DTPs Flashcards
Oxygen Drug Class, Pharmacology, and Metabolism
Drug Class: Gas
Pharmacology: A colourless, odourless gas essential for the production of cellular energy
Metabolism: N/A
Oxygen Indications, Contraindications, and Precautions
Indications:
- A wide range of conditions resulting in, or potentially resulting in systemic and/or localised hypoxia
Contraindication:
- Known paraquat poisoning with SpO2 equal to or greater than 88%
- History of bleomycin therapy with SpO2 equal to or greater than 88%
Complications:
- Patients with paraquat poisoning or bleomycin lung injury may be harmed by supplemental oxygen. Avoid unless the patient is hypoxaemic.
- Prolonged administration to premature neonates
- Newly born neonates will have low SpO2 for the first 10 mins after birth
- Patients with cyanotic heart disease may have saturation targets between 75% to 85%
- A BVM will not supply adequate oxygen unless IPPV is provided
- The use of high flow oxygen in an attempt to protect against subsequent hypoxaemia in the event of determination has the potential to delay the recognition of such determination (may provide false reassurance that patient is stable)
Oxygen Side Effects
- Hypoventilation in some COPD patients with hypoxic drive
- Drying of airway mucous membranes
Oxygen Presentation and Schedule
Oxygen Onset, Duration, and Half-life
Oxygen Routes of Administration
Oxygen Special Notes
Oxygen Dosages
Methoxyflurane Drug Class, Pharmacology, and Metabolism
Drug class: Analgesic (at low dosages)
Pharmacology: Methoxyflurane is volatile, self-administered inhalation analgesic indicated for short term pain relief. Methoxyflurane is more susceptible to metabolism and has a greater propensity to diffuse into fatty tissue
Metabolism: By the liver and excreted mainly by the lungs
Methoxyflurane Indications, Contraindications, and Precautions
Indications:
- Pain
Contraindications:
- Allergy and/or adverse drug reaction
- Patients <1 year
- History of significant liver or renal disease
- History of malignant hyperthermia
Precautions:
- ALOC
- Intoxicated or drug affected patients
Methoxyflurane Presentation and Schedule
Presentation: Bottle, 3mL methoxyflurane
Schedule: S4 (Restricted Drugs)
Methoxyflurane Onset, Duration, and Half-life
Onset: 1-3 mins
Duration: 5-10 mins
Half-life: Not available
Methoxyflurane Side Effects
ALOC, cough, renal/hepatic failure (following repeated high dose exposure)
Methoxyflurane Routes of Administration
Inhalation (INH)
Methoxyflurane Dosages
Adults: 3mL, repeated once after 20 mins, (total max dose is 6mL0
Paediatric (1yo or older): 3mL, single dose only
Ibuprofen Drug Class, Pharmacology, and Metabolism
Drug Class: Non-steroidal anti-inflammatory drug (NSAID)
Pharmacology: Ibuprofen is a non-selective NSAID that inhibits the synthesis of prostaglandins resulting in analgesic, antipyretic, and anti-inflammatory actions
Metabolism: metabolised by the liver and excreted mainly by the kidneys
Ibuprofen Indications, Contraindications, and Precautions
Indications:
- Moderate pain due to acute inflammation / tissue injury
Contraindications:
- Allergy and/or adverse drug reaction to any NSAID or aspirin
- Concomitant NSAID therapy
- Current GI bleeding or peptic ulcers
- Dehydration and/or hypovolemia
- Renal impairment
- NSAID induced asthma
- Heart failure
- Pregnancy
- Angiotensin-converting enzyme (ACE) inhibitor OR Angiotensin II receptor blocker (ARB) therapy
- Paediatric patients <13yo
- Geriatric patients >64yo
- Patients taking anticoagulant medications
- Diuretic Treatment
Precautions:
- Asthma
- Hepatic dysfunction
- History of GI bleeding or peptic ulcers
Ibuprofen Side Effects
Nausea, dyspepsia, GI bleeding, dizziness
Ibuprofen Presentation and Schedule
Presentation: tablet, 200mg ibuprofen
Schedule: S2 (therapeutic poisons)
Ibuprofen Onset, Duration, and Half-life
Onset: About 15mins
Duration: 4-6 hours
Half-life: 2 hours
Ibuprofen Onset, Duration, and Half-life
Onset: About 15mins
Duration: 4-6 hours
Half-life: 2 hours
Ibuprofen Routes of Administration
Per Oral (PO)
Ibuprofen Adult Dosages
200-400mg, must not be administered within 6 hours of previous ibuprofen administration
Ibuprofen Adult Dosages
Adult: 200-400mg, must not be administered within 6 hours of previous ibuprofen administration
Paediatric: QAS officers are not authorised to administer ibuprofen to paediatric patients
Paracetamol Drug Class, Pharmacology, and Metabolism
Drug Class: Analgesic, Antipyretic
Pharmacology: Paracetamol is a p-aminophenol derivative that exhibits analgesic and antipyretic activity. It does not possess significant anti-inflammatory activity.
Metabolism: By the liver, excreted by the kidneys
Paracetamol Indications, Contraindications, and Precautions
Indications:
- Mild to moderate pain
- Fever (causing distress)
Contraindications:
- Allergy and/or adverse rug reaction
- Patients less than one month old
Precautions:
- Hepatic dysfunction
- Soluble tablets
Paracetamol Side Effects
Nausea
Paracetamol Presentation and Schedule
Presentation:
- Tablet, 500mg paracetamol
- Elixir, 120mg/5mL paracetamol
- Soluble tablet, 250mg paracetamol
Schedule: S2 (therapeutic poisons)
Paracetamol Onset, Duration, and Half-life
Onset: 10-60mins
Duration: 4 hours
Half-life: Approximately 2 hours
Paracetamol Routes of Administration
Per oral (PO)
Paracetamol Dosages
Adult (tablet): 0.5g-1g, must not be administered within 4 hours of previous paracetamol administration, repeated every four hours, max dose in 24h is 4g
Paediatrics (elixir): children greater than or equal to one month old, 15mg/kg, single dose only, not within 4 hours of previous administrations
Paediatrics (soluble tablets): greater than or equal to 7 years, 15mg/kg, single dose only, not within 4 hours of previous administrations
Ondansetron Drug Class, Pharmacology, Metabolism
Drug Class: anti-ematic - 5-HT3 antagonist
Pharmacology: Ondansetron is a serotonin 5-HT3 antagonist. It works by blocking the action of seratonin, a natural substance that may cause nausea and vomiting
Metabolism: the majority of the circulation ondansetron is metabolised by the liver and excreted through the kidneys
Ondansetron Indications, Contraindications and Precautions
Indications:
- Significant nausea and/or vomiting
Contraindications:
- Allergy and/or adverse drug reaction
- Congenital long QT syndrome
- Current apomorphine therapy (used in severe Parkinson’s disease)
- Patients less than 2 years old
Precautions:
- Hepatic Impairment
- Elderly Patients
- Intestinal obstruction
- Patients with risk factors for QT interval prolongation or cardiac arrhythmias
- First trimester pregnancy (may only be administered for extreme and uncontrolled hyperemesis)
Ondansetron Adverse events
Common (>1%):
- Headache
- Constipation
Rare (<0.1%):
- Hypersensitivity reactions (including anaphylaxis)
- ECG Changes
Ondansetron Presentation and Schedule
Presentation:
- Ampoule: 4mg/2mL ondansetron
- Orally disintegrating tablet (ODT): 4mg ondansetron
Schedule:
- S4 (Restricted drugs)
Ondansetron Onset, Duration, and Half-life
Onset: 5 mins
Duration: several hours
Half-life: 3-4 hours
Ondansetron Routes of Administration
Per oral, IM, IV
Ondansetron Dosages
Adults: (PO/IM) 4-8mg, total max dose is 8mg
Paediatrics:
- PO: 2-4 years: 2mg, >5 years: 4mg
- IM: >2 years: 100microg/kg (rounded up to nearest 5kg)
Hydrocortisone Indications, Contraindications, and Precautions
Indications:
- Asthma (excluding mild)
- Acute exacerbation of COPD (with evidence of respiratory distress)
- Refractory anaphylaxis with persistent wheeze (and unresponsive to 3x IM adrenaline (epinephrine)
- Symptomatic adrenal insufficiency (with known history of Addison’s disease, congenital adrenal hyperplasia, pan-hypopituitarism or long term steroidadministration)
Contraindications:
- Allergy and/or adverse drug reaction
Precautions
- Hypertensive
Hydrocortisone Drug Class, Pharmacology, and Metabolism
Drug class: Corticosteroid
Pharmacology: Hydrocortisone is an adrenocorticoid steroid with multiple mechanisms of action including anti-inflammatory activity, immunosuppressive properties and anti-proliferative actions
Metabolism: Hepatic metabolism, renal excretion
Hydrocortisone Side Effects
nil
Hydrocortisone Presentation and Schedule
Presentation: Vial (powder), 100mg hydrocortisone sodium succinate
Schedule: S4 (restricted drugs)
Hydrocortisone Onset, Duration, and Half-life
Onset: 1-2 hours
Duration: 6-12 hours
Half-life: 1-2 hours
Hydrocortisone Routes of Administration
IM, IV
Hydrocortisone Dosages
Adult (Asthma/ acute exacerbation of COPD/ symptomatic adrenal insufficiency)
- IM: 100mg, single dose only
- IV: 100mg, slow push over 1 minute, single dose only
Adult (Refractory anaphylaxis with persistent wheeze)
- IM: 200mg, single dose only
- IV: 200mg, slow push over 1 minute, single dose only
Paediatric (Asthma, refractory anaphylaxis with persistent wheeze)
- IM: 4mg/kg, single dose only, not to exceed 100mg
- IV: 4mg/kg, slow push over 1 minute, single dose only, not to exceed 100mg
Paediatric (Symptomatic adrenal insufficiency), IM and IV:
- 0-4 years: 25mg
- 5-10 years: 50mg
- >10 years: 100mg
single dose only, for IV slow push over 1 minute
Ipratropium Bromide Drug Class, Pharmacology, and Metabolism
Drug class: Anticholinergic agent
Pharmacology: Ipratropium bromide is an antimuscarinic agent which promotes bronchodilator by inhibiting cholinergic bronchomotor tone
Metabolism: Hepatic with excretion by the kidneys
Ipratropium Bromide Drug Class, Pharmacology, and Metabolism
Drug class: Anticholinergic agent
Pharmacology: Ipratropium bromide is an antimuscarinic agent which promotes bronchodilator by inhibiting cholinergic bronchomotor tone
Metabolism: Hepatic with excretion by the kidneys
Ipratropium Bromide Indications, Contraindications, and Precautions
Indications:
- Moderate bronchospasm (unresponsive to initial QAS salbutamol NEB)
- Severe bronchospasm
Contraindications:
- Allergy and/or adverse drug reaction
- Patients less than 1 year of age
Precautions:
- Glaucoma
Ipratropium Bromide Side Effects
- Dilated pupils
- Dry mouth
- Palpitations
Ipratropium Bromide Presentation and Schedule
Presentation: Nebule, 250microg/1mL ipratropium bromide monohydrate
Schedule: S4 (restricted drugs)
Ipratropium Bromide Onset, Duration, and Half-life
Onset: 1.5-3mins (peak 1.5-2hours)
Duration: 4-6 hours
Half-life: 3 hours
Ipratropium Bromide Routes of Administration
Nebuliser
Ipratroprium Bromide Dosages
Adult:
- 500 microg, repeated at 20 minute intervals, total maximum dose 1.5mg
Paediatric:
- 1-5 years: 250 microg, repeated at 20 minute intervals, total maximum dose 750microg
- 6+ years: 500microg, repeated at 20 minute intervals, total maximum dose 1.5mg
Salbutamol Drug Class, Pharmacology, and Metabolism
Drug class: Beta-adrenergic agonist
Pharmacology: Salbutamol is a direct acting sympathomimetic agent which mainly affects B2 adrenoreceptors. It primarily acts as a bronchodilator but also has inotropic and chronotropic actions. Additionally, it lowers serum potassium levels through its direct stimulation of the sodium/potassium ATPase pump, drawing potassium into cells.
Metabolism: Hepatic with renal excretion
Metabolism:
Salbutamol Indications, Contraindications, and Precautions
Indications:
- Bronchospasm
- Suspected hyperkalaemia (with QRS widening and/or AV dissociation) (CCP ONLY!!!)
Contraindications:
- Allergy and/or adverse drug reaction
- Patients less than 1 year
Precautions:
- Acute pulmonary oedema
- Ischaemic heart disease
Precautions:
Salbutamol Side Effects
- Anxiety
- Tachyarrhythmias
- Tremors
- Hypokalaemia and metabolic acidosis
Salbutamol Presentations and Schedule
Presentation:
- Metered dose inhaler, 100microg/puff salbutamol
- Nebule, 2.5mg/2.5mL salbutamol
- Nebule, 5mg/2.5mL salbutamol
Schedule:
- Metered dose inhaler: S3 (therapeutic poison)
- NEB: S4 (restricted drugs)
Salbutamol Onset, Duration, and Side-effects
Onset: 2-5 mins
Duration: 16-60 mins
Side-effects: 1.6 hours
Salbutamol Routes of Administration
- Metered dose inhaler (MDI)
- Nebuliser (NEB)
- IV (CCP ONLY!!)
Salbutamol Dosages
Adult (Bronchospasm):
- MDI: 12 (1.2mg) inhalations, single dose only, no maximum dose
- NEB: 5mg, repeated prn, no maximum dose
Paediatrics (Bronchospasm):
- MDI (1-5 years): 6 (600 microg) MDI inhalations, repeated at 10 minutes, no maximum dose
- MDI (>6 years): 12 (1.2mg) MDI inhalations, repeated at 10 minutes, no maximum dose
- NEB (1-5 years): 2.5mg, single dose only
- NEB (>6 years): 5mg, single dose only
Midazolam Drug Class, Pharmacology, and Metabolism
Drug Class: Benzodiazepine (short acting)
Pharmacology: Midazolam hydrochloride is a short acting CNS depressant that induces amnesia, anaesthesia, hypnosis and sedation. It achieves this by enhancing the action of the inhibitory neurotransmitter gamma-amino butyric acid (GABA). Depressant effects occur at all levels of the CNS
Metabolism: By the liver and excreted by the kidneys
Midazolam Indications, Contraindications, and Precautions
Indications:
- Generalised seizures/focal seizures (GCS <12)
- Sedation (for maintainance of an established LMA/ETA, for procedures, CPR induced consciousness, to facilitate safe assessment and treatment of agitated head injury patient, as an adjunct to opiate analgesia, for ketamine emergence)
- Acute behavioural disturbance (with SAT score < 2, unresponsive to max dose of droperidol
Contraindications:
- Allergy and/or adverse drug reaction
Precautions:
- Reduced dosages must be considered in: low body weight/older or frail patients, patients with chronic renal failure, congestive cardiac failure, or shock
- Can cause severe respiratory depression in patients with COPD
- Myasthenia gravis
- Multiple sclerosis
Midazolam Side Effects
- Hypotension
- Respiratory depression particularly when associated with other CNS depressants including alcohol and narcotics
Midazolam Presentation and Schedule
Presentation: Ampoule, 5mg/1mL midazolam
Schedule: S4 (restricted drugs)
Midazolam Onset, Duration, and Half-life
Onset (IM): 5-15 minutes
Onset (IV): 1-3 minutes
Duration: Variable
Half-life: 2.5 hours
Midazolam Routes of Administration
Intranasal, IM, IV Intraosseous injection (CCPs ONLY!!!)
Midazolam Adult Dosages
Gneralised Seizure:
- Intranasal/ IM: 5mg, repeated every 10 minutes, total max dose of 20mg
- IV: 5mg, repeated every 5 mins, total max dose 20mg
Sedation:
- CCP ONLY!!
Acute behavioural disturbance
- IM/IV: clinical consult line must be called
Midazolam Paediatric Dosages
Seizure:
Intranasal/IM:
- 200microg/kg, repeated at half initial dose (max 2.5mg) every 10 minutes, total max dose 10mg
- IV/IO: CCP ONLY
Sedation:
- CCP ONLY
Acute behavioural disturbance
IM/IV: consult line must be called
Water for Injection Drug Class, Pharmacology, and Metabolism
Drug class: N/A
Pharmacology: sterilised water used to dilute or dissolve drugs
Metabolism: N/A
Water for Injection Indications, Contraindications, and Precautions
Indications: To dissolve and/or dilute drugs for the purpose of IM, IV, or IO administration
Contraindications: Nil
Precautions: Nil
Water for Injection Side Effects
Nil
Water for Injection Presentation and Schedule
Presentations: Ampoule, 20mL water for injection
Schedule: Unscheduled
Water for Injection Onset, Duration, and Side Effects
N/A
Water for Injection Routes of Administration and Dosages
IM/IV
As authorised on individual DTPs
Sodium Chloride 0.9% Drug Class, Pharmacology, and Metabolism
Drug class: Isotonic crystalloid solution
Pharmacology: Sodium chloride 0.9% is an isotonic crystalloid that acts as a vehicle for many parenteral drugs and as an electrolyte replenisher for maintenance or replacement of fluid deficits
Metabolism: This drug has 100% bioavailability. Excess sodium is predominantly excreted by the kidneys
Sodium Chloride 0.9% Indications, Contraindications, and Precautions
Indications:
- Inadequate tissue perfusion/shock
- Hypovolaemia
- Significant burns (total body surface area >20% for adults and >10%)
- To dissolve and dilute drugs (for the purpose of IM, IV, or IO administrations)
- As a flush following IV or IO drug administration
Contraindications:
- Nil
Precautions:
- Patients with acute and/or history of heart failure
- Pre existing renal failure
- Uncontrolled haemorrhage (unless associated with severe head injury)
Sodium Chloride 0.9% Side Effects
Excessive administration will result in fluid overload
Sodium Chloride 0.9% Onset, Duration, and Half-life
Onset: Immediate
Duration: Variable
Half-life: N/A
Sodium Chloride Routes of Administration
IV injection, IV infusion, IO injection (CCP only), IO osseous (CCP only)
Sodium Chloride 0.9% Adult Dosages
Inadequate tissue perfusion/shock, hypovalaemia (IV INF):
- PRN, titrate according to patients needs andindication and the patient’s physiological response to treatment
Significant burns (IV INF):
- 15mL/hour x TBSA (nearest 10%)
- If over 100kg, administer an additional 200mL/hour
To dissolve and dilute drugs (IV, IM):
- As authorised on individual DTPs
As a flush following IV or IO drug administration:
- PRN
Sodium Chloride 0.9% Paediatric Dosages
Inadequate tissue perfusion/shock, Hypovalaemia (IV INF):
- APPROVAL REQUIRED (clinical consult line)
- 10-20mL/kg, may be repeated twice, max dose 60mL/kg
Significant burns:
- Call consult line
To dissolve or dilute drugs (IM or IV):
- As authorised on individual DTPs
As a flush:
- PRN
Glucose Gel Drug Class, Pharmacology, and Metabolism
Drug class: Hyperglycaemic
Pharmacology: Glucose gel is a form of pure glucose that is absorbed quickly in the intestinal tract after ingestion. It is the principle energy source for body cells, especially the brain
Metabolism: Broken down in most tissues and distributed throughout total body water
Glucose Gel Drug Class, Pharmacology, and Metabolism
Drug class: Hyperglycaemic
Pharmacology: Glucose gel is a form of pure glucose that is absorbed quickly in the intestinal tract after ingestion. It is the principle energy source for body cells, especially the brain
Metabolism: Broken down in most tissues and distributed throughout total body water
Glucose Gel Indications, Contraindications, and Precautions
Indications:
- Symptomatic hypoglycaemia (with the ability to self administer oral glucose)
Contraindications:
- Unconsciousness
- Patients with difficulty swallowing
- Under 2 years
Precautions:
- Nil
Glucose Gel Side Effects
- Nausea and/or vomiting
- Diarrhoea
Glucose Gel Side Effects
- Nausea and/or vomiting
- Diarrhoea
Glucose Gel Onset, Duration, and Half-life
Onset: ~10 mins
Duration: variable
Half-life: N/A
Glucose Gel Routes of Administration
PO
Glucose Gel Dosages
Adult:
15g, repeated at 15 mins (if BGL <4), max dose 30g
Glucagon Drug Class, Pharmacology, and Metabolism
Drug class: Hyperglycaemic
Pharmacology: Glucagon is a hyperglycemia agent that mobilised hepatic glycogen, which is released into the blood as glucose. Glucagon has inotropic and chronotropic effects that are not mediated through beta-receptors.
Metabolism: By the liver, kidneys, and in plasma
Glucagon Indications, Contraindications, and Precautions
Indications:
- Symptomatic hypoglycaemia (with the inability to self administer oral glucose)
- Refractory anaphylaxis with persistent hypotension/shock (unresponsive to 3x IM adrenaline injections and adequate fluid challenges)
Contraindications:
- Allergy and/or adverse drug reaction
Precautions:
- nil
Glucagon Side Effects
Nil
Glucagon Onset, Duration, and Half-life
Onset: 4-7 mins
Duration: Variable
Half-life: 3-6 mins
Glucagon Dosages
1mg +1mL water (in 3mL syringe)
Glucose 10% Drug Class, Pharmacology, and Metabolism
Drug Class: Hyperglycaemic
Pharmacology: Glucose is a sugar that is the principle energy source for body cells, especially the brain
Metabolism: Broken down in most tissues and distributed through total body water
Glucose 10% Indications, Contraindications, and Precautions
Indications:
- Symptomatic hypoglycaemia (with the inability to self administer oral glucose)
Contraindications:
- Nil
Precautions:
- Hyperglycaemia
Glucose 10% Side Effects
Nil
Glucose 10% Onset, Duration, and Half-life
Onset: Rapid
Duration: N/A
Half-life: N/A
Glucose 10% Routes of Administration and Dosages
Routes: IV and IM
Dosage: 15g (150mL), repeated at 10g (100mL) every 5 mins until BGL >4
Aspirin Drug Class, Pharmacology, and Metabolism
Drug class: Antiplatelet
Pharmacology: Aspirin inhibits platelet by irreversibly inhibiting cyclo-oxygenase, reducing the synthesis of thromboxone A2 (an inducer of platelet aggregation) for the life of the platelet. This action forms the basis of preventing platelets from aggregating to exposed collagen fibres at the site of vascular injury
Metabolism: Aspirin is converted to salicylic acid in many tissues, but primarily in the GI mucosa and the liver. It is subsequently excreted by the kidneys
Aspirin Indications, Contraindications, and Precautions
Indications:
- Suspected ACS
- Acute cariogenic pulmonary oedoma
Contraindication:
- Allergy and/or drug reaction to aspirin or any NSAID
- Chest pain associated with psychostimulant overdose
- Bleeding or clotting disorders (eg haemophilia)
- Current GI bleeding or peptic ulcers
- Patients <18 years
Precautions:
- Possible aortic aneurysm or any other condition that may require surgery
- Pregnancy
- History of GI bleeding or peptic ulcers
- Concurrent anticoagulant therapy (eg warfarin)
Aspirin Side Effects
- Epigastric pain/discomfort
- Nausea and/or vomiting
- Gastritis
- GI bleeding
- NSAID induced asthma
Aspirin Onset, Duration, and Half-life
Onset: ~10mins
Duration: ~ 1 week
Half-life: 3.2 hours
Aspirin Dosages
300mg tablets, single dose, chewed and swallowed with water
