsions Symptomatic cocaine toxicity (severe hypertension, chest pain and convulsions)
41
Actions of diazepam?
CNS depressant, acts as an anticonvulsant and sedative
42
Cautions of Diazepam?
Use with caution if alcohol, antidepressants or other CNS depressants have been taken as side effects more likely Dose of buccal midazolam or rectal diazepam given by a parent or carer may be the first dose administered for this seizure.
43
Side effects for diazepam?
Respiratory depression may occur, especially in the presence of alcohol. Opioid drugs similarly enhance diazepam's cardiac and respiratory depressive effects. Hypotension may occur. Lightheadedness Unsteadiness Drowsiness Confusion Amnesia
44
Dosage of Naloxone?
400 mcg
45
Contraindications of Naloxone
Neonates born to opioid addicted mothers can suffer from serious withdrawal effects.
46
indications of naloxone
the reversal of acute opioid or opiate toxicity for respiratory arrest or resp depression. Unconsciousness, associated with resp depression of unknown cause, where opioid overdose is a possibility in cardiac arrest, where opioid toxicity is considered to be the likely cause
47
actions of naloxone
complete or partial reversal of the respiratory depression effects of opioid drugs (the aim of naloxone administration is to restore adequate respirations, but not necessarily to restore full consciousness)
48
side effects of naloxone
In those dependant on opioids, severe withdrawal symptoms may occur - cardiac arrhythmias. Vomiting
49
MAX DOSE
4,000 MCG
50
Dosage of GTN
400-800 mcg (1-2 sprays)
51
MAX dose
no limit
52
indications of GTN
cardiac chest pain due to angina or myocardial infarction, when systolic bp is greater than 90mmhg -breathlessness due to pulmonary oedema in acute heart failure when SBP is greater than 110mmHg -Patients with suspected cocaine toxicity presenting with chest pain
53
Actions of GTN
A potent vasodilator drug resulting in: dilation of coronary arteries/ relief of coronary spasm dilation of systemic veins resulting in lower preload reduced blood pressure
54
Caution for GTN
patients with suspected posterior myocardial infarction or right venticular infarction
55
contraindications of GTN
hypotension (systolic BP <90 mmHg) hypovolaemia head trauma cerebral haemorrhage unconscious patients known severe aortic or mitral stenosis Viargra or related drugs - do not give if they have had this in last 24 hours
56
side effects of GTN
headache dizziness hypotension
57
furosemide indications
IV furosemide for pulmonary oedema and/or respiratory distress due to acute heart failure
58
contraindications of furosemide
reduced GCS with liver cirrhosis cardiogenic shock severe renal failure with anuria children under 18 years
59
actions of furosemide
potent diuretic with rapid onset (within 30 mins) and short duration
60
cautions with furosemide
hypokalaemia (low potassium), could induce arrhythmias pregnancy hypotensive patient
61
side effects of furosemide
hypotension gastrointestinal disturbances
62
dose of furosemide
40 milligrams
63
MAX DOSE furosemide
40 milligrams
64
strength of adrenaline for anaphylaxis
1:1,000
65
indications of adrenaline 1:1000
anaphylaxis life threatening asthma failing ventilation and continued deterioration depsite nebuliser therapy
66
actions of adrenaline 1:1000
reverses allergic manifestations of acute anaphylaxis relieves bronchospasm in acute severe asthma
67
Cautions of adrenaline 1:1000
severe hypertension may occur in patients on non-cardioselective beta-blockers eg propanolol do NOT adminster IV adrenaline is cases of anaphylaxis
68
dosage of adrenaline 1;1000
500 mcg
69
MAX dose adrenaline 1;1000
no limit
70
Route of administration for adx 1;1000
IM
71
dosage of aspirin
300mg
72
MAX DOSE aspirin
300mg
73
indications for aspirin
Clinical or ECG evidence suggestive of myocardial infarction or ischaemia Suspected TIA with ALL if the following: -where symptoms are fully resolved -patient is not being conveyed to hospital -patient has been referred into local TIA pathway
74
Actions for aspirin
has an antiplatelet action which reduced clot formation
75
contraindications for aspirin
known aspirin allergy or sensitivity children under 26 years active GI bleeding haemophilia or other known clotting disorders severe hepatic failure with jaundice
76
cautions for aspirin
asthma pregnancy renal failure moderate hepatic disease without jaundice gastric or duodenal ulcer current trt with anticoagulants
77
side effects of aspirin
increased risk of gastric bleeding wheezing in some asthmatics
78
Indications of TXA
-Any ptn where hemostatic gauze, arterial torniquets, chest dressings, pressure dressings have been applied -ptn who has suffered traumatic cardiac arrest -women who have recently given birth but have suffered subsequent trauma -head injury aged 18<. + GCS 12 + The injury occurred less than 3 hours ago. -PPH. Given birth within 3 hours, lost more than 500ml, unresponsive to syntometrine. -PPH - uterine trauma/rupture is suspected. -PPH - uterotonic drugs are contraindicated -Woman who are breastfeeding should have TXA administered in life threatening circumstances
79
Actions of TXA
Anti-fibrinolytic which reduces the breakdown of clots
80
Contra indications of TXA
-known previous anaphylactic reaction to TXA -bleeding started more than 3 hours ago. -obvious resolution of haemorrhage -PPH before the administration of an uterotonic unless trauma is suspected cause -critical interventions required
81
cautions for TXA
contact local senior on call clinician for advice on the below if required: -patients with a known hx of convulsions or convulsions from the incident. -patients with known hx of acute venouc or arterial thrombosis -patients with known severe renal impairment. -rapid injection may cause hypotension -do not administer through same line as blood products or penicillin inc comoxiclav
82
side effects of TXA
nausea vomiting diarrhoea hypersensitivity reactions inc anaphylaxis rapid injection may cause hypotension arterial or venous embolism
83
dosage of TXA
1G
84
MAX DOSE
1G
85
dose of morphine IV
0.1mg/Kg
86
indications of morphine
pain associated with suspected MI severe pain as a component of a balanced analgesia regimen end of life
87
actions of morphine
strong opioid analgesic produces sedation, euphoria and analgesia, it may both depress respiration and induce hypotension histamine is released following morphine administration and this may contribute to its vasodilatory effect.
88
contraindications of morphine
children under 1 resp depression hypotension head injury with significantly impaired LOC known hypersensitivity to morphine
89
cautions with morphine
head injury acute alcohol intoxication medications - antidepressants, tranquillisers chest injuries pregnancy
90
side effects of morphine
respiratory depression cardiovascular depression nausea and vomiting drowsiness pupillary constriction
91
dosage of activated charcoal
50g
92
MAX dose activated charcoal
50g
93
indications of activated charcoal
the emergency treatment of acute oral poisoning and oral drug overdose -adults and children aged 1 and over who have ingested toxins less than 1 hour before attendance by an ambulance clinician OR adults and children who have ingested toxins and where TOXBASE have been contacted and have advised
94
contraindications of activated charcoal
children under one year patients presenting to the ambulance clinician more than one hour since ingestion adinistration not advised following TOXBASE or NPIS vomiting patients patients with reduced gi motility poisoning known to be due to the ingestion of: cyanide petroleum distillates metal salts including salts of lithium and iron ethanol, methanol, ethylene glycol, iron salts, sodium chloride, lead boric acid, other mineral acid malathion corrosive substances
95
side effects of activated charcoal
black stool intestinal obstruction bezoar formation intestinal perforation
96
cautions of activated charcoal
prevent aspiration in younger children reduces effects of other antidotes ptn who have taken an overdose and have also consumed recreational alcohol can be administered this providing they are alert enough to safely swallow shake bottle before administration

203 Drugs (1 decks)

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