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MSRA Content > EMERGENCY DRUGS > Flashcards

EMERGENCY DRUGS Flashcards

1
Q

Drugs used in cardiac arrest?

A

Adrenaline IV

Amiodarone IV

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2
Q

Prescription of adrenaline in cardiac arrest?

A

 In cardiac arrest (pre-filled syringe 1:10,000, 1mg in 10mL)
• If shockable, adrenaline 1mg IV given after 3rd shock and repeated every 3-5 minutes
• If not shockable, adrenaline 1mg IV ASAP and repeated every 3-5 minutes

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3
Q

Mechanism of adrenaline in cardiac arrest?

A

 Potent agonist of A1, A2, B1, B2 adrenoreceptors
 Fight or flight sympathetic actions:
• Alpha-1 – Vasoconstriction
• Beta-1 - Tachycardia, inotropy, myocardial excitability
• Beta- 2 - Vasodilation of vessels in heart and muscles
• Bronchodilation and suppression of inflammatory mediators from mast cells

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4
Q

Side Effects of adrenaline in cardiac arrest?

A

 Hypertension
 Anxiety, tremor, headache, palpitations
 Angina, MI and arrhythmias

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5
Q

Contraindications of adrenaline in cardiac arrest?

A

 LA with adrenaline to areas supplied by end-artery (fingers, toes, penis) - tissue necrosis due to vasoconstriction

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6
Q

Dose of amiodarone in cardiac arrest?

A

 In cardiac arrest, given after 3rd shock
• 300mg IV, followed by 20ml of 0.9% NaCl flush
 Consider a further 150mg IV after 5 shocks

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7
Q

Mechanism of amiodarone in cardiac arrest?

A

 Block of Na, Ca and K channels
 Antagonist of α- and β-adrenergic receptors
 Reduce spontaneous depolarisation, slow conduction velocity, and increase resistance to depolarisation, including in the AV node

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8
Q

Side Effects of amiodarone in cardiac arrest?

A

 Hypotension during IV infusion
 Chronic – pneumonitis, bradycardia, AV block, photosensitivity, grey discolouration and thyroid abnormalities
 Long half-life and takes months to be eliminated

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9
Q

Dose of oxygen in acute pulmonary oedema?

A

 15L/min via non-rebreathe mask if severe

 If needed, CPAP, BiPAP and intubation

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10
Q

Mechanism of oxygen in acute pulmonary oedema?

A

 Increase PO2 in alveolar gas, driving more rapid diffusion into blood

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11
Q

Side Effects of oxygen in acute pulmonary oedema?

A

 Discomfort of face mask

 Dry mouth

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12
Q

Dose of furosemide in acute pulmonary oedema?

A

 IV 40-80mg furosemide slowly initially

 Subsequent boluses, IV infusion or maintenance may be needed

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13
Q

Mechanism of furosemide in acute pulmonary oedema?

A

 Act on ascending limb of loop of Henley
• Inhibit the Na+/K+/2Cl−co-transporter
• Responsible for ions transport from lumen into epithelial cells, water then follows
• Inhibition has diuretic effect
 Dilatation of capacitance veins
• Reduce preload and improve contractile function of heart muscle

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14
Q

Side Effects of furosemide in acute pulmonary oedema?

A

 Dehydration and hypotension
 Low electrolyte state – Urinary excretion of Na, Cl and K and increase excretion of Mg, Ca and H ions
 Hearing loss and tinnitus

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15
Q

Dose of nitrates in acute pulmonary oedema?

A

 Glyceryl trinitrate (2-5mg buccal) if BP>90 systolic
 Glyceryl trinitrate IV 50 mg in 50 ml 0.9% sodium chloride at 2 ml/hour, titrating up to 20 ml/hr, maintaining BP > 90 systolic

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16
Q

Mechanism of nitrates in acute pulmonary oedema?

A

 Converted to NO which increases cGMP synthesis and reduced intracellular Ca2+ in vascular smooth muscle cells causing relaxation
 Venous and arterial vasodilatation
 Relaxation of venous capacitance veins
• Reduce preload and LV filling
• Reduce cardiac work and myocardial oxygen demand

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17
Q

Side effects of nitrates in acute pulmonary oedema?

A

 Flushing, headaches, light-headedness and hypotension

 Tolerance with sustained use – nitrate free period overnight to minimise

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18
Q

Contraindications of nitrates in acute pulmonary oedema?

A

 Avoid in phosphodiesterase inhibitors – hypotension

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19
Q

Dose of morphine in acute pulmonary oedema?

A

 Diamorphine 2.5-5mg, at 1mg/minute IV slowly

 Morphine 5-10mg (lower in elderly), at 2mg/minute

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20
Q

Mechanism of morphine in acute pulmonary oedema?

A

 Relieves breathlessness alongside oxygen, furosemide and nitrates
• Blunt medullary response to hypoxia and hypercapnia to reduce respiratory drive and breathlessness
 Activation of opioid u receptors in CNS to reduce neuronal excitability and pain transmission
 Reduce sympathetic nervous system
• Reduce cardiac work and oxygen demand

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21
Q

Side effects of morphine in acute pulmonary oedema?

A 
	Respiratory depression
	Euphoria and detachment
	Nausea and vomiting
	Pupillary constriction
	Constipation
•	Increased smooth muscle tone and reduced motility
	Itching, urticaria and sweating
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22
Q

Contraindications of morphine in acute pulmonary oedema?

A

 Dose reduction – hepatic failure, renal impairment and elderly
 Avoid in biliary colic – spasm of sphincter of Oddi

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23
Q

Does of oxygen in acute severe asthma?

A

 15L/min via non-rebreathe mask

 Maintain oxygen saturations 92-96%

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24
Q

Mechanism of oxygen in acute severe asthma?

A

 15L/min via non-rebreathe mask if severe

 If needed, CPAP, BiPAP and intubation

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25
Q

Side effects of oxygen in acute severe asthma?

A

 Discomfort of face mask

 Dry mouth

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26
Q

Dose of nebulised salbutamol in acute severe asthma?

A

 5mg every 15-20 minutes if not helping, or back-to-back

 Can combine with ipratropium bromide 500mcg

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27
Q

Mechanism of nebulised salbutamol in acute severe asthma?

A

 Stimulation of GPCR leads to smooth muscle relaxation
• Improves airflow in airways
 Stimulate Na/K/ATPase pumps on cell surface membranes
• Shift of K into cells
• Useful in hyperkalaemia

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28
Q

Side effects of nebulised salbutamol in acute severe asthma?

A

 Tachycardia, palpitations, anxiety, tremor

 Increase glucose levels

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29
Q

Dose of ipratropium in acute severe asthma?

A

 500mcg nebulised every 4-6 hours if needed

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30
Q

Mechanism of ipratropium in acute severe asthma?

A

 Competitively inhibit acetylcholine
• Increase HR and conduction
• Reduce smooth muscle tone
• Reduce secretions

31
Q

Dose of hydrocortisone in acute severe asthma/COPD?

A

 Asthma
• IV 100mg every 6 hours until conversion to oral prednisolone
• Or oral prednisolone 40mg OD if not too severe
 COPD
• IV 200mg

32
Q

Mechanism of hydrocortisone in acute severe asthma?

A

 Upregulate anti-inflammatory genes and downregulate pro-inflammatory genes
 Glucocorticoid effects
• Supress circulating monocytes and eosinophils
• Gluconeogenesis from fatty acids
 Mineralocorticoid effects
• Stimulate Na and water retention and K excretion in renal tubule

33
Q

Dose of aminophylline in acute severe asthma?

A

Slow IV injection

Child - 5 mg/kg (max. per dose 500 mg)

Adult - 250–500 mg (max. per dose 5 mg/kg)

Followed by IVI

34
Q

Dose of magnesium sulphate in acute severe asthma?

A

o Given IV in severe acute asthma
o Sometimes in polymorphic VT
o Adult - 1.2g-2g over 20 minutes
o Child 2-17 – 40mg/kg over 20 minutes (max 2g)

35
Q

Drugs given in anaphylaxis?

A 
Oxygen
Adrenaline
IV fluids
Chlorphenamine
Hydrocortisone
36
Q

Dose of adrenaline given in anaphylactic shock?

A

 In anaphylaxis (0.5ml of 1:1000, 1mg in 1ml IM into anterolateral thigh)
• Adults or child >12 years - 500mcg IM (0.5ml)
• Child 6-12 years – 300mcg (0.3ml)
• Child <6 years – 150mcg (0.15ml)
 Repeat every 5 minutes if needed

37
Q

Mechanism of adrenaline given in anaphylactic shock?

A

 Potent agonist of A1, A2, B1, B2 adrenoreceptors
 Fight or flight sympathetic actions:
• Alpha-1 – Vasoconstriction
• Beta-1 - Tachycardia, inotropy, myocardial excitability
• Beta- 2 - Vasodilation of vessels in heart and muscles
• Bronchodilation and suppression of inflammatory mediators from mast cells

38
Q

Side effects of adrenaline given in anaphylactic shock?

A

 Hypertension
 Anxiety, tremor, headache, palpitations
 Angina, MI and arrhythmias

39
Q

Dose of IV fluids given in anaphylactic shock?

A

o 500-1000mls IV 0.9% NaCl

40
Q

Dose of chlorphenamine in anaphylactic shock?

A 
	IV slowly/IM
•	Adult or child > 12 years - 10 mg
•	Child 6 - 12 years 5 mg
•	Child 6 months to 6 years 2.5 mg
•	Child less than 6 months 250 micrograms/kg
41
Q

Mechanism of chlorphenamine in anaphylactic shock?

A

 Antagonist of H1 receptors
 Histamine released from mast cells as a result of binding to IgE on cell surface
 H1 increases capillary permeability, oedema (wheal), vasodilation (flare) and itch

42
Q

Side effects of chlorphenamine in anaphylactic shock?

A

 Sedation

43
Q

Contraindications of chlorphenamine in anaphylactic shock?

A

 Severe liver disease – precipitate hepatic encephalopathy

44
Q

Dose of hydrocortisone in anaphylactic shock?

A 
	Anaphylaxis (IM or slow IV)
•	Adult or child > 12 years - 200 mg
•	Child 6 - 12 years - 100 mg 
•	Child 6 months to 6 years - 50 mg
•	Child less than 6 months - 25 mg
45
Q

Mechanism of hydrocortisone in anaphylactic shock?

A

 Upregulate anti-inflammatory genes and downregulate pro-inflammatory genes
 Glucocorticoid effects
• Supress circulating monocytes and eosinophils
• Gluconeogenesis from fatty acids
 Mineralocorticoid effects
• Stimulate Na and water retention and K excretion in renal tubule

46
Q

Drug given in benzodiazepine overdose?

A
  • Flumazenil
47
Q

Dose of flumazenil in benzodiazepine overdose?

A

 Flumazenil IV 200-300ug over 15s, then 100ug at 60s intervals
 Needs expert advice before given

48
Q

Mechanism of flumazenil in benzodiazepine overdose?

A

 Benzodiazepine antagonist

• Reverses CNS depression

49
Q

Side effects of flumazenil in benzodiazepine overdose?

A

 Risk of provoking seizures

50
Q

Drugs given in hypoglycaemia?

A

Glucose

Glucogon

51
Q

Mild hypoglycaemia treatment?

A

o 10-20g oral fast-acting carbohydrate (GlucoGel, Lucozade, sugar lumps)
 Repeat if necessary
o If fixes then carbohydrate snack

52
Q

Severe hypoglycaemia treatment?

A

 Glucagon
• 1mg SC/IM (not suitable for alcoholics)
• Given is IV access not available or at home
 Glucose
• 10g IV infusion as Glucose 20% in large vein (75-80mls)
• Then oral glucose once patient recovers consciousness

53
Q

Dose of IV fluids in hypovolaemic shock?

A

9% saline 500mls over 5-15 minutes

 Repeated up to 2L then expert help needed

54
Q

Drug given in opioid intoxication?

A

Naloxone IV or IM

55
Q

Dose of naloxone given in opioid overdose?

A

 IV injection
• Initial 400mcg
• 800mcg for up to 2 doses at 1-minute intervals if no response
• Increased to 2mg for 1 dose if still no response
 Can be given SC or IM if IV route not feasible but IV has more rapid onset

56
Q

Mechanism of naloxone given in opioid overdose?

A

 Competitive antagonist to opioid receptors and reverses the effect of opioids

57
Q

Side Effects of naloxone given in opioid overdose?

A

 Opioid withdrawal – pain, restlessness, nausea and vomiting, dilated pupils, cold/dry skins

58
Q

Drugs given in seizures?

A

Lorazepam/Diazepam/Midazolam

Phenytoin

59
Q

Dose of lorazepam in seizures?

A

 Given after 5 minutes, 1-2mg Lorazepam IV slow bolus up to 4mg
• Repeat if necessary after 5 minutes

60
Q

Mechanism of lorazepam in seizures?

A

 GABA is chloride channel and main inhibitory neurotransmitter in brain
 Facilitate and enhance binding of GABA to GABAa receptor
• More resistant to depolarisation

61
Q

Side effects of lorazepam in seizures?

A

 Drowsiness, sedation

 Loss of airway reflexes

62
Q

Dose and route of diazepam in seizures?

A

0.2-0.5mg/kg (maximum 20mg/dose) rectally as single dose

 Or 10mg IV

63
Q

Dose and route of midazolam in seizures?

A

 Buccal in community

 IM 10mg single dose if >40kg, 5mg if <40kg

64
Q

Dose of phenytoin in seizures?

A

 20mg/kg (maximum 2g/dose) IV as single dose

 Maintenance 100mg 6-8 hourly

65
Q

Mechanism of phenytoin in seizures?

A

 Reduces neuronal excitability and electrical conductance

• Potential Na channels binding, prolonging inactivity

66
Q

When and what drugs given in hyperkalaemia?

A
  • Immediate treatment if K>6 with ECG changes or K>6.5
  • Calcium gluconate or calcium chloride (IV)
  • Insulin-glucose solution (IV)
  • Salbutamol (nebs)
  • Calcium resonium (oral or PR)
67
Q

Dose of calcium gluconate or calcium chloride in hyperkalaemia?

A

 10% Calcium gluconate 10ml IV via large vein over 5-10mins (up to 30ml)
 10% Calcium chloride 10ml over 5-10 mins
 Repeat dose after 5-10 minutes if no improvement in ECG

68
Q

Mechanism of calcium gluconate or calcium chloride in hyperkalaemia?

A

 Raises myocardial threshold potential
• Reduces excitability and risk of arrhythmias
• Protect cardiac membrane

69
Q

Dose of insulin-glucose solution in hyperkalaemia?

A

 10 units soluble insulin in 50ml 50% glucose over 5-15 minutes

70
Q

Mechanism of insulin-glucose solution in hyperkalaemia?

A

 Drives K into cells, reducing serum concentrations

• Once stopped, K leaks back out of cells and only short-term measure

71
Q

Dose of salbutamol nebs in hyperkalaemia?

A

 10-20mg nebulised (5mg back-to-back) over 10-20 minutes

72
Q

Mechanism of salbutamol nebs in hyperkalaemia?

A

 Stimulate Na/K/ATPase pump causing K shift into cells

73
Q

Dose of calcium resonium in hyperkalaemia?

A

 15g oral every 6-8 hours with lactulose

 30g BDS PR

74
Q

Mechanism of calcium resonium in hyperkalaemia?

A

 Remove K from body by exchanging for Ca in resin

 Slow method

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