Emergency Drugs Flashcards
When can you give adrenaline in a cardiac arrest?
During the 3rd round of chest compressions if VF / pVT is persisting
Can also be given during compressions of non-shockable rhythms (PEA and asystole)
What does of adrenaline should be given during CPR and how often?
Give 1mg IV every 3-5 minutes
When can amiodarone be given to treat cardiac arrest?
Given to treat SHOCKABLE RHYTHMS
Given after trial of adrenaline
What dose is amiodarone given in?
300mg IV
What 4 drugs should you consider giving for acute pulmonary oedema?
Opiates (morphine and diamorphine)
Nitrates
Furosemide
Oxygen
Why is morphine/diamorphine given in acute pulmonary oedema and in what dose?
By taking the edge off pain patients are more likely to successfully breathe for themselves
Also means patients tolerate NIV better
Reduces sympathetic nervous activity meaning symptoms of anxiety and stress are eased
DOSE: 1-3mg
Why is furosemide given in acute pulmonary oedema and in what dose?
Loop diuretic given to start drawing fluid out of lungs and removing it in urine
Inhibit Cl-, K+ and Na+ reabsorption in loop of Henle
DOSE: 40-80mg (consider the higher doses for patients in CKS or who are already taking a diuretic)
Why are nitrates given in acute pulmonary oedema and in what dose?
In small doses they cause venodilation leading to decreased preload and in high doses cause arteridilation leading to decreased after load. Both decrease work of the heart and decrease pulmonary vascular resistance
DOSE: 5-10mcg per minute double dose by 5mcg every 5 minutes until max dose 200mcg per minute
What dose is nebuliser salbutamol given in and how often can they be given?
2.5-5mg (usually 5mg in acute asthma cases)
Can be run back to back or spaced hourly, 2 hourly, 4 hourly if necessary
What dose is IV salbutamol given in?
5mcg a minute or 250mcg slow injection
Only given in very serious cases - senior decision
How should hydrocortisone be given in an acute asthma attack?
IV
Children 4mg/kg every 6 hours up to max 100mg
Adults max 100mg
Reduces inflammation, reduces secretions
How does ipratropium bromide work and how is it given?
Is a MUSCARINIC ANTAGONIST and so causes smooth muscle relaxation –> bronchodilator
Given inhaled or nebulised
How long does ipratropium bromide take to work and in what dose should it be given?
Onset of action is 10-15mins
Given as 20-40mcg doses 3-4 times a day - aerosol
Or 200-500mcg doses 3-4 times a day
What dose is magnesium sulphate given in and how does it work?
IV bronchodilator
1.2-2g IV over a period of 20 mins
40mg/kg max for children
What should your non-pharmaceutical initial management for anaphylactic shock be?
Work through A-E and respond
Lie patient flat and lift their legs
Remove allergen
What should your immediate pharmaceutical management for anaphylaxis be? And in what dose is it given?
ADRENALINE
1 in 1000 preparation
DOSE for ADULTS: 0.5mL IM (500mcg)
What other pharmaceutical treatment options are there in anaphylaxis?
10mg IV CHLORPHENAMINE
200mg IV HYDROCORTISONE sodium succinate (eases bronchospasm)
IV FLUIDS
How does chlorphenamine work and what dose should it be given in?
It is an anti-histamine agent and is particularly effective against H1 receptors meaning it works well to ease swelling
Should be given as 10mg slow IV or IM
What sort of fluid therapy should you consider in anaphylaxis?
BOLUS of CRYSTALLOID
500ml NaCl 0.9% - repeat if not responding
What drug can be given to reverse benzodiazepine overuse? In what dose?
FLUMAZENIL 200mcg given over 15s then an extra 100mcg every 1 min if necessary
Competitive inhibitor of BZD receptors
How can IV glucose be given as part of treatment for hypoglycaemia?
500mg/kg IV infusion of 10% glucose solution -must give through wide bore cannula as glucose can be very irritant
Other than IV glucose what other pharmaceutical agents should be considered for hypoglycaemia? How should it be given?
GLUCAGON - frees up the glucose stored in the liver quickly
Can be given IM or IV
1mg - if there is no response after 1 min give IV glucose
What drug can be given in opioid intoxication or overdose?
NALOXONE
What sorts of symptoms does naloxone cause?
Symptoms of opioid withdrawal:
- Restlessness
- Agitation
- N&V
- Sweating
- Tachycardia
What dose is naloxone given in and what do you have to remember about its action?
400mcg IV
Then up to 2 additional 800mcg doses every minute if not responding. Then one 2mg dose
***naloxone is broken down much faster than the opioid so its effects will wear off and the person can once again be under the effects of the opioid - need repeat doses
What is the first pharma step of emergency seizure treatment?
Carbamazepine, lamotrigine or phenytoin 600mg (in patient with TONIC-CLONIC seizures)
Always consider phenytoin 20mg/kg loading dose (max 2g) then slow IV infusion
What anti-convulsant should be considered if seizures are just partial or atonic?
Consider sodium valproate
What anti-convulsants should be considered in absence seizures?
lamotrigine, sodium valproate or ethosuximide
What anti-convulsant should be given in myoclonic seizures?
Sodium valproate or levitaracetam
