Emergency Drugs Flashcards
What is the treatment dose and route for TIA and acute ischaemic stroke in those with aspirin hypersensitivity or intolerance despite PPI?
Clopidogrel
75mg OD PO
Second antiplatelet for STEMI and NSTEMI? give dose and route
Clopidogrel
STEMI: 18-75 years 300mg, then 75mg daily for at least 4 weeks (PO)
>76 years 75mg daily for at least 4 weeks (PO)
NSTEMI: All adults - 300mg, then 75mg daily for up to 12 months (PO)
What is the first line emergency drug for acute anaphylaxis?
Epinephrine (Adrenaline)
Dose: 500micrograms, 1 in 1000 (1mg/mL) injection - repeat dose after 5 mins if no response
Route: IM injection into anterolateral thigh
What is the emergency treatment for hypoglycaemia?
< 4 mmol/l, with or without symptoms, who is conscious and able to swallow:
15-20g of fast acting carbohydrates by mouth e.g. through liquids, glucose 40% gels or glucose tablets
If necessary, repeat after 15 minutes up to a maximum of 3 times in total.
In those who are conscious but unable to swallow:
15-20g of 40% glucose gels via buccal administration
If necessary, repeat after 15 minutes up to maximum of 3 times in total.
In those who are not conscious or reduced GCS:
IV 20% Dextrose 75ml-100ml
If greater than 4 mmol/l this should be treated with a small carbohydrate snack e.g. slice of bread or a normal meal if due.
Emergency drug for NSTEMI, STEMI, suspected TIA, acute ischaemic stroke?
Aspirin
300mg
Suspected TIA 300mg until diagnosis established
Stroke 300mg for 14 days start 24hrs after thrombolysis
Treatment for thyrotoxic crisis (thyroid storm)
Hydrocortisone
Dose: 100mg every 6 hours - administered as sodium succinate
Route: IV injection
What is the emergency drug for severe hypocalcaemia or hypocalcaemic tetany?
Calcium gluconate
Dose: 10-20mL of 10% calcium gluconate with plasma calcium and ECG monitoring - repeat as required
Route: Slow IV injection
What is the emergency drug dose and route for acute hypersensitive reactions including angioedema and anaphylaxis?
Hydrocortisone
Dose: 100-300mg adminstered as sodium succinate
Route: IV injection
Dose of prednisolone in severe or life threatening acute asthma?
40mg - 50mg for at least 5 days - oral
What is the dose and route for fluid resuscitation and initial treatment?
Identify cause of deficit and respond
Give a fluid bolus of 500ml of crystalloid (containing sodium in the range of 130-154 mmol/l) over less than 15 minutes
What is a drug that can be used to treat an acute panic attack?
Lorazepam
IM or slow IV Injection - 25-30 micrograms/kg every 6 hours if required, only use IM if IV routes not possible
What drug can be used to treat status epilepticus?
Lorazepam
slow IV injection - 4mg for 1 dose, then 4mg after 10 minutes, administered into a large vein
What emergency situations can hydrocortisone be used to treat?
Thyrotoxic storm
Acute hypersensitivity reactions e.g angioedema of upper respiratory tract and anaphylaxis
Adrenocortical insufficiency from septic shock
Adrenal crisis
What emergencies might morphine be used as the pain relief? Dose? Route?
Myocardial infarction- Slow IV injection, 5mg-10mg (for elderly 2.5mg-5mg) followed by another 5mg-10mg if required
Rate of injection 1-2mg/minute
Acute Pulmonary Oedema - Slow IV injection, 5-10mg (for elderly 2.5mg-5mg)
Rate of injection 2mg/minute
Treatment for acute opioid overdose?
Naloxone
- high dose regimen IV injection (Initially 400 micrograms, then 800 micrograms for up to 2 doses at 1 minute intervals) or continuous IV infusion for those using an infusion pump.
Overdose in a non-medical setting - IM - 400 micrograms every 2-3 minutes until consciousness regained and medical assistance is available. Anterolateral thigh or deltoid region
Alcohol withdrawal emergency treatment?
Diazepam - IM or slow IV injection - 10mg, then 10mg after at least 4 hours, IV can be administered into a large vein at a rate no more than 5mg/minute
What dose of diazepam can be used in severe acute anxiety?
Diazepam - IM or slow IV injection - 10mg, then 10mg after at least 4 hours, IV can be administered into a large vein at a rate no more than 5mg/minute
What is the dose and route for diazepam in status epilepticus, convulsions (including convulsions due to poisoning)?
Adult 10 mg, then 10 mg after 10 minutes if required, administered at a rate of 1 mL (5 mg) per minute. (BNF)
What drug is indicated for cardiopulmonary resuscitation? (Dose and route)
Epinephrine (Adrenaline)
Dose: 1mg every 3-5 mins as required, 1 in 10000 (100micrograms/mL) solution
Route: IV infusion
What drug can be used as symptomatic relief for allergies such as hayfever, urticaria, food allergy, drug allergies?
Chlorphenamine
Dose: 10mg repeat if necessary up to 4 times a day
Route: Oral
What are the key information you want to know to be able to work out someone’s maintenance fluids?
Daily requirements:
Water: 25-30ml/kg/day
Na, K, Cl: 1mmol/kg/day
Glucose: 50-100g/day (e.g glucose 5% contains 5g/100ml)
Plus the existing fluid or electrolyte deficits or excess
Treatment for severe and life threatening asthma?
Salbutamol 5mg repeat 20-30 mins or as required - nebulised
What other conditions can nebulised salbutamol be used in?
COPD or anaphylactic reactions - dose is 2.5mg - 5mg, nebulised
Treatment for bradycardia due to acute beta-blocker overdose?
Atropine
Dose: 0.5-1.2mg repeats may be necessary
Route: IV injection
Outline the treatment of acute hyperkalaemia (>6.5mmol/l, or ECG changes) include doses and route of administration:
10% Calcium gluconate 30mL by slow IV injection - repeat if no improvemnt in ECG within 5 - 10 minutes
Insulin/ dextrose infusion 10 units actrapid, 50mL of 50% glucose IV
Nebulised salbutamol 20mg (4 x 5mg back to back)
Anaphylaxis management?
-Remove trigger
-Maintain airway 100% O2- 15L non-rebreathe
-IM adrenaline 500 micrograms (1 in 1000, 1mg/mL) injection every 5 mins as needed
-IV or IM injection Chlorphenamine 10 mg (repeated if necessary max 4 doses/day)
-If hypotensive lay flat and fluid resuscitate - 500ml over 15 mins 0.9% saline
-Nebulised salbutamol for bronchospasm
-Nebulised adrenaline for laryngeal oedema
How is organophosphorus insecticide or nerve agent poisoning treated?
Atropine (in combination with Pralidoxime chloride)
Dose: 2mg every 5-10 mins until skin becomes flushed and dry, the pupils dilate and bradycardia is abolished (frequency depends on severity)
Route: IV injection
Emergency drug, dose and route for adrenal crisis?
Hydrocortisone
Dose: initially 100mg then 200mg every 24 hours
Route: initially IM injection or IV injection, then continuous IV infusion
Emergency drug dose and route for adrenocortical insufficiency resulting from septic shock?
Hydrocortisone
Dose: 50mg every 6 hours, in combination with fludrocortisone
Route: IV injection
Drug, dose and route for bradycardia following a myocardial infarction?
Atropine
Dose: 500 micrograms every 3-5 mins, max 3mg per course
Route: IV injection
