Emergency Drugs

Question 1

What dose of adrenaline would you give an adult for cardiac arrest?

Answer 1

1mg every 3-5mins as required. Usually as 100micrograms/mL solution.

Question 2

How is adrenaline administered for adult with cardiac arrest?

Answer 2

Slow IV injection

Question 3

What dose of adrenaline would you give an adult with acute anaphylaxis?

Answer 3

500 micrograms using 1 in 1000 injection (1mg/mL injection). Repeat after 5 mins if no response.

Question 4

Where is adrenaline injected for acute anaphylaxis?

Answer 4

Anterolateral aspect of middle third of the thigh

Question 5

How is adrenaline for acute anaphylaxis administered?

Answer 5

IM injection

Question 6

How is hydrocortisone administered for adult with thyroid storm? What dose?

Answer 6

IV injection. 100mg every 6 hrs.

Question 7

How is hydrocortisone administered for adult with adrenal insufficiency after septic shock? What dose?

Answer 7

IV injection. 50mg every 6 hrs. With fludrocortisone.

Question 8

Hydrocortisone can be given in acute hypersensitivity reactions, including as an adjunct to adrenaline. How is it given, and at what dose?

Answer 8

IV injection. 100-300mg

Question 9

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?

Answer 9

Dose - 25-50mg.
Administration - IV injection or IV infusion, at induction of surgery.

Question 10

How would you treat adrenal crisis? Give dose and administration route.

Answer 10

With hydrocortisone.
IV injection.
100mg as initial dose. Then 200mg hydrocortisone every 24hrs diluted in 5% glucose (by continuous IV infusion).

Question 11

In severe acute or life threatening acute asthma attacks, how is hydrocortisone administered? What dose?

Answer 11

IV injection.
100mg every 6hours until can convert to oral prednisolone

Question 12

How can chlorphenamine be administered as emergency treatment of anaphylactic reactions?

Answer 12

IM injection or IV injection

Question 13

What dose of chlorphenamine would you prescribe for emergency treatment of anaphylactic reactions?

Answer 13

10mg IV / IM - max 4 times a day

Question 14

What drug might you prescribe for post - MI bradycardia?
Give name, route and dose.

Answer 14

Atropine, IV, 500 micrograms

Question 15

What dose and administration route of atropine would you give for post-MI bradycardia?

Answer 15

500micrograms every 3-5mins. Up to 3mg per course.
IV injection

Question 16

How would you treat STEMI, NSTEMI? Give name of drug, dose and administration

Answer 16

Aspirin
300mg
By mouth - chewed or dispersed in water

Question 17

What is the usual route of administration of clopidogrel?

Answer 17

By mouth/oral

Question 18

What dose of clopidogrel is given to patients experiencing TIA or acute ischaemic stroke with hypersensitivity to aspirin?

Answer 18

75mg once daily

Question 19

What dose of clopidogrel is given to patients (who don’t already take it) alongside aspirin for percutaneous coronary intervention?

Answer 19

Loading dose 300mg before procedure.

Question 20

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?

Answer 20

75mg once daily

Question 21

What dose of clopidogrel is given for prevention of atherothrombotic events in ACS WITHOUT ST elevation (given with aspirin)?

Answer 21

Initially 300mg then 75mg once daily up to 12 months

Question 22

What dose of clopidogrel is given for prevention of atherothrombotic events in ACS WITH ST elevation (given with aspirin)?

Answer 22

Initially 300mg then 75mg od for at least 4 weeks.
If over 76+ = 75mg od for at least 4 weeks

Question 23

What dose of clopidogrel would you prescribe for pt with AFib ? Note: for this pt, warfarin is unsuitable

Answer 23

75mg once daily

Question 24

How is calcium gluconate administered for severe acute hypocalcaemia?

Answer 24

Slow IV injection

Question 25

What dose of calcium gluconate would you prescribe for severe acute hypocalcaemia ?

Answer 25

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.

Question 26

What dose and administration route would you suggest for calcium gluconate to treat acute severe hyperkalaemia ?

Answer 26

Dose: 30ml Calcium gluconate 10%. Single dose.
Admin route: Slow IV infusion

Question 27

Insulin infusion dose for DKA?

Answer 27

0.1 units /kg/hour

Question 28

What to give adults with symptoms of hypoglycaemia who have a blood-glucose concentration greater than 4 mmol/litre?

Answer 28

Small carb snack e.g. slice of bread

Question 29

What do you give to pt with blood glucose less than 4 mmol/litre who is conscious and able to swallow?

Answer 29

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.

Question 30

Diazepam dose for status epilepticus, Febrile convulsions, Convulsions due to poisoning?

Answer 30

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.

Question 31

Diazepam dose for Acute anxiety and agitation

Answer 31

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.

Question 32

Diazepam dose for Severe acute anxiety,
Control of acute panic attacks,
Acute alcohol withdrawal

Answer 32

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.

Question 33

Lorazepam dose for Acute panic attacks

Answer 33

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.

Question 34

Lorazepam dose for Status epilepticus,
Febrile convulsions,
Convulsions caused by poisoning

Answer 34

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.

Question 35

Nebulised salbutamol dose for Moderate, severe, or life-threatening acute asthma

Answer 35

For Adult
5 mg, repeat every 20–30 minutes or when required, give via oxygen-driven nebuliser if available.

Question 36

Dose and frequency of Nebulised salbutamol for exacerbations? (reliever)

Answer 36

2.5–5 mg, repeated up to 4 times daily or more frequently in severe cases.

Question 37

Prednisolone for Mild to moderate acute asthma,
Severe or life-threatening acute asthma

Answer 37

For Adult
40–50 mg daily for at least 5 days.

Question 38

Morphine is used for acute pain.
Dose, route, frequency?.

Answer 38

5mg, Slow IV injection, every 4 hours.
10mg, Oral, SC or IM, every 4 hours. Or 5mg in elderly in this route

Question 39

Naloxone is used for acute opioid overdose.
What is route, dose scheme and frequency?

Answer 39

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.

Question 40

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?

Answer 40

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

Question 41

Maintenance fluids for adults:
?ml/kg/day
Na/K = ?mmol/kg/day
Glucose = ?g/day

Answer 41

25-30ml/kg/day
Na/K = 1mmol/kg/day
Glucose = 50-100g/day

Question 42

What concentration does potassium come in?
When to prescribe alongside fluids?

Answer 42

20mmol and 40mmol bags - need to be prescribed separately

Need to be prescribed to replace acid and bicarb in D&V

Question 43

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)?

Answer 43

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