DTPs Flashcards
Haloperidol metabolism
Metabolism in the liver exerted by urine, bile and faeces
Haloperidol indication
Acute psychosis
haloperidol dosage
Adult
Intramuscular injection only IMI
> equal 50yo 5mg max 5mg
< 50yo 10mg max 10mg
Haloperidol contraindications
KSAR
Parkinson’s disease
Haloperidol precautions
Dystonic reaction Neuroleptic malignant syndrome NMS Tardive dyskinesia Elderly debilitated patients Etoh or drugs - hypotension Aloc
Haloperidol side effects
Lethargy & drowsiness Hypotension Respiratory depression Extra pyramidal reaction Anxiety euphoria
Haloperidol presentation
5mg : 1ml
Haloperidol drug action times
Onset : 5 minutes (peak 20 min)
Duration : 2-3 hours
Half life : 20 hours
Benzotropine pharmacology
Synthesized from components of atropin and diphenhydramine drug molecules . Possesses anti-histamine, anti cholinergic properties while inhibiting dopamine re-uptake. These drugs enable restoration of the balance between ach and dopamine in the CNS, thereby alleviating acute dystonia .
Benztropine metabolism
Hepatic
Benztropine indications
Acute dystonic reaction
Haloperidol Pharmacology
Strong activity against delusions and hallucinations, most likely due to an effective dopaminergic receptor blockage in the mesocortex and the limbic system of the brain .
Benztropine precautions
Sedative effects of other drugs maybe enhanced
Children <12 years
Benztropine side effects
Dilated pupils Dry mouth Tachycardia Urinary retention Nausea & vomiting Toxic psychosis confusion and visual hallucinations
Benztropine presentation
2mg:2ml cogentin
Benztropine time onset
Onset : 1-2 minutes
Duration : 1-2 hours
Half life : 16 hours
Benztropine dose
Adult
IVI & IMI 1-2 mg single dose only
Promethazine pharmacology
A phenothiazine derivative with potent antihistamine & sedative/hypnotic effect. It also possess antiemetic, anti motion sickness, anti vertigo, anti cholinergic properties and local LA action. It competitively an reversibly antagonizes the effects of histamine at the H1 receptor site on effector cells .
Promethazine metabolism
Hepatic
Promethazine contraindications
KSAR
Lactating women
Patients < 2 years
Promethazine indications
Nausea & vomiting
Motion sickness
Symptomatic rash / moderate allergic reaction
Teneteplase times
onset 15min
duration several hours
1/2 life 2 hours
Promethazine precautions
Co-comitant use of promethiazines
History of dystonia
May potentials the effects of ETOH
Promethazine side effects
Dry mouth
Hypotension
Dizziness
Sedation
Promethazine presentation
50mg: 2ml
Promethazine time onset
Onset 3-5mina
Duration 6-12 hours
1/2 life 7-14 hours
Promethazine dose
Adult
Nausea and vomiting
Motion sickness
> equal 16 yo 12.5 mg (0.5ml) slow push 1 min single dose only.
Symptomatic rash / moderate allergic reaction
12.5mg slow push 1min single dose only
Ondansetron metabolism
Majority metabolized by liver excreted kidneys
Ondansetron pharmacology
A serotonin 5HT3 receptor antagonist used primarily as an antiemetic . It works both periphery and centrally. reduces the activity of the vagus nerve, which activates the vomiting centre in the mendulla oblongata, and also blocks serotonin in the CTZ .
Ondansetron contraindications
kSAR to ondamsetron or 5HT3 receptors
Patients < 3 yo
Ondansetron indications
Nausea & vomiting
Prophylactic use in patients who has previously experienced nausea and or vomiting with narcotics
Ondansetron side effects
Headache Constipation Sensation warmth and flushing Extra pyramidal effects Dysrrhythmias
Ondansetron presentation
4mg: 2ml Zofran
Ondansetron onset times
Onset : 5 minutes
Duration : several hours
1/2 life : 3-4 hours
Ondansetron dose
Adult
IMI and IVI
4 mg : 2ml max dose
Midazolam pharmacology
Midaz plan hydrochloride is a short acting CNS depressant which induces amnesia, sedation, hypnosis and anesthesia. It achieves by enhancing the effects of the inhibitory neurotransmitter GABA gamma-amino butyric acid . Depressant effects occur at all levels of the CNS
Ondansetron complications
Hepatic impairment
Intestinal obstruction
Midazolam indications
Seizure convulsion
Sedation :
> maintain ett
> severely Agitated patient
> agitate head injury to facilitate assessment and Tx
>procedure (tcp & sync cardio version )
> ketamine disinhibition or emergence
Patients with trauma # reduction or splinting or extrication distressed an agitated despite narcotic analgesia .
> patients with burns distressed and agitated by pain
Midazolam contraindications
KSAR to benzodiazepine s
Midazolam precautions
Reduce dosages maybe required in the elderly , ccf, chromic renal faiulre or shocked patients
Myasthenia gravies
Multiple sclerosis
Severe respiratory depression in patients with copd
Midazolam side effects
Hypotension
Respiratory depression particularly when associated with etoh & narcotics
Midazolam presentation
5mg:1ml
Midazolam times onset
Onset : 5-15 min IM
Onset : 1-3 min IV
Duration : variable
1/2 life : 2.5hours
Midazolam dosages
Adults seizures
Seizures/convulsion -
IMI - < 50 yo 5mg rep 10 minutes @ 5mg no MAX dose
IMI - >equal 50yo 2.5mg rep 10 min @ 2.5mg no MAX dose
IVI & IO - up to 2.5mg rep 5 min @ 2.5mg no MAX dose
Midazolam Dose
Adult Maintain ETT
IVI 1- 2.5mg rep PRN consider administration of narcotics no MAX dose
Midazolam Dose
Sedation agitated head injury requier assessment and treatment
IVI & IO 1-2.5mg rep at 5 min @ 1-2mg no MAX dose
Midazolam Dose
Sedation for procedure (TCP & sync cardioversion)
1mg every 2 min no MAX dose
Midazolam dose
for disinhibtion or emergence following ketamine administration
IVI 1-2.5mg PRN MAX 5mg
Midazolam dose
Severely agitated patient
IMI < 50 yo 5mg rep at 10 min @ 5-10mg MAX 25mg
IMI > 50 yo 1-5mg rep at 10 min @ 1-5mg MAX 15mg
IVI < 50 yo 2.5mg-5mg rep at 5 min @ 2.5-5mg MAX 25mg
IVI >50 yo 1-5mg rep at 5 min @ 1-5mg MAX 25 mg
Midazolam dose
Pt with trauma requiring reduction, splinting or extrication who are distressed and agitated despite narcotic analgesia
Pt with burns
IVI 1-2mg total max dose 2mg
Calcium Gluconate presentation
10% 0.953g :10ml
Calcium Gluconate 10% Pharamcology
Calcium gluconate is a electrolyte which is vital to muscular and neuronal systems. It is involved in smooth muscle contraction, excitative coupling in cardiac and smooth muscle and as an intracellular secondary messenger. These effects combine to exert a positive inotropic effect in the post cardiac arrest patient and addiotinally has a role in cardiac membrane stabilization in hyperkalaemia.
Midazolam metabolism
By the liver excreted by kidneys
Benztropine contraindications
KSAR
Tardive dyskinesia
Children < 3 years
Calcium Gluconate 10% Metabolism
calcium is filtered by the renal glomeruli and reabsorbed, the remainder is excreted in faeces.
Calcium Gluconate 10% indications
Suspected hyperkalaemic cardiac arrest
Severe Hyperkalaemia (haemodynamic compromise or significant cardiac rhthym disturbance
Calcium channel blocker toxicity
Hypotension associated with magnesium infusion (that fails to repsond to addequate fluid therapy)
Calcium Gluconate 10% contraindications
KSAR Digoxin (digitalis) overdose
Tenecteplase Contraindications
identical to those listed in the CAR checklist
Calcium Gluconate 10% Precautions
Respiratory acidosis
Calcium Gluconate 10% side effects
Suspected hyperkalaemic ccardiac arrest NIL All other QAS indications bradycardia cardiac dysrrhythmias hypotension Syncope cardiac arrest
Calcium Gluconate 10% time of onset
onset - 1-3 min
Duration 30-60 minutes ( in hyperkalaemia)
1/2 life nil applicable
Calcium Gluconate 10% dose
ADULT
IV & IO 10ml slow push over 2-5 minutes rep once at 10 minutes
Clopidogrel Pharmacology
specific and potent platelet aggregation inhibitor, it selectively inhibits the binding of adenosine diphosphate (ADP) to its platelet receptors, thereby inhibiting platelet aggregation.
Clopidogrel metabolism
hepatic metabolism with near equal amounts excreted in faeces and urine
Clopidogrel indications
For patients with STEMI (as defined by the QAS CAR checklist) and who:
> have been accepted for PCI (as an adjunct therapy to aspirin and heparin)
>have received fibrinolysis therapy (as an adjunct therapy to aspirin, enoxoparin, tenectaplase)
Clopidogrel Contraindications
KSAR
pts < 18 years
pts currently taking clopidogrel
Identical to the CAR checklist unless otherwise specifically authorized under LWI
Clopidogrel Precautions
Sever renal impairment
Clopdogrel Side effects
Haemorrhage Headache / dizziness Stomach upset and or pain Constipation Diarrhoea
Clopidogrel onset times
Onset : 30 min
Duration : 7- 10 days
1/2 life: 8 hours
Clopidogrel Dose
PCI - 600mg (8tabs)
Fibrinolysis - 300mg (6tabs) (lower dose due to increase risk of haemorrhage)
Clopidogrel Presentation
75mg pink tablet ISCOVER
Enoxaparin pharmacology
several actions on the clotting pathway which occur due to binding to antithrombin III. the antithrombotic activity is related to inhibition of thrombin generation and inhibition of two ket ccoagulation factors: Xa andd thrombin.
Enoxaparin Metabolism
metabolised by the liver but mostly excreted unchanged
Enoxaparin Indications
Pts with STEMI as defined by the QAS CAR checklist who will receive QAS Fibrinolytic therapy as an adjunct therapy to aspirin, clopidogrel, tenectaplase.
Enoxaparin Contraindications
KSAR to enoxaparin or heparin
Identical to those listed in the QAS CAR checklist, unless otherwise sepcifically authorised under relevant LWI.
Enoxaparin Precautions
renal hepatic impairment history of GI ulcerations Diabetic retinopathy low body weight (women < 57 kg) Elderly Pregnancy and lactating women
Enoxaparin side effects
thombocytopenia
Haemorrhage
Enoxaparin presentation
IV 40mg:0.4ml
SC 100mg :1ml weight adjusted dose
Enoxaparin dose
ADULT
Loading dose 30mg followed 15 minutes later by
Maintenance dose 1mg/kg max 100mg
Heparin pharmacology
Heparin is an anticoagulant agent which combines with anti-thrombin III to inhibit X and the conversion of pro-thrombin to thrombin. Heparin therefore reduces the propensity for new clot formation and also inhibits other process in the clotting cascade.
Heparin metabolism
metabolised via biotransformation in the liver and reticulo-endothelial system. metabolites are excreted in urine.
Heparin Indications
for patients with STEMI as defined by the QAS CAR checklist and LWI and who have been accepted for PCI
Heparin contraindication
KSAR
identical to those listed in CAR checklist unless specifically authorised under the LWI
Heparin Complications
Renal impairment
Heparin Side effects
Thrombocytopenia
Haemorrhage
Heparin Presentation
5000 units in 5 ml
Heparin time onset
Onset : 30 seconds
Duration : 3-6 hours
1/2 life: 1.5 hours
Heparin Dose
ADULT
IV - single dose only 5000 units
Hydrocortisone Pharmacology
hydrocortisone is an adrenalcortical steriod that produces an anti-inflammatory process. this inhibits the accumulation of inflammatory cells, phagacytosis, lysomal enzyme release and synthesis & release of mediators of inflammation. additionally it supresses cell mediated immune reaction
Hydrocortisone Metabolism
Hepatic
Hydrocortisone Indications
Moderate - severe asthma
Acute exaccerbation of COPD with evidence of respiratory distress
Symptomatic adrenal insufficiency (with known history of addison’s, congenital adrenal hyperplasia, pan-hypopituitarism or long term steroid administration)
QAS management plans
Hydrocortisone Contraindications
KSAR
Hydrocortisone Precautions
Hypertension
Hydrocotisone Side effects
NIL
Hydrocortisone presentation
100mg powder - to be dissolved with 2ml WFI
Hydrocortisone dose
ADULT
asthma, COPD, allergic reaction/anaphylaxsis 200mg single dose only Symptomatic adrenal insuffciency 100mg single dose only QAS management plan AS list on plan
Ibatropium Bromide Pharmacology
anti-cholinergic (antimuscarinic) agent which promotes bronchodilation through inhibition of cholinergic bronchomotor tone
Ipratropium bromide metabolism
hepatic and excretion by the kidneys
Ipratropium bromide indications
moderate to sever asthma
Ipratropium bromide contraindications
KSAR
pt < 2 yo
Ipratropium bromide precautions
glucoma
prostatic hypertrophy
Ipratropium bromide side effects
dilated pupils
dry mouth
palpitations
Ipratropium bromide presentations
250mcg: 1ml
Ipratropium bromide dose
ADULT
500mcg single dose only
Ketamine pharmacology
ketamine is an anaesthetic agent which acts as a NMDA receptor antagonist. At lower doses this drug produces significant analgesia while the airway reflexes and respiratory drive are preserved. unlike other general anesthetics there is minimal haemodynamic compromise as ketamine acts as a sympathomimetic agent. however this may result in transient tachycardia & hypertension . ketamine produces a dissociative state which will potentially cause the patient to have significant issues with preception, resulting in disinhibition and emergence phenomenon
Ketamine metabolism
exstensive hepatic metabolism with approx 90% of the drug excreted in the urine as metabolites
Ketamine indications
severe traumatic pain (following narcotics) associated with;
> fracture reduction or splinting
>multiple or significant fractures requiring facilitated extrication
severe traumatic pain following burns (third line treatment) post narcotics and benzodiazipines
Ketamine contraindication
KSAR age 180, Dys >110 known hydrocephaluas / raised intraoccular pressure Age < 1 yo Pt gcs less than or equal 12 ACS or acute heart failure
Ketamine precaution
age >65 y
midazolam or other cns depressant agents
hypovolemic shock (exaggerated effect prolonged onset)
globe injuries
pt exhibiting pyschosis
complex facial injuries or fractures
impaired respiratory function
Ketamine side effects
disinhibition dissociated state depression of consciousness hypersalivation hypertension hypertonicity (clonus) nystagmus nausea & vomiting respiratory depression (rare) laryngospasm emergence
Ketamine presentation
200mg;2ml ketalar
hydrocortisone onset
onset 1-2hr
durations 6-12hr
1/2 life 6-8 hrs
Ketamine dose
10-20mg rep 2-3 min MAX 1mg/kg
Enoxaparin onset
immediate peak 3hr
12-24 hours
4.4 hr for 40mg
Tenecteplase pharmacology
Tenecteplase is a anti-thrombotic agent which combines to the fibrin components of the thrombus and converts thrombus-bound plasminogen to plasmin, which degrades the fibrin matrix of the thrombus.
Tenecteplase Metabolism
Hepatic
ketamine onset
onset 30sec
duration 5-20min
1/2life 10-15 min
Tenecteplase Precautions
NIL
Tenecteplase Side effects
haemorrhage
headache
reperfusion arrhythmia
Nausea and vomiting
Tenecteplase presentation
50mg in powder form with solvent -10000 IU graduated syringe weight adjusted dose
Tenecteplase Indications
Classic ongoing ischemic chest pain (atypical chest pain excluded) and ECG criteria suggesting STEMI who meet the QAS CAR checklist:
GCS15
ongoing ischemia chest pain < 6 hours
12 lead ecg with persistant ST segment elevation of >equal 2mm in 2 contiguous chest leads and >equal 1mm in 2 contiguous limb leads.
normal QRS width (< 75 YO
Systolic BP < 180 at all times during care
Diastolic BP < 110 at all times during care
