Emergency Drugs

Question 1

What is the treatment dose and route for TIA and acute ischaemic stroke in those with aspirin hypersensitivity or intolerance despite PPI?

Answer 1

Clopidogrel
75mg OD PO

Question 2

Second antiplatelet for STEMI and NSTEMI? give dose and route

Answer 2

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)

Question 3

What is the first line emergency drug for acute anaphylaxis?

Answer 3

Epinephrine (Adrenaline)
Dose: 500micrograms, 1 in 1000 (1mg/mL) injection - repeat dose after 5 mins if no response
Route: IM injection into anterolateral thigh

Question 4

What is the emergency treatment for hypoglycaemia?

Answer 4

< 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.

Question 5

Emergency drug for NSTEMI, STEMI, suspected TIA, acute ischaemic stroke?

Answer 5

Aspirin
300mg
Suspected TIA 300mg until diagnosis established
Stroke 300mg for 14 days start 24hrs after thrombolysis

Question 6

Treatment for thyrotoxic crisis (thyroid storm)

Answer 6

Hydrocortisone
Dose: 100mg every 6 hours - administered as sodium succinate
Route: IV injection

Question 7

What is the emergency drug for severe hypocalcaemia or hypocalcaemic tetany?

Answer 7

Calcium gluconate
Dose: 10-20mL of 10% calcium gluconate with plasma calcium and ECG monitoring - repeat as required
Route: Slow IV injection

Question 8

What is the emergency drug dose and route for acute hypersensitive reactions including angioedema and anaphylaxis?

Answer 8

Hydrocortisone
Dose: 100-300mg adminstered as sodium succinate
Route: IV injection

Question 9

Dose of prednisolone in severe or life threatening acute asthma?

Answer 9

40mg - 50mg for at least 5 days - oral

Question 10

What is the dose and route for fluid resuscitation and initial treatment?

Answer 10

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

Question 11

What is a drug that can be used to treat an acute panic attack?

Answer 11

Lorazepam
IM or slow IV Injection - 25-30 micrograms/kg every 6 hours if required, only use IM if IV routes not possible

Question 12

What drug can be used to treat status epilepticus?

Answer 12

Lorazepam
slow IV injection - 4mg for 1 dose, then 4mg after 10 minutes, administered into a large vein

Question 13

What emergency situations can hydrocortisone be used to treat?

Answer 13

Thyrotoxic storm
Acute hypersensitivity reactions e.g angioedema of upper respiratory tract and anaphylaxis
Adrenocortical insufficiency from septic shock
Adrenal crisis

Question 14

What emergencies might morphine be used as the pain relief? Dose? Route?

Answer 14

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

Question 15

Treatment for acute opioid overdose?

Answer 15

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

Question 16

Alcohol withdrawal emergency treatment?

Answer 16

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

Question 17

What dose of diazepam can be used in severe acute anxiety?

Answer 17

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

Question 18

What is the dose and route for diazepam in status epilepticus, convulsions (including convulsions due to poisoning)?

Answer 18

Adult 10 mg, then 10 mg after 10 minutes if required, administered at a rate of 1 mL (5 mg) per minute. (BNF)

Question 19

What drug is indicated for cardiopulmonary resuscitation? (Dose and route)

Answer 19

Epinephrine (Adrenaline)
Dose: 1mg every 3-5 mins as required, 1 in 10000 (100micrograms/mL) solution
Route: IV infusion

Question 20

What drug can be used as symptomatic relief for allergies such as hayfever, urticaria, food allergy, drug allergies?

Answer 20

Chlorphenamine
Dose: 10mg repeat if necessary up to 4 times a day
Route: Oral

Question 21

What are the key information you want to know to be able to work out someone’s maintenance fluids?

Answer 21

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

Question 22

Treatment for severe and life threatening asthma?

Answer 22

Salbutamol 5mg repeat 20-30 mins or as required - nebulised

Question 23

What other conditions can nebulised salbutamol be used in?

Answer 23

COPD or anaphylactic reactions - dose is 2.5mg - 5mg, nebulised

Question 24

Treatment for bradycardia due to acute beta-blocker overdose?

Answer 24

Atropine
Dose: 0.5-1.2mg repeats may be necessary
Route: IV injection

Question 25

Outline the treatment of acute hyperkalaemia (>6.5mmol/l, or ECG changes) include doses and route of administration:

Answer 25

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)

Question 26

Anaphylaxis management?

Answer 26

-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

Question 27

How is organophosphorus insecticide or nerve agent poisoning treated?

Answer 27

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

Question 28

Emergency drug, dose and route for adrenal crisis?

Answer 28

Hydrocortisone
Dose: initially 100mg then 200mg every 24 hours
Route: initially IM injection or IV injection, then continuous IV infusion

Question 29

Emergency drug dose and route for adrenocortical insufficiency resulting from septic shock?

Answer 29

Hydrocortisone
Dose: 50mg every 6 hours, in combination with fludrocortisone
Route: IV injection

Question 30

Drug, dose and route for bradycardia following a myocardial infarction?

Answer 30

Atropine
Dose: 500 micrograms every 3-5 mins, max 3mg per course
Route: IV injection