Emergency Drugs Flashcards
Which (2) drugs are indicated in cardiac arrest
1) Adrenaline
2) Amiodarone
Dose and use of Adrenaline in Cardiac Arrest
10ml IV of 1:10,000 (=1mg) every 3-5mins
- in VF/VT after 3rd shock (with amniodarone)
- in PEA/Asystole
Dose and use of Amiodarone in Cardiac Arrest
300mg slow injection after 3 shocks
THEN 150mg after 5 shocks
Mechanism of adrenaline in CA
Non-selective adrenergic agonist - mostly Beta and some alpha to boost sympathetic tone (HR, inotropic), vasoconstrict, and bronchodilate
Cautions/Side effects of adrenaline in CA
Hyperglycaemia - stimulates glucagon
Hypokalaemia - ATP Na/K stimulated so moves intracellularly
Hypertension - post arrest
Cautions/side effects of amiodarone (cardiac arrest)
Not to be used if iodine hypersensitivity
C/I in heart block, bradycardia, hypotension
Long half-life
Can cause thyroid issues
Mechanism of Amiodarone (cardiac arrest)
Class III antiarrhythmic
Blockade of Na/K/Ca channels
Antagonist of alpha- and beta-adrenoreceptors
Increases conduction time to reduce arrhythmia
Mnemonic approach to managment of Acute Pulmonary Oedema
L - loop diuretics M - morphine/opiate N - nitrates O - oxygen P - position (sat up)
Loop diuretics for acute pulmonary oedema - dose, mechanism
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
Side effects/cautions of furosemide
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
Interactions of furosemide
Lithium (reduces excretion)
Ototoxic drugs (aminoglycosides, cisplatin)
Other diuretics/antihypertensives/ nephrotoxins
Potent vasodilator decreases LV filling and dilates veins to reduce vascular resistance in pulmonary oedema
Nitrates
GTN IV dose in acute pulmonary oedema
0.5mg/hr
Contraindications of Nitrates
Severe aortic stenosis - can cause cardiovascular collapse
Haemodynamic instability
Hypotension
Mechanism of nitrates
Converted to NO, then induce cGMP to decrease intracellular Ca causing vasodilatation and reduced preload
Treatment algorithm for acute severe asthma exacerbation
Oxygen Salbutamol (B2B) Hydrocortisone Ipratropium Bromide Theophylline Magnesium Sulphate ET tube
Use and mechanism of salbutamol in severe acute asthma
Back to back 5mg nebulised salbutamol until wheeze resolves
Beta-2 selective agonist results in bronchodilatation to improve airway diameter
Cautions with salbutamol in acute severe asthma
Can cause tremor, nausea, sweating, tacchycardia
Can lead to hypokalaemia, especially if administered with diuretics, glucocorticoids
Hydrocortisone in acute severe asthma - dose, mechanism
IV 100mg
Corticosteroid has anti-inflammatory properties to reduce long-term inflammation
Side effects of hydrocortisone in acute severe asthma
Paraesthesia, can suppress HPA leading to Cushing’s syndrome
Ipratropium Bromide, dose mechanism, and indication
500mcg/2ml every 6 hours if salbutamol insufficient. Anticholinergic - competitively antagonises muscarinic receptors causing bronchodilatation
Side effects of Ipratropium
Anti-chiolinergic - nausea, dry mouth, local irritation, change in GI habit, headache
Risk of co-administration of SABA and Ipratropium
Narrow-angle glaucoma - anticholinergic effect
Magnesium Sulphate - dose, indication and cautions
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)
Anaphylaxis in one
3 drugs, 1 fluid
Dose, mechanism, reason
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)
Drug used in benzo intoxication/overdose - name, dose, mechanism, side effects
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
