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ICP Dtps > DTPs > Flashcards

DTPs Flashcards

1
Q

Haloperidol metabolism

A

Metabolism in the liver exerted by urine, bile and faeces

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2
Q

Haloperidol indication

A

Acute psychosis

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3
Q

haloperidol dosage

Adult

A

Intramuscular injection only IMI
> equal 50yo 5mg max 5mg
< 50yo 10mg max 10mg

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4
Q

Haloperidol contraindications

A

KSAR

Parkinson’s disease

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5
Q

Haloperidol precautions

A 
Dystonic reaction 
Neuroleptic malignant syndrome NMS
Tardive dyskinesia 
Elderly debilitated patients 
Etoh or drugs - hypotension 
Aloc
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6
Q

Haloperidol side effects

A 
Lethargy & drowsiness 
Hypotension 
Respiratory depression 
Extra pyramidal reaction 
Anxiety
euphoria
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7
Q

Haloperidol presentation

A

5mg : 1ml

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8
Q

Haloperidol drug action times

A

Onset : 5 minutes (peak 20 min)
Duration : 2-3 hours
Half life : 20 hours

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9
Q

Benzotropine pharmacology

A

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 .

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10
Q

Benztropine metabolism

A

Hepatic

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11
Q

Benztropine indications

A

Acute dystonic reaction

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12
Q

Haloperidol Pharmacology

A

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 .

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13
Q

Benztropine precautions

A

Sedative effects of other drugs maybe enhanced

Children <12 years

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14
Q

Benztropine side effects

A 
Dilated pupils 
Dry mouth 
Tachycardia 
Urinary retention 
Nausea & vomiting 
Toxic psychosis confusion and visual hallucinations
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15
Q

Benztropine presentation

A

2mg:2ml cogentin

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16
Q

Benztropine time onset

A

Onset : 1-2 minutes
Duration : 1-2 hours
Half life : 16 hours

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17
Q

Benztropine dose

Adult

A

IVI & IMI 1-2 mg single dose only

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18
Q

Promethazine pharmacology

A

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 .

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19
Q

Promethazine metabolism

A

Hepatic

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20
Q

Promethazine contraindications

A

KSAR
Lactating women
Patients < 2 years

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21
Q

Promethazine indications

A

Nausea & vomiting
Motion sickness
Symptomatic rash / moderate allergic reaction

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22
Q

Teneteplase times

A

onset 15min
duration several hours
1/2 life 2 hours

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23
Q

Promethazine precautions

A

Co-comitant use of promethiazines
History of dystonia
May potentials the effects of ETOH

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24
Q

Promethazine side effects

A

Dry mouth
Hypotension
Dizziness
Sedation

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25
Q

Promethazine presentation

A

50mg: 2ml

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26
Q

Promethazine time onset

A

Onset 3-5mina
Duration 6-12 hours
1/2 life 7-14 hours

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27
Q

Promethazine dose

Adult

A

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

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28
Q

Ondansetron metabolism

A

Majority metabolized by liver excreted kidneys

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29
Q

Ondansetron pharmacology

A

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 .

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30
Q

Ondansetron contraindications

A

kSAR to ondamsetron or 5HT3 receptors

Patients < 3 yo

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31
Q

Ondansetron indications

A

Nausea & vomiting

Prophylactic use in patients who has previously experienced nausea and or vomiting with narcotics

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32
Q

Ondansetron side effects

A 
Headache 
Constipation
Sensation warmth and flushing
Extra pyramidal effects 
Dysrrhythmias
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33
Q

Ondansetron presentation

A

4mg: 2ml Zofran

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34
Q

Ondansetron onset times

A

Onset : 5 minutes
Duration : several hours
1/2 life : 3-4 hours

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35
Q

Ondansetron dose

Adult

A

IMI and IVI

4 mg : 2ml max dose

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36
Q

Midazolam pharmacology

A

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

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37
Q

Ondansetron complications

A

Hepatic impairment

Intestinal obstruction

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38
Q

Midazolam indications

A

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

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39
Q

Midazolam contraindications

A

KSAR to benzodiazepine s

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40
Q

Midazolam precautions

A

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

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41
Q

Midazolam side effects

A

Hypotension

Respiratory depression particularly when associated with etoh & narcotics

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42
Q

Midazolam presentation

A

5mg:1ml

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43
Q

Midazolam times onset

A

Onset : 5-15 min IM
Onset : 1-3 min IV
Duration : variable
1/2 life : 2.5hours

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44
Q

Midazolam dosages

Adults seizures

A

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

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45
Q

Midazolam Dose

Adult Maintain ETT

A

IVI 1- 2.5mg rep PRN consider administration of narcotics no MAX dose

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46
Q

Midazolam Dose

Sedation agitated head injury requier assessment and treatment

A

IVI & IO 1-2.5mg rep at 5 min @ 1-2mg no MAX dose

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47
Q

Midazolam Dose

Sedation for procedure (TCP & sync cardioversion)

A

1mg every 2 min no MAX dose

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48
Q

Midazolam dose

for disinhibtion or emergence following ketamine administration

A

IVI 1-2.5mg PRN MAX 5mg

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49
Q

Midazolam dose

Severely agitated patient

A

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

50
Q

Midazolam dose
Pt with trauma requiring reduction, splinting or extrication who are distressed and agitated despite narcotic analgesia
Pt with burns

A

IVI 1-2mg total max dose 2mg

51
Q

Calcium Gluconate presentation

A

10% 0.953g :10ml

52
Q

Calcium Gluconate 10% Pharamcology

A

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.

53
Q

Midazolam metabolism

A

By the liver excreted by kidneys

54
Q

Benztropine contraindications

A

KSAR
Tardive dyskinesia
Children < 3 years

55
Q

Calcium Gluconate 10% Metabolism

A

calcium is filtered by the renal glomeruli and reabsorbed, the remainder is excreted in faeces.

56
Q

Calcium Gluconate 10% indications

A

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)

57
Q

Calcium Gluconate 10% contraindications

A 
KSAR
Digoxin (digitalis) overdose
58
Q

Tenecteplase Contraindications

A

identical to those listed in the CAR checklist

59
Q

Calcium Gluconate 10% Precautions

A

Respiratory acidosis

60
Q

Calcium Gluconate 10% side effects

A 
Suspected hyperkalaemic ccardiac arrest 
NIL
All other QAS indications 
bradycardia
cardiac dysrrhythmias 
hypotension 
Syncope 
cardiac arrest
61
Q

Calcium Gluconate 10% time of onset

A

onset - 1-3 min
Duration 30-60 minutes ( in hyperkalaemia)
1/2 life nil applicable

62
Q

Calcium Gluconate 10% dose

ADULT

A

IV & IO 10ml slow push over 2-5 minutes rep once at 10 minutes

63
Q

Clopidogrel Pharmacology

A

specific and potent platelet aggregation inhibitor, it selectively inhibits the binding of adenosine diphosphate (ADP) to its platelet receptors, thereby inhibiting platelet aggregation.

64
Q

Clopidogrel metabolism

A

hepatic metabolism with near equal amounts excreted in faeces and urine

65
Q

Clopidogrel indications

A

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)

66
Q

Clopidogrel Contraindications

A

KSAR
pts < 18 years
pts currently taking clopidogrel
Identical to the CAR checklist unless otherwise specifically authorized under LWI

67
Q

Clopidogrel Precautions

A

Sever renal impairment

68
Q

Clopdogrel Side effects

A 
Haemorrhage
Headache / dizziness
Stomach upset and or pain
Constipation 
Diarrhoea
69
Q

Clopidogrel onset times

A

Onset : 30 min
Duration : 7- 10 days
1/2 life: 8 hours

70
Q

Clopidogrel Dose

A

PCI - 600mg (8tabs)

Fibrinolysis - 300mg (6tabs) (lower dose due to increase risk of haemorrhage)

71
Q

Clopidogrel Presentation

A

75mg pink tablet ISCOVER

72
Q

Enoxaparin pharmacology

A

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.

73
Q

Enoxaparin Metabolism

A

metabolised by the liver but mostly excreted unchanged

74
Q

Enoxaparin Indications

A

Pts with STEMI as defined by the QAS CAR checklist who will receive QAS Fibrinolytic therapy as an adjunct therapy to aspirin, clopidogrel, tenectaplase.

75
Q

Enoxaparin Contraindications

A

KSAR to enoxaparin or heparin

Identical to those listed in the QAS CAR checklist, unless otherwise sepcifically authorised under relevant LWI.

76
Q

Enoxaparin Precautions

A 
renal hepatic impairment
history of GI ulcerations
Diabetic retinopathy
low body weight (women < 57 kg)
Elderly 
Pregnancy and lactating women
77
Q

Enoxaparin side effects

A

thombocytopenia

Haemorrhage

78
Q

Enoxaparin presentation

A

IV 40mg:0.4ml

SC 100mg :1ml weight adjusted dose

79
Q

Enoxaparin dose

ADULT

A

Loading dose 30mg followed 15 minutes later by

Maintenance dose 1mg/kg max 100mg

80
Q

Heparin pharmacology

A

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.

81
Q

Heparin metabolism

A

metabolised via biotransformation in the liver and reticulo-endothelial system. metabolites are excreted in urine.

82
Q

Heparin Indications

A

for patients with STEMI as defined by the QAS CAR checklist and LWI and who have been accepted for PCI

83
Q

Heparin contraindication

A

KSAR

identical to those listed in CAR checklist unless specifically authorised under the LWI

84
Q

Heparin Complications

A

Renal impairment

85
Q

Heparin Side effects

A

Thrombocytopenia

Haemorrhage

86
Q

Heparin Presentation

A

5000 units in 5 ml

87
Q

Heparin time onset

A

Onset : 30 seconds
Duration : 3-6 hours
1/2 life: 1.5 hours

88
Q

Heparin Dose

ADULT

A

IV - single dose only 5000 units

89
Q

Hydrocortisone Pharmacology

A

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

90
Q

Hydrocortisone Metabolism

A

Hepatic

91
Q

Hydrocortisone Indications

A

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

92
Q

Hydrocortisone Contraindications

A

KSAR

93
Q

Hydrocortisone Precautions

A

Hypertension

94
Q

Hydrocotisone Side effects

A

NIL

95
Q

Hydrocortisone presentation

A

100mg powder - to be dissolved with 2ml WFI

96
Q

Hydrocortisone dose

ADULT

A 
asthma, COPD, allergic reaction/anaphylaxsis 
200mg single dose only 
Symptomatic adrenal insuffciency 
100mg single dose only 
QAS management plan
AS list on plan
97
Q

Ibatropium Bromide Pharmacology

A

anti-cholinergic (antimuscarinic) agent which promotes bronchodilation through inhibition of cholinergic bronchomotor tone

98
Q

Ipratropium bromide metabolism

A

hepatic and excretion by the kidneys

99
Q

Ipratropium bromide indications

A

moderate to sever asthma

100
Q

Ipratropium bromide contraindications

A

KSAR

pt < 2 yo

101
Q

Ipratropium bromide precautions

A

glucoma

prostatic hypertrophy

102
Q

Ipratropium bromide side effects

A

dilated pupils
dry mouth
palpitations

103
Q

Ipratropium bromide presentations

A

250mcg: 1ml

104
Q

Ipratropium bromide dose

ADULT

A

500mcg single dose only

105
Q

Ketamine pharmacology

A

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

106
Q

Ketamine metabolism

A

exstensive hepatic metabolism with approx 90% of the drug excreted in the urine as metabolites

107
Q

Ketamine indications

A

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

108
Q

Ketamine contraindication

A 
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
109
Q

Ketamine precaution

A

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

110
Q

Ketamine side effects

A 
disinhibition 
dissociated state
depression of consciousness
hypersalivation 
hypertension 
hypertonicity (clonus) nystagmus
nausea & vomiting 
respiratory depression (rare)
laryngospasm 
emergence
111
Q

Ketamine presentation

A

200mg;2ml ketalar

112
Q

hydrocortisone onset

A

onset 1-2hr
durations 6-12hr
1/2 life 6-8 hrs

113
Q

Ketamine dose

A

10-20mg rep 2-3 min MAX 1mg/kg

114
Q

Enoxaparin onset

A

immediate peak 3hr
12-24 hours
4.4 hr for 40mg

119
Q

Tenecteplase pharmacology

A

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.

120
Q

Tenecteplase Metabolism

A

Hepatic

121
Q

ketamine onset

A

onset 30sec
duration 5-20min
1/2life 10-15 min

122
Q

Tenecteplase Precautions

A

NIL

123
Q

Tenecteplase Side effects

A

haemorrhage
headache
reperfusion arrhythmia
Nausea and vomiting

124
Q

Tenecteplase presentation

A

50mg in powder form with solvent -10000 IU graduated syringe weight adjusted dose

125
Q

Tenecteplase Indications

A

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

ICP Dtps (1 decks)

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