Emergency Drugs Flashcards
What dose of adrenaline would you give an adult for cardiac arrest?
1mg every 3-5mins as required. Usually as 100micrograms/mL solution.
How is adrenaline administered for adult with cardiac arrest?
Slow IV injection
What dose of adrenaline would you give an adult with acute anaphylaxis?
500 micrograms using 1 in 1000 injection (1mg/mL injection). Repeat after 5 mins if no response.
Where is adrenaline injected for acute anaphylaxis?
Anterolateral aspect of middle third of the thigh
How is adrenaline for acute anaphylaxis administered?
IM injection
How is hydrocortisone administered for adult with thyroid storm? What dose?
IV injection. 100mg every 6 hrs.
How is hydrocortisone administered for adult with adrenal insufficiency after septic shock? What dose?
IV injection. 50mg every 6 hrs. With fludrocortisone.
Hydrocortisone can be given in acute hypersensitivity reactions, including as an adjunct to adrenaline. How is it given, and at what dose?
IV injection. 100-300mg
A patient is undergoing minor surgery with GA. She usually takes 20mg (so, over 10mg) prednisolone each day. What dose would you give and how would you administer this dose?
Dose - 25-50mg.
Administration - IV injection or IV infusion, at induction of surgery.
How would you treat adrenal crisis? Give dose and administration route.
With hydrocortisone.
IV injection.
100mg as initial dose. Then 200mg hydrocortisone every 24hrs diluted in 5% glucose (by continuous IV infusion).
In severe acute or life threatening acute asthma attacks, how is hydrocortisone administered? What dose?
IV injection.
100mg every 6hours until can convert to oral prednisolone
How can chlorphenamine be administered as emergency treatment of anaphylactic reactions?
IM injection or IV injection
What dose of chlorphenamine would you prescribe for emergency treatment of anaphylactic reactions?
10mg IV / IM - max 4 times a day
What drug might you prescribe for post - MI bradycardia?
Give name, route and dose.
Atropine, IV, 500 micrograms
What dose and administration route of atropine would you give for post-MI bradycardia?
500micrograms every 3-5mins. Up to 3mg per course.
IV injection
How would you treat STEMI, NSTEMI? Give name of drug, dose and administration
Aspirin
300mg
By mouth - chewed or dispersed in water
What is the usual route of administration of clopidogrel?
By mouth/oral
What dose of clopidogrel is given to patients experiencing TIA or acute ischaemic stroke with hypersensitivity to aspirin?
75mg once daily
What dose of clopidogrel is given to patients (who don’t already take it) alongside aspirin for percutaneous coronary intervention?
Loading dose 300mg before procedure.
A pt has had an MI within 35 days. Another pt has had a stroke within the last 6 months. The third patient you see has peripheral arterial disease. What dose of clopidogrel is commonly given to all these groups of patients?
75mg once daily
What dose of clopidogrel is given for prevention of atherothrombotic events in ACS WITHOUT ST elevation (given with aspirin)?
Initially 300mg then 75mg once daily up to 12 months
What dose of clopidogrel is given for prevention of atherothrombotic events in ACS WITH ST elevation (given with aspirin)?
Initially 300mg then 75mg od for at least 4 weeks.
If over 76+ = 75mg od for at least 4 weeks
What dose of clopidogrel would you prescribe for pt with AFib ? Note: for this pt, warfarin is unsuitable
75mg once daily
How is calcium gluconate administered for severe acute hypocalcaemia?
Slow IV injection
What dose of calcium gluconate would you prescribe for severe acute hypocalcaemia ?
Initially: 10-20ml calcium gluconate 10% - administered with plasma-calcium and ECG monitoring.
Then repeated as required or followed as a continuous Iv infusion to prevent acute hypocalcaemia again.
What dose and administration route would you suggest for calcium gluconate to treat acute severe hyperkalaemia ?
Dose: 30ml Calcium gluconate 10%. Single dose.
Admin route: Slow IV infusion
Insulin infusion dose for DKA?
0.1 units /kg/hour
What to give adults with symptoms of hypoglycaemia who have a blood-glucose concentration greater than 4 mmol/litre?
Small carb snack e.g. slice of bread
What do you give to pt with blood glucose less than 4 mmol/litre who is conscious and able to swallow?
Fast-acting carbohydrate by mouth. Fast-acting carbohydrates include Lift® glucose liquid (previously Glucojuice®), glucose tablets, glucose 40% gels (e.g. Glucogel®, Dextrogel®, or Rapilose®), pure fruit juice, and sugar (sucrose) dissolved in an appropriate volume of water.
Diazepam dose for status epilepticus, Febrile convulsions, Convulsions due to poisoning?
IV 10 mg, then 10 mg after 10 minutes if required, administered at a rate of 1 mL (5 mg) per minute.
PR:
For Adult
10–20 mg, then 10–20 mg after 10–15 minutes if required.
For Elderly
10 mg, then 10 mg after 10–15 minutes if required.
Diazepam dose for Acute anxiety and agitation
PR
For Adult
500 micrograms/kg, then 500 micrograms/kg after 12 hours as required.
For Elderly
250 micrograms/kg, then 250 micrograms/kg after 12 hours as required.
Diazepam dose for Severe acute anxiety,
Control of acute panic attacks,
Acute alcohol withdrawal
IM or slow IV
For Adult
10 mg, then 10 mg after at least 4 hours if required, intravenous injection to be administered into a large vein, at a rate of not more than 5 mg/minute.
Lorazepam dose for Acute panic attacks
intramuscular injection, or by slow intravenous injection
For Adult
25–30 micrograms/kg every 6 hours if required; usual dose 1.5–2.5 mg every 6 hours if required, intravenous injection to be administered into a large vein, only use intramuscular route when oral and intravenous routes not possible.
Lorazepam dose for Status epilepticus,
Febrile convulsions,
Convulsions caused by poisoning
By slow intravenous injection
For Adult
4 mg for 1 dose, then 4 mg after 10 minutes if required for 1 dose, to be administered into a large vein.
Nebulised salbutamol dose for Moderate, severe, or life-threatening acute asthma
For Adult
5 mg, repeat every 20–30 minutes or when required, give via oxygen-driven nebuliser if available.
Dose and frequency of Nebulised salbutamol for exacerbations? (reliever)
2.5–5 mg, repeated up to 4 times daily or more frequently in severe cases.
Prednisolone for Mild to moderate acute asthma,
Severe or life-threatening acute asthma
For Adult
40–50 mg daily for at least 5 days.
Morphine is used for acute pain.
Dose, route, frequency?.
5mg, Slow IV injection, every 4 hours.
10mg, Oral, SC or IM, every 4 hours. Or 5mg in elderly in this route
Naloxone is used for acute opioid overdose.
What is route, dose scheme and frequency?
Route: IV or IM
Dose: 400mg —> 800mg for up to two doses at 1 min intervals —> 2mg for 1 dose —> review diagnosis
—> = what to do if no response to that dose.
Resuscitation fluids for adults:
What is used?
Volume?
Over what time period?
Max volume you can resus with?
What to do after each bolus is given?
What is used?
- saline or hartmann’s
Volume?
- 500ml (or 250ml in elderly)
Over what time period?
- over 15 mins
Max volume you can resus with?
- can continue this until 2L is reached. After this need to get inotropic support.
What to do after each bolus is given?
- reassess
Maintenance fluids for adults:
?ml/kg/day
Na/K = ?mmol/kg/day
Glucose = ?g/day
25-30ml/kg/day
Na/K = 1mmol/kg/day
Glucose = 50-100g/day
What concentration does potassium come in?
When to prescribe alongside fluids?
20mmol and 40mmol bags - need to be prescribed separately
Need to be prescribed to replace acid and bicarb in D&V
Paediatric fluids:
1) Resus fluids - what is the vol/kg?
2) Maintenance fluids - what fluids to use?
3) Explain the Holliday Segar method of prescribing fluids in paediatrics (4-2-1 rule)?
1) 20ml/kg or 10ml/kg in less than 15 mins (10ml usually used in trauma setting)
2) 0.45% saline +/- 5% glucose
3) First 10kg = 4ml/kg/hr. Second 10kg of that child’s body weight = 2ml/kg/hour. Thereafter, every kg left = 1ml/kg/hr
