Drugs JRCALC Flashcards
Strength of Adrenaline for Cardiac Arrest?
1:10,000
Indications for adrenaline 1:10,000?
Cardiac Arrest
Post ROSC
Contra-indications for adrenaline 1:10,000?
None
Cautions for adrenaline 1:10,000?
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
Dosage of adrenaline 1:10,000?
1 milligram
How often do we administer adrenaline 1:10,000?
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.
Actions of adrenaline 1:10,000?
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.
Dosage of Amiodarone?
300 milligrams, then 150 milligrams
When do we administer amiodarone?
After 3rd and 5th shock.
MAX DOSE of adrenaline 1:10,000?
NONE
MAX DOSE of Amiodarone?
450 milligrams
Contraindications of amiodarone?
NONE
Indications of amiodarone?
Cardiac Arrest where shockable rhythms (ventricular fibrillation or pulseless ventricular tachycardia) is unresponsive to defibrillation.
Actions of amiodarone?
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
Side Effects of Amiodarone?
Bradycardia
Vasodilation causing hypotension - flushing
Bronchospasm
Arrhythmias - Torsades de pointes
Dosage of Atropine?
600 micrograms
Dosage interval of atropine?
3-5 mins
MAX dose of atropine?
Up to 3 milligrams
Indications of Atropine?
Symptomatic Bradycardia:
absolute bradycardia
bradycardia post ROSC
systolic bp less than expected
inadequate perfusion causing confusion
paroxysmal ventricular arrhythmias requiring suppression
contraindications of atropine?
Do not administer if bradycardia is induced by suspected hypothermia
do not give to those with cardiac transplants
Why do we not give atropine to those with cardiac transplants?
their hearts will not respond to vagal blocking by atropine and paradoxical high degree AV block or sinus arrest may result
actions of atropine?
reverses the effects of vagal overdrive
increases HR by blocking vagal activity in sinus bradycardia, 2nd or 3rd degree heart block
enhances AV conduction
Side effects of atropine?
dry mouth, visual blurring, pupil dilation
confusion and occasional hallucinations
tachycardia
do not use small doses (<100mcg) as they may cause paradoxical bradycardia.
Dose of salbutamol?
5 milligrams
Presentation for salbutamol
Goes in a neb
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
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.
Contraindications of salbutamol?
NONE
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
Nebulisation with oxygen for those COPD should be limited to:
6 mins
side effects of salbutamol?
tremor
tachycardia
palpitations
headache
feeling of tension
peripheral vasodilation
muscle cramps
rash
indications of ipratropium bromide?
Expiratory wheezing
Acute, severe or life-threatening asthma
acute asthma unresponsive to salbutamol
exacerbation of COPD, unresponsive to salbutamol
dosage of ipratropium bromide?
500 mcg
contraindications of ipratropium bromide?
NONE
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
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
Side Effects of ipratropium bromide?
Nausea
Dry mouth
tachycardia / arrhythmia
paroxsymal tightness of the chest
allergic reaction
Dose of Diazepam?
10 milligrams
Contraindications of diazepam?
Patients with known hypersensitivity
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)
Actions of diazepam?
CNS depressant, acts as an anticonvulsant and sedative
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.
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
Dosage of Naloxone?
400 mcg
Contraindications of Naloxone
Neonates born to opioid addicted mothers can suffer from serious withdrawal effects.
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
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)
side effects of naloxone
In those dependant on opioids, severe withdrawal symptoms may occur - cardiac arrhythmias.
Vomiting
MAX DOSE
4,000 MCG
Dosage of GTN
400-800 mcg (1-2 sprays)
MAX dose
no limit
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
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
Caution for GTN
patients with suspected posterior myocardial infarction or right venticular infarction
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
side effects of GTN
headache
dizziness
hypotension
furosemide indications
IV furosemide for pulmonary oedema and/or respiratory distress due to acute heart failure
contraindications of furosemide
reduced GCS with liver cirrhosis
cardiogenic shock
severe renal failure with anuria
children under 18 years
actions of furosemide
potent diuretic with rapid onset (within 30 mins) and short duration
cautions with furosemide
hypokalaemia (low potassium), could induce arrhythmias
pregnancy
hypotensive patient
side effects of furosemide
hypotension
gastrointestinal disturbances
dose of furosemide
40 milligrams
MAX DOSE furosemide
40 milligrams
strength of adrenaline for anaphylaxis
1:1,000
indications of adrenaline 1:1000
anaphylaxis
life threatening asthma failing ventilation and continued deterioration depsite nebuliser therapy
actions of adrenaline 1:1000
reverses allergic manifestations of acute anaphylaxis
relieves bronchospasm in acute severe asthma
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
dosage of adrenaline 1;1000
500 mcg
MAX dose adrenaline 1;1000
no limit
Route of administration for adx 1;1000
IM
dosage of aspirin
300mg
MAX DOSE aspirin
300mg
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
Actions for aspirin
has an antiplatelet action which reduced clot formation
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
cautions for aspirin
asthma
pregnancy
renal failure
moderate hepatic disease without jaundice
gastric or duodenal ulcer
current trt with anticoagulants
side effects of aspirin
increased risk of gastric bleeding
wheezing in some asthmatics
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
Actions of TXA
Anti-fibrinolytic which reduces the breakdown of clots
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
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
side effects of TXA
nausea
vomiting
diarrhoea
hypersensitivity reactions inc anaphylaxis
rapid injection may cause hypotension
arterial or venous embolism
dosage of TXA
1G
MAX DOSE
1G
dose of morphine IV
0.1mg/Kg
indications of morphine
pain associated with suspected MI
severe pain as a component of a balanced analgesia regimen
end of life
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.
contraindications of morphine
children under 1
resp depression
hypotension
head injury with significantly impaired LOC
known hypersensitivity to morphine
cautions with morphine
head injury
acute alcohol intoxication
medications - antidepressants, tranquillisers
chest injuries
pregnancy
side effects of morphine
respiratory depression
cardiovascular depression
nausea and vomiting
drowsiness
pupillary constriction
dosage of activated charcoal
50g
MAX dose activated charcoal
50g
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
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
side effects of activated charcoal
black stool
intestinal obstruction
bezoar formation
intestinal perforation
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
