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Pharmacology > Emergency Drugs > Flashcards

Emergency Drugs Flashcards

1
Q

Which (2) drugs are indicated in cardiac arrest

A

1) Adrenaline

2) Amiodarone

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2
Q

Dose and use of Adrenaline in Cardiac Arrest

A

10ml IV of 1:10,000 (=1mg) every 3-5mins

  • in VF/VT after 3rd shock (with amniodarone)
  • in PEA/Asystole
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3
Q

Dose and use of Amiodarone in Cardiac Arrest

A

300mg slow injection after 3 shocks

THEN 150mg after 5 shocks

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4
Q

Mechanism of adrenaline in CA

A

Non-selective adrenergic agonist - mostly Beta and some alpha to boost sympathetic tone (HR, inotropic), vasoconstrict, and bronchodilate

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5
Q

Cautions/Side effects of adrenaline in CA

A

Hyperglycaemia - stimulates glucagon
Hypokalaemia - ATP Na/K stimulated so moves intracellularly
Hypertension - post arrest

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6
Q

Cautions/side effects of amiodarone (cardiac arrest)

A

Not to be used if iodine hypersensitivity
C/I in heart block, bradycardia, hypotension
Long half-life
Can cause thyroid issues

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7
Q

Mechanism of Amiodarone (cardiac arrest)

A

Class III antiarrhythmic
Blockade of Na/K/Ca channels
Antagonist of alpha- and beta-adrenoreceptors
Increases conduction time to reduce arrhythmia

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8
Q

Mnemonic approach to managment of Acute Pulmonary Oedema

A 
L - loop diuretics
M - morphine/opiate
N - nitrates
O - oxygen
P - position (sat up)
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9
Q

Loop diuretics for acute pulmonary oedema - dose, mechanism

A

40mg IV Furosemide (slow, over 10 mins)
Inhibits Na/K/2Cl cotransporter on ascending limb of LoH to increase Na and water excretion. Increases capacitance veins to reduce preload on heart

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10
Q

Side effects/cautions of furosemide

A

Can reduce blood pressure in severe dehydration.
Electrolyte imbalance as Mg/Ca/H all secreted with Na + water
High doses cause tinnitus/hearing loss as similar transporter works on endolymph in ear

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11
Q

Interactions of furosemide

A

Lithium (reduces excretion)
Ototoxic drugs (aminoglycosides, cisplatin)
Other diuretics/antihypertensives/ nephrotoxins

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12
Q

Potent vasodilator decreases LV filling and dilates veins to reduce vascular resistance in pulmonary oedema

A

Nitrates

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13
Q

GTN IV dose in acute pulmonary oedema

A

0.5mg/hr

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14
Q

Contraindications of Nitrates

A

Severe aortic stenosis - can cause cardiovascular collapse
Haemodynamic instability
Hypotension

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15
Q

Mechanism of nitrates

A

Converted to NO, then induce cGMP to decrease intracellular Ca causing vasodilatation and reduced preload

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16
Q

Treatment algorithm for acute severe asthma exacerbation

A 
Oxygen
Salbutamol (B2B)
Hydrocortisone
Ipratropium Bromide
Theophylline
Magnesium Sulphate
ET tube
17
Q

Use and mechanism of salbutamol in severe acute asthma

A

Back to back 5mg nebulised salbutamol until wheeze resolves

Beta-2 selective agonist results in bronchodilatation to improve airway diameter

18
Q

Cautions with salbutamol in acute severe asthma

A

Can cause tremor, nausea, sweating, tacchycardia

Can lead to hypokalaemia, especially if administered with diuretics, glucocorticoids

19
Q

Hydrocortisone in acute severe asthma - dose, mechanism

A

IV 100mg

Corticosteroid has anti-inflammatory properties to reduce long-term inflammation

20
Q

Side effects of hydrocortisone in acute severe asthma

A

Paraesthesia, can suppress HPA leading to Cushing’s syndrome

21
Q

Ipratropium Bromide, dose mechanism, and indication

A

500mcg/2ml every 6 hours if salbutamol insufficient. Anticholinergic - competitively antagonises muscarinic receptors causing bronchodilatation

22
Q

Side effects of Ipratropium

A

Anti-chiolinergic - nausea, dry mouth, local irritation, change in GI habit, headache

23
Q

Risk of co-administration of SABA and Ipratropium

A

Narrow-angle glaucoma - anticholinergic effect

24
Q

Magnesium Sulphate - dose, indication and cautions

A

IV 40mg/kg up to 2g over 20 mins
Used if unresponsive to bronchodilators when on ICU with ECG and easy bloods
C/I in renal failure
Can cause muscle weakness, arrhythmia, resp failure and hypermagnaesaemia (N&V, flushing, CNS depression)

25
Q

Anaphylaxis in one
3 drugs, 1 fluid
Dose, mechanism, reason

A

Adrenaline IM 1:1000 0.5mL
Catecholamine gives alpha-adrenergic vasoconstriction and beta-adrenergic bronchodilation to reduce hypotensive/distributive shock

Hydrocortisone 1-200mg IV
Glucocorticoid to prevent second phase (20%) reaction and anti-inflammatory

Chlorphenamine IM 10mg
Histamine 1 antagonist to suppress hypersensitivity response

IV fluid challenge over 10 mins (1L if hypotensive)

26
Q

Drug used in benzo intoxication/overdose - name, dose, mechanism, side effects

A

Flumazenil - IV 200mcg in 15s then 100mcg every 60s until response (max 1mg)

Selective benzo receptor antagonist reverses OD by competitive inhibition - short half life, repeated doses needed

N&V, anxiety, fear, palpitations

Pharmacology (14 decks)

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